Botox vs. fillers

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 in '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) they 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 also combine platelet treatments with hyaluronic acid (to boost moisture) and, or Botox (to soften lines) for optimum results.

How has women's attitude around appearance medicine changed in recent years?
It's been an interesting 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 marketed this aggressively, the awareness increased. But so did misinformation and horror stories, which were usually completely 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 is growing acceptance. Especially in the case of younger people choosing the treatments to delay ageing.

Do unrealistic expectations happen often?
Not often and usually they develop over time. Most patients are very realistic about the ageing process and, in fact, do not want to look 'younger', 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 keep 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. And 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 development of wrinkles.

What treatment would you say makes the most difference to women in their 40's?
Collagen boosting treatments like dermal needling or platelet rich plasma or hyaluronic acid infusions for maintaining the quality of the skin. Relaxing over-active 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 most requested?
Improving frown lines, which makes one appear grumpy even when you're 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, around 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, by affecting targeted muscle groups. It is also widely used medically for certain neurological and pain conditions. Dermal fillers conversely are injected under the skin, to achieve a variety of 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, soften temple hollowing. And of course, plump up lips. Another non-volumising effect of hyaluronic acid fillers (in their thinnest form), when injected very 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', not different. To me, the ideal is that it is virtually impossible to tell 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 look like 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 an optimal result. Similarly with a face-lift, 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 ends up looking different to 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 totally agree! However, they should look the best they can for their age, whatever that may be.  Not tired, not gaunt, they should look and feel like they've just had a fabulous holiday.