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Smoothing Lines & Wrinkles

One of the three key areas of non-invasive Cosmetic Dermatology is smoothing facial lines and wrinkles. There are three different types of facial wrinkles which each largely determine the kind of treatment. Firstly, 'dynamic lines' (or 'mimic lines') are caused by the contraction of underlying muscles. They include 'frown lines' (glabella lines) between the eyebrows, 'worry lines' on the forehead, 'bunny lines' on the nose and 'crow's feet' at the outer eye corners. The second group, 'static lines', are independent of muscular movement. They can develop on their own ('primary static lines') or from long-established dynamic lines ('secondary static lines'). Lastly, gravitational folds are usually deeper furrows resulting from a combination of loss of volume and gravitation. A prime example of these are nasolabial folds running from your nose to the corners of your mouth. What happens is that as we get older, our faces tend to lose fat and first to go are the fat pads in our cheeks. This loss of volume leads to an envelope of loose skin which gravitation pulls downwards - hence the folds.

Wrinkle-relaxing injections with botulinum toxin ('Botox')

Botulinum toxin (often referred to as 'Botox' after its first brand name) is a substance that, when injected into a muscle, will temporarily stop it contracting. This is why botulinum toxin is an excellent treatment for dynamic facial lines. It has been used in cosmetic treatments for more than 20 years now and in the right hands is a safe and highly effective non-surgical solution for certain types of wrinkles. The great thing about cosmetic botulinum toxin is that it works at the root cause of dynamic lines by preventing the muscle from doing the very movement that's causing the problem. For this reason, botulinum toxin also plays a useful wrinkle-prevention role in people who tend to over-use certain facial muscles.

It takes on average about five days for botulinum toxin to start kicking in. The effect on the muscle is fully reversible and lasts about three to six months and patients usually come for top-ups two to four times per year. However, many patients report that in time the intervals between clinic visits get longer, as our muscles seem to 'learn' not to do the wrinkle-causing movement so much. Ideal lines for botulinum toxin treatment include 'crow's feet', 'frown lines' between the brows, 'worry lines' across the forehead and 'bunny lines' on the nose. We can also perform a gentle, non-surgical brow lift with botulinum toxin and 'train' the corners of your mouth to turn downwards less, so you lose that grumpy look.

It's important to know that for botulinum toxin to be optimally effective, you should start treatment when the line is still 'dynamic' and not yet 'static'. You can test this in the mirror by stretching the wrinkle between two fingers. If it disappears completely, it's still 'dynamic' and easily treated. But if stretching the skin only softens the line, then it's starting become 'static' and additional treatment may be needed. In these cases we can offer a filler or bio-revitalisation as a follow-up treatment two weeks after botulinum toxin. In our clinic we use both traditional Botox^® (marketed as Vistabel^® for cosmetic purposes) and a new generation botulinum toxin, called Bocouture^® or Xeomin^®. This a purer form of botulinum toxin, developed in Germany. Usually injections with botulinum toxin only cause very mild discomfort and an anaesthetic cream isn't usually needed - unless you really would prefer one. But rest assured, Dr Stefanie has a very slow, gentle injection technique to maximise your comfort.

Costs - wrinkle relaxing injections:
One area - £290
Two areas - £380
Three areas - £460

Fillers

Dermal fillers are the main solutions we use for 'static lines' and 'gravitational folds'. They are injected directly beneath a line or fold to fill the depression it makes in the skin. There are countless fillers on the market and new ones are constantly being released. That's why it's so important to know which ones have the best safety records and give the best results.

Think of fillers as belonging roughly to either 'permanent' or 'temporary' groups. Temporary fillers are preferable for several reasons. Firstly, our face changes with time and cosmetic treatments must be adjusted to keep pace with these changes. A permanent filler couldn't allow for this adjustment - you'd be stuck with it forever, like it or not! And while you may have been pleased with the initial result, it might look unnatural or out of place years down the line as your face ages further. The other reason is that various scientific studies have shown that permanent fillers are associated with a higher risk of unwanted side-effects and problems.

For all these reasons, we only use gold standard non-permanent fillers containing hyaluronic acid. Hyaluronic acid fillers include Restylane, Perlane, Belotero and Juvederm. Hyaluronic acid (hyaluronate) is an important physiological substance that all skin contains naturally. Its key roles are to maintain the plumpness and moisture that help keep the skin surface smooth and lifted, but levels decline with age. We inject fillers containing transparent hyaluronic acid gel, which over time are degraded by your body's natural enzymes, just as happens with your natural hyaluronic acid. An extra advantage is that there is an 'antidote' for hyaluronic acid fillers - an enzyme called hyaluronidase. So if for some reason you would like us to dissolve your filler, we can do that easily.

Fillers can be used for all sorts of lines and wrinkles, from deep nose-to-mouth lines to superficial 'lipstick bleed' lines around the mouth. The effect is instantly visible, although there may be some swelling and bruising. How long the effects last depends on the individual patient, their lifestyle, age and the areas injected. But they usually last around six to nine months. In certain areas of the face such as the crow's feet, a filler lasts longer in combination with botulinum toxin ('Botox'). You'll also be pleased to hear that we offer several forms of effective pain prevention. Many of the fillers we use already contain a local anaesthetic, so no extra is needed. We also often use a very special 'magic needle' (PixL canula), which is non-traumatic and slightly flexible, so tends to cause less discomfort and bruising than traditional rigid needles. For those fillers which don't already contain anaesthetic, we offer an effective numbing cream or even a dental block. A dental block is a local anaesthetic injected inside your mouth - similar to those at the dentist's - to completely numb certain areas of the face, including nose-to-mouth lines.

Costs - fillers
Line Smoothing (1 syringe - light lines) - £420
Line Smoothing (2 syringes - medium lines) - £630
Line Smoothing (3 syringes - deep lines) - £790
'Liquid face lift' (multi-syringe filling, contouring & wrinkle relaxation) - £1950

Bio-revitalisation, Needling & 'Gel Needling Lift'

We can also address fine lines and crinkling of larger skin areas and overall loss of skin elasticity, for example on the cheeks. To do this, we can perform a bio-revitalisation treatment, medical micro-needling or a 'Gel Needling Lift'. See Improving skin surface and texture for details on this.