In search of perma-youth

Botox, lasers, lifts, peels: anti-ageing treatments get ever more sophisticated. But, asks Markie Robson-Scott, are we buying into an unhealthy obsession?

In her book, Lift: Wanting, Fearing and Having a Facelift (Viking), Joan Kron quotes a Los Angeles dermatologist who, in his Manual of Chemical Peels, writes that "skin ageing is a chronic disease, needing daily treatment to control and reverse". Just the sort of statement guaranteed to infuriate Dr Eileen Bradbury, a psychologist with 15 years experience of helping patients whose cosmetic surgery has gone wrong. She loathes the idea of ageing as a disease, worries about the quest for "perma-youth" – she coined the phrase – and is happy to be raising the voice of doubt at the Royal Society of Medicine's conference on Ageing Skin in the New Millennium, where the other speakers are all from the ever more confusing world of rejuvenation – experts in the fields of Botox, lasers, lifts, peels, fillers and retinoid creams.

Bradbury is 53. Like most women, she has considered having "something done" – she knows all the right people, after all – she doubts that surgical procedures would make her more attractive or solve her life problems. A taut look, she thinks, is not necessarily a good thing in an older person. And do we all want to end up looking the same, with all history wiped off our faces? "I'm not wholly against these treatments, they're not always a bad idea and they can be valuable, but I see the other side. Even Botox isn't innocuous – any nurse can do it, but you are injecting a poison and you're paralysing muscles so they won't show expression. It's not the same as having your eyebrows shaped in your lunch hour."

Maybe not, but millions of us love it. Everyone knows someone who's getting Botoxed every four months or so (that's how long it lasts – then back come the frown lines). And at least it has been around long enough for us to know it's safe, as long as it's done by an experienced doctor. My friend Jean, who is 45 and has had hyaluronic acid gel fillers on mouth lines as well as N-lite laser treatments around the eyes, even thinks Botox has a calming effect on herself and others. "If you look unworried, the world responds accordingly." Wendy Lewis, a beauty consultant and the author of The Lowdown on Facelifts and other Wrinkle Remedies (Quadrille), calls Botox the best bang for your buck (about £200 a go) when it comes to non-invasive, non-surgical treatments (she rates an eyelid lift as the best bet when it comes to surgery).

The RSM guys are excited about Botox, too. "There are no side-effects, as far as we know," says the plastic surgeon Kevin Hancock, chair of the conference, "and neurologists use doses 100 times greater for facial and back spasms." Even so, it's best to confine it to frown lines and crow's feet. Try it around the mouth and you're likely to get what Hancock politely calls an "undesirable result" – as the muscles are paralysed, speaking and smiling is difficult.

But although Botox isn't permanent or invasive, it can be a gateway drug. As Joan Kron says, "Botox injections often become a dress rehearsal for a facelift".

Kathy Phillips, Vogue's associate editor (health and beauty) is also concerned about the knock-on effect if young women start preventative Botox treatments: "These women may be so used to tampering with their faces that they'll add fillers, then resurface with peels, then lasers, then surgery, and the end results will not be attractive [see the wedding guests at Liza Minnelli's wedding]. There's no substitute for staying out of the sun, a good diet, and cleansing and moisturising – but people just don't want to hear about the long way."

Apparently not. Treatments combining Botox and the new non-invasive lasers such as N-Lite and CoolTouch, says Professor Nicholas Lowe, a plastic surgeon who works here and in California, are increasingly popular: "You pre-treat with Botox to reduce the dynamic lines, then you don't have to be so aggressive with the laser." These new lasers don't have the ghastly side effects – oozing, scabbing, itching, redness, even permanent scarring – of the old carbon dioxide ones. These had "disastrous results in inexperienced hands," says Professor David Gault, a laser surgeon who has developed a new plasma kinetic device, not yet on the market, which, he says, will be much safer and require less regulation than a laser, though it will do the same job.

CoolTouch and co don't break the surface of the skin; instead, they emit a cooling spray to protect the epidermis before heating the dermis (deeper layer) and stimulating new collagen formation. Professor Lowe says you would need a treatment every four to six weeks for six months for a good result. And there's no down-time when you look too monstrous to be seen. As Jean says, "What puts me off invasive treatments is the scariness, the price and the time out of one's life."

The wrinkle filler is another relatively non-invasive treatment that has come on apace. Once there was silicone (side-effects included moving and hardening), then there was collagen (you need a skin test to see if you're allergic, and it comes from cows or pigs). Now, there's hyaluronic acid, a substance approved in the EC since 1995, which comes from rooster combs or from lab-produced bacteria and which exists in the skin already. Restylane is used for lines around the lips and eyes, Perlane, which is thicker, is used for deep facial lines and lip augmentation, lasts for three to six months, and costs around £300. Possible side-effects include swelling and bruising.

These still aren't approved for use in the USA (when they are, probably later this year, they are expected to take over the American market). And there are several fillers on the market in Europe, according to Professor Lowe, that haven't been tested extensively enough. So the moral is: don't try anything new.

But what if you'd rather not try anything at all, or anything that involves needles or surgery, but you still want to keep the signs of age at bay? Professor Chris Griffiths, a dermatologist at the conference, is behind Kathy Phillips when it comes to sun-avoidance. Wear factor 15, he says, and don't just apply it once because the effect doesn't last. "Many moisturising creams contain sunscreen, but they're not applied enough or in a thick enough layer to be of use." And smoking, he says, is just as harmful to the skin as sun: a high percentage of the same collagen-destroying enzyme (matrix metallo-proteinase) is found in the skin of both smokers and sun-worshippers.

Can skin creams help wrinkled, sun-damaged skin? Some over-the-counter "bio-active" creams such as AHAs, says Griffiths, are fine as sophisticated moisturisers, but you need the prescription-strength ones containing high percentages of retinoic acid, such as Tazarotene and Retinova (about £25 a tube), which act like a mini chemical peel, to really get a result. They stimulate collagen as well as inhibiting production of the dreaded matrix metallo-proteinase. They take about three months to work, and some people find their skin gets red and scaly, though this usually clears up after the first few weeks.

I've been Botoxed

Natasha Bruun, 30, is a manager at a telecom company. She is from Texas and has lived in London for two years. She had her first Botox treatment at a Harley Street clinic three months ago.

I know 30 is young to have an anti-ageing treatment, but I look at it as preventative maintenance. I smile a lot, so I do have a lot of lines round my eyes, as well as one between my brows, and I want to stop them deepening. Botox is so simple ­ it takes 15 minutes and hurts less than giving blood or a mosquito bite. The worst you get afterwards is maybe a slight headache, and you can't have a facial involving massage for three days. It lifted my smile lines so they're less prominent, and the effect on the forehead one was amazing. And I didn't lose the character of my face in that frozen way that people get when they've overdone it.

I had three injections around the line between my brows. You don't inject directly into the line, but around it, because of the way the muscles work. I thought it hadn't taken at first and I called the doctor, but he laughed and told me to wait for 48 hours. When I couldn't frown it was strange at first, but then, when you don't see that deep line, it's so nice. Now I look at other people and think, "If they only knew how much better they'd look without those lines".

I'm open to everything ­ I want to learn about all the new anti-ageing treatments available. Obviously, I wouldn't go cutting and slicing now, but I'd do the laser or a peel. And I'll have the Botox every three to six months.