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

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

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

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

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

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

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

I recently undertook accreditation in the latest treatment option for permanent fat reduction under the chin. Marketed under the different name in the USA, it has been available in Australia since February and I finally caved. I did a brief blog post on it here and while I am still on the search for suitable models to treat at cost price, I recently did a treatment on my colleague Dr Holly of Dr Holly Cosmetics. Here are the photos from before treatment Holly has thus far had 3 treatments, and I was doing her 4th using 1.5 vials of the product. She has kindly consented to allow me to use her photos. We met at my clinic in Moorebank to do treatment #4 on a Sunday morning. We marked out her anatomy after the usual prep and clean while chatting. Then we got down to business. Remember: most people will need a minimum of 2 treatments to see results, and many will need more than this amount. The RRP for 2 treatments begins from $2500 for the 2, six weeks apart. I charge cost price of $1000 for every subsequent treatment after the first 2 for my patients. Yes it is pricey and yes as of yet, Allergan is the only company selling this in Australia so they can set the price without much competition. BUT it is non surgical – no anaesthetic, no chin and neck braces for weeks afterwards, no time off work and lost income and time. And it is permanent. Here is a link to more medical information. More questions? Email me! Want to discuss it further with me? Book here for an obligation free consultation to discuss your expectations, budget and cost for you. Hope to see you in a clinic soon! Any questions? email us at contact@skinessentials.com.au Hope to see you in a clinic soon!

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

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

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

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

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

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

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

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

So why is that a problem? Well. This is where my passion for primary prevention, ie General Practice, which is the speciality focused on preventing things from going south in the first place, shows. Prevention is always better than cure, so I encourage people to be proactive about their skin just like their health. So if it feels like one day, we literally wake up, and there is a mass of wrinkles where there used to be lovely smooth skin: If that is you, then we’ve missed the opportunity to prevent and have moved to the “cure” stage. Which is more time consuming, worrisome and expensive. Some will simply say, “Why bother!” and carry on. Others will say “I embrace my wrinkles!” to which I say, more power to you, and good for you. But, for someone who is very much wash-and-wear, I am rather vain about my face, especially since I don’t wear makeup but do like to look good for my age. Exercise, as great as it is for your heart and general health and mood, isn’t as good for the rate at which you lose fat, including from your face; it predisposes to fat loss from the face, resulting in the “runner’s face” – wrinkles, hollows, eyebags and jowls. Some examples of ladies I have done subtle work on: 29 year old busy mum of many, looking tired and drawn with early under-eye hollows and mid face volume loss. Top: before anything. Bottom: after 0.5ml filler to each cheek. Lady in her late 40s with years of midface volume loss. Her deep eyebags worried her the most, but we had to restore the cheeks first before her eyes began to look better. Total volume used over 3 months- 5 mls. So what can you do? Like all preventative care, begin before the damage has occurred if possible focus on a diet that is low in processed foods and high in fruits and vegetables get enough sleep – most adults need 7-9 hours/ day quit smoking! watch your alcohol intake use sunscreen, rain, hail or shine! care for your skin – it is the biggest organ of the body, and will be with you from birth to death, so it deserves that you care for it like you would the rest of your body! Get exercise and work on your heart and bone health with a good mix of cardio and weight bearing exercises. bear in mind that cardiovascular exercises, like running and aerobics, will stimulate more fat burning and cause a more gaunt appearance over time. BUT they are also great for mood, and the increased blood flow to the skin will help circulation so that’s a win! weight bearing exercises are important for bone health, and an important role in osteoporosis prevention as we age. Don’t shy away from spending on quality products to care for your skin try not to be penny wise but pound foolish – many of the OTC products you slather on your skin will do only so much, especially once past a certain age. fillers will not only plump up skin from within, they will also attract water to the site, evening out lines and wrinkles and they provide a lasting hydration that surface moisturisers don’t mimic as well. anti-wrinkle injections will relax muscles that predispose to wrinkles, smoothing them out over a year or more of sustained use. So, budget for quality care and care for your skin, look after it and it will repay you for years and years to come! Any questions? email us at contact@skinessentials.com.au Hope to see you in the clinic soon!

LED takes the power of light therapy to the next level to correct even more skin imperfections in one place than ever before.  Our specifically formulated treatments use over 4000 LED lights in a combination of red, yellow, green and blue to make an exclusive blend of skin-perfecting light therapy. LED Therapy is your secret weapon The effective LED system operates using of 5 different types of coloured light therapy paired with revolutionary for greater coverage. How does it work? Blue Light works to reduce acne causing bacteria, clear skin and reduce congestion Red Light increases blood circulation and lymphatic flow, encouraging the renewal and revitalisation of ageing skin Green Light targets skin tone correction and detoxifies the skin to reduce redness and irritation Yellow Light boosts the skins collagen production capacity, resulting in rejuvenated and younger looking skin Near-Infrared regenerates, rejuvenates, repairs and tightens ageing and lacklustre skin Who can benefit from LED light therapy?   Everyone! LED is not heat-based so all skin tones and types will benefit from LED light therapy. Targeted light therapy LED treatments are so versatile that treatment can be performed not only on the facial area, but on other areas of concern as well. Our large LED panel is simply positioned over the treatment zone which may be the décolleté, back, hands, or any other region of the body requiring treatment. Dr Joshi will conduct a detailed consultation to match your skin concerns with a targeted LED treatment. It’s simply the secret to skin that looks and feels radiant.

Previously we wrote about the types of acne and its causes. In this blog we'll discuss the long term effects and some of the treatments for problem acne. What is the treatment for acne? Mild acne Creams, gels and washes, OTC as well as prescribed, often work well, as part of a regular and basic skincare regimen to get into the habit of. With the confusing array of over-the-counter (OTC) products available, it is often wise to seek the advice from a doctor with training and an interest in acne across all stages, who can advise on the best products and active ingredients and also recognise their limitations and when to refer on.  For young women, the Pill can often work well as the oestrogen works to improve skin quality and have a positive  effect on hair and skin   Chemical peels of higher strength overseen by a doctor, using acids, may work well within 3-6 sessions - to be used with caution in skin of colour and under supervision by a doctor LED and laser therapy can also work well over a treatment course which may be as frequent as twice weekly initially for a few weeks and then for maintenance, every few weeks as needed. Moderate acne a variety of medications in conjunction with treatment options for mild acne above Severe acne Referral to a dermatologist for more restricted medication with more significant side effects, not usually used as a first line agent Lasting Effects of Acne  Unfortunately, depending on the severity of the acne, the duration as well as what was used to combat the issue, common outcomes include such complications as scarring and in many skin types, post inflammatory hyperpigmentation, PIH.  While these are often reminders of the acne one had, they can often significantly affect a person’s confidence in a time when we are bombarded with images of perfect skin. A personalised consultation and treatment plan will ensure that a plan specific to you, your skin type with its unique qualities, will be used, to help improve skin quality and may involve one or more of several methods, beginning with skin needling, a series of chemical peels and even laser treatment and subcision, which is a way to break up the scarring that tends to cause skin to tether, giving rise to a pockmarked appearance.   How do you know what is the appropriate treatment plan for you?  Book an appointment so we can begin with a personalised treatment plan for you, addressing your specific concerns, overseen by our doctor and undertaken with our trained staff.