All treatments and consultations are carried out by
Dr Baljit Kalsi
Botulinum Toxin Patient Information
What is Botulinum Toxin?
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium Botulinum. In a purified form, as is the case with many drugs/medications such as Penicillin, Botulinum toxin is a very safe, effective treatment not only used in cosmetic clinics, but also for a number of medical conditions, including migraine and excessive sweating.
All botulinum toxins are prescription only medicines (POM) and can only be prescribed by doctors, dentists and nurses with the prescribing qualification, following a face to face assessment and consultation with the qualified prescriber. Botox® is a licensed brand of Botulinum toxin A.
How Does it Work?
The toxin blocks the transition of chemical messages from the nerve to the muscle so that the muscle stays in a resting state for a period of 8 to 12 weeks on average.
This may be only a partial reduction in movement allowing some remaining movement or a full block in which case there is very little remaining muscular movement in the area – this very much depends on the amount administered and location of product placement –treatment may be tailored to suit your individual requirements. Your expected treatment outcomes and whether they can be achieved will be discussed at the time of consultation.
Used to Treat
The aim of the licensed treatment is to significantly reduce the movement of the muscles causing expression lines (dynamic lines) specifically the frown and crow’s feet and worry lines on the brow may also be treated as an ‘off label indication. Successful treatment may not cause the expression lines themselves to disappear completely. It may not ‘completely freeze’ the expression, particularly if extreme effort is exerted to make an expression.
Botulinum toxin is not suitable for lines present without expression (static lines), I will advise you about that. Advanced and off-label indications include; horizontal brow lines, lip lines and to improve the appearance of the neck.
It is important you tell your practitioner about any medicines or dietary supplements you are taking, some medicines can adversely affect the way the toxin works or increase your risk of bruising.
If you are taking supplements such as Vitamin A, C or E, Gingko Biloba, Garlic, fish oils, St. Johns Wort or some pain killing medicines such as aspirin or ibuprofen, then these can increase your risk of bruising and it may be advisable to stop taking them a few days before your treatment. It is also advisable that you do not drink alcohol the night before your treatment, for the same reason.
Make-up will need to be removed prior to the injections and you will be advised not to reapply it for 12 hours in order to reduce the risk of infection or irritation at the injection sites.
Be aware of the necessary after care advice and that your schedule allows for you to follow it.
You will be advised to keep the target muscles active for a few hours and to avoid extremes of heat or cold, vigorous exercise, lying down or leaning over for 4-6 hours.
After treatment it is expected that you will start to see an improvement within 2 or 3 days. For some people this takes longer. The full result may be judged at 2-3 weeks. You will be invited to attend a review appointment at 2-3 weeks where the success of the treatment may be assessed and adjustments to your personal treatment plan made, if necessary.
How Long will it Last?
Results tend to last 3-4 months. Movement will begin recovering from 8 weeks. Frequent treatment at intervals of less than 3 months is not recommended. Repeating treatment when movement recovers will deliver optimum results over time. Frequency of treatments may be reduced according to the quality of your skin and your response to treatment.
Should you experience any unexpected side effects or any that concern you, please contact me.
Hyperhidrosis Patient Information
What is Hyperhidrosis?
In some people, the body’s mechanism for cooling itself down is over active - so over active that they may sweat four or five times more than is necessary, or normal. When sweating is this extreme it can be embarrassing, uncomfortable, anxiety inducing and life inhibiting. It can disrupt all aspects of a person’s life, from career choices and recreational activities to relationships, emotional wellbeing and self-image. This kind of excessive sweating is a medical condition called hyperhidrosis.
‘Hyperhidrosis affects approximately 3% of the population, but due to lack of awareness, more than half of sufferers are never diagnosed or treated for their symptoms.’
What Causes Hyperhidrosis?
Excessive sweating can be a symptom of certain medical conditions or a side effect of some medications. You should not have treatment for your hyperhidrosis without first consulting your GP to exclude any underlying medical condition which requires treatment.
Your GP will check for potential causes of secondary hyperhidrosis to avoid symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of the underlying disease.
The cause of primary hyperhidrosis is not known.
What Treatments are Available?
There are a range of treatments available for hyperhidrosis, many are available on prescription. They include Antiperspirants, Creams and Lotions, Iontophoresis Medications, Laser, Surgery, MiraDry, Injections of Botox.
There is a wealth of information available on the internet, not all of it responsible, factual or impartial. We recommend you visit the website of The International Hyperhidrosis Society; www.SweatHelp.org for useful and reliable information.
Botox® has been licensed to treat underarm sweating since 2004. Research has shown that treating excessive sweating of the armpits, hands, feet, and face with Botox®(Botulinum Toxin A) is safe and effective. In one clinical study involving 322 patients with severe underarm sweating, 81% of the patients receiving botulinum toxin injections achieved a greater than 50% reduction in sweating. And, 50% of the patients had their excessive sweating relieved for at least 201 days (nearly 7 months).
How Does Botox® Work?
Botox® is a natural, purified protein with the ability to temporarily block the secretion of the chemical that is responsible for "turning on" the body's sweat glands. By blocking, or interrupting, this chemical messenger, botulinum toxin "turns off" sweating at the area where it has been injected.
While sweating is an essential body function for temperature-control, the underarms house less than 2% of the body’s sweat glands. The treatment of these sweat glands has no effect on body temperature regulation and compensatory sweating (sweating on other body parts), has not shown itself to be a concern.
Botox® is injected into the skin to treat the symptoms of severe underarm sweating (severe primary axillary hyperhidrosis) when medicines used on the skin (topical) do not work well enough.
Am I Suitable for Treatment with Botox®?
If you have seen your GP, your diagnosis is confirmed and you have tried and failed to get along with alternative topical treatments, then it is likely, subject to your medical history, that Botox® would be an appropriate treatment for you.
I will take a full medical history to confirm you have no medical contraindications to Botox ®.
You may not be suitable for Botox® treatment if you have any of the following:
- A neuromuscular transmission disorder such as Myasthenia gravis or Eaton Lambert Syndrome.
- Aminoglycoside antibiotics within the last 3 days (Gentamycin, Clindamycin, Tobramycin)
- If you are pregnant (or might be) or are breast feeding.
- If you have a skin infection at the site for treatment.
- If you have had previous adverse, sensitivity reactions to any botulinum toxin.
What Does the Treatment Involve?
I will first identify where the sweat glands are most active. This is done by applying iodine solution to the treatment area, then dusting with starch powder. The area turns blue/black where there is sweat. The area is marked with a surgical pen, then cleaned prior to injection. Injections are spaced approximately 2cm apart to treat the area. The needles are tiny, the injections are not deep and most patients report tolerable discomfort rather than pain.
Please shave underarms and avoid using over the counter antiperspirants or deodorants 24 hours before.
It is advisable to avoid aspirin and non-steroidal medication, vitamin E, gingko biloba and St. John’s Wort for at least 24 hours prior to treatment as these may increase the risk of bleeding and bruising.
If you have been prescribed aspirin for a medical reason, it is best to continue this. If you have a bleeding disorder, or are taking Warfarin, discuss this with me prior to receiving botulinum treatment.
Wear a dark, loose top, preferably an old one to the appointment. You may bleed a little and iodine may stain clothing.
The treatment area may feel sore and or tender for the first 24 hours. Some patients describe an achiness, tiredness or heaviness of the arms which usually resolves within a few days from occurring.
Results are gradual and may be judged at 2-3 weeks. You are invited for a review appointment to record the effectiveness of treatment and modify your treatment plan if necessary. Sometimes an additional treatment is required to achieve optimal results.
Keep the area clean. You may apply antiperspirants as soon as the skin has recovered from the injections- usually within 4-12 hours. Avoid vigorous exercise or extreme heat for 48 hours after treatment.
Should you experience any unpleasant side effects that you are not expecting, or suffer symptoms that concern you, please do not hesitate to contact the clinic and an appointment will be made for you to be seen.
The treatment may not completely stop any sweating, but we expect the sweating to be significantly reduced. Treatment results are expected to last approximately 6 months. For some individuals this may be shorter, or even longer.
Once the Botox® wears off, your condition will return to its previous state, there is no permanent effect on your condition, either for the better, or for the worse.
If you have any further questions, before, during or after the treatment, do not hesitate to ask your practitioner.
HA Dermal Filler Patient Information
The majority of brands are made from hyaluronic acid
Lasts 6-18 months depending on the product, treatment site, lifestyle factors and the individual.
What is Hyaluronic Acid?
Hyaluronic acid is a naturally occurring sugar chain molecule found in all skin and soft tissues throughout the body, identical across species. It attracts and binds water in the skin, providing volume and hydration, but also ‘cushioning’ and supporting collagen and elastin fibres and providing a medium, or carrier, for chemical messages between the cells.
Dermal fillers are manufactured, usually through fermentation and cross linking with proteins to produce a clear, sterile gel for injection into the skin.
In the UK, there are over 160 brands on the market due in some part to weak regulation. Not all hyaluronic acids are the same, each brand has a range of ‘tissue tailored’ products designed for specific results. One size does not fit all. At this clinic we use only tried and tested brands. If you have a particular brand you prefer, please discuss with us.
Leading and well established brands include Teosyal, Juvederm, Restylane.
How Does it Work?
Hyaluronic Acid dermal fillers are a clear sterile gel in a syringe for injection into the skin providing instant correction.
Used to Treat
- To correct or enhance facial contours; cheeks, temples, jawline, nose, chin.
- To define, correct or enhance lips
- To soften and correct facial wrinkles or folds
- To restore lost volume in hands to reduce the appearance of veins and tendons
- To improve the tone, texture and hydration of the skin.
Does it Hurt?
Most leading brands also contain a local anaesthetic and we will apply topical anaesthetic cream, or ice, prior to treatment to numb the skin. Treatment need not be painful.
All make up will need to be removed prior to treatment, so please come ‘fresh faced’ if possible. Alcohol, aspirin, Ibuprofen and a range of dietary supplements including; St. Johns Wort, fish oils, Gingko Biloba, Vitamins C and E- may all contribute to bruising and are best avoided 24 hours before treatment. Treatment cannot be administered if there is an active skin infection, including acne or cold sores or if you are unwell- including colds, coughs, sore throats etc. Do contact the clinic to discuss any illness or new medicines prior to attending.
How Long will it Last?
Longevity does vary between products, and between individuals, but most will last between 6 months and 18 months.
Is it Safe?
Dermal fillers are safe, but not risk free, I will discuss all the risks and benefits with you at consultation and again prior to treatment.
Am I Suitable for Treatment?
I will take a detailed medical history to ensure you have no conditions that might increase risk of unwanted side effects, consultation is also important to discuss your expectations and whether or not this treatment is able to meet them.
Most people are able to continue with normal activities with immediate improvement in their appearance. Some will have some redness, pin prick marks, possibly swelling- particularly in the lips. Possibly bruising. Any swelling and bruising may be more apparent the next day.
Make-up should not be worn for 12 hours
You are advised to avoid alcohol, vigorous exercise, sun bathing, and extremes of heat or cold for 14 days post treatment. These activities have been found to increase and prolong swelling.
Swelling may worsen in the first 24 hours, and then should settle within the first few days. Cold packs can be helpful in reducing swelling. As a consequence of swelling, the product may feel harder or lumpy and you may notice some asymmetry. The final result may be judged at 2 weeks.
Bruising may take a few days to appear, arnica can be helpful in clearing bruising. It is advisable to avoid aspirin and alcohol for 12-48 hours after treatment. Tenderness should settle as swelling goes down.
Athletes should be aware some ingredients in the product may show a positive in ‘anti-dope tests’
Please contact me if redness, tenderness, itching or swelling worsens after 3 days, rather than settling.
Please do not hesitate to contact me if you have any concerns.