With the boom of Aesthetics globally, especially since the pandemic, when most of us have been looking at ourselves via a Zoom lens far more than ever before, coupled with hours spent mindlessly scrolling through perfectly curated, often photoshopped and filter-heavy images on Social Media, has come a demand for aesthetic procedures, especially dermal fillers in addition to anti wrinkle treatments. As someone who has been doing this for many years now, the problem I am seeing more of, especially among my patients who first began with me several years ago and who are therefore now several years older than they were, is the mistaken belief that fillers will fix all problems. At least weekly, I see a patient who committed and spent the necessary time, energy and money to invest in what I call "full face rejuvenation aka facial renovation", and who became used to compliments from others she met, on how great she looks, how she passes for someone 20 years younger etc, and who is nonetheless, some years older than she was when we began and beginning to see the underlying bony changes of ageing that none of us, even surgery, can fully reverse or halt. So read on as I explore the limitations of what dermal fillers can do, and what they cannot. Mistaken Belief # 1 - Dermal Fillers can erase wrinkles. I had a patient in her late 30s on the weekend who is beginning to notice accordion lines, those smile lines on the sides of the mouth due to volume loss that is a sign of ageing, and asked if I do facelifts or if I know a surgeon who does. She was half joking, and yet she was not. So among other things possible, we spoke of using small amounts of dermal filler in the area to help add some volume - when she smiles, the wrinkles are still there, but the muscles are not pulling on thin tissue as much as before, thereby softening the lines, giving the illusion of "erasing or easing lines". Accordion lines are also hard to erase completely and best treatment options in this area would be a series of sessions of  laser toning, small amounts of dermal filler applied very superficially and mono threads and similar collagen inducing therapies such as skin needling and RF microneedling. Mistaken Belief # 2 - Dermal Fillers lift sagging tissue. This is among THE commonest reasons older patients ask for more filler. Filler does not lift, and it certainly does not lift sagging tissue by as much as 2-3cm which is what people expect fillers (or threadlifts for that matter) can do - they simply cannot. In a volume depleted person, when we begin by adding filler, we are replacing lost volume, and restoring sagging, deflated tissue back to where it belongs- as a result of this, a subtle lift is apparent, not because we have done any lifting, but because we are lifting skin folds that have occurred due to lost volume, back to their correct anatomical position. With age, even if we had perfect sun protection habits and perfect diets and great genetics that allowed us to age beautifully, there is bony depletion that occurs, along with ligaments that begin to sag and collagen that is being rapidly depleted, that simply cannot restore a 45 or a 50 or a 60 year old face to one in its 20s or 30s with its cherubic qualities.  Yet for some reason, people continue to believe (and erroneously be told) that fillers can lift when they cannot. The definitive treatment for truly sagging tissue and ligaments and really lax, poor quality skin is a face (and neck) lift. Other cheaper options include options such as threadlifts which temporarily lift sagging tissue and reposition them, but they last 12+ months and are by no means a replacement for surgery. Mistaken Belief # 3 - Starting dermal fillers when you are younger can help you stay younger. In large part due to social media influencers, many young women are literally waiting to begin their aesthetic journey as soon as they turn 18. This group is often short on cash, and so may opt to turn to a chain clinics and groupon deals, where the "price is right" as opposed to a reputable clinician with many years of experience under their belt for their lip enhancement, or non surgical rhinoplasty or tear trough fillers. The problem is, you cannot fix a problem you do not have. Most young people are the epitome of youth and beauty, and do not have any medical need of "fixing" anything unless it is skin problems such as acne or dermatitis from overuse of skin products. Once we get into the habit of getting lip filler, or any other type of filler, to plump up lips, or fill other perceived defects, it becomes a case of returning on a regular basis once we feel the filler is "gone" when it usually hasn't, for more;  it is the swelling and side effects that are gone, leaving in their place, compliments and comments from people that massages our egos.  Over time, these regular top ups when unnecessary can lead to stretching skin and contributing to an unrealistic and excessive focus on what needs "fixing" as opposed to recognising all the other beautiful attributes one has. Which leads to Mistaken Belief # 4. Mistaken Belief # 4 - Dermal fillers (or any injectables) will not treat unrealistic expectations or a desire to look Forever 21. It is important in clinic, to regularly remind patients of what they used to look like when they first began attending the clinic 3,4,5 or 6 years ago and how much improvement we have made and how great they look now, compared to when they first began investing in themselves. It is human nature to lose sight of the bigger picture; to forget what we used to look like, and to become almost addicted to regular

Here in the Southern Hemisphere, we consider ourselves lucky that summer coincides not only with school holidays, but also, Christmas, New Year and the end of one year and the beginning of another. As the busy year begins to wind down, it seems the perfect time to lie back, take some time off no matter how hard we have worked through the year, and relax with family. Summer Daze.... When I think of summer, I think of long, lazy days, lots of water activities and books, cool drinks and food! Already, when walking around, I see fellow Aussies out and about, enjoying the sun, and while I don't like to think of myself as a party pooper, my main concern is for their skin. Although most people love the warmth and light of the sun, too much sun exposure can significantly damage human skin. The sun's heat dries out areas of unprotected skin and depletes the skin's supply of natural lubricating oils. The sun's ultraviolet (UV) radiation can cause burning and long-term changes in the skin's structure. The most common types of sun damage to the skin are: Dry skin — Sun-exposed skin can gradually lose moisture and essential oils, making it appear dry, flaky and prematurely wrinkled, even in younger people. Sunburn — Sunburn is the common name for the skin injury that appears immediately after the skin is exposed to UV radiation. Mild sunburn causes only painful reddening of the skin, but more severe cases can produce tiny fluid-filled bumps (vesicles) or larger blisters. Actinic keratosis — This is a tiny bump that feels like sandpaper or a small, scaly patch of sun-damaged skin. Unlike suntan markings or sunburns, an actinic keratosis does not usually go away unless it is frozen, chemically treated or removed by a doctor. It develops in areas of skin that have undergone repeated or long-term exposure to the sun's UV light, and is a warning sign of increased risk of skin cancer. About 10% to 15% of actinic keratoses eventually change into squamous cell cancers of the skin. Long-term changes in the skin's collagen — These changes include photoaging (premature aging of the skin because of sun exposure). In photoaging, the skin develops wrinkles and fine lines because of changes in the collagen of a deep layer of the skin called the dermis.   Over a lifetime, repeated episodes of sunburn and unprotected sun exposure can increase a person's risk of malignant melanoma and other forms of skin cancer.   So what does skin damage look like? Sun-damaged skin may shows the following: Dry skin — The skin appears dry, flaky and slightly more wrinkled than skin on other parts of your body that have not been exposed to the sun. Dry skin is also one of the most common causes of itching and ageing skin gets drier, so needs more care to keep it hydrated. Sunburn — Mild sunburn causes pain and redness on sun-exposed skin. In most cases, there are clear boundary lines where the skin has been protected from the sun by shirt sleeves, shorts, a bathing suit or other clothing. More severe cases of sunburn produce painful blisters, sometimes together with nausea and dizziness. Actinic keratosis — An actinic keratosis appears as a small bump that feels like sandpaper or a persistent patch of scaly (peeling) skin that may have a jagged or even sharp surface and that has a pink, yellow, red or brownish tint. At first, an actinic keratosis may be the size of a pimple. Rarely, an actinic keratosis may itch or be slightly tender. Long-term changes in the skin's collagen — Symptoms of collagen changes include fine lines, deeper wrinkles, a thickened skin texture and easy bruising on sun-exposed areas, especially the back of the hands and forearms.   Outcomes Sun damage may result in a permanent cosmetic concern, only some of which may be treatable, but not usually reversible, with judicious use of personalised skincare regimen, careful sun protection for life and treatments as recommended by your doctor - chemical peels, laser and light treatments, prescription medications as well as injectables. Some treatments for actinic keratoses can leave a pale (de-pigmented) area of the skin surface. More important than appearance is the long-term impact of sun damage on your chances of developing skin cancer. The more unprotected sun exposure you have during your lifetime, the greater your risk of skin cancer, especially if you have a light complexion so it is important to have your doctor care for these and check your skin regularly and to keep monitoring it yourself for any new changes. As an example, I have attached an example of what happens with the most simple measures that most of us ignore - suncare. Using the app Sunface, I took a pic of myself, and then compared myself in 5, 15 and 15 years, with daily sunscreen vs no sun protection. See the results for yourself. In someone with lighter/fairer skin, the damage is faster and deeper, as would be the lines. In someone with darker skin, it is slower, but still unavoidable if one is not careful about sun protection.   Take home message? It is NEVER too late to care for your skin. it begins with simple measures such as sun protection - all day, everyday, sun or rain, winter or summer - hat, sunscreen, glasses and clothing regular reapplication of sunscreen during the day apply sunscreen 15 mins before getting in the car - the windshield and windows don't block out sun rays SPF 30+ regularly through the day, 5mls (teaspoon) to the face reapply more often when sweating, or in the water References  Weird things that happen as we get older.

Not everyone wants to have injectables.   The vast majority of people who contact us at Skin Essentials are afraid of injectables.  They usually come in frightened of having lips or anything, that looks too obviously fake.  They come in armed with pictures on Instagram of what they do NOT want to look like- big pouts, pillow faces, fake high cheekbones and more. One patient said to me, “they look stunning in selfies but I have to wonder, with the almost cartoon-like faces, what do they look like when they talk and move their faces.”  And that’s it exactly. None of the people I see, wants to look like that.  They don’t want people to know they’ve had “work done” or “what work”.  And some simply haven’t the budget for injectables but still want to age well. So what options are there?  I like to think of beautiful skin as a blank canvas for all kind of enhancements, from the barest of makeup, to injectables, if that’s your thing. So let’s go from the basics to the slightly more involved for those who are wary of injectables.  1. Personalised skincare regimen Not all skins are equal in the way they behave and react to chemicals placed on their surfaces. Knowledge is power and as much as automated systems can be to help you decide what skincare type or brand to use, the best way to do it is to enlist the help of someone who can sit with you and work out your own personalised regimen based on you, your lifestyle, your needs as well as your likelihood of compliance ie how likely are you to use the skin plan if it’s 5 steps vs 2 steps? 2. Medical Skin Peels  These are simply great, in sets of 3-6 peels, for rejuvenating skin, removing the most superficial layer of skin allowing healthier skin underneath to come through. Over time, combined with step 1 above (home care) you’ll notice your skin feels smoother, more even toned and lustrous. Makeup if you wear it, will go on smoother and you’ll receive compliments on your skin. What’s not to love about that? Peels start at $120/session and may be booked with our therapist or Dr Joshi herself.  3. Medical Skin Needling  This is a 2-in-1 treatment- controlled micro trauma to the skin, ie controlled irritation and trauma, just enough to stress the skin out, without causing lasting damage, to stimulate new collagen and elastin production of your own, over time. We add in a cocktail of serums while the channels are open, to help them penetrate deeper. Results again, are, over 3-6 monthly sessions, smoother, firmer skin, tighter pores and skin that feels wonderful. Fantastic for all skin types, even those with melasma and hyperpigmentation, with adequate care taken. Price $350/session  4. AquaGold AKA Mesotherapy with a cocktail of options  This is a new treatment option of a cocktail of treatments, inserted just under the skin surface, to cause micro trauma similar to the skin needling, but with added benefits of a. Small dose of antiwrinkle treatment to tighten pores, b. Filler to help plump skin surface c. A mix of serums and a. And b. Above. Prices start from $600/session every 3 months. 5. SkinBoosters  For ultimate hydration that’s long lasting year round, it’s hard to go past this treatment. We’ve posted on it here (link) and here (link)  We recommend, for best results, an initial treatment of 3 sessions 2-3 weeks apart, 3mls each session ($700, normally $900) and then twice a year to maintain, 3mls ($900). Makeup will go on smoother, skin won’t feel as dry in winter, and look smooth, even and rejuvenated in summer. Win-win-win 6. BBL for skin rejuvenation  For women who do NOT suffer from melasma/hyperpigmentation, this treatment is a win-win. The treatment itself has no downtime, and involves a test patch at the initial consult, to ensure no adverse effects before booking you in. We suggest 3 treatments a month apart for best results- smoother, plumper skin over time. Full face treatment from $349/session (also possible for hands and neck and décolletage)  7. Laser for skin rejuvenation Similar to BBL above in its collagen inducing properties but suitable for all skin types, laser toning involves no downtime, and we recommend minimum 3 sessions a month apart initially.  8. Facials incorporating enzyme peels  For those with sensitive skin, or prior to an event, this is the perfect option to have amazing skin as the enzymes slough away surface skin and reveal glowing skin underneath. 9. Hydrodermabrasion  New in our offering, hydrodermabrasion is a gentler way to offer hydrodermabrasion with infusion of peptides and other serums to help you not only rejuvenate your skin but also help cleanse pores, help with acne and more. Prices from $140/session  Confused? Book a consult with Dr Joshi and let her guide your choices with a personalised treatment plan that works with your lifestyle and budget.  Finally, remember that any of these are in addition to, and AFTER  Sunscreen twice a day, SPF 30-50 under makeup if you wear it, and on top of your skincare.  Sun hat during the peak hours of the day (approximately 9-4)  Sunglasses Long sleeved clothing  NO smoking (or QUIT if you are)  Enough water and sleep  A healthy diet with lots of fruits and veggies  Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi. Book Now