It seems we are bombarded weekly by new procedures, products, and technology all claiming to be the latest and greatest. What really works? Are the risks worth the reward? Can the claims live up to the promised results? As a plastic surgeon with a research background, I am interested in advances in technology and surgical procedures. I believe all new technologies must be evaluated on effectiveness, cost, and safety. Just because a new product or procedure works does not guarantee acceptance by the patient. Why is it everybody wants to try a new procedure just because it's new? We all are looking for the next great breakthrough in looking younger but we should be a little cautious. Before embracing a new procedure or product, I believe certain criteria must be met.
Effectiveness – This obviously is one of the most important points if a new treatment is going to last more than a year or two. Increasing competition for market share in the cosmetic therapy business has led some companies to issue false claims of effectiveness. Don't feel bad — I have been duped also! Companies send out salespersons who tout their latest product. They always tell you how great it is with lines like "No anesthesia needed" or "It will pay for itself in 6 months". They then show you studies published in non peer reviewed journals and quite often paid for by the company. Of course not all companies operate like this. Unfortunately for all it usually takes a couple of years to evaluate a product or procedure.
Safety – This is one of my biggest concerns regarding new products and procedures. My worst case scenario would be to perform a procedure on 100 patients only to learn 2 years later that many had terrible unforeseen complications. What if only a handful of patients had any results at all? Either outcome could be potentially damaging to the patient or to the surgeon's reputation. Again, complications could take many years to become evident. Therefore, I will not adopt a new technology unless I believe in its safety and low complication rate.
Cost – New technologies can be very expensive with many lasers costing well over $100,000. If a treatment is not cost effective from the patients perspective it will never be popular. Quite often it is impossible to make a new procedure affordable due to the high cost of machines and products.
Training – With all new technologies there is a learning curve. Some are steeper than others. New procedures require specific training and honesty with the patient. If a doctor performs a new procedure for the first time the patient should be well informed. Sometimes new procedures are performed at minimal or no cost. With any new procedure ask your doctor how many of these he has performed. Talk with other patients who have undergone the same procedure.
Let's look at some of the relevant new technologies:
Thermage – Introduced in early 2000 and billed as a non-surgical face lift, Thermage claims to tighten skin, improve scars, and to reduce wrinkles. This is accomplished by application of radio frequency energy via a hand piece which is cooled. Cooling is necessary to achieve optimal results. Local anesthesia is needed although many advertise "no anesthesia necessary". Many patients have informed me the treatment can be very painful with only topical anesthesia.
Downtime is minimal and results may take many months to become evident. It is possible that some patients may see no improvement at all. Often the treatment has to be repeated in six months. It is unknown how long the results will last. Complications are rare but at one recent meeting two patients with subcutaneous atrophy were presented. This is anecdotal as we do not know if these patients were treated properly. Patients who have a large amount of loose skin should undergo a face lift as they will see minimal results with Thermage. Bottom line – Thermage is basically safe, somewhat expensive, and results will vary from patient to patient. I give it a neutral rating.
Mesotherapy – This was the hot topic for 2005. It seems advertisements were popping up everywhere. Highly touted as non-surgical removal of fat, it seemed that doctors everywhere were establishing their own clinics. Whenever you see the word "non-surgical" and "cosmetic" you can bet that most adopters of this technique will be general doctors who do not perform surgery. I received weekly fliers for seminars which would train you how to perform it correctly (of course they were usually $2000). This technique originated in France and consists of a series of injections directly into the fat using a variety of substances. The most common substance used is phosphatidyl choline which has unknown effects on the human body. None of the substances used to inject patients are approved by the FDA and there is no standardization of techniques used. With minimal evidence of efficacy and safety, I can't recommend this treatment. I give it a thumbs down for now.
LED skin rejuvenation – LED lights (light emitting diodes) are used to improve the health of the skin. The two major companies (GentleWaves and OmniLux Photomodulation) claim LED light treatments have dramatic antiaging effects on the skin. The procedure is painless with minimal to no downtime and can be combined with other non-surgical procedures. Multiple treatments will be required. I looked at the GentleWaves earlier this year but decided against buying it. There are studies which show increased healing of skin wounds with LED lights. I think this technology is probably effective and very safe, but I believe the results will be minimal. I give it a weak thumbs up.
Threadlift – Also known as APTOS lift or Featherlift. I find this to be another marketing bonanza with many patients inquiring about this fairly new procedure. It sounds simple. A short, minimally invasive procedure is performed under local anesthesia where a "thread" is inserted just under the skin and pulled up tight. Areas that can be lifted include the brow, face, and neck. The “threads” are actually sutures that have been designed with barbs on them to anchor the lift. One surgeon has even given his procedure a catchy name-the "Woffles Lift". Candidates include patients with minimal laxity in their skin or those who want only subtle changes in their appearance. According to plastic surgeons experimenting with this technique, results may last only 4-6 months. Complications include visibility of the suture and bunching up of the skin. I have been to 3 meetings this year where this procedure was discussed and feel that simply pulling up the skin (without any type of dissection) will not provide long lasting results. I have actually taken out sutures from a previous threadlift (done elsewhere) due to chronic pain and bunching of skin. This underscores the point of selecting a surgeon who has experience with this type of a procedure. I have elected to not perform this procedure (it's technically not difficult) until more data is accumulated and long term results are in. I believe that in the next couple of years there will be some role for this procedure in the practice of facial rejuvenation. I give it a weak thumbs up.
Fraxel laser – Recently introduced and FDA approved, the Fraxel laser is a nonablative laser relying on the science of fractional photothermolysis. Fine lines, wrinkles, and pigmentary changes are all improved following multiple treatments spaced at 4-6 week intervals. The laser penetrates the outer layer of skin (stratum corneum) and causes the deeper dermis to undergo tissue remodeling. Clinical studies show that most people will get some benefit from the procedure (low rate of nonresponders). A topical anesthetic is used along with oral sedatives or pain medicine but some patients still complain of moderate stinging and burning. Treatments average approximately $1000 each. This technology continues to undergo intensive research and I give it a weak thumbs up. For more information log onto www.reliant-tech.com.
