TIGHTER SKIN WITHOUT SURGERY
Carolyn Lamb has dipped her toes in the proverbial fountain of youth more than once. "I've had Botox, fillers, laser treatments - you name it," admits the 62-year-old grandmother of six from her home in Miami. A longtime patient of Fredric Brandt, M.D. (305-443-6606), the dermatologist on speed dial for some of New York's and Miami's most fashionable women, Carolyn has been pricked, plumped and lasered, all in the name of staving off Father Time. But what she intends to put off for as long as possible is going under the knife. "Anything I can do to avoid surgery, I will try," she says, echoing the sentiments of many of today's most result-conscious ladies.

So when Brandt presented Carolyn with the opportunity to try Titan, a brand new FDA-cleared infrared-light device that promises to improve slack skin, she eagerly signed up. Since the procedure is practically pain-free with little or no downtime and averages $1500 to $2500 per treatment - reasonably low compared with the cost of plastic surgery - the only thing she stood to lose was an hour or so of her time. What Carolyn gained, she says, is tighter, lifted, more radiant0looking skin on her face - immediately, and after only one session. "I'm thrilled with the results," she says. "Injectables filled in my lines, but Titan changed the overall condition of my skin."

Carolyn isn't the only one touting the benefits of this revolutionary new treatment. "Titan is going to be huge," predicts David J. Goldberg, M.D. (201-441-9890), a New York and New Jersey dermatologist who has treated more than 100 patients with the system. "It's tightening the skin without surgery," he says. "I have not had a single patient so far who is not happy with the results."

What is Titan?
The laser like infrared-light device is held on the skin and, as it slowly passes over the area being treated, delivers a series of quick, heated zaps that reach below the surface to repair and stimulate collagen. In fall 2003, aesthetic laser and light company Cutera began developing Titan because at the time, it saw few real alternatives for patients who wanted to look younger but did not want an invasive procedure. Titan was created with those scalpel- and needle-wary people in mind, as it works to treat sagging skin without changing its inherent structure. In October 2004, the FDA declared the system safe and effective for heating the skin, and the company expects to have FDA clearance for wrinkle reduction as early as this fall.

How does it work?
The natural aging process, along with sun damage, causes collagen fibers to stretch and loosen like worn rubber bands, resulting in less elastic skin that eventually droops. Titan tackles this problem by delivering infrared light deep into the dermis, the inner layer of skin where collagen resides, and prompting the collagen to repair itself. The light works in two ways: It heats up the weak collagen, causing it to immediately contract and thicken, and it also creates micro-injuries to the dermis, encouraging it to produce new collagen over a period of months. The result? A smoother, tighter, more toned look that occurs naturally, as opposed to with fillers, muscle freezers or physical alteration of the skin. But perhaps one of the biggest draws of Titan is that it is almost painless, a major difference between skin-tightening system first launched three years ago. Though both systems work by heating the dermis and contain cooling devices within the hand pieces that continuously control the temperature of the skin's surface, ThermaCool uses radio-frequency energy, which dermatologists claim is much more intense and harder to control than light energy, possibly making the treatment quite painful. Radio-frequency energy can also go too deep, destroying fat under the skin and resulting in dimpling, unevenness and skin depression.

"With Titan, there is no risk of skin irregularity because it doesn't go deeper than the dermis," says dermatologist Bruce E. Katz, M.D. (212-688-5882), director of the JUVA Skin & Laser Center in Manhattan, who participated in the FDA clinical trials for Titan.

Who is the best candidate for it?
Doctors are finding that age is not the determining factor in Titan's success. They stress that it's more about the condition of the skin and tackling the problem when the first signs of sagging start to occur, which differs from patient to patient. "I've had people in their late 20s with modest results and people in their 70s with great results," says Javier Ruiz-Esparza, M.D. (760-436-7546), a San Diego dermatologist who took part in the Titan FDA clinical trials. Though doctors agree that collagen doesn't respond or form as well after the ago of 50, they maintain that mature patients can still achieve favorable results - if they have taken proper care of their skin. "It's not about your chronological age but your biological age," says Brandt. "Someone who has stayed out of the sun and treated her skin well might see results, even if she is older, because there is less damage to repair."

What happens during the treatment?
Forget having to clear your calendar - Titan truly seems to be a lunchtime procedure. It takes anywhere from 10 minutes to one hour depending on the size of the area being worked on and the meticulousness of the doctor performing the procedure (many treat the same area two or three times in one session). There is almost no pain involved and nearly no side effects, save a bit of redness that typically lasts an hour or so and a slight swelling that usually subsides after a day or two. Doctors and patients agree that you can go right back to work post-treatment, with your colleagues none the wiser. "I am probably the only one who even noticed that swelling," says Carolyn. "I actually liked it because it made my face look a bit more plump!" A topical numbing cream is applied to most patients before hand, though several doctors claim it isn't needed. The hand piece, which looks like a small vacuum head, hits about one square inch of skin per zap, and each one lasts about six seconds. The sensation feels like a surge of heat that comes and goes. "It's more discomfort than pain," says Carolyn, whom Brandt treated with a numbing cream before the procedure. "It feels like a concentrated heat, but it's nr that bad." The company claims to have no reports of long-term side effects, though it has heard of a few patients experiencing mild blistering immediately afterward that resolves itself within a few days. Ruiz-Esparza says that about 3 percent of his patients have experienced this, "but the blisters go away quickly and are more of a nuisance than anything else."

How many sessions are required?
Doctors are divided as to how often the procedure is needed and how far apart the sessions should be spaced. The average recommendation is one to three treatments performed two to four weeks apart. Katz advised up to five sessions, while Ruiz-Esparza suggested only one and lets his patients decide whether they want to continue with it. Most doctors conclude that it depends on the person's needs and the area being treated. Quite a few space the sessions one month apart, but Katz feels strongly that Titan should be administered every two weeks. "The skin produces more collagen when the dermis is still a little inflamed, and if you wait a month, all the inflammation goes away," he notes. "We're keeping up the momentum." How often the entire series needs to be repeated remains to be seen. "It's too early to tell when patients will need to be retreated," says Goldberg, "but we're thinking every one to three years."

When are results visible?
While many patients report immediate tightness, dermatologists argue that it may be from the slight swelling of the skin post-treatment. It takes three to six months for new collagen to form, so optimal results should occur after three to eight months, depending on how often the treatment is repeated. The extent of improvement varied. "We don't know why some patients get better results than others," admits Ruiz-Esparza. Brandt agrees: "It's too soon to understand the long-term effects. We have to treat hundreds of subjects to see all of the good and negative outcomes." Still, women are lining up to get zapped, since there is so little risk involved and the cost is relatively low compared with surgery. "What's great about Titan is that it doesn't preclude you from having surgery later on," notes Goldberg. "But once you cut skin, that scar is there forever."

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