Diving in the fountain of youth and better looks

What parts of their body are we Maltese filling the most? Is the cosmetic side of ageing separate to people’s actual health?

If you’re living in the first world, showing signs of ageing has become a problem. In fact, you will most probably feel like you are not allowed to wrinkle and crinkle.

Although physical signs of ageing are a perk that comes with years of wisdom and experience – and modern medicine is allowing us to age well into our eighties and beyond – they are often frowned upon. Ah wait, remember that frowning too is a major source of wrinkles.

The Journal visited Dr Joanna Delia from People and Skin, a clinic in the medical-cosmetic industry that is working hard to improve people’s self-improvement through cosmetics.  She immediately starts to challenge our perception of the cosmetic side of ageing being separate to people’s actual health.

“Health is about making sure the human body is functioning in its maximum potential. It’s about the organs functioning at their best. The skin is the body’s largest organ. When the skin fails, it affects us psychologically. It effects the way we perceive ourselves and the way society perceives us. Many doctors deal with the way the body works on the inside both anatomically and physiologically. Medical aesthetic doctors deal with the way the body looks on the outside,” explains Dr Delia.

“Medical aesthetic doctors make sure that the years we spend on earth in that borrowed time are spent with confidence and personal satisfaction,” she adds.

What are the Maltese filling the most?

Long story short: their lips and noses.

But let’s take it from the start.Dr Delia explains that dermal fillers, or skin fillers, are used to fill in lost volume. They are medical devices usually with a prescription anaesthetic inside, which can only be used by doctors according to EU medical standards.

“The most popular requests for dermal fillers would be lip augmentation, mostly used to replace lost volume after menopause but also to improve proportions. Dermal fillers also improve and reverse mid-face sagging, which happens with age and which creates prominent nasolabial folds, or the lines between the nose and the corners of the lips,” reveals Dr Delia.

Another dermal filler treatment that is becoming more popular is the non-surgical rhinoplasty, where a filler is injected in the nose to make It smoother, thus avoiding surgery. This treatment involves a very technical procedure, since the circulation of the nose is very delicate. Consequently, the treatment carries potential, serious side effects and the risks are higher if it is not done by an experienced doctor.

Dr Joanna Delia

Who can and is getting these fillers?

Medical Aesthetic Treatments are there to improve a person’s appearance – in a way which improves their self-perception. Our appearance effects our confidence, and this is when the medical field comes in.

Dr Delia says that patients opting for a filler treatment should be over 18. However, she confirms that most are usually treated over 35 years of age, with a peak first-time treatment in the peri-menopausal period, or after extreme weight loss especially after treatment for illnesses like cancer and other health conditions.

“A person starts looking into finding out more about our services when they start seeing that some lines on their face are becoming more permanent, for instance – sometimes making us look perpetually angry or tired. When we are younger our skin tends to bounce back quicker. When the folds and lines start appearing even when the face is at rest, that is the time when these treatments come in,” says Dr Delia. 

We ask whether there are any common factors among people who get fillers, such as their level of education, or type of job. Dr Delia tells The Journal that persons from every demographic, sex, gender, and economic bracket seek out dermal fillers. Most new requests happen when people start being affected by the lack of elasticity, and facial fat pad volume loss related to age, illness, or weight loss.

It’s not a cheap affair, and the durability of the product depends on the individual. However, on average, a filler lasts between 12 and 18 months. Dr Delia says that it always depends on the product being injected and the location on the face. The price of these medical treatments depends entirely on which dermal filler is used and the volume being injected.

“Every face is different. It is impossible to determine the price of a procedure unless the doctor is seeing you face to face,” says Delia.  

Watch out for illegal injectors

Like any medical treatment and intervention on the body, fillers can have mild to very serious side effects.  Nowadays, the main ingredient in reputable fillers is Hylauronic Acid. This ingredient is already found in human skin, therefore there is negligible risk of allergy.

After a dermal filler treatment, one should expect some swelling which usually lasts between 24 and 48 hours, at times longer. Bruising might also occur. These are temporary side effects and one can see the final result approximately 7 to 10 days later.

Dr Delia makes clear that it is of the utmost importance that the fillers used are safe and registered as medical devices with the local pharmaceutical authority. “Unfortunately, there are illegal injectors advertising ruthlessly on social media,” she warns.

“Since it is illegal for non-doctors to inject in the EU, these rogue injectors are purchasing cheap, often sub-standard unregulated fillers, usually online. These can have very serious side effects like embolisms, causing anything from necrosis (ulcers and death of tissue) to strokes and blindness.”

In Europe, safe products on the market have a CE mark, which stands for ‘Conformité européenne’.

Products licensed for use in the United States, which has even more rigorous licensing protocols and can therefore be considered safer, are ‘FDA Approved’, meaning they passed the test of the Food and Drug Administration. Such certifications have trusted procedures which make sure that the companies that manufacture fillers are passed through years of rigorous testing before their products are put on the market.

In Malta, it is the remit of the Health Standards Authority to regulate and stop these rogue injectors from injecting people and exposing them to harm.

So what can you do to prevent being injected with dodgy stuff?  In Malta, we have an Aesthetic Physician Association (APAM), a registered voluntary organisation that works to ensure and lobby for regularisation and the promotion of safe practices. Dr Delia encourages anyone looking into having this medical procedure to contact the association on APAM.care, prior to deciding on which doctor to choose.

“The safety of the community should be a priority. I cannot emphasise enough how dangerous bad practice is. Patients should make sure the person injecting them is a medical doctor registered with the Malta Medical Council, and that the filler used is CE marked,” Dr Delia insists.

Her approach exemplifies safe methodology. Before any treatment, a consultation is scheduled, where the doctor thoroughly discusses all potential side effects. Prior to commencing any procedure, clients consistently receive a consent form detailing all aspects, and they are provided with a copy for their personal records. Additionally, clients are urged to pay attention to and follow all post-treatment care recommendations.

How much is too much?

Another thing to look out for is how ‘touched up’ you want to look.

“Most filler patients look for a natural result, but unfortunately some trends which seem to promote disproportionate amounts of filler mean that only the grotesque choices are visible in public – the persons with natural-proportioned treatments are not easy to spot, leading to most people believing that filler treatments are more likely to be disproportionate,” explained Dr Delia.  

She was adamant that a good doctor strongly believes in giving the face a harmonious appearance.

“We react to beauty in a natural way led by the way nature presents beauty to us – with its incredible golden-ratio proportions. Any intervention with fillers should be done following nature’s rules,” says Dr Delia.

Since fillers make you look good and feel good, we wonder whether they can be addicting. Dr Delia replies in the affirmative.

“Unfortunately, body dysmorphic disorder, known as BDD, does exist. This means that there are individuals who might see something or obsess about a specific facial feature which is not as bad, or small, or large as they imagine,” she explains. This is where ethical, professional doctors come in and take proper care of the patient.

“Little tweaks in a way a consultation is carried out can make all the difference. And a doctor’s training and experience should be adequate enough, so that they recognise when a person is suffering from this condition.”

Throughout our conversation, Dr Delia reiterates that these treatments should be empowering and give confidence to the individual.

“Good doctors should refuse to inject anything if the end result will be fake and unnatural. Experience in dealing with and counselling each and every individual is key.”

We ask what the criteria are for assessing clients prior to start their dermal filler treatments. She replies that the medical history of each patient is taken and information about any previous treatment is requested.

Interestingly, there are some dermal fillers which are not compatible with each other. This is something that is always asked during the initial consultation at Dr Delia’s clinic. If the client is aware of which product was previously injected this helps in making sure it is safe for the client to undergo a new procedure.

Unfortunately, bad practices get in the way of this too. Dr Delia explains that people are being injected with dangerous fillers by illegal injectors, giving them long term side effects. “This is why we cannot stress enough how important it is to know what is being injected in people’s faces,” she asserts.

Turning our frown upside down

Through our conversation with Dr Delia, we come to realise several things.

Firstly, the notion that dermal fillers are done for the sole purpose to mitigate the signs of ageing is wrong. Little did we think of cancer patients, or people who have gone through great lengths to reach a healthy weight and have skin issues as a result.

Secondly, we realise it’s not very logical to separate the skin from any other organ. Wanting a human organ to perform at its best is, after all, what the medical world is all about.

Thirdly, we admire the way in which a doctor by the likes of Dr Delia takes people’s wellbeing at heart. It’s not about fixing perceived defects as it is about responsibly improving the way one looks at oneself. It’s quite reassuring to hear words against exaggerating one’s features straight from a med-aesthetic professional’s mouth.

Finally, we realise the importance of knowing what to look out for when getting such interventions. As with anything that we touch, ingest, and consume, safety is the very least we can consider in order to respect our bodies.   

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