Study Up

By R.J. Ignelzi

December 7, 2007 8 min read

STUDY UP

Do homework before undergoing any cosmetic procedure

By R.J. Ignelzi

Copley News Service

A few pokes with a needle. Some laser snaps against your cheek. The minor discomforts and risks of noninvasive cosmetic treatments are usually nothing compared with plastic surgery. But you still need to consider them carefully.

"There are a lot of different noninvasive (procedures) available, and some of them are only good for certain people in certain areas of the face or skin. That's where the experience of the person (treating) you becomes important," says Dr. Richard Fitzpatrick, a dermatologist with La Jolla Cosmetic Surgery Centre. "If you're injected in the wrong anatomical location, the complication rate can be high. These (procedures) may seem simple, but don't take them lightly."

The following are questions you need to ask before any noninvasive cosmetic procedure.

- Who will be performing the procedures?

Although board-certified dermatologists and plastic surgeons are the gold standard for performing any injection or laser therapy, physicians aren't the only ones allowed to perform noninvasive cosmetic procedures in California. As long as there is a supervising doctor available (but not necessarily on site, as in medi spas), most cosmetic treatments may be performed by other medical practitioners, including physician assistants, nurse practitioners or registered nurses.

- How long have you been doing facial injections or using these lasers?

The longer the better, with a minimum of one or two years.

- How often do you perform facial injections or laser procedures?

It should be a major part of their practice, and they should do them every day.

- Are cosmetic procedures your specialty?

It should be the focus of the practice.

- What kind of injectables or lasers do you use?

The practitioner should use a variety of materials. Don't use a doctor or other medical practitioner whose treatment plan is, say, Botox for everything.

- May I see other patients' before-and-after pictures?

This is the best way to determine that you and the medical practitioner are on the same aesthetic page.

- May I talk to former patients who have had these procedures?

You should be supplied with names and phone numbers of patients who have had similar treatments.

PRODUCTS AND PROCEDURES

Botox

($300 to $600 per syringe)

What it is: Derivative of botulinum toxin

What it does: Temporarily paralyzes muscles to smooth forehead, creases between brows, crow's feet

Duration: Four to six months

Pros: Safe, immediately effective for movement-related wrinkles

Cons: Not good for lower half of face; short-lived effect; can be diluted by injector so it's less effective. Overdoing can result in an expressionless forehead and eyes.

Restylane

($500 to $700 per syringe)

What it is: Hyaluronic acid wrinkle filler

What it does: Binds water to plump up wrinkles in lower face, including nasolabial fold ("marionette lines") and lip lines

Duration: Four to eight months

Pros: Immediate results, molds well in tissue, minimal discomfort and recovery Cons: May cause slight bruising, redness

Juvederm

($550 to $750 per syringe)

What it is: Hyaluronic acid wrinkle filler gel

What it does: Adds fullness to lines and wrinkles. Effective for lip lines.

Duration: Six to 10 months

Pros: May last a little longer than Restylane. More viscous, so may better fill deeper wrinkles.

Cons: May cause slight bruising, redness

Radiesse

($700 to $900 per syringe)

What it is: A wrinkle filler/volumizer composed of tiny calcium particles

What it does: Adds volume, fills out nasolabial fold. Triggers collagen production.

Duration: One year or longer

Pros: Lasts longer than some other products, promotes collagen

Cons: Can cause bruising or bumps under skin. Not good near eyes or for thin skin.

ArteFill

($1,200 to $1,600 per syringe)

What it is: A combination of synthetic polymer beads and bovine collagen used as wrinkle filler

What it does: Stimulates collagen production. Fills out wrinkles. Often used in nasolabial fold.

Duration: Estimated four years or more

Pros: Very long-lasting or permanent

Cons: Allergy test is required. Long-term effects unknown. May cause lumpiness. Not for thin skin or lip or eye areas.

Sculptra

($800 to $1,400 per injection)

What it is: Poly-lactic acid volumizer

What it does: Adds volume, promotes new collagen, works well in cheeks

Duration: Approximately 1 1/2 to two years

Pros: Lasts a long time, triggers collagen production

Cons: Requires three or four treatments. Slight swelling or bruising. May cause lumpiness. Expensive for total treatment package.

Noninvasive laser

(Fraxel or Affirm; $800 to $1,600 per treatment)

What it is: Nonablative resurfacing laser

What it does: Makes pixilated microwounds deep in skin to stimulate collagen. Tightens skin. Improves pigmentation, acne scars. Used in eye and lip areas. Duration: At least two years

Pros: Long lasting. One of few treatments that improve skin texture.

Cons: Mild swelling and redness. Can be painful. Need four treatments over several months.

Radio frequency resurfacing techniques

(Thermage or Aluma; $2,000 to $3,500)

What it is: Hand-held device delivers heat energy using radio frequency technology

What it does: Heats up collagen, which contracts and tightens skin. Used for sagging skin; improves texture.

Duration: One to two years or more

Pros: Need just one treatment of Thermage. Generates new collagen.

Cons: Can be painful. Need a series of Aluma treatments. Doesn't work for everyone. Minimal to modest results.

AESTHETICIAN TREATMENTS

Still not ready for facial injections or lasering? A visit to your local aesthetician may be enough of a cosmetic procedure for you. "These are superficial spa-type treatments and not for making (major) changes. They're for maintenance and to make you look good for a special occasion," says Coronado plastic surgeon Dr. Jeffry Schafer.

Some aesthetician treatments include:

- Facials

By applying a variety of creams, clays and other ointments to the face, aestheticians can individualize treatments depending on your skin's needs. Usually a relaxing experience, facials are designed to deeply cleanse pores, exfoliate, hydrate, soothe, and temporarily tighten the skin.

Cost: $85 to $165

- Facial peels

Light chemical peels, such as those using alpha hydroxy acid or lactic acid, help exfoliate the skin and speed cell turnover. Salicylic acid peels are recommended for acne-prone skin to help promote healing. Some peels, which can help with fine wrinkling and heavier pigmentation, cause mild redness and skin shedding. Deep peels must be performed by a medical practitioner.

Cost: $120 to $250

- Microdermabrasion

Using a device that mechanically delivers a steady stream of fine crystals directly onto the skin, dead skin cells are sloughed off, leaving the skin polished. The face may be slightly pink afterward, but there's no downtime. Cost: $100 to $160

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