September-October 2008 | Health

Mirror, Mirror

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

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

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.

What’s new
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.

What you’ll like
Botox only takes about 10 minutes. “It’s the quintessential lunchtime procedure,” Sommerville says.

What you’ll want to consider
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.

What may surprise you
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.”

What you’ll pay
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.

What’s new
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.

What you’ll like
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.”

What you’ll want to consider
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.

What may surprise you
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.

What you’ll pay
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.

What’s new
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.

What you’ll like
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.

What you’ll want to consider
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.

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.

What may surprise you
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.

What you’ll pay
Prices vary, but a typical peel starts at $100 per session.