I will never forget the 22-year-old girl who came to my office with a long list of procedures she had already undergone: Fraxel (fractional laser), HIFU (lifting and modelling treatment), injections with platelet-rich plasma, botox and fillers. All for the purpose of rejuvenation
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Agnieszka sees someone’s nose first, then the rest of the face and silhouette. Before the surgery, she was careful not to show her profile in photos, and when she crossed the road, she covered her face with her hair.

She comes from a small town. At school, she wouldn’t hear any negative comments, but after school, on the street, she would. Sometimes she would be accosted by strangers. They would say: "Baba Yaga", "look at that nose", "go and have some surgery done". At the age of 16 she made her decision, at the age of thirty – she chose a surgeon.

She had a complete corrective surgery, including narrowing of the wings, her nose broken in four places, and her hump removed. The operation lasted about two hours under full anaesthesia. Then she wore a cast for a week. "When I looked in the mirror after taking it off, I saw myself as I should have always been. It was like coming home. As if that face before the surgery hadn’t been mine. I burst out crying and hugged the doctor. Plastic surgeons remove unnecessary things from people’s heads. Such treatments are often performed to heal the soul, not the body," she says.

Now Agnieszka is more likely to show her profile in photos than her front, and in clothing stores she likes changing rooms with double mirrors. "If something does not suit us in our appearance, we have two options: either accept it or correct it. Sometimes it is better to take the easier path and relieve the psyche," she says.

Appearance from the application

According to Dr Anna Galęba, PhD, MD, a specialist in aesthetic medicine, there are fewer and fewer people like Agnieszka who remove only one defect, something that has disturbed them throughout their lives. "Now someone will correct their nose, a few months later they will want to enlarge their breasts, then correct their figure," she says and adds that the same thing happens in aesthetic medicine. "When I started working in my profession fifteen years ago, patients came to the office less frequently and for a specific purpose. They wanted to improve the appearance of their skin or get rid of wrinkles, and they felt satisfaction fairly quickly. Now, after the procedure, they are also satisfied, but a month later they are looking for new things that they would like to change."

This tendency is most evident in women under the age of 30 and there are more and more such patients.

The expert says that they often come to her office with a clear concept in mind. "They show screenshots from Instagram or their photos modified with filters or a special application and say: ‘Please make me look like this.’ Sometimes they admit directly that they are tired of constantly editing photos," says Dr Anna Galęba. In her opinion, social media has significantly changed the perception of oneself and the approach to ageing. "For a large group of the patients who come to me, becoming 30 is something terrible. It is a kind of limit for them as becoming 70 is for me, I guess. I remember a 27-year-old girl who sat in my office, dissatisfied with her age and appearance. A moment earlier in the corridor she had passed an energetic patient in high heels. When I told her that person was 78, she didn’t believe me. And for me, the most striking was the contrast between them: a cheerful, lively elderly woman and a young one, totally devoid of energy."

A sense of empowerment

Alicja is 35 years old. She started using aesthetic medicine when she was around thirty. "By using it prophylactically, I can be a better version of myself. Botox eliminated wrinkles on the forehead and crow’s feet, skin booster under the eyes makes me look refreshed even after 12 hours of work, I smoothed my face with needle mesotherapy, and now I took care of my neck and décolleté to remove the side effects of many years of tanning in the solarium. I filled my mouth with hyaluronic acid, I also had lipolysis, i.e. reducing fat from the chin," she enumerates and admits that aesthetic medicine improves her well-being and increases her self-esteem. "I accept myself, but only after treatments. I don’t know how I would feel without them. I am a hairdresser, I see myself in the mirror all the time."

Julita, 33, also worked in the beauty industry when she started using aesthetic medicine.  At the age of 29, she decided to enlarge her lips. "I had no insecurities about them, they were normal, symmetrical, but I thought, ‘maybe they will look better?’ And they really did. Then I repeated the treatment until the effect was completely satisfactory to me." "After lips, it was time to use fillers. The tear trough, puppet lines, mouth corners, cheeks, chin," she lists. Then botox for crow’s feet and needle mesotherapy under the eyes. "When I put make-up on, I can’t conceal everything," says Julita and admits that she cannot accept ageing. "I try to prevent wrinkles from appearing. I want to look attractive as long as possible. I don’t understand the statement: ‘Grow old with dignity.’ I prefer to age nicely, aesthetically and consciously."

Kasia is 40 years old and has been using aesthetic medicine for the last three of those. She was afraid of the needle, pain and artificiality. During the first treatment – the application of fillers – she passed out. But she liked the effects. "I had the satisfaction of a kind of agency. Fighting nature: one-nill to me," she laughs. Today she also does needle mesotherapy and botox.

For Julita, aesthetic medicine is a form of self-care. "People who live in the cult of naturalness will say that every smile is beautiful because there is an emotion behind it. But I think it can be more beautiful."

Kasia admits that she had a lot of insecurities until she was 30. She had reservations about her face, especially her sad appearance, which she claims is a sign of ageing. "I am 40 years old, I feel 33. I could not accept what I saw in the mirror. My face was not what I had inside."

38-year-old Karolina thought about aesthetic medicine a year ago, before her birthday. "I didn’t have an idea for a gift, so I asked my loved ones to chip in and I figured I’d enlarge my lips," she says. A day later, she texted me: "The truth is, I wanted to regain my lost time, both physically and mentally. I have wasted over ten years of my life on unsuccessful relationships and addictions, and then on a return to normality and happiness. And I guess before that birthday it somehow overwhelmed me." Three months after doing her lips, she enlarged her breasts. "I’m not the kind of person who stands in front of the mirror and over-analyses my appearance, but I had a phase for correcting myself back then," she admits. She was also on fillers and mesotherapy, then she began to think about lifting threads (for the cheeks), but the doctor advised her not to use the latter. Karolina likes the fact that there is an immediate effect in aesthetic medicine. "With three children, I do not have time to sit at the beautician," she says.

Alicja readily reads about new treatments, and often hears about them from her clients in the hairdressing salon. "When I was thinking about lifting threads, my doctor said it was not for young girls. She also advised me against the fractional laser, and instead of injecting my cheeks with botox, she suggested retinol treatment," she says. Sometimes, during a visit at the office, Alicja asks what else she can have done. When there was nothing left to do on my face, I took care of the neck and décolleté. I suppose in a while I will start injecting my hands because they are showing signs of rapid ageing," she plans. She also straightened her teeth, because she believes that when you work in services, a nice smile is important.

More and more

Dr Anna Galęba does not state specific amounts because, for example, the price for filling the face depends on individual needs. As she says, "getting the patient straight", that is, a series of the first treatments that will help obtain the desired result, usually costs several thousand zlotys. Then they are repeated to maintain the effects. These are much lower amounts and less frequent visits to the office.  "Aesthetic medicine is more affordable today than it used to be. It is used not only by wealthy people and people of high social status," she emphasises.

Alicja: "If I have to choose between new shoes or botox, I will definitely choose the treatment. When I meet friends and they say, ‘You don’t change at all,’ it is the biggest compliment to me. If I started doing botox in my forties, it would have been too late. Then it would be obvious that I am using aesthetic medicine."

Today, women start reaching for this type of treatment much earlier than before. The people I talk to are not among the youngest patients. The first office visits are before the age of 30, but there are more extreme cases. "I will never forget the 22-year-old girl who came to my office with a long list of treatments she had already undergone: Fraxel (fractional laser), HIFU (lifting and modelling treatment), injections with platelet-rich plasma, botox and fillers. All for the purpose of rejuvenation. At this age, creams should be used," says Dr Anna Galęba. If she sees that someone does not need another treatment, she refuses to perform it, instead offering, for example, a chemical peel. Many patients do not accept this approach. They leave dissatisfied, slamming the door. Some come back after a few months, ready to listen to advice, some go elsewhere.

The desire to improve one’s appearance may be associated with less acceptance of the ageing process, but it is very often influenced by personal or professional circumstances.

"I have patients who have been left by their husbands. Some want to rejuvenate themselves, to look better than the new partner, or to get their ex back. Such people are often difficult to stop in the process of correcting themselves," says Dr Galęba. "I tell them, ‘If you hope that by improving your appearance you will change your life, you may feel very bitter when you don’t. Do it for yourself, not for others.’"

There are women who use aesthetic medicine treatments because of their friends. Either they want to look better than them or they told them that they should take care of themselves. "A 27-year-old girl came to see me. Beautiful. She decided that she had to do something with herself because she looked unattractive. Her friends kept telling her to do it. The first thing I told her was to change them. She saw wrinkles and imperfections that she did not have."

People also come to aesthetic medicine clinics for professional reasons. "Business people, including gentlemen, want to look serious, but younger. They usually use botox and fillers. These are treatments that can be performed even during a break at work because they only last a few minutes. For this reason, we sometimes call them lunchers," explains Dr Anna Galęba. "There are also a lot of teachers. They claim that students can say terrible things about their appearance. And now, when working online, there is a greater tendency to smooth wrinkles or even correct the face because during video meetings we see ourselves in the webcam and analyse defects all the time."

Hypocrisy

Kasia has recently changed her job after 13 years. It turned out that her new associates are much younger. "The fact that thanks to aesthetic medicine I do not look my age gives me confidence. Appearance is an important part of my image," she says. "When my colleagues found out how old I was, they were very surprised." Also in private circles, her younger appearance did not escape the attention of her friends. When she admitted to using aesthetic medicine, one seemed disgusted, but another admitted that she had had such treatments as well. Kasia is most outraged by hypocrisy. "When someone says, ‘You look nice,’ we often hear the answer, ‘Thanks, I run, eat healthy and sleep well.’ And I say: ‘Thank you, I’m trying very hard.’ If they asked, ‘What do you do to look like this?’ I would tell them the truth." According to Kasia, some women have a problem admitting to using aesthetic medicine because they do not want to be seen as stupid or give the impression that their beauty is important to them. "And it is and we lose it with age. It is unnecessarily infamous," she says. "Since we dye our hair, apply hybrids, and put on permanent make-up, why not say that we have had an injection that strengthens the appearance of the skin?"

Dr Anna Galęba: "Patients generally admit only to mesotherapy, platelet-rich plasma and lasers because it is accepted by society. And I repeat: you cannot be 40 years old and have no wrinkles without taking advantage of the full range of aesthetic medicine treatments."

According to Alicja, many people have a negative attitude to this type of treatment because the only thing they associate with are the inflated lips or buttocks of Instagram girls. "Some friends ask why I use botox because wrinkles are OK. Others say that at the age of 50-60, I will look bad. And then I laugh under my breath, ‘Then we’ll see how we look when we stand next to one another,’" she says. When someone told her at a wedding that she looked great, she said, "Thank you, I have a good doctor." "I’m not going to wait until I’m fifty to look after myself. I want to be pretty now and feel good about myself. If I could not benefit from aesthetic medicine treatments, I would wear large-brimmed hats or a peaked cap and glasses."

Julita says: "We were sitting at a friend’s house, drinking coffee and talking about what treatment she would like do. I had already had lip filler done. My friend said that she was also thinking about enlargement. A friend of mine, who did not even put on make-up and adhered to the principle that everything must remain natural, asked if we wanted to be plastics. We answered ‘yes,’ and that’s where the conversation ended. And then it turned out that the one who was criticising us had also had her mouth filled. And she had persuaded her mother to also have this procedure done."

"The environment, social status and size of the city do not matter – everyone uses aesthetic medicine treatments," says Dr Anna Galęba. "In smaller towns people just tend to conceal it. They don’t want their neighbours, colleagues or even the closest ones to know."

Magnifying mirror

All the people I talk to admit that you can get addicted to good looks. "When I see that an effect fades away, that the skin returns to its original state, I want to go to the doctor right away. But it is not only in my head because when I ask people from the closest circle what I look like, they also admit that it was better after the surgery," emphasises Julita. We talk almost a year since her last visit to an aesthetic medicine clinic. "Now I feel frustrated. In the morning, when I put my make-up on, I already feel worse. I can get enough sleep and still look tired. After the fillers, my face looks great, which translates into a good mood and relationships with others. I am more open, I smile more."

Kasia: "I have botox for three months, but I do not have to make an appointment to repeat the procedure right away. I did the second one after a year. I treat it a bit like a banquet mask. When there is a big party, I don’t go to the hairdresser, I don’t wear my make-up, but I invest in shoes, a new dress and my face." She emphasises that the most important thing for her is to look relaxed, younger than on record. However, she has set herself limits and does not want to change too much. "I used to want to have nose surgery, but I changed my mind because it wouldn’t have been me."

Alicja would not be reluctant to interfere more strongly. "I don’t mind plastic surgery. If my eyelids start to droop, I will definitely lift them up. I would also consider my breasts because now I am on diet and I do not know what they will look like in some time," she says. She’s already gone through one plastic surgery anyway. She corrected her appendix scar. "It was terrible, it started and ended with a hole. Even though it was tucked under my clothes, I could see it all the time. The new one is definitely better."

Julita also does not rule out that she will expand her range of treatments. "Plastic surgery by all means, but so far my financial situation does not allow it. I would like to do abdominal liposuction because I have the kind of build with which no diet or exercise works," she admits. "It’s not a fad, I think only plastic surgery can help me."

Dr Anna Galęba admits that when patients change and get prettier, they want more and more. She often has to stop them. "I think that you can go too far with treatments just like with losing weight. People with anorexia do not see that they are getting thinner. Here, successive treatments are used and patients do not have the impression that they are overdoing it. That is why I always tell them that I am on guard."

She always lights the red lamp when women talk about a magnifying mirror. "They sometimes have big mirrors in their purses. They often look at themselves in them while talking to me."

The expert claims that at least 10 percent of her patients suffer from dysmorphophobia, i.e. a disturbance in the perception of one’s own body. It is related to the fear of beauty imperfections, often not seen by others. People with dysmorphophobia will always find something to improve. "Often, dysmorphophobia develops over time. The patients undergo subsequent treatments and although they look better and better, their satisfaction decreases. It mainly affects young girls up to the age of 30. The older ones, in their fifties, can also go too far sometimes, but it is easier to stop them, to explain something to them. Younger ones are more likely to be offended or look for another specialist to perform the procedure they want." Dr Anna Galęba admits, however, that she once made a wrong diagnosis. She did not want to see a patient, but instead sent her to a psychologist because she was convinced that she had dysmorphophobia, and with time it turned out that the reason for her unnatural appearance was something completely different. "She looked very bad. She was 72 and had too much of everything. It turned out that she was very wealthy and someone had taken advantage of it. She sat down in the armchair and said: ‘Please do what you feel is right.’ This ended up in very large sums of money. It took me a few months to change her appearance, but it was worth it," says Dr Anna Galęba. There are many more cases in which women with exaggerated faces end up in her office. They are mostly young girls. "The worst thing is that those who overdo it usually don’t want to undo the effects at all. They do not see that they look bad and unnatural."

Alicja says she may accept a wrinkle in the future. "When I am 60 years old, I will not be smooth as glass. But today, wrinkles scare me."

Dr Anna Galęba: "When I ask young patients who are constantly looking for new treatments what they will do when they are 60, they reply that they will perform a full face lift at a plastic surgeon or that they are not thinking about it yet because then aesthetic medicine will definitely have new things to offer."

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