About 12 years ago, Ann Jones had an eyelid lift that left her unable to look in the mirror for weeks while she used icepacks and ointments day and night as part of the healing process. Recently, Jones decided she wanted a younger look but did not want to go through a similar recovery again. She turned to Dr. Ruth Hillelson, a plastic and reconstructive surgeon at American Self, for a possible alternative: a noninvasive procedure.
Years ago, the only option for patients like Jones was surgery and a lengthy healing period. Today, noninvasive cosmetic procedures have become a major combatant in the battle against age and other skin issues, such as rosacea and acne scars. In 2008, the American Society for Aesthetic Plastic Surgery released its annual statistics on cosmetic surgery, which revealed that since 1997, nonsurgical procedures have increased by 233 percent — and that number only continues to grow.
"Basically, noninvasive [procedures] are considered to be the holy grail of rejuvenation," says Dr. Galen Fisher, a cosmetic dermatology and laser specialist at the Laser & Skin Surgery Center of Richmond. "People want to look younger, but they don't want to take off time because of their busy careers."
A variety of these procedures — from laser and heat-based treatments to prescription skin-care lines — are available today, and they boast minimal recovery time. In addition to this convenience, other factors attract people to noninvasive cosmetic procedures — "they're easy to do and less expensive," explains Dr. Robert DeConti of DeConti Plastic Surgery.
One of the skin rejuvenation procedures Fisher specializes in is fractional resurfacing, meaning that the laser treatment treats only a "fraction" of the skin and targets the skin cells that need to be altered, regenerating their collagen and elasticity. This ensures a speedy recovery time because the body only needs to focus on re-growing small areas of skin as opposed to large portions. He uses two different types of lasers to achieve these results: the Fraxel re:store and the Fraxel re:pair. Debuting in 2004, the re:store laser is designed to improve mild to severe skin damage (including things that develop with age such as fine lines and wrinkles) as well as the texture of the skin. A topical anesthetic is applied about 60 minutes before the procedure, which lasts about 20 to 25 minutes for the full face. Patients usually can return to their normal routines the next day.
The carbon dioxide (CO2) laser, known as the Fraxel re:pair, became available in January 2008. The intensity of this laser makes it possible to use it on the most critical skin damage because it targets deeper tissue in the skin; it tackles deep wrinkles, tightens skin and even treats severe acne scars. A topical numbing cream is applied about 60 to 90 minutes before the treatment, which lasts about 30 to 40 minutes for the full face. The re:pair offers results similar to those of surgery, and with downtime of about a week.
In December 2008, Corrie Strange, a sophomore at the University of South Carolina, went to Fisher to have her acne scars removed via the Fraxel re:pair laser and Vbeam Pulsed Dye Laser, which alleviates facial redness. "I expected to have to receive four or five treatments," Strange says, "but after only two sessions, you couldn't notice any scars or redness on my face."
Dr. Douglas Rowe, a plastic surgeon at VCU Medical Center, calls noninvasive procedures "adjuncts to surgery." He explains, "They aren't replacements to surgery, but in terms of people who are looking to maintain, they may start with a noninvasive procedure for some tightening and smoothing of the skin." About four months ago, Rowe began using the more powerful fractional CO2 laser to rejuvenate patients' skin. In addition to targeting areas on the face, the ability to control the power of the laser, he says, allows for other areas to be targeted, such as the neck, chest, hands and arms.
A good candidate for noninvasive surgery, Hillelson says, would be someone whose conditions are mild to moderate. People with more severe muscle issues in the face and neck that can cause a double chin would require surgery, as those issues deal with the platysma muscle.
Patients going through any type of procedure need to be mentally prepared for the outcome and expect realistic results. Although the health risks and side effects are minimal in most cases, the possibility of swelling, redness or blistering with any type of laser procedure always exists. They can ask their doctor to show them before and after pictures to get an idea of what to expect. The key question patients who are considering a noninvasive procedure should ask themselves is, "What do I want to achieve?"
"Once you have an idea of exactly what they want to achieve," Fisher says, "you can then start to figure out which techniques you have that will help them achieve that."
Sandi Pitini came to Fisher about a year ago with severe rosacea and badly broken blood vessels around her cheeks and chin. Fisher used a series of four noninvasive laser procedures on Pitini, each about a month apart, to help reduce her skin problems. Pitini experienced some swelling after the first session, she says, but each subsequent session left her with nothing more than what felt like a sunburn — and the results were far better than what she had expected. "My skin looks like it did 20 or 30 years ago," says Pitini, who was 53 at the time of her procedure.
"People are looking for more natural-looking results," Hillelson notes. "I think that people understand that as technologies for noninvasive procedures grow, the results get better and better."
Hillelson specializes in a noninvasive procedure called Thermage, which the Food and Drug Administration approved in 2002. Thermage works by stimulating the collagen and creates natural and subtle results. It uses a deep-heating radiofrequency technology to tighten the existing collagen and form new collagen for tighter, smoother skin in one treatment.
As for how long the results last, it varies depending on how old the patient is and what condition he or she is in. In general, Hillelson says, a single Thermage treatment on the face will usually last about a year and a half to two years.
"The benefits of Thermage were vastly superior in appearance, pain level and recovery time," says Jones, who recently had Thermage done for the first time on her upper neck, face, and above and around her eyes, lifting the lids without leaving scars. Compared with the long recovery she faced 12 years earlier for her eyelid surgery, Jones says the best part about the Thermage treatment was the lack of recovery time. "I could have the Thermage treatment at lunch and go directly back to work," she says. "There was no recovery time."
Although the results were not immediately apparent, Jones says, she began to see astonishing results within a couple of months. Jones, who is 60, says she now looks 48. She plans to go back in the future for a laser-therapy treatment on her cheeks, lips and chin to remove those "pesky fine lines."
Since having a good skin-care regimen is part of the first line of defense against age, Hillelson has developed a patented bioactive skin-care line, meaning that the components of the products have the ability to interact and integrate with the cell membranes. The products penetrate deep into the skin and increase the energy output of the cell, resulting in an increase in collagen production and tautness of the skin. "The ability to manufacture collagen and the ability to increase elasticity — all done with the skin care line," Hillelson says.
"Skin care is the first step," affirms DeConti, who also offers prescription-strength skin-care products in his office. "You maximize the health of the skin so you can go on to do other procedures later."
Dr. Joseph Niamtu III, a cosmetic surgeon at Cosmetic Facial Surgery, also favors a medically based skin-care regime. "We call it lifetime skin care because you have to get in the mindset that skin care is just like brushing your teeth," he says. "You don't brush your teeth once a month or when you want them to look good, you do it several times a day. It should not be foreign to spend a little bit of time each day on your skin."
Niamtu also carries a product that has the ability to extend eyelashes without any type of surgical procedure. Patients apply a drop of the product, called Latisse, to the upper eyelashes once a night and can expect "darker, thicker, longer lashes" over a 90-day period, Niamtu says. When patients stop using the product, the lashes simply revert back to their pre-treatment length, he explains. Latisse recently received FDA approval.
Niacin-based products have also made their way into the skin-care market. Niacin, also known as vitamin B3, is a key ingredient that protects the skin from sun damage and helps repair signs of aging. A niacin-powered skin-therapy line called NIA24 can be found in several doctors' offices in the area, including Richmond Aesthetic Surgery, Zinsser Plastic Surgery, Richmond Plastic Surgeons and the Virginia Institute of Plastic Surgery.
As the popularity for these procedures grows, the American Society for Aesthetic Plastic Surgery predicts that in 2009, new techniques and products will advance the science of noninvasive and minimally invasive procedures to produce even more impressive results and shorten downtime. "As you know with any technology," Hillelson says, "as it grows, develops and blossoms, the technology either gets better or it disappears. [Noninvasive technology] has only gotten better and better."