From PEOPLE Magazine Click to enlarge
When it comes to looking good, "there is always that extra pressure in Hollywood," says Jenny McCarthy. So recently, the 36-year-old added Botox injections to her calendar of regular Microdermabrasion facials and twice-annual detox cleanses. "I go every two months," she says. "My tricks are, I get Botox in my forehead—I just have my doctor do a little shot there." Why not erase every last wrinkle? Because, McCarthy explains, "if you overdo, it looks bad." That means going in more often than most patients—doctors typically suggest shots every three to four months—but, McCarthy says, "I believe in just a little bit. It allows you to keep that mobility in your face. It's a great little secret."

Not too long ago, the fact that she was getting Botox at all would have been the secret. In the Hollywood version of a don't ask, don't tell policy, actresses have typically kept mum about cosmetic procedures, crediting their ageless complexions to moisturizers, good genes or staying out of the sun.

Over the past year or so, however, a number of high-profile celebs—from Brooke Shields and Courteney Cox Arquette to Vanessa Williams and Jennie Garth—have 'fessed up to keeping their faces free of lines with Botox. Joy Behar talks frequently about her Botox shots on The View, and late last year Sex and the City star Kim Cattrall told Britain's Sunday Times that Botox was part of her skin-care regime. Even male stars like Simon Cowell and David Hasselhoff have gotten in on the action. "I think it's beautiful that people are telling—women want to know!" says Gossip Girl's Kelly Rutherford, who has used the injectable.

This increasing openness about Botox (which is a protein derived from the botulinum toxin that has been shown to relax muscles) may have something to do with its growing popularity: Celebrity doctors in Los Angeles and New York City estimate that, based on their experience, as many as 75 percent of stars over the age of 35 get injected. But Botox isn't on the rise only in Hollywood; in 2007 nearly 5 million Americans went in for Botox, a 13 percent increase from just a year earlier.

"Such a large segment of the population is getting Botox now, it doesn't have the same stigma as it did in the past," says New York City-based dermatologist Dr. Neil Sadick, whose celebrity client list includes a 30-something Oscar-winning actress. In fact, Botox has become so routine in some circles that doctors like Beverly Hills dermatologist Mark Rubin often gets calls from agents requesting it for their clients. "It was unheard of years ago," Dr. Rubin says, "but every two months or so, I'll get that call saying, 'We need help for so-and-so. We're hoping you can do something.'"

What doctors are offering these days is a far cry from what Beverly Hills dermatologist Arnie Klein calls the "frozen forehead" look that identified Botox users after the drug first got FDA approval in 2002. "A lot of women [went] too far," Sharon Osbourne, a longtime Botox user, told PEOPLE. "If you take the natural lines out of your face, you look like you've been starched." To avoid that outcome, most doctors today eschew the old technique of paralyzing the entire upper face—upper and lower forehead, brow bone and crow's feet—and instead focus on one or two areas; they are also using smaller doses. "I use it very sparingly," says Ugly Betty star Vanessa Williams, who goes in for injections every three months. "I want to look natural."

At the same time, however, doctors have started working on a broader canvas, using Botox to treat everything from gummy smiles to clenched jaws (see box). Some even believe that by starting Botox before the age of 40 their clients will never have to go under the knife. For example, some of the more experienced practitioners inject a tiny drop of Botox into the lower eyelid, lifting the eye; injections into the bands of the neck are also said to prevent the sagging that was once only addressed by a neck-lift. "The problem before was, we couldn't avoid gravity and sagging," says London-based dermatologist Dr. Jean-Louis Sebagh. "Now you really can. Botox is a preventative tool."

Still, not all actresses are thrilled about this addition to the antiaging arsenal. With so many of their peers getting Botox, the pressure to look young has hit an all-time high. "I once had a big star come to me—she was very angry because she'd been sent by the studio," recalls nurse practitioner Rand Rusher, a partner in a prominent Beverly Hills dermatology practice. "They demanded she get [Botox], but she didn't want to do it and was very upset. Then her agent called to say that, legally, they couldn't force her. She got up and left."

Given the reality, however, of having "to look as young as you can, for as long as you can, so you can pay the rent," says former Designing Women star Annie Potts, who has had Botox, it seems likely that fewer and fewer actresses will be able to avoid the needle. "I don't know why people want to make a controversy about Botox—it's a basic thing, like getting a manicure, or getting your hair dyed," Dr. Sebagh says. "It's on the grooming checklist. It is part of the game."

  • Contributors:
  • Additional reporting by Bryan Alexander,
  • Diane Clehane,
  • Sandra Marquez,
  • Monica Rizzo,
  • Jenny Sundel,
  • Ulrica Wilhborg,
  • Susan Yara.