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.    

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

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.