What are realistic expectations for noninvasive cosmetic procedures?

As the number of physicians providing noninvasive cosmetic services increases, there is a tendency for many to make unsubstantiated claims as  to what outcomes can be expected.  This ultimately can lead to unhappy patients and certain procedures can be tarnished in reviews or in the press for not living up to what was promised.  Patients need to be careful if something sounds too good to be true.  In addition, patient’s sometimes expect way too much from a procedure, often well beyond what the procedure is capable of, and need to discuss what they want, in detail, with the physician before agreeing to it.

Some of the most common misconceptions are:

1. Most people need several different procedures, not just one to become more youthful.  Don’t expect one treatment (or series) with a laser or skin tightener to be all that is needed.  The Fraxel (Dual, re:pair) will make your skin less wrinkled, tighter, and more clear.  Will it make you look “10 years younger” as some physicians claim.  Probably not.  The majority will look better but not by 10 years and will need other modalities such as filler and Botox to complete the youthful correction.
2. Don’t expect to have significant results from any cellulite treatment except for Cellulaze.  All other treatments (Velasmooth, Velashape, Endermologie) are very temporary and end up being costly and time consuming.  From the presentations I’ve seen with Cellulaze, there are significant long term results which are impressive.
3. Laser hair removal will not allow you to “throw away your razor”.  Complete hair removal is not possible with any of the lasers which remove hair.  You can expect up to 75-80 improvement with a series of about 6 treatments in the bikini and underarm area in most cases.  Back, chest, and legs require more treatments, maybe up to 10.  Darker skin individuals can require more treatments too because the laser needs to be turned down on these patients.  Extremely fine hair on the face probably shouldn’t be treated at all because of the risk of making the problem worse.  For all areas, touch ups every 6-12 months are required.
4. Some physicians were claiming Zerona was a weight loss (“fat zapping laser”) and slimming technology.  This claim was completely unsubstantiated.   There were no studies which showed long-term improvements with the technology and none which showed weight loss.  The company is now bankrupt.  Enough said.
5. A syringe of Restylane or Juvederm can’t usually make a significant improvement in volume in the face.  Keep in mind that a syringe of these fillers is 1cc.  There are 5cc in a teaspoon.  So a syringe of the filler is a fifth of a teaspoon.  In severely volume depleted patients, it’s not uncommon to use 4-8 syringes in one sitting.  Some dissatisfaction commonly expressed on RealSelf.com are from patient’s which feel that there was no result with a filler procedure or that the filler was metabolized in a week or two.  In actuality, they were expecting way too much from that fifth of a teaspoon.  (In the lips, one syringe can make a noticeable improvement.  This discussion is directed towards the patient needing volumization of face.)
6. Botox or Dysport is great for improving wrinkles which appear with expression but the wrinkles which are there at rest are helped to a much lesser degree.  If you spread out your frown line and there is still a groove, this will not improve with Botox at one session and either requires multiple treatments to improve or the use of dermal fillers.  Also remember, everything returns back to baseline unless injections are repeated every 3-4 months.
7. For an extremely strong frown line, complete “freezing” of the muscles is not possible.  Studies show Botox can improve the frown line 1 or 2 grades (there are 4 grades/degrees of strength).  You can’t go from a 4 to a 1 in one session.
8. Ulthera won’t give you a result that is comparable to a facelift.  It will however give noticeable improvements for a procedure which takes about an hour with no long-term risks or downtime.  Repeated treatments will give even further improvements.   We send patients to be evaluated for surgery if they want tightening beyond what we can deliver with the Ulthera.  Most still come back and request treatment from us.
9. Acne scars cannot be eradicated with any laser.  You can expect up to about 50-60% improvement with the Fraxel Dual.  This can take up to 10 treatments for the severely scarred patient.
10. Results for treating a smoker’s face will be diminished when compared to a nonsmoker.  Smoking decreases the circulation to the facial skin by up to 60%.  With this decreased “nourishment” to the skin, healing, collagen stimulation, tightening are all going to be significantly less.  Smoking accelerates the aging of the face.
11. If you are 60-65 and are considering cosmetic procedures for the very first time, it’s been my experience that expectations from noninvasive procedures are unrealistic.  Multiple procedures are required including:  dermal fillers, Ulthera, skin care, peels, and possibly laser to turn back the clock.  Thinking that a Botox treatment or a syringe or 2 of filler will do the trick is very unrealistic.  I suggest that these patients consider surgical intervention, but if that’s not what they desire, we can definitely make noticeable improvements, but it takes time and multiple procedures.

In conclusion, this is an era of the minimal invasive cosmetic procedures.  The future looks even more promising as to new procedures with even greater results and with more indications.  Just make sure that you go to a trusted physician that can give you realistic expectations.