FUTURE FACE

Janetta Mackay explores the latest advances in appearance medicine

Whether or not you keep your wrinkles with ageing is becoming a choice, like grey hair,” says Dr Sarah Hart, one of Auckland’s leading cosmetic medicine physicians.

From warding off those lines in the first place with so-called “baby Botox” to tackling their reduction later, it’s all part of the growing popularity of using appearance medicine to reshape both face and body. From tweaks to more drastic corrections, the choice to fix flaws, chase an ideal or intervene with the ageing process is being made more often. In the interests of making that choice an informed one, we’re looking at the latest advances and exploring how to minimise risks in the unregulated area of injectables.

Leaving aside scare stories and vanity shaming, it’s worth remembering that appearance medicine encompasses a whole raft of valuable treatments that make people’s everyday lives easier: from Botox to decrease sweating, jaw-clenching, headaches and bladder leaks; to the use of lasers in treating skin cancers and pre-cancerous lesions, birthmarks and pigmentation; to simple surgeries to pin back protruding ears or nix painful veins. Many of these services come by way of GP referral.

In good hands, appearance medicine undertaken for appearance’s sake can be, as Dr Hart of the Skin Institute notes, easy and effective. Whether you’re a millenial after your best selfie, in peak career years and trying to look less tired or grown mature enough to know you can't hold back time but still want to look as good as possible for your age, there are options on offer.

Whatever bracket you might fit in, be sure you proceed cautiously and consult widely. Now is a good time to do your homework, with many courses of treatment — especially laser and IPL for skin reconditioning or hair removal — recommended to be taken over the cooler months, when tans have faded and you are less exposed to sun. ... says Dr Joanna Romanowska, summing up the current direction in appearance medicine. “It’s using combinations ... for optimum effect.” So not the trout-pouts modelled by some of the contestants on the Married at First Sight television show, about which Clinic 42’s co-founder observes: “Somebody’s planting huge lips on petite faces and bodies without taking the individual’s specific needs into account.” The other practitioners we spoke to all agreed that personalised and toneddown approaches were the modern way to go. Here are their current favourites.

CONTOUR DEFINITION is the key goal for a more refreshed and youthful appearance. Noteworthy ways to achieve this, says Dr Romanowka, include Belkyra (an injectable to reduce fat) for jawline definition, new-style thread lifts to recontour the face and jawline, and fillers to shape cheekbones and soften hollowing.

Dr Hart has been using Belkyra as an international trainer for several years and rates it for shrinking double chins. A new method of using hyaluranon filler, called MD Codes and developed by a renowned Brazilian plastic surgeon and filler expert she has trained under, is bound to be a trendsetter, she says. It places larger volumes of filler strategically to support the face, rather than inflating lips and

NOW “IT’S ABOUT BESPOKE TREATMENTS, TAILORED FOR EACH INDIVIDUAL — RATHER THAN NEW TREATMENTS...”

cheeks. “To improve sagging of jowls, we might place filler near your hairline and ears." This gives a more natural-looking lift, especially with smiling.

FINER FILLLERS that help with skin texture and hydration, smoothing rather than pumping — such as Juverderm’s new Volite — will appeal to newcomers to injectables, says Prescription Skin Care’s medical team leader, nurse Angela Frazer. Volite can help with acne scars or fine lines, be used for proactive care, or on older patients who have lost elasticity. In combination with more structural filler such as Voluma, she says it’s the “icing on the cake.”

Dr Catherine Stone, principal of The Face Place is impressed with Volite’s ability to improve skin quality and glow without adding volume. Injectable moisturising treatments, such as Dermagun, taken as a course post-summer are another way of boosting hydration in skin, says Dr Hart.

THREAD LIFTS are minimally invasive and focus on the mid-to-lower face and jawline. They’ve been around for years, but the use of dissolvable threads rather than permanent ones has catapulted the practice back into view. Gwyneth Paltrow's Goop website talking about them has helped too.

Skin Institute boasts a national threads pioneering trainer in Dr Pier Marzinotto. His colleague Dr Hart says interest in the lifts is “taking off”. Dr Romanowska added them once satisfied about the dissolvable medical-grade sutures coming into play. (Permanent threads are more likely to have issues with infection.) Threads are cheaper and more gentle than an actual nip and tuck but results will obviously not be as tight or as permanent. Successful insertion requires a sound knowledge of facial anatomy. The process can be done in around an hour and is best suited to those with mild to moderate ageing. Between two and eight threads are typically used, and once they dissolve, collagen induction will help keep the lift in place for up to two years.

NON-SURGICAL FAT REDUCTION is a way of improving definition to the body. Its uptake over the last few years has been huge, says Nurse Frazer. So-called fat-freezing isn’t a weight reduction method, instead it targets those pesky pockets on tummies, bottoms and thighs that even diet and exercise won’t always shift. This walk-in, walk-out half-hour treatment now employs smaller machine heads for use on bra bulges, knee fat and chins. Prescription uses well-established Cool-sculpting machines, but brands such as Cooltech and ChillSculpt also carry US FDA and/or Australian TGA approval. (It’s worth checking on approvals, because New Zealand lacks an equivalent regulatory body.) ... agree forward-looking practitioners. The focus will be more on skin’s intrinsic quality, supported by injectables, topical vitamins and antioxidants. Expect the selling of clinical skincare and supplements to grow. Nurse Frazer says advance skincare ranges with active ingredients give best results.

“The new trend is about addressing the whole body, so healthy diet, nutrients, probiotics and gut health,” says Dr Romanowska. “Good gut health minimises inflammation, which contributes to rosacea and acne.” Dr Stone has begun the holistic shift, adding a nutritionist to her team in Takapuna.

ADD IN ELASTIN to fillers of the future. The first is on the horizon, says Dr Hart. This essential component of youthful looking skin — along with collagen and hyaluranon — declines with age but has not previously been able to be topped up. An Australian innovation, now purchased for further development by Allergan (the giant company behind Botox and Juverderm) is set to change this. Nurse

Frazer also picks fillers as an area of expansion, saying research done in Australia shows more than half of women are concerned about loss of volume on the face and lips. As more of them realise

non-permanent dermal fillers are an option, use will grow. “Patients are feeling more confident that they will still look natural and because of this are using higher volumes of filler.”

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