A dermatologist friend introduced me to Marie, who ran a “skin science” clinic next to his office in Calgary, Canada. This was not a medical office, but a clinic that provided cosmetic services and products aimed at helping people enhance the look and condition of their skin. “I am, really, a skin coach,” Marie told me as she showed me around the office. She had a degree in microbiology, was infectiously good-natured, and had absolutely flawless skin.
Marie invited me into her all-white office: white table, white walls, white chairs, and white machinery. Using a machine that would be at home on the bridge of the starship Enterprise, she took a picture of my face that, she explained, would provide a host of information about the treatment she would recommend. The machine produced a series of colorful, and less-than-flattering, images of my face, each highlighting a particular skin property, such as wrinkles, redness, sun damage, and pore quality.
Now, this machine looked impressive, but despite the good bit of digging I did after the appointment, I could not find an independent analysis of its clinical value. The website for the company that manufactures the machine states, among other things, that the company has “deployed [their] complexion-analysis software as a sales tool to promote” brands of cosmetic products, that it “impressively increases business in all of your skin-care services,” and that the machine “was never intended for clinical trials.” Reading between the lines (or, actually, simply reading the lines), it seemed the company viewed this machine as a way to move product. So there were reasons to be dubious about the meaning and relevance of the results.
Still, the premise of the device, taking pictures of my face to assess its condition, was not far-fetched. I went with the flow.
The good news: My wrinkle situation was great. For my age and ethnicity, I had fewer wrinkles than about 95 percent of the population. The bad news: “You have the worst pores I have seen in over eight years,” Marie told me with a shake of her head. I stifled the sudden impulse to dash out of the room to scrub my face with an industrial-strength solvent.
I left Marie’s office with a bag full of high-end beauty products, including a cleansing-exfoliation gel that was designed to decongest aging skin, another cleaning lotion to control bacteria, a nighttime moisturizer that claims to be specifically designed for bad pores, and a morning moisturizer that doubles as a sunblock. The plan was to use these products morning and night for three months.
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The beauty industry is, of course, massive. It involves everything from teeth-whitening toothpaste to ridiculously expensive shampoo that will transform your hair from “ordinary to extraordinary,” if you believe an advertisement for a product that contains white truffles and caviar and costs more than $60 for an 8.5-ounce bottle. It involves celebrity-endorsed cosmetics, perfumes, and a host of fashion products. And it involves numerous fitness and slimming gimmicks. I will make no attempt to undertake a comprehensive analysis of every allegedly beautifying product that is touched by a celebrity. The number is infinite. It’s enough to know that the beauty industry is a huge cultural force in a tight, symbiotic relationship with celebrities and the celebrity-oriented media. The size and influence of this industry creates challenges for anyone seeking to get to the truth about the products it makes and promotes.
In my research I worked hard to find experts who could provide a reasonably independent view of the alleged benefits of the myriad beauty and anti-aging products and services. This proved to be much more difficult than I anticipated. Many experts I found were not independent scientists, but dermatologists who also had a clinical practice and, as such, benefit (some greatly) from a thriving industry. I am not saying that physicians knowingly twist information about the efficacy of beauty treatments, but there is ample evidence that such conflicts of interest can have an impact on how research is presented and interpreted.
To make matters worse, the popular press is rarely critical of new beauty products. While I found many excellent and balanced media stories on beauty treatments (usually panning them), the vast majority of articles simply trumpet their alleged value, using vague descriptors such as revitalize and radiate. Rarely did I find any real evidence or expertise beyond personal testimonies (which I don’t need to remind you are not evidence). The so-called experts who are quoted in these stories are often part of the beauty industry or individuals with no research background. To cite just one example, a frequently quoted “expert” who is a beauty columnist for a well-known women’s-health magazine, and an advocate for all things pseudoscientific, describes herself as an eco-advisor, television personality, and restaurateur—interesting resume, for sure, but hardly a background that lends itself to a critical analysis of beauty products.
Publishers don’t generally sell magazines by reminding readers that nothing works. Consequently, getting straight answers about anti-aging and beauty products is nearly impossible. There exists a confluence of fact-twisting forces: lots of money to be made by manufacturers and providers, huge advertising campaigns that deploy vast quantities of pseudoscientific gobbledygook, a lack of independent research and information, and consumers who desperately want the products to do for them what is claimed. The cumulative impact of all these forces results in a massive bias toward representing a product or procedure as effective. I call this the “beauty-industry efficacy bias,” or BIEB for short. (Note: The link between the BIEB acronym and Justin Bieber’s nickname was not intentional, but it does work out well.)
Given the existence of the BIEB, we should always bring a furiously critical eye to the assessment of any claim made by Big Beauty. Phrases such as “clinically proven” or “dermatologist approved” have little meaning because they could refer to almost anything. For example, what kind of study led to the representation that a given product was clinically proven? Did the manufacturers simply ask a couple of buyers? Do not be fooled by this kind of language, particularly when the presence of the BIEB makes critical analysis of the claims unlikely.
In many ways, celebrity culture sits at the center of the massive skin-care and anti-aging industry. Some estimates put the global skin-care market at approximately $80 billion, and it has been suggested that the entire anti-aging industry will be worth almost $300 billion by 2015. Celebrity culture helps to set the benchmark for how our skin is supposed to look. Celebrities are increasingly used to market skin-care products. And through their well-publicized beauty rituals, they help to perpetuate an assortment of anti-aging and skin-care beliefs—the vast majority of which are unscientific and completely unproven.
A cursory scan of popular newspapers and magazines turns up an overwhelming number of questionable celebrity beauty tips. Virtually every magazine with a focus on fashion, celebrities, health, or fitness offers regular advice on skin care and combating aging. Most newspapers have a weekly style or beauty section. At any given moment, probably hundreds of beauty-related recommendations are sitting on the average midsize magazine stand. And all these stories are almost completely devoid of any reference to credible evidence. Beauty advice is a science-free zone. Anything goes.
It is no surprise, then, that celebrity anti-aging activities, whether mildly nutty or utterly senseless, usually evade informed scrutiny. For example, many newspapers and magazines reported, often without a single reference to science, that Kate Middleton used a bee-venom facial as a needle-free shortcut to youthful, line-free skin. A similarly uncritical attitude characterized stories about Demi Moore’s famous leech therapy (which, as one source boasts, “cleanses the blood, improves circulation, and boosts tissue healing”) and the use of snails on the face, favored by celebs such as Katie Holmes, that, as reported by Glamour, leave a trail of “mucus that’s packed with proteins, antioxidants, and hyaluronic acid, which leaves the skin looking glowy and refreshed.” Apparently, the face-crawling gastropods are fed only organic vegetables.
I realize that most of us don’t take these stories too seriously. They are fun and entertaining diversions. Only a small segment of the public is willing to pay the ridiculous prices demanded by purveyors for purifying snails, insect poison, and nightingale excrement. But these stories help to frame how we think about beauty, and they foster the illusion that celebrity status (and wealth) provides access to magically effective anti-aging treatments. They make it seem as if there is something that can be done.
I have been using the products provided at my visit to the skin-care clinic in Calgary relatively faithfully during the past year. This is the most, by far, that I have ever done for my skin. The products used in the routine were expensive and the commitment of time considerable. So are there any measurable improvements?
Instead of going back to the original Calgary clinic, I decide to go to a different dermatologist, one who has no idea that this is an “after” test. This strategy, or so my thinking goes, will help to ensure a relatively objective assessment. If my skin has improved, it should be noticeable by any skin-care expert. I simply tell the staff at the new clinic that I am curious about the condition of my skin, which is absolutely true, and that I want to know what can be done to improve it.
The new clinic, which will remain nameless, has the identical Star Trek machine that was used to assess my skin in Calgary one year ago. The clinic staff takes pictures of my face just as the first staff did. To be fair, I suppose there may be calibration differences between the machines. But any significant difference, one that would be visible to the outside world—which is, after all, the whole point—should be detectable.
The results? Not impressive. Compared to people of my age and ethnicity, I’m told, my skin actually got worse on four of the eight assessment criteria, including texture and the all-important wrinkle category. My skin scores are about the same (within a few percentage points) on two of the criteria, including pores.
After the dermatologist finishes reviewing my skin analysis, he recommends several over-the-counter anti-aging products, at the cost of more than $500 for a six-month supply. These products and potions will dramatically improve my skin situation, he promises.