Pursuit of youth isn’t always pretty

Over the past couple of years Botox has become the most popular cosmetic procedure for female patients ages 19 to 35, with nearly 400,000 wrinkle-reversing (or preventing) treatments in 2007.

Last month, Rachel Cothran, 26, visited Alster for her very first Botox fix smack between her brows, where she was starting to notice the beginning traces of a furrow. “Nip it in the bud,” she says. “Why wait until you’re older and completely dissatisfied?”

Cothran, who considers preventive Botox “a no-brainer — like wearing sunscreen” says she and her friends are thinking about aging much earlier than their parents’ generation. “Things are happening so much younger these days — 19-year-olds start companies like Facebook, and 26 doesn’t feel like a spring chicken anymore, so there’s pressure not to show your age even when you’re still pretty young.”

Losing the forest for the trees
The increasing obsession with perfectly smooth, unlined, ageless skin is reminiscent of what Dr. Katharine Phillips sees in her psychiatric practice that specializes in treating patients with body dysmorphic disorder (BDD). These patients become so obsessed with perceived flaws that it can overtake their lives, says Phillips, a professor of psychiatry at Brown Medical School and Butler Hospital in Providence, R.I.

“I’m not saying it’s pathological or problematic to pay attention to your appearance or pursue treatments for aging,” says Phillips. But like patients with BDD, some women can become so myopic about their imperfections — a crease between their brows, a line around their mouth, a droop of the eyelid — that they lose sight of the forest for the trees, she says.

Perhaps that’s how so many women end up looking bizarrely puffed, pulled or frozen-faced, yet are thrilled — because that pesky wrinkle is gone.

Plastic surgeons can be just as guilty of zeroing in on specific flaws at the expense of someone’s overall appearance, says Dr. Sam Hamra, a Dallas plastic surgeon who specializes in revision facelifts.

“Even good plastic surgeons, I’m not talking quacks here, too often are taking normal-looking people and making them look abnormal,” Hamra says.

Courtesy of Veda Combs Veda Combs through the years. At far left, Combs is age 48 and her face has full, youthful appearance. In the middle photo, Combs is 51 and the recipient of a facelift that she says gave her a look of perpetual surprise by raising her eyebrows and propping open her eyes. Today, at age 70 (far right) after a revision facelift, Combs says she's thrilled to often get mistaken for a woman 20 years younger.

Hamra is probably the closest thing the plastic surgery community has to a whistle-blower. A decade ago, he published an article in the journal Plastic and Reconstructive Surgery blasting the unnatural looking results of most facelifts. “Everyone has seen it — it’s that pulled-back look and those hollow-looking eyes. Go to a party in Aspen or Palm Springs and these ladies look like they’re standing in a wind tunnel.”

That’s because the traditional facelift — still done in most cases — pulls back the cheeks and lower face, often giving the face the look of a stretched mask. Hamra developed and teaches a technique called the “composite facelift,” in which he hikes up the forehead and cheeks while pulling back the lower face to avoid the swept-back look. This takes a lot more time in the operating room and that eats into a surgeon’s profits, which is why Hamra says it hasn’t been widely adopted.

Veda Combs, a 70-year-old plastic surgery veteran from outside Dallas, says it took three facelifts to get it right. The first one, intended to get rid of “that turkey thing hanging from under my chin” left her looking “like he pulled back my face and tied it behind my ears.” So she went to another surgeon to try to correct this and at the same time lift up her sagging brow. “This time my forehead was pulled so tight that it looked like my eyes were propped open like an owl. I looked like I was constantly being startled.”

After reading about Hamra’s approach, Combs came to see him in November 2006. Hamra undid the telltale swept-back look with his technique. “Now I look more natural; still, people nearly fall out of their chairs when they hear I’m 70,” Combs says.

More news from MSN Health MSN guide to healthy aging Ageless beauty from MSN

“You know, when you’re all pulled back tight and don’t have any wrinkles, it draws even more attention to your age,” Combs says. “It’s like those older women who try to dress all young and skimpy — it just makes you notice that they’re old.” 

Youth and beauty
The problem, according to Bobbi Brown, the makeup artist and cosmetics tycoon, is we’ve confused the issues of youth and beauty.

“Some of the most beautiful women that I meet have lines on their face,” says Brown, 51, whose book “Living Beauty” shows women how to look their best with makeup meant to enhance their best features.

In her view, women who try to blast away every line and wrinkle with surgery or shots end up failing on both counts. “They certainly don’t end up looking beautiful and they don’t end up really looking younger either,” she says.

“I was looking at one of those women, a celebrity on TV, the other day and you don’t look at her at think wow, she looks like a beautiful 24-year-old; you think, who is that 40-year-old weird-looking lady?”

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