Most women hear the words 'appearance medicine' and understand them to mean a longer-lasting solution to age-erasing. However, there is more than one option when it comes to treatments. Editor Trudi Brewer asks Doctor Joanna Romanowska from Clinic 42 to shed some light on trends, techniques, and how she makes subtle changes to refresh rather than erase the signs of ageing from your face.
What is the future of anti-ageing treatments?
The very exciting (but not yet available) future lies in 'autologous stem cell' treatments. Autologous means 'the patient's own', which is the ultimate 'natural' when it comes to appearance medicine. I've been forecasting this evolution for more than a decade, and it is rapidly becoming a reality as the techniques for harvesting and processing of the stem cells improve and the costs come down. In the meantime, another autologous treatment is platelet-rich plasma injections (available for several years now), which are producing excellent results in improving the health and quality of skin as well as in other fields of medicine, such as tendon and ligament, knee and shoulder repairs. Today, we can combine platelet treatments with hyaluronic acid (to boost moisture) or Botox (to soften lines) to achieve optimum results.
How has women's attitude toward appearance medicine changed in recent years?
It's been a fascinating evolution over the 17 years I have been practising. Initially, there was zero awareness of the availability of injectable procedures for appearance enhancement. Then, when Botox gained FDA approval for cosmetic use 15 years ago and was marketed aggressively, the awareness increased. But so did misinformation and horror stories, which were usually untrue but fabulously outrageous and great fun to gossip about and propagate. Over the past ten years, as there has been an increase in people (both men and women) choosing to have treatments, and continuing to look natural and not turn into monstrosities, there has been growing acceptance, especially in the case of younger people choosing the treatments to delay ageing.
Do unrealistic expectations happen often?
Not often, and they usually develop over time. Most patients are very realistic about the ageing process and, in fact, do not want to look 'younger' but just as well as they can, at whatever age they are.
What would you tell a woman in her 20s and 30s to do now to slow the ageing process?
Wear sunscreen and stay out of the sun! Also, use good-quality topical vitamin A and niacinamide serums on all sun-exposed areas of skin to delay the ageing effects of sun damage and prevent non-melanoma skin cancers. For those with very expressive faces, occasional use of small amounts of Botox to give the skin a rest from repeated scrunching helps to delay the development of wrinkles.
What treatment would you say makes the most difference to women in their 40s?
Collagen-boosting treatments like dermal needling, platelet-rich plasma, or hyaluronic acid infusions maintain skin quality. Relaxing overactive muscles with Botox, and dermal filler (Restylane or Juvederm) injections to replace the loss of volume, which occurs with ageing and smoothing lines and wrinkles. In this age group, it becomes even more important to use high concentrations of topical vitamins and invest in vitamin infusion treatments.
What anti-ageing treatment is most requested?
Improving frown lines makes one appear grumpy even when merely concentrating or squinting in the sun. The most efficient way to treat frown lines is with Botox, and this does not mean that you will appear completely immobilised. We can soften excessive movement while maintaining expression.
What are the most common misconceptions about fillers V Botox?
First of all, they are entirely different procedures achieving different effects. Botox relaxes muscles and allows the overlying skin to recover and repair any damage caused by decades of repeated scrunching. It can be used to change expression, affecting targeted muscle groups. It is also widely used medically for certain neurological and pain conditions. Dermal fillers are injected under the skin, achieving various effects. They can lift the skin to smooth lines and wrinkles, they can be used to change facial contours and define cheekbones, jawline, chin, nose, and soften temple hollowing. And of course, plump up lips. Another non-volumising effect of hyaluronic acid fillers (in their thinnest form), when injected superficially into, rather than under the skin, will draw water from the circulation to the skin and hydrate or moisturise treated areas from within. This treatment improves the texture and brightness of the skin while doing nothing to the contours or shape.
How would you define great results from any procedure?
When a patient looks 'rested' and 'well', it is not different. To me, the ideal is that it is virtually impossible to tell if a patient has had a procedure at all.
What, to you, is overdoing it?
Whenever a treatment is evident, that's a poor result. Overdoing a Botox treatment results in loss of expression or a 'perpetually surprised or startled' expression. Overdoing filler results in a ridge in the skin or excessive filling of cheeks, which results in a pillow-face effect. Or overfilled lips that resemble Marge Simpson's (duck-like or tyre-tube-looking lips). If you can tell a face has been treated with filler, it is overdone and not optimal. Similarly with a facelift, the 'wind-tunnel effect' is exaggerated and unattractive. Another pet hate of mine is when the face is repeatedly (or surgically) treated over some years and looks different from the rest of the body; the discrepancy created between the face and the body is unattractive and more ageing.
What is your response to critics when they say 'women should just look their age?
I agree. However, they should look the best they can for their age, whatever that may be. They should not look tired or gaunt; they should look and feel like they've just had a fabulous holiday.