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Botulinum Toxin (otherwise known as Botox®) is used in the face and neck area to soften or neutralize muscle action. The resulting change or softening in the facial expression decrease how much the skin gets folded and ultimately decrease expression line formation. In a young face, the Botulinum Toxin can “prevent” the formation of lines and in an older face it can slow down the process.

There are multiple frown patterns and individual variations in forehead muscle size. It is key that the treating doctor has a keen eye for detail. There is a balance between muscle groups and in order to preserve as natural look as possible (whilst softening expression lines at the same time), an artistic approach as well as excellent knowledge of facial anatomy and a steady hand is required when it comes to injecting the face.

Botulinum treatments typically last 3 – 4 months and the motto “you can always add” has been proven wise on many occasions. Once Botulinum Toxin has been administered, there is no way to remove it from body but to wait for the time it takes the body to break it down.


Hyperhidrosis – For anyone who knows the anguish of excessive sweating under the arms, Botulinum Toxin treatment of the skin of the axillae has been a breakthrough. No more wearing dark colours and worries about large wet patches on clothes or stains left by antiperspirants. Using tincture of iodine followed by starch powder, the exact areas to be treated are revealed and typically a 6 monthly treatment is sufficient for excessive underarm perspiration.

Excessive sweating of the palms of the hands used to be treated by thoracic sympothectomy, whereby parts of the sympathetic nervous system next to the 1st – 5th thoracic vertebrae was removed. Thankfully due to advances in surgery techniques, this is nowadays done by “keyhole surgery”. This still requires a general anesthetic and one of the side effects is that the surgery can change the way the nerves function in the body wider than just the sweating of the hands.

Using Botulinum Toxin directly in the hands reduces sweating and even though this treatment needs to be repeated 6 monthly it is safer overall whilst being really effective at the same time.

Using Botulinum Toxin in the feet for sweat reduction is widely accepted and brings relief to many who suffers with the problem.


The most widely used filler in the cosmetic field is Hialuronic Acid Fillers (HA Fillers).

Allergic reactions are almost unknown with HA Fillers, quite different to earlier collagen fillers of years ago, in which the beef or pork proteins could trigger an allergic reaction.

There are many HA Fillers on the market and this benefits the patient, as healthy competition between pharmaceutical manufacturers encourage better priced packages and wider research. As long as a product is CE marked and has reliable pharmaceutical backing, the “best” product will be the product your injector has the most experience in!

The range of HA Fillers has widely increased and consists of almost pure HA, which hydrates the skin, to “softer” HA Fillers which is used in thin skinned areas, eg. eye area (and which lasts 3 – 6 months), up to thicker HA Fillers which gives more “lift” as the molecules are more cross-linked (and which lasts 6 – 9 months) and ultimately the very thick filler which is used for larger volume replacement and body treatments, eg. augmentation of breasts, buttocks and calves (which can last up to 24 months).

These fillers are fully reversible, using the enzyme, Hialuronidase.


This group of fillers gives the immediate filling effect of an HA Filler. Add to that the collagen inducing effect of the calcium spheres (calcium hydroxyapatite) and you have a treatment which can last up to 18 months.

These fillers, of which Radiesse® and Redexis® are examples, have wide application in the face (temples, cheeks, nose, naso-labial lines, ‘sad corners’ of the mouth, chin and jaw-line) as well as being suitable for the back of the hands. This filler is also trusted to soften disfiguring defects after life saving surgery or accidents. It stays exactly where it has been injected and is a great tool for the correct indication(s) in the hands of an experienced injector.


This type of filler is a suspension once reconstituted and not in gel form like most other fillers. It is exclusively injected in the deeper layers of the tissue, where the PLLA stimulates collagen formation after 6 weeks as it is broken down by the body. Even up to a year after treatment, the process of volume increase might still be ongoing.

In the initial phase of the treatment (1st month), daily firm massage by the patient ensures that the collagen is formed evenly in a sheet-like (flat) fashion and prevents any nodule formation.

The overall effect of this treatment can last 2 – 5 years and even though both patient and practitioner need to show patience in waiting for the transformation, over correction should be avoided at all cost, as this treatment is not reversible at all.

PLLA, of which Sculptra® is an example, can be used for rejuvenation of the back of the hands as well. So PLLA is used in the temples, cheeks, naso-labial lines, ‘sad corners’ of the mouth, chin, jaw-line and chest area.


Mesotherapy has been used for years (especially in France) to administer nutrients to the skin.

The treatment is used to ‘hurt & feed’ the skin on a microscopic level, thus stimulating collagen formation in the skin.

By careful selection of the specific nutrients like caffeine, artichoke and metabolites, micro-circulation and improved lymph drainage can be encouraged, thus treating and improving the appearance of cellulite and loose skin with stretch marks during body treatments.

This treatment is also more effective when a course of 6 – 10 treatments are done. Areas that benefit from mesotherapy are: Scalp (hair loss), face, neck, chest area and body.


This treatment, during which a portion of a patient’s own blood is used as a healing agent, is widely in use in the medical field, eg. orthopaedic joint replacement and skin grafts treating burns.

Platelets contain growth factors and by injecting plasma which contains platelets into facial lines, the rejuvenation by collagen formation is “kick started”. The platelet rich plasma (PRP) can also be dripped onto the skin during skinroller treatment, with exciting rejuvenating results. The blood is collected from the patient and prepared by using a centrifuge
to separate the red blood cells and the plasma with platelets and few stem cells. By adding lignocaine the platelets are encouraged to release the growth factors directly before injection.

PRP is used on the face & neck, chest area, and the back of the hands by aesthetic practitioners.This treatment can rejuvenate the lower eyelid skin with little down time. The usual 12 week treatment regime is one PRP session & skinroller, followed by two skinroller treatments.


Many different chemical peel agents are available on the market to effect a ‘hurt’ to the skin that results in a rejuvenation of the skin as it heals itself a few days after by increased collagen formation.

Medical grade trichlore-acetic acid (TCA) is 15% to 30% and should only be administered by a trained, experienced doctor. In the face, skin peels/sheds 3 – 5 days after the treatment and on the neck and chest area after 5 – 7 days. Hands take even longer, 7 – 10 days after treatment. Using specially formulated creams during the healing period can enhance the effect of the chemical peel.

Skin is more sun sensitive after peel treatments and sun protection with a high SPF should be worn during the course of peels. Usually 4 treatments of 15% TCA one week apart is recommended. Above 22% TCA treatment should not be closer than 6 weeks apart.


Skinroller treatment – ideal for treating acne scars and loss of collagen in the skin – utilizes the body’s healing mechanism to stimulate collagen formation. In a controlled fashion the tiny needles in the skinroller ‘hurts’ the skin on a microscopic level, which ‘switches on’ the healing mechanism which causes the collagen to be formed in the skin. This happens by the process called neo-collagenesis.  By week 6 the type 3 collagen is changed into type 1 collagen (long lasting). With repeated treatments, visible improvement in the fine lines, pigmentation and depth of acne scarring can be seen.  By the process of neo-angiogenesis new capillaries are sprouted due to needles stimulating the cells lining blood vessels in the skin. This improved blood flow increases nutrition to the skin.

Skinroller treatment offers up to 800% increased absorption of skinceuticals like anti-ageing serums, treatment for hair loss and mesotherapy.

The skin appears flushed for less than 24 hours, so down time is a minimum for this very effective rejuvenation treatment. The skin is more sun sensitive after skin roller treatment and high SPF sun protection is a must for a month after the skin roller treatment. Hydrating specially formulated creams used during this period can enhance the effect of the skin roller. What follows is a phase of exfoliation.

After week 1 texture and tone improves; after week 2-3 pigmentation improves. After week 6 skin tightening helps smooth lines and even out scars as well as decreasing large pores.

Skinroller treatments can be done in the following areas: scalp (hair loss), face, neck, chest area and body.

A typical course of treatment is 3-5 sessions, each a month apart.  It  can take up to 6 weeks for visible signs of regeneration and repair to be seen and improvement will continue for months providing a gradual and long-lasting enhancement.

The newest development on this front is an electrical device called the Micro Needling Pen which uses multiple needles that vertically pierce the skin.  Due to the fast speed by which the piercing is done with this device, the level of discomfort is greatly reduced. An added benefit is that the needle length is adjustable so treatment can be varied according to thickness of the skin, without added cost as one needle tip does it all during the treatment.

The Micro Needling Pen has shown amazing improvement in scar tissue (other than acne scarring) like keloid scarring and even stretch marks.

A special precaution to keep in mind is to stop Vit A skin creams a few days before microneedling, up until all redness has subsided afterwards.


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