In an ideal world, we would stay out of the sun—or at least slather on the sunscreen— eat right, maintain our optimum weight and get plenty of exercise. An impossible goal? Probably. Environmental and genetic factors, the natural aging process and, sometimes, just a devil-may-care attitude interfere with the promise of smooth, unblemished skin, a full head of hair and a trim, taut body.
The American preoccupation with youth and our desire to feel and look fabulous at every age have given rise to day spas where therapeutic massage, facials and general pampering are the norm. Physicians, particularly in the fields of plastic surgery and dermatology, now offer more and varied cosmetic procedures.
The depressed economy has not slowed demand for cosmetic procedures, which are rarely covered by insurance. The number of such surgeries, including less-invasive options, rose by 5 percent in 2011, according to the American Society of Plastic Surgeons. “There are a lot of women and men in their 40s and 50s and older who realize that the job market is competitive,” says Dr. Omar A. Ibrahimi, a dermatology expert and director of cutaneous laser and cosmetic surgery at the University of Connecticut Health Center in Farmington. “For better or worse, appearances matter. Anything they can do to give themselves more selfconfidence or an edge is an advantage.”
Plastic surgeons also are seeing more men in their offices because “in the workplace, I think there is ageism,” says Dr. Jennifer Pennoyer, a board-certified dermatologist in private practice in Bloomfield and a clinical instructor in dermatology at UConn School of Medicine. “Just like anyone else, they are competing in the workplace and want to look good.” The services that men request most often are Botox and filler and fat injections, hair restoration and skin resurfacing.
The desire to improve one’s appearance coincides with a request for non-surgical alternatives. “The trend is moving away from full-scale, more invasive surgeries like a face lift or tummy tuck to procedures that have less downtime, shorter recovery and less risk,” Ibrahimi says. These less-invasive techniques tend to produce results that don’t scream, “I just had a face lift.” Instead, the person may look “more rested, relaxed and refreshed,” he says.
Zeltiq CoolSculpting, the technique that Pennoyer uses to eliminate fat, requires no incisions or anesthesia. Developed by scientists at Harvard-affiliated Massachusetts General Hospital, CoolSculpting’s targeted cooling process eliminates fat cells by freezing them. The fat cells are then eliminated naturally from the body. “When [CoolSculpting] was cleared by the FDA in 2010, we were the first local practice to offer it, and there is solid research to back it,” Pennoyer says.
The process involves attaching small cooling machines to problem areas. “It grabs you like suction,” she says. “The more [fatty area] we can fit in, the better it will be.” The patient can feel the suction for about five minutes until the cool temperature numbs the area. The process takes about an hour and can eliminate about 25 percent of the fat cells. “It works best for love handles, the roll around the middle, the inner thighs and inner arms,” Pennoyer says.
After the procedure, some patients may experience achiness, but they will not see immediate results. “You go out with the same size pants you came in with, but over the course of four months, the fat cells dissolve and melt away,” she says.
“CoolSculpting results in the permanent removal of fat cells. It’s simple, with no needles or cutting.”
Like other cutting-edge dermatologists and plastic surgeons, Pennoyer says she offers a wide menu of services and is constantly researching the latest treatments. More patient requests for cosmetic procedures are driving physicians to provide those services.
In 2011, minimally invasive cosmetic procedures increased 6 percent, the ASPS says, with Botulinum Toxin Type A (better known by one brand, Botox), soft-tissue fillers, chemical peels, laser hair removal and microdermabrasion the most popular treatments.
Microdermabrasion removes the top layer of dead skin, giving the skin “better glow and texture,” Ibrahimi says. The results are short-lived, but a series of treatments can produce some improvement. “Botox is a very popular procedure,” Ibrahimi says. “It is a toxin and that gives it a negative connotation, but it’s been used for more than 20 years and is extremely safe.” While Botox is a highly recognized brand, other pharmaceutical companies produce variants (Dysport and Xeomin) that encourage competition and keep costs down.
Dermal fillers serve to plump areas of the face. As skin ages, fat and collagen decrease and gravity begins to tug at the skin. “The most popular [fillers] are natural substances that the body produces,” Ibrahimi says. “They are injected in a purified form into the skin.” The effects are soft and natural, although there may be some bruising for a day or two. There is another upside, however. “If the patient has buyer’s remorse, we can easily undo the filler,” he says.
One of the newer trends in cosmetic non-invasive surgery centers around lasers. “Lasers work great for photo-aging,” says Ibrahimi, who also is visiting assistant professor of dermatology at Harvard Medical School and Massachusetts General Hospital’s Wellman Center for Photomedicine, where today’s lasers were developed. “They can treat brown spots, acne scars, irregular skin texture and wrinkles.”
Lasers “are amazing tools we have based on Einstein’s theory of stimulated emission and modern physics,” Ibrahimi says. Lasers are used to treat and remove birthmarks, tattoos and hair. Fractional laser skin resurfacing helps to improve skin texture, diminish the appearance of wrinkles and acne scars and stimulate collagen renewal. Some lasers can partially undo damage that puts one at risk for precancerous or cancerous lesions, he says.
Although laser work does not require general anesthesia, a topical or injected numbing medication may be in order, depending on the treatment or the individual. Discomfort is limited to a slight snap, like an elastic band, as the laser does its work.
Ibrahimi makes the case that a dermatologist’s study and understanding of the skin provides the foundation for proper treatment. “To treat brown spots and fine wrinkles, you can’t do that without an understanding of the biology of the skin. No other specialist has as in-depth an understanding of how to medically and surgically treat the skin as a dermatologist,” he says.
He recommends that those seeking treatments not just seek out the cheapest provider of a given service, but someone who you feel comfortable with and who is performing a service within their training qualifications. That advice extends beyond laser treatments. With any cosmetic technique, “the public needs to remember that just because [a procedure] is non-invasive doesn’t mean it is always safe,” Pennoyer says. “It needs to be performed by a board-certified plastic surgeon or dermatologist. You should know what you’re getting.”
Ibrahimi, whose passion includes treating and removing birthmarks through laser treatment, says that the future will bring more and more uses for lasers. “There may be some exciting things on the horizon a few years from now,” says Ibrahimi. “Everything we have for acne today focuses on controlling the symptoms, however, there may possibly be a cure—not just a treatment—for acne with lasers that target the root cause of acne: the sebaceous gland.”
In the meantime, stay tuned—and don’t forget the sunscreen.