Light Makes Right

By CATHY BOOTH/LOS ANGELES

The mad scientist stands over me with a laser pointed at my face. His fiendish helper claps goggles onto my eyes. I tense. A searing sensation rips into my face. As the laser traces tiny spider veins across my cheek, zapping them into oblivion, I hear a faint pop, pop, pop. It begins to sting. Yeow, I swear silently. Is that burning flesh I smell? Hey, Doc? Owww. Yeowww! DOC! Dr. Harold Lancer, my Beverly Hills dermatologist, is laughing. He had warned me to take some Valium before the procedure (or risk scaring off his celebrity clients, no doubt). I can't stand any more. "Ye-ooowww!!" I yell out loud. Then it's over. I leave with a red Etch A Sketch drawing on my cheek.

A few weeks later, the pain forgiven, my cheek peachy and clear, I'm back for more. This time Lancer zaps an ugly brown spot on my left cheek--the result of driving with the California sun constantly bombarding my face. (Seems my chic metal sunglasses had been channeling the sun onto one spot.) This time he uses a different, less powerful laser. Surprise--there's barely any pain! Within days there is also no sign of the stupid blotch that had been bothering me for years. I'm getting to like these lasers.

O.K., I'm like most baby boomers, a narcissist. In pursuit of the perfect body, we've tried spinning and step, aerobics and anaerobics, Pilates and Tae-Bo. But not even a hunky personal trainer and all those Kathy Smith exercise tapes can keep the lines, wrinkles and age spots away. No wonder plastic surgery is so big--with an estimated 4.9 million cosmetic procedures done last year, according to the American Academy of Cosmetic Surgery, up more than 800% since 1990.

But baby boomers are squeamish too. Does trying to stay young mean having to subject your delicate face to the surgeon's knife? What we'd much rather have is a cosmetic "quick fix": fresher, firmer skin with no blood and gore, very little healing time--and cheaper too. Cue the laser.

Cosmetic lasers can now zap away everything from bikini hair and tattoos to spider veins and liver spots. They can eliminate crow's-feet around the eyes and fine lines around the mouth. Dentists even use lasers to brighten teeth. A projected 3.4 million aesthetic laser procedures will be performed next year, up from an estimated 1 million in 1996. And baby boomers brought up to admire the Bain de Soleil tan will doubtless be turning even more to lasers, as the years go on, to try to reverse the damaging effects of sun. "What we're facing in American health is the problem of longevity, women living into their 90s, men to their 80s," says cosmetic-dermatologic surgeon Dr. Edward Lack, a board member of the American Academy of Cosmetic Surgery. Most of the 45-to-70-year-old laser-surgery patients Lack sees in his Des Plaines, Ill., office are seeking facial resurfacing, a laser procedure that can erase fine lines, sunspots and broken vessels while tightening the skin--all at once.

At least, that's the promise, and that's why lasers have become the hottest medical accoutrement since the stethoscope. Plastic surgeons who once spent their time doing nose jobs on teenagers are now turning their offices into decorator-chic "medical spas," where they perform laser "facial rejuvenations" and hair removal as well as cosmetic surgery. At least 50 different laser systems are currently being marketed for cosmetic purposes. The market in hair-removal laser machines alone has risen from $85 million in 1997 to a projected $185 million this year, says Jacob Golbitz, industry analyst at Fector, Detwiler & Co. Ads tout the latest in laser treatments with impossible results: "Made Me Look 20 Years Younger in Just Days!" or "Laser Hair Removal: 5 Year Guarantee!" "No one wants to undergo the knife, so they look at the laser as some sort of magic wand," says Joan Kron, 71, author of Lift: Wanting, Fearing and Having a Facelift, her 1998 primer on facial surgery. "It's a very exciting field. But it's a double-edged 'light' sword, because there's a lot of bamboozling out there."

Even setting aside the hucksterism, laser surgery is hardly a risk-free procedure. Lasers work by emitting a powerful beam of light that vaporizes skin. Though some newer lasers can skip the top layer, or epidermis, penetrating to the lower dermis to kill abnormalities and hair follicles, lasers "wound" the skin to some degree, and healing can have complications. Long-term effects can include pigmentation changes in the skin: patients with darker complexions, such as African Americans or those of Mediterranean origin, are especially susceptible to skin lightening. And everyone is vulnerable to doctors or technicians who do not handle the equipment properly, which can result in burning.

Don't tell any of this to Randee Bank, 38, who admits she's a cosmetic-surgery junkie. You name it and the suburban New York housewife has had it done: Botox injected in her forehead to paralyze the facial muscles and prevent wrinkles from forming, liposuction on her stomach and thighs, fat transferred from her behind to her face--and lots of laser work. She's had pulse lasers to erase broken blood vessels in her cheeks, diode lasers to remove the hair on her upper lip and an Erbium laser to zap the crow's-feet around her eyes. "It's unbelievable. It took 10 minutes, and then you go home," says Bank, whose husband David, a dermatologist, did the work. "No hospital, no anesthesia, no stitches. It's just a little beam of light and it's gone."

Laser surgery is far less expensive than full-scale plastic surgery and thus more accessible to people of every income and social stratum. "It's not just the young and the beautiful or the wealthy any more," says Jenifer Lloyd, a dermatologist in Boardman, Ohio. "I just lasered the wrinkles on an 85-year-old woman. Now she's dating again." Men, who account for about 20% of all cosmetic work, are succumbing too. Stan Madray, 36, who works for an entertainment company in Orlando, Fla., was unhappy with his "chipmunk cheeks that made me look older and worn." His doctor liposuctioned his cheeks and jowls, then beamed a laser under the skin to sort of "shrink wrap" his face. It was done on a Friday, and he was back at work by Monday, and nobody was the wiser, despite some swelling.

Peg Booth, a publicist in Cardiff-by-the-Sea, Calif., had her face fully resurfaced by a laser two years ago, just before turning 50, to eliminate smile lines, wrinkles on her forehead, frown lines between the brows and crow's-feet around her eyes. Before the procedures, she says, "I looked mean, and I felt older." She also felt vulnerable at the office. "People want to work with people who appear youthful, vital and exuberant. I wanted to look outside how I felt inside. Does that sound shallow?"

On the other hand, there's Carol Pighini, 43, a mother of three from Florida. Bothered by some broken capillaries on her face, she picked a dermatologist in Tampa through an ad for gentler Erbium YAG laser treatments. To her horror, her face blistered for three days afterward, her eyes were swollen shut, and pits formed in her skin. "When the laser started hurting, I asked what was happening, and they said they had 'turned it up.'" She says with a sigh, "All this because I couldn't stand wearing makeup." Lancer, the Beverly Hills dermatologist, is now removing the damage with microdermabrasion treatments; he says the Florida doctor failed to discover that Pighini, despite her blond hair, had Cherokee ancestry and was hence at risk.

So what's a confused consumer to do? Here's a rundown of what lasers can--and can't--do:

LASER RESURFACING

Carbon dioxide, or CO2, lasers have been widely used since 1994 to bloodlessly eradicate wrinkles and sun damage by vaporizing the upper layer of skin, thus stimulating the underlying collagen fibers to rejuvenate the skin. Some 170,000 people had laser resurfacing done last year, making it by far the most popular laser procedure. Though chemical peels do essentially the same thing--and cost less than the average $2,500 to $3,000 for laser resurfacing--lasers have the advantage of being more controllable, since chemicals are absorbed at different rates by different skin.

Yet laser resurfacing requires anesthesia and good skin-care follow-up, which usually involves great globs of Vaseline or special creams and a mask. Patients can be left raw and oozing for weeks or, even worse, end up looking like the Phantom of the Opera. Skin heals faster (often in a week) with the newer Erbium lasers, which are cooler and can be used on the thinner surface of the neck and chest as well as the face, as long as the doctor exercises caution. Yet even these supposedly gentler lasers can sting and, in inexperienced hands, burn and scar if they penetrate too deep. Worse, up to 20% of CO2-laser patients (and possibly some Erbium ones as well) risk ending up with whitened skin one to two years after the procedure, according to Dr. Jay Burns, a laser specialist at the University of Texas Southwestern Medical Center.

REMOVING BLEMISHES

Lasers that target only the color red have been used since the 1970s to treat birthmarks, port-wine stains and other blemishes. Doctors now believe these lasers work better in children than in adults, but they can help diminish unsightly scars and red stretch marks left over from childbirth or breast surgery. Lasers can also soften acne scars, though removing the scars altogether is difficult. Green-light lasers are effective at zapping broken blood vessels and spider veins on the face, hands and neck. But the process can be painful--just ask tough guy Mark Anfangar, 44, vice president of a Los Angeles party-equipment-rental company, who underwent some 1,000 zaps in one session alone to get rid of the angry red veins on his face. "Halfway through, I was dizzy," he admits. But it took only three days to heal, and he went back for another day of 800 zaps.

HAIR REMOVAL

Laser procedures to remove unwanted hair have grown rapidly in popularity since being approved by the Food and Drug Administration in 1995, but many doctors still consider them experimental. Lasers zap the hair follicle underneath the skin, thus retarding future growth. Whether lasers can remove hair permanently, however, is still an open question. A 1998 report from Harvard, where Dr. Rox Anderson has patented a popular hair-removal laser, showed it can last six months to two years. Results for laser hair removal in general seem to vary widely, often depending on the patient's complexion: those with dark hair and light skin have the most success.

Hair removal is not cheap (an average $500 a treatment). But for many women (and some men), it seems a small price to pay to solve a problem that still carries a stigma. Even in this feminist era, female mustaches and chin hair are not openly discussed or even much written about. "A lot of people feel psychologically scarred by heavy hair," says Dr. Edward Tobinick, director of UCLA's Institute of Laser Medicine. "One woman got up at 2 a.m. to shave before her husband got up."

DENTISTRY

This is the newest and fastest-growing field for lasers. Within the past two years the FDA has approved the use of lasers in fixing cavities. On the cosmetic side, lasers can be used to whiten teeth by activating bleaching compounds, and to remove gum tissue and reshape the gum line. "Lasers have dramatically changed dentistry," says Dr. Jeff Golub-Evans, a leading New York City cosmetic dentist. "The things we can do with them are spectacular."

But don't be too dazzled by technology. "Patients get excited by the high-tech gadgets, and many physicians exploit them because they have to pay for expensive machines," says Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami. A walking advertisement for cosmetic procedures herself at age 33, she often favors cheaper chemical peels over lasers. "You have to be savvy. Some chemical peels can give the same effect [as lasers] at much better prices." Physicians who recommend laser work, moreover, are not always objective; some are paid consultants or stockholders in the very laser company whose machine they're using.

Picking the right doctor, of course, is crucial. A number of boards certify plastic surgeons and dermatologists, but what's more important is the doctor's experience in the specific procedure you're contemplating. Some physicians contend that you need to have done 200 or more laser procedures to be fully proficient. When choosing a doctor, recommendations from previous patients are a better guide than come-on advertisements. "Very intelligent people make poor decisions when choosing a physician for plastic surgery," says Dr. Tina Alster, a Washington dermatologist known as Dr. Fix It, who sees an average of two patients a week with laser-burn scars. "They believe all those hideous commercials." Finally, make sure the doctor is doing the work, not an aesthetician.

Laser technology is changing so fast that even veterans of the field can hardly keep up. When he developed the first argon lasers back in the 1970s, says cosmetic-laser pioneer Dr. Richard Fitzpatrick, "we had one laser for everything. Now I have 25 lasers." Soon, he predicts, lasers will reach beneath the skin without causing any surface wound at all, to rejuvenate the skin's structure and reverse sun damage. In five years we may even have home lasers for facials. Fitzpatrick's partner, cosmetic-laser surgeon Mitch Goldman, predicts that in 10 years, you'll be able to wheel yourself into a huge machine like that for an MRI and come out with new skin. "It will take your hair off, resurface your skin to remove spots, wrinkles, age spots."

Did somebody mention age spots? I've been noticing a couple of brown splotches on my hands. It can't be; I'm not that old... Hey, when is that home laser coming along?

--With reporting by Greg Aunapu/Miami, Andrew Keith/Chicago and Elaine Rivera/New York

With reporting by Greg Aunapu/Miami, Andrew Keith/Chicago and Elaine Rivera/New York