Holistic Approach to Aesthetic Medicine

Interview with Dr. Anna Maria Veronesi

Doctor Veronesi is a surgeon registered both in the register of surgeons and in the register of dentists of Pavia. Over the years she has obtained various specialization courses in aesthetic medicine, thermal medicine and then she approached integrated medicine.

Integrated aesthetic medicine

Dr. Veronesi explained this new therapeutic orientation which involves extreme attention to the patient not only from an aesthetic and external point of view, but which involves, for the patient, an internal journey of reconciliation with the self and with the world around us. The doctor in this case takes care of the patient from a physical, psychological and energetic point of view. “The goal” explains Veronesi “is to be happily beautiful”.

Dr. Veronesi begins by saying that she approached holistic medicine in phases, starting initially from a personal journey that led her to undertake aesthetic medicine specialization.

“Years ago, I worked as a dentist and had an apparently enviable life, until I started having panic attacks, which were increasingly disabling. I decided to undertake a course of psychotherapy, because I didn't want to be at the mercy of drugs to face my daily life. Over time I understood that I was living a life that didn't belong to me. So, I undertook some changes, one of which was to turn aesthetic medicine, a great passion of mine that I had started to cultivate, into a profession."

Over the years, however, Dr. Veronesi's sensitivity has allowed her to analyse patients not only aesthetically, but also psychologically. “After years of work and my experience, I realized that patients are looking for something beyond an aesthetic medicine treatment. When they come to my practice, they are determined to solve a specific problem, sagging cheeks, skin blemishes, unwanted fat deposits. But then, during the visit, listening to the patient carefully, going beyond the problem for which s/he came, issues related to the more intimate sphere emerge. These are generally of an emotional nature, like anxiety, stress, lack of self-esteem. At that point I try to delicately delve into their discomforts, recommending targeted techniques which, combined with appropriate medical-aesthetic treatments, contribute to the achievement of overall well-being. Integrated aesthetic medicine is able to combine aesthetic medicine treatments with techniques that work at a subconscious level."

To define integrated medicine, Veronesi uses a phrase from Plato which excellently explains the concept behind this discipline: "make me beautiful inside, and out make me like the inside". The doctor therefore becomes the analyst of a discomfort that is not necessarily, or not only, physical and to cure which a filler or laser application is not enough, but requires dialogue and an almost psychoanalytic study of the reasons behind it. “Patients must feel welcomed, listened to, because often the discomfort due to some blemish arises from a deeper suffering, which undermines self-esteem. For this reason, an integrated approach is needed. The aesthetic doctor must be able to guide the patient, directing him to pursue results that offer the right harmony between what he is and what he would like to be".

We therefore asked Dr. Veronesi if she sometimes doesn't feel overwhelmed by the inconveniences and experiences of her patients. The answer given to us by the specialist is very interesting and makes us understand her profound analysis and conviction in her way of approaching medicine: "Patients have always been and still are a great help in my personal growth path, both professional and spiritual. A path that led me to be who I am now, so that I can make myself useful, understanding their hardships without making them become mine, giving practical suggestions on how to start changing what disturbs them. All this gratifies me greatly, because it makes me feel useful, giving meaning to my way of practicing medicine."

Patient Analysis

The analysis of clinical cases led Dr. Veronesi to argue that the patient's attitude towards aesthetic medicine is dictated by a desire to feel and see themselves better. This, according to Veronesi, is a change that has been felt especially post-Covid: "it is a start to seeking that emotional stability, which the pandemic has taken away from many people and since one has to start somewhere, the aesthetic choice seems the easier” she says.

In some cases, however, the patient's requests are not acceptable, as they do not meet the real therapeutic needs or in some case appear to be extreme compared to the doctor's modus operandi. In this regard, Dr. Veronesi is very clear: “I don't always fulfil the patient's requests, because sometimes they have unrealizable expectations and I prefer to be very sincere about it. Other times, however, it happens that patients are surprised, because the final result is better than they might have expected."

Therapeutic Protocols

As regards aesthetic medicine treatments, Dr. Veronesi divides them into seasons. “We need to talk about seasonality to define treatments. In any case, fillers, botox and biorevitalizations are for the 4 seasons. In winter and spring, I use the various devices to treat pigmentations, wrinkles, scars, laxity and to carry out surgical dermatology treatments".

Speaking of medical devices, Dr. Veronesi describes the use and advantages of ThermaDAS technology, which she has been using for several years with great success and excellent results for her patients.

ThermaD.A.S. is a device that combines, in a single compact platform, plasma technology and thermoregulated radio frequency. Plasma technology acts on a superficial level and is indicated in the case of a non-surgical blepharoplasty on the upper or lower eyelids in the presence of excess skin, without the need for surgery.

Veronesi explains, “I also use plasma technology to treat seborrheic keratoses, fibroma pendulans, warts, dermal nevi and angiomas, without the patient feeling any pain. I instead opt for thermoregulated endodermal radiofrequency (Intralifting), which acts internally at a subcutaneous level, when I want to improve the mandibular profile, reducing, if not eliminating, the "wattle" effect, or when I want to treat the laxity of the abdomen or, even, to treat the upper part of the knees”.

Endodermal RF, EndoD.A.S. mode, is based on the emission of electromagnetic waves which cause a controlled increase in the internal temperature of the tissues undergoing treatment. The hyperthermia thus produced promotes vasodilation with a consequent increase in cell oxygenation and biostimulation of cellular components.

Dr. Veronesi explains that "the biological effect of the heat produced by radiofrequency is a denaturation of the collagen fibers with consequent immediate contraction of the fibers themselves and with a progressive effect in the following 4-6 months and a stimulation of the activity of the fibroblasts with synthesis of new collagen, elastin, hyaluronic acid and histologically proven increase in dermal density. The contraction occurs in a stereoscopic way, at 360°, reorganizing the skin tension lines in a physiological way, relaxing the tissues and reducing skin laxity, determining the stretching effect similar to a facelift".

These technical characteristics turn into real advantages for the doctor during her daily practice. In fact, Veronesi continues by saying that “the advantages are that at the end of the treatment the patients immediately resume their activities, because it leaves no marks. It is not painful at all, so it is well accepted by patients. It is complementary to other aesthetic medicine treatments, so as to be able to give a harmonious and natural result. It requires a single session and has a low cost."

The doctor explains that she often recommends the ThermaDAS medical device to colleagues as she finds it extremely useful.

Treatment with ThermaDAS

ThermaDAS treatment is painless for the patient and has a low impact on the doctor. It lasts about an hour. Immediately at the end of the session the patient does not notice any visible signs, other than a localized redness which fades quickly.

As regards the results, immediately after the treatment the patient feels some tension in the tissues. The effect of the heat radiated in depth generates a lifting result and reduction of wrinkles and laxity in the following six months, reaching a stabilization of the result at one year after the session.

“I explain to patients that being it a monopolar radiofrequency it is specific to treat skin laxity and naturally I explain why laxity is created over time. I say that they cannot expect an effect like a surgical facelift, but that there will be an improvement with definition of the jaw profile, reducing or eliminating the annoying wattles. At the same time there will also be an improvement in the neck, resulting precisely from the new definition of the face", explains the specialist.

The treatment protocol used by Dr. Veronesi is divided into phases. “During the first visit I explain to the patient what can be achieved from this treatment, without creating false expectations, which is fundamental for the success of the work. I recommend taking amino acids or collagen by mouth for a couple of months, in order to emphasize the action of ThermaDAS, precisely because of its specificity at the collagen level. Before starting the session, I have all the metal objects worn by the patient removed and before making him/her lie down I mark the two entry points of the probe with a dermographic pencil. Then the patient lies down, I apply the return plate to his/her back, as ThermaDAS is a monopolar RF. In the points previously marked, I inject the anaesthetic with a 2 ml syringe and a small needle and while I wait for it to act, I turn on the device, activate the disposable probe and set the desired parameters, based on the thickness of the skin. With a needle I prick the access hole of the probe and so I begin the treatment."

Dr. Veronesi generally draws and treats 6 lines of 180 seconds each per half-face, with variable power, based on the degree of heat felt by the patient. During the session, the doctor chats calmly with the patient, demonstrating that the treatment does not cause discomfort. At the end, Dr. Veronesi applies a small amount of antibiotic cream only to the entrance holes of the probe. “The patients, if they wanted, could leave the office and go and have an aperitif with friends” concludes Veronesi.

ThermaDAS treatments can be performed individually or combined with injectable products. “When treating the face, I tend to propose to the patient, if needed, a protocol that includes a hybrid filler with a lifting action to be used in the temporomandibular area and ThermaDAS in the lower third of the face”.

Instead, Dr. Veronesi generally does not use the two modalities, endodermal RF and plasma, in the same session. "Normally I prefer not to combine both treatments, not because it is impossible to combine multiple methods on technical level, but to avoid keeping the patient lying down for too long. In particular cases where, for example patients coming from afar or upon express request for further treatment, I use the double technology in the same session".

In Conclusion

Integrated aesthetic medicine is an interesting approach to medical practice, but it poses considerable challenges.

Dr. Veronesi is proof that body and mind are closely related and that an all-encompassing method of approaching the patient can work optimally to guarantee better results. A patient who is satisfied with himself or who undertakes an internal journey will appreciate the results of aesthetic medicine treatments more.