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Bypassing the knife in cosmetic treatments

If you think cosmetic procedures generally involve a knife, think again.

Eighty-three percent of all cosmetic procedures performed in the offices of cosmetic plastic surgeons in 2010 were nonsurgical, according to the American Society for Aesthetic Plastic Surgery.

Almost 8 million nonsurgical cosmetic procedures were performed last year at a cost of $4.1 billion.

"There's a huge demand for nonsurgical procedures," said Dr. Jeffrey Kenkel, a cosmetic plastic surgeon in Dallas.

The reasons are simple, said Kenkel, who is president of the plastic surgery society. "Some patients only want a little bit of change," he said. Others "just aren't interested in a surgical option." They're seeking procedures that are less expensive, less painful and less disruptive than, say, a facelift, which costs an average of $6,600 and takes weeks of recovery time.

In the last year alone, the Food and Drug Administration has approved two new devices, Zerona and Zeltiq, for the nonsurgical removal of fat. The latter is quickly gaining favor as a surgery-free alternative to liposuction.

Zeltiq is a device that vacuum-attaches to the body and delivers precise and controlled cooling through the skin to target subcutaneous fat deposits. The one-hour treatment is designed to freeze and kill fat cells without damage to the skin or internal organs. If the treatment is successful, over the course of several weeks, the fat cells are broken down and processed by the liver, and ultimately expelled as excrement.

"The ideal candidate is somebody who's in reasonably good shape, somebody who has some love handles or a post-pregnancy pouch or back fat that doesn't want to disappear," said Dr. Dieter Manstein, co-inventor of Zeltiq with Dr. Rox Anderson. Both of them work with the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston, a teaching affiliate of the Harvard Medical School.

The number of FDA-approved skin-tightening devices, in particular, has dramatically increased in recent years, including products such as Exilis and Pearl.

The Exilis device uses radio frequency waves in an attempt to stimulate and strengthen collagen (and to reduce fat). About 100 Exilis devices are in use in the United States.

But Kenkel says some of the devices can be unpredictable. "That's the frustration many clinicians like myself have. It's great to have a device that tightens skin, but can it do so (again and again)? Can it tighten skin or remove fat consistently and reliably?"

Many cosmetic plastic surgeons test devices on themselves or offer new procedures to their patients for free or at a reduced cost.

Kathy Weatherwax, a 48-year-old mother of four, wanted her skin "to look brighter and younger and fresher," without surgery. "I wanted maximum results with minimum downtime because I have two little ones," she said. "I want to save surgery for when I really need it, when I'm 70 or something," said Weatherwax, who paid $1,500 for an ultrasound face tightening treatment and was comped the CO2 fractionated laser therapy by her doctor.

Weatherwax was hoping to reduce the ever-deepening groove in her forehead and the sun damage on her lower face from when she worked as a lifeguard as a teenager and used her breaks to lie in the sun and deepen her tan.

Presented with a menu of options including microdermabrasion, fillers and a brow lift, Weatherwax chose ultrasound therapy to lift and smooth her brow, and a fractionated laser to deal with the sun damage.

Weatherwax says she got the results she wanted.

"I think I could pass for 40," she said.


Here is a sampling of some FDA-approved devices and cosmetic procedures that are associated with them.


What it is: A device that contains a freezing unit that is used to freeze and kill fat cells without damage to the skin or internal organs. The procedure is known as CoolSculpting.

FDA-approved: 2010

Length of treatment: One hour

Downtime: None

Cost: $700 to $1,500 per treatment


What it is: A device that uses radio frequency waves to stimulate and strengthen the skin's collagen. The goal: tighten skin, shape body contours and smooth wrinkles.

FDA-approved: 2009

Length of treatment: About 20 minutes

Downtime: None, though redness and swelling may last a few hours after treatment

Cost: $400 to $600 per treatment


What it is: A laser used to target the red in blood vessels, heating them to the point of collapse and disappearance

FDA-approved: 2010

Length of treatment: 15 minutes

Downtime: None

Cost: $1,000 or less


What it is: A laser used to treat a portion of the skin without affecting surrounding tissues. Stimulates collagen production, diminishes fine lines and age spots and resurfaces skin.

FDA-approved: 2004

Length of treatment: 80 minutes (60 minutes to numb the skin, 20 to 30 minutes for laser treatment)

Downtime: Two or three days

Cost: $750 to $1,000 per treatment


What it is: A laser used to resurface and tighten skin and reduce wrinkles and sun spots

FDA-approved: 2007

Length of treatment: 45 minutes

Downtime: Five days

Cost: $2,500 to $4,000


What it is: A radio frequency device designed to smooth the skin and soften wrinkles. It heats the deepest layers of skin to help tighten existing collagen and stimulate collagen renewal.

FDA-approved: 2002

Length of treatment: 20 minutes to two hours, depending on location of treatment

Downtime: None

Cost: $1,000 to $5,000


What it is: A low-level laser scanner used to emulsify and remove fat nonsurgically

FDA-approved: 2010

Length of treatment: 40 minutes

Downtime: None

Cost: $1,700 to $2,500 for six sessions

Bypassing the knife in cosmetic treatments 09/23/11 [Last modified: Friday, September 23, 2011 4:31am]
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