The Mind-Beauty Connection: 9 Days to Less Stress, Gorgeous Skin, and a Whole New You by Amy Wechsler

From the Publisher

By your thirties you've accumulated the first signs of normal aging: crow's feet, a bit of sag, some broken capillaries. But stress aging-how the madness of modern life affects your physical features inside and out-is today's biggest skin and health challenge. High stress may be here to stay, but you don't have to show it.

Happily, stress aging is very reversible. The link between how you live and how you look-the mind-beauty connection-is powerful and can dramatically affect how well and how fast you age. While you may never be able to totally turn off all the pressure (if only!), Dr. Amy Wechsler is here to show you exactly how to turn back the stress-aging clock. In her book, she shows you how to:

Find out your SkinAge with a groundbreaking test that reveals how old (or young!) you really look

Personalize a 9-day renewal plan that's right for your face, wallet, and psyche

Understand the different cosmetic procedures and products available today and decide what's best for you and your lifestyle

Adopt a mind-beauty regimen that will keep your whole body looking and feeling terrific-not just for now, but for life

You'll not only look better, you'll also sleep better, feel better, and likely lose unwanted weight as you begin to feel healthier and more alive. And yes, even less stressed.

Product Details

• Table of Contents
• Read an Excerpt
• Read a Sample Chapter

Table of Contents

Read an Excerpt

introduction

An End to Stress Age

How old do you look? How old do you think you look? If a simple Q&A test in front of the mirror could tell you what your physical age is — regardless of your chronological age — what do you think it would reveal? You are about to find out. In the very first chapter, you're going to take three quizzes, one of which is revolutionary. Designed by RealAge, the SkinAge test will tell you exactly how old you really look. It will mark your starting point for a step-by-step program outlined in this book that will transform you from the inside out, and it will get everyone to notice.

If you have been frustrated or unhappy with your appearance — whether you are twenty-two or sixty-two — then this is the book for you. Chances are, you picked up this book for a reason. Maybe it's the unprecedented acne, the deep lines and shallow crinkles, the lack of a healthy glow, the thinning hair and brittle nails, the extra ten pounds you didn't have a year ago, or perhaps it's the accelerated aging in general that is evident everywhere you look when you step in front of a mirror. And maybe you avoid the mirror at all costs now. No matter what your personal issues are with your appearance, I am here to show you how to change all that. After all, loving the skin you are in is essential to personal well-being. In fact, in my practice, how you look is a vital sign of health.

There is so much you can do with great results without taking radical action or going under a knife. My approach is uncomplicated, effective, and empowering. No frills. No gimmicks. You'll be shocked to learn my easy daily practices that can bring out radiant,natural beauty. And for you busy moms who feel as though you are not allowed to look fabulous, listen up. I'm a mom, too, and I can't express how important it is to nurture yourself with today's cutting-edge strategies to maximize health and, of course, beauty. Your whole family will benefit.

When RealAge approached me to do a book, I was thrilled at the opportunity to get the message out about what it takes to stay looking and feeling as vibrant as possible, with a focus on the very skin that wraps us up so wonderfully. Some people will stop at nothing to find the secrets to maintaining their youthful looks and heightening their attractiveness, and throw thousands of dollars at the beauty industry. If only they knew that the secret is learning one powerful principle, and following a plan that abides by it.

This principle is the mind-beauty connection, and it lies at the heart of achieving the most beautiful skin (and, I might add, body) possible. On a most basic level, the mind-beauty connection is about the powerful force that exists between our inner minds and outer appearances, which is based on proven biochemistry. Astonishing new science is revealing just how our minds affect how well, and how fast, we age physically. This includes not only how we think and our behavior, but also how we cope with the madness of modern life, and how we preserve our bodies' self-healing and inherent beautification capabilities. What's more, scientists continue to uncover incredible insights into how our skin, in addition to our brains, is also an extraordinary command center for communication, and is able to effect change in our inner bodies and outer appearance in ways we never thought possible before.

the sensitive and simple approach

This book will inspire you to make a few small shifts in how you take care of yourself with practical and doable recommendations. I'm not here to sell you expensive products, or tell you to use anything that hasn't been clinically proven to work on people. You see, so many of the lotions, potions, and so-called must-haves that line the drugstores' shelves and beauty counters overclaim and underperform. Promising laboratory studies don't always translate into real-world effectiveness in humans. I will not only dispel myths in the beauty-market circles, but I will also give you sound advice to help you distinguish the hype from the truly helpful. I will state plainly what you can do starting today to improve your appearance (and strengthen your self-confidence, too!) without falling prey to great advertising. And for those who do choose to explore more aggressive procedures like Botox and resurfacing, I'll give you the guidance to find the right solution for you, your wallet, and your peace of mind.

Premature aging and adult acne are the two most common skin problems I see, and I often find that I have to get to the bottom of exhaustion or emotional issues in order to treat these symptoms of modern life. There are plenty of combination strategies that can help reverse the effects of tension and time. I was a psychiatrist for seven years before I became board certified in dermatology and switched specialties. I put my old hat on every day to untangle the psychological from the physical and find sensitive, simple, solutions for both.

the front line of defense

My experience in psychiatry complements my current practice like no other specialty could, and has also made me a much better mom, wife, friend, and doctor. A lot of patients come for help with their appearance and end up talking about myriad life issues. For example, if someone sees me for upper-lip laser hair removal, I like to talk about how it feels as a woman to have excessive hair there. Skin care can be so emotional; people cry in my office every day. I certainly don't let them leave crying, but I know it's a positive experience for patients.

When it comes to beauty and a sense of self, these two fields of medicine coalesce brilliantly. So much of how we think affects how we look, and vice versa. I have always believed in treating the body as intrinsically connected to the mind. By virtue of my specialty, I keep up with a lot of other fields of medicine. I refer to ear, nose, and throat doctors all the time, as well as ob-gyns, in vitro specialists, massage therapists, a good spot to get a manicure and pedicure, and even the places to go for the perfect shoes.

Seeking help from a dermatologist should not be viewed as a luxury; it's as important as getting a regular checkup. Like any general practitioner, I see myself as representing the front line of defense for taking better care of yourself so you don't have to resort to radical measures such as plastic surgery, or learn someday that you have a serious form of skin cancer or an age-related disease that threatens your life. Because my techniques aim to lower your stress and heighten your natural beauty, the benefits that await you could be infinite. They will spill over into your heart health, brain health, digestive health, and just about every other aspect of you that makes you, well, you.

The reason I left psychiatry to pursue dermatology is simple: I missed the hands-on, physical element of medicine that is so fundamental to dermatology but largely absent from the field of psychiatry. I knew that I was quite adept with my hands and believed I had a calling to use them somehow to take care of more than just people's minds. After all, the essence of being a physician is having the knowledge and opportunity to treat patients' bodies with healing hands and established procedures. I get to do so many different things in dermatology that can truly transform a person's life in a relatively short period of time. Admittedly, there's a definite allure to the immediate gratification that comes with being a dermatologist. A patient can walk into my office and, with one consult or treatment, leave looking and feeling better. That can be difficult to achieve in psychiatry on a regular basis. Skin diseases are interesting, but it's really the interaction with people that is so satisfying.

in this book

Starting in the first chapter, you'll assess your appearance with three separate quizzes, one of which is the groundbreaking SkinAge test that was designed exclusively by RealAge's top scientists to tell you how old your skin is as compared to your chronological age. I'll get you started with revitalizing your looks in chapter 2, and take the confusion out of knowing how to treat your skin daily, weekly, and monthly so it glows naturally. You'll learn the basics of skin care as I go into detail about which beauty products and in-home techniques are worth considering, or are a complete waste of your money. Then, you will prepare to embark on a nine-day journey tailored to your specific needs. Whether you have trouble getting a restful night's sleep, juggling an overbooked schedule, finding time to exercise, or choosing the right foods for your skin, I've got recommendations. You will learn about the seven free habits for healthy skin. These are the habits that support your natural beauty, many of which can encourage cellular restoration. Before you begin the nine-day program, you'll identify which stress profile you match, using a few straightforward questions. This will help you to personalize your program within my day-by-day guidelines outlined in chapter 4, as you learn more fascinating ideas about the intersection of mind and beauty, especially as it relates to your diet, activity level, hormones, age, and lifestyle.

Later in the book, I'll give you an eye-opening peek into your body's dynamic physiology in not only the aging process, but in its response to what you encounter in everyday living. This is when you will begin to fully understand stress aging and the mind-beauty connection. Sprinkled throughout the book you'll find answers to my most frequently asked questions. You will be surprised by how many people come in with the same question but feel like they are the only ones to ask it.

Those who are troubled by particular skin conditions — from acne to skin cancer — will find chapters 8 and 9 especially helpful and encouraging. Then, in the last chapter, I will share all you've ever wanted to know about the more aggressive treatments and procedures available to you should you choose to go that route with a licensed practitioner, and I'll help you find the right doctor, too. This includes straight talk about cosmetic surgery, pharmaceutical interventions, as well as body-image issues that may be weighing too heavily on you. I'll hold nothing back on what I think about certain techniques, some of which are the most popular used today. In all, by the time you're done reading, you'll have accomplished the following steps.

• know your true SkinAge, including how much is physical and how much is emotional

• be ready to complete an easy, practical, and inexpensive nine-day mind-beauty program that can take years — years — off your looks

• have found a renewal plan that's right for your psyche, body, and wallet

• have a long-term maintenance regimen that takes only minutes a day and will keep your skin looking and feeling terrific forever

For help in tailoring this program to your body, especially if you have any special health concerns or needs, please speak with your doctor. For example, some of the ideas may not be suitable if you are pregnant and/or breastfeeding. I also encourage you to keep your personal health practitioner in the loop if you plan to commence an exercise program, as suggested in the book, and have not been active in a while. Everyone's response to this program and results will be different. Also be advised that the products and companies mentioned in this book do not reflect an endorsement of any kind, as I currently have no affiliation whatsoever with any of them. I simply want to give you easy, accessible ideas and examples to get you started, because I know so many of you crave specifics and need that extra guidance. I do, however, encourage you to explore other products on the market that may work better for you, or that you may prefer simply for your own reasons. Last, some of the names and identifying characteristics of people described in the book have been changed.

This book is for all of us who have ever looked in the mirror and wished for a better-looking reflection. However, looking in the mirror and seeing a wrinkle you want to eliminate is only part of the equation. Yes, this book keeps a strong focus on skin, but the rewards for making the mind-beauty connection go far beyond a quick fix. I bet many of you will lose unwanted weight, and witness your own medical transformation as you begin to feel healthier and, in a word, alive. Everyone's individual results will be different, but I guarantee that everyone who takes my recommendations and strategies to heart will see and feel an improvement, however big or small, on both the inside and outside. We all deserve to look and feel our best, no matter how young or old the calendar says we are. Ready for a whole new you? Turn the page and let's get going!

Copyright © 2008 by RealAge Corporation

1

the skinage test and other reality checks

How Do You Really Feel About Your Looks?

Admit it: At some time or another (perhaps many times), you looked in the mirror and thought, "Where did that come from?" I wish I had a dime for every time a woman said this to herself; I'd be the richest person on earth. I think the experience is shared among all of us, and, when this question first crosses your mind, it gets you to examine more than just one particular spot. Suddenly, you feel the need to take a closer look all over. So you then follow the tracks of previously unrecognized wrinkles across your forehead, a discolored area or brown spot on your cheeks, and the genesis of a deeply rooted pimple on your chin. You step back to take inventory of other body parts. Hair. Neck. Chest (décolletage). Hands. Hips. Waistline. Profile. You don't look like you did ten, maybe even just two, years ago. An ugly, sinking feeling washes over you. Your face — correction, your whole body — is morphing and you can't control it. Or at least you think you can't control it. Yes, you are getting older and can no longer be mistaken for a youth (the days of getting carded to buy alcohol are over). I bet you wouldn't want to be a kid again anyhow, but still, you wouldn't mind having the energy and vibrant looks of one.

Here's the good news: You can do something to rejuvenate the appearance that the stress of modern life has stolen. That's right: A lot of what you see is reversible. And the program described in this book will also help you recapture the energy and vitality that life has momentarily confiscated.

Who knew that a little word like aging could conjure so much emotion. None of us really thinks about it until we see evidence of it in the mirror one random day.

It doesn't take a doctor like me to tell you that, over time, the first signs of aging become evident and the skin, which is our largest organ, accounting for 12 to 16 percent of the body weight, reveals the first clues of this process. This is when we notice wrinkling, creasing, dryness, and drooping...and perhaps have that sad moment in front of a mirror. While it may seem to come on suddenly (my face changed overnight!), it has, in fact, been slowly coming about day after day, year after year. You probably knew that, too. No one etched your face in the middle of the night because you had a bad day or week. Don't blame your spouse, your kids, your job, your financial troubles, or weight woes, and don't you dare blame yourself. We've all had those moments; they are uniquely human. Luckily, we don't have to resign ourselves to the thought there is nothing we can do about it.

The cyclical process of cellular turnover — the complex phenomenon of tissue growth, repair, and breakdown — says a lot about how we age. When we think of aging on the outside, we are really talking about how fast our collagen and elastin, which are the protein fibers that keep our skin springy, resilient, and vibrant, deteriorate. Once damaged, these fibers become dry and brittle, leading to wrinkles and sagging.

When does this collision course for collagen really pick up pace? Most people start to complain around the age of thirty-five. That is when the breakdown speeds up; and keeping the twentysomething appearance (with taut, dewy, and fresh skin worthy of a magazine cover) gets to be an uphill battle. On the bright side, your lifestyle plays a lead role in your health and looks. And no matter what cards you think your mom and dad dealt you when you were born, you can hold the remote control to your appearance and come out looking beautiful. Top health institutions now agree that 70 to 80 percent of our health and longevity is up to us. In other words, the decisions we make and habits we keep account for at least 70 percent of our health (and, in that regard, our appearance). Now, that's an empowering fact. So, the time has come to live the most beautiful life with the best strategies to looking and feeling terrific.

By the time you finish this book, you'll be on your way to looking younger and fresher, and having skin that's healthier and happier than it's been in a long time. And ironically, the more tired and stressed you are, the bigger the difference you'll see. Along the way you are going to learn a lot about the aging process in general. We can't talk about skin and beauty without a discussion about aging and health in general for that matter. These are all interconnected; the actions you take to repair and rejuvenate the outside will also give your interiors a much-needed improvement.

Just as our skin cells need a constant supply of water, oxygen, vitamins, and nutrients, so does every organ and tissue in our body, from our brain and heart down to the tendons in our toes. And, just as we will be revitalizing the connective tissues in our skin, we also will be addressing similar connective tissues on the inside — in blood vessels, nerves, joints, tendons, and ligaments. The state of all these body parts has a profound say in how well we age, how beautiful we look, and how long we live. Tackling inflammation on the outside, including conditions like acne, eczema, rosacea, and so on, can result in treating inflammation on the inside, too. Inflammation, by the way, will be a topic of discussion throughout this book, because it's at the core of ugliness. I say that in reference to what we don't like to see when we look at ourselves in the mirror, as well as what we don't want to hear from our doctors in the exam room.

As stated in the introduction, this book aims to enhance everything about you — mind, body, and quality of life. The goal, of course, that we all want to achieve is to shorten the time we spend sick or diseased — in other words (and to echo the late anthropologist Ashley Montagu), to die as youthful as we can but as late as we can.

The very first step in this journey, however, is understanding two things: how you really feel about your looks and what you can do to see a better, more vibrant you tomorrow. The next chapter deals with number two. For now, let's focus on where you currently stand by taking three tests. Consider this the starting point from which you can set goals and begin to track successes as you move forward and welcome all the benefits that can await you in this beauty program. The time has come to celebrate the demise of wrinkles, age spots, puffy eyes, chronic exhaustion, and so much more.

test 1: the quickie

This test takes all of five seconds. It's a simple gut check to assess how you feel about your skin this moment. While it's certainly okay to focus on your facial skin, I recommend thinking about your skin all over your body. After all, looks go much further than the face; if that mole on your belly or those spider veins on your legs really bother you, you'll think about them immediately. Don't look in the mirror. Don't think about it for more than a few seconds. Just check which face below expresses how you feel about how you currently look.

• Very Unhappy

• Unhappy

• Okay

• Happy

• Very Happy

While this test may be simple, it reveals the type of journey you'll take in this book. If you selected "Happy" or "Very Happy," you're more content with your appearance than most. But if you answered anything from "Okay" to "Very Unhappy," I suspect you have the same internal conversation going on that a lot of my patients do. It's often a running commentary, and it's likely to be loudest and most insistent when you're looking in a magnifying mirror. It goes like this:

• I have bad skin. No, I have good skin. No, my skin used to be good and now it's bad.

• Where did this wrinkle come from? Did I get it overnight? Omigod, I'm getting old!

• All of a sudden I have to wear all this makeup. I never had to before. What's happening here?

• I've got acne? I haven't had zits since my twenties! Where did these pimples come from?

• If I see these bags under my eyes one more day, I'll scream! Okay, so I only got four hours of sleep last night, but when am I ever going to make up for all the sleep I've lost?

Sound familiar? These are just the short versions. Sometimes the stream-of-skin-consciousness in your head plays endlessly, going on and on in a maddening loop. Are you ready to hit the stop button once and for all? Then let's put some real science to work with the second test: finding out your true SkinAge.

This is not an ordinary beauty quiz, the kind that make brief, monthly appearances in most fashion magazines and then vanish forever. Two of the scientists who devised the RealAge test, which involved reviewing more than 30,000 studies to find the 100-plus factors that determine your body's biological age, developed the SkinAge test. Alex Goetz, MD, PhD, and Harriet Imrey, PhD, dug into the research, went through a decade's worth of scholarly papers, compared countless causes and key effects of skin aging, then boiled down the data to find a scientifically valid way to measure SkinAge — that is, to give you a real fix on how old you look versus how old you are.

What they came up with is brilliant in its simplicity: Instead of assessing your exposure to the endless variables that can cause skin aging — genes, sun habits, whether you ever smoked, stress levels, ethnic background, if you have an indoor or outside job, where you live, pollution factors, and so on — they looked only at the results: how many signs of aging actually exist on your face. The test here entails just thirteen questions, but it's a very reliable SkinAge predictor. For those interested in taking this to a deeper level, you can use an even more precise calculator at www.RealAge.com. As a bonus, the site will do the scoring for you.

For the SkinAge test to work, you must be between the ages of 27 and 81. Why the cut-off points? If you're younger than twenty-seven, you don't have enough visible aging yet to measure. If you're older than eighty-one, the gap between your SkinAge and your calendar age won't be significant.

Ready? It's time to find out if your SkinAge is younger, older, or the same as your body age. (Oh, and if you also want to find out your entire body's RealAge — how old you are biologically, not according to the calendar — you can take the free test at the RealAge site.)

the skinage test

Sometimes we don't see ourselves very clearly. Take this test right after you've washed your face or gotten out of the shower. Dry off, rub in some moisturizer (it won't affect your visual exam), then take a good look in the mirror as you answer these questions. Add up your score using the box below to find out your SkinAge. Try not to cheat! If any of these questions brings you to see something you didn't notice before, or that you wish to avoid acknowledging, 'fess up! This is your chance to take inventory of your looks — face them dead on and be honest. Only then can you effectively take action to turn back the clock. Also avoid pulling or tugging on your skin as you do this to influence your answers. No one is watching you and you won't be graded, so be true to yourself.

1. Is the skin of your cheeks (and maybe your forehead, too) smooth or sagging?

a) Smooth

b) Somewhat sagging

c) Sagging and forming jowls on my jawline

2. Do you have bags under your eyes?

a) No

b) Small ones

c) Distinct bags

3. Are your upper eyelids drooping, almost touching your upper lashes?

a) No

b) Slightly

c) Definitely

4. Do you see fine lines on your forehead and/or cheeks?

a) No

b) Some

c) Quite a few

5. Do you see deep wrinkles on your cheeks?

a) No

b) Yes, some deepening wrinkles

c) Yes, several deep wrinkles

6. Do you see smile lines leading from the corners of your nostrils to the corners of your mouth?

a) No

b) Yes, soft lines

c) Yes, very clear lines

7. Do you see crow's feet at the outer corners of your eyes?

a) No

b) Yes, slight lines

c) Yes, marked lines

8. Do you see wrinkles under your eyes?

a) No

b) Yes, fine wrinkles

c) Yes, very marked wrinkles

9. Are there any frown lines running horizontally across your forehead and/or vertically between your eyebrows?

a) No

b) Yes, slight lines

c) Yes, very marked lines

10. Do you see fine vertical lines above your upper lip?

a) No

b) Yes, a few

c) Yes, many

11. Do you see fine up-and-down lines on your lips?

a) No

b) Yes, some

c) Yes, many

12. Instead of the coloring on your cheeks or forehead being even, do you have any small red dots or uneven coloring?

a) No

b) Some dots or uneven coloring

c) A lot of dots and uneven coloring

13. Do you have any milia on your forehead or cheeks (milia are small bumps that look like little whiteheads but don't go away)?

a) No

b) Yes

DETERMINING YOUR SKINAGE

Now we're ready to figure out just how young or old your skin really is. Circle the points for each answer, then add them up.

1.

a=0

b=3

c=6

2.

a=0

b=1.5

c=3

3.

a=0

b=1.5

c=3

4.

a=0

b=1.5

c=2.5

5.

a=0

b=1

c=2

6.

a=0

b=0.5

c=1.5

7.

a=0

b=0.5

c=1.5

8.

a=0

b=0.5

c=1.5

9.

a=0

b=0.5

c=1.5

10.

a=0

b=1

c=2

11.

a=0

b=1

c=2

12.

a=0

b=7

c=14

13.

a=0

b=5

Total points ___ + 27 = ___ Your SkinAge!

Is your SkinAge younger, the same, or older than your chronological age? If it's more, don't panic. Just imagine how good you're going to feel when you can take six years or more off your SkinAge. That, and you living the rest of your life with the healthiest, best-looking skin you can have, is my goal.

the self-image test

This final test determines what your body language reveals about you. How you look on the outside and what is actually happening inside at the cellular level, especially in the brain, given your emotions, mood, and overall stress level, go hand in hand. You cannot spot treat your body without taking in and evaluating your whole being.

Whenever someone comes into my office — male or female, for the first time or the tenth — the psych part of my brain automatically springs into action. While we're meeting and greeting, I instinctively speed-read their body language, checking for signs of emotional stress that might be involved in whatever skin problems triggered the appointment. If there seem to be more than skin-deep issues at play, I need to address those too when I'm figuring out what treatments to prescribe.

These are the nine questions that go through my mind when I see any patient. Ask them about yourself, jotting down your answers either right in this book, on a piece of paper, or in a journal if you keep one. This won't take long, but be thoughtful and frank; don't cheat by predicting what you think would be a good or correct answer. The more honest you are about yourself, the better you can achieve the results you want with the knowledge you gain in the book. It's okay if some of these questions get you thinking, but try to avoid overanalyzing these particular questions, or which answers are the right ones. Simply think about how you normally look when you go out, and not necessarily how you look while you're curled up with this book. After you take the test, I'll show you how to decode your body language the way I would if we were meeting in my office for a personal consultation.

1. How do you wear your hair?

2. Do you pluck or wax your eyebrows?

3. Does your mom (sister, best friend) still nag at you to stand up straight?

4. When it comes to makeup, do you normally wear:

• little or none

• a moderate amount

• the works

5. Are your hands more likely to be touching your face or in your lap?

6. Do you usually wear fitted clothes or loose ones?

7. Describe your normal walk. Is it more:

• slow and ambling

• quick and intent

8. When you talk to people, do you tend to look directly at them or let your eyes roam around the room?

9. Do you try to quickly check your appearance before meeting people?

WHAT YOUR BODY LANGUAGE IS TELLING YOU

Here's what I'm looking for when I scan someone's appearance. See how this compares with your answers to get a clear idea of the signals you're silently telegraphing to the world — and to yourself, if you're listening. (Some of these may sound like generalizations, but they do happen to reflect clinical evidence that I — and most other doctors — have witnessed in practice. There are some gray areas here, and not every interpretation is black-and-white, but I encourage you to be as open as you can to the following explanations and see if you can pinpoint where you are on the spectrum of possibilities.)

• Extralong bangs or sideswept hair that half covers your face can be a dramatic style statement, but sometimes suggests that you're covering up something (acne, aging?) or a little nervous around people.

Regardless of what hairstyles are in or out at the moment, a woman who is self-confident tends to wear her hair in a way that reveals her face and accentuates her features. Whether it's pulled back, piled up, or tucked behind an ear, it broadcasts: I feel good about how I look. Women who are self-conscious about themselves or worried about their skin often use their hair as a barrier or cover-up, or disguise.

• Untouched or heavily plucked eyebrows both get my attention.

When I see a woman who has thick, heavy brows with stray hairs across the top of her nose, self-esteem questions register with me, particularly if she has also made little effort with her hair or makeup. It implies that spending time on herself doesn't seem worth the effort. At the other extreme, overplucked brows suggests a tendency toward obsessiveness that could also involve picking at the skin, something dermatologists always worry about (see "If you constantly touch your face").

• When you sit, do you slump? When you stand, do you hunch?

Either one can signal a few things: exhaustion, self-consciousness, poor muscle tone, some depression, or just a woman who is not quite comfortable with her height. That happened to me as a kid: I grew fast and early, outstripping half my class, and started slumping to fit in better physically. My mom helped me understand the good things about being tall (i.e., playing sports, reaching top shelves, and raiding her closet) and now I wish I were even taller than my five feet, eight inches. As a result, I'm really tuned in to people who don't stand up straight. Is it because they are too tired...or down in the dumps? Ironically, that's when good posture is more important than ever, because slumping makes it harder to breathe deeply and the resulting lack of oxygen can make you feel even gloomier, not to mention tired.

• The messages that your makeup can send.

It can be a tip-off to everything from where you were born to how full your calendar is. No makeup is often a statement. It's up to me — and, in this case, you — to figure out what it's saying. That you prefer to be all natural? That you don't feel very feminine? Or that you're too busy to even swipe on some lipstick? It can be hard to judge someone who prefers to wear no makeup, because people can have uniquely different reasons for avoiding makeup. Because makeup is so much a part of our culture I question whether the person is having problems with self-confidence and self-esteem to the point where she doesn't have the motivation to use any.

When we are sick, sad, tired, or just relaxing over the weekend we typically forgo the makeup. It's rare to meet someone so overly confident that she vows to show off her natural looks by going bare on a regular basis (hey, even supermodels usually wear makeup when in public). The right amount of makeup can do wonders for our self-perception, which then relates directly with self-confidence. If you don't like to wear makeup because you fear it's the root of your skin troubles, you will love my ideas in chapter 3. News flash: Bad skin does not have to be related to makeup. In fact, rarely do skin issues arise from reactions with makeup or products. They arise from mistreating your skin.

Light to moderate makeup is pretty straightforward. It says that you don't have much to hide — acne scars, discolorations, undereye circles. Unless it seems more haphazard than deliberate, chances are you're basically comfortable with your looks.

Heavy makeup almost always makes me wonder if someone's covering up something, from breakouts to a birthmark. But — big exception here — sometimes wearing quite a bit of makeup is traditional: It's practically a birthright in much of the South and in Texas. On the other hand, some women use makeup as a social mask. When they say, "I can't go out without my face on," they mean it. They want the world to see them in one unchanging, perfect way — even though nothing's ever perfect and life changes constantly.

• If you constantly touch your face, think about why you do.

Some people are trying to hide crooked teeth. Others may be uncomfortable about showing their emotions. But what I'm really looking for here are what skin doctors call pickers. I mentally divide patients into pickers and nonpickers. If a nonpicker has a mosquito bite, she tries not to scratch it; if she has a scab, she generally leaves it alone. Pickers, on the other hand, are often anxious and can't leave anything alone — flaky areas, skin tags, small sores, ragged cuticles, peeling sunburns, they'll go at them all relentlessly. And picking always, always gets worse with stress.

What's the big deal? Persistent picking discolors and scars. I'm forever telling patients to stop touching their faces because the first step is to become conscious that they're doing it — not everyone is aware of it. Next, I ask pickers if they use a magnifying mirror and tell them to throw it away if they do. Examining their skin in minute detail seems to feed the urge to pick. Of course, picking can just be a reaction to stress ("When I'm tense, I pick, twist my hair, chew my nails") but if it turns into a habit, it's a hard one to break. That's why I always try to nip it in the bud.

Being a picker may be hardwired a little bit, or modeled after a parent. Some people are wrongly taught to, say, pop pimples. I see kids pick and prod at themselves when they are anxious, and this continues into adulthood although it may take other forms. Most people who pick are aware that they do it, but in the moment it can be a mindless act, which is why trying to be more mindful of what triggers the picking, and finding methods to break the habit through healthy alternatives to the act, is important.

Most pickers do it at the end of the day in the comfort of home. This is when they are no longer distracted by work, plus they know it's not socially acceptable to pick in public. But, in the evening, our underlying worries grow bigger as the day slows down. Now we have time to mull over our woes and for some, picking at scars, scabs, or acne is relieving. I once had a patient who broke down to me about how she and her husband bought a vacation house on the beach in an isolated area. Her husband worked out of town a lot, so she would retreat to their second home while he was away on business. While she was there, in her loneliness (the trigger) she would start picking and manipulating her face with tweezers in the magnifying mirror they had in the bathroom. She said she never picked when her husband was home, but was troubled by her behavior when left alone in this particular bathroom with a gigantic mirror.

Our first order of business was alerting her husband to the problem. She brought him into my office and I explained how he could help her avoid the constant picking that was doing a number on her face. Throwing out the mirror was also on the agenda. When people don't have a partner they can rely upon to help them in this manner, I recommend that patients gain a better awareness of their picking so when they feel the urge to pick, they can switch gears by calling a friend or reading a book. If picking happens as a result of a sore or itch, an ice pack or cold compresses can be very helpful. A little hydrocortisone cream on an incessant itch or a milk bath will also squelch the flames, and the urge to touch it.

• If most of your clothes are fitted or baggy, that can be a clue too.

Sure, this is a generalization, but the more comfortable you are with yourself and your body, the more likely you are to wear clothes that set off its shape. For instance, if someone comes in with a thin face who is wearing lots and lots of layers, I wonder if she is hiding anorexia. If someone comes in with a full face who is wearing lots of layers, I wonder about recent weight gain. But if someone comes in who is a little heavy but wearing well-fitted clothes, I suspect that she's lost some weight and is proud of it. If a normal-weight woman arrives in baggy clothes, though, it might suggest the reverse. If all four look like they dressed carefully, it suggests — whew — a sense of self-worth. All of us use clothing to say things about ourselves; think about what your message usually is.

• How you walk is a major confidence clue.

When you cover ground with energy and motivation, it telegraphs to the world that you are self-assured, in charge of yourself, and full of life. When you don't, the message is just the opposite. Slow, shuffling walks don't just say you're vulnerable, they shout it: Women who become the targets of street crime have been proven in studies to walk with slower, less purposeful, less confident strides.

• Social ease is often seen in the eyes.

Avoiding eye contact suggests anxiety, depression, embarrassment, shyness, or just vague discomfort. Sometimes, of course, people are just nervous about being around a doctor. Or they may have this distorted sense that they have done something bad, such as let themselves go physically, and that I am going to lecture them about it. Maybe they're uneasy about why they came in — "It's only a little rash but, you know, it's down there." Maybe they think I'll judge them for wanting Botox. Maybe they feel silly — "It's just a few pimples." To make them feel more comfortable, I share personal stories (about my horrendous high school acne) or show them where I use Botox myself (a little between my brows). But if someone constantly avoids eye contact, even after a few appointments, when we seem to have established a good relationship, I'll bring it up and say, "I notice you have a hard time looking at me. Do you know that you're doing that? Does it ever happen at work or on a date? Do you realize that it makes you seem nervous or shy?" It's something I keep working on. I want to see it improve over time.

• If you don't check your appearance before meeting people, why not?

Before seeing any patient, I take a quick look in a mirror and check my teeth (especially right after lunch!), maybe put on a bit of lipstick or smooth my hair. This isn't just trying to present myself well. It also shows my respect for the people who've made the trip to see me, whether they came from two streets or two states away.

If you don't make a little spruce-up effort when you're about to see someone, is it because you don't think it will make a difference...or you really don't care how you look...or you just never have time to give yourself a second glance? All three bring up questions. If you're always putting your kids before yourself, or you're insanely overscheduled, or you think your looks are beyond help...you're neglecting and/or undervaluing yourself. It's time to give yourself permission to take care of you!

congrats

The hard part is over. Self-examination can be tough, but hopefully these tests have helped you to understand where you are on the SkinAge test and how your physical appearance ties into your emotions and sense of self. You'll be getting a full dose of information coming up in later chapters that will help you to truly see the connection between your mind and body. The science is stunning. And I think that the more information you have, the less fear you'll have about aging.

My goal in this chapter was simply to help you take a first look at the physical and psychological factors contributing to your skin's looks and health. Now let's fast-forward and get right to those recommendations that will turn back the clock and help you to reverse the signs of aging. You'll be able to set your personalized program in motion today.

Copyright © 2008 by RealAge Corporation

Read a Sample Chapter

An End to Stress Age

How old do you look? How old do you think you look? If a simple Q&A test in front of the mirror could tell you what your physical age is -- regardless of your chronological age -- what do you think it would reveal? You are about to find out. In the very first chapter, you're going to take three quizzes, one of which is revolutionary. Designed by RealAge, the SkinAge test will tell you exactly how old you really look. It will mark your starting point for a step-by-step program outlined in this book that will transform you from the inside out, and it will get everyone to notice.

If you have been frustrated or unhappy with your appearance -- whether you are twenty-two or sixty-two -- then this is the book for you. Chances are, you picked up this book for a reason. Maybe it's the unprecedented acne, the deep lines and shallow crinkles, the lack of a healthy glow, the thinning hair and brittle nails, the extra ten pounds you didn't have a year ago, or perhaps it's the accelerated aging in general that is evident everywhere you look when you step in front of a mirror. And maybe you avoid the mirror at all costs now. No matter what your personal issues are with your appearance, I am here to show you how to change all that. After all, loving the skin you arein is essential to personal well-being. In fact, in my practice, how you look is a vital sign of health.

There is so much you can do with great results without taking radical action or going under a knife. My approach is uncomplicated, effective, and empowering. No frills. No gimmicks. You'll be shocked to learn my easy daily practices that can bring out radiant, natural beauty. And for you busy moms who feel as though you are not allowed to look fabulous, listen up. I'm a mom, too, and I can't express how important it is to nurture yourself with today's cutting-edge strategies to maximize health and, of course, beauty. Your whole family will benefit.

When RealAge approached me to do a book, I was thrilled at the opportunity to get the message out about what it takes to stay looking and feeling as vibrant as possible, with a focus on the very skin that wraps us up so wonderfully. Some people will stop at nothing to find the secrets to maintaining their youthful looks and heightening their attractiveness, and throw thousands of dollars at the beauty industry. If only they knew that the secret is learning one powerful principle, and following a plan that abides by it.

This principle is the mind-beauty connection, and it lies at the heart of achieving the most beautiful skin (and, I might add, body) possible. On a most basic level, the mind-beauty connection is about the powerful force that exists between our inner minds and outer appearances, which is based on proven biochemistry. Astonishing new science is revealing just how our minds affect how well, and how fast, we age physically. This includes not only how we think and our behavior, but also how we cope with the madness of modern life, and how we preserve our bodies' self-healing and inherent beautification capabilities. What's more, scientists continue to uncover incredible insights into how our skin, in addition to our brains, is also an extraordinary command center for communication, and is able to effect change in our inner bodies and outer appearance in ways we never thought possible before.

the sensitive and simple approach

This book will inspire you to make a few small shifts in how you take care of yourself with practical and doable recommendations. I'm not here to sell you expensive products, or tell you to use anything that hasn't been clinically proven to work on people. You see, so many of the lotions, potions, and so-called must-haves that line the drugstores' shelves and beauty counters overclaim and underperform. Promising laboratory studies don't always translate into real-world effectiveness in humans. I will not only dispel myths in the beauty-market circles, but I will also give you sound advice to help you distinguish the hype from the truly helpful. I will state plainly what you can do starting today to improve your appearance (and strengthen your self-confidence, too!) without falling prey to great advertising. And for those who do choose to explore more aggressive procedures like Botox and resurfacing, I'll give you the guidance to find the right solution for you, your wallet, and your peace of mind.

Premature aging and adult acne are the two most common skin problems I see, and I often find that I have to get to the bottom of exhaustion or emotional issues in order to treat these symptoms of modern life. There are plenty of combination strategies that can help reverse the effects of tension and time. I was a psychiatrist for seven years before I became board certified in dermatology and switched specialties. I put my old hat on every day to untangle the psychological from the physical and find sensitive, simple, solutions for both.

the front line of defense

My experience in psychiatry complements my current practice like no other specialty could, and has also made me a much better mom, wife, friend, and doctor. A lot of patients come for help with their appearance and end up talking about myriad life issues. For example, if someone sees me for upper-lip laser hair removal, I like to talk about how it feels as a woman to have excessive hair there. Skin care can be so emotional; people cry in my office every day. I certainly don't let them leave crying, but I know it's a positive experience for patients.

When it comes to beauty and a sense of self, these two fields of medicine coalesce brilliantly. So much of how we think affects how we look, and vice versa. I have always believed in treating the body as intrinsically connected to the mind. By virtue of my specialty, I keep up with a lot of other fields of medicine. I refer to ear, nose, and throat doctors all the time, as well as ob-gyns, in vitro specialists, massage therapists, a good spot to get a manicure and pedicure, and even the places to go for the perfect shoes.

Seeking help from a dermatologist should not be viewed as a luxury; it's as important as getting a regular checkup. Like any general practitioner, I see myself as representing the front line of defense for taking better care of yourself so you don't have to resort to radical measures such as plastic surgery, or learn someday that you have a serious form of skin cancer or an age-related disease that threatens your life. Because my techniques aim to lower your stress and heighten your natural beauty, the benefits that await you could be infinite. They will spill over into your heart health, brain health, digestive health, and just about every other aspect of you that makes you, well, you.

The reason I left psychiatry to pursue dermatology is simple: I missed the hands-on, physical element of medicine that is so fundamental to dermatology but largely absent from the field of psychiatry. I knew that I was quite adept with my hands and believed I had a calling to use them somehow to take care of more than just people's minds. After all, the essence of being a physician is having the knowledge and opportunity to treat patients' bodies with healing hands and established procedures. I get to do so many different things in dermatology that can truly transform a person's life in a relatively short period of time. Admittedly, there's a definite allure to the immediate gratification that comes with being a dermatologist. A patient can walk into my office and, with one consult or treatment, leave looking and feeling better. That can be difficult to achieve in psychiatry on a regular basis. Skin diseases are interesting, but it's really the interaction with people that is so satisfying.

in this book

Starting in the first chapter, you'll assess your appearance with three separate quizzes, one of which is the groundbreaking SkinAge test that was designed exclusively by RealAge's top scientists to tell you how old your skin is as compared to your chronological age. I'll get you started with revitalizing your looks in chapter 2, and take the confusion out of knowing how to treat your skin daily, weekly, and monthly so it glows naturally. You'll learn the basics of skin care as I go into detail about which beauty products and in-home techniques are worth considering, or are a complete waste of your money. Then, you will prepare to embark on a nine-day journey tailored to your specific needs. Whether you have trouble getting a restful night's sleep, juggling an overbooked schedule, finding time to exercise, or choosing the right foods for your skin, I've got recommendations. You will learn about the seven free habits for healthy skin. These are the habits that support your natural beauty, many of which can encourage cellular restoration. Before you begin the nine-day program, you'll identify which stress profile you match, using a few straightforward questions. This will help you to personalize your program within my day-by-day guidelines outlined in chapter 4, as you learn more fascinating ideas about the intersection of mind and beauty, especially as it relates to your diet, activity level, hormones, age, and lifestyle.

Later in the book, I'll give you an eye-opening peek into your body's dynamic physiology in not only the aging process, but in its response to what you encounter in everyday living. This is when you will begin to fully understand stress aging and the mind-beauty connection. Sprinkled throughout the book you'll find answers to my most frequently asked questions. You will be surprised by how many people come in with the same question but feel like they are the only ones to ask it.

Those who are troubled by particular skin conditions -- from acne to skin cancer -- will find chapters 8 and 9 especially helpful and encouraging. Then, in the last chapter, I will share all you've ever wanted to know about the more aggressive treatments and procedures available to you should you choose to go that route with a licensed practitioner, and I'll help you find the right doctor, too. This includes straight talk about cosmetic surgery, pharmaceutical interventions, as well as body-image issues that may be weighing too heavily on you. I'll hold nothing back on what I think about certain techniques, some of which are the most popular used today. In all, by the time you're done reading, you'll have accomplished the following steps.

• know your true SkinAge, including how much is physical and how much is emotional

• be ready to complete an easy, practical, and inexpensive nine-day mind-beauty program that can take years -- years -- off your looks

• have found a renewal plan that's right for your psyche, body, and wallet

• have a long-term maintenance regimen that takes only minutes a day and will keep your skin looking and feeling terrific forever

For help in tailoring this program to your body, especially if you have any special health concerns or needs, please speak with your doctor. For example, some of the ideas may not be suitable if you are pregnant and/or breastfeeding. I also encourage you to keep your personal health practitioner in the loop if you plan to commence an exercise program, as suggested in the book, and have not been active in a while. Everyone's response to this program and results will be different. Also be advised that the products and companies mentioned in this book do not reflect an endorsement of any kind, as I currently have no affiliation whatsoever with any of them. I simply want to give you easy, accessible ideas and examples to get you started, because I know so many of you crave specifics and need that extra guidance. I do, however, encourage you to explore other products on the market that may work better for you, or that you may prefer simply for your own reasons. Last, some of the names and identifying characteristics of people described in the book have been changed.

This book is for all of us who have ever looked in the mirror and wished for a better-looking reflection. However, looking in the mirror and seeing a wrinkle you want to eliminate is only part of the equation. Yes, this book keeps a strong focus on skin, but the rewards for making the mind-beauty connection go far beyond a quick fix. I bet many of you will lose unwanted weight, and witness your own medical transformation as you begin to feel healthier and, in a word, alive. Everyone's individual results will be different, but I guarantee that everyone who takes my recommendations and strategies to heart will see and feel an improvement, however big or small, on both the inside and outside. We all deserve to look and feel our best, no matter how young or old the calendar says we are. Ready for a whole new you? Turn the page and let's get going!

Copyright © 2008 by RealAge Corporation

1

the skinage test and other reality checks

How Do You Really Feel About Your Looks?

Admit it: At some time or another (perhaps many times), you looked in the mirror and thought, "Where did that come from?" I wish I had a dime for every time a woman said this to herself; I'd be the richest person on earth. I think the experience is shared among all of us, and, when this question first crosses your mind, it gets you to examine more than just one particular spot. Suddenly, you feel the need to take a closer look all over. So you then follow the tracks of previously unrecognized wrinkles across your forehead, a discolored area or brown spot on your cheeks, and the genesis of a deeply rooted pimple on your chin. You step back to take inventory of other body parts. Hair. Neck. Chest (décolletage). Hands. Hips. Waistline. Profile. You don't look like you did ten, maybe even just two, years ago. An ugly, sinking feeling washes over you. Your face -- correction, your whole body -- is morphing and you can't control it. Or at least you think you can't control it. Yes, you are getting older and can no longer be mistaken for a youth (the days of getting carded to buy alcohol are over). I bet you wouldn't want to be a kid again anyhow, but still, you wouldn't mind having the energy and vibrant looks of one.

Here's the good news: You can do something to rejuvenate the appearance that the stress of modern life has stolen. That's right: A lot of what you see is reversible. And the program described in this book will also help you recapture the energy and vitality that life has momentarily confiscated.

Who knew that a little word like aging could conjure so much emotion. None of us really thinks about it until we see evidence of it in the mirror one random day.

It doesn't take a doctor like me to tell you that, over time, the first signs of aging become evident and the skin, which is our largest organ, accounting for 12 to 16 percent of the body weight, reveals the first clues of this process. This is when we notice wrinkling, creasing, dryness, and drooping...and perhaps have that sad moment in front of a mirror. While it may seem to come on suddenly (my face changed overnight!), it has, in fact, been slowly coming about day after day, year after year. You probably knew that, too. No one etched your face in the middle of the night because you had a bad day or week. Don't blame your spouse, your kids, your job, your financial troubles, or weight woes, and don't you dare blame yourself. We've all had those moments; they are uniquely human. Luckily, we don't have to resign ourselves to the thought there is nothing we can do about it.

The cyclical process of cellular turnover -- the complex phenomenon of tissue growth, repair, and breakdown -- says a lot about how we age. When we think of aging on the outside, we are really talking about how fast our collagen and elastin, which are the protein fibers that keep our skin springy, resilient, and vibrant, deteriorate. Once damaged, these fibers become dry and brittle, leading to wrinkles and sagging.

When does this collision course for collagen really pick up pace? Most people start to complain around the age of thirty-five. That is when the breakdown speeds up; and keeping the twentysomething appearance (with taut, dewy, and fresh skin worthy of a magazine cover) gets to be an uphill battle. On the bright side, your lifestyle plays a lead role in your health and looks. And no matter what cards you think your mom and dad dealt you when you were born, you can hold the remote control to your appearance and come out looking beautiful. Top health institutions now agree that 70 to 80 percent of our health and longevity is up to us. In other words, the decisions we make and habits we keep account for at least 70 percent of our health (and, in that regard, our appearance). Now, that's an empowering fact. So, the time has come to live the most beautiful life with the best strategies to looking and feeling terrific.

By the time you finish this book, you'll be on your way to looking younger and fresher, and having skin that's healthier and happier than it's been in a long time. And ironically, the more tired and stressed you are, the bigger the difference you'll see. Along the way you are going to learn a lot about the aging process in general. We can't talk about skin and beauty without a discussion about aging and health in general for that matter. These are all interconnected; the actions you take to repair and rejuvenate the outside will also give your interiors a much-needed improvement.

Just as our skin cells need a constant supply of water, oxygen, vitamins, and nutrients, so does every organ and tissue in our body, from our brain and heart down to the tendons in our toes. And, just as we will be revitalizing the connective tissues in our skin, we also will be addressing similar connective tissues on the inside -- in blood vessels, nerves, joints, tendons, and ligaments. The state of all these body parts has a profound say in how well we age, how beautiful we look, and how long we live. Tackling inflammation on the outside, including conditions like acne, eczema, rosacea, and so on, can result in treating inflammation on the inside, too. Inflammation, by the way, will be a topic of discussion throughout this book, because it's at the core of ugliness. I say that in reference to what we don't like to see when we look at ourselves in the mirror, as well as what we don't want to hear from our doctors in the exam room.

As stated in the introduction, this book aims to enhance everything about you -- mind, body, and quality of life. The goal, of course, that we all want to achieve is to shorten the time we spend sick or diseased -- in other words (and to echo the late anthropologist Ashley Montagu), to die as youthful as we can but as late as we can.

The very first step in this journey, however, is understanding two things: how you really feel about your looks and what you can do to see a better, more vibrant you tomorrow. The next chapter deals with number two. For now, let's focus on where you currently stand by taking three tests. Consider this the starting point from which you can set goals and begin to track successes as you move forward and welcome all the benefits that can await you in this beauty program. The time has come to celebrate the demise of wrinkles, age spots, puffy eyes, chronic exhaustion, and so much more.

test 1: the quickie

This test takes all of five seconds. It's a simple gut check to assess how you feel about your skin this moment. While it's certainly okay to focus on your facial skin, I recommend thinking about your skin all over your body. After all, looks go much further than the face; if that mole on your belly or those spider veins on your legs really bother you, you'll think about them immediately. Don't look in the mirror. Don't think about it for more than a few seconds. Just check which face below expresses how you feel about how you currently look.

• Very Unhappy

• Unhappy

• Okay

• Happy

• Very Happy

While this test may be simple, it reveals the type of journey you'll take in this book. If you selected "Happy" or "Very Happy," you're more content with your appearance than most. But if you answered anything from "Okay" to "Very Unhappy," I suspect you have the same internal conversation going on that a lot of my patients do. It's often a running commentary, and it's likely to be loudest and most insistent when you're looking in a magnifying mirror. It goes like this:

• I have bad skin. No, I have good skin. No, my skin used to be good and now it's bad.

• Where did this wrinkle come from? Did I get it overnight? Omigod, I'm getting old!

• All of a sudden I have to wear all this makeup. I never had to before. What's happening here?

• I've got acne? I haven't had zits since my twenties! Where did these pimples come from?

• If I see these bags under my eyes one more day, I'll scream! Okay, so I only got four hours of sleep last night, but when am I ever going to make up for all the sleep I've lost?

Sound familiar? These are just the short versions. Sometimes the stream-of-skin-consciousness in your head plays endlessly, going on and on in a maddening loop. Are you ready to hit the stop button once and for all? Then let's put some real science to work with the second test: finding out your true SkinAge.

This is not an ordinary beauty quiz, the kind that make brief, monthly appearances in most fashion magazines and then vanish forever. Two of the scientists who devised the RealAge test, which involved reviewing more than 30,000 studies to find the 100-plus factors that determine your body's biological age, developed the SkinAge test. Alex Goetz, MD, PhD, and Harriet Imrey, PhD, dug into the research, went through a decade's worth of scholarly papers, compared countless causes and key effects of skin aging, then boiled down the data to find a scientifically valid way to measure SkinAge -- that is, to give you a real fix on how old you look versus how old you are.

What they came up with is brilliant in its simplicity: Instead of assessing your exposure to the endless variables that can cause skin aging -- genes, sun habits, whether you ever smoked, stress levels, ethnic background, if you have an indoor or outside job, where you live, pollution factors, and so on -- they looked only at the results: how many signs of aging actually exist on your face. The test here entails just thirteen questions, but it's a very reliable SkinAge predictor. For those interested in taking this to a deeper level, you can use an even more precise calculator at www.RealAge.com. As a bonus, the site will do the scoring for you.

For the SkinAge test to work, you must be between the ages of 27 and 81. Why the cut-off points? If you're younger than twenty-seven, you don't have enough visible aging yet to measure. If you're older than eighty-one, the gap between your SkinAge and your calendar age won't be significant.

Ready? It's time to find out if your SkinAge is younger, older, or the same as your body age. (Oh, and if you also want to find out your entire body's RealAge -- how old you are biologically, not according to the calendar -- you can take the free test at the RealAge site.)

the skinage test

Sometimes we don't see ourselves very clearly. Take this test right after you've washed your face or gotten out of the shower. Dry off, rub in some moisturizer (it won't affect your visual exam), then take a good look in the mirror as you answer these questions. Add up your score using the box below to find out your SkinAge. Try not to cheat! If any of these questions brings you to see something you didn't notice before, or that you wish to avoid acknowledging, 'fess up! This is your chance to take inventory of your looks -- face them dead on and be honest. Only then can you effectively take action to turn back the clock. Also avoid pulling or tugging on your skin as you do this to influence your answers. No one is watching you and you won't be graded, so be true to yourself.

1. Is the skin of your cheeks (and maybe your forehead, too) smooth or sagging?

a) Smooth

b) Somewhat sagging

c) Sagging and forming jowls on my jawline

2. Do you have bags under your eyes?

a) No

b) Small ones

c) Distinct bags

3. Are your upper eyelids drooping, almost touching your upper lashes?

a) No

b) Slightly

c) Definitely

4. Do you see fine lines on your forehead and/or cheeks?

a) No

b) Some

c) Quite a few

5. Do you see deep wrinkles on your cheeks?

a) No

b) Yes, some deepening wrinkles

c) Yes, several deep wrinkles

6. Do you see smile lines leading from the corners of your nostrils to the corners of your mouth?

a) No

b) Yes, soft lines

c) Yes, very clear lines

7. Do you see crow's feet at the outer corners of your eyes?

a) No

b) Yes, slight lines

c) Yes, marked lines

8. Do you see wrinkles under your eyes?

a) No

b) Yes, fine wrinkles

c) Yes, very marked wrinkles

9. Are there any frown lines running horizontally across your forehead and/or vertically between your eyebrows?

a) No

b) Yes, slight lines

c) Yes, very marked lines

10. Do you see fine vertical lines above your upper lip?

a) No

b) Yes, a few

c) Yes, many

11. Do you see fine up-and-down lines on your lips?

a) No

b) Yes, some

c) Yes, many

12. Instead of the coloring on your cheeks or forehead being even, do you have any small red dots or uneven coloring?

a) No

b) Some dots or uneven coloring

c) A lot of dots and uneven coloring

13. Do you have any milia on your forehead or cheeks (milia are small bumps that look like little whiteheads but don't go away)?

a) No

b) Yes

DETERMINING YOUR SKINAGE

Now we're ready to figure out just how young or old your skin really is. Circle the points for each answer, then add them up.

1.

a=0

b=3

c=6

2.

a=0

b=1.5

c=3

3.

a=0

b=1.5

c=3

4.

a=0

b=1.5

c=2.5

5.

a=0

b=1

c=2

6.

a=0

b=0.5

c=1.5

7.

a=0

b=0.5

c=1.5

8.

a=0

b=0.5

c=1.5

9.

a=0

b=0.5

c=1.5

10.

a=0

b=1

c=2

11.

a=0

b=1

c=2

12.

a=0

b=7

c=14

13.

a=0

b=5

Total points ___ + 27 = ___ Your SkinAge!

Is your SkinAge younger, the same, or older than your chronological age? If it's more, don't panic. Just imagine how good you're going to feel when you can take six years or more off your SkinAge. That, and you living the rest of your life with the healthiest, best-looking skin you can have, is my goal.

the self-image test

This final test determines what your body language reveals about you. How you look on the outside and what is actually happening inside at the cellular level, especially in the brain, given your emotions, mood, and overall stress level, go hand in hand. You cannot spot treat your body without taking in and evaluating your whole being.

Whenever someone comes into my office -- male or female, for the first time or the tenth -- the psych part of my brain automatically springs into action. While we're meeting and greeting, I instinctively speed-read their body language, checking for signs of emotional stress that might be involved in whatever skin problems triggered the appointment. If there seem to be more than skin-deep issues at play, I need to address those too when I'm figuring out what treatments to prescribe.

These are the nine questions that go through my mind when I see any patient. Ask them about yourself, jotting down your answers either right in this book, on a piece of paper, or in a journal if you keep one. This won't take long, but be thoughtful and frank; don't cheat by predicting what you think would be a good or correct answer. The more honest you are about yourself, the better you can achieve the results you want with the knowledge you gain in the book. It's okay if some of these questions get you thinking, but try to avoid overanalyzing these particular questions, or which answers are the right ones. Simply think about how you normally look when you go out, and not necessarily how you look while you're curled up with this book. After you take the test, I'll show you how to decode your body language the way I would if we were meeting in my office for a personal consultation.

1. How do you wear your hair?

2. Do you pluck or wax your eyebrows?

3. Does your mom (sister, best friend) still nag at you to stand up straight?

4. When it comes to makeup, do you normally wear:

• little or none

• a moderate amount

• the works

5. Are your hands more likely to be touching your face or in your lap?

6. Do you usually wear fitted clothes or loose ones?

7. Describe your normal walk. Is it more:

• slow and ambling

• quick and intent

8. When you talk to people, do you tend to look directly at them or let your eyes roam around the room?

9. Do you try to quickly check your appearance before meeting people?

WHAT YOUR BODY LANGUAGE IS TELLING YOU

Here's what I'm looking for when I scan someone's appearance. See how this compares with your answers to get a clear idea of the signals you're silently telegraphing to the world -- and to yourself, if you're listening. (Some of these may sound like generalizations, but they do happen to reflect clinical evidence that I -- and most other doctors -- have witnessed in practice. There are some gray areas here, and not every interpretation is black-and-white, but I encourage you to be as open as you can to the following explanations and see if you can pinpoint where you are on the spectrum of possibilities.)

• Extralong bangs or sideswept hair that half covers your face can be a dramatic style statement, but sometimes suggests that you're covering up something (acne, aging?) or a little nervous around people.

Regardless of what hairstyles are in or out at the moment, a woman who is self-confident tends to wear her hair in a way that reveals her face and accentuates her features. Whether it's pulled back, piled up, or tucked behind an ear, it broadcasts: I feel good about how I look. Women who are self-conscious about themselves or worried about their skin often use their hair as a barrier or cover-up, or disguise.

• Untouched or heavily plucked eyebrows both get my attention.

When I see a woman who has thick, heavy brows with stray hairs across the top of her nose, self-esteem questions register with me, particularly if she has also made little effort with her hair or makeup. It implies that spending time on herself doesn't seem worth the effort. At the other extreme, overplucked brows suggests a tendency toward obsessiveness that could also involve picking at the skin, something dermatologists always worry about (see "If you constantly touch your face").

• When you sit, do you slump? When you stand, do you hunch?

Either one can signal a few things: exhaustion, self-consciousness, poor muscle tone, some depression, or just a woman who is not quite comfortable with her height. That happened to me as a kid: I grew fast and early, outstripping half my class, and started slumping to fit in better physically. My mom helped me understand the good things about being tall (i.e., playing sports, reaching top shelves, and raiding her closet) and now I wish I were even taller than my five feet, eight inches. As a result, I'm really tuned in to people who don't stand up straight. Is it because they are too tired...or down in the dumps? Ironically, that's when good posture is more important than ever, because slumping makes it harder to breathe deeply and the resulting lack of oxygen can make you feel even gloomier, not to mention tired.

• The messages that your makeup can send.

It can be a tip-off to everything from where you were born to how full your calendar is. No makeup is often a statement. It's up to me -- and, in this case, you -- to figure out what it's saying. That you prefer to be all natural? That you don't feel very feminine? Or that you're too busy to even swipe on some lipstick? It can be hard to judge someone who prefers to wear no makeup, because people can have uniquely different reasons for avoiding makeup. Because makeup is so much a part of our culture I question whether the person is having problems with self-confidence and self-esteem to the point where she doesn't have the motivation to use any.

When we are sick, sad, tired, or just relaxing over the weekend we typically forgo the makeup. It's rare to meet someone so overly confident that she vows to show off her natural looks by going bare on a regular basis (hey, even supermodels usually wear makeup when in public). The right amount of makeup can do wonders for our self-perception, which then relates directly with self-confidence. If you don't like to wear makeup because you fear it's the root of your skin troubles, you will love my ideas in chapter 3. News flash: Bad skin does not have to be related to makeup. In fact, rarely do skin issues arise from reactions with makeup or products. They arise from mistreating your skin.

Light to moderate makeup is pretty straightforward. It says that you don't have much to hide -- acne scars, discolorations, undereye circles. Unless it seems more haphazard than deliberate, chances are you're basically comfortable with your looks.

Heavy makeup almost always makes me wonder if someone's covering up something, from breakouts to a birthmark. But -- big exception here -- sometimes wearing quite a bit of makeup is traditional: It's practically a birthright in much of the South and in Texas. On the other hand, some women use makeup as a social mask. When they say, "I can't go out without my face on," they mean it. They want the world to see them in one unchanging, perfect way -- even though nothing's ever perfect and life changes constantly.

• If you constantly touch your face, think about why you do.

Some people are trying to hide crooked teeth. Others may be uncomfortable about showing their emotions. But what I'm really looking for here are what skin doctors call pickers. I mentally divide patients into pickers and nonpickers. If a nonpicker has a mosquito bite, she tries not to scratch it; if she has a scab, she generally leaves it alone. Pickers, on the other hand, are often anxious and can't leave anything alone -- flaky areas, skin tags, small sores, ragged cuticles, peeling sunburns, they'll go at them all relentlessly. And picking always, always gets worse with stress.

What's the big deal? Persistent picking discolors and scars. I'm forever telling patients to stop touching their faces because the first step is to become conscious that they're doing it -- not everyone is aware of it. Next, I ask pickers if they use a magnifying mirror and tell them to throw it away if they do. Examining their skin in minute detail seems to feed the urge to pick. Of course, picking can just be a reaction to stress ("When I'm tense, I pick, twist my hair, chew my nails") but if it turns into a habit, it's a hard one to break. That's why I always try to nip it in the bud.

Being a picker may be hardwired a little bit, or modeled after a parent. Some people are wrongly taught to, say, pop pimples. I see kids pick and prod at themselves when they are anxious, and this continues into adulthood although it may take other forms. Most people who pick are aware that they do it, but in the moment it can be a mindless act, which is why trying to be more mindful of what triggers the picking, and finding methods to break the habit through healthy alternatives to the act, is important.

Most pickers do it at the end of the day in the comfort of home. This is when they are no longer distracted by work, plus they know it's not socially acceptable to pick in public. But, in the evening, our underlying worries grow bigger as the day slows down. Now we have time to mull over our woes and for some, picking at scars, scabs, or acne is relieving. I once had a patient who broke down to me about how she and her husband bought a vacation house on the beach in an isolated area. Her husband worked out of town a lot, so she would retreat to their second home while he was away on business. While she was there, in her loneliness (the trigger) she would start picking and manipulating her face with tweezers in the magnifying mirror they had in the bathroom. She said she never picked when her husband was home, but was troubled by her behavior when left alone in this particular bathroom with a gigantic mirror.

Our first order of business was alerting her husband to the problem. She brought him into my office and I explained how he could help her avoid the constant picking that was doing a number on her face. Throwing out the mirror was also on the agenda. When people don't have a partner they can rely upon to help them in this manner, I recommend that patients gain a better awareness of their picking so when they feel the urge to pick, they can switch gears by calling a friend or reading a book. If picking happens as a result of a sore or itch, an ice pack or cold compresses can be very helpful. A little hydrocortisone cream on an incessant itch or a milk bath will also squelch the flames, and the urge to touch it.

• If most of your clothes are fitted or baggy, that can be a clue too.

Sure, this is a generalization, but the more comfortable you are with yourself and your body, the more likely you are to wear clothes that set off its shape. For instance, if someone comes in with a thin face who is wearing lots and lots of layers, I wonder if she is hiding anorexia. If someone comes in with a full face who is wearing lots of layers, I wonder about recent weight gain. But if someone comes in who is a little heavy but wearing well-fitted clothes, I suspect that she's lost some weight and is proud of it. If a normal-weight woman arrives in baggy clothes, though, it might suggest the reverse. If all four look like they dressed carefully, it suggests -- whew -- a sense of self-worth. All of us use clothing to say things about ourselves; think about what your message usually is.

• How you walk is a major confidence clue.

When you cover ground with energy and motivation, it telegraphs to the world that you are self-assured, in charge of yourself, and full of life. When you don't, the message is just the opposite. Slow, shuffling walks don't just say you're vulnerable, they shout it: Women who become the targets of street crime have been proven in studies to walk with slower, less purposeful, less confident strides.

• Social ease is often seen in the eyes.

Avoiding eye contact suggests anxiety, depression, embarrassment, shyness, or just vague discomfort. Sometimes, of course, people are just nervous about being around a doctor. Or they may have this distorted sense that they have done something bad, such as let themselves go physically, and that I am going to lecture them about it. Maybe they're uneasy about why they came in -- "It's only a little rash but, you know, it's down there." Maybe they think I'll judge them for wanting Botox. Maybe they feel silly -- "It's just a few pimples." To make them feel more comfortable, I share personal stories (about my horrendous high school acne) or show them where I use Botox myself (a little between my brows). But if someone constantly avoids eye contact, even after a few appointments, when we seem to have established a good relationship, I'll bring it up and say, "I notice you have a hard time looking at me. Do you know that you're doing that? Does it ever happen at work or on a date? Do you realize that it makes you seem nervous or shy?" It's something I keep working on. I want to see it improve over time.

• If you don't check your appearance before meeting people, why not?

Before seeing any patient, I take a quick look in a mirror and check my teeth (especially right after lunch!), maybe put on a bit of lipstick or smooth my hair. This isn't just trying to present myself well. It also shows my respect for the people who've made the trip to see me, whether they came from two streets or two states away.

If you don't make a little spruce-up effort when you're about to see someone, is it because you don't think it will make a difference...or you really don't care how you look...or you just never have time to give yourself a second glance? All three bring up questions. If you're always putting your kids before yourself, or you're insanely overscheduled, or you think your looks are beyond help...you're neglecting and/or undervaluing yourself. It's time to give yourself permission to take care of you!

congrats

The hard part is over. Self-examination can be tough, but hopefully these tests have helped you to understand where you are on the SkinAge test and how your physical appearance ties into your emotions and sense of self. You'll be getting a full dose of information coming up in later chapters that will help you to truly see the connection between your mind and body. The science is stunning. And I think that the more information you have, the less fear you'll have about aging.

My goal in this chapter was simply to help you take a first look at the physical and psychological factors contributing to your skin's looks and health. Now let's fast-forward and get right to those recommendations that will turn back the clock and help you to reverse the signs of aging. You'll be able to set your personalized program in motion today.

Copyright © 2008 by RealAge Corporation

Continues...

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Excerpted from The Mind-Beauty Connection by Amy Wechsler
Copyright © 2008 by Amy Wechsler. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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