The Future Perfect

Dec. 13, 2006— -- Like the exaggerations of an online dater, plenty of skin products aren't as rich, successful, or sensitive as they claim. And still, many of us never lose faith that the next one to come along will be more than just empty promises in a handsome package.

But there's a little good news for hopeless dreamers: A handful of treatments are being developed and tested, and already they look as if they'll fulfill some of our wildest expectations.

One is a wrinkle smoother that may well achieve the same results as Botox, but without needles. Another cream, this one for eyes, actually repairs sagging skin on the cellular level rather than just moisturizing it.

And, as the knight in shining armor, there's a new machine that, like liposuction, removes fat -- but unlike liposuction, does it without so much as scratching the skin.

Compared with traditional doctor's-office treatments, some of these advances are less painful and less invasive, so they carry less risk; some are faster; some last longer; and some are simply more effective. Although a few are available now, others are still being studied or refined in the laboratory, known to only a select group of doctors.

While no one can promise that they will replace scalpels, needles, and suction entirely, they're the result of impressive research, offering hope that despite the disillusionments and disappointments of the past, it's possible to find true loveliness after all.

Wrinkle-Reduction Treatments

A LINE-SMOOTHING GEL

What it is: In the foreseeable future, doctors may be able to wipe out wrinkles -- literally. When rubbed on the skin, a novel gel that contains botulinum toxin is designed to temporarily smooth frown lines and crow's-feet just like Botox does. But since no injections are involved, there's no pain and no bruising.

How it works: The gel, which hasn't been named yet, permeates the skin with the help of technology patented by researchers at Revance Therapeutics in Mountain View, California. Unlike the multitude of over-the-counter muscle-relaxing creams on the market today that last only 24 hours at most, one application of this gel is being engineered to last at least as long as Botox -- three to five months.

When available: Clinical studies were started in November 2006, and Dan Browne, president and chief executive officer of Revance Therapeutics, says the FDA could approve the product "in the next several years."

THE 70-SECOND WRINKLE ELIMINATOR

What it is: Lasers can burn, Intense Pulsed Light can redden skin, but GentleWaves Select has neither of these drawbacks. This device is a smaller, more portable version of GentleWaves, the light-emitting diode (LED) machine cleared by the FDA last year for diminishing the appearance of eye wrinkles. (Some doctors believe it can also reduce pore size and speed wound healing.) This compact model--intended for spas operated by physicians--emits the same strength of pulsing yellow light as the original, and it is just as effective. The only difference is that the larger version treats the whole face in 35 seconds, whereas this one can treat only half the face in that time.

How it works: The light stimulates skin cells to produce healthy, new skin-plumping collagen and slow the breakdown of existing collagen. When study subjects were exposed to this light twice a week for eight weeks, they had a measurable improvement in fine lines and wrinkles. Research has found that a rest period between sessions is important for effectiveness.

When available: This medical-spa version was released in March 2006. According to some doctors, an at-home version is on the drawing board.

ULTRASONIC SKIN CARE

What it is: Ultrasound waves activate a cream containing tiny molecules of bovine collagen, driving them into the skin. The treatment, which is designed to fill wrinkles and add moisture, is called Javani Skin Rejuvenation.

How it works: The cream stimulates the growth of new collagen and decreases the kind of aged collagen that causes sagging and discoloration, says Jay Burns, assistant professor of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, who has no financial interest in Javani. Burns was skeptical at first because theoretically, protein molecules cannot cross the skin barrier. But now he and other doctors in his practice have seen evidence that the ones in Javani do penetrate. In addition to noticing visible improvements in patients' skin, he says, "we took a sample of the skin and looked at it through a microscope and saw changes in the collagen." More definitive testing is under way. He and his colleagues have found that the cream "is a phenomenal moisturizer. We're using the system to enhance everything we do on the face and hands, from chemical peels to laser treatments."

When available: Javani is for sale through dermatologists, plastic surgeons, and medi-spas.

Dream Creams

ELASTICITY BOOST

What it is: Sun exposure, cigarette smoke, and stress can all deplete the skin of its elastin--and its resiliency. Until now, says Leslie Baumann, director of cosmetic dermatology at the University of Miami, no product or procedure has been proven to replace this crucial component of healthy skin. But Relastin, a new eye cream, prompts elastin production, which in turn restores springiness to skin and diminishes fine lines and wrinkles, according to studies Baumann has reviewed. In a snap test--which determines how long it takes the skin to bounce back after being pulled--undereye skin treated with Relastin recovered more quickly. Doctors have also seen some evidence that Relastin improves puffiness and dark circles and may even tighten hand and abdominal skin as well.

How it works: Ingredients in Relastin stimulate the function of a gene in the body that is responsible for making elastin, Baumann says. Studies found that the cream improves crepeyness around the eyes after two weeks.

When available: Relastin can be purchased online at relastin.com.

REDNESS REMEDY

What it is: Rough, red skin may be fine for new potatoes, but most women don't find it appealing on themselves. A nonprescription face cream, Cutanix Dramatic Relief, significantly reduces redness as well as inflammation and scaly, dry skin. It is especially helpful for people with rosacea and eczema, but it can also take the sting out of insect bites and help heal sunburn. Doctors have become increasingly aware of it and have been recommending the cream to their patients ever since Zoe Draelos, a dermatologist at Wake Forest University School of Medicine, demonstrated its effectiveness in a study published in 2005.

How it works: The active ingredient in the product is quadrinone, an FDA-cleared natural food flavoring with a nutty scent that is sometimes added to cake mixes and glazes. It acts as a moisturizer to plump the skin and an anti-inflammatory to even its color, resulting in a more youthful appearance. "The redness in aging skin is actually inflammation, and this causes blood vessels to break and skin to become thinner and more fragile, leading to a prematurely aged look," explains Adam Gridley, vice president of BioForm Medical, Cutanix's manufacturer. The cream is most effective when applied twice daily, in the morning under sunscreen and before bed.

When available: Cutanix Dramatic Relief is sold online at cutanix.com for $39.95 per tube (a 30-day supply).

COLLAGEN BUILDER

What it is: Maintaining healthy skin doesn't necessarily require masses of products, but it does require an abundance of collagen--the network of fibers that supports the skin. The next frontier in skin care, Baumann says, is "harnessing the power of cytokines," growth factors in the skin that play a role in wound healing and the formation of collagen.

How it works: By stimulating collagen production and blood supply, face creams containing cytokines thicken and brighten the skin.

When available: Some skin-care products made with cytokines are already on the market--for instance, TNS by Skin Medica (available on the Web and through physicians) and Topix Citrix (sold on skinstore.com). New, more powerful versions are expected within the next two years and will probably be expensive, because extracting active cytokines from skin cells, Baumann says, is a lengthy and costly process. "But we may finally have a skin-care product that is worth the high price!"

Fat Removal and Skin Tightening

LIPO WITHOUT INCISIONS

What it is: Two similar competing systems in development, UltraShape and LipoSonix, eliminate small amounts of body fat at a time, allowing patients to lose up to an inch in one treatment and go right back to work. "I believe the future of body contouring will be noninvasive, and this is the first system to show promise," says Steven Teitelbaum, a plastic surgeon in Santa Monica, who conducted one of several studies on UltraShape.

How it works: Low-energy sonic waves break apart fat cells and destroy them permanently. The fat is metabolized and burned by the body as energy. Because only a limited amount of fat can be safely melted and absorbed during each session, targeting a single area may require multiple treatments a month apart. (LipoSonix can remove 600 cc--approximately one pound of fat--at a time, says Peter Fodor, associate clinical professor of plastic surgery at UCLA.) Both systems claim to be virtually painless. Patients in the LipoSonix trials, conducted in Mexico, were given no anesthetic and "described a tingling sensation or something like a series of pin pricks," says Jens Quistgaard, chief executive officer of LipoSonix. Studies performed on both systems have so far concentrated on the waist, abdomen, hips, buttocks, and outer thighs.

When available: UltraShape received the European equivalent of FDA approval in July 2005 and is also cleared by the health agencies in several South American countries. Now American studies of UltraShape are complete, and government approval could come by 2007. LipoSonix plans to complete American trials in 2007, with the hope of receiving approval.

FACE-LIFT OF THE FUTURE

What it is: The UltraSite ST System is being engineered to lift and tighten facial muscles without surgery, according to its manufacturer, Ulthera, an ultrasound company in Mesa, Arizona.

How it works: Under the skin of the face there's fat; under the fat there's what doctors commonly refer to as the SMAS (superficial muscolo aponeurotic system), a gauzy layer of muscle fibers that sags with age. This is the area that many plastic surgeons tighten surgically when performing face-lifts; it's also the area the machine targets with ultrasound vibrations to shrink facial tissue and muscle. Because of its ability to home in precisely where directed without disturbing surrounding tissue, "this is an exciting technology," says Richard Fitzpatrick, associate clinical professor of dermatology at the University of California–San Diego, who is conducting one of several planned clinical trials. (Fitzpatrick has tried it on his own arm and says, "There is a warming feeling. The treated area got red and swollen for a few hours.")

When available: Safety tests, the first step toward FDA approval, are complete, and clinical trials of its effectiveness are under way. Ulthera's president, Matthew Liken, says he expects that by the first half of 2007, a small number of physicians will have it.

Botox for Weight Loss?

Doctors keep discovering more and more uses for Botox, which may be why it's often called the penicillin of this decade. Besides smoothing wrinkles, botulinum toxin alleviates migraines, inhibits sweating, and helps heal surgical wounds with less scarring, for example.

Now it's being administered as a controversial weight-loss method. A doctor injects the stomach wall with Botox (in order to target the right area precisely, the shots are administered with sedation through the esophagus, rather than directly through the skin into the abdomen). In theory, this weakens muscles in the area, slowing down food digestion and creating a feeling of fullness.

But in a small Mexican study published in 2005, only a quarter of patients had statistically significant results, says Michael Kane, a plastic surgeon in New York City and author of The Botox Book (St. Martin's Press).

No FDA clearance is needed since Botox is already an approved drug, and doctors may administer it for any medical purpose at their discretion. But one study on mice showed that an excessive dose could cause death.

Though Kane says that overdoses in humans are unlikely, he points out that there is a risk of needles piercing the stomach lining. He believes that physicians' refinements may well make the procedure more effective, but he says, "I don't think it will catch on in large numbers any time soon."

Joan Kron is Contributing editor-at-large for Allure magazine where, for the last 15 years, she has been covering the high-tech world of cosmetic surgery. She has won more than a dozen journalism awards and is the author of Lift: Wanting, Fearing, and Having a Face-Lift (Viking 1998/Penguin 2000). Before joining Allure, Kron covered fashion for the Wall Street Journal and design for New York magazine and The New York Times, where she helped create the "Home Section."

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