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What you need to know about 12 of the most popular cosmetic enhancement procedures
By Leah Ariniello
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 low risk 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.
Tummy Tuck
Also known as abdominoplasty, this
surgery generally involves the removal of excess fat and skin, as well as the
tightening of weakened muscles to create a flatter stomach.
What’s new
Tummy tuck surgery comes with a painful recovery phase, but
doctors say it’s much improved from years past. Now, surgeons can insert an
infusion pump that diffuses numbing medication for the first few days after
surgery when the pain is at its height, according to Dr. Stéphane Corriveau, a Chevy Chase plastic surgeon and head of
plastic surgery at Washington Adventist Hospital in Takoma Park. “When it works well, it can cut the use of pain medication in half,” Corriveau says.
What you’ll like
“It’s a major shape-changing procedure,” Corriveau says. “Most [women] go down two to four dress sizes after.” And, without
excessive weight gain, the results last.
What you’ll want to
consider
The surgery, which lasts about three hours, can take a lot
out of patients, compared with many other cosmetic procedures. It could be two
to three weeks before you are ready to head back to work, and an additional few
weeks before you feel like you’re back to your original energy level.
Also, patients must contend with large incisions and
resulting scars. Generally, the procedure requires a hip-to-hip cut, as well as
an incision around the bellybutton. Patients occasionally can get results with
a “mini tuck,” which requires a cut in the pelvic area about the size of a
C-section incision.
What may surprise you
When muscles get seriously stretched out during pregnancy,
surgery may be the only way to reclaim your old shape. “You can improve the
muscle tone with exercise, but usually you can’t improve the contour when it
becomes prominent,” says Dr. Roger Oldham, a Bethesda plastic surgeon. “It
usually takes surgery.”
What you’ll pay
The cost varies, but expect to pay from $2,000 to $6,500 to
the surgeon, depending on whether it’s a mini tuck or full tuck, along with an
estimated $2,000 in operating room and anesthesia fees.
Laser Skin
Resurfacing
In this procedure, a laser does away with skin discolorations
such as dark spots that are caused by sun damage and aging, as well as acne
scars and fine lines, evening out skin tone and texture.
What’s new
Laser technology has come a long way. Just a few years ago,
the lasers used by doctors vaporized entire layers of
skin cells, leaving open sores that took weeks to heal. “The downtime was a big
deterrent, especially with people in our area who are very business oriented
and often in the public eye,” says Dr. Douglas Forman, a plastic surgeon who oversees
laser procedures at Bethesda’s Plastic Surgery Institute of Washington and is a
co-director of The Physician’s Laser Center of Bethesda. Now, new lasers,
called fractional lasers, are available. They target smaller portions of
damaged tissue, which helps speed healing. Patients generally undergo from
three to five sessions and notice dramatic improvements in the look of their
skin without any downtime, according to Forman, who also oversees laser
procedures at The Plastic Surgery Institute of Washington in Bethesda. “You can
put on some sunscreen and go out the same day,” Forman says. After each treatment, the skin will appear
wind burned for a few days. “It’s a huge, huge advance,” says Dr. Tina West, a
Chevy Chase dermatologist and laser surgeon who has conducted laser resurfacing
since 1996.
What you’ll like
Beyond the easy recovery and significant results,
improvements in tone and texture should be relatively long lasting. “You’ll
continue to age, and if you continue to go in the sun, you’ll get more sun
damage, but the improvements you get [from laser resurfacing] shouldn’t go away
at any time,” says West, who heads The West Institute.
In addition, the fractional laser procedure is only slightly
uncomfortable, feeling like small pinpricks, according to West.
What you’ll want to
consider
There’s little downside to fractional laser resurfacing if
the person doing it has adequate training, according to West. If someone uses
the wrong energy level, scarring could result, she says. There is a potential
for infection or a reactivation of cold sores or herpes, West says.
What may surprise you
Doctors commonly use laser skin resurfacing to treat the
face, but the fractional laser also can refresh skin on the body and even
minimize white stretch marks, West says.
What you’ll pay
Costs vary, but plan to pay from $400 to $1,000 per session,
depending on the surface area treated.
Microdermabrasion
During microdermabrasion, a
special device gently polishes the skin to improve texture and provide a
healthy-looking glow.
What’s new
Older microdermabrasion techniques
abraded the skin by emitting a spray of messy crystals, but many doctors now
offer microdermabrasion treatments that are particle
free. Commonly, topical solutions are combined with the procedure to
individualize the treatment and boost benefits.
What you’ll like
Newer techniques are gentler and can be spa-like, according
to Sommerville, the Chevy Chase dermatologist. She
performs a multiple step microdermabrasion procedure
known as sapphire abrasion while classical music is playing. “It’s painless and
actually very relaxing,” Sommerville says. Another
plus: There’s no downtime.
What you’ll want to
consider
For the best outcome, you’ll likely need to undergo around
five or more treatments. Improvements in skin texture often are subtle and
temporary, generally lasting about six months.
What may surprise you
Microdermabrasion performed in a
doctor’s office is more intensive than microdermabrasion at a spa, according to Bethesda dermatologist Jaffe. “It will still be subtle,
but you’re going to see a more noticeable result with the stronger machine.”
What you’ll pay
Fees vary, but a typical session costs $135 or more.
Eyelid Surgery
During eyelid surgery, doctors use a variety of techniques,
such as skin removal and muscle and fat modification, to correct droopy eyelids
and puffiness, creating a more youthful and rested look.
What’s new
Surgeons have adjusted their techniques so that the results
continue to look good longer. “For years, we were taking all this fat out—and
it looked great when patients were young—but as they got older, they started to
look skeletonized because as you age, you lose fat
[in the eye area],” says Dr. Philip Schoenfeld, a
Chevy Chase facial plastic surgeon. Now, instead of removing fat, surgeons will
take fat that pooches out, making the eyes appear puffy and tired, and
reposition it in the eye area, according to Schoenfeld.
“By preserving the fat and re-draping it, you can create a
much more natural appearance,” says Dr. Kevin Perman an oculofacial plastic surgeon in Bethesda.
What you’ll like
There is minimal discomfort during recovery, according to
Dr. Jennifer Parker Porter, a facial plastic surgeon in Chevy Chase. “Most
people don’t take any pain medication, except maybe a few Tylenol,” Porter
says. The bigger problem, she says, is that some of her patients don’t rest
long enough after the surgery. Patients should plan on about a week of downtime
to insure proper healing.
What you’ll want to
consider
Complications, such as bleeding or infection, are a
possibility. During early recovery, you’ll probably want to wear large
sunglasses in public. The surgery requires incisions in the upper eyelid,
bottom eyelid or both. The resulting scars often fade and are hidden in the
natural creases of the eye, or can be covered by makeup. But during the healing
process, the area can be red, bruised and swollen for about seven days.
What may surprise you
Eyelid surgery will not take care of lines around the eyes.
“It’s not a wrinkle treatment,” Porter says. Results are long-lasting, but the
surgery does not stop the aging process, so you may have more sagging skin and
puffiness as you get older.
What you’ll pay
Expect to pay from $1,800 to $5,000, depending on whether
the surgery is needed for both upper and lower lids, and about another $1,000
to $2,000 in operating room and anesthesia fees.
Liposuction
During liposuction surgery, doctors suck away pockets of
unwanted fat through small incisions in an attempt to reshape the body.
What’s new
Newer liposuction techniques are gentler on the body than
older techniques, says Dr. Sheilah Lynch, a Chevy
Chase plastic surgeon. “We can use less force to get the fat out so there’s
less bruising and a shorter recovery time,” she says.
Newer technologies also can provide more refined sculpting.
“When liposuction started out, you’d take a big bulge and make a smaller
bulge,” says Dr. Mark Richards, a plastic surgeon in North Bethesda. Today,
Richards uses a liposuction technique that liquefies fat with sound waves to
ease extraction. Richards says the technique, in addition to sculpting the
body, allows him to finely etch an area, even providing some exercise
enthusiasts with six-pack abs.
What you’ll like
The procedure can permanently remove fat cells from a
disproportionate area of the body, making it particularly ideal for exercise
and diet-resistant trouble spots, such as love handles, saddle bags or “cankles.” “Liposuction can treat areas that people can’t
treat on their own, and it can really make them feel better and look better,”
says Dr. Mark Mausner, head of plastic surgery at
Suburban Hospital in Bethesda. Any modest weight gain or loss after treatment
should appear more evenly distributed.
What you’ll want to
consider
There are downsides, including the possibility of infection
or an asymmetrical result. Although recovery has improved, patients will still
need to rest for a few days and may feel sore for two to eight weeks. They also
typically need to wear a girdle-like garment over the treated area for several
weeks to aid healing.
What may surprise you
Liposuction requires incisions, but the resulting scars are
only about the width of a small fingernail, and are often hidden in areas like
the bellybutton, a breast fold or a butt crease.
What you’ll pay
Fees vary, but plan to pay $2,000 and up per area, plus
another $1,500 or so in anesthesia and operating room fees.
Laser Hair Removal
A laser permanently reduces unwanted hair on the body or
face. Common target areas include the bikini line, underarms, upper lip and
chin for women, and the neck and back for men.
What’s new
Laser hair removal is being performed more and more in
salons and other nonmedical settings, according to Chevy Chase dermatologist
Tina West. She advises those seeking the treatments to be cautious. “I think a
lot of people are not aware of the side effects lasers can cause if they’re not
in trained hands,” West says. “They’re not magic wands.” Potential problems
could include scarring or permanent changes in pigmentation, as well as
infection.
What you’ll like
The procedure causes minimal discomfort, typically a
pinprick sensation, according to Kathy Shay, a nurse who has been performing
laser hair removal at the Center for Laser Surgery in Washington, D.C., since
1998. “I’ve never had a patient who couldn’t finish a treatment because of
pain.” What’s more, the recovery is pretty simple. Generally, patients are
asked to take it easy and avoid submerging treated areas in water for 48 hours
or so and to protect the area from sun exposure for a couple of weeks.
What you’ll want to
consider
To see results, three or more sessions are common. Laser
hair removal results in “permanent hair reduction, not permanent hair removal,”
says Douglas Forman, a Bethesda plastic surgeon who oversees the treatment in
his office. Growing hair follicles zapped with the laser should stop growing
permanently, but straggling hairs may pop up even after multiple sessions.
What may surprise you
The lasers available can be used on every skin tone, but not
on every hair color. “If you have white or true blond hair, [laser hair
removal] won’t work,” says Forman, because the lasers target pigment.
What you’ll pay
Expect to pay from $150 to $1,500 per session, depending on
the size of the area treated.
Breast Implants
In breast implant surgery, a doctor inserts artificial,
disc- or teardrop-shaped implants to expand breasts and create a curvier
figure.
What’s new
There are two types of implants. After being taken off the
market for aesthetic uses in the early 1990s amid questions about safety,
silicone gel-filled breast implants recently have become widely available again
following an FDA review. “They are fabulous implants with a very natural
feeling,” says Mark Mausner, head of plastic surgery
at Suburban. The other implant option is filled with saline, a saltwater
solution. Generally, either option can provide good results, he says, but they
do have their own pros and cons, which you’ll want to go over with a doctor
during a consultation. For example, it can be harder to determine if a silicone
gel implant has ruptured, compared with a saline implant. On the other hand,
for some women who have very little of their own breast tissue, the silicone
gel implant can provide a more natural feel than a saline implant, according to Mausner.
What you’ll like
These days, breast augmentation is more natural looking,
particularly since surgeons often place implants under the chest muscle. “Most
patients are really excited about the results,” says Dr. Jules Feledy Jr., a Bethesda plastic surgeon.
What you’ll want to
consider
Doctors say that before getting the surgery, it’s important
to carefully discuss the downsides of breast implants during the consultation
phase. For one, they’re not lifetime devices, and there’s a high likelihood
that over time a patient could need additional surgery to remove the implants
or to replace them, according to Feledy. There’s a
risk that implants could break, for example, move out of position, or that scar
tissue could distort their shape. Since there’s so much to carefully consider, Feledy requires patients to have two consultation
appointments.
In addition to talking with a doctor on the risks of breast
implants, they can be researched on the FDA’s Web site: http://www.fda.gov/cdrh/breastimplants/.
Expect at least two to three days of full recovery before heading back to work.
Also, patients typically experience about two weeks of soreness if implants
were placed under the muscle, rather than over it.
What may surprise you
It takes some time after surgery—around two months, before
breasts settle into a natural look, according to Feledy.
At first, they can look a little high on the chest, he says.
What you’ll pay
Expect to pay between $4,500 and $7,000 to the surgeon, and
another $1,500 in anesthesia and operating room charges.
Breast Reduction
In breast reduction surgery, a doctor removes skin and
breast tissue from large breasts and reshapes them into a smaller, lighter and
firmer pair.
What’s new
Breast reduction surgery today results in smaller scars.
Today’s incisions generally are smaller and less traumatic, with doctors
typically cutting around the nipple and down the front of the breast, according
to A. Dean Jabs, a Bethesda plastic surgeon who has been performing breast
reduction surgery for 25 years.
What you’ll like
During recovery, discomfort is minimal. “A lot of women are
amazed at what little pain they have with it,” Jabs says. In addition, the procedure can relieve
shoulder, neck and back pain caused by very large breasts. “A lot of women feel
more comfortable after surgery,” says Dr. Jorge Reisin,
a Chevy Chase plastic surgeon. It can also help jump-start an exercise routine,
according to Reisin’s son, Dr. Elan Reisin, a plastic surgeon who works with his father.
“Almost every patient comes back in the post-op period and tells me they can do
things they could never do before and that they are really feeling good about
themselves,” Elan Reisin says.
What you’ll want to
consider
Complications like infection, bleeding or changes in
sensitivity are possible.
What may surprise you
In the past, insurance plans may have covered breast
reduction surgery, but today, it’s more likely that you’ll have to pay for it
yourself. “We’ve noticed in the last couple of years that more and more
insurance companies are dropping breast reduction surgery as a benefit, or
they’re changing [breast] volume requirements,” Bethesda plastic surgeon Feledy says.
What you’ll pay
Expect to pay about $6,000 to the surgeon and another $1,500
or so in anesthesia and operating room fees.
Sclerotherapy
Sclerotherapy targets spider
veins, those red or bluish web-like markings that pop up on the legs. A special
solution is injected into each problem vein, causing the vein to close up,
collapse and eventually disappear.
What’s new
These days, there are more physicians who work on veins day
in and day out, providing them with a special expertise in sclerotherapy and vein issues, according to Dr. Paul McNeill, a Bethesda vascular surgeon.
“That can have a big impact on results,” says McNeill, whose practice conducts
about 30 sclerotherapy procedures a week.
What you’ll like
Patients typically have minimal discomfort during the
procedure, which feels like a small pinprick and may cause a slight burning
sensation. After the session, patients often can head right back to work. Also,
serious complications are rare. “Today’s methods are very safe,” McNeill says.
“The most common thing that can happen is that you can get a little pigmentation
on the skin, but that usually goes away with time.”
Once treated, many patients have told Bethesda vascular
surgeon Louis A. Ivey that they feel much more confident wearing leg-revealing
clothes. “Sclerotherapy has quite a positive
psychological effect,” says Ivey who has performed more than 30,000 sclerotherapy treatments in the last 18 years.
What you’ll want to
consider
Multiple sessions—from two to 10—might be necessary, and it
can take six to 12 months for veins to fade.
What may surprise you
Many people with spider veins have an underlying medical
problem that needs correction before sclerotherapy can produce lasting results, according to local vein experts. “A lot of these
patients go to several physicians and have injections for years, but [the
spider veins] keep coming back,” says Dr. Samir Neimat, a Chevy Chase cardiac surgeon who treats vein
problems. The reason, he says, is that they have reflux, an underlying vein
issue. Doctors can correct reflux with an in-office procedure called closure
therapy, which often is covered by insurance, according to Neimat.
“Closure therapy restores the health of the leg internally,
taking pressure off the skin vein so the results of sclerotherapy are much more effective and long lasting,” says Dr. Jonathan Calure, a Chevy Chase cardiovascular surgeon who treats
spider veins and conducts up to 40 closure therapy procedures a week. The
procedure can also alleviate leg discomfort caused by reflux, according to
Jeanne Sanders, president and CEO of Horizon Surgical Group, which specializes
in the treatment of vascular disease and has locations in Rockville, Olney and
Frederick. “[Before treatment], many patients say they can’t stand up for long
periods of time because they have significant swelling and their legs feel very
heavy,” she says.
What you’ll pay
Expect to pay around $350 for each sclerotherapy session.
Bethesda writer Leah Ariniello has also written for The Washington Post and Washingtonian.
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