The Pressure to use Botox - Part I

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Age shall not wither them  

Unlined foreheads, bagless eyes, supple skin: today's celebrities have stopped ageing. Some admit to treatments such as Botox - but many deny it. But why do women in the public eye feel they cannot age - and what pressure does it put on ordinary people? Kira Cochrane reports

by Kira Cochrane - The London Guardian, Tuesday 7 April 2009

A couple of months ago, a photograph was hungrily circulated around gossip magazines and websites, and at a glance you would have had trouble explaining why. It showed an ordinary-looking woman in her mid-40s, out shopping in California, her specs on, cardigan buttoned. The clue was in the picture of Madonna that ran beside it. The anonymous woman was identified as the singer's younger sister, Melanie Henry, and readers were encouraged to compare and contrast.

The difference was striking. Because while Henry, snapped unawares, looked as good as any woman could hope, Madonna seemed to have been beamed from another planet. Where Henry had the natural features of middle-age - mild creases beside her nose and beneath her eyes, for instance - Madonna's face was eerily unlined, skin glowing, cheeks conspicuously plump. It's not so much that, at 50, she looked much younger than her sister, as that she had no signs of age whatsoever. Not a crinkle on her brow, crow's-feet by her eyes, or the slightest sag to her cheeks.

Of course, Madonna isn't the only famous woman to look, quite literally, ageless. Over the last 10 years, the public face of ageing seems to have changed completely, and many of the world's most prominent women hardly seem to grow older at all. It's not so much that they always look young, exactly, or that they have the tightly pulled skin of traditional facelifts. But they do look completely different to their non-famous peers. Where other women's lips recede, theirs stay mysteriously plump. Where others have laughter lines, they remain undimpled. And when describing how they stay so taut, the explanation is generally this. They moisturise. They drink water. They work out. They eat well. They avoid the sun. They don't smoke. Which is enough to make the average healthy-living woman wince while inspecting her own wrinkles.

Occasionally someone does break rank, and admits to having had treatments - in the past. Last week Kylie Minogue ended speculation when she admitted to UK Elle magazine that, "I've tried Botox ... But I'm preferring to be a lot more natural these days." Minogue added that she's "definitely not one of those people who says, 'You shouldn't do this' ... Everyone individually can do what they want."

Geri Halliwell says a similar thing in the latest edition of Red magazine ("I had some [Botox] squirted into my forehead and it gave me a headache"), echoing the comments of Jennifer Aniston earlier this year, who said she had "tried Botox once and it was really not good for me. I felt like I had a weight on my head." Aniston's former Friends co-star, Courteney Cox, told US Marie Claire magazine late last year that, "I went to this doctor once, and he was like, 'Oh, let me do it just here and here and here.' And I was miserable ... It's not that I haven't tried Botox - but I hated it."

For other performers, though, the rumours persist. Heat magazine has asked "Has Madonna had cheek implants?" while Grazia speculated "Has Madonna had the ribbon lift?". (This procedure apparently involves a "flexible, tube-like device" covered in tiny hooks being inserted beneath the skin on the face. The hooks then attach themselves to the subject's tissue, before the device is hoiked upwards.) But the source of most speculation is probably Nicole Kidman. The smoothness of her skin has caused the salon.com film critic, Stephanie Zacharek, to wonder whether her forehead is made of melamine, and Dr Martin Braun - who runs the biggest Botox clinic in Canada - to say he believes she has been an "enthusiastic user" of Botox.

Kidman has denied this. In 2007 she told US Marie Claire magazine that, "To be honest, I am completely natural. I have nothing in my face or anything. I wear sunscreen, and I don't smoke. I take care of myself. And I'm very proud to say that." Madonna, meanwhile, has stated she is "not going to have a press conference if I have plastic surgery. But I have said many times that I think about it, like everybody, and I sure don't rule it out."

What is beyond doubt is that, in general, the aesthetic of ageing has changed, and that many women in the public eye are having extensive cosmetic work done, starting ever younger. Speaking to the cosmetic doctor, Tracy Mountford, who specialises in "non-surgical skin rejuvenation" - including Botox and other injectables - she says that many well-known women will "have had quite a bit done to maintain that 'natural' good look. People would be staggered ... The majority of people [in the public eye] will be having something done."

And in some ways, this is completely understandable. After all, ageism is alive and well. As Anna Ford said after leaving the BBC in 2006: "How many presenters do you know on television who are over the age of 60?" In 2002, the actor Rosanna Arquette made the documentary Searching for Debra Winger, in which she and other Hollywood stars questioned the paucity of roles for older women. Madonna has also commented on age discrimination, saying that, "Once you reach a certain age you're not allowed to be adventurous, you're not allowed to be sexual. I mean, is there a rule? Are you supposed to just die?"

Until very recently, older women were simply expected to fade from view. As Susie Orbach, the feminist psychoanalyst and author of Bodies, says: "Thirty years ago, a woman of my age [62] wasn't really in public space or contributing - you were terribly exceptional if that happened." And the result is that women are still in the earliest stages, historically, of negotiating how to remain in the public eye.

So far, the most popular approach seems to be to deny the ageing process altogether. Professor Virginia L Blum, author of Flesh Wounds, an analysis of cosmetic surgery culture, points out that a performer's looks are "their livelihood, and we do know that actors - and especially actresses - can't even really appear on screen unless they look a certain way. So they're constantly forced to manufacture the look of youth and keep producing it."

It's also true that performers are under more scrutiny than ever before, at the mercy of both high-definition TV - which lays bare the tiniest "imperfections" - and tabloid culture. It's an environment that is at once trashy and highly exacting: every hangnail a sin, every eye-bag a crime.

In the face of such constant surveillance, it's not surprising that women would want to erase marks that might otherwise be circled with an exclamation of disgust. And the tools are now widely available. The stereotype of a woman who has work done was once of someone in their 50s or more, who visited a cosmetic surgeon in the hope of having a decade or two erased through a facelift - her skin sliced open, pulled tight and stitched.

But since Botox was first used for cosmetic purposes 20 years ago - and particularly since 2002, when it won approval in the US from the Food and Drug Administration for the removal of frown lines - the landscape has been transformed. Now the onus is increasingly on "non-invasive" treatments that don't require scalpels but involve substances being injected into the face, whether it's botulinum toxin (of which Botox is the best-known brand name), which reduces wrinkles by temporarily paralysing the muscles; Juvéderm, a wrinkle-filler made of hyaluronic acid; or Restylane Vital, also made of hyaluronic acid, which promises to "counter the effects of sun damage and provide deep dermal hydration". (Juvéderm and Restylane Vital are also approved by the FDA.) Non-invasive treatments have boomed over the last decade. While cosmetic surgery procedures in the US increased by 114% between 1997 and 2007, non-surgical procedures increased by 754%. In 2007, 55,000 Botox injections were administered in the UK....continued