Non-Surgical Cosmetic Treatments



BOTOX® Cosmetic (Onabotulinumtoxin A)

Botulinum toxin is a prescription medicine that is injected in small amounts into muscles and used to temporarily improve the look of both moderate to severe lines and wrinkles in adults.

Response is usually seen 2-10 days after the injection. Typically, the muscle action (and wrinkles) will return in 4-5 months. At this point, a repeat treatment will relax the muscle and soften the lines again. Several sessions may be needed to complete the injection series. There is a separate charge for any subsequent treatment.

Possible side effects include: transient headache, swelling, bruising, pain during injection, twitching, itching, tearing, numbness, asymmetry (unevenness), temporary dropping of the eyelids or eyebrows, flu-like symptoms, wheezing and dizziness. These side effects are rare, but have been reported. Neurological diseases and pregnancy are contra-indicated. In a very small number of individuals, the injection does not work as satisfactorily or for as long as usual, due to resistance.
 
Bruising may occur after Botox® injections. Substances that increase the risk of bruising include herbal medications, Omega 3, Vitamin E, Aspirin, Warfarin, and other non-steroidal anti-inflammatory drugs. If you have taken any of the above within the past 7 days, you have an increased risk of bruising. It is important that you provide your physician with a list of all your current medications and supplements.

Botox® is best at treating dynamic facial lines, those caused by facial muscle activity; lines present at rest may or may not improve. A treatment may be effective for variable lengths of time with subsequent treatments, may not work as well or for as long as expected, or may not work at all. Alternatives which exist for the treatment of wrinkles include: topical creams, chemical peels, laser treatments, surgical removal of the frown muscles, forehead/brow lift, facelift, collagen or hyaluronic acid filler treatments.

Payment for this cosmetic procedure is the patient’s responsibility and that there will be an additional fee for touch ups. Because Botox® therapy for wrinkles is considered a cosmetic procedure, insurance does not pay for treatment. Payment at the time of service is requested for all patients. You may request a price quote before your treatment. We request a 48-hour notice of cancellation for all scheduled Botox® appointments. If less than 48 hours notice is given, the patient will be held responsible for any costs incurred.

Typically, a follow-up is scheduled 2 to 3 weeks after the initial appointment. You authorize the taking of clinical photographs and their use for clinical and educational purposes. Your identity will be protected at all times. Please take note that the practice of medicine and surgery is not an exact science and that no results are guaranteed, including Botox® therapy for wrinkles and lines.

Please see BOTOX® Cosmetic full
Product Information including Boxed Warning and Medication Guide.

LATISSE® (Bimatoprost ophthalmic solution) 0.03%

Bimatoprost solution is a prescription treatment for hypotrichosis (inadequate growth) of especially the eyelashes. Although the precise mechanism of action is unknown, LATISSE® is believed to affect the growth phase of the eyelash hair cycle in two ways: firstly, it increases the length of this phase; and secondly, it increases the percentage of hair in this growth phase. LATISSE® is indicated in New Zealand to treat hypotrichosis of the eyelashes (or eyebrows) by increasing their growth including length,
thickness, and darkness.

The practice of medicine is not an exact science and no guarantees can be or have been made concerning expected results. You may see results from LATISSE® treatment by week 4 it will take up to 16 weeks to experience the full effect. If you stop using LATISSE® your eyelashes are expected to abate after discontinuation. The recommended use of LATISSE® is once nightly with a special applicator.

Side effects reported during clinical trials were mostly mild to moderate. The common side effect after using LATISSE® solution included an itching sensation in the eyes and/or eye redness. LATISSE® solution may cause other less common side effects which typically occur on the skin close to where LATISSE® is applied, or in the eyes. These include skin darkening, eye irritation, dryness of the eyes, and redness of the eyelids. LATISSE® use may cause darkening of the eyelid skin which may be reversible. LATISSE® use may also cause increased brown pigmentation of the coloured part of the eye which is likely to be permanent. It is also possible for hair growth to occur in other areas of your skin that LATISSE® frequently touches.

Please see LATISSE® full
Product Information.

JUVÉDERM ULTRA PLUS® XC and JUVÉDERM VOLUMA® XC

JUVÉDERM® injectable (a stabilized hyaluronic acid) gel is injected in the areas of facial tissue where moderate to severe facial wrinkles and folds occur to temporarily add volume, which may give a smoother surface appearance to the skin. The role of hyaluronic acid in the skin is to deliver nutrients, hydrate the skin by holding water, and to act as a cushioning agent. Hyaluronic acid  can be synthetically produced from a process of bacterial fermentation, chemically stabilized and purified for use as an injectable soft tissue filler.

JUVÉDERM® injections are customized per patient, depending on the depth of the wrinkles and the locations. Multiple injections may be necessary depending on the site, depth of wrinkle and technique used. These can be performed in areas involving the cheeks and eyelid region, forehead and lips. It cannot, however, stop the process of aging. It can temporarily diminish the look of wrinkles and soft tissue depressions. These injections may be performed as a single procedure, in combination with other treatments such as Botox®, or as an adjunct to cosmetic surgery.

Most side effects are mild or moderate in nature, and can last up to 7 days. The most common temporary side effects include: redness, pain/tenderness, firmness, swelling, lumps/bumps, bruising, itching, and discoloration. In extreme rare cases patient may present with scaring, anaphylactic reactions, skin necrosis or even sudden blindness from intra-arterial injections. As with all skin procedures, there is a risk of infection.

After treatment, you should minimize exposure of the treated areas to excessive UV light exposure and extreme cold weather until any initial swelling or redness has gone away. You should also avoid strenuous exercise or alcohol for at least 24 hours after treatment. Continuing treatments are necessary in order to maintain the effect of JUVÉDERM® over time. Once injected it will be slowly absorbed by the body. The length of effect is variable per individual; however, studies have shown the results may last as long as 9 months to 1 year.

For more information, please see the About Safety page at www.juvederm.com

PLATELET RICH PLASMA INJECTIONS
 
Platelet Rich Plasma, also known as “PRP” or "Vampire Facelift" is an injection treatment whereby a person’s own blood is used. A fraction of blood (20cc‐50cc) is drawn up from the individual patient into a syringe. This is a relatively small amount compared to blood donation which removes 500cc. The blood is spun down in a special centrifuge (according to standard Harvest Techniques) to separate its components (Red Blood Cells, Platelet Rich Plasma, and Plasma). 

The platelet rich plasma is first separated then activated with a small amount of calcium to allow the release of growth factors from the platelets which in turn amplifies the healing process. PRP is then injected into the area to be treated. Platelets are very small cells in your blood that are involved in the clotting process. When PRP is injected into the damaged area it causes a mild inflammation that triggers the healing cascade. As the platelets organize in the clot they release a number of enzymes to promote healing and tissue responses including attracting stem cells to repair the damaged area.
 
As a result new collagen begins to develop. As the collagen matures it begins to shrink causing the tightening and strengthening of the damaged area. When treating injured or sun damaged tissue it can induce a remodelling of the tissue to a healthier and younger state. The full procedure takes approximately 45 minutes ‐ 1 hr. Generally 2‐3 treatments are advised, however, more may be indicated for some individuals. Results are generally visible at 4 weeks and continue to improve gradually over the next 3‐6 months with improvement in texture and tone. Touch up treatments may be done once a year after the initial group of treatments to boost and maintain the results. Results may last 12‐18 months.
 
PRP used for aesthetic procedures is safe for most individuals between the ages of 25‐80. There are very few contraindications; however, patients with the following conditions are not candidates: 1) Acute and Chronic Infections; 2) Skin diseases (i.e. SLE, porphyria, allergies); 3) Cancer and/or Chemotherapy; 4) Severe metabolic and systemic disorders; 5) Abnormal platelet function (i.e. Haemodynamic Instability, Critical Thrombocytopenia); 6) Chronic Liver Disease; 7) Anti‐coagulation therapy; 8) Underlying Sepsis; 9) Systemic use of corticosteroids within two weeks of the procedure; and 10) Pregnant or breastfeeding.
 
Side Effects of PRP injections are very rare, but may include: 1) Pain or itching at the injection site; 2) Bleeding, Bruising, Swelling and/or Infection; 3) Short lasting redness (flushing) of the skin; 4) Post-inflammatory pigmentation; 5) Allergic reaction to the calcium based solution; 6) Injury to a nerve and/or muscle tissue; 7) Nausea and Vomiting; 8) Dizziness or fainting; and 9) Temporary blood sugar increase.

INTENSE PULSED LIGHT

Intense Pulsed Light (IPL) use various wavelengths of light to treat sun-induced changes on the face, including pigmentation, age spots and broken blood vessels. IPL is also regularly used for the treatment of rosacea, acne and hair removal. IPL may be used on the face, hands, neck, limbs, back and chest. It is safe, non-invasive and is tailored to the individual patient’s skin.

When the pulses of light are applied to the skin, you may feel some stinging, similar in sensation to the snapping of a rubber band against the skin. This is usually tolerable, but an aesthetic cream may be applied to reduce the pain. The treatment area is cleansed and a cooling gel is applied immediately prior to the treatment. Dark glasses are always worn to protect your eyes from the light. Treatments usually take approximately 30-45 minutes, depending on which area is being treated.

IPL is very safe and no recovery time is needed after treatment. You can return to work or normal daily activities the same day as your treatment. Some patients may experience minor redness and possible pinpoint bruising after the treatment. Some pigmented spots may appear darker for a few days and then peel off. You can apply makeup immediately after IPL treatment if necessary.

The number of treatments you need will depend on the condition of your skin and your desired results. Generally, patients need a series of 3-6 treatments, 4-8 weeks apart. After the initial series, additional treatments once every six months are recommended in order to maintain the effects. The cost of your treatment will depend on the condition of your skin, the size of the area being treated and your desired results.

PHOTODYNAMIC THERAPY

Aminolevulinic Acid 20% (ALA 20%) is a naturally occurring photosensitizing compound, which has been approved by Medsafe to treat pre-cancerous skin lesions called actinic keratosis. ALA 20% is applied to the skin and subsequently “activated” by a specific wavelength of light. This process of activating ALA 20% is termed Photodynamic Therapy. 

The purpose of activating the ALA 20% is to reduce precancerous skin lesions. The treatment may improve the appearance of the skin and other signs of photoaging, decrease acne, reduces sebaceous hyperplasia, decrease oiliness of the skin, and improve texture/smoothness by minimizing pore size. Improvements of these skin conditions (other than actinic keratosis) are considered an “off-label” use of ALA 20%.
 
ALA 20% will be applied to your skin. After an incubation time determined by the doctor, the area will be treated with a specific wavelength of light to activate the ALA 20%. You should avoid direct sunlight for 48 hours following the treatment due to photosensitivity. 

Any, even indirect sun exposure during this time can increase possible side effects including; swelling, burning, redness and pain. You should wear sunscreen, a hat and a scarf on your face returning home from this treatment. You must stay home and avoid ANY light from windows for 48 hours and I must diligently use sun protection for 7 days following this treatment. 

Possible side effects of ALA 20% treatment include discomfort, burning, swelling, redness, and possible peeling, especially in any areas of sun damaged skin and pre-cancers on the skin, as well as lightening or darkening of skin tone and spots. The peeling may last many days, and the redness for one week. The greater the number of pre-cancers on your skin the more exuberant these reactions will be. 

Photographs will be taken of your face before each treatment session. The recommendations, based on many studies and thousands of patients treated, are 1-2 treatments for AK’s (actinic keratosis) and 2-4 treatments for acne. Medicine is not an exact science, and there can be no guarantees of your results. While some individuals have fabulous results, it is possible that these treatments will not work for you. Alternative treatments may include topical therapies, oral medications, cryosurgery, or excisional surgery.

RADIOFREQUENCY TREATMENT

Radiofrequency (RF) is a non-invasive cosmetic procedure that helps to increase blood flow, smooth, tighten, contour skin and breakdown cellulite. The energy generated by RF heats the skin without damaging it. This breaks down fatty cells and stimulate collagen production, which improves skin's tone and elasticity. RF treatments are ideal for those who wish to effectively contour the body, reduce sagging skin and improve the appearance of cellulite deposits. 

Treatment usually takes from 30-90 minutes depending on the size of the treatment area. A cooling lubricating gel will be applied over the treatment area to allow the handpiece to move smoothly over the treatment area and cool down the outer skin layer.
Depending on the device being used, it may be recommended to have a session every 1-2 weeks with an average of 6-8 sessions in a treatment programme. On-going monthly maintenance sessions will be required after the initial programme.

The treatment is very safe and has minimal downtime. Most people can return to normal activities immediately after treatment. The most common side effects of RF treatments are minor swelling, redness or bruising around treated areas, which will typically disappear in a few days. Results should be visible immediately and improve over a period of two to six months.

CHEMICAL PEELS

A chemical peel refers to the application of one or more chemicals to the face or hands which induce accelerated exfoliation or controlled skin damage. As the skin damage is repaired by the natural healing process of the body, the skin's appearance will improve with due time.

The most common candidates for a chemical peels are patients with pigmentary disorders (e.g melasma, freckles, solar lentiginoses and post-inflammatory hyperpigmentation), acne vulgaris, acne scars, photo-aging, wrinkles, seborrheic keratoses and actinic keratoses.

Pre-treatments may include tretinoin, alpha hydroxy acid and hydroquinone containing creams. They will improve the results seen from chemical peeling. First the skin is thoroughly cleansed to remove make-up and surface residue. The chemical solution is then applied for several minutes, usually 5-6 minutes. A stinging sensation will be experienced and this will depend on the concentration and duration of the application. The chemical solution is then either removed with saline solution or neutralised by an alkaline agent.

Chemical peels are broadly defined by the depth of skin damage they produce. They are categorized as superficial, medium, and deep. We use only medium depth peels in our practice e.g alpha hydroxy acid, lactic acid, salicylic acid, Jessner's and retinoic acid peels. Medium depth peels result in moderate inflammation and swelling, which resolve within a week.

Complications are uncommon if performed properly. These may include comedones, secondary infection, scarring and patchy pigmentation. Persistent actinic keratoses may require additional treatment with cryotherapy, 5-fluorouracil cream or even a biopsy a lesion in case a skin cancer is suspected.


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