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elen Duke dosen’t
do spa facials any
more. For the last
eight years, the
Indianapolis boutique owner has
been going to
Stephen Perkins,
M.D.’s office for regular facials, peels and
microdermabrasion, as well as using his
line of skin care. This yar, for her fortieth
birthday, she asked him to inject her brow
and forehead lines with Botox. And sometime in the next decade or so, she says, she
might even ask him to do
beauty ►388
what he's trained to do: give her a facelift.
Three nights a week (including Saturdays), the OR at Steven Pearlman, M.D.'s,
Park Avenue practice morphs into a beauty
lounge. Aesthetician James Kivior uses
Oriental screens to hide the surgical equipment, puts out a heated feather bed, lights
some aromatherapy candles, and Operation
Rejuvenation begins. The socialites and
professionals who swoop in for the service are
greeted with a baby cheesecake and a virgin
piña colada before settling in for the $125
beauty sampler, which combines a facial,
peel, and microdermabrasion with hot stone
massage and a salt foot scrub. Afterward,
they can pop next door to get Botox from
the doctor himself. Pearlman describes it as a
"comprehensive
approach
to
facial
rejuvenation. I hate to use the term, but it really
is one-stop shopping."
Suddenly, plastic surgeons' officestraditionally the places to go for full-scale
"procedures" like rhinoplasties, tummy
tucks, and browlifts-are feeling a lot like
dermatologists' offices, offering wrinklefilling injectables (Restylane, Perlane),
collagen-plumping lasers, and complexion-
polishing microdermabrasion. And yet it
was only a year or two ago that dermatologists' offices-where women historically went to find solutions for acne,
and to have moles checked-started to feel a
lot like spas, offering a range of facials and
body treatments (albeit souped up with
prescription-strength
ingredients),
generally performed to the strains of a
New Age soundtrack.
What is going on? As technology advances, the demand for agelessness increases, and virtually anyone with a medical degree sets up shop administering
Botox, the question of exactly where one
should go for what becomes fuzzy. Ac,
cording to Dean Toriumi, M.D., president
of the American Academy of Facial Plastic
and Reconstructive Surgery, plastic
surgeons and dermatologists are both
qualified to perform these "relatively
minor office procedures." As long as the
doctor administering the treatment is
board-certified (by either the American
Board of Facial Plastic and Reconstructive
Surgery or the American Board of
Dermatology) and experienced with the
medium (a good question to ask: How many
of these procedures do you perform a week?),
who to go to is a matter of personal
preference.
What has prompted surgeons to dip their
toes into dermatology-spending as much
time filling syringes as sharpening their
scalpels? The current trend toward speedy
antiaging solutions-a subtle move away from
invasive, expensive surgical
procedures has forced them to
find new ways to stay in the
game, even if that includes
cheesecake. "I do more Botox,
collagen, Restylane and
dermabrasion than I do
liposuction,
facelifts,
and
eyelids," says Manhattan
surgeon Thomas W. Loeb, M.D. "I can
Botox a patient and be out of the room in ten
minutes. If I'm doing a facelift, it's three, four
hours, so there's a limited number I can do."
According to the American Society of
Plastic Surgeons, the number of
facelifts performed last year decreased by 5
percent, while Botox injections increased by 31 percent. As Loeb puts it:
"There's Botox dollars out there."
Skin-care dollars, too. Loeb joins Manhattan plastic surgeons like Lawrence
Reed, M.D., whose two-year-old S.T.A.R.
(Skin Therapy and Anti-aging Rejuvenation) Center focuses on deep chemical peels and
microdermabrasion, and Scott B.
Wells, M.D., who’s Skin New York Center
has offered vitamin-packed rejuvenating
facials, Endermologie, and body contouring for the last year. This
f a l l , a e s t h e t i c i a n E l l e n Lange
"I do more Botox, collagen,
Restylane, and dermabrasion
than I do liposuction,
facelifts, and eyelids," says
plastic surgeon Thomas Loeb
388
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(creator of the best-selling home peels) joins
her father and two brothers-plastic surgeons
Alvin, Mark, and Robert Glasgold-at a plush
new Park Avenue satellite of their popular
Highland Park, New Jersey, practice, the
Glasgold Group. In Beverly Hills, celeb
favorite Norman Leaf, M.D.'s, seven-year-old
Solutions Skin-Care Medical Clinic was
one of the first such centers where patients
indulge in power peels and injections in
addition to - or perhaps in place of-actual
surgery.
But don't think that all plastic surgeons are
totally Blissed out. "We don't do hair. We
don't have a masseuse,"
beauty ►390
VOGUE NOVEMBER 2003
says Aron Kressel, M.D., who recently expanded his Park Avenue practice to include
$210 micro-current facials using the sought
after Biologique Recherche products just one
of several "quick lunchtime fixes" he offers.
Kressel says that this "noninvasive facial
lifting" procedure can prolong or even
prevent the need for a surgeon-i.e., him.
He's aware of the irony. "Surgery has
downtime; it's an expense," he admits. "By
doing little things along the way,
[women] might never need surgery. I'd
like for them to have surgery, but it's certainly a happy patient that will come back
and continue to do the treatments, and
we're happy for them," he says.
nd
don't
forget:
This year's pumpkin
peel
client
could be next year's
browlift.
A
major
benefit of visiting a
surgeon rather than a
dermatologist-or spa-for treatments that may
fall into the "skin care" category is that he or
she keeps a trained eye on what to do when
wrinkles go beyond Botox. "Some people
aren't ready for bigger procedures," says
plastic surgeon Frederick N. Lukash, M.D.,
who has "medical skin-care centers" in
Manhattan and Manhasset, New York.
"So you need to do smaller things, like
skin care, collagen, and fat, that help them
along physically and psychologically, and also
keep them within your own loop. If they're
happy with you, you don't want to lose
them."
Mia Stern, a former publicist, is a good
example. Stem began seeing Fifth Avenue
plastic surgeon John Sherman, M.D., four
years ago for Botox and collagen. At 31, she had
crow's-feet and forehead and laugh lines
that were barely perceptible, and she wanted
to keep them that way. Asked why she chose
to see a surgeon instead of a skin doctor, Stern
says it seemed logical: "Dr. Sherman is
trained to shape a face with surgery. When
he's injecting Botox into my foreheadanything that is going to change the way my
face looks-I feel more comfortable," she
says. "And if he thinks you would be better
served by something more serious, he'll tell
you to stop wasting your money on Botox
and to get surgery instead." Indeed, two
years ago Stern took her doctor's advice and
had eyelid surgery.
390
Further encroaching on dermatologists'
"There's definitely a turf war going on,"
domain, plastic surgeons like Wells, Reed,
says Manhattan plastic surgeon Robert
and Leaf have recently entered the private Guida, M.D. (who points out that Botox was first
label-skin-care arena, too. The welcome
used by plastic surgeon Andrew Blitzer, M.D.,
in the eighties to correct facial spasms).
from dermatologists, who dominate this lucrative market, has been
skeptical, to say the least.
“A lot of dermatologists resent that
Asked about the trend, nutrition
plastic surgeons do Botox.
-ist Elaine Linker, Ph.D.,
who co founded the DDF line
Their attitude becomes, `What do
with her brother, dermatologist Howard Sobel, M.D., you need to do Botox for when you
says, "It's ridiculous! They have
make $10,000 from a facelift?”
zero training in skincare. Skin
"But I think it's good for patients; it makes
care is a b o u t c h e m i s t r y s chool, not
everyone practice on a higher level."
med school." But few doctors of either
"It's a morass of overlap," sighs Lukash.
specialty are personally mixing potions in the
"Once upon a time, plastic surgeons just
lab. "Cosmetic chemists make the creams,
did surgery and dermatologists took care of
not dermatologists," clarifies Lange. Indeed,
pimples." ■
the vast majority of doctors simply specify
which ingredients they'd like, add their own
LIFE IN PLASTIC
label, and voilá.
The most established plastic-surgeon
Surgeons who double
helmed skin-care line is Re Vive, developed
-duty in skin care
in 1987 by Louisville surgeon Gregory Bays
■ JEFFREY S. EPSTEIN, M.D., F.A.C.S.
Brown, M.D., after doing extensive reMiami; (305) 666-1774
search on wound healing to help postop paSpecialties: hair restoration, eyelifts
tients. His new cream, Intensité Creme
■ RUSSELL W.H. KRIDEL, M.D., F.A.C.S.
Lustre, uses IGF (Insulin-like Growth
Houston; (713) 526-5665
Factor), produced from cloned synthetic
Specialty: rhinoplasty
human molecules, to soften wrinkles and
thicken skin. The $375 price tag might have
■ WAYNEF.LARRABEE,JR.,M.D., F.A.C.S.
something to do with Brown's cutting back
Seattle; (206) 38 6-3550
his office hours to focus on Ré Vive. But he
Specialty: rhinoplasty
believes that skin care would eventually ren■ NORMAN LEAF, M.D., F.A.C.S.
der him obsolete anyway: "Probably in my
Be verl y Hills; (3 1 0) 274-8 001
lifetime, skin-care-like things will replace
Specialty: platysma facelifts
and certainly curtail the magnitude of a lot
■ THOMAS LOEB, M.D., P.C.
of plastic surgery," he says. "The molecules
NYC; (212) 327-3700
and delivery systems are there."
Specialties: liposuction, eyelid surgery
Just as plastic surgeons once felt that dermatologists were invading their territory
■ COREY S. MAAS, M.D., F.A.C.S.
by fighting wrinkles instead of rosacea, derSan Franci sco; (415) 567matologists are on edge about the new
7000 Specialty: necklifts
crossover. "I personally believe that plastic
■ STEVEN PEARLMAN, M.D., F.A.C.S.
surgeons are surgeons, and most other
N YC ; ( 2 1 2 ) 2 2 3 - 8 3 0 0
things related to skin care [are] appropriate
Specialties: rhinoplasty, facelifts
for a dermatologist," says dermatologist
■ STEPHEN PERKINS, M.D., F.A.C.S.
Brad Katchen, M.D., founder of
Indiana polis; ( 31 7) 575-0 330
SoHo's SkinCareLab.
Specialties: corrective rhinoplasty,
"I think a lot of dermatologists resent the
facelifts, blepharoplasty
fact that plastic surgeons do Botox," says
■
LAWRENCE REED, M.D., F.A.C.S.
Wendy Lewis, a plastic-surgery consultant
N YC ; ( 2 1 2 ) 7 7 2 - 8 3 0 0
and author of Americas Cosmetic Doctors
Specialty: corrective rhinoplasty
and Dentists (Castle Connolly Medical,
Ltd.). "Their attitude becomes, `What do
■ SCOTT WELLS, M.D., F.A.C.S.
N YC ; ( 2 1 2 ) 7 9 4 - 3 9 0 0
you need to do Botox for when you make
Specialties: S-lifts, tummy tucks
$10,000 from a facelift?"'
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VOGUE NOVEMBER 2003
Visit Dr Guida’s website at: www.drguida.com.