Botox gel and internal bras? The future of cosmetic procedures

Despite a daunting 10.7% unemployment rate, America's love affair with cosmetic procedures rages on. While people are spending less on more invasive surgeries, they are still making room in their budgets for non-invasive treatments like Botox and Restylane. Last year, these nonsurgical procedures increased by almost 1%, while surgical procedures fell 17%, according to the American Society for Aesthetic Plastic Surgery (ASAPS).

"[T]he economy reminded people that there is a limit to how much downtime they can afford," says Dr. Julius Few, commissioner of cosmetic medicine for the ASAPS. "What I see is an increased expectation for results, but also an increased expectation of no or little recovery time."
While the scalpel will remain the tool of choice for certain cases, the future of plastic surgery and cosmetic procedures will be in noninvasive techniques -- the next generation fillers, new types of Botox, stem cells, and fat being used for things like breast augmentation, says Dr. Daniel Baker, professor of surgery at New York University.

Here are six next-generation cosmetic procedures to look forward to:

Relaxing muscles without injections

Until recently, Botox had a monopoly on relaxing those pesky facial lines. but in April 2009 the U.S. Food and Drug Administration (FDA) approved Dysport, a form of botulinum toxin, that for some experts has proven to be slightly more attractive than the old standby.

"Dysport, in my practice, is as effective as Botox, but the onset of effects is a bit faster -- one day as opposed to two or three for most people," says Dr. Alexander Rivkin, founder of Westside Aesthetics in Los Angeles. "The main benefit of Dysport is that it introduces price competition to the neurotoxin market." Dysport can cost about $75 less than Botox per treatment.

But one of the products experts are most excited about is Revance's topical form of botulinum toxin. This gel would be administered by a physician on the skin, so forget those scary needles. The product is currently in clinical trials and is being studied for crow's feet and underarm sweat. If all goes well, Revance could apply for FDA approval within the next two years.

However, Revance's overall effectivenes and whether it can be used on other parts of the face have yet to be established, says Dr. Anthony Youn, a board certified plastic surgeon based in Michigan. "Studies are currently looking at crows feet wrinkles, not the frown lines, which are the most common area Botox is injected."

Fighting fat without a scalpel
Want to lose a couple of inches of fat from your thighs, but are too afraid of liposuction? Machines that use ultrasonic energy to break down fat cells so the liver can metabolize them are creating waves among experts. Ultrashape and Lipsonix, for example, have had good results in Europe, but are awaiting FDA approval in the U.S. -- a process that may take another year or two.

These non-invasive procedures may require less recovery time than liposuction, but they are still time-consuming. They are also best used on only small areas and on only one area at a time, says Dr. John Perrotti, a board certified plastic surgeon and an assistant clinical professor of surgery at New York Medical College. To have one area done, a patient may need to see a doctor up to six times. In the U.K., a package of five to six sessions can run $3,000 -- still less than one liposuction procedure.

"Liposuction is probably one of the safest procedures we do if done by the right hands, but for people with small areas who want a small change and are afraid of surgery, these modalities have the potential to open a new market," he says.

Another method for getting rid of fat is to melt it away by injecting a compound of chemicals, enzymes, and vitamins that help the body to metabolize fat. For the first time, a FDA-approved clinical study is underway to determine the effectiveness of injection lipolysis, also known as lipodissolve or mesotherapy.

Perrotti says he has also seen a new product that claims to temporarily shrink fat cells that could hit the market within the next year. The product would be ideal for small areas and costs about $500 per procedure instead of up to $800 for lipodissolve. Still, much more needs to be known about side effects and the uniformity of the treatment. For example, if you inject the product into the thigh, how much smaller and how smooth will the thigh become?

Whether you go for the machines or injections, experts say it's still not clear how much fat the body can metabolize. For permanent removal of fat, liposuction still remains the standard to beat.

Filling in fine lines the 100% natural way
New hyaluronic acid fillers have been approved recently that, thanks to the addition of lidocaine, make the injection experience more tolerable. But if you want something 100% natural, you didn't have a choice -- until now.

Once the tool for injured athletes, platelet rich fibrin matrix (PRFM) is now being used by experts as a device to fix imperfections like scars, divets and acne scars. Selphyl, the FDA-approved procedure developed by Aesthetic Factors, spins small vials of your blood in a centrifuge to gently separate platelets from other blood materials. Those intact platelets are then mixed with a calcium chloride solution to produce fibrin, a protein that is a key factor in blood clotting. The PRFM can then be easily injected into the targeted areas, with the whole procedure typically taking 20 minutes.

"Right now there isn't anything that a doctor can inject you with that is not artificial," says Dr. Joseph Gryskiewicz, co-chair of the Hot Topics Seminar for the ASAPS and a board certified plastic surgeon based in Minneapolis. "They've done 8,000 patients in Japan and have had no serious adverse effects. That is good data."

The procedure costs about $900 and preliminary observations show that PRFM may have lasting effects. Aesthetic Factors is following some U.S. patients to find out just how long.

Lifting breasts with your own internal bra
According to Youn, doctors in Europe are working on an implantable internal bra made of either silicone or synthetic mesh. "The idea of this device is that it may be able to prevent the gradual drooping seen with all breasts," he says.

since breast augmentation topped the ASAPS's list of the five most popular surgical procedures last year, there could be huge demand.

Unfortunately, the procedure is still experimental, with no studies being conducted as of yet for FDA approval. Should they start, Youn says they must address concerns about whether the hammock-like implant would interfere with breast cancer screening.

Brightening the skin
Skin treatments like microdermabrasion and chemical peels continued to be among the five top nonsurgical cosmetic procedures in 2009, according to the ASAPS. So it's no surprise companies have been on the hunt to find more powerful peptides to reduce fine lines, wrinkles, hyperpigmentation, and, in general, give patients of all color brighter, more youthful skin.

One that Rivkin likes, is JolieMD Metamorphosis, developed by two facial plastic surgeons in Beverly Hills. "These products address not only the pre-existing discoloration, but also its root cause: the inflammation that leads to excessive pigment production," he explains.

To combat any possible skin irritation, Metamorphosis contains anti-inflammatory ingredients like green tea extract and bisabolol (chamomile extract). Despite it's natural ingredients, it is "a strong regimen," warns Rivkin. "Patients who tend to have dry skin normally should start first on an every other night basis to let their skin adjust." A one-month supply costs $96.

Banishing undereye circles
Are those dark circles under your eyes getting you down? There is now a procedure that can remove them for up to 10 years. During blepharoplasty (eyelid surgery), a physician now takes the natural fat from under the eyelids to fill in the hollows under the eye.

"This procedure doesn't require an external incision, which means no scar," says Dr. Andrew Jacono, a dual certified facial plastic and reconstructive surgeon based in New York City. "It's also a vast improvement over procedures of the past. Older procedures would remove tissue underneath the eye, which actually accentuates dark circles."

While it is minimally invasive, the $7,000 procedure is surgery and will result in some bruising. Still, says Jacono, "it's something that you can do on a Friday and be back at work by the following Monday or Tuesday."

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