Holding back the years

The quest for eternal youth - is it all in vain?

by Sumiko Oshima

Katsuya Takasu regards his body as a vehicle to carry his mind. So what he had done to his face two years ago was, as he puts it, “just like fixing an old jalopy.”

A cosmetic surgeon himself, Takasu gave instructions from the operating table as a senior colleague performed face, forehead and eyelid surgery and hair transplantation on him at his Nagoya clinic — one of nine he runs around the country. Later that year, he had cheek fat removed by a French doctor and an “aggressive” chemical peel of facial skin done by an Israeli surgeon. In the space of those 12 months, he looked 15 years younger.

To top it all off, though, after a conference in Sao Paulo later in 1999, he had a cutting-edge jowl lift performed by a Brazilian surgeon who put 12 gold wires in his jaw.

Now, at 56, Takasu’s face is as smooth as the proverbial baby’s bottom, with no trace of drooping or sagging to be seen.

Not that he’s stopped there. Takasu regularly has fearsome-sounding chemicals such as botolinum toxin and hyaluronic acid injected into his face to remove wrinkles. He also has the latest laser-resurfacing techniques to maintain skin condition tested out on himself before his staff use them on patients.

“Am I scared of aging? Certainly, because my body is becoming worn out while my inner self has never gotten old,” Takasu said with a wrinkle-free smile. “It’s rather like desperately running up a down escalator to escape the effects of aging.”

Not so long ago, weakening muscles, diseases, liver spots and lines were expected and unavoidable aspects of our advancing years. Wrinkles and sags were sometimes even admired as symbols of graceful aging. In a country where the body was often regarded as a “gift” from parents (and, for warriors, the overlord’s property) going under the knife for mere reasons of appearance would have been thought unethical. Those obsessed by a desire to look and feel young would have drawn disdain for their immaturity, counter to the ideal of gedatsu (emancipation from worldly attachments).

Now, though, just as Mickey Mouse, Doraemon and the like have largely supplanted the fables and folklore of old, many people no longer accept the traditional view of aging as a inevitable process. Instead, it is seen as akin to a disease — to be combated by all available means.

Cosmetic counters are filled with dozens of anti-aging creams claiming to prevent wrinkles and liver spots. So popular has marketing made them that Shiseido, Japan’s leading cosmetics company, has sold 600,000 jars of its anti-aging Revital cream — at 20,000 yen each — since it went on the market in November 1999, exceeding forecasts by more than 50 percent.

So-called regrowth tonic to counter hair loss is another “rejuvenation” product selling at record levels, while the wig industry is riding out the recession in style: Market leader Aderans Co. Ltd. announced sales of 50.7 billion yen for its men’s hairpieces in 2000, up 14 billion yen since 1996.

Meanwhile, as the professional success and personal predilection of Katsuya Takasu seems to prove, the stigma once attached to cosmetic surgery is fading fast. Surgical rejuvenation of the face and body is no longer the preserve of movie starlets. Japanese cosmetic surgeons, whose main job for decades has been making “double” (folded) eyelids for young customers, say they are increasingly being asked to perform face-lifts on older clients, male and female. Medical practitioners in related fields, too, have been quick to eye this lucrative demand. Increasingly, plastic surgeons and dermatologists at general hospitals are offering cosmetic treatments, breaking with the medical convention that shunned therapies outside the scope of the national health insurance system. Tokyo’s renowned Kitasato Institute Hospital in Minato Ward is in the vanguard of this trend, having opened its Aesthetic Medical Center in 1999. Procedures such as face-lifts, chemical skin peels and laser resurfacing are conducted on the basis of diagnoses which evaluate aging using various techniques.

A person’s features are the key to a youthful appearance, says Ryuichi Utsugi, the center’s director and chief plastic surgeon. What makes the face look beautiful, he explains, is not chiefly — as commonly believed — the shape and arrangement of the eyes, mouth and nose, but their function as a “highlight” of the face. Our attention focuses on this area, and when the sag of aging interferes with its contours, attractiveness diminishes.

Despite widespread economic anxiety, Utsugi confirms that the high cost of treatment is proving little deterrent to those seeking medical help to stay young. Laser treatment to remove a 1-cm-diameter spot costs 10 yen,000-30,000 yen, while a chemical peel course including a skin examination, three peel treatments and skincare cosmetics costs 80,000 yen. Even face-lift surgery, at a cost of 1.1-1.57 million yen and requiring a seven-day stay in hospital, has the same waiting time as the other procedures: two months. And that is the mere blink of a perfectly fashioned eye compared with the center’s 35,000 yen cosmetic check-up service to determine facial condition, which is fully booked a year ahead.

Younger people are increasingly among those seeking face-lift surgery. “Our youngest request was from a 27-year-old woman,” Utsugi recalls. “I was surprised, because [a check-up] showed no indication that she needed anything done. I just sent her home.” This example perhaps illustrates how women are pressured to feel old before their time. Utsugi believes that “it is important for customers to study themselves beforehand, as there might be other approaches more suitable for them.” Indeed, he reports that when he shows potential customers a post-operative computer-simulation, 40 percent decide against having a face-lift after all. “In the end, many people find they prefer a face which is old but gentle — and is loved by everyone,” he points out.

However, aging is not just a matter of appearance, Utsugi says. “I think an aging body is an acquired deformity, which needs therapeutic care.”

The pursuit of youthfulness isn’t just about external appearance, as has long been recognized. There is still no magic formula to stop the clock, but along with popular supplements and health foods with supposed anti-aging properties, pharmaceuticals are increasingly playing a part in the quest to stay forever young. Other than the vogue for Viagra, which attends to aging males’ longings for youthfulness in one particular area, another fast-growing field is hormone replacement therapy, involving cocktails of hormones taken to make up for those depleted by advancing age.

HRT has been around for several years as an established medical treatment to relieve the symptoms of menopause. Estrogen supplements are known to alleviate hot flashes, deterioration of skin texture and lower the risk of osteoporosis for many women in and after menopause, while also decreasing vaginal dryness and sustaining sex drive. However, the most recent form of this procedure, known as anti-aging HRT, is more aggressive. Patients are supposed to take a hormone booster, which includes growth hormone, estrogen, testosterone, melatonin and steroids.

Yoshikazu Yonei, a physician at Nippon Kokan Hospital in Kawasaki, is a keen advocate of this latest, preventative approach. As a physician authorized by the American Academy of Anti-Aging Medicine, Yonei is conducting “aging checks” for people seeking to slow the course of their aging, based on the procedures of the Las Vegas-based anti-aging clinic Cenegenics. In addition to tests performed in ordinary health checks, such as blood tests for chronic diseases, blood pressure monitoring and electrocardiogram tests, the aging check includes a computerized examination of auditory, visual, lung and muscle functions, measurement of hormone levels, bone density and body flexibility.

At Tokyo’s Aoyama Clinic, where Yonei also conducts Cenegenics aging tests, 238 people have undergone an examination so far this year, and 78 are now on the anti-aging HRT program.

Yonei himself is a patient. “My examination indicated I am 34 years old, which pleased me,” said Yonei, 43. “But I was really shocked by my memory test result, which was far below the average. So I started treatment.”

His prescription includes injections of human growth hormone, melatonin and steroids in pill form, as well as a handful of supplements. Ten months into the program, Yonei says his sleep problems have gone away and his hair now grows much faster, while graying at a slower rate. “I’m not exhausted even after a night duty. I’m now more confident about my job,” Yonei says. Oh, and it’s not that he forgot to comment on his poor memory, just that he hasn’t noticed any improvement yet, he said.

Beyond any benefits to the individual, resisting aging has a significant social benefit, says Keiichi Watanabe, chairman of Japan’s Academy of Anti-Aging Medicine established in June. In a rapidly graying society, where one in four Japanese will be 65 or over in 20 years, staying youthful helps reduce the high social and financial costs involved in caring for the chronically ill and bedridden, he says.

Anti-aging therapy, he says, “requires a comprehensive approach including exercise, nutrition, basic research and much more — not just cosmetic surgery and hormone therapy.” The group plans to press the case for transforming Japan’s regular check-up clinics into “aging check-up clinics.” At these, academy members believe, various biomarkers — including the body’s levels of human growth hormone and sex hormones — could be studied to gauge where people are on the aging scale and help them choose appropriate anti-aging services.

While such progress is all very well, especially when it goes hand in hand with socially responsible treatment, it still begs the question of why we are so attracted by the idea of looking and feeling young.

In one sense, of course, it represents a natural human desire. Humans have long pursued dreams of eternal youth or super-longevity, and modern-day medical, scientific and technological advances have brought us closer than ever before to realizing that dream.

Yet taking up the anti-aging challenge remains a gamble. In the absence of convincing long-term clinical studies, for instance, the apparent elixir which is HRT may yet turn out to be all hype. The U.S. National Institute of Aging has stated that hormone supplements have few clear-cut benefits for healthy individuals, and no proven influence on the aging process. And with no established quality-control system in place, aggressive cosmetic treatments such as chemical peels and face-lifts may — and, when mishandled, do — prove highly damaging.

Despite this, increasing numbers of people are deciding the benefits outweigh the risks.

“In societies where people no longer feel any anxiety about providing themselves with food, clothing and shelter, it is natural for them to wish to stay young as long as they can, and to enjoy life to the full,” Watanabe says.

While the current trend reflects a clear shift to regarding the body as an individual’s property, with no debt incurred to parents or one’s social superiors, it has retained its primary role as a means of production. Bodies with a high capacity are regarded as more “valuable” — and if it comes to being productive, being young has all the advantages over age.

Anti-aging technologies and treatments may help people to look and feel younger, but a society that denies the aging process and sees beauty only in youth may be piling on new pressures. “Cosmetic surgery and other anti-aging services could fuel anxieties about aging, although they are meant to alleviate them,” says psychiatrist Rika Kayama. “And this anxiety may, in turn, drive people on an endless quest for the Fountain of Youth.”