Say no to the scalpel

Who, over a certain age, hasn't stared in the mirror and wished to turn back the clock? If only it were possible to lift and tighten the skin on your face – but without resorting to the surgeon's knife. Looking good may not be the route to inner happiness, but a youthful complexion can certainly give us a boost. It's not all about trout pout and those wind-tunnel or pillow-face looks sported by many celebrities who overdo Botox and fillers. The most modern treatments are much less radical and more subtle. All the same, some sound pretty scary and most are expensive, so how do you know what to try?

"Ageing in the face is a result of skin damage to the surface, loss of elasticity and skin tone, that causes wrinkles, as well as loss of volume, which causes the face to drop and sag," says Dr Nick Lowe, consultant dermatologist at the Cranley Clinic, London and clinical professor of dermatology at the UCLA School of Medicine, Los Angeles. "All these are accelerated by exposure to sunlight, toxins, smoking, yo-yo dieting and stress. There is lots you can do with modern technology to easily knock 10 years off your face." The secret, he says, a little alarmingly, is to start a little younger, in your mid-thirties. "Then the changes to the skin can be anticipated and treated to prevent them."

IPL (Intense Pulsed Light)

How does it work? IPL is an intense, pulsed low-density light that passes through the epidermis and penetrates deeper into the dermis, where the pulsed light energy stimulates cells called fibroblasts to produce fresh collagen.

Results: Over three to four treatments, this new collagen smooths and softens the appearance of fine lines, wrinkles, pores and textural irregularities. Pigmentation abnormalities, spider veins and rosacea, which absorb the light, are damaged until they fade from view. After several sessions, the smoothing effects are dramatic.

Scary factor: During the 20-minute treatment it feels like a rubber band is being snapped on your face. Go to a doctor, not a beautician, as this is serious stuff. "The scariest factor is not having the energy and wavelengths of the IPL taken into account with anybody with a tan or dark skin," Dr Lowe says.

Down time: If done properly, you'll have only mild redness. You could have IPL in your lunch break. "IPL is perfect for people with a mixture of some discoloration from sun damage or hormonal changes from pregnancy as well as early redness and thread veins, because of its broad number of wavelengths," Dr Lowe says.

Cost: £400 for one session, but more will be needed to get the full effect. Expect to shell three or four times that amount. On the plus side, the effect lasts for years.

PRP (Platelet-Rich Plasma)

How does it work? The new "vampire facelift" or "Dracula treatment" uses your own blood to combat wrinkles on the face and neck. Blood is drawn from a vein and put into a special centrifuge that concentrates and separates platelets. The platelet-rich plasma is then injected into the areas needing rejuvenation, releasing special growth factors that lead to tissue healing: the production of new cells, remodelling of epidermis and collagen production.

Results: Your skin is shiny, plumper, smooth and glows. "There is a good amount of evidence to suggest it works in 75 per cent of patients," says Basim Matti, consultant plastic surgeon at the Cromwell Hospital in south London, who is researching the technique. "You have to wait six weeks for results. It's best to check the quality and quantity of your platelets first or you might be wasting your money." Combine it with Fraxel Laser to get skin in hyper-repair mode.

Scary factor: Not for the faint-hearted. Repeated jabs could make you feel like a voodoo doll.

Down time: One day.

Cost: From £800 – a lot of money for something that might not work on you.

Fraxel Laser

How does it work? Microscopic laser columns penetrate deep into the dermis to create tiny wounds, which trigger your body's natural response system to heal. Lighter-duty Fraxel Re:store is a non-ablative laser, so your skin's protective barrier remains intact, but this needs two to four treatments. Heavy-duty Fraxel Re:pair treatment uses a carbon dioxide (CO2) laser which can go deeper into the subcutaneous tissue, in a single treatment.

Results: Fraxel is the gold standard for revitalising your skin, and much used by the Hollywood set. "It is going to stimulate collagen, tighten skin and address sun damage, giving the skin the plump vitality and texture you had in your youth," says Dr Diana Piana-Mariton at Dr Sebagh. "Your skin does the work – after three weeks, two months, four months, it will continue to look better." Lasts two to three years.

Scary factor: High (see below). For wimps, try Fraxel Glow, the "red-carpet" treatment developed by Dr Piana-Mariton. It combines high-radio-frequency Polaris/ReFirme with a less dense Fraxel. "You can look photogenic in two hours – but the results aren't long-lasting."

Down time: Fraxel Re:store recovery time is two days; there's mild sunburn and some possible swelling. Fraxel CO2 Re:pair renders you housebound for five to seven days. Expect pinpoint bleeding, and oozing for 48 hours until the wounds close, as well as swelling and redness.

Cost: Fraxel Re:store from £700; Fraxel Glow from £700; Fraxel Re:Pair CO2 laser £2,000.

Combined Dermaroller

How does it work? A small handheld tool is rolled over the skin, to produce thousands of microscopic needle columns in the skin's dermis, which stimulate the blood supply to generate new skin cells. Hyaluronic acids, minerals and vitamins are infused into the skin, to give an immediate skin-plumping effect.

Results: "All you want is bleeding to make the skin go into repair and produce more collagen – the fine blood vessels are no more than 1.5 millimetres under the skin – so this is more precise than laser, with no associated risks of scarring or pigmentation," says Dr Michael Prager, who pioneered the combination treatment.

Scary factor: High. This treatment lasts for two hours. Ten minutes is painful as tiny needles prick your skin.

Down time: One to three days. Face is a bit pink, tiny specks of red pinpoints, though no big deal.

Cost: £980.

Thermage (one-off facelift)

How does it work? Heralded as "the knife-less facelift". A handpiece delivers radio-frequency technology to heat the dermis and subcutaneous tissue, where it tightens and stimulates new collagen.

Results: "Thermage works best on moderate sagging of the lower face,especially sagging around the mouth and along the jaw line, but it also helps lift the brow," says Dr Jeffrey Dover, associate clinical professor of dermatology at Yale University School of Medicine. "We performed a face Thermage study of 5,700 patients. Ninety-four per cent of patients were pleased with the outcome."

Scary factor: Nothing like for a real facelift. "We used to use oral and intramuscular injections of pain medications to help tolerate the procedure. Since the introduction of the new vibrating tip, only two out of hundreds of patients have required any pain medications," Dr Dover says.

Down time: You need only one treatment, with little or no down time. "If you are a facelift candidate it is not going to help you. To call it a knife-less facelift is an exaggeration – patients need a correct perspective," Dr Lowe says. "If it is combined with newer tiny microneedles radio frequency called Intracel to treat upper lip, jowls, eyelid sagging, it is highly successful."

Cost: £2,000.

Fractora (eye lift)

How does it work? A brand new non-surgical eye lift, the treatment takes a couple of minutes. Radio-frequency energy is transmitted through a series of small bipolar needles that heat the skin and result in minuscule pinpricks, which the body then heals.

Results: "It will lift, firm and tighten both the skin of the upper and lower eyelids," says Dr Jean-Louis Sebagh. "It is especially effective in the treatment of skin that is naturally thin or where eye-lift surgery is not practical as there is not enough skin around the eye to trim. It can prevent or delay the need for surgery, as long as it is not left too long. It's not effective if the patient has fatty deposits in their under-eye bags or where the eyelid muscle is very loose."

Scary factor: Low. Surgery can change eye shape but this can't. One single treatment tightens the skin and can last for up to two years.

Down time: There is an initial recovery time/down time of four to 10 days, with initial bruising and swelling expected.

Cost: From £800.