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Ivan Foo

Consultant Plastic Surgeon

MBBS (London), FRCS (Eng), FRCS (Ed), FRCS(Plast).

Non Surgical Treatments (Fillers & Botulinum Toxin Injections)

What are the aims and benefits of performing Non Surgical treatments?

The first thing most people notice in facial ageing are lines and creases e.g. crow's feet, cheek folds (nasolabial) and folds around the mouth. These early stages of ageing can be improved temporarily and without surgery with injectable fillers to build up and disguise lines and furrows and Botulinum Toxin, to relax and smooth out wrinkles. These treatments can be performed in conjunction with a Facelift, Browlift and Blepharoplasty surgery in rejuvenation surgery.

Fillers

Hyaluronic Acid based fillers are the most commonly used. With ageing, the skin loses collagen, becomes thinner and loses its support. This results in wrinkles and folds and can be improved by injecting a filler under the skin. Hyaluronic acid is a naturally occurring substance found between the cells in the body and the injectable form is manufactured in the laboratory. Unlike collagen products, no pre-testing is required and the risk of a reaction or allergy is extremely low.

According to the American Society for Aesthetic Plastic Surgery over 1.4 million treatments were carried out in the USA in 2007. It is also very popular in the UK.

There are a number of injectable fillers on the market but Mr Foo tends to recommend Juvèderm™ and Restylane™.

What areas can be treated?

How is a Non Surgical Filler injected?

Following a consultation to discuss your concerns, goals and assess your suitability for treatment, you may go on to receive treatment in clinic or you may wish to return on another day. The filler is injected just under the skin with a very fine needle and local anaesthetic is not usually required as this is a quick and superficial procedure. Improvement is immediate and you will be shown this in a mirror after the first side is treated.

Sometimes a second injection of filler is required after 2-4 weeks to 'top up' up a line that is deep or receiving treatment for the first time.

What can I expect afterwards?

There may be some swelling and redness for 1-2 days, however simple makeup usually covers this and you should be able to go about your day to day activities.

How long do the effects last?

The improvement is temporary and gets reabsorbed by the body. It usually lasts 4-6 months, after which it can be repeated.

Are there any side-effects?

Although every care is taken to minimise complications, these can occur. They are usually minor like temporary bruising, slight lumpiness and asymmetry.

Who should not have Non Surgical Fillers ?

You should not have fillers if you are pregnant, breastfeeding or on medication that thins your blood e.g. warfarin and aspirin.

Botulinum toxin injections (Botox™, Vistabel™)

In USA, in 2007, the American Society for Aesthetic Plastic Surgery reported that this was the most popular cosmetic procedure. Botulinum toxin has been used for many years by the eye surgeons to treat squints and blepharospasm. The use of "Botox" for cosmetic surgery was developed when the wrinkles and crow's feet around the eyes of these patients also improved. This is also widely carried out in Europe and in 2007 the MHRA in the UK approved Vistabel™ for the treatment of frown lines.

"Botox" works by blocking nerve messages that are transmitted to the muscle causing them to contract. It causes temporary paralysis. It therefore needs to be injected by a skilled person to ensure that this only affects specific muscles targeted by the treatment.

What areas can be treated?

It is best for the upper face:

Although "Botox" can be injected in the lower face, Mr Foo does not recommend this as it affects the smile and facial expression.

It is also very effective for excessive sweating of the underarms (Hyperhidrosis).

How is a Botox Injection performed?

Following a consultation to assess your concerns, goals and if you are suitable for the treatment, you may go on to receive treatment in clinic or you may choose to return for treatment on another day.

Mr Foo carries out all Botox injections personally with the aim of weakening the muscle but still preserving some muscle movement in order to maintain a natural look.

Botulimun Toxin injections are injected superficially through a fine needle and without any need of local anaesthetic. The muscle relaxing effects of this treatment may take up to 10 days to become fully effective.

Deeper lines may need to be softened by the use of a filler in combination with Botox treatment

What can I expect afterwards?

There may be some superficial redness or bruising after treatment. The result is not immediate and "Botox" takes effect between 1-10 days after treatment. For the first few hours, you should not rub the injected area but should try to deliberately contract or 'work' the injected muscles. Occasionally some patients complain of a slight headache (especially if they have had their forehead lines treated), although most patients go about their daily routine after treatment.

How long does it last?

The effect of "botox" is temporary, usually lasting about 4-6 months before a repeat treatment is required.

Are there any side-effects?

Although every care is taken to minimise complications, these can occur.

Who should not have Botulinum Toxin injections?

You should not have Botulinum Toxin if you are pregnant, breastfeeding or suffer from any neuromuscular diseases. It is also not recommended for patients on Aminoglycoside Antibiotics or on medication that thins your blood e.g. Warfarin and Aspirin.



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