The State of Plastic Surgery

Two top surgeons debate the state of plastic surgery today.

Knife-shy patients have long awaited alternatives to traditional plastic surgery procedures like facelifts and liposuction, and earlier this year, the Federal Drug Administration added two treatments, Zeltiq body contouring and Ulthera skin- and tissue-tightening therapy, to its growing list of approved noninvasive and injectable cosmetic procedures. But are these new no-surgery techniques effective? We asked two Upper East Side surgeons, Dr. Gerald Imber, a pioneer of minimally invasive procedures such as the mini-facelift, and Dr. Haideh Hirmand, a classically trained surgeon exploring noninvasive treatments, to weigh in on the new versus the tried and true.

What are the noninvasive treatment options for lifting the eyes? Are they as effective as a facelift or an eyelift?

Dr. Hirmand: There is really no alternative to a facelift, but if you’re, say, 45 years old and beginning to see aging around the eyes, microthreading of the eyelids (from $2,500) is a great option. I use a 32-gage needle (which is as thin as a strand of hair) with a blunt tip to inject microscopic beads of hyaluronic acid (Restylane) under the skin and muscle of the lower lid, right where it touches the eyeball. This corrects the look of sunken eyes with less bruising and swelling than fat injections.

Dr. Imber: You have to be careful when using Restylane in such a delicate area. If you use too much, it can cause bumps and unevenness. Plus, it’s only a two-year-old procedure, so we don’t yet know the long-term results. A safer option would be fat transfers under the eye to fill in the area (from $4,500), but the needles for this are larger, to avoid killing the fat cells.

Are the new radio-frequency treatments as effective as a facelift?

Dr. Imber: A few types of procedures use electromagnetic waves. One is Thermage, which uses pure radio frequency to pass through the epidermis and treat the layers underneath, increasing collagen and redistributing it to smooth out the face. It’s instantly noticeable because of the swelling it creates, but it is also expensive and decidedly temporary (lasting three to five months). Instead, I would use microsuction on the neck and jowls (from $4,500), or even perform a short-scar facelift, or S-lift (from $10,000), which I pioneered almost a decade ago. Instead of yanking back the skin, I make a tiny incision behind the ear to lift the muscles under the skin. The scarring is minimal, and patients can be back to work in ten days.

Dr. Hirmand: I haven’t used Thermage because it only treats the skin, and it hasn’t produced consistent results. About six months ago I started doing Ulthera (from $1,500), which uses ultrasound waves to treat precise depths under the facial skin with heat and to regenerate collagen. Basically, it’s the closest we’ve come to tightening the skin without cutting it. Skin can be tender for a week afterward, and the procedure is only effective on mild to moderate skin looseness. It has become the perfect tool for someone who wants to maintain his or her appearance but is not quite ready for a facelift.

Does the fat-freezing treatment Zeltiq work for body shaping?

Dr. Hirmand: Absolutely. What Zeltiq does is cool down the fat cells in the layers under the skin. In the two to three months after the hour-long procedure ($750 per area), the cells are broken up and metabolized very slowly into the bloodstream, reducing the fat layer by 10 to 20 percent. It can feel uncomfortable at first, but it doesn’t actually hurt. It’s best for someone who is fit but has pockets of fat that just won’t budge.

Dr. Imber: Of all the new noninvasive procedures, this seems to be the most promising. Studies show that it does in fact destroy fat cells. But I have two concerns: First, how significant is the increase of lipids entering the bloodstream? Some of Zeltiq’s ideal candidates could also already be on cholesterol-correcting medication, and we don’t want to put their cardiovascular health in danger. And will the treatment leave the area smooth? Ten years ago, ultrasound liposuction was the rage, but it was eventually found to produce a rippled appearance. If Zeltiq does prove to leave the skin smooth, it could be a great alternative to liposuction.

Dr. Imber’s office is at 1009 Fifth Ave.; 212-472-1800. Dr. Hirmand’s is at 105 E. 73rd St.; 212-744-4400.