Tweaking the Body

Sometimes less is more—or at least enough. When it comes to cosmetic surgery, sometimes we just need a tweak, a little nip—or tuck—to get us where we want to be. There is an increasing number of noninvasive cosmetic treatments on the market these days, and many have no side effects or recuperation time. What, for instance, could be simpler than using radio-frequency waves for tightening saggy skin? And who knew that infrared light delivered painlessly by laser can turn off the aging gene? It’s a new world out there.

Oh dear, those frown lines, those spidery traces of laughter! What’s to be done about the effects of emotion on a face? Dr. Joseph Muccini of the MidAmerica Skin Health & Vitality Center uses a linen napkin as metaphor for what happens around the eyes after a lifetime of smiles and frowns. “Fold it once and there’s no crease,” he says. “But iron the folded napkin, and the creases become harder to get out.” Frowning, he says, stamps its mark in the vertical lines between the brows–referred to as 1s (ones), 11s (elevens) or 111s (one-elevens) depending on how many there are. Smile lines, or crow’s feet, are the little ‘sunbeams’ at the sides of the eyes, which also can be caused by squinting.

Muccini says Botox (a botulinum toxin) is the simplest solution to both these issues, but he stresses that the process doesn’t wipe history off the face. “Facial expression gives us an instant read of a person, but it may be inaccurate,” he says. “Sometimes, patients simply want to put their best face forward.”

One of three botulinums, Botox is injected in very small amounts to a precisely targeted area. “A common misconception is that it is a filler, but we use it to knock out the muscle that is doing the contracting,” Muccini explains. Because of its paralyzing effects, the treatment must be done judiciously. “If it goes wrong, it can have life-altering consequences like blindness,” he cautions. “But it is so easy to do well.” Treatment, he says, takes less than 10 minutes and involves one tiny needle inserted numerous times. “It isn’t terrible in the slightest,” he says.

Dr. John Holds, ophthalmic plastic surgeon and owner of Ophthalmic Plastic and Cosmetic Surgery, says a particularly easy tweak can be made to the eyelashes for a more youthful appearance. About 20 years ago, it was discovered that one of the drugs used to treat glaucoma (prostaglandin) was causing lashes to lengthen, thicken and darken. Now marketed as Latisse, the liquid medication is painted onto the upper lid (and even eyebrows), and slows the natural cycle of shedding. Initially, daily application is encouraged, but Holds says long-term use might involve only three applications per week. Latisse can be bought over the counter and costs between $110 and $240.

Holds says another symptom of aging—ptosis (drooping of the upper eyelid)—can be addressed easily with few side effects. Unlike blepharoplasty, a surgery that involves incisions of skin, muscle and fat, a ptosis repair tightens the tendons that lift the lid through a small incision either inside or outside the lid. “It’s not scary at all,” says Holds. “In fact, it’s fabulous.” He cautions, however, that any time you cut into the body there is a risk of swelling, bruising and infection. If done well, this repair has negligible effects and little downtime. Correction to one eye costs around $2,000, and Holds points out that faces often are asymmetrical and need only one correction. It’s an outpatient procedure that takes 30 minutes and requires sedation and local anesthesia.

We want a waist and a flat stomach. We don’t want to struggle with our buttons and zippers. We don’t want stretch marks. According to local physicians, however, certain noninvasive treatments can offer good results when it comes to the stubborn midsection. Venus Legacy is a hand-held device that uses radio frequency to tighten saggy skin by heating collagen, the latticework that holds the skin together. “As the targeted area heats, the collagen coils tighter,” explains Dr. Richard Moore, medical director of The Lifestyle Center. He says some results are seen immediately; more improvement is apparent two to three months later, after the body has produced new, more elastic collagen. Moore says each session takes 20 to 30 minutes and treats an area half the size of an 8-by-11 inch sheet of paper.

Good candidates include those who have excess skin due to weight loss or pregnancy. He cautions, however, that the older we get, the less responsive the body might be to this treatment. “Loose, soft skin is just not going to tighten as well,” he says. While the Legacy is designed to address loose skin, a procedure called Vanquish ME specifically targets fat removal. Also using radio-frequency waves, this technique destroys 30 percent of fat cells over the course of four one-hour sessions, Moore says. “That can amount to a 2-inch size reduction.”

However, some physicians say abdominoplasty (more affectionately known as a ‘tummy tuck’) really is the only effective way of removing both fat and excess skin. “Most of my patients hate that thick wad of skin and fat in the midsection that they can grab,” says Dr. Michele Koo, board-certified plastic surgeon. “They hate not being able to tuck their shirt into their pants or looking like a pear. They hate looking matronly.”

A mini tuck, she says, is suitable for anyone who has excess bulge below the belly button, while a full tuck is a more involved surgery that addresses pockets of fat and skin that has lost elasticity due to age and pregnancy. Koo says that even a full tummy tuck is not considered “major” surgery, although it does require a two-week recovery period during which the patient should not drive. (A mini tuck has a much shorter recovery time.) Otherwise, Koo says the midsection can be tweaked with liposuction, which removes fat around the belly button. This procedure is performed in-office and takes no longer than an hour.

Koo says she is skeptical of new noninvasive treatments involving heat and energy waves. “They remove very small amounts of fat, and I am not a proponent of anything that doesn’t give significant discernible results,” she says.

Oh, that droop … those pesky capillaries. The texture. Bring on the needles and lasers!

“Stress has collagen for lunch!” says Carol Anderson, certified aesthetic nurse specialist and owner of Nouveau, A Boutique Medspa. There are many reasons for collagen breakdown (which results in poor skin quality), including sugar, sun and lack of sleep. But a relatively new technique called Forever Young is helping reverse their effects by kickstarting the production of new collagen. According to a 2012 Stanford University study, Forever Young works because the broadband and infrared lights it uses actually cause the aging genes to turn off and the youth genes to turn on. “This means the cells themselves behave more youthfully, and for one to three months afterward, it translates to a more youthful appearance,” Anderson explains, adding that Forever Young must be repeated for the effects to be maintained. “If you have it regularly, you may be able to avoid more invasive procedures later on,” she says. “But as with most treatments in this industry, you aren’t just ‘one and done.’’’

During the one-hour procedure, the lights are delivered to face, neck and chest (or any other area of the body) via Sciton laser. There are almost no side effects and no downtime. The best candidates, Anderson says, are those with skin on the fairer end of the scale; an in-office consultation can determine your skin’s suitability for this treatment.

Microneedling has become a mainstay of anti-aging technology in recent years, says Jacqueline Carr, RN, of Aesthetic Medispa of West County. It, too, is designed to stimulate collagen growth, but it involves micro-perforation into the upper layers of skin to minimize pore size, reduce fine lines and wrinkles, and lift and tighten the skin. During the procedure, a hand-held device with nine precisely spaced needles glides across the face while the needles minutely pierce the epidermis. “There is some bleeding,” says Carr, but she stresses that patients are numbed with a topical anesthetic for an hour beforehand. Side effects are minimal, but Carr says anytime the skin is broken, there’s a risk of bruising, swelling and infection. She adds that most people experience only a mild discomfort akin to sunburn for 48 hours afterward.

Carr notes the effectiveness of microneedling varies by case. “It works better on some people than others,” she says, adding that treatments need to be ongoing for long-term results. She suggests patients receive three to six treatments spaced three to six weeks apart, and then one or two sessions yearly thereafter. Each one-hour session costs $300.

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