What you need to know about 12 of the most popular cosmetic enhancement procedures.

Transcription

1 Mirror, Mirror What you need to know about 12 of the most popular cosmetic enhancement procedures. BY LEAH ARINIELLO PHOTO CREDIT: HILARY SCHWAB These days, many women and men are heading to dermatologists, plastic surgeons and vascular surgeons for help in smoothing wrinkles, reshaping their bodies and doing away with unwanted veins. In 2007, doctors performed nearly 11.7 million surgical and nonsurgical cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery (ASAPS), although their patients may not be talking about it. In this area, people are so conservative that they don t want to admit to getting anything done, says Dr. Margaret Sommerville, a Chevy Chase dermatologist whose patients often keep their treatments a secret from friends and spouses. Bethesda Magazine interviewed more than 20 Bethesda-area doctors about what s new in cosmetic enhancement procedures. Included is information on the benefits and downsides of 12 different treatments, as well as how much you can expect to spend. Botox

2 Botox injections temporarily reduce muscle contractions to smooth wrinkles and create a rested, youthful look. It s the most popular physician-administered cosmetic procedure, according to the latest statistics from ASAPS. In addition to treating frown wrinkles between the eyebrows, doctors also use Botox to minimize forehead lines, crow s feet and, occasionally, neck wrinkles. Botox also can be used to lift eyebrows. It opens the eyes and really gives patients a wow effect, Sommerville says. Botox only takes about 10 minutes. It s the quintessential lunchtime procedure, Sommerville says. The results, which gradually appear in about a week, last three to four months. You may experience side effects such as bruising, but the procedure is safe and relatively lowrisk when skilled hands inject the correct dosage, according to Sommerville. The injections, which doctors administer directly into facial muscles, are quick and only mildly uncomfortable, similar to the feeling of having blood drawn. The needles we use are the smallest needles they make, says Dr. Elizabeth Liotta, a Rockville dermatologist. We ve had patients who ve even said they ve fainted when they ve had other injections, and they had no problem with [the Botox] shot. Expect to pay about $350 per treated area. Temporary Fillers Injections of fillers, such as Restylane, Juvederm and Radiesse, to name a few, can temporarily plump up the skin to smooth wrinkles in the face and add volume. Fillers, made of various substances, are commonly used to correct a line here and there, or to plump up lips. Recently, however, some doctors have also started to inject fillers into cheeks, temples, eyebrows, above the lip and around the jaw line, creating a liquid face-lift by replacing volume lost with age. You can literally turn back the clock and make someone look five to 10 years younger, says Dr. Roberta Palestine, a Bethesda dermatologist. The results are immediate. It s instant gratification, according to Dr. Pantea Tamjidi, a dermatologist in Chevy Chase whose office conducts about 20 filler treatments a week. You walk into the office with the lines, and walk out 100 percent completely enhanced and improved.

3 A variety of FDA-approved fillers are available, each with its own pros and cons, which you ll want to discuss during a consultation with a doctor. For example, some types work better in different areas of the face, and some last longer than others. The most popular types are made from hyaluronic acid, a natural component of the skin, and last about six months. Beware of filler agents that are not FDA approved for treating wrinkles, such as silicone; these can cause serious problems, such as a buildup of scar tissue under the skin,tamjidi says. If it s not FDA-approved, I d be very cautious, she says. The injections, which are administered directly into the face, can sting, particularly in the lip area, during the moment of injection. We can use an anesthetic to take the bite out, but it can still be a little uncomfortable, says Liotta, the Rockville dermatologist. In addition, the area may feel tight or sore for a few hours. Generally, fillers are used to treat deeper, stationary lines like the parentheses lines near the mouth, while Botox treats movement lines, such as the frown line. The products also can be used together, which may extend results. Fees vary, with longer-lasting fillers costing more, but expect to pay at least $450 to $900 per treated area. A liquid face-lift can cost $3,000 and up. Chemical Peels A chemical solution is applied to the skin, typically on the face. The skin flakes or peels away, improving skin texture and skin tone. Today, many doctors steer away from performing one deep peel a common method in the past and instead perform a series of three or more peels, according to Dr. Mark Jaffe, a Bethesda dermatologist. Since the peels are done in a series, there s generally little to no downtime, according to Jaffe. For a few days you might have a mild case of dry skin and a little flaking, but you re not peeling sheets or anything like that, he says. Peels offered by doctors can vary according to the strength of the chemical solution. Generally, patients can choose from low level peels, which create the least amount of flaking, and produce a nice glow, or select a slightly stronger peel, which means more flaking, but can clear skin discolorations and lessen fine lines. It s important to go to someone who is an expert in the technique. If you use too strong of a chemical, you could scar someone, says Dr. Richard Castiello, a dermatologist in Chevy Chase.

4 Like laser resurfacing, newly treated skin should be protected from the sun, particularly after stronger peels. You don t need to go into hiding, but you re definitely not going to want to go on a beach vacation and lay in the sun right after, says Dr. Hema Sundaram, a North Bethesda dermatologist. Generally, today s peel techniques create only mild discomfort. People think they are going to really, really hurt, Sundaram says. She had a strong chemical peel and felt only a little bit of prickling and stinging. It s not bad at all, she says. Prices vary, but a typical peel starts at $100 per session. Tummy Tuck Also known as abdominoplasty, this surgery generally involves the removal of excess fat and skin, as well as the tightening of weakened muscles to create a flatter stomach. Tummy tuck surgery comes with a painful recovery phase, but doctors say it s much improved from years past. Now, surgeons can insert an infusion pump that diffuses numbing medication for the first few days after surgery when the pain is at its height, according to Dr. Stéphane Corriveau, a Chevy Chase plastic surgeon and head of plastic surgery at Washington Adventist Hospital in Takoma Park. When it works well, it can cut the use of pain medication in half, Corriveau says. It s a major shape-changing procedure, Corriveau says. Most [women] go down two to four dress sizes after. And, without excessive weight gain, the results last. The surgery, which lasts about three hours, can take a lot out of patients, compared with many other cosmetic procedures. It could be two to three weeks before you are ready to head back to work, and an additional few weeks before you feel like you re back to your original energy level. Also, patients must contend with large incisions and resulting scars. Generally, the procedure requires a hip-to-hip cut, as well as an incision around the bellybutton. Patients occasionally can get results with a mini tuck, which requires a cut in the pelvic area about the size of a C-section incision. When muscles get seriously stretched out during pregnancy, surgery may be the only way to reclaim your old shape. You can improve the muscle tone with exercise, but usually you can t improve the contour when it becomes prominent, says Dr. Roger Oldham, a Bethesda plastic surgeon. It usually takes surgery.

5 The cost varies, but expect to pay from $2,000 to $6,500 to the surgeon, depending on whether it s a mini tuck or full tuck, along with an estimated $2,000 in operating room and anesthesia fees. Laser Skin Resurfacing In this procedure, a laser does away with skin discolorations such as dark spots that are caused by sun damage and aging, as well as acne scars and fine lines, evening out skin tone and texture. Laser technology has come a long way. Just a few years ago, the lasers used by doctors vaporized entire layers of skin cells, leaving open sores that took weeks to heal. The downtime was a big deterrent, especially with people in our area who are very business oriented and often in the public eye, says Dr. Douglas Forman, a plastic surgeon who oversees laser procedures at Bethesda s Plastic Surgery Institute of Washington and is a co-director of The Physician s Laser Center of Bethesda. Now, new lasers, called fractional lasers, are available. They target smaller portions of damaged tissue, which helps speed healing. Patients generally undergo from three to five sessions and notice dramatic improvements in the look of their skin without any downtime, according to Forman, who also oversees laser procedures at The Plastic Surgery Institute of Washington in Bethesda. You can put on some sunscreen and go out the same day, Forman says. After each treatment, the skin will appear wind burned for a few days. It s a huge, huge advance, says Dr. Tina West, a Chevy Chase dermatologist and laser surgeon who has conducted laser resurfacing since Beyond the easy recovery and significant results, improvements in tone and texture should be relatively long lasting. You ll continue to age, and if you continue to go in the sun, you ll get more sun damage, but the improvements you get [from laser resurfacing] shouldn t go away at any time, says West, who heads The West Institute. In addition, the fractional laser procedure is only slightly uncomfortable, feeling like small pinpricks, according to West. There s little downside to fractional laser resurfacing if the person doing it has adequate training, according to West. If someone uses the wrong energy level, scarring could result, she says. There is a potential for infection or a reactivation of cold sores or herpes, West says. Doctors commonly use laser skin resurfacing to treat the face, but the fractional laser also can refresh skin on the body and even minimize white stretch marks, West says. Costs vary, but plan to pay from $400 to $1,000 per session, depending on the surface area treated.

6 Microdermabrasion During microdermabrasion, a special device gently polishes the skin to improve texture and provide a healthy-looking glow. Older microdermabrasion techniques abraded the skin by emitting a spray of messy crystals, but many doctors now offer microdermabrasion treatments that are particle free. Commonly, topical solutions are combined with the procedure to individualize the treatment and boost benefits. Newer techniques are gentler and can be spa-like, according to Sommerville, the Chevy Chase dermatologist. She performs a multiple step microdermabrasion procedure known as sapphire abrasion while classical music is playing. It s painless and actually very relaxing, Sommerville says. Another plus: There s no downtime. For the best outcome, you ll likely need to undergo around five or more treatments. Improvements in skin texture often are subtle and temporary, generally lasting about six months. Microdermabrasion performed in a doctor s office is more intensive than microdermabrasion at a spa, according to Bethesda dermatologist Jaffe. It will still be subtle, but you re going to see amore noticeable result with the stronger machine. Fees vary, but a typical session costs $135 or more. Eyelid Surgery During eyelid surgery, doctors use a variety of techniques, such as skin removal and muscle and fat modification, to correct droopy eyelids and puffiness, creating amore youthful and rested look. Surgeons have adjusted their techniques so that the results continue to look good longer. For years, we were taking all this fat out and it looked great when patients were young but as they got older, they started to look skeletonized because as you age, you lose fat [in the eye area], says Dr. Philip Schoenfeld, a Chevy Chase facial plastic surgeon. Now, instead of removing fat, surgeons will take fat that pooches out, making the eyes appear puffy and tired, and reposition it in the eye area, according to Schoenfeld. By preserving the fat and re-draping it, you can create a much more natural appearance, says Dr. Kevin Perman an oculofacial plastic surgeon in Bethesda.

7 There is minimal discomfort during recovery, according to Dr. Jennifer Parker Porter, a facial plastic surgeon in Chevy Chase. Most people don t take any pain medication, except maybe a few Tylenol, Porter says. The bigger problem, she says, is that some of her patients don t rest long enough after the surgery. Patients should plan on about a week of downtime to insure proper healing. Complications, such as bleeding or infection, are a possibility. During early recovery, you ll probably want to wear large sunglasses in public. The surgery requires incisions in the upper eyelid, bottom eyelid or both. The resulting scars often fade and are hidden in the natural creases of the eye, or can be covered by makeup. But during the healing process, the area can be red, bruised and swollen for about seven days. Eyelid surgery will not take care of lines around the eyes. It s not a wrinkle treatment, Porter says. Results are longlasting, but the surgery does not stop the aging process, so you may have more sagging skin and puffiness as you get older. Expect to pay from $1,800 to $5,000, depending on whether the surgery is needed for both upper and lower lids, and about another $1,000 to $2,000 in operating room and anesthesia fees. Laser Hair Removal A laser permanently reduces unwanted hair on the body or face. Common target areas include the bikini line, underarms, upper lip and chin for women, and the neck and back for men. Laser hair removal is being performed more and more in salons and other nonmedical settings, according to Chevy Chase dermatologist Tina West. She advises those seeking the treatments to be cautious. I think a lot of people are not aware of the side effects lasers can cause if they re not in trained hands, West says. They re not magic wands. Potential problems could include scarring or permanent changes in pigmentation, as well as infection. The procedure causes minimal discomfort, typically a pinprick sensation, according to Kathy Shay, a nurse who has been performing laser hair removal at the Center for Laser Surgery in Washington, D.C., since I ve never had a patient who couldn t finish a treatment because of pain. What s more, the recovery is pretty simple. Generally, patients are asked to take it easy and avoid submerging treated areas in water for 48 hours or so and to protect the area from sun exposure for a couple of weeks.

8 To see results, three or more sessions are common. Laser hair removal results in permanent hair reduction, not permanent hair removal, says Douglas Forman, a Bethesda plastic surgeon who oversees the treatment in his office. Growing hair follicles zapped with the laser should stop growing permanently, but straggling hairs may pop up even after multiple sessions. The lasers available can be used on every skin tone, but not on every hair color. If you have white or true blond hair, [laser hair removal] won t work, says Forman, because the lasers target pigment. Expect to pay from $150 to $1,500 per session, depending on the size of the area treated. Breast Implants In breast implant surgery, a doctor inserts artificial, disc- or teardrop-shaped implants to expand breasts and create a curvier figure. There are two types of implants. After being taken off the market for aesthetic uses in the early 1990s amid questions about safety, silicone gel-filled breast implants recently have become widely available again following an FDA review. They are fabulous implants with a very natural feeling, says Mark Mausner, head of plastic surgery at Suburban. The other implant option is filled with saline, a saltwater solution. Generally, either option can provide good results, he says, but they do have their own pros and cons, which you ll want to go over with a doctor during a consultation. For example, it can be harder to determine if a silicone gel implant has ruptured, compared with a saline implant. On the other hand, for some women who have very little of their own breast tissue, the silicone gel implant can provide a more natural feel than a saline implant, according to Mausner. These days, breast augmentation is more natural looking, particularly since surgeons often place implants under the chest muscle. Most patients are really excited about the results, says Dr. Jules Feledy Jr., a Bethesda plastic surgeon. Doctors say that before getting the surgery, it s important to carefully discuss the downsides of breast implants during the consultation phase. For one, they re not lifetime devices, and there s a high likelihood that over time a patient could need additional surgery to remove the implants or to replace them, according to Feledy. There s a risk that implants could break, for example, move out of position, or that scar tissue could distort their shape. Since there s so much to carefully consider, Feledy requires patients to have two consultation appointments.

9 In addition to talking with a doctor on the risks of breast implants, they can be researched on the FDA s Web site: Expect at least two to three days of full recovery before heading back to work. Also, patients typically experience about two weeks of soreness if implants were placed under the muscle, rather than over it. It takes some time after surgery around two months, before breasts settle into a natural look, according to Feledy. At first, they can look a little high on the chest, he says. Expect to pay between $4,500 and $7,000 to the surgeon, and another $1,500 in anesthesia and operating room charges. Breast Reduction In breast reduction surgery, a doctor removes skin and breast tissue from large breasts and reshapes them into a smaller, lighter and firmer pair. Breast reduction surgery today results in smaller scars. Today s incisions generally are smaller and less traumatic, with doctors typically cutting around the nipple and down the front of the breast, according to A. Dean Jabs, a Bethesda plastic surgeon who has been performing breast reduction surgery for 25 years. During recovery, discomfort is minimal. A lot of women are amazed at what little pain they have with it, Jabs says. In addition, the procedure can relieve shoulder, neck and back pain caused by very large breasts. A lot of women feel more comfortable after surgery, says Dr. Jorge Reisin, a Chevy Chase plastic surgeon. It can also help jump-start an exercise routine, according to Reisin s son, Dr. Elan Reisin, a plastic surgeon who works with his father. Almost every patient comes back in the post-op period and tells me they can do things they could never do before and that they are really feeling good about themselves, Elan Reisin says. Complications like infection, bleeding or changes in sensitivity are possible. In the past, insurance plans may have covered breast reduction surgery, but today, it s more likely that you ll have to pay for it yourself. We ve noticed in the last couple of years that more and more insurance companies are dropping breast reduction surgery as a benefit, or they re changing [breast] volume requirements, Bethesda plastic surgeon Feledy says.

10 Expect to pay about $6,000 to the surgeon and another $1,500 or so in anesthesia and operating room fees. Sclerotherapy Sclerotherapy targets spider veins, those red or bluish web-like markings that pop up on the legs. A special solution is injected into each problem vein, causing the vein to close up, collapse and eventually disappear. These days, there are more physicians who work on veins day in and day out, providing them with a special expertise in sclerotherapy and vein issues, according to Dr. Paul McNeill, a Bethesda vascular surgeon. That can have a big impact on results, says McNeill, whose practice conducts about 30 sclerotherapy procedures a week. Patients typically have minimal discomfort during the procedure, which feels like a small pinprick and may cause a slight burning sensation. After the session, patients often can head right back to work. Also, serious complications are rare. Today s methods are very safe, McNeill says. The most common thing that can happen is that you can get a little pigmentation on the skin, but that usually goes away with time. Once treated, many patients have told Bethesda vascular surgeon Louis A. Ivey that they feel much more confident wearing leg-revealing clothes. Sclerotherapy has quite a positive psychological effect, says Ivey who has performed more than 30,000 sclerotherapy treatments in the last 18 years. Multiple sessions from two to 10 might be necessary, and it can take six to 12 months for veins to fade. Many people with spider veins have an underlying medical problem that needs correction before sclerotherapy can produce lasting results, according to local vein experts. A lot of these patients go to several physicians and have injections for years, but [the spider veins] keep coming back, says Dr. Samir Neimat, a Chevy Chase cardiac surgeon who treats vein problems. The reason, he says, is that they have reflux, an underlying vein issue. Doctors can correct reflux with an in-office procedure called closure therapy, which often is covered by insurance, according to Neimat. Closure therapy restores the health of the leg internally, taking pressure off the skin vein so the results of sclerotherapy are much more effective and long lasting, says Dr. Jonathan Calure, a Chevy Chase cardiovascular surgeon who treats spider veins and conducts up to 40 closure therapy procedures a week. The procedure can also alleviate leg discomfort caused by reflux, according to Jeanne Sanders, president and CEO of

11 Horizon Surgical Group, which specializes in the treatment of vascular disease and has locations in Rockville, Olney and Frederick. [Before treatment],many patients say they can t stand up for long periods of time because they have significant swelling and their legs feel very heavy, she says. Expect to pay around $350 for each sclerotherapy session. Bethesda writer Leah Ariniello has also written for The Washington Post and Washingtonian.