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Botox is out. Plasma injections are in. But is L.A.'s 'natural' anti-aging movement any better?

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Botox is out. Plasma injections are in. But is L.A.'s 'natural' anti-aging movement any better?

When Ali Weiss, 30, shares a selfie on Instagram, she often adds a disclaimer: This is a face that hasn’t had any work done.

“The most punk thing you can do in 2024 is not f— with your face,” the New York City-based on-air host and podcaster writes via email. Surrounded by peers who got fillers early and often, she believes her choice puts her in “the minority,” especially for those working in front of the camera. “The fact that people seem to be more shocked by a-30-year old who hasn’t gotten work done than a 30-year-old whose entire face is frozen is bonkers,” she says.

Weiss writes of her filler-less face with pride, but she still cares about her youthful appearance. She has several less-invasive treatments in her arsenal, including a red-light therapy gadget, laser facials and facial massages. In a few years, she hopes to try more invasive laser treatments that cost thousands. Anything before considering injectables.

For the last few decades, the consumer base for neuro-modulators like Botox and dermal fillers like Juvuderm has grown exponentially. In 2010, more than 5.3 million people got Botox and more than 1.7 million received filler in the U.S. In 2022, 8.7 million received Botox and more than 6.2 million received filler, according to the American Society of Plastic Surgeons. Especially in recent years, these procedures have gone from an indulgence for the wealthy and famous to casual and frequent appointments that cost a few hundred dollars.

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“They are incredibly effective, relatively low cost and have become part of an accepted mainstream lexicon for self care,” said Dr. Steven Williams, president of the plastic surgeons’ group.

But now, a number of beauty-conscious consumers are saying “no” to injectables and directing their money toward expensive natural treatments instead.

Marta Freedman, 33, is one of them.

“I grew up in the era of excess injections and the Kardashian era, so for me, it makes sense that the pendulum would swing the other way as people investigate alternatives,” the L.A.-based entrepreneur said.

Weiss and Freedman are among a chorus of anti-injectable sentiment on social media and in beauty publications that has intensified in recent years.

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“The art is in making the work disappear and look like nothing has happened.”

— Dr. Ava Shamban, founder of Skinfive Medical Spa in Pacific Palisades

TikTok and Instagram feature thousands of videos of (mostly) women chronicling the process of dissolving their filler. The sometimes painful process can take multiple sessions and is done by injecting an enzyme called hyalase that can cause facial features like lips to bruise and balloon before settling back into their original shape.

Many Los Angeles-based practitioners are noting filler fatigue among their clientele. They’ve seen more patients who are asking not only for their fillers to be dissolved but also seeking alternative procedures to maintain an enhanced, albeit more technically natural, look.

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“There is a pendulum swing back to the more natural, best version of yourself, similar to the ‘no makeup makeup look,’” said Dr. Ava Shamban, founder of Skinfive Medical Spa in Pacific Palisades. “The art is in making the work disappear and look like nothing has happened.”

So what are the beauty-obsessed, but Botox-averse doing instead? Some will pay top dollar for all-natural ancient practices, while others opt for high-tech, sometimes painful treatments — just so long as they can say they’re toxin-free.

Julie Civiello Polier has amassed more than 120,000 followers on Instagram by espousing noninvasive anti-aging facial massage techniques. Before the pandemic, the Los Angeles-based aesthetician and Chinese medicine practitioner offered in-person facials to her celebrity clientele, including Goldie Hawn, Miranda Kerr and Christy Turlington, but has since moved her practice online, teaching clients massage techniques for facial lifting and sculpting.

Her Instagram videos — with titles like “Support for ovaries and eyebrow lift” and “No Botox needed forehead sculpting” — have built her a dedicated audience . The services she provides range from live-streamed classes on DIY face-lifts (that cost $100 per ticket) to one-on-one coaching packages, priced at more than $2,000.

“I don’t feel aligned with filler or Botox, I prefer myself with a more natural look.”

— Marta Freedman, L.A.-based entrepreneur

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Angela Cravens, a 45-year-old copywriter based in San Diego who prefers chemical-free beauty products and Eastern-inspired natural practices, is one of her followers. Since finding Polier’s free tutorials on Instagram, she’s built a gua sha and facial routine that works for her. She says people often mistake her for being younger than she is — something she posits may be because she avoids injectables, “not the other way around.”

Polier says her clients come for the aesthetic benefits but find unexpected emotional release from her techniques. Inspired by traditional Chinese medicine, she believes inner traumas can affect parts of the face.

“This one client kept getting surgeries on one part of the face and it kept kind of drooping back down or kept kind of being really inconsistent with the other side, until we started looking at her relationship with her father,” Polier said. “That left side of the face is where our relationship to [our] father is stored.”

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In West Hollywood, a three-year-old cosmetic acupuncture practice called the Reset caters to people in their late 20s to 40s who don’t want to try injectables. Owner Toni Weinrit, a board certified and licensed doctor of acupuncture and Chinese medicine, says that although some of her older clients still use injectables, the younger generation is thinking twice.

Freedman, the L.A.-based entrepreneur, found Weinrit on Instagram and did weekly treatments at the Reset for about 10 weeks last year. She plans to resume them there soon. (In the meantime, she’s supplementing with at-home electrocurrent devices, Frownies wrinkle reducing patches and professional facial massages).

“I don’t feel aligned with filler or Botox. I prefer myself with a more natural look,” she said.

Weinrit charges $250 a visit for the service, advising a regimen of 10 sessions across five to 10 weeks (after which she recommends once-a-month maintenance, combined with occasional $500 microneedling, which she said aids in improving skin texture).

The American Institute of Alternative Medicine says cosmetic acupuncture “operates on the belief that the face reflects the body’s internal balance and health.” While the practice is rooted in more than 2,000 years of traditional Chinese medicine, there have been limited scientific studies investigating its benefits on facial skin elasticity.

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Though Weinrit’s services are significantly more expensive and time-consuming than your average Botox or filler treatment, her schedule is booked. She theorizes that that’s because the results are gradual.

“If you get Botox, 24 to 48 hours later, you have a different face,” said Weinrit. “This is not that.”

“If you get Botox, 24 to 48 hours later, you have a different face. This is not that.”

— Toni Weinrit, owner of West Hollywood acupuncture studio The Reset

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Some clinics have begun counseling patients about the changes they want to make, going so far as to refuse requests that won’t look natural.

Cosmetic nurse Vanessa Lee nearly left the industry after being asked to give lip injections to a teenage girl with her mother’s approval. In 2018, she opened The Things We Do, a medspa in downtown’s Arts District (now with locations in Chino Hills and Venice too) that focuses on a moderate approach. Lee, who has more than a decade of experience, says the medspa receives so many requests to dissolve filler done by other practitioners that she has had to begin charging for the once-complimentary service.

The Things We Do has a naturopathic doctor, a licensed healthcare provider on staff who is trained to address skincare through gut health. Lee says she has turned away patients who request excessive work and has referred them to a therapist.

“If somebody comes in and they’re saying things like ‘This guy just broke up with me’ or ‘I’ve been through the hardest year,’ maybe they’re not at a place to be making a big decision about full facial balancing while they’re in this emotional state that needs a bit of support,” she said. “Let’s start somewhere else first.”

Even so, Lee is running a business. For patients who are seeking a youthful refresh, she and her nurses first suggest bio-stimulating treatments like platelet-rich fibrin matrix.

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The treatment, which clinical studies have shown can reduce wrinkles and hyperpigmentation, involves drawing a patient’s blood, extracting the plasma from it and either injecting it in the face for those with volume loss in a specific place or using it with microneedling devices for patients with thin or dull skin.

One session starts at $1,100 for results that can last up to two years when done twice. Yes, needles are used, but no foreign bodies are injected into the face, a technicality that is meaningful to clients who want to avoid chemicals.

The procedure is proof that, though the pendulum may be swinging toward a more natural approach and look, one thing will never go out of style: the willingness to pay — and suffer — for the promise of beauty.

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What’s in a Name? For These Snails, Legal Protection

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What’s in a Name? For These Snails, Legal Protection

The sun had barely risen over the Pacific Ocean when a small motorboat carrying a team of Indigenous artisans and Mexican biologists dropped anchor in a rocky cove near Bahías de Huatulco.

Mauro Habacuc Avendaño Luis, one of the craftsmen, was the first to wade to shore. With an agility belying his age, he struck out over the boulders exposed by low tide. Crouching on a slippery ledge pounded by surf, he reached inside a crevice between two rocks. There, lodged among the urchins, was a snail with a knobby gray shell the size of a walnut. The sight might not dazzle tourists who travel here to see humpback whales, but for Mr. Avendaño, 85, these drab little mollusks represent a way of life.

Marine snails in the genus Plicopurpura are sacred to the Mixtec people of Pinotepa de Don Luis, a small town in southwestern Oaxaca. Men like Mr. Avendaño have been sustainably “milking” them for radiant purple dye for at least 1,500 years. The color suffuses Mixtec textiles and spiritual beliefs. Called tixinda, it symbolizes fertility and death, as well as mythic ties between lunar cycles, women and the sea.

The future of these traditions — and the fate of the snails — are uncertain. The mollusks are subject to intense poaching pressure despite federal protections intended to protect them. Fishermen break them (and the other mollusks they eat) open and sell the meat to local restaurants. Tourists who comb the beaches pluck snails off the rocks and toss them aside.

A severe earthquake in 2020 thrust formerly submerged parts of their habitat above sea level, fatally tossing other mollusks in the snail’s food web to the air, and making once inaccessible places more available to poachers.

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Decades ago, dense clusters of snails the size of doorknobs were easy to find, according to Mr. Avendaño. “Full of snails,” he said, sweeping a calloused, violet-stained hand across the coves. Now, most of the snails he finds are small, just over an inch, and yield only a few milliliters of dye.

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Video: This Parrot Has No Beak, But Is at the Top of the Pecking Order

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Video: This Parrot Has No Beak, But Is at the Top of the Pecking Order

new video loaded: This Parrot Has No Beak, But Is at the Top of the Pecking Order

Bruce, a disabled kea parrot, is missing his top beak. The bird uses tools to keep himself healthy and developed a jousting technique that has made him the alpha male of his group.

By Meg Felling and Carl Zimmer

April 20, 2026

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Contributor: Focus on the real causes of the shortage in hormone treatments

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Contributor: Focus on the real causes of the shortage in hormone treatments

For months now, menopausal women across the U.S. have been unable to fill prescriptions for the estradiol patch, a long-established and safe hormone treatment. The news media has whipped up a frenzy over this scarcity, warning of a long-lasting nationwide shortage. The problem is real — but the explanations in the media coverage miss the mark. Real solutions depend on an accurate understanding of the causes.

Reporters, pharmaceutical companies and even some doctors have blamed women for causing the shortage, saying they were inspired by a “menopause moment” that has driven unprecedented demand. Such framing does a dangerous disservice to essential health advocacy.

In this narrative, there has been unprecedented demand, and it is explained in part by the Food and Drug Administration’s recent removal of the “black-box warning” from estradiol patches’ packaging. That inaccurate (and, quite frankly, terrifying) label had been required since a 2002 announcement overstated the link between certain menopause hormone treatments and breast cancer. Right-sizing and rewording the warning was long overdue. But the trouble with this narrative is that even after the black-box warning was removed, there has not been unprecedented demand.

Around 40% of menopausal women were prescribed hormone treatments in some form before the 2002 announcement. Use plummeted in its aftermath, dipping to less than 5% in 2020 and just 1.8% in 2024. According to the most recent data, the number has now settled back at the 5% mark. Unprecedented? Hardly. Modest at best.

Nor is estradiol a new or complex drug; the patch formulation has existed for decades, and generic versions are widely manufactured. There is no exotic ingredient, no rare supply chain dependency, no fluke that explains why women are suddenly being told their pharmacy is out of stock month after month.

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The story is far more an indictment of the broken insurance industry: market concentration, perverse incentives and the consequences of allowing insurance companies to own the pharmacy benefit managers that effectively control drug access for the majority of users. Three companies — CVS Caremark, Express Scripts and OptumRx — manage 79% of all prescription drug claims in the United States. Those companies are wholly owned subsidiaries of three insurance behemoths: CVS Health, Cigna and UnitedHealth Group, respectively. This means that the same corporation that sells you your insurance plan also decides which drugs get covered, at what price, and whether your pharmacy can stock them. This is called vertical integration. In another era, we might have called it a cartel. The resulting problems are not unique to hormone treatments; they have affected widely used medications including blood thinners, inhalers and antibiotics. When a low-cost generic such as estradiol — a medication with no blockbuster profit margins and no patent protection — runs into friction in this system, the friction is not random. It is structural. Every decision in that chain is filtered through the same corporate profit motive. And when the drug in question is an off-patent estradiol patch that has negligible profit margins because of generic competition but requires logistical investment to keep consistently in stock? The math on “how much does this company care about ensuring access” is not complicated.

Unfortunately, there is little financial incentive to ensure smooth, consistent access. There is, however, significant financial incentive to steer patients toward branded alternatives, or simply to let supply tighten — because the companies aren’t losing much profit if sales of that product dwindle. This is not a conspiracy theory: The Federal Trade Commission noted this dynamic in a report that documented how pharmacy benefit managers’ practices inflate costs, reduce competition and harm patient access, particularly for independent pharmacies and for generic drugs.

Any claim that the estradiol patch shortage is meaningfully caused by more women now demanding hormone treatments is a distraction. It is also misogyny, pure and simple, to imply that the solution to the shortage is for women’s health advocates to dial it down and for women to temper their expectations. The scarcity of estradiol patches is the outcome of a broken system refusing to provide adequate supply.

Meanwhile, there are a few strategies to cope.

  • Ask your prescriber about alternatives. Estradiol is available in multiple formulations, including gel, spray, cream, oral tablet, vaginal ring and weekly transdermal patch, which is a different product from the twice-weekly patch and may be more consistently available depending on manufacturer and region.
  • Consider an online pharmacy. Many are doing a good job locating and filling these prescriptions from outside the pharmacy benefit manager system.
  • Call ahead. Patch shortages are inconsistent across regions and distributors. A call to pharmacies in your area, or a broader geographic radius if you’re able, can locate stock that your regular pharmacy doesn’t have.
  • Consider a compounding pharmacy. These sources can sometimes meet needs when commercially manufactured products are inaccessible. The hormones used are the same FDA-regulated bulk ingredients.

Beyond those Band-Aid solutions, more Americans need to fight for systemic change. The FTC report exists because Congress asked for it and committed to legislation that will address at least some of the problems. The FDA took action to change the labeling on estrogen in the face of citizen and medical experts’ pressure; it should do more now to demand transparency from patch manufacturers.

Most importantly, it is on all of us to call out the cracks in the current system. Instead of repeating “there’s a patch shortage” or a “surge in demand,” say that a shockingly small minority of menopausal women still even get hormonal treatments prescribed at all, and three drug companies control the vast majority of claims in this country. Those are the real problems that need real solutions.

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Jennifer Weiss-Wolf, the executive director of the Birnbaum Women’s Leadership Center at New York University School of Law, is the author of the forthcoming book When in Menopause: A User’s Manual & Citizen’s Guide. Suzanne Gilberg, an obstetrician and gynecologist in Los Angeles, is the author of “Menopause Bootcamp.”

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