Facial plastic surgeon Dr. Patrick Byrne gives Botox injections to patient Sandy Rosenblatt of Sterling, Va. (Barbara Haddock Taylor, Baltimore Sun / September 21, 2011)

When Sandy Rosenblatt looked in the mirror, the striking brunette could see nothing but one big flaw — her eyes, which were sunken and seemed a little dark. So at 34 she had a plastic surgeon smooth them over. While she was there, she decided to have her long oval face made a little cheekier and her brows a little less creased.

Since then the Sterling, Va., resident has had to return to her doctor in Baltimore several times a year for new applications of commercial fillers and wrinkle removers, a drawback of such products.

But a biomedical engineer at Johns Hopkins is experimenting with a new material that is part biological, like the fillers, and part synthetic, like implants used in bigger facial reconstruction jobs. The liquid can be injected under the skin, molded into just about any facial feature and locked into place with the energy of a light.

This new substance, called a photo-activated composite biomaterial, has the potential to become the most long-lasting, and versatile, of products used on people like Rosenblatt, as well as those born with defects or who suffer trauma and need a whole new face.

"There are soldiers suffering blast injuries and people who face plant on their bikes, and they just want to look like they did," said Jennifer Elisseeff, the Hopkins researcher who has lead a team working on the new substance for three years. "On the cosmetic side, people want to look like they did 10 years ago. Now, what's available is so limited."

There are no guarantees that this will be approved for use in doctors' offices, but Elisseeff and others watching her progress say the research is extremely promising. It could mean trips to the doctor for touch-ups every few years instead of every few months — a convenience and potential money-saver, though it's too soon to say how much it might cost.

Rosenblatt's doctor says it's the kind of product he's been waiting for. Dr. Patrick J. Byrne, director of facial plastic and reconstructive surgery at Hopkins, says existing products are restrictive, especially for those in need of extensive reconstruction.

Those patients typically need many surgeries, which come with potential complications such as bleeding, nerve damage and infection.

"This is a bit of a holy grail," said Byrne, also an associate professor in Hopkins departments of otolaryngology, head and neck surgery and dermatology. "There have been countless times I wished I had some surgical putty that I could sculpt. I tell patients your face is not like clay, I can't sculpt it. But this offers that potential."

He said there is clear demand. Already cosmetic procedures are a $10 billion industry in the United States. And even during tough economic times, the number of procedures inched up 1.2 percent from 2009 and 3 percent the year before, according to the American Society of Plastic Surgeons.

In all, there were 13.1 million cosmetic procedures in the United States in 2010. The most common included breast augmentation, nose shaping, eyelid surgery, liposuction and tummy tucks, the society reported. The fastest-growing treatment were Botox and Dysport, which use a toxin to relax muscles and smooth wrinkles, and soft tissue fillers, such as Juvederm and Restylane, which augment features, including lips and cheeks. They were up 12 and 3 percent, respectively, last year.

The society also reported that there we 5.3 million reconstructive procedures performed last year, with tumor removals, laceration repairs and breast reconstruction on the rise.

Elisseeff, who is the director of the Translational Tissue Engineering Center in Hopkins' School of Medicine, said her goals are to benefit victims of trauma and disease, as well as those fighting the effects of aging.

Rosenblatt has been using Dysport between her eyes and Restylane for her eye sockets and cheeks. Now 37, she was recently back for a touch-up.

Over about 10 minutes, Dr. Byrne stuck her with multiple small needles, some through her mouth and into her cheeks. Immediately her features began to subtly fill and round, though Botox takes a few days for the full effects. Byrne said he aims for enough change that onlookers know there is something different, "more beautiful," but not enough to readily know what's not natural.

Rosenblatt said it's obvious to her when she looks at old pictures.

"I think I look refreshed," she said. "I think I look better now than I did five years ago. I can't give it up. It would be nice if it was a little more permanent."

Elisseeff's new material holds that promise because of its makeup. It's made of hyaluronic acid found in existing fillers, a naturally occurring component that gives young people's skin its elasticity, and a synthetic polyethylene glycol gel that is used to make surgical glue and contact lenses.

Alone, hyaluronic acid dissipates quickly, leaving users in need of regular treatments. The acid also can't be used over large areas in need of remodeling. And synthetic materials alone aren't so natural-looking and don't always age the same way as people.