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No Time for Wrinkles; Women have more beauty-treatment choices
than ever. Is that a good thing?
Source: Newsweek
Date: 5/10/2004
Author: Barrett, Jennifer
Alisa Kauffman has been practicing dentistry
for nearly two decades, but some new patients still mistake the
petite, 44-year-old New Yorker for a dental-school student. "I
tell them it's just the Botox®." But the popular treatment,
which paralyzes the muscles that form wrinkles, is actually just
one weapon in Kauffman's anti-aging arsenal. She began applying
Retin-A (trans-retinoic acid) daily to wrinkle-prone areas of
her face at 28, well before the vitamin-A derivative became widely
accepted as a topical treatment for fine lines. At 40, she added
more potent products. Besides periodic Botox® shots for her forehead
and eyes, every few months she gets injections of Restylane®
to smooth the skin by her mouth (the transparent hyaluronic acid
gel, used to fill wrinkles, was approved by the Food and Drug
Administration in December). Kauffman also regularly undergoes
intense pulse-light (IPL) treatments--laserlike pulses of high-intensity
light that penetrate the skin--to get rid of a sprinkle of sun
spots on her face. "I am very vigilant," says Kauffman,
an attractive redhead. "I try to take care of things before
they happen."
That's much easier to do these days. The quest
for youth--or, at least, the appearance of it--is ages old. But
the range of nonsurgical, anti-aging options has soared in recent
years. Most women are wary of going under the knife in their 30s
and 40s, but they'll undergo a temporary treatment that can smooth
their skin in one lunch break. Less costly and more convenient
than surgery, cosmetic injectables, IPL therapy and other wrinkle
remedies are booming as more and more women incorporate them into
their beauty-maintenance routines. The American Society of Plastic
Surgeons says 6.9 million such procedures were performed last
year--up 41 percent from the year before. Women made up 86 percent
of the patients.
A few years ago doctors relied on collagen that
came from cows and required a skin test. Now there's a range of
fillers, from Restylane® to CosmoDerm and CosmoPlast--both made
from human collagen that require no test--and, of course, Botox,
which gained FDA approval just two years ago for the treatment
of frown lines. "They're extraordinarily quick to perform
and have an extraordinarily rapid recovery--if there is a recovery
period at all," says New York surgeon Philip Miller, who
performed Kauffman's procedures. He and other practitioners say
the uncomplicated nature of the treatments keeps women coming
back for more. "I have several female patients who feel that
because they are in the workplace and around so many young people,
they need to do whatever they can to keep up a more youthful appearance--without
using surgery," says Boston dermatologist Lynn Baden. "It
makes you look good, so why not do it?" says Robin Rothkopf,
46, a real-estate investor in Newton, Mass., who has had Botox,
Restylane® and human collagen injections. "Every single person
I know does it. Young and old--everybody." While the side
effects of such treatments appear minimal, no U.S. studies have
tracked long-term use. The psychological impact on women is also
a concern. Clinical psychologist Rita Freedman, author of "Bodylove:
Learning to Like Our Looks and Ourselves, A Practical Guide for
Women," calls it the "creeping disease." "One
woman gets Botox® and then her neighbor and relatives look at her
and feel relatively unattractive and feel they need to do something,
too," she says.
Women in the work force seem particular susceptible
to such pressure. "Working women are judged in a different
way than men; they have to be equally productive but also keep
their appearance up," says Elliot Jacobs, a Manhattan plastic
surgeon who treats several high-powered executives. "A man
can have lines on his face and look 'distinguished,' whereas a
woman looks 'old.' They're judged by different standards. It's
sad, but it's true."
Younger women are not immune. While nearly half
of those who underwent minimally invasive procedures last year
were between 35 and 50 years old, almost 20 percent were between
19 and 34. That has critics of cosmetic procedures particularly
concerned. "When people in their 20s and early 30s are running
off to have Botox, there's a real problem. We place far, far too
much emphasis on youth and beauty," says Lia Macko, coauthor
of "Midlife Crisis at 30: How the Stakes Have Changed for
a New Generation--And What to Do About It."
But research shows that more attractive people
get better jobs and salaries, and more respect from peers. "We
have evidence showing that, whether we like it or not, appearance
does matter," says David B. Sarwer, assistant professor of
psychology at the University of Pennsylvania School of Medicine
and director of education for the school's weight and eating disorders
program. "They get preferential treatment in a variety of
situations across a life span. And we know that especially with
women, we equate beauty with youthfulness. So trying to present
yourself as looking as young as possible might actually make practical
sense."
Though maybe not financial. At $500 or more
per session, noninvasive treatments can add up. But patients say
it's worth it. "The cost does bother me, and it's a pain
to go back every few months," admits Rothkopf. "But
what's the alternative? "
Women like Rothkopf and Kauffman might be able
to decrease their visits, and maybe their bills, in the near future.
Several longer-lasting treatments are pending FDA approval. One
is Radiance, which contains calcium hydroxylapatite (a component
of teeth and bones) and has been shown to keep wrinkles filled
for more than three years when injected. Another, polylactic acid
(marketed as Sculptra), stimulates collagen production to fill
wrinkles and is already widely used in Europe. It has been shown
to last up to 18 months. (Restylane's effects, on the other hand,
wear off after four to nine months.)
Such long-term temporary treatments, however,
can only postpone the need for permanent procedures so long, say
some experts. "You reach a point where you might as well
do the face-lift. In the end, the only thing that is really going
to tighten your skin is to lift it up--and that requires surgery,"
says Boston plastic surgeon Ramsey Alsarraf, coauthor of "The
Aging Face: A Systematic Approach. " More than 8.7 million
cosmetic plastic-surgery procedures were performed last year,
according to the American Society of Plastic Surgeons--an increase
of nearly one third. Eyebrow lifts and face-lifts were among the
most popular procedures.
Even Kauffman admits that at some point
in the not-so-distant future, her temporary treatments might not
be enough. Her 65-year-old mother, Theda Kauffman, who still gets
Botox, had a face-lift when she was 55. Kauffman doesn't plan
to wait even that long. "You don't want to do it right away,"
she says. "But get it before you need it. Then you keep looking
good." For now, anyway.
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