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Beyond Vanity

Plastic Surgeon Dr. Rick Antell’s Studies on Twins Show How Sun, Smoking and Stress Produce Premature Aging



Photograph by William Taufic

(page 1 of 2)

In the right hands, plastic surgery is both a complex discipline and a subtle art. The ancient and sometimes suspect practice, which took a quantum leap forward in the first decades of the twentieth century, is by definition the very essence of creativity. With a knowing eye, deft hands, and skills both learned and innate, plastic surgeons can perfect that which nature made imperfectly. They can accomplish Einstein’s dream of manipulating time and undo the inexorable drag of the years on muscle and flesh. And when a plastic surgeon of national renown, like Greenwich resident Darrick “Rick” Antell, takes identical twins whose faces have aged differently and restores them to the mirrorlike similarities of the past, it can seem miraculous.

“Plastic surgery has nothing to do with plastic as we think of it today,” Dr. Antell is quick to point out. “It comes from the Greek word plastikos, which means to mold. What we do is mold tissue.”

Plastic surgery predates Hippocrates. Descriptions of procedures have been found in papyrus writings dating back to 3000 b.c. Modern plastic surgery, which often combines both cosmetic and reconstructive skills, was born in the trenches of World War I. Young doctors inexperienced in battlefield medicine struggled with old techniques and gave birth to whole new areas of medicine, including dental and plastic surgery, with the emphasis on repairing jaws and faces savaged by shell and machine gun fire.

“In trench warfare,” Dr. Antell says, “the soldiers looked up over the trenches and were hit in the face.” All that many people know about plastic surgery is from Nip/Tuck (the cable television series about two wildly dysfunctional Miami surgeons), he says, “so you have to educate them about World War I and the injuries, and how it came to be the way it is.”

A quick explanation: Plastic surgery includes reconstructive surgery, which Dr. Antell defines simply as taking someone and basically getting them back to normal; and cosmetic surgery, which is taking someone who is basically normal and improving their appearance. (While cosmetic surgery is not covered by health insurance, reconstructive surgery, theoretically, is.)

Dr. Antell maintains a busy Park Avenue practice in New York and teaches at Columbia University. He is a devoted family man to wife Lisa and their four children. When they used to vacation on Fisher’s Island, he volunteered as a general practitioner and would be given vegetables and fruit by patients in return. A lifelong believer in giving back, he has treated patients from Kuwait, Egypt and England as a medical consultant in plastic surgery to the United Nations, operated on victims of the August 2003 terrorist bombing of the UN headquarters in Baghdad and is involved in Operation Smile, which provides free reconstructive surgery to inner-city children in the New York metropolitan area.

His groundbreaking study on aging and identical twins, which concluded that lifestyle and environmental factors were the most significant contributors to premature aging, was sparked by conversations with his patients. “I think I’m probably best known for face-lifts,” he explains, “and patients always ask, ‘How long will my face-lift last?’ When I say, ‘forever,’ they look confused. So I would say, ‘If you had an identical twin that had not had surgery and you had, you would both continue to age, but obviously you would always look better than your twin.’ We can push the clock back but we can’t stop it — the clock keeps ticking.”

“I thought it would be interesting to see what would happen if I operated on one twin and not the other, which was why I initially went to Twinsburg,” he says, referring to the annual Twins Day Festival in Twinsburg, Ohio. “So I went there with photo equipment and questionnaires and set up a research booth.” Over the next two years, Dr. Antell conducted intensive interviews, reviewed hundreds of photographs, and performed face-lifts on selected twins so that they again looked like their siblings.

“How Environment and Lifestyle Choices Influence the Aging Process,” was published in 1999 by the prestigious medical journal Annals of Plastic Surgery. “When one identical twin looks noticeably older than the other,” Dr. Antell has said, “only external factors can account for the differences in appearance.” (He also presented the study at a national plastic surgery conference in Newport, Rhode Island, and at an international conference in Venice, Italy.)

“When I got back to New York that first year,” he says, “I was struck by how different some of these twins looked in the pictures.” Perhaps the most stunning case is that of Gay and Gywn, two women approaching sixty; both had strong features, luminous dark eyes and short, similarly cut iron-gray hair, but their photographs eerily resemble “before” and “after” shots of the same woman. Gay had been a California sun worshipper for three decades, smoked a pack of cigarettes a day for four years, used marijuana heavily for seven, drank socially for ten years, and had undergone the horrific stress of losing a child to leukemia. Gwyn had lived in Maryland with moderate sun exposure, never smoked or drank, and had not had as stressful a life; as a result, she was free of Gay’s pronounced wrinkles and leathery skin. Even more telling were Kathleen and Karen, two Maryland-based twins in their fifties with comparable lives and lifestyles: Kathleen looked noticeably older; the only difference between them was that she had smoked for thirty years. (She has since quit.)

“This is a good story to get people to stop smoking,” says Dr. Antell. “You can tell people about their lungs turning black until you’re blue in the face. You tell them they’re going to look older? It’s a much better sell.”

Through his research Dr. Antell was able to pinpoint three factors that he calls “the three Ss” — smoking, sun exposure and stress — that impact on premature aging. “This is really the first study of its type,” he says, “that documented the effects of nature versus nurture. We’re all going to get old anyway, we can’t do anything about that. But this study conclusively proved that you can affect the rate at which you age. Nature is highly overrated,” he says with a distinct twinkle. “I think we can control about 80 percent of how we age by healthy lifestyle choices and by doing all the right things Mom always told you to do: don’t smoke, eat right, exercise and get good sleep.”

Dr. Antell has said of cigarettes, “What we see in a face of a smoker is a window to what’s happened inside.” Damage caused by sun exposure is arguably better known today than ten or even five years ago, although a large part of the reconstructive work Dr. Antell does is related to skin cancer. Perhaps his most shocking case was that of a woman who had, through a terrible and sad kind of denial, allowed a basal skin cancer to grow over much of her face. “The hardest thing was that it encroached onto her eyelid,” he says soberly. “We rebuilt both the inside and outside of the nose. The reason I point this out is because we used basically a reverse face-lift technique, taking all the skin from her neck and moving it up. This is why reconstructive surgery and cosmetic surgery blend together. She really had a face-lift but for a different purpose.”

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