Aesthetic medicine: a booming medical activity


Jean-Jacques Legrand, MD, President of the French Society of Aesthetic Medicine, 154 Rue Armand Silvestre, 92400, Courbevoie, France. E-mail:

Aesthetic medicine was born in France about 30 years ago. The French Society of Aesthetic Medicine was the first of its kind in the world. Its first Congress was held in 1973 in France.

The start was rather difficult since aesthetic procedures, in the early years, were only surgical. At that time the first aesthetic doctors and cosmetic dermatologists had very few real medical procedures to offer their patients for treating aesthetic problems on the face and body. Consequently, during the 1970s, several of them directed their practices toward surgical procedures. This shift created much confusion and some criticism from cosmetic surgeons.

Beginning in the 1980s, viable medical procedures started to emerge in Europe for aesthetic and cosmetic purposes. Mostly, they were imported from the United States: these included collagen injections for wrinkles (Zyderm by Dr Stegman), and chemical peels (phenol by Dr Baker, TCA by Dr Obagi). Subsequently, European research on aesthetic medicine gained momentum. Hyaluronic acid (Restylane by QMed, a Swedish company) appeared on the market, because it was discovered that it could be used as a filler for wrinkles. Recently, Restylane has been exported to the U.S.

During the 1990s, the use of lasers offered new possibilities to aesthetic doctors and cosmetic dermatologists. The beam revolution started with the CO2 laser for facial resurfacing. Today, CO2 it is not used as much anymore because of the long, difficult postop. CO2 was replaced with the gentler YAG and Erbium lasers and more recently by non-invasive lasers for facial rejuvenation including IPL and radiofrequency. These new technologies allow today's aesthetic doctors and cosmetic dermatologists to offer their patients procedures with very low risk for postop complications. The procedures include long-lasting hair removal; treatments for disfiguring vascular problems such as telangiectasias on the thighs and legs, and couperose on the face; and treatments for brown age spots on the face and/or hands.

Recently, botulinum toxin (BTX) (first publication in Canada by Drs Carruthers for cosmetic purpose) has ‘invaded’ both sides of the Atlantic Ocean. Today, BTX injections are the most popular treatment for expressive wrinkles on the face. BTX injections are now so popular everywhere that many cosmetic surgeons have given up their scalpels for the syringe.

Today aesthetic medicine has the tools needed to address all major procedures within the aesthetic field. What has been realized is that men and women prefer less-invasive procedures – injected fillers for wrinkles and folds, BTX, and chemical peels – to surgical procedures like facelifts. As a means to avoid scarring and difficult healing postop, men and women typically choose less-invasive treatments even if it means only a few months of cosmetic results that must be renewed with additional injections or doctor's visits.

After 30 years, aesthetic medicine is represented in 19 nations in the world (France, Italy, Spain, Belgium, Morocco, Poland, Russia, Switzerland, Romania, Kazakhstan, Algeria, Brazil, Argentina, Uruguay, Venezuela, Colombia, Chile, Mexico, and the U.S.A.). All 19 are members of the Union Internationale de Médecine Esthétique (U.I.M.E.). In seven countries (France, Italy, Belgium, Spain, Brazil, Argentina, Mexico), aesthetic medicine is taught in Universities that deliver diplomas after 3–4 years of study.

What is the future of aesthetic medicine? In the last few decades, patient desires to look and feel younger have fuelled aesthetic medicine and cosmetic dermatology. As such, many different procedures have been developed to satisfy the demands. As lifespans have increased, patients today are not only asking about aesthetic procedures, they are also asking for a way to stay in good physical condition in the last decades of their lives. As a direct result, anti-ageing medicine, which covers skin ageing and general ageing, has recently emerged and expanded very quickly. Anti-ageing medicine can offer senior patients better nutrition, dietary supplementation with vitamins, minerals, antioxidants, and hormone replacement therapy when needed. Today, and in the near future, both aesthetic medicine and anti-ageing medicine will offer patients who now live longer, better wellness with aesthetic treatments for skin ageing and anti-ageing treatments for general ageing.