The aesthetic world is an exciting industry that opens many opportunities for both medical and dental practitioners. You can perform these cosmetic injectable treatments right after you complete a Botulinum Toxin and Dermal filler training course.

Additionally, a Botulinum toxin and Dermal filler training course will provide you with the skills and education to offer predictable and effective cosmetic treatments that complement the treatment you are already providing. When you undertake training, you need a training provider, just like us, that provides scientific evidence and anatomical based training. And furthermore, you need ongoing mentorship and support. Our foundation is: Anatomy. Technique. Product. We will ensure you understand all three important facets of treatment.

Our e-learning platform is robust, packed with informative and interactive content that you can review and learn from over time. We regularly update this content as advancements come forward and techniques are progressive over time.

Both Botultinum toxin and dermal fillers are two of the most requested treatments in the cosmetic market. More and more people place their trust in certified well-trained practitioners for these aesthetic treatments. This is especially so since they are already your client, and already trust your judgement and care. The increasing market for Botulinum toxin and dermal fillers makes it the training you need to enter the medical and dental cosmetic and therapeutic enhancement industry.

The Similarities Of injectable Treatments

Many medical conditions require the use of Botox and dermal filler products to treat different illnesses.

In the medical cosmetic industry and dental cosmetic industry, Botulinum toxin and dermal fillers are primarily helpful for treating many skin ageing and rejuvenation conditions.

For example, both of these treatments can resolve your problems with wrinkles and fine lines.

This similarity between Toxin injections and dermal filler treatments allows for many training platforms to combine their lessons in one training course. It means you get to learn about Toxin and dermal fillers in one training period, so that you come away with both practical skills. Our Complete Lip artistry course is an entry level course that provides you with these foundation skills.

However, there are other options for you for your Botulinum Toxin and filler training. Some practitioners choose to step into the cosmetic injectable space by learning about botulinum toxin first, by attending our Level a: Botulinum course.

The Difference Between Botulinum Toxin and Dermal Fillers

Despite both Botulinum toxin and dermal filler injections targeting skin ageing issues, they both work differently.

Botulinum works by blocking the neurotransmitter acetylcholine from the nerve, so that the facial muscle cannot contract. It means Toxin temporarily weakens or stops the facial muscles from working, thus making the skin smoother. Better yet, we can use Botulinum toxin to reduce the downward pull of muscles, so that the overall shape of the face is more youthful, through the elevation effect toxin use can have.

On the other hand, dermal fillers work by adding volume to the injection target spot. Dermal fillers enhance and redraw the skin, lifting sag through volume replacement. This means that again, the cheekbones can be more prominent, the chin can be projected forward with chin filler and more.
The added volume on saggy skin reduces its appearance. That way, you get to look youthful.

Regardless of how old you are, moisturising should be an integral part of your daily skincare routine. That means twice daily, 365 days a year. And if you’re not currently doing this, start now - no matter if you have oily, combination, dry, acne-prone or normal skin. You may be a 20-something with amazing skin, but trust me, give it a few years and you’ll be wishing you had hit the moisturiser sooner (as hydrated skin functions better). The moisturiser is the basic cornerstone of any great skincare routine - without it our largest, most visible organ would be dry, prone to premature ageing and look very dull.

What’s in moisturiser?

There are tons of moisturisers out there that claim to perform miracles, but there are certain key ingredients that all moisturisers include, and which actually make skin softer and smoother. “What are these amazing ingredients?” I hear you shout. Ok, ok, hang on - I’ll tell you…

Ok, so you will find at least one of three types of ingredients in moisturisers which help keep us - well - moisturised. These are humectants, occlusives and emollients, each of which has individual properties that, when combined, create the ideal moisturising product. Yes, the names sound a bit science-y, but stay with me.

Humectants

Humectants absorb water from the atmosphere into the epidermis (the outer layer of skin), hydrating the skin - which makes them great for dry skin. You may see ingredients such as glycerin, hyaluronic acid or propylene glycerol listed on the back of a moisturiser, which are all types of humectants, though there are loads more out there too.

Emollients

Emollients themselves don’t actually add moisturise, but work like a barrier, filling in deficiencies between skin cells and also providing a barrier to further moisture loss. They are great for dry complexions and conditions such as eczema and psoriasis, as they soothe dry skin, prevent inflammation and keep us feeling soft and smooth. Common emollients include shea butter, aloe vera and ceramides.

Occlusives

Similar to emollients, occlusives don’t add moisture, but instead form a protective film over the skin, locking in the moisture we already have. Occlusives are generally oil-based and common ones include petroleum jelly, beeswax, lanolin and jojoba oil. There is a trend buzzing around at the moment about "skin slugging", which is where you use Vaseline or similar to block the skin. But beware of these trends, as this can be such a barrier that skin cannot work as usual.

What is it about moisturiser that helps us age better?

In our twenties, the vast majority of us hadsoft and supple skin, and clear skin. That comes down to the fact that skin cell turnover is regular, and our bodies naturally develop copious amounts of collagen and elastin. However, as we approach our thirties, collagen and elastin production diminishes slightly, and skin cell turnover is slower - so our skin quality isn’t quite as good as it was. This decreases more and more, the older we get, leading to the onset of lines and wrinkles. A great inclusion into your skincare regime, is the use of a retinol. This should be in addition to your moisturiser to help regulate skin turnover.

However, according to the British Journal of Dermatology, using good moisturiser will help wrinkles develop at a much slower rate than if we were to leave our skin dry and unmoisturised.

In your thirties and forties, you should be looking for a moisturiser that contains anti-ageing properties. Hyaluronic acid is a must as it is a naturally occurring substance that helps lighten dark areas, and absorbs water in the skin like a sponge, keeping it feeling soft, plumped and fabulous.

The older we get, the drier our skin becomes. Obviously this doesn’t happen overnight - it’s a gradual process - but you will start to see a difference as you age. As we reach our fifties, sixties and beyond, our skin also becomes thinner and more fragile, so a lovely rich moisturiser will become your new best friend, helping to hydrate the skin and keep it feeling wonderful, and provide added protection.

Moisturiser alone will not stop wrinkles, but it certainly helps combat them for longer. Keeping your skin hydrated through drinking tons of water, not smoking or drinking too much alcohol, using a moisturiser best suited to your skin type, eating a healthy diet - and - of course, using a high SPF sunscreen are all important for great skin, no matter what age you are. And if you’re simply blessed with amazing genes, well, good for you!

Whether we treat our patient superficially, whether it be with chemical peels or dermal needling, we constantly assess the facial profile, to ensure that we have balance, symmetry and harmony in the results we achieve. To finalise the aesthetic results and to complete our treatment plan, the use of botulinum toxin can be engaged to enhance the traditional cosmetic treatments that dentists are used to employing for a great outcome. One of my favourite techniques to use botulinum toxin in my practice is for facial rebalancing.

What is Rebalancing?

Our entire body is based on balance. To stand up, we engage certain key muscles in our core and legs, just as we engage different muscles to move our arms and so on. So let’s look at the face. The same can be said of the face. We have muscles that balance each other so that we can have a neutral expression. When we smile, we activate muscle to elevate the lips, raise our brows and eyes into a ‘happy’ expression and so on. This engagement of muscles is such that the elevators hold the balance, creating uplift and a pleased expression. When we want to show that we are unhappy, we will engage a different set of muscles, so that the balance is held by depressor action.

Newton’s third law: For every action (force) in nature there is an equal and opposite reaction.

By using our knowledge of elevators and depressors, we can selectively choose and then treat which muscles will hold the balance in our chosen area. This is a key decision making process that I undertake when I treat my patients, and part of the treatment discussion. I need my patient to understand that freezing one muscle completely for the sake of wrinkles and lines, will lead to the opposing muscle having the balance of muscle pull in the other direction.
When we treat one muscle with Botulinum toxin type-A (BTX-A), the opposing muscle will take over. So it is always important to consider the elevators and depressors of the face. There are two pivotal areas where this is extremely important, as we can change the facial contours by selecting where the balance of muscle pull lies. Namely these areas are the brows and lip regions.

Facial anatomy and muscle action

Lines will run perpendicular to the muscle action. If a muscle pulls up, the lines with run across the face. If the muscle pulls laterally, the lines will run vertically on the face. So when you look at the muscle action map, you can assess which muscles elevate, which muscles pull laterally or medially, and those that are depressors.

The only elevator of the upper face and eyebrows is the Frontalis muscle. So what happens if a patient wants complete freezing of the frontal muscle? This means that the depressors will hold the balance of the brow position, making the brows heavy. This can create a downward pull and heaviness that is undesirable to the patient and the aesthetic outcome. Some of you might be thinking that you can overcome this by undertaking a toxin brow lift, but your efforts will be futile, as the muscle around the eye, the orbicularis oculi pulls down under the brow. Adding toxin here will stop the muscle pulling down. So the balance between the frontal inaction, and the orbicularis oculi brow lift is neutral or no action.

For a patient with heavy eyebrows, it would be important to under-treat the Frontalis, to avoid further creating heaviness in the brow, as the frontalis is the only muscle to lift the heavy brows. Too much relaxation will leave the patient unhappy as the orbicularis oculi muscle cannot lift the brows, and the heaviness will burden the patient. However, if we minimise our frontal doses so that there is still some movement, we can minimise forehead lines, whilst maximising the facial rebalancing of the muscles. Win-win.

Similarly, if we add too much relaxation in the central frontal region, the so called ‘drop zone’, the frown will bulge and be heavy. Therefore, when we make a decision about dosing and freezing muscles, we are really deciding which muscle gets to hold the balance of function.

Now let’s look at the oral commissures and jawline. Again we have elevators and depressor action. Generally speaking, it is aesthetically pleasing if the elevators hold the predominant balance of action. If we are using the facial rebalancing technique, we would select the depressor muscles to treat to improve the jawline and oral commissure position. This means we might add toxin doses to the Depressor Angulis oris, and if appropriate, the Platysma. By minimising their action, the jowl will lift, creating more definition of the jaw line, and the oral commissures may rise at rest. This is an aesthetically pleasing result for our patient.

When treating, we need to avoid accidentally dosing muscles that would create a functional change that would be detrimental to our patient. We need to leave the Depressor Labii Inferioris active, or the lip will be incompetent. Similarly, the Levator Labii Superiors Aqualae Nasalis (LLSAN) can be treated where the patient has a gummy smile, even though it is an elevator. Minimising the action of this elevator muscle would create a positive change for a patient with excess gum display.

Golden tips for use of toxin

Great training is essential, and remaining competent is absolutely necessary in any area of cosmetic medicine or skin treatments. Cosmetic injecting is no different. A single course is not adequate to have recency of practice and keep updated with your techniques. Always look for a course that is heavy on anatomy and medical evidence. As with all other dental treatments and techniques, there are advances that occur, and the cosmetic practitioner needs to remain current with the updated.

In Australia, there are three brands of botulinum toxin on the ARTG register. These are Botox (Allergan), Dysport (Galderma) and Xeomin (Merz). No matter which brand of toxin used, each brand will have a "halo" effect. This means that the toxin will have an effect on the surrounding muscle 1cm from the point of injection. So this becomes important around the eyes in particular, where we should try and stay at least 1cm away from the orbital rim to avoid inadvertent treatment of the ocular muscles, resulting in blurred vision. This can be debilitating for the patient, and the source of a complaint.

Manual spreading of toxin can also occur. The patient should be asked to avoid leaning, touching or sleeping for 4 hours post-treatment. Rubbing the treatment area before this time may result in a changed result or the toxin being diffused to a muscle that was not targeted by the injection. I stress this many times with my patients as I am a skilled injector, and only wish for the best results for my patients.

It is important that your patient does not undertake dental or facial treatments immediately after treatment, to avoid the manual spreading of the Botulinum Toxin. I would recommend deferring all facial and skin treatments for 14 days so that you can properly assess the work you have undertaken without interference. For example, if a patient undertakes skin tightening the day after your botulinum treatment, assessing the result of your work will be difficult. And what if there is an adverse outcome from the skin tightening, or in fact your treatment? How can you determine what treatment caused the problem? You may be able to as you know what muscle relaxants do, but how can you explain this to the patient without appearing defensive? It is difficult. I would recommend delaying any other facial treatments until you have assessed the results of your treatment.

Even so, it can be tough to decide whether to charge patients consultation fees in the competitive aesthetic industry. On the surface, it appears that covering your clinical time and the associated costs can be difficult if the patients are not lining up. However, drawing in the wrong crowd is not the way to go, even in the early days where we might be concerned about making money, and it might seem that any money is better. Ultimately, the answer of whether to make the consultation free or attached to a fee, will be different for every clinic and every practitioner. So let's break it down a little.

A great practice needs value

Let's look at the Oxford dictionary meaning of value. Value is defined as "the regard that something is held to deserve; the importance, worth, or usefulness of something." When we think about value then, we make a judgement about whether we will invest out time or money into the item or service. As a patient, if we now attach no monetary fee towards our consultation, for many patients this might mean we do not value our time or what we are offering. It has no or limited value to us, and therefore also to the patient. Is that what we want to convey? The practice of charging consultation fees is most common in clinics that offer cosmetic surgery in addition to non-surgical treatments. This is because surgical treatments may meet resistance among potential patients who are interested in these procedures but are perhaps still wavering on the commitment.

Ideas to value add in cosmetic injectables

A consultation is not just talking about a specific pain point for the patient. When we do cosmetic consultations at my practice, there are photos, dental records and a detailed skin analysis associated with the consultation. Why? Because I want the patient to know that I look at the whole picture - their face, skin, skeletal and dental structure and health. I don't have blinders on and nut it down to one specific area. I want results for my patients. So a consultation with me, is a value-added experience. Sure we will talk about a specific concern, but I will also give my detailed and expert opinion about the overall picture too. I value add. It is important that your potential patient knows that you do too.

Go after quality patients

Depending on your target market and services offered, you may want to charge at least a nominal fee for aesthetic consults. If you’re seeking a more discerning clientele, charging a consultation fee is necessary to increase the perceived value of your services. This will also help you to weed out any patients who might be no-shows, lowest-price shoppers, or not fully motivated buyers.

In fact, some practices have found that charging a consultation fee increases their conversion rates of prospective patients. At the very least, it makes good business sense to at least cover your overhead for 30 to 60 minutes of valuable staff time.

It also sets the tone for the consultation. During the discovery portion of the consultation, identify the patient’s main concern, get an idea of their lifestyle, and see how open they are to various treatment options. Show some before-and-after photos to give them a sense of what could be possible from their commitment. Then hone in on a solution that makes sense for them while setting realistic expectations about results at the end of the treatment plan. Ensure that the aesthetic treatment is described in a way that patients understand. Avoid jargon, give examples, and encourage dialogue. Organize a formal process for your consultations so that patients can walk away with information that are of value to them even if they don’t sign on for a full treatment plan. A personalized touch is key in these one-on-one sessions.

Focus on the First Impression

A positive first impression goes a long way. Your goal is to establish your expertise and trustworthiness in this interaction. Aesthetic patients all want to achieve their desired results with their investment. Showcasing your knowledge and professionalism will let them know that they are in good hands. Remember to cater to the convenience factor in your discussion so that they understand you value their time and presence.

How to Avoid Deterring First-Time Patients with Client Consultation Fees

The drawback of charging for an initial consult is that you may deter some prospective patients, including those who would be persuaded by the expertise and care in your office or during their initial call. One way to counter these potential reactions is to offer to apply the consult fee toward their first treatment. This way new patients who are serious about seeking treatments will likely be more persuaded to book with your clinic, knowing that they won’t be losing their initial deposit.

Alternatively, you could consider more creative ways to reward your loyal patients by offering cards for free consults so they can refer their friends. Since those referrals are likely to already have a positive impression of your practice, there is a higher likelihood that those consults will turn into treatments. To further entice them to offer your name to curious friends seeking first-time treatments, you could offer loyal patients a small discount on their next treatment if they bring in a new patient using your free consultation cards. However, if you’re seeking a more discerning clientele, avoid offering promotional discounts to ensure you’re consistently marketing your clinic as established in your marketing plan.

What are fine lines?

Fine lines are subtle, shallow wrinkles on the skin’s surface. They can form on the face, neck, chest and other areas of the body. They are not always easy to spot, unless you look very closely at your skin, or make different facial expressions.

For most people, fine lines are among the first noticeable signs of time passing by. They appear in your 20’s or 30’s and gradually deepen as you get older. Eventually, fine lines will become wrinkles, although treatment can help slow this process.

What are wrinkles?

Wrinkles are more deeply set than fine lines and are more easily visible. Like fine lines, they can form on the face, neck, chest, or anywhere else on the body. Wrinkles can be classified as dynamic or static in nature:

Dynamic wrinkles are those that appear only during certain facial expressions

Static wrinkles are those that are consistently present, no matter your current expression

Wrinkles are more difficult to treat than fine lines, but their appearance can be minimized with either surgical or non-surgical options.

What’s the Difference Between Fine Lines and Wrinkles?

The difference lies in the detail. The depth of the crease is what signifies the difference between fine lines and wrinkles. Fine lines are defined as those lines that are less than 1mm deep, whilst a wrinkle is 1mm or deeper.

Do Fine Lines and Wrinkles Occur in Different Areas?

A wrinkle can form anywhere a fine line does, and vice versa. Wrinkles may appear sooner in areas where skin is thinnest, where creases more regularly form, or where skin is exposed to sun and environmental pollutants.

What causes wrinkles?

Fine lines and wrinkles both have the same causes. Lines will generally form where the skin naturally creases. In youth, the skin will be resilient and bounce back. But as we get older, there are a few changes that occur:

a. Loss of Structural Protein: Collagen and elastin both naturally decline with age. These are two important proteins which help give skin its structure and elasticity.
b. Sagging Skin: The epidermis is the outermost layer of our skin, while the dermis lies beneath. Aging weakens the bond between the two. As the dermis separates from the epidermis, skin begins to sag, leading to more wrinkles.
c. Slower Skin Cell Turnover: As we get older, nutrients are delivered more slowly to the skin. Damaged skin cells are less quickly repaired and the production of new skin cells slows down. This is where skincare can really shine.
d. Thinning Skin: Skin becomes thinner as we age, while the fat content below also diminishes. This loss of thickness and volume contributes to wrinkling. Skin treatments that induce collagen are the best way to tackle this issue.

Each of the above factors is largely dependent on genetics. But lifestyle and environmental factors can speed up the aging process, regardless of our genes.

i. Sun Damage: Damage from UV light is the greatest contributor to aging skin. UV rays not only degrade collagen and elastin, but disrupt the connection between the epidermis and dermis. This leaves skin looser and more vulnerable to wrinkling.
ii. Smoking: Toxins in cigarette smoke also break down collagen and elastin, leading to wrinkle formation, especially around the mouth.
iii. Pollution: Pollutants in the air from cars and busy cities not only degrades structural proteins, but creates free radicals. These unstable compounds damage skin cells, leading to wrinkles.

Treating fine lines

If you’ve already begun to notice fine lines, beginning a prevention and treatment protocol is key. Treating fine lines can help prevent them from becoming static wrinkles, which are far more difficult to treat. The following can help minimize the appearance of fine lines and deter the onset of wrinkles.

Avoid Sun Damage: Any type of sun exposure contributes to aging skin, even if you don’t burn. Use broad-spectrum sun protection daily, one that blocks both UVA and UVB light. In addition, keep your skin protected with hats, sunglasses and clothing.

Stay Hydrated: Fine lines and wrinkles are more visible on skin that’s dehydrated. For hydrated skin, drink plenty of water every day, and avoid diuretics such as caffeine and alcohol.

Use Moisturizer: Moisturizers can help minimize the appearance of fine lines and wrinkles. Those containing hyaluronic acid help skin hold on to water, which helps maintain a plump appearance.

Begin a great Skin Care Routine: Over the counter anti-aging serums and creams can help tighten skin and prevent fine lines from getting worse. Look for the following ingredients - Hydroxy acids, Retinols, Niacinamide, Vitamin C, Caffeine and Hyaluronic Acid

Prescription Medication: Prescription-strength retinoids such as Tretinoin reduce the visibility of fine lines, improve skin’s texture and also treat discoloration.
Treating Wrinkles

Once fine lines have progressed into wrinkles, they cannot be permanently erased, but they can be minimized. Surgical treatment offers the most dramatic results, but non-surgical options can also help smooth skin.

Treatment Options for wrinkles

A. Botulinum toxin& Dermal Fillers: Toxin works best as a preventative, as it slows the formation of wrinkles by temporarily paralyzing muscles that would typically contract into creases. Dermal fillers are used to treat wrinkles by smoothing creases and adding volume to areas with thin skin. Our courses here are Dermal Distinction Academy will help to cover theses treatments.

B. Chemical Peels: Chemical exfoliation removes skin’s outermost layers. This triggers a healing process in which new skin cells are formed, without their predecessor’s imperfections.

C. Microneedling: Microneedling encourages new collagen and elastin production by damaging the skin’s surface with thousands of tiny pin pricks.

D. Laser Resurfacing: Laser treatment also works by causing micro-damage to the skin’s surface. As skin repairs itself, new collagen and elastin is produced for greater firmness.

E. Plastic Surgery: Cosmetic surgery may be the best treatment option for severe, deeply set wrinkles. A surgical procedure can tighten skin and transfer fat for a dramatically more youthful look.

What is dermal filler training?

Dermal filler training means that you’re learning how to inject dermal filler into the skin and face in order to build a beautiful result. It provides you with the knowledge and experience necessary to safely execute a cosmetic procedure in the safest way possible. As a result, this allows you to have more control over your day-to-day business activities, and improve patient treatment time spent injecting dermal filler and also reduces the risk of any complications. The purpose of dermal filler training is to improve your technique and ability to inject dermal fillers with as little discomfort as possible. This is why it’s important to get trained before undertaking your first treatment so that you can protect yourself from any potential side effects after the fact.

Dermal Fillers 101: what you need to know

Dermal filler training is the process of using small amounts of hyaluronic acid gel material to create a change in the skin, such as adding volume or smoothing out wrinkles. This process takes time and can be difficult to execute well. But with patience and dedication, you will be able to achieve your goals. As you continue through this guide, you’ll learn more about dermal fillers and what they can do for your patients face. The beauty of dermal fillers is that they are incredibly versatile and can help you achieve many different things depending on what type of filler you use. For example, high volumizers can be used to reduce the look of deep lines while retaining moisture levels in the skin. Skinboosters help combat rhytids by improving the appearance of pores and also improving the surrounding skin texture. All these things are possible with dermal fillers because they work by creating smooth new tissue from tiny injections of HA gel material that are injected into the soft tissues.

Why should you do dermal filler training?

Dermal filler training is a practice that helps minimize the risks and complications associated with dermal fillers. You will have greater control over the dentistry you do, improve your career pathway in cosmetic nursing and medicine. The effect of this training is two-fold: it will give your patients results that they are asking for and want to achieve, and it reduces the risk of complications and minimizes bruising. The best part? You can undertake the training using our hybrid e-learning and hands-on practical program. This allows you to learn at your own pace from home or work, and then complete treatments in our accredited training facility with mentoring of your trainer. You simply need to enrol and we will guide you through the rest!

Benefits of dermal filler training

#1: It’s a cost-effective and a valued treatment that will be in demand by your patients. The beauty of dermal fillers is that they work quickly and results are seen immediately. That fast-acting nature, when combined with the relatively low cost of these treatments, makes them ideal for patients who want to improve their results without surgery. And because they are so quick and easy to insert, patients who receive this type of treatment often do not experience much discomfort during the procedure.

#2: It helps your patient improve their facial contours and skin hydration levels. But you do need a robust educator to help guide you. Our training is based on Anatomy first principles to ensure that you understand the face and the structures you are working in. Next we focus on technqiue - both a need and cannula are essential when using dermal fillers. I know that when I first learnt to undertake fillers, I was given no cannula instruction, where cannula treatment is the medical standard amongst injectors worldwide. At Dermal Distinction Academy, we understand this and focus on more than one technique to allow you to choose the safer and best alternative for you and your patient.

#3: It requires minimal time away from work. Our robust e-learning modules are very rich in content, and have been described as the best that any injector has even seen. This is important. We want you to gain a solid level of knowledge before you ever treat a patient with these techniques. Too many training providers ask you to attend one day of lectures and then the very next day you are injecting a live patient. This does not give you the time to absorb the information, critically analyze what you are learning, and you have little reference to refer to once the lecture day is done. Once you complete the e-learning (which we recommend will take around 14 days to complete), you will then attend the practical session. That means you may miss just one day of work to learn this valuable treatment process.

When should you do dermal filler training?

Dermal filler training is best done once you would like to take your training and treatment offerings to the next level. Instead of focusing on just the teeth, or the regular nursing and medicine that you have always done, dermal filler training will give you a skill set that your patients want, and they will ask for. In the healthcare industry, we already have an excellent understadning of infection control and a good aesthetic eye for detail. Dermal Filler training will set you up into a higher tier of service for your patients, and will give you perfect occupational satisfaction.

How to start dermal filler training program

It is relatively easy. The first step is to enrol. On your way to becoming a dermal filler pro, you need to learn about the different filler types, including hyaluronic acid, which is one of the most popular fillers. The process begins with education. You’ll need to know about the basics of how injectable fillers work and what types of fillers are available. The next step is choosing a dermal filler. These can be used for lifting deep lines and wrinkles or filling in scars or cancerous lesions. When making your treatment decisions, we will teach you to consider the type of results you can achieve, your desired aesthetic goal, and whether you want an all-inclusive package that includes other supportive skin treatments too. Finally, once the course is complete, it’s time to start injecting! Dermal filler training programs typically involve numerous classes over a period of time, so don’t be discouraged if it takes some time before you feel comfortable enough to get started. Remember that we are here to support and mentor you, and you may attend further coaching sessions along the way!

Conclusion

It’s never too late to start your career in the cosmetic injecting industry. Whether you’re a fresh graduate, or you’ve been working in the industry for years, consider dermal filler training as your next step in the right direction. Do your research on dermal filler training and consider enrolling today!

When we first begin our education at university, we seemingly undertake anatomy wondering why we need to know it. It is only a little later on that you understand the relevance of that level of education. Then as you career progresses, sometimes we take it for granted that we learnt anatomy as we continue on in “auto-pilot” mode, doing what we have always done.
Whenever we learn a new skill, as well as hone our already established skillset, it is important that we always reflect back on the patient anatomy. After all that is what we are dealing with. This is particularly important when we are performing cosmetic injectable treatments.

When it comes to the face, there are four components of anatomy.

Anatomy: Part 1 - The vertical fifths

The most balanced faces and results are when the vertical fifths of the face are of equal width. We look at this orthodontically, but we should also look at this when we are considering enhancement of the face. Asymmetry in one of the fifths will lead us to see that “something is not quite right”, and we want to balance it out. The nasal alar should lie below the medial canthus of each eye for perfect balance. The most lateral fifth extends from the lateral helix of the ear to the lateral canthus of the eye. The next two fifths are represented by the eyes (medial canthus to lateral canthus). Of course there are racial and genetic variations to this “perfect” ideal of balanced fifths, but having some kind of reference helps us to identify where one fifth is wildly different to the other side.

Anatomy: Part 2 - the horizontal thirds

The face can also be divided horizontally into three parts. Before we define this, let’s point out some important landmarks. The trichion is the hairline, and defines the most superior border of the face. The nasion is the bridge of the nose, and is the midline bone depression between the frontal bone and where the two nasal bones meet. The trichion and nasion define the borders of the upper horizontal third.
The next third runs from the nasion (or bridge of nose) to the sub-nasale, which is sub-nasal, as it’s name suggests, is the point where the nasal columella joins the upper lip. So essentially the length of the nose makes up the middle horizontal third.
The lower third therefore runs from the sub-nasale to the menton, or the lowest point of the chin / mandibular symphysis.
Where one of the thirds is too short, we may consider orthodontic treatment, maxillofacial surgery or dermal filler to extend the third that is lacking. They are all equally valid, with proper discussion and consenting with the patient.

Anatomy: Part 3 - Depth of Anatomy

So now we have looked at the superficial components or surface anatomy, now we need to consider depth. Where is the deficiency for the patient? And when I am thinking about enhancing the deficiency, what structures are of importance in the area? An area that is a frequent concern for patients is the jawline area. Patients dislike the excess draping that occurs through life, where the jawline definition is lost. Indeed, it may have never been present in the case of a severe class II orthodontic malocclusion. So some options that we might present to the patient may again include orthodontics and maxillofacial surgery. But what options do we have that are non-surgical and present a short timeline for our patient. We have of course dermal fillers, where we can add to the jawline in key areas to improve both the projection of the chin in both the vertical and horizontal plane, but we can also add to the mandibular border and gonial angle. When we do this, it is vital that we reconcile the structures in the plane we are thinking of injecting.

If we remember back to the first year of anatomy back in dental school, we should recall that the facial artery passes over the mandibular border in the antegonial notch, which can be palpated by running your index finger along the jawline. So when we use dermal filler, it is so important that we avoid the facial artery. So how do we do this? We need to keep the dermal filler in the subcutaneous plane. Where the facial artery is deep, we must treat the patient superficially, and vice versa. We can use imaging devices such as laser guidance (which I love and use in my practice) or ultrasound. However ultrasound in particular has a steep learning curve and cannot be learnt in one day. Whilst useful where there are complications and in high-risk areas of the face, the use of ultrasound is certainly not the new standard, despite the misinformation that is sometimes spread by those with financial incentive to do so. I would recommend that you invest in studying an anatomy-based injecting course, to understand the areas of risk in the face. This is too important to ignore. You must know this when you inject. We understand this intimately when we undertake a local anaesthetic block. We must also recognise and appreciate the anatomy when you inject filler or toxin.

Anatomy: Part 4 - Movement

When I first studied cosmetic injectables, the dynamic movement of the face was not discussed at all. But as time has gone on, this is an area that is now recognised as being of high importance in the aesthetic zones. For this component of anatomy, we need to appreciate how the superficial and deep fat pads of the face move in relation to each other. Why? Because it will influence our dermal filler choice. If we recognise that the patient requires filler in the anterior cheek, for example, we often need to place dermal filler both superficially and in the deep fat pads too. And we will not use the same product in both. In the deep fat pad, which overlies the bone, the fat pad is fairly immobile on smiling and movement. In this area, we need to place a rigid filler, or one with a higher G-prime In the superficial fat pads of the face, the fat pads will re-drape on smiling, showing anger and sadness. So in the superficial fat pads, we need a filler that is resilient, that bends and stretches with the face, but also retains its original shape at rest. These fillers need to have resilient or dynamic bonds that move and stretch with the patient, resembling a lower G-prime product.

Cosmetic dentistry has always been an interest of mine, and I fell in love with cosmetic injectable treatments back in 2012. Since then I have done countless CPD courses and formal study. In 2015, I undertook a dermal therapy qualification through an RTO to fully understand skin and skin treatments. Despite all this study, the hardest part of cosmetic injectable treatments is talking to your patients. I am at ease with this conversation now, and I did not learn this skill through study. I learnt this part through real life experience.
Talking about dentistry and teeth is easy. There is an expectation that the patient wants to hear whatever information you have to deliver because you are a dentist and they came in to talk about their teeth. So how do we move into talking about cosmetic injectables? This is a sticking point for both dentists, medical practitioners and registered nurses alike. I see this barrier amongst practitioners regularly. A real turning point was when I attended a multi-disciplinary conference in years ago called the Non-Surgical Symposium. More about that later.
Remove the stigma!
Cosmetic injecting is dentistry. You need to start believing it. I shudder to think of the days when the only dental options where cleans, filings and tooth removal. The huge development of dental implants to replace missing teeth was immense. We talk about that so easily now because it is the norm. The use of botulinum toxin and dermal fillers should also be included in the conversation you have with your patients. It should be the norm, as these treatments offer legitimate aesthetic results for your patients, in a short period of time, with low to no downtime.
Consider this scenario. A patient comes into your practice with a gummy smile. What are your treatment options for that patient? Traditionally the only real options were orthodontic treatment and maxillofacial surgery, or periodontal surgery to reduce the gum display. What if your patient didn’t want a protracted treatment plan? What if your patient did not want, or was not suitable for surgery. What then? Before cosmetic injectables, there really was no other option. However, the use of botulinum toxin is so straightforward and simple for your patient, you would be doing your patient a disservice by not including this option in the discussion.
The biggest limiting factor to success with cosmetic injectables is belief in yourself and the validity of what you have to offer your patient. Of course you need to offer the traditional dental and medical options, but the non-surgical approach is equally valid. The conversation should not be difficult for you. You are doing your patient a good service by informing them of the options that they have available to them.
The foundation of the patient-practitioner relationship: The discussion
In this day and age, expectations are high when it comes to healthcare. Patients are more conscious and deliberate. They want their needs to be met quickly, effectively, and with care. The digital age means that information is extensive, but it can be difficult for the patient to decipher good information from the not-so-good, but also what is right for their particular circumstance.
You as their health care provider need to offer valid treatment options, and be all inclusive when you do so. Do not put your subconscious bias on that discussion.
Suppose patients feel like their concerns are not taken seriously or their voices are ignored. In that case, it can result in missed treatment option discussions, omissions in their treatment discussion, increased risks or poor outcomes, and overall poor healthcare quality.
Communication is the key to success in every relationship. It is no different in healthcare and cosmetic medicine procedures. Understanding how to communicate with your patients effectively will help you be a better practitioner and deliver a satisfactory patient experience.
Here are five tips to help you foster effective practitioner-patient interactions:
1. Avoid Assumption When It Comes to Your Patients Needs
Many healthcare provider-patient interactions fail early on because of assumptions that the healthcare provider has drawn. This is why it is vital to allow patients to voice their concerns and be receptive to them. This will entail you asking more questions and letting your patient describe their situation in detail. Your patients will feel respected and valued when you ask their opinion on things.
2. Listen Attentively to Your Patients
The key to a successful healthcare provider-patient interaction lies in the healthcare provider’s ability to listen to their patients. For a healthcare provider to provide the best possible care, they must understand each patient's unique needs.
Show care and interest in the patient you are treating by actively listening to them. Show that you are engaged in your patient’s needs, thoughts, and emotions through your words, tone, facial expressions, and body language. It takes time to listen. The patient will see that you are genuinely interested in their health and well-being, which leads to compliance.
3. Acknowledge Your Patients Emotions
It’s not just about the technical side of medicine and prescribing the right prescription. There’s a psychological aspect attached as well. People's emotions, as well as what's going on in their lives, shape who they are.
This is why it’s so important to take your time and slow down during healthcare provider-patient interactions. Ask your patients questions about their situation and let them know you will be there for them every step of the way.
4. Help Your Patients Manage Their Expectations
In some situations, you may need to manage your patient’s expectations about treatments and recovery. When you have a conversation with your patient, try to put yourself in their shoes. Let them know what to expect.
Take the time to outline any possible complications or side effects, treatment options, long-term outlook, and alternative treatments. Vague answers leave patients wondering why they received a specific treatment or, worse yet, feeling a sense of mistrust or a lack of confidence in their healthcare provider.
5. Never Respond Defensively to Your Patients
Try to understand what your patients are concerned about and acknowledge their concerns if they become upset. You should remember that this is a stressful time for the patient, and they are more likely to be emotional.
Where can you learn more?
Effective communication is essential to have a successful healthcare provider-patient interaction. You can change a patient's perception of you by making them feel understood, valued, and heard. The results could ultimately improve their health by complying with medication schedules, treatment regimens, and follow-up appointments. When you create a strong healthcare provider- patient relationship, your patients feel heard and understood, and all their treatment options explored.
There is great value in attending conferences focussed on multi-disciplinary approaches to treatment. It brings doctors, dentists, nurses, and dermal therapists together to discuss and provide you with the education for your patient treatment plans. The Non-Surgical Symposium is being held on the Gold Coast in June 2023 and all dentists and health practitioners are invited to join.
The benefits of the NSS are immense. The key benefits are:

1. There will be many keynote speakers from both Australia and across the globe coming to
   discuss all things related to the treatment and business of cosmetic injectables. I am excited this year to attend the anatomy workshops, as well as attend the business lectures to hear about the approach that successful clinics use to implement treatments that work for their financial success and importantly for patient results. There are business and communication lectures from leaders in the field.
   
2. All the suppliers in one place. Similar to dental conferences, the NSS exhibition brings together equipment and product suppliers from across the globe. If you are thinking of venturing into more than just cosmetic dentistry and cosmetic injections, this is the place to be.
   
3. Dentists are welcomed to the NSS. The convenor of the Non Surgical Symposium, Naveen Somia is a well respected plastic surgeon based in NSW. He envisions the conference as a meeting place, where we all learn together for patient safety. This conference bridges the gaps between professions and helps us network together.
   

I will be attending this conference, as I have over the last few years. It is my favourite. Find out more about the NSS, visit: https://nonsurgical.org.au/

On July 1, 2023, new AHPRA guidelines were established that help to support and guide practitioners in their treatment of patients. Many dental practitioners, like myself, are undertaking cosmetic injectable procedures to improve dental outcomes, and enhance results with skin treatments. These rules apply to both the cosmetic injectable treatments we do, but also the other cosmetic procedures we perform in the role of traditional dentistry. Often the lines are blurred between clinical need and aesthetic desires, and it can be harder to judge the ethical way forward. In this article, I am going to focus on aesthetic non-surgical cosmetic treatments, but really you could apply these principles to your clinical treatments too.

What are ethics in Non-surgical cosmetic treatments?

Ethics is a system of principles that are based on our obligation to put the patient first, undertake the best treatment, based
on trust, honesty and actively “doing good”. This applies to our interactions with our patients, our staff and our dental and medical colleagues. We all benefit from ethics. I know that ethics for me is determined by my sense of doing what is right, even when no one is looking. It is important in both my clinical interactions, and those interactions that I have when I am teaching practitioners in the science and art of injectable treatments.

The key principles of ethics

Ethics pillar 1: Patient Autonomy.

Technology has revolutionized the aesthetic medical industry. Procedures are safer, more effective and have better results than decades ago. Whether it is because of social media or just knowledge that treatments exist around improving one’s image and appearance, these advancements have increased the desire for aesthetic cosmetic treatments.

Unlike traditional clinical practice, where practitioners treat illnesses and injuries, aesthetic treatments are considered elective. All patients have the right to decide whether to undergo a procedure. Patient autonomy is even more important in aesthetic cosmetic injectable treatments, where patients can elect to have non-surgical intervention to enhance or correct.
You can support patient autonomy by helping each individual make informed decisions. You should explain each procedure’s risks in detail and inform each patient about the procedures you undertake and its benefits. Each decision should be a partnership between you and your patient, and you should always provide all of the necessary information without pressuring your patient into a procedure.

Ethics pillar 2: Non Maleficence

Non Maleficence is you duty to do no harm. And in order to do this, this requires several approaches:

a. Stay up-to-date with your education.

I know that many practitioners that enter into the injectable space undertake a short course. At Dermal Distinction Academy, you have months to go through and grasp the theoretical aspects of anatomy, the techniques and pharmaceuticals, and also the complications that may occur and how to deal with them. The practitioners that commit to training in a new procedure need time to learn. Time to absorb. Time to review and revise. And our theoretical learning is supported by detailed videos, scientific journal articles and more. Whenever there is an update in guidelines, such as those that occurred on July 1, our material is also updated. This is so important. You need to be competent to undertake treatment.

b. Recency of practice.

Not only should you be up-to-date, but you need to ensure that you continually apply yourself to the treatments you do. It is not good enough to take a course years ago, have a pause in your treatments and then start offering procedures. Clinical practice is a continual process of learning, updating, refining of skills and practice.

c. Withdrawing when required.

If you are not well or too tired, or your team are not well or not performing their best, you will not perform to your best standard. Ethically you should reschedule your patients to a day and time where you will do your best work. I know that this can be hard as you feel financial pressures, but it is our obligation to do no harm. Sometimes this means, delay the treatment.

d. Screening for Body Dysmorphia.

Ethical integrity and a patient’s best interest are vital in the practice of cosmetic treatments. You want to help your patients achieve their desired outcomes, and aesthetic treatment can help give patients meaningful life improvements. However, some patients are not ideal candidates for cosmetic procedures. One example is those with Body Dysmorphic Disorder (BDD). BDD is a psychiatric syndrome characterized by a pre-occupation with a non-existent cosmetic defect that may include repeated attempts to correct it surgically. Performing procedures on patients with BDD or other psychiatric disorders that dwell on imperfections ultimately leads to dissatisfied patients.

e. You should also avoid performing unnecessary procedures on patients with comorbidities, individuals with unrealistic expectations and those going through life crises. As an aesthetic provider, it’s important to consider these potential obstacles when consulting with a patient about undergoing a cosmetic procedure.

f. Practice within your areas of expertise.

We know that with cosmetic injecting, there are areas that are considered of higher risk than other. Evidence dictates that there are two main areas on the face that have a higher incidence of vascular occlusion following soft tissue augmentation with filler: the glabellar region and the nasolabial fold, nasal tip, and alar triangle. You should not treat these areas unless you have the knowledge, training, insurance and support to undertake these procedures. You should also be able to recognise a complication when they occur and know how to deal with them. If you cannot treat the complication yourself, part of your clinical protocols should be having an action plan in place to have your patient treated accordingly.

Ethics pillar 3: Beneficence

Not quite the opposite of non maleficence, this is more than that. This ethical pillar is about actively doing good. This is about going above and beyond.

a. Your patients’ best interests should always pre-empt all other consider- ations, including financial and emotional factors. If a patient wants and can afford a procedure but has a condition making it unsafe, their health and safety are the priority. Considering a patient’s motivation for wanting a procedure is also essential. Similarly you should not put your financial incentives above the patients health. For instance, it would be unethical to push a patient toward a more expensive treatment, when a simple treatment would have a great outcome. This may have a huge impact on the treatment plan process. It is important to start with the foundations first (skincare, skin treatments), then move to controlling the movement (use of muscle relaxants), before finalising with dermal filler enhancements.

b. You should avoid doing a procedure if a patient’s goal is to meet someone else’s expectations or keep up with trends. For example, knowing what is the best treatment to do for a patient is really important. Many of my patients have asked for a Russian Lip enhancement, but often have another treatment instead. This is because they are asking for a trend, based on a social media awareness. However after assessment and a consultation, we plan a better suited treatment instead. It is your role to know the trends, know the procedures, but plan and assess for your patient properly. If you do procedures for the right reasons, you can help patients meet healthy, realistic goals.

c. Throw out expired products. Do not chance it. You cannot afford, not can you justify to have a complication based on treatment that was undertaken using expired dermal filler. This comes down to rotating your stock, checking products before using them and disposing of products that fall below our standard.

d. Disclosure. Some years ago now, it became a mandatory requirement to supply patients with an implant card following the use of dermal filler. The implant card details the type of filler, the batch number, the expiry date and also your contact number after hours. On july 1, 2023 this also became a mandatory obligation whereby you must inform patients of where to go and who to contact if there is a complication after hours. You cannot leave the patient in a situation where they do not know where to go.

Ethical Pillar 4: Justice
A major part of strong ethics is accepting all patients, regardless of their sexuality, race, ethnicity, gender, class, and so on. It is therefor our responsibility to recognise
that if we have a bias or inability to be fair and show justice, we should delegate the patient to an alternate practitioner of their choice that can proceed.

Everyone deserves to be a healthy, pain-free person. But, some circumstances mean you’ll need to reach out for help in treating certain patients. For example, you might encounter someone dealing with a disability or disease you aren’t equipped to handle. In that case, you’ll need to look for assistance from other dentists in your network. And, while it’s fair to work on the patients of other dentists, it’s not fair to bad-mouth other practitioners. Instead the ethical approach would be to listen and treat the patient in the usual way, remembering that we do not know exactly what transpires in a clinical room outside of the patient’s account. Keep in mind that it’s considered your obligation to report the failed care of another practitioner – if it falls outside of the accepted standard of care.

Key takeaways
+ Being a clinical practitioner means responsibilities beyond just looking at your primary area of interest. It is not just about injecting a patient or filling a tooth. It is about doing good, doing no harm and being unbiased. You should aim for high standards.
+ It’s about caring for your patient, your team and also your professional standards, whilst maintaining a strong code of ethics.
+ Communicate honestly and clearly, and present your patients with all treatment plans possible – even if they’re not your most profitable. Sometimes this might mean recommending that the patient be referred on, or that they undertake no
+ Do no harm, but even further, take the time to give back to your profession.
+ Care for your patients to a high standard, and you’ll end up seeing positive results.
+ Remember, sometimes the right thing to do for yourself is doing the right thing for others.

If you want to know more about ethical injecting and responsible cosmetic non- surgical treatments, please contact us.

Discover the crucial role of reputation management in influencing how potential customers perceive your brand, involving the generation, monitoring, and response to customer reviews, along with the creation and sharing of positive brand-centric content.

Read on to understand why reputation management is vital for med spas and how it can contribute to business success.

What Is Reputation Management?

Reputation management shapes how customers view your brand, encompassing the generation, monitoring, and response to reviews, as well as the creation of positive brand-centric content. It involves utilizing social media and other marketing strategies to shape your image and connect with potential clients.

Why Reputation Management Is Important for your clinic

Though online reputation management might not be everyone's expertise, it is indispensable, especially for medical spas. Whether through an in-house team or a reputable reputation management company, building a positive public perception is a collective effort.

1. Helps Attract More Patients

A positive online reputation directly influences your ability to attract and retain customers. Consumers heavily rely on online reviews, and a high rating on platforms like Google, or Facebook can significantly increase website traffic, conversions, and referrals.

2. Builds Trust and Loyalty

Given the personal and sensitive nature of medical aesthetic treatments, a comfortable and confident client is essential. Proactive reputation management, through showcasing successful treatments, patient testimonials, and transparent communication, not only attracts new clients but also solidifies trust among existing ones.

3. Improves Your Service and Performance

Beyond promoting services, reputation management involves listening to customer feedback, identifying strengths and weaknesses, and enhancing overall patient experience. Positive online reputation acts as motivation for excellence.

4. Increases Your Visibility and Reach

Search rankings correlate with high-quality reviews, making reputation management essential for online success. Securing a top position when someone searches for "clinic near me" expands your visibility and reaches potential customers seeking med spa services.

5. Differentiates You From Competitors

Creating a unique brand identity sets you apart from competitors. Highlighting your unique selling proposition, values, mission, vision, and culture, along with showcasing awards, certifications, and affiliations, helps establish your clinic's distinctiveness.

6. Protects Your Brand Image

Reputation management acts as a shield against online negativity, mitigating the impact of negative feedback. Monitoring online discussions and responding professionally to complaints, while encouraging positive reviews, helps maintain a positive brand image.

How to Manage Your Online Reputation Effectively

• Claim you online business profiles and keep them up to date. This is important.
• Respond to reviews. Please be aware of AHPRA requirements when doing this, but your response does play into the Algorithm
• Display your ethical before and after results. Same lighting, No makeup. Real results are important.
• Be present and engage with your audience.

Approach interactions with authenticity to strengthen your reputation against criticism.

Common Reputation Management Mistakes to Avoid

Knowing the importance of reputation management, avoid these common mistakes:

• Don't ignore or delete negative reviews; address them constructively.
• Take the high road instead of being defensive or aggressive. This is also important to ensure that you keep your AHPRA compliance in check.
• Regularly monitor and update your online presence. If there is out-dated information, address this.
• Avoid posting fake or misleading reviews; focus on delivering quality services. Again remember that AHPRA requires that we represent ourselves honestly and with integrity. You should strive for this above all else as a core business pillar.

Garner More Positive Reviews with Clinic Reputation Management

Take control of your narrative and showcase the excellence that defines your practice to unlock success in the digital age.

However, achieving confidence in injecting procedures is a process that requires intentional efforts. In this article, we will provide you with educational and firm guidance on how to build confidence when administering cosmetic injections and fillers, enabling you to serve your patients more effectively.

1. Focus on Patient Communication

Selecting suitable patients is a crucial aspect of aesthetic injecting. Take a thorough approach, especially if you are relatively new to injection procedures. Getting to know your patients, understanding their aesthetic goals, and discussing their expectations will not only manage their expectations but also contribute to your confidence. Being selective in patient choices, especially with dermal fillers or Botox, is a prudent strategy to build confidence.

Encourage feedback from your growing clientele to assess satisfaction levels and identify areas for improvement. Reflect on both positive and challenging experiences, viewing them as opportunities for personal and professional growth. Learning from each encounter will bolster your confidence in handling diverse situations.

2. Practice, Practice, Practice

Variability in Botulinum toxin and filler results demands hands-on experience. Completing your injection training with live models is essential to comprehend the effects of these treatments on diverse facial structures. Study the impact on different age groups, genders, and face shapes, enhancing your understanding and predicting outcomes.

Experience is the foundation of confidence. Familiarize yourself with the unique aspects of injecting Botox to eliminate surprises and bolster your confidence.

3. Schedule Longer Appointments

Avoid turning injecting sessions into a race. Schedule longer appointments, especially for first-time patients, allowing ample time for a thorough assessment and personalized treatment plan. Investing time in preparation significantly contributes to feeling more confident when administering Botulinum.

4. Read a Patient’s Body Language

Building verbal rapport is crucial, but understanding non-verbal cues is equally important. A patient’s body language can convey their comfort or dissatisfaction. Sharpen your observation skills during training and mentoring sessions to interpret subtle changes in body language, ensuring a positive and comfortable experience for your clients.

5. Continuous Education and Training

Stay abreast of advancements in aesthetic medicine by attending workshops, conferences, and training programs. Continuous education enhances your knowledge, instills confidence, and aids in effective communication with clients. Specialized courses, such as advanced dermal fillers or lip filler training, showcase your commitment to professional development, increasing your credibility as an injector.

6. Attend Skills coaching sessions.

Honing your skills through ongoing education is critical in establishing trust with clients. Confidence is derived from a deep understanding of treatments, and continuous learning ensures you remain at the forefront of industry standards.

Building confidence in injecting Toxin and fillers is a journey that requires belief in your abilities. Set yourself up for success by enhancing your skills at Dermal Distinction Academy. Our accredited training center provides a conducive environment for practicing with state-of-the-art equipment under professional supervision. Our courses adhere to Australian standards, ensuring you stay ahead in the competitive field of aesthetic injecting. Believe in your capabilities, and let Dermal Distinction Academy guide you towards confidence and success in your aesthetic career.

Among the popular choices is the trend of getting lip fillers, a non-surgical cosmetic procedure that works wonders in restoring volume and proportion, resulting in a more youthful look.

However, it's important to note that in the hands of under-trained practitioners, lip filler injections might not always provide the desired results. Sometimes, the fillers can move or spread to different areas of the lips, which, while not harmful, isn't the outcome people are looking for after investing in lip fillers.

Wondering if there's anything you can do to avoid or rectify such a situation? Dive into the details in the article below!

Understanding Lip Filler Migration

Lip fillers, the dermal fillers responsible for plumper lips and a visible pout, can occasionally "migrate" to areas different from the original injection site. Some practitioners also call filler Migration, filler Redistribution - which is true to what is actually happening.

Why Does It Happen?

Selecting a well-trained injector who employs the correct techniques is the first step in minimizing filler migration. Excessive filler can lead to "bleeding" to other facial areas, typically the white part of the upper lip. It's crucial to trust your injector's judgment regarding the amount of filler needed. Overfilling a particular area may prompt your body to naturally readjust to ease tension.

Getting too much filler too frequently can also contribute to migration. While maintaining treatments is essential for optimal results, injections should be scheduled appropriately and spaced over a reasonable amount of time. Additionally, touching or massaging the injected areas post-treatment can cause the filler to move and is also unhygienic due to the small wounds created during the injection.

Identifying Lip Filler Movement

Mild swelling immediately after injection is normal, making it unlikely for lip filler to move within a couple of hours. Migrated fillers become more noticeable in the months following the injections. Unnatural fullness, a mound or bump above the lip border, "duck lips," lumps along the lip borders, and changes in lip texture are signs that the filler may have moved.

Fixing Filler Migration

If you suspect filler migration or a botched procedure, seek assistance from a highly-trained professional promptly, especially if you experience discomfort, intense pain, discoloration, swelling, or blisters on your lips. In some cases, the body naturally breaks down hyaluronic acid dermal fillers over time. However, if waiting isn't an option, a professional can use hyaluronidase to dissolve the filler, accelerating the body's dissolving process.

Expect some injection-related reactions if you choose hyaluronidase treatment, such as redness, swelling, or bruising. If these persist, consult your healthcare practitioner for a comprehensive treatment plan.

Preventing Filler Migration

While uncommon, undesirable results are disheartening. Take note of the following to minimize the risk:

1. Choose an Experienced Injector:
Opt for a qualified injector with deep knowledge of facial anatomy and injection techniques. If you are a practitioner, it is important that you inject with precision, and reduce the amount of filler you are using. In some cases, this will mean not injecting at all if your patient already has lips of good proportion.

2. Choose the Right Filler:
Not all fillers are suitable for all areas; trust your injector's recommendation for the right filler. From a practitioner point of view, using a filler with dynamic properties would be a good decision, as lips are highly dynamic and we need to ensure that we follow the laws of physiology.

3. Follow Post-injection Instructions:
Adhere to aftercare instructions diligently to minimize swelling and bruising. Avoid touching your face post-procedure to prevent complications. From a practitioner point of view, this means that we need to ensure our patient understand what to do after filler, but also what not to do too. I would recommend:
a. Do not ask your patient to ice their lips
b. Do not ask your patient to massage their lips
c. Ask your patient to return one week after treatment so that you can review their lips, and massage the result if needed.

In conclusion, ensuring a positive outcome starts with careful planning and choosing experienced professionals who prioritize your safety and satisfaction.

Your skin, a haven for approximately 1.5 trillion bacteria, plays host to a vital community that collaborates with your immune system. This collaboration serves as a shield, safeguarding against pathogens that could induce illness or skin issues. These microscopic allies combat infections, regulate inflammation, and aid in the healing of wounds.

Discover more about your skin microbiome and the ten practices to preserve its health for a radiant complexion.

Factors Impacting Your Skin Microbiome

Your skin's unique microbiome is determined by your DNA and gradually acquired from various sources, including your mother's vaginal canal, breast milk, human interaction, and the environment. Stability is achieved as early as the first three years of life. Despite its resilience, certain factors can disrupt this delicate balance, leading to skin dysbiosis:

Puberty: Hormonal changes during puberty, causing increased sebum release, often lead to acne.
Oral Antibiotics: While effective, antibiotics, if not used cautiously, can harm beneficial skin bacteria.
Skincare Overuse: Excessive use of skincare products, even probiotic ones, can upset the microbiome balance.
Environmental Influence: Urban living and exposure to pollution can impact the skin microbiome negatively.

10 Practices to Safeguard Your Skin Microbiome

If inadvertent damage has been done to your skin microbiome, fear not; corrective actions can support its functionality:

1. Eat a Balanced Diet: Prioritize plant-based foods, probiotics, good fats, proteins, and limit sugar and processed foods.
2. Avoid Over-Sanitizing: Excessive cleansing, hot showers, and antibacterial soap can disrupt the microbiome, leading to skin issues.
3. Exercise Regularly: Physical activity enhances blood flow, oxygenating and nourishing the skin.
4. Quit Smoking: Smoking disrupts the skin microbiome, contributing to inflammation and premature aging.
5. Manage Stress: Chronic stress reduces microbial diversity, exacerbating skin problems like acne, psoriasis, and eczema.
6. Use pH-Appropriate Products: Choose skincare products with a pH around 5 to maintain the skin microbiome's balance.
7. Moisturize: Opt for natural ingredient-based moisturizers, especially those with prebiotics to support the skin's bacteria.
8. Support Gut Health: Addressing digestive issues positively impacts skin health, preventing manifestations like rosacea and eczema.
9. Treat Medical Conditions: Managing health issues such as diabetes and inflammatory bowel diseases can alleviate accompanying skin problems.
10. Embrace Nature: Nature trips enhance both physical and mental health, positively influencing the skin microbiome.

Unlocking Skin Wisdom with Dermal Distinction Academy eCourses

As cosmetic injectors, our expertise goes beyond procedures. We play a pivotal role in educating patients about their skin, evaluating their suitability for treatments, and providing guidance on maintaining results. Join our Skin e-course to gain comprehensive knowledge and strike the right balance for optimal skin health.

When do fillers start to dissolve on their own?

Let’s start with the question “does filler dissolve naturally?” Well, if we’re talking about hyaluronic acid filler, yes, it does. But, unlike botulinum toxin, which takes around three to four months to metabolise, filler can last up to a couple of years or even longer in some patients. This means you cannot just "wait it out".

The great thing about hyaluronic acid filler is that it’s reversible, so if you do have any issues with it or don’t want to wait for it to dissolve on its own, you can dissolve it. With that in mind, let’s take a look at what you need to know when it comes to dissolving fillers, whether that’s lips, cheeks or elsewhere.

Simon Cowell spoke openly about getting his facial filler dissolved.

Why are so many people talking about dissolving fillers?

There have been countless headlines recently about celebs getting their fillers dissolved. Courtney Cox, Meg Ryan and Simon Cowell. So, why do people, generally, get their fillers dissolved?

The most common area by far people come to get dissolved is lips, and nine out of ten times it is due to filler migration. This is when the filler moves from it's original location due to facial muscle movement, and sometimes from over-filling or incorrect placement. This makes the face look unnatural or "done". The terms ‘pillow face’, ‘sausage lips’, ‘duck lips’ and ‘trout pout’ have all come about as a result of this ‘overdone’, unnatural appearance that many people are beginning to distance themselves from, nowadays. Practitioners should be aiming for natural results that look proportionate and like they have always been there.

Rarely, dissolving dermal filler may also need to be done as a treatment for a specific complication from filler. For example, an infection, nodule or as a matter of urgency in the case of a vascular occlusion. This is a much more serious reason to get fillers dissolved and, without the treatment, can leave patients in a critical condition. If filler hits a blood vessel, causing a vascular occlusion, it could lead to blindness, necrosis or even death. If this is the case, the practitioner who treated the patient, or a medically qualified practitioner needs to begin the process of restoring the blood supply to the skin.

When it comes to fillers (and dissolving filler), it’s vital to search for a healthcare practitioner who is trained not only in aesthetic procedures but also in complications. One who will be there for you in case anything does go wrong - and there’s a chance it will with any aesthetic procedure.

What is filler migration?

As I mentioned above, one of the key reasons for dissolving fillers - particularly lip fillers - is migration. So, what is filler migration?

Filler migration is where the filler, which is injected into one area, shifts to another area, making it look strange and unnatural. This is more likely to happen when the injector isn’t experienced or skilled in fillers. So, as we always say at Dermal Distinction Academy, do your research and get your training from an academy that covers all the areas of cosmetic injections, including complications. It’s your patient's face and the last thing you want, instead of the fillers making your patient look fresh, plumped or rejuvenated is to look weird, bumpy or unnatural.

What is used to dissolve fillers?

Ok, so how does dissolving fillers work? For lips, cheeks and other parts of the face that have been filled with hyaluronic acid fillers, there’s an enzyme called hyaluronidase - or Hyalase - that can be used to dissolve fillers. This is a prescription only medicine and should only be used by a healthcare practitioner to dissolve fillers, as it does come with side effects and risks that the injector should be fully aware of and capable of dealing with if they arise.

Hyaluronidase is injected into the target area, and gets to work by dissolving the filler in that area. After a bit of initial swelling, you’ll likely see a significant reduction in the area that’s been dissolved.

Does dissolving filler hurt?

Hyaluronidase is a prescription-only medicine, meaning it can only be prescribed by a suitably qualified practitioner. And this is for very good reason, as, in the wrong hands, it could be incredibly dangerous. It is possible that your patient may have swelling as a result of Hyalase treatment, but the risk is low. If there is a medical emergency reason for dissolving the filler, this must come before the need to check for allergies, as the patients skin and eyesight depends upon it.

Can I dissolve fillers if my patient is pregnant?

No. No healthcare practitioner worth their degree would consider treating a pregnant woman with fillers or filler dissolving solution. Furthermore, you should not undertake fillers or get fillers dissolved while breastfeeding, as it’s not yet clear what effect this could have on babies.

Is dissolving fillers safe?

Dissolving filler with hyaluronidase is safe when done by a healthcare professional with the right credentials and skills. As I keep saying, this is crucial! But there are still some risks that can occur, even in the safest of hands. These vary depending on the area being treated, but filler dissolving side effects and risks include:

1. Slight bleeding
2. Bruising and or tenderness
3. Redness
4. Swelling
5. Volume loss or skin laxity
6. Allergic reaction

What do I tell my patient after dissolving the filler?

Ok, so you’ve dissolved the fillers for your patient; now what? Well, as a good healthcare professional you will now run through the dos and don’ts after filler dissolving treatment but, essentially, these include (but are not limited to)...

1. Taking paracetamol in case of post-treatment pain
2. Using arnica cream or tablets to reduce bruising
3. Covering the treated area with ice packs if there’s a lot of swelling
4. Refraining from rigorous exercise for 24-48 hours
5. Staying hydrated

How long after dissolving fillers, can I do new filler for my patient?

It might be the case that you want to dissolve the existing fillers because they look unnatural or that have been causing your paitent issues and want to replace them with new fillers. However, it’s recommended that you wait a couple of weeks before doing so. This is because
A) it might take this long for the filler dissolving swelling to go down, and
B) the hyaluronidase that’s been used to dissolve the previous filler might actually also dissolve any new filler that’s put in too soon after the dissolving filler treatment.

Therapeutic Goods administration (TGA) is the government body responsible for evaluating, assessing and monitoring products that create therapeutic change to a person. This might be as seemingly simple as a sunscreen, all the way through to a Carbon dioxide ablative laser, and everything in between. We are extremely fortunate to have a body like this as it creates protection for the public and practitioners. Only products that are proven to be effective and safe will be included on the TGA register, known as the Australian register of Therapeutic goods (ARTG).
In the medical, dental and cosmetic practice, all equipment should be assigned an ARTG number, such that we can use it legally and safely on our patients. It is also important that we do not take it upon ourselves to import goods into Australia, under the guise that the product is already available here and listed on the ARTG register. To import a good from overseas, you must be a registered sponsor, and then apply for your own ARTG number for that product. There are huge penalties for a breach of the TGA rules.
If we look at the overseas markets, there are literally hundreds of brands of cosmetic injectables on the market. It is quite literally out of control. The situation is so much better and safer because of the checks and balances we have here in Australia. Although it takes sometimes a very long time for products to gain an ARTG listing here, we can sleep soundly knowing that stringent testing and scrutiny has taken place before the products are unleashed into our hands.

What is new in cosmetic injectables in Australia?

Profhilo

There is a new class of injectable called Profhilo, manufactured by the company IBSA in Italy. Profhilo is an injectable bio-remodelling agent in a class of it’s own. Profhilo contains bio-identical hyaluronic acid, meaning that when injected, it looks and acts exactly like your own innate hyaluronic acid. However unlike other traditional fillers, Profhilo is not a volumizing filler. Instead it is injected in the upper dermis of the skin, in what are called Bio-aesthetic points (BAP). There are five sites on each side of the mid and lower face. Once injected, the injected HA will spread through all the layers of the skin over the next 12-24 hours, within a circumference of three to four centimetres. The technique and treatment is unique, and the practitioner will need to attend hands-on training to master this new pharmaceutical.

How does Profhilo work?

Profhilo has 32mg/ml of high molecular weight, and 32mg/ml of low molecular weight - thus the name “hilo”. The highly dense gel (having a total of 64mg/ml of HA in the product) is formed under intense pressure and temperature, and has no cross-linking at all. This means that is looks like very runny gel compared to the globular appearance of regular hyaluronic acid, despite its very high density. Profhilo is delivered in a 2ml syringe.
Profhilo will not fill and it will not restore contour to the skin or lips. Instead it targets fine lines, dullness, skin laxity and lack of elasticity. Results will not be immediate, instead seen over time. It acts as a bio-remodelling agent by reactivating skin turnover, fibroblast activity and even having some effects on the deep fat and bone. Adipocytes will being forming deep fat, which is essential for a youthful appearance, as the loss of these fat pads over time are a large contributing factor to the ageing process.
Once injected, the product will sit in a “raised bubble” until it dissipates through the layers of the skin, meaning that the downtime is based on the disappearance of the injected product only. There is no local anaesthetic included, so some areas of the face can be quite uncomfortable to treat, but it is a swift treatment.

Is Profhilo Safe?

Profhilo gained an ARTG listing around may 2022 here in Australia, but it has been used in New Zealand for over two years. It has been available in the UK and Europe for over 7 years. There have been well over 5 million treatments performed globally, and only 12 adverse reactions reported. All of these were minor, requiring minimal or no intervention from the treating practitioner.

What has gone under the radar?

Teosyal Redensity 1

There has been a product in the Teoxane range called Teosyal Redensity 1 for some time. As a Teoxane Australian expert, I feel that this Hyaluronic acid gel has been very overlooked for far too long. All the interest has been in the volumizing and lifting dermal fillers on the market. Redensity 1 is a non-cross-linked hyaluronic acid gel that contains a cocktail of 14 essential nutrients, including 8 amino acids (glycine, lysine, threonine, proline, isoleucine, leucine, valine, arginine), 3 anti-oxidants (glutathione, N-acetyl-L- cysteine, alpha-lipoic acid), 2 minerals (zinc and copper) and 1 vitamin (Vitamin B6). Essential amino acids cannot be made by the body, and instead must be supplied by the food or other supplements. So injecting this product into the skin ensures delivery of those essential nutrients exactly where they are needed.

What does Redensity 1 do?

Redensity 1 must also be injected into the superficial or mid-dermis
so that it can deliver its result, which is a re-densification and rehydration of the face. Traditionally called a skinbooster, Redensity 1 is a little bit more than that. Unlike
other products on the market, the addition of the amino acids and minerals makes this HA product a standout. I might be a bit biased, but the results do speak volumes. Your patient will notice an performed once a month, and at least twice to get the most benefit out of treatment. The practitioner can tailor treatment for the patient.
Unlike traditional skinboosters that require 100’s of individual applications all over the face, Redensity 1 can be delivered strategically in the areas of most need, such as smokers lines, the lower face, pre- auricular area and upper cheek. Again, training is required to deliver this treatment, which should be focused on anatomy, technique and the product itself (ATP).
Redensity 1 contains non-cross-linked high molecular weight hyaluronic acid (15mg/ml), along with some anaesthetic. This helps with patient comfort as you inject the product. Redensity 1 is delivered in either a 1ml or 3ml syringe.
Similar to the “raised bubbles” described earlier, Redensity 1 also has some downtime. It takes around 24 hours for the injected bumps to disappear, working its way through the skin layers, delivering the results and essential nutrients to improve the skin as it does.

Is Redensity 1 safe?

Again, this product has been used globally and in Australia for many years, and has an impressive safety profile. When delivered in the right layer of the skin, there is an expected projection of HA in the skin until the product dissipates. Usually this takes around 24 hours, but in some patients has been reported to take up to 72 hours. Bruising can occur, but is usually minimal when the practitioner delivers the Redensity 1 into the upper dermis of the skin. Some patients may also experience some puffiness as HA will attract water into the skin, however this is also a beneficial quality, rather than an adverse event. It should go without saying that any cosmetic injectable product should not be used without training to ensure that safety, anatomy and patient wellness is always respected.

What is coming to the cosmetic injection market in Australia?

Daxxify

There is a new Botulinum Toxin coming soon called Daxxify. The pharmaceutical has just gained it’s FDA approval in September, and is currently being used in the USA and Europe. Similar to other neuromodulators, Daxxify works by modifying the release of Acetylcholine from the nerve ending to the muscle, so that the muscle contraction is softened or frozen altogether.
What makes Daxxify exciting is that is has an increased longevity profile. Approximately 80% of people still had muscle relaxation at the 4 month mark, and around 50% of the participants in the trial had no lines or wrinkles in the treated area at the 6 month mark. Currently there are 3 other drugs on the ARTG register here in Australia, with most having a pharmaceutical effect for up to 3 to 4 months. This increased longevity that Daxxify promises will be a game-changer, particularly for those patients that have had great success in the relief of pain.

Therapeutic Use

Neuromodulators are used for many therapeutic reasons, and commonly used as a treatment to soften tooth grinding and clenching. In those patients, the actual contraction of the muscle can cause tooth pain and breakage, as well as hypoxia in the muscle from over-use. The jaw joint itself will also suffer due to the constant pressure and wear-and-tear in a grinding patient. Neuromodulators are an option to reduce the symptoms and cycle of pain, and from my practical experience with my patients, it has been quite life-changing. Using Daxxify as the neuromodulator for these patients looks promising, as treatment will likely be required less often. However we will need to watch the overseas trends, reports and outcomes for now, as the drug is not yet available here in Australia.
All indications are that other neuromodulators will probably be more appropriate initially, until the practitioner and patient have established the results and outcomes that they are happy with since botulinum toxin effects are not reversible. Daxxify would be more appropriate to use as a second treatment to gain a longer-lasting effect. Again, we will watch this space as we learn more about this pharmaceutical from our global colleagues.

The majority of your patients won’t consider themselves a patient. They’ll consider themselves a customer or client and treatments like Botulinum toxin and lip fillers are beauty and cosmetic treatments, not medical procedures for cosmetic purposes. We’re not saying this is right or how it should be, but it’s how it is, largely thanks to social media and influencers, the public are trained to think.

Patients are sometimes completely unaware of the risks that injectable treatment entail, but also that cheaper clinics are cheaper for a variety of reasons that will deeply change the way treatment and the follow-up will take place. Patients often assume that if someone is offering toxin and fillers, they have been properly trained and assessed, that providers undertake the same protocols and use the same products, no matter what. They assume it wouldn’t be allowed otherwise. But just like so many industries, there are the high turnover - churn them through - kind of clinics, and those that take time to really care and communicate for the patient.

It’s Not As Important To Patients

If you are anything like me, you live and breathe anatomy and cosmetic injectable treatments. It is literally at the centre of my universe and I am constantly reading a journal, assessing faces everywhere and absorbing information all the time. Again if you are like me, you read a lot about the industry, all of your social media is taken up with posts and pages that are related to skin and cosmetic injectables. You and I think about it a lot, we talk about it a lot, we update our skills and we work with injectables - a lot.

Patients are not like us. Patients think about their face. They think about the specific things that bother them - their forehead lines, their crows feet, their thin lips… they don't have a broad interest in anything other than what they need or want. They don’t care what’s happening with protocols or how you as the practitioner might follow them up. Patients generally don’t feel as passionate about cosmetic injecting industry as you and I do - and they probably never will. In the morning, they might try and fix a facial feature with makeup, but once it becomes something that is time consuming or not fixable, they will seek out a practitioner to ease their pain point.

The patient we want

Once a patient decides to have treatment - whether it be for their wrinkles, thin lips or whatever, in very simple terms we can divide patients up into two broad groups. There are "Low-cost Lisa's" and "Exclusive Elizabeth's".

I know this sounds harsh, but there are some patients that just want work done for the cheapest fee possible, and are not fussed by the details. These are our Lisa's. Lisa will scan your website and social media and look for the fee list first. They will travel for the cheapest fee, and are happy to go from clinic to clinic, practitioner to practitioner. They are not worried about quality as a primary consideration, as Lisa believes that all qualifications are the same, all products are the same, and that the fee is the only definitive difference.

Elizabeth's are quite a different patient. Elizabeth will look at your website, consider the branding and the way it makes her feel. She wants to feel that her money will invest in the best outcomes, so the fee is less important that the clinic, practitioner and the care that she will receive. She will take her time to choose a clinic, but once she trusts the "brand", she will stay. Elizabeth has a number of key considerations. These include:

• Branding - The clinic and website needs to look polished
• Before and after gallery - Treatment outcomes need to be natural, look cohesive and look comparable. Elizabeth can spot changes in lighting, makeup and little details
• Care - This type of patient will evaluate your communication style, time and consenting process. She will interact with the injector, asking questions about complications, experience and aftercare. Elizabeth wants exclusivity - no rushing, no churning, no cheap shortcuts.
• Results - This type of patient does not want to have any complications. She wants to trust her face to you, but she needs some time to make this assessment.

Elizabeth is in demand

You don’t want Lisa. You want Elizabeth. Once Elizabeth starts researching cosmetic injectable treatments, she will want a reputable practitioner that makes her feel special, that she can trust and continue care over the longterm, and someone who has experience. Elizabeth might not fully appreciate your talent and experience yet, but she trusts the brand and the message that the brand conveys - polished, trustworthy, reliable, experiences, professional.

All the little attributes that make you better than a cheaper clinic may not be fully processed - but the fact you’re a doctor, dentist or nurse will be the reassuring factor that gives Elizabeth confidence she’ll be in safe hands. She knows now she needs to see someone qualified and trustworthy - she might not acknowledge exactly what that means but your pricing indicates to you that you have experience that she is willing to pay for. The fact you’re ‘expensive’ is reassuring for Elizabeth, Elizabeth thinks; ‘She must be good.’ Indeed Elizabeth won’t consider it expensive, even if you’re concerned it is, Elizabeth will process it as value. Elizabeth believes that higher priced items and services, are generally better quality and more reliable. Higher fees convey your experience, time that you will take, and your training.

What about Lisa? Lisa doesn’t care about any of that. She hasn’t looked into it that much, it hasn’t occurred to her that not all clinics are equal, Lisa just wants her lips and she wants them now and for as little money as possible so she books the first person she sees in her area offering cheap lip fillers. She literally doesn't care who does it, or where she goes. Price is really the only consideration.

Don’t Be Embarrassed About Your Fees

Your fees reflect you and the quality care that you offer. You have spent time and endless education getting to this point, you’ve completed a degree, worked long hours, had years of training and learning. You have invested in your clinical space, your website, your equipment, your products. Your patients aren’t just paying for 1m of filler or 50 units of Botox. They’re paying for your knowledge, experience and skills. They’re paying for your time and effort and your commitment to safety and only acting in their best interests. They are paying for the brand that you have created and the way you make them feel. They know that you care, and that is important to them. They’re paying for your care, your accountability and your responsibility. They are paying to see you, and you alone. They don't want just any injector, they want you. They’re paying because you’re good at what you do - don’t be too humble to recognise this. You worked for this and continue to work for this. Be proud that your patient sought you out, because of you.

Forget the Lisa's

There are enough Elizabeth's for you to run a business with. Forget the Lisa's. Let them go to the beauty salon next door. You’re not losing them because you never wanted Lisa in the first place. That is not the brand that you emit. That is not your vibe. Lisa will never be your people. Chanel doesn't get worried that some people buy a handbag from Kmart. Kmart will never be Chanel, and Chanel knows it. They know they can charge more because their customers get a product that is exclusive, high quality and a better service with guarantees and a commitment to quality. Chanel does not mess around for being high priced when compared to Kmart, or any other brand. They are Chanel. You know when you buy Chanel, that you are buying design, style that doesn't date and that will stand the test of time. Kmart knows that it is fast fashion, and relies on turnover to survive.

You want patients who respect you for what you’re charging. And they will. There are enough of them. Even if they think ‘Ooof, that seems like a lot of money’ it’s not because you’re too expensive, it’s because they recognise they have to pay good money for good work. Quite frankly, there’s enough Elizabeth's who won’t give it a second thought - they will find a way to get treatment from you because they trust the brand!

Don’t Waste Your Time Comparing

It’s easy to convince yourself you’re business is going to fall apart when you know people are going to the cheaper competitor. Perhaps you’ve even lost a few patients to cheaper clinics? Sometimes even an Elizabeth might leave to try a cheap clinic to save money. But they will come back because no one will look after them like you and the way you make them feel. Don’t focus on patients that are no longer yours. Focus on the Elizabeth's you have. It’s worth remembering that other practitioners are thinking about you too - even the cheap clinics. They might be wishing that they could charge more to be successful like you. The cheaper clinics might be wondering why you get so many patients, why you’re able to charge what you do, how they can be as good as you. They might feel envious about your perceived success. It’s pointless to compare.

Love and maintain Elizabeth

Once you have secured a patient, who is happy to pay your prices and loves the service they receive, don’t become complacent about it. Don’t assume Elizabeth is yours forever. Loyalty takes time to achieve and can’t be taken for granted. However, once you’ve achieved it, you’re a lot less likely to lose Elizabeth, because Elizabeth trusts you and knows how you make her feel. She is now part of your brand, part of your vibe.

Make it too easy for them: Send them appointment reminders and tell them when treatment is due. For Botox and fillers, we send out automatic alerts to patients, advising that it has been x months since their last treatment and it’s time to get booked in for their next one. This works really well as it means they don’t bother looking elsewhere and just click on the link to make their appointment.

Keep chatting to them: Ask your team to reach out or send them an SMS or email a couple of days or weeks after their treatment, check they’re happy with the results, ask them if they feel good, check there are no concerns. If you follow them on social media give their posts the odd like or comment on how great they look in a selfie.

Make them feel special: Send them special offers, position it as a thank you VIP deal - perhaps a free sunscreen or face mask or LED treatment with their injectable appointment. It’s different from offering all your patients a discount. This is rewarding your loyal patients, it’s a way of recognising and loving them. They’ll feel special and want to stay with you.

Newsletters: If you’re a little bit of a wordsmith and enjoy a bit of creative writing, send out a newsletter to your patients. Tell them about new treatments, or training you’ve been doing. Share a story you’ve seen about aesthetic treatments, give them some tips for glowing skin, remind them to put their serums on. There are heaps of templates on Canva or other design templates can be found on Etsy too.

Essentially you simply want Elizabeth to feel cherished and special. By doing these things you’re offering extra value and subtly staying top-of-mind for Elizabeth. You are making sure that when Elizabeth’s friends decide to have a treatment, that Elizabeth recommends you - tells them how good you are, how nice you are. You want Elizabeth to become an advocate for you and all of these little gestures that you might consider irrelevant will contribute to ensuring that happens and Elizabeth will become a rich source of more Elizabeths for you. We have gained a number of patients in our clinic at Dermal Distinction because we wrote a personal message on a skincare delivery that we did. It is the simple things that matter.

So here is the main point

You don’t need to compete with cheaper clinics. They can have Lisa, you want Elizabeth. Elizabeth is not interested in the cheaper clinics, she wants quality, experience and your brand. She will pay money for that, because your brand delivers the results she considers to be top tier, and that is her main goal.

With all of this in mind, patients will base their decision on an emotion that they feel to begin with. Your website and social media is super important to convey that emotion from the get-go. After that, it is all on you and your clinic. You and your team need to make Elizabeth feel like she has made the right decision in choosing you and your clinic, and not only that. You want Elizabeth to feel that she is part of the vibe and branding. That is where Elizabeth will put her money. It has never been about the fee, but the value that you bring. Remember that!

ps. No Lisa's or Elizabeth's where hurt in bringing you this article!

Thanks for reading!

About Dr Benji Dhillon

Dr Benji Dhillon is a graduate of the prestigious King’s College London and a member of the Royal College of Surgeons since 2009.

Following graduation, Benji spent time as a cosmetic surgeon with several top London hospitals and on London’s Harley Street, before becoming clinical director for Europe, Africa and the Middle East with Allergan – the developers of Botox®.

At Allergan, Benji led scientific studies into anti-wrinkle and aesthetic treatments, including the leading Juvederm filler brand. He developed a global education program which trained thousands of doctors on delivering safer, more effective treatment and helped to set up Allergan’s Medical Institute (AMI) promoting excellence in clinical practice.

Benji now puts his diverse clinical experience into action as one of the country’s most sought-after aesthetic practitioners at Define Clinic – the nation’s leading centre for Harley Street-quality care outside the capital of London.

About Nik Davies

Dr Nik Davies, owner and director of NDSKIN, has worked in the cosmetic industry for many years. He has a wealth of medical knowledge and trained to be a qualified GP over 10 years ago. In this time he has also studied and trained to be a cosmetic doctor.

He immerses himself in the cosmetic industry, constantly learning and keeping up with all the education in the fast paced cosmetic and skin world.
Dr Nik is also a trainer for Derma Medical Australia where he teaches cosmetic injectables and educates doctors and nurses.

He is also proud to be an Australian KOL (Key Opinion Leader) for the dermal filler company Teoxane. Here he takes on the role of dealing with complications Australia wide, teaching and presenting on stage at some of Australia’s best known aesthetic conferences and being a devoted brand ambassador.

About Dr Giulia D'Anna

Dr. Giulia D'Anna graduated from the University of Melbourne in 1996. After commencing her own dental practice in 1998, her interest in cosmetic facial procedures led to further training and study within the field of non-surgical cosmetic injectables and skin science.

Giulia has been a cosmetic injectable educator and trainer for over 7 years, having worked with other organisations previously. She has developed her own cosmetic training based on real-life experience, medical standard practice and protocols and the AHPRA standards required of health practitioners.

She has been an Australian KOL for Teoxane since 2020, and takes a humble attitude with her. She believes in the products, technology and science behind the brand.

THE WEBINAR IS AVAILABLE TO OUR MEMBERS ONLY

Do I need filler or botulinum toxin?

While both dermal fillers and Botulinum toxin address lines and wrinkles, they work in different ways. The best treatment options for each patient depends on the underlying cause of their wrinkles as well as their desired end results.

Neuromodulators are a botulinum toxin or neurotoxin. It smooths dynamic wrinkles and helps prevent static ones by temporarily paralyzing the muscles that cause them. It works best for dynamic wrinkles like crow’s feet, 11 lines and forehead wrinkles.

Dermal fillers inject a gel-like substance underneath your skin to smooth static wrinkles by filling them. Ideal for static wrinkles, filler can also plump lips and cheeks or help minimize nasolabial folds and marionette lines.

How do I know which filler to use?

It is important that you understand the anatomy of the area being treated as a primary goal. This will help you determine whether you need to treat the area superficially or in the deep tissue plane. Once you decide on the depth of treatment, this automatically eliminates fillers which are not suited to be used in the incorrect depth.
Next you need to determine the technique you will use: cannula or needle. Finally you get to choose the filler. I like to use Teoxane fillers as they have a filler made for every application, and they have a beautiful range of resilient hyaluronic acid fillers which are designed to stretch with the skin and facial expression, making treatment undetectable. This is required to achieve a natural, untouched look.

Can my patient afford ongoing maintenance?

The results of dermal filler are not permanent and this needs to be discussed with the patient prior to treatment. Most HA fillers will be slowly resorbed by the body over the course of 6-18 months, depending upon the site, volume and filler rheology. Giving your patient an expectation of maintenance treatment costs is vital for a long-term good relationship.

What are the side effects and risks of dermal filler treatment?

Fillers have been proven to be safe, especially when administered by an experienced injector. Most people will experience an extremely short recovery period. Common side effects of dermal fillers include swelling, bruising, or redness at the injection site. This typically resolves on its own within 1-2 weeks.

Less common side effects include bleeding at the injection site, infection, or raised bumps or lumps under the skin.

Very rare side effects include the complications that arise if filler is accidentally injected into the bloodstream. This can lead to blurred vision or blindness if it occurs near your eyes. Visiting an experienced, board-certified injector minimizes the above risks.

How long does it take to recover?

The greatest thing about dermal fillers is that there is almost no downtime, unless your patient has some swelling or bruising. But even then the patient can carry on with most normal daily activities immediately.
I would recommend that you advise your patient to avoid treatment within 2 weeks of an important life event, just in case of these potential side-effects.

Does the patient have realistic expectations?

Dermal fillers smooth or plump skin by adding volume where needed. That said, their ability to completely recontour the face is limited. You need to ensure that your patient knows that they will see an improvement, but not complete rectification of any issues.

If you’re patient is seeking a more dramatic change, you may need a treatment plan that includes more than dermal fillers alone. This may require referral to a plastic surgeon to address the surgical options.

What should you ask your patient to do to prepare for injections?

The week prior to the injections, ask your patient to refrain from taking ibuprofen or aspirin, vitamin E or fish oil. This helps minimize bruising and bleeding. Make sure you have a full medical history for the patient, and their medical conditions and medications.
Ask the patient to avoid the dentist for at least 7 to 14 days before and after cosmetic injection treatment.

What do I tell my patient after dissolving the filler?

Ok, so you’ve dissolved the fillers for your patient; now what? Well, as a good healthcare professional you will now run through the dos and don’ts after filler dissolving treatment but, essentially, these include (but are not limited to)...

1. Taking paracetamol in case of post-treatment pain
2. Using arnica cream or tablets to reduce bruising
3. Covering the treated area with ice packs if there’s a lot of swelling
4. Refraining from rigorous exercise for 24-48 hours
5. Staying hydrated

How long after dissolving fillers, can I do new filler for my patient?

It might be the case that you want to dissolve the existing fillers because they look unnatural or that have been causing your paitent issues and want to replace them with new fillers. However, it’s recommended that you wait a couple of weeks before doing so. This is because
A) it might take this long for the filler dissolving swelling to go down, and
B) the hyaluronidase that’s been used to dissolve the previous filler might actually also dissolve any new filler that’s put in too soon after the dissolving filler treatment.

Botched!

Botox is just one brand of botulinum toxin, and also one of the most well-known. It is the name brand that everyone knows, and often get's used to represent all anti-wrinkle injections. Just look around you - women in their 40s looking for a more rested appearance, men wanting to get rid of those pesky crow’s feet, your favourite celebrities - many are in love with the results.

But we’ve also all heard the horror stories of botched Botulinum toxin. We may even know someone who has experienced anti-wrinkle treatments gone wrong. Some blame the drug, others the injector, some are simply scared. Photos of ptosis, where eye brows or lids have drooped, or the Spock effect, where eyebrows have a constantly surprised look have cause a lot of people to worry they'll get the frozen look. So, how does this happen?

Botulinum toxin is a toxin! And it is safe.

Some people hear the word toxin and you think 'scary', right! Well, botulinum toxin is a neurotoxin that comes from a type of bacteria called Clostridium botulinum. Used in large doses, well beyond those used in cosmetic or medical treatments, it is lethal, and can lead to paralysis or even death. That’s not intended to scare you - just to give you a bit of vital information. Consider, even extreme doses of water can be deadly too.

Botulinum toxin used in tiny doses, well, that’s where it can do great things. Think younger, smoother looking skin. And it's not only used for cosmetic purposes, either. It is used greatly within medicine to improve a vast range of issues - from excessive sweating to cervical dystonia and migraine relief.

Who is the injector?

What else should you consider when it comes to anti-wrinkle treatment safety? One of the most important factors is whether the practitioner performing the treatment is properly trained and also whether they attend regular CPD - ongoing training. The fact that it has become such a popular - and more importantly, lucrative - treatment has been the driving factor for so many practitioner jumping on the bandwagon, without the desire to produce safe, and great results. You should also stay clear of injectable parties, the trivialise the medical procedure. Though it's important to note that it is a prescription only medicine and should really only be done in a clinical environment.

What is also particularly worrying is that some give their services cheap price tags, which can make them very appealing to customers. But what many clients don’t realise is that cheap treatment should be avoided. The old saying ‘you get what you pay’ for springs to mind here. And who wants a poor quality cosmetic job? After all, it’s on your face, which, let’s be honest, is quite hard to hide should it go wrong.

Find a training provider that offers ongoing mentoring and support

Training in a weekend course is simply not enough. Practitioners that are trained by Dermal Distinction Academy soon realise that they are entering a new branch of cosmetic dentistry and medicine. This will become a life work and passion to pursue it properly. And you need a training academy that will support this growth and educational pathway.

We offer:
+ one-on-one coaching sessions once a month
+ Free membership, with a live chat right to your trainer to answer questions and support you
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+ A resource vault packed with articles, forms, guidelines, on-demand webinars and so much more.

Non Surgical Symposium Scientific Advisory Committee 2023

Dr Giulia D'Anna has been selected as a Scientific Advisory Committee member for the upcoming premier Non Surgical Symposium conference in 2023. The Non-Surgical Symposium (NSS) is an annual 3 day conference dedicated to appearance medicine, with topics ranging from injectables, through to skin care, including laser/light devices, non-surgical body contouring tools, patient safety & science. Since it’s inception in 2011, the NSS has grown to become the largest conference of it’s kind in Australasia, and attracts delegates and experts from around the globe.

It is only natural that scientists would work on a vaccine to try and normalise the way we function. A successful vaccination worldwide program is necessary if we are to return to normal in the near future. And science has seemingly produced multiple vaccines that are being released. Like all new medicines, there are going to be reports of unexpected complications. Recently there have been multiple reports of delayed hypersensitivity reactions in patients that have undertaken dermal filler treatments. But are these reports true and should we be worried? Let’s look at dermal filler and the vaccine.

What is dermal filler?

Dermal fillers are the most common non-surgical procedure undertaken in the world with the aim of facial rejuvenation. They are a soft, gel-like substances that are injected under the skin to revolumise and redraw the skin where there has been volume loss as a result of aging. They can address a number of common problems, including reducing the appearance of under-eye circles, improving the contours and structure of the cheekbones, volumization of the lips, smoothing of fine lines and wrinkles, and nasolabilal folds, as well as many other deflation and deficient areas.

Dermal fillers made from HA are called Nonanimal stabilized hyaluronic acid (NASHA) dermal fillers , and have been used in the United States since 2003. NASHAs have always been described as temporary fillers, as they are thought to completely dissolve over time. Yet any injector who works routinely with NASHAs, like myself, can attest to patients that have received multiple treatments of filler requiring less filler volume over time, as there tends to be a retention of previous filler, or at least the effects that the filler has on the skin tend to persist. This may be due to the infiltration of collagen and elastin through the filler, and those components being retained even when the filler is long-gone.

So where does the HA actually come from?

The bacteria Streptococcus Equi. This bacteria produces a HA capsule to enable it to survive the immune response of its host. The bacteria are grown in a laboratory, the capsules are fermented and the HA is captured and processed into the HA dermal filler injectable gels used all around the world. HA coming from bacteria sounds terrible, but let’s not forget that Penicillin comes from mould, and it is the pharmaceutical that changed modern medicine most significantly in history.

Although Dermal fillers can be composed of a variety of different substances, the most commonly used is Hyaluronic acid (HA). HA is a naturally occurring poly-saccharide sugar complex found in our skin, and it plays a major role in keeping skin hydrated, structurally resilient and volumised. HA fillers vary in longevity based on their structure. In our body, our innate HA turns over every 24-48 hours. So the manufacturers of HA need to modify the basic polysaccharide complex to produce much longer lasting results. Some HA filler last up to 18 months, due to the complexity of the cross-linking that the manufacturers establish to achieve resilience, volume, torsional strength and longevity.

What are the risk with HA dermal filler?

One of the main benefits of HA fillers, aside from their natural appearance when injected, is that they can be dissolved in the case of a complication or unwanted visual appearance at any time. This is by introduction of the enzyme Hyaluronidase which also occurs naturally in our body. By injecting this enzyme in a concentrated area, the HA filler is quickly dissipated, and so are any complications that may be associated with it.

There are a number of possible complications. The most common and least serious are discomfort, redness, bruising and localised swelling. More serious, but less common side-effects are infection and allergy. Even more serious and rare side effects are vascular occlusion (blocked blood vessels) which can involve the retinal artery which supplies the eye. This can cause the partial or complete loss of vision where the blockage is not immediately and completely resolved. This is exceedingly rare, but a very serious side-effect that needs to be discussed with all patients prior to treatment. Adequate time needs to be given for the patient to understand the risk, the experience of the injector and the expected results of treatment.

A less common side effect that is not as widely known is called Delayed Hypersensitivity reactions. This is a Type IV hypersensitivity reaction, where the reaction may occurs days, weeks or months after the initial treatment. This is therefore not recognised as an allergy, but rather an immune system reaction that occurs when there is another challenge in the body. That challenge raises the level of T-lymphocytes circularising and in susceptible individuals, they settle into the injected filler and create a reaction. This has been a long-established possible side-effect or risk of dermal filler reactions, with reports dating back to 1985 in some of the first papers. So this is not new, but occurs so seldom, that there is generally little thought about it. Let’s look at the data here.

Delayed hypersensitivity: The stats

There have been many published studies over the years of Delayed hypersensivity, but to get a sense of where this occurs, to whom and how to prevent and treat it, we need to look at the data.

In the published reports, largely the treating practitioners are ophthalmologists, plastic surgeons or dermatologists. These are all highly experienced medical experts. To deliver the dermal filler to the patients that experience DH reactions, the practitioners use a variety of injection methods, including needle and cannula. No one delivery method determined whether a hypersensitivity reaction would occur or not.

Prior to treatment, the patients all appeared to be generally well without any relevant or significant medical history. A variety of dermal filler brands are represented in the patients that later present with delayed hypersensitivity reaction.

What is a delayed hypersensitivity reaction

Appearing like an allergy, a delayed hypersensitivity reaction occurs week to months after the injection of filler. The dermal filler is usually completely without any concerns or complications at the time of placement, so when the hypersensitivity reaction occurs weeks to months later, it is completely spontanoues and unexpected. The reaction appears to be mediated by T-lymphocytes. There usually appears to be influenza-like symptoms that precede the reaction.

It is suggested that the HA molecules in all fillers act as a foreign implant. Since HA molecules are a polysaccharide that is naturally found in the skin, the HA is not though to be the focus of the delayed hypersensitivity. Instead, all the filler manufacturers need to modify the HA so that it is resistant to breakdown by our body. This provides longevity, structure and predictability to the filler. The manufacturing process of the HA is where the filler differs from out innate HA, and it is hypothesised that this processing of the filler creates the seed for delayed hypersensitivity as the T-lymphocytes see these structural chains as foreign when the immune system is triggered by the influenza.

A delayed hypersensitivity reaction is characterised by induration (localised hardening), erythema (redness) and edema (swelling)

It is also very important to remember that more than 2 million of these procedures are performed in the US alone every single year, and many millions more worldwide, but these reactions only occur in a extremely small group of people that develop influenza-like symptoms, and not every time they are sick either.

All case reports of delayed hypersensitivity reactions contain a very small cohort of patients, and there is variation in the filler brand, position of the filler, treatment undertaken. Ideally there would be a histological study done, but most patients are understandably resistant to this as they prefer quick and non-invasive resolution. The delayed hypersensitivity rate is believed to be around 0.42% (https://www.sciencedirect.com/science/article/pii/S2352647521000083_) of all patients treated.

Treatment varies in each study, which also makes it difficult to evaluate. Some practitioners will use the Hyaluronidase enzyme to dissolve the filler, thereby removing the allergen potential. Others use steroids to reduce the reaction. Others that have patients with milder symptoms simply wait for the immune system to settle down, and the hypersensitivity reaction appears to resolve spontaneously without treatment.

How do vaccines work?

A pathogen is a bacterium, virus, parasite or fungus that can cause disease within the body. Each pathogen is made up of several smaller parts, usually unique to that specific pathogen and the disease it causes. These subparts of a pathogen cause our body to produce antibodies in response. This is how we fight disease. Each new pathogen produces a new antibody. The reason COVID-19 has been so deadly, is that our bodies have never been exposed to anything like it. No one had. So all of the sudden our bodies are exposed to pathogens with no antibodies to fight it.

Vaccines contain weakened or inactive parts of a particular pathogen, and this will triggers an immune response within the body. So before you are ever exposed to the actual pathogen, your body has prepared antibodies that are on standby for the real assault. Some vaccines, such as the Pfizer vaccine multiple doses are required so that the antibodies develop and are long-lived. Occasionally some vaccines have a more widespread effect in susceptible people. Those people react as though they are ill. I am sure that we have all heard people complain that they go the flu after a flu vaccine, and maybe they did. This is their immune system putting up a strong fight to being inoculated with a foreign antigen.

COVID-19 vaccine

It makes sense that any challenge to the immune system, will raise the level of activity in our immune system. This is an expected and desired sequelae to vaccination. This can lead to “chills”, feeling generally unwell and so on. What has been reported after COVID-a9 vaccines have been delivered is that a very small cohort of patients that have previously had dermal filler, may have experienced a delayed hypersensitivity reaction in the treated areas.

Why do I say, may have experienced a reaction? Because the data at this stage is poor. There are no statistics behind how many people that have had the vaccine have had filler. And those with delayed hypersensitivity type reactions did not have a biopsy. At present, the presentation of the delayed hypersensitivity reactions following the COVID-19 vaccine appears to consistent with the presentation of other virus-initiated hypersensitivity reactions. Those that have had influenza-like symptoms in the past and those with post- COVID-19 vaccination hypersensitivity appear the same. This is not a new phenomenon.

The Australian situation

In Australia, we are in the position of being able to see both the Pfizer and Moderna vaccines being delivered to overseas populations before it is rolled out here. Again the data that we are seeing in terms of the rollout, delayed hypersensitivity and dermal filler injection is very sporadic and limited. None of the patients that have been inoculated were asked on the medical history forms whether they had dermal filler. These questions were asked once the hypersensitivity reaction occurred. I am sure that there will be more data that will be disclosed as more of the population overseas and eventually in Australia are treated. There is some suggestion to wait 4-8 weeks between filler treatment and vaccination so that as the immune system reacts to the vaccine, there is no further challenge from dermal filler being injected, and vice versa. Additionally in the extremely small cohort of patients that have had the COVID-19 vaccine and experienced dermal filler delayed hypersensitivity reactions, the vaccine appears to be effective at the same level as in those that have had no reaction.

Should you get the COVID-19 vaccine if you have had filler?

As the vaccination program continues to roll out, I am sure that this will be an expanding area of reporting as more and more patients are vaccinated. However in the early stages, the vaccine appears to have the same low reports of delayed hypersensitivity as in the general population that might experience these concerns when confronted with influenza. I have had dermal filler treatment, and I treat patients every single day in my practice.

Will I still give and receive HA dermal filler? Definitely.
Will the risk of Delayed hypersensitivity change our usual treatment protocol? Maybe a little. We will delay treatment if you have received the vaccine for a couple of weeks so that your immune system is settled.
Will COVID-19 vaccines change the world? I hope so.
Will I get the COVID-19 vaccine? For me personally, yes I will.

In this eye-opening article, I will dissect the latest trends that are set to dominate the aesthetic scene for 2024. From exaggerated results to risky procedures, I will uncover the potential pitfalls and reasons to exercise caution so that you stay informed, but also are empowered for your clients.

Barbie-Tox
Barbie-Tox, also known as Traptox, Swan neck and a bunch of other layman’s terms, the correct medical nomenclature for this procedure is Trapezius Slimming or Trapezius muscle relaxant treatment. Although this is a trend of the moment, given the hype around the beautiful Margot Robbie in the Barbie movie, this is not actually a new treatment at all.

So what actually is the Trapezius muscle and why would you slim it? The Trapezius muscle, as it’s name suggests, is a diamond shape muscle that runs from the base of our skull, down both shoulders and onto the middle of the back. The Trapezius muscle is important for shoulder and neck movements, posture, and overall upper body function. It is commonly targeted in exercises to strengthen and condition the upper back and neck. Body builders and weight-lifters aim to increase the size of this muscle to improve strength and upper back strength. When it gets broad, our shoulders look more masculine and our neck more bulky and wide. Enter treatment with botulinum toxin. Inject the muscle and the shape of our shoulders and neck change, since botulinum toxin temporarily modifies the contraction of the muscle, causing it to atrophy.

So consider what happens when we start to target this muscle with anti-wrinkle injections, such as botulinum toxin. The Trapezius muscle starts to weaken since it cannot contract, leading to a square right-angle between the neck and shoulders, which can appear quite statuesque. However it comes at a cost. Any patient that has neck problems or weakness, will further experience weakness and lack of support in the neck. This can lead to a host of issues, such as poor posture, shoulder dysfunction, neck pain and staring as other muscles struggle to compensate for the trapezius weakening, and decreased upper body strength.

Treating a patient’s trapezius muscle without proper consultation of the risks and any underlying neck issues is bound to land you and the patient in a very uneasy position - literally. Some patients will have trouble holding their head up. You need to consider the patient’s medical history, their occupation (do they need to look up or down more than normal?) and previous neck injuries and surgeries. Consequently this trend might best be skipped to keep your patient comfortable and functioning optimally.

Exosomes

This one has a lot of buzz going into 2024. First let us look at what an exosome actually is. An exosome is a tiny vesicle that is released by cells in the body and acts as a messenger between cells. Exosomes usually play a role in communication between cells, releasing bioactive molecules, resulting in physiological processes. This might be to induce collagen and reduce inflammation, which sounds amazing for any aesthetic practitioner. Imagine all the possibilities here, if we could deliver the messages we select out for our clients. Amazing, right?

Before we get too excited, let’s remember that some exosomes are not so desirable. Some exosomes contribute to cancer progression. Others help to induce disease, such as those exosomes released in Alzeiheimer’s or Parkinson’s disease.

Now of course exosomes that are being developed for skin treatments promise to induce great things for us, like more collagen and more elastin. This could be the next big thing in skin, especially if we could deliver the right exosomes, right where we need them. Getting the right exosomes where we need them is the next step. How do we deliver these vesicles into the skin? Some practitioners have already started to focus on the heavy use of exosome treatments using all manner of methods to insert them into the skin. Some are using devices to stamp the exosomes in place, others are performing micro-needling and then applying them topically. What is the correct way to use exosomes? We simply do not know.

At the moment, although Exosomes look to be on-trend for 2024, we need to pull-back a bit. There is no validated scientific research to show that they are useful - yet. Exosome use and effects are little more than theoretical at the moment, so we need to wait for this trend to pass and watch the actual real data before we start promising our clients results that may or may not be achieved. I know for me that when I am looking after a client, if I say I am going to deliver a result, I actually want to achieve a result. You might want to sit this one out for a while.

IV infusions

In medical settings, Intravenous (IV) infusions are used to administer fluids or medications or nutrients into the bloodstream to improve the health of a patient. Before undertaking an IV infusion, there is generally some medical testing and/or blood tests undertaken to diagnose an illness or lack of essential nutrients to qualify the treatment. However there are some IV infusions which are becoming a trend in the health and wellness space. In some cases, individuals may seek IV infusions for non-medical reasons, such as for hangover relief, boosting thinking ability, vitamin boosts, clearer skin or general wellness. These kinds of IV infusion are done on client request, and usually in a non-medical setting.

There is no denying that a hydrated body functions well, however there is often a lack of reliability of the IV infusions in terms of ingredients and also medical need. Let’s now look at the data and methodology. Most wellness IV infusions lack the scientific evidence to support the claims being made about them. Furthermore, when a solution is infused straight into the bloodstream, we have bypassed the regular absorption processes of the body, forcing the solution in. In usual circumstances such as when we eat a diet rich in essential fatty acids and other nutrient, the nutrients are filtered by our gut, where our gut will absorb the nutrients we need, bypassing those that are already at good levels. However when an IV infusion is undertaken, our body absorbs all of it, whether we need it or not, meaning that we may actually be over-infused. To be clear, I am not disputing that some clients need medical infusions. It is where there is treatment undertaken because of a trend and without diagnosis that we need to be careful.

In Australia, we need to be very mindful about how we advertise and undertake such treatments, particularly if a claim is made about a clinical benefit. If there is no scientific evidence to support the health benefit that is being advertised, the administering practitioner will find themselves in breach of the National Law and subject to AHPRA or criminal proceedings. Worse yet, is if the patient suffers a medical incident as a result of the IV infusion such as an infection, not only have you caused harm, but your reputation and good-standing will suffer. Again this aesthetic trend might be one that is best left to medical practitioners in a medical setting.

Weight-loss drugs

I am ending this article on a big one! If you haven’t heard about weight-loss drugs from the semaglutide family, such as Ozempic or Saxenda, listen up. These drugs are fast becoming widely in demand and are set to grow even more in 2024. But what are they? Semaglutide pharmaceutical drugs traditionally are prescribed for the treatment of diabetes, to control blood sugar. The drug is injected, causing the body to produce insulin, leading to lower blood sugar, slower digestion and the feeling of fullness. One of the side-effects of feeling full, is that the drug is seen to cause rapid weight loss as a side-effect, making it in demand with celebrities and now every person struggling with their weight. Of course this sounds like the dream solution to weight gain.

So what do you need to know? Well these drugs are not listed on the Pharmaceutical Benefit Scheme for weight loss in Australia, meaning that they can be expensive. They are also so widely in demand, that they are becoming hard to get, pushing the price up even further. Doctors have been cautioned to avoid prescribing these pharmaceuticals to anyone who doesn’t need them medically to try and ease the medicine shortage in the meantime. What is worse, is that counterfeit drugs are starting to make an entrance here in Australia as a result of the out-of-control demand, putting those that venture that way at real risk.

Let’s look at the risks with rapid weight loss. Semaglutide pharmaceuticals can cause gastrointestinal reactions in some people, which may include vomiting and/or diarrhoea. There have also been reports of nutritional deficiencies and severe headache in some patients due to lack of adequate food intake and poor metabolite levels.

A little talked about side-effect of rapid weight loss is what this does to the face and body. Being in aesthetic medicine, I have consultations and perform treatments for patients who have lost fat from their mid-face area on a daily basis. Under normal circumstance, we lose around 6.5ml of fat from the deep fat pads of the face as a natural part of ageing between the ages of 30 to 60 years of age.

As an aesthetic medicine practitioner, I think that we are going to see a shift in cosmetic facial changes in patients facial contours that we have not faced before. I am starting to see interesting changes in the way patients are presenting to my office of late. I am seeing changes in the mid-face that I usually do not expect so early on in life, and I wonder if this might lead to over-treatment over the long-term as patients battle the balance between body weight and facial fat loss. Only time will tell on this one.


Where to from here?

Trends are definitely creating buzz in the aesthetic industry and probably always will. As aesthetic practitioners, it is our job to know what our clients are asking for. My passion for ethical aesthetics is strong and at the forefront of everything I do in the clinical and education space. It needs to be so that I remain client-centric. Like many of you, we see trends come and go, and we need to be aware of what benefits there are for our patients. It is also our role to know when to agree to treatment, but equally when to pull back and explain why a trend might not the best idea for your clients. If you want to hear more about Ethical Aesthetics, please tune into the Dermal Distinction Podcast on your favourite streaming service.

An effective consultation not only ensures legal compliance but also plays a pivotal role in preventing complications, boosting patient satisfaction, and fostering loyalty and referrals. Our step-by-step guide is designed to help you perfect the aesthetic consultation, ensuring optimal outcomes for both your patients and your practice.

Step 1: Prepare for the Consultation

Before diving into the aesthetic consultation, proper preparation is key. Collecting patient details, including medical history, previous procedures, allergies, and current medications, allows for a tailored approach. Set the stage by creating a comfortable and private environment, eliminating distractions, and providing necessary paperwork in advance to keep the focus on the patient.

Step 2: Establish Rapport and Trust

Building a positive rapport from the outset is vital. Begin with a warm greeting, introduce yourself and your credentials, fostering trust and confidence. Employ patient-centered communication, utilizing active listening, open-ended questions, and empathetic gestures to make the patient feel heard and understood.

Step 3: Assess the Patient’s Needs and Expectations

Understanding the motivations behind seeking aesthetic treatments is crucial. Sensitively inquire about satisfaction with their current appearance, specific concerns, and desired outcomes. Conduct a thorough skin assessment, examining relevant features and taking measurements or photos as needed.

Step 4: Educate the Patient About the Procedure

Patient education is key to a successful aesthetic consultation. Clarify the benefits, potential risks, and expected outcomes of the desired treatment. Tailor the discussion to the patient's level of understanding, using clear language and avoiding medical jargon. Provide before-and-after photos, discuss the procedure details, and explain pre- and post-treatment instructions transparently.

Step 5: Present a Treatment Plan

Based on the consultation results, recommend a personalized treatment plan. Review the patient's concerns, analyze their skin condition, and emphasize the uniqueness of each individual's response to cosmetic procedures. Co-create a roadmap with the patient, exploring alternatives, setting realistic expectations, and actively involving them in the decision-making process.

Step 6: Ask for the Patient’s Commitment and Get Informed Consent

Seek the patient's commitment to the proposed treatment plan, addressing any remaining questions or concerns. Obtain informed consent, ensuring the patient understands the risks, benefits, alternatives, and expectations. Respect their decision-making timeline and provide additional support or information as needed.

Elevate Your clinic’s Patient Experience With Dermal Distinction Academy Training

Understanding the pivotal role of a flawless patient consultation, Dermal Distinction Academy offers comprehensive training for practitioners in injectable therapies. Our courses not only equips you with foundational skills but also provides operational support with policies and procedures in our online resources, covering consent forms, pre- and post-treatment instructions, confidentiality agreements, infection control, and more.

Perfecting the patient consultation is your key to success, and Dermal Distinction Academy is here to support you every step of the way.

If stress has been affecting you recently, you might notice involuntary jaw clenching or teeth grinding. Neglecting these symptoms can lead to serious jaw disorders and dental damage. Considering Botulinum for bruxism is imperative when exploring treatment options, as this safe and non-invasive procedure can effectively relax muscles, preventing jaw clenching during heightened stress levels.

Understanding Bruxism

Bruxism, or teeth grinding, is a medical condition that may intensify with increased stress levels. While it can occur when awake, sleep bruxism is more prevalent, affecting millions worldwide. Mild symptoms might not necessitate treatment, and lifestyle changes or behavioral therapy can be effective. However, severe pain or sleep bruxism may warrant further consideration of treatment options.

Persistent jaw clenching and teeth grinding can lead to constant headaches, tooth damage, earaches, and temporomandibular joint (TMJ) pain.

Recognizing Signs and Symptoms

Regular dental check-ups are crucial, but at-home vigilance is equally important. Look out for signs such as oversensitive teeth, locked jaw, severe teeth grinding, jaw clenching, chipped teeth, worn-down enamel, neck pain, sore jaw muscles, unexplained earaches, mild to moderate temple headaches, and disturbed sleep. Seeking professional help is advised for anyone experiencing these symptoms.

Botulinum as a Treatment for Bruxism

While dental devices can protect teeth from grinding damage, they might not alleviate associated tension and pain. Botulinum for jaw clenching provides a safe solution by relaxing muscle contractions in the jaw. This treatment involves injecting small doses of botulinum toxin into the masseter muscles, reducing occurrences of muscle clenching and grinding. Despite its well-known use in aesthetic treatments, studies have shown neuromodulators to be safe and effective for severe bruxism and TMJ pain.

Strategic Injection Sites for Botulinum in Bruxism

Precise injection sites significantly impact the success of injectable treatment. For those with bruxism and TMJ pain, injections into the masseters can alleviate grinding and associated pain. Additionally, injections into the temporalis muscle, responsible for jaw closure and chewing, can address inflammation caused by bruxism, reducing painful migraines.

Determining Speywood Units for Bruxism and Jaw Clenching

The required units of Botulinum for bruxism vary based on individual conditions. Factors influencing the dosage include age, overall health, duration of bruxism, symptom severity, and the extent of dental and jawbone damage. Medical experts recommend 25-30 Botox units for each masseter muscle and 15-20 units per side for the temporal muscle.

Potential Side Effects of neuromodulators for Jaw Clenching

As with any medical procedure, Botulinum for bruxism may result in short-term side effects. Common and temporary side effects include swelling or bruising at the injection site, headaches, or flu-like symptoms. Masseter treatments may rarely cause temporary asymmetry around the mouth if incorrectly injected, resolving as the effects of toxin wear off. It is important that you seek out training from a dentist who knows how to look for the right symptoms, anatomical landmarks and what to look for in your patient before you inject.

This article delves into the mechanics of a lip flip, explaining how it works, identifying suitable candidates, detailing expected results, and more.

Unraveling the Lip Flip Magic

To comprehend the concept, let's address the fundamental question: What is a lip flip? Unlike traditional fillers, a lip flip is a non-surgical procedure utilizing Botox to relax muscles above the lips. This induces a subtle upward turn of the lips, creating the illusion of fullness and preventing inward turning during speech or smiles. Additionally, it aids in reducing wrinkles on the upper lips.

Ideal Candidates for a Lip Flip

Recommended for individuals with existing lip volume seeking a subtle enhancement, the lip flip does not add significant volume but can enhance facial harmony, providing a more youthful appearance. It may also help improve a gummy smile. However, those whose professions involve frequent lip movement, such as speakers, musicians, or singers, may not be ideal candidates due to potential limitations in lip pursing.

Where Botox Meets the Lip

During a lip flip procedure, the practitioner injects Botox above the upper lip, relaxing the orbicularis oris muscle surrounding the mouth. Additional targeting of lip elevator muscles on the sides of the nose may occur to correct hyperactivity in the upper lip.

Calculating Botox Units for the Flip

Typically, practitioners inject four to six units of Botox for a lip flip, adjusting up to eight units for those with excessive gingival display. Personalized dosages depend on individual characteristics, ensuring a natural look. A skilled practitioner assesses each patient's needs for optimal results. Remember that the higher the dose, the longer it lasts. But the downside is that there can be functional deficits that are induced. It will be difficult to pucker, sip through a straw or keep a denture in, if the patient wears one. So it is crucial that you discuss these points with your patient before proceeding.

Navigating Lip Flip Side Effects

Patients undergoing a lip flip may experience normal side effects such as swelling and bruising, usually resolving within a few days. The initial sensation of "strangeness" in the lips is temporary, as the relaxed muscle adjusts over time.

Reveling in Results

Visible effects emerge within three to four days, with the full outcome materializing in about a week. For those planning ahead for events or travel, a two-week buffer post-procedure is recommended to allow any lingering effects to subside fully.

The Lifespan of a Lip Flip

On average, a lip flip lasts around 3-4 months, with variations based on individual metabolism. As mentioned already, although higher doses achieve a longer lasting effect, we do not want a negative experience for our patients. I would recommend starting at lower doses before increasing the dose to a higher than average amount.

Athletes and those with high metabolic rates may experience a shorter duration. The secret to a natural pout lies in seeking a skilled practitioner with proper training, ensuring beautiful results without compromising functionality.

In summary, the artistry of a lip flip requires a meticulous approach, where a proficient practitioner not only administers Botox accurately but also considers each patient's unique characteristics for an aesthetically pleasing and functional outcome.

While traditionally favored by those aged 40 and above, the demographic landscape is evolving, thanks in part to a trending treatment known as "Baby tox," particularly popularized on platforms like TikTok. This article delves into the ethical considerations surrounding this aesthetic trend.

Unpacking the Term 'Baby tox'

Contrary to its name, Baby tox has no association with infants; rather, the term refers to the minimal amount of Toxin injected during the procedure. This technique involves administering smaller doses to achieve a more subtle, natural appearance while preserving facial movement. Jennifer Chwalek, a board-certified dermatologist, defines Baby Tax as a micro-droplet injection technique, employing fewer units precisely and superficially to create a more even and natural look.

The Ethical Dimension of Baby Tox

Treatment Methodology:

Baby Tox functions similarly to traditional Botulinum, utilizing injections to reduce signs of aging by partially paralyzing facial muscles. However, the ethical consideration lies in its emphasis on minimalism and preserving natural expressions.

Benefits and Target Demographics:

While Baby tox offers a smoother aesthetic, particularly appealing to younger demographics, ethical practitioners should educate clients that it doesn't completely erase fine lines. Instead, it lessens their prominence, fostering a more genuine appearance. Moreover, practitioners should ethically consider the preventive aspect, advising clients that starting Baby tox early may help deter the formation of deep lines, making it more suitable for younger patients.

Ethical Client Preparation and Procedure Insights

Client Consultation:

Prior to the procedure, ethical practitioners prioritize thorough consultations, discussing clients' aesthetic concerns and desired outcomes. Providing comprehensive resources on the treatment ensures clients are well-informed.

Procedure Details:

During the treatment, nurse practitioners meticulously mark areas with visible fine lines, using the smallest gauge needle for injections. Ethical considerations include ensuring the client is fully informed about the procedure's expected sensations, typically described as a small pinch.

Potential Side Effects and Aftercare:

Transparent communication about potential side effects, such as swelling and tenderness, is paramount. Ethical practitioners advise clients to avoid certain substances before treatment to minimize risks. Baby tox's ethical aftercare emphasizes sun protection, the use of vitamin C serum, and hydrating moisturizers to promote skin health.

Advocating Ethical Aesthetic Choices

In conclusion, Baby tox emerges as an entry-level treatment, ideal for those beginning their cosmetic journey. Ethical practitioners prioritize transparency, informed decision-making, and the preservation of a natural aesthetic. For the younger demographic, Baby tox offers a nuanced approach to reducing fine lines and wrinkles, reinforcing the significance of slow and steady progress in the realm of aesthetic enhancements.