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.

"SADLY, I'M NOT SURPRISED BY THIS NEWS REPORT" - DR NEAL HAMILTON

As someone who has practiced cosmetic injectables for 28 years now, sadly I'm not surprised by this news report.

What I am surprised and dismayed about though is the glossing over the fact that over 80% of cosmetic injectables are now delivered in Australia by non Doctors!!!
The rise of the nurse injector and the corporatisation of cosmetic injectables by chain clinics over the last 7 years is, I think, is lamentable.

This is almost exclusively an Australian phenomenon. In NZ, for instance, A DOCTOR ISN'T ALLOWED BY LAW to deliver cosmetic injectables without formal post graduate training and registration.

This is because NZ understands that while uncommon, there is precious little that a non-hospital surgical setting, can cause as much damage to a patient than when cosmetic injectable fillers go wrong - Not the anti wrinkle injections but the fillers mentioned in the news report.

In Australia, badly or untrained nurses, both registered and enrolled, are slipping through the cracks and being let loose on an unsuspecting public.

Ironically, while the Australian medical industry generally embraces progressive treatments and a foundation of conservative medical legislation, the regulatory bounds of cosmetic medicine and minimally invasive cosmetic surgery is relatively lax.

I would contend that the doctors shouldn't be the problem, but the solution and they should be promoted as the favoured choice for the wise consumer to deliver this service.

Gravity - It Gets Everyone Down.

Often I hear the remark “I feel like everything is falling down!” usually accompanied with a set of hands pulling up the sides of the face!!

As we age, we gradually lose both bone and our soft tissue. In particularly, when we lose our cheekbone platform, our soft cheeks which once was able to be supported starts to slide down creating a deeper nasolabial fold and jowls. In addition, marionette lines (lines from the mouth corners to the jawline) giving us a sad clown appearance starts to form as we age. This is why when we lie back and look at ourselves, we regain back several years with our soft cheeks sitting back up where they once used to be.

This bony loss can be replaced with a synthetic hyaluronic acid filler (hyaluronic acid naturally found throughout the body). To recreate a natural supportive cheekbone – the best way is to gently place a good supporting filler directly over the cheekbones. It is the carefully moulded over the cheekbone in order to create a natural support to the soft cheeks sitting above.

“assessing the face as a whole – not just individual folds and lines… the beauty of magic packs.”

At CCM, being able to package multiple fillers in one treatment allows one to be able to rejuvenate our facial structure as a whole into a more youthful natural looking self more cost effectively.

One of the most popular package is our 3 and 4 pack filler which is a great place to start to revolumise and lift our midcheeks. This ultimately softens our nasolabial folds (as opposed to just filling in the nasolabial line), as well as reduce the jowls. Often the marionette region (the area surrounding the sides of our chin) is treated at the same time with different fillers, which further supports this region from collapsing inwards as we continue to age and our chin starts to recede.

In order to be able to rejuvenate the mid and lower face at the same time, surprisingly not many needles is required when cannulas are used. Only several tiny injections for the local anaesthetic is all that is usually required to allow the cannulas to gently place the fillers. By using the cannula technique, it means less needles, which means less bruising and discomfort.

Unlike anti-wrinkle injections, the effects from fillers is immediate and last around 18 months to 2 years with topping up every now and then as the years go by. Most people have some mild swelling immediately post procedure which gradually reduces over 2-3 days.

If this is something that you have been thinking about, feel free to get in touch with us at CCM. 

Non-surgical Facial Thread Lift: A New Lease on Life

I think a lot of us forget that we humans are very visual creatures.

I haven't touched a stethoscope, nor have I saved anyone from the brink of death in over a year. I still however, challenge those who question my identity as a doctor. I still in my way help improve lives. I don't ever believe help should arrive when people are on the brink of death. If anything it should happen way before that milestone. In my previous article I wrote about the benefits of a non-surgical, natural and organic thread that has the ability to lift faces with no incisions nor downtime. But that's just science, let's talk about what it does for people.

Take for example the lady above. For confidentiality let's call her Jane Doe. I've known Jane personally for a year now. Single mother with two children, one with autism. She's had a rough few years with a persistently vexatious ex-partner. She's had to leave a toxic work environment. Though in the latter few months her life has improved due to her indomitable spirit, the emotional stress has aged her. She is 44.

Becoming a national trainer for Silhouette Soft threads gave me the privilege to train other cosmetic doctors in this art. I thought of Jane. I couldn't solve her issues with her ex-partner. I also knew that no doctor could cure her other child of autism. What I did know was that if I could teach to the best of my abilities my understanding of the product and procedure, I could reverse the effects of Jane's aging and emotional stress. In doing so, I could get her looking her best for her career as a dermal therapist. We literally made her look more like 33, ready to take on the challenges of her new job and her children as they grow into their teenage years

I think a lot of us forget that we humans are very visual creatures. We're hooked on Netflix, we love our Instagram and Pinterest. Tumblr and memes as a way of communicating has largely replaced long winded articles such as mine. But we're still evolutionarily human. We identify youthfulness with strength, vigour and potential. Yet paradoxically in our careers, as our minds grow sharper, our experiences become more nuanced and our skills become more enhanced, our outward appearances betray us. If we're living longer than ever and expected to work longer before retirement, is it not reasonable to redefine "aging gracefully" in the context of the scientific progress that has happened in health and beauty?

dr-qikun-bao

In Jane's case, reducing her jowls and the sagging of her cheeks from aging will have significant intangible effects on her career as a dermal therapist. Best of all, she required no downtime and no interruption to her career or role as a mother.

But hey, don't take it from a self-righteous doctor, lets let Jane do all the talking for us!

CONCEPT COSMETIC CONFERENCES

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

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

ConceptCosmeticMedicineSkin

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.

EMBARRASSED BY HYPERHIDROSIS? DON'T SWEAT IT.

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.

Hyperhidrosis.jpg

HYPERHIDROSIS

THERE ARE TREATMENTS AVAILABLE

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.

DR SILVAN

NEW TREATMENT FOR THE DREADED DOUBLE CHIN

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