The Gillian Andersons of the world, the Reese Witherspoons, the Lucy Lius, the Cate Blanchetts, the Zoe Saldanas. They look … so good, right? Young, but not baby-faced. Full, but not puffy. Wrinkled, but just an adorable bit. Radiant. Expressive. Weirdly normal. They have none of the flash-freeze, fish-lips, shiny foreheads, displaced eyebrows, and flattened philtrums that once whispered “plastic surgery.” But they have none of the dark spots, crepey, dull skin, and deep lines that come with lives lived and sunscreen forgotten, either.
I have no idea whether any of the above women have ever visited a dermatologist for more than rash cream and mole checks. As a class, prestige actresses still rarely admit to doing much more than guzzling water and wearing sunscreen to take care of their skin, and who am I to doubt them? Yet I do — and over the past year or two, particularly on Oscars night, I became obsessed with how Hollywood had finally figured out how to pass the Plastic Surgery Turing Test, giving us all these eerily young yet strangely natural-looking women.
Since those actresses never talk, I asked their plastic surgeons. And the short answer is this, with apologies to Michael Pollan: injectables and lasers, not too much, early and often.
The tide began to turn when actresses started demanding that they look like themselves, rather than simply looking younger — and technological advances allowed them to achieve it. A decade ago, the reigning aesthetic was sparse and tight: lots of Botox, lots of face-lifts, youth achieved by starch and marionette string. Half a decade ago, it was juicy: full baby-face, plush mouth, youth achieved by inflation. Today’s face is de minimis: nothing to see here, just as God made it, we swear. “Undone,” says Dr. Richard Glogau, describing what his clients request nowadays. “Maybe underdone,” said Dr. David Colbert. “Normal,” said Dr. Patricia Wexler, the famed dermatologist.
“Excluding the Kardashians, they all look quite natural,” Wexler said. “I’m so excited when I see foreheads move! The Meryl Streeps and the Cate Blanchetts are looking really good, and they’re looking really natural.”
In practical terms, this is achieved with the restrained, consistent use of injectable products — a move reflected in the broader market, where “minimally invasive” procedures are growing twice as fast as “surgical” procedures in women between 20 and 40. (Doctors now perform 7 million botulinum injections a year, according to one estimate.) “It used to be that I’d be in the office day and night before the Oscars and the Golden Globes,” said Wexler. “Now, my patients are in three times a year, but they’re not coming in before each individual program. They make little refinements. They ask for ‘mini-Botox.’”
In general, doctors have started to take more of a less-is-more, wait-and-see approach — adding more botulinum as necessary and recommending that patients come back more often rather than overdoing it at any given appointment. “We don’t do the correction in one fell swoop anymore,” said Glogau. “We do a little, wait, put a little more in, wait, put a little more in. There’s no problem with putting a little in and adding as needed, rather than trying to take a patient to the maximal end point in one treatment session. There was a tendency to overtreat, and to leave people looking a little weird.” That has helped doctors avoid both the deer-in-the-headlights look, and other changes associated with heavy botulinum injections, like eyebrows that start to overarch or move down on the skull.
In some cases, doctors have also started prophylactically injecting the toxin so that actresses never develop wrinkles as heavily as they might have otherwise — even as early as their early 20s or, heaven help us, late teenage years. The muscles weaken and the lines never groove too deeply, reducing the need for heavy doses of Botox down the road.
Ditto for the now-ubiquitous fillers: Rather than waiting for a significant decline in facial volume, doctors start boosting actresses in their 20s with small amounts of a man-made compound. (Moving your fat from butt cheek to face cheek, as awesome as it sounds, is less desirable than adding a synthetic filler whose results are easier to predict and manipulate. But moving fat from, say, your inner and outer thighs into your butt to round it out has become a lot more common.) They then repeat that process as necessary, ad infinitum, rather than applying a heavy dose of product later on to try to restore a face long changed by time and gravity.
On top of all of that, the products themselves have gotten better — with a plethora of new lasers, all sorts of new fillers, and improved techniques in using all of the above. (And why not? Americans spend $12 billion a year on plastic surgery and invasive cosmetic procedures, with companies competing intensely for market share. Indeed, competition works a heck of a lot better in the frivolous medical market than the necessary medical market.) “We have these better fillers that are more natural, more bioidentical, and we know how to use them better,” said Colbert. “Before, it was, ‘Let’s fill it up!’ You had dermatologists making people look like lollipop heads. There was absolutely no artistry. I don’t know what people were thinking.”
Finally, there are the lasers, where the technology itself has become less-is-more. These tools — Fraxel is one of the popular name-brand ones — help to reverse visible signs of aging, like fine lines, little wrinkles, age spots, and pigmentation changes. They do so by damaging the skin, prompting it to heal itself and erase those signs of aging in the process. “They changed the way that the energy exits the machine, from a broad sweeping band of light that burned everything in its path, to a computer-generated dot pattern,” explained Glogau. “You have more epidermal cells for healing, and healing is way faster. Most importantly, you don’t disturb the pigmentation of the skin. The procedure is much safer. It’s a huge step up.”
The upshot is a much more natural look, one that actresses and their doctors can carefully shepherd over time. A little too much Botox? It will fade in a matter of weeks. Too little Botox? No problem, come back for a tiny bit more. Uneven filler? Easy to add some on one side. Actresses look more like themselves, and the chemical preservation keeps them looking that way as they age.
Beyond that, for people in a minute-by-minute social-media spotlight, the less-more-often-is-more technique also helps them keep continuity of face. Actresses never look radically different from one paparazzi photograph to the next — and thus have better plausible deniability about using any given product or process — even as they have considerable amounts of work done. “They can’t change their looks!” said Wexler. “You can’t be in the middle of a shoot and have your filler done. You don’t want to look different picture to picture, so some editor in a magazine can say, ‘Look at her!’” And the techniques and practices used to achieve this new face allow many actresses to delay having surgery until much later than they used to.
The result is a barely there, totally natural look that helps freeze actresses in time, without having them ever look weird or frozen. You can see the results. Or can’t you?