Woman pinching skin on hip

What started as Mom’s home remedy for teething pain has evolved into one of the most popular nonsurgical fat-reduction techniques available today. CoolSculpting — technology that uses controlled cooling to target fat cells underneath the skin — was developed by Harvard doctors who noticed that children who were given popsicles to help ease teething pain lost fat in their cheeks and developed dimples. The doctors also found that women who rode horseback using English style in the cold Northeast tended to lose fat from their thighs. Since that time, CoolSculpting, along with a plethora of other beauty treatments, has evolved considerably.

“Patients seek cosmetic procedures to look and feel better and to get back to how they looked five or 10 years ago,” said Dr. Linda Leffel, a board-certified cosmetic surgeon and founder of the Leffel Center in Bend. “Here, the natural look is definitely what my patients are looking for. They don’t want overstretched, overfilled looks.”

Although some cosmetic procedures can create discomfort, most are not painful, according to Leffel, who has had CoolSculpting, Ultherapy and filler treatments herself. If a procedure does cause discomfort, an oral medication such as an anti-inflammatory can be prescribed.

If you are considering cosmetic surgery or other beauty procedures, the professionals agree that the key to success is to do ample research and ask the right questions. Selecting a provider shouldn’t be based on cost alone. Information to gather should include who will do the procedure, how much experience they have doing it, whether or not they are board-certified and if the treatment is FDA-approved. With some products, FDA approval exists, but only on certain parts of the body.

“By going to a plastic surgeon who has been trained in noninvasive procedures, you’ll get a thorough evaluation leading to the best recommendations based on your health, anatomy and age,” said Leffel. “The importance of going to a board-certified plastic surgeon for injectables is that they have an understanding of facial anatomy and how to get the best results. Not everyone who advertises as an ‘expert’ is board-certified; you need to look at degree, training and formal education.”

Dr. Mark Hall of Central Oregon Dermatology in Bend agrees that careful selection of a practitioner is vital to getting the results you want from a procedure. A properly trained professional with years of experience in a given treatment will provide the most realistic assessment of what you can expect from the procedure.

“This comes from proper education. You don’t necessarily always want to go to the lowest bidder. You want to be safe,” said Hall, who is certified by the American Board of Dermatology. “If the procedure is not done well and right, you may wind up with complications that could be irreversible.”

Cost for treatment will vary from provider to provider, and will depend upon the procedures prescribed and how many treatments are needed. Typically, a provider will create a custom plan during consultation, and price will be based on the individual regimen prescribed. Oftentimes, more than one type of treatment will be recommended.

“People want us to help them look better without having to go under the knife,” said Gwen DeBergalis of Northwest Medi Spa in Bend. “They don’t want the down time of more invasive treatments, or to spend $10,000.” DeBergalis, who is a licensed medical esthetician in Oregon and New York and a laser technician, suggests selecting a facility that focuses on the total picture, and that has a staff made up of providers with differing licenses and expertise.

“It’s nice to have doctors, nurses and estheticians all under one roof,” she said.

At Northwest Medi Spa, DeBergalis works with owner and operator Dr. Rebecca Morton-Nonweiler, a practicing anesthesiologist in Oregon and California. At the Leffel Center, Dr. Leffel is assisted by a board-certified physician assistant who is a Fellow of the American Academy of Physician Assistants. At Central Oregon Dermatology, Dr. Hall works alongside a physician assistant who is certified by the National Commission on Certification of Physician Assistants and a member of the Society of Dermatology Physician Assistants.

Following a treatment, the experts agree that home care plays a big role in how long the results will last.

“We like to educate our clients about proper product use at home,” said DeBergalis. “What a client does when they leave following a procedure really does matter. One of the best things you can do is wear sunscreen all year round,” she said. “We are at 3,000 feet here and have sun most of the year. People think they only need sunscreen while outside cycling or playing, but they need to wear it all the time. We see lots of people with UV damage. Twenty percent of skin damage is genetic, but 80 percent is due to external factors such as sun and lifestyle, including diet, exercise, smoking and drinking.”

Beauty treatments run the gamut, from simple techniques that can be performed during lunch-hour visits to procedures that take repeat sessions over a period of several months. Here are facts about some of the more popular treatments, all of which are available in Bend.

CoolSculpting

FDA-approved, with two new treatments approved as of April 2016 (bra fat rolls and back fat). Turkey neck? Love handles? This may be the procedure for you. With CoolSculpting, the treated fat cells are frozen and die, and over time the body eliminates the dead cells permanently. A gel pad and applicator are applied to targeted areas, which can be just about anywhere on the body. No anesthesia, surgery or down time are required. Results take anywhere from three weeks to three months to be seen, but are long-term.

“When I had CoolSculpting done, my daughter said, ‘Mom, you need new jeans!’ because I went down a full pant size,” said Leffel.

* Cost: For a very small bulge/treatment area, a procedure can start at $600. However, most patients usually have larger areas treated, which range from $1,200 to $1,500 per site.

Ultherapy

FDA-approved, non-invasive ultrasound treatment designed to lift skin on the brow, neck and under the chin, and to improve lines and wrinkles of the décolletage (lower neck line and chest area). Single treatment, no downtime. It has been described as a noninvasive “mini facelift.” Results become most visible two to three months after treatment, and are permanent, though the natural aging process will continue. Touchup treatments may be desired one to two years after the initial procedure.

* Cost: $800 or more for single area; up to $4,500 for full face and neck. This varies widely depending on number of areas treated, provider and number of treatments.

Kybella

FDA-approved for use under the chin only. A chemical that non-surgically and permanently kills fat cells under the chin, aka the “double chin.” Typical treatment is two to six injections depending upon the amount of fat. Side effects can include bruising and swelling, and some discomfort during the injections and in the hours following. Kybella is a prescription and must be administered by a doctor.

* Cost: The typical cost for Kybella ranges from $600 to $2,400, with an average cost of about $1,400.

Injectables and Fillers

There are many injectables and fillers on the market today. Among the brand names are Botox, Dysport, Xeomin, Restylane, Belotero, Juvederm, Sculptra, Radiesse, Voluma and Artefill. Some are FDA-approved, and some are not. According to Leffel, injectables such as Botox, Dysport and Xeomin are FDA-approved neurotoxins that are injected into areas such as the forehead and the sides of the eyes to temporarily reduce wrinkles. Downtime and discomfort are minimal, and results from the injections generally last about four months.

“Botox is by far the most common cosmetic procedure in the country, with fillers next in popularity from a dermatologist’s perspective,” said Hall. “Botox is the standard for all cosmetic procedures. There is a high repeat customer rate; people want to do it again because they get good results. It’s been used for a long time and is very safe.”

Fillers such as Restylane, Belotero, Juvederm, Sculptra, Radiesse, Voluma and Artefill are used to stimulate collagen and replace lost volume due to the aging process. These fillers are injected in areas ranging from the temples and cheeks to the lips and smile line, with results lasting anywhere from a couple of months to a year.

When deciding upon which filler to use, Hall said it’s essential to discuss all the options thoroughly with the providing physician.

“There are a lot of options depending upon the level of wrinkles and what the goals are,” he said.

* Cost: Varies widely depending upon the type of filler used, ranging from about $200 to $1,200 per injection.

Fraxel

A machine that provides skin resurfacing by using two wavelengths of light. The “Fraxel:Re:Store:Dual” machine is FDA-approved and is used to resurface acne scars, stretch marks, hyperpigmentation, fine lines and wrinkles, and can be used on the face, neck, chest, arms, legs and back. In addition to resurfacing, the Fraxel machine stimulates collagen formation to slow the skin’s aging process. Discomfort is minimal, and downtime is generally a few days of sunburn-like pink in the skin tone. A typical treatment regimen is three to five sessions spaced at two to four weeks apart. Results are immediate, with peak improvement typically visible in two to three months. Longevity of results can be several years, but will depend upon the homecare regimen, sun exposure and the ongoing aging process.

* Cost: Treatment pricing will vary depending on individual skin conditions and desired clinical outcomes. Generally, pricing can range from $650 to $2,000 depending on how many areas are treated.

Chemical Peels

There are three categories of chemical peels: superficial, medium grade and deep. There are many peel formulas available, some for medical use and others used strictly by estheticians. According to DeBergalis, a superficial peel — or “lunchtime peel” — is used to help refresh skin, unclog pores, exfoliate and help with superficial hyperpigmentation. Microdermabrasion falls under this category.

Medium grade peels are noninvasive and require no downtime. These peels penetrate deeper into the skin and can be used to treat sun damage, pigmentation and wrinkles. They can cause some discomfort, including burning and stinging that can last for 30 minutes to an hour after treatment. Downtime is a few days of pink and itchy skin and possibly some swelling, followed by possible patches of brown and white skin on the face during the healing process. Generally, recovery takes about a week, but skin can be a little pink for up to six weeks.

For deep peels, a doctor or plastic surgeon must be seen, as the peels can be painful and anesthesia is typically administered. These are the strongest type of chemical peel available and can achieve dramatic results for sun damage, scarring and deep lines and wrinkles. These peels penetrate the deeper, or dermal, layers of the skin. Following the procedure, skin will be very red and feel like it is sunburned. The face will be swollen for the first couple of days after the treatment, and then will scab. Peeling and itchiness are other side effects. Downtime can be up to two weeks. After recovery, results are long lasting.

* Cost: Chemical peels can range in cost from $150 for a light peel to as high as several thousand dollars for a deep peel with anesthesia. Price varies considerably depending upon the chemicals used, goals and the depth of the peel.

Dermaplane

A noninvasive exfoliation treatment for the skin that uses a surgical steel blade to remove dead skin cells and fine hair. DeBergalis describes it as a form of shaving, but offers assurance that the hair does not grow back thicker or coarser. This procedure can be performed by estheticians. There is no downtime, and the treatment can be repeated about once a month when hair grows back.

* Cost: Typically $65 to $150 per session.

CO2 Laser Skin Resurfacing There are a variety of CO2 resurfacing lasers on the market, with fractional lasers the newer of the technologies. Dr. Hall uses the DOT (Dermal Optical Thermolysis) fractional CO2 laser, which utilizes a dot pattern to create thousands of microscopic perforations in the skin. Down time with DOT is three to five days, and there is minimal discomfort. With DOT, a single treatment can produce results, though in some cases a series of treatments may be prescribed.

“We use DOT for wrinkles and age spots, and textural improvements after injury,” said Hall. “It stimulates the repair process and is a good choice for full face lightening and toning.”

* Cost: Full face treatments can range from $1,500 to $3,000.

Intense Pulsed Light (IPL) Therapy (aka “Photorejuvenation” and “Photofacial”)

IPL therapy machines use broad-spectrum wavelength to lighten and remove sun or age spots and brown blotches on the face, neck, chest, hands and other parts of the body. The machines can also lighten and reduce redness, rosacea, dilated blood vessels and broken blood vessels on the face, neck and chest; can remove spider veins; and can even remove hair. Most people need a series of three to five treatments, spaced out about one month apart. Results progress with each treatment, and following the last visit, annual maintenance treatments may be recommended. There can be mild discomfort following the treatment, and redness and dark spots can intensify prior to lightening.

* Cost: A single full-face treatment can range between $300 and $500. A face, neck and chest treatment can run from $800 to more than $1,000. Treating the hands is typically about $250 per treatment.

Exilis Elite

A non-surgical tissue tightening device that helps shape sagging skin and reduce excess fat using radio frequency technology. The device is designed to focus heat to varying depths of tissue, stimulating shrinkage of the fat cells and generation of new collagen. Results are achieved in two to six treatments scheduled one to two weeks apart, with final results visible in three months after the final session. The treatment is pain-free and has no downtime.

* Cost: The typical cost for Exilis ranges from $500 to $2,400 depending upon number and intensity of treatments, with an average cost of $1,375.

Vanquish

A contactless, non-invasive fat removal procedure that treats larger areas such as the abdomen and love handles. The device uses radio frequency to target fat cells, heating the cells to 120 degrees, which causes the cells to die and be eliminated by the lymphatic system. Four to six treatments scheduled one week apart are necessary to achieve desired results. Treatments are painless with no down time.

* Cost: The typical cost for Vanquish ranges from $1,500 to $3,750 depending on the number and location of treatments, with an average cost of $2,350.

ZWave

A non-surgical, FDA-approved cellulite treatment that utilizes radial pulse energy via an electromagnetic applicator to destabilize cellulite. There is no downtime, and the treatments are painless. The best results are achieved when treatment is followed with healthy eating and exercise habits.

* Cost: The average cost per session is about $100, and the typical treatment is 10 sessions.