Saturday, February 17, 2007

The New York Times
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February 18, 2007

And Thanks to My Agent, My Skin Doctor ...

THE weeks between the Golden Globe awards and the Oscars constitute a kind of Hollywood advent calendar for the doctors responsible for the care and feeding of celebrity skin.

For Dr. Ava T. Shamban, a dermatologist in Santa Monica, Calif., the countdown started five weeks ago when several dozen actors and agents, along with a few spouses and siblings, began coming in for laser procedures and facial injections, she said. And, in the days remaining before the Oscars next Sunday, two nominated actresses and one presenter are due in her office for last-minute facials or lip-plumping injections, Dr. Shamban said.

“Whoever is going to walk down that red carpet, actor, spouse, mother, sister, they all want to look like the burnished statuettes on the podium,” said Dr. Shamban, who herself became a minor celebrity after appearances on “Extreme Makeover,” “Extra,” “The Oprah Winfrey Show,” “Good Morning America” and the “Tyra Banks Show.” “They all want to look nice, smooth, glowing, untouched by woe and by time.”

This increased attention to the smallest details of the skin might be called red-carpet dermatology, a specialty spawned in response to the relentless scrutiny of celebrities by paparazzi, gossip magazines, entertainment shows, high-definition television, camera phones and Internet sites including awfulplasticsurgery, TMZ and YouTube.

Red-carpet dermatology involves scalpel-free procedures that create more temporary and potentially less detectable changes than a facelift, including Botox injections to paralyze the muscles underlying wrinkles, filler injections to pad lips and facial creases, or lasers for brown spots and broken blood vessels. These make possible the treatment of minutiae, like tiny crevices above or in the lips, about which actresses may fret more than civilians.

And red-carpet dermatology permits entertainers with augmented faces to utter stock lines like, “I only had Botox” — a little white lie that allows them to obfuscate a veritable arsenal of beauty interventions.

“Celebrities can’t afford to look like they have had something drastic done,” said Dr. Jessica P. Wu, a dermatologist in Los Angeles.

Dr. Wu said she has been working seven days a week for the last month ministering to actresses, agents and producers in her office and on movie sets, as well as making house calls. “But,” she said, “they are coming in for smaller procedures because they know that every inch of skin they show on the red carpet from head to toe is going to be picked over.”

Indeed, the increasing popularity among celebrities of less invasive procedures has turned the idea of cosmetic treatments into a kind of guessing game played with equal gusto by red-carpet commentators and couch potatoes at home. When Isaac Mizrahi reaches out, as he did last year at the Golden Globes, to squeeze the bosom of Scarlett Johansson — a wordless gesture that instantly translated as “Are those real?”— or Joan Rivers asks Sheryl Crow about the provenance of her teeth, the message conveyed is that the celebrity body has become a public document available for close reading and open to group interpretation.

“When all the smaller procedures became available, more people started to do them,” said Dr. Gary P. Lask, a clinical professor of dermatology at the David Geffen School of Medicine at the University of California, Los Angeles. “Then everybody became suspect because we knew there were more things available for them to do.”

Dr. Lask, who led a course for doctors titled “Cosmetic Dermatology: The Hollywood Perspective” at the annual meeting earlier this month of the American Academy of Dermatology, added: “Celebrities are so attractive to begin with that they may have had nothing done, or it may be all lighting and camera angles, or just a new hairdo, or new makeup, or weight loss or weight gain, but it is fun to speculate.”

None of the doctors interviewed for this article would name their celebrity clients because such a disclosure could constitute a violation of doctor-patient confidentiality. But they were willing to discuss in general terms the cosmetic treatments that are particularly popular in their practices during awards season.

Dr. Wu said an actor’s grooming process might begin a month before an awards ceremony with Botox injections to the hands and armpits, treatments designed to reduce sweating.

“Botox for excess perspiration is a must-have for the red carpet, for actresses so they don’t stain their dresses and for actors who don’t want clammy handshakes,” Dr. Wu said.

She recommends that some celebrities undergo what she calls a “Botox neck lift” about two weeks before an awards show. This involves injecting the jaw line and neck to relax muscles underneath the skin, she said.

“It temporarily gives you a sharper jaw line and a longer neck, which looks good if you are wearing a strapless gown or a low-cut dress,” Dr. Wu explained. “And it’s not likely to land the actress on the cover of In Touch with a headline like: ‘Did She Have Surgery?’ ”

These kinds of scalpel-free procedures are also popular among the entourages of producers, writers and stylists, she said.

“When they accompany celebrities to an event, they have to look good, too, because they might be shown on camera, they might be in the frame,” Dr. Wu said.

Up to one week before an event, Dr. Shamban said, she administers injections of temporary fillers like Restylane, a gel made out of hyaluronic acid, to pad lips and invert crow’s-feet. This week, she said, she will also give “superamped facials” to a few awards-goers; the facials involve an acid peel or microdermabrasion to exfoliate the top layer of skin cells, followed by an application of a moisturizing serum.

“If skin is hydrated, it plumps up more and looks glowing,” Dr. Shamban said. “It should last through a whole night of partying.

The Food and Drug Administration has approved Botox Cosmetic to treat vertical frown lines between the eyebrows and Botox as a drug for underarm sweating, and Restylane to fill facial creases and folds. It is legal for doctors to administer Botox for neck wrinkles and Restylane for lip plumping, but these are considered unapproved, off-label uses of these substances.

Dr. Lask cautioned that every patient —actor, bride-to-be or mother-in-law — who has a special event on the horizon should plan at least a month ahead to give any bruising, swelling or skin irritation that might occur after a cosmetic procedure the chance to subside.

But just because some Oscar attendees have opted for the syringe instead of the scalpel doesn’t necessarily mean the interventions go undetected. Telltale signs include raised Vulcan eyebrows (ladies, you know who you are), fleshy platypus snouts (ditto), paralyzed expressionless gazes (gentlemen of celluloid, this means a few of you) and overstuffed moon pie faces (come one, come all).

As Jay Leno put it in a recent monologue: “For the first half hour, I didn’t even realize I was watching the Golden Globes. I thought it was Extreme Makeover.”

Dermatologists, too, are watching the red-carpet parade with a critical eye on the work of colleagues.

“Too much filler can eliminate the natural contours of your face,” Dr. Wu said. “You don’t want to look like you just had dental work or an allergic reaction.”

Dr. Shamban added that television viewers have visceral reactions when they see actors on the red carpet who look as if they belong in Madame Tussaud’s.

“You just watch and think: something bad happened here and the results are not good,” she said.

But if awards-show commentators and viewers are more attuned to and more critical of celebrity cosmetic transformations, it may also be chalked up to schadenfreude.

“Celebrities are so beautiful that people kind of enjoy it when they start to age,” Dr. Lask said. “They become human. It brings them back to being like the rest of us.”