Face Facts

By staff June 1, 2006

Let's say you're old enough to know that what's inside you is attractive. You've worked on that. You know that the people who care about you don't base their affection on pigmentation or pores.

But you look in the mirror and face facts: Your skin is showing some mileage. It looks older than you feel. Plus, you like to hold a few things close to the vest, and it's not cooperating. It knows all and tells all, in fact. "Here's where she got way too much sun!" it announces. "Here's where she had that unfortunate struggle with teenage acne, and over here, you can see all those years of gravity doing their work."

But there's good news. We've been getting smarter about how to prevent skin damage-avoiding sun exposure, not smoking or overindulging in alcohol, using moisturizer, getting plenty of sleep and maintaining a healthy diet, say dermatologists. And some smart developments in damage repair also have been made. But another few words about smarts, before we look at old and new technologies that could put you on friendlier terms with the looking glass again.

The best doctors are clear about this: Turn off the television. Get information about cosmetic procedures from real-life experts, not The Swan. Specifically, remember that some treatments are more invasive than others and require a higher level of skill to perform. And some practitioners are not certified to do what they are doing.

It makes sense to educate yourself on any medical procedure you are considering, as well as the person who will do it. It may be particularly important in plastic or cosmetic surgery, because the field is rife with credentialing organizations, including some that require little more than a fee to obtain.

So if you're opting for a face-lift, eye-lift or other bona fide surgical procedure, it's best to be vigilant about credentials and, ideally, choose a specialist certified by the American Board of Plastic Surgeons.

You can't rely on advertising or even the most respected "Who's Who" lists of doctors to evaluate a plastic surgeon's real skill level, stresses Dr. James W. Marsh, a board-certified plastic surgeon in Sarasota who has done about 4,000 face-lifts and 5,000 eye-lifts in 30 years' practice. You need to ascertain whether he or she has the proper credentials and extensive experience in the procedure you are considering.

Quick-fix procedures come and go, often doing more harm than good, according to Dr. John L. Strausser, a past chief of staff and past chief of plastic surgery at Sarasota Memorial Hospital. As president of the Sarasota Plastic Surgery Education Foundation, Strausser is passionate about stopping the hucksterism he sees in the field, pandering to a public that's increasingly desperate to look younger, and more quickly. The fact remains, Strausser says, "If it seems too good to be true, it probably is. And 'new' or 'improved' doesn't necessarily mean better."

But if you're willing to do your homework, there's a range of options out there. Many of them are noninvasive and require very little downtime, and the results can subtract years from your face. Do realize, though, that results from the safest, least traumatic procedures probably aren't going to last more than, say, five years.

Among them, says Strausser, are the skin resurfacing treatments done with topical agents, such as phenolic or alpha hydroxy acids. Such treatments remove cells from the epidermis, the outer layer of skin that depends on the deeper layer (the dermis) for nutrient delivery. Skin atrophies as it ages, particularly on the outermost layer, the stratum corneum. As years go by, it just doesn't protect the deeper tissues the way it used to. Meanwhile, the deeper tissues in the dermis deteriorate over time and don't help the surface layer rejuvenate like it used to, either. It's a vicious cycle that roughens, dries and wrinkles skin.

Some people break that cycle with dermabrasion, which Strausser and other board-certified plastic surgeons do. Some form of dermabrasion has been around for nearly 100 years, although the methods certainly have grown more sophisticated with time.

When the goal is skin resurfacing to improve areas deeply damaged by acne, wrinkles, sun damage and age spots, a doctor freezes the skin under local anesthesia, then mechanically "sands" it, removing the top layer. The patient looks sunburned during healing, but after a week or two, a new layer of smoother, healthier skin has replaced the old.

Dermabrasion's little sister, microdermabrasion, is newer and gentler. Using a vacuum-like handheld device that abrades the skin with tiny aluminum oxide crystals, a practitioner sloughs off rough or dead skin, leaving the face with a wind-burned feeling but looking younger and healthier.

Among newer resurfacing options are two general types outlined by Dr. David L. Mobley of Sarasota Plastic Surgery: ablative and nonablative laser resurfacing.

Ablative treatments remove the epidermis, or top layer of skin, causing the one directly underneath to produce collagen and feed the growth of a new, smoother layer. Healing time can be anywhere from a week to two months, depending on the type of laser used. The most common types use either carbon dioxide or intense pulses of light to do their work.

It's the nonablative laser that has Mobley and some other area practitioners most excited. In this type, laser spikes in tiny, deep columns called microthermal treatment zones are delivered to the epidermal, or lower, layer of skin via a computer-guided handpiece. That's what makes it a fractional-or trademarked "Fraxel"-procedure that affects only some of the skin.

This treatment is normally done in a series of four sessions, in a medical office. When the full face is treated, 18 to 20 percent of it is done each visit, which lasts about 20 to 25 minutes and is done under topical anesthesia. Treatments are usually spaced two to three weeks apart.

That's not to say the patient isn't presentable for two or three weeks. Actually, "There's a short period of redness and swelling" after a Fraxel laser treatment, Mobley says. "And in a couple of days, you're back to your life."

With Fraxel laser treatment, marketed by Reliant Technologies, you can go through a treatment and put on make-up or shave right away; new epidermal skin develops within 24 hours. After the period of redness, the skin will look bronzed for anywhere from three to 14 days, then will flake as new skin begins to replace the old. It's like the peeling from a sunburn, although not painful. Over the following weeks and months, the body repairs the deeper dermal tissues that have been affected by the Fraxel treatment.

Clinical skin care specialist Sandra Day, under the supervision of Dr. W. Michael Bryant, began using the Fraxel laser in late March at Neoderm skin-care center in Sarasota. She points out another advantage to the system: While other laser treatments were intended for the face only, the Fraxel laser can treat virtually any skin area. Fees for the Fraxel service run about $1,000 a session, with generally four sessions needed.

Neoderm aims to bridge the gap between a day spa and a doctor's office, offering traditional peels, electrolysis, permanent make-up application and some injectable fillers that flesh out an aging face, such as plumping agents like Botox and filling agents like Restylane. And since prevention is still the safest way to have youthful skin, the center also carries more than a dozen skin-care product lines, with ingredients more powerful than a department store can offer.


For an invasive procedure such as a face-lift, what you need is a board-certified plastic surgeon. What exactly is plastic surgery? According to the American Board of Plastic Surgeons, "Plastic surgery deals with the repair, reconstruction or replacement of physical defects of form or function" of areas of the body.

A certified doctor has graduated from an accredited medical school and has completed at least five years of additional training as a resident surgeon. This includes a minimum three-year residency in an accredited general surgery program and a minimum two-year residency in plastic surgery. To become certified, the doctor then must successfully complete comprehensive written and oral exams.

And then he or she has a reputation to uphold. Ask around.


For more information on Fraxel laser treatment, go to To see if a doctor is a board-certified plastic surgeon, go to

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