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Saving Face: New Weapons in the Wrinkle Wars

What really works to help you look younger

spinner image Saving Face - Plastic Surgery
You can turn back the clock without having to go in for surgery with the latest non-invasive procedures.
Sean Justice/Corbis

Face-lift? So last century. These days, women and a surprising number of men are seeking ways to turn back the clock without going under the knife. Last year, Americans age 55-plus opted for 3.4 million minimally invasive cosmetic procedures, according to a report by the American Society of Plastic Surgeons. Topping the list: Botox, at 1.4 million injections, followed by fillers, at 818,000.

"People have always wanted to look as young as they feel," says Jody Comstock, a dermatologist in Tucson, Ariz. "But we're also living longer and working longer. To be a contender in today's tight job market, you need to look like you're still in the game."

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But you don't necessarily want anyone to know that you did a little something. "Technology has improved tremendously with these new procedures," adds Comstock. "They're quick — you see results, if not right away, then within a few days. And the risk of any kind of serious complication is far lower than with surgery."

The problem is that as we age, skin loses the elasticity it needs to hold its shape. "Wrinkles form, eyelids droop, cheeks hollow and you may appear more tired, worried or older than you are," says dermatologist Ellen S. Marmur, associate clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai Medical School in New York. "As dead cells accumulate, the complexion becomes dull and uneven, like having 10 layers of paint on your skin."

What can you do? No solution is right for everyone. Depending on your skin type, lifestyle habits and overall health, not to mention budget and amount of time and discomfort you're willing to accept, a doctor can outline the best options for you. She may even combine procedures as part of an ongoing treatment plan.

Keep in mind that not every procedure is right for every problem: "You don't need a full face-lift to smooth deep troughs next to your mouth, when a filler will do just fine," says Comstock. What's more, you won't walk out with that dreaded "deer in the headlights'' look, the hallmark of face-lifts back in the day. You'll look less tired, more energetic and youthful. Like you, only better.

To help you safely navigate the dizzying array of noninvasive choices available, we've culled from dozens of the latest procedures. Here's how to get glowing.

Crow's Feet, Forehead Furrow

What can help: Botox, Dysport or Xeomin are brand names for a highly purified form of botulinum toxin. By temporarily paralyzing small muscles, they prevent lines from forming and make those you have less noticeable. When Botox is injected into the vertical bands of muscles in the neck, it can ease the dreaded turkey neck, too.

What you need to know: "I cringe when I hear about Botox parties or people getting injected at a nail salon by someone who's taken a weekend course," says Marmur. "We hear so much about Botox that people think it's easy to do. Actually it's one of the hardest to get right." Expect results in a few days.

Downtime: None.

Cost: About $380 per treatment. You'll need a touch-up in three months.

Under-eye bags, rings or dark circles

What can help: Hyaluronic acid fillers such as Restylane and Juvederm (made from a sugar that naturally occurs in the body) are still the gold standard. They trigger the production of new collagen — the protein fibers that give skin its firmness and strength — diminishing moderate to severe wrinkles. The newest — Belotero Balance — erases superfine lines such as those on the lip or chin.

What you need to know: The injection itself may be slightly painful, though numbing cream is premixed with the filler, and your doctor can apply more topically.

Downtime: Expect a few days of redness or bruising. Effects can last six to nine months. Since these fillers gradually stimulate new collagen, you may need less next time.

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Cost: Restylane runs $750 per syringe, and Belotero about $800.

Smile lines (around the nose) or marionette lines (around the mouth)

What can help: A new hyaluronic filler called Juvederm Volumna is generating buzz. Injected near cheekbones and temples or along jawbones, it contours the face, instantly lifting and tightening several areas at once.

What you need to know: If you hate the result or want to tone it down, doctors can inject an enzyme that dissolves the filler completely.

Downtime: Same as above.

Cost: $1,500 per treatment; you may need more than one, but effects can last two years.

Age spots

What can help: By sloughing off dead cells, two procedures — microdermabrasion and chemical peels — can lighten superficial spots and fine lines as well as improve skin tone and texture. Microdermabrasion uses tiny crystals to buff and smooth the skin and encourage new cell growth. Many doctors combine microdermabrasion with a chemical peel of varying strength, depending on how damaged the skin is. However, to get rid of spots completely, you'll need one or two treatments with a laser.

What you need to know: For best results, you'll need a series of peels performed several weeks apart. "People of darker skin tones must be careful since the wrong kind of peel can leave discoloration and scars," says San Antonio, Texas, dermatologist Vivian Bucay. Keep in mind that some spots can be cancerous; your doctor will examine them and provide an appropriate course of treatment if they are.

Downtime: Microdermabrasion has no downtime; you'll notice some flushing of skin. Downtime for peels varies depending on the type of peel and the skin damage you want to correct. Lighter peels have virtually no downtime; you can go out to dinner right afterward. Medium peels may take a weekend for skin to look presentable. And with some stronger peels, you should expect to stay inside for up to two weeks while old skin peels. Laser treatments leave a small scab that will fall off in a week or two.

Cost: $150 to $300 for superficial chemical peels; $150 for microdermabrasion; $2,500 to $3,000 for a deep chemical peel.

Sallow, blotchy skin

What can help: By removing outer layers of skin with controlled focused light, fractional nonablative lasers spur collagen production; smooth wrinkles; zap spots, broken capillaries and scars; and, in general, improve skin texture.

What you need to know: Since there are so many types of lasers, consult a doctor who has several in his practice so that he can explain which one is right for you. "If all you have is a hammer, everything's a nail," says David B. Reath, a plastic surgeon in Knoxville, Tenn. "The laser your sister-in-law had may be all wrong for your skin, so don't go in requesting a specific tool." People with darker skin need to be sure they're dealing with an expert, since powerful lasers can also leave scars or discoloration.

Downtime: Again, this varies widely depending on the type of laser used and the skin damage you want to correct. You might need two or three sessions performed a month apart. You'll be red and peeling for a few days, but side effects are considerably less than the older CO2 ablative lasers.

Cost: Between $1,100 and $2,225.

Jowls or a double chin

What can help: The new kid on the block is Ultherapy, which uses heat and ultrasound waves to tighten jowls and neck wattle as well as lift brows. Another technique, Thermage, uses radio-frequency heat energy for similar results.

What you need to know: Skin should tighten up within a week and continue to firm over the next few months. The treatment hurts; you'll need painkillers.

Downtime: Virtually none. You might not even notice a difference, since it takes about a week or so for skin to tighten up.

Cost: The process can run between $3,500 and $4,000, but results last up to two years.

What about medi-spas?

"Any treatment is only as good as the doctor performing it," says Reath. "These are medical procedures and they involve risk — and that could mean burns, infections, scarring." If you go this route — which can be less expensive than a doctor's office — first have a consultation with a doctor who is board-certified in dermatology, plastic surgery or otolaryngology (ear, nose and throat, or ENT). You do not want a gynecologist or dentist to do your laser treatment, Reath says. Before you have anything done at a medical spa, or medi-spa, check that a doctor is on the premises, he recommends. The aesthetician doing your treatment should have a minimum of two years experience doing that procedure. Though state regulations vary, and in some places any physician can legally offer these services, a dermatologist, plastic surgeon or otolaryngologist will have had surgical training specifically in these areas, Reath says.

Note: If you're taking diuretics, blood thinners, aspirin or nonsteroidal anti-inflammatories, you will have to stop a week before any procedure. Herpes or other skin diseases must also be treated first.

Margery D. Rosen is a New York City-based writer specializing in health and psychology.

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