Cigs & Sun

Who said glamor is dead? Catherine Zeta-Jones (37) "out on the terrace, half-nude, very pregnant, and sucking down a cigarette" may typify a defiant backlash in Hollywood. Today we look at the effects smoking on the skin of the rich and famous.

Cigarettes, in combination with sunbathing, is what will build the character actresses of tomorrow– or at least ones who look the part:

"I really like smoking..." Salma Hayek (40)

"I only wanted to quit if it was easy." Courtney Cox (42)

"I smoke. I smoke Camel Lights. I'm not going to stop." Gwyneth Paltrow (34)

"There is a tremendous satisfaction in the spit, and I can do it and not mess up my lipstick." Ashley Judd (38)

"Britney Spears showed off the enormous rock given to her by new fiancé Kevin Federline on the balco

ny of her swish Los Angeles apartment - and then proceeded to empty an ashtray full of butts on to the street below." June 28, 2004, The Mirror (UK)

So who else smokes off-screen? Lindsay Lohan (20), Kirsten Dunst (24), Charlize Theron (31), Drew Barrymore (32), Cameron Diaz (34), Uma Thurman (37), Naomi Watts (38), Jennifer Aniston (38), Nicole Kidman (39), Elizabeth Shue (43) just to name a few. All of these younger actresses are known for their looks and have built a career on them. So what exactly does smoking do?

Free radicals form when the body is exposed to tobacco smoke; these highly unstable and powerful molecules cause disease and damage cell DNA. The cells of your body start behaving erratically, producing a range of responses that make your skin age faster. The immune system is impaired by smoking, as well. (Ask any plastic surgeon, they won't operate on a patient who's actively smoking pre- and post-surgery, movie star or not.)

"Smoker's face" is actually part of the medical lexicon. Lighting up affects your visage on multiple levels:

• restricted blood flow through the capillaries (tiny veins near the skins surface) preventing oxygen and nutrients getting to the skin;
• increased production of an enzyme which breaks down the supply of collagen vital to skin elasticity, accelerating age-related decline;
• reduces the body's store of vitamin A which provides protection from damage;
• inhibits absorption of vitamin C, a vital antioxidant for skin protection;
• continual puckering from drawing on a cigarette and squinting in reaction to the smoke create deep, premature wrinkles around the eyes and mouth.

But the really big film news is the come-back of Mr. Butts. New research shows more cigarettes, cigars and pipes are being smoked in films now than at any point over the past 50 years. An analysis of 150 films produced between 1950 and 2002 has found there are now about 11 depictions of smoking in every hour of the typical film. In the same time period, the percentage of smoking Americans dropped by nearly 45% to just 22% of the population; Hollywood depictions have doubled in the last 10 years.

Of course, there have long been iconic images associated with screen smoking. Audrey Hepburn ignored her mother's beauty tip to: "keep to six cigarettes a day only."At her worst times she chain smoked two to three packs a day. She also suffered from asthma and died of colon cancer at only 63, frail and old for her years. Not exactly what we want to imagine for the sublime Holly Golightly.

It's no secret that cigarettes are the preferred diet aid of the very thin. Kate Moss (33) is regularly photographed with her cigarette, a lighter and a mobile phone as her fashion accessories. And what do they have to look forward to? Here's Melanie Griffith (49) who smokes like a chimney: a poster child for the effects of cigs & sun– and at the outer limits of what plastic surgery can do for her. Take a good look. That's your skin on drugs (nicotine).

Lest you think the media influence is completely to blame for a new generation of smokers, there is one more influential factor: parents. Here's Melanie helping out her daughter, Dakota. Susan Sarandon (60) was quoted as saying "Kirsten Dunst asked me the other day how my skin looks so good. I said: 'Well, first off, don't smoke.' " Do you think Dunst will take her advice?


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

Which Breasts Are Best?

Let's go back to the question of breasts today– and get over it! This month's Jane magazine polled 600 adult women about their breasts: 74% of those surveyed said they were dissatisfied with the shape and size of their own breasts. Let's get this fixed.



























No, Jessica Simpson is not the real thing nor should any woman compare herself to silicone-enhanced breasts. It's like comparing apples and oranges. They're not the same fruit. But just to convince you, let's walk through how the all-seeing eye-of-Anne knows when those ta-tas are altered.

What gives away breast implants? Capsules, growth spurts, ripples, tunnel cleavage, adhesions, rimming, hardness, distortion, disproportion, immobility, scars, supernatural suspension. Shall we illustrate this?

Here's a candid picture of the original equipment from early in her career. Jessica Simpson's breast appear to be a small C-cup, her father's groping comments aside. She's 18 or so in this picture, about the time when breast growth is complete (pregnancy-related changes excluded). In the last eight years, however, Jessica Simpson has had some unusual growth spurts...and even more unusual circumscribed 'weight loss'...all in her breasts. They've been in, they've been out, they've been in again. Currently they appear to be out. Cue the music— "Thanks for the Many Mammaries." Does any of it make her look more or less beautiful? You decide.

In 1992 the FDA effectively took silicone breast implants off the cosmetic market and only recently re-approved them for elective augmentation surgery. Last November the FDA lifted its 14 year near-ban on silicone gel implants. None of this slowed down the current wild popularity of bigger bazooms through plastic surgery.

The viscosity of the filling material is what distinguishes the feel of the augmented breast, since all implants use silicone outer shells. Saline implants are round and filled with simple salt water. Most of what you see on inflated chests is in fact saline-filled and a poor substitute for real mammary tissue. These surgically implanted sacs can feel akin to a waterbed—especially during physical activity. Silicone implants, by contrast, are filled with a synthetic gel, a consistency not unlike a weak squeeze ball. Silicone gel also comes in a variety of shapes and conforms more closely with the natural tear-drop shape of real breasts. Saline implants have a round, balloon-ish quality and are much easier to spot with a quick glance.

A lot of women opt for subglandular placement (under the mammary tissue, over the pectoral muscle). The advantages? It can postpone a breast lift (mastopexy), by adding volume to counter mild sag (ptosis), but this is temporary. Keep in mind that the only thing supporting the implant is the elastic integrity of the skin and breast tissue.

Paula Abdul shows the perils of too much, too late. A subglandular placement requires less recovery time with less post-op discomfort, since the muscles are left intact. Actresses and strippers also prefer it for the enhanced projection. Conversely, a very large implant placed sub-muscular (without tissue expansion which is what post-mastectomy patients undergo) is agony. But it looks more natural.

Other disadvantages to a subglandular placement? Ripples and adhesions. As the implant drops, or settles into place, the surface of the shell can pull on the scar capsule, which in turn pulls on the skin. This produces traction rippling ala Beyonce.

A lot of surgeons operate through incisions you might not guess. The trendiest is transumbilical (TUBA), an approach through a naval incision. Transaxillary (armpit incision) is also popular. An incision hidden in the inframmamary fold (crease under the breast) or peri-areolar are the most common and can give truth to the lie. It also often impairs nipple sensation. Poor Tara Reid.

Placement of the breast implant over the pectoral muscle (subglandular) is very obvious in thin women with little natural breast tissue. The highly technical description is generally "bolt-on breasts." In Hollywood you really can be too rich and too thin. Just Victoria Beckham.

The most common cause of an unnatural appearance? Capsular contracture occurs when the scar tissue that naturally forms around the implant tightens and squeezes the implant into a hard, unnatural appearance. The previous older generation of silicone breast implants were particularly prone to this. No surgeon can completely control for the vagaries of healing and this has caused many stars, from Demi Moore to Courtney Love, to undergo multiple breast operations.

And most tellingly, when you squeeze on a breast– say with a tight bodice– the outline of any subglandular implant becomes more obvious, particularly in thinner, Hollywood-type women. The demarcation of the upper rim of the implant is a dead giveaway. It doesn't happen in nature.

Real, voluminous breasts look like Scarlett Johansson's "girls" in a fitted gown: pillowy with no tunnels in sight.


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

Dish with Lori & Julia

Today we dish with Lori & Julia on FM107. And what do inquiring minds want to know? For starters there's the ta-tas poll published in this month's In Touch magazine: top breasts in Hollywood. The number 1, 2, and 3 positions are held by Scarlett Johansson (22), Salma Hayek (39), Jessica Simpson (26). The tag line is that "they aren't afraid to embrace what nature gave them." Oh, boys and girls, it's a sad, sad day when Anne has to let you down, but...not everything in Hollywood is real.

Yes, we're here to tell you that only one of the above lovelies is wrapping her arms around what nature gave her. The other two are clutching silicone. In an interview, Scarlett Johansson talks about stripping nude for roles: “I’m proud of my breasts. I call them my girls. They’re my charms, my feminine wiles. I’m very comfortable with my sexuality, my body and my face…” In this picture you can see 'the girls' as no surgeon would have ever left them: soft, low, and asymmetric. And, as anyone who's viewed the opening frames of Lost In Translation knows, what you see coming you also get going: body fat is rarely distributed in isolation.

Our other two top polling place winners are sporting the handiwork of a surgeon. Do we really have to tell you that Jessica Simpson has implants? They're as fake as her front teeth.

Actress Salma Hayek sports a look not found in nature: Barbie® is a fiction. How can we be so sure? Just check out the photos from before and after and you decide. Outside of pregnancy, no woman grows breasts in adulthood. Both women appear to have had multiple sets placed.

Says Hayek: "I find it very boring to have to be skinny all the time. It bores me and makes me bitchy. And yet in Hollywood it’s okay if you’re a bitch - as long as you’re skinny!"
Oddly enough, these stripper-size implants make petite women look heavier, unless their clothes are skin-tight or nearly off.

And then there is the question of noses. Jessica Simpson is rumored to have undergone a competitive sibling rhinoplasty (see the post about her sister). Salma Hayek certainly underwent a very skillful tip rhinoplasty well before her breasts.

And what other nose has caught the eagle eyes of Lori & Julia? Michelle Pfeiffer turns 49 this month:

“When I’m rested, I look pretty darn OK. I can hold off on that facelift for another few years....(But) when I’m feeling weary, then I think, maybe I better make that appointment.”

Pfeiffer's nose is narrow and pinched, very 'tippy,' and the nostrils are notched. It's also gotten even thinner with age. All of this is unfortunately common, post-rhinoplasty, in patients with aggressive surgeons– and constitutes an 'over-operated look' (albeit in a very beautiful face). Her nose has looked like that her entire film career; check out stills from 1982 Grease 2. It could be a rare case of nature imitating art. Probably the only way to know for sure about whether her nose has undergone the knife is to locate a high-resolution picture from her high school days.

Courtney Love's (42) nose has certainly been all over the place. In December of 2006 she traveled to France for reconstructive surgery. Very few surgeons are skilled enough to resurrect a nose after it's been previously operated: it's a sub-subspecialty. Why is it difficult? Not only is her tip cartilage over-resected, her nose is very crooked. Revision of a twisted nose is probably the most technically challenging rhinoplasty. The surgeon must correct the septal deviation as well as straighten the 'nasal pyramid,' the bony framework supporting the tissue. And don't forget, you want to breathe through it. Sometimes the nose can be made completely straight; usually some tissue memory persists, reappearing six months to a year post-repair. That's why in the past Courtney Love's nose has sometimes looked relatively good (left) and then not-so-good. To date, her nose has been operated on four times.

The French surgeon also removed the hideous implant material from her lips (probably some form of Gortex). The post-surgical swelling she displayed (far left) at Hilary Swank’s Freedom Writers movie premiere in January 2007 was normal. Once it subsided enough for the result to be evident, she went in March for yet a third revision, probably a dorsal onlay and/or tip graft (near left) along with injected lip filler. She also announced that she had her breast implants removed. And no, she hasn't had a gastric band placed. It's just good old-fashioned weight loss and left-over lumpy liposuction.

And now you know.


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

HDTV & Adult Acne

All right, Mr. DeMille, I'm ready for my close-up.

We all know what happened to Norma Desmond in Sunset Boulevard and we of the 21st century are definitely not ready for our HDTV close-up. Broadcasting in the hot new digital technology makes TV faces look as crisp and sharp as...the real thing and we viewers aren't used to seeing the real thing in Hollywood. Just as talkies and technicolor redefined Hollywood stardom in the past, so too will high-definition, where every feature is in IMAX and in your face.

High definition televisions can display two million pixels, nearly 10 times the resolution of a regular, old-style TV set, on a screen the size of your dining room table. If an actor is aging or if they've got any skin damage, it just pops out at you. Additionally, more colors are used in HDTV, including some new shades of red: all the blotches, zits and tiny nose-veins can be presented with the brutal clarity of a dermatology textbook!

High-def is, in essence, a medium peculiarly unsuited to dissembling.

Who do you think is scary in high-def? Various lists name Teri Hatcher (42) and Rosie O'Donnell (45), underscoring that too little fat in the face looks skeletal and too much can't camouflage coarse skin. And broadcast news may suffer ala Tim Burton's Batman: Meredith Vieira (54) of the Today Show looks her age without botox and airbrushing. On HD-tv older definitely looks older. And it's guaranteed you'll never feel the same about It's Only Rock 'n' Roll after seeing Mick Jagger and Keith Richards on high-def. Both 63-year-old men are walking morality tales for the ravages of drugs, age, and rock 'n' roll.

High-def is particularly unforgiving of bad facial plastic surgery, young or old. It would have long ago spelled the end of tv roles for Michael Douglas (63), Burt Reynolds (71), Cher (60), Joan Rivers (73), Mary Tyler Moore (70), Faye Dunaway (66) and the like.

You can just as easily get slammed in HDTV for having imperfect skin. Many accomplished screen actors have relied on heavy makeup to blend into their parts and erase a legacy of acne, yet makeup artists are ham-strung with this new technology. Bill Murray (56), Tommy Lee Jones (60), Lawrence Fishburne (45), and Cameron Diaz (34) will never again pass for scar-free on television.

It's not enough to be merely young (though it helps). Britney Spears, everyone's favorite pop tart, looks 10 years older on HDTV, her face puffy and blemished with pucker wrinkles marking her two-pack-a-day cigarette habit. To truly look great in this new technology you need smooth skin and a healthy complexion.

Acne is a condition of the sebaceous glands, the glands attached to hair follicles which produce an oily substance called sebum. A lesion forms the hair follicle becomes plugged with sebum and dead cells.

Twenty-five percent of all adult men and 50% of adult women experience acne at some point. That's 1 in 5 women between ages 25 & 40. Male acne normally starts at age 12, gets worse at 16, and is outgrown by one's early 20s. Girls often breakout earlier but not so violently and continue to have flare-ups longer (witness Britney Spears, Lindsay Lohan, and Jessica Simpson all of whom endorse an overpriced OTC acne treatment line).

In adult acne, hormones, stress, and bad habits all contribute. Less commonly, chafing pressure (sports equipment) and some medications (anabolic steroids, anti-epileptic or anti-tuberculosis drugs, lithium and iodine-containing Rxs) can be the reason.

The pathogenic (disease-causing) events in the sebaceous glands are believed to be due in large part to changes in levels of androgenic (male) hormones in the body. This is why pregnant women often experience acne on their chest and back. It also explains the mid-40s onset when a woman's female hormonal levels drop, leaving endogenous androgens unopposed.

When under stress, the adrenal glands (which are located above the kidneys) overproduce cortisol as well as androgens in both men and women. These hormones in turn stimulate the sebaceous glands to secrete more sebum, which ultimately results in the formation of zits and yet more stress! It's also been established that psychological stress can decrease the wound healing capacity of immune systems by up to 40%. This factor doubles the impact of stress on acne.

And last, but not least, are the things we do to ourselves. Picking, rubbing, and scrubbing all aggravate acne-prone skin. The biggest science breakthrough in acne care has been the development vitamin A treatments, both topical formulations and oral (Accutane). Some of the best OTC products were developed by the scientist behind Retin-A, Dr. James Fulton and are readily available on the internet.

Early Intervention (Authentically Aging)

Today's topic deals with those first steps– no, not the toddler ones, the surgical ones. Is it ever too soon, too early? Or, the earlier, the better? Read on...

The statistics vary, but the percentage of 20-something patients seeking out anti-aging therapies is on the up-tick. And it's not just lotions & potions that they are after. It's also the non-surgical procedures like laser treatments and dermal fillers and botox.

Premature aging is really the venue of pack-a-day smokers and girls who own tanning goggles, yet full-blown age-orexics are popping up everywhere. Hollywood has it's share– just read the tabloids to see what Lindsay Lohan, Jessica Simpson, Nicole Richie, Britney Spears, etc. are having done– but the antiaging obsession is affecting younger and younger women all across the country.

A young woman may pursue a series of light glycolic peels and microdermabrasion over several months to encourage skin cell turnover; Intense Pulsed Light therapy (IPL) laser treatments to eliminate broken blood vessels and sun spots; lipodissolve for cellulite; a little bit of Botox to forestall furrow lines between the brows or crowsfeet; and finally, Restylane or Juvederm to soften any smile creases should she be so reckless as to grin a lot (see above). And of course religious application of a topical retinol (vitamin A) preparation at night and sunblock, moisturizer and topical vitamin C everyday.

(You could also institutionalize yourself transfixed, motionless, and out of the sun ala Oliver Sacks's patients in Awakenings. All of the above will keep the face looking younger, longer.)

These would-be patients are completely preoccupied with the quest for sexy, ageless skin. Physiologically they don't want to leave their 20s. Middle-age has become no-woman's-land. Where does this antiaging fanaticism originate?

In the last decade cosmetic procedures have moved out of the exclusive domain of the surgeon's office into day spas, salons, you name it. It's now ubiquitous amongst the beauty industry. More and more surgeons have responded to the competition with...well, injections, laser, etc. for those who request it– whether or not it's medically indicated.

It's been described by one provider as akin to giving a kid who's underaged a sip of beer: "Okay, take a little taste of this. Better you try it here than at some party." No one involved in this is going to put the kibosh on it.

And today's young woman is raised in a media-driven culture. There was a time when Vogue's top fashion models were actual society beauties well into their 30s and beyond, who could afford the dresses they were wearing. Now haute couture is sold on the backs of emaciated 16-year-old giants. Hollywood has only character parts for the 'aging actress' while the surgically rejuvenated ones try desperately to fit into roles written for cellulite-free 25-year-olds. Television shows most of all exemplify the media's ever increasing tendency to marginalize the middle-aged female.

When people think of facelifts, images of aging Hollywood stars with their faces pulled as tight as their red carpet gowns might come to mind. But some of these 'ageless beauties' hung on with the help of subtle early intervention; threadlifts were said to have long ago helped the facial contours of Catherine Deneuve (63) (she's since had a lot more). And Nicollette Sheridan (43) clearly had work done when she turned 40. Sharon Stone (49) had her first facelift in her mid-30s immediately after wrapping Basic Instinct.

What constitutes subtle? Endoscopic browlifts have replaced the old-fashioned hairline deforming coronal forehead lift (Elizabeth Taylor) and nearly scarless lifts allow plausible deniability. Top-flight aesthetic surgeons have refined the techniques used for early surgery to a fine art. The best are now able to combine several minimally invasive procedures to give a final result which surpasses that of traditional facelift surgery IF the patient starts early– in her late-30s to mid-40s and her skin is in great shape.

Key here is the integrity of younger, intact skin. Pampered epidermis is elastic and resilent before hormone shifts kick during a woman's 40s. So these 20-somethings do have some validity to their concerns: rejuvenation really is all about the skin.

Can you age-proof the body? Not really. You can turn back the clock, like daylight savings time, but the clock is always running. It is a youthful conceit to believe that medicine has conjured up a surgical Dorian Gray.

So what's a girl to do? The most effective anti-aging interventions are well within the pocket book of every 20-something. Wear sunscreen liberally, year round. Indulge your inner movie star with polarized sunglasses when you venture out. Exfoliate daily and avoid smoke like the deadly wrinkle-producer it is. Save some of your money for another decade or two when gravity really kicks in.


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