Does it work? I get this a lot — pretty much every time I mention a product (hi, Plated) or procedure (like Sofwave). And as I recently shared in a piece for Oprah Daily, I often struggle to answer the question completely — even, irony of ironies, when I’m assigned to do just that. (Foiled again by the almighty word count!)
Since my cutting room floor was littered with valuable gems after filing this story, I figured I’d share them here. (But please do go read the Oprah piece, which was thoughtfully edited to share some big-picture insights.)
Anytime someone poses the question, “Does it work?” my first thought is always: Define work. What does that word mean to you?
“‘Work’ is such a vague term and so subjective,” Amelia K. Hausauer, MD, a board-certified dermatologist in Campbell, California, tells me. And she’s 100% right. Even with a tried-and-true treatment, like Botox, people’s definitions of “work” can vastly differ. Think about it: If your idea of “working” is a frozen, furrow-free brow, but your doctor’s is more an easing of movement and relaxing of lines, then you’ll likely deem the shot ineffective, because it didn’t meet your standards.
I’ve heard this from several physicians over the years. Patients will call a week or two post-injection claiming the treatment “didn’t work,” because they can still lift their eyebrows. But in 2023, friends, it is the rare (and, dare I say, questionable) injector who aims to fully paralyze the face, robbing it of expression and individuality. Nevertheless, you should know this going in.
Beyond defining “work” for yourself, realize that your expectations and perceptions can influence your impression of what works. Doctors see this every day. “Two people can get the same result and one might be perfectly happy with it while another is profoundly upset over it,” says Mike Nayak, MD, a board-certified facial plastic surgeon in St. Louis.
Semantics play a fascinating role in setting expectations. We’ve talked before about the verbs “lift” and “tighten” — how they can overstate the power of nonsurgical treatments. Board-certified New York City dermatologist Jessica Weiser, MD, told me that when she’s describing the action of collagen-enhancing devices, for example, she chooses her words carefully, in order to prepare people for a reasonable payoff. She’ll say, “We can create firmness in the skin,” since that’s literally what collagen stimulation does. “The skin may look tighter as a result of the increased firmness,” she says, “but we are not actually tightening.”
I find Dr. Weiser’s approach to be incredibly refreshing. Because, let’s be honest, when the average patient hears “lift” or “tighten,” they’re usually thinking facelift-like outcomes, not millimeters of improvement. And this disconnect can breed disappointment.
As patients, as humans, we all have our own metrics for gauging success, satisfaction, worth-it-ness. And they’re essential, really, since efficacy isn’t always plain to see or easy to measure. Sure, some manifestations of work are obvious and incontrovertible — your sunspots are lighter, your jawline is sharper — but others demand careful scrutiny. Consider some of the most popular treatments out there, like the veritable army of tools aiming to spur collagen growth: They tend to yield small changes, over multiple visits, to nuanced effect. In such cases, your happiness may hinge (at least partly) on how observant you are, the keenness of your eye.
Can we look to studies for proof of work? In some cases, yes. But much of what researchers observe in a lab (increased collagen bundles, sturdier elastic fibers) are slight upgrades, transpiring in a petri dish, and — I’m being generous here — not always reflective of what we see in the mirror. Plus, the data, experts tell me, can be massaged to suit any number of marketing messages. So while the resulting claims may sound impressive, they may not be super reliable.
When you ask me if something works, I may try to draw from personal experience. But my skin — fair, easily triggered, and starting to sag after 46 years — is hardly a barometer of efficacy. You must factor in your own starting point — your age, your genetics, your personal history with poolside sun reflectors and Johnson’s Baby Oil.
I’m reminded of this whenever I come across a treatment review written by a 26-year-old, who looks just as fresh-faced in her before pic as her after. I often dismiss these accounts, assuming that if someone has smooth, taut skin at baseline, then whatever it is they’re testing doesn’t have to work very hard to impress. But according to Dr. Weiser, this isn’t the only reason younger patients enjoy better results.
“One’s innate collagen production in their 20s is so much higher than it is in their 40s,” she explains. “So, not only do they have less to ‘fix,’ but they get a more robust response [to the treatment], because their body has more to give.”
If I invest in, say, a radiofrequency microneedling treatment at 46, when my collagen cells are sluggish, and I walk away less than wowed — that subpar outcome may have more to do with my skin’s limitations than the machine’s. Make sense? Perhaps this particular treatment will only work for me, in a way that really registers, if I do multiple sessions at a spicier setting?
When evaluating efficacy, consider also the area you’re treating. As we know, the neck can be particularly tricky to address nonsurgically, given its unique anatomy. It requires a slow-and-steady approach. It also rebounds less quickly than the face. So, you may need to grade on a curve.
Even surgical solutions for the neck can seemingly fall short, if they’re inappropriately prescribed. “Doing liposuction when a facelift or neck lift is actually needed is a good example of this,” Dr. Nayak points out. It’s a fairly common scenario: Following neck lipo, a patient has lingering under-chin fullness or a still-blunted jawline and thinks the procedure failed. In reality, the lipo did its job — it removed fat from the underside of the skin. The root of the problem, however, was not superficial fat alone, but deeper tissues lying beyond the reach of the lipo cannula. Technically, the treatment worked; it just wasn't the right match for the patient.
Where does this leave us? Probably with an exhaustive list of Qs to ask at your next derm appointment. But that’s okay! Fire away! And think critically about the answers you receive.
My last two cents, for whatever they’re worth: For a treatment to find its way into a legitimate doctor’s office, it should have at least a modicum of science behind it. But that doesn’t mean everything on the menu will be to your liking. What’s more, even the most proven remedies can’t always fully correct what bothers us — be it lines or laxity, melasma or rosacea — certainly not in a forever sort of way.
So tell me: What was the last treatment that truly delivered for you? I’d love to hear about it. xx
Fantastic piece! I manage my expectations as a 54-year beauty writer, but can understand how easy it is to build up hopes.
Great post, Jolene. xo