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The "Non-Invasive Face Lift" - Facts and Information
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Titan

What is Titan?
The laser like infrared-light device is held on the skin and, as it slowly passes over the area being treated, delivers a series of quick, heated zaps that reach below the surface to repair and stimulate collagen. In fall 2003, aesthetic laser and light company Cutera began developing Titan because at the time, it saw few real alternatives for patients who wanted to look younger but did not want an invasive procedure. Titan was created with those scalpel- and needle-wary people in mind, as it works to treat sagging skin without changing its inherent structure. In October 2004, the FDA declared the system safe and effective for heating the skin, and the company expects to have FDA clearance for wrinkle reduction as early as this fall.

How does it work?
The natural aging process, along with sun damage, cause collagen fibers to stretch and loosen like worn rubber bands, resulting in less elastic skin that eventually droops. Titan tackles this problem by delivering infrared light deep into the dermis, the inner layer of skin where collagen resides, and prompting the collagen to repair itself. The light works in two ways: It heats up the weak collagen, causing it to immediately contract and thicken, and it also creates micro injuries to the dermis, encouraging it to produce new collagen over a period of months. The result? A smoother, tighter, more toned look that occurs naturally, as opposed to with fillers, muscle freezers or physical alteration of the skin. But perhaps one of the biggest draws of Titan is that it is almost painless, a major difference between Titan and its predecessor, ThermaCool, also known as Thermage, a skin tightening system first launched three years ago. Though both systems work by heating the dermis and contain cooling devices within the hand pieces that continuously control the temperature of the skin's surface, ThermaCool uses radio-frequency energy, which dermatologists claim is much more intense and harder to control than light energy, possibly making the treatment quite painful. Radio-frequency energy can also go to deep, destroying fat under the skin and resulting in dimpling, unevenness and skin depression. "With Titan, there is no risk of skin irregularity because it doesn't go deeper than the dermis," says dermatologist Bruce E. Katz, M.D., who participated in the FDA clinical trials for Titan.

Where can it be used?
Titan is appropriate for any area of the face, neck, or body where there are wrinkles or mild sagging caused by loose skin, such as the brow region, cheeks, jowls, neck, abdomen, thighs, back of arms, elbows and knees. However, doctors are debating where the best results occur. Because the technology is so new, different dermatologists are test-driving it in different areas, but all agree that it produces real results - in the right situation. "Titan is not meant to replace a full-blown, invasive facelift or a tummy tuck," says Katz. "It's not going to work well on very loose skin. The best scenario is to use it on areas that still have some elasticity but are starting to slacken." Yet dermatologists admit that Titan can make a difference even on less-than-ideal subjects. "If someone is a candidate for surgery but doesn't want to have it, she will get some improvement from Titan," says Goldberg. Two areas where doctors are seeing good results are the knees and elbows, regions that, until now, were virtually untreatable for drooping skin. Where it is ineffective is on the skin that is uneven due to excess fat, such as the butt, an area that few doctors are treating with Titan because "it's going to work only if you have loose skin," Katz explains. "The problem in the butt is usually bulging fat, which Titan does not treat." Some dermatologists are using the treatment in combination with other cosmetic procedures to enhance their results, such as to tighten skin post liposuction. Brandt is currently conducting a study in which Titan is used on the neck after Botox is administered. "We want to see if by relaxing the muscles first, Titan has an even greater effect because it is operating against less downward resistance," Brandt says.

Who is the best candidate for it?
Doctors are finding that age is not the determining factor in Titan's success. They stress that it's more about the condition of the skin and tackling the problem when the first signs of sagging start to occur, which differs from patient to patient. I've had people in their late 20s with modest results and people in their 70s with great results," says Javier Ruiz-Esparza, M.D., a San Diego dermatologist who took part in the Titan FDA clinical trials. Tough doctors agree that collagen doesn't respond or form as well after the age of 50, they maintain that mature patients can still achieve favorable results - if they have taken proper care of their skin. "It's not about your chronological age but your biological age," says Brandt. "Someone who has stayed out of the sun and treated her skin well might see results, even if she is older, because there is less damage to repair."

What happens during the treatment?
Forget having to clear your calendar - Titan truly seems to be a lunchtime procedure. It takes anywhere from 10 minutes to one hour depending on the size of the area being worked on and the meticulousness of the doctor performing the procedure (many treat the same area two or three times in one session). There is almost no pain involved and nearly no side effects save a bit of redness that typically lasts an hour or so and a slight swelling that usually subsides after a day or two. Doctors and patients agree that you can go right back to work post-treatment, with your colleagues none the wiser. "I am probably the only one who even noticed the swelling," says Carolyn. "I actually liked it because it made my face look a bit more plump!" A topical numbing cream is applied to most patients beforehand, though several doctors claim it isn't needed. The hand piece, which looks like a small vacuum head, hits about one square inch of skin per zap, and each one lasts about six seconds. The sensation feels like a surge of heat that comes and goes. "It's more discomfort than pain," says Carolyn, whom Brandt treated with numbing cream before the procedure. "It feels like a concentrated heat, but it's not that bad." The company claims to no reports of long-term side effects, though it has heard of a few patients experiencing mild blistering immediately afterward that resolves itself with a few days. Ruiz-Esparza says that about 3 percent of his patients have experienced this, "but the blisters go away quickly and are more of a nuisance than anything else."

How many sessions are required?
Doctors are divided as to how often the procedure is needed and how far apart the sessions should be spaced. The average recommendation is one to three treatments performed two to four weeks apart. Katz advises up to five sessions; while Ruiz-Esparza suggests only one and lets his patients decide whether they want to continue with it. Most doctors conclude that it depends on the person's needs and the area being treated. Quite a few space the sessions one month apart, but Katz feels strongly that Titan should be administered every two weeks. "The skin produces more collagen when the dermis is still little inflamed, and if you wait a month, all the inflammation goes away," he notes. "We're keeping up the momentum." How often the entire series needs to be retreated,: says Goldberg, "but we're thinking every one to three years."

When are results visible?
While many patients report immediate tightness, dermatologists argue that it mat be from the slight swelling of the skin post-treatment. It takes three to six months for new collagen to form, so optimal results should occur after three to eight months, depending on how often the treatment is repeated. The extent of improvement varies. "We don't know why some patients get better results than others," admits Ruiz-Esparza. Brandt agrees: "It's too soon to understand the long-term effects. We have to treat hundreds of subjects to see all the good and negative outcomes." Still, women are lining up to get zapped, since there is so little risk involved and the cost is relatively low compared with surgery. "What's great about Titan is that it doesn't preclude you from having surgery later on," notes Goldberg. "But once you cut skin, that scar is there forever."

Injectible and Filler Therapy

Botox Cosmetic, Juvederm and Radiesse
The way your skin looks is directly related to the way your skin is supported. As we age, the natural support layers in the skin break down resulting in the formation of wrinkles. With these simple, highly effective procedures that improve the skin's overall appearance by smoothing wrinkles and fine lines, eliminating furrows and crow's feet, filling in skin depressions, or volumizing areas of the face, you can now have the enhancement you desire. Often used by themselves or in conjunction with one another, these low invasive treatments can bring dramatic results. So, stop looking tired or upset and watch how those moderate to severe lines on your face can be smoothed with no surgery and almost no recovery time. Improvements can be seen instantaneously to within days, lasting months.

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