While I am a massive advocate for high-quality skincare to preserve and protect your natural features, I have not shied away from cosmetic treatments. Over the years I have had a major plastic surgery to regular cosmetic work like botox and fillers.
I am not alone. In 2017 Australians spent $1 billion on cosmetic surgery with the demand for these treatments only increasing since.
Done right, cosmetic treatments can be an incredible way to preserve your beauty, minimise signs of ageing or address a long-standing concern. That is not to encourage anyone to do it, this is not a fix for self-esteem issues and should be carefully considered before you decide to proceed. Always, always do your research before deciding to get anything done.
With this in mind, I sat down with a leading cosmetic doctor, Dr. Aaron Stanes to ask some common questions about treatments.
Beauty Space: Dr. Aaron, could you start by telling us a bit about what made you get into the cosmetic industry?
Dr. Aaron Stanes: I’ve always been interested in cosmetic medicine, even as a medical student. Having experienced my own insecurities growing up, I knew first-hand how feeling self-conscious about your own appearance can be very challenging to manage. As I learned more about cosmetic medicine and plastic surgery, I became fascinated at how very simple and safe medical procedures could be used to change the appearance of someone’s face and body, without making them look significantly different. I started attending training courses and reading research papers on the different treatments available, and learning about the industry. It all came together when I underwent my own cosmetic treatment – I had dermal filler in my midface as my mum would always (innocently) comment on how tired I looked. The results were truly amazing, I actually couldn’t believe how such a small change could make such a difference. I mean, no one could tell I’d had anything done, but the comments about looking tired just stopped.
Eventually, I made the leap from traditional in-hospital medicine into full-time cosmetic medicine. This was a huge decision, as you really are on your own, and not protected in the same way you are in a hospital. I attended as many courses as I could, networked like crazy, read a huge number of research papers, you name it, I did it. I trained overseas, and there I picked up some really great knowledge and skills, and then eventually started training others in things like Botox, fillers and thread lifts. It definitely hasn’t been easy, and there have been times when things weren’t looking like I was going to continue – building a reputation and having people come in for treatments is tough, especially given I wasn’t working anywhere else at the time.
Gradually, I carved out my own niche and have been fortunate enough for the hard work (I mean working almost every day in that 8 year period, even on vacation) to be finally starting to pay off. I’ve really come to enjoy the way I work, and the autonomy and flexibility I have – my work is completely on my own terms, but by the same token, the buck also stops with me, although I find this empowering. Now I really take pride in not only offering some really amazing treatments, but in helping other doctors and nurses learn about the industry, and also in helping people on their own cosmetic journey being able to learn about the treatments, how they work, and what can be achieved.
Unfortunately, there are many practitioners in this space that can be quite opportunistic, and often don’t even realise they are doing this. It takes a huge amount of work and dedication to truly appreciate cosmetic medicine, and what it can do for someone’s self-esteem.
What are some of the most common procedures you do?
My practice has become highly specialised in a variety of great non-surgical and minimally invasive cosmetic treatments. I really try to be realistic about what is achievable for the people that I consult, and so it follows that the treatments I predominantly perform and recommend have very high satisfaction rates. I’m less interested in fads and beauty trends, and more focused on helping people feel confident by addressing long-standing insecurities they hold, and by working towards elegant results based on timeless concepts of what is attractive.
The most common treatment I perform is a non-surgical nose job – essentially using dermal filler injections to improve the appearance of the nose. The results consistently blow me away.
It is so satisfying to be able to completely take away someone’s life-long insecurity in ten minutes. It truly makes my job very rewarding.
I also perform a lot of treatments that balance and harmonise the face, for both men and women. Things like total face rejuvenation and side profile augmentations. Or focussing on general areas – the male lower face, chin and jawline, as an example. Having a deep understanding of how the face is perceived as a whole really allows you to get amazing results, but without making the person look like someone else.
When I appraise someone’s appearance, my thoughts are essentially about how we can make this person look like the best version of themselves, without changing the essence of who they are. Being equipped in all types of cosmetic treatments in all areas of the face, I can really provide something truly personalised. I find that many people come to me worried they will look too different – they see the classic overdone look on Instagram and in public and are adamant that they don’t want this. A big part of my job is explaining what these treatments can really do, and that they can really be tailored to almost any aesthetic goal, as long as it is safe. My best advice is to find a practitioner who aligns with your idea of what is attractive, then your expectations will be aligned, and you will have a higher chance of achieving a great result. I also perform a number of treatments for the body, such as liposuction and injectable penis enlargements with dermal fillers.
You see a lot of male patients. What are the most common treatments they are seeing you for? Are there nuances of treating a male vs female?
I see a lot of men for cosmetic treatments. Even over the past 12 months, more and more guys are realising that these cosmetic treatments are simply just another element of the self-care they’ve started exploring (such as good skincare and grooming). Guys like to look after themselves! Understanding the male face and how to treat it is not well taught. When practitioners learn injectables, we almost always have female models, and a feminine face is very different to a masculine one. I’ve seen terrible results in men done by injectors who simply lack the experience in working with males, and aren’t aware that they lack it. A male face is generally more square, and more angular, and we primarily add bulk to the lower face, whereas in females, the face tends to be softer, more curved, and more focused around the cheek contour.
The treatments I perform most commonly for men are chin and jawline fillers, to give a squarer, more masculine face, and penis enlargements with fillers. This male enlargement procedure is absolutely exploding in popularity. I treat guys from all different backgrounds, but one thing they often share is that the reason for having an enlargement is very much a personal one. Almost similar in a way to women having breast augmentation. Traditional penis enlargement surgery is very invasive. Using fillers, we can get significant increases in the girth, and slight increases in the soft length with results lasting up to 5 years for some guys. The actual treatment has almost no discomfort and can be done in around 20 minutes, with essentially no downtime, and no stitches. There’s only a handful of trained doctors in Australia offering this because it is a very advanced procedure. However, when done properly, it’s super safe, consistent and reliable. The main advantage is that the results can be adjusted if there are any concerns, as the filler we use down there is immediately reversible.
What advice would you give for anyone who wants to get a cosmetic procedure but is scared of the pain?
Most cosmetic treatments have very little discomfort when done properly. A big part of performing a really good treatment also involves the experience. People are awake while these treatments are done, so I believe it is critical to know how to minimise discomfort and pain, and I don’t believe practitioners should just fall back on piling on numbing cream or using local anaesthetic injections unless really necessary. Lazy or overly aggressive techniques are simply not necessary, and just make procedures more painful, and have higher rates of bad swelling and bruising. It’s amazing what simply being gentle when you treat someone can do.
Lip fillers are a great example. Most people go in for lip fillers expecting it to be painful, and I’ve seen enough injectors work to know why. Oily and irritating number cream is often applied haphazardly, or numbing injections are done to cover for poor technique. I’m by no means saying these treatments are painless, but when you are gentle, the far majority of treatments are very tolerable. I cannot remember the last time I used topical numbing cream or local anaesthetic injections for dermal fillers, including lip fillers, and everyone is surprised at how comfortable the treatment is.
Pain is important, and it gives me feedback. If you are completely numb to compensate for an aggressive and lazy technique, this valuable feedback isn’t there. If someone has a sudden spike in pain, it’s a sign that I need to stop and assess what I am doing. It guides me on staying away from areas that I shouldn’t inject and assessing the situation to ensure nothing has gone wrong. The main treatments that require anaesthetic are fat dissolving and thread lifts, as no matter how gentle you are with these, they are painful without it. However, for simple anti-wrinkle injections and dermal fillers, pain is, with very very rare exceptions, very minimal.
What is the best age to start getting cosmetic procedures?
The minimum age that the far majority of practitioners are willing to treat is 18. This aside, there is no best age to start, as these treatments are a want, not a need. They aren’t a necessity, and not for everyone. Deciding to have treatment is a very personal decision, and there are many different considerations people have when coming to the decision to undergo any treatment. Generally speaking, if you want to look at the ideal time to start, you need to categorise the treatments. Broadly, treatments can either be of the augmentation type, where we change features to look different to how they ever did, or anti-ageing, where we preserve or work to restore features to how they previously looked.
Augmentation procedures should be performed when you consider the benefit of potentially improving your confidence and self-esteem to outweigh the expense, and risk, including the possibility of not achieving a result you are happy with.
This is one of the most fundamental considerations in all cosmetic treatments – a result and your satisfaction under no circumstance can be guaranteed, and you should be extremely suspicious of any clinic that tells you otherwise.
The reason guarantees are not possible is because there are variables that cannot be eliminated in every treatment – such as chance, variability of anatomy, and differences in tissue quality and how the body will react to the product. An experienced practitioner can only minimise, not eliminate this variability, increasing the probability of a satisfying and great result.
In contrast to augmentation procedures, anti-ageing procedures should be commenced as early as possible, as long as you are over 18, to achieve the best long term results. Preventing age-related changes to your appearance is far easier than reversing them. A simple way I ask my patients to think about anti-ageing is to imagine two versions of themselves. One has consistent and regular anti-ageing treatments such as Botox, conservative fillers to support the facial tissue, and skincare with dermal therapy. The other does nothing, but in 20 years decides to undergo intensive rejuvenation treatment. The first version will look far better and more natural, but the second will see a dramatic improvement that the first never had. The second will also need to undergo more invasive procedures with higher risk and more downtime, which includes things like time off work. The best option is to be conservative, minimise risk and variability as much as possible, and forgo the short term satisfaction of a dramatic improvement, to gain the long term benefit of graceful ageing.
As a general rule, the best approach to anti-ageing should include good active skincare at home, sun protection, avoiding cigarette smoke, and being active with regular exercise and a healthy diet, plus plenty of water. Beyond this, anti-wrinkle injections 2-4 times per year, radiofrequency skin needling annually, and skin peels every 6 or so months will keep everything tight, smooth and radiant. From there, dermal fillers can be used judiciously to preserve volume in strategic areas from which it is commonly lost (typically around the midface), although it is imperative not to overuse fillers. Lifting threads can be used to slow down sagging skin. And fat reduction treatments can be used to reduce heavy tissues that accelerate facial sagging through their sheer weight. Things like fillers, threads and fat reduction should be done very infrequently, anywhere between once every 2-5 or more years, depending on the specific treatment. This aside, the old adage, better late than never rings true for anti-ageing treatments. They simply must be prioritised according to your budget, risk and downtime tolerance, and expectations for results.
Who is not a good candidate for cosmetic procedures?
Almost anyone can be a candidate for a cosmetic procedure. However, there are some very key exceptions. The first is those with significant underlying psychological stressors, both short and long term, should not have treatments without very careful consideration. This cohort tends to be very vulnerable, and any practitioner who consults such a person should be very comprehensive in their assessment. Often, a treatment plan can be developed, but if there are added stressors, I often recommend that extra time is taken to consider the options before proceeding. There is no harm in waiting a few weeks so the person can process things before committing to a decision. When it comes to treating such people, we should always be very conservative. A balance must be found between what constitutes a legitimate cosmetic concern that is reasonable to treat, and where certain stressors are manifesting in how one feels about their appearance. The latter is very unlikely to feel better after a treatment and should be encouraged to prioritise their mental wellbeing with help from trained professionals. Cosmetic treatments are somewhat redundant if they do not make you feel better, and if the cause of your feelings is not directly related to your appearance, changing your appearance is not addressing the problem.
The second group who are not good candidates are those with unrealistic expectations of what can be achieved. If someone comes in expecting to look dramatically different, or with expectations of an absolutely perfect result, this is a big red flag. Perfection is simply not attainable, and cosmetic treatments cannot do everything. High expectations equal high likelihood of a disappointing result. This makes sense when contrasted with people who come in, and volunteer that they would be happy with any improvement. Such people are almost always universally satisfied. The process and the result will be the same, the expectation is what dictates how you feel about the outcome. And as I’ve said previously, if the probability of you feeling happy with your outcome is low (because either you have other reasons for feeling down, or because your expectations are too high), then you should not undergo any cosmetic treatment.
What’s the difference between botox and filler? How often would I need to get these treatments?
Botox is the trade name of one type of botulinum toxin, and is commonly referred to as anti-wrinkle treatment or injections. The two other types available in Australia are Dysport and Xeomin, although they all essentially do the same thing in the same way. Botulinum toxin works on nerve endings, interrupting the communication they have with their target – typically muscles, and sweat, oil and salivary glands.
Interrupting this communication stops the target from working. With muscles, you get a reduction in strength with one of two results. Firstly, you can get a softening of wrinkles on the face or male intimate area (depending on where you treat) as muscle contraction in these areas normally bunches the skin, forming wrinkles. Results with this effect generally last from 2-5 months, with the peak effect at the two-week mark. Longevity simply depends on how much you inject, relative to the size of the muscle you want to relax. The more you inject, the longer it will last, but the weaker the muscle will become. Wrinkle reduction results need to consider longevity and effect, if you put too much, you will look completely frozen, at least in the initial stages.
Secondly, relaxing large muscles can cause them to reduce in size, similar to when a bodybuilder stops lifting weights. This can be used to reduce muscle bulk in the jawline masseter muscle, often called facial or jawline slimming, and in the calves, for those who want slimmer, less muscular looking legs. Treating the masseter can also improve the symptoms of teeth grinding, jawline clenching and TMJ pain. The muscle shrinking effect generally take longer to be seen, up to 6 weeks, but can last longer, from 6-9 months.
Generally speaking, wrinkle reduction can be done every 3-6 months depending on the longevity, and how often you want to do it. Muscle slimming can be done every 6-12 months, but we often find that being consistent in maintenance treatments allows us to space treatments further apart each time, obviously up to a limit. Botulinum toxin can also reduce and prevent sweating, and control oil production in the skin, and this is a very popular reason why many men and women have this treatment. Anti-sweat treatment can be done almost anywhere, including under the arms, and on the hands, with results lasting generally from 6-12 months.
Dermal filler on the other hand is what we call a volumiser. This simply means that wherever the filler is injected will increase in volume and therefore size. You can use the volumising properties of filler to restore volume lost with age or weight loss, or to augment facial features by changing their shape.
The most common type of dermal filler used in Australia is hyaluronic acid-based dermal fillers. These are reversible with a dissolving solution that can be injected. While most manufacturers claim that hyaluronic acid dermal fillers are broken down by the body over 6-24 months, new research is showing us that the results can last longer than five years. Often, people either continue ageing over the top of their filler thinking it has worn off, or want unsustainable pronounced results. Those that want dramatic results use high quantities, putting the facial tissue under tension. This tension then slowly leads to the migration of the filler to other areas of the face, which is perceived by the person as the filler wearing off, so they go and get more, making the problem worse.
Understanding filler metabolism, migration and simple facial tissue dynamics is just so important in setting expectations into what is achievable and sustainable. There are other types of dermal fillers, known as collagen stimulators, that have a much more predictable longevity, plus they have the added benefit of stimulating the production of collagen, the most important structural protein in the face that gives the tissue youthful quality and fullness. The downside of these fillers is that despite being temporary, lasting on average from 2-5 years depending on the type, they cannot be reversed. So if you don’t like the result, or if there is a complication, it may be a much bigger problem to manage. It is critical that when using collagen-stimulating dermal fillers, that the treatment is done conservatively. You can always add more, but you cannot take away.
For someone getting lip filler for the first time. How many mls would you typically recommend?
Hyaluronic acid lip fillers come in syringes of varying size – anywhere from 0.6 to 1.2mls. Retail medicine and aggressive marketing have led to industry standard to push two options, 0.5ml or 1ml lip filler treatments. In reality, it is not common that someone will need exactly 0.5 or 1ml. The total volume can vary so much depending on a few things.
Firstly, you need to consider how big your lips are to start. Small lips need less volume to get the same relative increase compared to larger lips. Secondly, the tissue quality is important. Denser tissue may need more volume to fill it out compared to loose lip tissue. Thirdly, is the treatment goal. How do you want your lips? Finally, is what is achievable. The lips can only fit so much filler. Sure, once at volume capacity you can inject more, but as I have outlined previously, this puts the tissue under tension, and will always lead to gradual migration with distortion of the upper lip.
Generally speaking, a good rule of thumb is to never inject more than 1ml per session. Most people having lip fillers for the first time are worried this will be too much, however it rarely is. The most common volume I inject for someone having lip filler for the first time is between 0.7 and 0.8mls, and this includes framing the lips, as in injecting the areas around them to blend them in so they match the face they sit upon. After your lip filler injections, you should let things heal over at least a month. Then you can decide if you want further augmentation, although the far majority of people are happy with the results from one session.
The upper lip especially can fit far less than people think. I often hear of people who have been getting 0.5ml of lip filler every 6-12 months consistently for a number of years, and you can see the migration so clearly. However because they see their face every day, and migration is gradual, they don’t notice it occurring. The before and after photos online are a big reason for this. Almost all photos are taken immediately after when the lips are swollen. Many injectors will use techniques that give really defined swelling that is very eye-catching, but that is more painful, higher risk, and has more bruising and downtime. Once the filler settles, people are often left disappointed, and simply think they need more. In reality, no one’s lips look like these defined after photos once they heal.
I really try hard to be gentle when performing lip augmentation so that the after photos are more representative of what the actual result of lip filler looks like. Dr Steven Harris in the UK is leading the way for what lip fillers are realistically able to achieve without causing migration and is something I have incorporated into my practice. I encourage people to have lip filler as infrequently as possible. Once every few years at most.
Tell me more about this non-surgical nose job. What is it?
The non-surgical nose job is my most commonly performed treatment, and something I have become known for. I have performed countless nose fillers on men and women of all ages and all different backgrounds. Essentially, the treatment uses dermal filler injections to reshape the nose. It takes ten or so minutes, has almost no pain, and no downtime. The satisfaction rate is incredibly high, and when performed by someone with extensive training and experience, it is very safe. Results typically last 1-2 years and can be reversed.
The nose falls under the category of a timeless facial feature and is not a passing fad or trend. Many, and I mean many, people have big insecurities about the appearance of their nose. Bumps, humps, deviations, round and droopy tips. The thing about the nose is that contour irregularities are just so eye-catching, and always stand out in photos. Before the non-surgical option, the only treatment available was surgical rhinoplasty – an expensive and invasive procedure that requires you to have time off work. And, if the result isn’t as you’d hoped you have a big problem. The non-surgical alternative provides a solution for so many people who either had been considering nose surgery or just thought they had to live with the insecurity. I’ve treated men and women as young as 18, right through to those in their 60’s.
When done properly, nose fillers can disguise humps and bumps, make the nose appear straighter from the front and side, slimmer, and improve the projection of the nose tip, making it seem more lifted.
A well-performed non-surgical nose job has one of the highest satisfaction rates of all cosmetic treatments.
Unfortunately in the wrong hands, the results can be very underwhelming. A lack of experience and self-awareness from the practitioner can lead to the nose tip becoming swollen and round, the bridge looking too tall, as though it’s joined to the forehead), and migration with a loss of definition.
I have developed a very strict protocol for nose filler injections to ensure the best results are achieved while minimising any potential problems as much as possible. To date, I have never had to reverse the result of a nose filler treatment performed by me because the result wasn’t satisfactory. The great thing about the non-surgical option, aside from its safety and convenience, is that if you eventually move on from your insecurity you can simply let the results wear off. Or, if you decide you want a more permanent solution, the filler can simply be dissolved before you undergo surgery, and it will have no implication on the surgery itself.
This is in contrast to nose threads which I refuse to perform. These cannot be reversed and cause a lot of scar tissue. That, plus the fact that they are imprecise and painful to insert, and make any subsequent procedure more challenging and higher risk because of the scar, completely rules them out as a viable treatment option compared to dermal filler.
I am not satisfied with my results. What can I do?
The best thing about most non-surgical cosmetic treatments is that the results are not permanent, and in many cases can be adjusted. Problems are best avoided, and this can be done by ensuring your practitioner is not only highly knowledgeable, well trained, and with good technical skill, but that they truly understand how to use the consultation to understand you, and manage your expectations. Someone who simply does a treatment upon request is not giving you the service that is necessary to achieve the best and safest results.
When performing treatment, complications aside (as they are rare), it is always a fine balance between not enough of a result, and too much. The goal is to hit the sweet spot in the middle, with a preference for slightly undergoing it. With anti-wrinkle treatment, you can always top up the dose used, or just increase it next time you are due for treatment. If you over treat with anti-wrinkle injections, you can’t reverse it, you simply have to wait for some of the effects to wear off, which may take 1-2 months or more. The same principle applied to collagen-stimulating filler injections that are temporary but not reversible. Hyaluronic acid-based dermal fillers are more adjustable, as they can be dissolved, however, this should be avoided where possible as you can be allergic to the dissolving solution.
If your treatment is not as pronounced as you’d hoped, more filler can be injected as long as it is safe to do so, and the tissue is not at volume capacity. If too much has been injected, or the result just isn’t for you, the filler can be left to wear off, or dissolved if you are accepting of the risks involved. The final important point to make about cosmetic treatments, particularly fillers, is that there will always be a degree of swelling, which may be uneven. It is absolutely critical to know that the final result may take up to 4-6 weeks to be fully seen, although most of the healing is done in the first 2 weeks. For this reason, the best option, if you have concerns about your results, is to wait until things have fully healed. The far majority of concerns go away on their own as the treated area heals and the swelling goes.
Acting with further treatment before things have fully settled may give you a problem in the other direction that then must be addressed. A classic example is with lip filler swelling. If one side is more swollen, and not enough time is given to allow for healing, one may add filler to the smaller side. Once fully healed and the one-sided prominent swelling has settled, the area that had more filler injected is now the larger side. A new problem has been created, when just waiting would have been the logical solution. I would encourage everyone to ensure that their practitioner is confident, and doesn’t pander to your requests. Having trust that your practitioner is doing the right thing by you is absolutely critical, and you must listen to their expertise because they will know more than you. Remember, experienced injectors may treat up to 20 people per day, you may only undergo a treatment a few times per year at most. You must be wary of practitioners that bend to pressure without a logical and rational explanation.
The best advice I can give to anyone thinking of undergoing cosmetic treatments is to define your budget, tolerance for risk and downtime, and how much of a change you want. This will determine what treatments are right for you. Then, find an experienced, confident and informative practitioner who takes the time to understand your needs and concerns, and who develops a treatment plan that makes sense, and works for you. Finally, if you have ultra-high expectations and want perfection, or as close to it as possible, think again before proceeding. Improvement always trumps perfection. You should set yourself up to feel better after your treatments. Anything less completely misses the entire purpose of cosmetic medicine.
Dr. Aaron Stanes practices at various clinics in Sydney and Melbourne. You can learn more about him here and at @draaronstanes
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