Beyond Botox

New technologies fight wrinkles, fat and more.

Been there, Botoxed that? Think dermafillers like Juvéderm and Restylane are your only weapons in the war on aging?

Think again. Main Line doctors are making the most of the latest technology—ultrasound waves, lasers, radio frequencies—to fight fat, wrinkles and sagging. And it’s not just about nifty gadgets. “Technological advances allow us to perform many procedures without surgery,” explains Dr. Glenn Debias of the Institute for Laser & Aesthetic Medicine in King of Prussia. “Nonsurgical procedures involve fewer risks of complications and reduced downtime for patients.”

While results are different—and often better—with surgery, not every patient needs surgery. “Women and men are starting in their late 30s and 40s, and viewing the procedures as preventative maintenance,” says Dr. Kirk Brandow, of the Brandow Clinic in Bala Cynwyd. “It’s like, ‘What things can I do now to make what happens later not so bad?’”

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While injectables like Botox and dermafillers are part of those options, new technologies have a decided advantage. Their results last longer than injectables. Years longer.

Lasers and radio frequencies (rf) get the body to do what it does naturally: heal itself. The energy emitted by lasers and rf damage the skin, ever so slightly, to spur the body’s automatic healing process. “The skin interprets the energy as an injury, and responds by building collagen to heal it,” explains Dr. Andrew Kwak of the Lumen Laser Center in Bryn Mawr.

It’s called neocollagenesis, a biochemical reaction that doctors control with laser or rf energy. “Different systems allow us to deliver the right amount of energy to the right place, without scarring the skin,” says Debias, who created ActiveFX, a fractional laser system now used around the world.

The new and improved collagen causes the skin to tighten, reducing sagging and wrinkles. “The heat load delivered into the skin causes the collagen fibers to not only grow, but grow in an organized pattern, the way they do in younger skin,” Kwak says.

That reorganized pattern is what makes the new collagen—and its tightening effects—last so long. “The average life span of that collagen will be five years, as opposed to perhaps 18 months with an injectable,” says Debias. “And, really, I wouldn’t want the collagen to last much longer than that. The face—the whole face—has to change with time, or else parts of it will look artificial.”

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In addition to creating new collagen, rf and laser energy can improve the tone and texture of skin. Age spots, redness and dullness can be reduced as new skin is created. Still, downtime is a downside of these technologies. “The moderated, fractionated techniques will give you only three to five days of downtime,” says Kwak. “But we have to do it four to five times to get a cumulative effect. Using the higher frequencies, even fractionated, means a week to 10 days of looking pretty beat up. At the end of the day, with the lasers, you have to tolerate a certain amount of downtime.”

The newest innovation in facial skin tightening comes from ultrasound waves. “It’s called Ulthera, and it’s one of the most exciting new technologies I’ve seen in a while,” says Dr. Victoria Cirillo-Hyland of Cirillo Cosmetic Dermatology Spa in Rosemont. “The ultrasound not only delivers energy, but it also allows me to see where in the skin I want to deliver the energy. Do I want it in the dermis? The fat? The ultrasound will allow me to be more precise. Right now, it’s FDA approved only for brow lifts, but soon, it will be used to tighten the skin on the rest of the face and neck.”

Liposuction isn’t new, but there is a new way to perform it. It used to be that liposuction tubes used in the procedure were wide and thick, causing collateral trauma to the tissue surrounding the fat. That’s why there was so much post-operative swelling and bruising. Now, there’s liposuction 2.0, which uses ultrasound waves in systems like VaserShape, SmartLipo and others.

It’s called ultrasonic liposuction. The ultrasound waves break down the fat cells, which makes them easier to remove from the body. “That has several advantages,” says Dr. Emily Pollard, who practices in Bala Cynwyd. “I think ultrasonic lipo causes less trauma to surrounding tissue, which results in less bruising and swelling. Also, I have more control over it, and that’s always a good thing, especially if I am harvesting the fat.”

Harvesting fat? Yep. Pollard reports that demand is rising for what is medically known as fat grafting. Basically, doctors take it from one part of the body, where it isn’t wanted, and put it into a patient’s face, where it is wanted. Who wants fat in their face?

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“People looking to plump deep wrinkles—like nasolabial folds—and fight sagging skin by building up cheekbones, chins and jawlines,” Pollard says. “I’ve even put it on foreheads to fight tissue loss there.”

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Fat, it turns out, is the ultimate filler. For starters, it’s hard to get rid of. Unlike injectable dermafillers, which last for a maximum of 18 months, fat fillers will last for a maximum of 10 years. “Through the decades, it will degrade as the body ages, and the effect will change,” Pollard explains. “But once the fat survives the transfer, it’s there for good.”

Why isn’t everyone doing this? Because the procedure is surgical and requires healing time. There’s also a risk of infection, and research is still being done to determine the best places from which to take the fat. The goal is to have as much fat survive the procedure as possible.

Fat grafts aren’t new. But they are being performed more effectively with the help of ultrasound waves. “Ultrasonic liposuction doesn’t damage the fat cells as much, so I get a better result when I transfer the fat, and more of it survives,” Pollard says.

Two new technologies have just been introduced in what may be liposuction 3.0. Approved by the FDA in March 2010, Zerona is the first laser liposuction system. It uses laser energy to collapse fat cells.

“The fat cell develops a hole—a pore—and the oil seeps out,” Kwak says. “That oil circulates through the body and breaks down. We get a 3 1/2- to 5-inch reduction from the waist, hips and thighs.”

The other new fat-blasting system is Cryolipolysis. It’s exactly what it sounds like: freezing fat. Cleared by the FDA in September 2010, Zeltiq’s Cool Sculpting system freezes the fat cells, turning them into microcrystals that the body decomposes and eliminates. That process takes three to six months to produce results. And the procedure itself is time consuming, requiring several hours and some discomfort.

“The next generation of the Zeltiq system will probably have handpieces that we can use to work on different parts of the body, and that will likely speed up the procedure time,” says Cirillo-Hyland. “I’m going to wait to see what the extended results are before we bring that into our practice.”

Many doctors exhibit the same caution in embracing new cosmetic technologies. “New is not always better,” says Pollard. “Sometimes, it takes five to 10 years to find out what long-term problems exist.”

In fact, one doctor says that, when it comes to cosmetic procedures, technology can, in some ways, be harmful.

One technology that’s endangering patients (and everyone has it) is the Internet. “Just because you read about something on the Internet that promises great results doesn’t mean that the procedure is safe,” says Dr. Kirk Brandow. “The more dramatic the results claim to be, the more skeptical a patient should be.”

Brandow also voices concerns about the new forms of liposuction. He only performs liposuction surgically because lasers and ultrasound can create scar tissue and lumps that are visible on or through the skin—and they’re almost impossible to remove.

But there are technological advances that Brandow likes. He’s seen prototypes of an external ultrasound machine that may just be liposuction 4.0. It would function like a CAT scan, mapping fat deposits. “The machine emits ultrasound waves to create a grid of the fat, so we can see exactly where it is and its density,” he says. “That way, we would know exactly where to go and what needs to be done to remove the fat.”

Brandow is also fascinated by the potential use of stem cells for the regeneration of organs like the skin and possibly breast tissue. “And, personally, I would love a new technology that would make it possible to grow hair on the scalp,” he says.

5 Questions to Ask Before Laser Surgery

1. Will the doctor or a nurse be administering the treatments?
Many nurses are trained to work with lasers, but having the doctor perform the procedure is best. Ask if there is an appointment time that would allow the doctor to do the laser work.

2. What are the potential side effects? Temporary redness will result from the lasers, but inquire about atypical reactions that may require medical attention.

3. Has the laser been approved for your skin type? Race and age are important factors in determining if lasers will be safe and effective. Also, be sure to tell the doctor what medications you take.

4. Can you get a patch test to see how your skin reacts? Better to have a small area of skin be irritated than your entire face.

5. What kind of aftercare is needed? Some doctors insist on specific salves and serums, and they can be costly. Also, downtime differs depending on the type of laser and the procedure performed.

Source: American Society for Laser Medicine and Surgery

If Money Wasn’t an Issue, What Procedure Would You Get?

Teeth whitening:
Hair removal: 27%
Cellulite treatment: 14%
Injectable dermafiller: 12%
Micro-dermabrasion: 10%
Hair replacement: 9%
Botox: 7%

2010 poll by Harris Interactive for

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