Treatments for Sagging Skin and Under Eye Bags with Dr. Perry

Airdate: 7/28/2011

Skin-care products can only do so much and when we've reached the limit of their capabilities, we call on world-renowned cosmetic surgeon Dr. Arthur Perry. Dr. Perry explains the best surgical procedures and non-invasive treatments for your trickiest skin-care concerns, including sagging jowls, undereye bags, deep wrinkles, and more!

Paula Begoun: Good evening or good morning or good afternoon, depending on where and when you are listening to us. I'm Paula Begoun, the Cosmetics Cop. And my Paula's Choice Team – Desiree Stordahl and Bryan Barron are here. Desiree, how you doing?
Desiree Stordahl: Hello! I'm doing good. Welcome back home from your trip.
Paula Begoun: I am home. I am.
00:00:33: I am back from Disneyland. And Bryan, I got sunburned. I can't believe I am admitting this. Ah! You know it's funny, I wasn't going to say anything and then it just got overwhelming. I did the classic mistake and I mean the –
Bryan Barron: Uh-oh, what did you do?
Paula Begoun: The classic mistake. Well what I did is I got dressed, I put on – I layer sunscreen. Nobody had more sunscreen on me in the world. And wait a second, for some reason all of a sudden my phone is deciding to ring and I never have it on. Hold on, there we go. Just turned it off.
00:01:13 Leave me alone. My phone – sorry guys. I'm calling from home. Sorry about that. I'm sure it was somebody I don't want to talk to. So here is what happened. I was at Disneyland and actually Disneyland is a wonderful place. It is way too crowded and is way too expensive. But it is a wonderful place. I loved the Indiana Jones ride. It is the best ride in the world.
00:01:40 I was with my family, a big family. It was exciting. The kids were happy and hugging the Mickey Mouse. I was hugging – I had lunch with Daisy Duck. I mean I had a great…it was great. It was way too crowded though. So I am getting dressed and I put on this top and as I am getting ready to leave I thought, you know, it's going to be a lot hotter. I will wear this other top.
00:02:07 So I quickly changed, everybody is waiting for me, and I didn't get sunscreen on the back part of my collarbone and it got sunburned. It was classic. It was right at that…so I got my chest and that was fine, but right at the sides of my shoulder, my collarbone. I couldn't believe it. Unbelievable!
00:02:33 And I'm thinking, oh my god, I'm not going to tell anybody I got sunburned. That is like…I don't even know what the analogy is. It's not a good thing for me. And I just confessed on air that I got a sunburn. I'm just unbelievable.
Desiree Stordahl: What about your scalp? Did you wear a hat or how did you protect your scalp?
Paula Begoun: Well my scalp, I have way too much hair. I don't think the sun has ever seen up there.
00:03:03 But I wear a hat and sunglasses. I wear a brimmed hat and sunglasses and I was good in every other respect. Darn it was hot down there. It was great. I love Disneyland. Way too many people. But Bryan and I have been working on…well actually, I want to talk about facials a little bit. But before I do that let me just tell everybody what we are going to be talking about today.
00:03:30 Go get your friends because they are all going to want to hear Dr. Perry talk about treatments for sagging skin and under eye bags. Dr. Perry is our favorite plastic surgeon, my favorite plastic surgeon. He has cosmetic surgery offices in New York and New Jersey. He is author of a book called "Straight Talk about Cosmetic Surgery." And he is coauthor of "You Being Beautiful." That is the series of books with Dr. Roizen and Dr. Oz.
00:04:01 He is actually Dr. Oz's plastic surgeon. He is on the show all the time. He talks about very interesting things. I mean Dr. Perry has been…he took a mole off of Jimmy Fallon's face or body, somewhere on the show. And he lasered off red marks on Dr. Oz on the show. So Dr. Perry is very busy. He's been on Oprah. He is an incredibly diligent and just very well educated guy.
00:04:34 Too much praise but not enough praise. Dr. Perry is who will be talking to in just a little bit about sagging skin and under eye bags – the bane of almost any woman's over the age of 40 existence that I know of when it comes to beauty. But Bryan I wanted to let you know that I have been working on the facial.
00:04:58 So we are updating our article on facials. And I am obsessing over it. I am obsessing over it because it is very hard to get good information – reliable, some kind of research information about what facials are, what aestheticians do. First of all what aestheticians – we have to do a show…actually we have to get a show on about facials, kind of the very article I'm working on on what facials do and can't do and what machines they use and everything.
00:05:36 And I just am overwhelmed at doing the research on the internet, the crazy things aestheticians, spa websites tell their clients what these things can do for them. And the most insane one is they claim that they can do these treatment to your face with, and I have to ask Dr. Perry what negative ions are and what that has anything to do with opening a pore.
00:06:10 But they do some kind of electrical current on your face or some kind of ultrasonic wave thing on your face and they tell you that that is going to open pathways through your skin cells into the lower layers of your skin so the skincare ingredients can follow the path and get in deeper in the skin. And the reason I am laughing is what makes that so ludicrous –
00:06:40 Aside from the fact that there is no research is if that really worked then wouldn't the bacteria on the skin get in? You have staph and strep just living naturally, all kinds of stuff on your face. What about solution? What about skincare ingredients you don't want to absorb in, getting in.
00:07:01 Because one of the things they tell you with these ions and this electrical change and the ultrasonic waves is that if you do it often enough, because obviously they want you to come in for repeat visit, if you do it often enough those pathways remain open. Bryan, it's driving me crazy. I think I have to quit my job.
Bryan Barron: Oh no, don't do that, because then I will have to quit and what am I going to do?
Paula Begoun: I can't take it anymore.
00:07:37 Really, this one is just – this is so over the top…okay, it's not really over the top. There has been crazier stuff. You know what it is, with each article I am working on in the moment just drives me particularly crazy. And to be fair to the facialists, the aestheticians out there, there are wonderful procedures that they can do. They really can, you know, extractions and Microdermabrasion and some chemical peels.
00:08:06 And I mean there are talented aestheticians out there. Some of this other stuff is just so beyond the pale and such a waste of money and some of it particularly risky, dangerous to do that scraper thing like taking – there's this machine, Bryan, where they take a scraper and run it over your face like you are removing frost from your windshield.
00:08:31 And I swear to god it is a scraper. Bryan, okay, all right…
Bryan Barron: We need to do a separate show discussing the pros and cons of a facial. And I think that would be a great show. I think a lot of people would enjoy hearing about that.
Paula Begoun: And Desiree can we post on Facebook to get people's feedback about how they feel, do they get facials, what do they feel about facials on our Facebook page?
Desiree Stordahl: Yeah. Absolutely.
Paula Begoun: Let's see what people want us to take a look at and research and discuss on Facebook.
00:09:15 And then obviously we will get the show together for our "Be Beautifully Informed" radio show that we do here to keep you beautifully informed. But I have to talk to Dr. Perry. Dr. Perry, are you there? I have three million questions for you.
Dr. Arthur Perry: Paula, I am here.
00:09:34 I just want to say something. First, thanks so much for having me on the show. Second, you getting a sunburn is like a cardiac surgeon eating a bacon cheeseburger. Come on now!
Paula Begoun: I knew there would be a great metaphor. I knew there would a be a great metaphor out there. Can you believe I got…oh, unbelievable. So actually here is a question. So I got sunburned and obviously I got UVA and UVB rays hitting my shoulders like crazy.
00:10:07 So is getting burned, what's the difference? Isn't it all bad? I mean you hear that UVA rays, well no you hear, it's a fact – UVA rays mutate skin cells. Probably the main cause of skin cancer and UVB rays burn the hell out of your skin. Is one temporary versus the UVB, is it just a burn and not so bad, or it is really about the UVA?
00:10:34 What is the difference in terms of damage?
Dr. Arthur Perry: Well I think that the attempt to simplify UVA and UVB by kind of pigeonholing what they do, harmful or not, is kind of confusing to everybody. There is so much overlap in the toxicity that it really is unnecessary to even separate them. Both can cause skin cancer. Both cause photo-aging of the skin.
00:11:02 UVB causes more of a sunburn and that is why when you put sunscreen on, that doesn't protect you from UVA but protects from UVB; you don't get that red reaction but you still hurt yourself. And by the way, 20 minutes of UVA radiation without even getting red will suppress your immune system. And that ain't good for you, Paula.
Paula Begoun: Yes, thank you Dr. Perry. I know that absolutely is not good for me. I ain't doing it again.
00:11:35 In fact I am just going to cover myself in a big blanket before I go outside again. So, Dr. Perry is plastic surgeon to the stars of which particularly is Dr. Oz who you wouldn't necessarily think of Dr. Oz as being that interested in it but you have been on several times talking about plastic surgery, all kinds of things around the issues. Your books talk about cosmetic surgery. You practice in New Jersey and New York.
00:12:02 You have your own radio show on WOR 710AM on Saturday evenings, East Coast time that is 7:00 pm and I assume there are archives somewhere Dr. Perry. Where are your radio shows archived?
Dr. Arthur Perry: Well WOR puts some of those on. But you know I also do a national show with your friend Dr. Mike Roizen and that can be heard on and all those shows are archived.
Paula Begoun: So when you talk to Dr. Roizen, who is the heart doctor?
00:12:37 Dr. Roizen or Dr. Oz?
Dr. Arthur Perry: Dr. Oz is a cardiac surgeon. Dr. Roizen is board certified in both internal medicine and anesthesiology. And he really is one of the premiere anti-aging doctors. That is such a bad term, isn't it, anti-aging? But he is the guy who knows all of the real scientific literature. None of the BS but the real stuff about what you can do to keep your genes young.
00:13:05 He's the guy.
Paula Begoun: He is the guy. So the big topic what we are going to talk about is sagging skin and under eye bags and you are here to say that there is a revolution going on out there about sagging and bagging and under eye bags and maybe they are going to put you out of business.
00:13:28 Is that true? What am I doing right or wrong about my bagging and sagging that you haven't told me about?
Dr. Arthur Perry: Okay, well you know for those of you who are recording this broadcast, we are at 2011. By 2020, give it nine years, no one is going to be having facelifts. No one is going to be having eyelid lifts. How is that, Paula? Is that revolutionary?
Paula Begoun: It would be revolutionary if I wasn't going to be so old by then.
Bryan Barron: I'm happy.
Paula Begoun: It will make Desiree and Bryan happy. I mean, couldn't it be next year? What's happening in this arena?
Dr. Arthur Perry: Well we are getting there.
00:14:08 Let me explain why. There is really a revolution going on in plastic surgery and it is that, I call it the non-invasive revolution. So, let's think back to the things that we can do to surgically make you look younger. Since 1907 we have been doing facelifts. I was in high school at the time so I couldn't do them.
Paula Begoun: Cute. Are you serious, it really goes back that far?
Dr. Arthur Perry: It goes back all the way to 1907.
Paula Begoun: You are saying '07?
00:14:42 So 100 years ago they were cutting and pasting and lifting faces?
Dr. Arthur Perry: That's correct. However, it was done in a kind of early fashion. They took a little snip of skin from in front of the ear and kind of tugged on the skin and that was about it. And every decade after that surgeons became more and more aggressive and more and more daring.
00:15:07 So by the time the 1990s came, we were lifting all the way to the folds by the nose, we were lifting all the way underneath the neck. We were doing facelifts in at least two layers and some people all the way down to the bone. So that is where we are.
00:15:24 Now here we came in I would say about 1997 was the year that Botox really became popular. And of course it was FDA-approved for wrinkles in 2001 and that, Paula, that was the beginning of this revolution. Because Botox, no it is not going to lift the tissues, but what it did was it got surgeons thinking about what else we could do non-invasively. So 1997 was Botox. 2004 was Restylane. Restylane was that first wrinkle filler made of hyaluronic acid which is an important component of the skin. So by 2004 we were filling wrinkles around the mouth.
00:16:07 We were filling the nasal labial folds between the nose and the lips and those wonderfully named Marionette lines – remember Howdy Doody? Did you ever watch that when you were a kid?
Paula Begoun: I absolutely watched that. Was he wrinkled and I missed that?
Dr. Arthur Perry: Well no, what happened was that with the Marionette's, they would make their mouth move by dropping the jaw. So they had a line between the pieces of wood, you know, so that was called the Marionette line.
00:16:37 So we got pretty good at filling those lines with Restylane and then JUVÉDERM came and then one filler after another, RADIESSE was the deep filler. And there are fillers that have been FDA-approved right up to last week; there was a new one called La Vivre which is you own collagen, Paula. You take a little bit of your collagen from behind your ear, send it off to a laboratory in Pennsylvania and they grow it. They actually take the cells in your skin and grow your own collagens. Your surgeon gets syringes sent back to him or her.
00:17:13 And they inject it into you, your own tissue. That was just last week that was FDA-approved.
Paula Begoun: So what is the benefit of using your own collagen versus Restylane, somebody else's or [Rooster's] hyaluronic acid or whatever other kind of fillers that are out there?
Dr. Arthur Perry: The theory, Paula, the theory is that if it is your own tissue it will stay with you longer.
00:17:38 In practice, however, and this is the funny thing about these new multimillion, multibillion dollar markets that are out there, they've got to be better than what is out there in order to really be useful to us and the study on this brand new collagen, the human collagen that is taken from you, is that at six months only about a third of people look better, looked markedly better.
00:18:03 Now I would tell you that with Restylane at six months, probably well over 90% of people look better. So, to answer your question, I'm not sure it is better, but it's new.
Paula Begoun: I got it. New ones are coming out all the time. Oh, I bet it's more expensive.
Dr. Arthur Perry: Oh my goodness, because it involves culturing those cells and sending it back. It is much more complex. So new doesn't necessarily mean better and new also doesn't mean it is going to be a success.
00:18:31 There have been so many products that have come and gone. So, Paula, continuing this story --
Paula Begoun: Wait. Dr. Perry, wait, wait, wait. Because on your website it says, you just mentioned Botox from 1997 when it really started taking off for wrinkles. But on your website, you had a recent appearance on Dr. Oz talking about the dangers of Botox. What dangers of Botox did you talk about on the Dr. Oz show?
Dr. Arthur Perry:; Well there were a few people that died from it last year, Paula.
00:19:08 How is that for a danger? But let me very quickly tell you --
Paula Begoun: Wait, who died from Botox last year? Where did that happen?
Dr. Arthur Perry: Okay, let's not get everybody upset because Botox is one of the safest drugs known. When it is used in the upper half of the face for cosmetic reasons, the problems are very, very few.
00:19:31 When we can get into trouble…where we can get into trouble, rather, is when high doses are used in the neck. And in cases where people have these large muscles that are in constant spasm, they are disease names I won't bore you with, but in these disease situations many, many times the normal cosmetic dose of Botox is used it is injected into the neck and what can happen there is you can have difficulty swallowing.
00:20:00 And if you have difficulty swallowing you might not be able to protect your airway, if you can't cough properly. And the people that died from the Botox did not get it for cosmetic reasons. They got it for really severe medical problems and then they aspirated food into their lungs, got pneumonia and died. So we talked a little bit about that on the show. But we also talked about there is a fraudulent type of Botox that hopefully is no longer out there.
00:20:29 And there were four people that got injected in Florida with this stuff thousands of times the normal dose and they wound up in the intensive care unit. One of those came on the show with us on the Dr. Oz show.
Paula Begoun: That happened a few years ago and didn't the physician who shot it also die? It's like he injected himself? Wasn't that the story?
Dr. Arthur Perry: No one died. It is that story. No one died. The doctor injected himself and his wife and a chiropractor and his wife. And the chiropractor came on the show – I believe it was a chiropractor.
Paula Begoun: He got that out of Mexico, right?
00:21:04 Isn't that part of, something like that?
Dr. Arthur Perry: It actually came from a laboratory in Phoenix that used to send faxes around to plastic surgeons. I used to get them every week. And it said a research-grade Botulinum toxin, that is the official name of it, and they would sell 10,000 units for about $100. Now real Botox costs $525 for 100 units. So I used to get this stuff, these faxes and just throw them out and wonder why my name was on their research list since I don't do basic science research.
00:21:39 But, they knew what they were doing. They were trying to get the doctors that were unscrupulous and several hundred doctors around the country did buy that stuff. No one that I know of died. But there were many doctors around the country. I believe the FBI got involved in it or the federal Department of Health and they went after these sales lists.
00:22:03 The people that went to jail where the people that owned the company. It's a great story. It's going to be a book someday.
Paula Begoun: Wow. All right, so go back. So we have injectables, we have Botox and we have all kinds of laser systems doing all kinds of things like Fraxel and IPLs for red spots and brown spots. Now what?
00:22:29 I'm still sagging and bagging.
Dr. Arthur Perry: Right, exactly. Now here we are in the late 2000s and we had wrinkle fillers, we had wrinkle stoppers, that's Botox. We had all of these peels and lasers that you just talked about that can help the quality of the skin, the color of the skin, the texture of the skin. But we had absolutely nothing that could lift the skin except surgery. A major failure, huge failure, was the thread lift concept.
00:22:58 I think we talked about it last time I was on your show. Thread lifts were those barbed sutures. They failed. They shot up, people used them, they shot down. They are a disaster, absolute disaster. So they are off the market now. So we are still left in a void. Well, last year a new technology came out called High Energy Focused Ultrasound. This is the revolution in cosmetic surgery this year because here is what it does.
00:23:38 It sounds real fancy, right? High Energy Focused Ultrasound. It's actually a very simple concept. Now I will take you back to the 1970s Paula with Ella Fitzgerald.
Paula Begoun: I'm not old enough! Go on.
Dr. Arthur Perry: How come we don't have Ella Fitzgerald music here? Okay, I had to let you guys know in advance, right? Anyway, remember the Memorex commercial from about 1971 or something like that? Ella Fitzgerald sang and broke a glass. Broke a glass and the commercial on television was, "Its it real or is it Memorex?" Do you remember that one now?
Paula Begoun: Okay, I am old enough. I do remember. Go on.
Dr. Arthur Perry: So she broke the glass.
00:24:09 And the truth is, yes, sound energy can actually break glass. And that is true and it was done again four years ago on MythBusters. They actually recreated that. But it has to be leaded glass. But let's get to the point now. So if sound has energy, those scientists at, I believe MIT, figured out how to intensify the sound.
00:24:31 Make it so that you could not hear it. Put it in a frequency that even dogs could not hear. Intensify it and then focus it, like a magnifying glass. Like light can be focused with a magnifying glass. You know, every kid burns leaves with a magnifying glass, right? Well you can do the same thing with sound energy. So now we have this tool that can intensify and focus high energy sound but what does it do? We don't just want to make music for our skin.
00:25:00 It turns out that when we focus that skin down to a very, very, very small area, like a tenth of a millimeter. It will heat up the tissue. And we can focus it underneath the tissue, three millimeters, one and a half millimeters, four – whatever it is, we see with this particular machine how far down we want to go. We focus the energy and we fire the machine and, bang, we create a very small heat injury under the skin.
00:25:28 And you are thinking, why am I creating a heat injury under the skin? We are using the body's ability to respond to injury to our advantage. And that is what all of the technologies like IPL and lasers and Thermage and all of those things that do do something to the skin really work in the end the same way by creating a heat injury to the skin, or the underlying tissue.
Paula Begoun: But the new machine you are talking about, what did you call it again? This ultra – what did you call it?
Dr. Arthur Perry: High Energy Focused Ultrasound. It is called Ulthera.
Paula Begoun: Oh, that's why I am getting this is this new machine, Ulthera.
00:26:09 And you are using it, right? You think this is hot stuff, no pun intended?
Dr. Arthur Perry: Yes. Because for the very first time we can deposit that energy exactly where we want it. So we don't have to burn the skin like a laser. We don't have to heat up the skin like Titan. That is that one that is a great named machine – Titan.
00:26:30 It cooks the skin a bit. We don't have to fry the skin with Thermage – that is random electric currents through the skin. We can actually deposit the sound exactly where we want it. So we are looking at a picture of the skin just like ultrasound looks at babies in the uterus. We are looking at the skin and we are laying the energy exactly where we want it. And what does that do, Paula? When we aim at the muscle it tightens the muscle.
00:26:59 When we aim at fat it destroys fat. It actually destroys fat. I had it done in my neck. You will see me soon and hopefully we will see each other at the Oz show or something and you will look at my neck and you will say, "You lost weight," and I will tell you I gained two pounds. But it looks like I have lost weight because --
Paula Begoun: Wait a second. I'm looking at your picture on on your homepage. And there you are, you little ego cutie you with your picture right there dead center on your page.
00:27:32 And you have got Dr. Oz and Jimmy Fallon a little behind you, not quite so noticeable. And you are telling me you use this Ulthera where on your neck? Because it is a little cute chubby neck there. where did you use – you have to get a new picture now. I want to see this before and after. Where did you use this machine?
Dr. Arthur Perry: On me, on my cheeks once and my neck twice. So that means underneath my chin and I blasted away probably about a third of the fat on my neck and it got rid of my very early jowls that I was just starting to get.
00:28:11 I'm 54 years old. Just starting to get those.
Paula Begoun: Wait a second. Wait a second. So just to back up so I get the picture. This one machine, this Ulthera machine, and Dr. Perry I am going to ask you and I already know the answer because I know you. You don't work for Ulthera; you are not paid to do any studies for them? You are not on their payroll?
Dr. Arthur Perry: Full disclosure is on my radio show they advertised for a couple shows.
00:28:41 They are not advertising now. So I am not on their payroll. They were advertising a couple shows.
Paula Begoun: You know why they are not advertising anymore? Because you just said you blasted your neck with Ulthera and I'll bet you they don't like the association of blasting being used with their treatment. But that's okay.
Dr. Arthur Perry: I'll tell you why they are not advertising, because I talk too much about it favorably.
00:29:08 They don't have to pay me. I should stop.
Paula Begoun: As long as it is the real stuff. So you are saying Ulthera not only tightens. So when you say you can see where you are shooting it, it's like ultrasound where you are looking at a screen and you are seeing, really visually seeing where you are shooting it?
Dr. Arthur Perry: That's correct.
00:29:32 So at the same time that I am firing at the tissue I am looking at a picture of it. So in what we call real-time I am looking right at a cross section. I can see the skin, I can see the fat, I can see the muscle, I can see the bone. And that is why, by the way, surgeons have kind of an easy time with this conceptually and non-surgeons don't. And really for the last 20, 30 years I hate to say, I have been lifting tissue, cutting through it, lifting it, looking at it and working with it.
00:30:05 And now I am sort of doing the same thing looking at that tissue but I am working with it in a different way. So it was actually a surprisingly very quick adjustment for me to be able to be able to do this. But someone like a non-surgeon like a family doctor or even a dermatologist I think would have a little more difficulty with the concepts because they are not used to actually doing the surgery.
Paula Begoun: So this machine breaks up fat cells with the same setting that it tightens muscles and tightens skin?
00:30:42 Is that what you are saying?
Dr. Arthur Perry: Yes, because here I am going to simplify it again. In the end, Paula, this thing is just creating a heat injury. And where I put the heat there are different effects. So if I heat up the skin, it shrinks it. And then the skin lays down collagen over six months. Collagen is a good thing.
00:31:02 Because obviously collagen decreases as we get older. It's one of the problems of aging. So if we lay down new collagen that's a good thing. The laser also does that by the way. But the laser does it by killing off the top layer of skin. No matter how you look at it, it vaporizes it or it drills holes in the skin. That is the Fraxel. In the end it accomplishes kind of the same thing but the downtime is very significant and the complications are much higher with a laser.
00:31:32 So with Ulthera we go right through the skin. We deposit that energy where we want it on the bottom surface of the skin.
Paula Begoun: Just to back up, so you are saying traditionally – I don't know how traditional they are – but lasers like Fraxel or just any laser intense pulse light does some injury on the surface and is less controlled than what you are explaining happens with Ulthera. Is Ulthera cheaper or more expensive than other lasers?
Dr. Arthur Perry: The actually machine costs $95,000.
00:32:12 So it is right in-line with a lot of these lasers. Lasers generally cost --
Paula Begoun: That's your cost. I was talking about what is it going to cost me because I am dying of curiosity to see if I can afford this thing.
Dr. Arthur Perry: Okay. Well I will tell you typical fees and they are going to vary around the country but not as much as other procedures. And the reason is there is a cost per pulse that doctors have to take.
00:32:43 So that means there are 2,000 pulses out of the little cartridge that goes into the machine, kind of like an ink jet printer. And the company charges about $2,000 for that. Actually, somewhere close to that. So it is about a dollar a pulse for the doctor to do it. That limits somewhat the variability in the cost of the procedures. So, to give you an idea, the next is somewhere around $2,000. The cheeks are somewhere around the same.
00:33:11 And usually what happens is that you do more areas of the face, the cost goes down. And so we do the area –
Paula Begoun: So my personal particular bailiwick is under my eye area, can you actually do it under the eye area?
Dr. Arthur Perry: You can. Now, there are different areas – I have been doing it since last November. So here we are, what's that, about 8 months, 9 months or so?
00:33:40 And I've got a fair amount of experience. I have done, I guess, about 70 or 80 patients so far. Something like that. It started catching on around January or so. So, the area that I have found that it works the best – it is very effective at raising the eyebrows. Very effective. So if we do the forehead I can raise your eyebrows about 2 millimeters.
00:34:02 And those of you listening out there might not think that 2 millimeters is a lot, but if you stand in front of your mirror and you take your finger and raise your brow just a little bit it makes a difference. It is not going to make you look like Lt. Uhura. But your face looks better.
Paula Begoun: Right.
Dr. Arthur Perry: Star Trek.
Paula Begoun: Yes, Lt. Uhura, right. I think we got that. So here is the question.
00:34:31 I get this done and procedures like Fraxel and other laser procedures, you have to get them repeatedly. $2,000 for my neck and how knows how much else for my chin and eye area. Do I have to do it again? Is this like those other procedures? Separate from my getting older and I am going to continue sagging because I am getting older, does it require multiple treatments or is one enough?
Dr. Arthur Perry: That is a question that I can answer with a word, "It depends," two words I guess.
00:35:07 Most people will see an effect. Now, it is important that I explain that these effects are subtle. They are not dramatic like a facelift. They are not. I have had some, probably in those 70 or so patients, 75 patients, I have had probably about five people that said, "Wow," and I have had the majority of people say, "Yes, it's better and I can see that and when I compare my pictures it is better."
00:35:35 And I have had a handful of people that said, "Can't tell a thing." That's the honest truth. So there is going to be a range of results. The people that could not tell anything, I do again. And unfortunately because of the way this machine is set up, you can't guarantee a result, so there has to be a fee. I wish it was different but it is a reality of life that the machine costs money to operate.
Paula Begoun: Well of course.
00:36:06 You are not saying that Ulthera…so obviously at this stage because it is not 9 years out and you are prognosticating, you said 9 years out you are going to be out of a job as a plastic surgeon. But you are saying right now that Ulthera is this next level, next tier of fighting wrinkles, sagging actually, specifically sagging without plastic surgery.
00:36:36 Now the way you described what you did to your neck, that sounded pretty wow. I mean that sounded like you lost weight and got a tighter neck and got rid of your jowls and I am on your doorstop and then you said maybe not. So now I am not exactly clear what you are saying, doc. So help me out here.
Dr. Arthur Perry: Let me be clear. So, this is a procedure that some people will get that kind of result. I really did.
00:37:02 And I think I was starting to say where it is more effective and where it is less effective. So where I think it is most effective is getting rid of fat. So, when we --
Paula Begoun: Like a little liposuction without the liposuction?
Dr. Arthur Perry: Yes. That's correct. Again, not as dramatic, but if it is repeated a few times it well could be and save people a surgical procedure.
00:37:32 So fat removal, very good. Lifting brows, very good. Lifting the jowls, very good. Tightening the muscle in the neck, not so good. I wish it was but remember that this is early. This is year one.
Paula Begoun: The first generation.
Dr. Arthur Perry: It really is. And the company is working on all sorts of things. They are working on better things called tranducers that sit on the surface of the skin and do their thing.
00:37:58 And the reason I told you eyelid surgery is going to be extinct soon is because when we use this technology to tighten the skin and destroy the lower eyelid fat, I do think that, not in everybody of course, but in a lot of people who are going to have eyelid surgery, they are going to have this instead and get a very good result. We are getting there. We are getting there. This is the beginning. And it is a revolution in the beginning.
Paula Begoun: Okay, so just a couple of questions and then we need to take some callers, particularly Desiree, Denise from California is asking about lines around the mouth which is absolutely the worst, one of the worst parts of aging other than gray hair.
00:38:45 But so just to go back to the facial thing for a second, when a facialist tells you that the machine they are using has negative ion charge and that is opening pores or something, what the heck is a negative ion and what does that –
00:39:07 I know people talk about that is what rain, and when you are in the rainforest and whatever, that is the smell you get and it makes you feel better. What does it have to do with skincare?
Dr. Arthur Perry: It's called snowing people. It really is.
Paula Begoun: Okay, it is, it's like crazy right?
Dr. Arthur Perry: There is an entity called Iontophoresis and that is what they are talking about. And that is charging molecules to get them to pass through the skin better.
00:39:32 But let me tell you something, Paula. In our day long argument we had about two years ago, we talked about the 500 dolphin rule which is something that people's eyes glaze over.
Paula Begoun: So let's not glaze our audience over, but it is about penetration.
Dr. Arthur Perry: That's right. And it is about the size of a molecule that can get through the skin and there is nothing you can do to defy physics. And that is what it is.
00:40:01 There is just no way to get these large molecules into the skin, period. End of discussion, beginning of fraud.
Paula Begoun: Okay, got it. All right. One other question. So nasal labial folds, the lines on the mouth, that is still injections, right? The Ulthera is not going to do anything about those deep folds, the smile lines from the nose to the mouth?
00:40:33 That is not for Ulthera, right?
Dr. Arthur Perry: In this non-invasive revolution that I am talking about, these technologies work together. So what I do, it is very common now, is that first I do Ulthera on the cheeks, that is that High Energy Focused Ultrasound. And that does smooth somewhat. It is kind of like ironing the skin, by the way. You go over it and you go over it and you actually see wrinkles and folds going away. It's pretty amazing.
00:41:00 Now some come back and some don't. So first I do that and then I fill those with a combination of Restylane and it could be JUVÉDERM. They are basically synonyms now. I use that for the fine wrinkles and I use RADIESSE which is the deep filler, actually made of a bone-like material, for the deep folds.
Paula Begoun: And you are still doing Botox on the forehead?
Dr. Arthur Perry: On the upper half of the face, that's right. We don't want to inject gels around the eyes because they can cause blindness even though it is popular now. I like to be careful.
Paula Begoun: Doctors are doing that all over the place.
00:41:41 What is that about?
Dr. Arthur Perry: Well it is easy and dangerous. Easy and dangerous. There is no good study since 2004 on blindness but in 2004 I believe it was, there was a publication that came out that showed about four dozen cases of blindness injecting around the eyes.
00:42:01 Those years, 2004 there were 30,000 injections a year on the face, there is 1.6 million now. So it only makes sense to me that people are going blind. They have to be. They have to be. And again, I'm not going to bore people why it is different around the eyes but the blood vessels are different. And it can be permanent and irreversible and I can't say it enough. You know it is compelling to do because it is very easy and, yeah, you get away with it 99.999% of the time.
00:42:32 But whenever you say that word in medicine, "get away with something," I get worried. Because we don't want to get away with it. We want to do something that is uniformly safe.
Paula Begoun: So one other question that I think I just forgot as I was about to say one other question. There is always so much to ask you. We are talking to Dr. Arthur Perry, author of "Straight Talk about Cosmetic Surgery." He also has his own radio show with Dr. Roizen. And you can find out all about him on his website which is
00:43:11 And let's talk to Denise about lines around the mouth. Denise, are you there?
Denise: Yes, I am Paula. Hi. Thank you for taking my call. I love your products, by the way.
Paula Begoun: Thank you. Of course I just hate hearing that but thank you anyway.
Denise: Okay. I have lines around the mouth and, of course, you know the upper lip.
00:43:38 And I went to my dermatologist and he wanted to put Botox in my upper lip. What do you think about that?
Paula Begoun: Botox around the lips like a la Nicole Kidman who can't smile. Is that what happens --
Dr. Arthur Perry: Let me tell you about – go ahead, Paula, it's your show!
Paula Begoun: No, whenever I think about the Botox thing around the mouth I think about the number of actresses who literally can't lift up their lip – their smile is a straight flat smile because form my perspective they have clearly been Botoxed around the mouth.
00:44:20 Now they don't have lines anywhere and they don't have…Denise, do you notice sometimes when you do that purse thing with your lips you get those deep lines? You know you purse and you get those deep lines around the mouth?
Denise: Yes.
Paula Begoun: That's obnoxious and we have that.
00:44:36 But I assume that when those go away that is because these celebrities have had Botox around the mouth. But, Doc, you take this question. I'm just carrying on.
Dr. Arthur Perry: I think Botox around the mouth is terrible. I will tell you why. There are 23 muscles around the mouth. 23. And they all contribute to the smile.
00:44:58 In order to do Botox right, you have to knock out some of those muscles, leave some of the muscles, get the Botox in exactly the same location on both sides of the mouth so that there is symmetry, not knock out the good functions of the lips like chewing, speaking, like grasping a straw. But yet knock out the bad functions which are contracting and causing those wrinkles. If you think about what I just said, it is impossible. It's impossible.
00:45:30 And I have actually had patients come in and say, I will do it anyway. I don't care if I drool or lisp.
Paula Begoun: And then you send them to someone else.
Dr. Arthur Perry: It's absolutely crazy. So, the answer --
Paula Begoun: I got to tell you, Doc, I actually know a dermatologist…now I didn't get this straight from the dermatologist but pretty much I was 100% clear that that doctor injected lips, their own lips, and as a result literally was crooked.
00:46:02 It was almost like they were talking on an angle. It flipped me out. And you would think that I am pretty ballsy and I would say, "So did you just inject your lips wrong?" but I didn't have the guts to say anything. It was driving me crazy. So, Dr. Perry, would you tell Denise not to do that? Tell Denise to not do that to her lips?
Dr. Arthur Perry: You know Restylane or JUVÉDERM works so well, so well around the lips. I mean really well. But in order to do it well, the doctor has to take a lot of time. So if you go in for a 15-minute visit, you are not going to get a good job.
00:46:41 And that is when you are going to look like all of those ladies on TV that look like they have had pieces of salami stuffed into their lips. That is not good. You don't want that. What you want – go ahead.
Paula Begoun: Go on, Doctor. No, I am interrupting, so go on Doctor, I'm sorry.
Dr. Arthur Perry: It's your show again. Come on now!
Paula Begoun: I know it is. But they are tired of listening to me; they want to hear you.
Dr. Arthur Perry: All right. Well here is how it is done well.
00:47:09 First of all you have to be numbed up. If you are uncomfortable during the procedure the doctor is going to get these signals and he will rush or she will rush. The way you get numbed up is inside the mouth like a dentist does. There are four nerves in the cheeks and the chin. Get those numb and it will be just a completely painless experience.
00:47:32 It takes at least an hour to do this right. We inject the little wrinkles around the lips. Inject the nasal labial folds and the Marionette lines. And very importantly the white roll around the lips. Now those of you who are listening who are under 30, take your hands and run your finger over you lip and you will feel a little tiny ridge. And if you are about over, certainly over 50, you won't feel a ridge. Somewhere in between 30 and 50 that goes away. That white roll – that's why people get lipstick bleed, right Paula?
Paula Begoun: That is why people get lipstick bleed.
00:48:10 Their own lip pencil line has gone away.
Dr. Arthur Perry: That's right. So we restore that with a Restylane or the JUVÉDERM. We restore it. It's got to be done very subtly, very carefully, otherwise you will look like a [unintelligible]
Paula Begoun: So Dr. Perry, Denise's dermatologist – is Botox kind of an easy way out? Is that the idea? Because obviously Botox doesn't take an hour and most likely, given I have read about how these procedures are done and I know doctors who have done it.
00:48:48 It's four injections in 3.5 seconds. So it must be a time/money balance thing? What is that?
Dr. Arthur Perry: May be. It is hard to know. Or it could be an artistry issue. It actually takes a fair amount of artistry on the doctor's part to do injectables correctly.
00:49:08 You know Botox there is artistry, too. But Restylane and JUVÉDERM, there is a tremendous amount of artistry. That is why there are so many bad jobs running around. You have to look at just this month's Star Magazine which I don't read, but somehow I did, and you look at all of the terrible jobs.
00:49:29 And all of the bad plastic surgery and the bad injectables. And you say, well these are probably good doctors. But just because you are a good doctor doesn't mean you are a good artist. And it does take artistry. I have always said, there are two things that you can't teach a doctor. You can't teach him ethics because their mother and father have to do that. And you can't teach them artistry because that is an innate trait. I mean to a certain extent you can learn, but if you are a klutz, you can't do it.
Paula Begoun: So Dr. Perry, as somebody who has…Denise I have had my lips injected and I have to tell you, it was a scary thing to do. Somehow all I can see in my mind's eye is Pamela Anderson's or Cher's lips or just blown up in front of my face.
00:50:21 And actually I did leave all swollen. I thought, oh my god, my lips are taking over my face. But I actually am thinking I need to get it done again because my lines are showing up even more so. So I am going through exactly the same thing you are. And I strongly agree with Dr. Perry. I think Botox around the mouth is a huge mistake. A doctor simply cannot get it right. It is a shot in the dark. So, Denise, having said that. I need to send you…you have been such a trooper to talk about the lines around your mouth.
00:50:58 I have a couple of new products to send you, is that okay?
Denise: Oh yes, it is wonderful.
Dr. Arthur Perry: You will get some Botox.
Paula Begoun: You are such a trouble maker! I will send you my new Clear Skin Hydrator. And I will also send you…I'm blanking out right now. Oh my god. I can't remember the product I just wanted to send you. Where is my brain today? Oh, I know, it is still in Disneyland.
00:51:26 I will send you my Resist Antioxidant Serum and get you going on those if you don't already have them. Is that okay, Denise?
Denise: Yeah that's wonderful. And I did want to ask real quick, what if you use Retin-A around the mouth and stuff. Would that help a little bit?
Dr. Arthur Perry: It helps, but not quite as much as you would want. The studies actually show that only 21% of people, only 21% of people look in the mirror at a year and say that the wrinkles are better with Retin-A.
00:52:04 Now scientists and doctors with sophisticated machines will measure an improvement in everybody but that is not the test that counts – you know what it is – it is looking in the mirror. That's what counts.
Paula Begoun: What Retin-A does, forgive me Doc for jumping in. Denise, what makes Retin-A or Renova or any retinoid work considering we all want these products that will erase our wrinkles but these topical creams, even the medical ones like retinoids or my products or anyone's products is that they improve skin texture, they improve the way skin exfoliates.
00:52:39 They help skin function normally but those wrinkles that have come about because of muscle usage or because of collagen breakdown or elastin breakdown or just having more skin. Having skin sagging just because of gravity. It is just very – because I don't want to discourage using Retin-A or Renova because the good things they can do for skin cells, it just isn't the anti-wrinkle answer that replaces some of the stuff Dr. Perry is talking about.
00:53:13 But, yes, Retin-A or Renova is an option for skincare, no question. What Dr. Perry is saying is that the research is pretty clear that it isn't a wrinkle eraser. That is just not easy to come by. Now I have to say that I have been using…I started just recently using my own BHA product. I have a 2% BHA product and, Doc, sit down and try not to gulp.
00:53:40 I'm actually working on a 9% BHA product. And I have been using that around the lines around my mouth and I figure in another couple of shows, two months from now or so I will let you guys know if I think that it is helping at all. Right now it is looking good. I wouldn't say that my lipstick stopped bleeding but I will let you know if it is helping at all.
00:54:02 Denise, thanks for calling. Take care. Doc, I have to say goodbye. But I know that I need you. It's very sad that I can't just be Dr. Oz and you do Ulthera and all kinds of other things on my face right there on TV. Does Dr. Oz want you to do on him this stuff?
Dr. Arthur Perry: I have only lasered him and, of course, the sex change. But we can't talk about that on the radio. Oh, I'm off the show.
Paula Begoun: I don't even have a good comeback for that one but I'm sure he was thrilled with your work or she, depending on what you did.
00:54:47 So, Dr. Perry is absolutely one of the most informed and talk about straight talker about cosmetic surgery which is the name of his book. He is also just a straight talker about anything dealing with skincare, with ethics around dermatology and plastic surgery, what works, what doesn't.
00:55:08 His website is fascinating not to mention his cute little face right there in the center. See his books. Read about what he does, what he has done on the Dr. Oz show and other…Good Morning America. He is a media darling and just an all around good guy with the strangest sense of humor on the planet. Dr. Perry, thank you for taking the time this evening.
Dr. Arthur Perry: Paula, thanks so much.
00:55:42 Have a great week. And we will talk again.
Paula Begoun: We will talk again. Take care dear. So, wow, can you believe how much we have learned. Ulthera. Now I just need to jump in and do it. So, Bryan and Desiree, I didn't tell you that I was using the 9% BHA we are working on around the lines around my mouth. That was another secret I wasn't going to tell anybody that I just told everybody.
Bryan Barron: Well we will see what happens. According to some of our Paula's Choice customer service staff, they are getting phone calls daily asking when this BHA 9% is going to be available.
Paula Begoun: I do. I have created a…it is going to be a killer product.
00:56:40 I am hyper, but then I am hyper-focused about all of our BHA products. You know it's funny, talking to Dr. Perry about fighting wrinkles and what you can do with machines and Botox and Ulthera, the machine he feels strongly about and dermal fillers.
00:57:00 In terms of real before and afters when it comes to skincare, I'm a strong believer that alpha hydroxy acids and beta hydroxy acids when they are well formulated overnight you wake up and your skin is different. It just is. I mean I am not going to go into a discussion right now about why that happens, but absolutely it is one of the before and after kind of experiences when you do it right and you are not irritating your skin, you are not getting sunburned like I did.
00:57:29 So, separate from all of that, the takeaways for the show and what I want women to know is that it is a multi-fold approach to deal with getting older – sagging bagging skin, under eye bags. There isn't one way to go about it. We talk a lot about how to do it with skincare. We have talked about that on the show. I do feel strongly about alpha hydroxy acids and beta hydroxy acids. But it is a combination about what a great plastic surgeon or dermatologist can do and what you do with great skincare products.
00:58:03 Of course I prefer that you are using Paula's Choice and you can always visit me at But mostly it is about getting brilliant products, not overspending so you save up and can do some of these procedures that make the most incredible difference when combined with great skincare. Next week we are going to be back and we are going to be talking about how to tell if a product is working. We get that question a lot.
00:58:35 We have a caller, I know we didn't get to a lot of calls this week, but I promise I will get to all of your calls – well not all of your calls – but a lot more calls next week. But we get a lot of questions, a lovely woman who is calling saying I am using some of your products and I still have wrinkles, what is going wrong? We are going to talk about what to expect, how do you know when a product is or isn't working.
00:58:55 On the 11th we are going to be talking to Dr. Nase. Dr. Nase is a Rosacea specialist. That is a skin disorder with red flushing and you can get little pimples and bumps. He is brilliant, he is wonderful. He will help you solve some of your concerns around Rosacea. On the 18th we are going to talk about seven hair care secrets you need to know to have beautiful young hair. And on the 25th we are going to be talking with Dr. Leslie Baumann about looking younger without surgery.
00:59:26 Get her take on the issue of combining great skincare with plastic surgery or dermatologic – sorry, not using surgery but using other kinds of dermatologic procedures. I'm Paula Begoun, the Cosmetics Cop. Thanks to Dr. Perry this evening. Thanks to Desiree Stordahl, my assistant and producer. Bryan Barron, my coauthor and co-writer. And for everyone listening, we will talk to you next week. Come visit me at Take care.
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