In Profile: Professor Sebastian Cotofana

By Kate Byng-Hall and Shannon Kilgariff / 25 Apr 2023

Professor Sebastian Cotofana shares his unconventional path into aesthetics and his passion for advanced anatomy

Professor Sebastian Cotofana is a world-leading voice in medical aesthetic excellence, championing patient safety and best practice through anatomy education.

Professor Cotofana grew up in Transylvania, Romania, before moving to Germany. Although none of his family had a medical background, his passion for medicine began at an early age. “For me, there was never any alternative to becoming a doctor,” he says.

His initial aspiration when he began his medical studies at the Ludwig Maximillian University of Munich, Germany in 2002 was to become a trauma surgeon. However, after qualifying, he decided to further his anatomical knowledge to become an anatomy professor at the Paracelsus Medical University in Salzburg, Austria. “My secret love is still trauma surgery and emergency medicine,” he says, “But while studying anatomy, I fell in love with facial anatomy, driven by clinicians becoming more and more interested in the subject at the time.”

After two years working in trauma surgery, Professor Cotofana decided to revisit anatomy. He says, “I think you can never focus 100% on more than one thing, and when I do something in my work, I invest all my focus into that. That’s what I did when I returned to anatomy.” In his late 20s, he was the youngest anatomist on his team, and was assigned to conduct an anatomy cadaver course for cosmetic injectors to study facial muscle anatomy. His collaborators on the course were physicians from the German Society for Aesthetic Botulinum Toxin Therapy (DGBT).

Professor Cotofana notes that he had no knowledge of aesthetics or facial injections prior to the course, commenting, “As a young anatomical assistant, I wanted to prove that I knew my stuff, so I didn’t even think about if I enjoyed the work to begin with. I did lots of additional reading and tried various dissection techniques and it went well, so the DGBT team returned the next year.”

He was then invited to speak at a German meeting of top dermatologists and plastic surgeons. He shares, “I was incredibly nervous, but I met some brilliant clinicians who asked me to join them on anatomical research projects focused on facial reconstructive surgery. This led to an invitation to dissect at IMCAS 2015, and my work within aesthetic medicine continued from there.”

Professor Cotofana later became an associate professor of anatomy in Dominica in the Caribbean, giving him more scope to invest time into studies on areas including the lip and forehead. After this, requests for international speaking opportunities skyrocketed, and he moved to the US, fuelling more travel and collaboration in the specialty. Since then, he has been involved in studies on a range of facial zones, as well as injectable rheology. Such studies have allowed him to coin the terms ‘injectable biomechanics’ (referring to how injectable products behave once injected) and ‘facial biomechanics’ (emphasising the cruciality of mobility during various facial expressions and ageing).

In 2019, Professor Cotofana joined the Department of Clinical Anatomy at the Mayo Clinic in Minnesota as medical director of the clinical anatomy laboratory and director of the Mayo Clinic body donation programme, alongside teaching as a professor of anatomy. He remains dedicated to furthering the specialty with ongoing research. “I’m currently doing a research project on lip compartments,” he shares. “It appears that we do have compartments within the red portions of the lip, and the size and combination of each compartment determines the shape of the lip. That’s pretty exciting if you think about it, because if the lip has compartments, you can inject very specific areas.”

He believes engaging in research like this is the way forward. “Some great research work is being done, and the scientific component is finally catching up with the clinical,” he explains. “I do think aesthetics is still far behind many other medical fields in terms of research, but together with the industry and some opinion leaders, this trend is being forged that it has to be science first. There is still a long way to go,” he adds.

Anatomical education is another passion of his that he sees advancing in coming years, whatever the baseline knowledge of the practitioner. For example, “I think learning anatomy from plastic or silicone models will become more and more integrated in anatomical curricula in the aesthetic field,” he comments. “I think models are crucial because they simplify the anatomy into digestible pieces of knowledge.” Making anatomy more accessible to beginners will allow more practitioners to understand the ‘puzzle of human anatomy’, as Professor Cotofana explains.

“Aesthetic practitioners shouldn’t forget that they’re still practising in medicine,” he says, noting that injectors must remember their medical responsibility to their patients, emphasising, “you should focus on patient safety first.” He explains this also extends to saying ‘no’ to patients if it is necessary to protect them from harm, concluding, “Medicine, like any other scientific domain, should always be focused on evidence-based knowledge.”

What you would like to research further…

I’m very into debunking myths in aesthetics, the ultimate goal being an evidence-based rather than eminence-based specialty.

Tips for learning anatomy…

I don’t think attending a cadaveric dissection is beneficial without a trained eye – start with more base-level courses to advance anatomy knowledge.

Source of inspiration in aesthetics…

Plastic surgeon Dr Arthur Swift definitely inspired me – he’s an amazing educator who loves to share and is amazingly patient.

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