Poor Madonna. The 53-year-old star once made headlines for her raunchy dance routines and high-fashion outfits. But she - and a growing number of women like her - was at the centre of a rather different and more serious debate last week. Or rather, her face was.
At this year’s British Association of Aesthetic Plastic Surgeons (BAAPS) Annual Scientific Meeting, medics from all over the world met to discuss the problem she appears to have in common with other celebrities, from Kylie to Lulu - “pillow face”. And top of the agenda were the latest cosmetic surgery techniques being used to avoid it.
“This look is usually the result of too many injectable fillers,” says BAAPS president and consultant plastic surgeon Fazel Fatah. Fillers are injections - usually of chemicals that occur naturally in the body, such as hyaluronic acid or collagen.
Madonna has neither confirmed or denied having had cosmetic work, but recent pictures show her to have suspiciously full cheeks for a woman of her age and build.
“As we age, our skin becomes depleted in the substances that give it elasticity and volume. Older women, especially if they are slim, will notice a hollowing of the cheeks and around the eyes. These things visibly age the face,” explains Mr Fatah.
“Fillers are chemicals that are injected into areas in the face to plump out the skin, restoring a youthful look. The problem is that patients may be so thrilled with the results they want more and more injections. At a certain point, the face and lips look puffy and over-stuffed, hence the term pillow face.”
But there is a new approach - a technique called lipomodelling, which restructures the face from within, tackling deeper tissues.
Lipomodelling involves the removal of fat from another part of the body, such as around the hips. The fat is refined - separating it from liquid or oil from ruptured fat cells. A cannula about 1mm in diameter then deposits tiny particles in tunnels within the tissue, creating layers of new tissue. These have to take as a graft within the face - establishing circulation from around the tissue to become a viable part of the structure of the face. They don’t dissipate or move so there is less need for repeat procedures. It looks and feels totally natural.
“The pillow-face look is all about over-injecting filler material,” says Mr Fatah. “Doctors should take responsibility, and explain to patients that they may look ridiculous if they ask for more and more.”
Lipomodelling is more mobile than traditional fillers because it moves like natural tissue. It is also more easily reversible. Because it becomes part of your soft and fatty tissue, it can be suctioned out later.
Among other trends that are firmly out of fashion and were discussed at the conference was the so-called “surprised look”, which can be a product of brow-lifts. “This is a lot to do with training and expertise. There are 17 muscles on each side of the face, which need targeting to achieve discreet results,” says Mr Fatah.
“You can always tell if someone has had Botox when you see those over-raised eyebrows.” It may explain why celebrities including actress Nicole Kidman and supermodel Janice Dickinson look permanently astonished by life.
A new technique reshapes the eyebrows using surgery - and sometimes Botox as well - so that the eyebrow shape starts in the inner corner of the eye, rises over the pupil and then shapes back down to create a natural and feminine look.
Noses were also a hot topic of discussion. Now that all ethnic groups are requesting corrective procedures, surgeons are looking closely at ethnic rhinoplasty.
“The structure of the nose varies between different ethnic groups,” says Mr Fatah. “Surgery needs to maintain ethnicity. Choosing a nose from a different ethnic group is probably not a good idea.” Michael Jackson was a prime example.
The conference dedicated half a day to a workshop on the psychological assessment of cosmetic- surgery patients.
“This is vital in anyone considering surgery,” says Mr Fatah. “It is disastrous to operate on anyone with an underlying psychological condition that changes their perception of reality.”
The notion of subtle grafting, filling and tweaking applies even to such niche techniques as earlobe reshaping and eyebrow transplants for those who have over-plucked or have skin conditions such as alopecia, which cause them to fall out.
And if you thought the recession had hit us all hard, think again. “Times may be tough, but demand for cosmetic procedures is still high,” says a former president of BAAPS, plastic surgeon Nigel Mercer.
On a serious note at the meeting, shocking new statistics were revealed about the trivialisation of cosmetic surgery, particularly relating to the irresponsible ways in which some clinics are marketing their services - using voucher sites and even raffles.
“The whole point about this meeting was to present new procedures and ideas for peer scrutiny,” says Mr Mercer. “No one was selling any new procedures - we were discussing the future of surgery.”
Which is great news for the thousands of Britons who will be going under the knife or needle in the next 12 months.
Take note, Madonna. - The Mail on Sunday