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.    

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