Face treatments

Volume loss

If you ever look at a young person you will see how soft their skin is, how plump it is and how it recovers from each move and every gesture, how unblemished and how perfect the features. Clean, bouncy and as inviting as a hotel bed with new duvet and freshly ironed sheets. Plump is the right word – all the tissues supporting the skin are firm and healthy; the fatty layer, the blood vessels, the supporting collagen fibres and the "ground substance", the hydrating gel.

Youth is wasted on the young, or so they say. Slowly and imperceptibly the supporting layer starts to lose volume, sponginess and thickness. Like an apple drying in the fruit bowl the skin starts to sag, to line and pucker, eventually overhanging its bony margins at the jaw line and in the cheeks. In the absence of severe weight loss or other accelerating elements (smoking, sun exposure, extreme illness) volume loss precedes loss of elasticity by about seven years.

Most lines on the face are caused by the underlying loss of volume. Look at the face of somebody overweight – they have few (if any) lines and their face is still round and plump. Up till recently we used to fill the lines themselves, but now this new understanding has allowed us to replace the underlying volume disturbance and achieve better, more natural and longer lasting results.

Some lines still need filling, or the individual may desire a fast-fix in the short term - cheek lines, nose to mouth lines and lips, for example. These areas are subject to constant movement and micro-trauma in the skin. The newest generation of flexible hyaluronic acid fillers suits these areas very well by minimising the micro-trauma to the skin-filler interface. Fillers such as Esthelis (marketed as Belotero in the UK) are the flexible fillers that we use for these particular areas. Cheek lines, crows feet, forehead lines, lipstick lines, lines on the chest/décolleté all respond well to fine flexible fillers.

Cheeks

Cheeks are a sign of both youth and beauty. The cheeks highlight the eye area by catching the light. Together with the eyebrows they frame the eye, drawing the viewer's eyes to their target. Regardless of bony structure, the cheek area will disappear with age, leaving tell-tale signs – crow's feet, nose to mouth folds, loss of facial balance, heavy jawline and the "banana", the fold above the nose to mouth area.

Young people have voluminous cheeks, as well as "pretty" people, and a loss of cheek volume can be quickly and easily restored with a filler. Longer-lasting products such as Restylane Sub Q and Voluma are used to build up the cheek area and lift the jawline. Both Sub Q and Voluma are designed to give instant results, blend in naturally with the surrounding tissues and last about one year.

The other area that forms part of the face is the chin. Even with good dentition this shrinks, pulling back the lower frame of the face and causing stubborn marionette lines. This area must not be neglected when treating with fillers.

Volume loss is not always appreciable, but once noticed it is difficult to ignore.
Volume loss makes us look tired and older and makes us "disappear" in a crowd.
Volume turns heads and speaks, well, volumes!

Temples

Nobody really looks at the temples but in fact they also form part of the essential framing of the eyes. As time passes the temples hollow, especially in slim people, and make the eyes look “bony”. Normally just one injection into each hollow fills the temples, widening and hence softening the contours of the eye. Treating the temples also lifts the upper face; filling the hollow temples lifts the spare skin around the eyebrow area.

Lips

Lips, like the cheeks, are a sign of youth and fertility. The fleshy red aspect is due to circulating oestrogen, the female sex hormone. Young women have rich, fleshy red lips and this is a sign of their oestrogen level (=fertility). When red lipstick was first introduced, it was banned by the Pope on the grounds that it excited and incited men to sin. That may have been the case, but in fact we enhance our lips for ourselves, not for the men.

Lips require their own special filler. We use Juvederm Smile (0,8ml) or Restylane Lipp (1ml) to replace the lost volume in the flesh, under the skin of the lips or in the border. By placing the filler in different areas of the lips we achieve different results; a well-defined border, fleshy strawberry lips, soft, voluminous lips or a combination of all of these.

You can imagine that the lips are sensitive. We always offer a dental anaesthetic for the treatment of the upper and lower lip. This takes five minutes to perform and leaves the lips numb for about 45 minutes, ample time to perform the treatment. Once the lips have regained sensation, the lips might feel a little sore. They will certainly be swollen and will remain swollen for the next 24 hours. Rarely a bruise occurs, so please bear this in mind when planning treatment.

All of the fillers that we have described up till now are based on the natural hydrating substance of our skin, hyaluronic acid (HA). HA has been used as a filler substance for over fifteen years and technology has allowed the product to be made so that it is totally compatible with the human body. HA is a large sugar molecule that attracts water; it is a hydrating and lubricating agent and is identical across the mammalian and bird species. The first HA fillers were derived from the comb of the cockerel but nowadays all HA comes from bacterial fermentation (the standard process for all biological substances). It has even more exciting properties which will be explored in the Restylane Vital section.

Sculptra®

The concept of Sculptra is quite exciting in that Sculptra encourages the body to build up its own collagen and tissue volume. Sculptra is the trademark for poly lactic acid – many molecules of lactic acid joined together. Lactic acid is normally formed by the action of the muscles in the body, making the product totally compatible with the body's own tissue. However the product is not made from animal or human sources, like most cosmetic and medical products it is made from bacterial fermentation.

Sculptra should be considered as a volumising (or re-volumising) programme for the face, and certainly not a filler. The product is injected into the areas of the face that require volume. Although there will be a "result" after the first treatment, this is due mostly to swelling and merely gives us an idea of the end result. The initial swelling disappears after one or two days, but gradually and often imperceptibly the volume builds up until the next treatment, six weeks later. Yet again the face appears to show a further result, but this is short-lived and disappears after a two days. The real results will now start to show as the tissues of the face respond to the injected poly lactic acid. One third and possibly final treatment will complete the programme. The results should now last for up to three years. You may of course top the treatment up from time to time but with one injection session rather than the full three again.

The manufacturers of Sculptra suggest an average of six vials per treatment programme, but many clients who have only a small volume loss or who have taken care of their volume with standard HA fillers may need less, maybe three vials. We know that Sculptra will work, it sometimes takes time to work. We prefer not to over-inject but to take our time and wait for the results to show before adding more product. This is why we tend to recommend one or two vials per treatment and to space the treatments out to every six weeks. We can always add more product, we can never take it away.

Sculptra is best placed deep in the tissues to replace the deep fatty stores and to obtain a natural, soft result in keeping with the contours of the face. The temples thin early and these should be treated first. The other areas of the upper face (cheeks, eye area, nose to mouth area) need to be addressed before the lower face is treated, since the lower face begins to lift as upper facial volume is re-established.

In the lower face, Sculptra is used more to stimulate collagen synthesis in the skin itself, thereby increasing the quality of the skin and preventing fracture lines.

Sculptra can be used to lift the forehead. Very often treatment with BTX is requested for this area, but BTX would only make the forehead droop further. The real cause of lines is volume loss, and Sculptra can be placed in the forehead area to re-expand and re-curve the forehead, literally lifting the eyebrows.

As we begin to lose volume at about the age of 35, we should start thinking about volume treatment with either a HA filler or Sculptra from this age.

Combining Sculptra® with HA fillers
Those of us who insist on instant results will be reassured to know that Sculptra and HA fillers are compatible and can be used together. Once you have decided on a volumising treatment, perform the HA filler first to give instant results in the areas where it is recommended. Then, at your leisure, embark upon the course of Sculptra.

Adverse reactions to HA fillers
Manufacturers cite an "adverse" reaction rate to HA fillers of 1:20,000. We have never witnessed an adverse reaction to an HA filler in the clinic but it can and probably will happen. We will do our level best to ensure that it does not happen in the first place (use well-established products, maintain hygiene, select clients in good health, etc), and then treat you accordingly should the unfortunate event arise. Although the reaction rate is small, it is not insignificant if you are that one. Please remember this when deciding on a treatment. In our experience the most likely cause of "reactions" are infections. This is why we prefer not to treat you when you are unwell or have an obvious source of infection (eg infected tooth, bronchitis).

The advantage of HA is that it will dissolve and disappear totally with time. It can also be dissolved actively with the enzyme hyaluronidase should you really not like the result or suffer an adverse reaction.

Adverse reactions to Sculptra®
There are many historical reports of Sculptra causing lumps. There are two reasons for lumps developing; injection of undissolved product and infection. A recent paper exposed these two causes and has allowed us to take precautions against these two factors. The manufacturers have issued new guidelines on preparation and injection of the product. We have always followed these and to date have experienced no problems with lumps.

Rebalancing the muscles of the face

Botulinum toxin treatments

Injectable muscle freezing toxin is a treatment for the both lines and the balance of the upper face. In the same way that we now appreciate the role of volume in the face, so we now appreciate the balance of the face and the relative proportions that each part makes to the total.

Chasing lines is no longer our ultimate goal; rebalancing the face to achieve perfect harmony at all ages is.

Botulinum toxin is a prescription medicine and as such we are not permitted to advertise its use in our clinic by name. We understand that it can be frustrating for people wishing to find out about treatments for frowning, facial lines, facial rebalancing, upper face lifting and even more so those suffering with migraine. Let us use the term “BTX”.

BTX is a muscle relaxing agent used in medicine for over 25 years. It is still used more in NHS practice than cosmetic practice, for the treatments of tics, spasms and muscle tightness. In these cases very large doses can be used.

Much smaller doses can be used to improve the look of the face. Facial lines can be eliminated or reduced such as the frown area, chin puckering and crow’s feet.

Because BTX relaxes the muscle into which it is injected, BTX can be used to stop unwanted downwards movement of the face. This achieves a net lift especially of the upper face and eyes, opening up the eyes, conveying a sense of tranquility and freedom and eliminating that look of tiredness.

Many migraines seem to stem from excess muscle activity and frequently migraine headaches will respond to BTX treatment.

Other areas respond well to BTX – the neck and chest lines relax in response to the toxin. Sometimes BTX needs to be complemented with fillers in these regions, just like the rest of the face.

After treatment the area may be a bit red for half an hour and rarely there may be a small bruise. Make-up can be applied immediately after the treatment. The effects are seen three to seven days after injection and normally last for about three to four months. This figure is variable and some clients only require treatment once or twice a year.

The need for treatment diminishes with time as we “forget” how to frown, giving the skin a chance to recover.


Mycells autologous skin rejuvenation

The ultimate skin rejuvenation and scar reduction treatment. We all have the capacity to heal ourselves. When wounds are created bleeding and bruising occurs. Up till now we have considered this a nuisance (who wants a bruise?), but in fact our blood is rich in growth factors and human stems cells. These carry the message for healing and rejuvenation.

Obtaining the growth factors and stem cells is easy. Blood is taken from you at the time of the procedure and is spun in a centrifuge. The heavier blood cells move to the bottom of the test tube and the platelet and growth factor-rich plasma separates out in the upper part of the tube. This is drawn up into a syringe, the platelets are activated and ready for use. There is no risk of muddling up samples because the blood is taken from you and used at the same treatment; nothing is stored for later and the blood never leaves your sight.

The plasma mixture can then be used in various ways, depending on the needs of your face and your particular concerns.

The plasma can be injected just like a filler in order to revolumise the key areas; cheeks, lips, temples and nose to mouth areas.

It can also be injected into the skin to improve texture and quality. In this case we borrow the technique from mesotherapy; nappage.

Excitingly, the plasma can be used around the eyes where we would otherwise have to be wary. Plasma can be injected to give volume and to improve skin quality.

After the treatment the face looks a little red, can be swollen and there may be some bruising, especially around the eye. The treatment is no more discomforting than a normal filler injection or mesotherapy.

The results start to appear after about four weeks and continue to develop over the next six months. They are subtle and for this reason we prefer to take photos before the treatment. Repeat treatments are recommended; initially after three months and then after six months, depending on your age and desire for improvement.

Mycells is the ultimate in skin rejuvenation. Results can only be natural; the body cannot over-respond because your stem cells are genetically programmed to express your natural characteristics.

Mycells is good for those that like the concept of self-rejuvenation, who want the best out of their skin and perhaps for those who prefer not to have fillers or botox.

However, Mycells can be combined with fillers and botox for the very best of results.


Skin resurfacing - peeling

This is not the perfect term for a procedure that reverses sun damage, revitalises the skin, tightens it, closes the pores, reduces pigmentation, reduces fine lines, improves the texture of the skin and turns back the clock in terms of skin ageing. Nevertheless we are stuck with it.

Most peels these days do not cause peeling, redness, open skin, pain and weeping. Historically yes, they did, but not any more.

Even the classic TCA peel can be performed in stages to avoid the peeling phase; moreover some of our peels are so gentle that you may carry them out at home. The glycolic acid 10% mask or 25% for the body are very simple home care treatments.

You should think of peeling as a repair and revitalisation procedure and consider it as one of the first steps towards improving your skin. Peeling reverses sun damage, stimulates new collagen synthesis and reduces pigmented lesions. The type of peeling that you choose depends on your skin condition and your lifestyle.

Peeling is also an excellent treatment for acne, both in its active stage and for the scars and pigmentation that may result. Sometimes peeling needs to be combined with other treatments in order to completely eradicate the acne

Gentle peeling - glycolic acid, lactic or mandelic acid

Gentle peeling is a simple procedure and often the first that people choose. It is a simple procedure with no down-time. Gentle peeling is recommended for early signs of sun damage and ageing of the skin – open pores, fine lines, dryness and poor texture. Gentle peeling will improve the texture and luminescence of the skin as well as reducing fine lines, increasing hydration and decreasing open pores.

Glycolic acid is the classical gentle peel, although we now use a lot of mandelic acid (from almonds). This exfoliates the skin at the time of peeling and (apart from being very satisfying) means no further exfoliation. It is recommended for sensitive, oily skins and those with rosacea.

Lactic acid (from milk) is recommended for acne-prone skins and those that are a little thicker or oilier.

Any gentle peeling needs to be repeated every two weeks for a total of six treatments. We prefer to combine gentle peeling with the vitamin facial and then visible red light in our “combination facial” order to achieve far superior results in less time.

Nano peeling

In this peel the peeling molecule is embedded in a silica nanosome. Nanosomes penetrate the skin and deliver the peeling molecule exactly where they are needed. The silica envelope enhances repair from the peel. Thus the peel takes place below the surface of the skin, the skin peels and starts to heal immediately. This ensures a shorter recovery time, less product requirement and better results.

Unlike other preparations, the nano-peel is a gel formulation. This prevents any accidental spills, particularly into the eyes. This means that the peeling product can be placed very safely close to the eye with no risk of spillage. It also means that several different peels can be used on the same face without spread; different areas demand different degrees of peeling. The most popular peel in this range is the glycol eye peel, specifically designed to peel around the delicate eye area.

TCA single layer

TCA peeling is normally considered a medium depth peel simply because the product penetrates deeper to reach the medium layers of the skin. The deeper the product penetrates then the better the result will be. Deeper lines, acne scarring and some pigmented lesions will be more suitably treated by going deeper in the skin. Peeling is a bit like paint stripping – the more layers that we apply the more layers of skin will be removed (and the better results). However the deeper we go and the more layers we remove then the more peeling there will be. This is why we prefer to go layer at a time (unless you wish to do it all in one go and then we will happily oblige – see below).

A single layer of TCA will lift off a layer of skin cells and only cause a slight dryness the following day. A single layer will penetrate deeper than glycolic acid and therefore will achieve slightly better results that glycolic peeling. Single layer TCA can be repeated every two weeks for a total of three or four treatments.

TCA medium depth peel

By applying three or four layers of the TCA we will go deeper and remove more than one layer of skin. We aim to reach the area from which the skin grows and have some rejuvenating effects on the growing area itself. This is a bit more invasive than the other peels and for the time of application (a few minutes) will feel quite hot and stingy, say 9/10 on the discomfort scale. Afterwards the skin becomes red, then dry and brown and peels off a day five. Whilst you may apply make-up for these days the skin will be really dry.

A medium depth peel is recommended for sun damage, open pores, poor texture and for generally improving the skin in white Caucasian individuals.

Because this peel is stronger than a glycolic peel, it is not suitable for darker more sensitive skin types, or anybody prone to rebound hyperpigmentation.

We always use red light to promote healing and reduce recovery time after a TCA peel. Although the results are seen almost immediately after the peeling phase, the very best results are seen after six months.

Although it makes sense to avoid the damaging rays of the sun after a peel, sun exposure is not prohibited after our peels.

With the advent of the dermaroller we find that we are performing less peels in favour of the dermaroller. This technique also improves skin structure and reduces sun damage, but with noticeably less recovery time.

Skin cleansing; PPX

The PPX device (also known as the fifteen minute facial) combines suction with low dose pulsed light. The suction is intense but concentrated in a small area so that pores are literally sucked clean and the contents wiped away. The light helps to control redness, decrease pigmentation and to stimulate collagen synthesis. Because the device emits a preponderance of blue light acne and other spot-forming bacteria are killed. This makes the PPX device a great treatment for controlling acne and break outs.

The treatment does not hurt and takes about fifteen minutes. Afterwards the skin is a little red but this quickly settles. You need to ensure that your skin is at its base colour; avoid sun tans and fake tans before treatment as the results may not be so reliable.

We recommend a course of about six during which we gradually increase the level of light reaching the skin. While the suction cleanses the skin the light provides the therapeutic energy.

PPX is good for acne, break outs, problem skin, blocked pores, open pores, pigmentation, redness, rosacea and generalized skin rejuvenation.

Abnormal pigmentation

Abnormal pigmentation is a very common skin complaint. Even the pigment cells can become damaged; when they are damaged they do what they know best – make pigment!! Sun, hormones, pregnancy, stress, trauma and ageing are all features that can result in abnormal pigmentation. Darker skins, mixed race skins and oriental skins are more prone to pigmentation and must be treated cautiously to avoid more pigmentation.

For this type of skin, Cosmelan is advised. Cosmelan is a well-known depigmenting and skin rejuvenating treatments that originated in Spain.

The only way that pigment can be removed from the skin is by the natural exfoliation of the skin; for the treatment to be successful, further pigmentation must be prevented.

Cosmelan is a combination of both; exfoliation and prevention of further pigmentation. Cosmelan can be used in its full strength as Cosmelan 1 and 2, and in a more gentle manner with Cosmelan soft.

Cosmelan 1 and 2 involves the application of the Cosmelan mask for up to ten hours. This mask is yellow in colour, looks like thick foundation and has to be removed at home. The next day the skin is quite red and a little swollen, and a healing cream is applied. The following day, Cosmelan 2 cream is started which stops any further pigmentation. The Cosmelan 2 contains many pigment inhibitors, plus the anti-ageing retinoic acid cream and several other soothing ingredients. By applying Cosmelan 2 at this stage enables the skin to peel off, taking much pigmentation with it, and preventing further colour build-up.

Cosmelan 2 needs to be applied regularly for up to one year for reliable results. It is well worth the effort since the skin becomes younger, fresher and without pigmentation in 95% of cases. The sun should be avoided since it is the major stimulation of pigment and ageing factor of the skin.

The skin may remain red and flaky for about four days, so this must be remembered when planning treatment.

For those that so not wish to be red and flaky, Cosmelan 2 (the maintenance cream) can be applied after a more gentle mandelic acid peel. The peel is performed every three or four weeks and Cosmelan 2 is applied up to 3 times a day as a routine. In this case the results will appear slower than with the full-on Cosmelan 1 and 2, but nevertheless will be worthwhile.

Skin quality, restructuring, scar reduction - dermaroller

Dermaroller is just about the only treatment that the stars admits to! Dermaroller is a small disposable device that gives the same results as a fractional skin resurfacing, without the downtime, discomfort or cost.

The Dermaroller was created by a German metallurgist who appreciated the role of controlled sterile skin trauma in skin regeneration and repair. The Dermaroller creates tiny punctures in the skin which heal within three minutes. Unlike a fractional laser which “drills” a column of damage, the dermaroller needle penetrates the skin to reach the key layers, stimulating the fibroblasts and releasing huge quantities of growth factors into the dermal tissues. It is the combination of increased fibroblast activity and growth factor availability that stimulates the skin to repair itself, not just from scars but from ageing. Dermaroller is the only technique that recreates both the support tissues collagen and elastin.

Before the treatment we apply copious amounts of anaesthetic cream in good time to ensure that the procedure is tolerable. Once numb, it might feel a bit prickly but this is easily sustainable. The aim of the treatment is to release growth factors into the skin; these are found in the blood. We are therefore looking to make the skin red, with a few bleeding points. This takes about half an hour, after which we apply a cooling, soothing healing cream. The skin is a bit red on leaving but make-up can be applied immediately.

The face will remain red for the rest of the day, but by the following day it should start to settle down. Most people are able to return to normal activities by the next day although some people with more fragile skin take a bit longer.

Sometimes the skin can even peel, this is particularly the case when sundamaged skin has been treated. Small bruises are also possible over the bony areas (collar bone, jawline).

Depending on the response of the skin (ie redness at the time of treatment) we like to repeat the dermaroller treatment sooner or later. If the reponse was good and the skin went red quickly then we recommend a repeat treatment after about 4 – 6 weeks. If the response was sluggish then it is best to perform a repeat treatment at two weeks to benefit from the enhanced circulation.

Acne scars respond really well to the dermaroller. The needles penetrate and break up the scar tissue, growth factors encourage new skin growth in the scarred area. For acne, we recommend three treatments. Once the scars have been replaced by normal skin, they are gone for good.

Sundamaged skin also responds well to Dermaroller; again three treatments would be recommended.

We also have the Dermastamp for smaller areas such as scarring and the lip area.

Remember however that after each treatment results will be visible.

We only use the Genuine Dermaroller – this is CE marked and suitable for use as a medical device.

Treatments for acne

Salicylic acid peeling; skin cleansing; red light

Acne is due to a combination of factors; excess sebum production, increased activity of skin bacteria and build-up of dead cells and debris on the surface of the skin. As a consequence pores become blocked and infected.

The treatment of acne needs to address all of these underlying factors, which means that a single treatment will not be effective. We need to combine treatments. We also need to think about the underlying cause; sometimes hormone changes, stress and dietary indiscretion.

For our part we like to emphasise exfoliation with a gentle salicylic acid peel, particularly good at removing the excess oil and dead cells, combined with red and blue light to specifically kill the bacteria. Skin cleansing with the PPX skin cleansing/light device is also an essential and satisfying part of the treatment. (see earlier section on PPX)

We perform the treatment combination every two to four weeks, depending on the degree of the problem. The treatment can be performed even if the acne is active, although sometimes the acne flares up a bit before responding to treatment.


Acne scars

Once installed, acne scars can be disfiguring and distressing. There is no need to suffer any more; we can reduce these substantially using the new Dermaroller or Dermastamp treatment.

Treatments for saggy skin

Accent

Nothing in life is simple and likewise the ageing process. True, volume loss does account for the greater part of the sagging that we experience. Sadly, gravity does also play its part, as does the constant movement of the face slowly but inexorably stretching the tissues beyond their ability to return to their original length. Although this process of collagen stretching and loss of elasticity occurs later in our lives, it has to start at some time and it makes sense to address it as soon as possible.

The Accent device delivers radiofrequency (RF) energy to the support tissues under the skin, heating them up and making them shrink. Collagen fibres are made up of microscopic coiled-up spirals. Slowly they uncoil, aided by constant use, sun, smoking and gravity. Just as your favourite woollen jumper will shrink in the washing machine (remember that wool fibres have been teased out and stretched so return to their normal shortness on heating), your collagen fibres can also be encouraged to return to their normal shortness and elasticity on gentle heating.

Accent delivers a controlled heating that does not hurt. It warms the tissues. The amount of warming is controlled by a hand-held temperature gauge; as soon as the desired temperature is reached the head is moved to another area of the face. The treatment feels pleasant and has been described like a mixture of a hair dryer and a roll-on deodorant!

Once treated, the skin is a little red but this quickly subsides after half an hour. Make-up can be applied immediately.

In order to achieve the best results it is recommended to have the first three treatments in quick succession; preferably within two weeks. Thereafter you should repeat the treatments every three to four months.

Accent can also be used on the body. We use it as a routine after the Ultrashape treatment and it is recommended to tone the skin after pregnancy, weight loss and for postmenopausal skin laxity.


Radiolase

Radiolase has been used in the operating theatre for many years. Now that we understand the value of RF energy in skin tightening, we can use Radiolase to tighten tissue. Radiolase is a very gentle source of RF energy and heats the tissue, just like the Accent machine.

We use Radiolase to tighten the areas that Accent cannot reach – the hands, the neck, chest, arms and around the eyes. The head is small and is moved quickly over the area, heating it up and shrinking it as it goes. There is some redness and swelling with this treatment; this swelling is always welcomed by the client but disappears within 24 hours. Swelling is a healthy and positive response to the treatment and indicates a favourable outcome.

As for the Accent three treatments are recommended, the first three within two weeks and subsequent treatments every three to four months.

Treatments for fatty areas; chins, jowls and eye bags

Homeopathic mesotherapy

One of the less desirable features of age is the way that the fat cells behave. Whilst the fat stores in the upper face readily disappear with weight loss, stress, illness or general passage of time, fat stores on the lower face can increase. The tightness of the jawline is often spoilt by fatty deposits, known as jowls.

Homeopathic products can encourage the fat cells to behave themselves and to liberate the stored fat. We use a product known as “Metabolites”; a mixture of homeopathic dilutions known to act on fat cells.

The injections do not hurt, bruise or leave tell-tale marks. The area treated swells for half an hour, then over a period of two to four weeks the fatty area starts to diminish.

Normally three treatments are recommended. As usual with homeopathic treatments the best results are achieved in non-smokers and those who follow a healthy diet and lifestyle.