Beyond Botox

Age-defying alternatives offer safer (and effective!) results.
By Kate Hanley

Neurotoxin injections, laser resurfacing, chemical peels: They sound like punishments a comic book villain would inflict upon his victims. But despite the ominous-sounding names, more and more American women are embracing these cosmetic procedures in hopes of keeping their youthful appearance and moving closer to the homogenous ideal of beauty.

Why such an obsession with our looks? “Our culture is undergoing a shift from the power of words to the power of images,” explains Alex Kuczynski, a New York Times reporter who covers cosmetic procedures and the author of Beauty Junkies (Doubleday, 2006). “Looking perfect has become a mark of feminine achievement and worth,” she says, citing Speaker of the House Nancy Pelosi’s immaculate makeup and former New Yorker editor Tina Brown’s professionally blow-dried hair. After all, if we look flawless, perhaps our lives will be flawless.

The problem with idealizing physical perfection is that one wrinkle, age spot, or droop can trigger a downward spiral that results in a dangerous dip in self-love. “Society bombards us with images of perfect female beauty, and it can be hard for women not to judge themselves unfairly,” says Hema Sundaram, MD, a board-certified dermatologist specializing in cosmetic surgery in Washington, DC, and author of Face Value (Rodale Books, 2003). “A lot of women come to me with low self-esteem that borders on self-hatred.” And don’t think women “of a certain age” are the only ones affected by this quest for perfection: According to the American Society of Plastic Surgeons, women age 20 to 39 had just over 1 million Botox injections in 2008, while more than 227,000 sought out wrinkle fillers such as Juvéderm and Restylane.

No matter how old you are, the way to find true beauty, Sundaram says, is to embrace what makes you unique and then learn to nurture those qualities. She believes that meditation can help people develop self-compassion, which allows them to appreciate their unique beauty rather than seek to erase anything that falls outside of society’s norms. (See “Meditation on Inner Beauty,” page 32, for her seven-minute contemplative practice.)

But just because you’ve made peace with your freckly complexion, smile lines, and wattle-in-training doesn’t mean you should forego a beautifying skincare routine. After all, the skin is the body’s largest organ, its first line of defense against harmful bacteria and environmental toxins. A measured regimen can help the skin perform these functions properly while allowing you to age gracefully. And that can include safe alternatives for even the most popular conventional dermatologic treatments. While they may not offer the dramatic results of a surgical face-lift or injectable filler, these natural treatments can help protect your skin and make you look and feel beautiful, no matter your age.

Conventional treatment: Botox
Botox treatments involve injecting a minute amount of the neurotoxin botulinum toxin type A into the skin to temporarily paralyze the facial muscles that contribute to wrinkle formation. The procedure requires several injections, depending on the size of the area being treated. Poor application can cause droopy eyelids or brows, skin buckling, or a telltale “frozen” look—no movement in the forehead at all.
Alternative: Hypnox
This 25-minute guided meditation ($24.99, CD; $14.99, MP3; promotes overall relaxation and helps you “unlearn” the unconscious muscle contractions that lead to wrinkles, such as habitual lip puckering, squinting, and frowning. Pop in the audio CD as you hop into bed at night; a soothing female voice guides you through a full-body relaxation, with specific instructions on how to release chronically overworked facial muscles. Although hypnosis can’t compete with the paralyzing effects of Botox, this needle-free alternative helped me remember what an utterly relaxed forehead felt like so I could then recreate that feeling as I went about my day.

Conventional treatment: surgical face-lift
This operating-room procedure begins with an incision. The plastic surgeon then separates the skin and facial muscles from the deepest facial tissues; removes excess skin, fat, and/or muscle; and staples or sutures the lifted tissues back into place. Like any major surgery, a face-lift includes general anesthesia and its attending risks. Serious swelling and bruising can result—doctors counsel patients to recuperate for two weeks before resuming normal activity. Other potential side effects include scarring, nerve damage, and chronic pain and numbness. And let’s not forget a face-lift’s price tag of $7,000 to $9,000.
Alternative: lymphatic drainage treatment
This noninvasive process promotes flushing of your lymph system—the series of ducts and glands that gather cell waste and secrete it from the body—using a pneumatic pump attached to two hollow glass tubes via rubber hoses. A facialist applies a serum to your face, places the open ends of the tubes on your skin, and turns on the pump. She then rhythmically glides the tubes over your face toward the lymph nodes in the neck. This treatment “encourages the lymphatic valves to contract and release, causing lymph to move, resulting in the removal of toxins and distribution of nutrients to the skin cells,” explains Monica Watters, a New York City–based holistic aesthetician. “Once the waste is removed, your cells become much more receptive to the nutrients your bloodstream is continually delivering. As a result, your skin looks flush and vital—I call it a ‘natural face-lift.’?” Watters suggests clients add lymphatic drainage to every facial; the treatment costs between $80 and $105.

Conventional treatment: microdermabrasion
Using friction, this exfoliating treatment abrades the outermost layer of dead skin cells to reveal cells just beneath the surface; this reduces visible sun damage, hyperpigmentation, and acne scarring. A dermatologist presses a device against your skin that simultaneously sprays water and an abrasive element (most commonly aluminum oxide crystals, which give sandpaper its grit) and vacuums up dislodged cells. The safety of aluminum oxide is controversial—it’s very rough, and its high aluminum levels have been linked to Alzheimer’s disease. Another form of microdermabrasion uses a wand with a tip that’s embedded with tiny diamond particles to slough off skin cells. Depending on how deep the dermatologist goes, the procedure can be painful and result in redness that persists for several days.
Alternative: gentler microdermabrasion
Safer types of microdermabrasion use sterilized salt crystals as the abrasive element—much softer than aluminum oxide—or diamond-tipped wands that don’t penetrate as deeply. I had the latter done and noticed the vacuum’s suction more than the abrasion—the procedure was mildly uncomfortable but certainly tolerable. My skin was slightly pink immediately afterward but by evening it looked positively radiant. There are also at-home microdermabrasion kits, such as Zia’s Natural Microdermabrasion Kit ($79.99;, that come with battery-operated brushes, aluminum-free scrubs, balancing toners, and moisturizing serums.

Conventional treatment: synthetic fillers
Hyaluronic acid is a naturally occurring substance in the skin that the body uses to make connective tissue and lubricate joints. However, the hyaluronic acid used in wrinkle fillers such as Juvéderm, Restylane, and Perlane is created in a laboratory and derived from bacteria. Injected beneath deep wrinkles or into a general area such as the lips, the hyaluronic acid molecules break down, bind with water molecules, and swell, smoothing the appearance of wrinkles. A treatment typically lasts six to nine months and can cause severe swelling and bruising. Kuczynski’s lips swelled to “the size of a yam” after a Restylane injection, she said. Elina Fedotova, a Chicago-based cosmetic chemist, aesthetician, and founder of the Association for Holistic Skin Care Practitioners, calls fillers a horrible idea. “Any time you inject a foreign substance, you trigger your immune system and you can’t be sure how it will react.”
Alternative: facial acupuncture
This new application of the ancient Chinese art directs blood flow to where needles are inserted and relaxes muscles that may be contributing to wrinkle formation. The acupuncturist may also insert needles into trigger points on your body to address systemic issues such as sluggish digestion that could be affecting the skin’s appearance. You may feel a slight pinch upon insertion since the skin on your face is so thin. But once the needles are in and you’re left to rest, the treatment becomes profoundly relaxing—which also promotes a natural radiance.

Conventional treatment: laser resurfacing
A laser burns off the outermost layer of skin to remove sun damage, diminish acne scarring, and smooth out fine lines and wrinkles. It also penetrates the deeper skin layers, which stimulates new collagen growth. The goal is to wound the skin so that it will grow back stronger and more vibrant. Unlike chemical peels or microdermabrasion, laser resurfacing gives doctors more control over how deeply they penetrate the skin. “A normal outcome of laser resurfacing is redness and swelling for three to five days and pink skin for a week or two after,” Sundaram says. The Mayo Clinic reports that skin may remain pink for as long as nine months, and the International Rosacea Foundation cautions that results can be “disastrous” if your skin scars excessively or develops hyperpigmentation after burning.
Alternative: gentler light-wave treatments
Several treatments use less invasive forms of light waves to improve skin, including cold lasers, Intense Pulsed Light (IPL), and light-emitting diodes (LED). Where traditional laser resurfacing treatments use a slash-and-burn approach, these techniques “work like sunshine on flowers,” Fedotova says, “by bringing energy from light to cells deep in the skin and helping them grow.” Of the three, IPL is the most dramatic because, like a laser, it inflicts a low level of damage on skin cells, stimulating their innate healing response to grow back stronger. Cold lasers and LED treatments don’t actually heat the skin, Fedotova says—they deliver the stimulating effects of light waves without the damaging temperature jolt.

Conventional treatment: chemical peels
Peels exfoliate the outermost layer of skin in order to penetrate the deeper layers and stimulate collagen production. A dermatologist applies creams containing various concentrations of acids, such as alpha hydroxy and/or beta hydroxy, to the face. “The acid penetrates the outermost layer of skin, which then sloughs off via peeling,” Sundaram says. Most peels tingle, but those with higher concentrations of acids can be painful. Varying levels—from mild to extreme—of redness, irritation, and peeling can result, and typically last several days.
Alternative: fruit enzymes
Many fruits contain natural hydroxy acids. Regular use of a fruit enzyme mask, such as Dr. Alkaitis’ Organic Enzyme Exfoliating Mask ($45, 4 oz;, or a cleanser, such as Juice Beauty’s Exfoliating Cleanser ($22, 4 oz;, or adding a fruit-based peel to your next facial, delivers hydroxy acids in much lower concentration, yet with similar (albeit gentler) benefits.

Conventional treatment: Thermage
To tighten and firm skin, doctors apply a handheld device that emits radio frequencies, which penetrate and heat the deeper layers of skin while cooling the top layer (in order to minimize discomfort). The heat essentially traumatizes the cells and spurs their natural regenerative properties. Thermage can be painful (doctors use a local anesthetic and/or oral pain medication before the procedure) and the results uneven. Blistering, burns, discoloration, and loss of sensation can occur. At, where patients weigh in on cosmetic procedures, only 37 percent of reviewers thought Thermage was worth the $2,000 to $3,000 price tag.
Alternative: ultrasound treatment
Many aestheticians use an ultrasound machine, which emits radio frequencies to “stimulate skin cells through vibration, providing almost a flatiron effect,” Fedotova explains. Used to diminish wrinkles and lessen the appearance of scars, ultrasound also helps ingredients in serums and masks sink into the deeper layers of skin. This can be detrimental if the products your facialist uses contain harmful chemicals. “Ultrasound penetrates down to the blood level, so you have to be very careful to use it with only the purest, most natural products,” Fedotova says.

Conventional treatment: retinoids
These lab-synthesized vitamin A derivatives (the most well-known is Retin-A) are used to treat acne, improve fine lines and wrinkles, and smooth texture. Available only with a prescription, topically applied retinoids exfoliate the skin’s outermost layer and unclog pores. They also penetrate to the dermis, the skin’s middle layer, where they stimulate collagen production. Retinoids greatly increase sun sensitivity—users must always wear sunscreen—and cause redness, irritation, and extreme dryness, particularly in those with sensitive skin. Because high doses of vitamin A can be toxic, retinoids and retinols are not recommended for pregnant or breast-feeding women.
Alternative: retinols
Retinols—naturally occurring forms of vitamin A—are a gentler, over-the-counter version of retinoids. MyChelle’s Clear Skin Serum ($31.95, 1 oz; contains retinol to promote healthy cell renewal and collagen production.

Meditation on Inner Beauty

Sit somewhere peaceful with your spine straight, legs crossed, and hands lightly clasped and resting in your lap.
* Close your eyes and take several deep breaths, inhaling though the nose for a mental count of 10 and exhaling through the mouth for a count of 10.
* Continue breathing deeply and rhythmically. Begin to visualize your thoughts as wisps of white smoke. Notice how the quantity and quality of the smoke shifts, grows, and abates over time.
* As you relax into the practice, visualize yourself moving closer and closer to the smoke.
* Now visualize a brilliant orange flame just on the other side of the smokescreen—this represents the deepest, wisest part of yourself. Continue drawing closer to the smoke until you pass through it and come face to face with the flame.
* As you continue breathing deeply, notice the flame’s ever-changing beauty. Keep drawing closer to it until you can feel its warmth on your face.
* Stay at least 10 seconds basking in the heat and beauty of the flame. Then slowly open your eyes.

Adapted from Hema Sundaram, MD