Hitting cinema screens today, The Substance features Demi Moore playing a 50-year-old celebrity suddenly fired from her job as the star of a TV fitness show. When offered a cell-replicating substance that promises a younger, better version of herself, she goes for it. The movie puts a spotlight on our youth-obsessed culture, on our fixation with achieving unrealistic beauty standards — earlier this year, the global aesthetics industry was estimated to be worth €54bn.
Here too the industry is booming, with record numbers looking for cosmetic treatments. “Women have always wanted to look as youthful and beautiful as they can,” says Prof Caitriona Ryan, consultant dermatologist at the Institute of Dermatologists and clinical professor at UCD. What has changed, she says, is the increased normalisation of cosmetic treatments.
“They’ve become more commonplace and affordable. They’re not taboo anymore, especially in younger generations, who talk about getting anti-wrinkle injections in the same way as they talk about getting their hair done.” Dr Rosemary Coleman, consultant dermatologist at Blackrock Clinic, points to a very visual world, where we’re constantly being photographed.
“And we’re living longer. We’re in the workplace for longer. I often have patients coming in their 50s, who’ve been perfectly happy with their appearance all their life, but now the youngsters are coming into the workplace all glammed up and botoxed, and the 50-year-olds are saying, ‘I don’t want to be the old person in the corner’.
” A consultant ophthalmic surgeon at University Hospital Waterford, Dr Janice Brady has a special interest in medical aesthetics and practices privately at Eye and Face Clinic. Most of her patients are aged 40 plus. “For them, it’s about ‘I look tired, I want to look more rested’.
They want something more discreet. But there are younger patients too who are driven by algorithms on Instagram, by filters, by Love Island , by what they see in the online world.” Brady says older age groups are also increasingly seeking cosmetic procedures.
“There’s definitely an age when people wouldn’t consider it — women in their 60s will, in their late 70s they won’t really — but the age is getting older.” Botox brides Google ‘aesthetic wedding packages’, and you will find offerings from ‘resurfacing skin peels’ to ‘LED Light facials’, from ‘SkinPen microneedling’ to ‘wrinkle-smoothing injections’. “It’s pretty common for brides to come — people want to look good for their wedding,” says Dr Isabel Haugh, consultant dermatologist at the Institute of Dermatologists.
“I have a fair number of brides. I like them to come a year in advance. A lot of mothers-of-the-bride come too.
” Haugh, whose patients are mainly from mid-30s to 70s, believes beauty has been integrated into health and wellness. “I see a lot of women after they’ve finished having their families — they’ve been very focused on their children. Now they’re turning to their own self-care and skin treatments.
” Haugh details why her clients seek aesthetic enhancement: “A lot are bothered by the lines, the volume-loss that comes over time, which can make you look tired, by colour changes and brown spots that appear.” And while different people have different aesthetic goals, “the majority want to look natural and to feel the best version of themselves.” Among the less invasive procedures — tightening treatments and lasers — Coleman finds Intense Pulsed Light Therapy one of the most popular (prices start from €150).
“It improves complexion, reduces pigmentation and broken blood vessels, stimulates collagen and gives a radiant glow. It’s very popular with people who have rosacea or weathered Celtic skin — and among those who don’t want anything too invasive but just want their skin looking good.” She cautions, however, that in the hands of an untrained, or inadequately trained practitioner — or if the machine has not been properly maintained — burning and scarring can occur.
Over the past year, Brady has seen polynucleotides, a new skin-refining treatment, as “a game-changer” for boosting collagen and improving skin quality. “It stimulates fibroblasts in the skin, the regenerative cells that make collagen and elastin. These are the skin’s building blocks, which deplete as we get older.
” The usual recommendation, she says, is three treatments, two weeks apart, with another maintenance treatment six months later. “” Other than temporary bruising, it’s minimally risky. Brady charges €220 per session of polynucleotide.
Ryan finds anti-wrinkle injections (Botox) very popular. “There was a time when people did it in their mid-30s to 40s. Now it’s from mid-20s to mid-30s.
Most brides are doing it ahead of their wedding.” A treatment that should last three to four months for most people, it comes with a wide-ranging price tag – from €250 to €650 or €700, depending on the number of areas treated. Ryan says the aim is always to enhance the person’s beauty without making them look unnatural.
“If people can’t move their forehead, they look less attractive and engaged.” Brady cautions that Botox — anti-wrinkle injections — is a medical procedure, not a facial, and risks need to be explained to patients. “Bruising is the big risk but there are ways to minimise it.
And if the anti-wrinkle toxin travels, you could end up with temporary double vision or lip drop — in experienced hands this should happen very rarely.” And while patients might want anti-wrinkle injections, it is not always what their face needs, says Brady, who often “talks people down” to less than they had envisaged. “For a very expressive person with deep-set hooded eyes, giving anti-wrinkle toxin on the forehead can [give them] very heavy brows.
That won’t look well, and they won’t feel right.” Coleman is blunt about what can go wrong with Botox. You can look very weird and frozen, eyebrows peaked, mobility very reduced — too much around the mouth may mean you won’t be able to articulate properly, too much on the forehead and you can look like a boiled egg.
But while botulinum toxin A is a prescription medicine that can only be administered by qualified doctors and dentists, she points out that dermal filler, an equally invasive treatment, is not subjected to the same stringent regulations. Most commonly, fillers are made from hyaluronic acid, a sugar naturally present in skin and joints that depletes as we age — fillers are used for volume-enhancement in the face. Depending on the patient, they should last about 18 months.
“Fillers can cause far more harm than Botox,” says Coleman, adding that the drawbacks of any treatment depends on who’s doing it and how they are doing it. “With filler used by untrained hands, unwanted results can include a very artificial distorted look, with lumps and bumps — a blood vessel could be blocked, causing scarring and blindness. Ensure you go to somebody whose work you’ve seen and who comes recommended and trained.
” Dangers of filler and Botox A mum of two primary school girls, Brady is concerned about very young women getting fillers to look like social media queens. “They don’t realise these celebrities go monthly to get tiny incremental amounts to build their lips up. This costs a fortune — at 19 or 20 most women don’t have that kind of money.
“When filler is given with attention to fads – with the wrong technique, in the wrong place, in the wrong volume, you can end up with a snatched jawline or very big lips. What’s this going to look like in 10 years’ time?” Underlining the importance of doing “a proper medical mark-up” pre-administration, Brady explains: “I won’t inject filler in someone with an autoimmune condition — there can be an immune response. Has the person ever had a reaction to anaesthetic? If they’re on strong blood thinners, do they want to be getting injectables? “And if they have an infection, like a UTI, filler can collect around bacteria in the blood, forming a nodule on the face.
” The consequences of poor use can be even more serious if the practitioner is uneducated in facial anatomy. “If injected into a blood vessel, there can be loss of blood supply — skin tissue death. If injected into a blood vessel supplying the eye, there’ve been reports of blindness,” says Brady, adding that too much filler in the lips “can distort the architecture in the long-term”.
Fillers cost anything from €250 per vial, with Ryan confirming that a top-end filler can cost €650 a vial. For Coleman, people “typically, justifiably” start to notice signs of ageing in their mid-30s to 40s. “That’s an understandable age.
What’s not understandable is a 25-year-old talking about lines under their eyes, an 18-year-old wanting Botox. What’s worrying is young women being told the sooner they do Botox, the more likely they’ll prevent ageing — which is absolute rubbish. “Doing Botox early, you’ll have a higher chance of antibody formation.
So when you’re 40 it may not work anymore.” Why ‘tweakments’ are popular is because people don’t want to go “under the knife” unnecessarily, says Ryan. “Life has got a lot busier — people don’t want to take time off work or give up annual leave.
” Brady finds the term tweakment minimises the procedure being done. “It’s a disservice to what you’re doing to your face. Sometimes people pay more attention to the person servicing their car than to the person treating their face.
Look at the qualifications of the practitioner treating you, the quality of products they’re using on you. “If in doubt, you shouldn’t feel under pressure to get any treatment done. And if you can’t afford to go to somebody who knows what they’re doing, don’t do it at all.
Use your money on skincare — on sunblock and retinol.” The Substance described as a ‘body horror’ movie, we might take some comfort from what Ryan has to say: “I think there’s a pendulum shift back to natural. I’m hoping the era of grotesque-looking lip fillers, for example, is going away – that people are looking for natural looks rather than those strange, robotic, overfilled faces.
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