December 28 2011
Lucia van der Post
It was American musician Eubie Blake who famously remarked: “If I’d known I was going to live this long, I’d have taken better care of myself.” Well, many of us are going to live much longer than our forebears, and so the matter of looking as good as possible for as long as possible becomes ever more of a challenge. The cheering news is that almost every month there are technological advances and new machines that are making the full-blown face-lift seem increasingly old-fashioned. These new procedures are remarkably more effective than their pioneering predecessors.
Dr Nick Lowe, one of the most respected consultant dermatologists in the land, with a string of eminent academic appointments to his name and a raft of research papers behind him – not to mention lots of happy, less crumpled patients – thinks that “if you start some of these treatments at around age 35-40 it may be possible, in some cases, to go on looking very good for a long time without the use of the knife”. Take note, though, of the cautious language, for he is at pains to point out that while modern machines can do wondrous things, they can’t altogether counter a lousy deal in life’s genetic lottery (heavy jowls, big bags under the eyes), or the sort of lifestyle that involves smoking, drinking and too many late nights.
Nevertheless, he tells me that these days he can bring about results that even five years ago could scarcely have been dreamed of. There isn’t a single magic bullet, say the surgeons and aestheticians I spoke to, but if you use the new lasers and other machinery alongside fillers such as Restylane and Juvéderm, then you can get some really remarkable results.
Take sagging skin, one of the most intractable problems of ageing, for which a surgical face-lift used to be the only solution. These days lasers can make a huge difference. Fraxel’s laser treatment, Re:store (from £800), which uses fractional photothermolysis to deal with unwanted pigmentation, and reduce fine lines, wrinkles and scars is, according to Lowe, a very useful tool. In the past year Fraxel has brought out a newer, more active, version: Re:pair (from £1,500). The usually cautious Lowe calls it “the biggest breakthrough for wrinkle reduction in the last 10 years”. It is a very highly tuned carbon-dioxide laser that does all the things the earlier Fraxel machine did, but better: it tightens the skin more effectively, gives skin a smoother texture and is even better at reducing wrinkles and fine lines around the eyes. It’s able to do this because it can deliver much higher energy levels more safely, although it’s important to note that the skin will take seven days to heal properly. One treatment is usually enough, however, and the results last two to three years.
Another treatment undergoing improvements is mesotherapy, a method developed in the 1950s to tighten the skin, rejuvenate its appearance and stimulate collagen production by using platelets from the client’s own blood, which contain the active ingredients. Micro-amounts of the platelets are injected into the face, neck and other areas with a mesotherapy gun. It’s not without a little pain, as if the skin is being subjected to tiny pinpricks, and the result is said to be glowing, firmer skin. Several salons offer rejuvenating mesotherapy, but now Dr Véronique Simon has gone a step further in developing a heating mask that, she claims, improves the efficiency of the platelets to nourish at a very deep level. She says that three treatments (they cost about £440 a time) should result in visible improvement for two years at least.
Along with the slackening of skin, it is the loss of radiance that people mind the most, which is where Dermaquest’s Pure Roller (pictured on opening spread) comes in. Devised to make skin look firmer and more youthful, it’s also helpful where there is scarring, stretch marks or fine lines. It is a newer, more refined, development of the Dermaroller, using finer needles so that there is less visible damage to the skin and less downtime required. The micro-needles cause slight damage to the skin, encouraging it to plump up and then heal. At EF Medispa, the Pure Roller treatment is offered as part of a complete facial using first a light Stem Cell 3D Glycolic Peel, followed by the Dermaroller. Dermaquest Stem Cell 3D complex creams are then applied and the micro-channels opened up by the needles allow the active ingredients to penetrate more deeply. The skin might be left looking pinkish (so don’t have a treatment on the day of a big event), but that shouldn’t last for long. A single treatment costs £425, but the clinic recommends a course of six at £1,900.
Dr Mike Comins, president of the British Association of Cosmetic Doctors (BACD), who specialises in non-invasive and cosmetic minor surgical procedures and is medical director of The Private Clinic of Harley Street, says that the medical world’s understanding of what makes a face look old has changed vastly. It is now clear that instead of worrying about plumping up individual wrinkles and lines, the real problem is that the fat beneath the skin (under the eyes, on the cheeks) starts to gravitate downwards and form lines. “If you can restore the fat pads to where they were and at the same time lift the skin back to its original position then patients can look immediately a great deal better,” says Comins.
He is a great admirer of the very new model CPT (Comfort Pulse Technology) Thermage – a non-invasive procedure that helps tighten and contour skin but, crucially, he thinks the best results come when it is combined with a judicious use of fillers. The CPT Thermage uses radio-frequency technology to reach fibres deep in the skin and underlying tissues; it can be used on the eyelids (to deal with “hooded” eyes), wrinkles and fine lines around the eyes and lips, and it helps improve sagging skin, such as loose jowls, and stimulates collagen growth. “There is absolutely no downtime at all – you could go straight out to a special dinner,” says Comins. “If fillers were used at the same time there might be some faint bruising.” It costs from £2,200 per treatment, of which only one would be necessary. “It turns back the clock but it doesn’t stop the clock ticking,” he adds, and the effects should last for between two to three years.
Lowe also believes in the new CPT Thermage, and uses it for tightening the skin on the face but also for, say, the skin of the abdomen after pregnancy, as well as for treating superficial cellulite and tightening skin after fat removal. He also points out that unlike lasers it doesn’t break the skin, and so is gentler.
Dr Tancredi D’Amore, who works at a private clinic near San Francisco, agrees that the loss of facial fat is the major problem. He uses his patients’ own fat, usually taken from the abdomen, which he purifies before injecting using tiny needles into the face. This fat-grafting costs between $3,000 and $5,000, and the end result, he says, lasts for between three and five years, and is “wonderfully natural, with no complications since we are using the person’s own tissues”. But his favourite procedure of all is what he calls the Browpexy, which is usually done at the same time as removing unwanted skin from the upper eyelids (a surgical procedure). He places one single stitch underneath the outer edge of the eyebrow and it immediately gives a youthful, upward slant. “It is much less invasive,” he points out, “than a conventional brow-lift and it lasts for over 10 years.” The Browpexy and eye-lift costs $5,000.
Since the problems of ageing are multifarious, it’s no wonder that the machines and treatments are multifarious, too. After the skin slackening and the lack of radiance, the pigmentation and the scarring have all been dealt with, some people are worried about fat deposits in odd places – along the bra line, on the upper arms, love handles, post-pregnancy fat, fat around the jowls or even under the eyes (though, as Lowe points out, there is always some fat under the eyes because as we age the ligaments holding it in place sag and cause the fat to show). Well, there’s machinery to deal with these localised fat pockets, too.
The technique, used by Lowe in his London Cranley Clinic, is called Cryolipolysis and the treatment, by Zeltiq, is Coolsculpting (from £800, pictured on opening spread). It was discovered that fat freezes at a higher temperature than other flesh, therefore with Cryolipolysis the idea is to freeze the fat cells, killing them off, and leaving the rest of the skin cells unharmed. The dead fat cells are then gradually removed by the body’s own systems. More than 7,000 patients were treated and it was found that there were no dangerous side-effects – no increase in blood cholesterol or triglycerides, and the fat was gradually cleared over two to four months without risk to the heart or blood vessels.
Meanwhile, Lowe is evaluating another method of dealing with small areas that need localised lifting and tightening (once again, the jowls, the jaw, eye-bags, brows). As a professor at the University of California, Los Angeles, he keeps in close touch with all the new developments, such as Intracel – a needle-delivery system using radio frequency as a way of treating tissue in the deeper dermal layers of the skin. This increases the production of elastin and collagen fibres, and is ideal for those who have some mild-to-moderate degree of skin laxity and want to improve their skin firmness and volume. Dr Lowe suggest that one or two treatments, at about £1,000 a time, would be sufficient.
What can’t be emphasised enough, however, is that if you want to keep on looking your best there is no single answer. It’s the combinations that work. It’s minding about diet and exercise, using the right creams and potions, and then getting the right treatments for your own particular face and body. Only a good clinician can judge which laser is the one that is the answer to a given problem, and which fillers, and how much of them to put where. All the doctors I spoke to are agreed on one thing: though the techniques and machinery available today are improving all the time, what is almost more important than the treatments is who administers them. Always ask lots of questions and look at the credentials of the aesthetician or surgeon. Ask to see before and after photographs of their own patients, and try and get first-hand recommendations from people you know.
I will leave you with some wise words from Dr Lowe: “If a treatment sounds too good to be true, then it almost certainly is.” What modern technology can offer is lots of help on a broad range of fronts – but miracles? Not yet.