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More Options Than Ever to Looking Younger

New techniques and improvements help turn clock back

FRIDAY, Nov. 19, 2004 (HealthDayNews) -- As aging baby boomers who don't want to look their age seek help from dermatologists and surgeons to get rid of facial lines, hollows and acne scars, they are discovering more and more options -- many of which are noninvasive procedures requiring little or no recovery time.

So fast-moving is the world of cosmetic facial improvement that two American Medical Association journals -- the Archives of Facial Plastic Surgery and the Archives of Dermatology -- devote much of their November issues to discussion of new techniques and improvements in established ones.

The message for appearance-conscious consumers? Start small and bring out the big guns -- invasive cosmetic surgery requiring cutting and recuperation time -- only if needed.

"There have been a lot of advances in what we call minimally invasive procedures to improve the appearance," said Dr. June Robinson, editor of the Archives of Dermatology and section chief of dermatology at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

The emphasis, at least initially as signs of aging appear, is on minor "touch-up" procedures, Robinson said, including Botox injections or injections of synthetic filling materials such as hyaluronic acid to smooth out wrinkles. Then, people typically progress to more invasive procedures, such as surgical forehead lifts. "If you can look 10 years younger forevermore, so be it," Robinson said.

"People are most interested in minimally invasive treatments," agreed Dr. Wayne Larrabee Jr., who edits the Archives of Facial Plastic Surgery and is a clinical professor of facial plastic surgery at the University of Washington.

Among the most promising treatments, Larrabee and Robinson agreed, are improved uses of Botox, more advanced filler materials that last much longer than older ones, and better use of lasers. Sometimes they are combined with other treatments./p>

"We have new ways of using Botox which use larger volumes that are less diluted," Robinson said. Botox treatments involve injecting small doses of the same protein complex involved in food poisoning. It works by blocking the release of the chemical from nerve cells that signals muscle contraction. Using larger volumes, Robinson said, "you spread it out more. You can do a whole forehead with the amount you used to use to treat two crinkle lines. That's a real advantage." Botox typically lasts about four months, Robinson said, before a repeat treatment is needed.

When boomers age, old acne scars can look more visible, Robinson said. And she's found that the scars can be minimized effectively with a laser called the Q-switch Nd-YAG.

Another technique that has improved, Larrabee said, is the use of radiofrequency energy, such as Thermage, to tighten up facial muscles. Radiofrequency works by heating up the collagen beneath the skin's surface, causing it to thicken and tighten and give the skin a smoother, younger look. "They seem to be getting better, and the promise is you can do much for the younger patient, or do a touch-up for an older patient who has already had a face-lift."

For photodamaged skin seen in sun worshipers, combining intense pulsed light and a topical cream looks promising, Larrabee said. "Only a handful of people are doing it now," he said, but predicts that the approach will grow in popularity.

The cream boosts the effect of the intense pulse light, which is "not really laser but intense, filtered light," Larrabee said. "It's used mostly for treating brown spots."

Filler materials that doctors call "injectables" are improving, too. Among the most promising, according to one of the studies published in the Archives of Facial Plastic Surgery, is hyaluronic acid, or Restylane, often used to minimize the lines above the upper lip or the nasolabial folds, those deep lines that go from the nose to the outside of the lips. In a study of nearly 1,500 patients, nearly 61 percent were still pleased with the results after nine months. "It is essentially twice as effective as collagen," Larrabee said, referring to cow or human collagen, which are other commonly used injectables.

With the host of new treatments -- and another new laser or filler always being touted -- it's a buyer-beware approach, Robinson and Larrabee agreed. How can consumers get the best results?

Consult two or more doctors who specialize in the treatment you want, Larrabee suggested. Among the specialists who offer facial anti-aging treatments are dermatologists, facial plastic surgeons, plastic and reconstructive surgeons, and oculoplastic surgeons (ophthalmologists trained in cosmetic work).

Ask to see before-and-after photos of the treatment you want, Larrabee said. "You may look and say you don't consider it a dramatic enough result to justify having it," he said.

Remember that cosmetic surgery can't eliminate the need to take care of your skin, Robinson added. "Moisturizers and sun protection for life," she tells her patients.

More information

To learn more about cosmetic procedures, visit the American Society of Plastic Surgery.

SOURCES: Wayne Larrabee Jr., M.D., editor, Archives of Facial Plastic Surgery and clinical professor, facial plastic surgery, University of Washington, Seattle; June Robinson, M.D., editor, Archives of Dermatology and section chief, dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.,; November 2004 Archives of Dermatology, November 2004 Archives of Facial Plastic Surgery
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