NEW YORK PLASTIC SURGEON
Plastic Surgery New York, NY
Darrick E. Antell, M.D.
850 Park Avenue, New York, NY 10075
Over the past few years, age-conscious Manhattanites have filled their faces with all kinds of crazy stuff, from Botox to hyaluronic acids to fat from their own saddlebags. But recently, Jennifer, a slender 50-year-old who works on Wall Street, decided to plump up her cheeks with a new collagen called Juvederm, made from pig tendons, that she had seen advertised on television. “They mentioned that Demi Moore supposedly used it for laugh lines,” she said. “They intimated. And that kind of did it for me.”
Jennifer was untroubled by the barnyard origins of Juvederm, which arrived on the market in September 2008 but has yet to become a buzzword on the society circuit. “I heard in the media that it was derived from the pig and it sounded rather gross to me, but then they elaborated that we have similar tissue,” she said breezily.
And so on Monday, March 2, Jennifer arrived at the Park Avenue office of Darrick Antell, a plastic surgeon. Dr. Antell’s nurse wiped the makeup from the patient’s cheeks and applied a topical anesthetic; the doctor himself then injected a single syringe of whitish substance into her cheeks via a tiny 30-gauge needle. The entire procedure took 15 minutes and cost $700. Jennifer rode the subway immediately back to work afterward.
“I love it!” she enthused, calling from her office several days later. “I’m getting looks. ‘Oh, your skin looks great.’ I think it’s because the cheekbones are a little more defined. It’s kind of subtle.” There has been no bruising and no swelling—common, if typically short-lived, side effects of hyaluronic acid injections—just a minor, lingering pain to the touch. She even went back for another syringe the next day. “I just thought it looked so pretty,” she said.
‘A HUGE BREAKTHROUGH’
In the 1980s, we got ourselves shot full of bovine collagen (which required an allergy test several weeks beforehand, never desirable when one is seeking an instant pick-me-up). In the ’90s, we began freezing our faces with a derivative of the botulism toxin. In 2003 came Restylane, a breakthrough hyaluronic acid (or H.A., as it’s known in the trade) derived from bacteria. Nowadays many New York doctors also offer Radiesse, a filler made of synthetic liquid bone, and Sculptra, which was invented to treat the hollow cheeks of H.I.V. patients.
But … pig fat? Oy vay!
“It’s a huge breakthrough,” argued Dr. David Goldberg, a dermatology professor at Mt. Sinai School of Medicine, who will soon publish a study on the use of Juvederm in the eyelids; he estimates he’s used it on 200 or so patients already. “There’s nothing wrong with the H.A.’s, but the negatives of H.A.’s historically have been that there can be a fair amount of swelling, which you don’t get from any collagen, including Juvederm.”
“It’s easier in some cases to hide from the husband,” allowed Dr. Howard Sobel, a Park Avenue cosmetic dermatologist, in an email.
Carol R., 52, an Upper East Sider who has previously been injected with Restylane, Radiesse, Juvederm and longer-lasting silicon, tried Juvederm from Dr. Sobel’s needle for the first time two months ago. “I usually bruise down on my chin no matter what they inject,” she said. “It gets blue, and then it gets purple. It’s not very attractive. You look like either you got punched in the face or you did something. Every woman knows you did something.”
But with Juvederm, Carol exulted, “I didn’t swell at all!” She went out to dinner with two other couples the night of her injection. And it didn’t trouble her in the slightest that what was in her face might also have been offered on the menu. “I had [bovine] collagen for years,” she said. “I guess if you could eat bacon, you can put it in your face! And I like bacon!”
Doctors similarly scoff at the notion that New York women might be wary of using pig fat to achieve a baby face. “Oh, come on, when it comes to beauty?” said Dr. Francesca Fusco, a much-loved dermatologist who shares offices with Dr. Patricia Wexler. “In all the years I’ve practiced, nobody’s ever said, ‘I’m a vegetarian, so I don’t want the bovine-based collagen.’” Indeed, perhaps our fetishization of the greenmarket has made us more inclined to pork up, facially speaking. “It’s like we have farm-fresh faces!” Dr. Fusco giggled.
“A lot of people would rather have a natural substance derived from a pig than a substance made in some laboratory,” Dr. Goldberg said (H.A.s are cross-linked by chemicals; the creation of Juvederm entails a patented technology involving sugar, sort of like a closely guarded barbecue-rub recipe).
Perhaps Juvederm’s most surprising characteristic, however, is that it is made in … Israel, by a company called ColBar Life Sciences, which was purchased by Johnson & Johnson, the squeaky-clean American company widely associated with plump baby faces, in 2006.
“We think we have a game-changer on our hands,” declared Monica Neufang, a Johnson & Johnson spokeswoman for Juvederm, just after returning from the annual meeting of the American Academy of Dermatology in San Francisco, which she called the new brand’s “coming out.” (They had wooed dermatologists with live demonstrations and dinners).
Ms. Neufang said that the product had been approved by at least one rabbinical council but that religious patients should consult their rabbis for guidance “We do not have rabbis on staff,” she said. But: “By the time you purify the product, the collagen that results is virtually identical to human collagen.”
She admitted that her company has thus far been rolling out its find rather stealthily. “Our product injects very differently than H.A.’s, and since that is the lion’s share of the market, we wanted to make sure we have a robust training program in place for physicians, so we’ve really been focusing on that for the first six months,” she said. But in the next month or so, get ready to see Juvederm everywhere, as the brand targets consumers more directly.
‘RED AND BUMPY’
But even in an era when dissecting the work done on celebrity faces is all but public sport, and everyone from George Clooney to Debbie Harry admits cosmetic “enhancement”—brawny tennis player Lindsay Davenport is even the spokesperson for Juvederm!—might Juvederm’s feed-lot beginnings invite increased scrutiny of our beauty addiction?
Julie, a 36-year-old doctor (though not a dermatologist) in Manhattan who had a Restalyne injection several years earlier, tried Juvederm three months ago. “It still looks good!” she said the other day, calling from her office. “I didn’t have really bad lines to begin with, but it smoothed them out, gave it more of a fresh look.” She equated it to “a polish, like the top coat on your nail polish.”
A reporter wondered what she thought of the product’s porcine origins.
“I didn’t know that,” Julie said. “But thanks a lot!”
She is Jewish, she added, albeit nonreligious. “I don’t really eat pig, so the fact that it’s in my face isn’t thrilling,” she said. “But I guess if you’re doing something like this, you’re probably not too concerned about those kinds of things anyway.”
Karen, 58, of the Upper East Side, was more concerned about the adverse reaction she experienced after her first Juvederm injection last month, which kept her close to home for about a week. “I’ve had a lot of fillers,” she said. “If you get a bruise, that’s one thing, but I was very red and bumpy.”
Her concerns were echoed by several New York doctors who are not yet sold on the swinish collagen du jour. “There have been reports in the Canadian literature, one study where they had 20 patients who were injected with Juvederm in the lips and they developed nodules that had to be surgically removed,” said Dr. Lisa Zdinak, who has a practice on East 74th Street. “So I took that off my palette. I used it in the nasolabial folds, but when I read that I couldn’t use it in the lips, I thought, ‘Why am I even bothering with this?’ I have H.A.’s!” (Juvederm enthusiasts counter that Juvederm Breeze, a thinner form of the filler currently being used in Europe for lip-plumping, will likely be F.D.A.-approved in the near future).
“It’s late on the scene, to be honest with you,” said Ariel Ostad, a dermatologist on Lexington Avenue. “Everybody’s already so comfortable with hyaluronic acid. And then the fact that it’s pig.”
But the substance’s defenders grunt at such criticism. “It’s been used for several years in Europe and Israel; they’ve shown that there’s little correlation between sensitivity to collagen and sensitivity to Juvederm,” said Dr. Mauro Romita, a Fifth Avenue plastic surgeon who added that the product is currently his number one choice for the nasolabial region.
Dr. Paul Lorenc, a Park Avenue plastic surgeon who led Juvederm’s F.D.A. approval study, touted the fact that 76.5 percent of pork-injecting patients in his study were still showing notable improvement after one year, as opposed to our cow-plumped sisters of yesteryear, whose volume shrank in just three months. Moreover, Dr. Lorenc said, Juvederm flows more easily through the syringe than do H.A.’s, resulting in less of a chance of “over-correction,” as he called it.
As expendable income seems to be drying up in inverse proportion to patients’ ravenous appetite for filler, Juvederm’s long-term prospects are anyone’s guess. “I think it will come down to pricing and marketing,” said Dr. Sobel. “In my opinion, a lot of the injectibles are similar.”
Tell that to Laura, 49, a limousine company sales rep, bartender and enthusiastic recent Juvederm convert who works in Long Island City. “It’s outrageous,” Laura said. “It’s not, like, drastic, but people will just say, ‘You’re looking good these days!’”
But does it ever give her pause that she has our porcine friends to thank for this? “If you just say the word, ‘I have pigs in my cheeks …’” she said. “But no one knows. It is what it is. I don’t really care.”
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