Is Less More?

Alice Papp had always planned to have a facelift when she hit her 50s. So when the time came, the Estero resident did her research and selected Dr. Kriston Kent for the procedure. But the icing on the cake was something new called ELOS. Using a combination of intense light therapy and radio frequency, Kent was able to minimize the scarring and darkening that had so bothered Papp since an attack of adult acne.

"The difference is astounding," says Papp. "It's something I want to invest in to keep the results from my cosmetic surgery. It not only softened the acne; it's wonderful for keeping skin firm. It improved texture and also took away color irregularities."

Treatments such as ELOS-which don't hurt and require no surgery or downtime afterward-are tempting options for a public anxious to look younger faster with less hassle. Amid well-publicized reports of new fillers to plump sagging skin and less harsh, more effective lasers to tease away wrinkles, doctors are confronted by eager patients looking for a nonsurgical answer to aging. Some of these new procedures help younger patients stave off an actual facelift by several years, and some noninvasive treatments work well in tandem with more involved techniques.

However, most plastic surgeons-including the ones who offer noninvasive treatments-maintain that nothing out there can duplicate the results of actual plastic surgery. "Surgery is still the gold standard," says Naples plastic surgeon Dr. Stanley Gulin. "Minimally invasive treatments are used for lesser degrees of cosmetic improvement."

One such procedure involves making tiny incisions to insert sutures, or threads, that stay in the skin and lift it. Dr. Patrick M. Flaharty of Azul Cosmetic Surgery and Medical Spa says the procedure was often unsuccessful in the past because the sutures would fail. But the latest suture design has tiny barbs that hold the skin along many points. The procedure takes about an hour to perform, and though some patients may have some soreness, swelling and discoloration, Flaharty says many can apply makeup the next day.

"For a patient without a lot of laxity, it's a nice alternative," says Flaharty. "It helps younger patients with early jowling and laxity who may not be ready for a facelift. It's also good for patients who did a facelift 10 years ago and feel some laxity returning."

None of the less-invasive procedures could ever replace a facelift, says Dr. Kent Hasen of Aesthetic Plastic Surgery of Naples. "But on the right person, it can be very effective," he says. "A good thread candidate is someone with mild to moderate skin laxity, a moderate amount of jowls and mild to moderate nasolabial folds [the crease that runs from the nose to the corner of the mouth]."

Flaharty cautions his patients that the longevity of the threads is unproven,

as they were just approved by the Food and Drug Administration in January, and he usually suggests them in tandem with other procedures.

Picking and choosing from a menu of procedures is typical in most plastic surgeons' offices nowadays. "It's no longer a choice between a facelift and no facelift," says Gulin. "In the last 10 years, surgery has become less invasive, with less downtime and good, long-lasting results. It's no longer one procedure for the face; there may be half a dozen ways for treating cosmetic deficiencies, from a full facelift to cosmetic treatments."

Newer procedures range from variable pulse lasers that remove skin imperfections and wrinkles without removing pigmentation to endoscopic surgery that allows tissue to be lifted upward rather than outward, giving a more natural appearance.

With all the new technologies out there, choosing between effective treatments and those that may have short-term and disappointing results involves some research. Gulin advises potential plastic surgery patients to seek out procedures that have proven track records in medical journals.

"That's the true test of a procedure-longevity and efficacy-documented in plastic surgery literature, as opposed to a lay magazine or on Oprah," says Gulin.

Also keep in mind that ELOS and other procedures require multiple treatments and are enhanced with ongoing maintenance plans. And it's important to remember that plastic surgery is never a permanent solution, even with a surgical facelift. "That's one of the things people poorly understand about plastic surgery in general," says Kent. "They think that if you have plastic surgery, you'll be good forever. But the aging process continues."

Kent likens time to a conveyor belt. So while a surgical facelift might move you back eight to 10 years on that belt, a noninvasive procedure may set you back just a couple of years. For Papp, giving her skin just a few extra years has made all the difference. Since the ELOS procedure, she has gained the confidence to re-enter the work force.

"There's no way to gauge how awful the scarring makes you feel," she says. "Makeup doesn't hide it, and it's pretty hard for a woman. I wouldn't have wanted to go back to work. I wouldn't have felt as engaged with the world around me. Now I feel ever so much better."