May 14, 2007 The Seattle Times
Gracefully Aging Faces Turn Away From The Knife
…Here are the most common noninvasive procedures for rejuvenation:
Prescription skin products such as Renova and Retin-A work on fine lines and fine wrinkles. Hydroquinone, with repeated use, can lighten sun spots. Nonprescription products, such as the Obagi, Glytone and Skin Medica lines sold in doctors’ offices, offer less dramatic, but still significant results in evening out the skin tone and easing fine lines.
These will help hyperpigmentation (sunspots or uneven skin tone) but won’t help deep wrinkles and skin that has lost plumpness because of age, or excessive sagging.
Cost: Prices depend on the product. A prescription for Renova can cost between $100 and $120; individual Obagi and Skinceutical products can run from $30 to $85 or more.
Of the dozens of types, those that produce the most visible changes are the deep chemical peels doctors perform. A medium peel can help with fine wrinkling and heavier pigmentation. A deep peel is for those with severe sun damage; it will cause the skin to tighten somewhat and will require at least a few days to recover.
Light peels, such as those done with glycolic acid, work by speeding up skin cell turnover. They exfoliate and resurface the skin.
Cost: Deep peels done in a doctor’s office or operating room will cost several hundred dollars or more. Light peels can cost between $35 and $160 each at a salon.
Dr. Stuart Kaplan, a Beverly Hills, Calif., dermatologist, has a good analogy for how Botox and fillers differ.
“Think of a crease as a valley between two mountains,” says Kaplan. “Botox prevents the mountains from being pushed together. But sometimes, a bit of a valley remains, and a filler will fill in the valley.”
These will help minimize lines created by muscle movement, mostly around the forehead and eyes, but won’t help minimize wrinkles near the mouth, or skin that is sagging. Results are not permanent.
BOTOX: Injected into facial muscles, it is typically used only around the forehead and eyes and works best on minor creases. Deep lines that are always present cannot be treated with Botox. Doctors are reluctant to inject it around the mouth because it would create an unnatural, frozen appearance.
Cost: A Botox treatment starts at about $250 or $300 and goes up, depending on how many units are used. Injections need to be repeated every three to four months.
FILLERS: These fill in lines, such as the folds that run from the mouth to the nose. They also can fill in acne scars, enhance cheekbones, enlarge lips and fill in hollows under the eyes.
Type of fillers available:
• Radiesse is considered the longest-lasting filler (a year or more) and seems to work especially well in the nasolabial folds, the lines that run diagonally from the outer corners of the mouth to the nose.
Cost: It costs about $1,000 per injection.
• Collagen — injected under brand names such as Zyderm and Zyplast — comes from cow hooves and skin. Because a small percentage of the population is allergic to bovine collagen, users must be tested first. Zyderm is best for superficial wrinkles. Zyplast is better for deeper wrinkles, furrows, deep scars and lips. It lasts two to three months.
Cost: Collagen injections cost about $250 to $550; the allergy test costs an additional $50 to $100.
• Hyaluronic acids are better known under brand names Restylane and Juvederm. These agents bind to water to keep skin molecules plump. The filler is soft and pliable, so it feels more natural than Radiesse and collagen. No pretreatment testing is necessary. Restylane is for medium wrinkles and lasts about six months. Juvederm can be used for fine lines, as well as medium-to-deep wrinkles and folds, and feels smoother and less beadlike under the skin than Restylane. It lasts about nine months. No allergy pre-testing is needed.
Cost: The treatments cost about $500 for each syringe; most people require two.
• Sculptra is often used to fill in larger areas such as sunken cheeks. Sculptra can last a year, but there’s more downtime from swelling and bruising than from other fillers. Because of buildup, most fillers will gradually last longer after each subsequent treatment.
Cost: Sculptra costs about $3,000 to $3,500 for three treatments, about four to six weeks apart.
These devices use intense beams of light, a pulsed light or radio-frequency waves with little discomfort. Patients’ faces — or hands or decollete — are covered with a topical anesthetic or a cooling gel as the laser beams are applied. Afterward, the skin might be slightly red and peel a bit.
A laser treatment can help even out skin tone and stimulate collagen production to help plump out wrinkles. Among the most popular laser treatments:
• Fraxel penetrates deeply, in thousands of tiny columns, creating a pixilated area of damage. Surrounding tissue remains intact, allowing the skin to heal much faster than if the entire area were targeted. The body’s natural healing process creates new, healthy and tighter tissue; dark spots, also known as melasma, lighten; the body produces more collagen, which helps plump up skin. Also used for stretch marks and droopiness around eyes.
This helps repair damage from aging and the sun, such as fine lines and brown spots, on face and backs of hands, but it won’t help erase deep lines or fix major sagging.
Cost: About $300 for spot treatment to $1,000 for full face; at least three treatments are generally needed.
• Thermage. This treatment uses radio frequency, which heats deeper layers of the skin to stimulate and promote new growth of collagen. Generally requires only a single treatment lasting from 20 minutes to two hours.
Thermage helps smooth, tighten and plump up skin, and enhance contouring around a patient’s jawline and below the chin. It won’t help lift drooping skin or get rid of an extreme wobble under the chin.
Cost: Can range from $2,500 for the full face, to $3,500 if the neck area is included. Only one treatment is needed.