Dear Paula's Choice Research Team - Cosmetic Procedure

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Dear Paula,
I am wondering if you know anything about a method of hair removal called Transcutaneous Permanent Hair Removal? Unlike regular electrolysis, a gel-like substance is spread over the skin and an electric probe with a cotton swab on the end of it emits electricity, which is supposed to permanently destroy hair if it is in the growing phase. I have seen salons advertising this method as a pain-free way of removing hair. The company that makes the device is International Hair Removal Systems (IHRS), but I can't find out much about them. You can find claims on the Internet that this is either the most wonderful discovery in hair removal ever, or that this is unproven and quackery. Any insights would be so much appreciated.

Sharon, via email search

Dear Sharon,
Information I found about the type of hair removal system you are referring to was indeed shocking, but not in a good way. In fact, it's pretty startling to learn how useless it is and how disreputable the companies are that sell these machines. These devices go by several names, including transcutaneous permanent hair removal (the one you mentioned), transdermolysis, no-needle electrolysis, and transdermal electrolysis. All of these to one degree or another have been under scrutiny from the FTC, and the FDA has challenged the claims and the safety of the machines.

On the surface, the method seems pretty convincing, resembling a technique to deliver specific medications without a needle using a conductive gel and an electric current, but that's where the similarity stops. In other words, what works to deliver medicine cannot remove hair. A sure sign for consumers that this is nothing more than a scam is the exaggerated claim of 100% permanent hair removal. Even medically researched and FDA-approved laser hair removal devices can't make that claim. As far as transcutaneous permanent hair removal is concerned, there is no published research or clinical data of any kind demonstrating that it works.

A very informative, extensively documented Web site on all sorts of hair growth issues, www.hairfacts.com, states that "Claims by the promoters [of transcutaneous permanent hair removal] conflict with laws of physics. Hair is a poor conductor of electricity. Skin is a better one, and conductive gel is an excellent conductor. Because electricity follows the path of least resistance, any energy applied by the device is not going to travel selectively down a hair. It's going to dissipate across the gel on the skin's surface. The reason these 'transcutaneous' procedures don't hurt much is because the energy is not strong enough to stimulate the nerves, let alone damage the hair growth matrix permanently."

As recently as last year the FDA sent the manufacturer of these hair removal machines a strong warning letter to cease and desist in poor manufacturing practices, misbranding, and false claims that the devices are approved by the FDA. In fact, the company has changed names to avoid FDA scrutiny (Source: www.fda.gov).

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Category: Cosmetic Procedures

Dear Paula,
I am 25 years old, and a part-time model. Three days before a fashion show I felt a couple of large, deep pimples forming, and so I went to my dermatologist to see if some cortisone injections would help the situation. They did indeed eliminate the blemishes, but within a week I had large craters about the size and depth of a nickel at the injection sites!

I went back to my dermatologist, and she was as shocked as I was. She said I must have had an allergic reaction to the cortisone, and it had caused the matrix of my skin to disintegrate! Upon learning that it was permanent damage, I began to cry.

I began a battery of treatments with my dermatologist to improve the damage. The first treatment we tried was fillers. But this failed because the filler turned into hard lumps, shifted around, and left large dimples when I smiled.

After the filler had some time to deteriorate, she did a variation of deep, localized dermabrasion. The abraded areas bled, oozed, and eventually scabbed over. Three weeks later, the craters weren't so deep! The fourth treatment resulted in no improvement, and a lot of new blood vessels had grown in with the new tissue, resulting in a very angry-looking red color. She did a series of three laser treatments to reduce this redness, with modest success.

She then suggested Thermage, in hopes it would encourage the development of more collagen in those areas. Six months and two follow-up exams later, I am happy to report that (with the exception of some slight discoloration) it worked! The craters are gone! The dermatologist (thank goodness) performed all of this work free of charge.

I want you to know I was very diligent about using your sunscreen, moisturizers, and other skin-care products throughout this healing process, and I know they helped a lot. The rest of my skin looks better than it did in high school, and my husband now uses your products, too!

Shanna, via email search

Dear Shanna,
Your story sounds so frustrating and painful. I am so sorry you had to struggle with all that, especially during such an important time in your life. While I am impressed at your physician's dedication to correcting the problem, I'm confused why she was so shocked at what happened. What you experienced is a known side effect of cortisone injections. I'm assuming from what you wrote that you weren't informed of the risks that could occur when injecting cortisone into a blemish. Although cortisone injected directly into a cystic or swollen blemish, particularly an annoyingly large one, can be extremely effective in reducing swelling and redness, there is a risk it can cause a depression or dented area in the skin. This can happen when too much of the solution is injected, too strong a concentration is used, or if you have a reaction to the cortisone (which is why a patch test should have been done on some part of your body less obvious than your face). Often these demarcations go away without any intervention, but they can also be permanent. If you were told of this risk, you may have made other decisions.

I'm wondering now if you were warned about any of the risks associated with any of the procedures your doctor performed. Lumping is a known side effect of all dermal injections, and though dermabrasion does help smooth skin it can cause skin to become depigmented. Some lasers can help reduce the presence of surfaced blood vessels, but it is not always successful. Again, your doctor's diligence and dedication to correcting the mistake is admirable, but I think there was information missing along the way that could have waylaid some of the problems you encountered. I hope you continue to heal and that all traces of this problem are alleviated soon.

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Category: Cosmetic Procedures

Dear Paula,
I'm curious to know what you think of the radio frequency face lift I've been hearing so much about. Is it really as good as the ads and articles in magazines say it is?

JoAnne, Boca Raton, FL search

Dear JoAnne,
I can't tell you how many women have been asking me about this medical cosmetic corrective procedure. That isn't surprising considering there has been growing interest in the use of noninvasive methods to rejuvenate the skin. The radio frequency face-lift you've heard about refers to the ThermaCool system from the Thermage Corporation. This is a device that delivers radio-frequency waves deep into the skin, but, as benign as that sounds, it is not even remotely as innocuous as listening to your favorite station on the radio. ThermaCool heats the lower layers of skin, resulting in some tightening, which in turn can reduce the appearance of wrinkles. It is this effect that clever marketers are calling a "non-surgical facelift," particularly because there are no adverse side effects (Source: Journal of Drugs Dermatology, October 2003, pages 495-500). But does the ThermaCool really produce results similar to a face-lift?

A study published in Lasers in Surgery and Medicine (2003; volume 33, issue 4, pages 232-242) evaluated 86 subjects six months after they received one ThermaCool treatment. "Fifty percent (41/82) of subjects reported being satisfied or very satisfied. Objective photographic analysis showed that 61.5% (40/65) of eyebrows were lifted by at least 0.5 mm. Rates and duration of [redness and swelling] were very low¦. Three patients had small areas of residual scarring at 6 months." This study concluded that "A single treatment with [the ThermaCool] device produces objective and subjective reductions in [mouth area] wrinkles, measurable changes in brow position, and acceptable epidermal safety."

It is important to realize that while 50% of the patients were satisfied to very satisfied, there were still 50% who weren't. That's important to keep in mind if you are considering this treatment. Whether radio-frequency technology can live up to the early hype generated when it was first introduced in 2002 remains to be seen (Source: www.medscape.com/viewarticle/436024_5).

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Category: Cosmetic Procedures

Dear Paula,
I have talked with two plastic surgeons about the pros and cons of the Obagi TCA Blue Peel vs. nonablative laser resurfacing. One surgeon does the TCA procedure himself and recommends more than one application. He then recommends following up with the Obagi skin-care products. In his opinion, the nonablative laser resurfacing may not necessarily show enough improvement over the TCA peel to justify the higher cost of the laser surgery. The second surgeon has his aesthetician do one light TCA peel. The surgeon would then himself follow up with a laser resurfacing using the Cool-Touch Laser. I've read with interest your thoughts on nonablative vs. ablative laser resurfacing, but I'm confused on the pros and cons of the TCA peel and ongoing Obagi skin-care products. What is your take on this?

Floundering in Florida

Dear Floundering,
I'm not sure I can keep you from floundering because the truth is all the options you've been presented with are viable. A TCA peel is a type of chemical peel that uses trichloroacetic acid (as opposed to phenol, AHAs, or salicylic acid) to exfoliate layers of skin. TCA is available to all physicians for use in skin resurfacing. Obagi's Blue (TCA) Peel is a type of TCA peel Dr. Zein E. Obagi developed and he keeps the exact ingredients secret, so there is no way to know exactly how his differs or if it is only a blue dye that makes it special (which is what many physicians suspect). Regardless, because Obagi's Blue (TCA) Peel is only performed by those doctors who have spent a great deal of money taking Obagi's course to learn how to apply it, you can safely assume that those physicians would have a definite bias in recommending the Blue Peel over other procedures.

To answer your question, a TCA peel--light, medium, or deep--is not really comparable to nonablative resurfacing, but both are viable options for skin resurfacing or remodeling. The main issues you have to assess for yourself are downtime and risk. The light peel exfoliates the surface of skin with minimal scabbing, downtime, or risk of hyper- or hypopigmentation. In combination with the Cool Touch laser (for skin resurfacing and helping to stimulate collagen production, and which also has minimal risks or downtime associated with it), this can be a good option. A medium to deep TCA peel (Obagi's or otherwise) has some risk of skin discoloration and scarring, and there is a period of healing that can take up to several weeks. Yet a medium to deep peel can also be more effective for improving deeper or extensive wrinkling. Also, keep in mind that while the TCA peel is a one-time experience (or at least once every several years), the Cool Touch requires repeated treatments to gain maximum benefits.

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Category: Cosmetic Procedures

Dear Paula,
You might want to check Wendy Lewis' new book, available in the United Kingdom, The Lowdown On Facelifts and Other Wrinkle Remedies, which covers the use of Artecoll in the United Kingdom. There are numerous problems which Wendy has personally seen as a cosmetic surgery consultant, including lumping, bumpiness, and unevenness. It sounds like it's not problem-free by any means.

Concerned, via e-mail

Dear Concerned,
Wendy Lewis' book is an excellent, thorough look at the world of cosmetic medical procedures and surgeries. (It is available in the U.S. from Lewis' Web site at www.wlbeauty.com, or by calling (212) 861-6148 or (877) 952-3288.

In regard to Artecoll, I looked over my previous article and can see why you may have interpreted my comments to mean that there are no risks with this corrective procedure. That is absolutely not the case. It can have some of the same problems as any material that is injected into the skin, including bulging, allergic reaction, and lack of results. But Artecoll (among others) is still thought to cause fewer reactions than similar materials. Because this has not been well studied here in the U.S. (a Medline search found only ten published articles), it is hard to make a complete assessment. For example, an article in the American Journal of Dermatopathology, June 2001, entitled "Adverse Reactions to Injectable Aesthetic Microimplants," states that "New inert materials such as polymerized silicones, Bioplastique, Artecoll, and Dermalive are now being used as injectable aesthetic microimplants. These substances are better than the old ones because they tend not to migrate and do not usually produce much of a host immune response. Adverse reactions after injection of these materials are rare, although there are a few reported cases as a result of bad technique..."

Another paper published in the Journal of Aesthetic Plastic Surgery, September-October 1998, and entitled "Artecoll for Long-Lasting Correction of Wrinkles: Refinements and Statistical Results," states that "Questionnaires were sent to all patients who had received Artecoll in 1993 and 1994. Of a total of 950 questionnaires sent, 515 were returned by September 1995. Satisfaction was rated "very good" in 29%, "good" in 38%, "satisfactory" in 23%, and "no difference" in 8% of the patients. The question, "Would you repeat the treatment again?" was answered by 91% of the patients with "yes." The overall complication rate was 3%."

With Artecoll, as with any cosmetic procedure, there are pros and cons and related risks that every consumer has to weigh personally.

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Category: Cosmetic Procedures

Dear Paula,
To celebrate my 40th birthday, I had my first chemical peel last week, the "Precision Peel" from SkinMedica. The technician told me that my skin would look great for two days, peel for three days after that, and then all would be great. Well, to make a long story short, my normally wonderful skin became quite red and irritated the night after the peel and just got worse as time went on. By day two, I had developed lots of red itchy bumps all over my forehead that spread to the rest of my face over the next three days. After trying to get some medical attention from the spa where I had the procedure done, I ended up at my own doctor's office. The doctor said it was definitely an allergic reaction and put me on hydrocortisone cream and antihistamines. It should clear up within 7 to 10 days!

I told the technician before the peel that I had a lot of allergies and rather sensitive skin. She assured me that the Precision Peel was "the perfect peel for me." I'm thinking that next time I'll make sure that I choose a spa that has a dermatologist on staff who can administer or at least supervise the procedure. Have you heard much feedback from people having allergic reactions to a peel? Can you recommend any that are hypoallergenic? Thank you so much for your excellent reporting, and, by the way, my Mom and I love your products and live by your books!

Donna, via e-mail

Dear Donna,
I am sorry to learn you reacted so strongly to the peel you had, although your experience isn't rare or unusual. Anytime something is changing skin (in this case removing layers of skin tissue), then a reaction is likely, and highly likely for someone with sensitive skin. When it comes to any type of peel, there are potential risks involved that need to be carefully considered before the procedure is done. Even the gentlest peels can have significant side effects, and much depends on the skill of the person who prepares and applies the peel, how long it is left on the skin, how it is removed, and whether or not irritating products are used afterward. All of this can definitely have an impact on the final result.

Someone with sensitive, allergy-prone skin should be especially cautious around any type of peel, and an aesthetician who insists otherwise is either not concerned about your skin or is simply not informed enough to know better. There are no peels (or cosmetic products for that matter) that are considered hypoallergenic. It's odd how authoritative "hypoallergenic" sounds! We've just accepted that there must be something behind the term without thinking any more about it. Hypoallergenic is meaningless for your skin, because it is not regulated by the FDA or any other association--medical or cosmetic. That means anyone can use this word to describe any product or service without providing any evidence that the product truly fits that "no allergy" description. There are no regulatory standards as to what qualifies a product to be hypoallergenic.

Going forward, your best bet would be to consult a dermatologist about whether or not you are a valid candidate for any kinds of peels or other skin-resurfacing procedures.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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