Beverly Hills Beauty Secrets: A Prominent Dermatologist and Plastic Surgeon's Insider Guide to Facial Rejuvenation

Introduction

Forget Wall Street-Our Insider Trading Secrets Come Straight from Rodeo Drive!

Even I don’t wake up looking like Cindy Crawford.

—CINDY CRAWFORD

The boomers are aging—and don’t want to look it. Women are looking to nonsurgical procedures—and loving it.

Men are using beauty products—and not afraid to admit it.

We are a nation obsessed with appearance—and the statistics prove it.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), Americans spent approximately $12.4 billion on cosmetic procedures in 2007. This means that more doctors than ever before are performing more procedures on more people, creating an inherent confusion about not only which procedures are the most appropriate but also which doctor is the most qualified to perform them.

It doesn’t help to clarify matters that in the past decade, techniques to enhance the appearance of the face have grown exponentially. New technology makes surgery simpler and recovery faster. New products mean new brand names, and new brand names mean new buzzwords, which cause even more confusion. (Can you say Radiesse, Restylane, and Thermage, with a side of Artefill for good measure?)

Many of the latest techniques in cosmetic advancement involve nonsurgical procedures. In fact, recent statistics reveal a widening gap in the surgical versus nonsurgical conundrum: of the nearly 11.5 million surgical and nonsurgical procedures performed in the United States in 2007, surgical procedures accounted for only 19 percent of the total procedures, and nonsurgical procedures made up the other 81 percent.

The top five nonsurgical cosmetic procedures in 2005 were as follows:

1. Botox injections

2. Laser hair removal

3. Hyaluronic acids (Hylaform, Restylane)

4. Microdermabrasion

5. Chemical peels

Simultaneously, the demand for facial rejuvenation and beauty preservation has increased at an unprecedented rate because of increasing societal acceptance of cosmetic procedures. Popular magazines continue to tout the youth is power message through glossy photographs of young, unblemished, wrinkle-free models. Television has also had a huge impact: Extreme Makeover and Dr. 90210 and their countless spin-offs made cosmetic surgery fodder for reality TV shows, and Queer Eye for the Straight Guy turned beauty products for men into a fad that became a trend that continues as a habit today.

As a result, a significant amount of confusion has surfaced about the cornucopia of procedures, physician board certification, cost, and the validity of lunchtime makeovers. The trends are actually as surprising to physicians as they have been to patients. For decades surgery was performed in a medical center and nonsurgical procedures were performed at clinics, but recent statistics reveal newly emerging trends: of all the cosmetic procedures performed in 2005, 48.3 percent were performed in office-based facilities, 27.9 percent were performed in freestanding ambulatory surgical centers, and 23.8 percent were performed in hospitals.

The Best Source for Your Information

Traditionally, plastic surgeons and dermatologists were the experts who clarified the appropriate intervention to address an individual’s concerns. Today, however, the Internet as well as the print media and television have become important sources of information for people who are seeking the appropriate procedure and available intervention.

Advertisements by physicians and the makers of cosmetic products and procedures are abundant. Numerous books have also been published about beauty and health, but most of the advice in these books is limited by the experience and specialty of the physicians. Despite the significant amount of available information, people seem to be more confused than ever, and most do not think that they have an unbiased source for information on facial enhancement and preservation.

That’s about to change with the publication of this book. To our knowledge, this is the first book written by both a facial plastic surgeon and a dermatologist with expertise in facial rejuvenation. This groundbreaking dual expertise allows for a broad-based—and unbiased—approach to facial rejuvenation.

A mixture of excitement and concern has energized us to write this book. With the proper application of the technological and surgical approaches that are now available, many elements of facial aging can be addressed today in ways that were not imaginable even just five years ago. Nevertheless, with this advancing tide of technology and surgery comes some muddying of the waters.

The promises provided by these advances can be nullified by their inappropriate application in unqualified hands. This can range from doctors who are far removed from their specialties, with backgrounds as slight as a weekend course certificate, to nonphysicians who are employed in a business model in which medical professionalism has been suffocated by the drive to profit.

For individuals who seek to enhance and preserve their facial appearance, our goal in writing this book is to give insider trading tips of which most cosmetic health care providers are aware. These include the following:

• Providing the guidelines for understanding the aging changes that are specific to the face so that individuals can be educated about alternative treatments

• Clarifying the available surgical and nonsurgical treatments

• Providing the all-important criteria for choosing the physician specialist who would understand the appropriate procedure

Together, we have more than four decades of experience in facial plastic surgery and dermatology, all of which is poured into this book. Through a combination of sound advice, quantifiable research, unvarnished truth, and actual case studies from our two practices, we want to enable the reader to choose a life-enhancing result with money well spent—and hope and trust well placed. That is our sincere wish.

1

Beauty More Than Just Skin Deep?

The best and most beautiful things in the world cannot be seen, nor touched . . . but are felt in the heart.

—HELEN KELLER

What is beauty? Is it entirely in the eye of the beholder, as the saying goes? Is it something we can measure, test, rate, and evaluate objectively? Can you solve it with math, science, or physics? Is it subjective, quantifiable, or even worth pursuing?

Throughout history—and even today—each country, continent, or civilization has defined beauty in its own unique way. Open any copy of National Geographic and you will see beauty in all its various forms; facial and body modification, tattoos, piercings, and other depictions of unconventional (to us, anyway) beauty leap off the page.

How do we feel when we see bones piercing ears and necks elongated from a dozen brass rings that have been worn since birth? That is why it is said that beauty is in the eye of the beholder. What is beautiful to some is shocking to others—and vice versa.

As children, we know little of beauty. Our parents are beautiful, our siblings are beautiful, our own reflections are beautiful. It is only when we enter the so-called real world that the social structure can affect our own perceptions of beauty.

According to a study published in the June 2001 issue of Archives of Dermatology, many factors go into our self-perception of beauty:

Ironically, most people seem unable to accurately judge their own attractiveness. Correlations between self-ratings and objective measures of individual attractiveness are remarkably low. . . . Only high self-ratings of physical attractiveness are generated among those with relatively greater self-esteem, emotional stability, and capacity for dominance. Favorable ratings by others are more likely when the individual being rated has good social skills and is not self-conscious. Popular, sexually experienced people are rated as attractive by both themselves and others.

Clearly, those who feel more beautiful tend to rate themselves as more attractive. Where does this positive self-perception come from—and how can the rest of us get it? Quite often, the societies we live in dictate what most of us perceive as perfection or beauty. The handsome athlete, the supermodel, the square-jawed actor, and the blond actress are the images with which we in modern America are bombarded every day. After such constant bombardment, it is almost inevitable that we eventually come to see them as beautiful. Yet only rarely do we stop to realize that these celebrities are in the minority, not the majority, that they are the exception, not the norm.

Although we may sugarcoat such findings with laboratories and press releases, the research indicates that we are not as far removed from our Neanderthal ancestors as we like to think. Attractive features meant that a couple was more likely to reproduce; more reproduction meant more children; more children meant that a society was more likely to survive.

Can beauty be that simple and that prehistoric? Even now, dressed in bangles and bows and buffed with Bowflex, can we still be responding to the primal urges that tell us that a more beautiful person is likely to be a more healthy person or a better mating, hunting, or life partner? Does our quest for beauty really come down to nothing more than wanting to be with someone who is more likely to succeed in surviving, hunting, and gathering than all the other Average Joes and Janes at the bus stop?

Scientific studies indicate that from its very beginning, the ideal of beauty has always been about fertility and the survival of the species. The specimens who were deemed most beautiful often found the most mates, leading to more offspring and the notion of survival of the fittest. This is no less true in humans than it is in animals, for whom various stripes or plumage signify a more attractive, and thus more highly desirable, mate.

What plumage did the ancients prefer? How do different cultures view beauty? Research indicates that in every culture—regardless of race, religion, or geographic region—there is a preference by men for women with full lips, clean skin, lustrous hair, good muscle tone, a youthful gait, animated facial expressions, and a high energy level.

As for the qualities that women want in their mates, facial symmetry seems as important as body size. Although ancient women viewed large pectoral muscles and biceps as desirable weapons of war, it has also been discovered that in modern times, men with symmetrical faces have sex four years earlier than their asymmetrical counterparts and have two to three times as many partners during their sexual prime.

What Is Beautiful Is Good

The Greek poet Sappho once wrote, What is beautiful is good, and who is good will soon be beautiful. Since then, much has been written about beauty and, not surprisingly, Sappho’s quote has proven to be quite astute—at least the first part, What is beautiful is good. Indeed, from better grades to more room on the sidewalk, the people we consider to be more attractive receive preferential treatment in almost every area of life.

In an article in the July 1983 issue of the American Journal of Sociology, authors Murray Webster and James E. Driskell combine several previous studies to determine that the most general conclusion from research is that the world must be a more pleasant and satisfying place for attractive people because they possess almost all types of social advantages that can be measured.

Which social advantages are they referring to, exactly? The authors catalog myriad such advantages, beginning as early as childhood: Attractive schoolchildren are expected by their teachers to achieve higher school marks than unattractive children, and they usually do so; their misdemeanors are judged less serious and it is predicted that they will have more successful careers.

Attractive children often grow up to become attractive adults, and the benefits continue to multiply: Attractive adults are thought to have happier marriages than those who are unattractive, and that expectation seems to be fulfilled. Opinions of attractive adults are more likely to be agreed with; attractive adults are perceived as having better mental health. Attractive adults are even granted larger ‘personal space’ on the sidewalk than are the unattractive.

Supermodel Tyra Banks once wore a hidden camera while wearing a fat suit, and it was amazing at how differently she was treated compared to when the suit came off, but research reveals that what she experienced was not an isolated event. Studies prove that thin, attractive people really do earn more money and become more successful—in business and in love—than those who are heavier and considered unattractive.

For example, a 2005 study by the Federal Reserve Bank of St. Louis reports that good-looking, slim, tall people tend to make more money than their plain-Jane counterparts.

Writing in the December 2002 issue of the Journal of Young Investigators, author Charles Feng from Stanford University states, Psychological research suggests that people generally choose mates with a similar level of attractiveness. The evolutionary theory is that by mating with someone who has similar genes, one’s own genes are conserved. Moreover, a person’s demeanor and personality also influences how others perceive his or her beauty.

Furthermore, an article by Murad Alam and Jeffrey Dover in the June 2001 issue of Archives of Dermatology boasts research to support the theory that

the best-looking women in high school are 10 times as likely to marry as the least attractive, and they are more likely to marry sooner and marry persons of greater wealth or social status. Sexual encounters are more numerous and varied for attractive people. Better treatment for the better looking extends to the workplace. West Point graduates with facial features more suggestive of dominance are more likely to achieve high rank. In the private sector, the good-looking are more likely to be hired, given a higher salary, and promoted sooner.

Youth and Beauty

Some people say that youth is beauty. Research indicates that this truism may be more accurate than we ever imagined. Anthropologist Doug Jones studied the subject of youth—or neoteny, which means the retention of some larval or immature characters in adulthood—in five populations: Brazilians, Americans, Russians, the Aché Indians of Paraguay, and the Hiwi Indians of Venezuela. The study, which was published in the journal Current Anthropology, found cross-cultural evidence that males . . . show an attraction to females with neotenous facial proportions (a combination of large eyes, small noses and full lips) even after female age is controlled for.

Youth and beauty often go hand in hand. Our baby boomer patients almost always mention the words more youthful when describing their ideal appearance. Youth is truly fleeting, and there are qualities of youthful skin—its fleshiness, glow, tone, color, and tautness—that have an expiration date as we age.

Alam and Dover, in their June 2001 article in Archives of Dermatology, seem to conclude that age is indeed a grave concern for those who seek to define or recapture their own sense of beauty:

Ratings of physical attractiveness decline with advancing age for both men and women, with the decrease more steep for women. Older women are regarded as less feminine. Those who appear aged beyond their years complain of being repeatedly told that they look tired or unwell. As Ambrose Phillips poignantly observed, The flowers anew, returning seasons bring! But beauty faded has no second spring.

It is also true that we live in a youth-oriented society. Most movies are targeted to the young, magazines feature younger and younger models, and beauty products specifically target the youth market. In many instances, the word aging itself is considered less than appealing. Nevertheless, the definition of beauty remains elusive.

I believe being beautiful is a double-edged sword, says Leslie G. Christin, the founder and creative force behind Cara Cosmetics International, as I’m more critical of ‘beauty’ compared to someone in another field. Of course, I can make someone look beautiful—yet in TV and film you are not allowed to look bad, unless it is a character role. She notes, We define an actress on how old they look.

The beauty of living in modern times means that through very simple procedures or readily available products, the glow and radiance of youth can be achieved—within reason. Simply by using various creams and lotions and following a daily home regimen, people can often achieve a more youthful beauty in a matter of weeks or months, without surgery or other costly procedures. What they gain in return is more confidence—and that in itself is beauty personified.

Face Value

When it comes to the human face, the definition of beauty is elusive. We often hear patients who are not that far out of their forties—or even their thirties—complaining, I just don’t feel beautiful anymore. (What they really seem to be saying is, Make me young again!)

Many of us answer that call any way we know how, by using our professions to help our patients feel better on the inside and the outside. This may be one reason that Americans today spend more money on beauty products than they do on social services or education. Nevertheless, the question What is beautiful? confounds us.

What, then, is beauty?

Of course, there is physical beauty, which we see from the outside. Yet as cultures and cliques change, so too does our definition of beauty. The plump Rubenesque beauties of seventeenth- and eighteenth-century Europe have given way to the current chant of thin is in. What of the face, however? Can the size of your facial features play a role in your perceived beauty to others and, possibly, yourself?

According to a study by Karl Grammer and Randy Thornhill on human facial attractiveness and sexual selection, published in the 1994 Journal of Comparative Psychology, the answer could be yes. Grammer and Thornhill claim, The human face contains . . . facial features that develop or increase in size at puberty. . . . Enlarged jaws, chins, and cheekbones in men are examples of facial secondary sexual traits that are influenced by testosterone . . . largeness in these features are considered sexually attractive because of advertised immunocompetence.

So where do all these studies, quotes, and experts leave us? In our clinical practices, our focus is to improve areas on the face that stand out and detract attention from the eyes. The eyes should be the focus of the face, especially in social interactions. Features that are out of proportion to the rest of the face tend to draw the focus away from the eyes and create an imbalance to the face.

For instance, a large bulbous nose, sagging jowls, angry frown lines, and poor skin quality all tend to be distracting features. Using the latest in technology and computer simulation, we can now more clearly reveal what someone would look like after surgery; making side-by-side comparisons of before and after photos, we then decide together what the most ideal and natural outcome would be. People are often surprised by how even small changes can have a significant impact on one’s youthfulness and beauty.

Beauty Is Harmony

Beauty is harmony. So says the noted maxillofacial surgeon, Dr. Stephen Marquardt, who has even created a scientific method of defining beauty to prove his theory.

After years of studying beauty in a variety of cultures and eras, from ancient times right up to the present, Dr. Marquardt concluded that the groups in question worship basically the same perceptions of facial beauty. Here is how he arrived at this conclusion:

We computer-analyzed photos of thousands of attractive faces from every geographic race on the planet. This analysis included a deconstruction of these faces to determine their precise geometric constitution and how these faces differed mathematically from average and unattractive faces. We then applied hundreds of geometric algorithms to the faces to determine a mathematic and geometric commonality between these images. Ultimately, this led to the construction of an entire series of unique geometric forms, which appeared to predict high attractiveness or beauty. We called these unique geometric forms Archetypal Facial Mask Templates or Masks.

This sounds convincing, but can any equation based on hard measurements and empirical science really define something as esoteric and elusive as beauty? Or is it up to each individual to determine what beauty is—within oneself and about others?

In the course of his studies, Dr. Marquardt developed and patented the beauty mask. This mask is a result of his cultural surveys on beauty and, according to Dr. Marquardt, reflects the fact that all groups have an international standard of beauty.

What Dr. Marquardt calls the Golden Proportion drives the construct of the mask: all the defining angles and features of a beautiful face—eyes, nose, brow, forehead, cheeks, and chin—are proportionate to one another.

The doctor explains, With the use of mathematics, computers, and massive databases of ‘attractive’ faces, we have been able to quantify facial attractiveness in a consistent mathematical computer model. There are different masks for men and women, but both are built on the mathematical equations and the database of attractive faces.

The Marquardt adult female beauty mask

Amazingly, this mask aligns perfectly with beautiful faces throughout the ages, from Queen Nefertiti to Marilyn Monroe to Elizabeth Hurley. The mask is a perfect mathematic and geometric creation, and no biological system, or face, is perfect. However, the