Botox: Boomers smiling about nonsurgical face-lift alternatives

"Nothing says fun like a face full o' poison!" chirps Karen Walker, the sloshy socialite of TV's "Will & Grace," as she trots out with Will for a quick Botox session.

In that recent episode of the NBC sitcom, Will and Karen take part in an increasingly popular medical and social ritual: They get botulism toxin injected into their faces to temporarily smooth out their wrinkles.

That our closest prime-time TV friends are getting Botoxed could be a signal that such nonsurgical cosmetic techniques — Botox, collagen, fat transfer, lasers and chemical peels — have reached a point of cultural saturation, if not total acceptance. (It should be noted, however, that none of the patients quoted for this article wanted their last names published.)

As crestfallen baby boomers wake up to find new creases, spots, bumps and bags on their once-youthful faces, it's hard to resist the temptation of the quick, relatively low-cost nonsurgical fix. Having your face sanded down, your lips plumped with collagen or your laugh lines filled with fat from your butt might seem like crazy ways to spend your time and money, but when the nation's aesthetic revolution is under way, who wants to be left behind?

Scott, a Seattle salon owner and hairstylist, will turn 40 next June, but people tell him he looks like he's in his early 30s, which he takes as a "great big compliment." But Scott still gets Botox injections every three months to smooth the squint lines between his eyes and collagen injections to fill in the lines around his mouth and nose.

"People say, 'What are you doing that for?' " Scott said. "But I like the results. I look fresh and new, rested. I work at a mirror all day long; I have for 17 years. When you see yourself all the time, and then you start seeing your clients doing all these procedures, and the results look amazing ... "

Scott keeps a journal, filled with the names of clients' doctors and what they had done, just for his own future reference. He is planning for the day he'll get a face-lift.

"As a hairdresser, you see all the scars," he said. "Hopefully I have 10 or 15 years left."

Dr. Brandith Irwin, a medical and cosmetic dermatologist with a clinic in Seattle and a new book, "Your Best Face: Looking Your Best Without Plastic Surgery," (Hay House, $14.95), said more people are using Botox, lasers and collagen to defer plastic surgery. Beverly Hills may be the land of silicone breasts, pneumatic lips, and well, Joan Rivers, where there's no shame in multiple face-lifts. But in Seattle, most people keep their vanities close to the vest.

"In Seattle, the trend is toward a more natural look," Irwin said. "Not what I call the 'Oscar-night look.' People in Seattle want some expression in their faces."

Irwin said that while there are no exact figures, she believes that Botox and collagen use in Seattle is probably about the same compared with most other U.S. cities, but Seattleites are more reluctant to embrace plastic surgery than New Yorkers or Los Angelenos.

Irwin's clinic also offers procedures such as laser photorejuvenation, a series of treatments that beam lasers into the skin to even skin tone, hide broken blood vessels and promote collagen-building; microdermabrasion, a sort of fine sandblasting where crystals are vacuumed against the skin, taking the top layer off and cleaning pores; and collagen injections, in which a natural protein from cow skin is used to fill in wrinkles and scars.

But all of these are temporary, Irwin said, because we all live under the sun, and the sun is what does the damage.

The people who get these nonsurgical cosmetic procedures aren't always the people you'd expect. True, the Botox demographic is largely women reaching the 40- and 50-year mark, but more and more men are also tinkering with their looks.

Irwin treats CEOs in their 50s and 60s who, feeling the competitive heat from younger executives, want to look more vital. Other patients of both sexes include attorneys, salesmen, real-estate agents and teachers, who may be chronic "frowners" hoping to look more approachable to clients and students.

"I think if you work with the public it's important to look your best," said Scott. "People don't want to come into my salon and see me looking tired or drawn." A year ago, Scott and his partner were among the first in their circle of friends to get Botox. Now almost all of them have it done.

The economy is struggling, but tough times have not made much of a dent in the cosmetic dermatology industry. In fact, they may even be helping; people who might have considered a face-lift now opt to save money with these procedures. (Though regular maintenance can add up; see sidebar on cover.)

Irwin started the Madison Skin and Laser Center three years ago; she said business us up 20 to 30 percent in the last year.

Botox was approved for wrinkle-fighting in April; its high profile and relative ease created a lot of interest, and of course, the fabled Botox party.

According to Allergan, the company that makes Botox, sales in 2001 reached $310 million, an increase of almost 30 percent from the year before.

The American Society for Aesthetic Plastic Surgery listed Botox cosmetic injections as the fastest-growing cosmetic treatment performed by surgeons in the U.S. But all FDA approval means is that the company can finally market it to those with wrinkles, and income, to spare. Before the media blitz, it survived quite well on word of mouth.

Dr. Frederic Stern has been giving Botox for eight years at the Stern Center for Aesthetic Surgery in Bellevue. He also performs a spectrum of cosmetic procedures, from laser eyelid enhancement to collagen, liposuction and microdermabrasion.

Jean, 48, a non-practicing attorney and mother of two, has had laser eyelid surgery, laser resurfacing, collagen injections and five treatments of Botox.

"I hate needles," she said, as Stern injected Botox into the muscle above her eyebrow. "It's not so bad. Collagen — that, I can say, does hurt. Oh, boy, that's when you want your mommy."

One room over, Lori, 46, was also waiting to get Botox, but mostly to help prevent her debilitating migraines. Stern said Lori discovered the correlation between her Botox treatments and her headache relief before a national study confirmed it.

"I'd be throwing up, on the couch, I could barely walk," said Lori. Now she comes in every six months to keep the headaches at bay with Botox. She also has gotten five photorejuvenation and five microdermabrasion treatments. She said no one has ever noticed a lack of expressive ability which can sometimes occur with Botox.

"Anyway, I don't want to frown, I want to smile!" she said, asking Stern. "How soon do you think I should do laser eyelid surgery?"

Over the past two to three years, Stern has also seen a big increase in the number of people coming in for "microcannular" liposuction. Liposuction used to be a horror show of risk and slow recovery.

Now doctors use a suction wand only 1-2 millimeters in diameter, done under local anesthesia, while the patient is awake watching DVDs on a virtual reality headset. Such liposuction can reduce jowls and "turkey neck," and postponing face-lifts for years.

"We've eliminated the risk of anesthesia," he said. "I'm seeing a lot more people who want the procedure now that they know the lower risks. We've got them in their clothes walking out the door 15 minutes after."

One has only to look as far as Michael Jackson to see how plastic surgery can go horribly awry. Now patients can go back to work soon after having a nonsurgical procedure like Botox or collagen, without downtime and without extreme changes (take note, Greta Van Susteren).

"Everybody's talking about it," said Stern. "Most people tell everyone in their office they did it, then try and get their friends to do it too."

Caitlin Cleary: