Botox™(Botulinum toxin A)
What is Botulinum toxin A?
Botulinum toxin A is derived from the bacterium Clostridium Botulinum and is the most potent naturally occurring neurotoxin known to man. It has been used medically for many decades to treat muscle spasm disorders.
For facial aesthetics, botulinum toxin is used very effectively to smooth out wrinkles and to treat excessive sweating in the underarm area. It is injected in tiny amounts in very specific areas, using a very fine needle to relax the muscles. It is useful to smooth out wrinkles in the brow (frown lines), forehead, around the eyes (crow’s feet), nose and neck. It can also be used to make the jawline appear slimmer thereby making the face appear more oval rather than square in shape, smooth out the pebbled appearance of the chin and lift the corners of the mouth. It takes about 7 days for the effect to become evident and lasts for about 3 months. With continued use, the effect can last longer with reports of the effects lasting 6 or more months. Repeat injections can be done after 3 months when the effects start to wear off.
What are the side effects?
Possible side effects include redness, headache, bruising (that settles within a few days and can be camouflaged with make-up), drooping of the eyelid (ptosis- that in some cases can be treated with eye-drops or will settle when the toxin wears off) and asymmetry that may be addressed with further injections at 2-3 weeks.
Botulinum toxin is not given to women who are pregnant or breast feeding (as the safety has not been proven in these groups) and to individuals with a history of allergy, muscle or nerve disorders or those taking aspirin, certain antibiotics (aminoglycosides such as gentamicin or streptomycin) or other blood thinning drugs because of the increased risk of bleeding and bruising. It is essential to remain in the upright position for at least 4 hours after the treatment and advisable to exercise the injected area for the toxin to bind to the muscles for optimal effect. Make up should not be applied for 4 hours after the procedure.
What are facial fillers?
Facial fillers are used to enhance the shape and volume of the face and improve skin consistency. Fillers can be permanent (lasting indefinitely) or temporary (dissolve after some months). There are many different types available for injection. The difference between them is how long they last, their consistency and viscosity and how well they handle. Hyaluronic acid (HA) fillers are temporary fillers and can be dissolved with hyaluronidase which is an important safety factor. HA is naturally found in the human body. It gives a smooth, plump and healthy appearance to skin because of its hydrophilic (water attracting) properties. With ageing, the amount of HA in skin diminishes, leaving skin to appear thinner, less hydrated and wrinkled. In addition, soft tissues in the face thin and the bony skeleton resorbs to provide less support to the soft tissues. HA fillers can be used to plump out the skin, or to enhance the facial skeleton and provide support for the overlying soft tissues and skin. They are very popular and effective for enhancing the cheekbones, temples and lips, for lifting the midface to improve the nasolabial lines (between the nose and mouth) and for treating the marionette lines (between mouth and chin). Before the procedure, a local anaesthetic cream is applied to the area to be treated. Most HA fillers are already combined with a local anaesthetic for added comfort. They last for 6-12 months.
What are the side effects?
Common side effects are initial redness and swelling (lasts for a few days) and bruising. Implant nodules can occur and are best avoided by your practitioner choosing the correct filler and injection site and using the appropriate technique.
Facial fillers are not given to women who are pregnant or breast feeding or to individuals below the age of 18 years. Avoid blood thinners for at least one week before treatment to reduce bruising. These include aspirin, warfarin, dipyridamole, clopidogrel, nonsteroidal anti-inflammatory drugs(NSAIDs), fish oil, vitamin E supplements, St John’s Wort, garlic tablets, gingko biloba, and ginseng. HA fillers are not given to those with a history of hypersensitivity or allergy to lignocaine (local anaesthetic), where there is evidence of broken skin or an infection (such as acne). It is necessary to avoid: touching or massaging the treated area, extremes of temperature such as excessive heat (sauna or steam bath, hot drinks) or cold (swimming), alcohol, smoking and vigorous exercises for at least 24 hours after the procedure. Individuals with a history of herpes simplex infection (cold sores) can have reactivation of infection with injections to that area. Please discuss this with your practitioner.
Risks of HA fillers are rare. They include skin necrosis from injection into a blood vessel, visual loss(blindness), overfilling, asymmetry, infection, lumps, blueish discoloration of the skin (Tyndall effect). Visual loss or skin and tissue necrosis can occur with direct injection of the filler into an artery. In this case, the filler substance causes a blockage to the blood supply of the area supplied by that artery. It can also occur when a large volume of filler causes local swelling in the tissue that can compress the blood supply. It is essential that your practitioner has a sound knowledge and understanding of the anatomy of the area in order to avoid this potentially serious complication, and has a protocol in place to manage it if it does happen. Hyaluronidase can be used to dissolve HA fillers in the management of such complications.
Platelet Rich Plasma (PRP) ‘Vampire 0-shot’/ Vampire face-lift or facial
What is PRP?
PRP is derived from a patient’s own blood by separating it from the red blood cells in a centrifuge. It contains multiple growth factors and when injected back into the skin, will stimulate the production of collagen, stimulate the formation of new blood vessels and improve the quality and texture of the skin.
The ‘0-Shot’ is an injection of PRP into the vagina/clitoris. It enhances lubrication and sensation with the improvement of the quality of the vaginal wall. It is used in women who suffer with genito-urinary symptoms of menopause (GSM) like vaginal dryness, stress urinary incontinence and pain on sexual intercourse or for women who wish enhanced sensitivity in the clitoral complex.
How is it done?
Blood is taken from a vein in the arm and centrifuged to separate out the PRP. The area to be injected is prepared with local anaesthetic cream or injection. The PRP is then injected back into the area to be treated.
What are the side effects?
These are usually related to the injection and include redness, bruising and swelling that settle down after a few days.