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November 1, 2011

Saving Face: Your Guide to What Really Works

Laser away wrinkles? Smooth skin with blood plasma? Here's your tell-it-like-it-is guide to gold standard and breakthrough cosmetic procedures.

model with laser

Photo Credit: Bill Diodato

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Laser energy, radio frequency, and ultrasound all work by creating a controlled injury to the skin that sets a wound-healing response into high gear. This spurs collagen formation and cell regeneration, and firms and plumps the skin.

BEGINNER: EVEN YOUR SKIN TONE: Intense Pulsed Light (IPL) treats discoloration like freckles and rosacea, and uses a wide spectrum of light wavelengths in high-intensity pulses.

The Pros: "It smooths the complexion with no Downtime or discomfort," says Miami dermatologist Dr. Leslie Baumann, who favors the treatment for her own fair, freckle-prone complexion.

The Cons: Because IPL zones in on pigment, it can be risky to use on dark skin, as it has the potential to create uneven results. It's also not ideal for random brown spots (go with a pigment-targeting laser, such as the "Q-switched Nd:Yag," which zaps them one by one) or larger broken blood vessels (for those, a Vbeam pulsed dye laser works best).

When to Start: 20s+ Downtime: None. Cost: About $477 per session. Maintenance: A three- to five-treatment series to start; three times a year after.

INTERMEDIATE: REPAIR SUN DAMAGE: Fraxel Re:Store is one brand name for nonablative fractional laser resurfacing, laser energy that delivers heat deep into skin by drilling microscopic holes in the skin with hundreds of fractionated laser beams. This way the surface of the skin isn't completely scorched, since there are minute untouched spaces interspersed amid the lasered pinholes.

The Pros: "To minimize wrinkles, firm sagging skin, build collagen, and fix sun damage, this is your go-to laser," says Dr. Ellen Marmur, chief of dermatologic and cosmetic surgery at NYC's Mount Sinai Medical Center. "It also protects against skin cancers because it physically removes damaged cells in the dermis."

The Cons: While a numbing cream is applied beforehand, the pain factor can still be significant. It can cause hyper- or hypopigmentation (dark and light spots) on Asian and dark skin tones.

When to Start: 35+ Downtime: Two to three days max. Cost: $1,337 per treatment Maintenance: A series of three treatments (one per month) for best results.

ADVANCED: FIRM AND MINIMIZE DEEP WRINKLES: Cosmetic surgeons and derms across the country can't seem to rave enough about the latest ablative fractional C02 laser resurfacing innovations (brand names are Fraxel Re:Pair and Pearl). "While nonablative fractionated lasers treat skin tone, texture, pigmentation, and fine lines, the ablative version takes resurfacing quite a few steps further to significantly minimize deep wrinkles and create enough thermal damage to stimulate collagen formation and firm the skin," enthuses New York dermatologist Dr. Patricia Wexler.

The Pros: Because it's fractionated, these carbon-dioxide-powered devices aren't as destructive as the original C02 lasers, and you usually need only one treatment.

The Cons: You'll require at least a week or two of recovery for the post-procedure swelling, redness, and peeling. "Whenever intense laser energy is used on the skin, there's a risk of post-inflammatory hyperpigmentation," says Wexler.

When to Start: 40+ Downtime: One to 10 days. Cost: $2,424 per treatment. Maintenance: None.

EXTRA CREDIT COMBINATION THERAPY: Many dermatologists enhance the benefits of fractionated lasers by applying therapeutic chemicals to the skin immediately afterward. "Fraxel allows the skin's pores to be wide open so actives like hydroquinone, retinoic acid, or amino levulonic acid [to treat pre — skin cancers] penetrate deeper," says Marmur. She adds (as if reading our minds): "Your face is still numb from the first procedure, so you often don't feel the second one."


Thermage (electromagnetic radiation) and the newer Ulthera (ultrasound) devices firm sagging skin on the face, neck, eyelids, and brows sans a surgical lift by delivering heat to tighten tissue and stimulate collagen deep in the skin without injuring the epidermis. Thermage is time-tested, but some derms prefer the newer Ulthera. "It contracts the connective tissue covering the muscle, so you're able to sculpt the face," says Wexler. Doctors can also see the tissue they're aiming for on a screen. Baumann agrees: "I can target the heat exactly where I need to."

The Pros: You generally need only one treatment, and can see dramatic results in three to six months.

The Cons: Pain. One Thermage patient describes it as "someone plunging a sharp object into your muscle and bone." And she was on Demerol.

When to Start: 40+ Downtime: None. Cost: $1,500 to $3,000 per treatment. Maintenance: Thermage: One to two treatments. Ulthera: None.

EXTRA CREDIT TIGHTEN UP: The latest tightening technology to win FDA approval is ePrime, a "minimally invasive" procedure that delivers radio frequency energy into the dermis by way of micro-needle electrodes that puncture the skin. The jury's still out on the long-term benefits.


From Botox and Dysport to the new Xeomin, purified, diluted botulinum toxin type A injected into specific muscles of the face can temporarily erase wrinkles on the forehead, frown lines between the brows, crow's-feet, and even the vertical platysmal bands ("turkey neck" folds) on the neck.

The Pros: Serious — and, in the hands of the right doctor, artful — results. "A neuromodulator works with the yin and yang of elevator and depressor muscles to create better symmetry and open up certain areas of the face," says Santa Monica derm Dr. Ava Shamban, author of Heal Your Skin. "If you inject a lifting muscle, you get a drop, and if you inject a constricting muscle, you get a lift. Injecting the corners of a downturned mouth can lift up those corners slightly and refresh the whole face."

The Cons: "Too much Botox can extinguish facial movement and expression," warns Wexler. "It can take away the arch of the brows, and injecting every crow's-foot will prevent your cheeks from elevating when you smile."

When to Start: 30+ or when wrinkles start to bother you. Downtime: None, although bruising can occur at injection sites. Cost: $397 per treatment; varies with dosage. Maintenance: Results wear off in three to eight months.

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