- What/who inspired you to start practicing appearance medicine- and how long have you been practicing for?
I was on the surgical training program, working at Middlemore and training towards a career in Plastic and Reconstructive surgery when a friend of mine asked if I'd do his Botox for him, as I was studying Plastics, and he assumed that meant Cosmetic Surgery. At that stage I had only used Botox to treat children with cerebral palsy to help them walk (we treat babies as young as 18 months old, with amazing success), so it was a bit of a mental leap for me to consider using it for wrinkles! I told him I'd research it, and only do it if I was happy with the procedure.
While researching the Botox treatments, I realised that there was a lot more to it than people realised, and that it tied together my passions of human form art, procedural medicine, anatomy and helping people.
I was fortunate to go and train with the pioneers of Cosmetic Botox, and some of the top people in the world, and in 2001 I became the first doctor in Australasia to specialise exclusively in Botox, launching The Face Place in Vulcan Lane as NZ's first specialised Botox Centre. This means that we can (and do) use Botox for so much more than just frown lines. So I've been doing Botox for about 14 years now - wow, that sounds like a long time! It's been an awesome journey...
While I was travelling and training with these amazing international doctors, I saw the concept of the medical spa, so I came back and started researching how to do it here. In 2004 we moved 3 doors down Vulcan Lane, and re-launched The Face Place MedSpa as NZ's first medical spa. Our concept of the MedSpa is that it is that we have a team of experts who provide safe, simple and effective, medically proven cosmetic treatments that are non-surgical, and can be done in a lunchtime. We only provide high reward, low risk treatments, and we trial everything ourselves first, as we want to make sure our clients get the best advice and results.
Our highly trained doctors and nurses provide structural changes to the face with injectable treatments such as Botox and dermal fillers, while our medical skin therapists help you achieve beautiful, healthy skin, using the medical end of skin therapy. We don't do 'fluffy treatments', all the treatments are proven to make change in the skin - and we focus on beautiful, natural looking results with minimal discomfort and downtime.
- Tell me more about your on-going training...travelling to Harley Street Clinic to train must be amazing!
We have an incredibly strong training program for our doctors and nurses, with regular internal and external training, including regular conferences, and visiting experts who come to the clinic to share their techniques and experiences. I'm fortunate to have the opportunity to work with some of the top doctors in the world on a regular basis, as I'm constantly attending leading international conferences to keep our knowledge at the forefront of the industry in NZ. I then get to share this information with our team, and I'm really proud of the amazing team we have.
In London I work with Dr Tapan Patel, and Dr Raj Aquilla, at the PHI clinic in Harley St. Tapan and Raj are master trainers for Botox and Juvederm for UK and Europe, so I'm very blessed to have the opportunity to work with them. We have a lot of regular clients who travel from all over the world to our NZ clinic for treatments, and we realised there was demand for a northern hemisphere base. I have a British Passport and can work in the UK, so about 18 months ago I started working with Tapan, so that I could see our Northern Hemisphere based clients more regularly.
- Are you a fan of having any appearance medicine performed on yourself? If so, who does this for you?
I would not use anything in the clinic that I would not use myself, and I've trialed most of the products and procedures first hand, as have most of my team. I've been having Botox for the last 14 years. I have huge trust in my team as they are highly skilled, so I will usually get one of my team to treat me. In addition to our regular training, we have quarterly 'team training sessions' where we treat the whole team, and it's a great opportunity to trial new techniques and procedures on the team, as well as ensuring that the whole team is cohesive and consistent with our regular treatments.
- Aside from appearance alone, what are some other benefits of having these treatments done?
Most of the procedures we do have additional benefits beyond the cosmetic realm. Botox is approved in NZ to treat excessive sweating and has been successfully used off-label for many years to treat conditions such as migraine, tension headache, teeth grinding and Bell's palsy. Recent research has shown that Botox used in the frown line can reduce the symptoms of clinical depression over a 6 week period. There are hundreds of different medical concerns that Botox is used for, and they are increasing all the time. In the hospitals it is commonly used for various forms of spasms, chronic pain, and contractures. The use of Botox cosmetically was discovered as a side effect of treating eye spasm, when in 1987 Dr Jean Carruthers noticed that people she was treating for eye spasm wanted the other eye treated when their wrinkles disappeared!
Treatments such as PRP (platelet rich plasma) have been used for over 10 years in sports medicine and orthopaedics to help ligaments and tendons repair after injury. PRP uses the healing power of your own platelets and is increasingly used to improve healing and rejuvenation in all forms of tissues.
We have used PRP for skin rejuvenation for over 5 years at The Face Place, but in the last 1-2 years the treatment has blossomed in the range of concerns being treated, and its effectiveness as a rejuvenation treatment. I recently attended a conference in Venice of many of the top PRP physicians from all around the world, and there were doctors representing a plethora of different specialties, with presentations on using PRP to reduce hair loss, improve skin conditions, treat dry eye, improve sexual function in both men and women, reduce stress incontinence, treat osteoarthritis, rapidly improve non-healing ulcers, reduce scarring and improve the recovery and outcomes from many different types of surgery.
I believe PRP is on the verge of becoming 'the next Botox' in terms of the impact it will have on rejuvenation both medically and cosmetically. However I believe PRP will be 'bigger than Botox', as it uses something that is your own - your platelets - and is utilising your body's own natural healing processes.
- Do you think that things like Botox/dermal fillers are becoming more mainstream and accepted these days? If so, why do you think that is?
When I first started in the industry 14 years ago, not a lot of people knew about Botox, and I'd often have to explain what it was and how it worked. You have to remember that it grew from being provided in a few clinics in North America in the late 1980's to being the number 1 cosmetic procedure in the US by 2001 - purely by word of mouth. As a result, there were a lot of myths about Botox, due to the 'Chinese whispers' nature of word of mouth, and the misunderstanding by people who were non-medical, of some of the medical terms used. We still occasionally have to educate people to correct some of these myths, even today when there is so much more awareness.
In 2001 Botox received FDA approval for the cosmetic indications (it had been approved for medical indications prior to this). All of a sudden, this meant that Allergan -the company that makes and distributes Botox worldwide - could provide education and information direct to the consumer about the cosmetic benefits of Botox.
At The Face Place we have always been strong about educating our clients about whatever products or procedures we're using for them, mainly because it helps people understand the procedure, and makes it much less scary - once you understand and have had the procedure you realise how easy it is, and also the art that is involved for your clinician to achieve the best possible results for you.
I was fortunate to be one of the key doctors for a TV program called 'Ten Years Younger' which was incredibly popular in NZ and overseas (it went into 40+ different countries), which gave me the opportunity to provide accurate information and education about Botox and other cosmetic procedures, plus I wrote a column for NZ Woman's Day Magazine for several years. As people saw the procedures and started to understand them, they became much less scary... These days many people see it as just part of their maintenance routine, much like having your hair and nails done regularly.
It's not just a change in attitude that we've seen in the clinic. A 2011 study of 1000 people across Australia and NZ revealed that 96% of those surveyed felt that cosmetic procedures were much more socially acceptable than they were 5 years previously. I believe that much of that came from the procedures being used and talked about more regularly in the media and amongst their friends.
- I love that you’re well known for a less is more approach to treatments- have you ever had to advise against anyone getting a procedure done because you didn’t think it was necessary?
Almost on a daily basis! We have a strong culture based around providing honest advice, and not letting our clients go 'too far' with their cosmetic procedures, so we will regularly advise people against procedures we don't believe will benefit them. There is nothing worse than the 'gut wrench' you get when you see someone who has had far too much 'work' and has a flat, shiny, expressionless forehead, overblown lips, or puffy cheeks - I hate those looks and we will never do that to our clients.
Our aim is to soften the negative signs of ageing, while still retaining all the features of your face that make you uniquely you! I will usually put myself in my client's position and think 'now if I was them and I knew what I know, would it be the right thing for me?'. We reassess your face each time we see you to make sure that the treatment we are planning is still suitable for you, and we tweak it each time if we need to, to get you the best possible results.
- Are more males starting to receive treatment these days- and is their pain tolerance any different? ;)
We've always had quite a high number of men coming for treatments, however I think it's more socially acceptable for men to be investing in their appearance these days. Everyone has a different pain tolerance, and this can vary from day to day... I'm personally a complete wimp when it comes to pain (as most of my team will attest to), so we're always looking for ways to make our procedures more comfortable, more effective and have the least possible down time. We were the first in NZ to offer 'less ouch' Botox over 10 years ago, and I think that appealed to both men and women!!
- Speaking of pain...how much does it hurt? Does Botox hurt more than dermal fillers?
They're both actually really easy! They're not completely painless, but most people will put them on par with plucking your eyebrows, and speaking personally as a 'pain-a-phobe' they're definitely easier than having a Brazilian wax!! Dermal fillers used to be quite painful, however these days we use products that have an anaesthetic integrated into the product, so both Botox and dermal fillers are pretty quick, simple and easy treatments to have.
- You’ve recently started offering PRP facials at The Face Place (otherwise known as the infamous “Vampire Facial” that Kim Kardashian received)- she was exaggerating this, right? Is it as extreme/gory as she made it out to be? And what are the benefits?
We've been doing PRP at the Face Place for nearly 6 years, and the treatment has definitely come a long way in terms of reducing discomfort and downtime, so these days it's nothing like what Kim showed on social media. Most of the NZ PRP clinicians were shocked at how painful and gory she made it look! New technology of both the PRP itself, and the delivery systems, mean that it's a simple and almost painless procedure for most people.
We are the first clinic in NZ to have a delivery system which makes it really easy and almost painless to treat large areas such as the neck, chest, arms, hands and face with PRP. The U225 meso-gun delivers small amounts of PRP precisely into the level of the skin where it will be most effective, meaning that the product also goes a lot further. The gun looks like a high tech 'James Bond' gun, so we call the treatment our '007 Mesorejuvenation'. We use this treatment to improve skin thickness, texture and luminosity in the treated areas, and we can often find we get a reduction in fine lines or crepey skin, along with some tightening of the skin.
We have developed another treatment which combines PRP with dermal needling, called 'Renewed Radiance' because that is exactly what it does - it renews the radiance of the skin in the areas we treat. The results are synergistic, so we get a 1+1+1=5 result in terms of improving skin texture, tone, thickness and radiance. This is a treatment that almost everyone would benefit from, and is especially good if you have acne scarring, large pores, dull skin or fine crepey skin around the eyes.
I've actually met Dr Charles Runels, who is the founder of the Vampire Facelift, and he is coming to NZ early next year to train me in the updated Vampire Facelift along with some other new and exciting techniques which are taking the US and Europe by storm! We'll keep you informed...
- When people find out what you do, do they ask you immediately what work they should have done? If so- how do you handle this? I imagine it could be awkward at times!
I love what I do, and I'm passionate about educating people, so it's never a problem if someone asks me what I would recommend - just be prepared that I have pathological honesty, so I WILL tell you exactly what I think! When I'm not working, I don't actively look at people and think 'she should have such and such'... Otherwise I'd be working all the time. I really enjoy helping people, so it's always lovely when someone gives me that opportunity.
- Many MUO members are interested in enhancing their lips - what do you use for this, and how long does it last for?
There are several things you could use to enhance the lips, depending on what your concerns are. If you have a gummy smile, or your lip disappears when you smile, or you have lines above the lip, very tiny doses of Botox might be appropriate. In this area we tend to use smaller doses more regularly, so it would usually last about 6-8 weeks, but as it's a small dose, it's a small price too (we charge for what we use, as it's fairer).
If you would like to add definition or volume to your lips, then a dermal filler may be more appropriate, and this can last on average about 4-6 months, or sometimes longer depending on the product used. Both Botox and fillers can start to last longer in some people with repeated treatments, and everyone is different. We can use the same dose and product on 2 people and get quite different results and longevity. Part of the art of cosmetic medicine is tailoring it to the individual person and what will suit them best.
Be warned - we will NOT do 'ju-ju' lips - lips are one of the key areas of the face we all look at in other people, especially when we're speaking with them, so it's important that the lips should be balanced in your face and not over power your other features. Your lip aperture from the top of the Cupid's bow to the bottom of the lower lip should be approximately the same as your eye aperture, and your lower lip should ideally be approximately 1.6x the size of your upper lip. Many people get far too much filler put in their upper lip and it outweighs the balance and looks strange. Our aim is to give you beautiful, natural looking lips that balance and harmonise in your face, to help you look more attractive. We love doing lips!
- Do you think that anyone is “too young” to receive any treatments that are offered?
No matter what your age is, if we can't see what it is we're supposed to be treating, we won't treat you. Many people develop lines at a young age - I first developed forehead lines in my late teens - and if it's something that's discordant with the rest of the face, then we may consider treating it. We don't treat many under 20's, although a lot of people start getting preventive 'baby doses' in their early to mid 20's. If you are under 18, you will need parental consent for treatment. The youngest clients I've treated at the clinic have been 14, however in both cases it was for medical reasons such as excessive sweating, and was with parental consent.
- I know many people would love to come and see you and your team at The Face Place, but may balk at the cost; do you offer any plans/options that could prove helpful?
We have a pre-payment plan called 'My Face Plan', which has no fees, no set contract, and is purely a service to help you save for treatments. You can choose how much you want to pay, how often, and how you want to label it coming out of your account. After completing an application form, you simply set up an AP into the dedicated account that we provide for you. As money goes into the account, it gets loaded against your file. When you come for a treatment, you can use the money in your My Face Plan account to pay for the treatment. If, for example, it's a $500 treatment, and you have $450 in your My Face Plan account, you would pay the $50 difference at the time of your treatment, and we would pay the rest from your My Face Plan.
- Obviously it’s important to carry on implementing a good skincare regime- do you have a particular range you love? What sort of products do you use on a daily basis?
Your skin has to last you a lifetime, so it's important to give it proper nutrition and care. Your skin is the largest organ in your body, and the last organ to receive nutrients from the food we eat. It's also our first barrier to the environment, and as such gets the most exposure to UV damage, toxins and pollution that destroy the vitamins and minerals that are essential for good skin health.
In Australia and NZ we are chronically depleted of vitamins A and C in our skin due to the high level of damaging UV-A (= ageing) rays in our sunshine. Most of us will need topical skin nutrition with vitamins A and C to reduce the impact of UV ageing. Many of us will need other antioxidants and treatment serums for our skin to achieve optimum nutrition. A healthy skin is a beautiful skin! Over 80% of the results you achieve with your skin are from what you put on your skin every day. If you are using products with artificial preservatives and fragrances you may be doing more damage than you realise. Our medical skin therapists provide a comprehensive 1 hour skin assessment that we call a skin 'warrant of fitness' or 'WOF'. Once you become a client of ours, you get a free skin WOF every year, as we believe the health of your skin is paramount for ideal results.
We get approached about different products almost every month, and will trial between 1 and 4 ranges a year (we've trialed 3 ranges this year!). I will usually do a split face trial, and we're just in the final stages of our final trial for the year, so I've been using my regular products on one side of the face, and the product we're trialing on the other.
I've trialed all the ranges we have at the clinic - and from all the many skin product ranges we have trialed, we have only taken on 4 ranges: Environ, Cosmedix Rx, Osmosis MD, and our most popular product range, Aspect Dr. We were awarded 'Medical Clinic of the Year' last year by AST, who distributes the Aspect Dr range. We will be introducing some 'hero products' from the SkinMedica range in the New Year.
Everybody has different needs for their skin, so what might be a great range for me might not be the best range of products for your needs. This is where the tailored approach is important. As part of your skin WOF your Medical Skin Therapist will listen to your concerns, do a computerised analysis of your skin, consider what products you are currently using and have used previously, and will do a hands-on assessment of your skin. From this information they can determine what ingredients you need to get your skin back into optimum condition. You will then be prescribed a skin care regimen with the combination of products that best suit your skin - which may come from different ranges.
If you want to get the full picture and receive a truly scientific skin care regimen, consider adding in a SkinDNA test, which measures your genetic tendency to the top 5 causes of ageing, and how to treat them.