Products


More Than Skin Deep

Gerald Imber, MD, believes that people should not wait too long before they seek out aesthetic work. To him, starting in their late 30s with small aesthetic procedures makes more sense than going in for a large, drastic alteration later in life. He has written two books—one about men’s plastic surgery and one about how to avoid wrinkles—and has developed aesthetic procedures that have been adopted by many in the field. Yet, he is humble enough to recognize his contributions take place along a continuum of gradual improvements made to well-tested techniques.

“I think that no one really invents anything in medicine,” he says. “You kind of build on things, on ideas that you’ve heard or other people have heard.”

His talent for aesthetics begins with his authenticity as a person and his love for what he says he “happily does,” which also reflects on his clients. Mostly, he does faces but he won’t turn down a neck if someone calls him for it. As an artist, he describes his surgery as “a kind of ballet, with all the sutures falling in the same direction.”

THE YOUTH CORRIDOR

Imber’s biography is about someone who sought his true calling and nature, and was gracious enough to answer back with the necessary brains and skills to be able to execute it.

Today, he is considered a pioneer and teacher in the area of noninvasive or minimally invasive cosmetic surgery procedures. A new edition of his 1997 book, The Youth Corridor (Diane Publishing Co), was published in 2009. In his book, Imber calls the interval between the ages 30 and 55 the “youth corridor,” when most changes brought on by aging occur and can be controlled. His book is a guide to skin care, diet, vitamins, and exercise as alternatives to surgery. His earlier books include For Men Only (William Morrow; 1998) and Absolute Beauty (William Morrow; 2005). In 2010, he will publish Genius on the Edge: the Bizarre Double Life of Dr. William Stewart Halsted (Kaplan Publishing), a biography on the inventor of modern surgery in the United States.

What sorts of changes occurred to justify publishing a new edition of The Youth Corridor?

“A lot of things,” Imber says. “First of all, in the first edition I disparaged all skin care products as hogwash. In the course of those 12 to 14 years, the advent of alpha hydroxy acids and antioxidants became real. Before that, there was just sun block and nothing else. Now I would venture to say every single company making a line of skin care products is making products that actually work. Every company. Now some have better packaging, some work better, but the biggest change is that you can actually change the nature of the surface of your skin and protect it and encourage growth by what you apply to your skin.”

With the sea change in skin-treatment science, Imber decided to create his own line of skin care products. “For a number of reasons I thought there had to be something a little bit better,” he says. “I did study the literature, and in the course of this research I spent 2 years in a bunch of labs trying to put together proper formulations.”

In the end, he came up with a set of products. The product line uses the Youth Corridor name as a tie-in with his book. His success with these products proves that marketing tie-ins such as this can be very successful; however, as in Imber’s case, one would have to first publish a book.

PRACTICE AT A GLANCE

Name: Gerald Imber, MD

Location: New York City

Specialty: Facial and reconstructive surgery

Years in practice: 35

Days worked per week: 5

Days surgery performed per week: 5

Number of employees in practice: 8

Office square footage: 2,000

His suite of skin care products utilizes an unprecedented combination of Vitamins C, E, and melatonin. Melatonin’s lipophilic nature helps Vitamins C and E penetrate through the keratinized layer, where they can have the most impact. The antioxidants can directly target the harmful inflammation caused by the sun and free radical damage which, left untreated, has been shown to lead to collagen degradation and elastin cross-linking—the prime causes of wrinkling and sagging skin. Vitamins C and E have been used in skin care products for years with limited results, but when combined with melatonin there is enhanced delivery to the deeper layers of the skin, according to Imber.

“My patients loved it,” he says. Recently, he has made it commercially available, and, “The response has been great; it’s just so gratifying.”

Commenting on his approach to marketing the product, early on he made a couple of crucial decisions. “I was not going to get into one of these situations where the bigger you get the more money you lose,” he explains. “I wasn’t going to get in over my head, and I had no interest in being in department stores—where you have to hire staff and rent the space and they never pay their bills.”

Imber developed a strategy based on word of mouth and tried to keep expenses under control. “We have the luxury of having absolutely no debt, products that we love, products that are all money-back guaranteed, products that people actually like and that are actually helping them,” he says. “The growth of the business has been remarkably good, based on the fact that we’re not pushing growth. We’re doing something in a sane manner. We’re taking something that was meant for my patients and just expanding it. All the beauty editors have fallen in love with it. We’ve gotten great press for it. It’s already a self-sustaining business.

“There are two things that doctors do worse than anyone else,” Imber says with a knowing smile. “Flying airplanes and running businesses. Those are the two things we’ve always been warned against, and, you know, we’re just so damned dumb that we keep on trying. The highest number of accidents of any profession in private aircraft are [caused by] physicians. Surgeons—we all think we’re God. It’s just there’s no common sense.”

SURGEON BY DEFAULT

For someone who is so certain of his path and place in the world, Imber’s induction into aesthetic medicine was not what you would expect. “I went into the medical field because my friends did,” he confesses. “I was completely lost. I didn’t know what I wanted to [do].”

He didn’t remain lost for long. The people he liked and respected were in the scientific field, and they wanted to be doctors—he followed their lead. After being accepted to medical school, he “just fell in love.”

Imber is keenly interested in facial rejuvenation and the treatment and prevention of early facial aging.

Born in New York City, Imber went to school at the State University of New York. He split his residency in surgery between the East and West coasts, putting in a couple years at Long Island Jewish Medical Center and finishing at Kaiser in Los Angeles.

In addition, he put in 2 years with the Air Force. “When I was out in Kaiser, I was a general surgeon. I was out of the Air Force and I’m not the smartest guy in the world, but I’m technically adept. It was ‘idiot savant’ stuff. The chief out there, a man named Dr Roscoe Wilcox, said, ‘You know, you should be a plastic surgeon.’ “

It was at this time that fate turned a gracious eye to Imber again. Wilcox had attended medical school with the chief at the New York Hospital, who was retiring. “Dr Wilcox called his old roommate up. ‘I have a boy for you,’ ” Imber recalls, “and the rest is history.” For Imber, it was only the beginning. Also, his growth as an aesthetic practitioner has run concurrent with advancements in noninvasive cosmetic surgery.

FACELIFT REVELATIONS

Imber went on to do his residency at Weill-Cornell School of Medicine in New York City and then stayed on as attending plastic surgeon, where he came to some startling realizations. He was stricken by the fact that the facelift that everyone was performing at the time were full-drum-type, enormous procedures that were meant to iron out all the wrinkles of a lifetime.

Patients were “waiting until they looked like hell and then tried to turn back the clock,” he says. “You’d have women with skin-tight faces and wrinkled hands and wrinkled necks, and people were wasting 25 or 30 good years of their lives.”

It was this perception that helped him come to the conclusion that if a person were to attack little changes as they were happening, then a person could maintain their kind of good looks throughout their life, or certainly most of it. This seemed like a much better idea than having to deal with the downsides attached to other approaches, he adds.

“Is it inevitable that you would have had the same number of procedures as if you just went out and had a facelift at 65?” he says. “Well, sure, but you wouldn’t have wasted those years.”

It seemed to him that “the same shoe shouldn’t fit everybody. The operation that’s good for a 75-year-old woman with a road map of wrinkles is not good for a 50-year-old,” he says. “There’s got to be something better.”

With that in mind, he developed his vitamin-based formulations. In addition, Imber says, “I popularized and actually put a couple of procedures on the map. Primarily, they’re the limited-incision facelift and the microsuction procedure. “Before I started doing the short-scar facelift, I came home and copied someone else’s operation, in which he had eliminated the incision behind the ear,” Imber explains. “Then I also got rid of the incision in the scalp. But even though it’s my operation in my eyes, I didn’t have an epiphany. I saw something somebody else did and built on it. That’s how great progress is made.”

Imber and “a couple of other people in New York—Dan Baker being one of them—have done a lot to popularize that operation,” he says. “It doesn’t alter the hairline because there’s no incision in the scalp, and there’s no incision behind the ear. You can put your hair up without a telltale sign of the operation.”

Imber followed the same principle in creating the microsuction procedure, for which he made some alterations to procedures created by the father of liposuction, Charles Dujarier. Imber’s procedure involves inserting a 2- or 3-mm cannula through a tiny incision under the chin or behind the ear, and moving it along the jaw to remove fatty jowls. It has a side benefit of causing the skin to lift and tighten because of the irritation involved.

Imber’s practice specializes in cosmetic surgery and some reconstructive work.

After the procedure, “the patient was better immediately,” Imber says, adding that it is useful for patients who would have had much more extensive surgery or nothing. Imber did a lot to popularize noninvasive procedures as well.

At present, he is assistant clinical professor of surgery at Weill-Cornell School of Medicine and is on the staff of New York-Presbyterian Hospital. He also taught head and neck anatomy for several years.

At his private clinic in Manhattan, he performs a full range of cosmetic procedures. His special interest is in facial rejuvenation and the treatment and prevention of early facial aging. He has performed thousands of facelifts, including modified male facelifts, and is constantly striving for the most natural results and the least invasive techniques.

“My practice has been explicitly limited to cosmetic surgery with two exceptions,” he says. “If someone has trauma in the neck and they actually have my number, then I never say no. But I didn’t come first and I do a lot of postbone reconstruction—bone surgery of the face—because it’s a way to give back to society.”

As for Imber’s pro bono work, for many years he has been an honorary police surgeon in New York. He takes care of a large number of police officers injured on the job, surmising, “I don’t think I’ve done anything good other than that.” For a person with such accomplishments, his humility is astonishing.

UPS AND DOWNS

As far as where things are headed in cosmetic surgery and the science of skin care, “Some of it is good and some of it is bad,” Imber says.

On the good side, “Skin care treatments are working,” he continues. “All of that started with Retin-A, which was the first thing that you could apply after sun block [and] prevents accelerated aging. Retin-A actually created cell turnover and helped obliterate wrinkles and skin discolorations. It was the first actual product that made a dramatic change.”

Since then, skin care formulations have become very effective. It’s “happening by leaps and bounds,” he says. “I think it will happen first in the laboratory and then they’ll sneak their way into the cosmetic counter, just like alpha-hydroxy acids were originally just something that was applied by doctors, primarily dermatologists. When skin care companies found that if you use a concentration of less than 10% you can get slow and steady progress, you avoid the downside of terrible irritation.” This bit of medical therapy worked its way onto the department store cosmetic counter. “And that’s the way things are going,” he says.

Imber cautions of the potential bad side to the multibillion dollars’ worth of cosmetic procedures done each year—from dermal filler injections to Botox to facelifts—all of which is unregulated by insurance companies.

“I think that the level of economic competition has and will naturally breed an unnecessary level of dishonesty, or certainly misleading behavior and misrepresentation,” he says.

The phenomenon of more people getting into the field and less regulation “just kind of lends itself to people chasing the gold without doing the digging,” he adds. “When I became a plastic surgeon, the world of training was 4 years of medical school, a year of internship, 4 or 5 years of general surgery, 2 years in the service, 2 years in plastic surgery. Now, you finish medical school and it’s a 5-year program and you’re done. And that’s the most rigorous training—that’s the plastic surgery.

“But a lot of people want to get on the gravy train,” he continues. “They don’t want to do things that are paid for by insurance, and they want to make a better living. Trained or untrained, they decide to call themselves plastic surgeons. The law is if tomorrow morning I decided to be a neurosurgeon, I just change my business card, cross off plastic surgeon, and put in neurosurgeon. I’m legally allowed to do it, because we’re licensed physicians. It’s immoral, just like to me it seems immoral that someone who is untrained as a plastic surgeon should be doing any kind of plastic surgery procedure.

Based in New York City, Imber has been teaching head and neck anatomy for many years.

“Everybody who is certified by the American Board of Plastic Surgery is someone who should be completely qualified to do cosmetic and reconstructive surgery. And there are a number of other boards … places that those surgeons are trained to do cosmetic surgery in their residency, and that’s perfectly fine and they do a darn good job. But you have to be trained. You can’t just declare it.”

Imber is excited about the future of cosmetic surgery, and skin care in particular.

“In the world of skin care, it’s become far more serious than all of us ever predicted,” he says. “There will be enormous changes both in the world of skin care therapy and also primarily in genetic manipulation, which will deal dramatically with aging over the next decade. You hear about things like telomerase, which stops the aging of the cells by stopping the breaking down of the chromosomes.

“I read about Resveratrol, which stops aging by stimulating a kind of starvation mechanism. These things are real. They’re happening. We don’t know how much of them to give—most of these things have been proven in rats, and to give the same dosage to human beings you’d have to eat [them] by the shovel-full. But things are changing.”

THE OFF-DUTY LIFE

See also “Plastic Surgery, Teenagers, and the Media” by Frederick N. Lukash, MD, FACS, in the June 2007 issue of PSP.

PlasticSurgeryPractice.com

With all these achievements, one wonders if Imber has time for anything other than his medical life. However, he insists, “I think that my off-duty life is a lot more interesting than my on-duty life. But I’ve been doing this for a while and happily, and I love it.”

His “off-duty life” includes polo, which he’s played for more than 15 years, as well as racing sailboats. “Now that I’m an older gentleman, I don’t want to break any more bones,” he says. “I’ve broken everything; there’s nothing left to break.” Lately, he sticks to golf, tennis, and writing.

Imber has written for surgical journals and penned references for other writers’ beauty books, as well as columns for Departures, The Wall Street Journal, and other publications. In addition, recently he completed a biography of William Stewart Halsted, the “father of American surgery,” which should be available in bookstores by the time you read this article.

The book covers Halsted’s many accomplishments in the context of 19th-century society, including his origination of the residency training system and the use of sterile gloves; as well as procedures he popularized, such as hernia repair and radical mastectomy, among other things. Imber digs deep into Halsted’s personal life, with subplots about the surgeon’s use of cocaine as an anesthetic and his subsequent addiction to the substance, as well as the positives in Halsted’s extraordinary life.


Shelli Merrill is a contributing writer for PSP. She can be reached at plasticsurgery@nullallied360.com.

THE YOUTH CORRIDOR PRODUCTS

Antioxidant Boost Skin Serum with 10% Vitamin C, E, and melatonin—Imber’s signature product— claims to be “one of the most potent antiager available.”

Skin Brightener with Botanicals and AHA—An instant radiance booster that increases cell turnover and delivers skin-boosting botanicals to improve skin health.

Gentle Cleansing Foam with Green Tea Extract—A mild, soap-free cleanser to remove all traces of dirt, oil, and makeup without stripping the skin. Green Tea Extract provides additional antioxidant protection.

Soothe & Defend Moisturizer with SPF 30—A daily moisturizer that offers UVA and UVB protection in a lightweight formula.

Gentle Moisturizer with Green Tea Extract—A skin hydrator and soother that can be applied as often as needed.

Rejuvenating Eye Cream with Antioxidants and Peptides—A skin-firming treatment cream to protect and repair delicate skin around the eyes.