Common complaints I hear of when meeting patients for the first time, whether new to medical aesthetics or new to me, is issues with their anti wrinkle dose and "wearing off too quickly". So it bears repeating - anti wrinkle treatments work by paralysing the nerves that send signals to the muscles in your face to move, causing lines - eg frown lines, forehead and crows feet being the most common areas to treat. This effect may begin as early as 3-5 days and is complete by 2 weeks or 14 days when I normally like to review you to check the dose is right, you're happy with results and there is no unevenness or other fixes. After this, these nerves begin to regenerate as early as 6-8 weeks after treatment, when they begin to send signals to the muscles again, until at 3 months, movement is around 80% or more of movement before any treatment. Over time and regular treatment, or with a higher dose, this may stretch out to 4 months, but this is in effect how anti wrinkle treatments work. There is no -"on-off" switch, but a more gradual return to movement that will soften over time and repeated treatments. This is most common after the first 1-2 times you have anti wrinkle treatments, even if you had a standard dose, depending on how strong your muscle movement is before treatment and especially if you have lines visible at rest, usually indicating a stronger muscle. Occasionally, people believe this is dependent on the brand used, when it may have worn off quicker the first time with Brand D but worked longer with Brand X for eg. All else being equal, my experience has been that it is usually the fact that it is your first or second time having treatment rather than the brand (but it is good to keep it in mind). So some tips to keep in mind when seeking anti wrinkle treatments, especially if you are new to this. after your first treatment, it is common for some unevenness when it begins to kick in, until review at 2 weeks, and in 99% of cases this will settle by the time of review. we assess correct dose at 2 weeks, when the treatment is at peak effect if you are happy with the result. some movement the first few times, especially if you opt for a lower dose to "soften" lines rather than "freeze" lines, may return as 6-8 weeks and increase over time till re-treatment around 3 months lines present at rest, called static lines, are harder to fade and need regular treatment every 3 months with appropriate doses of the area to be treated until they fade, usually around a year; thereafter, they need ongoing maintenance to keep them from becoming worse again. unless we aim to freeze your face, it is usually not possible to completely prevent lines and wrinkles and it is important not to become hyper focused on chasing lines and wrinkles as opposed to an overall look of appearing refreshed, or rested, if that is your goal. as the result is dependent on the dose used, a goal of "no lines" usually will mean a higher dose is needed, and usually areas of the face next to the area to be treated will also need anti wrinkle injections as otherwise they will compensate for the frozen areas by becoming extra mobile (hyperdynamic) So as always, our advice at Skin Essentials, is to choose a provider whose face you like, including in animation, and to have a clear idea of what your goal is so you avoid disappointment. Realistic expectations and trust in your provider is the key on which longterm therapeutic relationships are built.    

The most seasoned business owners know firsthand that in order to succeed, you have to be willing to fail, sometimes many times over. Each time this happens, you pick yourself up and keep moving, learning from what worked, and what did not. Why do this to ourselves? While it seems like an exercise in self flagellation, the key is in the mindset it teaches you. I’ve learnt far more from my failures than I ever have by cruising and through success, even if none of us actively chases failure. In many ways, failure teaches us what we are truly made of, and teaches us grit and resilience. So why is this relevant in 2023 to Skin Essentials? In 2023 I am bringing about changes to the way I do business and I’m terrified if I am honest. Terrified because it’s raw, honest and comes from a place of wanting good for my patients, my staff and myself. Terrified because honesty, no matter how kind, can always be taken the wrong way when people receiving it feel defensive. Terrified because there’s always the fear that in making the changes, I will lose business and my business will tank and…and…and… I’ve done a lot of hard things in my life, as we all have; and one of the things I love about myself is my innate optimism, my ‘glass half full” approach to things especially when they are hard, and the immense privilege I have of having an education in a field where, even if Skin Essential does tank and I do close, I’ll have other options. So what are the changes and why? I entered medical aesthetics reluctantly in 2015/2016. I really didn’t want to do it because of all the fake faces I saw around me. It seemed fake, vapid and entirely unnecessary. At the same time, I was beginning to see early signs of ageing in my own face and a visit or two to the local chain clinic for skin needling left me with disastrous and painful results. I was stumped for next steps based on evidence rather than hype and fads. So I began to look into it, initially for myself, then as my knowledge increased I met patients and friends who wanted someone reputable, who would do good work, give them results and a longterm plan for ageing well. Like me, they were mostly women who had tried many things and had little success, and occasionally bad outcomes and they wanted someone they trusted to do the planning for them, so they could just show up, and get the work done and be told what to do. These are my best longterm patients, who come in when told to, get on the chair and say “whatever you think best doc!”. They trust me, trust the process, are realistic about what is achievable including over what period of time; they are patient, they remain calm with common side effects such as bruising, swelling, lumps and bumps and they show up. These are, quite simply, my ideal patients. Price is important, but not the most important factor, and as long as they know what they need to save in time for the next appointment, they plan appropriately. In 2023, I am moving away from a lot of the interactions that I found draining in 2022 with patients who, quite simply, were not aligned with me and the way I work, in part as I was not clear enough about it. So what are some examples of patients for whom I am unlikely to be the right doctor?  1. They are not looking for a longterm plan to help them age well.  Full face rejuvenation is my signature treatment and the one that gives me the greatest joy and the best results for my patients.  I am really not a fan of just some anti wrinkle to one area and  lip/ cheek filler as and when a patient feels they need more and orders some. It is not how I work. I look at the whole face as pieces of a jigsaw puzzle - as the ageing process begins to take hold, pieces of the puzzle go missing, and it takes more than just 1-2 mls of filler or some anti wrinkle treatment initially, to begin to correct this. For those patients who start at a good time, as early as their 20s and early 30s, it’s true that initially there’s not much to do beyond a focus on the basics including excellent, personalised skincare but having a comprehensive plan allows us to stay on top of it and to plan for what is likely to come and to prepare for it. These patients may need either occasional enhancement eg lip filler or maintenance by way of some anti wrinkle treatment to target early lines and wrinkles, some undereye correction and any other early signs of ageing. Costs are usually around $3000 a year or thereabouts depending on where you start and what’s needed. The older patient, as early as mid 30s and up, needs far more work if nothing has been done until then. This is the work I refer to as restorative. Many pieces of the jigsaw puzzle are missing and there are changes under the skin that need to be looked at. For these patients, the work involved at the beginning is more extensive over several months, usually in stages to get to maintenance and involves skin improvement as well as injectables and possibly permanent fat dissolving. Costs are typically $6000-10000 during this period depending on what is needed then maintenance is closer to $3000 a year or thereabouts. I won’t do just tear trough filler when what you need is mid face support to your temples and cheeks also. I won’t do just lip filler if you also need support around the mouth and to the chin to avoid a Marge Simpson lip. I won’t do just some anti wrinkle so your forehead and upper

Patient safety is a pet peeve of ours here at Skin Essentials. In as much as is possible, we pride ourselves on doing everything we can, from the time you book a consultation to the day of your planned treatment to aftercare and followup, to work in a way that is ethical and safe while keeping you informed every step of the way. So it is surprising to regularly see media articles about cosmetic cowboys as well as the sleight of hand that frequently shows up on social media feeds as medical aesthetics but which is largely clever marketing and gimmmickry to lure unsuspecting patients into procedures. So how is a patient to know and what are some red flags to watch out for to help yourself stay safe? Read on to find out our thoughts! 1. Your provider should state their credentials and qualifications clearly.  In Australia, only AHPRA registered healthcare workers (HCWs) are cleared with appropriate training, to inject for medical aesthetics - medical doctors, nurses and dentists. Dermal technicians can additionally, undertake some skin therapies that are within the scope of their practice. As doctor is not a protected term, you will find some people including naturopaths among others using the term “doctor” in their title, while not being a medical practitioner, which is a protected title. Equally, not all doctors are of equal standing - a dermatologist (FAAD) is not the same as a plastic surgeon (FRACS, Plastics) and not the same as someone like me an FRACGP. All three specialities are additional training years in respective fields, with scopes of practice, so it is important to understand these, versus doctors who have the base degree (MBBS, or MD or BMed) or a dentist (BDS) or a registered nurse (BN) to know who is treating you and their likely skillset and qualifications. 2. You should have a good idea of their years of experience in aesthetics and any prior medical experience.  In Australia, anyone can look up their AHPRA registered provider using the AHPRA website to check their provider’s qualifications, whether they are specialists as well as whether they are of good standing to practice in the community and how long they’ve been working for. Someone who has qualified in 2016 is not the same as someone who qualified in 2001 and has been working all this time. Likewise, someone who has the base MBBS degree since 2016 is not the same as someone who has the MBBS, FRACGP title for example. Speciality training programs involve extra years of a structured training program, as well as multi-part examinations they must pass to qualify for fellowship which ultimately serve to benefit patients. 3. They never promise or guarantee an outcome  No one can ever guarantee you won’t bruise, or only need a single treatment or even an outcome. The face is the most mobile part of our body and we rely on it to communicate our thoughts, mood and so much more. As such, none of us is completely symmetrical and it is impossible to guarantee an outcome no matter how diligent the provider, so be wary of anyone who over promises. Equally, unforeseen patient factors may be at play in consultation that may mean the procedure needs to be abandoned partway and either revisited at a later date or referred as is appropriate. When this happens, it is important to understand what the options are including around payment and your obligation for equipment and your doctor’s time. 4. They seek clarity with you regarding your wishes to allow your photos to be used to show other patients or on social media, and any conditions attached to these, in writing.  It is a direct violation of your rights as a patient to have photos or information disseminated without your consent. Being a highly visual industry, your doctor may ask for your consent to share photos with patients in clinic, or even on social media. If you say yes, they should clarify with you the extent of your consent, preferably in writing so there is no miscommunication. 5. They use machines and products that are TGA registered.  This is a big one. Terms such as “low level laser” and “medical grade” and even “standard dose” are in and of themselves, meaningless. What you are seeking to know ultimately is, whether your provider uses machines and products that have passed safety requirements ie are TGA registered (and therefore more expensive to buy, own and to maintain, raising cost of treatment) and not bought off back alleys or overseas or via eBay. 6. You know what is done and what products are used  At Skin Essentials, we aim to minimise paper wastage and email itemised receipts to you after each consultation and treatment with the name of the product that was used as well as the dose used if appropriate and cost included any discounts applied so you are in the know, and can also use this information with any other care providers you see in future. Equally, our initial comprehensive consultation plan is usually a written treatment plan emailed to you for your records of what was discussed including consent to share photos and for you to share with any other care provider. We aim to be as upfront and transparent as possible to minimise misunderstanding barring unanticipated patient factors. 7. They will refuse to treat at “injectables parties” and the like  We have all, at one time or another been asked if we’d treat at these parties. The problem with this is manifold. Injectables parties and medical procedures do not mix: guests may be drinking alcohol and may not be able to properly consent in the event of an adverse outcome alcohol is generally avoided at least 24 hours prior to injecatables in gatherings, we cannot guarantee privacy for patients, who may not want their medical history disclosed to friends. in the event of an adverse outcome, a home or party venue is not suitable to manage unlike