In addition to age-related changes, there are many aspects that can disrupt the harmony, which are often purely aesthetic, but can sometimes also cause health problems.
Perhaps you think that these disharmonies are only about appearance? Then we must correct you. Besides the sense of sight, other senses are often involved: Excessive sweating or bad breath affects the sense of smell, a crooked nose can also cause health problems and a dropping of our upper eyelids can cause us to lose our sight.
Often there are also disorders that are present from birth, which makes us wonder at what age such disorders can and should be eliminated?
In aesthetic medicine, there is actually an iron principle, namely that patients should be of age, i.e. that they can decide on their own lives. But as is the case with principles, they are usually not without exceptions. Adulthood is a legal term. The medical term is analogous to this, that the person who wants to be treated should be at least fully grown.
But even this medical principle has its exceptions. We would like to discuss this problem here in a little more detail. You all may still have a picture of Mikhail Gorbachev in mind. From birth he had a naevus flammeus on his forehead, popularly known as a fire mark. This disorder is the most common vascular malformation in children. During his time as party leader the naevus was often retouched away by party propaganda, later he came to terms with this disharmony very well. Today this malformation can easily be treated with a laser. It is not a big problem to remove it. Should one wait until the child comes of age to have it removed, and should one expect a more difficult childhood? Answer the question yourself. Apart from fire marks, there are a whole range of skin malformations, for example haemangiomas or blood sponges, which can lead to even greater disturbances of harmony, or larger moles in the wrong place.
Here is another case that shows the opposite: a 14-year-old boy came to the practice of a network doctor for treatment of his ear keloid. The keloid is a benign scar growth and was about the size of a cherry. During the conversation it turned out that especially the boy’s parents were interested in removal. The boy might have been concerned a little, but he did not really care. He had much more pressing problems, for example the next class test. A case for therapy? How do you judge the case? The doctor who was consulted refused treatment under these conditions.
We have presented these examples to you because we want you to realise that doctors must always evaluate the very specific individual case with the restriction that as many changes to the disharmony as possible should only be carried out once the patient has reached the age of adulthood. What disorders are we dealing with overall? We would like to give you a small summary here so that you can decide whether you belong in this patient group.
Disharmonies and malformations of the skin
This applies to all visible skin diseases and malformations such as those described above. This category also includes all visible scars, especially those types that can reduce a positive overall impression, such as hypertrophic scars (scar bulges), keloid scars (growth scars) and acne scars.
Too big, too small, too crooked, wrongly grown
Under this heading we can include in particular those disharmonies which are dealt with through operational procedures.
Breast enlargement (mamma or breast augmentation) is the most frequently performed aesthetic surgery. There are many reasons why it enjoys such popularity. It is important to us that the desire for such a surgical intervention must necessarily come from the person concerned. If the partner wants breast augmentation, this is not enough, the partner should also agree to it.
Nose operations (rhinoplasty) are often not performed for aesthetic reasons alone. Medical reasons often accompany the aesthetic procedure. Many different reasons can lead to a desire for change: Crookedness, size, fracture of the nasal bone or adhesions (hooked nose) can fuel the desire for change.
Breast reduction is also often not performed for aesthetic reasons alone. Too large breasts can lead to postural defects, which then cause chronic pain. But there are also many patients who simply feel disproportionate.
The laying on of big ears (otoplexia), for example, is a procedure that is often carried out at a young age to spare children the familiar abuses. Being cross-eyed, which can be corrected surgically today as well, also belongs in this category.
Further problems
We have already mentioned excessive sweating (hyperhidrosis), probably the most well-known olfactory disorder. Many patients feel uncomfortable when they become aware of the disorder, either because the familiar spots form in the armpits, because their hands are always wet or because others make them aware of the smell. It is important to remember that sweating is a very important body reaction. Only where it gets out of hand are therapeutic measures appropriate. For this indication there are a number of surgical and minimally invasive procedures.
Bad breath is a problem that cannot be solved by any aesthetic intervention. Here other disciplines are required to intervene to help.
Psychological disorders
Mental disorders can also lead to a poor self-image. If your poor self-image is caused by a psychological disorder (e.g. because you feel inferior), you should never judge this negatively. However, you should know that there is no aesthetic intervention that could offer a way out of it. Whatever you have changed aesthetically, nothing will help you to lose your bad self-image.
The medical indication
Whether aesthetic interventions in cases of physical disharmony are medically necessary is the subject of a broad discourse. Many skin malformations, for example, are covered by the health insurance companies, which always signals a social consensus that they are medically necessary. Conversely, there are some therapies that can offer actual help because of their study situation, but where the health insurance funds refuse to cover the costs, for example intralesional cryosurgery to remove keloids; simply because these therapies are not yet included in the relevant treatment guidelines. All other indications such as breast augmentation, for example, are not covered by the health insurance funds under any circumstances (except after mastectomy in cancer patients) and are therefore not considered medically indicated.
This is where the discourse and debate between aesthetically working doctors and all other doctors begins. After all, aestheticians are basically of the opinion that they should take the preamble of the World Health Organisation seriously and that there should be no distinction between medical and aesthetic indications. We would not like to deny here that in the case of serious illnesses such as cancer, for example, unrestricted acceptance by our health insurance system has a different meaning than if we “only” concern ourselves with making people feel better. We too can see the difference, which at first glance appears to be that on the one hand we are dealing with a life-threatening disease, while on the other hand the acute threat is not the main focus in terms of aesthetics. Nor do we want to be so presumptuous as to demand that the costs of aesthetic treatments be covered by the insurance companies.
Nevertheless, there is a need for debate here, because even psychological dissatisfaction – and this is shown by the increasing number of psychological problems – can ultimately lead to death, or at least to not feeling well. Those who feel committed to medical ethics, which is reflected in the preamble of the WHO – namely to help all people through medicine to achieve a state of complete health, as evidenced by the fact that one feels completely well – are on the right side, regardless of whether a society decides that such medical treatment is a private matter for patients and must therefore be paid for by them.