Desire for beautiful skin has always been with us

Dr Charlotte Gribbin.

Dr Charlotte Gribbin.

It would be easy to assume that aesthetic medicine is a very modern concept, but its history goes back further than you might think. Why did Cleopatra reputedly bathe in soured donkey milk? Perhaps she knew about the benefits of lactic acid (contained in sour milk ) which is now used as a chemical peel to gently remove surface skin cells and reveal smoother, blemish free skin underneath.

Centuries of home-made remedies and lotions suggest that the desire for beautiful skin has always been with us, but it wasn’t until the mid-19th century, when the hypodermic syringe was invented, that the idea of injecting the face to rejuvenate or beautify, first occurred. Needless to say, the fledgling attempts to inject paraffin and other unnatural substances, didn’t go well.

While chemical peels and laser treatments were useful interventions for managing wrinkles and pigmentation in the 1970s and 80s, it was the advent of botulinum toxin that launched modern aesthetic medicine.

The original botulinum toxin formulations were intended to treat conditions where muscle spasticity was a problem. In 1983, a Canadian eye doctor (Jean Carruthers ), who was conducting a clinical trial in blepharospasm (eye lid twitching ) began to notice that her patients were looking “serene” and refreshed, at their follow-up appointments. She and her dermatologist husband made the connection and tried it out on their receptionist. By 1991, they had published the first scientific paper and by 2002, botulinum toxin was licensed by the FDA in America, for the treatment of frown lines.

These days, aesthetic medicine could be described as a medical speciality, distinct from plastic surgery, providing minimally invasive medical treatments to enhance patients’ satisfaction with their physical appearance. All procedures should be elective and performed on healthy adult patients. Typical indications for treatment include aging or sun-damaged skin, lines and wrinkles, volume loss, scarring, stretch marks, uneven pigmentation, and broken capillaries. As technologies advance, hair loss management and body contouring are also growing in demand.

The injectables that are most asked for are Botox (most famous trade name of botulinum toxin ) and dermal fillers. These treatments are very different. Botox is delivered in very small quantities, in very specific areas, to relax muscles and smooth overlying skin. Dermal fillers are gel-like substances which can be injected to replace lost volume or add fullness.

Other injections include skin boosters which hydrate skin from the inside and collagen stimulators which aim to encourage the natural production of collagen in facial tissues.

Peels and lasers are still used to resurface and smooth skin. They vary in strength and depth.

Energy devices (including lasers ) use energy (e.g. heat ) to tighten skin and boost collagen.

Regenerative medicine

Regenerative medicine is the idea that we can stimulate our own cells to repair and rejuvenate themselves. The best know example of this is platelet rich plasma (PRP or “Dracula” facial ). Blood is drawn, spun in a centrifuge and the resultant serum can be injected or micro-needled to stimulate regeneration.

The field of aesthetic medicine is evolving quickly. The most interesting trends right now are in the direction of regenerative medicine. “Off the shelf” products, which stimulate regeneration and rejuvenation, are appealing to both doctors and patients.

All of these treatments are only as good as the person administering them. It is vital for patients to be aware that every procedure mentioned above has potential risks, some serious. Botox is a prescription only medicine. Much of its use is off label. Scarily, fillers do not require a prescription! However, the enzyme which dissolves filler (sometimes the need to dissolve filler is an emergency if a blood vessel is injected by accident ) does require a prescription. Deep peels, lasers, energy devices and regenerative medicine are advanced techniques.

I say this because the regulation of the aesthetics industry is far from ideal. Patients should research their practitioner carefully. Is the person medically qualified? Are they licenced to prescribe medicines? Do they belong to a regulatory body (e.g., registered with the Medical Council )? What insurance do they have? What specific training in aesthetic medicine do they have and how much experience? Have you heard good word of mouth recommendations and not just slick social media and marketing? Your safety should be your practitioner’s first priority.

Patients new to aesthetic medicine often worry that they will look overdone. Good work should not look like you’ve had anything done. The goal is always to refresh and rejuvenate. I am very wary of the desire to change facial features and rarely treat patients under 35. Reputable practitioners will advise and guide their patients towards treatments that suit their needs and their budgets. The aim should be to look good for your age, not 10 years younger.

Dr Charlotte Gribbin — Assistant Professor in Aesthetic Medicine at Ulster University. Has a master’s degree in Aesthetic Medicine from QMUL. Practices in Kent and London and regularly speaks at national and international conferences. Two presentations at Aesthetic Medicine Ireland next week on Regenerative Medicine and optimising skin health. She is a native Ballaghaderreen in Co. Roscommon, and attended school in the Mercy Convent in Tuam, before graduating from Trinity College Dublin


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