This year's Merz Aesthetics Expert Summit, which took place November 17th-19th, 2023, in Barcelona, Spain saw medical aesthetics professionals from across the globe once again gathering to share the latest aesthetic trends, treatment innovations and cultural shifts taking place across the world that will shape the future of the industry. MedEsthetics had the pleasure of attending again this year, and have returned with an exciting look into the incredible forces set to revolutionize the aesthetics industry around the world.
1. Regenerative Aesthetics: The Next Generation
Regeneration of tissue lost through trauma, aging and other factors, can only be achieved if the whole tissue, not just one component, is repaired. This means the difference between causing fibrosis and actual regeneration of the system as a whole. To achieve genuine regeneration, certain parameters must be met. Kate Goldie, M.D., explains, "If we want to measure to see if something is truly regenerating, it is important to maintain the scientific understanding of what constitutes regeneration. In order to ensure we are genuinely causing regeneration and doing it correctly and effectively, the tissue and cells have to regenerate in structure and function, so we can definitively say we are creating tissue that is like it was when it was younger."
The tricky part is figuring out the right formula to rebuild the perfect ecosystem and successfully trick our body’s natural defenses into accepting the new material as native, familiar material and not a foreign threat to be rejected. Biostimulators injected into the skin form biostimulatory scaffolds, a 3D matrix that mimics the biophysical cues of the extracellular matrix. These scaffolds essentially trick stem cells into clipping onto them the way they would the extracellular matrix. Once this is successfully achieved, the next test is tricking the immune system into accepting the new material. If the immune system recognizes the biostimulatory scaffolds as “friend,” the regeneration of tissue structure and function will begin as the cells are activated or “woken up” and directed to regenerate through biophysical cues the biostimulatory scaffolds send to the cell.
The emergence of exosomes has expanded the possibilities of regenerative aesthetics and pushed innovation in treatments as well as products that are advancing the area of regenerative aesthetics even further. If you’ve read our previous articles about exosomes and Dr. Jordan Plews' work on developing Elevai’s PREx (precision regenerative exosome) technology, you know that while they may be small in size, exosomes pack a powerful punch. Exosomes are extracellular vesicles within cells that contain the vital “message” created inside cells to be sent and communicate with other cells, directing them to act or function in a certain way. When put under the right conditions, cells can be provoked into creating a specific message, such as directing other cells to regenerate, that exosome containing this “message” can then be extracted and used to directly communicate this message to other cells. Exosomes can be used alone, topically, or combined with various energy-based treatments and biostimulators to work together and enhance results.
2. Navigating Social Media
It’s not surprising with all of the viral beauty trends and misinformation about DIY and professional aesthetic treatments and skin care that learning how to navigate social media is a hot topic at the moment. Jennifer Levine, M.D., discussed the significant impact of social media on aesthetic standards, with it serving as one of the primary influences on changing aesthetic standards. One example of this is the change in the preferred ratio for lips, which has a major impact on patients’ interest in injectable filler treatments to enhance lips. While the preferred lip ratio was previously 1:1.6, social media has had a direct impact on the changing the overall preferred lip ratio to 1:1.
This consistent exposure to specific aesthetic standards on social media results in a perception drift in patients, skewing their understanding of what is actually normal when it comes to individual beauty as opposed to the images they see on social media. It is important to note that these posts causing a perception drift are not from physicians but rather celebrities and social media influencers without any formal education in medical aesthetics.
One of the biggest culprits behind this perception drift is the monumental surge in the use of photo filters, which affect certain aesthetic standards such as the change in preferred lip ratio to 1:1, a result of automatic enhancements made by photo filters. Physicians now have the vital responsibility to address the impact of social media aesthetic standards with patients, educating them on what is aesthetically normal for their individual characteristics and manage patient expectations for achieving individual aesthetic goals. Another significant way industry professionals can help change the aesthetic standards being promoted is by changing who dictates these beauty standards. While medical aesthetics patients are comprised of 91% women, the providers are still primarily male. Having and promoting the positive aesthetic achievements of more female practitioners can help dictate more women-centric beauty standards.
During an interview with Daria Voropai, M.D., she made the insightful observation that while we women may make certain aesthetic choices to attract the opposite sex, we go the extra mile when it comes to beauty for each other. A great deal of the things we do to look and feel more attractice are really designed to impress each other. We certainly don't get manicures or, what's more, pedicures to get the attention of men. I have not met too many heterosexual men that notice or really understand when we get our toes painted in bright colors. We do that for other women to see and appreciate. Especially when considered in this light, it only makes sense that we should be dictating our own women-centric beauty standards.
3. Focusing On Patient Safety
Patient safety has been a rising subject in medical aesthetics lately due to a number of recent events, such as the FDA updates on dermal filler recommendations, the incidents and implementation of new IV therapy safety measures, as well as the issue of fatalities and complications with BBL procedures, that highlight the need to reevaluate the regulations and guidelines in place to ensure patient safety.
Tatjana Pavicic, M.D., highlighted the safety considerations related to HA fillers in her session, “Safety In Focus: What You Need to Know and Why It Matters.” Ensuring the safe use of injectable HA fillers by certified professionals is one of those issues getting a great deal of attention in the industry at the moment, frequently in relation to patient safety and proper medical supervision in medspas. However, this is a treatment that all aesthetic practitioners need to make sure they are handling with care, as mistakes can have serious consequences and even cause tissue necrosis if the product is accidentally injected into a vesicle. On top of that, the face is an area that is difficult to hide if something does go wrong, meaning practitioners that want happy patients need to take the utmost care to treat the face safely and with an artistic eye.
Communication is a key aspect of this, as physicians are tasked with listening to what a patient may tell them they want in terms of treatment, but it is then the physician’s responsibility to assess and translate what they are and are not saying into a clear picture of their aesthetic desires. Taking patient mental and emotional states into account can help in this endeavor. During the roundtable discussion, Saami Khalifian, M.D., explained the advantage of changing how physicians approach consultations with patients and the language used to ask patients about their aesthetic goals. He explained that asking a patient to explain how they feel when looking in the mirror (tired, angry, sad, etc.) can point to the area of their face they actually want treated more effectively than what they might say in response to being asked what area they want treated.
Looking out for the patient’s best interest when it comes to aesthetic treatments is another key point. Sometimes telling a patient “no” if they are requesting aesthetic changes based on passing social media beauty fads is ultimately better for them and you than giving in to their demands. Fads change and your priority as their doctor is to consider what is best for enhancing and maintaining their individual beauty, which lasts their lifetime. Prioritizing patient safety in conjunction with an artistic eye for maintaining aesthetic balance using individually tailored treatments designed to preserve the individual beauty of the patient is what will ultimately lead to optimal results and loyal, happy patients.
4. Celebrating Ethnic & Cultural Diversity in Aesthetics
Appreciating and understanding ethnic and cultural diversity in aesthetics and the need to take those differences into account when it comes to celebrating individual beauty across the spectrum is a trend spreading across the globe. Greater emphasis is being given to the impact that genetic and phenotypic diversity in people of color has on the aging process, and thus, the need to tailor treatments to address these differences in facial aging differences.
Dermatologist Sahar Ghannam, M.D., Ph.D., in her session on celebrating ethnic variations, gave the example of differences in facial aging in Middle Eastern ethnicities. Caucasian phenotypes with thinner skin have a tendency to develop wrinkles and fine lines. In comparison, the heavier face and thicker skin typical of middle eastern ethnicities, comprised of a more compact dermis, does not develop as many wrinkles. Instead, sagging occurs in the face and eyelids tend to grow heavier and begin to droop. These differences in facial aging require different approaches to facial rejuvenation treatments that cater to the specific ethnic aging characteristics being treated, addressing facial sagging in this case as opposed to fine lines and wrinkles. Aesthetic professionals are best served by their artistic eye when considering these differences, using an artistic approach to beautify and enhance the individual patient’s beauty through a comprehensive understanding of facial anatomy and how to restore the structure of that particular human canvas.
Beauty Trends Across Regions:
Middle East: Another aspect of embracing ethnic and cultural diversity in aesthetics is recognizing the different beauty trends across regions and the diverse perceptions of beauty. For example, beauty standards in the middle east can vary in relation to wearing a hijab. Women who choose to wear the traditional hijab tend to prefer the aesthetic of a rounder face with full cheeks, no sub-malar hollowness and no nasolabial folds. Greater focus is put on enhancing the aesthetics of the eye area. The aesthetic trends of younger generations choosing not to wear the hijab are the opposite, tending towards facial slimming and sculpting. The overall aesthetic standard focuses on enhancing facial contours while also preserving ethnic variations and enhancing individual beauty.
Asia: Aesthetic trends across Asia are shifting from more exaggerated aesthetic changes to celebrating natural, individual beauty and preserving ethnic variations. The perception of beauty is shifting from a preference for more westernized aesthetic looks made popular by celebrities such as the Kardashians to an aesthetic look that preserves and respects ethnicity while enhancing individual beauty. One aspect of this shift is the rising popularity of K-dramas, which highlight and celebrate the ethnic variations of Asian individuals, putting a spotlight on non-Western aesthetics in the media.
Brazil: Brazil is on a similar path, with aesthetic trends emphasizing the celebration of ethnic differences and enhancing an individual’s natural beauty. One of the prominent aesthetic trends is having sun-kissed skin with an emphasis on improved sun protection to ward off the aging effects of photodamage. Natural beauty that requires minimal makeup is another rising beauty trend, focusing on enhancing skin quality using treatments to improve firmness, evenness, skin tone and radiance for a naturally beautiful appearance. The controversial BBL procedure is going through a makeover in Brazil to improve safety and overall results. Physicians are exploring how to perform BBLs with minimally invasive procedures such as biostimulatory and HA fillers to improve skin quality, reshape and reduce cellulite in the buttocks.
5. Transgender Care & Aesthetics:
Bianca Viscomi, M.D., addressed the need for increased support and care in relation to treating transgender individuals and the importance of improving the availability of qualified professionals providing transgender aesthetics treatments. Just as there is an increasing focus on diversity and celebrating ethnic and cultural variations in aesthetics, the issue of inclusivity in aesthetics is rising. being increasingly put in the spotlight. The LGBTQIA+ movement has come to represent acceptance, freedom and self-expression. However, transgender individuals in particular are in need of support and care from medical professionals, and those in aesthetics specifically, in the form of gender-affirming care and treatments.
Transgender individuals live in a constant state of vulnerability, at high risk of encountering violence and harassment, with lack of access to fundamental human rights that many of us not in their situation take for granted. Aesthetic practitioners have the unique ability to change transgender patients’ lives, helping them to look, feel and live better. Practitioners can help free transgender individuals from being trapped in bodies that don’t express their internal identities.
These procedures are not new for aesthetic professionals, as aesthetic treatments in general are gender-affirming, even if they are performed on cisgender patients. Minimally invasive treatments to feminize or masculinize a face are commonplace when it comes to cisgender patients, so whether they realize it or not, aesthetic practitioners already know how to do these procedures and have the experience to provide these services for transgender patients. For transgender individuals, minimally invasive cosmetic facial feminization and masculinization treatments can go a long way toward relieving their gender dysphoria by creating better harmony between their physical and innermost selves. These treatments can set free transgender patients’ true faces and identities, helping them transcend the physical form they feel trapped in.