Ageing: cosmetic intervention versus maturing gracefully

While Botox and other treatments and injectables result in a marked reduction in lines and other signs of ageing, can the repeated use of such interventions truly be risk-free?

Janice Dickinson, left, and Dame Judi Dench. Maury Phillips / WireImage / Getty Images; Ian Gavan / Getty Images

Cosmetic intervention

Why age when we have the elixir of eternal youth at our fingertips? Why watch – with morbid fascination – as one's face falls apart, when we can be frozen, like a real-life Sleeping Beauty? Thanks to advances in medicine, we no longer have to accept our fate. As procedures become more available and affordable, and with many places offering so-called lunchtime fixes, the stigma of having work done is fading as fast as the bruises.

The most noticeable ageing occurs when collagen, the skin’s natural elastic and a binding protein, starts to break down. As we age, because of the ever-diminishing amounts of collagen to smooth things over, the creases created by movement (frowning, smiling, laughing) become permanent. The human body is thought to halt production of collagen from our mid-20s, which starts to show in earnest in our 40s.

However, there are a host of practices that claim to stimulate collagen formation, or at least disguise its decline. Fractional CO2 Ablative Laser therapy uses a carbon dioxide laser to bore tiny holes into the skin, which are said to encourage the production of collagen during the repair process. As the technology improves, downtime is reduced, with most patients needing only a week off work.

In an aid to camouflage the collagen loss, many are turning to Botox. When injected topically, this toxin temporarily paralyses muscles, causing them to relax, which allows the skin covering them to flatten out. The effect is a marked reduction in lines. However, the effects can wear off in three to six months.

Injectable fillers (such as Perlane, Juvéderm, Artifil, Restylane and Radiesse) are used to replump areas of the face that have hollowed, such as cheeks and lips. The filler is injected under the skin, to help recontour the face. A tip is to show the dermatologist a photo from your mid-20s, so they can ascertain where soft tissue used to be.

For mild sun damage, microdermabrasion can help you get a more youthful look. The skin is “sandblasted” with fine particles that remove the surface layers of the epidermis and, with them, imperfections. For greater sun damage and hyper-­pigmentation, one option is to resurface the skin with trichloroacetic acid. This process, commonly known as a skin peel, burns upper layers of the epidermis to allow the newer skin underneath to show through. Be prepared for a downtime of two weeks, and possible sensitivity to sunlight thereafter.

As with all medical procedures, thoroughly check all medical facilities, credentials and training. Techniques change quickly, so make sure the practitioner has up-to-date training. Mistakes can and do happen, and the most common cause is poor placement or over-application of fillers and smoothers. Bad results include an unbalanced or artificially tight look. Surgery is difficult, expensive and painful to repair; however, short-term injectables can be reversed with enzymes designed to break down the hyaluronic acid (the active ingredient). Permanent fillers are harder to remove, with the patient often having to wait the full time frame for the effects to wear off – in some cases, this can be up to one year.

Maturing gracefully

Ageing is normal. We get older and we look older. It’s called living, and at each stage that we pass through, we look different. This is an entirely natural process. A few lost souls, however, refuse to accept this, and instead try to halt the tides of time. Everyone wants to look their best, but surely it’s worrying when a 70-year-old wants to pass for 25?

As tempting as it may be to reach for creams and injectables (what does that innocuous word even mean, by the way?) to soften those deepening lines, one must first understand that time travel is impossible. No matter how many chemicals are pumped into middle-aged bodies, they will never be young again. Let. It. Go.

As these increasingly invasive procedures gain everyday acceptance, what are the long-term health implications? As patients get ever younger (why are 18 year olds getting fillers? What on earth do they have to smooth out?) and treatments get ever more aggressive, are we just opening up a Pandora’s box?

Cigarettes were once ­marketed as health-giving. We now ­under- stand they cause cancer. Thalidomide was prescribed to expectant mothers to cure morning sickness, until it was discovered that it causes terrible birth defects. Silicone implants were widely used until they were found to leak, unleashing poisonous silicon atoms into the body. Faced with the seemingly unstoppable quest for youth, will we learn too late how dangerous these treatments may turn out to be?

Botox is a widely used drug that can be called the poster child for cosmetic intervention. But what, exactly, is this elixir of youth? Botox (full name OnabotulinumtoxinA) is a purified form of botulinum, a neuro­toxin that causes botulism. Since the 1970s it has been ­licensed to treat strabismus (the inability to straighten both eyes), migraines, blepharospasm (involuntary closing of the eyelids), upper motor neuron syndrome, excessive sweating and incontinence. In 1990, by total accident, it was discovered that it also helps smooth wrinkles.

The effect of Botox on facial lines is listed by the FDA as “temporary”, meaning that to maintain the effect, injections must be repeated every three to six months. Obviously, once the injections stop, the natural ageing process will restart, so patients may be unwittingly signing up for a lifetime of continued use. It’s no wonder that Allergan, the company that produces Botox, saw their second quarter profits for 2015 jump by a quarter to US$3.71 billion (Dh13.6bn).

The drug is sold in a dried state and must be diluted before being administered. With few formal guidelines on correct dilution, however, there does not appear to be a standard dose. In the 25 years that Botox has had cosmetic use, its adverse side effects have been listed as ranging from blurred vision and drooping eyelids, to difficulties in speaking, swallowing and even breathing. In some cases, it has been described as life-threatening.

With the known health implications, possible dosage variations, and with many future years of repeated use, can these injections really, truly be risk-free?