By Francesca Castagnoli
I come from a family of tanners. In the 1970s, my mother would sunbathe holding a foil-lined piece of cardboard up to her face; she'd end up darker and more beautiful than a Bain de Soleil model. Yet even then I suspected it wasn't all good: Every morning, she'd come into the bathroom with her hands pulled tight against her cheeks to mock a face-lift and ask, "Just a tuck, right? All I need is a tuck?"
Her addiction to tanning was passed down to me, like her brown eyes and bunions. For several years, I've noticed that my wrinkles are getting just a bit deeper; by last year, I began to understand why my mom had such fondness for pulling her face back. I shared my concerns with a close friend, a Pilates instructor with exquisite skin. "Maybe I need more Pilates," I said. "I mean, look at you." "You don't need more Pilates," she said. "You need Dr. Yeretsky."
She confided that she has been getting Botox and fillers injected for three years. I was stunned. "But where? I can't tell at all." She smiled. "Exactly." Her look attests that the days of overfilled lips and cryogenically frozen foreheads are, thankfully, becoming a memory. We've entered the era of the quiet injection, where the goal is to make subtle, natural-looking adjustments.
Two weeks later, I met with Yelena Yeretsky, D.O., a board-certified medical aesthetic physician with a practice in New York City. Yeretsky looked at my face and assessed the damage: drab skin tone, crepe under my eyes, deep folds, etched lines, and cheeks that sloped and sagged. She explained that sun, stress, genetics, pollution, and habits such as smoking affect how much collagen we have. If her clients want to know how they're going to look in the future, she suggests they bring in photos of their parents. I showed her a picture of my folks, and she pointed out that I have the same facial structure as my dad. For me, the future holds deeper lines across my forehead and pronounced nasolabial folds (the crease from nose to lips), oral commissures (corners of the mouth), and marionette lines (mouth wrinkles). She suggested I get a botulinum-toxin injection on my forehead and crow's-feet to smooth lines, and a filler injection to lift my cheeks and fill in the creases around my mouth. It was a lot to absorb all at once, and I was, frankly, afraid. I was also skeptical that it would all look natural, so I decided to get a second opinion.
"It's not about changing the way you look," Bruce Katz, M.D., clinical professor at Mount Sinai School of Medicine and director of the Juva Skin and Laser Center in New York City, said as he studied my face. "It's about restoring the natural look you had 5 or 10 years ago and helping you maintain it." His advice for turning back my clock echoed Yeretsky's: He recommended injections of Xeomin, the newest cosmetic brand of botulinum toxin, in my forehead and around my squint lines. I decided I was ready to do a little time-traveling then and there; Katz is considered a pioneer in the field of injectables, and, judging from his forehead alone, I knew he favored a natural aesthetic. I was on my lunch hour, so I opted against the numbing cream, which can take up to 20 minutes to kick in. He began with two injections around each eye -- one under each brow and one in each of my crow's-feet. I was surprised to find that it wasn't painful; in fact, I've had flu shots and electrolysis that hurt more. But if I was asking for pain, it came with the four injections he administered along my hairline. The discomfort was more acute because he had to use a thicker needle to penetrate this tougher skin. My head ached, and the injection sites swelled into big Frankenstein lumps, on which the nurse instantly applied ice packs. The swelling was gone in about an hour, but a headache persisted all day, as did a warm sensation around my eyes that made me feel as if I had been crying.
When I came home that night, my husband, David, looked at me and asked, "Did you have a bad day? You look like you've been upset." I told him no and decided that I definitely was not going to reveal what I'd done. Three days later, he looked at me and said, "You know, you really are beautiful." "Thanks, honey," I replied, feeling a pang of guilt for not telling him what I'd been up to, yet delighted that it seemed to be paying off.
Fillers do what botulinum toxins can't: They plump up skin. I decided to go back to Yeretsky to try this type of injectable and asked my friend Erin to come with me to the appointment. Yeretsky would use Radiesse to lift my sloping cheeks and soften my nasolabial folds. This time, I gladly opted for the numbing cream. Yeretsky explained that she was going to use one syringe of 1.5 milliliters of Radiesse, doing four injections on each side of my face. She would start at my cheekbone and then do a second injection where my jawline meets my ear. This would lift my skin up, as if my hair had been pulled into a tight ponytail. Then she could fill in my creases. The needle was stunningly long -- almost as long as my index finger -- and according to Erin, who watched the procedure, there was blood. Lots of blood. We couldn't imagine anyone doing this at a girls-night-in party. Even with numbing cream, the pain was so lasting and deep that my toes curled, and I twisted a bunch of tissues into a tightly wound snake.
After the final injection, the doctor washed the blood off my face and applied ice packs to arrest the swelling and bruising. A few minutes later, she removed the packs and turned me toward the mirror. Even though my face was red and slightly swollen, the results were instant and unmistakable. My cheeks were higher; my skin, smoother.
Two weeks later, I was talking with David in the kitchen when he stopped midsentence, touched my chin and turned it a bit to get a better look. "How did you get that bruise?" he asked. It wasn't black-and-blue, but there was a greenish-yellow tint on my jaw. I panicked and told him that our 6-year-old son, Dashiell, accidentally hit me. He was so shocked, he threw his head back. I immediately knew I had made a huge mistake, so I blurted out, "No, no, I'm kidding! I had Radiesse!" There was no turning back, so I told him all about the Xeomin, and making Erin come to hold my hand, and how scarily long the needles were. "But I've told you, you don't need to do anything to your face," my husband said. "I know, but if you hadn't seen the bruise, you probably wouldn't have noticed," I replied. It was a relief to tell him. There was no need for secrecy or shame. My dominant feeling after all the treatments was, actually, surprise. Because while I'd gotten what I'd hoped for -- to look younger -- I also still look like myself.
How to Choose a Doctor
You want someone who is conservative and understands your desire to still look like yourself. Also, the doctor should always ask to review your medical history before any injectable cosmetic treatment is considered. Here are some questions to ask, along with the answers you'll want to hear.
Q: Can I see before-and-after photos of your patients?
A: If the answer isn't an immediate "Of course," steer clear. No reputable physician or aesthetician should ever be hesitant about showing a potential patient or client his or her work.
Q: Who will perform my procedure, and what training does he or she have?
A: Seek out a board-certified dermatologist or plastic surgeon. In some states, it's legal for a nurse or a physician's assistant to perform minor procedures. In these cases, make sure a doctor supervises.
Q: Can I get a written breakdown of all costs, start to finish?
A: You should be concerned about hidden fees if this information isn't freely provided to you. To avoid any budgeting surprises, look for the physician's fee, the cost for the drug itself, and the price for any mandatory follow-up visits.