Turn Back the Clock
All sorts of products promise to trim away years-without using a knife
Sunscreen, check. Laser treatment, check. Botox, check. Wrinkle filler, check. Cancel face-lift for another few years, check check.
Turning back the clock has long been done with a knife, followed by a lengthy, painful, and not-so-pretty recovery. But these days, a growing number of women are taking the nonsurgical route to rejuvenation--free of scars, long roads back, and that pulled, plastic look. And there have never been so many products and procedures aimed at helping them, including new types of tissue fillers that plump up wrinkles and firm the skin, gentler lasers that erase sun damage and redness, and a growing array of skin treatments and lotions to keep skin looking tighter and healthier. "One by one, these procedures can make a difference," says Peter Fodor, a board-certified plastic surgeon and past president of the American Society for Aesthetic Plastic Surgery. "But together they can produce a result that is more than the sum of its parts, and can push back the need for a face-lift."
That's what one Chicago lawyer had in mind last year when she bought herself a 50th-birthday present of Botox and Restylane injections to smooth out her deep lines and wrinkles and a series of laser treatments to reverse years of sun damage. "I didn't want to look done, or anyone to know I'd had anything done," said Mary, who asked that her last name not be used. "I just wanted to look better without having surgery."
She's in good company. Some 78 million baby boomers are approaching retirement age, and many of them have no intention of looking the part. The prospect of such a mother lode has created a feeding frenzy among doctors and pharmaceutical and cosmetic companies looking to cash in on a market where nearly 80 percent of cosmetic procedures are now nonsurgical. Obstetricians are now hawking wrinkle remedies; dentists are doing Botox injections.
For many, the youth quest begins in the drugstore aisles or at the department store makeup counter, where there are a dizzying array of antiaging lotions, potions, serums, and creams. Consumers spent $6.4 billion on antiaging skin products last year, an increase of 21 percent from the previous year, according to market research firm Packaged Facts.
Known as cosmeceuticals, these products do not require the approval of the Food and Drug Administration, and therefore their claims are not backed up by rigorous scientific testing. But many of them, such as Olay's top-selling Regenerist and Total Effects lines, include ingredients that dermatologists recognize to be effective in helping to keep skin healthy and reduce the appearance of aging. These ingredients include peptides, which can inhibit certain muscle movements that cause wrinkles; retinoids, which promote collagen production; glycolic acids, which smooth out skin tone; and antioxidants, which help offset sun damage.
Many over-the-counter products also improve appearance simply by hydrating the face. Since results are hard to substantiate, dermatologists suggest that patients use the product they feel works for them. And they shouldn't be fooled by cost or fancy packaging. "Price has no correlation to efficacy," says Mark Mandell-Brown, a Cincinnati plastic surgeon, noting that many drugstore products have the same ingredients as their fancier department store counterparts, but at much lower prices.
Crazy for Botox. The most popular nonsurgical fix continues to be Botox, which has been around for more than a decade and is the most widely prescribed and one of the safest "injectables" on the market. Last year more than 2 million injections were given, and the number is expected to increase as new uses are found. "For many women, Botox is as routine as a manicure and pedicure," says Jory Goldman, a registered nurse who specializes in aesthetic procedures such as injections of Botox and other fillers. Botox, which lasts about three months, is best known for its ability to paralyze muscles that create furrowed brows and laugh lines. But it is increasingly being used throughout the face to relax the muscles that pull down on your nose or brow, for instance, and let those that pull up dominate. Some younger patients have even started using Botox to prevent wrinkles and sagging. "We just keep finding new ways of using it," says Steven Dayan, a Chicago plastic surgeon and national expert on Botox. "The danger is when it is overused or used improperly." Too much Botox, for instance, can rob your face of expression and create an unnatural look.
A typical Botox treatment costs about $300 to $600 and should be administered by a physician or licensed nurse. If it is being offered for much less (probably in a mall, storefront, or spa) it may mean the product is being overdiluted.
Dermal fillers, which plump up wrinkles and firm up the skin, are among the hottest and fastest-growing new treatments. Last year, more than 1 million Americans used injectable soft-tissue fillers such as Restylane, Sculptra, and Radiance to compensate for the loss of fat and collagen in the face that comes with age. Restylane, a gel made from hyaluronic acid, has been the subject of several positive clinical trails in the United States and Europe, and the risk of an allergic reaction is very low (1 in 1,600). Most fillers are naturally absorbed by the body and have shown no evidence of building up over time or causing long-term problems. But they are still relatively new. Some people have their own fat injected, which is extremely low risk. Such fat is absorbed fairly quickly, and the effects usually last no more than a couple of months, doctors say.
Restylane is typically injected into the creases from the side of the nose to the corner of the mouth and along the upper lip to fill out fine lines. Restylane and other hyaluronics last three to six months and can cost anywhere from $400 to $1,000 and up, depending on how many vials you need. "Hyaluronics give very nice corrections if the patient isn't too far along," says Robin Schaffran, a Beverly Hills, Calif., dermatologist. "But if you need to use a lot of material it could lump up, and the person would be better off with a face-lift." Sculptra, which is injected deep under the skin to stimulate collagen production, can last up to two years and typically costs at least $3,000 for two treatments.
Deep wrinkles and extensive sun-damage are laser territory, which has traditionally meant removing the top layers of skin to reveal the fresh skin underneath. These "ablative" lasers are effective but require several days for the skin to heal. Now, there is a new generation of nonablative lasers that work beneath the surface of the skin, using short pulses of light to reduce wrinkles and sagging. They are supposed to stimulate collagen production, and treatment can be completed in an hour, thus the "lunch-hour lift." Anyone considering a new laser treatment should find out how long the laser has been in use and ask to see some results. "A lot of these lasers are being marketed very aggressively before there's any real science to support their efficacy or their safety is established," says Schaffran.
One of the fastest-growing new deep-skin treatments is Thermage, which uses a radio frequency to heat the inner layer of the skin, usually around the jaw line. The heat causes the collagen to contract and tighten the skin from underneath. The treatment also stimulates collagen growth. Although the effects are subtle, Thermage may require only one treatment that costs up to $2,000.
Buyer beware. By their very nature, noninvasive procedures are less risky than surgery. But there are still some serious precautions to take, starting with choosing a doctor. You don't need a medical degree to do most injections, and many plastic surgeons have shifted that work to nurses, so that they can better spend their time giving consults on $15,000 face-lifts. But there should be a physician nearby in case you have an allergic reaction or some other problem.
Checking credentials is a no-brainer, but word of mouth and your own eyes are also valuable resources. Cosmetic work is subjective. If you like the way someone looks, that matters. "In Los Angeles, cosmetic work is a rite of passage, and women like that "done" look," says Mandell-Brown, the Cincinnati plastic surgeon. "Here, women prefer more subtle changes, and they don't talk about it."
If you already feel comfortable in your own skin and want to stay there, there is still one product you shouldn't be without. "People come in here and they want all these procedures, and they think I have a magic wand," says Schaffran. "Then they tell me they don't use sunscreen. It's still the most effective antiaging remedy we have."
This story appears in the November 14, 2005 print edition of U.S. News & World Report.