Nonsurgical cosmetic treatments growing in popularity

Los Angeles Times

Dr. W. Grant Stevens calls it his fire and ice room. Stocked with lasers, skin-tightening devices, fat-zapping machines and, on a recent Wednesday, a 65-year-old woman named Helen, the brightly lighted corner of the Marina del Rey medical facility is a smorgasbord of the latest nonsurgical cosmetic procedures.

In one corner, there’s an Exilis electronic wand not much bigger than a pen, plugged in and ready to roll over Helen’s face, tightening her skin. Two boxy Zeltiq machines, which are used as a nonsurgical alternative to liposuction, sit in another corner. The room also holds the newest version of the radio-frequency skin tightener Thermage, a Xeo hair removal device, the Zerona laser, which is supposed to get rid of fat, and a Fraxel — a so-called fractionated laser used to resurface and smooth the skin.

“When I was younger, my husband called me yafah. He said I was beautiful,” said Helen, an Israeli socialite who’d flown to L.A. from Miami the day before to embellish a surgical body lift she received from Stevens, a cosmetic plastic surgeon, three months earlier. “For many, many years he forgot to call me yafah.... Now he asks, ‘Do you have a boyfriend? You look so good it doesn’t make sense anymore.’”

Helen, who asked that her last name not be used for privacy reasons, was having this conversation while the Zeltiq machines were attached to her legs and her cheeks were coated with numbing gel in anticipation of Exilis and Fraxel treatments. A book was propped open in her lap. Her iPhone was at the ready. Smiling as much as one can when one’s face is losing all sensation, Helen is evidence of a major trend: the growth of nonsurgical cosmetic devices and treatments.


Eighty-three percent of all cosmetic procedures performed in the offices of cosmetic plastic surgeons in 2010 were nonsurgical, according to the American Society for Aesthetic Plastic Surgery — and the American Society of Cosmetic Dermatology and Aesthetic Surgery reports a similar trend. What does that mean in terms of volume? Almost 8 million nonsurgical cosmetic procedures were performed last year at a cost of $4.1 billion dollars.

“There’s a huge demand for nonsurgical procedures,” said Dr. Jeffrey Kenkel, president of the American Society for Aesthetic Plastic Surgery.

The reasons are simple, Kenkel, a Dallas cosmetic plastic surgeon, said. “Some patients only want a little bit of change,” he said. Others “just aren’t interested in a surgical option.” They’re seeking procedures that are less expensive, less painful and less disruptive than, say, a face lift, which costs an average of $6,600 and takes weeks of recovery time.

In the last year alone, the Food and Drug Administration approved two new devices used for the nonsurgical removal of fat — Zerona and Zeltiq, the latter of which is quickly gaining favor as a surgery-free alternative to liposuction.

Zeltiq is a device that vacuum-attaches to the body and delivers precise and controlled cooling through the skin to target subcutaneous fat deposits. The one-hour treatment is designed to freeze and kill fat cells without damage to the skin or internal organs. If the treatment is successful, over the course of several weeks, the fat cells are broken down and processed by the liver, and ultimately expelled as excrement.

“The typical candidate needs one to two exposures on an average love handle,” said Dr. Dieter Manstein, co-inventor of Zeltiq with Dr. Rox Anderson (both of them work with the Wellman Center for Photomedicine at Massachusetts General Hospital in Boston, a teaching affiliate of the Harvard Medical School).


“The ideal candidate is somebody who’s in reasonably good shape, somebody who has some love handles or a post-pregnancy pouch or back fat that doesn’t want to disappear,” said Manstein, who also co-developed, with Anderson, a fractional laser skin resurfacing technique popularized by a device known as Fraxel.

FDA spokeswoman Erica Jefferson said the agency does not track the rate of applications for medical devices. But she added that the agency has cleared “tons” of devices for skin tightening, body contouring and wrinkle reduction in the last decade.

The number of FDA-approved skin-tightening devices, in particular, has dramatically increased in recent years, including products such as Exilis and Pearl.

The Exilis device uses radio frequency waves in an attempt to stimulate and strengthen collagen (and to reduce fat). About 100 Exilis devices are in use in the U.S., including in Stevens’ fire and ice room.

“We try to be very comprehensive,” said Stevens, a board-certified cosmetic plastic surgeon who practices at Marina Plastic Surgery Associates in Marina del Rey and also runs the aesthetic plastic surgery fellowship at USC.

Dr. Sanjay Grover, a cosmetic surgeon with practices in Newport Beach and Beverly Hills, says patients want options.


“The interesting thing these days is [that] if you watch TV or look in magazines, the drug companies are bypassing doctors and going straight to the consumer,” Grover said. “They’re creating a lot of awareness of their products among consumers.

“I offer a number of different products and services in my practice,” Grover continued. “Today’s cosmetic surgeon or medical provider needs to be able to offer a full-service shop to the patient… [and] you want to tell them what to expect with any of these modalities because for some patients it won’t be worth paying the money for some things until they go through certain [other] procedures.”

Kenkel says some of the devices can be unpredictable. “That’s the frustration many clinicians like myself have. It’s great to have a device that tightens skin, but can it do so [again and again]? Can it tighten skin or remove fat consistently and reliably? If a device tightens skin only 20% but does so 90% of the time, a patient can relate to it. A patient can’t relate to a device that in some people gives good results and in others doesn’t because you don’t know which group you’ll fall into.”

Many cosmetic plastic surgeons test devices on themselves or offer new procedures to their patients for free or at a reduced cost.

Kathy Weatherwax, a 48-year-old mother of four wanted her skin “to look brighter and younger and fresher,” without surgery. “I wanted maximum results with minimum down time because I have two little ones,” she said. “I want to save surgery for when I really need it, when I’m 70 or something,” said Weatherwax, who paid $1,500 for an ultrasound face tightening treatment and was comped the CO2 fractionated laser therapy by her doctor.

Weatherwax was hoping to reduce the ever-deepening groove in her forehead and the sun damage on her lower face from when she worked as a lifeguard as a teenager and used her breaks to lay in the sun and deepen her tan. Presented with a menu of options including microdermabrasion, fillers and a brow lift, Weatherwax chose ultrasound therapy to lift and smooth her brow, and a fractionated laser to deal with the sun damage.


Weatherwax says she got the results she wanted.

“I think I could pass for 40,” she said.