Alopecia areata or localised premature fallout of hair, is something I’m seeing lots more of recently. The books would suggest that stress has nothing to do with it but in my experience, every patient I see with this condition recalls a very stressful event when the hair loss began. The good news is that this condition doesn’t destroy the hair follicle and most will get full regrowth of all their hair within a year. However, if left untreated, there is a chance it can progress to alopecia totalis which is when all the hair is lost and this has a less than 10% chance of recovery. This patient was undergoing significant stress when he started to lose hair. Luckily, we started treatment early with triamcinalone injections into the scalp which switched off the inflammatory process to allow his hair to regrow. He required 4 sessions to get this result.
Xanthelasma are yellow plaques of lipid (fat) deposits that are most commonly seen on the eyelids. They can be caused by high cholesterol in the blood (hyperlipidaemia). However, in my experience, almost all of them have normal cholesterol levels. Therefore, I suspect there is a genetic susceptibility to developing this. The NHS does not treat this condition as it is considered ‘cosmetic’, however, patients find it very distressing. When on the eyelids, all treatments have to be performed with real care to avoid damaging or scarring the eyelid muscle. If that happened, the patient’s ability to open and close their eye can get affected. I treated this patient with Plexr, a plasma technology that carefully dissolves the xanthelasma into the plasma state while carefully ensuring I do not dissolve her eyelid muscles. The eyelids were anaesthetised with multiple injections which made the procedure painless for her. The procedure took 1 hour and the after photos are from 8 weeks later. The ‘pinkness’ to her skin will settle down completely. You will also notice that her left lower eyelid is tighter after the treatment. Plexr is also used to tighten eyelid skin. The patient was of course very happy about this! TOP TIPS if you have Xanthelasma; First, please ask your GP for a blood test to check you don’t have high cholesterol. Avoid harsh exfoliation of the plaques, as that can cause micro-inflammation and potentially cause them to swell. Apply a broad spectrum SPF 50 every day. If you are going to cover the plaques with make-up, use only mineral based products to avoid make-up induced over production of sebum and inflammation.
Melasma (excess pigment in the skin) is not only brought on by sun exposure. It is also not exclusive to skin of colour. This young Caucasian lady developed hyperpigmentation around her eyes, cheeks and mouth after taking the oral contraceptive pill. She was sadly turned away by the NHS, which does not offer any substantive treatments for this distressing condition. Lucky for her, as you will see on the ultraviolet (UV) images, most of her melasma was superficial or epidermal, which has the best chances of improvement. I started her onto the Dr Skin hyperpigmentation protocol and she noticed improvements within 1 week. The photos above were taken 7 weeks apart. There is still some milder melasma left which will improve completely over the next 2 months. She will, however, need to ensure she protects her skin from all of the usual triggers for melasma such as sun exposure, use of certain medications and using poor skin care that causes inflammation to the skin. Pregnancy also carries a high risk for developing melasma but when that time comes, we will work together to ensure she is on the best protocol for her skin which is completely safe during pregnancy. Top tips to prevent Melasma; Always ensure you wear SPF factor 50 every single day. And no! the SPF in your make-up is not enough, as it is usually only factor 15 and not broad spectrum. When you’re out in the sun, reapply your SPF factor 50 every 2 hours. Wear a hat and large sunglasses when out in very bright sunlight e.g. sunny beach holidays. Ensure you apply a good skin care regime every day that includes antioxidants, retinol and most importantly, broad spectrum SPF factor 50!
This weekend my nephew asked why I’m wearing my pyjamas in the daytime, so admittedly, this post is more about me striking a pose in scrubs than anything else. And a great weekend training with Derma Medical, as always!
This patient was concerned about her hooded eyelids which she felt made her look older than her age and tired all the time. She also struggled to apply make-up as it would clump into the skin folds of her eyelids. I used Plexr, a plasma technology which carefully sublimes the outer most layer of the skin (epidermis) into liquefied gas and essentially removes it. Plexr is the only device that can guarantee not damaging the middle layer of skin, the dermis, which would cause permanent scarring.
If you had a lesion on your shoulder and were only 33 years old, would you be worried? Because this gentleman wasn’t, until it started to crust and bleed. The lesion was the most common form of skin cancer, a Basal Cell Carcinoma. I’m seeing more and more of these in young patients. Thankfully, they’re very slow growing and they very rarely spread. However, they can grow and destroy the skin around them and therefore they always need removing. They are caused by UV sun exposure and have a genetic component. This young man is builder and while working outside, he would never protect skin with SPF. This photo shows how large and deep an excision I had to perform to ensure it was completely removed. TOP TIPS to prevent skin cancer; ALWAYS wear a broad spectrum SPF 50 on sun exposed skin every single day and reapply it after 2 hours of moderate sun exposure. If you’re a smoker, consider cutting down or quitting. If you take an immunosuppressant medication, take extra care when exposing your skin to the sun. Any lesion that bleeds, crusts, itches or looks unusual, always get it checked by your GP.
My clients often ask me how adding filler to the nose can make it look smaller and shorter. The trick is to sculpt the nose in such a way that when light strikes the nose, it stops exaggerating the bump and draws the eye to more aesthetically pleasing proportions. This client had 0.8ml of filler injected to create this result, yet don’t you agree it looks smaller and shorter?
Lip goals are when there’s harmony between the top and bottom lip, when the Cupid’s bow is beautifully shaped, when there are subtle pillows in the bottom lip, when there is minimal bruising and swelling and when straight after injecting 1ml of Restylane Kysse, they still look natural.
This woman was tired of looking 'tired' all the time because of her under eye hollowness, the tear troph. Tear troph hollowing, which is caused by loss of volume, can be one of the earliest signs of aging. She only required 0.5ml of a non permanent hyaluronic acid filler on each side to give achieve this result.