Three Doctors Indicted For Botox Knockoff

A Florida doctor and two physicians from Arizona have been indicted on federal charges that they engaged in fraud and the misbranding of an anti-wrinkling toxin similar to Botox that led to the paralysis of four people, including the Florida doctor himself, prosecutors said Wednesday.

The 48-count indictment issued by a federal grand jury Tuesday accused the three along with four Tucson, Ariz.-based companies of conspiracy to defraud the United States, engaging in mail and wire fraud and misbranding a drug.

Dr. Chad Livdahl, the president of Toxin Research International Inc., Dr. Zarah Karim, the registered agent for the corporation, and Dr. Bach McComb were also charged with wire fraud and misbranding of a drug. Livdahl was also indicted on perjury charges.

The three other Tucson, Ariz., companies named in the indictment are Powderz Inc., Z-Spa Inc., and The Cosmetic Pharmacy Inc.

Prosecutors said they would seek the forfeiture of $1.5 million in proceeds that TRI received.

Eric and Bonnie Kaplan, of Palm Beach Gardens, were paralyzed after being injected with a knockoff wrinkle-remover similar to Botox in November. Federal investigators say the Kaplans instead were injected with a mixture of botulism toxin 10 times stronger than Botox.

McComb also injected himself and his 34-year-old girlfriend, Alma Hall, with the toxin in November, prosecutors say. Both have been hospitalized with similarly severe symptoms.

Bach McComb

"This deadly toxin packaged in harmless-looking vials, wrapped in the guise of medicine, used on unsuspecting members of our community, represents a grave threat," U.S. Attorney Marcos Daniel Jimenez said.

Botulism is a rare, paralytic disease caused by a nerve toxin produced by a bacteria that, in nature, can enter the system through food or a wound. About 8 percent of those who contract it die. For those who survive, recovery can take years.

Botox is a much weakened version of the botulism toxin and is considered safe. It is injected at the site of a wrinkle to paralyze the nerve causing the crease, smoothing the skin. The treatment lasts a few months.

TRI was ordered last month to stop distributing raw botulism bacteria in place of Botox and to recall any of its 3,081 vials still in circulation. The bacteria was obtained from the same California supplier whose product was blamed for paralyzing the four people injected at an Oakland Park clinic.



Couple Paralyzed By Botox Knockoff Transferred To Rehab

A man paralyzed after being injected with a knockoff wrinkle-remover similar to Botox took his first public steps since Thanksgiving weekend before boarding a private plane Thursday to a Georgia rehabilitation center.

But Eric Kaplan's wife, Bonnie Kaplan, who was injected with the same toxin, has improved only slightly and was carried aboard another plane on a stretcher. She breathes with the help of a ventilator for more than 22 hours a day and rarely speaks, said her attorney, Stuart Z. Grossman. Both left a hospital intensive care unit for the Shepherd Center in Atlanta.

"How much of their life they will get back is unclear," Grossman said. "That they are even with us is amazing."

The Kaplans have been hospitalized since Nov. 26, just days after they went to Advanced Integrated Medical Centers in Broward County for what they believed were Botox injections. Federal investigators say the Kaplans instead were injected with a mixture of botulism toxin 10 times stronger than Botox.

The couple soon began losing their vision, speech, felt extreme flu-like symptoms and complained that they felt like their bodies weighed a few tons.

They are suing the company that makes the botulism toxin, the clinic where they received the shots, its owners, and the doctor who injected them. That doctor, Bach McComb, also injected himself and his 34-year-old girlfriend, Alma Hall, with the toxin in November. Both are hospitalized with similarly severe symptoms.

McComb faces criminal prosecution for practicing medicine after his osteopathic license was suspended. He created the excessively stronger solution by diluting powdered botulism intended for animal research with saline, federal investigators said.

Records seized from Toxin Research International, which is named as a defendant in the suit, showed it sold botulism to 13 southern Florida customers for more than $53,200, according to the U.S. Attorney's Office.

"There is botulism in South Florida. It may say, 'Not for human use,' but it's here and being used," Grossman said. "We know people like McComb can get their hands on it, and reputable doctors can get their hands on it."

Botulism is a rare, paralytic disease caused by a nerve toxin produced by a bacteria that, in nature, can enter the system through food or a wound. About 8 percent of those who contract it die. For those who survive, recovery can take years.

Botox is a much weakened version of the botulism toxin and is considered safe. It is injected at the site of a wrinkle to paralyze the nerve causing the crease, smoothing the skin. The treatment lasts a few months.

Grossman said Eric Kaplan was able to speak briefly before boarding the plane and asked about his wife who left about 15 minutes before him. Eric Kaplan took about 15 steps toward the plane with the help of others and then took five steps up into the plane. Previously, both he and his wife could not speak or move.

"They look pale and frail and hopeful," Grossman said.



Couple Paralyzed By Botox Shots File Lawsuit

A couple paralyzed after receiving what they thought were traditional botox injections is suing the company that makes the toxin, the clinic where they received the shots, and the doctor that injected them.

The Kaplans' son spoke to the media in West Palm Beach Thursday after the suit was filed.

Michael Kaplan said he was present when the treatments were administered at Advanced Integrated Medical Center in Fort Lauderdale. He claimed that Dr. Bach McComb used leftover botox treatments he had given himself and his girlfriend the day before.

The lawsuit says the botox used was a highly potent form and McComb didn't mix it properly.

"It's just one of those things. My parents went to get botox. How many people get botox and now they are fighting for their lives? It's unfortunate," Kaplan said. "They are breathing with help of machines. They cannot do it on their own."

The lawsuit names McComb, Advanced Integrated Medical Centers, where the shots were administered, and owners Thomas M. Toia Sr. and Thomas M. Toia Jr. An attorney for the Toias, Bruce Zimet, did not return phone calls Thursday.

Neil Garfield, an attorney for Advanced Integrated Medical Center, did not return phone calls.

Other defendants named in the suit, filed in Broward County Circuit Court, include two companies that make and distribute the toxin: List Biological Laboratories in Campbell, Calif., and Toxin Research International in Tucson, Ariz.

The Kaplans' attorney, Stuart Grossman, said the couple both were injected about six times with an unapproved toxin that was more than 200 times stronger than the botox injections that have become an every-day wrinkle treatment.

The next day, the couple started feeling dizzy, weak and had double vision. According to the lawsuit, McComb told them not to worry because the symptoms would clear up.

When they did not, according to the suit, the Toias went to the Kaplans' house and administered a holistic treatment, further delaying treatment they would have gotten at a hospital.

The Kaplan family is seeking unspecified damages in its suit.

McComb, his girlfriend, and the Kaplans all remain hospitalized.

Food and Drug Administration investigators are also investigating the case.



A cut above

LOOK closely at your fellow passengers the next time you are on the early-morning shuttle to Heathrow and you are likely to notice that there are one or two who eschew their complimentary newspapers for literature of a more pressing nature. Buff-coloured sheets of paper pulled from a handbag or briefcase are more likely to outline the chances of developing necrosis or a haematoma than be the minutes of their latest business meeting. They are reading up on the possible complications of their impending surgical procedure.

A dozen hours later, the return flights to Edinburgh and Glasgow are peppered with coy women whose dipped heads show traces of bruising around the eyes and unmistakable pinpricks on their marionette lines.

These women are part of a new generation of jet-setters, who are using cheap daily flights to gain access to some of the best cosmetic surgeons in Europe. While their friends make do with the local botox clinic, they prefer to pay for the expertise of doctors who can count Hollywood stars and royalty among their clients.

Fifteen years ago, according to David Butler, business manager of the eminent plastic surgeon Dai Davis, Aberdonian lilts were the only Scottish accents to be heard around Harley Street and Wimpole Street, its neighbouring medical mecca. In the late-1980s only women whose husbands had ‘oil money’ could afford a London cosmetic surgeon and the additional costs of a Park Lane hotel to recuperate in. Today, however, as botox injections become as popular as Tupperware parties were in the 1970s, though not quite so public, Scottish women (and a growing number of men) are flying south. The Viel brothers, Roberto and Maurizio, who run the Centre for Aesthetic Surgery in Harley Street, now consult in Edinburgh every second Wednesday, before inviting their Scottish patients to go under the knife in London.

Statistics vary, but it is estimated that 75,000 private cosmetic procedures take place in Britain each year, with Scots patients accounting for 10% of these. A recent informal Scotland on Sunday poll of a number of leading London doctors found that visits by Scots patients were on the rise. Dr Jean-Louis Sebagh, a close friend and business partner of Cindy Crawford, said visits by Scots had risen by 15% in the past three years. One consultant cosmetic dermatologist says business from Scots day-trippers was up by 100%. Dr Nick Lowe, who runs successful practices in Los Angeles and London, said he had seen a steady increase in the number of Scots visiting the Cranley Clinic, just off Oxford Street. "I would say that there has been at least a doubling of the number of Scots coming down over the last few years," he states.

For Sofia, an elegant 48-year-old blonde who works in property and banking, quarterly trips to London’s top doctors can be conveniently disguised as business trips. "Friends think I’m either hard at work drumming up new clients or wandering around Harrods. The truth is I’m lying flat on my back in Harley Street, feeling like a human pin-cushion."

Although now an Edinburgh resident, she first began using doctors such as Jan Stanek, the Czech cosmetic surgeon with a passion for polo, while she was on secondment to London 12 years ago. "I was pretty unhappy about the lines that were developing on my face and I went along for a consultation. It just snowballed from there. Since then I’ve had rhinoplasty, a MACS and a lower blepharoplasty." That’s a nose-job, a minimal access cranial suspension facelift and eye-bag removal to you and me.

"When I moved back to Scotland," she continues, "I soon found out there just wasn’t the same easy availability of good doctors. I had no choice but to nip back to London. Now at the beginning of each year I pencil in three or four trips to my diary for wrinkle management."

The travel is, she believes, a necessary evil, and one she is reluctant to give up. "I’ve had friends go along to places in Scotland to have their lines plumped up, and they end up looking lumpy or worse than they did in the first place. It doesn’t fill me with confidence and so I figure I’ll just stick with what I know."

Her attitude to the arsenal of cosmetic procedures that have recently become available is that you should shop around and find the right doctor for the job. "I’m already thinking about who is going to handle my next facelift, but I’ll certainly be heading to London."

It is not a cheap option. For Sofia, each trip to London costs more than £1,000, with flights and taxis totalling £200, botox injections costing £400, and Perlane (an injectable filler which plumps out nasolabial lines) at £500. "Of course I could probably save money by staying in Scotland, but, frankly, what is your face worth? I don’t see the point in taking any chances."

So what are you getting for your money, apart from the surgeons’ undoubted skill with the scalpel? A tour of some of London’s top practices soon shows where your cash goes. Jan Stanek, renowned for being cool and slightly aloof, consults in rooms suffused with restrained elegance. Nervous patients are distracted by a waiting-room stuffed with fine antiques, its walls lined with original Hogarth etchings.

The avuncular Dr Lowe is based at the Cranley Clinic, the interior of which is warm and relaxed. His office is dominated by a rich mahogany antique desk, piled high with the books he has written and behind which spreads an oasis of orchids and exotic greenery.

Dr Jean-Louis Sebagh is famous for his Gallic charm and for having the adoration of supermodels and actresses. He is as glamorous and challenging as some of the modern art that decorates his clinic. Philippe Starck’s Louis XV ghost chairs line his waiting-room, while his coterie of blonde assistants soothe the frazzled tempers of any new patient unaccustomed to the average three-hour wait. Hollywood’s top actresses look forward to his annual visit to LA, where he gets to work filling pre-Oscar wrinkles.

"Dr Sebagh is an artist with a needle," says Gillian, a 33-year-old who works in fashion in Glasgow and makes her "pilgrimage", as she calls her visits to his clinic, every six months. She says each trip costs between £600 and £900, depending on what treatment she requires.

"I got so tired of walking out of clinics in Glasgow with my lips looking lumpy or lopsided. I read about Dr Sebagh in Vogue, I think, and had already planned a shopping trip to London, so I called up to see if I could get an appointment and they fitted me in. That was a couple of years ago. He gave me a fabulous pair of lips and now I use him for botox and other fillers.

"I do find the trips to London a hassle. They started off as fun - I’d do some shopping and maybe meet friends, before slipping off to see him. But now the trips are just functional. If it wasn’t for the excellent result, I would find the wait of three or sometimes four hours intolerable."

Asked why his patients make the long haul south, Dr Sebagh explains, with a refreshing lack of modesty, that many are drawn by his reputation and techniques. "I would estimate that we have had a 15% increase in the number of Scottish patients in the past few years. They are mainly seeking botox and other fillers, as well as IPL - intense pulsed light - and Polaris laser. It’s really anti-ageing maintenance without the knife. They tend to come to London just for their appointments and to stay for the one day only."

As more and more people have procedures, plastic surgery has become less of a taboo subject. That doesn’t mean everyone who has had work done will admit to it, though. Many men prefer to believe that their wives’ high cheekbones and smooth brows are the gift of Mother Nature - an extremely generous Mother Nature, who’s still handing out gifts to those in their 50s - and the wives are happy to collude in the deception.

Of course, as any woman knows, you can fool everyone but your hairdresser. One regular visitor to London was forced to come clean to the second most important man in her life when, seeing her with a bruised face for the third time, he took her aside and asked if she was in an abusive relationship.

The burden of beauty has historically been placed on the shoulders of women. The ancient Egyptians tackled wrinkles by slathering on a paste of frankincense, moringa oil and ground Cyprus grass. The Romans experimented with breast implants, and in Victorian times doctors injected paraffin to plump up wrinkles, with disfiguring results.

Men going to the same lengths is a more recent phenomenon, but their numbers are growing. According to Dr Sebagh, many want the same treatments as women - botox and fillers. "They are more aware of the ageing process and want to take care of their skin."

Dr Nick Lowe’s Scottish patients have specific requests. "We have a quite a few men coming down from Scotland who are especially interested in hair transplants and laser treatments."

The Hurlingham Clinic, an American-style spa and cosmetic surgery centre in London, is another popular destination for visiting Scots. "Clients can have anything from a facial to a facelift, all under one roof," explains its founder, Dr Dan Goldberg. "We have had several patients from Scotland in the past few months for blepharoplasty, gynaeocomastia and implants." (Gynaeocomastia, in case you were wondering, is male breast reduction.)

One recent visitor to Dr Goldberg’s consulting room is James, a 29-year-old accountant from Stirling, who wants implants to give him a stronger jaw. "Very few surgeons do the operation that I want, and none at all in Glasgow. I liked Dr Goldberg, but for the jaw he wanted to use a new line of ‘injectable implants’. These sound very impressive in theory, but they’ve not been around for long enough to know how they will look in 20 years’ time, so I’m giving him a miss.

"Next stop, America. It will be a costly trip, but it’s worth spending that little bit extra to get it right first time. With the current exchange rate and cheap flights, it really doesn’t work out that much more expensive [than London], and the surgeon who’ll do the work is a world leader in implants."

London nevertheless continues to hold his attention. "I love the city and am always looking for an excuse to go. I’m planning to have my lips done by a specialist there. If they turn out well, which I am sure they will, I will make a regular six-monthly ‘lip trip’."

Trends come and go in cosmetic surgery. Among the must-haves to appear in the last 18 months are permanent acryl-derivative dermal fillers for the lips, cheeks and face. This option is not for the faint-hearted; abandoning temporary fillers may release you from the merry-go-round of top-ups, but you have to face the risk of late-onset infection and granuloma (an inflammatory mass). These products start at £600.

Thermage is a form of radio-frequency energy and has been described as a facelift without surgery. It costs from £4,000 for a full face-and-neck treatment. The epidermis is protected by a cooling gel while the deeper tissues of the skin are heated. The controlled heating of deeper tissue and the ensuing skin tightening is known as volumetric tissue heating. It is reportedly extremely painful, and has met with a lot of controversy in the US, where several patients have experienced devastating facial fat loss months after the procedure.

Mesotherapy was invented by Dr Michael Pistor in 1952, and has been used as a medical technique in France to treat everything from arthritis to migraines. It involves multi-pricking - lots of tiny superficial injections that contain different medications, depending on the condition being treated. Cosmetic mesotherapy utilises the practice to treat cellulite, ageing skin and problem fatty areas. A course of six treatments is normally advised, and costs approximately £400.

Scottish cosmetic surgeons may be thin on the ground and conservative, but we should be grateful that they cling to the old Scots motto, ca’ canny. They are the last to follow any marketing hype. Artecoll, one type of acryl-derivative wrinkle filler, was all the rage in London five years ago, but did not make it up to Scotland. Cosmetic surgeons north of the border were dubious about it - and rightly so. It is now obsolete in London, having caused all sorts of problems.

For a certain group of Scots, though, labels are all. Happiness is shoes by Louboutin, bag by Balenciaga, lips by Sebagh and eyes by Basim Matti. It may be exhausting trying to keep up appearances but, as Helena Rubinstein once said, "There are no ugly women, just lazy ones."



Some vital organs still paralyzed

Alma ''A.J.'' Hall, the woman paralyzed by bootleg Botox nearly six months ago, has recaptured some ability to speak and slight movement in her body, but some vital organs remain paralyzed.

Hall has left the New Jersey hospital where she's been since November, most of that time on a ventilator and undergoing surgeries. Hall moved to a rehabilitation center in the same state earlier this month but is still struggling to recover, her attorney, Daniel Dolan, said on Friday.

Hall and a Palm Beach Gardens couple, Eric and Bonnie Kaplan, received facial injections from suspended Broward osteopath Bach McComb in November. The four, including McComb himself, received a mixture with at least 200 times the life-threatening botulinum toxin used in licensed Botox products.

All four got botulism poisoning and suffered paralysis, prompting a state and federal investigation.

The Kaplans and McComb checked out of their treatment facilities about two months ago. Hall has no check-out date, Dolan said: ``She's been ravaged by this.''

Last week, Dolan filed a civil lawsuit in Broward County on Hall's behalf. She sued McComb, the Oakland Park clinic where he worked and a California company that made the toxin, List Biological Laboratories. The Kaplans have filed a similar lawsuit.

Dolan said he would not describe Hall as ''eager'' to pursue her lawsuit.

Hall, a massage therapist, was working at the clinic with McComb and had a romantic relationship with the suspended doctor -- and her medical bills have already topped $1 million.

Federal officials said McComb did not dilute the toxin properly when he prepared it for the injections. He has been arrested and charged with fraud and distributing unapproved pharmaceuticals.

McComb previously had injected Hall, 34, with cosmetic products.

''That's why she never thought twice about getting the one here,'' Dolan said.

The lawsuit launches a products liability case against List, which sells botulinum toxin. The company's website also showcases varieties of anthrax, cholera and diphtheria used by researchers.

List officials did not return a call for comment.



The skinny on cosmetic surgery

Getting older doesn't bother Brian Pouliotte, neither do the wrinkles that he proudly says he earned, but his family gene pool did go a bit far.

That's why Mr. Pouliotte, who owns a local security-consulting firm, went to the Facial Surgery and Cosmetic Centre of Ottawa to look into doing away with the jowls and excess skin on his neck that came from his mother's side of the family.

"To give you an example of how I was looking," he said, "my wife and I used to own a couple of boxers. As time went on, I started to look more and more like them."

Mr. Pouliotte had the work done about a year ago. Very active as a scuba diver and skier, he said the time had simply come. "One nice thing about getting older is that dogs die and the kids go out on their own," he laughed. "I had the disposable income to do it and it was something that had been kicking around in my head for a while."

Mr. Pouliotte is not a rarity. Although there's still a certain stigma attached to men who opt for cosmetic surgery, more and more businessmen are doing what they can to enhance their appearance in the dog-eat-dog corporate world.

Dr. Gregory Antoniak, the founder of Facial Surgery and Cosmetic Centre of Ottawa, said the number of men visiting his clinic has grown steadily since 1987 when he began to practice.

"I'd say men comprised about 10 per cent of my patients back then," he recalled, "but now it is much higher. There are no numbers in Canada, but the United States has them and the number of men is increasing all the time."

He estimated that men now comprise about 25 per cent of his patients.

Along with surgery, Dr. Antoniak offers such treatments as Botox, creams and collagen. A graduate of Western University, he specializes on the head and neck.

Mr. Pouliotte is a believer. "I was very impressed throughout the entire process. I did a lot of research on the web and settled on Dr. Antoniak. They were very informed and made me feel comfortable. I saw the doctor three times before anything was done."

Dr. Antoniak is just as picky when judging which clients to accept. Trying to get that Joan Rivers look? Then hunt elsewhere, he warned. "Outside of the surgery itself, choosing the right patient is the most important thing," he said. "It's not like buying a car, we have to understand their motivation. If it's a reaction to a divorce or to try to save a marriage because your partner wants you to do it, in the long run it won't pay off."

Far from changing his appearance, Mr. Pouliotte said the surgery makes him look more like he had a holiday than anything else, although he's happy to tell anyone who asks that he has had the work done.

Monica Hegmann of the Kanata Skin Clinic said women still represent the majority of her customers, but more men are poking their heads through the door all the time. Botox, microdermabrasion and chemical peels are some of the treatments offered there.

"People feel more confident afterwards, and if you feel more confident you tend to go out there and try that challenge you've been putting off," she said.

U.S. statistics for 2003 show women still represented 87 per cent of cosmetic procedures at nearly 7.2 million, an increase of 16 percent from 2002.

There were nearly 8.3 million surgical and non-surgical cosmetic procedures performed in 2003, according to the most comprehensive survey to date of U.S. physicians and surgeons by the American Society for Aesthetic Plastic Surgery (ASAPS). Surgical procedures represented 22 per cent of the total, and non-surgical procedures were 78 per cent of the total.

From 2002-2003, there was a 20-per-cent increase in the total number of cosmetic procedures. Surgical procedures increased by 12 per cent, and non-surgical procedures increased by 22 per cent.

Americans in 2003 spent just under $9.4 billion on cosmetic procedures, according to ASAPS.



Crease proof

Bright red face, sweat trickling down the forehead - and a crumpled linen suit. For years now, these have been the traditional hallmarks of the British hot-country expat. Until now, that is.

There's nothing we can do to our internal thermostats to reduce the perspiration, but there is, it seems, a new way to stop linen going saggy and wrinkled the minute the temperature turns even vaguely tropical, and it's thanks to the adventure clothing specialist Rohan.

It's the equivalent of sartorial Botox, and it's been made possible by the invention of something called "travel linen", a synthetic material that aims to replicate all the good bits of the original, while ironing out some of the other not-so-good bits.

Made of 55 per cent linen and 45 per cent polyester, this newly launched fibre holds out to all brow-mopping hankie-dabbers the promise of looking less like Peter Lorre and more like Humphrey Bogart. The question is, though, do these claims stack up, or are wearers of travel linen still doomed to end up with that origami effect down their backs, like all those sandbagged Graham Greene heroes?

In order to discover the answer, I've embarked on an experimental travel-linen trip to a southern Mediterranean resort where the mean daily temperature is at least 20 degrees higher than in Tunbridge Wells.

The irst test is the plane journey, which involves surprisingly equatorial levels of heat, as we sit stewing on the Tarmac and twiddling malfunctioning ventilator nozzles above our heads. Seven outfit-upsetting hours after leaving home, then, I am astonished to reach my hotel room and find both shirt and trousers as uncreased in Portugal as when I put them on in Putney. Even better, the jam I dropped down my front hasn't left a mark - the combination of plastic knife-scrape and human lick has done the job.

What of the spare outfit, though, which has spent the journey jammed against a pair of walking boots and a bulging sponge bag? It, too, has survived with barely a crease; no problem, then, meeting the hotel dining room's "smart-casual" dress code.

Reunited next morning with Outfit A, I note that it, too, hasn't suffered from a night spent draped over a chair. Whereas conventional linen has a somewhat jowly, sack-like guise, this travel stuff tends towards a stiffer, more sheet-like, deckchair material; instead of moulding compliantly to one's contours, it tends to swish across the skin - nice to start with (and breezy, too), but a little wearing after a long day's slogging along the beach.

In fact, on returning to the hotel that evening I discover that I am in a state of mild-to severe nipple-chafe. To test if this is the shirt's fault, I don a T-shirt underneath it for dinner; thankfully, come bedtime, I am able to downgrade the inflammation code from angry-red to low-alert pink.

Just to be on the safe side, though, I wear a T-shirt next morning, on a hilltop walk in the high seventies. Ideally, you don't want two layers in a foreign hotspot, but then again you don't want open wounds. As a compromise, I shed the lower layer for dinner that night, to see if the skin has had a chance to acclimatise - which happily it has.

After three solid days of warm-weather wear, then, both sets of travel linen still look commendably - some might say eerily - crease-free. Looks-wise, you can't fault the travel linen, it's only in terms of comfort that you can quibble; the fact is, the real stuff has a floppiness which feels like a second skin, while the travel variety has a stiffness to it that replicates not so much the touch of flesh - as the slight abrasiveness of mesh.

Nevertheless, it's just the job if you need to step straight off a plane and into a business meeting or modelling assignment. Plus, if you're concerned about comfort, you can always heed the words of your dear old Mum, and next time you go to one of those hot, foreign countries - take a vest!

Travel Linen is made by outdoor clothing specialist Rohan.

Men's trousers come in dark navy, dusky green and light stone, price £45; shirts, pictured top left, in olive sand and white, £39. Women's travel linen has a lower linen composition (15 per cent), with 62 per cent viscose and 22 per cent polyester: tunics (calico or white), top right, cost £45, trousers (dusky green, black, natural and natural strip) cost £49.

Order on-line at www.rohan.co.uk, or call 0870 601 2244 for mail order, catalogue requests or to find your nearest stockist.



Natural Alternatives to Plastic Surgery

We live in the era of invasive beauty procedures. From surgeries and liposuction to a variety of injections, there are hundreds of treatments designed to help turn back the clock. But often those procedures come with a cost. In the wake of recent news stories detailing the problems resulting in Botox treatments, including six deaths in South Florida alone, The Anti-Aging Clinic longevity center in South Florida offers effective, safer, more natural alternatives.

“We are on the forefront of technology,” says David Tippie, who, along with his wife Stephanie, who herself boasts an international background in high-tech medicine, founded the clinic five years ago, after fifteen years of research and development. “We seek out the best available alternatives to meet the needs of the Baby Boomer generation. As Boomers ourselves, we understand this generation’s concerns and are working to offer a number of health and beauty-oriented alternatives and choices.

ATX: An Alternative to Botox

The Anti-Aging Clinic offers an effective, safe alternative to Botox injections. The Botox alternative, compliments the clinic’s comprehensive, multi-faceted Anti-Aging therapies program that addresses the body’s natural aging process and expands upon the natural non-surgical face-lift procedure that has become a success story for the clinic, attracting clients from all over the country. David points out that Botox is the only botulinum toxin product approved for cosmetic use in the United States.

Further, Botox, or Botulinum Toxin Type A, comes from the waste of the bacteria Clostridium Botulinum, the same toxic byproduct that causes botulism food poisoning. “Why someone would gamble on the most dangerous toxin known to man on their faces is unexplainable?” says Stephanie.

“"ATX", for “alternative treatment”, is a unique anti-wrinkle hexapeptide used to reduce the depth of fine lines and wrinkles on the face by inhibiting the contraction of neurotransmitters that cause repeated expression movements of the facial muscles, thus promoting the appearance of smooth skin, especially around the eyes, forehead and mouth. It’s safe and it works,” explains David.

“Extending quality of life while making you as beautiful as you can be, is our mission statement,” says Stephanie Tippie. “Our clinic is about natural alternatives and options that work. You can’t have beauty without first emphasizing health.”



New Treatment Option for Excessive Sweating - Leading Dermatology Practice Offering Botox® for Hyperhidrosis

Westlake Dermatology & Cosmetic Surgery launched a campaign to educate people on a new alternative to treating hyperhidrosis. Dr. Lisa Rhodes specializes in a safe and effective procedure using Botox® to treat this medical condition commonly referred to as excessive sweating.

Excessive sweating is associated with over-stimulation of a nervous system pathway. In certain people heat and stress stimulate this system in an unpredictable pattern, resulting in hyperactive sweat glands. Recent evidence shows that genetics may cause excessive sweating.

Excessive sweating is diagnosed when a person’s sweating becomes uncontrollable and begins to adversely affect the individual. It can be a substantial burden to afflicted individuals, interfering with daily activities and causing social embarrassment and anxiety. Many people with the condition must change their clothing several times per day.

The FDA recently approved the use of Botox® for hyperhidrosis treatment. Botox® treatment works by blocking the conduction of acetylcholine, a chemical released by nerves to stimulate the sweat glands. Without this stimulation, the local production of sweat is stopped. Many insurance carriers will cover the cost of this treatment alternative.

About Westlake Dermatology & Cosmetic Surgery

Westlake Dermatology & Cosmetic Surgery provides state-of-the-art treatment for diseases of the skin, as well as the latest in cosmetic procedures. The practice of cosmetic dermatology continues to be one of the fastest growing medical specialties. Westlake Dermatology & Cosmetic Surgery patients have access to the most current, cutting-edge medical technology and therapies available for beautiful skin. Dr. Gregory Nikolaidis, founder of the practice, specializes in minimally-invasive cosmetic procedures. He is the leading provider of Thermage™ in Texas and his practice was recently recognized as a National Botox® Training Center. Visit www.westlakedermatology.com for more information.



Future- perfect skin

FIRST it was make-up artists hawking their own line of make-up in the legacy of Max Factor-Nars, Bobbie Brown, Shu Uemura, Laura Mercier, Stephan Marais, Lorac, Stila, et al. In the last few years, though, there has been an influx of (this time!) dermatologist-formulated skincare lines.

This is not new at all, with today's derma beauty pack being led by Hungarian dermatologist Erno Lazslo marketing his eponymous line in the 1940s (a cult line until today) and New York dermatologist Norman Orentreich consulting for Clinique in the 1960s.

Of course, today the market is flooded with MD lines a-plenty, such as Howard Murad, Dennis Gross, Fredric Brandt, the big-three among the countless. But it is one thing to put your name on a jar and another to be a dermatologist, specifically a distributor of such lines, then decide to create your own line with the purpose of creating newer, more efficient products. One begins to wonder, why? What did the others not have?

Geoffrey Heber of Australia who, together with his wife Dr. Deborah Davis, have formulated Ultraceuticals, a skincare line sold only through skin care specialists and salons. (www.ultraceuticals.com)

Dr. Heber started his practice in 1988. In 1991 he began to internationally distribute such dermatologist-backed skincare labels like MD Formulations, Neo-Strata and Cellex-C ,which were met with global success. Today, his practice in Australia specializes in non-surgical cosmetic medicine. Treatments include injectable filler treatments, Botox injections, laser treatment of various skin disorders and laser hair removal, sclerotherapy treatment of leg veins and the treatment of ageing skin with medical anti-ageing creams and peels.

Dr. Heber is known in the industry not only for this new and effective skincare line but primarily as the second largest user of Botox outside America, and one of the top five users of Restylane and collagen worldwide.

In Taipei as part of his Asian roadshow also covering Singapore/Malaysia and Hong Kong, Dr. Heber discussed his latest skincare line, how to achieve glowing skin and the REAL future of wrinkles and sagging facial muscles. His answers, all simple, straightforward and informative, will surprise you.

Having distributed other lines and having run a successful practice, why did you have to develop your own line?

My medical practice is very busy and, according to supply, we are the biggest Botox user in Australia. We have treated thousands and, from my experience, I knew what ingredients and combination of ingredients I needed to treat our patients successfully.

What would you classify as perfect skin?

Perfect skin is moist, firm, glowing and smooth in texture. To make skin beautiful we must first treat any existing imperfections like lines, spots, pigmentation and blemishes. Next, you must provide skin with nutrients like vitamins. And, finally, you must protect your skin with UV blockers and moisturizers.

What makes Ultraceuticals (UC) different from other MD formulations in the market?

Every person's skin is different. In fact, it is very much like fingerprints. Our formulations can be individualized from very mild for sensitive skin to stronger formulas and anything in between but only by professional advisers.

The line is not tested on animals but tested on humans for efficacy. We use the best ingredients-AHA, BHA, pure vitamin C and retinol. Then we have a patented system of delivery and stabilization of these ingredients such as vitamin C and vitamin A in retinol.

And finally, I know our products work because my patients are happy and they continue to use the products.

A Hong Kong dermatologist once told me that invasive surgery (plastic surgery under the knife) is now a last resort in the quest for youth. Can you comment on this?

We have to treat skin from an early age so our skin does not lose elasticity and we may not need invasive surgery. With current ingredients in topical applications (creams, ointment, gels) and non-surgical treatments (injectables like Botox, Restylane, collagen), we can make so much more of a difference now than in the past.

Can any current skincare treatment get rid of wrinkles?

Currently no skin care product can treat facial lines. That's asking too much, but we can add to results of an effective skincare line. Botox and Restylane are complementary (to an effective skincare routine.)

Do you think wrinkles and sagging skin will ever be treated topically?

Very likely, in years to come, we will be able to treat our wrinkles topically. Firming maybe, but for now we really have to create an injury or stimulate the skin so that it will want to heal itself to tighten up.

So there it is, boys and girls, straight from the doctor's mouth. Unfortunately, for now, you still have to bleed to firm up, but wrinkles are just a shot away. It doesn't hurt to take precautions, though and there is always hope....(perhaps one day) in a jar!

Doctor Says: “Are You Ready for Your Wedding Pictures?”

With your wedding date set, if you’re like most “brides to be”, that seemingly endless list of tasks may be overwhelming. You may be concerned on how the flowers will smell, how the music will sound, and how the food will taste which are all short lived. But the pictures taken that day will capture the memories that will last for generations.

At the wedding and thereafter in the wedding pictures, all eyes will be focused on the bride, her dress, hair and not to forget her glowing complexion. Additional items that may be added to that list of tasks should include minor non-invasive procedures such as skincare, lip augmentation, or photofacial treatments. “The goal is to help the bride look more radiant” says Dr. Kevin Sadati, a Facial Plastic and Reconstructive Surgeon in private practice in Seattle, Washington. He reports the most popular procedures for brides-to-be are, Botox, lip augmentation, and chemical peels. The perfect time to start a new skincare routine is at least two months prior to the big day. Botox can be utilized to eliminate the frontal and “crow's feet” wrinkles, or even quiet down the under arm sweat glands.

There are several different products to enhance lips. Restylane, Hylaform, and Radiesse are popular fillers which are injected easily within minutes, with minimal discomfort. These fillers have a duration of six months to two years depending on the product chosen.

According to Susan Cummins the director of Radiant Skin Care in the Seattle area, there are different ways to refresh the skin. Many blushing brides find microdermabrasion not only polishes the skin, but it allows their makeup to be applied flawlessly to create that “glowing” effect. Other procedures such as the Obagi “Blue Peel”, IPL (Intense Pulse Laser) and N-lite may be performed months prior to the wedding day. They will lend to the over all beauty of the skin by correcting issues such as hyperpigmentation, redness, fine lines, and wrinkles. At The Gallery of Cosmetic Surgery, where Susan provides skin care, patients will find the latest in technology, the best of products, and the guidance to make their wedding day photos truly unforgettable.

“Let’s not forget the mothers of the bride and the groom who also wish to look their best. Many will seek facelifts or other cosmetic procedures before the wedding date. Surgical procedures should be done up to 6 months prior to the set date to allow enough time for the healing process.” states Dr. Sadati. The most common pre-wedding cosmetic surgery misconception is waiting too long to see the surgeon about major procedures on the face, eyes, and abdomen. Make sure to schedule your consultation as soon as you have set your wedding date in order to discuss your options with the surgeon.

Free Fat Transfer is also a fantastic and natural way to enhance the cheek, chin, breast, and the buttock areas. Dr. Sadati and Dr. Alexander are experts in this field with many published articles in the American Journal of Cosmetic Surgery regarding Free Fat Transfer techniques. During these surgical procedures the patient’s harvested fat is combined with Platelet Rich Plasma (PRP) prior to transfer to ensure a longer lasting results and a more natural look. The doctors find that Fat Transfer is a reliable option to enhance your facial and body contours.

Do you have someone close to you planning a wedding? Consider giving cosmetic enhancements as a gift. Treatments range in price from a few hundred dollars to a few thousand depending on the procedures chosen. Inexpensive options would be Botox, microdermabrasion, Obagi Blue Peel, chemical peels, and lip augmentation. These gifts make the biggest difference on how the bride will appear on her wedding day.

Dr. Sadati has a strong background and interest in the arts, with training at the Pennsylvania Academy of Fine Arts. His personal interests lie in the areas of oil painting and sculpture. The photo is an original painting by Dr. Sadati entitled "The Bride."



The War on Wrinkles

THE HOTTEST ANTIAGING CREAM ON THE MARKET IS AN OINTMENT MEANT TO GET RID OF STRETCH MARKS--AND IT HAS THE BEAUTY BUSINESS BUZZING

Walk into a Sephora cosmetics store anywhere, and you'll be bombarded with slickly packaged products promising to make you look radiant, smell good and feel gorgeous. Yet almost hidden among those glamorous potions is a plain medicinal box--labeled with the unsexy pitch INTENSIVE CONCENTRATE FOR EXISTING STRETCH MARKS (STRIAE DISTENSAE)--that just happens to be one of the chain's Top 10--selling items. No, stretch marks haven't suddenly become big business. But thanks in part to aggressive ads that proclaim it "Better than Botox?," the scientific-sounding StriVectin-SD has become the hottest thing in the war on wrinkles--a booming industry that's generating billions of dollars for dermatologists, cosmetics firms and, yes, retailers like Sephora. "[StriVectin] is driving traffic in our stores," says Sephora vice president Rod McFadden, "and it's having a spillover effect: our entire skin-care business has benefited."

The fight against old age has long been good business, and it's only getting better. Global retail sales of antiaging skin-care products--up 71% since 2000--are rising faster than any other segment of the skin-care market, according to Euromonitor, a market researcher, hitting $9.9 billion last year. More than 2 million Americans got Botox injections and about 1.6 million got chemical peels or microdermabrasions in 2003 (the most recent year for which stats exist). Says Carol Hamilton, president of L'Oréal Paris: "Now you have a whole generation who basically believes that they never have to see a wrinkle. This is a powerful movement in the beauty industry." StriVectin is either the latest fad in that movement or an antiaging silver bullet, depending on whom you ask. But in either case, it is clearly one of the most talked about new products in the industry, roiling competitors, realigning expectations and even prompting lawsuits--from Botox maker Allergan, which disputes StriVectin's advertising claims, and from StriVectin itself, against alleged copycat marketers pushing similarly named knock-offs. Priced at a hefty $135 per 6-oz. tube, StriVectin, made by privately held Klein-Becker, a division of Salt Lake City, Utah-- based weight-loss-supplement maker Basic Research, last year tallied an estimated $60 million in sales, almost double the sales that a new skin-care product typically generates in its first year in U.S. department stores, according to NPD, a market-research firm. Clearly, for every vain soul who has undergone a dermatological procedure, there are thousands more as concerned about wrinkles but squeamish about needles. As Klein-Becker's marketing director Gina Gay puts it, "There are people who don't want injections."

In the past year, nearly every beauty brand, upscale and downmarket, has introduced a new antiaging skin cream--Estée Lauder's Perfectionist (CP+), Olay's Regenerist Perfecting Cream and Avon's Anew Clinical Line and Wrinkle Corrector, to name a few. "We've been on the antiaging track for a long time, even before StriVectin came along," says Estée Lauder's Peter Lichtenthal, the brand's senior marketing vice president. "But its success has provided further proof of how hungry the public is for these types of products."

Klein-Becker stumbled on StriVectin's effect on fine facial lines by accident back in 2002, when the company started testing its new stretch-mark cream. Says Klein-Becker's Gay: "There were no directions on the tube. So some of the testers used it on their face and discovered that it smoothed out their skin. It was just dumb luck." Many products throughout the ages, of course, have promised to reverse the aging process. StriVectin's particular solution relies on peptides--strings of amino acids that stimulate enzymes in skin cells to produce more collagen, a protein that restores the skin's structure and keeps it from sagging.

But here's the rub: many other antiaging creams use exactly the same types of compounds that target collagen production. Says Avon's research chief Janice Teal: "We've been using peptides in our products for years." Louis Rinaldi, head of Klein-Becker's new product acquisitions, counters that StriVectin's particular concentration of those compounds and the inclusion of a certain botanical extract make it more effective.

StriVectin certainly isn't the first antiaging cream to spark a frenzy with better-than-the-rest claims. Crème de la Mer, bought by Estée Lauder in 1995, was the first cream to become a cult favorite. Made with sea kelp, La Mer sold for more than $150 for a 2-oz. jar, the first skin-care product to break that price point. Another big push came with the publication of well-known dermatologist Dr. Nicholas Perricone's book, The Wrinkle Cure, in 2000 and the launch of his pricey line of skin-care potions. (Perricone just opened a flagship store on Manhattan's Madison Avenue last month.) At-home alternatives to dermatological procedures have also hit big. Last June, for example, L'Oréal Paris launched ReFinish, a $25 microdermabrasion kit; it's the brand's most expensive--and successful--skin-care product to date.

Meanwhile, Klein-Becker has some wrinkles of its own to worry about. There is competition from alleged knock-off brands, which so far has prompted the firm to file 16 trademark-infringement suits in federal court. Then there's a Federal Trade Commission suit scheduled for trial in July against Klein-Becker and its parent firm, Basic Research, alleging that its ads for several weight-loss supplements and tummy-flattening gels are misleading, although a spokesperson for Klein-Becker (which denies the charges) notes that StriVectin plays no part in that case.

Perhaps most important, though, is the Botox issue. Even as Allergan's litigation with Klein-Becker about StriVectin's "Better than Botox?" ads is pending, the Food and Drug Administration has warned that StriVectin might be reclassified as a drug (which Klein-Becker is seeking to avoid). At the same time, other cosmetics competitors have jumped on the opportunity to compare themselves to Botox. Estée Lauder's Perfectionist is promoted in its ads as the ideal cream "for every woman who says no to Botox"; Avon's Anew Clinical Deep Crease Concentrate jabs at Botox with the line, "look stunning, not stunned" and contains a trademarked compound called Bo-Hylurox, a combination of a plant extract and hyaluronic acid (a jellylike substance found in skin tissue that helps restore its moisture). Admits Avon's Teal: "We made the [term] up. It telegraphs Botox and hyaluronic acid." And then there is Allergan itself, which came out with its own antiwrinkle cream in January, Prevage (sold only through dermatologists), featuring a 1% concentration of the antioxidant idebenone.

The big question, of course, is whether any of those things actually work. The cosmetics industry spends millions on real science, employing teams of chemists, pharmacologists and microbiologists in labs all over the world. And in clinical tests, each company says its cream decreases the depth of fine facial lines to some degree. None of them claim, however, that their products make wrinkles disappear completely, the way a shot of Botox can. Still, the search for a better fountain-of-youth cream continues. Avon is about to complete a $100 million state-of-the-art research facility in Suffern, N.Y. And Clinique last month announced a $7 million research grant devoted to the study of skin with Weill Cornell Medical College, the first ever collaboration between a university and a cosmetic brand. Perhaps the most revealing insight comes from Estée Lauder's research chief Daniel Maes, who notes that along with peptides and other compounds, his firm's Perfectionist cream includes optic polymers that reflect the light that hits the skin--creating the optical illusion that a wrinkle is smaller by blurring its edges. In other words, it's all about appearances. And who could argue with that?



Cosmetic Surgeons Focus More on Teen Set

Cosmetic surgery procedures among children and teens rose by 9% in 2004, compared with 2003. Cosmetic surgery, says the president of the American Society of Plastic Surgeons, whose members perform most of it, is all part of growing up.

Scott Spear, M.D., the group's president, says that in his mind cosmetic procedures are done generally to help the child in much the same way that a parent will take a child to the orthodontist for teeth straightening, or that parents will help a child with diet or exercise to lose weight.

Dr. Spear, who is also professor and chair of plastic surgery at Georgetown, conceded that there was a whopping rise in injections of Botox among young people, but he warned that such statistics may signal a trend where none exists.

For instance, ASPS data state that 8,978 Botox injections were administered to patients age 18 or younger in 2004 -- a whopping 244% increase over injections in 2000 and up 60% from the number of injections given in 2003.

Botox, which is a paralyzing agent, is widely promoted for its ability to smooth away facial wrinkles, and Dr. Spear says that he, too, was surprised and puzzled when he first saw the number of injections given to teens. "It would be surprising if Botox were used in teens to treat wrinkles," he said.

The more likely explanation, he said, is that the injections were used to treat migraine or muscle spasm, which are two other fairly common uses for Botox.

The statistics on plastic surgery procedures are issued annually by the ASPS. Procedures for patients 18 or younger is a separate category. Rhinoplasty was listed as the number one surgical procedure for teens -- 51,931 done in 2004 -- followed by ear surgery (otoplasty).

While rhinoplasty is almost never covered by insurance, otoplasty, which is surgery to pin ears back against the head, may be covered by insurance, but Dr. Spear says that insurers are more likely to pay for the procedure if the patient is four or five than if the patient is 20-something.

The otoplasty example, he said, illustrates the difference between reconstructive and cosmetic surgery. "Reconstructive surgery is surgery to restore to normal appearance, cosmetic is surgery to enhance the normal.

"In the case of otoplasty, it is not normal to have ears that stick out. For a child, there is a time when kids start noticing differences and when this happens the kid who is different can get very self conscious and other kids can be very cruel about differences," he said. "So otoplasty is a reconstructive procedure for a child."

Dr. Spear pointed out that plastic surgeons don't operate on every teen that wants a straighter nose or bigger breasts -- although 3,962 teens did get bigger breasts via surgery in 2004 and 3,631 teenage boys had breast reduction. In either case the teen is typically referred by a pediatrician and is accompanied by a parent to the surgeon's office. And, again, there are medically valid reasons for either surgery, said Dr. Spear.

Making the case for breast reduction to treat gynecomastia, he said. "a tablespoon or a quarter cup of breast tissue in an adolescent boy can be very alarming to him." Likewise some teenage girls have "absolutely no breast development at age 17 or may have a breast on one side, but not the other."

But Dr. Spear added that it is also possible that some teenage girls are getting breast augmentation surgery for cultural reasons -- he speculated that in southern California or Florida large breasts are more culturally desirable than in "more conservative areas like Washington or Cleveland." Even so, he said that "I don't believe there is an epidemic of teens getting breast augmentation surgery."



Change your beauty destiny

No matter what your genetic blueprint, you can look younger longer!

It's the classic nature-versus-nurture debate: Is it your genes or your lifestyle that determines how you look as you age? "The rule of thumb in terms of wrinkles is that it's 10 percent genetics and 90 percent environment and lifestyle," says Tina Alster, M.D., of the Washington Institute of Dermalogic Laser Surgery, in Washington, D.C. What is genetic: skin thickness (which accounts for how much it sags) and wrinkle patterns.

The good news: The remaining 90 percent gives you a lot of control. To prove it, Darrick Antell, M.D., a plastic surgeon in New York City, studied identical twins and found that if their lifestyles were the same, their faces aged similarly. But if their habits were different, the contrasts were dramatic. Antell found one sister, who was a sun worshipper (and had premature aging) and the other who wasn't. "Seeing their photos side by side was like looking at plastic surgery before-and-after pictures," Antell says. So while your DNA may be immutable, what you do with its blueprint is up to you. Here, the lifestyle changes that will help you save face.

Protect yourself from the sun. The experts agree: The sun is, hands down, your skin's worst enemy. Exposure to the sun's ultraviolet (UV) radiation causes the skin's support structures (collagen and elastin) to break down, accelerating the aging process. "There are many habits that can age the skin, but the sun really trumps everything else," says Nancy Silverberg, M.D., a dermatologist in Newport Beach, Calif. "And even if you've already done a lot of damage, it's never too late to start wearing sunscreen. Daily use has been shown to actually reverse a significant portion of sun damage." And, it's not enough just to wear it; you need to wear the right one.

"Look for sunscreens that contain ingredients such as zinc oxide, titanium dioxide and Parsol 1789 [also called avobenzone], which all partially block aging ultraviolet-A [UVA] rays," recommends Cherie Ditre, M.D., director of the Cosmetic Dermatology & Skin Enhancement Center at the University of Pennsylvania School of Medicine, in Radnor. Best bet: Clinique Superdefense Triple Action Moisturizer SPF 25 ($40; clinique.com), which uses avobenzone to protect against UVA rays, and the ingredients octinoxate and oxybenzone to fend off burning UVB rays. It's available for oily, regular and dry skin.

Put out that cigarette. Smokers often end up with telltale lines around their lips (created by repeated lip puckering while inhaling), but the damage doesn't stop there. Silverberg points to a study of smokers that found they also were more likely than their nonsmoking counterparts to have significant lines around their eyes. Like sun exposure, smoking breaks down collagen and elastin, speeding up the rate at which skin sags and wrinkles. To help reduce the damage, try Estée Lauder Perfectionist Correcting Concentrate for Lip Lines ($35; esteelauder.com), which helps fill in wrinkles and keep lipstick in place.

Stop making faces. Think of your skin as being like the soft, fine leather of an expensive shoe. Just as the creases in the leather get deeper as you walk in the shoe, your skin reacts in a similar fashion to repeated facial expressions. "Years of constantly using those muscles causes the skin to get a crack, or wrinkle, in it," Antell explains. Botox is often used to soften expression lines (since it paralyzes the guilty muscle, you can no longer make the expression that's causing the wrinkle). A less expensive option: Break the habit. "You can learn not to make certain facial expressions, such as squinting or scowling," says New York City dermatologist Dennis Gross, M.D., author of Your Future Face (Viking, 2005). "Those are behavioral." Make a conscious effort to relax your face when you find yourself drawing your brows together or grimacing. Or apply a topical product to help relax the wrinkles; try Avon Anew Clinical Deep Crease Concentrate ($32; avon.com), which uses a patent-pending relaxant called portulaca, or Nuxe Crème Nirvanesque ($41; sephora.com), which uses the botanicals blue lotus, poppy and althea to help relax the contraction of facial muscles.

Control stress. The effect of stress on the body has been well documented: It can compromise the immune system and weaken your ability to fight off illness. Your skin suffers too. When your stress level goes up, your body goes into fight-or-flight mode. More specifically: "Capillaries shrink, and blood flow to the skin decreases as the body redirects blood to the internal organs," your body's way of preparing to defend itself, Antell explains. In addition, chronic stress can increase tension lines on the face and, if it impairs your sleep, you risk a further speeding up of the aging process (see below). In addition to learning how to reduce the anxiety in your life, you can also apply skin-care products to help reinvigorate your complexion. Try Caudalíe Vinosource Riche Anti-Wrinkle Cream ($50; caudalie.com) with grapeseed extract to moisturize and protect against age-accelerating free radicals (highly reactive oxygen molecules created by smoking, pollution and sunlight that speed up the aging process); 3Lab Hydrating-Vita Cream with the powerful antioxidant coenzyme Q10 ($120; 3lab.com) and Biotherm Line Peel ($40; biotherm-usa.com), which increases the skin's natural cell turnover process.

Get your beauty sleep. When you look in the mirror after a sleepless night, you're getting a preview of how your face may look in a decade or so. Fine lines will appear deeper; slight under-eye bags will look puffier. "When people are sleep-deprived, they look older and more haggard, especially around the eyes," Alster says. During sleep your body repairs itself, and you get an increase in circulation to the face; without quality sleep, the face sags and shadows appear under the eyes. The good news: The effect can usually be reversed by going to bed earlier the next night and keeping your sleep schedule as regular as possible. Before bed, apply Therapy Systems Retinol Cellular Treatment Cream/PM ($68; therapysystemsinc.com) with retinol and glycolic acid to help repair and exfoliate skin; American Beauty Uplifting Firming Eye Cream ($22.50) and Beauty Boost Overnight Radiance Cream ($27; both at kohls.com), which moisturize and firm as you sleep; or Nivea Visage Q10 Advanced Wrinkle Reducer Night Crème ($11; at drugstores) with the antioxidant coenzyme Q10.

Feed your face. It's commonly said that you are what you eat, and it might also be true that your looks are a direct reflection of your diet. Antioxidants (especially vitamins C and E) may help boost the skin's power to fight free radicals. There's also some evidence that omega-3 fatty acids (found in fatty fish like salmon) reduce inflammation and improve skin texture.

Equally important is what not to ingest: alcohol and sodium. Alcohol dilates capillaries and makes them more fragile (making your face look flushed, bruised or splotchy), and salt causes skin to retain water (think: swollen eyes and cheeks). Put the two together (in, say, a sushi dinner where you consume lots of soy sauce and sake) and you're going to wake up looking bloated. You can help feed your face topically with these editor's picks: IS Clinical Vitamin C Super Serum ($115; isclinical.com) with stabilized L-ascorbic acid, a potent topical vitamin C that works as a powerful antioxidant and anti-inflammatory agent, and Chanel Précision Hydramax + Sérum Intense Moisture Boost ($65; gloss.com), with vitamins B5, E and F to help protect against free radicals.

Believe in miracles. "We live in a golden age of ingredients," Gross says. "Even if you're genetically destined to have the same aging patterns as your mother, you have access to modern ingredients that can help build collagen, more effective sunscreens to protect against ultraviolet radiation and cosmetic procedures that can undo what you've inherited." He recommends consistently using modern "miracle" ingredients such as the antioxidant vitamins C and E, lycopene and green-tea extract (to fight free-radical damage), retinoids or genistein (to build collagen and elastin) and alpha- or beta-hydroxy acids (to speed skin cell turnover). Best product bets: Prevage Antioxidant Cream ($100; prevage.com) with idebenone, an ingredient that helps repair skin cells; Neutrogena Visibly Firm Lift Serum ($19; at drugstores), with concentrated active copper to restore firmness; L'Oréal Transformance Skin Perfecting Solution ($16.59; at drugstores), an oil-free serum with vitamin C to hydrate and protect; and CelGen Age Repair Moisture Solution ($45; stcbiotech.com), a toner that hydrates and promotes skin renewal.



Laser Resurfacing with No Downtime - Leading Cosmetic Surgeon Now Offering Fraxel™

Westlake Dermatology & Cosmetic Surgery announced today the addition of Fraxel™ to the procedures it offers. Dr. Gregory Nikolaidis is one of the first physicians in the country to offer the unique laser therapy that dramatically repairs fine lines and wrinkles while it improves skin texture and pigmentation – without downtime needed for healing.

The innovative Fraxel™ SR laser is specially designed to alter only fractional volumes of the target tissue at a time. Similar to digital alteration of photographs and paintings, the effect of this treatment technique is to alter the appearance of aging and sun-damaged skin. Unlike other resurfacing options, there is no downtime required with the procedure and side effects are minimal.

Reliant Technologies, the producer of the Fraxel™ SR laser, has received FDA clearances for its laser system in dermatological procedures requiring the coagulation of soft tissue and for treatment of periorbital wrinkles and pigmented lesions, including age spots, sun spots, and skin discoloration. According to Dr. Richard E. Fitzpatrick, internationally acclaimed laser surgeon, "The results we are able to achieve in healing and repairing the skin with the Fraxel™ treatment, without causing damage, are unlike anything I’ve ever seen before."

About Westlake Dermatology & Cosmetic Surgery

Westlake Dermatology & Cosmetic Surgery provides state-of-the-art treatment for diseases of the skin, as well as the latest in cosmetic procedures. The practice of cosmetic dermatology continues to be one of the fastest growing medical specialties. Westlake Dermatology & Cosmetic Surgery patients have access to the most current, cutting-edge medical technology and therapies available for beautiful skin. Dr. Gregory Nikolaidis, founder of the practice, specializes in minimally-invasive cosmetic procedures. He is the leading provider of Thermage™ in Texas and his practice was recently recognized as a National Botox™ Training Center. Visit www.westlakedermatology.com for more information.