The Nip and Tuck Next Door
Plastic surgeries and cosmetic enhancements are not just the domain of the rich and famous – or the ladies – anymore. everyday people – gentlemen, too – are doing it. It may be expensive but, to them, it’s worth it. Here, Real Canadians share their experiences before, during and post-procedure. Leanne Delap reports
How we as a culture feel about cosmetic face and body work is changing at a galloping pace. It was really only in 2001 that Botox was approved and entered the lexicon, first as a joke on Sex and the City and now as an everyday idea. The 2011 Canadian FACE Report, a survey commissioned by an independent group of doctors involved in the cosmetics field, found that 75 per cent of respondents believed Botox was now mainstream, with one in four considering some sort of injectable enhancement for themselves.
RELATED: Leanne Delap’s The Nip andTuck Next Door wins Best Beauty Feature Magazine, Newspaper or Online at the 2014 P&G Beauty Awards
The non-invasive offerings of the med-spa appeal to the 75 per cent of respondents who said they felt more confident now than 10 years ago but, at the same time, they wanted to look eight to 10 years younger, so that their outsides could better reflect how they feel inside. And despite the tabloid pictures of early adapters from Hollywood with that jug-cheeked, punch-lipped over-exuberance of fillers look, doctors now are promoting a much more subtle, natural and conservative approach to non-surgical injectables. Advances in fat grafting (using your own tissue as filler), vampire blood (your own platelets, concentrated in a centrifuge, to stimulate collagen) as well as new techniques in smaller doses for the more traditional hyaluronic acid fillers (Juvederm, Perlane) have made the Joan Rivers face a thing of the past. Radiofrequency is used for skin tightening and fractionated lasers both tighten and even skin tone.
But in this game, age does matter. A doctor’s consultation will determine when non-invasive techniques just won’t help any longer. There is no upper limit now on cosmetic surgery, and patients into their 90s are doing face and body work. Liposuction, still the most popular cosmetic procedure in North America, now involves far less downtime as new radiofrequency heating devices help melt the fat and tighten the skin right as the doctors work. There are a brace of new machines that superheat and alternatively superfreeze tissues around stubborn bulges, but these million-dollar babies only work to zap fat in candidates who are already quite thin.
And traditional facelifts and neck-lifts are relics of the past: new more delicate techniques and tools separate dermal layers so there is no longer any need to go deep to the bone. Therefore there is far less pain and downtime (the magic number of the plastic surgery game), a final result that shows less obvious “work done” and truly invisible scarring.
We asked ordinary Canadians* for their stories: why they pursued cosmetic work, how it felt, how the work turned out, and how they feel about it, and themselves, afterward.
Newest Minimally Invasive Body Procedures
Louise* is a 49-year-old advertising sales executive from Oakville, Ont.
“My whole life I was pin thin, more or less effortlessly a size 6. I had had three kids and always lost the weight straight away, except for a small pocket on my belly. But then at age 42, my second husband and I tried for a last baby. Two miscarriages later, I found myself not only depressed but a size 12 but only around my waist.
“I was okay watching my mid-40s become my late-40s, but the weight was really getting to me. It was beyond resistant to exercise. I play very competitive tennis, and my game was just off. I felt swaddled around the middle, and nothing in my closet looked good.
“We couldn’t afford it, but I started to fantasize about liposuction. Obsess, let’s be honest. I was at home sick one day, and I saw a doctor on one of the morning shows talking about BodyTite, which was sold as somehow less extreme than traditional lipo and tummy tucks, melting the fat and tightening the skin. I called and made an appointment. I was a good candidate for the surgery – which would all be done through my belly button under local anesthetic but I opted to be put right out. He figured it would take about two hours to suck out up to, what he called, “three litres, three milk bags of fat.”
“I went home and stuck three milk bags around my waist. It seemed gory, but I wanted to carve that off really bad. Signing the contracts and legal disclaimers made me bold, and I went into what I can now see is a denial zone. He had a cancellation so we set the surgery with less than two weeks’ notice, and I didn’t have time to fuss.”
Dr. Stephen Mulholland (www.spamedica.com) was the guy who put the three-bags-of-milk image into Louise’s head and who performed her BodyTite. He is glib and funny at the same time and prone to corny openers such as, “How young are you now?” He also lights up when speaking about his job: “I get to spend my days playing with fat and contouring bodies and rejuvenating faces!”
Mulholland used BodyTite technology on Louise, which is basically an improved form of liposuction. It involves a radio-frequency probe inserted under the skin to heat and liquefy fat cells in the area to be treated and to close off small blood vessels. The cells are then sucked out (aspirated) with a cannula. The RF also serves to tighten the skin up so that traditional tummy-tuck surgery (where muscles are tightened and excess skin is removed) is not necessary.
He recommends BodyTite for candidates with a reasonable amount of excess fat: “There is a limit to how much you can take out at one time, on an outpatient basis,” he says. Usually no more than three small zones, such as under the chin, or tummy and love handles. “It works well on thighs and saddlebags,” says Mulholland, “the tightening effect is very good on cellulite.”
Louise continues her story: “It is now four months after the surgery, and my feelings about it have gone up and down wildly. First off, I am much thinner, down two sizes in jeans (size 8). The healing has been a long and difficult process that I was not emotionally prepared for. I mean, they warned me fully and in triplicate, but it is one thing to hear the doctor say how much pain there will be and that that pain will become discomfort and that the swelling might last and last. But right now I am impatient because there is still a little pot, and it is now off to one side, the one I sleep on. He says that will go away, that it is either still swelling or scar tissue, and that if it doesn’t, he will suck it out another half-cup worth of fat in his office in another few months.
“So here is what happened with the actual surgery. The most startling memory is the jar of fat he proudly showed me as I woke up in the operating room. It was gross and real, and I was immediately glad it was no longer inside of me. I held onto that image as the next weeks were tough.
“I mean, technically, you are mobile right after surgery, in a compression garment (with drainage) but mobile. He sucked out my stomach area from just under my ribs to my pelvis and around the love handles at the back. So my whole torso was tender, and there were random shooting pains from nerves under the skin. But I also felt just beat up and I was not back at work the next day, as promised. It took about two weeks for me to get back to speed, and sleeping was uncomfortable for almost a month. Needless to say, it eliminated my sex life for some time.
“But how do I feel about it? I didn’t know if I would be public about what I had done. In the end, I didn’t tell anyone except my partner. Let them all think I did it with tennis.”
NB: Louise had the second procedure, this one under local anesthetic and reports that her stomach is now completely flat. She is “delighted, beyond. I just bought a bikini for a March break trip with my kids and I haven’t worn a bikini in much more than a decade.”
BodyTite (www.bodytite.ca): $3,500 to $5,000 per “zone”; most practices will offer you three zones for $10,000. (Three zones, as in Louise’s case, would be tummy and then two times love handles/hips.)
Newest Non-Invasive Body Procedures
Most of these are going to only reduce fat a little bit, and only a couple are permanent. And, sorry, the old Buckley’s cough syrup truism holds: the more it hurts, the better it works. Plastic surgeons’ offices are filled with an array of new toys. Remember, for many it is early days. Some will be weeded out, and others will improve with usage.
The options you may find include Zerona, which is a laser that emulsifies fat that is then eliminated through normal metabolic channels. The protocols for this system are a series of sessions (six for about $2,000; 12 for just more than $3,000) a couple of times a week. The manufacturer guarantees 3.5 inches total circumference loss from abdomen, hips and thighs.
Another promising machine is the Freeze, which uses Pulse Magnetic Fields to shrink the fat cells and tighten the skin. The Tite FX is also radio frequency with a high-voltage pulse to destroy the fat cell and shrink the skin simultaneously. And the Ultrashape, which is ultrasound energy delivered through a hand-held transducer to “disrupt” fat cells, causing permanent cell death. These procedures are often packaged together and cost around $2,500 to $3,000 for series of six to eight treatments.
But the industry favourite for non-surgical permanent fat-cell elimination is the Zeltique, also known as CoolSculpting (www.coolsculpting.com). The maximum fat reduction per treatment is about 20 per cent, though that result can be increased in subsequent treatments.
Dr. Trevor Born is the ambassador of CoolSculpting in Toronto; his face appeared on a barrage of bus ads for it this past summer. Born is our society celebrity doctor, and he splits his time between Toronto and Manhattan. He did the clinical trials at his offices in both cities for CoolSculpting and calls the in-office, no-downtime procedure “the only one that works.”
The process involves, in his words, “precisely controlled cooling to kill fat cells without harming other tissue.” The machine sucks an area of fat (not too large, Born says this only works for candidates close to their optimal weight, to get rid of small bulges and bumps). The machine can work on “problem areas like the muffin top, abdominals, love handles and back fat.”
How does it feel? “There can be discomfort for the first seven minutes,” he says, until the area is frozen. It crystalizes the cells, “permanent apatosis” in Born’s words, and they are later eliminated (you literally pee out the dead cells) and in one week or up to six weeks, the area will settle down and slim out. There can be some bruising and discomfort as the area unfreezes.
Anna* is now 58. At 48, she had liposuction on her abdomen and was very pleased with the results. But 10 years in, she had a small band of fat on her abdomen and a little bit of accumulation above her belly button, so she chose to try CoolSculpting.
“I had been so happy for so long that I was shocked this past year when I felt vulnerable putting on a bathing suit. I’m pretty active, not anything crazy, but I stay fit. I went back to Dr. Born, and we did Zeltique in two areas, just above and just below my belly button. It was quite comfortable. He has a nice office. I read magazines.
“It took a couple of months for me to be able to see and feel the full effects. I am down five or six pounds but I also used the treatment to kick-start a diet and exercise program. I definitely have had to have my clothes taken in. I used to feel bloated all the time and now I don’t.”
Cool Sculpting: most people do one or two treatments at $750 to $1,500 a pop, depending on the size of the area.
Face Work: The Whole Enchilada
Facelifts used to involve two months in hiding, the bandage-wrapped mummy in oversized sunglasses cliché. But the whole process has been revolutionized with faster healing times and smaller, more subtle procedures, says Dr. Wayne Perron, who is based in Calgary and has a patient roster from all over the Prairies (and, in fact, the world). Perron argues that a physician’s skill is key to the best result: someone who has done hundreds of operations a year and has seen things change over a long career. “Artistry, that is what it is all about. I go to work every day and I sculpt. We are trained in esthetic proportions,” he says. “The physiology works, or it doesn’t.” Perron is a big proponent of fat grafting, as in fat harvested from a patient’s abdomen and used to build up the hollows that develop in our facial scaffolding as we age and everything droops.
He uses fat grafting on its own or in combination with surgery and other injectables. He is very honest about who is a candidate for non-surgical work: “You can be too old for injectables.
There does come a point where you can’t do any more fillers, where you are not a candidate anymore. Your skin gets too old, too lax. But surgery remains an option.”
Richard* is a 59-year-old schoolteacher from Calgary.
“I went recently to get my driver’s licence renewed. The woman who took the picture looked at my old shot and said, ‘Wow whoever took that photo didn’t do a very good job. Must be terrible lighting!” She didn’t think for a second a male might have had a facelift.
It was when I saw that new driver’s licence picture beside the old one that I was blown away by how much better I looked.”
Richard is married, and his wife was totally supportive of his cosmetic surgery. “She said, ‘It’s your money, do what you want with it.’ ”
“My face didn’t match my body,” Richard says. A vegan and a serious athlete, he lays down 30 K every day, a combination of biking and running, even in 40-below Calgary weather.
Richard had been an early adopter on the Botox front, getting regular injections over a decade, and he had a little filler in the ridge between the eyebrows. When it came to the knife, he chose Dr. Wayne Perron for a neck and lower facelift ($9,200). The worst part of the experience for Richard was that he couldn’t run for two weeks. And coming home from the surgery, “I looked like a freak show all wrapped up in gauze like a Q-tip.”
But that didn’t last. Beyond a little numbness in his face that has long since passed (he is now some three years post-op), “There are no scars, you can’t see any evidence anything was done. They might be in my ears, or behind them, where there was a stitch or two. But I had no pain, no drains,” he says, attributing his super-quick recovery to his all-around robust and healthy lifestyle.
Non-Invasive Face Procedures
My story: “It would be ludicrous for me to pretend I have not tried all manner of this stuff: two decades as a fashion editor has allowed me to rub elbows with the country’s best needleworkers. I first wrote a story about Botox in its infancy in cosmetic use, when I was editing Fashion magazine, circa 2002, and I was in my early 30s. Now, I do not use any of these products regularly, a habit too rich for a single mother of any age. But I can tell you the artistry has improved considerably. It used to be heavy-handed and ‘frozen;’ now the effect is very subtle, the doctors have become musculoskeletal artistes. But I am still not a huge fan of Botox, as laxening the muscles of my forehead results inevitably in a flatness between my eyes that bugs me. And the brow ‘lift’ is always crooked on me because my face started out crooked.
“I have also had the ‘bags’ under my eyes filled: this was a disaster, requiring about $795 of hyaluronidase to remove the chipmunk cheeks I very briefly ended up with. Indeed, many plastic surgeons and dermatologists now believe that fillers do not work under the eyes; shop around for someone who has loads of experience if you do want to do this. I am not a fan of plumped lips, so I have not tried that nor have I done the nasolabial folds that start to drive one crazy as time marches. The only thing I will always keep up is the big worry crater between my eyes because you could rappel down into that thing if I didn’t fill it up with goop.”
Dermatologist Dr. Lisa Kellett owns the DLK medical spa on Toronto’s Avenue Road. She agrees that the skill level of doctors (dermatologists and plastic surgeons both do injectables, and the experience of the practitioner is everything in determining best results) has improved dramatically along with all the improvements in product. “We put far, far less in these days. And in different places,” she says. “The goal is to be as natural as possible.”
This means replacing lost volume, says Vancouver dermatologist Dr. Frances Jang. “We want to replace volume but not in that chipmunk cheek way that suddenly appeared on overworked patients around 2009. Now, we use fillers to lift from the jaw and at the temple.”
The face, explains Kellett, is an upside-down triangle in youth; the triangle flips and grows heavier along the jawline as we age. “Putting more product in the lower part of the face just serves to make more flesh that can ultimately sag.”
Both Jang and Kellett are fans of using the new generation of lasers, the Fraxel and Profractional units that can deliver multiple benefits to skin. These are particularly popular with male clients. Kellett’s Yorkville practice has been gaining men at a steady rate of six to eight per cent a year; she now says fully one-third of her clients are male. “They really demand results. And they don’t want to come for too many appointments. It is the male clients who have demanded packages.
Michael*, 50, works in real estate in Toronto. He has seen Kellett over the past three years for tune-ups – “this, that and the other things.”
“Your face is part of your wardrobe. In real estate, it is as important as your car. For communicating with people, the focus should be your eyes. You don’t want people distracted by wrinkles.
“I am looking for subtlety first. I did injections a few years ago, Juvaderm and a little bit of Botox. My upper cheeks under the eyes, like puffing up a balloon a little bit. It is almost like a perfume; it is strong off the top then backs off. Now, I know my expectations and the reality are more in line.”
Michael recently completed a three-part laser program: the first for colour correction, the second a deeper infrared process to tighten and produce collagen and the third a resurfacing, the removal of a layer of tissue on top, less aggressive than old-fashioned peels.
“You look like a baby when you leave the office. There is redness the next day, not a bad thing really. I wanted to feel like I had something done. The treatments were $1,500 a session!”
Another fancy machine, Ultherapy (www.ultherapy.com) is an extremely interesting new option for people who don’t want surgery or anything injected into them. It is a one-shot treatment, in office, with topical freezing. The machine is popular at Bay Dermatology Centre (www.baydermatologycentre.com), which is owned by dermatologist Dr. Sandy Skotnicki, the medical director of the clinic. “Ultherapy is ultrasound technology, which has been around for a long time and is very trusted,” she says. “It penetrates very deep and provides both a short-term lift as the muscles contract and then continued improvement for three to six months as collagen builds up.”
Emily* is 44 and works in the legal and finance sectors. She outlines her experience with Ultherapy.
“I was not nervous going in for the treatment but I should have been. It hurts, especially when the wand goes over areas close to the bone. It feels like a deep zap that reverberates through your head. The cheeks were okay, and so was the neck. The technician does two passes with the wand, and you see a bright light. There is a lag between the light and the jolt, so I found that hard. I almost chickened out of the second time around but then I thought about the cost and I gritted my teeth and went through with it. Basically, it felt like my face was being ironed. I was red and puffy for that night, but I looked great the next day and I was amazed for weeks. Then the initial lift wore off, and it took a couple of months to see a response. I can’t tell if the collagen is improving. Who can? But it is now almost a year later, and people do compliment my skin a lot.” Ultherapy: neck, $1,500; cheeks, $2,000; forehead, $1,000; full face, $3,500.
And, last but not least, the most subtle of treatments on the market, is also the most natural: the vampire blood treatment, or Selphyl (www.selphyl.ca).
This is the most “organic” of injectables because you are basically just juicing up your own blood and using it to stimulate collagen to “fill” out wrinkles or hollows. But be warned: it does not have the immediate or dramatic effect of a hyaluronic acid, what the pros call “packaged” fillers. As Born says, “It would not be the first product I would use for primary contouring except for people who do not want to use a packaged filler.”
During the treatment, Born extracts blood from the patient and puts it into a spinner. “The centrifuge essentially separates the platelets and blood serum from the red blood cells – giving a serum with a high concentration of platelets – the platelets are the main component to induce collagen production in the skin and soft tissue layers.”
The your-blood-but-better is injected back into you, and it can be used under eyes, in naso-labial folds, along the jawline. One of the benefits is that you don’t get creepy little nodules of “product” under the skin that you can often feel with injectables.
But again, Born, who was one of the first to use the process here and in New York and who has to date treated some 300 patients with it, says to be wary of it around the eye as many doctors, let alone med-spa technicians, are not qualified to work in that area. He prefers Selphyl for more subtle work: “This is particularly good for around the mouth and around the eyes for the fine lines and where the skin is very thin. These areas are difficult to correct with the other fillers.” He has also used it to treat facial burns with great success.
My story: “I tried this on my jawline with Selphyl with Dr. Born and then spent six weeks staring at myself in the mirror. Did it change things? Yes, in the end, my jawline was never chiselled from marble, to say the least, and I admit I am obsessed with it as it is the first thing I see in the rear-view mirror when I pull out of my garage every morning. But after treatment, it is now shored up for the time being; I personally will go for the heavy guns – Radiesse or a hyaluronic acid ‘packaged’ filler as Dr. Born calls it – if there is a next time.”
Selphyl costs about $750 to $2,000 per treatment and may require multiple treatment protocols, months apart.
*Leanne Delap’s The Nip & Tuck Next Door won Best Beauty Feature Magazine, Newspaper or Online at the 2014 P&G Beauty Awards
To find a doctor for cosmetic enhancements and for a full explanation of non-invasive treatment options: www.faceinstitute.ca