History of aesthetic medicine

History of Aesthetic Medicine Dr. Kamaria Idris

WHAT IS AESTHETIC MEDICINE?  An emerging branch of medicine that relies on procedures and techniques to improve and enhance the appearance, texture and contours of skin, face and body.  Is a term for doctors that focus on improving cosmetic appearance through treatment of conditions including: skin laxity wrinkles excess fat cellulites unwanted hair skin discolouration

ď‚— According to MMC, aesthetic medicine is defined as an area of multidisciplinary medical practice carried out by registered medical and dental practitioners to provide treatment which is evident-based with the objective of addressing the aesthetic desires of patients. ď‚— Also defined as the medical-surgical practice that applies the necessary techniques to restore, maintain and promote the aesthetic appearance, health and well-being of the patients.

Abstract ď‚— History of beauty dates back since time immemorial. People have tried to be more attractive and enhance their beauty. ď‚— Procedures like lipoplasty, breast augmentation and rhinoplasty was initiated more than a hundred years ago and evolved through technology to the modern standards of today.

Marilyn Monroe

Aim  To show the swift progress of aesthetic medicine to today’s highly specialized medical discipline of our time.  Combining the past, present and futures of aesthetic medicine, we will ultimately deliver better patient care.

Aesthetic Medicine  minimal cutting  no general anaesthesia  usually self-paid 3 main categories: a) Injectables - botox - dermal Fillers b) Lasers - hair removal - collagen stimulation - non traditional liposuction - hair stimulation - teeth whitening c) Minimally invasive cutting and suturing - hair transplant - certain skin lifts

History  The history of beauty is as old as mankind itself.  Through the years, people have been trying to improve their appearance and beauty.  Ancient egyptians have started using animal oils, salt and sour milk to improve their skin texture and appearance.  Properties such as clarity, symmetry, harmony and vivid colour are elements of beautiful appearance.

Up until the 19th century •Originating in India over 2000 years ago, the forehead flap for reconstruction for noses mutilated by war is the oldest known procedure in aesthetic medicine.

•Over the years, the techniques have been modified.

•In 1845, a Prussian surgeon published several monographs about facial reconstruction – first rhinoplasty.

•By end of 19th century, a cosmetic surgery saw a boom with many inventions.

•In 1871, 20% phenol was used in order to lighten the skin – the first chemical peel.

 In 1893, Franz Neuber was the first physician to use autologous fat as filler material.  In 1899, paraffin became a common material for augmentation for several years but it led to formation of granulomas.  End of 19th century, Vincent Czerny introduced the first augmentation mammoplasty. He transplanted a lipoma from the back of a patient into the patient’s breast to correct a defect rom removal of Ca breast.

Early 20th Century • In 1907, Charles Miller introduced procedures for cosmetic eyelid surgery, facelifts and chin correction. At the same time, Fredrick Kolle experimented with paraffin injections and implants for repair of wrinkles and tightening of skin contour.

• In 1912, Hollander introduced one of the first face lifts by removing skin pieces at the margin of the hairline to freshen up skin wrinkles and dropping cheeks.

• Also in early 20th century, a dermatologist, Dr. Suzanne Noel became the first woman in the history of plastic surgery to start facelifts and blepharoplasty. She has also emphasized on the importance of pre and post op photographs.

The 1950s and 1960s • 1955 - Augmentation and mammoplasty started.

- Started with the use of sponge-like breast implants made of polyvinyl alcohol. *Problem: incrustation and calcification were frequent

• 1963 - Implants made of thin silicone were introduced.

• 1965 - First study of silicone as a filling agent for tissue augmentation was published.

- Over the years, it was noted that the injected silicone could migrate and fistulise. In 1976, this was restricted by FDA.

Robert Redford

ď‚— In the 1950s, modern hair transplantation began with the theory of donor dominance by a German doctor. He was the first in the western world who showed that hair from the back of the head where it frequently falls out keeps growing when transferred to regions with hair loss. This is the basis for hair transplantation for many years.

ď‚— In 1965, a period for yet another significant innovation i.e. use of lasers in dermatology.

However, due to high rates of hypertrophic scarring and pigment alteration. The technology was abandoned for about 15 years.

Sophia Loren

Joan Collins

1970s and 1980s •This period was an important decade for lipoplasty.

•1972 – a German oral and maxillofascial surgeon started this procedure by curetting the subcutaneous fat. He used a sharp uterine curette which frequently resulted in prolonged drainage, hematoma and skin necrosis.

•1977 – Arpad and Fisher improved the technique by adding suction to facilitate fat extraction but the complication rate still remained high because the tip of the device was still sharp.

•1980 – Yves Gerard changed it to a blunt lipoplasty technique in combination with the infiltration of 200ml to 300ml of infusate.

• 1987 – Jeffrey Klein introduced the tumescent technique allowing the procedure to be done in an office set up under local anaesthesia.

• 1992 – Michele Zocchi first described ultrasound assisted liposuction. To date liposuction is the most frequent surgical procedure in the USA.

• 1983 – Also paved the way for laser-based innovations like the Q-switch ruby laser for tattoo removal.

• 1989 – Pulsed CO2 laser for ablative resurfacing was introduced by Lawrence David.

• 1981 – The first facial filler, namely the bovine collagen was approved for cosmetic used in the USA. Since its approval, an immense number of animal and human derived – natural and synthetic fillers have become available in the market. Collagen, although had notable disadvantages. It was the most important substance for augmentation for more than 20 years.

Michael Jackson

The 1990s •1992 – The Canadian ophthalmologist and dermatologist, Jean and Alestaire Carruthers published an article on the treatment of glabella frown lines with Clostridium Botulinum-A exotoxin that dramatically changed the public perception of cosmetic surgery in the last decade of the 20th century.

•2002 – The brand name of the drug ‘Botox’ became extremely familiar after its approval for cosmetic use. Today ‘Botox’ is used in dermatology for the treatment of glabella and horizontal forehead lines, crow’s feet, nasal flare and chin dimpling. ‘Botox’ is highly effective for the treatment of hyperhidrosis of axilla, palms of hands and feet.

•1998 – Another innovation when the first clinical study on skin augmentation with hyaluronic acid was presented.

Hyaluronic acid quickly replaced collagen as number 1 filler substance. It’s allergy is much lower.

•2003 – The first hyaluronic acid filler for augmentation of soft tissue defects such as facial wrinkles was approved in USA.

• The 90s – The decade when light-based devices such as laser and IPL grew large in cosmetic surgery.

• 1991 – Q-switch Nd:YAG laser with 1064nm were approved for tattoo removal.

• 1996 – It was observed that that hair regrowth has reduced after IPL treatments. This was reported to FDA as an adverse effect which resulted in the birth of hair reduction using IPL. • 1999 – Greg Menaker presented the successful treatment of facial rhytides with a nonablative Nd-YAG laser.

Celine Dion

Oprah Winfrey

Madonna

Halle Berry

The 21st Century 2001 – A Brazilian physician first published an article about the injection of phosphatidyl cholin to reduce localized fat deposits of infraorbital fat pads for cosmetic reasons – due to complications, it was restricted.

•2004 – It was found that sodium deoxycholate is better tolerable to reduce unwanted fat deposits at the hip, abdomen, ‘love handles’, neck or jowls as well as benign lipomas.

•2009 – Reduction of body fat was doctumented to be effective by cold exposure – the so called cryoliposis in the areas of flanks and abdomen without damaging the upper skin layers or peripheral nerves.

•2003 – A new non-invasive, non-surgical approach to tighten facial tissue by using energy in the radio frequency of electromagnetic spectrum to produce heat within the skin, thereby produces shrinking of the collagen fibres.

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2005 – This was further improved by a combination of RF with pulsed magnetic fields to increase the production of collagen fibres via a non-thermal mechanism.  2006 – The use of IPL was further enhanced to treat wrinkles and skin laxity. 

Angelina Jolie

Jennifer Lopez

The Future of Aesthetic Medicine The rejuvenation of the aging phase and body will remain a high priority for the future of aesthetic medicine.

Promotes the developments of new techniques and devices.

New developments need to be superior in quality and efficacy, safety and comfort without having any disadvantages to be successful in the fiercely competitive market.

One of the new technologies that have the potential to set new milestone in aesthetic medicine is Botox Gel for the topical treatment of facial wrinkles having no risk of injection related side effects.

Another innovation – which is already a reality is the use of autologous platelet-rich plasma (PRP) for skin improvement and rejuvenation. PRP is known to contain various growth factors like platelet-derived growth factor (PDGF), transforming growth factor (TGF) or vascular endothelial (VEGF) which are effective in stimulating dermal healing process. Studies have shown that PRP can improve skin wrinkling, elasticity and texture.

Another approach using autologous cells is the use of multipotent adipose derived stem cells (ADSC) obtained from liposuction fat aspirates for the treatment of aged skin. ADSC has the ability to differentiate into various cell types including adipocytes and keratinocytes.

Therefore, they hold promise to be effective in skin rejuvenation. However, this is still being studied.

There are many exciting new techniques in the pipeline, new advances in Botox and dermal fillers and I feel there will be improvements and perfections of various lasers existing now. The opinions of many doctors with regards to these machines change from day to day.

Nicole Kidman

Catherine Zeta-Jones

Conclusion ďƒŹ Over the years, aesthetic medicine has progressed through loops

and bounds. Over time, new developments and innovations have made aesthetic medicine one of the most diversified disciplines in medicine. ďƒŹ Currently, the trend is towards minimal or non-invasive treatment

with minimal risk to the patients, no down-time and highly satisfactory results. ďƒŹ The on-going research into stem cells and growth hormone is so

advanced that many experts are claiming with great certainty that in the future of aesthetic medicine, not only will we look younger but will also be able to live very long and healthy lives with the advancement of technology together with nutrition and hormones.

Word of Caution  Healthcare professionals should not be

complacent that nothing can go wrong.  Dermatologists or plastic surgeons may

not be trained in the minimally invasive procedures.  Should have appropriate training and

understanding of technology for patient’s safety.

Jocelyn Wildenstein

Donatella Versace

THANK YOU 