2 MYTHS ABOUT BEAUTY, SKIN CARE, and PLASTIC SURGERY

I’ve got a lot to tell you about what works, but before we dive into the truth and start remaking you so you look and feel younger than you do right now, let’s get some of the untruths out of the way. People have some pretty funny and strange ideas about beauty, aging, skin care, and especially plastic surgery. I hear myths described as sacred truth all the time. Patients do it, parents and friends of patients do it, and even doctors themselves have been known to propagate a few beauty and plastic surgery falsehoods.

As a plastic surgeon, I would like to clear up some of this misinformation because it gets in the way of the truth and the things that can provide real results and make a real difference in how young you look. Let’s start by separating beauty truth from beauty fiction. Here are some of the most popular questions I get in my clinic:

Q: Is it true that all celebrities get plastic surgery?

Not all, but a lot of them do. Quite a lot, in fact. And if you have been operating under the false impression that people who naturally look better than the rest of us are the ones who get to be celebrities, you may be surprised at how many of them resort to the knife. There is a huge amount of pressure in Hollywood to stay looking as young as possible for as long as possible. To many celebrities, plastic surgery is a sort of business expense.

However, plastic surgery doesn’t always go well for celebrities. Just like anyone else, celebrities sometimes pay too much for bad results. When you think of celebrity plastic surgery, you might think of some who’ve had obvious bad work. Or maybe you are inspired by those celebs who’ve admitted to having plastic surgery and look great after. Celebrities like Sharon Osbourne, Julie Chen, and Kris Jenner come to mind. However, you should know that for every celebrity plastic surgery you know about, there are dozens—no, more like hundreds—of celebrities who’ve had plastic surgery that is so good, almost no one can tell it’s been done. No one but a person with a trained eye, that is—like maybe a plastic surgeon.

For example, I suspect (although I have not treated them and cannot say for sure) that the following celebs may have had the following surgeries:

Julia Roberts—nose job? (To my eye, her nasal tip looks thinned, as if cartilage was removed from it.)

Helen Mirren—facelift? (It’s very unlikely that someone her age has a neckline so sharp and youthful without surgery.)

Julie Bowen—breast implants? (Although the change is modest, her chest now appears to me to match her frame more perfectly than it did before.)

The reason why I mention them is that these are three of the most beautiful celebs in Hollywood. We like to think that their beauty is effortless. But it’s not. Like us, celebrities have pimples, wrinkles, sun damage, droopy breasts, and cellulite. Unfortunately, unlike most of us, they also have teams dedicated to making them look good. They have stylists, hairdressers, facialists, plastic surgeons, dermatologists, aestheticians, personal trainers, dieticians, masseuses, and more. So how can you, a regular person, compete with this? You don’t need to be a millionaire and have a team of experts to look and feel young. All you need are a few dollars and the suggestions in this book to rock the red carpet as well as (and in some cases, even more beautifully than) the Hollywood stars.

Q: Do only excessively vain people get plastic surgery? Am I being shallow to care about looking younger than I really am?

You’re not vain or shallow to want to look younger than you currently do. I tell my patients that each one of us sits somewhere along a continuum or a scale indicating how much we are willing to do to look younger or better than we do right now. For some people, all they are willing to do to improve their appearance is to eat better and use creams on their skin. Others may be willing to undergo treatments at home, such as at-home microdermabrasion and handheld laser treatments. Some people are willing to have in-office lasers and other noninvasive procedures, whereas others may consider injections of Botox and fillers. A small percentage of people are willing to go under the knife to enhance their appearance. Still others truly don’t care about altering their appearance at all, and just let nature take its course. I suspect, however, that the latter category doesn’t include any of you. If it did, you probably wouldn’t be reading this book!

But no matter where you fall on this spectrum, whether you stop at creams or go all the way to surgery, no one should judge you for caring about your appearance. We have such a multitude of noninvasive, minimally invasive, and surgical options to look younger today that it’s a shame if you don’t take advantage of whichever of those you feel comfortable with. My patients include all types of people, like accountants, homemakers, pastors, teachers, doctors, social workers, nurses, engineers, police officers, firefighters, and—my favorite—military personnel. Vain? Shallow? I don’t think so!

Q: I’m not sure about surgery. Can I just do facial muscle workouts to keep my face from sagging?

Maybe you’ve seen the programs for facial exercises to keep your face young, tight, and uplifted. Can you really do the equivalent of push-ups and sit-ups for your face? If exercise tones your abs or lifting weights at the gym tightens up your deltoids and biceps, shouldn’t this approach work for your facial muscles, too? You certainly can strengthen your facial muscles if you feel like it, and stronger facial muscles might help you hold that big smile for photographs longer, but the bad news is that this will not combat sagging.

Unfortunately, your face and your abdomen don’t sag for the same reasons. The abdomen can sag when you lose muscle tone, but faces sag due to a loss of collagen and elastin in the skin. It’s true that the platysma muscle of the neck can become stretched and droopy with age, but no amount of exercise has ever been shown to cause this muscle to lift and tighten.

Once on the Rachael Ray show, I tested a facial exercising device. Not only did it not work, but everybody laughed at the person using it. Double humiliation! Don’t waste your money on these, and don’t waste your time making weird faces and repetitive movements in the name of a tighter, younger face. It’s not going to help, and you’re going to look mighty silly.

In fact, repetitive facial muscle movements combined with a loss of collagen and elastin can actually cause more wrinkles. It’s the same concept that’s behind smile lines and crow’s-feet and forehead wrinkles. The more often you make a certain facial movement that creases your skin, the more likely that crease is going to settle in and make a permanent home on your face. I once heard a rumor that Elvis Presley forbade his then wife Priscilla from lifting her eyebrows and crinkling her forehead, since he was concerned that doing this would cause her forehead to permanently wrinkle. While this story may or may not be true, the fact is, flexing the muscles of your face can worsen your wrinkling.

You’ve probably heard of Botox, the treatment that temporarily weakens muscles. (I’ll talk more about Botox later in this book.) The reason Botox works so well is that it stops you from moving your face, and that’s the best way to postpone wrinkles. There are some topical ingredients, like GABA and DMAE, which can temporarily tighten skin and theoretically smooth the muscle contractions that create wrinkles. Technically, these really shouldn’t work, but some of them do seem to show results. There are even better things on the horizon, which I’ll tell you about a little bit later in this book.

Q: Can pillow wrinkles become permanent?

If you periodically wake up after a hard night’s sleep with pillow wrinkles on your face, you might wonder whether they’re going to stick around. Your mother may have told you that frowning or looking cross-eyed too often could make your face “stick that way.” What can I say—sometimes mothers are correct! Actually, sleeping on your face can cause wrinkles. A crease on any given day won’t have an effect, but if you always sleep on your face or on your side, creasing your face in the same way night after night, the deep creases that are temporary in the beginning can become permanent over the years. These are called sleep wrinkles, and they are different from wrinkles formed by muscles (called expression lines). The best way to avoid sleep wrinkles is to sleep on your back.

I recognize not everyone can do this. Some of my patients say they can’t sleep on their backs because it is uncomfortable, or they have breathing or snoring issues, but your sleep position is usually nothing more than a habit. Unless you have a medical problem like sleep apnea, or you are pregnant, it’s worth a try. Do it for your face. Sleeping on your back is real beauty sleep, because gravity works with you, not against you. Here are some tips for better back sleeping:

Put a pillow under your knees to make you more comfortable. This can also take pressure off your lower back.

If you get congested at night, add an extra pillow so you can be just slightly propped up as you sleep. You could also try a breathing strip to help open your nasal passages.

Consider a more supportive mattress. Memory foam can make back sleeping more comfortable, because it molds to your body and holds you in place.

Try a cervical neck pillow. These pillows are designed to cradle your neck while you sleep and help prevent the dreaded neck spasm that many of us occasionally wake up with.

Q: If collagen is the problem, should I try collagen cream?

Not unless you like to spend money for no good reason. Collagen creams make a lot of exciting claims that sound too good to be true, and they are. Skin is made from collagen, and that collagen degrades and breaks down over time. Imagine a sturdy little log cabin. Over the years, when subjected to the elements and the wear and tear of people living in and around it, the cabin ages. The logs become chipped, weathered, and splintered. This is what happens to your skin.

It may seem logical that if your skin is losing collagen, rubbing collagen on your face would help the problem, but unfortunately, the collagen molecule is too large to penetrate the skin. You are simply placing collagen on the surface, and this cannot change the skin’s structure. The only thing collagen creams really do is moisturize your skin, which can make it look younger for a couple of hours, but you can do that for a lot less money than you will spend on a high-end collagen cream.

To fix an aging log cabin, you might have to deconstruct it and replace a few logs. Fortunately, there are also ways to get inside the skin and actually rejuvenate collagen, using procedures like laser treatments, chemical peels, and even injectable fillers. I’ll talk more about these treatments later in this book.

Q: I’ve heard that Preparation H will get rid of my undereye bags. Sweet! I didn’t think anything would work to get rid of those!

Don’t get too excited about slathering your face with hemorrhoid ointment just yet. This is an urban legend that has been out there for a long time. “Celebrity secret to get rid of undereye bags before red carpet event!” Unfortunately, the active ingredient that supposedly worked to eliminate undereye bags was removed from the product years ago—at least in the United States. Some people believe that the Canadian-formulated version of Preparation H still contains a live yeast extract called Bio-Dyne, and that this ingredient is responsible for the undereye miracle. The ingredient in the U.S. formulation that replaced Bio-Dyne, phenylephrine, is a vasoconstrictor and may help mildly improve lower eyelid puffiness, but most people believe it doesn’t work as well as Canadian Preparation H with Bio-Dyne.

However, if you want to try Preparation H (from Canada or elsewhere) under your eyes, be careful. This product is not meant to be used near the eyes, as it is intended for, shall we say, regions both lower and on the backside of the body. Don’t get it in your eyes, because it could cause major irritation. In fact, if you are looking for a cream specially formulated to immediately but temporarily reduce lower eyelid puffiness, I have some great suggestions later on in the book that are very affordable and really work (see here).

Q: Can I change the size of my pores? They are large and I hate them.

Pore size is determined by factors beyond your control: genetics, skin type, and age. However, you can reduce the appearance of pore size pretty easily, so you don’t have to obsess about those “gaping holes” in your nose that you keep examining in the magnifying mirror. The best ways to make pores less noticeable are:

Keep your face clean using a good cleanser. Dirty pores look bigger. Cleansers containing salicylic acid are good at cleaning out pores and preventing them from getting clogged.

Follow cleansing with an exfoliating product a few days a week. Look for one containing alpha-hydroxy acid (AHA). I’ll talk more about exfoliating later in this book.

Periodic chemical peels can also keep pores looking smaller. I’ll talk more about these later, too.

Q: Does my car window protect me from UV radiation? Or can I get a tan in the car?

Car windows block UVB rays, which cause the skin to tan and burn, but not UVA rays, which can cause sun damage, wrinkles, and even skin cancer.¹ If you drive a lot, check out your left hand and arm and the left side of your face. I bet you will notice more dark spots and sun damage on the left side than on the right side. This is very common. And it doesn’t matter whether you drive a Lexus, a RAV4, or even an old Gremlin. Later in this book, I’ll tell you exactly what to do about this problem.

Q: What about clothing, like hats and T-shirts? Those will protect me from the sun, right?

Hats and T-shirts seem like total protection, but it turns out that clothing isn’t as effective at blocking UV rays as we once thought. T-shirts provide the protection of a sunscreen with an SPF of just 5 to 10, and this protection is decreased if the shirt is wet.² This is not nearly enough to protect our skin for longer than a few minutes. For this reason, you should put sunscreen on your face and body even if you are covered up. There is, however, commercially available clothing that is specially manufactured to provide sun protection. It can be a reasonable option for you if you don’t want to slather sunblock over your entire body. Instead of being labeled with an SPF, its ability to block the sun’s rays is measured as UPF (ultraviolet protection factor). Look for clothing that has a UPF of at least 50. Some prominent brands include Solumbra, Coolibar, and Solartex. Don’t look for a UPF on your regular clothes, though. It’s reported only for clothing that is specially designed to protect your skin from the sun.

Q: I’ve read that sunlight is actually good for you because it creates vitamin D, and most people are vitamin D deficient because of sunscreen. I’ve also heard some of these people saying that sunlight is “natural” and humans are meant to be exposed to it. Should I be tanning to get my vitamin D level up, or should I be more “natural”?

It’s true that vitamin D is essential for the health and growth of bones and for other important processes in the body. It is also true that the skin produces vitamin D when exposed to sunlight. We all need vitamin D, and it is difficult to get enough from food. However, too much sun exposure really does damage your skin and causes premature aging, wrinkles, and skin cancer. This is an indisputable fact. The good news is that you can get your skin to produce vitamin D with very minimal sun exposure. The sunlight you get through your car window or walking around outside during the day is typically all you need, about ten to fifteen minutes each day.

If you are worried that you don’t have enough vitamin D, get tested. It is easy for your doctor to do a vitamin D test at your next appointment. Just ask. If you do have low vitamin D, the best solution isn’t to lie out in your bikini slathered in baby oil (it’s dangerous—and so 1980s). Instead, take a vitamin D supplement. A good starting dose in cases of deficiency is 600–800 IU per day, but your doctor can give you more specific advice for your individual needs.

Q: If I want the benefits of an ingredient, then I will get them as long as the ingredient is listed on my product’s label. Because they can’t lie to me, right?

Actually, although a company technically cannot lie on the packaging, they can include an ingredient in such a small amount that it doesn’t actually have any effect, and still advertise that the product contains that ingredient (because technically, it does). Sneaky, right? When a product contains something the FDA classifies as a drug (such as tretinoin) as opposed to a supplement (such as vitamin C) or a cosmetic (such as moisturizer), it must have a separate list called “active ingredients” for the drug ingredients. Everything else goes on a list called “inactive ingredients.” However, even an item on an active ingredients list isn’t necessarily present in therapeutic amounts.

Just as with food products, ingredients in skin-care and other personal-care products are listed in order of how much of that ingredient the product contains. The first ingredient is the most prevalent. The last ingredient may be there only in minuscule amounts. The product doesn’t actually have to tell you how much of each ingredient it contains, although some products use this as a selling point, telling you they have X number of micrograms or whatever measure of a particular ingredient, so you know for sure it is a therapeutic dose. Or they tell you the amount but assume you probably don’t know what a therapeutic dose really is. In general, if you want the benefits of a particular ingredient, make sure it is listed in the first half of the ingredients list. If it’s in the second half, it is probably present in amounts too small to be effective.

Q: Do hand sanitizers dry out and age my hands more than soap?

Hand sanitizers usually contain alcohol, and alcohol does have a drying effect on the skin. However, alcohol is actually less drying on your skin than soap and water, which strip your hands of essential natural moisturizing oils even more than hand sanitizers do. If you have a job that requires clean hands (if you are a health-care professional, for example), it’s better to use hand sanitizer when appropriate rather than constantly washing your hands with soap and water. Your skin will thank you and your hands will look better.

However, keep in mind that while hand sanitizer kills germs, it does not remove actual dirt from your hands. If you have been changing a diaper or handling food or gardening, wash your hands with soap and water afterward. Hand sanitizer is not enough. It is especially not “poop-worthy.”

Q: It seems like my leg/underarm/beard hair grows back thicker after I shave it. Is this true?

When I was in high school, I held off shaving for as long as I could, since I heard that once you start shaving hair, it grows back even thicker than before. I spent at least two years of high school with nasty, scraggly patches of recently sprouted hair on my chin and upper lip. My friends called me “Catfish Youn.” No wonder I couldn’t get dates. Unfortunately, I endured this torture for nothing.

For some reason, even twenty-five years later, people continue to believe hair grows back thicker after it’s shaved. But it is just not true. There is nothing about shaving a hair in the middle of its shaft that signals the body to change the quality, thickness, or anything else about the hair. Not even the length. Some people think that shaving triggers the hair to start growing again, but this isn’t how hair growth works. Hair grows to a certain length, hangs out for a while, then drops off the body. If you shave the dormant hairs, eventually they will fall out. If you shave the hairs that are still growing, they will continue to grow, and then stop when they get to their designated length, after which they will go dormant and then fall out. This is the hair life cycle.

However, hair does look thicker when you shave, because the base of the hair shaft is thicker than the tip of the hair shaft. When you lop off the skinny part of the hair, the thicker part grows out and feels stubbly and less pliable than it did when you could feel only the soft, thin end of the natural hair. It’s still the same hair of the same diameter, however, so shave away. You’re not going to transform into a caveman. Or a catfish.

Q: I have some spider veins and now even a few varicose veins. Yikes! Is this because I always cross my legs when I sit?

Fear not. There are many causes for spider and varicose veins, but crossing your legs isn’t one of them. The real causes of varicose veins are genetics, standing for long periods of time day after day (especially if you have a genetic propensity to develop them), and pregnancy. If you like how your legs look when you cross them, then knock yourself out. It’s not going to make the vein situation any worse (and there are ways to fix these veins, which I’ll talk about later in this book).

Q: Should I get a “lunchtime facelift”? Isn’t that a great alternative to a more drastic surgery?

Trendy lunchtime facelifts sound appealing. Fancy commercials claim they can take ten years off your face in an hour, with no recovery time. However, I do not recommend these procedures. In fact, I suggest you run in the opposite direction. Lunchtime facelifts are basically a commoditization of plastic surgery procedures by aggressive businesspeople and profit-motivated doctors. Here is the business model:

Hire a bunch of bargain-basement doctors to do surgery on the cheap.

Teach them to do one or two simple cosmetic procedures as quickly as possible.

Create infomercials and buy ads that claim these simple procedures are “revolutionary.”

Show deceptive photos. “Before” photos show patients looking miserable, with no makeup, under bad lighting. “After” photos have them holding their heads high to stretch out their necks, sporting professional makeup, and looking happy. We would all look transformed under these conditions, surgery or no surgery. (The photos could also show the results of more aggressive plastic surgery and not the lunchtime facelift procedures at all—because who is checking to be sure? Nobody.)

Hire professional salespeople to hard-sell to patients. These salespeople are trained to convince potential clients that they need this procedure and they need it now, and if they don’t do it soon, they will have to pay much more later. Pay these salespeople hefty commissions to sign up people for surgery.

Set up bogus websites full of fake testimonials about how great the lunchtime facelift procedure is.

Hire a team of attorneys to shut down anyone who tries to investigate the company or expose the truth about the company.

Rake in the profits.

Be aware that any cosmetic surgery is only as good as the doctor or surgeon who performs it, and doctors who do lunchtime facelifts are not usually doctors I would want working on me, or you. There is a reason why reputable, board-certified plastic surgeons like myself do not perform lunchtime facelifts. They do not work. If it sounds too good to be true, it probably is. If you need plastic surgery, do your research and work with a reputable professional, not a company that is less interested in doing the job correctly and safely than in making a quick buck by cutting corners (on your face!).

Q: Scars are signs of bad plastic surgery, right? If the plastic surgeon is really a good plastic surgeon, shouldn’t my scars eventually disappear?

If only we could perform magic, we would. However, there is no such thing as an invisible or completely disappearing scar. After even a short surgery that requires an incision, a scar is created. The body then begins to heal the scar, for twenty-four hours a day, seven days a week, four weeks a month, for six or even up to twelve months. At that time, the scar will be mature and you will know how it’s going to look pretty much for the rest of your life. The plastic surgeon has very little control over this process. Scars are permanent, and the way they heal has a lot to do with aftercare and your individual body and skin. Will the scar get infected? Are you picking at it? Does your skin heal quickly or slowly? These and many other considerations affect wound healing. You can try to alter your body’s healing response by using a good silicone-based scar cream or undergoing laser treatments or steroid injections to minimize scarring, but even if you do all of these things, your body might still create a thicker, more unsightly scar than someone else’s body. It might also create a scar that becomes barely noticeable over time.

What your surgeon should be able to tell you is whether the scar will have suture tracks (the tiny dot-like scars on both sides of a scar that can result if sutures are left in too long), whether the scar will look jagged, and whether it will look bunched up. But that’s about all we can tell. However, good surgeons do have a few tricks up their sleeves, like the best places to put incisions so scars are less noticeable. Beyond that, a scar is a scar and a necessary part of any plastic surgery that requires an incision.

One last thing: I’ve noticed over the last fifteen years that older people (typically older than sixty) tend to scar much better than younger people. Their scars are thinner and lighter and have a much lower tendency to thicken and look unsightly. This may be due to the collagen in their skin being thinner and less likely to overgrow and bunch up in the healing process. I find the people who scar the worst are in their twenties to their forties. This is one good thing about getting older!

Q: I’ve heard that liposuctioned fat comes back in a different place, and/or in a weird, lumpy shape. Is this true?

This is controversial, but personally, I think it sounds silly. I (and many of my plastic surgeon colleagues) have always believed and informed our patients that liposuctioned fat will not return to another area. If I suck fat out of your thighs, it’s not going to reappear on your upper arms.

However, in 2011, a study was performed at the University of Colorado that suggested this could actually happen.³ The study was performed on thirty-two volunteers, and it found that after liposuction of the thighs, strange excess pockets of fat appeared on the trunk and even the arms, as if the liposuctioned fat had somehow returned to a different location. I call it the “Popeye Effect.” However, another, larger study on 301 patients a year later refuted the findings, suggesting that perhaps there was a problem with the original, much smaller study.⁴

So what is the truth? Does liposuctioned fat come back? Does it trigger some kind of reaction in the body that causes the remaining existing fat to expand in size? All I can tell you is that over the past ten years, I’ve performed liposuction on at least two hundred people per year, totaling about two thousand patients. I’ve honestly had only one patient tell me the fat I removed came back. However, she admitted that this happened after she gained a lot of weight gorging on food over the holidays. As a doctor, I have to say that clearly, the old fat hadn’t come back. Her lapse into bad lifestyle habits had caused her remaining fat to expand. I have never had a patient tell me that the fat removed from one area came back in a different area. Never.

Q: I heard that if I get breast implants my breasts won’t droop as I get older. Is this true?

No! It’s completely false. Breast implants act as weights in your breasts. Gravity pulls on them, day in and day out. The bigger they are, the heavier they are and the more quickly they will sag. It’s simple physics. The only exception to this is Pamela Anderson. Her breasts are massive, and it’s even been rumored that her breast implants are stacked, meaning there is more than one implant in each breast. Still, even over fifteen years after she left Baywatch, her breasts look as perky as ever. They seem to defy gravity. Putting Pam and her amazing hovering breasts aside, there are some actions you can take (and your surgeon can take) if you have breast implants to prevent them from sagging as quickly as they might otherwise. Wear a supportive bra with underwire during the day. Wear a sports bra when you work out. And probably most important of all: If you do decide that you have to have breast implants, don’t go any larger than necessary to make you feel balanced.

These are the myths and truths I encounter day after day in my practice. Now that we’ve set the record straight, I bet you want to get right down to business. In the next section, we’ll talk about aging, what it does to your skin, and the easy routines and lifestyle changes you can make to get the most out of your natural beauty and youthful internal processes. Are you ready to start looking better today? Read on.

2 MYTHS ABOUT BEAUTY, SKIN CARE, and PLASTIC SURGERY

Beauty Secret