Has the botox backlash started?
He changed the way a generation of rich women looked. Hannah Betts and Tim Teeman on Dr Fredric Brandt, an unlikely beauty guru who said Botox is here to stay
It was a ruthlessly efficient system: a narrow corridor of treatment rooms inside which were women (and men) who had made appointments months earlier to have brows or foreheads smoothed, cheeks and lips plumped or necks tightened by the expert hands of Dr Fredric Brandt. When he finished one treatment, he would head into the next room. It was a dizzying blur of exits, entrances, jabs and flutey hellos.
Dr Brandt – nicknamed the Baron of Botox, and an exotically plumaged bird in his own right – was the largest cosmetic user of Botox in the world and was his own striking advert for the 5,000 vials his practice used in a typical year.
Before his death in April – which shocked the plastic world of beautiful people – Dr Brandt publicly crackled with spriteish energy. He was found at his Florida home having hanged himself after suffering what is believed to be depression.
But during his busy career, 65-year-old Dr Brandt, who had his own radio show, was at the vanguard of minimally invasive cosmetic surgery, of which there were 13.4 million procedures in 2013 in the US – including 6.3 million Botox injections and 2.2 million fillers. The global market is forecast to reach $2.9 billion (Dh10.6 billion) by 2018.
Last November, the company that patented Botox was bought for $66 billion. If there is a beauty aesthetic for this generation, it would be the one invented by Dr Brandt. A handful of celebrities may claim that there is a Botox backlash, but the 21st-century face, as smooth and plumped up as whisked egg whites, is everywhere, from the TV screen to boardrooms to the factory floor.
Yet Dr Brandt’s Manhattan clinic was not the glamour palace you might imagine: it was on the unfashionable midtown-east flank of the city. The first marker of his status and his love of expensive art
was the Damien Hirst painting in the reception. Dr Brandt was a keen collector and when we met him last year, he had just returned from Miami’s Art Basel. More striking than his chemically enhanced features was his honking laugh, which was guttural and strangulated.
He was known in the industry as the most creative practitioner – he knew just where to inject to get the best visual result, while the patient could still smile and move their features. Those patients included society women, wealthy professionals and celebrities (he declined to name the bestknown, but Madonna has spoken glowingly of him and Demi Moore is a rumoured former patient), as well as lawyers, rich housewives, designers and authors. Patients flew from western Europe, Russia and the Middle East to see him.
He cooed brisk greetings to every patient and then swiftly executed their treatments. The ones we met looked to be in their 50s, 60s and 70s. We were asked not to talk to them. Having dabbed the little bubbles of blood away from botulin or filler-injected skin, Dr Brandt smiled at his handiwork. Then he trilled, ‘Byeeee, see you soon. Make an appointment before you leave’, and he was off into the next room.
If you couldn’t afford his treatments, his fame meant that he became a brand, and you can buy his products for tightening, lifting and smoothing your skin.
The latest is called Needles No More, an anti-wrinkle cream he claimed targets crow’s feet and frown lines. It’s as effective as Botox, but Dr Brandt didn’t recommend you lather it on. His second office, in Florida, served as a lab where he tested new products with placebos used on human guinea pigs for comparison, refining the peptide concentrations that interfere with the contraction impulses of muscles. He was experimenting with a botulin toxin molecule to treat crow’s feet that, he said, would be effective for up to 120 days. Needles No More is the off-the-shelf version containing magnesium as a muscle-contraction inhibitor.
What treatments had he done, we ask. ‘Me? I’ve never done a thing,’ he replied. There’s that distinctive honk-honk laugh. ‘I’ve not had a facelift. Everyone thinks I have. Look behind my ears.’ No scars. ‘I haven’t had surgery, but I always want to experiment on myself because if something happens, let it happen to me.
‘I’ve done Botox on myself since the mid-Nineties. I’ve injected fillers to restore the cheek area and around the eyes to fill in the hollows, and my jawline to resculpt that.’
Was he dissatisfied with how he looked? ‘I wanted to see what the treatments do for patients, but of course I wanted to maintain myself.’ He said he did Botox twice a year, but ‘fillers I haven’t done in months’.
The younger of two brothers, Dr Brandt was brought up in a middle-class home in Newark, New Jersey; his father, who died when Dr Brandt was 15 (his mother died seven years later), owned a sweet shop. That wasn’t as much a wonderland for a child as you may imagine, he says.
His parents wouldn’t allow him sweets because they were bad for him, and they were so committed to the shop, they didn’t spend a lot of time with their children. The young Dr Brandt was a dreamer, ‘always wanting to know how things worked’. He took apart radios and put them back together. He liked maths and science.
‘I don’t think you think about your appearance at that age,’ he reflected. ‘You’re just a kid. I didn’t have the healthiest diet as a child, but I wasn’t heavy, although I was nothing like as lean as I am now.’ He worked out throughout his adult life – running, swimming, biking, cross-training – and later did yoga six times a week, first thing in the morning.
Dr Brandt studied at New York University and was due to go into oncology, but as a ‘very visual person’, observed the skin manifestations of disease and went into dermatology instead.
When Botox first appeared in the early Nineties, it was revolutionary. After the peels and collagen injections of the Eighties, it meant you could ‘do things without surgery you couldn’t do before’.
In the Eighties, Dr Brandt used retinol and alpha-hydroxy creams on himself. He was well-lotioned, using one of his creams to build collagen at night, along with a resurfacing serum, an antioxidant cream, and other special serums for the day.
Did he ever think, let nature take its course? ‘Never,’ he said firmly. A good sunscreen is the most important thing to use, he advised.
Was he vain? ‘I think everyone is to a certain degree. I don’t think I’m overly vain. My motto is, ‘You want to be the best you can be for yourself’. You can’t compare yourself to a movie star; you try to look as good as you can for who you are. That’s what I tell patients.’
Did he think he looked good? ‘People are surprised by my age, so I guess I’m in good shape.’
But he was at the top of an industry that trades on dissatisfaction with how we look. ‘I don’t really agree with that,’ he said, smile curdling. ‘Many people who have it are happy with how they look; they just want to look better or more youthful.
‘My patients will say, ‘I’m 60 or 70, but I feel the same way as I did when I was 25’. Then they look in the mirror and don’t see that person. It makes them feel a little better to have more balance between their perceived notion of how they feel and how they actually look.’ A lot of his patients want to remain ‘competitive in the workplace, especially the tech industry, and want to look youthful because of being in a youthobsessed society’.
Dr Brandt insisted he doesn’t inject people on command, but judges each patient’s needs. ‘You have to be people’s mirrors – their voice of reason,’ he said.
He COOED brisk greetings to every patient then swiftly EXECUTED their treatments. Having DABBED the bubbles of BLOOD away from BOTULIN or filler-injected skin, Dr Brandt SMILED at his handiwork
Vanity, he said, isn’t something new. ‘We just have more tools now, and people are living longer. I tell people, ‘This is not a matter of need. This is about choice’.
‘People want to look more natural now: cheek volume, which I was doing 12 years ago, is very popular. People are very concerned about their necks, and fatness in them. When people get older, the fat cells in their cheeks deplete, so we fill those out.’
Men like to have Botox in the neck to improve their jawlines. Dr Brandt used an ultrasound technique to tighten skin without cutting or scars, and the clinic was awaiting approval on a new product that would be injected into the fat pockets of the neck, melting the fat and tightening skin. Lasers were being used more in short pulses to rejuvenate skin. Dr Brandt imagined stem cells would be used in future treatments.
At the clinic, Dr Brandt’s average treatment costs $800-$1,000, and patients come twice a year. ‘It’s not cheap, but consider what women spend colouring their hair,’ he said. ‘It all adds up.’
Dr Brandt, who was single, got recognised on the streets of New York. ‘I don’t feel as much of a celebrity as everyone else feels I am,’ he said of his own stardom. ‘I’m a little bit of a showman. I could be in a classic movie.’
The day we met him, his first patient was in her early 50s and had acne scars. ‘He has the magic touch,’ she said. He injected, asking her to purse her lips, frown and relax, to monitor the animation in her face.
In the next room was a visibly richer woman in her late 40s. She had been seeing Dr Brandt for four years, coming for treatments every three months. ‘Did you go to Art Basel?’ she asked him.
‘Yes, I bought two paintings, including a Georg Baselitz,’ he told her.
She was slathered in numbing cream to reduce sensitivity to needles. ‘What’s great about Dr Brandt is that he does less,’ she said. ‘When I came to you, I had had too much.’
‘I evened it out,’ said Dr Brandt, peering through his wrap-around magnifying glasses. ‘Your lips held up good.’ He began injecting Botox into her temple and also pulled up her brows. ‘I’m injecting under the muscle to lift the whole cheek area,’ he said, ‘replacing the fat loss there and also picking up the muscle to give it a beautiful contour’.
The next patient was ready, a skin cancer survivor. ‘I’m a jewellery designer, I’ve been doing it 57 years, and I still love it,’ she said. ‘Jane Fonda is my age. How come she looks so perfect? Is it hereditary?’ She looked in her 70s, and was dry and funny.
‘Of course I’m frightened,’ she told Dr Brandt about her imminent, first Botox treatment. ‘I want to be able to smile. You’re the artist. You come highly recommended. All my friends swear by you, so here I am.’
He started injecting her around the lips. Filler will be put into sunken cheek pads.
As with all the women that morning, part of us wanted to tell her she looked fine. Our appearance-crazy, ageing-fearful world is mad and the clinic was the manifestation of that. But Dr Brandt’s work was deft and its results – if that was what you are after – were immediately visible.
‘I think this is going to exceed your expectation,’ said Dr Brandt to the woman. ‘Oh, it’s phenomenal,’ she
said. She looked at us. ‘You can use my name. I’m proud to be here.’
Carol Dauplaise was 76. ‘I am going to tell everybody I did it,’ she said of this debut treatment.
Will we ever fall out of love with Botox? ‘I think people want to look natural,’ said Dr Brandt. ‘Our catchphrase is, ‘Fabulous, not frozen’.’
The next patient was 57, with great, smooth skin and no visible sign of anything either needing to be done, or having been done.
She was having Botox for the first time. ‘I originally came for smile lines, which I haven’t seen since,’ she said. ‘He always leaves me looking natural.’ Do her loved ones notice? ‘Not at all. My partner of 11 years doesn’t know I do this.’
Dr Brandt started jabbing filler into the woman’s cheek pads. Then came the Botox into the forehead and brows. Jab, jab, dab, dab and she was done. And off he went into the next room down the long, narrow corridor. ‘How are you? What are we doing today?’
He may not have been the first to use Botox cosmetically (rather than medically, where it had been deployed to treat palsies and the like), but Dr Brandt was the first to use it aesthetically. His pioneering work back in the early Nineties spawned an industry that Americans clutched to their artificially inflated bosoms.
Celebrities who have admitted trying Botox but have now stopped include Gwyneth Paltrow and Nicole Kidman. ‘I did try Botox, but I got out of it and now I can move my face again,’ Nicole Kidman told a reporter in 2013.
But even today, the Botox business remains a gold mine. According to the American Society of Plastic Surgeons, Botox was the No. 1 minimally invasive cosmetic surgery technique used in the US last year with 6.7 million procedures performed, up 6 per cent from 2013.
Next in line were fillers at 2.3 million procedures, up 3 per cent from 2013. Dr Brandt was the colossus who bestrode this lucrative industry.
Yet while his work was celebrated for its nuance, the cowboys who came after him were not so discerning.
By the time Botox reached the UK in the late Nineties, it was viewed as the preserve of socialites with hair bigger than their brains, ladies who lunched despite difficulty opening their mouths and celebrities who were happy to look rather odd. ‘Early, clumsy practitioners just wanted to kill the line,’ recalls the London Botox guru Dr Michael Prager.
When Botox first became a phenomenon around 2000, people who had early, crude Botox looked startled and angry, actually older. Punters were promised lunchtime facelifts in the wake of which their features would stiffen into astonished impassivity, with permanently raised eyebrows the alarming giveaways. Facialists did it, dentists did it and women had it done while relaxing at parties.
Film directors complained that a generation of actress had sprung up who were suddenly unable to emote, their foreheads flatly, shinily and ultimately very spookily devoid of expression. Yet, among needle acolytes, a dysmorphia set in: no face was considered too bizarre so long as there was no hint of a wrinkle.
‘Look around London restaurants today and the richest women still often look the weirdest,’ sighs Dr Prager.
Once they’d rendered their foreheads rictus, the rich then sought to restore a youthful volume to the face, leading to suspiciously puffed-out filler faces. Fillers, skin-plumping bursts of hyaluronic acid, actually preceded Botox, but did not become obvious – very obvious – in their usage until Botox was making headlines.
First came the trout pout, where the upper lips were grotesquely over-plumped. Then came pillow faces, where the juxtaposition between anorexic bodies and painfully inflated chipmunk cheeks made certain celebrities look as if they were storing nuts and berries for winter.
‘The problem,’ says Dr Prager, ‘was a filler popular because of its long-lasting effects. Patients always want to know how long it will last. Well, it lasted a long time, but it also gave you cheeks like golf balls.’ He, as Dr Brandt did, favours a thinner product that he applies in tiny measures and which requires more frequent topping up. The effects make grown women go positively dreamy.
Opponents may protest that there has been a Botox backlash – actresses in particular feeling the need to insist that they would never do it – but who are they trying to kid? Botox is more popular than ever.
A recent UK government report on the British cosmetic surgery market stated: ‘The value of the UK cosmetic procedures market is growing. It was worth £2.3 billion [around Dh13 billion] in 2010 and it is estimated that it will grow to £3.6 billion by end of 2015. Non-surgical procedures account for 75 per cent
of this total.’ It’s just injected so deftly, in the manner of Dr Brandt’s work, that users can deny having had it.
For the great majority of famous names that coveted the naturally rested look includes a degree of natural-looking work.
Newby Hands, the content director of feelunique.com, is in her late 40s and refreshingly honest about her approach: ‘I still do Botox, but I do it in a really different way to how I used to. I have baby Botox, which is basically a diluted form, because I like to be able to move my face.
‘The dermatologist Dr Nick Lowe once said that patients are happy when he can stop their subconscious movement but still have conscious movement and I agree. So I can raise my eyebrows, but I don’t subconsciously frown while talking to you. Women want their children to be able to see when they’re happy or angry. This is a popular approach in Britain.
‘Plus I don’t do it too often because – like everyone – I got scared by those big, shiny, frozen foreheads. I saw a former intern of mine the other day and thought it couldn’t be her because she looked so old. She’s 30 but she’s so frozen she looks like someone of 40.
‘As a patient you have to get involved, talk about how the last lot went. It’s not an exact science, meaning it’s not the same experience every time. You can’t be passive.’ Hands sees Dr Anne Mendelovici at Dr Sebagh’s Clinic in London and also rates Dr Jules Nabet of Kensington.
In Dr Prager’s waiting room one sees actresses, business leaders and cultural figures, but also a good many ‘civilians’, male and female. For them, seeing a good Botox practitioner is as uncontroversial as seeing a good dentist – something you do to smarten yourself up without being obsessive about it.
This is where such treatments are now. In a sense, Dr Brandt’s professional legacy had finally come of age. Dr Prager, who is already besieged by clients from as far away as Australia, is viewed by many as the American’s natural heir. The good doctor is far too discreet to confirm this but I would be surprised if the phone to his Wimpole Street surgery were not engaged constantly as news of Dr Brandt’s demise broke. After all, the cult of youth isn’t going away. As Dr Brandt said last year, ‘Botox is here to stay.’
Strangely Dr Brandt considered his ageing and mortality keenly since he was a child. ‘I accept it as an inevitable part of the life cycle. Ageing doesn’t scare me: I’ve passed the scare point.
‘We’re all going to die. I just wouldn’t want to be in a nursing home. I want a quick death, to die in my sleep. It would be terrible not to be able to do what you like to do. It’s just not living.’
He said he’d like his own beauty TV chat show. He seemed so cheerful. ‘People say I’m always happy, but I say nobody is always happy.’ But he knows how to put on a necessary act. ‘Laugh and the world laughs with you. Cry, and you’ll cry alone.’
For ‘civilians’, SEEING a good Botox practitioner is as NATURAL as seeing a good dentist – something you do to SMARTEN up