A while ago I put out a call to ask questions to a cosmetic doctor. It turned out that you especially wanted to know more about fillers and botulinum toxin. I have found the cosmetic doctors of the Van Rosmalen clinic willing to answer the most frequently asked questions. Are you reading along? Note: in the article we are talking about botulinum toxin and not about Botox because Botox is a registered brand name of the Canadian company Allergan.

Are injectables (botulinum toxin and fillers) safe and have they been researched?

Unfortunately, as we age, our skin loses fat and muscle strength diminishes. The fat sags and folds and wrinkles appear. If you still want smooth and tight skin, realize that an expensive cream, despite the promises on the jar, will not help. Only with injectables you get a tight and firm skin again. The origin of injectables (both fillers and botulinum toxin) is medical.

Botulinum Toxin, a naturally purified protein produced by the bacterium Clostridium Botulinum, was originally intended as a remedy for squinting (strabismus) and excessive blinking of the eyelid muscle. The fact that we know the product mainly as a wrinkle-fighting agent is thanks to the Canadian ophthalmologist, Dr. Jean Carruthers. She notices that patients, whom she treats with the medicine for spastic eyelids, have fewer and fewer wrinkles. In 1992 she published about this in the Journal of Dermatologic Surgery and Oncology (1992). The conclusion is that botulinum toxin can be used simply and safely in the treatment of horizontal wrinkles on the forehead, vertical wrinkles between the eyebrows, crow’s feet along the eyes and the small wrinkles on the sides of the nose. By switching off the underlying facial muscles, the face relaxes and the skin becomes beautifully smooth.

Permanent fillers have been banned in the Netherlands since 2015. The clinics certified by NVCG use semi-permanent fillers consisting of the body’s own and degradable material, such as hyaluronic acid. A filler is injected under the skin, attracts and retains moisture, smoothing and filling the skin. Always check that a clinic, such as the Van Rosmalen clinic, only uses fillers that have been approved by the FDA (Food and Drug Administration). Years of research and trials are required before a drug is approved by the FDA.

In the clinics certified by the NVCG that treat according to the guidelines of the NVCG, doctors who have a lot of experience with injectables work. They follow an annual (mandatory) additional training to maintain the certification and have been awarded the title of cosmetic doctor KNMG since the beginning of this year.

How do pigment spots develop, can you prevent them and how do you get them away?

Pigment colors our eyes, skin and hair and protects our skin against UV radiation. If we expose our skin to the sun for too long, the cells that make pigment get confused, causing buildups of pigment: these are the dark spots on your skin. There are different types of pigmentation spots such as age spots and a pregnancy mask or melasma. Age or sun spots are common in people over the age of 50. They are brown spots on the skin that has been (too) exposed to sunlight, such as hands and face. The spots are almost always benign and are most common on your face, décolleté or arms. They are caused by exposure to sunlight or medication. When you are pregnant, these spots can become more intense under the influence of pregnancy hormones. We call this a ‘pregnancy mask’. After childbirth, these harmless spots disappear again. Melasma and age spots can be treated in different ways. The very best advice is prevention. Through education, do not expose the skin excessively to harmful sunlight from an early age and apply SPF30 or higher every day, even when it rains. Skin damage caused by the sun is stored in the DNA and can develop into skin cancer at an older age.

In general, all pigmentation spots can be treated. Whether they will disappear completely depends on a number of factors such as size, color and skin type. Pigmentation spots can be treated with the laser, a peel or cryop. And because beautiful skin starts at home, we advise our clients to invest in good skin care products that really do something for your skin, such as cosmeceuticals. These products have a high concentration of active ingredients that lighten the pigment spots, such as the Mela Cream from Skinceuticals.

Cryopen: the cryopen can freeze the spot with high pressure to the nearest millimeter so that the surrounding tissue is not damaged. After the treatment, the skin around the spot may turn a little red. This disappears after a few days, just like the scab on the treated area. For a good result, this treatment should be repeated 3 to 4 times. The cryopen does not cause scarring.

Laser: The laser treatment aims to remove the excessive and unwanted pigment in the skin and is only suitable for dark spots. The doctor or skin therapist flashes laser beams towards the skin cells. These energy pulses are absorbed by the pigment in the skin, so that it breaks down and the pigment is reduced. The advantage of laser therapy is that you can aim the laser flashes well, so that the skin cells around the pigmentation spot remain largely undamaged. The laser flash feels like a pinprick. After the treatment, the pigmentation spot sometimes turns a bit darker, this usually improves again. For superficial pigmentation spots, 1 to 2 treatments are required. For deeper pigment spots, several treatments (8-10) are required to achieve a good result.

Peels: pigmentation spots can also be reduced with a chemical peel. This removes the top skin cells and pigment granules from the epidermis. The result is an improved and fresher skin structure. Several treatments are required for good results. The effectiveness of a peel depends on the strength of the acid used. The deeper the peeling goes, the better the result.

What can you do about drooping eyelids and is it maintenance?

As you get older, the skin slackens and your eyebrows drop slightly. This often makes you look more tired. Fortunately, there is something that can be done with an upper eyelid correction in which a strip of sagging skin is removed from the upper eyelid. Mark the area of ​​skin that will be removed on the eyelids with a felt-tip pen. This is done under local anaesthetic. The doctor makes an incision in the crease of the eyelid, removes the excess skin, excess fat and sometimes a piece of muscle. The doctor then stitches the incision.

The scar falls in the crease of the eye and is therefore barely visible after a while. The procedure takes 45-60 minutes. After the procedure you will be checked for bleeding. If not, you can go home. The first week your eyelids are swollen and there may be some color difference between the skin above and below the scar. This is due to widening of the blood vessels in the eyelid after surgery. This makes the upper eyelid redder for the first time after the operation. This is especially common in thin-skinned and fair-skinned people. It is important to cool your eyes with a cool pack for the first few days after the procedure. After five to seven days you will come to the clinic for a check-up and the stitches will be removed.

After about two months you will see the end result which depends on hereditary factors, smoking, drinking and excessive sunlight. Do you use good skincare like cosmeceuticals? Then you can slow down skin aging somewhat. On average, the result remains visible for five to fifteen years.

After that, if necessary and desired, you can have a second eyelid correction done.

What is a ‘lion’s nose’ and how do you prevent it?

If someone has a ‘lion’ nose, too much botulinum toxin has been injected between the eyes and in the forehead. As a result, the botulinum toxin sinks and a thickening occurs between the eyebrows. This gives the nose of people with too much botulinum toxin between their eyebrows the same shape as a lion’s nose. Hence the term “lion’s” nose. You can prevent this by treating the client according to the guidelines of the NVCG and by using the right amount of botulinum toxin. Experienced cosmetic doctors assume the client’s natural appearance and are more likely to use less than too much botulinum toxin.

What are ‘smoker’s lines’ and is there anything that can be done about it?

With age, the volume of our jawbone decreases, causing the skin to loosen slightly and vertical wrinkles appear around the mouth. These stubborn wrinkles on the upper lip are popularly referred to as barcode or pleated skirt. They usually develop around the age of 40, especially in smokers or people who have been exposed to sun radiation for a long time without protection. Sometimes there is a hereditary predisposition.

Because these wrinkles are often deep and hard, treatment is difficult. We always advise the client to first improve the quality of the skin by undergoing one or more treatments (laser, dermapen, peels or a combination of these) with the skin therapist. The distance between the bottom of the nose and the upper lip becomes longer, there is more emphasis on the upper lip when this piece of skin is treated with fillers. We therefore avoid thick fillers because that gives an unnatural result. In many cases, a thin filler with hyaluronic acid in combination with a filler that provides hydration from the inside offers a nice result.

a treatment with the dermapen (aka enterpen)

What can you do about a ‘chicken’ neck?

Do you suffer from a slack jawline, overactive neck muscle (cable formation) and marionette muscle that pulls down the corners of the mouth? With age, not only does our skin weaken, the bone structure also changes. And that has an effect on the jawline. Cheeks sag and gradually our face loses its V-shape with high cheekbones and tight jawline. Often this is made worse by excessive activity of the neck muscle and marionette muscle causing the fat to sink higher up from the face, resulting in hamster cheeks. A slack jawline makes us look older and more tired than we really are. If you suffer from a slack neck due to drooping skin under the chin (‘chicken’ neck), a neck lift treatment (platysmaplasty) might be something for you. The slack muscles of the neck are corrected by making a small incision at the bottom of the chin. The plastic surgeon loosens the skin at the front of the neck and stitches the weakened muscles together. This is done under local anaesthetic. After the treatment, the neck feels a bit swollen. The stitches are removed after two weeks.

Don’t want to go under the knife? Fortunately, there is also something that can be done without surgical intervention with botulinum toxin. During this treatment of about 30 minutes, the doctor injects small amounts of botulinum toxin under the skin with a fine needle in the chin, lower jaw, neck muscle and marionette muscle. The result is immediately visible and lasts for about three months. Is the skin on your neck seriously sagging? Then opt for a treatment with fillers. The result is then visible for about 9 months.

Are you curious about what a cosmetic can do for you after reading this article? Or do you have a few more questions? Then make an appointment with a clinic near you. Always opt for a clinic certified by the NVCG, such as the Van Rosmalen clinic, our doctors have registered the protected professional title of cosmetic doctor KNMG and BIG. Our doctors are kept up to date with developments in the profession through continuing education and every treatment takes place completely according to the guidelines of the Dutch Association of Cosmetic Medicine (NVCG). That way you know your skin is in good hands.

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