DR. ROBERTO VIEL is a cosmetic surgeon based on London’s Harley Street. Founding the London Centre for Aesthetic Surgery with twin brother Maurizio, the Viel brothers are looking to the future of cosmetic surgery. Pioneering advancements in penoplasty, liposuction and stem cell injection therapy, DR. ROBERTO VIEL is redefining the role of a cosmetic surgeon. The Montebury met with DR. VIEL at his Harley Street office to discuss botox, penis enlargement and the secret to eternal youth.
DR. ROBERTO VIEL /
Cosmetic Surgeon
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| DR. ROBERTO VIEL and twin brother Dr. Maurizio Viel |
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“ What surgery can give you, there is no cream in the world that can give you the same result ”
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The Montebury: How would you describe your work?
Dr. Roberto Viel — I do cosmetic surgery, but what does that mean? That means that we are here to help people to improve their quality of life, to improve the way they look and feel and to slow down the aging process. Nowadays it is not only like in the past where you took the patient to the operating theatre and did the plastic surgery, nowadays it is about well-being, wellness, giving advice in lifestyle and seeing the patient as a proper entity, not just as a nose or a breast. We need to give advice to rejuvenate, to stay better and to slow down the aging process. This is done with surgery or non-surgical intervention, as well as exercise and lifestyle changes.
How has cosmetic surgery changed over the years?
DRV — In the past, it was just about the face lift, breast augmentation or whatever, but now you do that as well as having much more to do with non-invasive treatments. The direction of cosmetic surgery is to be less aggressive, less invasive, and more in the way of prevention and slowing down the aging process.
Have you seen an increase in male patients?
DRV — Yes, there has definitely been an increase in men. Men nowadays are much more concerned about the look and they want to look better, show less lines and wrinkles. Botox and wrinkle treatments are getting more popular as well as facial rejuvenation. In the business world, if you look rested, younger is better. One of the main operations for men is to remove fat from the body. I don’t like to remove fat from the face because you need some fat in the face to stay younger. What I do is to remove fat from the body and put it into the face. I can see more men who go regularly to the gym, but there may still be some fat deposits mainly on the lower part of the abdomen and the flanks that is resistant to diet and exercise. So, the rest of the body may look good but they may need some extra help there, which is why they come to me. I offer a less aggressive treatment that gives better results than the normal fat removal procedure. The other operation that is getting more popular for men is the removal of excess fat from the chest. Because of too much beer and too much estrogen in food, men have more of a female chest, which is a combination of fat and breast tissue.
Of course, we always have a lot of men who come for penoplasty, to increase the size of the penis. Myself and my brother introduced this operation to the UK in 1991 and we have seen constant growth in that area.
What is it that the skin needs on a daily basis in order to stay at its best, before cosmetic surgery?
DRV — To have good skin, you need two major factors: good genetics (which means you have to choose the right parents) and then looking after the skin, especially not so much exposure to sun. Sun damage is one of the main reasons for aging of the skin on the face, which is why we tell our patients to protect their skin when they go out in the sun. Also, when you go out in the cold and wind, use a good cream that protects the skin. Your skin needs water, so you need to drink enough water during the day, but men do not drink enough water. In that aspect, women are better because they drink more water. We also need a good moisturiser, using the proper range of skin care treatments.
What schedule should we follow every day?
DRV — You have to look after your skin, so I tell my patients that prevention is key. Do not use soap, because the pH of the soap is too aggressive for the skin, so you cannot have a nice healthy, younger looking skin. I always recommend to wash the face with water morning and night. Cleanse your face well with a proper face scrub. I have my own line of creams, a very simple line, but it is efficient and works well. An efficient cleanser along with a moisturiser, a cream to tone, a cream for fine lines and finally one for the eyes - that is basically what you need. I give the patients my way of thinking - I don’t use any aftershave, but use creams instead. Why should you put something on your skin that gives it a nice smell but irritates it? After shaving, the skin has been slightly damaged which allows it to absorb the cream more effectively, which is better. There are a lot of things that men need to look at. But, men are doing better.
You mentioned Botox. What is botox and what does it mean for men?
DRV — Botox is a commercial name. It is called botulinum toxin. It is a wonderful drug that is very efficient, and is not so new because it has been used in medicine since the eighties. It began to be used for cosmetic reasons in the nineties and I have personally been using this toxin since the nineties as well. It is safe, if done properly and administered by the right doctor with the right training. You inject the toxin into the muscle of the face and stop the muscle movement. |
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Some lines that we have in the face are caused by too much facial movement, so to improve these lines you have to go to the cause. You can reduce the movement with the botulinum toxin and you will have less lines and the lines will not become as deep. In a younger patient, it is important to do it at an earlier stage for prevention because if you continue to make these facial movements a patient will reach a point in their fifties where the lines are very deep. Men are now understanding that and are coming regularly, two or three times a year.
Is it something you need to continue with?
DRV — If you like the result, then you can continue with it but there are no reasons why you should stop, I have patients who have been coming for the past ten years and have had no problem at all. If the patient has this treatment regularly we have found that the patient needs to have less injected between the time gaps. |
DR. VIEL’s Cosmetic Range
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Can a man get the same results from a product as he can with cosmetic surgery?
DRV — No, not at all. What surgery can give you, there is no cream in the world that can give you the same result. This is why we need to understand when the right time to perform surgery is and what we can do afterwards to maintain the result. Non-invasive treatments are very useful in preventing and delaying the use of surgery and after the surgery to maintain a good result. When the skin is sagging too much, there is nothing else to do apart from a face lift.
At what age does the skin begin to age dramatically?
DRV — There is not a proper deadline for when the skin starts to decrease because it depends again on your skin condition, your skin quality, whether you have thick or thin skin, dry skin, oily skin, you sun exposure - all of these factors will interfere with your skin aging. If for example, you take a patient from a northern European country and a southern European country, you see the difference because the northern European skin is beautiful when it is young but it is a finer skin, so if you expose it to too much sun, wind and cold, it will age quicker. If you take southern European skin, the skin is oilier and thicker and so the skin will age slower. |
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“ Your own fat will be the future for rejuvenation because your own fat has a lot of potential stem cells ”
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 DR. ROBERTO VIEL and twin brother Dr. Maurizio Viel
What are the differences between botox and your new platelet injection therapy?
DRV — The treatments are completely different. Botox stops the movement of the muscle, so you will not have much lines and wrinkles because you stop the muscle movement. This is a good treatment for lines that are due to too much facial movement. The platelet injections are better for lines due not to facial movement but to a part of the face where the lines are there because you are losing extracts of the skin such as collagen and the support of the skin. If you inject botox into lines that are due to lack of collagen, then you have no result. The platelets use stem cells that help your skin to produce more collagen, which improves the lines because you give back to the skin what is missing. They are two different treatments that work well together but they are for two different types of lines.
A lot of men are afraid to have botox because you are left without any expression on your face. Is this the case of have there been advancements?
DRV — With botox, it depends on how it is administered. To choose the right doctor is very important, because the drug is good and very powerful but it depends on how and how much you give to the patient. When this treatment was first used, the patient liked to have a completely frozen look with no expression, but nowadays, they like to maintain some expression. We can adjust the way to inject and the dose according to what the patient wants, so if the patient does want to maintain some movement, we can do that. This is why the experience of the doctor is important with this kind of technique.
Men are worried about cosmetic surgery because of the invasive factor. Are there any non-invasive treatments that men can begin with?
DRV — Yes, botox is one and the platelet injections are another. If you want to go a step further, we can take the patient’s excess fat and inject it into the face to rejuvenate without the need of a more aggressive surgery. invasive is when you open the skin and you do something underneath the skin. A face lift is invasive surgery, but Vaser Liposuction is invasive but less-invasive because you work with small openings and in a closed environment.
You have been at the forefront of developing several treatments. What were they like before and how have they changed?
DRV — Before the Vaser liposuction became popular there was the traditional way of doing liposuction. I started here in the UK in 1990 and I introduced the first generation of ultrasound liposuction, which uses the ultrasound energy to remove the fat. Here in the UK there were still surgeons performing liposuction that was very aggressive. The ultrasound is much more aggressive to the fat, is less invasive and gives a better result. There was not a proper technique for penoplasty, and now the technique is much more refined and less aggressive. We always try to achieve a smaller scar and a quicker recovery time. We can now do a lot more as a day case under local anesthetic with sedation, because there are better anesthetic techniques and drugs. This can allow us to do an operation without the need for general anesthetic. This means a quicker recovery time. |
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What are going to be some of the big cosmetic developments in the next ten years?
DRV — The idea is to go in the direction of prevention and less-invasive techniques. Basically, prevention means slowing down the aging process, so I think the future will be to help your own body to slow down the aging process and rejuvenate from inside with the use of stem cells and genetic engineering. This will help us to achieve what we want in a less-aggressive way.
Are there any restrictions at the moment in using stem cells in your procedures?
DRV — There is always a debate on the use of stem cells, because if you have to use stem cells that come from embryos, that is a big issue and there are some regulations. What we are working on is to use stem cells derived from the fat of the patient. The fat is the organ that has the highest concentration of mesenchymal stem cells in your body. So, your own fat will be the future for rejuvenation because your own fat has a lot of potential stem cells. The mesenchymal stem cells can be used and developed for what you need, without needing to take stem cells from embryos and placenta. This is why I like to keep my own little piece of fat for the future!
Men are more concerned about the area around the eyes. How is it different to the rest of the face?
DRV — The eye area is very important because if you have too much loose skin on the upper eyelid or too much puffiness due to fat on the lower eyelid, you look tired and older. |
“ Some men think that to apply cream to the skin is too feminine but that is wrong because you need to protect and help your skin ”
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So, if you want some improvement, start with a simple operation to remove the excess of skin and the puffiness and you will look much better. This is something you can do without a face lift. Genetics are a main cause of problems around the eye area, and it is not so much to do with age. Then of course, if you do not sleep well and drink too much alcohol and smoke too many cigarettes, the skin around the eyes will be ruined. These are simple things, it is about common sense.
What are some of the mistakes that your male patients are making?
DRV — It is improving, but most of the men think that because they are men, their skin is strong and they do not need to use sun protection. This is a big mistake but there are still men who think that way. Some men think that to apply cream to the skin is too feminine but that is wrong because you need to protect and help your skin. They will pay for it in the end. It is good to get into the habit of buying daily cream that includes sun protection. It is never too late to start a good habit.
Is there a big difference between cosmetic products?
DRV — It is difficult to answer this question because there are lots of products out on the market and there are big companies who produce quite a lot. What is better is to use a line of creams created by the surgeons, not because I have my own line because all of my other colleagues have done the same, but because we think that our product can be better because we put more energy and resources into getting a good ingredient inside the jar. The packaging and marketing is less but the content is good. The bigger cosmetic companies spend more on the marketing rather than what is inside the jar.
What about creams that claim to replicate a collagen injection?
DRV — Collagen is a component of the skin that is underneath the surface. So, if you apply collagen on the skin, it is going to be very difficult for the skin to absorb it. So, it is better to use something that will help your skin to lose less collagen and to produce more collagen. There are some creams that help you to produce more collagen (one of my creams has that) as well as the platelets injection. What is better to apply at night is not the cream with collagen but a gel that contains uronic acid. Uronic acid absorbs well into the skin and that helps.
For more information on London Centre for Aesthetic Surgery, please visit www.lcas.com.
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— January 2010
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