Botox was the first game-changer, when it received FDA approval for cosmetic use in 2002. (For decades it had been used medically to treat neurological and ocular conditions.) Then the aesthetic floodgates blew open when the FDA approved the first fillers made of hyaluronic acid (which occurs naturally in the body), Restylane and Juvéderm. New products and treatments continue to emerge, while doctors refine techniques to help patients achieve more natural-looking results. Here’s an overview of what’s available locally.
Botox and Fillers
According to the American Society of Plastic Surgeons, Botox and fillers alone account for more than half of all cosmetic procedures performed. Today, most folks seeking cosmetic enhancement opt for a “combo platter” of these injectables. Botox, which is derived from the botulin bacterium, is considered the “upper-face gold standard,” since its paralyzing effect slows the creation of new wrinkles and minimizes the appearance of existing ones in the forehead, at the outside edges of the eyes (“crow’s feet”) and the “frown lines” between the eyebrows.
For the rest of the face – and the back of the hands – there’s a host of fillers to choose from. “Injectables have evolved quite a bit in the past decade,” says registered nurse Rachael Mullen, director at the 40-year-old Clinic of Cosmetic Surgery in Milwaukee. “Rather than taking a one-size-fits-all approach, we now work with different fillers to address different concerns in specific areas of the face.”
To compensate for the volume loss and sagging in the mid-face and cheek, which is a result of the natural decrease in collagen production, Mullen recommends Juvéderm Voluma and Restylane Lyft. “Juvéderm Vollure and Restylane Defyne are the new go-to’s for softening nasolabial folds and ‘marionette lines’ below the mouth, and defining the jawline. Juvéderm Volbella and Restylane Silk are specifically designed for subtle lip enhancement and smoothing wrinkles around the mouth,” says Mullen. Because these products have smaller, smoother particles, they’re easier to work with, integrate well into the tissue and produce a more natural and flexible result. The effects are immediate and can last six months to a year, but results vary greatly from patient to patient.
“Rather than taking a one-size-fits-all approach, we now work with different fillers to address different concerns in specific areas of the face.”
— Rachael Mullen, Director of Clinic of Cosmetic Surgery, Milwaukee
Beyond filling in creases, some fillers are effective at changing the overall structural appearance of the face. Sculptra is like a molding agent that can add volume to the cheekbones, lower face, temples and jaw lines. Multiple treatments spaced six weeks apart have a cumulative, longer-lasting effect – two to five years – thus requiring touch-ups far less frequently.
While these procedures are very common and relatively low-risk, there are things to be aware of. (There’s a reason for the disclaimers absolving the clinic or spa of all liability for a raft of potential side effects, including swelling, bruising and bleeding; skin eruptions or lumps; infection; asymmetry; scarring; drooping eyes; and even blindness.) In Wisconsin, you need a medical license (doctor, nurse, physician assistant) to inject neurotoxins and dermal fillers.
Microneedling, or skin needling, uses a device covered with tiny, shallow needles to poke holes (“micro-injuries”) in the skin that stimulate collagen production, which will naturally plump the skin and fill in fine lines. This “stand-alone” version is effective for wrinkles, discoloration, stretch marks and sunken areas caused by acne scars. It can also be done on the arms, neck, legs, abdomen, back and hands.
For maximum results, however, clinicians recommend the scarily named “vampire facelift.” This nonsurgical procedure, which is technically called platelet-rich plasma (PRP) rejuvenation, gets its nickname from the procedure itself. A doctor draws blood from your face, separates out the liquid and plasma, then remixes the plasma with hyaluronic acid (e.g., Juvéderm) and injects that back into the skin. “The procedure takes 45 minutes and leaves you with improved texture and firmness and a smooth, glowing complexion. To get the full effect – which can last up to two years – we usually recommend a package of four treatments,” says Chris Zajdel, medical aesthetician and co-owner of Skiin anti-aging lounge in Waukesha.
Another exploding trend is the use of lasers to tighten skin, stimulate the skin’s natural production of collagen and treat blotchiness, scars and sun damage. The gentler, “non-ablative” lasers like Fraxel are appropriate for people under 50 with fine wrinkles. (Fraxel can also be performed on the eyelids.)
The fractional CO2 (carbon dioxide) laser is recommended for older patients with deeper wrinkles, sagging skin and/or scars on the face, neck and chest and sometimes the arms and legs. These work on a deeper level and as a result require more downtime. Fractional lasers produce a pinging or stinging sensation, and leave the patient with a grid of tiny spots, which are visible for up to a week.
Intense pulsed light (IPL) is recommended for lightening the skin and removing spots on the face, neck, chest and hands caused by aging and sun exposure. This low-risk procedure is effective for treating rosacea and broken blood vessels. It typically involves a series of three to six treatments performed three to six weeks apart. Some patients report mild discomfort, noting that the first treatment is usually felt the most strongly.
Nonsurgical procedures aren’t just for the face. Liposuction to remove fat from a targeted area of the body has been around since the 1970s but is still expensive, requires anesthesia and involves days if not weeks of downtime. Over the past several years a procedure called CoolSculpting, which freezes fat cells and then allows them to be naturally eliminated from the body, has stepped up to replace it. Like liposuction, the results are permanent, but there’s virtually no down time.
“Not everyone is the right candidate, though,” notes Zajdel. “For one thing, the skin needs to be in good condition. And CoolSculpting works best on stubborn fat in problem areas like the thighs, buttocks, hips and ‘bra fat.’ We can determine this in a consultation, but the patient still needs to have realistic expectations.” Not all the fat is removed from any given area, and it can take four to six months for the results to fully show.
With so many options, the best approach is to find a doctor or medical spa you trust. Be sure to educate yourself with regard to risks as well as results, exercise healthy skepticism and check the practitioners’ credentials. Ask for a consultation, in which clinicians will explain how many treatments and what procedures are most likely to give you the results you seek (since it’s so different for everyone), and help you come up with a realistic, affordable treatment program.
Crème de La Mer devotees love the silky texture and rejuvenating results of this, the holy grail of all anti-aging moisturizers. Seaweed extracts are the secret of the “Miracle Broth,” which has withstood the test of time, despite a high price tag. La Mer Moisturizing Cream, $170; sephora.com.
Some foundations do more than even out your skin tone. This formula utilizes ingredients such as vanilla planifolia fruit extract to provide regeneration, firmness, uniformity and hydration. The glow is multi-layered without looking shiny, and skin appears makeup free. Chanel Sublimage Le Teint, $135; chanel.com.
You’ll see immediate results upon applying this cream, as it softens and smoothes your face. A blend of five hyaluronic acids act as a humectant, helping to plump skin. SkinMedica HA5 Rejuvenating Hydrator, $178; Bonness Skincare Boutique, Corners of Brookfield.
The active ingredient in this go-to staple is retinol, which speeds skin cell turnover, boosts collagen and reduces fine lines. With its low price tag, it’s a great way for first-timers to introduce anti-aging to their skin-care routine. Roc Deep Wrinkle Night Cream, $18; target.com.
Yes, girl, the main ingredient is snail slime extract, popularized by Korean beauty products. A perfect boost for tired skin, it helps with redness and inflammation and leaves you with a noticeable glow. Try it while on a long flight, and disembark from the plane looking fully refreshed. Missha Super Aqua Cell Renew Snail Mask, $6; target.com.
“Forever Young” appears in the 2018 Health issue of Milwaukee Magazine.
Find it on newsstands beginning April 30th, or buy a copy at milwaukeemag.com/shop.
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