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

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

At Skin Essentials, we focus on a holistic treatment plan, with the aim being a long term relationship between you and our team of practitioners.  As such, we encourage appointments so that adequate time is allocated to discuss your concerns, expectations and whether we can meet them in the allocated budget.  At present, it is our policy that all new patients have an initial consultation with Dr Joshi. This can be booked online or on the phone.    Prior to this appointment, we send you an email asking for information on you and your general health as well as your skin concerns, if any and what you’re hoping to achieve. It is in your best interest to fill this form out in detail prior to your appointment so we can set up a file for you, ready to go on the day of your appointment. During your consultation, Dr Joshi will be assessing your face and skin in real time, including your skin concerns. She will also be analysing your skin quality, while asking for a detailed medical history. Following this, she will conduct a skin analysis, including using equipment if needed, to assess for sun damage and (early) skin cancers, which will inform her advice to you and modify the treatment plan. At this point, if all is well, she will suggest one or several things, based on your concerns and needs: a skincare routine which can be basic, or more complicated, with prescription medication if needed Any preparation needed prior to any suggested procedures and when to book for review/treatment next Any procedure that MAY be undertaken that very day, at additional cost, if you are ready to go ahead A review date and further treatment as needed A written treatment plan for further treatment and a timeline and cost We focus very much on the assumption that like holistic lifestyle changes, the road to your best skin ever is one that will take time, effort and regular appointments as well as budget, and not usually something attained in a single consult or two. Skin, especially neglected skin, takes time.   At Skin Essentials, we believe very much in patient autonomy and do not want anyone to feel pressured or rushed into something they may regret, especially when it is all entirely elective, non medically necessary and involves significant sums of money.  We want you to be certain, and confident in our ability, not only during the procedure, but in the aftercare and ability to contact us for reassurance as needed.  Hope to see you in clinic soon to plan your best skin ever for years to come! 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

As we age, the repetitive use of the facial muscles under our skin begins causes wrinkle formation that progresses from being dynamic (ie present only when we use those muscles eg frown lines) to being static (ie present even when those muscles are not being used eg “angry lines” or “the 11s”; the grooves that run from the nose to the mouth; crows feet etc). The degree to which a person  develops wrinkles, their depth and appearance is variable and dependent on some known factors: Ethnic background General health Smoking and other drugs General diet and lifestyle, including exercise Sun protection – sunscreen use, avoiding excessive sun exposure, especially in Oceania As we age also, other changes take place in the body, and the facial structures : Skin begins to lose its elasticity Underlying collagen is gradually lost and thins Gravity takes its toll, adding heaviness to the lower face, away from the upper face.  Fat pads that give young people their “babyface” appearance are gradually lost, giving a gaunt/ hollow appearance There is remodeling (ie reshaping) of the underlying bones of the face, including the jaw, mouth, temples and eyes. All these factors contribute to the general  loss of appearance of youthfulness. In some people, these changes may cause them to look angry or sad, even when they are not. Some older women come to me because they keep being told they look angry when concentrating. Others report being told that they scare the grandchildren and want some gentle help.  How can cosmetic injectables help? Anti-wrinkle treatment work by relaxing/ paralysing the muscles underlying skin in specific areas such as the forehead, frown and around the eyes, they soften the static lines over time, and smooth the dynamic lines – I don’t believe in given people frozen faces, and will always talk to you about still retaining movement of your muscles so it is not obvious that you have had treatment unless you indicate otherwise. Some people notice with the formation of wrinkles, especially frown lines, “the angries” or also known as the “11s”, that they seem to appear angry a lot of the time, even if they are not. This can cause them to feel self-conscious, and is something that can be easily corrected with anti-wrinkle injections over time. By relaxing the overlying skin, the appearance is that of having had a relaxing holiday, or a facial; makeup goes on smoother, without the obvious caking in wrinkles that becomes more apparent over time. Are not permanent. Depending on the product used and your individual anatomy and physiology, you can expect your treatment to last 6-8 weeks in the forehead area; around 3 months in the frown and crows feet areas, or longer. The longer you continue to have treatment, the softer even static lines become. If you discontinue treatment, the product will eventually wear off with recurrence of the wrinkles.   Dermal Fillers Are synthetic products that mimic the natural collagen found in our skin that gives plumpness to tissues. As we age, the overlying skin thins, and the collagen under the skin begins to decrease With the loss of this padding layer, as well as the fat pads that we all have in our face, skin begins to sag, especially after the age of 40, giving us a tired, worn out and sometimes gaunt appearance. Dermal fillers work by replacing some of this volume under the skin – depending on the level and depth of injection as well as the site, results can be apparent immediately and will reach maximum efficacy about 2-3 weeks after treatment. Depending on the areas treated, fillers can last from 4-6 months (eg lips and other areas with lots of muscle movement) to 12 months or longer (eg temple hollows, under the eyes etc). The filler works immediately by padding out the areas of lost collagen; they also work by attracting water to the injected area over the next few weeks, resulting in a final appearance by 2-3 weeks of firmer, younger looking skin.

A few weeks ago, my team and I were trained in the use of a machine that allows more uniform and less uncomfortable injection of the same drug used in dermal fillers, directly under the skin.  I have posted about skinboosters before here and here.  Until recently, I was doing these manually, with great results especially for acne scarring, but skin rejuvenation in general and for crepy skin around the lower face/chin/neck/decollatage and hands. So when the opportunity arose to add this machine to provide more even injection, I jumped at the opportunity.  So what are Skinboosters?  Put simply, they are made of the same sugar molecule used in dermal filler, but manufactured differently, so that instead of lifting and adding volume, they sit in or on skin and attract water to the area, improving skin quality, texture and adding much needed hydration to the area that lasts months.  It is like a combination of skin needling with injection of medication that is beneficial for your skin directly under the skin – hyaluronic acid, as well as vitamins and other goodies.  When we first trained, there was a tiny bit of a learning curve, and my technique left a bit to be desired on my model.  What she ended up receiving was essentially, a skin needling session, with the medication smeared ON her skin, in direct contact with the areas that had been needled as soon as we had made those channels. However, she did not have the changes I was expecting soon after, which caused me to revisit my process, down to machine, equipment used and operator error.  So this morning, we repeated the process on myself, before redoing our model in case it was operator error ie me.  While numbing is usual and offered, I opted to go without as I wanted to see how uncomfortable it felt.  As you can see there are welts under my skin where the drug has been deposited directly under my skin.  Over the next 2-3 weeks, I expect, from experience doing this manually on patients, that there will be smoothing of fine lines and wrinkles, plumping of the skin and a general healthy luminous glow.  For those affected by sun damage, over time, repeat treatments help these areas improve also, providing long lasting hydration to the damaged, irritated and dry skin.  For novices we recommend 3 treatments of 3mls each time, 2 weeks apart – this is the biggest cost in terms of investment initially, setting you back about $2000. Thereafter, I recommend 3 mls every 6 months, ie twice a year to maintain skin in optimal condition.  So if glowing, summer skin is on your wishlist for summer and the holidays, now is the perfect time to get started on your skin, with skinboosters.  Remember, home care is important, but it is based largely on appropriate choice of products, chosen for you as part of your personalised treatment plan, that works best, and most medications are better IN skin than just ON it  Hope to see you in clinic soon.  Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi. 

Source - Plastic and Reconstructive Journal, 2009 by Guyuron - Looking at 180 sets of identical twins at the annual Twins Festival in Ohio These articles by plastic surgeon Dr Guyuron set out to examine risk factors for ageing that could be controlled by what doctors commonly refer to in Medicine as ‘modifiable risk factors”, sometimes as “lifestyle risk factors.” Some common examples of these are habits such as sun protection, avoiding smoking, exercising, eating minimally processed whole foods, etc. Given identical twins have the exact same genetic material, the baseline assumption was that any changes in their appearance must necessarily be due to contributions of their habits, environment and lifestyle factors. Some 180 sets of twins were looked at in these articles, one looking at some risk factors that included sun protection, smoking, weight, use of hormone replacement therapy, use of alcohol etc. And another article by the same author looked in more detail at the effect of smoking on the skin of identical twins. Look at the results below. When it comes to skin, doctors tend to harp on about some of these risk factors, including sunscreen use, direct sun exposure, smoking cigarettes, consuming alcohol, drinking enough water and even getting enough sleep and exercising. So I won’t harp here, and let the results speak for themselves. And while the jury is out on many factors, some are fairly clear and obvious. Effect of smoking on skin quality and appearance of ageing. 2. body weight, or BMI, which is a measure of how much weight a person carries. Study of these twin pairs found that under the age of 40, extra body weight was associated with the heavier twin looking older, BUT after the age of 40, more weight seemed to confer a younger appearance and after age 55, even more so. This is assumed to be because a lower body weight is also associated with more volume loss in the face, which is harder to fill with age, leading to sagging, eye bags and jowling. 3.  effect of the environment specifically sun protection, on skin quality and damage over the years. The effects of alcohol consumption, similarly, were suggestive of better skin with those who drank less on a regular basis, as was the use of HRT after menopause. So what are the take away messages? Quit smoking! Eat as healthy as is feasible for you, given your circumstances. Even if you had a childhood full of sunburn, sunbaking and sun damage, it is never too late to protect your skin now. Wear sunscreen daily, rain or shine, summer or winter. Sunscreen is additional to protective clothing including long sleeves, a hat and sunglasses. Watch your alcohol intake Get enough sleep A few extra kilograms of weight after a certain age are probably not THAT bad for your face HRT may be beneficial for your skin and in other ways, and best discussed with your doctor It is never too late to begin to care for your skin. The more damaged or neglected it is, the longer it will take to bring it to a state of health, so time, consistency and patience are key, as well as a commitment to working on it with a trusted doctor. 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

Last week my staff and I added Platelet Rich Plasma treatments to our list of offerings.  It generated a fair bit of buzz on Facebook and Instagram, and with good reason, so read on if you’re curious!  What is Platelet Rich Plasma (PRP)? PRP is blood plasma, or the golden liquid left behind after blood is spun down, leaving a high concentration of platelets, the cells in whole blood responsible for healing after injury and formation of new tissue over the injured site.  PRP is thought to help regenerate and revitalise damaged tissues.  While the jury is still out on robust evidence (eg injection of PRP in a patient compared to injection of just saltwater for example and comparing skin improvement) it is an area that is continuing to provide some promising results for use not only in skin rejuvenation, but also hair regrowth and inside joints for injuries and it is believed by many that the evidence does exist, pending appropriately planned clinical trials.  How does it work?  Direct injection of PRP is thought to help accelerate the process of tissue regeneration and repair with production of collagen, elastin and new blood supply to the injected site, much as happens when you cut yourself for example.  How many treatments are required?  This is best discussed with your doctor based on your situation. For most patients, a series of treatments are recommended, usually 2-3 treatments, 4 weeks apart and then maintenance.  There is good evidence PRP works better in some areas compared to others, example under the eyes for wrinkles and eyebags, less so for pigmentation under the eyes, which requires different treatment options. ARTICLE: Platelet-rich Plasma for Skin Rejuvenation and Treatment of Actinic Elastosis in the Lower Eyelid Area  There is also promising evidence of this working for female hair loss, usually requiring x3 monthly treatments of PRP to the scalp, with new hair growth unto 6 months after the last treatment, less breakage and increased volume. Read more about PRP and Hairloss. How quickly does it work? You may notice improvement as quickly as 3-4 days and then gradually over a few weeks with injection under the skin.  Unlike dermal fillers, this is NOT a quick lift/ volume replacement. If you have significant volume loss in your face, PRP is best used in addition to, and not instead of, dermal fillers, biostimulator fillers, thread lifts and other modalities to improve skin quality and volume over time.  Will I need much downtime? There is minimal downtime. There may be some redness at the injection sites, which will fade, and a small chance of bruising but that is it for most patients.  Are there side effects? PRP utilises your own blood cells, which Dr Joshi will collect on the day, spin down and then use to inject you. This is known as A-PRP or autologous PRP, so risks and side effects are minimal, and if any, irritation at the site of injection, bruising and some swelling.  Where can I have PRP injected? PRP may be injected on the face, the neck, décolletage as well as backs of the hands for skin rejuvenation. Bear in mind, a single treatment is usually NOT enough for lasting change and a series of treatments usually 3 monthly treatments, is recommended as the minimum.  How much will it cost? We are offering this treatment from $500/tube, depending on the areas of concern. As a guide, PRP under the eyes and around the mouth is approximately 1 tube.  To the entire face, 2 tubes. Face and neck or face and décolletage 2-3 tubes. The number of tubes will also depend on how much PRP is obtained from your collection in volume – this is dependent on you, and may range anywhere from 5mls of PRP/ tube to 7+ml/tube, as with our model above. Please enquire at contact@skinessentials.com.au for more info or to book online please do so here:

Giving You More Options with Medical Grade Skincare As I’ve branched into skincare and injectables, I field many enquiries regularly about skin regimens, if I know any that are worth spending on, evidence-based and what I would recommend.   As women, we feel a real pressure in a society that judges us first, by our looks. Sometimes our looks are seen as the only worthy thing about us.  While I don’t believe this is the only thing that defines us, I know most of us want to look our best, at any age! Additionally, I’m regularly approached by women with skin concerns that haven’t been addressed- rosacea, thin skin, adult acne, hyperpigmentation, prominent surface vessels and more. 1. Aspect Dr skincare products and chemical peels range which I’ve decided to stock. I shall cover these in more detail in another post, but in summary: chemical peels for skin maintenance, pigmentation, problem skin, including rosacea and ageing. 2. Rodan and Fields, from the USA. It is formulated by the two dermatologists who created Proactiv for teenage acne, and this brand targets sun damaged skin. I have some sample packs of these to those looking for a skincare regime for their sensitive skin, to combat general ageing and who are fighting hyperpigmentation and sun damage. The best part? All R+F regimens and products are backed by a 60 day empty bottle guarantee so you’ve literally nothing to lose. This is also a great option for those who are hesitant to try injectables, or simply don’t have the time for in-clinic appointments.  If you’d like to know more, here’s my website:  It contains a Skin Solutions Tool that’ll give you an idea of your skin needs which may help you (and me) determine which of the two will suit you better! Want to discuss it further with me? Book here for a consultation to discuss your expectations, budget and cost for you. Hope to see you in a clinic soon! Any questions? email us at contact@skinessentials.com.au

Two years ago, I wrote about SkinBoosters, and how they add hydration to the skin and improve general skin quality over time.  During that time, I have been using the skin boosters on my patients for multiple reasons:  Help improve the effects of sun damage in summer Help add hydration to the skin to combat the dryness, itchiness and even flares of acne and worse in winter Improve skin quality over time Help improve pigmentation issues over time Generally improve skin quality including fine lines We even used this to improve scarring from acne by breaking down tethering under the skin during treatments, called subcision The main issue with doing the skin boosters manually, was the amount of time it took, and the likelihood of significant bruising, especially in patients with poor quality skin. Bruising was sometimes significant enough to last a week or so, which was a deterrent for work and day to day life.  So when I heard about the V2 injector, a far easier and faster way to deliver 3mls of skin booster at a time, I jumped at the opportunity to be a model myself, and had my assistant, Erin as the other.  Using the injector allows us to inject close to under the eyes, helpful for those pesky smiles lines that are hard to fix with just anti wrinkle treatment or anything else! It also allowed us to inject tight and sensitive areas such as the forehead skin, without much discomfort. See image below. The best part of it? There was no bruising for either of us. Here is a picture of Erin the very next day, barefaced.  The solution hasn’t changed, still tried and true. ‘Redensity’ is a mix of non-cross-linked hyaluronic acid, amino acids, Vitamin B6 and antioxidants. In addition to hydration, it activates fibroblasts within the dermis making them lay down new collagen and elastin. The effect? Thicker, tighter, yet more elastic skin on the face, lower eyelid, forehead, neck, décolletage and hands. You’ll see results in the very first session. The skin achieves a better colour with less creasing plus improved hydration and suppleness. From one treatment to the next, you’ll notice your complexion looking increasingly radiant and your skin firmer. Thereafter I tend to recommend 3 ml treatment every 6-12 months for maximum ongoing benefit.  So, if, like me, you are too busy to do the necessary on a nightly basis, this may well be worth your time and effort.  Skinboosters are normally 3mls for $1200. As a promotional offer, given summer is just around the corner, we are offering it as a package:  3 sessions of skinboosters, 3mls at a time (enough for full face or neck and hands or neck and décolletage) 2-3 weeks apart for $2000 paid upfront, or $700/session.  Thereafter, you lock in the ongoing price of 3mls every 6-9 months for $900/3mls instead of $1200.  If you want to lock this in, for great skin, please make a note when booking in.  Want to discuss it further with me? Book here for a consultation to discuss your expectations, budget and cost for you. Hope to see you in a clinic soon! Any questions? email us at contact@skinessentials.com.au

There’s no denying we live in a time when there is enormous pressure to look good. Synonymous with the word “good” is the word “attractive” and “young”. Or young-er. To that end, from a young age, we feel pressure to look a certain way, dress a certain way and sometimes, to have attributes that nature hasn’t given us- luscious lips, cheekbones, for example. Some injectors have a niche market on this- the “doll makers” with their high end, boutique patients, some of whom want to look like a Kardashian, a Jenner or a Jolie. That’s not my goal, nor my aim. Have you seen me? The way I look and dress? So what do I stand for? How am I different? Not better, just different? When I see you, I want to look for natural assets and attribute I can enhance, or maximise. And if you are beginning to show signs of ageing, I want to help you minimise those but in a healthy “still you” way. And here, for many patients, lies the problem. How are we to know what that is, when we are bombarded by what it isn’t? I get patients coming to see me, wanting to be “completely frozen” by anti wrinkle treatments. They want frozen foreheads, frozen crows feet, frozen frowns. The result? A frozen face. Worse still, with age and continued freezing what happens is that the muscles that are frozen, are compensated for by other muscles that still move and create furrows- the bunny lines and other wrinkles. At best, it looks strange. At worst? Not such a good treatment. If it’s underdone, it can be topped up; if overdone, there’s nothing to do but wait till it wears off in 3-4 months. So let me ask you this: what ages you- Wrinkles? Lines? Volume? Who looks older? Why? To a degree, subtle use of anti wrinkle treatment for lines and wrinkles work well- they give the face a refreshed look, a brightness and an openness. So what ages us? I get patients asking for “filler” or “wrinkle treatment”. Sometimes they dislike an aspect of their face that bugs them that they want fixed. As with my other clinical work, I try and find out what is truly bothering them: What these patients are describing, is Volume loss by the time you reach this point, a significant volume of fillers is needed to replace the loss. To minimise or reverse the eye bags; the tired face; the wrinkles due to loss of Volume amd the sagging jowls. Not 1ml, or 2mls. But 4-8mls. It’s expensive, and it requires maintenance every 6-12 months. BUT the longer you leave it, the more you’ll need. So with my patients, a consultation is about assessing how realistic their expectations and costs are. How motivated they are to have ongoing maintenance. And if they are willing, we break it down- 2 mls in one go, 3-4 mls if they can afford it. Then we review in 6-8 weeks. Some of my patients deposit money into my account weekly as credit towards their treatment to avoid credit, interest etc. It has to begin with suitable knowledge, and a plan. So, when you look in the mirror? What ages you? When you’re younger, likely the lines. In your 30s and up, almost certainly volume loss +/- lines. My advice? Seek an opinion from a qualified injector, who understands anatomy, and the natural ageing process. Someone who isn’t afraid to tell you what you need, and scare you away with the cost, but who’ll explain to you what you’ll need to budget for, for good results and for maintenance. Understand that you are investing in your skin, the largest organ in your body, your lifelong companion and that it’s never too late to start, as long as you plan to keep going. Want to discuss it further with me? Book here for a consultation to discuss your expectations, budget and cost for you. Hope to see you in a clinic soon! Any questions? email us at contact@skinessentials.com.au

As we age, depending on our ethnic background, our age, the amount of pigmentation as well as genetics and other factors such as smoking and regular use of sunscreen, we develop lines where the muscles of our face regularly move under the skin. Over time, these give rise to wrinkles- first these are dynamic; these only occur when our muscles are moving. Over time and with age, these may become static- these are wrinkles that are visible even when our face is at rest. It is important to realise that anti-wrinkle treatments mainly treat dynamic, not static wrinkles, though many will notice some benefit even to these over multiple treatments. Following  are some examples of some areas that can be treated on the face using anti-wrinkle injections to help reduce or even remove dynamic wrinkles. Over time, with back to back treatment, even static wrinkles can be reduced, failing which, filler may be an option. Some more examples… While the mid and lower face usually needs filler for optimal results, sometimes some improvement can be achieved with uses of small doses of anti wrinkle treatments too: There here are many other things that a small dose of anti-wrinkle treatment can help with, such as excessive sweating on the face, underarms and even hands, as well as for gummy smiles, bunny lines around the nose etc, so if you are wondering how I can help you look your best, book your  consultation and ask!

Question: I don’t need anti wrinkle or filler treatment! Do I? Dr Imaan:  Before I began training in this field, I used to think similarly. When we are in our 20s and even early 30s, we are blessed with beautiful plump skin and provided we look after our skin with some basics, a skincare regime, a decent diet with enough fresh fruits and veggies and sun care, we radiate the glow of youth effortlessly even if we stay up late, drink too much every now and again. So I used to think that most people wouldn’t need anything till they began showing signs of ageing, whether premature, due to lack of care, or age appropriate. Training and working in Cosmetic  Medicine has led me to change my viewpoint slightly When I see patients in their late 30s and 40s and 50s, with static wrinkles, thinning skin, deep wrinkles and a gaunt hollow look or a jowled appearance around the jaw, I realise that to halt these changes takes a fair bit more time and a lot more money, than if they’d begun preventative care 5-10 years earlier. Age related skin changes aren’t just skin deep. As mentioned elsewhere, fat pads around the face are lost; skin thins and loses its elasticity; gravity begins to drag skin down, towards the jaw; bones change shape underneath the skin, leading to shadows and hollows and a general look of fatigue, anger or sadness. Wrinkles are more set in and harder to erase with some anti wrinkle treatment and many of the changes related to thinning requires large amounts of filler to replace. My approach now tends to be that of maintenance and prevention. in your twenties, when skin is still smooth, plump and beautiful, small amounts of anti wrinkle treatments help relax muscles without freezing and delay wrinkle formation. Filler may not be needed at all, or only used to plump naturally thin areas such as lips or cheeks for definition. in your thirties, preventative maintenance continues, with some anti wrinkle treatments aimed at reducing wrinkle formation and depth. Fillers may again only be needed as enhancement. in your forties, anti wrinkle treatments may be used in the lower face together with fillers, which may now have a bigger role in replacing lost collagen in the face- temples, forehead, cheeks and around the mouth. in your fifties and beyond post menopause ongoing maintenance would require a combination of anti wrinkle and fillers with great subtle results that will have you looking great for your age and even a few years younger and refreshed. So my advice would be: if you can afford to do so, consider incorporating some basic treatment when able so as to age gracefully and naturally in your 40s and beyond.

Question: I look after my skin and it’s in fairly good condition but it’s starting to sag around my mouth and jaws, making me look sad and old. It upsets me to see this in the mirror. What can I do about it? Dr Imaan: It can be upsetting to look at ourselves in the mirror after a certain age, and see someone older than our mental image of ourselves. As we approach our 40s, no matter how good our skincare, gravity begins to take its toll, which is seen mostly in the changes you describe- a sagging in the lower face that can be seen as the nose-mouth lines, the nasolabial folds; the downturned mouth, or marionette lines and the beginning of jowls, as the skin around the mid face loses its elasticity and volume and begins to sag. If budget isn’t an issue, ideal treatment of this issue is with dermal filler to replace the lost volume in the cheeks, as discussed in my post on cheek filler – that will usually also treat a variety of other issues, such as hollowing and circles under the eyes, hollowing of the cheeks and smoothing out of the lines around the nose and mouth. For most people, this would require 3-4mls or more over 1-2 months until the desired effect is achieved, which can be expensive. As a guide, a woman in her 30s would need around 3mls, one in her 50s 5 mls and so on. Thick filler lasts around 12 months and costs around $650-700/ml, depending on the brand. The filler would be injected around the mid face to replace lost volume, smoothing out hollows under the eyes, nasolabial folds and rejuvenating the face subtly. It can be expected to last around 12 months, and then need regular topup yearly or so, depending on the individual. In experienced hands, results may be similar to this photo below.   For those for whom budget is an issue, all is not lost. Targeted use of fillers can soften the areas of most concern- in this case, some filler to the corners of the month as well as to the marionettes themselves directly with 1-2mls filler together with some anti wrinkle treatment to the DAOs.

I often get people coming in and asking for filler, afraid it’ll change the way they look, or be too obvious. Most of the time, they underestimate how much they need; occasionally, I get caught out too. Most people don’t want to look like The Real Housewives of Sydney. They don’t want to look fake, fat or like they’ve had filler or botox. They simply want to look like the best possible version of themselves. To these people, I always say, that filler, if done well, is almost unnoticeable. The change is gradual and subtle. Likewise anti wrinkle treatment. YOU know something has happened, but the results are subtle, and usually, due to the cost involved for most people, gradual. Rather than going for what’s cheapest, possibly to regret it, I suggest budgeting for what’s better, if more expensive. There’s a reason why chain clinics are cheap. So, let’s look at some examples of cheek fillers, and how they work to help with many “problem” areas on the face- eyebags; nasolabial folds and marionette lines; jowls. Here, this lady had 1ml to each of her cheeks and cheekbone area in total as well as in her tear trough area, with significant improvement in her downturned mouth as well as nasolabial folds/lines. With age and further fat loss in the cheeks and around the jaw near the angle of the jaw, skin pools around the jaw, giving a jowled appearance. As may be apparent by now, many signs of ageing are related to loss of volume from the midface so correction necessarily begins with replacement of this volume with fillers in this area first. And filler is never wasted- the 1-2mls you spend money on, even if results aren’t striking, goes to form the base for further filler that will effect a change, and last anywhere from 9-12 months or more, depending on thickness and where it is used. So it’s money well spent, and an investment. Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi. 

Dr Imaan Joshi trained at Sydney University and graduated in 2001. Between 2001-2004 she spent 3 years in a rural NSW town, doing much more procedural work than most junior doctors undertake in city hospitals. This led to her passion for surgery and Women’s Health, and she was accepted into a training program to begin training at The Royal Hospital for Women in 2004. Between 2004-2011, amidst working long hours, which involved procedural work most days and 60-70 hour work weeks, Dr Joshi had 4 children of her own. These years led to an appreciation not only for procedures, but as with anything that involves repetition, it allowed a degree of muscle memory when operating, speed as well as an awareness of what can go wrong, and what to do without panicking when it does. As such, when Dr Joshi switched to General Practice training in 2012, she loved most of the work but missed the procedural aspects of the job. Seeing chain clinics pop up everywhere, and reading of cases gone wrong and being an avid promoter of caring for skin at every stage of life, she looked into the ethics of the cosmetic industry, and decided to up skill in it in 2014. Over time, she worked at mobile clinics, and built her patient base of people who want to invest in themselves, in their faces, without looking too different. Her focus has always been on enhancing the best a face has to offer, rather than to change it such that it is obvious that work has been done. Dr Joshi is firmly rooted in the medical principle of “first do no harm” and will turn away requests for any procedure that does not seem ethical, or any patient whose demands are not in alignment with her values for sensible rejuvenation. Dr Joshi is a skilled practitioner first, and a businesswoman second. Her focus is to treat each face as a unique canvas for enhancement, to help you look meticulous at any age.

This lady has been my patient for a full year now. I first met her on November 26th last year. She’d never had any injectables but was keen to try some anti wrinkle treatment in her early 40s. This is with her full consent. This lady took a year almost to the day- dark sunken eyes; hollowing cheeks. Deep smile lines that bothered her. And wrinkles. She was worried abt the wrinkles. She went from being someone who was terrified to let anyone know she was seeing me to showing everyone because she feels she looks fresh and happy, which reflects her inside. I’ve taken pics static and animated so it can be seen that she looks natural. The cost of something like this isn’t cheap. For eg: Anti wrinkle treatments up to 50 uts x 4/year= $3000Fillers, 2 mls medium and 4 mls thick over the year $3500 Going forward is maintenance- anti wrinkle every 3-4 mths $750Fillers 1-2 mls/year $600-1200 So that’s what a full face rejuvenation looks like – upfront cost and ongoing maintenance.  Any questions? email us at contact@skinessentials.com.au Hope to see you in a clinic soon!

Like any decent doctor and surgeon, my consent process for any procedure is fairly extensive- I explain many many things; what can go wrong; what to expect- immediately, soon, in two weeks’ time and in the next few months. When it’s time for a top up. If I have consent to take photos and use them for my website; if I have consent to email reminders etcetc. Sometimes, because I have done this process so many times, I forget that patients can’t take it all in at the time, may be nervous and therefore inattentive or excited and eager to proceed or any combination of the above. Because of this, we miscommunicate. And the single biggest question I get after the treatment, is “Do I need a topup/more treatment already?” in relation to static lines. What are static lines versus dynamic lines and why does it matter?  If you ask a 5 year old child to look angry, they’ll develop wrinkles between their eyes; these go away as soon as they are laughing however. These, are dynamic lines. Lines that are visible when the muscle underneath is being used, but disappear when it is relaxed. As we age, and our habits keep us frowning when we concentrate, or squint  or concentrate; or we use our forehead lines to see better, to open our eyes up for photos; or we laugh and over time, crows feet form around our eyes. Over time and repeated use over years and years, the lines don’t disappear completely when we aren’t using those muscles. These lines are static lines and they deepen over time as we continue to use our muscles, lose the plumpness of the skin with age and skin damage. Anti-wrinkle treatment is great at treating dynamic wrinkles; it is less effective at treating static wrinkles, BUT it does soften these lines over time, usually within a year of ongoing, back-to-back treatment. In this patient, I’d suspect that she’d been underdosed and would have benefited from a topup at the two week review with another 4-6 units for best effect. Or, quite possibly  due to the bunching effect next to her brows, that she was using other muscles instead of her frown muscles to cause the bunching and lines, none of which can be assessed except in person.