The era of undetectable injectables: The new treatments behind ageless faces

Last December 5, the dermatologist Radmila Dukian, founder of Lucia Clinic in Dubai, posted a picture of a make-up-free Lindsay Lohan on her Instagram account with the line, “Trust and confidence are the foundation of our relationship.” The post generated comments like, “I need the whole Lindsay Lohan pack” or “Oh my God, so you’re the one behind the secret glow everyone is talking about.” Since the summer, the various treatments the actress might have undergone to achieve her new look made countless headlines.

Over the last year, an increasing number of celebrities have been resorting to discreet treatments to achieve a look that defies the ageing process. Multiple online videos are trying to explain the protocols to achieve the undetectable era of beauty, which is just the opposite of the Instagram face characterized by frozen foreheads, XXL lips and obvious signs of the use and abuse of neuromodulators, fillers and filters. So what has changed?

Dr. Beatriz Beltrán, founder of the Beltrán clinic and the only Spanish member of the ISAC (International Society for Aesthetic Complications) explains, “There is a return to naturalness and patients want to look better without anyone noticing that they have undergone treatments. It is comparable to the discretion of silent luxury that prevails in fashion. Preventive treatments, which prevent the signs of aging from showing on the face, and correction without excess focused on maintaining the individuality and features of each patient, are on the rise. The patient looks better but can still recognize themselves in the mirror.”

Dr. Mar Mira, co-director of the Clínica Mira+Cueto agrees. “Patients ask for treatments that preserve their essence; they just want to look good, with a well-cared for and healthy appearance that is associated in general with lifestyle and a concept of self-care that translates into an increase in self-esteem, which in turn is flattering,” she says. “Years ago, aesthetic medicine was used only at advanced ages; today the age range has been greatly expanded. If we treat early, with a preventive approach, on the strategic anatomical points of the face – which are pinpointed with a facial analysis – we can improve someone’s look naturally and we will stop the signs of fatigue and future flaccidity.”

The rise of the natural look contrasts with the Instagram face that became ubiquitous online. Now, more and more people are getting rid of their excessive fillers. In the midst of all this maelstrom, the Spanish Society of Aesthetic Medicine (SEME) has just presented the campaign Tu cara ya no me suena – I no longer recognize your face – with the aim of identifying the typical mechanisms of malpractice in aesthetic medicine. So far SEME has found that 65% of treatments are performed by unqualified professionals, 20% are performed in unregulated beauty centers, hairdressers and even homes and only 7% of those interviewed know that techniques such as botulinum toxin infiltration or deep peeling are exclusively for medical use. Why have people been so exaggeratedly remolded?

“Years ago, the main objective of aesthetic medicine was to give volume and directly fill out wrinkles, without taking into account the overall structure of the face,” says Graziella Moraes, a doctor who works with Teoxane. “This led to unnatural results, with puffy faces and altered features. Today, thanks to the evolution of products and techniques, we understand that as we age, we not only lose volume, but also elasticity, luminosity and firmness. Now, instead of adding fillers in an uncontrolled manner, we work with a more refined approach, restoring the skin and stimulating collagen production for real rejuvenation.”

Dr. Ana Revuelta, a physician specializing in aesthetic medicine and director of the Renare clinics in Madrid and León, Spain, explains that patients are also changing and, in general, are not seeking an exaggerated look. “Young people want to improve the quality of their skin with injectable moisturizers and biostimulators; in middle age – from 35 to 50 years old – people want to rejuvenate with collagen stimulators and subtle facial harmonization techniques; and from the age of 50 upwards, they need a global rejuvenation that does not change their expression, consisting of a combination of personalized treatments.”

The downside of the undetectable era

But how does this ageless look affect our mental health? In a video, content creator Agus Panzoni states, “What comes after the Instagram face? Something much more disturbing. We have entered the undetectable era, say cosmetic doctors referring to the rise of treatments that are rejuvenating people. Cosmetic procedures are growing at record speed in younger and younger people seeking age-preventive treatments. While many celebrate this new era of stealth and invisible cosmetics, others fear that it will affect our vision of beauty.” As psychologist Buenaventura del Charco, clinical director of the online psychologist center Estar Contigo Terapia, says, “Looking ageless, or 20 years younger than our real age, generates a false idea of normality. Looking like this is not natural, but is the result of treatments and interventions. This creates unrealistic expectations about aging and how we look as we age. Older people have feelings of shame and guilt because they look so different.”

Skin health comes first

The road to naturalness is more complex than it appears and experts stress that to achieve it, it is necessary to add several protocols, because there is still no magic injection that helps us to rejuvenate. “First of all, the skin has to be healthy and this is achieved with a well-designed cosmetic routine, healthy habits with no tobacco or alcohol and a combination of treatments that include collagen inducers, biostimulators, different types of lasers, micro-focused ultrasound and radiofrequency with micro-needles to achieve a subtle and progressive rejuvenation,” dermatologist Carlos Morales Raya, creator of the Raya cosmetic brand and director of the Raya clinic in Madrid, explains to EL PAÍS. “All this must be combined with a diet rich in antioxidants, vitamins and essential fatty acids. Instead of seeking volume at all costs, we focus on improving skin quality, stimulating collagen and maintaining facial structure without transforming features, because in most cases the problem is not loss of volume, but flaccidity due to loss of dermal and fascial elasticity.”

Collagen inducers

As we age, collagen levels decrease resulting in the sagging of the oval shape of the face and flaccidity. That’s why many treatments focus on generating more collagen than we lose to create a reserve capable of slowing aging. “To increase the collagen bank, I recommend treatments with heat-based technologies such as HIFU, thermage radiofrequency laser treatment, fractional laser, and microneedling, which consists of creating micro-injuries to activate the healing process and collagen production, and the infiltration of biostimulators such as calcium hydroxyapatite, polylactic acid, polycaprolactone and platelet-rich plasma,” says Dr. Beatriz Beltrán.

New polynucleotides play an important role in the quest to achieve healthy, luminous skin with an even tone, without suffering the dreaded footprint left on the face by some medical-aesthetic fillers. “These are chains or groups of nucleotides, which are the basic units that form part of structures such as DNA and RNA, whose mission is to stimulate the production of collagen and elastin, cell renewal and improved hydration, without adding volume,” adds surgeon and aesthetic physician, Virtudes Ruíz.

A balanced approach to wrinkles and volume

Injectables continue to play an important role, but are now used with a strategic vision and in smaller quantities. This is the case with microbotox, which allows the face to move and only experience subtle tension. “We perform multiple injections all over the face of botulinum toxin that is very diluted and very superficial,” says surgeon and aesthetic physician María Vicente. “So we only treat the dermis and the dermal insertions of the facial musculature, to recover luminosity, elasticity and facial tension.”

So, have fillers become demonized? “Hyaluronic acid has gone from being a simple filler material to a true biostimulator of the skin,” says Dr. Morales Raya. “The new acids are more elastic, less dense, integrate better with the tissues and allow for more natural and expressive results. We also now have specific hyaluronic acids for different areas of the face, which makes it possible to personalize treatments to the maximum.”

According to Dr. Victoria Caballero, who works with Teoxane, “Ten years ago, we would see the wrinkle in the nasolabial fold and fill it directly with one or two vials or as many as necessary to remove it. The result was super-filled and exaggerated faces.” To avoid this effect, Dr. Mar Mira performs a facial remodeling with hyaluronic acid with very natural results: “We only apply it in strategic support points capable of attenuating the weak points and enhancing our features to make the most of our facial structure,” she says.

Dr. Beatriz Beltrán agrees. “I have been explaining for more than 15 years that flaccidity cannot be corrected only with volume injections. Hyaluronic acid is a basic and essential treatment in aesthetics. The problem arises when it is abused or used incorrectly. Especially in risk areas such as the angle of the jaw or bags around the eyes where often so many syringes are used, the weight of the material injected causes more sagging in the long-term. Now we apply it in other areas, such as the temples because if fat is lost from this part of the face, the effect is cadaverous. Filling them in a little bit gives a healthy, subtle and natural look that no one notices.”

New Injectable Moisturizers

Injectable moisturizers are becoming popular to address textural issues, dryness, fine lines or volume loss. “You can step up mesotherapy with skin boosters and vitamins, which are microinfiltrations of low cross-linked hyaluronic acid, which does not add volume, but provides a plumping hydrating effect to the overall appearance of the skin,” says Dr. Mar Mira. “The new moisturizers incorporate hyaluronics composed of two types of non-cross-linked hyaluronics, low and high molecular weight, at a concentration of 32 mgrs/ml. They have no support, projection or volumizing capacity. When injected into the tissue, they expand and lubricate the tissue due to their regenerative and hydrating capacity.”

Goodbye duck lips

The quest for plumper lips has been the holy grail for many. “In some young faces we observe alienation, a term which refers to faces with over-projected cheekbones that give the appearance of an alien, very voluminous lips and an exaggerated profile, none of which is integrated in a natural or harmonious way,” says Mira. “These faces are still seen on social networks, although, according to our criteria, without harmony there is no beauty.”

Dr. Morales Raya adds, “The focus now is on restoring hydration, defining the contour and improving the symmetry of the lips discreetly. So we use softer hyaluronic acids with better tissue integration, which respect the natural mobility of the mouth. We are looking for a more subtle and flattering result instead of excessive volume.”

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