Plump It Up
If deeper lines and wrinkles have etched their way into your skin, dermal fillers can enhance, plump, or fill in the gaps, giving you instant gratification without the expense or downtime of surgery. Substances like Juvéderm, Radiesse, Sculptra, Perlane, and Restylane, injected near the surface of the skin, not only add volume, but stimulate your own natural collagen, which gives skin elasticity and strength—so the more you do it, the less filler you will need.
What’s New: Loss of facial volume is the culprit for the lines that run from each side of the nose to the corners of the mouth (aka “parentheses”). Rather than “fill” these lines, William Greenberg, MD, medical director of Skin Thera P (www.skintherap.com), a cosmetic medical spa located in Scarsdale, injects new-to-the-market Voluma into the cheek area, which “lifts” the cheekbones, adds dimension to the face, and smooths out the lines. Because lidocaine, a numbing agent, is added to the formula, you should feel no pain from the injections. Unlike other fillers, which last anywhere from six to 12 months, Volumna can last up to two years.
Downtime: Minimal; you can return to work or to your activities immediately. Some common side effects, which generally last about two weeks, include lumpiness, tenderness, swelling, firmness, bruising, redness, and itching.
Cost: Average cost is $2,000 for two syringes (the typical amount needed).
Insider Tip: Rather than wait for the filler to completely wear off, it’s good to come back in after nine to 12 months for a “boost,” says Dr. Greenberg. “If you keep up with fillers, they’ll last longer, and you’ll use less and less each time.”
Hate those love handles? Stubborn pockets of fat may still cling on despite our best efforts at exercise and weight loss. “Liposuction, while innovative, requires anesthesia and downtime, [and can cause] bruising or other complications, and people are moving away from it,” says Jyotindra Shah, MD, medical weight-loss and age-management specialist at Amari Medical (www.amariclinic.com) in Scarsdale and Bedford Hills.
What’s New: Cool Sculpting, aka Zeltiq, brings fat reduction into the “ice age,” targeting and permanently destroying fat cells using intense cold energy. The ideal patient is someone who is within 20 to 30 pounds of their ideal body weight, who is maintaining or in the process of losing weight.
What to Expect: A special device draws the fat up between two cooling plates; you’ll feel a sensation of a firm pull and pressure. Read, text, or snooze during the treatment—about an hour later, you’re done. Roughly 20 percent of the targeted fat cells are killed, and you could start to see changes in as quickly as three weeks post-treatment, while your body flushes out the dead fat cells over the next four to six months.
Downtime: You may experience temporary pain or discomfort during the treatment. Afterwards, there may be some redness, bruising, swelling, or tenderness, which will gradually subside. Typically, there’s minimal downtime (or none—if you feel well enough, you can even go to the gym). As long as you maintain your weight with diet and exercise, results will be permanent, says Dr. Shah.
Average Cost: About $750 per area, and multiple areas can be treated at once. (Examples of chosen areas: lower abdomen, one love handle, etc.)
Insider Tip: While some patients obtain their desired results with just one treatment, you can lose even more fat with additional treatments if necessary.
A Hair-Raising Event
Does your hair grow everywhere but where you want it? You’re hardly alone: Forty million men and approximately 21 million women suffer from baldness or thinning hair. Hair-transplant procedures can restore the appearance of a full—or fuller—head of hair. Typically, a narrow strip of scalp, bearing some hair, is removed from the back of the head and prepared into tiny grafts containing an individual hair or a few hairs each. Then, holes or slits are created, with a scalpel or needle, into which each graft is placed. Sounds pretty time-intensive and painful, right? Now, advancements mean less fuss and “ouch.”
What’s New: Cosmetic physician Anca Tchelebi-Moscatello, MD, of Park Avenue Medical Spa (www.parkavenuemedicalspa.com), with offices in Rye Brook, Ardsley, and Armonk, offers NeoGraft, a faster and more precise, less invasive, and less painful automated hair-transplant procedure.
What to Expect: Under local anesthesia, individual hair follicles are gently extracted from the scalp with a machine operated by the physician, then precisely re-implanted to the balding areas. There’s no need for a scalpel—or pain. Depending on the number of grafts needed, it can take a full day. Once the hair follicle has been implanted, the grafted hair stays in place for about a month before shedding, with the new growth beginning in four to six months.
Downtime: A dressing covers the donor site for the first 48 hours. You can return to work after that time, but keep the comb away from the recipient area for about two weeks (the rest can be combed), and skip coloring hair for six weeks post-procedure (although you can color your hair a week prior to the procedure).
Average Cost: Between $5 and $6 per graft; depending on the area and number of grafts needed, costs could run between $12,500 and $25,000.
Insider Tip: Since normal hair loss continues over time, the procedure may need to be repeated in 10 to 20 years to treat new bald or thinning spots. “Sometimes we recommend certain topicals, like Minoxidil or Propecia, or laser treatments to slow the loss of existing hair,” says Dr. Tchelebi-Moscatello.
Breast augmentation consistently ranks among the most popular cosmetic procedures in this country, with nearly 300,000 procedures performed in 2013. The procedure is not commonly covered by insurance, but you might be eligible for coverage if it’s for certain aesthetic or medical purposes (such as reconstruction after mastectomy or some congenital defects), says board-certified plastic surgeon James R. Lyons, MD, of Bellava MedAesthetics & Plastic Surgery Center (www.bellavaspa.com) in Bedford Hills.
What’s New: Saline- and silicone-filled implants, the usual choice, have come a long way since their humble beginnings, giving women more options than ever before. The new “gummy bear” or tear-drop implant has a thicker silicone gel designed to mimic the natural shape of the breast (thicker at the bottom and tapered toward the top). For just a modest increase in size with a more natural approach, Dr. Lyons also offers the Adivive fat transfer procedure, in which liposuction removes unwanted fat from other parts of your body, like your abdomen or thighs, then harvests and injects it where you want it—into your breasts.
What to Expect: General anesthesia is usually required for the one- to two-hour outpatient procedure, except in the case of fat transfer, which can be performed under local anesthesia. For the full breast aug, most patients experience some discoloration and swelling, which will resolve within a month, says Dr. Lyons. A support bra, which can minimize swelling and supports your breasts as they heal, is worn around the clock. Expect to feel soreness and swelling for a few weeks.
Downtime: Varies from person to person; most patients can return to work in about one week and resume exercise in four to six weeks.
Average Cost: Expect to pay between $5,000 and $7,000 for the fat transfer; or between $6,000 and $8,000 for the full augmentation.
Insider Tip: Women with implants should still have scheduled mammograms; inform your technician or radiologist ahead of time that you have them. Extra X-ray pictures (called implant displacement, or ID, views) that push the implant back against the chest wall and pull the breast forward over it must be taken so that the breast can be better seen.
The Goldilocks Complex
Some people think their nose is too big; others think theirs is too small or misshapen. Rhinoplasty—a nose job—can make anyone’s “just right.”
What’s New: Plastic surgeon Andrew Kornstein, MD, of SkinCenter Advanced Medical Aesthetics (www.bestskincenter.com) in Hartsdale, sometimes complements rhinoplasty with fat transfers (from your own body) to the forehead and/or chin area to create a better balance in the face. “When the forehead or chin is weak relative to the rest of the face, it can make the nose look bigger,” he says. And since volume and bone loss increases with age, “filling these areas out with fat can slow the aging process dramatically.”
What to Expect: Two general techniques involve either incisions on the underside or outside of the nose (open rhinoplasty) or incisions made inside the nasal passages (endonasal, or closed, rhinoplasty). The outpatient surgery takes about two hours and is performed under general anesthesia. You may wear a splint, nasal packing, and a small triangular bandage beneath the tip of your nose for about a week, during which time you must avoid showering. Swelling and bruising lasts from one to two weeks. To speed healing and reduce swelling and bruising, Dr. Kornstein likes an FDA-approved device called PEMF (Pulsed Electro Magnetic Field), worn at home by the patient on the head for about two weeks. It works “almost like an ice pack”, but more effectively and without direct application to the nose, he says, which could be painful in itself. Dr. Kornstein also administers Ultherapy, which uses ultrasound to reduce swelling in the nasal tip and get quicker results.
Downtime: Expect to be out of work for about one week, with no exercising or partaking in strenuous activity for three weeks; you may need to keep your head elevated and relatively still for a few days post-surgery. Pain, which is usually minimal, can be managed with over-the-counter or prescription medications. Results should last a lifetime.
Average Cost: $6,500 for rhinoplasty; $10,000 or more if fat injections are added to the procedure
Insider Tip: Dr. Kornstein cautions that “just because your friend got a good result, doesn’t mean you will. It’s important for the physician to take the whole patient into account, allowing for his or her own unique anatomy,” he says. “Make sure you look at photos of patients with similar anatomical variations as yours.”
Do your brows hang low? Sagging brows can make you appear angry, sad, or tired—even if you’re not. Raising them rejuvenates the upper third of your face, giving you a more alert, youthful, and even friendly appearance. Two traditional methods are the coronal brow lift, requiring an ear-to-ear incision, and the endoscopic lift, which works through small incisions made within the hairline. The coronal method can result in the loss of hair follicles or temporary numbness for some people—an argument for endoscopic. General anesthesia, usually required, can add to the cost (which falls between $7,000 to $10,000).
What’s New: For a less invasive and more economical solution, Adam J. Messenger, MD, medical director of Euro Laser Spa Services, Inc. (www.eurolaserservices.com) in Rye has crafted a unique injectable approach. “My injection technique not only reduces the discomfort and downtime of surgery, but creates a smoother result,” he says. Brows are gently “lifted” by injecting Botox or Dysport into the corresponding muscle. A filler like Artefill or Restylane is sometimes also used to augment loss of bone, collagen, and muscle that occurs with many people in their 50s and 60s. “I’m not creating something new, but replacing what’s lost,” he explains.
Average Cost: The filler technique, costs run between $375 and $475 for Botox or Dysport plus an additional $700 to $1,800 for the filler, depending on the amount of filler used.
Downtime: To minimize swelling from injections, Dr. Messenger advises his patients to begin taking homeopathic Arnica by mouth about three days prior to the procedure and continue with the topical gel for about a week following the procedure.
Insider Tip: “Always go to an artist who knows the anatomy of the face as well as how we age to avoid looking overdone,” Dr. Messenger says. In other words, just say “no” to bargain-Botox parties, and be aware that counterfeit fillers and botulinum toxin are a major issue.
Tired of looking tired? Sagging skin got you down? Your eyes—upper or lower, or both—can be rejuvenated to make you look more rested and alert.
What’s New: Because traditional blepharoplasty removes skin, muscle, and fat, “if too much is removed, it can age the eyes over time,” says facial cosmetic surgeon Anthony Alessi, DMD, MD, FACS of Alessi Medical Spa in White Plains (www.alessimedspa.com). Now there are newer techniques like the CO2 laser, which eliminates the need for a blade while minimizing swelling and bruising. It shrinks the excess fat with heat to contour the shape of the upper eyelids, with minimal bleeding risk and improved healing time. The procedure, performed under local anesthesia with lidocaine to numb the eye, is performed at the natural eyelid crease and takes one to two hours. A lower-lid procedure (with an incision along the lash line) can also be done to remove puffiness and bags under your lower lids and tighten those muscles.
Downtime: Expect a little soreness, redness, and swelling, which peaks in 24 to 48 hours. Heavy lifting or bending should be avoided for one week, as should working out. You can return to work the next day—mineral makeup covers the redness well, although Dr. Alessi recommends waiting a couple of days for the skin to seal over before applying. Stitches are removed in one week.
Cost: Between $2,000 and $3,000 for the upper eye. A lower-lid procedure, which removes fat bags under the eye, is done from inside the eyelid and costs approximately $3,000. Fat or fillers, sometimes necessary to augment or smooth out surrounding areas, add about $2,000 to the total cost.
Insider Tip: To protect your eyes from irritation from wind or sun, wear sunglasses for about two weeks post-surgery.
Don’t Feel Bad About Your Neck
A double chin, sagging neck, or prominent “bands” can make you want to hide under turtlenecks despite the summer heat. Cosmetic neck surgery traditionally involves making small incisions directly below the chin, and, in some cases, below the ears as well, to trim away excess fat and skin, and tighten and sew together the platysma muscle if needed.
What’s New: For those who don’t require a total lift, an FDA-approved laser body-sculpting system called SlimLipo can permanently remove areas of unwanted fat, firm and tighten skin, and reduce sagging under the chin. SlimLipo can also be combined with traditional neck surgery to further redefine the jaw line and optimize results. It’s performed under local anesthesia through tiny incisions that close on their own within 24 hours, so no stitches are required. Dr. Messenger of Euro Laser Spa lifts the neck without surgery by using a series of injections: Botox or Dysport soften the platysmal muscles, as Artefill plumps the skin while streamlining the jawline and replacing lost volume in the neck.
What to Expect: Most surgical neck lifts require general anesthesia and can take from one and a half to three hours. It’s not uncommon to experience some discomfort, which can be managed with prescription or over-the-counter medication. A bandage or wrap is worn over the neck for 24 hours. With Dr. Messenger’s approach, there’s little to no downtime, nor any need for painkillers.
Downtime: Expect some swelling and bruising with SlimLipo, which will resolve over the next four to five days. Bellava’s Dr. Lyons says most patients are able to return to work within five to 10 days.
Average Cost: Expect to pay between $7,000 and $9,000 for a surgical neck lift and $3,000 to $4,000 for SlimLipo. Injections of the platysmal muscles run between $300 and $400; if filler is used, expect to pay between $4,000 and $5,000. This is not a permanent solution; to maintain results, return every three to five months (for neck bands) and every 18 to 24 months to “top off” the Artefill.
Insider Tip: Though incisions made during traditional surgery can leave scars, Lyons reports that they tend to be well concealed, as they are mainly located behind the ear and sometimes beneath the chin. If the patient maintains a healthy lifestyle with diet and exercise, results last approximately 10 to15 years for a traditional neck lift; results with SlimLipo can be permanent.
The Kim Kardashian Effect
Sags, dimples, or wrinkles can end up elsewhere besides just your face. “With time, the buttock flattens and droops,” says board-certified plastic surgeon Christian I. Guzman, MD, of Cosmetic Surgery Associates of New York (www.nycosmeticmd.com), located in Harrison. A buttock lift (aka belt lipectomy) can replace some of what weight loss, aging, genetics, or gravity has taken away; bottom line, you’ll be firmer, tighter, and shapelier, without scars or stitches.
What’s New: Liposuction removes unwanted fat from other parts of your body; the fat is thenthen re-injected into the buttock area. Although the method has been around for more than 20 years, Guzman reports that more advanced methods of both extracting and preparing the fat, which help it survive in the body where it didn’t before, have become more prevalent.
What to Expect: General anesthesia is used for the outpatient procedure, which takes about two hours. The most discomfort you may experience would likely occur at the fat-donor site (usually around the waistline or “love handles”), but it gradually disappears within 48 to 72 hours and can be managed with prescription and over-the-counter pain medication. The best butt-lift candidates are women whose dress sizes are between 8 and 12; if your dress size is 4 or smaller, you might not have enough fat to contribute.
Downtime: Expect to be out of work for about one week. A compression garment is worn over the fat-donor areas around the clock (except for when showering) for about two months. Exercise can be resumed in two to three weeks, but to maintain the new fat in the buttocks, stay away from any motions that isolate the gluteal muscles (like lunges and squats). To avoid any pressure on the buttocks, Guzman advises patients to sleep on their side and recline while sitting for about a month following the procedure.
Cost: Approximately $8,500
Insider Tip: To minimize swelling, and smooth out any residual lumps and bumps, Guzman recommends about 10 specialized lymphatic massage sessions beginning the third week after surgery.