Lookin’ Good

Is there anyone over the age of 40 who hasn’t looked in the mirror and thought, “Wish I could get rid of these frown lines (or spots or furrowed brow or …). Aesthetic medicine practitioners say that your wish can become reality. Aesthetic medicine, a relatively new medical specialty, is a broad category. It includes surgical procedures, for example, a facelift or breast enhancement. Aesthetic medicine also includes many non-surgical and minimally invasive procedures designed to enhance appearance.

Dr. Wayne Stadelman, a board certified plastic surgeon, says that demand for these new procedures has grown rapidly in the past decade. Stadelman’s aesthetic medicine practice is located on the campus of Concord Hospital. “These procedures can be done in the office,” he explains, “in relatively little time and for much less than a surgical procedure would cost. Recovery time is usually just a few days.”

Injections of botox, a purified form of the toxin botulinum, can eliminate the furrowed brow. Used in tiny amounts, the toxin deadens the nerves. The muscles that cause the brow to furrow do not get the message the brain may be sending to lift or compress. The brow stays smooth. Botox is also used to eliminate the nasolabial folds, the deep lines from the nose to the sides of the mouth, the “crow’s feet” near the eyes and the thick bands at the neck. In a few months the effect wears off and injections must be repeated to maintain the effect.

Dermafillers are used to enhance fullness in the face, producing a more youthful appearance. A dermafiller smooths fine lines and may eliminate the nasolabial folds. The filler can be one’s own fat, extracted from another part of the body. More likely it will be either bovine or porcine collagen, or a chemically produced collagen-like substance. There will likely be some temporary swelling.

Pigment blockers can eliminate freckling and the skin blotches that often come with aging. A blocker will usually contain hydroquinone, or kajic acid, which will inhibit the skin’s production of melanin. The full effect will be seen in four to six weeks. Pigment production will even out.

A chemical peel is used to give facial skin a fresh, even appearance. The peel eliminates or reduces uneven pigmentation and fine wrinkles. It may also be used to remove pre-cancerous growths and acne scars, and in some cases to control acne.

An acid is applied, causing the skin to burn. As the burn heals, a new layer of unblemished skin will replace the burned layer. Chemical peels are available in differing strengths, depending on skin condition. A light peel takes just minutes in the doctor’s office and two or three days to heal. There will be redness and some swelling. The peel may have to be repeated two or three times to get the desired result. With a deeper peel, recovery time will be longer.

In some cases, a chemical peel may be covered by insurance. With chemical peels, as with any aesthetic procedure, there is some risk. It is critical to work with a specialist and to understand the risks.

A new procedure is called the “thread lift.” A barbed suture is threaded under the skin and attached at either end, lifting the skin from the neck and attached to the bones at the temple. The procedure may also be used to lift the skin around the eyes or forehead. This procedure, which received FDA approval in 2004, is less invasive than a traditional facelift and costs less. There is, however, concern about the reliability of the results. Dr. Stadelman does not perform the procedure.

Several factors influence the appearance and functioning of the skin. Aging accounts for many changes. Collagen and elastin are reduced or damaged over the years.

Exposure to sun takes a heavy toll on the resilience of the skin. Other factors may be pollution, illness and trauma. Some patients will choose prescription-strength products for ongoing skin care. Dr. Stadelman uses the Obagi System, but notes that there are many other skin care systems. Products will likely include both vitamin and chemical-based substances.

Laser treatment has proven effective for removal of spider veins and excess body hair. It is also used to treat acne and scars. Mary Bidgood-Wilson is a family nurse practitioner at Moultonboro Family Health Center, a department of Lakes Region General Hospital. She opened Meredith Bay Laser Center in 2006. “The use of laser treatment is growing,” she says. “Patients are pleased with the results.”

Laser is an intense beam of light. In hair removal treatment, the beam passes through the skin to the follicles, where hair growth originates. Three or four treatments may be needed to kill the follicle and achieve long lasting results. Laser treatment is not effective on blond or red hair.

Many men seek laser treatment to remove excess hair on their hands and/or backs, Bidgood-Wilson notes. Women are more likely to want to get rid of facial hair and hair that shows when wearing a bathing suit.

The popularity of laser treatment has led to a proliferation of treatment sites, including some at spas and beauty salons. As with other aesthetic medicine procedures, however, there is risk. Treatment should be administered by a qualified medical practitioner.

The trend is upward, as more people seek to enhance their appearance with aesthetic medicine. Patients’ ages range from adolescent to senior citizen. Men now comprise 10-20 percent of patients. With many treatments costing under $1,000, aesthetic medicine is no longer exclusive to the wealthy. Over time, however, less invasive treatments may cost as much as a full facelift since they need to be repeated to maintain the effect.

Dr. Stadelman is enthusiastic about aesthetic medicine and the results that usually occur. “But remember,” he says, “these changes in appearance will not give you a new life, a better job or a new romance. You will still be you.” NH

Before you decide …

The American Society for Laser Medicine and Surgery (ASLMS) says if you’re considering laser surgery keep these safety tips in mind:

Find out who will be administering the treatment: If the procedure is not being performed by a physician, make sure that a supervising physician is present on-site and readily available to address any problems that might arise.

Ask questions: How many procedures has this person performed? Check the doctor’s credentials and ask to see before and after photos of other patients with similar conditions. How long is the recuperation period? What are the risks? What is the cost?

Discuss your medical history with your physician: Be sure to mention any pre-existing medical conditions, previous medical or cosmetic procedures, as well as any current medications you are taking.

Ask if this laser is right for your skin type: Has this laser been approved for your skin type, hair color and complexion and for use on the area of the body where you are seeking treatment?

Request a patch test: If you have sensitive skin, ask your physician to perform a patch test. It will be much easier to treat a complication on a small patch of skin than a larger area. Let your physician know in advance if you have a history of scarring or herpes: Both can affect treatment outcomes.

Manage expectations: Be sure to discuss with your physician what results can reasonably be expected.

Don’t delay: If you experience intense pain or unexpected side effects following a procedure, call your physician immediately. Don’t wait to see if it will go away.