Dr Imaan Joshi in Sydney, Australia | Doctor

Dr Imaan Joshi

Locality: Sydney, Australia

Phone: +61 2 9734 8845

Address: Suite 9, 42 Bigge Street Liverpool 2170 Sydney, NSW, Australia

Website: http://www.skinessentials.com.au/

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• Medical and health
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• Health/beauty

25.01.2022 After years, Im once more looking for a domestic cleaner to clean our home weekly. What Ive quickly realised this week is that there are different kinds of cleaners who do different types of work. Ive also realised that many people who want to hire cleaners dont recognise what hard work it is and haggle over rates. ... Equally Ive seen people overquote and overestimate the amount of work required on an ongoing basis. Then there are those who charge more, but seem to be willing to take the time to do a deeper clean, send the same person and have a plan eg cleaning grout every 3 weeks, moving furniture to vacuum under it etc Equally, some of these people, not all, also talk about paying their workers fair wages, ensuring they dont work too many hrs to avoid injury and burnout and so on. It caused me to pause and reflect on the kind of service I offer and always have. I refuse to price match because Im not competing on price. I refuse to push my staff to do something they dont want to, including working extra hours to accomodate requests if they dont want to When Covid19 struck I gave staff the option of stepping down for the week before we closed in March When I take staff on, I do everything with her, every.thing to ensure its done to a standard we can agree on, much as I have done my entire career, so that I know patients are in safe and competent hands. When mistakes occur, as they inevitably will, we fix the mistake and we learn from them. I dont like to rush but Im not slow either. Efficiency doesnt sacrifice accuracy and good practice. Lastly, when Ive had quotes this week, its been for more hrs than I think I need on an ongoing regular basis. It demonstrates to me a general inability for people to think, to plan and to execute. When I meet a patient, I assess their skin, their needs and wants and then I quote a plan. That plan is my if money was no object plan. They can pick and choose from it based on budget, priorities, expectations etc but if I expected them to do it ALL on the first appointment there would not be much to do at subsequent appointments and more people are likely to baulk at the time/cost commitment So Im still mulling and still searching and getting clearer, as in every area of my life, what I want and need from a cleaner and whose business I wish to support because we make a choice every time we vote with our wallets and the best money Ive spent has been on the cleaners, many of them (single) mums whove come in week after week with a plan, whove taken initiative and whove added to our lives in so many other ways.

25.01.2022 I was talking to a patient in clinic yesterday and mid conversation we both realised, its September! Spring, in the Southern Hemisphere! And 6+ months since Covid19 changed the way we live and work and do things for the foreseeable future. ... Australia has also formally hit a recession, our first in some 30 years. Hindsight is a funny thing. Entering 2020, I had all kinds of plans, as I usually do each year. Theyve mostly been derailed by: - stay healthy - stay employed if able - stay afloat (ie dont lose the clinic if possible) - keep the family safe - stay sane as the fatigue, exhaustion and grief kicks in Theyre good goals I think. Not sexy Not post worthy but we are six months into a global pandemic that the WHO hopes we can reign in within two years. So thats 1/4 down, 3/4 to go but its anybodys guess really. So when I get crabby, anxious, overwhelmed or just sad, I remember ALL the things I have that so.many.people at the moment dont: - I have my family - I have my health - I have a job- even if the hours are longer than Id like, or its not always fun, easy and often difficult, I have a job. Many Australians dont. - I get to work in personal protective equipment unlike many of the essential workers in retail and education. Reframing in times of stress is important. Looking for positive things to ride us over equally important to avoid quitting when things get difficult, and potentially making things worse. Most of all, reframing, realigning expectations and learning is a lifelong skill that we benefit from ourselves and model for our children when they can see that we have a high frustration tolerance. As the saying goes, when frustrated/overwhelmed, learn to rest, not to quit. Happy spring!

24.01.2022 The techniques that most of us use to navigate most of our decisions in life gathering information, evaluating it based on what we know, and choosing a course of action can lead to spectacular failures when it comes to a scientific matter.

23.01.2022 Each year, around Nov/Dec, I compile a collage of some of my most committed, compliant patients to share with them and, if I have consent, here also. This pati...ent here, has been one of my loyal patients since the beginning. From memory she was the first of my 5 pts or so. She used to come and see me and sneak in and out, presumably not wanting pple to know she’d had work done. We’d only done anti wrinkle treatments for about 9 months before she agreed to fillers. She was terrified, but we’d built trust by then and was willing to do as I suggested. Because she was so volume depleted, several sessions of fillers changed her significantly. We’ve never looked back. Over the year, she’s become my test patient, my guinea pig for many many reasons: - she’s become so confident and happy with the way she looks she’s been happy for years for me to use these pics and others to educate others on what’s possible AND still look natural. - she’s taken to investing in her skin like a fish to water. It’s become a crucial part of her self care - she budgets for her sessions, never cancels and books her next appointment at the time of departure. And her commitment shows on her face. She’s 4+ years older than when we began, but the biggest improvement is the improvement in the quality of her skin over years of doing what works: - SPF, hats etc - skin treatments including machines - injectables as needed Over time, like any relationship, many pts have dropped away because we aren’t a fit, they’ve found someone who’s better for them etc but this pt, among some others: - keeps showing up - keeps investing in herself and me and our relationship - has handed the reigns of her skin to me completely. She comes in and simply says I think I need X but you tell me, I trust you. It’s a win-win. It’s the reason why I wake up excited to go to work on the days I’m at my clinic.

22.01.2022 A microneedling treatment is exactly what it sounds like. Small needles lightly puncture the top layer of your skin. It doesnt hurt as much as it sounds like it would, but it can be a bit uncomfortable. Because the skin is being punctured, this treatment is best performed in a controlled medical setting, by an experienced professional. In addition to being in a sanitary environment, another benefit of having a professional microneedling treatment is that the needles are longer than youd find in at-home devices, which gives more dramatic results. https://www.realself.com//microneedling-side-effects-risks

21.01.2022 Not the USA but the trend is real...

20.01.2022 To celebrate spring, and to jump start your #skinjourney AND to encourage you to try what we have to offer especially on Saturdays... @ Bigge Street Medical Centre

20.01.2022 Ive offered psychotherapy since 2011 and attribute the bulk of my own progress in life to my taking it up, learning it, offering it to patients and having my own therapist weekly for some years. Change doesnt happen by wishing, it happens by planning, committing and making small changes in such small increments that we look back in 1,2,5 years and are surprised by the progress we made.

19.01.2022 Winter has ended and its time to get skin summer-ready. As these pictures prove, if nothing else, the best and most important thing you can do is use sunscreen, SPF 30+ daily, ideally reapplied during the day. Daily, 365 days a year. The first pic, June and then this week. The second and third, December and then six weeks later, in January. These are my patients, who use sunscreen and still tan. ... It all.adds.up. - Those 5 mins in the car dropping the kids off. - Those ten minutes hanging up the washing - The daily commute to work in a car/bus/train If you do nothing else: SPF 30+, all day, everyday Add other protection such as a sunhat, long loose clothing and sunglasses as sunscreen alone isnt enough. If you suffer from pigmentation issue- this is why itll never be cured, only managed.

19.01.2022 Dermatology, the medical specialty devoted to treating diseases of the skin, has a problem with brown and black skin. Though progress has been made in recent years, most textbooks that serve as road maps for diagnosing skin disorders often dont include images of skin conditions as they appear on people of color. Thats a glaring omission that can lead to misdiagnoses and unnecessary suffering, because many key characteristics of skin disorders like red patches and purple blotches may appear differently on people with different complexions, experts say. https://www.google.com.au//skin-diseases-black-hispanic.am

19.01.2022 What a year it’s been! Scrolling through some of my most committed patients, who are also generous enough to allow me to share their progress, I’m so gratified to see the huge improvement in their skin over time. It’s easier to replace volume loss and get wow results. That’s the dopamine effect, that keeps many going back for more, more, more even when it begins to look ridiculous (and why you need an injector that can say no) ... What’s much harder, like anything worth having, is committing to something where the results are less tangible, will take time and are 80%+ reliant on you- what you do : - in between clinic treatments - if you follow your at- home skincare regimen - if you are zealous about sun protection anytime there’s daylight out When someone embraces this wholeheartedly and invests in herself, beautiful things are possible- not immediately, not overnight, but like learning a new discipline, they are inevitable, and they’re teaching us patience. And when they do happen, they’re so so worth it. 2016- 2020

18.01.2022 A patient I saw recently, contemplating threadlift in her late 30s, made a comment during consult for an unrelated matter. I was considering threads but then ...I saw that they dont lift and they dont last so theyre no use to me. As much as I love Dr Google, it cannot replace personalised advice with your doctor, done face to face. There are two types of threads. Some that lift and some that dont. Mono or short threads, dont lift. - they go in place and stay in place till they dissolve and induce your own collagen. - you see them listed under thread lift but theres no lift as most of them are around 38mm long - theyre inserted into numbed skin over areas that would benefit from collagen induction eg forehead, smile lines, loose crepey skin around the jaw, under the chin/neck etc - mono threads are mostly made of a material called PDO, which can be very fine, dissolve in 3-6 months and induce your own collagen that lasts around 6-12 months. Long threads, in addition to inducing your own collagen as they dissolve, ALSO lift loose skin and allow Drs (in Australia long threads are limited to mainly Drs) to reposition the skin, lifting sagging tissue - think jowls, smile lines due to volume loss and more. - While nothing can replace a surgical facelift, threads can hold off the inevitable and even be good enough for many to give them a fresher appearance with better quality skin over time. - Long threads can be of PDO, as above and the longer lasting PLLA, which induces collagen that can last as long as 18 months. While no clinical paper, and taken with an iPhone (top left) then a DSLR (top right) then using a DSLR and standardised lighting (bottom two pics) heres an example of one of my first patients that I did a thread lift on- - in late 2017, pre threads (post filler) - in late 2018 post threads at 1 month, - in late 2019, 15 months post the threads - recently, bottom right, almost two years- we are planning a further lift soon to further tweak new areas that have sagged. As a non-plastics/surgeon, my aim and goal is to do what I feasibly can before only surgery is the only option. As an ex surgical trainee, Im also conscious that while people fear pain and discomfort, anaesthetic risk, surgical risk as well as cost and downtime, especially for elective, non medically necessary surgery may not be a feasible option for many. As an ex O&G trainee and now FRACGP, I regularly and routinely do minor surgical procedures on people while awake- from skin cancer removal, to burning off warts, to insertion of IUDs and even vasectomies under local anaesthetic while chatting to people. In my experience fear of pain and the unknown can stop us doing many things when it neednt. So my approach is always, if we can do something without the added hassle of general anaesthetic then its worth considering. So in short, in conjunction with fillers and other suitable treatments, long threads, in the right hands and suitably selected patients, can be a great way to tweak sagging skin and revising new areas that need touch ups every 15-24 months at a fraction of the cost, downtime and risk of surgery. As always, results are variable depending on genetics, age, patient compliance and budget.

18.01.2022 "If you simply pull the skin tight, it has a pretty unnatural look," The look we're born with -- cherubic face, puffy cheeks -- that's the look of youth." To figure out why so many people with face-lifts look "windswept" instead of youthful, keep reading......Continue reading

15.01.2022 Sunscreen/SPF The best sunscreen, as the saying goes, is the one you’re most likely to use regularly, consistently and correctly. Add to that #brownskinproblems of #sunscreens that don’t go on matte (even if they say they do) and leave you looking like an oil slick. ... Or sunscreens that go pasty white on non-white skins and leave a film- who’s gonna sign up for that?! So over the years at @skinessentialsdr we’ve tried many brands and ditched most. We sell one of those, we use it and as shown here, it still goes on white and fades to a matte that feels good in minutes- well before the 20 mins we are supposed to wait after applying #spf and before going out. - Sunscreen isn’t meant to be used sparingly. It’s one of the rare times when more is usually more and less may not suffice. - ALL skin tones need #spf - everyone would benefit from sunscreen SPF30+ during all daylight hrs 365 days a year - apply it on generously, don’t rub it in and let it sink it

14.01.2022 Slow and steady; fall, get up, rinse and repeat till its easy and you can be in the zone. Every task has the ugh parts and it takes reframing not to quit when tired, stressed, frustrated or overwhelmed. #alwayslearning

14.01.2022 My teenage daughter said to me in the car the other day, shes so glad I forced her to take Ethics and Commerce in high school as her elective subjects this year. Its making us think of money, how we get it, how we spend it, who it costs when we get something cheap and also, how to ask for what the work is worth because combined with ethics, its good stuff to think about. Unlike most industries. Doctors arent taught to talk about money to patients at all- not in med s...chool, not when training to become specialists or after. We tend to figure it out as we go and many of us stumble and fall. Doctors arent also actively taught about healthy boundaries beyond those which (rightly) protect the patient and can lead to deregistration eg dont get too personal with pts; dont text with pts such that it leads them to think youre pals; dont sleep with pts etc I had to figure it all out as I go, including running my own business as an ethical clinic and care provider, a HUGE part of which now involves -encouraging responsible spending of money on luxury -saying no if patient budget is unrealistic for what they need -saying no to what they ask for if its not my style/what I want to be known for -refusing to haggle around fees -asking about a patients commitment if theres regular,repeated cancellations for appointments and more! Boundaries are a necessity for life. I look at it as relationships- once we adjust our expectations we can decide on fit and if its not a good fit, youd be best going elsewhere so someone whos a better fit can take up that spot. #boundaries

14.01.2022 Sometimes the problem facing us seems so big, we feel it must be all or nothing. It can paralyse us, so that a year, 2 yrs, 5 yrs from now, we are still stuck, possibly worse off. Examples? ... - using SPF and skincare - quitting smoking - eating better - maintaining a healthier weight - exercising regularly The solution is to start- where you are, with whatever you have and add to it as the habit forms, cos in many ways, living with regret bites far worse than trying and failing.

14.01.2022 Thread lifts. I love using my hands, I love procedural work, its when Im happiest and in a zen-like state. My model here, is getting a thread lift after her... first one, also done by me, 2 years ago, to the month using Silhouette Soft threads. Her skin has held up really well but needed some tweaking so this time around around the lower face- jawline and into the area just under the chin. This time around I used MINT PDO threads. I usually hate showing procedural videos because the fear/cringe factor is high, but you can see, shes completely wide awake, interested and curious and we even laughed at various points during her treatment which took about 30 minutes under local anaesthetic and she drove home. Depending on the material of the threads and your age, results last anywhere from 12-24 months before further tweaks may be due. She returned to work today, minimal bruising, no pain relief, only requirements avoiding high intensity exercise for two weeks, and alcohol and blood thinning drugs for a few days. #threadlift #lowerface #mintpdo

13.01.2022 Im a huge advocate of boundaries. And therapy. When we face recurrent problems in our lives, venting to friends may FEEL good in the moment yes, S/hes a *^%# etc but it usually sets us up for failure in the long run because that high we get from venting, that self righteous yes, Im right and theyre wrong! can be addictive. Mostly, it doesnt allow us space to reflect on our own part in that interaction and what we couldve done differently or better, which is the ON...LY thing in our control. I used to be a doormat the first 40 years of my life. I used to feel resentful saying yes when I wanted to say no; avoiding difficult conversations so that Id walk away when someone had a tantrum. Then Id get angry at myself for letting that person walk all over me. Rinse, repeat. It led to many events in my life that didnt take me where I said I wanted to go. I upskilled, in 2012, in MH training and continued adding to it- first to help myself, and my family then my patients. Its incredibly hard to retain healthy boundaries and most of us, especially if female, are never taught these because society sees being nice as far more acceptable for women than having boundaries especially if that means saying no. Or having hard conversations. This year, I began adding to my years of MH training with a Masters in Psychotherapy, which is a form of long term regular therapy that serves to help people reflect and get to the root of their problematic issues in life. While some of that plays out in my other work, including at @skinessentialsdr when I see cosmetic patients and say no, its something I highly recommend to everyone because boundarywork is essential to a fulfilling life mostly free of drama and something most of us arent taught well, if at all.

13.01.2022 Great bosses change us for the better. They see more in us than we see in ourselves, and they help us learn to see it too. They dream big and show us all the great things we can accomplish. https://www.cnbc.com//10-things-great-bosses-do-every-day.

13.01.2022 Getting a Mental Health Care Plan isnt as simple as placing an order, which is what many online would have you believe. Your GP isnt just a gatekeeper to a referral to other care providers. Ideally, we are the ones you have an ongoing long term therapeutic relationship with and we assess your changing needs over time and decide, collaboratively, whats appropriate for you. As someone whos up skilled in mental health, the best component of therapy is the interpersonal the...rapy- IPT- that cant be simply achieved by bouncing from one person to the next but achieved over time. A therapeutic relationship is worth investing in and it begins with your family GP you can see being with for a long time. But to get access to these sessions, first you need to get a mental health treatment plan from your GP. This involves an assessment of your physical and mental health, and a discussion of your particular needs. The GP then helps you decide what services you need. All GPs who write mental health treatment plans have undergone additional training in mental health. There are also plenty of GPs with further interest and expertise in this area. It can be helpful to ask for recommendations from friends and family if you are unsure who to see.

12.01.2022 Static lines and anti wrinkle treatments This causes a fair bit of confusion when I see new patients. Our skin is a canvas overlying muscles, blood vessels, nerves and bone. The face has many many muscles that enable us to animate while we are talking, happy, sad etc to convey body language. The skin over these muscles is bunched up to lead to wrinkles, which are present even in young children. ... Over time, with age, as collagen production declines and muscles continue to move underneath the skin with laughing, smiling, frowning and so on, we get lines even at rest- these are static lines. When we first begin treatment with anti wrinkle injections, the muscles are weakened/paralysed, but the static lines from years of use, remain. Over time and consistent treatments (3-4 times/year, preferably before the effect has completely worn off) as the muscles weaken and new collagen replaces the lines, the skin smooths over. Its like magic! What are the key issues? You guessed it! - commitment - consistency - care with budgeting for it. Most skin things are not a quick fix and it takes time, patience and planning but for those who do commit, the results speak for themselves eventually. Anti wrinkle treatments start from: - $150 for forehead lines - $300 for frown lines - $150-180 for crows feet Actual dose determined by individual genetics, skin quality, muscle strength (stronger movement = bigger dose). We strongly recommend complimentary review at 2 weeks post your first time to measure effects to determine most effective dose. To book: www.skinessentials.com.au/bookings online or Call 02 97348845 or Email [email protected]

12.01.2022 Current #mood Some unexpected changes all amidst a global pandemic and its only 6 months in. Ive been doing Covid work since March and waiting to rest, and this week has perhaps tipped the balance. ... Im sure Im not the only #frontline HCW to feel this way, and as the saying goes, theres no emergency in a pandemic When we get tired/stressed/overwhelmed/fearful, I see it as a signal that I need to rest, not to quit. I teach my children, and those I mentor, the same, alongside my patients. Press pause. Reassess. Take a break if you can and if its safe. For me, for the rest of 2020, with ongoing Covid work, it means shifting clinic hours to one day/week till I can safely reassess what needs to happen in 2021. So for the rest of 2020, @skinessentialsdr will be open Thursdays and by arrangement, some other days and times for existing patients (email us pls) Taking time for things that make us happy is important and for me, that includes my skin, a small but definite pleasure, so while resting, find out what makes you happy that you can commit to.

11.01.2022 The effects of cumulative sundamage over years and decades cant often be seen until as early as our twenties and beyond. Ageing is chronological (time based) ...but also largely believed to be environmentally based. I remember a stat that the WHO classifies the sun as a carcinogen. In Australia the skin cancer capital of the world, we tend to be far too blasé about this, to regret it over time when we end up with a multitude of skin problems that can take years to fix, if at all. Posted here: - Cumulative sun damage in a skin type II over decades - Cumulative ageing and sun exposure in a skin type IV (sunscreen use since teen years) - Cumulative sun damage and melasma with areas of hyperpigmentation in a skin type III, undergoing treatment for it with personalised, prescribed treatment regimen See the improvement? Its time consuming and takes commitment and theres new areas of pigment coming through regardless. This in big part is why Im so passionate about prevention- once they occur, problems are much harder to fix AND at the same time, its never ever too late to plan for better skin. www.skinessentials.com.au/bookings

11.01.2022 What differentiates us is how we behave when we behave in ways that don’t align with who we say we are. Do we apologise, make amends and do better? Or do we double down, blame the other or walk away to avoid hard conversations?

11.01.2022 Today was a good day, despite some unexpected setbacks. I saw one of my regular patients, whos been seeing me for some 2 years now and....she brought a friend! By friend I mean relative. ... The best part about it? - shes a regular patient so knows what Im like and placed her confidence in me to treat her family member - because she knows what I do, her relative had already been briefed on what to expect including costs so there was no shock factor though the new patient DID joke I thought you might take pictures and say youre perfect! Get out! - when someone brings a new patient and hand delivers them, it boosts their confidence in the process of what to expect including time and cost commitment to get results- some are immediate (eg anti wrinkle and fillers) others take time and commitment (eg most skin therapies) In the end, because of her preparation this patient came prepared, mentally and financially and left feeling excited, looking great (but still cute) and with plans to return for review and already had questions about other treatments. To my mind, theyre the best kind of referrals because - word of mouth is a vote of confidence by someone whos been there - patients come in excited, not scared, and ready - the friends and relatives have firsthand proof of what my work looks like and usually they like that its so natural no one can tell except the people they choose to tell. - So for patients who refer to me, thank you. - Those who post on their Facebook walls, thank you - Those who link to me on beauty pages when someone is asking for a service we provide, thank you And those of you who physically bring a patient in, prepped and ready, a huge thank you I never forget how valuable a personal recommendation is, even if, as with all human dealings, the fit isnt always right, because youve done some of the initial work for us even before we meet your friends/relatives.

11.01.2022 So many of us arent ok at the moment. For a myriad of reasons. So if you have the margin, the space yourself to hold space for someone, without minimising their grief, without offering unsolicited advice or telling itll be ok ...then please check in on those you care about, ask if theyre ok and then, actually listen. #ruok

11.01.2022 Small things, done consistently and well, turn into habits which can be added to over time, leading to imperceptible changes initially that can add up. Times passes for us all; the alternative to not ageing is death but each day we neglect to care for ourselves, whatever that looks like, is an opportunity lost. So make it small, but do it till not doing it is unimaginable. Then add to it. ... Great things dont occur overnight, or by grand gestures or big things. They happen by effort, persistence and resolve, especially not to quit when wed do better to rest and resume. #quittersneverwin

10.01.2022 #threadlift Who are we to believe? Some plastic surgeons say it’s selling snake oil, you’re better to throw your money in the bin directly. ... Other plastic surgeons do offer threadlifts and many other treatments as an alternative to the gold standard- a facelift- for people who can’t/won’t budget for a facelift, or who simply don’t want to. So who do you believe? I didn’t get onto social media till 2011- I was a Luddite I admit. When I did, I resisted wildly then when I began my own aesthetic work, I realised, this is where people look to decide who to go to ( ) and your/my brand, is your/my face. Being on social media is a double edged sword however because people can make ALL the claims without any evidence to back them up and there will ALWAYS be someone who buys into it, believes it and pays for it; after all, that’s how advertising works: - say you’re selling X - say X can do something NONE of the others can (and create anxiety around the way you look) - say X will give you life/love/self esteem (the thing you lack) - discredit competitors offering Y (because you don’t offer Y, or other reason) Then wait for pple to buy your model. I’m very wary as a rule, of people pushing one version of events only. I won’t go into the why and how except to say, with ANY treatment option, managing expectations is 95% of the work. So with threadlifts especially. Who’s a good candidate for threadlifts (not to be confused with mono threads for collagen induction)? - mid 30s till 50s, depending on skin quality - areas of sag eg jowling, folds around the nose and under lips, under eyes that can’t be remedied with fillers only - realistic expectations of discomfort- I compare it to dental procedures- not as easy and simple as fillers for eg. - downtime- usually minimal/none but 1-2 days if any. - longevity- threadlifts have a 2-way approach- they work by lifting and repositioning sagging skin (of good quality) back to its origin AND, similar to mono threads, as they dissolve, they stimulate collagen. Collagen by definition, depending on the type, lasts 12-24 months. Now, some caveats: Is this equivalent to a facelift? Of course not. A surgical facelift, several hours under the knife, whereby a surgeon goes in, cuts away excess skin and cuts and repositions sagging ligaments etc, is the gold standard. - starting prices from AUD 10,000 before anaesthetic, hospital stay etc ie surgeon’s fee alone and usually higher. - risk of anesthetic and damage to nerves etc - hospital stay - downtime of weeks (including time off work and on physical activity) - months to final result- 6-12 weeks or more after swelling, bruising etc settles - results usually 5-10 years if beginning with good quality skin (because the ageing, volume loss and sag will continue for life) - surgery on its own cannot restore lost volume- fat grafting as an add-on often. Disclaimer- I’m not a plastic surgeon, so take the above with a grain of salt. If time, money etc was no object and there was zero risk, the surgical option is the best, hands down. For many of us, downtime, money and risks ARE the issues that hold us back so we look at alternatives that are: - cheaper - semi permanent ie need to revise every 2 yrs or so to reposition new areas of sag - have minimal downtime so we can return to work/the kids etc - have significantly less risk of anaesthetic, injury etc I suspect that is why the Drs who do offer #threadlift including among them, plastic surgeons, do so. And the ones who dismiss them, quite often, only do surgical facelift and nothing else. The single biggest thing I’ve found through my own experience as a surgical (O&G) trainee, is that it’s a very different skill set working on people who are awake compared to people who are asleep, and it’s not for everyone- practitioner and patient- so patient selection as well as the skill of the practitioner is critical to results. Beyond that, it’s an individual decision. I know for me, for eg, I haven’t the downtime time, nor the appetite (yet) for surgery and my goal isn’t to pretend I’m not ageing but to look great at every age and stage, so I prefer minimally invasive options (that DO become more invasive with age) over general anaesthetic based ones but to each their own.

10.01.2022 Of late, I’ve seen a number of patients who can not only only benefit from better proportioning of their lower face, but who actively benefit from chin enhancem...ent. Typically these are people in their late 20s and early 30s without any significant signs of ageing in their lower face, who nonetheless present with concerns but aren’t able to tell me exactly why, especially lack of definition in the jawline that isn’t explained by ageing ie jowling. The longer I do this work, the more I tend to use a full face approach and typically that involves more than just lip and cheek fillers. Ideal chin shape is considered to be one where the lower face is forward projected enough that a pencil placed along the side profile touches the tip of the nose, the lips and the chin. Many ethnic groups don’t naturally have this. For many people, my work also involves projecting the midface anteriorly (forward) because they have a rather flat face in side profile, with attendant issues. Some have a recessed enough chin with accompanying lower jaw (mandible) deficit that only surgery can help (especially if also affecting quality of life wrt eating and sleep apnoea) but for the purposes of vanity only there are easier options. Here are pictures of two of my recent patients, with their consent. It’s often a multi-session treatment because chins can take up large volumes (3-4mls minimum), and are often tight spaces and big volumes at once can often cause a mechanical problem temporarily with speaking for a day or two, so we aim to do 1-2mls at a time. One was so excited, she told staff on her way out Look at this, I’ve a chin now! Apparently I didn’t have one before! Ultimately in a year that continues to have its challenges, with many months at least till the light, I’m finding it’s my regular, compliant patients, including some new ones who’ve shown up, who make going to work at the moment such.a.joy.

08.01.2022 Bruises. A bruise occurs when an injury damages small vessels under the skin, causing them to bleed. Because the skin isnt broken, theres nowhere for the blood to go and it ends up pooling underneath the skin until the pressure stops the ooze, leading to a clot. ... Over the days that follow, the bruise will change colour in a predictable manner until its broken down and reabsorbed completely by the body by about two weeks. Factors that increase risk of bleeding- alcohol, use of blood thinning medication such as aspirin, warfarin as well as rare genetic conditions. Can anyone guarantee you wont bruise with injectables? Nope. Bruising is THE commonest side effect of injectables and many skin treatments which is why most practitioners will ask if youve any upcoming events in the weeks to follow- we know this is a risk, every.single.time. What can we do to mitigate risk? - avoid blood thinning meds if able - avoid alcohol the day before - ice post procedure for an hour or more - avoid exercise the day of treatment - once cleared, massage as directed by your treating practitioner - attend your followup appointment so we can all be assured all is well Over time, youll come to learn how your body responds to treatments, what you works for you and what doesnt so we can mitigate your risks better because ALL medical treatments carry a risk of side effects- the important thing is to choose wisely so you have the support you need when this occurs.

07.01.2022 This week, we had a patient try to book in, whos expressed concerns around confidentiality before to me and seemed hesitant to staff trying to book her in, about what she wanted. Context: some communities, more than others, especially ethnic communities, can often fall into a two pronged trap- that of doing things they feel may impact their standing in said community, and fear that word will get out and they will be the subject of gossip. As an ethnic woman myself, Id say..., until the last decade, the fear is often real and while no community is spared judgement and being the subject of gossip, in ethnic communities it can often be/feel worse. So at @skinessentialsdr we take great care to guard the nature of our work and our patients. - as a medical clinic, my staff and I are bound by confidentiality laws, unlike beauty salons and non medical premises, with dismissal of staff a result of breach of this clause. - no pics of pts for our before and after a are shown without express stated and written consent of the patients- I show them what I intend to post before posting - many of our patients wear hijab, some wear niqab and yet others dont do either AND want discretion about their visits - we are bound to respect each and every individual In saying that, if someone feels they cant openly discuss a treatment or a booking with my staff in my absence for fear of gossip, then it becomes difficult to engage them in ongoing treatments because Im rarely available to take these requests anymore and I trust my staff, one of whom only handles emails virtually now (Tara) and the other does all the on-the-ground work such as appointment reminder texts, phone calls and in clinic sessions (Mariam) Ive personally trained my staff around medical confidentiality and they both know better than to discuss one patient to another or to even let on, in social settings (because its a small world) that someone is a patient etc It was one of my biggest concerns when I did mobile clinics out of salons 2+ years ago, because the ethos of medical clinics is entirely different and based on hard and fast laws around confidentiality. So I do hope, going forward that our pts will have confidence that the staff is trained in confidentiality and that coming to see us is NOT the same as getting your nails/lashes/facial done.

06.01.2022 Static vs dynamic lines

05.01.2022 Goodbyes are always bittersweet and so its appropriate to feel a bit sad and nostalgic today as we bid goodbye and best wishes to Mariam. Mariam has been with... Skin Essentials soon after we opened the clinic and Ive come to rely on her as have patients when they booked in their skin therapies and when dealing with appointments and aftercare on the phone. Nonetheless, life is about change and part of growth is to adapt to change so it is with sadness (for us) that Mariam begins a new direction in her life and we wish her all the very best with the future. Moving forward for the rest of 2020, in the midst of a global pandemic, Ill probably stick to working solo again until I can free up time to begin to look for staff who can fill in the dual dermal therapist and receptionist roles so youre stuck with me and me only for now! If you have any upcoming appointments with Mariam, theyll now be with me, so if you have any questions or uncertainty around this, please email [email protected] or please call and leave a message on 02 97348845 and we will help you out to avoid double booking and accidental cancellations.

05.01.2022 Mono #pdothreads in progress. Great for lines in areas tricky to treat with dermal fillers such as smile lines, lines due to sundamage along jaw, on neck, décolletage and more.

05.01.2022 Via @drnaomi - less IRL meetings -less time sitting around waiting -less non essential physical contact with acquaintances ... -less traffic -less crowding on public transport -more Zoom and online meetings in my PJs -saying no more -setting better boundaries -prioritising time at home w family on days off See more

04.01.2022 This. Its the little things add up.

04.01.2022 Yes! Occasionally I get a new patient who believes the last injector dilutes the treatments cos the wrinkles began coming back around 2 mths. 1. This is why, for your first time with us, we offer a complimentary review at 2 weeks. We can take standardised pics of effect AND determine if you need a higher dose next time. ... 2. Review beyond this time are fraught because your body has already the downward trend post treatment, accelerated by factors such as smoking, cardio, higher metabolism etc #Repost @silversolutionsmedspa with @get_repost Tox does not last, and last then BOOM its gone. This graph shows that peek neuromodulator activity is at two weeks after treatment, then it slowly starts to wear off. At TWO MONTHS TOX is HALF GONE! Areas treated will start moving slightly again. Your muscles are waking up as Tox is wearing off. You may start seeing fine lines and wrinkles again. This does not mean you got bad Tox! This is a NORMAL progression of how Tox wears off. Maintenance treatment is at 3-4 months. You will not have perfect Botox face for ever and you need to see me at 3-4 months to maintain. Dont compare your treatment longevity to your friends, or relatives results. We are ALL different genotypes. Sometimes, your treatment does not last as long as it has in the past. This does not mean mean you got bad tox. This is normal! Our bodies are influenced by multiple factors both inside and outside of ourselves.

04.01.2022 Most of my patient demographic is very discreet and private. What happens, reasonably regularly though, is that some of my patients, seeing the results of their consistency and commitment, will decide theyre ok with being featured as an example of the kind of work we do here at @skinessentialsdr When we do post, featuring beauty from a variety of ethnicities, ages and stages, I inevitably get comments and DMs asking about what has she had and how much and more. ... Those who follow our pages will note that barring live videos or pictures of procedures, I dont discuss what I did, or how much product or cost etc because its moot. Its human nature to want to imitate that which we find attractive but thats not the point of posting- what worked for one person, one face, may be wrong for YOU. Im not in the business of cloning people, looks or trends. I examine each face and then see how I can best help bring out its best features, if the patient is willing, able and consistent. Each and every one of our ladies featured here, still looks like herself, still natural, fresher and many are animated and dont look odd. THAT is our brand, our aesthetic. What we did to achieve that is irrelevant to someone else because no two faces are alike. Some of our patients dont want or need injectables (yet) so we focus on great skin for acne, rosacea, sundamage and melasma. Others have genetic darkening under the eyes and so its a different plan. Yet others have other needs. Theres NO one size fits all. I post pictures with consent to show you whats POSSIBLE if you want, and commit and without looking fake or obvious. Beyond that, what shes had isnt anyones business except hers, her treating practitioners and whomever she wants to tell.

03.01.2022 For more information, fees for Medicare rebateable services and to book, please call 02 97348845 @ Bigge Street Medical Centre

03.01.2022 At work today, a non-medical colleague talked abt an event in his life that resulted in enough negative publicity for his brand that his company considered pulling out. When I questioned the financial ramifications of that, his reply was simple- money can be earnt, but our reputation is everything. Far too often, we make casual comments about people, TO people without much thought to the amount of time, effort, energy and experience that has gone into their being where they... are today, that proverbial iceberg principle of success. While Im a fledgling in my clinic, Ive been a doctor for 19 years. Ive built my career, my reputation and my brand based on my skillset and equally, my values and ethics of working with integrity and spending time with patients that they need even if its not what they want. When I began Skin Essentials and even prior to that, when I was working in various GP practices, trying to find my medical home, then doing mobile clinics out of salons, these values and ethics guided me. Its why, in large part, I setup a clinic of my own, so Id not be answerable to non-dr owners abt how I ran my medical business. Its why I moved GP practices till I found my way to a private billing GP practice that does not bulk bill AND the offers cradle to grave care and spends the requisite time with patients. Its why I refuse to co-locate a bulk billing GP service in Liverpool with Skin Essentials. Its why Im very particular about how things are done in my clinic- how things are done, on the phone, via email and in clinic as well as setting appropriate expectations so that if we arent a good fit, we can direct you elsewhere. My brand is me, its my reputation and while mistakes can and do occur, with any medical procedure, for anyone whos built a service based on a sense of trust and professional behaviour, to invite even a hint of the opposite is devastating no matter how untrue.

02.01.2022 The ageing process fascinates me and I admit, its a bit of an occupational hazard, permeating everything I do. I love watching faces of all ages- their inherent shapes, contours, curves as well as positive (enhancing) and negative (areas of deficiency) features. On TV opportunities abound to see faces that, left minimally or unenhanced, are ageing. ... Takes actresses Fiona Shaw (62) and Sandra Oh (49), shown here side by side in their youth and now, relatively untouched. Fiona is a great example of hollowing of the temples- leading to prominent orbital bones, dropping of the eyebrows alongside sagging of the skin that occurs with age. Like most Asians, Sandra has a different bone structure and genetics but again, ageing shows up differently for her. Both ladies are also a good example of the evidence that suggests that (peri)menopause and loss of oestrogen leads to women ageing more rapidly in their 50s and beyond. So what are the take home messages? - temples are an advanced area for a more youthful appearance. For someone with global volume loss due to age, this is often where I begin as people underestimate how much it helps. - if youre peri menopausal talk to a dr and consider realistically if HRT might be an option for you. - no matter how beautifully done, and setting aside cost, downtime, risk etc, I still think many if not most undergoing a facelift also need fat grafting for volume replacement to avoid looking unnatural - its ok to learn how to age well and to continue to care by improving the signs related to ageing that negatively impact your life (eg pple thinking you should retire; pple giving you pitying looks at work- real stories) while not buying into latest look like this trend, whatever that might be. @ Bigge Street Medical Centre

02.01.2022 Its been a tough week, for several reasons. One of the reasons I had a chance to amend unexpectedly yesterday when I met a regular patient of mine. As can be expected, with any ongoing relationship, problems can crop up. When this occurs, I believe in several things if able: ...Continue reading