Celebrity tabloids marvel over the genetic gifts of older actresses – women (and even men) whose appearances seem to have remained virtually unchanged since their twenties. Is it possible your favorite middle-aged actors and actresses have really hit 50 without a single wrinkle?
Probably not. Cosmetic enhancement has long been an open secret in Hollywood. But the days of unnaturally tight facelifts – or even the frozen foreheads of Botox – are gone. Now, a few forthright celebrities are admitting they're using more subtle, less drastic therapies.
Thermage, photofacial, Fraxel – the treatments go by many names, and the lingo can be confusing. But, say experts, these new techniques can produce younger-looking skin without the significant risks or downtime once associated with cosmetic procedures. A wider range of service providers, from medspas to specialty dermatologist offices, also means prices are becoming more affordable.
It's not just celebrities taking advantage. In a 2015 survey from the American Society for Dermatologic Surgery, two-thirds of the more than 7,300 consumer respondents said they were considering ultrasound, laser, light, and radiotherapy treatments for skin tightening or wrinkles, and half said they were considering laser or light treatments for redness or scars.
What do you need to know if you decide to take advantage of these treatments?
First, safety is paramount. Be sure to look for a doctor or medspa with extensive experience. Ask for references or pictures from previous clients (particularly those who share your skin tone), and look for providers who are willing to answer all your questions. Women with darker skin should seek out a practitioner who has experience working with the wide variety of therapies that have proved safe for Fitzpatrick skin types IV through V. You should also be fully informed of pre- and post-procedure care; both will likely involve avoiding retinoids, alpha hydroxy acids, and exfoliants. You'll also need to wear a high SPF, broad-spectrum sunscreen daily for at least two weeks before and after treatment, and it's wise to do so permanently to maintain results. (For other tips on safety and choosing a practitioner, see The Benefits and Risks of Laser Treatments.)
Then, consider what you'd like to have done. Technology is changing rapidly, and the equipment required is expensive. Practitioners – even doctor's offices – are only going to be able to offer you services from machines they own. You may want to get consultations from several providers, then ask about the benefits and drawbacks of the specific therapies they offer, which are likely to fall into several broad categories. To help, here's a rundown of the major options currently available.
Actually a brand name, Fraxel is often a shorthand used for different brands of lasers. All use a "fractionated" technique – meaning only a fraction of the skin is affected by the laser. These microinjuries stimulate collagen and skin rejuvenation throughout the treated area, while cutting down on actual damage and recovery time.
Fractional lasers can be ablative (removing a surface layer of skin) or nonablative (heating below the surface of the skin). Both are effective for smoothing wrinkles, tightening skin, lightening age spots, and removing scars, sun damage, and stretch marks. Ablative lasers are likely to produce more dramatic results, but are increasingly less common because of the longer downtime they require (typically two weeks, followed by a month to even six months of redness) and an increased risk of side effects. Nonablative lasers, on the other hand, produce minimal pain or downtime but require more treatment sessions, and their effects will take a while to see – several weeks to several months – as new collagen is generated beneath the skin.
Fractional lasers are a significant advance, because they're generally considered to be quite safe in experienced hands. They can also produce real results. In one 2014 study of a nonablative fractional laser, 10 women between ages 35 and 53 received two to four facial treatments, two to four weeks apart. After three months, the investigators reported average improvements of 70 percent in hyperpigmentation (dark spots), 80 percent in laxity, and 60 percent in surface roughness.
Other available options work on a similar principle: by causing controlled microwounding beneath the surface of the skin, they generate new collagen and elastin, the building blocks of youthful skin. Intense pulsed light, or IPL, uses a powerful broad-spectrum light to target sunspots, small spider veins, and sun damage. Because it works with a broader spectrum, this machine can be adjusted according to use – it's often used for hair removal, as well as "photofacials" or "photorejuvenation."
Two other methods are being used to heat and remodel the skin: radiofrequency (Thermage and other brands) and ultrasound (Ulthera and other brands). They may be more effective for sagging skin at the chin, neck, and chest, but they may also require greater skill on the part of practitioners to avoid risks like burning or hyperpigmentation – consumer reviews of these procedures are not as consistently positive as those for IPL or fractional laser.
If you're interested in trying any of these options, stay safe: start with the gentlest procedures, such as IPL, at the lowest settings. Ask for a test spot (choose an inconspicuous area on your arm, for example) to gauge how your skin will react to the procedure, then wait a few days before going through with the full treatment to watch for any delayed reaction. And use common sense – don't undergo a major procedure with a doctor or technician you haven't worked with before, and don’t jump at the newest treatments: wait at least a year or two for practitioners to work out the finer points.
January 22, 2016
Christopher Nystuen, MD, MBA