Laser Treatments

Facial Veins/Rosacea

Small red veins on the face are a common problem and are easily treated by the latest laser technology.

What is a laser?

A laser is a machine that emits a high intensity, narrow beam of light, usually of one single colour. Lasers have been used to treat a variety of vascular abnormalities for over 20 years. Yellow light lasers are used to treat vascular abnormalities.

Which conditions does the laser treat?

FACIAL TELANGIECTASIA (SPIDER VEINS) are the most common vascular problems treated. They are associated with sun damage, acne rosacea, excessive topical corticosteroid use, or genetic influence.

Other conditions suitable for these lasers are port-wine stains, spider naevi, cherry angiomas (Campbell de Morgan spots), and blood vessels associated with scarring. Poikiloderma of Civatte (ie a red sun damaged neck) can also be treated.

Which laser is suitable to use?

There are numerous vascular lasers in world wide use. In this clinic we use two vascular lasers: The CANDELA V BEAM PERFECTA LASER which is a pulsed dye laser. This laser produces a yellow light at a wavelength of 595nm.

The CUTERA EXCEL V LASER. This laser is the latest long pulsed yag laser producing wavelengths of 532 nm and 1064 nm.

How does it work?

The red component of the blood (haemoglobin) strongly absorbs the yellow light of the laser. Other skin components – sweat glands, hair follicles, connective tissues, do not absorb much of this light energy. As the laser beam is shone onto the skin the abnormal dilated blood vessels are selectively damaged. Over the next six to eight weeks these vessels will heal, but the final result is a vessel much narrower than the original vessel, therefore less visible. Because of the unique property of yellow laser light to be absorbed only by haemoglobin, the normal skin between vessels suffers no damage and therefore the risk of scarring is minimal.

Is the laser dangerous?

The laser light penetrates only to a maximum of one millimetre beneath the skin surface, so it cannot damage the other organs of the body. The exception is the eye, which can readily be injured; hence special goggles or eye shields are used whenever the laser is in operation.

The laser does not produce any rays known to be harmful, eg X-rays, UV rays, gamma rays etc. There is no reason to expect any risk of developing skin cancer in lasered areas many years later.

What can I expect after treatment?

Usually a photograph is taken prior to treatment.

Then once lying down or seated, protective eye wear will be applied. If laser work to the face is required, lead eye shields will be used and taped over the patient’s eyes. Goggles may be used if other areas of the body are being treated.

The laser causes a short, sharp, pricking sensation during treatment and is well tolerated by most people. A light spray of coolant onto the skin will be felt just before each laser pulse.

The degree of discomfort varies with each person, depending on his/her pain threshold. At your first consultation the doctor will advise you whether any analgesia is required. Patients are usually advised to take two Panadol one hour prior to treatment. Occasionally a topical anaesthetic cream EMLA, will be applied prior to treatment of birthmarks.

Immediately following treatment, ice will be applied to relieve any discomfort and to help minimise swelling that may follow treatment.

Following treatment with the laser, the skin will appear slightly red and swollen for a few hours. These side effects subside quickly and you may have some mild swelling the next day which is barely noticeable. In some instances mild bruising may be evident for a few days. Your doctor will discuss the possibility of bruising with you at the initial consultation. In most cases PURPURA (BRUISING) FREE treatment is achievable for facial vessels.

The vessels will show instant shrinkage or disappearance when lasered. They may reappear a day or two later and then gradually disappear over the following six to eight weeks.

Most facial telangiectasia require two to three treatments at six weekly intervals. Birth marks need to be treated every eight weeks for one to two years, depending on the size and colour.

Will they recur?

Depending on the cause of the vascular condition, vessels usually slowly reappear after a year or two. This recurrence is common if the underlying problem is sun damage or acne rosacea. However, the vessels are usually only minor and can be retreated. Birthmarks can take up to two years to completely fade and will need on going treatment. Again, recurrence of these vessels is only minor and on average may need to be retreated once to twice per year.

How much will it cost?

Medicare covers specific conditions – for example Birthmarks and severe facial and neck conditions. Your doctor will advise you at the initial consultation in regard to costs.

Aesthetic laser for all skin tones

Brown Spots

Pigmented lesions can be successfully lightened or removed with modern laser technology.

How does it work?

A laser removes pigmented lesions with the energy of light. A laser is designed to produce one or more specific light wavelengths which are absorbed by the pigment. Pigmented lesions are either lightened or removed when the laser light passes through the skin but is absorbed by abnormal concentrations of melanin. The rapid absorption of light energy causes the melanin to destruct to a point where the melanin concentration is reduced, leaving the treated skin looking uniform in colour and texture.
The Medlite Q-Switched Nd Yag laser is one of the most advanced lasers available today for the removal of pigmented lesions. The Medlite provides the appropriate wavelength of light for absorption by abnormal melanin concentrations. The Medlite also delivers the light in very short, high intensity pulses for maximum melanin destruction. The use of this specific combination of wavelength and rapidly pulsed light results in minimal damage to normal skin while providing maximum abnormal melanin removal.

Tattoos

Tattoos are easily applied but not so easily removed. Carbon dioxide and argon lasers have been used in the past to remove tattoos, but unfortunately, they often leave scars. Tattoo removal by surgery leaves a scar or skin graft, which is often cosmetically unacceptable. The Medlite Q-switched Nd YAG laser offers a new, but well-tried laser technique for removing tattoos without the risk of scarring. The laser uses the body’s own defence mechanism to make the tattoo pigment fade away.

The Technique

Tattoos are made up of clumps of pigment scattered through the lower layer of skin. The body is unable to cast out large clumps of pigment, and so simply seals them off with a protective fibrous wall to isolate them from surrounding tissue. The laser works by breaking up the fibrous capsules and dispersing the pigment into smaller fragments. The body’s natural defence mechanisms can then take over to remove these smaller particles gradually over a number of weeks. This procedure needs to be repeated several times to achieve visible fading of the tattoo.

The laser does not burn or cut the skin surface. There is no lasting damage to the skin, and consequently, little or no scarring. However, on occasions, the normal skin colour in the area treated may lighten or darken, and this may persist for several months.

Planning the treatment

An initial consultation is required to assess the tattoo(s), and explain the treatment, give an estimate of the actual cost and length of treatment, and discuss other treatment options if they appear more appropriate. Other treatment options would include simple excision, excision and skin grafting and excision following tissue expansion. The exact number of sessions required to remove a tattoo with the laser depends on such factors as the type of tattoo and colours involved. The length of each session depends on the size (area) and number of tattoos being treated.

Treatment

The laser nurse traces over the tattoo with the laser, which puts pulses of energy into the tattoo to break it up. The laser treatment may cause minor discomfort, usually no worse than the original tattooing. If you wish, you may have local anaesthetic to reduce the discomfort. Small tattoos take less than half an hour while large ones may take an hour per session.

Immediately after treatment a “whitening” above the pigment may be noticeable and the tattoo appears less dark. The whitening disappears slowly over a few hours and the pigment colour begins to reappear. This is a normal reaction. The skin in the area of treatment will become inflamed and swollen as part of the treatment reaction, and this appearance will slowly settle over a few days. Eight to twelve weeks is allowed between treatment sessions to let your body remove as much pigment as possible. Over the course of several treatments the tattoo will fade. Scarring has not been found in any of the patients treated by this method.

Amateur tattoos generally require 6-8 treatment sessions while professionally applied tattoos, which have more pigment, usually require 10-12 treatment sessions. Some tattoos which are extremely dense, with a lot of tattoo pigment, may require many treatments with the laser and alternative techniques for their removal may be preferred.

Costs

Any consultation or treatment regarding tattoos is NOT claimable from Medicare.

There will be an initial consultation fee which is halved if treatment is commenced at this appointment.

The fee per treatment session depends on the size (area) of the tattoo.

For example:

  • A tattoo measuring about 3×3 cm or its equivalent area would cost $110 per session.
  • A tattoo measuring 10×4 cm or its equivalent would cost about $275 per session.

These examples are given as a guide only as the exact cost per session will depend upon the pigment and the size of the tattoo. The final cost also depends on the number of treatment sessions undergone.

We require the cost of the initial consultation to be paid at the appointment.

We require payment of treatment on the day of the treatment.

The Erbium:YAG Laser

The Erbium:YAG laser is a high powered energy beam that removes (shaves) the top layer of skin to a precise depth. When the energy of the laser beam reaches a threshold, the water component of the skin evaporates suddenly, removing any solid component of the skin. This effect is called Photoblation.

What is a laser?

A laser is a machine that emits a high intensity, narrow beam of light, usually of one single colour. The emission wavelength of the Erbium:YAG laser is 2.94µm which is consistent with the fundamental absorption of water. The main constituent of skin, accounting for some 77% of its total volume, is water. The water thus plays a major role in interaction with laser light.

How does it work?

The Erbium:YAG laser is a high powered energy beam that removes (shaves) the top layer of skin to a precise depth. When the energy of the laser beam reaches a threshold, the water component of the skin evaporates suddenly, removing any solid component of the skin. This effect is called PHOTOABLATION.

Due to the short duration of the laser pulse and the thermal conductivity properties of the skin, there is no appreciable heating of the surrounding area. This results in a very thin coagulation zone directly adjacent to the laser beam. There is usually no bleeding or minimal bleeding so the exact depth of the photoablation can be visualised.

Which conditions does the laser treat?

Superficial, raised lesions of the skin such as seborrhoeic keratoses, solar keratoses and skin tags. Moles can not be treated as the base of the mole is too deep in the skin.

Is the laser dangerous?

The laser light penetrates only to a maximum of one millimetre beneath the skin surface, so it can not damage the other organs of the body. The exception is the eye, which can be readily injured; hence special goggles or eye shields are used whenever the laser is in operation.

The laser does not produce any rays known to be harmful, eg X-rays, UV rays, gamma rays etc. There is no reason to expect any risk of developing skin cancer in lasered areas many years later.

What can I expect during and after treatment?

Usually a photograph is taken prior to treatment.

Then once lying down or seated, protective eye wear will be applied. If laser work to the face is required, lead eye shields will be used and taped over the patient’s eyes. Goggles may be used if other areas of the body are being treated.

The degree of discomfort varies with each person, depending on his/her pain threshold. At your first consultation the doctor will advise you whether any analgesia is required. Patients are usually advised to take two Panadeine one hour prior to treatment. Occasionally a topical anaesthetic cream, EMLA, will be applied prior to treatment if a large area is to be treated.

Immediately following treatment with the laser, ice will be applied to relieve any discomfort and to help minimise swelling that may follow treatment.

Following treatment with the laser, the skin will appear slightly red, swollen and may ooze a clear fluid (serum). On larger lesions, a dressing (hypafix tape) may be applied. Usually on smaller lesions, no dressing is required.

The lasered area will form a scab within 24-48 hours and usually takes two weeks to heal. After the scab comes off, the new skin will be pink and may take 6-8 weeks to return to normal skin colour. Sun avoidance is necessary (or sunblock if sun exposed) until skin is “back to normal”, which may take 1-2 months.

You will be given an instruction sheet after treatment to tell you how to care for your lasered area.

How much will it cost?

Your doctor will advise you at the initial consultation in regard to costs. Usually treatment with the Erbium:YAG laser is considered a cosmetic treatment and is not covered by Medicare.

Skin Rejuvenation

Fraxel® Laser

Fraxel® treatments use safe, fractional laser technology to treat minor to severe skin damage, such as age or sun spots, wrinkles and other signs of ageing. Depending on your needs, Fraxel treatment can help prevent the signs of ageing, resurface damaged skin or correct severe damage.

How long has Fraxel been available?

The first non-ablative Fraxel device was first cleared by the FDA in 2003 and has been available in physician offices since then.

How does it work?

Fraxel treatment uses patented fractional technology to target damaged skin with microscopic laser columns that penetrate deep into the skin. The laser treats only a fraction of tissue at a time, leaving the surrounding tissue intact, which promotes rapid healing. This stimulates your body’s own natural healing process, replacing the old and damaged cells with fresh, glowing healthy skin.

How long is the treatment?

Depending on the size, location and condition of the area to be treated, Fraxel treatment can take as little as 20 minutes. However, we ask that you reserve at least 2 hours for your appointment.

How many treatments will I need?

The number of treatments you will need depends on your goals and desired outcomes as well as your lifestyle. We will work with you to weigh the aggressiveness of treatment with the downtime associated. Typically, patients receive their desired outcomes in 3-6 treatments.

Who can be treated with the Fraxel laser? Can you treat parts of the body?

Fraxel lasers treat women and men of all ages and skin colour. Fraxel treatment also works on delicate skin areas like the neck, chest and hands.

What kind of results can I expect?

Your skin will feel softer, look brighter and show more even skin tone. Other benefits of treatment may include:

  • Smoother, fresher, younger looking skin
  • Improved tone and texture
  • Erasing of unwanted brown spots
  • Reduced fine lines and wrinkles around the eyes

When do the results appear, and how long do they last?

The results of treatment are both immediate and progressive. Soon after the treatment, the surface of your skin will feel softer, look brighter and show more even tone. The next 3 to 6 months will bring more improvement as the deeper layers of the skin continue to heal. Results can last for years depending on your age and skin condition.

What will I look like immediately after the procedure? Can I go right back to work?

Fraxel treatment can be tailored to your desired outcomes. Depending on the aggressiveness of the treatment, you may experience redness or swelling after the procedure which diminishes as quickly as the next day or over the next several days. We will work with you to determine the best option to fit your lifestyle.

Does it hurt?

Most patients describe an increased sensation of heat during the treatment. We will apply a topical anaesthetic ointment before the procedure, which helps to minimize any discomfort during treatment.

Who performs the procedure?

Our physician and staff have been extensively trained on the Fraxel treatment.

Can I get a Fraxel treatment instead of a facelift?

The Fraxel non-ablative treatments can resurface damaged skin but does not offer the dramatic results of a facelift.

Can I avoid other cosmetic procedures if I do this?

Each procedure has its own benefits. Fraxel is a great choice for resurfacing your skin, helping to diminish age or sun spots, reducing wrinkles and fine lines and many other benefits. During your consultation our staff will discuss which procedure is best for you and your desired results.

Can I get a Fraxel treatment if I’ve already had other procedures?

Fraxel procedures may be compatible with most other cosmetic procedures, like soft-tissue fillers, Thermage or even anti-wrinkle injections. For best results you will need to discuss your past procedures, as well as your current expectations with our staff during your consultation.

Is it safe?

Fraxel treatment is a safe option backed by extensive research. Of course, as with any laser procedure there’s always some risk and/or downtime. Our staff can discuss those with you during your consultation.

How much does the Fraxel treatment cost?

The cost depends on the area you’re having treated and the number of treatments you need for your desired results. We encourage you to come in for a consultation at which point we can give you a more precise idea of cost.

Is there a website I can go to learn more?

Yes, if you’d like to visit the Fraxel website, the address is www.fraxel.com

The Clear + Brilliant® Laser

Clear + Brilliant® is a unique skincare treatment that uses safe, fractional laser technology that may help prevent and address early signs of ageing skin such as fine lines and loss of radiance. It’s comfortable, fast, effective and affordable.

How does the Clear + Brilliant® work?

Clear + Brilliant® is a gentle laser that refreshes your skin from the inside out. The laser energy creates millions of microscopic treatment zones in your skin, replacing damaged skin with healthy, younger-looking tissue.

What is Clear + Brilliant® Permèa?

Clear + Brilliant® Permèa is a new treatment offering in the Clear + Brilliant® family uniquely designed to produce visibly illuminated skin and enhance your skin’s permeability, which could significantly increase the benefits of your skincare products. This treatment integrates the elements of your skincare regimen to create longlasting comprehensive results.

Is Clear and Brilliant® Permèa better than the original Clear + Brilliant®?

Each of the Clear + Brilliant® treatment offerings serves a unique purpose. The Clear + Brilliant® Permèa treatment offers more visible enhancements in tone and radiance, while the original Clear + Brilliant® treatment is optimized to improve your skin’s texture. During a consultation, our staff can discuss the best treatment plan for you.

What does the Clear + Brilliant® procedure feel like?

Most patients describe a pricking feeling and an increased sensation of heat during the treatment. For the original Clear + Brilliant® treatment – topical anaesthetic ointment will be applied before the procedure. Afterwards, you may have mild redness and swelling, which typically subside within a few hours. For the Clear + Brilliant® Permèa treatment – topical anaesthetic ointment will be applied before the procedure. Topical skincare product, such as an antioxidant serum, will be applied to each treatment area after the treatment is administered. This combination approach decreases post-treatment skin responses such as redness and swelling.

What skincare product?

Depending on the reason for treatment (eg pigmentation or open pores) you will need to use a skincare product after treatment. Manufactured by Aspect Dr®, Active C Serum is a vitamin C antioxidant serum and Complete Pigment Serum is a brightening serum. The at-home skincare regime is an important part of your treatment.

What kind of results can I expect?

Your skin may feel softer and have improved tone, texture and radiance.

  • More even, uniform skin tone.
  • Renewed, ultra-soft and smoother texture.
  • Naturally radiant and glowing skin.
  • Minimised pore appearance and count.

When do the results appear, and how long do they last?

Treatment results are both immediate and progressive. A few days after the treatment, your skin will start to feel softer, look brighter, and show more even tone. With each successive treatment, the results will become more noticeable and significant. Results can last for months depending on your age, skin condition, and skin care and protection regimen.

What will I look like immediately after the procedure?

Clear + Brilliant® treatments are very gentle and are specifically designed to minimise side effects associated with typical laser treatments. You may experience mild redness and subtle inflammation immediately after treatment. These generally resolve within a few hours, but may last until the following day.

How long is the treatment?

Clear + Brilliant® treatments take about 20 minutes to complete. We ask that you reserve two hours for your appointment.

How many treatments will I need?

Texture and tone improvements, as well as the best visible improvements, are most often reported after six treatments.

How long has Clear + Brilliant® been available?

Clear + Brilliant® has been available since 2011. The new Clear + Brilliant® Permèa treatment was introduced in 2012.

How much does the Clear + Brilliant® cost?

We encourage you to come in for a consultation so we can accurately assess your specific needs and costs will be discussed then.

Is there a website I can go to learn more?

Yes, you can visit the Clear + Brilliant® website at www.clearandbrilliant.com

Ultraformer

Ultraformer is a revolutionary non -surgical, non-invasive face and neck lifting and skin tightening treatment that works by stimulating you body’s natural regenerative processes. It uses highly sophisticated Micro-Focused Ultrasound energy to rejuvenate three critical levels of your skin’s infrastructure. It has an immediate tightening effect by contracting the collagen fibres that support your skin. Most importantly, Ultraformer treatment stimulates long-term production of new, stronger collagen, helping to lift and tighten sagging skin and fill out wrinkles, without downtime.

Ultraformer Results

A single Ultraformer treatment will

  • Lift and tighten sagging skin
  • Improve elasticity and firm up skin
  • Provide treated areas with slimmer contours as the skin tightens
  • Rejuvenate and strengthen your skin

How Ultraformer works

Below the surface (epidermis), your skin is made up of three important layers: superficial dermis, the deeper dermis and the SMAS layer, the ‘infrastructure’ layer that connects you skin to the muscular structures below. With age, the building blocks of supple, youthful skin (collagen, elastic fibred and a gel-like substance called the extrafibrillar matrix) lose their strength and elasticity and the SMAS layer loses its ability to support your skin. The result is loose, sagging and wrinkled skin. Ultraformer treatment tackles sagging skin at all three levels.

Ultraformer works with geometric precision. Micro-Focused Ultrasound sends bursts of finely tuned ultrasound energy to precise depths to stimulate regeneration. The target tissues are heated to the specific temperature required to induce ‘thermal injury’, which causes collagen to contract, and then, over time, to produce new and stronger collagen. Ultraformers Exact Focusing Technology ensures that the right depth is always targeted. Treatment benefits build gradually over a period of a few months, as the production of new collagen provides a more youthful support structure for your skin. You can expect to experience a tighter, more toned skin, along with some reversal of sagging in treated areas.

What areas does Ultraformer treat?

Ultraformer treatment is ideal for areas that are particularly prone to sagging skin, such as the cheeks and jowls, the eyebrow area, the nasolabial lines (from the nose to the corners of your mouth), and the sub-mental zone (the area under your chin). However, it can also be used very effectively for skin tightening on problem areas of different parts of the body.

Are there conditions that Ultraformer does not treat?

Because Ultraformer’s Micro-Focused Ultrasound is specifically designed to treat the lower, foundational, support structures of the skin, it does not treat surface problems such as:

  • Sun damaged skin
  • Pigmentation
  • Rosacea, blue or red facial veins or capillaries
  • Acne or acne scarring

Your practitioner will advise you on the best treatment for the above conditions.

What results can I expect from Ultraformer treatment?

You can expect to experience two phases of Ultraformer results:

  • You will feel an immediate tightening of your skin in the treated area, as the heat from the Micro-Focused Ultrasound contracts the network of collagen fibres. The strands of protein that make up collagen shrink when exposed to the levels of hear used in Ultraformer treatment.
  • Micro-Focused Ultrasound also stimulates other cells, called Fibroblasts, to manufacture new, stronger collagen. This gradually develops over a period of months. The result is a gradual lifting of the skin in the treated area, as the support structure fill out.

Are the results long-lasting?

Ultraformer benefits will peak between six and nine months after the treatment. The new collagen produced will be stronger, and its structure more ‘youthful’ than previously. This in turn makes your skin stronger and better supported, helping to reverse the effects of ageing on your skin. A regular program of treatment every 6 to 12 months will maintain your results, and is likely also to give you some additional improvement after each subsequent treatment.

What to expect during and after your Ultraformer treatment

  • The degree of heat required for optimal results will probably cause some discomfort as the ultrasound energy is delivered. Your practitioner will advise a plan to optimize your comfort during the procedure. This may include medication to reduce the discomfort.
  • Ultraformer treatment is highly efficient. For example, a treatment for the full face and neck will last approximately 45 minutes.
  • Because Ultraformer is a non-invasive treatment, you can expect to be able to return to your normal routine right away.

Possible side effects from Ultraformer treatment

  • Your skin may appear red for a few hours after Ultraformer treatment.
  • You may experience slight swelling, tingling or tenderness for a few days after treatment. Rarely, some patients may experience temporary bruising, welts or numbness.
  • There is a slight risk of a burn to the skin, which may or may not lead to scarring. Both a burn and any scarring will respond to medical treatment.
  • Temporary nerve inflammation will resolve in a few days or weeks.
  • If a motor nerve has become inflamed, you might experience some temporary local muscle weakness. There could be some temporary numbness if a sensory nerve has become inflamed. However, due to Ultraformer’s precision engineering, it is highly unlikely that either of these complications will occur.

Ultraformer on Today Tonight

Collagen Induction Therapy (CIT)

Collagen Induction Therapy is a new innovation in aesthetic medicine for the treatment of fine lines, acne scars and improvement of the skin’s texture, tone and colour.

What is CIT?

During this procedure tiny needles in a micro needling pen are used to create controlled micro-injuries to the skin in order to produce collagen and elastin. The skin’s repair process results in a thicker dermis with softer wrinkles. The micro needling pen also creates microchannels which allow topical gels, creams and serums to be absorbed more effectively, enhancing their effects in deeper layers of the skin.

What are the benefits?

Wrinkle reduction, texture and tone improvements, younger looking skin with fewer signs of ageing. New collagen production reverses years of sun damage. CIT also has a positive effect on hyper-pigmentation as well as treating uneven skin tone, acne scars, traumatic scars and stretch marks.

What areas of the body can I treat?

CIT can be used on all parts of the body; face, neck, décolletage, arms, hands, legs, abdomen and back.

How is the procedure done?

A sterile needle-tip containing 12 micro-needles is attached to the micro needling pen. A thin layer of topical gel is applied to your skin and the appropriate treatment depth based on your unique needs is selected. Next, in a single motion, the pen will be gently pressed against the skin while simultaneously gliding in one direction until the entire treatment area has been covered.

What does it feel like?

The feeling associated with CIT is similar to sandpaper being moved across the skin. While some areas are more sensitive than others, the speed of the reciprocating needle tip makes the treatment comfortable.

How long does the procedure take?

The procedure takes 15-30 minutes depending on the size of the area treated. To make the treatment more comfortable an anaesthetic gel is applied 1 hour prior to treatment.

What is the downtime?

Immediately after the treatment you will notice a bright redness to the skin. On average patients are red for 2-4 days. Some patients heal completely in 24 hours.

When will I see results?

Patients notice an immediate ‘glow’ to their skin. Visible changes to the skin develop over the course of several weeks. Results continue to improve up to 6 months after the treatment as collagen production continues.

How many treatments will I need?

It is recommended for most patients to receive a series of 3 treatments spaced about 4-6 weeks apart. For patients with deep wrinkles, advanced photo-ageing, stretch marks or acne scars it is recommended to receive 6-8 sessions at 4 week intervals.

Where can I go for more information?

Non-Surgical treatment of varicose veins

Sclerotherapy

A procedure where a solution called a sclerosing solution is injected with a very fine needle directly into the blood vessel. In this clinic the solution injected is either hypertonic saline, Fibro-vein®, or Aethoxysklerol®

Which veins can be treated?

Dilated blood vessels on the legs, sometimes called ‘BROKEN CAPILLARIES’ or ‘SPIDER VEINS’ are best treated using the injection method called SCLEROTHERAPY. Some vessels are too large to be treated with this method, and your doctor will advise you if this is the case.

What caused these blood vessels to become visible?

The cause is unknown except that in many cases they seem to run in families. Women develop them to a far greater extent than men and there is no doubt that hormonal influences aggravate them – adolescence, pregnancy and menopause. They also appear to be associated with obesity and occupations involving prolonged standing. Once a person has this tendency towards venous disease of the legs it is always with them. Therefore the aim of treatment is to treat whatever is visible now, but you should expect that further veins will naturally appear from time to time.

What should one expect during sclerotherapy treatment?

A tiny needle is used to inject the vessel being treated. Then the sclerosant solution is injected which causes a mild stinging sensation. Generally one injection per vein or “spray” of interconnecting veins is needed.

A cotton swab is taped over each injection site. It is wise to wear a long skirt or loose trousers when coming for treatment to hide the swabs. The average treatment session is 20-30 minutes. It takes anywhere between 2 and 6 treatments to inject all veins of both legs. Your doctor will advise you during the consultation as to how many treatments you can expect.

What can one expect after treatment?

For 1-2 weeks the vessels may appear more prominent. The injection sites can be red and raised. You can experience aching in the legs for a day or so after treatment which is relieved by walking. You can take a Panadol to relieve the aching. Often there is extensive bruising over the legs especially if large veins are treated.

The veins begin to fade after a week or two and continue to do so for up to 8 weeks. After 6-8 weeks the larger veins will need to be treated again. Most patients will need between l-4 treatments depending on the severity of their leg veins.

After all veins large enough to be injected have been sclerosed there are frequently a few tiny pink vessels remaining. These are impossible to inject further as they are smaller than the size of the needle and do not respond to laser treatment. Patients should have realistic expectations that while 90% clearance is common, a 100% disappearance of all veins is rare.

As mentioned earlier it is normal to have some new veins appear from time to time. Often people book a “maintenance” treatment each August to “tidy up” for summer.

What do I do after treatment?

Maintain normal daytime activities.

Walk at least half an hour (4kms) per day – the more the better as this works calf muscles and pumps blood through other vessels back to the heart. Walking reduces pressure in superficial veins.

Standing for prolonged periods must be avoided for 2 weeks following injection sessions unless you are wearing compression stockings.

Avoid strenuous activity (aerobics and weightlifting) for the first 72 hours. However walking in the first two days is important as it will relieve most of the aching from your treatment. Wear your compression stocking daily as advised by your Doctor.

Are there any complications, side effects or treatment failures?

  1. Allergy
    Allergy to STS is possible (approx. 1 per 10,000) and can be severe ( i.e. needing emergency treatment). Allergic reactions are not possible to saline and are extremely rare to the local anaesthetic. Nonetheless you should report any known allergies to your doctor prior to treatment.
  2. Lumps
    Tenderness along the vein and an area which feels a little thickened may occur. This is due to a small superficial clot which can sometimes occur in the slightly larger veins which have been injected. This is in no way dangerous and the clots can never break off and travel but they can be an annoyance. The tenderness and thickening will settle in time. These can be treated by your Doctor so please report any such lumps.
  3. Brown Staining
    Brown pigmentation can occur at the injection sites of the larger veins. The brown pigment is a temporary effect and will fade in time. If the brown pigmentation is at all extensive then the doctor may choose to laser this to speed up the disappearance of the pigment. Please avoid iron tablets and iron-containing multi-vitamins for the duration of your treatment.
  4. Matting
    A condition called telangiectatic matting can develop in about 5% of patients. In this situation a mass or a cluster of blue spider veins vanishes after treatment but is replaced by tiny pink vessels that appear as a pink blotch. These usually disappear over 3-6 months but occasionally need re-treatment.
  5. Treatment Failure
    Sclerotherapy is ineffective if the spider veins overlie major varicose veins. Your doctor will asses you at the first appointment to see whether there are any varicose veins that need surgery. If there are rather prominent varicose veins you will probably be referred for vascular assessment and duplex scanning, however this will be discussed with you during your first appointment.
  6. Ulcer
    Small areas of skin loss (ulcer) can occur and are due to a small amount of solution leaking out of the vessels into the surrounding skin. These will heal but may leave a small scar. Please let your doctor know if this occurs so that it can be treated.
  7. Migraine
    Although rare, migraines can occur at the time of treatment with STS. This is almost only in people who have had a migraine previously. Treatment is Panadol or Panadeine or your usual migraine treatment.

What is the cost?

The fee varies and can be discussed with the doctor at the appointment. There is no Medicare rebate or Private Health rebate for cosmetic treatment.

Do the telangiectasias reappear?
The natural history of people prone to these types of veins is that more will gradually develop with age. The veins removed by sclerotherapy may recur but only at a rate of 5% per year. Many patients choose to return every couple of years for a maintenance treatment. There is no limit to the number of treatments that can be performed from the medical view point.

Check List Before your First Appointment:

  • Two Panadol one hour prior to appointment time
  • Buy stocking and bring to appointment (if ordered by your doctor)
  • Wear long skirt or loose trousers
  • No moisturiser or creams on legs
  • Bring comfortable walking shoes
  • No immediate travel plans
  • No impending surgery

Duplex Ultrasound Guided Injection Sclerotherapy

Recently, there have been advances in the diagnosis of varicose veins and management by compression sclerotherapy (injection followed by compression with a stocking).

General

First, with Duplex Ultrasound imaging, precise mapping of the abnormal varicose veins can be performed. This ensures that the doctor is able to see and therefore potentially treat all abnormal veins (both obvious on the skin surface and hidden beneath) which gives better long-term results for those with more major incompetent or backflowing veins.

Second, for suitable incompetent veins, Duplex Ultrasound can image the abnormal vein and guide an injection to the exact point of abnormality. The form of sclerotherapy results in quicker response with fewer injections being required.

Note

The procedure is done without any additional risks, since Duplex Ultrasound has no adverse reactions and is radiation free. The risks of sclerotherapy, which will have already been discussed with you, still apply. Please ask if you have forgotten these or lost your sclerotherapy information sheet.

Some abnormal veins cannot be treated this way and surgery may be the best option.

The Procedure

The patient lies on the treatment couch. The ultrasound technician localizes the abnormal vein with the ultrasound transducer and measures the distance between the vein and the skin surface. The doctor then guides the fine needle to the centre of the abnormal vein and injects a precise amount of sclerosant solution, which has the effect of sealing the vein off at the point – this will prevent abnormal flow down the vein.

The procedure involves minimal discomfort and usually 2 to 4 injections are required.

Afterwards

Following the procedure you are required to wear your compression stocking for two weeks continuously during the day and for the first week at night also. As with other forms of sclerotherapy, you must walk for 45 minutes each day and it is essential that you walk for 20 minutes immediately after the procedure.

An appointment will be made for 2 and 4 weeks’ time to check the results and a follow-up brief ultrasound may be ordered. Some people may require further ultrasound guided injections if there is any residual backflow, but this would be discussed on an individual basis if needed.

Varicose vein disease is a chronic disease that requires on-going maintenance and surveillance and it is important to remember that Ultrasound Guided Sclerotherapy, as with surgery, is unlikely to cure varicose veins.

However, treatment at the earliest stages will not only help to improve the appearance of the leg but also avert expensive and morbid complications including leg ulcer, stasis dermatitis, thrombophlebitis and a wide range of other unpleasant symptoms endured by varicose veins sufferers.

Endovenous Laser Therapy (CTEV™)

CTEV™ is the latest method for the treatment of major veins previously treated by stripping surgery under general anaesthetic.

For large varicose veins

The procedure involves the placement of a laser fibre with ultrasound guidance into the abnormal vein through a tiny incision. The vein is then numbed with local anaesthetic. The Laser is then activated as the fibre is slowly removed. This produces a reaction in the vein wall along the treated section. The procedure involves minimal discomfort. The published success of CTEV™ treatment is between 95-98% with far fewer complications as compared to surgery.
With the addition of CTEV™ to Ultrasound Guided Sclerotherapy it is expected that varicose vein surgery will be performed less frequently.

Other Procedures

Wrinkle Treatments

These treatments can help you regain naturally defined contours and youthful facial curves with natural-looking and feeling results.

For More Information

For more information, please visit http://www.myfacemyallergan.com.au.

Excessive Sweating / Hyperhidrosis

Excessive sweating can be embarrassing and uncomfortable, and can disrupt many aspects of a person’s life.

What is Hyperhidrosis?

Approximately 1 in 200 people in the general population suffer from excessive sweating that can involve the palms of the hands, soles of the feet, underarms and face.

To be classified as hyperhidrosis the degree of excessive sweating needs to be distressing and genuinely disabling to the individual for at least 6 months. Severe primary axillary hyperhidrosis (severe underarm sweating) is usually classified as primary focal hyperhidrosis and even though the cause is usually unknown there is evidence of a genetic link.

Cause

The condition can:

  • Occur for no known reason
  • Run in families (30 – 50% of people suffering this condition report another family member with the same symptoms)
  • Be associated with conditions such as diabetes, thyroid disorder, long term infections or alcohol excess
  • Be associated with disorders of the nerves to that area of the body.

How does injectable treatment work in this condition?

Multiple minute injections are administered into the affected skin (say underarms) which help to control the excessive release of sweat from the sweat glands in that part of the body by stopping the nerves from stimulating the glands.

What will I feel?

A grid of points is marked onto the affected area and minute amounts of the medication are injected into each point. Each injection site is gently massaged to help spread the solution into the skin.

You will feel slight discomfort during the procedure but virtually no discomfort afterwards.

The area may have a few pinpoint bruises that will disappear within a few days.

You can do normal activities immediately afterwards (go to work, exercise etc).

When will I notice a difference?

The procedure will start to take effect at about day three after the injections. Usually at 1-2 weeks the effect is complete. It will then remain at this level for an average of seven months (it occasionally may be as short as four months or as long as twelve months).

Will all the sweating go?

Sweating is part of the body’s normal heat control mechanism. Each individual will vary in their response to the treatment, but the aim is to try and reduce the sweating to a point where it is no longer disabling or distressing.

Every patient is offered a two week follow up appointment after the initial treatment to allow the doctor and the patient to assess the effect of the treatment. At this stage the doctor may decide to re-inject an area that is still sweating excessively.

How much does it cost?

The procedure costs $1100 for both underarms. Some patients may be able to get a partial rebate from their private health fund, depending on their level of cover.

What other options are available to me?

  • Tablets
  • Cream
  • Surgery

Is the injectable treatment safe?

  • The injectable medication is made in a pharmaceutical laboratory according to international standards of best practice.
  • It is safe to use in babies, children and adults on faces, on eye muscles and for other conditions.
  • The medication contains albumin, which is a protein that is sourced from human blood products. This albumin is the same product that is in vaccines and other medical products. It is as safe as current testing allows. Please inform the doctor if you do not wish to use blood products.

Daylight Photodynamic Therapy

Actinic keratosis, also known as solar keratoses, are precancerous skin lesions that commonly occur in sun exposed skin. In Australia there is a high rate of these lesions and it has been reported in 40-60% of adults over the age of 40 years. Daylight PDT is a new therapy for treatment of actinic keratoses. It is a simple, effective and well tolerated procedure.

What to expect?

  • 5-ALA solution is applied to the skin in the clinic by one of our nurses.
  • Immediately, or within 30 minutes you must spend 2 hours outside in the sunlight. If it is hot you can sit in the shade.
  • The ALA solution must be washed off thoroughly after 2 hours and then you should remain indoors.
  • You may experience burning, swelling, redness, peeling and crusting that will peak at 2-3 days in the treated areas. These symptoms usually clear within 7 days.
  • Most people describe this procedure as a painless and easy procedure.

How does it work?

  • Daylight PDT uses visible light which has a longer wavelength (380-780nm) than ultraviolet light (100-380nm).
  • A chemical sunscreen will be applied to the treated areas to protect the skin from the harmful UV light. The sunscreen is applied prior to the ALA solution.
  • 5-ALA once activated by visible light will destroy any abnormal cells in the skin, thereby eliminating the actinic keratosis.
  • Daylight PDT has a low risk of scarring or hypopigmentation.

Before you have PDT

You must tell your doctor if you have/are:

  • Porphyria (a rare blood pigment disorder)
  • A type of basal cell carcinoma called morpheaform
  • A type of skin cancer called invasive squamous cell carcinoma
  • Allergic to any medicine containing methyl aminolevulinate
  • Allergic to peanut oil
  • Allergic to any of the ingredients listed on packaging
  • Pregnant of plan to become pregnant
  • Breastfeeding

Take the following medications:

  • St John’s Wort (orally or as cream/lotion)
  • Thiazides (used to treat high blood pressure)
  • Tetracyclines, fluoroquinolones, griseofulvin, or sulfonamides (used to treat infection)
  • Sulfonylureas (used to treat diabetes)
  • Phenothiazines (used to treat serious emotional problems)

Results

  • Excellent results have been reported with clearance of actinic keratoses between 70-90% at 3 months.
  • Daylight PDT is a non-invasive treatment with low risk of scarring and mild to moderate side effects.
  • Any side effects are of short duration and can be easily managed.
  • The treated are can, and may need to be re-treated if there is incomplete clearance of the lesions.

Double Chin

Fullness under the chin or a ‘double chin’ is a common concern for both men and women. It can be caused by ageing, genetics or weight changes. You may feel like you look older and heavier than you actually are – no matter how much you diet or exercise! There is now a new treatment to tighten and sculpt your side profile.

How does the treatment work?

The treatment works by breaking down the fat cells under the chin. The treatment is administered by a series of injections into the submental fat under the chin, reducing the fat, resulting in a more contoured neck profile and jawline.

How long is treatment?

The treatment should take approximately 30-45 minutes. The procedure is not a surgical treatment.

Does it hurt?

Prior to treatment  your clinician will administer an injectable local anaesthesic (eg. lidocaine) to the treatment area to make you more comfortable. You may also benefit from taking an oral over-the-counter pain medication before your appointment.

How many treatments will I need?

Most people experience visible improvement in the appearance of their chin profile in 2–4 treatments.

How long does it last?

Once your desired results are achieved, re-treatment is not expected as results are maintained for at least 4 years.

What will I look like immediately after the procedure? Can I go back to work?

You will experience moderate swelling for at least 3-4 days following your treatment. Swelling should resolve gradually over the weeks to follow.

The most common side effects are: discomfort, swelling, numbness, bruising, hardness, redness, itching.

How much does it cost?

The cost depends on area having treated and the number of treatments you need for your desired results. We encourage you to come in for a consultation at which point we can give you a more precise idea of cost.

Is there a website I can go to learn more?

For more information go to www.nomoredoublechin.com.au.

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