Tuesday, 1 November 2011

Rosacea is a common condition. Often there is lack of awareness but there is no need to suffer in silence.

Consider rosacea if you have suffered from any of the following-facial flushing, redness, broken blood vessels, coarseness of skin and inflammatory eruption resembling acne.

Rosacea is defined by persistent redness of the central portion of the face lasting for at least 3 months. Other symptoms include flushing, acne like eruptions and visible blood vessels. Often there is burning and stinging, swelling, plaques, a dry appearance, eye symptoms such as redness and stinging and a swollen, bulbous nose.

Frequent triggers to flushing include acutely felt emotional stress, hot drinks, alcohol, spicy foods, exercise, cold or hot weather, and hot baths and showers and some skin creams.

There are four different types of rosacea; each with their unique features and treatment may differ. Some other conditions can resemble rosacea but usually this is a clinical diagnosis. Occasionally blood tests are required to rule out other conditions.

Erythematotelangiectatic type [ETR]
Central facial flushing, often accompanied by burning or stinging, is the predominant sign. The redness usually spares the skin around the eyes. These patients typically have dry skin with a fine texture.

Papulopustular rosacea [PPR]
Papulopustular rosacea is the classic presentation of rosacea. Patients are women of middle age who predominately present with a red central portion of their face that contains small red lumps, some with white heads.

Phymatous rosacea
Phymatous rosacea is defined as marked skin thickenings and irregular surface nodularities of the nose, chin, forehead, one or both ears, and/or the eyelids. This is more common in men.
Ocular rosacea
This is rosacea, which affects the eyes causing blepharitis, conjunctivitis, inflammation of the lids and conjunctival redness. Symptoms include eye stinging or burning, dryness, irritation with light, or foreign body sensation.


As rosacea is a poorly understood condition there is no cure but we aim to control the symptoms. It is important to avoid or reduce precipitating factors such as stress, spicy foods and sudden changes in temperature.
Your GP may prescribe antibiotic gels, creams or tablets that help in papulopustular type of rosacea but do little to help flushing and blood vessels. Other medications are vitamin A based creams or isotretenoin and some medications to reduce flushing.

Laser treatment is mainstay for flushing and broken blood vessels. We use IPL and a variety of lasers to help reduce it. Broken veins disappear in a few sessions but flushing control need multiple sessions. LED or light emitting diode therapy can help as well.

Phymatous rosacea is treated very successfully with a combination of vascular lasers and CO2 laser to remove thickened tissue under a local anaesthetic.

Ocular rosacea is currently not treated with lasers. Further research is likely to produce more treatment options but for now we advocate laser therapy, which helps a majority of rosacea sufferers.

Thursday, 28 July 2011

Lasers & blemish removal at the Coltishall Cosmetic Clinic.

Lumps and bumps are a very common complaint. These are not only a cosmetic issue but can cause symptoms such as itching, bleeding, catching on cloths etc.

Some darkly pigmented moles or changing, enlarging ones can indicate a need to see your GP or a dermatologist to exclude melanoma.

 Here we discuss some common types of lumps and bumps and treatment options.

Seborrhoic warts and skin tags are very common minor skin lesions which usually do not produce symptoms or turn nasty. These are very easy to remove very successfully with barely noticeable scarring.

Raised flesh coloured moles- these are again very common and usually do not indicate any significant problem. Most remain unchanged for many years. It is best to get them checked if there are any changes or concerns. These can be removed almost instantly with shave excision or vaporised with the laser.

Pigmented moles- are a little bit tricky to remove as we remove these with a margin of surrounding skin and this means the resultant scar is usually much longer than the original mole. We also recommend these be sent for pathological examination. Routine examination of removed tissue is best practice here.

Skin cysts- these can be removed through a very small hole in the overlying skin. We now treat most small and longstanding cysts with the help of lasers.

Lipoma-or fatty lumps can be removed through a very small cut in the skin.

Xanthelasma-these are small whitish fatty deposits around the eyes. Most of these can be very successfully removed under local anaesthesia. If these are very large, especially on lower eyelids then removal in a hospital setting may be required.

Broken veins/ birthmarks- most of these can be faded with the help of lasers and no surgery is normally required. A few sessions may be needed.

Rhinophyma or bulbous nose due to rosaces- this can be very successfully removed with the help of lasers. We may need to use 2-3 lasers and 3-5 sessions may be required. Results are very gratifying.

Warts- a variety of treatments are available and lasers are one option to cut off the blood supply so warts shrink and disappear. These can also be vaporised with CO2 laser.

Skin cancers-these are treated as a matter of urgency and treatment is available on the NHS. Laser therapy is not standard of care for skin cancers and we do not recommend it.

Log on to our website or call 0800 0430737 for more information or to book an appointment.

Image courtesy of coltishall clinic patients

Saturday, 9 July 2011

Wedding planner-how to look your best on your wedding day.

Anti-ageing specialist Dr Sanjay Gheyi MBBS MS FRCS BCAAM from Coltishall Cosmetic Clinic provides his tips for looking your best on your wedding day. The more time you have to prepare yourself the better it is. But if not, do not worry, our selection of treatments can do a wonderful job. A good moisturiser with SPF 25 and UV A & B protection, vitamins A,C and E based products are a good foundation for any skin care.

Treatments for the bride

Consider laser hair removal if unwanted hair is a problem. Don’t forget laser surgery to remove any unsightly blemishes or moles, lumps and bumps.

Try a course of very popular Photofacial™-  these are no downtime IPL and laser treatments and you get a beautiful complexion blending and brightening for your special day. Why not try it on neck, hands and décolleté for that flawless complexion! We recommend 3-5 sessions 2-3 weeks apart.

Fractional CO2 laser skin peel or deeper resurfacing to turn the clock back a few years! Especially important if you have issues with acne scarring or uneven skin texture. Try Madonna lift for rejuvenation of eyelid skin and crow's feet area.

Using a little botox™ can provide a smooth brow, forehead and iron out those crow’s feet and frown lines. Allow a few weeks for full effects to be apparent and these last about 4-5 months.

Restylane™ for softening nose to mouth lines, lips, cheek and chin enhancements, nose reshaping etc. Having deep lines can show with bright lights and photographers flashes from different angles. Why not fill out lines and wrinkles. Again allow a few weeks if possible but new technology now allows us to use these without any bruising or swelling and you can get back to your schedule immediately.

Dysport™ to eliminate sweaty underarms- You may not think you suffer from hyperhidrosis, but spending hours in a gown, stressful moments, pictures taking and speech-giving can induce sweating even in the calmest bride. If you are spending thousands on a gorgeous gown, protect it from unwanted sweat marks, and consider treating your underarms to minimise sweating.

The Mother of the Bride or Groom

Using Botox™ before your son or daughter’s marriage celebration is a great idea. Botox is fast, easy, has little down-time and will last approximately 4-5 months. It also helps with migraines, tension headaches and keeps you looking and feeling calm.

Dermal fillers- You can have a small amount or you can have a liquid facelift. Time is a little short to consider a facelift if that is what you have wanted, but a liquid facelift has several advantages-it is more economical, stress free and has no downtime.

You can tighten your jaw line without any downtime at all with radiofrequency technology.

Dysport™ to eliminate sweaty underarms- Excessive sweating can sometimes interfere with your well made plans for your son or daughter’s big day. Using dysport or botox to combat sweating works very well, and is a quick lunch time procedure.

IPL  Intense Pulsed Light treatments are helpful in removing sun damage (brown pigments such as sun spots and age spots, and red pigments such as broken capillaries, rosacea, and general redness). Creating more luminous skin with IPL treatments allows for a more even complexion and removes the unwanted effects of many years of sun damage. We recommend 3-5 treatments, approximately 2-3weeks apart, so be sure you leave yourself enough time to complete the series before the wedding. This treatment is so popular because there is little to no down-time. Areas such as the face, neck, chest and hands can be treated, as well as other areas, like the arms, which you may consider if your dress is sleeveless!

Laser skin rejuvenation With seven different lasers and light based devices at our disposal we are sure to have a treatment for your skin care needs. And, remember you are getting true skin rejuvenation and reduction in your skin age.

If you have wanted blepahroplaty [ eyelid surgery ] we can now do this laser eyelift avoiding downtime and cost of expensive operation.

Nice have treatments for everyone

Diamond microdermabrasion is a gentle, relaxing and enjoyable procedure. It provides you with a valuable ‘me time’ from your hectic schedule and you would love the smooth soft feel of your skin and luminous glow afterwards. This one is for everyone.

For more information log on to or call 0800 0430737

Wednesday, 8 June 2011

Sunday Times article on downside of fillers

Joker Face

Why do fillers frequently look so false?

risks of going under the needle-

"You’ve seen this face – it’s everywhere. There’s something muzzle-like about the nose and mouth. The lips are taut and bulbous, and a little wonky when she smiles. In extreme cases, the cheeks sit like ping pong balls under spongy skin, eyes peering out of puffy sockets.
The “pillow face”, our current answer to the 1990s wind-tunnel look, is down to dermal fillers. These semi-permanent gels are injected into the lips, cheeks and the lines between the nose and the mouth in a bid for youthful plumpness. Trouble is, the result is often not eternal youth, but a face like a water-retentive lion....."

My view
Dermal fillers can give impressive results but they have to be done for right diagnosis, right product has to be used in right amount and in the right place.
So there we have it, results from dermal fillers depend entirely on your practitioner. Next time you ask for price of a syringe of Restylane-please do consider this. Ask for before and afters and if you see lots of pillow faces you have the option to walk away!

What is wrong with the alternatives that have been suggested in this article?
I am surprised by some of the suggested alternatives and outline my concerns with each of these here-

Antislackening mesotherapy- 
This is a technique of injection of multiple ingredients and there are no standard formulations. You don't know what is being injected and results are not as good as standard cosmetic procedures such as botox, fillers, lasers & radiofrequency.

Dracula therapy 
This is a procedure involving injection of patients own blood cells into the skin. Again this has been tried in various forms for last many years. This reminds me of Isolagen which was a procedure involving taking patients own cells and injecting them. Majority of patients spent thousands of pounds but were very disappointed with the results and eventually it was withdrawn. My advice-don't be a guinea pig. There are lots of tried and tested products out there and these work very well.

The old-fashioned facelift 
Agreed, this can't be beaten for skin tightening. But, this only tightens loose skin, you may need a combination with fillers for restoring lost volume or you might get the dreaded wind-tunnel look. One more important point-no true skin rejuvenation takes place with a face lift, unlike laser resurfacing where true skin rejuvenation occurs. 

What can I say, I like radiesse but this is a type of dermal filler. So, to say avoid dermal fillers but try radiesse instead does not make sense.

Let me know what you think and you can find out more about these procedures on our website-

Natural look with dermal fillers

Soft restoration

Laser resurfacing



 Laser skin rejuvenation

Search Engine Submission - AddMe

Saturday, 28 May 2011

A Face-Lift or fat reduction in your lunch hour. No surgery, no injections and no pain.

I often get asked- “Doctor, I dont want a facelift, but cant you just tighten up some of this saggy skin a little? Or, “I don’t want to have liposuction but want to get rid of stubborn areas of fat.”

Previously my answer would have been a tentative “maybe” but today it is a qualified “yes”. 
Well, if this applies to you, then read on- technology moves fast and here at the Coltishall Cosmetic Clinic we like to offer it as soon as we are happy with the results and safety. If you have wanted to reduce wrinkles, jowls and sagging skin, improve your jaw line, remove crow’s feet and tighten skin anywhere on your face or body, then we have the best technology and expertise available for you.

We offer minimally invasive options and liquid facelifts but if needles worry you then we have an even better cutting edge option for you now.

How is this possible?

Gravity wins out over beauty and over time, untreated skin begins to sag and lose its elasticity. Advancements in technology have made it possible to tighten skin and reduce the appearance of wrinkles and sagging without undergoing surgery. Coax med is a new medical device that uses radio frequency (RF) and ultrasound to improve skin without any downtime or discomfort. It is the newest radiofrequency and ultrasound device from Italy.

The Coax Medical system uses a sophisticated solid tip, which delivers a controlled amount of RF energy in a very special, brand new way to help decrease wrinkles and tighten the skin in a matter of minutes. A small hand piece is applied to the skin and it warms deeper tissue, stimulating the growth of new collagen. The hand piece tip of the device is cooled before, during, and after treatment to protect the skin and make the treatment more comfortable.

This device can tighten the skin without any pain or discomfort and requires no preparation with numbing creams. It takes about 40-45 minutes to treat the whole face, and only 15 minutes to treat smaller areas such as around the eyes. Not only do we help wrinkling, it also decreases pore size, brings out a better texture and appearance to the skin. Unlike lasers, it can be used on all skin colours, even very dark skin.

Multiple treatments are needed to get the best results. Results continue to improve for up to 12 months. Patients have one treatment every two weeks for 4-6 treatments and they can see a big difference in their skin for a healthier and more refreshed look. Compared to all of the other options in skin tightening that patients have available, I find that the Coax Med is the most comfortable to go through and it actually puts you to sleep. Its gentle warming feels like a massage of the facial skin. There is no recovery period required and you can get back to your normal schedule without any downtime whatsoever. There is no need for strict sun-avoidance either.
It can tighten loose skin on any area of the body such as tummy and arms and can be used with ultrasound to reduce areas of localized fat that cannot be improved with diet or exercise. We will look at some applications for body fat and stretch marks in my next article.

So, we now have an option that does not entail surgery, needles or pain and, best of all there is no recovery period required. It is also much cheaper than surgery.

Log on to the website or call 0800 0430737 for more information

Friday, 27 May 2011

Get ready for summer. Reduce excessive underarm sweating.

Summer is upon us and unfortunately higher temperatures mean worsening of sweating issues for some of us. If you suffer from increased underarm sweating, worry about sweating through your clothes, work in close contact with others or in hot conditions or have to make public presentations then you may consider treatment.
Generalised sweating can be due to certain medical conditions but often sweating just affects underarms, most commonly affected area without any underlying problems. If underarm sweating is significantly interfering with your daily activities and anti-perspirants have not worked, you may be a candidate for botulinum toxin type A treatment.
Often patients have tried various over-the-counter products or stronger antiperspirants prescribed by the GP. One very simple and highly effective treatment option is botulinum toxin injection treatment which can result in dryness for up to one year or more. It takes only a few minutes and almost all of our patients have it once a year. The alternatives are surgical options or to do nothing. Lack of awareness can be a problem as we often see patients who have suffered for years with this crippling condition. They are delighted by the results from such a simple, quick and painless procedure.
If you would like to find out more please log on to or call 0800 0430737.

Monday, 14 March 2011

Why aesthetic use of permanent fillers is a bad idea.

Some people ask me why I don't use permanent fillers? One person wanted permanent fillers in her lips to avoid repeat treatments so she can avoid the cost.
Last week has been particularly hectic for me. I have used plenty of hyalase. This is an enzyme which is used to dissolve hyaluronic acid based fillers. I had to dissolve fillers done elsewhere as patients were not happy with the results. This may be due to various reasons but it illustrates the point which I have been trying to make. Unless there is a good reason not to use hyaluronic acid, it is always my first choice. I also prefer restylane range of fillers as these have unmatched safety data with more than 12 million treatments carried out worldwide.
OK, there are cheaper fillers available but I want to be absolutely sure that I am using the best product.
It gives me flexibility to reverse or modify the effects if there is a problem-and it is very rare to have to do this but it is nice to know that it is possible.
Permanent fillers can cause problems which are difficult to rectify. A filler that looks good today may look unsightly few years down the line, what will you do if you don't like it then?
Then there are bio stimulatory fillers which can also cause granulomas. This can occur many months or years after the treatment. Some doctors use fat but hyaluronic acid fillers are readily available, cheaper and one does not need to extract fat from somewhere! Also what happens if you gain weight in the future- the filler will become fat too!
I am not suggesting that there is no place for fat or permanent fillers or indeed bio-stimulatory fillers. I am sure some doctors are pretty good at doing these and get great results. I just think that there are simple and better options available and as aesthetic treatments are elective treatments we must try to minimise chance of things going wrong.

Sunday, 6 February 2011

Treatment of facial blood vessels

Facial redness and spider veins are a common cosmetic and medical complaint. These are particularly common in rosacea suffers. Common associations are seen with sun damage, a fair complexion, stress, spicy foods and fluctuations in temperature which exacerbate rosacea symptoms. As with many conditions, genetics plays a role too.
Numerous treatments are available but laser and light based treatments are the gold-standard treatment options. Commonly used lasers are ktp and pulse dye lasers for red veins and nd-yag lasers for blue veins. The smaller wavelength lasers work well on superficial spider veins whereas, the longer wavelength lasers are effective for the ablation of slightly deeper and larger veins. Pulse duration must also be matched to vessel size; the larger the vessel diameter, the longer is the pulse duration required to treat the vessel.
Recently intense pulsed light devices have gained popularity. Unlike lasers, IPL devices produce a broadband light and effectively target a number of cosmetic concerns such as brown/ black pigmentation and red and blue vessels simultaneously. IPLs also tend to have larger spot sizes and purpura [bruising] is not a required endpoint as is the case with certain lasers. Patients see gradual but very noticeable improvements with complexion blending and brightening achieving photo rejuvenation of the skin.

Often we see larger blood vessels especially around the nose and these may require treatments with nd-yag lasers. Caution is required with these lasers as high energy or pulse stacking can cause scars. Some doctors use sclerotherapy for facial veins and very precise small volume injections are made. I do not use sclerotherapy on the face as a rule. Area around the mouth and nose is a danger area as veins here communicate directly with venous sinuses inside the skull. Similarly veins around the eyes are another risky area as there is a possibility of flow of scleroscent in the retinal vessels. Sclerotherapy is very valuable for treatment of leg veins but laser and IPL treatment is safer and better for facial veins. We will look at leg vein treatments in my next blog.