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.

Wednesday, 8 December 2010

So, aspirin is the re-discovered wonder drug!

Recent media headlines are dominated by rediscovery of aspirin as a wonder drug. Doctors are well aware of benefits of low dose aspirin. It thins theblood so naturally reduces chances of stroke or heart attack which are predominantly caused by blockage of blood supply to these organs. It has also been shown to have anti-cancer properties.
So, do we all rush out and start taking aspirin!
Well, let’s put this in perspective. I am not against aspirin and use it very often in my practice. Some patients can have side-effects or problemswith intestinal tract bleeding with aspirin and its risks in certain
circumstances can outweigh the benefits. So, is there an alternative without the risks?
The good news is, yes. Omega 3 fish oils can provide many similar benefits.Populations that consume a diet naturally rich in omega 3 fish oils have a low incidence of cardiac and cerebro-vascular disease, cancer and all causemortality [a low death rate from all causes.] These populations also have other factors that contribute to their longevity but fish oils do play a role.
A natural approach to longevity and reducing diseases such as heart disease,stroke and cancer would include a number of things such as stress reduction, regular exercise, adequate sleep & hydration, positive relationships, positivemental attitude, balanced diet, avoiding sugar & tobacco, hormone balancing in certain circumstances and nutritional supplements suchas fish oils. It is synergy of these which is much more powerful than one thing in isolation.
So, what omega-3 oils do we consume? Vegetable oils such as flax seed oil provide some of these but not enough. The best source is fish oils. 1 gm of oily fish three times a week shouldbe adequate for most of us. Another option would be fish oil capsules, ideally these should be in enteric coated formulations and provide EPA and DHA as mainingredients.
Are there any risks? 
Due to contamination of our oceans, concern has been raised about mercury content of the large predatory fish such as tuna, grouper, snapper & bass etc. Theoretically smaller fish would be low in mercury content and better in this regard. Also, too much of fish oils can thin the blood so I would not recommend more than 1-2 gm a day for most healthy people. And, do remember to tell your doctor if you are having any aesthetic procedure or surgery. It is possible to run a fatty acid profile as part of a nutritional assessment. This would indicate omega-3,6 and 9 oil levels in the blood. Testing can also reveal mercury levels in the body. This testing however is not widely recognised by mainstream medicine at the moment.
Most important thing to remember is that there is no one answer or magicdrug to solve all our problems. It has to be a combined approach.

Monday, 8 November 2010

Non-surgical face lift in your lunch hour. Liquid facelift at the Coltishall Cosmetic Clinic.

If you have thought about having a facelift but worry about aneathesia,
bruising, pain or recovery then read on. You can now have a pain less face lift in your lunch hour. It provides great results at lower cost than surgery.
How is this possible?
A face lift only tightens loose skin; it does not replace lost volume from the face which is probably the most important component of facial ageing. It will not improve skin texture or tone either. We are increasingly using volumisation of the face in addition to skin tightening which if performed without volume restoration gives a tight but not a natural look. I prefer a natural look for my clients.
Most of us do not have time to recover from a surgical  procedure and with recent advances in non-surgical treatments we can achieve very impressive results. We have an impressive array of lasers and other devices to address all aspects of ageing skin.
Restylane Sub Q lifts your face in an instant and the results are great. It is being hailed as something of a breakthrough. My clients who have received this treatment are very pleased with it. It is performed under local anaesthesia and takes about 30 minutes. You can then walk away with a rejuvenated natural look and years taken off your face. As it is a deeper filler, there is usually no bruising or redness.
The best part is that I don’t use a needle anymore. I use a special cannula which has a blunt tip. So, now there is no pain or bruising which sometimes occurred when we used to use the needle. It is an alternative to permanent cheek implants which can be problematic as they sometimes cause infection or move, creating asymmetry in the face. Although fat can be used to transfer into the face and add volume, deep filler is the only method available to achieve a similar result without the need for surgery.
Restylane Sub Q is the brand name for an injectable form of hyaluronic acid
specially formulated for facial contouring. Hyaluronic acid is a sugar that is
found in the connective tissue of our skin and along with collagen forms the
building blocks of healthy tissues. As it is totally natural component of our
skin, no allergy test is required. Restylane is the most popular facial filler
in the world today and has been used in over 11 million treatments. It has a
proven safety record. The result from the treatment is immediate and can last more than a year.
Another exciting development is the use of botox to achieve a defined outline of the jaw. The so called “Nefertiti lift”. We also use botox for
eyebrow lift to correct drooping eyebrows. A combination of these procedures and other non surgical tools is now capable of producing remarkable results without going under the knife. Everyone is not suitable for these procedures and as we each have our unique features and requirements we tailor our treatments and pick and choose best options from our increasing number of non-surgical treatments.
For more information, phone 0800 0430737 or log on the

Friday, 8 October 2010

Do your hands give your age away?

Most of us look after our faces very well, but our hands take a lot of abuse and most of us pay little attention to their care and protection. They are subjected to cumulative sun exposure and wear and tear just like the skin on our face, neck, and décolleté. The skin on the hands also tends to be thin and sun damage causes brown spots, slackening, and wrinkling. These textural changes cause visible signs of ageing. Wearing a hand cream with SPF 25 and occasional exfoliation helps prevent some of this damage, but there are many effective treatments to help correct it. You can have a combination of treatments to reverse visible imperfections or pick and choose a treatment to best address the concerns that you have.

For discoloration, tone, and texture, a course of intense pulsed light treatments can help significantly over time. IPL treatments from Lumenis, for example, used to treat the hands address the effects of photoaging and sun damage without downtime. Brown discoloration will be lightened with each session. If deeper pigmented spots are your main concern, lasers such as the Q-switched Nd: YAG or alexandrite laser can lighten them more effectively. If you have sun damage generally, then we recommend a fractional CO2 laser peel for global improvement with a little downtime which can be customised to your needs.
Restylane vital is also commonly used for hand rejuvenation. Three sessions at monthly intervals can provide dramatic results as shown here.
If you are after a maintenance treatment and next step up from hand creams then a course of gentle chemical peels and or diamond microdermabrasion is all you need.