I have been a clinical dermatologist for over 25 years. “Do no harm” was the oath I took in 1987, when I graduated from medical school. In some ways, it’s a vague expression. Do no physical harm? Do no financial harm? Do no emotional harm? Eventually I came to believe that the oath meant all of those things. But doing no harm can sometimes be more difficult than it seems, especially in a practice like dermatology.
On a daily basis I experience the pain and humiliation of my patients — mostly women, but men too — who feel inadequate about themselves physically. How can I look younger? How do I get rid of this wrinkle? One woman asked me, “Why do I look 70 years old?” Of course the answer is because she is 70 years old. Instead of seeking out a miracle cure, as many of my patients do, I advised her to apply a well-formulated moisturizer twice daily.
Despite the ongoing battles in the media about whether skincare is a waste of time and money, there is ample research that supports the use of well-formulated skincare products to optimize skin health. Science has even shown that applying moisturizers can minimize the symptoms of certain skin conditions like eczema, rosacea, and even, acne. In addition, applying quality moisturizers can temporarily improve the appearance of skin by increasing the water content of the most superficial skin layer. But never has a moisturizer been shown to permanently get rid of a skin wrinkle or fold.
The fact is, science has yet to discover a single ingredient that can permanently reverse the aging process. And yes, aging is a gradual, irreversible and inevitable process. And yet, our culture has very unfortunately made aging into a battle. Although everyone must come to terms with his or her own mortality, the dreaded wrinkle has become our favorite scapegoat.
On a daily basis I experience the pain and humiliation of my patients who feel inadequate about themselves physically.
So what do many of us do? We spend an astronomical amount of money on cosmetic procedures and skincare products. One particular skincare “anti-aging” product is sold to physicians’ offices for $81 per ounce and sold to the patient for $162 per ounce. (The advantages, disadvantages and morality of medical office skincare endorsement and sales is a topic for a different article). Keep in mind that over-the-counter anti-aging products are typically classified as cosmetics, meaning that manufacturers can’t really claim such products can change the skin because, by law, the products would then be classified as a drug and have to get pre-market approval from the Food and Drug Administration.
Despite all of these caveats, however, well-marketed “anti-aging” skincare products, some with temporary benefits, continue to fly off drug store shelves.
Meanwhile, we inject botulism toxin, also known as Botox. According to the Cosmetic Surgery National Data Bank Statistics, the most common nonsurgical procedure in 2016 was botulism toxin injection, with more than 4.5 million treatments performed. Botulism toxin is injected into the forehead to paralyze the muscles so they can no longer move the face. This gives the skin a chance to rest, and yes, over time and with repeated Botox injections, even temporarily diminishes the appearance of nasty wrinkles. This means, of course, replacing the dreaded wrinkle with an expressionless forehead, sometimes to the point of plasticity. (This is not a youthful look I might add.) But it does solve the problem, at least temporarily, of the wrinkle.
In addition, many patients ask for fillers. The cheeks are plumped up and areas that were once occupied by fat are filled in, all with the intention of looking younger. A little here and a little there, a little more here and a little more there. Suddenly, the face has been transformed. The natural proportions of the cheeks are gone, the lips can swell to the point where they appear to be stuck in a perpetual pucker, and yes, the face looks different. Younger? Not so much. Just different.
It is a absolutely a woman’s right to consensually alter her own appearance in an effort to look beautiful — whatever that means to her — and feel better about herself. Not a popular thing to say, but the truth is, when a woman has all this “correction” done, and leaves a room, the commentary is rarely, “she looks beautiful.” No, instead you all too often hear the quiet whispers of those four dreaded words: “She had work done.” This isn't judgment, just reality.
Don’t get me wrong; there are definite medical reasons for Botox injections and even facial fillers. And it is a very good thing that there are trained cosmetic dermatologists and plastic surgeons who can perform these procedures safely. But they still carry risks, and for what?
A culture that sends the message that the aging face is inadequate, that wrinkles are unacceptable (but a plasticized forehead isn’t), that thin lips are a defect (but swollen lips are OK) is twisting itself into knots of unattainable beauty standards. Perhaps, if not for ourselves, for our daughters and granddaughters, we should stop reinforcing these norms. Besides, shouldn’t the question be, how could I become the healthiest version of myself?
Again, there is absolutely nothing wrong with physical beauty. And if you are one of the 2% of the population that won the genetic lottery, good for you. But do keep in mind that even the individuals considered singularly attractive are aging. Based purely on cultural norms, all physical beauty fades.
Aging is a gradual, irreversible and inevitable process. And yet, our culture has made aging into a battle.
From a medical perspective, optimal looking skin is a result of a healthy body and soul. Not the sexiest answer, and not the one that most people want to hear, but it is the truth. Skin is an organ. It serves many functions. It protects us from environmental stressors, from bacteria, fungus and other infections, from allergens and from the damaging effects of ultraviolet light.
To perform all of these duties well, skin should be well hydrated. So yes, apply a well-formulated moisturizer twice daily. Protect the skin from the damaging rays of the sun, wear sunscreen, daily, liberally and often. Eat a healthy diet, get adequate nights of sleep and exercise.
At the end of the day, this is what I tell my patients: Aging is powerful. Aging is a growing process that yields wisdom, confidence and insight. And while it might seem ironic coming from someone with my job description, I think we need to embrace it.
It may sound trite, but defining ourselves by something other than our looks is one of the wisest things we can do. Kindness matters. Accomplishment matters. Rectitude matters. Health matters. And none of these things comes in a syringe or a bottle. That, my friends, is the definition of "do no harm!"
Fayne Frey, M.D., is a board-certified clinical and surgical dermatologist practicing in West Nyack, New York, where she specializes in the diagnosis and treatment of skin cancer. She has consulted for numerous media outlets, including NBC, USA Today, and, the Huffington Post, and educates consumers on effective skincare treatments at FryFace.com. She is a fellow of both the American Academy of Dermatology and the American Society for Dermatologic Surgery.