Bro-tox and CoolSculpting
How to Cheat Age in the Age of Bro-tox
GQ Magazine by Josh Dean, October Issue
Here, in the sparkling, spa-like office of one of Manhattan’s finest dermatologists, I realize I am taking my first tentative steps onto an awfully slippery slope. Michael Eidelman, M.D., is 46 but looks ten years younger, a fact that is criminally under-utilized in the marketing of his practice, considering that his fresh-looking, tastefully unlined face is at least partly the result of Botox that he administers himself, using a syringe in the mirror. This is not the kind of Botox that you notice, the kind that paralyzes every facial muscle, rendering any expression except that of a stupefied newscaster impossible. No, this is a far more subtle application; I’d say it looks natural, except that it isn’t at all.
We are only in the very early days of the Era of Unapologetic Male Beauty, and Eidelman, a dermatologist specializing in noninvasive cosmetic procedures, is something of a pioneer. While the so-called aesthetic medicine he practices—this tinkering with muscle, fat, and skin to combat aging—has traditionally been used exclusively by women, men are now increasingly turning to it in search of eternal youth, or at least an arrested version. Today, roughly 40 percent of Eidelman’s clients at Chelsea Skin & Laser are guys, and he has thrice addressed national physicians’ conferences on this phenomenon of male beautification, giving talks entitled “Bro-tox” and “Menaissance.” The techniques men are trying span a gamut, from eyebrow sculpting to teeth whitening to high-tech procedures that’ll either grow hair where it’s wanted or laser-blast it away from where it’s not. Indeed, if Eidelman’s own busy office is any indication, the sort of procedure that once might have sounded outlandish for many guys is now beginning to sound more like routine upkeep. “What I’m seeing more now is, like, a straight stockbroker who just wants to look good,” Eidelman tells me. “These people would never have come in before. They’re taking care of their bodies, and they know it’s not a big deal.”
The number of men seeking Botox has increased 310 percent since 2000, according to the American Society of Plastic Surgeons, and a similar boom is happening with other noninvasive procedures like filler and laser treatments. These days you can even erase your paunch by freezing away fat cells. Combine the availability of easy outpatient treatments with wider cultural acceptance and an increased emphasis on the value of youth in the workforce and what you’ve got is the makings of a mini-revolution.
At Eidelman’s office, he often delivers a suite of treatments that includes fillers like Restylane, Juvéderm, and Sculptra to reverse sunken eyes and cheeks, and intense pulsed light (or IPL), which reduces sun damage and red spots from broken blood vessels. Some patients get one or two; others go whole hog. Me? I’m not sure. I hate aging as much as the next guy, and it will probably take great resolve one day to curb the urge to dye my hair when salt overwhelms pepper, but I’m also kind of scared of needles and terrified of looking like some kind of plasticized freak or, worse, a newscaster. Eidelman understands. He’s a kind person with a pleasant manner. He somehow doesn’t seem at all insulting when, within minutes of my arrival for a consultation, he begins to pick apart my flaws.
He had asked me to bring along a picture of myself ten years ago, when I was 30, and that photo—featuring a brighter-eyed, less gray version of myself somewhere on the Inca Trail in Peru—stares eagerly back at me from a tray next to the exam table where 40-year-old me is clutching a hand mirror.
“Every face is individual,” Eidelman says, standing over my shoulder and looking for areas where my face has aged. “Much as it is a science, there’s an art to it, too.” The treatments he suggests will be administered in an iterative process while Eidelman perfects “the recipe” for a regimen that will be repeated two or three times a year. One advantage of a doctor like Eidelman who specializes in these cosmetic treatments—as opposed to a mere family doctor who dabbles in them, or the staffers in the strip-mall Botox factories you find in affluent exurbia—is his careful attention to detail. We both notice the heavy lines on my forehead, and he begins to poke and pull at them, stretching the skin and then allowing it to slacken and fall back into place. He could smooth those lines with Botox, though one risk of overdoing it is making the brows so heavy they droop. “We can do some softening in that area and create a natural look,” he explains. Occasionally patients come in and demand to erase all lines. And in those cases, he tells them they’ll ultimately start looking pretty tired. “Then you end up with an effect like this,” he says, and pushes my forehead skin downward, giving me the sad eyes of Droopy Dog.
Eidelman continues with his lesson in the anatomy of facial muscles and the savvy application of neurotoxins. He points out the crow’s-feet near my eyes. “That’s from smiling, which is a good thing,” he says, and he zeroes in on my glabellar wrinkles, a.k.a. “the eleven,” those two lines that form between the eyebrows. All can be fixed. “You also look like you have some sun damage,” he says, pointing at the freckles and other dark spots that have clustered on my cheeks in increasing density over the years. That could be cleared up with the IPL treatment.
He picks up my photo. “What I notice is that your cheek has changed a little bit in its shape, and your chin.” This is a very typical change that occurs with aging, as we lose some of the fat that used to hold the cheeks up. In men, it also tends to happen under the eyes and at the temples. The result is a visage that can appear limp. To provide some smoothing and lift to my features, Eidelman says, he can use a filler that he injects just below the surface to make up for some of the volume I’ve lost over the years.
I’ve been with him through the neurotoxin injections and the light treatment, but something about the fillers—about inserting under my skin a viscous gel that I’d likely need to replenish in a few months—makes my stomach jump, and Eidelman senses it. “Usually the fillers are not something we do on the first visit,” he says, patting me on the shoulder. Fillers take longer to administer and tend to cause some redness and swelling. But every person reacts to treatments differently. Some patients go straight back to work. “You have to get to know a person to see how they do.”
Eidelman hands me back my picture. The options are a lot to process, and what surprises me isn’t that I’ve taken the critiques of my face in stride. It’s that some of these things seem easy and painless enough that I’m seriously considering going through with them. “Don’t worry,” Eidelman tells me, “I wouldn’t do anything to you that I wouldn’t do to myself.”
I am not a terribly vain person, which is different from not being vain at all. I feel few societal pressures to be prettier or younger. My job as a writer doesn’t require it, and I’m married, which means my wife is legally bound to be attracted to me, or at least pretend. The thought that I might be too old for anything has honestly never entered my mind, not even when it should, like when I’m snowboarding or playing pickup basketball with teenagers.
Then I turned 40—a symbolically fraught age that always seemed impossibly distant—and began to notice the effects of growing older more clearly. Suddenly I was the age of baseball coaches, not baseball players. This should be fine; after all, the culture has long accepted us guys wrinkles and all. But at some point, maybe when husbands began to see the simple improvements their wives have undertaken for eons—or perhaps when Simon Cowell admitted that he was such a youthful 53 because his beauty regimen included a few hundred push-ups per day, lemon bath milk, and Botox—guys have begun to unabashedly chase the dragon of youth, too.
“I think men are starting to realize you can get this stuff done without looking like you had it done,” says Cliff Kohler, a 38-year-old retired Air Force captain who now works in the pharmaceutical industry. “People say, ‘Oh, you look so much more rested.’ ”
Kohler got his first Botox injection when he was 26 and has since added regular filler treatments under his eyes. He’s recently come back from a job interview in Texas and tells me the interviewer used the word youthful at least four times. When the economy tanked, Kohler says, numerous friends sought treatments precisely because of the tightened market. “They wanted to look younger.”
Those guys were ahead of the curve. In Silicon Valley, where Mark Zuckerberg’s pronouncement that “young people are just smarter” has been adopted as a foundational tenet, the pressure to appear youthful is crushing, says Vic Narurkar, a San Francisco dermatologist who told me he’s seen a “significant increase in men looking for appearance-enhancing procedures in the last three or four years.” Narurkar does a lot of Botox and laser procedures on the skin—especially for men with broken capillaries in their noses who fear looking like drinkers—but lately he’s been seeing more and more male patients attracted by a fat-cell-freezing procedure called CoolSculpting.
Approved by the FDA in 2010, the procedure was pioneered by doctors in Boston who discovered a commercial application for a common phenomenon: Applying a cold object to the skin can kill fat cells. They used this insight to help develop a machine that dermatologists like Narurkar now use to kill up to 20 percent of patients’ fat cells.
The device is a wand that looks like a large vacuum and is held outside the body, affixed to a chunk of fatty flesh about the size of a stick of butter. Doctors apply the wand to the love handles or the pooch, and over the course of an hour or two, it freezes the fat cells in those problem spots; with a little massaging from a doctor, the dying cells are reabsorbed into the body and eventually pass harmlessly in the urine.
Narurkar says he was so taken by the results that he began having a colleague treat him. In his estimation, it’s more effective than liposuction and of course doesn’t require cutting anyone open. But he says CoolSculpting isn’t a weight-loss strategy; that’s not the point. “In New York and San Francisco, people are in reasonably good shape, but they have stubborn pooches. That’s the perfect patient,” he says. One of Narurkar’s clients, a 35-year-old paramedic who had the procedure before his wedding, estimates that it took off the equivalent of four to six pounds and tightened his midsection. He now recommends it to friends “who can afford it and need that extra bit here and there taken off.” As for him, “I’m married now, so I don’t care as much.”
At first, I felt something similar; deep-freezing my gut sounds highly unnecessary. But then again, I can’t deny that fatherhood has made me a little softer in the middle. And plenty of guys are doing it. I decide that I’ll simply keep an open mind—which feels better than fretting over that slippery slope I’m now negotiating.
The first decision I made was to get the Botox. And the Dysport, which is another neurotoxin from another pharmaceutical company that differs from Botox in some nuanced way that only a dermatologist or drug salesman can appreciate. And you know what? It wasn’t bad, just a bunch of needle pricks, and Eidelman did exactly what he said he’d do; he refreshed my face, in some cases eliminating finer lines but mostly softening the deeper ones so that the end result looked basically like the me that walked in, only less tired and with a slightly numbed forehead. The biggest difference was how my face felt: The sensation of my fingers on my own newly smooth and kind of numb skin felt unfamiliar, like I was sliding them across the cold pleather of an airline seat.
When I got home, my wife looked at me suspiciously, then came in for a closer examination. “You look the same,” she said, and asked me to frown. “Hmm. Now smile. Okay, the crow’s-feet are gone.” She studied my face. “Can you get me Botox?” she asked.
I was realizing that the ease and painlessness of Botox made it the gateway drug of the noninvasive-cosmetic world. Once I tried it—and liked it—the heavy stuff seemed less scary. I wasn’t ready to go full Kardashian, but I was curious. By the time I was back at the clinic a few weeks later, chatting with Eidelman over the tinkle of Spanish guitar jangling from his speakers, I had decided against the fillers. My eyes may look a little sunken compared with Inca Trail Josh’s, and I can see where I’m thinning a bit in the cheeks, but it’s not that dramatic, at least not to me. Plus, I feared the risk of pain and bruising and especially having to explain said bruising to people. I did, however, succumb to the light treatment that promised to smooth out my skin tone and eliminate sun damage and other blemishes of aging.
“Of all the things I do, intense pulsed light is the one that people complain about most,” Eidelman says, sliding the frosted-glass exam-room door closed. “It feels like a hot rubber band snapping on your face.”
This surprised me. Last time, he’d made the point that some women—and only women—come in for full-body IPL, to erase all those years of beach-sun damage one tiny light blast at a time. Wouldn’t that be torture? “I don’t want to make a sweeping generalization, but I think with women, especially those who’ve had babies, they have a different perspective on what’s painful,” he says. Even enduring the routine agony of cosmetic chores like waxing seems somehow unremarkable to many women. Eidelman clicks on a gray appliance from which he pulls what looks like a clean plastic gas-pump nozzle while an assistant covers my eyes and tapes them shut. Next, I feel a coating of pleasantly cool ultrasound gel applied to my right cheek.
The procedure works by injecting heat into pigmented areas of the skin. The machine hunts for red (a sign of busted blood vessels) and brown (freckles and sun spots) skin and uses the intense heat of the light to zap the discoloration away.
The assistant hands me a foam ball to clutch in case of pain, and I feel Eidelman settling his light blaster into place, resting it on the patch of cool gel. “And here we go,” he says. There’s a flash of red, a short, searing blast of heat, then the acrid smell of burning hair.
How was it? he asks.
“Not bad,” I say. “Exactly like getting snapped in the face with a hot rubber band. So, nice work, whoever came up with that.”
“Oh, good,” he says. “We’ll do one side and see how you do. Usually people want to do the majority of their face. But everyone’s got a different pain threshold. If you have to do thirty whacks with a rubber band, after the fifth or sixth one, some people are like, ‘I’ve had enough.’ ”
I survive a dozen, or maybe fifteen, and by ten I am feeling like one of those people, wanting to snatch the device and blast Eidelman. But the sensation is more annoying than excruciating, so I suck it up and endure, a real hero of participatory journalism.
It’s over in ten minutes, and by the time I leave the office, the only sign that anything weird has happened to my face is a slight redness in my cheeks. Eidelman has warned me that while the red spots tend to fade away as the body reabsorbs the shattered vessels, the brown spots will “slough up and flake off.” They’ll get worse, then better. And indeed, the next morning in the shower, when I look in my shaving mirror, the freckles are rising and getting dark. I poke at one, and it flakes off.
Two days later, I have noticeably better skin, with a more even skin tone. As with the Botox, it’s a subtle change, and again my wife looks at me sideways: “I think you look the same.” But I can see a difference; it’s clear enough if you know what to look for.
Days pass, then weeks. The average Botox patient comes in two or three times a year, and as I cross the two-month threshold, I catch myself examining my face extra-close in the shower mirror. I can see the results fading just a little, and it gets me thinking. At the outset, I had never considered the possibility that I might go back for more. Now I’m worried about how I’ll feel about my face when things go back to normal. Once you’ve looked refreshed, who wants to go back to tired?
By the three-month mark, the lines begin to reappear, gradually, like little rivulets carving channels into the topography of my forehead. A few weeks later, after my second child is born, I’m not sure if I look tired because I am actually tired or because the Botox is wearing off.
Around this time, drunk on new-parent sleeplessness and resigned to the sudden loss of any free time for exercising, I made a rash decision. I opted to freeze my belly fat, which explains how I ended up in the offices of Arielle Kauvar, M.D., whose New York Laser & Skin Care sits across from Central Park. Kauvar has been using a variety of dermatological lasers for years, but she was also an early practitioner of CoolSculpting. “It really works,” she told me shortly after my arrival. “Removing fat noninvasively has been the holy grail for a long time, and this is it.” She got her first unit in 2009, and “as soon as we had it, there was a line out the door,” she joked. “It’s been running day and night,” with men coming in huge numbers.
We both agreed that the best area for me to freeze would be my paunch, which has grown a bit since I became a father the second time, but there was a problem, she said. One of the only contraindications for this low-risk procedure is the presence of a hernia, and I happen to have one that’s untreated, unfortunately. Thus, we can only target my love handles, so that’s what we decided to do.
One of the many nurses who prowl these halls—all of them women, all attractive—asked me to strip down to my skivvies, put on a gown, and sit in the treatment chair, where I would spend the next four hours. The nurses uncapped a marker and traced an outline around the fatty area before strapping the applicator into place. “This will feel cold,” one of them said, and it did—the sensation of ice meeting flesh, a tingling and then burning, followed by a numbing. Two hours later, they switched sides, but not before aggressively rubbing my numb flank. Kneading my flesh this way allows the dying cells to dissipate into my body, where they’ll be filtered by my kidneys before passing painlessly through my urine. But it was this vigorous massage—imagine a thousand shards of ice shattering under your skin—that was the most painful part of the procedure. Fortunately, within ten minutes the pain passes, and after the whole routine was repeated on the other side, I was sent on my way.
A week later, my flanks were still so numb that scratching them felt like scratching someone else’s stomach. I seemed a little slimmer, with less of an over-the-waistline bulge, but maybe that was just better eating. As my wife routinely lifted my shirt to check for changes, it occurred to me that as with the other procedures, the more noticeable difference was in how I acted rather than how I looked. I’d become surprisingly preoccupied with my body, far more nagged by the supposed faults and enticed by the possible correctives. As for the CoolSculpting, the final results, I was told, would take some time to show, maybe up to two months. By then, of course, the lines in my forehead will probably have deepened and the carousel of self-improvement that I’d uneasily stepped aboard might be depositing me right back where I started, in Dr. Michael Eidelman’s chair.
How Far Is Too Far?
Knowing how to negotiate this slippery slope of male cosmetic vanity requires figuring out what you could stand to improve (without turning your face to plastic).
You’re Noticing Wrinkles and Lines
The fix: Injectable neurotoxins—like Botox—that relax wrinkles. You’ll pay $350 to $550 for a small dose and upwards of $1,100 for large spots like your forehead.
Feels like: A bunch of tiny needle pricks; afterward skin may feel numb for a few hours and moving some facial muscles may be difficult.
Your Skin’s Getting a Little Spotty
The fix: Intense pulsed light targets pigmentation to clear the complexion ($250 to $600). The procedure causes sun spots and freckles to darken, then flake and fall off after a few days. It’s also useful in combating facial redness brought on by spidery veins and by the residual effects of acne damage.
Feels like: Getting snapped with a hot rubber band—not entirely painful but plenty annoying.
You Look Tired. All the Time.
The fix: Dermal fillers injected beneath the skin of the face to add fullness, fix drooping, and smooth out deep wrinkles and lines ($600 to $1,100).
Feels like: The pain is minimal because the area is numbed, but bruising and soreness are common.
That Flabby Gut of Yours
The fix: Cryolipolysis—otherwise known as CoolSculpting—involves freezing the skin so that the fat cells beneath the surface die and are then passed through the urine. Perfect for your beer belly ($500 to $750).
Feels like: There’s the acute sensation of your skin freezing before the area goes numb. The thirty minutes of intense massaging afterward is a bit uncomfortable, as is the lingering numbness that can occur for several weeks.