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Marjorie Bekaert Thomas
Advances in health and medicine.
General Health Channel
Reported June 18, 2008

The Future Perfect: Knifeless Plastic Surgery -- In-depth Doctor's Interview

Heather Woolery-Lloyd, M.D., a dermatologist at the University of Miami Cosmetic Medicine and Research Institute, talks about the Titan laser and other new cosmetic procedures.



Why do you think Americans are obsessed with looking young?


Dr. Woolery-Lloyd: Practicing here in Miami, obviously, it's a culture that is very into looks -- how you look, how you appear -- so I find many patients, men and women, seek cosmetic treatments to improve their physical appearance. The question is, why? I think that it's just a natural instinct honestly that people want to always look better.


Do you think in our parents' and grandparents' generations they were just as obsessed?


Dr. Woolery-Lloyd: Yes and no. I do think that 50 years ago people were also concerned their appearance. The difference between 50 years ago and today is that we have so many more options available … so many more procedures that are available and I think what's making things a little more attractive to people that there are nonsurgical interventions that allow people to improve their appearance. So 50 years ago, you had to do surgery or you could wear makeup, I mean those were your options, and now we have lasers. We have light devices that can improve your appearance without the risk of surgery.


How long have lasers been around?


Dr. Woolery-Lloyd: I would say lasers have gained popularity in the last five to 10 years, but exponentially so in the last two to three years. There are lasers for everything. Lasers can't replace surgery, but there are lasers that can really achieve great cosmetic results. So we have lasers that treat dark spots on the skin, redness in the skin, loose skin -- all different types of skin problems. There are many different types of lasers and focus on whatever people are most concerned about.


Do you think we live in a youth-obsessed culture?


Dr. Woolery-Lloyd: I do feel that we are youth obsessed. I think that in the U.S. there is definitely more of an emphasis of looking younger whereas in other countries there is an emphasis on beauty but not necessarily looking younger. So that's something that is unique to us and it's especially common in certain cities. I do think that that we have an emphasis on looking younger here in the United States. I don't think it's worldwide, but definitely here.


What is the Titan laser?


Dr. Woolery-Lloyd: It's actually a light device, so sometimes we use the term lasers and light interchangeably, but Titan is a light that is used to tighten the skin.


How does it work?


Dr. Woolery-Lloyd: How Titan works is that it heats up the deep layer of our skin which is the dermis that contains collagen, and when you heat up the dermis it kind of tricks the dermis into thinking that it was injured so that you produce new collagen and the results of skin tightening.


How does the Titan tighten the skin?


Dr. Woolery-Lloyd: When we do studies in the lab we know that when you heat up collagen it does two things. One is that it contracts, so sometimes you see some immediate tightening because the collagen fibrils actually contract, but long term it kind of tricks your skin into thinking it's injured and then you produce new collagen. Just like if you cut your skin and you need to produce new collagen to heal that wound, this kind of tricks the skin into thinking that it's injured so that you produce new collagen and then you get a resultant skin tightening.


Can you feel the Titan?


Dr. Woolery-Lloyd: You can't feel it. It's definitely something you see. It's most obvious over bony structures, so I love it for the jowls on the face and sometimes on the cheekbones, but it works really anywhere on the skin. I treat every part of the body. So I treat the abdomen, the legs, the underarms … all over … every area where you have loose skin.


Who are good candidates for the Titan?


Dr. Woolery-Lloyd: I've seen great results on many different types of patients, but in my practice I think the ideal patient is someone who doesn't have that much skin laxity. Someone who is just getting some mild jowls in this area -- that is an ideal patient in my practice. I also like to use it on the upper part of the face to tighten where the cheeks are and then I have fantastic results in loose abdominal skin after pregnancy. That's a very common complaint. There's no real option other than a surgical intervention and this gives patients an opportunity to tighten their skin without surgery. Actually, I love it for that type of patient because they're young patients, so they have a lot of potential to regain some elasticity. Some people believe that it may be less effective or a little less long lasting in older patients, but in young patients, people tend to do very well. So these are young women who just had a baby and then one year later still have loose skin. They do really, really well and that is one of my favorite areas to treat.


What does the treatment feel like?


Dr. Woolery-Lloyd: I always describe to patients that the Titan feels like it gets warm, very warm, very, very warm and then cool. Each pulse lasts around six seconds and so we go over each area three times and the procedure can last anywhere between 30 to 60 minutes depending on how large an area we're treating. The treatments are once a month for a series of three, at least three treatments. Sometimes we do more, but at least three treatments to see initial results.


Can you see results after the first treatment?


Dr. Woolery-Lloyd: That's a great question and it's a little bit complicated. As I mentioned earlier collagen contracts when it's heated so you do see some immediate tightening and that's a great effect and patients love to see that. They sit up from the procedure and you hand them a mirror and they look better instantly. But that's actually not the effect that I'm most interested in. I'm most interested in the new collagen deposition that happens over a period of time. A lot of times I talk to patients that after the first treatment, it's okay if you don't see significant results. Usually after the second and third, you'll start to see some significant tightening and that can continue up to six months after your last treatment.


Do patients ever get four or more treatments?


Dr. Woolery-Lloyd: It depends on the patient. Some patients after three treatments are happy with the results and decide to come back once a year for a touch up if they feel that they need that. Other patients want to achieve better results and if economics isn't an issue, then they will continue to get more treatments. The one thing I do want to mention is that the Titan does not replace surgery. When a patient walks in and pulls their cheeks straight back and say I want you to do this, it's not the procedure for that person. It gives you great results, but they're subtle results and you have to recognize that this is not replacing surgery. It's just providing an option.


Is it a procedure that, unless it was you getting it done, you wouldn't know a person had it?


Dr. Woolery-Lloyd: No. It's a very subtle improvement, but the woman or man who has been treated always notices the improvement, or in most cases notices the improvement, but it's definitely a subtle improvement and it's not a replacement for surgery. For younger women who would just like to notice some subtle skin laxity or looseness in their skin, it's the perfect procedure. And for women after they've had a baby and they have loose skin and don't necessarily want an abdominoplasty or a tummy tuck, it's a great option.


How long do the results last?


Dr. Woolery-Lloyd: We are not exactly sure how long it lasts. We know that at least two years out, you can see some improvement, but what I tell my patients is to follow up in a year and if you need a touch-up or a series of touch-ups we can always do that.


How much does it cost?


Dr. Woolery-Lloyd: It depends on the area you're treating. For treating lets say the face, it can range anywhere between $600 to $1,200 per treatment. For the abdomen, anywhere between $800 to $1200 per treatment.


What type of patients, economically speaking, get this procedure done?


Dr. Woolery-Lloyd: There are definitely two types of patients. There are patients who don't have the economic limitation and so therefore, it is definitely an option for them and not something they have to worry about. But there are other patients who need to find the money and they want to choose between certain procedures and for example, someone with loose abdominal skin would be choosing between a tummy tuck which is a very costly procedure and this, which is a little bit less expensive, it doesn't give surgical results, but it's another option. So it really depends on the patient, but women and men who are troubled by these things, if it really bothers them they'll find a way to pay for it.


Some plastic surgeons say their patients aren't as wealthy as most would expect.


Dr. Woolery-Lloyd: Right, yes. And they've done studies on that. Some procedures are very, very expensive, but many cosmetic procedures can be affordable if, you know, it's a high priority for that person. I do a lot of laser hair removal and women with facial hair really will go out of their way to be able to pay for their laser hair removal because that causes such a tremendous impact on your self-esteem.


For something like that -- unwanted facial hair -- are there sometimes underlying causes of it?


Dr. Woolery-Lloyd: There are. There are medical things that can cause unwanted facial hair, but many of my patients I check and patients that I'm suspicious actually, in all of my patients with unwanted facial hair, I recommend that they have their hormones checked. And the vast majority of them have completely normal hormones and it's just hereditary and a normal variant, but in our society, it's not normal to have facial hair so those women will go out of their way to get that treated.


Why does the skin change with age?


Dr. Woolery-Lloyd: There are different things that give our dermis its volume and its youthfulness. There is hyaluronic acid, which is a sugar that's naturally found in our skin that binds 1,000 times its weight in water, so it gives us a lot of volume, it makes us look plump and our skin look very youthful. Collagen is what you can consider like a building block -- the main component of the dermis -- and elastic tissue is just another component that adds to elasticity. With aging skin we see a decrease specifically in collagen and in elastic tissue. As you age you're collagen and elastic tissue don't have the same integrity as they do when you're younger. So one of the things that replace frequently is hyaluronic acid and we do that with different fillers. Collagen was the original filler, but now our newer fillers contain hyaluronic acid and it's a gel that is injected into the skin to give it volume. And then newer devices such as lasers can increase collagen production and improve the collagen that we currently have in our skin.


What are some other devices used to improve the appearance of skin?


Dr. Woolery-Lloyd: There is another device. It's called Thermage and that uses radio frequency waves to heat the collagen to induce collagen production, so they both work similarly, the only difference is that the Titan laser uses light to heat the skin and Thermage uses radio frequency waves, and the results are similar.


Is one safer than the other?


Dr. Woolery-Lloyd: I think they're pretty much equivalent. There is the general feeling that the tightness probably hurts a little bit less than the other procedure and with the radio frequency waves, there is a small risk -- a very, very small risk of skin atrophy or getting a little dent in the skin that has not been reported with the Titan.


What are the risks with the Titan?


Dr. Woolery-Lloyd: The main risk of the Titan is there some discomfort so during the procedure if someone didn't want a procedure that has any pain at all. It definitely has some discomfort, but for most patients it's tolerable and I'm talking to them the whole time. The other small risk are blisters, which I haven't seen in my practice, but it's definitely a possibility. Those are usually superficial and will resolve on their own within one to two weeks.


Is this safe for all types of skin?


Dr. Woolery-Lloyd: This device is safe in all skin types. I treat every skin type from lighter skin to very, very dark skinned patients without any problems.


How long has the Titan been around?


Dr. Woolery-Lloyd: The Titan has been available for three to four years, I'd say.


How widely is it used?


Dr. Woolery-Lloyd:  It's a very popular laser because this is something that women and men frequently complain of -- loose skin on the face. And really in the past, the only other option was surgery. So this laser has offered patients a new alternative, so for that reason I think it's very popular. There are many doctors in every major city who has this light device.


What are some of the newer things that have you excited as a dermatologist?


Dr. Woolery-Lloyd: I have a lot of patients with skin of color and in patients with skin of color the most common complaint is uneven skin tones or hyperpigmentation. So the things that I'm most interested in are new treatments for hyperpigmentation. We have a treatment that has been available for over 50 years, tried and true, very reliable, called hydroquinone, but that really has been limiting. Our treatment armamentarium, was limited to hydroquinone. Now there are some newer agents for helping to improve pigmentation and those are the things that I'm really excited about.


There are many new lasers coming out … there is always a new laser coming out. There are some new lasers that are surfacing lasers, so in the past the old lasers that used to resurface the skin, remove the entire top layer of the skin, and you had down time of two weeks or more until you're epidermis was able to heal. And now there are newer lasers that are ablated so they do remove a portion of the epidermis, but they have less down time, maybe three to seven days of down time.


What are those lasers called?


Dr. Woolery-Lloyd: One is called the Pearl. Another is called Fractzel, which has been available for a while and there are many new fractionated devices that are being introduced. One is the Fractional CO2 laser. So there are many new lasers that help to ablate the skin and improve the texture and appearance and fine wrinkling, but without the downtime of the old lasers. Lasers tend to be very highly regulated, they tend to be regulated because for them they are costly to make and so for them to introduced.


What are some new things other than lasers?


Dr. Woolery-Lloyd: Besides lasers, something that's new that a lot of patients ask me about is mesotherapy. It's not actually new. It's actually been available for years but its gaining popularity recently. Mesotherapy is injecting various different chemicals or vitamins into the skin to help either shrink fat or make it look it more youthful to improve the appearance of the skin. That really hasn't been well studied and I have an open mind, but safety and efficacy has not been established yet.


What do you think the future holds for that field?


Dr. Woolery-Lloyd: That's a great question. It's hard to think about what the future holds because it's a very innovative field and there's always new things coming onto the market. I think there will be a lot of new fillers because fillers are very popular -- the older fillers with collagen, the new ones are hyaluronic acid, but I think that there will always be many new fillers. The ideal filler would be low risk, so low risk of bruising, low risk of side effect and long lasting. Fillers are one area that I think are going to grow and even toxins. Botox is actually the only FDA approved botulinum toxin right now, but new toxins will be introduced into the market and I think that's another area of huge growth. Topical creams is actually a new, there has been a lot of studies on a new Botox cream that would be applied in the doctor's office and for people who are scared of needles, it would offer them an option to treat their wrinkles without using needles to inject Botox. That's something that is new and on the horizon … not approved yet, but new. So it really is an innovative area of medicine and we're always surprised by the new things that are introduced.


Do you think there will always be a demand for new things?


Dr. Woolery-Lloyd: I think there will always be a demand for more. I mean living in Miami, you really see that this is a trend that is here to stay. That's my belief. I think, you know, just like everything there will be peaks and valleys in popularity of cosmetic procedures, but I do think overall cosmetic procedures, as long as there is safety and they are not especially expensive, women and men will always want to seek improvement if they can.


Have you ever had any cosmetic procedures done?


Dr. Woolery-Lloyd: I have. I've had Botox. Most procedures that I do on my patients I do them myself. I've done laser hair removal. I've done various lasers. I've done Botox I've done all types of procedures. I do that on purpose because I want to be able to explain to someone what to expect.



This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.


If you would like more information, please contact:


Heather Woolery-Lloyd, MD

University of Miami Cosmetic Medicine and Research Institute

Miami, FL

(305) 532-5552


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