The Age Fix

1 YOUTH and BEAUTY

How beautiful do you feel? How young do you look? These are questions that plague my patients, sometimes more than they need to, but as a plastic surgeon, I tend to be the one people come to for the answers to their questions about how to look more beautiful and, especially, younger. They come to me looking for an age fix.

They've come to the right place. In order to give my patients the solutions they want, I've spent the past sixteen years researching the secrets of plastic surgeons, dermatologists, makeup artists, and dieticians, and I have compiled all the solutions I've discovered to nearly every beauty problem right here in this book.

But that doesn't address the real question I want you to think about as you read through these chapters. I want you to think about what beauty and youth really mean to you. Are they important? Are they too important? And do you seek them out of fear, or do you seek them out of an impulse to love and take care of yourself?

When I think of beauty, the first thing I think of is my wife. She is beautiful to me, and always will be, no matter what her age. I also think about my mom. Although she is nearly seventy, her skin is flawless, with barely a wrinkle. Yes, I may have injected a little Botox (just a little!), but she's never had any actual surgery. The real reason she looks so young and beautiful is because she eats the right foods and lives the right lifestyle, and especially because she takes care of her skin. Every time she visits me, she goes on a shopping spree in my office. This petite Korean woman brings a trash bag with her and empties my cabinets into it. This lotion, that moisturizer, that antioxidant. She loves trying new products and takes at least two of each for the road. And she uses all of it. It really shows.

But how can someone who doesn't have a plastic surgeon in the family continue to look younger and better, just like my mom has done? My mom has already given you some clues. You don't have to spend an awful lot of money, undergo painful procedures, or burn your skin with lasers. You begin with a firm foundation: a healthy life. You eat well, you move, and you enjoy yourself. And if you can use a few products, devices, and home remedies to tweak your results? All the better.

This book will be your guide. It is a collection of information about how to address every possible beauty and cosmetic issue—an antiaging resource providing information on a wide range of appearance-improving strategies from natural to chemical, simple to super-high-tech, short-term to long-term, including a dietary intervention for maintaining vitality and youthfulness. From face to feet, you'll get the inside scoop on how to bring out your youngest, freshest, most glowing self. The solutions I offer are actually fairly simple, whether you are looking to treat that small perceived imperfection that drives you crazy or do a complete makeover on your face and other parts of your body.

But I also want to emphasize that I'm not here to tell you what I think is wrong with your skin or your shape or the relative size or firmness of any part of you. I'm not here to judge how young or old you look, or to weigh in on any of the eccentricities, irregularities, and signature features that make you who you are. We all have our beauty issues, and as we age, we take on more… battle scars, stretch marks, crow's-feet, and laugh lines are all badges of honor, the beautiful patina of a fully lived life. There is nothing wrong with having any feature if it doesn't bother you.

But what if it does bother you? What if it interferes with your peace of mind, your happiness, your self-esteem (whether it should or not)? Knowing I'm a plastic surgeon, is there something you would like to tell me or show me, maybe in confidence, that you wish you could fix? Something that you wish was different—younger, smoother, smaller, larger, tighter, or higher than it is right now? Maybe there is just this one little thing that keeps you from feeling good about yourself—an eccentricity or an irregularity or an age-related alteration that you don't like when you see it in the mirror. If that sounds like you, then I'm here to help. No judgment, just solutions.

FROM DIY TO OTC TO OR

In this book, I cover many different types of techniques, gadgets, products, and remedies, and even a few procedures that can maximize your assets and help you look younger. Some of them you can make at home. Some of them you can buy at your local pharmacy. Some of them require a prescription from a medical doctor. Some (just a few) require an operating room. I offer you many options because I want you to have a lot of choices. Maybe mixing up a face cream in your own kitchen sounds like your idea of fun. Go for it! I've got recipes. Maybe spending a little extra money on a really high-quality wrinkle cream or eye cream is in your budget and on your list. Great! I'll tell you where to spend your money and where not to waste it. Maybe you are Botox curious. Cool! I'll tell you what you need to know (and allay your worst fears). Maybe having your doctor use a high-tech laser on your stretch marks or sagging skin is totally you. Awesome! I'll tell you exactly what you should know before you go.

From nose to toes, I've got secrets that will rejuvenate you, but before we get into those chapters, I want to take just a short time to explain the differences between the kinds of treatments I'll be talking about.

Several levels of intervention are possible for just about every body part you would like to improve. Essentially they come down to these four:

Some people definitely gravitate toward the natural side of things. They like mixing up their own skin-care remedies at home and saving money on a DIY approach. Others are more likely to try more intense treatments because they want faster or more dramatic results. Some people enjoy the process of finding the most effective chemical treatments, like over-the-counter creams with the latest age-reversing ingredients. Some people like the fun of technical gadgets that can make them look younger. A few people may opt for a surgical procedure. You will have your opinions, but I will give you all the best options. Generally, I recommend chemical and technical solutions as the most effective, but I like many natural treatments, too. I'll give you the information you need. Let's talk about each one of these so you can best choose, in any of the following chapters, which kind of intervention will be best for what you want to do.

Natural

Natural methods are the least invasive. Unfortunately, they tend to be the least effective. However, there are some notable exceptions, which I will mention in this book—natural treatments that really do make a noticeable difference. This is good news, because a lot of people are very interested in natural treatments. I receive inquiries all the time from people seeking suggestions for less expensive, easier alternatives to the skin-care products and treatments that we sell in our office and that I've shared on TV. Many of these inquiries come from people for whom paying $20 for an over-the-counter retinol cream would be a stretch.

I once received a handwritten letter from an older woman who complained about terrible sun spots. She lived on a fixed income in rural Ohio and was hoping that I had a solution for her. She wrote, "I'd love to buy the ZO stuff you've talked about on TV, but to afford it I'd have to cancel my weekly Bunco night at Cracker Barrel with the ladies!" I wrote her back and told her to try one of the recipes you'll read about in chapter 4. It costs only pennies per application and, given enough time and dedication, can create some really nice changes. Four months later, I received a thank-you card with "before" and "after" photos of her. She looked great! Although some of her sun spots were still there, she had a definite improvement and was very happy. She recommended my sun-spot treatment to all her Bunco friends. So if you see a bunch of sun-spot-free faces at a Cracker Barrel Bunco party in rural Ohio, you'll know exactly what they're putting on their skin.

Making your own skin-care products at home is just one way to use natural treatments. Occasionally you can buy products with natural ingredients, but to me, natural remedies also include lifestyle shifts, like eating natural foods to look younger and practicing stress-management techniques to relax worry lines. I provide many recipes for homemade products throughout this book, and I share only those that I believe actually make a difference—but not every remedy works for every person (and that doesn't just apply to natural remedies). However, if you are oriented toward natural products, then you will want to look out for these.

There are some definite advantages to natural treatments. For one thing, you will avoid exposing your skin to too many of the negative aspects of commercially available products, like potentially harmful additives, including dyes, fragrances, preservatives, or other chemicals that could cause an allergic reaction. Natural products also tend to be much less expensive than commercially available options. The problem with many natural options you might hear about out in the world (and especially on the Internet) is that they don't really do anything. For example, there are some ingredients from your own kitchen that really do make a difference, like yogurt, but others that don't, and still others that may actually cause an allergic reaction just as distinct as one you might get from a commercially available product.

Unfortunately, there isn't an all-natural (or even a nonsurgical) solution to every cosmetic problem, but when they work, they can be a nice and inexpensive option.

Chemical

Chemical treatments include things like chemical peels, prescription treatments, and commercially available skin-care products. Although nonsurgical and generally noninvasive, in many cases they can dramatically reverse aging. I once had a patient, Candace, who came in to see me for a facelift. She was in her late fifties and complained about wrinkles and fine lines on her face. She also didn't like the subtly loosening skin on her neck, her age spots, and her sun damage. I thought Candace was an appropriate candidate for facelift surgery, so we made plans to perform the operation six months later, at the time of her preplanned vacation. She asked me if, in the meantime, there was something she could do to improve her skin prior to surgery.

I started her on a combination of tretinoin, 4% hydroquinone, and alpha-hydroxy acid creams, at a total cost of less than $200. Three months later, Candace called to cancel her surgery. She was so happy with how much better the combination of creams made her skin look that she felt she no longer needed the facelift. She saved over $8,000, didn't miss a day of work, skipped going under the knife, and, best of all, looked great.

The advantage of chemical treatments over natural treatments is that they tend to make a more dramatic difference in less time. Natural products are gentle and slow, and chemical treatments can be too harsh for some people, but when they work, they tend to work pretty well. I recommend many chemical treatments throughout the next few chapters that I like and believe to be quite effective.

Of course, chemical treatments don't always work for everyone, usually because people may react poorly to them. Some chemical treatments may be too harsh, causing irritation, rashes, itching, or peeling. In some cases you might be able to find a less intense version of the same treatment. After seeing the great results that Candace achieved with my cocktail of skin creams, I decided to recommend that same combination to my mother. If it worked for Candace, who had terribly damaged skin, how great could it make my mom's skin, which was nicer than the skin of 95 percent of women her age? Not nice at all! She reacted horribly to it, she developed a rash, and her skin flaked off all over. She looked like she'd forgotten her sunblock and fallen asleep while sunning herself on a beach in Mexico. As many people can attest, hell hath no fury like a Korean mother whose face looks like the inside of a pomegranate! I started her on soothing moisturizers and steroid creams, and she wore a surgical mask over her face in an attempt to hide the shame. Within two weeks, her skin finally cleared up, thank God! (My dad and I were also extremely thankful!)

Technical

Technical intervention is fun for those of us who like gadgets. These treatments can be divided into two groups: at-home and in-office. These days, consumers have access to all sorts of at-home gadgets that promise results similar to those we get with the treatments we perform in our offices. These devices range from the tried and proven (such as at-home microdermabrasion) to the large, bulky, and sometimes unrealistic (an at-home version of our in-office cellulite treatments). Then there is the advanced technology (like home laser hair removal) and devices that are just plain ridiculous (like a device that supposedly causes your nose to change shape). While none of these gadgets can typically approach the results of surgery or in-office treatments, some of them can be a valid alternative for people who want to save money and address issues in the comfort of their own homes.

In-office cosmetic treatments are now a multibillion-dollar industry. What started back in the 1990s with simple but effective CO₂ ablative laser resurfacing has expanded over the last several decades to include laser hair removal, wrinkle reduction, skin tightening, tattoo removal, acne reduction, and even what I call the Holy Grail of Plastic Surgery: noninvasive fat reduction. Yes, you can now lose fat and inches without having to diet or exercise! It's amazing how far in-office technology has come. In fact, according to the American Society of Plastic Surgeons, over the last dozen years the number of nonsurgical cosmetic procedures performed in the United States has increased 144 percent, while the number of cosmetic surgeries has actually declined 12 percent! Today, it's all about getting results without going under the knife.

Unfortunately, sometimes the hype of these technological devices precedes proof that they actually work. In fact, some device manufacturers use what is essentially a flaw in the approval system to allow them to sell and even market devices that are declared safe, but not necessarily effective. Cosmetic medical devices can be considered "FDA-cleared" or "FDA-approved." A device can be considered FDA-cleared if the manufacturer and the FDA agree that it is very similar to another device already on the market and is deemed safe to use. Becoming FDA-approved is a more rigorous process, used for devices for which there aren't other, similar approved models on the market. What makes it even more confusing is that some devices may be FDA-cleared for one indication but used and marketed by physicians for a completely different indication. For example, some devices may be FDA-cleared for pain reduction, yet plastic surgeons use them to reduce fat.

So the big question is: Which devices actually work? Plastic surgeons and dermatologists have an inside joke regarding obsolete devices or ones that never worked in the first place:

Many older plastic surgeons have several of these types of devices sitting in their offices gathering dust. I once had a plastic surgeon who worked in my building move out to a different office. On his way out, he dropped off a skin-rejuvenation machine that he had bought about eight years earlier for approximately $60,000. The device claimed to tighten the skin by deep-heating it, and was even heavily promoted on TV talk shows. He told me that he couldn't figure out how to get good results with it and ended up bequeathing it to me as a gift. "Maybe you can figure out how to get people happy with this," he said. Well, I'm not one for using old technology on my patients, especially technology that was never proven to actually, consistently work, so it sat in my storage room for months. I finally decided to put it on eBay and sold it for $4,500 to a laser-refurbishing company. I used the money to make a down payment on a fence to keep the scary dogs next door out of my yard.

In the upcoming chapters I will give you tips and advice on which devices work, which ones don't, and which ones on which the jury is still out. I hope I can keep you from wasting money and get you on the right track to using technology to remove the years. Because you may need that money for a fence.

Surgical

None of my patients actually want surgery, and I don't want to perform surgery on them. Surgery always has risks, and unless there is absolutely no other option available, I would prefer to do something less invasive. Sometimes this is the case.

A couple of years ago, a man came in for a consultation. He wanted to smooth his nasolabial folds. These are the lines that extend from the sides of your nose to the corners of your mouth, and they are typically shaped like commas. He was very flustered and said he had tried everything to get rid of them. He even went to one of those chain facelift centers (you know, the ones with half-hour infomercials on Saturday morning cable TV) and asked them for suggestions on how to treat his nasolabial folds. The "patient consultant" convinced him that their special lunchtime facelift would do the trick. She even pulled his cheeks back to show him how his comma signs would go away. After he'd paid $6,000 and undergone a painful two-hour operation, his nasolabial folds were still there. But now he had god-awful permanent scars around his ears to show for it. When he complained about it, the medical assistant told him that the doctor was no longer available to see him and that there was nothing else they could do. That was when he came to see me.

After $550 and one syringe of Juvederm, his nasolabial folds were gone. That was all he needed in the first place. Any plastic surgeon worth a nickel knows that facelifts don't treat nasolabial folds. Injectable fillers do. He emptied his bank account, underwent painful surgery by inexperienced hands, and gained permanent scars for nothing.

In other words, there are many, many times when surgery is not the answer. Most of the time, there are valid and even highly effective noninvasive solutions. The only major exceptions, which I will explain later in this book, are for breast augmentation, excessive hanging stomach skin, and drooping upper eyelids. In these cases, surgery is the only really good option if you find you can't live with your issue. Otherwise, you should never need to go under the plastic surgeon's knife, at least for antiaging issues. There are so many other fantastic and effective treatments you can explore that surgery can simply be a nonissue.

Doing Nothing