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For rejuvenating facial appearance and youth, the facelift was once "the gold standard."
No longer, argue Douglas Hamilton, MD, and Babak Azizzadeh, MD, authors of Beverly Hills Beauty Secrets (Wiley).
The simple truth: A facelift will not fix all the problems associated with aging, but several minimally invasive techniques can. Drs. Hamilton and Azizzadeh provide several of these options.
In their book, Drs. Hamilton and Azizzadeh, discuss options, alternatives and non-invasive secrets to a youthful appearance without facing a surgeon's knife. And, in some cases, it takes only two or three visits a year to your dermatologist to maintain the results, these author note, calling it the "the short and sweet."
And the two most effective ways involve minimally invasive options in injectable forms.
Botox
Arguably the most recognizable injectable, Botox relaxes and smoothes deep lines and furrows in the face. One treatment and patients can return back to work. But Dr. Hamilton warns that patients should seek out skilled professionals because it's a difficult procedure.
"So-called Botox parties have been highlighted in the media," says Dr. Hamilton, director of the Laser Rejuvenation Institute and an assistant clinical professor of dermatology at UCLA's David Geffen School of Medicine. It's an idea he rejects: "Any party that is centered around a toxin stronger than alcohol should be avoided."
Botox is a purified version of a natural protein-- Clostridium botulinum-derived from bacteria, which is "extremely safe in the hands of an experienced practitioner."
Administered in small intramuscular or subcutaneous injections, usually with no anesthetic, Botox provides smoother, far less prominent wrinkles. The effect lasts about three months.
But Botox isn't the latest in rages. In fact, Dr. Hamilton sees a shift towards other approaches, including fillers, which provide volume.
"Treatment of the mid-face with fillers is actually more important for the aesthetics of aging than the forehead is; the latter is not the focus of another's gaze and can even be covered by bangs," Hamilton says. "We predict that the emphasis will shift away from botulinum toxin toward the use of (other) fillers."
Filler Phenomenon
There are two types of fillers. The first, known as collagen, was introduced in 1981 and was the only filler substance used in the United States. But hyaluronic acids have recently gained favor among physicians since they don't require a skin test like collagen.
"Collagen is considered the gold standard for FDA clinical trials for all new fillers. As a result, collagen (was) the filler against which all new fillers are compared," Dr. Azizzadeh says. "However, it has been supplanted by longer lasting and more structural fillers over the past five years,"
Collagen is a natural fibrous protein found in the bones, skin and cartilage. In the natural aging process, collagen makes our cheeks firm until it disappears around middle-age and takes elasticity with it. Collagen injections fill in wrinkles (Historically, the product was known for targeting "laugh lines."), create fuller lips, and fill in scars and pitting. The effects can last six months.
However, hyaluronic acid fillers can last longer, between six and 12 months, according to experts. When injected into inelastic skin, hyaluronic acids create a fullness and volume. "They don't exactly eliminate the furrows," Dr. Azizzadeh says, "but they do reduce their prominence in the newly full skin."
Another advantage: "Unlike other fillers, hyaluronic acids do have a specific antidote if the desired results have not been obtained," Dr. Azizzadeh says. If a physician overcorrects or undercorrects the skin, he can administer hyaluronidase to safety break down the hyaluronic acid. There is no such antidote with collagen injections.
Restylane, Juvederm and Perlane are popular types of hyaluronic acid fillers and many physicians have favorites that they prefer to use. The key when picking a physician is ensuring they have done the treatment before and have experience.
"The only difference among fillers is duration and cost; they all look great the moment you walk out the door," says Dr. Azizzadeh. "If you need immediate gratification, that vibrant 'wow' factor, there is only one procedure in cosmetic enhancement, and that is fillers."
David J. Foster is a freelance writer based in Philadelphia.
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