Cheshire Cosmetic

Botox® (Botulinum toxin type 'A') is a purified protein produced by the Clostridium botulinum bacteria. It was developed during the 1970s 1980s to treat blepharospasm (spasm of the eyelids) and strabismus (squint). In 1997 it achieved FDA approval for cosmetic use in the USA and by 2006 was granted a license by the MHRA in the UK for the treatment of frown lines. Worldwide, now more than 3 million Botox® treatments take place per year.

Botox® is injected into the target muscle and works at the neuromuscular junction by blocking the transmission of signals from the nerve ending to the muscle. This causes temporary paralysis of the treated muscle, which results in the reduction or loss of wrinkles. The result is not permanent because the nerve ending re-establishes it's signalling by forming new nerve sprouts. This sprouting takes approximately 3-6 months, at which point the muscle regains it's activity and the wrinkles begin to reappear.

By a few tiny injections into facial muscles using a very fine needle.

No discomfort is minimal and no local anaesthetic is required.

The appointment is 30 minutes but treatment only takes around 10-15 minutes.

There is noticeable wrinkle reduction in 3-5 days and the final result appears by 2 weeks.

You should expect results to last at least 3 months.

Treatment is available from £195 and is priced according to the number of areas injected.

• DO gently exercise the treatment areas by frowning, smiling, squinting and lifting the eyebrows occasionally - this will optimise your result
• DO NOT rub or massage the treatment areas this may increase the risk of complications by spreading the product
• AVOID alcohol, aspirin and ibuprofen for 24 hours which can increase the risk of bruising and swelling
• AVOID lying flat or bending down excessively
• AVOID very strenuous physical activity

• Small area of redness at treatment site lasting 2-3 hours (common)
• Bruising / swelling of treatment area (less common)
• Dull heavy sensation +/- occasional headache (less common)
• Ptosis (droop) of eyebrow or eyelid (rare)
• Double vision (very rare)

No administered in the correct manner by a skilled professional carries very little risk. Botox has a proven safety record since the 1970s.

Although most people would benefit from treatment, you should avoid Botox® if any of the following are relevant:

• Known history of hypersensitivity to any ingredient in Botox®
• Disorders of muscle weakness (eg. myasthenia gravis)
• Concurrent use of certain antibiotics (eg. erythromycin)
• Anticoagulants and bleeding

Dermal fillers are injectable products that soften and correct lines, wrinkles and folds in the skin. In addition, they are commonly used to augment and enhance the lips, cheeks and facial contours.

There are a variety of dermal fillers on the market, which vary in their composition, however the most commonly used material is hyaluronic acid (HA). This is a natural, non-animal based, stabilised clear gel which hydrates and volumises the tissue. Most patients choose a HA product due to:

• Safety over 10 million treatments performed over 10 years
• Natural tissue tailored HA resembles the skin's own material
• Long lasting but not permanent (typical results last 3-12 months)
• Non-animal - reducing the risk of adverse reactions (only 1 in 20 000)
• Quick and simple most treatments take < 30mins to complete

Restylane® and Juvederm Ultra® are preferred by Dr Acquilla due to their superior performance and longevity in addition to cost effectiveness.

The most commonly treated areas are:

• Nasolabial (nose to mouth) lines
• Lip enhancement
• Cheeks and chin (volumising and contouring)
• Rejuvenation of the face, hands and dcolletage
• Glabellar (frown) lines that are resistant to Botox®

• Informed consent with pre-treatment photos
• Local anaesthetic cream or injections used to increase comfort
• Dermal filler injected into skin via fine gauge (27-31G) needle
• Injection sites massaged to promote even integration into tissue
• Tissue expansion associated with slight burning / stinging sensation

Most procedures can be completed within 30 minutes.

Some patients may experience a mild stinging or burning sensation as the product is injected. This is reduced significantly by application of a local anaesthetic cream prior to treatment.

Treatments are priced according to the number of syringes required to correct the lines, wrinkles or volume. Juvederm® treatment is available from £150 and Restylane® from £180.

Treatment result last between 6-12months, depending on a variety of factors such as product type, area injected, degree of correction, age, skin type and lifestyle.

It is recommended that following Laser or Peels, the skin is allowed to recover for 4-6 weeks before undergoing dermal filler treatment.

• Immediate redness, swelling, burning and itching around the treatment site are COMMON and should settle within the first few hours
• Bruising and swelling lasting up to 2 weeks are LESS COMMON and should resolve spontaneously
• Slight blue discolouration of the treatment area is LESS COMMON
• Cold sores may RARELY erupt following lip augmentation – this should be treated with Zovirax cream from the pharmacy
• Tissue infection / abcess is RARE and can be treated with antibiotics
• Granuloma (tissue nodules) are VERY RARE and can be treated with injection of steroid into the affected area
• Tissue necrosis (sores) is VERY RARE and usually resolves
• Hypersensitivity / allergy is VERY RARE and can be treated with antihistamines

Although most people would benefit from treatment, you should avoid dermal fillers if any of the following are relevant:

• History of severe allergy or anaphylaxis
• Known bruising or bleeding disorders
• Anticoagulant and immunosuppressant drugs
• Pregnancy / breast feeding

Sculptra™ is a collagen stimulator and is used to correct facial ageing by replacing the volume that is lost over time. It has been described as the "liquid facelift" and should not be confused with dermal fillers.

The active ingredient (Poly-L-lactic acid) is diluted to form a suspension. This material is then injected directly into the deep dermis of the skin. Poly-L-lactic acid stimulates a cell called fibroblast to produce collagen, which in turn creates volume to correct the signs of facial ageing.

• Informed consent with pre-treatment photos
• Facial mapping to identify areas of volume depletion
• Local anaesthetic cream or injections used to increase comfort
• Sculptra™ injected into skin via fine gauge (27g) needle
• Injection sites massaged to promote even integration into tissue

Most procedures can be completed within 30 minutes.

Some patients may experience a mild stinging or burning sensation as the product is injected. This is reduced significantly by application of a local anaesthetic cream prior to treatment.

The cost of Sculptra depends on the number of vials required to achieve the desired result. Typically a full course of treatment requires 3-6 vials, costing between £995-£1800.

The minimum number of treatments advised is 3, although a full course involves 6 treatments. Each treatment session is separated by a 6 week interval to allow adequate collagen production and volumising to occur. Top up treatments are recommended 2-3 years after the initial course.

It takes around 6 weeks for visible results to occur and following a full course of 6 vials, results should last between 2-3 years.

Massage is the most essential component of aftercare and should be performed for 5 minutes, 5 times a day over the first 5 days. Thereafter, massaging twice daily for 5 minutes is sufficient. Massage is an integral part of the treatment to ensure even distribution of the product in the tissue and to stimulate collagen production. This dramatically improves results and reduces the risk of nodules forming in the skin.

• Immediate redness, swelling, burning and itching around the treatment
• site are COMMON and should settle within the first few hours
• Bruising and swelling lasting up to 2 weeks are LESS COMMON and should resolve spontaneously
• Tissue infection / abcess is RARE and can be treated with antibiotics
• Granuloma (tissue nodules) are VERY RARE and can be treated with injection of steroid into the affected area
• Hypersensitivity / allergy is VERY RARE and can be treated with antihistamines

Although most people would benefit from treatment, you should avoid Sculptra™ if any of the following are relevant:

• History of severe allergy or anaphylaxis
• Known bruising or bleeding disorders
• Anticoagulant and immunosuppressant drugs
• Pregnancy / breast feeding

The products in each Obagi System are specifically designed to work together. When used as a system, the formulas combine to effectively balance the pH level and penetrate ingredients to the layers of the skin revealing superior results.

Obagi System skin care products are prescription strength formulations regulated by the FDA + MHRA and can only be sold with a prescription through a physician, such as a Dermatologist or Plastic Surgeon. Obagi System does not endorse purchasing prescription products from the internet without a written prescription.

Obagi System skin care products are prescription strength, or pharmaceutical quality products that work at the cellular level to improve the skin cell function. Products purchased from a retail store are Cosmeceutical products. When applied, they do not correct skin cells, instead they "mask" the damaged skin only on the surface of the skin for a temporary period.

With the exception of the Obagi Nu-Derm System Eye Cream and Professional-C 5%, you should avoid using products around the eye area, as that skin area is thin and delicate. The products can be used on the neck and chest, although this area can be more sensitive than the face.

The non-prescription products are safe to use during pregnancy and breast feeding. The prescription products which contain Hydroquinone and Tretinoin are contraindicated for women who are pregnant or breastfeeding and should be avoided.

Keeping in mind that extended sun exposure damages the skin, it is suggested to avoid prolonged sun exposure without protection. Always wear a sunscreen like the Obagi Nu-Derm Healthy Skin Protection SPF 35, Obagi-C Rx SunGuard SPF 30, or Obagi Nu-Derm Physical UV Block SPF 32. While on the system, you can participate in normal outdoor activity, however, your skin may be sensitive to the sun and heat. It is very important to apply sun protection every few hours while exposed to the sun.

The skin is your largest living organ and is constantly in the process of renewal. Skin cells mature and migrate to the surface approximately every 28 to 40 days. The dead cells remain on the surface for another 12 days before sloughing off. When you stop using the products, you have interrupted the healthy cell renewel process. Eventually, the improved healthy cells will revert to where you started with abnormal skin cell function. You will begin to see diminishing results within weeks..

As skin ages, just like the body, it loses the ability to properly renew itself. The Obagi Nu-Derm System is a prescription strength skin care system that is physician monitored to accelerate skin cell turnover so that it looks and acts younger and healthier.

The prescribed protocol and frequency is determined by your individual skin condition. By carefully following your customized protocol, you can expect visible improvements in 4-6 weeks.

You may experience several phases of Transformation. In the first phase, "Out With The Old", the System accelerates dead cell exfoliation, so expect flaking and peeling, revealing fresher, smoother skin. In the second phase, "In With The New", your skin will begin to build tolerance to peeling and flaking. During that time the System is working at the cellular level to continually transform skin cells. In the third phase, "Healthy Glow", histologically, collagen and elastin are increasing production and skin will feel supple and resilient. Uneven color and pigmentation begin to even out. In the fourth phase, "The New You", you keep your skin looking and acting younger and healthier.

Vitamin C belongs to an important group of antioxidants which fight the free radicals that age the skin. Studies have shown topical Vitamin C, in the most effective form (L-ascorbic acid), can help improve sun protection, repair sun damaged skin, reduce fine lines, stimulate collagen building and potentially reduce discoloration of the skin.

The Obagi-C Rx System is the first and only prescription-strength Vitamin C System of products in the UK. Its patented formulation, using proven ingredients, provides a simple to use system for brighter, more radiant skin. While many Vitamin C products simply moisturize the skin's surface, the Obagi-C Rx System penetrates to all layers of the skin, effectively delivering more Vitamin C than other brands.

There are two C-Exfoliating Day Lotion options. One has a sunscreen with SPF 12 and the other does not have a sunscreen. Some patients already use sunscreen, dislike the sunscreen smell or are prone to irritation or breakouts caused by sunscreens. Other patients need the extra sunscreen or want the added convenience of a sunscreen built into their lotion.

Those seeking skin resurfacing procedures (Blue Peel) usually have unhealthy skin. By improving important skin cell functions with the Obagi Nu- Derm System prior to the procedure, post-procedure care is enhanced and down time is reduced. Further, the post-procedure variables such as sensitivity, post-inflammatory hyperpigmentation, erythema and scarring are reduced. Early recovery of normal skin structure and function will ultimately boost satisfaction with the procedure.

It varies based on the skin type, skin condition and depth of the Blue Peel. Usually, a minimum pre-conditioning program lasts 6 weeks. Skin with more pigment or hyperpigmentation requires 12-18 weeks.

Because TCA is a clear aqueous solution, over painting and uneven penetration can easily occur leading to unsatisfactory results. The Blue Peel is a unique procedure enhacing control of the depth of TCA. The blue mixing base helps to ensure consistent results .

Depending on the depth level of the Blue Peel, healing time is between 3 and 10 days. After the procedure, you will experience light swelling and your skin will begin to peel within 2 to 3 days.

Genuine Dermaroller® is a recognised medical device which produces thousands of microscopic needle columns into the dermis of the skin. Each column is approximately 0.1mm wide and 1.5mm deep.

The fine medical needles cause strategic damage to skin, which stimulates a repair process, including new collagen formation and improved blood supply. This results in improved skin texture and volume.

Dermaroller® has been shown to markedly improve the appearance of

• Acne scarring
• Aged and sun damaged skin
• Lines and wrinkles
• Stretch marks

• Skin cleaned and prepared with local anaesthetic cream for comfort
• Dermaroller® applied to the skin twice in 6 directions
• Skin looks sunburnt with tiny areas of pinpoint bleeding
• Chiroxy cream applied to skin to improve healing
• Skin must be cleansed gently for 48hrs until columns close
• Heliocare SPF 50 cream advised for 6 weeks after treatment

After treatment, the skin looks red and sunburnt with minimal pin-point bleeding. Any redness, warmth and tightness settles within 2-3hrs. Bruising is very rare.

Most patients will achieve excellent results after 2-3 sessions at 6 weekly intervals.

Each treatment costs £295 and includes Chiroxy aftercare cream and Heliocare SPF 50 cream.

• LASER (Light Amplification by Stimulation of Radiation) is monochromatic (single colour) light, which is coherent (rays run parallel) and collimated (linear).
• IPL (Intense Pulsed Light) is broad spectrum light (like a rainbow) which non-coherant (diffuse rays) and divergent (spreads).How does Laser & IPL work?

• Haemoglobin – found in blood (eg. thread veins)
• Melanin – found in hair and pigmented skin lesions (eg. freckles)
• Ink & Dye – found in tattoos

Once the correct wavelength is selected, the light energy is absorbed by the target and converted to heat. The target (eg. thread vein / skin lesion / hair / tattoo) is subsequently destroyed and removed, with the surrounding tissue left unaffected.

• Pigmention problems :
  eg. Lentigo (age spots), actinic keratosis, melasma, poikiloderma, postinflammatory pigmentation (eg. acne scarring)
• Vascular (blood vessel) problems :
  eg. Rosacea, thread veins, haemangiomas, telangectasia, port wine stains and superficial varicose veins<
• Hair removal
• Tattoo removal

• Medical history to assess skin type and suitability for treatment
• Informed consent, pre treatment photographs and skin patch test
• Any residual hair in the treatment area is shaved
• Protective eye goggles are worn and cool gel applied to skin
• Laser / IPL handpiece applied to small patches of skin at a time
• Each laser shot feels like an elastic band flicking the skin
• Target is disrupted immediately and surrounding skin can be red
• Procedure takes 30-60 minutes to complete

This largely depends on the type of problem. Hair and tattoo removal usually requires treatment to be repeated at least 6 times at 6 weekly intervals. However, photorejuventation for pigmented and vascular problems (eg lentigo and thread veins) may only need 2-3 sessions.

Laser & IPL can lead to pigmentation if the inflamed treated skin is exposed to UV sunlight. Therefore sun avoidance and SPF >30 are advised for 4 weeks.

• Redness and warmth at treatment site (COMMON)
• Blisters, crusting and swelling at treatment site (LESS COMMON)
• Burning and itching at treatment site (LESS COMMON)
• Post inflammatory pigmentation changes (RARE)
• Infection and scarring (VERY RARE)

• Pregnancy and breast feeding
• History of diabetes or immune suppression
• History of skin cancer or keloid scarring
• Recent or planned sun exposure / tanning within 4 weeks
• Concurrent use of photosensitising drugs

Prices range from £60-300 per session and total cost depends on the area treated and the number of sessions required.

• Informed consent with pre-treatment photographs
• Skin cleaned and sterilized with alcohol or iodine
• Local anaesthetic injection into the lesion using a very fine needle
• Mole / skin lesion removed and the skin sealed or sutured
• All skin biopsy specimens are sent for histology analysis
• Any bleeding is treated with either an electro-cautery or silver nitrate tip
• The wound is dressed and should be kept dry for 24 hours

Typically, sutures are removed at 5 days from the face and 7 days from the body.

• Excision – a leaf shaped incision is made around the mole using a small tip scalpel. The wound is then closed using a fine suture. This technique is used for flat, pigmented moles and lesions and leaves a fine linear scar.
• Shave Excision – suitable for raised or fleshy lesions, especially on the face. The lesion is removed by running a blade flat across the base of the lesion and leaves a round and flat scar.
• Cautery – this is a similar technique to shave excision but uses a fine electrical cutting tip instead of a scalpel. It is commonly used to remove skin tags.
• Curretage – is a scraping technique and is appropriate for skin lesions which are superficial and look "stuck on" (eg. seborrhoeic warts).
  Scarring is minimal and is usually flat and slightly paler than the surrounding skin.
• Cryotherapy – uses liquid nitrogen spray to create a ball of ice in the tissue, which freezes and destroys the skin lesion. It is suitable for most warts and normally takes 2-3 treatments to remove the skin lesion. Scarring is minimal and usually depends on the depth of the lesion.

Full wound healing is achieved at 4-6 weeks, but the final cosmetic appearance may take 2-3 months to complete

• Scarring depends on the type, size and site of mole / skin lesion and is UNCOMMON
• Bleeding and infection are RARE when performed aseptically
• Allergy to the local anaesthetic or iodine is RARE
• Hyperthrophic (thickened) and keloid scarring is abnormal and VERY RARE