Mark H. Schwartz, MD
Mark H. Schwartz, MD, clinical assistant professor of plastic surgery at Weill Cornell Medical College and a board-certified plastic surgeon practicing in New York City. Dr.MarkSchwartz.com
The goal of plastic surgery and other cosmetic procedures is to create a better version of you, not to turn you into someone else. Thanks to 21st-century techniques, a lot can be accomplished with in-office procedures, many of which take less than an hour, are noninvasive and have no or minimal healing time.
Even as recently as the 1990s, plastic surgeons were taught that you can correct only with a scalpel, but today nothing could be further from the truth. Even though a full facelift still is the only answer to remove sagging skin and a drooping jawline, there are many other worthwhile procedures that can have impact and be much easier on your budget. There also are options for people who simply don’t want to undergo an operating-room surgery, even when money’s no object. Prices for all procedures vary regionally—expect to pay more in major cities than smaller areas. And keep in mind that these elective procedures are not covered by insurance.
These are among the most popular cosmetic procedures. Because an experienced doctor can be very precise, you can take a less-is-more approach, and start with a small correction and then decide if you want more.
Neuromuscular blockers. You will recognize the name Botox, but there are other neuromuscular blockers that help correct “dynamic lines,” including frown lines between the brows, horizontal lines across the forehead and crow’s feet, which all are caused by muscle movement. These medical-grade toxins relax the muscle causing the line. A common misconception is that it freezes the face, but when done with finesse, the injections will soften, not erase, these lines—the goal is not to take away your full expression.
Botox can be done around the face (and possibly some bands in the neck) in one session and in under an hour. There’s no need for anesthesia, though a numbing cream may be applied beforehand and an ice pack afterward for a few minutes to reduce any swelling at the injection sites. There’s no down time, but you need to avoid bending over for a few hours so that the blocker doesn’t travel to the eye muscle.
Advantage: If you don’t like the results, they’ll be gone in a few months. But that’s also the disadvantage—the injections need to be repeated an average of three times a year. Exactly how long your results last depends on how quickly your body metabolizes the toxin.
The cost can range from $600 to $1,500 depending on how many areas are treated and where you live.
Dermal fillers. These gels contain primarily hyaluronic acid, a naturally occurring sugar found throughout the body (it also is a prominent ingredient in some moisturizers). The two best-known brand names are Juvéderm and Restylane. Fillers are used to plump static lines, such as the nasolabial fold that goes from the outer nostril to the outer corner of the lips and the marionette lines from the corner of the mouth to the bottom of the chin. These gels also can restore volume in the cheeks, the temporal region and possibly the chin to redefine the jawline.
Fillers come in different consistencies so the right product can be matched to your needs, both in terms of the degree of correction desired and where on the face the injections will go. The gels are infused with lidocaine to numb the area as they’re injected. Results last between six and 12 months, depending on how quickly your body metabolizes the gel. Cost: $700 to $1,000 per vial/syringe.
Fat grafting. If you want results that last longer than other injectables, fat grafting can restore volume as well as improve static lines. Think of this technique as borrowing from Peter to pay Paul—your doctor removes your own fat from an area where you don’t want it, such as your abdomen, and injects it in an area that needs volume, perhaps the cheeks. It is a longer, more involved procedure that can be done with local anesthesia and oral pain medication in the doctor’s office. Expect one or more weeks of healing time from bruising and swelling. Cost: $2,500 and up, depending on how many areas are treated.
These procedures can smooth your complexion and/or tighten skin.
Lasers. Various strengths of chemical peels used to be the main treatment for resurfacing skin, but today’s lasers are more precise. Laser resurfacing improves skin texture, fine lines, wrinkles and irregular pigmentation, helping skin quality in ways that even surgery can’t.
Some lasers are non-ablative—their heat passes through the skin without harming it to target specific pigment problems such as age spots and spider veins. They can also stimulate collagen production to improve tone and texture for a clearer complexion. A non-ablative laser treatment usually takes about 20 minutes and causes minimal redness and swelling. Non-ablative treatments need to be repeated yearly or more frequently depending on the quality of your complexion.
Ablative lasers remove the outer layers of the skin to trigger new skin growth. Because of the many lasers available, your doctor can individualize how deep to go based on your needs as well as how much time you have for healing, whether it is just a weekend or a full week—the deeper the laser goes, the more redness and peeling you’ll experience. Because ablative lasers remove skin layers, full healing can take two to three weeks, with some discomfort, especially the first few days when the skin is red, swollen and peeling. Results can last for years. Laser treatments can be repeated if you want a greater result.
Ultrasound. A newer technique called Ultherapy uses ultrasound heat energy to tighten, tone and lift the neck, face, eye and brow regions, and to stimulate new collagen production for smoother skin. Treatment can take between 10 minutes for a single area such as the brow to just under an hour for the entire face. You’ll notice some tightness right away, with more improvement over three to four months. There is almost no healing time. Depending on your skin, you might benefit from a second treatment. Results often last up to two years.
Cost: Non-ablative laser treatment costs are similar to injectables, while ablative ones and ultrasound procedures are in the $2,500-and-up range.
There are smaller-than-a-facelift surgical procedures that can have big impact.
Upper-eyelid lift. This surgery can reframe your eyes by removing excess skin and fatty tissue on the upper lids. Small scars are effectively hidden in the upper-lid creases. This procedure may be covered by insurance—but that will require documentation from an ophthalmologist stating that the visual fields are blocked by the excess skin.
Mini-brow lift. This lifts the droopy outer portion of the eyebrow and forehead that can give a perpetual sad or tired appearance. The small scar is hidden in the hairline.
Both surgeries are done under light sedation and have a healing time of about a week. It’s important to consider the brow and the upper eyelids at the same time for the best, most natural results. Both procedures can be done simultaneously. Results often last 10 to 15 years depending on the quality of one’s skin. Cost: $5,000 and up.
Results depend on the skill of the doctor. Before you schedule a consultation, make sure any surgeon you’re considering is board-certified by the American Board of Plastic Surgery (ABPlasticSurgery.org). Also…
Pinpoint what’s bothering you. A productive consultation with your doctor starts with you communicating what you don’t like—is it an old scar, spider veins, droopy eyelids? Your doctor will advise, but he/she needs to hear from you.
Have realistic expectations. If you have a lot of loose, hanging skin at the jawline, only a facelift or a lower facelift will remove it (with fees for the surgeon, the anesthesiologist and the facility, costs can be well over $15,000). Also, be realistic about what the results will bring—you’ll see a better version of yourself when you look in the mirror and feel more self-confident, but it’s not going to change your life in any meaningful way. Know that you may need to repeat a procedure in the future—no treatment can halt the aging process.
Ask lots of questions. Learn about the cost, healing time and possible results of different types of procedures and how they differ. The more information you have, the easier it will be to decide what’s right for you.
Caution: Some people should not have cosmetic procedures. Physical and mental health stability are critical for successful results. And if someone has a medical condition such as untreated high blood pressure or poorly controlled diabetes, he/she may have difficulty with anesthesia or healing. Also, anyone with an untreated psychiatric ailment such as severe depression or who is recently recovering from a major life stressor such as divorce or death of a spouse should postpone having a cosmetic procedure.
