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Putting Your Best Face Forward

Just when we think we’ve reached the state of the art in facial rejuvenation, someone pushes the envelope. Pharmaceuticals formulated to fight diseases are found to restore youthful features. Last year’s miraculous wrinkle-erasing fillers and muscle relaxants—which plumped the face for a glorious three to six months between touch-ups—now seem positively prehistoric in comparison with their second generation, which can last up to two years. The scalpel is getting less of a workout these days, as surgeons perfect minimally invasive procedures using more precise instruments. Harsh chemicals and abrasion have taken a back seat to painless laser, light and gentle resurfacing techniques.

Just a decade ago, one had to go into hiding for weeks until the swelling of a facelift receded. Now the docs are talking in terms of days. In five years? Maybe hours.

And the news keeps getting better: Single-source products like frown-erasing Botox are geared to battle next-generation competitors launching this year at lower prices. Understanding that elective procedures are often the first to go in a down economy, doctors are responding with reduced fees and sensible—not gimmicky—promotions. It could be that our faces are among the rare beneficiaries of this economic environment.

Here’s a peek at what’s in the doctor’s bag now and in the coming months.

Move Over, Botox. Here Comes Dysport.

“What I’m looking for is an old-fashioned price war. I hope it begins soon,” blogs prominent Naples board-certified plastic surgeon Dr. Manuel Peña. He’s talking about the newly FDA-approved type A botulinum toxin, Dysport, due out this fall. It’s projected to be about 15 percent less expensive and last longer than Botox, which has had a lock on the market since its introduction in 1989. Though Dysport had not reached doctors’ offices at press time, Botox had already lost its edge on Wall Street in anticipation of market share losses.

Bambi Lashes

The nice people at Allergan Inc., who accidentally discovered the aesthetic properties of type A botulinum toxin while treating muscle spasms, are onto something else. And it’s big. Doctors using their bimatoprost ophthalmic solution to treat glaucoma reported that their patients were growing long, lush, dark eyelashes. A little tweaking, a long dance with the FDA, and now there’s Latisse.

With just a few drops at the base of the lashes each night, says Dr. John Snead, a board-certified ophthalmologist and medical director of Snead Cataract/Eye Physicians, you’ll be fluttering those lashes like Bambi in a matter of weeks. Exorbitant at $120 or so a month? Hardly, if you put it into the perspective of Allergan’s chief executive, David E.I. Pyott. An eyedropper of Latisse, he notes, costs about the same as a cup of designer coffee.

The potential side effects—itchy eyelids and eye-area skin discoloration—don’t appear to be a deterrent for Snead’s ecstatic patients.

Dr. John Nassif, a board-certified ophthalmologist and reconstructive surgeon, is getting the same response from his patients. “It’s easy to avoid problems,” he says, “if you apply the drops carefully and allow them to dry before sleeping. Of all the new products on the market, this is among the most exciting, because it works so well. The effect is really beautiful.”

Fillers: Cows and Pigs, Bone Particles and Sugar

That’s bovine collagen, porcine collagen, and synthetic human calciums and sugars; and they represent the fastest-growing segment of cosmetic science of the past few years. These are the injectable substances used to fill nasolabial folds (the deep “parentheses” surrounding the nose and mouth), enhance lips and plump up facial creases.

“As you age,” says Dr. Andrew Turk, a board-certified plastic surgeon, “you lose volume in the face. Like a balloon, it deflates. Rather than cut the balloon and pull it tighter, we [inject fillers to] reinflate it. It’s more natural-looking and far less invasive.”

Bovine collagen, introduced two decades ago, lost favor because of its side effects and allergy issues. A second generation of fillers emerged, using synthetic hyaluronic acid (replicating a naturally occurring sugar in the body) and synthetic calcium hydroxyapatite (bone particle). Now, just as leading brands Restylane, Juvéderm and Radiesse have begun to enjoy exponential sales growth, collagen reinvents itself—this time without the troublesome side effects. 

OrthoNeutrogena’s Evolence, introduced last spring, has been projected to last up to a year. “Evolence hasn’t replaced Juvéderm for me yet,” says Peña, “but because it causes less bruising, it’s a good choice for people taking blood thinners.”

Nassif prefers the bone-particle fillers such as Radiesse to the synthetic hyaluronics such as Restylane, Juvéderm and Perlane. “It’s almost like a putty—very easy to manipulate.” Also, he says, it causes the body to surround the injected material with its own natural collagen. The predecessors to these injectable fillers, chin and cheek implants, were often unnatural-looking. Another option—the transfer of the patient’s own fat—is undependable, Turk says. Because natural fat tends to dissolve over time, it is necessary to overcompensate with the injection. Also, each body reacts differently, so partially dissolved fat can leave an uneven appearance.

Lunchtime Nose Job

Got 15 minutes? If that little bump or indentation on your nose causes you anguish, a quick injection may be all you need. The doc simply injects the filler into the area around the offending spot, and with a little gentle manipulation, smoothes it out. And you’ll still have time to grab a sandwich before heading back to work with your “new” nose. Depending on the filler used, you may not need a touchup for two years. And at the rate science is going, the next one will be permanent.

Waxing is Waning

Bikini lines … facial hair … unwanted body hair: First there were the surface creams that lasted a day and left a five o’clock shadow. Waxing was good for two weeks. The next generation, electrolysis (ouch!), actually burns the hair out with an electric current and requires several time-consuming sessions. Now comes the intense pulsed light (IPL) laser, providing a huge leap in the field of hair removal, says board-certified dermatologist Dr. Sylvia Garcia. She uses a one-inch chilled wand to vaporize the hair without any trauma to the skin. It’s permanent, quick—as little as 10 or 15 minutes—and painless.

Fractional Gets Cool

A few years ago, the hottest thing going—literally—was “fractional” laser resurfacing. Reliant Technologies was among the first out of the box with its Fraxel laser. The light was directed just beneath the surface of the skin, burning off the top layer of wrinkles, sun damage and acne scars. The down side, says Garcia, was that this burning caused a red, raw appearance for seven to 14 days. The latest and greatest equipment, Palomar’s StarLux fractional non-invasive resurfacing laser, builds on that technology, she says, by using cool lasers to penetrate deeper into the dermis and stimulate the growth of new collagen. It doesn’t burn, it has more visible results, it costs less and it requires virtually no down time.

“The results won’t be as dramatic as a facelift,” Garcia says, “but at about $20,000 less, it provides a reasonable alternative.”

Instant Smile: No Waiting, No Grinding, No Touchups

At last week’s luncheon, you practiced your usual closed-mouth smile. You know, chipped, irregular or off-white teeth, old crowns that don’t respond to whitening solutions, spots or gaps between the teeth. This week, you’re showing off a natural, movie-star smile.

Disappearing are the days, says dentist Dr. Brian Olitsky, when cosmetic dentistry required weeks of down time, sleeping with trays of whitening solutions, grinding down the original teeth to pegs, and suffering through those “ugly duckling” days between preparation and completion of your new smile. Thanks to advanced ceramic technology, ultra-thin veneers and on-site preparation—not to mention such wonderments as injection-free, pain-free IV sedation—most patients are done in one visit. The new veneer products are bonded directly to the existing teeth. They don’t give that dreaded “Chiclets” look, and are five times stronger than porcelain. With the higher concentrations of hydrogen peroxide, in-office whitenings do not require touch-ups. Best yet, that new smile is good for 15 to 20 years.

Laser Gum Lift

Yes, you’re reading it right. If your teeth are on the small side, your smile may reveal a lot of gums. No problem, with the new laser gum lift. Replacing the old method involving a scalpel and electro-cautering, which was not a particularly pleasant experience, the newest technology uses a super-fine laser with a fiber-optic tip. It’s so precise, says Olitsky, that it is almost dissecting one cell at a time. There’s no bleeding, no pain and the slight redness disappears overnight. Because excess gums can give an aging appearance, some call it the “dental facelift.”

The 70 Percent Solution

What if a full surgical facelift is not in the budget this year? Perhaps, said Peña at his recent seminar on affordable options, you can achieve a 70 percent improvement by prioritizing and using less extensive procedures. “You can come up with a combination of procedures and a timetable,” he says, “that will not feel like a compromise but more like a collaboration.”

Garcia agrees: “I see patients who begin with a single procedure, such as a filler to address deep nasolabial folds. After they see the results, and become more comfortable with the concept, they return to take care of other areas and finer lines. After that, they might come in once a year for maintenance, or before a special occasion such as a wedding.”

Turk was among the first to respond to the market with his creative Facial Rejuvenation Boot Camp. The program allows the doctor and patient to develop a customized six-month plan of facial rejuvenation procedures before, or in place of, going the full surgical route. Services might combine a minimally invasive endoscopic facelift with laser treatments, and volumization through fillers, all on the patient’s timetable and budget. The successful program, originally designed for seasonal residents, is now available on a year-round basis.

Not ready to actually meet with the surgeon? Just upload your photo to Turk’s Web site, and his interactive “Visualizer” will show you what you might expect.

Good Side, Bad Side

It turns out that Hollywood divas aren’t just being, well, divas when they insist on being photographed on their good side. The fact that one side of your face looks lighter, brighter, warmer and more animated than the other is no old wives’ tale, and master hairstylist Betty Ann Murphy can prove it.

After years of making a dramatic improvement in her clients’ faces by simply parting their hair on the other side, she teamed up with a computer-aided design specialist and invented a program called Visage to illustrate her point. She projects the client’s photo onto the screen, and then vertically splits it in half. By merging the left side with its own mirror image, and doing the same with the right side, you see a left/left version of yourself and a right/right. The difference is startling. Your composite using the “good side” might appear bright and youthful while the other side appears saggy, angry or sad.

“You can try it yourself in the mirror,” says Murphy. Just cover one half of your face with a sheet of paper, then switch. Anyone’s face, on a grid, will have a definite imbalance. (Except, perhaps, Halle Berry, whose face is deemed one of the most symmetrical in the world.) While neither the left/left nor the right/right would look like “you” anymore, she explains, you can maximize your best features by exposing more of the “good side” with the right hairstyle. She also advises on balancing techniques through makeup artistry.

Murphy’s Visage consultation, available at The Spa at The Ritz-Carlton, Naples, includes onscreen digital symmetry and skin tone analysis, “good side” hairstyle and makeup recommendations and before/after photos to take home.

Five Years From Now?

The field of cosmetic medicine grows so rapidly that dramatic advances are measured in months, not years. Our doctors agree that five years from now the balance will sway from full-scale surgical procedures to a more holistic approach to rejuvenation. Already most Southwest Florida surgical practices have evolved to include some combination of skin care, education, med-spa and non-invasive services.

“Cutting things out doesn’t create beauty; it creates deformity,” says Nassif. “The approach now is to find ways to replace volume; to treat the skin without damaging it. In place of the old lasers, which burned the skin, the new lasers stimulate the skin to grow faster. Every year the technology gets better.”

Still, Nassif says, not all the early treatments are being tossed out. “I believe two of the best things for the face are oral supplements, especially fish oil, and topical treatments. Tretinoin, the acid form of vitamin A used in skin care treatments like Retin-A, and Resveratrol, the ‘good stuff’ from grape skins, are still the gold standard.”

The Next Holy Grail

“Over the next five years,” predicts Peña, “we will refine the use of fat and blood stem cells, which we harvest from around the patient’s belly button area, to stimulate rejuvenation of the face. Our focus is how we can make our bodies into healing machines.”

Garcia believes the biggest leap in cosmetic miracles to occur within the next five years will be a single, non-invasive procedure to target cellulite and smooth out sagging skin. That, she says, is the next Holy Grail.


As a fair balance to the symmetry issue, we thought it fair to point out that Lauren Hutton, one of the top supermodels of all time, has a noticeably unsymmetrical face, with one eye lower and narrower than the other. And the world proclaimed that trademark gap between her two front teeth extremely sexy.

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