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A look at Non-Surgical Cosmetic Procedures

Aired November 6, 2004 - 08:30   ET


ELIZABETH COHEN, HOST: Good morning and welcome back to HOUSE CALL. I'm Elizabeth Cohen in for Dr. Sanjay Gupta.
Checking today's medical headlines, combining coffee and cigarettes could be dangerous. A new study shows one cigarette, along with two cups of coffee temporarily increased stiffness in the aorta, possibly increasing your chances of developing heart disease.

A vaccine against cervical cancer may be on the way. A new study showed four years after getting the vaccine, 94 percent of women were protected from the virus that causes most cervical cancers. The cancer kills about 5,000 American women every year.

And in the U.K., some people are buying cosmetic surgery vouchers for loved ones for Christmas gifts. Gift vouchers are mainly purchased over non-surgical procedures such as skin peels and botox injections. Business demand for plastic surgery has skyrocketed over the past year. The drive to look younger is the focus of our show.

The line aging gracefully has taken on new meaning in recent years, with millions of Americans buying wrinkle creams to stay young or heading to plastic surgeon and dermatologist offices. The hottest procedures? Lunchtime pick-me-ups, the quick fix in the battle against aging.


COHEN (voice-over): Oh, the things this man has in his cabinet to help you look younger. Botox to paralyze your wrinkles, fillers to plump up your creases. And this, beams of microscopic light that go under your skin to rejuvenate it. They're all part of the dizzying array of non-surgical cosmetic procedures. Patients demand them instead of surgery as a way to look better fast and without a long recovery period.

BRIAN KINNEY, DR., PLASTIC SURGEON: If they could, they would like it to be a drive-through. And they could literally just talk into the speaker and have it their way and then drive on.

COHEN: You can't get them in a drive-through, but new techniques include Radius, are a synthetic form of what you find in bones and teeth. Similar to collagen injections, it plumps up creases in the face. Intense lasers can help with wrinkles by basically burning the top layer of skin, but it can take six weeks for the pink to go away.

Now a new generation of lasers, this one's called Fraxil (ph), does most of their work under the skin so the burn isn't as intense.

LAWRENCE BASS, DR., NYU MEDICAL CENTER: The skin does look pink and sunburned for usually about two days. And that can be covered with make-up.

COHEN: The Fraxil (ph) laser gives about a 20 percent reduction in wrinkles compared to the older, more intense lasers, which give a 50 percent reduction. Another difference? With the Fraxil (ph) laser, you need to receive several treatments, about four at a total cost of around $6,000. The older laser is a one-time treatment.

So between botox and fillers, old and new lasers, not to mention all the creams out there, how do you make a choice? Dr. David Amron says, first of all, don't be swayed by product claims that sound too good to be true.

DAVID AMRON, DR., DERMATOLOGIST: It actually upsets me that they're taking advantage of the consumers', I guess, lack of knowledge about things.

COHEN: And secondly, remember there's no magic cream or shot or laser for everyone. Different people respond differently. And even though it's great to have a short recovery time, there's still as of yet no replacement for the good old fashioned facelift.


COHEN: Those non-invasive procedures are the newest and most popular weapon in the arsenal against aging. They make up nearly 80 percent of all cosmetic procedures. The top sellers? Botox. It's gotten incredibly popular, increasing by more than 250 percent since 2000.

Then there are chemical peels, microdermabrasion, laser hair removal, and the popular wrinkle filler, collagen. Here to walk us through all of these options and more is Dr. Robin Ashinoff, a cosmetic dermatologist and dermatologic surgeon. She's also the medical director of the Laser Center at Hackensack University Medical Center in New Jersey.

Welcome, doctor. Doctor, what do you think is the best weapon against aging? I named a couple. There are several more. What's the best one?

ROBIN ASHINOFF, DERMATOLOGIST SURGEON: I try to convince my patients that above all, the best thing they can invest in is a good sunblock, because most of our photo damage is done by the age of 18. And then we add to it every year we lie in the sun. So a good sunblock and your foundation, in your make-up you're your moisturizer. And then, everything on top of that is sort of icing on the cake.

COHEN: But start with the sunblock?

ASHINOFF: Start with the sunblock and stay out of the sun.

COHEN: OK, we'll try to remember that. Well, we heard about lasers in our lead piece, but Rick from Georgia has a more specific question. He says, "I understand there is a laser treatment available that non only treats adult acne, but causes the skin to produce collagen thus reducing or eliminating acne scars. Can you give me some additional information?"

Doctor, what can you tell Rick about that?

ASHINOFF: Well, Rick, there's a lot of different laser systems. And intense pulse light systems that are being used not only to treat acne targeting the bacteria and the sebaceous glands, but because these also heat the dermis, they actually can stimulate collagen production, which can help with some acne scars and fine lines. So it's not one laser, but there are a variety of laser systems and intense pulse light that people are using to achieve those end points.

COHEN: Now why is it good to stimulate collagen production? What's good about collagen?

ASHINOFF: Well, living is sort of we break down our skin and build it up. Living cells go through cycles. So every minute we're breathing, we're exposed to the environment. Oxidants are causing our cells to die. They're producing chemicals that are injuring our cells. And so, we want to replenish that damaged collagen or elastic tissue. We want to absorb water into our skin to plump it up. And that's done by something called round substance.

And all of the creams that are out there are trying to increase these substances and make us look younger.

COHEN: A question now from our roving camera. Let's take a listen.


UNIDENTIFIED FEMALE: Does the microdermbrasion and the chemical peels really reduce the wrinkles or the appearance of wrinkles particularly around your eyes like the crows feet?


COHEN : Well, doctor, can chemical peels really help reduce crows feet?

ASHINOFF: Yes. Most of the chemical peels that we're talking about, the lunchtime peels, are done with glycolic acid and alpha hydroxy acid, which basically causes a very superficial peel. Even that sort of injury can stimulate collagen production within the skin, stimulate blood vessel formation, decrease pigment in the skin. And so, yes, it can efface fine lines around the eyes. Yes, to a certain degree, it can.

COHEN: Now chemical peels and lasers seem to do some of the same things. How do you know which one is best?

ASHINOFF: Sometimes you don't know. If you are targeting a specific lesion. For instance, if somebody has blood vessels on their face, and around their nose especially, or they have a disease called rosacea, well then I would recommend a specific laser to treat those blood vessels.

If somebody just has uneven skin tones, well, there are a variety of lasers that can do that, as well as chemical peeling. So it may be the choice of the physician and the patient.

COHEN: We have another question now from Lee in Tennessee who asks, "What are findings to date on a skin tightening treatment such as photo rejuvenation? Any downsides?"

Doctor, what exactly is photo rejuvenation?

ASHINOFF: Photo rejuvenation is another term coined for a variety of different treatments using laser intense pulsed light, whereby the light or the laser is shown on the skin. And it can get rid of blood vessels, it can lighten liver spots, it also can stimulate collagen production and get rid of some fine lines.

COHEN We'll be showing more of your e-mails coming up.



UNIDENTIFIED FEMALE: I was thinking of having some botox along my face.

ANNOUNCER: From injections to face creams, more options for looking younger and staying beautiful.

And is liposuction the best weapon in the fight to stay slim? All that coming up.

But first, takes today's "daily dose" quiz. How long does each injection of Botox last? That answer when HOUSE CALL RETURNS.



ANNOUNCER: Checking the "daily dose" quiz, we asked how long does each botox injection last? The answer, a treatment can last three to four months before lines and wrinkles start come back.


COHEN: Botox is by far the most popular anti-aging device doctors have, with nearly three million procedures being done in 2003. That's more than all cosmetic surgeries combined.

Botox injections take a couple of minutes. They're usually injected into the facial muscle to freeze or paralyze it. And as we said in our quiz, lasts about three to four months usually costing more than $300 per session. Dr. Robin Ashinoff has given her fair share of these injections. She's is cosmetic dermatologist and dermatologic surgeon with Hackensack University Medical Center.

Doctor, we've received so many questions about botox and these other injectables. Let's start with a question from Jennifer in Virginia. She wants to know, "What is the earliest age someone should consider Botox?"

Doctor, can you do it to newborn babies? Can you...

ASHINOFF: Well, I would sort of skipping in utero.

COHEN: OK, check that.

ASHINOFF: But this is certainly for cosmetic use I would probably avoid giving it to anyone under the age of 18. However, I have treated patients in their early 20s, who have frown lines that have developed that they hate, or horizontal lines on their forehead. Most of my patients. Though, are in their late 20s, 30s, 40s, all the way up into the 70s.

COHEN: We have another question now from Dana in Nevada. "What is the best way to clear my skin of fine lines, especially those above my upper lip? I have tried mild peels, and they make my skin look lovely and refreshed, but I still have lines above my upper lip."

Doctor, products called fillers are becoming more and more popular now used in the mouth area. Let's talk about those a little bit.

ASHINOFF: Well, fillers have really helped us out. The problem that you were speaking, those vertical lines, are really, really difficult to get rid of. And I find that instead of doing a deep procedure where we actually take off skin, if we fill the vermillion, the area that outlines the lip where women put their lip liner, we can actually do an internal lip liner. And that way, your lipstick doesn't bleed up into the vertical lip lines.

And we can fill them with Hyleronic acid. We can fill it with collagen. People have used more permanent fillers in there like Radius. Multiple different fillers can actually improve the area around the mouth very well.

COHEN: Now one relatively new filler that's on the market is Restilin. And we have some pictures, some before and afters. Can you talk about what Restilin is able to do?

ASHINOFF: Restilin is a hyleronic acid, which is a normal body constituent. So again, you don't need to be skin tested. Patients seem to really, really like the results of Restilin. And they last a lot longer than collagen in my experience.

And you can actually plump up the lip itself. Patients really like that pouty look. And it can last six months. And it really has been a great boon to this peri oral area right around the mouth. COHEN : Now doctor, botox and fillers are both used for wrinkles. Under what situation would you use fillers versus botox?

ASHINOFF: Well, botox is used all over the face, but primarily I use it in the upper face for the wrinkles between the eyes, forehead lines, crows feet. Fillers I use primarily around the mouth, the marionette lines to try to make the lip a little bit more prominent. So I use it in the lower face. And I use botox more often in the upper face.

COHEN: Let's get to another question now. Terry in North Carolina writes, "I've heard of a new procedure that uses a product called Radiance. Can you tell me anything about this product?"

Doctor, it's now called Radius. What can you tell Terry?

ASHINOFF: Well, Terry, it's made of something called calcium hydroxal appetite microspheres. And that is really sort of a bone material. And it's been used in medicine for paralyzed vocal cords. It's used to mark things radiologically in the body. And in Europe, they've been using it for several years as a filler. And people are using it here, as well, into the face to fill lines. And it lasts much longer than some of the absorbable fillers. It can last two to five years.

COHEN: But is it actually FDA approved yet for...

ASHINOFF: Not for cosmetic use.

COHEN: So if your doctor uses it, they're using it in what's called in an off label?

ASHINOFF: Yes. It is approved for medical -- as a medical.

COHEN: For other uses.

ASHINOFF: For other uses.

COHEN: OK. Well, the majority of questions we received were about the eyes. Let's get to one from Glen in Texas who writes, "Is there anything non-invasive that can be done to treat bags under the eyes?"

Doctor, what do you think? If you don't want surgery, can you do anything about those bags?

ASHINOFF: Well, some people think they have bags when essentially all they have is vascular congestion. People with allergies tend to have puffiness under - you know, puffiness under their eyes. And they can take a decongestant. They can put ice on there or a cool substance. Some people have what they call bags when they really have pigment. They have under eye circles. Sometimes we can bleach that. Sometimes we can use lasers, but if you really have what we call prolups (ph) of the fat pad, when fat is actually sort of protruding underneath the skin, really the only treatment for that is surgery. COHEN: So sometimes you have to do surgery?

ASHINOFF: Sometimes you just have to have surgery.

COHEN: There's no choice. Well, we've talked about what injections and peels can do next. More options in the battle against aging.

ANNOUNCER: Can make-up counter creams and drugstore lotions help turn back the hands of time?

Plus, the skinny on liposuction, coming up on HOUSE CALL. But first, more of this week's medical headlines in "The Pulse."


CHRISTIE FIEG, CNN CORRESPONDENT (voice-over): Flu vaccines can be given in smaller doses and still protect healthy adults says a new study in "The New England Journal of Medicine." Researchers found doses as small as one-fifth the size of a normal flu vaccine if given properly offer as much protection as a full dose of the vaccine.

Researchers caution that the dose sparing strategy has not yet been tested for effectiveness in anybody other than healthy adults between the ages of 18 and 40, and is not yet currently being used.

And the FDA warned consumers this week that the non prescription supplement Actra-RX may cause serious side effects, such as critically low blood pressure. Actra-RX is sold online and marketed as a treatment for erectile dysfunction, but the FDA says the drug contains prescription strength quantities of sildinfil (ph), the active ingredient in Viagra, which should not be taken without consulting a doctor.

Christie Fieg, CNN.



TIME STAMP: 0850:33

COHEN: Welcome back to HOUSE CALL. We're all bombarded with ads from televisions and magazines promising the fountain of youth in a bottle. But can over the counter products really help?

Let's go through some of the most popular ingredients you'll see. There are vitamin A or retinol products. Also, hydroxy and alpha- lipoic acids. Coenzyme Q-10 is also advertised to fight wrinkles along with copper, soy and tea. Plus there's vitamin C and vitamin E.

Manufacturers claim that each of these products will diminish those fine lines and plump up those wrinkles. Helping us sort out the fact from the fiction is Dr. Robin Ashinoff, a cosmetic dermatologist and medical director of laser surgery at the Hackensack University Medical Center in New Jersey. Dr. Ashinoff, help me out here. When you go to one of those stores that has every cream imaginable, there are so many, are there certain ingredients that people should look for? I know you can't endorse any particular product, but any ingredient that we should be looking for?

ASHINOFF: Well, certainly, prescription retinoids work the best and have been scientifically studied in controlled studies to get rid of fine lines and wrinkles.

Other than that, there are studies to support each one of the items that you said. Antioxidants, coenzyme Q-10, soy, green tea is a very, very interesting addition to the sort of cosmaceutical armamentarium.

And I do like a lot of these products. But I cannot tell people which product has the active ingredient, or which line to buy. And really, so right now it's very confusing, not only for the consumer but for me to actually recommend to someone. I usually tell them buy the substance, they would like to buy. Use it for a couple of months and tell me if it actually works because I would like to know, as well.

COHEN: A study of their own, I guess.

ASHINOFF: A study of their own. A study of one.

COHEN: A study of one. Let's get to a question now from Debbie in New York. "Are there any over-the-counter products that actually remove or smooth out the facial lines around the eyes, or laugh lines? Many products say they 'reduce the appearance,' of lines."

Doctor, I know, again, you can't endorse any product, but specifically for those kinds of problems that they were talking about, anything they should look for?

ASHINOFF: Well, certainly, again, get a product that has a sunblock in it. That's first of all.

Retinol, which is a -- is a component of many of the over the counter products now, can be very useful. I've had patients who really like retinol in their products. And retinol is converted to a small degree to the pharmaceutical retinoid in the skin.

However, of course, you'll get a heftier dose if you get a prescription from a physician. Green tea extracts, again they're anti-oxidants. They can be photo protective. They can actually protect your skin against the sun, as well.

Soy can help with pigments in hair, as well as being an antioxidant. Copper with actually act as a co-factor in collagen production and elastic tissue production. So growth factors are out there, which again, some studies have shown can be very helpful. So there's sort of a lot to choose from. And I think we need a lot more studies to compare them. COHEN: Well, speaking of trying to decide between two things, when HOUSE CALL returns, liposuction or exercise? Which is right for you? Stay tuned.


ANNOUNCER: Is there such a thing as a quick fix for fat?

UNIDENTIFIED MALE: Very often in our age of instant gratification, they want the result day after surgery.

ANNOUNCER: Our bod squad takes a closer look at liposuction. Plus, websites to help you find a certified doctor near you.



COHEN: Welcome back to HOUSE CALL.

Is liposuction the answer for getting slim? Or is a healthy diet and exercise the way to go? Our bod squad takes a look.


HOLLY FIRFIR, CNN CORRESPONDENT (voice-over): You've seen the dramatic before and after shots on reality shows like "Extreme Makeover," the pounds instantly zapped away with surgery.

Plastic surgeons have never enjoyed such a high profile. Last year alone, more than 300,000 liposuction procedures were performed in the U.S.

So is surgery the new answer to battling the bulge? Losing the fat the old fashioned way, by eating sensibly bring and working out remains the top recommendation from health experts. Doctors say removing body fat via liposuction will not cure obesity related conditions like diabetes or cardiovascular disease. Still, advocates say liposuction's cosmetic results might give some patients the mental jumpstart they need to eat better and get back on the treadmill. Even with surgery, there are no quick fixes.

MILES GRAIVIER, DR., PLASTIC SURGEON: Those expectations can be raised very high. And very often, in our age of instant gratification, they want the result the day after surgery. And unfortunately, it doesn't work quite that way. There is a time period of recovery. And in time period of improvement.

FIRFIR: Holly Firfer, CNN, Atlanta.


COHEN: For more information on liposuction, as well as all the procedures we've covered today, go to the American Society for Dermatologic Surgeries website at, or click on over to Both sites have information about each technique before and after pictures and tools to help you find a doctor in your area.

Now Dr. Ashinoff, we've talking for half an hour now about all of these different issues. And I have a question. People get wrinkles at different ages, some people earlier than others. Is that because of genetics or hard living or what are the reasons?

ASHINOFF: Genetics plays a great role in how we age, just like every other disease state that happens to us. But certainly we can protect ourselves against the sun. And that is extremely important in terms of aging. We can eat well. We cannot smoke. We can exercise. And then we can see our cosmetic dermatologist and get a little help.

COHEN: But I definitely sense a theme here. Sunblock.

ASHINOFF: Sunblock is key.

COHEN: So important.

ASHINOFF: Is so important.

COHEN: Well, Dr, Ashinoff, thank you so much for all of your wonderful answers this morning.

ASHINOFF: Thank you.

COHEN: That's all we have time for today. Join us next weekend looking as we look at some of the new ways to treat heart disease, America's number one killer.

And don't forget to send your e-mail questions to Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Elizabeth Cohen. Stay tuned for more news on CNN.


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