Elective Treatments

Woman at podium with microphones Elective Treatments

Think, for a moment, about the life of a politician in 2020. Up at 4 a.m. to Zoom in to morning television shows. Sitting, mask on, through hours of hearings and debates in the dry, filtered air of bureaucratic buildings. Constantly appearing on camera for videoconferences and virtual

alls across the internet, both staged and unexpectedly candid. The average age of a member of the 116th Congress is 57.6 years for the House and 62.9 years for the Senate. But all things considered, many look significantly younger. One explanation? The widespread— but still relatively hush-hush—prevalence of cosmetic treatments.

Without getting into a game of “guess the work,” it’s safe to say most politicians, especially the Gen Xers and Boomers, rely on dermatologists to look more youthful. Washington, DC, dermatologist Tina Alster, MD, estimates “50 percent, if not more” of our elected officials tweak their appearance with noninvasive treatments. “Female politicians won’t admit they come to see me even if they come in for a mole check or to get something more medical, because people would assume it was cosmetic,” Alster says.

And it’s not just women. Terrence Keaney, MD, a dermatologist who practices in Arlington, Virginia, thinks about 25 to 30 percent of the men in office get work done, a significantly higher number than the 10 to 11 percent of men in the general population that he estimates get cosmetic treatments.

These doctors would know. Keaney has treated patients with cabinet-level positions (“No one in the current White House,” he’s quick to clarify). And Alster, whose office is on K Street, is a go-to cosmetic dermatologist for politicians on both sides of the aisle. “Am I seeing every single senator or congressperson? No,” she says. “But I have a back door, off a back alley. The Secret Service knows about it.”

But with few exceptions—think Kellyanne Conway’s June glow-up that garnered media attention—political players usually don’t make changes that are dramatic enough to elicit public comment. “In Miami, when you do someone’s lips, that patient wants other people to know they had their lips done,” Keaney says. “DC is more conservative. They understand that the constituents, the media, their opposition can’t know should not know—that they’re doing this.” Politicians “need to walk a fine line, as if they don’t care about how they look. But at the same time, they need to look vibrant and healthy and not haggard,” says Heidi Waldorf, MD, a dermatologist in Nanuet, New York—just across the Hudson River from Westchester County, where the Clintons and Donald Trump own homes. Complicating things further, a 2019 study in the journal Sex Roles showed that attractive women are less trusted as leaders, whereas men have no such problem. While the Catch-22s seem endless, the best cosmetic doctors know how to strike just the right balance.

 Elective Treatments

Take neuromodulators, like Botox, Dysport, and Xeomin, which immobilize muscle movement. Rumors that Democratic presidential candidate Joe Biden has had Botox have prompted some to criticize him for looking “over-relaxed” or even “almost paralyzed,” says Cheryl Burgess, MD, a dermatologist who practices in Washington, DC. “The average person wants to see empathy. They want to see reactions, natural facial expressions.” To achieve that look, Burgess says she tends to use a lighter hand with neuromodulators on politicians than she does with other patients. And now that most people are wearing masks to prevent the spread of the coronavirus, she’s tweaked her methods slightly, smoothing lines on the forehead without immobilizing the muscles around the eyes. “No one can see your mouth right now, so you want to keep those crow’s-feet to show you’re smiling,” she explains.

Research shows that conveying emotion is especially important for female political candidates, says Kerri Johnson, PhD, a communication and psychology professor at UCLA. In her research, Johnson has found that voters generally respond more favorably to female candidates who align with their expectations of what a woman should look like. And, frustratingly, anger is still considered inconsistent with femininity, according to Johnson. “Any woman I’ve ever talked to has had somebody come up to her and say, ‘Smile.’ Men don’t get that,” she says, acknowledging the sexism. “People often said that Hillary Clinton didn’t smile enough—that she looked angry.”

Perhaps that’s also why some government officials get cosmetic treatments to reduce redness. Burgess and Alster say they’ve injected prominent patients with diluted amounts of neuromodulators to reduce the reactivity of blood vessels, so they don’t look as flushed. The technique—which involves injecting microdoses of the drug into the superficial layers of the skin in a grid-like pattern—is considered an offlabel use.

Keaney says Botox can help with sweating, too: It is approved for use on the underarms of patients with severe primary hyperhidrosis, a condition that causes excessive perspiration. But doctors often inject small amounts into the foreheads and scalps of their patients in politics for the same effect. “They want to look calm, cool, collected,” Keaney says.

Injectable fillers are also popular on the Hill. Burgess likes Sculptra for those in the public eye because it’s made with poly-L-lactic acid, which plumps the skin and stimulates collagen over time. She says her high-profile patients like the subtle effects, which last two to three years. Power players also get hyaluronic acid fillers, such as Juvéderm and Restylane, though not necessarily in the standard spots around the mouth or on the cheeks. Burgess uses fillers for a procedure that’s referred to as “skin boosting” in Europe: She loads a small device, like the 20-microneedle Aquagold, with hyaluronic acid, then “stamps” the filler superficially all over the face for subdued plumping and added hydration: “It looks really good, and the needles are so tiny. The hole heals in four hours; it doesn’t stay open. You look absolutely fine the next day.”

And that brings us back to the big question: Why do politicians still feel they must hide the fact that they’ve gotten cosmetic treatments? Waldorf thinks it’s because they don’t want to seem vain. Alster agrees: “People don’t want politicians to seem frivolous in any way. They want to know that they’re paying attention to more important things.”

Then there’s the frugality factor. Remember how everyone laid into John Edwards for getting $400 haircuts during his presidential run in 2007? And last year, the Washington Times criticized New York representative Alexandria Ocasio-Cortez for reportedly spending $260 on her haircut and color at a DC salon. Imagine if the public got wind of how much cosmetic treatments cost! Botox lasts three to five months, and hyaluronic fillers like Restylane last six to 12, so the yearly bill from a politician’s cosmetic dermatologist could easily be in the thousands. It’d be hard for an elected official to argue that $1,200 stimulus checks are sufficient for the American public when they spend twice that amount on their face each year.

Johnson also suspects the electorate’s objections could stem from the fact that altering one’s appearance can be considered dishonest: “I’m speculating here, but if female politicians were perceived to be using cosmetic interventions to persuade or mislead in any way—if it was deemed manipulative—then that wouldn’t be good.”

Ten years from now, things will likely be different. Attitudes toward cosmetic surgery and noninvasive treatments are changing, and doctors report that younger patients are more comfortable bucking gender norms and talking about having work done. They don’t think cosmetic treatments are vain; they consider them just another aesthetic choice, Alster says: “My younger patients say, ‘I get my hair cut, so why can’t I get my Botox or my lips filled?’ ”

That sentiment seems to be making its way into the mainstream. When some Twitter users responded negatively to Democratic vice presidential candidate Senator Kamala Harris’s appearance this summer, others came to her defense. One wondered why anyone was “bashing” her, and had this to say about Washington, DC: “Every woman in this city, and most men, have had Botox before or will eventually. Everyone does this.” Writer and media personality Carol Roth summed it up perfectly with her tweet: “I don’t care if it is Kellyanne or Kamala, can we stop talking about every time a professional woman looks different on TV? Botox, no Botox, weight changes, makeup—it’s none of your business.”

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