What's new in cosmetic surgery?

What's new in cosmetic surgery?
By Alana Semuels, Pittsburgh Post-Gazette

In the hot field of cosmetic surgery, look for advances this year in the use of lasers for everything from improving the appearance of that dreaded cellulite to removing gray hair.

Botox treatments and soft tissue fillers such as Restylane will continue to be popular in the Pittsburgh market as consumers opt for so-called "lunchtime procedures" that are less invasive and require less recovery time than a face lift or liposuction.

"If you subdivide procedures into surgical vs. nonsurgical, nonsurgical procedures are booming," said Dr. Leo McCafferty, a Pittsburgh plastic surgeon and a spokesman for the American Society for Aesthetic Plastic Surgery.
The number of minimally invasive cosmetic procedures performed has risen 1,504 percent from 1992 to 2003, according to data from the American Society of Plastic Surgeons, with 1.8 million procedures performed in 2003.

So if you received a gift certificate over the holidays for a cosmetic procedure or are just looking to freshen your appearance for 2005, here's a review of new procedures arriving in Pittsburgh and other local trends in cosmetic surgery.
Experts emphasized that as with all procedures, it is important to choose a doctor who is well-versed in everything available and can use the technology effectively.

Hyaluronic acid treatments

Some of the most popular treatments in 2004 were soft-tissue fillers such as Restylane and Hylaform, both approved by the Food and Drug Administration in 2003. They are made from hyaluronic acid, a naturally occurring substance found in human skin. When injected, the filler plumps up the skin by allowing it to attract and hold water.

Restylane is an alternative to collagen injections, and the American Society for Aesthetic Plastic Surgery predicts that it will surpass collagen this year as the most popular injectable cosmetic treatment. Collagen injections have been available since the 1980s, but sometimes cause allergic reactions. Such side effects are less likely with hyaluronic acid.

Hyaluronic acid is most commonly used around the mouth and on forehead wrinkles and smile lines and can be used to enlarge the lip. The process takes less than an hour, and requires repeat treatments every four months to a year. Hyaluronic acid treatments are more expensive than those using collagen, but last longer because they help the skin hold onto moisture. A primary cause for wrinkles is dehydration.

A syringe of Restylane or other hyaluronic acid product might cost $500 or up, while the national average surgeon fee is around $373 for collagen, according to the American Society of Plastic Surgeons.
"It's something that can be done as an office visit," said McCafferty about Restylane, "And you can go back to work, with really no down time at all."

Botox

Botulinum toxin, or botox, has been popular since it was approved by the FDA to treat eye muscle disorders in 1989, and in 2000 to treat a neurological disorder that causes neck and shoulder contractions. The FDA approved Botox to treat moderate to severe wrinkles in 2002. There were 2.27 million Botox injections performed in 2003, according to the American Society for Aesthetic Plastic Surgery, up 3,387 percent from the previous year.

Botox is primarily used to temporarily reduce or eliminate frown lines, forehead creases, and crows feet near the eyes, according to the American Society of Plastic Surgeons. Some studies suggest that Botox also helps get rid of migraines because it relaxes the muscles around the eyelids.
Botox injections take about 30 minutes and cost roughly $400. Treatments should be repeated every four to six months.

But consumers must be careful when shopping for Botox injections. Last year, four patients in Florida were paralyzed when they were injected a form of the toxin not approved for use in humans. To avoid this, consumers should ask their doctors to check the Botox bottle and should make sure their doctors are certified to administer it.

Thermage and Titan

A few local practices have started performing Thermage, one of the newest treatments available. Some doctors tout it as the most effective nonsurgical procedure for making faces look younger, while others warn it is not worth the risks or costs.

Thermage, which was approved by the FDA in 2002 for the area around the eyes, is now used to treat whole faces. It uses a radio frequency device called ThermaCool to heat the lower layers of the skin, while protecting the outer layers with a cooling spray. The result: a tightening of the facial layers that is not quite a face lift, but is as close as you can get without surgery.

"It allows you to turn back the clock," said Dr. Brian V. Heil, a plastic surgeon who has offices in Cranberry, Washington, Butler and Pittsburgh. "We haven't figured out how to break the clock yet, though." His office performs Thermage, and Heil says he has seen it cause some discomfort associated with the heat, and lingering pinkness.

In the initial clinical trials of Thermage, 80 percent of patients experienced improvement, and about 6 percent had slight burns.
As the only FDA-approved tissue tightening treatment, Thermage has a hefty price tag -- at $2,800 to $4,000 for a full facial treatment, Heil said.
Dr. Lori Cherup, who heads the Radiance Surgery Center in South Fayette is skeptical about the treatment.

"The machine is ridiculously expensive, and the patient has to have three or four treatments," she said. "It pretty much comes to the price of a face lift." The procedure is generally not focused on a specific area of the face, and so Cherup thinks that it completes something inaccurately that could be done otherwise with surgery.

Thermage "is pretty painful," because the frequency is conducted along nerve endings, said Dr. Suzan Obagi, director of the Cosmetic Surgery and Skin Health Center at the University of Pittsburgh Medical Center. Her practice gives a pain medication to patients undergoing Thermage therapy.
Obagi's office is testing a new treatment called Titan that could have the same results as Thermage, but with less pain. The Titan treatment, which costs from $1,750 to $4,000, is a light source that uses multiple wavelengths to tighten skin.

Optimal results for both treatments are available in three to six months.

Lasers

Although Cherup says she does not trust most laser companies because they often exaggerate the efficacy of their procedures, there will be a lot of interest in new laser treatments that will address everything from cellulite to gray hair.
"The new lasers try to do everything with one machine," said Cherup, who has seen lasers that attempt to obliterate freckles, sunspots and broken blood vessels.

The cellulite laser is a combination of a laser and a radio frequency device that remodels the collagen in the skin. Although there is not yet a treatment to get rid of the fat entirely, the machine is "finally something that improves cellulite," Obagi said. Although this treatment can be painful, Obagi thinks it will be palatable.

The second type of laser coming this year will get rid of light-colored or gray hair, which currently is difficult to do with traditional lasers. The heat from the lasers targets hair follicles and stunts the growth within them, Obagi said. This device is innovative because it can locate lighter-colored hairs in a way that current technology cannot.

This treatment would be comparable in cost to other lasers used for hair removal, or $150 for a small area like an upper lip up to $800 for removing hair from legs.
"With anything, if used incorrectly, there are risks for burns," she said, referring to both treatments.

Skin care as treatment

Doctors agree that the best way to keep skin wrinkle- and blemish-free is through prevention, so many offices have started patients on skin care treatments to supplement cosmetic procedures.
"For the past five years, there's been a real heightened awareness about skin care," said McCafferty.
This increased attention has led to an emphasis onprocedures that produce natural-looking results.
"Gone are the days of these tight face lifts and brow lifts," said Obagi. "People don't want to have that operated-on look."

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