Dr. Nabavian in SecondAct, “Stop the Clock: Lift and Tighten Without the Knife”

“Stop the Clock: Lift and Tighten Without the Knife”

By Melinda Fulmer

Forget the facelift. In the last five years, a flurry of new noninvasive cosmetic procedures have come along, promising to turn back the clock on aging skin without as much risk and recovery time as surgery.

From fillers to lasers, 83 percent of all cosmetic procedures performed in the offices of cosmetic plastic surgeons in 2010 were nonsurgical, according to the American Society for Aesthetic Plastic Surgery.

Of course, not all of the wrinkle-busting, skin-tightening treatments out there are worth the time and money. And because most require refreshing every few months or years — or look better used in combination with each other — they can be as expensive as surgery in the long run.

Unlike surgical lifts that simply pull the skin or muscles tight, however, these no-scalpel treatments increase the collagen and elastin in the skin, making it feel younger. “Some of these devices are changing the quality of the skin,” says New York City dermatologist Neil Sadick.

SecondAct enlisted the help of Sadick and two of the country’s top plastic surgeons to discuss which nonsurgical procedures are most effective at treating the most common aging-skin complaints.

Here are their picks:

Skin Tightening

While wrinkles get most of the attention when the topic of aging comes up, the lack of elasticity in aging skin is also a big issue. This is where the new crop of radiofrequency (RF) treatments comes in.

Thermage, Titan and Pelleve treatments use hand-held radio frequency energy devices to heat the underlying layers of loose skin, tightening the existing web of collagen and stimulating new growth while keeping the surface cool and intact so there’s no peeling or time off work needed — although the skin may appear a bit red or flushed. These treatments can be performed on the face, abdomen, backs of the hands, and even the knees.

Some improvement is immediately visible as the collagen contracts and will build over the next six months as more is created. The effect can last up to several years, says Dr. Reza Nabavian, clinical assistant professor of surgery at the University of Southern California Division of Plastic Surgery.

While this treatment can’t provide the same dramatic results as a facelift, it can take up some of the slack and improve skin texture. Indeed, some facelift patients use it after surgery to tone and tighten the skin.

There may be a bit of pain involved as the device zaps the energy into your skin. The amount of that discomfort varies with the treatment and method. Some procedures such as Thermage only require one visit and may be more painful, while others such as Titan or Pelleve require three visits using less power and more passes over the area.

New Jersey plastic surgeon Dr. Barry DiBernardo even uses Pelleve to do a nonsurgical eyelift, tightening droopy skin on the upper and lower lids.

A similar treatment that is relatively new, Ulthera, uses ultrasound to heat and tighten the underlying layers of the skin and stimulate new collagen growth. The difference with this treatment is that the device has a screen allowing doctors to see underneath the skin to the places where they should deliver the sound waves.

“If you don’t want a facelift, but need some tightening of the tissue under the jaw line, cheeks or brow,” this could be the treatment for you, DiBernardo says.

There haven’t been a lot of head-to-head studies to identify which of these treatments are the most effective, says Sadick, and different doctors favor different methods and machines. However, most are effective for mild cases of sagging, the doctors say.

Cost: $1,800 to $35,000, depending on the area

Wrinkle Fillers

These injectable substances — some natural, some synthetic — pad the age-related hollowing under the eyes, fill in marionette lines around the mouth, and plump up thinning lips, forehead creases and acne scars.

The most commonly used fillers (Restylane and Juvéderm) are made from a natural protein called hyaluronic acid that lasts for about 6 to 9 months.

“It is perhaps the biggest bang for the buck,” Nabavian says, and provides an immediate effect, unlike some other treatments.

Radiesse, made of calcium-based micro-spheres, is a bit denser and may last longer, Sadick says. It is used mostly to plump up cheeks or in the deeper creases along the mouth. There is a chance of bruising and swelling around the injection site, and in some rare cases patients have developed small bumps or infections under the skin.

Cost: $500 to $600 per syringe

Wrinkle Relaxers

Botox, Dysport and the newly approved Xeomin temporarily reduce wrinkles or expression lines on the forehead, near the eyes and between the eyebrows when injected around these areas.

The effects of these Botulinum Type A toxins usually last for about three to six months, after which time additional injections are necessary to maintain the results. Side effects are rare but could include swelling, bruising, allergic reactions and weak or drooping muscles near the injection site. A topical Botox-like gel is still awaiting FDA approval.

Cost: $400 or more per area

Sun Spot Slayers

Laser treatments are good for patients with excess pigmentation and coarse, leathery skin from decades of unprotected days outdoors. Fractionated or ablative lasers remove the outermost surface of the skin with light energy, allowing brighter, less-pigmented skin to come through.

Some of the most dramatic results come from the more aggressive carbon dioxide lasers such as Fraxel re:pair that vaporize small columns deep within the skin to resurface and tighten skin.

Unlike radiofrequency treatments, fractionated or ablative laser treatments (or ones that destroy the top layer of skin) do require more care and up to a week of downtime as the old skin peels and flakes off to reveal new, more even-toned skin. There is more risk of blistering, hyper-pigmentation or scarring with major treatments such as Fraxel re:pair, but the results are more definitive.

Not all fractionated lasers are as aggressive. A new at-home fractionated laser, Palovia, was rolled out last year to big chains such as Bloomingdale’s. The $500 device claims to zap fine lines and wrinkles around the eyes in 30 days of nightly treatments and should provide a small degree of tightening, Sadick says.

Conversely, nonablative lasers such as Laser Genesis, have no downtime because the skin is not burned, but mainly treat milder complaints such as uneven skin texture, redness and fine wrinkles. These treatments can be done on a lunch hour and require four to six sessions.

Intense Pulsed Light (IPL) Treatments (often called photofacials) also diminish excess pigmentation, tighten pores and stimulate new collagen growth. However, the effects of these treatments are more subtle than with peels or ablative laser treatments, and they happen over time. Nabavian says this should be done three to six times a year, with at least three weeks in between treatments for maximum results.

Cost: $250 to $400 for each IPL or Laser Genesis treatment; $3,000 to $5,000 for Fraxel re:pair

SecondAct contributor Melinda Fulmer writes regularly about issues of health and wealth for publications such as the Los Angeles Times and web portal MSN.


Looking Done is So Last Decade

Looking Done is So Last Decade: The Cultural Shift Towards Age Appropriate Cosmetic Procedures

Looking done is so last decade

Middle aged is no longer synonymous with matronly. The over 40 woman is a force with whom to be reckoned. She is no longer seeking the fountain of youth, but rather seeks to look as good as possible – for her age that is. Women want to look refreshed, healthy and energized. They are less concerned with looking 20 years younger

Instead, women over 40 are wearing their hair longer, sporting bikinis and have more economic power and independence than ever before. And, say these women, why should beauty be intrinsically linked to youth?

In an “age appropriate” movement, plastic surgery too has evolved. “Ironically, older techniques may have removed excess skin to combat aging, but these procedures did nothing to restore youthfulness,” says Clinical Assistant Professor of Plastic Surgery at USC, Dr. Reza Nabavian.

Dr. Nabavian reflects a school of thought that subtlety is best, advocating for minimally invasive and preventative techniques that avoid nipping and tucking where ever possible.

The first defense and treatment of aging, he says, resides in proper skin care. “Signs of aging begin with the condition of the skin itself. Sun damage, environmental factors and overall physical and mental health contribute to the health of the skin.” For younger patients, he suggests treating hyperactive glands and acne using treatments such as glycolics and sunscreens. More mature patients require more intensive agents, such as retinoids and vitamin C to gradually resurface the skin and decrease sunspots and wrinkles.

And where wrinkles stand their ground, Dr. Nabavian advocates the use of Botox, Thermage and fat transfers. Where Botox is concerned, Dr. Nabavian warns that, “Botox is commonly misused and has been known to cause a masked and unnatural appearance. One needs to keep in mind that facial movement is a natural process that needs to be preserved.”

Fat transfers, he says are the most natural and non invasive way of rejuvenating hollow or aging skin. “We can now use a patient’s own fat cells to restore fullness and proportion to the face and body. This procedure enhances the appearance with no use of synthetic fillers, implants and drastic surgery.”