Beyond Botox: 8 New Ways to Freshen Up

Skin losing its luster? Wrinkles giving you frown lines? We looked at pros and cons of 8 cosmetic procedures that fight age without putting you under the knife…

Most of us take youthful skin for granted – until, of course, we lose it.

Fortunately, there are several non-invasive techniques that can turn back the clock sans knife.

Popular non-surgical treatments such as Restylane, Thermage and Dysport can whisk away smile lines in a quick, 30-minute office visit.

But are they safe? Expensive? And what kinds of results can we expect?

Procedures like these can make you look youthful and rested.

But in untrained hands, bruising, lumps, droopiness, discoloration and temporary paralysis may result, according to Anthony E. Brissett, M.D., director of the Baylor Facial Plastic Surgery Centers at Baylor College of Medicine in Houston.

Plus, the fountain of youth doesn’t come cheap.

Health plans generally don’t pay for these elective procedures – although some doctors now offer low-interest monthly payment plans, such asCareCredit.
If you’re considering treatment, familiarize yourself with the latest non-invasive procedures and choose a physician with proven experience in the aging and rejuvenating process.

Here’s what you need to know:

1. Thermage
You’ve heard of magic wands, right? Thermage tightens skin using a stick-like instrument that sends thermal energy to wrinkled areas.

It was originally approved by the Food and Drug Administration (FDA) to treat the eye and forehead; the agency OK'd full-face treatments in 2004.

How it works: The heat from the wand tightens skin and reduces wrinkles by stimulating the production of collagen, the protein in skin that keeps it firm.

Upside: Firmer skin by the end of your lunch hour. This in-office procedure can take as little as 30 minutes, more if you’re tightening a number of areas.

“Patients see the most difference after 2-3 treatments,” says Brissett.

The tightening effect can last for several months.

Downside: Improvements are modest, so set realistic expectations. Plus, the procedure itself can be uncomfortable, “like having an elastic band snapped on your skin,” Brissett says.

Cost: $1,000-$5,000, depending on how much of your face is treated.

2. Dysport
FDA-approved for cosmetic purposes, this injectable form of botulinum toxin (yes, it’s like Botox) had been used earlier to treat neurological and motor disorders such as cerebral palsy.

How it works: Furrowing your brow, squinting and smiling tightens those facial muscles and eventually creates wrinkles. Injecting Dysport into these muscles stops them from contracting, preventing lines around the eyebrows, eyes and lips.

Upside: Dysport acts faster and lasts longer than Botox, says Brissett.

Treatment makes people look youthful and rested. If you have significant wrinkles, furrowing, or frowning, “it takes the worry off your face,” Brissett says.

The procedure is done in a doctor’s office in as little as 10-15 minutes, and effects last 3-4 months.

Downside: That frozen-face look.

“And in the wrong hands, it can cause temporary muscle weakness or paralysis, which creates a drooping eyelid, droopy eyebrows, or a pulling away of the lower eyelids,” Brissett says.

Cost: $300-$400 for partial; $500-$700 and higher for a full face treatment.

3. Glycolic Acid Peel
When wiped on your face, glycolic acid (found in sugar cane and grapes) removes the skin’s outer layers.

Peels can remove just the top layer (the epidermis) or go as deep as a small portion of the dermis, the layer just below.

How it works: Glycolic acid dissolves the adhesive that keeps skin cells together and takes off dead skin, says Oanh Lauring, M.D., chief of dermatology at Mercy Hospital in Baltimore.

“As you grow older, cells don’t slough off as quickly, so skin gets a dull tone. A peel keeps it looking smooth and fresh.”

Upside: Skin has a tighter look and fine wrinkles are minimized, says Lauring. Have freckles? A peel can lighten them.

Plus, treatments are fast: Your doctor puts on the acid with an applicator and leaves it on for just 2-5 minutes, then rinses it off.

Downside: Skin can be red, then peel and remain flaky for about 3-4 days.

If the peel is applied unevenly, more skin is taken off certain areas, leaving uneven discoloration. This risk is greater with darker skin.

Most of the time, discoloration isn’t permanent. But it can be if the acid is too strong and left on too long, says Lauring.

Cost: About $90-$120 per treatment.

4. Restylane
This injectable filler is made of hyaluronic acid, a carbohydrate naturally found in the body. This acid helps keep skin hydrated and plumped up, and we lose it as we age.

How it works: Restylane is injected into the face to smooth out nasal labial folds (or “smile lines,” which run from the nose to the corners of your mouth), plump up lips, or fill in acne scars or hollow cheeks.

The in-office procedure takes about 30-60 minutes, depending on which area is being filled.

Upside: Immediate results with minimal downtime, says Brissett. “You can go back to work that day with little discomfort.”

And unlike collagen injections, a similar treatment, Restylane doesn’t cause allergic reactions.

Downside: Lumps can appear immediately after treatment, but these can be massaged away.

You can also have bruising for up to a week, or swelling for the first 24 hours or so, Lauring says.

More serious: Months or even years later, you may develop a rare inflammatory reaction called granulomas (lumps) that have to be surgically removed.

“We don’t see those with the new fillers, but there’s always a risk,” Lauring says.

Cost: $500 for a minimal treatment (like lips) to about $2,000-$3000 for very deep folds in multiple areas.

5. Juvederm
This filler is derived from bacteria, but there’s no bacteria in the product, says Terry Myckatyn, M.D., assistant professor of plastic and reconstructive surgery at Washington University in St. Louis.

Like Restylane, Juvederm uses hyaluronic acid to freshen faces.

How it works: It comes in a thick gel usually injected into lips and nasal labial folds to add volume to wrinkles and give the face a smoother look.

The procedure, performed in a doctor’s office, takes about 10 minutes for each area injected, plus preparation time, which may require up to 45 minutes if the physician uses numbing cream.

A quicker alternative is an injection of local anesthetic, which takes only 5-10 minutes to prep the skin.

Also, in February, the manufacturer received FDA approval for Juvederm with anesthesia included, allowing for an even speedier procedure.

Upside: An immediate change that’s relatively inexpensive, says Myckatyn.

Downside: Effects last only up to six months and depend on which part of the face is treated. Areas you move more, like lips, absorb it faster, so results are shorter-lived, says Myckatyn.

Plan to lay low after the procedure, because you can have bruising or look over-injected. “That’s the numbing medication and the body’s swelling response,” Myckatyn says. Both reactions go away within several days.

Cost: About $500 per vial; one is enough to treat lips.

6. Latisse
This lash-growing liquid contains bimatoprost, a naturally occurring fatty acid. It was originally developed to control the eye disease glaucoma, but was approved by the FDA for cosmetic use in 2008.

How it works: When brushed on lashes and upper eyelids at the hair follicles' root, it thickens eyelashes.

“Once you get the growth you like [which usually takes about two months of daily application], use it only once or twice a week to maintain it,” Lauring says.

Upside: It’s extremely effective, according to Myckatyn. “People are now using it on chemotherapy patients whose eyelashes have become sparse.”

Downside: With overuse, lashes can grow long and bristly, like a camel’s, says Lauring.

It could also turn your blue (or green) eyes brown, which happened to some glaucoma patients.

“But they’re putting the drug directly in their eyes,” Myckatyn says: “As long as you’re applying Latisse to your eyelashes and not eyeballs, color change shouldn’t be an issue.”

Cost: About $120 a month.

7. Radiesse
This filler is made from hydroxyapatite, the main chemical found in our bones and teeth.

How it works: Radiesse is used to fill in hollow areas in the face and nasal labial folds. It’s not intended for fine lines, says Myckatyn. One in-office procedure takes about 30-45 minutes, plus preparation time.

Upside: It lasts longer - at least a year - than similar treatments.

Downside: If you don’t like how you look, you’re stuck with it for that year. And it’s not effective in areas where skin is thinner, like lips, says Myckatyn.

Cost: About $450-$475 per vial. Final cost depends on how many facial areas are filled.

8. Sculptra
This semi-permanent injectable filler contains synthetic Poly-L-lactic acid. It was first approved by the FDA in 2004 to repair the dramatic fat reduction that comes with HIV infection, and in 2009, the FDA approved it for cosmetic use.

How it works: Sculptra stimulates the production of collagen, elastin and fibronectin, materials that make up the skin’s structure, says Brissett. “So some of the effect is permanent.”

Its primary use is to restore lost volume to areas like deep nasal labial folds or wrinkles, not for fine ones around the eyes and mouth.
Patients generally need 2-6 treatment sessions, each separated by three months.

Upside: It’s quick – each treatment takes about 15-30 minutes, says Myckatyn. And effects last up to two years.

Downside: In untrained hands, the filler can create lumps of inflamed tissue that may disappear over time, says Brissett.

Cost: $1,000-$4,000, depending on the amount of volume added to the face.
What’s Your Cosmetic Procedures IQ?
Feel like getting "freshened up"? More people are opting for cosmetics procedures to take years off their appearance. From lasers to tummy tucks and microdermabrasion, there's a dizzying array of options. But how much do you really know about this growing industry?