Seeing cosmetic dermatology from all angles

Thankfully, a growing number of women and men are no longer ashamed to say they have had a procedure

Dr Lucia Gannon

@LuciaGannon

Recently, I unexpectedly found myself musing on the variety and effectiveness of cosmetic dermatology, studying the before-and-after faces of women on my social media feed, and wondering what it would feel like to place my face in someone else’s hands for a complete upgrade. Would I emerge as a different person – happier, more at ease with myself? And could this be achieved without anyone suspecting that I ‘had work done’? 

I assumed I was experiencing another existential crisis, hoping to slow the inevitable ageing process by reducing the lines and wrinkles, the sunspots and the now permanently furrowed brows that bore the evidence of my 60-plus years. Only when I was decluttering my living room and getting rid of old newspapers did I suspect subtler influences at work. A Sunday Independent Life magazine from October 2024 carried an article entitled ‘Tricks and Treatments’. Botox is commonplace, the article said. Vampire facials, LED masks for home use, SYN-AKE, a peptide replicating the muscle-freezing effect of a poisonous snake bite that stimulated collagen production, microneedling, and injection of exosomes obtained from the umbilical cord of a red deer, were just some of the interventions on offer throughout Ireland. In a further article in The Irish Times Magazine on 25 January, Liz Dwyer, founder of the Future Beauty Show (a clinical and aesthetic beauty event due to be held in the RDS in March), claimed that “tweakments” – non-surgical treatments such as injectables, laser, and bio-rejuvenations – are as prolific in this country as visits to the hairdresser.

So, despite my great age and sensible head, thoughts of physical self-improvement had not arisen in a vacuum. Mainstream media, directed mainly at people like me, regularly reported on the rise in aesthetic and cosmetic procedures, shared ‘success stories’ of eyelifts, liposuction, breast augmentation, and rhinoplasty. People like me subconsciously absorbed this new information and reacted to it.

Dr Fredric Brandt, also known as ‘the Baron of Botox’, was an American physician specialising in cosmetic dermatology. He was one of the first doctors to start using botulinum toxin and fillers in the 1980s. A charismatic and eccentric doctor, he was instrumental in getting FDA approval for these products. It couldn’t have been an easy sell – allowing someone to inject your face with toxins – but Dr Brandt was passionate about non-surgical cosmetic dermatology. Along with Botox, he offered fillers such as Juvederm, a modified form of hyaluronic acid for deep injection to plump lips, lift or contour the cheek, or shape the chin. Clients said Dr Brandt had a surgeon’s hand and an artist’s eye. He considered the face a work of art. While many women regard their face as a collection of parts, he appraised the whole face, and his treatments consisted of subtle tweaking that, he claimed, could fool a mother’s eye. Dr Brandt believed most people had a false idea of their appearance. Mirrors were not a true reflection of what other people saw. For this reason, he often did not do what a client requested, but instead what he thought they needed. The cost of such treatments (between $1,000 and $7,000 per consultation) meant that his clients were mainly rich and famous, many of whom would never admit to being patients.

Thankfully, a growing number of women and men are no longer ashamed to say they have had a procedure. In fact, many practitioners rely on the testimonials of their clients to generate business. There is no longer any need to sneak out the back door of a clinic. Many clinics offer lunchtime appointments, where a client could meet their next-door neighbour or best friend. 

So far, so good. In the hands of a skilled practitioner, what’s not to love about an odd tweak here and there to enhance natural beauty?

There is some evidence that Botox may make people feel better. Not because they look better, but because a face that cannot express emotion causes a deadening of emotions. Dr Richard Davidson, a neuroscientist and author of The Emotional Life of Your Brain, explains that while the brain controls the face by directing facial expressions, the face also provides feedback to the brain, modulating feelings. People who have even temporarily paralysed facial expressions feel a numbing of ‘big’ emotions, such as anger, and are less likely to express it (Botox administered in the upper face seems to have a lesser impact on positive facial expressions).

As it is mainly women who receive cosmetic procedures, some argue that Botox could become a sexist tool of oppression. According to Dr Davidson, a further potential downside of Botox is not being able to mirror another person’s facial expression, which reduces the capacity for empathy.

Whatever our thoughts or beliefs about cosmetic dermatology, it appears to be here to stay, and like every other aspect of medicine, it should be handled with care.