Even very young people want to have aesthetic procedures carried out

Interview with Nathalie Benelli, Walliser Bote

Laurence Imhof, you are the first woman to be appointed Head Physician at the Dermatology Clinic at the University Hospital in Zurich. I take it that wasn't a walk in the park?

It certainly wasn't a walk in the park. Women are still very much in the minority in management positions at university hospitals in Switzerland. 80 per cent of management positions are held by men.

Do you see yourself as a role model for young female doctors?

I hope that my example will encourage young female doctors to actively formulate their interests and express where they see themselves on the career ladder. During my training, I had good superiors who recognised my interests and gave me the opportunity to develop further. For example, I was able to complete fellowships in the USA and Asia, where I deepened my knowledge of dermatological laser technology and aesthetic dermatology.

You decided to specialise in dermatology/venereology. What does this field specialise in?

Dermatologists deal with the skin in general, mucous membranes, skin appendages and also venereal diseases. Venereology has nothing to do with veins, but with sexually transmitted diseases. In addition to hair and nails, skin appendages include sebaceous and sweat glands. Intolerances and allergies also offer points of intersection with dermatology.

Is specialisation necessary with so many areas of responsibility?

Dermatologists in private practice tend to deal with all aspects of the speciality. When it comes to more complicated cases, they tend to be sent to a centre such as the dermatology clinic at a university hospital. At a university hospital, they tend to deal with a speciality.

How would you describe your speciality?

I specialise in the interaction between the skin and various types of electromagnetic radiation. On the one hand, these are rays in the visible and infrared range (laser medicine). Others are UV rays or high-energy X-rays. I specialise in the therapeutic application of these rays on skin tissue. But that is only part of my specialisation.

What else is involved?

I also specialise in aesthetic dermatology. This includes treatments with botulinum toxin or fillers. Reducing blemishes and improving wrinkles is also typical of the work of a dermatologist. I also correct unsuccessful aesthetic procedures. The laser surgical reduction of scars and dirty tattoos after accidents or vascular anomalies in congenital defects also fall within my area of expertise.

So you also correct mistakes caused by others?

Yes, and this is becoming increasingly common.

Why is that the case?

On the one hand, aesthetic procedures are generally on the increase. However, not all providers are sufficiently trained to carry out aesthetic treatments, or they are not practised enough. There are providers who have no qualms about carrying out such procedures anyway.

Can all mistakes be rectified?

No, unfortunately not. For example, not all fillers can be reversed or dissolved. We therefore try to improve the result in other ways, but this is very difficult. You can improve scars, but you can't make them disappear.

What do you think is the reason for the increasing demand for aesthetic procedures?

Even very young people want to have aesthetic procedures done. They often see pictures of seemingly perfect people on social media. These images are often edited and don't correspond to reality, but many young people don't realise this or ignore it. They then emulate a certain ideal.

So aesthetic interventions are a means of getting close to this ideal?

That is the case. Thanks to the media, we know that many interventions are possible. And what is possible is also in demand. That's a dangerous tendency. People think they can achieve anything they want. People no longer accept themselves as they were created to be.

Are there any treatments that you reject?

When young women at 16 or even younger want an enlarged lip or other filler treatments to look like a certain actress, I say no. But then they often find someone else to do it. This often leads to complications. Only a few very young patients come to me for aesthetic procedures. I don't think I attract them. Finances also play a role here.

How would you describe a typical aesthetic dermatology patient?

They are middle-aged women, around 35, 40 years and older. Treatment of men tends to increase. Men tend to come for redness, scars or coarsened skin. The range of treatments for women is wider. It's often about pigmentation removal, rejuvenation and wrinkle reduction.

Are there treatments for which you are too old at some point?

Yes, if the skin is too saggy or wrinkled and the ageing process is too advanced, you can no longer correct everything with aesthetic procedures such as botulinum toxin type A, fillers or lasers. Surgical measures have to be suggested and plastic surgery recommended.

How would you describe healthy skin?

Healthy skin shows no cracks and is not reddened. It does not flake and has no spots. Healthy skin is even and smooth.

In addition to your extensive medical training, you also have a Master's degree from ETH in medical physics. What role does physics play in dermatology?

Laser medicine is based on physics. The basis of the X-ray surface therapies that I use to irradiate tumours is pure physics. The interaction of these light waves with matter or human tissue is based on the laws of physics. I wrote my habilitation thesis in this field and obtained my venia legendi in dermatology, specialising in physical therapies. At some point, I asked myself why we should always do everything the way it has been done for decades.

You wanted to know more?

Yes, medicine is also based on experience, but I wanted to know more about the background. At the university hospital, I reached a point where I almost started to get bored. I was the expert being questioned, but I couldn't learn much new. My brother-in-law, who was also studying at ETH, drew my attention to the medical physics programme. I applied and got a place on the programme. I did the programme while working.

What medical conditions are treated with electromagnetic radiation?

I use high-energy X-rays or light beams to treat patients with skin cancer. Photodynamic therapies and surface X-ray therapies are used for white skin cancer, for example, which is difficult to operate on due to its size or critical anatomical location such as the nose, eyelid or ears. In aesthetic dermatology, pigment spots, dilated blood vessels, various scars or hair can be treated with lasers.

How old are the youngest skin cancer patients?

We have noticed that patients are getting younger and younger. Skin cancer often occurs around the age of 40. We also see very young patients with black skin cancer.

What role does the sun play in the occurrence of skin cancer?

The damage that the sun causes to the skin is cumulative. They accumulate over decades. This does not happen overnight. The damage manifests itself step by step.

Despite all your knowledge about the harmfulness of solar radiation, do you personally still expose yourself to the sun?

I don't sunbathe and I don't tan. I use skin creams with a high level of sun protection and wear a sun hat and sunglasses when I'm out in the sun.

Patients who are tired of their tattoos also come to you. Do you make all tattoos disappear?

Various factors play a role here. Not all colours can be removed in the same way. It's not so easy with turquoise or yellow. There are now newer lasers that can do a better job, but it is still difficult. Then it depends on the localisation of the tattoo. It takes longer on the ankle than if the tattoo is in the centre of the body. It also plays a role whether the tattoo was done professionally or whether it was the result of an accident. Accidents, explosions or bicycle crashes can also result in foreign objects getting under the skin. These are then unwanted tattoos.

How many sessions does it take to remove a tattoo with a laser?

For large professional tattoos, it can take 10 to 20 sessions, sometimes even more. Removing a tattoo is more expensive than getting one.

What happens to the skin during tattoo removal?

The laser causes nothing more than a small explosion in the skin. This shatters the particles of the foreign colour that are in the middle or deep layer of the skin and makes them smaller. Some of them can then be removed via the lymph and some via the surface. But some is stored in the skin again. This is why it always takes several sessions. Once a tattoo has been treated with laser, it no longer looks beautiful. You have to go through with the treatment or leave it alone.

In winter, the skin is stressed by dry rooms and low temperatures. What does good skin care look like in winter?

Basically, you should moisturise your skin more. It is advisable to use products that retain moisture in the skin for longer and to moisturise regularly. Body lotions with lactic acid or urea are a good choice. The production of sebaceous glands decreases in older people. You need to use richer, oilier creams. In summer, when it is hot, a lotion with a higher water content or a lighter cream is sufficient.

Is it possible to over-care for the skin?

You can. We often see this problem in women. A rash around the mouth with redness and spots is typical. This type of skin condition can indicate over-care. Sometimes too many different products are used on the face. Less is sometimes better. A moisturiser tailored to the skin is often sufficient. In spring and summer, I would make sure to use a high sun protection factor. I also recommend a sun protection factor of 50+ in winter in the mountains.

What is special about the skin?

The skin is the body's largest organ and its protective covering. It is almost 2 m2 in size and weighs ten to 20 kilos, depending on whether you include the fatty tissue. The skin is always exposed to the environment. It offers a certain degree of protection against sunlight, injuries and infections. The skin regulates body temperature through perspiration and can produce vitamin D. It is a sensory organ and reacts to heat, pressure and pain - which is why it should be cared for and protected.

As a dermatology specialist, you regularly appear in the media. What is particularly important to you in this public relations work?

It is important to me to dispel untruths and myths and to provide information about the real situation. For example, I recently appeared on a programme about anti-ageing creams. These products are popular and promise a lot. But you have to realise that the promises they make are largely unrealistic. It is important to me to point out and clarify what is evidence-based and where the scientific evidence is insufficient.

So if a 60-year-old has skin like a 30-year-old, has she done more than apply a good moisturiser?

Yes, or she really hasn't seen much sun. The sun is the most important factor that you can influence. Over time, sun exposure causes spots and precursors of skin cancer and wrinkles. If you want to do something about skin ageing with creams, you should use sun cream. They really work to block some of the rays. This is often not the case with other products. For example, if the active ingredients are not concentrated enough or are unstable, they no longer work.

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