Looking good as a means to feeling good

Man’s quest for looking young forever has not been the sole preoccupation of women (just look at “The Picture of Dorian Gray”) nor has it only been recently that the media has bombarded us with endless advertisements for “younger-looking, wrinkle-free” skin. The pursuit of aesthetic beauty and looking ageless is as old as mankind itself. However, it is only in the last decades that aesthetic medicine has become a recognised medical entity.

Aesthetic medicine is defined as “an emerging branch of medicine that relies on procedures and techniques to improve and enhance the appearance, texture, and contours of the skin, face, and body.”

In general, unlike other surgical specialties, aesthetic medicine relies on non-invasive or minimally invasive techniques to achieve the desired results, using tools such as dermal abrasion/peelings (physical or chemical), injectables (such as neuromodulators and dermal fillers), stem cell stimulants, light-based therapies (IPL and Lasers) and radiofrequency/ultrasound machines. As such, it combines elements from many other specialities such as surgery, dermatology, gynaecology, endocrinology, psychology, ophthalmology and even nutrition and anti-ageing to best address the presenting problems.

And this is where it gets really interesting. As these procedures are generally totally elective and voluntary, and the presenting problems not life-threatening, they are often called pure vanity. However, one only has to look at some psychological studies to see that, statistically, these seemingly minor and often considered by some as unnecessary procedures have a major impact on the lives of those who undergo them. There has even been a recent study that linked botulinum toxin use to improvement of depressive syndromes!

Improvement in self-esteem and confidence can have a strongly positive effect on the person’s personal and professional life, boosting their personal and family relations, as well as their career options, especially if their outward appearance is an essential part of their job. And if that boost comes in the shape of a few injections every now and then … if they are administered safely and with informed consent … why not?

However, as with anything in life, this can be a double-edged sword as those tiny imperfections, which may be imperceptible to one person, may in fact be a major psychological issue to someone else, as in the case of body dysmorphic disorder (BDD).

Studies suggest that up to 15% of people attending cosmetic dermatology clinics and requesting aesthetic treatments are in fact suffering from BDD. They are often unsatisfied with repeated treatments, and leading experts actually suggest that BDD may in fact be a complete contraindication for such procedures.

It is up to the aesthetic medicine clinician to recognise these patients and rather than continue treating them (knowing full well that they will be multiple return clients), they should first be advised to have a full psychiatric/psychological assessment and therapy as needed.

The aesthetic industry has boomed meteorically in the last decade or so, with phenomenal returns for many companies and individuals. According to the 2014 American Society of Plastic Surgeons report, dermal filling is now the second most performed minimally invasive procedure in the USA, with an increase of 253% from 2000 to 2014.

This amazing growth really blindsided the medical fraternity with a resultant generally poor regulation of the aesthetic medicine field, an issue which is currently being reviewed and slowly addressed.

There are very few countries in the world which recognise aesthetic medicine as a fully fledged medical speciality with board examinations and regulatory bodies. This has led to many so called “cowboy” operatives, who with little or no medical training have set themselves up as “aesthetic practitioners” and are happily treating and even injecting their clients with products which are essentially for “medical use only” – which is the official category of products such as botulinum toxin and dermal fillers.

But let me just say one thing: not all people appearing on TV shows like “Botched” and “The Last Chance Salon” are the victims of non-medically trained aesthetic practitioners. There are plenty of doctors all over the world who are just as incompetent and unscrupulous in their medical (never mind aesthetic) practices. So be responsible, and make sure that the doctor you are seeing is in fact fully registered with the medical council of that country and has the relevant and adequate qualifications for the procedure they are about to do.

The aesthetic medicine clinician must create a balanced match between the patient’s needs and expectations, the product choice and the procedural technique; choosing the right patient, for the right product or procedure, administered in the right anatomical place, and in the right manner.

To achieve this, a thorough understanding of anatomy, the ageing process and the mechanisms of action behind each product and procedure is essential for a satisfactory outcome to both the clinician and the client.

As I said before, the ideal is a gentle Photoshop not a Picasso makeover.

By Dr Joanna Karamon
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Dr Joanna Karamon is a General Practitioner at Luzdoc International Medical Service; Medical Director – Medilagos-Rede Luzdoc
Aesthetic Medicine and Travel Medicine