The day before I turn 40, I start researching non-surgical cosmetic treatments. In my mind, the birthday and the research are not connected, but the story assignment from my editor assumes otherwise: “You may want to write in first-person, your recent birthday making you question the state of your skin and youthfulness as you age.” Well, sure.
Two weeks later I find myself in a consultation room at the Calgary Institute of Plastic Surgery, scowling, grinning and making surprised faces while the consultation nurse snaps photos. I’m here to have a non-surgical cosmetic procedure; specifically, to have botulinum toxin A, a neuromodulator, injected in my forehead and hyaluronic acid injected in my cheeks. I have not done this before.
These injections, better known as Botox and fillers, are just two of the FDA- and Health Canada-approved procedures I’ve been learning about. There are several others, involving things like blood plasma, lasers, ultrasound energy and tiny needles. Most of the procedures work by creating small wounds that kick-start the healing process, stimulating collagen and elastin production (the supportive, springy structural proteins that slow production as we age) and generating new skin cells. All are designed to make us look more smooth, defined, fresh and even-toned – in a word, youthful.
The treatments do get results, and they’ve risen steadily in popularity since the 1990s. The American Society for Plastic Surgeons reported a 158-per-cent increase in demand for minimally invasive procedures like Botox, fillers and laser-resurfacing between 2000 and 2015.
Dr. Andrei Metelitsa, medical co-director of the Institute of Skin Advancement, says 10 years ago the top cosmetic procedures were surgical: facelifts, nose jobs and brow lifts. Today, it’s non-surgical procedures: fillers, lasers and neuromodulators (usually called “Botox” in honour of the pioneering product made by Allergan). “[Non-surgical treatments] are safer, more predictable and more accepted by society. They’re also cheaper,” Dr. Metelitsa says. “They cannot do everything a surgery can, but they can do a lot.”
The private facilities that provide these services are generally termed “medical spas,” and Calgary has dozens. Some, like Derm.ca and the Institute of Skin Advancement, are dermatology-focused, doubling as treatment centres for skin cancer and cystic acne. Others, like Sante Medical and the Calgary Institute of Plastic Surgery, are devoted to cosmetic procedures.
Wanda McArthur, the vice-president of the Calgary Institute of Plastic Surgery, is the first person to ask if I’ve ever had anything “done.” I haven’t. “A virgin!” she says. She books me for a consultation and appointment with cosmetic and reconstructive plastic surgeon Dr. Jonathan Lee. McArthur tells me she’s a mother of four and she loves to see women take time for themselves. She wants me to have “the full experience.”
The full experience begins the following week when I have my scowl photographed. It’s two days after Christmas, and when I meet Dr. Lee he tells me he spent the holiday on call at the Peter Lougheed Centre dealing with “turkey-related hand injuries.” (Later on he describes avocados as a “danger food.”) Dr. Lee fields my questions about fillers and neuromodulators. He explains a service called “BeautiPHIcation,” which applies the golden ratio, or “phi” – a mathematical ratio used since ancient times to achieve balance in art and design – to the face. “We try to create that ratio in relation to structures in [a patient’s] face so that it optimizes their beauty,” he says.
Dr. Lee asks me what bothers me most about my face. I point out my acne scars and the circles (technical term: “tear troughs”) under my eyes. He notes the horizontal lines on my forehead, the early folds in my glabella (the triangle where nose meets eyebrows) and my “bunny lines” (scrunch your nose – there they are). My right eyebrow sits higher than my left. I have crow’s feet and nasolabial folds (the ones that run from nose to the corners of the mouth). Dr. Lee observes, Sherlock-like, that I sleep on my left, which has caused that side of my face to lose more volume than the right. Also, my chin could be a bit more prominent.
Each of these issues can be addressed using neuromodulator or filler. I thought I’d be up for anything, but I opt to keep my crow’s feet and my chin as is. Dr. Lee is happy. He’s not interested in giving people treatments they don’t want or need. “If it doesn’t bother you, there’s no point in talking about it,” he says. He’ll sometimes talk people out of procedures he believes will mute their character or worse, make them look odd or “done.” He wants patients to leave looking brighter and fresher, but above all, like themselves.
Looks may be superficial, but identity and appearance are intertwined. It’s not wrinkles that are undesirable, it’s what wrinkles represent. Dr. Corrina Iampen, medical director of Sante Medical, says most of her patients are trying to “embrace who they are as people.” She says she sees mature patients, 60 and over, who hope to look as good as they feel; independent people in the 40- to 60-year-old range who want to sustain their confidence; and 20- to 40-year-olds expanding their self-care regimens. Dr. Iampen’s patient demographic spans generations, but across the age groups, motivations are similar: Everyone wants to feel better by looking better.
More than 90 per cent of non-surgical cosmetic patients are women, but men’s numbers are on the rise. Ildiko Juhasz, clinic director and medical aesthetics specialist at Derm.ca, says PRP therapy (in which a patient’s extracted blood plasma is injected into his or her face), is as popular with men as it is with women – especially CEOs, job seekers and sales reps.
Back at the Calgary Institute of Plastic Surgery, Dr. Lee sets up the syringes. Neuromodulators – a Botox alternative called Dysport, in my case – feel like tiny insect bites. Dermal fillers (I’m having a product called Emervel) feel like needle jabs followed by pressure. They’re not particularly painful. I can faintly hear the fluid being injected, like toothpaste being squeezed from a tiny tube. McArthur holds a juice box for me when I get woozy after Dr. Lee inserts a cannula (a very thin tube) under my left eye.
Dr. Lee was an aspiring performance pianist before he became a plastic surgeon, a profession he chose because it’s the most creative of the surgical disciplines. He says it’s an art form. If you want to see a plastic surgeon’s glabella crease, ask how the esthetics industry is regulated.
For qualified practitioners like Dr. Lee, lack of regulation is an ongoing headache. It means he has to fix the mistakes of incompetent and irresponsible practitioners, and it contributes to the stereotype that all cosmetic procedures result in frozen faces, balloon lips and botched surgeries.
Physicians and nurses in this province are overseen by regulatory colleges (the College of Physicians and Surgeons of Alberta and the College & Association of Registered Nurses of Alberta), but no set qualifications exist for other practitioners in the esthetics industry. Instead, technicians, estheticians and specialists are loosely guided by standards created with other services in mind. For example, practitioners who use needles must follow Alberta’s Personal Services Regulation, but this public health act was written with non-medical services like tattooing and piercing in mind. An esthetician can’t prescribe Botox, but can administer it despite having no anatomical expertise. Regulations for laser treatments simply require equipment to be registered – practitioners are unregulated.
Patients who choose unqualified practitioners can end up disappointed or worse. Complications range from infections and skin discolouration to allergic reactions and nerve damage. Juhasz says it’s up to patients to ask questions and do their research. If a facility is run by a CEO instead of a physician, that should be a red flag. “It has to be sterile. It has to be a medical environment. If the facility is open, the doctor should be on site at all times,” she says. Always verify credentials and ask about experience. Look for high standards, not low fees. Make sure there’s an after-care plan.
My recovery is swift. It takes the swelling from the fillers a few hours to calm down and the Dysport three days to kick in. I still look like me, but smoother. Dr. Lee says if people can tell his patients have had work done, he’s failed. Kane agrees. “People should never ask, ‘Where did you get your treatment?’ They should ask, ‘Have you been on vacation?'”
I ask Dr. Lee how old he is. He’s 39 but looks much younger. He tells me gets asked his age all the time, that his youthful looks sometimes cause people to doubt his credentials and experience. “To be taken seriously, some people expect you to have more white hair and wrinkles,” he laughs. “I think people judge you based on how you look.”