Okay everyone, I’m going to keep this intro short and sweet today. Because my beautiful friend Dr. Sonja offered up such a wealth of knowledge in this interview that I want to make sure we can dive right in.
If you’re someone who’s interested in learning more about skincare, cosmetic treatments, and overall beauty tips from a world-renowned doctor- then this is the post for you!
Skincare and Beauty 101 with Dr. Sonja Mitreveska Scholtyssek
How long have you been practicing dermatology, and where?
Currently I’m living in Germany and practicing dermatology in a private clinic in one of the most beautiful German spa towns called Baden-Baden.
I started practicing and learning dermatology right after I finished medical university in 2011 and moved back to my home city Skopje, in Macedonia. I was lucky enough to be able to learn from my mother, who is also a dermatologist. She was the one of the first dermatologists to open a private clinic in my home country. And was the pioneer in aesthetic treatments like Botox and fillers. So I got to learn and practice aesthetic medicine even before I started my official dermatological training in 2013. During my residency I had the possibility to do some courses and training in Belgium, Austria and Germany, but always with the plan of taking over my mother’s practice in future.
After finishing my residency and passing the board exams in 2018, in a slightly unexpected turn of events, I moved to Germany after marrying my now-husband and started to learn the language from scratch. In the beginning I would fly back and forth every 2-3 weeks and still see patients in Skopje. But after I became a mom and especially with the pandemic taking over, things changed and I could focus more on mastering the German language and passing all the necessary exams.
It was not easy to start over in a different country, with a different language and a whole new health system, but something in me welcomed the challenge.
The clinic where I work now is great because it offers a complete approach to almost all dermatological problems. From initial diagnostic procedures to operative treatments.
I’m grateful that after 10 years of practicing dermatology, I still feel the excitement at the beginning of the working day and the sense of achievement at the end of it.
What are the most common procedures and treatments that you perform on a daily basis?
The reason I like my job so much is that it’s so diverse. In one day we can have anything from classic dermatological diseases and all sorts of dermatological operations all the way to aesthetic procedures and laser treatments.
My biggest focus right now is probably skin cancer and the operative treatment of it. We diagnose and operate skin cancers on a daily basis. And it’s disturbing to see how common melanoma and non-melanoma skin cancers are. That’s why rigorous sun protection and a yearly full body check are so important.
From the aesthetic point of view, I would say that Botox, fillers, lasers and mesotherapy for hair loss are treatments that we do on a daily basis.
If someone could only afford to do either Botox or filler for anti-aging purposes, which one would you suggest and why?
First I always ask the patients what bothers THEM the most. Then I say what I’m seeing and what can possibly be improved. And together we decide what the best approach would be. The most important thing is that the patient is happy with their own face. But sometimes we are so focused on one issue and what actually makes us look tired or aged is a completely other issue.
How to achieve the best results for Botox and filler:
I like having a full face (and neck) approach other than focusing only on one area. In order to achieve the best results you have to treat the face as a whole. Otherwise the aesthetic work will be very noticeable and unnatural.
I’m the happiest when my patients say that nobody noticed they had work done. But everyone complimented how well rested or more beautiful they look.
Where to get Botox:
Usually I would recommend Botox mostly for the upper third of the face. That means the mimic wrinkles on the forehead and around the eyes, sometimes also for the so-called bunny lines on the nose.
I like the more natural effect, so I try to keep a little bit of muscle movements in the forehead while still getting that subtle brow lift or softening of the glabella lines (the lines between the eyebrows). It’s important not to over-inject the forehead with the idea that the botox will last longer. Because then you’ll have that typical frozen look with the unnaturally lifted eyebrows.
When to get Botox:
My advice around Botox would be: when possible – start earlier. At the first visible signs of aging but with smaller doses. We are starting to slowly lose the collagen in our skin after the age of 25. And usually the first signs of aging are visible already in our mid to late 30s.
Of course, genetics, sun exposure, smoking, stress are important factors here. But for most patients the 30s are the best years to start with small “tweakments”.
When to get dermal fillers:
Skin boosters are also a good option, they are light Hyaluronic acid products that are injected underneath the skin. It’s like the perfect moisturizer that actually works and gives the skin a nice glow.
Hyaluronic acid fillers on the other hand are great for filling the already existing wrinkles and bring back lost volume. If you have pronounced nasolabial folds (the lines around the mouth) then fillers would be a perfect choice.
Fillers are also great for volume restoration in the mid face. Especially after fat tissue loss due to chronic diseases, chemotherapy or menopause. I also love a very natural lip augmentation and chin augmentation to balance the profile. It’s a miracle how much a slight improvement in the lip plumpness can make the whole face look younger and more balanced.
How much filler is too much:
That being said- I’m pretty much against big, disproportional lips that have lost their natural movement. They are maybe the main reason for so much controversy around fillers. It’s easy to overfill the lips, not understanding the anatomy of the tissue. But you need a good anatomical knowledge and a sense for art to create a natural looking, proportional, undetectable and yet plump looking lips.
I like the saying:
“You should buy your clothes on sale, but not your lips.”
In your opinion, are lasers or peels more effective, and why?
Chemical peels can be great for giving that glowy skin look, improving skin structure, helping with acne scars and discolorations, but they should be done regularly. They stimulate collagen production but not as much as lasers.
Cosmetic laser treatments:
Lasers like Fraxel, for example, are much better for deeper acne scars, wrinkles, sun damaged skin and fine lines. Fraxel is more invasive than peels. And there’s a down time of around 1 week, when the skin becomes red, crusty and then it completely renews itself. We can see big improvement only after one treatment.
Other lasers, like the Clear & Brilliant are a good option for something in between. But you also need several treatments for visible results.
If someone has more issues with facial redness or enlarged blood vessels on the face, then the vascular lasers are great for that. Pigment lasers like Rubin laser (or also known as tattoo removal lasers) are great for sun spots, age spots and melasma (or pregnancy mask). Since hyperpigmentation is probably the most difficult to treat, there has to be a complete approach to it (prescription medications, appropriate skin care, strict sun avoidance etc). One without the other will not provide the best results.
Before doing any invasive laser treatments, you should always consult a dermatologist. Because in some cases they can be contraindicated (like for example in darker skin types, where the risk of post-inflammatory hyperpigmentation is higher).
What is your favorite laser treatment to recommend, and who is a good candidate for it?
Fraxel is my favorite laser:
When it comes to visible and fast results, especially for scars and sun damaged skin. Fraxel is also good for the fine lines underneath the eyes and around the mouth. Which are very difficult to treat otherwise.
For anyone not wanting to go down the treatment and injectable route, what are your non-negotiable skincare products to recommend?
SPF is a non-negotiable in skincare:
It comes at no surprise – a good (medically tested) sunscreen! There’s no point of doing any aesthetic treatment if you are not using SPF on a daily basis. That means every day, not just in summer or at the beach.
You can always check the UV radiation on your weather app to see when the sun is the strongest, even in winter. SPF in makeup usually isn’t enough. So I recommend having a pleasant lightweight SPF cream that you can use at the end of your skin care routine, before applying makeup.
Never forget the neck! Always treat the face, neck and chest as one unit.
How to apply skincare morning and evening:
Skin care shouldn’t cost a fortune and shouldn’t be overcomplicated. Apart from a good sunscreen, and an adequate moisturizer in the morning, you can also include an antioxidant serum as the first step, before the moisturizer.
In the evening, for an anti-aging purpose, I would recommend a good quality retinoid (Vitamin A). All retinoids should be avoided during pregnancy, and in rosacea patients. Products with AHA (alpha-hydroxy acids) are great too, but never use them on the same night as your retinoid product.
It’s important to start slow with retinoids, and increase the frequency of application every week. For example, start with once per week and slowly increase to every other day. If you notice skin irritation or redness then pause until the irritation has calmed down and afterwards decrease the frequency of application. Consistency over quantity is very important.
To sum it up, skin care should be adapted individually for every patient and it will look different for acne patients, patients with sensitive skin or hyperpigmentation. We might need a second interview only for that.
What’s the best at-home beauty treatment we can do to improve the quality of our skin?
At home beauty treatments are often not worth it:
Sadly, I think that the market for at-home beauty devices is oversaturated, and there are many false claims out there. So, I wouldn’t recommend investing too much money in them.
Benefits of LED:
In our clinic we use a professional LED machine on a daily basis, but with the purpose of faster wound healing and decreasing of inflammation.
The at-home LED masks claim to help with collagen stimulation, but I think that’s a more subtle effect. The blue light in LED masks can also help with acne breakouts and inflammation.
Benefits of Microcurrent:
Microcurrent devices claim to increase the elasticity of the skin, but they need to be used daily.
For patients without sensitive skin the at-home chemical peels can also be an option. They should be applied maximum once or twice per month. Afterwards a rigorous sun protection, and usage of skin recovery creams to rebuild the skin barrier is essential.
Overall, I think we should never forget that ageing is a privilege, and we should embrace the process as gracefully as possible.
I really don’t like the term ‘anti-aging,’ as it sounds like we are fighting against something that should actually be accepted as a gift.
That being said, we can also try to age more seamlessly and take care of our skin without feeling any shame or guilt. After all, the skin is our biggest organ, and a mirror to our overall health, so we should always treat it with the utmost love and care.
Thanks, Dr. Sonja!