* smoothing the forehead



* relaxing the "frown lines" above the nose and between the eyebrows

* erasing crow's feet

* reshaping the eyebrows, especially increasing or decreasing the arching of the brows

* getting rid of "bunny lines" on the sides of the nose

* lifting the corners of the mouth (to soften sad frowns)

* minimizing the "pebbliness" of the chin

* diminishing the banding of the neck muscles

* minimizing sweating in the arm pits, hands, and feet

And, yes, a recent report published in the Journal of Drugs in Dermatology suggests that Botox can effectively treat acne too. Seventeen of twenty patients treated with Botox into the skin noticed that...

* their skin was less oily

* their pores were smaller

* their acne improved

Will Botox become a standard treatment for acne? Maybe, but I doubt it. Certainly, in the near future, the first line treatments for acne will remain...

* benzoyl peroxide creams

* oral antibiotics, such as doxycycline

And, for resistant, severe acne cases, physicians will still prescribe...

* salicylic acid peels

* light therapy

* Accutane

The issues which will make it unlikely that Botox will be widely utilized for acne are...

* Botox is an injectable agent, and youthful acne patients may be uncomfortable with the use of needles (even very fine needles, with anesthetic creams).

* Botox is a potent muscle relaxant. Could some of the Botox migrate to important muscles of facial expression? Could the teenage patient's skin become too smooth--no acne but no facial expression either??

* Apparently, it is technically difficult to inject Botox into the very superficial skin layers of the skin--to minimize the chances that the muscles will be over-relaxed. Many dermatologists and plastic surgeons have injected thousands of patients, so they have the necessary skills. However, there are many more physicians who treat acne than who have vast experience with Botox.

* Botox is currently not FDA approved for acne treatment. Hence, the makers of Botox will not be able to market their product for that indication.

* Likewise, without an FDA approval, insurance companies may not reimburse physicians and patients for Botox acne treatments.

On the other hand, topical forms of botulinum neurotoxin type-A (to be marketed as Topical Toxin) are in development. So, needles might be avoided altogether.

Also, the Topical Toxin is not supposed to penetrate too deeply. Could it, therefore, be less likely to produce inadvertant muscle relaxation? Might teenagers still have more dynamic faces than the nightly newscasters?

If a topical form of Botox is available, then issues about physician expertise become less important. While only a handful of dermatologists and plastic surgeons are truly great Botox injectors, any doctor can spread on a cream.

And, if the initial research remains promising, I suppose that the definitive research for the FDA approval could always be obtained.

I'm keeping my fingers crossed!