Facial Cosmetic Procedures: So Many Choices! What’s a Girl (or Boy) to Do?

There are those who say that one should age gracefully and take those inevitable wrinkles and loss of facial structure in stride. Wear them as a badge of honor, so to speak.  Well, that’s fine for some, and I say if that is what you choose, then you do you, right?

Let’s say, though, that you want to preserve your youthful appearance for as long as you possibly can and keep ‘em guessing about your age.  There are so many choices out there to help you achieve that goal, so where do you start?

First and foremost – skincare!  I have another article about that coming up, but the gist of it is that proper, hydrating skincare is a must, along with taking preventative measures intended to prevent or delay signs of aging (sunscreen, tretinoin or retin-A, proper diet, ditching those cigarettes or vapes, and enough rest, to name some of the most important).

But let's say you've done all that, and you are not satisfied with the results or your skin is not responding like it used to. You are ready to take the next step beyond what is considered “normal” skin care routines, yet doing research on available treatments and how they can affect you is daunting at best. A lot of women just plain give up because of too much conflicting information, or not enough information, or facts that get mixed up with myths.

Let me help!  Here are my favorite procedures, the rundown on each, what you can expect, the advantages, and yes, I would be remiss if I didn’t include the disadvantages:

Botox Injections

The rundown:  The benefits are substantial with high satisfaction rates.  Botox is derived from Clostridium botulinum, a toxin which is ultimately refined, then reconstituted with a saline which results in an FDA approved injectable solution.  This solution, when injected into targeted tissue, induces temporary muscle paralysis leading to significant cosmetic improvements  - with virtually zero side-effects for most.  Not only is it used for wrinkle reduction and to improve facial aesthetics, but it is also used in various other medical and dental applications, even down to treating migraine headaches successfully.  It is a great non-surgical cosmetic alternative.

What you can expect:  Your provider will map out the areas that need to be targeted on your face by asking you to frown, crinkle your eyes, look mad, pucker your lips, etc.  When you do this, your wrinkle lines become more prominent, and the middle of those unwanted little lines are marked with a white dot, which is the target for your tiny little injection.  The needle is very small (usually 30 to 34 gauge for any of you in the medical field) which causes less trauma to the tissues, minimizing bruising.  The injections are mostly superficial, meaning they don’t go very deep but target your wrinkles by paralyzing the underlying facial muscles directly underneath.

Advantages:  Botox is minimally invasive and the procedure takes minutes.  Recovery is instantaneous, and you see your optimum results very quickly, usually within a week or two as the toxin takes hold.  Botox helps you maintain a natural appearance, with visually appealing results and virtually no down time.  It is very effective in diminishing the appearance of wrinkles and fine lines.

Disadvantages:  If not administered correctly, Botox can result in an unnatural appearance or frozen face.  Botox is temporary, and so to maintain your desired aesthetic the procedure needs to be repeated every three to four months.  The injections can be uncomfortable for some, and cost can be significant.  The most common side effect is bruising, and migration to unintended muscles has been reported, as well as headaches and eyelid drooping (rare).

Dermal Fillers

The rundown:  Dermal fillers are injections that smooth your facial lines, eliminate wrinkles, and fill in your collagen volume loss from aging, eliminating sagging skin.  There are many types of fillers such as hyaluronic acid (Restylane®), calcium hydroxylapatite (Radiesse®), Poly-L-lactic acid (Sculptra®), and polymethylmethacrylate (Bellafill®), just to name some of the more common.  I won’t go into the specific properties of each one, that is your job to ask your provider what will work best for your needs and desired outcome.  Dermal filler procedures are becoming more and more common (last year over 3 million people in the United States alone utilized dermal fillers).  Results are visible right away, and some fillers can last months, or even years! Fillers are another great alternative to surgical intervention.  My personal favorite is Bellafill®, which can last up to five years.  Pretty impressive.

What you can expect:  You and your provider will formulate a plan, looking at your face together in the mirror so you are both in agreement about where the fillers should be placed and why.   A discussion about possible side effects and recovery time should occur, and your paperwork that you filled out before this consultation needs to include your medical history (if it doesn’t, run – don’t walk – away).  Target dots may be drawn on the face to show where the entry points will be for the procedure.  Once you have mapped out the areas, it is necessary to numb the entry points with small lidocaine injections (if a canula is going to be used) or a topical numbing cream if not. In the case of my filler of choice, Bellafill®, a canula is inserted at the target allowing for optimal delivery and spreading of the filler without multiple entry points.  You may feel a slight tugging and, in some cases, a little pop when the filler meets connective tissue, but for the most part, many tolerate the procedure well and with little discomfort.  Once the fillers have been injected, your provider will rub the area to make sure the fillers disperse correctly, and then you may be treated with a hot facial towel compress to stimulate lymphatic drainage.

Advantages: As with Botox, fillers are minimally invasive and the procedure can be done in your clinician’s office, usually taking an hour or so.  Recovery is fairly quick, and you see your optimum results instantly.  Fillers maintain a natural appearance, with visually appealing results and virtually no down time.  They are very effective in making wrinkles and fine lines disappear, and can last years – I choose Bellafill® because it can last up to five years.  Fillers are also much less expensive than elective facial surgical procedures, and unlike surgery, you can show your face in public immediately (if you do bruise, just utilize a good concealer once your provider tells you it is safe to do so).

Disadvantages:  Serious complications are very rare, but as with any procedure, do happen.  Any time you break the skin, you run the risk of infection, which is why it is important to have a provider that is knowledgeable, experienced, and is a stickler for sterility in their practice.  You will more than likely experience some form of bruising or swelling or both.  Other common side effects are numbness, redness, itching, and tenderness.  Cost can be significant, and the procedure can be uncomfortable for some.

Lasers

Oh boy, where do we start with this!?!  How many laser facial procedures are there?  Too many to list!  There are lasers for skin pigmentation, acne, skin tightening, hair removal, removal of skin tags, removal of vascular lesions, removal of tattoos, melting of fat, for toning and for texture.  What you choose to have done will depend upon your ultimate goals.

I have experience with BBL (broad band light) which evened out my skin tone, got rid of sun spots, and improved overall pigment, but doesn’t last especially if you have any sort of sun exposure at all.  I also used BBL for laser hair removal, which did last but I had to undergo multiple treatments.  I tried the Agnes RF (radio frequency) to remove fat and sculpt my jowl area, and was pleased with the results, but it could have been better.  But by FAR my favorite laser treatment is ENDOLIFT, so I am going to talk about that.

The rundown:   Endolift laser tightens tissue, lifts the skin and melts fat.  Yes, you read that right.  Melts. Fat.  It is minimally invasive, yet treats superficial and deep layers of the skin.  This results in toning, stimulation of collagen production, and fat melting, doing all this basically simultaneously using a microfiber optic the size of a hair inserted under the skin.  The effects of this laser treatment continue to improve and develop over the next six to twelve months after the procedure, but you can see results right away!  There is only one endolift practitioner in my whole state, Dominique Well of Well Medical Arts in Seattle (link to her webpage).  She just happens to be on the cutting edge of helping you look your best at ANY age, and I have been seeing her for six years now.  Dominique and other members of her staff have done extensive training on this procedure with a well-known provider in CA, and Dominique even had it done on herself so she would know the whole system including from the perspective of a consumer.

What you can expect:  You and your provider will talk about the areas to be done, and some facial/jowl/neck mapping will take place.  Entry points for the laser optic will be drawn on your skin, and then the whole area will be numbed.  In all honesty, the numbing portion is the worst of it, feeling like little bee stings until the lidocaine kicks in on the margins and then the rest of the numbing is not bad at all.  Once the numbing is complete, the microfiber optic laser goes under the skin through that pinpoint entry to reach the various areas for tightening and fat reduction.  You will hear the fat crackle and melt, but there is absolutely no pain.  And the best part?  Your skin will feel tighter IMMEDIATELY.  The whole procedure takes about 2.5 hours, so it is important to be prepared (well-rested, have something in your tummy, and be well-hydrated).  Subsequent to the procedure, you may  experience some mild swelling and a few little darker bruise spots.

Advantages:  Endolift is minimally invasive and results are seen and felt immediately.  The procedure is out-patient in your provider’s office, and there is very little visible swelling or bruising immediately post-procedure.  Your results will continue to improve over the following six to twelve months, and will last indefinitely if you take proper care of yourself with diet, use of sunscreen, and proper lifestyle.  Endolift is convenient and quick, helping to achieve more youthful and radiant skin without surgical procedures. Endolift stimulates collagen production with durable, long lasting results. 

Disadvantages:  You may experience numbness for weeks following the procedure, as the optic does disrupt some nerve areas (although your provider should be well-versed in areas to avoid that would cause undue permanent nerve damage).  The sound of the laser crackling may be disturbing for some, and the procedure is fairly lengthy, taking about two and a half hours minimum.  Treatment is moderately costly, actually around the same cost as a dermal filler session.   As with any procedure that enters your body, there is a risk of infection.

Now we come down to the BIG question:  What provider should I use?  Who do you trust to have these procedures done? There are tons of providers out there and honey, if you read the reviews, either clients hate them or clients love them, and who do you believe?

Well, we all know that one woman who always looks fantastic. Her skin is elastic and glowing, she has minimal wrinkles and it is nearly impossible to guess her age. This is where you put on your big girl panties, walk up to her and say “What is your secret if you wouldn't mind sharing?” If she won't share then ask the next fantastic looking woman you come across that you feel comfortable enough approaching.

All in all, though, I guarantee you that in your circle of friends there are plenty of people that have had successful cosmetic work done and would be willing to share who they go to, what they get done, and why.

My go-to is Well Medical Arts, and my reasons should be obvious (look at the before and after pictures at the bottom of this post).  If you do go see her because of what I wrote here, please do mention this blog.

In conclusion, every woman (or man, for that matter) should have the opportunity to look and feel their best at any age.  How they achieve that is a personal preference.  I am not too proud to say that I am doing everything that I can to preserve my skin elasticity and youthful appearance.  While everything I am doing is not just limited to the procedures we just talked about, it sure helps….

After Procedures: Still a few wrinkles (but in all fairness I AM smiling), plump in the right places and snatched in the others

Before Procedures: UGH