Original Article By Leah Prinzivalli. To be wealthy is to get regular blowouts. But to be ultra rich means you may never wash your own hair. The glow of affluence—achieved through personal chef-fed meals and trainer-shaped limbs—sets the ultra rich apart. More than likely, they also visit the dermatologist every six weeks.

The global market for anti-aging was valued at $250 billion in 2016. By 2021, it’s estimated to reach $334.1 billion. Those numbers aren’t so intimidating for members of the 0.01 percent. In the United States, the average income of a 0.01-percenter is $26.1 million. But it’s not just Americans who get beauty treatments and plastic surgery in the States. Members of the Saudi royal family, elite businesspeople from Hong Kong and plenty of tourists on Fifth Avenue are all here to shave a few years off their appearance and drop hundreds of thousands of dollars in the process.

Even the average beauty consumer may find anti-aging products more costly than other skin care. Ingredients like retinol and peptides are more expensive. Brands are certainly aware that the people who purchase them have likely entered an age where they have more disposable income to spend. For people who pay no mind to price tags, using the most expensive skin care products money can buy is a given. These products are layered on in tandem with surgical and nonsurgical beauty treatments, a handful of which they might try during any single appointment. Then all that gets repeated multiple times each year. Let’s say a syringe of filler costs $1,000. The super rich may not just get filler in their lines and lips, but also in their earlobes, the soles of their feet and their hands. They’ll do it at least four times per year, and that’s just the minimum.

“When you're talking to a regular patient, the focus is when they can get back to work. For a point 1-percenter, the focus is 'When can I get back on my yacht?’” says New York plastic surgeon David Shafer, MD. “I remember I asked one woman 'What do you do?' and she said 'I hang out on yachts, and I want to make sure I can look good in my bikini.' I said no problem.”

I heard the term “maintenance” repeatedly in my conversations with elite plastic surgeons and dermatologists. The nature of the medical industry everyone has access to the same aesthetic procedures—although, doctors tell me, international patients often ask for treatments they’ve heard of in other countries that aren’t necessarily FDA-approved. The difference is in the sheer amount of treatments the ultra rich can afford to try, and once they start, most treatments need to be repeated if they don’t want the wrinkles to eventually creep in.

“It's very rare that I see anyone with a lot of money who hasn't done anything for awhile,” says Washington, DC dermatologist Tina Alster, MD. “The 1-percenters are people who get their nails done every week, their hair done every day, and they've been on high-maintenance for a long time.” An anti-aging regimen is simply one more box to check off.

A typical appointment for one of Dr. Alster’s elite patients involves a Clear + Brilliant laser, a treatment averaging $825 that uses light technology to reduce visible sun damage and improve skin texture. Then they’ll opt for a few syringes of Juvéderm and Restylane to fill lines or plump lips for another $1,000 to $1,500 each. Botox—another $1,000—is injected into the forehead and around the eyes. Alster explains that most patients come back for a laser touch-up “at least” quarterly. Celebrities and public-facing clients might visit as frequently as every six weeks for “baby Botox,” a quick touch-up that means the face will never quite unfreeze.

Next come the hair growth methods. Hair loss, which affects two-thirds of men and 40 percent of women by age 35, is a $4 billion industry. Both women and men have embraced PRP injections, a relatively new procedure that uses the patient’s own blood as an agent to stimulate hair growth. Average price: $1,125. Dr. Alster’s patients will start with a series of four monthly treatments of PRP. If hair growth doesn’t meet their expectations, they’ll re-up the series with another four, and maybe another four after that. Why not? For guaranteed results, some patients opt for a hair transplant (picture Elon Musk’s before-and-after photos), which can run between $8,000 and $10,000.

At her Greenwich, CT Medical Spa, Marria Pooya will combine multiple treatments into an exclusive grab bag. She has created an “Activator” treatment for thinning hair. The package includes a series of PRP treatments, a laser cap administered by a nurse or doctor at home, vitamins, and prescription drugs. Where another patient might save up for just one of these options, she knows the elite will try them all at once.

Aesthetic doctors take a 360-degree approach to what they term a “rejuvenation” or “refresh,” aka “getting work done.” The face loses volume with age, which is why so many anti-aging products promise skin lifting or tightening. New York plastic surgeon, Daniel Maman, MD, who retains an office in an Upper East Side building so exclusive there’s an entire book written about it, compares his approach to a home renovation. “When you renovate your house, you don’t just renovate the foyer, and people are walking through an old house except for one room. You have to balance the whole place,” he says. He might address sagging skin with Ultherapy, use an injection such as Juvéderm Vollure or Voluma, or suggest a facelift. Patient retention is one of his goals: “We don't treat patients like they’ve just come to buy a dress and we’ll never see them again. We discuss everything in detail and create a comprehensive plan.”

Once a point 1-percenter has grafted and injected their way into an ideal face, attention turns to the rest of the body. Unlike a regular ol’ rich person who may prioritize their face, the elite expect head-to-toe service. “Hands are a big deal,” says Dr. Alster. She injects fillers or fat into the hands to keep her clients hands looking as youthful as possible to a Washington, D.C. receiving line. Hands typically take two or three syringes to fill, for $2,000–$3,000. One of Dr. Alster’s patients offhandedly mentioned to me that she gets filler in her earlobes.

On the West Coast, fairer weather means Beverly Hills, CA dermatologist Ava Shamban, MD also frequently advises clients on full-body treatments. “We have more skin exposed,” she says. Of course, each additional body part means an extra price tag. For the ultra rich who don’t have to prioritize, why not laser away your spider veins in addition to your hyperpigmentation?

The uber-wealthy can afford to extend what we typically consider a facial procedure to the entire body. “You might do CO2 laser resurfacing on the whole kit and caboodle,” says Dr. Alster. “I had a client who loved it so much and felt like her skin was so revived, that she got it on her legs.” Another $1,000 at minimum. Once scarf season begins in the fall, attention shifts to the décolleté and neck. Doctors perform Silhouette InstaLift, a minimally invasive procedure that uses absorbable threads to lift the face, which can run $2,500–$5,000.

The 0.01-percenters who pay top dollar for treatments also expect a level of service that most people never experience at all, and certainly not in a doctor’s office. At 740 Park, Dr. Maman maintains a “fly-in program” that books out-of-town guests into local five-star hotels. His staff serves as part nurse and part concierge, helping patients decide how long to stay and arranging their travel to and from the hotel, as well as assisting in recovery post-procedure. Nurses are on call to the hotel 24 hours, and Upper East Side doctors treat hotel floors like hospital floors, except with much better room service.

Dr. Maman’s NYC office retains contracts with the Carlyle Hotel, The Mark and the Surrey, where even basic rooms average $400 per night. Dr. Shafer’s office tends to book Middle Eastern patients into The Palace. “[The hotel] has some floors that have been decorated to look like you’re in Saudi Arabia,” he explains. “The art on the wall is Arabic; they have all the Arabic TV channels. It's not just medical, the whole hotel caters to them.”

“My office is right on Fifth Avenue, so people come in with their Gucci and Ferragamo shopping bags. They do their shopping and the plastic surgeon is just one stop on their trip,” says Dr. Shafer. “I have patients that live in Bermuda. They fly to New York ­in the morning, get their Botox and fly back in the evening.”

Patients who aren’t interested in travel can fly their doctors to them. Dr. Shamban once traveled from LA to Europe to fix an actress’s lips before the Cannes Film Festival. She was in France for one night. Dr. Maman has flown to the Middle East to do a procedure for the super elite. “I’ve taken care of members of the Saudi royal family who come with an entourage of 200 people, all conversations are through their entourage, and only sometimes am I allowed to see the patient,” he says.

For all their access, you might expect the wealthy to march straight into a doctor’s office with a list of exactly which laser to point where. But Dr. Shamban says the super rich don’t tend to have specific requests. They come to her office with a problem area or aesthetic goal, and her job is to figure out how to fix it.


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