Aesthetic medicine focuses on the subjective nature of beauty itself. It also aims to address what many people fear: unattractiveness. Attractiveness is deeply ingrained in our survival instincts and desires.1,2 We need to feel that we are able to attract a mate and be attractive to a group. Biologically, we are designed to identify signs of reproductive health and fitness in one another for procreation and protection.3,4
However, the physiological and subsequent psychological effects of aging are inevitable. Chronological and environmental aging result in architectural changes across tissue planes that alter the ratios and proportions of an otherwise youthful face.5 As we age, our epigenome, or molecular factors that control gene expression, begin to deteriorate, and unlike genetic insults, epigenetic changes are reversible through lifestyle modification.6 Aesthetic providers have the ability to interrupt this physiological process with procedures, injectable treatments and topical therapies. While most aesthetic treatments primarily address phenotypic changes in patients, there are likely significant positive associated psychosocial changes as well.7,8
Two hypothesized mechanisms may be at play in helping individuals feel and behave younger. The first is psychological; it is based on how a person feels when they look in the mirror and see an appearance that is more in line with their perceived self-image and their desired youthfulness.9 The second 
is biological; it may be associated with neurochemical changes in the brain when people have aesthetic treatments. Indeed, the positive impact of self-image on depression and other mental health disorders has been documented and implicated as a potential modulating target for aesthetic intervention.10
Recent studies have demonstrated the safety and efficacy of botulinumtoxinA injections in the glabella in improving depressive symptoms in patients with major depressive disorder and other mood symptoms.11 A randomized, observational clinical study looking at functional magnetic resonance imaging (fMRI) of the brain before and after glabellar botulinum toxin injections showed decreased activity in the thalamus, suggesting a modulatory role on brain activity.12 A possible confounder would be that less motor input from frowning may decrease thalamic activity. Nonetheless, patients treated with botulinumtoxinA in the glabella had a decrease in depressive symptoms that manifested as improved quality of life and improved mental health outcomes.
While these concepts may be somewhat intuitive, their importance was thrust to the forefront during the onset of the COVID-19 pandemic. The “Zoom Boom” led to widespread video calling, which suggested that the more time someone spends analyzing their own appearance, the more inclined they were to receive aesthetic treatments.13 Similarly, during COVID-19, interest in aesthetic procedures, weight loss and dieting increased.14-16 At the same time, rates of depression and social media usage also increased.17,18 The correlation between increased self-observation and aesthetic procedures may be explained by the interconnectedness of self-image and psychology.
Exploring Trends
We performed a simple analysis on Google Trends, probing temporal and regional changes on self-image. Google Trends is a publicly accessible online tool that temporally and geospatially analyzes a percentage of Google web searches and has been used frequently in healthcare to predict or analyze public interest trends.13,14,19, 20
Google Trends allows clinicians and researchers to assess and compare social interest in trends, terms, procedures and thought processes, both independently and relative to other search phrases over defined time intervals and geographies. Google Trends also includes related search queries and topics, defined as terms or topics searchers also searched for.
Results
In this study, a panel of researchers and healthcare providers working in dermatology and aesthetic medicine selected these phrases for social analysis: “Why do I look old?” and “Why do I feel old?”
Results suggest an increase in searches for
“why do I feel old?” over the past 10 years (2012-2022), including a significant increase in the rate of change starting in 2020, following the COVID-19 pandemic. This pattern was also highly correlated with searches for “why do I look old?” thus implying a relationship between looking older and feeling older. The U.S., UK, Philippines and Canada were among the top search countries for both phrases.
Another interesting observation from this simple analysis was in top/rising related queries. Several top related searches stood out to the authors: “Why do I feel tired?,” “Why do I feel sick?,” “Why do I feel alone?,” “Why do I feel empty?” and “Why do I feel depressed?” were all related search terms tied to people searching “Why do I feel/look old?” Select top related searches are given in Table 1.
“Breakthrough” searches, defined as a 5000% or more change over the time interval, suggest emerging trends related to perceptions of aging. These included “Why do I feel so empty?,” “Why am I so tired?,” “Why am I always tired?,” “Why do I hate myself?,” “Anxiety attack,” “Depression symptoms” and ‘Why do I look ugly?” (Table 2) and suggest that looking and feeling older are related and carry with them many negative feelings and symptoms. Further, public interest in dermal fillers and botulinumtoxinA has dramatically increased, which correlates to searches seeking plastic surgeons, dermatologists and medspas (Figure 1 A and B) and is likely reflective of the positive changes in the perception of and desire for aesthetic treatments.
The Role of Aesthetic Medicine
The results from our analysis largely support the notion that aesthetic providers have the unique opportunity to identify insecurities that can lead to distorted self-perceptions and heal patients by treating their individual beauty concerns, which can be applied across all genders, age groups and backgrounds.
There has been an aim to promote positive perceptions of aging in young and old individuals alike – which is where aesthetic medicine conveys its value to patients and the global healthcare system. Cosmetic procedures by trained aesthetic providers may improve physical beauty with the intention of manifesting positive general well-being. A large longitudinal survey of 8,434 participants found that greater facial attractiveness (as well as lower body mass index and greater height) was associated with higher psychological well-being and a lower risk of depression.21
Furthermore, ageism directly impacts the healthcare system from a cost perspective. A study of Americans 60 years of age and older revealed that the one-year cost of ageism (in relation to discrimination aimed at older people, negative age stereotypes and negative self-perceptions of aging) was $63 billion, or one of every $7 spent on the eight most expensive health conditions in 2013. Negative self-perceptions of aging was the highest ageism predictor accounting for $33.7 billion dollars of the total cost.22 Another longitudinal study of 85,225 adults revealed that within a five-year timeframe, individuals with high or increasing life dissatisfaction were significantly associated with higher healthcare utilization costs.23 A cynical attitude towards the future is financially draining the healthcare system today, and measures to combat this can have patient- and society-wide benefits.
Aging in itself is a disease where the body deteriorates at a rate relative to intrinsic and extrinsic stressors. Aesthetic medicine contributes to positive perceptions of aging and therefore benefits both society and the medical community in the contemporary era of prolonged lifespans. Our data suggest a steady increase in negative changes in self-perception, which were linked to symptoms of psychological and physiological illnesses like anxiety and feelings of loneliness. This data further warrants the long-term need for aesthetic providers to help improve patient self-perception. Ideally, an aesthetic provider should manage the aging process for a patient and, in addition to meeting their aesthetic needs, help to bring positive mental changes that can result in a beautiful, productive and meaningful life with patients achieving successful physical and psychological aging.
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Editor’s Note: The original article Exploring the Psychosocial Aspects of Ageing appeared in the March/April 2023 issue of PRIME JOURNAL and can be accessed online at: https://www. prime-journal.com/exploring-the-psychosocial-aspects-of-ageing/
