Skin Deep

A look at the rise in popularity of minimally invasive cosmetic procedures

Let’s face it, who among us has not looked in the mirror and thought about those couple of changes that would make us feel more confident or attractive. Statistics reveal that an increasing number of Americans are either curious about the options or taking the plunge where minimally invasive cosmetic procedures are concerned. Advancing technologies and innovative treatments may seem like a quick fix to some, but many see these procedures as a way to positively impact their appearance and alleviate body-image dissatisfaction. 

And the numbers don’t lie. Since the year 2000, minimally invasive cosmetic procedures have increased nearly 200 percent, according to the American Society of Plastic Surgeons (ASPS). Last year, there were 15.7 million minimally invasive cosmetic procedures performed in the United States. In fact, minimally invasive cosmetic procedures actually grew at a slightly higher rate than surgical procedures. There has also been a shift in attitude over the last few years, allowing many of us to feel more comfortable discussing our interest in exploring the various options. 

“The minimally invasive market has grown something like four or five times faster than plastic surgery procedures,” confirms Doctor Navinderdeep S. Nijher of Ocala Plastic Surgery. “What we have found is that people are starting with minimally invasive procedures much younger. If you start at a younger age, it creates a maintenance effect, so you can sort of hold back the aging process for a little bit longer. With older patients, who have not done injectables, the minimally invasive treatments may not be as effective, and they may be a better candidate for surgery. Our largest segment for minimally invasive is definitely a younger patient.”

Of the top-five minimally invasive procedures, Botulinum Toxin Type A topped the list with a staggering 7.23 million procedures last year. The public, of course, knows it better as Botox. 

“The formulation of Botox has not changed since it came out, but how we use Botox definitely changed. When it first came out, we wanted to literally freeze somebody’s face to prevent wrinkles, but we learned that it was not resulting in a healthy, natural look,” says Dr. Ashley Cauthen of MidState Skin Institute, who also reports that Botox is among the most requested procedures at her cosmetic and clinical dermatology practice. “What has changed is how we’re using it, the amount of units we use and where on the face we are placing it. We have learned, over the years, how to use it to give you a good, youthful appearance.”

But do we really feel good about having any toxin injected into our bodies? 

“Botox and fillers have been around for [many] years. A lot of people are unaware that Botox is the purified protein from the neurotoxin. It takes out the good part, and we inject that,” explains Dr. Tina Chandra, a cosmetic and neuromuscular dentist at Chandra Smile Designs, who added Botox and fillers to her treatment offerings 15 years ago when her patients expressed an interest. 

“Often, when we are talking about Botox, we may actually be talking about any of the products in this category, including Xeomin or Dysport,” says Dr. Cauthen. “It’s just that Botox has so much brand recognition that patients know the name. They all accomplish the same thing.” 

So what is the difference between Botox, Xeomin and Dysport, the three leaders in the category? Xeomin is known as the “naked injectable,” meaning that it contains only one ingredient: botulinum toxin A and no additives.

“Xeomin is the most purified form of neurotoxin. There is not extra binding protein,” explains Dr. Cauthen. “So if you have a patient who wants to get their toes wet with some cosmetic procedures, but really prefers to be more natural in the substances they use and take, then Xeomin may be a good option for them. It’s also a good option for younger patients.”

One of the most common misconceptions about these sorts of procedures is that they represent a quick fix. But all the providers we spoke to say that once you begin these treatments, you will generally need to keep going back for regular treatments to maintain the results you achieved.

“The reality with minimally invasive procedures, whether it is Botox or fillers, is that they are not permanent,” says Dr. Nijher. “The Botox will last anywhere from three to six months; the fillers will generally last nine months to a year. Someone who starts in their 30s will be on a maintenance regimen, and they probably won’t need a ton of product. But someone who comes in for the first time to have something done when they’re 45 or 50 years old will require a lot more product just to give them a decent result. Then it is all about maintaining it.”

Fillers took second place in the rankings, no doubt with some help from Katy Perry, who revealed to the world that she gets under eye filler injections to treat her dark circles. “Placing a filler under the eye really rejuvenates the face and brightens it,” says Dr Cauthen. “Almost every single patient is a good candidate for that, to some extent. But they might not even know that’s an option.”

Lasers are another option for those who don’t like needles or the idea of being injected. 

“Lasers have been very popular for the last 10 years. There are many different levels of lasers out there; some penetrate the surface of the skin, and some penetrate hard tissue like teeth and bone,” says Dr. Chandra. “As a dentist, one of the primary reasons I got into using lasers was to be able to perform dentistry faster and without the use of needles. When that high-energy beam penetrates that enamel, the nerve stays calm. I rarely have to give patients a shot anymore for something like a simple filling. 

“But over the last five or so years, that technique has also been perfected on the skin,” she adds. “As we age, we lose that collagen elasticity in our skin. When you lose that elasticity, the cells just break down. So what the laser light does on the surface, but without touching the skin at all, is to tell the cells to regenerate and rebuild that collagen that you have lost. But with this kind of resurfacing, it won’t happen over a few sessions. You may have to have three to five sessions, depending on how fine or deep the wrinkles are. To get the outcome you want, you need to do it repetitively (Treatments every 21 days is ideal.) to tell those cells to wake up and regenerate again. It’s not going to make your skin baby-butt smooth, but it will make your skin look less lined and wrinkled. It’s your own body restoring its skin. There is no recovery time. You can go right back to work, and nobody will know you had anything done.”

Another treatment that is keeping Dr. Nijher busy is CoolSculpting. 

“It’s primarily for patients who have fat deposits in the subcutaneous area (soft, pliable fat that lies directly under the skin),” he says. “You are hooked up to the CoolSculpting device, which creates a suction and freezes the fat. Once frozen, the fat cells essentially die, and the body gets rid of them. It is great for love handles, the abdominal and the flank areas. But you can use it pretty much anywhere on the body that you have focal deposits of fat. It is not for areas where you have extra skin that may need to be excised.”

Ah yes, the dreaded extra skin. Take heart because Nilam Patel, CCE, CME, clinical esthetician, electrologist, hyperpigmentation specialist at Pushti Brows and Skin Therapy, can help. 

“The most popular procedure we do here is skin tightening,” Patel explains. “That can be anywhere on the body, from the face to the stomach area. We can also handle loose, sagging skin and stretch marks due to fast and excessive weight loss. Another popular procedure is cellulite reduction.” 

Although Patel sees mostly female clients, she notes that she has a number of men who come in for facials, hair removal and fat reduction. 

“Men don’t want to get left behind in the game anymore. Most of the men who come in are doing neurotoxins, Botox, Dysport or Xeomin. Men have also jumped on the filler bandwagon,” says Dr. Cauthen. “They tend to get hollow in different places than women, and the way you inject them is different, too. Because the last thing you want to do is feminize a man’s face.”

Dr. Nijher has observed that men tend to gravitate toward minimally invasive treatments like Botox, Kybella and CoolSculpting. 

“We’ve seen a huge uptick in the number of men getting procedures,” he says. “Kybella tends to work well on men. We inject into the neck area to get rid of some fat under the chin. That helps us define that area.”

An issue that straddles the line between cosmetic and medical is the appearance of unsightly varicose veins and spider veins. Dr. Brittany Nagy of Lake Medical Imaging warns that besides being unsightly, these veins can represent something serious. 

“Many people will start having heaviness or pain in their legs or swelling in their ankles,” she says. “A very common cause is from reflux, meaning the blood is not going toward the heart as it should, because it is pooling into the legs because the valves in that vein are not working properly.”

Given all the great information out there on various procedures and practitioners, do some research on both before deciding on anything. Schedule a consultation. Ask about credentials like board certification. And don’t be afraid to ask questions.  


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