Saving Face: Cosmetic Procedure Smarts

By Kimberly Bazar
|  Sunday, May 31, 2009  |  Updated 12:46 PM EDT
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Saving Face: Cosmetic Procedure Smarts

In a culture that celebrates youth, it can be hard to accept new wrinkles and other skin "imperfections." So many people are turning to doctors to smooth out wrinkles and fix the unevenness and discoloration of the skin that can occur over time.

But these procedures can carry risks of their own. Below, Dr. Roy Geronemus, director of the Laser and Skin Surgery Center of New York and a clinical professor of dermatology at the New York University Medical Center, reviews some of the most common cosmetic skin procedures, and offers advice about how to help ensure you are protected from scarring and other permanent complications.

What are common types of cosmetic skin surgeries?
Dermasurgeons perform a wide variety of cosmetic procedures, including Botox injection, filler substance injection, laser procedures and chemical peels.

What are Botox injections?
Botox injections come from a substance botulism toxin. When used properly and appropriately, Botox provides a safe and effective method of relaxing muscles under the skin. In doing so, you can diminish the lines on the forehead, the eyes and even the neck. It is a fairly simple procedure performed right in the doctor's office. Botox can last anywhere from three to eight months, depending upon the condition and the needs of the patient. The treatments do need to be repeated at some point in the future.

Who is a good candidate and who is not a good candidate for Botox?
A good candidate is someone who has furrow lines between the eyes, horizontal forehead lines across the forehead, crow's feet around the eyes or some bands under the neck. Poor candidates are those who have lines on the upper lip or on the cheeks. Botox would also not help someone who has significant sagging of the skin. In terms of safety, it would not be appropriate to use Botox in people with neurological diseases.

What are the risks?
The risks of Botox, when administered properly and when using the appropriate substance, are very small. The most significant risk is a temporary drooping of the eyelids. It usually doesn't last very long and isn't common. It occurs in less than 2 percent of patients and, oftentimes, it's very subtle. You can get some bruising from the procedure or some asymmetry, but much of this can be corrected with subsequent treatments.

What are filler substances used for?
Filler substances are used to help plump up the cheeks, to add to the chin and to improve scars. In the past, doctors used collagen and collagen-like material, such as CosmoDerm and CosmoPlast.

Recently there has been an explosion of new filler substances that have come onto the marketplace, such as new hyaluronic acids, including Restylane and Hylaform, and Radience, which is a calcium hydroxyapatite material.

How long do fillers usually last?
The fillers last for varying amounts of time. Some of them just last a few months, others can last up to a couple of years. By and large, most of these filler substances do require a refill. You have to continually augment the area to maintain the benefit that you see from the initial injections.

What kinds of problems can arise from the filler substances?
Risks from the use of filler substances are generally small. In the past, when collagen was the only available agent, some people had an allergic response. So before injections could be given to a larger area, skin testing was required. But now with the large variety of products available, by and large, the only problems doctors see is some bumpiness of the skin due to over-correction.

What are the different types of laser treatments?
You can use different lasers for different purposes. "For example, we'll use one laser to treat redness of the skin, such as from a birthmark or enlarged blood vessels on the face," says Geronemus. "We'll use a second type of laser to treat brown spots and that same laser to remove tattoos." Doctors will also use a wide variety of lasers to remove unwanted hair. And different lasers are used to remove the signs of aging skin, such as wrinkles, loss of skin tone or a generalized discoloration of the skin. The choice of laser may also vary based upon the color of the hair and the pigmentation of someone's skin.

What are the risks of a laser treatment?
With any laser procedure, you can get scarring, burns, changes in pigmentation. That's all the more reason why one should go to someone who's experienced like a dermasurgeon. If you are considering a laser procedure, it is particularly important that you ask your physician a simple question: "Do you have the correct laser for my condition?"

What are chemical peels?
Chemical peels involve applying a substance, oftentimes acids, to the skin, to create a rejuvenation effect. Chemical peels are used to give you a fresher look and improve skin tone, to remove discoloration and improve mild imperfections in skin texture. Many of the chemical peels result in significant peeling or sloughing of the skin surface. There are some very superficial peels, like a glycolic peel or some of the fruit acid peels. With more mild peels, the effect is much less noticeable.

What are some of the risks of chemical peels?
The more aggressive the chemical peels is, the more the skin will be wounded and need more recovery time. Risks from chemical peeling would include scarring, a change or loss of pigmentation and some prolonged redness.

How does one go about selecting a physician?
Ideally, you should see a dermasurgeon, a dermatologist who has specialized training in the use of these procedures, whether it be laser or Botox injections. You would like to make sure that physician is board-certified. If need be, you can check with the state regulatory bodies to make sure that the physician is licensed and is in good standing.

You can also go to a society website, such as the website for the American Society for Dermatologic Surgery, or ask your primary care physician or dermatologist who the appropriate person would be to treat your condition. You also want to make sure that the physician has the appropriate treatment or technology for your condition. For example, if you're a dark-skinned patient and you want to go in for a laser hair removal procedure, there are a few lasers you could use and many you can't use.

You also want to make sure that the physician has experience in treating that particular condition over a period of time. Fair questions to ask the physician are: "Have you done this before? Can you show me photographs? Can I speak to another patient who's had this procedure performed?"

What is the difference between going to a spa or a skin surgery center?
In a spa, you're looking for beauty treatments or treatments to improve the condition of your skin, like facials, very light chemical peels, massages and other procedures that do not necessarily injure the skin. Spa treatments are generally delivered by aestheticians or other nonmedical professionals. But there are many procedures that are considered the medical procedures, such Botox injections and deep chemical peels, which should not be performed by an untrained medical person. These are procedures that should be done either by a physician or by a trained medical person under a physician's direct supervision.

Are there any red flags to watch out for?
"If someone promises that there's a procedure that's totally safe, I would be very concerned," says Geronemus. All procedures, no matter how many times they've been performed and how safe they may be, still carry some risk.

"The other thing that I would be concerned about is if you are guaranteed a cure," says Geronemus. There are many procedures where the success rate is extraordinarily high, and most people are very happy with the procedures that are performed properly in today's dermasurgical practice. "But, if a physician guarantees you that you'll be 100 percent satisfied, I would probably walk away."

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