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DERMAL DISTINCTION
TRAINING ACADEMY | MELBOURNE






Resources


DERMAL DISTINCTION
TRAINING ACADEMY | MELBOURNE



.
On the Aesthetics blog



  • Why Botox And Filler is essential training

    Here is why you should add these cosmetic injections to your dental practice.

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

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

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

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

    The Similarities Of injectable Treatments

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

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

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

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

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

    The Difference Between Botox and Dermal Fillers

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

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

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

    Thanks for reading!
  • Can we use moisturizer to slow ageing?

    As we get older, so too does our skin. The rate at which we produce collagen is reduced, and this leads to sagging, and lines and wrinkles (Nooooo!). However, keeping our skin moisturised can help delay the appearance of ageing - and make us feel great!

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

    What’s in moisturiser?

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

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

    Humectants

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

    Emollients

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

    Occlusives


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

    What is it about moisturiser that helps us age better?

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

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

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

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

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

    THANKS FOR READING!
  • Why you should stop freezing your patients! And some golden tips.

    Cosmetic injectable treatments are part of the full facial diagnosis and treatment plan, and can really complete the result for your patients. The teeth and lips, skeletal structure and musculature of the patient all equally contribute to the result you can achieve for your patient.

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

    What is Rebalancing?

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

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

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

    botulinum toxin

    Facial anatomy and muscle action

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

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

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

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

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

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

    Golden tips for use of toxin

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

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

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

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

    THANKS FOR READING!
  • Aesthetic consultation: Free or Fee

    There are so many free offers out there these days. Patients are lured in with the offer of a 'Free consultation'. This "no commitment to purchase" offer can be very attractive for patients, but if you read our last blog post, you don't want to attract the "Low-cost Lisa" patient.

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

    A great practice needs value

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

    Ideas to value add in cosmetic injectables

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

    Go after quality patients

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

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

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

    Focus on the First Impression

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

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

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

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

    THANKS FOR READING
  • Dissolving Fillers? Here's What You Need To Know

    Has one of your patients returned to your practice, unhappy with the apperance of their treatment? Here is everything you need to know about fillers so that you can proceed with confidence

    When do fillers start to dissolve on their own?

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

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

    Simon Cowell spoke openly about getting his facial filler dissolved.

    Why are so many people talking about dissolving fillers?

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

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

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

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

    What is filler migration?

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

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

    What is used to dissolve fillers?

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

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

    Does dissolving filler hurt?

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

    Can I dissolve fillers if my patient is pregnant?

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

    Is dissolving fillers safe?

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

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

    What do I tell my patient after dissolving the filler?

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

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

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

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

    THANKS FOR READING!
  • Game Changers in cosmetic injectables

    There are some new kids on the block when it comes to the cosmetic injectables, and there has been a lot of internet buzz around them. In a moment we will take a look at what is new, what is coming and what has been around for a while but gone a little under the radar. But first, let us take a brief look at how products are registered here in Australia.

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

    What is new in cosmetic injectables in Australia?

    Profhilo

    profhilo

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

    How does Profhilo work?

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

    Is Profhilo Safe?

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

    What has gone under the radar?

    Teosyal Redensity 1

    redensity 1

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

    What does Redensity 1 do?

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

    Is Redensity 1 safe?

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

    What is coming to the cosmetic injection market in Australia?

    Daxxify

    daxxify

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

    Therapeutic Use

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

    THANKS FOR READING!
  • Uh oh! I'm losing patients to cheaper clinics

    Let's look at how The Patients Think. Before we talk about the costs of treatment, let’s take a moment to look at things from your patients point of view.

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

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

    It’s Not As Important To Patients

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

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

    The patient we want

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

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

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

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

    Elizabeth is in demand

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

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

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

    Don’t Be Embarrassed About Your Fees

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

    Forget the Lisa's

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

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

    Don’t Waste Your Time Comparing

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

    Love and maintain Elizabeth

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

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

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

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

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

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

    So here is the main point

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

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

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

    Thanks for reading!

    THANKS FOR READING!
  • Teoxane: Lip Beautification Webinar

    Did you see our informative webinar on Lip Beautification? It was educational, interesting and packed with take-home messages for great treatment

    About Dr Benji Dhillon

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

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

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

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

    About Nik Davies

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

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

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

    About Dr Giulia D'Anna

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

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

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

    THE WEBINAR IS AVAILABLE TO OUR MEMBERS ONLY


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