Aesthetic medicine, and the dangerous consequences for our health. Episode 99

Mariusz Borkowski
More. I also see people so ageless that I look at myself and completely have no idea how old someone is. If a mum is already bringing a girl of that age for a lip augmentation procedure, it means that we are already generating this inception, something instilled in my brain that I am not perfect if my parent is offering me a procedure. I call it like a juicer juicer, that we want to squeeze this collagen production out of them, because collagen is 70% of this protein that builds our skin. Sometimes it's these soft stimulators that are better for certain patients, because we don't need to use a cannon straight away to do a certain treatment, but we can use this stronger stimulation for a certain group of patients. Somewhere there is some sense that we must and should take care of ourselves, but when it becomes an obsession or even an illness, that is the moment rather to see either a psychiatrist or a psychologist.

Monika Rachtan
Hi Monika Rachtan. I would like to welcome you very warmly to another episode of the programme. Firstly, we associate aesthetic medicine with beauty, with making ourselves look good, but we must remember that the use of aesthetic medicine can also have dangerous consequences for our health. And this is what I will be discussing today with Dr Mariusz Borkowski, MD. Welcome. Doctor, welcome. At the very beginning I would like to ask you if it happens that a patient comes to you and you at the outset say no. Interpreter.

Mariusz Borkowski
This happens very often because patients very often have a very misguided belief in the potential of the effects of aesthetic medicine. Very often they are treating with aesthetic medicine their emotional problems, sometimes psychological, sometimes what is happening in their private life, in their relationship with their partner or with their family. And this results in a distorted view of their body and themselves as a person.

Monika Rachtan
What happens in such a situation when a woman or a man comes to you? Because somewhere we associate aesthetic medicine primarily with women, but we know that men also use it and can also just go overboard. When a patient comes to you and says that he would like to have something else done, another thing, you open the patient's card, see that so many things have already been done and simply look at him and say that absolutely no more can be done. So what does that kind of conversation look like to you? Do you sometimes hear unkind words, patients getting annoyed, slamming doors, leaving the surgery?

Mariusz Borkowski
I mean, with me it is the case that I run my own aesthetic medicine practice and I have very few of these problems, because the patients who come to me are patients who want to work with me according to some complete vision of my work on that person's beauty, or on their well-being resulting from what we can achieve with aesthetic medicine. In the case of patients who sometimes come to me as a result of working in other surgeries around the country, well, in this case the patients experience a very strong push to have this procedure done. The record-holder was a patient who sent me more or less probably 60 pictures of her face from shots of various that were. I got the impression that every second was shown and the lady was very much expecting impossible results. And it was also very interesting, because the patient said to me, 'Sir, you can't give up on me, I'm giving up on someone', and that already showed that it was the right decision to refuse the procedure.

Monika Rachtan
You said about the record-breaker who sent you 60 photos. And you still remember.

Mariusz Borkowski
There were a bit more of these pictures. Only 60 - it was probably from two or three minutes of her life. So imagine how unhappy someone is sometimes who has so much time to look at themselves in the mirror. And I have to say that it is when we spend so many hours. I can see exactly everything. But the other day I was riding in the lift with my wife and I said Listen, I see some here, I've got grey hair, and my wife says You've had it for six years, and I sort of didn't even pay much attention to it. Whereas, well, somewhere there's a certain sense that we need to and should take care of ourselves, but when it becomes an obsession or even an illness, that's a moment rather to see either a psychiatrist or a psychologist.

Monika Rachtan
And you also happen to send patients away from your practice with this diagnosis. They said you have laid back, decent patients who don't behave in this way. But have you had situations like this?

Mariusz Borkowski
I have heard about such situations very often. I personally only once suggested to a patient that she should see a psychiatrist and, surprisingly, the patient behaved very sensibly, because she said that she felt that she had a problem with it and she thanked me for pointing it out and simply, well, there really wasn't that much need for such medical interference in the area of aesthetic medicine and, well, just a visual disturbance. And this, unfortunately, is a problem that is caused by many factors. First and foremost, very young people are exposed to comparisons to various social media people. If we are bombarded with so-called ideal bodies, ideal faces. Of course, there is no such thing as an ideal person in appearance and in character, but in general, when we are bombarded, we are unformed persons. This generates huge complexes in us. And these complexes are unfortunately very difficult to get rid of. And my experience in life is that the more beautiful a woman is and the more valuable she is, the bigger the problems and complexes she has, which I can't understand as a man, and as a doctor I have even more of a problem with, because I don't understand what the assumption is.

Mariusz Borkowski
In contrast, those people who gain the most are the most effective at work, reach the top of their careers and have the greatest opportunities in front of them, have the greatest problems with their appearance. And there was even a book called Obsession with Beauty about this, that book was just based on a lot of examples of scientific research from the United States. That these female principals who were subjected to cosmetic medicine treatments later in life precisely because they were in their prime at Stanford and other top universities, they were the ones who later had the biggest complexes about their appearance and they spent a relatively large amount of time later on improving that appearance completely unnecessarily.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content, subscribe to us on YouTube and Spotify. Monika Rachtan. Invited.

Monika Rachtan
But, you know, maybe it's also that it's this stress, this career, all these stimuli that these people in high positions face, that influence them to have this mood deterioration and some people get depressed. For some, depression or some kind of disorder manifests itself in such a way that they are out of touch, that they can't focus on their work, that they close themselves off at home, and these people simply have such a symptom that they start going to the aesthetic doctor And what else? They can afford to have a lot of these treatments.

Mariusz Borkowski
I wouldn't put depression here, because in this, in this area, because it's a very serious psychiatric disorder, which doesn't really have any connection to our appearance, because it's a neurotransmitter-based disorder, it really can lead to a tragic end to one's life. And I think here I would not particularly link these threads, but generally it starts with social media. It starts with youth, when I don't know, a girl meets a boy and the boy will say But you've got a weird following. And it's an innocent saying And I've encountered examples like this on three occasions, that a colleague I worked with in an aesthetic medicine practice, somewhere on a date, aged 19, was told by her boyfriend that her nose was weird, her nose was normal and looked wonderful and. But she had to perform. She was even obsessively waiting to be able to have the surgery done, despite the fact that the surgery was not needed at all, and in fact was somewhere in my opinion even a contraindication, given that surgery in a person with type one diabetes or RA em is even a contraindication and an absolute one at that.

Mariusz Borkowski
But this obsession with having this complex that is generated somewhere is such an Inception film and often this Inception goes into this patient, patient and they feel they are missing something. The second thing is that it is a question of the relationship with the family. The lack of acceptance with parental consent. I did a lip augmentation on a 16-year-old girl once in my life and I would never repeat that procedure in my life. Anyway, my wife talked to me very strongly about it and said Listen, if my mum is already bringing a girl of this age for a lip augmentation procedure, it means that we are already generating some of this inceptiveness, something instilled in my brain that I am not perfect, if my parent offers me a procedure or as a reward. I also have the example of an 18-year-old whose family funded a breast augmentation for her 18th eighteenth birthday so they wouldn't be so flat. And this is where we come to an absurdity. Well, because then what does this young woman think about her body and think about who she is as a woman, Since without these breasts she will not be a full woman. And at some point, these words, these inceptions all result in us starting to produce people who are complacent.

Mariusz Borkowski
Wrongly, and I stress wrongly. And at this point it is really very important to just have partners. To have people in the family who simply give us the right advice. And, of course, aesthetic medicine is there for us, so that when we think we want to improve ourselves a little bit or our appearance, we think in terms of a certain anti-aging process, that is, this slow ageing. And we do it for ourselves, but not to prove to someone that we're better or prettier or whatever, but that we just want to make some adjustments that result from the natural ageing process. Well, this is where I come to the thread, because here I was talking about young people. People who are a bit older or my age. I am just over 50. So this is the ageing process for me. When I turned 45, I had a very big crisis because I was getting older. At the moment, I don't have this crisis any more, because I accept the ageing process as a natural consequence of life. And here a lot of people are trying to catch up and then it's, well, let's do, let's do procedures to rejuvenate, rejuvenate, which doesn't lead to either.

Mariusz Borkowski
Only by applying aesthetic medicine to the right results, because we are talking about a certain holistic approach to therapy. That is, you have to change the way you live, you have to change the way you eat. You also have to change your environment, surround yourself with people who give you energy. And you have to love each other, because if partners, it has to be said, have sex, are happy with each other, it's really different. You look at each other differently.

Monika Rachtan
Yes, because if we have that feeling that someone loves us, that we are attractive to someone, then we get out of bed in the morning, look in the mirror and say well wow! You can do it though. But I wanted to ask you who started this fashion of just correcting something, changing something. Because you said at the beginning that social media, but the history of aesthetic medicine is a bit longer than the history of social media. Where did that come from? Is it celebrities maybe?

Mariusz Borkowski
Oh already man, because even thousands of years ago, as far back as ancient Egypt, people were already improving themselves. There is scientific evidence for this and it accompanies us with this need to be prettier, more beautiful. It has accompanied us for centuries and this will not change. However, this has certainly accelerated in recent times. This is due to the fact that we have the right preparations that can help us to look better. And we also have social pressure to look better. Let's see what a forty-year-old looked like in the very communist era, right? There was even a film of how we would see the 40-year-olds of today. It's as if it's been 10 years since then, because even this 60-year-old, if he takes proper care of his physical condition and appearance, can easily look like a 40-year-old. Nowadays, I also see more and more people who are so ageless that I look at them and have absolutely no idea how old they are.

Monika Rachtan
I 100% would agree that it is the very factors that we, around which we rotate, that allow us to control this ageing. Because, again, I have this observation that very often, as you know, I invite different doctors here on the couch, different medics who know a lot about healthy living and are themselves trying to be an example for patients on how to live healthy and often they sit down on the couch and they start to talk as we have talked. Before there is a camera start, we talk about different things. For example, I answer that my children, my son in his third year of university and I sit like this and I say Professor, do you have a son in his third year? I'm sorry, but a 40-year-old woman can't have a son in her third year of university if she's a doctor, Well, because the way it's always worked with doctors is that first the studies, then the children, and the professor replies Madam Editor, but I'm already in my 50s, I'm 51, I say Oh God, I would never say absolutely in my life.

Monika Rachtan
You look like 38. No, no, no. Thank you, editor. So actually this healthy lifestyle, this good diet, a healthy, wholesome diet and physical activity, I think that's really the key to ageing beautifully.

Mariusz Borkowski
I am an example because at the age of 45 my waistline was around a hundred centimetres. Nowadays, it's around 81.82 I can run a marathon with a good result at any time, and if I train a bit, I can run a hundred kilometres without too much trouble, so to speak.

Monika Rachtan
A hundred kilometres?

Mariusz Borkowski
It also happened in my life. So. But it's not about doing 100 kilometres. It's about doing healthy physical activity. Maybe forget the car sometimes, take a walk, use public transport, just use it to introduce more movement into your life. Of course, this also has to be done under control, because people who are a bit overweight should not take up running straight away, as this will certainly end tragically for their joints. But in general, we should think of our body as something beautiful that has been given to us for a certain period of time, and if we take care of our body, it will serve us better and longer.

Monika Rachtan
And tell me, as you walk down the streets of Warsaw, do you notice that aesthetic medicine has become very accessible to us and that in fact it used to be used only by a select handful of people and now the treatments are so common? Well, but as we see on these streets, not all of them are done well.

Mariusz Borkowski
I mean, the problem of performing aesthetic medicine procedures stems from the fact that a great many people, both authorised and completely unauthorised, are involved in performing aesthetic medicine procedures. Because it seems to some people that if we inject something into the facial area, well, it's like injecting a teddy bear and you can stitch yourself up and there's no problem. The problem is firstly visual and we also differ in terms of how we dress and some people may like one style or another and this can also translate into the appearance of aesthetic medicine. How do we want to look? The second thing is that very often these procedures are simply done badly and the result is simply some kind of degenerated look.

Monika Rachtan
Because I often, when I'm on such a popular portal for booking appointments with various specialists, I just come across, for example, beauty salons that offer various aesthetic medicine treatments and I'm a bit horrified. And even sometimes when I get to such a salon, but not to inject myself with something, but, for example, to get my nails done. I ask these ladies, for example, who is opting for such treatments? Or what kind of people are they? What drives them? Are they not afraid? And I often hear the answer that it's 50% cheaper at this beauty salon, though. But on the other hand, it seems to me that when we invest in our appearance and how we will see ourselves in the mirror every day. To have such a procedure done in a questionable place, that is, in a place that, well, shouldn't be providing such services, because we know that aesthetic medicine should be done by doctors who are trained for that. Well, it's a little bit controversial for me that people continue to do this to themselves.

Mariusz Borkowski
That is, as far as Polish law is concerned. It is Polish law that does not prohibit cosmetologists from performing aesthetic medicine. To my knowledge, as far as doctors are concerned, well, let us remember that doctors have the right to prescribe medicines. If there is a complication, well, the doctor is trained for this and can treat the complication. However, speaking of unauthorised persons. I was talking about people who do not even have a complete medical education, but who also perform aesthetic medicine. Simply people who take a syringe, have undergone some courses that they should not be doing and are performing these procedures. Let us remember that these people are also very numerous, which creates the need for a certain regulation, and we are waiting for this regulation all the time in order to distinguish who can perform these procedures and who cannot. We should also bear in mind that the procedures are performed by preparations that are medical devices, which means that they have gone through a certain process of registration and market authorisation and are authorised as preparations for injection, or in other words as injectable preparations. But you find preparations on the market that look like injectables. Because if we see an ampoule, a syringe with a needle, we think it is an injectable product, but it is a non-approved product.

Mariusz Borkowski
It is not a medical device that someone can simply give us and this product has none. It even says on it that it cannot be injected, which causes patients to be. They are very often misled. And here we are talking about a certain consistency. That is, the medical records that the doctor has to keep, i.e. what was injected, what quantities were injected, where it was injected versus surgeries that do not have to keep these records, or surgeries that no longer have any activity at all, medical activity that is simply dealt with by such people. Injectors, or administerers, which fascinates me already, and it's also on Instagram that we can see huge numbers of this type of person, to whom people flock, not being aware that if something goes wrong, because to go wrong and there could always be a complication.

Monika Rachtan
But what can go wrong? What can go wrong for a patient who has been injected in the mouth with a product that was not authorised.

Mariusz Borkowski
You never know how the preparation will work. I once saw a patient who simply had holes in her cheeks. I do not know what preparation this was from. Besides, this is not the place to say the names of any preparations. And the patient at the moment will require surgical, plastic treatment to make it work.

Monika Rachtan
But it was such a hole that you could put your fingers through?

Mariusz Borkowski
It was a hole from which it was just oozing. It was oozing such a serous fluid. It looked really scary. And there are more and more of these examples, given the massification of the procedures. However, when it comes to complications, let us remember that botulinum toxin is a drug. As a drug it should be performed, it must be performed by a doctor, because only a doctor in our country can perform the treatments and administer the drug. We have examples. Now, I also told you just before the recording of the programme that in Bulgaria, I think a fortnight ago, there was a very high risk of life from the administration of botulinum toxin which was introduced into the European Union from outside the official distribution. It was a Korean preparation and the patient had a disorder, a circulatory and respiratory disorder, which could have led to death. This received a lot of publicity in our community. Therefore, the drug goes through the full distribution route, through wholesalers and reaches a specific doctor. And that doctor should administer it. However, this botulinum toxin of foreign origin is transported somewhere, we do not know under what conditions, without any certificates, and administered to patients, which is, first of all, illegal on many occasions, and I am really surprised that people decide to have this type of treatment.

Monika Rachtan
Marius. I wonder, because I've never been to an aesthetic doctor, but I can imagine what it might look like. This is more or less how it works in practice. There's a patient who's in the chair, she can probably even have her eyes closed because she's scared of what's going to happen. It's still like she's in the surgery for the first time. You know, it's a stressful situation. And the doctor who administers the medicine to her, makes the packaging of the medicine himself, prepares the medicine for injection. And now, as a patient, if I'm scared, if I've listened to this programme and I'm worried, can I say, Doctor, can you show me what you're giving me?

Mariusz Borkowski
Let me put it this way, ladies and gentlemen, you have to be assertive and not be afraid to ask the doctor. I often forget in the frenzy to show the patient, but I try not to forget. I have had a couple of patients ask me, Doctor, can I see what it is and they just apologised terribly. I say I am very sorry. Not only is it my duty, but it is the patient's right to see what is specifically being administered, whether it is actually being administered what is claimed versus what the patient simply thinks is being administered. The second thing is that I also suggest that even if we do not have this type of documentation, that the patient does not have some kind of treatment booklet, we should take a picture of what preparation was administered. This is also very helpful so that if, for example, we do the mouth with a preparation from a certain company, we may be satisfied and, for example, we will not go to this doctor a second time for geographical or any other reasons, so that we can show the next doctor what preparation was administered, so that a similar preparation can be used.

Mariusz Borkowski
So these are normal things, you shouldn't be ashamed, that is Absolutely. Even if the doctor didn't say it by accident, nobody can be offended about it, because it's a natural thing. And I am very often asked by patients after these various media reports related to the boline toxin, for example, doctor, and are you sure you have the original one and what toxin do you have? There are relatively few of these toxins on the Polish market. Therefore, patients can easily find out which one is used. And I translate, I use that one, because for example I'm not comfortable with it, because it's for example liquid or whatever. And then this one I sort of explain what it is because of. Whereas it's not like that. That this patient always has the right to ask.

Monika Rachtan
And also, I think it is very important to point out that the patient has to sign a consent for such a procedure. Correct me if I am wrong. Yes, and such consent must state the complications that may arise after the procedure performed, because this consent must be informed. If we do not have this written, then it is difficult.

Mariusz Borkowski
But also leaving aside, of course, that consent has to be there, but you have to talk to that patient. We are also very often using tissue stimulators at the moment and very often patients think that tissue stimulators don't give complications and are much better than fillers, for example. Fillers at the moment have a very bad reputation, and wrongly so, because the degeneration we have seen on various streets in various cities is simply the result of exaggerated, excessive administration of fillers. On the other hand, there is no better way to fill the lips than with hyaluronic acid and it is the safest preparation, because if anything were to go wrong, we would have a complication. We have an antidote for this, hyaluronidase, which is not approved for injection. In Poland, no hyaluronidase, but for medical reasons, it is possible to perform this procedure by explaining to the patient precisely why we perform this Hyaluronidase. But if the patient is at risk of necrosis or some serious complications, hyaluronidase is the only way to reverse the action of the hyaluronic acid. But patients should speak consciously with their doctor and, in the case of tissue stimulators, I divide into two categories the softer, gentler stimulators, which give relatively little in the way of side effects, but their purpose is to gently hydrate the skin and gently stimulate the production of collagen by fibroblasts, the kind of cells that I call it like a juicer.

Mariusz Borkowski
We want to sort of juice them, that we want to squeeze that collagen production out of them, because collagen is 70% of this protein that builds our skin. Well, and at that point, as we age, that collagen just decreases. This is a little note in brackets, so that we know why this collagen is talked about so much in aesthetic medicine. On the other hand, they are supposed to act gently, but there are also strong stimulators and strong stimulators. This is, for example, lime acid or calcium hydroxyapatent. And they have a proven effect that they can even stimulate fibroblast production by as much as 65%. This is really a lot and people who have a very strong immune system, have autoimmune diseases. This body can start to act too intensely. On the other hand, let's remember that patients, as Dr House says, often lie, that is, they come to different surgeries. You have to be aware that you cannot exaggerate the amount of stimulation and sometimes these soft stimulators are better for some patients, because you do not need to use a cannon to perform a certain procedure, but you can use this stronger stimulation for a certain group of patients, but they have to be informed about it.

Mariusz Borkowski
What are the consequences? Are we able to help them? When would that consequence occur? Well, that's when the doctor's office comes in, because let's remember the interactions now with drugs, interactions with all sorts of just with dietary supplements that can occur with a certain therapy. This is what is called a syndrome, which can cause all sorts of autoimmune reactions or within the skin, or even muscle pain, malaise, which the patient does not even associate with the fact that hyaluronic acid has been administered.

Monika Rachtan
It's only those skin infections and only those pains you mentioned that can come up in the context of stimulators. Stimulators today are the hit of the internet in general all the influencers are saying look, I'm without a make up, a stimulator for life. Well, and now the question is precisely what consequences to be prepared for. If someone is going to overdo it, or just get too strong with a stimulator.

Mariusz Borkowski
To make it clear. I too use tissue stimulators, I just happen to have one administered in my lower face. Of course, I am not saying which one, but in general we need to be aware that a badly administered stimulator by someone who does not use the latest stimulator procedures can cause intense lumps to appear. Today I had a patient from Zurich who went to a practice where she had a tissue stimulator administered that was just given with a rotation that was not quite what should have been done. She saved maybe £100 or £200 and the result is that actually the whole lower face swelled up and it's the second week after the administration and the patient already has a lot of lumps and very badly swollen. And here it is also not very much understood by the patients, but the medical device imposes. The current MDR Act imposes that manufacturers must ensure a certain continuous supply chain. That is, we know that a product has been manufactured, goes into distribution and we know who it goes to at the end. It is very often the case that these products circulate between different countries, we do not know in what form they circulate, in what boot of cars they travel, and then the patient receives a product which may be a little cheaper, but we do not know in what conditions the product was stored, because in the case where we buy the product directly from the manufacturer and not from some other type of distribution or from the Internet, it is even worse, because very often, the people who perform these procedures simply buy it somewhere on the Internet, where we do not know whether the product is original or where it comes from, and patients are not aware of this either.

Monika Rachtan
It's a bit out of my head. Because, you know, I think to myself, you give something to your face with that face like it's your business card. You can see it all the time, you can't cover up your face so that when something goes wrong you can't see those effects. And that people are not inquisitive, that they are able to spend very big money or relatively big money. Some people save up for a few months to go to a cosmetic doctor or to a place where they give themselves these preparations and they don't check this very source, which is very, very publicised today, I think. Well, see, in the case of vaccinations, in the case of vaccinations, we are so afraid of what will be given to us. We know all the complications that can arise. There are those who refuse to vaccinate at all, because they say that vaccinations kill, and on the other hand we give preparations or allow preparations to be given just in the facial area and we are not sure what the origin of the preparation is. What about that patient from Zurich? That is how well I remembered.

Monika Rachtan
Have you been able to help in any way?

Mariusz Borkowski
I have started the treatment process. Just the day before yesterday there is already a high success rate of the treatment. I say right away that I am using medication for this, which is on prescription. Just in this case an injectable drug and there is a significant improvement. I hope that the patient will be brought out of her condition. On the other hand, we really have a lot of these examples. Let us remember that wherever this preparation is administered, it can cause side effects. For example, I think I had this on TVN. It was on the occasion of lip necrosis following administration of hyaluronic acid to a very well-known model. In fact, I didn't even know she was such a famous model. The problem was that many aesthetic medicine practices or doctors did not want to accept this patient. Well, for reasons such as saying ok, we don't know what was given where And at this point I think I was the only surgery that agreed to accept this patient. Taking into account the risks as well, because let's remember that if a complication comes out of my surgery, it is my responsibility to see the case through.

Monika Rachtan
And now you also know how to act, right? You have a map like this.

Mariusz Borkowski
I am trained. I know how to act and, of course, I perform those treatments where I can help the patient. In the case of practices that do not have a doctor, very often the patient cannot actually be helped at the end, because the doctor is not there and the process of looking for a doctor begins. There is a doctor in Poland who was even prosecuted by a patient for treating complications incorrectly. I hope that this, too, will be publicised more strongly in the media. On the other hand, why does this doctor then refuse to accept patients with complications? Well, because he or she is at the end of the chain and then the patient can say that the treatment was carried out incorrectly.

Monika Rachtan
It is the doctor's fault.

Mariusz Borkowski
Well here is another problem. This is that, for example, very often patients who have had a lot of these fillers given, for example, also even two or three years after the administration of hyaluronic acid, there can be a late immune reaction in the form of the patient simply swelling and sort of having such hard cheeks, if, of course, hyaluronic acid was given there. Patients do not connect this completely with hyaluronic acid.

Mariusz Borkowski
Treatment is relatively straightforward. All patients can be safely treated. I had such a patient in one of the clinics and she had already been treated. Everything came back to normal. But, of course, it was also related to the claim of this hyaluronic acid that she had in her.

Monika Rachtan
Was she very angry with you for taking it away from her?

Mariusz Borkowski
Listen, after three weeks the patient came back and said I'm looking but she's back after being filled in because she's gone to some surgery somewhere. I say Listen, what have you done? She says Listen well, I couldn't look at myself. Well, I leave it without comment. This is everything we talked about earlier. But also patients don't remember what they looked like before and how they suddenly go back to their original appearance. Well, then there's also the problem that they seem to have been done some kind of harm, well, because suddenly they're back to the look that they were. And besides, let's remember that we get used to what we see in the mirror and we also forget about the ageing process, which is a natural process that affects all of us.

Monika Rachtan
And do you think that these regulations that we haven't talked about yet, but that I want to ask you about, do you think there should be regulations that would protect patients from these situations that we're talking about today. Because as with dietitians, this market is very strong. There is a very big problem in the market for dietitians by the fact that there are precisely no clear rules for such people. The same seems to me to be true in aesthetic medicine. I think that if you walk down the street in Warsaw, you can find a place that does aesthetic medicine and has absolutely no authorisation to do so. Do you think regulations are needed here and that the Ministry of Health should get behind this?

Mariusz Borkowski
We create these regulations ourselves a little bit as doctors, because at the moment I have such a title as doctor of aesthetic and anti-aging medicine, which has its own code, also a professional one, and we try to make our members of the Polish Society of Aesthetic and Anti-aging Medicine and other medical societies to undergo such a certification of skills, to have such a skill And it is entered in the register. If we want to check whether someone is a doctor, all we have to do is write. Supreme Chamber of Physicians, even a search engine. Supreme Chamber of Physicians and, for example, write Borkowski. Then we can see the doctor or doctor, we can go to the profile and then we can see what degrees he or she has, whether he or she actually has a doctorate or not, and what specialisations he or she has completed. And then this description is normally thrown in as a medical skill, which is certified by an appropriate exam, which is performed by societies authorised to do so. In Poland, however, this obviously applies to doctors, it does not apply to other places, and it is difficult to check the skills of dental surgeries, as this is also usually verified on Instagram and not in reality. On the other hand, these regulations are incredibly necessary, because when a complication arises in an office that does not cooperate with the doctor, I have a patient after the administration of hyaluronic threads in the nasal area, infected with Staphylococcus aureus.

Mariusz Borkowski
It's a huge problem. Many months of treatment, on top of that a disturbance in self-image, we can already talk about depressive states, because it is very difficult to treat. And what happened? Well, the cosmetology clinic didn't answer the phone and blocked you.

Monika Rachtan
Well, then the patient remains.

Mariusz Borkowski
The case is in court. As far as I know, I was there writing opinions for this patient in this case as well. Well, but the point is that doctors are insured for this kind of situation, but above all the doctor is entitled to help to prescribe the right medicine. If the appropriate antibiotic treatment had been administered sooner, there would have been no problem. On the other hand, we sometimes generate this ourselves. In Germany, for example, it is the case that only a doctor is actually allowed to carry out aesthetic medicine procedures, from laser therapy to the administration of preparations. Any interruption of continuity can only be carried out by a doctor. Regulations vary. In the UK, nurse practitioners, nurses - those people who work with the patient anyway - are also allowed to do this. I am not saying that we should exclude anyone from the profession, because I think that my colleagues who are nurses should absolutely also be allowed to do this, and my personal opinion does not matter. This should be regulated and controlled. In Germany at the moment, this has simply been done consistently and I know that there are checks and this simply means that the patient can then be more confident that they are going to the right person who is trained and who can advise them in the event of any complications.

Monika Rachtan
You give an answer to my question. The kind of one influencer I follow, who is into aesthetic medicine and absolutely not qualified to do it, had to move out of Germany and move her business to Switzerland. I already know why. Well. Some people love aesthetic medicine, others hate it, but there are also situations where aesthetic medicine actually saves someone's life. And I'm not thinking here that someone needs to have bigger lips to feel happier. And that is his life saved. But many times aesthetic medicine, plastic surgery is used in situations where a patient has some kind of illness, some kind of surgery, and then it is very justified and I think very necessary.

Mariusz Borkowski
Well, because here we have been talking about a certain risk all along, but it is also a beautiful branch of medicine that allows us. Let's remember that these procedures are much safer than surgical procedures. It is a bit of a single ticket. With surgery, it's hard to recreate that pre-surgical state. In the case of aesthetic medicine performed sensibly step by step. These changes are reversible. And it's not like this is the end of the story. And these cases are really very few that we cannot reverse. On the other hand, it is a beautiful branch that allows us to feel better. I benefit from it too, of course. As a patient, I also benefit on my social media. I show how the treatments are performed.

Monika Rachtan
That is, you have your aesthetic practitioner or you, yourself.

Mariusz Borkowski
I don't recommend it myself, I really only put myself in the hands of people who can do it and I'm happy with it and I'm just delaying the ageing process. But I don't fight it obsessively. I just want to look younger for longer and feel better about it. But I am happy with my appearance and with my life, which makes me simply not obsessive. On the other hand, I also like to show patients which ones. How a procedure can be done properly, what results it gives, how it translates into the look of my 54-year-old self. And I think that's something that I think also sometimes causes women to carry out their husbands, to say listen, bring them on.

Mariusz Borkowski
To his own.

Mariusz Borkowski
Status. But of course it is not, as I said before, just aesthetic medicine. It's a whole approach to one's life and to just be happy.

Monika Rachtan
I think it is worth approaching all decisions connected with aesthetic medicine with reason, and absolutely not to think about bans and orders, or whether it is right or wrong, but about what we really need inside and what will be good for us. And with this thought I leave you today to answer this question: what do you want? If it is some minor aesthetic medicine procedure, then just go with the right hands. Thank you very much Mariusz for our conversation today.

Mariusz Borkowski
Many thanks to you and I hope you enjoy this podcast.

Monika Rachtan
My guest was Mariusz Borkowski, MD in aesthetic medicine. My name is Monika Rachtan. This was the programme First Patient. I would like to invite you very warmly to my social media, but also to Mariusz's, because you can see a lot of cool things there, too. Thank you very much.