Dermatologist Talks: Is Botox Truly Anti-Aging?

Episode 9-Part 1: Botox and Changing Perceptions of Aging

Celebrity J Lo caused a bit of a stir amongst a few US dermatologists when she claimed she hasn’t had any anti-aging Botox injections till this day- crediting her 51-year old, wrinkle-less visage to olive oil, notwithstanding her latest skincare line launch. Is there anything wrong with what she said or is she being scrutinised because of her celebrity status and the fact that she’s launching a new skincare line? In this episode, accredited Singapore dermatologist Dr. Teo Wan Lin discusses that, the ethics of aesthetic medicine practice and changing societal perceptions of ageing, with her plastic surgeon colleagues Dr. Chris Chui, Dr. Terence Goh and Dr. Zulfikar Rasheed from AZATACA Plastic Surgery.

Ep 9A: Botox and Changing Perceptions of Aging

Dr. TWL: Hello guys I’m Dr. Teo Wan Lin and welcome to my podcast, Dermatologist Talks: Science of Beauty. In this podcast we discuss all things beauty and science related, including whats new and trending. Just a couple of weeks back, celebrity J Lo caused a stir amongst dermatologists in the US. She claimed she hasn’t had botox till this day. She credits her 51-year old wrinkle-less visage to olive oil, notwithstanding her latest skincare line launch.

Now I definitely have my own opinions on that, both as a woman and as a dermatologist. But before you hear what I have to say, I want to introduce 3 guests, esteemed plastic surgeons, and friends of mine:

Dr. Chris Chui, Dr. Terence Goh and Dr. Zul Rasheed from AZATACA Plastic Surgery, who will be joining us today on this episode.

I had the pleasure of working with Chris, Terence and Zul who were my registrars when I was a junior dermatology resident. I was rotating through the Department of Plastic Surgery and Burns unit at the Singapore General Hospital over a decade ago. How time flies! They have now set Up their private practice AZATACA,  and are also my neighbours at Royal Square Novena Medical Suites. So big hello to you guys, it’s been a really long time! How has 2020 been for all of you?

Chris: Hi Wan Lin, this is Chris. thanks for having us on your podcast. My interest is a lot of mostly reconstructive surgery – some aesthetic work as well. In Singapore we do a bit of everything. 2020, I mean same for everyone, we’ve had our ups and downs but overall we’ve pulled through quite well. AZATACA is doing well, so it’s good to be your neighbor as well, and hopefully  we’ll see you around. 

Dr. TWL: It’s lovely to have you guys in the same building – again! Terrence, tell us what you’ve been up to.

Terence: Hi Wan Lin, thanks for having us on this podcast. This is my first time, so it’s quite exciting. AZATACA is formed by Chris, myself, and Zul, so we are 3 plastic surgeons together. We had, like Chris mentioned, a rough time in the earlier part of the year. But we managed to pull through. We have just relocated to the new AZATACA plastic surgery centre on level 14. So we’re looking forward to this new place that we have and also meeting you along the corridor.

Dr. TWL:Excellent, and likewise! Finally, we have the third musketeer – Zul.

Zul: Hi Wan Lin, how are you? can’t believe it’s been 10 years since we met in SGH. Yeah, I’m Zul, I’m also a plastic surgeon in AZATACA plastic surgery. My interest are in breast and body contouring. And yeah, 2020 has been quite an exciting year, and we’re all waiting for phase 3 to come about.

Dr. TWL: Well it’s so great to connect with you guys again!

JLo’s Botox denial controversy

Dr. TWL: So moving on, before this podcast we were each tasked to examine the video featuring JLo in her latest skincare line advertisement. She shows off her flawless face and body – that inflammed a few US dermatologists who claimed her botox denial was particularly galling. Because, she was showing off her superior genes and “zero effort beauty”. They were suggesting that by doing so, she was dismissing self care and the “discipline” it takes to achieve beauty at her age. 

Personally speaking, I was slightly surprised at the outrage. While it isn’t common for a 51 year old to look as flawless as she does in the video, and even less common for someone who never had cosmetic treatments. As a dermatologist, I am generally cautious about speaking about someone’s appearance or age, regardless of what they’ve done or not. However, it’s also relevant that we bring up the issue of whether her botox denial may have been offensive in any way. Would it have been different if she just credited a healthy lifestyle instead of her skincare routine?

Well more on that later because I want to hear what my colleagues in  plastic surgery have to say.

What do you guys think, is it at all possible that JLo hasn’t had Botox?

Chris: I’ll go first, Chris here. at 50 years old, she looks really good, she looks quite amazing actually. Her body as well as you were saying. But I guess it is possible, but it is quite highly unlikely. In circles that she’s running in, everyone around her would have some type of treatments done. It’s highly likely that she did something along the way. I’m not sure why she would say she hasn’t done anything along the way, especially anti-aging Botox injections- which is quite harmless. It could have something to do with the fact that she’s launching her own skincare range. But I guess we’d give her the benefit of the doubt and believe her. But it’s pretty hard at that age to not have anything done and look so good.

Terence: Like you mentioned, I think it is rare to look so good at this age without any wrinkles. I did go online to look at some of the other photos as a celebrity that has tons of followers. In some of the photos, she does have some under eye wrinkles, crow’s feet as well as some smile lines.

I think that was a video, so there could have been a lot of makeup or use of filters. There are a lot of technologies that are readily available – which I’m sure she has, such as a good makeup artist. You could conceal quite a fair bit. So I think she definitely used some of that to her advantage. But like Chris mentioned, I think it would be quite rare if she hadn’t tried any of it before. Certainly it would be advantageous for her to try to seem like she did it naturally or through her own means.

Zul: I think it certainly is possible that she hasn’t had the treatments like botox or stuff. But it is like the rest think, quite probable that she has had it. And I don’t think there’s any harm in admitting that you’ve had something like that. But there may be factors like her upcoming skincare range that she might be trying to promote, that is making her hide the fact that she might have some botox.

Dr. Teo: I have to disclose that prior to this podcast,

One plastic surgeon thought it was definitely possible that she hasn’t had any anti-aging Botox injections; and simply had amazing genes and a healthy lifestyle. What do you think are the chances of that? 

Chris: Well maybe she hasn’t had botox, but maybe she has done other things other anti-aging interventions? I think she also said she hasn’t done any fillers at all or any injectables. But maybe some other aesthetic treatments like HIFU or RIF, I don’t know. But healthy lifestyle would definitely help, getting enough sleep, looking after your skin. I think she said she uses sunscreen – that was the one thing she definitely said everyone should be using. It’s hard to say if she really has or hasn’t. But, most people at that age would look quite a bit older if they haven’t had anything done. 

Dr. TWL: My personal assessment is that its interesting that her body skin looks pretty homogenous with her facial skin. We know that it’s not easy to change the quality of skin. Anti-aging Botox injections do not directly prevent photoageing. Rather, it stimulates collagen production and relaxes the facial muscles responsible for deep wrinkles. An objective assessment of aging using the Glogau photoageing scale incorporates many other observations. For example, skin elasticity, texture/pore prominence, pigmentation and skin radiance.

She also has a really good facial bone structure, which really helps an individual age well. Is there a relationship between bone structure and aging?

Terence: Yeah I mean her bone structure definitely helps her, because as you mentioned, she’s got high cheekbones. Like Chris mentioned, she could have done other things that tighten the skin. For example, stuff like skin boosters, and maybe fat grafting. However, most of the time when patients have done these things, they would have already started with anti-aging botox injections or fillers. As these are after all, the most common and most readily accessible treatments. They are also one of the lease invasive procedures, so most people will actually start those. I mean we’ll never know if she ever did. 

Dr. TWL: Yeah, personally speaking, I have definitely met patients who had very photoaged skin and deep wrinkles. When you administer botox, they’re no longer able to use their facial muscles in that period of time. They’ll find that the lines become less deep, but it doesn’t change the fact that their skin is photoaged.

In terms of the skin on the body as well, do you think that’s an important clue? 

Zul: So basically you’re saying that there is a correlation and the body skin right? 

Dr. TWL: Yeah and I mean, we can’t really change the skin aging process on the body very convincingly. 

Zul: That’s right. So your observation that she’s got good body skin also suggests that there may be a good genetic component. She’s really taking care of her skin, her diet, the fact that she’s not smoking also contributes to it. So yeah, it’s certainly possible that she hadn’t had anti-aging treatments like Botox. 

There are other ways to have good skin without Botox

Dr. TWL: Yeah, I think at the end of the day, what I am really interested in, is how these dermatologists are just so convinced that there’s absolutely nothing other than Botox in order to account for her current appearance. Now, what Zul mentioned, actually is consistent with emerging research in dermatology. We call it the skin exposome concept. This essentially defines lifestyle factors in addition to genetics that play a key role in inflammaging. Inflammaging is a process that has been well defined in cell, animal, and clinical studies affecting our body systems.

Dermatologists also treat all conditions topically in addition to systemic therapy. More often than not, we’re treating skin disease. So when we’re considering cosmetic issues of the skin, the ability of the skin to absorb active ingredients, and also the science behind these free radical fighting antioxidants, and as Chris mentioned – photoprotection – all these are valid components. 

Now in terms of lifestyle, nutraceutical interventions – an antioxidant rich diet, has been shown in geriartric patients to improve both physical and psychosocial wellness. In terms of exercise, high intensity interval exercise, has been shown on a cellular level to stimulate fibroblasts production of collagen.

Read on for Part 2 here.

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