The Dermies 2015: Boyhood

Friday, February 20th, 2015

Probably the most interesting of all the movies I saw this awards’ season was Boyhood. Not only does it have a compelling premise around the growth and development of the main character over 11 years, but it shows the aging of the other characters over the same period.

My career as a dermatologist puts me in a position to stall the effects of aging in many of my patients who desire services such as Botox, fillers, lasers and more. While we see aging in this movie in the mother and father (Patricia Arquette and Ethan Hawke), do they seem to age normally or are they doing their best to stop the clock?

My thoughts are that Hawke is not doing anything to stall the effects of aging, whereas Arquette is almost certainly undergoing treatments such as fillers and neurotoxins. The changes on Hawke’s face are significant but due to normal activities like frowning. Similar to a piece of paper that is folded hundreds of times will ultimately retain a crease, the human face will also respond to repeated activities over time.

Hawke develops a crease in the middle of his forehead (glabella) over the course of the movie. Presently, he is 44 years old and shows definite signs of aging, perhaps more than his chronological age should show. With some very simple interventions, he could regain his youthful appearance. For example, just a little Botox or Dysport and filler, such as Restylane or Juvederm, could improve the mid-forehead crease. And he also seems to be a little gaunt, which could easily be improved with fillers such as Voluma in the mid-cheek area.

Lastly, EltaMD sunscreen would help with the Hawke’s noticeable sun damage. Being raised in Texas, Hawke most likely experienced quite a bit of sun growing up and this hasn’t helped him. It takes about 20 years for the effects of sun exposure to show up. We are now just seeing the results of sun exposure in his 20’s, so it may be rough over the next few years if he hasn’t ever protected himself. Additionally, if he is a smoker, smoking could complicate matters by contributing to premature aging.

As for Arquette, it seems she has done everything she can to keep her skin healthy. Her complexion is alabaster throughout the majority of the film and that is going to help prolong the excellent appearance of her skin and keep her looking youthful. It does appear that she is probably no stranger to the dermatologist, as she appears to have some fillers in her cheeks and minimal, if any, developing frown lines.

While many actresses let their wrinkles show up when they appear in movies lest they look ‘done’, my guess is that she is being treated with neurotoxins such as Botox, as she has little or no signs of aging. She does have some wrinkles around her eyes, which are also treatable with Botox, but they are very minimal. In short, Arquette is doing the sorts of things that will continue to keep her looking good for many years and as long as she stays out of the sun and doesn’t go overboard with treatments (something which is important and rests not only in her hands, but in the hands of her dermatologist), she will do just fine.

Whether or not the lack or presence of cosmetic surgery among the ‘parental’ cast of Boyhood will influence the award’s season decisions is not something I can say, but the fact that neither headliner in this movie did anything too drastic to their faces during the time of the shoot was helpful in portraying a relatively realistic aging sequence.

The Dermies 2015: The Grand Budapest Hotel

Monday, February 16th, 2015

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The birthmark, a ‘port-wine stain’, that is seen on Agatha’s (Saoirse Ronan) face in the “Grand Budapest Hotel” affords a huge opportunity for The Dermies to explain a condition that many dermatologists see and treat routinely, although it occurs in less than 1% of the population. I would like to think that this is one of the reasons this movie has been acclaimed during the awards season.

Port-wine stains are usually noted at birth as a flat pink mark on the face. Generally, they follow one of three distributions on the face in a pattern on the upper, middle or lower third of the face and on either the left or right side, but not on both. Over time they can become larger and often develop bumps or larger nodules that occasionally bleed. The port-wine stain in this film is slightly less noticeable than many we tend to see in persons the age of the actress in this film. Ms. Ronan doesn’t have a birthmark in real life, so the producers of the film intended to present it to audiences. The most noticeable person in recent times who brought attention to this mark was Mikhail Gorbachev, the leader of the Soviet Union from 1988 to 1991.

Many different lasers have been used over time in treatment of port-wine stains, pulse dye lasers and intense pulsed light devices most recently, and have generally been successful in diminishing them. Treatments are usually started early in life, with multiple treatments necessary to result in significant improvement. Some affected people have also used makeup, such as Dermablend that can effectively cover up the birthmark.

I was impressed with the portrayal and treatment of Agatha’s birthmark in the movie. Additionally, I was delighted to see that her beauty was a central factor of the movie, notwithstanding her birthmark. While I treat many birthmarks for patients who desire modification, it often strikes me that these are beautiful people whose birthmark accents their beauty, rather than detracting from it. Sadly, childhood isn’t easy for many of my patients with birthmarks or other, more common, conditions such as acne, and treatment does appear to be the rule rather than the exception because of the negative notice engendered by a birthmark.

While I wouldn’t bestow The Dermie for Best Picture on Grand Budapest Hotel, I do feel the movie deserves applause for allowing its heroine to display one of the more common birthmarks and introduce this to film audiences.

The Dermies 2015: Wild

Monday, February 9th, 2015

The Dermies 2015: Wild

While I wanted to start out with a movie for The Dermies that was nominated for Best Picture, I had to begin with Wild. This movie was nominated in the category of Best Actress (Reese Witherspoon) and in the category of Best Supporting Actress (Laura Dern). There were just too many great dermatologic aspects of this movie to not put it first, although there are other movies that I will review that also are a dermatologist’s dream.

In this movie, Witherspoon plays the part of Cheryl Strayed, who hikes more than 1,000 miles on the Pacific Crest Trail. The movie was incredible, but as a dermatologist, I found myself worrying about Cheryl’s skin. She doesn’t appear to apply sunscreen during the movie. Granted, the movie takes place in 1995 and sunscreens weren’t as good at that time as they are now, but still it would have been helpful for her future skin had she applied sunscreen every 2-3 hours. Carrying sunscreen would have increased the heavy load she was carrying, but from my standpoint, it would have been worth it. I hiked Mt. Kilimanjaro and Mt. Rainier, and I can assure you, EltaMD sunscreen was in my backpack at all times.

The good news is that there are now clothes with UPF (a form of sun protection) that Cheryl could have worn and wouldn’t have increased her load. Also, Cheryl didn’t wear a hat or sunglasses. This raises a dermatology warning flag as hats are essential coverage and ocular melanoma can result from poor eye protection.

There are many other fascinating dermatology aspects about this movie, ranging from blisters on the feet and hands, to bruises from the hike. There was also a particularly awful case of boot toe in the beginning, with a toenail that Cheryl removed due to ill-fitting boots. The nail probably should have not been removed as the strong keratin in the nail protects the underside and without a nail, there is zero protection. Instead, I would’ve liked to see her take duct tape and wrap her toe. As for the blisters, Cheryl doesn’t seem to have any moleskin with her, and it is always a great idea to take moleskin along when you hike.

As I watched it, I kept thinking about FixMySkin 1% Hydrocortisone Balm, the product that my son and I invented in 2010. Had this product been around it during the time, it would have been fantastic for Cheryl to use on her abraded and dry skin. She could have even put it in her pocket and saved weight in her pack.

During the movie, Cheryl gets a tattoo of a horse on her arm to match her soon-to-be divorced husband’s tattoo. This is an unusual thing for me to see, as most of the time tattoos for an ex-husband or ex-wife are ones that I am lasering off. In the case of this tattoo, it would be very easy to laser off as it is predominantly one color. If the tattoo was green, it would be much harder to remove.

Cheryl does many risky things in this movie, including recreational drug use, casual sex, and, of course, a presumed lack of sunscreen. However, it is important to point out that tattoos are also risky. The needles can be contaminated and they have a potential to transmit hepatitis.

At one point in the movie, Cheryl comes to a town and wanders into a beauty store. She is carrying a massive backpack with all of her camping gear. She looks into a mirror and applies some very red lipstick. She seems pleased with how she looks until the salesperson approaches Cheryl and realizes she is very dirty and fatigued. She mentions to Cheryl how important it is for a woman to be aware of her skin and personal hygiene, but she doesn’t offer to help her buy the lipstick or anything else in the store. Cheryl mentions that she is definitely working on her personal hygiene and leaves the store.

While I was shocked at how rudely the salesperson spoke to Cheryl, I was also shocked that she applied the lipstick from the sample. That it is something that we don’t do in our store, LovelySkin, as it can lead to the transmission of viruses and colds. Instead, we use a cotton bud to spread lipstick. Our staff would throw away the lipstick if they saw something like this happen in our store.

In another scene, Cheryl is at a camping site where a worker is trying to help her lessen her backpack load for her journey. The first thing the worker notices her deodorant. She decides to toss the deodorant and makes a comment that her underarm smell is the least of her bodily worries. Although deodorant may not be important to Cheryl, I do believe antiperspirants should play a huge role in most people’s regimens.

Although it seems that Cheryl spends a lot of time under sun exposure, especially in the Mojave Desert where the movie begins, Cheryl’s skin doesn’t tan. This probably means that she did wear sunscreen or that she used some sort of sun protection while hiking. I think her chances for the Best Actress award are very good as she was clever to protect her skin under extreme exposure, and of course, Reese Witherspoon is a superb actress! My vote for the Dermies Best Actress goes to Reese Witherspoon for her beautiful skin and great portrayal of Cheryl Strayed in Wild.

Introducing The Dermies

Monday, February 9th, 2015

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By Dr. Joel Schlessinger

It’s award season for the movies that we know and love. As a dermatologist, I have always felt there should be a special award for movies that portray the skin and beauty-related issues in a positive manner since this leads to better skin health and a focus on better skin care.

The Dermies have been created as an award for movies and other cultural offerings that celebrate beauty in a relatable manner and help inform the public about issues and procedures in a health-conscious way. I hope my audience finds these awards and my commentary entertaining and helpful!