Injectables! Despite the booming popularity of these office procedures, there are many people who are still new to the choices available, and who may enter their 30s, 40s and even their 50s, having never had a needle near their face. On these occasions, I like to allow for enough time to address concerns, answer questions and sometimes, manage unexpected anxiety that may rear its head as they get on the treatment bed. Some say to me “I was all psyched up, ready to go, when I booked and signed the consent form, but now I’m having second thoughts…” Why these second thoughts? At Skin Essentials, we mail out as many of the relevant forms to you prior to your appointment to fill out as possible, to maximise your allocated appointment time in clinic with your treating doctor. So common side effects we warn you about: bruising swelling temporary headache (with anti wrinkle injections) lumps and bumps (with fillers) asymmetry (fillers and anti wrinkle)   Additionally, we talk to you about rarer side effects and some medical emergencies, so it is no wonder some patients, on reading consent forms, begin to worry.  Informed consent is an important part of any consultation and not something to be simply rushed into. Equally, it helps you prepare to minimise the chances of adverse effects on the day. Having said that, how can you present to your appointment and have the best possible outcome? 1. No makeup means no makeup. Patients will often present with a full face of makeup, or “on my eyes since you’ll be treating my cheeks” etc. For anti wrinkle, it is less important than fillers, which are semi permanent implants, but an absolutely clean surface is vital to reduce risk of contamination of equipment and minimise risk of not only infection but also nodules down the track. This is non negotiable for me, not to mention makeup affects the quality of the pictures we take for our records and makeup removal especially of layers, can take up precious time in clinic. 2. Hair tied back or off the face Another big thing. Taking pictures before and after procedures is part of the process and hairstyles and hair in the face can affect results so it is imperative that hair is held off the face, and that you come with suitable hair bands and ties to do this, and during the procedure also. 3. Please avoid any supplements and medications as well as social drugs that may increase risk of bleeding Common culprits include Vit E, ginseng, fish oil, ginkgo biloba and some medications such as aspirin and ibuprofen. Also, alcohol. All of these will increase risk of bleeding and bruising. 4. Please plan to go home after the procedure and ice the area treated Patients often plan their treatments just prior to a lunch meeting, or a shopping date, and while with many minor procedures this is fine, if we are doing a fair bit in one go, it is safer to simply go home and to keep icing the area for best results and to minimise bruising risk. 5. Please don’t plan to exercise or get a facial or a massage immediately before or after your appointment Lying face down for a massage or having a facial may move freshly injected medication to an unwanted area, so these procedures are off limits at least for a day or two. 6. Please plan your injectables at least 2 weeks before any big events such as birthdays, weddings and more. Some of this is logistics - it takes anti wrinkle injections anywhere from 3-5 days to begin to kick in and to peak at 2 weeks. Fillers can take 2-4 weeks to settle and lumps, bumps and some asymmetry are common. Likewise, bruising is a common and well known side effect of all injectable treatments, so please plan these at least 2 weeks prior to any big events. 7. Please plan your appointment at least a week prior to any planned trips and flights away I like to have patients around for at least 2-3 days post treatments in the event that there is an unexpected and serious side effect. There are limited options to help if you are interstate, or worse, overseas. 8. Keep your mind open and your expectations realistic This is a big one. Please be guided by your clinician as to what is possible with your unique anatomy rather than insist on what you have seen on social media, complete with filters and photoshop. The face is a highly mobile area of the body, and subtle changes can make for big impact, but only if done well. Have an idea of what you’d like, but be willing to listen to your provider and take their advice on board if it is not possible (or out of your budget). What else would you add? What else would you wish to know if you were to consider injectables? 

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