FA L L 20 19
SAVE YOUR HAIR
THE TOP DOCTORS TREATMENTS TO GET NOW!
INNOVATIONS IN LASERS, PRP AND SURGERY
ANGELA BASSETT
CAN YOU GUESS HER AGE?
The BIG Injectable Debate
THE NEW NOSE JOB
LIFE-CHANGING Beauty 50
N E W B E A U T Y. C O M a sandow publication
TRANSFORMATIVE BEFORE & AFTERS
Let the Healing Powers of Nature Take Over Hydrate | Detoxify | Repair
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CONTENTS
FA L L 2 0 1 9
70
THE GUIDE: THINNING HAIR EXPERT-APPROVED SOLUTIONS, FROM TOPICALS TO SURGERY
14
24
34
42
54
16
Three women who inspire us share what inspires them
The duo behind Chemist Confessions demystifies retinol
29
36
How dermatologists Kathy Rodan and Katie Fields disrupted the beauty industry
Change your body, change your life at the top wellness retreats in the world
Inside stories behind beauty’s most iconic products
Three industry insiders reveal their day-to-night skin-care routines
EDITOR’S LETTER
IN THIS ISSUE
MEDICAL ADVISORY BOARD
21
NEWS
The top innovations from the 2019 Aesthetics Meeting
2 N E W B E A U T Y FA L L 2 0 1 9
MUSE
HOLY GRAIL
OBSESSED
24 HOURS
ICONS
46
THE TRIGGER EFFECT
Five women open up about milestone events that inspired a transformation
YOU VERSION 2.0
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CONTENTS
FA L L 2 0 1 9
58
CELL SERVICE
We deep-dive into the world of stem cells and their use in skin care 64
THE IMPORTANCE OF BEING ANGELA
Angela Bassett on how to get what you want and love what you have 83
THE CLINIC
84
ASK THE EXPERTS
Which cosmetic procedure creates the most inward transformation?
100
87
The standard procedure gets a major upgrade
Just how much do you know about who is filling your face? 90
THE RIGHT ANGLES
The most popular treatments and tweaks to get a youthful jawline 96
SHAPE SHIFTERS
How veneers and bonding can create a brand-new smile
109
BREAST RECONSTRUCTION
What’s new and what to know about the lifechanging surgery 114
THE DOCTOR IS IN
Best-in-class doctors give their expert insight on collagen 118
B+A GALLERIES
42 before-and-afters of revision, arm, hand and neck procedures 124
#MYNEWBEAUTY Our staffers’ favorite product discoveries
4 N E W B E A U T Y FA L L 2 0 1 9
ON THE COVER
Angela Bassett was photographed by John Russo at Quixote Studios, Los Angeles. Makeup: D’Andre Michael; Hair: Randy Stodghill at OPUS Beauty; Styling: Jennifer Austin at OPUS Beauty; Jumpsuit: Safiyaa; Earrings and ring: Misho Designs
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STRANGER DANGER
THE NEW NOSE JOB
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CONTENTS
S P O N SO R E D FA L L 2 0 1 9
FLOWER POWER
HICHAKO / GETTY IMAGES
NOT JUST A PRETTY PLANT WITH A POP OF COLOR, SAFFLOWER—SPECIFICALLY THE ANTIOXIDANT-RICH SEED OIL, A KEY INGREDIENT IN EPIONCE’S RENEWAL FACIAL LOTION—NATURALLY HYDRATES AND HELPS CALM REDNESS. FOR MORE SUPERSTAR INGREDIENTS, TURN TO PAGE 58.
6 N E W B E A U T Y FA L L 2 0 1 9
Kerrie Keegan PRESIDENT
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D I G I TA L E D I T O R
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Dr. Robert Singer
E D I T O R I A L A S S I S TA N T
EDITORIAL ADVISORY BOARD MEMBERS
Emily Taylor
Dr. Tina Alster Dr. Kenneth R. Beer Dr. Bradley Bengtson Dr. Kelly Bomer Dr. Joel Cohen Dr. Charles E. Crutchfield III Dr. Steve Dayan Dr. Jeanine B. Downie Dr. Steven Fagien Dr. Julius W. Few Dr. Ronald Goldstein Dr. Sanjay Grover Dr. Andrew Jacono Dr. Mark L. Jewell Dr. Laurence R. Rifkin Dr. Renato Saltz
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8 N E W B E A U T Y FA L L 2 0 1 9
MAGNUS CRAMER
O P E R AT I O N S M A N A G E R
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Wellness influencer and clean eating guru Candice Kumai shares her daily self-care tips and tricks for her on-the-go girl boss lifestyle.
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Calev Print Media
Follow her journey to living well @CandiceKumai
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10 N E W B E A U T Y FA L L 2 0 1 9
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Under the direction of a board-certified dermatologist, LovelySkin.com is one of the top 11 cosmetic websites in the world based on Internet Retailer data. Dr. Joel Schlessinger, the CEO, personally evaluates each and every product line before it is sold on LovelySkin.com. In addition, he helps to curate the content and voice of this site to make it a more authentic experience.
Colorescience® Sunforgettable® Total Protection Brush-On Shield SPF 50 “This brush-on sunscreen is the definition of simple yet effective. It’s easy to use on the go and provides water-resistant, broad-spectrum protection that’s also reef-safe.” lovelyskin.com/ NBSunforgettable, $65
Skin Research Laboratories neuBROW PROFESSIONAL™ Brow Enhancing Serum “We have seen phenomenal results from this product with clinical studies that demonstrate brow changes within 4-6 weeks.” lovelyskin.com/ NBneuBROW, $90
SkinCeuticals C E Ferulic® “When it comes to antioxidant protection, the combination of vitamins C and E with ferulic acid is the pinnacle, and this serum from SkinCeuticals is the best antioxidant out there.” lovelyskin.com/NBSkinC, $166
Obagi® Professional-C™ Microdermabrasion Polish + Mask 30% “This formula combines the benefits of a facial polish and and exfoliating mask for a multitasking product that delivers vitamin C to the skin in a unique manner.” lovelyskin.com/NBObagi, $69
Neocutis® Lumière® Eye Cream with PSP “For a do-it-all eye treatment, I love this eye cream. It addresses eye area concerns and provides outstanding results.” lovelyskin.com/ NBNeocutis, $97
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E D I T O R’S L E T T E R
S SEE MORE amazing products we’re loving on page 124!
#MYNEWBEAUTY
This issue, we’re launching #mynewbeauty, a place where our editors—and you as well—can share our favorite products. I just fell in love with Clé de Peau Beauté’s Wrinkle Smoothing Serum Supreme. I stopped my beloved Refissa when I got pregnant, and hadn’t been able to get back on the retinol bandwagon until I tried this super potent, yet super gentle serum. Follow @newbeauty on Instagram and then post your newest finds with the hashtag #mynewbeauty for a chance to be featured in a future issue.
14 N E W B E A U T Y FA L L 2 0 1 9
I love this woman: Angela Bassett for President in 2024!
McGrath–esque smudged liner? Perfection! Makeovers erase a bit of our personal style; every makeover implies that we need fixing, upgrading. In The Art of Travel, Alain de Botton says, “The pleasure we derive from journeys is perhaps dependent more on the mindset with which we travel than on the destination we travel to.” The same can be said for our beauty routines. I prefer the act of transformation much more than the final result: the artistry of carefully painting on a red lip; the chemistry of combining potent skin serums (beauty editor skin, be damned); the excitement of getting neurotoxin for the first time. Which is why we have changed the name of our annual makeover issue to the Transformation Issue. Because taking care of ourselves: we do it for us. Not for any Henry Higgins, any Breakfast Club Claire, any Clueless Cher, no matter how well intentioned they might be. Let’s celebrate the act of change, our bravery, our potential, and remind ourselves, every step of the way, that we’re beautiful and perfect just the way we are. We’re here, we’ve reached our destination: we just want to keep enjoying our journey.
E M I LY D O U G H E RT Y
Editor-in-Chief
CHRISTIAN OTH
No filter needed: When iconic photog Christian Oth pulled me in front of his camera for a quick snapshot, on-set makeup genius Mai Quynh transformed my skin zoom-zoom with the new La Prairie Skin Caviar Powder Foundation, a magical, foolproof quick-fix that captures, in a single sweep, the essence of our Transformation Issue.
o I’m cozy-cozy on a heated table, all swaddled in a cashmere burrito, while the best facialist from Australia examines my skin. “You have beauty editor skin,” she says. Why yes, yes I do, smiling from head to toe. “Thank you!” I say. “Oh,” she says. “I didn’t mean it as a compliment. I meant that you’ve damaged your skin by using too many products. It’s irritated.” I left the facial promising to strip back my routine—no more testing every new serum and mask. But after a few weeks, I said, “Eff ! This!” I like trying products. I don’t care if I have ‘beauty editor skin.’ With beauty, it is more about the journey than the destination. Because, with beauty, there’s no end point, no peak, no pinnacle: we are always changing, evolving, growing, aging. And that’s beautiful. I’ve never liked the word makeover, and always preferred the “befores” in movies: Julia Roberts’ Vivian with her big, beachy hair, huge hoops, thigh-high boots and that awesome body-con dress (a look that wouldn’t be out of place on Rihanna today). The Breakfast Club’s Ally Sheedy with her Alexander Wang, rocker-girl hair and Pat
SAY NO TO INCONTINENCE 1/3 of women who experienced incontinence said they were hesitant about physical activity for fear of losing urine.*
Don’t be a statistic. #LiveLife #BTLEmsella BTL Aesthetics | *Realself survey data available upon request
FOR DETAILS, VISIT BTLEMSELLA.COM
Results and patient experience may vary. As with any medical procedure, ask your doctor if the BTL EMSELLA® procedure is right for you. BTL EMSELLA is intended to provide entirely non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of male and female urinary incontinence. ©2019 BTL Group of Companies. All rights reserved. BTL®, EMSELLA® and HIFEM® are registered trademarks in the United States of America, the European Union and/or other countries. The products, the methods of manufacture or the use may be subject to one or more U.S. or foreign patents or pending applications.
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M E D I C A L A DV I S O RY B OA R D
E X P E RT TA K E
The Name Game
AS T H E L E A D I N G O RGA N I Z AT I O N FO R BOA R D - C E RT I F I E D P L AST I C SU RG EO N S M OV E S TO C H A N G E I TS M E SSAG I N G, T H E I N D U ST RY AS A W H O L E AS KS, “ I S I T T I M E TO T R A N S FO R M ? ”
W
Robert Singer, MD
C H A I R M A N O F T H E B OA R D
@SingerSurgical
hat’s in a name? For the American Society for Aesthetic Plastic Surgery (ASAPS)—the professional organization of 2,500-plus plastic surgeons certified by the American Board of Plastic Surgery who specialize primarily in aesthetic (cosmetic) plastic surgery and cosmetic medicine—a whole lot. Since it was founded more than 50 years ago, the organization has remained steadfast in its commitment to excellence: advancing its mission, educating the public and members of the medical field, spearheading innovation and artistry, and above all, advocating for compassion, ethics and patient safety. While those goals aren’t changing, there will be a shift in semantics this year as ASAPS renames itself “The Aesthetic Society”—an almost indiscernible modification, but one that speaks volumes.
It’s no secret that since the society began, the rise in noninvasive procedures has grown tremendously, and with that growth, the line between an invasive surgery and a “lunchtime treatment” have become blurred. Proper training, patient selection and guidelines for either approach are paramount. That is where the word “aesthetics” comes in, a true umbrella of a term that encompasses all things of beauty. As part of the initiative, ASAPS will also be revamping its publicfacing website to deliver increased public awareness regarding the validity and safety of procedures. This includes a focus on “hot issues,” like Brazilian Butt Lift safety, cellular-based therapies and FDA initiatives like the most recent breast implant controversy. The Aesthetic Society has done this because it recognizes that all medical specialties need to keep pace with valid scientific advancements and adapt so they remain relevant for the future.
ABOUT DR. ROBERT SINGER / drsinger@newbeauty.com Internationally renowned aesthetic plastic surgeon and noted educator Robert Singer, MD of La Jolla, CA is a diplomate of the American Board of Plastic Surgery and has served as president and chairman of the Board of Trustees of the prestigious Aesthetic Society (ASAPS), chairman of the Board of Trustees of the American Society of Plastic Surgeons (ASPS), president of the American Association for Accreditation of Ambulatory Surgery Facilities, and president of the Aesthetic Surgery Education and Research Foundation (ASERF), an organization he most recently received a Career Achievement Award from to recognize his contributions to the field.
16 N E W B E A U T Y FA L L 2 0 1 9
Congratulations to the illustrious Dr. Robert Singer, the chairman of our Medical Advisory Board, for receiving the 2019 Career Achievement Award from the Aesthetic Surgery Education and Research Foundation
Dr. Singer with his wife, Judith Harris, and daughter Blair on a philanthropic trip to Africa.
WE CELEBRATE YOUR LEADERSHIP, IMPACT, UNWAVERING GUIDANCE , AND ALL OF YOUR CONTRIBUTIONS TO THE FIELD. THE NEWBEAUTY TEAM
AN EDITORIALLY-CURATED COLLECTION OF 14 NEWBEAUTY FAVORITES
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8. Kiehl’s Cannabis Sativa Seed Oil Herbal Concentrate, 9. Lancome IDÔLE Le Parfum, 10. Mario Badescu Facial Spray With Aloe Herbs And Rosewater, 11. Philosophy Purity Made Simple 3-In-1 Cleanser For Face And Eyes, 12. Shiseido Ultimune Power Infusing Concentrate, 13. Strivectin® Sd Advanced™ Plus Intensive Moisturizing Concentrate, 14. Versace Dylan Blue Femme Eau de Parfum
FAVORITES
THE ORIGINAL
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NEWS
Brace Yourself NECK TECH
The world’s most beautiful minds gathered at The Aesthetic Society’s annual meeting to give us a glimpse into the future. What awaits? Knife-free necklifts, a shot for cellulite and more. TURN FOR MORE
TORKIL GUDNASON / TRUNK ARCHIVE; MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
T H E H O T T E S T I N N O VA T I O N S F R O M T H E 2 0 1 9 A E S T H E T I C S M E E T I N G
N E W B E A U T Y FA L L 2 0 1 9
21
NEWS SCAR-FREE
FACELIFT LITE?
Two minimally invasive technologies are aiming to deliver tighter skin without surgery. Through a series of micro-core excisions, the Cytrellis device removes 5 to 10 percent of skin on the face in a 20-minute procedure, and could earn FDA-approval by year’s end. A similar modality from Recros Medica, rotational fractional resection (RFR) drills out segments of loose submental skin with spinning “scalpets” and sucks away fat with a rotating cannula to contour the jawline. Rockville, MD dermatologist Hema Sundaram, MD, clinical investigator in the U.S. FDA study, said 99 percent of subjects were unhappy with their necks and jawlines before treatment; by 90 days post-treatment, 82 percent were satisfied with their appearance.
BIG GAINS
MUSCLE BOUND
22 N E W B E A U T Y FA L L 2 0 1 9
REAR VIEW
DIMPLE DISRUPTOR
90% of women—of all sizes, ages and ethnicities— are reportedly affected by cellulite
Could the elusive cure for cellulite lie in a syringe? Presently under investigation is collagenase clostridium histolyticum (CCH), an enzyme that breaks down collagen. “By injecting it into the cellulite dimples, we can dissolve or loosen the collagen-rich fibers tethering the skin to underlying muscles, allowing dimples to float up, and creating a smoother, more level skin surface,” explains New York plastic surgeon Lawrence Bass, MD. Based on study protocol, one can expect to need three appointments, involving up to 12 shots per treatment area, spaced roughly 21 days apart. Look for CCH in dermatologist and plastic surgeons’ offices toward the end of 2020.
BAARD LUNDE / TRUNK ARCHIVE; MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
Last year marked the arrival of Emsculpt— and the addition of “supramaximal contractions” to our beauty lexicon. Using high-intensity focused electromagnetic energy, the BTL Aesthetics device activates muscles in a way ordinary sit-ups and squats cannot. While originally approved for strengthening the abs and glutes, new applicators for the arms, thighs and calves are rolling out. In a study of the upper arms, four treatments over two weeks delivered a measurable volume increase, notes Montclair, NJ plastic surgeon Barry DiBernardo, MD. And “by increasing biceps and triceps, lax skin filled out as well in some patients.” (The company is now debuting Emtone, which attacks cellulite with monopolar radio frequency and targeted pressure energy.) Muscling its way in, Allergan’s CoolTone received FDA-clearance in June. According to Shreveport, LA plastic surgeon Simeon Wall, Jr., MD, the magnetic stimulation it induces “may recruit more muscle cells than Emsculpt, possibly making it a stronger tool.”
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ACID DROP
RED RIDDER
ALEXANDRE WEINBERGER / TRUNK ARCHIVE; MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
Tranexamic acid continues to stir excitement. “We have not really seen these types of improvements from anything other than devices,” says Dr. DiBernardo, referring to results achieved by U.SK Under Skin from pharma company the NC Group. In a six-week trial, the physician-dispensed formula diminished pigmentation and redness. “Our instruments showed a marked reduction in red blood vessels; it’s very unusual to see this from a topical,” he says, adding that tranexamic acid has been proven in separate studies to decrease certain markers related to the growth of vessels.
THICK OF IT
W E E KS The time it takes for a single injection of Renuva to grow its maximum amount of fat
BIG SHOT
U.SK Under Skin Anti-Aging Advanced Retinol Restorer $99, underskin.com
Lipo has long been a prerequisite for fat injections, but Renuva may be changing the game. New York plastic surgeon Haideh Hirmand, MD describes the injectable as a “sterile and preserved matrix derived from donated fat that possesses the qualities needed to make new fat and blood vessels.” (It’s approved and regulated as a transplant tissue, not a medical device.) With no actual living fat cells in the formula, it cannot be rejected, she notes. Developed by the nonprofit tissue bank MTF Biologics, the matrix was originally studied for correcting small irregularities, like cellulite divots, but is now being explored as a potential volumizer for the face. “It shows promise as an alternative to autologous fat and hyaluronic acid fillers. I can’t say we’ve struck gold yet, but I’m very excited about Renuva,” says Dr. Hirmand. “We need bigger long-term studies to sort out its nuances for aesthetic use.”
SWEET BEAM
MIDDLEWHITTLER
Irony of ironies: The fat-reduction category continues to expand. EonFR is an FDA-cleared, non-contact laser device “that preferentially heats up and kills fat cells, allowing them to be excreted over time,” explains Salt Lake City plastic surgeon Renato Saltz, MD. During the 15-minute procedure, the machine scans the topography of the patient before delivering a personalized treatment. As of press time, results of the 36-subject clinical trial were not available, but outcomes “are already equivalent to another well-known device on the market,” says Dr. Saltz, “and [may] improve with further development of the treatment protocol.”
MUSE
SCENT STAR You may recognize Bee Shapiro’s name from her New York Times column “Skin Deep,” but now, the mother of two and Kendrick Lamar enthusiast has another claim to fame: fragrance line Ellis Brooklyn. “I’ve always loved fragrance—it’s this invisible world that conveys so much and is so tough to describe. As a writer, that’s a fascinating challenge.” —D A N I E L L E F O N TA N A
MAKEUP MUSTS “I like the Dior Forever foundation line for days I need things to stay put, but for every day, I like Dr. Hauschka tinted face cream. RMS makes beautiful blushes; Kosas creates gorgeous everyday lip colors. For hair, I’m in love with Miriam Quevedo’s products.”
“I will buy anything Ulla Johnson or Altuzarra to the detriment of my bank account.” On her coffee table, it’s National Geographic books. “Paul Nicklen is an amazing photographer.”
BRIGHT IDEA “When I became pregnant with my daughter Ellis and was living in Brooklyn—hence Ellis Brooklyn!— I became sensitive to smell, but reviewing fragranced products was part of my job. It got me thinking about what I was putting on myself.”
P L AY I N G FAV O R I T E S “I created Myth for myself. It’s a skin scent that is soft and seductive in a way that feels real. It’s not a red dress and platform heels kind of scent; it’s more like a swath of skin showing from under your favorite, perfectly cut cotton shirt.”
BLACK BOOK
MAKEUP ARTISTS
DANIEL MARTIN + BENJAMIN PUCKEY
@danielmartin @benjaminpuckey
“They are both so crazy talented!”
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MASSAGE THERAPIST
DERMATOLOGISTS
WORKOUT
SOOTHE @soothe
PATRICIA WEXLER + DENDY ENGELMAN
SOULCYCLE @soulcycle
“There’s an amazing guy named Carlos on there who I always request.”
“They are both such brilliant women and I trust them.”
“The instructors and everyone there are so damn happy! They are like a spot of sunshine.”
@wexlerdermatology @drdendy
WEK WEK/GETTY IMAGES, PIDJOE/GETTY IMAGES, VICTOR VIRGILE / CONTRIBUTOR/GETTY IMAGES
STYLE SEARCH
It’s in our formula. It’s in results that positively glow—smooth skin, softened lines. It’s the beauty of being recognized as an industry leader, over and over. And over. TNS Essential Serum®. The go-to, period. SKINMEDICA.COM
Model. The SkinMedica® product described here is intended to meet the FDA’s definition of a cosmetic product, an article applied to the human body to cleanse, beautify, promote attractiveness, and alter appearances. This SkinMedica® product is not intended to be a drug product that diagnoses, treats, cures, or prevents any disease or condition. This product has not been approved by the FDA, and the statements here have not been evaluated by the FDA.
© 2019 Allergan. All rights reserved. All trademarks are the property of their respective owners. Allergan.com SkinMedica.com TNS126246 06/19 192379
A DV E RT I S E M E N T
V I S I O N A RY AN EXTRAORDINARY GROWTH FACTOR SERUM If you want to retain youthful-looking skin, look no further than the iconic TNS Essential Serum®. The number-one and highly awarded growth factor product, SkinMedica’s growth factor technology delivers the age-defying effects we all desire—less visible lines and wrinkles, smoother skin texture, even tone, and enhanced elasticity— for a more radiant, more youthful appearance.
SIMPLY REMARKABLE RESULTS * 1,
95%
92%
of patients agreed at 12 weeks
of patients agreed at 12 weeks
“improves smoothness and softness of my skin”
“makes my skin look healthier and more youthful”
THE AGE-DEFYING POWER OF GROWTH FACTORS Young, vibrant skin has naturally occurring proteins that fight against aging and maintain epidermal health. These proteins are called growth factors and are important for skin rejuvenation. Whether the goal is preserving the youthful radiance of your 30s, staving off the telltale signs of aging in your 40s or undoing existing damage that starts to show as you get older, topically applied growth factors offer multiple benefits. Maintaining healthy-looking skin is essential during each phase of skin care—from protection to correction—and growth factors help do just that.
*Percent of patients who agreed at month 3, based on 37 patients. Reference: 1. Data on file at SkinMedica® This SkinMedica® product is intended to meet the FDA’s definition of a cosmetic product, an article applied to the human body to cleanse, beautify, promote attractiveness, and alter appearances. This SkinMedica® product is not intended to be a drug product that diagnoses, treats, cures, or prevents any disease or condition. This product has not been approved by the FDA, and the statements have not been evaluated by the FDA. © 2019 Allergan. All rights reserved. All trademarks are the property of their respective owners. Allergan.com | SkinMedica.com 126761 07/19
RENAISSANCE WOMAN And we thought we had a busy summer! New York dermatologist Macrene Alexiades, MD spent hers running trials for the injectables and lasers we’ll all be using in five years, putting the finishing touches on her 2,000-page “magnum opus,” Alexiades Cosmetic Dermatologic Surgery, and relaunching her skin-care line, Macrene Actives.
FAS H I O N CUES “I have romances with designers. I’m going through a Gucci phase, thanks to my sister-in-law Dr. Patrice Buonocore, who has been a real influence on my classic style.”
LEO RISING Leonardo da Vinci and his “marriage of art and science” are sources of inspiration: the two even share an eye condition that, according to Dr. Alexiades, “enables one to understand and measure human faces.”
GREEK LIFE “I draw all of my vitality from the sea, the sky, the air, the earth and the people of the Greek Islands. They are my energy source. I have to drink at the well every year.”
EDNAM/GETTY IMAGES, MILANGONDA/GETTY IMAGES
D A I LY ESSENTIALS “When I get out of the shower, I apply my cream and then my serum to my face, and my neck cream to my neck, chest and tops of hands. Lately, I’ve been enjoying SkinCeuticals Metacell Renewal B3 on my arms and legs. For sunscreen, I go with Neutrogena SPF 100.”
BLACK BOOK
HAIRSTYLIST
JUAN CARLOS @jcmaciques
“He knows how to take long hair and give it bounce and movement.”
DENTIST
INTERNIST
MARC LOWENBERG, DDS
DAVID SILVERMAN, MD
“He’s simply super talented.”
“He is so thorough and so good. I wish I could clone him.”
@drmarclowenberg
COLORIST
KYLE WHITE @kylecolor
“He brought me back to the dark blond of my teens that matches my daughter’s.”
MUSE
PRINCE’S QUEEN Thirty-five years later, Prince’s love interest in Purple Rain, Apollonia Kotero, likes to think of herself as living the “mellow life”—meditating and going “au naturale” with makeup whenever possible. “He [Prince] always said: ‘Don’t leave the house without makeup, you never know who you’ll meet.’ I always remember what he said, but, sometimes, I need a break!”
PRIZED POSESSION “Anything Prince drew for me. He was a terrific artist. I have his art in a safe in a bank in a city in a country.” (She also says she has enough of the Purple Rain set “to fill a museum,” hidden in an undisclosed location.)
“When it’s time to celebrate, I’ll get a massage or travel. Traveling is my sanctuary of celebrations and I’m lucky to live on Oahu and in Beverly Hills. Hawaii is my favorite place.”
C A R R Y- O N “I’m never without my tape recorder, crystals, iPhone and Catholic guilt.”
BEAUTY DISCOVERY Kotero admits she’s tried it all. “I love all Giorgio Armani, all La Mer, all NARS. I also recently discovered the Original Hollywood Fashion Secrets tape. No wardrobe malfunctions here.”
SYMBOLIC RITUALS “My almost-daily indulgence is walking to Il Cielo restaurant for lunch. The vibe is glam and the food is delicious! Every night, I pray and apply True Botanicals Stress Relief.”
BLACK BOOK
HAIRSTYLISTS
NICK CHAVEZ + ALINA RATTA
@nickchavezbh @alinaratta
“Nick cuts and styles my hair; Alina preps me for events.”
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FACIALIST
WORKOUT
GABRIELA SAWAYA @gabrielasawaya
PURE BARRE @purebarrebevhills
“Gabriela at Bel Viso Skin Care is the best!
“I’m a big fan of pilates, breathing exercises, meditation and yoga.”
NUTRITIONIST
ZEN FOODS @zenfoods
“Zen Foods delivers my meals when I am in LA. I love to cook, but I am always on the go.”
MICHAEL OCHS ARCHIVES / STRINGER/GETTY IMAGES, WEK WEK/GETTY IMAGES, BOGAHAN/GETTY IMAGES, ART WAGER/GETTY IMAGES
C E L E B R ATO RY CAUSE
Actual patient. Results may vary.
Your face. Your decision. It’s time to say see you later to the judgment, oh, and to frown lines. And hello to Xeomin®. Xeomin is the only clinically proven anti-wrinkle injection uniquely purified to remove unnecessary proteins.* Find a doctor who can tell you all about Xeomin. XeominAesthetic.com
*Studies have not been performed to determine whether the presence or absence of accessory proteins has a long-term effect on safety or efficacy. Xeomin. By prescription only. A temporary treatment. XEOMIN (incobotulinumtoxinA) IMPORTANT CONSUMER SAFETY INFORMATION Read the Medication Guide before you start receiving XEOMIN (Zeo-min) and each time XEOMIN is given to you as there may be new information. The risk information provided here is not comprehensive. To learn more: • Talk to your health care provider or pharmacist • Visit www.xeominaesthetic.com to obtain the FDA-approved product labeling • Call 1-866-862-1211 Please see back of this page for important safety information.
USES: XEOMIN is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary). It is not known if XEOMIN is safe and effective in children under 18 years of age. WARNINGS XEOMIN may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems anytime (hours to weeks) after treatment with XEOMIN: • Problems with swallowing, speaking, or breathing can happen within hours to weeks after an injection of XEOMIN if the muscles that you use to breathe and swallow become weak. Death can happen as a complication if you have severe problems with swallowing or breathing after treatment with XEOMIN. • People with certain breathing problems may need to use muscles in their neck to help them breathe and may be at greater risk for serious breathing problems with XEOMIN. • Swallowing problems may last for several months, and during that time you may need a feeding tube to receive food and water. If swallowing problems are severe, food or liquids may go into your lungs. People who already have swallowing or breathing problems before receiving XEOMIN have the highest risk of getting these problems. • Spread of toxin effects. In some cases, the effect of botulinum toxin may affect areas of the body away from the injection site and cause symptoms of a serious condition called botulism. The symptoms of botulism include: loss of strength and muscle weakness all over the body, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice, trouble saying words clearly, loss of bladder control, trouble breathing, trouble swallowing. These symptoms can happen hours to weeks after you receive an injection of XEOMIN. These problems could make it unsafe for you to drive a car or do other dangerous activities. Do not use XEOMIN if you are allergic to XEOMIN or any of the ingredients in XEOMIN (see the end of this Guide for a list of ingredients in XEOMIN), had an allergic reaction to any other botulinum toxin products such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC), or abobotulinumtoxinA (DYSPORT®) or have a skin infection at the planned injection site. Before receiving XEOMIN, tell your doctor about all of your medical conditions, including if you: • have a disease that affects your muscles and nerves (such as amyotrophic lateral sclerosis [ALS or Lou Gehrig’s disease], myasthenia gravis or Lambert-Eaton syndrome) • have had any side effect from any other botulinum toxin in the past • have a breathing problem such as asthma or emphysema • have a history of swallowing problems or inhaling food or fluid into your lungs (aspiration) • have bleeding problems • have drooping eyelids • have plans to have surgery • have had surgery on your face • are pregnant or plan to become pregnant. It is not known if XEOMIN can harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if XEOMIN passes into breast milk. Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Talk to your doctor before you take any new medicines after you receive XEOMIN. Using XEOMIN with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received XEOMIN in the past. Especially tell your doctor if you • have received any other botulinum toxin product in the last four months • have received injections of botulinum toxin such as rimabotulinumtoxinB (MYOBLOC®), onabotulinumtoxinA (BOTOX®, BOTOX® COSMETIC) and abobotulinumtoxinA (DYSPORT®) in the past. Be sure your doctor knows exactly which product you received. The dose of XEOMIN may be different from other botulinum toxin products that you have received. • have recently received an antibiotic by injection • take muscle relaxants • take an allergy or cold medicine • take a sleep medicine Ask your doctor if you are not sure if your medicine is one that is listed above. Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine. Possible Side Effects XEOMIN can cause serious side effects that can be life threatening including allergic reactions. Symptoms of an allergic reaction to XEOMIN may include: itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you get wheezing or asthma symptoms, or if you get dizzy or faint. See “Warnings.” The most common side effect of XEOMIN in people with glabellar lines includes: • headache These are not all the possible side effects of XEOMIN. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
GENERAL INFORMATION ABOUT THE SAFE AND EFFECTIVE USE OF XEOMIN Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. You can ask your pharmacist or doctor for information about XEOMIN that is written for health professionals. Active Ingredient: botulinum toxin type A Inactive Ingredients: human albumin and sucrose Copyright © 2018 Merz North America, Inc. All rights reserved. Merz Aesthetics, the Merz Aesthetics logo, and Xeomin are registered trademarks, and Xperience Program is a trademark, of Merz Pharma GmbH & Co. KGaA. Botox®, Dysport® and Myobloc® are registered trademarks of their respective owners. ML02675-00
HOLY GRAIL S O U L C Y C L E V E R S U S F LY W H E E L ; D AV I D L E E R O T H V E R S U S S A M M Y H A G A R ; SPIKE VERSUS ANGEL: THERE ARE SO MANY THINGS ABOUT WHICH W E N E E D T O A G R E E T O D I S A G R E E . B U T, W I T H T H E S E S U P E R S TA R P R O D U C T S , T H E R E ’ S N O D E B AT E : T H E Y R E A L LY W O R K .
E N E R GY H E A L E R
BEBOE HIGH-POTENCY CBD FACE MASK A weekly (or daily) essential for calming stressed skin, each mask delivers a mega-dose of CBD (50 mg per sheet), vitamin C and niacinamide. Plus, the mesmerizing etchings designed by artist and Beboe cofounder Scott Campbell function as a map of energy ley lines for DIY acupressure. $78 for a set of five, neimanmarcus.com
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H O LY G R A I L
F O R C E O F N AT U R E
RED FLOWER ARCTIC BERRY CLOUD CREAM For Red Flower’s Yael Alkalay, the goal was not so simple: Create a product inspired by a cloud. “There was so much trial-and-error to get the texture right. It’s complicated to take something heavy and concentrated and transform it into something light.”
9
the number of years ago the cream debuted—a good seven years before the trend hit the U.S.
$77, redflower.com
WHY WE LOVE IT
The cream is beautifully complex: intensely nourishing and 100-percent natural, yet multitasking and magically scented. “Our guests expect products that are therapeutic, luxurious and mindful. It is all that and more,” says Simon Marxer, spa director at Miraval.
MIRACLE CURE
Beauty Heroes founder Jeannie Jarnot considers the cream the ultimate nourisher. “I use it on my husband’s dry hands and on my son after baths, and I keep a jar by my desk to reapply during the day.”
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NORTHERN SONG
While the formula is hand-whipped through a delicate heat process in New York, the bulk of the ingredients— including the star ingredient, vitamin C–rich cloudberries—come from Finland and can only be harvested in July.
LIGHT + LIFE
Alkalay’s goal is to deliver a “full experience.” “Skin care can provide a deeper place of reconnection, relaxation and stress reduction, all while delivering results.”
LUXE ELIXIR
RETROUVÉ INTENSIVE REPLENISHING FACIAL MOISTURIZER When Kiehl’s Jami Morse Heidegger couldn’t find the skin care she needed to treat her aging skin, she harnessed a lifetime of experience creating holy grail products and made it herself. $445, retrouve.com
WHY WE LOVE IT
A minuscule amount of this ultra-nourisher is enough to deeply hydrate the face, neck and décolleté. It works as an overnight treatment or a supercharged daily moisturizer; and with a new 15 ml “Voyage” bottle, it also jet sets as the perfect in-flight mask.
75
the years of collective experience, research and collaboration on which the brand is founded TA I L O R M A D E
Never intending on distributing the bespoke line, Heidegger spared no expense: ”I wanted intense, heavy-duty products, so I worked with a former Kiehl’s chemist, making sure to use only efficacious anti-aging ingredients in superior concentrations.”
HIGH-GRADE ACTIVES
INNER CIRCLE
At age nine, Heidegger mixed a custom scent for Stevie Wonder. Her serum has an A-list following, too: Tracee Ellis Ross swears by it, Zoë Kravitz says it “feels just like honey” and Rita Ora used it to prep for the 2019 Met Ball.
The brand often sources raw ingredients, like avocado oil, straight from the Heidegger Malibu family ranch. Ingredients like vitamins C and E, plant-based squalane, white tea, and apple stem cells help promote collagen production and surface repair.
FORCE FIELD
To protect the formula against oxidation, the highly potent extracts are mixed at high speeds using vacuum technology and dispensed into opulent, Italian glass bottles that are completely impenetrable to light and air.
S P EC I A L A DV E RT I S I N G S ECT I O N
breakthrough
BRIEF smooth sailing Macrene Actives drmacrene.com Packed to the brim with plant-derived actives like hyaluronic acid, watermelon extract and more than 12 amino acids, High Performance Face Serum works to tone and tighten facial skin while reducing signs of aging. This lightweight, silky formula contains everything skin needs to promote a smoother, more youthful complexion.
mega moisture Epionce epionce.com A botanical blend of flax, avocado, apple and date extracts combines in Renewal Facial Lotion to strengthen and repair skin’s natural moisture barrier and calm inflammation. This ultra-lightweight, ultra-hydrating lotion improves clarity and radiance for healthier-looking skin.
Take a sneak peek at these top shelf–worthy discoveries emerging from standout brands.
all in the eyes neuLASH® skinresearchlabs.com
Reach for this powerful lash enhancing serum once a day to achieve silky, longer-looking lashes without compromise. This nutrientrich yet gentle formula is chock-full of fortifying peptides and biotin to strengthen eyelashes and prevent future damage.
must-have multitasker INSTYTUTUM Result-Driven Skincare instytutum.com Dry, dull skin will be a thing of the past with this intensely moisturizing Powerful RetinOil. By combining granactive retinoid, bakuchiol, algae extract, 15 oils and raspberry stem cells in a superpacked formula, this next-generation facial oil delivers a flawless, dewy complexion while reducing fine lines, wrinkles, pore size and dark spots.
S P EC I A L A DV E RT I S I N G S ECT I O N
turn back the clock DefenAge defenage.com Three steps to beautiful new skin? DefenAge Clinical Power Trio’s anti-aging system relies on state-ofthe-art peptides called defensins that activate skin cells and the skin’s regenerative properties to deliver just that. This powerful combination dramatically minimizes the effects of aging, for fewer wrinkles and firmer, brighter skin.
unparalleled power Alastin Skincare alastin.com/transform Specially designed to use after fatreduction or skin-tightening procedures, TransFORM Body Treatment with TriHex Technology® can help accelerate the body’s natural removal process of broken-down fat cells to enhance results. This rich cream supports the skin’s natural ability to produce elastin and collagen for firmer, smoother skin, even when used alone.
youth in a bottle Le Mieux lemieuxskincare.com Harnessing the power of Alpine rose stem cells and age-reversing growth factors, the super potent StemCell EGF serum encourages the regeneration of new surface cells, assists in preventing collagen breakdown, and combats signs of environmental and UV damage. The end result: visibly minimized fine lines and wrinkles, and firm, soft, supple skin.
hydration station Mass Eden masseden.com Crafted for all skin types, specifically sensitive skin, Light Oil deserves a permanent placement in your skin-care routine—or your beau’s beard routine. Five simple ingredients come together in this natural formula to hydrate and restore parched skin.
age-proof pair AnteAGE anteage.com Powered by stem cell growth factors, the Serum and Accelerator system contains everything skin needs to restore its youthful glow. Fortified with classic anti-aging ingredients like hyaluronic acid and vitamin C, this two-step system reverses the causes of skin aging at the cellular level, helping to smooth wrinkles, minimize discoloration and leave skin more hydrated and radiant.
OBSESSED: RETINOL
GOLD STANDARD
I
n 2013, Victoria Fu and Gloria Lu became fast friends working as cosmetic chemists at L’Oréal. In 2016, they left their corporate posts to launch one of our favorite Instagram accounts, Chemist Confessions, with the goal of being fully transparent about skin-care products, ingredient labels and cutting-edge research. One ingredient they agree needs further explaining? Retinol. “It’s the gold standard anti-ager and can thwart everything from wrinkles to acne, but many of our followers are still intimidated by it, so we’re hoping to help educate.” —BRITTANY BURHOP FALLON
Within the retinoid family—derivatives of vitamin A touted for their ability to boost cell turnover—retinol is the most common, and mildest, version of the ingredient used in skin care. “Tretinoin—brand names include Retin-A and Renova, among others— is the strongest, Rx-only form, and a dermatologist favorite for reducing signs of aging and acne,” says Fu, noting typical pain points with regular use include redness, irritation and skin shedding (varying degrees of this are standard with use of all retinoids). Acne-prone skin types can find relief with adapalene (0.1 percent), which is comparable to tretinoin, but proven to be less irritating. “It treats acne deep in the pores and recently became available over the counter,” Lu says.
EASE INTO IT
"Retinol can break down when exposed to light, heat and air, so we prefer products in opaque, airless pumps or aluminum tubing,” says Fu. The strength of the formula matters, too: All skin types can use retinoids, but finding the sweet spot for your skin is essential. “Retinol can be highly irritating for the uninitiated,” Lu says. “It’s tempting to use the strongest one, but that can compromise your skin barrier. For those with sensitive or dry skin, we recommend starting with 0.1–0.3 percent two or three times a week and acclimating to higher concentrations or frequency. (The percentage of retinol can be found in ei-
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ther the product name or ingredient list.) And regardless of potency, Fu suggests using retinoids at night, as they increase skin’s UV sensitivity—always wear SPF during the day, too. Another way to introduce retinol into your routine? Try buffering, which involves mixing retinol with a hydrating moisturizer to dilute it and act as a buffer from irritation.
LEARN HOW TO LAYER
It’s best to avoid layering retinol with other strong actives like alphahydroxy acids (AHAs), which Fu says “can put your cell turnover on steroids.” Avoid Each ingredient also requires a layering unique optimal pH of the skin: RETINOL “AHAs work their magic under with other 3.5, while retinol is best at 5 and strong above, so separating the use of actives these ingredients is favorable.”
TRY BAKUCHIOL
like AHAs.
As demand for gentler retinoid formulas grows, one ingredient capturing attention is bakuchiol, a plant-derived antioxidant used in Chinese medicine that Fu says has been found to target similar pathways as retinol in the skin. One study showed products with 1 percent bakuchiol had acne-fighting benefits; another, Fu notes, “compared 0.5 percent bakuchiol to 0.5 percent retinol, and the plant alternative performed similarly in terms of wrinkle and hyperpigmentation reduction, and smoothing skin texture.”
MANDY DISHER PHOTOGRAPHY/GETTY IMAGES
FIND THE RIGHT FORMULA
Victoria Fu and Gloria Lu @chemistconfessions
RETINOL ROUNDUP
TROUBLE FINDING THE RIGHT PRODUCT FOR YOUR SPECIFIC CONCERNS? FU AND LU RANK THESE TOP OF THEIR LIST.
BEST FOR SENSITIVE SKIN
“It contains bakuchiol, a gentle, plant-based alternative to retinol." OleHenriksen Transform PLUS Glow Cycle Retin-ALT Power Serum, $58, olehenriksen.com
BEST FOR FINE LINES
“With fine lines being one of the first signs of aging, 0.3 percent is a good level to start targeting them." SkinCeuticals Retinol 0.3, $67, skinceuticals.com
BEST FOR WRINKLES
“The 0.5 is potent, but you can also try the 1.0 version if your skin is tough as nails." SkinMedica Retinol Complex 0.5, $78, skinmedica.com
BEST FOR ACNE
“Although it's overthe-counter adapalene 0.1 percent, we suggest checking with your doctor before using it." Differin Gel, $29, target.com
BEST FOR THE EYE AREA
“Clinical testing shows it provides both crow’s-feet and dark circle benefits." RoC Retinol Correxion Eye Cream, $18, target.com
24 H O U R S
SURFACE LEVEL N OT SU R E W H I C H P RO D U CTS TO U S E W H E N ? TA K E A C U E F RO M O N E O F T H E S E B E AU T Y P ROS W H O H AV E M AST E R E D T H E C OV E T E D G LOW B Y B R I T TA N Y B U R H O P FA L L O N
DAY
BALJEET PUREWAL, MD CHATHAM, NJ OCULOPLASTIC SURGEON
@drbaljeetpurewal
“Every product I use must serve a specific purpose for my skin.”
“To clean my skin without stripping it, I like Amorepacific Treatment Cleansing Foam ($50, sephora. com). Then I use SkinMedica TNS Essential Serum ($281, skinmedica. com), a blend of growth factors, peptides and antioxidants. For hydration, I like the plumping effects of SkinMedica HA5 ($178, skinmedica.com), especially around my crow’s-feet—under my eyes I use Environ Youth EssentiA Vita-Peptide Eye Gel ($86, dermaconcepts.com). For sun protection: SkinMedica Total Defense + Repair Tinted SPF 34 ($68, skinmedica.com).”
DAY
ROSE APODACA AUTHOR OF YOUR BEAUTY MARK AND FOUNDER OF A+R DESIGN
@roseapodaca
“As a beauty writer, I’ve learned to heed legit doctors, keep it simple and resist marketing hype.”
“After a cold splash, I dampen an organic cotton round with Thayers Rose Petal Facial Toner ($11, target. com) and gently pat my face and neck. Never forget your neck. I then massage Eucerin Q10 AntiWrinkle Face Creme into my skin ($13, amazon.com) before getting my daughter ready for school. Once she’s off, I slather Eucerin Daily Protection Face Lotion SPF 30 ($9, amazon.com) on my face, décolleté and the tops of my hands. If it’s not a matte MAC red lip day, I glide on eos Pure & Free Organic Stick Lip Balm ($4.50 for two, target.com).”
DAY
MICHELLE HENRY, MD
NEW YORK DERMATOLOGIST
@drmichellehenry
“I’m an advocate of products that are proven safe, backed by science and feel good.”
“First I use La Roche-Posay Toleriane Hydrating Gentle Cleanser ($15, cvs.com), and then Biologique Recherche Lotion P50 ($101, shoprescuespa.com) to minimize my pores. Next, I layer SkinMedica Lytera 2.0 ($154, skinmedica.com) to fight pesky hyperpigmentation and Skinbetter Science Trio Rebalancing Moisture Treatment ($135, skinbetter.com), which feels like a lotion, but moisturizes like a cream. Last up is CeraVe UltraLight Moisturizing Lotion SPF 30 ($18, ulta.com)—it’s transparent on my melanin-rich skin, which I love.”
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Clinique iD Dramatically Different Moisturizing Lotion+ and Active Cartridge Concentrate for Lines & Wrinkles NIGHT
When I apply my products, I like to take my time—it’s a treat to be able to nourish and protect my skin.
“I use SkinMedica AHA/BHA Exfoliating Cleanser ($47, skin medica.com) to both exfoliate and remove my makeup. Then I apply SkinMedica Retinol Complex 0.5 ($78, skinmedica.com) to minimize fine lines and the size of my pores. Twice a week, I use Fresh Face & Eye Brightening Pads ($160, available at Fresh Face & Eye) in place of retinol to even my skin tone and reduce breakouts. As my last step, I apply NeoCutis Lumière Illuminating Eye Cream ($97, dermstore.com)—it’s packed with growth factors and intensely hydrates my skin.”
NIGHT
“After completely removing any makeup, I lather up with gentle, circular strokes of Cetaphil Daily Facial Cleanser ($14.50, ulta.com). Then, like in the morning, I do my round of toner with Thayers. A few times a week, depending on the season, I cap this with a mildly vigorous massage of an organic oil; of late, I’ve been partial to cold-pressed sesame—it’s high in vitamins B, E and complex D—and I’m slathering Aura-Cacia Organic Sesame Skin Care Oil ($7, aura cacia.com) a boon head to toe.”
NIGHT
I’ve made a conscious effort to never go to bed, no matter the hour, without a clean slate.
“At night, I use SkinMedica AHA/ BHA Exfoliating Cleanser ($47, skinmedica.com) to remove dirt, oil, environmental pollutants and debris from the day. Then I follow with Lotion P50 again and ISDIN Melatonik 3-in-1 Night Serum ($160, isdin.com/us), which contains vitamin C and a gentle retinol alternative called bakuchiol. Lastly, I use Clinique iD—the Dramatically Different Moisturizing Lotion+ and Concentrate for Lines & Wrinkles ($39, clinique.com)—to help plump lines and wrinkles using a blend of whey protein and peptides.”
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Have You Felt the
MENTOR® MemoryGel® Xtra Breast Implant?
In a blinded comparison 9 out of 10 consumers chose MemoryGel® Xtra Breast Implants as feeling more like a natural breast than the other leading brand.*1
@BreastImplantsbyMentor #MemoryGelXtra #MentorBreastImplants #OwnTheDay *Head-to-head blinded in-person tabletop product comparison (MemoryGel Xtra vs. Inspira Responsive vs. Inspira Cohesive) with 452 respondents. 1. Mentor Consumer Preference Market Research Report - July 2017. IMPORTANT SAFETY INFORMATION MENTOR® MemoryGel® Breast Implants are indicated for breast augmentation in women who are at least 22 years old. Breast implant surgery should not be performed in women: With active infection anywhere in their body; With existing cancer or pre-cancer of their breast who have not received adequate treatment for those conditions; Who are currently pregnant or nursing. Safety and effectiveness have not been established in patients with autoimmune diseases (for example lupus and scleroderma), a weakened immune system, conditions that interfere with wound healing and blood clotting, or reduced blood supply to breast tissue. Patients with a diagnosis of depression, or other mental health disorders, should wait until resolution or stabilization of these conditions prior to undergoing breast implantation surgery. There are risks associated with breast implant surgery. You should be aware that breast implants are not lifetime devices and breast implantation may not be a one-time surgery. You may need additional unplanned surgeries on your breasts because of complications or unacceptable cosmetic outcomes. Many of the changes to your breast following implantation are irreversible (cannot be undone) and breast implants may affect your ability to breastfeed, either by reducing or eliminating milk production. Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications for breast augmentation with MemoryGel® Breast Implants include any reoperation, capsular contracture, nipple sensation changes, and implant removal with or without replacement. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture. Detailed information regarding the risks and benefits associated with MENTOR® Breast Implants is provided in the educational brochure for MemoryGel® Implants: Important Information for Augmentation Patients about MENTOR® MemoryGel® Breast Implants. The brochure is available from your surgeon or visit www.mentorwwllc.com. It is important that you read and understand the brochure when considering MENTOR® MemoryGel® Breast Implants. © Mentor Worldwide LLC 2019 109944-190320
TRANSFORMATION
CHRIS CLOR / GETTY IMAGES
ISSUE
Welcome to our METAMORPHOSIS issue, where we celebrate the most POWERFUL procedures and products: potent stem-cell skin care, the world’s top HEALING spas, and our favorite BRIGHT smile revivers. PLUS: NewBeauty editors share the treatments that changed our lives.
N E W B E A U T Y FA L L 2 0 1 9
41
ICONS
THE GAME
CHANGERS Dermatologists KATHY FIELDS and KATIE RODAN disrupted the beauty industry by launching two of history’s most successful lines and improving the skin of hundreds of millions of people along the way. by
M AGGIE BULLOCK
N
ow that the term “work wife” has entered the pop culture lexicon, the notion of starting a company with one’s best friend is standard operating procedure for entrepreneurial types. But when dermatologists Katie Rodan and Kathy Fields invented the now-iconic three-step acne treatment Proactiv in 1990, it was still a relative rarity (for women, at least). From the get-go, Drs. Rodan and Fields have been as savvy about business as they are about skin care. In 1995, they cut a licensing deal with infomercial giant Guthy-Renker that made Proactiv one of the best-selling acne products of all time. In 2002, they founded their namesake brand, Rodan + Fields, with a trio of four-step regimens. A year or so later, they sold the company to Estée Lauder and regretted it almost instantly. So, in 2007, they fearlessly bought it back and relaunched it with a scheme that, at the time, was so unfashionable, it was almost taboo: multilevel marketing. Now, 300,000 independent consultants sell the products in the U.S. and Canada; the brand’s annual conferences are sold-out, concert-style affairs that play to packed crowds. It’s no surprise to learn that Drs. Rodan and Fields are still practicing dermatologists; however, it may surprise you to learn that the company is the number-one selling skin-care brand in North America.
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Q&A
NEWBEAUTY: You met in the mid-’80s at Stanford, when you were both doing your dermatology residencies. What initially drew you to each other? DR. RODAN: You know the saying, birds of a feather flock together? Well, Kathy and I kind of stood out from the crowd. Our residency class was all guys—buttoned down, preppy ironed shirts and tan pants and Weejuns. Like a lot of female friendships, bonding happens over fashion. There with Kathy, in her white heels, just off the boat from Miami. And I was from Los Angeles, and known as “Rhinestone Rodan.”
NEWBEAUTY: Rhinestone Rodan! Why? DR. RODAN: I’m attracted to shiny little glit-
tery embellishments.
NEWBEAUTY: Did becoming business partners have to do with a sense of solidarity—being two women in a male-dominated field? DR. FIELDS: Dermatology was way ahead of its game—our class was about 50 percent women in 1984. Actually, Katie wanted me to get married. I was coming over a lot on
KAZMULKA/GETTY IMAGES
Katie Rodan (left) and Kathy Fields (right) in their San Francisco headquarters.
ICONS
NEWBEAUTY: And you got back into the teen acne game earlier this year. A molecule called BPO2 is in Spotless for teenagers. How does that interact with the microbiome? DR. FIELDS: We’ve always thought acne was caused by the presence of P. acnes bacteria. It turns out almost everybody has P. acnes. When [a pore is plugged], the oxygen level inside the pore goes down, and the acne bacte-
44 N E W B E A U T Y FA L L 2 0 1 9
ria goes wild. This crazy-bad bacteria now takes over the good bacteria. Benzoyl peroxide has been a cornerstone of treatment for 50 or 60 years, but it’s been usually in crystal form and has limited penetration. With Spotless, we’re using a tiny micronized crystal form of benzoyl peroxide to get through the plug. And then we deliver it in a leave-on form—the first-ever stabilized liquid benzoyl peroxide. The liquid O2 molecule brings oxygen in there to bring the bad bacteria back in line.
NEWBEAUTY: You’re both still practicing dermatologists. What can people accomplish at a derm’s office that they can’t do at home? DR. FIELDS: The most important attractive feature between two people isn’t your long blond hair. It’s the quality of your skin. So, we really hammer that home: You can do a lot of great things before we start squirting things or burning things off of you with our big toys.
NEWBEAUTY: Is there an in-office “toy” you think makes the biggest difference? DR. RODAN: I look at somebody’s face very carefully, analyze all of their asymmetries, and then try to give them symmetry and balance. That’s going to come from a combination of fillers and Botox, generally. So: injectables. DR. FIELDS: Advanced fillers can bring back the round softness of the face, which is really your fat pad that’s gone. Restoring that bounce is what the eye reads as youthful.
NEWBEAUTY: Do you have a favorite? DR. FIELDS: Basically, injectables can be lumped into deep, medium and superficial. It’s like building a house. You’ve got your foundation, your mid-structure and then the paint on top. But there’s no leading filler that’s safer or better in some magical way.
NEWBEAUTY: You bought Rodan + Fields back from Estée Lauder in 2007, and relaunched it. Where did the idea of multilevel marketing come in?
DR. RODAN: We realized retail was dying. You could roll a bowling ball down the aisle at Nordstrom and you wouldn’t hit anyone. The thing that was bringing customers to our counter was word of mouth. Women were recommended to our products by a friend or their hairdresser. We thought: We should be rewarding the people who love the product, who use the product and want to sell the product. Now we call them our independent consultants. DR. FIELDS: They’re an exceptional group of women. Impassioned, philanthropic, bright, very service-oriented. Somehow we’ve attracted people to us who are motivated to do good things, to give people self-esteem and confidence. DR. RODAN: Really, they are the secret sauce of this entire business. These are smart, savvy doctors, nurses, financial advisers.
WHAT WE SHARED, REALLY, WAS A PASSION TO HELP PEOPLE WITH THEIR SKIN. Women who took time off to raise their kids and want to get back into the workforce to make their own money and call their own shots. They really love the product.
NEWBEAUTY: Multilevel marketing can also be problematic. Salespeople often have to buy the product themselves, and end up spending more than they make. DR. FIELDS: Starting day one around a small table with me, Katie and some experts—we knew we didn’t want any of the old nastiness that goes with direct selling,
KAZMULKA/GETTY IMAGES
evenings, and she was fixing me up with some really great guys. [Laughs] I found my own in the long run. What we shared, really, was a passion to help people with their skin. It was hard to even see a dermatologist in 1990. And Katie identified a really giant niche: acne in adults. The textbook said 3 percent of adult women had acne. Katie goes, “I think all 3 percent live in San Francisco, or there’s a big problem [with that data].” Insurance refused to cover [acne treatments] for anybody over 18 or 20, more or less, but this was women in their 30s, 40s, 50s coming in with potentially scarring acne. That’s when we got serious. DR. RODAN: I became a dermatologist because I had acne as a teenager. When I got out into practice, I was seeing tons of acne patients of all ages. What really dismayed me is that I was writing the same prescription for topicals and orals that I’d been given 15 years earlier for teenage acne, that didn’t really work all that well for me and caused a lot of side effects. [Over the counter regimens] were spot-treating—applying medicine to a pimple—rather than the way a dermatologist would treat the whole face on a daily basis to prevent acne. Getting ahold of acne is all about prevention. Not reacting after the fact to the pimple. DR. FIELDS: A quick story: A patient came in with a referral to have a mole checked. The mole was fine, but her skin was really bad. The doctor told that patient, “Hey, what do you care? You’re married.” Ugh. Those are fighting words. Insurance and big business really didn’t give a damn. To them, acne was just cosmetic. Katie and I know how personal bad skin is, whether it’s acne, wrinkles, brown spots, or eczema realization. You know, we own it all.
where you have to buy products that you have to store in your garage—you know, more of the door-to-door, old-school way. We developed “consumer-connected commerce”: We have all the products. If you’re a consultant, you have a preferred price. But we have more than 2 million customers who are regularly buying. The consultants manage relationships and place orders through their personal websites. DR. RODAN: The idea was to make it easy. We’ve evolved with the smart phone, so everything is done online. Everything is done efficiently. We [teach] business skills to help people become great brand ambassadors versus old-fashioned selling that turns people off.
NEWBEAUTY: You have 300,000 brand ambassadors now. Tell us about the community you’ve built. DR. RODAN: Our model is really set up for three different kinds of consultants: We have [those high-sellers]; we have the product ambassadors—the people who are retailing the product; and we have a group of people who are selling a little bit. I think it’s the strength of the community that keeps the majority of people involved in selling the product. DR. FIELDS: I was at a college interview and a woman sneaks up to me and goes, “Hi, I’m a consultant.” And she ran away. On the tour, I went back up to her and said hi. I could see she was wearing a wig. She said she had cancer, and “thank you for the privilege to be here with my daughter today—the team continues to work around me, so I’m not missing my income or my goals because they’re supporting me. The most important part of my life is to be with my daughter right now, and that’s what this kind of a company affords me.” People can be with family and make some money, whether they want to work hard or just play with it.
NEWBEAUTY: What is it like to walk out on stage at one your Rodan + Fields conventions in front of a roaring crowd of 10,000 adoring consultants? DR. FIELDS: It’s incomprehensible. I can’t even describe the anticipation and quivers
Multi-Masking: Rodan + Fields Unblemish Clarifying Mask, Reverse Radiance Mask, Redefine Rejuvenation Mask, and Soothe Rescue Mask transform skin in less than 10 minutes.
that are going on before we make our entrance. It’s emotional. You look out on the crowd and the enthusiasm is just insane. DR. RODAN: What Kathy and I desire most of all is to be role models for these women. The collaboration she and I have had for all of these years, working together—we want to role model that, but also to share our struggles, because this is not easy. People look at us and say, well, they have it made, but what they don’t realize is that we made what we have.
NEWBEAUTY: What would you say is the advantage of working for a female-led company? DR. FIELDS: You know, our CEO is also a
woman. Our C-suite is about 70 percent women, and when you put the VPs in with the C-suite, it’s creeping ever higher to nearly 60 percent—not because they’re women, but because they’re the best for the job. DR. RODAN: I think it’s very nurturing. People really take care of each other. Most of our employees are millennials and they really love, again, that sense of community, of collaboration—that we can do something hard, and overcome challenges if we do it together. And our offices are open-space, there are really no walls. Even the executive offices are all glass. It feels like one big family. As you build a company, if you insert your values into it, you’re going to have a company you can be proud of, that will serve as a legacy to who you are and what you care about.
T R A N S F O R M AT I O N
THE
TETRA IMAGES / GETTY IMAGES
TRIGGER
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EFFECT We all have that voice in our heads that says, “What if I could change just one thing?� Here, five women share the major milestone that inspired their transformation. by
TATI ANA BIDO
T R A N S F O R M AT I O N
THE XENNIAL Aging in the era of filters and Kardashians is tough. For NewBeauty features editor TATIANA BIDO, reaching an important milestone meant finally trying some "prejuvenation" treatments she’d written about for years. MILESTONE
TREATMENT
DOCTOR
Turning 40
CoolSculpting under the chin and injectables
Delray Beach, FL dermatologist Dr. Janet Allenby
T
he overwhelming anxiety I had about turning 40 is almost embarrassing to admit. I count myself fortunate for having one of those Dorian Gray faces that, for the most part, conceals my true age. But as my birthday approached, the mere thought of turning 40 stressed me out so much I couldn’t help but fixate on it. No matter how many rounds of, “How old do you think I am?” I played when I met someone new, it didn’t matter. All the 28 and 29 guesses in the world couldn’t stop me from obsessing over my smile lines every time I glanced in the mirror. Couple that with a job that focuses highly on aesthetics and the popularity of skin-smoothing filters, and before I knew it, I was in the throes of a self-induced midlife crisis. In lieu of buying the clichéd cherry-red sports car, I rang up my dermatologist.
forehead, Sculptra Aesthetic into my scalp near my temples (off-label), Juvéderm Voluma into my cheeks, and Juvéderm Ultra Plus into my chin, and then led me to one of her CoolSculpting chairs for the first of two fat-freezing sessions.
THE GLOW UP
In just one day, I went from zero to 60. Never having had more than a facial, I officially turned in my cosmetic procedure V card. I noticed immediately that my smile lines had softened and the Botox had lifted my brows ever so slightly, giving my eyes a more awake look. My “tweakments” were virtually undetectable to friends and family, but I saw a softer, happier looking me every time I looked in the mirror, which was a lot. A few
weeks later, I began seeing the fat fall away from under my chin. As the results emerged, it proved Dr. Allenby was right. Reducing that small amount of distracting fat and adding a bit of filler to my cheeks and chin gave me that contoured and sculpted Kardashian-Jenner look. It didn’t take long for me to get used to my smooth forehead, “higher than the gods” cheekbones and razorsharp jawline. When my dreaded 40th birthday came around, I welcomed it, along with a slew of compliments about my updated look. The best one came from my dad: He looked at me like he was seeing me for the first time and said, “Are you in love? You’re glowing.” Without hesitation, I smiled and replied, “Yes, I am. With myself!”
ADDING + SUBTRACTING
Dr. Janet Allenby assured me that I didn’t really need anything done, but she totally understood how my areas of concern were becoming increasingly visible to me—even if they weren’t to anyone else. And while I had gone into her office completely focused on my smile lines, she pointed out that the pinchable fat under my chin was actually the main culprit. “That little extra fatty layer is drawing the eye down to your lower face,” she explained. “The solution is to not only add volume with filler to lift up your cheeks, thereby softening your nasolabial folds, but also to subtract the submental fat that is making you feel like your face is succumbing to gravity.” After careful measurements with her caliper, she began to inject Botox into my
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To achieve this result Dr. Allenby used 20 units of Botox Cosmetic, two syringes of Sculptra Aesthetic, 1 cc of Juvéderm Ultra Plus and Juvéderm Voluma, and two CoolSculpting sessions.
THE TV HOST The thought of going back in front of the cameras after more than a decade off-air was enough for this TV VETERAN to call on a well-known dermatologist to the stars. MILESTONE
TREATMENT
DOCTOR
Returning to the spotlight
Fraxel DUAL laser neck rejuvenation
Beverly Hills, CA dermatologist Ava Shamban, MD
A
year or so ago I noticed the skin on my neck was getting crepey. And then I noticed it seemed very loose in the front and overall pretty wrinkly, all things I was not excited about. And while, at 51, I don’t really let aging issues slow me down, I will admit to buying a few turtlenecks in the last year. Although I haven’t been on-air for more than a decade, a television show I worked on for a few years is coming back. And while I am super excited about returning on-screen, I want to look and feel confident in front of the camera. Even though I am very realistic about my age and how I look, I felt had to do something, but I didn’t think I needed surgery just yet—I just wanted some tightening and retexturizing. I don’t mind some lines and wrinkles; I just wanted to look a bit better.
LASER-FOCUSED
I went to Dr. Ava to see what I could do that didn't require much downtime. She recommended a Fraxel laser treatment that would address all of my concerns. “The dual-wavelength fractionated laser will target both the superficial ‘crepiness’ and laxity of the skin, as well as help restore elasticity and volume to the skin around the neck and collarbone,” she said. “It will also reduce other signs of aging like discoloration, pigmentation and sun damage.”
S P O N SO R E D
SKIN PERFECTER Getting a healthy, glowing, youthful complexion is easier than ever. As the first FDAcleared microneedling device, SkinPen® was created with your time and safety in mind. With as few as three noninvasive treatments, patients can improve the appearance of acne scars with little to no downtime. When placed on the skin, SkinPen delivers tiny vertical punctures to a precise depth, which allows for controlled induction of the skin’s remodeling process by creating precise, microinjuries. The treatment works on all skin types, can be used year-round and has a proven track record with having gone through more than 90 extensive and rigorous validation tests, making it a game changer in microneedling. Participants in the clinical trial were so happy with how their skin looked afterward that 90 percent of the subjects said they would recommend the treatment to friends and family.
THE WAITING GAME
After my treatment, my skin became sandpapery and then started to flake off, which I found really exciting. Dr. Ava said my neck would start rejuvenating from the inside out now and I would see more visible improvement over time. She stressed that with one treatment, I would only see mild-to-moderate changes, but a series would give more dramatic results. “The final improvements are seen at around eight weeks,” she advised. “You will see a smoother texture and your neck will look and feel more taut.” I never told my friends about my treatment, but some who hadn't seen me in a while commented that I looked better than ever. Excited about my new love for skin resurfacing, I told them everything. My reallife results quickly overshadowed my on-screen fears. Now, as I get ready for my big comeback, I am a lot less worried about how my neck looks on camera and more concerned about scheduling my next laser. —As told to NewBeauty
BEFORE
AFTER This patient underwent six SkinPen microneedling treatments to reduce the appearance of acne scars.
FOR MORE INFORMATION,
“I’m very realistic about my age. I don’t mind lines and wrinkles; I just wanted to look better.”
VISIT SKINPEN.COM
SkinPen® U.S. intended use: The SkinPen Precision System microneedling device and its accessories are intended to be used as a treatment to improve the appearance of facial acne scars in adults aged 22 years and older. Rx only.
T R A N S F O R M AT I O N
THE BRIDE-TO-BE When her fiancé popped the question, ANGELINA DEDVUKAJ began dreading saying “yes” to the dress. A year before the big day, she begins her preparations with two state-of-the-art body-contouring devices. MILESTONE
TREATMENT
DOCTOR
Wedding-day prep
Exilis Elite and Emsculpt for upper arms
Montclair, NJ dermatologist Jeanine Downie, MD
Y
ou wouldn’t know it by looking at me, but I have been self-conscious about my arms for years. No matter how much I worked out, I couldn’t spot-treat my upper arms or get the same type of results I could on the rest of my body. It’s frustrating going to the gym five days a week, watching your food intake and never seeing the results you want. When my fiancé proposed seven months ago, I was beyond elated. But once I began thinking about our wedding day, I feared that my excess arm fat would limit my dress options. I’ve always envisioned myself getting married in an elegant, sleeveless gown, but as I tried on various styles, I realized that killing myself at the gym just wasn’t going to cut it. I was finally motivated to do something and went to see Dr. Downie about what I could do now to make my arms more slender.
I explained to Dr. Downie that I felt my arms gave me a heavier look, when in reality, I’m a size six. She recommended Exilis Elite radiofrequency fat-reduction treatments, along with Alastin Skincare’s TransFORM Body Treatment, followed by Emsculpt’s new muscle- building arm treatment. “Exilis Elite targets deep layers of fat and tightens the
skin,” said Dr. Downie. “The Alastin body cream will help accelerate fat reduction, and the Emsculpt will build muscle and complement your regular arm exercises.” After my first Exilis Elite treatment, I saw my arms start to shrink a bit. After Emsculpt, I could really see more muscle definition. Although my results have been subtle, Dr. Downie assured me I would see more fat dis-
Dr. Downie’s arm treatment protocol included five weekly Exilis Elite treatments, Alastin Skincare’s TransFORM Body Treatment, and two sessions of Emsculpt a week for two weeks.
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appear over the next three months as my body continues to flush out the destroyed fat cells naturally through the lymphatic system.
HERE COMES THE BRIDE
I’m so excited to have more dress options now. There is so much pressure for the bride to look perfect, and now my arms are just one more thing I won’t be worrying about. Through this experience I’ve learned that the way we store fat is hereditary and it's really hard to completely get rid of it without surgery. Despite that, I am very satisfied with the changes I’ve seen so far. Every dress I try on now looks so amazing, it’s hard to narrow it down to just one. Above all, I am looking forward to just being in the moment on the day I marry the man of my dreams.
LUKE CHAN / EYEEM / GETTY IMAGES
THE PERFECT PAIRING
THE FIT GURU What do you do when you’ve already given it all you’ve got? KIRA COLLINS recalls the time she hit a wall maintaining her body through exercise alone. MILESTONE
TREATMENT
DOCTOR
Reaching a fitness plateau
AirSculpt fat reduction to the abdomen
New York plastic surgeon Adam Schaffner, MD
I
S P O N SO R E D
ULTIMATE LASHES
’ll admit it: I’m a total wellness junkie. But after four decades and three kids, there’s only so much my workout regime and stockpile of adaptogens can do. And because I spend so much time exercising in front of mirrors, I’m now even more aware of the little pockets of fat bulging from above my Lycra leggings. No matter how many lunges, side planks and spin classes I take, they won’t budge. So when I heard about AirSculpt, a precise fat-removal procedure performed under local anesthesia, I signed up faster than a SoulCycle addict on a Monday morning.
BYE-BYE BELLY FAT
AirSculpt uses a small cannula that moves in a fast, corkscrew-like motion to cherry-pick targeted fat cells. The other plus? The laser that melts the fat also encourages skin tightening in the treatment area. The morning of my surgery, I arrived ready to kiss my muffin top goodbye. I changed into a pair of black disposable underwear and was marked up by Dr. Schaffner, a triple board-certified plastic surgeon. Within minutes, I was on the operating table, feeling warm and relaxed thanks to a Xanax, laughing gas and Spotify. We started on my left side, which was fully numbed before the laser was inserted. I heard little pops (the sound of my fat cells exploding), but couldn’t feel anything. When the so-called cherry-picker was inserted, I could feel it vibrating, but it wasn’t painful. Honestly, I’ve had facials that hurt more. The process was repeated on my right side before Dr. Schaffner asked me to stand up so he could ensure he was happy with the contour (another benefit of local anesthesia). Afterward, my waist was wrapped in a compression garment. I was told to wear it day and night for two weeks to reduce swelling and promote healing.
SPEEDY RECOVERY
My recovery was relatively easy. I spent the first day on the couch, napping and watching television. By day two, I was walking around. I felt sore, like I’d had a ridiculously hard workout. The hardest part was being patient while the swelling went down. It took about two weeks for me to start seeing results, and it wasn’t until about six weeks post-procedure that I noticed a difference in how my leggings fit. I wasn’t the only one. People in the gym started telling me how great I looked. “Your workouts are really paying off,” one guy said. Umm, yeah.
“I could feel it vibrating, but it wasn’t painful. Honestly, I’ve had facials that hurt more.”
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AVAILABLE AT: ULTA.COM
T R A N S F O R M AT I O N
THE NEW MOM Thanks to Drew Barrymore, Dr. Frank and a transformative in-office muscle-building treatment, NewBeauty editor-in-chief EMILY DOUGHERTY becomes the best kind of power lifter.
A
MILESTONE
TREATMENT
DOCTOR
Getting strong for her son
Emsculpt
New York dermatologist Paul Jarrod Frank, MD
ll the cool girls are doing it!” I’ve always found this claim to be both wildly seductive and magnificently cringeworthy. And it’s to blame for my best beauty decisions (blue mascara and Clairol Lock ‘n Roll curlers) and my worst ("temporary" eyebrow tattoos and a $5 cosmetology-school perm). But this time, it’s sweet Drew Barrymore saying it! And she’s talking about Emsculpt, the miracle doctor-office treatment that uses magic (in the form of MRI-strength magnets) to make stomach muscles contract 20,000 times in just 30 minutes...while you just lie there! I haven’t done 20,000 sit-ups total in my entire life! Barrymore describes herself as a “mother who couldn’t put her body back together in the right way,” and even under the supervision of the best of the best trainers, she would get hurt—a sprain here, a pulled back muscle there—whenever she tried to cut back her workout routine. Thanks to Emsculpt’s muscle-building benefits, she’s now injury-free: “I’m working out smarter because I am working out stronger.” “When someone starts working out again after a hiatus, the most common injuries are due to a weak core,” says Dr. Frank (my Emsculpt angel). “Originally we thought Emsculpt was for the super fit who wanted to get even more fit—to make their six-pack abs an eight-pack. But now we are seeing people looking for the strength benefits.” Even the easiest pregnancy can be hard on our core: to make room for that little person, our abs and ligaments stretch. “After delivery, the muscles can take months to years to recover,” says Chicago dermatologist Carolyn
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The writer and her 4-year-old.
Jacob, MD. And C-sections can make things even worse: “Often when the muscle is cut during surgery, it is difficult to fully engage the muscle from origin to insertion,” explains Beverly Hills, CA plastic surgeon Brian Kinney, MD, who used ultrasound, MRI and CT scans to measure the benefits of Emsculpt on post-partum women. The average results? A 19-percent reduction in fat, 16-percent increase in muscle and 11percent decrease in diastasis recti (stomachmuscle separation).
SIGN ME UP!
Due to recurring complications from my C-section, I haven’t been able to pick my son up since he was born. If he skinned a knee, I've had to sit on the ground to comfort him.
If an ocean wave came in too fast, I couldn’t lift him out of the way. It’s the saddest math equation—how fast he grows compared to how slow I build muscle—and I thought I would never have the joy of picking him up. But just two weeks under the expert care of Dr. Frank —four Emsculpt sessions (I did both my glutes and abs to build maximum muscle)—changed everything. As a beauty editor, I’ve had many treatments over the years, but none have meant so much. I still don’t have a six-pack. I definitely don’t have a peach-emoji bottom. But, I can swing my son around. I can dance with him. When my beautiful boy runs to me—arms out, happy or sad, silly or mad—I can lift him up, hold him tight and whisper in his ear: I love you. I am here for you. Mommy’s got you.
TRE ATMENT TIMELINE E X P E R T A DV I C E
T H E R E I S N O AG E L I M I T FO R C OS M E T I C E N H A N C E M E N T, B U T I S T H E R E A N I D E A L T I M E TO CA L L I N T H E R E I N FO RC E M E N TS? T H E P ROS W E I G H I N .
20 I N YO U R . . .
s
• “It’s a good idea for someone in their 20s to start 'prejuvenating' to change the course of how they will age. ‘Baby Botox’ treatments with neurotoxins can be used in areas with dynamic wrinkles before they become static.” —DR. SHAMBAN • “Prevention is key at this stage.
Sunscreen is a must, and maintaining healthy lifestyle habits is what helps prevent future signs of aging. If you smoke, quit now.” —DR. ALLENBY
• “The 20s are a great time for light
peels. Salicylic acid peels are my favorite because they refine pores and brighten dull skin.” —NEW ORLEANS DERMATOLOGIST MARY LUPO, MD
50
30 I N YO U R . . .
I N YO U R . . .
s
• “Pigmentation and texture start to become apparent. I love regular, low-density, nonablative fractional laser resurfacing and microneedling to renew and refresh skin.” —NEW YORK DERMATOLOGIST RITU SAINI, MD
• “I think Botox is important to treat early wrinkles on the forehead and crow´s-feet, also Juvéderm Volite to keep a natural glow in the skin.” —TIJUANA, MX PLASTIC SURGEON JUAN CARLOS FUENTES, MD
• “Toward the late 30s, early 40s, you may consider a thread lift. These absorbable sutures help to lift facial tissue and reposition it in an upward, outward direction.” —DR. SCHAFFNER
60 I N YO U R . . .
s
• “Metabolisms fall off a cliff in the 50s, and hormones, medications, stress and lack of exercise only complicate the problem. Fat-reduction and muscle-building treatments can help counteract mother nature.” —DR. DOWNIE
• ”Loss of elastin, collagen and bony
remodeling occurs, especially after menopause. This is a good time to consider a blepharoplasty, fillers and laser skin resurfacing.” —LARGO, FL OCULOPLASTIC SURGEON JASMINE MOHADJER, MD
• “A patient in their 50s would benefit from a facelift, necklift and/or eyelid surgery. Nothing can replace real surgical results.” —LA JOLLA, CA PLASTIC SURGEON ROBERT SINGER, MD
40 I N YO U R . . .
s
• “For facial rejuvenation, we are usually addressing skin quality with different laser options, restoring facial volume with dermal fillers, erasing fine lines with neurotoxins, and tightening skin with facelift, browlift and/or necklift procedures.” —DR. ALDERMAN
• “If hair loss has progressed with age or has become permanent, a hair transplant is an increasingly popular treatment in women to restore density in the front. If the thinning is more diffuse throughout, scalp micropigmentation is a great nonsurgical option to create the illusion of thicker, denser hair.” —SCOTTSDALE, AZ DERMATOLOGIST DR. MARIEL BIRD
s
• ”Women in their 40s are finally realizing the day is theirs! If they've had children, it may be time for a Mommy Makeover to restore the breasts and abdomen. This includes breast surgery, liposuction and a tummy tuck.” —ATLANTA PLASTIC SURGEON AMY ALDERMAN, MD
• “This is when collagen and facial
fat is depleted, and we can see it in our cheeks, so fillers can help restore fullness and volume.” —DR. ALLENBY • “Although injectables are soaring in popularity, many patients are more keen on long-term solutions, like upper and lower eyelid surgery.” —BOCA RATON, FL OCULOPLASTIC SURGEON STEVE FAGIEN, MD
&
BEYOND • “Those with spider veins in the legs can be treated with sclerotherapy and lasers. If they are varicose veins, you may need surgical intervention.” —DR. SCHAFFNER • ”At this age, we need to address
every structure, including the bone. Sculptra Aesthetic is often used to mimic bone to restore bone loss and improve layers above it like the fat compartments, dermis and epidermis.” —FORT LAUDERDALE, FL DERMATOLOGIST IGOR CHAPLIK, MD
• ”For patients who have already had their eyes and face done at a younger age, injectables can help enhance; for others, a second surgery may be more appropriate.” —DR. FAGIEN
Individual results may vary. Undergoing these treatments does not guarantee these exact results.
ASJA CASPARI
WELLNESS
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Founded in Lans, Austria in 1984, Lanserhof has expanded to London, Hamburg and Tegernsee (shown here), with a beach retreat opening in Sylt in 2020.
Y O U
VERSION
2.0
Change your BODY, change your LIFE at one of the TOP LUXURY wellness retreats in the world.
WELLNESS
THE KIT
H AU T E C O U T U R E H E A LT H
LANSERHOF LANS
Everyone’s favorite vitamin C serum is also a best-seller. SkinCeuticals C E Ferulic
T H E LUXU RY BO OT CA M P FO R YO U R M I C RO B I O M E
Y
ou already own the Very Best Private Island. And you fly there on the Very Best Private Jet. But from eating in the Very Best Restaurants and the stress of your Very Important Job, you don’t have the Very Best Microbiome, the gut’s bacterial ecosystem that affects everything from weight to mood. For 35 years, celebs and moguls have escaped to Lanserhof for the LANS Med Concept, a detoxifying vacation for your digestive system inspired by the Mayr Cure, which was designed more than 100 years ago by Austrian gastro Dr. Franz Xaver Mayr. THE PROGRAM: After a battery of medical tests, your personal doctor micromanages—in the best possible way—every minute of your day, assigning you a series of therapeutic spa treatments (soothing stomach massages, warming seaweed packs, gentle body scrubs). At your next meal, you’ll head to your assigned seat, where you’ll find a posh, gray GioBagnara tray full of probiotics, bitters and vitamins
The Most Beautiful Doctor’s Office in The World: Lanserhof’s famous “blue couch” where you’ll wait for your appointments.
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prescribed for your unique needs. You’ll also be assigned a number from zero to three, which indicates your meal plan. Your fellow billionaires will be very interested in your number: Level Zero equals a cup of herbal tea and a slice of orange for each meal. Levels One and Two are built around low-glycemic, bland foods like buckwheat toast and boiled potatoes. Level Three, glorious Three, means you’ll be eating Lanserhof ’s nutrient-rich, insanely delicious “energy cuisine.” (Your fellow billionaires will boast that they are going to poach Lanserhof ’s chef, Karsten Wolf.) Regardless of your assigned level, you will be trained on how to properly chew: a minimum of 30 times per bite. (Even the tea drinkers are encouraged to “chew” each sip.) THE TAKEAWAY: By the end of the week, your eyes shine, your skin glows, your heart sings. At home, you’ll continue to chew your food with care: maybe not 30 times for each bite, but close. You’ll wonder on occasion what happened to the cranky Level Zero oligarch who disappeared on day two. You’ll eat salads only at breakfast or lunch (you had learned that raw foods at night are too tough for your stomach to digest). You’ve come up with your next billion-dollar idea. And you’ve already booked your return visits for 2020, 2021, 2022 and beyond. —EMILY DOUGHERTY
Neighbor Dr. Timm Golueke worked with the resort on a facial routine— he recommends a gentle cleanser during detox. Royal Fern Phytoactive Cleansing Balm
Dressing to impress, Lanserhof-style? A vintage Chanel hot-water bottle. Chanel black lambskin leather hot water bottle bag
PA R A D I S E F O U N D
THE BR ANDO LIKE GILLIGAN’S ISLAND IF THE HOWELLS GOT THERE F I RST ( W I T H T H E I R TA L E N T E D T E A M O F A RC H I T ECTS A N D I N T E R I O R D E S I G N E RS, N AT U R A L LY ) , T H I S F R E N C H P O LY N E S I A N P R I VAT E I S L A N D D O E S N ’ T S K I M P O N T H E S PA E X P E R I E N C E— O R T H E LUXU RY.
M
©ROMEOBALANCOURT
arlon Brando’s former personal retreat, The Brando, is a bit of a relaxation-meetsrejuvenation fairy tale, a true wonderland of wellness (it was one of Barack Obama’s first stops after leaving office) where the eco-friendly factor is high and so are the over-the-top touches. Set 30 miles north of Tahiti, privacy is key— besides being a legitimate private island, there are only 35 villas on the quiet property—and recent upgrades like well-appointed overwater suites seamlessly add to the natural, unspoiled habitat (sustainability is taken very seriously here). Michelin-star cuisine and an abundance of on-land, on-water activities round out the special, once-in-a-lifetime offerings the location is known for. The somewhat-hidden Varua Te Ora spa keeps to the tropical-sanctuary theme with traditional Polynesian treatments performed high above the trees. You’ll find your standard facial, massage, scrub, steam room fare here, but there’s something about being in “the bubble,” as insiders refer to it, that makes this special journey simply life-changing.
THE KIT
B E AC H B O DY
This reef-safe sunscreen was created specifically for the resort. Algotherm AlgoSUN
The spa’s own line of locally sourced body oils is a mustfit carry-on item to take home. Varua Te Ora Scented Monoi Oil
The spa’s “cocoon-like” vibe adds to the exclusivity element, as the spa cabins are perched up in a canopy of trees, almost like a tree house.
THE CARILLON M I A M I B E AC H M AY N OT T R A D I T I O N A L LY R A N K H I G H O N T H E W E L L N E SS C H A RT, B U T T H I S A L L-AC C E SS, D O CTO R- F U E L E D R E T R E AT I S H O P I N G TO C H A N G E T H AT.
N
eedle-less acupuncture, vitamin IV patches, sex therapists, world-class plastic surgeons, executive coaches, and that oh-so-bragworthy sidenote of having Beyonce’s trainer on hand are just some of the out-of-the-ordinary offerings the non-pretentious Carillon Miami Wellness Resort makes happen for its guests (they’ll hold the hand of a first-timer as they dip their toe into high-tech wellness, and seasoned spa-goers will be wowed as well!). This is not your typical spa—although it does also have bragging rights to being the biggest spa on the East Coast, ringing in at 70,000 square feet—and co-general manager Tammy Pahel, who is particularly proud of the fact that there are 160 classes available each week, wouldn’t have it any other way. “This is not just a luxury resort by the beach; it is a portal to integrative medicine, a real ‘wellness your way’ experience.” The departure from a one-size-fits-all formula works: The Miami Heat relies on the spa for its muscle-soothing float tank and cryo chamber, some guests have been known to stay for a month, and the special Wellness Weekend retreats are super popular. NEXT UP: The Future Beauty Wellness Retreat, a twonight, three-day experience filled with a dynamic mix of the latest anti-aging and wellness offerings, beachfront fitness and world-class spa-ing; November 15–17. For more information, visit carillonhotel.com.
INGREDIENT
CELL SERVICE Doctors around the globe rely on the regenerative power of stem cells to heal burns and injuries, but what can they do in skin-care products? We find out.
TERESA ZGODA / SCIENCE SOURCE / SCIENCE PHOTO LIBRARY
by
BR I T TA N Y BU R HOP FA L L ON
INGREDIENT trient Solution) Recovery Complex debuted in 2001 and was the first commercial cosmetic product made with growth factors cultured from human skin cells; its newest product launching early next year, TNS Advanced+, contains MRCx, a next-level growth factor technology derived from human stem cells that Dr. Naughton says has demonstrated “unprecedented effects on aging skin.” In a recent study, subjects applying TNS A+ twice daily for 12 weeks reported looking six years younger. “Visual results were consistent with histological results of skin biopsies and lab data that showed an increase in collagen, elastin and other important skin proteins associated with wrinkles,” says Dr. Naughton.
LIQUID GOLD
Augustinus Bader, founder of the eponymous skin-care line, is one of the many experts fascinated by the beauty benefits stem cells have to offer. “Human stem cells [not to be confused with plant stem cells; more on that later] have the unique ability to divide, renew and develop into specific types of cells such as muscle, hair and skin, and they play a critical role in the body’s ability to heal itself,” says professor Bader. “These extraordinary cells can be translated to skin care, as they help to produce healthier, more youthful-looking skin.” A common assumption is that actual human stem cells are formulated in the creams and serums we’re slathering on, when in fact, “skin-care products often only contain the liquid the stem cells are cultured in at the lab, referred to as ‘human stem cell conditioned media,’” says cosmetic chemist Stephen Alain Ko. “Think of it like beer: You could describe beer as yeast cell conditioned media—the yeast grows in the water and grain mixture, culturing and conditioning it, but is then removed to make beer.” In this magic stem cell liquid is a mixture of growth factors, potent proteins called cytokines, enzymes and other molecules that “produce biological signals to carry out the mission of the stem cell by amplifying the skin cells’ ability to talk to each other,” explains Knoxville, TN plastic surgeon David B. Reath, MD.
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growth factors can help reverse signs of aging in the skin by significantly reducing fine lines, wrinkles and sagging, as well as supporting an evening of pigmentation, increasing elasticity, and improving skin tone and texture.” A number of beauty brands have incorporated growth factors into their products over the years, and continue to evolve their formulas as new scientific developments arise. For example, SkinMedica’s TNS (Tissue Nu-
SOURCE CODE
Stem cells are also no stranger to controversy, which is largely due to how they are sourced. The National Institutes of Health (NIH) sets and upholds standards to make sure stem cells are ethically obtained in a controlled process: Typically, researchers take a few stem cells from human tissue that were do-
SCIENCE SOURCE / SCIENCE PHOTO LIBRARY
X FACTOR
The most valuable proteins released by human stem cells are growth factors, which when applied to the skin, bind to its cells to stimulate wound healing and tissue remodeling. “Growth factors work in a ‘lock and key’ manner, with each individual growth factor (key) having a specific receptor (lock) that it attaches to on the cell surface,” says Gail Naughton, PhD, a regenerative medicine researcher. “Since the ‘90s, clinical studies have shown that topically applied
THE EGF EQUATION
Some companies utilize the EGF (epidermal growth factor) protein, which was discovered inadvertently by doctors looking for nerve growth factors, who realized it could be used for tissue regeneration and wound healing. “Once EGF was bioengineered in quantities sufficient for research, it was eventually tested for other applications and proved to be a powerful anti-aging active,” says plastic surgeon Dr. Gregory Bays Brown, who founded RéVive based on his research on burn therapy 25 years ago and now incorporates a proprietary form of EGF in the brand’s products. “We have a patent that states: ‘EGF reverses epidermal senescence.’ Translation: EGF reverses skin aging.” Icelandic skin-care brand BIOEFFECT harvests a replica of human EGF using barley, which founder Dr. Björn Örvar says has the same amino acid sequence and 3-D structure as its counterpart, and therefore can recognize and bind to the same stem cell receptors in the skin. “Our barley-produced EGF signals skin cells to maintain their youthfulness and renew themselves in the same way EGF extracted from human tissue would.”
G R OW T H FAC TO R S
Super Serums
nated to science, and then cultivate them in a lab where they are developed into multiple cell lines that can be licensed by brands to procure growth factors for their products. Nevertheless, it’s often misconceived that in order for thousands of skin-care products to be created, an endless source of the human tissue is needed, when in fact, “the original few cells can be replicated in a lab and used continuously over time,” Dr. Naughton says. However, some brands still undergo scrutiny. One in particular, NeoCutis, formulates its products using proteins cultured from human embryonic stem cells, and has received backlash from pro-life watchdogs for doing so. (Although, the terminated pregnancy was medically necessary and donated to medical research with parental consent). Experts also stress that not all types of human stem cells are beneficial for aesthetic rejuvenation. “The industry seems to have the mindset that anything these cells produce will be great for the skin and anti-aging, but that’s not the case,” Dr. Reath says. “While they all produce biological signals, each stem cell yields a very different pattern and array of them—some proteins will be anti-inflammatory and others pro-inflammatory. We know definitively that aging and inflammation run hand in hand, so cosmetic companies must make sure they’re sourcing anti-inflammatory molecules.”
AnteAGE Serum, $150, anteage.com RéVive Intensité Complete Anti-Aging Serum, $485, reviveskincare.com Root of Skin Revitalizing Face Renewal Serum, $78, rootofskin.com DefenAge 8-in-1 BioSerum, $220, defenage.com
SkinMedica TNS Essential Serum, $281, skinmedica.com FactorFive Regenerative Serum, $199, factorfiveskin.com BioEffect EGF Serum, $160, bioeffect.com Le Mieux EGF-DNA Serum, $110, lemieuxskincare.com
Q&A
THE DOCTOR IS IN
Q
Q
Q
Q
Why can’t actual stem cells be applied to skin?
Should any ingredients be avoided when using growth factor products?
Can growth factors help boost collagen, too?
How did SkinMedica TNS get nicknamed “the penis cream”?
“They can’t survive outside of their optimal lab environment because they break down when exposed to light and air,” says Beverly Hills, CA dermatologist Ava Shamban, MD. “They’re also essentially the size of a cruise ship compared to other skin-care ingredients, so they can’t penetrate the skin’s deeper layers where they are needed.”
“Products that are highly acidic, such as vitamin C and alphahydroxy acids, can break down growth factor proteins,” says Dr. Naughton. “Although skin has an excellent ability to restore a normal pH quickly, if such ingredients are used, you should wait 10 to 15 minutes before applying growth factors.”
“SkinMedica scientists have shown that topical application of growth factors on a 3-D human skin model upregulates the genes responsible for collagen production,” says Dr. Naughton. “Some research suggests the use of growth factors early on can help us ‘bank’ collagen, too, leaving us better off later in life, but more studies are needed.”
As fun as it sounds, there are no male organs in the beloved TNS cream. “The growth factors in TNS were derived from neonatal foreskin cells taken from a donor more than 20 years ago for the purpose of treating acute burns, but were eventually found to also help reverse signs of aging,” Dr. Naughton says.
INGREDIENT
POWER PLANT
What do roses, lilacs, grapes and Swiss apples have in common? They’re some of the most commonly used plants in skin-care products for their stem cell cultures. “Entirely different from human stem cells, plant stem cells are specialized cells found in plants—fruits and flowers included—where their growth takes place,” says Lisa Reinhardt, director of education at Epicuren Discovery, which utilizes orange stem cell extract in its products. And while they do have a place in skin care, the experts interviewed for this story agree plant stem cell technology is widely misunderstood. “Although plants do contain their own unique cell lineage, the stem cells found in a plant’s meristem cannot be compared to the stem cells found in a human,” says Dr. Reath. “They cannot increase the communication potential in human skin cells because plants and humans do not speak the same biological language.”
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BOTANICAL BENEFITS
Valid scientific, peer-reviewed studies on these effects are scant, but some experiments reveal promising results: Switzerland-based company Mibelle AG Biochemistry tested the effects of cultured Swiss apple stem cells (Malus domestica) on human fibroblasts [cells within the dermis] induced with cellular DNA damage typical of normal
aging and reported “significant potential to reduce wrinkles in the crow’s-feet area,” which became shallower by 8 percent after two weeks and 15 percent after four weeks. Reinhardt says additional studies have shown “plant stem cells can also provide a brightening effect and an increase in fibroblast activity for a boost in collagen.”
FRANK FOX / SCIENCE PHOTO LIBRARY
NATUR AL REMEDY
What plant stem cells can offer the skin, however, is a variety of antioxidant, antimicrobial and/or anti-inflammatory benefits collected during the extraction process (plant stem cells are often lysed, or broken apart, to release the chemicals contained in the cells, Ko says). The thinking behind plant stem cells used in skin care, Dr. Shamban says, is that “many plants are able to survive or thrive in extreme environmental conditions, using nutrition or moisture to keep them alive, so these powerful abilities should be able to be reproduced within our skin.” Experts also point to the fact that plants have been used in Ayurveda and Chinese medicine for centuries for the treatment and healing of chronic ailments and inflammation, and we’re just scratching the surface of their stem cells’ capabilities and physiologic effects on the skin.
PLANT STEM CELLS
Garden Party
N E X T- G E N T R E AT M E N T S
OFFICE SPACE
Though not FDA-approved and frequently disputed, these stem cell–inspired in-office treatments promise big benefits.
INJECTABLES
Human stem cell proteins are being utilized in injectables overseas, and Dr. Shamban expects they will make their way to the U.S. in a year or so. “In Europe, doctors are injecting growth factor–laced fluid into the upper level of the dermis—the same way hyaluronic acid fillers are used there as skin boosters— to stimulate cell turnover and collagen production as cytokines are released,” she says.
LASERS
Naturopathica Plant Stem Cell Booster Serum, $84, naturopathica.com
Éminence Organic Skin Care Lavender Age Corrective Night Concentrate, $68, dermstore.com
DermaQuest Stem Cell 3D Complex, $248, dermaquestinc.com
IOPE Plant Stem Cell Emulsion, $40, us.aritaum.com
“The biggest trend I’m seeing with in-office stem cell treatments is the combination of growth factor products with other technologies like fractionated lasers,” says Chicago dermatologist Lana Kashlan, MD. “We apply the topicals post-laser, which allows for faster healing and enhanced outcomes.”
FACIALS
Juice Beauty Stem Cellular Vinifera Replenishing Oil, $72, juicebeauty.com
Epicuren Discovery InjecStem BioFirming Serum, $220, epicuren.com
Peter Thomas Roth Rose Stem Cell Bio-Repair Gel Mask, $52, sephora.com
The “vampire facial” (growth factor–rich platelet-rich plasma, or PRP, from the patient’s blood is applied to microneedled skin) was big in 2018, but new stem cell facials are on the rise. Though controversial and unproven, some doctors’ offices now offer facials using stem cells from human and animal placentas, which they claim is the best way to get young cells into aging skin for the ultimate youth boost. “Some places are using human placental extracts, but those from sheep are more common because of availability,” says Dr. Kashlan. (La Jolla, CA plastic surgeon Robert Singer, MD notes the FDA has significant legal issues with doctors doing these experimental procedures without proper protocols.) “The jury is still out on whether PRP is effective, and whether this new modality is any better,” Dr. Singer says.
ICON
T he
I M P O R TA N C E
ANGELA of being
SHE’S STARRED IN 50 -PLUS MOVIES, EARNED MULTIPLE IVY LEAGUE DEGREES, AND R AISED A HAPPY, HEALTHY FAMILY. ANGELA BASSET T—#GOALS BEFORE HASHTAGS EXISTED —SHARES HOW TO GET WHAT YOU WANT AND LOVE WHAT YOU HAVE.
W
hen Angela Bassett arrives to our cover shoot, she does the unthinkable: she shows up early. There are no airs—she got ready at-home with her loyal glam squad—there are no requests, besides a black coffee, and there is, thankfully, no drama, even though the rest of us are scrambling to finish prep. “I’m ready when you are,” the 61-year-old says, taking a deep, almost meditative-like breath as she steps in front of the camera, bringing that same energy she projects on the big screen to a still photo shoot. To say she is busy is an understatement: Besides being a mom to 13-year-old twins Bronwyn and Slater with husband Courtney B. Vance, there’s tomorrow’s flight to Berlin to start filming Gunpowder Milkshake, a female-driven action film Bassett says will be “strong and powerful for women.” There was also last weekend’s talk as a spokesperson for the American Heart Association.
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by
ELIZABETH RITTER
photography by
JOHN RUSSO
SKIN PREP Makeup artist D’Andre Michael used a mix of Dr. Barbara Sturm Hyaluronic Serum and Face Cream to prep Angela’s skin, L’Oréal Paris Voluminous Carbon Black Mascara on her lashes, and U.G.L.Y Girl Cosmetics Lip Gloss in Pout on her lips. Dress: Solace London; Earrings: Misho Designs
ICON
Soon, there will be her sort of start-of-fall, back-to-thegrind regular gig of Fox’s 9-1-1, what she refers to as “a feature film every week.” And then there is her first Netflix film, Otherhood, featuring Felicity Huffman and Patricia Arquette, available now. “Which child am I most passionate about work-wise? All of them. But this one [Otherhood] is special because it hits on my mother’s birthday and we filmed it in New York—is there anything better? “But you never know…” she trails. “Of course, you do this kind of work and you hope that there is an audience of people—hopefully a diverse audience who’ll get a chance to see you, who’ll come to know you and appreciate your work and become fans and all of that, but you never know who will like it or how it will turn out.” A surprising admission for one of Hollywood’s most celebrated actresses, maybe, but Bassett readily admits she feels as if she’s continually striving to grow and get herself out there when it comes to her career. “Of course, when they say, ‘I wrote this for you,’ it’s such a tremendous boost to anyone’s confidence, but it’s all about faith—you don’t know if a project will fly or if it will fail. You always go into it with the highest of hopes and expectations, but you never know what is going to capture the hearts. You want to go in with the greatest of intentions and come away with great experiences and wonderful relationships made. So you say ‘yes.’ It’s important to say ‘yes.’”
ALWAYS SAYING “YES” AT WORK CAN BE EXHAUSTING...
But you kept thinking, ‘Are we working? Can we call this work? By what other names can we call this but joy?’ Otherhood was a great experience and it’s about being a mother. It is about that stage after motherhood. You grow them up, you nurture them, and then at some point, you have to gently transform and take your hands off of them. You have to allow your babies to go.
YOUR “BABIES” JUST TURNED INTO TEENAGERS. THAT HAS TO BE A BIG CHANGE.
Talk about transformation! They are in those stages— they are still a little bit innocent, but you can also see that they are teenagers. It’s that time that they are very
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concerned about what their friends think, and not so much about what you think. You get some nos, you get some yeses, and all you can hope for is that that early work you put in will circle back around.
THEY HAVE TO THINK YOU’RE A LITTLE BIT COOL…
Well, I just surprised my son by flying him to Napa Valley for his first Logic concert. We told him, “We’re going away. We’re going to Northern California. Here’s your Logic T-shirt.” He loves this guy so intensely, so I wanted to surprise him and rock his world—I wanted to let him know who’s boss. Yes, it’s still his mama! It was his first concert. We’ll never, ever forget it. It was such a new experience for him. He even got to meet him and hang out. Because he’s only 13, he had no idea what the world even looked like after ten o’clock at night!
THAT’S EXCITING!
It was. His sister, his twin, was part of the conspiracy. She helped me out and told me, “I don’t have to go. I’m really happy for him. But what are we going to do, mom?” So I’m planning her surprise now. I think I’m going to have a friend bring her to Paris for a weekend while I’m in Europe. Bring her girlfriends and her over for a FridaySaturday-Sunday and come back Monday to school like, “I went to Paris for the weekend.”
HOW DO YOU KEEP SANE WHEN YOU ARE WORKING AND TRAVELING SO MUCH?
Between all that, it’s a lot! It’s time to go to work so I can rest! I have to get on that 10–12 hour flight where no one can get me. To be honest, a good deal of work feels like relaxation to me; it feels a little bit like a vacation when I’m away filming. Take going to Berlin. I joke to everyone, “Well, the only thing that I have to worry about when I’m there is work, eating right and getting to the gym.” And I’ll leave all my major responsibilities to fall on my husband at home! [laughs] But I do try to relax. If I’m home, I’ll text the masseuse. I need her to get in there with the deep tissue and get rid »
B O DY B O OST To keep Angela’s skin glowing, Michael dabbed Aquaphor on her cheeks, the bridge of her nose and her collarbone. Twopiece set: Solace London; Earrings: Monica Sordo
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of the knots and release the muscles. I try to get away— I went to the Golden Door last year in November just to think about nothing and I enjoyed all the rejuvenation that brought. Staying “prayed up” is also important to me. Being in touch with my spiritual side helps me keep the stress out. It helps you remember that there is something bigger than you and it’s not all about you— there’s a force that has you in the palm of his hands. What else do I do? Spending time with friends is always good because it’s the time to relax, appreciate one another and build each other up. It’s a bit of a support network. And I think I’m a physical type that needs to work out. When I don’t, I feel it.
IT MUST BE WORKING. YOU LOOK AMAZING. CARE TO SHARE ANY OF YOUR SECRETS?
I’m pretty passionate about keeping up with the skin care, especially being in front of the camera and on the stage. It’s important. When I’m not on stage or on camera, I’m pretty sans makeup—I think it’s good to keep a clear, clean fresh palette. I am a potions and lotions girl, so if you make me promises, I’ll give you a shot. I do really like the iS Clinical serums. I always come back around to them and they work really well for me. I also find good aestheticians everywhere, and then I have my dermatologist Dr. Pearl Grimes here in LA.
IS THERE ANYTHING YOU DO BEAUTY-WISE THAT WE MIGHT BE SURPRISED TO HEAR?
I know lashes are no surprise! Botox is no surprise! I’m a big supporter of being natural, but I’ve done it twice. Just a little bit, not too much—I still need to express myself. What else? I’ve tried Ultherapy, too.
“ I’M A POTIONS AND LOTIONS GIRL. IF YOU MAKE ME PROMISES, I’LL GIVE YOU A SHOT.” YOU ARE CLOSE WITH YOUR GLAM SQUAD. DO THEY EVER TEACH YOU ANY TRICKS?
We’ve been together a number of years. I trust them so much. Usually, I sit in their chairs, close my eyes and Zen out, or I think about the work I have to do. I so trust their creativity and their gift. Their absolute gift! I can just relax and try to prepare what I have to do. We all have gifts. We all have something to offer. And it’s great when you find those whose work you admire and trust, and whose personalities you enjoy.
YOU’VE ALSO BEEN OFFERING YOUR TIME TO THE AMERICAN HEART AND THE AMERICAN DIABETES ASSOCIATIONS. WHAT MADE YOU SAY “YES” TO THOSE CAUSES?
My mother passed away from cardiovascular disease, and she also had type-2 diabetes. I came into partnership with the two agencies to really get an awareness out there in the public space, and to maybe change the perception of those who are managing these situations. Sometimes you get such a heavy diagnosis, it’s overwhelming. Sometimes you just shut down and it drives you to do things that aren’t helpful and beneficial—it drives you in the direction you don’t want to go. Sometimes, if we can just change our perspective about something, we can turn it around for good. It’s a tribute to my mom, but I hope it will help a lot of people.
DREAM TEAM Makeup: D’Andre Michael; Hair: Randy Stodghill at OPUS Beauty; Styling: Jennifer Austin at OPUS Beauty; Jumpsuit: Greta Constantine; Earrings: Monica Sordo
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THE GUIDE
THINNNING
YASU + JUNKO/TRUNK ARCHIVE
THE GUIDE:
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HAIR From supplements to surgery, these expert-approved solutions help put an end to the fight against thinning hair by B R I T T A N Y BU R HOP FA L L ON
HAIR IS WAY MORE than inanimate protein attached to our heads. It highlights our personal style, acts as a security blanket and boosts confidence. There’s a reason hashtag #goodhairday has been used nearly 1.5 million times on Instagram: When someone’s hair looks good, they want to show it off. But for the millions suffering from hair loss, there may be more bad hair days than good. Thanks to cutting-edge products, devices and procedures, this doesn’t have to be the case. »
THE GUIDE
DIET
WHY HAIR THINS The average person has about 100,000 hairs on their head and loses about 100 of them every day (to the detriment of shower drains and bathroom floors everywhere). But, if those hairs don’t grow back at the same rate, or more than 100 hairs fall out, it may be a sign of thinning. And shockingly, the American Academy of Dermatology cites that a whopping 40 percent of women have visible hair loss by age 40. “The sooner you seek care, the better your chances are of successfully treating it,” says Beverly Hills, CA hair restoration specialist Dr. Craig Ziering. “But in order to prescribe a treatment, we need to determine the reason for the thinning.” These are the most common:
GENETICS
Androgenic alopecia (AGA), or male and female pattern hair loss, is the most common form of hair loss and affects nearly 50 million men and 30 million women in the U.S., according to the National Institutes of Health. Chances are, if sparse strands are common on either side of your family, you will experience the same. “Female hair thinning shows up in three different ways: enlarging of the center hairline part, frontal hair line recession and a diffuse thinning pattern,” says Beverly Hills, CA hair restoration specialist Natalie H. Attenello, MD. “Although often hereditary and occurring in healthy individuals, AGA has been associated with serious conditions such as hypertension, diabetes and polycystic ovarian syndrome, so see your doctor if you have concerns,” says Pittsburgh plastic surgeon Brian V. Heil, MD.
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In addition to taking the patient’s personal and familial histories into account, doctors often suggest a blood test, which can reveal mineral and vitamin deficiencies that may be affecting hair. “Low vitamin D and iron can be culprits, and it’s common to see depleted levels of them these days,” says New York dermatologist Dhaval G. Bhanusali, MD. “In those cases, I generally prescribe a daily dose of 5,000 IU vitamin D and an iron supplement.” Beverly Hills, CA dermatologist Rhonda Rand, MD says vegetarians often have less hair because they don’t eat as much protein. “You need 40 grams a day, and most of my vegetarian and vegan patients aren’t getting that much.”
HORMONES
A key hair loss offender is the DHT hormone (dihydrotestosterone), a derivative of testosterone that binds to receptors in hair follicles on the scalp and shrinks them until they can no longer function. “Blood work can disclose testosterone levels, and if they’re elevated, medication can balance them out,” says Dr. Rand. Sharp hormone shifts after pregnancy are also commonly tied to hair thinning, although the effects are temporary. “Women have some of the thickest hair they’ll ever have right before they give birth, and then two to four months post-partum, many of them experience telogen effluvium, a dramatic, yet temporary change as the hair goes into resting phase for two to four months and thins out,” Dr. Rand explains. “Around eight months after childbirth, the hair should be back to normal.” Menopause can stir up hair issues too, as lower estrogen levels are linked to thinning. “Many women lose substantial amounts of hair after menopause,” says Dr. Ziering. “Their hair tends to thin out all over, rather than develop a signature spot like men do at a similar age.”
STRESS
Alopecia areata is a form of sudden hair loss that’s often caused by stress and shows up in circular bald patches. “It’s considered an autoimmune disease because the immune system gets stressed and attacks the hair follicles, causing them to weaken and fall out,” Dr. Bhanusali says. There’s no cure yet, but Dr. Ziering says “it can be treated successfully with injectable steroids”—typically every three to six weeks—that suppress the immune system.
ILLNESS
“Any auto immune disorder could cause hair loss,” says Dr. Heil, “but it’s most common with lupus and thyroid disease due to the alteration of the body’s ability to function normally.” Once the disorder is treated and the body is in remission, hair growth should return to normal.
MIRACLE GROW
The three stages of the hair growth cycle.
1.
T H E A N AG E N P H AS E LASTS 2–6 YEARS
Also known as the growing stage, this is when the cells in the root of each hair divide, pushing the previous strand out to make room for a new one. “Hair that’s in anagen for less than two years is usually thinning,” says Dr. Rand, “and the length of a person’s anagen phase is genetically predetermined.”
2.
T H E CATAG E N P H AS E LASTS 2–3 WEEKS
Hair takes a break from growing and prepares to shed so it can eventually renew. This is referred to as the transitional phase, during which club hair (hair that has stopped growing) begins to form.
3.
T H E T E LO G E N P H AS E LASTS 3 MONTHS
This is the resting phase, during which club hair is fully formed—if one is pulled from the root, you’ll see a hard, white substance on its tip. Dr. Rand says about 10 percent of hair is usually in the telogen stage.
LISE-ANNE MARSAL / TRUNK ARCHIVE, MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
THE GUIDE
HOW TO TREAT IT Thinning hair isn’t a quick-fix condition— oftentimes a multipronged approach with changes to diet, products and treatments delivers the best results. “Some nonsurgical solutions are both preventive and effective, providing reasonable improvements," says Dr. Ziering, “but it’s important to have realistic expectations, as results can take months to manifest.”
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ESSENTIAL OILS
Whether they’re applied solo or infused into hair-care products, essential oils are praised for their stimulating, balancing and calming properties that have been shown to spur healthy hair growth. “Tea tree and cypress are proven to improve micro-circulation deep in the scalp and increase blood flow to each follicle,” says François Hourcastagnou, CEO of hair-care brand PHYTO and Alès Group, USA. “Rosemary can gently but effectively exfoliate the scalp, sage can help calm irritation and lemon oil can balance sebum production so follicles don’t get clogged.” According to integrative medicine specialist Dr. Elizabeth Trattner, one study on 84 alopecia areata patients revealed that massaging a mix of cedarwood, lavender, thyme and rosemary oils with either jojoba or grape seed carrier oils into the scalp for seven months produced significant hair growth improvement in 44 percent of the group,
compared to 15 percent of patients who used jojoba or grape seed alone. “Another study showed 3 percent peppermint oil applied topically helped facilitate hair growth by promoting circulation in the hair dermal papilla [cells at the base of hair follicles],” she adds. (Note: Applying essential oils directly to the scalp could be too strong and cause irritation, which is why most are mixed with carrier oils. Doing a patch test at the nape of the neck to check their compatibility with your skin is recommended.)
2
DIET + NUTR ACEUTICALS
To strengthen brittle hair, Dr. Attenello says its best to follow a balanced diet that includes protein and foods such as eggs, fish and nuts that contain omega-3 fatty acids. “We also recommend zinc, iron and biotin supplements, all of which have been shown to improve hair texture and caliber,” she adds. Dr. Ziering likes Viviscal, a daily supplement that contains a marine complex called AminoMar “that helps promote existing healthy hair growth from within, but is not an option for patients with shellfish allergies.” Another expert favorite is Nutrafol, which New York plastic surgeon Jennifer Levine, MD says is good for both thinning hair and anti-aging. “It neutralizes free radicals, rebalances stress-producing hormones
THE KIT René Furterer Triphasic Strengthening Shampoo $32, renefurtererusa.com PHYTO Phytopolléine Botanical Scalp Treatment $40, us.phyto.com Nutrafol Core for Women $79, nutrafol.com Viviscal Advanced Hair Health Supplements $50, viviscal.com
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and contains botanicals that promote the absorption of hair-boosting nutrients,” she adds. With the majority of hair supplements, some users can see results after one month, but experts say three months is standard.
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ACUPUNCTURE
In Chinese medicine, acupuncture is often used as a remedy. “Needles are placed on the face, body and scalp to promote blood and energy circulation to the scalp, stimulating hair growth,” says Dr. Trattner. “Studies show it can help treat female thinning better than male, although reasons for this are undetermined.” A series of treatments need to be done weekly or biweekly to restore balance, and then maintenance depending on individual results. “Some people get better outcomes than others, but when combined with Chinese herbal medicine, results are synergistic and almost always better,” Dr. Trattner adds. “It is also important to find a licensed practitioner who is familiar with hair loss.”
4
HAIR CARE
Thinning hair demands extra TLC, so any products used on it should have scalp health and hair growth properties. Some brands tout biotin as a strand booster, but Dr. Rand says “minoxidil—known over-the-counter as Rogaine—is the only FDA-approved OTC ingredient that has been clinically proven to increase the diameter of the hair follicle, producing thicker hair.” Results may take months to exhibit, and side effects associated with topical minoxidil can include scalp itching and flaking, so it's not an option for everyone. For those going the natural route, botanical-based topicals can also be effective: French hair-care brand René Furterer formulates with follicle-energizing pfaffia extract (aka Brazilian ginseng) and sebumreducing curbicia (a patented extract from squash seeds) to promote growth. No matter the product used, Dr. Rand notes: “If you stop using it, the results will stop too.” »
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Results: Substantial new hair growth in the temple area after 6 months.
THE GUIDE S P O N SO R E D
REVERSE THINNING HAIR NATURALLY
Whether you’ve recently had a baby, a major surgery or just a ton of stress weighing you down, unfortunately, thinning hair can result. It may feel like it happens randomly—you wake up one day and bam!—but research actually shows that two to three months after the event marks the time when hair is forced to abruptly enter the shedding phase before completing the growth phase, which causes sudden, temporary thinning. While the science can be confusing, the solution is simple: Rene Furterer’s NEW Triphasic Reactional Ritual. Infused with natural plant extracts and essential oils proven to energize hair follicles, the botanical-based regimen includes a pre-shampoo elixir, shampoo and conditioner for thinning hair, a leave-in treatment serum and a dietary supplement. It also has the clinical data to back it up: In a study, women revealed visibly denser hair within the first month. If hereditary thinning is the issue, try the Triphasic Progressive Ritual instead, as it provides the nutrients needed to boost natural hair growth while increasing the density of existing thin hair.
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5
PRESCRIP TION MEDICATION
Many doctors recommend using ketoconazole, an antifungal ingredient created to treat conditions like ringworm that’s now used in shampoos such as Nirozal to boost hair growth. Two other Rx options—finasteride and spironolactone—are also used topically to prevent the conversion of testosterone to DHT in the body, but are more frequently taken as oral medications (more on that below). However, a new platform called HairStim is now being offered by dermatologists around the country, who can customize products to include a mix of prescriptionstrength ingredients such as topical finasteride and spironolactone, depending on the patient’s concerns. “We’ve seen impressive results so far on both men and women,” Dr. Bhanusali says. Oral finasteride (you may know it by its brand name Propecia) is commonly prescribed in a 1 milligram dosage for men, and sometimes for post-menopausal women as well—"it’s not advised for childbearing women because of its hormone interference,” says Dr. Attenello. “This also applies to oral spironolactone.” A doubleblind study in 2014 revealed that 400-milligram capsules of pumpkin seed oil could mimic the effects of oral finasteride in men, but there hasn’t been much research since, and no studies that included women.
NEWBEAUTY
TOP DOCTORS Turn to page 129 to find one near you.
6
LIGHT THER APY
Low-Level Laser Therapy (LLLT) technologies—usually in the form of laser headbands and hats that can be worn at home or in a doctor’s office—are designed to improve follicle function and reverse the effects of thinning hair and hereditary hair loss. “LLLT is a noninvasive, pain-free and FDA-cleared solution that uses diodes that emit infrared or red light,” says Dr. Ziering. “It increases blood circulation to the scalp and helps the follicles produce thicker, longer, healthier hairs with improved pigment.” Dr. Rand says there are many doctors who use LLLT, and while the devices can grow some hair in carefully selected patients, they tend to work better on those who are balding (or quite thin) rather than those with moderate thinning. “The issue is that the lights can’t penetrate down to the scalp tissue if there’s hair in the way, which is why I prefer combs rather than caps for women because they separate the hair,” she explains. “In general, these devices tend to work better on men; however, as technology evolves and more hair loss studies are done on women, this may change.”
THE KIT The most high-tech headband we’ve ever seen, HairMax LaserBand 41 delivers follicle-stimulating energy to the scalp via 41 medical-grade lasers and is super easy to use. Just put it on your head, press the button and voila. Wearing it three times a week for just three minutes treats the entire scalp. $549, hairmax.com
THE GUIDE
PLATELET-RICH PLASMA (PRP)
P
latelet-rich plasma (PRP) factors, she explains, are that they promote is a newer biotechnology more hair growth. Critics point to the treatments’ lack of used to treat early androgenic alopecia or thinning hair FDA-approval and regulation: Dr. Garcia and involves drawing a small says there are numerous PRP preparation sample of the patient’s blood systems on the market today with FDA clearfrom the arm before putting ance for PRP used in bone graft procedures, it through a centrifugation process to extract but not those for hair. Therefore, “the use of the blood plasma—rich in proteins and PRP outside this setting is considered ‘offgrowth factors—and eliminate the red blood label’ and scrutinized by the FDA,” he excells. “The plasma is then injected into the plains. Nevertheless, it is widely considered hair follicles in thinning regions of the scalp, safe. Pasadena, CA plastic surgeon Gordon and the platelets bond to receptors in the Sasaki, MD and a team of doctors are curstem cells of the scalp tissue," says Las Vegas rently conducting the first randomized-conplastic surgeon Julio L. Garcia, MD, an early trolled clinical trials to study the safety and adopter of PRP treatments. "This activates efficacy of low versus high amounts of PRP the active hair growth phase and allows hair for hair regrowth in patients with androgenetic alopecia. “By four months, an increase to grow back where it has been lost.” Dr. Attenello says the treatments are best- in both terminal [longer, darker hairs] and vellus [shorter, thinner hairs] served for patients with hair have been documented with thinning, where the hair bulbs minimal to no side effects or still exist for the PRP to nourcomplications,” Dr. Sasaki notes. ish them, rather than those Typically, PRP injections Ian Sanderson, president of with hair loss that has been only take about 10 skin-care brand AnteAGE, is present for more than a year, minutes and can be done with topical dedicating his efforts to a newer where the hair bulb is likely numbing of the scalp area of research—the topical not intact anymore. “Preliminary studies have shown favorable results in application of growth factors to battle thinterms of hair count and density, but larg- ning hair—which, he hopes, will one day make PRP injections obsolete. er-scale trials are warranted,” she adds. “PRP is mostly effective by deploying Most PRP protocols involve treatment once a month for three months, and then a growth factors like VEGF—vascular endowaiting period of an additional three months thelial growth factor—and other stem cell before results are visible; maintenance treat- by-products like cytokines to restart dormant ments every three to six months following hair follicles. We’ve been able to engineer a may be necessary depending on the needs topical treatment solution containing all those hair growth factors in precise dosages, of the patient. There is also a next-generation form of along with several bio-signals that go beyond PRP called PRF, or platelet-rich fibrin, which what’s possible with PRP alone,” he says, addis extracted similarly to PRP, but contains ing that it’s also an alternative to minoxidil. more growth factors. Dr. Levine prefers PRF “It’s been recently understood that one of because “it allows the platelets to remain via- minoxidil’s key mechanisms of action is upble while releasing growth factors in a con- regulation of VEGF. Using this growth factor trolled manner that can last hours to days; topically—it’s a key ingredient in our hair PRP growth factors only last a few minutes to treatments—we may make minoxidil obsohours.” The benefits of longer-lasting growth lete, along with its potential side effects."
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THE PRP DEBATE Not all doctors see eye to eye when it comes to PRP. PRO
“I advocate the use of PRP for androgenic alopecia in men and women. Excellent clinical outcomes are seen after a series of four monthly injections. Diminished hair loss and noticeable new hair growth is typical.” —WASHINGTON, D.C. DERMATOLOGIST TINA ALSTER, MD CON
“There is some evidence that it can benefit those with hair loss, but it’s still very controversial because there’s not a wealth of good data or research done under appropriate FDA guidelines. There have also been some issues of PRP being done in salons and spas with catastrophic outcomes such as contamination and the spread of HIV.” —LA JOLLA, CA PLASTIC SURGEON ROBERT SINGER, MD
SURGICAL SOLUTION When nonsurgical solutions have been exhausted without success, hair restoration surgery can dramatically improve one’s appearance and self-confidence. “The gold-standard surgical option for hair loss is a hair transplant, which entails surgically removing hair from the back of the head— the area that’s most resistant to DHT—and implanting it into thinning areas,” says Dr. Attenello. “It can be done on both men and women, but because women have a different pattern of hair loss and hair thinning, not all female patients are ideal candidates.”
DAN CARABAS / AUGUST, MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
THE TWO MAIN TYPES
Follicular Unit Transplantation (FUT): “A strip of hair is removed from the back of the head, and then the hairs are separated and implanted into the areas that need to be addressed,” says Dr. Levine. “The advantage to FUT is that you’re able to cover a larger surface area of baldness, but the downtime is typically five to seven days.” Follicular Unit Excision and Extraction (FUE): The surgeon (the procedure can be performed robotically or manually) cuts around each individual hair follicle, removing and implanting it back into thinning areas. Many surgeons use handheld motorized devices to enhance the hair extraction process. “These procedures are lengthy and can take five to eight hours, depending on the size of the treatment area,” says Dr. Levine. “But, the recovery time is faster—two to five days—than with the FUT method and there is no linear scar on the head.”
POWER PLAY
No matter how skilled the surgeon, robots can offer exactness human hands can’t— they also don’t tire after hours in an OR. “The most advanced surgical technology currently available to treat hair loss is the ARTAS robotic system, which utilizes state-of-theart technology to assist physicians with difficult, manual placements of grafts that re-
quire repetitive and precise movements,” says Dr. Heil. “ARTAS was developed with leading hair transplant physicians and researchers, and offers a clinically proven, permanent solution that provides natural results without stitches, staples or linear scars.” Regardless of how the grafts are placed, Dr. Ziering says the hair will continue to grow and function like it normally would, although some routine maintenance may
be needed. Post-procedure, patients can’t color their hair for four weeks and need to avoid direct sun exposure for at least three months to reduce risk of hyperpigmentation, therefore many patients opt to have transplant surgeries in the winter. Dr. Ziering adds, “Noticeably thicker, natural-looking hair growth begins around six months, and the final outcome is seen one year following treatment.”
P RO M OT I O N
THE TUBE REPORT
2.
Each issue we round up our editors’ favorite products to help you discover new brands, unique product formulations and key ingredients all found in one place: your TestTube. 1. Bare Republic Mineral Sunscreen Lotion SPF 30 Bare Republic’s lightweight, mineral defends against UV damage and is loaded with antioxidants and moisturizers to help nourish and protect skin. gobareoutside.com, $14.99
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2. Skin Research Laboratories® neuLASH A powerful, once-a-day serum with peptides that strengthens lashes and delivers nutrients to the lashes in the blink of an eye. skinresearchlabs.com, starting at $95 3. Daily Concepts Charcoal Multifunctional Soap Sponge This two-in-one soap sponge infused with charcoal cleans and smooths skin in a single swipe to save you time. ulta.com, $8 4. Sanitas Skincare Brightening Peel Pads A professional-strength, corrective treatment with active acids that eliminate excess oil, exfoliate and even skin tone. Each jar comes with 50 convenient cleansing pads that come pre-prepped with the right amount of product, so application is foolproof! sanitas-skincare.com, $74
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P RO M OT I O N
5. Contours Rx Lids By Design + Precision Tweezers An eyelid correcting strip that recontours the look of heavy, hooded eyelids in seconds. contoursrx.com, $29.95 6. Chamonix Genucel Plant Stem Cell Therapy A potent treatment for under-eye bags, puffiness and fine lines. betterskintoday.com, $89
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7. Skin Actives Collagen Serum The vegan formula does everything from minimize the appearance of wrinkles to even out skin tone. skinactives.com, $20 8. Invisibobble Original The most powerful yet gentle elastic on the planet. The unique spiral design holds onto hair without knotting and works with all hair types. ulta.com, $8
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“An outward change often leads to an inward transformation.” —PLASTIC SURGEON ERIC MARIOTTI, MD Concord, CA
THE
WELCOME TO THE CLINIC
A comprehensive guide to the most advanced aesthetic procedures and the top doctors who perform them.
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ASK THE EXPERTS
INNER BEAUTY W H I C H C O S M E T I C P R O C E D U R E C R E AT E S T H E M O S T I N WA R D T R A N S FO R M AT I O N ? O U R M E D I C A L A DV I S O RY B OA R D W E I G H S I N .
DERMATOLOGY
Tina Alster, MD
DIRECTOR OF THE WASHINGTON INSTITUTE OF DERMATOLOGIC LASER SURGERY
@drtinaalster
“A laser treatment to remove traumatic or surgical scars that remind individuals of previous accidents or illnesses can lift their spirits and help them put those experiences behind them.”
DERMATOLOGY
Charles E. Crutchfield III, MD EAGAN, MN DERMATOLOGIST
@CrutchfieldDerm
“Platelet-rich plasma for hair regrowth and injected as part of a ‘liquid lift’ has been life changing. One of my patients commented: ‘When I look in the mirror, I recognize her again!’”
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DERMATOLOGY
Kenneth R. Beer, MD FOUNDER AND DIRECTOR OF COSMETIC BOOTCAMP
beerdermatology.com
“Fillers and botulinum toxins are transformative for many people. The inward change is frequently bigger than the outward one—I can’t tell you how many patients feel better about themselves and embark on a new interest.”
FACIAL PLASTIC SURGERY
Steve Dayan, MD
CHICAGO FACIAL PLASTIC SURGEON
drdayan.com
“The one cosmetic medical intervention with the most evidence of positively impacting mood has been Botox. Multiple peer-reviewed studies have supported the self-esteem and quality-of-life benefits.”
PLASTIC SURGERY
Bradley Bengtson, MD GRAND RAPIDS, MI PLASTIC SURGEON
@bengtsoncenter
“Although this is different at different ages, I believe the procedure that creates the biggest internal bang for the buck is breast augmentation. A woman’s breasts can have extra importance in her body image.”
DERMATOLOGY
Jeanine B. Downie, MD MONTCLAIR, NJ DERMATOLOGIST
@drjeaninedownie
“Kybella would probably be the cosmetic procedure that leads to the largest amount of inward transformation. Once people get rid of unwanted fat, they feel empowered. They eat better and wear different clothing.”
FACIAL PLASTIC SURGERY
Kelly Bomer, MD SCOTTSDALE, AZ FACIAL PLASTIC SURGEON
rejuvent.com
“Improving facial shape into better aesthetic proportions and the reduction of wrinkles with excellent ‘liquid facelift’ techniques has an amazingly positive effect on how people feel about themselves.“
OCULOPLASTIC SURGERY
Steven Fagien, MD BOCA RATON, FL OCULOPLASTIC SURGEON
drfagien.com
“The correction of lower eyelid bags, hollows or dark circles through surgery can be one of the most transforming procedures. It delivers almost immediate gratification and self-confidence that can last.”
THE CLINIC
ASK THE EXPERTS
DERMATOLOGY
COSMETIC DENTISTRY
Joel L. Cohen, MD DENVER DERMATOLOGIST
aboutskinderm.com
Ronald Goldstein, DDS COSMETIC DENTIST AND AUTHOR OF CHANGE YOUR SMILE
@RonGoldsteinDDS
“Treatments that minimize acne scars can literally resurrect some people’s self-confidence. While we can’t make acne scars go away, we can do several sessions of fractional ablative resurfacing and fractional radio frequency to see improvement.“
PLASTIC SURGERY
“Cosmetic contouring can instantly create an illusion of straighter teeth. This procedure has given my patients the most amazing inward transformation because one minute they hated their smile, and the next, they could not believe the difference.”
PLASTIC SURGERY
Julius W. Few, MD
DIRECTOR OF THE FEW INSTITUTE FOR AESTHETIC PLASTIC SURGERY
Mark L. Jewell, MD
PAST PRESIDENT OF THE AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY
markjewellmd.com
@JuliusFewMD
“I believe blepharoplasties lead to a dramatic inward transformation. Eyes are the window to the soul. Once the eye becomes the clear, dominant feature, the sense of confidence that comes with it is truly powerful.”
“The biggest transformation is when patients reach the time following a breast augmentation where they have incorporated their new appearance into their body image and accept it.”
PLASTIC SURGERY
Sanjay Grover, MD
NEWPORT BEACH, CA PLASTIC SURGEON; DIRECTOR, GROVER AESTHETICS AND LASER LOUNGE
drgrover.com
“One of the most rewarding procedures for me to do is a Mommy Makeover. Many women feel that they have given up so much of themselves for their children and it is time to do something for themselves.”
COSMETIC DENTISTRY
Laurence R. Rifkin, DDS BEVERLY HILLS, CA COSMETIC DENTIST
@LaurenceRifkin
“The ability to smile without fear is frequently a major obstacle. Undoubtedly, the greatest dental cosmetic procedure that promotes the highest inward transformation of self-esteem has been porcelain veneers.”
FACIAL PLASTIC SURGERY
Andrew Jacono, MD
NEW YORK FACIAL PLASTIC SURGEON
newyorkfacialplasticsurgery.com
“The most transformative cosmetic procedure I perform is a facelift. Although studies have shown that confidence comes from within, I can tell you that I have witnessed many inner transformations echo outer transformations.”
PLASTIC SURGERY
Renato Saltz, MD
PAST PRESIDENT OF ASAPS AND ISAPS
@saltzplasticsurgery
“In my experience, tummy tucks and body-contouring surgeries are the most gratifying procedures for improving patients’ lives. Patients have reported improved physical ability, work performance and social skills.”
The Medical Advisory Board was created with a singular mission: to position NewBeauty as the leading resource for aesthetic guidance. Our Board, led by Dr. Robert Singer, serves to ensure that all information published is backed by deep ethical standards and strong scientific integrity.
Find more insight and advice from our board members at newbeauty.com/board
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STRANGER DANGER J U ST H OW M U C H D O YO U K N OW A BO U T W H O I S F I L L I N G YO U R FAC E ? BY J O L E N E E D GA R
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t’s one of the biggest hot-button issues in aesthetic medicine today—an ongoing controversy, one embroiling providers of every kind and affecting millions of patients: who to trust with fillers and toxins. Much of the discord between leaders in the field springs not from sensationalism or ego, but a passionate, evidence-based desire to deliver results that are beautiful, bespoke, and above all, safe. Our experts have unique viewpoints and experiences— each worthy of consideration and respect. Our goal is to present all sides in hopes of carefully informing your beauty decisions. The International Society of Aesthetic Plastic Surgery (ISAPS) recorded more than 8.5 million injectable procedures worldwide in 2017. (Injectables as a category encompass both muscle-weakening botulinum toxins and various kinds of fillers used to restore youthful volume and contours.) In the United States, demand for such shots soared nearly 40 percent between 2014 and 2018, according to The Aesthetic Society. These figures, bear in mind, reflect only the number of treatments performed by plastic surgeons who are members of the aforementioned organizations. Factor in injections given by unaffiliated plastic surgeons, dermatologists, and dermatologic surgeons; plus “extenders” like physician assistants (PAs), registered nurses (RNs), nurse practitioners (NPs); and add to that doctors from specialties unrelated to aesthetics and even non-healthcare providers—the entire spectrum of injectors—and the tallies turn astronomical. “One of the reasons why injectables have become so popular is because they have an excellent safety profile,” says Vancouver der-
40% The growth in the demand for injectables between 2014 and 2018 SOURCE: THE AESTHETIC SOCIETY
matologist Shannon Humphrey, MD. However, she explains, as the scope of providers has expanded beyond aesthetic physicians to include people of myriad backgrounds, and as technique and treatment patterns have evolved, requiring injectors to venture into deeper planes of the face to achieve more of a three-dimensional remodeling (rather
than a superficial line-plumping), these procedures have grown more dangerous. “I often get calls from doctors concerned about potential complications,” says Chicago facial plastic surgeon Steven Dayan, MD. While side effects common to both toxins and fillers include bruising, swelling, soreness, asymmetries, and otherwise unsatisfactory » N E W B E A U T Y FA L L 2 0 1 9
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TOP hand, typically learn to inject outcomes—issues that resolve on their own has repeatedly taken to social DOCTORS by shadowing MDs and taking or can be corrected—fillers can carry more media to remind her followers Turn to page 129 to voluntary classes, but “there’s serious risks. The most catastrophic is vas- that injectables are, indeed, true find one near you. no formalized or regulated injectcular compromise, which occurs when the medical treatments with real ables certification for nurses and injected material enters a blood vessel, or risks. But convincing the public “has PAs,” says New York dermatologist Paul compresses it from the outside, impeding been a struggle,” she says, mainly because circulation to the skin or eyes, and the industry as a whole has “gone out of [its] Jarrod Frank, MD. More concerning, adds Dr. Dayan: “There’s potentially causing tissue necrosis (skin way to make patients feel comfortable with death) and vision loss respectively. “We’re these treatments.” Many injectors’ Insta- a flaw in our industry-based teaching. Barring seeing an increasing number of these vascu- gram feeds are looping reels of seemingly aesthetic MDs, the majority of new injectors lar complications—most arising from un- effortless filler transformations—and “this are learning from experts who are teaching trained injectors,” says Marina del Rey, CA is part of the danger of injectables,” explains based on FDA-approved indications, which plastic surgeon W. Grant Stevens, MD. New York plastic surgeon Lara Devgan, MD: aren’t necessarily the safest, and aren’t always (Toxins cannot clog arteries. An overdose or “They look far easier than they actually are, what we follow in clinical practice.” These inmisdirected jab could temporarily drop a especially on a time-lapse video, and this structors cannot, for instance, demonstrate brow or slur one’s speech, but the damage breeds a certain amount of cavalier brave- how to reverse a hyaluronic acid filler with the ness.” Before any provider sticks a needle injectable enzyme hyaluronidase, because isn’t usually irreparable.) into someone’s face, she adds, they should this is considered an off-label use of the drug. know the 3-D vascular anatomy well enough And, yet, this skill is vital to patient safety. BREEZY AS A BLOWOUT? Vascular events, while on the rise, are still to draw it from memory. Integral to this quite rare. With published rates of skin understanding is also recognizing that WHO SHOULD YOU TRUST? necrosis hovering around 0.09 percent, and “anatomic variation is real,” says Dr. Hum- The “core four” (board-certified dermatolo146 reported cases of filler-induced blind- phrey—“knowing the most common ana- gists, plastic surgeons, facial plastic surgeons ness in the scientific literature (only 10 of tomical patterns, but also respecting and oculoplastic surgeons) argue that they which were completely reversible), these the diversity among patients.” have the advanced education and anatomical While surgeons may have a bit of an edge training to keep us safe—not to mention undevastating side effects tend to fly under the here—“we’re working in and restricted access to aesthetic medical jourradar. Further obscuring the around the muscles, nerves nals and meetings for news and advances. possible perils, certain spas and “It’s a numbers game: and blood vessels every day,” (As an example, two doctors cited a just-out “injectable bars” are actively If you do 10,000 filler injections with needles, says Miami plastic surgeon study showing large-bore 22-gauge cannulas aiming to demedicalize the one of those times, you’re Adam J. Rubinstein, MD—all are less likely to enter vessels than smaller, shots by likening them to blow- going to enter a vessel,” says Dr. Dayan. “It’s doctors take a year-long more routinely used cannulas and needles.) outs—served with an Instacritically important for anatomy course in medical Nurses and PAs contend that experience— friendly vibe and fizzy drinks— injectors to know how to handle such school, complete with hands- injecting dozens of patients a day for many a comparison many board-certicomplications.” on cadaver dissections, notes years—and an artistic eye are equally crucial fied plastic surgeons and dermatologists find outrageous. “It turns my stom- Los Angeles facial plastic surgeon Kay credentials, and that continuing medical ach,” says Dr. Humphrey. “It reduces cosmetic Durairaj, MD. Physicians specializing in education courses keep them current. dermatology to the lowest common denomi- aesthetic medicine then receive injectables If it’s a toss-up, the government isn’t breaktraining through residency and cosmetic fel- ing any ties: “The laws [regarding cosmetic nator, prioritizing profit over patients.” New York dermatologist Doris Day, MD lowship programs. Extenders, on the other injections] vary state to state,” says Dallas
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4 Questions to Ask Your Injector 1. How often do you inject this type of filler?
2. Will you be my injector at every appointment?
3. How do you handle complications?
4. How can I follow up with you if I have a question?
You want someone who does this full-time, not as a side hustle. “If they tell you five times a week as opposed to 20 times a day, find a more experienced provider,” says Dr. Frank.
With different providers, you can “end up with multiple types of fillers and unknown doses of toxin,” says Seattle plastic surgeon Lisa Sowder, MD. “Find a good one and stick with them.”
Do they have hyaluronidase on hand? Do they know how to flood the treatment area to reverse a filler? How would they manage the rare retinal artery occlusion?
“Good injectors will send you home with a contact number and check in with you the next day,” says Dr. Humphrey. Don’t leave the office without a way to connect after hours.
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healthcare attorney Michael Byrd, who ad- two invaluable resources: an intimate familvises the aesthetics industry. They’re a bit iarity with risk, first and foremost—knowconvoluted, but generally speaking, he adds, ing, for instance, that the nose and glabella “only MDs, PAs and NPs can make diagnoses are most highly associated with vision loss and determine treatment plans. Most states and skin necrosis, and that such shots have allow RNs to administer injections under to be placed in precise spots and at specific proper delegation, and some states allow del- depths. And secondly, the expertise to immeegation to anyone whom a doctor believes to diately recognize and manage filler complibe appropriately trained.” (Did you catch cations—to be able to discern a bruise from that last part? This is the loophole that en- the earliest signs of necrosis; to know exactly ables non-healthcare providers, such as aes- how to respond to a patient with eye pain theticians, to inject in states like Texas and and blurry vision. “This is where inexperiColorado.) Legislation often provides NPs enced, inadequately trained injectors will with more independence. “In more than half fall short,” says Dr. Humphrey. When problems arise, prethe country, those who have paredness is everything. “Injecmet certain requirements can “The blood vessel supply tors should have at least 1,000 practice without a physician to the face is all, to an extent, interconnected. units of hyaluronidase on hand,” overseeing them,” says Alex This is why there are says Dr. Dayan. The dissolvent Thiersch, director of the Amercases of blindness resulting from filler can be expensive, however, and ican Med Spa Association. injections to the lips it expires quickly, so not everyGiven these regulations, and chin, and even the temples and earlobes,” one stocks it, he adds. But it’s how is it that an injectable bar says Dr. Humphrey. the only surefire way to restore can be manned exclusively by RNs? “The legal way to do this is to use tele- blood flow to the skin. And when blindness medicine for the diagnosis and treatment threatens, a shot of hyaluronidase into the plan,” explains Byrd. In many states, a su- eye socket has been reported to save vision pervising physician need only be available (though its efficacy here is controversial, by phone. “Their physical distance from the with pros viewing it as more of a “Hail Mary” practice they oversee is something of a than a guaranteed fix). “Injectors should eigray area,” says Thiersch. And that doctor ther be comfortable performing this retrobneedn’t have any aesthetic training, which is ulbar hyaluronidase technique, or have an a frequent phenomenon, notes Dr. Frank: “A ophthalmologist available in the event nurse in New York City will FaceTime with blindness does occur,” says Nashville ocuan anesthesiologist in Jersey, who receives a loplastic surgeon Brian Biesman, MD. In such scenarios, “patients can’t wait in an ER kickback to sign off on the procedure.” for hours,” adds Vancouver dermatologist THE IN- OFFICE ADVANTAGE Katie Beleznay, MD, lead author of a new Others interpret the law more stringently. study on filler-induced blindness in the AesDr. Durairaj meets every patient her nurse thetic Surgery Journal. The retina can’t surpractitioner treats. “I check her markings vive more than 90 minutes without blood; and approve her treatment plan—I’m always some reports suggest a much tighter window on site, ready to step in if there’s an issue,” of only 12 to 15 minutes. The bottom line: It may not always be she says. And plenty of nurses and PAs prefer this hierarchy—its built-in backup—to the possible to have a core-four specialist inject relative autonomy of unsupervised spas. “It’s your fillers and toxins, but injectors should safer, it’s better for the patient, and I sleep always be licensed healthcare professionals well at night knowing I have at least three “functioning in a level-appropriate manner physicians in the office at all times,” says Salt with adequate oversight,” Dr. Devgan says. If Lake City aesthetic nurse Inna Prokopenko, you are being treated by someone other than RN, who’s been injecting upwards of 35 an MD, it’s best to make sure a supervising physician is there, in the flesh, should anypatients a day for nearly 20 years. Degrees aside, the best injectors possess thing go awry.
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Expert Opinion: Complications 1/ “The frequent problem I see from patients who have used inexperienced or poorly trained injectors is inappropriate product choice and placement. Thankfully, with patience and usually a few treatments, I can undo unsightly work. A sadder case is when patients have lasting damage from permanent, non FDAapproved materials, like silicone. These patients tend to have a caricature-like disfigurement that is very difficult, and sometimes impossible, to correct.” DELRAY BEACH, FL DERMATOLOGIST DR. JANET ALLENBY
2/ “Injecting the wrong type of filler or using inappropriate technique in the tear troughs can cause the under-eyes to look bluish, bubbly and swollen. While we always attempt conservative approaches like massage and simply ‘waiting it out,’ misplaced or poorly applied fillers in the tear trough area— which can last well over a year— often need to be cleared using hyaluronidase. Many patients can’t wait that long for problems to resolve on their own.” NEW YORK OCULOPLASTIC SURGEON IRENE GLADSTEIN, MD
3/ “Signs of vascular occlusion usually show up immediately at the time of the treatment or very soon after. The pain will be intense—a severe burning that keeps patients up at night. It’s distinct from ordinary injectionsite pain, or the tenderness of a bruise. With intra-arterial injection, it hurts to have anything touch the skin. So watch out for pain in the treated area.” PALO ALTO, CA FACIAL PLASTIC SURGEON JILL L. HESSLER, MD
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“With people taking such excellent care of their faces, the jawline and neck are the next frontier,” says New York plastic surgeon Lara Devgan, MD.
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JAWLINE
THE RIGHT ANGLES F RO M O U R O B S E SS I O N W I T H FAC I A L C O N TO U R I N G TO I N N OVAT I O N S I N C OS M E T I C T W E A KS T H AT D E L I V E R M A J O R PAYO F FS, H E R E’S W H Y R A ZO R-S H A R P JAW L I N E S A R E T R E N D I N G B Y E M I LY TAY L O R
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e can blame a lot on selfies, but they aren’t solely responsible for the recent boom in jawline scrutiny. Pittsburgh plastic surgeon Leo R. McCafferty, MD notes that our collective jaw fixation stems simply from the vast number of treatments that can target this particular region. He notes that social media, “coupled with the many surgical options that allow for little or no downtime,” add to the growing interest in treating this part of the face. According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), 55 percent of plastic surgery patients in 2017 listed seeing themselves on social media as a reason for surgery, up from just 13 percent the previous year. The popularity of jaw “tweakments” transcends age, and no matter the end goal, many of the techniques are the same: shrink excess fat from under the chin; reshape facial contours with filler, implants or neurotoxins; tighten loose skin with energy treatments, thread lifts or strategic placement of injectables; or, for the ultimate transformation, a facelift or necklift.
JAW SCHOOL
“We are now understanding that throughout life, our facial bone structure remodels and changes,” says New York facial plastic surgeon Matthew White, MD. “There have been some great research studies published that really illuminate how important a patient’s bone structure relates to their overall facial appearance, particularly the jawline.” One such study published in the Aesthetic Surgery Journal details this reabsorption of bone, where bone density of the mandible (jaw bone) decreased by about 11 percent for male patients between the “young” age group—average age 30—and the older group
with men age 70. “Natural, chronologic aging of the lower face is attributed to changes in both bone and soft tissue atrophy,” notes Scottsdale, AZ dermatologist Dr. Mariel Bird. “Decreases in bone density caused by bone reabsorption and retraction of the chin lead to the development of hanging jowls and a weakened jaw angle.” Tissue in the upper parts of the face can weigh down the jawline, and as Dr. Bird explains, result in a collection of excess skin underneath the jaw. Thanks to the popularity of neurotoxins and fillers, many of us no longer worry about the top two-thirds of our face, and we now can’t help but notice signs of aging at the jawline.
JAWLINE RESHAPING 101 AVERAGE TREATMENT COST: Treatment costs vary. The cost of injectable treatments can range from $750–$1,500; $1,500–$3,000 for energy-based treatments; $4,000–$10,000 for an open necklift; and $7,800– $18,000 for a facelift. TREATMENT OPTIONS: Surgical procedures include a facelift, necklift, liposuction, or a chin implant. Noninvasive procedures include nonsurgical fat reduction, energy-based skin tighteners and injectable treatments. BEST FOR: Nonsurgical procedures can treat patients with mild-to-moderate fat or minimal-to-moderate loose skin in the lower cheeks and jaw. For patients with a moderate to a larger amount of fat and loose skin around the neck and jawline, surgery may be needed. LONGEVITY: Neurotoxins last for up to six months, and fillers can last anywhere from six months to two years, depending on the product used. Fat-reduction procedures deliver long-term results. Surgical results from a facelift or necklift may last for up to eight years or longer.
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FDA indication for CoolSculpting to treat If trimming is your aim, a handful of the submental—under the chin—area for fat-reduction treatments can slim the fat, it has also received FDA-approval for imjaw region. “I often use Kybella under the proving lax tissue under the jawline as well,” chin to reduce fullness,” says Eagan, MN he says. “That’s what gives it a distinct addermatologist Charles E. Crutchfield III, MD. vantage over other fat-reduction treatments where lax skin remains after the Kybella contains a synthetic deunder-chin fat is removed.” The oxycholic acid, the bile acid that “That’s what gives FDA approved CoolSculpting’s works in our stomachs to deCoolSculpting a skin-tightening benefits under grade fat for absorption. After distinct advantage over other fat-reduction the chin after an 18-week study multiple injections under the treatments where found that 77 percent of patients chin—the entire process of lax skin remains after the under-chin fat showed tighter skin in the area which usually takes about 20 is removed” says after treatment. But how does it minutes—cells are broken down Dr. Chien. work? The mechanism is not and are eventually expelled fully understood, and some believe that through the lymphatic system. “Kybella rerather than tightening, skin thickening may sults can be unpredictable, as it only works on the superficial fat layer under the skin be a side effect from the increased collagen and cannot reduce deep-layer fat under the production. “Much of the tightening effects platysma, which is commonly treated with is speculative,” adds Dr. Jewell. “It may actuan open necklift,” says Eugene, OR plastic ally be caused by skin retraction.” surgeon Mark Jewell, MD. “Usually, multiple THE SURGICAL OPTION treatments are required, and patients typiFor jawline contouring, liposuction cally experience a noticeable skin reaction uses suction technology to target and to the injections that includes swelling and remove individual fat cells from the area. bruising in the area.” It’s important to note that while liposuction doesn’t require a large incision, it is still a THE FREEZER Little known fact: CoolSculpting major surgical procedure, warranting invawas inspired by doctors who noticed sive techniques and local anesthesia. “A that children with penchants for popsicles small, 2-millimeter incision is made under showed fat reduction in their cheeks. During the chin and a small cannula is introduced the cryolipolysis procedure, paddles are ap- that removes unwanted fat,” notes Dr. White. plied directly to the skin to suction up fat Liposuction is considered the gold standard and crystallize the cells. And, because adi- for fat removal and can be an intermediate pose tissue is more responsive to tempera- option for patients in need of surgery, but ture changes than skin, the frozen fat cells not quite ready for a full-on facelift or neckbreak down and leave the skin unharmed. lift. “For younger patients in their 20s, 30s With several treatments, up to 25 percent of and early 40s, a less-invasive surgery is the targeted fat can be reduced. It’s also tout- liposuction under the jawline and/or chin ed to tighten some of the loose skin that may with the addition of a central neck-tightenaccompany fat loss, New York dermatologist ing approach to really sculpt,” adds Palo Alto, Peter Chien, MD explains. “In addition to the CA facial plastic surgeon Sachin Parikh, MD.
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TOP DOCTORS Turn to page 129 to find one near you.
BUCCAL FAT Targeting fat under the chin and around the jawline isn’t the only way to make a big impact. Buccal fat removal, which treats the pocket of fat under the cheekbone and above the jawline, is a facial contouring technique that can also give the illusion of a slimmer jawline. Hollywood starlets in the late ‘90s used to have it done to enhance their cheekbones—now, the same procedure is being used to remove signs of aging, according to Dr. Devgan. “Reducing the buccal fat pad decreases the heaviness of the tissue that contributes to jowling, she says. “It is ideal for those with moderate-to-good elasticity, and debulking heaviness can create a cleaner, leaner jawline contour.”
KRISTIINA WILSON / THELICENSINGPROJECT.COM, MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
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Though often injected to treat TMJ, or bruxism, in the jaw—typically causing a slimming side effect—neurotoxins can also be used alone to contour the masseters and create a narrower jaw. Houston dermatologist Paul M. Friedman, MD notes that the long-term effects of bruxism can culminate with tooth damage and may ultimately accelerate lateral bone loss that can become evident between ages 40 and 50. To help prevent this, Dr. Friedman injects neurotoxin into the masseters, reducing muscle bulk to ease clenching and grinding.
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As Palo Alto, CA facial plastic surgeon David Lieberman, MD explains, fillers can replenish lost definition and strengthen the line of the jaw. “They can contour the posterior jawline, the anterior jawline or chin area and create an elegant, elongated look.” A few ccs of dermal filler—or the use of microfat grafts, which last even longer than fillers—in the chin can go a long way. “Adding volume to the chin right in front of the jowls—called the prejowl sulcus—or to the angle of the mandible—called the gonial angle—enhances definition,” says Dr. White. “For the jawline, I like using the filler Radiesse, or calcium hydroxylapatite, because of its natural similarity to the mineral component of human bone.” Other doctors may prefer using hyaluronic acid fillers because they are reversible.
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Recently, chin implants, although a viable contouring option, have taken a backseat to temporary solutions. “Patients are moving away from permanent implants in favor of fillers,” says Beverly Hills, CA facial plastic surgeon Davis Nguyen, MD. However, for forever results, slicone chin implants have been around since the ‘60s and are still an industry standard for altering angles. “If the central part of the jawline is weak, a chin implant can increase the projection of the chin for balance,” says Laguna Woods, CA facial plastic surgeon Cory Yeh, MD.
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ABOUT FACE
The deep-plane facelift—a modified version of the conventional surgery— involves lifting the whole face by repositioning deeper muscles in addition to the overlying skin (in a traditional facelift, only the outer layers are lifted). The modified deep-plane is a go-to for facial plastic surgeons like Drs. Lieberman and Parikh, who note that, in their opinion, “it delivers the most consistent and transformative changes to the jawline and is ideal for patients with heavy jowling and excess skin.” Dr. Jewell mentions that while the deepplane technique is effective, the SMAS facelift is more of the standard. “The deepplane facelift is one of the accepted procedures for facial rejuvenation, but the more straightforward SMAS facelift works for the majority of patients.”
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“After an Ultherapy treatment, jawline and neck tissues gradually tighten,” says Dr. White.
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STITCH FIX
Thread lifts use dissolvable sutures (commonly referred to as threads) to address sagging in regions of the face, like lower cheeks and jowls, but are not the best option for patients with significant laxity. Silhouette InstaLift, which received FDAclearance in 2015, suspends lax skin by pulling up portions of the face with sutures that run underneath the skin. The procedure is typically done under local anesthesia, and patients usually experience minimal downtime and mild swelling. Though the sutures eventually absorb and results aren’t permanent (they last up to three years, but in some cases, as little as six months), Covington, LA dermatologist Christel Malinski, MD says “they trigger the body’s healing response to generate new collagen,” resulting in a firmer, more youthful look.
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ENERGY SHIFT
Nonsurgical skin tighteners utilize various forms of energy to target deeper layers of skin, causing them to contract and produce new collagen, thereby creating a tightening effect. They’re more effective for those with mild-to-moderate laxity (severe laxity responds best to a facelift), so patient selection is important. Thermage, a radio-frequency (RF) device, uses heat to induce the contraction and collagen boost; Profound RF combines microneedling and radio frequency to stimulate collagen production; and both can be used along the jawline. Ultherapy, an ultrasound procedure, can also tighten. “Focused ultrasound energy penetrates deeper than a laser and can induce collagen remodeling,” says Dr. White. “After a treatment—only one is normally needed— jawline and neck tissues gradually tighten.”
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T H E S E T I G H T E N -A N D - L I F T E RS H E L P G I V E L AX S K I N A BO OST
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JAWLINE
B&As AFTER
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FACE FORWARD
Palo Alto, CA facial plastic surgeons David M. Lieberman, MD and Sachin S. Parikh, MD reshaped this 28-year-old patient’s jaw with Botox Cosmetic injections in her masseter muscles. AFTER
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BEFORE
Two separate Kybella treatments, injected underneath this 28-year-old patient’s chin by Covington, LA dermatologist Christel Malinski, MD diminished submental fat. AFTER
BEFORE
To contour this 35-year-old patient’s jawline and eliminate excess submental fat, New York dermatologist Cameron K. Rokhsar, MD performed liposuction under local anesthesia.
This 47-year-old patient was concerned about jowling. New York plastic surgeon Lara Devgan, MD performed buccal fat pad removal and liposuction, and injected neurotoxin and filler.
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Many new innovations on the horizon are aimed at tossing the turkey neck aside, but are yet unproven in terms of safety and efficacy. Allergan is rumored to be launching a new injectable in 2020 aimed at the jaw and chin, though information has not become public yet. At-home DIY skin tools, like facial rollers and gua sha stones, are available to temporarily reduce puffiness around the jaw. Perhaps one of the most exciting new treatments is InMode’s new minimally invasive AccuTite device for both the face and body. “It utilizes radio frequency administered through a cannula to break down fat and re“Although AccuTite model tissue in a 30-minute, in-ofis new to the market, fice procedure with local anesthevariations of the technology—radiosia,” says Los Angeles facial plastic frequency assisted surgeon Kian Karimi, MD. Better lipolysis (RFAL)—show results can last up yet, it claims to be a one-and-done to five years or more,” job with lasting results. “AccuTite says Dr. Karimi. is a one-time procedure that delivers impressive results with minimal downtime,” adds Dr. Karimi. “Although it is new to the market, variations of the technology—radio-frequency assisted lipolysis (RFAL)—show results can last up to five years or more.” Dr. Karimi says he pairs AccuTite with the Morpheus8 radio-frequency microneedling treatment for optimal results. “Combining treatments can target multiple layers of the skin and soft tissues for a more significant improvement,” he explains. No matter the treatment, Dr. Jewell advises to find a board-certified plastic surgeon or dermatologist who knows facial anatomy and the risks associated with heating tissue: “This new AccuTite technology relies on deep-layer heating, which can be poorly controlled,” he cautions. “Some doctors try to heat under the surface of the dermis after they have heated the deep layers to perform additional tightening, but doing so risks full-thickness thermal burns. Choosing the right doctor is as important as choosing the right treatment.”
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“Right now, the pendulum is swinging away from the ‘bigger, whiter’ teeth of the late ‘90s and early aughts.” –Los Angeles cosmetic dentist Jon Marashi, DDS
THE CLINIC
SMILE
SHAPE SHIFTERS V E N E E RS M AY G E T A L L T H E FA N FA R E , B U T BO N D I N G —T H E I R L E SS S E X Y–SO U N D I N G C O U S I N — CA N A LSO P ROV I D E A N I N STA N T F I X
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BY LEANN HARMS
T H E B R E A K D OW N
very smile has its own unique set of issues and some need more TLC than just the recommended twice-yearly cleaning and at-home teeth whitening. From a major overhaul to restoring a handful of stained, worn or chipped teeth, veneers and dental bonding can provide a quick fix for common smile concerns. So, which option is best? The cosmetic dentists we spoke to say the one that gives the wearer the most natural look. “Right now, the pendulum is swinging away from the ‘bigger, whiter’ style of the late ‘90s and early aughts,” says Los Angeles cosmetic dentist Jon Marashi, DDS. “I’ve done a lot of revision work on actors who previously had that ‘Chiclet’ or ‘horse teeth’ look.” Today, anyone can get an A-list smile; here’s how these trending treatments stack up.
PORCELAIN POWER It’s no wonder veneers are credited for providing a “Hollywood Smile.” The first set was conceptualized in 1928 by California dentist Charles Pincus when he was called on by the Factor brothers (of Max Factor) and prominent makeup artists the Westmore brothers to create a way of fixing faulty smiles for the cameras. When officially introduced as a viable treatment in 1983, veneers offered patients a way to totally make over a smile and quickly ascended to game-changer status in the dentistry world. Fast-forward, and modern-day veneers can address the shape, size and color of a tooth with little-to-no damage to the original tooth structure. “A decade ago, they were much thicker, so we had to reduce much more of the tooth,” says San Jose, CA cosmetic dentist
Khalil Saghezchi, DDS. “Now, the porcelain materials are continually evolving and being refined for optimal aesthetics, strength and adhesion,” says Prospect, KY cosmetic dentist Sara Cummins, DMD. Dr. Marashi says along with materials, veneer techniques have also evolved: “I reshape no more than 0.5 millimeters of the original tooth enamel.” While veneers have become an industry favorite for instant makeovers, dentists are also using cosmetic bonding, which uses composite resin to achieve a similar result. “The comparison between porcelain veneers and composite bonding is always a hot topic,” says Dr. Marashi. “Bonding is a fabulous option when you want to repair a chip on the tooth or add minor length, and the rest of your smile and teeth are in good condition.”
VENEERS 101
AVERAGE TREATMENT COST: $1,875–$4,500 BEST FOR: Treating minor misalignment, misshapen teeth and discoloration HOW THEY WORK: Veneers cover existing stains and other slight flaws. They are custom-sized to widen and elongate teeth for a more uniform smile, and can be made as thin as contact lenses. The tooth surface is first filed down to make room for the veneers to be adhered in place. WHAT TO EXPECT: After a consultation, the design process begins, followed by a practice run using temporary veneers, and then finally the adhering of the actual veneers. PAIN FACTOR: Depending on how much tooth structure needs to be reduced, expect some discomfort that is alleviated with local anesthetic. LONGEVITY: With proper care, veneers can last upwards of 10 to 15 years. “The teeth underneath can still get cavities, so you must take excellent care of them,” reminds Sarasota, FL, cosmetic dentist Jenifer C. Back, DMD. “Brushing three to four times daily, flossing and frequent dental cleanings are key.”
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T H E B R E A K D OW N
BONDING 101
VENEERS VS. BONDING Which one is better? The best way to compare both these fixers is to consider the problem that needs to be corrected. Atlanta cosmetic dentist Ronald Goldstein, DDS adds, “It’s also important to choose a dentist who knows to place the junction of either porcelain or bonded resin where it will not be visible to the front of the mouth where future staining can occur.” VENEERS
BONDING
Tre atm e nt Type
It’s considered a somewhat-invasive procedure, as a thin amount of tooth surface must be removed.
Bonding may not require any permanent alterations to the teeth, as the resin is sculpted over the teeth.
Ane sth e sia
Anesthesia may be necessary to alleviate any discomfort.
No anesthesia is usually required.
Tre atme nt Time
The process of getting veneers takes several visits to complete.
Bonding procedures are typically done in a day.
Long -Te rm C are
The porcelain used in veneers is more stain-resistant.
The resin used in bonding is porous and more prone to stains.
Back Te e th
Veneers are usually used on the front six or eight teeth that are seen when one smiles.
Bonding can be used to build out back teeth to better support the cheekbone area.
C o st
The cost of veneers varies, but generally they range from $1,875 to $4,500 per tooth.
The cost of bonding is $350 to $2,500 per tooth, depending on how many teeth need to be addressed.
B e st Optio n
Patients who need to address all the front teeth that are seen in the smile are good candidates for veneers.
Those who need to address only a few teeth to transform their smile may find bonding to be a better option.
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AVERAGE TREATMENT COST: $350–$2,500 per tooth BEST FOR: Concealing stains and hiding minor imperfections HOW IT WORKS: Bonding is the use of tooth-colored resin that is molded over the surface of the teeth to eliminate discoloration while filling in and smoothing out any natural wear and tear. WHAT TO EXPECT: A conditioning solution is first placed over the tooth surface to roughen the outer layer of the enamel, which ensures a stronger bond to the resin that will then be sculpted over the tooth and set with a special light to harden the material in place. It may take up to an hour per tooth. PAIN FACTOR: Bonding is considered a painless treatment and typically no anesthesia is necessary. LONGEVITY: Five to 10 years with good oral care. “The most important thing is to find the right dentist who has the knowledge to set the bonding up in such a way that it will not chip,” says New York cosmetic dentist Irene Grafman, DDS. “Just like with porcelain veneers, bonding can also chip if your bite is not correct.”
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W H AT ’S T H E D I F F E R E N C E ?
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Q&A
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BONDING: Not wanting to remove tooth structure, New York cosmetic dentist Irene Grafman, DDS used bonding to correct worn edges and spacing on this 24-year-old patient’s smile. AFTER
VENEERS: This 25-year-old patient complained that her teeth looked too small. Charlotte, NC cosmetic dentist Patrick Broome, DMD addressed her concerns with a laser gum lift and veneers.
VENEERS: Unhappy with the shape and color of her teeth, this 38-year-old patient sought Huntington Beach, CA cosmetic dentist Katherine Ahn Wallace, DDS for 10 top and 10 bottom veneers.
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Despite their differences, veneers and bonding share the fact that they are meticulously customized. What works on some people may not work on others. “Social media has had a huge influence on cosmetic dentistry,” says Dr. Saghezchi. “But with it comes a lot of photo altering and filters, which have given some patients an unrealistic vision of what they can personally achieve. It’s important to remember that every patient cannot attain the same exact result.” Every step of the process, from choosing the shade of white to the final size of the teeth, is as unique as the patients themselves. “The materials we use are stronger and provide a larger range of beautiful results. We can make veneers as natural or as Hollywood as you would like,” says Dr. Back. “There is literally an infinite number of shades of white that are then modified with glazes and stains.” While results can range depending on the patient’s aesthetic goals, the best approach will take the patient’s entire facial structure into consideration. “You have to truly look at the entire face, from the shape of the face to the tone of the skin and the shape of the lips, jaw, chin and nose—this is how we decide what shape and shade will look best for the patient,” explains Dr. Saghezchi.
BONDING: New York cosmetic dentist Emanuel Layliev, DDS performed a whitening treatment and bonding on this 36-yearold patient’s front teeth to treat discoloration and asymmetry.
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MADE TO MEASURE
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2/ DR. GRAFMAN: “If you already have existing restorations or a lot of decay, then veneers may be the better option. Most people with healthy teeth just want a cosmetic improvement, whether it’s to change the color, straighten the teeth or recreate a beautiful smile. You can do that with bonding, too. All the things veneers can do can be done with bonding without having to remove any healthy tooth structure.”
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1/ DR. MARASHI: “I’m not a huge fan of using bonding in large quantities where it would cover the entire surface of a tooth because it tends to wear out after a few years. That being said, it is easily repairable and cost-effective compared to veneers. I do both procedures, but veneers are more popular with my patients because of superior aesthetics and longevity.”
BEFORE
WHAT THE PROS PREFER
B&As
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The size, shape and symmetry of one’s nose should allow it to “blend seamlessly into the face, encouraging the lips and eyes to come forward,” says Los Angeles plastic surgeon Jason Roostaeian, MD.
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NOSE
THE NEW NOSE JOB
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H AV I N G S E V E R E D A L L T I E S W I T H C O O K I E- C U T T E R C O N N OTAT I O N S, T H E M O D E R N R H I N O P L AST Y I S A ST U DY I N I N D I V I D UA L I T Y
nose is a nose is a nose...or is it? In a provocative study published last year in the journal Plastic and Reconstructive Surgery, researchers sought to determine how a nose job might influence public perception of a person’s appearance and personality. Upon examining pre- and postoperative photographs of women who’d undergone primary rhinoplasties, evaluators, naive to the purpose of the experiment, were asked which image better represented a variety of traits, and by what degree. Ultimately, the “afters” won for symmetry, youthfulness, facial harmony, likability, trustworthiness, confidence, femininity, attractiveness, approachability and intelligence. The “befores” scored higher in only one category: aggressiveness. While the study is not without limitations, its findings are unequivocal: The modern rhinoplasty is deeply transformative—with the power to enhance not just a physical feature, science says, but the way in which it portrays its owner. And, yet, the best work is praised for its relative invisibility—the change is somehow at once striking and undetectable. When escorted into recovery, patients should still look like themselves; their identities firmly intact. An “unoperated” appear-
BY J O L E N E E D GA R
ance is de rigueur in 2019—though this wasn’t always the case: “For a long time, rhinoplasty was viewed as a rather crude operation done to make the nose smaller, but not necessarily better,” says Campbell, CA plastic surgeon R. Laurence Berkowitz, MD. “It was almost understood that you were going to come out looking like you had a nose job.” Over the past 20 years, he adds, there’s been a big push toward natural results, culminating in a new era of refinement in rhinoplasty. “Natural” is a unanimous goal—on this rhinoplasty surgeons can agree. How best to achieve it, however, is up for debate. Some insist that “natural” doesn’t reflect the extent of work done to a nose, per se, but rather “that the end result looks like it’s always been there,” explains Toronto plastic surgeon Jamil Ahmad, MD. Other surgeons say the rising demand for subtlety has led to a shift in technique: “Procedures today aren’t as aggressive as they once were,” says Chicago facial plastic surgeon Steven Dayan, MD. “There’s not usually much grafting; the bony work has become gentler; and our instruments more delicate.” These less-invasive moves have helped ease the classic signs of surgery—conspicuous swelling and shiners. According to Dr. Berkowitz, recoveries that once usurped entire summer vacations are now often managed within a week to 10 days. Here, with the help of top pros, we delve into the nuances of the modern nose job.
“ Individualization is the biggest advance in the last two decades of rhinoplasty.”
T H E B R E A K D OW N
RHINO 101
The nose job, in a nutshell, courtesy of Westborough, MA facial plastic surgeon Min S. Ahn, MD. CONSULT: “We ask the patient what she’d like to change and how long she’s been considering surgery. Her answer tells us if she has expectations we can meet, and if she’s serious about surgery. We take standardized photos and use computer imaging to ensure we’re on the same page about the results we’re seeking.” ANESTHESIA: “While general anesthesia can be used, we prefer twilight. The patient is sleeping and won’t be aware of anything during surgery.” PROCEDURE TIME: “A primary rhinoplasty surgery can take up to two hours.” PAIN: “There’s very little pain following surgery, especially when packing isn’t used in the nose. Often patients don’t need pain medication, or they stop taking it after a couple of days.” RECOVERY: “You leave with a cast on your nose and gauze beneath it. The cast is waterproof, so you can shower without worry; the gauze can be tossed the next day. For the first few days, you’ll be bruised and swollen, and may feel congested. You’ll have to sleep on your back.”
LA JOLLA, CA PLASTIC SURGEON ROBERT SINGER, MD
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#TRENDING:
MIDLIFE MAKEOVER
RHINO REIMAGINED
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f Jennifer Grey taught us anything, it’s the importance of maintaining character through plastic surgery. And in recent years, this has become an unwritten rule of rhinoplasty—owning one’s individuality while aspiring to optimize it. As San Francisco facial plastic surgeon David Kim, MD explains, “Now more than ever, patients are embracing the attributes that make them unique, and asking to retain features they identify with—those that give their nose personality.”
PERFECT STRANGER
Gone are the prototype noses of the past—the scooped bridges, sharp angles, upturned tips. Today “we go for soft contours, smooth surfaces and a natural form,” adds Dr. Kim. While plastic surgeons refer to the “textbook proportions” carved out by their predecessors, most deem them wholly impractical. “We know what it takes to make a ‘perfect’ nose—mathematically, it can be defined,” says Dr. Dayan. But such noses tend to lack authenticity, he adds. And in practice, they blatantly clash with patients’ 21st-Century preferences. New York facial plastic surgeon Dara Liotta, MD says: “If I computer-image an ‘ideally proportioned’ nose during consults, many patients feel that it doesn’t look like them.”
CAN’T TOUCH THIS
Indeed, patients connect more with the traits they’ve come to recognize as their own—be it an aquiline bridge or a flare to the nostrils— which may seem paradoxical given their obvious desire for change, but surgeons say this is the new normal in rhinoplasty. “My patients are very specific about wanting to preserve certain features that would’ve once been thought of as disproportionate,” says New York facial plastic surgeon Edward S. Kwak, MD. “For an Asian nose, that may mean less projection of the tip and bridge. On an Eastern European, we might maintain a hint of hump instead of completely removing the convexity of the bridge.” Nashua, NH plastic surgeon Mark B. Constantian, MD has even been asked to restore inherited qualities that were obliterated by other surgeons. For some folks, he explains, “going from a bump to a straight bridge is an intolerable change. I find that when I deliberately preserve a bump, or put it back, these are some of my happiest patients.” Beyond any surgical update or flashy instrument, “individualization is the greatest advance in the last two decades of rhinoplasty,” says La Jolla, CA plastic surgeon Robert Singer, MD. “This includes better analysis of the patient’s goals and of the anatomy to refine.”
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of rhinoplasty patients in 2018 were 18 to 34 years old SOURCE: THE AESTHETIC SOCIETY
The nose job may be branded as a young-person’s procedure, but surgeons are now seeing a growing number of Gen Xers coming in to correct both lifelong gripes and newer issues that arise with age. While it’s never too late to make a change, surgical tweaks should be minor, serving to smooth and support the nose, not sculpt it.
EVOLVING ANATOMY
“The nose doesn’t actually continue to ‘grow’ throughout adulthood, but rather its tip-support mechanisms weaken, causing it to droop,” explains Philadelphia facial plastic surgeon Jason Bloom, MD. The skin and soft tissues also thin, skeletonizing the nose and spotlighting irregularities that may have gone unnoticed in our younger, plumper days.
SURGICAL FINESSE
Dallas plastic surgeon Rod J. Rohrich, MD estimates 30 percent of his facelift patients request simultaneous rhinoplasties. “It’s a new arena,” he says. Because older bones and cartilages can be delicate, the 40-plus procedure calls for a light touch. Instead of fracturing and reshaping the nasal bones—standard practice in many cases—surgeons may choose to gently file down the dorsum, Dr. Rohrich explains. Elevating and age-proofing the tip may require a more durable type of graft than is ordinarily used. And if the skin is really thin, laying down fascia—borrowed from the temple, say—or acellular dermal matrix can help soften the overall outcome.
THE FAT REFRESH For those seeking subtler changes, adding fat to the nose during facelift surgery can often camouflage the lumps and bumps that come with age, notes Dr. Berkowitz. Fat also improves blood flow to the area, giving skin a more youthful quality. It can’t boost the height of a bridge as much as filler, however, as bone isn’t the best breeding ground for grafted fat. On the upside: Whatever fat does take root tends to stick around permanently.
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MEET THE DISRUPTORS Open versus closed has long been the central debate in rhino. And when we excise the hype, the reality looks something like this: Opening the nose leaves a small scar between the nostrils, but gives surgeons a three-dimensional view of the anatomy, particularly the tip and septum, making it ideal for complex problems and revisions. More straightforward corrections can usually be tackled via a closed or “scarless” approach. “I purposely go closed when someone likes their own natural tip, because dissecting it off the skin can change its character,” adds Dr. Roostaeian. But, really, notes Dr. Singer, there is no single best method; a surgeon’s experience and artistry matter most. That said, emerging techniques are offering new sources of contention. With fan clubs spreading worldwide, both piezoelectric surgery and the preservation approach promise more natural results and a speedier recovery than conventional strategies—but are they more than just fads? Here, thought leaders help us navigate the claims. THE PROCEDURE
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PIEZOSURGERY
WHAT IT IS: The piezoelectric device is an ultrasonic power tool designed for cutting nasal bones. (Traditionally, fracturing/rasping bone is done with hand tools called osteotomes.) Much in the way a cast saw slices through plaster but not underlying skin, “the piezo vibrates so fast—at 30,000 cycles per second—that it cuts through bone, but when it hits the soft lining of the nose on the other side, it doesn’t damage it,” explains Dr. Berkowitz, an early adopter of the technology. Piezo currently requires an open approach, but “we are finding ways to use it for limited parts of the closed procedure, as well,” he adds. New tips for the tool, made specifically for this purpose, are now in development. THE CASE FOR IT: “Much of the bruising and bleeding associated with rhinoplasty comes from osteotomies done with hand
tools, and you just don’t see that [degree of trauma] with the piezo,” says Dr. Berkowitz. He also sees more natural results—“smoother interfaces between bone and cartilage”— with piezo at one, three and five years postop, but says in the absence of long-term outcome studies, there’s no definitive proof of this. Still, in the opinion of Cleveland plastic surgeon Bahman Guyuron, MD, “There’s going to be a role for piezo in rhinoplasty—
it’ll become a common tool for us—no question in my mind.” THE ARGUMENT AGAINST: The device demands good anatomical exposure, which translates to a wide undermining of the skin—and consequently more post-op swelling, says Dr. Rohrich. Dissecting a larger area also takes time, prolonging anesthesia. Overall, skeptics stress, it’s the surgeon, not a single tool, driving rhino results.»
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THE PROCEDURE
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“ Most swelling subsides within three weeks, but the tip can take a full year to resolve completely.” WESTBOROUGH, MA FACIAL PLASTIC SURGEON MIN S. AHN, MD
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PRESERVATION RHINO
WHAT IT IS: Dubbed the “let-down” or “push-down” technique, preservation rhino was first espoused in the 1950s, and is now experiencing a rebirth. Interpretations of the concept vary, but at its core, preservation focuses on maintaining the integrity of the bone and cartilage comprising one’s bridge, and treating them as a single unit when reducing a hump. Instead of disassembling the dorsum and shaving its top, space is carved out beneath it, and then the bridge is lowered down. When following the procedure’s principles more completely, surgeons aim to keep ligaments, cartilage, septum and soft tissue mostly intact, reshaping and suturing the structures rather than resecting them. THE CASE FOR IT: “Whenever we take apart and rebuild the nose, it can settle in unexpected ways over time: calluses can form on bone from rasping; a small rift or step-off may develop between bone and cartilage,” explains Dr. Berkowitz. “But preservation avoids those issues by respecting the continuity of the bridge, and removing only a small amount from the unseen underside.” Proponents say the technique tends to result in less swelling (especially when done closed). And as San Francisco plastic surgeon Dino Elyassnia, MD points out, the spared septum can later be used for grafting, simplifying any future surgeries. THE ARGUMENT AGAINST: Without longterm follow-up studies, experts can’t predict how preservation noses will fare three or five years after surgery: Can humps rise back up over time? Can pushing a bridge down too far beget what’s known as a saddle nose with an abnormally flat or concave bridge? Only time will tell. Critics also note that this strategy can’t be applied to every patient, but mainly those with a straight nose and moderate hump. Even so, more and more surgeons—even those once dubious—seem to be warming to the trend: “Rhinoplasty is all about precision, predictability and consistency,” Dr. Rohrich says. “I don’t know yet if preservation will meet those criteria, but I think it may have a good role in select cases.”
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THE SELFIE EFFECT
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n the spring of 2018, a study in JAMA Facial Plastic Surgery revealed that selfies—more specifically, the close distance from which they’re taken—make the nose appear about 30 percent larger than it actually is. Since then, the industry has continued to probe the link between digital photography and plastic surgery. In a poll conducted by the American Academy of Facial Plastic and Reconstructive Surgeons, 55 percent of surgeons reported seeing patients who were seeking surgery to improve their selfie game. Not only are selfies driving some to consults, but they’re also helping us hone in on even trivial imperfections.
FILTER PHENOM
In a separate paper published in the aforementioned journal entitled “Selfies—Living
in the Era of Filtered Photographs,” research- TRICK PHOTOGR APHY ers noted that prior to the rise of selfies, On a related note, photo fakery isn’t limited rhino patients’ chief complaint was the glar- to our personal feeds. At the Aesthetic Meeting dorsal hump, but today, it’s less-obvious ing in May, plastic surgeons spoke out about asymmetries picked up whilst popular digital tricks used by scrutinizing selfies. unscrupulous doctors: pulling “It’s fun to post Study author Neelam A. Vashi, back on an “after” shot to make intraoperative pictures MD, an associate professor of a nose look smaller following on social, and we all do that. But if a surgeon dermatology at Boston Universiliquid rhinoplasty, for instance. can’t show you multiple ty and Boston Medical Center, (In truth, using filler to disguise views of rhino results at more than one year out, also worries about selfies—the a bump or lift a tip can only inbe very suspicious,” filtering and doctoring—procrease the size of the nose.) Or says Dr. Rohrich. moting unrealistic expectations. showing a surgical rhino result “They blur the lines of reality and fantasy. from only one perspective, typically the proWe can’t always give the fix that patients de- file, rather than multiple views: front, left sire, and even if we could, it may not be ap- and right profile, three-quarter angle on both propriate in real life,” she says. A nose that sides, and base-of-nose or “worm’s-eye” view. looks good in a selfie, for example, would be “If a surgeon doesn’t show every angle, he or abnormally small and incapable of breathing. she is probably not proud of every angle,” notes Dr. Roostaeian. The most trustworthy B&As are taken in controlled lighting, at standard distances, against consistent backdrops and with the patient gazing straight ahead. “Afters” should be taken at least one year out. Be skeptical of anything less.
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According to a study published in JAMA Facial Plastic Surgery, and conducted by researchers at Rutgers New Jersey Medical School, “when taken at 12 inches away...selfies increase nasal size by 30 percent in males and 29 percent in females. Predictably, an image taken at five feet, a standard portrait distance, results in essentially no difference in perceived size.” (Here, NewBeauty staffer Allison Levy demonstrates the difference.) The authors go on to conclude: “Further studies are necessary to determine whether patients who take frequent selfies are less satisfied with their clinical outcomes and if this distortion informs future medical decisions.”
THE CLINIC
#ETHNICRHINO EXPLAINED
T H E H AS H TAG H AS B EC O M E U B I Q U I TO U S, B U T W H AT T H E H EC K D O E S I T M E A N ? FO U R P L AST I C SU RG EO N S W E I G H I N . 1/ “In the generalist of terms, it refers to a rhinoplasty on a patient who is not white. The traditional aesthetic ideals that were taught for years were based on Caucasian women with Northern European features—a straight or slightly concave bridge and a small, defined tip. Around 20 years ago, we started to see more being written about ethnic rhinoplasty—techniques and standards for patients who are Black, Hispanic, South Asian, Middle Eastern and so forth. To me, every rhinoplasty is an ethnic rhinoplasty: it means making a nose that is unique to that person and their features.” –DR. AHMAD
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2/ “The term ethnic rhinoplasty gets tossed around quite a bit, but I don’t really like it. Here’s why: Although indisputably wellintentioned, to me it seems like just another way to separate people’s facial anatomy into categories—Caucasian, and everyone else. In my practice, there is only one category of rhinoplasty: natural-looking. I create noses that harmonize with a person’s ethnicity, for sure, but also with their highly individualized anatomy: the angles, proportions and shapes that compose each patient’s unique countenance.” –DR. ROOSTAEIAN
3/ “In many cases, it implies an augmentation rhinoplasty, which is commonly done on Asian and African American noses. Rather than reducing the nose to make it smaller, we’re building up the bridge to create more structure. I’ve used this hashtag in the past, but not much lately because certain patients find it somewhat offensive.” –DR. ROHRICH 4/ “Ethnic rhino is a very broad term and open to interpretation. A big part of it is maintaining ethnic identity, and not applying Western aesthetic norms to every nose.” –DR. KWAK
DELMAINE DONSON/GETTY IMAGES; MODEL USED FOR ILLUSTRATIVE PURPOSE ONLY
NOSE
THE CLINIC
NOSE
AFTER
BEFORE
B&As
This 32-year-old disliked her dorsal hump and the width of her bridge where it met her cheek. San Francisco plastic surgeon Dino Elyassnia, MD performed a closed preservation rhinoplasty, reshaping her bridge without removing the hump. AFTER
BEFORE
FUTURE BUZZ
Los Angeles plastic surgeon Jason Roostaeian, MD conservatively reduced this patient’s dorsum to avoid a sloped look, and contoured the tip without over-rotating it, for a result that was congruent with her Indian heritage. AFTER
BEFORE
Following a rhinoplasty in her early 20s, this patient felt stripped of key ethnic features. San Francisco facial plastic surgeon David Kim, MD performed a revision to raise her bridge and return her tip to a lower position, restoring her sense of self-identity.
This 29-year-old patient did not like the overprojection of her nasal tip. Her dorsum ridge was refined by Beverly Hills, CA facial plastic surgeon Davis Nguyen, MD, in addition to a cheek enhancement, jawline refinement and Botox injections.
AFTER
BEFORE
As the hammer and chisel begin to fade into the rearview, innovations on the horizon promise a kinder, gentler nose job. One, in particular, could “change rhinoplasty irrevocably” should it come to pass, says Dr. Berkowitz, who tipped us off to a groundbreaking technique called electromechanical reshaping, or EMR. Developed by scientists at the University of California, Irvine, EMR softens and reshapes cartilage (and other soft and semi-solid tissues) using needle-administered electric pulses. While currently under investigation, it’s already been proven to work in a handful of animal studies. Just as we’ve learned to control thermal energy to harness the power of skin-resurfacing lasers, “we can tame the beast that is electrochemistry to control the effects of acids and bases,” says biomedical engineer and facial plastic surgeon Brian Wong, MD, PhD, one of the brains behind the technology. EMR, he explains, “creates highly localized regions of acid-base perturbation in the tissue that leads to an alteration of its structure.” Beyond molding ear and nose cartilage, EMR has the potential to correct vision by reshaping the cornea, and to treat and sculpt fat—all at a very low cost, says Dr. Wong. Manipulating more rigid structures, like bone, would prove more challenging, he adds, “because the amount of energy that would need to be expended would be massive.” More studies are needed to bear out the true benefits of this procedure, notes Dr. Singer, and “a healthy wariness about the promise of any new advancement is always critical.” Still, we’re pretty amped about being one step closer to a truly nonsurgical nose job.
THE POWER OF YOU
“I CAN DO THIS My journey so early in life has reminded me that and carry on.”
MARY
Actual breast reconstruction patient with Natrelle INSPIRA® Breast Implants. Individual results may vary.
SUPPORTING WOMEN AND THEIR BREAST CANCER JOURNEYS
#MyReconReason @NatrelleBreastReconstruction Natrelle ® Breast Implants Important Information Who may get breast implants? Natrelle ® Breast Implants are approved for women for the following: • Breast reconstruction. Breast reconstruction includes primary reconstruction to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality. Breast reconstruction also includes revision surgery to correct or improve the result of a primary breast reconstruction surgery. IMPORTANT SAFETY INFORMATION Who should NOT get breast implants? • Women with active infection anywhere in their body. • Women with existing cancer or precancer of their breast who have not received adequate treatment for those conditions. • Women who are currently pregnant or nursing. What should I know before getting breast implants? • Breast implants are not lifetime devices, and not necessarily a one-time surgery. • Many of the changes to your breasts following implantation cannot be undone. If you later choose to have your implant(s) removed and not replaced, you may experience unacceptable dimpling, puckering, wrinkling, or other cosmetic changes of the breast, which may be permanent. • Breast implants may affect your ability to breast-feed, either by reducing or eliminating milk production. • Rupture of a silicone-filled breast implant is most often silent and may not be detected by you or your doctor. You should have an MRI 3 years after your surgery and then every 2 years after that for as long as you have your breast implants to determine if rupture is present. If implant rupture is noted on an MRI, you should have the implant removed, with or without replacement. • With breast implants, a routine screening mammography and self-examinations for breast cancer will be more difficult. Ask your doctor to help you distinguish the implant from your breast tissue. Symptoms of a ruptured implant may be hard knots or lumps surrounding the implant or in the armpit, change or loss
of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening. Tell your doctor of these symptoms and remove ruptured implants. • Inform any other doctor who treats you of the presence of your implants to minimize the risk of damage to the implants. What should I tell my doctor? Tell your doctor if you have any of the following conditions, as the risks of breast implant surgery may be higher: • Autoimmune diseases (for example, lupus and scleroderma). • A weakened immune system (for example, currently taking drugs that weaken the body’s natural resistance to disease). • Planned chemotherapy following breast implant placement. • Planned radiation therapy to the breast following breast implant placement. • Conditions or medications that interfere with wound healing and blood clotting. • Reduced blood supply to breast tissue. • Clinical diagnosis of depression or other mental health disorders, including body dysmorphic disorder and eating disorders. Please discuss any history of mental health disorders with your surgeon prior to surgery. Patients with a diagnosis of depression or other mental health disorders should wait for resolution or stabilization of these conditions prior to undergoing breast implantation surgery. What are some complications with breast implants? Key complications are reoperation, implant removal with or without replacement, implant rupture with siliconefilled implants, implant deflation with saline-filled implants, and severe capsular contracture (severe scar tissue around the implant). Other complications include asymmetry, nipple/breast/skin sensation changes, scarring, or wrinkling/rippling. Talk to your doctor about other complications. Talk to your doctor. For more information see the patient brochures at www.allergan.com /labeling/usa.htm. To report a problem with Natrelle ® Breast Implants, please call Allergan at 1-800-433-8871. Natrelle ® Breast Implants are available by prescription only.
© 2019 Allergan. All rights reserved. All trademarks are the property of their respective owners. Natrelle.com NAT120913 01/19 191068
THE CLINIC
BREAST
RECON REVOLUTION AS B R E AST CA N C E R P R E V E N T I O N A N D P OST-SU RG I CA L O P T I O N S C H A N G E , SO D O E S T H E C O N V E RSAT I O N O N B R E AST R EC O N ST RU CT I O N BY ELIZABETH RITTER
B IMAGE SOURCE/GETTY IMAGES
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Many women choose a mastectomy in the case of having the BRCA gene or a familial disposition to cancer. “It is a good option and gives peace of mind,” says New York plastic surgeon Alexes Hazen, MD.
eth Fairchild is a mother of two, tattoo artist and yoga teacher. She’s also living with metastatic breast cancer. Her story isn’t necessarily so standard: Breast cancer runs in her family so she was always “incredibly conscious” of practicing a healthy lifestyle and being extra diligent about detection. Then, at age 34, she received the diagnosis of Stage 4 cancer. “Ninety percent of people who have breast cancer have an earlier stage cancer,” she says. “I never experienced a lump in my breast—I even had a negative mammogram, so I had a very rare presentation of the cancer. It was shocking news to receive.” Shock slowly turned to action, although Fairchild admits it was rather difficult to figure out all of her options right away. “We lost some time; at first, getting a mastectomy wasn’t on the table. Then, I decided I wanted the mastectomy. It was really a quality-of-life thing. I wanted them off. I wanted to know that tissue was gone.”
MAKING MOVES
This past May marked five years since Fairchild’s diagnosis. During her journey, she’s been most proud about being “transparent with her story,” and is especially passionate about promoting her skill of nipple tattooing post-reconstruction and her work as president of METAvivor, an organization dedicated to helping women and men living with» N E W B E A U T Y FA L L 2 0 1 9
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Stage 4 metastatic breast cancer. More recently, she also made the decision to get a breast reconstruction herself. “In the beginning I was terrified of imminent death, but now I’m living in the moment. I’m really savoring and enjoying what I have right now—and that was a big part behind why I decided to get a reconstruction,” she says. “I lived ‘flat’ for three years and was five years out from my diagnosis. But then I started thinking, what if I live for 10 more years and regret not getting the reconstruction? I don’t want to do that. I have to live in the now.”
OP TIONS ABOUND
While Fairchild’s story definitely doesn’t follow a set path, Dr. Hazen says the decision to get a breast reconstruction post-cancer is something many women don’t even know is an option. “Oddly, the majority of the women in this country who have breast cancer do not undergo reconstruction and do not realize it is available and covered by insurance. I wish every woman would know that! Secondarily, there are many, many options, and the options can be customized to your lifestyle and needs—both implant and tissue options have become more and more sophisticated over the years,” she says. “Also, the adjunct of fat transfer has really been a game changer in terms of the quality of results.”
IMPROVED EXPERIENCE
Dallas plastic surgeon Rod Rohrich, MD is also excited by the new developments in reconstruction, although he admits most women don’t realize the surgery is not a “onestage” procedure. “In most cases, either staged reconstruction with or without implants or expanders is needed, and the nipple reconstruction is often done as the final procedure, but most of the secondary reconstructive procedures are not as major as the initial one,” he says. San Jose, CA plastic surgeon Kirk A. Churukian agrees: “While the overall cosmetic outcome for reconstruction is improving, many women may not realize the multiple steps involved to contour and refine the breast shape. It is a “Depending on what team effort that inwe have to work with volves not only the following the cancer doctor and patient, operation and the level of patient expectation, but also staff memeach case is unique in its challenges,” says bers and the patient’s Dr. Churukian. family. A clear time line relating to a long-term plan helps to set expectations and improve the experience.”
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END NOTES
While Dr. Hazen admits we’re at a time of “heightened awareness” regarding implants, she doesn’t think it’s a bad thing. “This kind of examination of a product and data is so important. Patient safety is the most significant aspect of surgery.”
T H E B R E A K D OW N
RECONSTRUCTION 101
Breast reconstruction is not a one-sizefits-all surgery. “Not everyone needs an implant under their pectoralis muscle,” Eugene, OR plastic surgeon Mark Jewell, MD says. “Latissimus, TRAM flap and materials like mesh to support weakened tissues are some of the other options.” CONSULT: One key step of the consult will be determining if the timing of your reconstruction is approved, and discussing the desired outcome.
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WHAT ELSE TO KNOW: Post-mastectomy, Dr. Rohrich says that, typically, a tissue expander is inserted beneath the skin and chest wall muscle; injections of saline are then used to stretch the skin to prep it for the implant. Nipple reconstruction and removal of the expander and replacement with an implant can then be performed later. “But skin-sparing mastectomies [preservation of nipple and areola], in the right candidate, are becoming more common,” Dr. Churukian says.
M O D E L E S S AY:
ALLYN ROSE
ALLYN ROSE made history earlier this year when she became the first model with a mastectomy to be featured in Sports Illustrated. But, for the 30-year-old, that wasn’t the start—or the end—of her story: “My mother was diagnosed with breast cancer for the first time at 27 and had a unilateral mastectomy. My father begged her to remove her other breast, saying it was a ‘ticking time bomb.’ She refused, feeling like it was the last vestige of her ‘femininity.’ Unfortunately, my father was right; 20 years later, my mother was again diagnosed with Stage 3 breast cancer and ultimately lost her life. At age 26, realizing that almost every woman in my family had lost their life to breast cancer, I underwent a preventive bilateral mastectomy. I have since had the opportunity to speak to my generation about the importance of defining your own beauty and being your own advocate. Most recently, I started the social media campaign #SelfExamGram to remind women to perform monthly self breast exams, and I joined forces with the AiRS Foundation (and its partner, Allergan) to spread awareness about the nonprofit that helps women who have had a mastectomy pay for breast reconstruction—it also acts as a resource for women in all stages of reconstruction. Most people don’t realize how invasive the mastectomy process is, but women can look fantastic if they are given the choice of the right procedure and reconstructive tools, and a skilled surgeon.”
THE CLINIC
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15
SOPIKO MDIVNISHVILI/EYEEM/GETTY IMAGES
SECONDS
Every 15 seconds, a woman is diagnosed with breast cancer. SOURCE: GLOBOCAN, 2018
THE CLINIC
BREAST
PREVENTION INVENTIONS
WHAT A DERM WISHES SHE KNEW BEFORE BREAST CANCER
N
anuet, NY dermatologist Heidi Waldorf, MD is an expert in all things skin—but even she was surprised by several skin-related changes she experienced after being diagnosed with Stage 2B breast cancer at 43 years old.
SCAR TACTICS
“My treatment consisted of a lumpectomy with sentinel lymph node dissection, followed by chemotherapy, radiation and an oral anti-estrogen. Despite being smallbreasted and my cancer being 8 millimeters, I had no indentation or asymmetry after surgery, which was easy thanks to my fabulous breast surgeon. Whatever nearly invisible scar faded further with radiation, and given my fair skin and lack of sun damage, I had no radiation dermatitis during that phase.”
HAIR APPARENT
“The hard part, as expected, was the chemotherapy. The only time I cried during my oncology consult was when we discussed losing my hair. I picked the date to shave my head— a week after my first chemo—so I had control of how I looked; I couldn’t go to work with a half head of hair. It also allowed me to avoid seeing all those long strands piling up on my pillow. I shaved it and had the wig fitted on a Thursday, and went into work with the wig
on Friday. When not at work, I skipped the wig, applied plenty of sunscreen to my bald scalp and wore a hat for protection. In addition to losing the hair on my head, I was prepared to lose my lashes and brows. I got bright-blue eyeliner and a water-resistant brow pencil. They grew back, but I lost my eyelashes again every three months for a year, so I started using Latisse.”
SUN SENSITIVE
“I was very surprised at my susceptibility to the sun during chemo. As a second-generation derm with a dad who wouldn’t speak to me if I came home tan, I was used to applying and reapplying sunscreen and hadn’t gotten a new brown spot in adulthood. But just walking on Madison Avenue once or twice a week, I got enough sun exposure to develop a few lentigines. Once I saw that, I decided to wear a broad-brimmed hat and keep the wig in my bag while walking outdoors.”
DON’T DESPAIR
“The silver lining of breast cancer being so common is that we know so much about what to expect and what to do about it—so speak to your derm. I find that many cancer patients feel uncomfortable asking their oncos about aesthetic issues when they feel their onco is focusing on saving lives. But they should ask.”
“ When you are the patient, even a doctor loses some diagnostic skills.” NANUET, NY DERMATOLOGIST HEIDI WALDORF, MD
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NEW WAYS TO DETECT MAMMO VAN
At Stony Brook Cancer Center in New York, scheduling a mammogram has never been easier. Known as the “On-theVan Mammogram,” the mobile service comes to you—just find out when the van will be in your neighborhood, schedule an appointment online and you’re set. The all-female medical team will make you feel comfortable, and the spacious van features a registration area, waiting room, private changing and exam spaces, and state-of-the-art 3-D equipment.
IMAGING INTEL
With several locations in California, Scottsdale, AZ and Grand Rapids, MI, QTbreasthealth is offering an “evolution in breast imaging.” The centers offer the FDA-cleared QTscan, which provides breast imaging clarity, minus radiation and compression, and is specifically designed to improve imaging for dense breasts and in cases where mammograms are challenged such as breast implants and women in need of safe repeat imaging.
TESTING TAKEOVER
A new study published in Plastic and Reconstructive Surgery recommends that genetic testing should be considered for all women undergoing a unilateral (single) mastectomy or abdominal-based free-flap breast reconstruction.
NEWBEAUTY
TOP DOCTORS Turn to page 129 to find one near you.
THE POWER OF YOU
“GROUP OF WOMEN My journey has led me to a great
who I can count on for support.”
ANNA
Actual breast reconstruction patient with Natrelle® tissue expanders. Individual results may vary. Actual breast reconstruction patients with Natrelle INSPIRA® Breast Implants. Individual results may vary.
SUPPORTING WOMEN AND THEIR BREAST CANCER JOURNEYS
Learn more at Natrelle.com
#MyReconReason #ThePowerOfYou @NatrelleBreastReconstruction Natrelle ® Breast Implants Important Information Who may get breast implants? Natrelle ® Breast Implants are approved for women for the following: • Breast reconstruction. Breast reconstruction includes primary reconstruction to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality. Breast reconstruction also includes revision surgery to correct or improve the result of a primary breast reconstruction surgery. IMPORTANT SAFETY INFORMATION Who should NOT get breast implants? • Women with active infection anywhere in their body. • Women with existing cancer or precancer of their breast who have not received adequate treatment for those conditions. • Women who are currently pregnant or nursing. What should I know before getting breast implants? • Breast implants are not lifetime devices, and not necessarily a one-time surgery. • Many of the changes to your breasts following implantation cannot be undone. If you later choose to have your implant(s) removed and not replaced, you may experience unacceptable dimpling, puckering, wrinkling, or other cosmetic changes of the breast, which may be permanent. • Breast implants may affect your ability to breast-feed, either by reducing or eliminating milk production. • Rupture of a silicone-filled breast implant is most often silent and may not be detected by you or your doctor. You should have an MRI 3 years after your surgery and then every 2 years after that for as long as you have your breast implants to determine if rupture is present. If implant rupture is noted on an MRI, you should have the implant removed, with or without replacement. • With breast implants, a routine screening mammography and self-examinations for breast cancer will be more difficult. Ask your doctor to help you distinguish the implant from your breast tissue. Symptoms of a ruptured implant may be hard knots or lumps surrounding the implant or in the armpit, change or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening. Tell your doctor of these symptoms and remove ruptured implants. • Inform any other doctor who treats you of the presence of your implants to minimize the risk of damage to the implants. What should I tell my doctor? Tell your doctor if you have any of the following conditions, as the risks of breast implant surgery may be higher: • Autoimmune diseases (for example, lupus and scleroderma). • A weakened immune system (for example, currently taking drugs that weaken the body’s natural resistance to disease). • Planned chemotherapy following breast implant placement. • Planned radiation therapy to the breast following breast implant placement. • Conditions or medications that interfere with wound healing and blood clotting. • Reduced blood supply to breast tissue. • Clinical diagnosis of depression or other mental health disorders, including body dysmorphic disorder and eating disorders. Please discuss any history of mental health disorders with your surgeon prior to surgery. Patients with a diagnosis of depression or other mental health disorders should wait for resolution or stabilization of these conditions prior to undergoing breast implantation surgery.
Natrelle ® Breast Implants IMPORTANT SAFETY INFORMATION (continued) What are some complications with breast implants? Key complications are reoperation, implant removal with or without replacement, implant rupture with silicone-filled implants, implant deflation with saline-filled implants, and severe capsular contracture (severe scar tissue around the implant). Other complications include asymmetry, nipple/breast/skin sensation changes, scarring, or wrinkling/rippling. Talk to your doctor about other complications. Talk to your doctor. For more information see the patient brochures at www.allergan.com/labeling/usa.htm. To report a problem with Natrelle ® Breast Implants, please call Allergan at 1-800-433-8871. Natrelle ® Breast Implants are available by prescription only.
Natrelle ® 133S, 133 Plus, and 133 Tissue Expanders Important Information Approved Uses Natrelle ® 133S, 133 Plus, and 133 Tissue Expanders are approved for breast reconstruction following mastectomy, treatment of underdeveloped breasts and treatment of soft tissue deformities. IMPORTANT SAFETY INFORMATION Who should NOT get tissue expanders? Do not use if you: • Already have implanted devices that would be affected by a magnetic field. • Have tissue unsuitable for expansion. • Have an active infection or a residual gross tumor at the expansion site. • Are undergoing adjuvant radiation therapy. • Have a physiological condition (eg, obesity, smoking, diabetes, autoimmune disease, hypertension, chronic lung or severe cardiovascular disease, or osteogenesis imperfecta) or use certain drugs (including those that interfere with blood clotting or affect tissue viability) that may result in a high risk of surgical and/or postoperative complications. What else should I consider? • Natrelle ® 133S, 133 Plus, and 133 Tissue Expanders should NOT be used in patients who already have implanted devices that would be affected by a magnetic field. • Active infection anywhere may increase risk of infection around the tissue expander. Certain infections may require premature removal of the device. • Natrelle ® 133S, 133 Plus, and 133 Tissue Expanders are temporary devices, and are not to be used for permanent implantation or beyond 6 months. Tissue expansion in breast reconstruction typically requires 4 months to 6 months. What are possible complications? Deflation, tissue damage and/or appearance of the implant through the skin, infection, unwanted shape, unintended blood or fluid collection, capsular contracture (tightening of scar tissue that causes the breast to harden), premature device removal, bone/pain/ sensation changes, and inflammation. For more information, please visit www.allergan.com/labeling/usa.htm. To report a problem with Natrelle ®, please call Allergan at 1-800-433-8871. Natrelle ® 133S, 133 Plus, and 133 Tissue Expanders are available by prescription only.
© 2019 Allergan. All rights reserved. All trademarks are the property of their respective owners. Natrelle.com NAT120886 02/19 190648
THE CLINIC
Q&A
Q&A
THE
DOCTOR IS IN
C O L L AG E N I S T H E M OST A B U N DA N T P ROT E I N I N T H E H U M A N BO DY, A N D A N E SS E N T I A L FO R P LU M P, G LOW Y S K I N . H E R E , TO P D O CTO RS S H A R E H OW TO P ROT ECT, P R E S E RV E A N D B U I L D C O L L AG E N .
COLLAGEN! WHY DO I NEED IT? ARE THERE DIFFERENT TYPES I SHOULD KNOW ABOUT?
“Collagen is the main protein that gives strength and structure to the connective tissues—skin, tendons, bones and cartilage—throughout our bodies. Twenty-eight different types of collagen exist in total, and each has a different shape and structure. The strength and types of interconnections between collagen fibers within a network determine how strong or malleable the skin is. Type 1 collagen makes up approximately 70 percent of the dermis, a deep layer of skin that’s also rich in collagen type 3, which is the first type of collagen that forms as the skin heals itself from wounds.” JOSHUA ZEICHNER, MD NEW YORK DERMATOLOGIST
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SO, WHAT’S MY TIMELINE?
“We lose 1 percent of our collagen per year starting in our late 20s, and then there is a precipitous drop during menopause. In fact, during the first five years of menopause, the skin loses up to one-third of its total collagen. After that, the decline in collagen stabilizes at around a loss of 2 percent per year, evolving into deeper wrinkles and sagging skin in the form of jowls over time. WHITNEY BOWE, MD NEW YORK DERMATOLOGIST
WHY AM I LOSING COLLAGEN?
“Over time, UV radiation and aging factors cause collagen to become damaged, which is why wearing sunscreen is so critical, and the repair and production of collagen slows
down with aging. Hormones play a role in collagen degradation, too. As we approach menopause, estrogen levels decrease, which slows the renewal of collagen and accelerates aging. We can see this prematurely in those who have had their ovaries removed at a younger age, experienced early menopause, or had to take hormone suppression for medical necessity. Diets also play a role in how we age. Highglycemic diets are high in sugar and refined carbs and can result in the glycation or chemical alteration of proteins in the body and skin, which also leads to damaged collagen. Smoking is a culprit, too, exposing skin to free radicals that damage cells and collagen fibrils, accelerating collagen breakdown. It can be seen in those who have smoked for many years—their skin tends to show signs of this unhealthy habit.” KALLY PAPANTONIOU, MD MELVILLE, NY DERMATOLOGIST
THE CLINIC
Q&A
NEWBEAUTY
IS THERE ANYTHING I CAN DO TO SAVE THE COLLAGEN I ALREADY HAVE? DO I NEED A GOOD MOISTURIZER?
“Skin hydration is important to maintain a healthy skin barrier. Our skin barrier functions to keep moisture in and protect against free radicals and infection. An impaired skin barrier can lead to inflammation, which may cause an increase in matrix metalloproteinases that break down collagen. But, the biggest extrinsic factor that leads to collagen breakdown is still UV exposure from the sun that causes about 80 percent of the damage.” KATHLEEN BEHR, MD FRESNO, CA DERMATOLOGIST
WHAT IF I WANT TO BOOST COLLAGEN? WHAT INGREDIENTS SHOULD I LOOK FOR IN MY SKIN CARE?
“Copper peptides, when applied topically, appear to activate a wide range of skin functions, including wound healing, an anti-inflammatory response, antioxidant immune function, collagen synthesis, and pro-collagen support. As copper peptides are small molecules and important in several of our bodily functions, if applied to the skin topically, they can make it look more youthful and refreshed.” WM. PHILIP WERSCHLER, MD SPOKANE, WA DERMATOLOGIST
ANYTHING ELSE?
“Collagen itself is far too large a molecule to penetrate human skin, so we have to turn to other ingredients that can put collagen production into overdrive, such as retinol, vitamin C, alphahydroxy acids, peptides and growth factors. Most anti-aging products on
T OP D OCT ORS
Turn to page 129 to find one near you.
the market today contain a cocktail of these ingredients to provide added benefits.” PATRICIA K. FARRIS, MD METAIRIE, LA DERMATOLOGIST
MICRONEEDLING WAS ORIGINALLY KNOWN AS COLLAGEN INDUCTION THERAPY (CIT). HOW DOES IT WORK TO AMP UP COLLAGEN?
“Microneedling uses tiny needles to puncture the skin, creating microtrauma. When this microtrauma occurs, small inflammatory and vascular compounds are released in the dermis, which attracts repair cells to the area. In this process of wound healing, the fibroblasts—skin’s collagen-making cells— reactivate and generate new collagen in the area. Radio-frequency microneedling works even better because of the addition of energy, but both types work to improve fine lines and other surface skin imperfections we can see.” GILLY MUNAVALLI, MD CHARLOTTE, NC DERMATOLOGIST
CAN FILLERS INCREASE COLLAGEN LEVELS, TOO?
HOW EXACTLY DOES INGESTIBLE COLLAGEN WORK? WE KNOW IT CAN’T TARGET SPECIFIC SPOTS IN THE BODY LIKE TOPICALS CAN, BUT IT CAN STILL HELP OVERALL, RIGHT?
“There’s collagen we already produce within our bodies, and then there’s supplementary collagen that we ingest or apply topically to support collagen production. The collagen molecules that are naturally within our bodies are made up of amino acids chains: they’re large in size and can’t be absorbed effectively by the body. Fully hydrolyzed collagen—known as collagen peptides—has been broken down into smaller chains, meaning it’s easily digestible and quickly absorbed. This allows the skin’s fibroblasts to easily use the amino acids, and in turn, produce more collagen. It’s like using pre-built LEGO parts instead of individual single pieces to make the process and benefits of ingesting collagen a bit more efficient.” JULIE RUSSAK, MD NEW YORK DERMATOLOGIST
CAN YOU INGEST TOO MUCH COLLAGEN? AND IF SO, COULD IT BE HARMFUL?
“Biostimulatory fillers—calcium hydroxylapatite, poly-l-lactic acid and polymethylmethacrylate—are known for their longer duration compared to hyaluronic acid fillers, but both increase collagen by many different mechanisms, including by fibroblast stretching and an increase in cytokine production that affects gene expression.”
“Currently there are no Food and Drug Administration (FDA) regulations for ingestible collagen. If too much is ingested, some people may experience mild side effects, ranging from gastrointestinal symptoms to skin rashes, but it’s not common. Usually, those side effects come from additives in the formulation of the collagen, such as fish or sulfites, and not the collagen itself. In these cases, switching to another formula should help.”
YOON-SOO CINDY BAE, MD NEW YORK DERMATOLOGIST
ANN C. ZEDLITZ, MD BATON ROUGE, LA DERMATOLOGIST
A DV E RT I S E M E N T
THE COLLAGEN
CONNECTION THE KEY TO MAINTAINING HEALTHY, YOUTHFUL SKIN Top dermatologists say 30 is the age when wrinkles start to settle in, which makes perfect sense, as research shows this particular birthday marks the slow and steady decline of our body’s collagen, and we lose 1 percent every year thereafter. This loss of essential connective tissue can leave skin etched with lines and void of its youthful bounce, but with the help of potent skin-care products, these telltale signs of aging can be stopped in their tracks. The Common Problem: Unfortunately, you can’t simply apply collagen to the skin—the molecules are too big to penetrate the pores deeply enough to create any change. The Answer: StriVectin’s new and improved SD Advanced™ PLUS Intensive Moisturizing Concentrate, an upgraded version of the brand’s iconic wrinkle fighter that uses an innovative approach, targeting 10 types of collagen in the body that improve the skin. The Results: A dramatic improvement in skin quality—and not just fewer visible wrinkles. The formula also improves the look of stretch marks using a blend of green bean seed extract, a new oligopeptide and the brand’s signature NIA-114™ technology (a patented form of skin-strengthening niacin) for more supple skin from head to toe.
A DV E RT I S E M E N T
70%
Collagen makes up 70 percent of our skin and is the most abundant protein in our bodies.
COLLAGEN
Through the Ages How our supply of collagen changes over the years
30s
40s
Collagen and elastin begin to decline, causing expression lines on the forehead and around the eyes and mouth to become more noticeable and bothersome.
Estrogen levels slowly deplete, resulting in a drop in collagen, and laxity that wasn’t visible previously. This typically appears as sunken under, flattened cheeks and hollow temples.
50s
60s
Menopause impacts collagen and elastin levels more severely, causing the underlying structure of the skin to lose support. As a result, skin becomes more fragile and can take on a crepey texture.
NextGeneration Power SD Advanced™ PLUS Intensive Moisturizing Concentrate is more powerful than ever. Demonstrated in an ex-vivo study to target 10 types of collagen in the body—the 10 types that are most important to skin—the breakthrough formula features an upgraded Collagex-CE Complex with copper tripeptides and a proprietary marine ferment that visibly reduces fine lines, wrinkles and stretch marks while providing 72 hours of hydration*.
WATCH IT WORK In just TWO WEEKS: visibly reduces lines & wrinkles* In just FOUR WEEKS: fades the appearance of stretch marks** SD Advanced™ PLUS Intensive Moisturizing Concentrate, $79, strivectin.com
The aging process is accelerated, and collagen levels have dropped nearly 30–40 percent. Skin is significantly drier with deeper wrinkles and a loss of elasticity, particularly in the cheeks, jawline and neck.
*Based on instrumentation testing **Based on dermal evaluation
Undergoing a procedure for a second time can induce anxiety, but a second chance at a beautiful result can be worth the risk.
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RHINOPLASTY San Francisco plastic surgeon MICHAEL KULICK, MD performed a revision rhinoplasty after this 36-year-old patient expressed concerns about the uneven appearance of her nose.
RHINOPLASTY This 25-year-old patient had breathing issues after prior rhinoplasties. New York facial plastic surgeon Lee Ann M. KLAUSNER, MD reshaped her nose and restored function.
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RHINOPLASTY This 27-year-old patient had two prior rhinoplasties, but disliked how her nostrils looked. Beverly Hills, CA facial plastic surgeon ANDREW FRANKEL, MD performed a revision rhinoplasty.
EYELIFT After a previous double-eyelid surgery made this 28-yearold patient feel as if her eyes no longer looked alert, Pasadena, CA plastic surgeon LILY LEE, MD performed an upper eyelid lift revision.
NECKLIFT Unhappy with the appearance of her neck after a prior facelift, this 59-year-old patient sought New York facial plastic surgeon DILIP MADNANI, MD for a revision necklift with fat transfer.
RHINOPLASTY Beverly Hills, CA plastic surgeon GARY MOTYKIE, MD created a balanced look for this 45-year-old patient with a revision rhinoplasty and fat grafting in the midface and lips.
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DERMAL FILLERS New York dermatologist MARINA PEREDO, MD dissolved this 45-year-old patient’s “overdone” filler treatment and performed a corrective enhancement for a more natural look.
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REVISION PROCEDURES
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B+A
THE CLINIC
REVISIONS
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BREAST SURGERY Unhappy with how her breast implants looked, this 35-year-old patient sought New Orleans plastic surgeon KAMRAN KHOOBEHI, MD for a breast revision with fat transfer.
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BREAST SURGERY After a previous procedure created an uneven look, this 43-year-old patient underwent a breast lift and implant exchange with St. Louis plastic surgeon PAUL ROTTLER, MD.
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ABDOMINOPLASTY Pasadena, CA plastic surgeon MARTIN O’TOOLE, MD performed a tummy tuck revision on this 35-yearold patient to correct the poor results of a prior surgery.
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RHINOPLASTY This 52-year-old patient did not like her nasal tip after a prior surgery. Scottsdale, AZ plastic surgeon BRYAN GAWLEY, MD performed a revision for a more natural-looking result.
BREAST SURGERY This 36-year-old patient suffered from breast implant infection. Palo Alto, CA plastic surgeon DAVID BOUDREAULT, MD performed an implant exchange to create symmetry.
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BREAST SURGERY This 32-year-old patient underwent a breast lift with breast implant exchange performed by Newport Beach, CA plastic surgeon SANJAY GROVER, MD.
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RHINOPLASTY New York facial plastic surgeon EDWARD S. KWAK, MD performed a revision using a donor rib graft on this 38-yearold patient, which helped restore balance to her facial features.
BREAST SURGERY After a previous surgery left her with breasts that “didn’t look right,” this 34-year-old patient chose a breast implant revision with Atlanta plastic surgeon ASAF YALIF, MD.
Individual results may vary. Undergoing this treatment does not guarantee these exact results.
One syringe of Radiesse was used by Greenwich, CT dermatologist KIM NICHOLS, MD to reduce the visible veins in this 45-year-old patient’s hands and reverse their aged appearance.
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This 84-year-old patient sought New York dermatologist DORIS DAY, MD for a complete hand rejuvenation, which included injections of Radiesse and Fraxel skin-resurfacing treatments.
Hyperdiluted Radiesse injections, administered by Nanuet, NY dermatologist HEIDI A. WALDORF, MD, added volume and improved the texture of this 60-year-old patient’s hands.
To replace lost volume and address this 62-year-old patient’s concerns of “old-looking” hands, New York dermatologist HOOMAN KHORASANI, MD injected Radiesse into both hands.
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AVERAGE TREATMENT COST: $750–$2,500, depending on the procedure(s) performed FDA-APPROVED FILLERS: Radiesse (calcium hydroxylapatite) and Restylane Lyft (hyaluronic acid) PROCEDURE TIME: Several minutes to an hour PAIN FACTOR: Pain varies depending on the type of treatment. Topical numbing agents, anesthetic injections or lidocaine can be used to improve comfort during filler injections. Fat transfer, laser skin resurfacing, sclerotherapy and other in-office treatments may have some minimal pain and discomfort. POST-TREATMENT TIP: To ensure results are long-lasting, wear thin, anti-UV sun protection gloves while driving.
Valencia, CA dermatologist BERNARD RASKIN, MD injected Radiesse into both hands of this 45-year-old patient to minimize the appearance of veins and wrinkles and restore plumpness.
New York plastic surgeon JENNIFER LEVINE, MD used the Nordlys laser treatment to diminish dark spots and injected one syringe of Radiesse into each of this 70-year-old patient’s hands.
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From fillers and fat transfers to sclerotherapy, microdermabrasion and laser treatments, there are multiple methods to turn back the clock on one of the most visible areas to reveal signs of aging.
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HAND REJUVENATION
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B+A
THE CLINIC
H A N D S /A R M S
AVERAGE TREATMENT COST: $4,640 for an arm lift; nonsurgical treatment costs vary PROCEDURE TIME: Up to two hours for an arm lift; up to one hour per session for nonsurgical treatments PAIN FACTOR: Expect some pain, swelling, numbness, and other changes in skin sensation POST-TREATMENT TIP: Wearing a compression garment can promote better healing.
This 34-year-old patient underwent massive weight loss and was concerned about extra skin on her arms. Reston, VA plastic surgeon GEORGE W. WESTON, MD treated her with an arm lift.
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Greenville, SC plastic surgeon MICHAEL J. ORSECK, MD removed this 33-year-old patient’s unwanted arm fat with liposuction for a slimmer, more contoured look.
To address this 62-year-old patient’s concerns of drooping skin on her upper arms, Chicago plastic surgeon NIKI CHRISTOPOULOS, MD performed a brachioplasty.
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This 65-year-old patient always wore sleeves to hide what she called her “bat wings.” To boost her confidence, Mt. Pleasant, SC plastic surgeon JACK HENSEL JR., MD performed an arm lift.
To remove this 51-year-old patient’s excess skin after significant weight loss, New York plastic surgeon B. AVIVA PREMINGER, MD performed an arm lift.
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Sugar Land, TX plastic surgeon PETER CHANG, MD performed an extended arm lift on this 46-year-old patient to remove excess skin and fat to give her arms a more contoured appearance.
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ARM ENHANCEMENT
A brachioplasty (surgical arm lift) can eliminate excess fat and loose skin in the upper arms. Alternative procedures include arm liposuction, CoolSculpting and radio-frequency fat reduction.
Greenwich, CT dermatologist LYNNE HAVEN, MD performed CoolSculpting treatments to slenderize this 26-year-old patient’s upper arms, resulting in a one-inch loss around each arm.
Individual results may vary. Undergoing these treatments does not guarantee these exact results.
Newport Beach, CA plastic surgeon GORETTI H. TAGHVA, MD administered liposuction to this 30-year-old patient’s neck to define her jawline and remove excess fat under her chin.
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To address what this patient called her “heavy” neck, Beverly Hills, CA facial plastic surgeon NATALIE H. ATTENELLO, MD performed both a facelift and necklift.
Houston plastic surgeon HENRY A. MENTZ III, MD performed a facelift and necklift on this 57-year-old patient who complained of excess tissue gathering around her jowls.
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Houston dermatologists JENNIFER SEGAL, MD and SCOTT H. SMITH, MD diminished neck bands and minimized wrinkles on this 68-year-old patient’s neck using radio-frequency microneeding.
Frustrated by her “double chin,” this 47-year-old patient sought San Antonio dermatologist VIVIAN BUCAY, MD for Ultherapy treatments to nonsurgically tighten the skin.
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AVERAGE TREATMENT COST: $3,500–$10,000 for a necklift; nonsurgical treatment costs vary PROCEDURE TIME: Two to three hours for a necklift; up to one hour per session for nonsurgical treatments PAIN FACTOR: There is usually minimal pain associated with a necklift procedure. The recovery after noninvasive treatments is much less extensive than that of a traditional necklift. PRE-TREATMENT TIP: Winter is the best time to undergo a neck procedure because it allows patients to hide the area during recovery with cold weather clothing and accessories.
This 54-year-old patient sought Charlotte, NC dermatologist GILLY S. MUNAVALLI, MD for CoolLipo tumescent liposuction underneath her chin to redefine her neck and the area around her jawline.
BEFORE
To tighten lax muscles and eliminate sagging skin around the chin, neck and jowls, some variation of a necklift (platysmaplasty) is needed. In most cases, this procedure is performed alongside a facelift. Nonsurgical options to refresh the neck include neurotoxins, laser skin resurfacing and energy-based skin-tightening treatments.
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NECK REJUVENATION
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B+A
THE CLINIC
NECK
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To address this 55-year-old patient’s concerns of excess skin on her jowls, Beverly Hills, CA plastic surgeons ANDREW ORDON, MD and RITU CHOPRA, MD performed a lower facelift and necklift.
To address skin laxity on the neck, lower face and cheeks of this 52-year-old patient, New York facial plastic surgeon KONSTANTIN VASYUKEVICH, MD performed a facelift and necklift.
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This 62-year-old patient sought Palo Alto, CA facial plastic surgeons DAVID LIEBERMAN, MD and SACHIN PARIKH, MD for a facelift and necklift to refresh her appearance.
This 69-year-old patient wanted to improve the look of her lower face. Orange County, CA facial plastic surgeon CORY YEH, MD performed a facelift, necklift and micro fat transfer to the cheeks.
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Lake Oswego, OR facial plastic surgeon MARK A. PETROFF, MD performed a deep-plane facelift to address this 71-year-old patient’s sagging skin on her lower face and neck.
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Westborough, MA facial plastic surgeon MIN S. AHN, MD performed a lower facelift, necklift and skin resurfacing with Fraxel DUAL and Fractora on this 58-year-old patient.
Concerned with the appearance of slack skin, this 52-year-old patient underwent a facelift and necklift with New York plastic surgeon, ELIE LEVINE, MD to define her neck and jawline.
Berkeley Heights, NJ plastic surgeon REZA MOMENI, MD performed a facelift, necklift, chemical peel and laser resurfacing to provide overall rejuvenation for this 60-year-old patient.
Individual results may vary. Undergoing these treatments does not guarantee these exact results.
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