Developments in cosmetic medicine have proceeded at a rapid pace in last few years. But are all the developments equally welcome? And are all their practitioners real doctors? Three experts have their say.
TEXT: Jasper Monster
ILLUSTRATION: Carolyn Ridsdale
Erasmus MC offers botox lessons. Tamar Nijsten knew the decision to set up the country’s first formal training course in cosmetic dermatology would cause a stir. So the head of the department of dermatology at Erasmus MC chose his words carefully when making the announcement. But when the first headlines with the words 'botox lessons' hit the front pages three years ago, the board of directors was on the line immediately. "I got the call at half past seven that morning — I still remember that," he says with a smile, now that he can laugh about it. "But I’d still make the same decision. Developments in cosmetic medicine were proceeding at such a rapid pace that Erasmus MC could not afford to be left behind. After all, training is one of our core duties."
"Filler injections and laser treatments are just flung onto the market to make as much money as quickly as possible" - Peter Velthuis
Things occasionally go awry
Fillers to plump up the lips or botox to remove wrinkles. These procedures have been available since the 1980s, but their exponential rise in popularity only happened in the last ten years. Hence the launch of Erasmus MC’s cosmetic medicine complications consultation in 2011 — because, as with all other medical procedures, things occasionally go awry when you inject someone with filler. But it soon became clear that a half-day service would not be enough. The consultation now opens two and a half days a week. "Unfortunately, there are a lot of cowboys in this field," explains Nijsten. "Furthermore, since we were turning out lots of dermatologists each year, why shouldn't some of them too have the opportunity to work as cosmetic doctors? Training them to do just that was Erasmus MC’s responsibility." And so, since the course began in 2016, medical students have been able to learn everything there is to know about cosmetic medicine. Every six months, two students get to immerse themselves in the world of botox, fillers and wrinkles at DermaHaven, an Erasmus MC outpatient clinic of which Nijsten is director.
The first Velthuis Clinic
One of those who witnessed the exponential rise in the popularity of these procedures at close quarters is dermatologist Peter Velthuis. He was one of the first doctors to go work for 'the other side'. He left the hospital world in the mid-90s to set up his own laser clinic. "I’d begun to get a bit bored sometime after a promotion, and using laser therapy to combat wrinkles was on the rise, so I came aboard." His dermatologist colleagues didn’t take his decision to go over to 'the other side' well. "They considered it too cosmetic. I managed to straddle both worlds for a while, but that eventually grew impossible, which was why I made the leap." But blood is thicker than water, and Velthuis has been back in the familiar world of hospitals since 2015, and is now at Erasmus MC. "I’d become more CEO than doctor. And I really love training young people. So when Erasmus made the offer, I didn't have to mull it over for long." Few can explain the developments in cosmetic medicine better than him. "The innovations often lack scientific foundation. Filler and laser equipment manufacturers have no interest in doing years of research. New products are often launched for a quick return on investment, before whatever the thing is becomes outdated. Thus, the necessary research is mainly left to universities, and that's what we're trying to do."
"At last! People offering these procedures without medical training can now no longer call themselves cosmetic doctors" - Tamar Nijsten
Rotterdam’s wrinkles investigation
A case in point, Nijsten and some colleagues, including Professor of Genetic Identification Manfred Kayser, are involved in the large-scale cohort study known as ERGO (Erasmus Rotterdam Health Research). This is a long-term population study by Erasmus MC designed to track the health of 15,000 people over the age of 40 in the Ommoord district of Rotterdam. "Our 'wrinkles investigation' came in for a bit of ribbing when it first began," says Nijsten. "But we want to know whether there are, say, predictive genes that cause wrinkling. Knowing something like this could yield very interesting insights for cosmetic medicine, as you’d finally be able to substantiate your findings empirically."
Who’s legitimate and who isn’t?
But alongside the positive developments raised by the dermatologists are persistent downsides: "We maintain pretty high standards at DermaHaven," says Nijsten. "No low-cost offers, giveaway stunts or radio jingles. We’re also a bit more expensive than average in an industry that competes largely on price. The impossibly low offers are why some are still tempted to visit the cheaper clinics where people are carrying out procedures without medical training. A two-year training course in cosmetic medicine had been in existence for a while, but the title of cosmetic dermatologist had never been officially recognised. So the KNMG (Royal Dutch Medical Association), which had been harbouring concerns, stepped in. The title gained official recognition on 1 July, and anyone without medical training was now no longer allowed to use it." Velthuis and Nijsten aren’t the only ones breathing a sigh of relief at this development. Qualified doctors who work in private clinics have also welcomed the move. "This puts what we do on a professional footing," says Shai Rambaran. After qualifying as a doctor, he completed a two-year course in cosmetic medicine, and has been practicing at the Van Rosmalen Kliniek for the past six years. "It’s difficult for the public to know who’s legitimate and who isn’t. Mishaps by unlicensed practitioners tar the entire industry with the same brush. I recently had a patient who’d had filler injections administered by a beautician with zero medical training."
"I think it’s great that twenty-year-old women are having their lips filled. You get more out of it when you’re young" - Shai Rambaran
The taboo is lifting
The three have noticed a further development in recent years. Their patients are getting younger and younger. "Young women, in particular, are having their lips filled," says Velthuis. "Nineteen- and twenty-year-olds. This is quite worrying from a societal perspective, and represents a crossing of certain boundaries. More could be done to address this, including running public information campaigns." But Rambaran see things differently. "It pleases me to see younger patients. It means people are becoming more and more aware of their appearance and that the taboo of cosmetic procedures is lifting. The older you get, the more difficult treatment becomes. So you get more out of it when you’re young."
What the three do agree on is that the development of cosmetic medicine on so many fronts is a good thing. "What we do isn’t life-saving," says Velthuis, "but it has merit. Patients gain self-confidence and start to feel better after the procedures. And that, after all, is the point of being a doctor."
