January W. Payne

Injections of the now familiar Botox or of Dyspor -- which also contains botulism toxin -- can paralyze tiny facial muscles, smoothing out the appearance of lines or wrinkles

No one likes looking older ... which is why we spend billions of dollars every year on over-the-counter products, prescription creams and fillers, and, most drastically, cosmetic surgery. Do any of these actually work to reduce the signs of aging? In many cases, yes -- at least temporarily. But given the not-inconsiderable costs (and in the case of surgery and some procedures, the risks), it's important to be smart in your choices.

How to find a doctor? Dermatologists can prescribe skin creams and perform laser skin-resurfacing and chemical peels, and they can administer injections. Surgical procedures, meantime, can be performed by cosmetic and plastic surgeons, and some ear, nose, and throat doctors (otolaryngologists).

A good first step is to make sure that the doctor is board-certified by the appropriate organization (the American Board of Cosmetic Surgery, the American Board of Plastic Surgery, and American Board of Otolaryngology, for instance). Check with your state medical board to see if the doctor has complaints on file.

When you pick a doctor, ask how often and how frequently he or she performs the procedure that you're having (weekly is better than monthly). If the doc works from an outpatient surgical center, ask whether he or she has hospital privileges should any problems arise during your surgery.

Here's a quick guide to some of the most popular treatments and procedures:

1. Retinoid creams

A host of over-the-counter products claim to help fight wrinkles. One option: topical retinoid (derived from vitamin A) creams; look for retinol in the ingredient list. "They're the only thing that's been proven to get rid of wrinkles that you already have," says Leslie Baumann, a Miami Beach, Florida dermatologist in private practice and the author of "The Skin Type Solution: A Revolutionary Guide to Your Best Skin Ever." You can buy an OTC retinoid for under $20. Dermatologists can prescribe stronger retinoid creams -- like Retin-A -- than what you'll find on store shelves.

2. Over-the-counter peptide creams

Creams containing peptides -- short snippets of linked amino acids -- can be useful for reducing the appearance of wrinkles and fine lines, but they haven't been shown to work as well as retinoids. As skin ages, it loses collagen and becomes wrinkled and thin; creams containing peptides are supposed to encourage the skin to make new collagen. Peptides are found in a variety of products, from the inexpensive to the very expensive, but you don't have to ante up to get their benefit, advises Jeffrey Benabio, a dermatologist who writes The Dermatology Blog; he says Oil of Olay Regenerist (which costs less than $20) is as good as the pricey stuff.

3. Microdermabrasion

Microdermabrasion uses tiny, fine particles or a very hard diamond-tipped wand to slough off cells from the top layer of the skin and encourage new skin growth. The procedure is usually not painful, though it can be uncomfortable, and it doesn't require an anesthetic or recovery period; skin heals quickly. But you may require multiple procedures spaced a few weeks apart.

It also might be a good idea to discuss which technique your doctor plans to use, as a study published in October in Archives of Dermatology found that a rougher buffing of the skin is better than a lighter touch. The average cost of microdermabrasion was $164 in 2008, according to the American Academy of Cosmetic Surgery. The effects can last between three and five days; then you'll need another treatment.

"It just removes the top dead cells that regenerate quickly," Baumann says. Because the benefits persist only briefly, some people may not find it worthwhile, she says.

4. Laser skin resurfacing

Laser resurfacing uses high-intensity light to zap and improve the look of wrinkles and scars by tightening loose skin. The effect of your treatment and recovery time vary.

"We have lasers that can be superficial or intermediate and deep," says Bahnan Guyuron, chairman of the department of plastic surgery at Case Western Reserve University (Cleveland, Ohio), who has been researching cosmetic treatments for about 30 years. You may see redness from one day to two weeks, depending on how aggressive the treatment is, he says.

The average cost of laser resurfacing was $2,669 in 2008, according to the AACS. The benefits of laser resurfacing usually last between two and five years; if you smoke or don't use sunscreen, it's likely to be on the shorter end of that spectrum, says Baumann.

5. Chemical peels

Used to address mild acne scars, age spots, dull skin texture, skin discoloration, or wrinkles around the eyes or mouth, chemical peels remove the outer layers of the skin and encourage the growth of new, smoother, more evenly colored skin.

Depending on the peel's intensity -- which can range from superficial to medium to deep -- it may cause reddening and peeling that can last up to several weeks. The average cost for chemical peels was $672 in 2008, according to the AACS. The benefits of superficial peels last about a month, while deep peels have results that can last several years.

6. Botox or Dysport

Injections of the now familiar Botox or of Dysport -- which also contains botulism toxin -- can paralyze tiny facial muscles, smoothing out the appearance of lines or wrinkles. The cost of Botox will vary depending on location and doctor, but it averages about $400. The effects of injections may last three to six months, depending on whether you're a repeat customer. (The more injections you've previously had, the longer the results last, Guyuron says.)

7. Filler injections

Injections of fillers containing hyaluronic acid can fill in lines and wrinkles and add volume to skin. Hyaluronic acid is a "naturally occurring sugar that gets lost when you age," and injecting it into wrinkles effectively plumps them up, says Baumann. The average cost of hyaluronic acid treatment was $589 in 2008, according to the AACS, and the effects generally last between six months and a year.

8. Cosmetic surgery

Lifting the skin on the face, neck, eyelids, and forehead can give a tighter appearance. What were once traditionally open procedures -- with larger incisions -- can now often be done endoscopically, with smaller incisions strategically placed in difficult-to-detect areas, such as under the hairline. The procedures can run a few thousand dollars; face-lifts were the most expensive cosmetic procedure in 2008, with an average cost of $7,007, according to the AACS. The effects of cosmetic surgery are somewhat permanent.

"Let's say a person looks 10 years younger" as a result of having surgery, Guyuron says. "That person is going to look 10 years younger for the rest of their life. What we're doing is we're turning the clock back, but we're not stopping the clock."

9. Try prevention

If all this sounds extreme (and expensive), remember that you can start immediately to prevent any further damage: Start wearing sunscreen every day. Lifetime exposure to the sun can wreak serious havoc, says Angelo Cuzalina, president-elect of the AACS.

"When (people) were younger ... they didn't think (the sun) caused any bad signs. Now they're really feeling the effects of it 30 years later." And none of these treatments or procedures are a substitute for healthful eating and regular physical activity. Some doctors, Cuzalina included, will not perform surgery on patients who are so overweight that it might jeopardize post-surgical results.

When Cuzalina sees patients who have a body mass index above 30 (that is, obese), for example, he usually refers them to a weight-loss clinic before he'll operate.

© January W. Payne






Top Cosmetic Treatments for Aging Skin