From Wrinkle Creams to Needles to Knives or Not If I had a dollar for every time I’ve heard a flawless 26 year old with lineless skin exclaim, “I can’t imagine why women would ever stick needles in their faces!” I could have financed my facelift fund a hundred times over. My response to these naive young girls is an emphatic, “Come see me when you hit 35!” “Never say never” in fact, is the prevailing attitude when it comes to cosmetic enhancements. Imagine a grape shriveling up and becoming a raisin. It starts off juicy, round, and smooth, and gradually becomes dull, rough and wrinkly. That’s essentially the grim reality of what happens as you age. One day you look in the mirror and think to yourself, “How did that happen?” Choosing the right procedure or treatment plan involves many individual yet related factors including your budget, how much time you can take off work, school, or play, your pain tolerance, your acceptance of scars, and the inevitable fear factor. When most people think of cosmetic surgery, they tend to think of melon sized breasts and the wind tunnel facelifts seen on the big screen. Everyone can spot the obvious victims of overdone cosmetic surgery, yet the good work is virtually undetectable. Many women say they don’t want to have a lift because they have never seen a good one. “I can always tell”, is a common lament. However, modern lifts just look like the owners have aged well or look better than their chronological age. Cosmetic enhancements circa 2009 can be divided into three basic categories. Non Invasive includes wash and wear injections and resurfacing treatments such as lasers and peels, and clinical skin care. Minimally invasive falls somewhere in between surgery with visible scars, and the non invasive category, and can be performed in a doctor’s office. Invasive procedures involve surgery done to reshape or refine parts of the face and body, typically involving an office or hospital setting and anesthesia. . In the overall scheme of things, there is no ideal time frame to jump on the Botox® bandwagon, although the trend is certainly towards doing things earlier as a preemptive strike for maintenance and to forestall the day when everything goes south. But there will come a time when creams stop doing enough to make you content with the way you are aging, and you start to wonder what else is out there. You don’t have to take it lying down (although lying down does make sagging disappear – try holding a mirror above your head). The next logical step from wrinkle creams and sunscreen are peels and intense pulsed light treatments that can even out skin tone and improve texture. Botox® is brilliant for lines around the eyes, forehead and mouth. Dermal fillers such as Restylane®, Evolence® and Radiesse® are de rigeur for plumping furrows, creases and deeper folds. Brown spots and sun damage can be helped with a course of Fraxel® or Pearl®. For slack skin, tightening devices such as Thermage® and Titan® can deliver a subtle lifting effect on droopy brows and necks. The final stage before considering surgery tends to be a combination of several of these to maximize the anti-aging results. Of course, when the non invasive treatments stop delivering what you really want in terms of sagging, sinking and bulges, you might consider a short scar face or neck lift and some minor eye rejuvenation surgery to reduce excess skin and fat deposits.