What it's Really Like to Get Botox, Dermal Fillers, and Cosmetic Surgery

Airdate: 11/15/2013

Paula spills the beans on her experiences getting Botox, dermal fillers, and a lower face-lift! Hear what it's really like to be injected, what recovery can be like, how results may vary, and how the anti-aging isn't just about brilliant skin care—it's also about choosing the cosmetic corrective procedures that are right for you. Also, once and for all, find out when you should begin using anti-aging products.

Paula Begoun: Hello. I'm Paula Begoun, the Cosmetics Cop, here with my Co-writer and Research Director, Bryan Barron. We've been writing books for a very long time. We are the best-selling authors -- we are best -- isn't it great? Don't you love saying best-selling author?
Bryan Barron: I usually don't because I always tend to downplay what I do. And I don't know why that is. Well, I know you understand that --
Paula Begoun: You mean you don't tell people you're a best-selling author?
Bryan Barron: Rarely. No. No.
Paula Begoun: Well, first, let me tell everybody what we're best-selling authors --
Bryan Barron: I should.
00:00:28 My husband does. Ben will always step in and say, “He wrote a book. He wrote a big book!”
Paula Begoun: Ha! A really big book. Not to mention Beautypedia where thousands of reviews that you are in charge of, your team, updating. But let me just, I went off on a tangent. Bryan and I are best-selling authors of “Don't Go to the Cosmetics Counter Without Me,” which is currently in its ninth edition. And, of course, the living site where the book and updates from all of our work lives is on PaulasChoice.com which would link over to Beautypedia.
00:01:07 We're here keeping you beautifully informed so you can make the best decisions about everything from skincare, to makeup, hair care, cosmetic surgery, Botox. You name it and we'll discuss it. Wasting money isn't pretty. We like telling you the truth and you can make the best decisions for yourself. Come visit us at PaulasChoice.com or our Facebook page.
00:01:27 And today, today we're going to be talking -- it's about me today. Unfortunately it often gets to be about me, which I regret.
Bryan Barron: But it's about you to the benefit of others.
Paula Begoun: Oh, he's so nice. You're so nice. You're making my ego not so terrible.
Bryan Barron: We're going to talk, Paula is going to dish on what you can really expect from all types of cosmetic corrective procedures, some of which she's been through personally and she'll tell you. This is a no-holds barred show.
Paula Begoun: Yes.
Bryan Barron: And then some of which she's considered and maybe you can go into a little bit about why you kind of waited or backed out of going with a particular procedure.
Paula Begoun: Right.
00:02:05 Yeah, everything. And I am going to tell the truth. Well, some of it is I don't know how not to.
Bryan Barron: And that's gotten you in trouble in the past.
Paula Begoun: It has. It will get me in trouble again. But let's just go back to being best-selling authors because Ben, your adorable husband, is right. We are best-selling authors and that's a very important thing to mention because I've been a writer a very long time. I've been writing since the late seventies.
00:02:35 The notion that people read what we write and keep reading is a very big deal as an author and a writer because it's one thing to write and nobody reads it. It's another thing to write and people -- millions of people all over the world look to what we have to say. And hopefully part of why we're best-selling authors is because we write in a way that makes it easy for people to understand.
00:03:00 And particularly in the world of skincare, because we site all our research. I can't imagine my life without Bryan, creating what we create. And that a lot of women, like it is not only an ego rush but a testimony to your work. So, yes, best-selling author, “Don't Go to the Cosmetics Counter Without Me,” in its ninth edition. And, of course, all of our content on CosmeticsCop.com and Beautypedia.
Bryan Barron: Tons and tons of content.
Paula Begoun: So, before I talk about lifting, pulling, tucking, lasering, filling, all that other stuff, I have to mention a new product launch from Clinique. Their Dramatically Different Moisturizing Lotion Plus. And, so, you know, the longtime Clinique Three-Step Program was their yellow Dramatically Different Moisturizing Lotion.
00:04:01 Their toner with way too much alcohol, and they still contain alcohol.
Bryan Barron: Yes they do. Except for the mild formula, but yeah, all the main ones. And their best seller, which is Clarifying Lotion 2, is probably the most irritating. Because it has supposedly less alcohol than their 3 and 4 Clarifying Lotions, which are for oily and super oily skin. And alcohol is definitely going to degrease your skin.
00:04:28 But the Clarifying Lotion 2 also adds menthol to the mix and a fair amount of witch hazel, so it's kind of that triple whammy of irritation.
Paula Begoun: And just to be clear, alcohol degreases. It also causes free radical damage. It also increases oil production because of irritation and nerve endings in the base of the pore that trigger hormones that make oil production more. The -- oh, and the Three-Step Program used to include soap. Do they still have their bar soap? I haven't noticed that in a --
Bryan Barron: They do.
00:05:01 But in recent ads I've seen for the first time in years that they're replacing that hard bar of soap, which is literally lard and wax, with their water soluble liquid facial soaps.
Paula Begoun: Ooh!
Bryan Barron: Which are a more modern cleanser. The type of cleanser that the other Estée Lauder owned companies, of which Clinique is one, have been selling for years.
Paula Begoun: It's actually hard to find soap at cosmetic counters anymore. It's almost -- I think Clinique's diehard customers just can't let it go. It's just what they know and --
Bryan Barron: It's Clinique and then the lesser known brand, Erno Laszlo, still touts their famous soap and his routine of the hot water and the splashing.
Paula Begoun: Do they still do that?
00:05:40 And the cider apple vinegar? The pH thing?
Bryan Barron: I don't know about the cider vinegar type, that step, but it's still all about hot water, cold water, soap.
Paula Begoun: So, just to back up. Oh, we have so many things. All right, I just want to mention something about the Laszlo thing in a minute, but let me finish about the Dramatically Different Moisturizing Lotion. So, separate from the fact that bar soap is bad and the ingredients that keep bar soap in its bar form can clog pores.
00:06:09 It's drying and irritating. As a cleanser irritation is bad. The research about that is clear, same thing with their toner. Irritation is bad. There is no research saying that irritation is good. But their Dramatically Different Moisturizing Lotion, which the original is yellow because of synthetic yellow dye ingredients, they are actually promoting that as “Yellow Genius.”
00:06:37 They have actually taken those synthetic, not great ingredients, and showcasing as if it's good for skin. I thought I would fall off my chair when I saw that they were somehow spinning it that their yellow ingredients were somehow good for skin.
00:07:00 It is yellow insanity. It is yellow ridiculous. Oh, and they've created a nail polish!
Bryan Barron: Yeah, that's what really got us going is that we saw they took an artificial, really not great for skin, but --
Paula Begoun: Not horrendous for skin, but not beneficial for skin.
Bryan Barron: And that kind of assumes that women have been coming to the counter for years saying, “Gosh, I really love the color of this moisturizer. Could you do that for nail polish?”
Paula Begoun: Ha!
Bryan Barron: Because they did!
Paula Begoun: But it is a great -- talk about an incredible way for making it so that you're promoting two things and bringing attention. I mean, it's marketing genius.
Bryan Barron: Yeah.
Paula Begoun: But it isn't great skincare. Clinique Dramatically Different Moisturizing Lotion Plus is water, mineral oil, glycerin, Vaseline, thickening agents, lanolin alcohol.
00:08:00 It isn't that different from their original except this one does contain a high amount of urea, that would give it some amount of exfoliating benefit. But in terms of many, many other Clinique products or Lauder products, Clinique is a Lauder owned company, this is one that you absolutely need to leave on the shelf. It is dramatically not different from their original. It is dramatically not the best for skin.
00:08:26 So many better products out there. So many better. This is kind of like using a typewriter. Maybe it's kind of like using a pencil that isn't sharpened instead of your computer. And if you do feel a need to do this Dramatically Different thing, the Dramatically Different Gel that Clinique made a few years back is in that group of products is actually far better. It isn't “yellow genius.” It's jaundiced. It's just yellow bad news for skin.
00:08:56 Back to the Laszlo thing, the Erno Laszlo thing. So, Erno Laszlo long since passed away. Was an Eastern European physician who said the things skin needed was to be really clean. And what got skin really clean was this lava-based harsh soap, extremely hot water, and just scrubbing, and building up a layer of the soap so you didn't actually rinse the soap off the face. You were in a basin of water with the soap.
Bryan Barron: Yes.
Paula Begoun: So the makeup and yuck from your face and the soap scum, you were splashing that with hot water, as hot as your hands can tolerate, back on the face. I have no words to describe how bad that is for skin. The research is clear that that's bad for skin. Irritating. Hot water burning the skin. Surface capillaries. Damaged skin surface. On and on.
00:09:52 And then they adapted it -- do you know who owns Laszlo now? Who owns Laszlo? It was sold many years ago.
Bryan Barron: It's a private equity firm that unless you're in the financial sector…
Paula Begoun: World, you wouldn't know who.
Bryan Barron: or knee deep you wouldn't know.
Paula Begoun: Because I think maybe Colgate bought it and then they sold it. Something like that.
Bryan Barron: Chesebrough-Pond's owned it. It had multiple, multiple owners. But, to their credit, they were one of the first skincare lines, and definitely ahead of their time, that made a name for itself not only because of this Hungarian doctor, but also because this doctor had celebrity clients.
00:10:26 You know, supposedly Greta Garbo used this skincare. Joan Crawford. Audrey Hepburn. All of these gorgeous Hollywood divas, these starlets.
Paula Begoun: Right.
Bryan Barron: You know, women see Audrey Hepburn on screen and think, you know, how do I look like that?
Paula Begoun: And it must be because she's splashing her face with 120 plus temperature water and lava bar soaps. So, oh gosh, there's so much to talk about.
Bryan Barron: What to expect.
Paula Begoun: What?
Bryan Barron: What to expect from cosmetic procedure. Where do you want to start?
Paula Begoun: Oh, what to expect from cosmetic procedures.
Bryan Barron: Do you want to start at the forehead and work down?
Paula Begoun: Ha!
00:11:03 So, first, what I'd like to say is the way I have approached cosmetic corrective procedures over the years, and I got my first Botox injection when I was 49? I think I was 48, 49?
Bryan Barron: Yeah. That sounds about right.
Paula Begoun: Something like that. And that was accidental. I actually wasn't --
Bryan Barron: What, did you fall on the needle?
Paula Begoun: Ha!
00:11:29 I was consulting for a dermatologist in Florida, a very well known dermatologist who I actually respected his work, Dr. Mark Nestor, and he said, “I think you should, you know, sit down and let me show you.” And he also zapped some brown spots at the same time. That was completely accidental. I actually wasn't even thinking about it.
00:11:57 So, I kind of happened into it rather accidentally when Dr. Nestor, a Miami-based dermatologist injected my forehead. And literally in, I don't know, 48 hours, I had a smooth forehead. I remember being stunned. I came back to the office and nobody noticed. I couldn't believe nobody noticed. I thought I had made the most incredible change in my face and nobody noticed. And I finally said, “I've had Botox.”
00:12:28 And everybody is looking at me going, “You've had Botox? Where? What? What can't you do?” And I started trying to show people, look, I can't frown, I can't lift my eyebrows.
Bryan Barron: Yeah.
Paula Begoun: And everyone is going, “Ooh! Ooh!” And nobody really noticed. Botox was still new. Not everyone knew what a Botoxed looking face looked like. He didn't freeze my face. I didn't have it all over.
Bryan Barron: No, I think that was part of the issue is that we kind of had this preconceived notion that Botox was going to make somebody expressionless.
Paula Begoun: Right.
Bryan Barron: You wouldn't have your wrinkles anymore, but you wouldn't be able to do much else.
Paula Begoun: You wouldn't be able to do much else.
Bryan Barron: And you could.
00:13:05 I mean, you were a living, breathing example that you can get that nice, smooth look on the forehead but still look surprised and still smile.
Paula Begoun: Have expression. Right. And have expression. But what happened ironically in trying to show everybody what I couldn't do with my forehead and frowning is I started getting headaches.
00:13:29 And I didn't realize at the time, and I remember calling Dr. Nestor and saying, “I'm getting headaches. Are you supposed to get headaches with Botox?” And he said, no, just the opposite. If anything there's actual research showing it gets rid of headaches.
Bryan Barron: Bad headaches. Migraine headaches.
Paula Begoun: And then I realized that what was happening is I was trying to make muscles in my forehead work that couldn't work anymore. And that strain, because there are other little muscles that it didn't get, and the strain of making those muscles do what it really couldn't do was giving me a headache. So, I stopped showing people what Botox did for my face.
00:14:12 So, that was the first time. And also he zapped some brown spots on the back of my hands. It's actually the only time I've ever had the back of my hands zapped. And because I'm also very diligent about using sunscreen, those brown spots actually have never really come back.
Bryan Barron: Yeah. Your hands, I remember -- Paula has been neurotic about her hands since I've known her.
Paula Begoun: I am neurotic.
Bryan Barron: Very neurotic about keeping them looking young. And I know you struggle with the fact that the skin on your hands, first of all, the skin on anyone's hands is thinner period. But your hand skin is thinner due to years of cortisone use because of your eczema.
Paula Begoun: Right.
00:14:54 Years and years. You're talking almost 25 years.
Bryan Barron: There in terms of the sun damage potentially being even worse. And the top of your hands look roughly the same as when I first met you, maybe even better.
Paula Begoun: Right. Well, definitely right because I'm so, now I'm even more neurotic about sun damage than ever before. But once I got those brown spots zapped, and then was just, I mean, I always am putting titanium dioxide or zinc oxide based sunscreen on my hands.
00:15:24 I've been using Paula's Choice sunscreen products ever since I made them. I actually in terms of cosmetic corrective procedures, because the skin on the back of my hand is so thin from all of those years of using cortisone cream, one of the negative side effects of using cortisone cream is that it does thin skin. And I definitely have thinned, back of my hands -- that part of my hands where the veins are showing and the skin is very thin.
Bryan Barron: Right.
Paula Begoun: Does make it look older.
00:15:57 I am actually to get dermal fillers in the back of my hand to plump them up so you don't quite see the veining the way you do.
Bryan Barron: Cool.
Paula Begoun: So, I'll probably do that the middle of, later this year, in December.
Bryan Barron: Now, we have an article about aging hands and the options to make them look better in the Expert Advice section of CosmeticsCop.com.
Paula Begoun: Did we write about injections? I can't remember now.
Bryan Barron: Yes we did.
Paula Begoun: And what did I say? Which one should I get? I don't even remember what we wrote.
Bryan Barron: I would have to consult the article to be sure.
Paula Begoun: Sculptra? Was it Sculptra maybe?
Bryan Barron: Sculptra is one.
00:16:30 You could also use one of the forms of Juvederm which is a hyaluronic acid based filler. Just really quick to backtrack on the hydrocortisone comment, thinning skin, I wanted to make it very clear that hydrocortisone definitely has its place. It is thinning skin occurs after long-term consistent use, which can be three months or more of putting it on every single day.
Paula Begoun: Oh, even longer. It really takes -- it's not a short-term thing.
00:17:00 In other words, people often say to me, “Well, I don't want to use cortisone, it will thin my skin.” And I'm thinking, you're suffering, the damage to my skin to have sores and itching would be just as damning if not worse because of the risk of infection.
Bryan Barron: Right.
Paula Begoun: Than whatever thinning could come. There was no way I could have survived the itch and pain of the eczema I had, the blistering, the swelling, if I hadn't used cortisone cream.
00:17:29 I don't regret a moment of having used cortisone cream, because the rash, and the itching, and the cuts into skin that occur from having eczema, from having rashes, is as -- well, actually again, because of the infection issue, can actually be worse than what the cortisone cream --
Bryan Barron: Especially on hands that are always exposed.
Paula Begoun: I think if I had known, because this is so many years ago. I had eczema when I was a kid. What I know now is that what I would have done is I would have treated my skin differently. I would have not been using bar soap.
00:18:03 I would have not been using hot water. I would have been much more gentle with gentle cleansers. I would have been smarter with the kind of moisturizers that contain barrier repairing ingredients because the research shows that eczema skin lacks some of those healthy ingredients like ceramides and hyaluronic acids and etc that can build up the skin. I would have treated my skin differently. And then on top of that, rather than slathering on cortisone twice a day, I would have used cortisone more intermittently. I would have kept it under control.
Bryan Barron: Yeah.
Paula Begoun: And waited until I got a small flare up and used it again, as opposed to just using it every day.
00:18:43 But part of it I was also inflaming my hands every day so my skincare couldn't actually keep up with my rash. But I would have done it differently now because the intermittent use of cortisone is actually far better for the health of skin. But that's a bit of a departure. I'll have to read my article on PaulasChoice.com about having younger hands, because I can't remember now.
00:19:08 I've been looking at Sculptra and some of the hyaluronic acid fillers, I can't quite remember what we wrote, but definitely the approach I've taken once I did have Botox the first time was I wanted to address two major things. I knew what skincare products can give to skin in terms of antioxidants and AHAs and sunscreens.
00:19:34 And then there were the things that cosmetic dermatologic procedures provide that skincare products cannot provide. There are no skincare products that replace Botox, dermal fillers, plastic surgery, or even come close. The money you're going to waste on skincare products hoping they will put it in the bank and then in five, ten years it will be there in spades.
00:19:57 So, what I decided to do was to approach it systematically in terms of what would keep the skin younger as I went along that was the least invasive. And then proceed to more invasive as I got older, particularly when I made the decision to have a lower facelift, deeper peels as my skin was getting older. Because what happens, ladies, men, everybody, is you get older. The one thing skincare and even plastic surgery, or fillers, or Botox can't change is tomorrow you will be older and the day after that, god willing, you will be older again.
00:20:39 So, I went about it with that kind of approach, least invasive as I was younger to move invasive, more invasive as I've gotten older. The major thing people said to me along the way is you don't need, you know, “Why are you doing these things? You don't old.” And I know Bryan has heard me say this before --
Bryan Barron: It is so worth repeating though.
00:21:05 Because we get this every single day.
Paula Begoun: Really?
Bryan Barron: Oh yeah. Oh yeah.
Paula Begoun: Women ask all the time?
Bryan Barron: Yes.
Paula Begoun: “Why should I get it? I don't look older. Why is my friend getting it, she doesn't look old?” Really?
Bryan Barron: And what do you say?
Paula Begoun: It isn't about looking old.
00:21:20 I don't want to wait until somebody says, “Boy, your chin is hanging down on your neck. I think you should lift that thing up. Or your eye is sagging. I can't see the back corner of your eye anymore. Cut that thing off. Or your skin is all brown and patchy. I think you should get those brown age spots that make you look like you're 90, I think you should get those removed.” The longer you wait the harder it is to make skin look better without doing something dramatic that actually will be more noticeable.
00:21:55 It is the small steps to the better steps that make you look younger longer and also don't go day after night so that you don't look so dramatically different or the procedures are so deep you get that waxen fake look on your face.
Bryan Barron: Yeah. So, along the same line of that question of, “Well, you don't need to do this now, you don't look old yet,” in that same vein we get questions from women all over the world saying they want to know at what age should they start using anti-aging skincare.
00:22:29 And there's this real trepidation, and it usually comes from women in their mid to late 20s, they're seeing fine lines, they're seeing the first signs of sun damage from their teen years if they tanned. And they're really, really nervous because they think that if they start using anti-aging products, the big guns now, that when they really need it later it won't work.
Paula Begoun: That it won't work anymore. What is that about? I've heard that, too, over the years. So, what I say all the time is that you can never be too young using anti-aging products.
00:23:03 From the moment we're born you're a day older. You're old already. You come out of the womb and you're older and you're going to be older as every day passes. The ingredients that keep skin young, particularly sun protection, you never adapt to. You never adapt to. Along the way you just need more of it, but when you give your skin great sun protection, gentle sun protection, and you give it these great skin repairing antioxidants, etc, etc, those wonderful ingredients, it just helps protect your skin.
00:23:42 It would be like saying when should I start eating broccoli, when should I start eating spinach, when should I start eating, you know, fish with omega-3, omega-6 fatty acids. When should I start eating whole grains? Today! As soon as your digestive system will allow you to eat them, you start eating healthy the moment you're born, and along the way you add the things that your digestive system can take.
00:23:04 You do the same thing for your skin. The thing that makes your skin healthy today makes it healthy later and reduces what the sun and pollution and environmental damage, the more you give your skin what it needs to protect itself. You can't start using it too young. All of the products you should be using, almost from your youth, should contain these healthy ingredients, just like eating a healthy diet. It isn't different. Skin is an organ. It's a great big organ, and it needs those same wonderful ingredients.
00:24:40 There isn't a secret anti-aging ingredient. What products might have along the way are higher concentrations, they might have retinol, but even retinol can work for young skin, particularly because retinol is vitamin A, because of what it does for the size of a pore, or acne, or blemishes. I can't think of an ingredient, an anti-aging ingredient, maybe hydroquinone, maybe skin lightening is something you would want to wait until you have brown discolorations. It really isn't preventative.
00:25:11 I don't think you'd want to use that young. But in terms of wrinkles, and dry skin, and improving pore size, and blemishes, and fighting sun damage, and pollution and environmental damage, assuming the ingredients are great ingredients, I can't imagine what it would be that you wouldn't want to be using on your face from relatively young to older. But, yeah, the cosmetic industry leads us to believe that there is some miracle ingredient that at the age of 50 is going to turn it all around and that actually isn't how skincare works at all.
Bryan Barron: Right.
00:25:44 Or the whole arbitrary age where if you are age 49 and you're two days away from your 50th birthday you still don't have mature skin. But when you're in your 50s, all of a sudden your skin is mature.
Paula Begoun: And you've got to change what you do.
Bryan Barron: And you have to change every product and start using products for dry skin, even though as you enter your 50s, especially if you're starting to go through menopause, you may find that you're breaking out like no one's business, and your skin is actually getting oilier, not drier.
Paula Begoun: Exactly.
00:26:12 You know, I think the fashion magazines have really been a proponent of encouraging people to believe that skincare, your age, what you do in your 20s, 30s, 40s, 50s, 60s somehow differs. And, again, I'll go back to diet. There is no diet at the age of 20, 30, 40, 50, 60, and all of a sudden somehow skincare, again, which is just the largest organ of the human body, somehow differs decade to decade to decade. It does not.
00:26:44 Your need for sun protection doesn't differ at 20 as it does at 70. Your need for antioxidants doesn't differ at 20. I mean, I could go on and on. So, having said that, in terms of cosmetic corrective procedures, one of the things that people ask me all the time is they worry that the second they start seeing lines on their forehead should they get Botox.
00:27:08 So, that's a personal decision. I think getting, and lord knows I have my high maintenance side of me, and my age panic issues, but when you're young and you start seeing the first signs of lines and get panicky and want to make them go away, you know, unless you're making your money being a high end runway model, or you're a celebrity, I think that overdoes it.
00:27:38 I think that's an unnecessary expense. There is no research showing that Botox actually prevents wrinkles, that if you start using it in your 20s and your 40s you won't have wrinkles. Now, what we do know is that long-term use of Botox doesn't seem to be a problem. Botox has been around for 60 years. Yeah, at least 60 years.
00:27:59 Was originally used for disorders like eye ticks or laryngeal.
Bryan Barron: I forget the medical term, hyperhidrosis or something. But --
Paula Begoun: Sweating.
Bryan Barron: Excessive sweating. You'll get Botox injections under your armpits.
Paula Begoun: Right. Cerebral palsy to prevent jerking of the muscles. Dystonia which is generally a leg disorder where the muscle spasms. So, it's been around.
00:28:30 People have used it repeatedly. So, we know that there doesn't seem to be any long-term risks. I just am not sure you want to get that addicted, because it's addictive. There is no way -- not having wrinkles is cool -- you want to start quite that young with that kind of expense on a long-term basis.
Bryan Barron: So, going over all that, what can, for someone who has never had Botox before, and we can kind of tie in dermal fillers, too, because you've had your experience with those.
Paula Begoun: I've had both, right.
Bryan Barron: What can someone who has never had that before expect?
00:29:04 You know, you're there for your appointment, they're about to call you back. You're nervous…
Paula Begoun: You're nervous. It is nerve-racking.
Bryan Barron: What's it like?
Paula Begoun: Well, I have to admit, I've had it done so many times and I've had it done by other physicians. I keep going back to the same physician because I have had bad Botox injections. I've never had a problem where I've never had a negative side effect. But an untalented or a less than skilled injector can make you crooked.
00:29:35 And I have one eyebrow that tends to pop. And unless you really know what you're doing, meaning it gets kind of hyper-lifted, you can get uneven looking. So, the quality of the injector, somebody who really knows what they're doing, and I prefer -- I have to say -- I do prefer dermatologists. Plastic surgeons are not as skilled at Botox. They almost have their assistants do it. Most dermatologists do their own injections. I have to say that I have a preference for that.
00:30:03 I think the major thing, assuming that you are seeing the best there is, you know friends of yours who have it done and you've been impressed with their results. You just have to kind of grin and bear it. Ask them to do less than more to get you started, that they don't have to freeze you up. Don't do the lower half of your face. Don't do it.
00:30:29 They're going to want to do it. It's always a problem. They're going to tell you that they'll inject your mouth and it'll just make this line not look so deep. It will shift the way you smile. It has to. It's deadening the muscle. One of the techniques, though, is doing the chin to get rid of the [dippled] look on the chin. I actually think that's clever. And actually doesn't really freeze it.
Bryan Barron: You don't have that.
Paula Begoun: I have had that done.
Bryan Barron: You had it done there?
Paula Begoun: Right. That's why I don't have any of that cottage cheese look some older women have.
Bryan Barron: What causes that?
Paula Begoun: I don't know. I don't know. It's a good question.
Bryan Barron: It almost makes the chin look gravely.
Paula Begoun: Right.
00:31:04 I don't know. It's cellulite of the chin is what I call it. But it's not.
Bryan Barron: That's a good description. I know it's not the same thing, but it's kind of what it starts looking like.
Paula Begoun: Yeah. I don't know. And it's the only place on the face that that happens. I don't know why it happens. But Botox takes care of it quite nicely.
Bryan Barron: Or a beard.
Paula Begoun: Or a beard! For a guy, Bryan! But, of course, yeah right. So, the first time I had it done the trick of the trade was to not lie down. So, you don't want to get it done at the end of the day but at the beginning of the day.
00:31:37 Stay upright so that the Botox doesn't congregate, doesn't pool on the face, and does move through. Some people say massage your forehead and move your face around, again, to keep it from pooling and make the Botox move around. Again, if it stays localized it's not going to move around to other parts of your face. And it does take somewhere between 72 hours and a week.
00:32:00 I've always -- mine always takes hold pretty fast. I was kind of surprised how fast I noticed my face not moving. So, that kind of varies people to people.
Bryan Barron: Now, do you find that because you've had Botox for the past several years that each time --
Paula Begoun: No.
Bryan Barron: Is it any faster?
Paula Begoun: Oh, faster? I thought you meant lasted longer. No, not really actually. In fact, Botox, my experience after, I don't know, more than a decade is that it is incredibly consistent. You get injected. It takes me about 48 hours, 72 hours to see a complete difference, and it goes away in six months. Six to seven months.
Bryan Barron: Do they inject around your eyes, too, or just the forehead?
Paula Begoun: Just the, yeah, the crow's feet. Not as convincing around the crow's feet.
00:32:45 Crow's feet are very hard to control. A little bit under the eye, just a little bit. Some people do more of that. I think that's a little bit of a problem. I think it's kind of controversial in the world of Botox. But, again, one of the nice things about Botox, goes away in six months.
00:33:04 And so if there's a mistake or you didn't like it... -- And most physicians, for example, when I've gone in and I've had a brow pop, meaning that my right brow will become higher than my left brow, and they actually have to go in and lower it a little bit, I have a lot of space. I have high brows. I don't --
Bryan Barron: Yeah, you do.
Paula Begoun: I have high brows. I don't have the saggy brow area naturally.
00:33:27 They will go back in and even you up. So, if you didn't like it, go back in. A good injector will know how to, especially when they first do your face, to get used to how your muscles move and how to smooth the mouth.
Bryan Barron: They should keep a chart so that the next time you're in they know this is what we need to do differently.
Paula Begoun: And the second time, if they didn't have a chart, think twice, literally, about walking out, because, yes, they should know so they can keep track of what they did right, what they did wrong, how many CCs they put in, meaning how much units of Botox they put in. Was it enough? Did you have to come back in three months?
00:34:04 Did you have to come back in seven months. But, generally speaking, Botox does break down in six months. The other forms, Myobloc, all of it breaks down in about six to seven months. And then you have to consider if you want to go back in. In terms of dermal injections, I have had dermal injections less frequently than most people because I did make a decision many years ago to do what they call a semi-permanent, some people would call it a permanent filler called Artefill. It also goes by the name of Artecoll.
00:34:39 I had it done in Canada. It is being done in the United States under the name of Artefill. Not a lot of people do it. The positive thing about a semi-permanent permanent filler -- I had that done fairly young, too. I was starting to get the nasolabial fold lines. And even with Botox what they call the 11 lines between my brows were not going away.
00:35:01 I was starting to get lines around my mouth which are coming back. But I was starting to get thinning of the lips. And so I did go to a dermatologist in Canada who actually consulted for the company that makes Artecoll. And had the 11 lines filled. Had my nasolabial lines, what they call the laugh lines filled. And did my lip line.
00:35:28 And it is, you know, the positive about a semi-permanent permanent filler is that you don't have to have it done so often. I had this done, I've had it done twice in the past twelve years as opposed to when you use Juvederm, the hyaluronic acid fillers, collagen fillers. They don't do collagen fillers as much as they used to. Or any one of a myriad of fillers that are considered not permanent, that they go away in about six months to a year and a half. And I think a year and a half is really long out. It always depends on how much you use your face and how much they've used, you got to get it redone.
00:36:05 And because of the type of filler I had, which is what they call a semi-permanent permanent filler, I've only had it done twice. And that's been it. And I actually don't think I -- I, you know, still have full lips, although I am getting lines around my lips, but I don't think getting any bigger lips is going to change that, so I'm not interested in getting my lips done again.
Bryan Barron: So what about, again, going back to you're sitting there, you're nervous, the doctor hasn't come in yet, for both dermal fillers or Botox, does it hurt?
Paula Begoun: Botox, what they do nowadays for Botox is they numb you up beforehand.
00:36:43 They have these new types of numbing agents that they smear over your face and they let you sit for 30 minutes. Or they have you take it home and put it on before you go in, because the longer this numbing agent sits on the forehead the less likely you are to feel the injection.
Bryan Barron: Okay.
Paula Begoun: And that's a very big deal.
00:37:05 And do not get Botox the day before, or the week before, or even two weeks before an event, like a high school reunion, because one of the things that can happen with Botox is they can accidentally hit a vein. The best of injectors can hit a vein. You'll get a little bit of bleeding and that yellow/blue bruising. And it takes awhile to breakdown. It doesn't go away fast.
00:37:31 So, you definitely don't want to do anything like that or dermal fillers, or anything where there is a potential long out healing time. So, the more I'm good about leaving that numbing agent on my forehead and around my eyes for the crow's feet, the less I feel. In fact, when I'm really good about leaving it on for an hour I almost don't feel it at all, especially with the new numbing agents that they use.
Bryan Barron: So, when they're basically coming at you with the needle, do you just sit upright and close your eyes?
Paula Begoun: Yeah.
00:38:07 Sometimes. But now I've had it done so many times, I think I might be a little bit more cavalier about it. But the major thing is you don't want to move. You don't want to jerk around.
Bryan Barron: Right. Right.
Paula Begoun: So I try to keep very, very still. You know, I'll tell you one of the weirdest things about getting Botox is because it's being injected on your forehead, which is so near to your auditory, the way you hear, it's right next to the mechanical --
Bryan Barron: Auditory nerve. Yeah.
Paula Begoun: Yeah, the auditory nerve and the mechanical parts of the ear that hear.
Bryan Barron: Like when you hear yourself chewing.
Paula Begoun: Right. You hear -- you hear the injection and you can actually hear the liquid passing into the skin. I swear to god, that was the weirdest thing. I remember the first time I go --
Bryan Barron: That would be trippy.
Paula Begoun: I go like, “Am I supposed to be hearing this?” But, yes, you do hear it because it's right next to... --
00:39:01 I mean, it's happening anyway, wherever it's injected in the body. It just happens to be near your hearing, the nerves. But the thing about the dermal injections, most doctors numb you up the way a dentist numbs you up. The thing that is so traumatic about getting dermal fillers for me, particularly around my lips, in particular the lips, is because of the sensitivity of the lip area, which is one of the most sensitive areas of the body -- my lips blew up like balloons.
00:39:38 And I was speaking. I did exactly what I say not to do. I was doing a presentation at a dermatology conference three days later.
Bryan Barron: Oh no!
Paula Begoun: And my lips were the size. I thought I have made the biggest mistake of my life. And the doctor reassured me. He said just keep ice on it, it will go down.
00:40:01 And I know lots of doctors that say things will get better and they don't. I was in a panic. I mean, I was in a panic. But sure enough, 48 hours later, after the anesthetic, like the dentist type anesthetic wore off, the swelling did go down and my lips actually looked better than I could have hoped for.
Bryan Barron: Pfew!
Paula Begoun: And the nasolabial lines were -- I mean, the results actually happened even faster than with Botox because you're getting filled right then and there.
Bryan Barron: Yes.
Paula Begoun: And in my case because of the kind of filler I had, it actually got better with time, the way some of these semi-permanent permanent fillers work is they actually keep collagen building around them like a network. So, you actually get more improvement as you go along as opposed to the hyaluronic acid, the Juvederm and Radiesse.
00:40:54 Well, Radiesse is different, but the Juvederm kind of fillers, hyaluronic acid kind of fillers, because those do break down. But the kind of filler I had, the Artecoll, Artefill, actually increases collagen as it goes along. So, I don't think I'm due for -- I will be due for Botox again in another five months.
Bryan Barron: Yeah.
Paula Begoun: But right now, with dermal fillers, I'm good I think.
Bryan Barron: I want to talk a couple questions from our Facebook fans.
Paula Begoun: And then I need to talk about my facelift, and the lasers. But go on, take a question.
Bryan Barron: Oh, well let's do that towards the end.
00:41:27 But I wanted to make sure you touched on Fraxel, what having Fraxel is like. And then we can talk about the lift and move onto some questions. And wouldn't that be great?
Paula Begoun: One of the things about my own personal experience with lasers and Thermage and Deep CO2 laser is that along the way, because of my age, and because of the many years that I've been testing and trying some of these different procedures, my previous experience doesn't really count because new generations of lasers have come along that dermatologists have either loved or have gone away and come back again.
00:42:07 So, some of my own personal experience when it comes to lasers and IPLs, Intense Pulse Light Treatments, I'm hesitant to ever speak directly to my experience with a specific laser or IPL because different ones come out all the time and new research about different ones come out all the time.
00:42:30 There are dozens and dozens of these machines all over the world. Different derms like different machines for different reasons. Sometimes it's because the amount of money they spent on it. And sometimes it's because they work for the company that is making that particular laser. So, I'm always hesitant to speak to my own experience. However, the basic truth is that no pain, no gain. Lasers hurt. There's no way around it. And when they don't, they have minimal improvement.
00:43:06 Particularly that's true for Thermage. That's particularly true for Ulthera. When you have a Thermage treatment and you didn't feel it, you're going to get minimal to no results. Same thing with almost every laser I can think of. And particularly Fraxel. And then when you move from Fraxel, which is a pixilated version of Deep CO2 laser, it doesn't hurt, you will get less benefit.
00:43:31 I can't do anything about it. When they tell you that you can walk out and you'll be fine, you will not get the same benefit. I mean, you'll get some benefit.
Bryan Barron: Sure.
Paula Begoun: But you won't get the dramatic change in the skin and ongoing improvement that you're hoping to get when it doesn't hurt. So, whether you're doing Fraxel, or they now have combined with Thermage, or Thermage by itself, or Ulthera, I mean, so many different ones. If it doesn't hurt, it's not helping. And then in terms of the IPLs, which are the type of machine, so the Fraxels and the CO2s and the Thermages, they deal with building collagen and firming skin.
00:44:15 That's what those machines do. The IPLs, the Intense Pulse Light machines zap veins, the red veins that get rid of redness on the skin, and they zap the brown spots.
Bryan Barron: That's the one, yeah. I've had quite a few of those.
Paula Begoun: For the red angiomas, the surface capillaries?
Bryan Barron: Some of that, but also just some sun damage that starts coming up.
Paula Begoun: Like the brown spots?
Bryan Barron: Yup.
00:44:40 You have them treated before they get too dark. And then I continue to use great skincare, Paula's Choice to keep those under wraps.
Paula Begoun: Well, I'm so glad you use our products given you're part of the team!
Bryan Barron: It should be out by the time you're listening to this show, but I've been using our Resist C-15 Booster a few times a week mixed with one of our serums, or even on its own, and wow.
00:45:05 Remarkable. Remarkable.
Paula Begoun: Are you serious? I haven't done that yet.
Bryan Barron: Look at my arm. Look how much lighter that all is. It looks so much more even.
Paula Begoun: Ooh! How come I haven't been doing that? I made it!
Bryan Barron: I don't know. You've got to talk to the right people at your company!
Paula Begoun: You know, as high maintenance as I am, I get lazy. I really do get lazy. All right, I'm on it. I'm on it.
Bryan Barron: It takes a commitment just like anything else. If you only use it a couple times a month, yeah, don't be surprised if it doesn't do much for you.
Paula Begoun: Right.
00:45:35 Right. So, which IPL d you get for zapping the brown spots? Do you mind telling us? Do you know the type?
Bryan Barron: No.
Paula Begoun: Oh, you don't know the type? It doesn't matter. I mean, there are so many of them. I'm just curious.
Bryan Barron: Historically, the place I used to go, it really didn't hurt as you were just saying. So, I can testify to the point you were making earlier. And I wasn't really seeing great results.
00:45:58 And then when I switched and started going to another facility, like remember when I had that bad reaction?
Paula Begoun: Oy, yes, terrible. Terrible.
Bryan Barron: Then, you know, they got the settings right. But then after that, that's when I was like, okay, this hurts. And it wasn't just a bit painful during the procedure, but it was actually kind of painful afterwards, too.
Paula Begoun: Right.
Bryan Barron: But I saw results, for sure. And it's a temporary pain. It's not like you're --
Paula Begoun: Right, down for the count, forever.
Bryan Barron: Personally I would liken it to the feeling you get when your skin has had too much sun or you get a windburn.
Paula Begoun: Definitely IPLs don't hurt, are milder than the Fraxels or the Ultheras.
Bryan Barron: I haven't had Fraxel.
Paula Begoun: Well, and you're young yet. You are so young.
Bryan Barron: That's next.
Paula Begoun: Ha!
00:46:41 So, but, before we take questions, so the other thing that I had done fairly recently, it's about a year and a few months out, is I did have a lower facelift. I was starting to see jowling and what I know is that I never wanted to have a major difference where I had a very saggy lower part of my face and then all of a sudden decide to cut it all away.
00:47:10 I did not want that kind of dramatic difference. I wanted a subtle difference. And I decided to have a lower facelift and the difference -- most people can't tell I've had it. The surgeon did a great job. I often just flip my ear back because that's where the scar is most noticeable. The way he tucked the scar in the ear is really brilliant.
00:47:34 I am thrilled that I had it done. On retrospect I would have not done it at home. I would have gone to one of those facilities where you have it done and then you recoup there for a couple of weeks because it was very traumatic on my boyfriend. I can't believe I put him through that. Because it is traumatic. It is at least a two-week healing process, in particular because I also had a deep CO2 laser at the same time.
00:47:59 What I have not had done that I am in particular nervous about, and I'm lucky the way my face is aging, is my eye area isn't aging very much. You can still see my lid. I still have a crease. My eyebrow is not hanging down on my lower lid. That part of my face, for whatever reason, isn't aging like my neck was. But, it will. It will. That's just what happens. There's no eye cream that's going to hold that back.
00:48:30 That makes me nervous. When I'm ready to start jumping in and researching what that means to get -- the technical term is a blepharoplasty. We will do a show on it. But cutting around the eye, that seems pretty major to me. I'm not quite ready to do that. But when you have an aged eye, where you can't see the back corner of your eye, or your lid starts hiding the back corner of your eye.
00:48:58 Or the under eye area, in particular the under eye area, because that is so when the fat pads start moving and it starts sagging and the deep wrinkles that no eye cream will get rid of, not even close, then, yeah, that is the next step. But, thank goodness I'm not there yet. Although, they do have a Thermage and the Fraxel that you can do around the eye that definitely can help tighten and of course I would always suggest trying that before blepharoplasty.
00:49:28 Questions from our Facebook fans?
Bryan Barron: Okay, yes. We have a good one from Melissa B. She wants to know how to assess the skills of the doctor or aesthetician. And I wanted to point out, Melissa, before Paula jumps in to answer that -- an aesthetician is not who you should be talking to for really any sort of cosmetic corrective procedure, unless they are a registered nurse or have had some sort of training.
00:49:57 I mean, I don't know, Paula, would you get Botox from an aesthetician?
Paula Begoun: Oh god, I would never!
Bryan Barron: Not to discredit aestheticians and what they go through to be certified and all of that, but that training doesn't involve…
Paula Begoun: No, I wouldn't do --
Bryan Barron: …that type of procedure.
Paula Begoun: Yeah. Because they're not anatomical experts. They don't know all of the muscles of the face. If dermatologists know anything, dermatologists know anatomy and they know every muscle that exists on your face.
Bryan Barron: And there's a lot. I mean, one of the reasons that people's faces age at different rates as you were just talking about, your eye area is looking pretty good, is that the fat pads in our face, there are twenty-something of them, and they fall out of place and move around at different phase, different ages.
Paula Begoun: And they move around the muscles.
Bryan Barron: Yes.
Paula Begoun: And so particularly when it comes to Botox, how you inject --
Bryan Barron: This is why facial exercises don't work, people.
Paula Begoun: Which is why, blergh, facial exercises -- what a joke.
00:50:54 And now facial yoga. The anatomy, knowledge of anatomy, and what muscles do what on the face, which ones lift, which ones pull, and how that works I would never entrust to an aesthetician.
Bryan Barron: What about a doctor? When you're vetting?
Paula Begoun: I don't know. I don't know how you vet skill set.
Bryan Barron: Should you ask for before and after pictures?
Paula Begoun: Well, what are they going to show you? They're not going to show you the ones that they had problems with. If there is something tricky it is, you know, there's a website called Real Self.
00:51:34 Do you know that website, realself.com?
Bryan Barron: I've heard of it, yeah.
Paula Begoun: I think that although people can, and there are some websites that talk about people's experience with doctors, but somebody can have a bad experience with a doctor and that doesn't mean the doctor is a terrible doctor.
Bryan Barron: Sure.
Paula Begoun: Everybody is going to have a problem with something that they do, because by the very nature of these procedures, things in a small percentage of people can go wrong.
00:52:05 You know, I don't know how you assess talent. What I can definitely say is it helps when you know somebody who has been to that doctor and you like the results. Celebrity doctors do some of the worst work we've seen. You only have to look at some celebrities and you know what we're talking about.
Bryan Barron: Yes.
Paula Begoun: I don't know, because when you see the before and after pictures they're not going to show you the bad ones.
Bryan Barron: One other thing worth mentioning, as much as we love telling you about beauty bargains, and what you can get for less, when it comes to cosmetic corrective procedures, this is not the area to bargain shop.
Paula Begoun: Oh my gosh, no, no, no. Right.
00:52:45 And often the people that are doing it for the least amount of money are the aestheticians. People that don't have derms there, even though they say they do, the derm really isn't on premise, which I find reprehensible. You want as much as possible to have a dermatologist do it. Again, most plastic surgeons have their assistants do it, or their nurse do it. I don't necessarily think that's the worst thing, but for me personally I love the fact that dermatologists go to dermatology conferences.
00:53:18 They take classes. They know anatomy. That is their area of specialty. So, I would lean towards that. But at the very least it needs to be a nurse practitioner who works with a dermatologist and gets training.
Bryan Barron: Yes.
Paula Begoun: So, I just lean towards that. But, again, it's very hard to assess skill. Very hard.
Bryan Barron: Allison K. asks do any non-invasive cellulite reducing procedures really work?
Paula Begoun: Not the way you wish they worked. So, I think that the lasers using Renova or a Retinol cream, the Endermologie, the rolling stuff, there's just no research that doesn't come from companies selling the stuff that show that that really gets rid of cellulite in any way whatsoever other than incredibly temporarily from the swelling.
Bryan Barron: Yes.
00:54:21 There has been some interesting third party research compares Endermologie to placebo or another type of treatment. And that's been pretty, eh.
Paula Begoun: Right.
Bryan Barron: Which of course the Endermologie companies aren't going to promote those studies because they essentially show that you're not really getting any benefit from Endermologie whatsoever.
Paula Begoun: Right. Versus placebo. So, lasers, I just haven't seen -- I know they're using lasers for cellulite. I just haven't seen any compelling research that makes it worth the money. I don't think it's the worst thing to do. I just think for the expense you're not going to be that thrilled.
Bryan Barron: Okay. Last question for this round.
00:55:03 Shelly wants to know, and this is kind of an open-ended question -- what are the best non-invasive treatments? And I think, Shelly, the way that Paula should answer this is -- how do you want to answer this? What you personally recommend?
Paula Begoun: Well, there's only so many.
Bryan Barron: Yeah. And a lot of people are asking about Juvederm, too.
Paula Begoun: Well, Juvederm is the one that gets the most press.
00:55:29 That's what a lot of people know about are the hyaluronic acid fillers as opposed to the Sculptras, or the Radiesse, the semi-permanent fillers. I think that when it comes to cosmetic corrective procedures versus plastic surgery, the choices are relatively limited. I mean, they're just limited. There's Botox, and obviously Myobloc, and I think there's one new on the new block.
Bryan Barron: There's Dysport.
Paula Begoun: Oh, Dysport. Thank you. I always forget about Dysport. That are being used. But all three work in the same way.
00:56:03 Have the same risks. Have the same side effects. Have the same results, last about the same amount of time in terms of getting rid of wrinkles on the forehead and around the eyes. Dermal fillers which inject the nasolabial folds around the mouth and the 11 lines between the eyes. And there are all of the IPL machines, the Intense Pulse Light that deal with brown discolorations, skin tone, color, and blood vessels, the surfaced redness veins on the skin.
Bryan Barron: So, I think what you're getting at is that the best non-invasive procedure really comes down to what concerns the individual has and then what they're comfortable having done.
Paula Begoun: Oh!
00:56:44 I'm sorry. Yes. Exactly. Exactly. And how much risk you want to take. Obviously, well not obviously, but an IPL, an Intense Pulse Light to get rid of surfaced veins and redness on the face, or that zap brown spots, you know, almost no downside. Almost no -- I mean, everything has a risk, but almost no risk. The lightweight treatments that have very little intensity. There are some very lightweight Thermage treatments. Very little risk. You'll get a little bit of firming, but the more intense the treatment, the more intense the energy for the Fraxel, or the Thermage, or the Ulthera, or the CO2 laser, the more results -- by far the more dramatic results you're going to get.
00:57:30 Botox is Botox. So, if you don't have red surfaced veins you don't need an IPL for that. You don't have brown spots, you don't need an IPL for that. You're not having sagging and firming, you know, needing firming, you don't need the deep lasers. You have nasolabial folds you want to plump up, you look at a dermal filler. You want to get rid of the 11 lines between the brows, you look at Botox and dermal fillers.
00:57:57 So, it's the problem you consider and then the solution that is a part of the cosmetic corrective procedure world.
Bryan Barron: And if you have multiple problems, which what we hear --
Paula Begoun: You got to do a cocktail -- you got to do a menu. It's like one from column A, one from column B, one from column C.
Bryan Barron: Exactly. That is the one thing that there isn't yet is an all encompassing non-invasive procedure to address redness, brown spots, loss of firmness.
Paula Begoun: Actually, even cosmetic surgery only addresses one aspect -- sagging skin.
Bryan Barron: Right.
Paula Begoun: It doesn't address everything on the face.
00:58:37 I mean, it can address if you -- there are some procedures that cut, well never mind, we'll talk about forehead lifts another time. But there are things that facelifts can do. But it does not do everything.
Bryan Barron: Yeah.
Paula Begoun: Doesn't do brown spots. Doesn't do surfaced veins. Doesn't do skin color. Everything has its pros and cons and its benefits. There isn't one thing that does everything in terms of the complications of face aging.
Bryan Barron: Yeah.
00:59:07 Well, this was great.
Paula Begoun: I'm exhausted. Oh my gosh.
Bryan Barron: We have a ton more information about everything that we talked about in terms of the different procedures and what not. You can find that in the Expert Advice section at PaulasChoice.com. We have a section called -- there's a Cosmetic Surgery section as well as non-surgical treatments, so you can read all about that there.
00:59:29 And we do our best to present both sides, looking at what the research says, always looking at what the research says so that you can have the best experience possible.
Paula Begoun: So, I'm Paula Begoun, the Cosmetics Cop, with Bryan Barron who is the -- actually you really are the Cosmetics Cop now. It's not me so much anymore. We are co-authors of the book “Don't Go to the Cosmetics Counter Without Me.” You can find all our work at PaulasChoice.com. Wasting money isn't pretty. We will keep you beautifully informed on this radio show as well as all our other work. Come back and visit us whenever you can. Thank you.
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