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3. Aesthetic Medicine: Reflecting the Face Within

Beneath the needles of aesthetic medicine, the modern face longs to be smooth, eternal, flawless. Yet, behind this relentless pursuit of perfect skin lies a deeper anxiety, one rooted in our vulnerability, the passage of time and an unceasing desire to be seen a certain way. Between psychic defenses and illusions of control, the body becomes a social mirror, an intimate stage and a quiet battleground against our own finitude.

For humans, the skin is the body’s first layer. From an early age, it becomes a canvas, on which time leaves its marks and exposes our anxieties. In everyday life, a single white hair, a faint wrinkle or a subtle sag can trigger a profound inner crisis. D.W. Winnicott spoke of a “threat to the integrity of the self.” The moment this outer layer begins to give way, the anxiety of a psychic collapse is never far behind.

Many people, men and women alike, confess – between one Botox injection and the next, or between laser sessions – that they feel “older than their age.” What might seem like a mere vanity conceit actually signals a harsh confrontation with the reality of the body. Beneath the artificial smoothing lies a panicked fear of no longer being attractive, and therefore no longer loved. Behind that fear lurks an even deeper terror: the fear of not being fully alive.

The practitioners’ tiny needles become miniature swords, battling a hydra whose head – the wrinkle – must be cut off in a futile attempt to halt both aging and our own finitude. Beneath the cold, clinical light of the office, an ancient dialogue between Eros and Thanatos unfolds: we beautify the skin to push death from view, refresh the face to stretch life and mask what is lacking while denying incompleteness. The more we polish this mask, the more we fear what it hides – the flaw, the wrinkle. And yet, it is precisely the flaw that gives rise to desire. Overfilling creates the illusion of completeness, while lack allows fantasy to take shape.

S. Freud described a form of denial in which the subject acknowledges a fragment of reality while rejecting its painful meaning. Aesthetic medicine operates in the same way: yes, I see the wrinkle, but I deny that it marks my mortality. The technical act becomes an act of mastery – as if, by reshaping my skin, I remain in control of my own fate. This fantasy of omnipotence, echoing the earliest phases of childhood development, offers only a fleeting reprieve in the face of inevitable decline.

These treatments cannot be reduced to mere vanities. They reenact a fundamental dynamic of the psyche, the struggle against anxiety. The aesthetician’s office becomes a stage for this defense. Syringes, lasers and chemical peels serve as props in a carefully orchestrated repression. By substituting an idealized image for a reflection that has become unbearable, the subject keeps at bay the death drive which, as Freud noted, nevertheless operates invisibly within every organism.

Hardly anyone consults a dermatologist without wanting to “stay in the race.” This social imperative now comes with hashtags: #Ageless, #GlowUp, #ForeverYoung, a digital lexicon promoting an inescapable aesthetic. The wrinkle, once a sign of wisdom, is now perceived as an anomaly to be corrected. By promoting regenerative serums and “Botox-like” creams, the beauty industry forges an alliance between consumer culture and the ideology of a high-performing body. The phenomenon feeds itself: “perfect” skin earns compliments, likes, contracts and immediate proof of social success.

From this perspective, the use of injections is no longer purely defensive. It becomes offensive, a means of claiming a symbolic and economic space. The epidermis is then shaped according to a desirable morphology, defined behind the scenes by marketing offices and filter algorithms. The body becomes a product, reflecting the commodification of desire: you must appear a certain way to be valued.

Since the dawn of time, the adornment of the body has aimed to seduce. But in today’s hyper-mediated world, the stakes have shifted: it is no longer about seducing a real other, but a gallery of abstract, multiplied, anonymous eyes. The “Botox-and-filler” duo, by erasing age, pretends to guarantee the survival of erotic power. Yet, we subtly slip from lived seduction to the illusion of seduction.

Lacan reminded us that desire is always the desire of the Other: if the Other is reduced to a like or a “swipe,” the subject risks turning into an object offered up for consumption. By endlessly polishing their image, the individual suspends their own instinctual drives. They become a surface, a Narcissus captivated by their reflection, forgetting that they are, at their core, a subject of desire. The danger is twofold: submission to the tyranny of a frozen image on one hand, and the impoverishment of fantasy life on the other, where lack, though fundamental, is masked by the excess of visibility.

Psychoanalysis distinguishes the sexual – the relation to sexual difference – from the subjective position, which is a singular mode of enjoyment. In everyday language, femininity refers to the social inscription of traits considered “feminine:” gentleness, sensuality, attire, self-care and so on, whereas the feminine, in psychoanalytic terms, points to a mode of relating to the Other marked by lack, openness to the infinite and the enigma of unbounded desire. Similarly, masculinity describes a set of cultural signs – leadership, rationality, physicality and so forth – while the masculine is a subjective position, rooted in castration, the symbolic and the Law.

By increasing the emphasis on appearance, aesthetic medicine reinforces social stereotypes at the expense of the inner dynamics of the feminine and the masculine. Thus, a woman inflated with collagen may embody an exaggerated femininity that can sometimes hide a difficulty in inhabiting the feminine – that is, accepting incomplete enjoyment, and a body marked by a sense of incompleteness.

Similarly, a man, obsessively sculpting his pectorals, may display a performative masculinity while his masculine – that is, the anxious confrontation with castration – remains hidden. The contemporary obsession with images, fueled by high-definition screens, overwhelms the visual field. The pressure to appear tends to saturate psychic space. Photographing oneself, retouching, posting and then checking the responses – likes, messages, hearts – creates a cycle of narcissistic affirmation marked by frustration. Becoming the “ideal body” may come at the cost of losing the shadowy side of the body, that inner space where dreams and desire originate.

Aesthetic medicine offers the illusion of control over physical appearance, over how one appears and over inevitable decay. It confuses surface with depth. Yet, the subject of the unconscious slips between the swellings and the masks, eluding imposed control. When the skin no longer carries the story of life – scars, wrinkles, blemishes – it may no longer reflect intimate psychic trajectories. We then move into a time in which the excessive legibility of the face and skin conceals the fertile opacity of desire.