It's interesting to us here at Skin Essentials that we frequently see patients, who have either been to several other clinics before finding us, or who used to see us and then went elsewhere, only to eventually return, that we hear the following feedback from them: I went there because it was cheap and what could go wrong with some anti wrinkle injections right? I went there when I had an issue to fix that bothered me and wanted something done about it. I went and got lip filler/ cheek filler when I felt I needed it. I went there because I could take my child/ children in with me. I went when I had the money to treat myself. For the vast majority of us, this is probably a fairly typical number of reasons why you might go into a clinic for a treatment - for a pick me up; to fix a problem you noticed in the mirror; because it's cheaper than high-end clinics and more. So the second part of the above statements, that I also hear of from patients is the following, beginning with "but..." : it was rush in and rush out. there was no time to discuss anything, or make a plan I felt like they'd treat what I said was a concern, until the next time I went in with a new concern some of the results weren't the same as when I was coming here. I didn't feel like there was someone overseeing the plan, telling me when to show up, what to do in between I didn't feel like there was someone in charge other than me, and I didn't want to be in charge. When it comes to medical aesthetics, I'll be the first person to tell you to choose based on your desires, wishes and willingness to budget. There's no point choosing a clinic such as ours, where our signature approach is full face restoration and planning over some months, then maintenance, if all you want is some anti wrinkle or lip filler on demand. We will both be disappointed. At the same time, one of my favourite sayings about any service is, that it can't be good AND fast AND cheap. So at best, you can have 2 of the 3, so which 2 will you choose? In my experience, people who compete mainly on price do so because they don't have much else to compete on (yet) - they are usually new to the field, and building their skills. People who are good, are rarely cheap. And depending on how long you've disliked what you see in the mirror, the extent of sundamage and lifestyle choices, and your willingness to show up and to budget, we will be spending weeks to months to correct the many issues that bother you, and then work on a maintenance plan going forward. At Skin Essentials, there is no one size fits all approach to any face, at any age or stage of life. Each is unique and beautiful. Equally, our values and ethos means that if you've left it too late and surgery is your best option, we will say so to you, instead of taking your money to disappoint you. Occasionally we will have patients who do not wish to have surgery, understand the limitations of non surgical approaches and choose to proceed anyway. Either way, it begins with a comprehensive consultation with you, to assess your concerns, your plans, your willingness to budget and to be held accountable and to begin. On average, it will take anywhere from 3-12 months to get to results and maintenance, so you need to be aware of what is required of you. Along the way, we will spend the necessary time, we will hold your hand if needed and we will make changes slowly as skin and faces take time. Medical aesthetics done well, is not an impulse buy, nor a DIY project, but rather similar to orthodontics or planning a bathroom renovation - it takes planning, assessment, budgeting and some weeks to months of inconvenience where you entertain doubts and show up anyway, to get to the end goal. Most of our patients who have taken this road, tell us it is well worth it.

The most seasoned business owners know firsthand that in order to succeed, you have to be willing to fail, sometimes many times over. Each time this happens, you pick yourself up and keep moving, learning from what worked, and what did not. Why do this to ourselves? While it seems like an exercise in self flagellation, the key is in the mindset it teaches you. I’ve learnt far more from my failures than I ever have by cruising and through success, even if none of us actively chases failure. In many ways, failure teaches us what we are truly made of, and teaches us grit and resilience. So why is this relevant in 2023 to Skin Essentials? In 2023 I am bringing about changes to the way I do business and I’m terrified if I am honest. Terrified because it’s raw, honest and comes from a place of wanting good for my patients, my staff and myself. Terrified because honesty, no matter how kind, can always be taken the wrong way when people receiving it feel defensive. Terrified because there’s always the fear that in making the changes, I will lose business and my business will tank and…and…and… I’ve done a lot of hard things in my life, as we all have; and one of the things I love about myself is my innate optimism, my ‘glass half full” approach to things especially when they are hard, and the immense privilege I have of having an education in a field where, even if Skin Essential does tank and I do close, I’ll have other options. So what are the changes and why? I entered medical aesthetics reluctantly in 2015/2016. I really didn’t want to do it because of all the fake faces I saw around me. It seemed fake, vapid and entirely unnecessary. At the same time, I was beginning to see early signs of ageing in my own face and a visit or two to the local chain clinic for skin needling left me with disastrous and painful results. I was stumped for next steps based on evidence rather than hype and fads. So I began to look into it, initially for myself, then as my knowledge increased I met patients and friends who wanted someone reputable, who would do good work, give them results and a longterm plan for ageing well. Like me, they were mostly women who had tried many things and had little success, and occasionally bad outcomes and they wanted someone they trusted to do the planning for them, so they could just show up, and get the work done and be told what to do. These are my best longterm patients, who come in when told to, get on the chair and say “whatever you think best doc!”. They trust me, trust the process, are realistic about what is achievable including over what period of time; they are patient, they remain calm with common side effects such as bruising, swelling, lumps and bumps and they show up. These are, quite simply, my ideal patients. Price is important, but not the most important factor, and as long as they know what they need to save in time for the next appointment, they plan appropriately. In 2023, I am moving away from a lot of the interactions that I found draining in 2022 with patients who, quite simply, were not aligned with me and the way I work, in part as I was not clear enough about it. So what are some examples of patients for whom I am unlikely to be the right doctor?  1. They are not looking for a longterm plan to help them age well.  Full face rejuvenation is my signature treatment and the one that gives me the greatest joy and the best results for my patients.  I am really not a fan of just some anti wrinkle to one area and  lip/ cheek filler as and when a patient feels they need more and orders some. It is not how I work. I look at the whole face as pieces of a jigsaw puzzle - as the ageing process begins to take hold, pieces of the puzzle go missing, and it takes more than just 1-2 mls of filler or some anti wrinkle treatment initially, to begin to correct this. For those patients who start at a good time, as early as their 20s and early 30s, it’s true that initially there’s not much to do beyond a focus on the basics including excellent, personalised skincare but having a comprehensive plan allows us to stay on top of it and to plan for what is likely to come and to prepare for it. These patients may need either occasional enhancement eg lip filler or maintenance by way of some anti wrinkle treatment to target early lines and wrinkles, some undereye correction and any other early signs of ageing. Costs are usually around $3000 a year or thereabouts depending on where you start and what’s needed. The older patient, as early as mid 30s and up, needs far more work if nothing has been done until then. This is the work I refer to as restorative. Many pieces of the jigsaw puzzle are missing and there are changes under the skin that need to be looked at. For these patients, the work involved at the beginning is more extensive over several months, usually in stages to get to maintenance and involves skin improvement as well as injectables and possibly permanent fat dissolving. Costs are typically $6000-10000 during this period depending on what is needed then maintenance is closer to $3000 a year or thereabouts. I won’t do just tear trough filler when what you need is mid face support to your temples and cheeks also. I won’t do just lip filler if you also need support around the mouth and to the chin to avoid a Marge Simpson lip. I won’t do just some anti wrinkle so your forehead and upper

On 10th January 2023, aesthetic journalist Alice Hart Davis, who is turning 60 this year, was featured in a Daily Mail UK article on the treatments she’s had over the past 20 years entitled “I’ve got 20 years of filler stuck in my face - it’s meant to dissolve over two years” While the title is sensationalistic the overall message from the article is one that sensible injectors (and I like to think of myself as one!) have been saying for years - you do NOT need to have filler “top-ups” every 6-12 months as the industry training companies will often tell you because fillers can last far longer than we first believed, upto 11 years, as it turns out, depending on the individual, the brand and type of filler used and more.  So does this mean all dermal filler is bad and we should all abandon it? Alice says no, as do I, with my thoughts on her article as well as what I regularly discuss with patients in clinic and my advice around dermal fillers.  Choose your provider carefully, ensure they’re an expert and stick to them. one person/clinic for your face it does not have to be me (I say this in clinic to every new patient also)  is experienced and does their job well including complications management  the skill is in repetition over thousands of hours and many years, not in a 2-day or 2-week boot camp or doing this on the side  choose your practitioner based on their skill, not price of product - the same product in 2 different hands can yield very different results if they are cheap, there’s a reason for it; what corners are being cut or are they practising on you?  medical aesthetics is entirely discretionary and my advice usually is, if you can’t afford it (yet), keep saving; it’s better not to start than to start and stop as there can be an initial phase where it may look/feel like you are going backwards. Think of it like a home renovation - it can look & feel crappy while you are in the middle of it.  realistic expectations and managing your anxiety around slow results, and common non urgent side effects is vital; medical aesthetics is usually for patient people  trust in your provider and what they suggest. It’s ok to have a plan in mind, but go in with an open mind and be prepared to listen to the advice of the person you’re consulting.  Filler for enhancement, maintenance or volume restoration are different. younger people, mostly young women, commonly seek lip enhancement if they have genetically thin or asymmetrical lips. For these cases, 1-2 mls in 2 more more sessions is usually enough, and maintenance with additional treatments only as and when needed every 12-18 months or longer.  for maintenance from as early as our 30s, filler can be used to subtly replace early volume loss before it’s very noticeable and the standard guide tends to be 1ml (the size of a blueberry) per decade; so for someone in their 30s, you’d expect around 3-4 mls just to maintain volume. Keep in mind a ketchup packet is 5mls.  volume restoration is different entirely which is what Alice likely had when she began in her late 30s/early 40s, the typical age I start seeing women wanting to address persistent signs of ageing that they can no longer ignore, among them volume loss. When volume loss begins to take its toll on our face rarely as early as our 20s, they can present as hollows under the eyes, flatness around the cheeks and temples as well as prominent smile lines and early laxity around the lower face. Restoring lost volume can take far more than the 1ml/decade rule, easily double that in most cases, until maintenance is reached.   Once you’ve reached maintenance, less is more. while there is no doubt that the initial outlay for a holistic full face rejuvenation is expensive the longer you leave it to begin, I always compare it to other discretionary spending we all undertake - holidays away; home renovations; orthodontics; designer fashion and more.  thereafter, maintenance is far more manageable and given what we know of the longevity of fillers now, placed well, it can be the gift that keeps on giving for many more years until there is further volume loss due to the ongoing ageing process.  at this stage I actively discourage my patients to focus on other modalities to maintain their results.  For maintenance of skin quality without risking pillowface, collagen inducing therapies are my preferred treatment  when you pick a clinician with significant experience and a wide skillset, you’re more likely to have a bespoke holistic plan devised for you that avoids overcorrection and odd results.  at Skin Essentials, our focus is always on using dermal fillers in the initial stages to replace volume as quickly as your budget will allow, while working on skin, lines and wrinkles in the background, and then maintain with skin therapies and other collagen inducing modalities such as biostimulatory filler, which dissolve in a reliable manner to induce your own collagen in the process.  If sagging  is your biggest and most pressing concern especially if you are also postmenopausal, you should not delay surgery if you can afford it.  at Skin Essentials we pride ourselves on holistic, evidence based medical aesthetics  we would never feel comfortable taking your money or selling you a product or service that we didn’t believe was right for you.  fillers do not lift, they only replace volume which can subtly provide lifting effect in some faces if at any point what worries you isn’t amenable to non surgical or minimally invasive procedures, I’ll be the first to suggest a referral to a plastic surgeon as there is no reliable way as yet to LIFT skin without surgery.  The take home message from all of this?  dermal fillers in experienced hands are exceedingly safe and risks are rare but not

A cosmetologist in her late 50s in the USA posted recently about her skin transformation over 7 years and the true cost of it and it got me thinking. Much of the beauty and aesthetic industry is on an race to the bottom: they hire junior doctors and nurses to perform injectables purchased wholesale at bargain basement prices, with minimal training and minimal followup. consultations are cursory and complimentary and designed to convert on the day to people walking in expecting to pay hundreds to order a treatment off a menu irrespective of whether they’d be suited to that treatment.  In many cases, this is fine, there is definitely a market for this, and for those who don’t need much done, and want a quick pick-me-up, this is an absolutely ok model with lower risk treatments and no real problems to address.  This, however, is not the case for many as early as our late 20s and more typically our 30s and beyond.   By the time we get to our late 40s and early 50s, many, if not most women, if they’ve not had anything done till then, will begin to be reasonably bothered by what they see in the mirror, prompting online searches, a foray into online groups for advice, following influencers to see what their skincare routine is and even seeking a complimentary opinion from one of the clinics mentioned above, for guidance on how to fix what bothers them.   Many may decide not to pursue anything, and we have women who talk about this such as Mia Freedman on her notox stance .  On the opposite end we have beauty influencers such as Caroline Hirons known for speaking out against clean beauty and who is also a lot more open about spending on skincare as well as toxin and fillers. And who has drawn the line at plastic surgery for herself.      In your 20s, as a general rule, much of skincare, including injectables and skin therapies, tends to be relaxation and enhancement if there are no skin disorders such as acne. You may have lips that are thinner than you’d like, and 1-2 mls of filler is a quick and simple fix to address this.     In your 30s, these changes begin to become more pronounced: sun damage adds up lines and wrinkles become more apparent, especially if skincare has been minimal to date volume loss in the face leads to hollows, shadows and even sagging which can be distressing and invite unsolicited comments from others.     These changes, once present, will only worsen in our 40s, 50s and beyond as the perimenopausal and menopausal years set in alongside the relentless ageing process which is inevitable irrespective of what we undergo by way of skincare, in-clinic procedures and even surgery.            Depending on when you choose to begin your journey to ageing well, IF you choose to do so, the costs will begin to add up quite quickly at least initially, especially if there is a significant degree of effort needed to first halt or even reverse some processes eg acne with scarring; pigmentation including sungamage; etched in lines and wrinkles at rest; volume loss; loss of skin plumpness.  These concerns all require an approach that I call a Full Face Rejuvenation or an FFR and can be initially costly in terms of both your time commitment and money. There is quite simply, no easy or cheap way around this if you want to do it well. Would you expect to straighten your teeth for less than $7000-10000 and expect a good job for less than 12 months’ commitment?  Would you expect to pay less than say, $15000 for breast implants or a rhinoplasty and expect it all to settle within weeks rather than months? Would you expect to pay less than $30000 for a tummy tuck or a facelift and be driving the next week? The more work there is to be done, the more time, effort, consistency and money it will take and anyone who tells you otherwise is, quite simply, lying to you and selling you marketing Koolaid. It’s dishonest and it is taking advantage of vulnerable people. Sometimes I hear of people being told “You need 6-8mls of filler but if you can only budget for 1ml, let’s start with that and add to it over time.” My concern that I take issue with this is: 1 ml will almost always do nothing to show you any significant progress that will motivate you to save for more and to come back if you need 6-8 times that amount someone who has a budget for only 1ml is unlikely to be able to find the money for 6-8 times that amount in quick supply and may experience distress or financial angst as a result  there is a high chance of dissatisfaction and loss to followup and in the process, they’ve spent hundreds of dollars to achieve nothing, which could have been spent elsewhere on something else that might have brought joy FFR takes a degree of accountability - it is you that needs to decide if you will show up and commit and be consistent. The work in clinic is 20% of the entire process, if that. The remaining 80% is dependent on you and if you cannot or will not commit, then it is often easier and kinder for me to say no.  The woman who posted her own progress over 7 years in the USA, spent USD44,000 over the 7 years to achieve her results and for her, it has been totally worth it. This is what my own patients who have similarly spent significant sums of money, often in their 30s and 40s and hit maintenance which is far more manageable, tell me. As with all discretionary spending, it is entirely up to each individual what they wish to prioritise that makes them happy. No judgement here either way.  For some