Botox is great - but refreshing it every few months gets expensive. Why can't they come up with Botox that lasts?

I bruise so easily. Why can't they find a way to do liposuction that doesn't leave me black & blue?

The skin on my neck is starting to develop folds but I'm too young for a neck lift.
Is there a treatment for tightening skin without surgery?

These and other questions were addressed last month at the annual meeting of the American Society of Plastic Surgeons, the professional society I belong to. A five-hour session was held to review groundbreaking research in cosmetic medicine, all of it aimed towards satisfying the public's desire for more and better techniques to achieve their goals.

While I can't summarize everything that went on that day, I've culled a few items that I thought would be of interest to all of you.

Botox Revolution in 2009

Botox Without Needles?
2009 will be the year of injection-free Botox. Topical neurotoxins (paralyzing ointments) have already been formulated and presented for FDA approval that will give you the same results you get with Botox injections -- only without the injections.

The principle is the same: relax specific stress muscles such as the glabellar - or frown - muscles, the ones that create wrinkles and a strained, burdened look. Results will be immediate and natural-looking.

"Botox Costs Too Much"
If you're annoyed at how frequently you have to refresh Botox, and how the cost adds up, you too will get relief. A solution will be hitting the market some time this year called radiofrequency nerve ablation.

In this technology, a metal probe releases radiofrequency energy into your facial muscles. It produces a temporary paralyzing effect that lasts longer than just a few months. Early estimates reckon that radiofrequency ablation treatments will last for a year and a half -- many times that of current Botox injections.

Fat Removal

In the future, women bothered by fat deposits in the chin and neck area will have more options for keeping this problem under control.

Researchers have been busy finding ways to use laser technology to make liposuction more efficient and less painful. We've already seen some advancements: SmartLipo and Vaser LipoSelection were introduced in 2008 and widely observed to reduce the trauma of fat removal. 2009 will see even more ingenious inventions.

• Bipolar Radiofrequency - radiofrequency waves break up fat cells before removing them.

• Cryolipolysis - crystallizes lipids by freezing them to ease the process of removing fat. In animal experiments, Cryolipolysis was shown to reduce fat layers by 35%. (image>>)

• Ultrashape Ultrasound Liposuction - this technology has been in use for years in 57 countries, but is just now poised to win FDA approval for use in the United States.

Skin Tightening

Patients have been asking me about skin tightening treatments for years, and for good reason. Skin laxity is one of the most unforgiving results of the aging process. The neck is where most people see it first. Women starting down the road toward "turkey gobbler" neck begin preparing psychologically for their first facelift.

Early results with the new skin tighteners are said to be phenomenal.

• External Ultrasound

  The leading candidate in this field is called Ulthera. It uses focused ultrasound energy to tighten the skin's surface and diminish wrinkles. It's so effective at erasing wrinkles that it's even being considered as a non-invasive alternative to surgical brow lift. It's completely non-invasive, and is applied with an external handpiece that produces little discomfort.

Fat Grafting to the Breast

Every year I get a certain number of patients asking me about breast augmentation using fat transfers. There's something intrinsically appealing about the idea of removing hip/buttock/thigh fat and using it to build up the breast.

• It seems less artificial than placing implants in the breast.

• Women become their own "donors" in a process that relieves them of guilt about being overweight. After all, they're not fat, they just have their fat stored in the wrong areas.

The Reality of Fat Transfers to the Breast
The reality of fat-transfer technology for breasts is far from natural. It involves a cumbersome process of expanding breast tissue to render it porous enough to accept fat grafts. In order to do this, hard plastic suction-cup devices must be worn on the breasts for two to four weeks prior to the fat grafting procedure, and for a few weeks afterwards.

The grafting process itself is tedious, and can take four hours or more. I, for one, would not feel comfortable keeping a patient under anesthesia for that length of time. There's too much risk of complications.

So if you've been fantasizing about breast augmentation but waiting for a more natural alternative than breast implants, stop waiting. Seize the time and enjoy fuller breasts now. The silicone implants available today feel completely natural....and you're not likely to see a better option coming down the pike soon.

Future Updates

I'll be keeping close tabs on these and other new techniques as they pass the FDA approval process and come to market. Ones that have proven value will be offered here at our office. Ones that look promising but that may be "too good to be true," I'll monitor for you as others in my field try them out and report their results.

I'd never offer my patients a procedure whose real-world results hadn't been thoroughly investigated. At our office you'll always receive cutting-edge treatments in a medically responsible setting.

By the way, feel free to forward this article to your family and friends.