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 Majority of patients spent thousands of pounds but were very disappointed with the results and eventually it was withdrawn.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

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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.

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.