Dr Rozina Ali is an internationally recognised, multi-award-winning consultant plastic, reconstructive and aesthetic surgeon with more than three decades of experience. Renowned for her pioneering work in regenerative medicine and her philosophy of pro-ageing, she believes the most successful aesthetic treatments are those that work with the body’s natural biology in a multi-factorial, multi-layered approach. In this blog, Dr Ali shares a selection of ten principles that have shaped her approach to caring for thousands of patients over the course of her career.
Over the last thirty years, I have met thousands of patients, each with their own concerns, aspirations and reasons for seeking aesthetic treatment. Some come because they feel they look tired, are being overlooked at work, or at home. Others have noticed changes after pregnancy, weight loss or menopause. Others have suffered the ravages of disease or gravity, many simply want to feel more like themselves again.
All arrive having spent years quietly considering their options. They would have spent months seeking out opinions, articles and researching treatments online. These sudden ‘overnight’ changes have been years in the planning and hoping.
These are the ten things I wish for every patient on their aesthetic journey.
- Your consultation is the most valuable time you can spend.
People often arrive simply asking for a particular procedure. They want filler, Botox®, surgery or a specific treatment they’ve read about online. In reality, the consultation is where the real work begins.
I have always described consultations as a journey of mutual discovery. The patient can assess and interrogate the doctor. The doctor can get a measure of the patient and the problem. Together both parties can agree outcomes, strategy and whether or not to embark on any journey
The consultation is a therapeutic process. Not just a single meeting, it’s the information exchanged, the investigations requested, the results received and the discussions generated. Together we give each other the time and space to understand what is the issue, what are the consequences of the issue, what matters most to you. We peel back the layers, both literally and figuratively, before deciding whether treatment is appropriate or not, and if so, which approach is likely to achieve the outcome you want in a time-effective and affordable way. A good consultation is a professionally led honest, open dialogue in which your autonomy is respected. Very often, the treatment a patient thinks they need is not the treatment required, but the final decision is based on an informed understanding of what is desired, what is requested and what is possible. It’s the all important first step to establishing a trustworthy doctor-patient relationship.
- Ageing begins long before you notice it
One of the biggest misconceptions is that ageing starts when wrinkles appear. In truth, it begins decades earlier.
From our twenties onwards, collagen gradually declines, skin hydration reduces and the deeper structures of the face begin to change. Bone remodels, fat pads slowly deflate, ligaments stretch, muscles alter in tone and gravity quietly begins to influence every layer of the face and body..
By the time we notice visible ageing in our thirties or forties, these biological changes have often been developing for years. Accepting and understanding this completely changes how we approach rejuvenation and the primacy of tissue regeneration. Form and function both matter equally.
- Beautiful results are multifactorial
One treatment rarely provides the complete answer because ageing is not a single process.This philosophy has shaped my entire approach to facial rejuvenation.
Rather than treating one concern in isolation, I prefer to develop a comprehensive overview and work at multiple levels offering products and procedures as required and addressing all layers of concern. For example, it may be necessary to alter habits and optimise bloods or hormones, then improve hydration or skin quality, perhaps stimulate collagen or fat regeneration within the skin, restore fullness where volume has been lost, tighten tissues where appropriate and refine and sculpt the whole. Each layer supports the next. The outcome is more harmonious, more natural and longer lasting.
- Healthy skin always comes before volume
Patients are often surprised when I recommend improving well-being or skin alongside restoring facial symmetry or volume. For me, healthy skin is the strong foundation upon which aesthetics is built.
Treatments such as Profhilo®, mesotherapy, NCTF, polynucleotides and exosome therapy help restore hydration, stimulate collagen production and improve the quality of the skin itself. When skin is functioning well, every other treatment performs better. Healthy skin heals better, reflects light more evenly, hugs underlying tissues more tightly and ages more gracefully.
- Your own biology is often the most powerful resource available
One of the reasons I became such an early advocate of fat transfer and regenerative aesthetics is because I understand the body already possesses remarkable healing potential. Rather than simply softening lines, stretching or removing tissues or replacing descended fat with HA filler, I like to lean into the natural capacity of ourselves and use injectables or energy based devices to encourage the body to repair and regenerate itself.
Fat transfer has long been one of my favourite procedures; so much so that I often say, “fat is the elixir of youth – it is rich in stem cells, it offers volume and it allows us to replace like with like tissues. Using your own purified tissue allows us not only to restore volume, enhance healing, rejuvenate cells and tissues but also to improve skin quality through its regenerative properties. Fat really is firmly our future.
If fat is limited or not available, then other biostimulators such as collagen stimulators including Lanluma®, Radiesse®, Sculptra, Julaine platelet-rich plasma, exosomes and polynucleotides work with your own biology to rebuild healthier tissue over time.
- Sometimes less really is more
One of the greatest luxuries in aesthetic medicine is the ability to be moderate, measured and mature. The aim is never be to chase trends or continually add more treatment- that way lies excess and regret! No matter the temptation, my philosophy has always been “little and often”; I offer carefully sequenced multi-layered, treatments designed to evolve naturally, with you, over time.
I would much rather offer a course of several therapeutic and regenerative treatments over a number of weeks than create one dramatic change overnight. The compliments my patients prefer include “Gosh, you look good or you look well/happy/rested.” You never want to hear the shocked “You’ve had something done.”
- Menopause changes far more than your hormones
One of the biggest shifts I now see in clinic relates to perimenopause and menopause. The change in hormonal milieu in midlife effects men and women but is better recognised and more marked in women. Many women expect hot flushes, weight gain or changes in mood. Far fewer expect the profound structural changes that declining oestrogen has on collagen, skin hydration, facial shape and volume, breast tissue, fat distribution, muscle tone and even hair quality.
These changes can begin in the decade before menopause itself. Understanding what is happening allows us to manage expectations – that in itself can be helpful as well as respond pro-actively with a personalised combination of lifestyle advice, regenerative treatments, hormone support where appropriate and carefully considered aesthetic options.
- Surgery and non-surgical treatments should complement one another
Patients sometimes think they must choose between surgery and non-surgical treatments, but I have never seen them as competing options.
Throughout my career as both a reconstructive and regenerative aesthetic surgeon, I have believed the best results come from combining approaches thoughtfully. Regenerative treatments, advanced technologies, injectables, skincare and surgery each have an important role.
True expertise lies in understanding when each is appropriate and how they work together to achieve the best possible outcome. Otherwise the sad truth is, if you have a hammer, everything look like a nail.
- Looking like your true self should always be the goal
My philosophy is to help people look like the very best of themselves. If ageing makes some people unhappy, it’s best to be careful that un-ageing’ doesn’t make them equally unhappy. ‘cognitive dissonance’ applies to seeing a different image in the mirror to the person you believe yourself to be. We all understand the anguish of the beautiful young ingenue who has grown old. But the same pain applies to seeing a strange face each time you look in your mirror- it’s better if your reflection be familiar, loved and welcome.
I often talk about preserving your social memory; ensuring that friends and family continue to recognise you as you age, simply seeing someone who looks refreshed, rested and healthy. That’s also why it’s good to start early- so you are never perceived as old’ and that also fits with my ‘little and often’ philosophy of self-investment.
- Ageing well is an ongoing partnership, not a series of single appointments
Perhaps the biggest lesson I have learnt is that ageing well is never about one procedure. It is an ongoing partnership.
Sometimes that involves regenerative treatments delivered gradually over time. Sometimes surgery becomes the right choice. Increasingly, it also includes medical-grade skincare, nutritional support, supplements, wellness assessments and technologies that help support the body’s own repair mechanisms.
At the R&A Clinic in Central London, this whole-person philosophy underpins everything we do. Every treatment plan is tailored to the individual, recognising that ageing affects far more than the skin alone. There is no universal solution. Only the best solution for you, at that time.
That neatly leads back to where we started- the primary importance of the consultation process! That is the stage at which you shoulds set out to find a clinician or clinic you trust, you like and you would be happy to visit regularly. It’s a fundamentally important therapeutic relationship, so best you give it some time and thought.
A lifelong approach to ageing well
After more than thirty years in plastic surgery, I am amazed and awed at how pioneering, forward thinking and brave our specialty remains and that is entirely because of what our patients demand – A Future facing specialty.
As a consultant plastic surgeon, I remain convinced that one of the most rewarding aspects of my profession is not only performing procedures (I do still love that!) but it is empowering patients to make their own decisions. It is helping people to understand their own biology, the limitations of what is available and feel confident in the choices they make.
Ageing is inevitable and an undervalued privilege, but how we grow and support ourselves through that journey has never been better understood and more within our control.
