Botox, despite its years of use and now-mainstream status, is still a great source of fascination and debate in beauty and medical circles. The more experience dermatologists have with the drug, the more creative ways they are finding to use it. And as a result, a lot of ethical and social questions arise.

Botox Mom stole the headlines with her fake story, but we all believed that it could actually happen. In the last week no fewer than four Botox stories appeared in various outlets.

The Daily Mail wrote about the use of the neurotoxin for saggy breasts. The Telegraph debated the social consequences of using it in younger patients, and whether or not the intended effects backfire and women actually start to look older than their years. Then Dominique Browning wrote a strongly worded editorial in the New York Times beseeching women to put down the needles and embrace their wrinkles. That same week in T, designer Lela Rose admitted that Botox and Juvederm “make me feel and look much fresher and younger. It’s like an injection of confidence.” Recently there was a study that Botox can make people less empathetic because they forget how to read faces since they can’t move their own.

So what’s the deal with this hot button beauty product? Is it a curse on all humankind? We spoke to Dr. Elizabeth Hale, a board certified dermatologist at the Laser and Skin Surgery Center of New York, for a dose of common sense.

Why it works:
It works by weakening muscles. “The beauty of Botox is that when used in the doses we use for cosmetic use, it acts very locally and that’s why it has such a long history of being safe,” Dr. Hale told us. For the face, it relaxes muscles which automatically makes the skin look smoother.

Weird uses for Botox:
While Dr.Hale does not perform these procedures and it’s still fairly radical, the drug has been used for lifting sagging breast tissue and even–wait for it–penis elongation. Both the breast and the penis have suspensory ligaments, which are anchored in place by ligaments that are attached to muscles. So theoretically by inhibiting or weakening the muscle it can cause elongation and lift. It is also used for inhibiting sweat glands, and was recently FDA approved for treating migraines.

How young is too young?
Dr.Hale acknowledged that she’s seen an increase in women in their 20s coming to her office saying, “My mother told me if I get Botox now, it will prevent wrinkles later.” While this is true, Dr.Hale said,”That doesn’t mean it’s the right thing to do or that it’s good for us. In their 20s and young 30s, people are getting jobs and meeting their life partners and it’s an important part of your personality, and overdoing it with Botox too early can inhibit some of that social development.” So, to the detriment of business, she has turned women away. (This also goes for older women who already look too “plasticky.”)

What about guys?
Dr. Hale saw an increase in men coming in for treatments at the beginning of the recession; they were feeling the pinch to look younger and therefore more competitive. And while she’s been treating gay men for a while, straight men are coming in almost as frequently.

Other advice?
“Wear sunglasses!” Dr. Hale advises. It will prevent squinting and prolong the formation of those nasty furrows. And, of course, always wear sunscreen.

A healthy attitude towards Botox (and aging for that matter) is the message. Botox is such an unnatural concept, that it will likely always stir debate. But at least we can debate a bit more rationally.