Saggy Earlobes? We Hear You.

A normal part of the ageing process involves the loss of soft tissue and a decrease in skin elasticity. Whilst often overlooked, the earlobes are no different to other areas of the face in this respect. Saggy, wrinkly and floppy looking ears are also compounded by years of wearing heavy earrings.

Once the ageing process sets in, many women feel self-conscious wearing earrings at all because they don’t want to draw extra attention to their sad looking lobes.

Fortunately treatment with small amounts of hyaluronic acid filler is a quick and easy fix for this issue. It is relatively pain free and can be done in under half an hour.


One of the highlights of the cosmetic year is to attend the annual Non-Surgical Symposium and this year it was held in the fabulous Gold Coast. I fondly call it the boobs and bum conference but it’s really mostly about everything injectable and of course all the laser gadgets.

There’s a mixed bag of attendees, cosmetic doctors, nurses, industry and they all cram into the exhibition centre to fill their brains with the latest and greatest.

I have attended these conferences for the last 12 years and there’s been some great changes in the industry over that time. These emerging trends will be shared by international and local presenters. For example, we used to only bother filling lines and wrinkles but in the last few years we now see far more value in addressing the volume depletion of the face as we all age and involute. This concept was introduced to me at a conference I went to many years ago and changed forever how I perform cosmetic treatments.

For the second year in a row I went to the anatomy labs to study cadaver heads to further my knowledge and understanding of this fundamental topic.

There’s some fun to be had too! It’s not all learning and study. There’s lolly stalls and coffee and kale smoothies and a good opportunity to observe ones’ colleagues surreptitiously from the coffee stand. It is very refreshing and literally eye opening to look around and be reminded of just how alluring a face is when restored in a ‘natural’ way.  Certainly, one can have too much of a good thing when it comes to anti-wrinkle and filler injections. As one plastic surgeon put it- “there’s a load of lips and t#ts on sticks walking around!” Funny but true.

I always take a new tip or technique away from these gatherings. There are always internationally regarded presenters who give pearls of wisdom that I can adopt into my practice to make me a better and safer injector.  However, as each conference comes to an end it is both comforting and humbling to know just how experienced I am.

What's In A Face?

Before you decide to make any changes to your appearance, it’s only prudent to gain some knowledge on the basics before you venture into a world of many choices. In the interest of making an educated and more informed decision we’ve compiled some facial structure basics for a better understanding of differences in the human face - as it is seen in the real world from a non-medical perspective.

1. Male vs. Female Faces

As is the case with the rest of the body, male and female faces vary from the extreme characteristics of their gender, to androgynous ambiguity. This section covers the former – the extremes of female and male features displayed in the face.

The very first difference between a male and a female face is how pronounced and square the male jaw is compared to the soft curve of a female jaw. Other lines of the face are equally harder in males: the brow pronounced while it's more rounded in females. The chin is also more pronounced.

Typically, a female cranium is overall smaller than a male’s, also the neck more slender. Eyebrows are thinner and neater while lips are generally fuller with a higher contrast in colour. The male eyebrows are lower over the eyes and thicker and males generally have a tendency of more hair on their body. Men's lips tend to be thinner, but the mouth is wider. The eyelashes of grown women are longer and more visible, even without makeup.

2. The Face Over Time

Facial features and proportions change quite a bit with age.

Younger Faces

Before adolescence, there is little to no difference between male and female faces. Prior to sexual maturity children are quite androgynous in the face, and are only really identified, when we think of it, by the way they are dressed and their hair is cut.

As an adolescent (twelve to seventeen years of age) we are in every way between childhood and adulthood, every feature being close to its adult state but still retaining something childish (to different degrees depending if an individual is closer to twelve or to seventeen).

The most noticeable difference with adult faces at this age is the size of the eyes, which are still large. Our eyebrows however are now fuller, and lower on the eyes which in-turn adds to changes in our expressions. At this age our nose looks longer, even if it's still slightly upturned. Also, there is also a clear difference between male and female traits.

The Adult Face

Young adults (eighteen to thirties) are probably the most celebrated in Western culture. The features are at their peak appearance: chiselled nose, gazed toned down and matured by eyelid folds that are now visible, our facial contours show more bone and muscle structure than soft flesh. At this age a women's lips are at their most fleshy, and men's facial hair is it’s strongest.

Dark-haired men will often have a shadow around the jaw even when they’re shaved.

In late adulthood (our forties and fifties) there is not a dramatic change, but small ones start creep in - Eyelids are heavier, crow's feet begin to show as well as other lines. We may start to show a downward fold at the corners of the mouth, expression lines linking the latter to the wings of the nose, and possibly lines at the root of the nose.

The Older Face

In our sixties and onward, all these lines increase. Worry and frown lines, as well as smile lines, become permanent. Pockets may appear under the eyes. Around this age our skin begins to lose its elasticity and starts to “hang” at the jaws which results in a less firm jawline aesthetically.

From our sixties the female face starts to lose its youthful femininity, and by one's seventies, menopause having levelled the hormonal field, the only real difference between the two sexes is that a female's hairline recedes little while a male may be all lost by this stage. Also at this age veins, blemishes and age spots appear as the skin becomes thinner. The earlobes and tip of the nose give way to gravity and slightly droop. The colour of our iris loses intensity and our lips too lose colour. New lines appear above the lip and in the neck, while the cheeks become more hollowed out for various reason.

3. General Shape of the Face

This diagram shows the difference face shapes we perceive (they are more subtle in reality):

  1. Round: Appears equal in length and width, with rounded jawline and hairline.
  2. Oval: A reversed egg shape, narrowest in the chin and widest in the middle.
  3. Oblong: A long face almost even in width. It can be narrow or broad.
  4. Diamond: Narrow chin and forehead, face widest in the middle.
  5. Triangular and Heart-shaped: They are the same in terms of a face narrowest in the pointed chin and widest on top, but the one is framed by a straight hairline, the other a widow's peak.
  6. Inverted Triangle: Like Rectangular, but with a narrow chin that creates more angles in the shape.
  7. Pear-shaped (or Trapezoidal): Widest at the chin and narrowest at the forehead, very full jawline.
  8. Square: Appears equal in length and width, with squared jawline and straight hairline.
  9. Rectangular (or Long, or Oblong): Like Square, but longer than it is wide.

4. The Eyes and Typical Eye Shapes

Here are some well-known eye shapes independent of ethnicity:

The Almond eye is characterised by the upswept lift at the outer corner. In Hooded eyes, which can be present from birth or develop with age, a fold of skin hides the natural crease in the eyelid. In deep-set eyes, the eyelid crease is set back so that upper eyelid is hidden in shadow. Round eyes appear more open than usual, due to more curve in the lower part. Sleepy eyes have droopy eyelids. In downturned eyes, the eyelid curves down at the outer corner.

One other eye shape that needs study is distinctly ethnic: the Asian eye.

The best-known identifier of Asian ethno-types is the epicanthic fold (or epicanthal fold, or epicanthus). This is a skin fold of the upper eyelid, from the nose to the inner side of the eyebrow, that covers the inner corner of the eye. As a result the inner corner looks lower, making the eye look slanted (aka almond-shaped). How much the inner corner is covered, and how pronounced the fold is on the outer corner, both vary. When the eyes are closed, the inner corners point down noticeably.

There are two variations on the Asian eye. One is known as double-eyelid: the eyelid is creased like in Western eyes, but closer to the eyelashes. In the other, known as single-eyelid, there is no crease at all (therefore no "eyelid line" to draw), only smooth “padded” skin over the eye.

Typically speaking, Western eyes look bigger than Asian eyes, but that’s simply due to the absence of the epicanthic fold and the constant exposure of the inner corner. In the West we can broadly say that the further North you go, the smaller the eyes are, while around the Mediterranean they are large enough to look feminine.

5. The Nose

Basic nose shapes are as follows but this may very well be governed by ethnicity. Indeed the nose is the most distinctive Caucasian feature as it projects well forward of the eyes, has a high root and bridge, and wings usually pressed-in. In contrast, the Asian noses are typically small, with a low nasal bridge, and minimal projection; the characteristic African nose is broad and flat, with flaring wings that are merged with the ball of the nose. While Asian and African noses show the nostrils from the front, Caucasian noses more frequently show them from the sides if at all.

  • Hooked: Has a broken profile
  • Droopy: The tip droops very low, an effect of ageing.
  • Aquiline: Means "eagle-like”, in reference to the shape of an eagle's beak. In fact it has more or less pronounced convex curve.
  • Roman: A very slightly aquiline shape.
  • Grecian: Drops straight down from the forehead.
  • Button: Rounded and small, with the tip turned up, but so slightly the nostril openings don't show. The child version is worth noting as it's common to all babies and children before their nose takes it adult shape.
  • Upturned: The contrary of aquiline, a concave curve.
  • Snub or Blunt or Pug: A short and upturned nose. Often found in Asian types.
  • Funnel: Specific to African types, but not all African types have it!

6. The Lips

Here are the better-known lip shapes. They can be accentuated or even created with make-up, but females have more contrasting lips to begin with. Males lips display these in a more attenuated fashion (and their lips are relatively less fleshy) so they're usually not so noticeable.

  • Natural and Pointy Natural are two variants of the basic default shape (from a Eurocentric standpoint, that is).
  • Thin lips: It’s common for the upper lip alone to be thin, but the reverse is very rare.
  • Cupid's Bow: An exaggerated feminine shape.
  • Uni-lip: The peaks are joined in a single line.
  • Beestung: a narrow and very full mouth shape, fashionable in the early 20's and usually achieved with makeup.
  • Smear: Wide lips with spaced peaks, popular in the 40's.
  • Glamour: The upper lip is fuller than the lower.

7. The Eyebrows

The shape of the eyebrows is determined by two factors: their overall basic shape, and the height of their arch. Female eyebrows are thinner, particularly as they tend to be plucked (and a natural shape can be altered completely by this), while male eyebrows are fuller and bushier, their shape not necessarily "clean" as they're left in their natural state. Below are the basic shapes for females and males, and how they look with low and high arch.

What the heck are these dark patches that have just appeared on my face Doc?

There is a chance it's "Melasma". It’s a common question and yes, there is treatment available.

The dark patches may well be Melasma which is a form of facial pigmentation. It can be a difficult condition to treat as it can quite often reappear and if not treated correctly, it can result in the condition worsening.

So what causes it?

There are a number of triggers that can cause Melasma


Melasma is thought to be triggered by the female hormone Oestrogen around times when the Oestrogen exposure is more prominent like when taking the contraceptive pill,
pregnancy and sun exposure can make Melasma appear or worsen.

Those who have naturally darker skin or tan more easily tend to be more prone to the condition also however it may not be limited to the above - Skin trauma, some medications and even just ageing can trigger this sometimes embarrassing and unwanted blemish.

Treatment usually requires a particular skin regime complimented with a specific and gentle laser treatment to breakup the pigmented cells but not over-inflame the Melasma - Which in some cases can make it worse.

Treated correctly the appearance of Melasma can be heavily reduced but at the same time it is prudent to avoid trigger factors where possible and be vigilant in sun avoidance. In short Melasma can be managed and controlled.

Pigmentation can be troubling, but it doesn't have to be. Feel free to come and have a chat about what we can do to help.

Dr Silvan

Sleep Wrinkles - Iron Out The Problem


Another major factor contributing to the phenomena of ageing is the loss of elasticity in the skin due to collagen reduction. To restore elasticity in the skin remains one of the leading research elements in the science of Anti ageing.

When we lie down to sleep, a major area of the face comes in contact with an antagonising surface causing a compression force against it. This compression persists till the time the posture is changed during sleep. This force causes an unusual positioning of the facial musculature and overlying skin. The repetitive, consistent and persisting positioning during sleep causes the creases referred normally as sleep wrinkles. Studies show that sleep wrinkles are caused mostly in the cases of sleeping on stomach or sideways. If you experience asymmetrical and obvious stubborn lines on the face not responding to anti wrinkle injections then these could be sleep wrinkles. They mainly appear on the forehead, cheeks or the angles of mouth. As these lines are not caused by the physiological contraction and relaxation of facial muscles so they do not respond to anti wrinkle injections. The same reason causes them to be at angles different from the regular expression lines.


Laugh and the world laughs with you, snore and you sleep alone.
—  Anthony Burgess

A good example can be the compression marks around the waist area after wearing a tight trousers/dress. After a few hours of removing the dress, the compression marks are gone due to the elastic nature of the skin and ample fat padding in that area. Imagine if you wear the same dress everyday for 7-8 hours for numerous years with the gradual loss of skin elasticity and loss of structural fat as it happens in the face, the marks carry a huge tendency to become permanent. Now to avoid the sleep wrinkles, the easiest advise can be to change the sleep posture, just like not wearing that dress again. However, it can be an impractical advice as we may choose to begin our sleep in a posture free of any compression against the face, but as we dwell into the deeper aspects of sleep, the posture does not remain our choice.

A few everyday recommendations to avoid sleep wrinkles can be to go to bed well hydrated, use appropriate cosmeceuticals to provide skin its moisture during sleep and maybe try special anti wrinkle pillows designed to minimise facial contact with the pillow surface.

Hyaluronic Acid (HA) based Dermal Fillers have a role in treating Sleep wrinkles. They not only fill up the sleep wrinkles mechanically, but the physiological stimulation of collagen synthesis by HA contributes to the thickening of the skin over time and improving the elasticity. However, It would need multiple treatments and the results may vary depending on the extent and depth of sleep wrinkles. It is of importance to be mindful that the dynamic factor of sleep position would remain the major contributory factor in the mechanism of sleep wrinkle formation. So the mainstay of the treatment of sleep wrinkles through HA Dermal Fillers would be to achieve softening of the wrinkles giving out beautiful aesthetically pleasing results.


Excessive sweating of the palms, underarms, face and various other parts of the body is a common problem and can cause a great deal of discomfort - It has a name: Hyperhidrosis.

If you do not have the condition it’s difficult to understand the impact it can have on someone’s life day-to-day and it will always be at its worst just when you don’t want it to be. Holding a partner’s hand while watching a tense movie, giving a work presentation while presenting underarm sweat patches, hands slipping on the steering wheel in difficult driving conditions and so on has a huge impact on one’s self-confidence.




There are a number of causes for excessive sweating. Many would have tried daily topical medications to reduce one's sweating, some people spray just about every part of their body in anti-perspirant, some have even resorted to sticking pantyliners on the inside of their clothing! It’s an ordeal and a drain on life. 

Botulinum Toxin A, which is also used to relax wrinkles is highly effective in treating hyperhidrosis. A very fine needle is used to distribute the Botulinum Toxin A intradermally to block the nerve impulses that cause you to sweat.

Does it hurt? That depends on your own pain threshold but at CCM we provide the option of Nitrous Oxide (aka as Happy Gas) which makes the procedure more comfortable.

Will it last forever? No, Botulinum Toxin A is used in a wide range of treatments in the medical world and as wonderful as it is you will need a top up within 3 months time. 

We love talking about what we do at Concept Cosmetic Medicine so if you are troubled by hyperhidrosis feel free to get in touch and we'll answer any questions you have and the possible treatment options available to you.



The "double chin" is not an uncommon problem. A lot of people, at some point in their life find collars hard to button up or have a double chin mysteriously appear in photos.

The triangular shaped area of skin that starts at the top of our neck and follows through to our chin is typically known as the sub-mental region. If you were to use your index finger and thumb and basically pinch the area underneath your tongue you will be holding the skin of your sub-mental triangle.

Unfortunately this area also holds a layer of fat and from post puberty until later in life we have the same number of fat cells in this area. If you find yourself with one day with a double chin it’s not because there are more fat cells, they have simply grown bigger and historically this area is one of the most stubborn places reduce the appearance of fat.

Until now, there has been little to no surgical treatment options available in Australia to reduce the fat underneath the chin/jaw area. 

Injectable Fat Dissolving Treatment is a procedure similar to having anti-wrinkle injections - but through a series of tiny injections to the fat in the sub-mental area we can safely dissolve this under jaw fat.

The injectable fat dissolving treatment uses deoxycholic acid which is naturally found in our body and it’s used to help digest fat. When injected into the area under the chin the fat cells simply dissolve and with a reduced surface area the skin the tightens.

The treatment itself only takes around 20 mins but some light swelling and bruising in the area, which usually remains for several days you can notice the fat under the chin shrink over the next 4-6 weeks, while also tightening the skin.

Most patients with mild to moderate sub-mental fullness will see visible improvement of their jawline after just 2 treatments. Some may need more than 2 treatments to achieve optimal results. At CCM, we are able to perform this procedure comfortably with cool packs, and happy gas, or numbing gel if one wishes, this will depend on your own pain tolerance but generally speaking it’s not an overly painful experience

Below are before and after photos of what you could expect if you had mild to moderate submental fat which had been bothering her for many years.

If you are interested in non surgical treatment options for unwanted fat, please feel free to come in for a chat.

by Dr Silvan Lee


I'm a strong advocate for using sunscreen, not only for fighting the obvious - like skin cancer, but also in the fight against premature ageing.

If you were to calculate the total amount of time we expose parts of our skin to the sun during our lives you may well come up with a number that'll shock you. Any amount of time our skin spends, small or large exposed to the sun it adds up, it's not just long days at the beach during summer that ages us.

And if you have any doubt as to whether the small trips to the shop, pegging clothes on the line or your early morning walks with the dog don't affect your skin you just need to compare the skin that never sees the light of day (wherever that may be) to somewhere like your forearms or the back of your hand and compare the difference in wrinkles, softness and overall quality.

In this video below I explain the different types of sunscreen and the best practice for using it in the fight against premature ageing.

Doctor Rachel.

All About Acne

As a teenager, I suffered from terrible acne. I understand how it can create a terrible cycle of self-consciousness and poor self-image. Fortunately, my mother, who had also been an acne sufferer, quickly got me on to medical treatment for the problem and within a year it had cleared up completely. However, this was not without some side effects: nose bleeds, low mood, etc. It was all worth it though, because I have rarely had a blemish since and I was very lucky to avoid the residual scarring sometimes sometime left behind.

What is acne?

Acne is a skin disease where the hair follicle opening becomes blocked by a plug of skin cells from the follicular lining. This prevents oil from the sebaceous gland that attaches to the root of the hair from escaping, leading to a build-up of oil, bacterial growth and inflammation. This manifests as black heads, whiteheads, red bumps, pimples and most severely, cystic acne. 

These can occur on the face, neck, chest, back, shoulders, and even the upper arms. Onset is usually during adolescence with increased sex hormones, that stimulate and enlarge the oil (sebaceous) glands of the skin. Acne is experienced by both teenagers and adults all the way through their 40’s. 

How can we fix this?

There is a lot of misunderstanding about how to treat acne. I know of many teenagers who are told to simply stop eating so much chocolate and it will go away. How ridiculous! Whilst a good diet will improve general skin quality, it is not enough to control this disease. At Concept Cosmetic Medicine our goal is to clear your skin, stop future breakouts, reduce existing scars and prevent future scarring. 

Step 1

Skin care at home:

Wash face twice a day with a wash that contains alpha hydroxy acids (eg. Glycolic acid) or beta hydroxy acids (eg. Salicylic acid). Some people find the latter more effective.
At night use a cream that contains one of the above.
If this doesn’t improve the situation after 2 months, speak to your GP about adding a prescription cream containing adaptalene and benzoyl peroxide combination; or a retinoic acid cream.

Step 2

If Step 1 fails, there are two good options next:

Your GP may be able to prescribe oral antibiotics. These are usually a tetracycline antibiotic which are a broad spectrum antibiotic however very effective and commonly used in the treatment of acne. Improvement is usually seen after 2-3 months. It is relatively cheap however, having antibiotics in your system for extended periods can quite often be accompanied with the possible side effects.
Blue light therapy is a good alternative for those who can’t or don’t want to take antibiotics. Like the antibiotics, the blue light destroys the acne causing bacteria on the skin and can significantly improve the appearance of moderate acne in around 6-10 treatments. It is quick (under 15 mins), efficient and painless and there’s no downtime.

It is however, more expensive than oral antibiotics.

Step 3

Treatment Resistant Severe Acne:

Photodynamic therapy (PDT) is effective treatment and involves the application of a photosensitising agent to your skin and then going under an Omnilux light to activate the agent. This targets acne causing cells deep in the sebaceous glands, so its’ very effective for cystic acne. PDT treatment requires up to a week of down time. The discomfort could be likened to “sun burn” for the first few days and it gradually improves over the rest of the week. 1-2 treatments are usually adequate for most people, who will see significant reduction of acne lesions and an improved appearance in scarring and skin quality. This is a great option for people who want to avoid the nasty side effects of taking oral retinoic acid for several months.
Oral retinoic acid is a Prescription only medication that’s an extremely effective treatment, but it does have some bad side effects that vary between patients. You will need to be closely monitored by your GP and dermatologist whilst on this medication to minimise any harmful side effects.

If you are interested in Blue-light therapy, PDT for acne or even just want further information about problem skin then please, we love talking about it and we’re only too happy to have a no obligation chat - Simply phone us.

by Dr Phoebe Jones




Ladies and gentlemen of the CCM jury, I ask you . . .

<< Do you think this is:
(a)   Careless beach-goer
(b)   CCM staff member
(c)   CCM Doctor
(d)   The owner of CCM

You can probably tell by the flow of answers where I'm leading you....

YES! (d) The owner of our wonderful clinic.

GASP and cue dramatic revelation music!

Now above said example of bad sunburn was on holidays with above said's children who from this point will be called Exhibit "B".

 Exhibit "B"

Exhibit "B"

Now Exhibit "B" were, at the time advising Exhibit "A" to protect one's skin. Exhibit "B" are much younger with less life experience but to them it was obvious the danger Exhibit "A" was in.

Exhibit "B" later saw their warnings on that fateful afternoon had been ignored, and in the days following revealed in their subsequent lectures to Exhibit "A" on sun protection.

 Exhibit "C"

Exhibit "C"

<< Next I present to you Exhibit "C", friend of Exhibit "A".

Ironically Exhibit "C" was being warned by Exhibit "A" of the dangers she was facing and at one stage was told to remove oneself from a sun lounge to avoid any further "thermonuclear assaults".

Next I present to you an item that may very well leave you in shock and disbelief. Evidence that will prove to you beyond any reasonable doubt that this act of carelessness goes beyond what you may deem possible by most people, let alone the owner of a clinic that treats people with sun damaged skin - Ladies and gentlemen.... Exhibit "D"! 

 Exhibit "D"

Exhibit "D"

While Exhibit "A" and Exhibit "C" were not only getting burnt from the sun, Exhibit "B" took great joy in roasting Exhibits "A" & "C" even further - This was all the while . . . in a final twist, Exhibit "D" sat in the shed patiently waiting for a purpose.

Admittedly Exhibit "D" is merely a shade cloth umbrella from Bunnings and is not capable of the same level of protection of its more expensive relatives but, both ladies exposed themselves to the biggest killer of beautiful skin and have now paid the price.

Any protection (including an "el-cheapo" Bunnings umbrella) would have been better than the vulnerable position these ladies put themselves in while on holidays.

Were they careless and could they've easily done more to protect themselves?

Should they have led by example and shown the younger witnesses they were indeed sun smart?

Was this sunburn so easily avoidable . . . it's criminal?

You be the judge.


;) Dr. Neal.