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

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? 

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.