Fredric Sheldon Brandt was born on June 26, 1949, in Newark, New Jersey, the second son of Esther, a bookkeeper, and Irving Brandt, a veteran who had served as a private first-class during World War II. Together, the Brandts ran a candy store in the predominantly Jewish neighborhood of Irvington, a few miles outside of Newark. The candy store, and young Fred’s affinity for sweets, would later serve as anecdotal fodder for his famously disciplined lifestyle. He wrote in his 2007 beauty guide, 10 Minutes/10 Years, “My father was a diabetic who didn’t take care of himself or modify his diet as well as he could have, and he died way too young from renal failure.” Irving Brandt passed away in 1965 when Brandt was only 15 years old; his mother died just six years later, leaving 22-year-old Fred to fend for himself.

In high school, Fred — or “Freddy,” as he was known then — was in the debate club and on the political science team. “He was very bright,” recalled his former classmate Alvin Felzenberg, who played Brutus to Brandt’s Julius Caesar in sixth grade. “I’m sure he had straight As. I’d be shocked if he had an A-minus or a B-plus in anything.” Freddy was also private, avoiding his classmates’ questions about his family. “There was a general sense among those close to Fred that the household he grew up in was not a very nurturing one,” Lili Anolik wrote in a 2015 Vanity Fair profile of Brandt after his death. “He didn’t want anyone talking about his family — ever,” Felzenberg said.

If young Brandt was at odds with himself, his senior portrait from 1967 doesn’t betray it. In the photograph, 17-year-old Freddy wears a white button-down and black bowtie; his brown hair is neatly parted. His lips, closed in a small smile, are naturally and attractively plump. The accompanying text notes his “infectious grin and good sense of humor” and predicts a “medical career ahead.” Decades later, as Fred tested the boundaries of his natural bone structure, his features morphed into something more angular and modern. In 2014, he told the New York Times that people often asked whether he was from Sweden. “Actually,” he’d say, “I’m a Jewish kid from Newark.”

After graduating from Rutgers and then Hahnemann Medical College in Philadelphia, Brandt moved to New York City, where he completed his residency in internal medicine at NYU in 1978. It was during this time that he met an oncology nurse named Karen McDonald, who remembered him as prematurely bald, “schleppy,” and uncomfortable in group settings. “He was like a little mouse,” she said. “It didn’t even occur to me that he might be gay.” In 1978, Brandt moved to Florida to complete a residency in dermatology at the University of Miami. “I remember thinking, ‘That’s perfect for him,” McDonald said. “He can study his lesions and have a quiet life.”

“We all knew what we were getting into by going and getting these things done, but Fred managed to make everybody feel like this was normal.”

In the early 1980s, cosmetic dermatologists were mostly skin cancer specialists, mole removers, and pimple interventionists. During a time when people still smoked on airplanes and considered bronzed skin a sign of good health, Fred Brandt was hiding from the Miami sunshine and admonishing friends for tanning with baby oil. He began living with a young male dancer, but the romance was short-lived. By many accounts, Brandt never found himself in a serious relationship again. Instead, he surrounded himself with people who were the best in their fields — aesthetes, like himself, who valued their career and lifestyle over family. Brandt also began collecting art; early acquisitions from Marilyn Minter, Richard Prince, and Christopher Wool were “a way of keeping score, of being a trendsetter,” said Paul Frank McCabe, his personal art dealer. “To him, the aesthetic interaction, the living with it and being excited by it, was more important than the cash.” Brandt’s sexuality, though not a secret, was rarely discussed. “He definitely had some romantic interludes or involvements, a couple of which ended in a hard way for him,” said Jonah Shacknai, former CEO of pharmaceutical company Medicis, which distributed the filler Restylane. “Had he been born 20 years later, he would have lived a very different life.”

Brandt was undeniably beholden to the ideals — and the limitations — of his postwar generation. He grew up during the golden age of Hollywood, when studios had a stronghold over their stars and plastic surgery made its bombshells appear more blue-blooded. Brandt’s most famous faces shared the unmistakable contours of beauties like Bette Davis, Judy Garland, and Rita Hayworth, who reportedly had her hairline raised to obscure her Latina roots.

At the beginning of his career, in the 1980s and early ’90s, plastic surgery was the domain of the famous and conspicuously wealthy. Robbie Myers, the former editor in chief of Elle, remembers a dermatologist telling her how to recognize the handiwork of a certain plastic surgeon. “They wanted people to know they’d been to this Upper East Side doctor. They didn’t mind that it was obvious they’d had work done. His ‘look’ was a sign of status — like having an Hermès bag.” Brandt preferred not to leave a trademark. “My goal isn’t to make you look like you’ve had obvious work done. My goal is to make you look younger,” he wrote in 10 Minutes/10 Years. “What ages you the most… is a loss of volume. Fillers replace that lost volume. A face-lift takes it away.”

In 1980, the year Brandt became a board-certified physician in Miami, Dr. Alan B. Scott published a study on the effectiveness of injecting botulinum toxin to alleviate crossed eyes and eyelid spasms in humans. In 1989, the FDA approved Botox for ophthalmological use; two years later, Vancouver doctors Jean and Alastair Carruthers noticed that their patients enjoyed the wrinkle-erasing effects of eyelid injections. They presented their findings to the American Society for Dermatologic Surgery in Orlando in 1991. Jean later told Reader’s Digest Canada that medical friends considered it “a crazy idea going nowhere.” Brandt, who had been lecturing all over the world on the effectiveness of injecting collagen to erase wrinkles and fill lips, began to focus his efforts on the cosmetic application of Botox. (Though the FDA doesn’t endorse off-label usage of approved substances, it isn’t responsible for how doctors administer them.)

During a time when people still smoked on airplanes and considered bronzed skin a sign of good health, Fred Brandt was hiding from the Miami sunshine and admonishing friends for tanning with baby oil.

If you didn’t want to go under the knife back then, the only available cosmetic treatments were dermabrasion — a treatment that left a patient raw and wrapped in bandages — chemical peels, or microdrops of silicone, which were notorious for hardening under the skin. There was no such thing as volume-recapturing “filler.” Sculptra, the first product approved by the FDA to combat HIV-induced facial wasting, wouldn’t come to market for another 20 years. A dermatologist colleague who met Brandt back when they were both starting out described their early clientele as either “very wealthy” or “crazy.” In women who wanted to improve their appearance without having to cop to it, Brandt had stumbled upon an underserved and lucrative demographic.

Linda Wells didn’t hear about Botox until the mid-1990s — several years after its cosmetic benefits were discovered. “There was a lot of negative stories, a lot of bad news, a lot of skepticism and danger attached to the whole idea of injecting your wrinkles, and it sounded very sci-fi and really wrong,” she said. “It was hard to imagine that this would be a real thing. It was very buzzy and bizarre.” (An early headline in the New York Times: “Botulinum Toxin’s Promise as Drug May Rival Its Potential as Weapon.”)

Wells, who founded Allure in 1991, recalls first meeting Brandt at an event hosted by the magazine. “It was like, ‘My God, Fred Brandt is here. You have to go see him,’” she said. “It was a little bit unkind, because it was to get a look at this person who had experimented on himself. His face was distorted and unusual-looking. But also that he had this reputation as being a magician and an alchemist with these injectables.” Wells soon became a Brandt disciple, and like his other patients, she gladly submitted to his unorthodox techniques: “There were all these things he did that I didn’t know weren’t entirely kosher, but Fred was always one step ahead of the science.”