Vickie Lynn & the Needle

Today we'll delve into what everyone else is yammering about: Anna Nicole Smith (39). Having plowed through her autopsy reports, at least this commentary will be substantive, ie, a firm basis in reality. And, we look at one of the more interesting drugs she was injecting along with a lot of other public figures: hGH.

The blogs were vicious about her while alive and only slightly less so once dead. She was said to have had a 100 lb. weight loss, body contouring surgery, and liposuction. They said she died of complications after yet another breast procedure. They said she had lupus. They said it was illegal drugs. They were all wrong.

So, just what did the 13 people crowded into that medical examiner's room find? She died accidentally after taking a cocktail of eight prescription drugs, all at therapeutic levels.

She was ill and in need of medical supervision, but her companions in the room noticed too late that the backwater Texas girl who pulled herself up from nothing by her bra straps was "nonresponsive and not breathing." You can hear fait accompli in the officer's voice on the taped call to the paramedics. She was DOA: it took them six minutes of pro forma at the hospital to pronounce her dead.

Officially the postmortem reads: "Accidental death due to acute combined drug toxicity due to ingestion of multiple prescription medications." Toxicology found sedatives (Robaxin & Topamax), anti-anxiety agents (Valium, Klonopin, Ativan, Serax), painkiller (acetaminophen), antibiotics (Cipro), antihistamine (benadryl), atropine, and the metabolites of diazepam (Valium). And they found chloral hydrate, a schedule IV controlled substance marketed as the sleeping aid Noctec. What did her in was the synergistic effect of the chloral hydrate interacting with the other prescription drugs: 7 + 1 = 20. In short, it's called the potentiation effect: right drugs, right doses, wrong combination.

What was she doing? There was no trace of methodone or opiates for the previous few days. Instead, her psychiatrist "friend" had given her a dirty injection of most likely B12 while in the Bahamas. The resulting abscess in her buttock spilled bacteria into her blood stream during the flight and she deboarded one sick puppy: 105 fever, chills, and prostration. Her psychiatrist pal is also the one who gave her the broad spectrum antibiotic (Cipro), OTC painkiller, and the chloral hydrate. The sedatives and anti-anxiety agents were part of her usual arsenal taken in various combinations over the three-and-a-half days she suffered, disoriented and improperly cared for. The atropine was administered by the paramedics as part of the futile attempt to restart her heart and respiration.

What else did they find?

There was extensive scarring of the soft tissues in the buttocks and the right anterior thigh. The latter is exactly what you would expect to find in someone who had been self-injecting hGH since 1999. Like insulin, human growth hormone needs to be injected subcu, because the molecule is too large to be absorbed orally. The coroner misstated that hGH is used for weight reduction. (Actually, the on-label use, sanctioned by the FDA, is to counter muscle wasting in AIDS patients.)

Produced by the pituitary gland, natural hGH levels begin to drop by age 25-30, significantly by age 40. An hGH "deficiency" in adults has exactly the same symptoms as aging. Physicians promoting anti-aging or youthful-aging programs use bioengineered hGH (somatotropin) and other bioidentical HRTs as the centerpiece of their treatment protocol. Human growth hormone increases muscle mass, decreases body fat, improves aerobic capacity, stimulates the immune system, elevates mood, increases bone density and skin thickness, lowers LDL, and ups the libido. Dose-dependent side effects (joint pain and carpal tunnel syndrome associated with fluid retention, insulin resistance) are easily reversed. What's not to love?

Bioidentical hGH has been used illicitly by athletes ever since recombinant DNA technique made it widely available. The 1996 Atlanta Olympics were dubbed the "hGH Games;" no blood test is available. The hormone can only be indirectly measured by it's metabolite IGF-1, already present in healthy young athletes. And it's not just for Olympians anymore! Pitcher Jason Grimsley told IRS agents last year that "boatloads" of big league players use hGH: Jason Giambi, Barry Bonds, David Sequi, Gary Matthews Jr, John Rocker, just to name a few.

Sylvester Stallone's (60) recent bust by Australian custom agents underscores the widespread usage by body builders as well. The last two winners of the Arnold Classic, Victor Martinez and Ronnie Coleman, are both associated with accusations of hGH use. It's not a steroid; steroid molecules have a basic chemical structure consisting of four interconnected carbon rings. But it is a hormone, available by prescription only. In the USA, any physician can write a script for off-label use and the pharmacist can legally fill it. However, in Australia that's not the case. As Stallone found out:

"...you have not been validly prescribed the goods by any medical practitioner for any medical condition suffered by you, and for which the goods are recognized medical treatment."

Note the Boolian logic of how that Australian law is constructed. If Stallone had been searched by US customs, he would have made it through since no US law would have been broken. That said, look at Stallone's neck. He's got the engorged look of injected testosterone.


Hear Anne live on the Kevyn Burger show 11:00 to noon every Thursday featuring Knifestyles of the Rich & Famous.

Dish - By Request

Pull up a saucer and get ready: today we do our Dish By Request show. Meow! Thanks to all of you listeners who emailed in your must-know video clips and photos featuring knifestyles of the rich and famous.

First we'll start with the boys. I very recently refused to see Wild Hogs, the film about middle-aged men gone wild, but apparently most of you did pay the $6.50! The four men on a roadtrip (Tim Allen 54, John Travolta 53, William H. Macy 57, and the baby of the bunch Martin Lawrence 42) all play their age and have the bodies to match their parts. They look unoperated. The only juicy tidbit I could discern was Travolta's dependence on an elaborate hair system in his public outings - and, well, other sorts of public outings.

Now supporting actor Ray Liotta (52) is a different matter. Sometime after the wrap and before August 2006, he underwent eyelid surgery and what appears to be microfat transfer to his face. (The patient's own fat is carefully withdrawn, processed, and re-injected in micro droplets where acne scarring is present.) His handsome bad boy look has been replaced by a freakish squint and distorted mouth. He has what may be the worst upper lid blepharoplasty I've seen in a male star - look carefully and you'll see the incisions. His hooded eyes are now slits, a permanent squint and even lower brow line. About 50% of the transferred fat will reabsorb by one year's time, but it accentuates the creases of his oral commissure and unbalances the lower third of his face.

Katie Couric (50) is the nightmare patient: the surgeon's work is on high-definition view every evening for the world to judge (okay, CBS only pulls in 7 million). Fans everywhere panicked when America's smiley cheerleader transformed into a glowering anchor - a forehead that didn't move, eyebrows sharply arched. Oh no! Oh yes: botox injections require quite a bit of finesse and there was an obvious learning curve here. Her glabellar muscle was over-treated, springing the eyebrows apart and depressing the medial (inner) two-thirds of the brow. The outer third of the brow is released upward by injecting the lateral canthal area of the obicularis muscle which encircles the eye orbit. Too much and the result is that classic look-of-death that children receive from their mothers when teetering on the edge of public misbehavior. What you see on-camera now is a more skillful application of botox. The injections weaken, but don't freeze, the muscles of the forehead and the eyebrows retain some natural expressiveness.

And everybody's favorite girlfriends? Courtney Cox (43) says:

There are huge changes in my body and my face, and I obsess over them. I just try not to have too many mirrors around.

Her new show Dirt is all about remaking her into a mean, evil muckraker. The lighting, make-up, and camera angles all conspire to erase her charm and good looks. Combine that with weight loss and the natural facial fat atrophy that occurs with the onset of one's 40s, and you have the changes on display. Courtney Cox's only obvious surgical intervention has been lip fillers. Her surgeon has done a good job maintaining the natural lip proportions for someone of her ethnicity (the lower lip is 1.5 times the size of the upper lip). But she could look a lot better if she gained some weight.

And all that broo-ha-ha about Jennifer Aniston's (38) cleavage at the People's Choice Awards? Puh-leeze, ask any tranny, adhesive tape is a girl's best friend. Combined with a tight-fitting bodice you get the look Aniston was sporting that night. She has openly discussed the revision septoplasty recently performed by a prominent Beverly Hills facial plastic surgeon (her first was 12 years prior). Straightening her c-shaped deformity probably required some work on the nasal pyramid as well; it's difficult to straighten either the external nose or the septum in isolation.

And sadly, we have to report that Sharon Stone (47) has effectively erased her glamor. The lovely, subtle threadlift she underwent a few years ago has been poorly revised along with the installation of a set of breast implants. Basic Instinct II has been called

....a prime object lesson in the degradation that can face Hollywood actresses, especially those over 40.

Her face is now strangely inert and ill-at-ease, her breasts Barbie-like. She's become oddly generic and striving, the opposite of her former cool, blond self-assurance. Let's just remember Sharon as she once was (at right). See the movie if you want reality.


Hear Anne live on the Kevyn Burger show 11:00 to noon every Thursday featuring Knifestyles of the Rich & Famous.

Ethnic Surgery

Today we talk about ethnic surgery and what values are reflected in the Hollywood stars who chose to undergo the knife (or not).

Market studies report that African-Americans buy movie tickets at higher rates than any other ethnic group. The 79th Academy Awards were the most colorful ever: 8 of the 20 actors nominated were African-American, Mexican, Spanish, Asian, or African. Forty percent! Three African-Americans walked away with statues. Ten years ago never have seen Eddie Murphy, Forrest Whitaker, Djimon Hounsou, and Will Smith all simultaneously up for Oscars. Their looks epitomize the black male - they carry all the characteristic features of their race in very handsome fashion.

Adrianna Barraza, Rinko Kikuchi, and Jennifer Hudson were all up for Best Supporting Actress along with Penelope Cruz for Leading Actress. Barraza gained 35 lbs. to play her nanny role in "Babel" but this is less a stretch for Hollywood. Ethnic minorities historically have played character parts, particularly as "the help." Rinko Kikuchi got her role on sheer grit: she spent a year attending a school for the deaf in order to be fluent in sign language - and this was before she got the Babel part. Yet she showed up at the Globes as a blond, bleached brows and all. At the Oscars she morphed to a light brunette. She's tall, has a rounded western eye, and high nasal bridge. These last three features may well be natural, but it's certainly not characteristic of the Japanese race. Hudson has been hailed as "fresh" and "original." Both her talent and looks qualify on that point. As a dark skinned, classically black African-American woman making it on talent, she is a Hollywood anomaly.

Penelope Cruz floated in for her Best Actress nomination with just a touch of filler in her lips. Known for going topless in eight films, some of her scenes border on pornography, but all her equipment is real. They're good documentaries on how natural breasts function (they really are more fun than implanted ones). Yet, in her newest release Volver she strapped on a prosthetic bottom to fill out the role. She has this to say about Hollywood:

The most difficult thing in the world is to start a career known only for your looks, and then to try to become a serious actress. No one will take you seriously once you are known as the pretty woman.

All plastic surgeons will tell you that they are in the business of helping their patients "look their best." So how does looking your best become conflated with racial mores?

The poster children for race surgery are the Jackson family. Michael, Latoya, Janet, and now Jermaine have all but eradicated their ethnic heritage. Their judgment was clearly skewed by a weird infantile Caucasian aesthetic (perhaps influenced by early careers as child stars?) and resulted in rhinoplasties not found in nature – yet nose reshaping is the most common choice of cosmetic surgery among not just African-Americans but Asians and Hispanics as well.

Beyond having the bridge of the nose heightened, women of Asian heritage undergo cosmetic surgery to have their eyelids restructured. About 90% of that population has an epicanthal fold, yet they opt for epicanthoplasty, a procedure that forms a "double eyelid crease." It provides a more open-eyed look. A more Caucasian look.

South American tastes influence Latina women to favor large nalgas. That preference has migrated north to Hollywood (think Jennifer Lopez). Yet, as thin has become the fashion manifesto, augmentation surgery has risen in popularity. Gluteoplasty uses two distinct methods, neither entirely satisfactory: solid or semi-solid implants (usually silicone) or fat grafting (harvesting the patient's own fat and injecting it into her rear). The implants can cause significant scarring as well as shift in their placement. And no, they don't feel like the real thing. More common is the fat transfer, but only about half of the most carefully grafted fat remains at one year.

Traditionally, the motives for cosmetic surgery amongst minorities were to erase ethnic characteristics. Thirty to 40 years ago immigrant Italian and Jewish patients sought out surgery as a means of assimilation. From 2000 to 2005 there's been a 65% increase in racial minorities seeking cosmetic surgery, 91% of them women. Beyonce reflects that trend: breast implants, rhinoplasty, lips thinned, thighs starved, hair lightened and straightened. Academics say:

The beauty ideal has been white for a very long time. I think it's a little bit naive to say it [ethnic plastic surgery] is about personal esthetics and choice. That negates 400 years of history. The image that's in women's heads when they walk into a surgeon's office, when they think of 'proportionate' — that's very much shaped by the images they've been consuming in the media.

That's how Jennifer Hudson is changing Hollywood for women of color on-screen and off. She didn't gain entree as a "sepia sex symbol" ala Dorothy Dandridge. She did it like this year's male African-American nominees: on authenticity and talent. What happens in Hollywood mirrors the sexual, ethical, and racial double standards found in America and a shift in one brings about change in the other.


Hear Anne live on the Kevyn Burger show on Thursdays featuring Knifestyles of the Rich & Famous.

Looking Your Age

Trawling dating websites looking for an appealing late-40s to early-50s man can be a depressing experience. Most of them are older, uglier, and less fit then the women who are looking for them, yet those same men specify wanting women who are younger than themselves. What's up? What on earth do they see in the mirror?

Women that same age see something entirely different in every reflective surface they pass by. And they feel pressure to do something about the changes they see. The mere availability of procedures has heightened the pressure on women to consider a level of intervention that until recently was indulged in by only the famous or the rich. Women in America are involved in an internal debate, a negotiation with appearance, about how much they are willing to intervene.

Even AARP, the bastion to combat ageism, is jumping on the bandwagon with this month's magazine: Look Younger Now: Erase Ten Years (or More)! Is looking one's age something to be disdained, just on principle? Or a matter to be treated like shaving or a manicure? And where do you draw the line and why? Hip haircut? color? teeth whitened? veneers? or the blue plate special: head-to-toe surgery?

Three of the most recognized women in power today, Hillary Rodham Clinton (59), Oprah Winfrey (52), and Condoleezza Rice (53), have each answered the question in different ways.

Hillary Clinton has long been accused of having plastic surgery performed on her face, most loathsomely by John Spenser. Clinton adviser Howard Wolfson says she has had no plastic surgery or similar work. As an elected official, she's very well styled, her makeup and hair are perfect, and with good lighting she photographs well. Or not. She shows no obvious signs of a traditional cut and drape facelift. She did, however, seek out plastic surgery consultations and a lot is possible without obvious scarring. The surgeons' gossip is that work was done during & after the impeachment period when she was out of the public eye. If she has chosen an intervention, it was done very discreetly.

Billionaire Oprah Winfrey (52) can afford anything. While she has explored the topic on her show, Oprah categorically denies having any plastic or gastric surgery. Given her brilliant smile and difficult childhood, she most likely has had her teeth capped and probably subscribes to the usual Hollywood upkeep of botox. Her on-air and covergirl personna is carefully crafted to make the most of her looks. But remember, it takes hours, hours, of prep at the hands of professionals to achieve that glamour.

Condi Rice (53) is often caricatured for her gap tooth smile & famously furrowed glabellar scowl. But she's a natural: that's all original equipment there and she does her own hair and makeup. (None of these three women wear their hair naturally.) Her African-American heritage gives her an edge: her skin is thicker and less prone to wrinkling at any age, even with the cares of state.

At 50 you don't feel old. Where do you draw the line about looking your age? The Dove Pro-age campaign wants you to embrace middle age, even if broadcasters won't. Pro-age is about aging in the best way possible. Bobbi Brown in her new book Living Beauty advises that drastic changes are not needed. You are not walking the red carpet nor appearing on prime time media outlets, so "let go of some of the pressure," says Brown. Use any of the options available that you feel comfortable with– but remember, it's not about defying age, turning back the hands of time, or looking 10 years younger.

It's about looking good at the age you are.



Want this look? According to technique a facial plastic surgeon may charge: standard face lift $6,000-$15,000; midface lift $4,000-$10,000; threadlift face lift $2,000-$6000. In addition, eyelid surgery, brow lift surgery, and facial liposuction can be performed and increase the cost of treatment.

Oscar Fabulous

Being fabulous! Isn't that what the Oscars are all about? We're all vicarious Cinderellas, dreaming about being fabulous. Is it the perfect dress and makeup that makes the star? Or are they manufactured out of silicone, restalyne, hair extensions, and cash?

This year's Academy Awards was all about the revenge of the Real Girls. Jennifer Hudson overpowers Beyonce (you think that hug at the moment all cameras were on Jennifer Hudson wasn't calculated?) because she's real. Beyonce is as Hollywood as they get: a manufactured beauty. She's had her breasts done, her nose thinned and tip made pointier, hair straightened and dyed, starved her thighs. It's a volatile topic but she looks less African-American than before. Was she beautiful before? Absolutely– but a Caucasian aesthetic dominates Hollywood and it shows. Just look around at the Oscars. The men are allowed to be deliciously dark, while black actresses have to pass. Jennifer Hudson is fresh in part because she breaks that unspoken rule.

Example #2 of Real Girls' revenge? Nicole Kidman gets the Oscar award for the most obvious surgical intervention: forehead (botox), lips (Restalyne), breasts (implants) or maybe she just padded that big red dress. Her face is painted like an airbrushed masterpiece. As an actress she rarely breaks out of the mannequin role. Now look at her posed next to Meryl Streep. The best line of the Oscars belonged to her and the 14 nominations she's received as an actress so far: I'm a size 14, so it all matches! Do you think Nicole Kidman will have her pick of roles as a 58 year-old size 14?

Listen to what Real Girl A-listers have to say:

I would never ever have plastic surgery. We're all just going way too far. I know it's a product of the whole celebrity industry, but it's something I absolutely detest. I want my daughter to see what is real, not what is unachievable and fake.
– Julianne Moore, 46

[Plastic surgery] makes these people, actors especially, fantasy figures for a fantasy world...acting is about being real, being honest.
– Kate Winslet, 32

[P]eople who look too perfect don’t look sexy or particularly beautiful.
– Rachel Weisz, 36

Death is not going to be any easier just because your face can't move.
– Cate Blanchett, 37

The bottom line: if you're trading on your looks and not your talent, you're going to have a short, desperate career in film. I'm putting money on the Real Girls: they'll have longer, more fulfilling careers and their film output will be more memorable.

So, what makes Real Girls fabulous? What gives them light-up-a-room star quality? There's an often retold (but true) tale of Marilyn Monroe walking incognito down a busy street, just another hausfrau in a headscarf, offering to demonstrate this very principle to her companion. She simply turned on her star persona and in a moment had that New York city street at a standstill. No grand gestures, no lighting, no make-up, just that switch in attitude.

So all you vicarious Cinderellas: go out and be fabulous.


Hear Anne live on the Kevyn Burger show on Thursdays featuring Knifestyles of the Rich & Famous.