Completing the Picture

Illustration by Adam Niklewicz

There are more ways than ever to turn back the proverbial clock with surgery, spa treatments, and cosmetic procedures. Here are a few ways to sort through your options.

January 1, 2009

By Monica Wright

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We’re Americans: we love choices—the more the better. There are often so many selections in a day (caff? decaf? skim? soy?) that we don’t even realize we’re weighing in. But what’s good for your morning coffee can be daunting when it comes to more weighty decisions . . . like choosing to undergo a cosmetic procedure.

So you want to eliminate wrinkles? Of course, there’s the facelift and there’s photorejuvenation. Injectable fillers. And chemical peels. Arm yourself with a better idea of what works best where (and what the risks and recovery times are) with our primer to popular cosmetic procedures. We outline your options with input from local practitioners.

Eyelid Surgery

Otherwise Known As: Blepharoplasty
How It Works: An overabundance of skin around the eyes ages the face. Through blepharoplasty, excess eyelid skin and fat is removed from the upper and lower eyelid through small incisions (external for upper eyelid, either internal or external for lower eyelid).
Typical Patient: Men and women in equal numbers, typically beginning in their forties.
Risks: Bleeding, scarring, infection, malposition of the eyelids, asymmetry.
Recovery Time: You’ll experience puffiness and bruising around the eyes for seven to fourteen days. “The nice thing is that while you look banged up and puffy, you really have little if any discomfort relating to the procedure,” says William J. Lipham, board certified ophthalmologist and fellowship-trained ophthalmic, plastic, and reconstructive surgeon with Minnesota Eye Consultants. “It’s a good sympathy surgery because it looks like you should feel miserable, but you don’t.”
Maintenance: Results should hold ten to fifteen years.
Estimated Cost: $3,000 to $5,000 (for both eyes).

Brow or Forehead Lift

How It Works: Sagging brows and deep furrows in the forehead are combated by a brow lift. Through small incisions hidden in the hairline, the muscles causing the furrows are weakened and the brow is sutured into a higher position.
Typical Patient: Men in their forties, fifties, and sixties. “Brow descent is more common in men because their brow tissue is heavier,” says Lipham.
Risks: Bleeding, scarring, infection.
Recovery Time: A week to ten days.
Maintenance: Reduces the effects of aging by ten to fifteen years, and then a patient ages normally.
Estimated Cost: $5,000.

Lip Augmentation/Enlargement

How It Works: Lips thin as we age, and “lipstick lines” form around the mouth after years of smiling, kissing, and eating. Injectable dermal fillers such as Restylane and Juvederm (collagen is a thing of the past) plump up lips and fill in wrinkles.
Typical Patient: Women eighteen and up.
Risks: Bruising and infection.
Recovery Time: Expect swelling for twenty-four to forty-eight hours.
Maintenance: Results of injections last six to nine months.
Estimated Cost: $575 per cc, with one to three ccs the norm.

Facial Implants (Chin, Cheek, Nose)

How It Works: “Chins are frequently done to balance facial features or in conjunction with a facelift to create a stronger jaw or to correct a weak chin,” says Douglas Gervais, a plastic and reconstructive surgeon and co-owner of Minneapolis Plastic Surgery in Minneapolis. Cheek implants, which aren’t as common, result in higher, more defined cheekbones; nose implants reshape for cosmetic and reconstructive purposes.
Typical Patient: A mix of men and women of all ages
Risks: Infection, bleeding, damage to sensory and motor nerves in the face.
Recovery Time: Five to seven days.
Maintenance: Implants are a solid silicone material that sits on top of the bone and should last indefinitely.
Estimated Cost: $3,000 to $7,000.

Ear Surgery

Otherwise Known As: Otoplasty
How It Works: Prominent ears are set back closer to the head, while larger ears are reduced. Otoplasty requires a small incision at the back of the ear to reshape cartilage and bend it back towards the head.
Typical Patient: A balance of men and women in their teens and early twenties. “Men often have short hair, and women like to pull theirs back, so neither one is happy with prominent ears,” explains Nathan Leigh, a plastic surgeon certified by the American Board of Plastic Surgery, and partner at Edina Plastic Surgery.
Risks: Blood clot on the ear, infection, scarring.
Recovery Time: Patients can return to work in a matter of days, but swelling can last two to three weeks.
Maintenance: Results should be permanent.
Estimated Cost: $2,500 to $3,500.

Buttock Lift

Otherwise Known As: Belt lift
How It Works: An incision in the beltline area pulls tissue up from the lateral thigh and buttock and removes excess skin and fat. This procedure is also considered an extension of abdominoplasty because it goes around the patient’s entire midsection. “People love this procedure because it gets spectacular results,” says Gervais.
Typical Patient: Men and women who have lost a significant amount of weight, women who have had several children.
Risks: Infection, bleeding, scarring, fluid buildup under tissue flaps, numbness.
Recovery Time: Two to three weeks.
Maintenance: Results should be permanent.
Estimated Cost: $12,000 to $15,000.

Tummy Tuck

Otherwise Known As: Abdominoplasty
How It Works: Fat deposits are removed and loose abdominal skin is tightened, through an incision just above the pubic area.
Typical Patient: Women who have had multiple children or people who have lost a significant amount of weight.
Risks: Permanent scarring, infection, fluid accumulation, blood clots.
Recovery Time: This procedure is extensive and requires up to eight weeks of recovery before basic functions like driving are recommended, and several months before major physical activity such as sports.
Maintenance: Skin tightening is permanent, but patients need to maintain their diet and exercise routines to sustain results.
Estimated Cost: $6,000 to $10,000.

Liposuction

Otherwise Known As: Lipoplasty
How It Works: Localized areas of fat are vacuumed out of the body using a tube that is inserted through a small incision.
Typical Patient: Men and women of all ages with saddlebags at the hips or hip rolls that don’t respond to diet and exercise. “This is more of a shaping operation than a weight loss procedure,” says Leigh.
Risks: Infection, skin damage, contour irregularities, burns (with ultrasonic liposuction and laser liposuction).
Recovery Time: It will take a week to return to normal function, but swelling can last from a few weeks to a few months.
Maintenance: The permanence of liposuction is directly related to how well patients maintain their diet and exercise routines.
Estimated Cost: $4,000 to $7,000.

Facelift

Otherwise Known As: Rhytidectomy
How It Works: Through incisions made in front of and behind the ear, extra skin is removed, and facial tissue and neck muscles are tightened to reduce wrinkles, loose skin, jowling, and neck banding.
Typical Patient: Women (almost exclusively), generally in their forties to sixties.
Risks: Bleeding, infection, damage to the facial nerves.
Recovery Time: Swelling and bruising can be prevalent for up to two weeks.
Maintenance: Results should last ten to twelve years.
Estimated Cost: $7,000 to $12,000.

6 Essential Questions:

Who will be performing the procedure?
Will it be a board-certified dermatologist or a plastic surgeon? Anything less should raise red flags. The American Board of Medical Specialties allows you to check for yourself, as does the Minnesota Board of Medical Practice.

What is your training?
“Doctors are proud of their academic achievements and should have no problem answering questions about where they did their residency, fellowships, and what type of training they received,” says William J. Lipham, who is a board certified ophthalmologist and fellowship-trained ophthalmic and plastic and reconstructive surgeon practicing at Minnesota Eye Consultants in Minneapolis.

How many times have you done this procedure?
Are you dealing with a rookie, or is the procedure considered a specialty of this clinic?

Can I see before and after pictures?
This is a basic that all doctors should be able to provide—but make sure the photos are of actual patients treated by that clinic, not purchased images.

Do you have references?
Because of HIPAA (the Health Insurance Portability and Accountability Act), doctors can’t give out patient information to potential clients, but they can have former patients contact you to talk about their experiences with a procedure or clinic, and many doctors are happy to connect clients with such resources.

Where will the procedure be performed?
Doctors should be happy to show you around their clinic and let you see where your surgery will take place.

Says Charles E. Crutchfield III, a board-certified dermatologist and medical director of Crutchfield Dermatology in Eagan: “A good clinic will welcome these kinds of questions. A bad clinic will be afraid of them.”

Nose Surgery

Otherwise Known As: Rhinoplasty
How It Works: Those unhappy with their noses can have doctors reduce or increase the size, change the shape of the bridge or tip, narrow the nostrils, or change its angle. Surgery is performed from within the nose, where the skin is separated from the cartilage and bones to reshape the structure.
Typical Patient: Women in their twenties with “the family nose.”
Risks: Bleeding, burst blood vessels, infection.
Recovery Time: Swelling and bruising under the eyes (and a splint on the nose) will last seven to ten days.
Maintenance: Results should be permanent.
Estimated Cost: $5,000 to $7,000.

Breast & Pectoral Augmentation

Otherwise Known As: Augmentation mammoplasty
How It Works: Women looking for an increase in cup size, symmetry, or reconstruction have a saline or silicone implant inserted into the breast through an incision in either the armpit, the crease where the breast and chest meet, or the areola. Men who suffer from Poland’s syndrome are born with underdeveloped or absent pectoral muscles, which can be replaced with a solid silicone implant inserted through an incision in the armpit. The procedure can also be cosmetic for men seeking better definition.
Typical Patient: Women of all ages are receiving breast augmentation, while men in their twenties are the primary candidates for pectoral surgery, though this is decidedly rare according to Leigh. “We spend most of the year with our shirts on. If this was California and we were all on the beach, it might be different.”
Risks: Infection, bleeding, asymmetry, scarring, loss of sensation, nerve damage, hardening, implant leakage.
Recovery Time: Most patients are back at work in five days.
Maintenance: Women’s implants last anywhere from five to twenty-five years. Pectoral implants are permanent.
Estimated Cost: $5,000 to $7,000.

Breast Reduction

Otherwise Known As: Reduction mammoplasty
How It Works: Women with large breasts and men with gynecomastia (the development of abnormally sized breasts on males) can have fat, glandular tissue and skin removed to reduce and reshape the breast. In women, the procedure is performed through an anchor-shaped incision under the areola, and the nipple is often moved to a higher position. For men, an incision is made at the areola or in the armpit to remove glandular tissue (the cause of gynecomastia) and fat, to reduce the breast size.
Typical Patient: Women and men in their twenties.
Risks: Permanent scarring, pigment changes, asymmetry, loss of sensation, and numbness.
Recovery Time: One week.
Maintenance: A reduction is rarely repeated.
Estimated Cost: $3,000 for gynecomastia, $5,000 to $6,000 for breast reduction.

Mesotherapy

Otherwise Known As: Lipodissolve
How It Works: Injections of a molecule that dissolves fat, used to target stubborn pockets of fat and cellulite. “It’s not a substitute for weight loss or exercising or eating properly,” says Charles E. Crutchfield III, a board-certified dermatologist and medical director of Crutchfield Dermatology in Eagan. “It’s perfect for that little spot that bugs you, like love handles or a double chin.”
Typical Patient: Women of all ages.
Risks: Infection, bruising, bleeding, scarring.
Recovery Time: Swelling can last one to five days.
Maintenance: Results should be permanent.
Estimated Cost: $300 to $700 per treatment, per area. The average is around four treatments.

Thermage

How It Works: Thermage delivers tighter, smoother skin through a radio frequency treatment that heats up the deeper layers of the skin and tightens lines and wrinkles. “Ever since Thermage was featured on Oprah, it’s been very popular,” says Brian Zelickson, a board-certified skin specialist and owner of Zel Skin and Laser Specialists in Edina.
Typical Patient: Women, generally in their forties to sixties.
Risks: Redness, blistering, swelling, surface scars or irregularities, skin dimpling.
Recovery Time: Redness can last a couple of days.
Maintenance: One to two years.
Estimated Cost: $1,500 to $4,000.

Who Does What?

Board certified doctor: A doctor who is “board certified” has passed an evaluation process through an administering authority such as the American Society of Plastic Surgeons. Certification attests to a physician’s level of education in a specific area.

C.M.A.: Certified medical assistants provide a variety of clinical and administrative services to physicians, such as aiding examinations and handling medical files. Certification comes from the American Association of Medical Assistants.

Dermatologist: A doctor who specializes in treating skin.

F.A.C.P.: These letters mean your physician is a Fellow of the American College of Physicians.

F.A.C.S.: Similarly, these letters mean your physician is a Fellow with the American College of Surgeons.

L.P.N.: A licensed practical nurse provides basic bedside care and often assists R.N.s.

M.D.: Doctor of Medicine, from the latin Medicinae Doctor. This acronym signifies a medical degree.

Paramedical esthetician: These state-licensed professionals work with plastic surgeons and dermatologists on pre- and postoperative care for patients.

R.N.: Registered nurses must pass a state exam to become licensed and assist physicians.

Sclerotherapy

How It Works: A tiny needle injects a sclerosing agent into spider veins, causing them to get irritated and collapse, eventually disappearing over several weeks.
Typical Patient: Women of all ages.
Risks: Infection, bruising, recurrence of veins, brown spots or discoloration.
Recovery Time: Legs have to be wrapped in compression stockings for twenty-four to forty-eight hours, and support hose is suggested for several weeks following the procedure.
Maintenance: Results should be permanent.
Estimated Cost: $400 to $1,000.

Chemical Peels

How It Works: Chemical peels use an acid-type chemical (such as citric or alpha hydroxy) to remove top surfaces of skin. Chemical peels vary in intensity—some peel off just the top layer, others go deeper—and are used to treat acne scars, sun damage, and irregular pigmentation.
Typical Patient: Women, ages vary.
Risks: Redness and scarring.
Recovery Time: Depending on the type of peel, recovery ranges from a couple hours to several weeks.
Maintenance: Months to years, depending on personal contribution. “Keeping up sun protection and maintaining results with topical products help the results,” says Zelickson.
Estimated Cost: $100 to several thousands of dollars depending on the intensity of the treatment.

Microdermabrasion

How It Works: Skin is exfoliated with an abrasive to remove the top layer of dead skin cells to give a smooth, fresh look. “It’s really popular for patients who want smooth, fresh skin before a big event like a wedding or class reunion,” says Crutchfield.
Typical Patient: Women in their twenties and thirties.
Risks: Redness and burning.
Recovery Time: Recovery time is minimal; patients can have the treatment during lunch hour and go back to work.
Maintenance: Results last one to two months.
Estimated Cost: $100 to $200.

Photorejuvenation

Otherwise Known As: IPL (intense pulsed light)
How It Works: Broadband light is used to resurface the skin to improve pigmentation and redness, age spots, blood vessels, fine lines and wrinkles, and rosacea. A series of procedures in usually required. “This is a very common and very effective procedure for fixing common issues like rosacea,” says Beth Briden, owner of Advanced Dermatology and Cosmetic Institute in Edina.
Typical Patient: Men and women in their twenties to eighties.
Risks: Crusting, scabbing, redness.
Recovery Time: This can potentially be a lunchtime procedure; makeup can cover up the temporary redness.
Maintenance: With proper sun protection, results last three to five years.
Estimated Cost: $250 to $350 per treatment, with four to five treatments being the average.

Laser Peels

How It Works: A laser is used to vaporize the topmost dead layers of skin on the epidermis to eliminate fine lines and wrinkles, age spots, and acne scarring. “A laser peel is more invasive than IPL and much stronger than microdermabrasion,” says Briden. “It’s more in line with a strong superficial chemical peel.”
Typical Patient: Women beginning in their thirties on up.
Risks: Infection, crusting and scabbing, persistent redness, peeling, flaking.
Recovery Time: Five days or less.
Maintenance: With proper sun protection, results last three to five years.
Estimated Cost: $350 to $500 per treatment, with four to five treatments being the average.

Injectable Fillers

Otherwise Known As: Juvederm, Restylane, Radiesse, Sculptra.
How It Works: Fillers are substances injected under the skin into the dermis (and sometimes into subcutaneous tissue) for volume, to plump up skin and smooth wrinkles. These injections target deeper folds or wrinkles such as marionette lines on the chin, creases at the angle of the mouth, lipstick lines, and even depressed scars. “Injectable fillers are great for people who don’t want a facelift but are concerned about deep wrinkles and jowls,” says Briden.
Typical Patient: Women in their forties and older.
Risks: Temporary bruising, redness at the injection site, allergic reaction, ulceration.
Recovery Time: From a day or two, up to a week.
Maintenance: Six months to a year.
Estimated Cost: $600 to $800 for a tube, which contains 1 cc. Patients typically use one to three tubes.

Botox's Holistic Cousin

We all want to look younger...But for some, smoother and more youthful skin via Botox injections or surgical procedures can be difficult to reconcile with today’s eat-organic, live-natural lifestyle. Now there’s a holistic alternative: cosmetic acupuncture.

“Acupuncture targets specific muscles in the face that are creating wrinkles and retrains them to relax, while Botox just paralyzes the muscles for a period of time,” says Vincent Valeriano, a licensed acupuncturist with Fusion LifeSpa in Deephaven. According to Valeriano, by inserting needles on acupuncture points around the face, muscles relax and wrinkles smooth naturally.

Steven Sonmore, a licensed acupuncturist with Complete Oriental Medical Care in Minneapolis, likes to pair his acupuncture facial rejuvenations with dietary therapy and herbology, to create a total package that works inside the body to combat the outward signs of aging. “Things like Botox or surgery are working on a Band-Aid level,” says Sonmore. “This method works at the root issue of health problems, not just at the cosmetic level.”

A typical program requires ten sessions (spread out as two visits per week for five weeks), priced at around $75 to $105 per visit, with “tune-up” appointments every month thereafter. The results? Valeriano says his clients see a reduction in fine lines, wrinkles, under-eye bags, and better facial muscle tone—not to mention an overall aura of relaxation.

On top of the skin-smoothing results, cosmetic acupuncture is also appealing thanks to its promise to ease the health issues that can show on the face. “Oriental medicine works into the core to figure out why people are having health problems,” Sonmore says. Not getting enough sleep? Having digestive issues? It’s going to show on your face in the form of furrows, wrinkles, and puffiness unless you work to correct the problems, he says.

Those organic answers are translating into more clients for Sonmore, who gives all the credit to the search for a healthier lifestyle. “I think that people are looking for a more natural way to look younger and feel younger,” he says.