In the wake of the TGA regulations around cosmetic medicine, there continues to be a lot of fear around what this will mean. Most injectors to date have relied heavily on being able to show before/ after photos, often of a single treatment area, “before” and “after” treatment with an S4 (prescription) medication. For example? A before photo of someone frowning hard and an after photo of that person no longer able to frown. No guesses as to which class of drug is responsible for this; there is only one. 🤫 A before photo of someone with thin lips at rest (ie not smiling) and an after photo of that person with plump, juicy swollen lips. Again, no guesses as to which class of drug is responsible for this. 🫤 Many pages on social media are full of these images, and these injectors’ selling point, is that they treat with the drug in question for those who want similar results. The problem with this from the TGA’s point of view? it’s seen as incentivising it’s advertising a prescription medication stating prices, specials and packages often gets people to act on impulse and walk in to “buy” the treatment on sale as if it is an order for a burger. these advertisements often trivialise the fact that these are medical procedures, risks may be low but not zero and not everyone is suitable for it. these adverts may lure vulnerable people in who may have body dysmorphic disorder, unrealistic expectations and encourage injector hopping. advertising typically acts on people’s emotions and desire to act now to avoid missing out, and advertisers will typically put forward their best results, rather than average results and minimise poor results. So what is the solution now Before/ After photos are no longer permitted? With this easy means to generate revenue curtailed the TGA is likely hoping to return to a more medical model for medical procedures, often by very inexperienced people. More and more people are studying nursing who have no interest in nursing except to inject. Similarly many doctors post the mandatory year of internship, are opting to bypass speciality training to set up as aesthetic injectors. These people have the bare minimum knowledge of what it means to be a doctor or a nurse, much less to begin to know the ethics of medicine, and thus are at risk of falling into the retail model of providing medical services which goes against every code of medical conduct. In the absence of photos, how are you  to choose a provider? When we put the medicine back into medical aesthetics, we go back to basics, which should have been in place already. How do you choose a plastic surgeon, most of whom don’t advertise their work online through before/ after photos? How do you choose an orthodontist, most of whom don’t advertise their results? Or any type of doctor, dentist or provider? We do it through some means: word of mouth referral by friends and family who’ve seen that provider understanding someone who’s right for them may not be right for you. reviews on third party sites such as Google (though may providers incentivise these eg “leave us a 5 ⭐️ review and go into the draw for X worth $300”) stalk their social media pages for a while (usually months) ; observe how they work; observe their ethos, and their own face to get an idea of whether their outlook aligns with your own aesthetics and goals. Then….make an appointment. Go in with an open mind. Spend the time in consultation deciding: do you feel comfortable with them? do you feel safe with them? do you feel they get you, understand your concerns? do you feel confident they can help you? do you feel you can develop a longterm relationship with them? are you a fit for what they need from you, in terms of the timeframe, cost and appointments needed? we are still able to show before/ after photos of results in consultation with you; do the results appeal to you, and is each result optimised to the person being treated? Ie do they still look like themselves, or does everyone look the same after treatment? If you’re an ethnic person, it’s important to look also for representation of your ethnicity, or other ethnic types in the work, so you can see that the person who’ll be treating you, understands how to treat different faces and isn’t simply following trends and fads. Ok…I’ve attended the consultation and am ready to start. Now what? At Skin Essentials, our Full Face Aesthetics appointments are moving to an “expression of interest” form format for those who are keen to explore this. Why is this? it’s a significant investment of time and money. we have limited appointment slots for those who are ready to begin so spots are prioritised for those who are ready to begin on the day if appropriate. having an EOI form is an extra step for those who are ready and serious; Dr Joshi vets them prior to taking payment for the consultation. We don’t want to waste your money or our time together if you’re not ready. once we have your filled out EOI form, we’ll be in touch to advise on next steps including the ballpark time and monetary commitment and to offer you an appointment and take payment so we can begin the process. Still keen? Get in touch with us to get the ball rolling! We look forward to meeting you soon!  

As of March 7th 2024, the Therapeutic Goods Administration (TGA) of Australia implemented widespread changes that will limit most discussion about medical aesthetics on social media and most settings outside of a consultation with your doctor or healthcare professional (HCP). The ability to simply order treatment with prescription medications on demand over the last few years, often via barely qualified HCPs is resulting in the commoditisation of medicine and prescription medications, which carry far more side effects than over-the-counter (OTC) medications, with higher risks. This has led to increased risk and poor outcomes on occasion, in untrained hands. As such, long after it was due, the TGA is aiming to return this aspect of medical care back where it belongs, between a patient and their HCP, but I anticipate we will get a lot of pushback. So why is a consultation necessary for medical aesthetics, if you know what you want? Like any other concern, all consultations begin with a comprehensive consultation between you and your doctor to determine what your concern is. Even if you’ve googled the issue and believe you know what is wrong, your doctor has an obligation to exclude any other possibilities that may be the cause of your condition and to satisfy themselves that the treatment you request is not only the best option for you, but also something they can safely provide for you. Equally, they need to be certain that there are no reasons you should NOT have that particular drug/ medication. All this takes time and is far more than the cursory 30 second consultations often taking place up until now, whereby we exclude pregnancy, ensure you are 18 and make sure you have no significant medical illness. It’s also more than the 20 second video call with a doctor you’ll never see again, who nods and signs off on the drugs another HCP administers if you choose that model of care. By law, what is required, as stated above, is a list: your concerns if your doctor can help you with those how much they bother you and whether you’ve had any treatment for them to date any vulnerability you may have if you have any reason you may not be a suitable candidate for medical aesthetics eg a history of being underage, pregnant but also having anxiety, or a history of going from injector to injector and still being dissatisfied with the results or being overfilled. If you and your doctor determine you are a good candidate, there is still more to cover: what is possible given your concerns, your genetics, age and budget the timeframe if it is a time sensitive concern eg aging whether you have the budget for it without too much hardship whether you are able to stick to the treatment plan as agreed to between you and your doctor if you feel safe and comfortable with your doctor All the steps above take time, well above a half hour, and cannot be rushed. At Skin Essentials, if we cannot tick all of those boxes, I tend to suggest a patient goes away to think, and mull her options and to return if/ when that changes and she feels ready to proceed. Medical aesthetics is entirely optional and a want, even if it can feel like a need. It is still medical procedures that are entirely optional and as such, the stakes are much higher to get the results you want, or to wait until you are ready and able to commit. All of this requires clear, upfront communication about costs, timeframe and expectations - for you of your doctor and for your doctor of you. This is what the TGA is hoping for to limit the tide of poor work and vulnerable people being taken advantage of at present. In no other area of medicine would you be able to simply show up to an appointment and order a treatment with a bare minimum of consult or relationship with your doctor. So it is with medical aesthetics, a specialty in its own right with rare but real risks.  

In January this year, the Therapeutic Goods Administration of Australia, aka the TGA, surprised the non surgical cosmetic industry with the news that we are no longer allowed to use common terms to describe some of the services we provide, using the drugs used in those services. Medical aesthetics can no longer use certain terms and those terms will be going away? What Kind of Terms are Changing in Medical Aesthetics? Terms that you commonly associate with the services you receive from a medical aesthetics practitioner are no longer able to be used in advertising, information on websites, and other key places. Anti wrinkle treatment Dermal filler Biostimulatory filler Fat dissolving injections You get the idea. What Do the New TGA Guidelines Say? It sent the industry into a panic and the TGA took its guidance offline to await confirmation. As of 7th March 2024 it had finalised its guidelines, and the new changes will go through, effective immediately. What do they say in essence? Historically, the TGA has allowed indirect references to prescription medicines to be referenced in advertisements related to cosmetic health services. This was allowed only in the context of promoting the service and only by using generic non-product specific terms such as ‘wrinkle reducing injections.’ Express references to products or ingredients themselves, such as ‘Botox’ or ‘botulinum toxin’, were not permitted. The TGA considered this a pragmatic approach which would allow cosmetic clinics who offered these services to differentiate themselves from those that did not. It goes into further details, the gist of which is essentially: we are no longer allowed to refer to those terms as they allude to the use of prescription drugs we are no longer allowed to use before/ after photos that suggest the use of prescription drugs eg before photo with someone frowning, and after photo without the frown; or a before photo of someone with thin lips and after photo with plumper lips etc Why is the TGA doing this? Recently, the TGA has observed that clinics and health services in other industry areas are advertising the availability of prescription medicines, usually by referring to a class of goods (for example ‘weight loss injections’, ‘medicinal cannabis’ or ‘nicotine vaping products’). The TGA has interpreted that promoting a health service in this way is also an advertisement for a therapeutic good that refers to prescription medicines, which is unlawful. The update aligns with the focus of other regulators on health professionals performing non-surgical cosmetic procedures and acknowledges the increasing vulnerability of Australians influenced by advertising in the cosmetic space. Prescription only medications carry higher risks than goods available for self-selection. Decisions about treatments that involve the use of prescription medicines should only be made by a health professional in consultation with each individual patient. In brief, as with all other means of prescription medications, a face to face consultation is the first step to addressing a concern in collaboration with your medical professional/ doctor to then determine next steps, treatment and whatever drugs that might involve. As you can imagine, this has the industry in a tizzy all over again. Do the TGA Guidelines Change the Medical Aesthetics Approach at Skin Essentials? At Skin Essentials, we’ve never advertised drugs by prices, nor by before/ after pictures such as above. We take a holistic full face approach to the face in front of us at a paid-for, non redeemable consultation designed with one thing in mind : understanding and addressing your aesthetic concerns determining if they can be helped or if you need another expert eg a plastic surgeon determining if we are likely to work well together ie a good fit determining if you have any vulnerabilities that make you unsuitable for cosmetic work or have unrealistic expectations determining the timeframe to get you results determining the cost of those results, which is significant determining if you are in a position, psychologically as well as financially to commit to the process as outlined If we tick all those boxes above, then we start. If you or I cannot tick any of the list above, then we don’t start, but you’ve had some idea as to what the cause of your concerns is, what is needed to correct them if/ when you are ready to begin. So from our point of view, not much will change to our processes at Skin Essentials. What *will* change is the ban on educating the general public on social media and the stern limitation of terms I can use to do this. Media from the USA and UK and other parts of the world continue to flood our feeds, with drug names and explicit videos of procedures. I used to use this for educational purposes but I will no longer be able to do this as this would be a violation of the TGA rules. While the goal and aim of the TGA is to stop unscrupulous operators from enticing and luring vulnerable people into medical aesthetics, often from a very young age, the reality is that since these changes were announced, the rogue operators, who continued to operate during Covid lockdowns, continue to post and use the terms “anti wrinkle”, “dermal filler” “nose filler” “biostimulatory filler” and more. As I’ve said before, I suspect they see pesky fines and disciplinary action as the price of doing business. As a small business, I can’t afford to do this nor do I want to. One of my strongest stances at Skin Essentials is our ethics and our values based approach to patient care. That won’t change in coming weeks and months as we pivot to find a new way to educate people without using terminology illegally. In the meantime, we ask our current patients to help others find us by leaving us honest feedback of their experiences with us in clinic given social media is being heavily censored going forward to help us stay in business. Thank you for your ongoing support and we hope to see you

On 60Minutes recently, there was a feature showcasing the decisions of women in their 50s such as Justine Bateman of Family Ties fame and 80s supermodel Paulina Porizkova, and their decision to not have injectables and to age the way nature intends. I’ve yet to watch the whole feature, but it continues to bring up important key points, which I’ll reflect on here. When I meet women of a certain age, they usually tend to fall into one of two main camps: Young at Any Cost  This is the camp that has been having “tweakments” since a youngish age in an effort to stay ahead of the ageing curve, with enhancement as needed. Think, preventive anti wrinkle treatment because “the best wrinkle is the one you’ll never have” and lip, cheek and tear trough filler to address volume issues. Over the decades, they’ve ended up having most things, and in their 5th or 6th decade, are seriously considering surgery; “anything to stop ageing” is a comment I sometimes hear, which worries me in clinic. Social media is rife with accounts by injectors who share these ideas, showcasing examples in young faces, of “temple fillers to balance out this beautiful face due to hollowing created by cheek fillers”  Ageing as a privilege the other camp, is women who are older, and for any number of reasons, have decided that injectables are not for them for a variety of reasons they’re constantly exposed to bad work everywhere they see it as a sign of bad feminism they have daughters they want to set a good example for, by abstainin a combination of the above. What’s striking to me as an observer, is the very marked black and white thinking prevalent in these two groups, with little to no nuance to consider a middle ground. The first camp, as one may surmise, who begin at a young age, normalises the use of preventative anti ageing procedures, and over time, risk becoming overfilled or having filler migration because it becomes a habit and a means to feel good, as a pick me up, and as preparation prior to special events. Perception drift is so slow they may forget, over time, what they used to look like.  Given how heavily advertised medical aesthetics is to the public at large, who remains largely unaware of the rare but real risks, it’s easy to see how packages, specials and 0.5ml here and a few top-up units there can add up over time- to a lot of money, and possibly an overfilled, frozen or unattractive look which is often when I first meet them. The second camp, is one I rarely meet, but occasionally they see me for help with ageing  limited to a very narrow range of skincare options they may be open to - they may wish to minimise signs of ageing by focusing on beautiful skin, help with their adult onset acne, or be open to skin therapies without injectables.  They, or their spouses are bombarded daily, with overdone faces and in their minds, this is what ALL medical aesthetics looks like - bad - so they don’t want anything to do with it. Alternatively, they may have seen on social media frequent posts about “botched treatments” and even rare but real complications and decided the risk is not worth it. In these cases, I help with their concerns, without trying to influence their aversion to injectables unless asked for my opinion. Sometimes, over months of working together and with trust, they may reopen the door and ask again, but often they won’t.  So who chooses the middle ground and what does that look like?  The middle ground group is my ideal patient.  I came to medical aesthetics reluctantly in 2015/2016, largely due to my background in surgical work and procedural work which I didn’t get enough of as a Specialist GP. I had, and continue to have, reservations around the unregulated industry, the lack of ethics and the lure of easy money by untrained injectors who work unsupervised after a 2-day or 2-week boot camp with minimal procedural skills.  Equally, I identify with the desire to not look “done”, “fake” and more. It’s a topic that I continue to grapple with and for many years I struggled with the ethical issues I saw lacking in this industry.  As to my own aesthetic journey, all I did was practice rigorous sun avoidance until  my early 40s, when I noticed that despite my best effort, Oil of Olay SPF and Dove soap were no longer cutting it.  At the age of 42 I added active skincare to the mix.  The year I turned 45, I added a sprinkle of anti wrinkle, initially to avoid wasting a vial that needed to be discarded and loved the subtle but effective results.  Since then, I’ve had judicious use of non surgical and minimally invasive treatments to help me continue to like what i see in the mirror. My face is my brand, and many patients who choose to see me tell me my face, the fact that it moves, isn’t frozen and looks natural, is among the reasons they chose to see me despite their fears.  For these patients, when it comes time to meeting me, usually after a period of anywhere from 6-18 months of lurking and following my posts on Instagram, their motivation for doing so is different from the two camps above - they’ve seen firsthand evidence of the middle ground that I refer to as “ageing well” with a heavy focus on caring for the skin first and foremost, with judicious use of injectables - anti wrinkle treatment AND fillers - and then maintained by collagen stimulating therapies. The results for those who stay the course, have been nothing short of stupendous and life affirming, which is ultimately what matters especially as most of them, like me, aren’t open to surgery (yet).  So where do I stand on this issue?  I respect every woman’s

With the introduction of a new class of injectable diabetes drug that hit Australia in 2022, used off label for weight loss, the term “ozempic face” has really taken off in recent months. The drug, which is injected weekly, is approved for the treatment of certain types of diabetes and is a game changer in terms of regulating appetite and resulting in rapid and sustained weight loss with continued use, which leads to improved diabetes control. No wonder then, that when there is rapid weight loss well in excess of the safe limit of 1kg/week, a lot can happen. As the saying goes, after 40, you choose between your face and your body, but you can’t have both. As a general rule, I typically advise my regular patients against rapid, drastic weight loss/change, without a proper discussion first around the pros & cons - on their bodies & the biomechanics of weight loss as well as on their skin & face. Rapid weight loss, at any age, leads to a dramatic loss of skin elasticity that often cannot be entirely corrected, often requiring surgery for function as well as aesthetics. When pts ask me as part of treatment planning, my advice is always to undergo it as slowly as possible, aiming for a longterm, lifestyle change, rather than as a fad and to do it under supervision & to recognise that beyond a point, they WILL sacrifice the face for the body - they get to decide which based on their priorities. As with any rapid weight loss methods such as lap band and gastric sleeve surgery and now this class of injectable drugs, the body is placed under immense stress, which results in several physiological mechanisms to protect itself during “starvation”, and it is important patients understand this.  Common changes include but are not limited to : loss of fat in desired and undesired parts of the body, including the face. hair loss as a response to the stress of rapid weight loss which may be temporary or permanent loss of elasticity (ie spring) in the skin, leading to sagging since volume from skin quality and underlying fat is the main factor that contributes to a youthful appearance , fat loss results in a gaunt appearance, which can be very ageing Depending on the amount of weight lost and baseline skin quality as well as the patient’s age at time of the weight loss, they may suffer from enough sag that surgery may be their best option. Even so, volume replacement via fat transfer is likely to be needed during surgery.  If they’re younger, and not planning excessive, rapid weight loss, I suggest a plan we can follow to keep the worst of the effects at bay, even if they’re planning on eventually having surgery once their weight has stabilised and they’ve maintained it for 6-12 months, which is usually recommended prior to surgery.  The treatment plan would usually encompass multiple treatment options in stages as they begin to lose weight, and include addressing lines and wrinkles that may become more pronounced, as well as replacement of volume loss in the face and neck, with different types of fillers, for rapid replacement as well as for stimulation of your own collagen for slower volume and skin quality replacement.  Lastly, they may need measures to address hair loss, both maintaining what is left and helping regrowth of lost hair due to the weight loss, which may be temporary or permanent.  As always, with adequate planning and collaboration, it is possible to support patients as they shed the weight with minimal effect, provided they’re motivated to keep showing up and budgeting appropriately. Having said that, weight loss, if rapid, is not something to be taken lightly or entered into on a whim & requires planning to help patients navigate it well.    

It's interesting to us here at Skin Essentials that we frequently see patients, who have either been to several other clinics before finding us, or who used to see us and then went elsewhere, only to eventually return, that we hear the following feedback from them: I went there because it was cheap and what could go wrong with some anti wrinkle injections right? I went there when I had an issue to fix that bothered me and wanted something done about it. I went and got lip filler/ cheek filler when I felt I needed it. I went there because I could take my child/ children in with me. I went when I had the money to treat myself. For the vast majority of us, this is probably a fairly typical number of reasons why you might go into a clinic for a treatment - for a pick me up; to fix a problem you noticed in the mirror; because it's cheaper than high-end clinics and more. So the second part of the above statements, that I also hear of from patients is the following, beginning with "but..." : it was rush in and rush out. there was no time to discuss anything, or make a plan I felt like they'd treat what I said was a concern, until the next time I went in with a new concern some of the results weren't the same as when I was coming here. I didn't feel like there was someone overseeing the plan, telling me when to show up, what to do in between I didn't feel like there was someone in charge other than me, and I didn't want to be in charge. When it comes to medical aesthetics, I'll be the first person to tell you to choose based on your desires, wishes and willingness to budget. There's no point choosing a clinic such as ours, where our signature approach is full face restoration and planning over some months, then maintenance, if all you want is some anti wrinkle or lip filler on demand. We will both be disappointed. At the same time, one of my favourite sayings about any service is, that it can't be good AND fast AND cheap. So at best, you can have 2 of the 3, so which 2 will you choose? In my experience, people who compete mainly on price do so because they don't have much else to compete on (yet) - they are usually new to the field, and building their skills. People who are good, are rarely cheap. And depending on how long you've disliked what you see in the mirror, the extent of sundamage and lifestyle choices, and your willingness to show up and to budget, we will be spending weeks to months to correct the many issues that bother you, and then work on a maintenance plan going forward. At Skin Essentials, there is no one size fits all approach to any face, at any age or stage of life. Each is unique and beautiful. Equally, our values and ethos means that if you've left it too late and surgery is your best option, we will say so to you, instead of taking your money to disappoint you. Occasionally we will have patients who do not wish to have surgery, understand the limitations of non surgical approaches and choose to proceed anyway. Either way, it begins with a comprehensive consultation with you, to assess your concerns, your plans, your willingness to budget and to be held accountable and to begin. On average, it will take anywhere from 3-12 months to get to results and maintenance, so you need to be aware of what is required of you. Along the way, we will spend the necessary time, we will hold your hand if needed and we will make changes slowly as skin and faces take time. Medical aesthetics done well, is not an impulse buy, nor a DIY project, but rather similar to orthodontics or planning a bathroom renovation - it takes planning, assessment, budgeting and some weeks to months of inconvenience where you entertain doubts and show up anyway, to get to the end goal. Most of our patients who have taken this road, tell us it is well worth it.

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

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

On 10th January 2023, aesthetic journalist Alice Hart Davis, who is turning 60 this year, was featured in a Daily Mail UK article on the treatments she’s had over the past 20 years entitled “I’ve got 20 years of filler stuck in my face - it’s meant to dissolve over two years” While the title is sensationalistic the overall message from the article is one that sensible injectors (and I like to think of myself as one!) have been saying for years - you do NOT need to have filler “top-ups” every 6-12 months as the industry training companies will often tell you because fillers can last far longer than we first believed, upto 11 years, as it turns out, depending on the individual, the brand and type of filler used and more.  So does this mean all dermal filler is bad and we should all abandon it? Alice says no, as do I, with my thoughts on her article as well as what I regularly discuss with patients in clinic and my advice around dermal fillers.  Choose your provider carefully, ensure they’re an expert and stick to them. one person/clinic for your face it does not have to be me (I say this in clinic to every new patient also)  is experienced and does their job well including complications management  the skill is in repetition over thousands of hours and many years, not in a 2-day or 2-week boot camp or doing this on the side  choose your practitioner based on their skill, not price of product - the same product in 2 different hands can yield very different results if they are cheap, there’s a reason for it; what corners are being cut or are they practising on you?  medical aesthetics is entirely discretionary and my advice usually is, if you can’t afford it (yet), keep saving; it’s better not to start than to start and stop as there can be an initial phase where it may look/feel like you are going backwards. Think of it like a home renovation - it can look & feel crappy while you are in the middle of it.  realistic expectations and managing your anxiety around slow results, and common non urgent side effects is vital; medical aesthetics is usually for patient people  trust in your provider and what they suggest. It’s ok to have a plan in mind, but go in with an open mind and be prepared to listen to the advice of the person you’re consulting.  Filler for enhancement, maintenance or volume restoration are different. younger people, mostly young women, commonly seek lip enhancement if they have genetically thin or asymmetrical lips. For these cases, 1-2 mls in 2 more more sessions is usually enough, and maintenance with additional treatments only as and when needed every 12-18 months or longer.  for maintenance from as early as our 30s, filler can be used to subtly replace early volume loss before it’s very noticeable and the standard guide tends to be 1ml (the size of a blueberry) per decade; so for someone in their 30s, you’d expect around 3-4 mls just to maintain volume. Keep in mind a ketchup packet is 5mls.  volume restoration is different entirely which is what Alice likely had when she began in her late 30s/early 40s, the typical age I start seeing women wanting to address persistent signs of ageing that they can no longer ignore, among them volume loss. When volume loss begins to take its toll on our face rarely as early as our 20s, they can present as hollows under the eyes, flatness around the cheeks and temples as well as prominent smile lines and early laxity around the lower face. Restoring lost volume can take far more than the 1ml/decade rule, easily double that in most cases, until maintenance is reached.   Once you’ve reached maintenance, less is more. while there is no doubt that the initial outlay for a holistic full face rejuvenation is expensive the longer you leave it to begin, I always compare it to other discretionary spending we all undertake - holidays away; home renovations; orthodontics; designer fashion and more.  thereafter, maintenance is far more manageable and given what we know of the longevity of fillers now, placed well, it can be the gift that keeps on giving for many more years until there is further volume loss due to the ongoing ageing process.  at this stage I actively discourage my patients to focus on other modalities to maintain their results.  For maintenance of skin quality without risking pillowface, collagen inducing therapies are my preferred treatment  when you pick a clinician with significant experience and a wide skillset, you’re more likely to have a bespoke holistic plan devised for you that avoids overcorrection and odd results.  at Skin Essentials, our focus is always on using dermal fillers in the initial stages to replace volume as quickly as your budget will allow, while working on skin, lines and wrinkles in the background, and then maintain with skin therapies and other collagen inducing modalities such as biostimulatory filler, which dissolve in a reliable manner to induce your own collagen in the process.  If sagging  is your biggest and most pressing concern especially if you are also postmenopausal, you should not delay surgery if you can afford it.  at Skin Essentials we pride ourselves on holistic, evidence based medical aesthetics  we would never feel comfortable taking your money or selling you a product or service that we didn’t believe was right for you.  fillers do not lift, they only replace volume which can subtly provide lifting effect in some faces if at any point what worries you isn’t amenable to non surgical or minimally invasive procedures, I’ll be the first to suggest a referral to a plastic surgeon as there is no reliable way as yet to LIFT skin without surgery.  The take home message from all of this?  dermal fillers in experienced hands are exceedingly safe and risks are rare but not

Not one week goes by when I don’t see a new patient who wants “a bit of a lift” to sagging tissue and believes threadlifts (not mono threads) with either barbs or cones that temporarily reposition sagging tissues, are the solution. The vast majority of the time over the last few years on assessment they’ve not been suitable candidates and I’ve encouraged them to consider actual plastic surgery if it is enough of an issue or to consider other non surgical and minimally invasive options to address their concerns as part of a holistic plan to age well.  I briefly offered threadlifts some years ago, buoyed by the hype around it and frequent patient requests as well as posts by influencers about their own results.  Disappoitingly I found that for the spend ($3500-4500 on average for enough threads to do a good job), the results were disappointing - the lift lasted mere weeks; as early as 2-3 months tissue was back to where it belonged due to gravity. Any collagen induced takes weeks to months to form, and there are better options for collagen induction on the market all the time that were far more reliable and less risky.  More importantly, when I scour the database on evidence, I’m hard pressed to find any reliable source for good results beyond 6 months, if even that. Due to marketing trickery, many were having threadlifts, and posting their before and immediately after results but surprisingly silent on results at 3, 6, even 12 months.  If we were honest with people, as we are with anti wrinkle treatments for example, whereby we know results only last 3-4 months at best, they could truly make an informed decision about whether the spend is worth it, but we are often told by companies results last upto 18-24 months, which means in theory, we should have great results to showcase at these timeframes by the companies and providers - there’s none that exists to my knowledge.  It wasn’t until I began my skin cancer work in ernest, including skincancer surgery on the face, that it clicked for me. The material used in threads is similar to that used in suturing to close wounds. These materials hold the wound together for a few weeks, and then gradually lose their holding strength and are gradually absorbed by the body and removed. So the “lift” logically, would only last a few weeks, and the rest would be dependent on the collagen induced to support tissue.  Further, during skin cancer surgery, when we sometimes don’t remove enough of the tissue with cancer in it, I advise patients to wait around 3 months to allow skin to stretch and settle before we go back for another round of excision ie skin stretches (which makes sense- think of how it stretches to accomodate pregnancy, weight gain, and then deflates with weight loss) - so how on earth, with only threads to “lift” tissue to reposition them, would we expect them to last? We would not.  And here’s the clincher - there are easier, safer and more reliable ways to induce collagen that are less involved. Biostimulatory fillers as well as skin therapies such as laser genesis, chemical peels and radiofrequency  microneedling as well as add-ons such as the humble LED light, all work by inducing collagen over a series of treatments. The collagen gradually produced subtly adds volume to the skin, and that shiny, dewy glow but it DOES NOT LIFT.  So where’s the lie?  For these and other reasons - including the fact that in order for threads to even look good and to work, you need decent skin quality that is not too thin and not too heavy/ saggy as the threads only allow around 1-2cm of lift before breaking- I largely stopped offering threadlifts despite having had it twice myself with reasonable results. I simply could not justify the cost for the results for the demographic I was seeing - women in their 40s and 50s with significant volume loss and sagging, often significantly sundamaged skin whereas the only group that can be expected to have possibly decent results, are around a decade younger, when there’s hardly any sag, and it’s more of a preventive treatment.  The closest article I could find that discussed results, admittedly old (2009) in a small sample size  was here “Thirty-three patients underwent a thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, midface, jowl, and neck. Ten patients underwent thread-lifts only, and 23 had thread-lifts with other procedures. Ten additional patients having had non-thread-lift rejuvenation procedures, including lipotransfer, chemical peels, and rhytidectomies, were randomly designated as controls. The mean follow-up period was 21 months (range, 12-31 months). Photodocumentation was obtained at each visit. Although aesthetic improvement was noted in all groups at 1 month, measurable results persisted to the end of the study for all but the group that underwent the thread-lift procedure only. Aesthetic improvement scores of the non-thread-lift control group were better than the group that underwent thread-lift only. Similarly, when the thread-lift was combined with other procedures, scores were better than when thread-lift was used alone. Statistical significance was demonstrated in both of these comparisons (P < .01).” So what are the alternatives?  When I’m consulting with patients my key goal is to understand their concerns, and what they hope to gain from (any) treatment as well as how realistic they are about the degree of their own commitment to the process as these are the factors that will ultimately determine success.  If sagging is their primary concern, then if they are willing and able, I’d suggest plastic surgery as there is no comparable alternative at present. For everything else - sundamage, lines and wrinkles, volume loss, pigmentation, textural issues, collagen induction, excess fatty pockets there are non surgical and minimally invasive options available, but not significant and lasting lifting.  As with all medical aesthetics, my goal and aim in writing this is to inform

In December each year, historically, my children and I plan some time off during the summer school holidays during which we reconnect. For me, as someone who is (mostly) super organised, it is an annual tradition to plan my upcoming goals and aims for the year ahead in 4 domains: - personal - familial- professional - business Personal is obviously a huge category, emcompassing my personal and spiritual goals; health and fitness goals; skin and aesthetic goals, relational goals and more. So while I am behind on this goal setting for 2023, I find it soothing to have a plan, and a way to track my progress and to keep me accountable. With this in mind, I thought I'd share my top tips for helping you with your skin and aesthetic goals if you're not usually a planner and what I've seen work, time and time again, for my most successful patients over the years.  After all, as a Specialist GP with niche training and interests across several areas, including mental health, I find great joy and satisfaction in helping people who want to do better, simplify so they can see the results they say they want to see while holding them accountable; after all, as the saying goes, what is not measured, cannot be improved.  One of my longstanding patients said to me today, when times have been lean for her, she's prioritised the things that have given her the biggest bang for her limited buck so she could save for the more expensive things when things weren't as lean. 1. That is why at Skin Essentials, we focus so much on the initial consultation to understand your goals and aims, but also to give you a realistic picture of what we need from you to help you attain those goals, and over what timeframe. 2. It is why we hold you accountable to booked appointments, and will ask you if you are truly in the right frame of mind to invest in yourself if you regularly reschedule or cancel. In our experience we know this will not yield best results and the token late fee really does not pay our overheads.  3. Without trust there can be nothing - so the initial and subsequent consultations are designed to help determine fit - it has to be a two-way street, without which we cannot proceed. My patients I know, can see that I would never suggest anything that is not in their best interest, no matter how much money they have to spend on it. Equally, I don't work to your budget. I tell you what you need to budget, and you decide if you will find the money and how.  4. Lastly, realistic expectations are everything. So what are some realistic expectations I discuss with you and which we must align on if we are to work together?  I cannot help with significant lift - that is the job of a plastic surgeon. I can help with everything else - tone, texture, volume loss, even some tightening, but not lifting.  I cannot be oncall for you between appointments. This does not apply to emergencies obviously, in the first 24-48 hours when we touch base with you regularly if a treatment is new to you or you are new to us. Thereafter we do expect that if you have pressing concerns you will make an appointment online via video call or face to face to have your concerns addressed or make a note of it to discuss it at your next appointment - this especially applies to concerns to do with skin, skincare and changes which take months, not weeks to begin to show.  there is a mandatory wait period post injectables such as anti wrinkle and fillers, before which we will reassess you to address unevenness, lumps and bumps and more. There is a sound reason for this, and as I always say, medical aesthetics is for the patient patient.  Most medical aesthetics is entirely discretionary spending so it is important to me that you understand what your initial upfront cost will be, and also that you are prepared to budget and to commit so as not to waste your money and our time together. Equally, while we all have things come up occasionally, we also know that frequent cancellations and rescheduling of appointments will mean that you will end up with subpar results. As someone who prides herself on ethical care based in accountability, this is frustrating for me especially when significant sums of money and time are involved.  So as we round out 2022, the patients who've made the most progress and had the most gains have managed to:  stay on track communicate their changed goals if this applies, especially in view of current inflation and rising costs  remain compliant with at-home care, no matter how simple it is remain on schedule with all booked appointments remained patient with outcomes, understanding and accepting that it will take a minimum of 3 months, and often as long as 6 to 9 months to really begin to see progress communicated disappointment if I've said something to upset them, and likewise taken feedback on board when they've likewise because we have understood that boundaries help us stay in the therapeutic relationship.  So my advice with respect to goals, for my patients in 2023, if we are to continue working together to improve your skin, are:  Simplify your skincare, with expert help if needed and then stick to it. you don't need much, but the basics will make a massive difference OVER TIME and with diligence. once you know what that looks like for you, stick to it especially if you have sensitive or problem skin.       2. Less is more the media is constantly trying to sell you lots of STUFF everyone has an opinion on what will make your skin woes go away, yesterday. stop, ignore and press pause. if you have skin problems, you need

Earlier this week there was a post by a journalist Jolene Edgar who writes on all things medical aesthetics, about the effects of non surgical procedures on future face/neck lifts and a forum which has plastic surgeons weighing in on their experience of this.  Here's what she said  "Interesting discussion over the weekend on the topic of nonsurgical treatments (like certain energy based devices, threads and injections) complicating facelift surgery by creating scar tissue, fusing natural tissue planes, obscuring landmarks that guide dissection and so forth. As with nearly every topic in aesthetics, there's debate surrounding these claims - debate over which nonsurgical treatments are the worst offenders, how much damage they actually do, and what the repercussions of said damage may be (increased risk of nerve injury during a facelift, a less-than-ideal cosmetic outcome, longer/tougher recovery).  And as some pointed out, surgery itself is the ultimate scar maker and can therefore compromise the results of any nonsurgical treatments that may follow facial surgery."  As expected, there was a wide variety of opinions, from uber conservative surgeons who actively dissuade everyone from non surgical aesthetics in favour of surgery “at any age” and as young as their 20s, to surgeons who were more balanced in their view that given that face/neck lift and associated plethora of procedures costs upwards of $50,000 and easily much more ($100k and upwards) if we add in fat transfer, eye surgery, brow lifts and more, that this is not something most people will be able to budget for or afford, and as such it behoves  all of us to be more cautious about our recommendations of non surgical and minimally invasive procedures including steering patients away from certain procedures that are notorious for poor results on the table and post surgery, notably, Ulthera, Thermage, HIFU and similar options as well as arguably, threads.  For me, watching and commenting where able, it was an interesting insight into what I see over and over in the field of medical aesthetics, which, without the fence of sound and evidence based medical scaffolding, can often seem very much like the Wild Wild West - since this is a very new field, and fueled by want rather than need and since health care workers are only human, with little to no basic understanding of business (we are not taught that in medical school) it's no surprise that some of us fall into unethical and questionable practices with the lure of big bucks.  It is a big part of why I work the way I do. When I began, like many others, I began in a chain clinic and very quickly learnt how I did NOT want to work. Opening my own practice even pre Covid was a big risk, but it aligned with my ethical and moral values as a doctor who wanted longterm patient centered care that focused on longterm goals and realistic expectations, as opposed to on-demand, quick fixes that ultimately did not fix much at all.  So, as someone who was a trainee in a surgical field between 2002-2011 and is now a Fellow of the College of GPs, and has been doing procedural work for most of my career, what are my thoughts and experiences based on aesthetic work since 2016 since I do non surgical and minimally invasive surgical work in my rooms including FaceTite and skin cancer surgery?  these concerns are not new, but they are newly being discussed which can only be a good thing. It is a big part of why I have never offered, nor seriously ever been tempted to offer, certain energy based devices such as Ulthera, HIFU and Thermage. Aside from scant evidence suggesting they are highly operator dependent for results, and results only lasting around 6 months, I worry about the crude methods used to provide "lift" and what layers are being destroyed in the process. It would seem some of my concerns based on theory and logic, are possibly true.  in my experience, biostimulatory fillers that work by triggering collagen through inflammation, do not have quite the same effects for two main reasons - the filler is usually placed far more superficially, just below the skin, unlike the layers that surgeons usually work for deep plane surgery. Additionally, in my experience, since biostimulatory fillers need an initial course of treatments followed by annual maintenance, I've had the opportunity to revisit skin I've treated over the years and have not found any significant degree of scarring when I've done so. In saying that, anytime the skin is penetrated by sharp objects, there is the potential for scarring.  I love radiofrequency (RF) microneedling as well as its corollary, RF Assisted Lipolysis aka FaceTite and AccuTite for small pockets of fact and collagen induction and to date, have not found it induces any appreciable degree of scarring or access issues for other procedures.  a popular fat dissolving injection on the other hand, does cause significant scarring, and on the rare occasions when I've performed FaceTite following fat dissolving injections, it has been hard going and tough work which has led me to be far more selective about who might be suitable for these injections and where eg bra fat, back fat, fat pad over the neck as opposed to double chin etc especially if they are open to the idea of FaceTite or surgery at some later stage.  Obviously opinions and experiences are like noses in that everyone has one and barring a scientific trial, there's not much to be said except that this is one person's experience.  It does however, inform me in terms of what procedures I am more and less likely to do and to offer my patients, especially if they are likely to be open to the idea of surgery down the track because as always, the first adage ought to be, "First do no harm".  For these and many other reasons I believe it is so important to have a comprehensive consultation when you

It has been some time but every now and again I get asked if I offer 0.5ml lip filler. Equally, I get asked occasionally why I don’t offer 0.5ml lip filler as an option for touchups.  It’s a great question, so I thought I’d take the time to explain, rather than 1:1 as the occasion arises.  0.5ml filler is an option in many if not most, chain clinics, especially for lip filler, which is among the most commonly sought out injectables among young people seeking enhancement rather than rejuvenation.  Young people also have smaller budgets so it makes sense that they’d seek what they consider to be better value for their money by pursuing options they can downsize.  And yet…. Anytime I’ve given in on the spur of the moment, I’ve regretted my decision & lost money saying yes and risked feeling resentment towards the person asking, which is not my preferred method for dealing with tricky conversations especially around money and boundaries.  My personal feelings & business health aside, I’ve some solid reasons why I don’t offer 1/2 syringe options, ever. you’re paying for a service that includes my assessment, opinion & treatment. The syringe and how much of it I use is irrelevant to your stated and our agreed-to goal for what you wish to achieve.  I rarely agree to do touchups if I don’t feel you will need a decent amount of filler, usually > 0.5ml when you buy a meal you pay for the whole thing even if you only eat half of it, so why do we expect a 1/2 syringe option when the syringe comes in 1ml size?  once opened, that syringe can’t be stored so if I don’t use it, it’s wasted assuming I do it, it’s twice as long with two people, and more consumables including numbing cream on two people for the same price as 1 syringe.  legally that syringe is yours and yours only. I know many clinics will split a syringe between two friends on the same day but technically it’s not legal to do that. On the occasion I’ve done it, I’ve felt annoyed for feeling pressured to do it on the spot.  I dislike people “ordering” aesthetic treatments as if off a menu including number of units or mls.It’s not how I work and it doesn’t work for my business.  limiting me to your budget also limits what I’m able to achieve clinically. On the few occasions I’ve done this, patients have invariably come back for more because the dose (eg anti wrinkle) was inadequate to do the job or was barely visible (eg filler) once swelling settled. the dose I suggest we use, is the bare minimum to achieve the desired result/ outcome - this is a basic, sound medical principle, and dropping that dose to suit your budget often means you’ll get less than ideal results or need retreatment sooner.  I work in 3D and often need to use 0.6-0.8ml of a syringe on lips to achieve good results front, side and in aiming for symmetry, even for touchups.  In saying all that, there are many people who do offer 1/2ml syringes. I’m just not one of them. At Skin Essentials, I am all about as much transparency and healthy boundaries as possible and I like to think that patients who choose to see us understand and accept this. If they don’t then they should not be seeing me and I encourage them to go elsewhere. We value safety and following rules more than a quick sale, any day. 

The term retinoids is often the cause of a lot of confusion on social media and in skin clinics. After sunscreen and rigorous sun avoidance, everyone’s skincare should ideally, include a retinoid.  Retinoids are clinically proven to treat and improve acne, fine lines and wrinkles, even out pigmentation (eg pigmentation/ sunspots)  and a host of other skin concerns over time (3-12 months) in large part due to their ability to stimulate collagen and elastin, increase the rate at which skin cells renew themselves and decrease inflammation (eg rosacea and psoriasis)  The most powerful retinoids are available by prescription only, with one exception: Differin (adapalene). Differin is an amazingly potent but well-tolerated acne treatment and the only prescription-strength retinoid to be sold over the counter. People often use the terms retinols and retinoids interchangeably but the two terms are not the same. They are related, but different. So what is a retinoid? A retinoid refers to all derivatives of Vitamin A converted into the active ingredient retinoic acid for use in skincare. Retinoid is also the term used interchangeably to refer to both over-the-counter (OTC) retinols as well as prescription retinoids. They’re available in pharmacies, beauty stores and salons as well as supermarkets and may be as cheap as $10 or cost hundreds depending on formulation and other base ingredients used.  Most retinoids are used topically ie applied to the skin, but some are taken orally eg isotretinoin aka Roaccutane for severe cystic acne, among other things. What is Retinol? Retinol is a type of retinoid available OTC and while still effective, it differs from prescription retinoids such that it needs more steps for retinols to be converted to retinoic acid than for retinoids. More steps for conversion to retinoic acid = weaker retinoid. As such, OTC retinols work more gradually and can be less irritating especially for those with sensitive skin. Can everyone use retinoids? I believe that with adequate preparation and sensible onboarding, almost everyone can tolerate a retinol/ retinoid and reap the benefits, but the secret is in the onboarding.  Some of my top tips when starting out:  start with an OTC retinol and acclimate to using that nightly before considering if you’d benefit from prescription retinoid from a doctor (a minority will not tolerate prescription retinoids ) I generally recommend starting with using it 1-2 times a week then stepping upto 2-3 times a week the following week and then upto nightly if all goes to plan.  keep the rest of your skincare super simple - cut out all other active ingredients such as acids, scrubs and more.  common side effects of onboarding retinoids are dryness, temporary irritation, peeling and flaking - so prepare for them and extra serums and moisturiser will help calm skin down as it acclimates.  less is more when it comes to active ingredients - the lowest concentration of the drug that gives you results is the right dose for you. Higher strengths may cause more irritation causing you to use it less often or worse, abandon your regimen.  rigorous sun avoidance is non negotiable - you are more likely to burn if you are not careful, so daily SPF and sun protection should be an established habit by the time you onboard retinoids.  If you're not sure which one is best for you or want a tailored skin regimen specifically for you, make an appointment and we’d be happy to talk you through it all.  These drugs are not suitable if you're pregnant or breastfeeding; avoid using retinoids altogether once pregnant until after you’ve given birth.  Key take-home tips:  like all skincare, remember that retinoids are a longterm commitment to healthy and beautiful skin. If you stop using them, over time, your skin will return to its pre-retinoid state.  retinoids take around 3 months minimum for you to begin to see results, and as long as upto 12 months if you have significant skin concerns eg acne, pigmentation, rosacea  do not stop-start your prescription retinoids without medical advice. Make an appointment to see your doctor annually to obtain your prescription and to check all remains well with your skin. Being erratic with your prescription may do more harm than good.   

It’s here! After 7 years for TGA registration since it launched globally, the new biostimulatory, bioremodelling filler aka Skin Honey is here and at Skin Essentials. Why all the fuss? See for yourself!   It boasts the ability to hydrate skin, like many Skinboosters, upto 20x more in addition to stimulating your own collagen and elastin over time, for sundamaged, crepey skin on the face, neck and hands over a series of treatments.           The pictures certainly seem impressive and the track record for complications are very reassuring the world over, who has had 7 years on us in terms of real time experience with this product. So who’s it for? - the only person it’s not for, truly, is the pregnant person while they are pregnant. - risk profile is very safe, with minimal downtime and ability to work over time on just about any skin type. - it seems best suited to aged, sundamaged, crepey and volume depleted skin to restore some of this, like all biostimulatory fillers, with the added benefits of hydration also.   How does it work? For the month of November only, if you are new to Skin Essentials, consultation to discuss this treatment ONLY , is complimentary and your booking deposit is redeemable towards treatment using this link. For current patients, if you are booked for treatments and wish to add on this please email us so we can set aside a box for you as stock is strictly limited and once we run out, there is no further stock expected till February 2023. What is involved? - this type of filler does NOT volumise but rather hydrates deeply and stimulates your own collagen for glowing, healthy skin over weeks to months. It is a gradual treatment, like all biostimulatory fillers. - initial series of a minimum of 2 treatments per area 4 weeks apart eg face, or neck or hands = 1 area. - some people see enough of a difference, especially if they have significant sun damage and crepeyness, that they may opt for a third session 4 weeks after the second. - each treatment needs a minimum of 2 sessions for best results. - cost is $900/syringe. Each syringe is 2 mls. - $1800 for 2 treatments to one area 4 weeks apart - $2400 for 3 treatments at 0, 4 and 8 weeks to one area, paid upfront. Downtime is minimal and results can be seen and felt as early as the 4th week, just in time for summer and Christmas. So if you are keen, don’t delay, stock will run out when it does until February 2023.

As we rapidly hurtle towards summer and hot weather and plenty of time lounging outdoors, by pools and the beach, it is even more important than ever to be sun smart. Applying sunscreen with SPF 30 or higher daily dramatically reduces the risk of skin cancer, including the deadliest form, melanoma. Sunscreen is one of five sun protection measures (slip, slop, slap, seek, slide). Cancer Council recommends using sunscreen that is broad-spectrum, has a sun protection factor (SPF) of at least 30 and is water resistant. In addition to reducing your skin cancer risk, there is substantial evidence showing that sunscreen helps reduce your risk of skin aging. However, for some people, applying certain types of sunscreen can also cause skin sensitivity or an allergic reaction.  Reactions to sunscreen are rare and may be a result of a sensitivity or allergy to any of the many ingredients used in these products, including a fragrance, preservative, UV absorber or another component. Sensitivities to sunscreen are complex and can range from mild to severe. Reactions can be linked to a range of co-factors, including sunlight and can also be caused by or made more severe if sunscreen is used with some medications or other topical creams and lotions. Some reactions occur soon after applying the sunscreen, while others (e.g. allergic reactions) can develop after a couple of days or prolonged use of the same product. Reactions occur in a very low proportion of the population – fewer than 1% of all users, but can be upsetting when they occur.  As with all products, use of sunscreen should cease if an unusual reaction occurs. Individuals experiencing reactions should see a doctor to understand what may have caused the reaction and get advice on ingredients that should be avoided in the future. Physical vs Chemical Sunscreen  Chemical sunscreens are carbon-based compounds. They protect the skin from harmful ultraviolet (UV) light by absorbing the energy and preventing it from passing through. Physical or mineral sunscreens use ingredients such as zinc oxide and titanium dioxide which have not been reported to cause contact allergy. Mineral sunscreen is quite effective and tends to be less irritating than chemical sunscreen but it may be more difficult to spread on the skin and may leave behind a white or ashy appearance. Sunscreen ingredients are similar across all brands, and sensitivities to sunscreen are complex, so simply changing the brand of sunscreen may not eliminate a reaction. You may like to try a sunscreen that has been specially formulated for sensitive skin and begin with a test patch on a forearm for a few days to determine any potential allergies.  As always remember that sunscreen is best used together with the other 4 sun avoidance measures - a sunhat, sunglasses, seeking shade and protective clothing and is your last line of defence against sunburn, sundamage and skin cancer.   

We are well and truly into spring weather, and summer is just around the corner!  So what are some tips and tricks to help you get your skin summer ready while also helping you keep it safe from sunburn and other issues common to warmer weather?  My patients and followers know I’m a fan of the KISS method for skincare ie Keep It Simple Stupid - the least number of steps to achieve your goals, and once you’ve found what works for you, stick to it while avoiding latest fads and trends which might upset your skin. So a solid skincare regimen should see you through most seasons and climates with minor tweaks as needed.  In saying that, warm weather brings a whole slew of skin-care challenges and questions like, "Do I really have to moisturize even if it's 100 degrees out and my face feels oily?” (Spoiler alert: Yes.) Luckily, the experts know exactly how to face summer — pun intended — head on. 1. Sunscreen     Yes, yes I get it, it’s summer and you want to do summer-y things like go to the beach, and get into water sports so it may not always be possible or practical to cover up with hats and clothing and avoid the sun. This being the case, sun protection with the last line of defence ie sunscreen, becomes even more important because:    you cannot avoid the UV eg while in the pool or at the beach you sweat much more and will use up the sunscreen faster  Poolside surfaces reflect UV more than usual, so extra vigilance here is even more important than usual  water has a cooling effect, so it is possible to burn while partially submerged in water and not feel it (UV can penetrate water to a depth of 50cm)  So what can you do to protect your skin?  Apply enough SPF 30-50+ that is a dedicated sunscreen with an AUST-L number - 5mls for the face and neck including ears and 5mls for each area of the body eg each limb. Total body SPF would need a shot glass or 35mls to be enough.  Reapply frequently enough - every 2 hours if out and about, and more often, every 40 minutes if you are regularly getting wet when not in the pool, seek shade, wear protective clothing, sunhat and sunglasses because even perfect, adequate sunscreen of 50+ allows 2% of UV to penetrate the skin ie it is sunscreen, not sunBLOCK.    2. Lighten up some skincare    Heavier creams can feel like too much, or even oily when applied to skin in warmer weather. Does this mean you don’t need to moisturise? Nope, you still would benefit from a moisturiser, especially if using actives such as retinols and AHAs/BHAs but a lighter formulation eg a lotion instead of a cream, or a lighter formulation. You may also wish to swap out an oil based cleanser for a gentle foaming cleanser for sensitive skin during warmer months. Similarly, if you wear makeup, you may wish to lighten up some formulations and choose non comedogenic options where possible.    3. Consider a 2-in-1 moisturiser/SPF Heavier moisturisers and SPF in warmer weather may risk acne and an oily feeling skin;  a lighter sunscreen over any optional serums or a combination SPF/moisturiser formulation may be a great alternative during warmer months as long as you remember to apply enough and reapply regularly as you would any dedicated sunscreen.  4. Moisturising is STILL important though … Moisturizers improve skin barrier repair, maintain the skin integrity and appearance. Moisturizers improve skin hydration by directly providing water to the skin and reducing water loss, providing a soothing protective film and protects skin from friction. So even if you lean towards a lighter combo SPF/moisturiser, do remember to keep moisturising - sweat does NOT count as moisturising! 5. Invest in a good vitamin C serum. Vit C is a great active all year around, but it works to even out pigmentation and to protect against it, as well as working synergistically with your SPF to help protect skin and improve uneven skin tone, which is more important in warmer months when UV exposure is more intense. Vit C also induces collagen, and can help with fine lines and wrinkles. Find a brand that works well with your skin type and layer it between your cleanser and SPF/moisturiser.  6. Exfoliation  Judicious exfoliation with an AHA is often a good way to keep all skin types but especially oily skin healthy and keep acne at bay. Remember not to overdo it though, 1-2 times a week is plenty, and not at the same time as retinols if you are using those in your skincare routine also.  7. Don’t forget the other 4 Ss just because it’s summer!  As discussed above, it IS summer and while it’s unreasonable to expect to cover up completely while at the beach, it’s equally important to remember that summer is also the season when UV rays are highest and in places like Australia, it is possible to burn in mere 11 minutes at midday. So remember, whenever possible, to wear protective clothing, sunhats, sunglasses and to seek shade when and wherever possible, with sunscreen as your last line of defence.  8. Consider in-clinic skin therapies  Lastly, if you are open to consider in-clinic treatments to get your skin summer ready, or to help with dry scaly skin, congested pores and more, consider options such as chemical peels, laser genesis (or a combo of the two) as well as Skinboosters to get skin summer ready.   

The aging process. It is inevitable if you are a living being. None of us can avoid it, and for most of us, it can be a sign of immense privilege to be able to age well.  Nonetheless there are many things that we can do to help influence our overall ageing so it is kind to us - this includes many preventive habits such as eating well, exercising and keeping active physically and mentally to enable us to make the most of our time on earth.  Where our skin is concerns, with time, we all get visible lines on our face. With age our faces lose some of their cherubic fullness; our skin becomes thinner, drier and more prone to bruising. While our genes largely control when these changes occur ie intrinsic aging, this accounts for some 20% of the ageing process in our skin, the remaining 80% being more under our control, ie extrinsic aging.  What are the factors that affect extrinsic aging?  Our environment and lifestyle choices can cause our skin to age prematurely. Common examples of factors influencing this type of aging include UV exposure and smoking as well as poor diet, among others.  The WHO classifies UV exposure as a carcinogen yet there continues to be confusion around what constitutes UV exposure in Australia at least, where, in my weekly skin cancer work, I continue to hear from patients “I never go out” and “I avoid the sun” who nonetheless commute daily to work without much sun protection and who understand sun protection to mainly be necessary when going to the beach or playing outdoors sports for extended periods of time.  So why is sun avoidance our best anti ageing habit?  1. Effects of ultraviolet radiation on the skin  UVA triggers damage to the DNA in the presence of melanin (pigment)  UVB causes damage independent of melanin and directly affects DNA. The UVB triggers release of pro-inflammatory cytokines which cause sunburn DNA damage also causes the loss of structural integrity in the skin and photo-ageing. The accumulation of unrepaired DNA and UVR induced immunosuppression, increase the risk of mutations and the development of skin cancer. (Source dermnet)  2. Effects of chronic sun exposure and sun damage on the skin  Tanning is triggered by UVR induced damage to DNA and other skin parts. Chronically  sun-exposed skin such as on a bald scalp or face, neck, and hands has unique characteristics compared to skin that has not been exposed to UVR: Photo-aged skin is thinner than non-sun-exposed skin in the same individual. Photo-aged skin is dryer. Over time sunspots aka actinic keratoses appear in the most sun-exposed skin sites; these are tender, red, scaly lesions that may eventually turn into squamous cell cancer.  Sun-damaged skin is less elastic than skin in other areas and develops a dull yellowish undertone due to solar elastosis. Photo-aged skin has more uneven pigmentation than other sites due to freckles, solar lentigines, and hypopigmented and scarred areas. There are often prominent blood vessels  3. Effects of ultraviolet radiation (UVR) on skin cancer risk  As noted above by the WHO, UVR is a major carcinogen. It damages the skin by producing free radicals that damage proteins, fats, RNA and DNA. It is thought that UVR increases tumour risk through mutations in your DNA and UVR is a tumour promoter and causes progressive tumour growth once the process has begun.  4. Effects of UVR on the eyes  UVR causes free radical damage to mitochondrial DNA in the retina. UVR can also promote inflammatory changes within the eye, increasing risk of:  Inflammatory disorders of the eyes  Pterygium (that white stuck-on looking film over the eye)  Cataract Age-related macular degeneration Cancers of the eyes BCC —  > 90% of eyelid cancers SCC — the most common cancer affecting the cornea and conjunctiva Melanoma — the most common primary cancer within the eyeball. So how do we prevent skin ageing? Intrinsic ageing is unavoidable but given it is typically only responsible for some 20% of skin aging there is much that is within our control to minimise the effects and impact of the remaining 80% of aging.  In perimenopausal women, systemic hormone replacement may delay skin thinning - the skin is less dry, with fewer wrinkles, and wound healing is faster than without treatment. Menopausal hormone therapy (MHT) is less effective at improving skin ageing in the postmenopausal decades. See your doctor if this is a consideration for you.  Careful and regular sun avoidance is essential at all ages.  Be aware of daily UV index levels or better yet, establish the daily habit of sun avoidance and sun protection irrespective of the weather during daylight hours. Avoid outdoor activities during the hottest parts of the day. Wear sun protective clothing (eg, a broad-brimmed hat, long sleeves and trousers or skirts). Apply very high sun-protection factor (SPF > 30), broad-spectrum sunscreen to exposed skin. Apply enough to get the advertised protection, and reapply often.  Do not smoke, and where possible, avoid exposure to pollutants. Obtain plenty of exercise — active people appear younger than inactive people as the increased blood flow has a beneficial effect on skin.  Eat fruit and vegetables daily. Get enough sleep, since sleep is where the skin repairs itself  consider adding in oral niacinamide tablets especially if you are outdoors regularly for work and can’t avoid the exposure.  Many oral supplements with antioxidant and anti-inflammatory properties have been advocated to slow skin ageing and to improve skin health. These include carotenoids; polyphenols; chlorophyll; aloe vera; vitamins B, C, and E; red ginseng; squalene; omega-3 fatty acids as well as collagen supplements. Their role in combatting skin ageing is as yet unclear. Last but not least, get regular skin checks for cancers before they occur or progress. If photo ageing bothers you, there are many options available to help improve skin quality, but as always, prevention is better than cure.  Ready to book in for your skin cancer check? 

A cosmetologist in her late 50s in the USA posted recently about her skin transformation over 7 years and the true cost of it and it got me thinking. Much of the beauty and aesthetic industry is on an race to the bottom: they hire junior doctors and nurses to perform injectables purchased wholesale at bargain basement prices, with minimal training and minimal followup. consultations are cursory and complimentary and designed to convert on the day to people walking in expecting to pay hundreds to order a treatment off a menu irrespective of whether they’d be suited to that treatment.  In many cases, this is fine, there is definitely a market for this, and for those who don’t need much done, and want a quick pick-me-up, this is an absolutely ok model with lower risk treatments and no real problems to address.  This, however, is not the case for many as early as our late 20s and more typically our 30s and beyond.   By the time we get to our late 40s and early 50s, many, if not most women, if they’ve not had anything done till then, will begin to be reasonably bothered by what they see in the mirror, prompting online searches, a foray into online groups for advice, following influencers to see what their skincare routine is and even seeking a complimentary opinion from one of the clinics mentioned above, for guidance on how to fix what bothers them.   Many may decide not to pursue anything, and we have women who talk about this such as Mia Freedman on her notox stance .  On the opposite end we have beauty influencers such as Caroline Hirons known for speaking out against clean beauty and who is also a lot more open about spending on skincare as well as toxin and fillers. And who has drawn the line at plastic surgery for herself.      In your 20s, as a general rule, much of skincare, including injectables and skin therapies, tends to be relaxation and enhancement if there are no skin disorders such as acne. You may have lips that are thinner than you’d like, and 1-2 mls of filler is a quick and simple fix to address this.     In your 30s, these changes begin to become more pronounced: sun damage adds up lines and wrinkles become more apparent, especially if skincare has been minimal to date volume loss in the face leads to hollows, shadows and even sagging which can be distressing and invite unsolicited comments from others.     These changes, once present, will only worsen in our 40s, 50s and beyond as the perimenopausal and menopausal years set in alongside the relentless ageing process which is inevitable irrespective of what we undergo by way of skincare, in-clinic procedures and even surgery.            Depending on when you choose to begin your journey to ageing well, IF you choose to do so, the costs will begin to add up quite quickly at least initially, especially if there is a significant degree of effort needed to first halt or even reverse some processes eg acne with scarring; pigmentation including sungamage; etched in lines and wrinkles at rest; volume loss; loss of skin plumpness.  These concerns all require an approach that I call a Full Face Rejuvenation or an FFR and can be initially costly in terms of both your time commitment and money. There is quite simply, no easy or cheap way around this if you want to do it well. Would you expect to straighten your teeth for less than $7000-10000 and expect a good job for less than 12 months’ commitment?  Would you expect to pay less than say, $15000 for breast implants or a rhinoplasty and expect it all to settle within weeks rather than months? Would you expect to pay less than $30000 for a tummy tuck or a facelift and be driving the next week? The more work there is to be done, the more time, effort, consistency and money it will take and anyone who tells you otherwise is, quite simply, lying to you and selling you marketing Koolaid. It’s dishonest and it is taking advantage of vulnerable people. Sometimes I hear of people being told “You need 6-8mls of filler but if you can only budget for 1ml, let’s start with that and add to it over time.” My concern that I take issue with this is: 1 ml will almost always do nothing to show you any significant progress that will motivate you to save for more and to come back if you need 6-8 times that amount someone who has a budget for only 1ml is unlikely to be able to find the money for 6-8 times that amount in quick supply and may experience distress or financial angst as a result  there is a high chance of dissatisfaction and loss to followup and in the process, they’ve spent hundreds of dollars to achieve nothing, which could have been spent elsewhere on something else that might have brought joy FFR takes a degree of accountability - it is you that needs to decide if you will show up and commit and be consistent. The work in clinic is 20% of the entire process, if that. The remaining 80% is dependent on you and if you cannot or will not commit, then it is often easier and kinder for me to say no.  The woman who posted her own progress over 7 years in the USA, spent USD44,000 over the 7 years to achieve her results and for her, it has been totally worth it. This is what my own patients who have similarly spent significant sums of money, often in their 30s and 40s and hit maintenance which is far more manageable, tell me. As with all discretionary spending, it is entirely up to each individual what they wish to prioritise that makes them happy. No judgement here either way.  For some

I recently did a  live on Instagram with Clinical Psychologist Dr Toni Pikoos, in which we discussed the intersection of medical aesthetics and psychology as I have been reflecting on the type of patients who are less likely to have success with aesthetic treatments. As a doctor, I cannot overestimate the importance of the initial consultation in assessing patient concerns, their understanding of what is possible as well as their expectations of how aesthetic treatments will help them, whether they are willing to stick to the suggested timeframe and budget for the best possible outcomes. As such we simply will not engage with anyone who refuses to begin with an initial consultation or believes they can simply order a treatment as there is a chance they may be wrong, and feel they’ve wasted their time in attending the appointment. Perhaps especially because non-surgical treatments are largely elective from a medical point of view, I believe that practitioners have an ethical responsibility to select patients carefully, including screening for certain red flags and having protocols in place before treatment even begins. Related to this, it is imperative to look out for signs of body dysmorphic disorder (BDD) during the initial consultation and early stages of treatment as this is a contraindication to aesthetic treatment. The mental health of patients and the responsibility to protect the vulnerable ultimately lies with us so we have a duty of care to assess this before we inject or to press pause if we recognise it after starting if we can’t educate our patients.  Social media contributes to the disconnect between what is physically possible and what is best left to photoshop and filters, and marketing by big companies further encourages this by disguising medical treatments as just beauty - “lunchtime procedures” etc only serves to perpetuate this myth, so at Skin Essentials we go to some lengths to screen all new patients for potential red flags, but read on to see why this is harder than it seems. 3 key examples we encounter regularly enough: 1. Unrealistic expectations Often as early as during the consultation, but more commonly during the early treatment stages, it may begin to become apparent that the patient has expectations of aesthetic treatments that are unrealistic - for example, they may expect to be frozen with anti wrinkle treatments and to stay that way for the whole 3 months. or they may expect that 1ml of filler will replace typical volume loss in a 40 year old face, which might need on average, 4-6mls. others may come in with stories of having had treatment elsewhere with impossibly low doses which lasted unreasonably long periods of time.  At this stage, if it becomes apparent, I try and explore this expectation with them, how likely it is, and whether I can reasonably help them, including suggesting I may not be the right person for them if I am unlikely to be able to meet their expectations with respect to price, dose (and related to this, cost) or timeframe.  2. Budget vs true cost mismatch By the time we see people at Skin Essentials, most people have been dissatisfied with the ageing process for some time, usually months to years, and are keen to begin to do something about it. Unfortunately due to social media, as well as well meaning friends and a general sense of secrecy around the true cost of aesthetic treatments  they may severely underestimate the cost in terms of timeframe, frequency of treatments initially and the budget realistically needed to effect significant change in the areas that trouble them, which are usually also multi-factorial: skin lines, wrinkles and sundamage volume loss with hollowing of the face and sagging around the lower face  sun damage  pigmentation  redness/sensitivity etc  There is no one treatment that will treat all these various concerns; treatment options are usually best combined, and undertaken over multiple sessions over months to begin to see changes. For this reason, I commonly tell patients it is like orthodontic treatment - if it’s going to cost $10,000 and they only have a budget of $2500, they may be better off not beginning as they won’t achieve desired results. Equally, it is better to start and keep going than to wait because the ageing process will not.  3. Requesting to look like celebrities Rarely, patients will present with pictures of celebrities they wish to look like eg JLo, one of the Kardashians or specific attributes - big juicy lips, a non surgical butt lift for example - and it is then up to the practitioner to explain why it may not be a reasonable goal even if they have the money for it, due to limitations of anatomy.  So when this occurs, how do we deal with it at Skin Essentials?  1. Consultation  The fact is, there is never such a thing as “just some anti wrinkle treatment for X or Y” or “just some lip filler”. It does not matter how simple the prospective patient thinks the issue is, as a medical practitioner it is my responsibility and duty of care to assess each person, including a detailed medical history, assessment if appropriate and their expectations before we proceed to treatment, if it is appropriate to do so. We don’t do treatments made to order.  At Skin Essentials, you are emailed an intake form as soon as you have booked an appointment and it is in your best interests to fill this out as soon as feasible so we have a clear idea of your concerns as well as what is likely to be the problem. In truth, the consultation begins well before you walk through the door and we have a fairly good idea of what we will see and suggest when we finally meet you.  2. Education  We aim to maximise our time in clinic addressing your concerns, educating you on what they mean, and what, if any, the options to help improve them are; additionally, we discuss

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

Perhaps the biggest way to understand that medical aesthetics isn’t the same as hair, nails and beauty, is the fact that in order for us to carry out any procedures on you, it is a legal requirement to consent you for the procedure prior. While many, if not most people rush to sign the form at the very bottom and may not even properly read it, trusting their technician or doctor, it is in your best interest to not rush this, and to take your time and understand what you are signing up to and for. In my experience, a lack of attention and proper informed consent can lead to potential misunderstandings when something goes wrong. Think of consent forms as your opportunity to understand what you are saying yes to, and that you understand the risks and side effects - common and rare- as well as what is expected of you - eg a series of treatments in a given timeframe - as well as what you can expect from your doctor in terms of aftercare and followup routinely as well as in the event of a problem. Many clinics that offer complimentary consultations rely on the quick and cursory consultation that relies on a very brief process before waving a form under your nose to sign before treatment. They largely rely on a high conversion rate on the day (commonly boasting >95%) to generate revenue. This model does not work for me and feels inherently dishonest to me. Perhaps due to my background as a surgical trainee, I’m aware that consent is important and more than just cursory and often, a cooling off period is needed or a pause if a patient is uncertain, or more scared/ nervous than excited. So what should a consent form cover to give you peace of mind of an ethical provider? 1. You should understand the risks realistically before signing the form.  At Skin Essentials, we email all forms out at the time of booking so patients have plenty of time to read, process and look into any potential risks before signing if they are comfortable. On occasion, patients may hold off signing if they have further questions till they are back in for the treatment. Doing this ensures we allow patients enough time to read through the information without feeling rushed into signing. 2. The consent form should outline common and rare risks and side effects of the procedure and note that these are general, and your experience may nonetheless vary.  No two faces are the same, nor are two faces going to have the same anatomy and potential for complications. Equally, common side effects, while common, may be different for each person. So your consent form should give you some idea of what to expect from best case to worst case scenario so you can proceed with as much information as possible. 3. You should understand the costs, whether results can ever be guaranteed and the importance of the aftercare process or timeframe if appropriate and relevant.  Costs should be outlined for you, and you should understand what you will pay, your payment options as well as when payment is due as well as a reasonable estimate of any extra you may need to factor in for more, since aesthetics is an inexact science with no guarantees of outcomes. 4. You should be able to access the form to read over well before your planned procedure ideally.  Ideally, you should have access to the consent form well ahead of your planned procedure so you can read it in your own time, mull risks and side effects as well as downtime and sign with as much knowledge as you can reasonably be expected to have, without any pressure to go ahead. 5. The form may clarify what will happen if you need more treatment, and costs if applicable.  Due to medical aesthetics being an inexact science, many consent forms will often say things like “we cannot guarantee outcomes, only treatment” as well as costs if you were to end up needing more product than originally budgeted for/ estimated so you understand who’s liable for the cost. Equally, many will state cleary their policy with regards to refunds due to change of mind/ dissatisfaction with outcome etcetera. You should satisfy yourself that you understand all of these before proceeding. 6. You should have access to a copy of your signed consent.  Lastly, ideally, you should have a copy of your signed consent for your own records in the event of any dispute so you can see exactly what you signed consent to. Remember, medical aesthetics, unlike beauty, involves machines and procedures that frequently either break skin or go beneath the skin and carry rare but real risks so take your time, ensure you understand the risks and side effects including downtime and costs, to avoid misunderstandings. Anything else you’d add that you think should be included before signing a consent form?

Much of medical aesthetics done well, is subtle, so very subtle. People often believe they would not consider aesthetics because of the many, many examples of bad aesthetics we see walking all around us. They don’t want “duck lips” or “trout pouts” or “avatar cheeks”, “chipmunk cheeks” and more.   Many people never notice the temples hollowing even as other indirect signs of this begin to bother them - sagging around the eyes and cheeks, are a great and common example. The temples lose volume with age as fat pads are lost, overlying collagen in skin is lost, and bone gradually erodes. Since there’s already a natural concavity to the temples—actual hollows in the skull itself—you may see this area changing faster than other parts of the face or not be aware that this is what is contributing to your aged look: worsening of the crow’s-feet, dropping of the outer brow, giving a more mannish appearance, and even changing the shape of the face, giving it a peanut-shell shape. So what do you need to know to determine if you might be a suitable candidate for temple filler, or if it is what you need instead of more cheek filler? 1. Temple filler is subtle Almost all the work we do at Skin Essentials is subtle but with temple filler, we often get some pushback “I’ll cover the area with my hair/ scarf” except it doesn’t quite work like that. In order to address the areas that you do see, which bother you, we do need to begin with the temple if they are contributing or responsible for some of those changes. Done well, the temples still remain slightly hollow, but with better blending in of bones between your forehead and eye socket, which become more and more pronounced over time with temple hollowing. 2. Some people are more prone to hollowing in this area People who are naturally slim will look gaunt earlier, which can give an unhealthy look, but equally, in women, an overly angular appearance to their face which can be displeasing for them. Equally, people who are athletes and into high intensity cardiovascular exercise, are more prone to temple hollowing at earlier ages. 3. The Temples will hollow out in everyone, and those of with big cheeks may look worse than those with symmetrically slim faces Dr Joshi has yet to have any filler to her cheeks and around her eyes but she had temple filler 2 years ago and is likely due for more now, because when she smiles, her cheeks look “too big” next to her temples and out of balance. 4. Temples are a high risk area, so please choose your doctor carefully. Experience and qualifications matter here. Big blood vessels are close to the surface here, and you don’t want an inexperienced clinician treating you here. Look at the price as your insurance in the event something goes wrong and choose wisely. 5. Temple fillers are sensitive They can feel funny going in, and due to the tight space here, with swelling after treatment, they can cause a tight/swollen sensation, a headache as well as discomfort chewing for a day or two until it all settles. Any lumps or bumps, a given with any fillers, may also look or feel more apparent for a few weeks until they settle. 6. Temples are rarely treated alone By the time we see patients there’s significant ageing going on in the face, beginning at the temples and extending down to other areas - around the eyes, cheeks, the ears and the lower face. The skin is no longer held up by the loss of fat pads in these areas, and pools around the lower face, giving “eyebags”, hollows, sagging cheeks and eventually, jowls. This is exacerbated if sundamage also contributes to faster collagen loss, with more laxity.    The problem is to begin to address the concern from where it began and it can add up to a fair bit initially (8-10 mls or more depending on the degree of volume loss) over 3-6 months till we’ve addressed all the volume deficit. After that, you may need 1-2 mls a year as and when the need arises. Left too late, as with the patient on the left, who had a face and neck lift (not my patient), there’s not much we can do non surgically to help, so timeframe matters.      Ready to get started? If I can offer some advice, it would be to find someone who has a plan with a clear timeframe and budget to help you decide if you want to start at all - if you start, will you make it work and invest in yourself? As always, none of this is medically necessary, so if you are unwilling or unable, then my opinion is, you should not start. If you do decide to start, take a leap of faith with your trusted doctor, invest and trust. As always, I encourage you to seek the longterm therapeutic relationship over vending machine style aesthetics, wherever you go. 

At heart, I’ve always been a generalist. I love people, and I love the whole person, more than I love any single body system. My years of training across two training specialities, both dealing in whole person preventive care at various life stages, taught me firsthand the importance of whole person, preventive care that is broken down into parts - short, medium and long term. It is this training I also carry into my aesthetic and skin work when I first meet you. It is not simply a quick “hello” and “you want anti wrinkle treatment? Sure, let’s do it!” Rather, it is a meet and greet, and a proper, comprehensive consultation. After all, if I don’t understand what your concerns are, what has brought you to me now, how can I possibly assess what your priorities are, and what you are hoping to get out of skin or aesthetic treatments? It may seem silly, but in order for us to accurately treat the “problem”, we need to have the correct diagnosis.  When you Book the Initial Appointment  So at Skin Essentials, we get you to prefill your information before we even meet, so I know exactly what your concerns are likely to be. Often, with skincare audits, I can already tell, based on what you’ve written, what is causing your skin stress before your appointment.  In many cases, leading up to your appointment, I have an idea, and a plan, that I’ll hone once we meet and I get to assess your face in front of me, in animation before we move to the next steps.  The Initial Consultation  When we meet at the initial consultation, we go over your general medical history - past and current. Medication. Pregnancies if relevant, past, current and planned if relevant. Prior treatments including surgery. Allergies. Then we get to your concerns. What bothers you, what you are hoping to get out of the consultation and treatment if we decide to work together. We do photos of you, barefaced, and then I ask you for your consent to assess your face and explain to you, what bothers you, and WHY. I discuss with you, how and IF I can help you improve your concerns, a timeframe and associated cost if you decide to invest.  If I can’t help you as happens occasionally, I refer you to a colleague who can eg plastic surgeon for a facelift, or dermatologist for lasers I do not offer. If I can help you, and you understand the limitations of treatments, the timeframe and are willing and able to budget, we may proceed with something on the day, or not depending on how much time we have left and if you are keen to do so. There is zero expectation on my end that we must “do something” but many of my patients are time poor, busy professionals and often ask if they can get started with something on the day.  If this is reasonable, then we can and do, and I plan next steps, including review if appropriate and when you’ll come back for the next session if you agree with the treatment plan suggested, until we hit maintenance.  What do we not do at Skin Essentials?  At Skin Essentials, we do not offer complimentary consultations - in my experience, complimentary consultations are designed by their nature to convert to treatment on the day - you invariably end up paying for the practitioner’s time by having treatment you may or may not be ready for, or need or to redeem the deposit paid.   My own view is that this feels unethical and given aesthetic treatments are largely discretionary and expensive the longer you delay them, I do not want anyone to feel pressured to have treatment if they are unsuitable. I would rather you pay for an educational experience on what the ageing process looks like on your face, and what you can do about it, if you choose to, and proceed with as much knowledge and true consent as is reasonably possible.   At Skin Essentials, we also rarely do “just lips” or “just anti wrinkle” to an area. Our area of expertise is full face rejuvenation and helping you plan to age well, and necessarily involves a whole face approach because by the time I see someone, they’ve usually been dissatisfied with the way they look for some time, but often do not know how to explain it to someone else. So we take the guesswork out of it for you, and put together a plan to follow to effect change over the coming 3-9 months, if you are willing to invest treating, with your consent, all three areas : - skin, skincare and skin therapies including hydrating and biostimulating fillers and other collagen induction therapies - injectables including anti wrinkle treatments and fillers if you are open to it (some are not, that is ok) - “other” including minimally invasive options to address excess fat in areas such as the chin, around the jowls that may be amenable to treatment.   The more restoration needed, the higher the cost is initially. I always assess for this and say to patients to allow for an amount similar to orthodontics. Maintenance thereafter is more manageable and I’d rather you understand what is involved so you can make an informed decision to proceed. Or not. There is absolutely no pressure and no upsell.  For these reasons, and more, an initial consultation is necessary for all new as well as returning patients who’ve been lost to us for a significant amount of time between treatments when ageing has continued to change our faces and there may have been other medical developments meanwhile.  Ready to begin? Let’s start here! 

This seems to be among the coldest winters we have seen here in Australia for some years and we are not coping! Winter is a season characterised by lower humidity, scratchy fabrics and often, heating that leads to dry, irritated skin. So what are some winter basics to keep skin happy? Here are some basic tips to keep skin happy on a day to day basis at home that won’t break the bank, and some suggestions if you are open to in-clinic treatments. 1. Keep your skincare simple. I’m not a fan of complicated, multi-step skincare routines or switching it up too often at the best of tines, but winter is especially one time to go easy on changing your products too often! I typically pare products down to 3-4 steps, max when I see new patients for a skincare audit, and this is generally what I recommend, especially if you have sensitive skin. Year round, skincare really does not need much more than a cleanser, SPF during the day, an active or two if you can tolerate it and moisturiser. Serums and other creams are optional, but you may benefit from them, based on your skin needs, and in winter, you may need thicker and richer formulations to help keep more moisture in. 2. SPF and sun protection remains just as important as in summer We live in Australia, which means, barring very few states and areas, we get abundant sunshine and UV exposure year around, with UV index usually well above 3, which means daily sun protection will continue to be your best defence against photo damage as well as sunburn. Yes, even in winter, daily sun protection is vital.   3. Ease up on the exfoliants and scrubs It can be tempting to up the exfoliants to deal with dry, flaking and peeling skin, but this is usually a bad idea. As counterintuitive as it sounds, deal with dry, flaky skin by focusing on adding more moisturiser and if you must, use a gentle enzyme peel once a week instead of harsher products such as acids or physical scrubs, which may affect your skin barrier.   4. Moisturise, moisturise, moisturise This one cannot be emphasised enough! In winter, drier air, heating, warmer showers and winds can all lead to drier skin - on the face, lips, hands as well as extremities as our heart shunts blood away from them, leading to a multitude of problems including worsening of chronic skin conditions such as eczema, keratosis pilaris and more. So one of the good things to do, to switch up your skincare routine, is a gentler cleanser + serums that are hydrating, if you use them + moisturiser and consider adding in occlusive such as Vaseline at night to seal it all in while you sleep. 5. Go easy on the heat To combat the cold, we commonly heat our homes, our beds and in the shower, our bodies, all of which act to dry our skins out more. Add to this fabrics that can sometimes be scratchy and irritate dry skin, and it’s easy to understand why winter can often be so uncomfortable for skin. Simple solutions include not overheating the home, limiting overly hot showers, and consider a weekly warm bath with a soothing oil if you can to add moisture to dry skin. 6. Hydration is more important than ever Due to the cold, we drink less as we sweat less, and often stick to hot drinks, usually tea, coffee and yes, alcohol all of which can dehydrate in larger quantities. Watch how much you drink, especially water, and try and remain as hydrated as is possible. 7. Consider in-clinic treatments If your budget allows for it, winter is a great time to invest in your skin’s future health with skin therapies that will induce collagen and help reverse some of summer’s signs of sundamage and build collagen for the summer that is just around the corner! Minimal downtime treatments like laser genesis are great for collagen induction with no pain as well as other options, such as injectable hyaluronic acid (SkinBoosters) that add lasting moisture to skin, skin needling, RF microneedling and more. Be guided by your clinician as to what is best for you, and be sure to understand what is needed as most skin therapies need an initial series of treatments in close succession, followed by maintenance sessions 1-2 times a year. 8. Sensitive skin will need extra TLC Eczema, psoriasis, keratosis pilaris and more will all suffer more during the cooler weather and needs extra TLC, so if unsure, see your doctor to have a plan in place for the cooler weather so you don’t have to suffer unnecessarily or chase your tail once flares have begun to take place.     9. Don’t forget other body parts! Chapped dry lips, hands as well as lower extremities are all common areas that suffer from dry winter skin woes, so be sure to get on top of these too. Many of the same strategies for the face, neck and décolleté will work well for the body. Hands are especially prone to dryness and chapping, especially if you work with your hands so I often recommend applying similar skincare to your hands as to your face, and then a layer of Vaseline and then cotton gloves to sleep in at night. Tried the basics and still suffering? Consider making an appointment with a trusted doctor to problem shoot your concern!