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On this page: Top 5 cosmetic minimally invasive procedures for 2009

Putting Your Best Face Forward

We believe that it is natural to want to look your best. It is our goal at Laser & Cosmetic Surgery Specialists, PC to help patients feel revitalized and more confident through our specialized services. This is why people who consult with Dr. Rubinstein receive individualized recommendations and care that are based on their needs, goals, and lifestyles. Their sense of wellbeing and their desire to project a specific image to the world are of utmost concern to him. Countless patients have already benefited from his expert touch.

Dr. Rubinstein's specialty is facial plastic surgery, hence his patients often have a number of options available to them with regards to improving the different areas of the face. In many situations, should it be in the patient's best interest, less invasive procedures can be done with very dramatic results. In any case, because of our central Hudson Valley location, our Center is an ideal place for surgery and spa services that provides a relaxing recovery setting away from busy Manhattan.

At Laser & Cosmetic Surgery Specialists, PC, you can turn back the clock. We welcome you to make an appointment with Dr. Rubinstein for a consultation. Find out how we can help you put your best face forward.

Top 5 cosmetic minimally invasive procedures for 2009

1. Botulinum Toxin Type A. (4.8 million 2009)
    a. Trends: down 4 % for 2009 vs. 2008, up 509 % vs. 2000
    b. What is Botox?  Botox is an FDA approved anti wrinkle treatment.  The injections when placed in our facial muscles that create unwanted wrinkles in our forehead, eyes, and lips as well as sagging of our brows, lips and neck, can prevent, reverse and slow down these signs of aging.  A recent study published showed that women who were injected with Botox had a more positive outlook on life. The procedure when performed by an experienced and skilled physician is painless, safe, and the effects last 3 to 6 months.
    c. Psychological benefits of Botox have been well documented.  Its more than just about vanity
      i. Scientists reported in a study by the US Association for Psychological Science that Botox actually has an effect on the brain as well and help cheer people up.  It is thought that by not being able to frown, the brain is tricked into feeling happy.  When your face stops frowning, your brain gets the message that you've decided there's less to frown about.
      ii. A more recent study in the American Journal of Dermatology showed that 100 women when compared to placebo revealed that Botox injections result in improvements in quality of life and self-esteem. Those treated with Botox showed statistically significant improvements in answers to quality of life questions pertaining to physical health, mood, household activities, overall life satisfaction, body satisfaction, self-consciousness, intellect, self-worth, appearance, comprehension, weight satisfaction, attractiveness and sense of well-being. Additionally, increases in overall self-esteem and appearance-, social- and performance-related self-esteem were observed in those treated with Botox.
    d. Cost: average cost $ 405
      i. Drs charge by site or total units used.  Both end up costing the same.
     ii. Cost will go up if more sites or units are treated.
    iii. Cut throat pricing prevalent: see potential complications section
    e. Safety and potential complications
      i. Botox is among the safest medical treatments when performed correctly with real Botox.
     ii. There are unethical practices which can affect the results and safety.
       1. Watering down Botox: this is common practice to reduce the cost of the materials.  Unsuspecting patients have no way of knowing other than inferior results and shorter durations of effect.  If pricing sounds too good to be true, your Botox may be not as strong.
       2. Using fake Botox: A vial of real Botox costs $ 575.   Fake Botox only pennies.  The problem with the fake Botox is that it can be too weak or too strong.  If it is too strong, systemic complications can occur.  This practice is purely done to increase profits and lower the cost of Botox injections.
        a. A prominent plastic surgery group in Albany was recently convicted, fined, and sanctioned for using fake Botox!
      3. Injection technique: My only advice is to make sure patients go to qualified and experienced injectors.  Only go to board certified facial plastic surgeons,  plastic surgeons & dermatologists and avoid non cosmetic specialists such as gynecologists, internists, family practioners, or non physician injectors who are not supervised.


2. Soft tissue fillers (1.7 million in 2009)
    a. Trends: up 7% vs. 2008; up 164 % vs. 2000
    b. What are fillers? Fillers are used to replace lost facial volume that contributes to unwanted folds, lines and facial drooping.  When we age, our face begins to deflate, as we lose bone, fat, and collagen content in the face.  With less support to the overlying skin, the face begins its downward descent, creating the appearance of droopy eye brows, tired appearance around our eyes, sagging neck and jaw line.  In the past, surgery was the only option.  Today, when addressed early, restoring lost volume can reverse and even slow down these signs of aging delaying the need for invasive surgery.  Less is more these days when it comes to surgery.  Less surgical tightening/lifting has to be done when volume is restored in those older patients that elect to go under the knife (done before or after surgery).  Procedures like “Liquid Face Lifts” are becoming increasingly popular.  This non invasive trend is a big reason for surgical rejuvenation numbers being down when compared to a few years ago.  Filler injections can be temporary lasting 6 to 12 months (i.e. Juvederm, Restylane, Radiesse) , semi permanent lasting > 2 years (i.e. Sculptra, Artefill) , and permanent (Fat injections, silicone injections).  The pros and cons to all the various fillers are discussed with the patients at the time of their consultation.  Patients often begin with the temporary fillers and then switch to longer lasting ones for subsequent treatments.  Sculptra is a unique filler as treatments are injected in 8 week intervals, usually 3 treatments until the desired effect is reached.  Long lasting results are produced by Sculptra's ability to stimulate collagen.  Patients like Sculptra because it is natural, results are gradual, and long lasting- less money in the long term.  A single touch up treatment is typically performed every two years.
    c. Cost: depends on what substance is used and how often they have to be injected.
       i. Hyaluronic acid fillers ( ie Juvederm, Restylane)- $ 592
       ii. Calcium hydroxyapatite (Radiesse)- $ 649
       iii. Polylactic acid (Sculptra)- $ $ 1060
       iv. Fat injections- $ 1647
    d. Safety: very safe given appropriate use of products by skilled physicians.  See section on Botox for safety.
       i. Unnatural results: this is the biggest fear of patients.  They don't want to look overdone, overfilled like some people in the media.  This fear is legitimate and should be addressed at the time of the consultation.  It is helpful reviewing with patients photos they are asked to bring in from their youth, and show them where they have lost facial volume and where/how it will be replaced naturally.
       ii. Complications: bleeding, infection, allergic reactions, delayed reactions in the permanent fillers all possible but unusual.

3. Chemical peel (1.1 million in 2009)
    a. Trends: up 9 % for 2009 vs. 2008 but down 1 % vs. 2000
      i. Laser treatments can accomplish superior results vs. peels with less downtime and increased safety.  Their popularity has increased which is one reason for the decrease overall in peels performed over the last decade.
      ii. The recent increase in peels can be attributed to the poor economy as chemical peels cost far less than lasers.
    b. What is a peel?  Chemicals applied to the skin that when absorbed superficially help to exfoliate dead skin, giving more of a glow, to deeper penetrating peels that can also reduce lines and wrinkles and tighten the skin.  The superficial peels, often performed in medical spas, are performed on a more regular basis, cost less, have no downtime- i.e. alpha hydroxy peels.  Medium depth peels (i.e. TCA peel, Obagi peel) penetrate deeper, can be repeated in 3 months, and can help with some finer lines and toning.  Downtime is about 7 to 10 days.  For the deepest peels, and most aggressive results, Phenol peels are used.  One treatment is needed, downtime is often 2 to 3 weeks, but results are dramatic in reducing deeper lines and toning the skin.  The results can last for years as long as they are maintained with lighter exfoliating peels and yes, Botox injections.
    c. Cost: average cost $ 764 but there is a wide range in price as the superficial peels cost far less than the deeper peels.
    d. Risks
      i. Superficial peels: minimal to no risk as long as trained personal are performing them under physician supervision.
     ii. Medium and deeper peels: the deeper the peel the greater the risk in scaring and loss of natural skin color.  The depth of the peel can't be controlled as precisely as a laser.  It is for this reason, and less downtime,  that laser treatments have gained so much popularity.

4. Microdermabrasion (910,000 in 2009)
    a. Trends: up 8 % in 2009 vs. 2008; up 5 % vs. 2000
   b. What is microdermabrasion?  Microdermabrasion employs small crystals that are blown onto the skin with suction removing the exfoliated skin cells.  Results are similar to light chemical peels.  No downtime.  Performed in a series of treatments.  Doesn't treat deeper skin problems.
    c. Cost: $ 152
      i. Costs more than peels due to the need for a machine and higher cost of the crystals vs. chemical peel supplies.
      ii. No advantage over light chemical peels except in individuals with sensitive skin.
    d. Safety: same as light chemical peels

5. Laser hair removal (893,000)
    a. Trends: no change 2009 vs. 2008; up 21 % vs. 2000
    b. What is laser hair removal?  Specialized lasers that target the hair follicle are used to kill the unwanted hairs.   On average 6 to 8 treatments are required with bi annual maintenance.  On the actively growing hairs are killed.  As we age, new hair follicles come out of their dormant resting state and begin to grow.  This is the reason for the maintenance.  Laser hair removal is therefore not a permanent procedure as upkeep is required.  It is superior to electrolysis hair removal as treatments are quick and safer to perform vs. electrocuting one hair follicle at a time with a needle connected to an electric current.
    c. Cost: average $ 405.  Depends on how many body areas are treated.
    d. Safety & Risks
      i. Very safe if state of the art, new lasers are used and ongoing maintenance and upgrades are performed.  Minimal risk if appropriately trained and supervised personnel perform the procedure under physician supervision.
      ii. Burns and scarring can occur in rare instances if the above is not followed.  Beware of going to “medical spas” where true physician oversight is not present.