Aesthetic medicine is developing rapidly: new techniques are appearing almost every month. However, according to Christian Kohler, dr. med, people should apply a critical approach to everything. Dr. Kohler, considered to be an innovator in the application of the latest technologies of rejuvenation in aesthetic medicine and the first to use the best new tech in the world, is guided by the main principle: «Do no harm!»
– Dr. Köhler, in your opinion, what has changed in aesthetic medicine recently?
– There has been a qualitative leap forward in the sphere of noninvasive treatment methods, and this is primarily due to the development of new technologies and the emergence of more delicate and sensitive devices. For example, surgery is no longer used to remove tattoos in advanced medicine.
Nowadays, thanks to the laser, the whole procedure takes 15 minutes and no scalpel is used. Just as swiftly can you deal with cellulite. These latest methods make life easier for both doctors and patients. Of course, we use well-established methods like injections of botox, facelifts, liposuction, etc.
– But the age of the patients also varies. The range has become wider. Let ’s ta ke the simplest example. Sometimes the first signs of aging appear quite early – so-called “crow’s feet” around the eyes, facial wrinkles. If somebody applies to you with such problems, what is the treatment algorithm? Do you use the same methods for everyone?
– You are right. Very young people, even 20-year-old patients, are on a par with other patients in terms of age. Today an individual approach is required, so to begin with the doctor should learn as much as possible about the patient in order to suggest the best way to solve the problem, and the solutions are different. A lot of people, for example, are not satisfied with wrinkles on the forehead, not suspecting that the problem is connected with the upper eyelids. And this means that it is necessary to deal with the eyelids, but not with the wrinkles. Of course, the easiest way to solve this problem is an injection of botox – it’s quick, it does not hurt, and the result, as they say, is obvious. But the doctor should talk about all the options, their advantages and disadvantages, and only after that is it possible to make the right decision together with the patient.
– Is it possible to combine procedures like, for example, injections and laser treatment?
– We combine different methods of treatment – it gives the best results. For example, we combine botox and injections of other drugs, if of course, there are indications for their use.
And the laser is mainly used for the treatment of large surfaces – it can be used to improve the skin on the face as a whole. All these methods complement each other perfectly. However, I should note that we cannot avoid surgery in our treatment.
We have the best laser technology on the market at our disposal. We offer sparing treatments, as a result of which a person looks fresher and younger. Nevertheless, it is difficult to achieve such an effect surgically while using other techniques.
– Many people are afraid of the very word “surgery”; moreover, sometimes you see a famous actress or singer and you are terrified that the surgeons have made her unrecognizable.
– What can I say… Yes, t here are different doctors with different approaches to treatment. I consider that a person after surgery should look natural and he shouldn’t be changed beyond recognition. He should look so natural that people do not ask what exactly has been done to him. This especially applies to the eyes. Usually I ask the client to bring a photo from a decade ago and thus I find out how he looked when he was 10 years younger.
I understand that nobody wants to go under the knife, but modern surgery is not the same as it used to be. Firstly, it is more based upon preservation, and secondly, we do not rush to fulfil any and all desires of the patient, as it used to be at the beginning of the plastic surgery era. Sometimes it’s important
to say no. Moreover, today there is an alternative to any surgery and, as a rule,not just one. But the decision must be made by the patient – we cannot insist on anything. After all, it’s not about health but about such delicate matters as mood, as the attitude to oneself…
Let’s take blepharoplasty, for example. If you do not want to cut into your eyelids then welcome: plasma, lasers, botox etc is at your service. Some effect can be achieved with only botox. For sure the result will probably not be so impressive, but if the patient is happy then our goal has been achieved.
– Are there any risks today during blepharoplasty?
– All techniques have side effects; it is not only senseless to try to hide this but also unethical. Many doctors speak of the risks with extreme reluctance.
However, even during the injection of hyaluronic acid there is a chance of clogging the blood vessel, which can cause problems. Of course, such complications are extremely rare.
However, I believe that we should as frank as possible with clients. They have the right to know everything. The doctor should inform the patient.
– Do you deal with stem cells? Recently, their status in aesthetic medicine has become quite ambiguous.
– Switzerland is not an ideal country for applying stem cell treatment, as this sphere is very strictly regulated here. Anyway, you need to be careful with this technique; it has a lot of contraindications. But everything is developing rapidly, and maybe we will be able to talk about new technologies in this area in a year.
– What’s your attitude towards collagen? People say it is recommended not only in the form of injections but also for oral administration as part of various dietary supplements.
– Collagen was popular two years ago, but now the fashion for it has been fading. It may be good for the eye area, but I am skeptical concerning many filler materials, including collagen, using only verified products. It is mostly local. I don’t use collagen.
– Pigment spots are one of the signs of aging. What skin whitening methods do you consider the most effective?
– Pigmentation is not always a sign of aging. Recently, I had a young patient – his face was studded with spots. We decided to apply a procedure called cosmelan peeling. This is a relatively new type of chemical peel by which any browning, including freckles, can be removed. The advantage of this method is that it can be used with almost all patients and is compatible with any type of skin, including dark skin. In addition, this procedure can be used all year round, even when the sun is active. There are no analogs.
– And what do you think about the method of aligning the complexion using a laser? Is it fraught with complications?
– Laser procedures are becoming safer every year but there are still risks, such as skin burns. We refuse clients if, for example, they have recently been in southern countries and have got suntanned. By the way, patients can’t stay in the sun after laser therapy.
–It should be noted that one of the fashionable procedures in aesthetic medicine is phenol peeling. What can you say about this?
–It should be borne in mind that acids are used during deep phenol peeling. The result, as a rule, is excellent – a person really looks 10 years younger. But the problem is that after this procedure, the patient will have to recover for four weeks. In addition, after any peeling, the skin becomes irritated, susceptible to infections – its immunity temporarily decreases. An inflammatory reaction may also take place. At present there are so many varieties of peeling that you
can always choose the one which suits you best. But in any case, I would not advise exposing the skin to excessive peeling procedures.
– Lifting also comes with many options; it is sometimes quite difficult to understand the intricacies of a particular procedure.
– Some colleagues do deep lifting, after which a person is changed on the surface. We try to work minimally, invasively speaking. We have so-called soft-lifting, where fillers and botox are used. I choose this procedure if the patient’s goal is a fresh look. But often patients are over 55 and tuck-up surgery suits them better.
Plasma lifting is very effective; it means injections of the patient’s own blood. It is also called PRP therapy (Platelet-Rich Plasma) or “Dracula t herapy”. There have been many innovations in this area. Plasma-lifting has existed for many years already; it helps both women and men to combat baldness and hair loss. With it, you can strengthen and accelerate hair growth during transplantation. We also use plasma to align skin relief in the area of décolleté and face. This method is suitable for both eyes and lips – I could not get to these areas so well with other techniques. Women lose their greyness.
– And what can you do with nasolabial folds? I’m sure women often come to you with this problem.
– Nowadays, the most common way to deal with this is hyaluronic acid, and sometimes it can be combined with plasma. However, there are people to whom I used to say: “Look at your children’s photos – the evident nasolabial folds can be seen there. This is your individual feature, and if I remove it, all the facial expressions will shift to the surface and the result will be awful.” In this case, I propose lifting, for example: the appearance will brighten, but the fold will not completely disappear, and it will remain the same as in youth.
– The oval of the face also changes with aging. To solve this problem, so-called golden threads are often used. What’s your attitude towards this?
– This Russian invention is highly praised by both doctors and patients. Having explored it, I drove through different countries and came to the following conclusion. With the help of golden threads, Asians can perfectly maintain their facial contours – they have more adipose tissue in the face, and golden threads work well there. But it can’t be applied so well to Europeans – they, as a rule, have more skin and little adipose tissue. Well, what to do with the skin? It does not dissolve…
– You have said that you sometimes refuse a patient surgery. In which cases?
– First and foremost, of course, I do so for medical reasons. Moreover, our doctors do not create very large breasts in our clinic, for example, because due to the overweight chest the muscles of the spine will be in constant tension, and as a result, there will be a violation of the posture. This in turn leads to the progress of osteochondrosis, hernias and other diseases of the spine. In addition, the additional load has a detrimental effect on the joints.
However, breast surgery is the most frequent type of surgery in our clinic: I have already carried out more than 3000 breast operations. In most cases, the patients were girls from 18 to 25 years old.
Besides the breast operations, I have also carried out approx. 40.000 botox and filler injections and more than 3000 blepharoplastics.
– And how old is your oldest patient?
– 94 years old! We have no age restrictions – the main thing is that a person is healthy. However, of course, if comparing the patients, there are fewer risks at the age of 45 and the results will last longer.
– What do you consider the most important thing in your profession?
– The main principle of the doctor in any field of medicine is to do no harm. And in order for the patient to leave us satisf ied, he needs an individual approach. I have to take into account everything – age, circu msta nces of life a nd work, history, bad habits…. Personality traits should also be included. That is why a preliminary consultation is carried out: sometimes a few of them should be carried out. The key to success is a consensus to which the doctor and the patient arrive.
Dr. med. oec. med. MBA for PH. He started studying medicine in 1994. After graduating in 2002, he worked in a private clinic of aesthetic surgery in Dusseldorf and in general and vascular surgery at the Universitiy Hospital Zurich, then from 2004 to 2007 in the Department of Plastic and Reconstructive Surgery of the University Hospital of Zurich. In 2003, he trained at the American Society for Anti-Aging Medicine in collaboration with the University of Charleroi (Belgium). Since 2008 he has been the chief physician at the AG Preventive Center in Zurich, Zug, Horgen. Dr. Christian Kohler has over 13 years of experience in general surgery, as well as vascular, plastic and reconstructive surgery.