It’s a daily ritual for many of us after a certain age: standing in front of the mirror wondering how to restore the smooth, firm contours of our younger days. T&S turned to several local physicians for their take on the best options.
[smoothing Out wrinkles]
Dr. Richard Moore, medical director, The Lifestyle Center:
The trend today is to use a combination of laser-like procedures, fillers and Botox to tackle troubling wrinkles. Treatment takes place over seven to 10 days. Possible procedures include the Venus Freeze, Ultherapy, or fractional resurfacing such as with Fractora. Venus Freeze, which uses radio frequency waves and magnetic pulses, is very comfortable for tightening skin. Ultherapy uses sound waves to tighten skin from the inside out. There’s no downtime, and patients experience gradual lifting of skin in the treatment area. Fractora is a skin-tightening device that uses radio frequency waves to smooth fine and deep lines. It involves a treatment head with pins that deliver heat at pre-set depths to promote collagen restructuring. Fractora has a depth of penetration similar to Ultherapy. We’ve seen nice results with it for crow’s feet and crepey skin. Possible fillers include ArteFill and Voluma, both of which are longer lasting than other types.
Dr. Joseph Muccini, MidAmerica Skin Health and Vitality Center:
Wrinkles are to the skin what hills and valleys are to the landscape. Treatment falls broadly into one of two categories: bring something in to raise the floor of the valleys, or lower the peaks so they’re not as noticeable. In skincare, we accomplish this with fillers. The question is, do you need a John Deere tractor or just a rake? There are some new treatments available, and others have been modified. Belotero is a new hyaluronic acid filler that received FDA approval. It doesn’t have as high a risk for discoloration in touchy areas, such as under the eyes, as some of the other fillers. The protocol for Ulthera, which uses ultrasound, has been refined, making it more of a skin-tightening device. And microneedling, a non-surgical procedure that involves puncturing the skin with tiny needles, is getting more attention as a way to stimulate collagen rejuvenation.
[the eyes have it]
Dr. John Holds, Ophthalmic Plastic and Cosmetic Surgery Inc.:
In the upper eyelid, blepharoplasty surgery generally addresses the puffiness seen in the inner corner of the eyelid. Procedures such as a browlift can enhance the effect, giving a more youthful appearance. As we age, the smooth lower eyelid of youth gives way to sagging, grooves and bulging eyelid fat pads. Side lighting produces shadows in the tear trough that most people call ‘dark circles.’ A variety of corrective approaches can be used. Fat removal used to be the most common approach, but these days we partially remove and reposition fat to hide and obliterate the tear trough. Dermal fillers, such as Restylane or Belotero, and facial fat-transfer techniques can be used to volumize the mid-face. True pigmentary dark circles are uncommon and are treated with bleaching creams, peels and sometimes with lasers. They’re often difficult to eradicate. Most patients can expect significant improvement with these changes, but there’s a price to pay in dollars, discomfort and recovery time.
Dr. Michele Koo, plastic surgeon:
Fat protruding from deep tissues around the eyes can cause eye bags. Skin pigmentation can cause under-eye circles. As we age, our skin becomes thinner. This makes dark circles and puffiness more noticeable. If the problem is too much fat and skin, we remove and/or reposition the fat. If pigmentation is the problem, we prescribe medical-strength skin products and use MicroPen lasering. The MicroPen looks like a ballpoint with tiny needles for resurfacing. We then use plateletrich, protein growth factors for collagen and skin regeneration Blepharoplasty (eyelid surgery) can be accomplished in a doctor’s office or as an outpatient procedure. The MicroPen can be performed in-office. If the problem is deep, dark hollow under the eyes, filler can be injected to smooth out the ‘valley,’ improve the hollows and minimize puffiness.
It’s important that eye puffiness and darkness be correctly diagnosed, so the correct solution can be implemented. Surgery is not always the best answer, and many doctors and spas now use aesthetic approaches to treat cosmetic eye issues. Seek someone who has a great deal of experience handling tissues around the eyes. because complications can be serious.
[adjust the jowls]
Dr. Richard Bligh, medical director, Green Door Med Spa:
We now have a better understanding of how the face ages, and it’s different than what we thought. Besides losing skin elasticity, we also lose fat and bone. Consequently, we develop jowls and sagging necks with age.
There are minimally invasive procedures for treating age-related jaw and neck problems that produce phenomenal results with very little downtime. By injecting filler under the jaw where there is lost volume, we can fill it in and make the jawline look straight. I use some of the more long-lasting fillers, like ArteFill, a combination of collagen and PMMA (polymethlymethacrylate) particle—a man-made polymer. The collagen dissipates in about four months, but the PMMA particles continue to build collagen in the injection area for years. ArteFill costs more upfront, but studies show it can last five or more years. Fillers are also used on the neck to help tighten tissue. These procedures can help you put off a face-lift until you’re much older.
Dr. Michael Nayak, Nayak Plastic Surgery:
As the face ages, it looses its tautness. The resulting skin laxity tends to pool above the voice box, which is the lowest-lying area of the face and neck.
There’s an array of machines that use heat to shrink tiny bits of tissues in the face and neck. They include Venus Freeze, which is what we use, Ultherapy and Thermage. The face is treated from the temple down. Results are cumulative, but modest. I tell patients to expect 1 to 15 percent improvement. It’s not striking, but that’s all that’s available in non-surgical treatments. Injectables can fake a better jawline, but they do nothing for the neck. I would guesstimate their improvement from 0 to 15 percent, with no downtime.
If you’re looking for a 30 to 40 percent improvement in jaw and neck laxity with just a couple days of downtime, it doesn’t exist. If you’re looking for a 70 to 90 percent improvement with a couple of weeks of downtime, then you should consider surgery. You have to decide which camp you’re in: treatment with minimal results or surgery with fantastic results.
[facial veins]
If your face looks like the page of an atlas, relax. Lasers can help, and today’s are much gentler than the old heat-and-burn methods.
“We used to cauterize facial veins with electrocautery, a hot needle,” says Dr. Carolyn Mann, assistant professor of dermatology at Washington University. “It destroyed the dilated vein but also damaged the epidermis, the upper layer of the skin.” Consequently, patients would get a slight burn on the top layer of skin.
The ELOS-IPL (intense pulsed light) laser has a wavelength of light that can destroy targeted blood vessels without causing skin damage, but it requires several treatments. “We like to space treatments about a month apart,” Mann says. Each session lasts 30 minutes. “Over the course of three to five visits, you can expect your skin to have less veins and be smoother, clearer and healthier looking.” Normally Mann doesn’t use a topical anesthetic; most patients tolerate the treatment. “It feels like a little splatter of grease with each pulse,” she says.
“It’s a fairly quick procedure: we aim and shoot the laser over the vein, and you’re good to go.”
[voluma]
Want smoother skin? More volume might help.
Late last year, the U.S. Food and Drug Administration approved its first mid-face dermal filler, Voluma. It’s made by the same company that developed Botox and Juvederm. “Voluma is a hyaluronic acid product similar to Restylane and Juvederm,” says Dr. William Hart of Hart Cosmetic & Reconstructive Surgery Institute. “The big difference is that it takes longer to be reabsorbed.” That means Voluma lasts longer, about one to two years.
“We lose subcutaneous fat and volume in our faces as we age,” Hart explains. “Voluma can be used on the lower jawline, the chin, the external ridge of the nose, and to add volume to the cheekbone area. It’s also used to elevate the brow and to fill in sunken orbits, tear troughs and temporal hollows.”
Voluma is injected deep under the skin, close to the bone. The results are immediate. Patients may experience some redness or pinkness at the injection site but that fades within an hour or two. As it adds volume, Voluma gently ‘lifts’ the face. “It’s now possible to have longer lasting contour improvements that can be maintained with minor touch-ups.”
[top 10 facial fixes]*
1| Botox (6.1 million)
2| S oft tissue fillers (2 million)
3| Chemical peels (1.1 million)
4| Microdermabrasion (974,000)
5| Intense pulsed light treatments (553,293)
6| Laser skin resurfacing (509,055)
7| Nose reshaping (243,000)
8| Eyelid surgery (204,000)
9| Face-lifts (126,000)
10|Forehead lifts (44,722)
*According to the Amercian Society of Plastic Surgeons 2012 Plastic Surgery Statistics Report
