Face Time - Ranch & Coast

San Diego's Luxury Lifestyle Magazine - June 2007

by Andrea Naversen

Let's face it. We're not getting any younger. The aging process really begins when we're born. And even before middle age, we're already looking for ways to turn back the clock. It's not that we want to be younger, necessarily – who really wants to be an adolescent again? We just want to look a bit younger – the same old self, but new and improved.

Thanks to advances in technology, there is a range of options for those who want to fool Mother Nature. Lasers, for everything from fine lines to scars, are an increasingly popular option. Last year, 1.8 million skin rejuvenation procedures were performed in the U.S., a number expected to more than double by 2010. But here's the wrinkle. With so many options out there, which – and how – to choose?

"I think the primary choice the consumer has to make is how much downtime do they have?" says Richard Fitzpatrick, MD, director of the dermatology division at La Jolla Cosmetic Surgery Centre. "Do they want something that has no downtime for wound care, or are they able to have a procedure that can have as much as two weeks downtime? That's the first question. And then the second question is how much improvement do they want? Are they looking for just refreshing their skin, are they trying to get rid of brown spots and textural changes, or do they want to get as much improvement as possible?"

The trend is toward less invasive procedures, which also mean less downtime, compared to more aggressive treatments that carry more risk and keep patients out of the public eye for weeks on end. But if patients want significant improvement, there's something to the old saying, "no pain, no gain." "Many of the totally noninvasive procedures I believe were very safe gave very subtle results that just weren't good enough," says Fitzpatrick, a pioneer in laser resurfacing. "So it's kind of swung a little bit back the other way. Now people are willing to accept a little bit of downtime in exchange for a more significant result."

Rhytec's Portrait, one of the latest procedures to resurface the skin, uses ionized gas, the same type of energy that powers plasma TVs. The technology, which Fitzpatrick helped to develop, uses heat to penetrate deep below the skin's surface generating collagen and gradually smoothing crinkled and sun-damaged skin over three months. "So it's very good for tightening around the eyes, cheeks, and eliminating uneven pigmentation," says Fitzpatrick, "and the thing that's very nice about it, it doesn't leave a line of demarcation as can occur with a deep chemical peel." Portrait "feels like a bad sunburn" for four to six hours after treatment, followed by swelling and peeling. The downtime is about a week for more intense treatments. Cost is $2,500 to $5,000.

Mitchel Goldman, MD, medical director of La Jolla Spa MD, has 40 different lasers in his anti-aging arsenal. He's quick to point out one laser does not fit all. "Why would I have $4 million worth of machines?" he asks. "Because every laser does something totally different. And so you basically have to choose the right laser for the right person. It's not like a rubber stamp."

Goldman says lasers won't grow hair, add facial volume, or get rid of deep wrinkles. But he says they're great for getting rid of fine lines and mild wrinkles, facial blood vessels and brown spots, sun damage, and under-eye bags.

Goldman is particularly excited about Affirm by Cynosure, which combines technologies to target aging, photo-damaged skin and stimulate collagen. "It's now almost our most popular treatment in this clinic because we see a phenomenal effect on tightening the fine lines around the eyes, around the mouth, on the cheeks, and on the neck." He says the procedure doesn't require an anesthetic and there's virtually no downtime. Some patients return to work right away while others may be a bit red or swollen for about a day. Three to five sessions are needed, every three to four weeks, at $300 to $600 per treatment.

"The reasons I'm jumping on it so heavily, and I am usually very cautious, is because 95 to 99 percent of people are happy," says Goldman. "It's incredible, it's very rare in a cosmetic procedure to make 99 percent of people happy, especially when they've spent thousands of dollars. And once I started seeing that, I said, whoa, this is something real."

E. Victor Ross, MD, director of Scripps Clinic's Laser & Cosmetic Dermatology Center in Carmel Valley, says the trend now is to combine a variety of technologies for the best outcome. "You do a little bit of this and that, but you don't do it all at one time and you use the different technologies to complement each other so you have this nice sort of balance between downtime and efficacy with minimal risk. That's the new way to approach things."

Ross recommends visible light technologies if patients want the most benefit for the least downtime. "So that would include, for example, intense pulsed light, the KTP laser, or the pulsed-dye. Those three modalities, although they're really not that new, are still the standards for removing red or brown spots. Those are technologies that typically have really high rates of benefit to downtime, if you look at that ratio." Patients experience swelling and sometimes a temporary darkening of brown spots. They can resume normal activities right away, but if they have to look their best they might want to take a couple days off. Two to four treatments may be necessary, spaced three weeks apart. Cost is $350 to $700 per treatment.

Also showing promise, says Ross, is the Pearl procedure, a low intensity resurfacing technology being launched this month by Cutera. In studies he conducted at Scripps, Ross "definitely saw an improvement in fine lines and brown spots" with three to five days downtime for most patients. "It does achieve pretty good results and I think it's probably right near the point that people are going to be happy without taking the whole week off."

Fitzpatrick says patients should be willing to discuss their options with their doctors, based on their goals, rather than insisting on a procedure that might not be right for them. And in the end, choosing the right physician in the first place is perhaps the most crucial decision the patient will make. Experts recommend experienced physicians who are board certified, preferably in dermatology or plastic surgery, with extensive training on the devices they're using. "So it's like caveat emptor," says Goldman. "You've got to beware, you've got to do your research, you've got to go to a reputable physician. You can't just go to something because you saw it once on TV and it looks like it was great." After all, it's your face.

• Click to view the original article with before and after photos.