It all begins with

SPF 30 + H2O

(and a smile)

mouth

This is Dr Kristen’s most requested dermal filler procedure and refers to using a custom small volume of dermal filler to highlight the key structures in the lip. This procedure highlights the strengths you already have in your lips without changing them too much. The lip is treated with respect to your existing anatomy, with a tiny thread or bolus of filler being placed in anatomical segments of the lip, only where needed.
If possible, the very softest of lip fillers will be used. This is a non-standard approach, but my guess is you don’t want standard lips do you? It is preferred to have a softer product so that the lip moves and projects in the most natural fashion. Treatment with a mini lip enhancement usually lasts between 3-9 months, given the smaller volumes and choice of a softer product, it has less longevity than a standard dermal filler treatment.
Downtime is generally minimal due to the gentle nature of this treatment – you can return to your regular routine the following day. About 10% of patients will have a small bruise, and swelling is far less than a regular lip enhancement.

Mini Lip Enhancement

This refers to using a more substantial volume of lip filler, or perhaps a thicker product to achieve reinflation of lips with volume loss or with a size disharmony to the rest of the face. The word restoration means that we are putting back lost volume, or we are providing facial harmony that is congenitally missing, or has faded over time.
It is generally advised to slowly restore lip volume over multiple sessions, as slowed placement of filler creates a more perfect result, less downtime and ensures the true Minimal Effective Dose is utilised for you. An important marker for what lip volume you should have is the size of your eyes and the fullness of your facial tissue. As a general rule, a petite facial frame with smaller eyes does best with finer lips. Whilst a more rounded face with larger eyes will carry higher lip volume with ease.
Treatments like this with a more substantial volume will last between 6-12 months on average, however a reasonable portion of patients will get several years out of their treatment
Lip filler migration has been topical since some Melbourne doctors lead an investigation into how long-lasting fillers might be found to migrate after several years. Lip filler can indeed migrate, as the products can be longer lasting than is predicted, also the area is mobile without defined capacious borders to retain filler within their walls. If migration is an issue, it is very simple to solve by using a targeted dissolving technique to remove the migrated filler. Two weeks must pass before replacing filler if we agree it would best serve you.
Lip filler migration is more common than it should be due to the popularity of thick fillers being injected in over-the-top volumes. When we use softer products, with smaller volumes and a more precise technique, migration is less likely. The social media popularised ‘tenting’ technique where the lip is injected vertically also contributes to issues of migration as it will always result in deposition of filler in the white border of the mouth. I tend to steer clear of this technique, although it can be useful to use a vertical approach at times to highlight key structures like the cupids bow or lower lip tubercles.

Lip Restoration

From time to time we have lip treatments performed which don’t go to plan or don’t look as good over time. Lip Rehab refers to dissolving a previous treatment or blending out imperfections as deemed appropriate.
Lips that appear poorly treated sometimes are not in harmony with other facial structures such as the nose and chin. Occasionally dermal filler injection is required in these zones in order to provide the correct facial balance.
The best lip fillers are always those which maintain your natural lip anatomy. You should have the most height in the centre of the lip, fading out to the edges which disappear into the mouth corners.
It is important to have a thorough discussion prior to embarking on ‘starting over’ so that you can be assured of the best approach to rehabilitating poorly treated lips. If dissolver is used, you are asked to wait two weeks before replacing dermal filler, therefore you need to be comfortable having deflated lips for this time period at least.
Recent Australian studies have used MRI images to demonstrate that in many patients, lip filler can migrate. If it has migrated to the white part of the lip it can cause a displeasing ‘moustache’ of filler. If this has occurred, it can be very easily dissolved. If you are prone to lip filler migration, then there is an approach that can be used in order to prevent ongoing product migration

Lip Rehabilitation

The lines that run from the nose to the mouth, present in every face to a certain extent – even in children. Ageing of the nasolabial folds isn’t caused by excessive smiling, rather by volume loss in the mid/outer face as well as around the mouth, which causes the tissue to descend and fold inward toward the mouth.
Historically we used to inject these directly with collagen, nowadays we mostly prefer to treat the cause by replacing volume loss in the mid/outer face and globally around the mouth. This causes the tissues to lift, as though you were to put your fingers just in front of your ears and pull up, toward the hairline.
Treating nasolabial folds is about treating the cause (generalised volume loss) rather than the symptom (a cheek that has shifted down toward the mouth).
Often a deep smile line is associated with 1. A hollowing in the cheek 2. A deflated white part of the upper lip. These factors should also be reviewed and addressed if needed
Nasolabial folds are technically considered an Advanced Injection Area due to proximity to the facial artery. Because of this, injections are placed using a blunt cannula or in the superficial layers with a fine needle. This is to avoid entering this important vessel.
Dr Kristen’s approach to the nasolabial folds is to treat indirectly first by ensuring volume replacement in the suspensory zones such as the cheeks, preauricular area or white part of the upper lip. Once volume is restored, if there is any residual line that is worthwhile treating, it can be improved using a combination of cannula and needle to provide a multi-layered approach.

Nasolabial Folds

These are also known as the Accordion Lines which are the long oblique lines that occur in the cheeks upon smiling. These are uncommon before the fourth decade of life. They are due to a lack of skin firmness and depletion of tissue volume, but also muscular factors can play a role.
There are multiple options for treating them, however the best place to start would be with replacing generalised facial volume using dermal fillers.
Techniques to enhance skin firmness in this area also include PDO Monothreads, the new Bioremodeller injectable and some energy-based devices such as radiofrequency micro-needling.
Muscle relaxant injections may be used in select cases if it is thought that muscle activity is contributing and there is a hyperdynamic muscular pull on the tissue upon smiling
They can be somewhat resistant to treatment being in such a dynamic area, which is mobile when you eat or talk or smile. Also, because the lines are only there when you move, if we were to put filler in them, it would look weird when you are not smiling! Therefore treatments are aimed usually at softening the accordion lines rather than completely removing them.
A nice dermal filler technique in this area is called the ferning technique, involving micro-injections of soft dermal filler in multiple directions. The clinical outcome of this technique appears to be structural support of tissues in the event that they are highly mobile, such as those around the mouth.
Additionally, a new Skin Bioremodeller gel became available in Australia in 2022. It is to be used in the region where the accordion lines occur. It stimulates your own collagen, elastin and other layers of the tissue to become more plentiful and youthful. It has been giving excellent results in managing this area.

Smile Lines

Fine usually vertical lines occurring above the upper lip are sometimes called smokers lines or barcode lines. They are a result of both volume loss and repeated pursing of lips resulting in tiny folds.
What works best is usually a combination of muscle relaxant AND dermal filler.
The muscle relaxant helps to control the repeated micro-folding of the upper lip skin and also helps any dermal filler injected here to last longer. The dermal filler is often performed in two stages – first a deeper layer through the whole upper lip area to restore lost volume, and then some very fine dermal filler can be injected superficially into the fine lines to improve their appearance
Skin boosters are specific treatment to this area as they are essentially a very fine dermal filler which can soften superficial lines and go unnoticed. They are placed in the most superficial layer of the skin and cause a hydrated appearance without volumisation
An important principle in this area is to treat slowly and gently as it is highly mobile and a key visual point in the face. The mouth, eyes and complexion are the most attention receiving aspects of the face, and so treatments should be performed in the most gentle fashion, successively increasing the dose so that the structures move and look completely natural.
Also there is a strong neural pathway between the mouth and the brain. This is because the mouth is one of our most utilised sensory structures. Therefore, if muscle relaxant is used in this area, about 20% of patients will be able to sense the change in their mouth motor fibres within the first two weeks. Most patients find this subjective phenomenon passes quickly and will choose to still continue with the treatment. Because this area is highly mobile, muscle relaxant will only last up to six weeks. This is a reason why it is often recommended to also use small amounts of dermal filler or skin booster to support your results.
A nice dermal filler technique in this area is called the ferning technique, involving micro-injections of soft dermal filler in multiple directions. The clinical outcome of this technique appears to be structural support of tissues in the event that they are highly mobile, such as those around the mouth.
Additionally, a new Skin Bioremodeller gel became available in Australia in 2022. It is to be used in the region where the accordion lines occur. It stimulates your own collagen, elastin and other layers of the tissue to become more plentiful and youthful. It has been giving excellent results in managing this area.

Above Lip Lines

These are the inverted triangular shadows running from the corner of the mouth to the chin. Patients sometimes will refer to this as ‘sad face’ as it causes the facial expression to appear to be sulking.
They are caused by multiple factors, most often 1. Facial volume loss north of the region causing the tissues to droop 2. Volume loss around the mouth and lips 3. The repeated activity of muscles which pull down the corners of the mouth
The best way to treat these is using a combination of muscle relaxant injections and dermal filler. Some patients may receive only filler in the area of the marionette, known as the ‘Happy Face Technique’, whilst other patients require more extensive volume repletion with dermal filler
Injecting muscle relaxant near the mouth corners is a vital principle of Preventative Cosmetic Medicine at any age, as decreasing the activity of these muscles will slow or stop the down turning of the mouth corners. You might be aware of someone in the generation above you who has deep shadows that appear to pull down their mouth corners. This might be a reason why you’d choose to have muscle relaxant placed here prophylactically.
Marionette lines often appear in the mid thirties, and having some minor shadowing in this area does help patients look real. I have found over the years that overfilling this area detracts from the beauty of the mouth and central chin which are all key visual points in facial aesthetics. It is an area where I commonly encourage patients to seek ‘softening’ rather than complete obliteration of the shadow here. There are a few signs of ageing that help us to look real and beautiful.
It is always best to look around your age, rather than ‘ageless’ which is associated with the overly plastic look being marketed on social media. Having a slight shadow in the marionette, or perhaps the slightest hollowing in the mid cheek are common areas I will not always treat to complete fullness in order to achieve this.
Not all ageing must be reversed. Much of it is beautiful and we need to change our attitudes to this. Seeking complete reversal of facial ageing usually results in an unnatural look which can impact upon your ability to gain friends, progress in your career and ultimately affects your self esteem. The true art of cosmetic medicine is not knowing how to treat, but knowing when not to treat and how to educate your patients about why.

Marionette Lines

The corners of the mouth turn downward over time due the activity of the depressor angulis oris muscules or DAO. This muscle attaches to the mouth corners and pulls it downward as part of your usually facial expression. However it’s activity becomes dominant as we age, therefore the mouth corners appear to be permanently down.
Volume loss also contributes to a downturned mouth, causing a hollowing in addition to downturned corners.
Prevention of a downturned mouth is relevant to all ages. By injecting a tiny of amount of muscle relaxant every three months, we are able to decrease muscle activity on the mouth corners. This is one of the components of preventative Cosmetic Medicine.
Treatment of a downturned mouth consists of tox injection to relax the muscle here, and in some cases careful placement of dermal filler will support the tissues if there is contributory volume loss

Downturned Mouth

This is when the gums are visible during smiling, caused by overactive muscles pulling the upper lip too high. It is usually due to the LLSAN muscle which runs down the sides of your nose to the mouth. It can also be caused by the zygomaticus muscle which runs through your cheek. A lack of volume in the lip will also mean there is less coverage of the gums upon smiling.
This can be treated using muscle relaxant injections, often combined with dermal filler where there is a lip volume issue.
There are several target points for this injection along the length of the muscle, which runs either side of the nose down to attach on the upper lip. Therefore you may injected at the sides of the nose, or above the upper lip in most cases.
A definitive approach to treating the Gummy Smile is often a combination of muscle relaxant injections and a tiny amount of dermal filler in the lip. This is particularly helpful when the sides of the lip nearly disappears and folds inward when smiling.
The major downfall of Gummy Smile treatment is that toxin around the mouth wears off quickly usually within eight weeks. To curtail this, placing that small amount of dermal filler in the upper lip will give a longer lasting result.
A small proportion of patients dislike having any muscle relaxant injections in association with their mouth. They usually only know after they have tried it. To minimise this negative effect, your first treatment is usually done with a small dose which can be gradually increased according to your response and how comfortable you are with the treatment.
Some Gummy Smiles involves complex muscular anatomy and there may be sideways pull on the smile by muscles in the cheek. In these instances, sometimes injecting tox in the crows feet can help. Often this type of smile can be difficult to fully correct. It is most common to see this type of Gummy Smile in people who are asymmetrical and pull only on one side of the upper lip.

Gummy Smile

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eyes

The lines the radiate from the outer corners of your eye can be called crows feet. There are a multitude of lines that may occur around the eyes though. There might be true crows feet, as well as lines in the eyebrow skin, or commonly, lines under the eye. It is important to artfully reduce these lines, as they do contribute to making you appear friendly, dynamic and expressive which are all highly desirable in Natural Aesthetic Medicine
Muscle Relaxant injections can be placed in a highly customised fashion, to ensure the correct amount of contraction in this area when you smile or express yourself.
- Muscle Relaxants placed here can be helpful in preventing the Smiling Lines from getting long and ingrained into the skin
- Generally speaking, most patients are good candidates for muscle relaxant into the upper Smiling Lines. The lower lines that extend from below the outer corner of your eyes can be more difficult to manage.
- Lower lines are often formed by the muscle that keeps you under eye bag nice and firm, or the muscle which helps you to smile. Therefore relaxing these muscles is not advised. Lower smiling lines are often best left alone, but in a few select cases can be ameliorated with a combination of muscle relaxant, dermal filler and treatments to assist integrity of skin around the eye

Crows Feet

The Tear Trough is the hollowing underneath the eye. It is different to the ‘eye bag’ which is a bulge rather than a hollow. If you have a an undereye swelling, rather than a hollow, this will be due to a fat pad (if permanent) or allergic/lymphatic disorders (if fluctuant). If there is swelling under the eye, then tear trough filler is generally not advised. A true tear trough looks like a crescent shaped concavity, causing a ‘trough’ sitting as a rim above the upper cheek.
Filler in the Tear Trough is one of the most requested treatments and patient selection and examination is of utmost importance. For every ten or so patients who request tear trough filler, about seven of them actually need correction of the upper cheek area first or instead of direct tear trough filler.
In order to be a good candidate for this treatment you should meet the following criteria 1. There is hollowing present under the eye (as opposed to an eye bag or discolouration alone).
2. The undereye skin should snap tight when gently pulled meaning that you have the correct skin elasticity to hold the filler in and prevent it from superficializing
3. Surrounding structures such as the cheek and lower temple should be addressed first to provide as much support as possible to the skin
Importantly, tear trough filler should be avoided if you are prone to slight swelling under the eyes when you are fatigued, suffering allergies or sinusitis
Most often Tear Trough filler is performed in two stages, in order to allow the lymphatics of the orbital area to adjust and to ensure that you are ultimately given the Minimal Effective Dose
Sometimes for very deep Tear Troughs, it is necessary to place a firm filler to give height to the orbital rim (bony part of your under eye) prior to placing the classical soft luxurious Tear Trough filler.
Dr Kristen’s favourite dermal filler to use in this area contains amino acids and peptides which may act to assist with improving discolouration under the eye. This is the only dermal filler specifically marketed and with targeted research with regards to the Tear Trough region.
Surprisingly tear trough filler is generally not very uncomfortable, the area is generally not very pain sensitive. Local anaesthesia infiltration is used prior to passing a cannula to fill the area in many cases. In others, the tiniest of needle tips is used to place filler whilst minimising risk of bruising.
As far as complications go, tear trough filler has historically been prone to swelling or superficializing to the point where it can be seen under the skin as a blue stripe called the Tyndall effect. This complication generally occurs due to a combination of factors such as 1. Skin not firm enough to hold filler deep along the orbital rim 2. Too much or too frequent injection of the area 3. Inherent patient factors such as allergies or other complaints causing regular under eye swelling which could make the filler appear projected.
It is of utmost importance to have this area treated only after a thorough history and examination. Dr Kristen has treated many patients with tear trough filler and will be able to assess whether you are a good candidate with minimal risk of the complications that have historically been attributed to this area. The tear trough should never be over filled

Tear Trough Filler

The Plasma Pen is a handheld device which transmits energy very similar to laser, allowing Dr Kristen to perform lifting and tightening of the skin around the eyes
The Plasma Pen used is approved by the TGA for operation by medical professionals in Australia, which differentiates this device from other less powerful devices in circulation in the industry
Having three treatments provides a result very similar to a surgical blepharoplasty in appropriate cases
The downtime is one week, with tiny brown microdots appearing on the skin which has been tightened. These come off naturally over 5-7 days. The skin then appears red.
You will be provided with complementary healing LED light therapy as you recover
This treatment is only available at Dr Kristen’s Sandringham location, the highly regarded Southern Cosmetics Clinic
Having three treatments provides a result very similar to a surgical blepharoplasty in appropriate cases. The downtime is one week, with tiny brown microdots appearing on the skin which has been tightened. These come off naturally over 5-7 days. The skin then appears red. You will be provided with complementary healing LED light therapy as you recover
This treatment is only available at Dr Kristen’s Sandringham location, the highly regarded Southern Cosmetics Clinic.

Plasma Blepharoplasty

PRP Skin Rejuvenation

PRP refers to Platelet Rich Plasma. The procedure involves taking your bloods, then processing it in a centrifuge to isolate the platelets and associated growth factors. The serous component of your blood is injected into the skin to assist with skin rejuvenation.
This is a particularly good treatment for those who want mostly skin rejuvenation. Most PRP treatments by a doctor will result in some degree of bruising, however it can also be microneedled into the skin using a needling pen which causes only redness for a day.
The most common way to use PRP is to inject it globally to the entire face, and is a great option when you want skin rejuvenation without using dermal filler. It is also used for treating the delicate under eye area, usually as a series of treatments. It can also be used to stimulate hair growth where there is familial hair loss. Another interesting use of PRP is injection into joints where there has been injury or arthritis, in which case the cartilage is stimulated to heal.
PRP injections are only available at Dr Kristen’s Sandringham location

The under eye skin is the thinnest skin on the body and can be prone to premature ageing, as it is highly mobile when we laugh and smile. Dr Kristen may prescribe a compounded eye serum or series of laser or plasma treatments to cause collagen formation in the under eye skin.
Where there is a tear trough hollowing, dermal filler might be used.
Where there are skin issues like sagginess or crepe texture, then collagen stimulating modalities might be used.
Dr Kristen can prepare you a formula that has unique and powerful ingredients specifically focused on thickening skin when the cause of thinning has been loss of the female hormone oestrogen. This serum is generally used under the eye in patients who find that they have naturally fine and crepe-like skin in this area. The serum is from the Universkin range, and consists of raw ingredients which are prescribed according to your needs, and then mixed up for you.
In younger patients, a retinol containing under eye serum is recommended as tolerated. Where there is obvious lack of skin firmness, a series of laser treatments or PRP can be used to rejuvenate the skin.

Skin firming under eyes

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upper face

The lines across the forehead are a common concern for a patient who is new to cosmetic injectables. Lines across the forehead are due to a combination of muscle activity and sometimes volume loss of the tissue or skull.
They are best treated using muscle relaxant injections in an artful manner. Dr Kristen will carefully diagnose your forehead lines and treat them in the most natural appearing fashion, ensuring the eyebrow position remains neutral or heightened if that would look best
A frozen forehead in most cases is not appealing and there is a way to soften lines whilst allowing a pleasing range of movement.
In the male patient, it is desirable in many cases to have 2-3 lines in the middle of the forehead and treatment can be customised to this effect. The male forehead muscle is usually very strong and requires at least 10 units of muscle relaxant, even up to 20 units might be used.
It is particularly important to ensure a balanced treatment in the male patient by treating surrounding areas such as the frown or the crows feet. The precise balance of which areas to treat will be customised to you. Ideally, we allow the full range of facial expression, whilst diminishing the amount of wrinkles.
Whilst muscle relaxant treatments are performed every three months, a strong forehead muscle will most often start to break through treatment at the 6-8 week mark.
Forehead lines will look better with every treatment performed, as consistent treatment stimulates production of collagen which will naturally firm the skin and soften these lines
The forehead is best managed not in isolation, but alongside muscle relaxant injection of adjacent areas such as the frown lines and upper crows feet. It is the balancing of these regions that can create a refreshed appearance, which is the goal rather than having one area that is wrinkle free or limited in movement.
The role of the forehead muscle is to raise the eyebrows. Therefore, placing tox injections in this muscle can potentiate lowering of the eyebrows. This is rarely desirable, and so treatment is usually combined with a brow lift, which refers to treating partially in the frown and at the tail of the eyebrow. I’d mostly like to see your eyebrows stay neutral or be elevated a millimetre or two. Only rarely in my career have I been engaged to treat eyebrows to become lower.
A common misconception amongst patients is that we treat ‘movement’ of the forehead, for instance, two weeks after injection with muscle relaxant a patient attends for review complaining of the ‘forehead still moving’. This is normal and desirable in most instances, for it is the movement of this muscle that opens up your eyes and helps you to look friendly and real. If this persistent ‘movement’ causes an abnormal pattern of wrinkling, it is in which case, desirable to have adjusted

Forehead Lines

These are the vertical lines occurring in between the eyebrows. They can be either dynamic (only there on moving) or static (present when not moving)
Muscle relaxants give the best result for dynamic lines however static lines can be improved after consistent treatments which stimulate collagen production. This is a theory called ‘persistent denervation’ whereby topping up treatment with muscle relaxants will have a collagen stimulating and antioxidant effect on the skin.
This is the most common area to start with when it comes to muscle relaxant treatments
Treatment of the frown lines allows a subtle freshness of the appearance, whilst you may feel tired, you certainly won’t look so
Dosing in the frown lines really is aimed at giving you the best longevity possible, this is anywhere between 10 weeks and 16 weeks depending on your muscle strength
Frown line treatment is usually combined also with a brow lift, treatment of crows feet or horizontal forehead lines.
Injection of the frown lines at the earliest signs of ageing will prevent them from etching in.

Frown Lines

Eyebrow Lift

A brow lift looks great on most people. It refers to using a customised dose of muscle relaxant to lift the outer tail of the brow by a few millimetres. A brow lift will be included in most muscle relaxant full face treatments.
The brow lift involves a customised injection in the upper crows feet area and usually also the frown area.
The goal of an eyebrow lift is to attain about 1mm of elevation of the upper eyelid skin.
An eyebrow lift with muscle relaxants will only work if there is a muscular component to low set brows. In some cases there are structural components which may need be separately addressed, such as excess upper lid skin, low set brow bone or lack of tone in the skin and muscle layers above the brow. These options to address structural contributors might include PDO Monothreads or dermal filler to support the skin above the brow region. A surgical blepharoplasty may also be suggested in some cases.

These are the lines which are on the sides of the nose bridge, appearing as scrunched up skin when you smile.
Treatment of these involves a simple muscle relaxant injection on each side of the upper nasal bridge. A low dose is generally used (1-3 units per side). Bunny lines usually should be addressed when muscle relaxant is being used in the frown to avoid an imbalanced appearance.
Bunny lines very rarely can appear after a muscle relaxant treatment in another area, resulting from muscle recruitment and overactivity in the untreated muscle.
Anatomical precision is of utmost importance so that your smile is not affected during treatment, which is an incredibly rare but temporary complication. The bunny lines need to be treated superficially and quite high up on the nasal bridge.

Bunny Lines

The temples are the concave structures on the sides of the forehead, which become more hollow with time or as a result of weight loss. The female patient ideally has a very minor concavity in the temple, whilst the male patient looks best with a flat or full temple.
The temple can be injected with dermal filler or biostimulator using a deep or superficial approach, but occasionally a combination of the two is required. The most common approach is to fill the temple like a pond, filling the deepest layers to expand the whole area. It may also be addressed by volumizing the uppermost layers, or a combination of both deep and superficial approaches.
There are multiple options for treating them, however the best place to start would be with replacing generalised facial volume using dermal fillers.
Techniques to enhance skin firmness in this area also include PDO Monothreads, the new Bioremodeller injectable and some energy-based devices such as radiofrequency micro-needling.
Muscle relaxant injections may be used in select cases if it is thought that muscle activity is contributing and there is a hyperdynamic muscular pull on the tissue upon smiling
The temples are considered an Advanced Injection Area due to the important blood vessels contained in specific layers of the temple. If anatomy is not carefully considered, there is a risk that dermal filler could enter a blood vessel resulting in tissue necrosis or visual loss.
Dr Kristen ALWAYS performs careful vessel mapping prior to injection and uses the safest possible technique to treat you. In some cases, ultrasound mapping may be used prior to injection if there is any obvious anatomical anomaly.
Dr Kristen will examine you carefully and identify these blood vessels and mark them out, selecting the safest approach to treating the area. Either a needle or a cannula will be used depending on which option is A. safest B. aesthetically most appropriate. Dermal filler is then placed extremely slowly and carefully. Generally speaking the procedure is quite comfortable for patients and is completed within 15 minutes.
The skin of the temples can also be addressed by collagen stimulating PDO Mono Thread. Whilst this procedure is frequently promoted to cause a ‘brow lift’ it generally would only address the integrity of the skin in the temple region. In some cases, I have seen the slightest of brow lifts but this is very individually dependent.
Treating the temples has a very harmonising effect on the facial frame. The eye naturally will seek to draw a ring around the face in order to subconsciously determine whether a subject appears beautiful. Where there are interruptions to this oval ring, such as a hollow temple or a jowl, the pre-programmed subconscious mind will see less harmony in the facial aesthetic.

Temple Hollowing

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mid face

This is a technique where the facial ligaments are supported using dermal filler, resulting in lifting of the face. Whilst the classic technique involves quite a few syringes, a modified and customised version can be used to lift target areas.
When one side of the face is treated and the patient is shown the effects in the mirror, they are impressed with the way that this technique can give results approaching that of a face lift.
It is particularly useful for improving the appearance of jowls, lifting the cheeks and therefore improving the nasolabial folds and also the marionette shadows.
Best results occur when this is performed alongside muscle relaxant injections so that muscles that pull down the face can also be relaxed. To further enhance results, the complexion should be addressed using a range of custom skin care or laser therapy
A renewed model of this technique called the ‘True Lift’ technique is often used by Dr Kristen and refers to placing incredibly precise deposits of dermal filler directly in the vector of facial ligaments, causing the action of these ligaments to be reinforced. Immediately, it can be seen the nasolabial fold softens, the jowl may lift, the undereye circle lessens and the patient looks far less tired on the treated side. Of course, we do go on to treat the contralateral side!
The determination of whether you would be best served by a surgical face lift or a ‘liquid’ (dermal filler) face lift will always be discussed with you. Some patients who are borderline as to whether they need surgery will spend a few years using non-surgical treatments that create lift and improve their skin. This delays the need for surgical facelift and also improves skin health which is important if undergoing surgery. There are cases of significant volume loss across the entire face where Dr Kristen may elect to use a biostimulator to create volume in multiple pockets. Volume is always necessary before lifting - a surgeon would inject fat grafts, or if you have been seeing a Cosmetic Physician prior, you may have dermal filler or biostimulator to create this volume. If you are considering face lift surgery, Dr Kristen is able to refer you and has experience in working alongside facial plastic surgeons in treating patients before and after surgery, in a way that combines well with surgical procedures.

Liquid Face Lift

Volume loss in the cheek region is common and one of the earlier signs of ageing, often occurring in the late twenties or early thirties. It is also related to intense physical exercise or weight loss.
Cheek filler can be placed in multiple tissue planes to give a natural appearing result, often making the patient look less ‘tired’ or ‘drawn’. Filler placed in the cheeks in a strategic manner can lessen the under eye circles, and also can decrease the depth of the nasolabial fold!
Quite often, the patient who comes seeking tear trough filler finds that addressing the cheek volume does enough to restore the under eye area.
We are all aware that cheek filler seems to have been commonly ‘overdone’ in recent times. This is due to over injection in many cases, but also a failure of the practitioner to select the appropriate product for the patient. Some products seem to hydrate and expand over time, meaning the patient ends up appearing overdone.
Dr Kristen believes cheeks should be restored to their natural capacity, no more than this, perhaps less than this is desirable to match the remainder of the face. Generally speaking, mild flatness in the front aspect of the cheek is preferred to a round or projected structure.
There is a point of the cheek known as the Beautification Point which can be enhanced in order to give a beautiful light reflection - this is a favourite ‘pick me up’ procedure for patients who have a special event coming up.
Cheek filler is a safe procedure with minimal downtime. Usually patients will need between 1-4mls to achieve their final result.
The cheek is enhanced both along the cheek bone area known as the zygomatic arch, and also in the midcheek which is particularly useful in helping you to look less tired.
Cheek filler is extremely popular in patients of all ages, and works best in combination with treating the lips or area around the mouth, as well as the under eyes and chin.

Cheek Restoration and Lift

This is an important area when it comes to the ageing process. This is the area in front of the tragus of the ear, and it runs down to the angle of the jaw. You may not have noticed previously, but this area becomes hollow with ageing or weight loss.
A lack of support and volume in the preauricular area has two effects, it causes a sallow appearance of the side profile, and it causes the middle of the face to lose its support.
If you have ever stood in front of a mirror and pulled your face back using that skin in front of the ears, you could demonstrate the impact of preauricular volume on the remainder of the face.
There are a few options for creating volume and support in this area. Generally speaking in younger patients where there is good skin integrity, dermal filler can be used. Where there is a loss of skin integrity (the skin appears thin or devitalised), then the best option is a Biostimulator which will provide volume like a dermal filler does, but also provides stimulation for collagen synthesis. The improvement in skin quality alongside replacement of subcutaneous volume can provide powerful results for both the side profile and frontal views of one’s face.
PDO Mono Threads are also an option for improving skin integrity in this area, and are popular amongst my younger patients who wish to prevent degradation of the collagen in this important area.
The new Bioremodeller ‘firm and lift’ product that was released in Australia this year also provides hydration and support in this particular facial zone.
There are many options for treating this important facial zone, and Dr Kristen will encourage you to stimulate collagen synthesis alongside volume replacement in this area.

Preauricular Volumisation

Biostimulator is a type of dermal filler which replaces volume but also stimulates collagen, thereby improving the overlying skin.
It is one of Dr Kristen’s most performed treatments to use hyper diluted Biostimulator to restore volume and skin firmness in the outer frame of the face. The restoration of volume support and skin integrity in this area appears to help lift the central facial tissues.
As well as the facial frame, it is also great in the temples, cheeks and jawline. It is one of the best options when it comes to treating the hands as the collagen stimulating and volumising dual effect are highly appropriate for hand skin.
Biostimulator is an excellent choice for patients who are undergoing perimenopausal decline in skin quality, as regular dermal fillers often will not give a lasting effect and a Biostimulator is preferred for both its increased longevity in the skin as well as its collagen increasing effects.
Biostimulator is also a good choice for patients who rapidly metabolise their regular dermal fillers, as these products resist the hyaluronidase enzyme.
Biostimulator is a great choice for severe panfacial volume loss such as major weight loss or lipodystrophy, as it gives an incredibly natural finish and can be easily injected in multiple compartments in the one sitting.
There are three important things to know -
1. Biostimulator generally cannot be reversed - unlike regular dermal filler which can be dissolved almost instantaneously. So it is a good idea to try out treatment with reversible fillers prior to undergoing biostimulator treatment.
2. Biostimulator lasts around 25 months on average and resists breakdown by hyaluronidase in your body. Therefore it is a good option for those who are certain they like facial volumization and wish to have a prolonged effect from their treatments.
3. The results are biphasic, firstly there is volumisation so the structure looks less hollow, secondly there is collagen formation so the overlying skin looks better, any acne scars are reduced and the skin is less crepe-like.

Biostimulator Injection

Dermal filler can be injected into the midline of the nose in order to make it appear more straight and projected. A fine needle is used to place tiny aliquots of dermal filler deep in the nasal tissue into areas that appear as a depression on the side profile.
A cannula can also be used in some cases particular where there is a need to enhance the whole nasal bridge
This is an alternative to surgical rhinoplasty however it cannot make a nose smaller, only more straight. Filler always adds volume, whilst surgery can be used to decrease nasal size.
This is the riskiest area of the face to inject dermal filler so Dr Kristen will carefully assess and counsel you prior to the procedure. The risk of nasal filler relates to the arteries that run up the nose to supply the forehead and the retina of the eye. If filler were to enter an artery, there could be major tissue necrosis or blindness.
A group of Australian doctors reviewed the global literature on dermal filler rhinoplasty and found that the risk of visual loss was probably close to 1 in 100,000.
In Dr Kristen’s mind, this risk is high given that these procedures are elective and expected to involve minimal if any side effects. Therefore, if a referral for surgical rhinoplasty is the best option for you, Dr Kristen will refer you to a Plastic and Reconstructive Surgeon and will be able to recommend from her professional network.

Liquid Rhinoplasty

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lower
face

The jowl area is the pockets of loose skin which may contain variable amounts of fat, caused by the cheeks descending just lower than the jaw line.
Jowls are common and most people will get them. It is possible and fantastic to be in the habit of catching them early. Severe jowls can only be treated with surgery
Basically to treat skin that is sagging below the jaw line, it is imperative to replace the volume loss that has occurred above the jaw line. The most common areas to treat with dermal filler in order to lift the jowl would be the middle cheek, outer cheek and the facial frame, in particular the area in front of your ear. Any deficiencies around the mandible need also be addressed such as treating the chin and the angle of the jaw.
The jowls are lifted based on two principles when it comes to facial volume. The first is that if you replace the volume loss, it will act as a support area north of the jowls and thus pull them up. The other interesting principle is based on the Retaining Facial Ligaments. These structures are like fibrous pile-ons that hold the facial tissues to the skull. With age they become loose and allow the face to sag. It has been shown that injecting dermal filler directly into the zone of a Retaining Facial LIgament will cause the ligament to straighten up again and lift. Imagine a curtain rod that had gone floppy with time and you put a fresh new cast over the top to allow it to once again hold up the curtain.
First thing to say here is that, if you are a surgical candidate, you will be informed of this and a written referral will be provided to a reputable provider. It is rare, however there are some patients whose jowls will only budge if there is a surgical procedure.
Dr Kristen will commonly ask her patients to undergo HIFU treatment of the jowls which is ultrasound based therapy aimed both at fat reduction and tightening of the dermis. This will be performed in conjunction with injectable treatments.
Apart from the above options, there are thread lifts however a patient MUST undergo facial volume replacement with dermal filler prior to having a thread lift. Otherwise the results look strange and will not be lasting.

Jowls

Creating a defined jaw line has been a popular dermal filler treatment since the advent of social media images. If the camera angle is oblique, and you give a little tilt of the chin, there it is - a defined jawline. Moreso, in the age of Zoom meetings and working from home, it seemed that the image of oneself in an online meeting revealed to patient’s any concerns they may have about their lower face in general. So buyer beware - the illusive instagram jawline is often an illusion. It’s one of the common crimes of before and afters to take a jawline photo with a different amount of chin tuck. In fact if you took the amount of definition seen in photographs of the Kardashians and applied it to a real person standing across from you, that person would appear absolutely bizarre. Definition of the jaw line needs to be brought back to reality - realistic expectations and realistic results.
Jawline strengthening is best suited to 1. Younger patients who have a congenitally petite mandible (jaw bone) 2. The male patient seeking width on frontal view 3. Patients who have lost definition of the jaw angle due to the ageing process.
The best way to treat a jaw line is using a cannula which is a blunt ended instrument that is excellent at depositing filler in a linear defined formation.
The jaw can be filled both anteriorly (near the chin) and also posteriorly (in a straight line toward the ear)
The pitfall of dermal filler in the jaw line really is that it often requires significant volume to see a result. It is unusual that 1ml would be enough to provide sufficient volume
Some patients elect to add small volumes to their jawline consistently over time, for instance when having another area treated. This can be helpful in maintaining definition at the jaw angle
Another way to deal with the issue of needing high volumes to achieve a result, is to treat surrounding areas to ‘distract’ from the deficiency of the jaw line. For example, treating the chin and preauricular areas are often a fail-safe method of giving a more lifted and structured lower face without slogging away with multiple syringes along the bony jaw line.
An excellent option for volumizing the jaw line is a Biostimulator. These are able to create volume like a regular dermal filler, but also will stimulate endogenous (your own) collagen synthesis.
The reason these are not commonly used is mostly because they are not reversible. If you don’t like them, they can’t easily be dissolved like regular dermal filler. Given this, Dr Kristen will most often treat you first with regular dermal filler, and if everything goes well and you repeatedly desire this treatment, you can discuss having Biostimulator injection instead.
The Biostimulator is perhaps longer lasting than dermal filler (25 months vs 12-18 months) and has a ‘high G prime’ which means it creates excellent definition due to inherent characteristics of the product

Jawline Enhancement

A muscle within the chin structure known as the mentalis muscle can cause rippling of the skin during facial expression. It will not be apparent to you at rest when you view yourself, however when you speak, there are micromovements of the muscles and skin below the mouth. Over time, these micromovements cause fine lines to etch in.
Tiny amounts of muscle relaxant can be injected into the chin muscle aka ‘mentalis’ to reduce dimpling.
Mentalis muscle injection is a cornerstone injection when it comes to preventative treatment, as the activity of this muscle is responsible for much of the aging around the mouth.
Injection of mentalis is often combined with injection of the Depressor Angularis Oris (DAO) muscles which lie in the marionette crease. Injection here will stop these muscles from pulling the mouth corners down into a sad face. This is a great preventative and restorative treatment for all ages
A particularly hyperactive chin muscle may also need some gentle support with dermal filler. A concept called Myo Modulation refers to the ability of dermal filler to ‘brace’ a muscle and so prevent it from excessive tugging on the skin. Myomodulation works best with filler placed in the chin and marionette to soften the activity of these very mobile muscles
Some patients notice that their lower lip is slightly more full after chin muscle relaxant and this is a welcomed side effect.
Anatomical knowledge when injecting the chin is paramount due to the complexity and inter-relation of structures in the area.
The chin is a complex muscle and injection of muscle relaxant here can sometimes cause rippling or bulging of the muscle whilst the relaxant takes effect. Rarely, a patient might be aware of an altered sensation just after having this treatment, and usually this settles down after a few weeks. This is because the mouth has a lot of sensory feedback to the brain, so even the smallest of changes in this area can be registered by the brain as something a bit different.

Chin Dimples and Lines

The chin is the anchor point of your facial structure and one of the key paradigms of beauty is the harmonisation of the chin with the nose and lips. A combination of dermal filler and tox injections can be used to sculpt the chin into a more perfect structure to balance the remainder of the face.
Many patients seeking chin filler have congenital deficits in the volume of their mandible (the jawline) overall, which may result in early onset of jowls or neck sag, or a receded chin.
A receded chin is often associated with abnormal bite or dentition, and often the lip or perioral (around the mouth) areas will also need to be addressed. Oftentimes, patients with chin recession will have had it recommended that they undergo orthodontic work or jaw repositioning surgery to improve the vector of the chin.
The chin also changes with age, and the repeated activity of the chin muscles cause ultra fine lines all around the chin and perioral region. Older patients may find that the chin broadens, whilst the skin sags. Placing dermal filler and tox injections can help to relax the muscles that pull the area down, and also create volume to firm up the jaw line and the neck too.
The chin is best treated with at very least 1ml of dermal filler to project the central chin and perhaps 1-3 ml further to treat the sides of the chin. A combination of needle and cannula is used so that adequate projection can be achieved, whilst accessing the deep tissue plane in a very safe manner. There are very important vessels and nerves here which a cannula combined with a careful technique, will assist in avoiding.
The chin area is prone to bruising, however use of a cannula will minimise this effect and also makes the procedure safer, as a blunt cannula is less likely to enter a blood vessel compared to a sharp needle tip.
A firm and long lasting filler is always used for volumizing the chin which grants structural definition and maximal results per unit of volume. Generally, the injections are placed very deep along the bony surfaces as we are trying to replicate a bony structure.
Patients who have a congenitally petite mandible (jaw and chin bone) often seek out jawline filler, however chin filler is arguably a more powerful option. The chin can be enhanced and projected quite simply using a smaller volume of filler compared to the jawline, and can give a similar impact on having a locus of support and definition in one’s lower face.
Dr Kristen calls chin filler the ‘Cheat’s Jawline’ as it can tighten up the loose skin at the junction of the neck and the jaw, as well as more efficiently harmonise the facial features in those needing it. All the while using far less volume than the traditional jaw line filler treatments

Chin Reshaping

- Injecting muscle relaxant into the masseter muscles can be used to treat jaw grinding or to slim the lower face
- Unlike other facial muscles, treatment of the masseters only needs to be performed every 6-12 months
- Jaw grinding otherwise known as ‘Bruxism’ is a common problem, related to neurotransmitters like adrenaline and serotonin
- Management of severe Bruxism should include muscle relaxant in multiple contributory muscles as well as input from a TMJ specialist
When muscle relaxant is injected, it causes less activity of that muscle for a period of time. With respect to the masseters, this results in a decrease in jaw grinding and clenching. Because very large doses are used, deep within the muscle, there is also a decrease in the size of the muscle, referred to as a disuse atrophy. When a muscle isn’t used, it can become smaller. Jawline slimming or masseter injections are a treatment with a very high satisfaction rate. Patients enjoy both relief of symptoms and also like the new ‘heart shaped’ appearance of their facial frame.
Generally speaking your masseter muscle is over-developed, when we go to draw a ring around your face in a photo, you will see a distinctive bulge at the area of the jaw. If this bulge projects more than the temples, then it is likely that you are too square and would look better with jawline slimming. It is important to note that this is still very patient specific, because in some patients the jawline volume is actually providing a lot of support to the face. Over injecting these patients will result in over-slimming and will age the patient.
In some cases, where bruxism is severe, the muscle may be fully treated, in conjunction with dermal filler or PDO Mono Thread to assist in providing facial support when the muscle is taken out of action.
Careful history taking is very important to identify other factors contributing to bruxism. This may include particular psychotropic medicines, mineral deficiencies and sleep disorders. Dr Kristen can provide treatment for these issues where required. An examination will determine which muscles are contributing to your symptoms and also whether you would look better having had the muscle injected. This is very important. The procedure itself is straightforward, with multiple fine injections that feel much like acupuncture in an overworked muscle. Patients generally start to notice a benefit within 2-4 weeks, with the slimming effect noticed by six weeks. You will be asked to have a review at six weeks to see how your symptoms are and to check the facial reshaping outcome.
Often it does, however bruxism is a complex spectrum of disorders and where there is true TMJ arthropathy (joint disease) or intractable sleep disorders, it can be difficult to get a full cure. At this stage, Dr Kristen will recommend you attend a TMJ Specialist clinic for multi-disciplinary input. Often treating other muscles such as the classic muscles of migraine can be helpful, including some of the neck and scalp muscles. Most patients find this an excellent solution however and many of them will discard dental splints which they have found make the problem worse by providing a stimulus to bite.

Jawline Slimming/Masseters

The last few years with the increase in Zoom meetings has certainly propelled an interest in addressing the double chin
A double chin is usually due to a pocket of fat below the chin but can also be due to excess skin here. This excess skin can be primary, and due to focal neck sagging or weight loss. Or it can be secondary, and related to loss of facial volume which means the skin ‘falls down’ into the neck area.
Where there is a fatty deposit, Fat Dissolving Injections can be used in order to dissolve the fat, and it is then permanently removed by the lymphatic system. A small degree of skin retraction will occur in association with this treatment.
Where there is excess skin, usually surgery is the best option. In very mild cases, the skin can be firmed using PDO Mono Thread which helps to thicken skin by way of increasing collagen synthesis.
Sometimes after one or both of the above procedures is performed, filler can be placed along the mandible to further delineate between the chin and submental (under chin) areas. This strategically placed volume will define the border between neck and jaw, and also will slightly ‘lift’ the neck skin.
Another common procedure for this area is to treat the neck bands (platysmal bands) with tox. This relaxes a muscular structure which is trying to pull the skin downward. It is particularly useful in those who have fullness right along the region under the jaw which tends to be muscular in cause.
HIFU is a type of technology that is promoted to tighten this area. In my experience there is a variance in results – some patients get a result, and some get very minimal. Some patients will do anything to improve their double chin and will try HIFU, understanding that the results do vary.
Fat dissolving injections do take some time to obtain a result – usually three treatments are required, spaced by six weeks. Often there is a degree of swelling for a week after injection.
Whilst skin retraction does occur, in older patients, it usually isn’t enough and so skin tightening procedures can be used adjunctively.
The other thing to know is that sometimes liposuction or a neck lift is going to be the most efficient way to treat this area. I will tell you if this is the case and can provide a comparison of these options with what I can offer you.

Double Chin

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neck

This is a new product to Australia which has been very successful overseas prior to obtaining TGA approval here.
It basically is a hyaluronic acid gel that has specific properties whereby it improves all layers of the skin hence the referential name Bioremodeller.
The best way to understand it is to learn how it was discovered. They were doing studies on wound healing, and found this to be helpful. Upon microscopy, it was noted that the good skin components all increased in quantity and improved in quality.
It is able to stimulate collagen, elastin and other cells that become senescent during the ageing process. It basically is an injectable skin treatment.
It is a very simple procedure – ten injections to the area of concern (for example the dehydrated or loose appearing skin on your neck), and the gel diffuses through the area very quickly to create skin that appears plump, hydrated and smooth. After about six hours, the skin feels very soft. The actual cellular level changes continue to occur for weeks.
It is recommended to have two treatments if under 60, or three treatments if over 60.
It is remarkably safe with minimal down time or side effects. The most common negative reaction I have seen is getting minimal results, and as such patient selection and management of expectations is important. I have seen some fantastic results in patients of all ages.
The classical areas treated by Bioremodeller are the lower face, neck, decolletage and hands. There are other areas that have been treated by practitioners in countries where they have had the technology for longer. We will receive the ‘body’ treatment next year (which is the same gel as for the face, however comes in larger syringes).
The alternative option to this would be using a Biostimulator which has a more volumizing effect and so may be more useful where there is significant laxity of the skin. They are different compounds altogether, whilst both stimulating collagen. I would say that a Biostimulator is better at volumising, while the Bioremodeller is better at improving the skin.

Bioremodeller

Generally speaking, skin laxity is related to ageing. It can be accelerated due to genetic factors or sun damage. Other factors contributing to skin laxity are hormones such as oestrogen, smoking and weight loss.
As we age, we lose volume in all structures that underlie the skin. The bone resorbs, muscle atrophies, fascia becomes altered and the skin loses its collagen and elasticity.
Skin laxity in the neck is a common complaint usually presenting in those aged 40+
Treatments to improve skin laxity are usually multifactorial. If you think about it, the neck has lots of components – there is skin, muscle, fibrous bands and there are also important anatomical structures underlying these layers. Therefore multiple methods can be used to safely treat the neck skin
The least invasive option would be to use your facial skin care including sunscreen on the neck
Another simple method is to use ‘microtox’ which is a very unique method of injecting hyper dilute muscle relaxant into the uppermost skin layer. It has the effect of smoothing skin
If there is significant volume loss, then a Biostimulator can be used to both increase volume and to stimulate collagen
If there is a ‘dehydrated’ appearance without major laxity, then the new Bioremodeller will help to increase collagen and elastin and give the skin a permanent hydrated appearance
PDO Mono Threads are also popular in the neck skin and work by causing collagen formation in a lattice like pattern which gives support
Generally speaking, a combination of techniques will be selected and you will be provided with a treatment plan concerning your neck skin

Skin Laxity

Necklace Lines

These are the horizontal lines that go across the centre of the neck due to creasing
They often go unnoticed and don’t always bother people. However some people experience quite early onset of necklace lines and find they are quite bothered by them
We can’t make them completely go away because creasing of the neck skin is anatomically necessary so you can look at your smartphone! They can however be softened using a Skin Booster which is an ultra thin type of filler that has no cross linking proteins, therefore it can be injected into the uppermost layers of the skin to provide a softening of a crease or hydrated appearance
Skin boosters are best combined with ‘microtox’ where tiny drops of hyper dilute muscle relaxant are injected into the highest skin layer, causing smoothing of the skin
PDO Mono Threads can also be inserted into necklace lines, usually used to boost the results from the above treatments

Nefertiti Neck Lift

- This is a classic muscle relaxant treatment designed to create a firmer appearance of the neck and to minimise sagging of the lower face around the jawline region
- Dr Kristen will customise this procedure to your own anatomy, often using hyper diluted injection techniques which can cause crepey skin to appear more smooth
- This treatment may be performed in conjunction with other modalities that improve the firmness of the neck skin and the lifting of the lower facial tissues including skin booster, collagen stimulators and filler to strengthen the jawline and chin
This treatment involves a customised treatment of all the muscles along the jawline and neck that are contributing to A. jowl formation B. Ropey appearing neck bands C. Crepey neck skin.
Your functional anatomy will be examined and the muscles of importance in your case will be marked up. Injections may occur along the jawline, chin area, neck bands and also microdoses can be injected into the skin itself.
A full Nefertiti lift is usually performed every 6-9 months, however small top up doses can be used at your regular muscle relaxant appointment if there are regions that require it. If dermal filler or skin booster is also used, you will have a firmer appearing neck region for much longer.

- The neck bands are normal structures within the platysma muscle, appearing as vertical bands running from the jawline to the collarbones.
- When these bands are very prominent, they may be softened in appearance and activity using muscle relaxant
- Because the bands attach to the lower segment of the face and pull it downward, relaxing these bands with muscle relaxant can also contribute to stopping sagginess of the lower facial tissues
This is a nearly painless procedure, involving injection of muscle relaxant in small aliquots along the length of the band. Care is taken to avoid important structures in the neck, and direct the treatment toward the portion of bands causing the most downward tension on the lower face. The dose required is variable, between 30-60 units.
Neck bands are treated every 6-9 months in most cases. At times, top up injections involving smaller doses can be used if one segment starts to come back prematurely.
The majority of patients who request to have neck band treatment are aged over 40, however this can be an excellent preventative treatment in the younger patient particularly if there are signs that the neck bands are causing premature facial sag. Moreover, a personalised treatment of many of the lower face muscle groups such as the neck, chin and mouth depressor muscles can be one of the best approaches to preventing lower face ageing in patients of all ages.

Neck Platysmal Bands

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skin

Bio Remodeling refers to an injectable hyaluronic acid, which stimulates the skin age to be reversed. It was discovered during experiments in wound healing. This type of hyaluronic acid was found to stimulate skin health by increasing collagen, elastin and the other stem cells that are a part of healthy tissue
It is a very simple procedure – ten minor injections to the area of concern (for example the dehydrated or loose appearing skin on lower face, neck, decolletage or hands), and the gel diffuses through the area very quickly to create skin that appears plump, hydrated and smooth.
The down time is up to six hours, where there may be small bumps where the injection was placed. The downtime for the neck is sometimes longer - up to a few days of minor bumps. Most people are not overly conscious of them.
Two or three treatments are required and results will last for 12 months
The results occur very rapidly – after injection, the solution diffuses quickly through the treatment zone in a way called the ‘Glow Flow’ and the skin feels incredibly soft to touch and visually it will appear healthier, whether this be more plump, hydrated or diminishment of fine lines or acne marks.
The treated skin appears firmer, more radiant and the texture is better. It is great for young patients who have looser skin on their lower face or wish to prevent neck ageing. It is also great for older patients who have fine lines and volume loss in the lower cheeks and jowl or perioral (around mouth) area. It is very good for the neck.
A consultation is always the best way to find out. This is not a volumising treatment, and in some cases it is necessary to add volume. In these instances, dermal filler might be used first, or a biostimulator (different from the bio remodeller - I know, confusing), can be used which adds volume but also stimulates skin improvement.

Bio Remodeller (Firm and LIft)

They are sutures just the same as a ‘dissolvable stitch’ used when you have surgery. They are inserted into the dermis and dissolve over a period of three months. The suture material is designed to stimulate the healing process of the body, which means that where they are placed, you will have an increase in collagen and skin strength
Mono Threads are smooth, dissolve relatively rapidly and do not lift the skin. Thread lifting refers to the use of threads with barbs which anchor into the skin and pull it unidirectionally. They are completely different procedures.
The longevity of results from Mono Threads depends upon how long collagen is being preserved in your body. This depends on hormones, sun exposure, genetics, age, stress and probably some undiscovered factors. Most patients will have one or two treatments and then may repeat this the following year.
Your consent is obtained and your understanding of the procedure is checked. Photos are taken for Before and After purposes. The skin is prepped with antiseptic. The threads travel into the skin on an introducer (pink ended), and the introducer is removed once they are in place. You can expect bruising and swelling following this procedure and LED light therapy is recommended to stimulate healing and amelioration of bruising. Collagen synthesis takes time, so results do not usually start to appear until 4-6 weeks following treatment

PDO Mono Thread

Biostimulators are injectables which perform two functions, firstly they create volume much like a dermal filler but they have a secondary benefit of causing localised collagen stimulation
They can improve skin thickness, fine lines, loose skin and acne scars
They are great for treating the frame of the face – such as volume loss close to the jawline and hairline. Thickening skin and volumizing in these areas has a ‘face lifting’ effect on about 80% of patients
Biostimulators have been around for a long time, and they consist of an organic molecule which helps to restore volume as well as a stimulatory molecule that stimulates collagen formation. In my opinion, they are underutilised in the Cosmetic Medicine space in Australia, largely due to the lack of advanced practitioners seeking out the specialised training to use them. This then feeds into a lack of patient awareness. They really can be great when used in the right circumstance. Because they cannot be reversed, generally Dr Kristen recommends that you try treatments with reversible dermal fillers initially and if you find yourself wanting repeated treatments, then perhaps a biostimulator is a better option.
There are several major brands of Biostimulator in Australia, and they behave quite differently from one another. One is fluid like and is great for treating the face as a whole, for instance when there has been major weight loss. The other is good for volumizing and works particularly well in the facial frame particularly in the jawline
They are composed of different substrates, and whilst both provide volume, only a biostimulator will induce collagen synthesis. Therefore the skin and tissues will appear more firm and vital after treatment. A dermal filler on the one hand will last about 12 months and can be easily dissolved using the antidote enzyme, whilst a biostimulator cannot be dissolved and will last up to 25 months.
Results start to appear at 6 – 12 weeks, however improvement continues to occur over 6 – 12 months. It is recommended to have one or two treatments every 12-18 months.
Your consent is obtained and your understanding of the procedure is checked. Photos are taken for Before and After purposes. The skin is prepped with antiseptic. Markings are made to ensure a very precise placement of the Biostimulator. The injection is performed most often with a cannula and some of the product will be deposited quite close to the overlying skin so as to gain the benefits of collagen synthesis.

Biostimulator

There are many devices that use energy in order to produce a cosmetic result, laser is just one class of device which uses laser energy, usually to treat the skin
A very basic way of understanding laser treatments is that the energy will move towards a coloured target – this might be brown (pigment), red (blood vessels) or it may cause stimulation of the deeper layers (skin tightening)
Treatment with laser spans a wide spectrum and there are literally hundreds of different types of laser machines
Dr Kristen will be able to assist you with prescription of a course of laser treatment or perhaps treatment with LED light therapy in order to achieve your skin goals

Laser and Light Therapy

The skin on the back of the hand is vulnerable to both sun damage and repeated exposure to drying agents such as soap or hot water
The skin on the hands can be treated using Biostimulator or Bioremodeller which both act to volumise the tissue and also to increase collagen synthesis
If there is sun damage and pigmentation on the hands, this can be treated using lightening creams or with specific laser devices

Hand Rejuvenation

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medical

This is a technique of superficial mole excision, that is useful for benign, usually non-pigmented skin lesions such as intradermal nevi or skin tags.
Whilst surgical removal involves cutting of the skin, sutures and a scar, this procedure used radiofrequency energy to remove the mole from it’s skin base
All lesions are checked using a dermatoscope prior to removal – if there is any suspicion, a biopsy will be recommended
Recovery usually is between 3 days to 2 weeks, with a small circular mark which is the skin base of the lesion
Your mole will be medically examined using a dermatoscope. Dr Kristen has completed further qualifications and has work experience in the area of skin cancer. If your mole is suspicious, you will be referred for biopsy.
Yes. However this could be a misnomer. The term ‘scarless’ mole removal is used to refer to the fact that there is no linear surgical scar, however there is often a small circular site which will take time to heal and for its colour to normalise.

Cosmetic Mole Removal

Bruxism refers to overactivity of the muscles which oppose the teeth, and will result in jaw grinding or clenching. Most often the patient is unaware that they are suffering bruxism, and may only experience the ramifications which might include tooth fracture or flattening, gum erosion, pain in the jaw, neck or face and in many cases an overdeveloped muscle over the temporomandibular joint (TMJ)
You will be assessed holistically to ensure that other contributing factors to the disorder are addressed, and that underlying true TMJ or facial pain pathology is not overlooked.
It is important to note that this is a multifactorial disorder, it is related to high levels of noradrenaline often due to poor sleep or a stress response. It is important to address these issues, as well as treat with muscle relaxants. For example, antidepressant medications or poor sleep can cause high noradrenaline and therefore jaw clenching or grinding. Lifestyle modifications are often suggested to use in conjunction with tox injections.
The procedure is straightforward and not uncomfortable. The usual dose of muscle relaxant for a severe case of bruxism would be 20-30 units in each muscle. This should last around nine months, and a smaller maintenance dose is usually needed at this point in time.
A welcomed effect from this treatment is a slimming of the face. This is because the muscle relaxant will mean less contraction of the muscle and any muscle that is not working hard, becomes naturally more slender. This is a pleasing effect for many patients, however in some patients, this facial volume needs to be maintained and so the dose or treatment plan would be adjusted accordingly.
Your facial frame will be carefully assessed, as well as the degree of facial support you have. If deemed appropriate, the tox injections will be used to sculpt a more narrow jaw width. In these cases the dose is highly customised. On average, Dr Kristen will use between 8-20 units of tox per side in these cases.
As far as adverse effects go, it is generally speaking a safe procedure that creates beloved results. However, if the muscle relaxant were to migrate forwards, it might cause relaxation of the risorius muscle, resulting in a temporary crooked smile. This is exceedingly rare. To prevent this complication, you will receive careful anatomic marking and localisation of the injection target. You are also asked to not apply any pressure to the area following injection.
The other adverse effect is known as ‘paradoxical masseter bulging’ which usually occurs early after injection, and is due to the masseter muscle being quite thick and the muscle relaxant needing to cover the full surface area. In rare cases, this might need to be fixed with a further once-off injection
Overall, patients seeking treatment with muscle relaxant for bruxism are very satisfied. They find it more effective than physiotherapy or dental guards. However, it may be important for some patients to continue with physiotherapy and guards. In particular, those who experience issues with their teeth, or in those or have true dysfunction of the temporo-mandibular joint. In the instance of true TMJ disorders, it may also be important to screen for arthritic diseases that affect the joints generally

Jaw Clenching / Bruxism

When muscle relaxant is injected into the skin, it causes the sweat glands to diminish their activity.
Areas prone to excessive sweating commonly, the armpits or palms of the hands, can be treated using 750-100 units of muscle relaxant
Most patients will opt to have this treatment every 12 months, overall they are very satisfied with the reduction in sweating
It is generally a very safe procedure, from time to time a patient will need a small area topped up due to continuing sweat production in one zone. When it comes to the palms, it is preferred not to inject anyone who is gainfully employed in manual tasks due to the risk of a temporary hand muscle paralysis. This is a low but actual risk and these patients may be better candidates for other procedures that diminish sweating
Patients receiving treatment for axillary hyperhidrosis (sweaty armpits) usually are highly satisfied and will continue to treat every year. It is helpful to undergo an ‘armpit detox’ at the time of treatment which will wean you off aluminium based deodorants which are possibly toxic to the human body. Interestingly, long term use also trains your body to sweat more. A program of natural deodorant acclimatisation can be suggested to you.

Hyperhidrosis (excess sweating)

For many years, Dr Kristen has been treating patients with skin care regimens using a combination of prescription compounded creams and carefully researched proprietary products.
The consultation to determine your needs and ongoing adjustment of your routine is paramount to getting sustained results. There are several formulas which are commonly used, although being compounded, these formulas can be tweaked and individualised.
Common concerns being treated are red scarring from pimples, melasma, rosacea, post-inflammatory hyperpigmentation, acne and generalised ageing
This stuff is freshly made, highly active and pharmaceutical grade. It doesn’t contain unnecessary excipients or preservatives. It really, truly works. It is based on scientific studies which have shown what compound, at what concentration will give you results.
Dr Kristen also works with Skinceuticals skin care, which is a brand she has chosen based on its clinical grade results. Being part of the L’Oreal brand, the products have received lots of funding for scientific research and are capable of producing excellent results when used in a targeted manner

Prescription Skin Care

Acne occurs in all ages, and is related usually to hormones but can be triggered by stress. Diet is not proven to play a major role in acne, however low glycaemic index and low dairy diets can work synergistically with medical approaches
It is important to treat acne thoroughly to minimise both the psychological distress it causes patients, and also to prevent scar formation which can be hard to reverse. Dr Kristen is trained in Anti-Aging Medicine, which is like a science based version of naturopathy. Therefore she can help you to make sense of the natural or lifestyle treatments, but importantly also use medical treatments where needed. She strongly believes that patients should be treated in order not to scar. And that a fully natural approach sometimes does only a disservice to the patient and wastes their time and money. A combination, the best of both worlds is often needed.
The initial approach might involve prescription oral or topical medication and regular clinical facials. Sometimes stronger medications can be used, albeit at a low dose in order to fully cure the acne
If there is cyst formation, in select cases, steroid injections can treat these, but do come with specific risks so are used only when necessary

Acne

Rosacea

Rosacea is a disease of the facial blood vessels which become overactive, resulting in flushing, redness or acne like lesions
Rosacea usually has multiple triggers, commonly hormones, temperature change, alcohol or spicy foods
An initial approach to management is to use a combination of oral and topical prescription products, and vascular specific lasers can be used to decrease the overactivity of vessels. Lifestyle factors such as alcohol, skin care sensitivity and hormones can also be reviewed.
It is important to treat rosacea early in the disease process, as untreated rosacea can become severe and acne lesions may result in scarring or the disease can cause skin abnormalities

Melsma

Melasma refers to hormonally driven pigmentation usually occurring on the cheek bones, upper lip or upper forehead
It is common in the setting of the oral contraceptive pill or pregnancy which increase oestrogen exposure. Factors around states of oestrogen dominance can be reviewed.
Melasma is best treated using home care rather than in-office laser procedures. Home care is used for long stretches of time, and ingredients such as tretinoin, hydroquinone, vitamin C and other tyrosinase inhibitors are cycled.
Severe refractory melasma may require tranexamic acid treatment.
Cosmetic peels specific to melasma are available but do require the patient to be consistent with their home care both before and after the peel.

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It all begins with

SPF 30 + H2O

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mouth

Mini Lip Enhancement

Lip Restoration

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Smile Lines

Above Lip Lines

Marionette Lines

Downturned Mouth

Gummy Smile

eyes

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mid face

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skin

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PDO Mono Thread

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medical

Cosmetic Mole Removal

Jaw Clenching / Bruxism

Hyperhidrosis (excess sweating)

Prescription Skin Care

Acne

Rosacea

Melsma

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