Impact on facial rejuvenation with dermatological preparations

REVIEW Clinical Interventions in Aging downloaded from https://www.dovepress.com/ by 61.101.6.100 on 14-Apr-2020 For personal use only. Impact on facial rejuvenation with dermatological preparations Patrick J Bowler Court House Clinics, London, UK Abstract: The treatment options for facial rejuvenation using dermatological, nonsurgical techniques have dramatically increased in the past 10 years. This follows the introduction of botulinum toxin and a variety of dermal fillers. The public interest in noninvasive treatments has changed the market beyond recognition with more physicians involved in providing services to satiate the demand. The impact on the public and medical profession is discussed. Keywords: facial aging, botulinum toxin, dermal fillers, combination therapy, cosmetic market Introduction Definition of facial rejuvenation This review is concerned with the concept of facial rejuvenation utilizing dermatological preparations in a nonsurgical approach. The combination of art and science now provides physicians with the capability to make the face appear more youthful. Facial aging combines intrinsic or genetically determined and extrinsic factors including sun exposure, smoking, diet, and general lifestyle. The features of the aging face are well described and include loss of skin elasticity, lines, wrinkles and dyspigmentation. The management options are focused on moderating and even reversing some of these changes The market There are few reliable statistics in the UK. A Mintel™ report1 stated the number of cosmetic surgery operations in the UK in value terms had increased from £450 million in 2005 to £900 million in 2007, a 100% increase over three years. In 2005, this included 230,000 nonsurgical procedures such as Botox™ and fillers which rose to 472,000 in 2007. In the UK, the British Association of Aesthetic Plastic Surgeons (BAAPS)2 produces reliable cosmetic surgery figures but they only relate to its members. It is not known what percentage they form of the total number of UK procedures. In 2007, they performed 32,453 procedures, 12.2% up on 2006. In the US, there are more reliable indicators produced by surgical audits from the American Society for Aesthetic Plastic Surgery (ASAPS) (Figure 1). There were almost 11.7 million cosmetic procedures in the US in 2007, of which 18% were surgical and 82% nonsurgical. From 1997 to 2007, surgical procedures increased by 114% and nonsurgical by 754%. However in the year 2006–2007 there was only a 2% overall increase. The dramatic increases occurred between 1997 and 2004 with a leveling off in the past four years (Figure 2). Women account for 91% of procedures, but significantly men had a year of increase of 17% from 2006. In nonsurgical care, the main procedures were: Botox™ 23%, dermal fillers 18%, and laser hair removal 14.6%. Correspondence: Patrick J Bowler Court House Clinics, 30 B Wimpole St, London, UK Tel +44 84 5555 5050 Email Influences in the market The main forces in the market place are the written media, TV shows, radio, and celebrity endorsement and peer pressure. There are many sociological and psychological factors Clinical Interventions in Aging 2009:4 81–89 © 2009 Bowler, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Powered by TCPDF (www.tcpdf.org) 81 Bowler Clinical Interventions in Aging downloaded from https://www.dovepress.com/ by 61.101.6.100 on 14-Apr-2020 For personal use only. Number of Procedures (in millions) 11,855,013 8,470,363 11,427,868 11,701,031 12 10 8,251,994 8 6,889,531 5,741,154 6 4,606,954 4 2,772,924 2,099,173 2 97 99 98 00 01 02 03 04 05 06 07 Figure 1 Cosmetic surgery (surgical and nonsurgical cosmetic procedures: totals). Copyright © 2008. American Society for Aesthetic Plastic Surgery. that influence individual choices, which are beyond the remit of this review. Magazines often include features on cosmetic work with prominence given to “celebrities” which may have an influence on public opinion. In the UK, television series such as “10 Years Younger” and “Extreme Makeover” have brought into the comfort of our homes vivid illustrations of how the worst possible cases can be transformed. Women and men are under pressure to appear youthful and healthy. High separation and divorce rates, peers, work and career prospects all have a significant influence. The increased public awareness and the Internet are probably the most important features driving the market forwards. Demand for nonsurgical care We are at present in the middle of a minimally invasive, no downtime, socially convenient, quick recovery, costconscious revolution. The public is seeking easy, pain-free methods of appearing youthful and healthy without the problems of invasive cosmetic surgery. This demand has had significant impact on: 1. Suppliers of dermatological preparations and other noninvasive technology. The pressure to produce new innovative products is high which can lead to premature launches 97 1,126,177 04 9,735,029 05 9,297,731 06 9,533,980 2 4 6 8 10 Figure 2 Nonsurgical cosmetic procedures (millions). Copyright © 2008. American Society for Aesthetic Plastic Surgery. 82 before there is an opportunity for adequate clinical assessment. Unfortunately in the EU the regulations relating to the introduction of fillers are not demanding. This has led to over 70 filler products being currently available which causes professional and public confusion. At this time in the US where there is a more vigorous regulatory approach, there are less then 10 approved fillers. There are some pharmaceutical companies involved, Allergan (Irvine, CA), the manufacturer of Botox™ being a major player. They have recently added fillers, skincare and breast implants to their portfolio. Others are sure to follow. 2. For the medical profession in the UK, there is now pressure to find high standard, independently validated training courses. The Royal Colleges in the UK have to recognize the public and professional interest and become more actively involved in education and training. 3. Governments need to understand the importance of regulation in order to elevate standards and ensure public safety. Differentiation of nonsurgical/surgical care Up to the 1980s, the famous and privileged were the only segments of the population considering cosmetic enhancement. The procedures were limited to surgery and deep acid peels. The introduction of wrinkle fillers and botulinum toxins heralded the onset of the nonsurgical era, providing low risk, effective but subtle enhancements. Present nonsurgical options Skin care at home 9,621,999 07 Powered by TCPDF (www.tcpdf.org) 11,368,052 Effective skin care is one of the most neglected areas in cosmetic medical practice. Although Doctors have been convinced of the benefits of sunscreens and moisturisers, the concept of ski (...truncated)