What is the heart and soul of cosmetic dermatology? A personal view

I remember the days, when cosmetic dermatology/aesthetic dermatology has been considered as a kind of an academic beautician saloon, not really medicine at all – in particular at universities. There was a severe concern that cosmetic dermatology may harm dermatology as a medical subspecialty. Cosmetic dermatology was not any part of young doctors’ curriculum. Interestingly, this has obviously never been the same for aesthetic surgery.

Cosmetic dermatology/aesthetic dermatology has developed from the infancy of its early days. There are now specific guidelines for procedures and for management of possible adverse events. There are prospective randomized trials and meta-analyses. Cosmetic dermatology uses scientific methods and helps to provide a better understanding in such fundamental fields as ageing, anatomy, wound repair, and quality of life.

For a beginner in cosmetic dermatology, it is obvious that a deep knowledge of anatomy, physiology, pharmacology, and dermatology is essential to start a successful and solid work. Cosmetic dermatology is not an excuse for those who do not know the basics and it should never be.

Structured education and workshops provide a lot of benefit on the steps to a satisfying engagement with cosmetic dermatology. Serious medical journals offer a continuous training opportunity and a platform for discussion and exchange of ideas.

Despite all progress – new techniques, formulations, drugs – we should remember our ancestors. Cosmetics have been done since several thousand years of mankind. This “art decoratoria” is used until recent times. The renaissance surgeons in Italy and Switzerland developed the “ars reparatoria” – techniques to reconstruct body parts and function to gain happiness. The tradition in Indian medicine goes back much further. Nowadays we use fillers and botulinum toxin to correct facial palsy.

The ancestors recommended not to overcorrect or to perform unnecessary procedures since it would not lead to happiness but grief. Some of the overcorrections we experience with VIPs, celebrities and sometimes ordinary people are an example of a wrong direction and complete misunderstanding of cosmetic medicine.

What does heart and soul mean? Collin’s Dictionary defines it like that: ”If you put your heart and soul into something, you do it with a great deal of enthusiasm and energy.”

In my understanding, the best definition of a scientific, serious, and solid cosmetic/aesthetic dermatology is preventive medicine. Yes, we want to and aim to prevent a premature ageing. Here are some examples of daily practice: Regular use of sun-protection delays not only exogenous cutaneous ageing but helps to reduce actinic keratoses and keratinous skin cancer. Treatment of facial volume loss, wrinkles and furrows by hyaluronic acid fillers seems to be the first successful clinical use of adipose tissue-derived stem cells in dermatology. Laser technology and micro-needling significantly improve penetration of drugs in dermatology. Correction of frown lines by botulinum toxin reduces depression moods.

Thereby, we are able to reduce skin cancer, secure a healthy skin, and improve self-esteem and quality of life. That is how cosmetic/aesthetic dermatology should work.