How to find a doctor? A good first step is to make sure the doctor is board-certified by the appropriate organization (the American Board of Cosmetic Surgery, the American Board of Plastic Surgery or American Board of Otolaryngology, for instance). Check with your state medical board to see if the doctor has complaints on file.
When you pick a doctor, ask how often and how frequently he or she performs the procedure that you're having. If the doc works from an outpatient surgical center, ask whether he or she has hospital privileges should any problems arise during your surgery.
Here's a quick guide to some of the most popular treatments and procedures:
1. Retinoid creams
Many over-the-counter products claim to help fight wrinkles; topical retinoid (derived from vitamin A) creams may be the best bet. "They're the only thing that's been proven to get rid of wrinkles that you already have," says Leslie Baumann, a Miami Beach, Fla., dermatologist in private practice and the author of "The Skin Type Solution: A Revolutionary Guide to Your Best Skin Ever" (Bantam). You can buy an over-the-counter retinoid for less than $20. Dermatologists can prescribe stronger retinoid creams, such as Retin-A, than what you'll find on store shelves.
2. Over-the-counter peptide creams
Creams containing peptides — short snippets of linked amino acids — can reduce the appearance of wrinkles and fine lines, but haven't been shown to work as well as retinoids. As skin ages, it loses collagen and becomes wrinkled and thin; creams containing peptides are supposed to encourage the skin to make new collagen. Peptides are found in a variety of products, from the inexpensive to the very expensive, but you don't have to ante up to get their benefit, advises Jeffrey Benabio, a dermatologist who writes The Dermatology Blog (thedermblog.com). He says Olay Regenerist (which costs less than $20) is as good as the pricey stuff.
Microdermabrasion uses tiny, fine particles or a very hard diamond-tipped wand to slough off cells from the top layer of the skin and encourage new skin growth. The procedure is usually not painful, though it can be uncomfortable, and it doesn't require an anesthetic or recovery period; skin heals quickly. You may require multiple procedures spaced a few weeks apart.
It also might be a good idea to discuss which technique your doctor plans to use, as a study published in October in Archives of Dermatology found that a rougher buffing of the skin is better than a lighter touch. The average cost of microdermabrasion was $164 in 2008, according to the American Academy of Cosmetic Surgery. Because the effects last only between three and five days, some may not find it worthwhile, Baumann says.
4. Laser skin resurfacing
Laser resurfacing uses high-intensity light to zap and improve the look of wrinkles and scars by tightening loose skin. The effect of your treatment and recovery time vary.
"We have lasers that can be superficial or intermediate and deep," says Bahman Guyuron, chairman of the department of plastic surgery at Case Western Reserve University in Ohio, who has been researching cosmetic treatments for about 30 years. You may see redness from one day to two weeks, depending on how aggressive the treatment is, he says.
The average cost of laser resurfacing was $2,669 in 2008, according to the AACS. The benefits of laser resurfacing usually last between two and five years but if you smoke or don't use sunscreen, they're likely to be on the shorter end of that spectrum, says Baumann.
5. Chemical peels
Used to address mild acne scars, age spots, dull skin texture, skin discoloration or wrinkles around the eyes or mouth, chemical peels remove the outer layers of the skin and encourage the growth of new, smoother, more evenly colored skin.
Depending on the peel's intensity — which can range from superficial to deep — it may cause reddening and peeling that can last up to several weeks. The average cost for chemical peels was $672 in 2008, according to the AACS. The benefits of superficial peels last about a month, while deep peels have results that can last several years.
6. Botox or Dysport
Injections of the now familiar Botox or Dysport — which also contains botulism toxin — can paralyze tiny facial muscles, smoothing out the appearance of lines or wrinkles. The cost of Botox will vary depending on location and doctor, but averaged $443 in 2008, according to the American Society for Aesthetic Plastic Surgery website. The effects of injections may last three to six months. The more injections you've previously had, the longer the results last, Guyuron says.
7. Filler injections
Injections of fillers containing hyaluronic acid, a naturally occurring sugar that gets lost when you age, can fill in lines and wrinkles by plumping them up while adding volume to skin, says Baumann. The average cost of treatment was $589 in 2008, according to the AACS. The effects generally last between six months and a year.
8. Cosmetic surgery
Lifting the skin on the face, neck, eyelids and forehead can give a tighter appearance. What were once traditionally open procedures with larger incisions can now often be done endoscopically, with smaller incisions strategically placed in difficult-to-detect areas, such as under the hairline. The procedures can run a few thousand dollars. Face-lifts were the most expensive cosmetic procedure in 2008, with an average cost of $7,007, according to the AACS.
The effects of cosmetic surgery are somewhat permanent. If a person looks 10 years younger as a result of having surgery, Guyuron says, that person will always look 10 years younger.
If the measures mentioned here sound extreme and expensive, start wearing sunscreen every day to lessen cumulative exposure to the sun, which can wreak havoc later in life, says Angelo Cuzalina, president of the AACS. "When (people) were younger ... they didn't think (the sun) caused any bad signs. Now they're really feeling the effects of it 30 years later."
Healthful eating and regular physical activity also play into skin health. Some doctors, Cuzalina included, will not perform surgery on patients who are so overweight that it might jeopardize post-surgical results. Cuzalina usually refers obese patients to a weight loss clinic before he'll operate.