Best For...

Best for face
For more than 25 years, foreheads have been the main recipient of Botulinum Toxin. Having tried the treatment himself, however, Dr Prager has started using it on other areas of the face. He uses it to lift sagging jowls, lift naso labial folds (nose to mouth lines) and even to make chins fuller and more prominent. Known as ‘The Prager Lift’, Michael’s soft handed, yet effective, way with Botox focuses on lifting the facial muscles and is a huge hit with his A-list clients.  
 
Best for lifting
A combination of dermal fillers plus ‘The Prager Lift’ is where the brilliance of 3D imagery comes into its own. You’ll be able to see exactly how rejuvenated your face becomes with the before and after images. Expect your partner and friends to shower you with complements as they try to discover your secret. They’ll be looking behind your ears for the tell-tale signs of surgery! 
 
Best for lips
Full and luscious lips have long been sought after because they symbolise youth (babies and children often have full lips and our lips thin with age). However, injecting lips has many drawbacks thanks to the overdone Trout Pout look. Bigger is no longer better where lips are concerned, so Dr Prager gives lips a soft subtle enhancement that’s attractive and natural looking. 
 
Best for cheeks
Cheeks are one of the most wonderful features of the face. They give it shape and youth. Gently replacing the natural loss of volume in cheeks, guided by 3D imagery, while avoiding the over-plumped ‘pillow face’ look, is one of Dr Prager’s specialities. As part of the ‘Prager Lift’, cheeks are treated with hyaluronic acid based dermal fillers, which have added benefits for the naso-labial and jowl area.

Face Treatments

Botulium Toxin Type A (BTA)
Botox®, Xeomin® and Dysport® are all tradenames of this prescription-only medicine that, surprisingly, has been used in other forms of medicine for over 30 years.  As well as using BTA to treat frown and forehead lines, Dr Prager uses low doses of BTA for his “Natural Lift” method, injecting into the facial muscles that cause wrinkles, and above all, facial sagging. An improvement is visible within days, and the full effects come into their own over the next 2-3 weeks.
 
In the press Dr Prager is recognized to be the U.K. expert on non-invasive face lifting treatments

Jowls and Facial Sagging 
Saggy cheeks and Jowls are the most ageing feature in a person’s face. Many people who develop jowls at an early age have strong muscles around the chin and neck area. You will find that by relaxing these muscles, Dr Prager achieves a lift and prevents sagging of the cheeks and jaw-line. 
From £440

Dermal Fillers
Dr Prager uses fillers to replace volume, improve skin elasticity and recreate a youthful facial appearance. The dermal fillers used by Dr Prager are based on Hyaluronic Acid, such as Juvederm® or Belotero®. Your treatments will be performed with thinner, lighter products to reduce side effects like swelling or bruising. Long lasting, soft and natural, fillers become silky smooth once absorbed into the skin. Wrinkles are softened and results continue to improve over a period of weeks and months, with the effects lasting between 9 and 24 months. Dr Prager works to regain your youthful proportions by subtly replacing some of the missing volume with dermal fillers around the temple, under-eye and cheek area. This can be done over several sessions. Most importantly, the treatment is safe and no one need know you are having it.  
From £390


Botulinum Toxin Type A

Botulinum Toxin Type A treatments are one of the fastest growing cosmetic procedures today. American Society for Aesthetic Plastic Surgery statistics show that more than 3 million people in the U.S. were treated in 2005 alone. Botulinum Toxin Type A is a muscle relaxant. It is used to lift eyebrows, sagging cheeks and to make jowls disappear by injecting the muscles that pull the face down. Botulinum Toxin Type A eliminates frown lines, forehead lines, laughter lines around the eyes and lines around the mouth. In other fields of medicine Botulinum Toxin Type A has been used for over 30 years to treat muscle spasms and muscle hyperactivity.

Results with Botulinum Toxin Type A
Most people are concerned about Botulinum Toxin Type A treatments being obvious. Dr Prager is well known for achieving results that are natural, beautiful and most of all discreet. Injected properly, Botulinum Toxin Type A makes you look more relaxed, younger and fresher. Only you need to know. All that matters for you is to look better, not different.

Follow up treatments
After your first treatment it is advisable to make a follow up appointment within 4 weeks to evaluate the results of the procedure and for small top ups if needed. Most people have found that in order to get the best possible treatment results, you would repeat the treatment within 4 months. Treatment should not be more frequent than every three months. If you don’t continue treatment, the wrinkles between your brows will gradually return to the way they looked before your initial injection, this can take another several months.

Q: What Can Botulinum Toxin Type A Do?
A: “If you have Botulinum Toxin Type A at the right time (before you have very deep or obvious lines) it can prevent the need for drastic facial surgery later in life. Most people could avoid surgery if they had Botulinum Toxin Type A to relax the muscles in their face and neck in combination with fillers at an earlier stage in their life. It’s a great preventative if used in the correct way. Obviously, it depends on the individual but if you have obvious signs of “jowliness” when you are 30, then you can avoid the need of surgery at 50 if Botulinum Toxin Type A is employed properly. It’s so much easier to maintain a “youthful”, natural look with injectibles than it is with surgery. There are few surgeons who can pull it off.”

Q: Is Botulinum Toxin Type A Safe?
A: “Yes. It is licensed for the use in children from as young as 2 years onwards, has over 30 years of clinical data to document the safety and is used in over 5 million procedures annually. Much of the negative image attached to Botulinum Toxin Type A is down to the fact that people still think that there are only two alternatives - either looking old or looking “Botoxed” - i.e. frozen-faced!?

Q: How does Botulinum Toxin Type A Work?
A: “Botulinum Toxin Type A is a muscle relaxant which is injected in very small amounts into certain facial muscles to reduce muscle movement where it is injected. Botulinum Toxin Type A does not fill lines or alter the skin’s texture. It only reduces excessive or repetitive muscle movement that causes the skin to “crease” each time the muscles move – frown lines or crow‘s feet. Lines are caused when the skin has lost some of the elastic fibres and cushioning collagen that makes the skin plump and elastic. The movement squeezes the elastic material out of the skin and causes an indentation. This is less visible when we are young, but as we age, collagen and elastin production is reduced, making skin more vulnerable to developing lines in the areas where there is a lot of movement - between the eyebrows, around the eyes from the nose down to the mouth. Reducing the movement with Botulinum Toxin Type A allows the skin to replace the collagen, reducing the lines. Generally, you’ll start to see improvements two to four weeks after treatment. The results will continue to improve until the Botulinum Toxin Type A wears off, which is usually 3-4 months. Sometimes it takes longer for the line to disappear completely. That is why it is recommended to repeat Botulinum Toxin Type A every 4 months in order to get the best possible results.”
Dermal Fillers

Treatment with Belotero®, Juvederm Ultra® or other dermal fillers

While Botox® is used to lift eyebrows, saggy cheeks and to make frown lines disappear; dermal fillers are used to replace facial volume, smooth the lines and restore skin elasticity, the most visible effects of skin ageing. Dermal fillers can restore skin tone and texture and even prevent future ageing.

Belotero® or Juvederm Ultra® contain a synthetic form of hyaluronic acid, naturally found in the skin’s collagen layer. Hyaluronic acid in our skin gradually decreases over time. In fact, 50-year-olds are estimated to have less than half the amount of Hyaluronic acid they had in their youth. By the age of 40, signs start to show—skin starts to lose its elasticity and volume as lines and wrinkles appear.

Results with Belotero® or Juvederm Ultra®

If your treatment plan included lip enhancement, you’ll notice that your lips appear fuller and more defined. If your plan included adding volume to your cheeks, Hyaluronic acid is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. A way to think of Hyaluronic acid is as our skin’s own natural and internal moisturizer.

Injectable Hyaluronic acid gel is a modified form of the Hyaluronic acid that occurs naturally in your body. Hyaluronic acid filler supports your skin, provides volume, can correct skin deficiencies and improves facial lines typically found between the eyes and around the mouth area. Skin elasticity in the treated areas improves significantly, especially after the treatment has been repeated.

Follow up treatments

Filler treatments work over a long period of time. The results are long lasting and can improve continuously over a period of several months. The effects of HA last 9 to 18 months, in some cases or after repeated treatments up to 36 months or longer. Keep in mind that everyone’s skin is different; the timing of any additional wrinkle treatment will vary from person to person. When repeat treatments occur over time, either the interval between appointments becomes longer, or fewer products is required to achieve the same results, or more areas can be treated with the same amount of product.

Q: What are the benefits of dermal fillers?

A: “Most of the signs of facial ageing are due to loss of volume. As proportion plays a major role in how we perceive beauty, replacing volume is a very effective way to improve facial proportions and to make a face look “naturally” younger. Loss of volume takes place as early as our mid twenties, depending on lifestyle. From thirty onward, hollowing of the cheeks can start to be visible, especially in people who diet or exercise a lot. Replacing the reduced collagen and increasing volume is both preventative and effective in maintaining youthful facial proportions. Treatment with hyaluronic acid-based dermal fillers such as Hydrafill Softline or Juvederm Ultra, minimises and smoothes out fine lines. Facial volume replacement is just as important in rejuvenating procedures as Botox, especially when you think of how we perceive “youth”. You only have to think of a baby’s face - rounded, plump cheeks. A full upper face and chiselled jaw line are both signs of attractiveness and youth. As we age, we lose volume in the upper face and gain it under the chin and neck. Heart-shaped faces are often used by cartoonists to portray “likeable” beauty think Pocahontas while a wide-jaw (Shrek) is usually a sign of age or unattractiveness.

Q: How do fillers work?

A: Most modern dermal filler contain Hyaluronic acid, a substance present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. Fillers such as Belotero® or Juvederm Ultra® replace facial volume, smooth lines and restore skin elasticity, the most visible effects of skin ageing. They can also restore skin tone and texture and even prevent future ageing. The new generation of fillers give even results, un-lumpy results and some, such as Belotero® or Juvederm Ultra®, contain local anaesthetic which reduces the discomfort during injection, making it possible to use small amounts to treat a wider area to get the best results. As it is a naturally based biological material, Hyaluronic acid (HA) is similar to your body’s natural HA, so you don’t need a skin test prior to treatment. The procedure involves small series of injections under the skin, either to fill lines or to increase facial volume, where the deeper layers of the skin are injected. Immediately after treatment, it’s perfectly normal to experience temporary minor stinging, sometimes moderate redness and swelling. Bruising can also occur. Recovery may take a few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal activities immediately after the procedure. Generally we would say the products last between 12 to 18 months, in some cases however 2 to 3 years is not at all unusual. The cost for one syringe starts from £360.”

Under Eye Area

Under Eye and Tear Troughs

One of the areas in the face where we first notice the loss of volume in the mid face is under the eye. This area is also called the tear trough area. For years I have avoided to treat this area, now I actually find it enjoyable because I can achieve very good results without downtime and discomfort.

Even very small amounts of volume injected in the right places can change a face dramatically. The under eye area is the most rewarding area to treat but also the most difficult. I stopped treating there for quite some time because I did not feel I had the right products at hand.

Since products have become much thinner and absorb completely I can now achieve very good results without having to fear lumps or visible bumps under the skin. When we look at a person we look at their eyes, this is where we gather most of our information. If you came to me and complained about your friends and family members telling you how tired you look, before anything else, I would look at your under eye area.

Volume replacement in the under eye area can reshape the face. It is the loss of volume in the mid face that produces all the effects of bagginess in the under eye area. There is no need to go too near the eye, just gently massage the product towards the area that needs reshaping. This works very easily. Downtime should be short. There is very little bruising to be expected. Results are visible immediately but like with any injection, will improve over the coming weeks and months.

Of course there is a chance for the usual side effects linked to dermal filler injections, such as bruising, unevenness, tenderness or swelling. These are transient. The filler product can be dissolved completely.

Volume Therapy

How to treat Facial Sagging and Loss of Facial Volume

The difference between a young face and an old face is the absence or the presence of jowls. Saggy cheeks are the most ageing feature in a person’s face. For this reason we need to look at how the face moves and where the face has lost volume. Most people who develop jowls at an early age have strong muscles around the chin and neck area. By relaxing those muscles, similar to what you would do with the frown lines, we can get a great lift and even more important prevent sagginess of the face in future. The next step is to replace the naturally reducing facial volume.

Why should we think about replacing facial volume?

Our patients come to us for mainly one reason:They want to look younger, fresher and of course more attractive. Most people are very happy with their looks and they don’t want to change them. By replacing some of the missing facial volume, mainly around the mid face, cheeks and temple area you can get a great lifting effect even to the jaw line. This will also reduce the dreaded tired look around eyes and restores some of the youthful facial proportions, which are a fuller upper face and cheek region and narrower around the chin and jaw. Remember: The difference between a young face and an old face is the loss of volume.

1. Can you give us a short overview on what fillers are and what they can do for you.

Most commonly used dermal fillers contain a synthetic form of Hyaluronic Acid (HA), naturally found in the skin’s collagen layer. HA in our skin gradually decreases over time. In fact, 50-year-olds are estimated to have less than half the amount of HA they had in their youth. By the age of 30, signs start to show—skin starts to lose its elasticity and volume as fine lines and wrinkles appear. Visible ageing of the skin is to 90% loss of collagen. By replacing the missing collagen the skin can appear plumper and more hydrated but also smooth and more elastic. Injected into the deeper layers of the skin, fillers can be used to contour and shape the face.

2. So, the areas of the face that can benefit and why and what age does Dr Prager feel fillers should be used - from 30 onwards and why?

Most of the ageing of the face is due to the loss of facial volume. This starts in the mid face region below the eyes either side of the nose. As a result we tend to see the Naso Labial Folds deepening as a first sign of ageing. In the old days people had those lines injected regulrarly. The side effect was a slightly I hardly inject those now as first line treatment. It is the reduction in facial volume, fat actually that makes the lines appear as the cheeks sag. Therefore it is much more natural to replace this volume and lift the cheeks back up again. Facial proportions play a major role in how we perceive beauty. Replacing facial volume is therefore a very effective way to improve facial proportions and to make a face look naturally younger. Loss of volume takes place as early as our mid twenties. Look at an endurance athlete or a very lean person. The fat that gives the face its youthful shape is burned off and the athlete’s face can look much older prematurely. In a normal person hollowing and loss of volume in the cheeks can start to become visible at around 30. Especially in people who diet or exercise a lot. Replacing the missing volume in the face is preventative and maintains youthful facial proportions. At 20 dimples are cute and at 40 they can be deep lines. Dermal fillers prevent this from happening.

3. Loss of volume in cheeks and lips and so on

After treatment with hyaluronic acid based dermal fillers the lines on your face should appear minimized and softer. Facial volume replacement has almost taken over from Botulinum Toxin Injections. For example, young people with thin lips are estimated to be older than their age peers, simply because thinning lips are something that happens with age. Our understanding of youth is linked to a fuller upper face and a chiselled jaw line. As people age they lose volume from the upper face and gain it under the chin and neck. Heart shaped faces are often used by cartoon artist to portray the likeable beauty such as Pocahontas. The Shrek character has the complete opposite facial volume distribution, narrow on top, heavy and square around the jaw. As we age we turn from Pocahontas to Shrek…

4. Dr Prager, what kind of Dermal Fillers do you use in your practice, what do they consist of and why do you like to use them

In my office I use dermal fillers containing Hyaluronic Acid (HA). Modern HA fillers are much smoother and absorb completely compared to the first generation products. HA is present throughout our bodies, with 50% of it located in the skin. It occurs naturally in the deeper layers of our skin (the dermis), where it helps to keep skin smooth and ‘plump’ through its amazing ability to hold up to 1,000 times its weight in water. Dermal fillers based on HA are used to replace facial volume, smooth the lines and restore skin elasticity, the most visible effects of skin ageing. Dermal fillers can restore skin tone and texture and even prevent future ageing. HA dermal fillers can also contain local anaesthetic which reduces the discomfort during injection greatly. This way it possible to use small amounts and treat more often just like one would with Botulinum injections.

5. How would you explain the procedure, any downtime and the cost and how long do the effects last?

As a naturally based biological material, hyaluronic acid (HA) is similar to your body’s natural HA. In fact, it’s so similar you won’t need a skin test prior to treatment.The procedure involves small series of injections under the skin, either to fill lines or to increase facial volume, where the deeper layers of the skin are injected.Immediately after treatment it’s perfectly normal to experience temporary minor stinging, sometimes moderate redness and swelling. Bruising can happen. Recovery may take a few hours to a few days, depending on the area treated and the type of filler used. Most people find that they can return to work or go about their normal activities immediately after the procedure. Generally we would say the products last between 12 to 18 months, in some cases however 2 to 3 years is not at all unusual. The cost for one syringe starts from £390.

6. Next, what are the tell-tale signs of having too much filler? You see quite a few celebs with chipmunk cheeks!

Tell tale signs are patients in their 40ties and 50ties who’s cheeks and facial proportions are more Pocahontas now then they were in their twenties. Large amounts of even the safest dermal fillers can result in a strange look but is reversible. The more permanent products such as Silicone can cause permanent damage. Heather Locklear or Mickey Rourke for instance are examples for fillers gone wrong. Unfortunately any promising procedure that delivers amazing results is prone to be hijacked by the cosmetic junkies who will find a practitioner to supply them with even larger amounts of the stuff that makes them happy. In the end they are unable to see themselves, after all beauty is addictive. It is not the product or the procedure that makes people look funny, it is their need for more that eventually makes faces look pumped.

Hollow Cheeks

Hollow (Celebrity) Cheeks

have become a hot topic for discussion. There is hardly a week where we cannot see pictures of a famous actress or singer who is not noticeably enlarged in the cheek region. Why is that?

There are several reasons why cheeks are a favorite area where to inject volume. As we age, even from as early as our mid twenties the cheeks can lose volume. This can change our facial proportions and make us look older. Facial proportions change from the juvenile heart shaped face with the wider cheek region to the jowly aged look, haggard around the cheeks and square in the chin and jaw line.

There are several causes why people would look strangely enlarged and, or droopy in the cheek region. It would often be caused by a combination of too much Botulinum Toxin and dermal fillers.

Injected in large amounts around the crow’s feet area Botulinum Toxin helps to reduce the appearance of lines around the eyes, at a price though. The muscles that cause the smile lines are also part of the few muscles lifting the cheeks. Injecting Botulinum Toxin here is a mistake as it makes the cheeks droop. This is however still standard practice in most cosmetic practices because it makes the crow’s feet disappear due to the lack of movement around the eyes. The smile also becomes fake and expressionless as part of the famous frozen look.

Admittedly it is possible to give the jaw line and sagging cheeks a lift by injecting large amounts of dermal fillers around the upper cheek region. This helps to pull up the cheeks and lower face. However, you can imagine that it requires a lot of filler material and does rarely give a natural look.

In London this is called the Y lift, popular with French doctors. Very artificial and dubbed the pillow face in the press because the cheeks look so overly stuffed.

In Beverly Hills on the other hand a lot of the cheek enlargement is still done with fat transplant, this explains the initially huge cheeks and puffy faces which slowly return to almost normal after a couple of months. You might remember the pictures of Cameron Diaz in Grazia a couple of months ago…

How to spot a bad cheek job?

The highest point of the cheeks should be near the cheek bone, lateral, in a feline kind of way. In most over-injected patients the highest point of the cheeks slips and is more on level with the tip of the nose or even below in a side profile shoot. Watch out for that, you will be surprised how many of those you can spot in any of the glossies.

Lip Enhancement

"A Woman's Lips cannot really be big enough", Plastic Surgeon, Beverly Hills

Many women still think that injecting lips will leave them with overly pouty and inflated lips. Many women I see for the first time consider lips almost a tabu area for cosmetic injections. My patients complain about the smoker's lines, a common problem even in people who never smoke, and would like to seek treatment. Maybe just like you, these patients are afraid to end up with oversized lips as a result. Luckily times have changed and we can now offer a very subtle and really attractive way of treating thinning lips and fine lines around the mouth.

A couple of years ago it was definitely "Bigger is Better" when it came to injecting lips. Not so long ago injections of Hyaluronic Acid into the lips were performed solely with the purpose of visible enlargement. It was very fashionable to have big pop-star lips, the fact that those lips were not looking natural did not really matter. Times have changed and I rarely see patients who desire simple lip enlargement. What matters now is to redefine the lip shape, make lips more attractive and give back the youthful pout without the tell tale signs of over-injection.

With todays products it is possible to re-create a copy of a person's lips 10 or 20 years younger. The injection technique now is different from merely increasing lip size to actually reshaping and defining the lips. The products replace the missing collagen and integrate into the lips in a very natural way.

There is even a scientific case for plumping lips: In a study among college students, those with genetically thinner lips were in average estimated to be older than their age peers. Naturally beautiful lips are appealing and attractive and signal youth and beauty. Size does not matter...

To book your appointment phone us on 020 7323 3660 and speak to Maria, Cherie or Christina.
Hyperhydrosis

Excessive Sweating – 'Hyperhidrosis'

No more worrying about staining your clothes and body odour. No more restrictions on which colours and materials you can wear.

This is a surprisingly common problem yet it is undertreated because of lack of awareness and its embarrassing nature. Even simply shaking hands can become uncomfortable, making business and day-to-day life a problem.

Patients treated with Botox®, Xeomin® or Dysport® often report life-changing results.

Hyperhidrosis means excess sweating. There are 2 main types of hyperhidrosis:

Focal hyperhidrosis is the more common type (millions of people suffer with this) involving excessive sweating on the feet, hands, armpits and occasionally the face.

Generalised hyperhidrosis is less common.

2. What will happen during a treatment with Botox®, Xeomin® or Dysport®?
Using a very fine needle, your doctor will inject a small amount (1-2mls per armpit) of a solution of Botox®, Xeomin® or Dysport® into 10-15 place spread evenly in each armpit. Sometimes a dye is used to show up the areas where sweating is greatest and where the injections should be placed.

3. Is it painful?
The needles used are very fine so most people experience only mild discomfort. It is uncommon for pain relief to be required. A local anaesthetic may be used when treating the palms however as they are much more sensitive: this usually wears off in less than an hour.

4. How long does the treatment take?
Treatment time is approximately 30 minutes

5. How quickly will I notice an effect?
You should notice some change for the better within a week of your treatment. Different people have different responses to treatment. In a clinical trial, sweat production was reduced by 83% one week after treatment.

6. How many treatments will I need?
Usually just one session is required. All patients are invited to return for a follow-up appointment 2 weeks after their treatment. Very occasionally a 'touch-up' treatment is required: you will not be charged for this.

7. How long will the treatment last?
Usually between 4-7 months.

8. What happens if I decide to stop treatment?
The effects of Botox®, Xeomin® or Dysport® are completely reversible. If you decide not to have any further treatment there will be no lasting change in the areas treated. Sweating will gradually return to the level it was before you started treatment.

9. What are the possible side-effects?
Side-effects are rare, but a small number of patients experience an increase in sweating in another part of the body. This can also be controlled. Since the injection is made only into the skin, the effects of Botox®, Xeomin® or Dysport® will be limited to the nerves supplying the sweat glands. Occasionally, a very small amount of Botox®, Xeomin® or Dysport® may spread out from the injection site and affect a nearby nerve that supplies a muscle. Mild weakness of the arms may be experienced if this happens; but this does not last and gets better quickly without any treatment.

10. What are the other treatments for hyperhidrosis?
Aluminium chloride ('Driclor') is the active ingredient of some anti-perspirants. It is used in stronger solutions to treat hyperhidrosis. Treatment consists of applying the medication overnight using a roller-ball applicator and then washing it off in the morning. The effect lasts approximately 48 hours. Iontophoresis is the passage of a weak electrical current through a water bath (or 'electrogalvanic' bath). The area affected by sweating is immersed in water and electrically charged particles (ions) block the activity of sweat glands. The effects can last for up to 12 weeks, though this is highly variable and some patients report results lasting just a few days.

Antimuscarinic drugs reduce the activity of the nerves supplying the sweat glands. As these drugs affect the entire nervous system, side effects such as dry mouth, drowsiness and constipation can be troublesome.

Beta-blocker drugs or anxiolytics (tranquilisers) may help if sweating is made worse by stress and feelings of anxiety. Relaxation, psychotherapy or acupuncture.

Surgery is usually only considered when other methods of treatment have not worked. The results are permanent but there are always risks associated with surgery and the use of general anaesthesia. A 'sympathectomy' means blocking or cutting the nerve supply to the sweat glands. Blocking the nerve supply lasts 1-2 years; cutting the nerve supply last is permanent.

Additional Information on Botulinum Toxin Type A
Botulinum Toxin Type A treatments are one of the fastest growing cosmetic procedures today. American Society for Aesthetic Plastic Surgery statistics show that more than 3 million people in the U.S. were treated in 2005 alone. Botulinum Toxin Type A is a muscle relaxant. It is used to lift eyebrows, sagging cheeks and to make jowls disappear by injecting the muscles that pull the face down. Botulinum Toxin Type A eliminates frown lines, forehead lines, laughter lines around the eyes and lines around the mouth. In other fields of medicine Botulinum Toxin Type A has been used for over 30 years to treat muscle spasms and muscle hyperactivity.

Results with Botulinum Toxin Type A
Most people are concerned about Botulinum Toxin Type A treatments being obvious. Dr Prager is well known for achieving results that are natural, beautiful and most of all discreet. Injected properly, Botulinum Toxin Type A makes you look more relaxed, younger and fresher. Only you need to know. All that matters for you is to look better, not different.

Follow up treatments
After your first treatment it is advisable to make a follow up appointment within 4 weeks to evaluate the results of the procedure and for small top ups if needed. Most people have found that in order to get the best possible treatment results, you would repeat the treatment within 4 months. Treatment should not be more frequent than every three months. If you don’t continue treatment, the wrinkles between your brows will gradually return to the way they looked before your initial injection, this can take another several months.

Q: What Can  Botulinum Toxin Type A Do?
A: “If you have Botulinum Toxin Type A at the right time (before you have very deep or obvious lines) it can prevent the need for drastic facial surgery later in life. Most people could avoid surgery if they had Botulinum Toxin Type A to relax the muscles in their face and neck in combination with fillers at an earlier stage in their life. It’s a great preventative if used in the correct way. Obviously, it depends on the individual but if you have obvious signs of “jowliness” when you are 30, then you can avoid the need of surgery at 50 if Botulinum Toxin Type A is employed properly. It’s so much easier to maintain a “youthful”, natural look with injectibles than it is with surgery. There are few surgeons who can pull it off.”

Q: Is Botulinum Toxin Type A Safe?
A: “Yes. It is licensed for the use in children from as young as 2 years onwards, has over 30 years of clinical data to document the safety and is used in over 5 million procedures annually. Much of the negative image attached to Botox®, Xeomin® or Dysport® is down to the fact that people still think that there are only two alternatives - either looking old or looking “Botoxed” - i.e. frozen-faced!?

Q: How does Botulinum Toxin Type A Work?
A: “Botulinum Toxin Type A is a muscle relaxant which is injected in very small amounts into certain facial muscles to reduce muscle movement where it is injected. Botox®, Xeomin® or Dysport® does not fill lines or alter the skin’s texture. It only reduces excessive or repetitive muscle movement that causes the skin to “crease” each time the muscles move – frown lines or crow‘s feet. Lines are caused when the skin has lost some of the elastic fibres and cushioning collagen that makes the skin plump and elastic. The movement squeezes the elastic material out of the skin and causes an indentation. This is less visible when we are young, but as we age, collagen and elastin production is reduced, making skin more vulnerable to developing lines in the areas where there is a lot of movement - between the eyebrows, around the eyes from the nose down to the mouth. Reducing the movement with Botulinum Toxin Type A allows the skin to replace the collagen, reducing the lines. Generally, you’ll start to see improvements two to four weeks after treatment. The results will continue to improve until the Botulinum Toxin Type A wears off, which is usually 3-4 months. Sometimes it takes longer for the line to disappear completely. That is why it is recommended to repeat Botulinum Toxin Type A every 4 months in order to get the best possible results.”
Hands

You can tell a persons age by their hands… by Dr Michael Prager

Hands go through a similar process of ageing as the face. Even though most people seem to take greater care of their faces than of their hands. Plenty of treatment options have been successfully applied to treating sun damage in the face. 80% of skin ageing in face and on hands can be attributed to sun-exposure. Whilst most of the dermal ageing is due to sun exposure, which results in age spots, uneven pigmentation and loss of skin tone and elasticity, loss of subcutaneous fat tissue and skin collagen makes the hands appear thin, bony and wrinkled.

Treatment options
1. Topical Treatments to sun exposed and sun damaged skin can include a variety of different approaches. The first step would be sun protection as far as possible and the application of topical antioxidants such as Skinceuticals Phloretin and C+E. This would be followed by IPL or Laser treatments to improve uneven pigmentation and age spots. Thinning skin, fine lines and wrinkles, sun damage, loss of skin elasticity would be treated very successfully with Micro-Mesotherapy, including Dermaroller treatments.

2.Injection Treatments, in order to replace volume and make the hands plumper, fuller and younger looking we would use hyaluronic acid dermal fillers, similar to what is used for filling lines in the face or making cheeks fuller. The difference with hands is that the product needs to be slightly thinner and the treatment may have to be repeated once or twice. Overall the procedure is very successful. Because of the added anesthetic in the dermal filler the treatment is only moderately uncomfortable.

The use of a flexible canula has made injection treatments for hands very successful. Whereas previously lots of injections were necessary to achieve a smooth and even result, the canula makes it possible to get similar or even better distribution of product with maybe 2-4 injection points per hand. Highly successful and minimally invasive.

Conclusion
Hands can be treated very successfully by combining several treatments. We all know how hands or neck can give a person’s age away once the face has received plenty of attention. Hands are just as exposed, if not more to the environment as our face is but yet we still seem to forget our hands when it comes to skin rejuvenation and anti aging procedures.

Book now for your free IPL consultation at the Dr Michael Prager Clinic