Did you know there are three main types of anti-wrinkle muscle relaxants available in Australia- B is the best known, and D is the second and X just entered the market in 2016. TGA regulations prevent naming the product, however if you take the B add the O and D substitute the T for add an O and keep the X, you will get the picture.
What is the difference between B,D and X? Well 3 products contain the active ingredient called Botolimum Toxin. This works by temporarily paralysing muscles that cause dynamic wrinkle (wrinkles on movement). Examples include frown lines and smile lines. The difference between them is controversial – some patients prefer B as it last longer and the results are more predicable (from my personal account and experience). However in other patients the opposite is true.
Anti wrinkle injections are measured in Units- a B unit is much stronger than a D unit, whist the X is the same as the B. Units are guide as to the total dose injected into the area. This gives a scientific record of how much B/D/X is used. I can then refer to my previous notes for repeat injection and see how much is needed for best outcomes.
My method of performing anti-wrinkle injections is different from common nurse led injections. Instead of placing a large amount of units into a certain area, I place ‘micro units’. This means I use the same dose, but scatter the tox over a wider area. Why? I believe this gives a more natural look. Too much anti wrinkle injections gives a paralysed look to the face, with a lack of expression. Not a good look. Good injectors know how to relax muscles, and making you look less tired, less angry and refreshed, but you still can animate. This is the point of difference between an experienced injector and one who has just done a weekend course in injecting.
Some patients are happy with D, and in a small percentage it last slightly longer than B(this is the exception rather than the rule in my experience). If you fall into this category, stick with D as it is cheaper for you to have this product, and X is even cheaper. Note- all three muscle relaxants have been approved by the TGA, which means they all pass our high safety standards. (In fact they have all passed European and US standards well before Australia)
How long muscle relaxants last depends on individual and genetic factors. Patients who have had regular anti-wrinkle injections will last 6-8 months whilst new patients may only last 3-4 months. Usually with repeated injections, the average Botox user will need top ups ever 4 months.
In summary –
- I B, D, and X are all safe and provide the desired outcomes- namely to relax muscles of expression. Some patients have a longer response to one, and others the opposite is true
- I experience in all 3 product, however I only choose B
- Why do I choose B? It’s because I can control, within limits, the predictability of one product and not 3
- Muscle relaxants are not the be all to end all in regards to anti-ageing. It is just one small part of the puzzle – in fact patients in their 30s onwards should consider a tiny amount of filler with B as mid-facial volume replacement will often make a larger cosmetic difference than relaxing muscles.
- Think of B as prevention rather than treatment of wrinkles
- My method of injections are vastly different from nurse led injections- I use very small amounts in multiple areas- this gives a more natural look
- Why do I think this is important? Because looking natural never goes out of fashion
- Good B is when no one can pick that you have been Toxed!My personal preference is Botox over Dysport. In my opinion Botox is more predictable, and last longer than Dysport.
As the name suggest, anti-wrinkle injections can help treat and relax certain forms of wrinkling. Wrinkles can be classed as static (at rest) or dynamic (during movement, with muscle activity). B treats the later- muscle activity associated dynamic wrinkles. Classic sites for dynamic wrinkles associated with over use of muscles include-
- The frown lines- namely the area just above the area ‘in between your eyes’. B to this area can relax lines so that you frown less, and make you look less angry and stressed.
- The forehead lines. B to this area needs to be performed well to create a natural look- too much tox can give a ‘frozen-look’, something I always discourage.
- The Crow’s feet, or your smile lines- B to this are can reduce and prevent the wrinkles radiating from this area when you smile. Once again too much Tox here can prevent you from having a natural smile.
- The chin- this is a classic area in both men and women over the age of 40. As one ages, the chin muscles get stronger and become more prominent. Take a look at your chin area when you were in your 20s compared to the late 40s. Notice the upturning of your chin and the prominence? B relaxes this area. A tiny bit of tox goes a long way in this area.
- The angles of the mouth or DAOs. B to an area midway between the angle of your mouth and your jawline can target a particular muscle that pulls down on the sides of your mouth causing you to have a sad look. B relaxes this, and can relax this pull down effect. Ideally Botox should be combined with fillers for the best results.
- B can also treat a multitude of other conditions including eye bags (only if muscle overactivity is the cause), bunny lines on your nose, gummy smile lines, upper lip horizontal lines, and also slimming of the face. Muscle relaxants in the masseter muscles can reduce facial width and make the face softer for females. Another area I use muscle relaxants is in the neck. Softening of muscles and bands can give an ‘instant neck lift.’ B can also treat sweating in various areas of your forehead, scalp and underarms, and the list goes on.
I see B as both treatment and prevention. Especially forehead lines and frown lines. Injections will need to be repeated every 3-4 months to begin with, then I usually space out the injects to every 4-5, depending on how your muscles react.
Many cosmetic clinics believe that B is the answer for everyone, however my approach is different- I give patients the natural look, and use less units than most experienced injectors. If I could perform ONE procedure in someone that would make the BIGGEST difference to skin ageing, in 8 out of 10 times it would be a tiny bit of filler 0.5 ml, to the mid cheek ahead of B. This is not the belief of many cosmetic clinics, nor with the general public, because of the fact that fillers are relatively new in concept, whilst B has been with us in the cosmetic industry for almost two decades. Changing the paradigm of cosmetic treatments is difficult. Often I want to ‘lift’ more than I want to relax, this is especially true in patients over the age of 35.
How I differ in my Tox injections is that I’m a ‘sprinkler’ of tiny does to wide areas. Why do I do this? Because I believe that this gives a more natural look compared to large doses in small areas (traditional B). A great result is when people can not pick that you have been treated, in my opinion if you have little or no muscle movement animation is limited – resulting in an un-natural look. Sometimes ‘less is best’. BOTOX should be used in moderation.
The difference in price between my services and cosmetic clinics is in the experience of the Specialist performing the procedure. I liken this to a hair cut. Give a pair of good scissors to a junior hair stylist and give a similar pair to a senior director, and in most cases the results will be different. (Yes, in rare cases the junior will give better outcome than the director, but this is an exception rather than the rule!)
What is the best treatment for marionette lines- muscle relaxants or Fillers? I heard both can be used to treat this area, is that true?
Yes, in some patients B can reduce the appearance of marionette lines. Fillers like J or R can also be used. I often combine both fillers,muscle relaxants and energy devices such as Ultherapy to get optimal results. B in this area is very tricky and you can have complications that may last a few months. Always consult an expert who has experience in all method of rejuvenation, including surgical, non-surgical Ultherapy – Thermage, fillers and muscle relaxants. This ensures that you are given choices as to what can deliver the best, and most importantly the most natural outcomes.
I am interested in both Fraxel for my skin texture and would also like muscle relaxing injections. Can both be done on the same day?
To be on the safe side, I would leave it 4 days between treatments. Fraxel can give you mild swelling and this may displace the B to areas where it is not needed. This can potentially lead to side effects. Leaving it a few days after Fraxel is safer. Alternatively you can get your injections a week before Fraxel laser. Safety is always on the top of my list.
Fillers as the name suggest fill areas devoid of collagen and fat, and improves hollowness. Fillers can also be used as ‘lifters’ and provide what is known as a “liquid face lift.” Fillers can also reduce wrinkles that are static (wrinkles at rest), including prominent cheek groves, wrinkles and lines. Lip fillers can give volume, form and shape to older lips and restore youth.
Dermal Fillers replace a naturally occurring substance found in your skin called HA or Hyaluronic Acid. As one ages, HA will diminish with time. This in turn causes the skin to loose volume and alter the scaffolding of your skin. This results in wrinkles, hollowness and folds.
Remember B relaxes muscles and prevents wrinkles, fillers address volume changes, lifts and provides filling to wrinkles at rest. Depending on your age, in the ideal world, patients will benefit from both treatments. Older patients will need more fillers than Botox, middle age patient will require both, whilst patients in their 30s may only require either muscle relaxants or fillers. Everyone is different, and carefully planning facial rejuvenation gives rise to harmony, and this in turn gives rise to a natural but youthful appearance.
The areas that I utilize fillers are-
- The cheeks and mid facial areas
- Under the eyebags
- In the grooves of the eye of ‘tear troughs’
- In the corners of the mouth
- In the treatment of some types of acne scars
- The jawline areas to help reduce the look of jowl lines
- The temples and forehead as well as the brow area
There are many types of fillers from over a dozen cosmetic companies, however I use only the ones from Allergan (Ju) or R. I do not believe in using permanent fillers for several reasons including safety, but also the fact the once the filler is in –that it. Remember your body and facial structures change with time and having a permanent substance in your face in a particular location may not be ideal in 5-10 years time.
I choose filler primarily based upon function- if a filler is to lift and give volume, for example the mid cheek area, I would choose a thick filler that last up to 24 months an beyond. If I need finesse to fill in acne scars, or lines under the eyes, tear troughs and very fine cheek lines, I like a thinner filler like Restylane or Volbella. This is a ‘thin and fluid’ filler that is easy conform to areas it is placed in. Sometimes I layer fillers, thick filler deep down to lift and provide volume, thinner filler just under the skin to provide wrinkle filling. Thinner fillers don’t last as long as thicker fillers- on average 8-12 months.
Most fillers I use contain a local anaestheic within the filler, so the process of filling is comfortable for patients. Most often the procedure takes between 15 to 30 minutes to perform. The great aspect of filling is the lack of downtime following this procedure. Most patients go straight back to work after facial fillers.
Fillers can also be used to provide rejuvenation of the hands. As one ages, fat is loss between the tendons of the hands. Hand rejuvenation is usually a combination of both fillers in between the tendons to provide volume, but also laser to the surface of the skin to reduce pigmentation and wrinkling. I usually perform both procedures in the same sitting.
My style of filling is different to many cosmetic clinics, and I call this ‘Freestyle Filling by Dr Davin Lim’ This means I do not just fill in lines, but look, see, touch and tailor specific injection points to give the maximal lift, and ‘wow’ factor, whilst keeping a natural look. I can not emphasise how important it is to look natural. Good filler is when no one can pick you have had any specific areas corrected. You will see the difference, and so will others, but the aim is to keep others guessing what ‘magic holiday’ you had to look so fresh. That is my aim when I ‘Freestyle Fill.’
The optimal amount of filler for a natural look is usually proportional to the age, however individual facial features will naturally vary.
20-30s- 1 to 2 mls of filler
30-40s 2-5 mls of filler
40-50s 3-6 mls of filler
50s-60s 4-7 mls of filler
Fillers last up to and often beyond 2 years, depending on the location and product.
As a rough guide, dermal fillers cost between $990- $1490 per syringe. Discounts apply for patients who require several mls. of filler. Dr Davin Lim uses his “Freestyle Filling’ method, and rarely ‘just fills lines’. Remember- looking natural is the number one priority.
As previously mentioned I do not use permanent fillers. The family of fillers I use are termed HA or Hyaluronic Acid fillers, using special HYLACROSS technology to provide a super high concentration of cross-linked Hyaluronic Acid- this adds volume, but also extra longevity. Additionally, lidocaine (a local anaesthetic) is pre-mixed into the filler to help improve comfort during the filler treatment.
How long fillers last for depends on several factors including-
- The type of filler used
- The location of the filler
- Patient factors
Lets consider the type of filler. Even though all fillers that I perform are based upon HA or Hyaluronic Acid (a natural substance found in the skin), there are subtle differences between them.
J Voluma – typically last between 18 to 24 months. This is ideally used in the cheek area, and consists of a smooth but thick gel of HA. Best for age related volume loss of the cheeks. Restores lost volume, and also lifts the cheek creases. Depending on the age of the patient, the amount I use is typically between 1.0ml to 3.5mls in total. This filler contains local anaesthetic to help numb the treatment area.
J XC- typically last between 12 to 14 months. This filler is used to treat lines, wrinkles and folds around the smile lines, corner of the lips, marionette lines, and vertical lip lines, including smokers lines. Depending on how severe volume loss is, I typically use between 1.5 to 3.0 mls in total. Juvaderm XC, is different to Voluma due to the fact it is more fluid. This does not provide as much volume replacement but provides a finesse and lift as well.
J Volbella- typically last between 9-14 months. This filler is used to treat the lips, upper lip areas, fine lines, and wrinkles. This is my filler of choice for acne scars. My typical dose range is between 1 to 2 mls in total. This filler is very fluid and easy to work with. It is generally placed just under the skin to treat and fill fine to medium lines on the upper lips, lips and acne scars.
These 3 filler types account for 90% of the filler I perform- however I also use longer lasting collagen stimulating fillers in some patients.
Now lets consider the location of the filler. Fillers in the cheeks last the longest- typically upto 2 years, whilst fillers around the lips may last only 6 months. Acne scar filling can last up to 2 years and beyond, depending on where the scar is located.
Patient factors also play a role in the longevity of fillers. Patients who are on the extreme end of physical activity- ultra long distance runners and triathletes will notice that their filler will degrade faster due to a higher metabolic rate. Genetic factors and continued ageing will also play a role in the perceived longevity of fillers.
All skin types and skin colours can be safely treated with fillers, including Asian, Middle Eastern and darker skin races.
For more information on J fillers I use
For more information on E fillers I use
Dr Davin Lim uses a range of dermal fillers including, Restylane, Belotero, and Juvederm .
The actual treatment time to perform the filler procedure itself takes only 10-15 minutes, however planning time takes longer. My philosophy is to carefully look, plan, draw and visualise where exactly were I want the filler placed. During the planning stage I consider the following-
- What are the underlying structures in the filler region and the danger areas I need to take extra care.
- Where are the safe areas to place fillers- in some cases fillers must be placed very deep (like the tear trough) whilst areas such as the forehead fillers must be very superficially for lines, or very deep for volume.
- What areas of skin will I displace when I add volume? Examples are cheeks fillers- adding volume to the cheek can displace eye wrinkles upwards and bunch them ever more.
- What type of filler should I use in certain areas? Cheek volume fillers are thick, whilst fillers around the mouth and under the eyes are more fluid in nature.
- What is the minimum amount of volume I can use to give the maximal benefit to the patient? Fillers are charged by the ml. For example, patients in their 30s may only need one ml of filler to make a huge impact on facial ageing. Where to place this one ml. is extremely important for both results and cost savings to the patient.
In some cases I may spend up to 10-15 minutes planning and only a few minutes injecting. Treatment also depends on the complexity of filler placement. I give patients between 20 to 30 minutes for each session. Complex cases include blending in eye bags, multi-layer filling, and treating multiple atrophic acne scars. Simple cases are cheek lifting and jaw line definition.
Because of the way I perform filler treatment, the procedure itself is not painful. This is because I use fillers that contain Lidocaine, a form of anaesthesia pre-mixed in the filler itself. Also with the use of cannulas I also use lidocaine injections before inserting the cannula.
After filler treatment you will notice the treated areas to be lumpy. In some cases I will ask to massage the areas- especially if I am treating acne scars. In most cases, you only need to restrict your exercises for 24 hours after the filler procedure. Make up should not be worn on the day of the filler, but can be worn the day after.
Yes! The most natural results are achieved with combination treatments with dermal fillers and muscle relaxants. Remember anti-wrinkle injections relax muscles, whilst fillers give volume and lift. A combination of both treatments will give the most natural results. I also perform surgical and non-surgical lifting of key areas, including the lower and mid face. Mild to moderate laxity can respond nicely to energy devices such as Ultherapy or Thermage. These treatments should be conduced before dermal fillers.
Natural botox brisbane results can be achieved with good technique- Dr Davin Lim
Yes. One of my favoured treatments for acne scars is the use of fillers. Not every type of acne scar is suitable for acne scar treatment. Types of acne scars that can respond to fillers include atrophic or depressed acne scars, saucer shaped scars, pox scars, and tethered or anchored scars (often combined with subscision). Acne scars such a box car scars, rolling scars, and ice-pick scars respond best to either laser, or by TCA CROSS. Most patients will exhibit a multitude of scar types, and thus multiple treatment methods will provide the best results.
Fillers can have distinct advantages over laser treatment. First of all, little or no downtime is seen with filler placement. I usually perform fillers on a Friday or Saturday, and at most, redness is seen for a few hours after filler. Laser on the other hand is associated with a downtime of 8 days on average. Fillers are the only reliable method of improving atrophic and depressed acne scars. Lasers such as multiple fractional CO2 can ‘raise’ atrophic scars by stimulating collagen, the amount of improvement ranges from 30-80% after 3-4 treatments. With this type of scarring (atrophic and depressed scars), I can achieve up to 95% improvement with one to two filler sessions.
The disadvantage of fillers is that they do not last forever. HA or hyaulorinic acid breaks down over time. For acne scars, most patients should receive lasting improvement ranging between 12-24 months. Some patients are lucky and receive longer improvement as the needle and filler itself may stimulate collagen production within the scar.
Fillers for acne scarring is one of my favoured treatments because it is technically challenging. For complex cases I have to approach atrophic scars at different angles and levels. Some acne scar cases will only need one filling session, some patients with severe atrophic scars will require 3 sessions. Each session takes between 20-30 minutes to perform. My product of choice is Juvederm Volbella for atrophic acne scars.
If you have multiple scar types (ice pick, rolling, box car, atrophic and tethered scars), filler treatment is performed LAST in the series of treatments. Why? Because as I eluded, laser may stimulate collagen in atrophic scars, and if this happens you may only need a tiny bit of filler, or in some cases no filler at all.
Fillers remain an extremely useful tool in the management of acne scars, and unlike dermal grafting, have very little side effects and virtually no downtime. In some cases treatments maybe partially claimable thru Medicare (examples include if I perform a surgical release of tethered scars- subscion, during the process of filling). Filling acne scars with the latest generation of dermal fillers has shifted the paradigm of scar revision from a long downtime procedure to a now downtime ‘ instant’ fix. Longer lasting dermal fillers will further improve this technique of scar revision in the future. I predict that stem cells combined with dermal HA fillers will be the future of acne scar revision (for atrophic scars at least!).
Texture. Tone. Volume. These are the three things that need to be combined in just the right proportion to create natural harmony that is beauty. Texture is the palate of the skin- namely the fine wrinkles, brown spots, redness, sun damage, dark spots and uneven discolouration. Laser can address all these problems. Tone is how tight your skin is. As you age skin tone decreases due to a reduction of collagen and loosening of supporting structures in the deeper layers of your skin. If skin tone is markedly reduced, I perform a mini-s face lift, often combined with removal of excessive skin from the eyeslids. If skin tone is slightly reduced, laser resurfacing with CO2 CORE laser can address BOTH skin texture and skin tone.
The last puzzle in this picture is volume. Volume refers to how full your cheeks and certain key areas are. Volume can only be achieved via fillers or fat transfer.
Not everyone will require lifts, lasers and volume replacement. As a general guide-
20s to early 30s – Patients may improve skin texture via lasers such as Fraxel. Wrinkle prevention should be considered, and Botox plays a role.
30s-40s- often a tiny bit of filler makes the most difference. 1.0 ml to the mid cheek area in most patients will give a youthful and natural rejuvenation. If skin texture is altered, laser can be performed. In this age group Fraxel 1550 or CO2 Fractional with Fraxel 1927 can address both fine wrinkles as well as pigmentation changes.
40s-50s- volume loss is more marked in this age group, and smile lines tend to form. I use less Botox and more filler. In the 50s bone recession can be seen around the eyes, I may fill tear troughs, and also consider eyelid laser or surgery for loose lid skin. Skin texture should be address with Fraxel combined with CO2 Fractional laser. If the surface of the skin is good, I may use Ultherapy or Thermage to lift, without the need for lasers- this is only suited for mild to moderate skin laxity. a guide I like to use 2 different types of fillers in this age group- Voluma to provide volume to the cheeks, and Volbella to provide a finesse to the eye area and lips.
50s-60s– as per above, with accelerated changes in skin texture, tone and volume. Patients in this age group will generally have had lots of sun exposure in the past and show signs of premature ageing, warts, and sun damage. Laser resurfacing combined with 3- 5ml of filler is ideally needed.
60s and beyond – this age group will generally benefit from some form of face lifting. In moderate cases of skin laxity, laser lifting will suffice, once again combined with a few mls of Juvederm Voluma. In severe cases of laxity and poor skin tone, the treatment of choice is that of a mini-s-face lift, eyelid surgery (also known as blepharoplasty) and volume replacement. Mild to moderate skin laxity can be addressed with Ultherapy.
Filler technology has come a long way over the past 5 years. Now more then ever patients are given many choices in regards to filler brands and longevity. At Laser and Lifts I do not use permanent fillers- this is because your skin tone shifts with age, along with the filler. So, how can fillers help with the chin and cheek area?
One of the first places that looses fat is the mid cheek area- this is what we refer to as mid facial volume loss, and occurs in the late 20s, and early 30s. By the late 30s, this mid facial volume loss is very noticeable in 90% of people. Replacing volume in this area, in my opinion is far better than Botox. Remember, Botox should be viewed as prevention, whilst filler acts as treatment.
Volume filling also lifts. Notice all the before and after pictures of fillers in the cheek areas? See what happens to the nasolabial folds (the line that goes from the corner of your mouth to the side of the nose)? It lifts and softens. See that cheeks are not only fuller, but higher? Cheek augmentation goes beyond volume replacement, and lightening folds and lines. As Specialist injectors we also look at reconstruction of cheek bones and reflectance of light- this highlights the ‘point of maximal beauty’ and projects what we call the ‘ light reflex’. This highlights cheek and bone structure. Notice that beautiful people have high cheekbones? This is part of cheek augmentation.
Now to the chin and fillers. Jowl lines, marionette lines and ‘sad lips’ can all be corrected with fillers. Additionally the horizontal line that runs across the chin (almost universally seen with age) , can be corrected with filler and Botox.
Jaw line definition can also be reconstructed with fillers, both in men (angled and manly jaw lines) and in women (softer curves but still straight). Jaw definition personifies youth and beauty.
Ideally I like to combine fillers with procedures such as Ultherapy high focused ultrasound or radiofrequency-this adds to both volume and lifting, especially in patients over the mid 40s. Patients in this age group may benefit from Ultherapy first, then fillers to volumes at the end.
This depends on your genetic and environmental factors. Here is the absolute truth – there is no best cosmetic treatment in this age group. Some patients will have early sun damage, and hence the optimal treatment will be Fraxel.
If you do not have any wrinkles, nor crinkles, in my opinion B is a waste of money. On the flip side, if you start to have crinkles (static wrinkles), B will prevent and reverse wrinkling.
Volume loss- here is the controversial point. I believe 90% of people will benefit from filler (only 0.5ml- a tiny volume) on each side of the mid cheek before the age of 35. This will make a noticeable but natural improvement in skin age. I firmly believe that this procedure will be far better than B, dollar for dollar. Obviously if money is no object, filler and Botox for prevention is ideal.
Fine wrinkle and lines (especially under the eye) is a subtle sign of loss of skin tone. The solution? Simple! Fraxel high density improves both skin texture and fine wrinkling. Our Fraxel protocol necessitates only one treatment.
Hormonal pigmentation called melasma is common in this age group, the use of fading agents, chemical peels and skin toning with the Q Switch laser will address these issues. Pigmentation will be improved, and fine wrinkles will disappear.
Skin care products such as vitamin A, B, and Cs are an essential part of skin care and maintenance in this age group as it forms the cornerstone of your anti-ageing program for life. Our Specialist team of nurses and pharmacists can guide you thru what is the best product line for your skin type.
Volume replacement and textural improvement is paramount in this age group. Inevitably there will be crinkles present (wrinkles at rest), and hence procedures such as laser lifts, Fraxel, fillers and B will be advisable.
Volume replacement in this age group goes beyond mid facial fat loss. Lips get thinner (lip fillers will reverse inverted lip and give you a subtle pout, and re-define your lip borders. Cheek bones can do with a little lifting, and fillers can re-define borders, and give the ‘light reflex’, pointing towards the point of maximal beauty. In skilled hands, angles of the jaw can be reconstructed.
Eyelid hooding starts to form in the mid 40s- this can be corrected thru a process called blepharoplasty. This can be done with either laser, non-surgical lifting with Thermage, Ultherapy or surgery. These procedures involves tightening the upper and or lower eyelids.
Skin texture will definitely need correction. If your sun damage is mild, Fraxel or Pulse Fraxel will give a great result with just one treatment. If you have moderate to severe sun damage, then laser resurfacing can renew your skin, giving you younger, fresher, and healthier skin. Skin tone can always be improved in this age, as collagen is less and cross-linking or scaffolding is poor. This is why I advocate the use of collagen stimulating devices such as Ultherapy in this age group. Ultherapy is a non surgical energy device that uses Ultrasound to help stimulate collagen and is ideally suited for patients with mild to moderate skin laxity.
Volume replacement, laser treatments and eye rejuvenation.
This is when nature and gravity takes over, and what cosmetic outcome you want will be determined on what you are willing to undertake. Lets start with skin texture.
Skin texture can be improved with laser. Patients in this age group will have noticeable textural changes in the way of pigmentation and wrinkles- I suggest fractional CO2 laser or Fraxel 1550. Machines like IPL (intense pulse light) or light Fraxel 1927 can not achieve a good improvement as pigmentation and collagen deletion is marked at this age. Chemical peels? Great for the 20s, but in this age group peels are more for maintenance not treatment.
Let move to skin tone- I feel the greatest improvement in skin tone in this age group centres around the eye area. Why? It is because eyes are the first thing people see when greeting you. Opening and refreshing the eye area makes the biggest difference when it come to perception of age. How to I achieve this? In the early 50s- 60s, laser lifting and tightening can achieve great results, but once skin laxity is marked and ‘hooding’ and under eye wrinkles bunch up, surgery is the only option. This procedure is called blepharoplasty.
Laser to the periorbital area (around the eyes) can also tighten up wrinkles. In this age group, placing Botox in the crow’s feet with out tightening up the skin is a waste of time. Once you are in your 60s we want lifting, not muscle relaxing. If skin laxity is mild to moderate and if you have little sun damage in the past, Ultherapy in this age group can be viable. Ultherapy is a non-invasive method of stimulating collagen production with very little, if any downtime. It uses high energy focused ultrasound to stimulate and remodel old collagen, and provides contraction over a period of 3-5 months.
In some patients skin laxity is so marked that the only way to achieve a long lasting, natural and marked improvement in skin tone is a mini-s-face lift. Face- lifts have evolved over the past two decades. Gone are the days where by surgeons pull as tight as possible; this results in the Hollywood 80s lift- no a good look! Now face-lifts are done with minimal scarring, with a natural lift of the face and neck area. Scars are hidden behind the ears and in the hair line.
Finally, but most importantly is volume replacement. This is done at the end of rejuvenation. Why? Because laser can induce collagen remodelling and plump up the skin to a degree, and face lifting will ‘re-drape the skin’, preparing the face for volume replenishment. My preferred filler is called a layered or mixed filler technique. I use Juvederm Voluma for deep placement- especially in the mid facial and cheek areas. I like a softer filler for around the eyes, and lips. Fat grafting will be offered in late 2015, as stem cell replacement within fat grafts will be the future. Studies on fat grafting, stem cell replenishment, and volumizing are currently being undertaken to see the long term benefits of this procedure.
To summarise, patients in this age group will need multiple procedure to look their best- I can take your skin age back 10-15 years, depending on what procedure is performed.
Bone structure responsible for the hollows one sees, is constantly changing as one ages. A permanent solution is thus difficult. If the hollows are in part caused by volume loss, I prefer using a HA filler. If it is skin changes accounting for crepiness under the eye, I like to use my combination of erbium and fractionated CO2 treatment. Ultimately it is a combination approach, addressing the different signs of facial aging that give a natural and enhanced result.
Dr Lim uses Dysport , Xeomin and Botox Brisbane to treat wrinkles and rejuvenate skin.
My favourite dermal filler for tear thoughts and eye bag – under eye areas are Restylane, Juvederm Volbella a
Liquid facelift is a term describing a combination of dermal fillers and B. Both are used to correct signs of aging and enhance the youthfulness of the face. While the results of a liquid facelift are not comparable to the results of a surgical facelift, liquid facelifts can smooth wrinkles and replace lost volume that contribute to the aging face. Liquid facelifts have less risk and downtime than a surgical facelift and if performed correctly look more natural. Liquid facelifts are great options for patients who are not ready to undergo surgery and who do not yet have severe signs of ageing. If you exhibit mild to moderate skin laxity, I often combine Ultherapy with fillers to achieve an even better result. Ultherapy is designed to stimulate your own collagen production over 3-5 months, resulting in skin tightening. Downtime following Ultherapy is minimal.
Face- lifting itself does not address one of the most important aspects of facial rejuvenation- that is replacing loss volume. Fillers can act as both a lifting procedure as well as a volume enhancement treatment. This gives the best results. Remember its the balance between skin texture, tone and volume that gives the best and most natural results.
NO, lasers can in fact compliment fillers. Laser work by treating the upper part of the skin- namely improving skin texture such as red or brown discolouration. Deeper lasers such as fractional CO2 and Erbium laser only penetrate a millimetre or two into the skin, well away from fillers. Botox Brisbane can treat crow’s feet and forehead wrinkles.
Laser can also augment volume by stimulating collagen, improving skin tone, texture and volume. Wrinkles gone with Botox Brisbane treatments .
3 things- texture, tone and volume define youth, skin health, ageing and beauty. These all need to be treated in proportion to achieve facial harmony for a balanced and natural look.
Texture is defined as the palate or skin colour. Uneven texture will present as brown spots and dots, sun damage, age spots, red blotches, pimples and lumps, red veins, broken capillaries, and fine wrinkling. Good skin texture is fresh glowing, even skin colours with no visible signs of sun damage.
Skin tone is defined as how much elasticity and collagen your skin has. Young skin has ordered collagen bundles holding skin and the underlying structures up. As we age, collagen breaks down, and gravity takes over. What does this mean? Eyelids get heavier, eye bags and wrinkles form, jowl lines form, cheek creases get more pronounced, and wrinkles get deeper.
Skin volume is defined as fullness. Young skin has fat in just the right places- mid cheeks, high cheeks, temples, under the eyes. As we age, we loose fat in these key areas. Replenishing skin volume is one of the most important steps in achieving youthful, vibrant, and beautiful skin. Volume is often overlooked by many ‘cosmetic doctors’ and clinics.
How we correct and balance skin texture, tone and volume will depend on your age and your genetics. Some people will age faster than others. Unfortunately we can not modify our ageing genes, but environmental factors such as smoking and UV exposure can be avoided.
Here is a guide as to how we approach the correction of texture, tone and volume-
Skin texture– this can be treated with a variety of peels and lasers. Peels are only suitable for mild changes in skin texture. Patients in their early to late 20s are candidates for vitamin A peels, AHA, or lactic acid peels. Older patients are suited to Pulse Fraxel- the combination of IPL and Fraxel laser. Fractional lasers such as Erbium, or CO2 can markedly improve both texture and skin tone. Red veins and rosacea constitutes an alteration in skin texture, and hence V Beam lasers can help.
Skin tone– this can be treated by 4 ways to ‘lift’ the skin. Laser face lifts can do wonders for skin texture and poor skin tone. Ideally suited for sun damage, wrinkled skin, with sun spots, age spots, wrinkles around the eyes. Surgical face lifts are for patients who have severe skin laxity. Dr Lim performs a mini-s face lift, hiding scars in key areas. Most often this procedure is combined with eyelid surgery, known as surgical or laser blepharoplasty. Thirdly, skin tone can be improved with what is called a ‘liquid face lift.’ This form of lifting uses fillers such as Juvederm Voluma placed in key areas. Volume displacement of skin, lifts sagging skin in the jowl lines and nasolabial folds- lines that run from the nose to the outer lips. The advantage of ‘liquid face lifts’ is that this procedure is not associated with any downtime. This form of face lifting does not address any skin textural changes, unlike laser face lifts. The forth way is with the use of energy devices such as Ultherapy and Thermage. These devices have their limitations- ideal candidates are patients who exhibit mild to moderate skin laxity. They work by stimulating collagen over a period of 3-5 months.
Skin volume- one of the most undertreated and most overlooked aspects of skin ageing. Volume replacement, even as little as 0.5 ml in the 30s can make a huge impact on skin age. Volume depletes with time and age. Dermal HA fillers such as Juvederm can make a huge difference in volume replenishment. To a limited degree, collagen stimulation can also be achieved with lasers.
Natural beauty and youth is achieved by addressing all 3 factors in perfect harmony.
Underarm sweating is common in Brisbane, given its hot and humid climate. It is estimated that 3 to 6 out of 100 people suffer from this condition known as axillary hyperhidrosis (HH). This means out of 1 million people residing in Brisbane, there will be about 30,000-60,000 patients with axillary HH. What you do not know is that most people don’t talk about it, not even to family members. Axillary HH is poorly treated by many doctors because they don’t know about the one secret treatment that actually works- Botox.
Dr Davin Lim has been using Botox for the treatment for underarm sweating for over 15 years. This treatment was approved by the National Health System or NHS in the UK back in 2000, the US approved this treatment in 2007, under the FDA, and Australia has approved Botox for underarm sweating in 2012. There are however stringent guidelines. First of all you must have trialled and failed Driclor. Most patients with severe underarm sweating will have irritation with this product. Secondly Botox treatment must be performed by an accredited Specialist. Medicare and PBS partially covers Botox.
Here are some important points regarding Botox injections for sweating-
- Botox takes 90 seconds to perform
- Treatment is well tolerated, and each needle feels like an ant bite
- If need numbing gel can remove 80% of the discomfort
- Sweating will decrease by 70-90% within 10 days
- Sweat reduction following Botox injections last 4-8 months
- There are no side effects, apart from mild bruising in 5% of cases
- Treatments are repeated once underarm sweating re-commences
- Medicare and the PBS subsidies for Botox only for excessive underarm sweating
- An out of pocket cost of $440 applies
- 3 Botox treatments are subsidised annually by Medicare
- Patients who can not have Botox for axillary HH include pregnant women and those breast feeding
- Botox for sweaty hand and feet are not covered under Medicare
Another treatment for excessive sweating is called miraDry. Unlike Botox, miraDry is permanent. 2 treatment cycles, 3 months apart constitutes a treatment cycle. miraDry works by the use of electromagnetic energy that destroys the sweat glands. Botox works by blocking the signal to sweat.
Here are some facts on miraDry treatment for underarm sweating-
- 2 treatments are needed, the second treatment is 2-3 months after the first
- This treatment is not under Medicare and cost $3695 (for 2 treatments)
- Sweat reduction is less than Botox 60-80%, however it is permanent
- miraDry can only be done for excessive underarm sweating, and not sweaty hand or feet
- This treatment is safe, and has been approved by the US, Europe and by Australia’s TGA in 2014
- Unlike Botox (no downtime), miraDry is associated with a downtime of approximately 3-5 days
- The most common side effect following miraDry treatment is swelling and bruising
- For more information on this treatment visit www.sweatfree.com.au