Keeping Up Appearance

Keeping Up

Appearances

Hudson Valley doctors are performing many new, noninvasive cosmetic
procedures that are less time-consuming — and less expensive — than traditional plastic surgery. Welcome to the non-cutting edge.  By A. J. Loftin

“Beauty is as beauty does” was never so true. That’s because an entire nation is “doing” the plastic surgery thing.

In her new book, Beauty Junkies: Inside our $15 Billion Obsession with Cosmetic Surgery, Alex Kuczynski, a New York Times style reporter, describes spending some $8,000 on cosmetic treatments in just over a year. But after a series of, um, small misfortunes (culminating in a swelled lip the size of “a large yam”), she ultimately swore off beautification.

“I am not worried [anymore] about aging per se,” Kuczynski concluded. “What I do worry about is… getting that tired look that marks the faces of people who haven’t done what they want to do with their lives.” Apparently Kuczynski is still too young to realize that people who’ve done precisely what they want in life get that tired look, too. It’s called aging. And until the red wine pill comes along, Americans are going to fight it with every means possible.

But in the latest trend, many people are now refusing to go under the knife and are instead turning toward a new crop of less invasive — and less expensive — cosmetic treatments. From banishing wrinkles with Botox to freshening your face with a thread lift, these treatments are safer, less painful, and can often be done in the time it takes to scarf down your lunch. And you don’t even need to spring for a Metro-North ticket: increasingly, these procedures are being done here in the Valley.

According to the American Society of Plastic Surgeons, about 8.4 million minimally invasive cosmetic procedures were performed in the U.S. in 2005, up 53 percent from 2000. By comparison, only 1.8 million surgical cosmetic procedures took place.

Christine Dziegelewski, 39, a New Windsor resident, uses Botox as “a preventative” to ward off the aging process. “I had a lot of lines on my face from driving around in a convertible. But Dr. Feldman [Howard L. Feldman, M.D., an oculoplastic surgeon in New Windsor] has been working on me for five years, and now I don’t have a line on my face. And I’ve been able to go longer and longer between injections.” Asked if her husband notices any difference, she laughs. “He doesn’t notice. I just look less tired. He might say, ‘Wow, you must have had a good night’s sleep. You look refreshed.’ ”

Until recently, Dziegelewski owned a day spa franchise in New Windsor. She brought in Dr. Feldman to treat her customers with Botox, Restylane, and laser resurfacing. “Botox was a big seller for men,” she said. “Interestingly, it was the husbands of wives who’d already done it.” In fact, the doctors interviewed for this article estimate that men comprise 20 percent of their clientele.

The new minimally invasive cosmetic treatments come with a dizzying number of names and glossy pamphlets, with ever more on the horizon. (Among the latest injectable treatments approved by the FDA: Captique, a soft tissue filler; Hylaform Plus, derived from a naturally occurring sugar molecule in the body; and Sculptra, first used to treat HIV patients suffering from facial wasting.) But most treatments can be broken into four categories: fillers, resurfacers, muscle relaxants (like Botox), and minimally invasive surgical procedures (like micro liposuction and thread lifts).

Fillers are used — you guessed it — to fill in wrinkles and plump up sagging skin and lips. Doctors can use collagen or the now-unpopular silicone, although the soft filler of the moment is Restylane. Proponents say this substance, made from one of the skin’s natural components, provides more volume than collagen with fewer allergic reactions.

Rose, a 52-year-old Orange County resident, has been happily getting both Botox and Restylane injections for the past 16 months. She said she considered surgery, but “couldn’t afford the money or the time. My job is 60 hours a week.” She went to Dr. Ran Y. Rubinstein, a facial plastic surgeon in Newburgh. “He’s helped me tremendously,” she said. “The stuff is great.” After doing the basics, she opted for some extra filling in her upper lip, and doesn’t regret it. “If I had more money, I’d have more done.”

Resurfacers, including chemical peels and a wide variety of laser procedures, improve the skin’s appearance. The popular new Thermage treatment uses radio frequencies to penetrate the skin’s surface and stimulate the production of new collagen. “It’s an incredibly safe, low-risk procedure,” says Dr. Rubinstein, who has been using this “nonsurgical face-lift” since 2003. An added bonus, he says, is that “there is no downtime” following the treatment.

Then there’s Botox, the infamous muscle paralyzer, which was approved by the FDA to treat wrinkles in 2002. (It will soon be joined by a competitor, Reloxin.) Hudson Valley cosmetic surgeons says Botox remains by far the most popular noninvasive intervention. That mirrors the substance’s popularity nationwide: approximately eight million people in the U.S. tried Botox in 2004. Allergen, the manufacturer, estimates sales of $840 million this year. (Now there’s a growth stock!)

Minimally invasive surgery is also drawing more takers. Thread lifts — in which special threads are inserted under the skin and pulled to stretch the tissue for a more youthful look — have been around for nearly a decade. But improvements in the procedure (sutures no longer accidentally rise to the surface) make it an even more attractive option and one that can now last up to seven years. “You get a nice result for patients in their mid-40s and 50s,” says Dr. Manoj T. Abraham, a facial plastic surgeon in Poughkeepsie. “And the procedure only takes a half-hour, or an hour at most.”

What’s the downside? In general, the results from these new lunchtime treatments don’t last nearly as long as those from traditional plastic surgery. Still, it seems that many Valley residents don’t care, perhaps because of the reduced price tag. Compare the cost of a full neck-and-face surgical lift with that of a full-face Thermage treatment: Dr. Abraham estimates a “blue-plate special” surgery, including anesthesia and facility fees, would cost $25,000 here (more in New York City or California). Full-face Thermage, on the other hand, is about $6,000, with Botox injections costing an average of $375.

Another bonus: many plastic surgeons say that if these noninvasive procedures are started at the right age, they may obviate the need for plastic surgery at all. Most agree that the optimal age for noninvasive treatments is before 50. After that, skin is less supple, lines are deeper, and results are less impressive.

Dr. Rubinstein, who offers a package deal to lift all three face zones with a special composite thread lift, tells his patients, “It’s a 50 percent tradeoff from a surgical face-lift. You get 50 percent of the results, but you spend 50 percent less time in recovery, for 50 percent of the price.”

“People in California start with these procedures very, very early,” says Dr. Abraham. “When you look at those patients 10 to 15 years later, they don’t have the same degree of aging. Here, people wait. But then when they finally come in, they need major work, because they haven’t kept up.”

Buyer Beware

Perhaps fear has also played a part in turning people away from surgery and toward less invasive procedures. When The First Wives Club author Olivia Goldsmith died after a routine chin tuck in 2004, surgery aficionados took note. Now plastic surgeons are warning patients of another danger: a rash of unqualified doctors (and non-M.D. aestheticians) performing these minimally invasive procedures. Dermatologist Henrick Uyttendaele of Hudson Dermatology in Dutchess County has heard of psychiatrists injecting Botox on the side and beauty salon technicians performing facial procedures in shopping malls. “People think it’s a one-two-three thing, but it’s not. You need a good understanding of facial anatomy,” he says. “You have to be able to deal with complications. You don’t want to inject something into an artery.”

Of course, the danger is exacerbated by the fact that treatment-seekers no longer need go to doctors’ offices. Medi-spas, a staple of life in New York City and Westchester, have begun showing in the Hudson Valley. (See sidebar.) In theory, doctors train and supervise non-M.D. technicians, or administer the procedures themselves; but in reality, it depends on the place and the treatment. New Jersey law prevents aestheticians from doing any medical procedures; in California and Connecticut, a doctor must be present when these procedures are performed. But here in New York no such legislation in on the books, which means buyer beware. “Spas set up by M.D.s, that’s fine. But other places claim to be medical, and they aren’t,” says Dr. Feldman. “Their people aren’t trained.” Photo-facials, also known as Intense Pulse Light (IPL) treatments, for example, “should never be given without proper training,” he said. “You can easily burn someone.”

So what should you do? First, check New York State’s database of disciplinary actions taken against doctors (www. health.state.ny.us/nysdoh/opmc/main.htm).

“The key is to be an informed consumer,” says Dr. Abraham. “We joke that patients are willing to do more research when they’re buying a new car than when they’re buying a new face. Get a second opinion. Ask for before- and-after photos. Talk to people who’ve had the procedures done. Do your due diligence. These are medical procedures.”

Drive-Through Beauty

Botox

Purpose: Smooths wrinkles, frown lines

Average cost per injection: $388

Possible side effects: Bruising, numbness, droopy eyelids

Duration of results: A few months

Restylane

Purpose: Adds volume to face, lips

Average cost per injection: $440

Possible side effects: Redness, swelling, allergic reaction (rare)

Duration of results: Up to one year

Dermabrasion

Purpose: Softens surface irregularities,  such as pockmarks, scars, and fine wrinkles

Average cost per treatment: $136

Possible side effects: Temporary tingling, burning, itching, swelling, redness. Acute sensitivity to sun

Duration of results: Permanent, although new wrinkles may form as skin ages

Thermage

Purpose: Treats wrinkles, tightens and lifts skin

Average cost per treatment: $2,000

Possible side effects: Temporary swelling, redness, bumps and blisters on or around the treated area

Duration of results: Up to two years

Thread Lift

Purpose: Stretches and lifts loose skin

Average cost: $2,469

Possible side effects: Infection (rare), scar tissue formation, temporary lack of sensitivity in treated area

Duration of results: Three to 10 years

Haven