Cosmetic procedures for boomers
By Betsy C. McElfresh CONTRIBUTING WRITER

Page Dowdy/Chesterfield Observer Dr. Nadia Blanchet consults with a client regarding ways to look younger.

We can't defy gravity. As we age, it seems every part of the body heads south. With the economy struggling, too, some people are opting for less expensive, quick and easy cosmetic procedures to fight the telltale signs of aging. Local cosmetic surgery practitioners claim business is booming for baby boomers.

The cornerstones of rejuvenation are surgery, Botox® and injectable dermal fillers for the skin's foundation and chemical peels and lasers to treat the skin's surface, denotes dermatologist Dr. Jo Bohannon-Grant.

Injectables

Botox is the No. 1 cosmetic procedure in the U.S. with 4.6 million treatments performed in 2007, according to the American Society of Plastic Surgeons. Two of the three largest providers of Botox in Richmond are located in Chesterfield County: Bohannon-Grant and oral and maxillofacial surgeon, Dr. Joe Niamtu.

Each ordered more than 500 vials of Botox last year. Both also train other practitioners internationally on their techniques for using Botox and injectable fillers. Botox is used for the wrinkles or lines caused by muscle contractions from facial expressions.

"By putting Botox in the appropriate muscles of the upper face, it smoothes frown lines, softens crow's feet and lifts a fallen brow, producing a youthful, open-eyed appearance. When targeting muscles in the lower face, it can raise the corners of the mouth and soften a pointy, witch's chin," says Bohannon-Grant.

Second to Botox are injectable fillers, used to plump up facial tissue and fill in deep wrinkles and smile lines. The revolution in injectable fillers has been the introduction of hyaluronic acid used in products such as Restylane®, Perlane® and Juvéderm™, states Dr. Nadia Blanchet, a board-certified plastic surgeon.

"These fillers can last more than a year in some patients and be dissolved if the patient dislikes them," says Blanchet. "For years, all we had was collagen. It was white and thick, so it could show. It only lasted three months and was not reversible."

"Fillers are safe because they are composed of sugar molecules, which the body does not react to," relates Bohannon-Grant.

"Each year, new fillers come out that are less allergenic and last longer," notes Niamtu.

As someone ages, the cheeks tend to flatten and indent. Fillers are designed to contour the face by bringing the "apples" of the cheeks back out or filling in the hollows under the eyes or eyebrows and fixing the downward corners of the mouth. Women tend to focus on their nasolabial folds or the "parentheses" that line the corners of the nose to the mouth, which are caused by the flattening of the face, Bohannon-Grant describes.

Facial aging is also noticeable at the chin and jaw line. Products such as Radiesse® are useful for contouring and giving this area a firmer look. They can also be injected into the hands to make them appear less bony.

Skin resurfacing

The next most popular procedures are skin resurfacing techniques such as chemical peels and laser treatments. The concept is the same - to remove layers of skin and enhance collagen production by using your body's healing process - but the methods differ.

Not all chemical peels are created equal, cautions Blanchet. Chemical peels vary from superficial to deep, based on the type of solution used.

Peels are popular at the end of the summer for people who have had a lot of sun.

"Everything from milder lunch-time peels to more aggressive ones help to peel off the surface freckling of the skin and give a brighter complexion," explains Bohannon-Grant.

The deepest peel is comparable to laser resurfacing, a procedure that requires sedation for pain control. The deeper the peel, the longer the effect - and the recovery time - which is often several weeks. The lightest peel allows patients to go back to work the next day, notes Blanchet.

The same goes for aggressive lasers such as those using carbon dioxide. These lasers essentially burn the outer layers of skin, producing a more dramatic result for wrinkle removal, but have a recovery time of about two weeks. They are also best for lighter skin.

"Lasers are not good for darker skin," Niamtu advises. "They cause more reactions."

"You have to be extra gentle with darker skin or else it loses its color or turns darker," Bohannon-Grant relates.

Darker skin is best treated by using higher strength facial creams or very light peels that do the job slower, but safer.

Intense Pulsed Light (IPL) is not considered a laser, but a powerful light source that penetrates the skin with minimal skin damage. They are popular for removing unwanted hair, spider veins, sun or age spots, birthmarks or other pigmentation problems. There is virtually no down time for patients, although most IPL treatments have to be repeated three to five times, and results can vary from average to excellent.

Many new lasers are marketed to doctors each year.

"Just because it is a new technology, doesn't mean it is better," Bohannon-Grant says. "People have to do their homework and not be swayed because they saw it on a television show."

Skin-care products

Physician-grade skin-care products such as Retin-A® and hydroquinone have science behind them showing that they can decrease fine lines, wrinkles and dark spots and reverse the slowing of collagen production, explains Niamtu.

Cosmeceuticals are products that are not FDA-regulated, yet have biological activity on the skin to change its form and function, defines Bohannon-Grant.

"My work centers around prescribing an appropriate facial regimen for patients," she adds. "It doesn't have to be expensive, just effective. All you really need is a good sunscreen, antioxidant and retinoid product."

Retinoids include Retin-A and Renova®. Prevage® MD is currently the most potent antioxidant on the market. These are available only by prescription.

People who can't tolerate retinoids can use retinols, a gentler formulation commonly found in over-the-counter skin-care products, explains Bohannon-Grant. For those who cannot afford prescription-strength products, she recommends drugstore lines, such as Neutrogena®, RoC® or Oil of Olay®.

Choosing the right treatment and practitioner

Competition is stiff. While traditionally the domain of plastic surgeons, cosmetic procedures are now intermixed with many other specialties, including oral and maxillofacial surgeons, dermatologists, ear, nose and throat specialists, opthalmologists, gynecologists, family practitioners and nurses.

Along with the increase in other businesses doing cosmetic procedures, Niamtu has heard of more complications and unhappy people. He suggests that whoever people choose, make sure they have expertise in that area and can handle complications.

Choosing the right treatment depends on the extent of sun damage, skin color and how much recovery time a patient is willing to take.

Many of Bohannon-Grant's Botox patients either do not want to take the surgical risk of a face-lift or cannot afford it. Others simply don't need surgery. Many people show early signs of aging - the frown look, crow's feet or fat loss in the cheeks.

"Women want immediate, affordable, reproducible, safer results," believes Bohannon Grant.

"Botox and fillers take 10 or 15 years off a woman's face by simply returning what nature is starting to take away," she adds.

Most practitioners use the same pricing structure for aesthetic services - the more treatments you do, the cheaper it is.

Cosmetic procedures - once reserved for the wealthy and considered hush-hush - cross all barriers.

"There is something for everyone," says Niamtu. Although 95 percent of Niamtu's patients are women, he claims that men and minorities are the fastest-growing cosmetic populations.

According to Niamtu, the old saying regarding whether a woman colors her hair - "Does she or doesn't she - only her hairdresser knows" - no longer applies to hair color or cosmetic procedures.