Ask the doctor:Fillers,lipo, facelifts and lasers

March 1, 2008

Dr. Schlessinger and Dr. Niamtu answer questions about cosmetic procedures

Key Points

How do I know which type of filler is best?

Dr. Niamtu: Fillers largely come in two classes, the resorbable fillers, which will degrade in a six- to 12-month period, and permanent fillers, which will last many years. Although a permanent filler sounds beneficial, if the result is unacceptable, the patient and surgeon will have a problem.

The most popular fillers are made of gel consisting of naturally occurring sugars found in many tissues on the human body. These include Restylane, Perlane, Juvéderm Ultra and Juvéderm Ultra Plus. These fillers last from six to 12 months, which is twice as long as the older collagen fillers, and are most commonly used to fill lips and wrinkles.

Is "smart lipo" better than regular liposuction?

On the other hand, it is early in its development, and techniques such as tumescent liposuction could continue to prove beneficial over time. When compared to the "traditional" method of liposuction as performed under general anesthesia, however, it appears to have a distinct advantage.

I am waiting to see a head-to-head study with tumescent liposuction before I encourage my patients to switch methods.

Do smaller and faster-healing facelifts really work?

In addition, many of the less-invasive facelifts may not last as long the more comprehensive lifts. Patients must remember that just because something is new, it is not necessarily better. Surgeons have been performing facelift surgery for almost a century, and if a new "miracle" facelift truly were available, all surgeons would be performing it - not just doctors scattered throughout the country. If a patient truly wants to dramatically reverse a half-century of facial aging, he or she should not consider a recovery of several weeks an insurmountable drawback.

When patients read about facelifts that can be "done in an hour," they should carefully investigate the situation and the longevity of the result.

Is laser hair removal permanent?

Dr. Schlessinger: Yes and no. While the FDA clearance is for long-term hair removal, "permanent" implies a different expectation. We tell our patients that laser hair removal isn't FDA-approved as permanent, but probably is permanent in many cases.

On the other hand, electrolysis claims permanence, but probably isn't even close to as effective. And electrolysis is painful and unable to remove even a fraction of the hairs that lasers can remove in one session.