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What are wrinkles?

Fillers in Dubai | 13 September 2019

Although wrinkles can signify wisdom, or at least some level of maturity, there is no question that newly born infants also have wrinkles. The real concern that most of us have is that certain types of wrinkling are associated with the aging process. In our current “pop” culture, people do not view aging positively. Generally, the treatment of normal skin aging that does not result in a functional abnormality is termed “cosmetic.” Most cosmetic procedures are not covered by health insurance.

Many products and procedures promise to reduce wrinkles. Some do little or nothing (like the products that claim they reduce “the appearance of fine lines,” which means that they don’t reduce the lines themselves). Others can achieve a fair amount of success.

Although all of our skin ages, sun exposure dramatically enhances the rate at which this occurs. Changes brought on by sun damage (photoaging) include dry skin (really roughness), sagginess, skin growths like keratoses, lentigos (“liver spots”), and wrinkles. Just compare the skin on the face and neck of a poorly pigmented farmer to the skin of his buttocks.

Most wrinkles associated with aging appear on the parts of the body where sun exposure is greatest. These sites are the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows related to muscular contraction. Some deep furrows are anatomical in nature and have little to do with aging. Generally, it is only the aging wrinkles that really bother people. There are two basic approaches to the amelioration of these signs of aging: prevention and treatment. Topical wrinkle treatments are, in general, much more effective for fine lines. Deeper creases may require more invasive techniques, such injection of fillers, local muscle paralysis, or plastic surgery. There is a special form of wrinkling called “cellulite” that produces a “cottage cheese-like” appearance to the skin. Cellulite most commonly appears in the hips and buttocks of women and is due to fat deposition in certain anatomical areas in the dermis.

What are risk factors and causes of wrinkles?

Smoking

Degree of natural skin pigmentation (more is better)

Sun and ultraviolet exposure

Heredity (some families wrinkle more)

The loss of subcutaneous fat on a person’s body (people with more subcutaneous fat have fewer wrinkles)

Some of these factors are beyond our control. The main preventive measures we can take are to minimize sun exposure and not smoke. These measures can, at best, delay wrinkles.

Sun protection factor SPF numbers on sunscreen labels refer to protection against UVB radiation (the “sunburn rays”). Higher SPF numbers (50) are better at protecting the skin than lower numbers. Broad-spectrum sunscreens offer protection against UVB and UVA radiation (longer-wave ultraviolet light). UVA rays are abundant in sunlight and produced by tanning salon light bulbs; they may not cause immediate sunburn but do produce aging and an increase skin cancer risk over time. (Sorry, but there is no such thing as a “safe tan.”) Sunscreens that block UVA indicate this on the label and contain ingredients such as Parsol, Mexoryl, and benzophenones.

Procedural options

Glycolic acid peels: These superficial peels can make a very slight difference in the intensity of fine wrinkles.

Deeper peels: These peels use ingredients like salicylic acid and trichloroacetic acid and penetrate somewhat deeper into the skin. Deeper peels do a better job of smoothing fine lines. The deeper the peel, however, the greater the risk of side effects such as long-lasting pigment changes (changes in the color of the skin) and scarring. Such peels may require anesthesia. Mild sedation helps ease short-term but intense discomfort.

Microdermabrasion: This refers to “sanding the skin” with a machine containing silica or aluminum crystals; many estheticians offer this service, usually in “packages” of six or seven sessions. Microdermabrasion does not change skin anatomy, though it may make the face feel smoother. Cosmetic products marketed as “home microdermabrasion” are just mild exfoliants — harmless but not likely to produce any meaningful change in wrinkles.

Dermabrasion: This is a true surgical procedure, often performed under general anesthesia. The treating physician uses a rotating instrument to sand the skin down. Depending a great deal on the skill and experience of the operator, dermabrasion can result in excellent improvement but can also produce significant side effects, including scarring and permanent changes in skin color.

Laser resurfacing: Using instruments such as the carbon dioxide and erbium lasers, physicians can achieve results similar to those of dermabrasion with greater reliability and precision. A medical professionals passes the laser several times over the area to be treated until the damage reaches the middle of the dermis, the skin’s second layer. This helps stimulate the body’s natural collagen synthesis (production), which plumps up sagging skin and wrinkles. Some dermatologists perform laser resurfacing under “conscious sedation,” in which the patient remains awake and receives intravenous medications to calm and ease pain. Doctors combine this sedation with the application of topical anesthetic creams such as EMLA, as well as injections of local anesthetics like lidocaine. Patients may need to repeat procedures to maximize improvement. Skin takes a long time to heal (weeks to months) after resurfacing. In addition, this procedure, like dermabrasion, can cause permanent pigment changes and scarring.

Fractional resurfacing: Newer lasers work through a modification of traditional laser resurfacing. Treatments affect not the whole skin but instead only evenly spaced spots surrounded by undamaged skin. Healing is much faster than traditional resurfacing, with less “downtime” afterward. Patients may need several treatments to achieve full benefit.

Non-ablative laser resurfacing: Newer lasers attempt to stimulate collagen synthesis under the skin without damaging the epidermis. Studies and clinical experience suggest that such procedures can improve fine wrinkles, though not as much as laser resurfacing. Several treatments may be necessary. These procedures are almost painless and there is little or no redness, peeling, or downtime afterward.

Heat and radiofrequency: Another variation of noninvasive facial rejuvenation is to heat tissue using radiofrequency devices and infrared light sources. Techniques are still in development, but results to date suggest that such treatments are safe and can produce visible and lasting improvement, though not as much as surgical techniques like facelifts (rhytidectomy).

Cosmetic surgery: Surgical facelifts, brow lifts, and similar operations can be very helpful for selected patients.

Thread lift: In this procedure, a barbed, medical professionals insert a stiff thread into facial skin in the appropriate direction and the tissue is pulled to catch on the barbs, producing a lifted appearance. Whether or not the effect is sustained is controversial, but there is no doubt that in the short term there can be a modest cosmetic benefit using only a local anesthetic associated with minimal downtime.

Botox: Injection of botulinum toxin, the muscle poison, can paralyze facial muscles that produce the “frown lines” on the forehead, fine lines around the eyes, and other wrinkles. Improvement lasts several months, and patients must have repeated injections to sustain improvement.

Dermal Fillers: Medical professionals inject fillers into the skin to increase volume and flatten wrinkles and folds. In the past, the most popular filler was collagen. More recently, health care professionals use new filler substances such as hyaluronic acid (Restylane, Juvederm) and calcium hydroxylapatite (Radiesse), lactic acid (Sculptra), and autologous fat transplants because their effects can last six to nine months or even longer.

Anyone considering any of the cosmetic procedures should be sure to consult doctors who have experience in one or several of these techniques. Patients should fully inform themselves about the risks and potential benefits of the procedure they are considering before going forward.

Fillers vs Botox – Everything you need to know before getting treatment

Fillers in Dubai | 9 September 2019

They seem similar, but in reality they’re two very different things. The line between Botox vs fillers can sometimes seem a bit blurred, so if you’re just starting to look into injectables, it might feel confusing working out which is best for you.

What is Botox and how does it work? 

Botox is the short name for botulinum toxin, a group of molecules produced by the bacteria clostridium botulinum. It is called a ‘toxin’ because in very high quantities it can act as a ‘neurotoxin’ in the body, blocking the action of certain nerve types. In medicine, this toxin has been refined and tiny doses of the original toxin can be injected into areas where it is desirable to block the action of some nerves, for example in the tiny muscles of the eye, for squints, or in the bladder for hyperactive muscle. In aesthetics, it can be injected directly into the tiny muscles of facial expression to relax the muscle tension on the skin, where they create lines with age; this then relaxes the lines and wrinkles. It can also be used to relax muscles that pull down on the face, for example in the neck muscles, to give a lifting effect. Likewise, it can also be used to block sweat glands, so can be used for treatment of excessive sweating (hyperhidrosis). Migraines can also be treated effectively with Botox injected into several points in the scalp. Effects can last between 3-6 months, depending on the individual.

What are dermal fillers and how do they work? 

Dermal fillers are a group of injectable medical products designed to add volume to tissues. There are many different types of fillers, such as hyaluronic acid fillers (the most common type) and collagen-stimulating fillers (such as sculptra). Fat transfer might also be considered a ‘filler’. Generally speaking, fillers can be injected into areas to replace lost volume and revitalise the skin. There are many different consistencies and forms of fillers, for use in different areas, and the technology is improving rapidly. Results usually last for 18 months, but can be reversed before that time.

Anti-Wrinkle Treatments

Fillers in Dubai | 5 September 2019

Anti-wrinkle injections commonly referred to as Botox is a medical aesthetic treatment used to minimise fine lines and wrinkles on the face. These injections are usually used for the horizontal forehead lines, the crow’s feet and the frown lines between the eyebrows. Injecting Botox into the relevant muscles in these areas will relax the muscles causing the lines to soften. I only use products I trust so we use genuine Allergan Botox® to treat our patients to maximise patient safety and satisfaction.

Areas treated:

Upper Face 

Brow Lift

Crows Feet

Frown Lines

Gummy Smile

Jawline

Corners of the mouth

Excessive Sweating Treatment

Platysmal bands.

What Areas can Dermal Fillers Treat?

Fillers in Dubai | 2 September 2019

Where can dermal fillers be used?

Dermal fillers have a wide multitude of uses from the obvious to the not so obvious. If you have a patient that is interested in having dermal filler, we advise that you get them to attend an initial skin consultation with you before having the treatment. This will allow you to find out more about the patient’s medical history, and the look that they are hoping to achieve.

Tear troughs

These are the lines under your eyes that make your eyes look tired. A loss of volume in the area, a loss of tissue elasticity or a mild reduction in bone density could all be causes of concern. By using an advanced technique, dermal fillers can be placed in either the tear trough itself, slightly lower in the cheek area, or indeed a combination of both to achieve brighter, more rejuvenated eyes.

Naso-labial folds

Commonly known as the smile or laughter lines, these are the two skin folds that run from each side of the nose to the corners of the mouth. If you are bothered by your nasolabial folds, and wonder what to do to improve the area then filler is perfect to fill out these folds, and partnered with cheek filler the face will appear much younger looking.

Mouth corners

Sometimes the corners of your mouth can droop leaving you looking unhappy. Dermal filler can be placed below the corners of the mouth with a small amount directly into the corners of the lips.

Marionette lines

Marionette lines run between the corners of the lips down towards the chin and jaw giving a puppet-like effect. As we age, our facial bones become smaller resulting in lines like these appearing. Dermal filler is great for filling in these lines making them less prominent.

Cheeks

As you age you lose an amount of subcutaneous fat which can result in a loss of volume and elasticity to the face. This in turn highlights hollow cheek bones, and the presence of excess skin resulting in sunken cheeks. This can cause someone to appear gaunt and tired-looking. Dermal fillers can be injected into this area to plump out the face with natural volume and a gentle lift. This is an advanced technique and is offered at one of our specialist training days.

Lips & Vermillion Border 

A celebrity favourite and probably the most well-known use of filler. The lips can be injected with dermal filler either in the body of the lip to boost fullness or the border of the lips to increase definition. This treatment is ideal for correcting thin lips but can also help solve problems with a downward smile and the need to lengthen the mouth.

Chin augmentation

A perfect alternative to a surgical chin implant, is a non-surgical chin augmentation which is achieved with dermal fillers. Fillers will help define your jaw line and although only a temporary solution it is a great way to see what can be achieved surgically if you are unsure.

Smoker’s lines

These are the vertical lines above the lip that appear when you pout. They are mostly caused by regular lip movements but are also called smokers lines, because regular smoking means pressing the lips together.  If your lines are deep enough then they can be drastically reduced with a small amount of injectable filler to achieve a smoother appearance.

Nose

Have you heard of the lunchtime nose job? Dermal fillers can now be used to straighten out any lumps or bumps in your nose without the need for any surgical downtime. Fillers are injected into the nose to smooth out slight bumps in the bridge of the nose, or rectify a crooked line of the nose (particularly in profile view) and even cartilage irregularities at the tip of the nose all in less than 15 minutes! This is another advanced course available for those that have been practicing in dermal filler for a while.

Hands

Hands are a new use for fillers, patients have found that the use of the fillers in their face is great for concealing their real age, but then it is often their hands that give it away. Ageing hands lose volume and the skin appears thinner. Having filler injected into the skin on the back of the hands can make them appear plumper and less veiny.

A Beginners Guide to Lip Fillers

Fillers in Dubai | 30 August 2019

Latest figures show that lip fillers are becoming one of the most sort-after aesthetic treatments, so here is a summary of information about lip fillers or lip augmentation.

What are lip fillers?

Let’s start with what they’re not: they are not permanent. They last about three months to a year depending on how quickly your body breaks them down.

The type I recommend are made of hyaluronic acid — a sugar, found naturally in the body, that adds temporary volume and definition when injected into lips.

Know Your Options

Over the last few years, government bodies have approved various hyaluronic acid (HA) fillers for lips. The new formulas are all similar in composition with slight variations in longevity and density, which can determine when and how they’re used.

Know what you are looking for

I will be able to assess the shape and size of your natural lip line and show you what the optimal ratio should be. Sometimes the filler will be used to even out and correct the shape of the lips there are ratios that are generally used in terms of proportion. Your own expectations should also be addressed and the amount of volume is discussed.

Correcting balance and shape

The lips can sometimes tend to be uneven with the top or bottom one thicker than they should be. To get a perfect pout the top lip should be one third and the bottom lip should be two thirds. Sometimes they are also larger on one side than the other and the lips are a little lopsided. Dermal filler can even this out.

A quick breakdown of what is typically used:

Restylane and Restylane-L: Created for all over volume they’re the same basic formula, but Restylane-L is mixed with an anaesthetic called lidocaine
Restylane Silk: Suitable for more subtle enhancements because it contains smaller HA molecules)
Juvéderm Ultra XC: Higher density to give a plusher, pillowy effect and volume
Juvéderm Volbella XC: Refining the lip line (and treating fine lines around the mouth)

How to Ensure You’ll Love Your New Look

Do Your Research

The most important step in having a product injected in your lips is finding the right injector — Find a practitioner who has lots of experience. Look for a reputable medical practice.

Schedule a Consultation

During the initial meeting, you will review your medical history, discuss your goals and how you want your lips to look for example subtle definition, versus major volume.

You should also request to see before-and-after photos of previous patients and ask how often the practitioner does fillers.

If you need to wait to get an appointment don’t be put off as generally the experts treating lips daily will not have an appointment the next day. Also, don’t be rushed into the decision.

Don’t go for the cheapest

With most things in life, you get what you pay for. A higher price tag often means you’re paying for an injector’s experience. As for special offers, just Don’t be tempted. Offering services for a fee that seems too good to be true, could mean that your filler may have been cut with water or saline to cover the cost (meaning your fillers may not last or could come out uneven). It may also mean the practitioner is not as experienced.

EAR RESHAPING (OTOPLASTY)

Cosmetic Clinic Dubai | 28 August 2019

Ear reshaping, also known as Otoplasty, refers to a range of common cosmetic surgery procedures designed to correct the size and shape of the ear and earlobe. Typical procedures include pinnaplasty (to pin back ears), ear reduction (to reduce the size of the ears) as well as the correction of a range of ear deformities either apparent at birth (easily corrected by moulding the ear as it grows) or acquired later in life through trauma, piercing, surgery or cancer.

Ear surgery can be used to treat many other ear deformities such as; reshaping cartilage ears that have an unnatural shape, reducing overly large ears and reducing large earlobes or earlobes that have been overstretched (by wearing earrings, or as a result of ‘ear stretching’, also known as gauging). You are also able to have otoplasty to increase the size of a very small ear, or even rebuild new ears if you were born without an ear or earlobe. It’s even possible to reduce the formation of wrinkles or large creases found on ears, that could, in turn, increase your self-confidence.

Otoplasty surgery can be performed on children as young as age 6, as their ears may still be growing and developing. Otoplasty is a safe and effective surgery that can improve the function and appearance of the ear, as well as improving the patients’ self-image.

What is a “Mommy Makeover”?

Plastic Surgery Dubai | 26 August 2019

For those mothers out there who want a firmer, tighter body, even after childbirth, there is the Mommy Makeover Surgery. This revolutionary cosmetic procedure has been developed by cosmetic surgeons with the needs and desires of mother’s everywhere in mind. Essentially, this procedure brings together the best of several popular surgical procedures to restore and rejuvenate the mother’s body back to her pre-pregnancy body, as close as possible.

If you just had children and did not gain too much weight, a mommy makeover might be right for you. During your consultation I will give you several options of one or more procedures to regain your pre-pregnancy body based on your needs. These will usually be one or all of the main procedures involved which are a breast lift with or without implants, abdominoplasty also referred to as a tummy tuck), or liposuction. Depending on your situation you may opt in for all procedures or just do a specific one or two.

What you will learn

    • What exactly is involved in a mommy maker
    • Details about the procedures I may recommend
    • How long is the mommy makeover surgery
    • What to expect pre and post surgery
    • How long will your mommy makeover recovery time last

WHAT IS A MOMMY MAKEOVER?

A Mommy Makeover is a customized cosmetic treatment plan that brings a woman’s body back to normal after pregnancy. Mothers breast loose volume, they begin to sag and may require a breast lift combined with a breast augmentation to increase cup size and volume. Often times there is excess skin that appears like a kangaroo pouch and even with exercise this stubborn area will not go away. One of the main procedures is a tummy tuck with liposuction that contours and reshapes your body to where you feel confident and like your old self again.

Why is it so popular?
Having a child is one of the most amazing things a woman can experience in her life. With pregnancy woman loose the shape and firmness of their pre-pregnancy bodies. So now they have their kids but they still want to look good and feel good. Many mothers are busy and even with several good workouts a week results don’t always come easy. A Mommy makeover surgery can transform you and give you the body of your dreams.

Who is a potential candidate?
The ideal candidate is one who has had kids and has not been breastfeeding for the last six months. Additionally, it is ideal that you are close to your ideal weight and have remained so for the last few months. Any plans you may have for a pregnancy in the future should be discussed with me. Drastic weight changes will usually require additional procedures in order to fix your concerns and needs. I will talk with your about the three mommy makeover procedures, and recommend whether you should have all, one, or two.

WHAT ARE THE MOMMY MAKEOVER PROCEDURES?

Below are the following mommy makeover procedures that you may talk about with your surgeon and will likely recommend as options to reach your body goals.

Breast Augmentation

Breast augmentation surgery, also known as augmentation mammaplasty, is the surgical placement of breast implants, saline or silicone to increase fullness and improve symmetry of the breasts or to restore breast volume lost after weight reduction or pregnancy.

What happens during breast augmentation surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during breast augmentation surgery.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference.

Step 3 – Implant choice

Breast size and shape are important, so be honest and open about your expectations when talking with me. Implant type and size will be determined not just on your desired increase in size but more importantly on your breast anatomy, skin elasticity and body type.

Options for Breast Implants

Saline breast implants are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Silicone breast implants are filled with an elastic gel. The gel feels and moves much like natural breast tissue.

Step 4 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either under the pectoral muscle (a submuscular placement), or directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement). The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon’s recommendations.

Step 5 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade.

Step 6 – See the results

The results of breast augmentation surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for fuller breasts.

Tummy Tuck

A tummy tuck, or abdominoplasty, removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

What happens during tummy tuck surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during abdominoplasty surgery.

Step 2 – The incision

A full tummy tuck procedure requires a horizontally-oriented incision in the area between the pubic hairline and navel. The shape and length of the incision will be determined by the degree of correction necessary. Through this incision, weakened abdominal muscles are repaired and sutured while excess fat, tissue and skin is removed. A second incision around the navel may be necessary to remove excess skin in the upper abdomen.

Step 3 – Closing the incisions

Sutures, skin adhesives, tapes or clips close the skin incisions.

Step 4 – See the results

Your abdominoplasty procedure will result in a flatter, firmer abdominal contour that is more proportionate with your body type and weight. The final results may be initially obscured by swelling and your inability to stand fully upright until internal healing is complete. Within a week or two, you should be standing tall and confident about your new slimmer profile.

Breast lift

Breast lift or mastopexy surgery raises and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Many patients combine this procedure with a breast augmentation, choosing either saline or silicone implants.

What happens during Breast Lift surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during breast lift surgery.

Step 2 – The incision

There are two common incision patterns:

        • Around the areola and vertically down from the areola to the breast crease
        • Around the areola, vertically down from the breast crease and horizontally along the breast crease

Step 3 – Reshaping your breasts

After I make the incisions:

        • The underlying breast tissue is lifted and reshaped to improve breast contour and firmness.
        • The nipple and areola are re-positioned to a natural, more youthful height.
        • If necessary, enlarged areolas are reduced by excising skin at the perimeter.
        • Excess breast skin is removed to compensate for a loss of elasticity.

After your breasts are reshaped and excess skin is removed, the remaining skin is tightened as the incisions are closed. Some incision lines resulting from breast lifts are concealed in the natural breast contours; however, others are visible on the breast surface. Incision lines are permanent, but in most cases will fade and significantly improve over time. Sutures are layered deep within the breast tissue to create and support the newly shaped breasts. Sutures, skin adhesives and/or surgical tape may be used to close the skin.

Step 4 – See the results

The results of your breast lift surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for breasts which have been restored to a more youthful and uplifted position.

Liposuction

Also known as lipoplasty, liposuction slims and reshapes specific areas of the body by removing excess fat deposits, improving your body contours and proportion, and ultimately, enhancing your self-image.

What happens during liposuction surgery?

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. I will recommend the best choice for you.

Step 2 – The incision

Liposuction is performed through small, inconspicuous incisions.

First, sterile liquid solution is infused to reduce bleeding and trauma. Then a thin hollow tube, or cannula, is inserted through these incisions to loosen excess fat using a controlled back and forth motion. The dislodged fat is then suctioned out of the body using a surgical vacuum or syringe attached to the cannula.

Step 3 – See the results

Your improved body contour will be apparent when the swelling and fluid retention commonly experienced following liposuction subside. With continued practices of healthy diet and fitness, the loss of excess fatty tissue should be permanently maintained. However, substantial weight gain can alter an otherwise permanent result.

ARM LIFT & ARM REDUCTION

Cosmetic Clinic Dubai | 24 August 2019

A Brachioplasty is a surgical procedure to remove loose skin and excess fat deposits on the upper arm. This can be caused by age, as the upper arm skin becomes loose and flabby, or may simply be a feature of natural fat distribution and surplus arm skin (often caused by weight loss). Brachioplasty procedures tackle these conditions to leave a tight and smooth skin appearance by using one, or both, of two key surgical techniques; liposuction and skin excision.

There are two aspects to the problem of the upper arm, the relative amount of excess fat and the excess skin. These problems have two surgical solutions, which are often combined. At the two extremes, there are patients with large arms with surplus fat, who are treated very satisfactorily by liposuction. Unobtrusive stab incisions are made in the armpit and on the back of the elbow. We then need a skilled and obsessional surgeon to very carefully remove the fat smoothly from around the arm. There are other adjacent areas that we often treat at the same time, and in particular fat around the shoulder, armpit, adjacent back and so-called tail of the breast. This is fat that bunches up particularly when wearing a bra, below the front of the armpit. Also, we carry out liposuction of forearms and make particular note of the fat on the back of the elbow. All of these areas can be treated in the same session.

This liposuction carried out on its own is particularly useful when the skin is still relatively elastic and will, therefore, be more commonly carried out in younger patients. At the other extreme, we have skinny patients who simply have a lot of loose skin hanging down embarrassingly as ‘Bingo Wings’. Retraction of the skin after liposuction would not be adequate, and in any case, there is little or no fat to remove. In this case, the solution is skin reduction, and can only be carried out by removing a long ellipse of skin from the back of the elbow, along the line between the inside and back of the arm, curving into the armpit. It is important to consider the position of the scar to ensure it is as subtle as possible.

The scars themselves take some months to settle in. Some surgeons offer to tighten the skin with an excision of skin confined to the armpit. The skin then is pulled up towards the armpit like pulling up a sock. Unfortunately, this does not work for the vast majority of patients. The excess skin is around the circumference of the arm and not along the length. In patients who have had extreme weight loss, perhaps after bariatric surgery, there is surplus skin everywhere and an arm reduction can be incorporated into reductions of the skin of the back, flank and breast

Many patients do not fit into these two groups. They have both excess fat and excess skin. Liposuction alone will not tighten the skin sufficiently. In these cases, a combination of liposuction and excision of skin and fat is carried out. Experience and careful planning are required to produce a symmetrical result. We have all seen patients who have had unequal amounts of skin and fat removed with unnaturally shaped arms, of unequal size. There are even occasions where patients have required to have skin put back, using skin grafts.

 

Telltale Signs of Ageing: Hands

Cosmetic Clinic Dubai | 23 August 2019

One of the telltale signs of ageing is the hands. We don’t tend to apply the same youth-preserving routines to our hands as we do to the face. This, combined with years of hand washing, continual usage and exposure to the elements take their toll on our hands. Signs of ageing hands include dry, scaly and crepey skin, protruding veins, age spots, brittle nails and nobbly joints; which inevitably lead to people feeling self-conscious. How many children want to shake hands with their grandparents?

Where should we start?

The obvious place is the visible area, the skin. It becomes thin, dry and crepey. Lift it up and it stays lifeless, where it was. There is no springing back. We lose collagen, elasticity and the glands that secrete onto the surface. Soft suppleness is lost. There is no tender touch. Age spots or liver spots are the flat brown or grey patches appearing on the back of the hands of most people above 40 years old and particularly those with fair skin.

They occur due to exposure to the sun, resulting in excess melanin production. Sun also causes rough, scaly patches called actinic keratosis (AKs). Beware, these are pre-cancerous, developing into Squamous Cell Carcinomas (SCC). The patches of pigment are also not immune to malignant change. Beneath the skin, the veins and tendons become prominent and visible as the underlying supporting fat melts away. Nails become brittle and prone to fungal infection. The wrist and finger joints become nobbly, stiff, deformed and painful with arthritis.

EYELID REDUCTION (BLEPHAROPLASTY)

Blepharoplasty Dubai | 22 August 2019

As we age, the skin around our eyes starts to lose its elasticity causing gradual fine lines and wrinkles. Over time, under-eye bags will start to develop as the muscles relax and lower eyelids sag down. In addition, our upper eyelids can also start to droop with age. Comfort aside, this can also give the eyes an older, tired look and a hooded or bulging appearance that can make patients feel self-conscious. 

During a short operation (1-3 hours), loose skin and excess fatty tissue around the eye area is removed, tightening the relaxed muscles and giving the skin a firmer, more youthful appearance and a more attractive aesthetic.  I use eyelid surgery in conjunction with non-surgical techniques to counteract the effects of ageing around the eyes.

Non-surgical treatments can reduce the wrinkles but not the folds. Injectables can lift the eyebrows. Surgical skin reduction of the upper eyelids leaves a very fine scar in the natural fold and in the lower eyelid is disguised under the eyelashes. Bulging fat can be reduced surgically at the same time the skin can be reduced or re-positioned surgically at the same time as the skin reduction or in the lower eyelid often through the inner conjunctival side of the lid, thus avoiding any possibility of a visible scar. Finally, fat grafting can be added to restore lost fat of not only of the eyelids but of the brow and the temple. The tired hooded, look with bulging bags should now be a thing of the past.  A simple upper eyelid reduction takes less than an hour, but other options to restore vitality including fat grafting and tightening of relaxed muscles may take two or three hours.