New less invasive techniques are just as effective and easier on the pocket
BY DEBBIE K. SWANSON PATRICK
If wrinkles must be written upon our brows, let them not be written upon the heart. The spirit should not grow old. – James A. Garfield
RANDI MacCLAREN DIDN’T HAVE WRINKLES AT 54. What she had were sagging eye lids and her face was sinking in. It was time for her to do something. She met with a doctor and they determined what she needed—an eyelift and some fat put back into her cheeks to fill them out. One day after the procedures her face was bruised, but she was in the office for a follow-up visit and felt fine. Two months later she’s thrilled with the results.
“I had no problem,” she says, “except an allergy to the eye drop. No pain, as I took the prescribed pain medication. The worst thing was having to sleep upright in bed for two weeks.” ‘Mini’ me
Is it time for you? Have you looked in the mirror and thought, “Who is that person?” If so, you might have thought about doing “a little something” to bring back that youthful glow and elasticity.
Yet, this is also a time for accepting who we are. Dove skin care line, for example, is embracing “real women,” young and over 60, with a tasteful media campaign of nude images of women, all shapes and sizes. The modeling community is waking up at last to the deadly habits and unhealthy image of the billion-dollar industry. TV’s Ugly Betty is a smash, partly because of “Betty’s” less than petite figure. Today, determining what you really want to do is the key, not comparing yourself to some unrealistic ideal.
So what are the options?
There are dozens of new non-surgical cosmetic procedures on the market, starting with dermabrasion, which is nothing more than scraping or sanding the skin (oh, doesn’t that sound fun?) to remove the top layers of mostly dead skin to reveal new, younger looking skin underneath.
On the other hand, if just about everything has fallen and can’t get up again, you can go to the extreme of a full body lift, which is a rather wretched process of surgically lifting the entire rear, stomach and thighs with incisions nearly full circle around the waist. The incisions aren’t pretty.
Most of us just want a small procedure or two so that our appearance outside matches how we feel inside, if not a step better. We’re healthier, more active and live longer, and we want to look as good as we feel. So what do you do first?
Where to start
First, Dr. Kian Samimi of San Diego, and formerly chief of the Division of Plastic Surgery at the University of Arizona, says to get a thorough evaluation by a “board certified” plastic surgeon.
“This means they are licensed by the American Society of Plastic Surgeons, and if they are a specialist in a particular area, it’s wise to also be recognized by the ASAPS (American Society of Aesthetic Plastic Surgery),” says Samimi, who has traveled to Vietnam as part of a humanitarian mission to operate on poor children and young adults with facial deformities.
“Some ear, nose and throat docs also do facial plastic surgery, and they have their own board and are well qualified, but I know an eye doctor out there who is performing breast work,” he cautions.
Once you know the doctor’s credentials, have a lengthy conversation. “When someone comes in for consult, we spend a lot of time with the patient,” says Dr. Samimi. “I use mini-procedures as a screening tool. For example, a woman may come in wanting a facelift, but I may not be sure about their expectations of the results. I like to suggest a smaller procedure, assess her response, and go from there.” That means less expense, less pain, trauma and a quicker recovery. Then, at a later date she can decide if she wants to go further.”
Dr. Steven Svehlak of Sunset Cosmetic Surgery, who did MacLaren’s eye lift, agrees, saying to take as much time with the doctor as you need. “If you feel rushed or aren’t being listened to by the doctor, find someone else,” he says. Svehlak and his partner Daniel Yamini, MD, were the doctors who recently corrected actress Tara Reid’s botched breast enhancements, dramatically revealed to the world in a dreaded wardrobe malfunction at a red carpet paparazzi event.
“Do as little as needed to reach goals,” adds Svehlak. “We have many options now, so we like to talk about a patient’s vision of themselves, what they like, don’t like, want to see different. Then we can advise on the best ways to proceed.”
Consider the results you really want to achieve, discuss all of the options, costs and relative lasting effects. Here is a breakdown of the treatment, purpose, effects, and ballpark costs (as these can fluctuate widely depending on the doctor):
Skin Resurfacing: Dermabrasion and dermaplaning help to “refinish” the skin’s top layers like you refinish a wood floor. A series of controlled surgical scrapings through the epidermal layer give skin a smoother appearance. Most over the counter and spa treatments don’t go beyond epidermal layer and you need to go to dermal layer to get correction.
Men and women of all ages can benefit from dermabrasion and dermaplaning. Healing slows with age, but more important to consider are your skin type, coloring, and medical history to prevent discoloration, blotchiness or other skin reactions.
Chemical peels can accomplish some of the same goals, reducing fine lines, but without surgical instruments. Dermabrasion can reduce deeper lines.
“If you have very sun damaged skin, a product called NuDerm, based on Retin-A, (also called Tretinoin, Avita, Renova) can reverse aging caused by sun damage. It’s stood the test of time,” says Dr. Samimi. “Yes, there is peeling, but it’s a good long term solution. The old laser technology causes redness for about two months and is considered rather brutal. Beware that products that have retinol aren’t Retin-A, which is only available by prescription.”
Men can also use a topical skin care product called Prevage (produced by Allergan/ Elizabeth Arden), which is a 1 percent idebenone solution. “This product, like RetinA, can correct current skin damage and prevent further damage,” says Samimi.
Botox: Ah, the lunchtime makeover. What Botox does is prevent the muscle from moving, but it can be done gently leaving some animation in the muscles, or more dramatically to prevent any muscle movement. Dr. Samimi says, “Everyone in authority says Botox is safe. Yes, it’s a synthetic botulism, but so far removed from it chemically that authorities such as the ASPA say there are only occasional minor temporary side effects, no systemic effects.” Cost: $250 to $600 per injection. Lasts three to four months.
Fillers: Fill ’er up! It’s about being full, not taut, says Dr. Samimi. “We used to associate youthfulness with taut skin, now it’s fullness. Aging shows in the loss of volume in the face. Filler materials address that. The skin can be pulled tighter while at the same time products such as Restalyne can fill in where the face has hollowed. New fillers don’t need skin testing like collagen because they’re not ‘natural’ or animal products.” Cost: $250+ per injection. Lasts four to six months.
The difference between Botox and injectable fillers:
“When you can see a wrinkle on your face even when your face is still or “static,” then that wrinkle needs something to fill it in to make it disappear. When wrinkles show as the face moves, they’re called “dynamic” wrinkles, perfect for Botox to paralyze. These processes last for up to several months.
New fillers are synthetic so there is no allergy issue. Restylane is hyaluronic acid (the backbone of synovial fluid in our joints, also used to treat osteoarthritis, according to the University of Connecticut Health Center). It lasts three to six months, as does Juvederm.
A new product called Artefil, is supposed to be a “permanent filler,” raising the issue of what happens if it is injected wrong? You may have to live with the result the rest of your life. But Dr. Samimi says it may be good for certain places, like the fold along the sides of the nose. This is when temporary fillers have the advantage, because your face changes over time.
Thermage is a treatment using heat to tighten the skin. Some say it also stimulates collagen production, but Dr. Samimi says scientific studies don’t support that claim. Some scarring under the skin occurs over time after treatment, which can actually work to further tighten the skin.
Plasma lifts (trade name Portrait®): Dr. Svehlak describes this procedure as the replacement of laser peels to firm, improve skin tone and complexion and reduce wrinkles. It is getting raves in the plastic surgery community. Using a hand-held nozzle that pulses and heats the nitrogen gas, tissue under the skin is heated. Unlike lasers, it doesn’t burn the skin, it stimulates body’s own healing ability, increasing collagen, blood flow, elasticity and firmness. “The surface acts as wound covering,” says Dr. Svehlak, “so in three to six days, surface skin that’s treated will peel off and new skin is underneath. It looks like mild sunburn after a week, but can be covered with makeup.”
Results: Full results will be seen in three to four months with improvements possible for up to a year.
Thread and ribbon lifts: Tuca Jebbia, 51, is a professional esthetician who worked for a time for the doctor who performed her Ribbon Lift procedure two months ago. She loves the results. “It lifted my neck and face, you can see the difference,” she says. Unfortunately, she can also feel it a bit, but says it’s not noticeable to others. “I haven’t had any problems. I just love it.”
In a thread lift, also called a Feather-Lift™, a patented polypropylene thread with directional cogs is placed beneath the skin by the ear. Once inserted under the skin, the cogs form a permanent support structure for the tissue of the face, lifting and contouring it. The approximate one hour procedure is done using a local anesthesia and patients can normally return to normal activities within a week. “The problem,” says Dr. Samimi, “is the threads lose strength and can break.”
The Ribbon Lift, however, is more substantial. The dissolvable ribbon is secured with sutures by the ear. The problem with these is if the ribbons are not placed deep enough you can feel them.
An ASPS spokesperson says the jury is still out on the lasting effects of lifting the cheeks and jowls.
Jebbia was bruised by her ribbon lift, but wasn’t concerned. “I did have a bruise in my right side face close to the chin and my left down neck that lasted 5 days only.” Would she do more? “Yes, I would love to have more procedures in the future,” she says.
Like hair, fat tends to disappear from areas we do want it to areas we don’t. Liposuction has been around for years because it’s done in the office with little downtime, and is suitable for all areas of the body. Now there’s vaser ultrasound liposuction, which uses heat to melt the fat before suctioning it out. This is great for getting rid of the dreaded “turkey neck.” Cost: $3,000.
If you need more extensive work requiring hairline incisions and anesthesia, the cost can range from $8,000 to $12,000, sometimes up to $20,000. The upside: Losing 10 to15 years off your perceived age.
The eye lift that MacLaren had will reduce the loose skin or amount of fat around the eye with minimal or no scarring. Cost: $3,000 to $4,000 per set of upper or lower lids.
A brow lift is really a forehead lift, which pulls up the brows to reduce heaviness in the eyelids. Cost: $5,000 to 6,000. Two techniques are available, endoscopic and the older conventional surgery or “open” technique, which Dr. Svehlak says is more predictable and lasting.
Jebbia’s advice about her ribbon lift: “Do it! It is fast, it is simple, it cost’s less, you can return to work in a couple of days, and you can see results immediately.” And as for MacLaren, “Everybody says I look good, but they don’t know what I did to look that way.”