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What is Botox?

An understatement. Since their concentration on cosmetic medicine, their hefty resumés now include more than 100 new articles in peer-reviewed medical journals, 60 book chapters and five textbooks. Travelling the world, they give about 30 talks a year to cosmetic and plastic surgeons and dermatologists. Their kingdom includes a research institute (in the same building as their offices) that coordinates their studies on new products and procedures. All told, they employ about ten people: nurses, researchers, administrators and patient-care coordinators.

Cosmetic medicine demands a personal touch. The doctor-patient bond in the cosmetic world, Jean says, lasts 30 to 40 years: “We’re talking about family.” The Carrutherses’ staff are crucial to this bond, and each doctor has a coordinator of patient care.

Jean says admiringly that the staff all look like “after” pictures. Before I can comment, she continues, “It’s important that all of us in the office are…I’m going to say ‘users.'” Staff are treated for free, since it’s to the Carrutherses’ benefit if everyone in the office not only looks good but is a source of reassurance.

Christa Campsall, a friendly, statuesque brunette who works as the clinic coordinator, agrees it’s much easier for her to put a patient at ease now that she’s had Botox and Restylane tissue fillers. When she started managing the clinic seven years ago, she was only 32, and the other staff would tease her, reminding Jean, “Christa’s still a Botox virgin.” She hadn’t been there long before she volunteered to be injected.

Jean Carruthers, at 61, is too canny not to understand that she herself is the main poster girl for their office. She’s matter-of-fact about the procedures she’s had: a complete facelift ten years ago, lid lifts, Botox, fillers, Thermage (a skin-tightening and skin-contouring treatment) and intense-pulsed-light treatments.

She’s also matter-of-fact about costs. Botox runs $16 a unit and most people require 30 units. Restylane, one of the best-known fillers, used for lip augmentation and for injection into wrinkles and facial folds, costs $600 a syringe (one millilitre); most patients require three or four syringes. Botox and the fillers, as well as the newer thermal treatments, all need to be repeated, sometimes every three or six months. Jean tells her patients, “Think of a nice handbag or several manicures.”

When I ask her if she thinks of Botox as a watershed in her career, or if she sees the last 35 years as a continuum, her answer is typically savvy: “It’s a continuum, because it’s all about the patients.” She sees herself as being in the business of restoring self-esteem. Like it or not, she says, we’re hard-wired to be attracted to beauty. Beautiful people earn more money, and people who look after their appearance have better cardiovascular health and live longer. Botox, she says, is “penicillin for self-esteem.”

Asked if she feels part of a climate that makes people unhappy about aging naturally, she answers, “What is aging naturally?” Then she adds, “It’s a choice.”

Cassandra, a patient of Jean’s, equates the procedures she’s had with exercising and taking her vitamins: “They are part of my wellness package, and psychological wellness is not to be underestimated.” She agrees there may be too much pressure to look young, but on the other hand, it’s better for a woman who’s been “kicked to the curb in a divorce” to be able to feel good about herself. A “workaholic professional,” Cassandra has a pleasant, unlined face and sunny blond hair cut in a pageboy. Had she not told me that she’s 56, I would have taken her to be in her late 20s.

Sydney, a makeup artist in his 50s who is a patient of Alastair’s, rattles off the fillers he’s used, names that shimmer with promise: Radiesse, Evolence, Juvéderm, Dermalive. “I’m plastic from the neck up!” he jokes, but adds, “I just want to maintain the way I was at 35.” A professional in what he calls a “youth-obsessed industry,” Sydney is a discriminating user, keeping his horizontal forehead lines because he wants to look expressive.

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