The modern man’s tweakment guide
Dr. David Jack is one of a new generation of medical doctors making serious waves. Renowned for his minimalistic and integrated approach to treatments, working with different treatment modalities to create only ever natural-looking results. We talk to him about how to get the ultimate tweakments for your big day.
HOW DO YOU GET THAT INSTANT ‘REFRESH’
Most injectable treatments take a little while to work – so if you are looking for something to instantly refresh in a matter of hours, a high quality medical grade facial might be the thing to start with. Exfoliation, stimulation and regular medical grade facials are excellent at keeping the surface of the skin in check, as well as optimising the effectiveness of skincare products. Our most popular facial, The Egyptian Facial, is usually done on a 6-8 weekly basis pre wedding, so most people who are new to this start about 6 months before and fit in about 4 facials, with the last one about 5-7 days pre wedding. Not only does this improve the surface texture of the skin itself, but it also reduces the fine vellus hairs on the face, to help makeup sit better. This treatment involves a combination of a light blended chemical peel (bespoke to the individual patient), with dermaplanting and a post procedure vitamin treatment with vitamin C, retinol and hyaluronic acid. Other popular facial treatments pre-wedding include forma Radio frequency (which tightens and lifts the skin of the lower face). This is recommended over 6 weekly treatments to start 7 weeks before the wedding so that the last treatment is a week before.
To give the skin a glow immediately pre-wedding, mesotherapy has had a resurgence in popularity. This treatment involves very superficial injections of a hydrating vitamin based fluid. There is no downtime and the glow from this usually lasts for up to 4 weeks so would be recommended 1-3 weeks pre-wedding.
THE EYES
The eye area is probably the area in the face that people notice ageing first, with dark circles being a key reason for patients self referring to my clinic. Dark circles can happen for a number of reasons, so treatment options vary hugely from person to person so an individualised approach is always needed, depending on their specific issue. Genetic factors, sun damage and lifestyle factors can all influence changes in this area so it’s important to tackle things from a holistic viewpoint.
The major issues seen in this area that relate to dark circles include:
- Volume changes on the bone surface and in the fat pads around the eye and cheek – this is best tackled with dermal fillers, and addressing both the cheek and ‘tear trough’ area to both fill the underage groove that develops with age (between the fat pads of the eye and the cheek fat pads), as well as volume replacement on the surface of the cheek bone can help reverse the hollowing seen in many patients
- Thinning of skin causing a ‘crepey’ appearance and cause a purplish show of the muscle around the eye – this can be an issue in people and causes longer term darkening of the area. The main way to tackle this is with collagen stimulating skin treatments, such as morpheus8, profhilo (or a combination of both – ‘Morphilo’), PRP (platelet rich plasma) can be an option too, and ultra lightweight fillers such as Juvederm volite or teosyal redensity 1 may also help in some cases. Another treatment that gained some popularity and can provide dramatic results in some cases is the plasma pen (‘plexr’), which creates micro injuries on the skin by vapourisation of tissue using plasma energy, however, patient selection with this procedure is key as downtime can be fairly extensive and there is a risk of post-inflammatory erythema (PIE) (ie redness that can persist for months after the treatment).
- Pigmentation and colour changes – this is more challenging to treat around the eye area as some of the lasers and products you might use for pigmentation the rest of the face to treat pigmentation are more risky around the eyes. This being said – some lasers that use a yellow light have been shown to be effective in this area and in some select cases I’ve used hydroquinone for pigmentation, which has been effective.
- Festoons or ‘saddle bags’ are often seen with age – these result from laxity of the skin and tissue fluid collection in the undereye area. In these patients, filler can sometimes exacerbate the problem so skin tightening treatments like Morpheus8 might be an option, or the more definitive surgical option of lower lid blepharoplasty
The key take home from all of this is that the area around the eye is a complicated area anatomically, so a bespoke approach by an experienced practitioner is always needed – a cookie-cutter approach should never be taken. When using filler in this area, it’s important to have a very gradual approach, using lightweight fillers that have a low risk of swelling and treat over several sessions. Combination treatments are usually key to success and surgical options should always be considered.
THE NOSE
Probably the best non-surgical option for the nose is the ‘non-surgical rhinoplasty’ or liquid nose job.Certain issues with the nose can be corrected using injectables, for example a dorsal hump (bump on the bridge of the nose) and a downward pointing/hooked nasal tip.Where once surgery was the only option, today the non-surgical rhinoplasty using fillers offers a very effective non-invasive alternative.Mild corrections after surgical nose jobs are also possible.
Usually this procedure will combine very small volumes of precisely placed dermal filler to re-shape and re-contour the, often in combination with small doses of botox injections to relax the various muscles of the nose. It should always be performed by someone with high levels of experience as it is a more complex and risky area to inject vs other areas of the face – so always select a practitioner who is well versed in this procedure!
THE JAW
Jawline laxity and droop is caused by a number of factors as we age, in particular – gravity, stronger downward pulling ‘depressor’ muscles (vs upward pulling ‘levator’ muscles) , volume loss of both the bone and fat of the face and reduced skin thickness and elasticity. In order to tackle this effectively, we need to consider each of the factors in turn to give a natural looking improvement with any treatment done for this area. As the jawline starts to sag, this in turn affects the neck. The downward pull of the platysma muscle in the neck and reduced jawline bony volume can allow the fat pad in the neck to drop down, giving the impression of a double chin.
The best way to tackle these is by addressing each of the issues in turn. As a starting point, replacing lost bony volume on the jawline and chin with dermal filler such as Juvederm Voluma can help lift the overlying skin and fat pads, and correcting any mid-face volume loss with filler can also help support the jawline from above. By improving the jawline, the double chin and neck often automatically looks better.
I would then tackle the muscle layer pulling down on the jawline – usually this would comprise of some botox injections to relax the downward pulling platysma muscle that tugs down on the jawline and neck.
Morpheus8 is also great treatment for skin tightening, resurfacing and also lifting – so addresses many issues that people see over time in one.worlds most advanced radiofrequency devices. Morpheus8 combines exceptionally thin microneedles with high powered radiofrequency at 2, 3 and 4mm depths to target the various layers of the skin and subcutaneous fat, to produce both skin lifting and fat reduction in areas such as the fat under the chin and jowls.
THE SKIN
Good skin is really in these days – thanks to Instagram and other social media platforms. People seem to be moving away from makeup, more in favour of good skincare and skin rejuvenating treatments so newer skin-boosting treatments such as Profhilo have become extremely popular. Getting into a good, but simple, skincare routine is also very important – with daily SPF use and antioxidants to combat skin stress and optimise the skin’s microbiome will make a huge difference in your skin longer term.
Profhilo is one of a new generation of injectables known as ‘biorevitalisers’ or ‘biostimulators’, which utilise the body’s own responses to create rejuvenating effects. Like fillers, Profhilo is made of hyaluronic acid (HA), but works in a different way. Unlike in fillers, where the HA molecules are tightly stuck together, profhilo consists of a very high concentration of more free floating hyaluronic acid molecules. These have two main effects
- Firstly (shorter term), they hydrate the deeper layers of the skin, giving a transient plumpness and hydration
- Secondly (longer term), the free floating hyaluronic acid molecules trick the skin into thinking it’s been injured (due to the chemical effect of free hyaluronic acid molecules at this high concentration) – so stimulate the fibroblast cells of the dermis layer of the skin to ramp up their production of collagen and elastin, causing thickening of the dermis and overall lifting/rejuvenation.
Usually two to three sessions are recommended (one month apart from each), to repeatedly stimulate these fibroblast cells and give the best longer term effects. Downtime is fairly minimal but Profhilo usually results in little bumps forming under the skin at the injection points for around 12 hours post treatment (basically the bolus of hyaluronic acid), before the molecules dissipate throughout the skin. There is a tiny risk of bruising but overall it is an extremely safe and effective treatment. Occasionally, if Profhilo is injected too deeply people won’t see much of an effect (if its injected into the fat layer it will just cause swelling and then very little hydration or tightening), so it’s important to go to an experienced practitioner who really knows their skin layers!
