Tired eyes and sagging tear troughs age a face. The surgical eyelift, also known as a blepharoplasty, can require significant downtime and will occasionally leave scars. The skin surrounding the eyes is particularly thin and delicate; surgical scars can heal unpredictably and leave uneven results. A painful procedure, the average cost of a blepharoplasty can average £5000. Until recently, cosmetic creams and superficial eye masks were the only other option available to help hydrate and smooth wrinkles around the eyes. Plasma Pro is a revolutionary skin tightening treatment which uses high temperatures and a non-touch techniques to eliminate excess skin. Exposing the epidermis to (what temp?) degrees, dissolves surface skin cells to tighten fibres. Using a fine, pinpoint diathermy pen to ionise atmospheric gases and burn loose skin, when new cells form, a tighter, fresher appearance is instantly visible. Also effective when treating skin tags and stretch marks, results are visible within two weeks, with the maximum results taking up to twelve weeks to appear.
A quick and relatively pain-free procedure, the Plasma Pro procedure is quick and costs a fraction of it’s surgical equivalent.

Pre-procedure, avoid alcohol and NSAID’s such as Ibuprofen, both can increase bruising and bleeding. Post-treatment, be prepared for significant facial swelling for three to four days. Avoid social events for the next five days and sleep propped up on a pillow to encourage lymphatic draining. Resist picking scabs to protect healing skin from infection; Vaseline can help to shed dead skin. When washing your face and hair, be careful to eyes keep dry. Lastly, be generous with a high SPF over the next six months.

Some people notice an instant result after one treatment of Plasma Pro. If the skin is slightly more resistant to the procedure, further treatment may be necessary. Perfect for under eye areas and lids, your eyes will  instantly appear wider, brighter and more expressive. Results can last a lifetime, revolutionising eye contact and confidence. Visit Dermoperfection to find out more and get a quote today.


Dermal fillers

Dermal fillers is a term which refers to a wide variety of different things, many of which have been used or are used to fill out lines and reshape the face.

Fat transfer was first used over one hundred years ago, and a much refined version is available today. It is still a fairly time consuming and complex procedure with a fairly high failure rate but in the right hands can give good long lasting results. Liquid paraffin and silicone have both been used in the past but caused a lot of problems and thus they are not recommended any more.

Collagen injections were first used in 1976 and are still widely used. However, collagen is derived from the skin of cattle so there is a significant demand for alternatives that are non animal sourced and longer lasting.

Products containing hyaluronic acid such as Restylane, Perlane, Juvederm, Belotero and many others have become available over the last 5-6 years and have proved highly popular. Be wary of new fillers – The regulations at present are not very demanding so a product can be promoted after minimal testing.

Results depend on:

  • The part of the face which is treated
  • How much movement there is in the treated area
  • The condition of the skin
  • The experience and skill of the person performing the treatment. (This is the most important).

Dermal fillers can be used to improve:

  • Acne scars
  • Depressions or pockmarks in the skin due to injury or disease, for example, chickenpox marks
  • Unevenness in the skin after surgery or skin grafting
  • Deep ‘smile lines’ which run from the side of the nose to the corners of the mouth
  • ‘Crows feet’ at the corner of the eyes
  • ‘Frown lines’ between the eyebrows
  • ‘Smokers lines’ which are vertical lines on the top lip
  • ‘Marionette lines’ at the corner of the mouth
  • ‘Worry lines’ which run across the forehead
  • The definition of the lip border
  • Other facial lines.

Some defects can be difficult to improve with the first treatment and although you may notice some improvement, more treatments may be needed to get best results.

Treatment with dermal fillers is not going to be successful for every person, and results and duration are variable. For some people wanting treatment for deep facial fines other treatment may be required first, followed by ‘fine tuning’ with dermal fillers.

There are now over 60 dermal fillers on the UK market. The most obvious division between them being that some are temporary and some more long lasting. The BCAM would always recommend the more temporary solutions as they do have less problems and side effects. Please ensure that the practitioner explains in full his choice of filler and it’s expected duration and side effects.

Below are three of the more common treatments.

Restylane and Perlane

How does Restylane work?

Restylane adds volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as the lines from your nose to the corners of your mouth (nasolabial folds). Restylane works immediately by adding volume to smooth away wrinkles. A clear gel formulation of hyaluronic acid, Restylane is specifically formulated to act like your body’s own hyaluronic acid. So, you can use Restylane to visibly reduce moderate to severe facial wrinkles and folds.

Biocompatible with the human body, Restylane is eventually broken down naturally to water and carbon dioxide.

How does Perlane work?

Just like Restylane, Perlane adds volume and fullness to the skin to correct moderate to severe facial wrinkles and folds. Like Restylane, Perlane is a clear gel formulation of hyaluronic acid that is specifically formulated to add fullness like your body’s own hyaluronic acid.

What makes Perlane different is the average size of the particles and the depth of injection. On average, the gel particles in Perlane are larger than those in Restylane, which makes Perlane a good choice for wrinkles that benefit from a deeper injection into the skin.

In three clinical studies of 150 patients each, on average 70% of patients maintained improvement for six months after just one Perlane treatment. Most patients will require a treatment roughly every 6 to 9 months.

Restylane formulations

There are 6 different formulations of Restylane for different areas and results. Restylane is available with added lignocaine to reduce injection discomfort.

    1. Restylane

Restylane has an intermediate gel particle size that makes it suitable for moderate wrinkles and lip enhancement. It is recommended that it is injected into the middle part of the dermis (middle layer of skin).

      1. Perlane

Perlane has a larger gel particle size and is used for deep lines, facial contouring, and lip enhancement and is injected into the deep layer of the dermis.

    1. Restylane Touch

Touch is the smallest gel particle size in the Q-med range and is used for the correction of very thin superficial lines. It is injected into the upper part of the dermis.

    1. Restylane Lipp

Lipp has been specially designed and formulated for injecting into the lips for enhancement and contouring of thin looking lips, the cupid’s bow, or to simply add fullness. It claims to be structured to withstand the range of mouth movements and strains – like talking, smiling, laughing and kissing – that characterise the lip area and therefore the effects should last longer.

    1. Restylane SubQ

SubQ has the largest gel particle size in the range and is used to replace fat loss in the face and create or restore a more defined facial contour. The procedure requires a larger needle and deeper injections below the skin layers. This product is promoted as an alternative to fat transfer. As a result, you will find fewer practitioners who are adequately trained to use SubQ.

    1. Restylane Vital and Vital Light

Vital is aimed at a whole new approach to skin rejuvenation, using mesotherapy, (sometimes called biorevitalisation) techniques. It is targeted at a broad range of treatment areas including the face, neck, décolletage (the area between the neck and breasts) and hands; designed to replenish the hyaluronic acid lost through ageing, hence hydrating the skin and improving its elasticity and tone.


Much like Restylane Juvéderm® is available in various formats to be used in different parts of the face. These variations alter the depth of injection, the consistency and the duration of the product along with the suitable target areas.

Juvéderm® 3 and 4 are most equivalent to Restylane and Perlane and the same things described above apply.

Juvéderm® VOLUMA® is the equivalent of Restylane SubQ. Both can be used for facial volume.

Why is Facial Volume so important?

A youthful face is characterised by smooth, round contours, high cheekbones, hollow jowls and a thin, well-defined jawline. These features together comprise the “triangle of beauty” or “heart of face”, with its base at the top and summit below. As we age, facial fat loss, gravity, and loss of the skin’s natural elasticity conspire to reverse this triangle’s composition, leading to a narrower, less youthful forehead and temple area, and a wider, heavier jawline.

Juvéderm® VOLUMA® can restore the face’s balance and heart-shaped proportions, revolumising facial hollows and lost volume and recontouring the cheeks, cheekbones, and nose for a fuller, softer, more youthful appearance. Juvéderm® VOLUMA® helps recapture the facial volume that age and weight loss can diminish.

What is Juvéderm® VOLUMA®?

Juvéderm® VOLUMA® is an injectable hyaluronic volumiser that provides long-lasting restoration for facial volumes through injection. The results are immediate, even, and very natural looking.

Juvéderm® VOLUMA® restores youthful volume to cheeks, cheekbones, and chin that have become hollow or thin due to weight loss or age-related facial fat loss. It can also rejuvenate the effects of a sagging facelift.

What exactly is hyaluronic acid?

Hyaluronic acid (HA) is a naturally occurring substance found in the body that helps to hydrate and add volume to our skin. Natural hyaluronic acid is broken down by the body in one or two days so is constantly replaced. As we age this replacement mechanism diminishes so the moisturising and plumping effects of hyaluronic acid decrease. The hyaluronic acid used in Voluma® is stabilised and cross linked to achieve safe, long lasting results.

At what age should I start treatment with Juvéderm® VOLUMA®?

Juvéderm® VOLUMA® is intended for use by adults. It is the ideal implant for remodelling facial volume and correcting a receding chin.

How long will the effects of treatment with Juvéderm® VOLUMA® last?

The average effect of treatment with Juvéderm® VOLUMA® lasts about 18 months. It may sometimes be shorter or longer depending on:

  • your age
  • your physiology
  • your lifestyle (smoking and exposure to sun or UV rays may shorten the effect)
  • the amount injected and the practitioner’s technique.

Will the treatment hurt?

Most Aesthetic practitioner  use the latest techniques to minimise any discomfort. These can include ice packs and skin vibration. Patients do not need local anaesthetics and after the treatment any discomfort usually settles very quickly.

Why Juvéderm® VOLUMA® and not a wrinkle filler?

Juvéderm® VOLUMA® has been specifically developed to restore lost facial volume e.g. in the cheeks, cheekbones, and chin. While wrinkle fillers like Juvéderm® ULTRA offer excellent results when applied to fine lines and wrinkles around the mouth, nose, and eyes, Juvéderm® 4 and Juvéderm® VOLUMA® are often better suited to larger scale facial volumising.

When can I return to work and resume my social life?

The aesthetic results are immediate and very natural looking. You can return to work and resume your social life immediately.

Are there any side effects?

Following injection, you may experience redness, slight swelling, or bruising at the injected area. Your practitioner  will inform you about this. These side effects will not last and can easily be covered up with your usual makeup.

What about contraindications?

These do exist. They are not specifically related to Juvéderm® VOLUMA®, but to this type of treatment. This is why it is important to tell your practitioner  about any previous history of pathologies such as auto-immune diseases, allergies, known hypersensitivity to hyaluronic acid, any tendency to develop hypertrophic scars, immunotherapeutic treatment, inflammatory or infectious complaints (acne or cold sores) at injection sites, if you are pregnant or breast-feeding, any previous aesthetic treatment, particularly the use of permanent products.

Is there anything I should know before I have the treatment?

Do not take aspirin for at least three days before the injection session. During the injection, risk of bruising (haematoma) and swelling will be higher for patients under anti-coagulant treatment or taking aspirin.

Are there any recommendations I should follow after treatment?

You are advised not to apply pressure to or massage the injection site during the first days following injection session. In the first week following treatment, the injected product may feel unduly firm as it settles into the surrounding tissue. This is normal and your Voluma® will feel soft and natural just like your own fatty pads.

Sculptra® is a synthetic injectable material known as “poly-L-lactic acid.” Poly-L-lactic acid is biocompatible (a material that does not harm the body) and biodegradable (able to be broken down by the body). Poly-L-lactic acid has been widely used for many years in dissolvable stitches, soft tissue implants, and other types of implants.

How does Sculptra® work?

Sculptra® is injected below the surface of the skin in the area of fat loss. Sculptra® provides a gradual increase in skin thickness. Visible results appear within the first few treatment sessions. Sculptra® will not correct the underlying cause of the facial fat loss, but will help improve the appearance by increasing skin thickness in the treated area. No skin testing is required prior to use.

Are the results from Sculptra® immediate?

No. At your first treatment visit, it may appear that Sculptra® worked immediately because of swelling from the injections and the water used to dilute Sculptra®. In a few days, when the swelling goes down and the water is absorbed by your body, you may look as you did before your treatment. Sculptra® takes time to gradually correct the depression in your skin.

How many treatments are required?

Your Aesthetic practitioner  will decide the appropriate number of treatment sessions and the amount of Sculptra® you will need at each session (average 4 to 6 vials). Patients with greater facial fat loss may require 6 to 8 vials.

How long do treatment results last?

Treatment results will differ for each person. In a clinical study, the treatment results lasted for up to 2 years after the first treatment session, in most patients. Touch-up treatments may be needed to maintain the desired effect.

Do injections of Sculptra® hurt?

As with any injection, injections with Sculptra® may be uncomfortable. This is minimised by judicious use of topical anaesthesia.

What can I expect to happen at a treatment session?

  • Your Aesthetic practitioner  will answer all of your questions and prepare you for the treatment
  • Anaesthesia for the treatment area will be provided
  • The area where the injections will be given will be cleaned with an antiseptic
  • Sculptra® will be injected in small amounts into the skin using a very fine needle
  • Multiple injections will be needed
  • An ice pack should be applied to the treatment area to help reduce swelling.

After the treatment session, the area should be thoroughly massaged to distribute the product evenly.

What can I expect after treatment?

Immediately following a treatment session with Sculptra®, redness, swelling, tenderness, bruising or all of these signs can happen in the treatment area. These signs usually go away in a few hours to a few days, but occasionally last longer. You should massage the treated area (a few times each day) for several days after the treatment session and an ice pack may be applied for a few minutes at a time to the treatment area to help reduce swelling. Avoid excessive sun and UV lamp exposure until any initial swelling and redness has resolved.

Most patients feel comfortable going back to their normal activities following treatment. Make-up may be applied a few hours after treatment if no complications are present (for example, open wounds or bleeding).

What are the possible side effects of treatment with Sculptra®?

The most common side effects with the use of Sculptra® include injection-related side effects at the site of the injection such as bleeding, tenderness or pain, redness, bruising, or swelling. These side effects generally last, on average, 3 to 17 days.

Possible delayed side effect with Sculptra® can be small bumps under the skin in the treated area. These small bumps may not be visible, and you may notice them only when you press on the treated skin. These bumps tend to happen within the first 6 to 12 months after the first treatment.

Occasionally, these bumps go away on their own. Visible bumps, sometimes with redness or colour change to the treated area, have also been reported. As with all procedures that involve an injection through the skin, there is a risk of infection.

Questions you should ask your practitioner prior to any dermal filler treatment.

  1. What are your qualifications? (the BCAM would always recommend an experienced practitioner  for your treatment)
  2. How long have you been doing fillers?
  3. How many patients have you treated?
  4. Which fillers do you use and why?
  5. Are there any alternatives that I should consider?
  6. How often have your patients had “problems”?
  7. Is the is filler dangerous?
  8. What problems can occur?
  9. Do you audit your results and patient satisfaction?
  10. What do I do if there is a problem with my treatment?
  11. Do you routinely follow up the result?
  12. Do you have any patients who you have previously treated whom I could speak to?
  13. How much does it cost? (this is the least important question).



What is Juvederm Ultra?

There are various products of Juvederm Ultra which is 3D hyaluronic acid matrix dermal filler that is used for skin treatment. In addition to non-animal hyaluronic acid, it also contains lidocaine, local anesthetic that provides more comfort before and after injection.

Why to Use Juvederm Ultra?

Juvederm Ultra is used to improve the skin hydration and elasticity. It is most suitable for the person with dry, dull looking or other minor signs of aging, such as fine lines or wrinkles. The treatment is been done by a licensed medical practitioner who has undertaken training in injection techniques.

How Juvederm helps to achieve the results?

By having the treatment with help of Juvederm it improves the skin hydration by delivering deep hydration. Once after replenishing, the skin becomes firmer, smoother giving a refreshed appearance. The most noticeable areas for this treatment is the face, neck, décolletage, and hands. One of the most fundamental ways to the fresh appearance of the face is the skin hydration with help of Juvederm, else without hydration, many efforts are needed to reduce and repair the signs of skin damage.

What are the areas treated with this product?

This is a specialized skin booster that can be applied on patient’s body like the back of their hands, their neck, and their décolletage or on their face. After receiving with the treatment of Juvederm it makes the skin more vibrant and younger looking with skin glow. There are also several other benefits of Juvederm that is been described as follows.

Juvederm Products –

Juvederm Ultra Smile – is used for the treatment of lips and mouth area. Helps to enhance lip volume, redefine lip shape, treat vertical lip lines and depressions at the corners of the mouth.

Juvederm ULTRA 2 – Especially used for treatment of fine lines. Juvederm ULTRA 2 helps to treat corners of the eye and those very close to the surface of the skin.

Juvederm ULTRA 3 – Juvederm ULTRA 3 is used for treatment of deep wrinkles like those between the nose and corner of the mouth.

Juvederm ULTRA 4 – Smoothes wrinkles located between the nose and the corners of the mouth, and around the lips. Juvederm ULTRA 4 also helps in deep depressions of the skin as well as for lip enhancement and cheekbone augmentation.

Applications of Juvederm

• Used to make lips bigger
• Lower the number of lines, wrinkles of the face, neck
• Also cures with some hand problem
• In lips for volume and definition
• Fills back of the hand making veins look prominent
• Restore volume under eyes, cheekbones or cheeks
• Used for Nasolabial Fold

Benefits of Juvederm of Products

• Provides instant results
• More volume in the areas treated with youthful and fuller face
• Long lasting results
• Keeps signs of aging at bay
• Healthy Looking Skin

Juvederm Ultra effectively helps to replenish depleted levels of hyaluronic acid in the skin for the restoration of natural and healthy glow. It helps to hydrate and adds volume to your skin. Rather than this, it helps to attract and hold moisture with the skin making it smooth, soft and toned. Its autooxidising agent helps to prevent build up free radicals.
It is considered to be the future in dermal filler technology as the innovative technology contributes to highly favorable results. As well as it is FDA approved for safety and efficiency. There are various treatments available as Juvederm Ultra and Juvederm Plus. Juvederm Ultra is been used for patients with minor to moderate skin ailments whereas Juvederm Ultra Plus is used for patients with moderate to severe wrinkles and folds


Trust. Everything about the aesthetic decision-making process hinges on this one word. We may know we want to look younger, fresher, less tired, but.. than what? We need to find someone we know will take care of us and listen to what we tell them. Trust – in a procedure, a practitioner, or a clinic, and above all in ourselves – is crucial because it demystifies an exciting but often complicated industry.

As the filler chosen by millions of people around the world, Juvederm is one of these widely trusted skin solutions. as a Hyaluronic Acid (HA) filler – HA being a naturally occurring sugar in the human body – it can reduce signs of ageing and improve overall skin quality by adding moisture back where it is needed. Juvederm delivers lifting, smoothing and plumping with just one treatment, to create the lasting, natural-looking results that everyone wants.

If you’ve been wondering about facial fillers such as Juvederm, the next step is a conversation with an expert medical aesthetics practitioner:

    Know what look you want to achieve. Less tired? More youthful? More relaxed? Read about the procedures from reputable sources. The Juvederm range can contour cheeks for more definition, refresh the eye area , redefine the chin and jawline, add volume to the lips – all with a natural look and feel.
    Read trusted reviews about that practitioner and clinic – Save Face and RealSelf are both reliable sources based on the first-hand feedback of real patients.
    A consultation shouldn’t be rushed, and should include a verbal and physical assessment. Take along a list of questions, and don’t feel shy about asking them. Ensure you’re happy with all the answers before going ahead with any treatment. Find out what follow-up support is provided post-treatment, such as Juvederm’s aftercare. Remember: a consultation is about you deciding whether facial treatments is right for you.
    Don’t be afraid to ask questions and seek clarification for peace of mind. Seek a second opinion if you need to. Ask what product your practitioner is recommending so you can research it, and ask your consultant if your request is realistic. As Allergan say, its all about trust.
    There are many non-medical clinics offering medical aesthetics procedures, and price is only one of the multitude of factors involved in choosing which to go for. your choice should be based on a practitioner and a clinic you trust – yes, that world again. it really does matter.



Beauticians have been banned from joining a new register designed to make getting injected with fillers safer.

The voluntary register was opened by the Joint Council for Cosmetic Practitioners in April to everyone trained to a high standard.

But now it will include only those with medical training, after doctors and nurses threatened to boycott it.

The joint council said two beauticians had applied to be listed, alongside 20 clinicians with a further 105 pending.

However, the register will continue to list beauticians for other treatments, such as laser and chemical peels.

David Sines, who chairs the joint council, told BBC Radio 4’s You and Yours programme there was no way of checking whether beauticians had been adequately trained to inject fillers.

“We have found there are no training organisations or programmes in place in the UK to enable beauticians to qualify to the level we require.”

“We are arguing for statutory regulation.

“We cannot enforce these standards without that.”

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A Department of Health and Social Care official said: “The government takes the regulation of cosmetic procedures very seriously and we are currently exploring options to strengthen regulation.”

The register was backed by the actress Lesley Ash, who was ridiculed in the press for her “trout pout” after her lips were injected with industrial fillers.

She said: “I think it’s a fantastic thing that is happening now with the register. And I think a lot of it had to do with the publicity I got.

“Women having their lips filled were saying, ‘I don’t want to look like Lesley Ash.'”

Sue Ibrahim, from the British Association of Aesthetic Nurses, Doctors and Dentists, said the inclusion of beauticians for filler treatments had put the public at risk.


It’s true what they say; with age comes wisdom, maturity and a heightened desire to go under the knife and fix our appearance!

A study conducted by SunLife Big 50 revealed that 6 out of 10 people are enjoying life more than ever before since hitting the landmark age. However, being on the ‘wrong side of 50’ can sometimes spur aspirations to stay young and keep the number of wrinkles appearing at bay.

With growing attention surrounding social media and the pressures to look like those ‘perfect’ ‘un-edited’ celebs, it’s no surprise that the wiser generation are popping up more frequently in cosmetic clinics with an ambition to re-gain the lifted face they once had.

According to a study, a quarter of a million Brits admit to having opted for a nip, tuck, face lift or other procedure once hitting the big five-O. The surgeries they are undertaking have said to deduct four years physically but also ten years off their mental age.

The notions behind the surgeries, according to some of the clients, are that the procedures give them the body that matches their mind, looking as young as they feel which ultimately gives them confidence and the ability to no longer worry about what other people think of them.

Whilst those who undergo the cosmetic alterations say the surgeries have produced nothing but positivity in their lives; there is mounting concerns as to whether ‘growing older with grace’ still exists. It all boils down to should we be embracing aging rather than stopping it?

Managing client’s expectations. As a practitioner it is your job to make sure your customers do not come out of the surgery unhappy with the results; to do this they must be aware of what these results will be before they get on the table. Having a patient over the age of 50 believe that when they walk out of surgery they will look exactly like they did 30 years prior is incredibly unrealistic and automatically puts you at risk of a claim when the results are different to what they pictured.

You must make sure the customer has a realistic and reasonable idea of the outcome before the procedure is underway. Emphasis on the fact surgery will not turn the clock back 20 years but enhance already existing features is vital for handling their anticipations.

Ultimately you have to limit any potential risk of a claim. If you believe your client has impossible expectations you need to know when to say no. You can put yourself in danger if you carry out a surgery where you are aware the results will not match the client’s expectations.

If you need help on how to refuse surgery, take a look at our guide ‘How to say ‘No’ to Patients’.


Celebrities are sabotaging one of lifestyle magazines’ traditional scoops by openly admitting to procedures they’ve undergone. The big names of Hollywood, music and reality TV are, it seems, less concerned than ever before about saving face by denying they’ve had work done.

Actors, musicians and others who inhabit the celebrity sphere are taking the guesswork out of “have they haven’t they” features, which are normally accompanied by a before and after photo, by explaining what they’ve had done, why, and in some cases, by whom.

Kylie Jenner has become the poster-girl for lip fillers by not only citing the specific treatment used for her lip fillers (Juvéderm), but the clinician (Dr Ourian in Beverly Hills). Meanwhile, her sister Khloe Kardashian is not only happy to divulge her use of non-invasive fat banishing treatment CoolSculpting, but even documented it on her familial reality TV show, Keeping Up with The Kardashians.

As treatments and procedures have changed, so has the rhetoric. In the past, celebrities could truthfully say they had not “gone under the knife” – thanks in large part to the approval of botulinum toxin for cosmetic use in 2002 which meant that radical surgery was no longer necessary to achieve a youthful appearance.

Paradoxically, now that cosmetic enhancements are generally far more subtle and less invasive, celebrities are de-stigmatising aesthetic enhancement and not holding back when asked what was, for many decades, a question they dreaded.

Just ask Jamie Lee Curtis.

“I’ve done it all,” she confessed. “I’ve had a little plastic surgery. I’ve had a little lipo. I’ve had a little Botox.”

Curtis’ reasons for her no-holds-barred disclosures are part of a bigger picture in which she describes addictions to painkillers and surgery.

For every cosmetic procedure, celebrity or otherwise, there’s a motivation behind it, whether it’s a desire to cover over the imprint of 10 years worth of grief, as with singer Linda Nolan, or simply a wish to enhance a specific feature or reduce the signs of ageing. Noticeably, celebrity openness about the procedures they have undergone is increasingly accompanied by an outpouring of the reasons why.

However, while the reasons may not have changed significantly over the years, the acknowledgement by celebrities that they have undergone cosmetic procedures is a more recent phenomenon.

Rapper Iggy Azalea is no stranger to more drastic enhancements, having undergone rhinoplasty and breast enhancements, and has no interest in pretending otherwise. “I’m not denying it,” she says. “Denying it is lame.”

Meanwhile, some practitioners have raised concerns over normalising cosmetic procedures. One such surgeon is Anthony Youn, who has noticed more and more young patients requesting enhancements.

He has warned that there are just as many psychological ramifications as physical risks around having work done, “With plastic surgery, the fact is you don’t always look better. Sometimes you just look different — and that can be traumatic for certain people.” While celebrity openness about undergoing cosmetic procedures may be a positive shift in some respects, it could also be contributing to these concerns about normalising such procedures, particularly for younger patients who are perhaps more likely to be influenced by celebrity culture.

Despite the fears expressed by Youn and unlike celebrities who’ve been cajoled into “confessing” because changes are so noticeable, others, such as Azalea, are wholly unapologetic about her decision to undergo surgery.

“There was nothing wrong with me. I think it’s a personal choice and anybody, man or woman, should be able to make an informed decision. If you want to change something, then that’s up to you.”


Our recent infographic on What’s big in the cosmetic industry highlights the increasing trend for dimpleplasty, a quick and minimally invasive surgery that has tripled in popularity in recent years. Although dimples are actually a genetic medical deformity, they are in many cultures considered a sign of beauty, good luck and prosperity. In the western world, the continued popularity of dimpled celebrities has undoubtedly fuelled this trend, with Cheryl Tweedy possibly taking the dimple queen crown but closely followed by the likes of Katy Perry, Beyonce, Harry Styles and Ariana Grande to name a few.

But what does dimpleplasty entail? A muscle inside the cheek, known as the buccinator, is naturally indented in individuals who have dimples. The appearance of dimples can be formed by creating a defect in that muscle to surgically create dimples. The surgery only takes about 30 minutes and can be performed under local anaesthesia. Unlike some more invasive procedures, the patient should only experience minimal swelling afterwards and no noticeable stitches or a need for bandages.

Requests for dimpleplasty may have increased in part due to the ease of the procedure, the relative affordability and the lack of downtime afterwards. But surgeons have also noted the popularity of selfie photos and the impact of celebrities on this trend.

So, who is doing it? The key demographic seeking this procedure is women of the millennial generation, between around 22 and 30 years of age. Often heavily influenced by celebrities, women in this demographic are also keen to appear forever young and dimples have long been associated with youth. In some cases, patients like the idea of dimples because they work well with the overall proportions of the face. But in many cases, the rise in demand for dimples will simply be that dimples happen to be ‘in’.

Whilst dimpleplasty surgery is certainly less invasive than some other cosmetic interventions, it does nonetheless carry risks that could result in deformities that would be very difficult to correct. Thorough training and a clear understanding of the end result that the patient is seeking are essential, otherwise dimples could turn out to be overly dramatic, unnatural or in the wrong place, resulting in a dissatisfied patient and a potentially expensive insurance claim against you.


Cellulite affects up to 85% of adult women and can be extremely difficult to correct. Many treatments are ineffective or take multiple sessions to complete with very temporary results. “Orange peel skin” or “cottage cheese” affects all body shapes and sizes, from the slim to the full-figured.

It is common to confuse the concept of cellulite with that of normal fat and assume that cellulite is a direct response to overeating or lack of exercise. However, this is not the case. Normal fat and cellulite respond very differently to diet and/or exercise. When you diet, your body automatically burns its own reserves of stored fat. But cellulite is fat that is trapped in the dermal layer of skin and the body cannot effectively process it as fuel, so it remains.

Given the perplexing nature of cellulite, how can it be treated? Fortunately, there are a number of options available. Topical creams contain retinol or caffeine that can increase blood flow to the affected area, thus temporarily reducing the appearance of cellulite. Rollers (like Endermologie) can similarly reduce swelling and inflammation in the affected tissues and temporarily reduce the appearance of cellulite. Radiofrequency devices (e.g., BTL Vanquish, Thermi) can reduce the connective tissue in the affected area and increase blood flow to reduce the appearance of cellulite. However, each of these approaches is limited by the fact that the results are reversible and may only last weeks, days, or even hours. Similarly, they can only address relatively minor areas.

For more significant dimpling and for permanent results, patients require more intensive treatment. Liposuction and/or fat grafting can improve the appearance of cellulite in properly-selected patients. But for the best results, techniques that are specifically designed to treat cellulite are most often the best. Laser therapy (e.g., Cellulaze, CelluSmooth) works by placing a small laser probe under the skin through small stab incisions. The laser then specifically melts that fat and cuts through the fibrous bands that cause skin dimpling. These treatments require a single session and show immediate results. However, they do cause significant bruising and swelling, and can require touch-ups yearly.

Cellfina is the development for the treatment of cellulite. The treatment targets the fibrous bands which are the source of the dimpling in cellulite. It is most effective for the treatment of deep dimples and depressions of the buttocks and back of the thighs. It is less effective in the treatment of generalized waviness. To perform the procedure, a vacuum hand piece is placed over the dimpled tissue through which the surgeon will deliver a local anesthetic. Then a small, needle-like microblade is inserted to release the fibrous bands causing the cellulite. Investigational studies for Cellfina show a patient satisfaction rate of 85% at 3 months, 94% at one year and 96% at 2 years. This is a very exciting solution for the many women who suffer from the embarrassment of cellulite.

As always, it is essential that patients have an in-person consultation to develop a treatment plan that specifically addresses their personal surgical goals anatomy. I recommend that patients find a board-certified plastic surgeon with whom they are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your plastic surgeon and review before and after pictures of similar patients whom have had this procedure.


Which is better for your goals?

A healthy diet and consistent exercise are commonly touted as the fail-safe formula for achieving a slim and toned physique. While diet and exercise are indeed essential to health and wellness, many people discover that despite a strict diet and consistent exercise, certain areas of their body are resistant to change. For individuals unable to achieve their aesthetic goals by conventional means, a suitable surgical or nonsurgical fat reduction procedure may offer auspicious resolve. While liposuction remains the gold-standard surgical treatment for excess subcutaneous fat, nonsurgical treatment options, such as cryolipolysis (aka CoolSculpting), continue to gain popularity among patients seeking less invasive measures. While both liposuction and CoolSculpting have proven to be effective in reducing adipose tissue and improving body contour, these two cosmetic procedures are, in fact, very different.


Liposuction is one of the most commonly performed surgical procedures in aesthetic plastic surgery. According to ASPS Statistics, liposuction was the second most popular cosmetic surgical procedure in 2016, with over 235,000 procedures performed in the United States, alone. Liposuction is a surgical approach to removing excess subcutaneous fat and improving body contour. During a liposuction procedure, a plastic surgeon makes one or more very small incisions in targeted areas of excess fat. A long, narrow suction tool called a cannula is inserted though the incision(s) and functions to remove fat from the targeted treatment area. Depending on the number of body areas treated and the amount of fat removed, liposuction may be performed under general anesthesia, local anesthesia, or under sedation. Liposuction effectively treats a wide range of body regions and is commonly performed for fat reduction in the abdomen, waist, back, hips, buttocks, thighs, knees, upper arms, chin and neck.


From 2015 to 2016, nonsurgical fat reduction procedures increased by nearly 6%. CoolSculpting is a noninvasive, FDA cleared device that uses cryolipolysis technology to reduce localized subcutaneous fat. The device uses a vacuum applicator to deliver controlled cooling at the surface of the skin. By exposing fat cells to a critically low temperature, the CoolSculpting device induces crystallization and subsequent cell death in targeted fat cells. CoolSculpting is currently indicated for use in the submental region (“double chin” area), thighs, abdomen and flanks.

Which option is right for me?

When choosing between liposuction and CoolSculpting, the prospective patient should consider a few key questions:

What are your treatment goals?

  • The CoolSculpting device is designed to treat focal pockets of fat. For patients seeking a nonsurgical method to reduce fat in a localized area, such as in the love handles or outer thighs, CoolSculpting may be the appropriate treatment. Patients undergoing a CoolSculpting procedure should expect mild to moderate improvement in the area being treated. It is important to note that multiple treatment sessions may be necessary to achieve the best results. The number of necessary treatment cycles is dependent on the treatment area. Additionally, patient should understand that the results of CoolSculpting are not immediately noticeable. Changes in the treated area may become apparent as early as three weeks after CoolSculpting, and the most dramatic results can be seen one to three months after treatment. Your body will continue to process the injured fat cells from your body for approximately four months after your procedure.
  • For patients looking to treat excess fat over a larger area of the body or for patients desiring a more dramatic change in body contour, liposuction may be the more suitable choice. Liposuction is a more aggressive treatment option and allows for more fat to be removed during a single session. Further, liposuction can be performed in conjunction other surgical procedures, namely autologous fat transfer, for patients that desire more extensive body contouring. The fat that is extracted during liposuction can be reinjected into areas of the body where more volume is desired, commonly the breasts, buttocks and face. As opposed to CoolSculpting, an overall reduction in fullness and improved contour is noticeable within days after the procedure.

How long is the recovery period?

  • CoolSculpting is a nonsurgical procedure and, as such, offers patients a quick recovery, minimal associated discomfort and a low risk of complications. Typically, patients can resume normal activities immediately following the procedure. Occasionally, patients will have experience redness, minor bruising, tingling, numbness or discomfort in the treated area. These signs and symptoms can be expected to resolve quickly.
  • Following liposuction surgery, the recovery is relatively quick. Patients can typically return to work and resume most normal activity within a week of surgery. Swelling, bruising and numbness are common after liposuction and will subside over the weeks to months following surgery. It takes several months to one year to see the final results of most surgeries, as the body continues to make adjustments for up to a year after surgery. However, within days after liposuction procedure, you will notice an overall reduction in fullness and improved contour. It is important to note that the recovery is dependent on the amount of fat removed and the number of areas treated.

Are you a good candidate?

  • The ideal candidate for CoolSculpting is in good physical health, exhibits localized fat deposits and minimal skin laxity and has realistic expectations of the procedure. Patients considering CoolSculpting treatment should have expectations of mild to moderate improvement and understand that it is not designed for weight loss.
  • The ideal candidate for liposuction is in good overall health, exhibits excess fat deposits and has realistic expectations about the procedure. Liposuction is best suited for patients with minimal skin laxity as liposuction intervention can exacerbate the appearance of loose skin in the targeted treatment area. Discontinuing the use of any tobacco/nicotine for several weeks before and after a liposuction procedure is essential as tobacco/nicotine use can impair the healing process and increase the risk of complications. During the surgical consultation, you will discuss your aesthetic goals with your surgeon and your surgeon will determine whether liposuction is a good option for you. It is important to note that liposuction is not a substitute for proper diet and exercise and it is not an alternative to weight loss or a treatment for obesity.

Ultimately, the most appropriate treatment option is that which aligns with the aesthetic goals and individual preferences of the patient. Consulting with a knowledgeable board-certified plastic surgeon to discuss your aesthetic objectives is, undoubtedly, the best way determine which procedure is right for you.


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