New faces at the beauty salon

So many people seem to be Botoxing these days. Celebrities. Potential first ladies. Maybe even their politician husbands. Teresa Heinz Kerry, wife of presumptive Democratic presidential nominee John Kerry, makes no secret of the fact that she uses Botox to smooth her olive complexion. What many Botox devotees don't enjoy, however, is going to a doctor's office every two to four months to maintain their look.

Now, though, Mrs. Kerry and others like her will be able to forgo the exam room.

Once the clinical stuff of doctor's offices, now, in cities from Boston to Los Angeles, Botox is migrating to spas, health clubs - even corner beauty shops, where roving doctors give the injections. It's the latest move in a trend that's making aesthetic medical treatments more accessible, not to mention more palatable.

Yet some worry that by making Botox and other medical procedures so mainstream, people won't stop to consider the potential risks. Derived from the toxin that causes botulism, Botox prevents wrinkles by paralyzing facial muscles. It is used primarily to diminish lines in the forehead and around the eyes. In 2003, Botox was the most popular among noninvasive cosmetic procedures, up 11 percent from 2002, according to the American Academy of Cosmetic Surgery.

Jerome Vener uses the term "happy medicine" to describe his beauty-parlor practice. Since October, Dr. Vener, a plastic surgeon, and two colleagues have spent upward of 15 hours a week at the Michael Joseph Furie salon in Tarzana, Calif. There, in a tidy room tinted shades of orange and seafoam green, they erase lines with Botox, collagen, and Restalyne, the newest wrinkle filler approved by the FDA. The average cost: $300.

Vener says one reason for the growing trend is that doctors like working on customers who are in a good mood. "Most people who come to a doctor's office are there because they're hurting or sick," he says. But the purely aesthetic work is "akin to delivering a baby. Everyone is there because they want to be there. And they're happy."

It's the sense of serenity coupled with safety, the blend of spa and certified doctor that make these partnerships successful, say industry insiders. Customers want their Botox easy. But they also want assurance that they're being treated by a professional.

"There's a glut of [beauty] products and treatment offerings," says Amanda Freeman of Youth Intelligence, a New York company that tracks consumer trends. So in a sense, people are "using doctors as the way to differentiate between what's really going to work and what's not."

But some observers suggest that this blurring of doctor and beauty consultant could go too far. "Once these procedures get removed or displaced into a more conventional and less surgical setting, the surgical setting can start to feel like a beauty salon," says Virginia Blum, author of "Flesh Wounds: The Culture of Cosmetic Surgery." Professor Blum worries that people may begin to equate the risk of the surgeon's knife with the risk of the hairdresser's shears.

The shift from austere and antiseptic to softly lighted and music-infused settings has come gradually. Plastic surgeons and dermatologists began transforming their offices into after-hours beauty lounges in the late 1990s. As a way to attract a larger clientele, they hid unsightly pieces of medical equipment behind decorative screens and performed facials and massages alongside the more standard Botox and laser treatments.

About the same time, spas with doctors on staff became popular. Dermatologist Laurie Polis, whose confidential client list is said to include Madonna and Drew Barrymore, says she was one of the first to embrace the "medi-spa" concept in 1999 when she opened Manhattan's Mezzanine.

Last fall, Dr. Polis entered a partnership with the trendy Greenhouse day spa on the Upper East Side. She says the demand for spa Botox treatments only seems to be increasing.

"Going to a doctor's office, while comforting, is not the alluring concept of a vacation," says Polis. "However, going to a spa most certainly is."

Some critics worry - Polis does, too - that "more available" could come to mean "less safe." While most states require cosmetic medical treatments be performed by a doctor or under a doctor's supervision, the definition of "doctor's supervision" varies from place to place.

Vener, the plastic surgeon, and his Los Angeles partners aren't concerned with naysayers. With their newly formed Ultimate Laser Associates, they have turned the idea of traveling doctors into a full-fledged business model. In addition to the Tarzana salon, they've arranged to begin working out of a salon in Woodland Hills, Calif., next month. And they are looking into a dozen additional locations.

Rather than target high-end salons, whose clientele may have its own cadre of cosmetic doctors, they plan to enter midrange shops with prices that are more affordable.

CEO Andy Dube likens their new business to selling cars. But he's not talking about the economy variety. "Our goal is really to develop a model like the Mercedes C-Class," he says, referring to the luxury car brand's least-expensive model.

Such statements worry industry observers who say these businesses will make Botox more affordable - and appealing - to a wider range of consumers, including young people. Especially troubling is the effect this access may have in a time of TV shows like "Nip/Tuck" and "Extreme Makeover."

"A program like 'Extreme Makeover' absolutely captures [in] midstride the transition from being considered extreme behavior to becoming utterly normalized," says "Flesh Wounds" author Blum.

T.J. is leaning against a display case stuffed with silver body piercing rings and studs. His speech sounds normal, his serpent tongue hardly noticeable.

But when he opens his mouth wide, two slivers peek out. The fleshy pieces curl in toward each other as he shows how he can move them - either individually or in unison.

Many owners of the body piercing and tattoo parlors that crowd Sixth Avenue in Manhattan's West Village have never heard of the underground trend of tongue splitting, where the tongue is sliced down the middle, leaving it forked like a snake's.

But among those who have, the consensus seems to be that T.J. is the person to see.

The procedure has yet to go mainstream, says Amanda Freeman of Youth Intelligence. "It's an extreme form of body mutilation and self-expression. Some of the edgier members of the population are doing it, but it's definitely not a mass trend."

But T.J., as he wishes to be identified, says at least one or two people each day wander into Village Pop where he works to ask about tongue splitting. Nowhere near that many actually have it done. "A lot of people want it," he says, "but a lot of people are nervous."

Since he started this brand of body modification two years ago, T.J. has split 20 to 30 tongues, at $250 each. He refuses to work on anyone under 18, and he makes certain a customer is serious, because it's not a process that's easily reversed.

The reversal problem is worrisome, says Matthew Messina, an Ohio dentist and spokesman for the American Dental Association. "Once it's healed, if you decide that you don't want to be a snake, I'm not sure how someone would go about putting you back together. You have to open the pieces up again and sew them back together - like a rump roast."

Last year, Illinois was the first state to pass a law prohibiting anyone but a doctor or dentist from splitting tongues.