Brave New Botox
A few inches south comes the horse-teeth gummy smile - not the result of big gums or small teeth but rather facial muscles that are too strong. Some doctors treat it by injecting a small amount of Botox into five places around the upper lip, or into the band above the chin, so the top lip doesn't lift as high during smiles. But Wexler, who performs the procedure, warns that shots to this area require prudence. "Botox around the mouth can flatten the lip or cause asymmetry, giving people trouble pronouncing their P's or V's," she says. Dr. Macrene Alexiades-Armenakas, an assistant clinical professor at Yale University School of Medicine, recommends patients stick to a dermatologist or facial plastic surgeon with at least 10 years of experience, as opposed to a gynecologist trying to make some cash on the side. "Any doctor can legally administer Botox, but whether that's wise is a totally different thing," she warns. ($200 - $400)
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."