Beyond Beautiful

Introduction

Appearance is anything but superficial. Think about the days when you feel your most beautiful. What do you love about those days, and when does that “beautiful” feeling start? Is it with a caress of your soft, smooth skin when you first wake up; receiving a kind word from a friend, partner, or even stranger; or being pleased by your reflection in the mirror? This book is about improving your most important relationship—the one with yourself—in order to be your radiant best and enhance your presence in the world. To achieve these things, you must not think of the mind-body-skin connection as the meeting of three separate entities. Rather, consider that your mind, body, and skin are one and the same. This means that what you see, whether in the mirror in front of you or in your mind’s eye, is a reflection of the natural condition of your skin combined with the effects of specific life events and stressors.

When you look tired, sad, or “old,” you have a rash, an acne breakout, or flare-up of psoriasis, pay close attention: your skin is also transmitting information about what’s going on physically and emotionally. Some stress is heuristic and can work to protect your skin, your body, and your mind, but in many cases it triggers a negative cycle that accelerates aging. It is only through understanding and properly addressing the source of our stress that we achieve lasting results, optimal health, and true beauty. It’s not as hard as you might think and I will guide you through, step by step, on your personal journey.

I like to think of myself as a skin whisperer, helping to reveal and enhance skin’s beauty by identifying and addressing what’s aging it or causing it to look anything less than its healthiest and most radiant. I will teach you how to respond to this information, as well as show you the best ways to treat various skin conditions so you can always be your healthiest, feel your most beautiful, and look your very best.

I’ve been a board-certified dermatologist for more than twenty years, treating everyone from kids and busy moms (and dads), to celebrities, models, and CEOs. I’ve also worked in a research lab at New York University and have helped develop several skin care lines for major brands, including Estée Lauder Co. I take health, skin care, and beauty very seriously, and the radical idea fueling my approach is that by being aware of every aspect of our lives—genetics and internal and external stressors—we can change our skin and live the best lives possible. This belief, as well as my studies of philosophy and the humanities, has informed my years of medical practice, journalistic endeavors, and medical research to the acclaim of both my patients and peers.

My techniques are based on the latest scientific understanding of how we age and combine the most cutting-edge, nonsurgical treatments with the best ingredients and supplements to help you age beautifully. You should not consider having another treatment or procedure or buying another product before reading this book.

In addition to being something of a medical detective, unearthing the true nature of my patients’ health from the clues their bodies provide, I also consider myself a doctor of self-esteem. Sheryl Sandberg, the CEO of Facebook, advised women to “lean in” in the workplace. Well, I’m challenging you to “dive in” and examine all aspects of your life to understand how they equally contribute to your body and your skin’s reflection of you. The results of my treatments have been life-changing for my patients. And now you can experience the same results.

Throughout this book I will show you how to unlock the power of the mind-body-skin connection for yourself, explain the best treatments available, and explore what the future of skin care and beauty holds. I’ll share many fascinating stories of patients who have experienced and beautifully overcome many of the same problems you may be experiencing right now. If the advice I gave them helps you, too, I will have done my job.

I know many of you reading this book are searching for the best and most lasting ways to prevent aging, recapture your youth, or freeze time. You are not alone. In a 2017 consumer survey of over 7,300 people done by the American Society for Dermatologic Surgery, nearly seven in ten people surveyed said they were considering a cosmetic procedure. The top three reasons given were: (1) I want to feel more confident; (2) I want to look as young as I feel; and (3) I want to appear more attractive.

Substantial advances have been made that put reversing, and even preventing, much of the aging process well within reach of the average American. We can save the skin from damage, control and complement the repair of existing damage, and improve strength, resilience, tone, and clarity. One method uses the power of nonsurgical approaches to help you look and feel your best, what I call syringe therapy. Used correctly, it has great potential to help you age beautifully and look more like the way you feel inside. But used indiscreetly as a weapon against aging, in an attempt to wipe out any hint of a line, wrinkle, or hollow, it can leave you looking older and artificial. Sadly, when I look around, I’m struck by obvious cosmetic mistakes, from overfilled lips and cheeks to clearly missed areas that leave the face looking unbalanced and “done.” I call that syringe therapy gone wrong.

There are several reasons why a specific treatment may fail. The first is a lack of knowledge. This reason is two-part. On the one hand, science still gives us only a partial understanding of all the processes that age us.

On the other hand is the fact that you can optimize but cannot change your genetics. This means you need to alter your perspective, learning to examine your beauty with the same fine-tooth comb you use to scrutinize your flaws.

The third reason treatments fail is the emotional component. This is problematic when the way we “see” ourselves drives us to change our features, as if changing them alone will change our lives and how we feel about our lives.

And finally, there’s ineptitude—unfortunately, there’s always someone who’s willing to forgo basic aesthetic principles and add a little or a lot, here or there, whether or not you need it, to make a buck. In the hands of these practitioners, the patient ends up looking like a caricature of themselves, and in the worst case, entirely unlike the original version of themselves. I’m here to help you accomplish your aesthetic goals successfully, safely, and effectively.

Do your homework, which you are doing now by reading this book! You should research the experience and training of your physician, get recommendations from friends and other doctors you trust, and, most importantly, don’t cut corners. It is very important to see a trained aesthetic physician such as a dermatologist or a plastic surgeon rather than shop for the best price for treatment. It takes years to learn the art of rejuvenation, and continued study to hone the skills. The products themselves do not create the results, just as fabric does not magically fall into place as haute couture fashion on its own. Rather, just as gifted designers craft fabric to fit your body perfectly, we use our tools of fillers and devices to reflate, restore, and enhance your most natural and beautiful self.

A central theme of this book, which I mentioned above, is that there is an emotional component to the way we “see” ourselves, which drives our desire to change our features, as if altering them will also transform our lives.

An excellent example of this came from a woman named Debra who called my radio show, the dermatology show on Doctor Radio, asking about a Botox Cosmetic treatment for her son Jim. She told me and my listeners that Jim was twenty-three, and she casually asked about treatment options to help raise his drooping brows, which she said were negatively affecting his self-esteem. My guest expert, a plastic surgeon, gave a thoughtful account of all the ways the brows could be lifted: through injections of Botox Cosmetic, undergoing a surgical brow lift, and with devices.

I coaxed a little more background information from Debra. I hoped to uncover the internal catalyst driving her son’s, and maybe even her own, particular concern. I asked Debra if the appearance of her son’s eyebrows had been present since birth, if there was a trauma that had coincided with his brows beginning to droop, and how much her son really minded the look of his brows versus her minding it. She surprised me by replying that the noticeable drooping of her son’s brows was present at birth, and the issue was that it made him look like his dad. That caught me off-guard and required further discussion in a direction that was new for me too.

Upon my further, gentle questioning she told me, with great bitterness in her voice, that she had divorced her husband when their son was two. Her husband had since been absent, as well as in and out of incarceration. The picture started to come into focus. It was no wonder this young man was concerned about looking like his father. He may have felt that any resemblance to his dad would make him act like his dad. And given the feelings his mom seemed to have about her ex-husband, as suggested in the tone of her voice, he may also have harbored concern that his appearance could alienate him from her.

My guest and I encouraged Debra to consider how her feelings and her son’s fears might be bigger than the physical concern. As we spoke she became increasingly animated, discovering out loud her husband’s impact on her son, and how she might have been complicit in allowing her son to feel bad about his features. I could hear the tears in her voice as she recalled the suffering her son had experienced, and as she understood the better path for her son, and even herself, would be to talk about their experience so that, rather than changing his features, they could change what they symbolized. She was so happy they hadn’t pursued treatment for the brows before she called in to the show, because a purely physical treatment would not have addressed the underlying issue.

Jim’s brow issue illustrates the importance of understanding that looks and personal relationships are deeply reflective of each other. The skin can evoke the glow of love, the burning redness of anger, or the calm serenity of acceptance. As we go along, we’ll dig deeper into this connection. I will show you how to identify negative emotions and their potential effects on your appearance, and I’ll highlight and help redirect you down the path so you can see and feel the wonderful impact your healthy relationships have on how you look.

How you perceive your appearance is not solely about what’s external. Before you have a cosmetic treatment, or another treatment or procedure, I want you to consider that there is an internal component driving what you would like to change about your looks. Once you acknowledge it, you’ll be able to maximize the benefits of your treatment and enhance your unique, natural beauty with longer-lasting results.

Stressed Out or Stressed for Success?

We all have stress, whether it’s at home, at work, or in our social lives. It’s an inevitable part of living and not always necessarily negative. Sometimes stress is a natural result of pushing ourselves out of our comfort zone so we can grow and improve in our lives and the lives of those around us. However, recognizing the stressors and how we handle them is what makes all the difference and affects us in ways that we need to understand.

Since ancient times we have used the fight-or-flight response, which produces several hormones, including cortisol, in situations of danger. The fact is, you don’t actually have to be threatened to feel that you are. The mind is a powerful tool that can help us handle myriad situations and control our body’s response to nearly everything we are exposed to. Over our lifetime, we build millions of memories that are stored in different parts of our brain, immune system, and other organs. These memories affect, for better or for worse, how we respond to situations. What I will help you discern is the direct connection between a particular stressor and the visible physical reaction to it. It’s no accident that you are breaking out in sweat, rash, acne, or hives, or shedding hair. Ask yourself: Why is my stress showing up where it is and in the way it is? Why is it showing up now? Understanding the mind-body-skin connection involves getting to the source of your skin problems and finding the best ways to treat it, along with identifying the best treatments available to help the condition clear as quickly as possible.

I’m going to show you how your self-image and specific skin concerns do not form by accident. These issues are deeply rooted. You’ll learn how to decipher what your skin ailments really mean—from hair loss and rashes around the eyes, mouth, or hands to acne to how you see yourself aging. I’ll also help you employ a mindful approach to healing, to extend the results from any treatments and help you avoid future recurrences of problems. And I’ll share practical ways anyone can improve their look, for example, with facial yoga exercises to tone, tighten, and energize your skin. I’ll also explain how exercise and nutrition can give your skin that healthy glow.

Your skin is all-revealing, and beautiful, radiant skin equates with healthy skin that is well cared for. You might find that you have an easier time developing and maintaining great skin than others because of genetics, but the better care you take of those genes, the more it will show in your skin.

The ultimate goal is to age gracefully, not helplessly. This is your best chance to take optimal care of your genetic gifts to age naturally and beautifully. I want to help boost your self-image so you can put your best face forward and live up to your genetic potential. Whatever you decide to do next, please don’t feel guilty about wanting to take care of yourself. It doesn’t mean you’re any less serious about or devoted to your other life obligations.

After you read this book, the next time you look in the mirror you’ll understand the real reasons for what you see and how to fix what you want to improve. The most important way for you to attain the look you want will be by digging deeper, while also addressing the surface changes to your skin. And remember, you didn’t get here overnight, so you don’t need to (and probably won’t be able to) fix it overnight. Natural and beautiful results take time but are worth it and will last, because they are part of a complete package called YOU!

MY STORY

Everyone has a story—or several stories, good and bad—that affects their lives in powerful ways. Here are two of mine.

At the age of sixteen, my sister Adriane died. She was also my best friend, and in many ways my responsibility, even if I was only eighteen months older. I was the elder sister, but I saw her as prettier, way more self-assured, and wise beyond either of our years. Growing up we shared everything—a room, our clothes, our toys, our records, and our friends. We were inseparable, and while we had the usual sisterly spats, at night we often wound up in the same bed, talking, laughing, and snuggling until we fell asleep.

One day when she was nearly fourteen, she showed me a firm lump in her left bikini fold. She said, “Don’t tell anyone.” I was frightened by what I saw and could sense that something was clearly wrong, but she made it clear that this was to be our secret so I kept my word and told no one. I was too young and innocent to know how sick she was, and never for a moment thought it could kill her.

Over the next few months she continued to lose weight and experience unexplained fevers, and the lump continued to grow to the point where it was no longer possible to hide from our parents, who immediately took her to the doctors. Within a week the diagnosis of advanced non-Hodgkin’s lymphoma was made. She spent most of the next six months in the hospital, where she suffered through agonizing round after round of the most powerful chemotherapy available and high-dose radiation to avoid the spread of cancer to her brain. The result was waves of nausea, intense and unrelenting pain, both from the cancer spreading and from the treatments and tests that go along with it, organ failure, swelling of her body almost beyond recognition—and all to no avail.

One of the moments that stand out to me occurred early in her treatment. I remember going with her to buy a wig for when her hair would fall out from the treatments. Her hair was her pride and joy; it was long and beautiful, and she took great care of it her whole life. She broke down in tears when she saw it coming out in clumps. It caused her as much pain and agony as any treatment she had to endure, and to this day it still brings tears to my eyes to think of how sad it made her. (I treat hair loss in my practice, and I do my best to help anyone else in that same predicament, from any cause of hair loss.) She was wise way beyond her years, and her suffering, through all the treatments, only to die in the end, was a part of her life that I would need years and years to understand and come to terms with.

Losing someone you love takes enormous mental effort and persistence to pry a space between wishing there was a way to erase their suffering and bring them back, and to let the good memories in and to move forward. Over the years, I continued on my own life journey and tried to mask the pain I felt. But it was there and it showed through in its own way, over and over, through a fifty-pound weight gain that was apparent to the world, and in a more subtle but powerful way I saw in my eyes. The most obvious and clear expression of sadness is tears, but I had none. I felt guilty and numb and scared, and I wondered if I was even capable of love if I wasn’t capable of shedding a tear over the suffering and loss of my dear sister. Secretly, I also wanted to look older than my years. I know it seems like a strange thing for a young person to wish for, but at the time, I thought that wisdom came with age and it would help me understand what had happened and make it less painful. I wanted to see things differently, and I wanted my lids so heavy they would cover my eyes and my guilt at not being able to save my sister or protect her from harm.

Looking back I know it’s because I didn’t want anyone else to see how I had failed my sister: failed to keep her safe from harm, failed to support her, to be there for her as she suffered, because I was afraid of what I saw. I now realize these were fears based on the fantasy that I had control over what happened, but I didn’t accept this until much later in life.

When I finally hit my rock bottom of despair, fifty pounds heavier and feeling totally alone in the world, I realized I had a choice: I could keep going as I was—lonely, uncomfortably heavy, and sad—or I could do something different. It was time to rise above the hurt and negativity and dedicate my life to something positive, to educating and healing others.

My mission became to honor my sister’s memory by doing anything I could to help others see the good in any circumstance, even if there was no good in it at all, starting with themselves.

As an English major at Barnard College, I took courses in literature and philosophy, which helped save my life and shaped my future. My healers were my professors and great writers and thinkers like Kant, Nietzsche, Schopenhauer, Kafka, Mann, Shakespeare, Chaucer, and so many others who portrayed humanity, gave purpose to suffering, and helped me to climb out of my abyss.

I then went on to become a medical journalist, at least partly so I could share my sister’s amazing story of strength and dignity and write about hospice care, advocate for quality of life over longevity for its own sake, and explain how illness and medical treatment should involve the entire family, including the individual patient even if they are a child. I also wanted to contribute to changing medical care by becoming a doctor and being my patients’ strongest advocate and protector in any way I could.

My love of medicine was also passed on to me at an early age by my father, who was an anesthesiologist. He was a healer and an educator (in addition to being a poet and a wonderful singer). He started practicing medicine during the 1950s and was far ahead of his time regarding his understanding of health, diet, and even skin care. My dad had seen his older sisters age radically at a relatively young age from sun exposure. He was an advocate of using sunscreen and physical sun protection long before it became fashionable. He made sure I never purposely tanned. He also understood the power of nutrition. He always told me, “Never eat after 8 p.m.” And science has finally caught up with him. Studies show that if you do all your daily eating within a twelve-hour window, say, between 8 a.m. and 8 p.m., you have a better chance of losing weight and staying healthy than if you consume the same number of calories over twenty-four hours. He also knew the power of exercise and took daily eight-to ten-mile walks.

My dad loved his work and loved sharing his knowledge and seeing the difference that made in others. Sometimes people didn’t want to hear that they needed to lose weight or quit smoking, but he found a way to reach them. He taught me to respect the inextricable connectivity among the mind, body, and soul. As a teenager helping out in his office, I remember his saying, “You can’t just count on the textbooks—anyone can learn the science. You have to learn how to take care of the person in front of you. Some people are anxious and need you to talk to them about their family and get to know them. They have to trust and have confidence in you so you can take the best care of them with as little medication as possible.”

The confidence and calm he instilled in his patients, just by talking and asking questions, is something I incorporate into my own practice. One of the most important lessons my father taught me was how to be a better doctor by treating the whole person. I can help others heal by encouraging them to better understand themselves and learn how to live in the moment.

The credo that I follow is: “For every regret, you should do ten things differently going forward so that regret becomes a blessing.” And for all my regrets about not being there for Adriane in the way I wanted to be and wished I could have been, I can open my eyes, now genuinely older and wiser, able to do so many things differently based on what I’ve learned and experienced, and with gratitude for having had her in my life.

My father taught me the most important lesson in the last weeks of his life. On February 12, 2013, at the age of ninety-one, he was out on one of his daily walks around New York, the city he loved, when he was struck by an SUV that had lost control and swerved up onto the sidewalk and pinned him to the wall near the entrance of Saks Fifth Avenue, on Fifth Avenue and 50th Street, at 11 a.m. on a Tuesday morning. People posted pictures on Facebook of the scene, with comments saying one person was hit and killed. None of us had any idea it was my dad or that the reports were wrong and he was still alive. I got to the ER just as Dad suddenly and rapidly decompensated. He was surrounded by doctors and residents frantically working to resuscitate him. He was dying. I was shocked to see him in such a bad state since just shortly before I had been told he was under observation, alert, and stable. I ran to his side, begged, pleaded with him, and outright sobbed while telling him over and over again, “I love you, I need you, you can’t die like this, not now, I still have so much to learn from you!” I was desperate for him to hear me say those words and to hear me thank him for all he had done for me before he died. I knew it meant as much to him as it did to me.

The doctors were kind enough to let me stay. They could see Dad was responding to me; his pressure started to come back up and he came back to life. He survived another seven weeks and was fortunate to have suffered only a minor stroke and no internal injuries. But ultimately his ninety-one-year-old body could not overcome the trauma of all the broken bones, stress, and complications of life in an ICU, even though he was in otherwise excellent health.

In those seven weeks my mom never left his side. My brother and our spouses and children frequently came to visit. I was there every day on rounds helping to oversee his care, ultimately making the choice to accept hospice care to help him pass in peace, knowing how much he was loved and would be missed.

The greatest gift during this time was being able to tell him “thank you” and “I love you” and hearing him tell me he was proud of me and that he loved me. I was so grateful to be able to take care of him and not feel helpless as I had with my sister. I could help direct his care and make sure he was as comfortable as possible. He taught me about dying with dignity and that it is merely a transition, not an end. He told me I saved him, and he said his good-byes to everyone before continuing on his journey beyond this life.