I'm playing around with a computer program, usually operated by a smartly-dressed dermatologist with razor-sharp cheekbones. On a big screen, I can adjust the controls to show how my face would look, enhanced by skin softeners, fillers, or Botox. I turn up all the settings to the max. At the end the image looks nothing like me but bears a striking resemblance to Madonna.

As a glossy expert leads me to a stall boasting ‘revolutionary nitrogen plasma technology’, we pass several identikit women, all sharing the same shiny sheet of long hair, skinny supermodel pins, emotionless expressions and Chanel handbags.

They are here for the Aesthetic and Anti-Ageing Medicine World Congress (AMWC) 2025, the biggest medical beauty bunfight in the world, where doctors and nurses come to source and display their weapons against the horrors of ageing.

Thought The Substance was a schlock horror movie about an ageing star who injects herself with a mysterious liquid in order to shed her old skin and emerge as a dewy, juicy version of herself? It feels more like a documentary when faced with the maze of offerings in the six huge halls at the Grimaldi Forum in Monaco.

Here you’ll find a vast array of substances with which to tweak, transform and turn back the clock - and it’s not just about new ways of doing Botox or traditional fillers (though they’re still very much part of the future’s anti-ageing arsenal).

I stroll past the thousands of stands showcasing their wares, endless tables laid with needles as long and thick as a strand of spaghetti. Here are turkey baster cannulas to administer what is grandly called ‘regenerative aesthetics’ - everything from hyaluronic acid fillers and ‘Restylane skin boosters’ to neuromodulators and biostimulators. Injectables that make even me, a seasoned Botox and filler user, feel squeamish.

Kate Spicer plays around with a computer program that allows her to see how her face might look enhanced by skin softeners, fillers, or Botox 

Of course, not all the 12,000 delegates who gather annually in the playground of the rich and vain look peculiar.

In fact, many of the surgeons advertising their various devices and potions look glowing with health – the perfect advert for their world-class skills.

But when you step outside the main amphitheatres, into the cheaper areas of the show, where less blue-chip brands sell their products and services, it all starts to look less like a glitter-strewn Harley Street and more like a jaded suburban shopping centre, full of old-fashioned dupes of big name products.

The real innovation can be can be found in the lecture theatres where, over four days, the industry’s foremost doctors, surgeons and ‘thought leaders’ cover some very scientific topics indeed - including the AI revolution happening across healthcare. These are the people pulling cosmetic practice into the more serious medical fold - and it’s not just about looking good, but longevity, preventing disease, and brain and gut health too.

For all the gory detail, something important is happening here. A few years ago, the conference was just about making people look younger; now it’s about making them well, too. It’s a shame the slightly strange-looking faces don’t always reflect that.

So, what did I learn? Here’s what you need to know...

Big lips are out, the natural face is in

Though I found few in evidence, the ‘natural face’, as opposed to the ‘overly-done face’, is the big, growing trend. Many doctors seem truly committed to it and I must have heard the phrase a hundred times.

It’s partly a backlash to the exaggerated, gender-specific characteristics of recent years – the big sexy lips for women and over-emphasised male jaws. Mexican surgeon Dr Rodolfo Reynoso even showcased the ‘androgynous face’, which preserves the characteristics of the patient’s face without adding idealised feminising or masculine qualities.

What’s interesting is how taboo ‘having work done’ is, even in this great shrine to plastic surgery. Most people I meet tell me they have had nothing or very little done, ‘just a little skin boost’. It looks to me like every one of them is lying. One doctor - who shall remain nameless for kindness’ sake - has shelf-like chipmunk cheeks and huge chipolata lips, yet insists she has done nothing and her whole family looks this way. Another tells me she’s in her mid-40s, which made our photographer burst out laughing... thankfully behind her back.

The new Botox that combats over-sized pores

The natural look still requires a superhuman effort, especially if you want flawless, youthful skin or what’s known now as ‘baby’ or ‘glass’ skin - a look popularised in South Korea, home to some of the world’s most influential skincare companies.

‘Glass’ skin cannot be achieved via drinking eight glasses of water a day and cleansing. Step forward ‘mesobotox’, also known as micro-needled Botox. This uses the minimally-invasive technique known as mesotherapy, where injectables are targeted at the middle layer of the skin, combined with botulinum toxin.

The effect is to close pores - but it’s a very short-acting treatment and, unlike traditional Botox, which requires top ups every six months or so, you’ll be in every few weeks.

What’s interesting is how taboo ‘having work done’ is - most people I meet tell me they have had nothing or very little done, writes Kate Spicer

Test that shows whether a product is really working

Our organs can be tested for their ‘epigenetic age’, meaning how old they are biologically, as opposed to how old they were on your last birthday. They might be younger; they might be older. Now we can do the same for our skin.

Research and development wonder woman Dr Cristiana Banila developed two cancer screening tools for the NHS before she was 30. Now she has turned her attention to cosmetics and longevity with the MitraClock, which measures the pace of ageing in skin so you can see if the thousands of pounds you’ve spent trying to reduce the age of your skin has actually worked.

And as Italian doctor Pierfrancesco Bove tells me: ‘It’s pretty simple. If you have young skin, you are young.’

Dr Banila will have therapists and gadget manufacturers quaking in their boots. By testing skin age before and after treatments, we can definitively see how effective they are.

So far, she has found that retinoids (vitamin A derivatives) work, along with specific types of laser - but certain ‘energy devices’ which claim to rejuvenate the skin are actually ageing it, especially if they fall into the wrong hands, such as lesser-qualified therapists’.

Umbilical cord face mask

The breakthrough making the loudest noise at this year’s conference: ‘bioregenerative aesthetics’, aka non-invasive breakthroughs which claim to harness the body’s innate ability to heal and regenerate itself.

In recent years, as many as 235 companies have sprung up offering exosomes – tiny intercellular ‘messengers’ that carry proteins, acids and growth factors and are said to boost cell turnover, which promotes tissue repair and regeneration. Products carrying the exosome buzz word are flooding the market, but no one actually knows if they are any good and the market is currently a bit of a Wild West.

Dr Hernan Pinto, head of Barcelona’s Aesthetic Specialties and Ageing Research Institute, told me that in a study published in the journal Stem Cell Research and Therapy, ‘little evidence of safety and efficacy’ was found, and ‘in the seven exosome brands tested, less than half even had exosomes in them’.

Kate undergoes a treatment at the Aesthetic & Anti-Aging Medicine Congress in Monaco

Exosomes are harvested from stem cells - those cells in our body that can adapt, build and mend - and enthusiasts claim they provide similar benefits to stem cell therapy without many of the unwanted side-effects.

At the conference, a Korean brand called Primoris was selling sheet masks and micro-needling serums derived from human umbilical cord stem cells harvested from births. The material contains 1,470 different growth factors, I am told by its international sales director Alice Kim.

The stem cells are donated by altruistic new mothers whose only wish after giving birth is that your skin gets the ultimate regenerative boost.

The problem is that transmissible diseases can also be shared via stem cells, and human-derived exosome treatments are banned in many countries, including the UK and EU. Stem cells from red deer, apparently, are a good safe mimic of human ones. A Singaporean company called Calecim uses red deer umbilical cord lining in its skincare product.

I take my exciting, contraband human umbilical cord sheet mask to one of the many booths with the kind of machines needed to drive the mushy gelatine into the skin. A dermatologist sets it to the ‘abrasion’ setting and I undergo some ultra-fine micro-needling, with impressive results.

Other substances on offer here that can potentially kick start natural biological processes to make skin healthier (and might even have positive knock-on effects on bone and other tissues) include peptides (largely synthetic amino acids that mimic ones found in humans) and polynucleotides (most famously from salmon semen).

For the cosmetic medical field this pivot into health brings a new credibility. It’s also better for business. A cosmetic clinic can now present itself as a place for serious-sounding longevity treatments as well as tweakments for the vain. What’s more, administering these products is often a simple matter of smearing them on and running a bit of infra-red over them to help them sink in. No need for needles. Exosomes are 1,700 times smaller than our pores. Anyone can do it! For the clinics, at upwards of £200 a treatment, it’s a real money-spinner, too.

Veteran cosmetic doctor Joseph Hkeik says this is the biggest shift in the field since we swapped fillers made with bovine collagen – obtained from the skin of cows – for the far more versatile and natural ones made of hyaluronic acid. The problem is, he says, that some of the new regenerative treatments are good while others are useless. ‘Some of these clinics have patients coming in for boosters every other week. No one needs to be in and out of a cosmetic medicine clinic more than a few times a year.’

It’s not just ‘Ozempic face’ – fat jabs are trashing our skin from the inside out

‘I don’t think anything since antibiotics has had such a wide impact on society than Ozempic,’ says American plastic surgeon Steven Dayan. But while striking a broadly positive note, he warns that anyone taking weight-loss drugs such as Ozempic, Mounjaro or Wegovy must be managed not only by GPs – but by cosmetic doctors, too.

‘Patients should see aesthetic doctors early on in the process, otherwise we are going to be surrounded by 30 years olds who look 50.’

People on the drugs have unique issues beyond the much-discussed deflated balloon appearance of Ozempic face caused by dramatic fat loss. There’s hair loss, muscle loss, the knock-on effect of poor nutrition and fluctuating oestrogen levels due to rapid fat loss.

Dayan says that weight-loss drugs can also disrupt collagen production and the superficial musculoaponeurotic system, a fibrous layer of tissue that connects the facial muscles to the dermis. He believes it’s because GLP-1, the hormone in the drugs which slows down gastric emptying and can reduce appetite, switches off stem cells found in fat tissue that play a crucial role in tissue regeneration and metabolism. For this reason, he has to inject fillers much further into the skin of Ozempic users to achieve the same results. You have been warned.

Your digital twin will predict sagging before it happens

In this new age of huge biodata banks and AI, doctors can create a digital version of patients and using genetic and other tests, predict their risk of belly fat, or more seriously, cancer. At the cosmetic end of the scale, they can also foresee undesirable saggy bits decades before they actually sag.

‘Using this digital twin we can tell you how to adapt your diet and lifestyle and do things differently,’ says Dr Theodora Mantzourani, an anti-ageing doctor based in London. This rings some bells for me. While no one wants cancer, do we really want to become so neurotic about what might happen that we’re having tweakments in our tweens?

The next thing in lips is permanent gloss

Want lips that look permanently glossed or licked? Hungarian brand Glips offers a two-in-one shot that gives not only added volume but a shiny, wet look, too.

Popular in Dubai, Russia, Saudi Arabia, Iraq and Cheshire, according to the manufacturers, this moist and filled look is achieved by using both the natural ‘linked’ structure of hyaluronic acid and it’s artificially ‘cross-linked’ form (HAx), which together create a semi-permanent wet look as well as volume for several months. You can get them coloured too, of course.

A decade ago the talk was all of bleaching age-darkened skin in the most intimate areas, a procedure popularised by porn stars. Now it's about dyeing your vagina pink. The Italian company Promoitalia makes two forms of its Pink Booster micro-needling. One for lips, and one for labia.

People on weight-loss drugs have unique issues beyond the much-discussed deflated balloon appearance of 'Ozempic face', including hair loss, muscle loss and  nutrition and fluctuating oestrogen levels

Earlobe fillers

Around the exhibition space in break-out rooms, experts gave fascinating talks. The best-attended was a lecture dedicated to ‘New ways with filler’, where a respected Scottish doctor called Emma Ravichandran explained how to ‘restore patients’ confidence’ with earlobe filler. Yes, the crushing blow to self-esteem that comes with thinning or sagging ear lobes is at last a thing of the past.

Britain has plenty of experts – but its legislation is a joke

For some time there have been concerns about certain heat or laser-based treatments actually causing long-term damage to skin. This is not because the machine itself is inherently dangerous, but that they’re being wielded by inadequate so-called beauty experts. And this is more of a problem in the UK than elsewhere because in other countries regulations around who can use them are far tighter.

At many stands, when I asked whether the medical treatments they’re pushing need to be administered by a qualified doctor or nurse, or at least under the supervision of one, I was asked where I am from. Oh, in Britain anyone can do it, they would say.

Roberto Caldeira, chief executive of a small company called MyMed, which largely deals in fillers, told me he had changed his distributor in the UK because it was selling to too many beauticians and ‘we were starting to see problems’. So it still pays to check the qualifications of your expert before every treatment.