Radiofrequency technology produces an electric current that generates heat in the deep part of the skin called the dermis. Although radiofrequency has been used for many years in surgery, it is only recently that it’s skin tightening effects have been recognised. The studies that were done have shown distinct improvements in the tightening of the skin around the nasolabial folds, marionette lines, upper neck, jowls and tightening of the skin around the eyes. It works best in people with mild to moderate skin laxity and most of the successful treatments have been in people under 65 years of age. Side effects of this kind of treatment are mild – transient (usually less than 24 hours) of mild facial swelling being the most common. No skin colour changes or scars have been seen in patients with all types of skin pigment levels. You will usually see results after one treatment, but more definite skin tightening is seen after two or three treatments.

So how does Pelleve skin tightening work to tighten your skin? It does this by kick-starting your own skin cells to produce new collagen and elastin fibres. These are the fundamental parts of your skin that make it look refreshed and young. So it’s a natural process that the Pelleve stimulates. That’s why it’s so long lasting.

Radiofrequency Pelleve treatment gives most people a subtle but definite skin tightening effect particularly around the neck, under the chin, jaw line, mouth, eyes and forehead. It’s not painful and there is no downtime. It only takes about half an hour and then you can get back to work.

How long does skin tightening with pelleve last? Most people who were treated with pelleve saw a skin tightening effect that lasted at least six months.  I would therefore recommend having two treatments in the first six to eight weeks to get a nice skin firming and tightening result and then once every six months or so to maintain that younger look.

The solution to nasolabial folds depends on a comprehensive approach to the face where volume is added in locations where it really is deficient, especially in the cheeks. This serves to lift up the cheek and help flatten out the nasolabial fold. Filling the fold itself does help, nevertheless the surrounding areas are just as crucial.

By reducing the nasolabial folds, you not only diminish the grooves, you get a facelift effect by removing the downward draw of dark shadows on the lower section of the face . I think Radiesse is an effective option for a filler for nasolabial folds since it provides a good volumising effect and it is long-lasting.

Treatment for nasolabial folds is generally safe, effective and long lasting. There are potential risks, which though rare, are serious. Treatment methods are not permanent, and patients need maintenance touch ups, probably every 6 months for hyaluronic acid fillers and around 12-18 months for radiesse. Fillers will most definitely improve the appearance of the nasolabial fold, but frequently the cheeks and lips also require treatment. Fillers may well not last as long in areas of increased movement such surrounding the mouth. Treatment can take approximately 45 minutes, and you can see the result immediately. Treatment can be done in patients of any skin type or colour.

Radiesse is a completely synthetic compound composed of micro-spheres of calcium hydroxylapatite, in addition to an aqueous gel. It is a calcium gel , which is also contained in bones , this is therefore more longlasting . Radiesse had FDA approval to be used as a dermal filler for specific applications.  It is thick enough to produce a beautiful improvement in even very deep folds and hollows. It is an ideal option for deep nasolabial folds, hollow cheeks and down-turned corners of one’s mouth. Radiesse is filler that has gained much popularity due to its longer lasting effects.

Sculptra is a replacement for a conventional filler solution for the nasiolabial folds. Sculptra is not a filler, but instead it stimulates your own tissue to cultivate. It is an appealing new treatment choice for patients seeking longer-lasting facial volumetric enhancement. It is used for restoring volume and improving facial contours. There are some downsides to Sculptra treatment, particularly the risk of nodule formation and granulomas, but for most people these are not a problem and can usually be avoided with skillful management and attention to detail.

Some treatments like YAG laser resurfacing, CO2 laser resurfacing, dermabrasion and deeper chemical peels, although effective, can have quite a long recovery period, alterations in skin colour, infection and significant risks of scarring. Intense pulsed light is really a super treatment which, when correctly tailored for your particular skin type and rejuvenation needs, is very effective but doesn’t have a high risk of downtime or harmful effects. The main downsides of IPL are a temporary mild crusting lasting one to three days after treatment in 1 in 5 clients. Redness for more than 4 hours occurs in 1 in 6 clients. Mild bruising occurs in 1 in 15 clients and all of these usually go away within 1-5 days without subsequent hyperpigmentation. Mild facial swelling for 1-3 days occur in about 1 in 6 people treated with IPL. It’s very important that you are treated with intense pulsed light by a well trained and experienced operator. These are definitely powerful devices and in the wrong hands, these machines are capable of significant harm with risks of permanent scarring.

Just how much can this cost? Well, for your full face, neck and chest treatment the price is £150 per session or £600 for five sessions booked and purchased before hand. I would personally normally recommend five sessions at monthly intervals if you have significant sun damage. The rejuvenating effect with this is normally extremely striking and lasts for years.

Some of these fillers have now been used on patients for around ten years and so there is a growing body of literature about their long term effects. As more and more patients are treated more information is also becoming available about potential unwanted effects.

The most common unwanted effects of the fillers are those that you would expect from any injection, particularly bruising where the filler has been injected. Redness and swelling are also quite common after filler injection and will usually settle down after a day or two.

Much less common (less than 1% in experienced and well trained hands) but potentially more problematic are the following problems:

1. Early infection. Any procedure that breaks the skin can lead to infection of the skin. This is more likely to occur if you have an existing skin infection, so don’t have your filler if there is any evidence of active skin infection. The symptoms of infection are what you would expect – pain, swelling, redness and possibly feverishness too.

2. Late infection. When you have a filler injected your body now has foreign material present within the tissues. This could become the focus of an infection at a later point in time, so seek medical advice if you get swelling or pain in the days, weeks or months later in the area where your filler has been injected. Such infection is usually amenable to antibiotic treatment but occasionally the filler needs to be dissolved (this is possible with the hyaluronic acid fillers) or surgically removed.

3. Allergic reactions. Again, these can occur at an early stage or later on. They can manifest with redness, swelling and lumpiness in the area that has been filled. Unlike the usual swelling and redness that most people get to a mild degree in the day or two immediately after dermal filler treatment, allergic reactions will result in either more severe or longer lasting swelling or both. It is quite difficult to differentiate these kinds of allergic reactions from infections and most practitioners will consider antibiotic treatment as well as anti-allergic treatment in these circumstances.

4. Inflammatory nodule formation. This is a usually a kind of late allergic reaction, where the filler provokes a reaction from the surrounding skin tissue that results in the formation of lumps in the skin. These can sometimes respond to steroid injections and anti-allergic treatments, but if cosmetically significant they may require surgical removal. Sometimes they can be caused by infection in which case antibiotic treatment can be of help but again they may need to be dissolved with a hyaluronidase injection where possible or surgically removed.

5. Lumps in your skin. This can be due to the filler being injected too superficially, or a deep filler like calcium hydroyapatite has been used in a superficial place where it shouldn’t be used like in the lips. Again, if one of the hyaluronic acid fillers has been used and is causing a problem they can be dissolved with a hyaluronidase injection. The fillers can also pull in quite a lot of water which can result in swelling. This can be very obvious if the filler has been given too superficially (for example around the eye).

6. Vascular problems. These are among the most infrequent but also among the most severe complications. If the filler is inadvertently injected into an artery that artery can become blocked and the area of skin that is supplies can die. Your skin will quickly become white, painful and later on it may break down. This is more of a problem if the artery that is injected is an end-artery, that is it is the only artery that is supplying that area of skin. This applies to the lip artery and the artery that supplies the skin around your nose. If you are having filler around the “tear trough” of your eye there is a theoretical risk of blindness if you have the filler injected into one of the arteries that is linked to your retinal artery. If you are having filler injected into the area between your eyebrows there is a risk of the blood supply to your skin in that area being compromised if too much filler is injected there. This is due to the pressure of the filler itself on the blood vessels rather than the blood vessel becoming occluded by filler. There are a variety of emergency treatments for blood vessel compromise which must be put into place quickly if the skin is to be saved.

7. Neurological problems and cardiac problems. If the filler is accidentally injected into a blood vessel there is the potential for the filler to work its way round to more distant blood vessels leading to blockage of blood vessels that affect the brain or the heart. This could give you a stroke or heart attack.

Please note the above is for information only and should not be considered as constituting medical advice. If you have any concerns about dermal filler treatment, please speak to your dermal filler provider.

Vitamin C is one of the most powerful anti-oxidants that the body has available. If you have rosacea you need to be sure that your vitamin C levels are kept at adequate levels. This might mean taking vitamin C supplements if your diet is likely to be low in Vitamin C. Vitamin C is also needed to help the body make collagen, the essential binding protein that holds all the cells together. The skin of people with rosacea tends to be more fragile so again it is important that the there are adequate levels of Vitamin C so that collagen production is optimized.

It is also a good idea to use a moisturizer which contains Vitamin C. As well as protecting the skin from free radicals, there is evidence to suggest that the topical application of Vitamin C can also help to reduce redness in people with rosacea. Care needs to be taken to ensure that the formulation of the moisturizer doesn’t contain any irritants which people with rosacea are much more susceptible to.

An important aspect of protecting the skin is to use a good quality sunblock. Everyone should use a sunblock and it is even more important if you have rosacea as the ultraviolet radiation can lead to higher levels of free radicals in the skin which in turn damage already fragile blood vessels. The highest sun protection factor should be used, preferably at least a factor 30. Watch out for any alcohol content in the formulation of the sun block as this can irritate the skin.

The final aspect of protecting your skin is to avoid products that cause irritation. This can be very difficult as so many soaps, shampoos, moisturizers and cosmetics have ingredients that are likely to cause irritation. The usual suspects are the alcohol and fragrances used in these products. If you stick to products that are free from fragrance and cosmetics that are water-based or oil in water based you are less likely to run into problems with irritation.

So why does the total number of units that you are given matter so much? Because studies have shown a clear dose-response relationship between the duration of effect and the dosage that you are given. If you are given 20 units of Botox into your glabella frown line region it will last about 16 weeks in 75% percent of clients, whereas if clients are given half that dose it will only last that long 35% of the time, and you will therefore probably be needing more treatment well before the end of four months after your last treatment with this dosage.

So if you are of average build and normal facial muscles mass, and you are having the frown line and your forehead treated with Botox you should probably be getting a total dosage of around 40-50 units. This will reliably achieve an effect that is going to last you for the next four months or so. Clearly if you are exceptionally lean or exceptionally well endowed with facial muscles then the dosage will need to be altered accordingly.

Don’t forget that if your if your doctor is using Dysport (marketed under the name of Azzalure in Europe) then the number of units will be different. It will be about 3 times higher than with Botox or Xeomin as Dysport/Azzalure, unit for unit, is only one third as powerful as Botox. So one unit of Botox is equivalent to around 3 units of Dysport / Azzalure. When given in appropriate dosage studies have shown that Dysport/Azzalure is as effective as Botox. So ask your practitioner about the total dosage they are planning to use. If it’s a lot less or a lot more than the quantities mentioned above for the forehead and frown line areas, ask them why.

You can have a bad botox experience if you are given too much or too little Botox, if it’s given in the wrong place, or if your provider is unscrupulous and using something other than one of the regulated forms of Botulinum Toxin (the main ones at the time of writing are Botox, Azzalure (Dysport in the United States), and Xeomin.

You can tell if you’ve had a bad Botox experience if one of the following has happened after your treatment:

- drooping of one eyelid, which means that your provider may have given the botox too close to your eyelid muscle. Having said that, other factors can lead to migration of botox into the eyelid muscles, such as having a facial or lying down after Botox or vigorous exercise immediately after Botox
- drooping of both eyebrows (feels like you are looking out under the peak of a baseball cap). Usually means that your Botox provider hasn’t properly evaluated your forehead musculature and given the Botox too low down or has been too aggressive dosage or a combination of the two.
- completely frozen expression (unless, of course, you specifically requested it, some people do like this look!) which suggests that you might have had too much botox.
- drooping of one side of the face. The botox has probably been given too close to the cheek muscles.
- inability to close your mouth properly. Too much botox has probably been given into your lip muscles when trying to treat those upper lip lines and wrinkles.
- voice hoarseness or difficulty in swallowing. This is a potentially serious complication that can occur after Botox treatment in the neck. If you get this seek medical advice immediately.

So how can you reduce the chance of having a bad botox experience? The answer is to choose your Botox provider with care. Ask the following questions:

1. What is their training, experience, accreditation and qualifications? They should have been trained by an accredited Botox trainer. They should be thoroughly experienced in doing Botox injections and have an adequate number of patients each week with which to maintain their skills (ask them how many patients they treat in an average week, if it’s less than four or five you should be concerned).

2. Ask your provider what their complication rate is. Anyone doing regular Botox will experience occasional complications. If they are a UK doctor then they should know as one of the requirements of medical appraisal is audit. If they say they never have any complications then either they are not seeing enough patients or they are not being truthful and you should consider changing your provider.

3. Ask them what their on-going supervision and validation requirements are. As part of medical quality control (known in England as clinical governance) All UK and US doctors have to have strict annual appraisal requirements where the quality of their work is reviewed by an external expert.

4. Ask them which brand of Botulinum Toxin they use. All of the major brands (Botox, Azzalure (Dysport) and Xeomin work just as well as each other if given in the correct strength, but one unit of Azzalure does not equal one unit of Xeomin or one unit of Botox. Around two and a half to three times as many Azzalure units need to be used for every unit of Botox or Xeomin. So if your provider uses Azzalure ask them how many units they use for their treatment.

So you can see there are major advantages in choosing a fully registered doctor to provide your Botox treatment. It guarantees quality assurance in terms of knowledge, training, on-going experience and appraisal as this is needed to maintain registration as a doctor and validation to provide medical cosmetic treatment.

But Botox needs to be respected. You need to choose a provider who is properly trained and regulated. It’s a powerful drug and it can be used in a way that produces a balanced and harmonious look. But if used in the wrong places it can cause problems. These can range from cosmetic problems like an eyelid droop, to functional problems like not being able to form a proper seal around your spoon or fork when you eat, or not being able to swallow your food. These types of problems can arise from incorrect administration of Botox, which might mean too a high a dose for your particular muscles, or incorrect site of injection, or both.

The safest and best places to use Botox for cosmetic purposes are on the forehead, between the eyebrows and at the sides of the eyes. This will soften lines and wrinkles, and if given correctly, can also produce a subtle eyebrow lift. In these areas there is more leeway (particularly on the forehead and between the eyebrows) in terms of the dosage or injection points. Plenty of research has been done about using Botox on the forehead to define the correct average dose range and the optimal points for the injections. Botox for “crow’s feet” lines that extend out from the corners of the eyes can also be very effective.

Care needs to be taken about injecting Botox around the corners of the eyes because if it is given too low down on your face it can affect the cheek muscles that hold up the side of the mouth. If these are affected by the Botox on both sides you could end up with down-turned corners of your mouth and difficulty smiling. A rather sad, sallow expression. On the other hand, if only one side of your mouth is affected you could end up with an asymmetrical facial appearance, rather like after a stroke or Bell’s palsy. Fortunately with Botox none of these adverse events are permanent and the effect will wear off within three to six months.

Moving down the face another effective area for Botox treatment is the top lip, where fine vertical lines can develop. Here the margin for error is much less, and a lot of expertise and experience is required to get a good response and at the same time minimize the risk of lip incontinence. Particular care needs to taken when treating people who use their mouth muscles for the work, notably musicians. Loss of the fine motor coordination that they need from their lips might mean loss of their livelihood.

Some people have Masseter muscle hypertrophy, giving rise to a square-faced appearance. Injection of Botox here can produce subtle but worthwhile improvements if your appearance.

Botox can also be used in the chin area to reduce dimpling, and also to lift the corners of the mouth. This can be very effective but again a precise knowledge of the local muscle anatomy is required to avoid problems with lower lip weakness from incorrect injection.

Finally, Botox has been used in the neck to treat Platysmal bands. These are vertical bands that stretch up to the chin. Care needs to be taken with the dosage and injection site to avoid inadvertently affecting the muscles that are used to swallow.

So if we think about the face, we can start with those deep forehead lines that can develop as we age. They do respond to Botox treatment, but sometimes Botox isn’t enough and some dermal filler can make all the difference. Deep lines between the eyebrows usually need filler treatment as well as Botox, and this can produce a dramatically effective cosmetic result.

Moving down the face we can think about the dark circles that people can get underneath the eyes. When these are permanent, that is, not just after a bad night’s sleep it can be due to thin skin which shows up the dark blue veins underneath. Dermal filling here can produce a very satisfactory correction.

Next there are those lines between the cheeks and the mouth and from the corners of the mouth sagging down producing a somewhat sad expression. They tend to deepen with time and become overly pronounced. Again, dermal fillers can soften these and even correct down-turned lip corners.

Jaw lines can become quite pointed due to jowl formation. It used to be thought that the only way to correct that was by means of a face lift. Nowadays it is appreciated that correction of the loss of volume along the front of the jaw line itself can give a dramatic improvement in appearance.

The skin of the hands can become excessively thin with age, and this is often a give-away even when the face still looks quite young. Some filler volume injected under the skin of the hands can correct this instantaneously.

Finally there is the chest area between the breasts and the neck. Often this area is neglected when sun screen is applied and the skin suffers from thinning due to loss of elasticity as a result of ultraviolet radiation exposure from the sun. Injection of small volumes of filler over this area can make a big difference.