Younger skin without surgery — what works?

If Ponce de Leon returned today to search for the fountain of youth, he might find it filled with wrinkle fillers and powerful lasers that literally remodel aging skin.

In recent years, dermatologists have developed an array of procedures that can remove fine lines, fill in deeper ones, and lighten unsightly pigmented areas or spots. These procedures help rejuvenate skin worn by time and sun exposure with few side effects and far less recovery time than that required for surgical techniques such as facelifts.

Recovery time—the time it takes for skin to heal and return to normal color and texture—is one of the most important factors for people seeking skin rejuvenation. Most people want to return to work and social activities as quickly as possible. This has led to the increased use of less-invasive techniques that don't wound the skin as extensively as the deep chemical peels and full laser resurfacing of just a few years ago. The trade-off is that their effects are not as significant, and they often require a series of treatments as well as follow-up "maintenance" visits. With today's more sophisticated laser treatments, it is now possible to find a happy medium: moderately significant effects with minimal downtime.

Start with an evaluation to determine which skin problems you would like to treat and choose the procedure accordingly. You will need to evaluate your choices based on effectiveness, cost, recovery time, safety, and other factors. Repeat treatments are necessary for most procedures in order to attain the desired effect or to maintain the results over the long term.

Here is a list of the most common cosmetic skin problems followed by a brief evaluation of available treatments:

Treatments for brown spots

• Bleaching creams. Inexpensive; require no recovery time; only mildly effective.
• Retinoid creams. Moderately effective; moderately expensive. Lightens but will not fully remove brown spots. Can cause skin irritation. May be combined with bleaching creams.
• Chemical peel. Effective; expensive. Recovery time depends on strength of peel solution.

Fine lines or fine wrinkles

• Lotions containing alpha hydroxy acids or beta hydroxy acids. Moderately effective; inexpensive products are available without prescription.
• Retinoid creams. Moderately effective; lower-strength products available without prescription. More expensive, stronger products available with prescription.
• Growth factors. Moderately effective; expensive; short recovery time.
• Chemical peel. Effective; expensive; recovery time depends on strength of peel solution.

Forehead lines

• Botulinum toxin injections. Very effective; expensive; repeat treatments necessary; short recovery time.
• Injectable fillers. Very effective; less expensive; short recovery time; can be combined with botulinum toxin.

Hair removal

• Electrolysis. Effective; expensive; removes both dark and light hair; painful. Can only treat limited areas at one visit and takes many treatments.
• Intense pulsed light. Very effective; expensive; removes dark hair only; cannot be used on dark or tanned skin.
• Laser removal. Most effective; expensive; removes dark hair only; painful and takes many treatments.