Lately there’s been some blowback regarding Botox. Much of the controversy stems from an Italian study of rats, published in the Journal of Neuroscience in 2008, which showed that Botox particles could travel into the brain. The experts More consulted aren’t concerned. “Botox is one of the safest procedures out there,” says Brandt. “There’s been so much FDA research on Botox, and all the studies I’ve reviewed show that it binds to the muscle where it’s injected, and that’s where it stays.” Scheiner agrees: “If you inject Botox in high doses, it can move. But the amounts we use are minuscule.”
What’s new: Moderation. Gone are the days when doctors aimed to make faces as tight as possible. Plastic surgeons are dipping into the dermatologist’s tool kit, often lifting and filling at the same time for a more natural look. Surgery was once your only recourse; now, with all the gentler therapies, it’s typically a last resort.
What goes right: Some doctors believe that skin-only lifts can work well, especially in younger patients. But for natural, longer-lasting results, most pros recommend the SMAS (subcutaneous musculo-aponeurotic system) face-lift, which involves repositioning the face’s underlying muscle and fat layer along with the skin. Done properly, “it will give you a relaxed, refreshed look with good cheek volume, a nice jawline and minimal scarring,” says Kassir. Some of the younger generation of surgeons, including Rosenberg, go even farther into the face below the SMAS layer to do what’s called a deep-plane face-lift.
Note: A face-lift doesn’t affect your whole face. It tightens everything from the cheekbone to the collarbone; it doesn’t affect your eyes. If you want to give those a lift, you need to undergo treatment entirely separate from the face-lift. Expect to pay $6,800 to $30,000 for a face-lift, depending on the reputation of the surgeon and his or her location. Results should last eight to 12 years.
What can go wrong: “Face-lifts are operations. And as with other operations, unless the patient is vetted properly, there can be bleeding, infection, delayed healing or poor scars,” says New York City plastic surgeon Elliot Jacobs. Any procedure that requires general anesthesia involves risks, including, rarely, heart attacks and strokes. Make sure you check in with your regular doctor before you have the surgery to be certain you’re in good enough shape for it. Other risks are aesthetic. If the doctor removes too much fat or pulls your skin too much, you could end up with a warped look. Other telltale signs of a face-lift gone awry: disappearing sideburns, “pixie ears” (lobes stitched so tightly that they meld into your jawline) and high-set, Mommie Dearest eyebrows.
HOW DO I FIX MY TROUBLE SPOTS?
Use: Botox and fillers.
Jowls and a sagging neck
Use: Fillers and Botox if you’re looking at mild jowling or early-stage laxity in your thirties and forties. Laser treatments such as Ulthera and Thermage can tone and tighten. But if you have a lot of loose skin and it bothers you, consider playing the face-lift card.
Fine lines, brown spots and uneven skin tone
Use: Mild chemical peels. LED and resurfacing lasers like Fraxel abolish fine lines and improve skin texture on a deeper level. And Botox can freeze wrinkles in their tracks.
Tired, puffy eyes
Use: Botox, fillers or lasers. Properly placed injections can raise your brows a few millimeters, which can go a long way toward making you look more rested and relaxed. Lasers can smooth and strengthen skin. If you have heavy, sagging lids and lasers don’t yield the results you want, consider an eye-lift.
Use: A vascular laser, like Vbeam or Iriderm, to obliterate broken capillaries and dilated blood vessels, at least temporarily. For ideal results, you’ll need three sessions and an occasional touch-up.