What is the current run on botoxing all about? A conversation with Dr. Negin Pakravesh, doctor of dermatology and specialist in minimally invasive treatments.
dr NeginPakravesh is a dermatologist at the Bellari Rosenpark Institute in Hamburg and specializes in aesthetic treatments. Her focus is on so-called minimally invasive anti-aging treatments, i.e. those that do not require a scalpel. Particularly in demand: injections with botulinum toxin or hyaluronic acid fillers.
Wrinkle treatments with botulinum toxin, commonly known as botox, are more popular than ever in Germany: According to current statistics from the German Society for Aesthetic Plastic Surgery, they were the most popular beauty procedures in 2021 with 33.5 percent – an increase compared to the previous year by more than 37 percent. With the Hamburg dermatologist Dr. Negin Pakravesh we talked about the longing for the injection, about the risks – and why the desire for change is much more fundamental in younger patients.
Brigitte: Treatments at the Beauty Doc are currently booming, why is that?
dr Negin Pakravesh: There are several reasons for that. For example, I have observed a change in self-perception in many of my patients since we have been constantly seeing our own faces in video conferences.
And then you smooth out the wrinkles discovered on the screen with the help of botulinum toxin?
First of all, I take a very close look. Because some people also see things that do not exist in reality. After all, what they see on the screen is a two-dimensional and not a 3-D image. In addition, the light or the angle can be unfavorable. Of course, this has to be discussed, otherwise they might get too attached to individual wrinkles that they think they have discovered.
It sounds like you are also advising against treatments.
Naturally. Why should I inject someone with botulinum toxin when it might be enough to just move the laptop somewhere else at the next conference. Above all, I find it important to be honest with the people who come to me for treatment. If I see something, then I say so. But if not, then I rather advise against it.
Do your colleagues approach things so differently?
The danger, of course, is to see spraying as a quick side income. In Germany, only doctors are allowed to use botulinum toxin to treat wrinkles, but that’s not just us from minimally invasive aesthetic medicine, but all of conventional medicine with the exception of dentists.
What you see critically …
Because most simply lack the necessary knowledge. The facial anatomy is very individual. Every face has its own facial expressions, its own interaction of muscles. And that’s why it’s so important to design a treatment regimen that addresses each of these idiosyncrasies. But most doctors in Germany who want to work with botulinum toxin learn how to inject according to rigid schemes in a weekend course. Then they go home with a certificate. They can treat, but until they understand how individual facial expressions work, the result will never be truly ideal.
And that’s why we so often encounter rigid, conspicuously smooth faces?
Yes, exactly, because just imagine: not even these weekend courses are compulsory in Germany. I would really like to see a uniform seal of quality that offers people real orientation.
Interest in Botoxen is now also immense among those under the age of 30: According to a recent study, at almost 64 percent it is the most common treatment request. How do you explain that?
The reasons for wanting treatment are strongly age-dependent. Most of those who come to me are no younger than their mid-40s. Their main concern is to prevent or counteract age-related changes. Maybe they’ve seen photos of themselves that were taken on a day they actually had a lot of fun – and yet they still find their expression very negative. But they want their insides to be visible on the outside, and we’re happy to help with that. There’s nothing wrong with wrinkles as long as they don’t give me a negative expression that bothers me. It is completely different for younger people: They are often on social media platforms for several hours a day and are confronted with a flood of digitally processed images. So they emulate unattainable ideal images. Their desire for change is much more fundamental than that of older patients, because it affects their very personal characteristics. They want to universalize precisely what makes them unique.
And, unlike in the past, this is no longer just limited to the style of clothing and hairstyle…
Today it has to be the same nose and the same breasts. With this increasing uniformity, I sometimes feel like I’m facing an army of social media clones.
This year, Norway will be the first country to introduce mandatory labeling for edited photos that are used commercially on social media channels. A right move?
I support that very much. However, I think it is wrong to pass the problem off to Instagram & Co. alone. We doctors still bear the actual responsibility. In the end, if we don’t put the exaggerated ideas into practice, it doesn’t matter how many fake images are circulating in the world.
But you warn against the use of botulinum toxin at a young age for a completely different reason.
Right, it has something to do with the purity of the botulinum toxin. It is important to pay attention to a pure, active ingredient, such as the so-called IncobotulinumtoxinA from Merz Aesthetics, also known as “Bocouture” or “Xeomin”. It is well defined and classified. An immunization reaction is therefore unlikely.
What can happen with such an immunization reaction?
The body forms antibodies and the botulinum toxin can become less effective or not work at all. If it were just about wrinkle treatments, that would be manageable. But botulinum toxin does not originally come from aesthetics, but is used a lot in neurology, for example for spasticity after a stroke, for torticollis, but also for migraines, difficulty swallowing, bladder function and vaginal disorders. Unfortunately, however, new patients keep coming to me who do not know what kind of botulinum toxin preparation they were injected with. This information is also an essential part of good medical advice.