Finding the balance between an organic approach to health and beauty verses dancing on the knife’s edge of technology can be tricky. We’ve all seen celebrities who’ve gone too far in their quest for eternal youth, whose appearance is strange and even disturbing. On the other hand, indigenous tribe’s people, aging naturally in a purely organic environment grow weathered from hard living and stress.
Traditional cultures around the world practice forms of body modification, many of these, like neck rings, lip plates and tattoos, are not particularly healthy. Here in the West, technologies are being developed that stimulate our body’s natural systems of repair and cell reproduction, to extend the appearance of youth.
Despite a stream of denials, most celebrities use these procedures to appear youthful. In many ways, this is a Western form of body modification. One could argue that sewing shamanic spells into your skin is somehow more noble than Demi Moore spinning the aging process to appear youthful, but both are examples of cultural expressions of appearance.
Ahimsa is a concept in yogic philosophy which literally means to do no harm, the avoidance of violence. Whether you are a Yakuza covered in so many tattoos that your kidneys fail, a Burmese Kayan woman who has altered the angle of her collarbone or a Hollywood celebrity like Michael Jackson who spent too long under the scalpel, there must be a more benign approach to improving appearance.
So I spoke to Dr. Michelle Reyes MD, the owner and creator of The Med Spot, a full service medical spa that specializes in “non-invasive” cosmetic procedures to give us some insight into the techniques available to improve our appearance as we age without causing physical damage.
DL What got you started in this field?
MR I am an ophthalmologist, so I specialize in the anatomy, physiology and medical and surgical treatment of the eye. In my practice, I often see conditions like crossed eyes and eyelid muscle spasms; people who have very strong squeezing of the eyes. They look like they’re blinking or having a nervous twitch, but it’s really a contraction. Ophthalmologists have been using Botox to suppress these overactive muscles in and around the eyes for decades. So to me it was a great tool, because our muscles can cause us problems if we can’t calm them down. As I expanded my elective practice of refractive surgery in the late 90’s, clients and friends often asked me about various procedures, such as lasers or Botox. I could understand my clients concerns about these types of treatments, because I had some bad experiences with doctors and estheticians too. Once I was even badly burned by a chemical peel. In my early thirties, I was experiencing pigmentation problems from my pregnancies, as well as new onset adult acne. So I became interested in learning these procedures. I’ve always been athletic and health-conscious, so I was looking for a lower maintenance way to soften the aging process.
DL So you had experiences where you felt that people were too aggressive?
MR Yes, I had a twenty-something year old girl in a skin spa put glycolic acid on my face until I cried, “ouch!” I ended up with a burn. Because she didn’t explain it or didn’t understand the body’s immune response, I ended up with cold sores and inflammatory hyperpigmentation. In this case I wasn’t expecting the peel to be so aggressive.
DL Are all peels that aggressive?
MR No. Peels, when administered properly, are a wonderful tool to stimulate a healthy response in the skin. Any treatment can lead to complications if it isn’t performed correctly or carefully. So after that experience, I asked, My God, Michelle, why are you doing this to yourself? Instead of one brown spot, now I had them all over! So at first I thought, leave well enough alone. But patients and friends continued to ask me about various procedures, and I wanted safe and effective ways to improve my own appearance, so I started studying everything that was available. It was around this time in 2001 when Botox became FDA approved for cosmetic use. So naturally since Botox was initially an ophthalmologic treatment, I started doing Botox on select patients in my practice. When I was convinced the science was good and that a procedure or product was effective and safe, I added it to my practice. So my cosmetic practice grew bit by bit.
DL What about Lasers?
MR Laser is an isolated wavelength of light. The word Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. Lasers are used broadly in all fields of medicine. All tissue has unique properties, specifically a color, called a chromophore, which make it sensitive to different wavelengths of light. Ophthalmologists use lasers to treat a broad range of conditions in the eye, from electively treating the cornea in refractive surgery to repairing retinal diseases and glaucoma. In cosmetic laser surgery, we choose different wavelengths of lasers to get rid of pigments and blood vessels in the skin, to stimulate a healing response from the skin and to treat acne. Light pulse technology is the use of a band of wavelengths (light) which you can filter to target similar chromophores as one does with lasers. As an ophthalmologist, lasers are the backbone of my practice. Of course we use scalpels, but we also use every type of laser. So as cosmetic lasers and light pulse technology developed, I already had a deep appreciation for and was quickly comfortable with the use of laser technology. Using lasers on the skin was a natural progression from the lasers we use with eyes like LASIK procedures. So I took all the extra courses available to dermatologists and plastic surgeons. Things would come up, for example my mom had terrible varicose veins which were not treatable with laser technology (at the time) and so I learned the injectable treatment for this problem which is called sclerotherapy. So anything that inspired me, I would first make sure it could do no harm, or if there was risk, that I fully understood the risk and could communicate it to the patient, then I would take a course and learn it.
DL So your cosmetic practice evolved from friends and family members who were uncomfortable and wanted to improve their appearance and your own quest for better methodology?
MR Yes. My cosmetic practice is also a really good niche for my age. As I get older, I appreciate that people are not trying to look like a super-star; they just want to look healthy and fresh. They work out, they eat right and eat organic, and they do yoga. We’re all trying to stay healthy, so we want to take care of our skin too. A lot of the procedures we use are similar to working out or muscle building. You stimulate the muscle, break it down a bit so that it can rebuild. We work with the body’s own systems to create thicker, stronger, healthier skin and collagen.
DL What about non-surgical procedures to firm the skin using sound waves and light pulsing technology?
MR We have had a lot of energy techniques come out over the last fifteen years like Thermage, Refirme, and Titan, that stimulate the deep tissue, but don’t oblate the surface. As opposed to using specific wavelengths of light as in lasers, these treatment modalities utilize radio frequency and infrared energy to stimulate the body to rebuild collagen and volume in the face. Then there are the ‘pixilated’ lasers like Fraxel, which bore little holes in the deep tissue and stimulate the tissue to heal itself. Fraxel was developed as a treatment to attempt to create the same skin tissue healing response as the earlier more aggressive CO2 and Erbium ablative resurfacing lasers without the risk and downtime. It has turned out to be an excellent treatment to treat severe acne scarring as well. Techniques such as Fraxel are still more aggressive than procedures like ReFirme, which only stimulates, pokes and teases the body into producing more collagen. When these procedures are done wrong, they can harm you, but when done right, when thought out and performed carefully by someone like me, who cares whether I hurt you, they can be fantastic. I didn’t go into cosmetic procedures for the money. I came into it from my own experience, from the people around me who wanted a solution. I want to take care of you because that’s what I would want. I’d want someone who cared enough to communicate with me and give me good advice on what will be effective, which procedures are safe and work within my budget, finding ways to improve my appearance that is reasonable and not super expensive, that has longevity to it. I would want to hold off on the more dangerous or invasive procedures, so I try to deliver that to my patients.
DL Is there anything we can do to improve our skin naturally?
MR Of course! Eat whole foods, drink clean water, work out doing something you love and wear sunscreen. But there is a time frame we have. Obviously if you treat yourself like crap, you eat badly, drink excessively and don’t sleep and have toxic relationships, that will take its toll and by the time you’re sixty you can have an extreme situation on your hands. In a case like that, you might not be able to do much without a facelift. These more subtle techniques work with your body systems, so they are done a little at a time. A lifetime of bad habits, stress and neglect lead to more extreme choices.
DL So your philosophy is to attend to things along the way?
MR If you do things along the way, you can actually avoid extreme solutions like a facelift. We can look nice along the way, as we journey through life. And then when you’re seventy-five and you want to look hot for that widower in the nursing home, then get a facelift, if you are inclined that way. Blepharoplasty or upper eyelid surgery is probably the most invasive surgery that I do. For some people, that it is the only procedure they will ever need to do. It will brighten their eyes and their face, make them feel better and look younger, not so tired. Even when we choose to have a more invasive procedure, we can be judicious and minimal in our approach and still have a dramatic effect.
DL There’s a famous painting that contains a truism called Time Orders Old Age to Destroy Beauty, where Father Time is reaching out to touch a maiden’s face. How does aging work?
MR As you age, every decade has a kind of theme. In your 30’s there are issues with pigment and acne. Lines begin to form. In your 40’s, you get more lines and deepening creases. You lose volume and the skin grows thinner. Your lips lose fullness and begin to thin out. Then in your late 40’s, the above issues are compounded as you begin to lose hormones. In the 50’s, we lose volume in the face and as the hormone levels drop, our “glow” goes away. That’s why I added hormone replacement to my practice. For some people, the reason their skin looks terrible is that their hormone levels have dropped dramatically. But they are freaked out and afraid of the hormones we have available and have heard the horror stories from the medical community. Hormone replacement therapy has been a very risky, unstable, “don’t touch” kind of specialty lately, because of the risks involved with synthetic Hormone Replacement Therapy (HRT). But HRT varies wildly depending on whether or not you finely tune the treatment. We now have bio-identical hormones and if we test the hormone levels carefully, we can work more subtly with the body’s natural aging process.
DL Suzanne Sommers has been a crusader for Bio Identical Hormones while the medical industry seems to have a more mechanical approach.
MR A friend of mine had a surgical hysterectomy for Dysplasia in her 40’s. Because she was precancerous, they removed her ovaries. She started losing her hair, her breasts lost volume, her skin became dry and creased, she had severe hot flashes. This is an extreme example of ‘surgical menopause’ where her sex hormone factories were removed and her hormone status was that of an older woman who has gone through the process of menopause gradually. All women suffer symptoms of menopause of some form during our mid decades but with a more gradual presentation. The only thing the doctors would give her was synthetic estrogen, a form derived from equine urine, to deal with the hot flashes. She felt terrible and became anxious, because estrogen not balanced with progesterone can have that effect. Eventually distraught she came to me and I started her on a full complement of bio-identical hormones, balanced for her body. She went back to being an absolutely normal, glowing, healthy woman that I knew in high school. Most of us don’t have that drastic situation, a surgical menopause. All doctors really haven’t studied bio-identical hormones, or are not yet comfortable with their administration; they knew they could give her replacement estrogen to relieve her hot flashes, but what she needed was the whole gamut. We do a blood test and check hormone by hormone, then match the levels correctly. This is an exciting aspect of my practice that I absolutely love, it’s not surgical and it has a powerful effect to change women’s lives. I also treat the male version of age related sex hormone reduction, called andropause.
DL It sounds like you’ve experienced some disillusionment with the medical establishment.
MR It disappointed me in the beginning a little bit. When I started practicing as an ophthalmologist, I wanted to believe everything. It was all just shiny and believable. Then I realized that most studies were funded by drug companies who have a vested interest in the outcome. The studies I needed were funded by someone’s blood and sweat and donations from the University. It takes a long time to collect these small studies and to do the longitudinal studies and analysis. Rather than rely on these large studies funded by the specific companies done to promote certain products, which can be highly biased, you need to seek out the right information. In the end, studies that are biased are not reliable and bad things can happen as a result of misinformation or over treatment.
DL It’s rare to hear a doctor say that.
MR Pharmaceutical companies also do a huge amount to help us; they provide a lot of education. But in the end, every doctor has to do rigorous intellectual work to maintain personal integrity.
DL What about injectable fillers? It’s hard to imagine that a gel injected in your face could work with the body.
MR Well the fillers I use do. One of my favorites, Radiesse, is made of the same material as bone, called calcium hydroxyapetite, but without the boney structures or matrix of bone, mixed with a gel. The filler is injected into your tissue and the crease disappears or decreases. Then as your body dissolves the material, the surface tissue heals over with collagen, softening the line. It’s like taking the clothes out of the dryer, shaking them out and laying them over something so that gradually the wrinkles come out, instead of letting them crumple and pile. Fillers smooth out the crease and then the tissue grows over it. Other excellent dermal fillers, such as Restylane and Juvederm are called hyaluronic acids, a naturally hydrating substance that is abundant in young skin. Before I decided to use fillers, I needed to understand what happens when the filling agent is absorbed by the body. I understood from the studies that the products are safe and wouldn’t cause any problems to the skin or body as they naturally dissipated. However, I was particularly curious, especially with injecting young lips, would the previously filled tissue collapse, like a balloon stretches then collapses, making the skin worse? But over the years I have been pleased with my observations: that’s not what happens. The body is a growing system, so the filler stimulates the natural processes. As the filler disperses, the body fills in the gap gradually and we see an overall improvement. If you use a filler to treat wrinkles even once, from then on the wrinkles never look as bad. Often these fillers actually stimulate the body to produce its own collagen. Again, as I mentioned before, think of it as smoothing out the wrinkles from clothes that have been left in the dryer too long. You smooth them out, lay them flat and the wrinkles gradually get better, but skin is actually continuing to replenish itself so your skin smoothes out more dramatically than even clothes removed from the dryer. That’s true of Botox too. People’s mental patterns can create unconscious habits of constantly traumatizing the overlying skin and creating a crease by squeezing. Again, in this this type of situation, there can be permanent improvement in the appearance of the skin wrinkles by weakening that muscle and reducing the trauma that creates the skin crease.
DL What about Botox? Many people are afraid of the fact that it is a toxic substance.
MR Botox is extraordinarily safe systemically, that is, it does not have any effects on your body outside of the muscle we are trying to inhibit. It’s not going to travel all over and cause you illness or weakness or paralyze you. Botox stays right there in the muscle. We’ve used Botox safely for the last 35 years for hyper-contraction in the tiny little muscles around the eyes. If there were any possible way for it to spread, you could lose control of any number of the nerve-muscle junctions around the face. There are 12 cranial nerves in the face, so if there was a chance that it could hit those nerves and spread, it would be a disaster, cosmetically as well as medically. So we know Botox doesn’t spread any farther than we want it to, that if it is placed in the muscle, it doesn’t enter your blood stream, of course used in the proper doses. We know that wherever you put it, it stays. Usually when people come to me for Botox, they are over-using a negative, frowning muscle, which creates negativity. Studies have been conducted connecting facial expression to mood. Positive moods can be induced by positive facial expressions. If you frown, even if you are only squinting to see better or shielding your eyes from the sun, your brain perceives that as a negative emotion, it’s communication between your brain and body. So squeezing the muscle continually can have a serious effect. Emotion follows motion. If you smile you’ll feel happier, if you frown you’ll feel heavier. I don’t know about you, but I want to be a little bit happier, I don’t want my body to think I am angry, because I am squinting or furrowing my brow. Granted, we do need to try and relax our facial muscles day to day on a more organic level. We do need to breathe and to meditate, to induce states of calm. I would love to be an enlightened being tomorrow, but in the meantime, a little Botox can work wonders. Botox is also helpful for chronic headaches and Temporomandibular Joint Disorder (TMJ), the unconscious grinding of the teeth and clenching the jaw in sleep. Botox is an amazing tool that will relax the jaw. I want to help people feel better and sometimes we need a little crutch to get us there. Of course we need to be in balance and to do all the healthy things we can for our bodies. But from a healing perspective, these techniques can help people psychologically to feel more positive about life and to avoid more extreme treatment like the face-lift, which carries a higher risk.
DL The idea of not using a muscle reminds me of the Sadhus of India. Some of the more extreme yogis choose to not use a limb until it withers away.
MR And what is the purpose of that?
DL Well, in the case of the yogis, they are dedicating their limb to God, so it’s a bit different than a Western cultural ideal of beauty like not frowning. Maybe the yogis are going too far in their own way. Philosophically, do you think there’s a “too far” with cosmetic procedures? How far is too far?
MR Probably what “too far” means is that a patient takes on more risk than they realize they can handle. And that is the responsibility of the physician’s ethics to understand that. If you are 300 pounds and you want to remove 60 pounds of fat with liposuction, that is high, high risk—too much risk. Doctors sometimes do that in other countries and that’s how people end up dying. If a patient wants too much, they may have Body Dysmorphic Syndrome, where they don’t have an accurate perception of how they look and are trying to appear completely different. So we need to sense when there is a psychological problem.
DL Have you ever run across that?
MR I’ve had a lot of patients like that, but I am very cautious. I want the patient and myself to have the same vision, especially about what the end point is going to be. I will try to get their expectations to be realistic. I try hard to under promise and over produce. We also need to work within their mental, physical and financial comfort zone.
DL You also have a weight loss program that uses medical techniques?
MR Yes. The weight loss program at The Med Spot is a combination of science with the creation of healthy eating habits. At the beginning, for a short time, no more than three months, we use pharmaceuticals to decrease the appetite. The people I treat are not more than a hundred pounds overweight, but the cravings for food can be very uncomfortable, so the first thing we want to do is make it comfortable for you. This approach is short term though, for two reasons, first, the body develops an intolerance to pharmaceuticals (eventually the pills don’t work) and second, the core of weight loss is the establishment of solid habits based on knowledge and practice. So you have three months to change your habits and slowly release the crutch. I teach you good habits, what the routine is and how to maintain it mentally and physically. We use journaling, which is critical, to make sure that you are adapting and to understand any problems you are encountering with your relationship to food. So you come in every week. We make sure your body has all the vitamins it needs because you are under stress when you try and lose weight or when you begin to exercise, especially if you’ve been sedentary for some time. Moving the body is critical to weight loss and to forming healthy habits in the future. Every week, we council you, cheer lead you, look at your journal, see what you eat, why you eat, how your body is responding, how you’re feeling emotionally and what’s triggering the eating. It can be challenging to treat weight loss patients, because there are always underlying emotional issues, but at the same time incredibly gratifying. The next time you reach for an unhealthy snake, think about what is motivating you and you’ll see what I mean.
DL Sounds as intense as getting a Yoga certification!
MR Really? How so?
DL Because you are treating them at the moment of their transformation and anything transformative like that is intense.
MR Yes and so if you are a one on one yoga teacher you know how that feels.
DL Yes, in a way you are confronting all the student’s fears, all their ghosts, crystallized in physical form.
MR Absolutely, for the treatment to be effective, we need to get to the underlying issues. So people need to be committed. I try to bring all my philosophies, training and resources into the process to help them transform.
DL If you could sum up your philosophy, what would it be?
MR First and foremost, you’re never going to be beautiful if you’re not happy. If you do things to look a bit younger and fresher, it can give you a boost, make you feel happier and more comfortable and lighten the load a little bit, but real happiness is not skin deep. We’re all aging, that’s life and we’re lucky to continue to age, to move through the changes of life. The changes we go through in our appearance represent a life lived. We go through stages in life, both physical and philosophical. The majority of the time, people come to me because something is bothering them. And it can be a complex of things, and usually is. They might start by telling me, this line or sagging area is bothering me and end up relating that their son just moved to college last month. So they are going through an important change and improving their appearance is a way to make the change easier.
DL In a way it’s like they are meditating on the stage of their life.
MR Exactly, very often this is the case. And you might think, “That’s so superficial.” But it’s not. I don’t think it is superficial at all. Because I think that if you can present yourself to the world with confidence, that’s important. We want to look presentable, respectfully so. It doesn’t have to be absolute beauty. Most of the time people are coming to us at a phase in their life, when their kids are leaving, they are going through a divorce, they are having to go back out into the job force and face the world. It’s very interesting and it’s not just vanity that brings patients to me. People often come when they are going through a crisis and when they come to us we want them to feel that we understand. Tending to your appearance is important and healthy, little old ladies get their hair done every week to look nice, old gentlemen get their hair cut. We all get dressed up and go to church and for special occasions. It’s respectful to the world and to ourselves to look pleasant. It’s part our engagement with the world. We live in our body and we need to take care of it.