Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Cosmetic Botox Turns 10 September 3, 2012

 

In April, 2012 Botox turned 10 years old.  That is it has been 10 years since the FDA gave Allergan approval to sell Botox Cosmetic as a solution for moderate to severe frown lines between the eyebrows and not just for medical purposes (As many readers may know Botox has numerous medical applications as well).  Now that Botox is so widely used (and even abused some would say) this is a good opportunity to look back over the last decade to see what people had to say about Botox then and the reality of its use today.

Take for instance Dr. Richard Friedman’s piece Cases: A Peril of the Veil of Botox in The New York Times from August, 2002 just after Botox was approved for cosmetic use:

Unlike a face-lift, where the skin is stretched taut like a drum but facial expression is unaffected, Botox paralyzes the underlying muscles that control facial movement and produce wrinkles. Botox, or botulinum toxin, is the neurotoxin derived from the bacteria Clostridia botulinum, the cause of botulism.

Botulinum toxin is the most poisonous substance known and is a potentially potent bioweapon. A single gram of the purified toxin, widely dispersed and inhaled, could kill a million people.

Ingested systemically, botulinum toxin kills by paralyzing the diaphragm, the muscle used in breathing. The toxin prevents neurons from releasing acetylcholine, the neurotransmitter that causes muscle contraction. But injected locally, it paralyzes just a small area of skeletal muscle. The effect is temporary, lasting three to four months.

Little is known about the long-term cosmetic effects of Botox. But there is evidence that prolonged use can cause some people to produce neutralizing antibodies against Botox, which diminish or block its effect over time.

Botox had wiped the wrinkles from the woman’s brow but had also robbed her face of some human expressiveness. It made her appear not so much youthful as lifelike — a frozen imitation of youth.

Unlike this woman, many Botox users receive extensive injections above the nose, around the eyes and across the forehead, which deeply alter their expressions.

It made me wonder: Should we become a Botox nation? What are the implications for human relationships? I’m not too worried about the adults; they can figure out that their friends and loved ones are poker faced not because of lovelessness but thanks to Botox. But what about infants and children?

Now some of the above concerns have come true.  There are people who have developed a tolerance for Botox rendering it less effective or completely ineffective for them.  Additionally some people have gone overboard with their Botox injections causing their foreheads to become motionless and their expressions frozen, but keep in mind if Botox is used judiciously this should not happen.  Certainly the popularity of Botox among Hollywood celebrities has greatly contributed to its use amongst the general popular.  While celebrities are at the forefront of the use of new cosmetic products and procedures they can also clearly show the pitfalls of these procedures as well.  (For a good illustration of how this pertains to Botox see Shape magazine’s article Botox: Hollywood’s Most Frozen Faces)

The key to a positive Botox experience and a great result?  Finding an injector, either a doctor or a nurse (In the US any doctor, not just a dermatologist or a plastic surgeon can inject Botox, and any registered nurse can inject Botox.  I would love to know from my readers in other parts of the world about how popular Botox is in their country and who can inject it), who knows their stuff.  If you place yourself in the hands of a skilled injector your face looks refreshed, not overdone.  Your forehead will still move while you look alert and your wrinkles are smoothed.  There has been a great improvement in how Botox is injected since it was approved for cosmetic use in 2002 so the concerns from then as mentioned above, while not to be taken lightly, are not as much of a problem today.

Just how did the FDA approval of Botox for cosmetic use change the anti-aging game?  The impact of Botox should not be underestimated.  According to a Skin Inc. article about the 10th anniversary of Botox being approved for cosmetic use:

“When approved by the FDA in 2002, Botox Cosmetic changed the way that physicians could treat patients who were interested in improving the appearance of their vertical frown lines between the brows,” says David E.I. Pyott, chairman of the board, president and CEO, Allergan, Inc. “Botox Cosmetic has become the No. 1 neuromodulator in the United States and the number of patients considering talking to their doctor about treatment has more than quadrupled to 5.8 million since 2002.”

Botox secured its first FDA approval more than 22 years ago as a treatment for two rare eye muscle disorders, making it the first product of its kind approved in the world. In 2002, the same formulation with dosing specific to frown lines was approved under the name Botox Cosmetic.

“The FDA approval of Botox Cosmetic enhanced the practice of plastic surgery by providing plastic surgeons with a new treatment option for patients seeking to reduce the appearance of vertical frown lines between the eyebrows,” says Malcolm Z. Roth, MD, president of the American Society of Plastic Surgeons.

In the decade since Botox Cosmetic was approved, aesthetic specialty physicians–which include dermatologists, oculoplastic surgeons and facial plastic surgeons–have developed extensive experience in the art and science of administering Botox Cosmetic to yield predictable results for their patients. These physicians have performed approximately 11 million treatment sessions since 2002 and have also contributed to the extensive clinical database demonstrating the safety and efficacy of the drug.

“The approval of Botox Cosmetic in 2002 dramatically changed our ability to treat our patients by giving them an effective option to treat the appearance of moderate to severe vertical frown lines with a minimally invasive procedure,” says Susan Weinkle, MD, president of the American Society for Dermatologic Surgery. “Botox Cosmetic has become more accepted by the public, and this treatment has brought more patients into aesthetic practices to learn about other treatments available.”

Though I have yet to try Botox (or Dysport or Xeomin which do the same thing as Botox yet are newer to the market) I am certainly not opposed to trying it in the future.

Have you tried Botox?  Are you open to trying it?  Share your thoughts below.

Further Reading:

There is, of course, endless amounts of information available about Botox online.  Here are some good sources for more information about this product.

Image from allure.com

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Nora Ephron on Beauty July 12, 2012

Filed under: Outlooks and Attitudes about Beauty — askanesthetician @ 5:00 am
Tags: , , , ,

 

Nora Ephron passed away on June 26, 2012 at the age of 71.  A prolific essayist, screenwriter, and movie director Ephron was known for her wit and insight – particularly when it came to women’s issues and feelings.  Since she passed away I’ve been looking, knowing it must be out there, for Ephron’s take on beauty in order to share her thoughts with my readers.  I hit pay dirt when I finally found her essay On Maintenance which was published in the October, 2005 issue of O magazine.

The essay is a very funny discussion of everything that Ephron does in order to look good.  Since this is a blog all about skincare I’ll share what she had to say about skin maintenance:

I have cream for my face. I have lotion for my arms and legs. I have oil for my bath. I have Vaseline for my feet. I cannot begin to tell you how much time I spend rubbing these moisturizers into myself. But I still get pimples on my face and rough patches on my arms and legs. What’s more, the skin on my back is so dry that when I take off a black sweater it looks as if it’s been in a snowstorm, and the skin on my heels has the consistency of a loofah.

The conclusion of the essay is witty and insightful all at once:

I have no doubt omitted something where maintenance is concerned. The world of maintenance is changing every second, and I may not know about all sorts of things that women my age are up to. (The other day, for instance, I had lunch with a friend who assured me that I hadn’t lived until I had tried having some sort of facial that seems to include a mild form of electroshock.)

What I know is that I spend a huge amount of time with my finger in the dike, and that doesn’t begin to include all the things I promised not to go into—the pathetic things. I have never had plastic surgery, but I have done any number of things that fall just short of it. I even had all the fillings in my mouth replaced with white material, and I swear to God it took six months off my age. From time to time my dermatologist shoots a hypodermic needle full of something called Restylane into my chin, and it sort of fills in the saggy parts.

But the other day, on the street, I passed a homeless woman, and as I watched her shuffle down the street, it crossed my mind that I am only about eight hours a week of maintenance away from looking exactly like her—with frizzled flyaway gray hair I would probably have if I stopped dyeing mine, with a pot belly I would definitely develop if I ate just half of what I think about eating every day, with the dirty nails and chapped lips and mustache and bushy eyebrows that would be my destiny if I ever spent even two weeks on a desert island.

Eight hours a week and counting. By the time I reach my 70s, I’m sure it will take at least twice as long. The only consolation I take in any of this is that when I’m very old and virtually unemployable, I will at least have something to do. Assuming, of course, that I haven’t spent all my money doing it.

That’s just a little taste of what Ephron had to say about beauty and maintaining her looks.  Her wit and humor will definitely be missed, but you can always watch one of the movies she directed or wrote when you feel you need some humor and heart.

Further Reading:

 

Image from O magazine

 

Always Judging June 25, 2012

 

Ever feel like the whole world is full of haters?  I think we all have days that make us just want to hide in the house and stay away from all other people (and lets be honest the internet as well).   And to be perfectly honest – when we aren’t feeling like someone is judging us we are probably judging someone else.  I realize that more and more especially if I stop during the day and evaluate what I have been thinking.  Without even realizing it I’m at it again – judging someone.

I think we judge others simply because it makes us feel better about ourselves.  I think it is human nature to judge, unfortunately.  And breaking that habit is very, very, very hard.

The actress Ashley Judd recently made headlines not for her new TV show but for her appearance while promoting that show.  Judd’s face appeared significantly more puffy than it had in the past, and many people and media outlets rushed to judge and conjecture why she looked that way.  To say that the people were mean and judgmental would be a vast understatement.  The comments were cruel and derogatory.

Judd decided to address the storm of criticism directed at her appearance, and she did so in a op-ed piece in The Daily Beast.  Here are some of my favorite parts from Judd’s article:

The Conversation about women’s bodies exists largely outside of us, while it is also directed at (and marketed to) us, and used to define and control us. The Conversation about women happens everywhere, publicly and privately. We are described and detailed, our faces and bodies analyzed and picked apart, our worth ascertained and ascribed based on the reduction of personhood to simple physical objectification. Our voices, our personhood, our potential, and our accomplishments are regularly minimized and muted.

I hope the sharing of my thoughts can generate a new conversation: Why was a puffy face cause for such a conversation in the first place? How, and why, did people participate? If not in the conversation about me, in parallel ones about women in your sphere? What is the gloating about? What is the condemnation about? What is the self-righteous alleged “all knowing” stance of the media about? How does this symbolize constraints on girls and women, and encroach on our right to be simply as we are, at any given moment? How can we as individuals in our private lives make adjustments that support us in shedding unconscious actions, internalized beliefs, and fears about our worthiness, that perpetuate such meanness? What can we do as families, as groups of friends? Is what girls and women can do different from what boys and men can do? What does this have to do with how women are treated in the workplace?

I ask especially how we can leverage strong female-to-female alliances to confront and change that there is no winning here as women. It doesn’t actually matter if we are aging naturally, or resorting to surgical assistance. We experience brutal criticism. The dialogue is constructed so that our bodies are a source of speculation, ridicule, and invalidation, as if they belong to others—and in my case, to the actual public.

As much as I liked Judd’s article I was equally impressed by Linda Wells, editor-in-chief of Allure, who take on the controversy.  I’ve written numerous times in the past in this blog how much I like Wells’ take on all things beauty, and she actually made me like her more after reading her June letter to the editor:

[Judd] humanized the issue of beauty criticism, saying that it not only hurts but also demeans and reduces us all to our least interesting, least powerful aspects.

She’s right.  And when she asks, “What is the gloating about?” I might say, “How much time do you have?”  Judd was talking about nasty comments she received for something she didn’t do, but I also object to the stigma attached when a woman decides – for her own reasons, which don’t necessarily include self-loathing or “internalized patriarchy” – that she would like to get Botox or wrinkle-filling injections or lipo or a face-lift.  Those are perfectly legitimate options, too.  And if Judd or any other woman chooses to undergo these treatments, there should be no shame in that.  Being a natural beauty is excellent – and lucky.  Attaching a moral judgement to a cosmetic treatment is as unfair and ridiculous as carping about someone who colors her hair.  It wasn’t so long ago that women who wore lipstick or rouge were accused of moral turpitude.  The argument hasn’t changed.

 

What can we learn from all of this?  Perhaps to give ourselves and others a break.  Try for one day or even one hour to judge less.

 

For a great blog post about how to deal with haters see Rae from Scatterbraintures post:  Haters Can Cause Premature Aging – If You Let Them.   Check it out for her great advice on how not to let haters bring you down.

 

Image from wilmu.edu

 

Buy That Bag or Buy That Skincare Product? May 3, 2012

Lately I have been telling anyone who will listen how I like this show on VH1 called House of Consignment which follows the ups and downs of an online designer resale business based in Chicago.  I was intrigued by the show first because it takes place in Chicago (I live in the suburbs of Chicago), and also because I always like to see what other women have in their closets.  What struck me repeatedly while watching the show was how much stuff people buy, save, and then can’t give up even if they will never wear it again (or have never worn it to begin with).  I am also astounded by how much money people spend on their clothes, shoes, and bags.  It was interesting to see that women who are far from wealthy yet they find the money to buy numerous designer goods.  People shop for all sorts of psychological reasons that have nothing to do with the actual goods that they own but rather the feelings that the goods impart – such as status or a shopping high.

As you are reading this you are probably wondering – so what does that have to do with skin?  Well watching this show made me think – why do people invest so much in their clothes and accessories and not in their skin?  You wear your skin 365 days a year, 24 hours a day.  Your skin protects you and keeps in healthy – shouldn’t you return the favor by investing in your skin?   I am lucky that where I work I don’t have a quota about how much skincare product I need to sell per week or month since I sometimes feel bad suggesting that someone buy a skincare product that costs close to $100.  But lately I got to thinking – should cost really be that much of a factor in choosing skincare products if you know that they work?  Instead of buying that new pair of shoes shouldn’t you buy that moisturizer instead?  Investing in your skin means you are investing in your health and what is more important than your health?

So perhaps the next time you are debating between buying that new designer bag and a new sunscreen you’ll get the new sunscreen.  Keep your skin happy and healthy so that when you do invest in a designer dress you look great wearing it.

My related posts:

Image from internationalwomenofcolor.blogspot.com

 

How Much Does Your Beauty Regime Cost You? March 26, 2012

Recent false reports have claimed that Hollywood star Jennifer Aniston spends $8,000 a month on her beauty regime.  The reported hefty price tag included not only pricey skincare products and treatments but Aniston’s workout routine as well.   Aniston denied the reports saying to People:

“Although I am a sucker for an amazing moisturizer, love a great facial, have been using the same cleansing bar since I was a teenager and have always been a dedicated tooth-brusher, reports that I am spending eight thousand a month on a beauty regime are greatly exaggerated,” she says.

So what’s the true total? “By my tally,” she shares, “this month I’m in for about two hundred bucks.”

Of course this got me thinking – how much do I spend a month on my beauty needs?  It will take me some time to figure that out (ok – in all honesty I didn’t really want to take out the calculator and figure it out, but I guess depending on the month I use beauty products and make-up worth anywhere between $50 to $100), but ultimately does it really matter?  If you think that you look good you feel good, and investing in one’s self shouldn’t be anything to be embarrassed by.  In the end, can you really put a price on feeling good?

Feel free to share your thoughts below about pricy beauty routines, regimes, and products.

Image from beautylish.com

 

The Tyranny of Perfect Skin January 19, 2012

Recently I treated a client who had by far the worst skin I had ever seen during my time as an esthetician and even the worst skin I had seen – ever.  Every surface of her face was covered with papules and pustules; her skin was bumpy and extremely infected.  In order for her skin to both look good and be healthy this client will need very aggressive and long-standing anti-acne treatment, probably for the rest of her life.

Without any prompting I can rattle off everything that is wrong with my skin – blackheads galore, acne scars on my cheeks, persistent breakouts on my chin especially around the time of my period (I have two on my chin as I write this), sun damage and post-inflammatory hyperpigmentation.  Oh and did I mention that I have to pluck hairs from my chin on a daily basis?  Yes, my skin can be a lot of work.  But after treating this client I had to admit that I don’t have it bad when it comes to my skin.  I realized that I shouldn’t complain about my skin any more or at least not as much as I used to.

After seeing this client I also started to think, yet again, about how women have unrealistic expectations about how their skin should look and that most people think their skin looks worse than it really is.  Lots of times I have people come to me for facials who bemoan the state of their skin and make a catastrophy of every blackhead and wrinkle.  (Occasionally I do see the opposite kind of client as well who thinks their skin is fabulous and really they could be doing so much more for their skin, but they don’t think that they need to)  Though I am far from a therapist or cultural commentator I think  that part of this obsession with perfect skin comes from the completely ridiculous expectations and photos presented to us by the mass media.

I’ll give some examples.  In my mind one of the worst magazine offenders, when it comes to setting unattainable expectations for how your skin should look, is Lucky.  I’ve already written numerous times in my blog about how the skincare advice in Lucky is simplistic, unrealistic, and sometimes just downright wrong.  Unfortunately the advice is presented in a know-it-all tone that makes it sound like they really are the be all and end all authorities on any beauty topic.  So please take their skincare advice with a grain of salt.  Every month the magazine also promises perfect skin instantly, with the use of one moisturizer or one serum.  Real skin changes happen slowly over time and with the use of high-tech and/or prescription ingredients.  Every month I cringe when I receive my copy of Lucky thinking of women who want to make their skin look better and actually believe the advice in this magazine.  Take the February issue of Lucky for example.  The cover of the magazine promises the following:

Flawless skin, guaranteed!  Beat acne, shrink pores, and soften lines

You think to yourself “great!  I want my skin to look flawless”, but the advice inside falls so short of being helpful.  It is rudimentary at best.  How do you get poreless skin according to Lucky?  You cleanse with a scrub, use a serum that promises to shrink pores (by the way shrinking pores is impossible, see my post below for a longer explanation), use a primer, and then finish with foundation.  Hello!  Really what they are telling you is to use make-up.  The other two promises made on the cover?  I couldn’t figure out where the advice was inside the magazine.

The January issue of Vogue actually has an article (“Face Value” – not available online at the moment) about how to achieve poreless looking skin.  The key to a flawless face is the right foundation.  Let me repeat that – the key to a perfect looking complexion is make-up.  According to the article:

In this age of high definition, high resolution, and high expectations – where even the camera on an iPad can send a perfectly rational girl shrieking toward the dermatologist’s office – out-of-this-world skin doesn’t feel like an unreasonable demand.  After all, as Val Garland … says, “Your skin is the first thing someone notices about you.”

That’s where a new kind of camouflage comes in.  “Ten years ago, foundation was thicker, more opaque, matte.  You could tell that women were wearing it,” says Olivia Chantecaille, who, along with her mother, Sylvia, has built a beauty empire upon remarkable second-skin formulas with names like Real Skin (a translucent, balmlike gel) and Future Skin (an airy confection with the consistency of fresh-whipped cream).  “A really great foundation is like a really great pair of jeans,” she continues.  “It should make you look better instantly; it should make you feel better instantly.”

Obviously I am the last person to discount the benefits and necessity of a great skincare regime but don’t forget the power of make-up as well.  And above all – remember that the models in cosmetic ads and magazines are airbrushed within an inch of their lives.  Their skin “beauty” is completely unattainable.

Further Reading:

Related Posts:

Photo from Allure

 

To Inject or Not to Inject, To Avoid the Knife or Not – That is the Question June 9, 2011

Dominique Browning wrote an article in The New York Times called The Case for Laugh Lines which makes well quite the case that women should accept their bodies, mostly their faces, as they age instead of getting injections and plastic surgery.  Though she admits that a little work isn’t bad Browning writes that she is upset and sick of seeing friends completely change their appearance with injections and plastic surgery until they also get rid of all of their ability to express any emotion.

Browning writes in her essay:

We’ve gone too far. I’m becoming very, very scared.

We’ve reached a stage where cosmetic surgery is so readily available that in certain circles it is expected of women and men to avail themselves of these age-deniers. (You cannot call them youth-enhancers when you are no longer young.) If you choose not to partake of the benefits of needle and knife, you are judged to be making a statement. You are taking a position against the current standards of beauty.

We have triggered a weird, collective, late-onset body dysmorphia. What’s worse is that our anxieties about aging have trickled into our children’s generation, so that the mantra about cosmetic procedures even among some 30-year-olds is “intervention early and often.”   …

Too many people have had procedures that have gone awry. They look strange, and tragic. Is this inevitable? You do one thing, the effects begin to fade, you do another, and so on. You get puffy. You get rigid. Or you slide. And I wonder. Has no one said “stop”? Has no one, particularly the one wielding the needle, gently advised against further work? It used to be an unusual sight to spot cosmetic surgery addicts, but it has become astonishingly common.  …

Many people assume that in saying no to knife and needle, you are making a feminist statement; such is the lackluster aura that hangs over that label. Feminism has nothing to do with it. Feminists worry why women still make only 77 cents to every dollar a man makes, not whether women are going broke on Botox.

Though least you assume that Browning wants everyone to embrace a natural look completely she explains:

This is not an essay about why I am categorically against cosmetic surgeries. I am as supportive as the next gal if a certain someone feels so bad about her neck that she won’t leave home, or if another is so heavy-lidded that every time he blinks he misses half the picture. Plastic surgeons have done wondrous things.

As for the proliferation of smaller cosmetic procedures? The ones your dentist offers to do while he’s in the vicinity of your mouth anyway? The injections of fillers to plump up lips, smooth wrinkles, pad out laugh lines? At this point, it’s a wonder that the salesclerk at Barneys isn’t offering to shoot up your face while you’re trying on hats.

Again, I’m not against it. Well, maybe Botox. I’m the one to call for a rant when my friends are teetering at the brink of succumbing to the needle. I mean, who wants to inject a poison so lethal that it paralyzes nerves, sending tiny muscles to atrophy?

 

I work for a plastic surgeon so I would be a huge hypocrite to say that I don’t think women should get plastic surgery or have injections, but I completely agree with Browning about how and how much of that work should be done.  I liked when Browning wrote the following:

My current rule of thumb, when confronted with an enhanced face, is that if I find myself vaguely wondering whether there was work, the alteration was well done.

I completely agree with Browning’s statement above.  I truly believe in plastic surgery and facial injections if they make you feel better about yourself and help you look like a more refreshed version of yourself.  There is no need to freeze your face, just like there is no need to turn yourself into someone else.  As plastic surgery and injections become more and more easily available and affordable are we all going to end up looking like The Real Housewives of Orange County?  I certainly hope not.  (Also check out the latest issue of New Beauty to see the scary photos of over-injected celebrities)

 In my opinion it never hurts to get a little cosmetic help from a doctor in order to look and thus feel your best.  But avoid going overboard – there is nothing wrong with still being able to show your emotions!

Further Reading:

 

 
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