See how you can return to a younger you in this age of custom facial rejuvenation – without the scalpel.
BY Lisa Liddane, Sarah Mosqueda and Jessica Peralta
June 4, 2009 - 4:59 PM
Did she or didn’t she? Get it done, that is. It’s a question that’s asked more often these days about the face of a celebrity, a local socialite or the neighbor down the street. The quest to achieve or regain a youthful look has become much more mainstream and somewhat egalitarian. That’s partly because of the impressive arsenal of nonsurgical treatments that have emerged or been fine-tuned in the past decade. And they won’t cost you the price of a compact car. At the same time, there have been advances in facelift techniques, so that the results can be much more subtle and natural-looking. Here, a look at facial rejuvenation, from nonsurgical contouring to facelifts.
No scalpel needed From fillers to lasers, nonsurgical options have changed the landscape of facial rejuvenation over the past decade. Some patients are turning to these treatments to repair the signs of aging in lieu of cosmetic surgery, while others are using these treatments along with surgical procedures to keep time from leaving permanent marks. As many of these options have become available, dermatologists have been able to combine two or more treatments tailored to the unique skin and needs of each patient, says Dr. Christopher Zachary, chairman of the department of dermatology at University of California, Irvine. The goals can include tightening of loose skin, as well as what Zachary calls “dermal plumping,” in which youthful volume is restored, like putting air back into a deflated balloon. Here, we explore some nonsurgical treatments, including those that are popular and others that are in development. Each treatment comes with benefits, side effects, and risks of complications. If you are considering nonsurgical options, talk to your dermatologist/doctor about which treatment suits you best.
FILLERS Botulinum toxin Widely known under the brand name Botox, manufactured by Irvine-based Allergan, Inc., this purified protein is produced by Clostridium botulinum. Other brands of botulinum toxin in the works: RT001 from Revance Therapeutics, and PurTox from Johnson & Johnson. Reloxin, which has been sold in Europe as Dysport, was just approved by the FDA. It is toxic in large quantities, but when administered in small doses it can improve and reduce the appearance of fine lines, wrinkles and crows feet. In development: For the needle-averse, a topical cream version of the botulinum toxin is in the works at Revance Therapeutics. HOW IT WORKS Botulinum is injected directly into the problem area of the face, temporarily paralyzing the muscle by blocking the nerves and preventing it from contracting and forming wrinkles. THE GOOD, THE BAD AND THE UGLY Although the results may vary and are temporary, lasting roughly four months, there is no recovery time involved. Some side effects are bruising at the injection site and mild headaches. Injections administered to the wrong face muscles or too many muscles can result in a drooping eyelid or double vision. THE PRICE OF YOUTHFULNESS $175-$500
Collagen Collagen is a protein responsible for the skin’s strength and elasticity, but it weakens as we age, making the skin appear less toned and less resilient. Collagen fillers are derived from cows (Zyderm and Zyplast), pigs (Evolence) and human tissue (Cosmoderm, Cosmoplast, Cymetra, Fascian, and Autologen). HOW IT WORKS When injected in lips, wrinkles and lines, collagen fillers restore tone to the skin. THE GOOD, THE BAD AND THE UGLY Results vary and can last for months depending on the number of treatments and how quickly the body absorbs the collagen. In the case of animal-derived collagen, skin tests are usually performed prior to the procedure to ensure that the body is not allergic to the injections. There is no recovery time. Some side effects include redness, irritation and bruising around the injection site. In rare cases, scarring can result. THE PRICE OF YOUTHFULNESS $250-$600
Semi-permanent filler/Radiesse The injectable formerly known as Radiance may last from one to two years. This filler is made of calcium-based microspheres in a water-based gel. HOW IT WORKS Radiesse is injected into skin. Like other fillers, it smooths lines and folds and adds volume. The microspheres in Radiesse are designed to stimulate collagen production. THE GOOD, THE BAD AND THE UGLY Because the results typically last longer, touch-ups are few and far between. Most patients get the desired result in as few as one or two treatments. Side effects include redness, swelling, and irritation at injection site. Lumping, clumping and nodules can appear when Radiesse is injected into the lips. THE PRICE OF YOUTHFULNESS $650-$800
Hyaluronic acid Restylane, Juvederm and Captique are examples of hyaluronic acid-based injectables. The skin naturally produces hyaluronic acid to help keep the skin hydrated. HOW IT WORKS The molecules of hyaluronic acid injected into the skin naturally bind to water molecules. Those modified molecules may create a fullness under the skin to fill in lines and folds. THE GOOD, THE BAD AND THE UGLY Hyaluronic acid can last from several months up to a year. Usually only one treatment is required to achieve desired results. Some side effects include redness, tenderness, mild pain, and swelling. THE PRICE OF YOUTHFULNESS $275-$445
RESURFACING Lasers Lasers have been used for more than a decade to alter the surface of the skin. There are three main types: ablative, non-ablative and Fraxel. HOW IT WORKS No matter what laser, the basic premise is the same: Lasers use concentrated beams of light to vaporize the surface of the skin, layer by layer, and can diminish wrinkles and lines. The effects of skin resurfacing using an ablative carbon dioxide (CO2) laser are similar to those of chemical peels and dermabrasion. Non-ablative lasers such as the CoolTouch I or II, the MedLite and the N-Lite work beneath the surface skin layer, using short pulses of light. These pulses of light can build new collagen, improve skin tone and texture, and minimize fine lines and scars. A newer type of laser treatment, fractional rejuvenation (Fraxel), targets specific areas of the skin layers while keeping the surrounding areas untouched. THE GOOD, THE BAD AND THE UGLY Recovery time can range from less than one week to two weeks and redness can last for months. But the results may last years. THE PRICE OF YOUTHFULNESS $800-$1,000
Radiothermoplasty Titan and Thermage use radio frequency energy to stimulate the skin’s renewal process, tightening existing collagen and forming new collagen. HOW IT WORKS The radio frequency energy heats the inner skin layer, while cooling and protecting the outer layer. THE GOOD, THE BAD AND THE UGLY It’s a one-time treatment. There usually is no recovery time. The results vary and may take a few weeks or months to show, as new collagen forms. Side effects include redness and swelling. THE PRICE OF YOUTHFULNESS $1,000-$3,500
Chemical peels Chemical peels use a chemical solution to remove the outermost layer of the skin. Alpha hydroxy acids (AHA) are the most mild of peel formulas. Trichloroacetic acid (TCA) is used for a slightly stronger peel and phenol is the most powerful solution used. HOW IT WORKS Since the top layer of skin tends to be the most damaged, the removal of it improves the appearance of scars, blemishes and uneven pigment. The solution is applied to clean skin in a process that can take from 20 minutes to two hours. THE GOOD, THE BAD AND THE UGLY A mild AHA treatment will require the least post-treatment care. Washing the face twice a day will achieve the desired result, unless there is uneven pigment in the skin, in which case a bleaching treatment may be implemented. The face will become red and flaky and peeling may occur for up to three days. The TCA treatment may require a few treatments for results and will cause swelling along with the standard peeling. The face will become very swollen, and little movement of facial muscles and a liquid diet are strongly recommended. After seven to 10 days, the scabbed, flaking skin will begin to heal. It is critical that skin is not exposed to extreme sunlight. Some side effects are scarring, swelling and cold sore outbreaks. THE PRICE OF YOUTHFULNESS $150-$6,000
Photo rejuvenation/Intense Pulsed Light (IPL) therapy Photo rejuvenation uses highly concentrated light energy to stimulate the production of collagen in the face. HOW IT WORKS Photo rejuvenation resurfaces the skin by removing the outer layer. Pulses of intense light penetrate the skin, stimulating it to produce collagen. THE GOOD, THE BAD AND THE UGLY This requires a series of four to six treatments. Results may vary. The procedure is slightly painful, though a topical anesthetic may be used. Side effects include redness, bruising and temporary darkening of age spots. THE PRICE OF YOUTHFULNESS $500 per treatment
Microdermabrasion The dead outer layer of the skin is removed using an abrasive technique. Can be used on crow’s feet and age spots. HOW IT WORKS The hand piece emits crystals onto the surface of the skin, resulting in a gentle abrasion or “polishing” process. Each treatment takes from 30 minutes to an hour. THE GOOD, THE BAD AND THE UGLY The number of treatments recommended for best results can range between five and 12, spaced from two to three weeks apart. Maintenance of results requires periodic repeat treatments after the initial regimen is completed. Microdermabrasion may be combined with a light chemical peel to increase the effect. Side effects can include redness and swelling. THE PRICE OF YOUTHFULNESS $75-$100 per treatment
COSMETIC ACUPUNCTURE An extension of traditional acupuncture, cosmetic acupuncture uses needles on specific points on the face to enhance beauty. It deals with the muscle tension that causes wrinkles. HOW IT WORKS Fine and relatively painless needles are inserted into the face at specific points, stimulating the body’s natural energy. The treatment has been said to soften deep wrinkles and firm up jowls and bags under the eye. The treatment can take up to 90 minutes. A series of 10 treatments is recommend for maximum results. THE GOOD, THE BAD AND THE UGLY Like the controversy that surrounds traditional acupuncture, there is much dispute about how effective this ancient Chinese medicine is. There is no recovery time. Results may vary. Some treatments utilize herbal moisturizers and essential oils, which may make the experience more invigorating. THE PRICE OF YOUTHFULNESS $1,000-$1,500
SOURCES Dr. Christopher Zachary, chairman of the department of dermatology at UC Irvine, American Academy of Plastic Surgeons, American Academy for Aesthetic Plastic Surgery, the American Academy of Dermatology, WebMD.com, and consumer/physician Web sites for each of the brands mentioned in this article.
For more information American Society of Plastic Surgeons: plasticsurgery.org The American Society for Aesthetic Plastic Surgery: surgery.org American Academy of Dermatology: aad.org
Donna Bunce, before the facelift/Courtesy of Dr. Jay Calvert
After the facelift/Courtesy of Dr. Jay Calvert
The New Facelift: A More Natural Look
Having been entrenched in the world of beauty and style for many years, Coast’s fashion editor, Donna Bunce had seen all kinds of facelifts. Those so tight and overworked, they looked like a Hollywood cliché. And those so well-executed, the patients looked like they just came back from a luxury spa vacation.
So when she decided it was time to have hers done, Bunce, 66, knew what she wanted – a look that wouldn’t make her face seem “pulled back.” For this, she turned to Dr. Jay Calvert, a cosmetic and plastic surgeon who practices in Newport Beach and Beverly Hills (drcalvert.com, 949-644-2858). Bunce had seen his work up close and liked how the results looked naturally changed – not radically altered.
Calvert is among the coterie of cosmetic surgeons who advocate a new look that restores some youthful fullness to the aging face instead of what the doctor calls the “windswept” facelift of previous decades.
Here, Bunce and Calvert discuss her facelift and the new look in facial rejuvenation.
What prompted Bunce to have a facelift At 66, I began to notice wrinkles and a sagginess to my face and neck that was rapidly aging me. I chose Dr. Jay Calvert to do my surgery because two personal friends of mine had had plastic surgery done by him, and I loved his “refreshed” approach.
The kind of look she wanted I wanted to look 12-15 years younger. I wasn’t interested in a no-wrinkles look. I wanted a natural look – to still be Donna Bunce, just a slightly younger version.
Areas she wanted to address I wanted to get rid of the puffiness underneath my eyes, the jowls on my jaw line, the loose skin on my neck, and the lump underneath my chin.
Calvert’s assessment of Bunce’s face Donna had the makings for good results. She is an attractive woman. She had eyebags under her eyes and loss of volume throughout her face, but the neck and jowls were neither here nor there.
Calvert’s plan The latest trend in facial cosmetic surgery is to reposition the features of the face using minimally invasive techniques and instruments to create a youthful look. In Donna’s case, the goals were to give fullness to the cheeks and volume above the eyes, enable the corners of the mouth to turn upward and give the jawline a clean silhouette. I use an endoscope, which allows me to create small incisions, but enables me to lift soft tissues underneath the skin and move them as a unit. In old school facelifts, one lifted the skin over the soft tissues and pulled it tight.
Why Calvert typically uses minimally invasive cosmetic surgery over open surgery In my experience, there are fewer complications and faster recovery times with endoscopic surgery.
How Bunce prepared for surgery Dr. Calvert schooled me well on what to expect in surgery, immediately after and each week following. He had me begin taking bromelain and Arnica montana, which are herbs, two weeks prior to the surgery to help with swelling and bruising. He also suggested multivitamins, which I was already taking, with an extra daily dose of vitamin C.
On recovery The only difficulty, if you want to call it that, was headaches the first five days, but prescription pain medicine took care of it. It was the only medication I took. I was absolutely amazed that Dr. Calvert told me to take a shower and wash my hair the second day after surgery. With all the stitches and staples in my face and scalp, I thought it would be at least a week before I could do that.
On how she looked after surgery The jowls, the loose skin in my neck and lump under my chin, and the bags under my eyes were gone. I was ecstatic. I was home for two weeks and back to work covering two fashion events the second day after returning. I still had a bit of bruising, but I hid it with makeup and unless people knew beforehand that I had a facelift, they didn’t know.
Her immediate reaction to her new face Dr. Calvert said it would be five months before healing was complete, but I can honestly say I was delighted from day one. I looked younger, refreshed, but natural. It was exactly the result I wanted.
How people responded to her facelift If people knew I had a facelift, they were amazed – especially after I pulled out photos of myself taken right before the surgery. If they didn’t know I had had the surgery, comments ranged from “You look so rested” and “Have you been on a vacation or to the spa?” to “You look fantastic!”
The longevity of a facelift If a patient takes care of her/his face, six to 10 years.
