No more sagging, sweating or wrinkling
Doctors offer new options for eliminating tired faces, flat backsides and smelly underarms

July 20, 2004
BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

Aging faces. Droopy butts. Sweaty armpits.

They're old problems, but they're being solved by new approaches. New products are on the market, and innovative procedures are gaining acceptance in the United States, which tends to lag behind Europe and South America when it comes to plastic surgery.
One important caveat: The treatments are cosmetic or elective, so don't even think about whether your insurance covers it. It won't.
But if you want a lift, in more ways than one, here's what you need to know about five emerging trends for the face, butt and underarms.

Injectable fillers
Restylane and Hylaform are two new, federally approved injectable fillers that help temporarily reduce facial folds and wrinkles. They last up to six months, adding fullness and volume to the skin.

These dermal fillers are particularly helpful for the treatment of nasolabial folds -- lines from the side of the nose to the mouth that accompany aging -- and wrinkles or marionette's lines on the chin, says Dr. Lorna Thomas, a Detroit dermatologist with many African-American patients. Minority groups are not well represented in clinical studies conducted to gain federal approval, and Thomas' work gives African Americans insight into how well the procedures work.

She calls injectable fillers a great option for the aging face. "People really, really like the results," she says.
The downside is the cost, which varies widely throughout the United States.

A treatment using two syringes of the injectables, a typical dose, might cost $900 in Detroit but $2,000 or more in California, New York or southern Florida, Thomas says.

Restylane and Hylaform, administered during simple, 10-minute office visits, are made of hyaluronic acid, a non-animal product. They provide an advantage over collagen, an animal-derived product that plastic surgeons have used for years for wrinkle treatments.

Before it can be used, collagen typically requires two skin tests to determine whether patients will develop an allergic reaction, Thomas says. Collagen also "only lasts about three months maximum," she says, compared with up to six months for the new fillers.  The new injectables "are like going from black and white to color TV or from mono to stereo," says Dr. Alastair Carruthers, a Vancouver, British Columbia, dermatologist who recently spoke on a panel about semi-permanent injectables at the annual meeting of the American Society for Aesthetic Plastic Surgery. "Suddenly, we have this range."  Collagen, however, is better for shaping lips, he says.  Doctors numb the skin with topical anesthetics before the injection and massage it afterward to make sure the medicine spreads through a fold or wrinkle.  Side effects include possible bruises, pimple-like formations and temporary swelling or redness at the injection site. The swelling and redness usually subside within three days.

Sometimes doctors don't inject enough solution, says Dr. Steven Fagien, a Boca Raton, Fla., plastic surgeon, who spoke at the Vancouver meeting. "The biggest problem with Restylane is under-correction."  Diana Zuckerman, president of the National Center for Policy Research for Women & Families, a Washington, D.C., resource organization, says she urges caution about the products because little is known about long-term risks and little study was done in Asian and African-American patients.

For more information, visit http://www.restylane.com/, or http://www.inamed.com/.

Thermage
A noninvasive procedure to tighten loose skin also is gaining popularity in the United States.

Thermage uses heat, or radiofrequency waves, delivered by a computer-driven machine that takes the guesswork out for doctors. It uses grids to mark the face, much like a paint-by-numbers kit and a preset number of pulses to deliver the energy.  It's federally approved for treatment of wrinkles around the eyes, but doctors use it for other purposes, including tightening the butt, says Dr. Michele Hardaway, a Farmington Hills plastic surgeon. Doctors don't know yet how long results last because the procedure is new, but they expect them to last at least 1 1/2 years, perhaps much longer, Hardaway says.

Last week, Beverly Lay, a meeting planner for the Ford Motor Co., underwent a 45-minute procedure to tighten the skin around her eyelids and the bags under her eyes. She wanted a noninvasive procedure like Thermage instead of a conventional face-lift or the eyelid surgery known as belpharoplasty. Thermage uses only topical anesthesia, requires no stitches, causes no bruising and involves no recovery time.
The procedure is slightly painful, "a burning feeling," but tolerable, says Lay.  She returned to work the next day with only a slight redness under her eyes.

"Did it take 10 years off?" she asks.

"I should be so lucky."

For more information, visit http://www.thermage.com/.

Mesotherapy
Another noninvasive procedure, mesotherapy (pronounced ME-so-ther-ah-pee), involves injections of 20 compounds -- drugs, vitamins and hyaluronic acids -- to get rid of cellulite, which is lumpy, dimpled-in skin.

Popular in Brazil and France, where it has been performed since the early 1950s, the procedure is gaining popularity on the East and West coasts, says Dr. Charles Mok, medical director of the Michigan Mesotherapy Institute in Shelby Township. He's among the first to offer the procedure in Michigan.

He uses it for facial lines and legs, or "anywhere there's fat."

Liposuction removes fat but "doesn't help cellulite, the fat below the skin" and even can make skin bumpier, he says.  Thermage tightens skin but also doesn't remove cellulite, though it complements mesotherapy, he says.

Mok says a Brazilian doctor has followed his patients for two years and found that results are lasting if patients don't gain weight.  The 20-minute procedure costs about $300 a session. Many patients need more than one of the treatments, which are spaced two weeks apart. Each session involves four to 10 injections with a needle "the size of an eyelash," Mok says. "It's not painful."

Mesotherapy is not an appropriate treatment for severely overweight patients.

For more information, visit http://www.mesotherapy.com/.

Body odor and sweating
The predecessor of dermal fillers -- Botox -- is finding new uses.

Federally approved in 2002 for wrinkle removal, Botox, a prescription medicine injected to temporary paralyze muscles, has been used for a wide range of other problems, including rectal spasms and involuntary tics.  More than 2.2 million Americans underwent Botox injections last year, according to the American Society for Aesthetic Plastic Surgery. Most were for facial wrinkles, particularly between the eyebrows.
More recently, Botox has been used by teens, runway models and others to control underarm sweating and body odor. It requires as many as a dozen injections under each armpit and costs as much as $400 an armpit.

It lasts from four to six months.

Doctors say the injections don't block healthy sweating, just the kind from apocrine sweat glands, which are in the armpit or groin and produce odors.

Butt implants
Gluteal augmentation, performed for several decades by plastic surgeons in South America and Mexico, has arrived in the United States.
Only time will tell if it's just a passing trend.

"This is a procedure driven by exposure to stars such as Jennifer Lopez, by fashion and by the media," says Dr. Leroy Young, a St. Louis plastic surgeon who performs the procedure and teaches it to other doctors.

Two years ago, the idea was so new in the United States "it wasn't even on the radar" of most plastic surgeons, Young says. The trend has grown to the point that Dr. Tom Roberts, a Spartanburg, S.C., plastic surgeon, created a Web site, http://www.betterbuttocks.com/, to provide more information.

The American Society of Aesthetic Plastic Surgery began tracking the surgery only two years ago. Last year, 3,885 procedures were performed in the United States, up 533 percent from 2002, when 614 of the operations were done, the society says. (See http://www.surgery.org/.)  The $8,000 surgery -- a cost that includes doctor and hospital fees -- uses silicone products to enhance flat behinds. It's popular with men as well as women, Young says.

The first butt implants date back several decades to South America. Doctors used breast implants because manufacturers didn't have implants for the butt, Young says.  Young and a partner became alert to the issue when they went to a St. Louis underwear store a few years ago to discuss referrals for breast cancer patients. Eyeing what Young describes as a wall of padded underpants and girdles, he asked, "Do you do much business?"

"They told us the demand was so great they couldn't keep the underwear in stock," Young says. "We knew we were on to something."
Young, who went to Mexico to learn the technique, says interest in the United States is growing now. "The aesthetics of the butt had to be worked out," he says.

"With the breast, we know where the nipples are supposed to be. We didn't have a clear idea with the butt. Now we know the ideal anatomical proportions."  The perfect butt should project out at the same level as the pubic bone, Young says. The crease between the butt and the thigh should go only about two-thirds of the way across.

"If it goes beyond that, you get a droopy butt," he says.

Gluteal augmentation is a four-hour operation performed with general anesthesia. Surgeons make an incision in the crease between the buttocks, then open a pocket in each cheek to insert an implant.  The incision is sealed with a medical-grade glue. Patients wear compression or surgical wraps around their butts for up to two weeks to hold the incision in place. In that time, they must avoid too much sitting.
There are several surgical techniques, too. Young thinks the implants are best positioned under the fascia, the connective tissue attached to butt muscles. Placing them there helps doctors avoid a problem called capsular contracture, a hardening of the implant and nearby tissue. Placement under this tissue also allows doctors to use bigger implants, he says.

The most common complication is pain, and it occurs about 10 percent of the time. Up to half the time, a person can feel the implant, but "people want a firmer butt anyway," Young says. Several Michigan doctors said they have seen no interest in the surgery and wouldn't perform it until more is known about risks and outcomes.

"We don't need buttocks augmentation in Michigan," says Dennis Hammond, a Grand Rapids plastic surgeon.