A few months ago, I noticed that many people, celebrities included, were posting pictures of themselves with the hashtag “10-Year Challenge.” After finding out the story behind the pictures, I was surprised since many of the women looked exactly the same within a 10-year gap. However, the same can’t be said about me. I’ve never tried Botox because I’m mostly okay with my wrinkles. Unless it’s medically necessary, I’m reluctant to choose needles or uncomfortable procedures. Recently, however, the 89-year-old staring back at me in the mirror is becoming less recognizable. So I decided to ask some of my questions from the world-renowned surgeon, Dr. Maryam Zamani.

In your opinion, what differentiates the European approach to cosmetic procedures versus the Iranian one?

I think that Iranians have a rather different culture of looking after themselves than the Europeans. The style and approach is different. There is no stigma in the Middle East—and specifically in Iran—of having cosmetic surgery. Women and men openly walk the streets in Iran with bandages on their noses, not worried that others will know they have had surgery. Europeans are more discreet about such procedures. There is also less judgement on doing cosmetic procedures in Iran, and it is culturally much more accepted as a normal way to maintain oneself. In addition, Iranians have stronger facial features (larger eyes, high cheekbones, etc.) and tend to exaggerate these features with treatments.

Do you take a holistic approach to beauty and cosmetic surgeries?

In my opinion, beauty and cosmetic procedures should be undertaken to tweak an area rather than dramatically change the appearance of the patient. I prefer subtle, more natural results, though I realize that this may not be suitable for some. I think a woman or man can be intelligent, hardworking and take care of herself or himself; and this may sometimes necessitate a little help from procedures. There is nothing wrong with wanting to look or feel your best if you can and so choose to.

Since 2013, cosmetic surgery or injectables have increased by 24% in patients under the age of 30, according to a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery. Is there any concern that endlessly seeking a youthful appearance is beginning at a younger age?

Well, I do think that social media has created the image that everyone needs to look perfect all the time. Sometimes, these images and videos have been tremendously photoshopped or filtered. I do not think that injectables are used to prevent lines and wrinkles. I am a strong believer that you should only inject if there is something that is visible. For instance, no need to inject Botox unless you have fine lines and wrinkles. There is no benefit to having those botulinum injections if one does not have the associated lines. I also think that some things starting too young can lead to obsessive nature to try and ‘fix’ everything. Inevitably, once one starts, that leads to more scrutiny, which can lead to insecurities and further procedures.

Why is there still a stigma surrounding Botox and cosmetic procedures?

This has dramatically changed with the advent of social media. It is becoming more and more acceptable in the Western world. Nevertheless, I think its stems from the misconception that if you use fillers and toxin, you will look fake; but the best work is generally the one that you cannot see. Another misconception is that if you do fillers and procedures, you will have to continue all the time afterwards because you will change the tissue. This is also not true. You can be a person of substance and do cosmetic procedures.

What are the factors that determine when one should start Botox and with what quantity?

I always recommend only doing botulinum toxin if there are lines caused by muscle movements. We call these dynamic rhytids. The lines form only when the muscle is activated. When these lines become apparent even when the muscles are not moving, they are called static rhytids. When the lines are seen even though the muscles are not in use, it is the perfect time to use botulinum toxin. The amount injected depends on how much movement one wants to diminish.

How do the procedures and products you offer differ from others in the market?

Different countries have different products that they have access to and their governing body have approved of. I generally use the products and equipment that have been approved by the FDA in the United States for a number of reasons. The most important one is because these FDA-approved products and machines have undergone stringent testing to ascertain their safety and efficacy.

If there were five things that you could give as an advice to our readers, what would they be?

You can be a person of substance and have cosmetic treatments. Do what makes you happy. Less is always more. It is always easier to do more, but reversing procedures and treatments can be difficult. Do your homework; find a qualified doctor, surgeon, or specialist. Think of some treatments, like injectables, as implants that will live in your body for a specific amount of time. Check qualifications, look at before and afters, and last but not the least, think about what you hope to achieve.

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