Lately I've noticed a stubborn little crease on my forehead. I lift the skin just a bit, mimicking a facelift - and the crease disappears. During a facelift, the surgeon makes an incision, usually around the hairline, and then pulls the facial skin upward to smooth loose skin and wrinkles, and provide a more youthful appearance.

While a facelift can provide dramatic results, I'm not quite ready for all that. I'd just like something to freshen my face a bit. And yet I'm smart enough to know that some products and procedures billed as facelift alternatives are likely to have more of an effect on my wallet than on my face. But how to separate the facts from the fictions? I turned to an expert for help - and here's what I learned.

Topical Treatments

Dr. Joel Schlessinger, MD, FAAD, FAACS, president of the American Society of Cosmetic Dermatology and Aesthetic Surgery, assured me that creams can be very effective when targeting specific problems. No single cream can do it all, however, and sadly he could not tell me of a cream that is truly "better than Botox." He recommends the Obagi line for pigmentation and age spots, and he has found creams that accomplish such things as increasing eyelash growth and enhancing pouty lips.

Peels are another option, and their level of invasiveness depends on what you'd like. Prices range from low strength AHA peels at $30 - $100 per treatment to very strong phenol peels at $4000 or more. Chemical peels burn off the outer, damaged layers of skin, revealing the younger skin underneath. Babies have such soft skin because their cells are constantly regenerating, but this slows as we age. Chemical peels speed the process up.

There are some nasty stories about what happens if a chemical peel goes too deep, so be careful in your choice of practitioner. Some of the newer options, like blue peels, claim to be safer. At $200 - $1000, these peels may be adjusted to the desired strength. Milder peels can be repeated at regular intervals to achieve a desired result and minimize side effects and healing time. According to the blue peel website, a measured application of blue glycerine is mixed into the traditional peel chemical, trichloracetic acid (TCA), to "improve patient safety by visually indicating the TCA solution strength and facial skin coverage." Anything that helps keep the peel from going too far sounds good to me.

High Tech Salon Treatments

Laser treatments are increasingly popular these days, whether you're trying to remove unwanted hair or get rid of wrinkles. Laser "facelifts" use a carbon dioxide laser to remove outer layers of old skin and tighten muscles.

Dr. Schlessinger tells me that the first laser treatments had "a long recovery time and fabulous results. Today's technology produces only about 20-30% of the those early results, but with almost no side effects." The new buzz word, Schlessinger tells me, is "fraxellation." In today's treatments, you can "strafe" an area so that the laser only disrupts pinpoints of skin, leaving enough surface untreated to speed healing time. This one sounded good to me.

What's more, laser treatments are only one kind of skin resurfacing. Dermabrasion and microdermabrasion, which can be thought of as extreme exfoliation, are old standbys that are still quite popular.

In dermabrasion, the surgeon removes the outer layers of skin with an electronically operated wire brush or diamond-impregnated burr. It can leave you pretty raw and is moderately painful, with a 2 to 12 week recovery. Microdermabrasion is a bit easier on the patient. It involves spraying fine crystals onto the skin, then removing them along with the top layer of skin cells. It is not as painful as dermabrasion, and is safe to repeat every couple months.

Microcurrent "facelifts" go deeper, using mild electrical stimulation to activate chemicals in the skin. Dr. Schlessinger warns that some microcurrent treatments are nothing more than quackery. In general, he says, be careful of spa-type clinics that recommend the same treatment for everyone-chances are they might own only one piece of equipment!

Every woman trying to decide which procedure to have should have a consultation with a certified surgeon, Dr. Schlessinger tells me: "This is one area in which you get what you pay for."

Needles Required

Dr. Schlessinger cautioned me to be especially careful in selecting a good practioner if I decide to go with Botox. These days, Botox is being offered everywhere, from salons to parties. And yet, Botox is a powerful chemical that should be administered only by those with the training to do so. It is derived from a toxin that causes food poisoning. Injected in small amounts into the skin, however, it weakens or paralyzes certain muscles or blocks certain nerves, causing fewer frown lines and wrinkles.

"Many wrinkles are due to repetitive motion on the face-frown acquired as a habit," Schlessinger explains. These wrinkles disappear after a Botox treatment, and the very good news is that often after several treatments the habit is broken and no further injections are necessary.

But what about all the horror stories? The paralysis? Most of those are just urban legends. Botox is not permanent. In fact, injections last only three to four months, which means any side effects are also temporary.

According to Schlessinger, "the biggest complication we see is Botox done wrong." For two reasons, he advises going to a professional who specializes in Botox. One: the proliferation of Medspas and day spas has resulted in many unqualified practitioners. Two: you're more likely to get fresh Botox at a place that uses a lot of it. According to Dr. Schlessinger, we should buy our Botox fresh - just like we would want to get our fish fresh from a fish market.

Facial fillers are another injectable option. These injections actually help replace the volume that you begin to lose in your 30s. And sometimes they actually spur more collagen growth. A recent University of Michigan study even found that the supposedly non-permanent filler restylane sometimes provides long-term effects.

One popular name-brand filler is Juvederm, a hyaluronic acid dermal filler. Hyaluronic acid naturally occurs in all living organisms as a type of sugar. While the treatment does not last forever, it does last longer than Botox, typically at least six months or more.

I was also intrigued by the threadlift. In this procedure, barbed prolene facial sutures (threads) are attached to anchor points in the face (such as a sagging jowl) using a hollow bore needle. The threads are used to lift the sagging areas and can be tightened when necessary. I thought this sounded pretty cool, but unfortunately, it turns out that it's a risky procedure that Dr. Schlessinger says is "so popular, but so incredibly wrong." The threads used in the procedure are quite fragile and can break. When this happens, the effect becomes uneven and the threads can migrate to new areas, or even poke out through the skin! I have moved this option to the "no" column for me.

Go-Go Gadget Facelift

For those willing to try any weird science on their faces, there is such a thing as facelift tape, which uses exterior anchors and threads to physically pull the skin on your face tighter. Think Robin Williams in Mrs. Doubtfire. Unfortunately, you won't have a makeup team to help attach the device to your face every morning, and it seems like you'd need an awful lot of hair to hide the threads adequately. Not for me!

Sweatin' to the Oldies?

An au natural option is facial exercises. Rather than working from the outside-in, these programs claim to work from the inside-out, building tone and strength in your facial muscles. Some programs, such as Facial Flex, even include a resistance device that fits in your mouth to help improve the results of your "workout."

Sorry to say, Dr. Schlessinger says that these program claims are "a complete fabrication. If it were true, a person who chews a pack of gum a day would look great, but in fact the opposite is true." The more you stretch the skin out on your face, the more wrinkles you get. Remember, Botox works by temporarily paralyzing muscle groups, not by giving them a workout. I was a bit disappointed by this news, but at least I can take comfort in knowing there's something good about being a couch potato.

Minor Surgeries

While it may not seem like an alternative to some, there is the partial facelift option, in which a surgeon does not complete an entire facelift (which is extremely painful, expensive, and requires a large recovery time), but simply targets the areas you would most like to see improved. Neck lifts, upper brow lifts, and cheek lifts are common options, but the possibilities are truly endless. It's especially popular for women to have the fat removed under the chin, and in some cases, this is a liposuction procedure that doesn't even involve cutting removing skin. And it is, in my opinion, one way to look a lot younger through a relatively minor procedure.

Welcome to the New Millennium

It used to be unheard of to visit a plastic surgeon before you really needed it-at which point your skin and facial muscles are almost beyond repair. "Today," Dr. Schlessinger assured me, "we have better alternatives to keep people looking good for much longer." The trick is to do your research and take care of your face by starting early. And while an effective Botox cream is still five years off, new treatments are developed every day. With so many good options, short of a full facelift, I am very happy to know that I will never be trapped in a prematurely aging face.