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How do you know if you need cosmetic treatments? Anon, Whenuapai. A great question. Often pondered by the masses, taking the leap to having "work done" can be a daunting one.  First, we must clarify what "work" entails. Cosmetic treatments are designed to help us look and feel better.  The looking better part is really up to you.  It ranges from glowy, clear skin to less wrinkles to restructuring facial features , creating harmony and a refreshed appearance, where people comment you look great, but can't quite put their finger on it.  A holiday to the tropics?  A new diet?  New earrings? Therein lies the beauty of well-executed cosmetic medicine.  Both an art and a science, the delicate balance lies in the hands of the injector.  One who sees your unique beauty with acute awareness of the aesthetic end point. Various media have highlighted the dark side of cosmetic treatments, where aesthetic end points were crossed so fiercely, naturally beautiful people were given new identities.  Lovely lips turned to sausages, cheeks turned to chipmunks and jawlines turned to jagged messes. Such stories are wonderfully entertaining, alas not helpful for those seriously wanting the odd tweak to help them look and feel their finest.  Thankfully, there are a raft of ethical practitioners out there, properly trained with your best interests at heart. So it really all depends on you.  If that pesky frown is making you look grumpy, those forehead lines are becoming crevices for your make up, your skin is looking dull , you're tired of looking tired or if you just want a professional someone to cast an objective eye, then you are ready. The key is to sit firmly in the driver's seat, accept no pressure and do what feels comfortable for you and your budget.  The right practitioner will guide you, support you and care for you at every step. Your face and feelings are precious, so should always be handled with kindness, dignity and respect.   Quick Answers: How do I know if I need cosmetic treatments? If something about your face or skin is bothering you, or you feel you look tired, grumpy, or less refreshed than you feel, you may be ready. What are cosmetic treatments meant to achieve? Cosmetic treatments are designed to help you look fresher and more balanced, while still looking like yourself. What kinds of cosmetic treatments are included? They can range from improving skin clarity and glow, to softening wrinkles, to subtle facial restructuring for better harmony. What should good cosmetic treatment results look like? People may say you look great, but they should not be able to tell exactly what has changed. How do I avoid overdone or unnatural cosmetic results? Choose an ethical, properly trained practitioner who has a clear aesthetic end point and does not pressure you into treatment. If you have a question for Dr. Heather y ou would like answered anonymously, please email askdrheather@allor.co.nz .

A friend asked me the other day, why is sunscreen so important? With the upcoming long hot summer El Nino is expected to deliver (wahoo!), it got me thinking. Why do we bang on about sunscreen ? It must seem like sunscreen companies are sponsoring us to (they aren't). It all comes down to science. When the sun stuns us with her rays, she emits Ultraviolet Radiation (UV). There are different types of UV, the main ones that affect us are UVA and UVB. The energy they carry penetrates our skin and cooks us in a similar way to how a microwave heats up our dinner. Limited amounts of cooking (up to 15 minutes or so) are good for our tissues as it stimulates beneficial pathways in our body such as the production of Vitamin D, good for anti-ageing, bone and immune system maintenance. Too much of a good thing causes changes in our skin including altered pigmentation (spots), damaged collagen and dysfunctional deposits of elastin leading to wrinkles . Pigmented lesions/spots can also be triggered to mutate, leading to formation of cancer cells and the dreaded Melanoma. Sunscreen protects us from this radiation, broad spectrum the preferred choice to combat UVA (penetrates deeper and through glass, causing us to tan) and UVB (penetrates less deep and causes us to burn). Using this every day (even in Winter and when its cloudy) helps prevent and treat these changes. Like the necessity of wearing clothes, sunscreen should be part of the wardrobe. To be worn every day, except when the curtains are drawn and one is hiding inside. Quick Answers: Why is sunscreen important for your skin? Sunscreen protects your skin from ultraviolet (UV) radiation, which damages collagen, alters pigmentation, accelerates ageing, and increases the risk of skin cancer. What damage does the sun cause to skin over time? Too much UV exposure can cause pigmentation spots, wrinkles, collagen breakdown, elastin damage, and mutations that can lead to melanoma. What is the difference between UVA and UVB rays? UVA penetrates deeper into the skin, contributes to ageing and tanning, and passes through glass, while UVB causes surface damage and sunburn. Should I wear sunscreen every day, even in winter or when it’s cloudy? Yes. UV radiation is present year-round, even on cloudy days and in winter, so daily sunscreen use helps prevent long-term skin damage. How should sunscreen fit into a daily routine? Sunscreen should be part of your everyday routine, like clothing, and applied daily whenever your skin is exposed to daylight. If you have a question for Dr. Heather y ou would like answered anonymously, please email askdrheather@allor.co.nz .

What is Botox®? Anon, Whenuapai . A great question. Many assume they know as it's well splashed over the media, however I imagine many don't know more than "it freezes your face, Susan". Botox® is actually a brand name for Botulinum toxin (other brand names include Dysport® and Xeomin® ). All of these contain variable concentrations of toxin produced by the bacteria Clostridium botulinum.  Originally used by the United States Army as a bioweapon in World War II, this chemical has a powerful effect on paralyzing muscles. In large quantities Botulinum toxin can be dangerous, causing muscles needed for breathing to stop working. When used in much smaller concentrations, such as those used in Cosmetic Medicine , it is an effective tweaker of facial musculature, acting as a relaxant for muscles that cause pesky wrinkles. In skilled hands the result is a lovely, refreshed face, without looking frozen (think post-holiday-in-the-tropics glow).  In not-so-skilled hands it can lead to something that resembles a stroke. Botox® also acts on other parts of tissue such as sweat glands, providing an effective treatment for hyperhidrosis (excessive sweating).  It has also been shown to help reduce the appearance of scars.  The effect of this chemical is transient, lasting 3-4 months on average (up to 6-9 months in some).  Muscle fibre and sweat gland function completely returns once it wears off, so top-ups are required to maintain results.   Despite function recovering, repeated treatments on muscles leads to wasting, as one slowly diminishes their desire to do certain expressions targeted by treatment injections, such as frowning.  This alters the connectome in the brain, the complex wiring of brain cells connecting muscles of facial expression with emotion.  Gradual weakening of muscles leads to altered emotions, hence less frowning triggers us to feel happier.  Our animal instincts cause us to mimic each other, so if we look happier, so too do our peers. Like so many historical discoveries, Botox® began as a beast and morphed into a thing of beauty.  In the right hands, you too can benefit from its clever brilliance. Quick Answers: What is Botox® and how does it work? Botox® is a brand name for botulinum toxin, which relaxes targeted muscles in small, controlled doses to soften wrinkles and refresh facial expression. Is Botox® the same as botulinum toxin? Yes. Botox® is one brand of botulinum toxin, along with others such as Dysport® and Xeomin®. Is Botox® safe when used for cosmetic treatments? Yes, when used in very small doses by a trained practitioner. The doses used in cosmetic medicine are carefully controlled and safe. How long do Botox® results last? Results typically last around 3–4 months, although some people may see effects for up to 6–9 months. Can Botox® be used for anything other than wrinkles? Yes. Botox® can also be used to treat excessive sweating (hyperhidrosis) and has been shown to help reduce the appearance of some scars. Can repeated Botox® treatments change facial expression or mood? Over time, repeated treatments can weaken targeted muscles, which may reduce habitual frowning and can influence how emotions are expressed and perceived. If you have a q uestion for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Xeomin® (incobotulinum toxin) Prescription Medicine for the treatment of upper facial lines: glabellar frown lines, crow’s feet around the eyes, horizontal forehead lines.  Xeomin® has risks and benefits. Ask your doctor if Xeomin® is right for you (incobotulinum toxin A, purified Botulinum toxin type A 50 Units and 100 Units). For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz . Click for further details. Merz, Sydney. Distributed by Healthcare Logistics, Auckland. Dysport®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes. Dysport® has risks and benefits. Ask your doctor if Dysport is right for you. Botulinum toxin type A 300 or 500 Ipsen Units. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz . Click for further details. Galderma, Auckland. Botox®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes.  Botox® has risks and benefits. Ask your doctor if Botox is right for you. Botulinum toxin type A 50, 100, 200 Units. For product information check with your doctor or Consumer Medicine Information on  www.medsafe.govt.nz . Click for further details. Allergan, Auckland.

What is the best treatment for acne? Anon, Kumeu.   Acne is a frustrating beast.  It can rear its ugly face at all ages and can fluctuate at different stages of our lives.  Back in the infomercial days of acne skincare, many of us will remember the “miraculous” treatments all the popstars used that seemingly served to only irritate our skin, without any real solution (sorry Beibs).   Several types of acne exist, all relating to different stages of hair follicle blockage and inflammation.  These stages are referred to as Comedomal Acne (red spots and blackheads), Acne Vulgaris (pimples and blackheads), and Nodulocystic Acne (angry red pimples and sores).  Often an array of these features co-exist, and are further categorized as mild, moderate and severe.    Treating hormonal imbalances, tweaking medications, restricting the use of occlusive cosmetic products and reducing intake of dairy and high GI foods can all help as a starting point to minimizing acne .  Cleansing the face twice daily with a pH-balanced cleanser, ideally containing salicylic acid is the next step, followed by use of topical Retinol (Vitamin A).  The latter is famous for not only controlling acne, but also sports marvelous anti-ageing effects, plumping skin and evening pigmentation.  Hardy versions of retinol are available on prescription.   Chemical peels and microneedling can also help settle the skin; however need to be done on skin without active infection present.  Failing that, oral medication such as doxycycline and isotretinoin (Roaccutane) are an option to really help things clear.  Like any oral medication, these must be prescribed by a Doctor and monitored closely to ensure safety and adequate response.    As acne clears and scars emerge, these too can be minimized by treatments such as chemical peels and microneedling.  As complex as acne can be, advancements in skincare , topical and oral medications have thankfully altered the course of how we can treat this problem.  Goodbye pizza face, hello smoothness! Quick Answers: What is the best treatment for acne? There is no single best treatment for acne. The right approach depends on the type and severity of acne and often involves a combination of skincare, lifestyle changes, and medical treatment. What types of acne are there? Common types include comedonal acne (blackheads and small red spots), acne vulgaris (pimples and blackheads), and nodulocystic acne (deep, painful red pimples and sores). Can skincare alone help treat acne? Yes, for mild to moderate acne. Using a pH-balanced cleanser twice daily, salicylic acid, and topical retinol can significantly improve breakouts. Do diet and hormones affect acne? Yes. Hormonal changes, certain medications, dairy intake, and high-GI foods can all contribute to acne and may need to be addressed as part of treatment. When are medical treatments needed for acne? Moderate to severe acne may require prescription treatments such as oral antibiotics or isotretinoin, which must be prescribed and monitored by a doctor. Can acne treatments also help with acne scarring? Yes. Once active acne has settled, treatments such as chemical peels and microneedling can help improve acne scarring and skin texture. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz .

What is filler made of? Anon, Whenuapai.   Dermal filler is commonly made of Hyaluronic Acid (HA).  HA naturally occurs in our tissues and attracts water to help hydrate them.  Filler contains artificially made HA, chemically bonded together with various degrees of cross-linking to create different gels.  The more cross-linked a filler, the firmer the gel.  The firmer the gel, the longer it lasts in tissues and the better it is as mimicking bone lost to ageing.   Different fillers are injected into different areas of the face to replace lost tissue.  When done appropriately, this leads to a harmonious, natural result where it is difficult to tell if someone has had “work” done.  Too much filler leads to a puffy overdone look, as does too firm filler too close to the skin’s surface as modelled by many in the media (think girls of “Married At First Sight Australia”).   HA filler can be dissolved with the enzyme Hyaluronidase, also a naturally occurring entity we make in our tissues.  Cosmetic injectors should always have this at hand for dissolving HA filler in cases of emergency such as blocked blood vessels, as well as correcting overdone or undesirable results.  Irreversible fillers such as calcium hydroxyapatite are used less frequently; the latter used more commonly for skin rejuvenation and reduction in fine lines, although some also use it to alter facial structure.   Historically fillers such as silicone have been injected, however thankfully this is no longer a common occurrence as a raft of complications have been described with its use including chronic inflammation, lumps, swelling and skin changes.   The world of fillers is a rapidly growing one.  Products are becoming increasingly safer with better testing leading to improved outcomes.  Better results are achieved by injectors who appreciate the nuances of these products existing amongst a saturated market, coupled with their technical skills.  Just as our faces are multifaceted, so too should be our injectors. Quick Answers: What is dermal filler made of? Most dermal fillers are made from hyaluronic acid (HA), a substance that naturally occurs in the body and helps attract and retain moisture in the skin. Is hyaluronic acid filler safe to use in the face? Yes. When used by a trained practitioner, HA fillers are well studied, biocompatible, and widely used in cosmetic medicine. Why are some dermal fillers firmer than others? Fillers vary in how much they are cross-linked. More cross-linking creates a firmer gel, which lasts longer and is better suited to deeper structural support. Can dermal filler be dissolved if needed? Yes. Hyaluronic acid filler can be dissolved using hyaluronidase, an enzyme that naturally exists in the body and should always be available to cosmetic injectors. Are all dermal fillers reversible? No. Some fillers, such as calcium hydroxyapatite, are not reversible and are used more selectively, often for skin rejuvenation rather than major structural change. Why do some people look overfilled? Overfilled results can occur when too much filler is used, the wrong type of filler is chosen, or it is placed too close to the skin’s surface. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Dermal Filler, Medical Device Class III to smooth facial wrinkles and folds, correct facial atrophic scars, restore or enhance the lips or restore facial volume. Dermal filler has risk and benefits. Ask your doctor if dermal filler is right for you.  For product information check with your doctor or from product details with the supplier.

I think about doing cosmetic treatments but feel guilty.  I always put my family first, but my husband keeps telling me not to feel bad for wanting to put myself first for a change.  How do people get around feeling guilty?  Anon, Riverhead. Parental guilt is real for parents, so it is entirely understandable you feel this way.  We always put our family first and so naturally feel as if we don’t deserve the same.  Interestingly this concept often stems from us suffering low self-worth.  Taught to us by generations above, it is surprisingly common to feel as if we don’t deserve certain things because we feel we aren’t worthy.    Self-worth is a core belief we possess similarly to any other core belief such as religion.  It is different from low self-esteem as it does not fluctuate easily (think good hair day versus bad hair day).  It is instead a static mental space where one is so secure within themselves; they know they will be okay if they lost everything (a scary but very powerful space to be).   The seeds of low self-worth are often planted when we are children and continue to grow with dysfunctional adult relationships, where we suffer emotional abuse ranging from not feeling heard, through to being yelled at, severely criticised, or even physically abused.  Identifying this is not to necessarily lay blame on our parents, partners, or friends, as they are a product of their own experience, but instead allows us to identify patterns of intergenerational and interpersonal trauma that lay the foundations of low self-worth, so toxic cycles can be broken.    Low self-worth is often developed alongside an inner critic who negates our decisions and tells us we shouldn’t do things because we aren’t worthy.  It can also develop as a reflex of receiving criticism from influential figures in our lives and can be hard to turn off.  One of the most liberating things we can do to counteract our inner critic is to say DELETE every time it rears its ugly head.  Saying it aloud, with conviction is an extremely effective way to diminish its power and allows us to instead turn up the volume on compliments.  Sometimes naming our inner critic can further help disconnect from its influence.    When we shift our thinking in this way, we become more positive and allow ourselves to internalise positive feedback.  We then start to really respect and love ourselves.  We get to know ourselves.  We become our own best friend.  It then becomes okay to put ourselves first just as we are always told in flights to put our oxygen mask on first.  This also allows us to build stronger boundaries and we become happier with more capacity for acts of kindness, as we are no longer stomped on by negativity.    Whether it be cosmetic treatments , going out for that lunch with a friend or eating that piece of cake, being kind to ourselves by silencing our inner critic and welcoming in positivity can be a life changing experience.  The warm hug of grace we give ourselves can be just what the Doctor ordered. Quick Answers: Why do I feel guilty about wanting cosmetic treatments? Guilt often comes from low self-worth and the habit of always putting others first, which can make it feel undeserved to prioritise yourself. Is feeling guilty about self-care a sign of low self-worth? It can be. Low self-worth is a deep-seated belief that you are not worthy, and it often shows up as guilt when you do something for yourself. What is the difference between low self-worth and low self-esteem? Low self-esteem fluctuates with circumstances, while low self-worth is a more fixed core belief about your value as a person. Where does low self-worth usually come from? It often develops in childhood and can be reinforced by critical or emotionally unhealthy relationships later in life. How can I stop my inner critic from controlling my decisions? Actively interrupt it. Saying “delete” when critical thoughts arise can help reduce their power and make room for more positive thinking. Is it okay to put myself first sometimes? Yes. Looking after yourself builds stronger boundaries, improves wellbeing, and allows you to show up more positively for others. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz .

What is the best skincare regime? Anon, Whenuapai.   Skincare is complex.  There is a lot of noise in the market with zero regulation.  Most of us start (and often continue) a very basic regime inspired by supermarket shelves, television adverts and people we know.  I myself have been victim of using all the no-no things including face cloths, soap and the dreaded St Ives Apricot Scrub.    A good regime consists of a few basics.  Firstly, a pH balanced cleanser should be used to gently cleanse the skin without compromising the naturally acidic skin barrier.  It doesn’t really matter what product you use if the pH is balanced, however be weary of marketing ploys such as foam (foam does not equal better cleaning) and addition of ingredients such a hyaluronic acid as they are washed away during the cleansing process.   After cleansing, application of an antioxidant serum is a great idea.  Vitamin C is a fantastic option for daytime as it is great for environmental protection, minimising pigmentation and encouraging collagen production.  A good alternative for day (or nighttime) is Vitamin B, which helps minimise wrinkles , improve skin tone and also acts to enhance collagen production.   Another great serum for nighttime is the famous Vitamin A, AKA, retinol.  The hero ingredient to any skincare regime , this powerful micro-nutrient speeds up skin cell turnover, minimises pigmentation, reduces acne, stimulates collagen production and diminishes wrinkles.  Care must be taken when starting retinol however as it can cause skin irritation, so staggering its use initially and slowly building to nightly application is recommended.  Many products on the market claim to contain retinol , however shop around as some instead contain very weak retinoid esters (retinyl palmitate, retinyl acetate and retinyl linoleate), that take many years of consistent use to have effect.    On top of serums, one should then apply a quality moisturiser that suits your skin type.  Dry skin needs thicker moisturisers, whereas oily skin prefers oil-free concoctions.  Choose something that smells and feels good and be sure to also apply it on the neck and backs of the hands as these areas are often neglected and eventually become telltale signs of a person’s true age (you’ll start noticing those celebrity close-ups now).   Finally, during the day don’t forget SPF!  Super important to minimise ageing as the harsh ultraviolet rays from the sun (on cloudy and clear days) will undo all the good work you do with your skincare regime.  Just be sure to pick a product that you like that doesn’t make you look and feel like a greaseball.    Everyone can benefit from a good skincare regime; the key is to understand the basics and resist marketing tactics by big brands.  A good rule of thumb is if it’s advertised in mainstream media, it probably isn’t worth your time (and money) as quality products don’t need big advertisements to demonstrate their worth. Quick Answers: What is the best skincare routine? There is no single best routine. An effective skincare regime is built around a few core steps tailored to your skin type. What are the essential steps in a daily skincare routine? A good routine includes a pH-balanced cleanser, targeted serums, a moisturiser suited to your skin type, and daily sunscreen. What cleanser should I use for healthy skin? Use a gentle, pH-balanced cleanser that cleans the skin without stripping the natural skin barrier. Foam and added “hero” ingredients do not mean better cleansing. Which serums are most important in a skincare regime? Vitamin C or B serums are useful during the day for protection and collagen support, while Vitamin A (retinol) is best at night for cell turnover, acne control, pigmentation, and wrinkle reduction. How should I start using retinol safely? Introduce retinol slowly. Start a few nights per week and build up gradually to avoid irritation. Is moisturiser necessary if my skin is oily? Yes. Oily skin still needs moisturiser, but lighter, oil-free formulas are usually best. Why is sunscreen essential in a skincare routine? Daily sunscreen protects against UV damage, which accelerates ageing and can undo the benefits of even the best skincare products. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz .

How long does Botox ® last? Anon, Whenuapai. Botulinum toxin, more commonly known at Botox®  is a neurotoxin that relaxes muscles.  It is injected in different areas at different doses, in order to target muscles we no longer want to contract.   Results tend to last approximately 3-4 months, however this is dependent on a few factors.  Some injectors (and companies) argue certain brands of Botulinum toxin last longer than others, however research has consistently shown dose injected is the most important factor, as the higher the doses used, the longer results last.  Higher doses however are associated with more muscle paralysis, so a more “frozen” look, which can appear less natural.  A more targeted approach to individual anatomy can also yield longer results as no unit of toxin is wasted on muscles that do not need treatment.    Even though typical results last 3-4 months, repeat treatments often aren’t required for a bit longer as the facial muscles take time to re-train and catch up to the rest of the face to resume normal expression.  This means one can often obtain 5-6 months of longevity out of their anti-wrinkle treatments , which has the added benefit of allowing muscles to regain full strength before repeat treatment, so are less likely to waste and lead to an odd appearance long term.  It is also fantastic for the budget!   Utilizing evidence-based products from reputable brands that are reconstituted correctly, not expired and stored correctly will also enhance results.  It is always important to ask your injector what they use and why, and check they store their products correctly.  Make sure you also keep an eye on long-term changes in your face as result of anti-wrinkle injections, as repeated high-dose treatments when not required can often lead to heaviness and/or an odd appearance with strengthening of other muscles in order to maintain normal facial expression. Quick Answers: How long does Botox® last on average? Botox® typically lasts around 3–4 months , although this can vary between individuals. What factors affect how long Botox® lasts? The dose used, injection technique, and individual muscle strength all influence how long results last. Higher doses tend to last longer but can look less natural. Do different Botox® brands last longer than others? Not usually. Research shows that dose matters more than brand , with higher doses producing longer-lasting effects. Can Botox® last longer with repeat treatments? Yes. With repeat treatments, muscles often take longer to regain full strength, meaning results can last 5–6 months  for some people. Is it better to wait until Botox® fully wears off before repeating treatment? Often, yes. Allowing muscles to fully recover can reduce the risk of long-term muscle wasting and help maintain a more natural appearance. Does product quality affect how long Botox® lasts? Yes. Using reputable brands known to be stored, reconstituted, and injected correctly can help optimise results and longevity. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Botox®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes.  Botox® has risks and benefits. Ask your doctor if Botox is right for you. Botulinum toxin type A 50, 100, 200 Units. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz. Click for further details. Allergan, Auckland.

How much filler do you use during a treatment? Anon, Waimauku Dermal filler is a fantastic tool used to replace volume and enhance structure to achieve facial harmony.  It is designed for injection into different areas of the face, at variable depths, depending on what it is trying to replace such as bone loss, fat loss and/or skin smoothness.   As each treatment is individually tailored, it can be tricky to know exactly how much filler is needed.  We as injectors are pretty good at estimating, however tissues can respond differently, and some require larger volumes than expected.  This is why a volume range is often quoted when planning a treatment, the more deficient tissues requiring more filler to achieve the desired harmony and favourable light reflections we are looking for (think makeup contouring without makeup).   Dermal filler is typically manufactured in 1mL syringes.  Most injectors plan their treatment around what they can do with each syringe so they minimize waste and obtain the most bang for buck.  As filler is packaged sterile, it is best to use each syringe at the time of treatment to reduce the risk of contamination and therefore complications such as infection.    Cheeks, chin, jawline , temples and central face require at least 1-3mL of filler and more may be necessary for optimal results.  Smaller quantities however can also achieve lovely softening of problem areas, especially if done with a tactful artistic eye.  If your injector is clever, they will be able to target specific areas that will achieve overall improvement with minimal product.    Lips typically require the least amount of filler (less than 1mL), however this also depends on the surrounding tissues, as it is imperative lips are supported by their surroundings, so they look natural .  Forcing an entire 1mL syringe of filler into one’s lips is not a good idea for most of us to avoid looking overdone or puffy.    A good honest conversation with your injector is always a great place to start if you are looking at having dermal filler treatment.  Multiple considerations must be discussed including your needs, wants and budget.  You should always feel heard and in the driver’s seat so be sure to ask questions (writing them down can help).  The aesthetic journey is a personal one and should be respected, so listen to your instincts and ensure your injector is listening to you. Quick Answers: How much dermal filler do I need? It depends on your facial structure, areas being treated, and the degree of volume loss. Filler amounts are always individualised. How is dermal filler measured during treatment? Dermal filler is supplied in 1 mL syringes , and treatment plans are usually based on how each syringe can be used most effectively. How much filler is usually needed for cheeks, jawline, or chin? These areas often require 1–3 mL or more , depending on how much structural support or volume replacement is needed. How much filler is typically used in the lips? Lips usually require less than 1 mL . Using too much filler in the lips can lead to an overdone or puffy appearance. Does using more filler give better results? Not always. Strategic placement and injector skill often achieve better, more natural results than simply using more product. How do I know what amount of filler is right for me? An open discussion with your injector about your goals, facial balance, and budget is essential. A good injector will tailor the plan and adjust as needed. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Dermal Filler, Medical Device Class III to smooth facial wrinkles and folds, correct facial atrophic scars, restore or enhance the lips or restore facial volume. Dermal filler has risk and benefits. Ask your doctor if dermal filler is right for you.  For product information check with your doctor or from product details with the supplier.

Can Botox ® be used for sweating? Anon, Kumeu Botulinum toxin (commonly known as Botox®) is a versatile beast.  In addition to its well-known function of relaxing muscles , it can also stop sweat glands from working so is a great treatment for sweating.   When injected at a superficial depth (very close to the surface of the skin), it acts to interfere with sweat glands and results can last up to 6-9 months.  It is particularly helpful for those who experience excessive sweating ( hyperhidrosis ), which can affect a variety of areas including armpits, hands, feet and face.  The very superficial nature of the injections minimize muscle involvement, however sometimes muscles close to the skin surface are also weakened, so a tailored approach is needed to ensure treatment is appropriate.   It is also important to ensure your injector is confident other causes of hyperhidrosis have been excluded such as tumour, thyroid disturbance, medications and diabetes.  If any doubt, it is always best to check with your GP in the first instance.   As the warmer months approach (yay!), so too does sweating.  This can be embarrassing and affect quality of life significantly.  It is helpful to know reliable treatments for this exist and our good ol’ friend Botox®  can help us once again. Quick Answers: Can Botox® be used to treat excessive sweating? Yes. Botox® can block the signals to sweat glands and is an effective treatment for excessive sweating (hyperhidrosis). How does Botox® reduce sweating? When injected very superficially, Botox® interferes with sweat gland activity rather than muscle movement, reducing sweat production. How long does Botox® for sweating last? Results can last 6–9 months , which is often longer than cosmetic Botox® used for wrinkles. Which areas can be treated with Botox® for sweating? Common areas include the armpits, hands, feet, and face, depending on where excessive sweating occurs. Is Botox® for sweating safe? Yes, when performed by an experienced practitioner using correct technique. Treatment must be tailored to avoid unwanted muscle weakness. Should other causes of excessive sweating be ruled out first? Yes. Conditions such as thyroid problems, medication effects, diabetes, or rare tumours should be excluded, and a GP review is recommended if there is any doubt. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Botox®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes.  Botox® has risks and benefits. Ask your doctor if Botox is right for you. Botulinum toxin type A 50, 100, 200 Units. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz. Click for further details. Allergan, Auckland.

How long does filler last? Anon, Riverhead. Dermal filler is an injectable gel made of hyaluronic acid.  Every gel on the market varies in terms of firmness and in general, the firmer the filler, the longer it lasts. Filler selection is based on how well it mimics tissues, whether that be skin, fat or bone. Firmer fillers are usually injected deep onto bone and tend to last up to 1-2 years on average based on manufacturer information.  Softer fillers such as the sort that is typically injected into lips and wrinkles tend to last 6-12 months as they are metabolized quicker by our tissues. Recent MRI (Magnetic Resonance Imaging) studies have shown filler can last much longer, up to 8 years, possibly longer.  This has created quite the stir on social media.  Many injectors have claimed this is a bad and scary thing; even going as far as to say they will not inject filler anymore.  This is bogus in my opinion, as the product itself is inert and mimics naturally occurring hyaluronic acid we have in our tissues, so is safe to remain for years, unless there is a complication.  Thankfully complications are rare and minimised by appropriate patient selection and precise sterile injecting technique at the outset, so it is always best to choose your injector wisely. The trendy concern regarding longevity of filler is often aimed at people who look progressively odd, where filler on top of filler is administered over many years without a good objective eye keeping everything looking natural.  This is crucial, as there are many instances where filler may no longer serve us, the tear trough (under eye area) a classic example, where under eye bags become puffier over time.  The wonderful thing about hyaluronic acid filler however, is that it can be dissolved. Regular clinical photography and a good, sensible eye are imperative to prevent the slow deterioration of one's appearance, often coined "Boiled Frog Syndrome."  This phenomenon is where one is treated with multiple treatments over time just as a frog tolerates slow heating in a pot.  When the pot boils, the frog does not realise how hot it is and dies, much like the natural appearance of someone who falls victim to too much filler.  On the contrary, if a frog is placed into a pot of boiling water at the outset it quickly jumps out, just as one should stop and correct unnatural results that can only be seen with a keen, objective eye.  This is sadly variable amongst injectors, but a great rule of thumb is if your injector looks a bit puffy or odd, you probably will too. Quick Answers: How long does dermal filler last? It depends on the type of filler used and where it is placed. Firmer fillers can last 1–2 years , while softer fillers often last 6–12 months . Does the type of filler affect how long it lasts? Yes. Firmer, more cross-linked fillers last longer than softer gels because they are metabolised more slowly by the body. Do fillers really last longer than advertised? Yes. MRI studies show hyaluronic acid filler can remain in tissues for many years , sometimes up to 8 years or longer , even if the visible effect fades earlier. Is it dangerous if filler lasts for years in the face? No. Hyaluronic acid filler is inert and mimics a substance naturally found in the body, so it is safe to remain unless a complication occurs. Why do some people start to look worse over time with filler? Problems usually come from repeatedly adding filler without reassessment. Over time, this can lead to puffiness or distorted features if not monitored carefully. What can be done if filler no longer looks right? Hyaluronic acid filler can be dissolved. Regular review, clinical photography, and an objective injector eye help prevent long-term overfilling. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz . Restylane®, Medical Device Class III to smooth facial wrinkles and enhance lips by restoring volume and fullness. Restylane® has risks and benefits. Ask your doctor if Restylane is right for you. For product information check with your doctor or from product details with the supplier.  Click for further details. Stabilised Hyaluronic Acid 20mg/Ml. Galderma, Australia, Sydney or distributor Healthcare Logistics, Auckland.

I’m struggling to sleep as Christmas approaches, any tips? Anon, Whenuapai The holiday season can be stressful. Events, presents, gatherings, spending time with people you may not want to, it’s a lot. Squeezing in too many things can make us feel the weight of the world on our shoulders, and this commonly leads to poor sleep. Sleep hygiene is a great place to start when trying to achieve more slumber. It is where we do things to encourage our body clock to tick as it should, so we secrete the right amounts of the hormone melatonin and therefore achieve quality sleep. This means getting up and going to bed at the same time each day (easier said than done when there are presents to wrap). If that is difficult to achieve during the holidays, other tweaks such as exposing yourself to natural daylight as soon as you wake and darkening your bedroom with block out curtains can help. Our bodies like to be between 16 and 18 degrees Celsius for optimal sleep, so unless you have air conditioning (heaven!), it would be sensible to invest in a fan. There are clever mattress protectors that cool when you touch them, so are also a great option. A cold shower just before bed and sleeping with your hair wet is a great way to lower and maintain core body temperature as well - much easier to achieve if you start warm then go cold right at the end for a minute or so. Cold showers are also fantastic for stimulating release of anti-ageing proteins, strengthening the immune system, releasing endorphins and stimulating production of brown fat (fat that keeps us warm and helps us lose weight). A great option to add to your routine for multiple benefits – I now miss it if I don’t go cold at the end of my showers! Other great ways of stimulating sleep is to exercise during the day (a good walk can do wonders), avoid daytime naps and reduce blue light exposure from screens before bed. Avoiding caffeine at least 6 hours before bed is also recommended, as is having a solid bedtime routine, where you wind down with same sequence of events. A great example would be a cold shower, reading a book, meditating and a non-caffeinated tea such as chamomile. Writing a list of things you need to do to remove them from your mind is also a great way to minimize brain chatter when lying in bed. If these fail, the next step would be to have a chat with your family Doctor about medications and to address any other possible causes of insomnia, such as anxiety or thyroid dysfunction. Sleep is something we don’t miss until it’s gone. Sleep disruption is common, especially around the holidays so remember to be kind to yourself. Sometimes letting go of our own self-criticism can unlock the barriers we have with sleep, allowing a much more enjoyable slumber and holiday season . Quick Answers: Why do I struggle to sleep during the holidays? Holiday stress, overcommitment, and disrupted routines commonly interfere with sleep and can lead to short-term insomnia. What is the best way to improve sleep during the holidays? Focus on good sleep hygiene. Keep consistent sleep and wake times where possible, get daylight exposure in the morning, and darken your bedroom at night. What temperature is best for sleep? Most people sleep best in a cool room, ideally around 16–18°C , as a lower core body temperature supports melatonin release. Can cooling techniques help with insomnia? Yes. Using a fan, cooling bedding, or taking a cold shower before bed can help lower body temperature and promote sleep. What habits should I avoid if I can’t sleep? Avoid caffeine within 6 hours  of bedtime, limit screen use before bed, avoid daytime naps, and reduce blue light exposure in the evening. When should I talk to my GP about insomnia? If sleep problems persist despite good sleep habits, or if anxiety or medical causes are suspected, your GP can help assess and discuss treatment options. If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz .