Non-surgical beauty treatments

Skin imperfections are becoming a thing of the past. With the help of modern technology, even a solitary wrinkle or pigmentation spot can be erased – without surgery. Jenna Moore reports.

Only 15 years ago we had two main options for fighting the visual effects of ageing: a pot of cream, which acted as a good hydrator but was pretty ineffective in terms of fighting wrinkles and sunspots, or the surgeon’s scalpel – only one of many tools used these days. (We also knew of good nutrition, avoiding smoking and sun exposure, but that’s a whole other story.)

“The world’s changing,” says plastic surgeon Dr Steven Liew, owner of the Shape Clinic and MediSpa in Sydney’s Darlinghurst. “The biggest breakthroughs we’ve had in cosmetic surgery are the non-surgical aspects such as Botox, Intense Pulsed Light [IPL] and dermal fillers. If a patient has a bit of pigmentation we can use IPL, and for wrinkles there are injections. Something as simple as a small injection may help prevent further ageing and the need for major invasive surgery.”

Cosmetic acupuncture
Sometimes labelled the ‘Botox alternative’, cosmetic acupuncture, the hot ‘new’ thing in London and New York has been around for centuries. “The concubines in old China had it to maintain their youth,” says Dr Liew. “It stimulates points on the face and improves circulation and ‘Qi’ [vital energy].” Cosmetic acupuncture won’t give you a facelift, but your skin will feel tighter and you’ll gain a sense of wellbeing.
Treatment: Minimum of 12 sessions.
Cost: $80 to $100 per treatment.

Cosmetic injections
An umbrella term for injections used to give people a more youthful appearance, cosmetic injections include temporary muscle relaxers and wrinkle fillers. Proven to be safe and effective, a treatment takes about 15 to 20 minutes, and downtime is negligible. For a natural look the secret is not to overdo it and choose your practitioner wisely.

Restylane
“Restylane is made from a non-animal source of hyaluronic acid, a substance that occurs naturally in our bodies and attracts water to hydrate the cells and fibres of the skin,” says Dr George Calfas, cosmetic physician. “As we age, hyaluronic acid diminishes and facial lines and wrinkles start to appear. We can replenish them with Restylane.” There are four types on the market: Restylane, Restylane Touch, Restylane Perlane and SubQ (see New techniques, page 62). The difference is in the consistency of the gel particles; for example, Restylane Touch is fine and used for superficial lines and wrinkles, whereas Restylane Perlane has larger particles and is better for deeper lines such as the nasolabial fold (the crease that runs from the nostril to the edge of the mouth).
Longevity: About nine to 12 months.
Side effects: Some swelling for one to two days. Bruising is possible (and while it has not been scientifically proven, some women report bruising occurs if they have drunk wine the night before the treatment).
Cost: From about $350.

Collagen
Collagen is one of the natural proteins present in our skin and, along with elastin, is responsible for a plump, youthful appearance. The injectable version is derived either from a bovine or human source, and works in the same way as Restylane. Bovine collagen requires an allergy test as a small percentage of the population has experienced a reaction.
Longevity: About three to five months.
Side Effects: Similar to Restylane.
Cost: From around $350.

Radiesse
Radiesse’s point of difference is its longevity. Made of microspheres of calcium carried in a gel filler, the calcium provides a scaffold that encourages natural collagen to grow around it after the gel dissolves (two or three months). It is commonly used on nasolabial folds, the jowl and marionette lines (lines from mouth corners to chin).
Longevity: About 15 to 18 months.
Side effects: Similar to Restylane.
Cost: About $1,300.

Fat injections
Fat injections require a plastic surgeon to shift an area of fat and link it up with the nerves and tissues in another part of the body. In the past, survival of the tissue wasn’t always optimal. “We’ve refined our technique to ensure maximum survival time,” says Dr Moss. “It’s a logical procedure because we lose fat as we age so we’re putting it back.” Fat injections are used for traditional ‘filling’ techniques such as lips and lines but can also help with hollowing under the eyes. Performed well, it can last for a long time.
Cost: Usually part of a facelift.

Intense Pulsed Light therapy
IPL has proved to be worth its weight in gold for the treatment of pigmentation. “It’s not a laser, but it works through multiple wavelengths of light,” says Gold Coast-based plastic surgeon, Dr Craig Layt. “The light absorbs the pigment, damages it and subsequently decreases it. IPL works well for removing pigmented spots and generally brightens the complexion, but in terms of rejuvenation it only works to a small degree.”
Treatments: Up to six – three to four weeks apart.
Downtime: None.
Cost: Depends on the area to be treated. From $40 to $400 per treatment.

Microdermabrasion
“Microdermabrasion works by spraying a jet of fine micro-crystals across the skin,” says Dr Calfas. “The crystals have disinfecting and drying properties and lift dead skin cells from the surface of the skin, which are removed by vacuum suction.” Microdermabrasion can be used for a light peel or a deeper treatment. It is very good for cleaning out blocked pores and treating acne.
Downtime: None.
Cost: About $150 per treatment.

Light peels
“Peels used to be very strong, but we’ve moved to more gentle versions that are an extension of a good skincare routine,”says Dr Layt. Like a concentrated form of exfoliation, a light peel will leave you with a glow or pink tone to your skin. After several days light flaking may occur as skin sheds.
Downtime: None.
Treatments: A series is usually required.
Costs: $80 to $150 per peel.

Medium-strength peels
The most common type of peel to fall under this category is a higher concentration (about 20 to 35 per cent) of trichloroacetic acid (TCA). This treatment frosts and burns, and requires a hand-held fan to cool. After about a week the skin will darken and peel off. Initially, skin will be pink but this will fade after a few weeks.
Downtime: About five days.
Costs: Approximately $800.

Laser resurfacing
There are two types of laser available:ablative and non-ablative. Ablative treatments use lasers such as CO2 or Erbium YAG, which are less popular than they once were, but are still used. “They are very effective, but there’s also significant risk and downtime involved and a lot of people don’t want that,” says Dr Liew.

Laser works by using photons of light to heat an area and destroy it. As the tissue heals, new soft, youthful tissue is formed. “We usually use it for areas where there is bad sun damage,” says Dr Layt. “It’s very good around the mouth and lower eyelid. I usually use it in conjunction with a facelift. The Erbium YAG is the most common – the CO2 is old technology.”
Downtime: Seven to 10 days. Redness could last for several months and sunscreen will be non-negotiable.
Costs: Costs can vary greatly and start from several hundred dollars.

Non-ablative laser
The Cutera 3D laser system offers four technologies: Photo Genesis, Laser Genesis, LimeLight Facial and Titan. The differences are technical, but the technology works with light wavelengths and gently heats the deeper skin layer stimulating collagen production. More heat is generated in dilated capillaries, reducing redness.
Downtime: None.
Treatments: A series is usually required.
Cost: From about $450 to $2,000 to start.

New techniques

Botox
“We are using Botox to reshape the face,” says Dr Liew. “If a jawline is too bulky, we can inject Botox into the masseter muscle (the strong muscle in the jawline).” This leads to a softening and reshaping, and can reduce teeth grinding so patients don’t have to wear a mouthguard.

“Two other things we’re trialling are injecting Botox into the neck to get a facelift, and the Botox facial, where we inject into the skin, not the muscle,” says Dr Liew. “This reduces oil glands, sweatiness and pore size, and creates a more beautiful complexion.”

SubQ
SubQ is a form of Restylane and has only been available in Australia for a short time. It is the same as other forms of Restylane but the molecule is larger and is used to add volume to the cheek, which diminishes with time. “I call it a ‘cheek and chin implant in a syringe’,” says Dr Liew. “In twenty minutes a patient can have fuller cheeks that will last for about twelve months.”
Downtime: An afternoon.
Cost: $1,500 to $3,000.

Thermage
“Thermage is radiofrequency technology that heats up the deep dermal layer of the skin and creates a thermal injury,” says Dr Layt. “The body naturally heals the injury, which causes tightening. Practically all patients notice an improvement in their skin, but not everyone will get a good facial contouring result and we can’t tell who it will work on and who it won’t.” Thermage fills a gap in the cosmetic market between cosmetic injections and a surgical facelift. “We’re increasingly using thermage on the body and we’ve had some good improvements with tummies and sagging upper arms. I think we’re going to continue to see some really exciting results,” adds Dr Layt.
Downtime: None – tightening improves over two to six months.
Cost: $1,500 to $5,000.

Words: Jenna Moore. Photography: Steven Chee. Hair & make-up: Karen Hopwood.