Frankfurter Allgemeine Quarterly:
Ms. Pavicic, there is consensus that hardly anyone likes to age.
However, what aging should look like is subject to trends.
Which ones do you observe in your practice?
Tatjana Pavicic:
Ever younger people have been coming to me since 2019.
Many are in their thirties, some in their mid-twenties.
This development has intensified during Corona.
They don't come to be treated right away, but want to find out first: What can they do to prevent the changes that aging brings with it from becoming visible in the first place?
They have understood that if they start treatments early, the aging effect will not be seen or will be minimal.
Do you want to stop the aging process by undergoing preventive treatment?
Yes.
The ideal of eternal youth has had its day, as has the idea that the skin must be completely wrinkle-free.
The patients do not want to look changed or even artificial as a result of the treatments, they want to keep their own appearance for as long as possible and only improve it minimally.
The younger ones often say: "I know there is nothing I can do about it yet, but please recommend the right care products for me." The current ideal is even, plump, healthy skin.
Sun protection is essential for this, because sun-damaged skin shows up in pigment disorders and leads to sagging of the skin, especially on the neck and under the eyes.
A second aspect of preventive treatment is the care of impure skin.
We know that chronic skin inflammation also contributes to the aging process.
What do the patients want when there is "something to do" after all?
The most common is the treatment of frown lines, forehead lines and laugh lines with botulinum toxin or the treatment of smaller volume deficits with fillers such as hyaluronic acid, such as in the tear duct of the eye.
In order to preserve the firmness and tautness of the skin, mechanical treatments such as micro-focused ultrasound are particularly suitable up to middle age.
Botulinum toxin and fillers have been in use for a long time. Is their use changing due to changing ideals of beauty, or are there completely new methods and preparations for treatment?
The motto "Less is more" is also reflected in the applications, which I also see in current medical studies: In the past, men were injected with forty units of Botox to treat frown lines, today it is a maximum of 20-30.
Due to the focus on the appearance of the skin, there is a new trend towards so-called collagen-stimulating fillers.
How and for what are they used?
These fillers stimulate the production of collagen and elastic fibers in the skin.
They can be used in many ways, for rejuvenating and tightening the skin and some also for filling volume losses.
Three preparations are authorized on the European market: calcium hydroxyapatite, polylactic acid and polycaprolactone.
They all differ in how they work.
Polylactic acid, known under the trade name Sculptra, has hardly any filling effect, has to be applied three times and primarily improves the quality of the skin.
Polycaprolactone, which is very well known in Asia, is rarely used in Europe and not at all in the USA due to a lack of approval.
Calcium hydroxyapatite, known as Radiesse, can be used in its pure form for a defined cheek or jaw contour, or it can be diluted
to apply it flat under the skin of the neck and décolleté.
About the mode of action: If we inject calcium hydroxyapatite, for example, we trigger a minimal and controlled inflammatory reaction in the body.
As part of the wound healing process, connective tissue cells then migrate, which produce collagen and elastic fibers in particular, which lead to regeneration and tightening of the skin.
You speak of a minimal and controlled reaction - what are the risks of using it?
Excessive collagen production or the formation of false collagen fibers must not occur, otherwise hypertrophic scars (proliferation of connective tissue in the skin, editor's note) or nodules will form, which would worsen the complexion.
In principle one can say: If one finds the individual indication and choice of treatment for the patient, the side effects are minimal.
But this is exactly where the problem lies, because the training of doctors in terms of their specialist knowledge in the field of anatomy or knowledge of the product is not controlled.