Treatment
The first step is determining the right treatment for your aesthetic concern. You have numerous options. The most commonly performed treatments follow.
Botox Cosmetic
Botox Cosmetic is a purified protein derived from the bacterium Clostridium botulinum. It reduces muscle activity by blocking the nerve impulses that cause the squinting or frowning muscles to contract. Botox Cosmetic is approved for the temporary treatment of the vertical lines between the eyebrows, often referred to as the "11."
Only licensed healthcare professionals can purchase Botox Cosmetic. Plastic surgeons or dermatologists routinely administer Botox Cosmetic, although any physician with special training in facial anatomy may perform Botox Cosmetic injections. Some states also allow non-physicians such as registered nurses or physician assistants to administer the drug if they are directly supervised by a physician. Regardless of who administers your injection, always ask to see the vial and look for the manufacturer's safety hologram to ensure you are treated with authentic product.
It only takes a few minutes to be treated with Botox Cosmetic, and the effects last up to four months. Botox Cosmetic costs an average of $300 to $500 per area of treatment, and costs vary across the country based on a number of factors. Some aesthetic specialty physicians charge by the unit of product. This allows them to charge more or less depending upon the specific patient's need. Be sure to ask your physician the estimated total cost of your treatment.
Potential risks include allergic reaction, headache, bruising (if injections occur while taking aspirin or anti-inflammatory medications or if you've had alcohol within the previous week), redness and numbness at the injection site. There is a slight risk of paralysis of nerves adjacent to the injection site. If you are pregnant, nursing or have a medical condition, make sure you discuss the possible risks with your physician. Most products, including Botox Cosmetic, are not recommended for pregnant or nursing women.
Dermal Fillers
These injectable products fill fine lines and plump up wrinkles to provide a natural and smooth look. They are among the most popular nonsurgical cosmetic treatments According to the American Society of Plastic Surgeons (ASPS), the use of hyaluronic acid dermal fillers—one category of soft tissue fillers—has increased 68 percent among women by since 2004, making it the second most popular aesthetic injectable treatment behind Botox Cosmetic.
Dermal fillers work differently than Botox Cosmetic. Fillers are injected directly into wrinkles and lines, instantly adding volume. There are many dermal fillers to choose from, so make sure to ask your aesthetic specialty physician which type of filler he/she recommends to ensure that you receive your desired results. Also, certain dermal fillers may work better in different people and for different areas, so you may need to try more than one before finding the best product for you. Sometimes, aesthetic specialty physicians will use multiple products, depending on your needs, to obtain your desired result. You pay by the syringe, and several syringes may be required, so ask your physician for an estimated total cost before beginning your treatment.
FDA-approved dermal fillers as of August 2007 included:
Hyaluronic acid fillers (Elevess, Hylaform, Hylaform Plus, Juvéderm Ultra, Juvéderm Ultra Plus, Perlane and Restylane). Hyaluronic acid is a natural complex sugar found throughout all living animals. It absorbs more than 1,000 times its weight in water, thus adding volume to the skin's surface. With age, however, hyaluronic acid concentrations drop, causing wrinkles and folds. These fillers are used to temporarily replace lost hyaluronic acid and restore skin volume.
Hyaluronic acid dermal filler injections typically take less than an hour to perform. Duration varies among products; Juvéderm is approved to last up to one year and Restylane and Perlane are approved to last up to six months or more. Collagen fillers (CosmoPlast, CosmoDerm, Zyderm and Zyplast). Collagen is a protein substance found in all human and animal tissue. It makes your skin, bones and ligaments tough while providing structure. Collagen is often used for filling wrinkles and lines and scars on your face, neck and back. Zyderm and Zyplast cosmetic injections use collagen from cattle, called "bovine collagen." CosmoPlast and CosmoDerm injections use highly purified human collagen, a natural protein that supports the skin and helps replenish collagen lost with time, exposure to sunlight and other factors.
Collagen injections typically take less than an hour to perform, and the results last three to four months. Each syringe costs about $400. Plastic surgeons and dermatologists are best suited for providing collagen injections. Rare side effects include the formation of small, temporary bumps beneath the skin. Fat fillers. Your aesthetic specialty physician may also suggest a fat filler, in which fat is removed from another part of your body and injected into the wrinkle/line. Since the fat is of your own body, the risk of complications is very low. Synthetic fillers (Artefill, Radiesse and Sculptra). Synthetic fillers are used for filling facial wrinkles and folds. It takes less than an hour for synthetic filler injections, and the results can last anywhere from up to six months, to five or more years, depending on the filler product. Synthetic fillers differ depending on the brand:
- ArteFill contains polymethylmethacrylate beads suspended in collagen and the numbing agent lidocaine. Polymethylmethacrylate is an acrylic cement often used in orthopedics. Unlike other fillers, Artefill is not absorbed by the body. Average cost per syringe: $500 or more.
- Radiesse is an injectable calcium hydroxylapatite gel. Calcium hydroxyapatite is found in teeth and bones and is used for numerous medical applications including cheek, jaw, skull and chin implants. Average cost per syringe: $850 or more.
- Sculptra is an injectable poly-L-lactic acid (PLLA). This compound is used in numerous medical products, such as stitches and screws used to repair broken bones. Although Sculptra has only been approved to restore shape and contour to the faces of those with AIDS, it is often used "off label" for cosmetic treatments. Average cost per syringe: $2,500 or more. Sculptra requires several injections over time to rebuild the lost volume. It may last up to five years.
Synthetic fillers should be administered by plastic surgeons or dermatologists.
Skin Resurfacing
These techniques are designed to smooth fine lines and wrinkles, get rid of brown spots, reduce sun damage and shrink pores. The level of intensity varies from mild chemical peels to laser resurfacing and laser pulses, and after-effects range from mild redness to peeling and scabbing. Skin may also be very sensitive to sunlight and unable to tan.
Chemical peels. A chemical solution is "painted" onto your face to literally "peel away" damaged top layers of skin. Solutions range from mild alpha hydroxy acids to stronger acids like trichloroacetic acid (TCA) and phenol. It takes between 15 minutes up to three hours for a chemical peel, depending on the strength of the peel.
Chemical peels cost between $696 and $870, depending on the strength. Aestheticians may perform mild peels. Plastic surgeons or dermatologists are your best bet for stronger peels.
Microdermabrasion. A more superficial form of dermabrasion (described below), microdermabrasion uses crystals or a diamond tip to lightly smooth the top layer of your skin. It is used for fine lines, crow's feet, age spots and superficial acne scars. Microdermabrasion takes between 30 minutes to an hour and requires no anesthesia. For best results, multiple sessions are required two to three weeks apart, and the results are temporary. Each session costs an average of $162.
Microdermabrasion may be performed by aestheticians, licensed cosmetologists, plastic surgeons or dermatologists. Complications are rare.
Dermabrasion. This treatment involves "sanding" the top layers of skin. It works to reduce the appearance of acne scars, fine wrinkles and sun-damaged skin. The treatment itself takes anywhere from a few minutes to one and a half hours, and it is typically performed under local anesthesia or sedation. Dermabrasion may be performed with a rough wire brush or a "burr" containing diamond particles that is attached to a motorized handle. A similar treatment called dermaplaning uses a razor-like instrument that skims off the top surface of skin. The success of this procedure is highly dependent on the skill of the operator. It is not used regularly anymore.
The results are long-lasting, although multiple sessions may be required. Dermabrasion costs an average of $1,586 and should only be performed by a qualified plastic surgeon or dermatologist. Rare complications include changes in skin pigmentation, infection and scarring.
Laser skin resurfacing. In laser resurfacing, or laser peel, the doctor uses a carbon dioxide laser to remove areas of damaged or wrinkled skin. New cells form as the skin heals, creating a smoother, tighter, younger-looking appearance. Laser resurfacing is used for minimizing the appearance of fine lines, uneven pigmentation and facial scars. It works best for light-skinned women. The treatment takes from a few minutes to one and a half hours and is typically performed under local or general anesthesia. Each treatment costs an average of $2,160 and the results last a year or more. Laser skin resurfacing is best performed by a qualified laser specialist, usually a plastic surgeon or dermatologist. Possible complications include burns, scarring, obvious lightening or darkening of the skin. It may also activate herpes virus or other infections.
Photorejuvenation. Also called intense pulsed light (IPL) laser, this treatment uses intense pulsed light laser to remove brown spots, reduce redness, shrink pores, clear broken blood vessels and improve sun-damaged skin. Each treatment requires 15 to 45 minutes, and you may need up to three treatments, about three weeks apart, to see results. However, the results are permanent. Initially, skin may appear flushed, brown pigmented spots may appear darker, and capillaries may be more visible. This all fades with repeated treatments and time. Rarely, temporary swelling and/or blistering may occur. The treatment should be performed by a plastic surgeon or dermatologist.
Plasma skin rejuvenation (Portrait). This new nonablative procedure improves skin texture and reduces wrinkles and irregular skin coloring by delivering millisecond pulses of nitrogen plasma energy to the skin. The procedure takes about 15 to 40 minutes, depending on the extent of the work. Discomfort may be managed with pretreatment application of topical anesthesia. The skin is red for about six days on average. The optimal results may require one to three procedures, depending on the energy and settings used. There is marked improvement in wrinkles without creating a wound. Improvements are noted after a month and continue to improve with subsequent treatments.
Fractional photothermolysis or fractional resurfacing. This technology removes a small fraction of the surface of the skin during each treatment to resurface the skin. This procedure is similar to a resurfacing laser, but with much less down time. The micro-injury causes the collagen to remodel. This procedure is used for large pores, pigment abnormalities and acne scars. It is typically performed with Pixel and Fraxel lasers. The procedure usually takes about 30 minutes, and you may require three to five treatments for the best results. The cost is between $600 and $900 per treatment.
Thermage. Thermage uses radiofrequency technology to tighten and gently lift skin to smooth wrinkles and renew facial contours. Unlike laser treatments, it can be performed on all skin types.
Accent. Accent also uses radiofrequency technology to treat wrinkles and sagging skin. It can be used on all skin types, on patients of nearly any age and on any part of the body where skin tightness is a concern.
Hair Removal
Treatments such as electrolysis or laser hair removal can keep you smooth longer than razors, tweezers or waxing. The two most common treatments are electrolysis, in which an electric current is used to permanently destroy the hair follicle, and laser treatments, which use a laser to destroy the follicle. Both are eventually permanent after years of repeated treatments.
Electrolysis may be performed by an electrologist. Each session takes between 15 minutes and an hour, and the cost varies widely depending on the area from which the hair is to be removed. Risks include permanent holes where the needle penetrates into the skin.
Laser hair removal takes from 10 to 30 minutes, depending on the size of the areas to be treated, and multiple sessions—usually four to six—are required. Then the patient will need a maintenance treatment two to three times a year. It costs an average of $150 to $800 per session (again depending on the amount of areas treated) and is best performed by a dermatologist or plastic surgeon.
Possible complications of both include pain, scarring and pigmentation changes.
Pain Relief During Cosmetic Treatments
Because many nonsurgical aesthetic treatments can be uncomfortable, topical anesthetics are often used to numb the face. However, using them in high amounts, even if purchased over the counter, can lead to serious health problems, including irregular heartbeat, seizures, coma and even death. The FDA recommends you:
- Use a topical anesthetic containing the lowest dose of anesthetic drug to relieve your pain.
- Make sure you get specific instructions from your doctor on the proper and safe use of the anesthetic.
- Understand that wrapping or covering the skin after applying the anesthetic can increase the risk of side effects.
- Use a topical anesthetic approved by the FDA (go to http://www.fda.gov/cder/ob/default.htm and type in the product's active ingredient).
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Create Date: 11/5/07
Date Last Updated: 11/5/07
Review Date: 11/5/07
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