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Congress people leaving the Capitol Building Photo: Nicholas Kamm/Getty Images

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How DC Politicians Save Face

Dermatologists reveal what Washington politicos do to their faces.

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There’s been a mini-epidemic of teeth grinding in Washington, D.C., since Trump’s election. Often a sign of stress, grinding can cause headaches, jaw pain, and even an enlarged, squared-off jawline. The fix? Botox injections into the masseter muscle, which makes your jaw move. It’s a procedure that Dr. Tina Alster, a dermatologist who’s been practicing in D.C. for 30 years, used to do maybe once or twice a month. Since the election, she’s been doing one or two every day.

“That was really something out of the ordinary,” Alster says. “There was a big jump in that procedure. It’s come down a little bit now, but it’s still more than baseline pre-election.”

Washington, D.C., is a unique place to practice dermatology. Its denizens have concerns and schedules unlike those in the rest of the US, and a group of dermatologists have set up shop there to do robust business meeting these needs. Unlike their colleagues whose patients have more predictable schedules, they need to be able to accommodate a last-minute Secret Service security sweep of their offices and get someone ready for high-definition film with little notice.

Five doctors I spoke to all agree that first and foremost, patients in D.C. want subtlety. Dr. Noelle Sherber, a D.C.-based dermatologist and RealSelf contributor who is known for her light touch, says the goal is for your looks to not be “distracting” in either direction. “That can mean an appearance where they look like they’re not taking care of themselves,” she says. “But they also wouldn’t want it to appear too extreme, like they’re having too many procedures. There’s sort of a happy middle ground where they just want to look fit and rested.”

This is a particularly fraught issue for women in the public eye. “In the political sphere, the women are just placed under more of a microscope, and now with social media they are subjected to quite vicious comments about how they look, which can then make it even more difficult for them to decide what the next step may be to maintain their appearance,” says Dr. Sherber. She says that these women will often be the subject of before-and-after images on social media, where people scrutinize them to figure out who has had what procedures done.

“That’s why we do very small interventions very gradually,” says Dr. Sherber. “It isn’t obvious year over year that someone is perhaps intervening. [Instead, they] just look refreshed, or maybe there’s some yoga and green tea involved instead of aesthetic intervention.” To this end, many patients in D.C. have standing appointments every three months or even monthly to get smaller doses of Botox and fillers and regular laser treatments so that their appearance remains consistent over time. “I have a lot of feeling for these women who are trying to go out and represent their constituents and do great work on behalf of our country,” she says. “So when I can be helpful to them in feeling confident in their appearance, I’m always so happy to do that.”

Looking like you haven’t had work done doesn’t mean much if you’re spotted going into an aesthetic dermatologist’s office, so some derms have taken pretty elaborate privacy measures. Dr. Sherber doesn’t have a waiting room, but instead utilizes “private cabanas” where people can wait. She will stagger appointments so that certain notables don’t run into each other, and she has a separate Secret Service entrance. Dr. Alster, whose office is on K Street, two blocks from the White House, whisks VIPs and their security details out of their cars through a back alley entrance and up a flight of stairs. “It’s much easier for Secret Service to secure a stairwell that nobody uses as opposed to closing down a whole elevator,” she says. A select group of patients has her private email and can slide into appointments that she holds open every week for special circumstances.

Dermatologists also try to accommodate the unique schedules of elected officials and experts who need to go on TV at the drop of a hat to discuss breaking news. The dermatologists tell me that they generally do not offer procedures that require a lot of recovery time, because people are just too busy to hide away and nurse bruises or swelling for two weeks. A bit of pinkness for a few hours is about as much downtime as D.C. residents will tolerate.

TV screens
HD, the great equalizer.
Photo: NBC Newswire/Getty Images

Busy times for more intense procedures include the end of July and early August, before Congress goes on its month-long break, and Thursdays and Fridays to allow for weekend recovery (although some patients won’t get anything done at the end of the week in case they need to be on the Sunday political news shows).

The popular procedures in D.C. are the ones that tweak the story your face tells when you’re not talking. Dr. Sherber calls this “unintentional messaging.” For example, frown lines between your eyebrows can make you look judgmental or angry, and having a downturned mouth can signal disapproval. The goal is to gently correct these without giving the appearance of looking frozen. “People want to have some expression lines so they’re perceived as being receptive, listening, and empathetic,” says Dr. Melda Isaac, another D.C. dermatologist and RealSelf contributor who treats a lot of lobbyists in her practice — of both genders. Men, a growing contingent in dermatologists’ and plastic surgeons’ offices nationwide, are also hitting up derms in D..C.. at an increasing rate, which makes sense considering that most elected officials in D.C. are male.

High-definition (HD) television has caused a lot of angst among the D.C. set in the past few years, forcing dermatologists to up their games. HD accentuates light and shadow on the face, so someone with dark circles under their eyes will look really tired in HD. Dr. Sherber makes sure to keep her patients’ skin looking as HD ready as possible at all times. “There can be a piece of legislation that comes through or a bit of unexpected news and people don’t have a lot of time to get themselves together,” she says. “They may not always have the help of a pro makeup artist or great lighting, so it puts a premium on having great skin.” Being HD ready is all about the complexion’s texture — minimizing pores, dark spots, and acne scarring. “In the past, people would put on so much makeup that without the HD you couldn’t tell,” says Dr. Isaac. “Now, in HD, even with makeup people will see acne scarring or pore size so much more.”

The approach varies from doctor to doctor, though almost all of them utilize Botox and various fillers. Dr. Sherber uses a laser called Permea, which essentially pokes microscopic holes in the skin to help improve texture and tone. It also helps the skin absorb topical treatments more easily, which she likens to “aerating the lawn.” Dr. Isaac achieves the same thing with microneedling, a process whereby she rolls hundreds of tiny needles over her patients’ faces. They all use fillers to make undereye bags and hollows less visible.

Never letting them see you sweat, especially when you’re sparring on CNN or waving to constituents while campaigning, drives demand for another procedure. Several dermatologists reported injecting Botox into underarms to temporarily stop perspiration. Dr. Alster, who sees a fair amount of guys from D.C.’s sports teams in addition to the political set, offers MiraDry, a procedure that uses microwaves to permanently destroy sweat glands. She also does scalp Botox about four times a month: “I have a lot of men who have a tendency to perspire all over their faces and their scalp and so they look really shiny during interviews, so we do dilute amounts of Botox in the scalp area to minimize that perspiration.”

There’s a jawline obsession in D.C. also, the teeth grinding issue aside. Women get treatments like Kybella, an injection that destroys submental fat cells, otherwise known as a double chin. Dr. Alster was one of the first doctors in D.C. to perform the Silhouette InstaLift, a procedure in which absorbable sutures are placed to strategically lift the chin and neck skin. Results last for 18 months to two years.

Men especially are concerned about what’s going on below the chin. Dr. Sherber notes that studies have shown that “CEOs are more likely than the general population to have a strong jawline, [which] may relate to people’s perception of authority.” She treats men along the jawline with a structural filler like Voluma to enhance that contour. Just in the last few weeks, Dr. Isaac says a lot of male patients have asked about CoolSculpt, a treatment that freezes fat cells below the chin (and on other body parts), because they read about it in the business section recently when Allergan (which owns Botox) bought the company for almost $2.5 billion. Dr. Terrence Keaney, another D.C.-based dermatologist and RealSelf contributor, uses Kybella or CoolSculpt on his male patients, following it with a filler to get the manliest effect. “You want that shadow effect where you have a clear junction between face and neck,” he says. “In that case, [I put] filler in the chin to get more chin projection as well as along the angle of the chin to help define.”

While most of the derms said about 15 percent to 20 percent of their patients are men, Dr. Keaney sees about double that, mainly because he specializes in hair loss, which he says is his patients’ number-one concern. “A receding hairline will make a male look roughly around five years older than his age,” Dr. Keaney says. He uses a multi-pronged approach, treating his patients medically with drugs like Rogaine and Propecia, then using platelet-rich plasma (also called PRP and colloquially known as “the vampire facial”) treatments. This requires drawing a patient’s blood and spinning it down to a rich broth of stem cells and growth factors. Dr. Keaney then injects this four millimeters into the scalp to stimulate hair follicles. It requires one treatment a month for four months, followed by maintenance treatments every six months. “There’s no treatment where you do it and the hair loss just stops,” he says. “That would be the holy grail.” (Fun fact: Dr. Keaney’s patients often identify Ryan Reynolds as a celebrity inspiration because of his “age, looks, body, and good head of hair.”)

All of these procedures add up, and even the best private insurance plans don’t cover aesthetic procedures. Dr. Keaney charges $2,500 for a four-month package for PRP, then $750 for each treatment thereafter. Dr. Alster charges anywhere from $2,500 to $5,000 for the Silhouette InstaLift, depending on how many areas and how many sutures are used. Dr. Isaac says the average cost for Botox and filler visits is $1,500, and lasers are $500 and up. CoolSculpting can be $1,000 and up, depending on the area treated.

The new administration has really shaken things up for these doctors. Dr. Elizabeth Tanzi, another D.C. dermatologist, says that she gained a slew of new patients who had worked in the Obama administration and then subsequently landed new jobs in media. “Now they’re analysts on CNN, on MSNBC. I saw a huge influx of people who said, ‘Now that I’m out from behind a desk I need to spruce this up a little bit because I’m going to be on TV!’”

“[In this administration], there’s no regular way of doing things, so people always have to be prepared for something to become news that they have to comment on [on TV] right away,” says Dr. Alster. “Trump disrupts the whole game on a daily basis. There’s a lot of uncertainty.” Dr. Keaney says “half the city” lost their jobs in January, and he expects that over the coming months, new patients will find their way to his office.

Despite how busy all the dermatologists are, there is definitely an endless supply of potential patients in D.C. Dr. Keaney laughs: “If you look on the news, most of them need work, right?”

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