In Your Face » Celebrities

Botoxed Biden — how cosmetic docs helped Democratic debater

Colin Stewart — Fri, 03 Oct 2008 17:00:00 +0000

Photos: Sen. Joe Biden at vice presidential debate. (AP photos)

FIGHTING HAIR LOSS AND WRINKLES

Cosmetic doctors helped mold Sen. Joe Biden’s appearance in last night’s vice presidential debate.

Botox injections apparently both eased the 65-year-old’s wrinkles and constrained his facial expressions. That was in addition to the hair replenishment procedures that he underwent many years ago, which reversed the hair loss that he was experiencing.

I’m in the process of seeking expert comments from dermatologists and plastic surgeons. As those arrive, I’ll add to this post.

Plastic surgeon Dr. Jason Pozner of Boca Raton, Fla., starts it off with a critique of how Biden was Botoxed. Those injections reduced wrinkles caused by the frontalis forehead muscles, but also affected his drooping eyebrows, or brow ptosis, Pozner said:

Way too much Botox. It’s exactly what not to do -– take someone with brow ptosis and knock out their frontalis muscles – no wrinkles but their brows drop too much. As he speaks you can see the corners of his eyebrows twitch a bit.

Plastic surgeon Dr. John Di Saia of San Clemente believes that Biden needs more than just the Botox:

Sen. Biden has likely had Botulinum toxin treatments, but would he ever benefit from a simple eyelid operation! Or better yet, eyelids with an endoscopic forehead lift.

Related links:

For more on celebrities and cosmetic medicine, see links on the right side of this blog.

(This post was updated at 3:15 p.m. Oct. 3 to include Dr. Di Saia’s comments.)

Angelina is the star plastic surgery patients want to look like

Colin Stewart — Thu, 02 Oct 2008 19:27:40 +0000

See ‘MULTIFACETED ANGELINA’ slide show

Survey: Is Angelina Jolie the world’s most beautiful woman?

Photos: Above, Angelina Jolie last May at the Cannes film festival. Below right, Angelina Jolie last year. Bottom photo, with husband Brad Pitt in Cannes last May. (AP photos)

WHO’S THE FAIREST OF THEM ALL?

Actress Angelina Jolie, 33, maintains a strong grip on people’s imaginations, with few indications that her status as top-ranked ideal beauty is slipping.

It’s a prominence that can cause problems for plastic surgeons, since they can’t transform patients into the image of Angelina.

Last year, Jolie was named No. 1 on a list of 100 sexiest stars compiled by Empire movie magazine. She was also voted “Ultimate Female Hottie” of all time, edging out Raquel Welch, Marilyn Monroe and Jessica Alba among readers of Entertainment Weekly’s Web site.

Her lips are No. 1 on a newly released list of female celebrities’ features most desired by patients, according to an annual survey by the Beverly Hills Institute of Aesthetic and Reconstructive Surgery. That’s a drop from some past editions of the list, such as in 2004, when both her lips and eyes were rated No. 1.

Plastic surgery patients worldwide most often request Jolie’s smile, lips, eyes and cheeks, according to an informal poll earlier this year by the International Society of Aesthetic Plastic Surgery, which surveyed 20,000 plastic surgeons in 84 countries.

That “wannabe” approach is a problem for plastic surgeons such as Dr. John Di Saia of San Clemente.

Di Saia says:

I used to have patient requests like these and it was frustrating. Seeing as it is rarely possible to actually pull off such a transformation outside of Photoshop, working in this framework is a “no-win” for both surgeon and patient.

It is more honest to talk in degrees of change than to talk about putting Angelina Jolie’s nose on another person’s face. That nose might not fit on the patient’s face well anyway, even if it could be surgically re-created in that way. I don’t know of any good surgeons who work [that] way.

Plastic surgeon Dr. Alan Bienstock of Lawrenceville, N.J., has a similar difficulty. As CosmeticMakeovers.com reports:

Many women who come into Dr. Bienstock’s office ask for breast implants ‘like Angelina Jolie’s.’ But in this case he has to tell them that her breasts are natural and have not been augmented via any kind of plastic surgery.

Jolie’s lips are often mentioned by patients, either as desirable or too large, says plastic surgeon Dr. Michael Persky of Encino. But they aren’t patients’ No. 1 request, he says:

The most common request from my patients regarding a feature of Angelina Jolie’s that they would like on them is Brad Pitt! (Pictured at right.) Second to that are lips. Most patients would love to have her lips, while others do not want their lips to “be as full as Angelina Jolie’s.”

Cosmetic doctors disagree about why people find Jolie so attractive. Here’s Persky’s view:

Angelina possesses the classical features of beauty that were described by Leonardo da Vinci during his anatomy studies and drawings of 1511. His proportions are used by plastic surgeons today.

Angelina’s face is very symmetric. Her face can be divided into 3 equal thirds horizontally, her forehead, her brows to her upper lip, and her upper lip to chin. Likewise, vertically her face can be divided into equal fifths, each the width of the distance between her eyes.

Her forehead is flawless (Botox?). Her nose fits her face and allows us to focus on her beautifully shaped eyes. And then of course those sexy Angelina lips. Are they real or not? I won’t tell, but only Angelina and her injector know for sure.

Beautiful? Yes. But symmetrical? Not so, says dermatologist Dr. Ava Shamban of Santa Monica:

To me, she’s the gold standard of beauty. There’s something about her that is both exotic, yet accessible, and she has those almost-cartoonish features – exaggerated eyes and lips – and a sense of mystery.

See ‘MULTIFACETED ANGELINA’ slide show

Related links:

For more on celebrities and cosmetic medicine, see links on the right side of this blog.

Did you miss?

It was a hectic week, no? So, we can’t blame you if you missed of few of these Orange County business gems …

Is Angelina Jolie the world’s most beautiful woman?

Colin Stewart — Thu, 02 Oct 2008 19:25:18 +0000

This reader survey is a companion to the post “Angelina is the star plastic surgery patients want to look like.”

Is Angelina Jolie the world's most beautiful woman?

Slide show depicts many facets of Angelina Jolie

Colin Stewart — Thu, 02 Oct 2008 19:20:09 +0000

See ‘MULTIFACETED ANGELINA’ slide show

This slide show is a companion to two blog posts:

Risks, safety of plastic surgery unchanged by veto of Donda West Bill

Colin Stewart — Thu, 02 Oct 2008 15:33:12 +0000

Gov. Arnold Schwarzenegger has vetoed the toothless “Donda West Bill,” which would have required doctors to check a patient’s medical history and perform a physical examination before cosmetic surgery.

The bill wouldn’t have established any criminal penalties for doctors who violated those basic safety standards. In effect, it was aimed at letting legislators believe they had done something to make plastic surgery safer in response to last year’s death of Donda West (pictured), the mother of rapper Kanye West.

As I said in August in the post “Donda West Law is futile attempt to make plastic surgery safer”:

That’s a bit like passing a law to require surgeons to wash their hands before an operation. Anyone who would ignore such basic safety precautions isn’t likely to worry about the prospect of such a technical infraction.

See the post “How to avoid bad doctors” for a more helpful method of protecting yourself against slipshod work by careless surgeons. That post includes information on the California medical board’s disciplinary action against Dr. Jan Adams, the plastic surgeon who operated on Donda West.

Schwarzenegger said he vetoed the bill because this summer’s budget stalemate left him with time to deal with only top-priority bills.

“This bill does not meet that standard, and I cannot sign it at this time,” he said, which was the same reason he gave for rejecting many of the 131 bills he vetoed Sunday. Facing a Sept. 30 deadline, he signed 64 bills that day.

Donda West, 58, died Nov. 10, 2007, while recovering from breast reduction, tummy tuck and liposuction procedures. An autopsy report found that West likely died of heart disease coupled with complications from the plastic surgery.

Adams, her plastic surgeon, has denied wrongdoing. West’s family believes a physical exam would have revealed that she had coronary artery disease, making the surgery hazardous.

Plastic surgeon / blogger Dr. John Di Saia of San Clemente called the bill “Feel Good” legislation, which was passed because “legislators probably felt impelled to appear as if they are doing something even if it really does nothing.” He said:

Good doctors already do this. The bad ones will probably not change or they will offload the responsibility to someone else.

Plastic surgeon Dr. Tenley K. Lawton of Irvine added:

Patients should be educated about the importance of seeking a board-certified plastic surgeon to perform their procedure. There are many doctors out there who perform plastic surgery but are board-certified in other specialties. This becomes confusing to patients who do not understand the difference. They only see the words board-certified and assume that the physician has the appropriate training.

Related links:

For more on cosmetic medicine, see links on the right side of this blog.

Palin’s lip liner is a tattoo? Wasilla makeup artist doubts it.

Colin Stewart — Tue, 30 Sep 2008 20:41:03 +0000

Photos: Close-ups of Sarah Palin’s lips, courtesy of the Huffington Post.

TATTOOED LIPS?

Sarah Palin’s lip liner is the latest focus of people’s fascination with the Republican vice presidential candidate.

Is it really a tattoo?
That’s the suggestion of commentators at the Huffington Post and Wonkette, who are no fans of the GOP ticket.

Professionals who apply tattooed permanent cosmetics for a living are divided on the question after looking at photos of Palin’s lips.

But a permanent-cosmetics technician who has spent time with Palin, face-to-face, in her hometown of Wasilla, Alaska, thinks it’s highly unlikely.

Deena Williams, founder of Ageless Beauty Permanent Makeup in Wasilla, said she spent much of an hour talking to Palin last year as they both were getting pedicures.

Williams, who is a permanent makeup technician and instructor, told Palin about her work and gave her a business card, she said.

“She didn’t indicate that she had permanent makeup,” Williams said. “You’d think that she would have told me if she had.”

Tattooed permanent makeup can be hard to distinguish from normal lip makeup, especially if a woman enhances it with regular lipstick, the professionals said.

Dr. Laura Reed, an optometrist who runs Artistic Cosmetic Solutions in Garden Grove, said it’s “a definite possibility” that Palin has permanent tattooed lip liner, based on her first look at close-ups of her lips.

“And it looks like a pretty good job,” Reed added.

The conversation between Williams and Palin isn’t conclusive, she said:

I find that women do not always reveal that they have had permanent makeup done, even when it looks good. Some are open and freely talk about their experience (as I do). However, others do not. … It’s every woman’s prerogative to not tell her age or share her beauty secrets.

She’s unsure about Palin’s case, though, and after spending time reviewing photos of Palin’s lips, she was more doubtful. In one photo in particular, she said:

“The lip liner looks like it could be conventional makeup, e.g. a liner created with a lip pencil on the surface of her skin. …

It is likely there are makeup artists and stylists who do her hair and makeup before an appearance. Hence, the liner can look really good when done by a professional. Also, since she competed in pageants 20 years ago for college money, she had to learn how to apply her own makeup in an attractive manner.

If Palin has permanent lip liner, Reed said, it’s probably a “blended liner,” which includes a tattooed outer line plus soft additional tattooed coloring to blend the shade of the line into the shade of the lips.

Blended liners look much better than a simple tattooed line around the lips, which “look horrible,” Reed said.

If it turns out that Palin does have permanent lip liner, Reed added, “That might be a boon for our industry.”

The appearance of having tattooed lip liner could be because of Palin’s makeup style, said Liza Sims of Anchorage, Alaska, a certified permanent-cosmetics trainer and board member of the Society of Permanent Cosmetic Professionals.

“Her makeup style is a little ’80s-ish, with a heavy dark line,” she said.

After looking carefully at close-up photos of Palin’s lips, Sims decided that she would looking at permanent makeup.

“It’s not a good job though, not at all. They went too far outside the lip line on the upper lip and gave her the perpetual ’something smells bad in here’ look. I see the tell-tale fanning of the ink just outside the vermillion border. … I believe it is tattooed on. I’m just glad I’m not the one responsible for it!” said Sims, who operates Wake Up with Makeup in Anchorage.

After seeing close-up photos of Palin’s lips in a slide show, about 45 percent of people who took part in a reader survey at the Huffington Post said they think Palin’s lip liner is a tattoo. Another 21 percent said no, while 29 percent said they were unsure.

Having permanent makeup is unappealing to D.C. gossip blogger Wonkette. It’s “gross,” the site’s post says.

But for those who use or apply it, permanent makeup is efficient and attractive. As Reed says on her Web site:

Permanent makeup on the lips saves time and trouble from having to apply lip liner and continually reapply lipstick.

Permanent lip liner can help correct and balance the symmetry of lips that are uneven, too thin, too thick, or scarred.

Permanent lip color (“lipstick”) can restore color to lips that are too pale or seem washed-out.

(This post was revised at 3:20 p.m. Sept. 30 to include Reed’s additional comments and again at 1:15 p.m. Oct. 1 include additional comments from Reed and Sims.)

Related links:

For more on celebrities and cosmetic medicine, see links on the right side of this blog.

Did you miss?

It was a hectic week, no? So, we can’t blame you if you missed of few of these Orange County business gems …

12 Hollywood stars who reject plastic surgery

Colin Stewart — Tue, 30 Sep 2008 16:31:39 +0000

Photos: Top, Jodie Foster. Next, right, Eva Longoria Parker. Next, left, Gwen Stefani. Bottom, Kevin Costner. (AP photos)

JUST SAY NO

Call them the Don’t-Do-It Dozen. They’re 12 top Hollywood stars who have sworn off plastic surgery.

Many are in their 30s, so they haven’t faced the full brunt of the aging process, but they include Kevin Costner, age 53; Jodie Foster, 45 (pictured at right); Brad Pitt, 44; Julianne Moore, 43; and Halle Berry, 41.

The newspaper Sunday Life in Belfast, Northern Ireland, compiled the list of nay-sayers, which is far from a complete tally of Hollywood opponents of cosmetic procedures.

Are they all telling the truth? Several have been the topic of speculation that they have already undergone plastic surgery, including Drew Barrymore, Gwen Stefani, Halle Berry and Costner.

And, of course, some might change their minds after looking in the mirror sometime in the future.

In addition to Cate Blanchett, 38, and Moore, whose views have already appeared in this blog, here’s the lineup:

Kate Winslet, 32, rejects cosmetic work, saying, “I want to be able to really show the expressions on my face.”

Eva Longoria Parker, 33, (pictured right):

“God blessed me with some great, unique features - some beautiful, in my eyes, and some not so beautiful. But I think we are all created this way for a reason, so I have no desire to tamper with that.

“I do a lot of anti-ageing things to slow the process down, but I will never cut my face.

“I think 80 is beautiful. I think my mother is beautiful, my sisters are beautiful.”

Drew Barrymore, 33: “I just know it’s a slippery slope, and everybody’s starting to look a little waxy lately. I’m going to do everything I can not to go down that road.”

Rachel Weisz, 37: “People who look too perfect don’t look sexy or particularly beautiful.”

Gwen Stefani, 38, (pictured at left): “I’m hoping my children will save me from my vanity. It sucks to have to grow older. We all have to accept it.” However, she has also been quoted as saying that will consider having plastic surgery.

Halle Berry, 41: “You have this plastic, very much copy-cat sort of face that’s evolving, and that’s very frightening to me. It’s really insane, and I feel sad that that’s what society is doing to women.”

Brad Pitt, 44: “I’m one of those people you hate because of genetics. It is the truth.”

He adds:

“One thing sucks, your face kind of goes. Your body’s not quite working the same. But you earned it. You earned that — things falling apart.”

Jodie Foster, 45, says she would prefer hearing that she has a bad nose than a bad nose job.

“I’d rather have a comment about who I am than about something that identifies me as being ashamed of who I am.”

“It’s not my thing,” but “I don’t have anything against it for other people,” she says.

Kevin Costner, 53, (pictured at left):

“I am never going for a hairpiece, dye or nips and tucks. You will always have to take me as you find me.

“We can all hear whispers. In my case, they still say, ‘He’s taller than I thought’.

“But there will come the day when they will say, ‘He is much older than I remember him’.”

The twelfth star on the list is Liv Tyler, 31, who might not belong there.

She’s quoted as saying, “I really do look after my skin because I don’t want to ever have plastic surgery. I want to do the best I can with what I have.”

But the Make Me Heal cosmetic-medicine Web site reported last year that she has changed her mind.
“I’m definitely going to have some (plastic surgery), I’m sure,” she said then. “Especially when you see what happens to your body after you have a baby.”

She’s also the subject of rumors that she has had a nose job. Her full lips arouse speculation that they’re the result of a doctor’s intervention, but it’s more likely that she gets them from her father, rock star Steven Tyler.

Related links:

For more on celebrities and cosmetic medicine, see links on the right side of this blog.

Plastic surgery for dogs and beauty queens

Colin Stewart — Mon, 29 Sep 2008 19:26:28 +0000

Dogs as well as women undergo plastic surgery to boost their chances of winning beauty contests.

But while the rules for humans are lax, those for dogs are strict.

With specific traditional exceptions, plastic surgery is prohibited for dog show entrants. It’s allowed only if the history of the breed includes practices such as cropping the tail or ears.

In contrast, anything goes for beauty contest contestants. In fact, plastic surgery is routine among students at the Venezuelan beauty academy that has graduated seven Miss World and Miss Universe winners, including Miss Universe 2008.

Dogs with a similar background of plastic surgery would be barred from the Westminster Dog Show. The American Kennel Club prohibits surgery to change a show dog’s appearance outside of traditional breed standards — and even those are controversial.

Yet beauty queens’ use of plastic surgery is an issue that’s not often discussed.

One exception was an unscientific survey that this blog posted in July, which showed that 82 percent of respondents think plastic surgery should also be prohibited for beauty pageant contestants. (The survey, “Is plastic surgery OK for beauty pageant contestants?,” is ongoing, so readers can still participate.)

When Dayana Mendoza (left) won this year’s Miss Universe pageant, she was coy about her own plastic surgery. Asking about it, she said, was “like you asking me my age.”

Brazilian veterinarian Dr. Edgard Brito is among the most prominent of plastic surgeons operating on dogs. He offers Botox anti-wrinkle injections, eyebrow correction and face lifts.

“It’s perfectly reasonable to use simple surgery to make a dog beautiful,” he says. “There’s nothing unethical about that.”

“Plastic surgery is good for dogs,” says his Web site.

But he’s an extreme case. Debates about plastic surgery for dogs focus on more common practices such as:

Tail docking. This refers to permanent trimming of a dog’s tail, an operation that has been performed on Rottweilers, Dobermans, Vislas, Weimeraners, German Shorthaired Pointers, Poodles, Schnauzers, Old English Sheepdogs and Springer, Brittany and Cocker Spaniels. The advocacy group In Defense of Animals states:

Tails are usually docked on 2-10 day old puppies, without either general or local anesthesia. If the procedure is done by a veterinarian, the tail is clamped a short distance from the body, and the portion of the tail outside the clamp is cut or torn away.

Ear cropping. This is a surgical procedure (pictured above) that makes floppy ears stand up straight in breeds such as Great Danes, Boxers, Schnauzers and Doberman Pincers. The Web site Vets4Petz.com explains:

Usually recommended to be done around the age of 10-14 weeks old, the procedure requires full anesthesia. The ears are then cut in a way that instead of flopping down to the side of the head, they stand erect on the head to a point.

In most breeds however, the ears require a period of bandaging and support splinting in order to get them to stand. This is essential for the ears to ultimately stand, and if not done sufficiently, the ears may not stand erect. The longer the ear length is, the more time required for splinting is necessary.

The American Veterinary Medical Association opposes those procedures. Its policy states:

Ear cropping and tail docking in dogs for cosmetic reasons are not medically indicated nor of benefit to the patient. These procedures cause pain and distress, and, as with all surgical procedures, are accompanied by inherent risks of anesthesia, blood loss, and infection. Therefore, veterinarians should counsel dog owners about these matters before agreeing to perform these surgeries.

In Defense of Animals uses stronger language:

“The historic tradition of cropping and docking should be made as obsolete as the equally historic tradition of slavery.”

Dewclaw removal. This refers to surgery that amputates a vestigial toe in dogs such as Dobermans.

Prosthetic testicles. These are barred by the American Kennel Club, but sometimes are implanted in dogs that are “monorchid,” which means that only one of the two testicles is visible. As one online pet enthusiast writes:

An animal with one or both testicles undescended cannot win prizes or be used to breed from. Although a monorchid dog or cat may well be fertile, there is evidence that the trait can be inherited. By fitting a monorchid animal with a prosthetic testicle to match the one that has descended normally, no one need know that it has a potential genetic defect.

Silicon testicles have even spread into dog show urban legend which tells the story of a dog whose “missing” testicle descended naturally and whose prosthetic was revealed when the judge encountered three testes in its scrotum during judging.

Except for prosthetic testicles, these practices are accepted by the American Kennel Club if the procedures are traditional for the breed. The group states:

The American Kennel Club recognizes that ear cropping, tail docking, and dewclaw removal, as described in certain breed standards, are acceptable practices integral to defining and preserving the breed character and/or enhancing good health. Appropriate veterinary care should be provided.

Related links:

For more on cosmetic medicine, see links on the right side of this blog.

Photo: Doberman with Hoytt ear brace.

Pacino, Nicholson and De Niro vs. old age

Colin Stewart — Thu, 25 Sep 2008 16:27:32 +0000

Photos: Top, Al Pacino, 68, and Robert De Niro, 65, in “Righteous Kill.” Below, Jack Nicholson in 2006 at age 68. Reader survey: Who is aging most gracefully?

Which actor is aging with the most grace – Al Pacino, Jack Nicholson or Robert De Niro?

Film critic John Podhoretz would vote for Nicholson, 71, as he makes clear in his review of the new police movie “Righteous Kill.” He calls the film “at best entirely predictable and formulaic and at worst a terribly sad display of vanity on the downward slope.” Nicholson isn’t even in the movie, but he wins all the praise.

He’s not alone in panning the movie, which achieved only a 23 percent positive rating in the Rotten Tomatoes site’s overview of film critics. But other critics tended to focus on Pacino, 68, and De Niro, 65, as great “veteran actors” who were working with a poor script.

But for Podhoretz, actors’ attitude to aging is a problem, as he writes in the Weekly Standard. The root cause is a culture of “facelifts, and Botox, and hair implants, and hair extensions” that actors and actresses overuse in their “efforts to halt the ravages of time on the human body.”

Despite that critique, he doesn’t actually fault Pacino or De Niro for overindulging in cosmetic medicine, which isn’t apparent in their wrinkled faces. But he blasts them for related shortcomings — clumsily trying to adopt a youthful style and taking roles that are suitable only for younger actors.

Podhoretz writes:

Pacino clearly wants people to think he can play someone in his mid-40s. As a result, he has allowed himself to turn into a freakish-looking person, with boot-blacked hair that stands up like a kewpie doll’s and a wardrobe more appropriate for Johnny Cash than a veteran of the NYPD.

For his part, De Niro spends most of the movie with a puzzled expression on his face, as though he wandered onto the set by accident from his Tribeca restaurant Nobu. This is especially true when he is called on to conduct a torrid, sadomasochistic affair with a forensics officer played by 37-year-old Carla Gugino, who not only is young enough to be his daughter, but actually looks like Robert De Niro’s daughter.

In these scenes, De Niro has the decency to look embarrassed. He knows he’s in this for the paycheck; Pacino is in it to stave off the Angel of Death.

Nicholson is much different, the critic says:

There’s a reason that, alone among the actors of their generation, Jack Nicholson is still a major star at 71. Twenty years ago he decided to act his age, and has allowed himself to travel onward with the years.

In so doing, he has maintained and even deepened an essential aspect of any great motion picture performer’s aura: his dignity.

Do you agree? You can add your two cents’ worth in this reader survey:

Who is aging most gracefully?

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Experts to Cindy McCain — more Botox, surgery would help

Colin Stewart — Wed, 24 Sep 2008 17:02:07 +0000

See ‘CINDY McCAIN STYLE DISPUTE’ slide show

Photo: Cindy McCain at the Republican Convention, 2008, age 54

COSMETIC DOCTORS’ ANALYSIS

Cindy McCain’s face is a divisive issue. Did she or didn’t she get plastic surgery?

People with the least expertise are the most convinced that they know what the wife of Republican presidential candidate John McCain has done. Of course she had plastic surgery, many say:

“She looks like a mannequin with a very tight enhanced lips. … Too much plastic surgery and too much Botox,” said one critic.
“She just looks so plastic-y, doesn’t she?” said another.
Estimates of the cost of her outfit when she addressed the Republican convention should have included her “pre-convention Botox touch up,” said a third.

Cosmetic doctors are more restrained, rarely taking a stronger stance than “probably she did.” But they recommend more work to improve her looks, including more Botox, laser skin treatments, and surgery on her neck and jowls.

Has she already undergone major repairs?

“It’s hard to tell,” said dermatological surgeon Dr. David Sire of Fullerton, but he noted that Cindy McCain’s appearance has undergone “significant change in the last few years.”

Dermatologist Dr. Vince Afsahi of Newport Beach and Tustin said the smoothness of her face could be the result of genetics or of plastic surgery.

Photo: Cindy McCain in 2004 at age 50

Afsahi said:

Cindy McCain has several areas of her facial structure which stand out beautifully. Her soft, smooth forehead and glabella [area between the eyebrows] can of course be a “genetic gift” or could have been enhanced either with a surgical brow lift or Botox treatment. In her case the results are superior and she looks very good for a woman her age.

Dermatologist and skin-care-products entrepreneur Dr. Patricia Wexler of Manhattan said that for a woman of 54 it’s remarkable “how young she looks for her age.”

“It looks like she cosmetically enhances herself … and she does a good job.”

Other doctors said Cindy McCain would benefit from more cosmetic procedures.

Sire would recommend:

Botox not just for the forehead but also around her eyes.
A cheek and jowl lift.
Surgical treatment for sagging skin on her neck.
Fractional laser treatment of the skin of her face and neck.
Possibly some fillers under her eyes.

“She would look great!” he concluded.

Afashi would recommend less work than Sire suggests:

Cindy McCain has wonderful bone structure, classic looks, and has aged beautifully. Only minor procedures could be considered.

Bringing fullness to her upper and lower lip through a filller such as Juvederm would be a consideration. Similarly, fillers could soften her laugh lines and [around her mouth] creases.

The vertical lines around her upper and lower lip could be softened with laser-based procedures or chemical peeling.

See below for several more close-ups of Cindy McCain in recent years.

See ‘CINDY McCAIN STYLE DISPUTE’ slide show

Related links:

For more on celebrities and cosmetic medicine, see links on the right side of this blog.

Photo: Cindy McCain in 2007, at age 53

Photo: Cindy McCain at the Republican Convention, 2008, age 54

Photo: Cindy McCain on Sept. 11, 2008, at age 54

Photo: Cindy McCain at the Republican Convention, 2008, age 54