By Susan Stevens Daily Herald Health Writer
For you, maybe, a face lift is off the table. You don’t want to spend weeks recovering and dislike the idea of such a radical change.
But the march of decades has left its mark across your brow. Too many hours in the sun have stolen your bright complexion. And lately you’ve noticed your jaw line looks a little, well, indistinct.
“All of us eventually look in the mirror and realize our skin just doesn’t look the same any more,” said Dr. Mary Massa, a dermatologist and director of the cosmetic program at Rush University Medical Center in Chicago. “Everyone is getting a little older, their skin is getting a little bit duller, there’s unevenness of color, irregular brown spots, lines in the upper face.”
A host of new cosmetic skin treatments can fulfill those cravings for a skin fix. In many cases, they are less painful, less risky and more effective than what was available a decade ago, so you can see significant improvement without ever going under the knife.
Before you pick and choose, most experts recommend you see a physician trained in these techniques to evaluate what’s best for you.
“It’s important to match the right technique with the right patient,” said Dr. Stephen Bloch, a plastic surgeon and founder of Skin Deep Medical Spa in Glenview and Highland Park.
Fraxel
A new resurfacing laser treatment can help fade wrinkles around the eye, erase age spots and improve skin texture.
The innovation: Unlike traditional laser treatments that remove the top layer of skin, the Fraxel laser treats thousands of tiny points of skin in a checkerboard pattern, leaving surrounding areas untouched. The laser heats the deeper dermis layer of skin to stimulate the production of collagen and new skin cells.
About 20 percent of the skin is treated at one time. This “fractional” approach results in a much quicker, less-painful recovery than ablative treatments like the CO2 laser.
What you get: For $750 to $1,500 per treatment, you’ll see fresh skin in a few days. Usually four to six 30-minute treatments are required. Even with anesthetic cream, you will feel mild prickling or a burning sensation. Afterward your skin will feel tight and swollen, and you’ll look like you have a sunburn. In a couple of days your skin will look bronzed. After a week the top layer will start to slough off as new skin emerges.
Patient experience: After four Fraxel treatments at Skin Deep Medical Spa, Rosalind Alvarez, 60, of Mundelein said dark spots have disappeared and her skin texture has improved. She retired most of her cosmetics, keeping just a little concealer and her eye makeup. “It’s truly like when you first started wearing makeup,” she said.
Alvarez scheduled her treatments for Friday morning and said she was red and swollen enough that she appreciated the downtime over the weekend.
Expert opinion: Fraxel is new – it won FDA approval last year – so long-term results are unknown. Doctors who perform Fraxel say the results are not as dramatic as the more aggressive lasers, but neither do you suffer through two weeks of crusting and oozing.
“It’s good for sallow complexions, irregular pigmentation, some fine lines,” said Dr. David Van Dam, a dermatologist in Barrington. “In some cases it’s fairly dramatic, but in most cases it’s just a nice improvement in the quality of the skin.”
Dr. Val Fugali, who performs Fraxel treatments at Skin Deep Medical Spa in Glenview, said Fraxel is also good for the delicate skin of the neck, chest and hands. It’s also an option for people with darker skin who are not candidates for ablative lasers.
“It does really great things for patients who have acne scarring,” Fugali said. “Every patient I’ve treated has commented on how fresh her skin looks.”
Where to find it: At dermatologists’ and plastic surgeons’ offices. To find a doctor near you, visit www.fraxel.com.
Thermage
If you’re not ready for a facelift, Thermage might offer the tightening you need.
The innovation: Using radiofrequency energy, Thermage ThermaCool penetrates to the dermis layer of your skin to tighten existing collagen and stimulate new collagen.
What you get:
For roughly $2,500, Thermage can tighten skin around the jaw and neck and smooth out wrinkles. The hourlong treatment feels like a rubber band snapping against your face. Redness and swelling might last a few hours to a few days. Your skin continues to build new collagen for up to six months, so doctors recommend waiting at least that long before considering another treatment.
Patient experience: Joyce Gonnerman, 55, of Barrington had Thermage at Skin Deep Medical Spa five months ago, when she noticed the skin under her chin had started to sag. But surgery scared her, and she didn’t want to leave work for a long recovery.
Since her treatment, Gonnerman said her skin is tighter.
“Since I have had it done, I’ve had people look at me and say, ‘God, you look great,’ but they don’t know what the difference is,” she said. “I look five to seven years younger, easy.”
Expert opinion: According to the American Society for Dermatologic Surgery, Thermage results in mild to moderate skin tightening in most patients. But some patients complain it hurts too much, and at least 20 percent see no benefit. Some doctors say that percentage is actually higher.
Bloch said the technique has evolved in the past four years. Physicians are performing more passes at lower energy levels, which reduces pain and achieves better results with less risk of blistering or pitting.
Not everyone is a good candidate, Bloch said. It’s best for those in their 50s or 60s who are starting to see their skin loosen.
“I’ve had the treatment, and there’s no doubt in my mind that it works,” he said.
Where to find it: In dermatologists’ and plastic surgeons’ offices. Visit www.thermage.com to find a doctor near you.
Titan
Newer than Thermage, Titan has similar goals: tightening loose skin.
The innovation: Using infrared light, Titan heats up the deeper layers of the skin to stimulate collagen to contract while leaving the top surface unharmed. Titan can be used on loose flesh from your face to your knees, including areas not helped by surgery.
What you get: Depending on the area treated, Titan costs $1,000 to $3,000 per treatment. You could see firmer, tauter skin immediately, but final results might take several months as new collagen fills in. Doctors often recommend two or three treatments. You will feel a warming sensation followed by mild swelling and redness. Some areas, such as the abdomen and thigh, tend to be more painful. Recovery is minimal.
Expert opinion: Since Titan has only been around a year or so, doctors aren’t sure how long results will last. Titan is a good choice for a patient with little fatty tissue but some skin laxity, such as after pregnancy, Bloch said.
“The results are a little bit variable,” he said. “Rather than treating the entire face, we tend to just spot treat.”
Other manufacturers are developing similar devices, which could become available next year.
Where to get it: At dermatologists’ and plastic surgeons’ offices. Visit Titan’s manufacturer at www.cutera.com to find a physician near you.
Intense pulsed light
Intense pulsed-light treatments can lighten redness, age spots and freckles.
The innovation: Pulses of visible light in specific wavelengths are directed at the skin and are absorbed by pink and brown discolored areas. The unwanted pigments become fragmented and absorbed by the body.
What you get: Treatments cost $350 to $500 each for a full face, and you might need several sessions. Treatment feels like tiny pricks on the skin and does not require anesthesia. Dark spots disappear in the weeks after treatment. The effects last for years – unless you go back to your sun-worshipping ways.
Patient experience: Joyce Gonnerman of Barrington had a FotoFacial for freckles and dark spots on her face.
“These dark spots turn darker right after the treatment, and then all of a sudden they just start flaking off,” she said. “I had one really dark spot that was as big as a pencil eraser, and it’s gone. I’m delighted.”
Expert opinion: Intense pulsed light treatment is not a good option for people with darker skin, Bloch said, but it’s an excellent treatment for sun-damaged skin in fair patients.
When combined with prescription medication, the pulsed light can also be used to treat precancerous areas on the skin.
The treatment carries a low risk of side effects, but be choosy. Van Dam said he is seeing more patients who suffered scars and burns after treatment in a salon or other facility with less training in the device.
Where to get it: Intense pulsed-light treatments have been around long enough that several manufacturers offer slight variations. Brand names include FotoFacial, Lumenis and Palomar. They’re available at many dermatologists’ and plastic surgeons’ offices.
LED rejuvenation
A quick, pain-free light treatment can give your skin a nice glow.
The innovation: Light-emitting diodes cause subtle changes in tissue at the molecular level to stimulate collagen.
What you get: After exfoliating your skin, you sit in front of an LED panel that flashes light on your face for about 30 seconds. Twice-a-week treatments for four weeks might be needed to see effects, including brighter, smoother skin. Later maintenance treatments might be spaced out to once a month.
If you are receiving another treatment such as microdermabrasion, laser treatment, chemical peel or even a facial, dermatologists often add LED photo rejuvenation for free. A la carte treatments range from $50 to $150.
Expert opinion: The American Society for Dermatologic Surgery found LED photo rejuvenation can achieve “incremental improvement” of sun-damaged skin, but the results might not be dramatic enough for LED to stand alone. Patients could get similar results with creams that contain retinoids, according to the ASDS.
“It’s a good procedure for those folks who have really good skin and just want to get a little glow going,” Massa said. “It’s good for people who are very frightened to do anything more aggressive.”
Where to get it: LED photo rejuvenation is marketed under several brand names, including Gentlewaves, Dermillume, Lumiphase, Omnilux and Soli-Tone. Most dermatologists offering cosmetic treatments offer LED treatments.
Microdermabrasion
This widely available treatment is a popular way to improve your complexion.
The innovation: A technician blasts the skin with aluminum oxide particles, salt or a jet of water to slough off the outermost, dulling layer, leaving your complexion brighter and more even- toned.
What you get: For $125 to $200 per session, you’ll see some improvement in texture, pore size and color. A dermatologist or medical spa can be more aggressive than home kits, so you likely will see a bigger impact. Your skin might be pink for several hours.
Patient experience: “They get in every nook and cranny,” said Joyce Gonnerman. “I think they have a lot more consistency. When I did it myself I would rub some areas until I was raw and there were other areas I missed.”
Expert opinion: Doctors often recommend a course of microdermabrasion sessions combined with other treatments and skin products.
“I feel very strongly that patients can get more out of microdermabrasion if they’re using an effective skin care program at home,” Massa said.
Where to get it: Dermatologists’ offices, medical spas and salons.
Chemical peels
A variety of chemical peels can revitalize your skin.
The innovation: The most popular “lunchtime” peels use glycolic or salicylic acid to dissolve the top layers of sun-damaged or thickened skin, stimulating the growth of healthy new skin. Tricholoracetic acid, or TCA, penetrates deeper into the skin and offers a more dramatic improvement, but with more risks and longer recovery.
What you get: Glycolic or salicylic acid peels cost $125 to $200. For each peel, a doctor or technician applies an acidic solution to your face. Depending on its strength, you will feel a mild stinging or a strong burn for the few minutes it remains. Recovery varies. “Some people are very pink, some people are red, some people will flake like coconuts for a week,” Massa said.
Doctors might recommend a series of lighter peels, or, if the patient doesn’t mind the longer recovery, a single TCA peel that penetrates more deeply. For $500 to $650, the TCA peel will turn your face red, shiny and flaky for a week, revealing fresher skin underneath. The full effect could take months to emerge.
Expert opinion: “It’s really good for texture and that spotty sun damage,” Massa said. “It does nothing for red.”
Like microdermabrasion, chemical peels work best when paired with a good skin care regimen.
Where to get it: Dermatologists’ offices, medical spas and salons. Physicians offer higher- strength peels than aestheticians.
Cosmeceuticals
Creams and lotions containing retinoids, alpha hydroxy acids and antioxidants can help erase all that time you spent in the sun.
The innovation: While drugstore aisles display dozens of products promising skin miracles, only a few ingredients have stood up to scientific study.
Numerous studies have shown that retinoids – synthetic derivatives of vitamin A – improve skin color, elasticity and wrinkling. Alpha hydroxy acids have also been well-tested and can improve skin appearance.
The newest trend is antioxidants like green tea and grape seed extracts, vitamin C and a recent product called idebenone, which is sold as Prevage in doctors’ offices. Antioxidants aim to control free radicals that may lead to premature aging. Unfortunately, proof that antioxidants work often rests in small studies, Van Dam said.
“People need to understand the scientific evidence of their effectiveness is lacking,” he said.
What you get: The products you buy in the drugstore or at the cosmetics counter will typically be a weaker concentration than what is available at a dermatologist’s office. The alpha hydroxy acid creams at a drugstore are about 10 percent solutions; physicians’ formulas go as high as 30 percent.
Doctors usually recommend a combination of products tailored to a patient’s skin problems. Prices can range from $22 to $250 for a two- month supply.
“If someone comes in and they have a really limited budget, you can pick one or two things you think will make the biggest difference for them,” Massa said.
Expert opinion: You’ve got to actually use what’s in those pretty bottles to see the effects. It might take a few months of regular use to see results.
“It took 20 years to make the skin the way it is. Give us four months to make a change,” Massa said.
And dermatologist agree the most important skin care product is one you probably already own: sunscreen.
Where to get it: Physician’s offices or drugstores.
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