An interview with nationally recognized cosmetic dermatologist Charels E. Crutchfield III, M.D
Cosmetic dermatologists use a number of innovative techniques to treat stubborn fine lines and wrinkles, effectively turning back the clock. Best of all, the procedures can be performed without surgery and in a single afternoon, often allowing patients to return to work the next day. For these reasons, non-surgical cosmetic procedures are increasing in popularity. The American Society for Aesthetic Plastic Surgery (ASAPS) reported a 51 percent increase in non-surgical cosmetic procedures in 2004, compared to 2003. Among the most-requested non-surgical cosmetic procedures are Botox, fillers such as collagen, and chemical peels.
Our facial muscles age us
The facial muscles used for smiling, frowning, squinting, and laughing eventually leave creases where they expand and contract. As we age, these lines become more noticeable. Cosmetic dermatologists use a compound called botulinum toxin— commonly referred to by its brand name, Botox—to treat these wrinkles.
Doctors discovered the cosmetic benefits of Botox in the early 1990s. At first, patients were concerned about the product’s safety, because the botulinum toxin is related to botulin—a toxin that can sometimes induce fatal food poisoning. “People used to be afraid, but they realize now that it’s very safe,” says Dr. Charles Crutchfield III, from Crutchfield Dermatology in Eagan, Minnesota. “There has never been one adverse event or fatality.”
Cosmetic dermatologists ensure patients’ safety by using a diluted concentration of the toxin for procedures. “With the amount that’s in one vile of what we use to treat patients, you would need 300 viles to cause any problems,” Crutchfield says.
The substance is injected directly into the muscles that cause wrinkles in order to relax them, softening frown lines, furrows, and crow’s feet. The procedure is performed in one office visit, and patients can immediately return to work.
However, the results are temporary. Patients need to return to their doctor every four to six months to maintain their younger-looking appearance. “Once you achieve the look you want, then you maintain it,” Crutchfield says. “Some patients say, ‘I have to redo this every six months?’ Well how often do you have your hair color touched up or your nails redone?” Compared to a surgical facelift—which may cost thousands of dollars and require significant healing time—Botox is relatively convenient and inexpensive. For example, treating a single area, such as the forehead, costs $300 to $400.
Because of its ease and effectiveness, Botox is becoming increasingly popular. According to the ASAPS, more than 2.8 million Botox injection procedures were performed in the United States in 2004. “The operative phrase is ‘less is more,’ ”Crutchfield says. “Botox is probably the number one non-surgical procedure in the United States today.”
Search for the perfect filler Cosmetic dermatologists use other treatments to repair aged or damaged skin on the rest of the face. One method is to make the skin plumper by injecting materials, such as collagen, underneath the surface.
Collagen is a natural substance that is already present in the skin and promotes elasticity. Another natural substance called “hyaluronic acid” is also a crucial component of human skin.
As we age, the body produces less collagen and hyaluronic acid, causing the skin to become wrinkled. Replacing these substances restores the skin’s volume, thus smoothing out wrinkles.
The collagen used for cosmetic procedures is usually derived from cows, and has been in use since the 1970s. The results from bovine collagen are short-lived, because the body naturally dissolves the foreign substance in only a few months.
Many patients also develop allergic reactions to bovine collagen.
In search of a better alternative, many dermatologists are switching to human bioengineered collagen, or they’re using hyaluronic acid to safely replace the other component found in skin.
Recently approved by the FDA, hyaluronic acid works by connecting the natural collagen and another compound in the skin called elastin to create a framework under the skin. This framework then absorbs water and builds volume, which fills in the wrinkles. The effects of hyaluronic acid last longer than collagen, without posing the risk of an allergic reaction.
However, hyaluronic acid gel does not contain any anesthetic to numb the pain of the injections. As with collagen, there is usually temporary inflammation following the injection. Hyaluronic injections cost $500 to $1,000. Collagen tends to cost a bit less, starting at $400. Other fillers are awaiting FDA approval, such as polymethylmethacrylate, which is a mixture of miniature plastic spheres and bovine collagen. Once injected into the skin, the collagen holds the synthetic spheres in place. The collagen