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Can you tell us a little about yourself?

Roland Ney: (looking at Luigi Polla with a smile) Do you want to start?

Luigi Polla: No, you start.

Roland Ney: Right. So, I’m Dr Roland Ney, with a background in general internal medicine. I have a wide range of professional experience, having started out in tropical medicine and population genetics in Indonesia, before returning to internal medicine. I then opened a practice near Lausanne where I practiced general medicine and acupuncture for 20 years. It was through acupuncture that I turned, in spite of myself, but to my great delight, to aesthetic medicine. From the ’86s onwards, I initiated acupuncture treatments with gold needles to tone facial skin. My patients were very happy and came every three months. I was then naturally drawn towards the treatment of wrinkles, particularly with the appearance of beef collagen on the market in the 90s. That’s how I started injecting myself into the field of aesthetic medicine.

Luigi Polla: Impressive. For my part, I’m a dermatologist, with a sub-specialty. On my return to Switzerland, I set up Europe’s first real laser platform, which enabled me to treat many children suffering from angioma planus, those red spots on the face, as well as tattoos from that era. I got into aesthetic medicine by chance, treating facial dyschromias, whether vessels or pigmentation. I then decided to set up my own clinic, dedicated to aesthetics, while continuing to practice dermatology part-time. A few years later, I became scientific co-director at IMCAS. Together with my friend Roland, we founded the Society of Aesthetic Medicine and Surgery, with the aim of exchanging ideas and advancing our knowledge of medicine.

When was your first experience of aesthetic medicine?

Roland Ney: For me, it goes back to aesthetic acupuncture treatment. We didn’t treat disease, but took a purely aesthetic approach to improving skin quality.

Luigi Polla: As a dermatologist, I began by sclerosing small venules on patients’ legs. That was before 1986, before I moved to the United States. On the way back, I injected beef collagen, just like Roland. My first injections date back to 1986. And thanks to the laser, I started to remove things that weren’t aesthetically pleasing, even though at the time I thought I was just doing dermatology.

Roland Ney: Our core business has gradually been overtaken by aesthetic medicine. As time went by, we could see that this field was becoming increasingly complex, and we had more and more organizational tasks in our clinics. Gradually, our basic treatments, such as dermatology for Luigi and general medicine for me, became less important in our practice than aesthetic medicine.

What were the milestones that led to the modern aesthetic medicine we know today in 2023? And the modern use of lasers in aesthetic medicine?

Luigi Polla: I’d say that the big changeover from almost archaic aesthetic medicine to modern aesthetic medicine came with the arrival of hyaluronic acids on the botox market and lasers capable of specifically eliminating certain unattractive features.

Roland Ney: You have to realize that, in the 80s, aesthetic medicine was in its infancy. No one was interested in her, and dermatologists, apart from Luigi, were extremely uninterested. They said: “This isn’t medicine, it’s business, and we’re not shopkeepers”. So basically, it developed as techniques and the industry became interested in the subject, seeing the development that could come later. While conventional medicine has been around for generations, aesthetic medicine has not. So aesthetic medicine, I’d say, isn’t even 50 years old. She’s more like 35.

Luigi Polla: In the beginning, nothing was structured. We were learning from each other, weren’t we? As I said earlier, these three elements have enabled us to have far fewer side effects. It was really if we acted according to the art of aesthetic medicine and medicine, we avoided as many side effects as possible. And this has helped to popularize aesthetic medicine with the entry not only of the industry, but also of the media. The media, all of a sudden, have, I don’t know if you’ve said it, but they’ve taken an interest by becoming positive about aesthetic medicine, understanding that it’s a social phenomenon. And that was a big step forward. Then, I’d say there was also a better understanding of anatomy at all, of the face and aging, of the anatomy of aging, how a face ages, and so on. This, of course, thanks to the involvement of a huge number of researchers and anatomists, as well as medical imaging and all that, has exploded.

Can you tell us about the history of fillers?

“There was even something we didn’t see in Europe, but that was collagen from human cadavers.”

Roland Ney

Roland Ney : So fillers started with beef collagen, there were two or three other attempts with pork collagen, there was even something we didn’t see in Europe, which was human cadaver collagen that wasn’t a success, but was never introduced in Europe. After a decade or so, collagen was replaced by HA, which has not yet been dethroned. Then there are molecules that are not absorbable that have appeared on the market and continue to be used. Maybe it’s getting better and better, because we now have a better understanding of the dilutions we need to use, and there are fewer side effects. So it’s a gradual diversification, because the industry has developed hyaluronic acids for the different objectives we have in facial treatment, for the different planes we want to treat, for the different goals, i.e. if we want to stimulate collagen production or if we want to improve volume loss, they won’t be the same products. Botulinum toxin has been used in the United States since the 1980s. It was an American ophthalmologist named Scott who discovered the toxin’s relaxing properties, and it was used in ophthalmology to treat strabismus. The toxin then developed with different indications. A new indication has emerged for the treatment of perspiration. There have been many, many indications for internal medicine and even now, more than half of the toxin used worldwide, i.e. more than 50% of toxin, is used for medical treatments and not for cosmetic treatments. The quality of the toxins has also improved. A very small number of laboratories manufacture high-quality toxins. So it remains a very specific niche, but that’s it for injectable products.

Can you tell us about the history of lasers?

“There was the great revolution brought about by Rox Anderson explaining the concept of selective photo thermolysis, making it possible to destroy a target inside the skin without destroying the rest of the tissue.”

Luigi Polla

Luigi Polla: Up until then, we had continuous emission lasers, which meant that you pressed the pedal and the laser emitted a beam of light that didn’t stop, and finally produced heat. For dermatologists or those involved in aesthetic medicine, it wasn’t so interesting because everything was burnt. The only people who have benefited from these continuous-mode argon lasers are ophthalmologists. Then came the great revolution brought about by Rox Anderson, who explained the concept of selective photo thermolysis, enabling a target inside the skin to be destroyed without destroying the rest of the tissue. This was thanks to a precise choice of wavelengths and the introduction of new lasers with very short pulse durations. This kept the heat inside the target. That was the great revolution. And then came other devices such as focused ultrasound to microlift the skin, radiofrequency to firm the skin, shockwaves to break down cellulite fibers, and cold to eliminate fat panicles, enabling great advances in aesthetic medicine.

In all your years of practice, do you have any offbeat anecdotes?

Roland Ney: “Oh, oh, we’ve got several, I think, I’ll tell you two. One, it was my first conference, I think, on aesthetic medicine. It was in Brussels and I didn’t quite realize what laser treatment entailed. And there was the whole audience. And then we say if there’s an involuntary who wants to come, we’ll do a small vessel treatment. So I raised my hand and stretched out. And then they started treating me, and then I could see all the faces above me saying oh, ah, oh like that, oh there there. And then I didn’t quite realize what was happening at the time. And then when I came out and looked in the mirror, my cheeks were completely purple because it was a laser that produces purpura, which means it blows up the vessels. So I had a huge hematoma on both cheeks that took a good 15 days to fade.

The second, sadder anecdote is about a patient who asked to see me a few years ago, two years ago I think, saying “I had injections in the under-orbital area two months ago. Since then, I’ve lost my vision, and I’d like you to give me hyaluronidase”. I said okay, come on, let’s have a look. She came. She said, “Well, I’ve seen another doctor who’s already put me on hyaluronidase and then it got a little better for a week, but it didn’t go beyond a week.” And then I examined him and after my examination, I said to him, “Look, what you have is unrelated to HA. You have symptoms that are absolutely not normal and not compatible with HA” because she had a squint that she didn’t have before. “And you have to do a magnetic resonance. And it’s inside the head that you have to see if there isn’t something.” And indeed, she had a very large brain tumor. So, just to remind doctors who are future or present aesthetic doctors that we must always be doctors first and always think, on the one hand as doctors, i.e. isn’t there another diagnosis behind it, and on the other hand, not to carry out treatments that would be either useless or to the detriment of patients’ health.

Luigi Polla: Let me tell you an anecdote that has nothing to do with the practice of aesthetic medicine. My first assistant, a doctor, came to my institute to learn the profession she now practises. When she was hired, she only made one request. She said “I’d really appreciate it if you didn’t tell anyone I was coming to work for you”. Surprised, I asked why. She says to me: “You know, you’re the ‘black sheep’ of dermatology, and people say that aesthetic medicine is like being a hairdresser. That was in ’97, so not so long ago.

What would you recommend to a doctor wishing to enter this specialty?

Luigi Polla: I’d say that aesthetic medicine, like any other branch of medicine, is an art based on science, an aspect that we perhaps tend to forget a little too often in aesthetics, unlike other medical specialties. In addition, as Roland pointed out, it’s essential to remember our Hippocratic oath and keep in mind that, in every gesture we make as aesthetic physicians, we must always prioritize this ethical commitment.

Roland Ney: I’d like to add one more thing: aesthetic medicine has become so complex that, to practice it satisfactorily for the patient, you have to devote yourself entirely to it, or practice it alongside a specialty such as dermatology. However, I don’t see how aesthetic medicine could be a complementary activity for specialists in gynecology or urology, or in other medical fields. So, for a young doctor attracted to this field, I’d recommend diving in if you’re seriously considering making it your main profession, or at least the major part of your professional commitment. Devoting just 5% of one’s time to it will never bring the results patients have a right to expect.

Luigi Polla: I couldn’t agree more. As in any business, to succeed, whether in medicine or any other field, you have to give 100%. That’s how you succeed, achieve great things, and feel proud at the end of each day. Indeed, after a certain period of time, which may seem relatively short, total 100% commitment leads us to excellence in our practice and in achieving our professional goals.

Roland Ney: And as for giving 100%, I have an anecdote, because in the ’95s, I think, I sometimes went to see Dr. Polla when he was in his practice at Place Cornavin. He had this peculiarity, starting work at six in the morning and continuing until ten at night. So he’d tell me, “You can come if you want, so come between 6 and 9 or between 7pm and 10pm.” Thus, Polla’s 100% commitment was actually closer to 200%.

How do you see the future of aesthetic medicine?

Luigi Polla: Let’s say, based on the history of how aesthetic medicine has evolved, it’s very difficult to say because, in fact, things happen that we didn’t expect. But we can imagine that genomics, for example, will certainly enter our profession and perhaps take away a large part of our work because we’ll be doing interventions that are more medicine, I’d say, almost internal medicine, with the pharmas introducing molecules that will enable tissue regeneration. And that, in any case, is not with the products we now have. We can, of course, partially regenerate tissue, but we’re a long way off, maybe 5%-10% of what we’ll probably be able to do. And if not, the other thing, what could come into play, is artificial intelligence, as in all other branches, in all other professions, with these devices that will enable us to analyze our patients’ faces and tell us what brilliant things we could do. And even after robotization, we won’t even be told what to do. Of course, it will be the robot that does it, but the human being will always be there. The doctor will always be there to keep an eye on things. But I think it would help us a lot if we were to, I think in the next couple of years, have a big development of artificial intelligence in our field.

Roland Ney: Artificial intelligence and 3D imaging are going to revolutionize things. In my opinion, a significant proportion of aesthetic medicine will no longer be practiced by doctors, but by other healthcare professionals who will be trained or will be trained by robots. The current state of affairs, where it’s virtually all doctors who work in this field, will change in my opinion, because it’s in society’s interest to reduce costs and it’s above all in the industry’s interest to have more people or more machines performing these aesthetic medical procedures. So, I think there will be quite a big change in the panorama of players in aesthetic medicine. That’s why doctors who want to get involved now need to have very solid training to stand above all this variety of gestures performed by machines, robots or non-physician collaborators empowered to perform treatments.

Luigi Polla: Yes, I have an anecdote on this subject that made me smile a week ago. My 11-year-old grandson, Leonardo, said to me, “You know, Papou, I’ve been talking to Mom about going into dermatology because I want to take over from you when I’m older.” I’m not going to tell you the rest, but I told him: “You know, if you want to go into dermatology, you won’t be set up until you’re 40. And above all, you’re going to study medicine first, and then, at the same time, you’re going to do a master’s at EPFL or another big school like MIT, and so on. Because the future is not going to be in the hands of the ordinary doctor.” That’s exactly where we’re heading. Indeed, I think that if you’re a young doctor still in training, you should take an interest in what’s being done in the humanities and also in the technical sciences.

Conclusion

This interview with Dr. Roland Ney and Dr. Luigi Polla, two pioneers of aesthetic medicine, plunges us into the roots and evolution of this fascinating discipline. Their dialogue reveals an innovative journey marked by passion, exploration of the limits of aesthetic medicine, and a relentless quest for improvement. These personal and professional stories highlight not only the importance of solid training, but also the need for an ethical and dedicated approach. Their vision for the future, where technology, especially artificial intelligence, will play an increasingly important role, underlines the crucial importance of staying at the forefront of progress and innovation. The interview, rich in anecdotes and insights, is a powerful reminder that in the field of aesthetic medicine, as our interviewees emphasize, if one chooses to engage, one must do so with excellence and integrity.