Dr. Nick Milojevic

Milo Clinic

One of the leading british aesthetic doctors


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Dr Milojevic discusses pigmentation in the Aesthetics Magazine

Practitioners share advice on how to safely and successfully treat hyperpigmentation with chemical peels

Sun exposure, hormonal activity and general ageing can all contribute to the development of hyperpigmentation, which is often a significant concern for aesthetic patients. The darkened patches of skin that appear as a result of increased melanin production can vary in size and appear anywhere on the body,1 although, according to the practitioners interviewed for this article, patients generally request treatment for those on the face.

“My patients are often hugely stressed by hyperpigmentation; often placing more importance on treating it over lines and wrinkles,” says German board-certified dermatologist Dr Stefanie Williams, who runs Eudelo in London, and notes that hyperpigmentation is the most common reason people visit her clinic. Aesthetic nurse prescriber Kelly Saynor, founder of Renew Medical Aesthetics in Cheshire, agrees, saying, “They can become a bit depressed, in the same way as those patients suffering from acne, and feel the need to cover up their skin.”

While lasers are well known as an effective treatment for hyperpigmentation, this article will focus on key considerations when using chemical peels to treat the common aesthetic concern.

Aetiology

Hyperpigmentation is a result of an overproduction of melanocytes, the pigment-producing cells that are located in the basal layer of the epidermis.2,3 According to the practitioners interviewed, there are three main causes for its occurrence. These include:

Sun exposure: “I have found that the most common form of hyperpigmentation is sun damage,” says Saynor, noting that it can affect patients of any age. If skin is over-exposed to sunlight then it can increase pigment production, leading to hyperpigmentation.1 Aesthetic nurse and founder of MBA Clinics, Petrina Nugawela, explains that sun damage tends to be located superficially, so is fairly easy to treat.

Hormonal influences: Most commonly, hyperpigmentation presents itself as melasma as a result of hormonal changes, due to pregnancy or taking contraceptive pills, and can be difficult to treat. As such, it is often referred to as ‘the mask of pregnancy’.1 “If patients are on the contraceptive pill you will have real trouble getting a good result,” says Dr Williams. “It is worth discussing this with the patient to see if they would consider changing their contraception ahead of treatment,” she adds.

Post-inflammatory hyperpigmentation (PIH): Following damage to the epidermis or dermis, inflammation can trigger melanocytes to increase melanin synthesis and transfer the pigment to the surrounding keratinocytes.3 Aesthetic practitioner Dr Xavier Goodarzian, founder of the Xavier G. Clinic in Southampton, says, “PIH is luckily easy to treat with skin lightening topicals and generally clears up well.” Although, it is important to note that the pigmentary changes as a result of PIH can occur with greater frequency and severity in Fitzpatrick skin types IV-VI.4

Consultation

Understanding your patients’ expectations from treatment should be the main priority of any consultation, says Dr Nick Milojevic, aesthetic practitioner and founder of the Milo Clinic in London. Saynor highlights that many of her patients have unsuccessfully tried lots of over-the-counter (OTC) creams and other treatments before presenting to her clinic. “Patients may have over- or under-used products, or just been using the wrongs ones,” she says. As such, Saynor emphasises that practitioners also need to find out how long they’ve had the hyperpigmentation, how they feel about it, what treatments they’re prepared to undergo and how much they’re prepared to spend – “Be tactful and go in with trepidation,” she suggests. Once you’ve established their expectations, the practitioners advise that you then need to carefully outline what can be achieved with chemical peels, the side effects that patients will experience and the complications that could occur.

Saynor adds that ensuring your patient understands that hyperpigmentation can never be completely eradicated is essential. “We can suppress it with the products we put on topically, but it can come back. As long as patients understand that and comply with your pre- and post-procedure advice then they will be happy,” she says.

Then, you can move on to tailoring treatment to your patient’s individual requirements. “The best thing to do is to make sure you understand where the pigment has come from,” says Dr Goodarzian, advising that practitioners should ask for a past medical history, as well as a family history to try to establish an accurate skin type. In addition, he advises practitioners to ask patients what products they currently use on their skin and what treatments they may have undergone in the past. “I would then recommend using something like a Wood’s lamp or an imaging device to look at deeper pigmentation under the skin, to understand and demonstrate to the patient the type and extent of their hyperpigmentation.”

Dr Williams agrees, adding, “The first thing I do is diagnose what type of pigmentation it is by thoroughly examining the skin and doing a digital face scan, with a Wood’s lamp where we can look under the skin, as well as on the surface. Once we have a diagnosis we then look at how the patient would be treated.”

Treatment

The practitioners agree that having a thorough understanding of the different Fitzpatrick skin types and how they react to chemical peels is an essential part of your treatment approach.

As mentioned above, while using chemical peels on Caucasian skin is generally considered safe, treating darker skin types carries an increased risk of developing PIH.4 Nugawela explains that approximately 80% of her patients are Asian. She says, “If you are treating darker skin, you have to be able to make an assessment on skin colour and texture. You cannot always go with the basic instructions on a piece of paper, you need to be able to make that visual judgement for yourself and never take a risk with a patient.”

She continues, “With higher Fitzpatrick skin types, you have to be so careful and treat every patient as an individual. You could have 10 people in front of you who have the same colour skin tone, but they all react differently.” Nugawela advises that practitioners should apply a very thin layer of product to begin, and carefully watch how the skin reacts. “You don’t leave the patient; you don’t take your eyes off them,” she emphasises.

Superficial and medium-depth peels are used to treat hyperpigmentation, while deep peels are generally reserved for lines and wrinkles. Careful skin priming and the appropriate selection of peel is essential for successful treatment. However, it is important to note that the peeling solution alone does not necessarily determine the depth of the peel. Depth can be determined by a number of factors including the concentration of the solution, the pH, the availability of free acid, the length of time applied to the skin, the condition of the skin, and the method of application.5

Skin preparation

Prior to treatment with chemical peels, practitioners advise priming the skin with topical de-pigmenting agents, which act as an adjunctive to treatment and can enhance the effect of the peeling agent.4 This also allows practitioners to identify any potential sensitivity to ingredients that may be used later with the peel. The ingredients included in such de-pigmenting agents usually contain a combination of ingredients such as hydroquinone, azelaic acid, kojic acid, licorice extract and retinoids, amongst others, which work to lighten the skin and create an even-toned appearance.6

In addition, Dr Williams recommends that patients use an antioxidant serum and an SPF. Her product of choice is Kligman’s Formula, a prescription-only formulation, which she describes as the ‘gold standard of anti-pigment treatment’. For Dr Milojevic, the Obagi Nu Derm System is his topical product of choice prior to a chemical peel. He recommends that patients use it every morning and night for three months, and visit their practitioner once or twice during this time to check the skin’s progress. “If the patient is examined thoroughly by a practitioner and appropriate dosages are prescribed for home use, then results can be hugely successful,” he says. Dr Goodarzian, on the other hand, has had particular success with Dermamelan, which aims to pause the skin’s melanin production to reduce the appearance of skin blemishes caused by excessive melanin.7 Once a treatment approach has been decided, Dr Goodarzian explains that he creates a skincare programme for each of his patients. “I specifically write down a programme with one to four steps for the morning and night. I try not to make it too complicated as people generally don’t want to spend too long putting creams on their face,” he says, adding, “However, for treating hyperpigmentation, the routine does tend to be a little more complicated so I do try to ensure that patients understand the importance of following it precisely.”

Dr Goodarzian emphasises the importance of using sun protection in each of his programmes and recommends that patients use an SPF 30 or above every day. The practitioners agree that getting patients to comply with staying out of the sun and using protection on a daily basis, regardless of the weather, is one of hardest issues to combat. Dr Williams says, “Patients underestimate the importance of sunscreen; one day of sun can essentially undo three months’ worth of treatment.”

Superficial peels

For patients suffering from mild hyperpigmentation, or for those who do not want the discomfort and downtime associated with a deeper peel, there are a number of types of superficial peels that can be used with reliable results.

Alpha hydroxy acids (AHAs) and beta-hydroxy acids (BHAs) are applied as the peeling agents for superficial peels, as they work to penetrate the epidermis, break the bond between the keratinocytes and allow for faster exfoliation of those skin cells. The most common AHAs are glycolic acid and lactic acid, although they can use a number of different formulations including citric acid, phytic acid and kojic acid.

Dr Goodarzian explains that while the AHAs main role is to exfoliate the skin, their secondary role is to lighten the skin by having an influence on the physiology of the melanocytes’ pigment production.9 According to Dr Goodarzian, patients usually need a minimum course of four AHA-based peels, although it can be up to eight, spaced two weeks apart for effective results. His current products of choice include the Neostrata peeling range, which he says offers different percentages of glycolic acid, as well as citric acid and mandelic acid packaged separately so that you can mix with the glycolic acid as needed. “They’ve been around a long time and have got brilliant data in regards to efficacy,” he says. At each clinic session, Dr Goodarzian advises that practitioners should check that the skin is healing properly and is progressing at the rate it should be. With superficial peeling there is minimal downtime, he says, noting, “Patients won’t need to take time off work, even if they’ve had six peels.”

Salicylic acid is the most frequently used beta hydroxyl acid (BHA). It is different to AHAs as it is lipophilic, whereas AHAs are water-soluble, which is why salicylic acid is often chosen to treat oily and acne prone skins.8 Nugawela says that she uses mainly glycolic and salicylic acid-based superficial peels and highlights that she has had successful results with both the Jan Marini glycolic acid portfolio for its high safety record and the salicylic acid-based Obagi Blue Peel RADIANCE, which she says is a bit stronger than a glycolic acid-based peel but does not stress the skin. “I love Obagi Blue RADIANCE as patients feel like they’re having something done as there is a little burning sensation but it doesn’t irritate the skin,” she says. In addition, she notes that the fact that the peel changes colour (from a blue to white frosting on the skin) is a really good indication for how well the product is working and when to stop application.

While superficial peels are effective at treating the outer layers of the skin, particularly for sun damage, and taking a more gradual approach to skin improvement with minimal downtime, some patients may require a deeper treatment and request quicker results. As such, a medium-depth peel may be appropriate.

Medium-depth peels

“Medium-depth peels have a better chance of being able to suppress and reset the skin,” says Saynor, although she does note that sometimes it will get worse before it gets better. Medium-depth peels are most commonly performed with trichloroacetic (TCA) acid and Jessner’s solution, in various combinations and concentrations.10 and typically result in a patient’s skin peeling for a week following treatment, so it is essential that they are prepared for the downtime. Dr Goodarzian says, “TCA can look weird but you can still go out – it just looks like you’ve got cling film on your face. Patients will start peeling after about two to three days, and on day three, four and five it looks really obvious that the patient has had something done, so most patients prefer to stay at home.” Dr Williams uses peels from a range of different brands, including NeoStrata, Sesderma, Image Skincare and the SkinTech Easy Peel. “I’m not saying these are the only good ones,” she says, adding, “Practitioners should look at the clinical trials and evidence behind products before deciding on a peel brand – also, you can’t compare peels directly, even if they have the same concentration of active ingredient on paper.”

For Saynor, her product of choice is The Perfect Peel, a product distributed by her company Medica Forte. The peel is made up of glutathione, vitamins and minerals, and five different types of acids, all at low percentages, that work together aiming to reduce pigmentation, correct wrinkles, exfoliate the skin and reduce inflammation.11 Saynor says, “It allows the practitioner to bridge the gap between the old and new style peels.”

Following any type of peel, Saynor emphasises that patients should aim to keep their skin hydrated, with the use of a cosmeceutical hydrating product that has active ingredients, rather than an OTC moisturiser, to further enhance the results of the treatment.

Side effects and potential complications

As expected, the main concern with undergoing a chemical peel treatment for patients is the peeling itself. “Following a superficial peel, there may be faint flaking after a couple of days, but very often not even that,” says Dr Williams.

Medium-depth peels, on the other hand, are associated with much longer downtime, with skin peeling for, on average, up to three weeks. In addition, the practitioners interviewed all say that patients are very often tempted to pick at the peeling skin, which can have serious implications. “If you’re picking at scabs, greatly increases the risk of scarring and can potentially also create an entry point for bacteria so, in theory, you have a higher risk of infection,” explains Dr Williams, although she notes that she has never seen this in practice.

Dr Goodarzian adds that infection is either bacterial or viral and the practitioner should treat accordingly. “You would normally see red patches or, in a worst-case scenario, pus-filled spots with a bacterial infection,” he says, noting that these are easily treatable with antibiotics. However, a viral infection could result in herpes simplex virus (HSV). “You should always ask patients if they have any cold sores and cover them with HSV treatment prior to the peel,” he says, adding, “If you don’t there is a risk that they do get herpes and it can spread across their entire face, which can lead to severe scarring and pigmentation problems.”

Dr Goodarzian notes that there is sometimes a misunderstanding that superficial peels can’t cause scarring. This is very wrong, he says, explaining that it is possible to get scarring as a result of a superficial peel if the skin has been too well prepared, is overly sensitive or if product has been left on for too long. “Even with a 50% glycolic acid peel it is absolutely possible to get scarring so it’s important to stick to the protocols,” he says, adding, “Don’t leave the peel on for too long and if you do start to see a negative reaction then neutralise and remove the peel immediately.”

Dr Goodarzian advises that practitioners should start using peels with a low percentage before working their way up. “I would recommend you stick to somewhere between 15-20% and layer it up, which will drastically reduce the risk of scarring,” he says. Although rare and not something seen by the practitioners interviewed, they explain that some patients can suffer an allergic reaction to a chemical peel. As such, it is important to monitor the skin closely through both the preparation phase and the peeling phase, and remove the product used immediately if an adverse reaction begins to occur. Finally, Dr Goodarzian says, “A good consent form is really important, as well as good aftercare instructions that people take home, read and really understand what they need to be doing. In addition, having a system where patients can call you or the clinic if there are any issues is hugely valuable.”

Education is key

While chemical peels offer promising results and improvements to the appearance of hyperpigmentation, they do not come without their risks. Having thorough training in their application, as well as a high level of understanding of treating different skin types and how to manage complications is hugely important to safe and successful results. Dr Goodarzian says, “Please make sure you get training; don’t just think you can buy something off the internet and slap it on. Educate yourself; read about it. The two textbooks I recommend are The Textbook of Chemical Peels by Dr Philippe Deprez and Obagi Skin Health Restoration and Rejuvenation by Dr Zein Obagi. If you read these books as background, they will really help you with the basics of peels.”

Saynor adds, “The skin responds differently from person to person, so make sure you do your homework, listen to your peers, attend as many courses as you can and really understand your patients’ skin.” In addition she says, “Don’t think you can get into peeling overnight – everyone will get that patient who doesn’t respond as you think they will, so it is imperative that you armour yourself with knowledge so that you are able to look at the skin, assess it correctly and treat it appropriately.” Dr Williams concludes by emphasising the importance of also educating patients on the damage that can be caused by the sun, and how to make the most of their treatment. She says, “In most cases, we can’t switch off the internal reasons why you have a predisposition to hyperpigmentation, however we can change patients’ attitude to the sun, which goes a long way.”

Disclosure: Kelly Saynor is the owner of Medica Forte, the distributor of the Perfect Peel.

The Telegraph writes about Dr Milojevic and his wow treatment of non surgical nose shaping

 

We are very proud that the Daily Telegraph has written a wonderful article about Dr Nick Milojevic and his signature treatment of non-surgical nose shaping (non surgical nose job procedure). The journalist was delighted with his new nose!

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Would you join the 5,000 men who have cosmetic surgery each year? I did…

I was always told not to stick my nose into other peoples’ business. But, when the one you have still boasts the trauma of a teenage sports injury, sometimes an outsider’s expertise can be the only solution.

Given that men are going under the knife in record numbers, plenty of others clearly agree. Statistics for 2015 by BAAPS (the British Association of Aesthetic and Plastic Surgeons) revealed the blokes having work done increased to 4,614 from 2,440 in 2005. Even more shockingly, I was about to join them.

The decision comes twenty years after a spirited game of football left me with a bloody nose… and a bump which acted as a lasting memento of a humiliating 4-1 defeat.

Not that it was bad enough to keep me awake at night, of course, but for a perfectionist like me, it was a mild annoyance. Yes, most of the time I could ignore it, but every now and again I’d catch myself in certain lights and be irked by its centimetre presence.

Over time it became like a nagging note on a ‘to do’ list – akin to a creaking cupboard door or the proverbial dripping tap. And, as someone who’s a fixer, I was always compelled to do something about it. But what, exactly?

I certainly didn’t want to undergo the drama of a rhinoplasty, which (quite literally) sees a masked surgeon take a hammer and chisel to my face, leading to black eyes, bed-rest and an embarrassing cast. No way. Then again, there seemed little alternative, which – in a world where Richard Branson is planning to send people to the moon – was frustrating.

In fact, when mind-over-matter failed, there were moments of frustration-inspired madness when I truly thought good, old-fashioned home remedies might be the answer… a bit of regularly applied pressure, perhaps, or some brave, bite-the-bullet shaving with a file from my tool kit. Fortunately, a quick look at the DIY in my flat put an abrupt end to that.

Instead, I needed something more proportionate, yet still professional – which, thanks to my GP, led me to the non-surgical nose job. Something I’d never really heard of, but is apparently one of the most popular procedures among us fellas.

A ten-minute tweak which sees dermal filler injected into the outer nose to provide the optical illusion of symmetry and smoothness, it cleverly makes the nose look smaller by increasing its size. The best bit? It’s discreet and has no down-time, meaning no sick leave, no pain.

Oh, and with a price tag of £700, it was 90 per cent cheaper than a typical rhinoplasty. Now you’re talking.

However, I quickly learned that it wasn’t without its own risks. Friends in the industry shared horror stories of people who’d been left with necrosis (tissue death), pulmonary embolisms and blindness by amateur practitioners who accidentally injected the material into blood vessels, but – because I don’t scare easy – I took it all with a pinch of salt.

That was until I stupidly responded to an advert on a famous voucher code website, which saw one woman try to perform the procedure within minutes of me entering her rented ‘office’ – without actually bothering to examine my face or mental state.

Needless to say, I didn’t stay. But it was the wake-up call I needed.

Fortunately, the research I then undertook pointed me in the direction of Harley Street’s Dr Nick Milojevic, who’s touted as a celebrity favourite. His work, I was reassured, was all filler, no killer. Thank God.

During our consultation (in which I spent much of the time surreptitiously looking as his nose) he interviewed me as much as I did him. Interestingly, he revealed that he often turns people down (“If a patient has unrealistic expectations or if the request is not one that we can fulfill”) and has been operating in the capital for more than a decade.

Weeks later, after insisting I go away and think about it, I was back in his chair with a needle pointing at my nose. “You may feel a little prick, he said, without irony. But, before I could laugh our make an inappropriate joke, he was already injecting Restylane (stabilised hyaluronic acid, which is already present in the body – thus natural) into the area around the unsightly bump.

Painless, it felt no more uncomfortable than having my gums numbed at the dentist.

Then, as I braced myself for some intricate artistry, he handed me a mirror. It was over.

Instantly, I was delighted with the results. For the first time in two decades my nose was symmetrical.

The bump, which previously seemed to exert so much power over me, had suddenly gone – and, with it, went all the precious time I’d spent thinking about it. Secretly, I felt foolish for not being decisive enough to do it sooner.

Then again, Dr Milojevic reassured me, the procedure is only now hitting its stride.

“It only became available about eight years ago and the dermal fillers are improving every day, making this now a very refined procedure with great results,” he explained.

“This is perfect for any patient with a bump on their nose, but is especially good for someone like Owen Wilson who has a crooked and very uneven nose.

“With careful application, he could certainly achieve a really nice and natural result. Owen would not be changed much, and indeed people might not realise that he had something done, but he would look better.

“This is the beauty of this treatment… and the appeal for so many men. The fact that people won’t know they’ve had it done.”

And, given the huge spike in numbers, that’s a clearly a convincing selling point.

“Twelve years ago, at the beginning of my career, only ten per cent of my patients were men. Now, it’s more like forty per cent.

“Noses are the most common request, because of minor sports injuries, but men are also having non-surgical eye-bag removal and botox for excessive underarm perspiring.

“Science is catching up with demand… and men are catching up with women.”

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Tatler Magazine names Dr Nick Milojevic in the prestigious top doctors list for the second year running

We are very proud and thrilled to be included in the TOP DOCTORS list for the prestigious TATLER BEAUTY & COSMETIC SURGERY GUIDE 2016. Our very own Dr Nick Milojevic has been named as one of the top doctors in the UK for botox treatments.

Here is what Tatler had to say about our doctor:

“Smooth-talking Milojevic has one of the lightest touches on Harley Street. Botox is still going strong, he says; what’s changed is the volume used. ‘We’re doing micro doses much more now. If baby Botox was using half of the original amount, micro Botox is using just a quarter.’ The effect is startlingly natural. In fact, some of his tricks with it are downright ingenious, like the muscles that cause gummy smiles, and doing a point in between the nostrils to give the subtlest lift to the tip of the nose.”

“The latest string to his bow is PRGF (Platelet-Rich Growth Factors), a souped-up version of PRP (Platelet-Rich Plasma – injections of rejuvenating platelets to the skin). It’s great for those tiny lines that creep down the cheeks – notoriously difficult to treat with Botox  – as well as pepping up tired faces. ‘It gives people their original shine back’.”

‘Stunning results’ by Dr Milojevic in Woman’s Own magazine’s September issue

We love seeing published success stories, almost as much as seeing patients leave our clinic with smiles all round!

So when we invited Nilufer Atik in to our clinic to try our Tear Trough treatment, we were delighted to hear she was delighted with Dr Milojevic care and her ‘stunned’ with her instant results in Woman’s Own Magazine September 2015 issue. 

Here is what Nilufer, had to say about her experience with our doctor; 

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Jawline, neck, skin and hand rejuvenation using hyaluronic acid fillers and skinboosters

Milo Clinic TV always bring you informative films on the most interesting aesthetic medicine treatments in the industry. In this film, we can see how skin tightening and rejuvenation around the jawline and neck are perfomed, using dermal fillers and botox in the “nefertiti neck lift” procedure. Also, we can see how the incredible hand rejuvenation is performed using restylane vital skinboosters.

Obagi Nu-derm for Pigmentations and Skin Rejuvenation, “A kind of miracle for the skin”

Take a look at this new Milo Clinic TV  film about the Obagi Nu-Derm system and cosmecueticals,  which I call ” a kind of miracle for the skin”. This system of medical creams and peels is by far the best answer on the cosmetic market for the removal of pigmentations, as well removal of pores, acne scarring and perfect rejuvenation of the skin. Do take some time to watch this film and find out everything you ever wanted to know about Obagi medical creams, Obagi peels and the Obagi cosmecueticals range, as well as a detailed instructional part to the video, where you can see exactly how to apply the Obagi Nu-Derm creams.

Tatler Magazine names Dr Nick Milojevic in the prestigious top doctors list

We are very proud and thrilled to be included in the TOP DOCTORS list for the prestigious TATLER BEAUTY & COSMETIC SURGERY GUIDE 2015. Our very own Dr Nick Milojevic has been named as one of the top doctors in the UK for the non surgical eyebag removal, botox and botox for hyperhydrosis treatments.

Here is what Tatler had to say about our doctor:

“Eye bags. They just make you want to cry, don’t they? But crying never made anyone look pretty. Deep breath, man up and head over to Dr Milojevic’s treatment room on Harley Street (he has bigger, plusher clinic in Zagreb if you are in the area) for this non-surgical eye-bag removal treatment. This snappy procedure uses artfully place, filler to treat the tear troughs making it significantly less eye-watering option then surgery. Milo, as his friends know him, is also a Botox genius. Tennis ace Goran Ivanisevic has written a gushing testimonial on his web site thanking him for curing his excessive sweating with Botox injections. There is little this man can’t do with a needle.”

“Airbrushed perfection is possible without going under the knife. A straightened nose can be achieved with no scarring. Intrigued? Meet Dr Nick Milojevic, a leading aesthetic medicine expert in the UK who combines long-standing methods with his own signature techniques for a revolutionary approach to cosmetic surgery. Dr Milojevic pioneers new treatments and has firmly established himself as one of the forerunners in cosmetic excellence. With over 12 years experience in the industry, Dr Milojevic has been at the helm of his own practice, the Milo Clinic, since 2006.

20,000 cases of botox and fillers later, he is considered to be the best kept ‘open secret’ in Harley street with clients flocking to the practice to avail of quick, agedefying treatments. In fact, such is the reach of Dr Milojevic’s reputation, that patients travel from far flung destinations – Dubai, New York, Russia – just to benefit from his light touch and precision technique. Recognised as a key opinion leader in London and wider Europe, Dr Milojevic frequently provides comment in the media on new developments in cosmetic surgery. But perhaps most important of all, Dr Milojevic’s approachable and kindly manner puts his patients instantly at ease. Milo has become the name to trust.”

Cosmetic Surgery Guide: Dr Nick Milojevic – Cosmetic Doctor

Dr Nikola Milojevic is the owner and clinical director of the Milo Clinic, one of London’s leading aesthetic medicine clinics. He specialises in an array of cutting-edge aesthetic procedures and treatments for both men and women.

Dr Milojevic is continually named in the media’s lists of top experts for Botox in the UK, and is recognised as the leader in his field for non-surgical eye bag removal using dermal fillers and non-surgical nose shaping using Restylane.

The Milo Clinic’s aim is to halt the aging process, turn the clock back, rejuvenate and to make patients look as they feel inside

Dr Milojevic’s passion, ambition and artistic feeling for aesthetic medicine are unrivalled and his friendly, reassuring approach puts even the most nervous of patients at ease.

Known to have “the lightest hand’s in Harley Street”, he has a unique and modern approach to this fast growing field of medicine, which he believes to be the future (and increasingly the present) of cosmetic and plastic surgery.

Expertise & Services

  • Face: dermal fillers, Cheek Augmentation, Lip Augmentation, Nose Shaping, Non-Surgical Eye Bag Removal, Wrinkle Injections, Dermal Roller
  • Body: Excessive Sweeting, Fat Removal –Ultrasound Assisted, Sclerotherapy  for Spider Veins
  • Skin: Restylane Vital Skinboosers, Obagi Nu-Derm, Chemical Peels,

Specialist Areas

  • Non-Surgical facial rejuvenation

Professional Membership

  • British Collage of Aesthetic Medicine
  • General Medical Council (GMC)

Hyaluronic acid dermal fillers in anti aging medicine – facts, myths and innovations

In the ever growing and evolving, magical world of anti aging medicine, we can use hyaluronic acid dermal fillers as a multi talented tool, filling and wiping away eyebags, straightening noses, performing non surgical facelifts, erasing wrinkles, augmenting lips and rejuvenating the aging skin itself.

But how does the consumer (read patient), make a choice of which filler to choose. What is the best dermal filler? (This is a title of a “vintage blog” of mine which you can find in these blog pages) Which filler will give the best results? Which is the softest? Which the longest lasting filler? Which is the safest filler?

From the IMCAS conference in Paris (a wonderful yearly non surgical aesthetic medicine conference I am going to this weekend!) to the Anti Aging medicine conference in Monte Carlo, thousands of aesthetic doctors gather every year to hear about yet another batch of hyaluronic acid fillers being launched onto the scene, and there are now hundreds of fillers out there.

But without confusing you too much, here is a quick guide, with some facts, myths and innovations, from 2 of the best and leading dermal fillers currently dominating the European and American markets.

RESTYLANE

FACTS – Restylane and Perlane were the first hyaluronic acid fillers invented over 15 years ago by a Swedish genius Bengt Agerup in Upsala. This clever scientist first invented NASHA, non animal ,stabilised hyaluronic acid, and hence  transformed the world of aesthetic medicine. There are now many copies and new fillers on the market, but with the longest track record of good results and great safety, this filler is still the gold standard, the original, the “coca cola” of dermal fillers

MYTHS – The biggest myth I hear from patients is that this filler does not last as long as some like Juvederm, and more importantly, that it is a filler which is more likely to leave lumps, and possible the “tyndall effect”, of a blue line under the skin, in my experience these are facts which are not true. Restylane in my mind is the best filler, with the longest lasting results. Some of my patients for naso labial lines have results for up to 7 years, and eyebags for up to 4 years! And safety of the results? Indeed, this filler is an “advanced” filler, so yes, in inexperienced hands, lumps or blue lines are more possible than with for instance the Dermavisc filler for instance (discussed below), but in expert hands, Restylane is by far the best tool, allowing the best shaping, moulding and the most efficient natural results

INNOVATIONSIt may be the “oldest” filler, but the innovations from Galderma never stop. The skin rejuvenating SKINBOOSTERS like Restylane Vital and the brand new “clicky” syringe are incredible, and a little bird tells me that a Restylane mixed with growth factors is just around the corner!

JUVEDERM

FACTSJuvederm is the second oldest filler on the market and with the aesthtetic giant “Allergan” behind it (Allergan is the pharmaceutical company behind our other friend Botox), Juvederm has taken over a large chunk of the aesthetic market in the US and Europe, and is still the fastest gowing filler in the world. A great filler, with fancy packaging no doubt, but I do have some doubts about this filler, and still believe it to be the second best in the world of fillers, behind the original Restylane. Juvederm in my opinion is a filler which should NEVER be injected in the tear trough areas under the eyes as Juvederm fillers give a lot more swelling than some other brands. Granted, the thicker filler Voluma is probably the best volumising filler on the market, and I use this filler a lot!

MYTHS – The main myth I would like to dispel is that Juvederm is somehow magically the filler which gives the longest lasting results! Great marketing from Allergan, as with great adverts and “convicning” medical proof, many now truly believe that this filler does ineed do exactly what is says on the tin, but dear readers, my 10 year experience in the industry has taught me that ALL hyaluronic acid fillers have a similar longevity, and indeed how long your results will last relies more on the skill of your doctor!

INNOVATIONS – The Juvederm range has always like a cameleon, had a great capacity to reinvent itself, and the latest is the launch of their “new” Vycross technology, which includes the new fillers Voluma, Volift and Volbella. Nice fillers, and with  less swelling than with the older Juvederm 3, and Juvederm 4. Indeed, Allergan  were the first to come out with fillers with lidocaine local anaesthetic, but is the Vycross technology truly new and innovative? Many in the industry claim that this is just an older technology like Surgiderm, relaunched and repackaged! Allegedly!

Festina Lente… Lets move on quickly but carefully. For in order not to lose you at this point of what is proving to be a longish blog, lets take a look at 3 more popular European fillers, but a little more concisely.

TEOSYAL

FACTS – The favourite for some aesthetic greats such as Jean Louis Sebagh, and I can understand why. From Teoxane laboratories, Switzerland, Teosyal has firmly established itslef as the third best filler in the industry. A solid filler, with good moulding capacity and a wide range of fillers, it is a good but not a great filler. Their tear trough filler for instance (Teosyal Redensity) is in my experience not an effective one at all!

MYTHS – As with all companies, Teoxane claims that their hyaluronic acid is a product from the most supreme state of the art technology, BUT , in truth  ALL hyaluronic acid fillers come from very similar technologies, with slight twists and differences which make some better than others. And did you know, most of the bacterial hyaluronic acid on the market is bought from a large factory in China, before it is stabilised in to various filler brands?

INNOVATIONS – Teosyal certianly has the widest range of fillers, forever coming up with new ones, and has innovative names for their fillers such as Teosyal Kiss, and I will let you guess where that filler is used!

EMERVEL

FACTS – A great new filler which over the last couple of years has entered the market. Also from Galderma, I guess the only problem is that only a few months after a big launch of the Emervel range of fillers, Galderma took over Q-med , the makers of the king of fillers Restylane!! “Oh my goodness, what do we do now?” I am sure was the cry by the Galderma bosses, and hence this good filler has taken a while to come to the fore, but with good thicker fillers like Emervel Volume, this range is making it’s mark on the market for sure.

MYTHS – Newest is not always the best, and the myth that just because this new hyaluronic acid technology is the latest and the most cutting edge, that it is the best is not of course true. Restylane was the original formula, (like in the Cola world where Coca Cola which is still the best formula), and  is still the top filler to beat, and has the longest safety record.

INNOVATIONS -  Nothing particularly new or bold has come from this range, but being a new kid on the block, new members to the range, and innovations with their nice syringes are always around the corner.

DERMAVISC

FACTS – I thought I would throw this filler into this blog to make things a little more interesting! A filler which is becoming ever more popular on the continent and in countries like Sweden and Croatia,  and one which is on its way to the UK for sure. The fascinating fact about this filler is that it is the first successful filler on the market which is not bacterial in origin, but actually of animal origin!! “Animal!” I hear you say, but this is a perfectly safe filler harvested from rooster combs (poor roosters!”), and a filler which can be injected safely without the need for an allergy test. I have tried it, and indeed even gave some courses on it. It is an OK filler, with some not bad results, but it is different from other fillers, and it does not give as strong results, and they do not last as long. And I must admit, the short safety track record worries me, as does the animal origin. Non animal fillers for me!

MYTHS – Bochus Biotech, the makers of Dermavisc will claim that this “purer” filler of animal origin is much better and safer than the laboratory non animal fillers, but my dear reader, I would claim completely the opposite!

INNOVATIONS – This being the first good animal origin filler is an innovation in itself, and an innovations to be applauded despite som of my doubts described above. However, this filler is the only one on this list which does not have lidocaine added to it (treatments with fillers with lidoacine are much less painful), an innovation which Biotech will have to push through quickly if this filler is to survive this tough market!

Aesthetic Medicine – Past, Present and Future – “Vintage Blog”

After 7 years of aesthetic blogging, I have decided to bring you some vintage blogs I have written over the years. These “vintage blogs” will include some of my favourites and where start but with the first blog I ever wrote, back in July 2008 with the above heading.

I am very fond of this informative but personal blog  (it originally  came in two parts as it is very long, but here you can read it in it’s wonderful entirety, do be patient and read it all!!) and it describes what aesthetic medicine exactly is. Reading it again today, many things have changed since those long 6 and a half years ago, but it is wonderful to see just how many things have not changed at all…

So what is aesthetic medicine? Well, it is the newest and the fastest changing field of modern medicine and it is quite literally the younger brother of the well established plastic surgery. I saw an interview recently with Britain’s number one tennis player Andy Murray, and in the interview he describes how form a very early age he had a fierce tennis rivalry with his older brother Jamie, but by the time he turned 14 he became better and started beating his older sibling regularly. Well in my opinion, aesthetic medicine is just turning 14!

So what is the difference between my passion of aesthetic medicine and that of plastic surgery? It is a question I get asked by my patients every day and there are many ways to answer it. Simply, aesthetic medicine is the minimally invasive alternative to plastic surgery. Plastic surgery uses the scalpel as it’s main tool, in aesthetic medicine we use small needles, cannulas, peels and lasers. For the Star Trek fans out there, you will remember Dr Mckoy performing surgery, curing ailments and even in one episode reversing the aging process with what looked like a hand held laser. As futuristic as this sounds, that future is already here and I am very sure that the scalpel will soon become very underused and will indeed become a museum relic in not too distant future. We all want less pain, less scarring and smaller risks, and now in many fields of modern medicine, the technology and new modern techniques make minimally invasive procedures a very palatable meal on many people’s menus.

Plastic surgery gives often brilliant but permanent results, the downside being that it involves general anaesthetic and scarring amongst other things. It is important to stress here that plastic surgery is a wonderful field of medicine which was my first love, and many procedures performed will probably never be replaced by aesthetic medicine, rhinoplasty (nose operation) being a very good example. Then again who knows, I am remodelling noses with Perlane every week! Only one year ago I told a patient that breast enlargements may one day become a non-surgical procedure, and now that procedure is already here! This accelerating field of aesthetic medicine is a more natural alternative to plastic surgery for many conditions and it’s main asset is that the treatments are non-permanent. It is this non-permanence which has brought aesthetics to the masses and which has normalised the process. People have realised that there is now a very safe and painless alternative to rejuvenation of the face and body, and because it is non-permanent the fear factor has been taken out. Many of our patients tell us that they would have never considered plastic surgery, and yet aesthetic treatments such as botox and fillers are very acceptable to them.

So where did aesthetic medicine start? Well for this we can look to the discovery of botox and like many of the greatest medical discoveries such as the discovery of penicillin, this was an accidental finding! Since the early 1970s botox was used for the treatment of many medical conditions including squints and blepharospasm (involuntary twitching of the eyes). In 1987 a Canadian ophthalmologist, Dr Jean Carruthers was treating blepharospasm in her patients with botox, and to her amazement she noticed that as a side effect there was a reduction of wrinkles around the eyes! With the help of her husband, who is a consultant Dermatologist, they devised clinical trials to assess the effectiveness of this potential aesthetic treatment and hence aesthetic medicine was born!

To explain my ingrained passion for aesthetic medicine, I briefly have to tell you about my past.

I was born in the capital of Croatia, Zagreb. My father, Professor Bosko Milojevic was one of the finest plastic surgeons of his time and was the first doctor to open a private clinic of any kind in that part of Europe. Quite an amazing feat in what was then Socialist Yugoslavia! He was a great man and a brilliant and hugely ambitious surgeon, widely acclaimed to be the best rhinoplasty surgeon of his time. He operated on many of the world’s biggest celebrities and world leaders, all of whom would travel to his clinic in Zagreb, often to combine their operations with a holiday on the beautiful Croatian coast and islands.

Ah Croatia, the wonderful country of my birth! You will have to forgive me, for at this point I have to digress, I just can’t help it! Having moved to this country as a young boy in 1982, England has grown very close to my heart and I support it wholeheartedly through it’s many achievements in fields such as sports and science. However you crack me open and inside you will only see red and white cheques and in fact you don’t even have to do that, for I wear my Croatian heart very firmly on my sleeve. And at the time of writing this blog, your writer is a very happy man because Croatia have just beaten Germany 2-1 at Euro 2008. A magnificent performance, perfect football and I must say aesthetically very pleasing to the eye!

From a very young age, my father’s passion for aesthetics was ever present in my life. I saw my first rhinoplasty aged 2 in my mother’s arms. At 6 – 10 years of age I remember that family conversations around the breakfast table were just as likely to be about plastic surgery, as they were about my homework or my favourite football team Dinamo Zagreb’s latest exploits! My father’s brilliance and passion were so infectious, and from a very early age I fell madly in love with aesthetics.

I studied medicine at The Royal Free School of Medicine in Hampstead, London starting in 1990, and my main aim from day one was to become a plastic surgeon. In 1992, my father suddenly died of a heart attack while playing tennis (the way he would have liked to go), and my life was turned upside down. Not only did I tragically lose my amazing father, but I also lost my role model and mentor.

In the mid to late 1990s during my surgical training, a new ace in the pack of aesthetics started emerging. With a keen interest and great excitement I read about the emergence of these new minimally invasive injectable aesthetic treatments, the leader being botox. At the turn of the century and at the end of my training, I entered this amazing new field and have never looked back. It seemed like a very natural progression for me, as very early on I realised that this was the future of plastic surgery. My father would have been so proud!

So what about the PRESENT? Aesthetic medicine has seen an unpresedented boom in the last few years and despite the depressing credit crunch, this boom appears to be continuing. Why? The UK population is living longer, living faster and feeling younger, and hence the appetite for rejuvenation is ever growing. The treatments are quick, painless and non-permanent, and with no potential for long term side effects. These treatments have become a very acceptable part of our lives, and many people find them just as normal as going to their dentist or hairdresser, and quite rightly so! These non-surgical aesthetic procedures start from as little as £200 per treatment, and even though this is a lot of money, this is much cheaper than the expensive creams and regular facials, and with better rejuvenating results.

The PRESENT and FUTURE of aesthetic medicine are merging in front of our very eyes, with the very recent addition of the non-surgical lower eye bag treatments, and non-surgical breast enlargements. I am so excited about these very effective and brilliant procedures and have already incorporated them into my aesthetic armoury with great enthusiasm.

So what about the FUTURE? There are many exciting new techniques in the pipeline, many new advances in botox techniques, new dermal fillers (soon we will be able to use fillers for penile enhancements!) and the greatest advance I feel will be seen in the improvement and perfection of various lasers which already exist now. The current lasers, which are used for various things including facial rejuvenation, skin tightening, hair removal and laser lipolysis have some good results but are not perfect. The opinions of many doctors with regards to many of these machines change from day to day, and what may be the big star in the team one day, many clinics relegate to the bench the next. Me? I am closely waiting and watching all the various technologies evolving, a lot of them from Israel, and just waiting for the biggest star. Diego Maradona perhaps?

As a final thought for this blog, I want to quote what my sister said to me the other day : What is the point of trying to make us all look much younger when we will inevitably age inside? What a great question and I have a great answer! Ongoing research into stem cells and growth hormones is so advanced, that many experts are claiming with great certainty that in the FUTURE of aesthetic medicine, not only will we look younger, but we will also be able to live very long and healthy lives, with estimates ranging from 100-120 years of age being the average life expectancy during our lifetimes. So there is hope for us all and we may yet live to witness a British Wimbledon champion!

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