Face it: You’ve seen her around town. She has lips so puffy that they make Lisa Rinna look like the “before” picture.

Or that permanent deer-in-headlights startled look that is usually reserved for drivers on the 15 during a rare Vegas rainstorm.

Even worse, the woman who was talked into getting so much filler injected into her face that her eyes are there … somewhere. Really.

Dr. Seth Matarasso, Board Certified surgeon and clinical professor of dermatology at the UCSF School of Medicine says it’s time to stop the anti-aging madness.

“It is no longer that windswept, tight facelift with a frozen forehead,” said Matarasso, who is also one of the country’s top Botox providers. “Say goodbye to the trout pout where your lips walk into a room before you do.”

What’s in? “Subtlety,” he said. “Less is definitely more. That is the new trend.”

Case in point is the 2018 awards season in Hollywood where the latest accessory seems to be a face that looks more natural and dare anyone say…real?  Stars like Sharon Stone, Frances McDormand, Jennifer Aniston and Angelina Jolie allowed the rare hint of a facial rare line to be broadcast across the globe. Even “Thelma and Louise” — Geena Davis and Susan Sarandon — weren’t pretending to be in their 30s, but looked relaxed and beautiful. And there are stars like Helen Mirren, gorgeous at every age, who insist that life is their best beauty secret. “I don’t have a beauty routine I can tell the world. I like to garden. Does that even count?” Mirren jokes.

Dr. Matarasso, whose clients include A-listers and mere mortals alike, said that the goal now is restorative beauty as you age. “People want facial movement. They want to be demonstrative in their emotions. They don’t mind looking their age,” he said. “The paradigm is ‘I eat right. I sleep right. I gave up smoking. I want to look as good as I feel while avoiding that deer in headlights look.”

Decades of shock and awe over overly tox-ed and pumped up Hollywood types has changed the anti-aging ideal.

“The public has seen all the celebrities and rock stars who are so overdone and it’s a cautionary tale,” he added. “That’s why the trend now is to look like yourself, but a bit refreshed, more relaxed and a little less stressed.”

He credits a less Botox-ed, filler-ed up look to the idea that doctors are also refining the way that they erase the years from a face. “Physicians have these wonderful neurotoxins and fillers, but in the last years they’ve really learned how to finesse their techniques on how to use them.”

For example, the idea of erasing all of your lines and wrinkles is yesterday’s thinking. “I think the big change as a physician is that when we first got Botox and neurotoxins, all we knew was how to paralyze, so that you had no facial movement. You know what? That looks good in a cemetery and doesn’t look good in a boardroom. It doesn’t even look good in Vegas at a poker table.

“You need some facial movement, which is why paralysis is no longer the esthetic goal with toxins,” he said.

For those who run the other direction from fillers, Dr. Matarasso said that there is a new mindset on how to turn back the clock. “With fillers, we’ve learned not to chase each and every line. We’re volumizing or recreating the loss of volume that we had when we were younger, but not overly filling.”

What about the big trout pout?

The doctor recalls the days of actress Barbara Hershey from the 1988 film “Beaches.” “She came out with her collagen lips, which became all the rage. All of a sudden everyone was trying to recreate a youthful face with big lips.”

He’s not against lip augmentation. “It’s important to retain a homogenous appearance. So many go overboard with the lips.”

“Cheeks became the new lips,” he said. “Cheeks are so engorged with filler that you can’t even see the person’s eyes.” He pointed to the late actress Kim Novak. “She had so much filler put into her cheeks that there was no movement. You couldn’t even see her eyes. Again, it’s about subtlety. Do a little bit. You can always put in more. It’s about a gradual improvement.”

That’s accomplished by doing your homework when it comes to finding the right doctor. That’s especially confusing in today’s world where everyone from a gyno to a dentist is offering filler and Botox.

“The most important thing is to find a doctor who has an aesthetic eye,” said Dr. Matarasso. “I just met with a woman from the East Coast who went to some local person offering Botox. There was a problem.

“It’s important to remember that the science of doing an injection is not that rigorous,” he said. “It’s the art behind the science that’s so important.”

His waiting room is often home to those who need a fix from an anti-aging treatment gone AWOL.

“Right now, I’m dealing with a woman who went to some office. She doesn’t even know what they put into her face. All she knows is her face is irregular now,” he said. “She’s panic stricken about it.”

“The sad thing is she went to this place to look good and feel better about herself,” he said.

He mentioned another patient who decided to pump up her lips with silicone. “Her lips are hard as rocks with lumps in them. It’s permanent,” he said.

The good news is that the public is becoming more educated about these treatments and those doing them. “You have to be vigilant because everyone is advertising that that can take years off your face. These treatments are so readily accessible, especially in Vegas, where they’re available in so many places.

“I see unsuspecting people going to people claiming to be doctors. Just because they have on a white coat doesn’t mean they’re a board-certified physician who knows what he or she is doing. Your first job is to become educated. Ask yourself: Whose hands do you trust with your face?”

“You must look for the appropriate physician to do the procedure,” he warned. “Don’t be attracted to the glossiest website or the snazziest URL. You should rely on referrals to find the right doctor. Women are great at networking and getting references.

“It’s a little harder with men who are also getting Botox and fillers, but don’t get referrals as easily,” he said, adding, “I go to the gym every day and see men doing their normal hygiene and grooming. I see them put on the Retin-A and sunscreen. But they’re not going to turn to the guy next to him and say, ‘Hey, you don’t have any wrinkles. Who did your forehead?’ Women are more comfortable in that realm.”

“This is a case of buyer beware, which is why you should ask questions,” he said.

This is especially true when deciding if it’s time for a true face lift. When should you go under the knife? “When you need to go under, you’ll know it,” said Dr. Matarasso. “I call it ‘Injector Fatigue.’ Perhaps you’ve been getting neuro toxins and fillers for some time. It’s not meeting your aesthetic needs anymore. Hopefully, you and your physician will agree and both say, ‘It’s time.’”

That time might not be soon because of the strides being made with the latest in fillers and toxins. “You can put a little filler in the cheekbone and really lift the face up,” he said. “A little neurotoxin into the neck gets rid of that saggy wobble that hangs over your collar.

“The creativity we’re seeing with injectables, as well as lasers, is remarkable,” he said. “I’ve been in practice for 25 years. This is not the evolution. This is the revolution.”

“The neuro toxins are longer lasting,” he said, mentioning that can be a double edge sword if you don’t have the right doctor. “They also have longer lasting complications. There are also longer lasting fillers on the horizon. But again, there is a tail to that dog. I always say, ‘Slow and steady.’ You don’t want to have a problem.”

Another breakthrough comes from stem cell research. “It will be about taking your own ‘product,’ recycling it and getting a more natural appearance.

“We’ve literally scratched the surface of what’s coming down the pike,” said Dr. Matarasso. “It will be exciting to be able to use your own plasma for stem cell therapy.”

“It’s a good time to be getting older,” he said. “We can relax your face with neuro toxins and resurface with lasers and then replenish the loss of collagen with fillers. We have so many ways to rejuvenate the aging face and many more than we had a few years ago. It’s an exciting time with a lot of different options.”

Aging gracefully has never been more important – for both self-esteem and job security depending on your line of work.

“I work near the Silicon Valley where the average age of a tech person is 24. They come to work in sneakers, jeans, a fancy tee and carry a backpack. You don’t know if it’s a CEO or someone just out of college. Men and women who are aging are trying to compete in this youth orientated society.

“You want to look like you came in with 20 years of experience, but don’t want it to look like you had that 20 years of experience.”

What about the “Tox-aholics” out there who can’t get enough treatments?

Dr. Matarasso admitted, “It’s a bit addictive. I always say that a little bit of Botox goes a long way. A little filler goes a long way.

“Again, that’s why it’s so important to go to someone who is ethical and says, ‘You’ve had enough. You look good. Stop while you’re ahead.’ It’s very important to have that open dialogue with your doctor,” he said. “I’ve lost a handful of people who wanted more and I told them to stop. You don’t want that Michael Jackson experience where someone does more and more and more.”

He said to be wary of grand promises. “No one is going to take a 70 year-old-person and remove 20 years from her face. You can, however, make a significant impact on someone’s appearance, so they look and feel better.”

And that’s the real win. “I find people become kinder when they feel good about themselves,” said Dr. Matarasso. “There have been studies showing that having neurotoxin treatments have reduced depression. I feel like neurotoxins are the aspirin of the decade.”

More younger people are trying them as a preventative aging measure.

“Does an 18-year-old need Botox? No,” he said. “Someone who is 28? Probably not. But as your break into your ‘30s and find the first lines that your mother and grandmother had on their faces then you want to start to do prevention.”

Men are also asking for their ‘Tox. “I love when a man comes in to have me look at a mole. He will say, ‘And by the way, what do you think about these lines?’ Or he will say, ‘Gee, my wife doesn’t like the way this looks, so as long as I’m here…..’” He recalled a CEO who insisted, “When you do that toxin stuff around my eyes then I can see better.’ I have a sportscaster who asked me to put a bit of toxin in his neck, so he wouldn’t look like his grandfather.”

Speaking of them, it’s good to respect your elders. You just don’t have to age like them.

“The bottom line is we don’t need to look like our parents and grandparents,” said Dr. Matarasso. “They looked great, but it was a different era. They didn’t have social media and met through friends instead of online.

“You have to put your best face forward,” he said. “If you need a bit of assistance in the form or some needlework or injectables then do it. It does translate into a more confident person.”

Photography courtesy of Nikki Ritcher Photography

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