On Tuesday, Margaret Miller was injected with Botox for the third time. She did not wince or bat an eyelid as the nurse pricked her in the head three times with a needle. She said it felt as if she was having her eyebrows plucked.

The procedure took approximately ten minutes to complete, and within minutes, the vertical crease between her brows, which had started to reappear somewhat since her last treatment, appeared to be relaxing. The fifty-something-year-old mother looked refreshed, jumped up, and promptly returned to work.

In four to six months, when the results wear off, registered nurse Willi Lawrence will inject Ms Miller again, but she could be competing for the nurse's time as she is one of hundreds of locals currently receiving the cosmetic treatment - and the numbers are increasing daily.

The injection of Botulinum Toxin Type A (Botox) is the number one cosmetic procedure in the world, helping millions to look younger without the "downtime" connected with surgical procedures.

When the substance is injected into a muscle, the muscle becomes temporarily paralysed into relaxation and after several days, the years seem to be pushed back as the skin smoothens out.

What makes Botulinum controversial is that it is actually a lethal poison. However, when used in small, diluted doses it can temporarily improve the appearance of facial lines and wrinkles, prevent migraines, and stop excessive sweating.

Botox was approved by the American Food and Drug Administration (FDA) in 1989 to treat disorders like muscular spasms and twitches, but for years cosmetic surgeons have been discretely using it in cosmetic services. Since the FDA approved the use of Botox this year for the treatment of frown lines, more locals are expected to join the millions around the world receiving the treatments each year. In Bermuda, it is mostly women who are spending between $100 to $500 per treatment - a cost sometimes less than in the United States due to a UK supplier - to the upper third of their faces to improve frown lines, crow's feet and forehead lines, and a smaller portion of clients are being treated for migraines.

Nurse Lawrence, of the Dermatology & Skin Care Centre, said that since Botox was approved by the Health Department and she obtained supplies last year, she has seen the numbers of patients receiving the treatment increase steadily. "When I first got it in November we were doing it every few weeks, and now we're doing it almost every day," she said.

Facial plastic surgeon Dr. Bruce Lattyak of the Bermuda Wellness Centre said he has amassed a client pool of around 150 people since he returned to the Island from California last year, with the numbers steadily increasing since the FDA approved its use on frown lines. He anticipates that once people realise how safe, easy and affordable the procedures are, there will be a greater increase.

"It's very popular. Of all the non-surgical things I do, it is probably the one with the highest satisfaction rate," he said.

Dr. Lattyak said that his clients are from all economic backgrounds, and now more of those in their early to late thirties are wanting to delay the onset of wrinkles by using Botox as a preventative measure.

Ms Lawrence noted that she sees more white clients because they more prone to wrinkles. The melanin in darker skin protects from wrinkles.

What makes Botox so appealing is that it is quick and subtle. People can have Botox performed during their lunch hour, for example, and no-one would be the wiser, and it certainly seems to help women feel better about themselves.

Ms Miller, who actually works as a receptionist at the Dermatology & Skin Care Centre, said she got the procedure done to remedy heavy indentation between her brows. Having seen many people have the treatments, including one woman in her sixties who had no lines at all afterwards, she said she wanted to undergo the procedure herself. Now, people are constantly asking her what she has done to her face.

"Everybody says how well I look. They say, 'What have you done?' and I don't say anything, and then I tell them and they come in here and have it done," she said minutes before she had her third treatment. Sallyann Smith, a patient of Dr. Lattyak who has had Botox done for her crow's feet, forehead lines and frown lines, said that Botox was great because people do not have to know it has been used, and she called it a "great experience for women".

But unlike Ms Miller and Ms Smith, many people in Bermuda prefer to keep their treatments a secret.

The choice of privacy keeps the procedure safe, whereas in the US Botox fans have engaged in Botox parties where, similar to Tupperware parties, doctors provide services at private residences. However, both practitioners offering Botox in Bermuda said they would only perform the treatments in the office. Ms Lawrence said she would want to ensure that patients had not been drinking and could follow directions after having the treatment.

So, what about the negative side to using Botox? Critics have claimed that Botox can make a person expressionless, particularly when used to smooth out frown lines, and it can be known to cause minor complications. Botox cannot be used around the mouth due to possible drooping or drooling. And, it was interesting that after her treatment yesterday Ms Miller was warned not to lay down or bend over for several hours to prevent the toxin from moving to other areas. However, local practitioners maintain that the complications are not too common and are easily reversible as Botox will eventually wear off.

Ms Lawrence said she always aims to make her patients look as natural as possible.

"I like for people to be able to move their brows," she said.