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:

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.

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.