Part 21
The Med Spa Menu: Skin, Shape, and Sex
ILLUSTRATION. A woman likes the results of her cosmetic treatments. She also has untreated cardiovascular risk and has not discussed bone health. There is no need to dismiss her pleasure in her appearance. There is a need to give each appointment its proper purpose, and to make room for the less visible care.
Clinical scenes in this edition are explicitly labeled illustrations. They describe imagined situations used to explain medical decisions, not documented patients, diagnoses, conversations, or treatment outcomes. They should not be read as evidence that a particular intervention works. Personal recollections are recollections, not medical records.
Evidence grade (draft mapping). 12 questions; a question with mixed evidence counts under each grade.
- 314. Do cosmetic treatments have anything to do with longevity?They change appearance, not aging. Their real value is in how you feel about yourself, which is not nothing.JClinical judgment / author synthesis
- 315. Is Botox safe?Yes, when it is the genuine product injected by a trained clinician. It has more than twenty years of safety data for cosmetic use.ARobust human trials
- 316. What are the risks of fillers?Usually minor, occasionally catastrophic. If filler enters an artery it can block blood flow, causing skin loss or blindness.Grade pending
- 317. Microneedling, radiofrequency microneedling, and “vampire facials”?Plain microneedling modestly improves acne scars and texture. The radiofrequency version carries more risk. The “vampire” version adds cost without clear benefit.BLimited or small human studies
- 318. Lasers, light, and peels?These have the best evidence of any cosmetic procedure for sun damage, wrinkles, and discoloration. Results depend on depth, and so do risks.Grade pending
- 319. What actually works for skin at home?Sunscreen every morning and a prescription retinoid at night. Everything else is a distant third.ARobust human trialsBLimited or small human studies
- 320. Do skin-tightening devices work?A little. Ultrasound and radiofrequency devices produce a real but modest lift, far short of surgery.BLimited or small human studies
- 321. Does fat freezing work?It reduces a pinchable bulge by roughly a fifth. It is contouring, not weight loss, and it does nothing for health.Grade pending
- 322. Can a machine build muscle while I lie down?It can thicken the muscle it is applied to. It does not replace exercise.BLimited or small human studies
- 323. Is it safe to get weight-loss injections from a med spa?Be very careful. Many are selling compounded copies whose legal basis ended when the drug shortages ended, and dosing mistakes have put people in the hospital.RRegulatory status
- 324. What about treatments marketed for sexual function?The proven treatments are ordinary ones. The procedures advertised under catchy names are mostly unproven.BLimited or small human studies
- 325. What do couples actually ask you about sex in midlife?Whether it is normal for things to change, whether it is safe for the heart, and whether anything can be done. Yes, almost always, and yes.GGuideline-based / consensus