Joan wasn’t getting any younger, and she had the wrinkles to prove it. Though Botox had helped to smooth the fine lines on her forehead and around her mouth, the doctor insisted it was a bad idea to inject her with Botox Cosmetics around the eyes (it could leave her with that terrible partial stroke, Mary Jo Buttafuoco look). This was horrible, as the crow’s feet around her eyes were so big they had varicose veins. So she was thrilled to learn that dermal fillers injected into the skin would eliminate them. But again, that meant injections, and Joan hated needles!
Joan decided she was going to do it her way, so she went to the Home Depot for some caulking. She figured if it could keep a shower in a pre-war walk up from leaking and looking brand new, surely it could smooth out her rough edges.
Once inside the Home Depot, with the help of a butch lesbian couple shopping for lumber for their new shed, she was directed to what she needed for her own secret fountain of youth: acrylic bathtub caulk! Joan had a choice to make, though: beige or fawn? She selected the sealant that most resembled her complexion and generously applied it to the avian footprints around her eyes. The caulk was nice and dry when she arrived home. Joan excitedly wiped the caulk from her crow’s feet only to be struck with horror to see that the result resembled the dirty grout of a crackhouse bathroom. She knew it was time to call a dermatologist, and quickly!!
Clear, smooth skin is the foundation of beauty. We call makeup “foundation” for this reason. A shining, radiant face—unlined and well rounded—triggers just about every receptor in a man’s reptilian brain. When he sees a fresh-faced woman, he instantly knows she’s well fed, healthy, active, young, fertile, carefree, and not tormented by crushing anxieties. (Men are pre-programmed to avoid women with “issues.”) An open face is an open invitation.
Our skin is our canvas. Even perfect facial features don’t look good on spotty, wrinkled, and sagging skin. You could have the biggest, juiciest lips in creation, but they wouldn’t look so alluring if rimmed with cracks and tiny creases. The most adorable nose in the world doesn’t look so delicate with deep trenches extending down from the nostrils to the corners of your mouth. Your forehead might be ivory, but it won’t gleam in the light with gash-like horizontal wrinkles running across it.
Fine lines are not fine at all. Okay, yes, yes, I’ve heard the argument for lines and wrinkles, that they’re “badges of honor,” the “sign that you’ve lived a rich, full life,” or that you “demonstrate your feelings with your face.” Congrats for being an emotional person. But most of that was said before facial fillers arrived on the scene.
Now, we no longer need to justify the existence of wrinkles… we can get rid of them!
Although emotions and expressions are how we experience our lives and communicate with others, they wreak havoc on your skin. Make an expression enough times, it’ll be etched on your face. The parentheses between your eyebrows? Frown lines. Smile a lot? You’ll get crow’s feet, the lines by the corner of your eyes that look like bird footprints in wet cement.*
Some of you might remember an old “Twilight Zone” episode, one of my faves, where relatives of a dying man were told they’d get their hands on his fortune only if they spent the entire night in his mansion wearing hideous masks. The masks were exaggerated versions of their true personalities: pathetic, morose, hateful, angry. Anyway, the greedy relatives all stuck it out in the mansion until morning and were granted their inheritance. But when they took off the masks? Their faces had turned into the masks’ shapes. They were rich but doomed by horrible, disfigured faces.
This show was made, clearly, in the days before plastic surgery. Nowadays, the greedy relatives could wear the masks, take the money, and then spend a chunk of it fixing their faces back.
I tell this story because, by age sixty, our faces do turn into the masks of our true personality.
I’ve never tried the popular filler Restylane. It lasts a long time, but you get bruising, so that doesn’t work for me. I do collagen injections, however: I can get a shot in the morning, and I can be on camera in the afternoon. I also have some collagen on my chin to get rid of dimples. It’s not a Shirley Temple dimple. More Shirley Bassey. Also, I’ve had injections around my lips.
It’s a tragedy to have smoker’s lips when you don’t even smoke…like doing the time without committing the crime.
Our faces are maps of our expressions. Luckily these days, for many women, that map leads them directly to a good dermatologist, who has fillers to erase the lines, take a decade off their faces, and recalibrate the way the world looks at them and—most importantly—how they look at themselves.
All this can be yours for less than a thousand dollars. Go ahead and smile. Those crow’s feet can’t hurt you anymore.
From HELL, of course.
Besides habitual facial muscle action, there are four main skin enemies: 1) sun damage, 2) smoking, 3) gravity, and 4) aging.
1. Sun damage. You know how putting a plant under a sun light makes it grow faster? Well, spending a lot of time in the sun does the same thing to your face, making it age faster.
Therefore, the only times it’s safe to leave your house are after dark and/or during a solar eclipse.
The UVA and UVB rays are especially damaging when you’re young, before age twenty. That wicked sunburn from Daytona, Spring Break ’85 can’t be undone. Sun damage after age twenty? It’s not as severe, but be careful just the same. Besides causing wrinkles, the sun also causes cancer.
Who cares if you’ve got gorgeously tanned skin if you’re dead? But if you’re still alive, use an SPF 15 moisturizer …every day! You can’t be too careful. If I could, I’d use SPF 322,000. (In a confusing twist, now doctors are telling women to get more Vitamin D and are recommending they sit in sunlight for fifteen to twenty minutes a day! Consider it the RDA of daytime.)
2. Smoking. What’s even worse than lying out on the beach? Doing it with a cigarette in your mouth. Can I just say, not to lecture, that smoking is like committing harakiri to your skin. You might as well stick the lit end of the cigarette into your cheek. A decade of smoking will do no worse. The smoke literally draws out precious moisture and stymies collagen production, drying your skin and sapping its strength, especially around the mouth.
What man is going to want to kiss a pair of cracked, withered, grandma lips—when you’re only thirty-five?
For your skin’s sake, quit smoking. Otherwise, don’t blame me when, for your lips, forty is the new eighty.
3. Gravity. Well, it’s no rainbow. Your face droops and sags, just like your boobs and behind. The natural pull toward the center of the earth would not be so bad if your skin weren’t progressively weaker, too. Which brings me to …
4. Aging. As we get older, our production of collagen (what makes your skin firm) and elastin (what makes it springy) slows down. Without as much connective tissue holding our skin up, fighting gravity is next to impossible. Your skin can only take so much of the onslaught before it succumbs.
And that, dear reader, is where wrinkles come from.
How to send them back to hell? Read on.
Each wrinkle is unique. They’re like orgasms. Some are deep. Some are shallow. Others make you scream. Unlike orgasms, however, when even a bad one is still pretty good, there’s no such thing as a good wrinkle. They’re all bad, unless you’re a shar-pei.
Wrinkles come in a variety of styles:
1. The least horrible are called lines. They’re shallow and thin, little whispers that say, “I’m barely noticeable now, but just you wait!”
2. The basics are called wrinkles, deeper and clearly visible on your forehead, around the eyes and lips.
3. The biggest kind are called folds. There are the deepest creases, including the nasolabial fold, which is the trench that runs from your nose to the corners of your mouth.
Another set of folds is charmingly referred to as “marionette” or “Howdy Doody” lines, which extend from the corners of your mouth down to your chin. They make you look like a wooden puppet with a moveable mouth that’s saying, “Help me! Help me!”
The easiest way to identify the distinction between lines, wrinkles, and folds is their depth …as in, how deeply you hate them.
A quickie reminder from medical school: Our skin, the six-pound organ of human tissue that covers our entire body, has many purposes. Protection, insulation, regulating temperature, providing a home for hair follicles and sweat glands. It comprises three main layers: the epidermis is what we show or hide from the world, our birthday suit; the middle part, or dermis, is connective tissue, the infrastructure of our skin; underneath the dermis is a subcutaneous layer of fat that cushions our skin against the muscle beneath that.
Aging (and for sun goddesses and smokers, make that premature aging) takes place on all three skin levels. It’s a systematic breakdown. On top, the epidermis loses 10 percent of its cells per decade. Fewer cells mean the skin gets thinner. The thinner the skin, the less it’s able to hold moisture.
No moisture = dryness.
Dryness = wrinkles.
Got it?
In the middle, the dermal layer takes a staggering hit by the passage of time. The dermis’s collagen and elastin fibers, the network of support that holds your skin together, gets thin and stretched. Imagine a once-taut circus net slowly sagging and sinking to the sawdust-sprinkled floor. Also, sweat glands’ productivity slows, and your natural oil reserves dry up.
I don’t need to repeat—but I will—that dryness is next to wrinkliness.
Last, the fat layer underneath your skin also thins with age. Ordinarily, I’d say, “Great.” Thin is in. But, on your face, the fat layer fills out wrinkles and holds up your cheeks, forehead, and chin. Without fat to fill you out, wrinkles will show in high relief, and your skin will sag, which creates not only more wrinkles, but deep, devastating folds.
As a veteran of the anti-aging war, it’s my duty to deliver the harsh truth about skin aging. I don’t like doing it. But I feel I must. Nature has a way of robbing us of our youth, bit by bit, and that’s the sad reality of life.
Fortunately, the happy reality of science is that we can turn back the clock with a needle.
Dermal fillers are the rage. Why? They do for you what over-the-counter creams and lotions wish they could, but don’t. The use of injectable fillers is often called a “liquid face lift.” You can take five to ten years off your face, for a fraction of the cost of surgery, with hardly any risk. No knives. Only needles.
That said, fillers are great for forty-five-year-old women who want to look thirty-five. Not so great for sixty-five-year-old women who want to look fifty-five. By the time you’re sixty, using fillers won’t be enough. You can’t rebuild an entire house using caulk. You need beams, bricks, the heavy-duty structural goods that a surgical face lift can provide. (See Chapter 7: About Face Lifts).
We all know what happens when a trend gets popular. The marketplace is flooded with product. Everyone—and his grandmother, her dog, and the dog’s grandmother—wants a piece of the action. In the twenty years since collagen was first injected into a woman’s face, dozens of facial fillers have become available. And dozens more are on the way. What I’m including in the filler round-up that follows are the tried and true, time-tested, people-friendly fillers that I, or friends of mine, have personally used with good results. You’ll notice that some of these fillers were mentioned in the previous chapter on lip augmentation. The ones listed here are for wrinkles and folds, not necessarily lips.
“Since there are so many fillers out there, it does seem hard to choose which one to use,” said my friend, Michigan-based surgeon Anthony Youn, M.D., author of the highly entertaining blog Celebrity Cosmetic Surgery. “Fortunately, your doctor knows each one, what it’s best for, and can recommend one based on his preferences and experiences. Other factors to take into account are how long you want the filler to last, how much pain you can handle, how much recovery time you have, what type of wrinkles need to be filled. There are so many variables, and once you address each one, a filler will emerge as the best choice for the situation.”
I’ve made a pretty comprehensive list. Your doctor might be in love with something I haven’t included. *Fine. If you trust him—and you will, having screened him carefully—then listen to his pitch and research the product on your own. Should it check out, go for it! All told, almost 1.5 million people had soft-tissue fillers in 2007. And, as far as I know, they’re all smiling.
Cosmoderm/Cosmoplast: It’s practically the same stuff that’s been in your skin your whole life, except it’s purified and grows in a laboratory. Use human collagen products for any line, wrinkle, or fold on the face, including frown lines, crow’s feet, forehead lines, marionette lines, lip cracks, and nasolabial folds. For the deep etch marks, use Cosmoplast. For lighter ironing, go with Cosmoderm.
Rx: No pre-allergy test required. After the doctor cleans the area, he’ll inject the syringe into the wrinkle or fold, massage the area for equal distribution, and that’s it. Collagen usually comes with lido-caine mixed in, but, like I always say, if you’re wimpy about pain (like me!), get extra local anesthesia along with it.
There are side effects like redness, swelling, bruising, maybe some small lumps, but they’ll fade. In fact, about half of the collagen injected fades after the first few days. You’ll be over-inflated at the doc’s office, and then settle down in the days to come.
$$: Around $500 per syringe. Depending on how many areas you want treated, you might need two syringes. In terms of annual cost, you’ll have to reinject every three or four months. So call it, on the low end, $2,000 a year.
Dr. Youn’s Expert Opinion: “With longer-lasting options out there, collagen is largely obsolete. I don’t use it in my practice anymore. But it does have the advantage of a quick recovery time. It’s for ‘right now,’ to look good tonight.”
Zyplast/Zyderm: These were the first collagen products to receive FDA approval for treatment of wrinkles anywhere on the face and lips. Both are made from bovine collagen. That means cow. You’re not injecting a porterhouse steak into your crow’s feet, but rather the dermal fiber that once sat atop a juicy, raw porterhouse. Hope that eases your mind.
Word of warning: Don’t try this in India where cows are considered holy.
Rx: A month before injection, you should be tested for an allergic reaction. It’s cow, after all. Some people’s bodies don’t appreciate the bovine invasion. If you have no reaction, the doctor will inject the syringe into the wrinkle or fold, massage the area for equal distribution, and that’s it. You’ll look udderly fabulous. As with human-derived collagen, the side effects include redness, swelling, and bruising.* About half of it fades after the first few days.
$$: Like its human equivalent, the results last only three or four months. For a year’s worth of wrinkle plumping, at $500/syringe a quarter, expect to pay a baseline of $2,000.
Dr. Youn’s Expert Opinion: “Same as human-derived collagen. It doesn’t last as long as other options, and it’s just as expensive. Plus, you have to wait a month to clear the allergy test. But it’s reliable, safe, and effective, with a fast recovery time.”
Hot off the presses! In the near future, look for the product Evolence, an FDA-approval-pending porcine collagen product.
Warning: Though you’ll squeal with delight, it might make your face smell like bacon.
Hyaluronic acid is a carbohydrate that we produce naturally in our bodies. Its main job is to act as a sponge, absorbing a thousand times its weight in water. The problem of dehydration? Fixed. Problem of dryness? Nixed. Hyaluronic acid also latches onto collagen and elastin, giving those fibers nutrients and liquid to make them play at the top of their game. There are many of these types of filler out there.
Preville Silk and Captique™: Two brand-new options in the hyaluronic-filler class. Preville Silk is the first one to have lidocaine built in, to ease pain in injection. Early reports are that Preville goes in as thin and smooth as silk (hence the name), and is virtually painless with no recovery time. Same with Captique. Easy in, then go out. Both are plant-based, or non-animal-derived, so you won’t need pretesting for allergies.
Rx: The advantage is such ease in injection—no numbing needed, just insert, squirt, and put on your dancing dress—and no recovery. You’ll be good to go as soon as the needle’s removed, without swelling, bruising, or redness.
$: Only $400 to $500 a syringe sounds reasonable. But since these two last up to ninety days, you’ll be visiting the doctor’s office and the ATM frequently.
Dr. Youn’s Expert Opinion: “They’re both marketed as ‘today for tonight’ fillers. I think of them as the lighter category of filler. They’re thinner, easy to inject, less painful, less trauma when injected, no recovery time, but they last only three months. You get these and look good right away. I wouldn’t use them on deep folds and wrinkles, though.”
Restylane: As close to a gold standard as there is in facial fillers, Restylane is a non-animal-derived hyaluronic acid. In other words, it’s made in a lab using ingredients not found on any creature with a face. Vegans can use it with a clear conscience. This stuff is great for the lips, mouth wrinkles, adding volume to the eye areas, the brows, the cheeks, plumping up wrinkles and folds. Doctors are now using it to add volume to noses, soften old-looking hands, and even in the area under the eyes to disguise dark circles.
Rx: No allergy testing needed, but you will appreciate some local numbing at the injection site first. The doctor injects directly into the wrinkle or near it and then massages the area for equal distribution. Expect redness, bruising, swelling, a bit of pain and tenderness for a day or two. Worst-case scenario: The doctor injected too close to the surface of your skin, you can see and feel the filler.
$$: A bit pricier than collagen, at $600/syringe. You’ll go back for more every six months, to the tune of $1,200 a year minimum.
Dr. Youn’s Expert Opinion: “I use a lot of Restylane in my practice. The advantages are that it lasts longer than collagen, doesn’t fade after a few days, and you can use it anywhere, on all wrinkle types. The disadvantages are that it’s more expensive, hurts more, and has a longer recovery time. Basically, the longer a filler lasts, the bigger the needle, the more it hurts when injected, and the greater the reaction risks. Restylane is a jack-of-all-trades middle-category filler.”
Juvéderm Ultra: The first hyaluronic acid filler to win FDA approval all the way back in 2001, Juvéderm Ultra, which is a gel, is a time-tested winner. Use it to treat all facial wrinkles and folds, around the mouth, eyes, forehead, chin, what have you. Juvéderm can also add volume where needed: under the eyes, to raise scars, to round off hollowed cheeks. Juvéderm Ultra Plus is the same stuff, with bigger particles for deeper wrinkles.
Rx: No allergy testing needed. You will want some local numbing shots or a topical numbing application before injecting. The doctor injects, massages, and then you walk out the door. Expect redness, bruising, swelling, possible tenderness, itching, and pain for a few days. Worst-case scenario: if a hasty doctor inserts the needle too close to the surface of your skin, you might be able to see and feel the filler, or small bumps under the skin.
$$: About $600 per syringe. It’ll last for six months and cost $1,200 per year, at least.
Dr. Youn’s Expert Opinion: “I put Juvéderm Ultra in the same category as Restylane. If there is any difference between the two, Juvéderm Ultra is a little softer. I use Juvéderm Ultra for anything, shallow or deep wrinkles.”
Perlane® and Juvéderm Ultra Plus: These two have thicker gel particles than the other hyaluronic fillers, making them like Restylane and Juvéderm Ultra on steroids. Its bigger particles work better on deeper wrinkles and folds. They’re used for all the same problems as the middle-category fillers—wrinkles, folds, to increase volume where needed—but for more severe cases.
Rx: No allergy testing needed, but, believe me, you will appreciate local numbing at the injection site first. Same drill you’ve heard already. The doctor injects directly into the wrinkle, or near it, and massages for equal distribution. You’ll have the same recovery risks, but amplified, and longer-lasting. Expect redness, bruising, swelling, a bit of pain and tenderness for a week. Worst-case scenario: The doctor injected too close to the surface of your skin, you can see or feel the filler; a particular worry, considering Perlane and Juvéderm Ultra Plus’s thicknesses.
$$: Only slightly more expensive than Restylane, at $650 per syringe, but the results last twice as long.
Dr. Youn’s Expert Opinion: “I put these in the heavy category, which means more expensive, more pain, bigger needle, longer recovery. Perlane has bigger particles, so it’s grittier. You can’t use it on shallow wrinkles, and you do have a higher risk of lumps. For deep wrinkles, though, these both work well, and last a long, long time.”
Artefill mixes two concepts to create one giant step forward for womankind. It’s made of tiny polymethylmethacrylate microspheres (a synthetic polymer used in surgical implants), suspended in bovine collagen. Think of it like a peanut M&M. The peanut center is the implant material that lasts forever, and the crunchy bovine collagen coating stimulates the growth of your own collagen. The results are permanent. Or, in other words, “non-reabsorbable.”
Rx: Cow allergy testing is needed beforehand. Once you clear that hurdle, you’re ready to proceed. After some cleaning of the facial areas, your doctor will inject Artefill into the site. It already has lido-caine built in, but you might want extra painkiller. The doctor might be conservative with the amount because it’s permanent. Better to add more later than worry about putting too much in. You’ll walk out a bit swollen and bruised. The wrinkles look improved immediately, and they’ll continue to improve over the next six months as your own new collagen has had a chance to grow.
$$$: Higher, but cost-effective. An Artefill treatment might run you up to $2,000. But it’s a one time expense. One Artefill injection costs less than two years of hyaluronic filler shots.
Dr. Youn’s Expert Opinion: “Permanent does sound good, I know. But a lot of doctors aren’t fond of permanent. If you inject it in the wrong place, or the patient doesn’t like it, the only option is to cut it out. Also, when people age, their faces change. The filler might look good at fifty, but at sixty, it’s not in the right place and looks strange. There’s always the risk of infection, even five years down the road. And the last disadvantage to Artefill is the allergy testing period. You have a couple of months to wait before a doctor can inject.”
Radiesse® is made from calcium-based microspheres, a substance found in bones and teeth, suspended in a water-based gel. Like Artefill, Radiesse stimulates the growth of your own collagen, so the results continue to improve and last a lot longer than collagen and hyaluronic acid fillers. It’s great for all wrinkles and folds, but keep it away from the lips! It tends to get lumpy there.
Rx: No allergy tests. No numbing agent needed. You’ll be cleaned, and injected with Radiesse. You hear “calcium” and you might think “calcify.” Have no fear. The stuff stays soft. It won’t go hard in you. In fact, it takes on the texture of the surrounding tissue, like the Predator in the Arnold Schwarzenegger movie. Basically, it blends and lasts for a year or more.
$$$: Pricey. Up to $1,500 a syringe. But, as it’s good for a year, it works out to be roughly the same price as a hyaluronic acid filler.
Dr. Youn’s Expert Opinion: “It’s basically a bone paste. I don’t use it. I think Perlane is close enough to the same results. Not to slam Radiesse. I’m just more comfortable with Perlane. Another doctor might be more comfortable with Radiesse. It’s a personal preference. Coke or Pepsi.”
Sculptra™ was originally intended to treat lipoatrophy (facial fat loss) for HIV patients. Now it’s being used to plump up the cheeks in perfectly healthy people. And why not? It works like a dream on wrinkles and folds, too. It’s made of millions of microspheres of the same chemical used in dissolving surgical sutures. We produce poly-L-lactic acid in our bodies naturally. The synthetic variety is biocompatible (meaning it gets along great with human tissue). When it’s injected, it thickens skin and fluffs up sad, depressed areas, like hollows and wrinkles.
Rx: No allergy testing is needed here, but you’ll want that hit of lidocaine before you get multiple shots around the treatment areas. There’s a bit of bruising, redness, and swelling. Next step, do it again five more times, every six weeks. But after that, you’re good for two years. The results come on you gradually, as you produce your own collagen, and as more and more of the poly-L-lactic acid is injected.
$$$$: Another pricey one. A hit of Sculptra costs $600, and you need multiple syringes at each of your six sessions to see the best results. Calculators out: That’s $3,600 minimum.
Dr. Youn’s Expert Opinion: “Sculptra is really only for revolumizing the face, to fill out hollow areas. It’s not really practical to fill wrinkles. You can use Sculptra on deep folds, but it won’t be as effective as Restylane, and it’s a lot more expensive.”
If you want to add fat to your face, you might as well use some of what you’ve got on your butt. I mean, it’s already there, and would be honored to make better use of itself than being sat on.
A fat transfer is when you take fat from one place (that can spare it, like the butt, thighs, or belly), and put it in your cheeks, or lips, or wrinkles, or eye hollows. No way will you have an allergic reaction to the fat that’s been thriving on your belly for twenty years. Like a plant that grows beautifully in one space, however, it might not like being moved to another spot. The transferred fat needs to find a blood supply in its new home, or it’ll die and be absorbed by the body. It’s a dramatic race against time, actually. The cells will live three or four days without blood. And it takes three or four days for the transplanted fat to hook up with a new supplier. About half of it won’t survive the trip. The half that does? It sticks for a year or more.
Rx: The first step is for the doctor to take fat from where you don’t need it—butt, belly, hips, your call. Then he’ll purify the fat to get good, dense fat cells to transfer. Next, he’ll put the good cells in a syringe, and make a series of pinpoint injections into your wrinkles in multiple layers. Of all the fat injected, 30 to 50 percent will stick. The rest is absorbed by the body. Typically, a doctor purposefully adds too much fat, expecting much of it to die. You’ll have to wait four days to see what your wrinkles or lips are going to look like from now on.
$$$$: The fat transfer is a multi-step, multi-tool, double dose of painkiller, two-stage production here. Which means? You pay more for it. A lot more. Up to $5,000. But it’s semi-permanent. Some of the fat will hang around forever. But over time, most of it will eventually be absorbed by the body. It’s all organic. Recycling your own fat for better use? Al Gore would be thrilled.
Dr. Youn’s Expert Opinion: “Fat grafting is better for filling in facial hollows, to revolumize sunken areas. For wrinkles and folds, it’s a lot less expensive and easier to use than a filler like Restylane.”
Less expensive and easy? That’s speaking my language.