There have been decades of public health education around skin cancer, yet Australia remains the skin cancer capital of the world. Australia has some of the highest levels of UV radiation in the world – in fact, UV radiation is strong enough to cause sunburn in as little as 11 minutes on a fine summer day. Skin cancer rates remain high and sunburn a common annual occurrence each year for many. With two in three Australians diagnosed with skin cancer by the age of 70 and over 2,000 deaths due to skin cancer in Australia each year, it is vital to get the message through about sun protection in Australia.  The majority of the visible signs of ageing are the result of damage to the skin caused by UV exposure. It is believed that as much as 80% of premature facial ageing - such as wrinkles and fine lines - is due to sun exposure. The positive association between self-reported lifetime sun exposure and skin damage (hyperpigmentation) and ageing (wrinkling) is particularly strong for those aged under 50 years. In my weekly work at a dedicated skin cancer clinic, these are conversations I have with patients all day, and I continue to be surprised at the common myths and misconceptions that abound in the general community. We are about to head into another summer, and after nearly 4 months of lockdown cooped up inside, people are eager to be out and about, so let’s get to mythbusting and hopefully save our skin. Myth 1: You cannot burn if you wear SPF SPF forms just one part of the required means to minimise the risk of sunburn. That is why there is a national campaign that refers to the 5 S - slip, slop, slap, seek and slide. If you cannot remember each of these steps:       Slip on long sleeved protective clothing Slop on some high and broad UV protective sunscreen and reapply regularly Slap on a broad brimmed hatSeek shade wherever possible Slide on some sunglasses Myth 2 : you cannot burn in the shade I regularly see patients during skin cancer checks who wear a broad brimmed hat when out in the garden, or who work outdoors and wear protective clothing including sunglasses and hats, but who still have significant chronic sun damage to the areas inadvertently exposed - the back of the neck, the area of the chest exposed by shirts and sometimes even the lower face, where the hat does not shade the lower face. Even under shade sails, and by bodies of water for example, surfaces can reflect light and intensify the UV rays. Similarly, unless completely impermeable to the UV, most shade sails and similar still allow some UV rays to penetrate the material and shade under trees and foliage is only as reliable as the thickness of the canopy you seek shade under. Myth 3: You cannot burn in the water Research has shown that upto 40% of UV rays can penetrate water for as much as 50 cm. Additionally when immersed in water, you may not notice you’re burning as the water has a cooling effect. Reflective surfaces around water can also amplify UV, therefore it is important to reapply sunscreen often (every 30-40 minutes) and to seek shade and practice as many of the 5Ss when not in the water.     Myth 4: You cannot burn in the car with tinted windows This is one of THE commonest myths I hear every single week. While some windows in cars might be tinted, thereby reducing UV transmission to some extent, the truth is windscreens and the driver’s windows are not tinted so anyone who is in the car for any length of time is a sitting duck for a sunburn and associated sequelae of sunburn, photoageing and skin cancer risk.       Myth 5: My skin is just red, it’s not sunburn. Chronic sun exposure degrades collagen and elastin in your skin, and this can result in uneven pigmentation. In some people, the sun may also cause permanent stretching of blood vessels, giving skin a mottled, reddish appearance that does not go away. Tan lines are another sign of sun damage. How do you know this is sunburn, and not just your skin? I often get patients in clinic to compare the skin on exposed areas to covered areas, so they can see how much damage the sun is causing on a regular basis.         For anyone who is outdoors much- exercise, walking the dog, in the garden, working outdoors, spending any amount of time in the car- my advice is always, always, always:  get in the habit of applying a broad, high SPF sunscreen daily; just as most of us would not even work from home without brushing our teeth, so it should be with sunscreen application, 365 days/ year.  if working outdoors, do not leave sunscreen in the car - it will degrade in the heat. Keep it cool so it works the way it is meant to. reapply if you can, especially if you are outdoors any significant amount of time; most sunscreens are maximally effective for 2 hours (40 minutes if in the water)  practice the 5 Ss as much as you can Like any new habit, start slow, get in to the habit of doing one small thing, and doing it well. It takes on average 42 days to form a habit, and then once established, add to it. Factor an annual skin check into your preventive care checklist, especially if you work outdoors, but everyone should be getting an annual skin check from their 20s, younger if there is a significant history of sunburn when younger. How many of these myths did you believe in?

Every few weeks of late, it seems, we are seeing posts on social media of young women with rare complications due to injectables, namely, dermal filler. Not that long ago, it was a young woman who posted of her experience on TikTok. Shortly after, well known influencer Lily Ghalichi posted of her own experience with a blocked blood vessel, ie a vascular occlusion, a well known, if rare side effect of dermal fillers, to her Instagram and how it was treated when caught (early). Yesterday another young woman from the USA posted and what stood out to me this time, was the way she presented her story and the red flags present within it, to anyone who knew what to look for. It got me thinking, why are more people not aware of what red flags to look out for and by the same token, what green flags to indicate you are in safe hands?  So I posted on my own IG, to try and educate those who choose to have dermal fillers. What are some safety features, or GREEN flags you should be looking out for in your aesthetic practitioner? their qualifications - in Australia currently, injecting S4 drugs (anti wrinkle treatments, dermal fillers and other related drugs) are limited only to AHPRA registered medical practitioners - nurses, doctors, dentists. Is your practitioner registered and of good standing with AHPRA? their experience? How many years post graduate are they? Injectables flooded the market two decades or more ago, and it is becoming more and more common to see people taking up the briefest of training simply to be able to go into aesthetics, often without much if any, post graduate experience. "Would a reputable clinic or clinician take someone with no experience on?" and if not, where are these people likely to find work and at what prices?  do they take their time with you in the consultation or is it designed to convert you? Do you feel pressured to proceed with the treatment on the day? Do they cover complications in a way that is designed to be realistic or simply to get you to proceed? when, not if, when, something does go wrong, do they have a safety net in place to help you until the concern is resolved, or a way to refer you to someone else who can help? Do they have the necessary drugs stocked and ready to go? Do they practice in a location whereby if you had an emergency at 11pm, they can open the clinic or salon to see you if needed? do they have a clear aftercare plan and system to check all is well and a means for you to contact them if you have concerns? When and if there are complications, can you rely on them to be there with you and to refer you appropriately if it is out of their skillset, until the issue is resolved? Beauty and Aesthetics especially, is a multi-billion dollar industry and it feels some days like everyone wants in because the demand is so huge. Unfortunately even though we are not like the UK, where literally anyone can inject and buy drugs off eBay, we are still a largely unregulated industry and people are frequently sold the illusion that it is “just beauty” and the “customer is always right”.  Many practitioners seem to undersell the gravity of rare but serious complications when talking to and consenting patients. It is often sold as “fun”, “sexy” and with minimal complications for patients, and simply, great revenue for practitioners.  In my clinic, patients are often shocked when they’re told about the rare but serious risk of vascular occlusion or even blindness, even though they have had filler elsewhere before, prior to proceeding.  They are similarly surprised when I turn some of them away and refuse to do anything because of : unrealistic expectations they bounce from injector to injector and remain unhappy with results  they do not know what was done where, or by whom, or what product was used they are unprepared for any downtime or the time taken to build results, which may involve several sessions on a tight timeframe they've left it too long and done the bare minimum and then woken up, often in their 40s, 50s or later, and hate what they see but do not want the cost or downtime of surgery so go from practitioner to practitioner who give disparate advice, none of which is appropriate or right.  Others report feeling pressured into it on the day due to hefty consultation fees redeemable only with treatment on the day and then have regret around proceeding.  It is worth remembering that as AHPRA registered practitioners, doctors, nurses and dentists have a duty of care, which includes “first do no harm”, to act always in the patient’s best interests, to not be seen to be inducing vulnerable people (incentives, specials, posting testimonials and even using drug names are all prohibited in Australia) even and especially if that means saying no and not placing undue pressure on the day to “convert” regardless of whether that is what the patient wants or expects and the loss of revenue that may entail.  I admit it, as a small business owner who has limped along due to Covid, I'm the first to feel my heart sink when I see a new patient who has done nothing to date, and now feels desperate for a quick, low budget fix; or a patient who's been to several practitioners and been dissatisfied with all of them, or someone who wants to "look younger" but is opposed to everything suggested...I know I am going to spend the time they have booked to educate them and then wish them well and generally refuse to touch them if it'll not make them happy.  I tend to tell patients not to rush, that aesthetic treatments, by their very nature, are entirely non essential, and to take the time; I

It is not uncommon for patients to present reporting they have sensitive skin. Equally, it is common to see patients presenting after product overuse, or combining the wrong active ingredients and developing contact dermatitis or worse as a result. One of the first things a skin consultation is designed to help us determine is whether a patient truly has sensitive skin (eg someone with a history of eczema) or sensitised skin, often due to overuse or incorrect use of skincare ingredients. Some common culprits? many chemical exfoliants such as lactic, glycolic and salicylic, often found in washes, exfoliating formulations and even toners physical scrubs and exfoliators - yes apricot scrub is a no-no but there are others, with beads, gels and other ingredients. Equally, physical scrubs include battery operated exfoliating brushes as well as anything else that may rub against your skin and cause irritation such as even makeup remover wipes! retinols and other Vit A derivatives, well known for causing irritation in most of us, with time needed to build to daily use; these include all the over-the-counter Vit A derivatives - retinol, retinaldehyde as well as prescription retinoids such as tretinoin, adapalene and tazarotene. Vit C (ascorbic acid) again, may be irritant in many people with sensitive (and definitely sensitised) skin and may need careful progression to build use other examples of irritants include other brightening agents commonly found in skincare such as azelaic acid and kojic acid combinations of two or more potentially irritating actives eg an acid + retinol occasionally fragrance may also irritate your skin, and occasionally, the other ingredients used to formulate your skincare It is completely understandable that you may want to try the latest skin trend, or ingredient on the market. For many however, combining ingredients without understanding your own skin, its needs or misdiagnosing its nature, can lead to multiple skin concerns and complaints which can then be costly in terms of time and money, to fix. I commonly see people after weeks to months, sometimes years, of skin pathology often begun through an innocent enough treatment which led to an adverse outcome, which was attempted to be fixed by doing other things, leading to more irritation in a loop fashion. In most cases, the longer the cycle of irritation continues, the longer it might take to fix the underlying concern and get skin back on track. Weeks, sometimes months. The ingredients listed above are are well known, even in those with healthy skin, to cause problems and to need a slow buildup to daily use. For people with sensitive skin, some of them may be no-go and for those with damaged skin barriers we may need to take time to repair the barrier first before even considering adding in any active ingredients or in-clinic treatments. In these cases, it is best to start with a doctor who can oversee this for you, recognising that this will take time, effort and budgeting. That said, there are often predictable reasons why a skin ingredient that gets rave reviews everywhere may wreak havoc on your skin. Read on to find out what they might be! 1. Active ingredients known to cause side effects The common ingredients are listed above, and as you can see, it is not an exhaustive list, and most of us have at least some of these ingredients in our cleansers/ toners/ serums, so it is easy to see how, and why, most of us have, at some stage in our lives, experienced irritation or worse. The problem is then compounded when we do not understand why this may have occurred and try to fix the initial problem with something else sold to us by advertisements, well meaning friends and so on, as being “the solution”. No! Stop, please. Stop using, and seek medical advice, please. 2. Damaged skin barrier Reason 1 above leads, if disregarded, to reason 2 - a damaged skin barrier. What does a damaged skin barrier feel/ look like? No two persons, faces or skins are the same, so your mileage may vary but I routinely ask patients during consultations what their skin FEELS like, to give me clues as to what might be going on and if what they are using works for them. If it works for you, there is no need to buy “my” brand or “a” brand of product that is sold by your favourite shop/clinic/ influencer/ beauty blogger. If you say yes to one or more of these, then maybe your routine needs some work: dry feeling skin after cleansing redness, irritation that does not settle stinging and burning after applying anything to the face tendency to acne/ pimples (which often leads to more use of anti-acne skincare) tight feeling skin tendency to tear easily How many of these did you say yes to? 3. If less is good, more must be better! If I had a dollar every time I get asked about the concentration of the chemicals I use in the peels that I use, or the number of times patients present with sunburn or contact dermatitis because we began an active ingredient and they decided to speed up the process because “if a little is good a lot must be better, amirite?” Skin cannot be rushed. It is a living, breathing organ, and the largest one you have. It puts up with a lot of wear and tear on a daily basis to keep us healthy and safe - UV exposure, pollution, changing weather conditions, makeup and related to that, (multiple) daily cleanses, to name a few. Good quality skin can take this and more in its stride, but too much of a good thing is still bad. Just as you cannot expect to show up and run 5km after being a couch potato your whole life, so it is with skin. It takes time for skin to adjust, and to respond, and by rushing you may actually be doing more harm than good. There is a

It is refreshing to see journalists write about the dissonance of seeing women, often around their own age, on screens, who seem to be resisting the societal pressure to undergo injectables and other aesthetic treatments, known, in the wrong hands, to “go overboard” and to alter the face, or simply, freeze it, alongside their own reflections on the pressure we all feel to give in.  In May 2021, just prior to Sydney lockdown, mamamia’s Tamara Davis wrote about fine lines on 30-something year old actresses alongside her own musings about jumping on the wagon and holding off “for now”. More recently, Mamamia’s Jessie Stephens wrote similarly, about Sarah Jessica Parker’s 56 year old face, looking age appropriate, as giving permission to women who choose not to go down this path through her own choices. To be clear, both women are supportive of women’s choices to do as they please with their own faces and bodies, as they ought to be. Feminism is not about forcing women (and minorities) , after all, to fit into yet another restrictive box and to follow rules, but rather about allowing each of us to decide what works for us, and feels right for us; in the case of aesthetic treatments, that may mean doing nothing, or everything even if it is not wise or advised. That is not why I am writing though. It was striking to me, reading both articles, the choices presented around injectables were almost “and-or” even if the authors did not intend to do so. Drawing black and white conclusions without nuance almost always leads readers to want to ally themselves into the “do” and “don’t” groups and in doing so, leads away from the nuance that beauty and medical aesthetics and where they fit into our world and the pressures women disproportionately feel to fit in. I felt drawn to respond because I see a logical fallacy with the arguments the way I read them, namely that we can either choose to age the way nature intended, OR we can go all out and have foreheads that don’t move and succumb to the pressure of being constantly on guard against the next wrinkle, sag and hollow. As an experienced cosmetic doctor, my anecdotal experience is vastly different and I felt moved to write about it here based on my own personal experience as much as that of my patients.  Some background - in case it is not already obvious, I am an ethnic woman with brown skin who dresses in a rather drab way. I’ve had comments to dress up my whole life (my approach to fashion is aligned with Steve Jobs’). I have worn makeup some 2-3 times in my life, and believe makeup should be optional, not to cover up flawed skin (because, doctor) and I do not colour my hair because I’ve largely been a wash-and-wear person.  I have used daily SPF for the vast majority of my life since my teens, religiously; I have brown skin which confers advantages and disadvantages; I did not begin using active skincare till my early 40s and began prophylactic anti wrinkle treatments a couple of years later. I am very open with my patients about what I do because I believe lying about it, or looking “this good” is just not possible beyond a certain age, and it adds to the pressure women already feel about deteriorating looks due to age over time.   It is not normal or common to look like JLo or Jennifer Aniston without significant work and effort. Faces like Gillian Anderson, Paulina Porizkova and Sarah Jessica Parker more realistically tell us what is down the road if we choose to age the way nature intended so we can make an informed choice that aligns with our values and our budget.  In my work at my medical aesthetics clinic, what I do see is the following:  The vast majority of the patients that see me (98% are women) do so to help with what I refer to as “the negative signs of ageing” that distress them. Most are professional women with their own incomes and successful careers and businesses who worry about the impact an ageing face will have on their perceived ability to do the job, especially if self employed.  To many of them, looking well rested and refreshed is an integral part of their business/ career and the face they put forward and also important to their sense of self. Almost none of them wants to look 5, 10 or 20 years younger. In fact in my clinic, when I conduct an initial consultation with all new patients, I specifically screen for such red flags, whereby people have unrealistic expectations because I can almost always guarantee they will be disappointed. Most of them are bothered by etched in lines on their faces even at rest where skin was once smooth; many are bothered by enlarging pores due to collagen loss with ageing; many are distressed by sag and drooping of the lower face, leading to lines around the mouth and jawline and occasionally, a change in face shape to a more mannish one. These are issues they’d like addressed while still looking like themselves. Why do I hear those complaints and not think, “she is asking to be frozen and to look different?” Most of the people who go on to become longterm patients, complain to me about their lines, sag and wrinkles. What we do in consultation, is unpack what those lines and sag translate to for them in real life: “I look angry/ cranky/ sad and people say so to me, often” “I get told I look grumpy when I’m really not and it is frustrating” “I get asked all the time if I am sleeping enough because of the dark circles under my eyes that are getting worse with age and it upsets me”  “I got told by my Allied Health provider I might have lymphatic drainage issues on

One of my favourite cartoonists Lainey Molnar, recently put up a comic capturing what acne can be like for many of us. We may laugh and it is funny. Equally, it is one of the commonest presentations to doctors for women past the age of 25.             Adolescence is meant to be a time of some acne; it is almost a given, due to hormonal changes that puberty brings with it. Upto 85% of adolescents, male and female, will have some form of acne between the ages of 16-18 years of age. As with all acne, it is classified into mild, moderate and severe and treatment modalities are based around classification due to increased risk of persistence and knock on effects such as pigmentation and scarring which can be very distressing for people. Acne tends to improve by age 25, but can persist, especially in females when it is then classified as Adult Female Acne or AFA. How does AFA differ from adolescent acne? Can be very persistent can last into one’s 30s, 40s and even menopause in some women, it may show up for the first time in adulthood, or around menopause. Premenstrual flares are common. the cause is believed to be due to hormonal fluctuation due to menses, pregnancy as well as menopause itself. it tends to be mild to moderate in severity, unlike adolescent acne. Unlike adolescent acne, it tends to be largely around teh lower face and neck but may be anywhere on the face, chest and back How do we treat adult acne? Treatment is similar to that in adolescence. However, due to persistence, more aggressive treatments and a combination of treatments may be needed to get it under control even for relatively mild symptoms. By the time I see patients with persistent acne, they have usually tried various over the counter products, they may have been to salons for facials and other treatments, some of which may paradoxically have the effect of making the acne worse, and may contribute to scarring and pigmentation rarely. Acne is a medical disease and treatment options need to be medical, with adjunctive therapies as appropriate added in where needed and beneficial. I’d suggest saving time and beginning with a skin consultation with a trusted doctor who is comfortable with skin diseases and obtaining personalised advice including prescription medication if it appropriate. Treatment is time consuming and depending on what is involved, may be costly, but the alternative means that acne continues to persist and cause unwanted side effects such as scarring and pigmentation that will also need to be addressed at some point, with added time and cost.

It is likely true that before early 2020, Zoom was not a well known remote conferencing system, and if we'd bought shares in it, we'd like be very very wealthy now. That aside, most of us have used teleconferencing extensively, for meetings and even for patient consultations that we would in days prior, have conducted face to face, in real life. Teleconferencing has been such a boon to most of us, we do not wish to see it go away entirely, especially if it obviates the need, especially in Medicine, for face to face when no procedures are planned with ongoing risks due to the novel Coronavirus.  It can only be all good right? Not so. Since the pandemic and the more recent Sydney lockdown, we are seeing more people book in for the first time, because they "hate the way I look." and a lot of the time, this is contributed to, or added to, by necessary meetings on tele platforms where you get to see your own face, in unflattering light and angles. Equally, we see ourselves animated, wrinkles and all, in a way that never previously bothered us because we did not see our own faces while interacting with others, but do now! I have seen several new patients for video consults as well as face to face consults who were finally ready to take the step towards non surgical treatments BECAUSE they were repeatedly seeing their own dark undereye circles, or wrinkles and sag while on video calls for work.       So what is Zoom face? Zoom face is a form of disconnect between the brain and the eyes; how we perceive ourselves as presenting to others based on looking at ourselves in 3D, eg in the mirror, and how we appear in selfies (2D) with distortion of lighting as well as camera angles. Video conferencing adds to this by adding in the element of our being able to see ourselves animated with other people, and watching that animation in the form of lines, wrinkles, hollows (under eyes) and sag (lower face) we did not realise exist (to quite THAT EXTENT) when we are merely speaking in the mirror. When we are genuinely animated, we tend to use far more facial muscle movement than when we are going through the motions in front of the mirror due to a feedback loop between our eyes and our brains, to help us keep looking “good’ to our own eyes.  The combination of these factors can lead to a jarring sense for most of us of looking "wrong". Many of us have realised, during seemingly endless calls during these past 20 months, that this is how others likely see us, and for many of this, where we have been slightly bothered by aspects of our appearance before, this may become a more persistent discontent, leading to seeking out help and cosmetic opinions , including surgery. So what can we do about it from a realistic angle? I am first and foremost, a doctor. As such, I have an ethical obligation to "first do no harm". For most new patients, I spend a significant amount of time not only taking photos in good standardised light, but also in discussing what bothers someone and why it has led to them presenting now. We spend a lot of time discussing their concerns, what they are, how realistic they are in their expectations, within the limitations of their unique anatomy and whether they have the means and willingness to budget for it and the time to be patient.         Equally, I discuss with patients what the phenomenon of "zoom dysmorphia" or "zoom face" is: - a distortion of facial proportions if using a handheld phone such that aspects of the face appear bigger, such as the nose. a conversion of a 3D image that we would see in a mirror for example, into a 2D image, that loses some of its depth, leading to a flatter look often, reversal/ flipping of the image that our brain cannot quite comprehend as being "normal". the jarring sensation of watching ourselves animate and seeing unexpectedly, hollows, sagging skin and wrinkles where we would not usually see them when taking stills or even talking to ourselves in the mirror poor lighting or shadows in videos that may highlight or exaggerate this appearnce, leading to a more marked distortion than we are used to seeing.         What can be done about it? As always, start with a conversation with a trusted clinician you can speak to about your concerns, who will take the time to understand your point of view, if they are amenable to being "fixed" or improved, and what can be done about them, over what timeframe and at what cost. These are conversations that take upwards of 20+ minutes, with clinical photographs and standardised lighting and rely on time taken to understand your expectations.  Unlike Beauty, we are not simply covering up worrying problems with makeup and filters. It is important to understand that we are working with your underlying genetics and anatomy, as well as age and cumulative factors such as sun damage and other lifestyle choices such as smoking, which may limit outcomes, even if money was no object. Lastly, once you have had this discussion, and understand realistically what is feasible, and what is not, via committing to  skin improvements, injectables, minimally invasive surgery or referral to a Plastic Surgeon, and associated costs and timeframes, you can decide if it is an avenue worth pursuing. Equally, some patients, once they understand how zoom face works, and the time and costs associated with making longterm changes involved, will decide to do nothing, which is as it should be, without any pressure or salesy tactics.  Have you struggled with Zoom Face during the pandemic and have you done anything about it if so? Images courtesy of Daniel Boschung of his photography project. 

Shortly prior to the Greater Sydney lockdown, we added a new machine and technology to our repertoire of what is possible in clinic, the Embrace RF machine that allows us to offer RFAL, also known as RadioFrequency Assisted Lipolysis. AccutTite™ & FacetTite™ are revolutionary minimally invasive cannula devices that contour and precisely deliver radiofrequency to reduce facial fat and tighten skin, under local anaesthesia in an office-based procedure. This FDA & TGA approved technology from Inmode, is an non-surgical procedure that allows Dr Joshi to target smaller areas of the face like brows, upper & lower eyelids, nasolabial folds, lower face and neck giving permanent fat reducing, skin tightening results approaching that of a surgical face and necklift without the cost, downtime or risks. It works regardless of your skin colour. Less downtime – compared to surgical alternatives though surgery is still the gold standard. Long-lasting results – results typically last around 3 years,  up to 5 years Performed by a Dr trained in surgery What is RFAL? RFAL is a new technology that bridges the gap between non surgical treatments such as injectables, and plastic surgery  for patients who are not ready for this, or who are not yet suitable for this. Where can this be used? The RFAL probes can be used in multiple areas of the face where there is accumulation of fat due to the ageing process and/or mild to moderate skin laxity with wrinkles that would benefit from permanent tightening and lift. Common areas include: the area above the brows which begin to sag with age the area under the brows, along the upper and lower eyelid, with fat accumulation and sagging- loose and lax skin alone, without much fatty tissue, may be better treated with a surgical blepharoplasty - a consultation is needed prior to booking any surgical procedures by law the smile folds and area around the mouth, which may see fat descending from the lateral face descending here, forming a pouch one of the commonest areas where fat redistributes with age, the lower face, causing jowls and pooling under the chin and neck How does RFAL work?  it is minimally invasive, and the procedure takes around 1-2 hours in total with the patient awake, though it is possible to administer light sedation if they wish. it is conducted using local anaesthetic, similar to threadlifts, and when you go to the dentist it works by melting fat in areas where its appearance adds to a heavy and unattractive look, and heating the skin at the same time, inducing tightening and collagen production that will be most apparent over the following 3 months with ongoing skin tightening benefits for upto 12 months. it is a permanent procedure and results are expected to last anywhere for 3-5 years, though it may be repeated in a year's time if needed with larger volumes of fat. the procedure does not replace a facelift and neck lift if you are a suitable candidate for these and a thorough consultation with Dr Joshi is needed prior to discuss your options.   Please note individual results may vary based on patient skin quality, age, compliance with instructions, budget and expectations and no guarantee can be made about results or outcomes. Where do I begin?  A consultation to determine suitability, discuss options, plan the procedure and consent with respect to downtime and common and rare side effects is necessary as the procedure takes around 2 hours. A 20% non refundable deposit is required to secure the procedural appointment and by law, a cooling off period of a week is necessary after the consultation. What can I expect after the procedure?  you will be able to drive yourself home unless you chose to be sedated, then you will need to have someone drive you home. you will likely be able to work the next day if you wish. you will have some bruising, swelling and some discomfort for a few days, usually 7-10 days, manageable in most with simple painkillers over the counter. results will take upto 3 months to be fully apparent Ready to find out more? Begin by booking a consultation for an accurate assessment of suitability and a detailed quote based on your areas of concern.

Telehealth- what's not to love about it? One of the nicest things to come out of the pandemic is the fast tracking of the ways in which humans can remain connected, via video communication, including in Health. For those of our patients who are limited by geography, whether they were outside of the 5km radius during Sydney's lockdown, or are patients who are within NSW but several hours travel away, or interstate, and wishing to see us, teleconsultations allow you an easier way to access personalised advice specific to you and your skin and aesthetic concerns. We have made it easier than ever - book online, using the "New Patients, Skin Consultation, Telehealth Only" option and we will email you the relevant forms and instructions to fill out prior to your appointment. At this appointment, which will last upto 30 minutes we will address as many of your concerns as possible and write up a treatment plan for you to follow through with if you decide, when you decide, which may include a plan, if for in-clinic treatment, a budget and downtime. Ready to begin? Book here and we look forward to meeting you online soon to get your skin journey started!

Valid as at 30/09/2021 Skin Essentials will reopen the week beginning 11th October 2021. ​Per NSW government regulations, only double vaccinated patients will be served when we reopen and we will be checking vaccination certificates for all patients upon booking. This requirement may change as of December 1st, and we will advise you accordingly. Please email us (contact@skinessentials.com.au) or text us (0413174654) your vaccination certificate as soon after booking as you can. We will not be able to see anyone for treatments or confirm appointments without this. In the interest of full disclosure, transparency and patient safety, all patient facing staff will be fully vaccinated by the time of reopening.   Have questions? Read on to see if we have addressed them below!  ​1. Vaccinations and injectables - is there a time frame I need to wait before having injectables before or after my vaccination? There is no evidence that anti-wrinkle treatments have any bearing on vaccination timing. There is some evidence that dermal fillers within 2-3 weeks of vaccination may cause temporary swelling and so we advise you wait 2-3 weeks between vaccinations and dermal fillers to minimise these potential risks. ​​2. What COVID-19 safe measures will you be applying at all appointments? Given that cases are expected to surge post lockdown, we want to minimise your time in clinic spent on administrative tasks that can be attended to prior to your appointment, for the safety of all concerned. As such, please ensure you follow the instructions to the best of your ability. ​1. Please ensure all required forms, which will be emailed to you on booking, are completed prior to your appointment, including consent forms and acknowledgment of our late rescheduling/ cancellation policies. 2.Please arrive on time, allowing for traffic and unexpected delays. If you get to the clinic earlier than your appointment time, please have a seat on the bench outside the clinic or in your car and call or text to let us know you are waiting outside to minimise the numbers within the clinic per government regulations. We will call you in when we are ready for you. Masks remain a condition of entry to all indoor spaces including the clinic and must stay on until we ask that you remove them if needed.  3. Please come alone unless you are a minor with an accompanying parent. Due to limits on numbers allowed within the clinic, family and friends will not be allowed in with you and will have to wait outside. ​4. Please come with a clean, bare face and hair tied back. Removing makeup thoroughly is time consuming and will take up additional time in clinic. If having a skin treatment that requires pre-numbing, you will have been instructed to use a topical numbing cream from your local chemist and to apply it to your clean face 60 minutes prior to your appointment. ​5. If you are planning fillers and anti-wrinkle treatments on the same day, please book for both, or dermal filler treatment to allow for sufficient time to treat you. Please keep in mind, we will not be able to accomodate additional requests on the day for extra treatments as we need to allow enough time for spacing and cleaning between patients. We look forward to seeing you in clinic!

  Dark circles under the eyes are among the commonest reasons people, mostly women, seek help with as early as their late teens and early twenties. Among the reasons cited- well meaning but unhelpful comments from family, friends and even colleagues about looking tired such that people become self conscious even looking at themselves in the mirror. Over time, this issue can become consuming enough that it can affect ability to socialise, to go out and to especially engage in certain activities that are usually makeup free, such as swimming. There are so many "quick fixes" promised out there, it is easy to get confused and to end up spending a lot of money with minimal results if the person treating you does not fully understand the cause of YOUR dark circles.  This explainer talks you through what a trained doctor looks for when assessing someone concerned about their under-eye area, so you can be aware of some factors at play and what might be possible to do  so you can decide if it is worthwhile  to pursue an appointment with a professional to get a personalised treatment plan and quote for you.  What are the cause of MY dark circles? No two faces are alike, not even identical twins, and it makes sense that no two causes for a common problem, will therefore be the same. The area around the eyes is a complex one and multiple causes contribute to give you the dark circles that bother you: GENETICS Some people have dark circles even as young children, ie it may be an inherent characteristic of their under-eye area           SKIN QUALITY     Thinner, paler skin  may show underlying blood vessels more prominently, especially with age, giving rise to a faint bluish/ purplish hue that gives you an "always tired" look.     In such individuals, as we age, we lose fat pads around the eyes, leading to hollowing of these areas, together with loss of collagen, which thins the skin, worsening the appearance of tired, sunken eyes.              MEDICAL CONDITIONS   Allergies, if untreated, may contribute to darkening of the delicate skin around the eyes as well as abnormal thickening leading to puffiness, discolouration and in skin of colour, pigmentation here.        HEREDITARY CAUSES Genetic deficiency of the tear trough, as well as a tendency to pigmentation around this area may contribute to a marked discrepancy in skin colour in ethnic skin from a young age.          DIET AND LIFESTYLE Chronic lack of sleep, poor diet, habits such as smoking all contribute to dark circles. It is imperative to sleep 7-9 hours/ night as it is when we are resting that the skin repairs itself and generates collagen. Similarly, in addition to chronic unintentional sun exposure that breaks down collagen, smoking is also linked to faster collagen breakdown, leading to hollow, shadowed eyes no matter your age.  AGEING   As early as our twenties, fat pads in our faces, especially under the eyes and in our cheeks, are lost and descend, giving rise to a more hollowed, gaunt and tired appearance. Additionally, bony changes to the eye socket leads to loss of support, with deepening wrinkles and in some people, may lead to some fat protrusion in this area.     In skin of colour aka ethnic skin, this is often compounded by pigmented skin, which is often slightly darker in areas where the skin is thin and folds, such that in someone with ethnic skin, they seem to achieve the trifecta of volume loss + folding pigmented skin + wrinkling, giving rise to seemingly overnight, a marked difference in skin colour between their eyes and their face, which can often be very distressing for patients.  HAPHAZARD TREATMENT PLANNING Usually intended to help with the dark circles, lack of adequate planning of treatments or even the wrong treatments without understanding underlying cause(s) may on occasion, lead to unintended consequences, especially in skin of colour, with hyperpigmentation due to unexpected burns, or other injuries.           WHAT CAN YOU DO? 1. Lifestyle changes are the cornerstone of any longterm changes. Just as you would not expect to attain to and maintain a strong body by running once or twice, so it is with skin. The best treatments are the ones we can undertake as small daily changes at home with personalised skincare, and in-clinic treatments as and when needed to maintain results. Realistic expectations are key as treatments can take up a fair bit of time and money initially. Aim to get 7-9 hours sleep most nights. Our skin repairs itself and builds collagen during sleep so skimping on this important and free step is a bad idea.         Watch alcohol intake and when you do drink, follow it up with water whenever possible. Quit smoking! Smoking accelerates the ageing process.       Daily SPF 30+ 365 days/ year. Get into the habit of wearing SPF daily no matter what the day holds, and you will see the difference in a year even if you do nothing else.     Consult a doctor for a personalised skincare regimen suited to you and your skin and the age and stage of your life, based on your concerns or as a preventive. It may seem cheaper to simply buy at the latest sale or bundle or kit, but many people find they overdo it; contact dermatitis from overuse of over-the-products is real and common, and it is far easier to have a doctor talk you through what your skin needs. I call it skin coaching. In addition to SPF daily, have the other basics covered - a sunhat, sunglasses to protect the delicate area around the eyes, and whenever possible, cover up as much of your skin as possible from the UV or use SPF on exposed skin, and seek shade whenever and wherever possible.       2. Seek help

I love watching the natural progression of the ageing face. Often the best way to do this, is vicariously, through television shows and movies. Unlike much of social media and heavily curated and filtered pictures, the medium of animated shows still retain some degree of honesty about the ageing process. Additionally there is a small but rising number of actresses who have been more forthcoming about the ageing process, their own struggles with it, as well as the  ways in which they choose to age well, as opposed to ageing the way nature intended. These faces, unlike heavily airbrushed, filtered and  “worked on but denied they have had anything done” are the best proof of the ageing ‘well” process, and what it might look like for us, not because we choose to do nothing, but more realistically, because we choose do some of the things to help us continue to look fresh and alert and vital for as long as possible, which, I think, ought to be the main aim and goal of any aesthetic treatments, if we choose this as an option for ourselves. Can we avoid ageing?  Ageing is a genetically programmed occurrence that is unavoidable for all of us, no exception so it makes sense to shift the fear based, often unhealthy focus on getting rid of every imperfection, which is impossible anyway, to “how can we help you age well, by judicious use of strategies and therapies that will serve you not just now but for years to come, so that you can continue to feel your best for decades to come.” This tends to be my philosophy at Skin Essentials, rather than unattainable and unrealistic goals that feed into fears around ageing and may encourage an unhealthy fixation on impossible goals and standards. We only need to look at our parents to get a glimpse into the future of how we will look in our 40s, 50s and older. Equally, we need only look at some of the celebrities in their 20s, 30s, 40s and 50s to see, in HD, the ageing process as it begins to take hold, and is ultimately unavoidable. Ageing is a complex combination of genetics that seem to begin as early as our teen years for some, as well as important lifestyle choices that do not often get emphasised enough. Some genetically protective factors for ageing well: Ethnicity- generally speaking many non Caucasian ethnicities age better due to a combination of different bone structure that may minimise sagging and jowling in middle age as well as increased melanin/ pigment which is protective against cumulative sun damage over the decades. Many ethnicities also have a cultural tendency to minimise sun exposure, which is also protective. Genetics – a stronger baseline jaw, chin, cheekbones usually tend to provide better bony support for facial tissues with age. Think of Angelina Jolie or Lucy Liu, with their classic jawlines, compared to someone with a genetically weaker lower face- less prominent jawline and a weaker chin. In aesthetics, for this reason, facial balancing is so important, as these deficits are what will seem to enhance the ageing process beyond a certain age, as tissue begins to sag, muscles begin to spasm in some areas, causing dimpling and puckering of overlying skin. Additionally, even if one is genetically blessed, it is undeniable that the vast majority of factors that contribute to ageing poorly are in our hands, and based largely, on lifestyle choices: Daily and regular SPF30+ use; it is estimated that 80% of skin damage and collagen loss is avoidable by careful sun protection Eating well most days, and watching heavily processed foods including sweets. Mindful alcohol consumption Avoiding smoking, or quitting ASAP Getting enough sleep In saying all this, it is undeniable that ageing is a fact of life, and as aesthetic physicians, we can only help improve what nature gave you, or minimise the effects of what is being lost, rather than create something that is nonexistent, given the limitations of biology. Additionally, oestrogen seems to be the main driver of skin quality as well as bone health in men and women. For this reason, among others, it is currently thought to be the main driver of ageing in women being at an accelerated pace compared to men, as early as our 30s to middle age compared to men,  in whom oestrogen is a more gradual decline, with ageing related changes more obvious in middle to old age.   So what are some of the telltale signs of ageing you should be watching out for? I have a list of 9 from some of the earliest you may notice, to some later ones.   The area around the eyes The area around the eyes is among the first to show signs of ageing. In some, there is a congenital (ie they are born with it) defect of the tear trough, such that they seem to have dark circles/ hollows from as early as childhood; in someone with skin of colour, this may be more accentuated due to pigmentation. Nonetheless, as early as our teens, this area may begin to age. Eyelid skin is thin and delicate and may begin to sag over eyes, giving a heavy, hooded effect as early as our 30s. Loss of fat under the eyes together with this delicate skin can enhance the appearance of dark circles or prominent vessels in fairer skinned individuals, giving rise to a perpetually “need to sleep” and tired look that invites unsolicited comments. The eye socket also begins to change with age, with less bony support for the eyeball and surrounding structures, leading in some, to bulging of the fat in this area, eyebags and loose skin, which can be distressing for many.   Furrows and lines and wrinkles on the face From our childhood years, we convey our feelings and desires with our faces. Humans are among the most expressive species and it is for this reason, compared to other mammals,

  People look at me funny when I talk about prevention.   I am a primary care doctor, ie a specialist GP, aka Primary Care Physician and our focus and training tends to be holistic, cradle to grave care and a big part of that, is preventing problems before they occur. As someone who has a special interest in Primary Care Dermatology including Aesthetics, a conversation that comes up regularly is “HOW do I age well?” On the one hand, I am stoked that people are taking an interest in ageing well because in many ways, the ageing process begins as early as our twenties. On the other hand, I am less pleased about the fact that most young people seek their skincare and ageing advice from unreliable sources, usually on social media, that can cause more harm than good. So if I was to summarise suggested care by decade, here it is, with the following caveat: -generalised advice. If you have specific concerns, make an appointment with a trusted doctor that you can have a therapeutic relationship with. - advice is mostly based on what is most commonly seen by decade; fairer skin types begin to show age on average a decade earlier than ethnic skin ie late 20s vs late 30s or even older. This seems to even out around 60 for everyone.   Your Teenage Years -young bodies may be thin but young faces are full of fat. Youth is beauty personified. -attention span is short, acne is almost a given, since upto 80% of teens will have acne to some degree. - keep skincare routine simple –I tend to personalise it to 3 steps including prescription Vit A if needed. - establish a daily SPF30+ habit now - avoid taking up bad habits- don’t do drugs; get enough sleep; exercise; eat mostly well. Your Twenties -if you have no skin concerns, focus should still be mainly on prevention as during your teenage years. -consider adding in a Vit A; talk to your doctor about options -you may begin to notice hollowing under the eyes in this decade, and especially if fair skinned, fine lines and wrinkles during movement ie frown/forehead lines and crows feet, but also in some, at rest. - if this is you and it bothers you, consider a consultation to address these with skin therapies that stimulate collagen, and judicious use of injectables- a little can go a long way without freezing movement. Your Thirties -many of us, if we choose to have children, will spend some of our 20s and/or 30s unable to use many prescription skincare products, as well as in-clinic treatments. -These usually include Vit A derivatives as well as pigment fading medications. Use them when able, under the guidance of your doctor, who may also be able to suggest alternatives to use while pregnant/ breastfeeding -additionally, hormonal changes in pregnancy can wreak havoc on skin in the form of pigment and late nights and disrupted sleep with young kids can  seem to exacerbate the ageing process. - if this is you, when able, talk to your doctor about a personalised skincare regimen that is pregnancy/ breastfeeding safe. -if able and willing, this is the perfect time to begin to get serious about ageing well as prevention is no longer enough. -you may benefit from in-clinic treatments when able and this will almost certainly involve a multi-modality approach as the concerns are beginning to add up-  large pores; adult acne in some; fine lines and wrinkles; sun damage in the form of age spots, pigmentation and melasma; volume loss typically under the eyes and around the mouth leading to a tired/ sad look. -What you invest in now will stand you in good stead for years to come, if you take a holistic approach Your Forties -this is the decade in which,  without an effective plan in place, you will begin to see the ageing process really take hold. - in addition to all the excellent habits from your youth,  this may be the time to consider if you are planning to age the way nature intended, or to age gracefully. The two are not interchangeable. -this is the age when skin begins to thin and feel dry from declining oestrogen, peri menopause is a thing from your mid forties and bony loss in your face- around your eyes, your mouth and your jawline leads to deepening skin folds -drooping eyelids,  sunken eyes,  eyebags, deep smile lines, “smoker’s lines”, receded chin, jowls and “double chins”. - lines also become more prominent and may be present even at rest on the face and around the neck -this decade is THE time to begin planning the years ahead, caring for skin and minimising the negative effects of ageing: thinning skin with poorer resilience; global volume loss in the face with uneven fat distribution to the lower face; bony loss in the face,  leading to sagging overlying skin around these areas. -if you have been getting regular tweakments until now, there should not be any major surprises. - if you have not, this may be the decade you really begin to notice all the ways in which there is now a mismatch between how you see yourself and what you see in the mirror -with a curated treatment plan over some months and budgeting,  it may still be possible to slow the process and manage the negative effects of ageing. Your Fifties and beyond I often see the sixth decade of life as being the opportunity that is “do or do nothing” and I often say this to patients who want to look younger but lack the budget, the willingness to show up or do not want injectables, much less surgery. In this decade and beyond, it becomes harder and harder to undo decades of neglect and damage with only non surgical options and it may be cheaper to encourage them to spend on a face and neck lift for significant loose

In my work as a cosmetic physician (and even in my work as a skincancer doctor) I regularly have the discussion with patients who are beginning to see signs of ageing they dislike as early as their 20s, about options. I have come to realise that for women at least, as the vast majority who have these discussions, are women (thank you patriarchy!),there are definite lines drawn by some when it comes to anti-ageing options. There is the “skincare only” cohort, who cite a variety of reasons for being anti-injectables and other enhancements and it is these I want to focus on today, because it is an entirely valid choice, as long as women understand what they are actually saying when they say they  are "not afraid of ageing” and “want to age gracefully” and “role model to my daughters that you don’t need to be afraid to age” and similar concepts. So what DO I say to women I meet and consult with, who are hesitant about, or afraid of, considering in-clinic treatments, especially injectables such as anti-wrinkle treatments and fillers as we begin our therapeutic relationship? 1. Most skincare is surface deep. Our skin is the largest organ we have, whose sole function, is to keep “us” separate from the world. Formulations and skincare designed to be used topically, are typically very hard to formulate as most ingredients do not penetrate this barrier very well, unless it is damaged, and even when well formulated (eg hormone patches and gels, nicotine replacement patches), only a percentage of the active ingredient has the ability to penetrate. So as much as the hype may say so, there is a limit on how much change most skincare can effect, over time, with some exceptions- Vit A derivatives are a great example of this.  As a guiding principle, over-the-counter formulations, which are not regulated as they are classed as cosmeceuticals, may vary widely in their formulations and strength as well as efficacy of their ingredients. Prescription topical products on the other hand, are classified as medicines and heavily regulated – these are usually formulated not for feel and elegance and fragrance, but for efficacy, so these miss the lush/ pampering element, but usually do the job much better for skin problems than OTC stuff, provided they are formulated well and packaged to last, since many of them are also sensitive to air and light. Apart from that, in-clinic treatments ie skin therapies such as chemical peels and medical grade skin needling are other examples of ways to improve surface skin texture, even out skin tone, improve fine lines and wrinkles and boost collagen production, with ongoing repeat sessions. Discontinued, skin will gradually return to its normal state pre treatments so maintenance is an important part of treatment plans with all skincare and skin therapies. 2. There is no skincare that will replace injectables There is a lot of fear among women I see about injectables, often with the explainers such as “I don’t want to look like so many women out there” “I don’t want people to know I’ve had WORK done” and “I’d be horrified if I got duck lips” Others are adamant that it is not in line with their ethos on ageing well, which is fair and reasonable if that is their stance. What I usually say to these women, who also usually want to look “younger” and “fresher/ less tired” and “have less wrinkles” is that there is no skincare or skin therapy that will replace injectables. Why? Ageing is a genetically programmed process that is individual to each person, influenced by their genetics including ethnicity and overall health and many of the changes we see over time are ONLY amenable to in-clinic interventions or, left too late, surgery. I was recently asked if face yoga will erase the wrinkles – short answer? Nope. I understand the fear around looking fake, looking stupid and as one woman said, looking like “mutton dressed as lamb” as well as being judged. At the same time, I like to offer my opinion:- We only notice the BAD injectables jobs walking in our midst. The ones who have had it done well, are imperceptible. I had a woman in her 40s recently, who saw me for her first injectables treatment, and was very worried about looking fake/ done as she has teenage girls “and they will notice if I look odd!”. When she returned for her review appointment and was ready for more, she advised me that her teenagers HAD noticed she looked better, fresher, but could not put their fingers on the WHY. Done well, this is exactly the goal of injectables, or as one of my patients said to me early on in our therapeutic relationship, “I want to spend a lot of money to look like I wake up like this everyday” - Injectables (anti wrinkle injections as well as dermal fillers) once we begin to notice the things in our faces that we dislike, take time. It is unlikely to be a “one and done” treatment and like any worthy goal, usually involves many elements of treatment and modalities, of which injectables form just one, and usually the most costly aspect initially. Maintenance is usually more manageable. With my patients I often begin with injectables if they need it, as it will give the most immediate results, and in the background, we keep working on the longterm goal – which may involve more injectables, skin therapies, at home skincare and more. In saying all that, if someone is adamant they do not wish to have injectables, then that is completely ok too, as long as they understand the limitations of skincare only. 3. Most skincare involves lifelong changes and commitment Just as we would not expect to be able to run 5km the first week we begin an exercise program, so it is with skin. Years of neglect cannot be magically undone by a single session (or 3)

It seems to be everywhere we look. Pillow face. Overfilled. He used to be so handsome, now he just looks odd. She used to be beautiful, now when she talks, she just looks WRONG. There are examples of people who have gone too far with dermal fillers, aka hyaluronic acid fillers- Zac Efron comes to mind of late; Meg Ryan; Nicole Kidman and Madonna, among others. The theory, as has been discussed before, is that somewhere along the way, “less is more” has morphed into “more is more” and if a little is good, a lot MUST be better. Not so. As I get tired of sometimes explaining, filler does not lift sagging tissue. Many of the times, the sag and loose, crepey skin that we see, is due to loss of collagen and elastin in the skin. Many causes contribute to this- ageing, sun exposure, smoking, poor diet and other lifestyle choices among others. When skin quality is poor, we are limited in what we can do to help improve it. We certainly cannot “just” lift it, with threads, with filler or anything else. The foundation of almost all healthy, glowing skin that is responsive to treatments, often begins with inducing collagen and maintaining it.  Hyaluronic Acid Fillers While hyaluronic acid (HA) fillers are great for adding volume to parts of the face that are clearly depleted, leading to some hollowing and potential sag in surrounding areas, they do little more than add volume and hydration beyond a point. Adding more and more fillers, will risk distorting the skin, stretching it and leading to very odd looking faces that resemble caricatures of their original selves aka PillowFace, Overfilled Face Syndrome and more. Biostimulator Fillers Are a Potential Solution for Skin Volume Depletion When someone who is volume depleted is replaced to maintenance, I begin to nudge them away from HA fillers to biostimulator fillers if they wish to consider an injectable form of collagen induction. Why? These fillers (there are currently 3 on the market in Australia) work differently: - 2 of them work by replacing some volume immediately - one is especially good for gaunt, slim faces and restores collagen while adding volume.  - all 3 of them work by stimulating your own collagen production over some months,  which may then last up to 2 years at a time. Hyaluronic Acid Fillers vs. Biostimulator Filters If Biostimulator Fillers  are so great, why are we not using them more, and on everyone? - unlike HA fillers, most of these fillers cannot be dissolved if a mistake is made or a vessel accidentally injected into. - so it makes sense that these fillers are better used by far more experienced injectors on their regular patients they have a relationship with. Can something still go wrong? Of course, but as with everything else, experience absolutely matters. - they are also less commonly used and therefore more expensive even though they usually last longer and look more natural - unlike HA fillers, they cannot be used on all areas of the face. For example, they cannot be used in lips, or under the eyes for the most part, two of the commonest parts injected even in young people. So why should anyone consider Biostimulator Fillers? - unlike HA fillers, they do not usually lead to overfilling- over time, these fillers work by stimulating your own collagen, which can last up to 2 years in the treated areas- it is not an immediate result, but a far more gradual one, over 3-6 months, like most skin improvements, but your own collagen, once stimulated, will last a long time. This collagen is also your own, so does not move around the way filler might over time and repeated movements in highly mobile areas of the face such as the eyes and lips.  - HA fillers, we are learning now, may be far more finicky than initially thought- they do not dissolve in the promised 6-18 months as we were told; they can migrate and cause duck lips and filler moustaches and unsightly bulges under eyes, among other things. Biostimulator fillers, for the most part, are more reliable in their mechanism of action, their ability to dissolve and stimulate your own collagen, which ultimately, is YOU. Biostimulator fillers are also great at stimulating collagen in other areas of the body such as lax skin around the abdomen after birth, cellulite ridden hips, flat buttocks and more. they are especially great at replacing collagen in gaunt people with significant hollowing and while collagen production slows down with age, and rapidly so after menopause, it is never too late to induce your own collagen if you want an injectable means to do it.   So the next time you want to consider ways to improve skin quality, add luminosity and do not want to look overfilled in the process or want a more gradual process that continues to build over time, make an appointment to talk to your doctor about biostimulator fillers and see if you might be a suitable candidate for a biostimulator filler over HA filler.

The personalized skin care and beauty worlds are dazzling and baffling with its array of products for sale, backed by influencers touting the benefits and showcasing their uses on all social media channels one might be on. But it begs the question - how are you to choose a skincare regimen that will suit you? The industry is showing no signs of slowing down, and only of increasing over the years to come, with sales set to rise also if predictions are to be believed.  Getting Back to the Basics With Personalized Skin Care Weekly, when I consult with patients, I see that a large numbers of many skin concerns and problems are iatrogenic, ie caused by treatment, leading to disruption of the skin barrier, causing dryness, and even dermatitis due to over zealous use of too many products, often too concentrated or in combination with other ingredients that may cause issues.  When this happens, almost without fail, I tend to discuss paring skincare back to the very basics, which usually consists of a simple cleanser, and spf during the day and a cleanser and moisturiser at night until the skin settles before we discuss anything more. So how do you choose a skincare regimen to suit your skin and its needs? To answer that, I often explore with patients what good skin looks like to them as they age; what they are willing to do to invest in their skin as it ages, and what that investment looks like realistically.  For many, it will focus solely on skincare regimens, but no injectables or in-clinic skin therapies. For others, it will be the opposite- a basic skincare regimen, and a monthly luxurious in-clinic treatment and for yet others, it may be everything I suggest.  A Personalised Skin Care Regimen For Your Needs This is where personalised skincare comes in. Not simply a bundle of cosmeceuticals sold to everyone, which is fine if you have no significant skin concerns, like it, it suits you, and the price is right, but an individualised treatment plan designed to help improve your skin, based on your current concerns, over 3-6 months of consistent use with regular support from us. This is what an individualised skincare consultation at Skin Essentials is designed to do. If you have essentially healthy skin free of any significant skin problems, concerns or diseases, we can recommend a simple skincare regimen from one of our cosmeceutical brands in addition to daily SPF to help you maintain results in between in-clinic treatments. We have a small range of curated cosmeceuticals we use and sell in clinic that we like the smell and feel of, which are also Australian brands.  If, on the other hand, you have problem skin eg acne, rosacea or hyperpigmentation/ melasma, cosmeceuticals won't help as much as prescription compounded creams that we personalise to your skin and its needs, sold in clinic after compounding by our chosen curated skincare service, based on Evidence Based Science and designed to last you 3 months of daily use. This is supplemented by support from us and regular checkins over time.  We have always offered skin consultations and since the pandemic, we can do this via Telehealth also if you are not local to us. Through this consultation we can talk you through what you are currently using, your skin concerns and problems, and ways to remedy that, should you choose, and how to do it and if we do choose, together, to go ahead with the suggested regimen, it will be mailed out to you, whether it is a compounded cream, or one of our cosmeceuticals products or sunscreen.  More often than not, it will likely involve paring back what you are using if it might be contributing to your skin concerns, and returning to a very simple skincare routine, followed by adding in a prescribed product designed specifically for you and your concern. Ready to get started? Book in a Skin Consultation, and we will talk you through the next steps. Help 

As it becomes easier and easier to access anti wrinkle injections and dermal fillers in chain clinics and via mobile setups in hair and beauty salons, it is also becoming more common to see adverse outcomes due to some of these treatments, in part due to inexperienced and new injectors often left on their own after brief training stints, and equally, injectors being guided by the latest trends on social media, be it big lips, tear trough fillers, highly structured faces by way of "snatched" jawlines and cheeks and more. As a result, it is becoming more common now than it was 5+ years ago, to see more patients coming in to clinic wishing to discuss more filler, sometimes to hide "bad filler" elsewhere or to even dissolve filler gone rogue. In almost every case, the reason cited is either that the injector kept telling them it was normal and to wait it out without offering the option to dissolve, or occasionally, that they were told there was nothing wrong. Equally, we are beginning to see filler that has been in place for years at a time, when we were told by companies that it only lasted 6-12 months, and would need topups to stay viable every 6-12 months. Over time, some of this filler accumulates by being added to every 6 months, or in very mobile areas such as lips and around the eyes, moves ie migrates. Think of how mobile these areas are - the way the muscles around the eyes move when we blink, smile, close our eyes; or the way our lips move when we smile, talk, sip through a straw, kiss. Or even in cheeks, how filler might move when we laugh, smile and regularly animate our faces. Over time, in some of us, for reasons we do not fully understand, the filler does not integrate as we are told it is meant to, but instead is pushed by small, repetitive muscle actions, to areas it does not belong. When this happens, we may see it as a shelf or moustache above the lips. Or as lumps or waterlogged areas under the eyes or even around the cheeks. Occasionally, if the wrong type of filler is used in an area of the face, it can lead to a puffy appearance, or conversely, a highly structured look in an area that does not need it eg in the cheeks, leading to a "peanut head" appearance in the temples which look hollow by comparision. Think of Molly-Mae Hague as an example when, by her own admission, she went overboard with the jaw filler and cheek filler such that it ended up distorting her face. When I see patients like this to discuss dissolving fillers (not all of them want to start over), there are some key commonalities I notice among all of them: - they dislike the way they look - AND they are afraid nonetheless to dissolve the filler because they are afraid of what they will look like post dissolution. Will they have a giant gaping hole where their overfilled lips were? A sunken hollow where their overshaped cheeks are? Will their own hyaluronic acid be dissolved in the process leaving them with even less to work with? - there is almost a psychological toll on people at the idea of dissolving filler, even filler they are unhappy with; it is almost like they are grieving the loss of money they spent to look a way they are unhappy with, only to spend more money to dissolve it and then potentially more money again to refill the area. As such, I have found, giving them time and space is vital, as is having an open and frank discussion and setting realistic expectations. As with so much of aesthetics, we are working with living anatomy and physiology and what worked for your friend may not work for you. You may need as much as she did, or more or less and we will not know until we begin. Additionally, I like to touch on some other important information: - the enzyme used in Australia is derived of animal origin. As such, barring an emergency, it is important to do a test patch, in anyone we are contemplating dissolution in as long as they do not have a history of bee or wasp allergy due to a small risk of allergic reaction including anaphylaxis. For this reason, I always advise using a dedicated clinic rather than a mobile setup in a salon. - the enzyme is acidic and stings/ burns but can be made more comfortable by the use of a numbing agent to minimise the side effects. - depending on the amount of filler to be dissolved and how quickly it responds, more than one session may be needed to dissolve the filler- I usually do a test patch and if safe to proceed, we will begin slowly to minimise dissolving too much filler/ filler they do not want to dissolve in surrounding areas- I observe them in clinic for 15-20 minutes more before they head home and we touch base with them over a day or two till everything has settled- we review them at 2-3 weeks post dissolution to see if we need more, or if they are happy with results and/or want to refill Occasionally, despite multiple conversations, some patients are simply not ready to dissolve even though they do not like what they see in the mirror and they want more filler to disguise the area they dislike. In such cases, if it is possible, I may add filler elsewhere to hide the disliked area, but if it not possible to do so, it is essential in the interest of ethical practice to say no and to save the patient their money till they are ready to dissolve and possibly start again. In areas such as lips and often under eyes, depending on what the problem is, dissolving is almost always

Despite all the chatter about anti wrinkle injections and treatments on social media, I regularly meet patients of all ages who come to see me asking for anti wrinkle treatments who do not necessarily understand how it works, or how it differs from dermal fillers. As a medical professional, patient centered care is a central and key tenet of what I was trained to do- first, do no harm. Given that all aesthetic treatments are essentially elective and medical unnecessary, it is important to me that patients are as well informed as possible to make their choice and decision to proceed or mull some more. So what are some common myths I have heard patients believe about anti wrinkle injections? (PS in Australia by law, we are not allowed to use drug names, hence terminology like “anti wrinkle” and “muscle relaxant” to get around health regulations that could land us in trouble with AHPRA!) Myth #1 They work immediately Occasionally a patient will reach out wanting to know if we can squeeze her in “today or tomorrow” due to an important event coming up in 3-4 days for which she wants to look fresh and though anti wrinkle treatments might do the trick.  While there are some promising new versions of anti wrinkle treatments available around the world that apparently kick in as early as within 24 hours, we do not have that authorised yet in Australia; the apparent downside of these? They also wear off faster, in 2-4 weeks. Duration of onset aside, I am not a fan of impulsive decision making when it comes to entirely elective treatments for the simple reason that they are still medical procedures and side effects, while rare with an experienced doctor, are still possible, the least of which is bruising, which may be apparent for a few days after treatment, potentially ruining an important occasion. Most anti wrinkle injections on the market at present take anywhere from 3-5 days to begin to take effect and peak at approximately two weeks, when I tend to offer new patients a review, so we can determine if the effect is what they desired, and to determine correct dose for future treatments. Myth #2 Anti Wrinkle Treatments will age you when you stop having them Many people are worried that having these injections will permanently affect their face, or the way they use their muscles or even prematurely age them if they eventually decide to stop having treatment. In reality, the botulinum toxin works by paralysing/ weakening the muscles that cause movement. Over time (usually weeks rather than months) new nerves are regenerated to supply these muscles, resulting (from as early as 6 weeks post injection) in return of gradual movement to these muscles; by 3 months, and often earlier depending on the dose used as well as desired movement by the patient, the dose will have worn off and the patient is ready for re-treatment. Over time and with continued use, these muscles will remain slightly weaker compared to untreated muscles, resulting in the same dose lasting longer/ working better, resulting in smoother skin, fewer/ fainter lines especially in the forehead, frown and crows feet, giving a more youthful and refreshed appearance. Therefore, in theory if one was to have regular anti wrinkle injections 4 times a year for 2-3 years and then decided to stop doing so, it would likely take some months for full movement and strength to return to those muscles, and to then lead to reformation of the lines that led the patient to begin treatment in the first place. Myth #3 Anti Wrinkle Treatments can make you look frozen Not unless you want to! The way we used to use the toxin in its early days is likely quite different to the way we use it now. While I certainly have a small number of patients who ask to be frozen, by and large patients these days are more concerned with looking frozen and looking fake and simply wanting to look refreshed and well rested. Many of my patients also rely on the full range of facial expressions at work and in their personal lives (I have had several mums say to me “I want my kids to STILL know when I’m angry!”) and want anti wrinkle injections to help soften the appearance of etched-in lines, rather than risk loss of movement in an area of their face, such as the frown lines, or forehead lines. Ultimately, aspiring to a frozen look means that your treating clinician has to use an excessive dose at least initially, to stop you moving your muscles at all. Over some weeks as nerves begin to regenerate, movement will return, as early as 6-8 weeks, so it is almost impossible to completely freeze areas of the face for months at a time without regular treatment in between the 3 months, which I do not recommend. Myth #4 Anti Wrinkle Injections are only for Women While women remain the biggest demographic to seek elective aesthetic treatments, some 10-15% of patients tend to be men, many of whom also want to age well, and discreetly, and many of whom want to keep up with their young looking partners. Men tend to need slightly larger doses than women for the same effect as testosterone in men tends to confer greater muscle strength. Conversely, societal expectations of men tend to be such that men who age well, are “rugged”, still have some wrinkles, so that men usually look to soften lines rather than erase them. Myth #5 Anti Wrinkle Injections are addictive The only thing that is addictive about injectables is the real risk of patients coming to rely on it to feel good about themselves to the extent that a small number will begin to hyper focus on this. When this occurs, I tend to try and discuss this with my patients and to point out the hyper focus on them, as becomes the duty of any

There are many myths around sun protection and suntanning in Australia, a land with plenty of sun year round. Is there such thing as a safe tan?  We frequently hear of how people don’t like having “pasty white skin”, how they love the feel of the sun on their skin and in skin cancer clinic weekly, I meet at least one or two people who love the sun so much, they still sunbathe, regularly, most days, with variable amounts of sunscreen, from none to some. One patient whom I diagnosed a skin cancer on, not their first, even said “You gotta die of something doc!” Equally, I see some beautiful tans on these days, mostly unintentional, due to incidental sun exposure and hear many of the myths addressed in an earlier blog post. Today, I want to delve into what actually happens when we tan, intentionally or otherwise ie is it ever possible to tan safely? Short answer? No. Excess UV exposure is estimated to contribute to 95% of melanomas and 99% of non-melanoma skin cancers. These skin cancers account for up to 80% of all new cancers each year in Australia. In countries such as Australia, the amount of sun exposure, especially in the warmer months in southern states and all year around in northern states, is so high that even a few minutes of incidental exposure - checking the mail; hanging up the washing; collecting the kids from school; walking to your car- all adds up to hours and days of exposure over months, years and a lifetime. When it comes to tanning, I regularly say to people, ANY degree of tanning is an indicator that your skin is under stress, due to higher than normal amounts of incidental sun exposure, triggering a protective mechanisms, resulting in increased activity of your melanin (pigment) producing cells, the melanocytes ie your tan. Even so, this tan is not really protective at all, giving your skin an SPF, studies indicate, of about SPF 2. Ie if you are someone who would normally go red with sun exposure in 10 minutes, an SPF of 2 means you would now burn in 20 minutes 2/3 of Australians will develop a skin cancer over their lifetimes - a single incident of sunburn increases your risk of melanoma by 20% from baseline, and the cumulative sun damage over decades of UVA, which penetrate deeper and cause damage, premature skin ageing and cellular damage, are largely responsible for the non-melanoma skin cancers that we see in older people 50 and up. That aside, 90% of sundamage and ageing related skin changes are avoidable through rigorous sun protection - leathery wrinkled skin; yellowish tinge to skin, age/ liver spots and much more. What if I like the way I look when tanned? Fortunately spray tans can give you most of the joys of looking vibrant, and healthy without any of the associated damage of a tan. How do I minimise my risk of sundamage without avoiding life? Unfortunately, most Aussies know the feeling of sunburn all too well. The red, painful skin that stings when you touch it. The blisters and peeling that can break out for days afterwards. It's so common that 2.4 million Aussies get burnt every weekend in summer. - get into the habit of wearing SPF 30+ daily - most of us would not leave home without brushing our teeth - place your SPF next to your toothpaste and slather it on after your teeth - carry a spare tube of SPF in your bag (do not leave it in the car where it will degrade) and reapply frequently as SPF is designed to have maximum efficacy for 2 hours only - do not rely on SPF alone for your sun protection - carry a hat, sunglasses and wear protective clothing where possible and seek shade Additionally, I’d suggest that all Australians should add regular skin checks to their preventive health repertoire from their 20s annually, in addition to regular self skin checks.

With the boom of Aesthetics globally, especially since the pandemic, when most of us have been looking at ourselves via a Zoom lens far more than ever before, coupled with hours spent mindlessly scrolling through perfectly curated, often photoshopped and filter-heavy images on Social Media, has come a demand for aesthetic procedures, especially dermal fillers in addition to anti wrinkle treatments. As someone who has been doing this for many years now, the problem I am seeing more of, especially among my patients who first began with me several years ago and who are therefore now several years older than they were, is the mistaken belief that fillers will fix all problems. At least weekly, I see a patient who committed and spent the necessary time, energy and money to invest in what I call "full face rejuvenation aka facial renovation", and who became used to compliments from others she met, on how great she looks, how she passes for someone 20 years younger etc, and who is nonetheless, some years older than she was when we began and beginning to see the underlying bony changes of ageing that none of us, even surgery, can fully reverse or halt. So read on as I explore the limitations of what dermal fillers can do, and what they cannot. Mistaken Belief # 1 - Dermal Fillers can erase wrinkles. I had a patient in her late 30s on the weekend who is beginning to notice accordion lines, those smile lines on the sides of the mouth due to volume loss that is a sign of ageing, and asked if I do facelifts or if I know a surgeon who does. She was half joking, and yet she was not. So among other things possible, we spoke of using small amounts of dermal filler in the area to help add some volume - when she smiles, the wrinkles are still there, but the muscles are not pulling on thin tissue as much as before, thereby softening the lines, giving the illusion of "erasing or easing lines". Accordion lines are also hard to erase completely and best treatment options in this area would be a series of sessions of  laser toning, small amounts of dermal filler applied very superficially and mono threads and similar collagen inducing therapies such as skin needling and RF microneedling. Mistaken Belief # 2 - Dermal Fillers lift sagging tissue. This is among THE commonest reasons older patients ask for more filler. Filler does not lift, and it certainly does not lift sagging tissue by as much as 2-3cm which is what people expect fillers (or threadlifts for that matter) can do - they simply cannot. In a volume depleted person, when we begin by adding filler, we are replacing lost volume, and restoring sagging, deflated tissue back to where it belongs- as a result of this, a subtle lift is apparent, not because we have done any lifting, but because we are lifting skin folds that have occurred due to lost volume, back to their correct anatomical position. With age, even if we had perfect sun protection habits and perfect diets and great genetics that allowed us to age beautifully, there is bony depletion that occurs, along with ligaments that begin to sag and collagen that is being rapidly depleted, that simply cannot restore a 45 or a 50 or a 60 year old face to one in its 20s or 30s with its cherubic qualities.  Yet for some reason, people continue to believe (and erroneously be told) that fillers can lift when they cannot. The definitive treatment for truly sagging tissue and ligaments and really lax, poor quality skin is a face (and neck) lift. Other cheaper options include options such as threadlifts which temporarily lift sagging tissue and reposition them, but they last 12+ months and are by no means a replacement for surgery. Mistaken Belief # 3 - Starting dermal fillers when you are younger can help you stay younger. In large part due to social media influencers, many young women are literally waiting to begin their aesthetic journey as soon as they turn 18. This group is often short on cash, and so may opt to turn to a chain clinics and groupon deals, where the "price is right" as opposed to a reputable clinician with many years of experience under their belt for their lip enhancement, or non surgical rhinoplasty or tear trough fillers. The problem is, you cannot fix a problem you do not have. Most young people are the epitome of youth and beauty, and do not have any medical need of "fixing" anything unless it is skin problems such as acne or dermatitis from overuse of skin products. Once we get into the habit of getting lip filler, or any other type of filler, to plump up lips, or fill other perceived defects, it becomes a case of returning on a regular basis once we feel the filler is "gone" when it usually hasn't, for more;  it is the swelling and side effects that are gone, leaving in their place, compliments and comments from people that massages our egos.  Over time, these regular top ups when unnecessary can lead to stretching skin and contributing to an unrealistic and excessive focus on what needs "fixing" as opposed to recognising all the other beautiful attributes one has. Which leads to Mistaken Belief # 4. Mistaken Belief # 4 - Dermal fillers (or any injectables) will not treat unrealistic expectations or a desire to look Forever 21. It is important in clinic, to regularly remind patients of what they used to look like when they first began attending the clinic 3,4,5 or 6 years ago and how much improvement we have made and how great they look now, compared to when they first began investing in themselves. It is human nature to lose sight of the bigger picture; to forget what we used to look like, and to become almost addicted to regular

Two days a week, I work in a dedicated role doing skin cancer checks including skin cancer surgery. Over the years, I've learned about the various sun protection myths that people may hear from Internet or other anecdotal sources. On a regular basis, as part of my job, I ask about occupation, sun exposure and lifestyle and it continues to baffle me how, in spite of the campaigns by agencies such as the Cancer Council, most of us buy into many of the myths around sunscreen use and sun protection, so I am hoping to address some of them here.  Myth #1 - Sunscreen is only needed when “going out”. When I first began this work, I was stumped when people said they only used sunscreen when “going out”, or “I don’t go out at all”. I had visions of people working underground all day; commuting to and from work, school and more via a tunnel and essentially living like vampires who would combust spontaneously if exposed to any sunlight at all.  On closer questioning it became apparent to me that many of us, if not most, see “going out” as engaging in outdoor sports, going away on holiday to a tropical location or sunbathing at the beach.  On an average day: - if we work from home and are surrounded by natural sunlight; - if we commute to work even if work is a 5 minute walk or drive from home; - if we walk the kids to and from school; - if we go out to get a coffee; - if we walk out to check the mailbox (and might say hello to the neighbour); - if we take the washing out and then bring it in again. These examples of  5-10 minute exposure times, whether it is at 7am, 10am, 2pm or 4pm contribute to what I refer to as incidental sun exposure - what you get on a day to day basis, while not intending to be exposed. Over 365 days, that adds up to hours of sun damage via UVA, even if you never burn and avoid most of the UVB, which is the UV we are warned against during peak hours of the day to avoid burning.  For that reason, organisations like the Cancer Council and doctors recommend daily sunscreen, preferably at least SPF 30+, regardless of what the day holds. Quick Tip - most of us would not dream of leaving the house without brushing our teeth, so place your tube of sunscreen next to your toothpaste and slather it on after brushing your teeth till it is a formed habit! Myth #2 -You do not need sunscreen in winter, or on less sunny or cloudy days. In a country such as Australia, in most states, we get plenty of sunshine year around, and the UV index is rarely below 3. The Cancer Council states that everyone should be wearing sunscreen daily on any day when the UV index is expected to be at 3 or above. For most of Australia, especially the more northern states, this would be most days of the year, regardless of weather. Also in this sunburnt land, even when it rains, it is a rare day that we would have rain lasting for hours or days, with the sun peeking through at some stage. Quick Tip - Unless you are allergic to an ingredient in sunscreen, it is best, much like brushing your teeth, to establish the habit of wearing SPF 30-50+ daily before leaving the home and reapplying through the day. Myth #3- Some sun exposure is needed to produce Vit D for your bone health. The sun’s UV radiation is at once both the major cause of skin cancers and the best source of Vitamin D. At the same time, in a country such as Australia we need to balance the risk of skin cancer from too much exposure and making enough Vit D. The truth is, most people, while attempting sensible sun protection, will still get some unintended UV exposure - even people who have an established habit of wearing sunscreen daily, do not regularly wear it twice, much less reapply every 2 hours - this has the potential to leave gaps in the hottest parts of each day where we have unintended sun exposure that is sufficient to stimulate enough of our own Vit D production. It may also be beneficial to talk to your doctor about whether a Vit D supplement may be helpful for you. Quick Tip - the more fair skinned you are, the more easily you can get enough UVB exposure to maintain your Vit D leaves- in summer, incidental sun exposure is usually sufficient and in colder months for those of us in the Southern parts of Australia, brief outdoor periods with some skin exposed suffices. Darker skinned people’s pigment reduces UV penetration so they are at higher risk of Vit D deficiency compared to fairer skinned people. Myth #4 - There is SPF in my makeup that suffices for my needs. Tinted creams and foundation with SPF in them are not usually designed to be used as standalone SPF. The Cancer Council recommends 3-5mls of SPF 30+ to be used to the face/ ears/ neck and reapplied ideally every two hours. In reality if we were to use 5mls of tinted creams or foundation, it would likely appear caked on and clownish in order to provide enough sun protection. As such, the general advice stands that it is far better to apply a standalone sunscreen in the morning before leaving home, 5mls as directed, and then reapply tinted formulations in smaller quantities throughout the day, especially if over makeup, to continue to add some cover as any sunscreen used (yes, even SPF50+) is only fully effective for 2 hours and then efficacy wanes.  Quick Tip - If you wear makeup, applying a decent layer in the morning under your makeup is best, followed by either a tinted

Where Medicine meets Art, for your best skin ever....

When the COVID19 pandemic hit us and lockdowns began, we were likely expecting to be facing restrictions for much longer than we’d wanted and expected. Months, possibly. Instead, thanks in large part to frontline workers and the efforts of everyone else who has stayed at home and done the right thing, we’ve managed to flatten the curve and to avoid overwhelming the health system- for now. In the wake of this, there are plans afoot to open up certain types of surgery from next week, 27/4/2020 and to see what effect that has, if any, on cases. It’s worrying to see that some others have continued injecting and others will be resuming business from 27/4/2020. I’ve sought advice from my medical defence organisation and while it’s not illegal, their advice remains - they strongly advise against all non essential medical services in view of the risk despite all due precautions and the ongoing shortage of protective equipment for frontline workers including GPs to see actual sick people. I can’t in good conscience open at present so we will delay and wait until May 11 or so to see what the recommendation is. I’d hate to see a second wave because people take it upon themselves to open too soon after all the success we have achieved as a nation, largely due to the hardworking frontline workers who have taken the risk for all of us. We hope to open around May 11th or just after, and all being well, we will have plenty of time to focus on your skin goals this winter in a safe and ethical manner without taking away from frontline workers. Until then, please stay at home, stay safe and keep saving for your treatments. For those observing Ramadan, Ramadan Mubarak, we hope to open up bookings from Monday, May 11th if all remains well, and we look forward to welcoming you in our purpose built clinic just for skin soon. Bookings may be done here. We will post more closer to the date about how we aim to protect you and ourselves while caring for your skin, all being well. Hope to see you in clinic soon.  

Here in the Southern Hemisphere, we consider ourselves lucky that summer coincides not only with school holidays, but also, Christmas, New Year and the end of one year and the beginning of another. As the busy year begins to wind down, it seems the perfect time to lie back, take some time off no matter how hard we have worked through the year, and relax with family. Summer Daze.... When I think of summer, I think of long, lazy days, lots of water activities and books, cool drinks and food! Already, when walking around, I see fellow Aussies out and about, enjoying the sun, and while I don't like to think of myself as a party pooper, my main concern is for their skin. Although most people love the warmth and light of the sun, too much sun exposure can significantly damage human skin. The sun's heat dries out areas of unprotected skin and depletes the skin's supply of natural lubricating oils. The sun's ultraviolet (UV) radiation can cause burning and long-term changes in the skin's structure. The most common types of sun damage to the skin are: Dry skin — Sun-exposed skin can gradually lose moisture and essential oils, making it appear dry, flaky and prematurely wrinkled, even in younger people. Sunburn — Sunburn is the common name for the skin injury that appears immediately after the skin is exposed to UV radiation. Mild sunburn causes only painful reddening of the skin, but more severe cases can produce tiny fluid-filled bumps (vesicles) or larger blisters. Actinic keratosis — This is a tiny bump that feels like sandpaper or a small, scaly patch of sun-damaged skin. Unlike suntan markings or sunburns, an actinic keratosis does not usually go away unless it is frozen, chemically treated or removed by a doctor. It develops in areas of skin that have undergone repeated or long-term exposure to the sun's UV light, and is a warning sign of increased risk of skin cancer. About 10% to 15% of actinic keratoses eventually change into squamous cell cancers of the skin. Long-term changes in the skin's collagen — These changes include photoaging (premature aging of the skin because of sun exposure). In photoaging, the skin develops wrinkles and fine lines because of changes in the collagen of a deep layer of the skin called the dermis.   Over a lifetime, repeated episodes of sunburn and unprotected sun exposure can increase a person's risk of malignant melanoma and other forms of skin cancer.   So what does skin damage look like? Sun-damaged skin may shows the following: Dry skin — The skin appears dry, flaky and slightly more wrinkled than skin on other parts of your body that have not been exposed to the sun. Dry skin is also one of the most common causes of itching and ageing skin gets drier, so needs more care to keep it hydrated. Sunburn — Mild sunburn causes pain and redness on sun-exposed skin. In most cases, there are clear boundary lines where the skin has been protected from the sun by shirt sleeves, shorts, a bathing suit or other clothing. More severe cases of sunburn produce painful blisters, sometimes together with nausea and dizziness. Actinic keratosis — An actinic keratosis appears as a small bump that feels like sandpaper or a persistent patch of scaly (peeling) skin that may have a jagged or even sharp surface and that has a pink, yellow, red or brownish tint. At first, an actinic keratosis may be the size of a pimple. Rarely, an actinic keratosis may itch or be slightly tender. Long-term changes in the skin's collagen — Symptoms of collagen changes include fine lines, deeper wrinkles, a thickened skin texture and easy bruising on sun-exposed areas, especially the back of the hands and forearms.   Outcomes Sun damage may result in a permanent cosmetic concern, only some of which may be treatable, but not usually reversible, with judicious use of personalised skincare regimen, careful sun protection for life and treatments as recommended by your doctor - chemical peels, laser and light treatments, prescription medications as well as injectables. Some treatments for actinic keratoses can leave a pale (de-pigmented) area of the skin surface. More important than appearance is the long-term impact of sun damage on your chances of developing skin cancer. The more unprotected sun exposure you have during your lifetime, the greater your risk of skin cancer, especially if you have a light complexion so it is important to have your doctor care for these and check your skin regularly and to keep monitoring it yourself for any new changes. As an example, I have attached an example of what happens with the most simple measures that most of us ignore - suncare. Using the app Sunface, I took a pic of myself, and then compared myself in 5, 15 and 15 years, with daily sunscreen vs no sun protection. See the results for yourself. In someone with lighter/fairer skin, the damage is faster and deeper, as would be the lines. In someone with darker skin, it is slower, but still unavoidable if one is not careful about sun protection.   Take home message? It is NEVER too late to care for your skin. it begins with simple measures such as sun protection - all day, everyday, sun or rain, winter or summer - hat, sunscreen, glasses and clothing regular reapplication of sunscreen during the day apply sunscreen 15 mins before getting in the car - the windshield and windows don't block out sun rays SPF 30+ regularly through the day, 5mls (teaspoon) to the face reapply more often when sweating, or in the water References  Weird things that happen as we get older.

Not everyone wants to have injectables.   The vast majority of people who contact us at Skin Essentials are afraid of injectables.  They usually come in frightened of having lips or anything, that looks too obviously fake.  They come in armed with pictures on Instagram of what they do NOT want to look like- big pouts, pillow faces, fake high cheekbones and more. One patient said to me, “they look stunning in selfies but I have to wonder, with the almost cartoon-like faces, what do they look like when they talk and move their faces.”  And that’s it exactly. None of the people I see, wants to look like that.  They don’t want people to know they’ve had “work done” or “what work”.  And some simply haven’t the budget for injectables but still want to age well. So what options are there?  I like to think of beautiful skin as a blank canvas for all kind of enhancements, from the barest of makeup, to injectables, if that’s your thing. So let’s go from the basics to the slightly more involved for those who are wary of injectables.  1. Personalised skincare regimen Not all skins are equal in the way they behave and react to chemicals placed on their surfaces. Knowledge is power and as much as automated systems can be to help you decide what skincare type or brand to use, the best way to do it is to enlist the help of someone who can sit with you and work out your own personalised regimen based on you, your lifestyle, your needs as well as your likelihood of compliance ie how likely are you to use the skin plan if it’s 5 steps vs 2 steps? 2. Medical Skin Peels  These are simply great, in sets of 3-6 peels, for rejuvenating skin, removing the most superficial layer of skin allowing healthier skin underneath to come through. Over time, combined with step 1 above (home care) you’ll notice your skin feels smoother, more even toned and lustrous. Makeup if you wear it, will go on smoother and you’ll receive compliments on your skin. What’s not to love about that? Peels start at $120/session and may be booked with our therapist or Dr Joshi herself.  3. Medical Skin Needling  This is a 2-in-1 treatment- controlled micro trauma to the skin, ie controlled irritation and trauma, just enough to stress the skin out, without causing lasting damage, to stimulate new collagen and elastin production of your own, over time. We add in a cocktail of serums while the channels are open, to help them penetrate deeper. Results again, are, over 3-6 monthly sessions, smoother, firmer skin, tighter pores and skin that feels wonderful. Fantastic for all skin types, even those with melasma and hyperpigmentation, with adequate care taken. Price $350/session  4. AquaGold AKA Mesotherapy with a cocktail of options  This is a new treatment option of a cocktail of treatments, inserted just under the skin surface, to cause micro trauma similar to the skin needling, but with added benefits of a. Small dose of antiwrinkle treatment to tighten pores, b. Filler to help plump skin surface c. A mix of serums and a. And b. Above. Prices start from $600/session every 3 months. 5. SkinBoosters  For ultimate hydration that’s long lasting year round, it’s hard to go past this treatment. We’ve posted on it here (link) and here (link)  We recommend, for best results, an initial treatment of 3 sessions 2-3 weeks apart, 3mls each session ($700, normally $900) and then twice a year to maintain, 3mls ($900). Makeup will go on smoother, skin won’t feel as dry in winter, and look smooth, even and rejuvenated in summer. Win-win-win 6. BBL for skin rejuvenation  For women who do NOT suffer from melasma/hyperpigmentation, this treatment is a win-win. The treatment itself has no downtime, and involves a test patch at the initial consult, to ensure no adverse effects before booking you in. We suggest 3 treatments a month apart for best results- smoother, plumper skin over time. Full face treatment from $349/session (also possible for hands and neck and décolletage)  7. Laser for skin rejuvenation Similar to BBL above in its collagen inducing properties but suitable for all skin types, laser toning involves no downtime, and we recommend minimum 3 sessions a month apart initially.  8. Facials incorporating enzyme peels  For those with sensitive skin, or prior to an event, this is the perfect option to have amazing skin as the enzymes slough away surface skin and reveal glowing skin underneath. 9. Hydrodermabrasion  New in our offering, hydrodermabrasion is a gentler way to offer hydrodermabrasion with infusion of peptides and other serums to help you not only rejuvenate your skin but also help cleanse pores, help with acne and more. Prices from $140/session  Confused? Book a consult with Dr Joshi and let her guide your choices with a personalised treatment plan that works with your lifestyle and budget.  Finally, remember that any of these are in addition to, and AFTER  Sunscreen twice a day, SPF 30-50 under makeup if you wear it, and on top of your skincare.  Sun hat during the peak hours of the day (approximately 9-4)  Sunglasses Long sleeved clothing  NO smoking (or QUIT if you are)  Enough water and sleep  A healthy diet with lots of fruits and veggies  Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi. Book Now

Why can you now offer Zip Pay at Skin Essentials? Has there been a change in the law? New guidelines by the Medical Board of Australia came into effect in May 2019 which govern how we conduct work as cosmetic practitioners. Prior to this we were not able to offer Zip Pay or Afterpay for treatment. When it comes to paying for cosmetic procedures (including ‘minor’ cosmetic procedures such as anti-wrinkle, dermal filler or double chin treatment) the Medical Board now states that Afterpay and Zip Pay can be used for patients looking to have cosmetic injectable treatments. Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi.  Book Now