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Why is the face I see in the mirror every morning suddenly looking droopier? It couldn’t have occurred overnight, but why does everything suddenly appear to be looking down, not up?
‘Your skin is made up of strands of collagen and elastin fibres and both change during the ageing process and as a result of sun damage,’ explains aesthetic practitioner Dr Alek Nikolic, who has a practice in Chelsea Village, Cape Town. ‘Collagen loses its alignment as we get older and it also loses its ability to provide tautness to the skin structures. In your twenties you can imagine your collagen strands lying neatly alongside all the other strands like matches in a matchbox. But in your forties the strands start to get a bit haphazard, lying around like a freshly dropped pile of pick-up sticks. Meanwhile elastin, which gives your skin “bounce”, becomes overstretched, like an overstretched elastic band.’
Scattered collagen
I swallow nervously as I picture the state of my scattered collagen and worn-out elastin but I’m reassured to hear that these days there are treatments that can help collagen strands and elastin fibres regain the neat alignment and springy tautness that gives younger skin its texture and firmness. Practitioners use a range of machines that work either through radio frequency or infrared light to heat the collagen layer and force it to ‘remodel’.
Nowadays the trend is to have non-surgical treatments before opting for ‘the final cut’ in the form of a facelift at the hands of a plastic surgeon. ‘In some cases, patients opt to combine both surgical and non-surgical treatments for enhanced results,’ says Dr Nikolic.
‘Of course a facelift will give you results that cannot be achieved with skin-lifting and -tightening treatments, but not everyone wants to undergo surgery,’ says Dr Nikolic. ‘As we age there are many other procedures that can slow down and remove wrinkles, pigmentation (age spots), uneven skin texture, enlarged pores and veins, and help lift sagging skin.
‘Between the ages of 40 and 50, regular anti-ageing treatments can have the effect of slowing a woman’s external ageing process. I like to see patients before they develop even mild to moderately deep wrinkles because then I am able to get better results,’ says Dr Nikolic.
What about the risks?
I know I am more neurotic than most women but I’ve recently read some alarming reports in the press about risks associated with dermal fillers and Botox. I ask Dr Nikolic whether he can allay my fears and he says: ‘The safety of fillers will depend on the type used and the area injected as well as the injecting technique.
‘Side effects and complications may be experienced with any of the various fillers manufactured worldwide today, but generally speaking, the non-animal hyaluronic acid (NASHA) fillers are the safest. Possible side effects of NASHA fillers are seen in both the short- and intermediate terms. Short-term side effects may include inflammation (which may last from a few hours to a few days), swelling, bruising and even lumping. All these usually resolve spontaneously. On an intermediate level you may see infection (as is the case with any injection) and granuloma (a small, firm, pea-sized lump). Granulomas are seen in one in 5 000 people and typically respond well to a local injection of hyaluronidase (Hyalase) if treated early.
‘With regard to the safety of Botox, there’s never been a death or severe anaphylactic reaction reported worldwide with cosmetic use of Botox. Botox has had bad press recently because both adults with neuromuscular disorders and children with cerebral palsy who were treated with Botox for limb spasticity suffered from respiratory problems leading to hospitalisation and, in some cases, death. However, these patients were given high doses of Botox (more than 800 units) and the dose for cosmetic usage is typically between 50 and 70 units. In my opinion the cosmetic use of Botox is extremely safe and I have no concerns about using it on myself, my wife or my family.’
FEMINA’s testing team
We asked eight FEMINA readers to test some of the non-surgical anti-ageing treatments on offer. Four readers had short-term, quick-fix treatments, namely dermal fillers, Botox, chemical peeling and Thermage, while four volunteered for longer-term treatments. These included skin-rejuvenation and -tightening treatments and wrinkle reduction using various forms of light therapy, radio frequency and laser treatments. Two also received several months of skin-tightening and -rejuvenation treatments, culminating in Botox and dermal fillers – ‘the works’ in terms of non-surgical facelifts.
Case studies: short-term treatments
Test: Chemical peels
Barbara Potgieter, 46, housewife
Philippa Crichton of Tusc Clinic says: ‘I examined Barbara’s skin and decided she would benefit from a series of peels to remove dead cell build-up and encourage new cell growth, as well as needling roller treatments.
'The needling roller treatments help improve blood circulation to the skin, improving the production of fibroblasts, which are responsible for the production of collagen and elastin fibre. They also help to firm the skin. I decided to alternate Lamelle beta hydroxy peels with the roller treatments on a weekly basis over a six-week period.’
Barbara says ‘I felt as if my skin looked tired and sun damaged (after living in Mauritius for a year) and any improvement would be good. I hoped to see the appearance of the fine lines around my eyes reduced, as well as the deep groove between my eyebrows.
Overall the chemical peels and roller treatments were not bad. The initial acid treatment was a bit of a shock but it was over so quickly I didn’t have too much time to dwell on it. The roller treatment was a doddle and I didn’t feel much due to the anaesthetic cream that was used. My skin tingled afterwards but it was more of an “alive” feeling than anything else and was actually quite pleasant.
The skincare required between treatments was basic and I was advised to stay out of the sun.
A few weeks into the treatment my husband made a positive comment about my skin. I was quite surprised because men don’t generally notice how your skin is looking!
I have been thrilled with the outcome. My skin looks more radiant and feels good as well. There has been a noticeable difference with regard to wrinkles and I think it has made me look years younger.’
Where: Tusc Clinic, Shop L31f, lower level, Sandton City, Johannesburg
Contact: 011 884 6577
Cost: R3600
Test: Botox
Nickey Grant, 48, financial director
Dr Albert Niemann of Renew Time Restoration Clinic says: ‘I conducted a VISIA complexion analysis of Nickey’s skin and recommended treating her frown lines, crow’s-feet and the lines on her forehead with Botox.’
Nickey says: ‘I have a permanent frown line between my eyes and the muscles in my forehead are extremely active when I talk. I’m hoping the Botox will smooth out my frown and forehead lines, but I’m nervous about having the injections without an anaesthetic. Dr Niemann suggested I take some painkillers, as a precaution, an hour before arriving for my treatment, which I did.
I took my husband along for moral support and two assistants prepared me for the procedure by applying a local anaesthetic cream to the areas to be treated. The cream was left to work for 10 minutes before Dr Niemann started administering the Botox.
I can honestly say I felt nothing more than a very slight pinprick here and there.
The next day I jumped out of bed at 5am to see if my frown lines were gone but, unfortunately, it takes up to 10 days for the effects to be visible. So I had to be patient. I couldn’t wait for someone to notice that I didn’t look angry…
Four days after my treatment I noticed a distinct change in my facial expressions. I looked a lot more relaxed and my forehead was a lot smoother.
A week later I went for my follow-up appointment and Dr Niemann did a little top up on my forehead – I have very strong muscles and needed a little more Botox in two areas. Four days later, all my frown lines were gone!
I have received many compliments in the last few days. People have remarked on my smooth-looking skin. My children and husband love the new me because I look happy all the time.’
Where: Renew Time Restoration Clinic, Umhlanga Rocks, Durban
Contact: 031 561 1277, renewclinics.co.za
Cost: R3200
Test: Dermal fillers
Hedda Baxter, 51, estate agent
Dr Alek Nikolic of Aesthetic Facial Enhancement says: ‘Hedda showed characteristic volume loss seen in all of us as we age. This loss is attributed to the reduction of pockets of fat just below the skin.
'These fat pockets help define, support and lift certain areas of the face. Hedda and I discussed the loss of volume in her eyebrows, around her eyes, between the corners of her nose and mouth, her jowl and cheek area and her lower lip. We decided to treat these areas with NASHA dermal fillers to correct the volume loss, giving her a more youthful look.’
Hedda says: ‘I’m 51 and looking old and tired – very tired! I’ve got frown lines, deep grooves running down my face and dark, sunken circles under my eyes. But the thought of invasive plastic surgery with weeks of recovery is depressing.
I had never heard of dermal fillers so, after the first consultation, I was excited about the possibilities. The treatments took place over a couple of weeks. Dr Nikolic constantly assessed the results and was always cautious and mindful of my opinion. He used an anaesthetic cream and, at times, a quick-acting local anaesthetic in sensitive areas. There was no discomfort or pain and the results were immediate.
A tiny needle was used to inject the gel just under the skin and I felt a mild stinging, which lasted a few seconds. There was no redness or bruising and only slight swelling that settled within hours. The following day I received compliments such as: “Wow, your skin looks fantastic’’ and “You must have had a great night’s sleep!”.
My skin looked younger, the folds and wrinkles were plumped up and far less noticeable, my eyes looked brighter and I felt great.’
Where: Dr Alek Nikolic, Aesthetic Facial Enhancement, 31 Piers Road, Chelsea Village, Cape Town
Contact: 021 797 0960, aestheticfacialenhancement.co.za
Cost: R9900
Test: Thermage
Angelique Schoeman, 43, personal assistant
Dr Riekie Smit of Vivacité says: ‘Angelique lives a healthy lifestyle and has always looked after her skin. However, she has developed some sagging on parts of her face due to weight loss. She also suffers from under-eye puffiness due to seasonal allergies.
'I decided to give her a full-face Thermage treatment to improve the puffiness under her eyes and tighten the contours of her face. Thermage emits radio-frequency energy through a small metal circle or plate. These radio waves are absorbed by the skin, causing it to tighten. Although patients see results immediately after their treatments the skin continues to improve for six months after the treatment.’
Angelique says: ‘I have always been very active outdoors – horse riding, swimming and running – and this has left me with quite a lot of sun damage to my skin. I hope to see an improvement in the condition of my skin, especially the puffy area under my eyes.
I was delighted to be given the chance to try out the Thermage treatment. It took approximately an hour and 10 minutes. I felt a burning sensation on my skin but the pain was minimal and quite bearable. I didn’t have to have any downtime after the treatment and I went out that evening looking and feeling 10 years younger.
I am very pleased with the results of this treatment. I have noticed a reduction in fine lines and my previously tired and dull-looking skin has been rejuvenated.
My skin has a healthy glow that I haven’t seen in years and is definitely firmer. It feels “lifted” and the bags under my eyes have almost completely disappeared. I am quite curious to see what my skin looks like over the next six months as I am already looking so much better. I would certainly recommend a Thermage treatment. It’s much better than having surgery.’
Where: Vivacité Clinic, Plot 36, Dr Van der Merwe Road, Montana, Pretoria
Contact: 012 548 6374
Cost: R25000
Case studies: long-term treatments
Test: Syneron skin rejuvenation and skin tightening, chemical peels, dermal fillers and botox
Caroline Cloete, 42, systems engineer
Dr Alek Nikolic says: ‘Sun damage is one of the major contributors to the changes in Caroline’s skin, including the loss of smooth texture, fine lines on her cheeks and corners of her nose, wrinkles around her eyes and cheekbones, and smile lines. She has also lost volume around her eyebrows, eyes, in the nasolabial fold, the smile lines, at the corners of the lower lips and in the area between her chin and the beginning of the jowl.
I decided to give Caroline a total makeover: her skin’s laxity was treated with the Syneron machine, which uses a combination of intense pulsed light and bipolar radio frequency (for skin rejuvenation) and infrared with bipolar radio frequency (for skin tightening). The skin rejuvenation reduces pigmentation, eliminates veins, reduces pore size, improves elasticity, removes fine lines and softens deep wrinkles.
The skin-tightening treatments lift the area around the jowls and eyes. NASHA fillers were used to address the loss of fat volume on her face and to enhance her lips, and Botox smoothed out frown lines and crow’s-feet. In addition I used the Matrix IR non-ablative fractional laser to treat stubborn wrinkles only and gave her several glycolic-acid peels to further enhance the condition of her skin.’
Caroline says: ‘My face has suffered loads of abuse from late nights, smoking and the sun, and has started to look old. I have thread veins on my cheeks and a spider vein on my nose that bother me. I have added more fruit and vegetables to my diet and I take antioxidants daily, but the damage to my skin has already been done. When I saw Dr Nikolic the first time he asked me what I’d like to change about my face. I pointed out my tired eyes and the deep creases when I smile. I hope these treatments will leave me looking younger and fresher.
The Syneron skin-rejuvenation treatment uses heat and what feels like little electric shocks, or a light flick from an elastic band on your skin. There were different levels of intensity and I was able to tell Dr Nikolic when he needed to turn it down. The hairy areas around my mouth and nose were a little more sensitive than the rest of my face.
I found the skin-tightening treatment relaxing: when Dr Nikolic held it over a muscle it felt as if the muscle was dancing – a bit strange but not at all uncomfortable.
After the treatment I had a few dark spots, like freckles, on my cheeks, which I was assured would go away. The surface veins on my cheeks were also zapped and Dr Nikolic assured me they would be gone after the next treatment. My skin was left glowing and I was told to keep my face out of the sun and apply sun block every day.
Three weeks after my first Syneron treatment, Dr Nikolic’s wife Sam gave me a chemical peel to remove dead skin cells. It lasted a few minutes and felt a little tingly and itchy. I then saw Dr Nikolic for my second Syneron treatment: it seemed to go more quickly than the first time and was not at all painful.
Sam then applied a soothing face mask. She also gave me a foaming face wash, creams for day and night use and a factor-50 sun block to use. There were more light marks on my skin, which will disappear, and my skin definitely felt softer. Three weeks after my first treatment I noticed that the broken veins had vanished and the spider vein was smaller and lighter.
Three weeks later I returned for the first of four Matrix IR laser treatments, which were done every three weeks. I found them more uncomfortable than the Syneron treatments and had a few welts on my face for a day or two. I covered them with make-up.
Dr Nikolic gave me fillers mid-way during the laser treatments. I took a friend with me to hold my hand, but it wasn’t too bad because I had anaesthetic injections to numb the area. Afterwards, I was very impressed with my plump lips!
A month after the fillers I went back for my Botox injections and some more fillers under my cheeks, eyebrows and eyes. It was an almost pain-free experience, thanks to the anaesthetic cream and small, frozen balloons I was given to numb the area. I had a few pinprick bruises under my eyes afterwards. Dr Nikolic did some top-up fillers around my eyes two weeks later.
A male colleague I have known for at least 10 years commented on how young I was looking. He said he couldn’t believe how a new hairstyle could take 20 years off of a person’s face!
My eyes have lost their tired look, the texture of my skin has improved, and my wrinkles are less noticeable. I’m extremely happy with the results and plan to maintain my youthful new look.’
Where: Dr Alek Nikolic, Aesthetic Facial Enhancement, 31 Piers Road, Chelsea Village, Wynberg, Cape Town
Contact: 021 797 0960
Cost: R24860
Test: Peels and IPL treatments, collagen remodelling
Tracey Honeywill, 43, office manager
Philippa Crichton of Tusc Clinic says: ‘Tracey has problem skin and constant breakouts. Her skin is also quite reactive (to heat, light, etc.) and has a fairly fine texture and poor elasticity and collagen strength. She also has some sun damage.
'I decided to give her a series of three chemical peels for the breakouts and three Intense Pulsed Light (IPL) treatments for sun damage, as well as collagen remodelling to improve texture and address her skin’s poor elasticity and collagen strength. I also recommended she use three QMS products to aid the collagen remodelling.’
Tracey says: ‘I’m a bit apprehensive about the chemical peels and series of IPL treatments I’m going to have over the next four months, but I’m hoping to achieve a blemish-free complexion. More importantly I want the deep grooves around my mouth to be flattened and the trenches around my eyes ironed away. Philippa started my treatment with a peel. It burnt a bit but only for a few minutes and the pain was alleviated by Philippa fanning my face to cool it down.
She applied a thick, soothing balm to my skin and I came away with a sun block for my face, the same repair balm to be applied twice daily until the tautness disappeared, as well as powerful antioxidant pills I had to take daily.
Three days later my skin started to flake off around my nose and chin and two days later I went back to see Philippa.
She decided I needed another peel, which burnt like crazy. This time my skin peeled a lot more from day three and I was told this was the desired effect.
I went back to the salon for a skin-rejuvenation treatment and the first of the Intense Pulsed Light (IPL) treatments.
An anaesthetic ointment was applied and I had to wait 15 minutes for it to take effect. Then a roller with fine needles was applied to my face about five times. This was uncomfortable but not painful. The light-therapy treatment was next and I found that extremely painful.
The treatments took around 45 minutes. My skin was sensitive for a day or two but I thought it felt and looked better. I bought a needle roller for home use and used it every second day before applying my moisturiser at night.
Unfortunately I couldn’t have my final peel because I’ve moved to Dubai. But I’ve noticed that a dark pigmentation mark on my jaw has virtually disappeared and the elasticity of my skin has improved. But I’m still getting breakouts, although not as many as I used to.’
Where: Tusc Clinic, Shop L31f, lower level, Sandton City, Johannesburg
Contact: 011 884 6577
Cost: R12 800
Test: Aluma skin tightening, botox, dermal fillers, IPL, Omnilux light therapy and microdermabrasion
Karen Chittenden, 51, sales rep
Dr Albert Niemann says: ‘I conducted a VISIA complexion analysis and decided to give Karen a three-month course of different treatments, starting with weekly sessions of Aluma skin tightening on her face and neck, Botox for her forehead, frown lines and crow’s-feet, Juvéderm filler for nasolabial folds, the corners of her mouth, top lip, chin and frown lines, Omnilux light therapy to promote healing and skin rejuvenation, IPL (Intense Pulsed Light) to improve skin texture, reduce enlarged pores and attend to facial veins and sun damage, and microdermabrasion before and after the IPL treatments to remove dead skin cells.’
Karen says: ‘I’m hoping to see a softening of the wrinkles on my face, particularly around the eye area; tighter skin along my jaw line; elimination of deep lines on my face and a general improvement in my skin texture.
The Aluma treatment was painless: a cooling gel was applied to my skin and, when the tip of the handpiece was placed on my skin, I felt a slight, warm, suction sensation. The treatment was over in 45 minutes. I had the Aluma treatment once a week for three months and I could see an improvement in my skin after the sixth treatment – the texture had improved, the lines around my eyes were softer and my frown lines were smoother.
After the eighth treatment I had Botox and Juvéderm fillers to complement the Aluma treatment. My therapist gave me an Omnilux phototherapy session to help reduce any swelling after the Botox and fillers.
On the day of my Botox and filler treatments, Dr Niemann anaesthetised the area around my mouth and top lip. He then injected Botox into my forehead and between my eyebrows (I’ve needed this since I was two years old!).
He then injected the Juvéderm filler into the corners of my mouth, my top lip, into the nasolabial fold to the right of my mouth, and into my chin, just under my bottom lip. After the anaesthetic wore off my top lip was bruised and tender.
I saw Dr Niemann seven days later and I couldn’t believe how my skin had improved. I now have no lines on my forehead and the lines between my eyebrows are almost gone. I needed more filler in my top lip, nasolabial fold and chin, and more Botox above and between my eyebrows. My next check-up was scheduled for seven days later.
At my check-up, Dr Niemann injected some more filler below my bottom lip and into my nasolabial fold. I told him he could inject it without anaesthetic but I probably shouldn’t have because it was very painful.
I have had comments from friends saying I look as if I’ve had a wonderful holiday, because I look so “rested and relaxed”. I loved hearing that! It made it all worthwhile. And it all looks very natural, which I am pleased about.
Two weeks later I returned for microdermabrasion followed by IPL treatments, which improves the skin’s texture by reducing the size of pores, age spots, sun damage and fine lines by up to 30 percent. The staff at the clinic advised me to take a painkiller beforehand and I can see why: it was quite painful when the light pulse penetrated my skin. Ten days after the IPL treatment another microdermabrasion treatment was scheduled to remove dead skin cells.
I always thought the knife was the only way to go and was very sceptical about using these types of machines, but I am absolutely delighted with the results: my skin texture has improved, fine lines have gone, and deep lines have softened.’
Where: Renew Time Restoration Clinic, Umhlanga Rocks, Durban
Contact: 031 561 1277, renewclinics.co.za
Cost: R25 000
Test: Fraxel laser wrinkle reduction
Viv Pullin-Rosenberg, 55, dance teacher
Jo Selzer of Laserpoint says: ‘Plastic surgeon Professor Donald Hudson felt Viv’s skin displayed the classic signs of premature ageing and sun damage.
Viv was a suitable candidate for wrinkle reduction using Fraxel laser. She had four treatments on her neck and face. The laser fractionally resurfaces 25 percent of the skin covered per treatment, so after four treatments you have a fresh, new layer of skin. The laser fires thousands of microscopic beams of light per square-centimetre of skin.’
Viv says: ‘I am fair-skinned and have spent a lot of time in the South African sun, so I’ve got the wrinkles that go with ageing and sun damage. I’d like to see an overall reduction in the wrinkles on my face and neck. Fraxel is known as the new laser because it involves a fraction of the downtime usually associated with laser treatments: the Fraxel machine leaves 75 percent of the skin’s surface untreated.
The treatments are repeated every three to four weeks over three to four months.
On the first day I arrived feeling apprehensive but Jo reassured me and explained the procedure. She applied an anaesthetic cream to my face; it made it feel very numb but not uncomfortable.
I relaxed in the waiting room for an hour while the cream went to work and, when Professor Hudson arrived, I lay down on a bed next to the laser machine.
The laser consists of a tip that’s rubbed across the skin from one side of the face to another, starting at the forehead.
I could feel a prickly, burning sensation and in certain areas it was quite painful, but bearable. The area around my mouth was very sensitive and I asked for a local anaesthetic when he worked there. The treatment took about 30 minutes.
At the end of the treatment I felt as if I had very bad sunburn and my eyes were weeping and felt quite uncomfortable. I drove myself home and within an hour I felt much better.
I thought I would have to stay at home for a day or two after the treatment but it was fine: my skin looked very red and was quite swollen the next day but I was able to carry on as usual. After three days I was back to normal.
I had three treatments over four months: all the treatments were the same and I had the same reaction. There has been a change in the texture of my skin and my wrinkles are less pronounced. I have noticed a reduction of wrinkles in my neck and my cheeks are much smoother.’
Where: Laserpoint, Warwick Street, Claremont, Cape Town
Contact: 021 683 5060, laserpoint.co.za
Cost: R32000
(This is an edited extract of a feature that appeared in Femina magazine, September 2008 issue. For more fascinating features like this, see the current issue of Femina, on sale now.)
