Thursday, March 28, 2002 | 8:21 a.m.
A small dose of a substance that is lethal in large doses can erase years from tired brows, and turn a weary smile into a killer grin.
Which is why women and some men are clamoring for the paralyzing charms of Botox.
Botulinum toxin, type A the bacteria that causes botulism and is otherwise known by its brand name, Botox can cause nausea and cramps during poisoning. But in small amounts it can smooth wrinkles and shed years from a person's face.
Injected directly into a muscle in tiny doses, Botox attacks nerve endings and blocks signals from the brain that cause muscles to contract. It paralyzes the muscle in a stretched state so the attached skin is smooth on the surface.
It may seem extreme, but since Botox was approved for cosmetic use by the Food and Drug Administration in 1997 the public has responded favorably.
Celebrities inching toward their 50s, such as Madonna and Celine Dion, are opting for the liquid face-lift. Doctors in Los Angeles, Atlanta and more recently at the Palms in Las Vegas are throwing Botox parties, where shots of Botox are served up with hors d'oevres and cocktails.
Beverly Hills, Calif., facial plastic surgeon Dr. Paul Nassif who married Adrienne Maloof, Palms owner George Maloof's sister, earlier this month performed more than 25 Botox injections last month at the hotel's first Botox party. Palms' next Botox bash is planned for sometime in April. Admission is $35.
With champagne cocktails and better-beauty dreams, many of the 50 invited guests walked away with Botox at work in their face and a higher self-esteem.
The party prompted Sherri O'Boyle, senior vice president of Leisure Industries Corporation, a real-estate company in Las Vegas, to test Botox's benefits.
O'Boyle, 45, attended the Botox bash with her husband, Erin, a local commercial photographer. "I was a little nervous, because it is your face," Sherri O'Boyle said. "I didn't want to change my face, I just wanted to soften the lines."
She preferred the party's intimate setting to the more sterilized atmosphere of a doctor's office. However, O'Boyle met with Nassif for a private consultation before deciding to go to the party.
At first O'Boyle was timid about sitting in the reclined chair and lifting her face to the surgeon's needle, but that fear passed.
"It was friendly, social," O'Boyle said. "It was fun. I'd do it again."
As would her husband. Erin O'Boyle hated looking in the mirror and seeing the deep furrow in his brow that caused people to ask if he was upset.
"I'm getting old and I want to hide it as much as I can," Erin O'Boyle, who is in his 40s, said. "It can't be solved, but it can be helped."
He opted for Botox because of the casual atmosphere at the party, as well as the ease of the five-minute procedure.
"Botox isn't a face-lift, it's a subtle difference that I notice," Erin O'Boyle said. "It's almost like a subliminal awareness in the public eye that something's different about my face."
Botox is a hot toxin.
A 2001 study by the American Society for Aesthetic Plastic Surgery in Los Alamitos, Calif., reported there were more than 1.6 million Botox procedures conducted last year, which is nearly twice as many as in 2000, and five times that of 1997.
Botox's noninvasive properties has clearly made it the No. 1 aesthetic procedure nationwide, said Dr. Robert Bernard of White Plains, N.Y., who is vice president of ASAPS.
"The good news and the bad news about Botox is that it is temporary," Bernard said. "If you don't like it, it goes away. But if you do like it, it goes away."
Before it was hailed as a wrinkle remover, it was approved by the FDA in 1989 to treat strabismus, also known as "lazy eye," a condition in which muscle imbalances cause the eyeball to drift.
After its strabismus approval, Botox began to be used by plastic surgeons for quick, near-painless application around wrinkle-prone areas on the face, such as the eyes, mouth and neck.
Because it stops muscles from contracting or excreting, the powder botulinum was approved in 1997 to ease migraines, reduce back pain, soothe facial tics, assuage cerebral palsy symptoms and slow excess sweating in armpits and palms.
Its benefits are impressive. So are its hazards.
In doses of thousands of units, botulinum can cause massive paralysis and possibly death.
But Botox isn't your mother's botulism, Dr. Julio Garcia, a Las Vegas plastic surgeon, said.
"We were told if a (food) can was dented, don't eat it, it was dangerous," Garcia said. "Here we are 30 years later taking it, using (botulism) on purpose."
The units used for treatments are too small to cause much damage: 20 units for the forehead, 10-40 for frown lines, 10-20 for crow's feet and one-two for tiny lines around the mouth. In Las Vegas and nationwide the cost averages about $400 per session, or roughly $10 per unit.
"It can make a person seem less angry looking or stressed," Garcia said. "You still look like you, but people say you look better rested."
Since the toxin is injected into the muscle and doesn't enter the bloodstream, it can't harm the patient.
"It isn't free to float around and cause any damage," Garcia said.
When the Botox breaks down the muscle returns to its healthy state and wrinkles re-appear.
Following the pinprick procedure a patient must keep his or her head upright for four hours to ensure the toxin attacks the intended nerves. If a patient rests flat the toxin could travel to other areas, such as the eyelid, and cause unwanted muscles to freeze.
"It doesn't happen very often, but it can," Garcia said. "This is a medical procedure and it should be taken seriously."
The minute muscles around the mouth can especially cause major problems with speech if the Botox drips into surrounding muscles.
"Every time you expose yourself, there is a small, small risk," Garcia said.
Old age revisited
Two years ago, 50-something Judy August, owner of Judith August Cosmetic Solutions in Las Vegas, went under the needle and had her first Botox injection around her eyes.
She hasn't looked back. About every six months, August receives Botox treatments from a doctor in Los Angeles and plans on continuing the procedures well into the future.
August has heard rumors of botched Botox treatments and has a friend whose eyelid drooped for a few weeks from an errant Botox strain.
"There's a slight fear factor, because it is botulism," August said. "But I wake up in the morning and know I look well-rested. Any time you look better, you feel better."
August's friend, Las Vegas businesswoman Toni Reiser, saw the difference the painless procedure made on August's outlook and decided to test the waters at the Palms' Botox party.
She observed groups of brave Botox beginners getting poked while she relaxed with a flute of champagne and chocolate- covered strawberries.
"I had read about it and thought it had to be safe," Reiser said. "Otherwise the doctor wouldn't put their reputation on the line at this big party."
A few of her friends backed out before going under the needle, citing the creepiness of the event.
"It was scary from the fact that it's needles and you know it's Botox and you don't know what it's going to do," Reiser said.
As the party wound down, Reiser realized it was too late in the evening to undergo the five-minute procedure and remain upright for the required four hours. But the next morning she had the clear solution injected into her 50-something brow by Nassif at a Las Vegas doctor's office.
"Everyone (at the party) seemed so happy with it," Reiser said. "Why not?"
At the site of the initial injections there were small, red bumps that lasted a few hours. Within 48 hours Reiser saw a marked difference in the area around her eyes and forehead. Clients and friends asked if she had done something to her hair or lost weight.
"People knew I looked better, but they didn't know why," Reiser said.
But injecting botulism?
"I know," Reiser said. "But I'm at an age where I want to look the best I can and here's my opportunity. It's part of a balanced life with good diet and exercise."
"You are having foreign material injected into your body," Reiser said. "You have to be prepared for that."