Home Ask The Doctor

Ask an Evolve Doctor

Is it Good to Remove Blackheads?

It’s not necessarily a bad thing, but don’t make it a weekly habit! Stubborn Blackheads will not come out on their own and normally need some pressure to come out. After you have extractions done by an experienced dermal therapist it’s best to adopt ingredients in your home care that maintain the outcome for long periods of time. Useful ingredients include: retinol (Vitamin A), alpha-hydroxy acids, beta-hydroxy acids, zinc, and niacinamide (also known as nicotinamide, or Vitamin B3). If you’d like to read more about the treatment of acne and blackhead, learn about a microdermabrasion.

Can filler really cause blindness? Can I go blind from anti-wrinkle injections?

You may have heard in the media lately of a recent tragic event involving a patient losing the vision in one eye following treatment with dermal fillers. The details have not been made public, and I have no familiarity with the specific details of the case or what has occurred, but I do know that this case has shocked the cosmetic community and our hearts are with the unfortunate patient.

Blindness following injection with dermal fillers is far and away the most feared complication that cosmetic injectors have to think about, and one that we all must talk about with our clients before treatments. Even though the risk is so tiny, the consequences are so catastrophic that injectors should be morally and legally obliged to mention it to every client prior to their filler injection.

The reason that blindness is a risk following dermal filler injections has to do with the anatomy of the arteries that provide the blood supply to the eye. Most of the blood to the eye actually comes from an artery called the “ophthalmic artery”, which runs from deep inside the skull and then forwards to the back of the eyeball.

In many arteries however, there can be “cross-channels” from other arteries which communicate with each other. Sometimes there are arteries from the area between the eyes above the nose, a region also known as the glabella, which can communicate with the ophthalmic artery and the eyeball. Sometimes this also happens from arteries in the temples.

These anatomical variations are so variable amongst people that we never can be sure when and where we will find them. We just have to assume that they are there, in order to avoid the “worst case scenario”. The reason that this feared complication has never before been seen in Australia has a lot to do with the high standards followed in the Cosmetic Injecting Community and the general commitment to ongoing education and patient safety. The “No-Go” injecting “Danger-Zones” are generally avoided, or if injected they are done with extreme caution and only by the most experienced injectors with the safest techniques.

Whilst this is the first case of blindness in Australia, there have been multiple incidents worldwide, especially in some parts of Asia where injections to the glabella (or the bridge of the nose) are common. When you look at the statistics, with the number of people treated with dermal fillers each year numbering in the thousands, and fillers having been around for so many years, the number of cases of blindness is extremely low.

What is slightly more common, and not spoken about as much, is tissue ischemia and necrosis from injections into an artery. Ischaemia means “lack of blood to a tissue”, and necrosis means “tissue death”. It’s essentially the same thing as happens with filler being injected into an artery that travels to the eye, except the artery (and the filler) in this case travels to and lodges in other tissue, usually skin.

It’s another rare and feared complication, but thankfully in experienced hands the risks are very low, as the “No-Go” injecting “Danger-Zones” are well known. One more possible complication is injecting so much filler into a “tight” area (such as the nose, where the skin is bound down much more tightly to the underlying tissue). Too much filler may actually compress the veins and arteries in these areas, and ischaemia and necrosis may occur.

How would I notice if I had these problems? How would they be treated?
If you had filler inadvertently injected into an artery which travelled to your eye, the visual changes would be noticeable very quickly, within minutes usually. Your injector would then have to immediately flush the area with an enzyme which breaks down filler.

This could potentially mean an injection between the eyeball and the eyelid, to get to the back of the eye where the filler may be lodged. You would then be urgently sent to the nearest large hospital with an eye specialist (Opthalmologist) for treatment. A hyperbaric chamber (if available) can sometimes be used to increase the amount of oxygen in the blood and hopefully save the precious eye tissue. An important question to ask your injector is, “do you have filler dissolving enzymes in your clinic”?

Ischaemia and necrosis to other tissue can be more difficult to notice and diagnose, because it can come on slowly, typically four to six days after the injection. The skin may become “dusky”, painful and the capillary refill may be slower (capillary refill is where you compress some skin to squeeze out the blood, and then wait to see how long until it goes from white back to normal). Again, the answer is large amounts of filler dissolving enzymes injected in the area to dissolve the filler.

How can these complications be avoided?
These devastating complications can be avoided by risk management. There is a risk to every medical procedure (and it’s sometimes easy to forget that cosmetic injections are in actual fact a medical procedure). Clinicians perform a mental calculation and weigh up the risk versus the benefit of every procedure and fillers and anti-wrinkle injections are no different. Avoiding the “No-Go” injecting “Danger-Zones” is the best way to minimise risk.

The use of a blunt tipped cannula as opposed to a needle may be preferred in some areas to minimise the chance of puncturing and injecting into an artery. In theory at least, a blunt tipped canula should push aside a blood vessel rather than puncture it. Cannulas aren’t appropriate for every injection though, so after puncturing the skin and finding the exact place that we want to inject it’s a good idea to “pull back” or “withdraw” the plunger of the syringe.

If the needle tip is sitting in a vein or artery we will see a backflush of blood, which we won’t see if the needle is sitting in other tissue. Injector experience is of such huge importance, and sometimes we as injectors need to have the confidence and the courage to say “no” and refuse to inject in a situation or area which we find unsafe. After all, we get cosmetic injections for beauty, so why would we risk serious injury?

Can I go blind from anti-wrinkle injections?
This is highly unlikely for a number of reasons, but mostly because of the very different effects of filler and anti-wrinkle injections. Filler works by doing exactly that: filling. It is a big molecule, designed to take up space and expand. Anti-wrinkle injections work by paralysing and weakening specific muscles in the face that cause wrinkles when they contract. They are very small molecules and are highly unlikely to block an artery, even if they were injected into one.

After all has been said and done, these serious complications are very rare. Otherwise we would not be injecting fillers into anyone! No clinician wants to cause a serious complication. Far and away the most common side effect of dermal filler injections is swelling and bruising to the area, which usually settles down after a few days and is easily managed. But it is important to be aware of the risks involved, and to be able to discuss them with your injector for your own piece of mind and safety.

How can I stop myself passing out when I get anti-wrinkle injections or filler?

Why exactly do you pass out? And when? Before, during or after the injection? If you have a fear of needles, perhaps you can ask your injector to “hide” the needle from you so you don’t see it at all.

Does the actual sting of the injection cause you to pass out? Your injector can use ice to numb the area beforehand to minimise discomfort. Ensure that you have eaten a small meal prior to your injections so your blood sugar doesn’t drop, and drink a few glasses of water beforehand so that you are well hydrated.

If you start feeling dizzy, perhaps a jelly bean to raise your blood sugar may help. You can also ask to lay down, with your feet above the level of your heart if you are feeling dizzy.

After the injections, take a few moments to catch your breath before you stand up. Hopefully all of these things will help you!

Are chemical peel safe for the skin?

Chemical peels can revitalise and rejuvenate dull, lifeless skin giving you healthy appearance, as well as minimising fine lines and other signs of ageing. Chemical peels can also unblock clogged pores which aids in the treatment of acne, whiteheads and blackheads, and can aid dehydrated skin and uneven skin tone and colour.

Treatment with chemical peels is not limited to the face, and can be very useful on the neck, back, upper chest and upper arms. Treatment with chemical peels can also be combined with microdermabrasion or Photo-LED therapy to enhance the rejuvenation process.

A series of chemical peels, in conjunction with Dermafrac, microdermabrasion or Laser Genesis and occurring over a period of weeks or months, may be recommended by your dermal therapist

What does anti-wrinkle treatments do for eye wrinkles?

Anti-wrinkle injections work by injecting a small amount of a prescription-only medication into specific facial muscles. This medication leads to relaxation of the muscles which cause and worsen wrinkles. In the case of wrinkles around the eyes, commonly known as “crow’s feet” or “smile lines”, the muscle injected is named Orbicularis Oculi, which is ring of muscle around the eyes. It is important to remember that anti-wrinkle injections are a prescription-only medication, and should only be performed by highly trained doctor or nurse.

What are the side effects of Coolsculpting?

Coolsculpting is a non-surgical, safer alternative to liposuction, which does not require an anaesthetic, however it is still a medical procedure and it is important to realise that there is small risk of side effects. Apart from the mild discomfort during the treatment, some patients may feel bruised or mildly tender for a twenty-four to seventy-two hours.

A rare complication is late onset pain thought to result from irritation of the nerves during treatment: this pain generally appears on the third to fifth day after treatment, and although it usually resolves by itself, some patients may require a stronger pain medication which your doctor should be able to write you a prescription for. An extremely rare complication (seen in less than on in every ten thousand patients) involves growth of fat, rather than fat loss at the site and may require surgical correction.

Is it true that anti-wrinkle injections in your armpit keeps you from sweating?

Yes, this is correct. Anti-wrinkle injections also have an effect on the sweat glands, so it is possible to inject into the arm pits, the palms of the hand, the soles of the feet or the face if you have excessive sweating.

Are double chin fat injections as effective as lipo under the chin?

Double chin fat injections and liposuction both have their place, and whichever one that you choose depends on your budget and your treatment goals. Liposuction under the chin has excellent and immediate results but involves a surgical procedure and a general anaesthetic with all of the risks that go along with it. You will have to be admitted to hospital. Surgical liposuction may also be more expensive, more invasive and requires you to wear a chin compression garment post-operatively. Injections for treatment of the double chin may be cheaper and are certainly much quicker and less invasive. The injections can be done in a matter of minutes and you can continue about your regular activities. There is usually a degree of swelling associated with double chin injections, and most people require at least two treatments spaced at six to eight weeks apart. It is estimated that about 85-90% of people are happy with the results that they achieve from their double chin injections, and there have been no permanent side-effects reported.

How important is technician experience for a Coolsculpting treatment?

The experience of your Coolsculpting technician is very important. Because Coolsculpting is non-invasive and quick, it’s easy to forget that the fat reduction is permanent and that the placement of the applicators is very important in achieving an even outcome. If the wrong applicator is applied, of if the applicator is applied at the wrong place, the result of your fat reduction can be uneven or asymmetrical. It’s important to talk to an experienced Coolsculpting technician and have a thorough assessment so your goals can be discussed and the correct and number of applicators placed in the correct positions!

Does fat freezing work for weight loss?

The non-invasive fat-freezing technique utilises a process as cryolipolysis: the fat cells in your body are known to freeze at a different temperature to other, healthy cells. Coolsculpting takes advantage of this fact by applying a device that resembles a cold vacuum to your love-handles, double-chin or other problem areas, and freezing the fat cells, while leaving the normal tissue unharmed. The body’s natural processes then break down and eliminate the fat cells over the next few weeks and months. No hospital stay, no anaesthetic, no painful surgery or incisions, and you can go back to work immediately after your treatment. The most commonly treated areas include the stomach, hips, love-handles, thighs and double-chins, although almost any problem area can be targeted with a Coolsculpting fat-sculpting treatment.

Are Double Chin Injections Safe?

Although double chin injection is a cosmetic procedure, it is important to understand that it is still a medical procedures, and that some small risks exist, as for any medical procedure. The most common side-effect is a significant amount of swelling, which you should be prepared for, and may want to plan around.

The swelling is a good sign that the treatment is working, and is expected to peak at forty eight hours after injection. The swelling lasts for an average of seven days. If bruising occurs most patients find that it can easily be covered by makeup until the bruise resolves, which takes a few days.

Another, much rarer side effect is a temporary, asymmetrical smile. This may occur if the medication is injected too close to the nerve that helps move some of the muscles of your mouth. This risk can be minimised by avoiding injecting too close to the jaw, which is where the nerve usually runs.

Your highly trained doctor is familiar with the anatomy of the area, and will discuss with you the safest sites for treatment. If this asymmetrical smile occurs it is likely to last for an average of six weeks until the nerve recovers. Allergic reactions are also possible after any medication injection, although the likelihood of this is small.

How are double chin injection different to coolsculpting?

As opposed to Coolsculpting, which freezes fat, double chin injection use a prescription only medication which kills the fat cells, setting off an immune reaction which leads to the immune system removing the fat from body. The injections will do the same to fat anywhere in the body, but the safety of the procedure has only been studied in the chin, so it is the only region approved by the FDA

Can I have anti-wrinkle treatments and dermal fillers at the same time or is this not recommended?

You can most certainly be treated with both anti-wrinkle injections and dermal fillers at the same time. It is recommended that after treatment with anti-wrinkle injections, you not massage the area for twenty four to forty eight hours to prevent the medication from migrating to other muscles. Dermal filler treatment often requires that the area be massaged to ensure an even appearance and minimise lumps. For that reason, you should be treated with dermal fillers before you have your anti-wrinkle injections.

I have Eczema on my face, will anti-wrinkle injections help me?

Anti-wrinkle injections will have no effect on eczema. The reason that anti-wrinkle injections work to minimise the appearance of wrinkles is because they relax or mildly paralyse certain specially selected muscles in the face. When these muscles contract they cause skin to wrinkle: relaxing them means that the wrinkles won’t form. Eczema is an allergic-type reaction and is not related to the action of facial muscles, so anti-wrinkles will not have any effect. I would recommend seeing a dermal clinician or dermatologist to ask their opinion on treatment.

I have bruxism, Would there be any reasons to avoid anti-wrinkle injections and in your experience is it a successful treatment?

Bruxism is excessive teeth grinding or jaw clenching. The symptoms include headaches from overactive and aching jaw muscles, sensitive teeth from grinding away of the top layer of the teeth, general wear and tear of the teeth, very flat teeth, and damage to fillings and crowns. Anti-wrinkle injections can be a fantastic treatment for bruxism. The reason that anti-wrinkle injections work to minimise the appearance of wrinkles is because they relax or mildly paralyse certain specially selected muscles in the face. When these muscles contract they cause skin to wrinkle: relaxing them means that the wrinkles won’t form. People with bruxism may also benefit from having their chewing muscles injected with anti-wrinkle injections. The muscle is called “masseter”, and you can feel it contracting in your cheek when you chew. Injections into masseter help to relax the muscle and minimise grinding, especially when sleeping. It can also have an amazing effect on slimming the face, as the muscles is very bulky and contributes to a “round” facial appearance. Unless you are sensitive to anti-wrinkle injections, there is no reason why this treatment should be avoided,

Has anyone had anti-wrinkle injections for spasticity and if so did it help?

The reason that anti-wrinkle injections work to minimise the appearance of wrinkles is because they relax or mildly paralyse certain specially selected muscles in the face. When these muscles contract they cause skin to wrinkle: relaxing them means that the wrinkles won’t form. People who have muscle spasticity also benefit from having certain specifically selected muscles relaxed as well. For example, in someone who has had a stroke a muscle may be contracted in such a manner that may be uncomfortable and interfere with everyday activities. Selectively weakening that muscle can be very useful in minimising discomfort and even pain. Very large doses are needed, as the muscles involved are much bigger than the facial muscles involved in wrinkling.

I have wrinkly lips, Is this something that dermal fillers can help with?

The reason that your lips have become wrinkly is because of loss of volume, which makes the skin and lips appear “hollow and empty”, and also due to loss of collagen. Collagen is the protein in the skin and lips that keeps it “tight and elastic” and prevents wrinkles from forming. As we age we tend to lose volume and collagen, which can be especially noticeable in the lips. Smoking and sun exposure can make these fine lines and wrinkles much worse. Replacing this lost volume with dermal fillers will definitely help in the appearance of your lips.

Can lip fillers be done to only certain parts of the lip?

Absolutely! It’s possible to deposit a small amount of filler just under the corner of the lips, giving a slight lift to the corners. Another trick is to inject a small amount of anti-wrinkle injections, only a few units each side, to a muscle called depressor angularis oris (DAO). This muscle attaches to the corner of the lips and pulls it downwards. If you make your mouth frown strongly, you can probably see this muscle working. A small amount of anti-wrinkle injections will slightly weaken this muscle, meaning that the corners of the lips won’t be pulled downwards as much.

Do lip fillers shrink lip size afterwards?

Lip fillers will give an immediate increase in size to the lips. It’s noticeable straight away. Then the swelling begins, and the lips will get fairly big for the next 24 to 48 hours. Once the swelling subsides you will see your “final” lip size, and your lips will stay that size until the filler starts to get absorbed in six to twelve months. Once the filler has totally reabsorbed your lips will go back to the same size that they were before the fillers were injected. Your lips will not shrink because of having had filler: however, as we age our face loses volume, and this includes the lips, which get thinner.

Can CoolSculpting be applied directly over the kidney area cause damage to the kidney?

The Coolsculpting process draws skin and fat into the applicators, but not the deeper structures. The kidneys are a much deeper structure, protected by muscles. In someone with normal anatomy, there is no reason to think that the kidneys could be damaged, and there is no evidence to suggest that this is the case.

Is it common to get Spock eyebrows with anti-wrinkle injections?

Getting a “Dr Spock” eyebrow, or an overly raised or arched eyebrow, is not an uncommon occurrence following anti-wrinkle injections to the forehead. It happens when the injections are not placed laterally enough. The muscle in the middle of the forehead has been weakened and is unable to raise the eyebrows upwards, but the muscle at the edge of the eyebrows is still fully active and pulls the edges of the eyebrows upwards. To correct this you need a small number of units at the edge of the of the forehead muscles. It sometimes happens that after the first injections that a “correction” is needed. However, for this to happen every single time is unusual! I would advise that you discuss this with your injector, or perhaps find someone with more experience.

Is abdomen CoolSculpting okay for someone with an insulin pump?

As far as I am aware, there is no evidence that Coolsculpting is less effective in people with either Type 1 or Type 2 Diabetes. It would be safest to discuss the treatment with your endocrinologist beforehand, and ensure that your blood sugar levels are optimally managed prior to your treatment. I’d recommend having your treatment in a clinic where a doctor is on hand in case of a hypo. I’d also recommend using your insulin pump on an area that is not being treated for a few hours before the treatment, and wouldn’t put it back onto the treated area until all of the bruising and tenderness from the Coolsculpting has fully resolved.

After anti-wrinkle injections, how long do the result last?

Every person is different, and anti-wrinkle injections last for a different length of time in everyone, but as a general rule, I tell my clients to expect their injections to last for approximately twelve weeks. The factors that influence how long the injections last for include the muscles injected (bigger muscles need more units and tend to use up the medication quicker), the number of units injected, and the person themselves (some people just use their anti-wrinkle injections more quickly than others). Some people find that with repeated treatments their anti-wrinkle injections start to last a little bit longer each time, but this can’t be guaranteed.

Will a steroid injection affect my CoolSculpting results?

Although there is no way to know for sure, as there is no data on the topic, this steroid injection is unlikely to have an effect on your Coolsculpting results. In any event, you were wise not to compromise your health and your regular medical treatments for Coolsculpting, which, after all, is a cosmetic procedure.

Is it normal and common to get a burn from CoolSculpting?

No, it is definitely not normal to get a burn after a Coolsculpting treatment. Coolsculpting uses freezing technology to destroy the fat cells in the area treated, so there be no area of heat to cause a burn. I have heard of people using inferior technology having “frost-bite” after a treatment, but I must stress that this was not the original Zeltiq Coolsculpting technology. Coolsculpting has a “freeze-detection” technology safety feature, which ensures that the area treated does not go below the minus eleven degrees. If you think that you have a burn I would advise you to seek medical attention immediately.

Coolsculpting is newly approved for upper arms? Has it been successful?

In our clinic we have treated many clients on the upper arms, with great success. If you have a pocket of fat which can be pinched, you should be a good candidate for Coolsculpting. I would recommend an in-person assessment with an experienced Coolsculpting clinician to assess your suitability.

Would dermal fillers help under eye bags and marionette lines?

People are often amazed that simply adding volume to the cheeks can have such an amazing effect on bags under the eyes. I would start with using some filler your cheeks, which will “lift” the cheeks and minimise the bags, and then perhaps inject a small amount directly into the nasolabial folds. Injecting filler in the area under and around the eyes is one of the most difficult cosmetic treatments in the face. The skin in the area is very thin, and if not injected carefully it is possible to see lumps of filler under the skin, or even a “blueish colour” due to light being reflected from the filler. The area is also prone to swelling and bruising.

As we age, we lose bone and fat in the face. We also lose collagen in our skin. Collagen is the protein that keeps our skin tight and minimises wrinkles and sagging. Ageing, and the loss of bone, fat and collagen causes the youthful “heart-shaped face” to fall with gravity, and become more “square” and hollow. Replacing lost volume in the face with filler is a great place to start. Think of it as building the strong foundations for a house. Not many people realise just how much difference replacing lost volume can make. The results are subtle, but noticeable. It is a very natural way of making someone look more youthful. Rather than look like you’ve obviously had fillers, it just gives you a subtle freshen up, like you’ve had a great night’s sleep.

The benefit of using non-permanent fillers is that they are much safer and have the advantage of being able to be dissolved if you are not happy with the results. Careful injection of filler will minimise the risks of lumpy and visible filler under the eyes. An injection performed with a blunt tipped micro-cannula, as opposed to a sharp needle, is not only less traumatic, with less bruising and swelling, but also allows deeper filler placement with minimal lumpiness. The use of cannula will permit much more accurate filler placement, and your results will be much more natural looking.

You would need treatment approximately every six to twelve months depending on how quickly your body breaks down filler, how much filler you are treated with, and what type is filler is used.

What is better for nasal labial folds, Injectables or a surgical face lift?

As we age, we lose bone and fat in the face. We also lose collagen in our skin. Collagen is the protein that keeps our skin tight and minimises wrinkles and sagging. Ageing, and the loss of bone, fat and collagen causes the youthful “heart-shaped face” to fall with gravity and become more “square” and hollow. Replacing lost volume in the face with filler is a great place to start. Think of it as building the strong foundations for a house. Not many people realise just how much difference replacing lost volume can make. The results are subtle, but noticeable. It is a very natural way of making someone look more youthful. Rather than look like you’ve obviously had fillers, it just gives you a subtle freshen up, like you’ve had a great night’s sleep. People are often amazed that simply adding volume to the cheeks can have such an amazing effect on the nasolabial folds. I would start with using some filler your cheeks, which will “lift” the cheeks and minimise the lines, and then perhaps inject a small amount directly into the nasolabial folds.

Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector or surgeon, and your budget. I would recommend a review with an experienced injector and surgeon who can assess you in person (as a two-dimensional photo doesn’t tell the “full 3-D story” of your face), discuss your goals, and formulate a treatment plan.

Is swelling, bruises & hardness normal 3 days after lip filler injections?

Because the lips are quite a sensitive area, some people experience bruising and swelling for the first two or three days after lip filler injections. This is very normal, and nothing to be concerned about. You may wish to have your procedure when you have a free day following, so you don’t need to worry about the swelling! That said, there are a number of tips that can help to minimise the swelling experienced: Ice to the area may help for the first evening, as well as mild painkillers such as paracetamol. Aspirin and ibuprofen should be avoided as they thin the blood. An anti-histamine tablet also helps some to minimise swelling. I advise clients to spend the first night sleeping on an extra pillow or two can minimise the swelling experienced when they wake up the next morning. If you do have any small bruises, arnica cream can also be helpful.

Post TMJ anti-wrinkle injections treatment, was it done correctly?

Anti-wrinkle injections into the masseter muscle are a great treatment for TMJ (temporomandibular joint) dysfunction, bruxism (teeth grinding), tension headaches and even facial slimming. The masseter is one of the large chewing muscles, and you should be able to feel it moving when you clench your teeth. I presume that your dentist injected the anti-wrinkle injections into a place where you can feel the muscle contracting. The muscle runs downwards along the side of the face and can be injected anywhere along its length. Some injectors like to divide the injections into two or three doses, although it may not be necessary. Masseter is quite a large muscle, and this dose seems very reasonable.

CoolSculpting vs CryoDefine?

When it came time for our clinic to decide on a body contouring / cryolipolysis machine we evaluated all of the available evidence and decided on Coolsculpting for a number of reasons. First and foremost, Coolsculpting is safe. Coolsculpting has a “freeze detect” technology that detects if the skin is getting too cold, and automatically shuts down the treatment. I have heard disaster stories of clients undergoing cheaper treatments overseas and having frost-bite from unregulated freezing technology. Secondly, as a medical clinic, we wanted to have the treatment with the most clinical evidence behind it; this is clearly Coolsculpting. Coolsculpting was developed in conjunction with Harvard Medical School and has been the subject of multiple clinical trials in peer reviewed journal articles. Millions of Coolsculpting treatments have been performed worldwide, and the results speak for themselves.
The new Coolsculpting treatment applicators have a temperature of minus eleven degrees, while many other treatments only go down to minus eight or even minus three degrees. The colder the treatment, the quicker the treatment, but also the more fat cells that get damaged and the more effective the treatment.

Which do I do first, CoolSculpting or gastric banding?

Gastric sleeve and gastric banding surgery is extremely successful in helping people lose weight. You will lose fat from many areas on your body, and of course we can’t predict exactly how much and where from. Some of the best results that we see from CoolSculpting have come in people who are at the end of a weight-loss journey and need the final “touch-up”. CoolSculpting is fantastic for those last pockets of fat that just won’t shift no matter how hard we try, whether it be with exercise, diet or surgery. My thoughts are that you should lose as much of the weight as you can with the surgery, and then assess your options when your weight has stabilised. At that stage you can also assess what your arms look like. Depending on amount of weight loss that you undergo, you may wish to consider surgical treatment of your arms if there is a significant amount of loose skin. If there is not loose skin, CoolSculpting can be the perfect non-invasive treatment. CoolSculpting for the upper arms has had fantastic success in our clinic, and although in general CoolSculpting doesn’t tighten skin, there is often enough elastic recoil in the skin that you won’t notice sagging.

Is there much difference between the Zeltiq and Clatuu fat freezing devices?

When it came time for our clinic to decide on a body contouring / cryolipolysis machine we evaluated all of the available evidence and decided on CoolSculpting for a number of reasons. First and foremost, CoolSculpting is safe. CoolSculpting has a “freeze detect” technology that detects if the skin is getting too cold, and automatically shuts down the treatment. I have heard disaster stories of clients undergoing cheaper treatments overseas and having frost-bite from unregulated freezing technology. Secondly, as a medical clinic, we wanted to have the treatment with the most clinical evidence behind it; this is clearly CoolSculpting. CoolSculpting was developed in conjunction with Harvard Medical School and has been the subject of multiple clinical trials in peer reviewed journal articles. Millions of CoolSculpting treatments have been performed worldwide, and the results speak for themselves.
The new CoolSculpting treatment applicators have a temperature of minus eleven degrees, while many other treatments only go down to minus eight or even minus three degrees. The colder the treatment, the quicker the treatment, but also the more fat cells that get damaged and the more effective the treatment.

If the botulinum toxin is so poisonous, then how can you get anti-wrinkle injections without dying?

That’s a fantastic question! The reason it’s safe to use for cosmetic purposes is because only tiny doses are used, and the toxin is delivered directly to the facial muscles that cause wrinkles. The toxin is also sterile, and purified, so we know exactly what dose we are giving.

In the illness “Botulism”, very large doses of the toxin are released in the body from contaminated food. These very large doses of un-purified toxin affect the muscles in the face in a uncontrolled way, as well affecting breathing by paralysing the diaphragm and other breathing muscles.

Anti-wrinkle injections are safe because we can deliver the medication in a highly controlled way. It’s important to realise that complications can sometimes occur though, and that’s why it’s important to choose an experience injector.

Do anti-wrinkle injections for migraines really work?

The short answer is: “it depends”. There are different types of migraines with different causes. Anti-wrinkle injections work by causing muscles to relax: if your migraine or headache is caused by muscular tension, injections may help. The doses are larger than those used for facial wrinkles, and should only be administered by highly trained neurologist.

Where does the fat go after Coolsculpting?

Coolsculpting freezes the fat quickly, but the process of eliminating the fat takes a few months: typically three to four months. The process of cryolipolysis (fat freezing) sets off a natural process called “apoptosis” which causes the fat cells and the fat to be broken down and eaten by cells of the immune system. The fat is then excreted in the breath, sweat, urine and faeces over the next few months. Because your body does not make new fat cells, the fat is gone for good. Coolsculpting is the definitive fat freezing and non-invasive body-contouring technique available, as well as the safest and most reliable with the largest body of scientific evidence demonstrating real results.

What should I do about intense abdominal pain after CoolSculpting?

I’m sorry to hear that you have had the result. Most people find that Coolsculpting is a very comfortable procedure, and even if they are mildly tender afterwards, they can usually manage with simple and mild pain killers such as paracetamol. That would be my first suggestion, along with heat packs and gentle massage to the area if you can tolerate it. Avoid painkillers such as aspirin and ibuprofen, as they can thin the blood and increase the chance of bruising. In some rare cases, Coolsculpting has been known to cause a nerve pain, which can feel like a burning or tingling sensation. It only lasts for a few days but can be uncomfortable. In these cases I usually advise the use of a medication for neuropathic pain for a short time. If your pain continues, please consult you Coolsculpting provider or local doctor for a prescription. Your Coolsculpting provider should be informed about this outcome so it can be properly documented and logged with Zeltiq.

Will it cause saggy skin with the volume loss of fat?

Coolsculpting has been very successful in our clinic for treatment of the upper arms, and has not led to saggy skin. This seems to be because the skin on the arms is fairly tight to begin with. If there is a lot of saggy skin over the area to be treated, it is unlikely to get better. I would recommend that you have a consultation with a Coolsculpting expert, who can assess your body in person, and give you a realistic idea of your potential to benefit from treatment. Coolsculpting is very good at treating pockets of “subcutaneous fat”, the fat just under the skin. If you can “grab hold of” an area, it is likely that it can be treated effectively with Coolsculpting. Approximately 20-25% of fat cells in the area are killed with each cycle of treatment, so many clients may wish to have a number of treatment cycles to the same area, spaced at a few months apart, to maximise the treatment effect.

Could puffy pubis area benefit from CoolSculpting?

If you “grab hold” of a pocket of fat, then you may be a good candidate for Coolsculpting. I would recommend that you have a consultation with a Coolsculpting expert, who can assess your body in person, and give you a realistic idea of your potential to benefit from treatment. Coolsculpting is very good at treating pockets of “subcutaneous fat”, the fat just under the skin. If you can “grab hold of” an area, it is likely that it can be treated effectively with Coolsculpting. Approximately 20-25% of fat cells in the area are killed with each cycle of treatment, so many clients may wish to have a number of treatment cycles to the same area, spaced at a few months apart, to maximise the treatment effect.

CoolSculpting – each side of waist was a 30 min. session. Is this standard?

There are a number of different CoolSculpting applicators. The older style applicators take around forty-five minutes to one hour for each treatment area, depending on the treatment area. The newer applicators, which have a greater area of freezing and are colder than the older applicators, have a reduced treatment time of thirty-five minutes for most areas, and forty-five minutes for other larger areas.

Would I be a good candidate for CoolSculpting on my arms?

Although it is difficult to tell from your photo, in general Coolsculpting has been very successful in our clinic for treatment of the upper arms. I would recommend that you have a consultation with a Coolsculpting expert in . Melbourne, who can assess your body in person, and give you a realistic idea of your potential to benefit from treatment. Coolsculpting is very good at treating pockets of “subcutaneous fat”, the fat just under the skin. If you can “grab hold of” an area, it is likely that it can be treated effectively with Coolsculpting. Approximately 20-25% of fat cells in the area are killed with each cycle of treatment, so many clients may wish to have a number of treatment cycles to the same area, spaced at a few months apart, to maximise the treatment effect

Does a CoolSculpting massage impede results?

The two-minute massage following Coolsculpting treatment is recommended for optimum results, although the majority of fat cells in the treatment area have still sustained a cold-injury that will lead to fat cell death. The reason for the massage is that it is thought to give the last small amount of damage to fats cells on the very edge of the treatment area to “push them over” into cell death: these cells have sustained some damage by the cold, but not as much injury as the cells in the centre of the treatment. You will definitely still have the effect of death of fat cells; you may just find that you have a slightly lesser effect than if the full two-minute massage were performed.

Can injectable fillers be used to better define the jawline?

The chin and jawline are a common area to be enhanced using dermal filler injections, but also remember that there are injections available which can dissolve fat under the chin (pre-platymal fat or “double-chin”). These injections can also help give a more defined, masculine appearance to the jaw.

After how many days post lip filler can I get my facial or facial massage done?

Many people experience swelling of their lips during the first twenty-four to forty-eight hours following injections, so massage may be uncomfortable. However there is no reason that you cannot have massage after the swelling has resolved and you feel comfortable. I always massage the lips immediately following injection to ensure an even result and minimise swelling, so there will be no harm to the filler. Following anti-wrinkle injections however, I would wait at least a week before having a facial massage, to minimise the chance of the medication moving to (and causing weakness of) the wrong muscles.

Is it okay to get fillers while having iron tablets for anemia?

It is totally fine, but why are you anaemic?

It is completely safe to have treatment with dermal fillers while you are on iron tablets for anaemia: there is no interaction with the filler. Do you know why you are anaemic? There are many important and potentially serious causes of anaemia, and I strongly advise you to visit your family physician for a thorough investigation of these causes!

Help! Can I fix these mouth lines with dermal fillers?

When it comes to nasolabial folds, my first choice is to actually fill the cheeks! This may sound strange but as we age we tend to lose volume in the mid-face (in the cheeks and under the eyes). Replacing this lost volume serves two purposes: firstly, it restores a more youthful, “rested” look under the eyes; and secondly it indirectly gives a “lift” to the nasolabial folds. If need be, more filler can later be added directly along the nasolabial folds. Of course, it’s hard to judge from just one picture, so I recommend an in-person assessment with an experienced injector who can see the “full three-dimensional” picture of your face and discuss your treatment goals with you.

Should a doctor know where the arteries in the face are to avoid causing blindness or skin necrosis from filler?

The arteries in the body follow a general plan which is similar in everyone, but there is variation from person to person. Veins are more variable but also follow a general plan. It is important that your injector understand the anatomy of the face, not just the veins and arteries, but also the nerves, muscles, bones and fat pads to help you achieve the optimum aesthetic result in the safest fashion. There are certainly “danger zones” where filler should not be injected, as this can result in blindness. Thankfully such devastating side effects are extremely rare. In my practice I use a blunt tipped cannula to inject dermal fillers, as there is a much-reduced risk of injections into arteries and veins. It’s important to make a fully informed decision regarding injections with fillers, and to find an injector who is adequately trained in anatomy and safe injecting technique: your safety should be the number one priority.

What’s the best option for fillers for nasolabial folds?

Fillers come in many different types, but the most commonly used are made of a substance found naturally in the body, which comes in different sub-types, some of which are thicker and therefore good for recreating lost volume, while some are softer and better for filling lips. When it comes to nasolabial folds, my first choice is to actually fill the cheeks! This may sound strange but as we age we tend to lose volume in the mid-face (in the cheeks and under the eyes). Replacing this lost volume serves two purposes: firstly, it restores a more youthful, “rested” look under the eyes; and secondly it indirectly gives a “lift” to the nasolabial folds. If need be, more filler can later be added directly along the nasolabial folds. Of course, it’s hard to judge from just one picture, so I recommend an in-person assessment with an experienced injector who can see the “full three-dimensional” picture of your face and discuss your treatment goals with you.

Is this ptosis of the eyelid or brow after anti-wrinkle injections and is it a forever lazy eye?

This may be an unfortunate case of a ptosis, or drooping eyelid. Where in the face did you have your anti-wrinkle injections? A potential side-effect of injections with anti-wrinkle injections is migration of the product into other muscles. If the product goes into the eyelid muscle (“levator palpebrae”), a ptosis can result. Ptosis is only temporary, and lasts as long as the anti-wrinkle injections, usually about twelve weeks. There are also some eye drops available which can be used to lessen the appearance of the ptosis.

Can you get anti-wrinkle injections while getting LED treatments?

You can certainly have treatment with anti-wrinkle injections while you continue your Photo-LED treatments. In fact, Photo-LED treatments may help you heal faster after the injections, and may even cause the anti-wrinkle injections to last longer.

Can anti-wrinkle injections cause the brain to stop using a muscle, resulting in a permanent effect?

Anti-wrinkle injections work at the junction of the nerve and the muscle, an area known as the synapse, and block the transmission of nerve impulses to the muscle. The muscle then fires less, meaning less wrinkles due to skin creasing. Anti-wrinkle injections have a limited period of action, generally twelve weeks on average. Of course, everybody is different and in some people the effect will be longer or shorter. The length of action also depends on the dose (number of units used), the size of the muscles treated, and injection method. The action is not permanent.

Fat dissolving injections are only approved for under-chin fat, but I was wondering is there any scientific or technical reason as to why it can’t be used some time in the future to melt fat bags under-eyes?

While in theory fat dissolving injections can be used to treat fat in any area of the body, the FDA has only been approved it for use under the chin. There have been trials performed demonstrating that the injections are safe and effective for treatment of fat under the chin, but there is no data on its safe and effective use in any other body region. I would strongly advise against using these injections under the eyes, as there are many important structures in this region, and no recognised “safe-zone” for injection. There are other options for treating bags under the eyes, including the use of injectable dermal fillers to the region, and this would be my preference. I would suggest that you seek advice from a plastic surgeon or aesthetic physician who can discuss your aesthetic treatment goals with you and discuss the safest options for you.

Are there any long-term nerve damage caused by fat-dissolving injections that did not resolve?

Fat dissolving injections are injected into a “safe zone” under the chin, into a region known as the “preplatysmal fat”. This is to avoid the important structures that pass deep to the muscle in the neck, and especially to avoid injuring the nerve that controls the lips. Provided that this safe zone is identified, the injections are highly unlikely to damage the nerve. If the nerve is damaged, the resulting nerve damage (known as “neuropraxia” is temporary and has an average duration of 6-8 weeks). The large studies on fat dissolving injections have not demonstrated any permanent side-effects of the treatments.

I want fat dissolving injections but have two large visible veins under the chin area. Is it safe to get it where the veins are?

Fat dissolving injections are injected into a “safe zone” under the chin, into a region known as the “preplatysmal fat”. This is to avoid the important structures that pass deep to the muscle in the neck, and especially to avoid injuring the nerve that controls the lips. Provided that this safe zone is identified, the injections have not been demonstrated to have permanent side-effects. A skilled injector will be able to easily avoid the veins in your neck, but to reassure yourself you should point them out before the injection! Bruising is a common side effect of any injection, and can always be covered with make-up until it resolves in 48-72 hours.

I have a significant double chin when I look down. What is the best treatment for this?

Coolsculpting is an excellent treatment for permanently removing fat under the chin, but don’t forget about fat dissolving injections. They are both excellent options, and both have their place in my practice. There are a number of reasons to use one instead of the other. Firstly, do you have enough submental fullness to fit the CoolMini vacuum applicator? If you do not have enough, the applicator may not stay in position during the treatment, and your results may be less than optimal. Although it is difficult to tell from your photo, you may fall into this category. The benefit of CoolMini is that there is less “downtime” than you will experience following fat-dissolving injections The swelling following fat dissolving injections can be quite severe for the first 24-72 hours, although this is actually a good sign that the treatment is having its desired effect. I would recommend a review with an experienced injector and Coolsculpting specialist who can assess you in person (as a two-dimensional photo doesn’t tell the “full 3-D story” of your face), discuss your goals, and formulate a treatment plan. I would also suggest a review at a clinic where both Coolsculpting and fat-dissolving injections are available, so you get an unbiased opinion!

How long does it take to see results from Coolsculpting?

The non-invasive fat-freezing technique utilises a process as cryolipolysis: the fat cells in your body are known to freeze at a different temperature to other, healthy cells. The body’s natural processes then break down and eliminate the fat cells over the next few weeks and months. Coolsculpting does not work instantly: it can take four to six weeks before results begin to be seen, and it may be up to three months before the maximum effect is seen. Approximately 20-25% of fat cells in the area are killed with each cycle of treatment, so many clients may wish to have a number of treatment cycles to the same area, spaced at a few months apart, to maximise the treatment effect. I would recommend having an assessment with a Coolsculpting professional to discuss your treatment goals and the likely number of cycles required.

Is hair growth common after an IPL Photo-LED Facial?

This is called paradoxical hypertrichosis, which is the adverse stimulation of hair growth that can occur in areas treated. It is unknown why this occurs but there may be a correlation between hormone imbalance and skin colour. You can have the area re-treated for the hair growth and I would recommend having an assessment and laser hair removal, by a trained professional.

Did my face get burned by an IPL Photo-Facial?

It sounds like an IPL burn. It is best to go back and speak to them and get some advice on how to look after the burn. Keep the area moist with a good quality burn ointment or pure aloe-vera gel. If the technician offers no help I would highly recommend you seek a second opinion from another skin professional. Avoid direct sunlight until the area is healed and get onto some good homecare from a professional to address any post-inflammatory hyper-pigmentation that can occur as a result of the treatment.

Is doing chemical peels between IPL sessions a standard procedure?

Are you being treated for a specific condition, or do you have a specific goal in mind? Chemical peels tend to treat the epidermis (outer layer of the skin) and cause some form of resurfacing depending on the type of peel used, whilst an IPL photo-facial can treat a variety of depths in the skin depending on the skin concern and setting used. Results can be slow as you are trying to exert change within the skin and it can take multiple treatments to notice a difference. The best way to keep track of your skins progress is to have the clinic take before and after photos and if they haven’t done so, request them to or take some yourself. Homecare is also crucial when undergoing chemical peels and IPL. Discuss this with your skin professional if you have any concerns.

Should all treated brown spots turn darker after a facial laser treatment?

This sounds like a fairly normal response to a first treatment. Generally, we like to see “coffee ground” spots appear in all areas treated within a few days and if this doesn’t happen we will probably need to re-treat the area once healed and re-assess the settings. It is best to treat the skin using safe parameters that may require multiple facial laser treatments than a setting that can increase chances of adverse reactions such as burns, post-inflammatory hyperpigmentation, de-pigmentation or blistering. If the area treated has a variety of lighter and darker pigment colours, parameters should be chosen for the darker pigment to avoid over-treatment. Lighter pigment should be treated on subsequent visits. Go back to your skin professional and have them re-assess the treated area at your next visit.

Does Retinol still work even with irritation present?

It sounds like you’re having a “retinoid reaction”. Clinically it takes about 3 weeks for skin cells to adapt and build a tolerance to the use of a retinol. If you feel that your skin is reacting far too much, cut back the use of the retinol to twice a week for several weeks and add in an extra day if you feel your skin can tolerate it. Ensure you are using a good quality moisturiser to keep skin hydrated and an SPF in the day to protect the skin from the sun, as retinols increase sun sensitivity. If your symptoms persist, go back to your skin professional and have your skin re-assessed for a lower dosage retinol and re-introduce slowly.

How can I repair my badly damaged & prematurely ageing skin after too many TCA peels?

Peels should always be performed under the supervision of a trained professional. I would highly advise against performing peeling treatments at home due to a lack of understanding of the properties of the peel and how to control its action in the skin. I would suggest that you consult a dermal therapist and have them address your skin concerns.

What is a Dermal Therapist? Am I being treated by a Dermal Therapist at Evolve Advanced Cosmetic Medicine?

A Dermal Therapist, or Dermal Clinician, is an expert in the diagnosis, treatment and management of skin conditions.

To obtain qualification as a Dermal Therapist in Australia requires a four-year university degree in a Bachelor of Health Sciences, with a major in skin sciences. The Australasian academy of Cosmetic Dermal Science is also a specialized body for such academic training.

Dermal Therapists have a detailed knowledge of human anatomy, physiology, endocrinology, chemistry, plastic surgery, dermatology, nutritional relevance to skin, wound management, infection control, and the physics and real-world applications of laser technology. A core component of a Dermal Therapist’s education is the unbiased evaluation of peer reviewed evidence relating to skin and tissue interaction with lasers and other light modalities such as intense pulsed light (IPL).

Dermal Therapy qualifications are highly prized in the aesthetic and skin-care industry, and leading clinics will employ Dermal Therapists for their evidence-based approach to skin health. Dermal Therapists are experts in the management of many skin conditions including acne, dry or sensitive skin, pigmented lesions, rosacea, redness and other vascular lesions. They are able to individually tailor a skin-care program specifically for you. This may consist of treatments such as microdermabrasion, chemical peels of varying strengths, skin needling, laser and light therapies and a personalised home-care cosmeceutical regimen. Working with in partnership with a doctor they can also assist in obtaining prescription only treatments for pigmentation and acne.

Dermal Therapists are also experts in the appropriate and safe use laser technology in a clinical setting. In the State of Victoria, there are no restrictions on who can operate a laser in the setting of an aesthetic clinic. Unfortunately burns, scars, and permanent changes in pigmentation are all too common following laser treatments by inexperienced practitioners. At Evolve Advanced Cosmetic Medicine, you are always treated by our certified and trained Dermal Therapists. For your safety, it is important to ask, “am I being treated by a Dermal Therapist”?

Will taking a daily zinc supplement have an effect on Coolsculpting results?

The non-invasive fat-freezing treatment utilises a process as cryolipolysis: the fat cells in your body are known to freeze at a different temperature to other, healthy cells. The body’s natural processes then break down and eliminate the fat cells over the next few weeks and months. As your fat cells have already sustained the cold injury, they will undergo cryolipolysis no matter what you do now; zinc supplements are highly unlikely to decrease the effect.

I had a tummy tuck and liposuction 2 years ago. Will Coolsculpting help?

I would recommend that you have a consultation with a Coolsculpting expert, who can assess your body in person, and give you a realistic idea of your potential to benefit from treatment. Coolsculpting is very good at treating pockets of “subcutaneous fat”, the fat just under the skin. If you can “grab hold of” an area, it is likely that it can be treated effectively with Coolsculpting. The other type of fat is “visceral fat”, the fat that sits around the organs in the abdomen. Coolsculpting is not effective in treating this type of fat, as it can’t be frozen effectively using the vacuum applicators. Approximately 20-25% of fat cells in the area are killed with each cycle of treatment, so many clients may wish to have a number of treatment cycles to the same area, spaced at a few months apart, to maximise the treatment effect.

After Coolsculpting, what happens to new fat coming into the body?

Each Coolsculpting cycle kills 20-25% of the fat cells in the treated area, and you are correct in saying that they will not return. Newly consumed fat will go to the remaining fat cells, which enlarge. You won’t notice anything strange, as the fat will be evenly distributed to the remaining cells.

Provided that your diabetes is well controlled, it should still be possible to undergo Coolscultping. You will have to keep a close watch on your blood sugar levels and may want to have a source of sugar close at hand in case of a “hypo”. In theory you may also be at slightly risk of nerve pain, due to the nerve problems that can be caused by long-standing poorly controlled diabetes. If you have any queries, I would certainly recommend that you discuss it with your endocrinologist beforehand.

Coolsculpting under the chin?

Coolsculpting and liposuction are both excellent methods for reducing double chin fat. Another option to think about is fat dissolving injections All three of these methods give a permanent reduction in double chin fat. Liposuction can give excellent results for large areas of fat, although it may be considerably more expensive; it is also an invasive procedure involving the risks of surgery and anaesthesia and has a longer period of “downtime”. Coolsculpting and fat dissolving injections both have the benefit of being lower risk, non-invasive, quick and having less “downtime”. Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector, Coolsculpting Specialist or surgeon, and your budget.

Coolsculpting upper abdominal, no massage after – will this effect treatment?

The two-minute massage following Coolsculpting treatment is recommended for optimum results, although the majority of fat cells in the treatment area have still sustained a cold-injury that will lead to fat cell death. The reason for the massage is that it is thought to give the last small amount of damage to fats cells on the very edge of the treatment area to “push them over” into cell death: these cells have sustained some damage by the cold, but not as much injury as the cells in the centre of the treatment. You will definitely still have the effect of death of fat cells; you may just find that you have a slightly lesser effect than if the full two-minute massage were performed.

Is Coolsculpting beneficial for saddle bags?

The outer thighs are one of the areas most commonly treated with Coolsculpting. Other commonly treated areas include the stomach, hips, love-handles, and double-chins, although almost any problem area can be targeted with a Coolsculpting fat-sculpting treatment. The non-invasive fat-freezing technique utilises a process as cryolipolysis: the fat cells in your body are known to freeze at a different temperature to other, healthy cells. Coolsculpting takes advantage of this fact by applying a device that resembles a cold vacuum to your outer thighs, love-handles, double-chin or other problem areas, and freezing the fat cells, while leaving the normal tissue unharmed. The body’s natural processes then break down and eliminate the fat cells over the next few weeks and months. No hospital stay, no anaesthetic, no painful surgery or incisions, and you can go back to work immediately after your treatment.

Had I a hiatus hernia repair as an infant. Can I get Coolsculpting on my stomach?

How was your hernia repaired? Hiatus hernias are when a small part of the stomach slides upwards through the diaphragm into the chest. As long as you have no further issues resulting from your hiatus hernia, you should be able to have Coolsculpting with no issues. If you have any ongoing issues from the hernia, or any other hernias from other surgical scars, you may need further review by a surgeon prior to your Coolsculpting treatment.

Can I get a Coolsculpting treatment after spinal surgery?

It sounds like you had your spinal fusion operation performed with an incision along the middle of your back; you should be able to have Coolsculpting with no problems. The only reason why spinal surgery may be a problem is if your incision is on the front or side of your abdomen; in this case Coolsculpting is still possible, but your treating Coolsculpting professional should check your abdomen for a hernia at the site of the scar. When was your operation? Your spinal surgeon may prefer for you to wait a few months between the operation and your Coolsculpting. If you have any concerns at all, I would advise you to speak to your spinal surgeon before having Coolsculpting. As a general rule, surgical implants are not a concern when we are treating with Coolsculpting, as the applicator cools the skin and superficial fat only.

When do I need to stop taking blood thinners before having Coolsculpting?

I would definitely not stop taking your blood thinner (for any reason) without discussing it with your specialist physician. Why are you taking a blood thinner? Your physician has prescribed you this blood thinning medication for a reason and ceasing it may put you at risk of blood clots that can cause strokes and other serious complications. Coolsculptingis an elective procedure for fat-loss and body-sculpting, and your health and safety must be your number one priority. That said, being on a blood thinner in and of itself is not an absolute contraindication to Coolsculpting. It may put you at an increased risk of bruising from the treatment, but the risks of Coolsculpting are still lower than for other invasive treatments such as surgical liposuction. Your treating Coolsculpting professional may wish to be provided with a letter from your specialist physician explaining the reasons why you are taking a blood thinner, and their opinion on the safety of your being treated with Coolsculpting (I certainly would require this, if I were your Coolsculpting professional). Best of luck!

Can I Coolsculpt the same area more than three times?

There is no reason why you cannot have multiple Coolsculpting treatments to the same area. As long as there is a pocket of fat which you are able to pinch, you are able to treat the area. It may be worth waiting three months between treatments to see what kind of results you are able to obtain before investing in another round of cycles. Paradoxical adipose hyperplasia is a rare, poorly understood side-effect, but the number of treatment cycles doesn’t seem to affect the likelihood of developing it. As far as we know, you will either develop PAH, or you won’t: the number of cycles is not a factor.

Can a person with cold-induced hives get Coolsculpting?

Patients with a known sensitivity to cold such as cold urticaria or Raynaud’s disease may not tolerate Coolsculpting as well as other patients, although it is not an absolute contraindication to treatment. Personally, I would be reluctant to treat you, as the Coolsculpting head gets down to minus seven degrees centigrade, and even with anti-histamines you still may break out in hives. Coolsculpting is an elective procedure, and your overall health and safety must be the number one priority in any treatment setting. There are other options to consider, such as surgical liposuction, or fat dissolving injections for double chin fat. Patients with a history of cryoglobulinemia, cold agglutinin disease, or paroxysmal cold hemoglobinuria should definitely not undergo treatment with Coolsculpting.

Which is the best most effective method for removing unwanted double chin fat: CoolSculpting or Liposuction?

Coolsculpting and liposuction are both excellent methods for reducing double chin fat. Another option to think about is injections with fat dissolving injections. All three of these methods give a permanent reduction in double chin fat. Liposuction can give excellent results for large areas of fat, although it may be considerably more expensive; it is also an invasive procedure involving the risks of surgery and anaesthesia and has a longer period of “downtime”. Coolsculpting and fat dissolving injections both have the benefit of being lower risk, non-invasive, quick and having less “downtime”. Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector, Coolsculpting Specialist or surgeon, and your budget.

Could Coolsculpting Mini cause permanent nerve damage to your face & chin?

I received Coolsculpting mini for my double chin on Monday and immediately after noticed numbness from the side of my jaw to my lip which is causing my smile to droop. This was a serious concern of mine before getting the procedure and the technician assured me it wouldn’t happen. I’m worried it may have caused permanent damage to my nerve. Is this possible? If so, how long will it take?

I’m very sorry to hear about this event. Nerve damage, or neuropraxia, is a possible, rare side-effect from Coolsculpting. In most cases it effects the nerves just underneath the skin and leads to some temporary changes in sensation. In this case, it is possible that the nerve which controls the muscle to your lips has been temporarily injured. In most cases of nerve injury, the nerve function returns fully in an average of six to eight weeks. You may wish to consider consulting a specialist neurologist. Best of luck.

Can anti-wrinkle injections be used in areas other than crow’s feet and forehead wrinkles? What are other benefits?

Anti-wrinkle injections can also be used in the “chewing” muscle to relieve tension headaches, reduce teeth-grinding and slim the jawline. Dimpled chins and down-turned lips can be treated with anti-wrinkle injections to the muscles that pull down the corners of the lips.

I’ve never had cosmetic treatment. Where should I start?

As we age, we lose bone and fat in the face. We also lose collagen in our skin. Collagen is the protein that keeps our skin tight and minimises wrinkles and sagging. Ageing, and the loss of bone, fat and collagen causes the youthful “heart-shaped face” to fall with gravity, and become more “square” and hollow.
Replacing lost volume in the face with filler is a great place to start. Think of it as building the strong foundations for a house. Not many people realise just how much difference replacing lost volume can make. The results are subtle, but noticeable. It is a very natural way of making someone look more youthful. Rather than look like you’ve obviously had fillers, it just gives you a subtle freshen up, like you’ve had a great night’s sleep.
People are often amazed that simply adding volume to the cheeks can have such an amazing effect on bags under the eyes, and lines from the corners of the nose to the corners of the mouth. It’s my favourite place to start.

How many CoolMini sessions would I need to treat my double chin?

How many CoolMini sessions would I need to treat my double chin? I’m interested in getting CoolMini to reduce my double chin and reveal my jawline a bit more. I am a 5’6, 180 lb female. I’m not looking for a totally sculpted jawline, but just to reduce the double chin area. How many CoolMini sessions do you estimate it would take to accomplish this? Would I need more than one applicator per session? I also have quite a bit of fat in my ‘jowls’ area, can CoolSculpting help with that?

I suspect that you will require two applicators per treatment, and most likely two treatments. Another option to consider is fat-dissolving injections. Both Coolsculpting and fat dissolving injections are amazing treatments for permanently removing submental fat and both have their place in my practice. I would recommend a review with an experienced injector who can assess you in person, discuss your goals, and formulate a treatment plan. I would also suggest a review at a clinic where both Coolsculpting and fat dissolving are available, so you get an unbiased opinion.

Which would you recommend: Coolsculpting or fat dissolving injections?

Which would you recommend: Coolsculpting or fat dissolving injections? I decided on Coolsculpting over fat dissolving injections for my procedure, what are your thoughts? One never can have too many opinions! Sometimes I believe I almost have a jawline then I turn sideways and never mind!

Both Coolsculpting and fat dissolving injections are amazing treatments for permanently removing submental fat and both have their place in my practice. There are many reasons to use one instead of the other. Firstly, do you have enough submental fullness to fit the CoolMini vacuum applicator? If you do not have enough, the applicator may not stay in position during the treatment, and your results may be less than optimal, so be mindful, you may fall into this category. The benefit of CoolMini is that there is less “downtime” than you will experience following fat dissolving injections The swelling following fat dissolving injections can be quite severe for the first 24-72 hours, although this is actually a good sign that the treatment is having its desired effect. I would recommend a review with an experienced injector and surgeon who can assess you in person, discuss your goals, and formulate a treatment plan. I would also suggest a review at a clinic where both Coolsculpting and fat dissolving injections are available, so you get an unbiased opinion.

Will fat dissolving injections help with my double chin, undefined jawline and weird lumps in my cheeks?

Will fat dissolving injections help with my double chin, undefined jawline and weird lumps in my cheeks? Will fat dissolving injections solve these issues or will I need some other form of surgery to help with this? What would be an estimated price for this/these procedures?

Fat dissolving injections are injected into the “preplatysmal fat”, also known as “submental fat” or “double-chin fat”. It’s a very specific area, and I would recommend a review with an experienced injector who can assess you in person, discuss your goals, and formulate a treatment plan.

I would like to improve the appearance of my jaw and neck, would fat dissolving injections work?

I would like to improve the appearance of my jaw and neck, would fat dissolving injections work? What is the least invasive procedure with the least potential for adverse effects that could improve my saggy neck, double chin, and lack of jaw line of a 52-year-old woman. I am thinking fat dissolving injections versus lipo plus some tightening procedure?

Fat dissolving injections are injected into the “preplatysmal fat”, also known as “submental fat” or “double-chin fat”. The body’s natural processes then break down and eliminate the fat cells over the next few weeks and months. Once the fat cells are destroyed, they are permanently removed. The treatment also promotes the formation of new collagen. This acts to tighten the skin. Most people notice either an improvement in their skin tightness, or no change. Although it’s difficult to tell from a photograph, it looks like you may be a good candidate for treatment with fat dissolving injections.

As for liposuction or other surgical treatments; these can certainly be of benefit, but are considerably more expensive, involve the risks of surgery and anesthesia, and may have variable lengths of “downtime”. Conversely, the outcome of these surgical treatments may be more pleasing to you in the long term. Injectables often can’t compare to the outcome of surgery, but have the benefit of being lower risk, quick, and having less “downtime”.

Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector or surgeon, and your budget. I would recommend a review with an experienced injector and surgeon who can assess you in person, discuss your goals, and formulate a treatment plan.

Can I massage my chin to drain the fluid from my fat dissolving injections?

Can I massage my chin to drain the fluid from my fat dissolving injections? I got fat dissolving injections four days ago and it’s still quite swollen, however not nearly as swollen as the first two days. I’m used to using my clarisonic massage head to massage my face neck and chest and was wondering I’d be able to use it to drain the fluid faster or should I just not touch it and let it run its course?

The inflammatory reaction from fat dissolving injections takes about 6-8 weeks to have the desired effect, namely the breakdown and removal of the fat cells under the chin. The swelling is actually a good sign that the treatment is having the desired effect in killing the fat cells. There is little evidence to suggest that massage can improve the resolution of the swelling or improve the outcome with regard to loss of fat. Anti-inflammatory drugs should be avoided if possible, although paracetamol may be used if the area is tender. Applying ice to the region may be of benefit initially, but more from the point of view of helping with pain. It is unlikely to make the treatment more of less effective. Ultimately, it’s just a matter of letting the fat dissolving injections do its job.

Would fat dissolving injections work for me? I’m 25 years old and my chin has always been weak.

Would fat dissolving injections work for me? I’m 25 years old and my chin has always been weak. I have always had the same amount of fat underneath it and on my neck. I have always been very insecure about this and was planning on getting a chin implant, until I heard about fat dissolving injections. I want to achieve a very sharp jawline but am unsure of how much fat dissolving injections I would need, and if it would probably be a better idea to get a chin implant/lipo because I do know my case is a bit more severe than most people.

It is important to remember that fat dissolving injections are only licensed for use in a specific area under the chin, in a “safe-zone” designed to minimise the chance of damage to underlying blood vessels and nerves. I’d also like to see a photo of your “front-on”.

With that having been said, I think you may be a good candidate for treatment with fat dissolving injections. As for chin implants or surgery; these can certainly be of benefit, but are considerably more expensive, involve the risks of surgery and anesthesia, and may have variable lengths of “downtime”. Conversely, the outcome of these surgical treatments may be more pleasing to you in the long term. Injectables often can’t compare to the outcome of surgery, but have the benefit of being lower risk, quick, and having less “downtime”.

Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector or surgeon, and your budget. I would recommend a review with an experienced injector and surgeon who can assess you in person, discuss your goals, and formulate a treatment plan.

I have extremely deep smile lines at 29, what can I do to get rid of them?

I’m a 29 year old male and I have extremely deep smile lines around my mouth. I’ve had them for a few years but never really paid much attention to them when I was younger but now they are prominent even when I’m not laughing or smiling and make me look way older than I actually am. Are there any ways to get rid of the lines and if so what would the cost of such a treatment be? Are there any natural alternatives for it too? Please help!

These lines are called nasolabial folds. It is difficult to tell from a two-dimensional photograph, but I suspect that you have lost volume in your cheeks. As we age, we lose bone and fat in the face. We also lose collagen in our skin. Collagen is the protein that keeps our skin tight and minimises wrinkles and sagging. Ageing, and the loss of bone, fat and collagen causes the youthful “heart-shaped face” to fall with gravity and become more “square” and hollow. Replacing lost volume in the face with filler is a great place to start. Think of it as building the strong foundations for a house. Not many people realise just how much difference replacing lost volume can make. The results are subtle, but noticeable. It is a very natural way of making someone look more youthful. Rather than look like you’ve obviously had fillers, it just gives you a subtle freshen up, like you’ve had a great night’s sleep. People are often amazed that simply adding volume to the cheeks can have such an amazing effect on bags under the eyes, and, in your case, the nasolabial folds. I would start with using some filler your cheeks, which will “lift” the cheeks and minimise the lines, and then perhaps inject a small amount directly into the nasolabial folds.

Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector or surgeon, and your budget. I would recommend a review with an experienced injector and surgeon who can assess you in person, discuss your goals, and formulate a treatment plan.

Are fillers a good option to help a recessed chin and to make a jawline more defined?

Are fillers a good option to help a recessed chin and to make a jawline more defined?

I would like to get a better jawline; would fillers be a good alternative to implants or sliding genioplasty.

Filler are a good first option with a low “risk to reward.” Dermal fillers can certainly be used to sculpt the appearance of the chin and jawline, although this can sometimes be a difficult area to treat with fillers.

As for chin implants or surgery; these can certainly be of benefit, but are considerably more expensive, involve the risks of surgery and anesthesia, and may have variable lengths of “downtime”. Conversely, the outcome of these surgical treatments may be more pleasing to you in the long term. Injectables often can’t compare to the outcome of surgery, but have the benefit of being lower risk, quick, and more easily reversible.

Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector or surgeon, and your budget. I would recommend a review with an experienced injector and surgeon who can assess you in person, discuss your goals, and formulate a treatment plan.

Would filler work well on a very mildly recessed chin and jowls?

Would filler work well on a very mildly recessed chin and jowls? I’m only 20 and recently my facial skin has dropped, leaving me with jowls and an emphasis on my slightly off chin. I already know with my luck that a chin implant would only cause irritation (I have intermittent inflammation and my body doesn’t heal itself well). I want a minor enhancement to my chin and for my jawline to be restored. Is this possible? (I am not considering surgery for either of these problems and would rather keep up with fillers as they last long in my skin).

Dermal fillers can certainly be used to sculpt the appearance of the chin and jawline, although this can sometimes be a difficult area to treat with fillers. Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector, and your budget. I would recommend a review with an experienced injector who can assess you in person, discuss your goals, and formulate a treatment plan. An experienced injector is a must!

Which is the best filler for these so-called smokers’ lines?

Which is the best filler for these so-called smokers’ lines (I have never smoked)?

I would also like the vermilion border improved. As I age, the lip line is not what it used to be. I am wary of all the different fillers and would like to know if there is a specific one for the lip area which produces a natural result. Thank you.

Small amounts of a softer filler. Start slowly! This is quite a difficult area to treat with satisfying results, and should only be attempted by experienced injectors, as there is a small risk of the filler being visible under the skin. The best place to start is along the vermillion border (the line along the lip and the skin) to give some more volume to the lip border, and only then under the wrinkles themselves. Massage after treatment is very important to minimise the chances of lumpiness. You can also combine this treatment with small doses of anti-wrinkle injections to the orbicularis orbis muscle. This is the muscle which causes the lips to pucker, so small doses of anti-wrinkle injections can minimise the appearance of movement lines in the area.

I have a small amount of fat I would like to remove, but hernia in my abdomen. Is there a safe alternative to Coolsculpting?

Several years ago, I was diagnosed with a hernia in my abdomen. I did not need surgery then or since then. I’ve been seen from several doctors answers that Coolscupting should not be done on someone with a hernia. I have a small amount of fat I want removed from my stomach and abdomen. Is there another noninvasive alternative?

The Coolsculpting technique uses a vacuum and should not be placed over a hernia. However, if your target treatment area is sufficiently far away from your hernia, you may find that you can still undergo treatment with Coolsculpting.

If you have any concerns at all regarding your suitability for Coolsculpting (for whatever reason), it is important to discuss your concerns with your doctor beforehand, and in this case a physical examination is essential. I would also recommend that you speak to your surgeon regarding the hernia before undergoing treatment.

Will lines completely disappear after treatment with anti-wrinkle injections?

At 30 years old I got my first treatment with anti-wrinkle injections between brows on Wed. I can see a small change in lines but I am hoping they will become less indented. When I frown it’s slightly restricted but the current results aren’t what I was expecting. I know full results take up to 14 days, but I was hoping for them to (if not) completely disappear – be very faint. Will they become fainter in the next few days since it’s only been 3 days since I got the treatment? Will they ever completely disappear?

Typically, anti-wrinkle injections begin to have an effect 48 hours post-injection, and the effect continues to increase to a maximum at anywhere from 7 to 14 days post-injection. So, it is still early days for you! Of course, the maximum effect also depends on the dose that you were given. I like to see my clients after two weeks for a quick review appointment, as sometimes people will need a “touch-up”.

If your lines are “static-lines” (lines which do not disappear even when there is no muscle movement), you may find that they become less visible with every subsequent treatment.

Is a hard lump after filler in the lips a concern?

Is a hard lump after filler in the lips a concern? I had filler done to my lips. It looked great at first, with minimal bruising and swelling, perfectly even and symmetrical. I have this hard lump on my top lip that developed a few days ago I also feel it inside my mouth. It shows when I smile with my teeth. Do I still have any shot that this is part of the healing process or am I screwed and need to dissolve this and get it redone. Also, the lump has like a pearly bluish tint to it if I pull the skin back. Help!

Small lumps following injection with lip fillers that don’t resolve with massage can be dissolved if they are of concern to you. Your injector should be able to dissolve just the lump, leaving the rest of your lips and filler alone. The blue-tint is called the “Tyndall Effect” and is common when filler is very close to the skin.

I’ve also written a simple but complete guide to lip fillers aftercare for some more tips and other things to expect.

Advice on under eye/temple hollows, possibly tear trough?

Advice on under eye/temple hollows, possibly tear trough? I have bad under eye circles and deep hollows around my temple area which are both particularly noticeable when I’m standing directly under light. The circles under my eyes run from the inner eye area all the way down to the upper cheek area. Please help me with some information on what the cause of this is and what my options are in regards to potential treatments to rectify. Will dermal fillers help?

As we age, we lose bone and fat in the face. We also lose collagen in our skin. Collagen is the protein that keeps our skin tight and minimises wrinkles and sagging. Ageing, and the loss of bone, fat and collagen causes the youthful “heart-shaped face” to fall with gravity and become more “square” and hollow. Replacing lost volume in the face with filler is a great place to start. Think of it as building the strong foundations for a house. Not many people realise just how much difference replacing lost volume can make. The results are subtle, but noticeable. It is a very natural way of making someone look more youthful. Rather than look like you’ve obviously had fillers, it just gives you a subtle freshen up, like you’ve had a great night’s sleep. People are often amazed that simply adding volume to the cheeks can have such an amazing effect on bags under the eyes, and lines from the corners of the nose to the corners of the mouth. It’s my favourite place to start. Replacing lost volume in the hollows of the temples with dermal filler can help restore a more youthful appearance to the face. It also acts to tighten skin under the eyes, giving a “mini-facelift” that can help to minimising wrinkles under the eyes.
Ultimately your treatment will depend on your own aesthetic goals, the experience of your injector, and your budget. I would recommend a review with an experienced injector who can assess you in person, discuss your goals, and formulate a treatment plan.

Why does my treatment with anti-wrinkle injections only last 2 months?

Why does my treatment with anti-wrinkle injections only last 2 months? I use a very good doctor with a fantastic reputation in Ireland. However, my anti-wrinkle injection treatment only lasts around 2 months on my forehead. I do have a young face for a man in his 30s. Any ideas as to what biological process could be the reason and/or any way to get longer out of anti-wrinkle injections?

The length of effect of anti-wrinkle injections is multifactorial. The average length of anti-wrinkle injections effectiveness is 12 weeks, but that’s just an average: everyone is different. Just as some people are taller or shorter than the “average height”, some people will metabolise and breakdown their anti-wrinkle injections quicker or more slowly than others. Part of this is just due to your biology. Other factors that influence the length of anti-wrinkle injections effect include the initial dose (a larger dose of more units will tend to have a greater effect that also lasts longer), and where it has been injected. Larger muscles generally break-down the anti-wrinkle injections much more quickly than smaller muscles. Discuss your concerns with your injector, and perhaps discuss using a slightly larger dose. Unfortunately, however, perhaps you are just one of the people who metabolise anti-wrinkle injections faster than others!

I have large, deep pores on my nose, as well as scarring. What treatment and products help this problem?

I’m a woman, not on birth control and I have large, deep pores on my nose, as well as scarring. What treatment and products help this problem? I also have hirsutism and my skin is very sensitive and very damaged. What are the best products and treatments to clear pores and fix the scars. What’s the best hair removal method for face? What causes these problems? My skin tends to darken when shaved. The very deep excessively large pores are worse than anyone else’s. Everyone mentions it to me and I need to fix this ASAP, but how?

A review with a dermal therapist will help you assess your options. There are number of different methods of treatment for enlarged pores and hirsutism. A dermal therapist is someone who has studied to become an expert in these issues and they will be able to guide you in your treatment. In our clinic, our dermal therapists have had a lot of success treating clients with acne scarring using Laser Genesis, a popular treatment that involves gently heating the dermis with a laser, leading to increased collagen formation, decreased scar appearance and decreased redness and pore appearance.

What is the long-term side effect of fat dissolving injections to salivary gland or muscle?

What is the long-term side effect of fat dissolving injections to salivary gland or muscle? I am considering fat dissolving injections and concerned of short term and long-term side effects of fat dissolving injections to salivary gland or platysma muscle?

The most serious potential complication of fat dissolving injections is injection into the nerve that helps to elevate the corners of the mouth. If this nerve is damaged, the corners of the mouth can “droop” for 10-12 weeks while the nerve heals. However, if injected correctly by an experienced injector, the chances of the nerve being damaged are minimal. If injected with the correct technique, the fat dissolving injections will be superficial to the platysma, and away from the salivary glands. In the studies evaluating the effects and safety of fat dissolving injections, no permanent side-effects were reported.

Is there anything I can do after treatment with fat dissolving injections that will increase or harm my results?

Is there anything I can do after treatment with fat dissolving injections that will increase or harm my results?
I understand anti-inflammation medicine isn’t recommended, will heat help? Should I be taking supplements that will help my liver process the chemicals?

The inflammatory reaction from fat dissolving injections takes about 6-8 weeks to have an effect. Anti-inflammatory drugs should be avoided if possible, but there is no evidence to suggest that the fat-dissolving properties can be increased or decreased by other means.

I accidentally combined microdermabrasion with retinol .5. Now my skin is red, burning, and peeling, but no open wounds. I am worried I have permanently harmed my skin, have I? Will I scar?

What it sounds like you are experiencing is called a “retinol reaction”. It is normal for skin to react this way when having undergone a form of resurfacing from the microdermabrasion followed by the topical application of a retinoid. The removal of skin debris has allowed for deeper penetration of the retinol and the itching, redness and peeling is an indication the retinol is working. It can take a few days to clear up and the skin will return to normal.

Ask Us A Question

To find a doctor or hospital, we’ll help you find a doctor to search.