Botox, the cosmetic treatment that minimizes facial wrinkles with injections of a paralytic toxin, took off in the early 2000s and has been changing the face of America ever since.
Louisiana State sociology and gender studies professor, Dana Berkowitz, says the treatment has also done plenty in the last decade and a half to alter the way American culture perceives beauty and aging.
"It is changing our expectations about what a normal aging woman's face should look like," said Berkowitz, author of "Botox Nation: Changing the Face of America."
Since 2002, approximately 10.9 million vials of Botox have been sold in the United States, according to the drugmaker’s website. Berkowitz said the population of users is growing, and it's something she predicts will continue.
But contrary to common perceptions, it isn't just older people getting Botox injections. There was a 41 percent increase in Botox treatments in the 19-34 age group from 2011 to 2015, according to the American Society for Aesthetic Plastic Surgery.
Unlike the majority of cosmetic medical procedures that aimed mostly at middle-aged women, Berkowitz said, Botox is targeted toward younger women because it doesn't just erase existing wrinkles, it also paralyzes the facial muscles that express emotion.
"It can then prevent those wrinkles from forming in the future and this is, you know, very seductive to young women," Berkowitz said.
But is it actually preventative? Here’s the thing: Botox is temporary and goes away after 4 to 6 months.
"You have to keep getting it, and so, to an extent, it is preventative," Berkowitz said. "Yes, if you are paralyzing your facial muscles such that you cannot make that expression for the rest of your life, then absolutely, it is going to prevent that specific wrinkle. However, you are signing up for this lifetime of Botox use."
Botox can also be costly. Berkowitz said while it's less expensive than a facelift, it runs between $300 and $400 for one procedure and sometimes more, depending on who's performing the treatments.
From a cultural perspective, Berkowitz described Botox's popularity as both a symptom and a shaper of the way Americans think of beauty.
"Even though (women) are granted extraordinary opportunities that we once did not have access to, I think that so much of these opportunities depend on the societal policing of our looks," Berkowitz said, noting that politicians and women in leadership are often held to higher standards than men are in terms of attractiveness and value.
"I think all of things together make such that you know aging women are not regarded as beautiful. In fact, as a society, we're pretty repulsed by aging women," she said. "Just look at Hollywood."
While a small percentage of Botox users are men, Berkowitz pointed out that it's used predominately by white women.