2011 Skinnies Awards

As a ballerina going from baseline to ballistic in "Black Swan," Natalie Portman strives for perfection in appearance and ability. Her mental state is nowhere near perfect, filled with anxiety fueled by her overbearing mother, played by Barbara Hershey. Ultimately, Portman's skin betrays her.

Whether real or imagined, Portman's character develops scratch covered rashes, and picks at her nails and fingers, drawing blood. Eczema is a common condition for adults. Unlike children, for whom eczema can represent a food allergy, in adults there are two major triggers, dry skin and stress. The skin develops itch and is paired with its dancing partner: scratching. This increases itchiness, pirouetting into a vicious cycle.

We've heard of dry, cracked skin, but this is ridiculous! For many, moisturizing the wet skin can restore the balance. Effectively hydrated skin improves function like a worn in pair of ballet slippers. Yet prescription options are often necessary.

High strength cortisone creams can reduce the dance's drama, but can also impair perfection by potentially thinning the skin. An alternative to the classic style are the newer, non-cortisone anti-inflammory creams. Elidel and Protopic can calm inflammation without causing atrophy.

Potentially, Portman's poise and perfection can be restored. Though may we suggest she leave Mama Hershey and move out on her own? Just a stress reduction tip: Doctor's orders!

On a side note, are we the only ones to notice Barbara Hershey's resemblance to another 80's movie icon altered by cosmetic procedures gone awry? The director of "Black Swan," Darren Aronofsky, last helmed "The Wrestler" starring Skinnies award winner Mickey Rourke. Perhaps Aronofsky's next flick will feature these two in a spooky tango...

Runner-up, Stressed Out Skin: Anne Hathaway in "Love and Other Drugs"

In this recent romance, Hathaway foreshadows her health issues by showing a doctor a blemish on her breast. Fearing it represents some sort of cancer, her stress is relieved by his diagnosis: a bug bite. Many patients are anxious about new and changing lesions, a situation not helped by scary web searches.

It is one of life’s injustices that so many people are plagued by acne at such an emotionally and physically challenging period: their teen years. Yet not every adolescent has to deal with acne. There is a lucky minority that sails through high school blemish-free. Pop idol Justin Beiber appears to hang out with that clique. Bieber signed on this year as the latest spokes model for Proactiv, a heavily marketed over the counter acne regimen. However, we performed an extensive search for candid internet pics showing even a single blemish sullying Bieber’s cheeks. The kid's clean, not a zit in sight.

Previous shillers for the Proactiv line, which relies on the over the counter ingredient benzoyl peroxide, such as Jessica Simpson (left) and Katy Perry (right), actually allowed acne-ridden “before” images to be broadcast as part of their infomercials. In an industry fixated on perfection, just authorizing such images deserves a big paycheck. Whether Proactiv has truly helped Perry or Simpson is hard to assess. Benzoyl peroxide should reduce the inflammation of pimples initially, but usually doesn’t have a long term benefit. Simpson, for one, was treated with a strong prescription treatment, Accutane, which likely cleared her face before she endorsed Proactiv. Perry was photographed this year still broken out, despite being on the corporate dole.

Yet Bieber, in his Proactiv spot, reveals no facial spots. Rather, he claims that he “was starting to get acne on my chin and Proactiv definitely helped out a lot.” It worked sowell that there is not one paparazzi photo of a Beiber blemish? Hmmmmmm.

Certain prescription creams, like Retin-A and Differin, have ingredients that can clear clogged pores. Technically, these compounds could prevent pimples. Yet even dermatologists wouldn’t usually recommend such treatments if a teen is one of the lucky few who happens to be blemish-free.

We give Bieber credit. By getting tweens to buy acne creams, his nail polish, perfume, and officially endorsed pillows (all actually available), he is doing his part to stimulate the economy. The sad truth is that those with no zits as teens can still develop adult acne in their twenties. If Beiber saves his pennies, he should be able to pay for insurance copays if he needs prescription treatments down the road.

Runner-up, Epidermal Entrepreneur: Katy Perry

Even though she doesn't seem to be responding to Proactiv, at least she's getting paid...

Few parents would want their kids to emulate the antics of the cast of the reality show “Jersey Shore.” The excessive drinking, possibly unprotected sexual activity and potentially criminal acting out by the nicknamed celebrities like “Snooki,” “The Situation” and “Jwoww” would get most teens grounded for rest of the TV season. Yet, many families turn a blind eye to a potentially life threatening behavior that is a central activity in the “Jersey Shore” lifestyle. In the first season, “The Situation” announces his motto for a staying fresh is “GTL”: Gym, Tanning, and Laundry. Tanning beds, though seemingly benign, may put this gang and their impressionable viewers, at great risk.

The coolest cast members have nicknames to go along with their bronzed skin: Nicole "Snooki" Polizzi Jenni "Jwoww" Farley Mike "The Situation" Sorrentino John "The Congressman" Boehner

Developed in the 1970’s, tanning beds were thought to be safe. The UVA rays supposedly caused a “healthy glow” without the wrinkles, sun spots, and cancer risks of the burning UVB rays. Years of study now show that tanning rays also contribute to aging, spot-covered skin and melanoma skin cancer. Healthcare legislation enacted in 2010 recognized the risks of tanning beds and levied a tax on their use. “Snooki” went public with her dismay, but we feel any disincentive to tanning beds is good policy.

Another reality show stalwart, Kim Kardashian, saw the downside to sun exposure. While vacationing in Mexico, the sun overwhelmed her natural pigmentation and caused a particularly glamour-free sun burn. The attention she received by posting this image on her Twitter page may (in her mind) make up for the sun damage and wrinkling this lapse can cause her later. If not operated correctly, tanning beds can also cause a burn.

So viewers of all ages: Be entertained by the “Jersey Shore” gang. But when it comes to tanning, these are “professionals.” They get paid to put themselves at risk for our amusement. Don’t try this at home!

Runner-up, Anti-Role Models: The delinquents of "Jackass 3D"

In one of the closest races in recent Skinnies Award history, "Jersey Shore" barely edged past Johnny Knoxville's pack of masochistic stunt boys.

We also wouldn't recommend copying the Jackass high jinks. Intentionally subjecting oneself to scorpion bites, bull horns and skin-to-skin application of Krazy Glue (left) is not a healthy skin regimen. We feel moisturizers, sunscreen, and anti-oxidant creams are better choices. But at least these shenanigans don't result in skin cancer...

In “Rabbit Hole,” Nicole Kidman is cast as a woman whose child has died. The Academy award-winning actress would seem to have the performing chops to take on this type of demanding role. Yet onscreen, her face appears passive. Her forehead is not just free of unsightly wrinkles, it also shows only limited expression. Usually, movement of the human brow actively conveys emotion. Yet in "Rabbit Hole"...

Kidman's brow moves little whether angry... ...happy... ...or sad.

Kidman's lips also appear unnaturally swollen. Though she is not our patient, Kidman, shows changes consistent with the use of Botox to the forehead and filler injections to the lips. While these treatments effectively reduce facial lines, for actresses there is a balancing act between the glamor of smooth skin and procedures that draw attention to themselves. Many reviews of “Rabbit Hole” specifically comment on Kidman’s facial appearance, a distraction that reduces the power of her performance.

Kidman's smooth skin is in stark contrast to movie hubby Aaron Eckhart's... ...Blotchy, moley, and creased. Imperfect but authentic.

Is Kidman’s role model the legendary actress and pop star Cher? In “Burlesque,” Cher appears strikingly youthful. She’s not obese, her fishnet stockings show no sagging. Her full cheeks and lack of facial wrinkles in no way betray the fact that she is SIXTY-FOUR years old. Yet her lack of facial movement in the film is distracting. For certain scenes, the producers hide her face in shadow. Presumably singing in the dark was preferable to an expressionless face in the spotlight.

As doctors that treat with Botox and fillers, we can vouch for their benefit and safety. There is usually little risk of allergy or long term problems. We feel the goal should be conservative. Finesse work, to take the edge off of (gulp!) aging (there we said it!), yet not to appear odd or artificial.

The rare celeb that is up-front about cosmetic treatments, actress Courtney Cox told Instyle magazine this year: "Sometimes I use Botox. Compared to most, I use it very sparingly. One time I did too much, though. I feel weird if I can't move my face, and that one time I overdid it, I felt trapped in my own skin. I don't have a problem with any of that stuff; if it makes you feel better about yourself and it's done properly, then fine."

It’s not too late for Kidman. Botox and most fillers eventually wear off. Navigating the cosmetic obstacle course is going to take as much skill as her as her formidable acting talents.

Runner-up, Time for an Intervention: Mel Gibson's deep furrows

Some consider Kidman over-treated. But her fellow US born, Aussie-raised thesp, Mel Gibson, might benefit from some of Kidman's left over Botox. The original “Sexiest Man Alive” shows skin as ravine-covered as the Australian outback.

Okay, Mel, not that much work, but SOMETHING. Consider it if and when you get your personal life in order!

In "The Fighter, " Mark Wahlberg portrays the real life boxer Micky Ward, a working class guy who was consistently overshadowed by his flamboyant older brother. Seen briefly in the film is a lesion with a similar story. In "The Fighter," Mark Wahlberg's opponent takes a hard right. Was he distracted by Mark's small chest lesion?

Mark Wahlberg is an exceptional Hollywood success story. He was able to parlay a teen career in hip hop into bona fide movie stardom. He also has impressive producing credits, having created the TV show "Entourage." It may surprise some that Wahlberg has a single lesion entourage all his own: An extra nipple.

Arising from the shadow of Wahlberg's consistently toned left chest, this "nipp-let" is a form of a birthmark. They can occur singly or occasionally on both sides of the chest or abdomen. Other than occasionally rubbing or becoming irritated, they usually represent no health risk. Usually, they are small enough that there should be no cosmetic concern.

The editors of "Sports Illustrated" must have disagreed. Perhaps they thought an extra nipp might distract readers from Wahlberg's impressive pecs and abs, so they heartlessly photoshopped it away from published pics. Echoing the situation of Micky Ward, like so many of those who toil behind the scenes in Tinsel Town, Mark's nipple was overshadowed and ignored by a hard driving media machine.

Wahlberg wasn't always so reticent with his spot. In his early days as hip hop rapper, he seemed to flaunt his nipple like a piece of permanent bling. Though now more hidden away, Wahlberg has opted not to have is surgically removed, an outpatient procedure done under local anesthesia. While some might prefer a linear scar, not Marky Mark. He retains the lesion, which could be called "Marky Mark's Mark".

Both men and women can have extra nipples. Lily Allen is a British singer and TV personality who shows no shame about her special appendage. She has revealed her lesion at least three times on TV, giving new meaning to the term, "overexposure."

Lest you think third nipps only adorn hunky movie stars and Brit pop chicks, none other than American country singin' sensation Carrie Underwood admitted to having one. No, you can't see it in the photo, so back it up. During the first round of her American Idol audition, she confessed that it had looked like "a mole" and that she had it removed. Her honesty must have impressed the judges--she went on to win the competition.

Runner-up, Uncredited co-star: Christian Bale's facial mole in "The Fighter"

Wahlberg's "Fighter" co-star also has a little lesion that is his constant companion. Bale's sticky-outy facial mole seems to jut into the shot during his most dramatic scenes.

Sharply bordered and evenly colored, it is unlikely to become cancerous. It certainly didn't distract from his performance, audiences are too busy staring at his funky teeth, male pattern hair loss and coke-fueled emaciated frame!

Actress Laura Linney appears to crave challenge. Her character on the Showtime series “The Big C,” has cancer. Realistically, for her age and fair skin, the cancer is stage 4 melanoma, starting with a black skin growth from sun exposure that has metastasized throughout her body. It is a testament to her acting abilities that she somehow manages to infuse her performance with humor . Yet we hope that this dramatic premise, a young person dying of melanoma, will soon become an historic footnote rather than the central theme of a series.

For the most part, melanoma skin cancer is preventable and treatable. Avoiding sun burns and tanning, especially for those with fair-skin, will limit the risk. Surgically removing early superficial melanoma can be curative. However, once the cancer has thickened and spread to lymph nodes and beyond, as in Linney’s role, the prognosis becomes grim.

In an impulsive moment, Linney takes some sun... ...the same rays that put her in danger in the first place.

In the last two years, incredible research breakthroughs have occurred. Experimental immune treatments have achieved cancer remission in certain patients with metastatic melanoma. Hold on, tanning fans, don’t toss the sunscreen yet. Unfortunately, the cancer appears to regroup and become resistant to treatment. But there is hope that soon, combination therapies will make this deadly cancer a curable condition. That Hollywood types will have to look elsewhere for a dramatic plot line seems a small price to pay.

Freddy Krueger (left). Scarface. That tattooed dude in "Cape Fear." What do movies associate with evil characters: Bad skin. Scars, strange birthmarks, tatts: Traumatized skin means a troubled soul. Don't believe it? There is a large chunk of server space at this website devoted to examples of blemished bad guys.

The remake of "True Grit" provides a classic example. Like many a movie villain, a murderous Josh Brolin is marked for easy identification with a traumatic gun powder burn scar on his cheek. No wonder he's evil--it's hard to relax when audiences are judging your appearance. Unfortunately for him, plastic surgery or laser treatments weren't readily available in the Old West.

Yet that skinematic mainstay seems to be breaking down. Summer 2010 saw four major releases with heroic roles featuring skin usually seen on thugs. Before he showed his "Grit," Brolin wandered the West with worse scarring as "Jonah Hex." Paradoxically, he was this movie's hero. In the adaptation of a graphic novel, this fellow is capable of good deeds despite the appearance of damaged goods.

Even though it is easiest for film makers to mark villains with scars, lesions and hair loss, 2010 seems to have taken a cue from the box office giant with the little wand: Harry Potter. Daniel Radcliffe's Potter continues to generate major revenue despite his Voldemort generated forehead scar.

"Machete" starred Danny Trejo, covered with acne scars, scars from his boxing days and enough body ink to mark many movie muggers. In fact, Trejo has spent most of his career playing prisoners, drug dealers and assassins. It is a sign of the times that in this B-movie, even with a dermatology clinic's worth of lesions, he still takes on his betrayers and ends up with Jessica Alba.

That Dragon Tattooed girl returned to action in 2010 playing with fire and kicking hornet's nests. Usually a character this pierced and covered with serpentine body art would be the villain. Instead, Lisbeth Salander was heroic enough to warrant the currently filming American version of the series.

Speaking of action ladies, Emma Thompson is back in "Nanny McPhee Returns," as the moley, warty, unibrowed baby-sitter with a rosaceous nose and bad teeth. She's not the evil witch from Oz, but rather is armed with benevolent spells to enlighten her brood.

Kids with hair loss, whether from chemotherapy or medical conditions, have it hard in school. Add an odd forehead tattoo, and this little guy should be bully bait. Instead, as "The Last Airbender," this tyke saves the world. In your face, playground punks!

Will this trend continue? Will people with scars and lesions be given further movie heroes to admire? Early 2011 suggests that they might, with a modern retelling of "Beauty and Beast" in the wings called "Beastly." Baldness and extensive tattooing replaces hirsutism in this teen romance.

The doting house staff of "Gray's Anatomy" welcome new patients... ...with no judgement... ..no matter their appearance?

In the Fall of 2010, the program “Gray’s Anatomy” aired an episode with the cruel title “Superfreak.” Character actor Art Chudabala pulls up to the hospital with his wife, eliciting gasps and exclamations from the usually calm and reserved medical residents. His is the extremely rare appearance of wart viruses run amuck.

Nobody likes warts, but many are plagued for a time by one, a few or even 20 of these viral growths. Potentially contagious, affecting embarrassing areas like the hands, face or (Nooooooooooo!) the groin, the burdensome bumps can linger for months or years. Only when the person’s immune system fully recognizes the presence of the viral intruder is the infection cleared. Yet little do these patients realize how much work their immune cells are already performing. That they are lucky not to look like this...

Though created with prosthetic makeup, the TV drama's character is based on an actual case, the “Tree Man” from Indonesia. As seen on the Discovery Channel and CNN, this unfortunate individual is missing the crucial element of his immune system to control the viral infection. In these actual unaltered pics, one can see hundreds of lesions. Particularly debilitating are the large, so-called cutaneous horns growing from his hands.

Or this...Images of an actual man... ...with many warts... ...and stick-like growths called "cutaneous horns."

Like the “Tree Man,” the character in “Anatomy” underwent massive surgical procedures to clear and remove many of the disfiguring warts, especially the cutaneous horns. Every day dermatologists use scalpels, liquid nitrogen sprays and lasers to ultimately help stimulate a successful immune response. The fact that the overwhelming majority of us can ultimately clear these types of warts proves our immune systems are working hard after all.

Runner-up, Ripped From The Headlines: Bed Bugs on "Bored to Death"

In the second season of this HBO comedy, magazine publisher Ted Danson develops a groin rash (not shown) that his doctor diagnoses as bed bug bites. Always hungry for a new epidemic to sell papers, the media in 2010 focused on bed bugs. These pesky night biting critters give patients the heebie jeebies, but are quite treatable by exterminators. A little Valium might help as well...