You’re Looking Very Well

by Lewis Wolpert

  Those undergoing or planning to undergo cosmetic surgery still constitute a distinct minority, but the numbers would increase if it could be done safely. As with any surgery, there are some risks associated with these procedures. And not every procedure will have the desired results, as the case of the unfortunate American Jocelyn Wildenstein, who allegedly spent $4 million on facial plastic surgery to please her husband, illustrates. She has been unkindly dubbed ‘The Bride of Wildenstein’, and her horrified husband apparently commented, ‘She seems to think you can fix a face the same way you fix a house.’ But the emotional benefits of plastic surgery results can be many times greater than the physical rewards. If you have felt bad about the way you look, plastic surgery can make you feel better about yourself.

  Treatment based on Botox injections is probably the most popular cosmetic surgery worldwide. The adverts refer to the frown lines, crow’s feet and wrinkles around the mouth that can cause a person to look worn out, tired and old. Botox treatments were first approved by the FDA in 1990 for the treatment of eye muscle spasms for those under 65; however, its cosmetic value was quickly realised. Botox cosmetic is an approved trade name for botulinum toxin, produced by the bacterium Clostridium botulinum. When injected in small doses in designated areas, Botox blocks nerves activating muscles responsible for the repetitive action that causes fine lines and wrinkles, and literally paralyses the area. Normal Botox treatment with a doctor will cost about £400, and results can last up to eight months. But it doesn’t always, of course, have the desired effect, and can lead to a face that looks angry as well as to headaches. One actress claimed that it made her look like an extra from the Planet of the Apes.

  A multitude of wrinkle creams and lotions sold in chemists and department stores promise to reduce wrinkles and prevent or reverse damage caused by the sun. At the top end of the market, Oro Gold Cosmetics has introduced a set of anti-ageing products (including eye serums, bionic facial treatment and skin moisturisers and other products) infused with 24k gold—which, they claim, but without reliable evidence, has many properties that induce rejuvenation in the skin. But do any of these products actually work? Some research suggests that wrinkle creams do have ingredients that may diminish wrinkles. But according to Mayo Clinic physicians, many of these ingredients have not undergone scientific research to prove their benefit. Creams and lotions may slightly improve the look of your skin, depending on how long you use the product and the type and amount of the active ingredient, but any effects from non-prescription wrinkle creams will not last very long. You’ll have to dab on wrinkle creams once or twice a day for many weeks before noticing any improvement. And once you stop, your skin will very likely return to its original wrinkled appearance, according to dermatologists. Studies have confirmed that more expensive wrinkle face creams work no better than cheaper products.

  Which? magazine decided to put anti-ageing creams to the test. It selected 12 ordinary moisturisers and 12 anti-ageing creams. Groups of four women tested each product for four weeks. None of the 96 women knew which product they were using and at the end of the trial they were asked to guess whether they had been using a moisturiser or an anti-ageing cream. Three quarters chose moisturiser. Most had not noticed any difference in the look or feel of their skin, and of the 48 women who had been using an anti-ageing cream, only 10 reported any improvement.

  Which? concluded that ‘some of the claims made for the ingredients of anti-ageing creams can be substantiated but, with the low concentrations used in the creams, they are unlikely to do more than moisturise your skin’. There is more support for this view from a beauty-industry insider: ‘There is no miracle ingredient that will take years off your appearance,’ says Gisele Mir, a cosmetic scientist and founder of the holistic skincare range Mir. ‘The only miracle is that the cosmetics industry has managed to persuade us otherwise for so long. In my opinion you can harm your skin by using anti-ageing products. I believe many of these products accelerate ageing rather than prevent it.’ Tretinoin, a derivative of vitamin A, is the only topical medication that has been proven to improve wrinkles.

  The advertisements and publicity seem endless. A full-page advertisement in several UK newspapers proclaims: ‘Is your skin ageing too fast? Our scientists definitely think so… Inspired by 25 years of groundbreaking DNA research, Estée Lauder now innovates anti-ageing skincare…’ In the US: ‘Discover the FIVE SECRET RITUALS from a Hidden Himalayan Monastery that Make You Look 30 Years Younger—In Just 10 MINUTES A DAY! $39. This unique complex of Bio Enhanced trans-resveratrol and potent polyphenols and anthocyanins is formulated specifically to fight ageing at both the genetic and metabolic level.’ It is claimed that CoverGirl Simply Ageless Foundation significantly improves skin condition in just four weeks, and super model Christie Brinkley’s affiliation with CoverGirl was a huge success. She said: ‘CoverGirl is part of my DNA and I’m thrilled to be back with my family. I’m excited to promote a new product developed specifically for women like me, who want flawless coverage combined with the latest science in skincare. I’m looking forward to working with the brand at a time when there is so much innovation.’ But there is as little real evidence for the benefits of agents that prevent facial ageing as there is for medical treatments.

  In April 2009 there was a report that a new product from the chemist Boots, which works by stimulating the production of a protein that promotes skin elasticity, made a significant difference to the wrinkles of 70 per cent of volunteers aged between 45 and 80. This was a properly conducted trial by the University of Manchester and so seems an important advance. It led to a stampede to Boots’ shops which is still continuing. In one month, February 2010, Boots sold more than 700,000 anti-ageing creams. However, other experts say that only one in five users will get something more than from using common moisturisers. A new product of a quite different nature is a device that electrically stimulates the muscles in the face; there are claims that it is safer and more effective than plastic surgery, and acts due to stimulation of the facial muscles, but there are no reports of proper trials.

  The links between ‘expert opinion’ and the commercial interests behind a product are always worth considering. A recent report in the Boston Globe said that when a 73-year-old patient recently asked a prominent dermatologist how she could look more youthful, he had a ready answer. He suggested she visit a drugstore across the street to shop for a specific brand of anti-ageing, wrinkle-fighting, and lip-plumping creams. The products were part of the doctor’s own line of cosmetics.

  The use of wrinkle creams twice a day can plump up the skin temporarily, which causes the wrinkles to be less visible. These creams may also be excellent moisturisers, and they may smell and feel good. But no matter how expensive they are and no matter what they claim to do, they won’t turn back the clock. An important way to avoid wrinkles is to practise sensible sun avoidance and use sun screen. Yet are wrinkles really such a terrible sign of ageing compared to certain other indicators?

  Weight and other factors can affect how one looks. A study in the USA of the photographs of 186 pairs of identical female twins together with detailed interviews showed surprising results. One twin aged 70 could look six years younger than her sister if she had more weight, as this filled in the wrinkles on her face. Antidepressants and alcohol made a twin look older, as did suntan and cigarettes. Before 40, the lighter twin looked younger and more attractive, but over 40 the heavier twin looked younger, the weight difference being about 24 lbs. So it may well be that what you eat has a more beneficial effect than what you dab on your skin in the war against wrinkles. But being overweight, of course, can have many ageing effects on one’s health.

  There are studies that suggest that hair is more important than wrinkles in judging someone’s age—it can make a differences of 4 to 5 years in one’s appearance. Also important is the fullness of lips, which makes a face appear much younger and is almost entirely determined by a person’s genes. This accounts for the large number of co
smetic surgery procedures for lips, some leading unfortunately to ‘trout pout’.

  It is reassuring to learn from the attitude surveys that many think real beauty comes from the inside, not the outside. And in spite of the enormous amounts of facial treatments to avoid looking old, there are those who argue that we should learn to live with this universal process. Anne Robinson, a well-known TV presenter in her 60s, had a facelift at 61 and currently uses Botox. An article in the Daily Mail recognises that it is tough to still be a TV presenter at her age; but would it not be better, it argues, for someone like Robinson, who is a role model for women, to champion the rights of women as they grow old? When women like her resort to cosmetic surgery it puts unwelcome pressure on women of a similar age. As a cosmetic surgeon comments, facelifts are dangerous, and he is dismayed that injectible fillers for wrinkles are advertised on TV.

  All these procedures can lead to an obsessive desire to achieve an ideal beauty. An article in the London Evening Standard offered ten tips to make ladies look ten years younger: remove dead cells from your skin using a wrung-out face cloth every night; fill out the volume of your face with injections; get baby Botox to get rid of embedded frown lines; wear sunscreen every day; use an expensive serum to exfoliate; get rid of uneven skin tone using a light concealer; get made up by an expert; get advice on hair colour and shape; tint eyelashes and eyebrows; make sure your teeth are a harmonious shade of pale. How much time will be left in the day for life’s other pleasures?

  Oscar Wilde found a way to prevent the signs of ageing in The Picture of Dorian Gray. Dorian is a cultured, wealthy, and exceptionally good-looking young man who has his portrait painted. He curses his excellent and attractive portrait, which he believes will one day remind him of the looks he will have lost as he ages. In a fit of distress, he pledges his soul if only the painting could bear the burden of age and infamy, allowing him to stay young for ever. This wish is fulfilled and he does not show signs of ageing, but the portrait does. Only when he dies does the portrait turn back to a youthful image, while his body show all the wrinkles. A well-known quotation from the book says: ‘The tragedy of old age is not that one is old, but that one is young.’

  Perhaps Lucille Ball got it right: ‘The secret to staying young is to live honestly, eat slowly, and lie about your age.’

  10. Treating

  ‘Age appears to be best in four things: old wood best to burn, old wine to drink, old friends to trust, and old authors to read’

  — Francis Bacon

  Evolution cares not for the old once they no longer contribute to reproduction or the care of those who can reproduce. And while love for children is universal and genetically determined, since reproduction is what life is for, attitudes towards the old are not. How the old are treated can vary in different cultures; even within a single society people do not look upon the aged as belonging to one clearly defined category, and attitudes are diverse.

  Largely as a result of increases in retirement age, and of people living and working longer, attitudes to ageing and being old have changed, and nobody really knows what ‘old’ is any more. A recent UK survey found that, on average, the public believed that ‘youth’ generally ends at 45 years of age, and that ‘old age’ starts at 63 years of age. Older respondents considered that youth continues longer and old age starts later than did younger respondents. The oldest age group of those in the survey thought that old age started at just over 70, whereas the youngest group estimated old age started at around 55. In terms of the end of youth, the oldest estimated age for this was 57, whereas the youngest was 37. Categorisation of ‘old’ and ‘young’ is so variable that an older person assumes someone is still in their youth at 57, whereas a younger person assumes that by this age they are already old. Ageing now happens more slowly, and people get ‘old’ later. This post-modern attitude to ageing reflects a feeling that while ageing comes to everyone, how you deal with it by keeping active, both physically and mentally, can put off ‘getting older’. But there are many views that make those who are ageing, and particularly women, refuse to tell even friends their true age.

  ‘Implicit ageism’ is the term used to refer to the unconscious negative thoughts, feelings and behaviour relating to older people. Becca Levy, whose research explores psychosocial influences on ageing, focuses on how psychological factors, particularly older individuals’ perceptions of ageing, affect cognition and health in old age, and reports that they ‘tend to be mostly negative’. One can compare these attitudes with those of the Nambikwara Indians, who live in the south-western part of the Brazilian Amazon, and who have only one word for young and beautiful, and another for old and ugly. The old are on the whole viewed as physically unattractive. This makes sense, as since the old no longer reproduce, from an evolutionary point of view they have lost all beauty; but they can help children and younger people, which does not require attractiveness.

  * * *

  It is far from clear whether views of the old in ancient times have affected modern views. In ancient Greece, Sophocles, Euripides and Plato lived productively into their 70s, and the views they espoused of the elderly were positive and respectful. But we should remember that there were only a few old in those times, with life expectancy being around 30, and half of those born not passing the age of 10. The chief killers were infectious diseases such as typhoid, smallpox, cholera or malaria. So to reach the age of 80 was exceptional. Many Greeks thought physical decay with age a curse worse than death itself.

  Plato and many of the Ancients had a positive view of old age: ‘Old age has a great sense of peace and freedom. When the passions have lost their hold, you have escaped, as Sophocles says, not only from one mad master, but from many!’ Plato also wrote that ‘As age blunts one’s enjoyment of physical pleasures, one’s desires for the things of the intelligence and one’s delight in them increase accordingly.’ He emphasised the respect with which children should treat their parents, and both he and Socrates pointed out that one could learn much in the company of the elderly. In Sparta the old were protected and venerated, and government policy was made by a council of twenty-eight elders over the age of 60, elected for life. But there were other views.

  Aristotle praised youth and his views of the old were quite the opposite to those of Plato: ‘Because they have lived many years, because they have often been deceived, because they have made mistakes, and because human activities are usually bad, they have confidence in nothing and all their efforts are quite obviously far beneath what they ought to be.’ For Aristotle, man only advanced until the age of 50, and when older became garrulous and kept on going over the past. A distaste and disgust for old age was openly expressed in Greek culture. Many believed that the gods took those they loved at a young age, leaving the unwanted to experience old age. Yet several Greek laws were passed requiring children to provide for their parents, and there were severe penalties—including, in Athens, the loss of civic office—for those found guilty of maltreating their parents.

  In Ancient Greece, Aristophanes was among the first to mock the old in his plays as being feeble. Euripides also had a negative view of old age; in his play Alcestis, Admetus says ‘Old people always say they long for death—their age crushes them—they have lived too long. All words! As soon as death comes near, not a single one wants to go, and age stops being a burden.’ Nor was Aeschylus in the Agamemnon any more positive:

  What is an old man?

  His foliage withers

  He goes on three legs and

  No firmer than a child

  He wanders like a dream at noon.

  The riddle of the Sphinx who guarded the entrance to Thebes is well known: what, she asked, has one voice and is four-footed, two-footed, and three-footed, and goes slowest when it has the most feet? Oedipus, passing by, answered: it is a human being that starts on all fours, is mature on two feet, and then when old has three, as there is also a cane. The Sphinx killed herself when, on this occasion, her riddle was answered correct
ly.

  The philosopher Cicero, who introduced the Romans to Greek thought, was positive about ageing, celebrating the delights of intellectual activities in old age such as civic service, writing, learning a language, and the study of philosophy. But he also listed the difficulties:

  As I give thought to the matter, I find four causes for the apparent misery of old age: first, it withdraws us from active accomplishments; second, it renders the body less powerful; third, it deprives us of almost all forms of enjoyment; fourth, it stands not far from death.

  The Roman poet Ovid was also unenthusiastic: ‘Farewell to laughing, happy love and easy sleep’, and ‘Time, oh great destroyer, and envious of old age, together you bring all things to ruin.’ It has been estimated that about 20 per cent of the senators in Rome at any one time would have been 60 years of age or older. Both Cicero and Plutarch, in their own old age, felt that their years did not earn them the respect they merited. The Roman playwright Plautus created sympathetic old male characters, and in one play points out that an old man should be careful to avoid prating about public affairs, or slipping a hand under the dress of a woman whom he does not know. It has been suggested that from Ancient Egypt to the Renaissance the theme of old age was handled by writers in a stereotyped manner, with similar comparisons being made and little attempt to really look at old age deeply.