Saving face Aging: In an effort to stay young at any cost, baby boomers keep searching for the latest cosmetic fix. They don't have far to look.


In an article in Sunday's Home & Family section, the status of Sinai Hospital's methadone treatment program was reported incorrectly. The SHARP program remains open.

The Sun regrets the errors.

As a ravishing hippie, you swore off sunscreen. Lazing on beaches, dancing at festivals, you fried, but so what. You were setting the tempo for generations to come, and unfettered solar worship was part of the job.

Now those ungrateful generations have come, and you've nothing to show for your efforts but a stack of useless LPs and as many wrinkles. And in our country, wrinkles "are considered ugly," says Paula Begoun, author of "The Beauty Bible," "Don't Go to the Cosmetics Counter Without Me" and a syndicated cosmetics column.

Luckily, baby boomers have as much money as skin to burn. They're reaching their middle years in the age of "cosmeseuticals," when technical skin-care advances, the explosive market for elective cosmetic surgery, and doctors dodging managed care have converged in the fiercely competitive battle against aging.

Unhappy with those frown lines? Obsessed with solar damage? Hate staring at those broken capillaries? Dermatologists, cosmetic surgeons and plastic surgeons are scrambling for permission to perform a cosmetic, uninsured procedure on you.

Willing clients are spending millions on a slew of constantly evolving cosmetic options: fat injections for plumper skin, lasers to resurface skin and even out skin-color, botulism-toxin injections to smooth forehead lines, chemical peels to zap weary surface skin.

It doesn't seem to matter that none of these techniques offers lifelong results. Cosmetic surgery procedures in the United States have climbed 75 percent in four years. In 1997, 2 million Americans sought cosmetic surgery or nonsurgical cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery. Men and women from ages 35 to 50 accounted for nearly half of all cosmetic treatments performed. Men accounted for 14 percent (most opted for hair transplantation).

Another big change: Cosmetic procedures are no longer about looking better; they're about looking younger. In 1992, nose jobs reigned, but in 1997, chemical peels, cosmetic eyelid surgery, collagen injections and laser skin resurfacing have cornered the market.

Many recipients, like Carol Butler of Baltimore, will tell you that a physical transformation is a crucial middle-age pick-me-up.

In 1996, Butler's management job ended after 25 years when Sinai Hospital shut down its methadone program. Devastated, she knew it was time for a physical and mental makeover.

Butler made an appointment with Mercy Medical Center plastic surgeon Dean P. Kane and his wife, cosmetic consultant Lauri P. Kane. They started Butler on the Obaji Nu-Derm system, a $200 ensemble of topical creams that exfoliated her skin, improved and lightened her splotchy complexion.

After eight weeks, Butler's skin was pink and smooth, and Butler wanted more. Since then, Butler, now project director for a mobile drug-treatment unit, has had two $650 Obaji Blue Peels, a procedure that exfoliated deeper skin layers. At $350 a treatment, Dean Kane has also given her four treatments of Botox, a mild concentration of the botulism toxin, to paralyze the muscles responsible for forehead and frown lines.

Now Butler is preparing for a $1,200 outpatient procedure in which Dean Kane will harvest fat from Butler's body and use it to eliminate the furrows between her eyebrows and the wrinkles around her mouth by plumping the affected skin. By the time she undergoes the plumping procedure, Butler will have spent $4,100.

It's worth it, says Butler, 52. "If I feel 10 years younger, I'll carry myself differently, and I'm probably going to look 10 years younger."

For those not prepared to invest in cosmetic surgery, a bewildering array of topical products, from antioxidant vitamins A and C to alpha and beta hydroxy acids to emu oil and green-tea solutions, is available. Americans spend $3 billion a year on these elixirs.

The ways of tricking the skin into looking new and smooth are many. But whether you invest in a $20,000 face lift, a $5,000 laser skin-resurfacing procedure or a $6 over-the-counter alpha hydroxy product, there is no permanent - or perfect - fix for skin damage.

Aging occurs when skin tissue (elastin and collagen) breaks down, making skin dryer and less elastic. You pay the price for years spent in the sun or smoking. Muscles slacken, causing wrinkles, sagging and burst capillaries. Age spots appear.

A skin-care patient must have realistic expectations about a procedure's ability to eliminate such flaws, says Dr. Stanley J. Miller, director of dermatological surgery at Johns Hopkins Hospital. "Even if a doctor did the best job in the world, if the expectations aren't reasonable [the patient] is not going to be happy."

Miller advises interviewing two or three doctors before hiring one. "When it comes to surgery, you want somebody who does a lot of whatever it is, [but] you don't want them to be a factory."

Of the 2,000 complaints Maryland's Physician Quality Assurance Board receives annually, five to 10 involve cosmetic surgical procedures, not an alarming figure, says Barbara Vona, chief of compliance.

If you're considering an aggressive skin-care course, Marianne J. Kelly, a licensed Baltimore cosmetologist, suggests emulating "the European way." That means a "little tucking, a little alteration, periodically, nothing dramatic," says the founder of the regional Image Recovery Centers, where recovering cancer patients learn to enhance their post-treatment appearance.

When relying on topical skin-care products, bear in mind that nonprescription cosmetics cannot make medical claims without approval from the Food and Drug Administration.

In her seventh "commandment of beauty," Begoun cautions: "THOU SHALT NOT believe in the existence of anti-wrinkle, firming, toning, lifting, or fill-in creams, lotions, or masks that can permanently erase wrinkles." Begoun also says high-end prices don't guarantee cosmetic quality: "Many expensive lines own inexpensive lines" and their ingredients are the same.

Who does what

No law prevents any physician from performing cosmetic surgery. If you are considering a surgical cosmetic procedure, the American Society for Aesthetic Plastic Surgery recommends selecting a physician who is board-certified in a surgical specialty, such as plastic or ocular surgery.

Plastic surgeons certified by the American Board of Plastic Surgery have had at least five years of approved surgical training after medical school, including at least two years of a plastic-surgery residency.

Although there are physicians who call themselves "cosmetic surgeons," the American Academy of Cosmetic Surgery, which provides referrals for experienced cosmetic surgeons, is not recognized by the American Medical Association as a specialty board. Its members practice cosmetic surgery, but their specialty is not necessarily surgery.

Dermatologists trained to treat skin diseases also do chemical peels to rejuvenate the aging face.

Ear, nose and throat doctors often reshape noses.


The American Academy of Plastic and Reconstructive Surgery maintains a list of certified plastic surgeons and their specialties. Call 800-635-0635.

Referrals are also available from:

* American Society of Dermatologic Surgery: 800-441-2737.

* American Society of Facial and Plastic Reconstructive Surgery: 800-332-3223.

* American Society for Aesthetic Plastic Surgery: 888-272-7711. (You may also find a qualified plastic surgeon through the ASPS Web site at:

* American Academy of Cosmetic Surgery: 800-A-NEW-YOU.

* For list of local dermatologists, call 888-462-DERM, Ext. 44.

Pub Date: 5/17/98

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