Lip enhancement – Fillers are not the only answer!

Sothys, my longstanding skincare range, has just launched two new items: a Lip Plumping Serum, and an Eyelid Tightening Serum. In this article I will be looking at the first product only and will write about the other in a companion piece soon.

I was prompted to write after reading a timely article by Amelia K. Hausauer, MD in New Beauty Magazine about the factors that cause lip ageing viz. Loss of collagen and hyaluronic acid means lips lose their distinct shape and border as well as the ability to hold onto internal moisture over time.

I expect you are all aware that the diminishing of collagen and hyaluronic acid in facial and body tissues causes ageing but may not be so aware that because the lips have thinner skin than other parts of the body – having no oil or sweat glands to preserve their fullness – deflation and dehydration show up more quickly in this area. The consequence is the loss in volume, making the lips lose definition and shape, and giving them a thinner appearance.

It is this phenomenon which has driven the increase in fashion of lip plumping procedures. Back in 1996, I was asked by QMed (the manufacturer of the fillers Restylane and Perlyane) to give a talk at the Royal Society of Medicine on the topic of Changing Lip Shapes. [As an aside, I should say I opted to speak instead on Practising Beauty Within a Health Promoting Framework]. My point in referencing this event is that the trend has gained considerable momentum over the past 25 years and it does not appear to be slowing down.

There are television documentaries aplenty showing some of the disastrous results of bad practice in the use of incorrect injectable products which, far from enhancing the lips, have served only to deliver the opposite effect. So, if you are looking to go down the lip filler route please make sure you do your research and make it absolutely clear to the practitioner the precise look you want. The correct filler in the hands of an experienced practitioner can deliver a more natural look to that of the (usually absurd) full pout. In fact, Dr. Hausauer recommends Retalyne Kysse and Juvederm Ultra for a more structured lip, and Vobella for a smoother texture with minimal volume.

Research shows that UV (the ultra violet wavelength) in daylight also causes lip ageing. Daily exposure will inevitably accelerate the ageing of this delicate tissue and can also create cancers in this area. My loyal clients are only too aware of how frequently I labour on about the use of sun protection (a baseline of SPF30) for the face and body!

Dr. Hausauer makes a salutary point that oil-based balms can actually increase the risk of burns – much like the old days when baby oil was the go-to for creating a tan. She holds that using a good protective lip cream, applied frequently, is a must to protect this delicate area of the face.

For years we have been encouraged ‘keep hydrated’, and rightly so, as dehydration can also affect lip volume. Hydration is not the only factor to consider; the body also needs anti-oxidants in the from oily fish, dark green vegetables and dark fruits to ensure the optimum delivery of oxygen to the tissues.

Those fine lines that appear around the mouth take years to cultivate. Smoking (which purses the lips and simultaneously inhibits oxygen to the tissues) and any repetitive puckering of the lips (e.g. drinking from straws) can accelerate the aging process, according to Dr. Hausauer.

And thus to the Sothys Lip Plumping Serum. Sothys cream contains:

  • Gluconolactone (PHA) a prickly pear extract that encourages cell turnover (to renew)
  • Kombucha extract and tripeptides that plump the tissues by their hydroscopic nature of attracting water to the tissues (to plump), and
  • Hyaluronic acid and vitamin E which creates a smoothing and lessening of fine lines (to smooth)

Unlike a number of lip plumping products, the Sothys serum does not contain irritants such as chilli, capsicum or cayenne pepper which have been used to increase lip volume by agitating blood circulation and swelling. I have always been sceptical to such products being used on a long-term basis.

Before application, I would recommend a gentle exfoliation to improve the penetration of the product and and maximise the absorption of the lip cream. There are products which have been created especially for the lip area and can be used prior to application of the lip cream. As an alternative caster sugar grains in an olive oil base can also be used for a gentle scrub without damaging delicate lip tissue.

But whichever route you decide to take – fillers or not – good lip care will only serve to enhance and protect this most delicate part of the face. I will be recommending Sothys lip cream as part of a facial care routine.

My next piece will be on Sothys Eyelid Tightening Serum.

Dermal fillers and COVID-19 vaccines

[Moderna/Health copyright image]

I came across an article titled Can dermal filler patients have the Moderna vaccine? in the magazine Aesthetic Medicine and thought it sufficiently topical to merit discussion here. Admittedly, the Moderna COVID-19 vaccine is a U.S.-developed product currently unavailable here** and there is no evidence to suggest that the U.K.’s AstraZeneca vaccine will pose the same problems for people with hyaluronic acid dermal fillers.

It was the U.S. Food & Drug Administration (FDA) medical officer Rachel Zhang who said, “in Moderna’s own Phase 3 trial three people developed facial or lip swelling after receiving the vaccine. Two people had cheek fillers within six months of vaccination and the other had had lip fillers two days after receiving the vaccine.” In each of these cases the reactions were small and easily treated by medical staff using antihistamine and steroids. “It shouldn’t stop people with fillers taking the vaccine,” said the doctors on the FDA’s committee. 

I have always steered my clients away from these kinds of aesthetic procedures on the basis that they are foreign substances injected into the body. But, I believe fillers may be less harmful than say, the botulinum toxin (e.g. Botox), which is a live bacteria that ingests nerve endings in order to immobilise muscle contraction. However, reading the FDA report has caused me to reflect on the use of fillers. Dr Purvi Parikh, an allergist and immunologist told Health, “A filler is a foreign body and when your immune system is switching on due to the vaccine it would make sense that areas that have foreign bodies that aren’t normally in your body would also have inflammation – this is because your immune system is designed to counteract any [my emphasis] foreign substance.”

It is stated in the research that the allergic response does not necessarily occur in everyone who has had hyaluronic acid dermal fillers in combination with the Moderna vaccine and, so far, there has been not been any reported cases with the Pfizer vaccine. My concern is that if fillers can be the cause of an allergic response (inflammation) to a vaccine then what of the botulinum toxin?

[ ** Update: since writing, Moderna has been approved for use in the UK ]

Maskne (mask acne)

This is a skin condition which arises from the need for many more people to wear face masks for prolonged periods. Although this isn’t a skin condition which is affecting many of my clients, I thought it might be helpful to take an overview of its cause and effects.

Attr: Designed by pikisuperstar / Freepik

There are three major ways in which the the skin is affected by being unnaturally enclosed for a length of time; put simply, mask-wearing is an unhealthy environment for the skin.

  • Increased temperature leads to excess perspiration
  • Trapped moisture/sebum cannot evaporate
  • Absence of light on the skin hinders cellular respiration

These combined factors provide a breeding ground for usually harmless surface bacteria to multiply and penetrate into the skin’s pores. They become irritants and the skin’s defence mechanism goes into overdrive, producing increased blood circulation, pore dilation and perspiration.

This has given rise to three types of maskne:

1. Acne Mechanica
2. Allergic Dermatitis
3. Acne Vulgaris

Although grouped under the umbrella of maskne each condition requires a specific treatment.

1. Acne Mechanica – this condition is created by the constant rubbing or chaffing of the mask’s material against the skin’s surface. This produces inflammation, senstivity and micro-tears compromising the skin’s protective barrier. The skin needs to be cleansed both morning and evening to remove surface debris and allow the penetration of calming serums or topical creams. The aim is to introduce a protective layer of emollient (containing anti-inflammatory ingredients) to reduce the chaffing. The best type of mask to help alleviate this condition would be a natural, organic material (cotton/silk) which allows the skin to breathe and reduces irritation. These type of masks must be washed daily after each use and in a non-biological, fragrance-free detergent. (Tip – treat them as you would your underwear). Try to remove the mask whenever possible to expose the skin to the air.

2. Allergic Dermatitis is a consequence of a reaction to the material of the mask itself. This reaction encourages the skin to produce excess oiliness, congestion and inflammation in the skin leading to pimples, whiteheads for example. Countering this problem requires the use of anti-inflammatory topical agents – exfoliators that are non-comedogenic (i.e. doesn’t block the pores) and ceramides that provide a protective barrier. As for treating the effects of acne mechanica use an organic (cotton/silk) mask where possible and wash it after every use.

3. Acne Vulgaris is the most commonly known and recognisable form of acne. It is a systemic condition (hormone-related) and is particularly aggravated by mask wearing. The facial coverings increase the skin’s oiliness and create inflammation, perspiration and congestion resulting in a biological zoo for this skintype. The important point (as with the above conditions) is that sufferers should use an efficient exfoliating cleanser every morning and night. The ingredients for such cleaners should include non-comedogenic emollients, glycolic and salicylic acids, benzyol peroxide (this can cause staining on cotton masks so sulphur is a good substitute). Spot treatment sticks/roll-ons can be applied to specific outbreaks to accelerate healing.

I have to emphasise that for each of these skin conditions it is important to cleanse morning and evening with an appropriate cleanser to remove surface skincells and allow the skin to abosorb the products required to combat the effects of prolonged mask wearing. Despite the advice of Dr Jaskaren Midha in the Daily Mail article (see link below) – and though it may seem counter intuitive – I do not recommend a double cleansing regime because this can contribute to over-stimulation of the sebaceous glands which thus produces more oil. A good efficient cleanser will be suffice, especially if you’re not wearing make-up, a tinted moisturiser or BB cream. The least amount of stimulation on this skintype the better.
Makeup should be avoided if possible, but you can use a tinted moisturiser or BB cream as an alternative.

SPF 30 should be applied as the last application to protect the vitamin C and collagen of the skin. Unfortunately there are currently no masks which have a SPF component.

I appreciate that that some of the information and terms I’ve provided makes this a little complicated for a general blog. Correctly identifying these different conditions is critical in determining a course of treatment and that process does require specialist skills. It is why I would recommend consulting a skincare specialist to ensure that you are treating the condition correctly particularly to avoid any long term effects, such as scarring or hypersensitivity to your skin.

Oh, for the day when we can again show our faces (uncovered) to the waiting world!

BBC article 

Daily Mail overview

Back To The Future

It’s been two weeks since I returned to work and though the prospect of PPE, cleaning schedules and medically interrogating my clients about their current state of health was initially daunting, I was pleasantly surprised by how it came together so smoothly.

I attribute a lot of this to the wealth of webinars I have attended over the past five months. Those from The Royal Society of Medicine, Mertz Aesthetics, WHO, CDC – to name a few – have contributed to my knowledge and further enhanced my safe practice procedures.

I also want to thank my clients who have been wonderful and continued to show faith in me and my safety-first regime by resuming their treatments without question. It has made my return to work that much easier: so much so, in fact, that it feels like I haven’t been away.

My business model has long been based upon having a single client only on the premises at any one time. The additional benefit is it makes social distancing easier and facilitates the cleaning regime between between client appointments. Also as many of my clients have been with me for years (in some cases, decades!) it means there is ‘Retreat bubble.’ It is for this reason that I am not currently taking on new clients and – though it has a financial penalty for me – I will ensure this continues until it is safe to relax this policy.

The health and safety guidelines have required longer periods between client bookings and thus fewer opportunities for appointments. Fortunately, this hasn’t proved to be a problem as my clients understand the constraints.

The foreign travel restrictions means some of my clients are taking late holidays, mostly in the UK which has reduced my bookings while I await their return. There has been a steady trickle of appointments coming this way but not enough to keep me fully booked at present.

All in all, my return to work has been a good experience despite the additional measures which are needed in these Covid days. This experience has also been enhanced by the appreciation shown to me by my clients. It has been good to catch up with them to hear their news and learn of the events in their lives and how they have been affected in this unprecedented time. And despite the scary PPE no-one has been put off by the experience!

Thank you, each and every one, for making this an overall positive experience.

Lessons Learned

I remember having to learn my times table by rote. The repetition engraved the multiplication tables in my memory so that half a century later I can recall them with ease. I was also obliged to learn by heart Lady Macbeth’s speech admonishing her husband for his weakness, and that too I can remember decades later. It took a lot of time to learn these things. I imagine we all have a similar experience, but I do find it remarkable how these things stick.

But what has that got to do with the lockdown and the restrictions imposed on our lives these many long months?

Well, for me, the enforced absence from work is unique. Until now the longest I have been away from work in the 30 plus years of running my business is my annual 10 days or so holiday.

So one of the singular benefits of the lockdown has been a sense of liberation. Initially, I battled with a sense of guilt. Without the nine-to-five routine to mark the day, I felt I was wasting time. Having worked a five-day week the whole of my adult life, the absence of a work focus proved to be a real challenge. But gradually I came to realise that this was not a theft of time but rather a gift of time. Changing my perspective resulted in a change of attitude which enabled me to use my new-found leisure for a different but nonetheless productive purpose.

I learned to use Zoom! This came with a steep learning curve for me as I’ve tended to shy away from social media as I never felt it had much relevance for my type of work (hence the infrequent blog posts). With time now available I was able to attend The Royal Society of Medicine seminars on COVID19 topics and also took in tutorials and forums at other medical and aesthetic industry sites. I’m much better informed as a result and better equipped to return to my clinic with the beneficial knowledge I’ve gained.
Another precious benefit was the ability to spend more time with my brothers. The fact that we all get on so well made me reflect on the importance of family and the values imparted to us by our mother, father and grandparents. We constituted a family ‘bubble’ and congregated in my flat on alternate days. I suppose it was so easy because we have maintained contact throughout our lives. I have been devouring cookery books (no pun intended) and my gracious brothers have been adventurous enough to act as guinea pigs, or should that be lab rats! Look out Nigella!

Last, but not least, I want to thank my clients. They have been faithful, loyal and generous. They have chosen to purchase their products from me and not go online or to supermarkets or alternative retailers. I’m convinced they have done so to be supportive and not out of any fear that I would know what they’ve been up to, would be less than pleased and that there would be consequences! The support of my clients has meant so much to me. It has been a vital focus in reinforcing my belief that my work is appreciated and provides health benefits. It is the reason I do what I do.

This has been some of my experience of lockdown. I do not want to dismiss any of the horrors, heartache and pressure that some people have had to go through. I am especially mindful of those on the front line battling to care for the sick and dying, for those that have lost loved ones; those who are caring for recovering patients, and for those who have survived but will have to live with the consequences of the physical trauma as well as the mental one.

As of writing I have been saved from such traumas. I am conscious, though, that this experience has had and is still having an effect on all our lives. I could focus on the negatives which the five month closure has had on my business, my loss of earnings (which will not be recouped), the possible loss of some clients due the closure. The list could go on.

My experience has not been anywhere near as awful as some. I am grateful that my loved ones are well, that I have a business to return to and have clients that have been supportive and loyal.
Lesson learned? Time is a very precious commodity. Our lives can change at a moment’s notice. We need to cherish every day and cherish the people who are part of our lives. The realisation that we are human beings, not human doings, may help us to think more carefully how we spend and invest our time.

The Retreat – Going forward

Alert, Controlled and Safe

The Government has now said that certain types of businesses can re-open. Mine is one of them!

So I’m am delighted to say that I’ve opened my appointment diary and will be taking bookings for 7th July 2020 onward. However, I will be open only for my existing clients and will not be available to treat new customers. When a more comprehensive model for testing and tracking has been developed by the government I will be able to reconsider taking on new clients. I trust you will appreciate and agree with my reason for adopting this strategy .

I would like to say a huge thank you to you all. You have been an enormous source of encouragement and support, especially through your purchases and have helped with my greatly depleted cashflow. I mention a particular instance by citing one client who offered to pay for her booked treatment even though it was unavailable due to the lockdown. I was left speechless and for those who know me that takes some doing! I can’t thank you enough for your generous support and encouragement.

When I reopen shortly you can be confident that I will continue to work to and maintain the highest standards of hygiene and of equipment sterilisation. It has been the foundation of my business to deliver the best possible standard of care to benefit the health of my clients in conducting treatments, use of products and the equipment in used in all the treatments offered.

I have used high quality masks and gloves for many number of years and will continue to do so when appropriate to the treatment.

As some of you may be aware I have discouraged and sometimes turned away clients, if they present with a communicable illness, for both the sake of my clients health, as well as my own. Needless to say I do not conduct treatments if I too am unwell and it is policy that has been operational since my business began.

A further example of my safe working practice is that I treat one client only at a time and bookings are made with a minimum of 15 minutes for clean-down and preparation between bookings. The issue of social distancing will, therefore, not be a problem.

I am confident that my clinic will continue to be one of the safest personal treatment establishments and I will be examining all relevant Government guidelines to ensure that I am compliant with any new hygiene practices.

I look forward to restarting The Retreat, welcoming you all back, treating you again and catching up with your news.

Please email me with the dates and times you’d like to book an appointment and I’ll confirm as quickly as I can.

Thank you all.

Keeping up appearances

I wanted to put something encouraging and uplifting at this challenging time and was reminded of my mother’s advice to me when I was a young girl (not that long ago!).

My mother was a combatant in the Second World War with its many enormous personal challenges. I remember her telling me how, when stockings were nonexistent, she used to dye her legs with gravy browning and then draw a line with her eyebrow pencil up the centre of the back of her legs to make it look like a seam. Quite ingenious really. Having red lips was also a symbol of femininity in that era. What was all that about? Surely, staying alive was the primary focus? Why bother trying to look feminine?

We’re not on a war footing, despite the parallels being drawn, but there are similar dynamics at work: struggling to get food and maintain a healthy diet, keeping our bodies and minds active, maintaining our morale and just trying to stay alive. And all this within a framework of isolation and stress. Consequently, it may seem a little trivial to think about taking care of ourselves aesthetically.

But nurturing the right attitude does keep us from despondency. And thus, back to what my mother told me. When she shared her wisdom she had already had a series of major strokes which left her partially paralysed. Getting out of bed was a considerable challenge for her and she had great difficulty in lifting her arms. Yet, each morning, she would change from her bedclothes into her day clothes, wash and do her hair before she would come downstairs. When I asked why she made so much effort because, as she was housebound, only her family could see her. She replied, ‘ You should look after your appearance for your own self-respect, not for anyone else’s approval.’ As a woman of few words you took notice when she spoke and her words have stuck with me some 35 years later.

I think her attitude helps to reinforce a sense of self esteem, not by worshipping the body beautiful but by creating routines in your life to maintain the health of mind, body and spirit. We can all vouch for how much better we feel when we’ve had a relaxing bath, invigorating shower, haircut, manicure or pedicure. These outward activities have a influence on our inner self.

I would therefore encourage the instigation or maintenance of a beauty routine for the benefits it brings in helping us to focus of how life must go on; in lifting us out a tendency to despondency. It reinforces our sense of purpose, helps us to look beyond our immediate circumstances and recreates a sense of normality.

I read recently a beautiful and sobering notion that ‘women set the temperature of the home’. So let us make it an ambient one. It isn’t selfish or vain to spend some time on ourselves.Everyone benefits from our reduced stress if we give ourselves permission to take a mental as well as a physical breathing space.

I am grateful to my mother for her wise words: they have influenced my life and informed the ethos of my clinic.
As an aesthetician of 40 years experience I can testify to the truth of the proposition that my clients obtain health-giving benefits which go beyond the positives of the physical treatment alone. It is why I love what I do – it’s ‘whole-istic.’