An even more controversial but potentially promising new use for Botox is to reduce acne by shrinking the appearance of pores, a treatment that's been practiced for several years in Asia. Dr. Kamran Jafri, a New York City facial plastic surgeon, injects a much smaller amount less deeply than he would for wrinkle-smoothing to paralyze the oil-producing sebaceous glands without affecting the muscles. After the shots, mostly in the T-zone, "you see a 50 to 75 percent reduction in pore size," he says. Alexiades cites an encouraging study in which Botox decreased oil production in 17 out of 20 patients, but she bristles at the idea of using Botox on patients younger than, say, 30, since the research goes back only three decades. "Does it have any ill effects 40 years later? We don't know. We don't have adequate follow-up to assure we're not doing these young people harm," she says. ($500 - $600)
The boldest frontier in body Botox is the chest. Regardless of size, some docs are getting surgical breast-lift-like results with Botox. Injected into several points from just below the sternum to underneath each breast, it counteracts the upper back's rhomboid muscle, which usually pulls the breasts down. Though Wexler was initially enthusiastic about performing the procedure, she hasn't done one in months since the results were "unpredictable - it could work beautifully or it could not work at all," and patients pay $1750 either way. Some doctors, like Alexiades, believe you shouldn't use Botox in the chest, given the area's susceptibility to breast cancer: "This is an area with a very high risk for a deadly cancer, so you have to apply more stringent rules about off-label use." Though Botox hasn't been linked to breast cancer, "it is a neurotoxin, so that's my conservative recommendation."
Another way Botox gets breasts bikini-ready is by fighting cleavage crinkle. The deep V in the chest is caused by the weight of the breasts (usually leaving vertical lines) and sun damage (lines that crosshatch). To treat both at once, Wexler uses laser procedures combined with Botox to relax the muscles, which works on cleavage grooves the same way it does on crow's-feet or frown lines. If you do get chest injections, Alexiades warns that "breast tissue extends from the nipple all the way up to the shoulder, a fact that a lot of physicians aren't necessarily aware of," so stick to a derm or plastic surgeon with breast experience. ($1500 and up)