Younger by the Hour

Minimally invasive cosmetic procedures deliver results with less risk and recovery time than surgery.

By Mia James

Cosmetic surgery to address signs of aging may not be going away anytime soon. In fact, the American Society for Aesthetic Plastic Surgery reported that the demand for plastic surgery rose by almost 9 percent in 2010. Facelifts, eyelifts, necklifts, and the like, however, are no longer the only effective path to younger-looking skin. Innovation in minimally invasive cosmetic procedures has resulted in alternatives to surgery—options that deliver desired results as well as some added benefits such as faster recovery and less risk.

According to Darrell Rigel, MD, clinical professor of dermatology at New York University Medical Center and a past president of the American Academy of Dermatology, surgery is no longer the only or most desirable way to treat signs of aging. Many patients favor less invasive cosmetic procedures, says Dr. Rigel, because they require less recovery time than surgery and carry a smaller risk of complications like bleeding and infection. “A lot of people are busy, number one, and they don’t want to put up with a lot of downtime,” he explains. “Number two, these lighter procedures are good because the chance of a problem is reduced.”

Surgery, however, still has its place, says Dr. Rigel. Candidates for more-invasive procedures are individuals who want a more dramatic effect than nonsurgical options produce and whose schedules can accommodate extended recovery time.

Some of the currently popular, less invasive anti-aging treatments include nonablative laser procedures and the injection of neurotoxins—such as Botox® Cosmetic (onabotulinumtoxinA) and Dysport® (abobotulinumtoxinA)—and fillers, such as Juvéderm® and Restylane® (hyaluronic acid). Here’s how they work:

Nonablative laser procedures. Newer nonablative procedures require much less downtime than older ablative laser procedures. An ablative laser destroys the upper layer of skin, leaving the patient’s skin raw, red, and basically not presentable for 10 days to two months, says Dr. Rigel. Non-ablative lasers, on the other hand, use wavelengths that are targeted at the area of concern (sun damage or freckles, for example example) and are absorbed by these areas rather than the entire skin surface. “You’re using the laser to go through the skin, but it’s not burning off the upper layer,” he says.

Neurotoxins. Neurotoxins can temporarily smooth wrinkles between the eyebrows (known as frown lines). When a neurotoxin is injected, it blocks the nerve signals that cause the muscles between the eyebrows to tighten. As a result, frown lines become less visible. Because results from neurotoxins are temporary, injections must be repeated regularly to maintain the effect.

Fillers. Fillers are composed of hyaluronic acid, which is naturally present in the body. They can be injected around the mouth and the nose to smooth wrinkles. Dr. Rigel explains that fillers can be permanent or semi-permanent. Though a permanent result may seem desirable, he says that there are also disadvantages. For example, if the patient isn’t happy with the result, it can be difficult to fix, and permanent changes may not hold up well with age.

In as Little as a Lunch Hour

As mentioned, one of the leading benefits of less invasive cosmetic procedures is the shorter recovery time compared with surgical approaches. Downtime for these lighter procedures ranges from none at all to about a week. This rapid recovery, says Dr. Rigel, represents a “major evolution” in cosmetic treatment. “It’s made it so much easier for people to have these procedures,” he says.

The procedure with the shortest turnaround time is the injection of neurotoxins, which can literally be done over a lunch hour, with no visible signs of the procedure. “You come in at lunchtime, and you’re back in the office after lunch,” says Dr. Rigel.

Fillers may require a little recovery time (one or two days), and even then the visible effects (such as bruising), if any, are minor and can usually be concealed with makeup. Dr. Rigel says that patients who receive filler injections on a Friday afternoon are recovered by Monday morning.

Nonablative laser procedures can leave patients’ skin slightly pink—“It almost looks like you’re wind-burned,” says Dr. Rigel—but, like filler bruising, this won’t last long and can be easily masked with makeup. Even a “slightly” ablative laser, such as is used in Fraxel therapy, he says, requires only about a week of downtime. According to Dr. Rigel, this quick turnaround represents a major improvement over older ablative therapies, which could leave skin red for two to three months.

Thinking Ahead

The long-term results of any cosmetic procedure will vary according to the type of treatment, personal skin care practices, and the patient’s natural aging process. The bottom line: “Nothing is permanent—not even a facelift,” says Dr. Rigel. For sustained results, patients should expect routine maintenance.

Neurotoxins degrade gradually, says Dr. Rigel, meaning that patients will notice slow rather than overnight changes as the agents lose effectiveness. Botox, he says, may last 4 to 6 months, whereas Dysport

(a newer agent) may last 5 to 8 months. Results from semi-permanent fillers will last 9 to 12 months, whereas results from permanent fillers are literally permanent. Patients who receive nonablative laser treatments will typically undergo a series of three to five treatments at one-month intervals and then receive a booster treatment about once a year. Dr. Rigel says that sun protection and good skin care habits can reduce the frequency of ablative treatments.

Safety

The risks of complications with noninvasive procedures are low, but there are a few potential negative reactions of which patients should be aware. Dr. Rigel explains that any procedure that involves an injection (such as neurotoxins and fillers) carries a risk of infection and bleeding. He adds that because cosmetic treatments may require multiple injections, bruising is a possible though infrequent side effect. As well, in rare instances patients have an allergic reaction to the material being injected.

Laser treatments, non-ablative and ablative, carry some risk of burning; this risk is higher with ablative treatments. The possibility of burning, says Dr. Rigel, underscores the importance that any laser treatment be administered by a dermatologist. He says that even though these therapies may be offered in spas and salons, a dermatologist is more likely to deliver safe and effective care.

Skin Care after Treatment

The results of anti-aging procedures are largely dependent on your personal skin care practices. “It really pays to protect and baby your skin,” Dr. Rigel says. “All of these treatments will last longer if you do.” Critical to healthy skin and satisfying long-term results are sun protection and hydration with a good moisturizer.

Keeping Perspective

The outcomes of anti-aging cosmetic procedures can be very satisfying, but Dr. Rigel says that all patients should approach these treatments with realistic expectations. “No matter what you do, nothing will make you look like you did when you were 12 years old,” he explains. Furthermore, procedures may help correct some signs of aging, but none will stop the aging process. The clock, says Dr. Rigel, will start running forward again even after you’ve turned it back. With these considerations in mind, he says it’s important for patients to listen to their physician’s advice. In other words, take seriously all recommendations and any of your doctor’s attempts to discourage certain procedures.