In January this year, the Therapeutic Goods Administration of Australia, aka the TGA, surprised the non surgical cosmetic industry with the news that we are no longer allowed to use common terms to describe some of the services we provide, using the drugs used in those services. Medical aesthetics can no longer use certain terms and those terms will be going away? What Kind of Terms are Changing in Medical Aesthetics? Terms that you commonly associate with the services you receive from a medical aesthetics practitioner are no longer able to be used in advertising, information on websites, and other key places. Anti wrinkle treatment Dermal filler Biostimulatory filler Fat dissolving injections You get the idea. What Do the New TGA Guidelines Say? It sent the industry into a panic and the TGA took its guidance offline to await confirmation. As of 7th March 2024 it had finalised its guidelines, and the new changes will go through, effective immediately. What do they say in essence? Historically, the TGA has allowed indirect references to prescription medicines to be referenced in advertisements related to cosmetic health services. This was allowed only in the context of promoting the service and only by using generic non-product specific terms such as ‘wrinkle reducing injections.’ Express references to products or ingredients themselves, such as ‘Botox’ or ‘botulinum toxin’, were not permitted. The TGA considered this a pragmatic approach which would allow cosmetic clinics who offered these services to differentiate themselves from those that did not. It goes into further details, the gist of which is essentially: we are no longer allowed to refer to those terms as they allude to the use of prescription drugs we are no longer allowed to use before/ after photos that suggest the use of prescription drugs eg before photo with someone frowning, and after photo without the frown; or a before photo of someone with thin lips and after photo with plumper lips etc Why is the TGA doing this? Recently, the TGA has observed that clinics and health services in other industry areas are advertising the availability of prescription medicines, usually by referring to a class of goods (for example ‘weight loss injections’, ‘medicinal cannabis’ or ‘nicotine vaping products’). The TGA has interpreted that promoting a health service in this way is also an advertisement for a therapeutic good that refers to prescription medicines, which is unlawful. The update aligns with the focus of other regulators on health professionals performing non-surgical cosmetic procedures and acknowledges the increasing vulnerability of Australians influenced by advertising in the cosmetic space. Prescription only medications carry higher risks than goods available for self-selection. Decisions about treatments that involve the use of prescription medicines should only be made by a health professional in consultation with each individual patient. In brief, as with all other means of prescription medications, a face to face consultation is the first step to addressing a concern in collaboration with your medical professional/ doctor to then determine next steps, treatment and whatever drugs that might involve. As you can imagine, this has the industry in a tizzy all over again. Do the TGA Guidelines Change the Medical Aesthetics Approach at Skin Essentials? At Skin Essentials, we’ve never advertised drugs by prices, nor by before/ after pictures such as above. We take a holistic full face approach to the face in front of us at a paid-for, non redeemable consultation designed with one thing in mind : understanding and addressing your aesthetic concerns determining if they can be helped or if you need another expert eg a plastic surgeon determining if we are likely to work well together ie a good fit determining if you have any vulnerabilities that make you unsuitable for cosmetic work or have unrealistic expectations determining the timeframe to get you results determining the cost of those results, which is significant determining if you are in a position, psychologically as well as financially to commit to the process as outlined If we tick all those boxes above, then we start. If you or I cannot tick any of the list above, then we don’t start, but you’ve had some idea as to what the cause of your concerns is, what is needed to correct them if/ when you are ready to begin. So from our point of view, not much will change to our processes at Skin Essentials. What *will* change is the ban on educating the general public on social media and the stern limitation of terms I can use to do this. Media from the USA and UK and other parts of the world continue to flood our feeds, with drug names and explicit videos of procedures. I used to use this for educational purposes but I will no longer be able to do this as this would be a violation of the TGA rules. While the goal and aim of the TGA is to stop unscrupulous operators from enticing and luring vulnerable people into medical aesthetics, often from a very young age, the reality is that since these changes were announced, the rogue operators, who continued to operate during Covid lockdowns, continue to post and use the terms “anti wrinkle”, “dermal filler” “nose filler” “biostimulatory filler” and more. As I’ve said before, I suspect they see pesky fines and disciplinary action as the price of doing business. As a small business, I can’t afford to do this nor do I want to. One of my strongest stances at Skin Essentials is our ethics and our values based approach to patient care. That won’t change in coming weeks and months as we pivot to find a new way to educate people without using terminology illegally. In the meantime, we ask our current patients to help others find us by leaving us honest feedback of their experiences with us in clinic given social media is being heavily censored going forward to help us stay in business. Thank you for your ongoing support and we hope to see you

With the introduction of a new class of injectable diabetes drug that hit Australia in 2022, used off label for weight loss, the term “ozempic face” has really taken off in recent months. The drug, which is injected weekly, is approved for the treatment of certain types of diabetes and is a game changer in terms of regulating appetite and resulting in rapid and sustained weight loss with continued use, which leads to improved diabetes control. No wonder then, that when there is rapid weight loss well in excess of the safe limit of 1kg/week, a lot can happen. As the saying goes, after 40, you choose between your face and your body, but you can’t have both. As a general rule, I typically advise my regular patients against rapid, drastic weight loss/change, without a proper discussion first around the pros & cons - on their bodies & the biomechanics of weight loss as well as on their skin & face. Rapid weight loss, at any age, leads to a dramatic loss of skin elasticity that often cannot be entirely corrected, often requiring surgery for function as well as aesthetics. When pts ask me as part of treatment planning, my advice is always to undergo it as slowly as possible, aiming for a longterm, lifestyle change, rather than as a fad and to do it under supervision & to recognise that beyond a point, they WILL sacrifice the face for the body - they get to decide which based on their priorities. As with any rapid weight loss methods such as lap band and gastric sleeve surgery and now this class of injectable drugs, the body is placed under immense stress, which results in several physiological mechanisms to protect itself during “starvation”, and it is important patients understand this.  Common changes include but are not limited to : loss of fat in desired and undesired parts of the body, including the face. hair loss as a response to the stress of rapid weight loss which may be temporary or permanent loss of elasticity (ie spring) in the skin, leading to sagging since volume from skin quality and underlying fat is the main factor that contributes to a youthful appearance , fat loss results in a gaunt appearance, which can be very ageing Depending on the amount of weight lost and baseline skin quality as well as the patient’s age at time of the weight loss, they may suffer from enough sag that surgery may be their best option. Even so, volume replacement via fat transfer is likely to be needed during surgery.  If they’re younger, and not planning excessive, rapid weight loss, I suggest a plan we can follow to keep the worst of the effects at bay, even if they’re planning on eventually having surgery once their weight has stabilised and they’ve maintained it for 6-12 months, which is usually recommended prior to surgery.  The treatment plan would usually encompass multiple treatment options in stages as they begin to lose weight, and include addressing lines and wrinkles that may become more pronounced, as well as replacement of volume loss in the face and neck, with different types of fillers, for rapid replacement as well as for stimulation of your own collagen for slower volume and skin quality replacement.  Lastly, they may need measures to address hair loss, both maintaining what is left and helping regrowth of lost hair due to the weight loss, which may be temporary or permanent.  As always, with adequate planning and collaboration, it is possible to support patients as they shed the weight with minimal effect, provided they’re motivated to keep showing up and budgeting appropriately. Having said that, weight loss, if rapid, is not something to be taken lightly or entered into on a whim & requires planning to help patients navigate it well.    

It’s here! After 7 years for TGA registration since it launched globally, the new biostimulatory, bioremodelling filler aka Skin Honey is here and at Skin Essentials. Why all the fuss? See for yourself!   It boasts the ability to hydrate skin, like many Skinboosters, upto 20x more in addition to stimulating your own collagen and elastin over time, for sundamaged, crepey skin on the face, neck and hands over a series of treatments.           The pictures certainly seem impressive and the track record for complications are very reassuring the world over, who has had 7 years on us in terms of real time experience with this product. So who’s it for? - the only person it’s not for, truly, is the pregnant person while they are pregnant. - risk profile is very safe, with minimal downtime and ability to work over time on just about any skin type. - it seems best suited to aged, sundamaged, crepey and volume depleted skin to restore some of this, like all biostimulatory fillers, with the added benefits of hydration also.   How does it work? For the month of November only, if you are new to Skin Essentials, consultation to discuss this treatment ONLY , is complimentary and your booking deposit is redeemable towards treatment using this link. For current patients, if you are booked for treatments and wish to add on this please email us so we can set aside a box for you as stock is strictly limited and once we run out, there is no further stock expected till February 2023. What is involved? - this type of filler does NOT volumise but rather hydrates deeply and stimulates your own collagen for glowing, healthy skin over weeks to months. It is a gradual treatment, like all biostimulatory fillers. - initial series of a minimum of 2 treatments per area 4 weeks apart eg face, or neck or hands = 1 area. - some people see enough of a difference, especially if they have significant sun damage and crepeyness, that they may opt for a third session 4 weeks after the second. - each treatment needs a minimum of 2 sessions for best results. - cost is $900/syringe. Each syringe is 2 mls. - $1800 for 2 treatments to one area 4 weeks apart - $2400 for 3 treatments at 0, 4 and 8 weeks to one area, paid upfront. Downtime is minimal and results can be seen and felt as early as the 4th week, just in time for summer and Christmas. So if you are keen, don’t delay, stock will run out when it does until February 2023.

Ok, so we’ve been getting a lot of enquiries about biostimulatory fillers, and we wrote a post on one of them here. Here is the other one on offer here at Skin Essentials, also known as calcium hydroxyapatite. What do you need to know about it to help you decide if you might be a candidate for it? Here is some initial information :  FDA approved since 2006 versatile biostimulatory filler to restore volume loss and improve lines and wrinkles also the only FDA approved injectable to date for use for rejuvenation in hands like other biostimulatory fillers, NOT reversible (so choose your clinician wisely)    How can it be used?  1. As a straight out filler, for cheeks, jawlines and more, where it has among the best ability to volumise sunken faces.  2. Diluted, in a ratio of 1:2 or higher, as a “wash” under the skin, to improve fine lines and wrinkles, crepiness, acne scars and even cellulite. Used this way, it can be used for overall subtle rejuvenation of the face, neck, hands, arms, abdomen and buttocks to improve skin quality by inducing collagen without adding volume.    So how does this filler work?  unlike hyaluronic acid fillers, the base material is calcium hydroxyapatite which stimulates collagen induction offer time. like HA fillers, CaHa works immediately to provide subtle volume and improvement to the treated area and over time, as the gel carrier is absorbed by the body, it stimulates your own collagen which lasts 18-24 months. used as a hyperdilute wash, this improves texture of skin where it is injected including in areas affected by chronic sun damage such as the face, neck, chest and hands.  Are there any side effects?  As with any injected medical procedure, commonest side effects include bruising and swelling and temporary lumps and bumps.  There is minimal aftercare unlike with the other brand of biostimulatory filler and I’d suggest 2-3 sessions in total a month apart for the initial course and then annually to maintain.  How much are you likely to need?  This filler comes in syringes of 1.5ml usually. Depending on the part of the body being treated and whether it is used diluted or undiluted will make a difference how much is needed.  Here is a guideline as to number of syringes needed, though the consultation is designed to address this with an accurate quote as well as detailed informed consent prior to proceeding with treatment (usually on another day unless time permits).  face and neck - usually a single 1.5ml syringe each per session hands - usually a single 1.5ml syringe for both hands, diluted to 3mls total buttocks - 1 syringe per cheeks for cellulitis and sagging skin (not for non surgical BBL which is much more) thighs - 1 syringe per thigh area (inner or outer) abdomen - minimum 2 syringes arms - usually 1 syringe per arm  2 sessions are initially needed for any given treatment area, spaced a month apart then repeated 6-12 months for maintenance and results last upto 2 years. 

Biostimulator fillers seem to be on the rise and gaining popularity rapidly. We are seeing many more enquiries for these fillers compared to years gone by, including from patients prepared to travel some distance who want to have the initial consultation and treatment on the same day, especially with poly-L-lactic acid. Due to Australian AHPRA regulations, we are not permitted to use drug names here. Invariably, the answer to consultation for a new patient and treatment on the same day is a no. Why is that, especially if they are coming from some distance? Read on to find out! There are two main brands of biostimulator fillers on offer at Skin Essentials, brand S and brand R. The one we are discussing here, is brand S  The aging process catches up with us all eventually, as seen in the loss of skin elasticity, sagging as well as (deep) lines, wrinkles and seemingly enlarged pores. The bulk of these skin changes are due to progressive collagen loss over the years:  we begin to lose around 1% of collagen production from our mid 20s for women, the menopausal process accelerates this through loss of oestrogen, with an estimated 30% collagen loss over 5 years thereafter, collagen loss continues at an accelated rate in women at 2% per year by age 70, it is estimated we’ve lost 80% of our collagen producing capabilities  So in addition to bony changes with ageing, most prominent around our eyes, our jawlines and around our mouths, thinning and sagging skin due to collagen loss over time contributes in large part to the loss of youthful glow in most of us.  This is why, beyond volume replacement, rejuvenation and maintenance should rightly shift to collagen induction and maintenance of healthy, supple skin in a variety of ways.  So what is this brand of biostimulatory filler and how does it work?  1. Full Face Rejuvenation  it is an injectable powder that is made up to form a solution that is injected into the skin where it stimulates collagen production it is usually an initial series of 3-4  treatments a month apart results are gradual, from around 6 weeks, look natural and last longer than most other injectables, as it is your own collagen. In studies, results lasted at least 25 months by inducing collagen production, this product works to restore some of the underlying structure of the face/ body that has become gaunt due to significant volume loss and improves skin radiance by thickening skin quality the added fullness, over time, improves the appearance of fine lines, wrinkles and folds. Bony areas can be softened and gaunt areas of the face, such as under the cheeks, and temples, can be rejuvenated also.  2. No PillowFace  the initial course recommended is 3-4 treatments a month apart over areas of the face that need the volume and skin improvement thereafter, maintenance is recommended with a single session annually unlike hyaluronic acid based dermal fillers, which can look overfilled, this is not possible with biostimulatory fillers, which can only stimulate your own collagen production, done well  3. Long Lasting Results  in studies, treatment with biostimulatory filler lasted at least 25 months, and likely longer. because it stimulates your own collagen production, with care to protect and maintain this collagen, the results are much longer lasting than many other treatments.  4. Low Maintenance Treatment Option  initial treatment is a series of 3-4 monthly sessions with a significant cost depending on how many vials are used thereafter, maintenance is a single annual session this is a great option for the face, crepey skin in the neck as well as décolleté and hands    Sold? Great, so why can’t you have it on the same day as the consultation, especially if you’re already familiar with it via Google?  1. Adequate informed consent is key  Results depend on the injector and their skill but no outcome can be guaranteed as the medication relies on your collagen induction powers AND your compliance with instructions  training for biostimulator fillers is not as common as with hyaluronic acid fillers. they’re also more expensive than hyaluronic acid fillers, especially for the initial course of treatments in terms of time commitment, consistency and budget this is not a treatment to be having with a new injector (or a new patient whom I do not know well)  2. Biostimulator Fillers are not reversible  unlike hyaluronic acid fillers, which can be reversed in the event of an adverse outcome, all biostimulatory fillers are not reversible in the event of an unexpected side effect or if you do not like the result  3. There is some aftercare needed and some side effects are reliant on aftercare  with this biostimulatory filler, I advise people to massage the treated area 5 times a day for 5 minutes, for 5 days, firmly. I show them how to do this to distribute the filler evenly among the tissue where it was injected, unlike with hyaluronic acid fillers lack of attention to this, rarely, may lead to nodules that need to be surgically  4. Results are gradual, over months  patients need to understand this they need to commit to the initial 3-4 sessions monthly and budget for it as delays will lead to a suboptimal result they need to understand aftercare and commit to it to minimise risk of adverse outcomes  5. It needs preparation prior to injection because it is prepared as a powder, it needs to be diluted and prepared with adequate mixing at least 24 hours prior to injection, preferably slightly longer. at Skin Essentials, this usually means that we spend our time in consultation addressing your concerns, assessing your suitability for it, and then talking you through what is involved including aftercare and then giving you some time to think about it and decide without any pressure. should you decide to go ahead, you’ll be required to pay an upfront non refundable deposit of 50% of the cost of each session before we start preparing