The facelift seems to be going away. And I will happily send a card to the funeral, letting them know I approve of it

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“The facelift seems to be going away. And I will happily send a card to the funeral, letting them know I approve of it,” says Rick Schaler, M.D., of Lone Tree Facial Plastic and Cosmetic Surgery Center, about the future of cosmetic surgery.

While some of us might appreciate his modern spin on a famous Mark Twain quote, we might find it odd to hear such a thing from a plastic surgeon, particularly one certified in facial plastic and reconstructive surgery. But, in fact, quite a few experts in the field seem to agree that going under the knife, especially when treating the face, will no longer be a necessity in a few years. Since 1997, nonsurgical cosmetic procedures in the United States have increased by 233 percent while surgical procedures have only gone up 80 percent, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Today, nonsurgical procedures make up 83 percent of all treatments.

In other words, despite what pop culture might be insinuating, you don’t have to get all Nip/Tucked to see results, especially in the area of facial rejuvenation. “I tell my patients that we can do an East Coast look or a West Coast look,” says Cherry Creek cosmetic surgeon Jack Zamora, M.D., of Cosmetic Surgery Consultants of Colorado, “and I think more of our patients are looking for a more East Coast, conservative, natural look. The pendulum is swinging back.”

These days, the majority of local patients are seeking noninvasive procedures, Zamora says, and these options are readily available and improving every year. With Colorado’s dry climate; 300-plus days of mile-high, UV-ray sunshine; less oxygen in the air; and outdoor lifestyles, most agree that’s probably good for the people of Denver. Here are just a few local procedures that are generating buzz:

ASAPS rates laser skin resurfacing as the fifth most popular nonsurgical procedure in the United States — behind Botox, laser hair removal, hyaluronic acid (Restylane, etc.), and chemical peels. But lasers have improved dramatically in the past decade and tend to be what most people are talking about these days.

“Interest in lasers has been exponential in the last three years because of the change in the technology,” Schaler says. “Early experiences with lasers were disappointing. But now we can get the majority of people to have 60 to 70 percent of the results of a facelift without the incision, the complications, the numbness, or the downtime.”

Lasers, says David Verebelyi, M.D., medical director at the Colorado Center for Photomedicine in Highlands Ranch, are one of the fastest growing fields in medicine and can be used to treat everything from discoloration, sun damage, acne scarring, and fine lines and wrinkles to precancerous skin cells, as well as to tighten and firm the skin.

As one of the first doctors in the United States to use many of the newest laser technologies, including Cutera’s Pearl and Cynosure Smartlipo MPX systems, Verebelyi says the constant influx of new lasers and innovations can make it both an exciting and complicated industry. Right now, he thinks the fractionated CO2 lasers (a $3,000, one-time treatment marketed as Lumenis ActiveFX and DeepFX, collectively called Total FX) are the “best bang for your buck” for laser facial rejuvenation. Countless Websites debate the merits of different lasers, such as Fraxel v. Lumenis v. Cutera. Verebelyi says consumers need to know all lasers are not created equal nor are all offices offering laser procedures.

Side effects can still include burns and discoloration, and these are more likely to happen with untrained technicians or with older, inferior lasers.

“The best thing to do is make sure the physician is well trained with lasers,” says Verebelyi, who is also a fellow of the American Society for Laser Medicine and Surgery, “that it’s not just: ‘I bought a laser; I got a one-day course, and now we’re running a laser business.’ Because that’s how most of them work. That’s 90 percent of what’s out there.”

Because it’s holistic, natural, and based on thousands of years of application, there is a growing trend to take something like acupuncture, which has generally focused on pain relief, and apply it to the face for rejuvenation effects.

“Acupuncture is not only working the region, it is also working on the body itself,” says Tamara Hutchins, founder of the Zen Redhead Acupuncture and Meditation Clinic in the Denver Tech Center. “People who have had facial rejuvenation acupuncture have this glow that you cannot achieve with lasers or injectables.”

The results take a little longer than injectable fillers like Botox but often last longer, cost less (around $135 a session, insurance may even cover portions), have little to no side effects, and look more natural, says Hutchins. If you receive it regularly (which is roughly a couple times a year for a young person or a series of 10 for a middle-age person), you may never get to the point where you need lasers or a facelift.

Martha Lucas, Ph.D., an acupuncturist in the Capitol Hill area who specializes in Mei Zen cosmetic acupuncture, says the needles create tiny wounds, engaging the body to send microblasts of collagen to the site. Before-and-after photos indicate it’s very effective in smoothing skin and evening its tone, but because there haven’t been many randomized, controlled studies, some in the community have been slow to embrace it as a viable choice.

“It’s kind of the same debate between modern v. Chinese medicine, and modern medicine is more of what people are comfortable with,” says Lucas. “But more and more practitioners of Chinese medicine who take my classes are saying their patients have been asking for this.”

If You Must Cut
Not everyone buys into the death of the facelift, and some facial procedures may always require cutting. But everyone generally agrees a facelift, which, on average, will run you roughly between $6,000 and $15,000, should be your last resort.

“You never want to do an operation until it bothers you enough to have an operation,” says Paul Zwiebel, M.D., D.M.D., of Zwiebel Center for Plastic Surgery and Skin Care in Littleton. But if the time comes, he recommends a plain old, unromantic scalpel over whatever the fad du jour may be: “When it comes to something as important as your health and your appearance, I’ve often found that tried and true is your best bet.”

Still, in this day and age, that scalpel is making tinier cuts, and downtime has also been radically reduced. Zamora, an ophthalmologist and oculofacial surgeon, says his specialty, upper eyelid rejuvenation, now takes as little as 20 minutes with dissolvable stitches, local anesthesia, and a recovery as short as three days. It’s just one of many traditional surgical procedures that is incorporating lasers with scalpels to create better and less-invasive results.

So what’s next on the horizon? Experts say you can expect to read about more celebrities getting noninvasive treatments, including facial acupuncture, as the “frozen” look dies out and the more natural, holistic trend continues. And expect continued improvements in the laser industry, especially in the training of laser technicians. In the next year to 18 months, Verebelyi says there will be a more comprehensive, standardized, national course for operating lasers that he hopes malpractice insurance agencies will adopt.

And like many other fields of medicine, several local cosmetic surgeons agree the far-off future of their business actually lies in stem cell technology. While many say it’s still in its infancy, they are excited to imagine where stem cells might take the field in 25 or 50 years. “Stem cells are going to be the direction of rejuvenation for facelift and the body; it’s just a matter of time,” says Zamora. “Instead of a Botox injection, you’ll have a stem cell injection. And instead of three months, it’ll last forever.”


April 2009

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