Make the Most of Your Looks: Nonsurgical Cosmetic Procedures

Never before have there been so many nonsurgical solutions for your aging face. Our 40+ beauty guide tells all.

By Gale Ritterhoff
Photograph: Photo by: Plamen Petkov

Nonsurgical Beauty Treatments

‘It’s a good time to be over 40," says New York City cosmetic dermatologist Deborah Sarnoff , MD. "I’ll be the judge of that," you might say. But Sarnoff has a point. Thanks to a boom in noninvasive, anti-aging procedures, you can choose from an extensive menu of smoothing, tightening, and firming treatments that don’t involve a scalpel, extensive downtime, or a $20,000 medical bill. Sound appealing? According to figures from the American Academy of Plastic Surgeons, millions of U.S. women think so: Between 2000 and 2007, the number of nonsurgical beauty procedures performed in this country jumped 81 percent. But is an injectable filler or laser treatment the right next step for you? It depends on how much "aging" (for example, fine lines, dark spots, and slack skin) you can you live with — and what you’re willing to endure (nonsurgical procedures are pricey and not entirely pain-free). To help you figure it all out, we’ve compiled a primer of the latest knife-free treatments. The info here covers everything out there, from the least invasive treatments to the most aggressive (short of surgery). So sit back and survey the latest ways to make the most of what you’ve got.

Starting Small: Lasers and Light Treatments

Reducing redness, uneven tone, dark spots, and spider veins

The earliest lasers were ablative, meaning they literally vaporized the top layer of your skin, causing your body to make fresh, new cells, while also triggering a healing process that boosts the production of skin-plumping collagen. The procedure was intense but very effective at evening out mottled skin and minimizing deep wrinkles, says New York aesthetic plastic surgeon Lawrence Reed, MD. However, the prolonged healing time (often six to eight weeks) and lasting redness are "not what modern women want," he says. So today, when it comes to reducing redness and fading dark spots, patients rarely subject themselves to the ablative lasers, opting instead for newer, less aggressive technologies that take longer (for some, a series of up to eight treatments done every four to six weeks is required) but offer comparable results. Important to note: The following lasers and light treatments may not be effective on very dark skin because the devices have difficulty deciphering between normal skin and hyper-pigmented cells. Check with your doctor to find what’s right for you.

To Calm Inflamed Skin

For reducing redness and inflammation (from rosacea, acne, or the aftereffects of a chemical peel), Mary Lupo, MD, director of the Lupo Center for Aesthetic and Cosmetic Dermatology, in New Orleans, says a good entry-level procedure is the light-emitting diode, referred to as LED. This treatment uses several wavelengths of light (a laser generally uses just one wavelength) to activate the cells that produce collagen and elastin, accelerating repair and evening out uneven tone without the weeks of healing required by the lasers of old. The LED works best in a series of six to eight treatments spaced every four to six weeks. Happily, you should experience no pain or downtime; and the cost per session ranges from $100 to $200 (or $600 and up for a series).

To Fade Sun Damage

If you suffer from age spots or discoloration, you may want to try intense pulsed light therapy, commonly referred to as IPL. Similar to LED, IPL relies on strong, broad-spectrum light (the damaging UV rays are filtered out) that destroys dark pigment. (Tissue is left unharmed so the skin suffers minimal irritation and there is virtually no downtime.) In addition, the process boosts collagen production and smoothes skin. Sarnoff notes that this is an excellent way to erase age spots on the hands and chest as well. Cost per treatment is $350 to $900, and you will need about three to six sessions performed every four to six weeks to get the best results.

To Shrink Broken Capillaries

If spider veins are a problem, consider the Vbeam Laser, which delivers long, intense pulses of light into the blood vessels, gently breaking them apart, says Manhattan dermatologist Dennis Gross, MD. Although quite effective at taking the red out, the Vbeam doesn’t damage the skin’s top layer so there’s no downtime, and discomfort is minimized during the treatment by applying a coolant, such as cryogen, directly onto the skin just before each energy pulse to prevent pain and burning (as well as to minimize any redness afterward). The cost of a Vbeam treatment is $200 to $1,600 per session, depending on the number and size of spider veins you’re treating. One session is typically enough, though if your skin’s redness is pronounced, a second may be necessary.

Serious Help: Injectables

Erasing lines and plumping and firming slack skin

To smooth skin (almost) instantly, you need a slightly more invasive treatment than light therapy. Typically called injectables, these procedures now produce better results than ever before, says Neil Sadick, MD, clinical professor of dermatology at Weill Cornell Medical College in New York. So rejoice: The days of frozen foreheads and crazy fish lips are over.

To Fill in Wrinkles

Hyaluronic acid — under the names Restylane, Juvederm, and Perlane — is one of the most common line fillers and skin plumpers on the market. Highly versatile, it comes in different densities formulated for different purposes: thinner for fine lines around the eyes and thicker for deep grooves like the marionette lines around your mouth. Your doctor can also use it as a volumizer (meaning it can fill in a whole area of the face as opposed to just inside a wrinkle) to plump hollowed-out cheeks.

Because a hyaluronic acid injection lasts only up to 10 months, it’s considered temporary. (Most patients require a series of two to four injections in order to see full results.) Be prepared for a bit of post-injection swelling, redness, and/or bruising. The cost is $600 and up per treatment, depending on how many syringes are used.

To Plump Deep Grooves

Nonhyaluronic acid fillers like Radiesse (made of calcium hydroxylapatite, a substance found naturally in the body) and Sculptra (made of poly-L-lactic acid, a synthetic substance) are used to fill in your deepest wrinkles and add volume to the face. According to Sarnoff, Radiesse is most commonly injected in the grooves that form next to the nose and mouth (the nasolabial folds, in doctor parlance). As a bonus, once this area is filled, the cheek also gets pushed upward and the whole face gets a subtle lift. Both injectables last in the skin for two or three years, thanks in part to the fact that they have been shown to boost your skin’s own collagen production. Cost: $1,000 and up per procedure and you may need one additional treatment, six to eight weeks after your first treatment.

Some doctors also use a patient’s own fat to add fullness to an aging face, says Jack A. Friedland, MD, a Phoenix plastic surgeon. It’s a safe alternative since you don’t have to worry about any adverse (allergic) reactions to the substance, but the harvesting process, that is, taking fat from somewhere else on your body, does require local anesthesia. Cost: $350-$5,000 and up and results last for a year or more.

Finally, Evolence, a recently approved injectable derived from pig collagen, is also being used in the nasolabial folds. It is said to present less chance of allergic reaction than bovine (cow) collagen, another popular plumper. One big benefit is that it offers a pliable texture that is especially "soft and natural when used around the mouth," Sarnoff says. Prices start at around $300, and results last at least six months.

To Smooth Fine Lines

When it comes to erasing clusters of fine lines around the eyes, between the brows, and across the forehead — as well as lifting droopy brows and jawlines — nothing beats Botox. "We’ve learned so much about the muscles and what they’ll do," Reed says. To lift and smooth the neck and jowls (a popular new way to use this injectable), Botox is placed in the platysmal bands, which run from under the jawline to the base of the neck, relaxing the muscles that pull down on the face. Cost: $300 to $1,500 per treatment; results last up to six months.

To Lift Slack Skin

Some doctors are using fillers in revolutionary ways that literally change how the skin hangs on your face. New York cosmetic plastic surgeon Yan Trokel, MD, created the Y-Lift, in which Juvederm is utilized to subtly boost the lower half of the face. Trokel inserts an instrument into a small hole made near the ear, gently lifts the skin back, then injects Juvederm to hold the tissue in place. "This allows you to lift up the lower face. And in the process, the neck is tightened, and lines there go away too," Trokel explains. The procedure is performed under local anesthesia; results can last up to two years. Cost: about $5,500.

In general, say experts, you will see best results with injectables if you start slowly with a temporary filler like Restylane or Juvederm (as opposed to a formula that stays put for several years). Also, you may want to try Botox in baby steps. You can always add more if you’d like, but subtracting is impossible (and you have to live with the results for at least three months).

The Big Guns: Hi-Tech Procedures

Smoothing, tightening, and boosting radiance

Depending on the intensity at which they are performed (most may be dialed up or down), these procedures are more costly and the age-defying results more pronounced than nearly any other in-office treatments, short of surgery. But beware: A single session with one of these high-tech devices can run well above $1,000, and you must go to an experienced doctor to have the procedure done. Yes, you can find someone who charges less (especially outside of a doctor’s office), but bargain hunting is definitely not advisable when it comes to heavy-duty lasers. If you can’t afford what an experienced dermatologist or plastic surgeon charges, then rethink your plan.

To Erase Sun Damage

If you have mottled skin and abundant age spots, a fractional laser (Fraxel is one of the most popular) is an effective option. This type of laser is broken into separate pinpoints (think pixels in a digital photo) that are able to target very specific areas like dark spots on the skin. The tiny wounds made in the skin by the laser kick-start a healing process that stimulates collagen production (your hands, neck, and chest can be treated this way as well). Recovery time is minimal, but for optimal results you will most likely require at least one more blast (if your sun damage is severe, you may need three to four treatments). Cost: $800 to $3,000 per treatment, with results lasting a year or more.

To Smooth Texture and Tone

If your complexion is dull, rough to the touch, and starting to grow slack, the Pearl Laser and Portrait Plasma Skin Regeneration are good choices for you. The Pearl uses a light wavelength to target the top layer of the skin, causing a remodeling process through collagen growth and resurfacing. One caveat: Your complexion may be quite red and flaky for three or four days, requiring what’s often referred to as "social downtime." (A trip to the movies? Absolutely. A trip to your high school reunion? Probably not.) Physical discomfort is manageable, say the experts, but the full recovery (as in no more flakes or pink skin) takes about a week, sometimes longer. Cost: $1,200 to $3,500 per session, and you should only need one. Results last up to three years.

Portrait Plasma Skin Regeneration, a procedure that uses heat from nitrogen plasma to cause a shedding of the skin’s outer layer, has the added benefit of also stimulating collagen builders deep within the skin to improve skin tone and texture over time. The healing process is said to last about a week, as the cells slowly exfoliate off, revealing a new, refreshed layer of skin underneath. Cost: $3,000 and up per session; most patients will need only one. Results last up to two years.

To Lift Very Saggy Skin

Few treatments (short of a facelift) are more effective at raising droopy skin than Thermage and Titan. Thermage uses radio frequency to stimulate the cells that produce collagen, lifting and tightening the skin almost instantly. Titan works in a similar way but uses gentle infrared rays to cause the collagen production. (Both companies claim the face-firming results will continue to improve for about six months after getting the treatments.) Deep-heat procedures may also be used on the neck and hands, and Thermage has recently developed a version for the eyes (some doctors swear the results rival those of an eye-lift). A pain reliever or local anesthetic is sometimes used as these treatments are called hot for a reason. Cost: For Thermage, you can expect to pay $1,000 to $5,000 per treatment, and one session is typically enough. For Titan, prices range from $1,000 to $2,000 and you will probably need two to three for optimal results. With Thermage and Titan, the tightening effects last up to four years.

To Tighten Loose Skin

To get rid of loose, saggy skin under the chin (not-so-affectionately referred to as the wattle), many doctors are now performing the SmartLipo procedure. In this treatment, a tiny laser fiber is inserted underneath the skin in the neck via a small incision. The laser fiber heats up and destroys fat, tightening any loose tissue, Sadick says. Results are permanent; as with regular liposuction, once the fat cells are eliminated, they’re gone for good.

But before you run out to try any of the above treatments — from the mildest light therapy to the most intense laser — heed the following words to the wise consumer: Make sure you find an experienced, board-certified doctor who performs the procedure you’re considering on a regular basis. That means he or she uses injectable treatments at least 10 to 20 times a week. For lasers, look for a doctor who has worked with the technology for at least a year. "The worst complications arise when, for instance, a family practitioner injects a dense filler like Radiesse in the wrong place, leaving your skin looking lumpy," Lupo says. Similarly, a laser operated by someone who has not been trained appropriately can leave you badly burned. To locate a board-certified cosmetic dermatologist or plastic surgeon in your area, go to the Web sites of the American Academy of Dermatology at, or the American Society of Plastic Surgeons at

At-Home Light Therapy

We’ve heard of do-it-yourself microdermabrasion. Now at-home light therapies are hitting the market too. Magic bullet or an exercise in futility? The jury is out but that hasn’t stopped a plethora of anti-aging options from popping up on shelves this fall.

The Light Renewal Skin Rejuvenation Therapy, ($335, by Perricone MD Cosmeceuticals, consists of a small screen filled with what looks like tiny lightbulbs (they’re so bright, the package includes eye shields). The device uses LED technology to soften fine lines and wrinkles; results are said to be noticeable in about two to three months.

Another new at-home device is the Tanda Professional, a light therapy duo for daily use. Its purpose is to both prevent and heal acne and to stimulate collagen production. How it works: The device uses blue-based light to kill acne-causing bacteria, then adds red light to stimulate collagen (which reduces acne scarring by smoothing and firming the skin). At present this device requires a doctor’s prescription and costs about $395.

Rethink Your Beauty Routine

Put down the: Shimmer

Pick up the: Matte

Payoff: Shimmer sparkles on the young, but when you’re over 40 those light-catching flecks only highlight fine lines. Better ideas? Matte loose powder and eyeshadow.

Put down the: Bronzer

Pick up the: Moisturizer

Payoff: "Too much bronzer looks unnatural and old," says Estee Lauder global makeup stylist Rick DiCecca. Want that natural glow? Wear moisturizer, for a dewy effect. "It reflects light more subtly."

Put down the: Pointy lip pencils

Pick up the: Soft, fat pencils

Payoff: "A too-harsh lip line" is a red flag for aging, says New York City makeup artist Sue Devitt. Use color pencils with softer, wider tips to blend the lip’s edges.

Put down the: Orange- or red-toned blush

Pick up the: Blush with blue or pink undertone

Payoff: Blue-based pinks help revive dull skin without leaving it looking ruddy. Apply blush high on the apple of the cheek for overall brightening, and to enhance the whites on your face (eyes, teeth), Devitt explains.

Put down the: Heavy foundation

Pick up the: Lighter formulation

Payoff: A sheerer layer of base lets your skin show through, for a more youthful appearance. Use your heavy foundation as an easy-to-blend concealer to spot-cover anything more prominent, Devitt says.

Put down the: Powder blush

Pick up the: Cream blush

Payoff: New York City makeup artist Genevieve Herr says powder blushes tend to sit on top of the cheek, enhancing fine lines. The moist effect of cream blush gives a youthful-looking appearance.

Put down the: Tweezer

Pick up the: Brow pencil

Payoff: Over-tweezed brows leave eyes without a frame, highlighting fatigue and fine lines. "A fuller, natural brow looks young and soft," New York-based makeup artist Vincent Longo says.

Bobbi Brown’s "Less Is More" Approach to Anti-Aging

Step one, Brown says, is to give your face a "cushiony look" (translation: skin that looks moist and plump). To achieve, apply a hydrating sunscreen like Estee Lauder DayWear Plus Multi-Protection Anti-Oxidant Lotion SPF 30 ($38,, then layer a balm on top. One to try: Bobbi Brown Extra Moisturizing Balm ($85, all Bobbi Brown products at This product stays put, "locking in moisture for dewy skin all day," Brown says.

Once the skin’s surface is prepared, Brown says the over-40 woman should brighten her undereyes with a pink or peach-toned color corrector. We like the Bobbi Brown Tinted Eye Brightener in Light Peach ($32) or Yves Saint Laurent’s Touche Eclat Radiant Touch Highlighter ($38,, available in four shades.

Then sweep a vibrant blush on the apples of your cheeks. Brown recommends her Pot Rouge for Lips and Cheeks in Pink Raspberry or Powder Pink ($22). On your lips, steer clear of dark colors; they age you instantly. Better bets? Tinted lip balms in soft, neutrals like Brown’s Lip Sheer in Pale Pink ($22).

Last step: Add a little shine to your mouth. Brown’s Brightening Lip Gloss ($20) comes in myriad, wearable shades, and Lancome’s Color Fever Gloss ($23, comes in perfect-for-fall hues such as Solaire and Hotness. For more application tips, look for Bobbi Brown Makeup Manual, in stores December 1.

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Originally published in MORE magazine, October 2008.

First Published Mon, 2009-04-06 18:35

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