Question 1

Meet Dr Laura J. Leon

Accepted Answer

Hello, good afternoon. I’m Dr Laura Jiménez León. I’m a specialist in maxillofacial surgery and facial plastic surgery, and I’m also an aesthetic doctor. I trained at the Autonomous University of Madrid and did my specialist training in Seville, at the Virgen Macarena Hospital. I’m currently working here in Marbella, at No1Q Clinic.

Question 2

Meet Dr Ángel Vidal

Accepted Answer

My name is Ángel Vidal, and I have been a specialist in plastic, reconstructive and aesthetic surgery for more than 30 years. I trained at the Gregorio Marañón Hospital in Madrid and completed my training at hospitals such as Mount Sinai in New York and Harvard Medical School in Boston. For many years I have devoted myself to aesthetic medicine, reconstructive surgery and cosmetic surgery.

Question 3

Should a good result be as visible as possible?

Accepted Answer

No, not at all. That’s completely false. A good result doesn’t have to be visible to other people. As I said before, for me a more natural result is a better-executed result, and you can have that ‘looking well’ effect without the result being very obvious and without people going around telling you that you’ve had fillers or neuromodulators.

Question 4

Is there a facial shape or proportion that aesthetic medicine considers “ideal”?

Accepted Answer

Facial proportions have been studied for a very long time. They differ between men and women. Women have a more triangular face, with more defined cheekbones, a narrower jaw and perhaps a slightly more pointed chin, whereas men have squarer faces, with straighter jaws and more prominent foreheads. There are also ethnic differences, and differences with age, depending on the loss of support over the years. But yes, there are indeed harmonious measurements or proportions that the aesthetic doctor must identify and should try to preserve.

Question 5

Is a single procedure enough for a long-term result?

Accepted Answer

No. Whether a single procedure gives long-term results depends on the patient’s age, the condition of the skin and genetic factors. The ideal is the minimum; let’s say a procedure can be stretched out, it can be six months. Why? Because with hyaluronic acid, which comes in different brands and different concentrations, the patient’s metabolism plays a big part. Some patients have used up all the hyaluronic acid within a month, while for others it lasts more than a year. So it varies a great deal. The important thing is to start, to take the first step and say: right, I’m going to have something done to feel better, to see my skin brighter, more radiant and a little more rejuvenated. Sometimes the first step is just one vial, but then, gradually, we can add other treatments in a particular area to help that face look much more rejuvenated.

Question 6

If a bruise appears after the procedure, does it mean something went wrong?

Accepted Answer

Not at all. A bruise is normal with any aesthetic medicine treatment. The face in particular has a very rich blood supply; in other words, there are a great many blood vessels throughout the body and, as I said, especially in the face. So it’s normal, and not a warning sign at all, to get a bruise after any procedure done with a needle.

Question 7

What is the most surprising or unusual request a patient has made?

Accepted Answer

Well, we all have a few anecdotes about patients' requests over the course of our professional lives. From patients who come in with photos of people who look nothing like them and want a result like the one in the photo… And in my own experience, I remember a patient who wanted to have ears like an elf. It's called auricular elfification, and it really surprised me. It seemed to be an aesthetic trend within a certain social group and, of course, I didn't do it.

Question 8

Are aesthetic procedures only for older patients?

Accepted Answer

Today, aesthetic procedures are for all kinds of patients who want to rejuvenate and feel good: from middle-aged patients to younger ones, from 25, or even 22 or 23. It depends a lot on the condition of the skin, on the patient’s lifestyle, on whether they rest. Sometimes very young patients have very aged skin, and aesthetic medicine treatments help them rejuvenate, men and women alike. Older patients, in their 70s or 80s, can also have treatments: they start with a treatment that may need more frequent sessions at the beginning. But once they have regained that smoothness of the skin, that radiance and hydration, they can maintain it, and that is very worthwhile too.

Question 9

Is lip enhancement always noticeable to others?

Accepted Answer

Lip augmentation isn’t always noticeable to other people. In fact, in my view, the best treatment is the one people don’t spot, but they see you looking better: they see lips that look more hydrated, juicier and prettier.

Question 10

Can you quickly tell when a patient arrives with unrealistic expectations? How?

Accepted Answer

The key to a good result in this specialty, and in every medical specialty in general, is to correctly identify what the patient expects and whether that expectation matches the treatment the plastic surgeon is able to offer. It's not unusual to meet patients who aren't very clear about what they want to achieve, and even patients who want results that are beyond what is possible. With patients who have very marked signs of ageing and want to treat them with aesthetic medicine alone, you sometimes have to be cautious, because you need to be clear about the limits of the specialty.

Question 11

Do hyaluronic acid fillers always look unnatural?

Accepted Answer

Hyaluronic acid fillers always look natural, precisely because of the diagnosis the doctor makes, then the technique, and then the amount of product injected. There is a trend for putting a lot of product into the lips, the cheekbones, the temples, the eyebrows, the brow projection, the chin, and that gradually distorts the face. It is not good for a patient of 45 or 50 to suddenly have the face of a 20-year-old, without a single wrinkle, all puffed up. That is what is unnatural. The priority should always be a treatment that brings out the patient’s natural features: the patient looks younger, at her best, with brighter skin, so to speak, and nobody can tell what she has had done. That is a successful result in aesthetic medicine.

Question 12

Is treating a single area enough to achieve facial harmony?

Accepted Answer

Normally we assess the patient and tailor the treatment to them. Very often, treating a single area isn’t enough. It’s about looking at the whole face together and seeing which areas need improving and which don’t. Above all, it also depends a lot on age: with age and ageing we gradually lose volume, so most often we need to reposition more than just one area of the face.

Question 13

How do you think aesthetic medicine will evolve over the next ten years?

Accepted Answer

The evolution of aesthetic medicine, like that of many areas of medicine, will go hand in hand with biostimulators over the coming years, that is, with stimulating the patient's own capacity for rejuvenation. This is already done with certain substances that can stimulate the patient's own production of elastin fibres, collagen and hyaluronic acid, and it is also already done using a cell called the platelet, which is the repair cell par excellence and which is injected into the face using a technique called PRP, or platelet-rich plasma. The future probably lies in stimulating the patient's own intrinsic rejuvenation factors.

Question 14

How can you tell if the specialist performing the procedure is truly qualified?

Accepted Answer

To know whether the doctor who is going to carry out the treatment is qualified, it is important that the doctor is registered with the medical association in Spain (colegiado) and also holds the qualifications that authorise them to do it. The clinic must also be authorised, in other words, have its NICA number. Those two points are what matter most when deciding where to have the treatment.

Question 15

If you can’t see the result, does it mean the treatment didn’t work?

Accepted Answer

Not at all. As I said before, a result that doesn’t show means it looks natural, and in my view that’s always better than people saying ‘you’ve had your cheekbones done’, for example.

Question 16

Which aesthetic trend will we look back on in a few years as a big mistake?

Accepted Answer

In a few years we will recognise some mistakes that we have probably made in the past and are now trying not to make. For example, trying to treat the appearance of nasolabial folds, which are a sign of laxity in the middle third of the face, by working on the fold itself will probably prove to be a mistake in the long run, because what we are doing is adding a lot of weight to that fold without treating the real cause of the laxity in the middle third. Little by little we are identifying the real problem, and we are able to correct signs of laxity and the fold with minimal injections into the fold and by increasing support in the middle third of the face.

Question 17

Why is it important to choose a qualified aesthetic doctor, and what complications can follow procedures?

Accepted Answer

When it comes to choosing where I’m going to have my lips done, or where I’m going to have my cheekbones filled, or what I can do to feel better, or what I’d like to rejuvenate, or when I don’t like some aspects of my face and I think I could be more beautiful, or more handsome, or younger, that is the moment to say: right, where do I go? The first thing is to go to a clinic with a qualified doctor, that is true. When deciding on an aesthetic medicine treatment, we cannot consider not being in the hands of professionals, because that is very, very risky. The most serious complications are necrosis, that is, when it dies… an artery is blocked and the blood doesn’t reach the skin. That area turns darkish, then turns black, and after that it is lost. That is the most serious complication. It can happen in the lips, it can happen in the face; there can be infections, and there can also be paralysis, when the injection goes right along the path of a motor nerve. So all of these things mean that medicine has to be practised by doctors. Hyaluronic acid injections have to be carried out by qualified doctors, aesthetic doctors who have trained, who have their master’s degree and have experience, because doing a nine-month master’s does not guarantee us experience either. Experience comes with the years, and that is very important when you are deciding: right, where do I have the treatment?

Question 18

Do hyaluronic acid fillers migrate across the face in every patient?

Accepted Answer

They don’t migrate around the face. As a rule, with good technique, the right indication and a good product, filler doesn’t migrate and there’s no reason for it to. It also depends a lot on the amount we inject: if we inject too much, the filler will end up migrating.

Question 19

What are the most common mistakes patients make before a consultation or treatment?

Accepted Answer

Before undergoing an aesthetic treatment, it's important for patients to be aware of the right attitude to adopt both before and after the procedure. It's common, or at least possible, for a patient to come to an aesthetic medicine consultation showing a lot of signs of tiredness and a lot of signs of sun exposure, and this can make the plastic surgeon's or aesthetic doctor's assessment only partial when it comes to determining the real defect the patient wants to correct.

Question 20

Can aesthetic medicine improve not only appearance but also self-confidence?

Accepted Answer

Yes, aesthetic medicine greatly improves self-confidence, because when it is properly indicated, when it is placed correctly, when the patient feels after the treatment that it didn’t hurt, that the experience they came to with a lot of fear suddenly wasn’t like that after all… Or perhaps they had another experience that wasn’t good, and they find it hard to take the step a second time, a third time, and they keep trying, this doctor, that doctor, this clinic. Unfortunately that is how it is: sometimes we have to reach a point where we have to… it is trial and error. But in general, I think patients leaving comments, writing on the website about how their experience went, is very important when deciding where to go, which clinic to go to, because technique matters and so does the way the patient is treated.

Question 21

Is a single syringe enough for ideal facial harmony?

Accepted Answer

It depends a lot on the type of patient. With some patients, a single syringe of hyaluronic acid may be enough to achieve the right facial harmonisation. Usually we need a bit more volume, and achieving harmonisation of the whole face is very individual and varies a lot from one type of patient to another.

Question 22

Can you recognise a well-done aesthetic treatment? Is the best result the one nobody notices?

Accepted Answer

As for results in aesthetic medicine, as in plastic surgery, it's very common that when you ask a patient what they want from a particular procedure, they tell you they want it to show, but not to show. That duality is typical of our patients. Clearly, the balance between a result that is visible, striking and elegant, and a result that looks natural, is the key to success. Any imbalance, whether too much naturalness or too much correction, any imbalance on that scale, is clearly not considered a good result […].

Question 23

Does the face lose its expressions after aesthetic treatments?

Accepted Answer

No, the face never loses, or should never lose, its expressions after aesthetic medicine treatments, as long as it is properly indicated where they should be placed and in what quantity. In aesthetic medicine it is very important that the less we put in, the more results we get. Another very important point is waiting. You always have to wait: after placing a vial of hyaluronic acid, wait at least two weeks, 15 days, for the patient to take in that treatment, that product. The patient is told to drink water, in other words to hydrate their face and skin, and then a touch-up is done if necessary, or another procedure. But it is very important to use only a little product and to wait that time.

Question 24

If you can “feel” the filler, was the procedure done badly?

Accepted Answer

No, not at all. At first it’s normal to feel the filler, and you may well feel it, but over time the whole treatment settles and you’ll stop feeling it.

Question 25

Which small changes can completely transform the proportions of a face?

Accepted Answer

There are a few important points on the face that, to some extent, set the harmony between its measurements. From the front, those key points are the cheekbones and the angles of the jaw. If you change that structure a lot, you're changing a great deal of the features, or the harmony of the face's proportions. From the side, in profile, the relationship between the nose, the lips and the chin is a subtle one that you can alter quite easily if you change those structures a lot.

Question 26

Can every patient have the same procedures without an individual assessment?

Accepted Answer

Every patient is a face that the doctor has to study. Not just study it from a basic point of view, or according to what the patient wants, but study the anatomy, the areas of projection, the hollow areas, the expression lines, the wrinkles that are already set in, which are deep lines, the asymmetries. All of those details together matter when carrying out a treatment. We cannot give every patient the same lip filler, or put hyaluronic acid into every pair of lips in exactly the same way, because each patient has an anatomical structure and a beauty to be discovered. That beauty is discovered only by the doctor who does the treatment. It is very hard to think, or very foolish to think, that we can do the same treatment on every patient and that they will all turn out perfect, because that is precisely when everything ends up looking unnatural, when we do things that way.

Question 27

Can a good specialist correct everything in a single visit?

Accepted Answer

It’s very difficult to correct everything in a single visit. Especially if we want it to look natural, we correct volume and skin quality gradually over time, and never all at once.

Question 28

Are there important differences between aesthetic treatments for men and for women?

Accepted Answer

As we were saying earlier about facial harmony being different in men and women, treatments need to be differentiated for one or the other, because it isn't very natural to give a man an aesthetic treatment with a feminising result, nor, the other way round, a masculinising one in a woman. So it's important to identify those elements, those key points of male and female facial aesthetics, when planning the procedure.

Question 29

Does the quality of the result depend only on the product, not on the doctor’s experience?

Accepted Answer

No. The products in Spain are very good. Hyaluronic acids come in different concentrations and also differ in how they are formulated. In other words, a particular acid is meant for a particular area, and we shouldn’t use another type of acid there; that is very important. For example, the under-eye area, the lips, and other products we need to fill, to add more volume, which also have a different chemical composition. It is important to know the products well, but the technique used by the surgeon or the aesthetic doctor is also important. For example, treatments done with cannulas are much gentler and avoid bruising. So it is very important to know the anatomy well. When you know the anatomy, you always work in a safe plane, because you know where the small arteries are and which area will cause bruising or not. So all of that background means the doctor’s knowledge is a fundamental pillar for getting good results, for the patient to be satisfied with the result and for her not to have complications.

Question 30

Do aesthetic treatments look unnatural on men?

Accepted Answer

Not at all; it depends on the technique we use. If we use a technique that’s properly suited to men, the treatment looks natural.

Question 31

Can you estimate someone’s age just by looking at their skin?

Accepted Answer

Yes, age… A person has different ages: one is biological age and the other is skin age. They don't always match. And yes, you can make a rough estimate of a patient's biological age from the characteristics of their skin age.

Question 32

If the result is subtle, was the treatment insufficient?

Accepted Answer

False. A subtle treatment means it’s turned out very well, that it’s natural, and very often patients, women and men alike, improve enormously and nobody realises they’ve had an aesthetic medicine treatment. And for me, that’s the ideal.

Question 33

Which procedure gives the biggest “wow” effect with the least product?

Accepted Answer

Clearly, the best results come from combining treatments, doing what is now known as a full face approach. In other words, if you can treat different aspects of facial ageing, you can improve a loss of volume, you can improve a lack of support, you can improve an area of dynamic contraction. You don't need to use large amounts of product, but being able to treat all the anatomical areas of the face allows you to achieve a fairly complete rejuvenation.

Question 34

Is facial swelling after injections a complication?

Accepted Answer

It’s not a complication; it’s completely normal. Swelling after an aesthetic medicine procedure is normal and doesn’t worry us at all.

Question 35

Have social media changed or distorted the idea of beauty? How do you see it in your practice?

Accepted Answer

Social media has been a revolution in how the results of plastic surgery and aesthetic medicine are judged. In the past, judging a result was part of a medical or surgical procedure, assessed by the surgeon, the patient and the people around them. Social media has turned your result into something displayed in a worldwide shop window, which anyone can comment on without knowing the circumstances beforehand. That distorts the medical act itself, because to know whether a result is right or not, it's very important to know the patient's situation beforehand and what their expectations were. So social media has become a form of mass opinion that isn't always beneficial to the practice of our specialty.

Question 36

Is the skin left stretched after a filler is dissolved?

Accepted Answer

After a filler is dissolved with hyaluronidase, the filler disappears, and where there was volume, that volume is no longer there. So it’s not at all unusual for the skin to go back into place a little, but you’ll most likely need an assessment after the hyaluronidase treatment to see whether we need to restore those volumes in the face.

Question 37

What advice would you give someone who wants to look younger without major procedures?

Accepted Answer

The first piece of advice I'd give a patient who wants to look younger is: if you spend a lot of time in the sun, don't, or at least use sun protection, and if you smoke, stop. Those are the two most important external factors in facial ageing, apart from internal genetic factors or the patient's own individual make-up. So a patient who doesn't want to age, or wants to age better, should first of all avoid too much sun, not smoke and stay well hydrated. Those would be the basic rules, the basic advice I'd give a patient before starting any aesthetic medicine procedures.

Question 38

Should every patient aim for the same “Instagram” face?

Accepted Answer

Not at all. Every patient gets a personalised treatment. Not all patients are going to have the same face or be suited to the same treatment. Ideally, you come in for a consultation, we assess you and see what suits you best. We don’t do everyone’s lips, or everyone’s cheekbones.

Question 39

Are there cases where you decide not to treat a patient? Why?

Accepted Answer

There are many cases where I decide not to treat a patient. Well, not many: there are cases where I decide not to treat a patient. It comes back to what we were saying earlier. If you see that the patient's expectation doesn't match the result you can achieve with your range, your arsenal of techniques, it's better not to treat the patient, because the patient isn't going to be satisfied. They won't understand that what you did had one goal, and that their goal was a different one that you can't achieve.

Question 40

If the skin is thin, are fillers unsuitable?

Accepted Answer

Fillers can be used whatever your skin type, because fillers go into different layers. With very thin skin, fillers can be placed in a deeper layer without any problem.

Question 41

Does a more expensive product automatically give a better result?

Accepted Answer

Results will depend mainly on the technique used, on how the product is placed and on the professional who does it. It doesn’t just come down to the product being more expensive, and that doesn’t mean it’s better.

Question 42

Is aesthetic medicine only for women?

Accepted Answer

Not at all. That’s false too, because more and more men are having aesthetic medicine treatments.

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