Tighter skin. Fewer wrinkles. Plumper cheeks. Once upon a time, it could take days — if not weeks — of recovery time to accomplish such lofty cosmetic goals. Today, though, a new wave of injectables and technology is offering a youthful glow on demand.
“There’s been a paradigm shift,” says Dr. Mark Sofonio, a board-certified plastic surgeon who practices in Rancho Mirage. “People want to try nonoperative, nonsurgical procedures like Botox, fillers, and lasers.”
While cosmetic enhancements once required actually going under the knife, many of today’s patients will never see the inside of an operating room.
“People want noninvasive procedures with little to no downtime,” says Dr. Timothy M. Jochen, a board-certified dermatologist at Contour Dermatology and Cosmetic Surgery Center in Rancho Mirage and Palm Springs. “And there’s never been a better time to age well, as we have so many options today.”
To help you navigate the choices, we asked seven local cosmetic surgery experts to break down the latest in aesthetic advances.
Injectable fillers made of hyaluronic acid are quickly becoming one of the nation’s most in-demand nonsurgical cosmetic procedures. In fact, the only nonsurgical procedure to beat fillers in popularity in 2014 was Botox, according to the American Society for Aesthetic Plastic Surgery.
“The reason Botox and facial fillers are such popular treatments is due to their immediate and natural-looking results,” Jochen says. “And there’s no downtime. We can help people look refreshed without looking ‘done.’ ”
The increase in demand and popularity has led to a constant stream of new fillers hitting the market, addressing a range of patient concerns including fine lines, uneven eyelids, wrinkles, and sagging skin.
Today, patients can customize their filler regimen to target their specific problem areas, rather than settling for a one-filler-fits-all approach.
“People used to ask, ‘Which filler is best?’ Now with so many choices, we can choose the best filler for a patient’s particular problem,” says Dr. Andrew Ordon, the Emmy-nominated co-host of The Doctors whose practice is in Rancho Mirage. “It is not uncommon to use two fillers in one treatment to handle all of our patients’ concerns.”
One of the most popular treatments since hitting the market in 2013 is Voluma, the first injectable filler approved by the FDA to add volume to the cheeks.
“Voluma can be injected very deep, and since it’s cohesive, it sticks together and provides long-lasting results for the cheeks,” Sofonio says.
Traditionally, facelifts or fillers for wrinkles and fine lines were the go-to procedures for those looking for a more youthful appearance. Tightening, however, is no longer seen as the holy grail for a more youthful look. Instead, products like Voluma that plump up the skin are the new fountain of youth.
“Rather than just tightening the face with a facelift, adding volume to the cheeks creates a more youthful appearance,” says Dr. Harry Marshak, who practices ophthalmic plastic and facial surgery on El Paseo in Palm Desert. “A moderate amount of sagging in the face can be corrected by volumizing the cheeks.”
According to Dr. Scott Aaronson, a board-certified plastic surgeon at Aaronson Plastic Surgery Center, Voluma’s benefits can be visible for up to two years, much longer than other standard fillers. He also uses Sculptra for lasting effects. The facial injectable “stimulates your body to produce collagen, and can be used in multiple areas of the face, as well as in conjunction with other fillers,” he says. “With Voluma, you see immediate results. Sculptra develops over the course of four to six weeks and also lasts up to two years.”
Dr. Suzanne Quardt, who practices in Rancho Mirage, says the hyaluronic acid filler Juvéderm Ultra Plus XC offers versatility and can be used on more areas of the face than Voluma. The newer formulations can last as long as one to two years.
She also recommends daily preventive, noninvasive treatments like cosmeceuticals — skin care products that offer clinically effective anti-aging benefits — at home. Over-the-counter face creams may contain limited anti-aging ingredients, such as retinol or vitamins A and C, but the best money is spent on medical-grade formulations that incorporate growth factors, vitamin A, and hyaluronic and glycolic acids, she says. Another major advance, Quardt says, particularly for desert residents facing so much sun exposure, is the new SkinMedica Total Defense and Repair SuperScreen. It blocks heat and a full spectrum of damaging solar rays — UVA, UVB, and infrared — and includes growth factors and other active antioxidant ingredients.
Patients looking to perfect their pouts can use fillers like Restylane Silk, a thinner hyaluronic acid approved in June 2014 that can be used for both lip enhancement and to address fine lines around the mouth.
And for hollowness or a sunken appearance under the eyes, Marshak recommends Belotero, which can smooth out the skin of the lower eyelids.
“[Belotero] integrates well into the tissues and can fill in any hollows in the lower eyelids,” Marshak says. “This makes it much less likely to cause bulges that can sometimes be seen with other fillers under the eyes.”
One of the early problems with laser resurfacing, according to Ordon, was pigment changes in the skin, which could result in hyperpigmentation (dark spots) or hypopigmentation (light spots). The lasers targeted the skin in square millimeter beams, too large a surface area to ensure even pigmentation. Today’s fractional CO2 lasers are able to treat the skin with many tiny, concentrated dots, which avoids these issues.
“[Fractional CO2 lasers] offer faster recovery, a better treatment and way less ‘change of pigment’ problems,” Ordon says.
FACIAL AND EYELID REJUVENATION
The demand for non- and minimally invasive procedures has shifted the way cosmetic surgeons approach the traditional facelift. Instead of surgery, many patients opt for the facelift’s nonsurgical counterpart: Ultherapy.
“This is one technology that’s advanced past all the others,” Sofonio says. “Ultherapy is a focused ultrasound that goes through the skin to release a significant amount of heat in the tissue without injuring the skin itself. This releases collagen that tightens the skin.”
Quardt calls Ultherapy “one of the most effective nonsurgical skin-tightening technologies that we have to date for the face and neck.”
The nonsurgical One-Day Face “Lift,” from Dr. David Morrow of the Morrow Institute Medical Group, combines Botox with dermal facial fillers and injectable implants such as Radiesse. A specialized skin peel completes the facial rejuvenation treatment.
Morrow also offers lower-eyelid reconstruction using local anesthesia. The technique entails making small incisions in the scalp — versus in the lower eyelids themselves — and then moving the surgical instruments under the skin to restructure the eyelid tissue. Recovery time is minimal.
LIPO BY INJECTION
New treatments are continuing to enter the market, such as the so-called double chin injection, which made headlines this spring for its claims of being able to remove fat from under the chin with a simple shot.
“Instead of doing liposuction, you just do a few injections,” Sofonio says. “You come in and get a few quick shots, the fat melts, and the skin tightens.”
Sofonio plans to make the injection available at his practice this summer.