Can my Client on Immunosuppressants get Botox or Filler?!

Can my Client on Immunosuppressants get Botox or Filler?!

We have the general day-to-day Q&A’s as practitioners, prime example being “I’m pregnant, is it safe for me to have botox treatment?” but then every so often we stumble upon clients in slightly more rare circumstances than the usual and it’s why we have a thriving practitioners group on Facebook where expert opinions, advice and knowledge is shared from practitioner to fellow practitioners. Recently someone posted the following question: Can a patient on immunosuppresants for a kidney transplant, receive botox and / or filler? We think this answer to this case, although rare, is something that is worth sharing outside of the group, so here it is! The issue with this clients situation is that they are on immunosuppressants to stop their body rejecting the transplanted kidney. From the outset we know Botox isn’t an issue – we don’t think many practitioners would disagree with that. However, Dermal Filler treatment is potentially an issue as it remains in the body for 6-18 months, depending on the product and the area injected. If an infection develops with filler, it can be tricky to treat, requiring several strong antibiotics for a long period. Filler infection is fairly rare, but I  have seen it twice and it can be difficult for the patient to cope with because of the side effects to the antibiotics and due to the fact that the face gets inflamed which can’t be covered up. Being on an immunosuppressant makes it more likely that they could get an infection. So in summary, we say – yes to botox and maybe to filler. As a practitioner it’s essential to...
The Nefertiti Facelift & Working with Platysmal Bands

The Nefertiti Facelift & Working with Platysmal Bands

Did you know that you have four Platysmal Bands? You have two on each side. What are Platysmal bands? Wikipedia describes Platysmal muscle this way – “The platysma is a superficial muscle that overlaps the sternocleidomastoid”… The platysmal muscle covers the upper part of the chest and shoulders rising to the sides of the neck. So now that we’ve cleared that up… we can imagine the process of aging in this area which is situated below the jawline and along the neck area. Usually we picture the aging process as the skin ‘drooping’ and loosing elasticity. However the same is not to be said about the Platysmal Bands – these bands actually tighten over time which forms prominent lines at the front of our necks. Enter the Nefertiti Facelift. It is most common for only one or a couple of the bands to become more prominent, causing the tenting out at the neck which affects the cervico-mandibular angle (the angle of your chin to neck). So how do we treat this problem area for so many? We hear from Dr Michael Aicken, founder of as well as trainer and practitioner at Visage Aesthetics U.K. – First up:  “Ask your patient to tense up and relax from the sides and identify which one(s) are causing the issue…” Next:  “Inject Botox down the muscle band, directly into it by grabbing it like a rope between your finger and thumb. No anaesthetic cream is best as then it isn’t slippy,  (this area is not usually tender anyway). 4 units Botulinum Toxin (Allergan) or 5 graduations of a 1ml insulin syringe if you trained with Visage Academy / Dr Aicken...

Large Swelling Immediately After Dermal Filler Treatment

Imagine that you have just injected a patient’s lips or cheek. Suddenly, the area swells up like nothing you have ever seen before. It’s an unfamiliar sight… you panic… you vaguely remember about some of the rare but catastrophic complications of dermal filler. You reach for your emergency filler pack. Should you do that? Are you sure? Skin ischaemia is now a complication of dermal filler treatment that most practitioners are aware of but thankfully, few have experienced it first hand. With an estimated incidence of 1 in 1 million, in an industry still experiencing record growth rates, the occurrence of dermal filler related skin ischaemia and many other complications are bound to increase. Haematoma formation (a large, swollen bruise) is another, more common and less severe complication of dermal filler; one that differs from skin ischaemia is almost every possible way, is frequently being misidentified as skin ischaemia by aesthetic practitioners from various medical and non-medical disciplines. Whilst it is vitally important that aesthetic practitioners identify skin ischaemia and take action if they suspect this, it is also important that misdiagnosis is avoided so that perceived rates of skin ischaemia are not inflated and that unnecessary stress is not brought upon these practitioners and their patients. So, what’s the difference? Ischaemia would be white and painful and not associated with swelling. If you see swelling develop before your eyes, you may have hit a blood vessel, causing a haematoma / large bruise. It may not look discoloured like a bruise *YET*, but this may just be because the bruising is so deep that you can’t see it through...

Lipstick Lines (Smoker’s lines): A Quick Guide for Practitioners

Lipstick or ‘smoker’s’ lines can be tricky to treat. They are relatively difficult to access because the nose gets in the way, and it’s difficult to get yourself and the patient into a comfortable position so that you can concentrate on the treatment itself AND when you’re finished, initially, the lines may look worse than when you started! So how do you do it? Lipstick line filler gives ok results if done well. It’s tricky. I recommend using strong anaesthetic gel as it’s a tender area. It can also bruise; remember that each time you insert the needle, you cause more trauma. If the lines are below the nose, approach from below if the lines are lateral to the nose, approach from above. Use a max of 0.4 ml for top lip lipstick lines. If you try a treating a line twice and it still hasn’t lifted, it’s probably better to leave it rather than risk giving them a thickened top lip. Avoid injecting into the lip (i.e. Below the vermilion border), to save on causing unnecessary swelling. Mould the area afterwards to limit the lumps that you leave behind. Be aware, and advise the patient before you start, that initially the lines may look WORSE as they will be highlighted by pink / redness, from the injections themselves. Reassure the patient that on covering with their regular makeup regimen the following day, the true effect of treatment will be seen. I use Dermal Revolution (DERM) now for lipstick lines, but again, remember that no-matter what product you use, apply a strong anaesthetic gel liberally before...

Dermal Filler Doses – Article in Aesthetics by Dr Michael Aicken

Dr Michael Aicken, founder and course director of Visage Academy has this month written a detailed article published in Aesthetics Journal. This article touches on what doses of Dermal Filler should ideally be used in different situations. We have made this article free for our Visage Academy blog readers and can be viewed below with the permission of Aesthetics Journal who we recommend strongly for your CPD requirements.  ...

How Much Filler Should I Use?

With Botox there are standard doses that most practitioners use as their starting point. Adding more as a “top-up’ if required and taking note of the full dose needed for a given result so that it can be reapplied later, Botox doses are relatively straightforward. But with filler we don’t tend to have these “standard’ doses. On our training courses I often explain that Botox administration is a scientific method whereas dermal filler treatments are much more of an artform. So how do I answer this common question, “how much filler should I use?’ Firstly, there is a facetious answer. Teachers and lecturers i’d venture, will always have this answer in mind, and will dream of bursting out with the answer that makes their student look or feel stupid for asking. The vanity from within me, wants me to guffaw, “how long is a piece of string‘ then drop the proverbial mic to the applause of the other students. I also keep wanting to ask in retort, “how deep are the lines?’ Of course, the answer to both is tricky and not unilateral- exactly my point. But wait, i’m supposed to know the answer to this- that’s why people pay me to teach them! Of course, the questioner is asking a specific question about a poorly-defined hypothetical scenario, but in this reply, you can see that knowing how deep the lines are doesn’t really even help decide on the volume you should use. A better question might be – “what volume has been lost’. For an accurate answer you are likely to need to use expensive 3D imaging in...