The Fight for Your Face

Janet McMahan was facing her 50th birthday, a college reunion and the end of her marriage in one year. Looking in the mirror didn't make her feel any better. "I was sick of looking tired all the time," she says. That's when McMahan, now 54, became a fan of injectable wrinkle treatments. It wasn't a cheap option for the single Nashville mother of three, who lives on a piano teacher's income of $40,000 a year. But she decided to shell out about $1,500 year for Botox to smooth the lines in her forehead and dermal fillers to plump out the creases around her mouth. "I'm not glamorous," she says. "I get my hair done at the beauty school for $15 and I don't buy lattes. I choose to spend my mad money this way."

Gone are the days when ads asking, "Does she or doesn't she?" referred to hair coloring. Now, that question would come with the answer: only her dermatologist knows for sure. And if you're old enough to remember that ad, you're just the person biopharmaceutical companies have in their sights. For women who are sliding toward 40 (or 50), conversations with friends about cosmetic procedures that used to start with "I'd never do that" are often edging closer to "never say never," as wrinkle fixes become more available and acceptable. Botox and dermal fillers like Restylane are now being offered not just in doctor's offices, but at walk-in spas and private parties—even dentists are hanging out shingles offering to whiten your teeth and make you look younger all in the same easy chair.

About a million Americans regularly go un­der the needle to get doses of Botox, which works by temporarily para­lyzing wrinkle-making mus­cles in the forehead, and Restylane, a hyaluronic-acid dermal filler that fills in deeper folds or unevenness in the lower part of the face (think spackle). But Allergan Inc. and Medicis Pharmaceutical Corp.—the leading U.S. makers of injectable wrinkle reducers—want to draw in a much larger market.  By their estimates there are another 25 mil­lion or so American women who can afford the $1,500 to $3,000 for two to four treatments a year, but haven't yet been convinced that they want to go that route. "There are women spending significant amounts of money at hair salons and at cosmetics counter for ineffective products," says Jonah Shacknai the CEO of Scottsdale-based Medicis, which makes the leading dermal filler, Restylane, "and as far as we're concerned, they should all be patients of Medicis."

To turn those Middle American women into patients, the two manufacturers are using very different tactics. You could sum up their pitches as "healthy mom" versus "hot mom." Irvine, Calif.-based Allergan has signed up "Sideways" actress Virginia Madsen, 45, to extol the virtues of eating right, exercising and "treating" your wrinkles. It's a Bob Dole-Viagra moment for Allergan, which five years ago probably wouldn't have been able to get a celeb to confess to regular injections of Botox.

Medicis, for its part, has created a campy reality show called "Hottest Mom in America"—a cross between "Desperate Houswives" and "American Idol." Winning moms audition for a spot on the show by demonstrating that they do a great job balancing their family and work obligations while taking care of themselves. In return, they can receive cash prizes and a year's supply of Restylane. The program, which has yet to find a television outlet, will also offer tips on looking more attractive because, says producer Jeff Greenfield, "it doesn't matter what level of hotness you have, you can always improve."

Both marketing experts and critics of the industry admire the novel packaging of a familiar perfect-yourself pitch. Analysts like Ronny Gal of Bernstein Research in New York think a mass popularization of injectables is inevitable:  "These guys are riding trends that are as old at the bible: vanity, aging and the globalization of wealth," he says. Deborah Sullivan, author of "Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America" (Rutgers, 2000), agrees that the companies are adopting smart marketing strategies.  "You can't go wrong with business models that bet on women's insecurity," she says. "I'm wondering how women will resist these messages."