Dermatologists are pushing smaller, more frequent interventions that promise the same pipe dream as always: eternal youth.
“Did you have really chubby cheeks as a kid?,” aesthetician Lisa Goodman asks me as I’m sitting in her office beginning the diagnostic process for my “healthy aging plan” — a decade’s worth of treatments, dictated by Goodman, based on the particulars of my face.
“They were enormous,” I tell her. Goodman, a nurse practitioner who founded Good Skin in New York and Los Angeles, moves closer. This cheek fat, she says, is now moving down my face unevenly. As the first step of my plan, she suggests filler on the right side to stave off jowls. I’ve already had my photo taken from several angles (following the assistant’s instructions to make an “eek” face and a kissy one), and Goodman has cupped and yanked at my face to analyze my bone, muscle, skin, fat, and connective tissue. The goal is to use this information — and whatever injectables, lasers, or other interventions she prescribes — to make me age better. Goodman’s “healthy aging plan,” and similar versions offered by other practitioners, don’t entail stopping my older face from emerging entirely. Goodman assures me she wouldn’t turn it into a frozen, puffed-up example of injectables gone bad — that’s unhealthy aging.
“I started the clinics with this idea that if you had a European technique, which I learned from two French doctors, that you would ensure people not looking done,” she says.
Derms can do a lot these days, and anyone alarmed by new wrinkles or dark spots, or the start of their own jowls, might be considering taking advantage of that. If you can remove the fear of coming out with a face that looks more like a Brentwood Country Mart regular’s than your own, all the better. The goal, Goodman says, is to return your face to one you recognize in the mirror. “We want to pull you back to yourself,” she says.
The basic idea is that patients get smallish dermatological treatments over a number of years so they’re never confronted with a completely new face (and friends who gasp, “What did you have done?”). Edylenne, who works in technology in New York, visited Dr. Shereene Idriss for the first time when she was 43. “Look, I’m aging,” she told her. “I’d like to do it gracefully. Can you help me do that?” In the following three years, she’s had Botox and filler and is considering a laser treatment.
It sounds sensible, but what’s billed as a considered, minimalist way of improving aging skin could also be a way to keep you coming back to the dermatologist’s office for more procedures, decade after decade, with no end in sight. After my diagnosis in Goodman’s office, I could see that she was right about my right side being more jowly than my left, and I haven’t been able to unsee it. But I haven’t gotten the filler that she suggested in a big part because I worry that once I start, I won’t be able to stop. For now I’m comfortable with less intense treatments, like lasers to remove the occasional dark spot and prescription Retin-A.
I asked Goodman’s patient Ann, a 71-year-old former backup dancer for Tina Turner turned social worker in Santa Monica, California, and all-around inspiration — she still dances hip-hop multiple times a week — if she’d ever stop. She’s been seeing Goodman since she was 57 (and had a facelift before she started with Goodman). “I kind of feel like I have to keep this up, to be honest,” she says. “Maybe if I had a man and we were off and running, and I felt secure. I say that not really knowing how I would be with a man because I might just be the same way.”
Not that Ann’s lacking for attention. “I know that I feel good about how I look,” she says. “It’s not like guys are looking at me like I’m 25, but I have people come up to me and say, ‘Oh my God, you never age. What’s happening here?’”
In general, no matter what you think about how long-term your relationship with injectables should be, the industry is trending toward these tinier treatments. Derms and surgeons are using a lineup of Botox, fillers, lasers, and peels, as well as facials and prescription skin care, instead of major surgical overhauls to keep people smoothed out and lifted enough that they look fresh but not overly tight or poofy. “Doing that kind of combination treatment has evolved into, ‘Hey, we can keep you looking great,’” says Dr. Ava Shamban, a cosmetic dermatologist in Beverly Hills who’s been practicing since 1989. “It’s not like go in and have this enormous face lift, eye lift, and neck lift and then you’re done. We’ll see you in seven years when it all goes away.”
As for whether these tweaks can prevent the “cut and sew” altogether, Dr. Shamban says it’s possible if you start early enough with the right skin stimulating and correcting treatments. “For many it will push back the drooping point to delay the need for more extreme measures by a few years,” she says, “and for some, even stave it off forever.”
Shirley, a Pilates instructor who’s about to turn 60, has seen Dr. Shamban for the past 14 years. She gets injections and laser treatments at least every six weeks, but loves that she doesn’t look like she clocks that kind of time in a plastic surgeon’s office. “If I went to a high-school reunion, I don’t look like the weirdo,” she says. “Everybody would recognize me, and they’d all say, ‘You look exactly the same.’”
Practitioners being linked to their patients more strongly, through years of working together, also means derms are taking a firmer hand when it comes to what treatments they won’t do.
Dr. Idriss frequently restricts her patients (she also gives herself Botox and fillers no more than twice a year). She tells them, “I’m losing money telling you no, but my goal is to grow with you so that you don’t look like a freak, and we’re all happy because, at the end of the day, my name is on your face.”
“The goal is when I look at the pictures from today, they don’t look different from five years ago,” she says. “Their state has been a steady state, and if we’re lucky, they look even more refreshed.”
Goodman withheld Botox from her patient Jessica, a 44-year-old stay-at-home mom in Los Angeles, who’s been seeing her since she was 29. When Goodman opened her own practice, Jessica was surprised to be told that she was no longer going to get as much Botox in her forehead. Goodman said it was making her short forehead look too heavy. As they kept working together, at one point, Goodman even requested she take an entire year off Botoxing her forehead to lighten it. “I’d be staring in the mirror and be like, Ugh,” Jessica says, “and she’d be like, ‘Nope, it’s too heavy.’”
That doesn’t mean patients have no say. Ann, the 71-year-old dancer turned social worker, only got a little Botox when she started seeing Goodman. Gradually Goodman got her to integrate filler — Renuva for overall volume loss and Belotero for lines. Ann’s for it, but occasionally balks at the cost. “I am not one of these rich women that have a husband that can throw money at it all,” she says. “I don’t have that. I spent a lot of money to the point where like, she’ll say, ‘Do you wanna do this?’ I’ll say, ‘I have to pay my taxes first.’”
She also has had to put the brakes on when she feels Goodman expands her face toward too unnatural with filler. “Look, I don’t want it all blown up here,” she says to her. “I like it a little bit caved in.” Goodman then pulls back.
It’s okay to have some lines,” Ann says. “Look at Mick Jagger. If he can do it, I can.”
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