Mirror, Mirror, Say It Ain't So

At some point, the mirror betrays you. It shakes your sense of youth with vivid signs of aging -- little wrinkles around the eyes or lips, age spots, maybe some sagging skin. There used to be few options for turning back the clock without going under the knife. But today, you can soften the signs of aging with a wide range of non-surgical procedures for the face. Learn how these techniques work -- and see before-and-after photos.

Botox Basics

If forehead creases are bringing you down, Botox and Dysport injections can provide a temporary fix. Botox and Dysport contain the purified toxin of botulism bacteria. In tiny doses, this toxin relaxes the clenched facial muscles that cause crow's feet, frown lines, and the like. The injections take only a few minutes and cause minimal discomfort.

Botox: Before and After

Botox injections usually take three to seven days to reach their full effect. The result is smoother skin in the treated area. As the muscles slowly regain the ability to contract, lines and wrinkles reappear. To maintain the desired effect, injections must be repeated every four to six months.

Chemical Peel Basics

Chemical peels use an acid solution to exfoliate the outer layers of skin. The solution often contains a combination of glycolic acid, lactic acid, salicylic acid, phenol or trichloroacetic acid (TCA). Application can take as little as 15 minutes and may cause some stinging and irritation. Over the next few days, the upper layers of skin will peel, revealing newer, younger and smoother looking skin.

Chemical Peel: Before and After

A series of treatments can reduce age spots, fine lines around the mouth and eyes, acne scars, and wrinkles caused by sun damage or aging. Mild peels, like the one shown here, have more subtle results. The application may be repeated every few weeks until the desired effect is reached. Deeper peels initially cause swelling and crusting but ultimately have more dramatic results. Moderate to deep peels may be repeated in six to twelve months.

Microdermabrasion Basics

You may have heard of dermabrasion, a procedure that sands away the top layer of skin. It's an effective way to treat severe sun damage, but it causes bleeding and requires a week of recovery time. Microdermabrasion is a non-surgical alternative. Often called a "power peel," it blasts the skin with tiny crystals that exfoliate the outer layer. This can reduce fine lines, brown spots, and mild acne scars -- usually with no recovery time.

Microdermabrasion: After

As the outer layer of skin is exfoliated, the powdery dead skin cells are suctioned from the face (shown on left). Immediately following microdermabrasion, the newly revealed skin looks pink and feels tight, like a sunburn (shown on right). The irritation usually subsides in about 24 hours leaving subtle improvements in tone and texture. It can take up to 10 sessions, several weeks apart, before the differences are clearly visible.

Thermage Basics

For saggy, crepe-like skin, thermage can come to the rescue. This device uses radio frequency energy to heat the skin. The heat stimulates the body's production of collagen, tightening the skin. Thermage can be painful, but one treatment is usually enough for good results.

Thermage: Before and After – Eyelids

Droopy eyelids respond particularly well to thermage. The results won't appear until four to six months after the procedure, but the difference can be dramatic.

Nonablative Laser (Fraxel) Basics

Nonablative lasers, such as Fraxel, penetrate beneath the surface of the skin without damaging the outer layer. This stimulates collagen production, reduces fine lines, and improves skin tone and firmness. The procedure can be painful, so a topical anesthetic is applied. Because nonablative lasers do not damage surface skin, there is no recovery time.

Nonablative Laser: Before and After

Nonablative laser therapy is a good option for people hoping to improve both skin tone and texture without taking time off from work. Each session may cause mild redness, which improves quickly. For the best results, plan on four to six treatments with several weeks in between.

Nonablative Laser for Melasma

Nonablative lasers are especially effective in treating melasma, the splotchy brown patches that often develop during pregnancy. This image shows a striking difference in the cheek area after four treatments with a Fraxel laser.

Diode Laser Basics

People with severe acne are experiencing dramatic results from another laser procedure. Diode lasers can destroy the oil-producing glands that feed acne. Like Fraxel, diode lasers penetrate below the surface without damaging the skin's outer layer. The main side effect is short-term redness and inflammation, but patients usually do not require a recovery period.

Diode Laser: Before and After

Diode laser therapy may require several sessions to maximize results. In this image, acne has improved significantly six months after a series of five diode laser treatments.

Intense Pulse Light (IPL)

Like lasers, IPL goes below the surface to a deeper layer of skin called the dermis. Short pulses of light are administered to heat and destroy targeted cells and stimulate rejuvenation. Unlike a laser, IPL delivers a broad spectrum of light which can treat a variety of skin imperfections at the same time and causes only moderate sensation.

IPL: Before and After

IPL can reduce the redness associated with Rosacea or lighten dark circles under the eyes caused by clusters of blood vessels showing through the skin. Several sessions of IPL vaporize the blood vessels, leaving the surface skin undamaged. IPL can also remove unwanted pigmentation (like melasma and age spots) by destroying pigmented cells. IPL also stimulates collagen production, which can reduce fine lines and wrinkles.

Cosmetic Filler Basics

Cosmetic fillers are substances that help smooth facial wrinkles and folds by bulking up the tissue underneath. The fillers are injected directly into problem areas in hopes of reducing wrinkle lines and facial creases. Collagen, a natural firming fiber, is the oldest and best-known cosmetic filler. Newer alternatives include hyaluronic acid, calcium hydroxyapatite, poly-L-lactic acid, polymethylmethacrylate beads, and ordinary fat harvested from your own thigh or belly.

Cosmetic Filler: Before and After

The results of hyaluronic acid injection, shown here, can last nine months or longer. The results of collagen injections vary but may need to be repeated every three to six months. The effects of injecting a wrinkle with fat cells are often permanent. Another filler that yields permanent results is polymethylmethacrylate or PMMA. PMMA has long been used by surgeons in bone cement for joint replacement, but is now approved for cosmetic procedures.

Cosmetic Filler: Beyond Wrinkles

Today's cosmetic fillers have become sophisticated enough to treat problems beyond fine lines and wrinkles. Here, a middle-aged woman's "sunken cheek" (left) is plumped up with a filler made from human tissue (right).

Cosmetic Filler for Dark Circles: Before & After

Fillers can also mask tired-looking "bags" and dark circles under the eyes. By filling in the hollow area around the eye socket, this strategy reduces shadows, puffiness, and sunken eye appearance.

Cosmetic Filler for Lips: Before and After

Many of the same cosmetic fillers used to treat wrinkles and dark circles can also plump up the lips. Collagen and hyaluronic acid injections have a temporary effect. Injecting the lips with fat cells sometimes achieves permanent results.

Making the Decision

Non-surgical cosmetic procedures are not without risks. There's the possibility of an allergic reaction to topical anesthetics or injectable fillers. Chemical peels and microdermabrasion can result in scarring or uneven skin color. But these procedures are generally considered less risky than cosmetic surgery. To assess your personal risks and benefits, talk to your dermatologist.

More Reading on Cosmetic Procedures

• Botox Treatment
• Wrinkles
• Chemical Peel
• Microdermabrasion
• Collagen and Injectable Fillers
• Lip Augmentation
• Plastic Surgery (Cosmetic Surgery)