Fractional ablative laser (brand names include Lumenis DeepFX or ActiveFX): A laser with a pixilated beam vaporizes small portions of the epidermis to smooth deep lines, improve pigmentation, and generate some skin tightening. The treatment is painful; doctors offer injectable anesthesia (to numb the nerves in your face), an oral narcotic (like Percoset), and a topical numbing cream. Skin is very red, swollen, and flaky for five days afterward.
Fractional nonablative laser (brand names include Fraxel Dual or Palomar Lux 1540 Fractional): A laser's pixilated beam targets collagen and pigment beneath the surface of the skin. It can soften fine lines and treat diffuse freckling. Three to five treatments (at 30- to 60-day intervals) are usually recommended; a topical numbing cream and ibuprofen prevent discomfort. Skin is red and peeling for a couple of days afterward.
Intense pulsed light (IPL): Pulses of light are delivered to the skin to reduce hyperpigmentation and redness. Three to five sessions are usually suggested. The treatment is virtually painless (you may feel some warmth); skin could be red for a few hours afterward.
Q-switched laser: Emits beams of red light that are absorbed by melanin to fade brown pigmentation. The treatment feels like rubber-band snaps; each spot darkens and falls away after about two weeks.
Thermage: Radiofrequency energy heats lower layers of skin, tightening collagen. Requires some over-the-counter pain medication; only one treatment is necessary, and there is no downtime. Results peak after six months and last one to two years.
Titan: An infrared laser heats lower layers of skin to tighten collagen. Treatments are painless, and most effective in a series of three. There is no downtime; results peak after six months and last one to two years.
Blepharoplasty: Surgery in which excess skin is removed from the upper and/or lower eyelids. The procedure is performed under general anesthesia or intravenous sedation. Downtime is about four or five days; some bruising and swelling could last for several weeks.
Browlift: Plastic surgeons usually use one of three techniques: An endoscopic browlift repositions tissue beneath the skin through three to five small (less than an inch) incisions along the hairline. A coronal browlift raises the brow, and removes extra skin, through an incision made from ear to ear, several centimeters behind the hairline. A lateral temporal browlift cuts away excess skin through two incisions (of about an inch and a half), made just behind the hairline. General anesthesia or intravenous sedation is required for all procedures. Downtime is about five days; swelling may not completely subside for several weeks.
Facelift: Through incisions made along the hairline and around the ears, a surgeon cuts away excess skin and lifts underlying tissue. General anesthesia is recommended; downtime is at least one week (often two), and bruising and swelling may not subside for a month or more.
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