1. Frown Lines
Botox is the go-to for smoothing frown lines between the eyebrows. “It removes unpleasant facial expressions but still allows you to communicate happiness, joy and amazement,” says Dr. R. Brannon Claytor of Claytor/Noone Plastic Surgery Institute. Dr. Victoria Cirillo-Hyland gets Botox requests from patients as young as 35. “Not only is it safe, but using it over a long period of time relaxes those muscles to the extent that they almost atrophy,” she says. “Then I don’t need to inject as much, and what I do inject lasts longer. It’s a win-win.”
Nonsurgical rhinoplasty is the newest remedy for nasal bumps. By using fillers like Juvéderm, Pinnacle ENT specialist Dr. Satyen Undavia adds volume to correct asymmetry. The procedure is also effective for the low bridges common in those of Indian, Latino and African descent. “When done correctly, patients can avoid surgery and the recovery time that comes with it,” Undavia says.
Pretty up your pout with fillers. Restylane Silk and Juvéderm Ultra add youthful-looking volume. (Note: Silk and Ultra are different from regular Restylane and Juvéderm.) Longer-lasting augmentation can be done via fat grafting, with tissue harvested from the stomach or thighs. Between 50 and 70 percent of the grafted fat remains where it’s placed, says Dr. Christian Subbio. The body reabsorbs the rest.
Bryn Mawr Dermatology’s Dr. Christine Stanko uses Radiesse to augment flat or depressed chins. “Some people’s profiles have the nose and lips more forward than the chin,” she says. “The entire face looks more balanced with augmentation, and Radiesse is a great, nonsurgical way to achieve that, with almost no recovery time.”
5. Under the Eyes
Dr. Ryan Hoffman of the Main Line Institute of Plastic Surgery lightens and tightens under-eye bags with radiofrequency, which heats the layers of skin, causing them to contract. Undavia uses Restylane and Juvéderm fillers to treat tear troughs and dark under-eye circles. He injects the fillers via a blunt cannula, an applicator that causes less bruising, swelling and pain than the sharp needle that’s commonly used.
To enhance the midface, Stanko uses a trio of fillers: Radiesse, Voluma and Restylane Lyft. (Note: Restylane Lyft is different from regular Restylane.) “Radiesse is the thickest, so I use it [on] cheekbones,” she says. “Voluma and Lyft are gel-based, and I use them to restore volume to cheeks’ soft tissue. What I use depends on the patient, but the overall effect is lovely and youthful.” The fillers last anywhere from six to 15 months, says Subbio.
The CO2 laser is the gold standard for tightening skin on the face, jowl line and neck, but it does entail a week of recovery, Stanko says. Microneedling is another option, and though it requires only a few days of downtime, it isn’t as strong as the CO2 laser, so more treatments may be needed. Dr. Sean Wright injects a note of caution about these procedures. “Granted, I’m a surgeon, but I think that surgery is often the best option for a lot of patients who want to tighten their faces and necks,” he says. “If you have to squint at the before-and-after procedures to see a difference, then be skeptical about the procedure’s efficacy.”
8. Double Chin
Kybella is among the newest treatments to hit the Main Line. An injectable that dissolves fat right under the chin, it became available in August. Cirillo-Hyland and Main Line Center for Laser Surgery’s Dr. Jason Bloom are using it, as is Dr. Franziska Ringpfeil. “It’s advised for use only on patients who have small to moderate amounts of fat under their chins, and it’s not safe for use on the sides of the neck,” says Ringpfeil. Ten days of redness and swelling follow the injections, but Cirillo-Hyland contends that the results are dramatic enough to make the procedure worthwhile.
Bloom uses ThermiTight’s radiofrequency to tighten the neck muscle and skin, while Hoffman opts for Reaction by Viora. Ringpfeil uses Infini, a new machine that delivers fractionated radiofrequency into the dermis via microneedles and a stamping technique. “It sounds bad, but it works beautifully,” she says. “For years, the challenge has been to deliver enough heat to achieve tightening without damaging the skin. Infini does it more perfectly than any device I’ve seen.” Infini can be used everywhere on the face, except for eyelids. Several treatments may be required, and recovery time is a week.
10. Dark Spots
The CO2 laser treats skin damage caused by aging and sun exposure. Another laser option is intense pulsed light. IPL removes the top layers of darkly pigmented skin, like those dreaded age spots. Dr. Larry Jonas also uses it to treat rosacea, skin blotches and broken capillaries. Some should proceed with caution, however. “Using lasers on darker skin can lead to hyperpigmentation or depigmentation in certain areas, and that is not the desired outcome,” says Wright. “That goes for Indian, Latino and African-American skin. You can do it, but you have to be cautious.”
11. Skin Tone, Fine Lines, Acne Control
Peels treat a wide range of dermatologic issues. “On the light end of the spectrum, we have a lunchtime peel that’s great for maintenance and has no downtime,” Stanko says. Stronger peels can be effective in decreasing fine lines, like creping around the eyes, says Jonas. Either way, aftercare is critical. “The big things are to keep the skin moist and use sunscreen and sunglasses every day,” says Wright. “If my patients stayed out of the sun altogether, I’d be a happy doctor.”