The Interview: Dr Mica Engel of Cosmetica London on creating balance in aesthetics, skincare, business and life

Dr Mica Engel is a leading aesthetic doctor, based at her clinic Cosmetica London in Balham. Dr Engel started her career as a GP and A&E doctor in her native Brazil, before eventually moving to London with the intention of studying for a postgraduate degree in aesthetics.

She fully intended to return to Brazil upon completion of her studies, but instead was offered opportunities to work at Urban Retreat in Harrods and on Harley Street. Some 20 years later, she is still here and runs her own aesthetics practice, where she blends in-depth medical know-how, cutting-edge technology and holistic procedures to achieve the ultimate in balanced results. Dr Engel also has her own skincare line, called D.E.N, to help her patients achieve great results for their skin at home.

Her approach to facial aesthetics focuses on harmonising the features and delivering natural results. Meanwhile, for the body she has just launched the pioneering body sculpting technique TruSculpt. This procedure heats up fat cells, which are then flushed out through the body's natural waste system over time. With the help of manual lymphatic drainage, the process delivers more effective and even results, compared to other popular techniques.

In this in-depth interview, Dr Engel discusses her career, her philosophy and approach to aesthetics, and the key movements she feels are driving the industry forward.

Can you please tell me about your background in skin and body aesthetics, you trained under one of the best in the business, I understand…

I originally qualified as a doctor in Brazil in 2004, where I began my career working as a GP and in A&E. It was an incredible foundation, very hands-on, very human, and it taught me to look at patients as a whole rather than simply treating one isolated concern.

From there, I moved to Udine in Italy to study preventive medicine, and that’s really where my interest in anti-ageing medicine began to deepen. What fascinated me most was the idea that medicine could be used not only to treat illness, but also to help people age better, feel better and maintain confidence in a very holistic way. At the time, my plan was actually quite simple. I came to London to complete a second postgraduate degree in aesthetic medicine, fully intending to return to Brazil with two international diplomas and continue my career there. But life had slightly more dramatic plans.

After finishing my postgraduate training, I was offered an opportunity to work at the Urban Retreat at Harrods, as well as in a Harley Street clinic, and it felt like one of those rare moments you simply don’t say no to. I remember thinking, “Well, one more year in London working in places like these can only be good for the CV…” Fast forward nearly 20 years, and I’m still here.

Along the way, I’ve also had the privilege of training with some of the most respected names in the field, including Dr Mauricio de Maio, who is truly one of the pioneers of modern facial aesthetics. Learning through specialised Allergan training with him had a real impact on the way I approach facial assessment and treatment planning.

His work around MD Codes and facial harmonisation was particularly influential for me because it helped move the conversation in aesthetics away from simply “filling lines” and toward understanding the face more structurally and strategically. That philosophy, treating the face with balance, respect and a much more refined understanding of ageing, has absolutely shaped the way I practise today.

What started as a short professional chapter in London ended up becoming a long-term journey, and one that has allowed me to blend my Brazilian medical background with years of experience in one of the most sophisticated aesthetic markets in the world.

Brazil is known for its expertise in aesthetics and beauty, what would you say it is about the approach in Brazil that sets it apart?

Brazil has always had a very intense and unapologetic relationship with aesthetics. It’s a country that is genuinely fascinated by beauty, body confidence and visible results, and because of that, it often pushes aesthetic innovation right to the edge. There’s a real “more is more” energy to the Brazilian market. Patients are highly engaged, highly knowledgeable, and often very open to treatments, which means practitioners there are constantly evolving, refining and sometimes even challenging conventional approaches.

In many ways, Brazil has been a little bit of a maverick in aesthetics, always experimenting, always advancing, and often ahead of the curve. What that creates is an incredibly rich arsenal of techniques, technologies and treatment philosophies. And I think that’s where the real value lies. When you take that very advanced, highly developed Brazilian understanding of aesthetics and combine it with a more refined, “less is more” approach, like we often favour in London, you get something really special. You have far more tools, more nuance, and more ways to personalise treatment while still keeping the end result elegant and natural.

For me, that blend has been incredibly important in my work. I think some of the best aesthetic outcomes happen when you combine Brazilian creativity, confidence and technical versatility with a more restrained and sophisticated eye for harmony. That’s where the magic tends to live.

The Cosmetica London Clinic

How did you come to be practising in London and when did you establish Cosmetica London?

My beginnings in London were, in many ways, quite organic. I initially came here for further training, fully expecting it to be a relatively short chapter, but once I started working in some of London’s most prestigious aesthetic environments, I realised this city had quietly started becoming home.

After gaining experience in established clinics and really understanding both the clinical and patient side of the industry here, I reached a point where I felt ready to build something of my own, something that reflected not just the treatments I believed in, but also the kind of patient experience I wanted to create.

So, around 14 years ago, Cosmetica London was born. And like many businesses people see today and assume were always polished and glamorous… it started very modestly. We began in a tiny little room, and I still laugh when I think about those early days because my business partner at the time, who looked after the admin side, would literally sit outside with a laptop on her lap managing patient bookings and messages while I treated inside. It was very much a case of small space, big ambition.

From those very humble beginnings, Cosmetica has grown into something I’m incredibly proud of. We’ve built a beautiful, loyal patient base, an amazing team, and over the years have been recognised as one of the Top 10 Clinics in London three times by The London Lifestyle Awards. But more than any award, what means the most to me is the trust of the thousands of wonderful patients who have supported us and grown with us over the years. That, really, is the heart of Cosmetica.

Can you tell us about your personal approach and philosophy to your work. Which treatments did you specialise in and why have you chosen them?

My personal approach has always been centred around one thing: helping people look fresher, healthier and more confident, without ever losing what makes them them. I’ve never been interested in trends for the sake of trends, or in creating faces that all start to look the same.

For me, the best aesthetic work is subtle, thoughtful and beautifully balanced. It should enhance, not overpower. I’m very focused on natural results, intelligent treatment planning and long-term skin and tissue health, which means I’m always thinking beyond a quick fix. I want treatments to work not only in the moment, but also in a way that supports how someone will continue to age over time. That’s really what has shaped the treatments I’ve chosen to specialise in.

I’ve always been drawn to treatments that deliver elegant, visible results while still respecting the anatomy, the skin and the individuality of each patient. As aesthetic medicine has evolved, I’ve also naturally evolved with it. I still love tried-and-tested gold-standard treatments, but I’m equally passionate about the newer regenerative side of aesthetics, treatments that focus less on simply adding volume and more on improving skin quality, structure and overall tissue health.

That blend of classic, effective treatments and more regenerative, modern approaches is very much at the heart of how I practise today.

Is there one treatment in particular that you are most specialist in or you most believe in?

If I’m honest, I don’t think I could choose just one, because for me the most beautiful results usually come from understanding what role each treatment plays. Botox will probably always be my hard love. It’s still one of the most satisfying treatments in aesthetic medicine because when it’s done well, it just works. A couple of weeks later, the lines are softened, the brows are fresher, the face looks more rested, and confidence tends to quietly rise with it. It’s a classic for a reason.

Fillers, when used well, are the foundation. I think they’ve had a slightly dramatic reputation in recent years because of overuse, but in the right hands they remain incredibly important. Used strategically, fillers can restore structure, support and balance in a way that is subtle, elegant and completely transformative without ever looking obvious.

But where my heart really is at the moment is in the regenerative side of aesthetics. That’s where my current dream trio comes in: Julaine from Sweden, Profhilo and WOW Fusion. What I love about these treatments is that they’re less about “adding” and much more about improving. They work to support the skin, stimulate repair, improve hydration, encourage collagen activity and enhance overall skin quality in a much more biological and refined way. That, to me, is where aesthetics is becoming really exciting, not simply changing the face with volume, but helping the skin and tissues behave in a healthier, more youthful way.

So if Botox is the old faithful, and fillers are the architecture, regenerative treatments are definitely the love affair I’m most excited about right now.

You have launched TruSculpt, can you please explain the origins of this treatment and how you rate it over other body sculpting treatments?

One of the reasons I felt so confident launching TruSculpt is because I’m probably the ideal body treatment patient in the sense that… I’ve tried almost everything. And I don’t say that lightly. Over the years, both professionally and personally, I’ve seen and experienced many of the technologies that have come and gone in body aesthetics. So when I say I’m selective about what I offer, it’s because I’ve learned, sometimes very directly, what works beautifully in theory and what actually works well in real life.

The concept behind TruSculpt is not new in itself, and that’s actually one of the reasons I like it. It uses radiofrequency, a technology we’ve trusted in aesthetics for many years to heat tissue and target fat very effectively. Radiofrequency has long been known to “melt” fat with excellent results when used properly.

The challenge with many older radiofrequency body treatments, however, is that they were often very operator-dependent. That means the result, and the safety, relied heavily on the practitioner’s technique, consistency and constant monitoring. And frankly, anyone who has ever done enough Accent RF treatments and developed a shoulder injury knows exactly what I’m talking about. It was hard work for the practitioner, physically demanding, and because you had to constantly monitor temperature and movement, there was always that balance between getting enough heat for results and avoiding overheating or burns. It worked, yes, but it wasn’t exactly elegant.

Then there were other technologies, such as cryolipolysis, which for me personally was not a great love story. I experienced significant bruising and lingering tissue changes afterwards, particularly on the arms and legs, and it really highlighted how not every “non-invasive” treatment feels particularly kind to the body.

I also tried ultrasound-based technologies like VASER, which can absolutely have a place in the right setting, but in my own case left some unevenness and textural irregularity that then needed correcting. And that, quite honestly, is part of why TruSculpt impressed me so much.

What I love about it is that it takes a technology we already know works, radiofrequency, and delivers it in a far more controlled, comfortable and sophisticated way. The treatment is consistent, the machine does the work with much less operator variability, and it removes a lot of the physical strain and guesswork that older systems relied on.

From a patient perspective, it’s also a completely different experience: no real downtime, very manageable treatment sessions, and none of the drama that some body contouring treatments can come with. For me, that’s what makes it stand out. It combines science, comfort, safety and reproducibility, which is exactly what I want in a body treatment.

It’s not about hype, it’s about offering something that genuinely performs, and does so in a way that is much kinder to both the patient and the practitioner. And after trying enough things to practically deserve my own loyalty card in body contouring, that says a lot.

The D.E.N. Body Ritual

You combine TruSculpt with manual lymphatic drainage treatments; why is that important?

For me, combining body treatments with manual lymphatic drainage (MLD) is not an optional extra, it’s a fundamental part of achieving the best possible results. In Brazil, this is actually considered standard practice, especially after any form of body contouring or surgery.

The lymphatic system plays a key role in how the body processes fluid, inflammation and waste, so supporting it helps reduce swelling, improve comfort and enhance the final aesthetic outcome. It’s very much seen as part of the treatment, not something separate from it.

I remember being quite surprised when I had plastic surgery myself a few years ago and realised that this wasn’t routinely integrated into post-procedure care here in the UK. It felt like such an important piece of the puzzle was missing.

That’s when I found Flavia Morelatto, who truly works her magic. Working with her really reinforced for me how powerful lymphatic drainage can be, not only in improving healing and reducing swelling, but in refining and elevating the final aesthetic result. That philosophy has naturally carried into how we approach treatments at Cosmetica.

When we combine TruSculpt with lymphatic drainage, it’s about helping the body respond more efficiently to the treatment. Supporting lymphatic flow can help reduce post-treatment fluid retention, improve comfort and, importantly, help create smoother, more even results. It turns the treatment from something purely mechanical into something much more holistic and intelligent, where we’re not just treating the tissue, but also supporting the body in how it processes and responds. For me, that combination is where you really start to see the difference between a good result and a beautifully refined one.

How many of these treatments have you done now and what sort of results are you seeing?

As we’re still in the early stages of offering TruSculpt, we’re just beginning to build our own treatment numbers, but the response so far has been very encouraging. Patients have been really positive, not only about the treatment experience itself, which is comfortable and straightforward, but also about the early changes they’re starting to notice in contour, definition and how certain areas feel and fit in clothing. T

hat said, I’m always very careful not to base my confidence solely on anecdotal early results. What gives me real trust in a treatment is the scientific data behind it, and that’s a big part of why I chose to introduce TruSculpt in the first place.

The clinical evidence around the technology is very reassuring, with studies showing an average fat reduction of around 24% in the treated area. For me, that matters enormously because it means we’re not relying on hype or marketing language, we’re working with a treatment that has genuine data behind it.

So, while we’re still at the beginning of our own journey with it in clinic, the combination of strong published evidence and the positive response we’re already seeing in patients has made me feel very confident that it’s a really valuable addition to what we offer.

In terms of both body and facial aesthetics, which are the biggest changes you have seen over the past five years?

 One of the biggest shifts I’ve seen over the past five years is that aesthetics has started moving from the outside in… to the inside out. For a long time, both facial and body aesthetics were very focused on what we could visibly change from the outside, lifting, freezing, dissolving, tightening, sculpting. And while those treatments still absolutely have their place, the conversation has become much more sophisticated.

There’s now a much stronger focus on regeneration, prevention and longevity. In facial aesthetics, that means patients are increasingly interested in skin quality, collagen support, tissue health and subtle structural preservation, rather than simply adding volume or chasing every individual line.

People still want to look good, of course, but they’re asking much smarter questions now. It’s less “What can we fill?” and more “How can we keep my face looking healthy, fresh and well-supported over time?” The same shift is happening in body aesthetics too. It’s no longer just about reducing one area or “fixing” one concern.

Patients are much more interested in treatments that support overall body confidence, tissue quality, circulation, skin tightening and metabolic wellbeing, not just the number on the scales or a quick visual change.

I think what’s really changed is that people are beginning to understand that aesthetic medicine works best when it’s part of a bigger picture of health and wellbeing, not separate from it.

That’s why regenerative medicine and longevity have become such exciting areas. They reflect a much more modern way of thinking, where we’re not simply trying to disguise ageing, but actually support the body and skin to function better for longer. To me, that’s one of the most important and positive changes the industry has seen.

And which are the biggest and most important developments you are expecting to see in the coming years?

I think the next few years in aesthetics and skin health are going to be defined by one big shift: moving from correction into true regeneration and biological optimisation.

For a long time, aesthetic medicine was largely about what we could do to the face or body from the outside. What’s becoming much more exciting now is what we can do to support the skin, tissues and ageing process from within, in a way that is smarter, more preventative and much more aligned with longevity medicine.

There are four areas I think are going to have a particularly big impact. The first is regenerative medicine, especially the growing interest around exosomes, peptides and other cell-signalling technologies. These are exciting because they move us away from simply “adding” volume or masking change, and toward actually supporting tissue repair, collagen signalling and skin quality at a much more biological level. That said, it’s also very important to separate what is genuinely evidence-based from what is currently more hype than science, because not every regenerative trend is clinically ready yet.

The second is longevity-led aesthetics, which I think will become absolutely central. We’re already seeing a growing shift toward treatments and protocols that support cellular health, inflammation control, barrier repair, mitochondrial function and long-term tissue resilience, rather than just chasing a visible short-term result. Aesthetics is becoming much more intertwined with the broader conversation around healthy ageing and healthspan, and I think that’s one of the most important changes in the industry.

The third is artificial intelligence, which I think will quietly revolutionise beauty and medicine in ways people are only just beginning to appreciate. AI is already being explored to help analyse skin quality, biological ageing patterns, treatment response and even assist in the development of smarter biomaterials and regenerative therapies. Used properly, it has the potential to make treatments far more personalised, predictive and precise. In other words, less guesswork, more intelligence.

And then there’s the much bigger frontier, which is genetics and DNA-level intervention. I think this is where the conversation becomes truly fascinating. We are not at the stage where aesthetic medicine is going to start “editing ageing away” in clinic, and I think anyone claiming otherwise is getting a little carried away. But there is no doubt that advances in gene editing, epigenetics and cellular reprogramming are beginning to influence how we think about ageing, regeneration and the future of medicine as a whole. Even if that remains more of a long-horizon development for now, it will absolutely shape the future of beauty and longevity.

If I had to summarise it in one sentence, I’d say the future of aesthetics is becoming less about changing appearance superficially, and more about helping the skin and body function younger, for longer. And to me, that’s where things become really exciting.

Can you give us some insight into your clientele and the most requested treatments they are now seeking?

Our clientele is wonderfully diverse, but what they tend to have in common is that they’re looking for natural, refined results that fit seamlessly into their lives. A lot of our patients are busy professionals, parents, people in the public eye, or simply individuals who want to feel confident and well-presented without looking like they’ve “had something done.” There’s a real appreciation for treatments that are subtle, intelligent and tailored, rather than one-size-fits-all.

What I’ve noticed over the past few years is that patients are becoming much more informed and much more selective. They’re not just asking for a treatment anymore, they’re asking why, how, and what will this look like long-term? Which I think is a very positive shift.

In terms of what they’re seeking, there has been a clear move toward treatments that improve skin quality, support collagen, and maintain a fresh, rested appearance, rather than anything overly dramatic. Treatments like Botox remain consistently popular, but always with a lighter, more refined approach. There’s also growing interest in regenerative treatments, things that improve the skin from within, enhance hydration, support tissue health and help the face age more gracefully over time.

On the body side, patients are increasingly drawn to non-invasive contouring treatments that fit into real life, minimal downtime, comfortable, and with results that feel natural rather than extreme.

Overall, I’d say our patients are looking for confidence, not transformation. They want to look like themselves on a really good day, and they want to get there in a way that feels safe, considered and aligned with their lifestyle.

The D.E.N. Post Injectables Protocol

You have your own skincare line. Can you tell us when and why you launched that and what products are in it?

Yes, and for me, launching D.E.N. felt like a very natural evolution of the clinic, but also a very personal one. Over the years, one of the things I kept seeing again and again was that even the best in-clinic treatments can only do so much if the skin isn’t being properly supported at home. Patients were investing in advanced treatments, but often going back to skincare routines that were either too aggressive, too complicated, or simply overloaded with ingredients that weren’t necessarily helping the skin function better.

I wanted to create something that felt results-driven, clinically informed and genuinely useful; skincare that made sense medically, but still felt elegant and easy to use in real life. D.E.N. stands for Dr Engel Naturals, and that name reflects a big part of the philosophy behind the brand. For me, “natural” doesn’t mean simplistic or less effective. It means being much more intentional with formulation, using high-quality, well-chosen ingredients of natural origin, that support the skin rather than overwhelm it.

That philosophy became even more meaningful to me after going through my own experience with lymphoma. Seeing first-hand how the skin can recover after chemotherapy and radiotherapy, if it is simply given the right support, had a huge impact on how I think about skincare. It really reinforced something I now believe very strongly: the skin already knows how to heal, repair and regenerate. Our role is to support it in doing what it does best.

That mindset sits at the heart of D.E.N. The range has been created around the key pillars of healthy skin, including cleansing, hydration, antioxidant protection, renewal and recovery, all designed to help the skin barrier function well, reduce unnecessary stress and support stronger, healthier skin over time. What I’m especially proud of is that D.E.N. isn’t about “more for the sake of more.” It’s about creating skincare that is effective, elegant and purposeful, where every ingredient has a reason to be there. For me, that’s what modern skincare should be.

Where is the range available to buy?

The D.E.N. range is available directly through us at Cosmetica London, both in clinic and through our online platform: www.denskincare.com That’s been a very intentional choice, because I’ve always felt that skincare works best when it’s properly guided rather than simply purchased.

By keeping it within the clinic environment, we’re able to make sure patients are using the right products for their skin, in the right way, rather than navigating an overwhelming number of options on their own. It also allows us to integrate skincare much more effectively into each patient’s overall treatment plan, so it becomes part of a cohesive approach to skin health, rather than something separate.

For me, it’s not just about selling products, it’s about making sure people are actually getting the results they’re looking for.

It’s quite an extensive range already, but are there any plans to develop it further?

Absolutely, but in a very intentional way. Although the range may look quite extensive at first glance, it was actually designed to work in a very straightforward and intuitive way. I never wanted D.E.N. to feel like one of those overwhelming skincare wardrobes where people need a spreadsheet and a support group just to wash their face.

At its core, the routine is very simple and is built around the main pillars of healthy skin. In the morning, it’s about: cleanse, tone, protect. And in the evening, it becomes: cleanse, tone, stimulate and hydrate. So really, it’s a very manageable three- to four-step routine, designed to support the skin consistently without overcomplicating things.

That simplicity is actually a big part of the philosophy behind the range. I’m much more interested in creating products that work cleverly together and deliver real benefits, rather than encouraging people to pile on endless layers for the sake of it.

That said, there are definitely plans to continue developing D.E.N., particularly in areas I feel are still underserved, such as sensitive, reactive and compromised skin, as well as products that support skin recovery, barrier repair and regeneration.

I’m also very interested in continuing to bridge the gap between clinical treatments and at-home skin health, so future additions will always be developed with that same philosophy in mind: effective, elegant, and easy to use consistently.

So yes, there is definitely more to come, but always with the same principle: less confusion, better skin.

From the perspective of your wider business, how would you like to grow and develop it in the coming years?

I think my perspective on growth has changed quite a lot over time. There was definitely a stage in my career where growth meant more, more patients, more expansion, more everything. But a personal wake-up call made me really reflect on what actually matters, not just professionally, but in life as a whole. It made me realise just how precious our time is, and how important it is to build a life and a business that feels not only successful, but also enjoyable, sustainable and aligned with the people and things we value most.

So, while I absolutely want to continue growing and developing the business, it’s no longer about growth for the sake of it. It’s about growing in a way that feels intentional and meaningful, with the right team, the right environment and the right energy. I truly believe in the idea that if you love what you do, it shouldn’t feel like constant work, and that’s something I’m very conscious of protecting, both for myself and for the team around me.

In a field like aesthetics, where we talk so much about ageing, it’s also important to recognise that one of the biggest contributors to how we age is stress. So, for me, success is not just about building a thriving business, it’s also about creating a way of working that supports wellbeing, balance and longevity, both personally and professionally.

So, the future of Cosmetica, for me, is about continuing to do beautiful work, with wonderful patients, alongside a team I genuinely enjoy working with, while making sure that the journey itself feels just as rewarding as the results. That balance is what I value most now.