Face Facts

Guide to Noninvasive Facial Cosmetics

Creases on a Marine's crisp pant leg say order, lines on a roadway say safety and folds in fresh laundry say task complete. But creases, lines and folds on your face tell another tale.

As we age, collagen, the natural protein fabric that provides shape to our skin, breaks down faster than we can produce it. Aging men and women see the results of this collagen loss in the mirror every day. As non-surgical treatments evolve, recapturing a youthful face has become simpler, less costly and less time-consuming. While providers debate whether liquid and laser procedures are tools for a bladeless facelift or just a temporary eraser, appearance-conscious patients who guard their free time and finances are choosing injectable and laser treatments in increasing numbers.

Figures released last year show that noninvasive cosmetic procedures rose 47 percent in 2009 alone, according to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). In an era where hope comes in a jar and we purchase beauty in an instant, it comes as no surprise that consumers expect liquids and lasers to lift faces without a surgeon lifting a scalpel.

But can it be done?

“The lift part is a misnomer,” says board-certified plastic surgeon Dr. Christopher J. Ewart of Augusta Plastic Surgery Associates. “It’s more of a camouflage of the aging process.”

“As everyone ages, their cheeks drop…The upper cheek fullness is associated with youth and beauty. By calling it a liquid facelift, basically you’re filling in the area back where the cheek used to be,” Dr. Ewart explains. “You camouflage the aging process by doing that. You’re not lifting per se. You’re hiding the fact that it’s not there anymore…And giving the appearance that you’re less tired, more youthful, more awake.”

Consumers need to understand the difference between marketing and real medical information, cautions Dr. Achih H. Chen, a board-certified facial plastic and reconstructive surgeon and director of the Georgia Center. The line between the two arenas is often blurred, he says, as in the idea that a facelift can be done using solely liquid medical products.

“A liquid facelift is overly optimistic in what it can produce,” Dr. Chen says. “Like every marketing tool, there is truth in it. As our faces age, we lose volume. So if you re- create some of that volume, you do produce a more youthful face. Is it a facelift result? It is absolutely not a facelift result because you cannot deal with the jowling and the excess skin, but you can re-volumize and produce a nice result.”

Surgeons are cautious when predicting the outcome from the nominally invasive options. “There has been a huge movement over the past 20 years towards more noninvasive treatments of the aging process, but the less invasive a procedure is, the less results you’re going to get,” says board-certified plastic surgeon and former chief of surgery at St. Joseph’s Hospital, Dr. Gary Williamson of Augusta Aesthetic Surgery. “The more invasive the procedure, the greater the result. But more invasion and more aggressive treatment result in greater downtime, which is part of the problem with women who have very active schedules.”

So if you’re looking for results you can get on your lunch break, then read on for the details of what to expect from the current noninvasive face treatments explained by physicians who perform them and the latest news in upgrades for your eyes, mouth and overall skin tone and texture produced with no downtime.

For most women over 40 and some men, the unwritten complaint list about the eye area includes crow’s feet, puffy or hollow undereyes, crepe-like skin and droopy lids. Enter the minimally-invasive menu of procedures that address it. The two most common injectable solutions—denervating agents, like Botox and Dysport, which impede wrinkles from expanding on your face, and hyaluronic acid fillers, like Juvederm or Restylane, which fill in lines and add volume, can dramatically improve the appearance of the eye. Laser resurfacing and chemical peels can also help correct minor wrinkling around the eyes.

Of the two injectables, Botox rises to the top as the number one non-surgical procedure administered in 2009, according to the American Society for Aesthetic Plastic Surgery. Though only FDA approved for use on the glabellar lines, the spot between the eyebrows, physicians routinely use it in multiple locations with definite results.

Dr. Chen applies the agent to crow’s feet, the c-shaped spot on the outside of each eye and to the glabellar lines. “It works best on a dynamic wrinkle,” says Dr. Chen. Dynamic wrinkles occur when facial muscles are used to form an expression. For static wrinkles, those created by the loss of natural substances like collagen, fillers work best, he says.

When you study a more youthful eye, Dr. Chen explains, it’s not necessarily about just lift or being wrinkle free. “A youthful eye doesn’t have a lot of eyelid showing. It has a full brow pad and just a little bit of eyelid showing,” he says. To create a younger appearance, he often injects fillers in the brow area.

Wrinkles around the eyes can also be significantly reduced through various laser techniques or chemical peels. Both procedures offer multiple levels of invasiveness. For minimally invasive lasers, also referred to as nonablative, patients can expect mild redness and little to no recovery time, but multiple treatments may be necessary to achieve a desired result. Ablative lasers used to perform resurfacing and more concentrated chemical peels penetrate deeper and are considered invasive procedures.

Like Cinderella, remember the clock strikes midnight on all injectables and everything will revert to its original form. Fillers typically need to be repeated every nine to 18 months and Botox treatments usually last three to four months.

The Mouth

Though dermal fillers ranked second as the most popular non-surgical treatment choice in 2009, many approve of the number one impact they can have on lips, fine lines and deeper folds around the mouth. Using hyaluronic acid fillers and longer lasting, next generation products like Radiesse, patients can find plumper, fuller lips and significant wrinkle reduction around their mouth.
Radiesse, made of naturally occurring calcium hydroxylapatite, stimulates natural collagen growth. In his practice, Dr. Chen prefers to use it for augmentation in a cheek area, not for fine lines or lips.

“As we age, our midface deflates and nasolabial folds [the vertical parentheses lines on either side of your mouth] get deep,” says Dr. Chen. Dermal filler manufacturers focus on the folds and they want you to fill it, he says. “The reason they want to talk about it is because that’s the only place they have FDA approval to advertise. They can’t advertise for anywhere else. This is anatomically incorrect…It’s totally normal to have that fold. It’s not normal to fill it.”

Instead, he says, a youthful face has a fuller mid-face, which decreases the appearance of the nasolabial fold. “It’s very much like pumping a tire back up…Volume loss is a sign of age. A quick way to make people look younger is to volumize the mid-face.”
“I keep harping on that it’s normal, it’s normal to have that [nasolabial lines] and if you fill it flat, it’s not normal and you will look weird.”
Here, too, lasers and chemical peels can wipe away fine lines and wrinkles. The option for each requires more frequent treatments, but also doesn’t require you to cancel your weekend plans.

Skin Rejuvenation

Rejuvenating the entire face through laser and chemical peel treatments has increased exponentially in the past five years, according to American Academy of Cosmetic Surgery 2009 member census. Laser resurfacing alone increased 370 percent between 2005 and 2009. With lasers, patients can reduce wrinkles, erase age spots, tighten loose skin, improve skin tone and color, remove blotchiness and even eliminate damaged blood vessels.

For the least invasive laser and chemical peels, the temporary side effects of mild redness, swelling or minor discomfort disappear within a few days. “The lighter the peel, the quicker the healing time. The lighter the peel, the less the result,” Dr. Chen intones. “It goes back to what our parents told us. Nothing worthwhile happens without a little bit of work.”Nonablative lasers like Fraxel target tissue under the skin and promote new growth. Fraxel can be used successfully for skin pigmentation issues, minor wrinkles and scars, Dr. Williamson says, and is usually performed in a series of four to five treatments.

Noninvasive laser or chemical peel treatments do not require any downtime and should not result in a severe peeling or crusting as typically happens with more invasive treatments.

Great Expectations

Your cosmetic process road begins with research. Before meeting, patients can make the most of their face-to-face time with their doctor by thoughtfully considering what they want to accomplish through the treatment.

“Everybody has different goals in what they’re trying to achieve. I individualize it. I try to get as much information as possible and find out what kind of work they do and how much time they have off, what are their goals and what are they trying to achieve,” Dr. Ewart says. “Are they just trying to get some improvement? Are people telling them they looked tired and they’re just tired of hearing that? Do they just want to be refreshed? Or are they really looking for some long-term improvement?”

While physicians solicit information from patients about their ultimate ambitions, patients should educate themselves through research before meeting with their doctor. Search the internet. Look for medical associations and academic websites, not specific products being marketed. “The more information they get, the better decision they can make,” says Dr. Williamson. “…The more you educate your patient, the more time you take, the better patient you’re going to have and the more satisfied they will be.”

Patients often come with impractical visions in mind of what they want to look like at the end of their treatment, he says. “All patients come with greater expectations than can be achieved. My job is to set the expectations at what I can do and not what’s in their minds.”
The reality is that through less invasive methods, doctors can help women and men have smoother skin, simulated lifts and reduced wrinkles with little inconvenience to their schedules. Reputable cosmetic procedure providers practice reality medicine.

“At the end of the day, happy patients are what makes a good practice,” Dr. Chen explains. “Most surgeons don’t want to overpromise, they want to counsel patients on realistic results so that everybody’s happy in the end.”