Denverites aren’t known for their vanity—not in the way that, say, Los Angelenos or Miamians are known for their high-gloss, high-maintenance (and sometimes highly enhanced) facades. But just because those of us who live a mile high don’t go for the Barbie doll look doesn’t mean we don’t work at it a bit. “Colorado’s definition of beauty is just a little more healthy, sporty, active, and outdoorsy,” says Dr. Cory Dunnick of the University of Colorado Cosmetic Services center. “People here tend to go for more natural results.”
In other words, Coloradans aren’t above a little augmentation (yes, we’re talking plastic surgery as well as less invasive procedures); they simply have different ideas about what constitutes beauty—and how to attain it. According to local dermatologists, plastic surgeons, and others in the beauty industry, Coloradans are seeking out the same cosmetic treatments as everyone else—but in moderation. “It’s all about enhancing what you’ve already got, not about looking like a celebrity,” says Tahl Humes, M.D., owner of Denver-based Vitahl Medical Aesthetics. To that end, patients are getting savvier about navigating the preponderance of technologies and procedures available to help us look beautiful and age gracefully. “We don’t hear ‘I’m too young for that’ anymore,” Humes says. “This is the new preventive medicine.”
They smooth, they remove, they lighten, and they brighten—and there are dozens of lasers and laser companies out there. We break down the types of lasers and then ask Sara Kubik, a certified laser specialist at Denver’s Rejuvenate! medical spa, for suggestions on which brands of devices best treat various problem areas.
Ablative laser treatment
A “wounding” laser that removes the outer layer of the skin surface, ablative laser treatment allows the skin to heal over time and promotes a new layer of collagen.
Commonly used for: reducing the appearance of fine lines, wrinkles, and uneven surfaces.
Nonablative laser treatment
A “nonwounding” laser that targets the surface of the skin, nonablative lasers stimulate collagen growth in underlying layers but leave skin intact.
Commonly used for: sunspots, broken capillaries, and redness.
Fractional laser treatment
Fractional lasers work on very small areas of skin while leaving the rest intact, meaning this treatment has very minimal downtime.
Commonly used for: wrinkles, acne, or discoloration.
Intense Pulsed Light (IPL)
Also known as photo-rejuvenation or a photofacial and often marketed as a laser treatment, nonwounding IPL therapy sends pulses of light energy into the skin. IPL brings pigmentation to the surface where it creates a “coffee-ground effect,” allowing for exfoliation and a more even skin tone after about a week. Three to five treatments are usually necessary for the most noticeable results.
Commonly used for: reducing red and brown spots and broken capillaries.
The Complex Complexion
Dr. Richard Asarch, a 35-year veteran of cosmetic dermatology and head of Englewood’s Asarch Center for Dermatology & Laser breaks down the four “spheres” of action required to keep your skin looking healthy.
Prevention. In Colorado, every 1,000 feet of elevation increases the intensity of sun exposure by five percent. (Psst: Hikers, bikers, skiers—pay attention!) Those exposed at high elevations should wear sunscreens that incorporate a physical blocker, like zinc or titanium, that blocks both UVA and UVB rays. Chemical blockers, on the other hand, absorb one or the other. “If you’re going to do nothing else, you have to wear great sunblock,” Asarch says. Why? Skin cancer, age spots, wrinkles, mottled pigmentation, sallowness, and skin sagging, to name just a few reasons.
TIP: If you’re fair-skinned and burn even with sunscreen, Asarch recommends taking a daily capsule of Heliocare, an over-the-counter antioxidant herbal product derived from a plant in South America, to help your skin fight the damaging effects of the sun.
Nutrition. Many people are vaguely aware that what they’re eating affects their skin. But taking the time to learn which ingredients are beneficial—much less putting the knowledge into practice—is another story. Certain foods, such as salmon (omega-3 fatty acids), brightly colored fruits and vegetables (vitamins and antioxidants), and olive oil (no processed oils such as vegetable oil) can help with sagging, discoloration, and dulling by inhibiting the production of free radicals and reducing inflammatory reactions. While tweaking your diet isn’t a cure-all and won’t help against external factors like the sun, it is a good complementary technique.
TIP: Asarch’s The Beautiful Skin Diet provides an in-depth rundown on foods that benefit your skin with antioxidants and nutrients, plus recipes incorporating these ingredients.
Topical agents. Asarch has been researching cosmeceuticals (cosmetics with medicinal effects; the FDA doesn’t recognize these products) since the 1990s. In Colorado, hydration is important, and using a topical product is the best way to prevent that moisture from escaping. The biggest problem, Asarch says, is how a skin-care product presents its ingredients. The label might hype that a lotion contains collagen—a misleading skin-care buzzword—but your body cannot absorb collagen by rubbing it in; the molecules are too large. Or, the ingredient list may include a formula that contains antioxidants, or vitamins C and E, but it’s unlikely to say how much. Many of the recipes don’t have high enough concentrations of influencing ingredients to make a difference. So Asarch researched the most effective recipes and developed his own line, Dermaspa Rx.
TIP: Find more than 20 Dermaspa Rx products at dermasparx.com.
Procedures. The proliferation of technology makes this the field with the most dramatic results. The Asarch Center offers treatments that range from medical (eyelid reduction, sweat gland removal, spider vein diminishment) to cosmetic (ultrasounds for skin firming, tightening, and smoothing; injectables like Juvéderm). “We have the ability now to do some amazing things that run the whole gamut,” Asarch says, “from the top layer of skin down to the fat.”
TIP: Asarch thinks of the skin as a painting. The top layer is the paint—it should be bright and smooth. Underneath is the canvas, which should be taut. Even if you use effective topical treatments on the top layer, your canvas can deteriorate. He recommends a little TLC—procedures such as laser and/or IPL treatments—every so often.
We’d all love a more defined set of abs or a shapelier waistline. But surgery? No thanks. Many Coloradans are too active to tolerate an extended recovery period. Which means more patients are requesting fat-blasting, skin-smoothing treatments that let them get up and go immediately after the procedure. But these devices aren’t meant for instantaneous or drastic results, physicians warn. They aren’t fixes for someone who is 50 pounds overweight or someone who thinks she needs a tummy tuck. “None of these devices can help that,” says Dr. Tahl Humes of Vitahl Medical Aesthetics. “If you want surgical results, you’ll have to get surgery.” Rather, patients are more likely to see a slight reduction of fatty tissue in the problem area—a good outcome for someone at a nearly ideal body weight who simply wants more svelte lines. Here, a brief sampling of the latest noninvasive fat-zapping technologies available locally.
Note: Consult your physician and the provider to determine whether you’re a good candidate for these procedures.
Body contouring with a handheld applicator, which is about half the size of an iPhone, typically takes less than an hour with minimal side effects beyond mild redness and tenderness that recede quickly. Applied to the skin (usually in two treatments about a month apart for about $2,000 to $2,400 total) over stubborn areas such as tummy bulges, cheesy thighs, or the dreaded double chin, the compact handpiece emits a radio-frequency energy pulse that warms your fat cells and eventually destroys them. Once a fat cell is dead, it cannot regenerate, and the body naturally absorbs the material. Find it at Vitahl Medical Aesthetics, the first office in Colorado to offer the treatment.
In August, the Asarch Center was the first of just four clinics in the country to purchase the Vanquish machine, which is the only treatment on the market that targets the abdomen and both sides of the torso (hello, love handles!) simultaneously. You simply lie beneath the triple-paneled device (it does not touch you) for 30 minutes—$2,600 gets you four sessions—while radio frequency heats up your fat cells (your skin reaches 101 degrees, creating what patients describe as a pleasant warmth, while the underlying fat reaches up to 120 degrees) and eliminates them. No downtime, no pain.
Rather than radio-frequency or laser energy, this handheld device penetrates surface skin layers with high intensity focused ultrasound waves to obliterate fat in specific areas without damaging surrounding tissue. Although it may take weeks to show, one hour (prices vary depending on size of area treated) can diminish some people’s waistlines by a pant size. The drawbacks? Discomfort during the procedure and possible bruising, swelling, or redness following the treatment. The downtime is nothing like recovery from surgery, but clients should expect a short period of recuperation. Liposonix is available through the University of Colorado Cosmetic Services center.
Considering cleavage? Here’s the buzz on today’s techniques and technologies.
When it comes to being busty, local plastic surgeons agree: The clientele in Colorado isn’t looking for outrageous, look-at-me changes. As one surgeon put it, most women simply want to fill out their clothing; anything larger becomes a hindrance during physical activity.
Techniquewise, breast augmentation has remained fairly consistent, say both Dr. David Charles of Denver’s Plastic Surgery Clinic and Dr. Gary Snider of Plastic Surgery of Denver, with two notable exceptions: First, many surgeons today are inserting the implant behind the pectoral muscle instead of between the chest and breast tissue. This gives women who don’t have a lot of natural breast tissue—such as athletes who work hard to keep their bodies trim—an extra layer of tissue over the implant. Second, some patients are requesting fat transfers instead of implants. In these procedures, the surgeon takes fat from the buttocks or thighs and injects it into the breast tissue to bulk up cup size. Although many doctors like this process, Charles believes the technique could have negative consequences: Fat cell calcifications that can occur as a result of the treatment might interfere with the early detection of breast cancer.
Mostly, though, it’s the technology of the actual implants that has improved. For years, saline implants were used because studies in the early 1990s indicated silicone gel implants could cause disease. Intensive scientific investigation ensued that disproved the studies, and silicone implants—known for feeling more “real” and having fewer side effects than saline—have been deemed safe by the FDA since 2006. One of the newest versions of the silicone implant is a cohesive, form-stable gel known as the “gummy bear implant.” The name comes from the fact that if you slice the implant down the middle, both halves retain their shape and firmness without any liquid or runny misshapenness—much like the consistency of a gummy bear if you cut it in half. While some surgeons have moved exclusively to the recently FDA approved and slightly more expensive “gummy bear” implants, other local physicians aren’t convinced the technology is different enough from the standard silicone implant models to make a difference.
Upgrading The “Uglies”
Not happy with the, uh, visuals down there? Don’t despair. You can get that fixed in Colorado, too.
There’s no getting around the ick factor of what Dr. Oscar A. Aguirre does. But that doesn’t mean it’s not worth talking about. Aguirre specializes in a field so unique that not until 2011 was it designated as a board-certified subspecialty: female pelvic medicine and reconstructive surgery. Translation: He performs cosmetic surgery (among other procedures) to improve the appearance—and sometimes function—of a woman’s private parts.
Women generally have two concerns, says Aguirre, who founded Englewood-based Aguirre Specialty Care: They’re bothered by the way their labia look, or they’re not enjoying sexual activity (either as a result of childbirth or because of psychological hang-ups over their appearance in that area). One thing he stresses: His patients’ concerns are almost always self-generated. “I’ll never operate on someone who says, ‘I think I’m fine, but my boyfriend wants it done,’?” says Aguirre, who performs 300 surgeries a year, 20 percent of which involve a cosmetic procedure.
It’s a good policy, considering patients can incur bills upwards of $10,000—as high as $30,000 for combination surgeries—and insurance doesn’t cover cosmetic work. “It has to do with how they feel about themselves,” Aguirre says. “These women aren’t strippers or Playboy models. There are normal women everywhere who are just really bothered by these things.”
We talked to one of Aguirre’s Colorado patients, a 39-year-old registered nurse, who spent thousands for an in-office labiaplasty, clitoral hood reduction, and skin excision around the anus.
Tell us a little about yourself.
I love the outdoors. I love to hike, backpack, snowboard, and white-water raft. I’ve always been big into the mountains. They bring me a lot of joy. I’m also a fighter—I’m into Mixed Martial Arts. I really enjoy keeping myself fit. And I like to look beautiful.
Why did you visit Dr. Aguirre?
As far back as I can remember, I felt very uncomfortable about the way my vagina looked. I had very long labia. Even though I never compared myself, I remember feeling like I wasn’t normal. Even into my adult years, I was really embarrassed. Once I got into my 30s, I started researching possibilities for change.
What were your husband’s thoughts?
My husband was completely for it. He told me, “I love the way you are; you don’t need to do this for me. But if this is something you want to do to feel better about yourself, then let’s do it.”
Was there much recovery?
As far as downtime, I was in bed, having difficulty walking, for five to six days; no physical activity for four weeks; no sexual activity for six weeks.
If only you and presumably one other person see this area of your body—and that one other person was totally happy with it—why go to the trouble?
Because I always had insecurities about myself. During sexual activity, I’d put up a mental block and have difficulty reaching orgasm. Now, it’s totally changed my perspective on my body. I feel beautiful now. I feel accepted, normal. When I’m with my husband, it’s like it should be with a husband and wife. I feel complete, and everything is just falling into place. I’d do it again tomorrow.
M.D. or Beauty Degree?
According to Colorado law, aestheticians and other cosmetic professionals can administer laser therapy and injectables—both regulated by the Colorado Medical Board—as long as a physician has delegated that authority in writing. The doctor isn’t required by law to be on-site during treatment; he or she must, however, be available to consult. Patients should be aware that lasers emit very intense light energy, and accidental burns can happen. “The problem with nonphysician providers performing cosmetic procedures is that they may not have the resources to address complications should they arise,” says Dr. Cory Dunnick of the University of Colorado Cosmetic Services center. As such, the Colorado Medical Board has established certain requirements, such as weekly on-site monitoring of the delegatee using the lasers or performing the injections, to ensure proper protocols and quality of service.
If you aren’t being treated by a physician, Dr. Tahl Humes of Vitahl Medical Aesthetics says to make sure the clinician has been trained by a physician who understands the lasers, rather than only by the laser company or a course instructor. “They’re all medical procedures,” Humes says, “and we’re starting to forget that.”
Gimmick or not, the Vampire Facelift has arrived in the Mile High City.
OK, it sounds morbid, and perhaps like a hokey marketing ploy in the face of America’s recent Twilight obsession. But proponents of the nonsurgical Vampire Facelift—a combination procedure of hyaluronic acid filler injections (think Juvéderm or Restylane) and platelet-rich plasma (PRP) therapy—swear by the body’s natural ability to heal itself. PRP is used frequently in orthopedics to help heal injuries and was introduced as a facial rejuvenation method in 2009. The therapy entails drawing one’s own blood, spinning it in a centrifuge to separate the platelets from the red blood cells, and injecting that platelet-rich plasma back into the skin. Platelets contain growth-factors that can stimulate the regeneration of collagen to help reverse the effects of aging on your skin, says Wendy Clifton, owner of Parker-based Synergy Aesthetics & Wellness, which has been offering the Vampire Facelift for about a year. Rather than injecting the platelets with a needle, which can be painful, Clifton prefers another method: Dermapen technology penetrates the skin, creating tiny holes, which then allows the technician to simply massage the platelets over the newly porous areas, creating a colander effect to absorb the platelets.
Although PRP can be used on its own for a simple boost (the “platelet facial”), the most noticeable results—aka, the youngest-looking appearance—occur after the facial lines have been plumped with filler, Clifton says. Expect to fork over up to $1,500 for the full procedure. Says Clifton: “It’s like cheating Mother Nature.”
Why I’ve (mostly) changed my mind about laser hair removal.
I think of myself as an open-minded person when it comes to trying new things, especially in the beauty arena. For this job, I’ve tried Botox (loved it!). I’ve also done IPL (eh) and microdermabrasion (not for me) and a host of weird seaweed-based skin-care wraps and mildly irritating salt glow treatments (yuk). I’ve been waxed—everywhere (totally worth it). But I’d been hesitant to try permanent laser hair removal. I’m not really sure what my reluctance was about. I guess I always thought shaving seemed like a pretty straightforward and reasonably priced everyday option. Plus, lasers had always seemed scary.
Six months ago, though, I decided it was time to be a little adventurous. I was researching Colorado’s beauty industry (for this article) and had been focusing on the state’s newest companies. That’s what compelled me to visit Ideal Image, one of the country’s largest laser hair removal companies, which had recently opened locations in the metro area. So, on a sunny afternoon, I threw on a tank top under a sweater and set out to rid myself of armpit hair.
Ideal Image’s Westminster location feels like your typical medical spa—perky receptionist, sleek decor, technicians dressed in hospital-style scrubs. My type A personality had duty-bound me into asking for a brief orientation to the two types of lasers (the alexandrite and YAG lasers) and the procedure before I threw my arms above my head.
I learned that laser hair removal is unlike the hair removal one might seek from IPL therapy. It’s different in that it’s permanent (after a series of about nine treatments). It’s different in that it’s way more expensive (nearly $2,000 just for arm pits). It’s also different in that it kinda hurts.
If I had to compare it to something, I’d say the 10-minute armpits procedure executed by a registered nurse—not a doctor—hurts less than waxing and more than a knick while shaving. Although the treatment is quick, it is a bit disconcerting. The technician determines the laser settings based both on her knowledge of the machine and your answers to a few questions (How well do you tan? What is your ethnic background? What color is your hair?). At that point, I hopped on a treatment table, the technician handed me protective eyewear, and then she directed a laser beam at my skin. And then—zzzzaaap! I felt a quick prick and then detected the smell of singed hair.
Ten minutes and a dozen zaps later, the skin under my arms was free of stubble and a little red and tender. Eight weeks later and then eight weeks after that and so on, I returned to get subsequent—and increasingly intense—laser treatments.
So what do I think? I kinda dig it. I have to admit that not ever having to think about throwing on a sleeveless shirt or spending extra time in the shower every day is straight-up awesome. In fact, if I had $10,000 to blow on my beauty regimen I would be bare as a baby’s bottom—everywhere. But I don’t. And that’s the real downside to this whole thing. Because for about $50 a year and a little extra time in the shower, I can create smooth on my own.
Want to even out your skin tone—affordably? Denver’s M.Pulse center has the fix for you.
So you’ve got some blotches on your face…not surprising, considering Colorado’s elevation; we mountain folk are exposed to an especially intense version of sunlight. But do you really want to drop a paycheck on treatment? We thought not.
Enter M.Pulse, which opened in Colorado in December 2012 and has expanded to six centers around the state. M.Pulse offers a light-based process called photo-rejuvenation, aka a photofacial, via intense pulsed light (see “Laser Vision,” page 32) to give you a clearer, lighter, more even surface, similar to the skin on the inside of your wrist (which likely hasn’t been exposed to too much sunlight). How? The light targets the blood, water, and pigmentation in your epidermis and encourages skin renewal.
The kicker: M.Pulse offers its services (which also include hair reduction, acne treatment, chemical peels, and facials) at about a third of the market cost without locking clients into confusing packages or contracts. “Affordability and transparency are huge,” says M.Pulse CEO Beth Anne Walker. “We’re not medical, and we’re not a spa. We’re creating our own niche in an accessible retail-slash-clinical environment that provides high-quality treatments.”