"Parties hit a sour note with me," Cohen said. "This is a medical procedure and should be done in a sanitary environment. Not homes or hotel rooms."

Cohen also said that alcohol stimulates bleeding and bruising and could decrease the patient's ability to pay attention to the aftercare instructions.

Warning statements about the dangers of Botox parties have even been issued by the FDA.

Physician assistants and nurses can be trained to inject botox, and you can even have this procedure done in some beauty shops. But if the injections are not accurate, unwanted side effects such as a droopy lid could occur. And if sterile practice is not adhered to, infection could result. Aesthetic specialty physicians like dermatologists and plastic surgeons are generally more experienced.

Chances are you won't die, because it would take 3,500 units of botox to kill you ­ equivalent to 35 vials of 100 units each. Cohen dilutes each 100 unit vial with 3 CC of .9 percent saline and uses between 35 to 40 units for each treatment. Clostridium botulinum bacterium is a neurotoxin which is attenuated and purified. The amount used is small and injected with the smallest needle (30 gauge) directly into the overactive muscle. When Botox Cosmetic, which is the brand name for the botulinum toxin type A (in use since 1990), is administered by a trained professional, reported side effects have been minimal and infrequent. They include headache, respiratory infection, flu syndrome, temporary eyelid droop and nausea.

The cosmetic use for botox was discovered accidentally in the 1980s when a doctor and his wife, who used it for eye spasms, found that it worked on wrinkles. Botox was also used to treat muscle spasms, strabismus, spastic esophagus, back pain, cerebral palsy and migraine headaches. Its use has been expanded to treat hyperhidrosis (excessive sweating), lip wrinkles and turkey neck. It was FDA-approved in 1989 for limited medical use. In April 2002, cosmetic use of botox was FDA-approved for temporary treatment of frown lines for people between the ages of 18 to 65.

In 2001 Myobloc, which is the brand name for botulinum toxin type B, was introduced. It's easier to store, and results are seen quicker, but it is more costly and the effects don't last as long as botox.

Botox Cosmetic made by Allergan helps wrinkles which are made by "dynamic" contractions of muscles (frowning) between your brows causing them to relax by blocking the transmission of nerve impulses to the injected muscles. The treatment lasts up to four months and costs about $300 to $400. Insurance companies might pay for botox injections if you have dystonia (involuntary rhythmic muscle contractions) or muscle tightness related to brain or spinal injury.

Discomfort during treatment ­ which patients say feels like a bug bite ­ is brief and temporary. Most people resume their normal activity following the procedure which lasts from two to several minutes. You can smile, frown, or look surprised without the creases forming between your brow, and your expression remains intact. If you decide to stop botox treatment, your lines gradually go back to their pre-treatment appearance. Some patients build up a resistance and 3 percent to 5 percent of the population will not respond at all.

Sherri Smith, who moved to Marco Island with her husband Darrell from Kansas City, Mo., last June said botox injections administered by Dr. Cohen on April 29 did not hurt. She chose this doctor because she trusted him.

"He saved Darrell's life," Smith said. "Dr. Cohen suspected that my husband had melanoma, but the oncologist said he didn't have cancer. Dr. Cohen insisted that the biopsy be sent back a third time. And that's when it was confirmed as melanoma. Darrell would have died. So I didn't want anyone else to do the botox."

In less than two minutes, Cohen injected Botox Cosmetic into the procerus, corrugator and frontalis muscles above and between Sherri Smith's browline. He instructed her to squint for the next few hours ­ which helps to bring botox into the proper area ­ not to lie down for four hours and not to use ice.

Cohen uses botox for crow's feet, glabellar lines (frown lines between the eyebrows), and lines that furrow the forehead. Botox won't work on static wrinkles (wrinkles caused by aging), sun damage or smoking.

For deep wrinkles, frown lines, smile lines, lip border, acne and other facial scars, collagen injections are used. They last three to six months. Cohen has used collagen for the last 20 years which is different than botox because it acts as a "filler" where botox relaxes the muscle to smooth the wrinkle. With collagen, results are apparent immediately. Botox results start to appear 24 to 48 hours after the injections with a maximum effect seen in two weeks.

"I don't do Restiline because I want to be 100 percent comfortable that the patient can trust that their results will be what I say they will be," Cohen said. "Botox is a wonderful non-surgical cosmetic procedure because of its safety and ease of use. It should be done in a professional and sanitary environment by an experienced, qualified technician."

For information call Island Dermatology at 642-3337.