Aesthetic Medicine Institute SA

06/03/2018

Another amazing day of knowledge sharing with internationally renowned Facial Aesthetics Opinion Leaders. Thank you to Galderma Restylane Global for your support in consistently bringing the best to our shores and for hosting at the beautiful Kloofzicht Conference Center.

30/11/2017

Just Excess Fat, or is it Gynecomastia?

Afflicted male patients struggle to make sense as to what is happening to their breast tissue. Weight is always perceived to be the single most important causative factor that plays a role in the puffiness of the male breast. “Man b***s”, as they are called, are depressing for a man of any age, as the presence of breasts is a feminine physical characteristic.

No Two Breasts are Alike !

Not every case of gynecomastia is the same. There is therefore no definitive or single causative factor. Gynecomastia is a condition that may present in a man of ideal body weight or in a man who has weight to lose. When weight is the only reason that the breasts are enlarged (no hormonal causes) the condition is termed pseudogynecomastia.

Whilst weight may play a role in exacerbating the problem of man b***s in obese and morbidly obese patients, we most often find that this area of excess fat is a treatment challenge in moderately overweight patients.

Can You Get Rid of Pseudogynecomastia with Diet, Exercise, or Pills?

What this means is that in overweight patients, diet and weight loss are first recommended to see just how much non surgical correction is possible. After a couple of months if the condition remains, it will likely not eliminate the excess breast tissue. This is why exercises for man b***s and pills, creams, or supplements rarely, if ever, work to any degree.

There are two areas on a man's body that are highly resistant to fat loss using traditional methods: the love handles and the breasts. Diet and exercise habits are advised for our patients mainly as a recommendation for a healthy lifestyle, but not for the correction of man b***s.

Don't Give Up - Trying to Do it on Your Own Can Be Especially Discouraging

In pseudogynecomastia, weight loss will help reduce fat in the breasts. If necessary, non surgical and surgical interventions can fully correct the problem. In true gynecomastia, however, no amount of diet and exercise will cause man b***s to resolve.

When a man attempts and fails to correct gynecomastia through these means, he may suffer even more emotional turmoil.

The treatment plan for correction of gynecomastia is planned in stages. Whilst the overall look of the breast may be the same externally, it is the internal structure that is more important in the planning of corrective procedures.

Were a surgeon to remove only fatty tissue in a case of classic gynecomastia, the patient may be left with smaller breasts but still experience puffy ni***es.

Although liposuction or lipodissolution may remove fatty tissue, it is important to assess the glandular structure of the male breast. At times excess breast tissue may need to be removed to give the patient a chest that is ideally contoured.

A well informed male patient can understand the specifics behind gynecomastia, and the more informed his decision will be when considering his options.

Call us on 011 202 5035 for an assessment.

29/11/2017

WOMEN AND AGEING - The importance of multiple hormone replacement therapy

Your car needs more than just petrol to run properly doesn’t it? With only petrol it may run ok for a few kilometres, but very soon afterwards you will run into catastrophic problems. If your car doesn’t have oil in the sump or water in the radiator the engine will be destroyed. Without air in the tyres you’ll be left stranded; and without brake fluid there will be no stopping you!

Well it’s the same with your body. It needs more than just estrogen. Replacing estrogen only, which is usually the case, is like putting only petrol in your car. You may go, but you may not go well. And there could be problems waiting for you around the corner.

There are a multitude of hormones that decline as you age, and they each perform different functions. Just as with your car, it’s important to replenish them all, because they all work in symphony to help your body remain healthy, energetic and disease free.
Each woman is different, and so are her hormones. Depending on your age and stage of life, blood levels and symptoms, each woman may need different doses of each of these hormones. Therefore it is important to see a doctor that specialises in individualised total hormone restoration. He or she will then be able to prescribe the exact hormone combination and concentrations which will then usually made up by a compounding pharmacy which specialises in formulating individualised patient-specific medicines and hormone replacement therapies.

Let’s take a look at each of these hormones in a bit more detail

Estrogens
There are 3 forms of Estrogen in women, Estradiol, Estriol and Estrone:

Estradiol is important for the heart, bones and brain. A reduction in Estradiol causes menopausal symptoms such as night sweats and hot flushes (or as the Americans say “hot flashes”). Estradiol is the most commonly prescribed hormone for post-menopausal women.

Estrone is the dominant estrogen in post-menopausal women. It has been linked to an increased risk of breast and other hormone sensitive cancers. For this reason estrone replacement has fallen out of favour. Furthermore, since the body naturally converts other estrogens into estrone, it is a good idea for all women taking estrogen HRT to take cruciferous vegetable extracts too. These extracts, known as DIM (di-indole-methane) and I3C (indole-3-carbinol), convert the dangerous estrone form (known as 16-hydroxy estrone) into a safer form (known as 2-hydroxy estrone).

Estriol is the weakest of the 3 estrogens in terms of its noticeable effects on the symptoms of menopause, and many doctors therefore don’t bother prescribing it. But is it a mistake to ignore estriol because there is evidence that this type of estrogen may have unique cancer-protective effects.

Unlike the other two Estrogens (Estradiol and Estrone) which can bind to receptors in the breast that can cause breast tissue proliferation (which is sometimes a precursor to breast cancer), estriol binds to receptors that oppose breast cell proliferation and therefore may slow down the development of breast cancer tumours. This evidence highlights the importance of including Estriol in any hormone replacement program, to replenish youthful hormone levels and guard against breast cancer.

Progesterone
Progesterone is a balancing hormone. It opposes some of side-effects of Estradiol such as breast tenderness and breast-cell proliferation. Progesterone also has beneficial effects on brain function. A decline in progesterone can manifest with insomnia, so taking progesterone at bedtime often results in a good night’s rest. Progesterone levels typically begin to decline about 10 years prior to the onset of menopause, a few years before the Estrogens begin their decline. Therefore progesterone replacement is often started earlier than Estradiol and Estriol.

DHEA
DHEA is a hormone that declines about 2% every year from the age of 40 onwards. Reduced DHEA levels are associated with cancer, diabetes, lupus, mental disorders, insomnia, pain and disability. It also boosts mood, energy and immune system health. However, too much DHEA can cause hair loss on the scalp, hair growth on the lip, and agitation. Therefore it should always be prescribed when indicated by low blood levels, which should be monitored regularly.

Testosterone
Testosterone is not only found in men. Women produce it too, albeit 10 times less than men. Testosterone is important for a woman’s libido, bones, muscle tone, mood and energy levels. Progressive doctors now combine testosterone with estrogens (estradiol and estriol) in the treatment of menopause. This combination has been shown to improve quality of life, mood, brain function, concentration and sexual satisfaction.
It is important that women have their hormone levels checked prior to starting any HRT program. Testing should be repeated one month after beginning HRT, and then again 2-3 months after that, to ensure blood levels are not too high or too low. If you are at a high risk of developing hormone sensitive cancers (eg a diagnosis of such in parent or sibling), then HRT should be used with caution and only under the supervision of a physician.

Article Credit - Brent Murphy - B.Pharm (Rhodes), MPS

Contact us on 011 202 5035 for a discussion on an individualised bio-identical natural hormone replacement program.

14/11/2017

26/10/2017

ADVANCED ACNE TREATMENT

As most patients with acne know, acne is a very difficult and frustrating condition to treat. The majority of patients have pursued numerous treatments throughout their lives resulting only mild improvement. The treatment efficacy varies significantly from patient to patient and the treatment regimens are quite different from one practice to another.

Although some patients may benefit greatly from a single type of remedy, most require a combination of treatment modalities to obtain the most significant improvement and control. We are able to combine medical, laser (non-surgical) and surgical treatments to provide the most advanced outcomes.

WHY DO I HAVE ACNE?

Acne is in part caused and worsened by specific types of bacteria, but the majority of the predisposition to acneiform skin comes from each individual’s skin characteristics. Skin types that are prone to acne vary but are most typically those with very active pilosebaceous units and overall hyper-reactivity. This means that these skin types typically provide a nice environment for the growth of harmful bacteria and when the skin becomes irritated, it demonstrates an exaggerated reaction when compared to more tranquil skin types. Some of the issues related to acne, such as “ice picks,” “boxcar Scars,” and “rolling scars” may be very difficult to treat. Certain “craters” may be a result of excessive treatment with steroids. Steroids such as Triamcinolone (Kenalog) cause tissue atrophy. They do so very effectively because they are particulate steroids, meaning they deposit small particles into the tissues that aren’t washed away like other soluble medications.

MEDICAL TREATMENT FOR ACNE

Treatments for acne consist of both topical and oral medications. The most successful doctors are most often prepared to try a variety of treatments in order to find the most suitable type for each individual. The goal of these medications varies, but they can be used to target bacterial growth, redness & rosacea, hyperpigmentation, skin quality, clogging of pores, and pore size.

Oral medications such as IsoTreinoin is one of the most effective available and has a few limitations that patients should be aware of. Topical Retinoids such as Tretinoin (Retin-A) are very helpful in improving skin quality and increasing skin turnover. May other medications such as Benzoyl Peroxide, Vitamin C and Salicylic Acid and Azelaic Acid have also shown some benefit. A variety of combinations of antibiotics such as Doxycycline and Clindamycin have shown wonderful results as well. Depending on the patient, chemical peels have also shown significant improvement for many patients. We are continuously learning and developing the most novel and cutting edge treatments to see if they can help us better improve and treat our patients.

LASER TREATMENT OF ACNE

Lasers have shown great promise for mild to severe cases of acne. The specific type of laser used depends on the goal of treatment. While certain lasers can be used to lessen the appearance of ridges and cavities others can be used to improve skin texture and color. Pore size can also be improved with certain treatments.

For resurfacing, the most effective laser we have seen in our practice is the Fractionated CO2 laser. This is an ablative laser, which does require some downtime especially in patients with acne who tend to have an exaggerated healing response. For those patients who are unable to sustain the downtime, they have the option of performing repeat treatments using either Fractionated Erb:YAG (2940) or Erb:Glass lasers (1540). The effect of these lasers is not as pronounced after a single treatment, but significant improvement is seen after a short series of treatments with little to no downtime.

In order to treat pigmentary changes, a variety of lasers and lights are available. These include IPL (Intense Pulse Light), Filtered IPL with much higher power, Pulse Dye Lasers and a number of others available to treat areas of redness or blotchiness. The laser type most suitable to you can only be determined after an assessment.

SURGICAL TREATMENT OF ACNE

What most patients don’t realise is that surgical treatment of acne is available especially for the more severe and resistant cases. The most straightforward treatment is to address large depressions that have formed during cystic acne exacerbation or following steroid injection. Depressed and sunken areas of skin improve only marginally from needle-stimulation therapies.

Given the amount of deep scarring, they are even less likely to improve with the use of Facial Fillers except in certain instances. Although depressions may improve with Chemical Peels, Dermabrasion or Laser treatments, some of these regions must simply be removed by excision and closure. What one must be aware of is although most acne-forming skin tends to heal over quickly following excision and closure, it also has a tendency to demonstrate a prolonged period of redness until healing has more thoroughly occurred.

In select patients, especially those with heavy anterior cheeks, Deep Plane Cheek and Face Lifting techniques have also shown great promise.This procedure varies significantly from standard face-lifting techniques used nationwide as other types invariably fail to show any long-lasting results. Using this specific technique we have successfully treated patients from 30 years of age and older. A deep plane cheek lift can spread and lessen the density of scars caused by acne and effectively re-position heavy anterior cheeks to a more appropriate superior and lateral position. Our patients have been ecstatic about the results, especially when combined with laser resurfacing procedures.

During consultation we will thoroughly evaluate your skin type and give realistic expectations of the improvement you can receive. It is very rare for chronic acne skin to demonstrate full resolution, but improvement is definitively seen and our patients have been thrilled with the treatments and results they have not been able to otherwise obtain. We understand the social pressures and stress that skin irregularities may cause and we are very attentive to your needs. Contact us on 011 202 5035 to schedule a consultation for you or a family member.

24/10/2017

SCAR REVISION THERAPY

Traumatic injuries can happen to anyone at anytime, leaving emotional and physical scars. Scarring from injuries can leave disfigurement unlike any other.

Although deep puncture wounds to the face are typically first treated in an emergency room, follow up treatment is usually necessary. Often times, these types of injuries also require that lost tissue be replaced. We can work to not only replace lost tissue, but also restore damaged underlying bone structures.

We perform scar revision therapy to help remove the effects of scarring and restore a more natural look to the injured area. A complete assessment of the injured area is necessary to take into account the color, texture and thickness of the scar. From there, we will want to know your goals for the surgery in order to set out the correct methods for treatment.

Steps towards healing the cosmetic scaring from traumatic injuries can be a great step toward healing the emotional scars as well. If you have scarred tissue that needs revision surgery, contact us on 011 202 5035 and schedule a consultation. We look forward to hearing from you.

13/10/2017

HAIR LOSS & HAIR TRANSPLANTATION COSTS

We fully understand that as you explore your hair transplant options, you are also considering the cost. Hair transplantation is undoubtedly an important investment. However, we work hard to ensure it is an investment that will provide an invaluable return. Patients who choose our Follicular Unit Transfer (FUT) or NeoGraft Hair Transplant system leave with a permanent solution to a hair loss condition that often has emotional, social and professional consequences. We help both men and women understand the profound benefits of choosing our advanced hair restoration procedures, including the newfound confidence that they can gain from their investment.

Whether you choose FUT or NeoGraft's automated FUE technique, you can trust that your hair transplantation will be performed using state-of-the-art solutions for hair loss using safe and comfortable methods.

How much do hair implants cost?

The cost of your procedure is an important consideration that we will gladly discuss with you. It varies from patient to patient depending on the specific hair transplant method you choose and the number of grafts needed to address your concerns. We can offer an accurate cost estimate after evaluating your donor hair volume and type as well as calculating how many grafts it will take to restore your hair to its most natural and full appearance.

Our facility does offer both Follicular Unit Extraction and Follicular Unit Transfer, which tend to carry a cost difference that must be weighed against the advantages of each. The FUE method using NeoGraft is often more expensive due to the individual follicular unit removal. However, patients who choose the FUE method over FUT benefit from a more comfortable procedure and recovery and do not have linear scarring. For these reasons, the extra investment in NeoGraft is often outweighed by its benefits. A permanent hair transplant procedure can range from R10 000 to R200 000 in cost, but this depends on your personal needs and goals.

Regardless of the hair transplant procedure you choose or how much hair you want to restore, we always work to address your concerns with respectful adherence to your budget.

Contact us on 011 202 5035 to schedule an assessment, consultation and an accurate price.

16/09/2017

Saturday morning Peri Orbital Rejuvenation Masterclass with internationally acclaimed London based Occuloplastic Surgeon Sabrina Desai. Committed to bringing the latest techniques and products to patients.

15/09/2017

NON-SURGICAL PERI-ORBITAL (EYE) REJUVENATION

For patients of any age looking enhance the appearance of the their eyes and brows often looking for a more rejuvenated and refreshed look, we offer quality facial injectable, filler and botulinum products as part of our eye and brow lift services.

Crow's Feet

The most effective treatment other than surgery to improve or prevent the appearance of Crow's feet (lines around eyes) is to simply calm the muscle activity with Botox. This can be done with absolutely no down time and without giving the patient a frozen or surprised appearance. Occasionally other injectables are used to help improve deeper creases in the skin. Xeomin and Dysport are other products similar to Botox that are always available and have shown to be very valuable as well.

Frown Lines (The 11's)

Frown Lines also known as Glabellar Rhytids, "1's" or "11's" are vertical and horizontal creases that form over time between the brows. The creases form as a result of the strong contraction of the Procerus and Corrugator muscles which help depress & lower the brow while pulling the brows closer together. The pull of these muscles over time can cause dynamic and static problems. Dynamic means that the lines that are seen while those muscles are flexed while Static means the lines are there even when the muscles are fully relaxed. The Dynamic lines can be treated or prevented with the use of Botox, Xeomin, or Dysport while the Static lines can be improved by a number of options including injectable fillers, laser resurfacing, and dermabrasion among other options. The art to treating this area is knowing exactly how much to inject and exactly where to inject it to give the desired result avoiding frozen or surprised appearances.

Heavy Brows

Although a procedure such as a brow lift gives very long-lasting results in lightening the eyes and brows laterally and/or centrally, many patients prefer to avoid having a procedure done. For these patients a simple injection with no downtime can be used to lighten the appearance of the eyes and brows medially and laterally. Botox, Xeomin and Dysport achieve a more refreshed and lightened appearance with ease.

Forehead Lines

Lines seen in the forehead are typically formed in a horizontal direction as a result of the movement of the Frontalis muscle. These lines can be treated as they occur with age, or treated earlier for prevention. The pull of these muscles over time can cause dynamic and static problems. Dynamic means that the lines that are seen while those muscles are flexed while Static means the lines are there even when the muscles are fully relaxed. The Dynamic lines can be treated or prevented with the use of Botox, Xeomin, or Dysport while the Static lines can be improved by a number of options including injectable fillers, laser resurfacing, and dermabrasion among other options. The art to treating this area is knowing exactly how much to inject and exactly where to inject it to give the desired result avoiding frozen appearance or lowering & hooding of the brows.

Tear Troughs, Bags & Darkening Under the Eyes

One of the most commonly noted issues in the face even at a young age is a tired and exhausted appearance caused by deepening of the tear troughs, swelling, or bags under the eyes. This is a problem in both men and women and is quite distressing as friends and family often comment on their appearance wondering if they've had a lack of sleep. Fillers such as Restylane and Juvederm are invaluable in the treatment of deepened tear troughs (naso-jugal grooves) as they immediately add volume to these hollowed out areas. This gives a more youthful and refreshed appearance with no down time. Often, these injectables are combined with cheek enhancement in patients with sagging or sunken cheeks which can worsen the appearance of the tear troughs as well. These procedures must always be done with an expert to decrease the chance of complications such as the Tyndall Effect (Tyndall Scattering) which gives the appearance of a blue hue under the skin. Darkening of the skin under the eyes is a much more complex issue to treat and can be discussed in consultation to find the most appropriate treatment.

Resistance to Botox

Many patients complain that Botox treatments are not working for them anymore as well as they used to. There are several theories behind why this happens, but none of them have been proven. In cases such as these, some physicians elect to increase the dosage of Botox used or switch to a different botulinum toxin such as Dysport or Xeomin. In nearly all cases, these changes are effective. Ultimately if the results are inadequate, there are several minimally invasive surgical options available (such as PDO threading) to achieve better, longer-lasting results.

Bell's Palsy, Hyperhydrosis (excessive sweating), Headaches

Use of Botulinum toxin is very successful in facial paralysis to help make the face more symmetric. This can be done alone or in conjunction with surgery. Although Botulinum toxins such as Botox, Dysport, and Xeomin are used to paralyse or weaken a muscles action, they also have the added effect of decreasing sweat production when injected at the level of the sweat glands. Many patients seek Botulinum injections as they have been proven to be very effective for Bruxism (grinding of teeth), tension Headaches and migraines related to tension headaches.

With several combinations of injectable treatments, we can give you natural, rejuvenated results with no downtime. In fact, very few patients see swelling or bruising and can resume normal activities almost right away. While they are temporary solutions and not as dramatic as surgical procedures, facial injectables and facial fillers are a great solution.

Call us today on 011 202 5035 for an assessment.

12/09/2017

FACIAL AGING

The earliest signs of facial aging often appear in the mid-face area, a triangle defined by the inner and outer corners of the eye and the corner of the mouth. Lax and wrinkled lower eyelid skin and fat bags become prominent, oftentimes casting shadows beneath them. The line of demarcation between the lower eyelid and the cheek (lid/cheek junction) begins to drift lower, as time and gravity exert their effects making the entire eye area appear enlarged. In addition, the cheek drifts downward and begins to bulge, thereby accentuating the naso-labial fold. The net effect is that of “hills and valleys,” rather than a smooth and graceful cheek line.

Background

Traditional facial surgical procedures have been ineffective in correcting all of the problems, even in combined lower eyelid and facelift procedures. The classic lower eyelid tuck could remove excess skin and fat bags, but could do nothing with the lowered lid/cheek junction. The result would often be smooth, taut skin without fat bags but with a hollow-look to the eye. The traditional facelift, or cheek and neck lift, has minimal effect on the midfacial area, including the prominent naso-labial fold.

In fact, traditional facial plastic surgical procedures, intent on smoothing skin and removing fat, frequently resulted in taut-skinned, gaunt appearing faces. This, most certainly, was not rejuvenation.

Recent developments in Mid-face Surgery

During the late 1990’s, there was a sea of change in the philosophical approach of facial plastic surgery towards treatment of facial aging. We realised that youthful faces were full faces, and that fat itself was not essentially bad. Fat itself was good, although it was often times in the wrong place. Emphasis was placed on preserving fat where possible, to move it to advantageous places on the face and to sculpt it to provide optimal results.

The answer

As a result of these changes in philosophy, a new and sophisticated facial plastic surgical procedure – the mid-face lift emerged to address virtually all the problems of the aging eye in one procedure.

What would I expect from a Mid-Face lift?

The result of a mid-face lift is a smoother lower eyelid. Fat bags are removed. The lid-cheek junction is both softened (or eliminated) and elevated, thereby avoiding the “operated upon” hollow-eyed look. Thicker tissues of the cheek are placed over the cheekbone, resulting in an enhancement of the cheekbone with the patient’s own tissues. The naso-labial fold is also softened. The results of a mid face lift are subtle. The objective is to rejuvenate the mid facial area, not to change your appearance. The goal is a refreshed, rested, youthful look without a tell-tale “operated-upon” appearance. The mid face will be full, graceful, and continuous, without “hills and valleys.”

While the mid face lift does not address all facial areas, when it is combined with other techniques, it adds a certain smoothness to the area around the outer corner of the mouth by providing a vertical lift with the mid face and a lateral lift with the facelift. The net result is that the corners of the mouth and it’s attendant accessory cheek lines, wrinkles and jowls, are all improved to provide a youthful appearance.

Prior cosmetic lower eyelid surgery does not prelude a mid-face lift. Indeed, a midface lift is often used as a reconstructive or rescue procedure to improve the results of prior surgery, such as inadequate removal of skin, over- or under-removal of fat, a low-placed lid/cheek junction or prominent naso-labial lines. Obviously, a decision for surgery is based upon very careful and individual assessment of the problems presented.

How can I simulate a Mid-Face lift?

One may simulate the results of a mid-face lift by looking in a mirror, placing a finger on the cheekbone just below the outer corner of the eye and very gently elevating the tissues 90% upward and 10% backward. Note that the upper half of the naso-labial fold is improved. The eyelid skin would be smoother and the fat bags would be gone. It is important to understand that a lengthy naso-labial fold, which extends beyond and below the corner of the mouth, will not be totally improved with a mid face lift alone. Also, jowls will not be improved at all. These conditions would require other procedures.

How is the Mid-Face lift performed?

A mid face lift operation takes about an hour and is performed under local anesthetic using a set of nerve blocks that profoundly anesthetise the face. There is virtually no discomfort during surgery and the eyes are closed throughout the procedure.

It can be performed solely through an incision immediately below the lashes of the lower eyelid and extends slightly down and out at the outer corner of the eye, thereby mimicking a crease line. Through this incision, the entire mid-facial triangle of tissue is gently separated from the bone, lifted vertically, and secured to the bone at a higher level. Fat bags may be trimmed if excessive, but most often the fat is preserved and utilized to “fill in” the lid/cheek junction line. Then, the excess skin is carefully trimmed so that it is smooth. Many dissolving sutures are utilised under the skin surface to produce and hold these changes in place. The skin incision itself is closed with fine surface sutures, which are generally removed within 4 – 6 days.

Is it painful post-operatively?

Afterwards, there may be soreness but no significant pain. One is aware of feelings of swelling, pulling and tightness – but there is no pain. There is usually a period of swelling, which lasts 48 – 72 hours, after which the swelling gradually diminishes. There may be bruising, which usually disappears within one to two weeks. There will, however, be continued healing under the skin surface, which may last for three to four months. One should be capable of returning to sedentary-type work – perhaps with some camouflage makeup – within seven to ten days post procedure. One may return to vigorous athletic activities within three to four weeks.

Call us today on 011 202 5035 for an assessment.