Botox is a truly effective treatment to prevent and reduce the appearance of lines and wrinkles. However, as we have seen on numerous celebrities it can also leave you unattractively ‘frozen faced’. Likewise, fillers are an exceptional way to bring a plump youthfulness back into the face… or they can leave you with ‘trout pout’ or a puffy 'chipmunk' face. Je t’aime chats to Dr Teresa Cattin to find out more about just what’s going wrong with appearance medicine...

I first met Teresa Cattin at a Juvederm launch and was impressed with her vast knowledge on the subject of appearance medicine. At the event, she showed various pictures of celebrities and talked about what they could do and what they should not have done. It was a relief to hear someone else admit that many women are crossing the line with appearance medicine. And what better person to discuss this than someone who really knows what she is talking about. Teresa Cattin is a physician who trains other doctors in Botox techniques in both New Zealand and Australia and has been instrumental in the development of cosmetic techniques using Botox. Her belief is that a ‘softly softly’ approach should be taken with appearance medicine.

When we catch up to discuss the topic, she explains that she is most fond of the French appearance medicine techniques. “The French have a different take on beauty. To them it is not about wrinkle-free skin, but rather the French appearance medicine techniques aim to target selected lines with small doses, not stop movement in entire areas of the face. The result is a softer look and a face that retains its character and natural movement. True beauty is about harmony and balance, not about attempting to look younger.”

It’s refreshing to hear someone say these words. We all know the social pressure for women to look ‘young and younger’. It’s a pressure that doesn’t seem to cross the genders very fairly. Hollywood’s heroes: Sean Connery, Bruce Willis and Mel Gibson - to name just a few - have long been wearing their thinning hair and deep set lines like a badge of honour. Like most women, I get frustrated by this pressure to look young, but at the same time, I want to look as good as I feel. I’d like to keep my face a reflection of the youth I feel inside. However, I know that at some point in my future, I will likely feel like a 21-year-old trapped inside a 60-year-old’s body – and I concede, it’s not a day that I look forward to.

As a social experiment, I took my very healthy - and just slightly fine-lined 31-year-old face to an appearance medicine clinic. A nurse there asked me to smile and then advised that, “Your crows feet area could certainly take a full dose – that would be 22 units of Botox.”

When I told Dr Teresa Cattin the outcome of my trip to an appearance medicine clinic, she was not impressed that I had been recommended a full dose. “No! You would look completely frozen; we don’t want you to end up looking like Nicole Kidman!”

Teresa has a point, I wouldn’t mind ‘looking’ like Nicole Kidman - she’s a beautiful woman; but there’s a whole lot more to her frozen, unmoving features than just an obsessive use of sunscreen as she claims. If I may be so bold, I now feel that her face, while ‘pretty’ is also somewhat devoid of character and expression. That’s not attractive to me either.

Teresa’s recommendation was what she calls a ‘baby dose’ of Botox (just 10 units – less than half the former recommendation). The theory is that instead of eradicating facial movement, this softens the lines so the face appears less ‘crinkly’ but still has normal movement and the joys of expression. Fortunately, Teresa’s experience in the industry has proved that with an artful use of Botox, the face can look fresher and more rested and she knows the types of comments that her clients get after a treatment. “People you know should not ask if you have had Botox, but rather, they might enquire as to whether you have had your hair done or just come back from a relaxing holiday.”

Another aspect of facial ageing to consider is the lack of volume in our faces. Despite billions of dollars spent on the skincare industry and a multitude of anti-wrinkle potions and treatments on the market the fact is that as we age our lips thin, the cheeks deflate and the area under our eyes hollows. There’s no cream in the world that can provide a satisfactory ‘plump’ and if it can plump at all, it does so by causing an irritation to the skin of which swelling is the reaction. If you've ever wondered, this is how lip plumpers work. Referring again to European theories on facial ageing, Teresa explains that the French believe this volume loss has more effect on our appearance than the development of wrinkles or lines. Their approach to enhancing the face is to carefully replace volume in areas it has been depleted, rather than attempting to eradicate lines. This is done using ‘new generation’ dermal fillers such as Voluma and Juvéderm. Juvéderm has been a firm favourite amongst appearance medicine doctors in Europe for many years and has proved very effective at filling in hollows and reducing unwanted “dark circles” under the eyes as well as plumping lips that have become thinner with age. Again, Teresa emphasises that this should be done in proportion to your face so that the result is balanced and natural. “As we age, our cheeks lose their plumpness and the skin starts to drag downwards and sag. A touch of Voluma is marvelous for adding a little padding to the cheeks and enhancing the natural cheek bone.” Like Botox, over-use of the product has its downfall; in this case it will result in a plump face and undefined features. Sure, the skin might appear to be healthy and full, but something about these middle-aged ‘baby faces’ looks off. Yes, Madonna, I’m sorry to say that you spring to mind right now.

Madonna and Nicole are far from alone. Many celebrities that have taken youthfulness via appearance medicine too far. Lisa Rhinna is known for her ‘trout pout’, Belinda Carlyle has a very taut over-Botoxed shiny forehead and far too plump cheeks. Sadly, even Kylie Minogue is beginning to look a little odd; at 40-something and with over-arched brows and not a single line on her face, it’s obvious that more than a little something is going on.

I don’t intend to criticise these women. Celebrities might live in a luxury world, but it comes at a cost. That cost is a huge amount of industry pressure to retain their youth. That is a sad reality of the world that we - and more particularly ‘they’ live in. My point is that despite these women giving appearance medicine a ‘bad name’ it doesn't have to be that way. Though numerous celebrities are looking swollen and frozen - ‘plastic women’ is how my husband describes them - the truth is with the right techniques you can wear appearance medicine well.

If you've ever had a girlie dinner party conversation on the topic, you'll know that injectables are a dividing topic among women. While some of my friends freely admit they love a bit of Botox or plumping, other women I know say that they are disgusted by the concept. I find this odd considering the huge number of chemicals (most not tested for safety, many that are known to be unsafe and some proven to be carcinogens) that these very same women will happily slather across their face to try to maintain youthful skin. Is it more ‘noble’ to use an ‘anti-wrinkle cream’ as opposed to an ‘injectable’? Why is the use of topical potions considered to be ‘ageing gracefully’ and appearance medicine is not? I believe it is safe to say that the heavy-handedness of celebrity doctors has certainly done some damage to the reputation of appearance medicine.

What is right for you?
The decision to do anything at all with your face is not something you should take lightly. If you are looking at your options for slowing the skin’s ageing process with appearance medicine, a highly trained specialist should be your first port of call. Be honest with them and be realistic about your expectations. Do not, I repeat – DO NOT - attend drunken Botox parties with your girlfriends. Choose a doctor who respects a 'less is more' approach or a ‘French technique’ of appearance medicine and your face (and no doubt your partner!) will thank you. Don’t be afraid to shop around until you find a specialist you feel really comfortable with and make sure they talk you through your options, rather than rush through your appointment in an effort to get bums on seats.

As for all the Hollywood princesses that just keep going back for more to the point where they are starting to look odd? Well, it’s hard to know exactly what causes a woman to always want ‘more’. The Los Angeles prevalence of 'tanorexia' and ridiculous implants is nothing new, and celebrities like Heidi Montag highlight this in every magazine we open. Perhaps it is because women tend to view ourselves through such critical and non-loving eyes and are so accustomed to a false perception of ‘reality’ such as air-brushed models, that we are on an unrealistic drive to rewind the clock or to look like the ultimate plastic woman ‘Barbie’.

For me, I know that ageing is something that I will be tackling both emotionally and physically. On those days when I feel at peace with myself, ageing ‘gracefully’ means staying in love, keeping busy doing things that make me happy, precious days with family and friends and quality time ‘being’ on my own. It means yoga, long walks on the beach, eating well, laughing lots and worrying less. And maybe, just maybe, one day it might mean a little filler here and a little Botox there – but just a baby dose thanks!

Article by Je t’aime Hayr, with thanks to Dr Teresa Cattin of Faceworks

Have you had botox or fillers? How was your experience? Share your comment below...