The Brazilian aesthetic industry has grown exponentially over recent years and according to figures released by the International Society of Aesthetic Plastic Surgery (ISAPS), was second only to the US for total number of procedures performed in 2011. There are few people better qualified to talk to about the growing Brazilian aesthetic market than Mauricio de Maio, a Plastic Surgeon from Sao Paulo, and member of the Brazilian Society of Aesthetic and Reconstructive Plastic Surgery.
‘Brazil has always been a cosmetic-orientated country,’ Dr de Maio tells me when I bring up the ISAPS statistics that reveal a total of 1.5 million surgical and non-surgical procedures were performed in Brazil in 2011. To put that in perspective, there were 211000 procedures performed in the UK. Brazil has over 5000 plastic surgeons, second only to the US, and more than Italy, France, Germany, and the UK combined.
The rise of the aesthetic industry in Brazil over the previous few decades can be attributed to many factors, including economic stability, falling unemployment, and the increasing availability of credit. However, to truly explain why aesthetic procedures are more popular in Brazil than most other countries, you have to look at the Brazilian culture.
‘We are almost brought up to believe that we should look good. This belongs to our culture,’ explains Dr de Maio. This is a culture very different to any he experiences when he visits Europe.
‘In Brazil people are more open about having surgery. Compare that to a culture in Europe; for Europeans, in general, the fact that they are submitting themselves to a procedure is seen as a negative, whereas in Brazil it is seen as a positive. It is something to talk about.’
Brazil has over 5000 plastic surgeons, second only to the US, and more than Italy, France, Germany, and the UK combined.
The differences between Brazilian patients and their US and European counterparts goes beyond attitudes towards plastic surgery, but also to what procedures they are choosing and what they wish to achieve. Dr de Maio tells me Brazilians are not busy trying to follow trends in the European market, or attempting to emulate their favourite Hollywood stars in the US. Brazilians, in general, wish to have an overall treatment that looks natural.
‘When you are in Brazil you will hardly see the excessive treatments you see in Hollywood stars. I think we are slightly more conservative in quantity, but more keen on overall treatment. So if we put in breast implants we work on shaping the rest of the body too,’ he says.
‘However, in countries like the UK and Russia I have witnessed a trend of ‘more is better’, and for external observers we can see there has been too much injected. In this perspective we are more conservative but we are more open about having treatments. We end up developing techniques which are more adaptable to the overall treatment of the face rather than one single area.’
Dr de Maio also believes a big difference between the Brazilian market to any other is the role of the physician in the decision making proces.
‘Another important thing about Brazil that I do not find in the other countries where I travel to is that, in Brazil, a patient would come to me and ask ‘Doctor, what would you do for me?’ This allows the doctor to use their expert knowledge to improve the patient’s apperance.
‘Whereas when you come to Europe, doctors are more reactive. Patients tell them ‘I want my lips’, or ‘I want my glabellar lines’. This linear way of thinking, of doctors as only delivering patient requests, can sometimes work because patients have an accurate perception of themselves. However, sometimes patients have a misperception and then you end up delivering unfavourable results.’
Education is key
Dr de Maio believes there is an inversion of roles in aesthetic medicine that should be addressed. Physicians injecting dermal fillers need to be educated to see past the patient’s request and not simply inject wherever they are told.
‘One thing I do is patient assessment, try to understand the patient’s motivations. Try to compare the expert analysis against the patient’s request. When they match it is really easy but they can sometimes be totally divergent.’
It is clear that Dr de Maio’s own treatment style stems from his work in Brazil. He prefers for the physician to have a greater say in exactly what procedures are used to achieve the results the patient desires, rather than being dictated to by the patient. His approach is to treat the whole face rather than just one area for more subtle, natural results.
It has been through this treatment style that he developed his own eight point approach, which addresses eight separate areas of the face to achieve a whole, natural, and non-surgical face lift.
Working with Allergan
Dr de Maio began working with Allergan in 2004 in their Aesthetic Academy. They provided him with a platform to educate other physicians on his treatment approaches and he was able to educate those less experienced on matters they may not have covered at university.
Dr de Maio also found the ideal product for his treatment approach in Allergan’s JUVÉDERM injectable hyaluronic acid (HA). He pioneered the use of JUVÉDERM for facial rejuvenation, achieving natural results through volume restoration. He is now leading a series of masterclass workshops sponsored by Allergan on the use of their new range of dermal fillers powered by JUVÉDERM VYCROSS™ technology.
‘A lot of companies are trying to develop biodegradable products with longer duration. JUVÉDERM VOLBELLA, VOLUMA with Lidocaine, and VOLIFT are a new technology of hyaluronic acid preparations,’ he explains.
Every patient has a different degree of complexity and we cannot be na”ve and think a single product can solve the complexity of the ageing process.
These products offer the natural results through a whole face approach that Dr de Maio strives for. JUVÉDERM VOLUMA is a volumiser that recontours the face to restore volume to chin, cheeks, and cheekbones that have become hollow or thin due to weight loss or age-related facial fat loss. JUVÉDERM VOLIFT is for the nasolabial fold and any deep skin depressions. JUVÉDERM VOLBELLA is designed to be used on the lips. Allowing for lip definition without excessive projection. According to Dr de Maio all three products meet a need.
‘Allergan already has a portfolio of fine products delivering excellent results, but there are always gaps. For example, some lips are so difficult to treat that it was difficult to get natural looks. These products are leading to natural results and filling the gaps of those patients you would normally be reluctant to treat. I think this will be the trend for many future products: to be more adaptable,’ he explains.
‘The gap these products are also filling is you get natural results even with excessive smiling, crying or other animation. I think this will be very suitable for Europe and their culture of not having people know they’ve had a procedure.’
While the trio of fillers from Allergan meet a need in the market, Dr de Maio still believes there is room for improvement on the side of the injector.
‘Every patient has a different degree of complexity and we cannot be naive and think a single product can solve the complexity of the ageing process. One of the misunderstandings of this industry is injectors try to compensate for the ageing process with treatment of one single product or in one single area. So I think the gap is that while we have very good products on the market, we have to improve the development of patient assessments by the injector. As they are not used to assessing the patient and only delivering the request, work still needs to be done in this area.’
Dr de Maio will continue to work on addressing this gap in development by continuing to take part in masterclasses and expert meetings, and promote the natural-looking results so sought after in his native Brazil.