Don’t you love the way popular women’s magazines glorify, applaud, celebrate and exalt so-called ‘older’ female celebs for looking so amazingly ‘fresh’, fabulous and ageless, as if they had somehow done something extraordinarily worthy by simply looking glam when perhaps the people to whom we really ought to be paying tribute are their long-suffering plastic surgeons and dermatologists? On one page ‘maturing’ celebs like Demi Moore, Raquel Welch, Elle Macpherson and the like are held up as role models and praised for ageing (or basically not ageing, in fact apparently getting younger) so enviably, sometimes becoming better known for the work they’ve had done than any work they’ve done in recent times… while on the next page the Heidi Montags, Lindsay Lohans and Tara Reids are ridiculed and lambasted for having sought assistance from the same source.

Older celebs coo about beauty being all about being ‘beautiful on the inside’ and the how they owe everything you see to good genes and sunscreen, much as Sophia Loren used to say she owed everything to pasta: ‘Everything you see I owe to spaghetti…Beauty is how you feel inside, and it reflects in your eyes. It is not something physical.’

Without any hint of irony, Nicole Kidman has weighed in with ‘For an actor, facial expressions and emotions are really important. That’s why I’ll never have Botox. I’ve always been against that and seeing Botox on TV with all the swelling and pain put me off it anyway. The directors always allow actors with Botox but I just say. “No way, not for me”. Drinking lots of water, eating fruit and doing yoga is what keeps me looking young naturally. I swear by it. I also use creams with natural ingredients to make wrinkles less visible. Everybody should try these things rather than going the plastic route, which I just hate.’

To whatever extent women’s mags reflect what is preoccupying the psyche of women today, it would seem that botox, fillers and plastic surgery are the new obsession. Whereas once the big stories dominating women’s mags were about who had lost weight, gained weight or lost, gained, lost and re-ganied weight (alternating with articles about the latest fad diets and how to stick to them, followed by impossibly enticing recipes for the richest, lushest, most indulgent, fat-filled choc desserts complete with gastro-porn images of the luscious treats to salivate over and tempt you to break your newly established resolve to stick to the diet…) nowadays it is all about which Hollywood celeb is looking ‘fresh’, fabulous and ageless. The flawlessly airbrushed photo is accompanied by the obligatory quote about beauty being all about ‘being beautiful on the inside’ and crediting it all to good genes, sunscreen and perhaps the odd Wonderbra or Spanx girdle. Hmmm.

But just as some celebs are hailed and venerated for their chemical peel and filler-enhanced glow others are lambasted and ridiculed for overdoing it. Women are sent mixed messages: ‘Look fabulous like these ageless “natural beauties” Kylie and Nic (complete with a flat screen forehead)’, ‘Be a fabulously-forty-plus cougar like Demi Moore with a hot younger man to match’ and ‘You’re worth it’ but also ‘Oh look she’s so plastic, she can’t move her forehead, she’s gone too far, beauty is on the inside let’s just age gracefully and embrace our wrinkles’ ‘ followed by ‘Oh my god, she’s let herself go, she looks so old!’ Behind every cautionary tale is a moral judgement: ‘Look where vanity lands you’. Behind each laudatory tale is a tacit encouragement: ‘You’re worth it; this is what you too could achieve if you “took care of yourself”; live the dream – be forever young, at least on the outside’.

One way or another, with the proliferation of stories highlighting the rich and famous and their successes and skirmishes with such anti-ageing procedures, even if botox, fillers and the like aren’t in your skin, they are increasingly on your mind. More than ever before, women are contemplating such procedures and either crossing their fingers and taking the plunge or thinking twice before taking the Mark Twain approach to ageing (mind over matter – if you don’t mind it doesn’t matter). After all aren’t dim lighting, Vaseline lenses, foggy mirrors and most importantly of all a profoundly myopic partner a woman’s best beauty secrets?

Figures released in April 2010 by the Cosmetic Physician’s Society of Australia indicate that an estimated $448.5 million was spent in Australia on non-invasive and minimally invasive treatments to the year ending 31 March 2020, representing an increase of 30% on the previous year.

‘Australians’ appetite for cosmetic treatments continues to grow at a staggering rate and outstrips that of other countries, largely due to the greater skin damage and earlier ageing caused by our exposure to the sun’, says Dr Gabrielle Caswell, President of the CPSA. ‘As cosmetic medicine has become more commonplace and less of a social taboo, CPSA members have seen a steady increase in male patients…One of the primary drivers of growth in our profession is that patients are increasingly selecting ‘walk-in walk-out treatments that deliver great results. Many of the treatments, such as Botox and fillers, aren’t permanent so patients are more comfortable trying these procedures.’

Cosmetic dermatologist Dr Terence Poon (from the Neutral Bay Laser and Dermatology Clinic) says ‘These procedures are becoming more and more accepted and “mainstream”, hence more patients are having them performed. Basically all ages are choosing them, there is no one particular age group that stands out in my experience.’

Dr Lionel Chang, a highly experienced and respected Plastic and Reconstructive Surgeon in Sydney, says ‘The trend is towards office procedures with little or no down time to fit in with modern lifestyle. Botox is popular with all age groups and I would have thought that affluence and affordability may be the more important determining factors. Microdermabasion, skin-peels and night and day creams are popular with all age groups, as are skin bleaching agents such as hydroquinone. Lip augmentation with dermal fillers is popular with all age groups and especially influenced by film stars and advertising. Volume augmentation for cheeks, tear troughs and deep naso-labial folds are more popular with the advancing age group for obvious reasons, as there is a loss of volume in subcutaneous fat with ageing and replenishment restores that deficiency, having the reverse effect.’

While there are no definitive statistics on non-surgical anti-ageing procedures in Australia, US trends tend to be predictive of demand down under. Associate Professor Anand Deva, Head of Cosmetic, Plastic and Reconstructive Surgery at the Australian School of Advanced Medicine, Macquarie University says ‘The only statistics come from the American Society of Aesthetic Plastic Surgery (ASAPS) and Australia tends to be about ten years behind America. In the US, a total of 10 million procedures were performed in 2009 with 85% of these being non-surgical. Since 1997 there has been a 231% increase in non-surgical procedures. The top 5 were botox, hyaluronic acid (fillers), laser hair removal, microdermabrasion and chemical peel. Women represent 90% of the total.’

Data from ASAPS shows that Americans spent almost 10.5 billion dollars on cosmetic procedures in 2009. People aged 35-50 had the most procedures, making up 44% of the total; people aged 19-34 had 20% of the procedures; those aged 51-64 had 27%; age 65 and over had 7% and age 18 and younger had 2%. The most common procedures for age 18 and younger were laser hair removal, microdermabrasion, rhinoplasty, chemical peel and amazingly, Botulinum Toxin.

According to the ASAPS survey, 59% of women and 51% of men say they approve of cosmetic procedures, 37% of women and 19% of men say they would consider it for themselves now or in the future and 73% of women and 66% of men say they would not be embarrassed if people outside their family and close friends knew about it. 22% of women and 17% of men are more favourable towards cosmetic procedures as compared to 5 years ago.

So given that it seems that attitudinally we are increasingly erring towards ‘all systems go’ for these procedures, what do we need to know to navigate these botox-and-hyaluronic-acid-infested waters?

Professor Deva says ‘While everything does carry risk, things going wrong is still the minority. With botox the biggest risk is unwanted paralysis. You could get a droopy eyelid or more rarely if one of the eye muscles is affected you could get double vision. In some cases botox could unmask an underlying facial muscle weakness leading to unwanted or asymmetrical facial droop.’ On the plus side, being non-permanent means that at least these adverse effects are only temporary; on the down side, having a droopy eyelid or cheek for six months is literally no laughing matter.

With fillers, the nature of any adverse effects will depend on what type of filler is used. Professor Deva says ‘There’s been a move away from permanent fillers such as silicone fillers which had problems like scarring, infections and lumps. There are now a whole range of different fillers – hyaluronic acid, hydroxyapatite crystals, fillers that stimulate fibrosis – you need to take the marketing claims with a grain of salt and err towards the ones that have been used with good results over a period of time, that we have experience with. Complications don’t occur often and it varies from product to product but the main complications with fillers include irritation and inflammation, which can occur straight away; granulomatous reactions or foreign body irritation; allergic reactions which might manifest as redness, swelling and pain, and then of course the problem of putting the filler in the wrong spot which is more practitioner-dependent. The main thing is to not be too excessive, not cross that line, the line between where it looks natural versus unnatural; you need to look at the proportions.’

Dr Poon says ‘All treatments have risks such as hypo or hyperpigmentation and scarring. Generally the more invasive a procedure the greater the risks involved. Unfortunately with respect to IPLs and lasers there is little regulation as to their usage in some states which means that anyone can purchase and use them with little or no training. We have seen many patients who have had burns, scars and pigmentation changes as a result of treatments elsewhere.’

So with all these potential pitfalls, why do it? ‘Women love botox because it works,’ says Professor Deva. Dr Chang says ‘Botox is good for reducing dynamic wrinkles only but has no effect on static wrinkles. Dermal fillers injected superficially can diminish static wrinkles and injected deeply can replenish volume depletion such as with deep naso-labial folds or tear troughs. Chemical peels get rid of the dead skin cuticles to improve complexion. Laser serves the same function as chemical peels or dermabrasion but its advantage is the greater depth of penetration so it is both more aggressive and effective in ridding wrinkles and uneven pigmentation. IPL is supposed to have the same function as laser and because it is an intense light pulse has the whole spectrum of light at its disposal so can therefore treat a greater range of problems, but it’s a jack of all trades and master of none type of device that is more Mickey Mouse than anything else in my view.’

Dr Poon, whose practice in Neutral Bay is possibly one of the most specialised in laser treatment, says ‘Dyschromia (pigmentation changes) or sun damage can be treated by using a variety of different types of lasers such as vascular, pigment or ablative. While dynamic lines such as frown lines and crows feet require botox, static lines would require a treatment such as resurfacing or Fraxel laser.’

Clearly each practitioner will have slightly different expertise and preference for different technologies and procedures for different needs, but on the question of whether any of these procedures actually has any preventative effects, opinion seems fairly unanimous. ‘That’s what the advertisers would have you believe to sell products,’ says Dr Chang, ‘In my view, the use of creams, peels, microdermabrasion and so on – like daily showers, application of lipstick, nail polish, perming your hair and applying make-up – is part of the grooming exercise and has no value in terms of prevention. Chronological ageing cannot be stopped and its rate is determined by our genes. The way to prevent photo-ageing due to sun damage is by reducing sun baking and using sun block. You should also avoid such ageing factors as alcohol and cigarettes and lack of sleep, depression and anxiety and general lifestyle abuse.’ Dr Poon agrees ‘Non-surgical anti-ageing procedures like botox are not preventative. The only clinically proven treatments to prevent premature ageing are sun protection and topical retinoids.’

Professor Deva adds ‘I’ve had 20 year olds coming in wanting botox and I say to them “You don’t need it. What you need is to avoid sun between 10 and 4 and use a strong sunscreen.” For sunscreen to work you have to actually use it and reapply it every two hours. What causes ageing is genetics and sun damage. Treatments like botox are not preventative. We’ve proven that; in fact I was involved in a study that analysed botox dosages over time and this showed no significant variation.’

So how long do effects of treatments last and what happens if you stop? Will you age suddenly like the picture of Dorian Gray in fast forward? ‘Different procedures last different times, for example botox usually lasts on average 3-4 months, dermal fillers can last 9-12 months,’ says Dr Poon, ‘Laser treatments can provide an improvement in skin complexion and quality which can then be maintained by diligent sun protection. When you stop it is not so much that you age rapidly as you return to your predetermined appearance which could give the appearance of rapid ageing.’

Professor Deva says ‘If you stop, you age back to where you should be. Most people forget that ageing continues regardless of whether you use these treatments or not.’

So what drives our desire for these treatments? Is it a collective affliction with varying degrees of Dorian Gray Syndrome? This syndrome (alluding to Oscar Wilde’s famous novel The Picture of Dorian Gray) is defined by Wikipedia as ‘a cultural and societal phenomenon characterised by an excessive preoccupation with the individual’s own appearance accompanied by difficulties coping with the ageing process and with the requirements of maturation. Sufferers of Dorian Gray Syndrome are heavy users of cosmetic medical procedures and products in an attempt to preserve their youth.’

Dr Poon says ‘It is obviously driven by the importance our society places on appearance. Women are working longer and may feel the need to “keep up” with their younger colleagues.’

Professor Deva notes ‘There is so much societal pressure on women. I have often heard patients say they don’t want to become “invisible”. It is sometimes hardest for those who have all their lives been considered “good-looking”; when their looks deteriorate, they can’t cope psychologically and it becomes a big issue. In some cases there will be a tipping point: they’ll see a photo where they see obvious signs of ageing for the first time or they’ll look in the mirror and see their mum looking back. Whilst I think that we are very quick to judge people based on their facial appearance, women are sometimes their own worst critics.’

Women experiencing angst about ageing can be vulnerable and open to pressure. There is a lot of marketing out there with different practitioners – from highly qualified and experienced plastic surgeons, dermatologists and doctors to beauticians and other less qualified therapists – offering all sorts of services, making all kinds of claims and charging a range of fees. With so many practitioners essentially competing for the same dollar, not all of the advice and recommendations will necessarily be in the patient’s best interest. It’s vital that women do their homework and tease out the valid information and research from the pulsating sea of advertising, marketing and pushy salesmanship.

Professor Deva says ‘A personal recommendation is far better than relying on websites and advertising. Be prepared to ask questions about any advice you are given and don’t be afraid to challenge your practitioner.’ He suggests that some good questions to ask might include ‘How many of these procedures have you done?’ and ‘Can I look at some results or speak to other patients?’

The most important thing is to avoid feeling pressured but rather comfortable with your decisions, so Professor Deva recommends that you start small with the gentlest treatments such as a peel or some botox to wrinkle lines and then see whether you like it. Most of these procedures are temporary so the risk is relatively small. But bear in mind that there is only so far non-surgical treatments will go. ‘Older women or women with excess skin to eyelids and neck should consider surgical treatments,’ says Professor Deva, ‘I often see patients who have spent a fortune on botox and fillers but should have been advised to consider surgery.’