Dermal Fillers

Dermal Fillers

Dermal Fillers are commonly used to fill lines and wrinkles on the face as well as to replace volume. Loss of volume, especially on the face, is usually related to ageing.

Typical lines and wrinkles that can benefit from filler treatment include:

• Crow’s feet around the eyes
• Smile lines (nasolabial folds, from the corners of the mouth to the edges of the nose)
• Frown lines
• Marionette lines
• Forehead lines
• Frown lines
• Fine lines around the lips and mouth
• Occasionally, acne scarring

Common areas of volume loss that can be improved with fillers include:
• Sunken cheeks
• Sunken temples
• Narrow or thin lips

Often, replacing lost volume in the cheeks can have an uplifting effect on other lines and wrinkles, and help achieve a more youthful appearance.

The dermal fillers can be classified in a number of different ways.

Permanent fillers are rarely used nowadays and most Plastic Surgeons do not recommend permanent fillers for cosmetic use.

Temporary fillers, the most common of which are hyaluronic acid fillers, are the most widely used. Hyaluronic acid forms the foundation of most tissues and rarely causes allergic reactions. These dermal fillers come in various consistencies and have numerous uses, from filling fine lines and wrinkles to replacing volume in the cheeks, lips and temples. Hyaluronic acid fillers, depending on the type of dermal filler and area in which it is used, can last from 6 to 18 months.


As with any treatment, the injection of dermal fillers carries risks. While very rare, the most serious risks include skin loss and in extreme cases blindness (when injections are carried out around the eye region). A well trained practitioner can minimise these risks.

It is important, therefore, that filler injections are carried out by a fully trained expert who understands the anatomy of the face, as well as appreciates the aesthetic needs of the patient. Each treatment is individualised for every patient after a detailed discussion of their concerns.

For further details please visit this link for information on dermal fillers.

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The Thermage procedure is a non-invasive, little or no-downtime treatment that aims to deliver tighter skin, renewed facial contours and healthier collagen. Some times described as non-surgical facelift.

At the heart of Thermage is the patented Thermacool TC system. This sophisticated device enable doctors to deliver energy deeper in the skin than conventional laser therapy.

Suitability for any patient for the Thermage procedure is decided only after careful consideration of their wishes and expectations. The plastic surgeon at The Renacres Hall Hospital will help assess the degree of skin laxity and recommend exactly where the thermage procedure could tighten up skin and renew the contours of the face. This procedure is most suitable for those with early ageing changes, (age 35 to 60) It is not a substitute for surgery.

This procedure has also been shown in some studies to be an effective therapy for moderate to severe active acne. While it will not cure the condition it can, in selected cases, reduce the incidence and severity of recurrence.

Skin is made up of two layers, the visible thin outer layer called the epidermis, and the deeper layer called the dermis. The main structural component of the dermis is a protein called collagen, which provides the skin its strength. As we age, the body produces less collagen resulting in wrinkles and laxity. The Thermage procedure causes the collagen in the dermal layers of the skin and its underlying tissue to tighten, thereby; without surgery, reducing skin laxity and wrinkles and renewing facial contours.

The Thermage procedure for Skin Tightening uses patented radiofrequency technology to create a precisely controlled zone of heating in the dermis and the underlying tissue. At the same time the epidermis is protected with continual cooling. Heating of the collagen to critical temperatures, initiates a natural biological reaction that causes the collagen to contract and thicken. This process, called denaturation, provides the initial results of tighter, smoother looking skin. In addition, the body also initiates a second response to heating within the dermis and underlying tissue. This response is part of the body’s natural wound-healing response and initiates new collagen creation over the next 3 to 6 months, providing long-term tightening of the skin. The combination of these two processes, provide immediate skin tightening and long-term tightening effects.

We are receiving requests for information about Thermage. If you would like to know more, book an initial consultation to discuss what Thermage could offer you.

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Texture Changes / Surface Irregularities

Thermage has received a low incidence (reported less than 0.2% of the total estimated number of treatments) of reports citing the development of focal “surface irregularities”. Such reports have been received for treatments that have been performed in the forehead, and mid/lower face areas. These surface irregularities have been variously described as “small dents in the surface of the skin” (localized) and “rippling”, “ridging” or “waffle patterns” (covering a larger surface area). Frequently these irregularities are not present immediately post-treatment but show up later (1 or more months post-treatment). In a few cases these symptoms have resolved over the course of time.

Burns, Blisters, Scabbing, Scarring

The procedure may produce heating in the upper layers of the skin causing burns and subsequent blister and scab formation. Burns have been reported at a rate less than 0.3%. There is a small chance of scar formation (rare). Scars may be raised or slightly depressed. Deployment of the technology over areas where metal objects may be present is done with caution to avoid burns. Please inform doctor of such sites (e.g. dental fillings, metal plates, etc.).

Texture Changes / Surface Irregularities

Thermage has received a low incidence (reported less than 0.2% of the total estimated number of treatments) of reports citing the development of focal “surface irregularities”. Such reports have been received for treatments that have been performed in the forehead, and mid/lower face areas. These surface irregularities have been variously described as “small dents in the surface of the skin” (localized) and “rippling”, “ridging” or “waffle patterns” (covering a larger surface area). Frequently these irregularities are not present immediately post-treatment but show up later (1 or more months post-treatment). In a few cases these symptoms have resolved over the course of time.


In very rare cases, the treatment may cause bruising which typically dissipates within several days.

Erythema / Blanching

The treated area may become temporarily red (erythema) or white (blanching). Erythema typically resolves within a few hours, however, on rare occasions, has been seen to last longer (up to several weeks), blanching typically resolves within twenty-four hours.


The treated area may swell. Swelling typically resolves in three to five days or less but can persist up to several weeks.


Most people will feel some heat-related discomfort (pain) with the treatment. This discomfort is usually temporary during the procedure and localized within the treatment area. A small number of patients have reported transient aching in the treatment area (lasting up to several weeks). In addition, a small number of patients have reported headaches following forehead treatment.

Altered Sensation

Thermage has received a low incidence (reported less than 0.1% of the total estimated number of treatments) of reports of focal, transient altered sensation, variously described as “numbness”, “tingling” or “temporary paralysis”. These cases have typically resolved in a short period of time but in a few cases have persisted up to several weeks. Reports have been received with respect to patients treated in the forehead, mid/lower face and neck areas.

Other Unknown Risks

All of the risks of the ThermaCool system are not yet known. Other unexpected risks or complications may occur, and no guarantees or promises can be made concerning the results of the treatment.

Pregnancy & Breast Feeding

The effects of the procedure on women who are pregnant or breast-feeding are unknown and could be harmful. However, there is no evidence that other radiofrequency surgical devices in use for decades have had a significant role in pregnancy.

Auto Immune Diseases

The effect of the procedure on patients with autoimmune disease (eg. lupus) is unknown.

Herpex Simplex

Herpes simplex eruption may result in rare cases in a treated area that has previously been infected with the virus. Reactivation of HSV is generally thought to occur most commonly in the perioral and genital skin areas after various stimuli.


Patients on steroid treatment and Warfarin are more likely to have problems.

Medical Implants

Pacemakers, defibrillators and internal hearing aids are strict contraindications.


Because all individuals are different, it is not possible to completely predict who will benefit from treatment with the ThermaCool device. Some patients will have very noticeable improvement, while others may have little improvement. It is possible that additional treatments may be needed to achieve the desired end result, or that smaller touch-up procedures may be required.

Off Label Use

Thermage has studied The ThermaCool System in U.S. clinical trials for treatment of facial and periorbital wrinkles and rhytids. The U.S. Food & Drug Administration has currently cleared the ThermaCool System for these indications. All other areas of deployment are considered “off-label” and “investigational”. Thermage is aware of studies that have been conducted internationally for use of the system for skin tightening on arms, abdomen, legs …etc. This body of knowledge, along with the information gained during the initial period of commercial use, is extensive, but not yet sufficient to allow Thermage to determine additional risks that may accompany the use of the Thermage procedure in such “off-label”, investigational areas.

Allergic Reaction

There is a possibility of an allergic reaction to materials used during the Thermage procedure. For example, an allergic reaction to the anaesthesia, to the ink used for marking the skin or any other drugs or substances used during the use of ThermaCool.

Skin Care

Skin Care

The Northwest Cosmetic Surgery provides a skin care programme, which is individualised to your needs after a careful assessment. This is quite different from over the counter “Commercial” skin care which is often nothing more then cosmetics with no therapeutic effects.

Medical skin care treatment may help to improve skin surface, correct surface discolouration and blemishes, and encourage cell renewal and collagen production.

At Northwest Cosmetic surgery we use pharmaceutical grade skin care product lines in a treatment programmes personalised for you.

The anti-aging programme may include a combination of hospital based treatments (chemical peels, Thermage) and home therapy products.

While anti-aging medicine may not correct every skin flaw, it can in most cases make your skin look fresher.

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Chemical Peels

Chemical Peels

There are three types of peel:

Superficial peel is the most commonly used, it removes the outer layer of cells, lightly exfoliating the skin to give a healthy glow.

Medium-depth peel penetrates further into the skin to reduce small wrinkles and acne scars, and to even out skin colour and tone.

Deep peel is not widely available (we don’t provide this), it penetrates the lower dermal layer of the skin to remove or lessen deeper wrinkles, lines and scars.

Most often used to improve the appearance of sun-damaged skin on the face or backs of hands. They are also effective on some spots and blemishes and acne scarring.

Chemical Peels can’t alter the size of pores, improve sagging skin or remove deep scarring.

Superficial peel is a quick and easy treatment. The face is cleansed and peel painted on and left for two to ten minutes. Mild stinging may occur. The peel is then washed off and neutralised.

The skin will look pink afterwards and may show faint white discolouration or blotches which fade in one or two hours. There are no after-effects, and you can go straight back to normal daily life.

Repeat the treatment weekly for four to six weeks, and maintain the effect with a monthly peel.

Medium-depth peel -The skin is cleansed and peel applied evenly. The treated area turns whitish grey over several minutes. Cool saline compresses are then applied to neutralise the acid in the peel. The face may swell when the peel is applied, and burning or stinging lasts for about an hour after treatment.

Recovery takes a week or more, depending on how quickly you heal (older skin heals more slowly). In the five to six days after treatment, the skin may turn dark brown, with white streaks. It will itch and begin to peel, after which the skin is bright red, fading to fresh pink over the next three to six weeks.

Repeat the treatment monthly until you achieve the effect you want, and then maintain it with a peel every 6-12 months.

After a superficial peel, the skin immediately looks brighter and more radiant.
With the moderate and deep peels, you won’t see the results until the skin has peeled off, then healed. It’s important to follow the after-care instructions you’ll be given, to help the skin to heal successfully.

Chemical peels probably won’t be recommended if you have a history of skin scarring, any abnormal pigmentation, facial warts, Afro-Caribbean or Asian skin (loss of skin pigments can occur), red hair and freckled skin, or have used certain acne treatments within the last year.

Superficial peel
Using a high factor sunscreen at all times helps prevent the problem of increased pigmentation. New skin may have too much pigment which will turn to brown blotches in sunlight (hyper-pigmentation). A rare side-effect is skin infection or cold sores, in patients with a history of these complaints. Use of antiviral medication is recommended prior to peeling in patients with history of cold sores.

Medium-depth peel
Increased pigmentation (Hyper-pigmentation) can occur even if you use sunscreens. Brown blotches can be treated with bleaching creams. The red face can sometimes last longer than two to three months. Permanent scarring is a very rare risk.

Alternatives to a chemical peel.
Anti-ageing cosmetics containing fruit acids, or retinol, could improve the skin’s appearance.

Stop smoking and drinking, take regular exercise to improve circulation, have a healthy diet, and use sunscreen—- all help prevent deterioration in the skin’s condition.

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Wrinkle Reduction Treatments

Wrinkle Reduction Treatments

For patients who have fine lines or wrinkles, or deeper furrows in the skin of their face, we offer at our practice a convenient, quick, and effective treatment.

Botulinum Toxin injections are done in our clinics and take a very short amount of time.

Botulinum Toxin is a neurotoxin which, when injected into the facial tissue, relaxes the muscles around the injection site. Tightening of the muscles is often the cause of facial wrinkles, and when they are relaxed by the action of the Botulinum Toxin, wrinkles are smoothed and the area takes on a younger appearance.

The effects of Botulinum Toxin can last up to three to four months. For more permanent facial smoothing, however, surgical procedures like the Facelift or Eyelid surgery or Thermage (non-surgical skin tightening) may be a better choice.

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