The Ultimate Guide to the latest Trends in Cosmetic Medicine

Words by Kate Roxby

For most of my 20s, I could never imagine being concerned with the appearance of fine lines and wrinkles. My main concern was beautiful, clear skin, free from pimples and dry flakiness.

Now, as I am one year away from turning 30, I have found myself drawn to examining the lines around my eyes and the way in which the skin around my lips has started to droop slightly. When did this happen? And is it just me or a concern for all women my age? After confiding in the women around me (of all ages), it became apparent that I was not alone. In fact, this was the single main concern for all women when talking about their skin. What I didn’t realise, is that some of these women were already taking measures to sustain and restore their youthful vitality. And by ‘measures’, yes, I am referring to Cosmetic Medicine. What I thought to be once a taboo topic turns out to be quite the popular remedy for anti-ageing concerns amongst today’s women.

Being quite new to the world of Cosmetic Medicine, and suffering overwhelming images of Heidi Montag’s ‘cosmetic’ journey, I felt that I needed the advice and professionalism of an expert in this field to inform me properly. I wanted to know what was available, what was popular, the risks associated, and whether it was just me that found the concept of maintaining my youth ever appealing? In my research for the top Cosmetic Medicine practitioners in the state, a particular name persisted in its appearance – Dr. Irene Kushelew. A Founding Member and former SA President of the Cosmetic Physicians Society of Australasia (CPSA) and Founding Director of Beauty & Medicine, Dr. Kushelew is one of the most sought after and leading practitioners in Cosmetic Medicine with over 20 years of specialised experience. Working alongside her and sharing in her passion and knowledge of the latest Cosmetic Medicine, is Registered Nurse, Deraly Fleming. Boasting over a decade of experience herself, Deraly works closely with Dr. Kushelew, educating, treating and caring for many patients. After chatting with these lovely ladies of resounding skill and knowledge, I started to realise that Cosmetic Medicine is really just a method of skincare that works from the inside, out. Having become increasingly popular — and backed by an astounding amount of research and development, it is a choice that is much safer than I initially thought.

What is involved in a Facial Rejuvenation cosmetic procedure?
Facial Rejuvenation involves injectable treatments, which help both men and women reflect the way they feel on the inside, says Dr. Kushelew. Administered by a trained medical professional, these cosmetic procedures include both injectable muscle relaxants and injectable facial fillers. Deraly adds that Facial Rejuvenation is more of a holistic approach to cosmetic medicine, considering not just where lines are forming on the face, but how they came to be, which is commonly due to a loss of volume.

WRINKLE TREATMENTS

What do you mean by an injectable wrinkle treatment? Dr. Kushelew explains that this type of treatment involves the injection of a naturally occurring protein to treat significant wrinkles that are prominent during facial expressions. It doesn’t necessarily ‘fill’ the wrinkle as such but, instead, relaxes the muscles that are used to form the wrinkle itself. These include ‘worry lines’ and frown lines across the forehead, and the common crows feet that develop with age and expression. This type of treatment can gradually smooth the appearance of wrinkles over time.

What else can this procedure be used for?
Wrinkle treatments offer an incredible range of treatments, Dr. Kushelew says. Not only can they smooth the appearance of expression lines and crows feet, but they can also be used in a way which creates definition of the jaw line, reshapes and lifts the brows, rejuvenates and smoothes the skin on the neck, and contours the lower part of the face, causing it to appear slimmer and more defined. (Book me in!!)

Deraly has seen many patients benefit from this treatment for jaw-grinding in particular. She explains that grinding your jaw can often change the shape and size of the muscle, and therefore increases the jaw line. Wrinkle treatments not only provide great relief she says, but shapes the jaw back to a slimmer, more sculpted look.

How long does this type of treatment last for?
Although a wrinkle treatment can last up to 4 months, the full effect can take up to 7 days to appear, with the first signs developing 2-3 days directly after treatment. After multiple treatments of the correct dosage, the effect can last up to, and over, 6 months depending on the area being treated, and doses can be gradually reduced.

How much do wrinkle treatments cost?
Depending on which area is treated, Dr. Kushelew advises that costs of this treatment can vary between $200 and $1000. She says “typically a frown area is approximately $400-460 if using the most popular formulation of wrinkle treatments. Prevention of facial ageing in the lower face may require very little and cost as little as $100.”

INJECTABLE FACIAL FILLERS

What is an Injectable Facial Filler?
Facial fillers involve a qualified medical practitioner and/or a qualified registered nurse injecting a substance beneath a wrinkle and/or fold in the skin in order to ‘fill out’ and `plump up’ the depression, creating a smoother and more youthful appearance. It can be used to treat static wrinkles (the lines that are visible when at rest), and to softly enhance the fullness of your lips. Facial Fillers are becoming so advanced in their development, says Dr. Kushelew, that they are even being used to restore volume in the cheeks, around the mouth, in the lips and around the eyes. Deraly confirms this, and says that these fillers are being used to provide the ‘wow’ factor for many patients, especially in their cheeks.

Deraly continues to inform me that, by considering the entire face when injecting fillers rather than just ‘filling a line’, it is possible to restructure the rest of the face as a result. For example, jowls are often a result of a loss of volume in the cheeks. Therefore, by injecting the fillers into the cheek area only, this not only creates volume in the upper half of the face, but also lifts the lower parts of the face as well, reducing the appearance of the jowls.

According to Dr. Kushelew, facial fillers and the way in which they are used, have undergone significant changes in the last few years, making them safer and more akin to our own physiological make-up. Facial filler procedures that use proprietary HYLACROSS technology use a natural injectable gel as a skin ‘filler’ to gently restore structure and volume to the skin. She says “the most commonly used fillers now are natural fillers called hyaluronic acid gels (HA gels). These are totally natural gels, and present in many tissues in the body to form structural support between cells. The HA gels used in facial fillers are non-animal in origin and are produced by a process of fermentation. HA gels are really just complex sugars.”

How long does this type of treatment last for?
A facial filler treatment will most likely last between 6-12 months, providing lovely, natural results with HYLACROSS technology in particular. “The only filler available when 1 began 18 years ago was collagen. Compared with today’s products, it was restricted to treatment of very limited areas and only lasted 3-4 months. Some of the HA gels are now lasting 12-18 months. The big advantage is that these fillers provide better and more long lasting results” says Dr. Kushelew.

How much do facial filler treatments cost?
Price will depend on the strength and formation of the filler, but prices are recommended to start at $650 per syringe. A complete facial rejuvenation may require a sequence of multiple treatments incorporating both wrinkle treatments and facial filler procedures, and can cost up to $5000, and occasionally beyond. Dr. Kushelew adds, however, that minimal costs are required to maintain this kind of rejuvenation on an annual basis, and the results are beautifully natural.

What else can Facial Fillers be used for?
An injectable facial filler treatment is so dynamic in its uses that, in addition to facial rejuvenation and improvement of facial smoothness and texture, facial fillers can be used to reshape the face, assist in lifting the cheeks and brows, and even enhance and define the chin. Dr. Kushelew says that “fillers can even be used in non-surgical rhinoplasty, or shaping the nose for cosmetic purposes.

How long do these treatments take to do?
Dr. Kushelew says that a great advantage in the development of these products is the very little time in which they can be administered. Due to the development and advances in these products over recent years, these kinds of treatments are much more comfortable for patients and are generally completed within 45 minutes. She says that wrinkle treatments, in particular, can take as little as 10 minutes to complete. Deraly tells me that many of her patients are known to come and receive their treatments during their lunch break —there is no need to plan for any days off post-treatment.

So I don’t need to plan to take the day off work or stay at home to recover after a treatment?
Normally, no. Normal activities can generally be resumed immediately following facial injections, advises Dr. Kushelew. However, individual reactions and recovery time may vary, depending on the person. Occasionally, a brief amount of time off such as the remainder of the day may be recom-mended. With the most recent advances in ‘no needle’ techniques, there is rarely any bruising associated with these treatments any more. Are there any immediate risks or side-effects associated with these treatments? Mild redness can occur directly after treatment but generally only lasts for about 10 minutes.

There is a small risk of bruising in isolated cases lasting up to a few days, but this is rare. It is always important to consider individual allergic reactions and medical history in any cosmetic procedure, however NO allergic reactions to wrinkle treatments have been reported and such a reaction is also a very rare and unique occurrence with the new and advanced fillers being used in today’s treatments. Dr. Kushelew emphasises how important it is to avoid intense exercise for at least 24 hours straight after a treatment. She also advises to try and maintain an upright position wherever possible. It is important not to touch the area being treated for at least 4 hours, as doing so will increase the risk of spreading the product. If this occurs, it increases the risk of the eyebrow or eyelid drooping after treatment. Although this has been reported, Dr. Kushelew assures this is also a rare occurrence. It is also important to consider your individual experience with local anaesthetic, as this may be used in certain areas prior to a filler treatment.

How have these treatments been revolutionised over the last decade?
“The greatest revolution in the last 5 years has been the effectiveness of the HA gels in providing much longer lasting treatments than collagen & the areas of the face that can be treated,” says Dr. Kushelew. “After full facial assessment a much more harmonious and natural result [is achieved] rather than just concentrating on treating one area such as the frown. The value of these treatments is also much better — a syringe of collagen at $600 lasted only 3-4 months, while a syringe of HA gel filler at $650 will [now] last 12 months.”

How have these treatments been revolutionised within the last 12 months?
The use of microcannulas, small non-sharp injecting tubes, has made the dermal procedure virtually ‘needle free’ with little discomfort and virtually no bruising, say both Dr. Kushelew and Deraly. On a recent trip overseas, Dr. Kushelew found that the use of this specific technique, initially developed in France, was widespread across the whole of Europe. Dr. Kushelew is one of the Cosmetic Medicine specialists introducing these advances in treatment into Australia. She says “I have now been using these cannulas for 12 months and found them to be revolutionary in the results and delivery of the product.”

Deraly says that the introduction of local anaesthetic in filler treatments over the last few years has also made it more appealing to patients who are concerned about the discomfort of these treatments. She continues to tell me that there used to be a need to numb the entire gum/jaw area for some treatments, and patients weren’t able to enjoy a coffee afterwards, or would often have that horrible numb feeling after treatment. This is no longer required, with all modern fillers having anaesthetic built into the product itself. Deraly informs me that only a small amount of ice is generally needed to numb the area beforehand and, as a result, the treatment itself has become much more comfortable for patients.

Do I have to have both treatments for the best results?
Dr. Kushelew consults with her clients on their individual needs before determining the best facial rejuvenation procedure which, yes, can sometimes include a combination of both muscle relaxants and facial fillers. It all depends on what the client wants to achieve. Both Deraly and Dr. Kushelew extensively consult with their patients prior to treatment, and often ask them to express what concerns them most. Deraly says, “What we see is not always what they see.”

Who benefits from these types of treatments?
Initially I thought that it was only women close to my mother’s age who were so concerned about the ageing process that they would consider injectable cosmetic treatment.

However Dr. Kushelew assures me that, although she still has a large database of older patients booking in for rejuvenation work, many men and women are approaching these methods of skin care as preventative alternatives at an earlier age. She says “many women, in particular, can see the areas in which their mothers (and fathers) have aged — such as in the formation of jowls or deep frowns —and this is often an indication of how their faces will also likely age. So the ability to slow down the ageing process through some preventative procedures is now a large part of the work.”

Deraly says that she has treated girls as young as 18 who have already developed quite prominent frown lines. A common concern among younger women also is a very thin upper lip, and it is these types of treatments that really help boost a woman’s self esteem, making this a really exciting option for them. What may not be immediately visible to us, may be a major concern for the individual, and it is helping these men and women feel better about themselves through these treatments that Deraly finds most rewarding.

What do these treatments offer women of the following ages?

• Women in their 20’s Beautification — women can use these treatments to enhance their looks through treatments such as lip enhancement and augmentation, cheek enhancement, and facial harmonising for better proportion.
• Women in their 30’s Preventative treatments to slow down the ageing process
• Women in their 40’s and beyond Treatment of immediate concerns such as corrections and/or facial rejuvenation

What should I look for when considering these treatments as far as the reputation and credibility of a cosmetic practitioner?
Dr. Kushelew emphasises the importance of confirming the credentials and experience of the practitioner administering the treatment. She recommends asking how many particular procedures they have done, as there are many practitioners establishing businesses with minimal experience in the field. She also agrees that the best kind of recommendation is word of mouth and reminds us ‘A newer practitioner is likely to be discounting heavily to get new business. Sometimes you need to pay for experience and expertise.”

Deraly explains that it is also important to consider the experience of the practicing nurse or practitioner in the field of cosmetic medicine. She says that, although someone may have been a nurse or a doctor for a significant part of their career, they may not have had much experience at all in these particular kinds of treatments. She emphasises how important it is to discuss your medical history with the nurse and/or doctor, and that you should take the time to become familiar with and educated about the type of treatments available and which ones are best suited to your own needs. At Beauty & Medicine, Deraly and Dr. Kushelew pride themselves on their attention to correct and detailed quotations, assessing medical history, understanding the patient’s concerns and taking the time to tailor the right kind of treatment. There is no pressure to book in for the treatment on the day, rather, patients are actually encouraged to go away and consider the procedure before deciding. Deraly says “this promotes a safe environment and results in a very satisfactory outcome for the patient.”

Beware Of… Permanent Fillers!
Dr. Kushelew strongly advises to seriously consider the permanency of this type of treatment before proceeding. She relays a quote by a Melbourne dermatologist on the subject; “Permanent Fillers may equal Permanent Problems.” She suggests that Permanent Filler that is not administered or placed perfectly within the face can often lead to the need for surgical intervention to remove the treatment product.

Did You Know???
Dr. Kushelew also uses the same wrinkle treatment to treat hyperhidrosis (excessive sweating), bruxism (teeth clenching, grinding) and the management of migraines! She explains that excessive sweating can be treated for up to 7-8 months at a time by injecting the wrinkle relaxer formulation through an ultra-fine needle into the skin of the armpits, and the natural purified protein then enters the glands that are responsible for producing excessive sweat, ultimately blocking the release of the chemical that makes your perspire.

THE AMAZING DR. IRENE KUSHELEW

Not just gorgeous and glowing herself, Dr. Kushelew is warmly spoken, approachable and one incredibly intelligent and gifted woman. Graduating with a degree in medicine in at Flinders University in 1982 (and winning the 1981 Pinard Prize in Obstetrics & Gynaecology in the meantime), Dr. Kushelew practiced as a GP for much of her early career. Since developing a passion for knowledge and expertise in the field of Cosmetic Medicine, she has become one of the most recognised and trusted names in the industry, continually increasing her knowledge and training through international conferences and master classes on the topic. With an undeniable passion and care for her work, Dr. Kushelew spends a lot of her time sharing her knowledge and skill with others.

Founder and Director of the former Adelaide Rejuvenation Cosmetic Clinic, a member of the Australian College of Cosmetic Surgery (ACCS), Member of the Allergan Advisory Board, and National Trainer for Allergan, this inspirational woman of resounding knowledge now also conducts national training workshops and in-clinic training for plastic surgeons, cosmetic physicians, and nurses, which takes up half of her professional time.

Currently based on the Sunshine Coast, Dr. Kushelew maintains her connection with Adelaide, making regular business trips to consult with new and returning patients from her clinic in Unley. However, because of her training commitments and the limited time she has available to travel to Adelaide from her new base in Queensland, her highly qualified and talented RN, Deraly, one of Adelaide’s leading nurse injectors, now treats many of her patients. With extensive experience and skill in both treatments and full certifications in the advanced methods of these procedures, Deraly also comes with an impressive 10 year history in cosmetic tattooing, making her a perfectionist in her attention to detail. Whether it is Dr. Kushelew herself or Deraly who looks after your cosmetic concerns, it is clear that you will be in some of the best and most qualified hands that SA has to offer in Cosmetic Medicine.

CONTACT DR. KUSHELEW
PH: 0425 075 500
67 King William Rd
UNLEY SA 5061

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