Posted on

Focus on Microneedling

What is microneedling?
Microneedling is a safe, minimally invasive therapeutic technique initially developed for facial rejuvenation, but now used to treat a wide range of dermatological skin conditions. It involves controlled piercing of the skin with a derma roller or more recently, automated devices with miniature fine needles. Dermal rollers are available for home use, but recently patients prefer to have their treatments done at a skin clinic with the expertise of a trained professional. Microneedling has also proven to be safe for use in all skin types, which has bolstered its popularity.

How does microneedling work?
Miniature fine needles cause superficial, controlled piercing of the skin without completely damaging the epidermis. The result is minimal bleeding and skin injury which is why it is a safe procedure with virtually no downtime from work or play.
The skin ‘injury’ leads to a wound healing cascade with the release of numerous growth factors, resulting in 2 important processes- neocollagenesis and neovascularization.
Fibroblasts lay down intracellular matrix and new collagen, elastin and blood vessels are produced. The process continues for as long as 6 months after the treatment course and the results have been confirmed with biopsies and histology of the treated skin.

What can you expect?
The skin is prepared for at least a month before treatment begins with a tailored homecare regimen, generally combining vitamin C and vitamin A to optimize the treatment results.
The process is quick and relatively painless. You will need to arrive an hour early to apply a topical anaesthetic cream to numb the skin. The skin is cleaned with an antiseptic wash before the procedure.
The treatment is generally well tolerated and post procedure there is minimal pinpoint bleeding and redness. The treated skin is then cleaned with saline, and soothed with ice packs.
There is virtually no downtime and you can expect to go back to work the next day.

Derma roller versus automated microneedling device
The home care rollers have varying angles and depth of skin penetration which could give inconsistent results. The automated devices can penetrate to a maximum of 2 mm and the depth can be adjusted to suit the area treated.

What are the uses of microneedling?
Microneedling which is also known as collagen induction therapy was initially developed for skin rejuvenation, but is proving to be effective for a range of conditions. The evidence is varying and consistent efficacy hasn’t been proven in all cases.

Microneedling leads to breakdown and reorganization of old collagen and production of new collagen, elastin and blood vessels. The result is decreased fine lines, wrinkles and pigment spots and an overall youthful looking skin. A minimum of 6 sessions is recommended with strict sun protection and tailored homecare combining vitamin C and vitamin A.

Microneedling has shown great results with the treatment of scarring from various causes, including acne scars, burn scars, surgical and traumatic scars as well as chicken pox scars. There are many clinical studies supporting the benefit of needling scars. It is safe to use in all skin types with minimal downtime. Again, a minimum of 4- 6 sessions is recommended with a good homecare routine, and maintenance after treatment.

Microneedling in mild to moderate acne targets sebaceous glands causing them to produce less sebum. The process helps to clear sebum and keratinocyte build up that block the sebaceous glands. Needling assists with acne scar management and has been reported to minimize the appearance of pores. Microneedling is not suitable for active, severe acne.

Microneedling has shown benefit in treating melasma and periorbital pigmentation. It enhances the penetration of topically applied skin lightening agents. For best results, it must be combined with strict sun protection and a tailored home regimen. The device can be adjusted to safely treat the eye area.

Microneedling is beneficial in the treatment of actinic keratosis and sun damage as it can be combined with photodynamic therapy to enhance penetration of the photosensitizing cream. This improves the treatment outcomes in resistant areas.

Recently microneedling has been used to treat Alopecia Areata and Androgenetic alopecia. It can be combined with conventional treatments like topical minoxidil and topical steroids. Overall there has been some promising results.

Microneedling can be combined with various treatment modalities including chemical peels, platelet rich plasma and photodynamic therapy. It can be used to enhance penetration of topical agents during the procedure, including hyaluronic acid, vitamin C and tranexamic acid.
Combination therapy is key for best overall results and a minimum of 4-6 sessions is recommended.
Your treatment plan including homecare and maintenance is tailored for your skin condition and can be adjusted depending on your response to treatment.

Please visit our rooms or contact our medical therapist Annika for a skin consultation and treatment plan on [email protected]




Posted on

What is Botox?


We’ve all heard that familiar hushed phrase ‘Too much Botox ‘ used to describe a cosmetic treatment gone wrong. But what does it really mean?

BOTOX is the name of the first registered brand of botulinum toxin used for cosmetic treatments. DYSPORT is another registered brand. Both these brands are used in South Africa.
Internationally there are other botulinum toxins registered for use, but the word ‘Botox‘ is often incorrectly used as a blanket term to describe all forms of aesthetic treatments.

Botox or other botulinum toxin treatments should not be confused with treatments with fillers, surgical threads and plastic surgery.
Botulinum toxin is a neurotoxin produced by a bacterium, clostridium botulinum, which causes food poisoning. Botulism is a rare and potentially fatal disease. It is fascinating that a poisonous toxin is now synthesised and used therapeutically in multiple medical disciplines across an ever increasing range of indications.

That ‘lightbulb’ moment
Botulinum toxin was first approved to treat blepharospasm and strabismus in the 1980’s. It’s ability to treat wrinkles was discovered by accident.

It began when a husband and wife team of ophthalmologists (Jean and Alastair Carruthers) noticed that patients treated with botulinum toxin had fewer wrinkles in the treated areas. They were initially met with much skepticism, but in 2002 the United States food and drug administration (FDA )approved Botox for use for frown lines, and subsequently for crows feet and forehead lines.

How does it work?
Botulinum toxin is injected into muscles causing paralysis (weakness) of these muscles resulting in a reduced ability of the muscles to contract and therefore, in terms of cosmetic indications, reduced wrinkling of the overlying skin.
It is also injected into skin to reduce excessive production of sweat by the sweat glands.
The toxin works by preventing the release of the enzyme acetylcholine at the neuromuscular junction and sympathetic and parasympathetic neurons.

The effect, in all cases is temporary.
Muscles recover after 3-4 months and are able to contract again. This means that if you have toxin injected, and you don’t like the results, you can take comfort that it will reverse in 3-4 months. The bad news is that botulinum toxin needs to be injected every 3-4 months to sustain the desired effect.
With regular injections the wrinkles or hyper-dynamic lines caused by repeated muscle movements will soften and the skin will become smoother.

Muscles that have hypertrophied (enlarged) will shrink in size with regular treatments.
Excessive sweating caused by hyper-secretion of sweat glands will reduce in the treated areas.
The effect on the sweat glands may last longer, ranging from three months to a year in varying reports.
Botulinum toxin does not treat wrinkles or creases that are not caused by the movement of muscles. This means it will not treat static lines that occur when one sleeps in the same position repeatedly, or wrinkling caused by redundant skin which forms when skin loses elasticity.

What are the uses?
In a recent Time magazine article Alexandra Sifferlin aptly referred to Botox as “The drug that’s treating everything ”
The uses of Botulinum toxins are extensive and extend beyond the uses approved by regulatory bodies like the US FDA.
We call these uses off-label uses. Remember that when the Carruthers first started using Botulinum toxin for frown lines it was also initially off label.
In South Africa Botox has been registered for use for frown lines, crows feet and underarm sweating, but in practice botulinum toxins are used for more indications, ranging from facial paralysis, muscular pain to scars, headaches and depression.
It has proven to be safe to use, especially since its effects are not permanent.
The approved indications are both cosmetic and medical and vary in different countries.

What is the process?
Botulinum toxin comes freeze dried in a small vial. It is reconstituted with saline before it is injected. The process is relatively pain free and well tolerated.

For aesthetic treatments small amounts of botulinum toxin are injected with a very fine needle at key points on the face, corresponding to the muscle anatomy.
The number of injection sites vary depending on the area treated. The amount of toxin injected depends on the size and activity of the muscles. You may need more toxin injected for stronger muscle activity.
I usually inject a conservative amount and review the patient in a week to see if more is needed.

Frown lines or glabellar lines.
These are the lines that form between both eyebrows, and often give one an angry or worried expression. They are caused by muscles called the glabellar complex.
5 to 6 points are usually injected.

Crows feet or lateral canthal lines
These lines form on the sides of the eyes and are caused by the orbicularis oculi muscles
Generally 3 injection sites per side are needed.

Forehead lines
These are horizontal lines on the forehead that form as result of contraction of the frontalis muscle.
There are a few techniques ranging from 5 injection points to multiple small injection points.

Excessive sweating of the underarms and palms
The treatment of hyperhidrosis (excessive sweating) needs large amounts of toxin compared to the cosmetic indications.
The toxin is injected at multiple, more or less equidistant sites on the affected areas.
The area to be treated can be anesthetised with a topical anesthetic or nerve block.

Bruxism is grinding or clenching of the jaws and usually occurs during sleep. It results in pain in the head and neck, teeth and temporomandibular joint (TMJ). The masseter muscles attached to the jaw increase in size. The condition can be successfully treated by injecting botulinum toxin into the masseter muscles causing them to reduce in size and decrease pain in the jaw. It also results in a slimmer narrower jawline.

Off label cosmetic uses are numerous and include injections for lateral brow lift, marionette lines, perioral lines and gummy smile. These have varying success amongst patients, and can be discussed with your doctor or dermatologist.

Make sure you have your toxin injected by a trained professional who has knowledge of the injection points and muscle anatomy to avoid poor results or a flat and expressionless face i.e. ‘overbotoxed’ results.

Some signs that indicate poor results are ‘spock eyebrows’, a lowered brow (brow ptosis) or a droopy eyelid (eyelid ptosis). These problems can sometimes occur even in the best hands, but can potentially be corrected so it is important to go for your follow up check with your treating doctor.

When performed well, aesthetic treatments can improve one’s appearance and self esteem. Remember it is the bad jobs that are noticed the most. The good jobs are difficult to see.

Please call 021 531 1107 if you have any queries or book an appointment if you would like to come in to discuss a treatment.

Posted on

What is a skin peel?

Superficial skin peels involve the application of a chemical peeling agent to the skin in order to remove the damaged outer layers, resulting in the appearance of new, regenerated skin which is smooth-textured, even-toned and less wrinkled. These controlled peels range in strength from superficial peels, which can be performed by doctors and aesthetic therapists, to much deeper peels which are only conducted by medical professionals.


Superficial chemical peels are generally safe because they only affect the epidermis and can have beneficial effects on an array of skin concerns, including acne, pigmentation, melasma, sun damage and ageing. Even though penetration is superficial, positive changes can also be seen in the deeper layer of the skin, with the stimulation of collagen production in the dermis. Collagen is important for anti-ageing and skin repair.

There are a number of ingredients that can be used to peel the skin, but the most commonly used are alpha hydroxy acids (AHA), eg. glycolic, lactic, citric and malic acids, and Beta Hydroxy acids (BHA), eg. Salicylic acid.

AHAs occur naturally in sugar cane, milk, and a variety of fruits, and have been used on the skin for thousands of years, beginning with the Ancient Egyptian women who would bathe in sour milk to smooth their skin.

Patients usually tolerate the peel well, and will experience a tingling or itching sensation, or a feeling of warmth. The degree of tingling or itching is usually indicative of the overall condition of the skin, ie if the client is using good homecare products and the skin is well-hydrated, she may not feel the peel as intensely as a patient that has not looked after her skin well. Once the peel has been ‘neutralised’ the skin will once again feel comfortable, and only perhaps a little warm. This is due to increased blood circulation.

When the acids are applied to the skin, they break down the bonds between dead skin cells and the skin then sloughs off these cells over the next 2-3 days. As a result, the patient may experience a sand-papery texture, mild flaking or a tight feeling of the skin.  It is important at this time to keep the skin well-hydrated and to apply a good quality sunscreen.

Following this short period of dryness or flaking, a more youthful, healthier looking skin becomes visible. So the skin typically looks it’s best 3-4 days post treatment, with a beautiful radiant glow!

Post peel care is vitally important. The skin has been sensitized by the peel, so excessive sun exposure must be avoided for the next 48 hours. Heavy cardiovascular exercise should be avoided for 48 hours as perspiration will burn the skin, and will make the skin more vulnerable to bacterial infection. Do not use products containing active ingredients, like Vitamin A for 3 days pre- and post-peel.

It is always advisable to do a series of skin peels in order to achieve best results on specific skin concerns, and consult with your therapist regarding other aesthetic procedures like laser, microneedling and microdermabrasion, and how to structure good in-clinic routine treatments for optimal results.