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

There is a recent trend of famous actresses and models embracing ageing and encouraging other women to do likewise. It is refreshing, certainly far more so than the famous women of similar vintage claiming all they use is olive oil. We now have some famous and beautiful faces that are showing us firsthand what ageing in our 40s and 50s can look like, if we simply allow nature to take its course: Paulina PorizkovaSarah Jessica Parker to name a few. It is certainly brave of these women and others like them to do so, especially in an industry where looks are seemingly everything. At Skin Essentials we don’t believe in defying ageing, or helping patients look like mutton dressed as lamb, rather we recognise that ageing is a disease, a decline in our bodies and our skin, that over time, for many of us, can also affect our self esteem, our morale and especially if we are working, how others see us. For us, the aim and goal is always a holistic approach to ageing well, whatever that may look like for each individual, man and woman, though our society disproportionately places a heavier emphasis on women than on men to look ageless forever. With that in mind, I though I’d do a case study on some famous faces and their aging process in their 50s, which is the decade of peak decline for most women, if nothing is presumably done. Caveat - as actresses and models, each of these women had stunning bone structure in her youth to begin with, which offsets a lot of the signs of ageing in our 40s and 50s - high cheekbones, strong chin and jawline, when most of us begin to notice sagging and jowling as early as our late 30s if our lower face is not strong and well defined. Sarah Jessica Parker 56       At 56 the actress is openly and freely embracing the ageing process and good on her!  Note - she has a strong side profile to begin with and being always slim, she never really developed any significant jowling, except where the skin has sagged due to 3 factors:  - bony loss - around mouth, including chin and angle of jaw; around orbits of the eyes - fat pad loss and movement downwards  - ligament laxity due to loss of support  - hooding of her eyes in part due to bony loss around the eye sockets but I also suspect, due to drooping eyelid skin  Many of these are amenable to tweaks not to hide the fact she is 56 but to help her appear less tired and grumpy, what I refer to as “negative signs”. The signs in an ageing face that elicits unwanted comments about looking tired, sad, angry and may lead others to see us as being untrustworthy.  Paulina Porizkova 54  A supermodel with impeccable bone structure as evident in her youth, the perfect heart shaped face, she continues to wear it well into her 50s, with only noticeable changes due to her bone structure. Paulina is another one ageing naturally and she does it well!  In fact, barring anti wrinkle treatment, and skin therapies (which she takes up consistently to improve skin structure and quality) her bone structure will likely continue to carry her for years to come with minimal drooping even around the eyes and lower face.  My main issue when women in their 40s and 50s urge others to embrace ageing is this:  - it is admirable that they do so and encourage us mere mortals to accept ourselves as we are - it is equally telling that these are often individuals who, by virtue of their career choices, are usually in the top 1% in terms of looks and have at their disposal, immeasurable amounts of money and staff as well as genetic advantage that the rest of us simply do not have.  - just as telling, many of these supermodels and actresses have made more money in their youth than most of us will see in our lifetime, such that they can afford to retire far earlier than we would. For those of us who continue to work till 65 or later, especially if in customer facing roles, we still have to look well enough that we don’t solicit unwanted comments or pity because we look “like you should be retired”, a comment made to one of my patients in her 60s.  Ultimately what anyone does or does not choose to do, we ought to be supportive and if we cannot, simply go past. As a doctor, like all doctors, I see and hear firsthand the impact careless comments have on someone’s self esteem and psyche, and the very real fears some have around their careers in their 40s and 50s when competing against younger fresher faces.  I advocate for looking your best at every age and stage, rather than looking like the latest face or trend of the day.  Just as we advocate for exercising regularly to keep your heart strong, and keeping your brain young through exercising it with mental activities, learning a new language and more, so it is with our skin and faces if we want to invest for years to come - we must make the time, effort and budget to enable us to indulge in our faces and our skin that will allow us to like what we see in the mirror for years to come.     

If you've followed the series from your 20s through to now, you know the basics:  sun protection is the holy grail to ageing well  good longterm lifestyle habits are key - eating mostly well, limiting alcohol, not smoking (or quitting) and exercising regularly are all good habits to implement sooner than later  obtaining personalised medical guidance for your skin is just as important as obtaining advice on other aspects of your health as is prioritising preventive care such as regular skin checks. Prevention is not sexy, or heroic, but it is the best bang for your buck longterm and far easier than undoing damage.  In saying all that, it is never too late to begin exactly where you are, as long as you are mindful that the longer you leave it, the harder it is to reverse some of the changes, the more expensive and healing may be impeded from minimally invasive surgery due to thinner more fragile skin.  Our life expectancy is now well into our 80s in countries like Australia, and many if not most of us, will work till 70 or beyond if we hope to maintain a similar standard of living post retirement.  Focusing on judicious medical aesthetics is then not only about vanity but about continuing to look our best at every age and stage, to look functional and competent to our colleagues and if we are in a service role, to our clients and patients, as well as informing our sense of self and healthy self esteem.  The desire to continue to like what we see and to feel good about ourself goes far beyond mere vanity for most of us, and at Skin Essentials we take a holistic view of this, with a roadmap drawn up especially for you, over time - weeks, months and years to come to help you age well. In return we ask for your commitment, consistency and your budgeting to allow you to follow recommended treatment plans. Without this investment, we cannot attain success.  The fact remains, however that in our 60s, no matter how diligent we were in the earlier decades, there will be inevitable changes in our skin over our entire body but treatment and care in the earlier decades can influence how much the ageing process shows up on your face and body.  Volume loss continues to be the biggest issue as we age in this decade:  there is loss of fat pads and their migration south in the face as well as bony loss around the mouth such that skin can seem to hang off a frame there is loss of skin elasticity, giving rise to fine lines and wrinkles and crepeyness in skin - around the eyes, around the mouth, and on limbs.  continued collagen loss also means that skin lacks the usual plumpness and glow of youth. In the 5 years immediately post menopause, there is as much as 30% collagen loss, and thereafter 2% per year instead of the previous 1% per year from our 20s.  So what can we do in our 60s, if we are still active and our outside seems a mismatch to our inside?  1. Surgery  As always, beyond an age, I usually raise the idea of a face and neck lift with patients in this age group and their willingness to consider it. Will their budget and lifestyle allow for it? If so, it may be a feasible option and I can help refer to a plastic surgeon.  2. Minimally Invasive Fat Loss and Skin Tightening  For many people, surgery may not be an option or a path they wish to go down. Minimally invasive fat loss and skin tightening procedures may then be a suitable alternative as discussed also in the 50s age group.  3. Volume Replacement  It is important for patients to recognise that surgery along will not replace volume loss in the face - specifically, in the temples, around the forehead, in the cheeks and more. Even if they opt for surgery, to reposition ligaments and muscles and to remove excess skin, they will also need volume replacement for best results, otherwise they risk looking windblown, as the old face and necklift cases of the past often show. Some may opt to have the surgery first and then return to us for volume replacement via dermal fillers, skin therapies that replenish collagen, or both.  4. Ablative Laser Resurfacing  With deeply etched lines and wrinkles due to sun damage, this may be a sound choice and option for patients. There is usually downtime of 7-10 days and is a treatment undertaken in clinic if you are a suitable candidate.  5. Medium Depth Chemical Peels  Medium depth peels are another way to resurface superficial skin layers and reveal fresher less lined skin underneath. They can be used on the face, neck and decollete as well as hands, depending on the concern and like lasers, have an associated downtime of several days.  6. Focus on other areas - hands, neck, decollete  For many patients who start at a younger age, the 50s and 60s can often be a time to shift focus from the face to the other exposed areas of our body that can age us - our hands, our neck and decollete.  They are all subject to sun exposure and ageing. Hardworking areas such as our hands may look thin, heavily veined and far older than our chronological age depending on how much work we do with our hands, while the neck has thinner skin and not a lot of fat, which is progressively lost with age, such that from our 40s onward, it can begin to age quite rapidly without a commitment to improvement.  As always, at Skin Essentials our aim and goal is a longterm holistic relationship with you, personalised for you and your specific concerns with a focus on honest, ethical beauty. Ready to start a conversation?   

The 50s are often the decade where it may feel like it all goes downhill, especially if you are female.  Perimenopause may have begun to make its mark known from your mid 40s, but it is often not until menopause that many women begin to struggle - the plummeting in oestrogen levels can cause an impact on most of our systems, from mood, to brain fog to dry skin, hair loss and more.  This is the time, if it is appropriate to do so, to talk to your primary care provider about your options including and especially for MHT or HRT, aka hormone replacement therapy. Menopause is nature's way of allowing us a reprieve from the draining and exahusting role of childbearing and caring for young children but with improved quality of life and function, many of us will live to our 80s and it makes no sense to be chronically miserable in our skin (literally!) and body and deprived due to outdated ideas of what we ought to accept as being normal; additionally a holistic approach will ensure that any in-clinic procedures we formulate with and for you will strengthen each other to help you live life to the best of your ability.  That said, your 50s are the time when if you've maintained some degree of care of your skin in the preceding decades, you will begin to see them pay off dividends now, as you continue to build on it.  Many women tell me they look in the mirror and no longer recognise themselves. Others regularly get unsolicited comments from colleagues and friends and family about how tired/ cranky they look as well as questions asking if they are ok. If these women are still working outside the home, this can be challenging and sometimes demoralising since we place such an emphasis on the way we present to the world and how we are seen based on it.  Even if you've thus far done the bare minimum or even neglected your skin, it's never too late to begin, as long as you have realistic expectations of what is and is not possible.  For many women who have done nothing to date and who find themselves disliking what they see in the mirror now which is usually a myriad of things- age spots (brown discolourations), deepening wrinkles even at rest and sagging skin due to volume loss. Sagging is by far, the biggest issue for this age group.  Many non invasive techniques may be insufficient and this may be the perfect time to consider minimally invasive surgical options or,  if budget and downtime allows, we can refer to plastic surgeons who can address this concern with you if needed via a face and neck lift.  If surgical options are not feasible for you, read on to see what else you may wish to consider to help improve your skin quality over the years and decade to come.  1. Eyelid Correction Surgery Often recommended for people in their 40s, this continues to be a staple for many people in their 50s also, not just for vanity but also because in many people the drooping eyelids which began in their 40s begin to affect functional ability, especially at the end of the day or when tired, when they might droop a bit more, or with the use of anti wrinkle when even a judicious dose of treatment to the forehead lines causes discomfort. Some patients also report chronic headaches that resolve post eyelid correction surgery.  This surgery is undertaken in clinic under local anaesthetic and most patients tolerate this very well. There is some downtime as with most procedures involving the eye area, and we would suggest a week or two of time off work, not due to any disability but due to expected swelling and bruising as the wound heals. Results are permanent and last years until further skin sags over the eyes again.  2. Dermal Fillers  If you first explore medical aesthetics in your 50s, it may be sagging and volume loss that brings you in for an opinion. Hollowing under the eyes, eyebags (which may only be amenable to surgery), excess skin around the eyes as well as jowling around the lower face and deep smile lines may be causes for concern as well as the seemingly overnight appearance of a double chin due to volume loss and sagging of skin from above.  Used judiciously dermal fillers may be used to replace some of the volume loss while we work on the deeper underlying issues, which will take longer and require planning, time and budgeting. The risk of too much dermal filler of course, is that they risk overfilling and leading to a caricature so it is best to stick to a practitioner who understands medical aesthetics and whose work you like.  3. Skin Therapies  By far and away, the mainstay of skincare in your 40s and up is effective skincare that is personalised to you and your concerns. In our 20s and sometimes even our 30s, we may get away with dabbling and trying every new trend that erupts on the scene, but by our 30s, we begin to see signs of a childhood with too much sun, or active facial muscles or chronic sun damage that never quite turned into an actual sunburn.  Fine lines and wrinles on animation as well as the appearance of dark discolouration on the skin begin to accelerate with age and over time if we do nothing in addition to progressive collagen loss that leads to a loss of plumpness and glow in our skin.  For most patients who are adequately volume replaced, my go-to in clinic is a combination of collagen induction therapies using biostimulator fillers 6-12 monthly as well as a series of skin therapies personalised to your skin concerns, with our skin therapist.  Most skin therapies take time, and a series of regular treatments to begin to see effects - usually 3-6 months minimum, in conjunction

For many of us, our 30s can be a time of much change. Many of us may have children, with pregnancy and associated changes, breastfeeding, chronic sleep deprivation and wrangling little children. Additionally many of us may be dealing with work outside the home at the same time, and making progression on the career ladder, with the requisite sacrifices of time and some quality of life in the process. These combinations of sleep deprivation, late nights and long hours, plus physiologic changes such as pregnancy, birth and raising babies, can all wreak havoc on our wellbeing, and our skin. 1. Hormone related changes may result in pigmentation that becomes very hard to get rid of and is mostly an ongoing lifelong management issue. 2. Fine lines and wrinkles may begin to make themselves known on our faces from decades of frowning, squinting and even smiling. 3. Skin begins to thin, and superficial blood vessels may become more apparent, with easier bruising. With the decreasing collagen that began in our 20s, skin begins to lose its plumpness and glow and for some, adult acne may make itself known. Chronic sleep deprivation and stress may contribute to overall slight decline in skin health and our general sense of feeling blah. It is never too late to begin however your 30s heralds a shift in focus from prevention to more correction and if you've done the minimum to date, you may find initially there will be significant upfront costs before maintenance. So here are some tips to halting the ravages of time and beginning to reverse some before the process worsens. As always, the foundation of great skin in your 30s remains the same: - daily sun protection - getting as much sleep as is feasible - limiting poor food choices - processed foods, alcohol- avoid or quit smoking as it's among the worst choices you can make for your overall health and shows on your skin, teeth and nails. - get regular exercise. - consistency with all of the above. 1. Personalised skincare including prescription skincare If you are noticing problems on your skin that you dislike, over the counter skincare may no longer cut it, and may even make matters worse.  Consider a trusted doctor who can help assess and treat your skin concerns including with bespoke prescription ingredients. Common skin concerns in our 30s and older include pigmentation, rosacea as well as acne. These are all skin diseases, and once present, may be tricky if not impossible to cure, so do yourself a favour and spend on a personalised assessment, diagnosis and treatment plan to manage these conditions instead of experimenting and risking making matters worse.   Skincare favourites in this decade of life, provided there are no pregnancy related concerns, are Vit A derivatives and Vit C alongside any others your doctor may prescribe. 2. Anti wrinkle treatments Unlike anti wrinkle treatments in our 20s, when some use them in baby doses for prophylaxis, by now, you may noticed the faint beginning of lines even at rest aka static lines- a combination of declining skin quality and receptive muscle movements. These are much harder to soften and take time, and regular anti wrinkle treatments are a great way to do this. The drug works by softening/ paralysing the muscles used in forming the lines such that over time, the lines are softened. Using smaller doses as preventatives in other areas of the face remains a viable option to prevent deep etched in lines a few years later. Additionally, anti wrinkle treatments help smooth out skin and pores, giving skin an added luminosity that is hard to beat when done well. 3. Dermal Fillers This is often the decade when we begin to notice a definite loss of volume in the face as the combination of chronological ageing, cumulative sun damage and lifestyle choices begin to take effect. Depending on our genetics we may notice the changes under our eyes, or our cheeks, with dark circles, or deepening lines around the mouth. In some of us, we may even begin to notice hollowing of the temples.  We may get unsolicited comments about how tired or sad we look. Dermal fillers work to replace some of the lost volume in our faces that give a hollow, gaunt and tired appearance. While they don't lift, they do replace some of the lost volume, creating the illusion of lifting and refreshing the face, in small amounts. Too much filler, however is a bad thing and risks venturing into the territory of the faces we see all around us - duck lips, Simpson lips, chipmunk cheeks and more so stick to the one injector who knows what they are doing and who takes a holistic approach to the ageing process. Importantly, ensure they know when to say no. 4. Laser neocollagenesis Laser toning or neocollagenesis is a great way to gently induce collagen production with little to no downtime. On the surface, it's simply a laser session that seems quite relaxing, and doesn't seem to do much immediately.  A series of sessions are needed for best results, as with all skin therapies, but the laser heats skin layers under the surface, stimulating your own collagen in the process. In the process and depending on the type of laser, it may also help with pigmentation and mild redness.  5. Collagen Induction Treatments Treatments such as skin needling, Radiofrequency micro needling as well as Aquagold, PDO threads and PRP treatments are among some of the options available to help induce your own collagen over multiple sessions to induce your own collagen that will last you upto 2 years at a time.  While the exact method may differ, and different options may be recommended to you based on your skin, your concerns and your budget, they all work by inducing your own collagen production where applied leading over 3-6 months to smoother, firmer skin that has that glow we all seek.  6. Radiofrequency treatments Radiofrequency treatments

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

At Skin Essentials, we focus on a holistic treatment plan, with the aim being a long term relationship between you and our team of practitioners.  As such, we encourage appointments so that adequate time is allocated to discuss your concerns, expectations and whether we can meet them in the allocated budget.  At present, it is our policy that all new patients have an initial consultation with Dr Joshi. This can be booked online or on the phone.    Prior to this appointment, we send you an email asking for information on you and your general health as well as your skin concerns, if any and what you’re hoping to achieve. It is in your best interest to fill this form out in detail prior to your appointment so we can set up a file for you, ready to go on the day of your appointment. During your consultation, Dr Joshi will be assessing your face and skin in real time, including your skin concerns. She will also be analysing your skin quality, while asking for a detailed medical history. Following this, she will conduct a skin analysis, including using equipment if needed, to assess for sun damage and (early) skin cancers, which will inform her advice to you and modify the treatment plan. At this point, if all is well, she will suggest one or several things, based on your concerns and needs: a skincare routine which can be basic, or more complicated, with prescription medication if needed Any preparation needed prior to any suggested procedures and when to book for review/treatment next Any procedure that MAY be undertaken that very day, at additional cost, if you are ready to go ahead A review date and further treatment as needed A written treatment plan for further treatment and a timeline and cost We focus very much on the assumption that like holistic lifestyle changes, the road to your best skin ever is one that will take time, effort and regular appointments as well as budget, and not usually something attained in a single consult or two. Skin, especially neglected skin, takes time.   At Skin Essentials, we believe very much in patient autonomy and do not want anyone to feel pressured or rushed into something they may regret, especially when it is all entirely elective, non medically necessary and involves significant sums of money.  We want you to be certain, and confident in our ability, not only during the procedure, but in the aftercare and ability to contact us for reassurance as needed.  Hope to see you in clinic soon to plan your best skin ever for years to come! 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:

What is interesting to me, and strikes me during cosmetic clinics, is that most people that I see, are drawn into cosmetic clinics by the (cheap) prices, BUT: – have no idea what they had in the past elsewhere (brand, anti-wrinkle vs filler; amount; injector experience and qualification)– sometimes I see these people because they have had poor experiences elsewhere and want correction, or because the clinic has closed; or because there is a special on- go in, tell them what you want, it is done and they are out the door. But did they get what they paid for, even if it was “only” $200? What is also interesting, to me, is the way consent is done- several people have had filler to their deep frown lines, without being advised, reportedly, that it can cause permanent, irreversible blindness. It is one of the riskiest areas to inject with filler due to the catastrophic consequences though theoretically, the face being a minefield, any part of it could lead These patients, “clients” have signed a consent form without an actual discussion of side effects and expectations. So what do you need to know about cosmetic injectables before you sign up, whether with me, or anyone else? 1. who your injector is.2. how long they have been doing this.3. what their qualifications are – at minimum they need, in Australia, to be a doctor with appropriate training; or a dentist; or a registered nurse working with a doctor who can authorise the medication for him/her, ONLY after a consult with the doctor.4. how do you feel with them? Do they spend time to get to know you or do you feel rushed? Do they understand what your concerns are, even if you think you know what you want/need? Are they willing to advise you if they believe your expectations are unrealistic, or if you may need more product than you have budgeted for? Are they willing to turn you away if what you are expecting for your budget won’t get you the desired result?5. Is there a followup planned with them? Do you have access to them if something does go wrong (and something CAN go wrong, it is a medical procedure, no matter how much it is sold as a beauty procedure.)6. how good is their understanding of facial anatomy, especially if something goes wrong? Can they fix the problem or are they likely to need to call someone else? So, having said all that, what CAN go wrong? None of these are my patients’ photos, but here are some examples from Google. Another more common risk is vascular occlusion or blockage of the vessels supplying parts of the face: This is not to scare you, nor to put you off anti wrinkle treatments or fillers. It is more to highlight the fact that I see too many people who attend for treatments at places where 1. price alone is the determinant of what is done. 2. consent is a token thing, a form for patients to sign, rather than a process whereby it is explained to each person the small but real risk of real complications. As I am fond of saying, “It is your FACE” and, “You get what you pay for.” 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

Common, recurring themes that come up when I am discussing treatment with patients is that of expectations, and cost. When I meet people for the first time, or they contact me to chat, if inexperienced, most are unaware of the basics – the difference between anti wrinkle and filler treatment for example. What each does and how it works. How long each may be expected to last. Different types – permanent, semi permanent and temporary Animal vs non animal origin Brands and costs Who the injector is (I often have to ask if they had to have a Skype consult to determine who the injector may have been), some of which is covered in my post last week I spend a fair bit of time, during the initial obligation-free consult discussing: your face, because every face is different- injectables are not a One Size Fits All approach your concerns what you think would help with your concerns your budget what I see, to help with your  concerns the amount of product you are likely to need, and the cost. So. What does appropriate financial consent mean and involve? a guide to how much anti wrinkle or filler a person is likely to need in TOTAL, even if we only use a fraction of that on the day. the amount of time over which that product is likely to be needed- usually 3-6 months initially and then for maintenance, around 3-6 months and then yearly. how much may be expected in terms of maintenance to help you decide if it is worth investing in. how much they need to budget for if they wish to retain the lip volume/ cheek volume/ wrinkle free areas. whether realistically this is something they wish to undertake, or spend on a holiday instead. Sometimes, I get it wrong, and it is not obvious till we have begun and I see product being sucked into someone’s cheeks, or their chin, or their temples. In that case, I think it is important to be honest. Without this information, it is not really informed financial consent. Sometimes people may be tempted to cut corners, to haggle, to ask for discounts, or to budget, and to get “half of what you say I need”. I understand the desire for that, I truly do. My response is still – “My job is to tell you what I think you need, and what the cost of that is likely to be. It is not to fit within a budget that will not give you the results you want, if your budget, or your expectations are unrealistic. Likewise, I don’t haggle because this is not just about the product, but about the service. If someone cannot value that, then we probably are not a good fit and you should keep looking for another injector.” Let me share some examples with you, especially around the area of fillers. Most people understand the principle of wrinkle relaxants- it’s a lot of money, but it’s relatively straightforward, with few things that can go wrong, and it gives you the most bang for your buck. Effects kick in as early as 2-3 days, peak at around 14 days and last around 3-4 months when a topup is needed. It gives you a refreshed, rejuvenated look that people notice and it’s immediate gratification. Fillers are a bit different. Work with filler, done well, takes time, good knowledge of facial anatomy and the effect though immediate, grows over time and serial treatments to avoid an odd looking face; the hallmark of fillers, if done well, is so subtle, only you and your injector knows that you’ve had anything done. People mainly notice you look fresh, less tired. That is the desired outcome BUT it may not be worth it to many, to spend thousands, to simply look “fresh”. It is more a delayed gratification. By the time most people notice enough that bothers them, they’ve left it too late and need decent volumes of fillers- around 2-3mls in someone in their late 20s and 30s. Upto 8mls or more over 6+ months in someone in her 60s. So financial consent at the beginning is essential- there is no point charging someone for 2mls and $1200 if you know they’re unlikely to follow through with further treatment they need in 3 months. Fillers build on each other and each layer and can last for a year or more. By the time most people notice enough that bothers them, they’ve left it too late and need decent volumes of fillers- around 2-3mls in someone in their late 20s and 30s. Upto 8mls or more over 6+ months in someone in her 60s. So financial consent at the beginning is essential- there is no point charging someone for 2mls and $1200 if you know they’re unlikely to follow through with further treatment they need in 3 months. Fillers build on each other and each layer and can last for a year or more. Some examples: These are just some examples of people I see regularly. Most of these patients don’t want to look fake- they are professionals, with careers- they want to look subtly refreshed and rejuvenated and to feel better about the quality of their skin. Filler is a great way to achieve that as the product stays under the skin for 6-12+ months per treatment session and reduces need for more potions and lotions. Additionally, the process of injecting these products acts in a similar fashion to microneedling and other techniques, stimulating more natural collagen production- win/win! 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.auBook Now

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.

I often get people coming in and asking for filler, afraid it’ll change the way they look, or be too obvious. Most of the time, they underestimate how much they need; occasionally, I get caught out too. Most people don’t want to look like The Real Housewives of Sydney. They don’t want to look fake, fat or like they’ve had filler or botox. They simply want to look like the best possible version of themselves. To these people, I always say, that filler, if done well, is almost unnoticeable. The change is gradual and subtle. Likewise anti wrinkle treatment. YOU know something has happened, but the results are subtle, and usually, due to the cost involved for most people, gradual. Rather than going for what’s cheapest, possibly to regret it, I suggest budgeting for what’s better, if more expensive. There’s a reason why chain clinics are cheap. So, let’s look at some examples of cheek fillers, and how they work to help with many “problem” areas on the face- eyebags; nasolabial folds and marionette lines; jowls. Here, this lady had 1ml to each of her cheeks and cheekbone area in total as well as in her tear trough area, with significant improvement in her downturned mouth as well as nasolabial folds/lines. With age and further fat loss in the cheeks and around the jaw near the angle of the jaw, skin pools around the jaw, giving a jowled appearance. As may be apparent by now, many signs of ageing are related to loss of volume from the midface so correction necessarily begins with replacement of this volume with fillers in this area first. And filler is never wasted- the 1-2mls you spend money on, even if results aren’t striking, goes to form the base for further filler that will effect a change, and last anywhere from 9-12 months or more, depending on thickness and where it is used. So it’s money well spent, and an investment. Want to know more? Get in touch, make an appointment and let’s set up a treatment plan for you with Dr Joshi. 

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!