Chapter Excerpt

You look in the mirror on Monday morning and see the face of a middle-aged woman peering back at you. Who is that tired-looking person? Sure, you’re not as young as you used to be . . . and the small “laugh lines” around your mouth and eyes don’t really bother you too much. They’re the signs of a life well lived, right?

But it’s your complexion—which always seems dull these days—and those persistent, deeper creases on your forehead that really get you down and make you feel, well, old. Maybe your physician is right. Maybe it’s time to look into Botox. But ugh, the idea of injecting a toxin like botulism into your face seems downright foolish. Doesn’t Joan in the office know someone who had some awful side effects from that procedure?

Sighing, you hop into the shower, hurriedly dress, grab a bagel and a coffee on the way to the office, and spend the day trying to keep up with the crazy rat race that is your life. At night, despite your best intentions, you forgo the gym to stay late at the office, then you rush home for some takeout with the family before crashing into bed . . . and getting up early the next morning to do it all again.

What if I told you that you didn’t have to subject yourself to procedures like Botox, Restalin, brow lifts, or other invasive or surgical procedures to have sexy, vibrant, young-looking skin? What if I told you that some doctors—despite their good intentions—actually make big bucks off these types of cosmetic procedures even though there are other, affordable techniques that are even safer and more responsible in the long term? What if I showed you another way to make your skin look beautiful and ageless?

My name is Ben Kaminsky. I am a pharmaceutical and dermatological chemist, cofounder of the cosmeceutical company B. Kamins, Chemist, and president of Odan Laboratories. For more than thirty years, I have been in my laboratory, developing medicines and dermatological preparations that are prescribed by physicians and widely used in hospitals to treat skin conditions and other medical problems. I also formulate very specific cosmeceuticals, the cosmetic products that have healing druglike benefits and are intended as a bridge between the physician’s office and traditional cosmetics. My chemist colleagues and I are on the front lines of skin care research: we test new products, develop new formulations, and relay that information to your doctor so he or she can learn about the newest advances in beauty, cosmeceuticals, and skin care.

Although dermatologists and other physicians diagnose skin conditions, most doctors have varying knowledge in how to actually treat skin problems, depending on the courses they took in medical school. In fact, it is the pharmaceutical chemist—the professional who researches and develops the precise formulations—who ultimately understands how to resolve skin disorders safely and effectively and who helps dermatologists and other medical doctors do the same. That’s the work that I do every single day, and I’m thrilled to have the chance to bring my findings directly to the consumer—to you—and let you know the truth about what products, procedures, and lifestyle choices really make the most difference for your skin.

Since I started my pharmaceutical career in the early 1970s, we have learned much about skin care and what ingredients are most effective. I have seen tremendous advances in moisturizing materials and in methods to renew aging skin, and we are constantly improving our older formulations to produce revolutionary new products that are far more effective in rejuvenating aging skin and healing dermatological problems than ever before. In particular, we’ve discovered several topical formulations (i.e., products that can be applied directly to the skin) that are remarkably effective in combating the signs of aging. In addition, certain lifestyle changes (like eating specific foods and maintaining a proper sleep regimen) have dramatic and lasting effects on the skin.

But even as we learn more about what really works to keep skin looking healthy and gorgeous, I have observed an ever-increasing tendency for many physicians and cosmetic dermatologists to turn away from such topical formulations and lifestyle recommendations. Instead, many medical doctors lean toward invasive procedures to rejuvenate aging skin, such as the currently trendy injections of Botox. Botox, as you surely know by now, is a highly diluted and purified form of botulinum toxin (a neurotoxin that causes botulism). When injected into the skin, Botox temporarily reduces the ability of the underlying muscles to contract and crease the skin.

These days, it’s hard to open a magazine or turn on the television without seeing an advertisement for Botox or hearing about a glamorous Hollywood star who has reportedly used the procedure. Because of a multimillion-dollar marketing campaign, the money to be made from providing Botox, and, yes, the procedure’s sometimes dramatic short-term effects, we are left with the impression that Botox is the cure-all for revitalizing aging skin.

The results, admittedly, can be dramatic . . . in the short term. In the past five years, the use of Botox has caught the imagination of numerous physicians who now offer it to their patients, both young and old, as a “quick fix” wrinkle treatment. However, I strongly believe that not everyone is a candidate for such an invasive procedure, and I respectfully but firmly disagree with those doctors who tout Botox as the only effective long-term solution. The effects of Botox are temporary—and in some cases even harmful—and this type of quick fix is not the secret to long-lasting, beautiful skin. I believe that there’s a safer and ultimately more effective alternative.

What goes underreported about Botox is the fact that, as with all relatively new procedures, there are certain risks involved. Many times these Botox injections can even cause unwanted side effects. For instance, some patients have the tendency to bleed and bruise easily. They also may be slow to heal, allergic to the injected ingredients, or have difficulty with the topical anesthetics. Although it happens rarely, there is a risk that the doctor slips a bit when injecting Botox—and the consequences of this can be dire. The worst that can happen is that you won’t be able to raise your eyelids all the way, or, if the shot was near the mouth (which is unapproved usage according to the FDA), you could be left drooling. If this occurs, you would have to wait for the toxin to wear off, which can take several months. Moreover, because the toxin actually paralyzes the muscles that cause deep frown lines, even if the doctor did a perfect job, you might not be able to frown, raise your eyebrows, or squint. This could lead to a diminished range of facial expressions, so you might want to consider that too.

And if your wrinkles and/or sagging skin are resulting from loss of elasticity that occurs with aging, sun exposure, and smoking, sometimes Botox won’t work at all. There are other treatments for such conditions. Just keep in mind that Botox isn’t a miraculous cure for all wrinkles.

In addition to checking to make sure you’re not allergic to any of the ingredients in Botox Cosmetic, you should not use Botox if you have an infection where you want it injected, or if you are pregnant or think you might be pregnant. Also discuss with your doctor any medications you’re taking. And though the Food and Drug Administration (FDA) has approved Botox Cosmetic to temporarily improve the appearance of moderate to severe frown lines between the eyebrows (called glabellar lines), the FDA also warns that “the most common adverse events following injection are headache, respiratory infection, flu syndrome, blepharoptosis (droopy eyelids), and nausea. Less frequent adverse reactions (less than 3 percent of patients) included pain in the face, redness at the injection site, and muscle weakness. These reactions were generally temporary, but could last several months. Because Botox Cosmetic is a prescription drug, it must be used carefully under medical supervision.” For a supposedly “safe” elective procedure, this is scary stuff!

Despite all the press and hype, only 2 percent of women in the United States used Botox last year. The other 98 percent went “beyond Botox,” instead opting for noninvasive topical treatments and healing lifestyle therapies to resolve problematic or aging skin.

The bottom line is this: Botox is not the cure-all for sun-damaged skin or the wrinkles associated with aging; there are other alternatives.

The FDA cautions that the recent rise in the popularity of Botox has much to do with the manner in which it is marketed. For instance, some practitioners buy the toxin in bulk and arrange get-togethers (called Botox parties) for people who want to receive treatments. As in business, volume discounts are available in medicine. Not only has the FDA voiced great concern that Botox has the potential for misuse and abuse, the American Society for Aesthetic Plastic Surgery (ASAPS) recently reported that unqualified people are dispensing Botox in salons, gyms, hotel rooms, home-based offices, and other retail venues. In such cases, consumers run the risk of improper technique, inappropriate dosage, and unsanitary conditions.

Maintaining the smooth “Botoxed” face is also an expensive proposition. Most print and television ads do not tell consumers that to maintain the anti-wrinkle effect, Botox shots are necessary approximately every three to four months, costing from $350 to $500 for a single injection, $400 to $900 for areas requiring more than one injection, and $600 to $1,300 for larger surfaces such as forehead wrinkles. On an added note, contrary to what some experts claim, there are now those who advise that Botox injections may result in the development of new wrinkles as nearby muscles “overcompensate,” creating new facial expressions in the area where the muscles are paralyzed.

For dermatological purposes, Botox is only approved by the FDA to reduce the severity of frown lines (for up to 120 days). Yet hundreds of dermatology and medical Web sites found on Google widely advertise the use of Botox for treating myriad cosmetic conditions such as brow furrow, crow’s-feet, forehead creases, and neck bands. When the botulinum toxin was improperly used, there have been cases of paralysis and even deaths after an injection. You might remember the widely publicized story in late 2004 about the Palm Beach County, Florida, osteopath, his girlfriend, and another couple who were paralyzed and put on ventilators after being injected with a “cheap alternative to Botox.” It was revealed that the ill people had contracted botulism, a rare disease that is fatal in 10 percent of cases. In another case in 2003, a Florida woman went into cardiac arrest after receiving a Botox injection, dying shortly thereafter. The cause of death was listed as anaphylactic shock associated with Botox injection.

Don’t get me wrong. Along with Botox injections and cosmetic procedures, many physicians prescribe numerous topical therapies. We all know the big names in this skin care field—celebrity dermatologists with pricey products and quick-fix plans to make you look younger yesterday. Some of them have good things to say and good products to promote. In fact, not a week goes by that I don’t get a call from a dermatologist or his or her agent asking me if I would be interested in formulating a line of topical skin-treatment products for use under the physician’s name. When I ask the good doctor if he or she wants to build upon his or her clinical studies or revolutionary findings acquired in years of medical practice, the answer is usually no. It then becomes apparent that these medical doctors realize that there is a significant financial benefit to combining business and medicine, and they are looking for a way to get into the retail skin game. My response to them is always “Thank you for thinking of me, but no, thanks.”

The reality of skin care today is that many of these self-promoting physicians are successful as both marketing executives and doctors. Their use of the media is brilliant; it is easy to use ostentatious terminology when addressing a captive nonprofessional audience. The talk is impressive, the promises are grandiose, and people think that the flamboyant health care professionals surely know what they are talking about . . . or do they?

One such popular dermatologist turned entrepreneur and anti-aging author has extensively touted the use of alpha lipoic acid as “a quintessential antioxidant, anti-aging ingredient.” Yet new findings on alpha lipoic acid by Dr. Jing-Yi Lin with the Department of Dermatology at Chang Gung Memorial Hospital in Taipei, Taiwan, contradict these claims. In extensive research published in the November 2004 issue of the Journal of Investigative Dermatology, Dr. Lin concludes that this nutrient is completely ineffective as a topical antioxidant, contradicting the previous “hyped” benefits of alpha lipoic. The aforementioned anti-aging author also recommends megadoses (400 to 800 International Units [IU] daily) of vitamin E in all of his anti-aging books, when in fact this is contrary to the latest scientific findings. Reports from the American Heart Association at their Scientific Sessions in 2004 state that high doses of vitamin E supplements “do more harm than good, can increase the risk of death, and should be avoided.” By the way, the American Heart Association defines a high dose as over 400 IUs daily (the lowest starting dose in the doctor’s prescriptive program).

So where does the truth lie? How can a consumer know what is truth and what is marketing hype? Many marketing-savvy executives use cosmetics studies to hype claims for anti-aging skin products, promoting them as magic potions for young-looking skin. The fact is, many of these cosmetics studies do not mimic the hard scientific work required for approval by the FDA, and the result is a shelf full of cosmeceutical products that are of questionable value to you, the consumer.

I am not a dermatologist. For more than three decades, I’ve worked as a pharmaceutical chemist—on the front lines of the skin care industry, making and testing and perfecting the products that your dermatologist prescribes. During this time, I have become increasingly distressed to see the hype that many cosmetic dermatologists and skin care companies use in advertisements simply to sell products. And the products they sell are not cheap. In the United States alone, more than $45 billion is spent annually on cosmetics and toiletries. This amount does not include the billions spent on doctor-prescribed therapies for the skin. With highly scientific words such as retinoids, hyaluronic acid, nonosomes, and liposomes appearing in product ingredient lists, is it any wonder that most women are confused and even overwhelmed when it comes to making responsible choices for their skin?

From the time I started my pharmaceutical company, I have observed specialists touting many topical products they claim to have formulated but which they have actually purchased from private-label contractors—not pharmaceutical labs. Consumers do not realize that many of these dermatologists and other physicians who claim to have found the “magical treatment” for aging skin are actually selling the exact same topical product as their counterparts but with their own brand names stamped on the packaging! The problem arises because dermatologists and physicians are specifically trained in medical school as diagnosticians—professionals who identify skin conditions such as aging or wrinkling skin, sun-damaged skin, acne, eczema, rosacea, and skin cancers—and not as chemists—scientists who understand the composition, structure, and properties of substances and the transformations they undergo when formulated into medications and dermatological treatments.

Many in the health care profession believe there is a potential conflict of interest when cosmetic dermatologists practice medicine along with selling their own brand of topical “formulations.” I firmly believe, as do many clinical dermatologists, that these doctors compromise their reputation as medical professionals when they add marketing their cosmetic wares to the practice of medicine. When I see doctors marketing their topical products, it also leads me to the disturbing conclusion that much of the popularity of topical products has to do with the marketing rather than the therapeutic formulation.

Devising a cosmeceutical to alleviate acne, reduce scars, diminish under-eye puffiness, or reverse the obvious signs of aging is both an art and a science. The chemist fully understands atoms and molecules and how matter interacts with matter in the classic chemical reaction. The pharmaceutical chemist comprehends how chemical substances interact with living systems and which compounds have medicinal value, including the composition, properties, interactions, toxicology, and desirable effects.

Once the chemist has researched and developed a new product over a period of years, the pharmaceutical companies further study this compound in clinical trials before marketing it to doctors, who then prescribe the product for consumers (patients). During every stage of scientific research and development, the chemist and pharmaceutical company work side by side to perfect the formulation before marketing it to doctors and consumers, making sure they fully understand how it is used, including the dose, the side effects, and the contraindications, among other factors.

Does everyone in the skin care industry give consumers an honest appraisal of a product’s benefits and risks? As a scientist and chemist, I think the answer is no, and this causes me great distress. I remember attending a skin care convention in the late 1990s and being appalled at the faulty or blatantly misleading information leaders in the cosmeceutical industry were giving consumers. They were cleverly deceiving both media and customers, with, I imagine, the intent of profiting from their cosmetics and the skin care products they had formulated. Not only did the exaggerated claims indicate a cynical, irresponsible marketing ploy, but they also made the skin care field appear to be solely a business rather than a medical profession where trained professionals are passionate about the health and well-being of consumers.

In addition to being fervent about my profession, I am devoted to my family and absolutely in love with my wife, children, and grandchildren. Like most of you, I constantly worry about my family’s health, particularly their skin problems. I want to make sure my children and grandchildren are using products without harsh ingredients that can wreak havoc on delicate skin and with adequate protection against the sun’s ultraviolet (UV) rays.

For years prior to starting the B. Kamins line of cosmeceuticals, I had been formulating topical preparations for the needs of my young family. I started with diaper rash ointments when our children were newborns and moved into personalized poison ivy lotions, shampoos, hair conditioners, and even fragrance-free body lotions for my wife and daughter. I formulated outstanding and gentle acne gels for my teenagers that did not leave their skin inflamed as the popular gels did, and I prepared a variety of sunscreens for my kids’ sensitive skin.

But for my family—as well as in my professional career—I am extremely conservative about recommending treatment unless there is scientific proof that it is necessary. As an example, our first child, Howard, was a fair-skinned, hazel-eyed, redheaded baby. As a young, inexperienced parent in the early 1960s, my lovely wife, Mildred, kept Howard sleeping in the sun for a period of time each day, which resulted in unintended skin reddening. My wife’s phone call to our competent, friendly pediatrician resulted in a scolding and a prescription for a sunscreening lotion containing para-aminobenzoic acid (PABA). Quite distraught, Mildred immediately called me at the lab to tell me about the scolding. She also mentioned the prescription for a PABA sunscreen, which was being used extensively in North America at the time.

In my lab, I had myself been working on topical preparations to protect the skin from heightened sensitivity to the sun’s ultraviolet radiation for patients who were taking various categories of medications including antidepressants, tranquilizers, diabetic medications, anticonception drugs, and antibiotics. After reviewing some adverse clinical findings regarding PABA, I had chosen not to include this ingredient in my own sunscreen formulations. I remember telling Mildred to hold off filling the PABA sunscreen prescription.

That evening, I brought home a preparation I had been working on in the lab. My sunscreen preparation contained a safe formulation of titanium dioxide and an octyl salicylate complex. Both these ingredients had been proven safe, nonirritating, and effective sunscreens when used in well-formulated preparations. At that time, few chemists were testing the sun protection factor (SPF) in topical sunscreens, but I believed that the SPF in my preparation was approximately 15, which gives a few (two to three) hours of protection against ultraviolet sun rays.

Later that evening, I called our pediatrician and questioned the use of PABA preparations. I received a standard answer from our kind doctor—that the medical review boards had approved the product, and who was he (or I, for that matter!) to question their wisdom. Despite his advice, we didn’t use the PABA-based sunscreen and instead used my formulation. I learned early on in my career as a pharmaceutical chemist that it takes time and sometimes repeated bad experiences for doctors’ prescribing habits to change. Often, topical therapies worsen skin conditions until there are enough complaints and the review boards halt the product and call for change. Today we know that PABA causes both sensory and visual skin problems, including rashes, itching, tingling, and redness. Nowadays, sunscreens do not usually contain this ingredient.

The point is this: even though we call on our medical doctors seeking treatment for symptoms, and despite their best intentions, they don’t always get it right. What they do know is that patients expect something from them; they are often hard-pressed to prescribe medications, which is why antibiotics, procedures, and products are often overprescribed and misused.

Over the years, as I created more and more cosmeceuticals for our family’s needs and even therapies for friends and colleagues, I began to realize that these topical treatments could offer tremendous benefit to others too. In 1997, my son Howard and I cofounded B. Kamins, Chemist, an innovative skin care collection and a pioneer in the cosmeceutical industry. Howard has a business degree from McGill University, a law degree (LLB) from the University of Sherbrooke (Canada), and an LLM from Notre Dame Law School (Indiana). Apart from being an attorney turned entrepreneur- marketing executive, Howard is a very devoted husband to Laurie and father of three-year-old Isabelle (and a new one on the way).

While I toiled in the lab, Howard made it his goal to build the B. Kamins brand with a personal touch. He went door-to-door to spas and specialty stores throughout the Northeast and educated anyone who would listen about responsible skin care. Today, as CEO of B. Kamins, Chemist, Howard manages the multimillion-dollar corporation from our offices in New York City and spends what little downtime he has with his family.

Whether lecturing to professional societies or cosmeceutical and skin care organizations, or talking with the personnel at day spas, medical spas, or resort spas, Howard and I continually remind professionals and consumers that there is no one-size-fits-all approach when it comes to dealing sensibly with skin care problems. What might work to resolve your colleague’s skin problem may cause a rash or sudden outbreak of pimples on your skin.

No matter how much you hydrate or exfoliate, skin does age —and sometimes well before its time. That’s why we promote a combined cosmeceutical and lifestyle approach to having sexy, ageless skin. No doubt, the sun caused most of the skin damage you see on your skin right now. But smoking cigarettes, drinking too much alcohol, extreme temperatures, and a host of noxious chemicals and pollutants in the air outside can also damage skin. Chronic stress is another known skin irritant that can make your skin highly reactive and result in outbreaks of pimples, acne, or rosacea at most inappropriate times. Lack of sleep makes your skin puffy, ashen, and pale, and accentuates the deep reddish blue of under-eye circles. A poor diet lacking in immune-boosting nutrients can make your skin appear sallow, overly dry, or even too oily. And exercise obsession can result in hormone imbalance even in college-age women, which can lead to osteopenia (pre-osteoporosis), with thin bones that fracture easily. Strong bones are essential to stretch your skin and keep it taut through the years, and tight skin is younger-looking skin.

So where do you begin? A reasonable approach to understanding and treating skin in each stage of the life cycle is critical. And finding that proper balance—a responsible, noninvasive program that you can adapt to your unique skin care problems and that also empowers you to play an active role in improving and protecting your health—is the purpose of Beyond Botox.

Unlike other books on aging skin, this book places you, the reader, center stage by focusing on where you are in your life cycle and identifying your risks for particular skin problems. For example, pregnant women can have darkened pigmentation on the face and bright red spider veins, while women in the perimenopause years (the two to eight years preceding menopause) may have the beginnings of fine lines and wrinkles and under-eye bags. Women in menopause (around age fifty-one) contend with blotchy, thinning, and transparent skin, as well as added dryness, flaking, and dark age spots on the face, arms, and hands. Still, no matter what your life stage or skin problem, there are noninvasive answers in this book.

As you read the book, you will see that it quickly moves beyond a discussion of skin basics and how I formulate cosmeceuticals in my Montreal-based lab to page after page of skin-saving strategies that you can use right now to have sexy, ageless skin.

In chapter 2, “What’s Your Skin’s Real Age?,” we discuss the skin and how it represents a unique “fingerprint” of what goes on inside (and outside) your body. We will explain what occurs when skin ages and what you can do to stop it. You’ll learn how specific risk factors (such as sun exposure and even the way you sleep at night) predispose you to visible signs of premature skin aging. And at the end of the chapter, you’ll take a “Real Skin Age Quiz” to find out your skin’s true age and determine which risk factors you can change right now to slow or even reverse your skin’s aging.

Chapter 3, “What’s in Your Medicine Cabinet?,” is a most crucial chapter. I’ll take you into my lab and introduce you to my passion: understanding how to best treat women’s skin. I believe that cosmeceuticals, when properly formulated and properly used, are the future of skin care. Here I will help you appraise the various ingredients used in your own creams and lotions and let you know if a product has merit or is nothing but marketing hype. You’ll learn how to go to the drugstore or cosmetics counter and shop for the perfect products that will complement your skin type and lifestyle . . . and you’ll also discover what ingredients to avoid at any cost. After all, why pay money for a product that has no curative value—or may even damage your skin—just because it comes wrapped in a shiny package with a celebrity endorsement? I’ll tell you what I tell my children: always know what you are applying to your skin!

In Part II, “The Beyond Botox 7-Step Program,” Howard and I will explain our renowned, scientifically based lifestyle program, which will help you meet your individual skin care needs with the following strategies:

1. Nourish: Feed your skin from the inside out

2. Move: Exercise regularly but don’t go for the burn

3. Rest: Get quality sleep to rejuvenate skin

4. Relax: De-stress to boost skin healing

5. Super-Saturate: Moisturize properly to quench your skin’s thirst

6. Pamper: Become spa savvy for wellness and balance

7. Radiate: Combat specific skin problems . . . at any age

I believe that women today are left in a terribly difficult position—with serious questions about how to handle the myriad skin problems they may face. While women know they will get older, they do not want to look old. Yet without a responsible skin care game plan, including a full understanding of invasive procedures such as Botox, women are putting their skin health in jeopardy and may have to live with less than acceptable results the rest of their lives.

Throughout this book, I will only suggest products that I believe are safe and effective for you and your family members. In that regard, whether you are in your thirties, forties, fifties, sixties, or beyond, I want to give you responsible, stage-specific guidance to help you assess your skin right now and stop—even reverse—the specific problems that keep you from looking youthful and sexy. I believe that everyone must make a personal and lifelong commitment to be the ultimate guardian of his or her skin, focusing on the skin care regimen that fits his or her life stage, lifestyle habits, and skin problems. To that end, this book will provide you with the information and tools you need to determine a balanced skin care approach that works for you and your family.

Together we can do it. Let’s get started!

Copyright © 2006 by Ben Kaminsky and Howard Kaminsky