COSMETIC MEDICINE
In this regular “Face to Face” feature, the Register invites readers (you, right now) and local cosmetic doctors (see end of file) to discuss what they see in the changing faces of celebrities.

EXPERTS’ ADVICE FOR VIRGINIA MADSEN:

Sunscreen, dental surgery, Botox, skin laser, neck lift. See details below.

READERS’ ADVICE FOR VIRGINIA MADSEN:

Overall, readers who responded to our survey urged Virginia Madsen to do nothing except use sunscreen. Specifically, 66 percent said, “Do nothing”; 25 percent favored sunscreen; and 8 percent voted for Botox.

Who: Actress and Allergan spokeswoman Virginia Madsen, shown at age 45 in 2007

Born: Sept. 11, 1961

Quotes:

“I have been very open over the years about my use of these medical products because I have had a good experience with them. In fact, I consider them part of my normal health and beauty routine along with eating right and exercising.” – Virginia Madsen

“I believe it is important for women to talk honestly with each other, to ask questions and get the facts so we can make responsible and informed treatment choices. I have been using Botox Cosmetic for years to treat the vertical frown lines between my brows that look like an ‘11’ and give me the appearance of looking tired and stressed, and now I use Juvederm dermal fillers to treat the ‘parentheses’ around my nose and mouth. I like the results because I lost the lines but still look like me.” – Virginia Madsen

“She really been outspoken about her use of Botox and dermal fillers. Even though pretty much all of Hollywood is getting these types of procedures, she’s the first one who has come out and been open about it.” — Robert Grant, president of the medical division of Irvine-based Allergan, which makes Botox and Juvederm.

Doctors’ advice: A neck lift possibly. Botox for crow’s feet. Dental surgery to reduce visibility of gums. Fraxel laser to soften lines on cheeks. Protection from sun whenever outside. Perhaps do absolutely nothing. (More details below.)

Botox, filler, perhaps dental surgery, chemical peel or laser

Advice and comments from plastic surgeon Michael Niccole, M.D., medical director of CosmetiCare in Newport Beach:

Virginia Madsen is a very, very pretty lady. If I would do anything, it would be on her neck, at least based on one photo where it could use tightening.

For a 45-year-old, she has 35-year-old eyelids.

In one photo, a tremendous amount of gum shows. A bone cut could bring the upper teeth up, but that’s really nitpicking, since she’s such a beautiful woman.

There’s a little bit of crepe-paper wrinkling beside her mouth. That could be treated with a little bit of chemical peel, laser treatment or a filler such as Restylane. A lot of surgeons would advise plastic surgery.

She could use filler — collagen or Restylane — for her nasolabial folds.

She has very nice brows. They look like she had a brow lift.

Some Botox could help the little bit of crow’s feet that she has.

She might have had a mini-lift in the past. For age 45, the skin looks pretty tight on her face, but overall she’s a very, very attractive 45-year-old, an elegant lady.

Wear a hat and sunscreen, use more Botox, and get a Fraxel laser treatment

Advice and comments from dermatologist Renee Cobos M.D., F.A.A.D., of Premiere Dermatology and Laser Center in Fullerton:

If she were my patient, I would recommend that she wear an SPF sunscreen of 30 or higher every day and wear a hat when she goes outside to protect her very fair skin.

I would also recommend that she consider Fraxel laser to help soften the fine lines on her cheeks.

I believe that she has had Botox on her forehead, but not on her lateral eye area ( crow’s feet), or her “bunny ” lines on her nose area. I would recommend that she consider Botox to these areas because it would soften her eye area, and nose and make her appear younger.

She also has a tattoo on her upper arm. I would recommend that when she wants it removed, that she consult a dermatologist and have it removed via laser.

In general, living in southern California with all of the sun exposure will greatly age your skin if you do not wear a sunscreen every day. it will also increase your risk for developing skin cancer as time goes on. The ordinary reader can learn that they too can look like Virginia Madsen if they take care of their skin (as she obviously does).
I recommend an SPF sunscreen of 30 or higher every day and wearing a hat with a broad brim to protect the face and neck if going out in the sun.

Maybe do absolutely nothing

Advice and comments from dermatologist Christopher Zachary, M.D., F.R.C.P., chairman of the UCI Department of Dermatology:

If Virginia Madsen were a patient of mine, I would hand her a mirror and ask her to highlight for me a few key areas of concern. I have to say that she has obviously looked after her skin, is a natural beauty, and I might advise her to do absolutely nothing.

However, most patients present with something concrete in mind, like Botox, fillers, or similar. The fundamentals of skin maintenance are sun block, moisturization, topical retinoids and bleaching agents. These are effective, inexpensive, and largely available over the counter.

Prevention of aging is helped these days with better diets, more exercise, and “maintenance therapy” before the skin becomes obviously lax. Over the last two years, the Department of Dermatology here at the University of California, Irvine has helped develop newer lasers that will maintain the skin in a manner that will markedly reduce the requirement for skin tightening surgical procedures later on in life, such as facelift or blepharoplasty (surgical tightening of the eyelids).

These devices reduce the overall volume of the lax skin of the face before it starts to sag. Each treatment with the new Reliant Re:pair will remove about 5-7 cubic centimeters of skin, and leave the patient with a very natural appearance, and without the stretched look of a tight face lift.

If she has undergone any cosmetic procedures, they all look very natural. And that is the key to success. The “overdone look” is never appropriate.

Many women of her youthful vintage have had Botox to relax the muscles in the areas between the eyes (to prevent the unintended expression of anger, tiredness, suspicion, irritability), and in areas that will elevate the lateral brows to accentuate than feminine look. (Conversely, some women have flat brows which are curiously ambiguous. Variety is the spice of life …)

I wouldn’t be surprised if she had received one of the popular filler injections for her lips such as Restylane or more recently Juvederm, manufactured by Allergan.

Sometimes I have patients present for a dermal filler or Botox, only to be surprised at the cost. But on reflection, when they compare these with the costs of their regular hair, health and beauty maintenance, it all seems more reasonable.

She is absolutely right that we should all seek out the facts in order to make responsible and informed treatment choices. Unfortunately, one would need a Ph.D. in informatics to sift through all the baloney out there, in the fashion magazines, on the Web, and yes, from our great friends next door. My advice is to read selected texts from reputable sources, such as the Web sites of:

• The American Academy of Dermatology;
• The American Society for Dermatologic Surgery; and
• The American Society for Laser Medicine and Surgery.

Also, find a physician who really understands the skin, and tread carefully.

As to the importance of women talking honestly with each other, I believe this is a great way to find a pediatrician for one’s kids, or a real estate broker, but one should probably seek the advice of an expert cosmetic physician when deciding on one’s cosmetic options. And if you want good information about health matters, the last place to look is in the fashion magazines. These are written for one purpose, to entertain. Education comes as a low second, in my opinion.

[The second photo above] shows fine bone structure, an engaging appearance, and prominent strap muscles of the neck, so called “platysmal bands.” Some people just hate these, most of us just accept them. Either way, it is remarkable how these just fade away with appropriate use of Botox Cosmetic. But this is not the stuff of Botox parties, nor should it be injected by anyone other than an expert, otherwise significant complications could arise.

See also:

Virginia Madsen says her use of Botox does not create “a dramatic result because I don’t use it over my entire forehead. I like that my brows go up and down and that my eyes crinkle at the corner. I didn’t want any of that expression to disappear.”

– An interview with the Inland Valley Daily Bulletin.

Doctors in Orange County are invited to participate in Face to Face analyses of celebrities if they are members in good standing at the professional society of plastic surgeons or dermatologists and have not been subject to disciplinary proceedings by the Medical Board of California or other agency. For more information, e-mail Register columnist Colin Stewart at   Share and Enjoy: These icons link to social bookmarking sites where readers can share and discover new web pages.