Drop Dead Healthy

The Skin

The Quest to Erase Blemishes

I’VE BEEN RESEARCHING THE VARIOUS OINTMENTS, chemicals, and sprays that humans apply to their faces in their quest for healthy skin. Or healthy-looking skin, in any case.

And it’s an astonishing list, ranging from the delicious to the unimaginably repulsive.

In the appetizing category: yogurt, lemon, walnut oil, honey, almonds, avocados, mint, and pumpkin. The foreheads in Beverly Hills are better fed than the average laborer in an equatorial nation.

On the other hand, people also pay to have an alarming assortment of bodily fluids applied to their face. A New York spa will spread bird excrement on your pores for two hundred dollars. Another spa will shine your skin with spermine, an antioxidant originally found in sperm that is now manufactured in Norway. Snail secretion facials are also available. Seems we haven’t come so far from Elizabethan times, when there was a fad for puppy urine skin cleanser.

Skin treatments are not a new trend. In the Old Testament book of Esther, the evil king needs a new queen, so he holds an American Idol–style contest. Every night, he sleeps with a different woman. But not before the contestant has undergone beauty treatments that last an entire year. Six months with oil of myrrh, and six months with spices. Which makes a half hour in front of the mirror before a first date seem reasonable.

In my forty-two years, I’d never put anything delicious or disgusting on my face, apart from suntan lotion and face paint during camp color war. Why should I? I figured my skin can take care of itself. Don’t micromanage.

But recently I got paranoid that I’m the last man in modern times with no skin-care regimen at all. I was in the Penn Station bathroom before heading off to Philadelphia, when I overheard two guys talking. Leather jackets, Harley tattoos, belt-obscuring guts. They were either bikers or overzealous undercover cops.

“The sun is fucking killing me. I’m moisturizing like crazy. I’m using every fucking thing. I’m using fucking aloe. The whole thing.”

The other shook his head in sympathetic exasperation.

As part of the project, I have to take care of my skin. Skin cancer is the most common form of cancer in the world. There are two million cases a year in the United States alone, according to the American Cancer Society. And on a more superficial level, as my Penn Station friends can tell you, your skin broadcasts your age. So this month is the month of skin.

Smoothing Things Over

But what skin products to apply? Skin care is estimated to be a $43 billion industry, and the quackery level is astoundingly high. Doctor and journalist Ben Goldacre gives a thorough lashing to the skin cream industry in his book Bad Science. Manufacturers throw in scientific-sounding ingredients like “specially treated salmon roe DNA.” If your skin actually did absorb salmon DNA, Goldacre points out, you might grow scales, which would appeal to a niche group.

The skin-care choices are dizzying. But Goldacre writes that unless you have a skin problem, one moisturizer is almost as good as any other. For now, I’m using my wife’s Aveeno lotion.

Wrinkles are a different story. Of all the dozens of wrinkle-preventing options, just a few actually work. The most established: tretinoin, known more widely as Retin-A. This acid helps the skin retain collagen, the elastic material. It might even have health benefits in addition to the cosmetic ones. According to The New York Times, it’s been used to treat precancerous skin cells. Studies show that after two years of use, abnormal cells returned to normal.

At my request, my dermatologist prescribed me a tube of Retin-A. It’s absurdly expensive—eighty dollars for two ounces. I decided to submit a claim just to give the insurance guy a good belly laugh.

I started spreading the thick, white lotion around my eyes and forehead. A week. Nothing. Two weeks. Nothing. Third week . . . something? The fourth week, definitely something.

The deep cracks around my eyes remained, but the little crevices filled out, like an inflating balloon.

It wasn’t a placebo effect: I asked Julie.

“You look younger,” she tells me. “It’s weird.”

“You can borrow it if you want.”

“Why?” Julie says. “Do you think I need it?”

Huh. This is one of those Joe Pesci–style “do you think I’m a clown?” questions. There’s no winning. You end up backpedaling and being shot in the foot with a Glock 19, if only metaphorically.

Julie did borrow my tube, and it backfired on her. Her skin got all red and puffy. “You’ll have to deal with wrinkled old me,” she said as she gave me back the tube.

I went back to dabbing it on each night. I watched the tiny dents in my face erode like a handprint in the rising tide. I spent an embarrassing amount of time in the mirror studying the skin around my eyes. I never thought of myself as being concerned about mini wrinkles. Who cares? They add character, right?

And yet, it’s an astonishing feeling to watch such a clear cause and effect. Apply cream, wrinkles vanish. It’s like Photoshop, but in real life.

Then I started studying the rest of my face. What else can I fix? What about that chin? It sort of flows smoothly into the throat, creating a combined chin/throat: a choat.

Or maybe my slightly asymmetrical nose? Maybe I should get that fixed.

I snapped out of it after a couple of minutes. I remind myself that vanity is more addictive than most Schedule IV drugs.

I can see how this quest for physical perfection might slide into insanity. How a reality-show star can have forty-three plastic surgeries in a month and how author Alex Kuczynski can sustain a whole book on beauty junkies.

Plus Retin-A has other downsides. It makes skin more likely to get sunburned as it allows in more UV light. And God knows what other unforeseen side effects will bubble up over the years. Not to mention that it’s a money vacuum.

So on a random Wednesday, I put the Retin-A in the back of my closet. Though maybe I’ll start up again for the book tour. You know, for business purposes.

The Bronze Age

When I was a kid, sunscreen rarely touched my body. I loved a good tan, which I somehow thought made me look less scrawny. As a result, my skin is a canvas of craters and crow’s-feet and splotches.

I was kindly reminded of this on a recent vacation. We met a fellow tourist who remarked that Julie and I looked young. We smiled. Until her husband, a dermatologist, replied:

“No, they don’t. I can see a lot of skin damage. A huge amount.”

He guessed, correctly, that we were in our forties. Julie still hasn’t forgiven him. “Unless you work at a carnival, keep your age guesses to yourself,” she said.

But he’s right about our skin damage.

And for this, I’ve decided to blame Coco Chanel. In researching suntans, I found out the French designer is considered the godmother of modern bronzing. For centuries, middle-class white people avoided tans for fear of looking like they worked in the field like a common peasant. But in 1923, Coco Chanel vacationed in the Mediterranean on the yacht of an aristocrat friend, and was spotted on board with a deep tan. Caramel-colored skin soon became the rage, the sign that you could afford a sun-drenched holiday.

After learning this story, I added Coco Chanel to my list of the top-five health villains. Think of how many cases of fatal skin cancer this woman is responsible for. Thousands? Millions? Maybe that’s too harsh. Maybe I shouldn’t be angry at this delightfully chic lady, the creator of plumed hats and Marilyn Monroe’s nighttime wear (“five drops of Chanel No. 5”). Maybe we shouldn’t fault her and her alone. Maybe. But in my defense, Coco Chanel had some other rather serious flaws. She had a notorious years-long affair with a Nazi spy during the occupation, and was later charged by the French government as a collaborator. (She escaped trial only thanks to intervention by her friends in the British royal family.) Which makes her life especially ironic—she was involved with two opposed evils: white supremacy and tanning.

Coco Chanel needed more sunscreen. A lot more. As do most of us. When Americans put on sunscreen, we underapply the stuff, using about a quarter to half of the correct amount, say dermatologists.

The American Academy of Dermatology suggests a shot-glass-ful of sunscreen every two to four hours. You should apply it regardless of the weather—whether it’s cloudy (80 percent of UV rays penetrate clouds) or winter (especially with snow, which reflects sunlight).

So, on a Saturday morning, before walking our kids to a friend’s birthday party, I squeezed my Coppertone Sport Broad Spectrum UVA/UVB sunscreen (plus antioxidant defense) until it filled a shot glass, and then dipped my finger in and started slathering it on my body.

A shot glass is about 1 to 1.5 ounces. It’s hard to comprehend just how much sunscreen this is unless you try it yourself. Go ahead, I’ll wait. Still waiting. You see? You’re probably exhausted from squeezing the sunscreen tube, right?

With my shot glass, I had enough sunscreen to coat my body four times. I glistened like a Mr. Universe contestant, only without the distracting abs.

“I’ve run out of body parts,” Julie said, when she tried to do it. “And I think I got it in my mouth. The dermatologists have to be getting kickbacks from the sunscreen companies.”

Applying it every two hours, Julie and I emptied an entire eight-ounce bottle in a single day. We finished more than half of another bottle for the boys.

When I tell my aunt Marti, she’s appalled. She thinks sunscreen is filled with toxins. I’m avoiding scented sunscreens, which might have phthalates, but otherwise, I’m ignoring the risk. Sorry, Marti, again.

Some vitamin-D advocates are also skeptical of sunscreen. For the last few months, D has been the trendiest of all vitamins, the Lady Gaga of supplements (or whichever pop star the bar mitzvah DJs are playing ad nauseam these days). Its fans—such as Dr. Sarfraz Zaidi, a professor of medicine at UCLA—say vitamin-D deficiency is linked to cancer, heart disease, diabetes, kidney disease, chronic fatigue, asthma, dental problems, and depression, among many, many other ills.

Not counting supplements, we get vitamin D from foods such as salmon and egg yolks, and from sun exposure, which lets us synthesize it ourselves. The D fans say that we use too much sunscreen and suppress our levels.

The quarrel between dermatologists and vitamin-D advocates is an example of a problem infecting all medicine: the specialty bias. Most experts see the world through the prism of their specialty.

Based on my advisory board’s counsel, I’m taking a middle path: exposing one sunscreen-free limb every other day for fifteen minutes. I vary the limb, to reduce the chances of overexposure to any particular part.

The Mole

Among my skin’s many imperfections: I have a mole on the side of my nose.

Had I been alive 250 years ago in France, this would have been quite a boon. I read in the encyclopedia that back in the days of Louis XV, there was a vogue for moles. Black patches of gummed taffeta were popular with chic women and men who wanted to emphasize the beauty and whiteness of their skin. The smart set had plenty of patch designs to choose from. For the understated, there were the simple spots. But the truly fashionable had patches in the shapes of stars, crescents, elaborate animals, insects, or figures. Placement was also important, seeing as these patches had their own language: A patch at the corner of the eye symbolized passion, while one at the middle of the forehead indicated dignity. Women carried their patch boxes with them, in case they wanted to slap on a fresh one during the royal ball.

My mole, sadly, isn’t in the shape of a giraffe or spider. Just a regular old spot, about the size and color of a chocolate chip. And unfortunately, instead of inspiring coquettish smiles and fluttering eyelids from ladies of the court, it inspires lingering stares that lie on the border between curious and dismayed.

After a visit to the dermatologist—not the insulting one, a kindly friend of the family named Dr. Eileen Lambroza—I decide to have it removed—along with the mole on my back, which is actually more worrisome to her, since it’s asymmetrical.

A mole—the medical term is “nevus”—is an abnormal clump of skin cells that produce the brownish-black pigment melanin. Caucasian adults each have an average of thirty moles on their bodies. And it’s not a small health problem: More than a million Americans are diagnosed with skin cancer every year. And worldwide, at least fifty thousand die each year of skin cancer that came from moles, according to the World Health Organization.

A few days later, I’m in the office of a plastic surgeon, an Orthodox Jewish man. He’s wearing those glasses with miniature telescopes protruding from the lenses. He studies my mole, before announcing his analysis.

“That thing is the size of Providence!”

Well, at least he chose a midsize city without much suburban sprawl.

The surgery took all of twenty minutes. I couldn’t see what was happening, but I felt a needle prick, heard some emery-board-like scratching, smelled burning skin, and felt thread tugging at my nostril.

The doctor was nice and apparently at the top of his field. He was also talkative. I knew from my research on multitasking that chatting can interfere with performance. So I answered his questions in monosyllables. No, I didn’t speak Polish. Not much happening at work. I felt guilty being terse.

When I got home, Julie was at her desk paying some bills. She looked up. For a few seconds, she peered at me like she was trying to solve a four-dimensional topology problem.

“You got your mole taken off?”

I nodded.

“You didn’t tell me? No warning? No debate?”

I shrugged.

“It’s such a part of you. You’ve had it forty-two years.”

I could see tears welling up. Actual tears. I didn’t expect this much emotion over a hunk of melanin. I got nervous.

“So I should have kept it?”

“No, I’m happy about it. Overwhelmingly happy. I never wanted to say what I thought about it before . . .”

They were tears of relief and surprise, not sadness. Interesting. We’ve been married more than a decade, but Julie’s never brought up my mole, for fear of hurting my feelings. What other secret opinions does she have that she’s too polite to say?

A week later, Dr. Lambroza called with the results of the biopsy. The nose mole was fine. But the one on my back, well . . .

“It was atypical.”

Huh. That doesn’t sound good. Atypical is fine when it comes to movie tastes, but medically, I want to be as dull, boring, and typical as possible.

“It didn’t qualify as cancerous. There weren’t enough atypical features to diagnose it as a melanoma. But it was still atypical. It’s a good thing you’re writing this book and you had a dermatology appointment,” she says.

If I hadn’t caught it, it would probably have turned into cancer in a few years.

There it is, another little wake-up call about mortality. A tiny wake-up call. Not a noble or impressive one. Nothing that would get me a lot of sympathy at the corner bar, but a wake-up call nonetheless. My body is filled with imperfections, and one of them will get me.

Checkup: Month 17

Weight: 161 (creeping back up)

“I am grateful for” e-mails exchanged with mother: 27

Personal record for most superfoods eaten in one meal: 11 (salad with black currants, red peppers, wheat germ, cooked shiitake mushrooms, blueberries, avocados, pomegranate seeds, lentils, mango, flaxseed oil, almonds)

Trips to the gym this month: 11

Yes, my gym attendance is shameful. My running schedule isn’t much better—three times a week instead of every day at my peak. I need motivation. I’ve realized 80 percent of this year is about motivation. Most health advice can be summed up in five words: Eat less, move more, relax. The question is: How do you do that? That is my struggle.

How do you gag the voice in your head that says, “You don’t have to go to the gym today. There’s always tomorrow. C’mon, my friend, it’s just one plate of curly fries. Yes, just for you!” (My inner voice reminds me of a particularly aggressive rug salesman at a Turkish bazaar.)

Motivation will be next month’s theme.

My friend Charles Duhigg—a reporter for The New York Times—is working on a book about developing good habits. He tells me that one important element is rewarding yourself. So after every workout, I’ve been rewarding myself with ten minutes of the sleazy, lowbrow but highly entertaining gossip site TMZ.com. It’s helpful, as is my photo of Old A.J. But I need more.