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Category: Chemical Peels

Multi-Modal Treatment Planning For Natural Looking Aesthetic Rejuvenation (Or how we get it right! )

2nd November 2016 | Thread Lifts

Anti-wrinkle injections weakens muscles, we know that.  But ageing is multifactorial, not just a product of muscle over activity.  To create natural looking aesthetic rejuvenation it stands to reason that we need more than just anti-wrinkle injections to keep us looking younger.  Obvious isn’t it!  Yet we still find that anti-wrinkle injections is the worlds number one requested cosmetic treatment.

Dr Simon Ravichandran on how to achieve natural looking aesthetic rejuvenationHere’s a picture of me taken recently, you can ignore the beard, that’s gone now 🙂

Anti-Wrinkle Injections can relax the lines and wrinkles on my forehead, if I had any there.  It can also smooth lines and wrinkles around my eyes and between my eyebrows, likewise if there were any there. However, it’s not going to help overall with making me look and feel a bit younger.  In fact, if I had nothing but anti-wrinkle injections for the next ten years I’d start to look decidedly odd! With a smooth and wrinkle free upper third of my face but quite an aged appearance to everything else.

What I am seeing when I look at this image is the deeper shadow developing at the side of my nose, the hollowing at the cheek at the side of my mouth, the wrinkling of the skin underneath my eye and the flattening of my cheek underneath the eye. If I was being super critical I’d probably also mention some very early volume loss just above my eyebrow that will probably develop over time and make my eyes look a bit more skeletal.  For the sake of a complete picture I can also see a receded hairline and marked thinning of the hair on the top of my head.  That’s what more than ten years in Aesthetic Medicine will do to you!

The answer is clearly not just anti-wrinkle injections.

Let’s think about a real person now, a typical prospective aesthetic patient who presents to a clinic just like Clinetix wanting to look and feel refreshed and rejuvenated.  Lets assume it’s a female patient right in the middle of the age range of people who attend my clinic about 45.  When she sits down in front of me and tells me she feels her appearance makes her look and feel tired or depressed I don’t reach immediately for the wrinkle syringe, I reach for the mirror and ask her to point to what is causing her concern.

These days it’s getting less likely for the fingers to be pointing at the crows feet, or the frown lines. Instead they generally go to the middle and lower parts of the face first, indicating sagging skin, jowl formation, downturned mouths with thin lips and changes in skin quality like roughness, pigmentation or large pores.  We consider these features as part of a holistic rejuvenation process in order to create better results for our patients.

Creating Natural Looking Aesthetic Rejuvenation with a Multi-Modal Treatment Plan

As ageing is multifactorial we approach rejuvenation with a multi-modal treatment plan.  This means we can use a wide variety of treatments to address individual aspects of ageing together to create a synergistic and harmonious natural looking rejuvenation.

The Volumetric Approach To Facial Rejuvenation

I like to visualise the ageing face from the bottom up.  Think of an old house that’s sitting on dodgy foundations.  The roof is falling apart and the window frames are all broken.  I can fix those things easily but the house will still be sinking on it’s foundations. Therefore there’s not a huge amount of point other than for the temporary cosmetic fix.  For a long term fix you need to start with the foundations to build a house that will last.

The foundation of the face is the bones of the skull and the dense layers of fat that sit above.  As we age we get specific changes in the shape of the skeleton, areas that flatten and regress.  We also get reduction in the amount of dense fat that overlies it.  Most of my consultations begin with an assessment of the foundations of the face and a plan to replace that lost volume.  The volumetric approach to facial rejuvenation.  With a detailed understanding of the anatomical changes of the skeleton with ageing, and the availability of safe injectable implants (dermal fillers) we create a plan to inject in specific areas to restore a natural shape to the deep face.

This will build up a strong support upon which the upper layers of the face can be more naturally restructured. The amount of dermal filler required to achieve such a correction varies with age of the patient. However it is usually fairly predictable using the formula 1cc per decade of life plus 1cc.  This means that someone in their mid forties will usually require 5 syringes, someone in their mid fifties may require 6 and someone in their mid thirties may require 4.  We place the dermal filler in the areas of the face to give maximum support as required for the patient. Typically these areas are the cheeks, the temples, the side of the nose and the jawline.

Lifting Jowls and Sagging SkinNatural looking aesthetic rejuvenation using Thread Lift, What Treatment is Right for Me at Clinetix Rejuvenation

The next area of concern is the more superficial fat layers of the face, these can be smoothed with softer, less lifting dermal fillers to correct irregularities and improve contour. But when sagging of the skin and early jowl formation become a concern then we often need to think in terms of re suspending the user layers.  The traditional approach to achieve this is the surgical facelift. However, the advent of safe and effective thread lifting techniques now gives us a non-surgical alternative.

Threads are introduced through small holes made with a needle at the side of the face and placed into the upper layers of the faced.  Using a thread called a PDO Cog, we can place a fan of threads that can be gently pulled. This creates a lift and repositions the upper layers of the face.  This technique is very effective at lifting the upper fat layers of the face. Which in turn has an effect on the appearance of nasolabial lines, marionette lines and jowls.

Rejuvenating the Appearance of the Skin

Once we have revolumised and lifted the face the final thing to consider is the skin.  There are many many different ways to rejuvenate the appearance of the skin and the decision will depend on the desired result, the budget and the desires of the patient to have a quick result with one or two treatments, or a more gradual process with several skin treatments over a period of time.  With our non-surgical rejuvenation packages we offer CO2 Laser resurfacing or Chemical Peels to get rapid and dramatic results.  We also have a range of specially designed combination skin treatments that treat multiple layers of the skin using different techniques at the same time for improved results with no downtime.

Laser Resurfacing

Laser resurfacing or Fractional Ablative resurfacing uses a high powered laser to cause controlled damage to the skin at a specific depth. The skin responds by creating more healthy collagen and more ground substance in the dermis. This results in firmer and more resilient skin.  The epidermis is also resurfaced providing a fresher and more lustrous skin with less blemishes, pigmentation and surface irregularities. The recovery period following a laser treatment is about a week.  Initially your skin will be red and it is likely to take some time to heal afterwards.

Chemical Peels

Natural Looking Aesthetic Rejuvenation with Chemical Peels at Clinetix RejuvenationFor Chemical peels there are many many options but for a rapid result we recommend a medium depth TCA peel. This is a solution that is applied skin and allowed to soak through the deeper layers of your skin.  The TCA causes a controlled damage to the dermis at a specific layer. The skin above this layer then peels off over the course of a week as healthier fresher skin grows underneath.

To summarise, a complete facial rejuvenation treatment plan should consider all the signs of ageing. It should also be able to address each one separately in order to achieve a natural aesthetic result.

Our goal is to make our patients feel better about the way they look. In turn make them feel more confident about themselves as a whole!  The goal is never to make someone look like they have had a treatment.  After a treatment people should be complimenting you about your appearance, but they won’t know what has changed.  As I often say to my patients, if anyone asks you who your Doctor is, come and tell me because it means I’ve done something wrong.  If they ask you if you’ve been on holiday or changed you hair then we’ve got it right!

If you’d like to have a chat with Dr Simon or Dr Emma Ravichandran about a personalised treatment plan, get in touch here or give us a ring on 0141 221 0229 for our West End clinic or 01698 854 221 for our Bothwell clinic.

Which Treatment Is For Me?

5th July 2016 | Dermal Fillers

Part I

Emma Question Mark

for Part II of this article click here

The sheer number of different treatments now available for non surgical aesthetic rejuvenation can be bewildering for anyone starting to do a bit of research and find out what is best for them. In this article I’ll explain the main treatments available for various concerns, and hopefully make things a bit easier.

Before we even start to discuss the treatments though, you should remember one really important thing. This is not a process that should be commoditised. In aesthetic practice we are not retailing products or aesthetic medical services in the first instance. We are offering a consultation to give our patients the information they need about the treatment choices that would be best for them.

Here’s an example. Patient x has abdominal pain, does a bit of research and thinks he has appendicitis. Patient x doesn’t go to his surgeon saying “Doc, you need to take my appendix out” He says “Doc I have abdominal pain, can you tell me what it is?” Doc then takes a thorough history, undertakes an examination and on the basis of his knowledge and experience provides a differential diagnosis (possible causes) and a list investigations required to find the definitive diagnosis (actual cause). The Doc presents patient x with the available treatment options, explains the pros and cons of each treatment option, including no treatment at all, and together with this information the patient makes an informed decision about his or her treatment.

It’s similar in aesthetic medicine. A patient with sagging skin may have read about a thread lifting procedure and present to the clinic requesting the same, but often the patient has the diagnosis slightly wrong, and often has requested an inappropriate treatment. We prefer you come to us and say “This concerns me about my appearance, what do you think?” To be fair this is becoming more commonplace in our clinic and it means our patients are leaving happier, with better advice and more appropriate treatments.

Anyway, back to the list of things you may wish to consider. Starting with the worlds number one requested aesthetic procedure, anti-wrinkle injections.

Anti-wrinkle injections use a potent medicine that is injected into muscles to cause a temporary weakness that lasts for about 4 months. This can result in a reduction in lines and wrinkles associated with facial expression in the upper part of the face. Commonly used to treat glabella lines (verticle frown lines between the eyes) as well as horizontal forehead lines and crows feet. It is not particularly useful for treating lines around the mouth although it can be used in this area to smooth out the chin and prevent excessive movement of some muscles in this area. It can also be used to reduce the bulk of a master muscle resulting in narrowing of a wide jaw, and it can be used in the neck to reduce vertical tension bands and help in defining a jawline.

The second most common requested non surgical procedure is Dermal Fillers.

Dermal fillers are gel like implants that can be placed within the skin itself, or into the tissues beneath the skin to smooth lines, create contour and reshape a face. The most common area for treatment with dermal fillers in the UK is the lip (Lip Fillers) Typically this is to increase the size of the lips but in expert hands the treatments is used not for enlargement, but for rejuvenation. This means using the fillers carefully to recreate the structure of the lip without making it look larger than it should! A real expert will be able to use dermal fillers together with anti-wrinkle injections to replace lost facial volume, restore lip structure, lift eyebrows, jawlines and temples to create outstanding rejuvenation results that look completely natural.

Chemical Peels

Chemical peels or skin peels are a treatment to improve the quality of the skin and address fine lines, wrinkles, pigmentation, textural concerns and lack of lustre. They are often misunderstood and in Clinetix we frequently find our patients are put off by the description of acid peeling the skin off! However it is important to understand that chemical peels are safe and effective treatments for skin improvement. If you forget the term “acid” then a peel is simply a solution that is applied to the skin for a set period of time, before being removed or neutralised. There are a number of different solutions that will have different sorts of effect and are used for different types of skin concern. For example we have a number of very superficial chemical peels that are not painful and have no actual “peeling” of the skin that are incredibly useful in the treatment of acne and rosacea. For skin rejuvenation, treatment of fine lines, and pigmentation we have some solutions that may induce some dryness or flaking for a few days but again no actual peeling or pain.

Okay that’s the three commonest treatments we perform at our clinic. Most patients attend with a variety of concerns relating to an ageing appearance as well as skin concerns and it is usual for a treatment plan to be created that involves addressing all concerns with combinations of the above three treatments.

If you’d like to know more about the treatments or anything else contact us here.

Next time I’ll talk about other rejuvenation treatments including Thread Lifts, Laser treatments, Large Volume Treatments and how we use them all in combination to achieve amazing results.

Medium & Deep Chemical Peels

6th May 2016 | Chemical Peels

Interested in finding out more about chemical peels? Dr. Simon recently spoke to Aesthetic Journal to explain the properties of medium and deep peels.

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Acne and Acne Scarring

9th September 2015 | Chemical Peels

Acne is a common skin condition that is often overlooked and under managed, in the belief that it is a temporary affliction that will resolve itself with time.  Whilst there is a small amount of truth in this, acne often remains problematic for years, and the pigmentation and scarring that sometimes occurs can last for a life time.

What is acne?

Acne is a disorder of the pilosebaceous unit.  This is essentially a structure that contains a hair shaft and a sebaceous gland, that makes sebum.  Sebum is a substance we need to lubricate and waterproof our skin.  It is currently thought that acne develops after a variety of processes that narrow or block this structure.  This causes a build up of sebum within the structure leading to some irregular lumps and bumps on the surface of the skin.  This is commonly known as comedonal acne.  The blocked glands can then become inflamed resulting in pustules. These can then progress to cause rupture of the structure with inflammation extending to surrounding tissue with resultant scarring and nodules.

What causes it?

The main causes are hormonal changes and a bacteria called Propionibacterium acnes (P. acnes)  The hormonal changes are easily seen as androgen levels increase in puberty, resulting in an increased sebum production and an increase in acne lesions.  This can also be seen in who start or change their contraception.

The bacterial role is complex. P.acnes (the bacteria) is thought to increase the stickiness of some of the cells in the gland, resulting in blockage and comedone formation.  It is also thought to be responsible for secreting enzymes that contribute to comedone rupture and the tissue injuries that result in scarring and pigmentation.

How can we treat acne?

Topical treatments

The first line treatments are  usually skin preparations such as benzoyl peroxide.  Benzoyl peroxide is effective in reducing the bacteria, and also helps “unstick” the stuck cells in the blocked comedone and promote it’s recovery.  Antibiotics can also be used, either in creams applied to the skin or in tablet form.  Retinoid creams have a number of actions that help normalise the skin cells and are effective in the management of acne.

Phototherapy

If initial treatment is not effective it is worthwhile adding phototherapy to the treatment regime.  LED phototherapy uses low energy light to stimulate a variety of cellular responses that can destroy the bacteria, as well as suppress inflammation and pigmentation.  LED phototherapy is very effective, particularly when combined with topical treatments.  It is currently recommended to have treatment blocks of 10 or more sessions, two or three days in-between sessions.

Chemical Peels

Chemical peels are solutions that are applied to the skin and allowed to soak through the epidermis for a set time, before being neutralised.  Some chemical peels such as Salicylic peels or Pyruvic peels have been shown to be particularly effective in the management of active acne, with reduction in the number and severity of lesions with a course of treatments.  6 treatments or more may be required with one or two weeks in-between treatments.

What about Scarring and Pigmentation?

The long term consequences of inflammatory acne can include pigmentation changes and facial scarring.  Both acne scars and pigmentation can be improved with skin resurfacing treatments such as dermaroller, chemical peels or laser resurfacing.  The treatments vary in term of the downtime required, the number of procedures required and the outcomes.  In general terms laser resurfacing is considered the gold standard treatment with fewer sessions required and better outcomes, however there may be up to a couple of weeks of recovery after each treatment.  Dermaroller also gets excellent results but will typically require more treatments.  There is less downtime with a dermaroller, often the skin is just a little red for a few days.  Chemical peels can get good results depending on the depth of the peel.  The deeper the better, up to a point, but deeper peels have longer downtime.  You need to discuss your options with your doctor and decide on what treatment works best for you, in terms of the outcome desired, the downtime tolerable and the number of sessions you can commit to.

 

We hope this short article answers some of your questions.  If there is anything you would like to know more about please contact us here and we will be happy to answer your enquiry.

Simon Ravichandran

What are Chemical Peels?

22nd May 2015 | Chemical Peels

Superficial and Very Superficial Peels

Superficial peels penetrate only the uppermost layers of the skin, causing a faster turnover of skin cells to improve the appearance of the skin. They are often described as lunch time peels or advanced facials because they usually cause no redness of the skin at all and feel just like getting a normal facial, with a bit of tingling! They can address pigmentation, fine lines, pores and comedonal acne depending on which type is used. They can also improve the appearance of fine acne scarring. A series of treatments is required, and the frequency depends on the peel type, typically intervals of two to four weeks are recommended and four to six peels may be required to achieve the desired result. We have a range of superficial skin peels at Clinetix including the signature facial and ZO Red Carpet peel, which are suitable for all skin types as a general rejuvenating treatment, or specific peels such as lactic, salicylic or glycolic for conditions such as acne, dryness or pigmentation.

Medium Peels

Medium peels affect a deeper layer of the epidermis than the superficial peel, and so cause some reddening of the skin with shedding or flaking over a few days to a week depending on the peel type. They address the same issues as the superficial peels, but to a greater extent. So they are better at addressing fine lines, pigmentation and have a greater effect on collagen synthesis, leading to a firmer more tones skin after treatment. Generally fewer treatments are required to reach the desired result, so if you are prepared to have a few days of flaking and shedding, and are looking for a faster result then medium peels would be an option for you. Clinetix offer Jessner’s Peels, TCA and combined medium depth peels. The choice depends on the desired outcome and your Doctor will be able to advice you as to which peels would be the best depending on your own personal situation.

Deep Peels

Deep peels effect the dermis, the layer of skin beneath the epidermis. They can have amazing results as they literally cause an almost complete regrowth of skin, however they have a much longer downtime and are painful if not performed under an anaesthetic. The most common deep peel used worldwide is a Phenol Peel. We do not perform this peel at Clinetix as we prefer to use Laser Resurfacing to acheive the same level of skin rejuvenation, however we can discuss the pro’s and con’s of all treatments with you and are happy to refer you on should you wish to consider a Phenol Peel.

I have dark skin. Is a chemical peel suitable for me?

Darker skin types are generally more prone to problems such as excess pigmentation following chemical peels, and for that reason medium and deep peels are not often performed. Superficial peels with mandelic acid however have been found to be very effective in improving skin quality and reducing pigmentation in darker skin types and this treatment is performed at Clinetix.

How can I get the best result from my chemical peel treatments?

It is always advised to prepare the skin before treatments and maintain a good skin care program after the treatments. You will be advised to use a high factor SPF for at least two weeks before treatment, as this will reduce the likelihood of pigmentation problems after the treatment. A cleanser and moisturiser with an alpha hydroxy acid is also usually prescribed, as regular use will smooth the skin and thin the upper dead layer allowing for a more even penetration of the peel solution. This results in a more uniform improvement in the skin after treatment. Retinol skin care products are often also prescribed for the same reason. If you suffer from pigmentation you would also benefit from a pre treatment skin lightening product such as hydroquinone or kojic acid. A complete skin care program will be discussed with you when you have a consultation for a chemical peel treatment at Clinetix.

Are there any risks involved in chemical peel treatments?

As with all medical procedures there is an element of risk. Generally the deeper the peel the greater the risks. Superficial peels are very safe and complications very rare, hence their popularity. The main risks of chemical peel treatments are redness, increased pigmentation, blistering, and extremely rarely infection and scarring. The risks are reduced when you follow a prescribed pre and post treatment skin care program and when you have your peel performed by an experienced practitioner.

 

If you have any questions about chemical peel treatments or would like to discuss your skin care concerns with a member of our team, please get in touch by telephone on 01412210229, or you can contact us through our contact page here.