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...

When Not To Treat

“Good surgeons know how to operate, better ones when to operate, and the best when not to operate.” (Anon) This is a rough guide for those involved in the treatment of patients with Botulinum Toxin type A & Hyaluronic Acid. Here we’ll use the medical history form from the Flourish Cosmetic App as a reference – this can be viewed here. You may find it useful to open this now in a new window. This medical history form incorporates the questions taken from the medical history and consent forms disseminated by all of the leading Botulinum Toxin and Hyaluronic Acid manufacturers. It seeks to be comprehensive. The Flourish Cosmetic App is currently co-owned by Visage Aesthetics UK (the same company that owns this website). Introduction Basically, there aren’t many conditions that we need to absolutely avoid when using Botox and Fillers, which is why, if you took a punt and treated everyone without question, you’d probably get away with it. But i’ll go through the Flourish medical history form so that you can see the kinds of things I pick up on when I review this with a patient, either before I treat them myself or whenever I consult with them and decide to go ahead and issue prescriptions for them to their own practitioner. Are you attending or receiving treatment from a doctor or specialist? This one should catch most things and many of the later questions are just double-checking the answers. For example, many people who have chronic illness can forget to mention it when you ask them about medical problems. That’s why Doctors often ask this same question in...

Lumps

I probably get asked about lumps more than anything else related to Botox or Fillers. Usually it’s lips, but here’s my short, simple advice on lumps, wherever they appear. With lips, patients will often describe their lumps appearing days after the procedure. This is not due to the filler enlarging or growing. Check you aren’t leaving visible lumps post procedure before the patient leaves. Do this by feel as well as visually. Remember that lips swell when you insert a needle into them. This has little to do with the filler and is mostly related to the act of puncturing the skin and small blood vessels with a needle. This swelling hides from plain sight any lumps of filler left behind. As the swelling subsides over the coming days, the lumps are then revealed. Think rocks on the beach. When the tide goes out, the rocks are visible but the rocks were there all along and could be found below the surface. If you have purposefully left a lump (a bolus of filler) anywhere that you can feel with your fingers (and if you are replacing volume this is often the standard method) it’s important to explain to the patient that this is your intention and that this is normal but that they shouldn’t see the ‘lumps’. It’s also useful to provide an aftercare sheet (and if you’re using Flourish they will have ticked a box to say that they have downloaded and read the aftercare sheet) explaining again about lumps and what to do about them if they are present. I definitely don’t recommend telling patients to massage...

Guidance for doctors who offer cosmetic interventions: My take

It’s 24 pages long and fairly repetitive so I have read the GMC’s “Guidance for doctors who offer cosmetic interventions” (12th April 2016) and reflected here on its significance for me; a cosmetic practitioner, a cosmetic trainer and a prescriber for others who use ‘Botox’. Download the full guidance here You may be employed by a cosmetic clinic or more likely, acting in a self-employed role, undertaking work for a clinic, so you might consider yourself as not being ‘the boss’. But, a point that these guidelines reinforce is that if you are a doctor and you work alongside another member of staff in the provision of medical treatments, you are their supervisor and the care of patients you have prescribed Botox for, has been delegated by you to your colleague. Here’s what i’ll be clarifying with anyone I prescribe for and also what i’ll be checking with colleagues in future before I start working for them in a prescriber role: I would like a copy of their training course certificate and evidence of insurance I will make it understood that written consent of the particular procedure is the responsibility of the person carrying out that procedure As a doctor I must not put my interests or loyalties or the interests or loyalties of the clinic, ahead of patient safety Treatments must not be given out as prizes OR in discounted sales that might pressure a patient to receive a treatment now rather than waiting and considering it further I will provide patients with a way of contacting me should they be concerned regarding any of the following- Lack...

Treating Under-arm Sweating with ‘Botox’ or ‘Azzalure’: A Quick Guide for Practitioners

Here’s a summary of what we cover on our Foundation course regarding the underarm treatment with Botulinum Toxin Type A: – 1 vial Azzalure each side or 50 units Botox each side – explain alternatives (surgery, special deodorant/powders / referral for treatment via the NHS- advise patients to discuss with their GP) – Advise no shaving for 48 hours before or after treatment – Look where the hair follicles are and mark a “circle’ 1cm further out than this. Divide up into 16 sections plus another 2 sections for the tail, going into the deltoid/pec.major/biceps section of the axilla. – Divide the volume of BTXA (whichever product) and give equal amounts into each injection site, as superficially as possible for best results. – Note, some trainers / courses recommend painting the axillae with iodine then dusting with cornflower, allowing the water in the sweat to transform this into purple patches where sweating occurs- I don’t do this as it makes a big mess and hasn’t given me any better results than the above method – If top-up is required, usually the patient can point to where sweating still occurs. If not, use a gloved finger to map out areas where sweating still occurs as follows; if gloves slides over skin, there is no sweat; if the glove “sticks’, there is sweat (whether you can see it with your bare eyes or not) Whether or not you are “allowed’ to perform this treatment is between you and your insurer. I know that some Dentists don’t offer it as they don’t typically treat “below the neck’ but Doctors and Nurses don’t...