'Cosmetic' Changes

‘Cosmetic’ Changes

The latest in looking younger for less.

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A couple of decades ago, seeing a plastic surgeon for an anti-aging procedure was all but synonymous with getting a face-lift or brow-lift.

Now, area plastic surgeons and dermatologists say, patients are turning instead to a host of nonsurgical treatments to tighten, plump and resurface skin, many of which promise subtler results at a lower cost and with less recovery time than surgical procedures. A face-lift costs an average of $6,881 and requires about two weeks of recovery; a Botox treatment, by contrast, costs an average of $397 with no downtime, according to The American Society for Aesthetic Plastic Surgery (ASAPS).

Nonsurgical procedures increased by 1 percent from 2008 to 2009, while surgical procedures decreased by 17 percent, according to the ASAPS.

“There’s so much available that’s not surgical these days,” says Dr. Jennifer Parker Porter, a Chevy Chase facial plastic surgeon and a clinical associate professor at Georgetown University Medical Center. “People want things that will give them an instantaneous boost with little or no downtime, and the industry is trying to keep up with that.”

The following are new or revamped anti-aging procedures giving face-lifts a run for their money.

Fillers with lidocaine.

Dr. Susan Elliott, a Washington, D.C., dermatologist, says it’s hard to overstate the impact of injectable fillers, which eliminate deep wrinkles or replace lost facial volume. “The use of filler for volume enhancement of the mid-face by itself has decreased the popularity of the face-lift,” Elliott says.

In the past, filler injections could sting, so the recent addition of lidocaine, a numbing medicine, to hyaluronic acid fillers such as Juvéderm and Restylane represented a “huge advance,” Parker Porter says.

Side effects of hyaluronic acid fillers include temporary redness, pain, tenderness, swelling, lumps or bumps, bruising, itching and discoloration of the treated areas. Hyaluronic acid fillers cost an average of $562 per treatment, according to the ASAPS.


New products such as Sculptra, an injectable filler that makes skin cells create more collagen, promise longerlasting results—up to two years, compared with one year promised by many other fillers, Parker Porter says. Sculptra costs an average of $1,071 per treatment, according to the ASAPS, with three treatments usually required to see full results.

Side effects include temporary injection site discomfort, redness, bruising, bleeding, itching and swelling, along with small lumps under the skin.


Botox, the wrinkle-zapping injection that freezes lines in the forehead and around the eyes, was until recently the only botulinum toxin on the market. Now Dysport, an anti-wrinkle shot approved in April 2009, is providing some competition. Chevy Chase dermatologist Dr. Margaret Sommerville says some patients have reported seeing results slightly sooner with Dysport, but she thinks the two products are basically identical.

Regardless of whether Dysport is any better than Botox, doctors say the new product is significant. “Botox Cosmetic has essentially had a monopoly,” Sommerville says. “This gives physicians an alternative.”

Dr. Mark Mausner, a Bethesda plastic surgeon, says Dysport and Botox sell for the same price.

Fractional lasers.

Laser resurfacing has long been an effective tool for eliminating discoloration, wrinkles and scarring. But Chevy Chase plastic surgeon Dr. Jorge Reisin says earlier lasers required significant downtime, with a healing process similar to “recovering from a significant burn.” Fractional lasers can focus on a very small area of skin for treatment, meaning less pain and faster recovery. “These are tiny little microscopic zones of treatment, so you’re not just taking off a sheet of skin,” says Bethesda dermatologist Dr. Roberta Palestine. “That allows for much faster healing.”

Fraxel, a popular fractional laser treatment, costs an average of $1,337 per visit, according to the ASAPS. Treatments vary greatly in terms of downtime and the number of treatments needed to see results, with less aggressive plans requiring three to six treatments, but no downtime after each visit.

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