PUT ON A HAPPY FACE BOTOX INJECTIONS AREN'T JUST FOR THE RICH AND WRINKLED ANYMORE.

Byline: Denise E. Swibold Staff Writer

CALL IT word-of-forehead advertising.

Even before last week's Food and Drug Administration endorsement, Botox injections to erase forehead creases and relax wrinkles around the eyes had become the most widely used cosmetic procedure in the nation.

``It's spread like wildfire,'' said Dr. Andrew S. Frankel, a Beverly Hills plastic surgeon whose practice includes the treatments. ``Any kind of social gathering you're at, someone mentions Botox.''

Now, thanks to the FDA approval, mainstream advertisements also will be touting Botox. And experts predict both doctors and patients will be lining up to reap the benefits.

Making that first appointment

Lisa J. Davis, a Los Angeles TV producer in her early 30s, took the plunge last month, smoothing her brow with her first treatment.

``I am getting to the point where the lines are a little more noticeable,'' she said. Botox ``is an easy way to soften that change.''

Hidden Hills attorney and mediator Janet Rubin Fields is another first- time user. She wanted to erase wrinkles on her forehead and crow's-feet area. The injections, she said, seem to have eased her migraines as well.

``I have seen a difference,'' said Fields, 45, who is so enthusiastic about Botox that she has helped arrange Botox ``parties'' where groups of women undergo injections in the relaxed setting of dermatologist Debra Lustman's Encino office.

``It was a great experience,'' she said. ``It's all been very positive.''

Not for everyone

Dr. Marc Kerner, an Encino facial plastic surgeon, fears the FDA approval won't be all positive for patients. He expects Botox to be widely marketed to doctors, even those with little knowledge of facial muscles.

``Everybody's going to want to pick this up and do it,'' Kerner said. ``We'll be seeing the signs in the (general practitioners') offices: Get your Botox here.''

In fact, Botox's manufacturer, Allergan Inc. of Irvine, is embarking on a $50 million campaign to market the drug to users and doctors. That campaign, said company spokeswoman Christine Cassiano, will include outreach to physicians, offering them information on Botox training as well as other details.

Kerner, who has 13 years of experience with Botox and performs about 750 injections a month, worries these Botox newcomers may do a poor job administering it.

Droopy eyebrows or eyelids are a telltale sign of a botched treatment, he said.

``I see so much bad Botox right now,'' he said. ``Now I expect to see a lot more of that.''

Find an expert

Kerner urges users to seek out facial plastic surgeons, or general plastic surgeons or dermatologists with facial muscle expertise. Consumers should aim for doctors with lots Botox experience, he said.

Frankel warned that for Botox to be administered properly, the doctor or nurse requires good lighting, a familiar setting, sterile conditions and an atmosphere that allows for concentration.

So he finds reports of Botox ``parties'' or festive settings for the treatments disturbing.

``It puts the wrong message out,'' he said. ``There may be a tendency to take it lightly and overdo it. It is a serious medication. It needs to be taken seriously.''

Luckily, even a botched job is reversible, wearing off in three or four months.

``I think it's the greatest drug in America - if done right,'' Kerner said.

Unlike other cosmetic procedures, little stigma is attached to Botox use, said Frankel, who has been treating clients cosmetically with Botox since 1994.

``Many people will admit to having used Botox,'' he said. ``I think people are almost proud. It's almost a bizarre thing.''

One woman's poison ...

Bizarre, too, because what users are having their wrinkles treated with is a diluted form of a deadly toxin.

``We're basically injecting botulism into people,'' Frankel said. Botox works by blocking the transmission of impulses from nerve cells to muscles. It causes temporary weakening or paralysis, interfering with a muscle's ability to contract. As a result, creases are smoothed.

Botox's popularity is easy to explain. The injections are quick, taking only about 15 minutes per treatment, and, compared to a facelift, relatively inexpensive. Botox takes effect within 24 to 48 hours after the injection, and the effects wear off after about four months, on average.

Still, there can be drawbacks. Frankel's patients include actors and actresses who make their living conveying emotion, and he discusses with them the possibility of muting or losing expression.

Complaints, when they arise, tend to be from women whose crow's feet have been treated and who find that without smile lines at the eyes, their smiles become ``too cheeky,'' Frankel said.

The mouth area, with its complexity of muscles, is a particularly difficult area to treat with Botox and Frankel does fewer of those injections.

Still, he said, ``I have a patient who plays the flute, and I have injected her around the lips, and she still plays the flute.''

Nothing drastic

Susan Sager, a former actress and model from West L.A., is practically a Botox pioneer. She's been getting treatments for the last five or six years as an alternative to facelifts and such, and specifically sought out plastic surgeon Frankel for his expertise.

``I wanted to avoid surgery,'' said Sager, in her mid-50s. ``I wanted not to do anything drastic.''

Sager is careful how much she gets done. Not too high on the forehead so she can still raise her brows. After the injections, she usually gets a headache and has some sensitivity in her facial muscles.

``It's not perfect, but it's pretty good,'' Sager said. ``I really look great.''

The Associated Press contributed to this report.

BOTOX BITS

Botox is a strain of the toxin that causes botulism, a potentially fatal poisoning characterized by muscular paralysis, disturbances of vision and breathing. Botulism can result from bacteria growth in improperly preserved food.

It has been FDA approved for more than a decade for therapeutic uses, like blocking facial twitches or easing the muscle spasms of cerebral palsy. It was approved by the FDA last week for cosmetic use.

Injections of Botox and Myobloc (a similar though less-popular product) were the top cosmetic procedure last year. More than 1.6 million of the procedures were performed in 2001, an increase of 46 percent over 2000 and 2,356 percent since 1997.

Botox maker Allergan Inc. of Irvine reported $310 million in Botox sales in 2001. A third of that, the company estimated, was for cosmetic uses.

Botox is injected directly into muscles in the forehead, crow's feet, upper lip and neck. Temporary bruising, swelling and headaches are sometimes reported after treatments.

Botox takes effect within 24 to 48 hours after it is injected and wears off after about four months, on average.

Treatments typically cost $90 to $500 per area, with repeat injections necessary to maintain the effect.

CAPTION(S):

4 photos, box

Photo:

(1 -- 2 -- color) BOTOX

Wrinkle-fighting injections are NOT just for celebrities anymore

Courtesy of Dr. Marc Kerner

(3) ``I am getting to the point where the lines are a little more noticeable. (Botox) is an easy way to soften that change,'' says Lisa J. Davis.

(4) no caption (bottle of Botox)

Box:

BOTOX BITS (see text)

Sources: The American Society for Aesthetic Plastic Surgery, Allergan Inc.