Greenwich
Cover Story
Saving Face: Dr. Antell's Groundbreaking
Study of Identical Twins
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In the right hands, plastic surgery
is both a complex discipline and a subtle art. The
ancient and sometimes suspect practice, which took
a quantum leap forward in the first decades of the
twentieth century, is by definition the very essence
of creativity. With a knowing eye, deft hands, and
skills both learned and innate, plastic surgeons
can perfect that which nature made imperfectly.
They can accomplish Einstein's dream of manipulating
time and undo the inexorable drag of the years on
muscle and flesh. And when a plastic surgeon of
national renown, like Greenwich resident Darrick
"Rick" Antell, takes identical twins whose
faces have aged differently and restores them to
the mirrorlike similarities of the past, it can
seem miraculous.
"Plastic surgery has nothing to do with plastic
as we think of it today," Dr. Antell is quick
to point out. "It comes from the Greek word
plastikos, which means to mold. What we do is mold
tissue."
Plastic surgery predates Hippocrates. Descriptions
of procedures have been found in papyrus writings
dating back to 3000 B.C. Modern plastic surgery,
which often combines both cosmetic and reconstructive
skills, was born in the trenches of World War I.
Young doctors inexperienced in battlefield medicine
struggled with old techniques and gave birth to
whole new areas of medicine, including dental and
plastic surgery, with the emphasis on repairing
jaws and faces savaged by shell and machine gun
fire.
"In trench warfare," Dr. Antell says,
"the soldiers looked up over the trenches and
were hit in the face." All that many people
know about plastic surgery is from Nip/Tuck (the
cable television series about two wildly dysfunctional
Miami surgeons), he says, "so you have to educate
them about World War I and the injuries, and how
it came to be the way it is."
A quick explanation: Plastic surgery includes reconstructive
surgery, which Dr. Antell defines simply as taking
someone and basically getting them back to normal;
and cosmetic surgery, which is taking someone who
is basically normal and improving their appearance.
(While cosmetic surgery is not covered by health
insurance, reconstructive surgery, theoretically,
is.)
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| This woman, a
U.N. employee from Ethiopia, was injured in
2003 when a truck bomb exploded outside her
Baghdad hotel. Her facial scar almost disappered
after Dr. Antell's reconstructive surgery. |
Dr. Antell maintains a busy Park Avenue practice
in New York and teaches at Columbia University.
He is a devoted family man to wife Lisa and their
five children. When they used to vacation on Fishers
Island, he volunteered as a general practitioner
and would be given vegetables and fruit by patients
in return. A lifelong believer in giving back, he
has treated patients from Kuwait, Egypt and England
as a medical consultant in plastic surgery to the
United Nations, operated on victims of the August
2003 terrorist bombing of the UN headquarters in
Baghdad and is involved in Operation Smile, which
provides free reconstructive surgery to inner-city
children in the New York metropolitan area..
His groundbreaking study on aging and identical
twins, which concluded that lifestyle and environmental
factors were the most significant contributors to
premature aging, was sparked by conversations with
his patients. "I think I'm probably best known
for face-lifts," he explains, "and patients
always ask, 'How long will my face-lift last?' When
I say, 'forever,' they look confused. So I would
say, 'If you had an identical twin that had not
had surgery and you had, you would both continue
to age, but obviously you would always look better
than your twin.' We can push the clock back but
we can't stop it the clock keeps ticking."
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| Dr. Antell and
some of the twins he's operated on were featured
several years ago on Good Morning America
with Diane Sawyer. |
What we see in a face of a smoker is a window
to what's happened inside.
"I thought it would be interesting to see
what would happen if I operated on one twin and
not the other, which was why I initially went to
Twinsburg," he says, referring to the annual
Twins Day Festival in Twinsburg, Ohio. "So
I went there with photo equipment and questionnaires
and set up a research booth." Over the next
two years, Dr. Antell conducted intensive interviews,
reviewed hundreds of photographs, and performed
face-lifts on selected twins so that they again
looked like their siblings.
Twins before Dr. Antell
operated
Twins after Dr. Antell operated
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"How Environment and Lifestyle Choices Influence
the Aging Process," was published in 1999 by
the prestigious medical journal Annals of Plastic
Surgery. "When one identical twin looks noticeably
older than the other," Dr. Antell has said,
"only external factors can account for the
differences in appearance." (He also presented
the study at a national plastic surgery conference
in Newport, Rhode Island, and at an international
conference in Venice, Italy.)
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| The woman on the
left smoked for 30 years while her identical
twin with a more youthful face (right side)
never smoked |
"When I got back to New York that first year,"
he says, "I was struck by how different some
of these twins looked in the pictures." Perhaps
the most stunning case is that of Gay and Gywn,
two women approaching sixty; both had strong features,
luminous dark eyes and short, similarly cut iron-gray
hair, but their photographs eerily resemble "before"
and "after" shots of the same woman. Gay
had been a California sun worshipper for three decades,
smoked a pack of cigarettes a day for four years,
used marijuana heavily for seven, drank socially
for ten years, and had undergone the horrific stress
of losing a child to leukemia, Gwyn had lived in
Maryland with moderate sun exposure, never smoked
or drank, and had not had as stressful a life; as
a result, she was free of Gay's pronounced wrinkles
and leathery skin. Even more telling were Kathleen
and Karen, two Maryland-based twins in their fifties
with comparable lives and lifestyles: Kathleen looked
noticeably older; the only difference between them
was that she had smoked for thirty years. (She has
since quit.)
"This is a good story to get people to stop
smoking," says Dr. Antell. "You can tell
people about their lungs turning black until you're
blue in the face. You tell them they're going to
look older? It's a much better sell."
Through his research Dr. Antell was able to pinpoint
three factors that he calls "the three S's"
smoking, sun exposure and stress that impact on
premature aging. "This is really the first
study of its type," he says, "that documented
the effects of nature versus nurture. We're all
going to get old anyway, we can't do anything about
that. But this study conclusively proved that you
can affect the rate at which you age. Nature is
highly overrated," he says with a distinct
twinkle. "I think we can control about 80 percent
of how we age by healthy lifestyle choices and by
doing all the right things Mom always told you to
do: don't smoke, eat right, exercise and get good
sleep."
Dr. Antell has said of cigarettes, "What we
see in a face of a smoker is a window to what's
happened inside." Damage caused by sun exposure
is arguably better known today than ten or even
five years ago, although a large part of the reconstructive
work Dr. Antell does is related to skin cancer.
Perhaps his most shocking case was that of a woman
who had, through a terrible and sad kind of denial,
allowed a basal skin cancer to grow over much of
her face. "The hardest thing was that it encroached
onto her eyelid." he says soberly. "We
rebuilt both the inside and outside of the nose.
The reason I point this out is because we used basically
a reverse face-lift technique, taking all the skin
from her neck and moving it up. This is why reconstructive
surgery and cosmetic surgery blend together. She
really had a face-lift but for a different purpose."
| Excess exposure
to sun, plus smoking and stress, made the twin
on the left look much older than her identical
twin sister (right). |
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As for the effects of stress, Dr. Antell confirms
that one can indeed "turn gray overnight,"
or at least within months. "What happens with
stress is what's called the fight or flight mechanism,"
he says, "that shunts all the blood away from
the perimeter to your brain and your central organs.
And the blood is being shunted away from the scalp
over time. So that's one aspect of stress. You also
tend to tighten the muscles in the forehead and
between your eyebrows with stress. It's like a tin
can in that if you bend it enough times, eventually
it will crack."
For someone with a national reputation his work
has been written about in such diverse publications
as People, Town & Country and Vogue magazines
and the Wall Street Journal Rick Antell is also
about as down to earth as it gets, perhaps a reflection
of his Norman Rockwell childhood in Cleveland, Ohio,
the son of a dentist. Plastic surgery has its origins
in dentistry, and Dr. Antell earned a DDS at Case
Western Reserve University before attending Medical
College of Ohio.
"While I was in dental school," he says,
"I met Clifford Khein, who was a well-known
plastic surgeon, and I started following him around.
I really got interested, so I applied to medical
school knowing that I wanted to be a plastic surgeon."
Then came internship and residency at Stanford University,
where he met Lisa (who also has a medical degree
but these days concentrates on the family), then
to New York Hospital/Cornell University Medical
Center for training in his specialty.
"As a kid I was very finicky, very detail
oriented," he says with a grin. "I was
always straightening up without thinking about it,
so I liked the precision of plastic surgery. Having
gone to dental school first was really helpful;
it's terrific training in using your hands.
No matter how much we want to deny it people
do judge a book by its cover.
When I started practicing, I did a lot of jaw reconstruction
because of that the kind of surgery where you cut
the bones and reposition the jaw. Today, with what's
called rigid fixation, we put tiny little screws
and plates in. It's all through the mouth, and it
shortens the recuperation process because you don't
have to wire the jaw." In some cases, the patients
can open their mouths right after surgery.
"You know," Dr. Antell says, "in
some ways my life has been a series of lucky accidents.
Years ago I was playing baseball with my buddies,
and the kid who was at bat wasn't hitting much,
so I was getting kind of bored out in right field.
There was a fly buzzing around my face, and I took
my glove and went to swat at it... and the ball
landed right in my glove. Everyone was applauding
and saying, 'What a great catch!' If I'd been one
foot over, the ball would have hit me right in the
head.
"Another example? Shortly after I started my
practice, New York Magazine came out with one of
their Best Doctors lists. Now they do them all the
time, but back then they only did them every ten
years so it was a big deal. I wound up on the list
for breast reconstruction, so I started doing more
and more of them. As a practice develops, you do
more elective surgery and that s cosmetic sur gery,
which is the bulk of what I do at this point
A successful plastic surgeon must be part diplomat
part father confessor and above all, kind. "Everyone's
got their own deal," Dr Antell says bluntly.
"Sometimes we'll see someone with a very minor
deformity, but they are very concerned about it.
If you can make that a little bit better and help
them, that's fine. We sometimes refer to it as surgical
psychiatry. After surgery, they stand a little straighter,
their chins up in the air instead of down on the
floor, they feel better about themselves. No matter
how much we want to deny it, people do judge a book
by its cover. It can even have an impact on survival,
like the animal kingdom where symmetry is important.
A cleft lip, for example, is not symmetric, and
in some cultures those people used to be killed
at birth. And plastic surgery was considered a dark
art because to change something like a cleft lip
was going against the will of God.
"There's plastic surgery that changes the
way you look," he continues, "like taking
a bump off someone's nose, and there's plastic surgery
that makes you look more youthful. I've had surgery,
I'm happy to say, and you can quote me. I had my
eyelids done over twenty years ago. I had bags of
fat under my eyes that were driving me crazy. Everyone
always thought I looked tired when I wasn't. I just
got tired of hearing it. I'd get a good night's
sleep, and I'd go to work and someone would ask,
'Were you out late last night?' I'm self-employed,
but what if you had an employer? What sort of subtle
message would that send? I mean, we've all been
there, where you get a new blouse or a new tie,
and you just feel better. You really can help people,
and as a doctor that's what it's all about."
Dr. Antell also cheerfully admits to having used
Botox, which he deems "the greatest thing since
sliced bread." "When Botox was first used,"
he says, "it was primarily in ophthalmology,
for things like twitchy eyelids. When you get really
tired, your eyelid twitches, and in some people
it twitches all day long. When Botox was used for
this, people noticed that their crow's feet went
away, so they started applying it for other uses."
Botox is most commonly used to relax deep worry
lines between the eyebrows. "I had it done
because when I looked in the rearview mirror of
the car, I looked angry," he says, laughing.
"I saw these two number eleven signs. Botox
has been used for back pain, when your back goes
into spasm, and it's been shown in retrospective
studies to be extraordinarily effective on migraines.
The downside is minimal as long as it's properly
administered."
Which segues neatly into Dr. Antell's concern that
patients should know what they're getting in a doctor.
"If you're going to have plastic surgery, the
most important part of getting a good result is
the surgeon you choose," he says firmly. "Not
only should you check that they're board certified,
you should check what they're board certified in.
Legally, you can call yourself anything you want
to, even in a specialty; I could call myself a neurosurgeon
and do neurosurgery, even though I'm not trained
in it. People know the buzz phrase 'board certification,'
but they don't take it to the next level. And this
is one area in life where it pays to pay retail-----
you can't take it back, like a pair of shoes.
"Unfortunately, for some people, plastic surgery
is that which you can see," he concludes. "Well,
it shouldn't show. The good results should be those
you're not aware of. I always say plastic surgery
should whisper, not shout."
By: Jane Kendal
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