I am the
Make-up maestro Pat McGrath meets the Botox King.
By Pat McGrath
Photographs by Mathieu Perroud
For those seeking the light of youth, there is one man, a pioneer in non-surgical cosmetic treatments and injectables whose undetectable enhancements have established him as the Botox King. But prior to earning his reputation as one of the most sought-after cosmetic doctors in the world, Dr Jean-Louis Sebagh spent years rebuilding the faces of cancer and burn victims at the Hôpital Foch in Paris. Today with close to 5,000 patients and having a super-luxury cosmetic line of creams and serums worth millions, he is a staple in the beauty regimen of many of the world’s most famous faces. With offices in London and Paris, and the occasional pop-up clinic – a fixture in LA during the lead-up to the Oscars each year – Dr Sebagh is always on the go. After turning her away at her first consultation, fashion’s go-to make-up artist Pat McGrath finally has a chance to sit down with Dr Sebagh to discuss fish lips, vampire lifts, and what it means to be ‘in frame’.
It’s been so long! You look so young, Dr Sebagh!
I take care of myself, darling. I’ve got new products; I’ve just finished a new prototype. Oh my God, it’s a facelift in a bottle! I’ll send you some samples as soon as I can. Anyway, you look great, have you lost weight since I last saw you?
Yes, I’ve been going to the gym.
I can tell, it shows.
I always wanted to know, when you see a woman walking down the street, can you see the exact work she’s had done? Like just now with me, you could immediately tell I’d lost weight.
Yes, more or less. If I know someone, I can tell immediately. I have terrible memory for names, but faces are imprinted on my mind. You know, if we use the analogy of painting, the contrast between the two of us is that I deliver the white canvas and you apply the paint. You are the artist. I am the restorer. My life is in black and white; I just see lights and shadows. Your life is in colour. My job is to deliver to you, the make-up artist, a clean slate onto which you can create your fantasy, from nude to cinematic, changing characters.
‘My job is not creative. If a plastic surgeon believes he is going to create something, it’s a disaster. That’s when it all goes wrong.’
I only see women in the nude without their make-up. I have to make them feel comfortable and attractive as they are. For you, it’s different. They ask you to create something. My job is not to create. That is the worst thing a plastic surgeon can do. If a plastic surgeon believes he is going to create something, it’s a disaster! That’s when it all goes wrong. My job is to restore. To give a woman the youth she had five or 10 years ago. I give a woman little tweaks, but when she has to go to the Oscars and wants to look completely glamorous, she has to come and see you, and you will create something amazing.
That’s true. Sometimes women or men want to have something ultra-creative, but other times they just want their skin to look like it belongs to a baby, and then we have to create something completely natural and undetectable. Of course, if someone needs a little work done, they have a little work done. The thing I love most about Botox and fillers is that when it’s done well, it’s pretty much undetectable.
Yes. It just gives more highlights and shadows, that’s it.
Exactly. I think plastic surgery gets a bad name for itself because what we see mostly are the mistakes. The work of a good plastic surgeon is when someone says, ‘Oh, you look really well and rested. Have you been on holiday?’ When in actual fact you’ve just had fillers.
That’s exactly what I said 30 years ago. If you can point something out, it’s wrong. Everything has to be undetectable.
Do you have patients who become addicted to your treatments? Do you notice and tell them when to stop?
It’s very complicated. With the people who are addicted, I have two options: either I tell them I will not go further because it’s too much, or sometimes I keep them on but try to limit the disaster by giving them touch ups to calm them down. I don’t like doing that, but sometimes you can’t fight the addiction because you know they will just find someone else who will do it, and it’ll be much worse. So it’s a tricky game that you have to play – although you don’t enjoy playing it. Thankfully we don’t have too many patients like that.
What sort of a rapport do you have with those kinds of patients?
I try to tame them and educate them, so they feel more confident to avoid this urge to do more. I tell them how often I need to see them and let them know they can rely on my judgement. Most of the time, they come back and ask for more, but I tell them it’s not necessary. And if I see that they don’t need more at their next appointment, I will postpone it. Sometimes I can be pushy and tell them, ‘You can’t carry on like this, it’s too far!’ I am extremely conservative, but in order to honour the confidence that my patients put in me, it’s also my business to be honest. If my patients don’t trust me, then they’ll leave and find another doctor to do the job. If a patient wants to leave me and see someone else then that’s fine – it’s a free world – but I don’t push them to do injections all the time. I’m lucky I don’t need to be like that; I develop long, serious partnerships with my patients – I’ve had some of them for 30 years now – but unfortunately many doctors are only in this for the business.
Do you do many corrections on people who have gone to bad doctors?
Yes and no. I’m fully booked with my existing patients, but some do stupid things, and then they come back with fish lips or something dodgy like that, and I have to repair it. They say, ‘Oh, I am so sorry, I made a mistake! I promise, I’ll never go see anyone else!’ Unfortunately, 10 or 20 years ago when they used silicone, that would not have been the case – you were doomed for life. Now it’s mainly hyaluronic acid which is easily dissolvable, so thankfully you can repair the mistakes. I don’t like anything too permanent – that’s why I only use dissolvable products. It’s not good to do something long-term because ageing is a continual process, which you need to adjust around. Everyone is slightly different. What I do is permanent adjustment. It’s like a moving puzzle, and it’s about maintaining the balance.
‘People laugh about cougars, but they’re only 45 to 55. Who’s talking about very attractive 55 or 65-year-olds? That’s a whole new world developing.’
So you can’t do anything with silicone.
No, it’s a nightmare. All these poor women who were injected with silicone 20 years ago are all disfigured for life. Although the big silicone lips can now be cut out; that’s common practice.
Does it look ok?
Yes, but when they’ve been injected in their face, they end up with lumps and bumps everywhere, and unfortunately there’s nothing you can do. Thankfully though, that’s a thing of the past. The new generation won’t have to experience those problems.
When someone does Botox, do their muscles become lazy or atrophy?
I honestly haven’t seen many cases of that in my life. I have been doing Botox on my own forehead now for nearly 20 years. I was 39 when Botox came out in the early 1990s, and personally speaking I have perfect movement, no atrophy. Most patients keep it for five or six months, but some can keep it for eight to nine months. It depends, some are more resistant than others.
That’s amazing. You only have to go twice a year. In which part of the body do people mostly have it done?
Most people think it’s all about the forehead, but for me the most important area is the lower part of the face. This is the area I believe is really essential because you can prevent a saggy jawline and neck and therefore avoid the need for a face lift.
When should you start?
It’s good to start on that area around 35 to 40; then you’ll never need a neck lift which is the main issue at 50. I do more Botox on the lower face than on the forehead now.
You don’t want that surprised look, right? You don’t want to do it too much.
I’ve always had a soft vision on Botox. I dilute it more than is recommended, to make it softer. Twenty years ago when Botox came out, I came up with the term ‘emotional Botox’, because you have to maintain expression. I visit Taiwan twice a year, and I find that local people there don’t age the same way Westerners do. In fact, throughout much of Asia, you notice that although people have the same anatomy as Westerners, they don’t move their face muscles in the same way. I have always been amazed by this: they don’t frown or squint as much, and subsequently Asian people don’t really need Botox.
But an Asian person must age at some point and need Botox, no?
No, not much. Botox is for muscles: some people are very Zen and age classically, whilst others aren’t or have strong expressions – this is called mechanical ageing. It’s an unfair ageing process which essentially means the more ex-pression you have, the more lines you are going to create.
So there are different types of ageing?
You have three types: genetic ageing, which very much depends on your genes, lifestyle ageing which is based on how you live your life, and mechanical ageing – which has nothing to do with your lifestyle. Usually the problems begin when you go from hyper-expression to no expression at all. In a way, you have to be a good puppeteer and carefully pull the right strings in order to maintain natural expression and not kill it completely. It’s very tricky though, you have to analyse the face, see all the different expressions and the way it moves before you can tweak anything or control the movements. In a way, it’s an artistic exercise. It’s not simple black and white, it’s far more sophisticated than it seems.
Amazing, it’s like painting under the skin with the muscles.
Yes, but it’s also animated, so it’s complicated. Also, we have to find the softness in the expression.
You have to make sure that the face moves correctly after it’s applied. Sometimes when women get Botox and fillers, when they talk and smile, everything looks strange.
There’s a sociological issue behind this. There’s quite a difference between women in Europe and those in America. In America women want to be in control, they actually like the mask. When Botox came out, it was amazing for them because they could freeze the face into a proper mask where nothing was moving, and everything was pulled and tight. I am not saying that it’s very attractive, but they felt more comfortable and in control. In Europe, we are a little more relaxed. I think this is why Botox tended to be so frozen in America for so long. Generally speaking though, American women have always been a little more concerned with their looks, and this corresponds to how they interact with make-up too; they want to wear more make-up than Europeans.
In the US, they go crazy over make-up. I love that.
Yes, of course you love that!
I do think that in the States there is a real obsession with beauty, thank God!
Yes, thank God! But it’s driven by in-security.
I think England is becoming much more like the States. People are increasingly obsessed with preserving their youth here, so I think eventually it is going to become a worldwide phenomenon. From my own experience, I can tell you that with my friends in England, we spend our entire lunch hour discussing this stuff – it’s what we’re all obsessed with right now.
Maintenance is the keyword.
So, it’s definitely better to start early? How young would you say?
I would say 25 or 30. Taking care of your skin is essential from a very early age – I would say 15 or 16. Being careful with the sun, using the right moisturiser, exfoliating – all those sorts of things. It’s important to have a very good skincare regime, applying the right products depending on what suits your skin type, understanding the concept of cleansing and exfoliation. The borders between skin care and make-up are diminishing now too, and there’s a fusion between both worlds. It’s important people educate themselves on how to look after their skin properly.
‘A client said, ‘I’m an emerald digger in South America. The guys in the mines are nasty. I want you to scar my face so I look like them.’’
I agree. One thing I’ve got to ask you, what’s the strangest request you’ve ever had from a patient?
I have a lot of funny stories! One time a man came to see me, and he said, ‘I’m an emerald digger in South America. In the mines, they are tough guys. I want you to make a big, nasty scar for me on my face because I want to look like them.’
Are you kidding?
No! He said, ‘I want a big, nasty, nasty scar on my face because I want to look like one of the nasty guys.’ I said, ‘Sorry, I can’t do that to you.’
He really wanted that?
Yeah, it’s crazy! Then he said, ‘Ok, I’ll have to get into a bar fight with a bottle!’ ‘If you want’, I said, ‘but I can’t do anything for you.’
Oh my goodness, that’s amazing, the best story ever. Who do you consider to have the most perfect face? Is it someone we know?
I was in LA three weeks ago for Cindy’s 47th birthday, and she’s amazing. She hasn’t changed at all.
I recently met someone else you must know very well – Tyra Banks. I found her so beautiful. She’s soon going to be 40. Amazing body. Amazing face. I have a big crush on her. Elle est belle!
Very, very beautiful. I love her.
And you, who’s your ideal beauty?
Oh, I can’t think.
It’s difficult. I mean, I’m only thinking about the people I’ve seen recently.
There are so many. Some of the models and celebrities I work with may hate a certain feature on their face, but I might find it very beautiful. The nose might be a little too big, but you’re like, ‘Without that nose, you wouldn’t be you; you look exquisite like that.’
Absolutely. I was so impressed by Mrs Graff, the diamond dealer. She’s 75 and absolutely amazing. She’s not an actress or anything, but she looks so good. It’s normal if you’re a top model, and you’ve always been beautiful – it’s God’s gift, and you just have to preserve it – but to look amazing, attractive, and beautiful at 75, this is a challenge. This is the real meaning of maintenance for me.
I think we’re going to have more beautiful 75-year-olds now.
Yes, more and more. It’s going to be a disaster because there are no men to match these women. They are all definitely going to have young boyfriends! Attractive women between 55 and 75, and I mean attractive, attractive – never really existed before as a category. People laugh about cougars, but they’re only like 45 to 55. Who’s talking about 55 or 65-year-olds? That’s a whole new world developing.
‘Botox was amazing for American women because they could freeze the face into a proper mask where everything was pulled tight.’
That’s so true. And are you finding that more men are coming to see you because they’re trying to keep up with the women?
Yes and no. I think men want to, but with them it seems to depend on the economy. Before the recession, I used to have so many men coming, 20 percent or more. Since the recession, this has decreased. So, when the economy is good, then yes.
They have other things to worry about.
At one time, I was so surprised by how many male clients we had. It was like a surge of men. And then suddenly, we went back to less than 10 per cent. But we will definitely have more and more. It’s a future market for sure.
If they’re going to keep up with the women, they’re going to have to. Do you ever tell patients that they need to gain weight?
Yes. Put on weight, lose weight. Very often, I tell them to lose weight.
What about asking them to gain weight so as to make the face look a little bit more… plump?
For me, it’s mostly losing weight for definition between the jawline and the neck. I have this lovely expression they sometimes don’t understand: ‘You’re out of frame.’ And they say, ‘What do you mean, I’m out of frame?’ ‘You see the frame? You’re out of it. So I cannot work. Get yourself back into the frame!’
When you tell someone they’re ‘out of frame’, do they ever get mad with you?
Yeah, sometimes. I remember this famous songwriter in America. She was petite, but I told her, ‘You’re really too fat at the moment, you’re out of frame.’ She almost choked. Every time she sees me now, she remembers that. But you know what, she lost the weight – two or three kilos –and she came back in the frame.
So, when you sent me out of your office… [Laughs] Oh my God! I came to see you 100 years ago… Do you remember that?
Of course I remember, but I didn’t…
…because I was out of frame!
But you know, the issue is that most of the rejuvenation we do without surgery restories volume. All of these non-surgical techniques are mainly done by volumising and not pulling. When there is too much volume in the lower face, we’re in trouble – then we make the face huge. So it’s really important that there is volume in the right places. We have a new concept now which is very interesting, and I love it. We do threading.
By threading, you mean, threads that go under the skin?
Yes, you can’t just add volume, sometimes you need to pull you need tension if you don’t want to have surgery because it’s too early, we can use these dissolvable threads called Silhouette Soft from America. Ten years ago, the Russians launched the first threads, but I never liked them because they were nylon barbed wire and permanent. I hate anything permanent; I want people to be able to change their minds.
They would start to disfigure the face, I remember.
Yeah, but now we have very gentle soluble threads, and we can create amazing tension in the cheek, in the temple, in the jawline, in the neck… It’s my new toy.
And how do they go in?
They go in with a needle. They last 12 to 18 months, and you create the tension wherever. You can lift the eyebrow, you can lift the cheek, you can pull the jawline and the neck.
How long is the procedure?
Do you have to go under completely?
Absolutely not! You take a little local anaesthetic, and it’s in and out. It just takes 20 minutes to half an hour.
Are you kidding?
I’m not kidding. In half an hour, you can have your facelift done. Absolutely spectacular.
That is amazing! I love that. That is genius.
And it’s FDA approved. The downside is that you create some skin gathering because you pinch, so you will have an excess of skin to hide which will even out and disappear within a week or 10 days.
And you’ve never had any adverse effects with anyone doing it?
If the thread breaks, you can pull it out from where you put it, or you can even leave it inside.
And it dissolves?
100 per cent, it completely dissolves. That’s why I’m doing it.
And then you have to do it again?
Yes, they last about 12 to 18 months, and then if it’s the right moment, you can adjust them. For those women who are around 45 to 50 years old, and who are in long-term maintenance – I’m not talking about the woman who woke up at the last minute at 50 but the women who have had Botox and fillers to prevent the sagging when they needed them – this still works perfectly for them and prevents or postpones the need for surgery. You always have to respond to what you see. The more tools you have, the better you are able to do your job. You have lots of tools at your disposal, not one tool for everything and you need to know how to combine them – a little Botox, a little filler, a little thread in order to do the job and deliver something nice.
That sounds like a real sculpture!
There’s also a new technique with blood – the plasma lift – to re-firm the skin. It’s a new technique we call the vampire lift. That’s the best.
‘Ten years ago, the Russians launched the first threads, but I never really liked them because they were like permanent barbed wire.’
Oh my gosh, the vampire lift? I have never heard of this.
I’ve heard of the vampire facial from Kim Kardashian…
That’s it, that’s it! But the way Kim did it was the ugly way, very gory, but you can make it clean. That woman is obsessed. It’s funny, she emailed me months ago and wanted to come into my office – I don’t know why, maybe to do that. I said, ‘I think I read that you’re pregnant.’ She said, ‘Yes,’ and I said, ‘Stay away from me.’
Let me ask you more about the vampire in more detail. What is it? You take your own blood?
It’s a very bad name… It’s actually called the plasma lift or the PRP [Platelet-Rich Plasma]. To understand how it works: if you burn or cut yourself, your skin will repair naturally, right? Why is that? Because your blood contains something which we call growth factors. It’s these growth factors that rebuild tissue to help you heal. So, you have this natural repair system in your blood. We draw the blood, just four tubes – 30ml – and then we centrifuge it with a special gel to separate the yellow and red parts which form our blood. The yellow is the plasma, and it is made up of two parts – the upper part, PPP [Platelet-Poor Plasma] and the lower part PRP [Platelet- Rich Plasma]. It’s the platelets that are in fact very rich in growth factors. By selecting the parts of the blood naturally rich in platelets, we can create a concentrate containing 600 times the normal amount of growth factors. Then, we simply re-inject this concentrate back into your skin.
Amazing. So it’s injected like Botox?
We have a very clean way of doing this with a mesotherapy gun – it’s not that rough gore technique – we just place the syringe into it, and then tack, tack, tack, thousands of mini-injections – painless, bloodless, and no downtime. We can do it on your face, your neck, your chest, your hands – it’s amazing. As humans we have stem cells in our body: not in our organs but in our bone marrow and in our skin. After a certain age, they fall asleep and don’t manufacture new cells which means our skin starts ageing; but by using this procedure, if you’re lucky, you not only repair and stimulate the skin, but in 75 per cent of cases, you wake up your own stem cells. When that happens, it’s like a miracle of the skin. You see youth and new skin emerging. The luminosity and radiance is something unseen. Even with make-up, you can’t create that. It’s the light of youth. It’s unbelievable.
Does it work well with dark or black skin? Sometimes I see scarring from the needles on the skin of friends.
I don’t see why not. We have a lot of black patients. What you get – regardless of skin colour – is that occasionally the needle can make a lot of scratches. If you’re not careful, you can make hundreds of little scratches on the face which take four or five days to disappear. You have to be really careful during the procedure to not be too heavy-handed, and to change the needle quickly if you feel it’s a bit crunchy. Sometimes you only realise this at the end, and it’s like you’ve been attacked by a dozen cats. It’s more about the operator than the colour of your skin.
So there’s no damage to darker skin. What about the effects of lasers on dark skin?
With laser and dark skin you have to be really careful. Fraxel is dangerous because it makes you photosensitive. The best and safest technology we use for black skin is radio frequency. We have many machines from Thermage to E Two that are based on radio frequency and are more concentrated on firming. That’s what I have done on my own skin for years.
I’ve got so much work to do! [Laughs] I’ll be booking appointments.
You have to maintain the firmness of your skin, you have to keep the layer and also maintain your muscles. It’s a three or four layer problem. You have skin, fat, muscle, and bone, and everything is ageing. When you’re young, everything is intertwined together – skin, fat, muscle, bone, it all sticks together. The problem with the ageing process is that all these different layers age at different speeds for different reasons, and things become destabilised. That’s why I refer to it as a puzzle. It’s your job to maintain the firmness and elasticity of the skin as much as you can.
‘You have to be really careful during the procedure not be too heavy-handed, otherwise it’s like you’ve been attacked by a dozen cats.’
So brilliant. I love it. When I told my friends I was going to be talking with you, everybody had so many questions to ask you! There was something about men… Do you have to use different tools or techniques on them?
Yes and no. The anatomical problem is the same – it’s about skin, fat, muscle, and bone. All the techniques with Botox or fillers work amazingly on men, especially when they’re 60 or 60-plus. Lots of young men are doing it, but unfortunately old men don’t know about it or don’t dare think about it. But honestly when a 65-year-old man redoes his lips to restore some volume, it’s so nice, it’s much better than any surgery! Women want to be flawless, but this is not the case for men – you play around with crow’s feet or smile lines. Mainly, it’s about volume because young men have a tendency to do too much sport – they’re obsessed with the gym – so their faces become gaunt because they lose too much fat. Sometimes their faces look 15 years older than their bodies.
This is what you say with women: if they’re too skinny, it ages them more.
The worst thing for a woman is to run.
Do you ever say to them, you need to eat? Just fill it up?
You know what the mistake is? Skinny women, the ones who don’t eat, they keep their face most of the time. The ones who really destroy their faces are joggers, the ones who run too much; they really damage their skin because there is no fat padding anymore, and they become gaunt. It’s really traumatic. Some skinny girls manage if they’re young enough to keep a balance within the whole body.
Do you think that exercising can be ageing?
Yes. Too much can be damaging. It depends what exercise – running is the worst, but if you do yoga, Pilates, cardio training, it’s fine. Intense sports and running are really bad for the face and for the breasts – saggy boobs. You can see that all of these running girls, they really have the gaunt face.
That’s amazing to know.
They run too much because they want the endorphins, but it’s not good. You can walk as much and as quickly as you want, do Pilates, yoga, whatever, lift weights if you want, but you shouldn’t run more than four miles twice a week.
Do you recommend facial exercises? Do you think they work?
Not really. The only exercise you should be doing is smiling all the time, if you can. And chewing.
‘The worst thing a woman can do is run. Women who don’t eat keep their face most of the time. The ones who really destroy their faces are joggers.’
I love that.
All of the other muscles are depressor muscles. There is also one good yoga exercise – when you stick your tongue out 10 times, and you put your finger in and pull the tongue. Every woman complains about not having any muscle in the floor of her mouth – there are muscles either side, but in-between there is nothing. You can make it firmer by pulling out the tongue and keeping the neck high. It’s good for double chins.
I’m going to be doing that all day. I’m so happy we’re doing this. Have you heard of anyone being allergic to Botox?
Resistant but not allergic. Strangely, the only resistance I’ve seen has been from Russians, and I have a very international clientele. I think I have an explanation for it. Botox is derived from the botulinum toxin which is food poisoning. During the Cold War, the Russians had very few food supplies, so they used to receive expired cans of food from Europe. They used to eat out-of-date food, so they must have had a lot of food poisoning and became immune to the botulinum toxin! Weird, no? You can inject 10 bottles, and they won’t react. Nothing! They really have antibodies.
My friend asked a question: if a woman is getting her lips done every six months, would you suggest that she just opted for something more permanent?
Never do anything permanent. Normally a good lip filler should easily last one year anyway. And when you build up, it should last longer up to three years. But sometimes you please some women and put a little drop in the lower lip – I call it ‘the sexy drop’. The pout. Going back to your earlier question about the people who become addicted, sometimes you find these little tricks to please them. I say, ‘I’ll give you the sexy pout,’ or they come and say, ‘Oh, will you give me the sexy drop?’ and I say, ‘Sure’ and it’s just enough to make them happy.
That’s a clever bit of psychology.
Why do they want such big lips? I can give them a nice shape to start with… but then you have the gloss and so much make-up to style the lips to make them anyway you want. I just provide a good base.
A lot of people have body dysmorphia. They think they haven’t got anything, and they say to me, ‘I’ve got nothing in, my lips are too small.’ But they’re huge!
You’re right. Does that cause you problems with your work?
No, not really because I work with a lot of celebrities and models, and they know that they have to be very careful. The actual models are so young that most of them aren’t doing anything. The ones who are slightly older are very careful, they take it to almost an art form. With the people who don’t seem to realise how much they’re doing, how do you cope with them and talk them down? It’s like psychology because you really need to get into someone’s mind.
I say, ‘I want you to be the most beautiful woman on a Sunday morning.’ You know when you wake up on a Sunday morning, and it’s a day off, you don’t put on make-up, you don’t put on anything, and you look gorgeous.
Wow, I love that – a Sunday morning beauty.
Easy, fresh, natural. You have to be comfortable. I fully understand the woman wants fantasy. She wants to be extremely glamorous, to be noticed. At night, she puts on her dress and high heels and everything else, but I’m not part of that world; I’m part of the Sunday morning. The rest is fashion designers, hairdressers, make-up artists – it’s a wonderful fantasy world where you can please yourself and have whatever kind of look you want. One day you can be punk rock or gothic and another you can be sexy and glamorous. That’s the pleasure of being a woman, you can dress yourself in so many different ways.
Sometimes women are so afraid of make-up; I say to them, ‘Don’t be afraid, experiment! It comes off. It’s not permanent.’ You should have fun with make-up and be free.
It’s an absolute fantasy, it’s beautiful.
Fantastic. I love it. Oh well, this has been so much fun.
We should see each other more often.
Well, now, am I in frame?
[Laughs] I thought you rejected me because I was too young.
I’m teasing you! You were too young. You didn’t need anything.