Wednesday, 10 May 2017


Before I start this, let me explain that I have tried Botulinum Injections (Botox), in the past for a feature, but this was a few years ago and I was interested to see if there have been any developments or techniques in this procedure.

I was invited to the Court House Clinic to meet with Dr Kishan, a very highly qualified skin doctor with a decade of experience in anti-ageing injections, to find out the latest news in aesthetics.

I was given the opportunity to try out 'Baby Botox', ideal for someone who just wanted a natural, refreshed look without any risk of look 'frozen'. Whilst, some people actively seek the mirrored effect on a forehead that can be achieved with Botox, for me I prefer to be able to have full movement of my face and most specifically, when I cry or laugh that my whole face moves and not just my nose.  It's common to see in the press, celebrities who prefer this look and as such come with headlines such as 'what has he/she done to her face'.  A good indication of successful Botox is one where you wouldn't even know that it's been injected, simply that the person looks like they've taken care of their well-being.

Dr Kishan shared my view, that not only less is more but that Baby Botox (or 'sprinkles' as some clinics call it), was by far the most attractive way to achieve the 'few years younger' look I wanted to achieve.

When I visited the Court House in Brentwood, I was impressed that only doctors were allowed to give the injections. As I mentioned in my previous feature, Botox is a prescription only medicine, thus meaning that whomever administers must hold a license to be able to give out prescriptions, so usually falls under a doctor or a dentist. However, many clinics and salons then follow guidelines (at this present time this is under review and likely to change), that once the prescriber has written out the prescription then a nurse or therapist can administer these injections.  Most concerning should anything go wrong, then insurance companies do not hold the 'injector' responsible rather the 'prescriber', and that current guidelines state that the prescriber must always be present and this is why the Court House will only use doctors to give Botox.

After reading all of Dr Kishans credentials (see below), I was more than confident to go ahead and more so with his holistic approach, encouraged he would be 'gentle' with me. My consultation was over an hour long, and required me to fill out a detailed medical history including any medications I was currently taking. We then studied my face and the outcome I hoped to achieve.

One of the areas I pointed out were lines down by the side of my cheeks however, he explained that for this he would have to use 'Fillers' as these are what fills in lines, whereas Botox relaxes the muscle. I'm not a fan of the look of Fillers and so we agreed, that we would just do a small amount of Botox on my forehead and around my eyes.

He also made sure I was fully aware of any possible side effects such as bruising and 'droopy lid' that can happen if the wrong area is injected. This is incredibly rare and can be rectified as Botox is not permanent.

After lying me down, my face was thoroughly doubled cleansed with antiseptic to make sure there was no bacteria on the skin. He advised that patients should never wear make-up on the day as even the tiniest particles can seep into the injection site and possibly cause infection. Again another reason why he double cleanses the skin.

After marking with a pencil the areas he was going to inject, he then coaxed me through some deep breathing exercises as I'm quite needle phobic. Not that I needed to have worried, as I can honestly say that I didn't feel a thing, in fact I felt the marking of the pencil more than the actual injections. Possibly this is the result of using micro fine needles.

Botox takes up to 2 weeks to achieve its full effect and so I was invited back for an out-patient appointment, so that Dr Kishan could see if I was happy or if more was needed, then this would be injected (this is included in the initial cost).

You can see with the before and after photos the results and I have to say I'm absolutely delighted with the outcome. I didn't need any further treatment and whilst my skin was in quite good shape before, there is a gentle improvement to the extent, even my mother just said I looked healthy. There is no sign of a 'frozen face' and for those that don't know I've had it done, I've received compliments of 'you look well' and 'your skin is amazing, it must be all those products you test'. I have full movement in my face and so my kids know from my expressions, when they've pushed me to my limit.
I was talking about my experience on the radio, and you can listen to the link here. In addition I also sent some questions to Dr Kishan in advance for the radio prep.

Please could you give a short paragraph on your biography i.e. where you studied, qualifications etc, as well as a small paragraph on Court House Clinics?

Dr Kishan: Qualifications:
MBChB – Medicine and Surgery
BDS – Dental Surgery
BSc – Experimental Pathology
Dr Kishan is an Aesthetic Doctor from qualifying from Leeds Medical School and also the Royal London Hospital, he began his career in anti-ageing injections and fillers for surgical applications in 2003 and has spent many years since working in Maxillofacial surgery across the UK before developing his expertise in Aesthetic Medicine. He is passionate about treating cosmetic concerns and believes in natural-looking results. He is renowned for his gentle manner and skillful technique as well as his holistic approach to treating his patients.

Dr Kishan has a keen interest in post-graduate education and has undertaken numerous academic and practical studies in order to continue providing his patients with the best possible care. He has been awarded full membership of the British College of Aesthetic Medicine.

Courthouse Clinics is the UK's most trusted and Doctor led chain of anti - ageing clinics where the full range of facial and body rejuvenation treatments are offered. Treatments include wrinkle smoothing injections, advanced skin rejuvenation, laser and light therapies, body contouring and nutritional programs as well as intravenous vitamin infusion services. Courthouse Clinic Doctors and Medical Aestheticians are all highly trained and required to regularly update their knowledge and skills to offer the same excellent standards of care in whichever clinic our patients choose to attend for treatment.

Many people contact me as they approach their 40s, as they would like to look 'refreshed', but are scared by the images of celebrity frozen faces, what would you suggest for them?

The frozen look can be avoided by seeking out a doctor who is able to give you a thorough clinical assessment and consultation at the first appointment and working with them to create a treatment plan that you are both in agreement with. This is a key step in achieving great, natural looking results. Botox is the best known format of the Botulinum protein which we use at Courthouse Clinic. It works by reducing the contraction of the specific facial muscles it is injected into which reduces "mimic" moment of the skin overlying them. Results can look overdone or frozen if the injection doses are too high for a patient's muscles so great care needs to be taken at the initial appointment to give the minimal doses expected to give the desired result. Then, if necessary, the treatment can be adjusted further with additional doses at a follow up appointment 2-3 weeks later after the initial appointment. My techniques involve giving very small doses in a specific way to give the most natural looking effect, a look that doesn’t look unnatural or frozen.

Are there any treatments for 2017 and upcoming that will replace Botox?

I'm aware of a "freezing" treatment which lowers the temperature of the facial muscles to bring about a similar type of relaxation to wrinkle smoothing injections. However I understand it cannot be used in all the muscles that Botulinum is used in, and I can’t comment on the results as I have not had experience in it yet. One exciting treatment that we do offer at Courthouse Clinics is the skin remodelling injection treatment known as Profhilo which addresses fine lines and crepiness of mature skin by hydrating the tissues from within. This is achieving great results in areas of the face that we do not use Botulinum in.

If I have a needle phobia, is there anything that can be used as an alternative?

Apart from the Frotox treatment, there are no injection free treatments that achieve the same reduction in mimic lines, that rival the results of Botulinum, and this probably why Botox remains one of the most popular cosmetic procedures globally.

Does Botox hurt, will I bruise?

At Courthouse Clinic doctors use extremely fine needles to carry out the treatment and many of my patients remark that they have almost no pain if not completely pain-free injections with me.  With any injectable medical treatment there is a possibility that a bruise may develop afterwards and we cannot guarantee that it won't happen. However because of our technique, experience and the fine needles that we use, this risks of pain and bruising are significantly minimised.

How long does Botox last?

The real effect of Botox depends on several variables e.g. the pre-existing strength of the muscles, and the anatomy of each individual face. This leads to a wide variation in duration of effect - between 2-6 months.

How safe is Botox, there have been cases of eyelid drooping and so what can be done to prevent this?

Eyelid and brow dropping is a recognised complication of wrinkle smoothing injections and while we can't promise it will not happen, the risk is low and largely minimised by using safe techniques and a good understanding of anatomy from the injector.

I don't want to change the shape of my face, does Botox change the shape of your face?

Botox is active on mimic lines, and therefore can really only affect the surface skin that it is injected under. It does not change the volume or contours of the face unless it is injected into the jaw muscles for a very different indication.

Do I need to prepare for Botox treatments?

It is best to avoid alcohol and blood thinning medications (if not necessary for medical conditions) prior to being injected because the risk of bleeding is higher.

It is important to inject into very clean skin and I take precautions to deeply clean and disinfect the skin prior to the treatment. If possible, avoid wearing make up before the appointment.

What is the after-care for Botox? Can I exercise, drink alcohol, wear make-up etc?

Avoid exercise, hot baths, saunas, steam rooms and drinking alcohol after treatments as complications such as bruising may be more likely. Make up can worn once the needle entry points have started to heal but best to leave the skin clean for as long as possible immediately after injection.

There are many salons and in-house therapists, which offer Botox - is this advisable even if my friend's results look good?

Ultimately patients choose where to treatments based on their own decisions. I personally believe that Botulinum injections are medical treatments best delivered by medical doctors for reasons of safety, after care and of course optimal results.

I would actually advise people to look for 5 important things when considering Aesthetic Medical treatments:

1.             Feeling confident in your doctor is vital, for example, are they well qualified and suitably experienced to treat you? Do they have a good standard of knowledge about facial anatomy and skin? Do they spend time studying your unique anatomy and do they seem reassuring to you? Do they explain the treatments carefully to you? Lastly they should never make you uncomfortable or feel pressured into having a treatment.

2.             Are they carrying out these treatments regularly and do they devote time and energy in keeping current and offering you the best standards in practice?

3.             Is the treatment being offered in a clinical, safe and hygienic environment that is subjected to regular checks from patient protecting bodies such as the Care Quality Commission?

4.             Has the doctor been recommended to you from reviews or have you seen positive reviews from other patient experiences?

5.             Are the outcomes of the practitioner you choose regulated by an external standards body that is protecting patients, such as the General Medical Council?

What are the advantages aside from looking younger with Botox?

Some of the features we address with Botulinum are less about looking older, more about looking fresher and "softer". For example the furrows that develop between the brows can give rise to a 'concentrating' or even 'angry' facial expression. Relaxing these particular wrinkles gives a softer, more relaxed facial expression. Botox treatments should leave you looking like yourself, just more refreshed and softly rejuvenated.

People get confused with Botox and Fillers, please could you explain the difference?

Botox works by softening surface wrinkles that lie on overly active facial muscles, whereas dermal fillers are different formulations of hyaluronate gel which has a wide range of applications. Depending on their viscosity, dermal fillers can be used to ‘fill’ facial lines, recontour facial features, augment lip shape, give the appearance of a straighter nose, and even give glow to the skin in ‘skinbooster’ treatments. Dermal fillers are very popular because of their multiple applications and formulations.

Often people are scared the Botox is 'leaked' into their bodies and can cause side effects, is this true?

Botulinum protein needs to be injected within specific muscles to carry out its effect and only act locally.  It is a very safe protein that has been used for years in other numerous medical applications including migraine, excessive sweating, abnormal muscle and bladder function with very low risk of side effects or toxicity.

Is Botox regulated, if so by whom?

Botox is a prescription only medicine, and therefore can only be procured by a prescription from an appropriately qualified medical person. Doctors in aesthetic medicine are not only regulated by the General Medical Council for carrying out these procedures, but also, as part of the mandatory appraisal process, they have to annually demonstrate commitment to maintaining standards and improving practice by studying and updating knowledge. I personally submitted my log of 201 hours spent in educating myself this year (around four times the recommended amount)!

Is there anyone who shouldn't have Botox or who could be taking medicine that could contraindicate with the treatment?

Pregnant patients and individuals with active skin infections, and specific neurological conditions should not be treated with Botulinum.  This should be looked into carefully as part of the consultation process.

What is the cost of Botox?

£200-£400 depending on the doses required and the areas selected for treatments.


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