About Face

Not too long ago, “having a little work done” on one’s face meant a clandestine trip to the cosmetic surgeon, a hush-hush healing phase and a post-op period of donning dark Jackie O’s in the supermarket. Now, rather than cost-prohibitive surgical procedures available only to a select few, most noninvasive cosmetic procedures are priced for all budgets, done in the span of a lunch hour and require little or no recovery time.

Aesthetic centers, cashing in on the antiaging craze, are sprouting up along the Gold Coast, offering a laundry list of services including injectables, peels and all manner of laser therapies. But just how qualified are the people who are administering these treatments, and how can you make sure that you don’t end up looking like you belong in Madame Tussaud’s Wax Museum? Here, we interview local experts about the risks and rewards of the top quick fixes and offer tips for finding a truly skilled practitioner to help turn back the hands of time.

Below, you’ll find a primer on some of the most popular noninvasive skin treatments on the market. Just beware: Savvy marketers are paid to “sex up” each procedure to make it sound unique and appealing. When you read about “liquid lifts,” don’t be dazzled by clever copywriting. Instead, meet with a qualified doctor and let him or her assess your health, skin and lifestyle. The doctor can walk you through your options, and be sure ask a lot of questions!

Autologous Fat Injections
The deal: In this outpatient procedure performed under local anesthesia, a doctor basically takes a portion of your body’s own fat from one area and injects it as a soft-tissue filler to recontour the face, plump up wrinkles and fill in depressed spots. If you don’t mind borrowing from Peter to pay Paul, this type of injectable offers a more holistic, longer-lasting effect than other injectable fillers.

price tag:
$1,200 – $3,500, depending on the number of treatment areas.
recovery: Three days to two weeks, depending on the amount of fat injected. Over-injection is required at first, resulting in a potentially longer recovery procedure.
repeat: May require up to three sessions at three-month intervals.
risks:  It can create an uneven, lumpy appearance and, in some cases, cause infection.
duration: Temporary to long-lasting, varies with individual and treatment area.

The deal: If you can get past the fact that you are injecting your face with a neurotoxin, Botox is the big kahuna of all injectables, offering immediate gratification and no recovery time. Administered without anesthesia, Botox basically inhibits muscle action — decreasing frown lines, forehead furrows and around-the-eye wrinkles caused by squinting. According to the American Society of Plastic Surgeons, it was the runaway favorite noninvasive cosmetic enhancement in 2005, with more than 3 million injections performed.  

price tag: $400–$1,000 per treatment. recovery: Nil.
repeat: Every three to four months.
risks: Bruising, numbing and burning sensations during treatment. Eyelid droop is possible, but not common. Flu-like symptoms, including headache and upset stomach, may also occur. Risk of botulism (a life-threatening illness that makes it hard for a person to move arms and legs or to breathe) is exceedingly rare but possible.
duration: Temporary — requires periodic treatments to maintain results.

Injectable Fillers
The deal: The market for temporary collagen or hyaluronic acid injectable fillers, including Juvéderm®, CosmoDerm, CosmoPlast, Captique, Restalyne® and Hylaform Plus, is exploding. But consumers should be aware that the semipermanent fillers RadiesseTM, Sculptra® and Artefill are not yet sanctioned for cosmetic use. They are used to plump up lines and furrows around the mouth, eyes and forehead and recontour the face. In addition, they are designed to stimulate collagen deeper into the skin. Your best bet with the semipermanent-to-permanent fillers is to make sure an experienced plastic surgeon performs or oversees the procedures.

price tag: $500 – $2,000 per treatment, depending on area.
recovery: Zero to ten days, depending on filler and area.
repeat: May require only one treatment. If original begins to be reabsorbed, more treatments are required to maintain results.
risks: Temporary bruising, swelling, possible infection. The semipermanent and permanent fillers may not be well tolerated by the body and may migrate or cause lumps or granulomas. Extreme caution should be used with the semipermanent fillers, listed above, which are not yet FDA approved.
duration: Temporary fillers last from three to six months. Semipermanent fillers may last two years or more. Permanent fillers are just that — they can be corrected or removed only by surgery.

Skin Resurfacing
The deal: The goal with skin resurfacing — nonablative (microdermabrasion, dermaplaning, light chemical peel) — is to slough away dull surface skin and reveal fresher, tighter skin underneath. Nonablative is essentially the gentle approach, as it does not cause wounding. Generally a thirty-minute outpatient procedure that can be administered with a numbing cream for people with high pain sensitivity, microdermabrasion uses fine abrasive crystals to polish the skin. Dermaplaning involves skilled scraping with a scalpel. Chemical peels involve acids, such as glycolics, retinoic acid or amino acids.

price tag: $150 – $300 per treatment.
recovery: Skin may be unnaturally pink or red for a few hours following treatment.
repeat: This is one of those “addictive” procedures in that it can be repeated quite often, as frequency maximizes results. Check with your doctor for the right schedule for your skin.
risks: Redness, irritation, possible wounds or scarring if performed incorrectly. This should only be done by skilled dermatologists or practitioners.
duration: Results vary, but patients should avoid sun exposure to maintain results.

Laser Hair Removal
The deal: Lasers are terrific for removing sections of unwanted hair via low-watt energy, but they’re not for everyone. Those with dark or tanned skin should avoid this treatment, as heavily pigmented skin is more prone to burns or splotchy skin discolorations. Best candidates have fair skin and dark hair. That said, there are a number of advances on the horizon for those with darker pigments. Check with your doctor to see if one might be right for you.

price tag: $200–$500 per treatment, depending on size of treatment area.
recovery: Nil, although skin may be red or sensitive for about an hour or so after treatment.
repeat: Due to the growth cycle of hair, patients must repeat this treatment to ensure that hair is in its active growth cycle when follicles are zapped. Treatments every three months, for up to a year, are not uncommon.
risks: Skin sensitivity, redness, swelling or, in rare cases, scarring.
duration: After about three sessions, patients should see marked decrease in hair growth, although follow-up sessions may be required for permanent hair removal.

We caught up with Dr. Joel B. Singer, a board-certified plastic surgeon who has practiced in Westport for twenty-five years, and Dr. Howard Stupak of ElixirSpa in Westport, a board-certified facial plastic surgeon with dual certification by the American Board of Facial Plastic and Reconstructive Surgery, and by the American Board of Otolaryngology Head and Neck Surgery. Both operate out of medical spas that offer traditional cosmetic surgery as well as a range of cosmetic procedures, such as pharmaceutical-grade skin care, facials, injectables and photofacials. These procedures are performed by the doctors and, in some cases, by trained, registered nurses or physician’s assistants under their supervision.

WM: It seems that everywhere one looks, another local skin-care facility is opening its doors touting everything from Botox injections to micro-dermabrasion to laser treatments. How should consumers protect themselves?
Dr. Singer: I would first ask if there is appropriate supervision of the employees in these facilities by a board-certified plastic surgeon or dermatologist. The second question would be whether the personnel are properly trained and certified in that procedure.
Dr. Stupak: Each injection is only as good as the specialist administering it. Similar to other medical procedures, facial injectable treatments should be performed by a specialist. Treatments like Botox and Restylane or Juvéderm should be performed by an individual highly trained in facial anatomy and thoroughly trained in injection techniques.

WM: What sort of licensing does a practitioner need in order to perform laser treatments, injections, light therapies or chemical peels? Is there a governing body in Connecticut? What questions can a consumer ask to find a practitioner who is skilled, experienced and safe?
Dr. Singer: Any licensed physician or dentist may inject these materials or perform these treatments. That doesn’t mean that they are qualified to do so. In Connecticut, medical practice is regulated by the Department of Public Health. As a consumer, I would ask if the practitioner is certified by the American Board of Plastic Surgery or the American Board of Dermatology to assure myself that the individual has the highest qualifications to take care of the skin and problems that may arise. The actual procedure can be delegated to a registered nurse or a physician’s assistant as long as there is appropriate supervision and training.
Dr. Stupak: Any state-licensed physician and his or her appropriately supervised personnel may actually perform these procedures. However, similar to all medical procedures, injectable treatments should be performed by a specialist with experience, ideally board certified by a recognized specialty board. The American Board of Facial Plastic and Reconstructive Surgery website can help consumers understand physician qualifications.

WM: If one goes to a cosmetic surgeon for procedures other than surgery, will the costs be higher than at a facility staffed by nonmedical professionals?
Dr. Singer: This is not necessarily so. The cost will vary as to the location of the facility [higher in Manhattan] and competition in the area. Also, it is important to compare the same treatment. For instance, Botox is often charged by the area treated. It is much more accurate and fair to charge by the number of units injected.
Dr. Stupak: Even similar treatments in name or technology performed by highly trained professionals and nonmedical practitioners can actually have very different results. An experienced professional may be more willing or able to tailor individual treatments to patient need, while a nonmedical practitioner may be more likely to follow a standardized set of instructions. On the same note, with the development of even slight problems, the professional becomes a resource for any correction or observation required. These factors would account for some variability in price.

WM: What about injectables — can there be too much of a good thing?
Dr. Singer: Any treatment can be overdone and abused. In general, deep furrows and lines are unattractive. Botox and fillers can help smooth out these furrows, but not get rid of them entirely. You will appear less stressed and more rested because the muscles involved in these expressions have been made to relax. The other muscles of facial expression still remain and, therefore, there is no “overdone” look.
Dr. Stupak: Absolutely. More is definitely not necessarily better. A conservative approach to nonsurgical rejuvenation is the key to a natural and attractive look. Tailoring treatments to the individual needs, concerns and objectives of each patient is critical. I consider such factors as exercise, sun exposure, age and degree of improvement desired when deciding on an appropriate treatment. Just as important is to decline individuals who, for medical or other considerations, are unsuitable candidates and may be better served by alternative techniques.

WM: What are the risks with Botox parties and other cosmetic outings where injectables are administered in a nonclinical setting?
Dr. Singer: There is a greater risk to the consumer when Botox or other treatments are administered in nonclinical settings. Botox “parties” should be frowned upon because this is a medical procedure and should be taken seriously. It is inappropriate to serve alcohol and then treat with Botox. It is also inappropriate to do these treatments without adequate informed consent, a medical history and a provision for sterile technique to prevent infection.
Dr. Stupak: The pitfalls of having medical procedures performed in a spa that is not medically supervised can be numerous. There may be improper adherence to sterility protocols and health-code regulations, and inconsistent or improperly performed treatment regimes. Higher risks can range from inappropriate treatments to imitation or substandard quality materials or even incorrect proportions for reconstitution of medications.

WM: Which procedures would you recommend to someone who is seeking to turn back the hands of time without opting for surgery?
Dr. Singer: I would recommend Botox first, because it minimizes the wrinkles in the forehead and crow’s feet areas that start early. Next, I would recommend hyaluronic acid fillers such as Juvéderm or Restylan for the nasolabial folds [that is, the deep folds which run from the side of the nose to the corner of the mouth] if they are starting to deepen.

Skin-surface treatments that are very effective without downtime are the light TCA peel that I call the “Westport Peel,” the photofacial and microdermabrasion. Pharmaceutical-grade skin care, such as Remergent, Obagi or Skin Medica, will also help with surface aging.

I am very excited about the results that I am seeing from Sculptra, a long-acting, soft-tissue volume-enhancer. It acts to stimulate your own collagen and increases the volume in your face. It works especially well in people that have flattened cheekbones and hollowed cheeks. It is truly a “liquid facelift” for those who need it.

I have recently had excellent results with Sculptra for rejuvenation of the hands. Radiesse, a longer-lasting, calcium-based filler, does a great job of improving the jaw line, cheek bones and even chin augmentation.
Dr. Stupak:  Our patients are very well-informed and conservative compared with those in other parts of the country. They come into our offices with a solid base of knowledge and know a good deal about what they want, whether it’s an injectable, a peel or a laser treatment.
These days, many of them are looking to fractional laser resurfacing to improve the texture of their skin, soften fine lines or reduce age spots.
We also see a lot of mothers and daughters coming in together for IPL hair removal. Our treatment protocols will vary according to each individual’s particular situation.

WM: Are women seeking skin treatments at earlier ages than in the past?
Dr. Singer: I see women in their twenties and thirties who want to prevent aging and wrinkling before it happens. I believe that this can be done by starting early.
Dr. Stupak: Studies show that Botox may be an effective way to prevent aging in younger women, but that doesn’t mean that it’s right for everyone. Some people are pushing for more aggressive treatments at a younger age, but, in many cases, I have to re-educate and explain, “You’re a little young for this. Here are some things you can do to keep your skin healthy right now.”

WM: How is high-tech equipment changing the industry?
Dr. Singer: This is a rapidly evolving industry. Besides the new lasers, such as the Fraxel, there are advances in pharmaceutical-grade skin care, and nanotechnology.
Dr. Stupak: I am excited by a lot of the advances in skin care but am a “late adopter,” meaning that I take a fairly conservative approach toward implementing breakthrough technologies. I do my homework and bide my time to see how well a particular advancement is working before
I consider introducing it into the practice.

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