Enjoying the summer heat? However, is sweating a big problem? Underarm sweating ruining your clothes? Do you get embarassing hand  or facial sweating? Well we have a very simple answer and yes you have guessed it , it is botox!

Botox treatments for sweating are both revolutionary and life changing. The procedure takes only a few minutes, is relatively painless (except in the hands which can be quite uncomfortable), and you will be sweat free for more than 6 months.

The price at the Milo clinic for these procedures is from £600.

I just want to set the record straight….

 If you read the recent Daily star article, which “quoted” some of my statements about Jordan’s supposed cosmetic treatments, you must know that there are many things in that article which I never said. Once again, these are products of Daily Star journalist’s rich imagination, and their need to make the story as juicy and readable as possible. I have said this before and I say it again, having worked with the press extensively in the past, I completely understand why they do this, and I do not judge them.  However, here are things in that article which I never said:

1. I never gave Katie a “public warning”!

2. I never called her a “freak”!

3. I never said that if she did not stop botox soon, that she risked “permanent facial paralysis”, as apart from anything else, this medically is not true. Botox can not give you facial paralysis permanently at all. I feel that the journalist must have misunderstood me on this point.

When asked by the very nice Daily Star journalist what I thought of Jordan’s latest look, and did I think she was having too many cosmetic procedures,  after a slight hesitation (as I do not like to gossip or talk badly of anyone), I decided to give my honest opinion after all….

Why did I do this? Well I have been a great fan of Jordan (aka Katie Price) and have always been impressed by her fortitude, ambition, non nonsense attitude and above all natural charm and looks. Even before her rhinoplasty, which by the way I think was very well done indeed, I felt that she was naturally beautiful, and even though people were very quick to criticise her, I felt that she was a woman and mother to be admired.

However, I felt compelled to comment, when I was sent this photo by the Daily Star journalist, as I strongly felt that she was either being very badly advised on which cosmetic treatments to have, or that she should change her doctor quickly!! (if indeed it is a doctor she has been seeing for her procedures, one of my big bug bears as you know!)

Too much botox ? Yes! Too many fillers? Yes! Her lips especially have been hugely overdone and are not in balance with her face at all. If you note, she has actually had too much filler put above her lip. Also I feel she has definitely had too many fillers injected in her upper face and cheeks, giving her that slight “pillow face” look, as coined by Grazia magazine. Tatooed eyebrows? Yes indeed, and this is another bug bear of mine, I hate permanent eyebrow tattoos.

Leaving all of this aside, I hope that Katie is happy, and that her second marriage turns out to be a success. She deserves happiness, and with happiness I am sure that her natural looks will return once again. My recipe? A small break from it all, and then some baby botox and small amounts of filler once or twice a year. This way she will still be one of the most beautiful women in Britain, and yet she will still preserve her youthful looks.

Until next time….NM

PS Ban those VUVUZELAS now! It’s like listening to an attack of crazy wasps! All the singing has gone….

PPS Come on England today against Slovenia, your world cup starts HERE!!

Here’s the article in full:

 http://www.dailystar.co.uk/news/view/140168/Katie-Price-is-warned-by-top-doctor-Stop-surgery-now/

A City AM (a daily free newspaper) journalist interviewed me recently, asking me about the trends of surgical and cosmetic procedures men are increasingly seeking. I discussed many topics, including the tear trough treatment for eyebags, the increasingly popular “baby botox” and also the life changing “sweatox” treatment, which stops underarm and hand sweating .

To put the whole issue of men having more and more cosmetic procedures in a nutshell, here as story:

I always tell a story of a cab driver, who once picked me up and overheard me talk on my mobile about botox. “Oh I would never have any of that stuff done guv!” he said as I got off the phone.  “Well do you use daily facial creams?” I said. “Yes I do guv!” the cabbie responded rather sheepishly.  “If I had asked you 10 years ago whether you used facial creams, what would you have said Mr Cabdriver?”. “Can I have your card doctor!!!”.

A short anectodal story illustrating a very true fact, which is that men are meterosexual beings these days, and they care about their appearance. We are all aging slowly but surely, and yet we feel so young. So men, why not just do it!! I can give you my card…

On that note, I must admit that I have not been a true man this morning, and technology has got the better of me! On the right you can see the scannned in article I have been talking about, but I just don’t seem to be able to enlarge it for you to read. I have therefore been very practical on this occasion, usually a female trait, and have written out the relevant text below for your enjoyment. Speak soon. NM.

The CITY AM article (the relevant bits):

SWEATOX

A procedure currently gaining ground – especially at this time of year – is the injection of botox around sweat glands in specific areas – shazam, no grim sweat patches on your shirt. The procedure works by blocking nerve signals to the sweat glands, thus preventing sweat in that particular area. While armpits are the most common area, it can also be applied to sweaty palms, feet or even the groin – anywhere perspiration’s a problem. It’s perfectly safe since you’ll still sweat in other areas, and lasts six to nine months.

DERMAL FILLERS

Whereas botox is injected into muscles to relax them, dermal fillers like Restylane and Juvderm are inserted into wrinkles and lines to fill in and flatten them. As well as getting rid of wrinkles, fillers can be useful for smoothing out misshapen noses, acne scars, nose-to-mouth lines and sorting out eye-bags and tear troughs. Dr Nick Milojevic specialises in the latter, and says he has many male clients. “You can reduce quite strong eye bags by putting injections below them and filling out the troughs, and it only takes 20 minutes to do.”

BOTOX

The word might suggest women with freeze-dried expressions, but botox has become a
sophisticated treatment and one that’s increasingly popular with men. Micro-botox treatments, known as “baby botox”, in which half the normal dose is injected, are particularly appealing to chaps who want to subtly freshen up their look rather than fundamentally change it. When injected in tiny doses, Botulinum toxin works to relax the muscles that cause creasing and wrinkles. For men, that most commonly means the frown line between the eyebrows – long hours staring at the computer screen can exacerbate this – but it’s also good for forehead wrinkles, crow’s feet lines and neck lines.

Well to be honest  I am not that bothered about what happened, but it makes for a good blog..

So let me tell you a story…

Following our press coverage in last month’s Grazia, Look magazine contacted me to help them put together an article on 6 of the new procedures loved by the A-listers and they proposed that these were quick nip/tuck procedures, perfect for red carpet outings. Having previously read about our expertise on eye bag and nose procedures, the journalist asked for our help in putting together texts on these two topics. I gave them a long interview and put them  in touch with some of our willing patients who would be happy to talk to the press, and having thanked me, the journalist said that she would be in touch when the article was published.

A few days later, the PR agency from the Harley Medical group contacted me (I still do some occasional sessions for them) asking me to talk to Look magazine for an article on new Nip/Tuck procedures, as having heard about my leading status in the field of baby botox, they were very keen for me to give an interview on the topic. This sounds familiar , I thought to myself..

Imagine my surprise when on the day of the article coming out, Milo clinic was only attributed to the eye bag section, baby botox was suddenly the expertise of some phantom doctor at the Harley Medical Group, and most surprising of all, the nose shaping procedures were attributed to an even more invisible doctor at the other large aesthetic chain, Transform. In addition, Juvederm Ultra was suddenly the filler of choice for noses, and restylane for eye bags.. A balancing act me thinks?!

Well as the great  Oscar Wilde once said : 

“In America the President reigns for four years, and Journalism governs for ever and ever”

And how apt and how correct he was, especially during the current pre election fervour which is sweeping the UK .. (just as an aside, it is my humble opinion that only David Cameron and the Conservatives can save this country right now from a certain apocalypse. Go Dave! I’ll be watching all night on Thursday..and of course Dave will be leading us for 5 years at least.)

In our profession, we rely on journalists quite a lot , we need them to spread the word of our wonderful ever expanding profession, with all it’s daily advances and novelties. We also rely on them to recognise us when we do good work, when we have gained great experiences, and rely on them to spread the word far and wide. And I have learned through years of dealing with journalists, that they are hardly ever wrong. Yes they do need to sell their publications, and that means that they sometimes over step the mark, but usually they are very very fair and give very balanced opinions.

In the case of the Look article we are discussing, it is obvious that it was the editor’s decision to make some of the changes. Was he wrong? As I said, definitely not! At first I thought to myself, rather self boastfully, I AM the leading expert in these 3 fields, and should be credited for it, but when I had time to think I realised that what the editor did made absolute sense. They were trying to give a balanced view, and in describing 6 cutting edge aesthetic treatments, they wanted to point the reader to 6 different centres of excellence. To point the reader to the same clinic for 50% of these procedures, would have just looked lazy and biased…

Until the next blog, “All is fair in love and war” and I can’t remember who said that….

Just like with all the different dermal fillers, there are so many available chemical peels out on the market, and it can be quite confusing for the consumer to decide just which one is the best, so here’s a little help. I will survey 4 different popular chemical peels, and with marks out of 10, I will try to point you towards what I think is the best of them all. For the winner and the wooden sppon, read the top 4 list at the bottom of the blog.

 OBAGI NU-DERM AND OBAGI BLUE PEEL

RESULTS  10/10 In my experience with all the different the peels, this is as I have said many times,  “a kind of miracle for the skin” . It eradicates practically all pigmentations, removes most acne scars, blackheads and imperfections, and it gives the skin a flawless appearance. And rejuvenation? Well it really can make the patient look 10 years younger.

VERSATILITY 10/10 It can be used with all skin types, and with hydroquinone and tretinoin in the mix, it is the only chemical peel system which can be used completely safely on darker skin types.

SIDE-EFFECTS 7/10 The side-effects of the trademark Obagi Blue peel are mild and serious side-effects very rare. The patient will have a week of serious peeling which is more than some of the other chemical peels, but this happens for a reason, and it will obvioulsy produce better results. While preparing the skin for the peel, with the NU-DERM creams , there can also be some mild side-effects such as redness and dryness.

PACKAGING 9/10 With the designer box and tubes, trendy wash bag and user friendly instructions, the Obagi systme is a joy to use. And as a finale, the peel is blue blue blue..

CLINICAL EVIDENCE 9/10 Obagi was invented by Dr Obagi all the way back in the 1970s, and therefore there is copious evidence on safety and efficacy of this product. Obagi in the USA, has been placed on the safe and effective drugs list by the very stringent FDA.

TOTAL  45/50  VERDICT: we love it!!

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SKINTECH TCA PEELS AND CREAMS

RESULTS 7/10 Until we discovered Obagi , this was our mainstay, and yes it does produce some very good results. It rejuvenates and smooths the skin and it can get rid of blemishes, pigmentations and small scars. However, it just doesn’t go far enough and deep enough.

VERSATILITY 7/10 Even though skintech provides a wide range of preparation creams, these peels can not be used no darker skin types at all.

SIDE EFFECTS 7/10 Just the same as Obagi, side-effects do exist, but are minor.

PACKAGING 6/10 I know that this section may feel irrelevant, but the appearance of your products in my experience is all important. As most of you who would have spent a lot of money on facial creams in the past, you enjoy your creams all that more if they look good. The design of Skintech creams?? Dull!! And no trademark BLUE peel.

CLINICAL EVIDENCE 8/10 Maybe not as extensive as with Obagi, but there is plenty of good clinical evidence backing up this product.

TOTAL 35/50 VERDICT: Last decade’s news..

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GLYCOLIC PEELS

RESULTS 4/10 The eagle-eyed and well educated readers among you, you will notice that I have chosen a very general term in GLYCOLIC PEELS. Yes indeed there are many many different types of glycolic peels including AGERA, NEOSTRATA and JAN MARINI peels to name a few of the most popular ones, but for the purposes of making this survey easier for you to understand and easier to make your decision, I made a decision to put all glycolic or “sugar peels” together. These are all wonderful products, which can be applied by pretty much anyone with appropriate training, but the honest truth is that they can not make a big difference, and they can not be used to treat big problems. If you already have good, young looking skin and want a little freshen up, then this can work, but do not expect results which are much better than just a good facial

VERSATILITY 6/10 Following on from the above point, glycolic peels are not very versatile as they can not treat very many conditions and problems. Having said that, in another way, they are very versatile as they can usually be used on all skins.

SIDE-EFFECTS 10/10 The trump card for Glycolic peels, as there are virtually no side-effects. I had a NEOSTRATA peel once, and I was just very slightly red for a few hours, hardly noticeable. So if you want a lunchtime freshenup of your skin, this may well be the one for you.

PACKAGING 8/10 Difficult one to mark this one, as we are lumping together many different products, but glycolic peels and creams are usually beautifully packaged and a joy to use.

CLINICAL EVIDENCE 8/10 Lots of clinical evidence and a great safety record for these types of products. Especially NEOSTRATA , our favourite.

TOTAL 36/50 VERDICT: Nice and friendly peels without a punch

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PHENOL PEELS

RESULTS 9/10 These are the very deep and strong peels which can only be performed by doctors in a hospital setting. As far as results are concerned, these can be incredible. I have seen results where it looks like the patient must have had extensive plastic surgery, and yet all they have had was a phenol peel. I have marked this product down slightly as side-effects can be severe, but more on that below.

VERSATILITY 3/10 This is a severe treatment and not too many patients are suitable to have it. Many medical conditions will exclude the pateint from being able to have this procedure. And as far as being used on darker skin types, forget it!!

SIDE-EFFECTS 1/10 This procedure is not very commonly performed these days, the main reason being paind, discomfort and the potential for lots of side-effects. The peeling process: Your face will be swollen, red, oozing, and crusted. Over several days, your face will become stiff, dark, and begin to flake. Within seven to ten days peeling and flaking will be complete, and you will be left with healthy, smooth, bright red skin. This sunburned appearance will take two to three months to improve. Thereafter, your skin will appear extremely pale.
Presentable in public: You will be presentable in 2 weeks with makeup. This is just a description of the post peel process, but other side-effects can be severe.

PACKAGING 1/10 Forget packaging with this bad boy!

CLINICAL EVIDENCE 6/10 Over the years, much clinical evidence has been gathered on this peel.

TOTAL 20/50 VERDICT: If the results of this peel sound too good to be true, you would be right. The risks are too high..

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Winners list:

1. OBAGI 45/50 The king peel, nothing comes near it!

2. GLYCOLIC PEELS 36/50 Nice and friendly, and nothing to lose

3. SKINTECH PEELS 35/50 The old kid on the block

4. PHENOL PEELS 20/50 Results can be good but it just too harsh

Here is this model’s testimonial which describes everything beautifully:
“I have always had a complex about the shape of my nose and always cringed when I would see photographs of my profile and it’s “hooked” nature. I have therefore been considering a surgical rhinoplasty for a long time , but the cost and fear of the operation have been stopping me.

I was therefore intrigued when I heard of these non-surgical nose shaping procedures with Restylane. When I met  Dr Milojevic, he put me at total ease, and explained that this was a quick and painless procedure with no serious side effects.

He used a new type of Restylane with local anaesthetic , and the procedure was indeed painless. Apart from some swelling for a few days, I had no other side-effects afterwards.

Now, 1 month later, I have a beautiful new nose! I must say that not in my wildest dreams did I think that the results Dr Milojevic achieved were possible. I have a gorgeous profile and a straight nose. I couldn’t stop looking at photographs of me from a recent wedding. What is amazing, and I don’t know how this is possible, is that my nose looks smaller! It’s like magic!”

Q-med and Milo clinic are together  looking for any willing models to come in to our clinic for a nose shaping procedure (the non-surgical rhinoplasty) or indeed a tear trough procedure (the non-surgical eyebag removal). This is a very good opportunity, and these models would have to be willing to have their photos taken, and to talk to the press and possibly make appearances in the media.

For anyone interested please call the Milo clinic on 0207 1001234, and do make it clear that you want to be a model for one of these procedures.

For further information on these procedures:
NOSE SHAPING  http://www.miloclinic.com/treatments/nose-shaping.aspx
TEAR TROUGH   http://www.miloclinic.com/treatments/tear-trough.aspx

Dear Readers

A golden rule of blogging, especially for blogs such as this survey blog which I wrote about 1 year ago, is that you have to update them from time to time. This couldn’t be more true for this specific blog, especially because my opinions on what indeed is the best dermal filler have changed somewhat! What a difference a year makes! And I have to tell you many things have changed in our lives in the last year, not least the birth of my son almost exactly a year ago, but then there was a blog about that too!

I feel like an ageing footballer updating his autobiography..

What has changed? Well read on and see if you can spot the differences.. (the older version of this blog post is on http://www.miloclinic.com/blog/?p=22 if you want to compare and contrast). As a preview, my top five are definitely not the same as 1 year ago, and there has been one significant move up the charts….Can you guess?  All that I will say is that in my opinion, hyaluronic acid fillers are still the best , and restylane and juvederm ultra are the coca cola and pepsi cola of the dermal filler world. Very similar and both very good. Here’s the new UPDATED blog:

I have wanted to write this blog for a long time , about botox’s slightly less famous but equally brilliant brother.

Dermal fillers complement botox so well in the wonderful world of non-surgical rejuvenation. They remove wrinkles and folds, they contour and shape the aging face,they correct facial assymetries,  they help to create  the non-surgical facelift and they fight side by side with botox in the eternal battle against the aging process. Call them Butch Cassidy and the Sundance kid, Torville and Dean or even Morcambe and Wise , they are a truly magnificent partnership. 

 Dermal fillers are a brilliant tool in the aesthetic doctor’s tool box, and in the right hands of the right doctor dermal filler procedures create  the most wonderful and natural rejuvenating results. The popularity of dermal filler treatments has been rising exponentially over the last decade and hyaluronic acid fillers are now in the top 3 most popular treatments in the aesthetic medicine world along with botox and laser hair removal.

But what are the best dermal fillers? Which give the best and most natural results? Which last the longest? Which one should you choose? These are just some of the questions I get asked by patients, colleagues and pupils every day. Well here is a comprehensive and user firendly guide  to what I think makes the best dermal filler, spelling out the strengths and weaknesses of some of the most popular and most effective fillers.   A nice compare and contrast list,  just like those you may have seen when searching for a new TV or a new mobile phone. The scores are out of 10 for each category and out of a total of 100. I have chosen the 5 leading dermal fillers to compare. And which is the king of fillers? The answer is at the bottom of the blog..

RESTYLANE

RESULTS–9/10– Q-MED’s Restylane and Perlane give the perfect  natural rejuvenating results when used to correct lines, wrinkles and folds. In my opinion, these hyaluronic acid fillers are the best fillers on the market for facial contouring and shaping such as cheek enhancement. 

DURABILITY–8/10–In my experience, the results can last from 9 to 18 months, even though literature will tell you that the durability is a lot shorter. With repeat treatments, which induce the body’s own collagen production, the results can last a lot longer. These Q-med fillers are made of particles, and in my opinion it is this along with the stabilisation technology that makes them last so long.

CLINICAL EVIDENCE–10/10–This is definitely the “trump card” for restylane fillers, with well over a decade of copious and second to none clinical research testing the efficacy and safety of these fillers.

SIDE-EFFECTS–8/10–Side-effects,  more serious than swelling, redness and slight bruising are rare with only a 1 in 15,000 chance of side-effects such as  prolonged lumpiness or infection. Allergic reactions are also very rare as hyaluronic acid fillers are non-animal. And the best thing, just like other hyaluronic acid fillers, if the patient does not like the result, for example the lips being too large, there is a special enzyme which can be injected to melt the product away safely.

PAIN–9/10– In the last few months Q-med have come up with Restylane Lidocaine and Perlane Lidocaine, which have local anaesthetic already pre added making this an almost painless procedure.. Procedures such as tear trough have suddenly become so much more comfortable for the patient. For procedures such as lip enhancement, dental block may still be necessary, but these new fillers are revolutionary.

SYRINGE DESIGN/EASY TO USE?–9/10–Again this almost another “trump” for Restylane. The design of the restylane syringe is second to none, and other companies are trying to copy it. Why is this important? The better the design of the syringe, the easier it is to use and  for the doctor to achieve the best possible results.The reason it doesn’t get a perfect 10 is that sometimes, and I see this on courses I teach on, beginners do find it just slightly harder to use compared to some other fillers as it is a slightly thicker product .This however is reassuring as the thickness of the product does give better results and you should only be seeing experienced aestheticians anyway!

VALUE FOR MONEY–7/10–Taking into account the great durability, the quality of the results and the actual reasonable price, these fillers do represent pretty good value for your “credit crunched” pound!

POPULARITY–10/10–These Q-med fillers are still  the market leaders in the UK by a long mile. As the TV advert says: (I saw it I am embarassed to admit during Desparate Housewives!) “Ask for Restylane by name!”

RANGE–9/10–With Restylane, Perlane,Reatylane Lidocaine, Perlane Lidocaine, Restylane Lipp, Restylane Touch, Restylane Vital light, Restylane Sub-Q, and now the big brother Macrolane, Q-med have the most varied and most relevant range.This range is also one of  the only ones which has half size syringes, for those subtle procedures and small touch ups. No frills here, just fillers designed to address various signs of aging , various volume deficiencies and with the great Restylane Vital light, even skin rejuvenation is covered.

VERSATILITY–10/10– Restylane does not really have any limits unlike many other fillers which can’t treat various areas as you can see further down the list. We used to stay away from the under eye area, but with the new Perlane treatments for the “tear trough” area, there are now no stones left unturned for the Q-med family of fillers.

TOTAL 89/100

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JUVEDERM ULTRA

RESULTS–7/10–Juvederm ultra is the newest member of the Hydrafill/Juvederm family produced by Allergan, the makers of botox. In my experience the results are good and reliable, and many clinicians rave about these fillers due to the smooth homogenous make-up of this stabilised hyaluronic acid gel giving a smooth and natural result. However, exactly because of this smoother gel, I find it is slightly less accurate,  and while injecting it,  it sometimes does not stay where we place it, unlike Restylane which stays put. I also used to think that it was not as good as the Q-med fillers for volume replacement and contouring, but with the relatively recent advent of Voluma, these Allergan fillers are hot on the heels of their Q-med counterparts.

DURABILITY–7/10–The results of the Juvederm family should last up to 12 months, but in my experience these fillers do not last quite as long as their biggest rivals, the restylane family.

CLINICAL EVIDENCE–7/10–Corneal and now Allergan have published many papers and clinical research is ongoing, but the weight and volume of evidence is not as great as some of it’s rivals.

SIDE-EFFECTS–8/10–Due to it’s homogenous  smooth nature, the side-effects are  very rare just like with other Hyaluronic acid fillers. Due to it’s user friendly nature, side-effects such as lumpiness are probably even less common than with other fillers, and some practitioners report that they get less bruising.

PAIN–9/10–The pain is minimal, and with the addition of a small amount of lignocaine to the Juvederm ultra syringes, this is a bit of a “trump” feature for the juvederm range. I did a cheek augmentation procedure with juvederm ultra recently and was rather pleasantly surprised by the lack of pain experienced by the patient.

SYRINGE DESIGN/EASY TO USE?–8/10– For those of you who read my original blog on dermal fillers, this is one of the biggest differences you will notice. (I think the old mark was 4/10!). The juvederm ultra syringes are now almost as good as the restylane ones, and are very easy to use. Restylane still has the edge, but it’s a close one!

VALUE FOR MONEY–6/10–This is the only section where I am giving juvederm a lower mark comapred to last time. The allergan fillers used to be much cheaper than their restylane counterparts, but having spent so much money on reserach and marketing, these fillers can now be even more expensive than their rivals.

POPULARITY–8/10–Allergan have recently run a very expensive advertising campaign promoting  juvederm ultra, and their adverts could be seen all around the US open tennis courts this year, and even during X-factor advert breaks. The popularity of these fillers is increasing.

RANGE–7/10–The addition of Juvederm ultra 2,3 & 4  versions to cover thin wrinkles all the way up to thick folds, the range is much improved. The addition of Voluma for facial contouring has made this range even better. My big bug bear here used to be that in the same family of allergan fillers we have also had Hydrafill 1, 2 and 3, and also Hydrafill Softline and Softline Max, oh yes and Juvederm 18, 24 & 30. And why would such a wide range be a bad thing? Well all of the fillers I have listed are all variations on pretty much the same filler, so really quite confusing!  Having said that, most of the aforementioned fillers apart from the juvederm ultra range, are fast becoming obsolete, therefore clearing up the confusion from the past. However,there are still no specific lip fillers , rejuvenating fillers or indeed any product for breast enlargement such as macrolane.

VERSATILITY–8/10–Juvederm ultra is a good versatile filler which can treat most signs of aging and can treat patients of all ages and both sexes efficiently.

TOTAL 75/100

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SCULPTRA

RESULTS–5/10–Sculptra is not strictly a filler, but is a sculpting and volumising agent. Unlike Restylane and Juvederm it is not a hyaluronic acid filler,  but is made up of Poly L Lactic acid, which is a sugar molecule said to be a collagen stimulator. In the right hands, and used for carefully indentified facial corrections, sculptra results are very good indeed, earning in it’s media nickname of “the liquid facelift”. For filling large depressions and for facial contouring this is arguably one of the best, but when used to  remove wrinkles it does fall slightly short. It is a very “technique sensitive” product and in inexperienced hands the results can still be less than perfect. And another thing, if you are the kind of person who wants to see immediate results, you will be very disappointed as the full results with Sculptra can take as long as 6-18 weeks! On the flip side this means you achieve rejuvenating results gradually and naturally! My big problem with Sculptra is , that you are somehwat in the “lap of the Gods”, in that you are not seeing instant results, but are relying on the body’s own ability to produce collagen in order to get good and accurate results. With hyaluronic acids, you are a lot more specific and accurate with you treatment.

DURABILITY–9/10–According to reserach and and from our experience,  results can last as long as 3 years. Having said that, is that a good thing? If you don’t like the results, you have to wait for much longer for them to go away..

CLINICAL EVIDENCE–6/10–There has been some very good and very valid clinical evidence backing up the efiicacy and safety of this product. However, a lot more is needed.

SIDE-EFFECTS–6/10–In it’s previous guise of Newfill, Sculptra had many problems, small hard long lasting lumps being a common one. To their credit the manufacturers of sculptra went back to the drawing board, and with strict new guidance on the injection technique, these side-effects have become very much more rare. However, these problems do still arise as this is still quite a technique sensitive procedure.  Due to Sculptra’s longevity, unlike it’s hyaluronic counterparts, if the results are not satisfactory there is nothing else you can do but wait for 3 years or more..

PAIN–9/10–This is a relatively pain free procedure, as lignocaine local anaesthetic is mixed in with Sculptra.

SYRINGE DESIGN/EASY TO USE?–5/10– Sculptra does not come in pre-filled syringes, and the syringes usually used are very easy to use. However, the relatively low score in this category is partly because the injector will often experience a lot of blocking of the syringe during the Sculptra procedures which are due to the particle filled fluid being injected, and this can be very frustrating indeed.

VALUE FOR MONEY–8/10–Scupltra possibly provides the best value for money. Even though the patient may need an initial 2-3 treatments at a cost of £1000-£1500, Sculptra can cover a lot more areas of the face at that price, definitely more than the hyaluronic acid fillers, and don’t forget 3 years!!

POPULARITY–6/10–Popularity of sculptra has been increasing, although I have noticed a slight levelling off recently.

RANGE–7/10–This category is slightly unfair on Sculptra as it does not have a pre-packaged range for different treatments, but actually the experienced doctor can fashion their own range by varying the dilution of Sculptra for different treatments and different facial areas.

VERSATILITY–6/10–Despite my enthusiasm for Sculptra, it’s versatility is not great. It is brilliant for treating hollow cheeks, for filling big depressions and for the non-surgical face lift, but it is poor for the treatment of fine lines and wrinkles. It also can’t be used on areas of the face such as lips. It is also an age specific product, great for over 50s, but definitely not as effective for the younger patients. The perfect patient is one over 40 or 50, with a lot of lines , wrinkles, folds and loose hanging skin, who may need far too much botox and dermal fillers, and sculptra can achieve some good results, but a lot more cheaply.

TOTAL 67/100

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RADIESSE

RESULTS–6/10–Radiesse is made up of synthetic Calcium Hydroxylapatite microspheres, and it is both a filler like restylane, and a collagen stimulator like Sculptra. It is the new kid on the block, having been launched as recently as 2004, and there have been some good reports on results achieved. For me however, the jury is still out!

 DURABILITY–7/10–Being a collagen stimulator, this product will last as long as 18 months. One draw back however is that when some patients, especially the older ones,  are not great at producing collagen  the durability could be greatly affected.

CLINICAL EVIDENCE–6/10–Even though there is over 8 years of clinical research behind this filler, the direct rivals have been around for longer and can show a longer safety and efficacy record. At a recent conference, I saw a few studies on radiesse presented, and I did identify a few flaws in the research!

SIDE-EFFECTS–6/10–Radiesse is made up of calcium crystals, and basically it’s make up is the same as that of bone or teeth. It is partly because of this make up that the use of radiesse is a lot more technique sensitive, and in unexperienced hands side effects such as hard nodules are more likely than in fillers such as restylane. It is also a more viscous filler which makes it more durable, but it is this viscocity which means that more severe side effects such as artery compression more likely. Also there is no antidote for these fillers, unlike the hyaluronic acid fillers, so if you don’t like the results or you have some undesirable side effects, tough they are there to stay, and for as long as 18 months. Having said all of this, all these side effects are relatively rare in the hands of an experienced doctor.

PAIN–6/10–Many patients comment on an “after pain” when Radiesse is injected which they say is stronger than when they were previously injected with restylane or juvederm. They describe it is a delayed pain, which is slightly burning in nature and comes a few seconds after the injection.

SYRINGE DESIGN/EASY TO USE?–7/10– A very good syringe design, easy to use. The material is viscous so quite hard to inject, and in inexperienced hands this is not the easiest filler to get side-effect free results.

VALUE FOR MONEY–6/10–Taking into account the relatively good durability and the larger 1.3ml syringe , radiesse does provide good value for money.In addition, due to it’s very viscous nature, 1 syringe of radiesse will go a long way! On the flip side, Radiesse will cost you as much as on average £400-£500 per syringe, as opposed to an average of £300-£350 for many hyaluronic acid fillers. Also Radiesse treatment often require a 3 month top up, incurring an extra cost.

POPULARITY–6/10–There is no doubt, Radiesse’s popularity is increasing, and allegedly this was the filler of choice at this year’s Oscars ceremony. However, Radiesse is still 3rd or 4th choice for many patients and doctors alike.

RANGE–4/10–No range, just Radiesse!

VERSATILITY–7/10–There is no doubt, this is a potentially good filler , and definitely one that any good cosmetic doctor should consider. It’s versatility however does not compare to some of it’s filler rivals. It is not recommended for use in lips or tear troughs, for fear of nodule formation. It is also contraindicated for use in the frown area, due to risk of skin necrosis. I am prudently going to keep an eye out for this potentially good “tool in the box”, but for now not my cup of tea..

TOTAL 61/100

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TEOSYAL

RESULTS–6/10–Just like other hyaluronic acid fillers, good dependable results, just not quite as good as it’s nearest rivals.

 DURABILITY–5/10–In my experience and that of many my colleagues, this filler last much shorter than all the other fillers on this list.

CLINICAL EVIDENCE–6/10–Only launched in 2005 in the UK, so has a long way to go to prove it’s long term safety and efficacy through more studies.

SIDE-EFFECTS–8/10–Like other hyaluronic acid fillers, the side-effects are usually minimal.

PAIN–5/10–Pain levels are minimal, just like the other hyaluronic acid fillers, but unlike it’s hyaluronic filler counterparts, still no pre-added lidocaine, hence the mark down since the last blog on this.

SYRINGE DESIGN/EASY TO USE?–7/10– Teoxane, the makers of the Teosyal range, have replaced the terrible old syringe  with a very good restylane like compact syringe. However, they have almost gone too much the other way in the ease of injection, with great pressure needed to squeeze the product out.

VALUE FOR MONEY–5/10–Despite slightly cheaper prices for Teosyal syringes  which can be found at many UK clinics, the poorer durability and results which are just not effective, in my opinion teosyal fillers do not provide great value for money.

POPULARITY–5/10–The popularity of teosyal has increased slightly, but in the long term it is very unlikely that these fillers can fight the bigger and better brands of coca cola and pepsi! No sorry I mean to say restylane and juvederm!

RANGE–8/10–This is the only other filler in this review apart from restylane , which provides a good varied range of fillers for all occasions!

VERSATILITY–7/10– This is a versatile filler, just not the best!

TOTAL 62/100

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So the winners list:

1. RESTYLANE 89/100    Still the gold standard! The longest track record, the best results. The king filler! Coca Cola!

2.JUVEDERM  75/100      The biggest chart climber! I like it more and more! The queen filler! Pepsi Cola!

3.SCULPTRA  67/100      Dropped down to bronze! Still brilliant at times, 3 year longevity, the liquid face-lift!

4.TEOSYAL   62/100      Off the bottom!  A decent filler, tough competition! Room to improve…

5.RADIESSE  61/100       The new kid on the block. Tougher, longer lasting! Still has to prove itself!

Breaking News! Gordon Ramsey recently admitted to having  botox ! I never thought I would see the day!

Gordon is quoted as saying ““Anyway, I was getting a complex for the first time in my life, so I did it. Botox. A jab here and one here. And no one has f****** noticed.”

My patients have so often used Gordon as an example of how they do NOT  want their wrinkles to look! His signature  furrowed brow has become famous the world over. All those hours in hot steamy kitchens, hot sunny holidays and a tough life to boot had taken their toll.  And now he has done it!

A high profile “frowner” such as Gordon Ramsey having botox  is yet again proof of the increasing trend of “boytox” or “mantox” , where men are catching up women fast in the botox stakes. Men just don’t want to look older than women any more. They are all reaching out for these “new age” facial steam irons..

See the interview on Channel 5 news with Dr Milojevic talking about “boytox”.

So yet again botox to the rescue!

Open letter to Gordon Ramsey from the Milo clinic:

Dear Gordon,

We hope that you are well.

If you want your botox done by the best, most experienced doctor in London, we invite you to come and see our very own “Botox King” , Dr Nick Milojevic at the Milo clinic.

And Mr Ramsey,  if you present a copy of this blog when you book your appointment, you’ll get your botox for half price.   ;0)

We look forward to welcoming you to the Milo clinic soon

Yours Sincerely

Milo clinic

As it turns out, Samantha didn’t do her research or read her consent form properly, where she would have found that there IS some downtime involved, and you can imagine how the party went!

All great fun but joking aside, I was glad to see this Amanda Platell feature at the beginning of this month,  as I have been so excited about Obagi treatments for quite some time. Amanda Platell is a well known TV and newspaper journalist, and she was treated with Obagi creams and the blue peel and she wrote about her experiences in the Daily Mail . It was a brilliant article, and Amanda from all accounts is thrilled with her results. As a criticism of the article, the before and after photos were really not very good at all, but the article does illustrate  the magic of Obagi perfectly!

For the full article: http://www.dailymail.co.uk/femail/beauty/article-1197162/AMANDA-PLATELL-Ill-try-look-young-Im-blue-face.html

Obagi truly is a miracle for the skin. Just 6-12 weeks of using the obagi creams can quite literally give the patient new skin, removing all blemishes, pigmentations, scarring, pores, thickened skin, fine lines and it’s not a myth, the skin does look 10-20 years younger as a result. The treatment removes the old dead outer layer of skin and allows the new collagen rich skin to come to the fore.

It is safer, more versatile and gets results which are incomparably better than the other chemical peels on the market.

As Amanda says, “I’ll try to look younger until I’m blue in the face”, and yes you can look a little bit like a Smurf or a Blue Man Group member straight after the treatment, but most of this will be removed before you leave the clinic. But don’t book any chic parties for a few days after the peel, as your old skin will be “leaving” you for a few days. A week or so after the peel however, you will be the Belle of the ball with your glowing perfect skin! I know that you probably think I am exaggerating, but trust me it is that good!

For more information on Obagi : http://www.miloclinic.com/treatments/obagi-chemical-peels.aspx

Attending this year, lecturing and teaching was Jean Carruthers, the goddess herself! Jean Carruthers, as you will know from my previous blogs, is the woman who 20 years ago stumbled upon the fact that botox can remove facial wrinkles, and if it wasn’t for her  none of us would probably be here today. She is quite literally the godmother of modern aesthetics and a true celebrity.

I  booked myself onto a half day masterclass with Jean Carruthers, and it is the best half day I have had for a long time. Apart from anything else, she is such a wonderful person, kind, gentle and humorous in equal measures. And as far as her knowledge, well it seems to be a never ending  well…

Before attending this masterclass, a colleague of mine told me that they decided not to attend, saying : “Well what else new is there to know, surely we are such experienced doctors that we probably will not learn anything new?” However , I have always said that we all need a coach throughout our lives and careers , no matter how experienced we are or we think we are . Even  Roger Federer, the world’s most brilliant tennis player of all times  has a coach.  And you know what, what a great coach Jean Carruthers proved to be… I learned so much, so many new secrets and beautiful tips and pieces of information.  And what are they, well that would be telling!

Everyone who has had the priviledge of meeting Barack Obama in the last 6 months, talks about stardust.. Well I made very sure that I tucked away my little bit of stardust on meeting the woman we all have to be very thankful to, Jean Carruthers..