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Botulinum Toxin is an exotoxin produced by the bacterium Clostridium Botulinum and occurs naturally in nature. Botox (Botulinum Toxin A) is a purified protein derivative that relaxes muscles.

What is it? (Cascade title)

• The simplicity and safety of Botulinum Toxin A treatments are among its most compelling attributes. Its cosmetic use demands a thorough understanding of facial muscles and the neurotoxin, as well as a sound understanding of proper injection technique.

• The message for a muscle to contract is mediated via a chemical transmitter (messenger substance) called Acetylcholine (Ach).

• After injecting Botulinum Toxin A, the release of Ach is blocked (“road block” for Ach). The muscle, therefore does not contract.

• Due to the muscle not exercising, the muscle bulk decreases over time. There is no direct damage to the muscle (or sweat gland, if done for Hyperhidrosis).

• If injections are discontinued, the muscle action will resume over time.

• Regular injections, however, lead to long-term gain due to the fact that the muscle becomes smaller. Botulinum Toxin A has been proven to improve the texture of overlying skin and is locally acting. Botulinum Toxin A is also an extremely effective treatment for excessive sweating (primary focal hyperhidrosis).

Who can use it? (Cascade title)

If you are pregnant or breastfeeding or have diseases of muscular weakness (myasthenia gravis, etc.) you should not be receiving botulinum toxins.

How often should I use it? (Cascade title)
• The normal duration is 3-4 months.
• However, due to loss of habit and decreasing muscle bulk, the duration of action may increase over time, making less frequent treatments possible.
• The duration for hyperhidrosis (excess sweating) is longer – on average 7 months for armpits.

Fractional Laser

Do you struggle with sun damage, pigmentation, age spots or uneven skin tone problems?

Dermatologists have been eliminating fine lines, wrinkles, sun damage and other undesirable skin conditions with help of resurfacing lasers for years.

In general, laser resurfacing treatments fall under one of two categories: ablative lasers and non-ablative lasers. Both ablative and non-ablative resurfacing can give you dramatic improvements, but they do differ significantly in the final results they produce.

We have the following fractional resurfacing wavelengths available:

1. Thulium for complexion blending
2. Erbium for increased elasticity
3. CO2 for reducing wrinkles or severe sun damage.

Fractional Thulium is a non-ablative laser treatment that is for used for complexion blending. It strengthens skin and gives it a freshness that very few other treatments can do.

Thulium is also the medical laser of choice in the treatment of actinic keratosis – a crusty, scaly growth caused by damage from exposure to ultraviolet (UV) radiation and the early signs of skin cancer.

The Fractional Thulium Laser treats sun damage, known as “actinic damage”. Take note that the laser does create some downtime, which needs to be taken into consideration.

One of the unique key indications of Fraxel is that it offers a solution for treatment areas that have been untreatable in the past, such as the neck, chest, arms and hands.

Is it safe? (Cascade Title)
Safety is a key feature of Fraxel technology that has not been overlooked. In most patients it can achieve 20-40% of the results of standard laser resurfacing (with minimal downtime and side effects). The technology is highly advanced and many safeguards have been built into the system, enabling us to treat a wider range of skin types.

This treatment fits into its own niche between the less aggressive microdermabrasion and Photofacial on one hand, and standard ablative laser resurfacing on the other. The treatment area acts as a computer screen with many pixels that are unable to be seen with the naked eye. Only a “fraction” of the pixels (17-20%) are affected with each treatment. With 80-85% of the face untreated, the healing is rapid, safety is guaranteed and the downtime minimised.

Who is a good candidate? (Cascade Title)
• The best candidates are those with mild to moderate wrinkles, who have brown age spots and rough skin – all characteristic findings of actinic damage. For patients with an outdoor lifestyle or living in an “outdoor” environment, such as sunny Cape Town, that are subject to the ongoing free radical damage and, despite their best efforts, have suffered sun damage and mild to moderate wrinkling, this treatment would be ideal.

Who should not be treated? (Cascade Title)
• This treatment is not for those who have primarily vascular issues, such as redness, Rosacea, telangiectasia or broken capillaries. Photofacials or Pulsed-Dye Laser (hyperlink) would serve these patients better.

• This treatment is not also not ideal for those requiring significant improvement in skin laxity or the treatment of severe wrinkles.

How often should I be treated? (Cascade Title)
Treatments are classically repeated every 4 weeks so that eventually the entire face, neck, chest and hands can be treated thoroughly. Therein lays the basis for the development of fractional resurfacing. Take note that the more aggressive the treatment and the higher the fraction treated with each treatment, the more downtime the patient can experience.

What should I expect? (Cascade Title)
• The treatment pixels vary in thickness and depth, depending on the energy utilised and the number of passes. The heating of these tiny columns of tissue destroys the old and damaged collagen fibres. The skin releases the destroyed collagen to the skin surface, resulting in the skin feeling dry and flaky, much like sandpaper, for a few days.

• The columns of heated tissue initiate a response by the body to lay down a new layer of youthful collagen as part of wound healing, thus addressing and improving mild to moderate wrinkles. This collagen remodelling is done over time; therefore the final result may take several months to maximise.

• These columns of tissue are fairly unique in the fact that they can be much deeper than any standard laser treatment, such as Photofacials or Vascular Lasers (hyperlink), and the treatment is even deeper than standard laser resurfacing itself.

• The key is in sparing 80% of the skin surface with each treatment, which allows continuation of normal daily activities within 24 hours with the exception of aggressive treatments on sensitive skins.

• Patients see significant improvement in alteration of the colour of the skin (dyschromia) and hyperpigmentation and mild to moderate improvement of wrinkles. The value of this treatment is that every patient sees an improvement, unlike some other techniques, which may be more variable.

• Depending on the aggressiveness of the treatment a 20-40% improvement of wrinkles and a 70-95% improvement in pigmentation can be expected as the result of 3 to 5 treatments. The more aggressive the treatments and the higher energy the patient can tolerate, theoretically, the better the result.

What is downtime?
• Most patients have several hours of mild swelling and redness, much as if they have acute sunburn.
• The redness usually fades within a day, although in sensitive skins it can last for 2 days.
• Mild and residual swelling, noticed most commonly around the eyes for 24 hours, may also be lengthened to two days in sensitive skins.
• All patients have been able to return to work the following day, depending on the patient’s schedule, personal desires and aggressiveness of treatment and sensitivity of the skin.
• Scaling or scabbing and crusting are extremely rare and have been unreported to date with Fraxel.

Does it hurt?
• In order to promote the production of new collagen, the laser treatment needs to reach the dermis and will have some effect on the nerve endings, which results in variable degrees of discomfort.
• Superficial and mild treatments are not painful, but lack the effectiveness that most patients with the conditions noted above require.
• Fractional resurfacing is a reasonable compromise, as the discomfort is manageable.
• Patients describe the sensation equal or mildly more uncomfortable than a Photofacial (IPL) (hyperlink), but not nearly as uncomfortable as Thermage (hyperlink).
• The face needs to be prepped with a topical anaesthetic gel, which is applied 45-60 minutes prior to the treatment. This suffices for most patients.
• Every patient’s pain tolerance is different, but extreme measures, such as oral anti-anxiety medication or narcotics, should not be necessary.

Fractional C02 Laser

Do you suffer from severe wrinkling or sun damage to your skin?

Dermatologists have been eliminating fine lines, wrinkles, sun damage and other undesirable skin conditions with the help of resurfacing lasers for years.

There are various laser treatments available on the market, so if you’re thinking about laser resurfacing, it’s important to consider all of your options before making a commitment to one particular laser treatment.

In general, laser resurfacing treatments fall under one of two categories: ablative lasers and non-ablative lasers. Both ablative and non-ablative resurfacing can give you dramatic improvements, but they do differ significantly in the final results they produce.

Fractional CO2 laser delivers the results of traditional ablative lasers (which work by vaporising the outer layers of the skin, causing the skin to heal and restructure), but with the faster healing and safety of fractional technology.

How are Fractional CO2 treatments different from Fraxel? (Cascade Title)
As a non-ablative laser, Fraxel changes the epidermal and dermal tissue to a semi-solid or solid state, while penetrating the outermost layer of the skin (Stratum Corneum) without breaking the skin. As a result, there is no clinical downtime and, depending on the aggressiveness of the treatment, social downtime is only 2-4 days.

The ablative CO2 Fractional Laser, on the other hand, still treats the skin fractionally, but it microscopically removes all layers of the skin in its treatment zone, including the outermost layer of the skin. Due to the removal of the skin’s protective barrier one can expect pinpoint bleeding and some oozing. There is a very small risk of infection following the treatment, due to breakage of the skin’s barrier function.

Thanks to fractional technology, the risk is much lower than traditional ablative lasers. Depending on the aggressiveness of the treatment, clinical downtime may last up to two days and social downtime may last 1 week.

What should patients expect after Fractional CO2 treatment and what are the risks involved? (Cascade title)
• Due to the aggressiveness of the treatments, patients may have some pinpoint bleeding, as mentioned above, as well as some oozing for up to 48 hours until the wounds close up.
• The most common side effects are swelling, which usually subsides within a week, and redness, which may last up to a month.
• Other temporary side effects may include minor itching, dry skin, peeling or flaking and a bronzed skin appearance.
• Some of these skin reactions may not occur with all patients.

Facial Lifting

Our faces can tell many stories, and while wrinkles might say “experience”, droopiness can say “tired”. Surgery has always been an option, but now there’s ULTHERAPY, a non-invasive ultrasound treatment for counteracting the effects of time and gravity on your skin.

The beauty of the ULTHERAPY procedure is that it uses the body’s own regenerative response to gently and gradually restore the angles of the face and underlying tissue support.

How does it work? (Cascade title)
• As with ultrasound, a smooth applicator placed upon your skin projects an image onto a screen that allows your dermatologist to plan where the energy will be directed.
• This same applicator is then used to deliver low levels of focussed heat at just the right depth below the skin at the muscle layer to achieve a constricting effect, all the while leaving your skin undisturbed.
• Your skin’s response to the energy is to stimulate the growth of new collagen.
• A gradual tightening occurs, resulting in a natural lift over time.

Hyaluronic Acid Fillers

Would you like to restore volume loss and prevent the sagging that occurs with age? Hyaluronic Acid Fillers (HA) has been proven to improve skin quality both by improving hydration and stimulating new collagen production.

What is it? (Cascade title)
• Fillers are an injectable treatments used for lifting, beautifying features, filling lines and also improving quality of skin.
• Hyaluronic acid is a substance occurring naturally in the human body, whilst synthetic forms are used for treatments. One of the unique and major advantages to using HA is the fact that it is reversible by injecting an enzyme that dissolves it.
• Non-HA fillers do not have this advantage.

What can I expect? (Cascade title)
The filler is injected with a fine needle. We may apply a topical anaesthetic gel prior to procedure.

How long does it last? (Cascade title)
The duration of effect is related to the number of cross-linkers used and varies within each product range. New technology fillers can last up to 18 months.

Mole Mapping
Mole-mapping is a medical record which records images and the location of lesions and/or moles or dark spots on the body. It is useful because it not only detects an immediate problem, but your moles are also scanned digitally and then stored so that when you return for a follow up later, you can detect any changes in the composition and density of the mole – which is one of the key signs of skin cancer.

Who should come for this procedure (Cascade title)
Adults over the age of 18 years. Practically speaking, the following people should consider mole mapping:
> Patients with many moles
> Patients with atypical moles
> People with fair skin and a history of excessive sun exposure
> Patients with a personal history of melanoma
> Patients with a family history (1st degree relatives) of melanoma
> Anyone who is concerned about his/her moles.

What can I expect? (Cascade title)
Mole mapping takes place in 2 stages:
• Full body photography is done to record where the moles are located on the patient’s body.
• Each mole is photographed with a specialised dermoscopic camera. The picture is stored in the computer’s database and the position of the mole is captured on the patient’s body.
• The image of the mole in then analysed, either by the dermatologist or by the computer itself.
• On the patient’s future return visit, each image can be compared with its earlier picture.

How often should I be mole-mapped?
• This would depend on the patient’s risk analysis.
• Most people require an annual visit. However following the diagnosis of a melanoma, patients are seen every 3-6 months, for the following 2 years. This is then followed by annual visits.

Photodynamic Therapy

PDT is a medical treatment for severe actinic damage and pre-cancerous lesions, such as actinic keratosis. An ALA cream (Aminolevulinic acid) is applied to the skin which is activated by LED light that selectively destroys cancerous cells. A consultation is advised prior to procedure.

It can also be used for sun damage and rejuvenates skin texture and appearance.

What can I expect? (Cascade title)
After the treatment one must avoid sunlight and other intense light sources completely for 48 hours. The majority of people will have mild redness and minimal discomfort but about 5% will experience a “sunburn” like reaction in which they are uncomfortable for 24 hours and the skin looks red and peeled for 2-3 days.

Sclerotherapy is a popular method of eliminating varicose veins and superficial telangiectasia (“spider veins”) on the legs during which a solution, called a Sclerosing agent, is injected into the veins. Sclerotherapy treats the visible blue and bright red veins but it does not treat large veins.

What can I expect? (Cascade title)
You should expect the disappearance for approximately 60% of the visible spider veins after a treatment.
The legs are dressed in a compression bandage or stocking for 8 hours post-treatment. The legs look bruised for approximately 2 – 4 weeks. Results are seen after about 4 months of treatment.

How many treatments do I need? (Cascade title)
The number of treatments needed to clear or improve the condition differs from patient to patient, depending on the extent of varicose and spider veins present. Usually patients require between 1 – 3 treatments. These are done a few months or even a year apart, as the legs continue to improve for months after treatment.

How long does it last? (Cascade title)
This varies between patients, but the effect of sclerotherapy holds well for more than a year. Patients often come for a top-up after 1 or 2 years.


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