An injection of youth Women (and men) in their 20s and 30s make up a third of those getting Botox treatments. Indianapolis Star November 1, 2005 Sharra Kris does not believe that 30 is over the hill. And nobody would say the dynamic 33-year-old looks a second older than her years. But last year, Kris, who co-hosts the locally produced UPN show "Steel Horse," noticed something disconcerting as she watched herself on the screen: She was aging. So she decided to do something she'd never thought she would -- Botox. Kris has no regrets, saying the Botox treatments act as a "mini eyebrow lift" and give her a peppier look. "God knows, 30 years old is not old, and I know that," she says. "But I started to see things age in my body . . . If anything, it makes me feel better." More people in their 20s and 30s are taking the Botox plunge, not waiting until wrinkles set in. In 2001, 26 percent of people who had Botox treatments fell in the 20- to 39-year- old age range. Three years later, 33.7 percent of those who had Botox were in that group, according to the American Academy of Facial Plastic and Reconstructive Surgery's annual survey of plastic surgeons. Those statistics jibe with what Dr. Michele Finley, medical director of Raphael's, a self- described advanced medical rejuvenation institute, experiences in her Carmel office. In recent years, she's seen more younger people concerned about the effects of time on their skin. "People are starting to get smarter. Instead of having to deal with a problem that already exists, they're being preventive," Finley says. "It's so much easier to prevent problems than to react to them." A sterile protein derived from the same bacteria that can cause botulism, Botox weakens or paralyzes the muscles around the area into which it is injected, often for a period of months. Botox-free people crinkle their faces, creating fleeting creases known as dynamic wrinkles as they smile, frown, squint or make almost any other facial expression. Eventually these dynamic wrinkles can become permanent static wrinkles, Finley says. And as we age, our skin becomes less elastic. So with each fold it's more likely that a permanent wrinkle will take hold, says Dr. Stephen W. Perkins, owner and founder of the Meridian Plastic Surgery Center in Carmel. "By stopping the muscles temporarily, you're stopping the formation of a wrinkle," says Perkins, past president of the AAFPRS. "It's a lot easier to prevent the formation of wrinkles than to actually correct the wrinkle later on." Not every plastic surgeon endorses Botox to stave off permanent wrinkles. Botox keeps people from making facial expressions they don't like -- the ones that make those dynamic wrinkles pop out, says Dr. Barry Eppley, co-founder of the Ology medical spas at Clarian West and Clarian North Medical Centers. But Botox has less impact when it comes to static wrinkles, which are more responsive to chemical peels and laser resurfacing, he adds. "My professional opinion is that this is not something that people should be doing as a prophylactic measure to prevent wrinkles," says Eppley, a professor of plastic surgery at Indiana University School of Medicine. By the time Sarah Goss, now 26, had her first treatment about a year ago, however, that nasty wrinkle across her forehead had taken hold. Prone to "a frowny face" that she chalks up to strong eyebrow muscles, Goss hated the resting wrinkle she saw on her face in the mirror. When she put on foundation, she felt like it would just settle into that crease. If she sat alone in a restaurant, it was not unusual for a passer-by to advise her to smile. Now the Zionsville resident loves how she looks. She's even trying to get her mother -- from whom she inherited that deep furrow -- to consider having treatments herself. "It's so subtle, but it makes such a difference when you can relax those lines," she says. So is any age too young for Botox? As doctors do more plastic surgery on teens (in 2004 just under 20 percent of nose jobs were performed on people under 20), can Botox be far behind? Doctors say at certain ages it just doesn't make sense. "I'm not sure we would even see the effects in a teenager that would warrant the use of Botox," Perkins says. Still, everyone's skin ages at a different rate. Smoking, sun exposure and genetics all contribute. Personal habits can also make a difference, Finley says. Some people happen to frown or squint more than others. For some people, even drinking through a straw can have an effect on those pucker-up muscles. That's why most doctors do a consultation before telling a client that he or she would definitely benefit from the treatment. And not everyone they see will leave with an injection. "It's not infrequent that I will say, 'I really don't think you need this at this time,' " says Dr. John Malooley, medical director of Beau Visage, a Downtown medical cosmetic center. "I can't say that everybody's going to need Botox. I think that would be an overstatement." One down side is that those who hop on the Botox bandwagon should expect to stay aboard for life -- or watch wrinkles creep on in. That doesn't faze Jeff Horton, 38, one bit. The Indianapolis resident, who works in cosmetics at Saks Fifth Avenue, takes his skin very seriously. Two years ago, he added Botox to his regimen. Since then, he's seen Finley every four months to erase the wrinkles around his eyes. And now, when people guess his age, they usually shoot between five and 10 years too low. "It's good skin care," Horton says. "It's like taking a vitamin: When you stop using a vitamin, the benefits are going to stop. " For many, Botox will be their first cosmetic procedure, before they move on to additional aesthetic surgery procedures, says Eppley. The fact that "a whole subculture of Botox addicts" has arisen makes perfect sense in light of these factors, Eppley says. "It's simple and effective, which accounts for why it is the true wonder drug of the aesthetic field," he says. "This generation, the 30-to-50-year-old crowd, accepts Botox as normal." Plastic surgery prep essential Pioneer Press Oct. 29, 2005 What doctors say to keep in mind before having plastic surgery: If you ask for preoperation advice, your loved ones will probably not be honest. They think they're supposed to tell you not to bother — you're perfect just the way you are. After surgery, however, many will say, 'You look much better; I always hated your drooping eyelids.' Young children can be upset by seeing a parent with facial bandages. It's best to let them know in advance and in a general way what's going on ('A doctor is going to help Mommy see/breathe better'), rather than surprising them. Beware, however, of giving too much information. When one woman told her young son she was getting implants, he became quite upset. He demanded to know how the plants would be watered if they were inside her. You'll go through a 'confessional' period when you feel compelled to tell everyone about the work you had done. As you become accustomed to your new appearance, this passes. Soon enough, when people say you look great, you'll simply say, 'Thank you.' Get ready for the copycat spouse. A man is much more likely to get work done after seeing how much a cosmetic procedure improved his wife's appearance. The good, the bad, and the ugly Boston Globe November 2, 2005 Dr. Cap Lesesne's recently published book, ''Confessions of a Park Avenue Plastic Surgeon," offers some very tasty dirt on the inside world of celebrity plastic surgery -- up to a point. Unfortunately, a pesky thing called doctor-patient confidentiality gets in the way of Lesesne revealing the names of the movie stars, television anchors, and royalty that he has had the pleasure of liposuctioning and lasering. Yet another example of ethics getting in the way of a good time. Needing a bit more to chew on, we rang Lesesne, who has performed more than 15,000 procedures, and asked him to run through the good, the bad, and the desperately in need of plastic surgery in Hollywood. ''Have you seen the new Chanel ad?" he asked. ''It looks like Nicole Kidman has had some work done, and not just Botox." Keep talking, doctor. CHRISTOPHER MUTHER The good plastic surgeries: CHER: ''It works for her. Obviously, she looks different, but she's still an attractive woman. So you can have plastic surgery that can seem obvious, but it can still be beneficial. She was very clever. She started early and did small things." JOAN RIVERS: ''Let's face it, Joan Rivers is a great-looking woman for her age. I met her multiple times up close. It's served her well." MICHELLE PFEIFFER: ''She's had great plastic surgery. She still looks stunning." ARNOLD SCHWARZENEGGER/ SYLVESTER STALLONE: ''They look OK, although it might be a little bit obvious to people that they've had work done." The bad plastic surgeries: FARRAH FAWCETT: ''She's such an attractive woman, and the bad work has not only changed her face, but her persona. Plastic surgery has that capacity. For good and for bad. It can change people physically and psychologically." FAYE DUNAWAY: ''Some of the things she's had done I would do a little bit differently. Her surgery gives her the appearance of being an entirely different person. Good plastic surgery shouldn't be noticeable." DONATELLA VERSACE: ''Her lips have gotten much larger, but not necessarily in a good way." THE WOMEN OF ''DESPERATE HOUSEWIVES": ''Some people may say the women of 'Desperate Housewives' are overdone. But beauty is in the eye of the beholder. That's the one big caveat of surgery. People try to achieve different things." Could stand a bit of nipping and tucking: MARTHA STEWART: ''She's a very attractive woman. And with some small things, she could look even more fabulous than I already think she is." TOM CRUISE: ''He may have already had some surgery on his nose. If you take a good- looking man, small things go a long way. He has fairly low-set eyebrows. A small amount of Botox would preserve his youthful appearance." NICOLAS CAGE: ''He could really use some work on his forehead and eyebrows. His brow is quite furrowed." HELEN HUNT: ''She has heavy upper lids. You'd have to be very careful about doing work on Helen Hunt, because you'd need to make her look like a younger version of Helen Hunt, not a different version. A full brow lift would be a disaster." Turn back the clock All sorts of products promise to trim away years-without using a knife U.S. News and World Report November 14, 2005 Sunscreen, check. Laser treatment, check. Botox, check. Wrinkle filler, check. Cancel face-lift for another few years, check check. Turning back the clock has long been done with a knife, followed by a lengthy, painful, and not-so-pretty recovery. But these days, a growing number of women are taking the nonsurgical route to rejuvenation--free of scars, long roads back, and that pulled, plastic look. And there have never been so many products and procedures aimed at helping them, including new types of tissue fillers that plump up wrinkles and firm the skin, gentler lasers that erase sun damage and redness, and a growing array of skin treatments and lotions to keep skin looking tighter and healthier. "One by one, these procedures can make a difference," says Peter Fodor, a board-certified plastic surgeon and past president of the American Society for Aesthetic Plastic Surgery. "But together they can produce a result that is more than the sum of its parts, and can push back the need for a face-lift." That's what one Chicago lawyer had in mind last year when she bought herself a 50th- birthday present of Botox and Restylane injections to smooth out her deep lines and wrinkles and a series of laser treatments to reverse years of sun damage. "I didn't want to look done, or anyone to know I'd had anything done," said Mary, who asked that her last name not be used. "I just wanted to look better without having surgery." She's in good company. Some 78 million baby boomers are approaching retirement age, and many of them have no intention of looking the part. The prospect of such a mother lode has created a feeding frenzy among doctors and pharmaceutical and cosmetic companies looking to cash in on a market where nearly 80 percent of cosmetic procedures are now nonsurgical. Obstetricians are now hawking wrinkle remedies; dentists are doing Botox injections. For many, the youth quest begins in the drugstore aisles or at the department store makeup counter, where there are a dizzying array of antiaging lotions, potions, serums, and creams. Consumers spent $6.4 billion on antiaging skin products last year, an increase of 21 percent from the previous year, according to market research firm Packaged Facts. Known as cosmeceuticals, these products do not require the approval of the Food and Drug Administration, and therefore their claims are not backed up by rigorous scientific testing. But many of them, such as Olay's top-selling Regenerist and Total Effects lines, include ingredients that dermatologists recognize to be effective in helping to keep skin healthy and reduce the appearance of aging. These ingredients include peptides, which can inhibit certain muscle movements that cause wrinkles; retinoids, which promote collagen production; glycolic acids, which smooth out skin tone; and antioxidants, which help offset sun damage. Many over-the-counter products also improve appearance simply by hydrating the face. Since results are hard to substantiate, dermatologists suggest that patients use the product they feel works for them. And they shouldn't be fooled by cost or fancy packaging. "Price has no correlation to efficacy," says Mark Mandell-Brown, a Cincinnati plastic surgeon, noting that many drugstore products have the same ingredients as their fancier department store counterparts, but at much lower prices. Crazy for Botox. The most popular nonsurgical fix continues to be Botox, which has been around for more than a decade and is the most widely prescribed and one of the safest "injectables" on the market. Last year more than 2 million injections were given, and the number is expected to increase as new uses are found. "For many women, Botox is as routine as a manicure and pedicure," says Jory Goldman, a registered nurse who specializes in aesthetic procedures such as injections of Botox and other fillers. Botox, which lasts about three months, is best known for its ability to paralyze muscles that create furrowed brows and laugh lines. But it is increasingly being used throughout the face to relax the muscles that pull down on your nose or brow, for instance, and let those that pull up dominate. Some younger patients have even started using Botox to prevent wrinkles and sagging. "We just keep finding new ways of using it," says Steven Dayan, a Chicago plastic surgeon and national expert on Botox. "The danger is when it is overused or used improperly." Too much Botox, for instance, can rob your face of expression and create an unnatural look. A typical Botox treatment costs about $300 to $600 and should be administered by a physician or licensed nurse. If it is being offered for much less (probably in a mall, storefront, or spa) it may mean the product is being overdiluted. Dermal fillers, which plump up wrinkles and firm up the skin, are among the hottest and fastest-growing new treatments. Last year, more than 1 million Americans used injectable soft-tissue fillers such as Restylane, Sculptra, and Radiance to compensate for the loss of fat and collagen in the face that comes with age. Restylane, a gel made from hyaluronic acid, has been the subject of several positive clinical trails in the United States and Europe, and the risk of an allergic reaction is very low (1 in 1,600). Most fillers are naturally absorbed by the body and have shown no evidence of building up over time or causing long-term problems. But they are still relatively new. Some people have their own fat injected, which is extremely low risk. Such fat is absorbed fairly quickly, and the effects usually last no more than a couple of months, doctors say. Restylane is typically injected into the creases from the side of the nose to the corner of the mouth and along the upper lip to fill out fine lines. Restylane and other hyaluronics last three to six months and can cost anywhere from $400 to $1,000 and up, depending on how many vials you need. "Hyaluronics give very nice corrections if the patient isn't too far along," says Robin Schaffran, a Beverly Hills, Calif., dermatologist. "But if you need to use a lot of material it could lump up, and the person would be better off with a face-lift." Sculptra, which is injected deep under the skin to stimulate collagen production, can last up to two years and typically costs at least $3,000 for two treatments. Deep wrinkles and extensive sun-damage are laser territory, which has traditionally meant removing the top layers of skin to reveal the fresh skin underneath. These "ablative" lasers are effective but require several days for the skin to heal. Now, there is a new generation of nonablative lasers that work beneath the surface of the skin, using short pulses of light to reduce wrinkles and sagging. They are supposed to stimulate collagen production, and treatment can be completed in an hour, thus the "lunch-hour lift." Anyone considering a new laser treatment should find out how long the laser has been in use and ask to see some results. "A lot of these lasers are being marketed very aggressively before there's any real science to support their efficacy or their safety is established," says Schaffran. One of the fastest-growing new deep-skin treatments is Thermage, which uses a radio frequency to heat the inner layer of the skin, usually around the jaw line. The heat causes the collagen to contract and tighten the skin from underneath. The treatment also stimulates collagen growth. Although the effects are subtle, Thermage may require only one treatment that costs up to $2,000. Buyer beware. By their very nature, noninvasive procedures are less risky than surgery. But there are still some serious precautions to take, starting with choosing a doctor. You don't need a medical degree to do most injections, and many plastic surgeons have shifted that work to nurses, so that they can better spend their time giving consults on $15,000 face-lifts. But there should be a physician nearby in case you have an allergic reaction or some other problem. Checking credentials is a no-brainer, but word of mouth and your own eyes are also valuable resources. Cosmetic work is subjective. If you like the way someone looks, that matters. "In Los Angeles, cosmetic work is a rite of passage, and women like that "done" look," says Mandell-Brown, the Cincinnati plastic surgeon. "Here, women prefer more subtle changes, and they don't talk about it." If you already feel comfortable in your own skin and want to stay there, there is still one product you shouldn't be without. "People come in here and they want all these procedures, and they think I have a magic wand," says Schaffran. "Then they tell me they don't use sunscreen. It's still the most effective antiaging remedy we have." Prosthetics doctor molds self-esteem in patients with facial defects The Daily Utah Chronicle 11/9/05 Section: News Paul Tanner doesn't just mold prosthetic facial features for his patients; he also molds his patients' self-image. Tanner is an anaplastologist at the Huntsman Cancer Institute and creates "artificial anatomy" for people with absent facial features such as an ear, nose or eye. "I was born with microtia, an undeveloped ear, and when I had reconstructive surgery, it didn't work," one of Tanner's patients, Shaury Rice, said. Rice decided to get a prosthetic ear, which Tanner made for her. "I feel a lot better about myself now. I never wore my hair back before, and now I do all the time," she said. When Jim Lindow, a graduate student in occupational therapy at the U, had to have his ear amputated after being diagnosed with malignant melanoma, he also looked to Tanner for a prosthesis. "Paul did a great job; he is an artist. Once, I had a biopsy on my neck, and the doctor had no idea I had a prosthetic ear until I told him," Lindow said. One of the biggest reasons Lindow decided to get a prosthetic ear was that he couldn't keep his glasses up with one ear. He said Tanner can make a perfect ear, and it is a much better alternative to plastic surgery, which entails invasive surgery and no guarantee of perfection. Tanner makes three to four prosthetics a month, and each takes about 16 hours to complete. "Sixty-five percent of my patients are cancer related. The rest are split between trauma, generally from car accidents or burns, and microtia," Tanner said. The beginning of the process is similar to when a dentist takes impressions of teeth, Tanner said. First, Tanner takes an impression of the facial feature and duplicates it in a plaster-like material. With the plaster duplicate of the facial feature, he sculpts a wax model. A permanent mold is made from the wax model, and silicone is colored to match the color and translucency of the patient's skin. Most prosthetics are attached with an adhesive; others are attached via small implants in the skull. Tanner became interested in anaplastology after one of his relatives had to go out of state to get a prosthetic ear made. He found there were virtually no facial prosthetic specialists in Utah. "It makes the biggest difference in patients' interactions with others because people don't treat them differently anymore. As you can imagine, stares and comments make people with facial disfigurements feel very insecure and uncomfortable," Tanner said. Rice and Lindow agreed that for those who are self-conscious about their appearance, missing an ear or any other facial feature is a big deal emotionally. Prosthetics can "restore people's normalcy," Lindow said. Tanner's patients can go on and live normal lives without anyone noticing their conditions, unless they choose to let them be known. "It's liberating," Rice said. The Look of a Winner Tina Gee has plenty to smile about after winning makeover contest Sheboygan Press Tina Gee never used to smile. Now she can't stop. "It was pretty bad," Gee said of her teeth. "That was the big incentive. I was listening to the radio and pondered it for a month or so and then I thought, what the heck." In May, Gee found out that she had won the Million Dollar Makeover, a contest hosted by radio station B93.7 FM in Sheboygan. "My girlfriend and I were listening to the radio and finally Jesse James, the DJ, said, 'We've put this off long enough,'" Gee remembers of the morning she found out she'd won. "Then the radio went silent and my phone rang. And my girlfriend and I looked at each other like deer in the headlights. "I'm not a screamer. But I screamed." In no time at all, the 40-year-old Sheboygan woman found herself on the receiving end of every treatment she could imagine but had never thought she'd be able to afford. At the top of that list for Gee was dental work — including veneers and crowns valued at around $18,000 at Northstar Dental. "She totally looks different," said Gee's mother, Evelyn Gardner of Sheboygan Falls. "I'm getting used to it. She changed so drastically. The teeth really made a drastic change." Gee said she still finds herself covering her smile, an old habit that is hard to break. "I would not smile with my mouth open," she said of her previous teeth. "In fact, one of the first comments from a life-long friend was 'Holy cow, you're smiling!' when she saw my after picture." According to B93.7 FM, the Million Dollar Makeover contest started in January when people were asked to submit their photo, along with an essay of why they deserved to win. One man and 49 women entered. The final winner was decided upon by the businesses who donated services and was mostly chosen based on her ability to use all of the services involved. Gee said she has worked hard in the years leading up to this makeover. She suffered a back injury at work and has since lost about 125 pounds in the last two years and has been putting herself through nursing school at Lakeshore Technical College. She recently received her LPN license and is about to start classes to become a registered nurse. With all of this in mind, she said entering the contest was something that was important to her. "I feel like with all of the issues since my injury at work two years ago, I've pretty much been through the ringer," she said. "I've been going to college, staying in school, raising teenagers and keeping a household going with very minimal resources. I thought I deserved it." Gee wasted no time scheduling appointments once she found out she had won. She received a facelift, rhinoplasty, eyelid lift and intense pulse light laser treatment at Dr. Andrew Campbell's plastic surgery office in Sheboygan. "It's more of an enhancement than a real change," Campbell said. "We're taking what she had and modifying that for the better. We're not making her look different, we're making her look better." Gee also received LASIK eye surgery to correct her farsightedness to perfect 20/20 vision, as well as a new haircut and style and new makeup. "I never used to wear makeup," Gee said. "It didn't matter. But because of the way she did it, I didn't feel like a clown afterwards. I wear it on a daily basis now." Gee said her family, including her husband Karl and four children, have been very supportive. They were also quite surprised at the new look. "It was unreal," said daughter-in-law Mary Gardner, who married Gee's son, Bill, on the day that Gee got the news that she had won the contest. "When she had the face stuff done, it was like 'Wow!' I didn't think she had to improve on anything. Then she started having it done and it was incredible." As a result of her experiences, Gee said she would advise other women to not be afraid to try new things. "I didn't let any of the pitfalls stop me along the way," she said. "There was a time when everything was kind of overwhelming. "I just turned 40, but I feel like I'm just starting my life," she said. "I have a new body, new face, new confidence, a new career — and I have a new grandson … they have achieved their goal of making me feel like a million bucks."