The Quick Fix
When it comes to plastic surgery, I am, for better or for worse, a product of Boston's puritanical milieu. Sure, everyone should do what needs to be done to make themselves feel attractive, but within limits; unless plastic surgery is really necessary, I'm against it. Don't misunderstand: I'm all over the vanity thing. Makeup is my best friend; waxing is a social responsibility; and hair coloring is practically a hobby. But going under the knife? No, thanks.
Thirty-year-old women who gush about getting eyelifts make me shudder. I'm proud to live in a city that doesn't parade around expensive physical reconstruction as a status symbol. L.A.'s fashion scene is great and Miami's style may be daring, but walking down those city's streets against a tide of breast implants and unnatural-looking liposuction jobs on women who have literally cut themselves open to achieve what they believe to be perfection makes my feminist heart freeze.
But that was all before the beauty industry revolutionized itself and opened the floodgates to fast, efficient, relatively inexpensive, and notably pain-free procedures Â— even here. The last two years have seen a tsunami of options, set off by the advent of microdermabrasion and pushed forward by the FDA approval of Botox and the refinement of more and more laser treatments. Now, in under an hour, you can have wrinkles zapped away, forehead creases smoothed, unwanted hair removed permanently, sunspots flashed into oblivion, or your teeth brightened to a neon white Â— and then go straight back to work.
Are these miniprocedures the miracles they're being billed as? To find out, I volunteered to act as guinea pig and offer myself up to the lasers and injections, and to finally get the lowdown on what works and what doesn't. And if this native New Englander comes out looking just a little closer to perfection in the end, well, that's just the harsh price of being a journalist.
Botox and Mini-Eyelifts
“You'll feel a slight crunch when I do this,” Dr. Ramsey Alsarraf says, standing over me with a needle. “It's just the sound that tells me I'm in the muscle.”
This is my taste of the infamous Botox. For anyone who's managed to escape the past year's onslaught of information about this product, it's a neurotoxin that is injected directly into your face, beneath expression lines.
Exactly where patients get injected depends on how they move their faces. Creases in the glabella region Â— the nook just above the nose and between the eyebrows Â— are most common; but mine are across the forehead, made by forever raising my eyebrows. Apparently, I've been a lot more surprised than angry over the years.
The tiny 30-gauge needle doesn't particularly hurt, and Dr. Alsarraf's down-to-earth manner keeps me relaxed. He literally wrote the book on taking care of the face: Coauthor of The Aging Face: A Systematic Approach, Alsarraf is a Massachusetts Eye and Ear Infirmary-affiliated surgeon who does everything from rhinoplasty to full facelifts. Lately his art-filled Newbury Street office has become a headquarters for Boston's Botox revolution.
“You picture Botox clients as tending to be just one kind of person,” Alsarraf says. “But that's really not the case for us. We have more and more men coming in Â— husbands come in whose wives are doing it, plus CEOs and ad executives.”
Alsarraf's patient roster has its share of well-heeled women, too. So many, in fact, that two years ago he became the first doctor in Boston to host Botox parties. “They're a great way for people to both fit it into their busy schedules and to get over their fear of the procedure, to do it with friends,” says Alsarraf, who hosts the wine and cheese get-togethers after office hours.
If ever there was an indication of just how quick and easy the procedure is Â— and also just how cavalier many people have come to feel about these injections Â— the Botox party is it. The popularity of Botox parties is also a sign of just how effectively the procedure is erasing the social stigma previously associated with any kind of face work. In addition to Botox, patients can learn more at such parties about surgeries done there.
“It's evolving fast in Boston,” says Alsarraf, who before setting up his practice here did a residency in Seattle and a fellowship in New Orleans. “Bostonians certainly get a lot of work done, but they don't talk about it as much as in New Orleans. There, it was a badge of honor. But here, I have patients who haven't even told their sisters they've done anything.”
That same secretiveness may be behind the popularity of another of Alsarraf's popular quick treatments: the mini-eyelift. “It's a more subtle change, more natural if it's done at a younger age,” he says. The procedure is best for either people in their thirties and forties with noticeable bags under their eyes or for older patients who have already had a facelift they want lifted further. It takes under an hour, Alsarraf says, requires a light general anesthetic, and heals almost completely over a long weekend. (This shouldn't be confused with a mini-facelift, which many practices advertise as fast-healing, but which typically takes two weeks of recovery time.) Healing time is an important sticking point for any doctor looking to woo a client base as historically procedure-wary (and busy) as Boston's.
“People here have a real fear of surgery,” he says. “But a good doctor shouldn't talk you into doing anything you're uncomfortable with, and they shouldn't make you look like a different person. You should look like you, just better.”
Forty-eight hours after my Botox injections, the middle of my forehead feels slightly tight and numb, though I can still feel anything that touches it. Because Alsarraf has been careful about injecting exact amounts in specific areas, I can raise my eyebrows Â— just not completely. It feels unnatural at first. Paranoia tells me everyone is looking at my forehead. They're not. Besides, it hasn't looked this silky smooth since my teens. All weekend, I ask friends to tell me if my forehead wrinkles. It doesn't. Then comes the biggest surprise of all: Within a week, I'm completely used to it.
Lasers: Nonablative Collagen Replenishment, Sun Spot and Hair Removal
“You look like you got punched,” my boyfriend says, staring closely at the puffy and reddened area under my eyes.
I'd just come from sitting under an NLite laser Â— the first nonablative (read: no cutting) laser approved by the FDA for wrinkle reduction. “If this works,” I reply, “I ought to be absolutely wrinkle-free in two or three months.”
The laser procedure is supposed to be the current heavyweight contender against moderate wrinkles anywhere on the face. But with “moderate” the operative word, I'm sure I'm a good candidate. With my shiny new Botoxed forehead, the only real wrinkles I have left to try this out on are the embryonic imprints of crow's feet underneath my eyes.
A visit to Brookline's Rockoff Dermatology Center (which offers Botox injections, laser hair removal, microdermabrasion, and chemical peels, all quickly enough to fit into lunchtime) convinces me I'm wrong. Registered nurse and clinical manager Rose Rogers takes one look at me and says that I should have a go. “The skin under your eyes is just starting to show its loss of elasticity,” she says after a consultation. “That's where you start to get sort of a crepe-paper effect. Your lines are fine, too, but we can fix them up. You'll see the difference.”
I follow her into a separate treatment room where she places small, dense metal shields on my eyes and tapes them down. This will be the first of three treatments spaced at least two weeks apart; each time, a yellow laser light will pinpoint and “insult” collagen at its source deep in the skin, forcing it to replenish and reduce fine lines. Within 30 to 90 days of the first treatment, those lines are supposed to start their disappearing act.
Rogers warns me that, since my skin is fair, there may be tiny pinpoint bruising for a few days. (From that description, I didn't envision puffy and red, which is what I was that evening as I arrived at a friend's wedding.) “When I start this,” she says, “you'll see a flash and hear a beep of the machine. You'll see the flash more intensely as I get closer to your eye. You may see light on some of the veins of your eyes. That's the part that makes most people nervous. They think something's wrong. But don't worry. It's normal.”
And that's what happens. There are bright flashes, but no pain, no anesthetic, no drawn-out boring procedures, no fuss. Three months later, however, there are also no particularly noticeable results. On very close inspection, I can see a slight change, but no more than after applying a good eye cream. “Our ideal candidates are 35 to 50,” Rogers explains. “The finer the line, the better the result. Anyone with deep wrinkles will see a softening, but they won't go away entirely. In consultation, we make sure each patient has realistic expectations.”
Rogers herself has had the procedure done, and she looks all of 35. (She's 50.) Why hadn't it worked on me? If I didn't have more than a few tiny wrinkles to start, shouldn't they all be gone by now?
“It's an ongoing process,” she says. “Starting at that three-month point, you're constantly forming new cells. We compare before and after pictures at the six-month point, because everyone's collagen builds up at a different rate.” Within two weeks of this conversation, I finally begin to see changes. The lines aren't gone completely, but only the abnormally farsighted could see them. People ask me if I've had a facial, and my impatience subsides.
Patience, however, is not something that most lunchtime makeover clients tend to have. Dr. Leslie Lucchina, founding director of Aesthetic Dermatology at Brigham and Women's Hospital, knows this better than anyone.
“An office needs to run efficiently for people who have fixed amounts of time,” Lucchina says, sitting in her own Longwood office. And despite the quick-and-easy nature of many of her procedures, she says she considers it a major part of her job to help people understand the risks and limitations of the lunch-hour procedures she performs. “Really, there is no free lunch,” she says. “And even though we're working on more noninvasive procedures, there are always risks.”
Lucchina lists microdermabrasion, chemical peels, and lasers for broken capillaries, and laser-assisted hair removal as her most requested procedures. And, thanks to four years of lifeguard duty while in college, I just happen to have a few sun spots handy. “Don't plan on going anywhere important right afterward,” Lucchina says. “This will only take a few minutes, but you will have small, open red spots where I've put the laser.”
The machine lets out a series of high-pitched beeps and makes a ticking sound as she begins Â— each zap seems to take about a nanosecond, and feels like a tiny pinprick met with a soft burst of cool air. In three minutes, we're finished, and Lucchina is applying a balm, telling me to keep the areas clean: no makeup. Since the spots linger over the next few days and I've got meetings and dinner appointments to keep, I damn the consequences and disobey. In spite of this, within a week, as Lucchina promised, the spots are healed, and new, fair, and fresh skin has taken their place.
“Sure, I want to make people feel good about how they look. But just as importantly, my goal is to get people to get more comfortable with the aging process,” says Lucchina, who is writing a book on the topic. “New York is constantly pushing the envelope in terms of developing new techniques to create a more youthful appearance. That said, it isn't necessarily a bad thing that Boston isn't on the cutting edge in this area.”
That's a philosophy also espoused by Claire McCardle, owner of Beauty Therapies medical day spa. One of the city's (and the laser industry's) most experienced plastic surgery RNs, McCardle doesn't pull punches.
“Some of the quick treatments that people pay a lot of money for just aren't effective,” she says. She isn't one to advocate aggressive tactics, either. “My clients want to feel better about how they look. But at the end of the day, it's about safety, and what's realistic for their lifestyle. No one wants to show up somewhere looking terrible after a particularly strong chemical peel. I won't tell a client to get one on Friday if they have to out that night.” (One of Beauty Therapies' most popular procedures is the “Epifacial,” an intense-pulse light treatment that removes sun damage, improves texture, and eliminates brown spots; it takes about one to three days to recover.) “On the other hand,” McCardle says, “there are procedures that truly are quick and easy. For example, I can laser someone's facial hair in less than 15 minutes.”
So that's just what we do. The new CoolGlide laser is billed by many technicians Â— McCardle included Â— as the most effective way of dealing with hair removal. It uses what the industry refers to as “selective photothermolysis” to target and destroy several hairs at once, rather than the arduous one-by-one approach of earlier lasers (and electrolysis). The machine sends a pulse of light into the root of each individual hair, gradually killing the follicle. Unlike predecessors that really work only on fair skin and dark hair, these latest machines claim to be equally effective on tanned and darker-skinned patients.
McCardle says she can focus on any area of the body, so just to be difficult, I pick the most typically stubborn region: the face. I'm lubed up with numbing cream, and then McCardle shaves the area clean, smoothes on a gel, pops some huge colored goggles on each of us, and we're up and running. The blip of the laser precedes each pulse of light, and as the rays target each hair, I can feel the light absorbed down into the follicle Â— particularly in the sensitive area directly above the lip. It's a strange but painless sensation. Before I know it, the handpiece McCardle is using turns cold and she ices down the skin that's been treated, which feels hot. It stays red for about an hour, and delicate for about four. But it isn't sore.
“You'll need more treatments,” she says. “Four to six is typical. And because this hair grows on a monthly cycle, that's how often we'll treat it.” Sure enough, over a series of five treatments, the hair begins to thin. Like most state-of-the-art lasers, McCardle's has no skin type restrictions. Within two days of each treatment, the fine hairs fall out, and they grow back thinner with every treatment.
If laser hair removal is the obliteration of your face's natural state, then tooth whitening is the return to its natural state. Years of coffee, red wine, cigarettes, and other vices gradually dull the hues of anyone's choppers. After one seemingly endless at-home whitening run under the care of a dentist, the notion of reclaiming my once high-wattage smile in an afternoon sounds almost too good to be true.
“We can basically get your teeth as white as they can possibly be,” says Dr. Steven Spitz, sitting in his Kenmore Square office at SmileBoston. Most reports echo him: In-office whitening procedures like the kind Spitz provides Â— called BriteSmile Â— can make teeth up to 10 shades whiter in one hour, while dental trays typically take two weeks to a month (but cost much less: BriteSmile averages about $700, and trays usually run from about $400 to $500).
After a thorough cleaning, we get right down to the brightening process. First, Spitz applies a hydrogen-peroxide gel to my teeth, and then on goes another pair of goggles. (I've donned more oversized goggles during treatments for this story than all the skiers at Sugarbush.) A light is aimed at my head, as is a small movie screen. The process takes about an hour and a half Â— just enough time to watch a movie, which SmileBoston provides. In honor of this vanity hunt of mine, I ask for Bridget Jones's Diary.
Three times the gel is changed, the heavy contraption on my head is refastened, and the blue light is flipped back on. Just as the movie ends, I'm done. “You're off the charts white,” says the hygienist. She turns around, palming a color chart to match my current color. My teeth are so white, they could rival Donny Osmond's; they're a shade lighter than the brightest sample.
“For many people, it's become the new facial,” says Beauty Therapies' Claire McCardle of the popular exfoliating treatment. Indeed, the minute the method made its debut several years ago, it was rolled out to spas on nearly every corner of Newbury Street.
Each treatment typically takes about 30 minutes (minus any additional masks or cleansing services) and uses a vacuum-like tube filled with a steady stream of microscopic aluminum oxide crystals to essentially “sandblast” away old, dead skin. It isn't a pleasant feeling, but it's tolerable. The sensation feels like the pins-and-needles that come when an arm or leg falls asleep. But the process uncovers fresher, undamaged skin and, in the best of circumstances, lightens up any hyperpigmentation, reduces wrinkles, and improves elasticity. Because it's only the outermost layer of the epidermis that is taken off, most practitioners recommend a series of treatments.
“This technique can allow exfoliation into the second layer of skin. But, of course, we don't do that. Typically this is used to exfoliate the very outermost skin cells to create a more youthful appearance,” says the Brigham's Lucchina.
There are, however, a few subtle downsides. First, clients who (like me) have more sensitive skin end up with flakes at first. “That's normal Â— it's part of the healing process, and it's good for you,” says Candela Spa veteran aesthetician Alla Froyman. “You just need to be very careful to administer the correct amount of exfoliation for individual clients' skin. Otherwise, there might be too much redness.”
Also, the process can dry skin. In answer to that, McCardle has created the oxyderm facial, which follows microdermabrasion with soothing, soft blasts of pure oxygen Â— something she says has kept more than a few clients' faces plump and dewy. She, like Froyman, chases that with a cooling mask to cut down on any remaining redness.
Like most of these procedures, results vary from patient to patient. “While many of these treatments are useful, they have their limitations,” Lucchina says. “If it took 40 years for someone's face to look like it does, it's not going to be markedly altered within 30 minutes.”
Dr. Alsarraf agrees. “There are a lot of great quick fixes out there,” he says, “but you can't come in at lunchtime and have a light flash in your eyes or get a quick injection and look like you're 20 years old. No matter what you do to someone, not everyone can look like J.Lo.”
After months of lunch hours spent in doctors' offices, do I look drastically transformed? Not even close. But there are small differences: My skin glows (and is hair-free) thanks to Claire McCardle's oxyderm; my Botox may be wearing off, but it's kept my forehead smooth for months; my freckles (okay, sun spots) are history, thanks to Dr. Lucchina's laser; and Dr. Spitz has made my teeth Aspen-white.
I still look like me. I have yet to be stopped on the street with, “Can I have your autograph, Ms. Lopez?” Then again, that may not be such a bad thing. After all, Ben Affleck may be a Boston boy Â— but J.Lo, God love her, is pure Miami.