The New Natural : Your Ultimate Guide to Cutting-Edge Age Reversal

Obvious face-lifts and Botox overload are no longer in vogue, but a new generation of fillers, laser treatments, and topical preparations are keeping millions looking younger - and more natural - for decades longer. Prominent dermatologist and cosmetic surgeon Dr. Neil Sadick explains how every woman, at any age, can have beautiful, healthy skin without a scalpel or surgery. Starting with the basics of skin care we all need in our early adult, damage-prevention years, Sadick cites the most efficacious cosmetic products and discusses the best practices for preserving a glowing, youthful appearance. For older readers looking to maintain healthy skin and reverse damage, he explains the various nonsurgical options available: from the modern day miracle of cell therapy to cosmeceuticals, fillers, and treatments for cellulite and hair loss. Throughout he mentions brand-name products at every price point and treatments for every budget.

CHAPTER ONE

THE NATURAL AESTHETIC

NOBODY IS PERFECT

Ann couldn't recognize herself anymore. After multiple cosmetic procedures, including a brow-lift, a neck-lift, and a nose job, she was starting to get that alien plastic look, and she was distraught. The 55-year-old housewife from Long Island had so much filler in her cheeks that she looked as if she had balloons under her eyes, her lips--overly plumped with silicone-- resembled those of a platypus, and their disproportion made the rest of her features look as if they didn't belong on her face. When Ann showed me a picture of how she looked before she had all that work done, I noticed that she had once been a stunningly beautiful woman. She had a few lines and folds, and a little sagging around the jowls, but nothing that would have required the drastic surgical intervention she had endured over the years.

Many aging women just like Ann have bought into the myth that cosmetic surgery can turn them back into their younger selves, and the results can be disastrous. And every time they try to improve upon the first bad job, it just gets worse. That's when they come to see me.

The above patient has had multiple treatments and surgeries, resulting in an unnatural look: overfilled mid-cheeks, uneven lips, and an overly taut, pulled appearance from excessive brow and face lifts.

While I couldn't get Ann completely back to the pre-surgical look she was born with, I could clear up some of her damage with a few fine-tuned procedures (all of which I will discuss in more detail throughout the book). Luckily, the filler in her cheeks was Restylane, which has an antidote. After I toned down that puffy chipmunk look, she already looked much better and more natural. But there were still several pull marks on the side of her face from the lifts, so I treated her with a laser resurfacing procedure, which softened the lines and greatly improved the overall texture of her skin. A few weeks later, I added Sculptra--a volumizing filler--deep below the skin's surface, to correct the architecture of her face as much as I could and to build a more natural plumpness around her cheeks. The lips were another matter. The silicone could be removed only with a painful surgical procedure, and the resulting scarring could be worse than what she already had. I referred her to a plastic surgeon I trusted and encouraged her to weigh the pros and cons of yet another potentially risky surgery.

LESS IS MORE

The anti-aging treatments I discuss in this book are not meant to turn you into a totally different person. They are designed to correct marks of aging gradually and gently as they occur so that you can maintain your natural looks and always look gorgeous, young, and healthy--for your decade. Don't make Ann's mistake and try to look unrealistically younger.

Appreciate your unique beauty and do everything you can to protect what you already have. Instead of seeking the surgical quick fix, focus on the new paradigm for age prevention and reversal: cell turnover, or the shedding of dead skin cells to make way for younger cells and improve the texture of your skin's surface and stimulation of collagen, a major component of connective tissue. Collagen is basically protein, made up of amino acids strung together like long chains of linked building blocks, and it is the foundation that gives your skin its support and thickness. The more collagen you have, the tighter the skin and the more you can fight against gravitational pull. In later chapters, I will discuss many ways you can put your skin to work for you. Maintaining a natural, youthful look is not about cutting and removing skin as you would in a face-lift. Instead, the focus should be on volume repletion for thick, plump, youthful skin.

Before I launch into the various anti-aging options you might want to consider at different stages in life, you should know that I am biased. Everything I stand for is about reversing the past trends that have distorted our perceptions of human beauty and caused lifelong damage to patients like Ann. Ninety percent of the time I advocate against plastic or cosmetic surgery, but I am not saying never. I am a board-certified cosmetic surgeon and I do occasionally perform surgical procedures, but for most of my patients, I just don't feel that cutting and removing skin and fat tissue are necessary.

HOW MUCH IS TOO MUCH?

Doctors and patients have lost sight of what's natural when it comes to the aesthetics of cosmetic enhancement and age reversal. Young actresses are distorting their features with fillers to create pouts like a pair of sausages. It's not sexy, it's comical. And it doesn't look real. Women are getting childlike button noses that don't fit their faces. Women and men are getting brow-lifts that pull their faces up so high, they look permanently surprised. When I see these patients, I immediately think of Howdy Doody. Other patients are freezing their faces into perfect Botox masks and going crazy with injectable fillers and implants for a lumpy, cartoonish effect.

People generally know when someone has had too much done--whether it's a nip and tuck or filler. We've all seen the celebrities with cosmetic procedure disasters. They're under enough public scrutiny, so I am not going to add my voice to the choir by naming names. All you have to do is pick up a tabloid at the supermarket checkout for the latest in the list of top 10 worst makeovers. But the trick is knowing when you are going too far on your own path to age reversal. It's hard for us to see ourselves as others do. We may focus on a flaw that we think needs to be corrected where the rest of the world sees nothing. A doctor can guide us, and even opt to refuse a procedure, but patients can always find someone less scrupulous who is willing to give them what they believe they need.

Eyes, lips, nose, cheeks--these are all features that can throw off the proportions of the rest of the face. Lips are the most common problem area, which is why I always urge patients to leave them alone. But it's all too easy to overfill other areas of the face as well. Instead of looking rested and refreshed, a patient who goes too far looks puffy, even lumpy. So manage your own expectations and decide what you are really going for when you step into that doctor's office. Bring in a picture of yourself looking your best 5 to 10 years ago to give the doctor a visual guide. Much depends on the aesthetic sense of your dermatologist or plastic surgeon. Make sure their artistic instincts lean toward the subtle. Ask to see as many before and after pictures as you can. That is your right as a patient. The rest is up to you.

You know you are in good shape when your friends have no idea you've gotten work done. They think you look great and assume it's because you've spent the last month at the spa. They ask you where you went on vacation. But if they starting asking you who did your nose, or your eyes, or your cheek implants, it's a bad sign. And if they say nothing because they are too embarrassed to draw attention to the elephant in the room, it's even worse.

KEEP IT REAL!

Set your skin up for success with proper prevention: sunblocks, antioxidants, cosmeceuticals, and proactive skin care.

Choose a practitioner with aesthetic goals that match yours--if a doctor is known for one look, it's not likely that you will get something different.

Build good anti-aging practices now to avoid drastic surgical measures later.

THE NEW NATURAL

Recently there's been a backlash to this quest for inhuman perfection. Hollywood actresses who have had too much surgery are losing roles. Casting directors are eschewing the frozen foreheads in favor of women who can move their faces and show emotion. They're giving the juicy parts to actresses from outside of Los Angeles, and even outside of America, where the plastic surgery craze hasn't gone as far and most women in show business still have their original noses and lips.

One of the best examples of that rare actress who has aged gracefully is Betty White. While she has been tweaked over the years, she still looks age appropriate, and her recent comeback is a clear sign that we are appreciating people with a more natural, realistic appearance.

This new natural look is what discerning men and women are now asking for when they come to my office. They want a combination of volume, elasticity, and smooth, supple skin with few (if any) wrinkles. And no surgery! Take my patient Barbara, for example. When she first breezed into my office, I could tell she'd taken great care of herself over the years. She was one of those perfectly groomed, elegant women you often see out shopping or walking their poodles on Madison Avenue. A nonsmoker who avoided the sun and rarely drank, she had very few wrinkles for a woman who was probably in her mid- to late fifties. But she wasn't happy.

"Doc, I need a pick-me-up. I'm starting to look like somebody's mother. I'm not ready for that."

I asked her: "Barbara, exactly what is it you are hoping to achieve with cosmetic procedures?"

"I want to look perked up and fresh. But you can forget about surgery. I am afraid of going under the knife, and I do not want to look like one of those creatures I see all the time on the Upper East Side. You're not cutting me up and pulling my face back. No way!"

I assured her that's not what I do. Women and men come to me for noninvasive anti-aging procedures because they avidly hope to avoid cosmetic surgery. My use of fillers and Botox is very conservative. Barbara had tried both before, but the doctor had gone overboard and given her a hard, frozen look that she hated.

"Barbara, I promise you, I will keep you looking natural. When you walk out of here, no one will know you've had a cosmetic procedure. My approach is to simply make you look younger and more refreshed, as if you've just come back from the most incredible vacation of your life."

I could see she liked the notion. Even though I made it clear to her that it would take time, commitment, and money--one Thermage treatment alone can cost around $2,500, while a course of Botox and filler can add up to at least another $2,000--Barbara was more than ready to put in the work and investment if it meant turning back the clock on her terms.

First, I used Botox, sparingly, to smooth out her crow's feet. Then I injected some filler, Sculptra, into strategic spots underneath her cheekbones to smooth out the nasolabial folds--those marionette lines that run between the sides of the nose and mouth--and build some overall volume into her face. Over time, the filler would help her produce more collagen on her own, to thicken and tighten her skin.

On her next visit, I treated her neck and jawline with Thermage, a radio- frequency therapy that heats the deepest layer of the skin to stimulate collagen and tighten as it heals. I used the same treatment on her upper eyelids to open them up and eliminate some of the droop at the sides.

On her third visit, to keep her skin wrinkle-free and even out her skin tone, I started her on Fraxel, a laser therapy that's used over a course of multiple treatments. To help her maintain a smooth, glowing look, I also custom-blended prescription-strength com£ds for Barbara to use at home, morning and night, to protect against environmental stresses during the day and to reverse the damage and rejuvenate the skin at night. They take only a few extra minutes a day to apply, and the long-term benefits will sustain her youthful appearance for years to come.

The results of this multipronged approach were subtle, just as I had promised, and the improvement was gradual. It takes 3 to 6 months to see final results with Thermage, but by then Barbara had turned back the clock by at least 5 years. Now, 7 years later, Barbara looks even better than she did after the initial round of treatments. She's been coming in twice a year for peels and maintenance shots of Botox and once every 2 years for Sculptra, and she sticks to her at-home skin care routine religiously. Her friends and family tell her she doesn't look a day over 45, and I know she will continue to look this good well into her next decade. She couldn't be happier.

"Thank God you didn't make me look like a freak," she exclaimed to me recently. "I didn't want to go through the rest of my life looking like I'm sitting in a wind tunnel. I feel like myself, only much, much better."

YOUR AGE, AND BEAUTIFUL

When I see pictures of Katharine Hepburn at any age, I think, "That's how a woman is supposed to age." She looks beautiful in her twenties, forties, sixties, and eighties. She was a stunning octogenarian. Sure, she had a few age spots and lines toward the end of her life, but so what? She took good care of her skin, and it showed all the way into her final years. Had she lived the majority of her life in this century, with access to all the age reversal technology we have today, she could have looked even lovelier for her years. And perfectly like herself.

The era of knock 'em out, stitch it up, or pull it back is over. Less is more. We're on the cutting edge of a kinder, gentler anti-aging revolution that's so much more elegant and natural than the current norm. An older face has so much more going on that makes it attractive. If a woman takes care of herself from an early age, she grows into her face beautifully. Her features tell a story about who she is.

Of course, everyone has a different aesthetic. When you're consulting with a dermatologist or a cosmetic surgeon, it often helps to bring in a photograph from a time when you felt you looked your best. Seek to restore the beauty that's already there.

GRADUAL REFINEMENT