The Pioneers of Aesthetic Medicine: Meeting with Dr Roland Ney and Dr Luigi Polla

Article written by Samba Academy. Watch the video interview click here.

Exploring the roots and recent developments of aesthetic medicine, we had the privilege of talking to Dr Roland Ney and Dr Luigi Polla. Through their exceptional careers and significant advances, these pioneers have had a profound influence on the field of aesthetic medicine.

Their complicity is obvious from the very first exchanges. From acupuncture with gold needles to hyaluronic acid fillers by Dr Ney, to Dr Polla's creation of the first laser platform in Europe, these masters of aesthetics share captivating anecdotes and lessons learned from decades of practice. Imagine Dr Ney volunteering at a conference and finding himself with deep purple cheeks following laser treatment, or Dr Polla facing the stigma of being the 'black sheep' of dermatology for embracing aesthetic medicine.

These never-before-published stories, combining technical feats and moments of profound humanity, reveal the spectacular evolution of a field where every advance is a promise of renewal.

Read on for an intimate exploration of aesthetic medicine, where past and future meet to sketch out the face of tomorrow.

Can you introduce yourself in a few words?

Roland Ney (looking at Luigi Polla with a smile) Do you want to start?

Luigi Polla : No, you start.

Roland Ney : OK. So, I'm Dr Roland Ney, with a background in general internal medicine. I have a wide range of professional experience, having started out in tropical medicine and population genetics in Indonesia, before returning to internal medicine. I then opened a practice near Lausanne, where I practised general medicine and acupuncture for 20 years. It was through acupuncture that I turned, against my better judgement but much to my delight, to aesthetic medicine. Starting in 1986, I began using acupuncture treatments with gold needles to tone the skin on the face. My patients were very happy and came every three months. I was then naturally drawn towards the treatment of wrinkles, particularly with the appearance of bovine collagen on the market in the 90s. That's how I started injecting myself into the field of aesthetic medicine.

Luigi Polla : Impressive. I'm a dermatologist, with a sub-specialty. When I returned to Switzerland, I set up the first real laser platform in Europe, which enabled me to treat many children suffering from angioma planus, those red spots on the face, as well as the tattoos of the time. I entered the field of aesthetic medicine by chance, treating facial dyschromia, whether related to blood vessels or pigmentation. I then decided to set up my own clinic, dedicated to aesthetic medicine, while continuing to work part-time in dermatology. A few years later, I became co-scientific director at IMCAS. With my friend Roland, we founded the Society of Aesthetic Medicine and Surgery, with the idea of exchanging ideas and making progress in our medical training.

When was your first experience of aesthetic medicine?

Roland Ney : For me, it goes back to aesthetic acupuncture treatment. We didn't treat illnesses, but took a purely aesthetic approach to improving the quality of the skin.

Luigi Polla : As a dermatologist, I began by sclerosing small venules on patients' legs. This was before 1986, before I went to the United States. When I came back, I injected beef collagen, like Roland. My first injections were in 1986. And thanks to the laser, I started to remove things that weren't aesthetic, even though at the time I thought I was just doing dermatology.

Roland Ney Our core business has gradually been taken over by aesthetic medicine. As time went by, we realised that this field was becoming increasingly complex, and we had more and more organisational tasks in our clinics. Little by little, our core treatments, such as dermatology for Luigi and general medicine for me, became less important in our practice than aesthetic medicine.

What were the major steps that led to the modern aesthetic medicine we know in 2023? What about the modern use of lasers in aesthetic medicine?

Luigi Polla : I'd say that the big changeover between almost archaic aesthetic medicine and modern aesthetic medicine came with the arrival of hyaluronic acids on the botox market and lasers capable of specifically eliminating certain unattractive features.

Roland Ney : You have to realise that at the start, in the 80s, aesthetic medicine was in its infancy. No one was interested in it, and dermatologists, apart from Luigi, were extremely uninterested. They said: "This isn't medicine, it's business, and we're not shopkeepers". So, basically, it developed as techniques and industry became more and more interested in the subject, seeing the development it could bring later on. Whereas conventional medicine has been around for generations, aesthetic medicine has not. So aesthetic medicine, I would say, is not even 50 years old. It's more like 35.

Luigi Polla : In the beginning, nothing was structured. We were learning from each other, weren't we? And then, as I said earlier, it was precisely these three elements that enabled us to make progress and have far fewer side effects. It was really if we acted according to the art of aesthetic medicine and medicine, we avoided as many side effects as possible. And this helped to popularise aesthetic medicine with the arrival not only of the industry, but also of the media. All of a sudden, the media - I don't know if you mentioned it - became interested in aesthetic medicine and became positive about it, understanding that it was a social phenomenon. And that was a big step forward. Secondly, I would say that there has also been a better understanding of anatomy in general, of the face and ageing, of the anatomy of ageing, how a face ages, and so on. This, of course, is thanks to the involvement of a huge number of researchers and anatomists, and also medical imaging and all that, so it's exploded.

Can you tell us about the history of fillers?

"There was even something we didn't see in Europe, which was collagen from human cadavers. "Roland Ney

Roland Ney : So fillers started with beef collagen, then there were two or three other attempts with pig collagen, and there was even something that we didn't see in Europe, which was collagen from human cadavers, which wasn't a success, but was never introduced in Europe. After about ten years, collagen was replaced by HA, which has not yet been dethroned. After that, non-absorbable molecules appeared on the market and continue to be used. Perhaps better and better because we now have a better understanding of the dilutions that need to be used and there are fewer side effects. So it's a gradual diversification because the industry has developed hyaluronic acids for the different objectives we have in treating the face, for the different areas we want to treat, for the different goals, i.e. if we want to stimulate collagen production or if we want to improve volume loss, they won't be the same products. Botulinum toxin has been used in the United States since the 1980s. It was an American ophthalmologist called Scott who discovered the relaxing properties of the toxin and it was used in ophthalmology to treat strabismus. The toxin then developed with different indications. It was used to treat perspiration. There were many, many indications in internal medicine and even now, more than half of the toxin used in the world, i.e. more than 50% of toxin, is used for medical treatments and not for cosmetic treatments. And toxins have also improved in quality. There are a very small number of laboratories producing high-quality toxins. So it's still a very special niche, but that's it as far as injectable products are concerned.

Can you tell us about the history of lasers?

"There was the great revolution brought about by Rox Anderson, who explained the concept of selective photo thermolysis, making it possible to destroy a target inside the skin without destroying the rest of the tissue "Luigi Polla

Luigi Polla Until then, we had continuous emission lasers, which meant that you pressed the pedal and the laser emitted a beam of light that didn't stop, and in the end it produced heat. For dermatologists or those who practised aesthetic medicine, it wasn't very interesting because you burned everything. The only people who benefited from these continuous-mode argon lasers were ophthalmologists. Then there was the great revolution brought about by Rox Anderson, who explained the concept of selective photothermolysis, making it possible to destroy a target inside the skin without destroying the rest of the tissue. This was thanks to a precise choice of wavelengths and the introduction of new lasers with very short pulse durations. This kept the heat inside the target. That was the great revolution. Then came other devices such as focused ultrasound to microlift the skin, radiofrequency to make the skin firmer, shock waves to break down cellulite fibres, and cold to eliminate fat cells, all of which led to major advances in aesthetic medicine.

In all your years of practice, do you have any offbeat anecdotes?

Roland Ney I'll tell you about two of them. One was my first conference, I think, on aesthetic medicine. It was in Brussels and I didn't quite realise what laser treatment entailed. And there was the whole audience. And then they said if there was anyone who didn't want to come, we'd do a treatment on the small vessels. So I raised my hand and stretched out. And then they started to treat me, and I could see all the faces above me saying oh, ah, oh like that, oh there there. I didn't quite realise what was happening at the time. And then when I came out and looked in the mirror, my cheeks were completely purple because it was a laser that produces purpura, so it blows up the blood vessels. So I had a huge haematoma on both cheeks that took a good 15 days to fade.

The second anecdote, which is sadder on the other hand, is from a patient who asked to see me a few years ago, two years ago I think, saying "I received injections in the under-orbital region two months ago. And since then, I can't see very well, so I'd like you to give me hyaluronidase". I said OK, come on, we'll have a look. She came in. She said, "Well, I've seen another doctor who's already given me hyaluronidase and then it got a little better for a week, but it didn't last much longer than a week. And then I examined him and after my examination, I said to him "Listen, what you've got is unrelated to HA. You have symptoms that are absolutely not normal and not compatible with HA" because she had a strabismus that she didn't have before. "And you need to do a magnetic resonance. And it's inside the head that you need to see if there isn't something wrong. And indeed, she had a very large brain tumour. So, just to remind doctors who are future or present aesthetic doctors that we must always be doctors first and that we must always think, on the one hand as doctors, i.e. whether there is another diagnosis behind it and on the other hand, not to carry out treatments that would be either useless or to the detriment of the patient's health.

Luigi Polla I'll tell you an anecdote that has nothing to do with the practice of aesthetic medicine. My first assistant, a doctor, came to my institute to learn the profession she now practises. When she was hired, she made just one request. She told me "I'd really appreciate it if you didn't tell anyone I was coming to work for you". Surprised, I asked why. She said, "You know, you're the 'black sheep' of dermatology, and people say that aesthetic medicine is like being a hairdresser. That was in '97, so not that long ago.

What would you recommend to a doctor wishing to take up this speciality?

Luigi Polla : I would say that aesthetic medicine, like any other branch of medicine, is an art based on science, an aspect that we perhaps tend to forget a little too often in aesthetics, unlike other medical specialities. What's more, as Roland pointed out, it's essential to remember our Hippocratic oath and to bear in mind that, in every gesture we make as aesthetic doctors, we must always prioritise this ethical commitment.

Roland Ney : I'd like to add one more thing: aesthetic medicine has become so complex that, to practise it satisfactorily for the patient, you have to devote yourself entirely to it or practise it alongside a speciality such as dermatology. However, I don't see how aesthetic medicine could be a complementary activity for specialists in gynaecology or urology, or in other medical fields. Therefore, for a young doctor attracted to this field, I would recommend diving into it if they are seriously considering making it their main profession, or at least the major part of their professional commitment. Limiting yourself to devoting just 5% of your time to it will never bring the results that patients have a right to expect.

Luigi Polla : I totally agree with that. As in any business, to succeed, whether in medicine or any other field, you have to give 100%. That's how you succeed, that's how you achieve great things, and that's how you can feel proud at the end of each day. Indeed, after a certain amount of time, which may seem relatively short, total commitment to 100% leads us to excellence in our practice and in achieving our professional goals.

Roland Ney And as for giving yourself over to 100%, I have an anecdote, because back in '95, I think, I sometimes went to see Doctor Polla when he was in his practice in Place Cornavin. He had this peculiarity, starting work at six in the morning and continuing until ten in the evening. So he used to say to me, "You can come if you like, but you'd better come between 6 and 9 or between 7 and 10 in the evening. So the 100% commitment for Polla was actually closer to 200%.

How do you see the future of aesthetic medicine?

Luigi Polla : Let's say, based on the history of how aesthetic medicine has evolved, it's very difficult to say because, in fact, things happen that we didn't expect. But we can assume that genomics, for example, will certainly enter our profession and perhaps take away a large part of our work because we'll be doing procedures that are more like medicine, I'd say, almost like internal medicine, with the pharmas introducing molecules that will allow tissue regeneration. And that, in any case, is not with the products we have now, we can, of course, partially regenerate tissues, but we're a long way off, we're perhaps at 5%-10% from what we'll probably be able to do. And if not, the other thing that could come into play is artificial intelligence, as in all other branches, in all other professions, with these devices that will enable us to analyse our patients' faces and tell us what we could do that would be brilliant. And then even after robotisation that will tell us, we won't even be told what to do. It will be the robot that does it, of course, but the human being will still be there. The doctor will still be there to keep an eye on things. But I think it would be a great help to us if, over the next two years, we were to see a major development in artificial intelligence in our field.

Roland Ney : Artificial intelligence and 3D imaging are going to revolutionise things. In my opinion, a significant proportion of aesthetic medicine will no longer be practised by doctors, but by other health professionals who will be trained or will be trained by robots. The current state of affairs, where it's practically only doctors who work in this field, will change in my opinion, because it's in society's interest to reduce costs and it's above all in the industry's interest to have more people or more machines performing these acts of aesthetic medicine. So I think there will be quite a big change in the panorama of players in aesthetic medicine. That's why doctors who want to get involved now need to have very solid training so that they can stand above all this variety of procedures carried out by machines, robots or non-physician collaborators authorised to carry out treatments.

Luigi Polla : Yes, I have an anecdote on this subject that made me smile a week ago. My grandson, Leonardo, aged 11, said to me: "You know, Papou, I've been talking to Mum, I'm going to do dermatology because I want to take over from you when I'm older". I'm not going to tell you the rest, but I told him: "You know, if you want to go into dermatology, you won't be established until you're 40. And above all, you're going to study medicine first, and then at the same time do a Masters at the EPFL or another top school like MIT, and so on. Because the future won't just be in the hands of the doctor". That's exactly where you're going. Indeed, I think that if you're a young doctor still in training, you should take an interest in what's being done in the human sciences and also in the technical sciences.

Conclusion

This interview with Dr Roland Ney and Dr Luigi Polla, two pioneers of aesthetic medicine, takes us back to the roots and evolution of this fascinating discipline. Their dialogue reveals an innovative journey marked by passion, exploration of the limits of aesthetic medicine, and a relentless quest for improvement. These personal and professional stories highlight not only the importance of solid training, but also the need for an ethical and dedicated approach. Their vision for the future, where technology, particularly artificial intelligence, will play an increasing role, underlines the crucial importance of staying at the forefront of progress and innovation. The interview, rich in anecdotes and insights, is a powerful reminder that in the field of aesthetic medicine, as our interviewees emphasise, if you choose to engage, you must do so with excellence and integrity.