"Technology today is so far advanced that you don't really need to go under anesthesia or have surgery, especially if you start early enough."

She should know; in recent years, she has become a master of non-surgical cosmetic techniques.

Gabriel, one of her patients, works in the executive world.

"It's highly competitive," he explains. "Most of my clients are in their 30s; they don't want to look at an aging face." On the other hand, he adds, "I wasn't prepared to go under the knife to cut off a few years. Down the road I'd be in the same place."

He has nothing but praise for the doctor who helped him redefine his face without a single cut.

"When he came to me he had heavy jowls and his neck and face were one line," explains Madison.

Gabriel agrees. "I still need to lose some weight, but my wattles are gone and I have a jaw line. And that's with only two injections."

How did she do it?

It starts with injections of Botox in the platysmal bands. Botox has been in use for more than 50 years. It began as a means of helping people with strabismus (crossed eyes) and dystonia (tics). By paralyzing the muscle (a process which sounds more serious than it really is), the problems were resolved.

The cosmetic value of Botox was discovered by a Canadian, Dr. Jean Carruthers, who found that her patients liked the "peaceful expression" their injections gave them. Botox is considered completely safe.

The platysma is a sheet-like muscle that extends from the lower jawbone all the way to the collarbone. In younger people, this is nice and tight, but as we age, these bands become thick and cord-like, creating folds in the skin of the neck as they contract. This results in the stringiness and turkey wattles typical of aging necks.

Madison explains how the Botox works: "When you break a leg and it's put in a cast for a long time, the muscle becomes smaller through disuse. Your leg looks thinner. We're doing the same thing to the muscles in the neck."

The result is a smooth neck and reduction in the jowls. But the treatment doesn't end there.

Once the muscle is out of commission, small amounts of loose skin can be left behind. Madison uses an advanced 'Refirm' technique (using equipment from Europe) which tightens and firms the skin, leaving a smoother jaw line.

Carmela had heavy wattles and no neckline at all when she came to Madison.

"If you had put your hand under her jaw, you would hold a pouch of flesh," the doctor explains. After just two treatments, her jaw line is already becoming visible. "After the first treatment about 50 per cent of the volume is lost," Madison says. "After the second, another 15-25 per cent is gone. It usually needs three or four times with such a major problem as Carmela's."

Diana is fairly slim but her neck is starting to develop the stringiness and a hint of wattles. She will probably only need two injections says Madison. But after just three weeks, the first injection is already starting to make a difference. Her jaw line is more defined and already the thickness has started to recede.

It's important to note that this isn't a quick fix; while some changes are immediate, it takes time for the muscle to become smaller and for the full effects to be seen.

The good news is that there is no down time. It can be done during lunch and the patient can simply return to work.

"There is a long recovery period for surgery; that's why it's tough for men to consider this," says Gabriel. "I didn't have the time to take off six weeks while my face healed."

The cost for this relatively new procedure runs between $300 and $1,000, depending on the structure of the neck and the extent of the problem. Madison expects the effects to last for a few years.

"Some people might eventually need a little addition of Botox on and off to keep the muscle from gaining volume," she says, adding, "I have one patient who is in her 70s and she has the neck of a 30-year-old."

All this without a surgeon's knife, and at a fraction of the cost.