The Evolving Face of Cosmetic Surgery

Leslie Kollar | Cutting Edge
The Evolving Face of Cosmetic Surgery

image by: cottonbro studio

Minimally invasive procedures, from thread and liquid lifts to body contouring and facial rejuvenation, have moved the traditional facelift to the back of the bus. And it doesn't cost an arm or a leg

Stories about plastic surgery obsessions have graced the front pages of newspapers, magazines and web sites for years. Almost everyone has heard of Jocelyn Wildenstein. No? How about aka "The Catwoman", the 63 year old socialite who had $4 million worth of cosmetic procedures to end up looking like a sci-fi version of a lion/woman. reports that Courtney Love has sworn off plastic surgery after seeing Jocelyn in person. Heidi Montag goes on talk show after talk show (again) regretting her foray into multiple plastic surgeries – the list goes on of celebrity plastic surgeries gone awry. 

However, I said I'd never have a facelift. Then one morning I got up and looked in the mirror – "Mom? What are you doing here?" Okay never say never. Maybe it was time to start saving my pennies and thinking about the unthinkable. Then I watched this video – I'll never have a facelift.  But the good news is that the surgical facelift is not the only option any more. Now you can inject, fill, peel, scrape, implant, do lipo, rejuvenate, resurface, get permanent make-up, go to a spa and even spend hundreds of dollars on creams, lotions, potions and notions to help maintain (or recapture) that youthful look.  

According to the American Society of Plastic Surgeons (ASPS) in 2011 there were 13.8 million cosmetic procedures with the majority being minimally invasive procedures as opposed to surgical procedures.1 Although facelifts were among the top 5 cosmetic surgical procedures from 2000 – 2004 according to the ASPS, facelifts dropped out of the top 5 as people turned toward body contouring and less invasive procedures for facial rejuvenation.

The International Society of Aesthetic and Plastic Surgery (ISAPS) also cites a downturn in surgical procedures in favor of less invasive and less expensive options in their 2009 Biennial Global Survey. And the most recent ISAPS survey reports the top five nonsurgical procedures are Botulinum Toxin Type A injections like Botox and Dysport (32.7 percent), hyaluronic acid injections (20.1 percent), laser hair removal (13.1 percent), autologous fat injections (5.9 percent) and intense pulsed light (IPL) treatments (4.4 percent).2

So, what are these minimally invasive procedures that have moved the 'traditional facelift' to the back of the bus? 

Mini Facelift or the Thread Lift

One of the most recent options to the full surgical facelift is the mini facelift or the thread lift. Two types of thread lift procedures are currently being performed: the Contour Threadlift and the FeatherLift or Aptos Thread lift.  The thread lift is the process of using barb sutures and lifting the skin from within. A hollow needle is inserted into just under the fat layer of the skin, anchored to a deeper structure in the face, then pulled through a different insertion. When the thread is pulled, the barbs catch and the skin is lifted. The results are immediate, the risks are minimal, and the best part is no down time. Many patients choose to have this mini facelift and complement it with injectable fillers, laser therapy, chemical peels and other non surgical procedures. 

The best news about the thread lift is that it is reversible if the patient is not happy with the results. The cosmetic effects are said to last approximately 5 years. However the age range for the best candidates is subject to some debate. Some say women in their late 30's to mid 40's, others say women in their 50's are best suited for the thread lift.  A thread lift can cost anywhere from $2,000 to $5,000, much less than a full face lift without the risk of general anesthesia.3

Liquid Face Lift or Facial Fillers and Injectables

The liquid lift uses injectable fillers to fill out the skin from the inside out, filling wrinkles and restoring fullness to the face. Injectables are minimally invasive and the good news is the same as the bad news – they are not generally permanent. The types of facial fillers and injectables are many and varied. They are made from different substances, last varying lengths of time, have different effects and are used to treat different parts. They also have varying sensitivities, side effects, results, and costs.

Collagen - a natural protein derived from human dermis include Cosmoderm, Cosmoplast, Artefill (see PMMS) and Evolence. Bovine collagen derivatives are Zyderm and Zyplast and require allergy testing prior to use.

Hyaluronic Acid - a natural substance found in our bodies that can add fullness to the skin in a number of places including thin lips and facial creases such as nasolabial folds. The results are said to last typically 3 to 4 months but in some cases can last 6 months to a year. Brands include: Captique, Hylaform, and Hylaform Plus, Juvederm Ultra and Ultra Plus, Teosyal, Perland, Prevelle Silk, Puragen and Restylane.

Hydroxylapatite - a mineral-like compound found naturally in human bones, suspended in a gel-like formulation. It is the heaviest of facial fillers and is recommended to fill deeper creases such as nasolabial folds. These fillers and hypo allergenic and non toxic and said to last up to a year. Brands include Radiesse and Radiance FN.

Fat Injections - human fat harvested from your own body can be reinjected to enhance facial fullness, fill deep creases and to build up shallow contours. Fat is extracted through the use of liposuction and then reinjected into the specific areas. Because this procedure uses liposuction first it is more costly than other injectables but the results can last longer and may even be permanent.

Polymethylmethacrylate (PMMA) - PMMA fillers contain 20% tiny PMMA microspheres suspended in 80% purified collagen gel. PMMA fillers such as Artefill are recommended for the correction of facial wrinkles known as smile lines. These fillers are considered to be semi permanent to permanent, so introduction may be slow and require several treatments until the desired result is achieved.

Collagen Replacers - collagen replacers such as Sculptra are made from a synthetic material called poly-L-lactic acid, which is gradually and naturally absorbed by the body as it works to replace lost collagen. They are used for the correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. Treatment with Sculptra is done in a series of 3 to 4 injections with the results lasting one to two years or longer.

Botulinum Toxin Type A - most people will recognize it under the name of Botox, however other players in that market include Myobloc, Dysport and Xeomin. Botulism bacteria is also associated with food poisoning. In the case of injected botulinum, the substance paralyzes the muscle, thus taking away the wrinkle.

There are several potential minor side effects with injectables and fillers including swelling, redness at the injection site, bruising, and lumps forming underneath the skin. In some patients with a history of herpes simplex or cold sores, the stress of the injections may cause an outbreak. And people with a history of cold sores may require prophylactic treatment with an anti-viral. compares the various fillers and injectable products by brand name and type, cost, use and more.4 *Not all fillers and injectables are approved for use – consult a qualified plastic surgeon to determine which filler is best for you.

Resurfacing or Rejuvenation

If needles and injectables are not for you then perhaps you may want to consider one of the skin resurfacing/rejuvenation options which includes laser resurfacing, dermabrasion and microdermabrasion, and chemical peels. For those of us who are old enough to remember Logan's Run – yes I know this dates me – where lasers run amok and slice off important body parts, the thought of lasers on our face is a little daunting, but laser technology today is finely tuned and can produce very positive results.

Laser skin resurfacing is used for the removal of wrinkles, sun damage, age spots, scars, stretch marks and actinic keratosis. Pulsed light is directed in short bursts to the areas of concern allowing the surgeon to remove the skin layer by layer. Types of lasers used include the CO2 laser, erbium laser and radio frequency laser. The type used will depend upon the area being treated, the depth of the area of concern and what your physician determines from your history and current state of health to be the best option for you.5

This procedure is generally done on an outpatient basis and can be done either under local or general anaesthesia and is often combined with other procedures. The area is dressed in sterile bandages, and the patient is sent home with specific post-op instructions for the care and cleaning of the area. There will often be some swelling, discomfort, redness and crusting after the procedure and patients are usually told to stay out of the sun for some period of time. The cost varies tremendously depending upon geographic location, the size of the area being treated, medications, number of visits required and so on. It can range from $1,000 to $8,000 with the average being around $2,500.6

Three years ago I had some laser resurfacing done to the area around the lips, chin and cheeks and an age spot removed from my temple. The age spot has never returned and the resurfacing did a remarkable job of taking away a few years and smoothing out my skin. I did experience the weeping and crusting and took great care to wash and care for the area as instructed. I was quite satisfied with the results and would undergo laser resurfacing again in the future in an effort to ward off those unwanted wrinkles.

Photofacials - there are two types, the IPL - Intensed Pulsed Light Therapy or the LED light emitting diode photofacial. Being less expensive than the usual form of laser resurfacing photofacials are becoming quite popular. An IPL treatment can run anywhere from $300 to $600 again depending upon the geographic area, and the amount of area being treated. LED photofacials are more likely to be found as spa treatments.

IPL photofacials use a laser treatment and can treat a wider variety of skin conditions than the LED type. IPL photofacials use a blast of bright light with high energy. Some IPL's have a cooling component but this procedure although non invasive, can be uncomfortable. Some patients have said the IPL facial is akin to having a small rubber band snapped against your skin. The IPL photofacial may also take several treatments to reach the desired effect. The LED uses narrow spectrum light to encourage the production of collagen which in turn plumps the skin and creates a younger look. This is a cool process which results in virtually no down time or risk of burns to the area. The desired effect, however, may take more than one treatment or a series of treatments.

Dermabrasion and Microdermabrasion - according to the ASAPS, in 2010 microdermabrasion was one of the top 5 non-surgical procedures for men and women. Dermabrasion is more extensive and used to treat deeper problems like scars, keloids, stretch marks and deep acne scars.

Basically the skin is frozen (with the patient under anaesthesia) then sanded or planed with a special instrument that exfoliates the outermost layer of skin cells. New skin replaces the removed dead skin creating a smoother appearance. Microdermabrasion is also known as a "power peel" and uses tiny crystals on the skin to treat the more mild and superficial problems. This process is useful in treating sun damaged skin, reducing the fine lines and wrinkles, removing age spots, and lessening acne scars. Vacuum pressure is used to remove the dead skin cells, and then reversed to infuse the exposed skin underneath with special solution.

Since dermabrasion goes deeper into the skin, anaesthesia is used and there is a slightly higher risk for complications. Microdermabrasion requires much less down time with less associated risks. The net benefit of either procedure is smoother, younger looking skin with the removal of the associated signs of aging. The cost of dermabrasion is again largely dependent upon geographic location of the physician, but on an average will cost between $1,000 and $3,000 depending upon the extent of the procedure.7

Chemical Peels - this is a process where a peel solution is applied to the face or certain parts of the face to improve skin appearance. There are a number of chemical peel solutions, the strength varying depending upon the desired depth of skin penetration required.

Peels include the glycolic peel which uses aha's or alpha hydraulic acids that only treat the skin superficially. No sedation is required for a glycolic peel and it is used to treat the fine lines on the face or to "freshen up" the appearance of the facial skin. Other peels include the tca peel using trichloroacetic acid, and the phenol peel which is used to treat deeper wrinkles, sun damaged skin and deeper creases. Glycolic and tca peels can be used on the face, hands and neck. Phenol peels can be done on the face only. The type of peel and the duration and extent to which the solution should be applied should be determined only after an in-depth conversation with a physician. As with any procedure, a chemical peel can carry with it certain risks anywhere from uneven bleaching and scarring to adverse allergic reactions.

The cost of a chemical peel in the U.S. will vary depending upon geographic location and also depending upon the type and depth of a peel. A light peel may range from $150 to $300, a medium peel with tca can cost from $1,000 to $2,000, and a deep chemical peel or phenol peel can cost anywhere from $2,500 to $6,000. Make sure to discuss the costs with your physician or their office personnel prior to the procedure, and also make sure that all the costs are discussed including physician fees, anaesthesia, products, hospital stay if necessary, operating room use and any other applicable fees.

Implants or Augmentation

Besides the option of fillers and injectables, some are turning to augmentation to reduce the signs of age including synthetic lip implants and lip implants made from human tissue. The American Society of Aesthetic Plastic Surgeons (ASAPS) does an excellent job of explaining what these implant options are on their site under lip augmentation.8

A bit more radical and definitely invasive, but yet not a full face lift is the option of facial implants. Usually done on an outpatient basis by a board-certified plastic surgeon, facial implants would include chin, cheek or jaw implants. Often these types of implants are done in combination with other treatments, but as with all surgery requiring general anaesthesia carry risk including infection, swelling and allergic reaction. These procedures can range from $2,000 to $5,000 again depending upon the type and extent of the treatments. Your Plastic Surgery provides an excellent resource explaining the procedures, complications and alternatives to facial implants.

So, what are you waiting for?

For the past several years I have considered myself a candidate for the thread lift, especially now when I see my mother looking back from that mirror (sorry mom). The thread lift didn't currently fit into my budget constraints so I decided to pony up the cash and go for a tube of Juvaderm – I know, what I do for my craft!

When I arrived at the office of prominent Beverly Hills (you thought I'd go elsewhere?) plastic surgeon Dr. David Hopp, I walked into an inviting office with current reading material and was met by extremely pleasant and professional staff that already inspired confidence. The next stop was the patient exam room. Dr. Hopp entered with a warm smile and a reassuring manner that put me at ease. After a few minutes and some well received compliments about what I didn't need, we decided to attack the vertical lines around my lips that provide great conduits for that liquid lip gloss that likes to travel. He applied anaesthetic cream around the outside edges of my lips and left me to relax and get numb just like in a dentist's chair.

A few minutes later he reemerged, gloved, and filled a syringe with Juvederm, ready to attack those nasty 50+ year old lines. Now, I will admit to being somewhat of a needle phobe and a small needle placed numerous times around the outside edges of my lips did not do much to get rid of that phobia, but the good news is that it only lasts a very brief period of time.

After my procedure I was able to spend a few minutes with Dr. Hopp about the current state of plastic surgery and surgical facelifts specifically. Dr. Hopp believes that the current trend is away from full facial plastic surgery or facelifts. "We are seeing people come in more for spot treatments," said Hopp. "They generally just want to target one specific area at a time." When asked if that trend was a result of the economy or a fear of general anaesthesia Dr. Hopp related that the trend seemed to be an economic one, regardless of economic status. "Because the economic climate is so unsteady at this time people have become more conservative in their treatment options. That coupled with the fact that there are so many other less invasive options available."

What's the latest and greatest? 

In December 2010, the American Society for Aesthetic Plastic Surgery (ASAPS) released it's Predictions for Plastic Surgery for 2011. They cite the growth of injectables, the development of new techniques, consumer sophistication for the latest procedures, body contouring and facial rejuvenation as growth areas for plastic surgery in the coming year. But pay close attention to item #9 – aka: junk in the trunk. Finally!!! Something I have that I won't have to pay for!

According to Shine from Yahoo!, 48 year old mega star Demi Moore is reported to spend $140,000 a year on her looks with her favorite new procedure being weekly thermage treatments.9 What is thermage? According to the manufacturer, "Thermage is a safe, non-invasive, radiofrequency (RF) cosmetic procedure that's clinically proven to help smooth, tighten and contour skin for an overall younger looking appearance. The treatment delivers natural looking results with little to no downtime—on all skin colors, on and off the face, all in a single procedure".10 

How does it work? Again according to the manufacturer  "Thermage uses radiofrequency technology to heat the deep, collagen rich layers of your skin. The heat helps tighten existing collagen and stimulate the formation of new collagen, which reduces sagging, renews contours, and improves the smoothness and texture of the skin's surface."

The benefits of thermage include no down time, no peeling or blistering of the skin, non-invasive, immediate and reportedly long lasting results and no anaesthesia. So much for the good news, now the cost – according to, thermage can run anywhere from $900 to $5,000 plus per treatment with mixed reviews on the outcome. Well, if it's good enough for Demi . . .

The Bottom Line

Keep in mind that these minimally invasive treatments do not do the same as a surgical facelift, but they will go a long way in erasing some of the time that begins to show up on our faces as we age. And always make sure to discuss the costs with your physician or their office personnel prior to the procedure, and also make sure that all the costs are discussed including physician fees, anaesthesia, products, hospital stay if necessary, operating room use and any other fees that may be incurred.11

Although my procedure did not take away the 10 or so years that most of us would like to lose, it did something to my psyche that made me feel like I looked better. The jury is still out, but if my budget allows me, I will probably do other non-invasive procedures to scrape away the grime of a few years.

One of my favorite lines is from the movie Steel Magnolias, "Time marches on, and it marches all over our faces." Well thanks to today's medical developments, we may just be able to slow that march down to a quiet walk in the park.

Published February 14, 2011, updated July 26, 2012



  1. 2011 Plastic Surgery Procedural Statistics,  American Society of Plastic Surgeons
  2. Worldwide Plastic Surgery Statistics Available for the First Time, ISAPS Biennial Global Survey 2009
  3. Contour Thread Lift, 
  4. Injectables Overview, All about Facial Rejuvenation 
  5. Skin Resurfacing, The American Society for Aesthetic Plastic Surgery (ASAPS)
  6. Kita N, Laser Skin Resurfacing - What You Need to Know, Plastic Surgery,, June 27, 2008 
  7. Cost of Dermabrasion Surgery,
  8. Lip Augmentation, The American Society for Aesthetic Plastic Surgery (ASAPS)
  9. Demi Moore spends $140,000 a year to look hot, Shine, November 29, 2010
  10. Thermage,
  11. Chemical Peel Cost and Financing Information, 


Leslie Kollar has over 20 years of experience in the health care field in both the U.S. and Canada. She has worked professionally in medical offices and hospital administration, using her BA in Communications/Public Relations and MBA in Marketing. She has also seen the other side of the health care coin as a 15 year cancer survivor. As a survivor she is passionate that each and every person is and should be responsible for their own health - and with this passion she hopes to inspire, inform and educate through HealthWorldNet. Leslie can be reached at LK Communications [email protected]  

Introducing Stitches!

Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!

Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.

Be the first to know when Stitches starts accepting users

The Latest from Cutting Edge

Jet Lag…Timing is Everything
Jet Lag...Timing is Everything

Welcome to the jet age. On any given day millions of people suffer from jet lag. Can we minimize the curse of modern day travel?

E-cigarettes: Clever Marketing or Wonder Cure
E-cigarettes: Clever Marketing or Wonder Cure

It looks and glows like a cigarette. Yet it is supposedly healthy and safe and helps you kick the nicotine habit. Is it a contradiction in terms or a wonder cure for smoking?

Erectile Dysfunction - A Really Big Issue
Erectile Dysfunction - A Really Big Issue

ED is a health disorder that is treatable and even curable. But, most people don't have the patience to control ongoing health issues or change their lifestyle. Do you?

Stay Connected