The future of natural-looking cosmetic medicine

The best cosmetic medicine treatment results leave you looking like you have just been on a fabulous holiday. Refreshed and healthy - the best version of yourself, says editor Trudi Brewer. Here she talks trends and expectations with one of Auckland’s top practitioners.

Image Instagram

Image Instagram

In a world where Instagram drives beauty trends and quick fixes are becoming the norm when it comes to delaying the signs of ageing, Dr. Joanna Romanowska and her team at Auckland's Clinic 42 are focused on keeping it real. They offer a full range of skin, and life-changing treatments such as stem cell therapy, botulinum toxin, and dermal fillers, the thread lift, the vampire treatment (platelet-rich plasma or PRP), micro-needling and more. But with those treatments comes an unique bespoke approach to cosmetic medicine that leaves you looking 'rested' and 'well', not different. Here's an update on cosmetic medicine trends, and how you can get a natural-looking result.

What is the future of anti-ageing treatments?

Autologous stem cell treatments. Autologous means 'the patient's own' which is the ultimate in 'natural' when it comes to cosmetic medicine. I've been forecasting this evolution for more than a decade, and it’s 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) is producing excellent results in improving the health and quality of the 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 levels beneath the skin) and, or botulinum toxin treatments (to soften lines) for optimum results.

How has women's attitude around appearance medicine changed over the years?

It's been an interesting evolution over the 20 years I have been practicing. Initially, there was zero awareness of the availability of injectable procedures for appearance enhancement. Then, when Botox gained FDA approval for cosmetic use 18 years ago and marketed this aggressively, awareness increased. During that time there has been an increase in people (both men and women) choosing to have cosmetic medicine treatments. Most people want to look natural, a better version of themselves, and not turn into monstrosities, so with that comes growing acceptance, especially in the case of younger people choosing treatments to delay ageing.

What are the most common misconceptions, around fillers vs. botulinum toxin?

First of all, they are entirely different procedures achieving different effects. Botulinum toxin such as (Dysport and 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’s also widely used medically for certain neurological and pain conditions. Dermal fillers such as Restylane and Juvederm (hyaluronic acid-containing dermal fillers designed to reduce the appearance of wrinkles), 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, and 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, rather than deeply 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.

What's new or on-trend when it comes to fillers?

I'm fascinated with how the filler Radiesse (calcium hydroxyapatite) a semi-solid volumizing filler used for wrinkle reduction that can be used for its bio-stimulating rather than filler properties. It essentially makes skin look younger and more refined visually (as well as under the microscope). Also, there are many new ways to use filler in the chin area to make a face appear more feminine or masculine. This technique can reduce the need for botulinum toxin treatments of the lower face, as well as soften dimpling and the crease, and allow the lower lip to avert reducing the need for filler volume in the lip.

What about the neck and jowls?

Commonly this problem is known as the “jeck” where the jowls and neck blend into one, similar to cankles (calf-ankles). The lower face loses definition as we age, with the jawline begins to blend into the neck. Today treatments such as Belkyra can treat double chin fat, botulinum toxin will address the muscular neck bands and dermal fillers are ideal for volume loss around the jawline.

Do women have unrealistic expectations of cosmetic medicine treatments?

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 look, at every life stage and age.

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 botulinum toxin to give the skin a rest from repeated scrunching. This approach helps to delay the 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 overactive muscles with botulinum toxin, a neurotoxic protein (Dysport and 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 micro-needling and 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 botulinum toxin, and this does not mean that you will appear completely immobilised, we can soften excessive movement while maintaining expression.

How would you define great results from any cosmetic medicine procedure?

When a patient looks 'rested' and 'well', not different. To me, the ideal is when the result is virtually impossible to tell that the 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 botulinum toxin treatment results in loss of expression or a 'perpetually surprised or startled' expression. Overdoing dermal 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 car tyre tube-like looking-lips). If you can tell a face has been treated with filler, it’s 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. It’s important to remember these treatments may help correct signs of ageing but none can stop the ageing process entirely.

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.

Editor Trudi Brewer shares her thoughts on TV3’s The Cafe with host Melanie Homer.