Saving Face: Dr. Antell's Groundbreaking Study of Identical Twins

Home » Doctor Article » Saving Face: Dr. Antell’s Groundbreaking Study of Identical Twins

In the right hands, plastic surgery is both a complex discipline and a subtle
art. The ancient and sometimes suspect practice, which took a quantum
leap forward in the first decades of the twentieth century, is by definition
the very essence of creativity. With a knowing eye, deft hands, and skills
both learned and innate, plastic surgeons can perfect that which nature
made imperfectly. They can accomplish Einstein’s dream of manipulating
time and undo the inexorable drag of the years on muscle and flesh. And
when a plastic surgeon of national renown, like Darrick “Rick” Antell,
takes identical twins whose faces have aged differently and restores
them to the mirror-like similarities of the past, it can seem

“Plastic surgery has nothing to do with plastic as we think of it
today,” Dr. Antell is quick to point out. “It comes from the
Greek word plastikos, which means to mold. What we do is mold tissue.”

Plastic surgery predates Hippocrates. Descriptions of procedures have
been found in papyrus writings dating back to 3000 B.C. Modern plastic
surgery, which often combines both cosmetic and reconstructive skills,
was born in the trenches of World War I. Young doctors inexperienced in
battlefield medicine struggled with old techniques and gave birth to whole
new areas of medicine, including dental and plastic surgery, with the
emphasis on repairing jaws and faces savaged by shell and machine gun

“In trench warfare,” Dr. Antell says, “the soldiers looked
up over the trenches and were hit in the face.” All that many people
know about plastic surgery is from Nip/Tuck (the cable television series
about two wildly dysfunctional surgeons), he says, “so you
have to educate them about World War I and the injuries, and how it came
to be the way it is.”

A quick explanation: Plastic surgery includes reconstructive surgery,
which Dr. Antell defines simply as taking someone and basically getting
them back to normal; and cosmetic surgery, which is taking someone who
is basically normal and improving their appearance. (While cosmetic surgery
is not covered by health insurance, reconstructive surgery, theoretically,

Dr. Antell maintains a busy Park
Avenue practice in New York and teaches at
Columbia University. He is a devoted
family man to wife Lisa and their four
children. When they used to vacation on
Fisher’s Island, he volunteered as a general
practitioner and would be given vegetables
and fruit by patients in return. A lifelong
believer in giving back, he has treated
patients from Kuwait, Egypt and England
as a medical consultant in plastic surgery to
the United Nations, operated on victims of
the August 2003 terrorist bombing of the
UN headquarters in Baghdad and is
involved in Operation Smile, which
provides free reconstructive surgery to
inner-city children in the New York metropolitan

His groundbreaking study on aging
and identical twins, which concluded that
lifestyle and environmental factors were
the most significant contributors to premature
aging, was sparked by conversations
with his patients. “I think I’m probably best
known for face-lifts,” he explains, “and
patients always ask, ‘How long will my
face-lift last” When I say, `forever,’ they
look confused. So I would say, ‘If you had
an identical twin that had not had surgery
and you had, you would both continue to
age, but obviously you would always look
better than your twin.’ We can push the
clock back but we can’t stop it — the clock
keeps ticking.”

“I thought it would be interesting
to see what would happen if I operated on
one twin and not the other, which was why
I initially went to Twinsburg,” he says,
referring to the annual Twins Day Festival
in Twinsburg, Ohio. “So I went there with
photo equipment and questionnaires and
set up a research booth.” Over the next two
years, Dr. Antell conducted intensive interviews,
reviewed hundreds of photographs,
and performed face-lifts on selected twins
so that they again looked like their

“How Environment and Lifestyle
Choices Influence the Aging Process,” was
published in 1999 by the prestigious medical
journal Annals of Plastic Surgery.
“When one identical twin looks noticeably
older than the other,” Dr. Antell has said,
“only external factors can account for the
differences in appearance.” (He also
presented the study at a national plastic
surgery conference in Newport, Rhode
Island, and at an international conference
in Venice, Italy.)

“When I got back to New York that
first year,” he says, “I was struck by how
different some of these twins looked in the
pictures.” Perhaps the most stunning case
is that of Gay and Gywn, two women
approaching sixty; both had strong
features, luminous dark eyes and short,
similarly cut iron-gray hair, but their
photographs eerily resemble “before” and
“after” shots of the same woman. Gay had
been a California sun worshipper for three
decades, smoked a pack of cigarettes a day
for four years, used marijuana heavily for
seven, drank socially for ten years, and had
undergone the horrific stress of losing a
child to leukemia. Gwyn had lived in
Maryland with moderate sun exposure,
never smoked or drank, and had not had as
stressful a life; as a result, she was free of
Gay’s pronounced wrinkles and leathery
skin. Even more telling were Kathleen and
Karen, two Maryland-based twins in their
fifties with comparable lives and lifestyles:
Kathleen looked noticeably older; the only
difference between them was that she had
smoked for thirty years. (She has since

“This is a good story to get people to stop
smoking,” says Dr. Antell. “You can tell
people about their lungs turning black until
you’re blue in the face. You tell them
they’re going to look older? It’s a much
better sell.”

Through his research Dr. Antell
was able to pinpoint three factors that he
calls “the three Ss” — smoking, sun exposure
and stress — that impact on premature
aging. “This is really the first study of its
type,” he says, “that documented the
effects of nature versus nurture. We’re all
going to get old anyway, we can’t do
anything about that. But this study conclusively
proved that you can affect the rate at
which you age. Nature is highly overrated,”
he says with a distinct twinkle. “I
think we can control about 80 percent of
how we age by healthy lifestyle choices
and by doing all the right things Mom
always told you to do: don’t smoke, eat
right, exercise and get good sleep.”

Dr. Antell has said of cigarettes,
What we see in a face of a smoker is a
window to what’s happened inside.”
Damage caused by sun exposure is arguably
better known today than ten or even
five years ago, although a large part of the
reconstructive work Dr. Antell does is
related to skin cancer. Perhaps his most
shocking case was that of a woman who
had, through a terrible and sad kind of
denial, allowed a basal skin cancer to grow
over much of her face. “The hardest thing
was that it encroached onto her eyelid,” he
says soberly. “We rebuilt both the inside
and outside of the nose. The reason I point
this out is because we used basically a reverse face-lift technique, taking all the
skin from her neck and moving it up. This
is why reconstructive surgery and cosmetic
surgery blend together. She really had a
face-lift but for a different purpose.”

As for the effects of stress, Dr.
Antell confirms that one can indeed “turn
gray overnight,” or at least within months.
“What happens with stress is what’s called
the fight or flight mechanism,” he says,
“that shunts all the blood away from the
perimeter to your brain and your central
organs. And the blood is being shunted
away from the scalp over time. So that’s
one aspect of stress. You also tend to
tighten the muscles in the forehead and
between your eyebrows with stress. It’s
like a tin can in that if you bend it enough
times, eventually it will crack.”

For someone with a national reputation
— his work has been written about
in such diverse publications as People,
Town & Country and Vogue magazines and the Wall Street Journal — Rick Antell
is also about as down to earth as it gets,
perhaps a reflection of his Norman Rockwell
childhood in Cleveland, Ohio, the son
of a dentist. Plastic surgery has its origins
in dentistry, and Dr. Antell earned a DDS at
Case Western Reserve University before
attending Medical College of Ohio.
“While I was in dental school,” he
says, “I met Clifford Khein, who was a
well-known plastic surgeon, and I started
following him around. I really got interested,
so I applied to medical school knowing
that I wanted to be a plastic surgeon.”

Then came internship and residency at
Stanford University, where he met Lisa (who also has a medical
degree but these days concentrates on the
family), then to New York
Hospital/Cornell University Medical
Center for training in his specialty.
“As a kid I was very finicky, very
detail oriented,” he says with a grin. “I was
always straightening up without thinking
about it, so I liked the precision of plastic
surgery. Having gone to dental school first
was really helpful; it’s terrific training in
using your hands. When I started practicing,
I did a lot of jaw reconstruction
because of that —the kind of surgery
where you cut the bones and reposition the
jaw. Today, with what’s called rigid
fixation, we put tiny little screws and plates
in. It’s all through the mouth, and it shortens
the recuperation process because you
don’t have to wire the jaw.” In some cases,
the patients can open their mouths right
after surgery.