Is the “Botax” Anti-Beauty?

December 17th, 2009

Back on November 19, Democrats proposed enacting a five percent tax on elective cosmetic procedures as a way to raise six billion dollars to pay for the nation’s healthcare system overhaul.  Immediately dubbed the “Botax” by pundits, the idea drew instant fire from cosmetic surgeons, dermatologists and women who enjoy free access to the cosmetic procedures that enhance their appearances and often their self-esteem.

One of our areas of greatest interest and academic study is the intersection of beauty and the brain.  A great deal of research has shown that having cosmetic improvements improves one’s mood, self-image and quality of life.  It’s not known yet whether that improvement is purely due to greater confidence and pleasure in seeing oneself looking younger and more attractive, or whether there is a mechanism that affects brain function (akin to reports from women with Botox injections that they have a harder time crying).  What remains clear is that improvements in beauty tend to correlate with improvements in mental state.  So what does lawmakers’ willingness to tax breast implants and tummy tucks say about our attitude toward beauty?

Let’s use other popular taxes as a parallel.  The most common tax on elective “lifestyle” choices is the “sin tax” placed on cigarettes and hard liquor in most states.  These taxes are levied in part because smoking and drinking are perceived as potentially harmful activities that are basically recreational luxuries; the taxes are, in part, a way of the government saying, “If you’re going to do these things and cause potential problems such as drunk driving and lung cancer, we’re going to tax you for the privilege.”  So, by this logic, is Congress saying that cosmetic procedures are equally frivolous and harmful choices made primarily by women (who, by the way, make up only 91 of the 535 seats in the legislative branch)?

That might be overstating, but it’s clear that the message being sent is that Botox and the many other procedures upon which women (86 percent of patients are women) spend billions per year are a somewhat frivolous luxury primarily enjoyed by rich people with too much time on their hands.  This could not be more wrong.  First of all, according to the American Society of Plastic Surgeons, 60 percent of women who get work done have household incomes between $30,000 and $90,000 a year.  These are not the idle rich, and a five percent levy would have a real impact on their lives.

More importantly, while a small minority of cosmetic procedures may be playthings for desperate cougars trying to defy time, most women are simply trying to look and feel their best, correct what they see as defects, and enhance the quality of their lives.  Beauty matters; it shapes our self-image, our relationships and our career opportunities.  It is not an idle luxury nor a socially costly habit like smoking two packs a day, and it should not be forced by a tax into the “sin” category.  Beauty, and the doctors and patients who pursue it, should be given their proper respect.

The “New Normal” Body Weight

October 4th, 2009

Recently, the author of the Fox Medical Blog, Dr. Keith Ablow, published a piece debunking the supposed connection between the fashion industry’s obsession with rail-thin models and the “epidemic” of anorexia and bulimia among young girls that is supposedly the result of that obsession.  In keeping with Fashion Week, Manhattan’s Super Bowl of haute couture, we thought it appropriate to weigh in on this from a woman’s—and a beauty—perspective.

To cut to the chase, this comment by Dr. Ablow seems to minimize the complexity of the issue: “If size zero fashion models cause anorexia, why have decades of exposure to them resulted in an epidemic of obesity among young people?”  That seems fatuous or naive at best.  Dr. Ablow’s take on the topic is that the whole idea of marketing and media making healthy people more susceptible to things like eating disorders, smoking and violence is nonsense.  In the simplest way, he’s probably right: exposure to a flood of magazine images telling her that only being a size four or smaller is beautiful will probably not make an otherwise emotionally healthy young woman say to herself, “You know, I think I’m going to start binging and purging.”

But treating that as the end of the issue oversimplifies it.  First of all, we know that childhood exposure to extreme stimuli can produce extreme behaviors.  For example, as psychologist Craig A. Anderson wrote back n 2003, solid studies show conclusively that “violent video games are significantly associated with increased aggressive behavior, thoughts, and affect.”  But are five-year-old girls watching modeling reality shows and reading Vogue and later becoming anorexic?  Insufficient data.

However, what we do know is that unrealistic body images do exert subtle but real negative effects on women who are exposed to them. In their article “Media and Body Image,” published in the 2003 journal Media Effects, Jennings Bryant and Mary Beth Oliver showed that in a majority of studies, women who were exposed to images of ultra-slender models showed a substantial drop in satisfaction with their own bodies.

The point is not that such effects don’t directly drive women to develop bulimia and anorexia. It is that the saturation of images that convey an unattainable (and often unhealthy) ideal produce damage self-esteem in ways that can manifest as a range of behaviors.  Those can manifest as depression, social anxiety, yo-yo dieting (surely a contributor to the obesity epidemic) and yes, anorexia and bulimia.  It’s the subtle message that starvation-thin bodies are normal, and you’re not quite acceptable unless you have one, that’s partially responsible for our culture’s dysfunctional relationship with food.

Finally, about the supposed non-increase in anorexia and bulimia, says who?  This material courtesy of the Harvard Mental Health Letter, released September 25, 2009, puts the lie to that:

The Agency for Healthcare Research and Quality (AHRQ) reported that hospitalizations for eating disorders have increased in the new millennium. The most common diagnosis was anorexia nervosa, accounting for 37% of hospitalizations in 2005 to 2006, an increase of 17% over those reported for 1999 to 2000. The next most common diagnosis was bulimia nervosa, characterized by binge eating followed by purging, which accounted for 24% of hospitalizations in the year ending 2006.

Add to that the extremely disturbing increase in websites dedicated to anorexia and bulimia as a lifestyle.  It’s hard to imagine anything more unhealthy for a young girl than online communities that promote these deadly disorders as paths to healthy weight maintenance.  Ignoring these facts in favor of a “So why do we still have all these fat people” view overlooks the most important issue: balancing our unhealthy “body culture” with images and education that teach women of every age that there are many ways to be beautiful, and that nothing is more beautiful—regardless of your BMI—than total vitality and total self-confidence.

Stay beautiful,

Debi & Eva

The Skin Type Solution

August 19th, 2009

Every so often we like to promote authors and experts who share our passion for getting useful, accurate information about beauty to the public.   Dermatologist Leslie Baumann, M.D., author of The Skin Type Solution brings women a great deal of information.  Professor and Director of Cosmetic Dermatology at the Miller School of Medicine at the University of Miami (where she and Eva are both longtime faculty members), Leslie takes a unique approach to skincare with her “16 skin types” model, which enables readers to target care regimens to their unique type of skin.

Leslie’s book and a network of blogs maintained by female dermatologists in India, Brazil and Mexico, as well as her own blog, contain most of the insights.  In these blogs, readers can find an array of  information about everything from skin types to the lowdown on skincare products, cosmetic procedures like dermal fillers and Botox, and news about products, companies, and medical advances.

The books, websites and blogs are useful resources for women who are trying to choose the best options for making their Outer Beauty the best it can be, as well as navigating the often-confusing claims of cosmetics companies, cosmeceutical makers and medical technology companies.  Leslie has given women a destination for finding the latest in skin care news and leading-edge research into skin health and the safety of some of the world’s most popular dermatological products.

Stay beautiful,

Debi & Eva

Beauty Prescription Conference in Jacksonville

August 18th, 2009

We’re very excited to announce another event in what is becoming an increasingly busy schedule for the Beauty Prescription doctors: the first-ever Beauty Prescription Conference in Jacksonville, Florida. On Saturday, August 22 at the campus of Florida State College at Jacksonville, more than 250 women of all ages will come together to learn about the principles of Inner and Outer beauty and the Beauty-Brain Loop, share their personal stories, and discover paths to empowerment.

Sponsored by the college’s Beauty Prescription Club (also the first one of its kind in the country) and advisor Gloria Balmaseda-White, the conference will bring together devotees of our book for the first time to openly discuss important beauty-related issues: how society views women, how we view ourselves, what we can do to become the most beautiful people possible and much more.  We will be on hand to host, speak and share our ideas and personal experiences as authors, physicians, wives, mothers and twenty-first century women.

On August 21, 2009, Eva will be signing The Beauty Prescription at Barnes & Noble at St. John’s Town Center in Jacksonville from 5:00 to 7:00 p.m. The next day, the following speakers and presenters will join Eva:

  • Linda Sue Fortenot, RN, a retired plastic surgery recovery nurse and owmer of Parisian Spa and Hair Salon, will speak on Outer Beauty—specifically skin care and protection.
  • Christine Granfield, MS, an expert in women’s medical imaging will talk about breast health Issues.
  • Ms. Mondy from Dress for Success will present fashion ideas that address the Environment component of the Beauty-Brain Loop.

Lancome will give make up demonstrations and free samples.  Galderma will provide free samples of sun block and Aveno will provide free samples of anti-aging skincare products.  There will also be door prizes consisting of beauty services and a gift basket from Lançome, as well as a raffle of Ravaléskin anti-aging skin care products.

If you’re going to be in the area, please join us.  You can get more information about the conference by e-mailing, and also from our Facebook page.  We are looking forward to this event with great enthusiasm, and we hope it’s only the beginning of many more Beauty Prescription meetings, conferences and get-togethers around the country.  We are planning to form Beauty P{rescription clubs where women meet regularly and support each other in their journey to become more beautiful inside and out.

Stay beautiful,

Debi & Eva

Our appearances at the Exclusive Premier Women’s Empowerment Expo

August 18th, 2009

We are delighted that both Beauty Prescription doctors have been selected to participate in an event that is important for all women.  We’ve been asked to speak about The Beauty Prescription and the Beauty-Brain Loop at the third annual Exclusive Premier Women’s Empowerment Expo, to be held August 28-30 at the Long Beach Convention Center near the Queen Mary in Long Beach, California.  More than 5,000 women are expected to attend to enjoy more than 450 exhibitors in hair care, cosmetics, skin care and other products, cooking, personal care and other desirable products and services.  Attendees can get professional styling tips, learn healthy cooking secrets, and listen to celebrity speakers such as Susan Powter, Dr. John Gray, author of Men Are from Mars, Women Are from Venus and a wide range of experts on subjects from relationships and eating disorders to complementary and alternative medicine.

We don’t know precisely when or where we’ll be speaking yet, but we will be talking about the book and signing copies, so watch our Facebook or Twitter pages for more specific information.  For more details about the Expo, visit  We hope we can help empower women, educate them about how to be more beautiful inside and out, and make a positive difference in the lives of women from all over the country.

See you there!

Stay beautiful,

Debi & Eva

The tanning bed debate: game, set and match

August 15th, 2009

You can tell when an industry or company has its back to the wall because it starts spinning the bad news so fast that Ginger Rogers would get dizzy. Late in July the International Agency for Research on Cancer (IARC) announced in the new issue of the Lancet Oncology that the evidence was unequivocal: tanning bed use increases the odds of developing melanoma, the deadliest form of skin cancer.  In fact, the organization, which until now has avoided stating flatly that tanning beds and sun lamps cause cancer, moved tanning beds to its highest cancer risk category: “carcinogenic to humans,” a designation shared by such substances as tobacco and mustard gas.  It reported that an analysis of clinical research shows that teens and young adults under age 30 who regularly use tanning beds increase their melanoma risk by a staggering 75 percent.

News doesn’t get more damning than that, and it only reinforces the point we have made so often in our book, on this blog and in our other writings: avoiding excessive sun exposure is one of the most important steps you can take to improve not only the health of your skin but your overall health.  The trouble is, the tanning salon industry isn’t, as you would expect, turning cartwheels over this news.  For years, the industry has caught a great deal of flack for opening up new salons directly across from high schools in an obvious attempt to woo young girls looking to get bronzed before prom.  So it’s not surprising that the official response of the industry was this, from an MSNBC story:

“The fact that the IARC has put tanning bed use in the same category as sunlight is hardly newsworthy,” said Dan Humiston, president of the Indoor Tanning Association (ITA). “The UV light from a tanning bed is equivalent to UV light from the sun, which has had a group 1 classification since 1992. Some other items in this category are red wine, beer and salted fish. The ITA has always emphasized the importance of moderation when it comes to UV light from either the sun or a tanning bed.”

That is more than a little disingenuous.  The IARC Group 1 classification includes ethanol as a carcinogen, a type of alcohol that is indeed found in alcoholic beverages like red wine and beer.  But drinking a glass of red wine is hardly the same as drinking pure ethanol, and it’s probably safe to say that the proven health benefits of red wine also counterbalance the cancer risks.  This comes across as desperate spin from an industry that’s heard its death knell…maybe.

That brings up the real point: will this announcement change behavior. There are some positive signs already: MSNBC also reports that tanning salons around the country have seen a spike in cancellations after this cancer information was made public.  But how long will that last?  If history is any indication, teens who believe they are immortal will revert back to old habits unless this new information is followed with continuing education.  So if you’re the parent of a young woman (or man, since guys tan, too), take it upon yourself to learn more about this announcement, the dangers of tanning beds, and melanoma in general, and talk to your kids.  You can learn more here:

Stay beautiful,

Debi & Eva

Independence Day

July 19th, 2009

I’m going solo on this blog posting because as those who know me know, the last year of my life has been an emotional hurricane that I never saw coming.  I certainly didn’t have time to evacuate.  But rather than dwell on the crises, I want to talk a little bit about what they have yielded for me: a new independence that I have never known before and have come to treasure.

I’m on a Costa Cruise through the China Sea from Singapore to Shanghai with stops in Vietnam, Hong Kong, Okinawa and Taiwan.  Amusingly, I’m eating spaghetti Bolognese while seeing Asia.  It’s one of the greatest adventures of my life, and I’m sharing in with more than 850 other passengers (only 63 Americans), including my own incredible group of eight women and girls and two kids with disabilities.  As we were passing over these waters on the Fourth of July, it occurred to me that this marvelous journey would not have been possible had I not rediscovered my own independence through the most painful emotional experience of my adult life.

In the last year, my marriage came to an abrupt, agonizing end.  But even as my world was turned upside down and shaken, I slowly came to realize that this experience had the potential to become a blessing if I chose to make it so.  There’s the key word: chose.  That is where this comes back to my favorite topic, Inner Beauty and the Beauty-Brain Loop.  Because one of the most vital aspects of Inner Beauty is choosing a healthy, self-affirming way to respond to the things that happen to us as women.  We have little control over the things that will happen in our lives; we have total control over how we prepare and respond.  In fact, those may be the only things we have control over.

When divorce shatters the world you knew, your Inner Beauty dictates how you respond.  Do you blame yourself or sink into a self-recriminating depression?  Do you lash out in anger at everyone and anyone who crosses your path?  Or do you use the crisis as an opportunity for self-discovery and self-reinvention, clearly the healthiest path?  If your Inner Beauty—your self-love, compassion, empathy and belief in your own strength—is robust, you can choose to make a dark time into a time of renewal.

After a natural period of anger, grief and confusion, that’s the choice I’m trying to make.  I think I’m doing pretty well, and that brings me back to independence.  In the past year I have tried new things and had new adventures I might never have tried before.  I truly didn’t know what I was missing until I realized that the only factor limiting me…was me.  In doing things like this cruise, I’m spending time in the company of loving, beautiful women and literally testing new waters.  I’m free to become who I want to be at a stage of my life when many of us cannot or will not evolve.  Talk about a blessing.

As you know, everything flows from Inner Beauty.  I’ve tried to give some attention to every aspect of the Beauty-Brain Loop.  I saw a new dermatologist and got some new skin products that I adore, exercised, saw my doctor, and made sure I got the kind of healing sleep most of us busy people deny ourselves.  I gave up my occasional glass of wine and spent more time in deep talks with friends.  I spent time with family, talked with my therapist, made some new friends, cleaned my house…cleaned the cobwebs out of my mind and my life.  Spring cleaning for the self.

My new sense of independence and possibility has helped me focus on taking great care of my Health and my Outer Beauty, and certainly when I look around me and see the people I am with, I am deeply grateful that my Environment is starting to reflect what I feel inside.  It’s been a difficult road to the deck of this ship, but it has most certainly been worth it.

Happy Independence day to us all…

Eva Ritvo

Acne Affects How We See Others

July 7th, 2009

Coming from different aspects of the beauty continuum as we do, we’ve both had a longstanding interest in beauty and the perception of beauty and how they can impact how people feel about themselves and one another.  Two of the biggest things to impact teens’ psyches are weight/body issues and acne, so we decided it would be interesting to conduct an image-based study quantifying exactly how acne can alter others’ perception of teens.  The study coincided with National Acne Awareness Month, and the results were very interesting.

Working with the American Acne & Rosacea Society (AARS), we asked thousands of teens and adults to offer their first impressions of teens based only on photos of their face.  One face was without acne and one had been digitally enhanced with acne.  The results showed that teens with acne are more likely than teens without acne to be perceived as shy (39% vs. 27%), nerdy (31% vs. 17%), and lonely (23% vs. 13%). Perhaps not surprisingly, the opposite also proved true: teens without acne were more commonly perceived as self-confident (42% vs. 25%), happy (50% vs. 35%), and leaders vs. followers (49% vs. 29%).

We were expecting the results of the study to show that having acne would be difficult for teens, which it does, but what we both found most distressing was the extent to which acne can really skew the way society perceives teens. We live in a very visual society and based on the survey results, people do make snap judgments about teens with acne.  The results illustrate the fact that unfortunately, acne does play a role in how teens are viewed by both their peers and adults. So, what starts as a purely medical condition can have emotional and psychological implications for young people who are often already dealing with social, sexual and cultural chaos.

Our colleague Dr. Diane Berson, Assistant Professor in the Department of Dermatology at Weill Medical College of Cornell University and a founding board member of AARS said, “What surprised me most about the survey was confirming the length teens will go to improve their acne and what they are willing to sacrifice.”  According to the study, if they could have clearer skin, 59% of teens would go cold turkey on Facebook for one year, 30% would give up dating for 12 months, 13% would take their mom or dad to the prom (now that’s a sacrifice), and 11% would be OK with seeing their grade point average drop.  That’s testament to the desperation with which teens view acne and its role as a kind of marker of social stigma—a modern-day Scarlet Letter, if you will.

To us, this indicates a strong and urgent need to connect with teens about what acne is and who develops it so that we can bust the myths surrounding it and foster greater self-esteem in those unfortunate enough to develop it.  Human beings of any age have a hard enough separating appearance from intelligence and moral character.  How much more difficult must it be for youths who are in the process of slowly (and sometimes painfully) discovering who they are and developing own their body image?  By teaching teens that acne is a disease, not a verdict, perhaps we can help foster greater understanding and kindness while making one of the obstacles on the path to adulthood a little easier to climb.

Stay beautiful,

Debi & Eva


July 6th, 2009

Back to some skin issue for a couple of posts.  Since our skin is the most visible aspect of our Outer Beauty, it’s always going to be an important subject.  Our consistent advice from Day One has been: protect yourself from too much sun exposure.  Solar radiation dehydrates, damages collagen, and causes skin cancer, as you know.  One remedy has been to wear broad-spectrum sunscreen right?


Now news has come out from the Environmental Working Group (EWG) that the majority of the 1,100 sunscreens they tested did not work as well as claimed.  In particular, they worried about broad-spectrum products, which are supposed to offer protection from UVA rays (which penetrate the skin and cause damage) and UVB rays (which cause sunburns).  Basically, sunscreen makers don’t have to tell you how much protection their products offer from UVA and UVB rays, so they don’t.  You have no idea if you’re blocking the burning rays while the UVA wreaks havoc on your skin.

The other concern the EWG found was that people who regularly used sunscreens had levels of the UVA blocker oxybenzone in their urine.  Now, the FDA requires that sunscreens be topical, which means their ingredients can’t be absorbed into the bloodstream.  So how does this happen?  Clearly, some sunscreen makers aren’t formulating their products safely, and that’s a problem because oxybenzone in pregnant women has been shown to affect birth weight.

There’s more about oxybenzone.  Back in the 1980s, a chemist for Warner-Lambert cosmetics company found that oxybenzone had anti-inflammatory properties.  It’s taken this long for the industry to publish his findings, because if your sunscreen reduces the pain of the sunburn you get after too much exposure, then you might spend more time in the sun and do some real damage.

So what now.  Do we go back to white dabs of zinc oxide or titantium cream, which don’t go really well with a toned beach body?  For one thing, you can lobby your representatives to demand that the FDA adopt a more precise SPF rating system.  Sunscreen makers are fighting this, as they always do, but consumer pressure helps.  For another, you can contact smaller companies that make sunscreen (presumably, they will be more responsive than a major corporation) and tell them you would love to buy and recommend their products if they a) contain no oxybenzone and b) have a totally transparent SPF rating that reveals both UVA and UVB protection.

Otherwise, use common sense.  Wear UV-resistant clothing.  Limit your sun exposure.  Check the ingredients.  There are sunscreens without oxybenzone: Natural Sun SPF 25 for Active Lifestyles by Aubrey Organics, Vanicream’s SPF 30 and Oat Protein SPF 30 by Kiss My Face are three examples. However, they use minerals like zinc and titanium dioxide to block rays, so they may not be as invisible as you’re used to.  And if you must use sunscreen, reapply it every two hours and use something with at least 45 SPF.  If you’re not sure you can trust the companies who make your sun protection products, at least you can trust your own sound judgment.

Stay beautiful,

Debi & Eva

Those Are Some Sexy Genes You’re Wearing…

July 3rd, 2009

We’re creatures of the physical as well as the mental and emotional, and so it’s not surprising that we are hard-wired to find certain qualities attractive based on their implications for passing along our genes.  We’ve talked about this at some length in our book.  We know that men are drawn to a certain hip-to-waist ratio and to glossy hair because both suggest that a woman is healthy and fertile.  We know that women tend to be drawn to size in a man as well as maturity and material wealth because both suggest the ability to protect and nurture offspring.  We might not love the idea that our perception of beauty hinges on ancient evolutionary imperatives, and that’s not what we’re suggesting; there is clearly much more to attraction and romance.  But initial, visceral attraction is clearly fueled by primal instincts.  We’re not really all that far from the veldt and the savannah, after all.

But when matchmaking takes its first tentative steps into basing the art of the hookup on the science of evolutionary biology, some folks get uneasy.  We find it fascinating, because anything that casts new light on why we find some people magnetic and irresistible…well, it’s our raison d’etre.  In the latest issue of Time, we found a story about a Swiss company called GenePartner that uses genetic matching to help people find that partner who makes their heart go pitter-pat.

The company partners with several matchmaking websites to test the DNA of applicants and matches people based on their genes for creating HLA, or human leukocyte antigens, a key component of the immune system.  The idea was sparked by the famous 1995 experiment in which women who were not taking birth control pills (and so were experiencing their normal hormonal levels) preferred the scent of men who had certain genes that were different from their own.  Based on the notion that “opposites attract” has a genetic component, GenePartner thinks that people will be attracted to others with different HLA genes than their own, because the couple’s children stand to inherit a more robust immune system and therefore be more resistant to disease.  It’s that survival of the fittest thing again.

The company has developed a computer algorithm that matches the lovelorn with ideal potential mates based on HLA profile.  This concept is hardly demonstrated conclusively, but it’s certainly interesting.  From a scientific perspective, it may not explain attraction but it could certainly shed some light on why some parents have better luck with healthy offspring while others seem to have nothing but health disasters.  What about HLA screening to predict the chances of immune disorders like lupus and multiple sclerosis?  Dating is peachy, but that seems more important to us.

If nothing else, this technology could save a lot of people the time and trouble of filling out a long questionnaire or writing up a charming profile while trying to locate that one photo where they’re not making a funny face.  Just pony up your $99, get your kit, swab your cheek for a tissue sample, mail it to Switzerland and get your very own GenePartner ID.  Sweaty t-shirt not included.

Stay beautiful,

Debi & Eva


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