A face-lift tightens sagging skin by pulling it up, but the surgery doesn't give the skin itself a younger look. Now cosmetic dermatologists offer options to create younger-looking skin by getting rid of many lines and age spots. Some techniques make it possible to "plump" the face to reverse the sunken look that age can cause. These techniques are all nonsurgical and safe.


Fillers are materials that create volume to make up for the tablespoons of facial fat people lose as they age. The filler is injected directly into deep wrinkles to plump them. The materials are effective for many people over age 60, assuming that their skin is reasonably taut. Fillers can decrease facial lines and wrinkles, treat frown lines between the eyes and also plump hollow cheeks and thinning lips.

Although there are a number of fillers, Restylane is one of the most popular along with Perlane (a thicker form of Restylane), which is used for deeper wrinkles. Procedures take about an hour. The results are immediate and last for three to six months, after which the body absorbs the material. The procedure can be a bit uncomfortable, but the only side effects are a few hours of slight puffiness in the area and sometimes small, barely visible lumps that will disappear within a few days to a few weeks. Restylane is an FDAapproved, bioengineered, non-anim al, stabllized hyaluronic acid, a substance almost identical to one naturally found in the body, making it safe to have repeat procedures.

I like to combine Restylane treatments with Botox.** Although many people associate Botox skin injections with the "frozen" look sometimes seen on the faces of film stars, I prefer to use it more judiciously to relax muscles and give the face a de-stressed look.

Note: I do not recommend silicone injections to smooth the skin. Unlike other fillers, silicone has a permanent result, and your face may not age well around it.

Cost: Restylane and Perlane cost about 9750 for the first syringe with some discount for additional syringes used during the same treatment.* Most people need more than one syringe. Botox costs $400 to $600 for a single area of the face treated, also with some discount for each additional area treated.

A patient's own fat is a good filler, as well, because it gives the face an especially soft, natural look. For such fat transfer, the person's own fat is taken from another area of the body, usually the thighs or buttocks. Because this requires a micro liposuction procedure, exceptionally thin people are not candidates. Once the fat is harvested, it is frozen and remains usable for the next three years.

Fat transfer requires several treatments over a few months. Although this procedure hasn't been in use long enough for us to give a definitive time frame for the results, we are finding it to be semi-permanent.

*All costs are approximate and are not covered by insurance.

**Botox has risks. Consult your doctor.

And unlike synthetic fillers, natural fat tends to build up and stay—eventually eliminating the need for more injections. You may experience some bruising and swelling for a week or so after the procedure. There is a slight risk of infection. While this is a more expensive treatment (total cost is around $5,000), it is cost-effective because it is so long lasting.


Peels are available in gentle, medium and strong intensities. All peels chemically remove skin on the face and/or hands, which exposes the under layer-new skin that has been sheltered from the sun and other elements and so looks better. The difference among peels is how deeply they penetrate.

  • Gentle peels affect only the top layer, diminish fine lines and fade age spots. Ideally, you would get gentle peels once a month. Many spas offer them, but technicians there may not have adequate training and use weaker chemicals than dermatologists do. You can resume normal activities immediately afterward.
  • Medium peels go deeper and more effectively remove age spots and fine lines and improve skin color and texture. They require two or three sessions over three to five weeks. You can resume normal activities immediately afterward. Results last about a year.
  • Deep (or strong) peels. The strongest peel—either a phenol or a TCA (trichloroacetic acid) peel—penetrates deep into the skin. It dramatically rids the face of moderately deep lines and age spots in just one treatment. Often, just specific wrinkled or discolored areas of the face are deep-peeled.

This peel is relatively painful because it destroys the upper layer of skin and results in temporary blisters and scabbing. There is some risk of infection, so meticulous post? Procedure care is necessary. People with darker skin are not candidates because these peels lighten the skin and would create too much contrast with the neck. Also, anyone who has taken the drug Accutane in the last year is not a candidate because the skin would be too sensitive for a deep peel. The recovery process takes at least three weeks.

Cost: Gentle peels run from $200 to $400 each...medium peels run from $200 to $1,200, depending on how much of the face is peeled...phenol or TCA peels up to $4,000, also depending on the amount of skin treated.


Laser treatment tones skin and improves texture. Photo rejuvenation uses pulsed light to rid the face and body of age spots and undesirable pigmentation.

Laser therapy also stimulates production of collagen, the natural substance in the skin that helps keep it plump and unlined. This stimulation continues several months after the treatment, giving ever-improving results. These treatments are painless and it takes from one to three treatments to achieve desirable results.

For skin that appears leathery and discolored by sun exposure, a topical photosensitizing solution called Levulan is applied an hour before the light based therapy session begins. Levulan allows the light to go deeper into the skin, thereby enhancing the effect of the treatment. 'We have not found any risks or side effects for laser or photo rejuvenation treatments.

Cost: Laser and photo rejuvenation treatments run from $200 to $1,200 depending on how much skin is treated. Adding Levulan brings the cost to $500 to $1,500.


The most intense form of skin rejuvenation comes from an infrared light machine called the Titan. Skin rests on support collagen that keeps it firm, but this collagen collapses and loses elasticity with age, The heat from the Titan's infrared light contracts and tightens collagen deep in the dermis (the second of the three major layers of the skin) and at the same time stimulates collagen production. The result is an overall tightening of the skin on the face, jawline, arms and/or legs with an effect that lasts from one to three years.

One to three treatments are needed, depending on the patient's age, previous sun exposure and general skin condition. I combine mild photo rejuvenation for the outer layers of skin with the Titan to tighten up the underlayer of skin.

Cost: $2,000 to $3,000 per treatment. There are no currently known risks or side effects for Titan treatments.

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