Is your Depressor Anguli Oris (DAO) muscle the reason for your ‘frowny face’?

Dr Harry Singh explains how we can relax this muscle with botulinum toxin to turn your smile from ‘upside down’ to ‘happy clown’!

Do people often ask you if ‘everything is alright?’, or tell you to ‘cheer up’? If so, then this could be a sign that you have a reverse or ‘upside down’ smile, such that the corners of your mouth, even when you are not moving your mouth or lips, have a tendency to point downwards, creating an uphappy look.

The cause of this downwards ‘tugging’ is an overactivity in one of the many muscles that we use to move our mouth so we can speak, eat and make facial expressions.

The muscle in question is called the Depressor Anguli Oris or DAO for short. The clue in its name is the word ‘depressor’, as this is the muscle that is responsible for lowering the corners of the lips and mouth, often used when we wish to express displeasure or repulsion. We have a DAO muscle on each side of the mouth. It is triangular-shaped with an anchor at the corner of the mouth and a flat side along the chin. If this muscle is too active, then it can start to tug down on the corner of the mouth even when we aren’t calling on its services to make faces. This repeated action can lead to the formation of marionette lines, as the overlying skin is constantly being pulled down by the overactive muscle. As we age, these lines will become more and more pronounced.

In another recent blog, I looked at treating deep marionette lines with dermal fillers. Marionette lines are the lines, folds or wrinkles which start from the corners of the mouth and head in a downwards direction, eventually reaching the chin. They get their name from the mouth shape of marionettes or ventrilloquist’s dummies.

If you try to do a sad face, you will be able to see and feel the constriction of the DAO muscle at the jawline and can see how strong it is at tugging down the corners of your mouth.

As well as treating deeper lines and wrinkles in this area with dermal fillers, such as the Restylane range which I use in my clinic in Stevenage, Hertfordshire, the DAO can also be relaxed with the use of botulinum toxin injections. This is a prescription only medicine and isn’t right for everyone, but after a face-to-face consultation with me, I will be able to diagnose if you have an overactive DAO and if injections with botulinum toxin, on its own, or with dermal fillers would be the most appropriate treatment for you. In my clinic, I like to use the Azzalure™ brand of botulinum toxin, other products include Botox®.

Treating the DAO and marionette lines in this way, in fact any injections of botulinum toxin in the lower face, i.e. below the usual areas of crow’s feet and frown lines, is very much an advanced technique and must be performed by someone with significant training and experience. I have been prescribing and performing wrinkle-relaxing treatments of this kind for over fifteen years. In the wrong hands, complications could arise through incorrect placement of the treatment in the muscles which could have an effect on the positioning of the mouth, lips and teeth, and even effect your ability to bite, chew, suck or talk. That’s why it’s important to see someone like me, with years of experience; plus as a dentist, I am very familiar with the anatomy of the mouth.

If you are fed up of everyone asking you to ‘smile’ or thinking that you’re miserable, then please call 01438 300111 to book an appointment to see me, Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

Everything you need to know about the signs of skin ageing

Dr Harry Singh is here to enlighten you on the changes in your skin as you age

Ageing, yes, I know it’s a dirty word and none of us want to think about, but like death and taxes, it is sadly unavoidable. The first signs of ageing will start to appear around your late 20s or early 30s, maybe not until your 40s, depending on luck and lifestyle. Luck in terms of your genetics – have a look at how well your mother and father are ageing – and lifestyle in terms of how good you are to your body – smoking, drinking, bad diet and sun exposure all lead to premature skin ageing.

Most us expect to see fine lines and wrinkles as we age, but there are other signs that show that your skin is not as youthful as it once was. When we are young, we have plump, smooth skin, but as we age skin becomes more dehydrated, dull, poor in texture and tone and everything starts to sag and lose volume. Other signs of skin ageing, and photo-damage caused by ultra-violet radiation from the sun, include pigmentation changes, often referred to as ‘age spots’, ‘sun spots’, or ‘liver spots’, which are like oversized freckles plus areas of dark patches or hyperpigmentation.

Fine lines and wrinkles will usually start to appear around the dynamically moved areas of the face and are most commonly noticed as crow’s feet around the eyes, noticeable when smiling. Other common early wrinkles are ‘eleven’ lines in between the eyebrows, caused by frowning. Reduction of lines and wrinkles, caused by dynamic movement, can be achieved with botulinum toxin injections such as Azzalure™ or Botox®. Deeper wrinkles can also be smoothed out or filled with the use of dermal filler injections, with hyaluronic acid-based gel products like Restylane®. Skin tone and texture can also be improved by stimulating new collagen production using treatments like medical-skin needling with Dermaroller.

Hyaluronic acid (HA) is an important component of the skin and an essential, natural moisturiser that we produce daily. HA helps our body to draw in moisture to our skin and it is this which gives it the plump, youthful appearance. In our youth, we produce HA in abundance, but as we age, production slows down and we simply don’t make as much HA as our body would like to keep skin at its optimum levels of hydration. A lack of adequate HA leads to lacklustre skin which is dry, rough, lacking in firmness and elasticity, as well as prone to sagging in places such as the jawline. Dark circles around the eyes may also become more apparent. Thankfully, hyaluronic acid can be put back into the face with products such as the Restylane® SkinBoosters which can be used to deliver small droplets of HA gel across the whole face using superficial or mesotherapy style injections to restore hydration. Regular maintenance treatments can make a real difference to the quality of your skin as moisturisation is returned.

As well as reduced levels of hyaluronic acid, skin can suffer from volume loss, both due to a loss of collagen and elastin structures as well as shrinkage of the fat compartments in the face, most noticeably in the cheeks. With gravity being the enemy, this loss of elasticity and skin firmness leads to a drooping of the tissues. Eyes may start to ‘bag’, the forehead and brows will lower leading to droopy upper eye lids, jowls will form in the lower face and naso-labial folds, or nose-to-mouth lines, will appear as the cheeks lose their volume.

But it’s not as terrible as it sounds, careful placement of dermal fillers and botulinum toxin can address many of these signs of ageing, and Silhouette Threads can also be used to lift tissue in a non-surgical thread lift. Alongside a good skincare regime, we can hold back the flood gates of ageing, as well as rejuvenate the skin to a more youthful appearance.

If you’re worried about the signs of facial ageing then why not arrange a consultation appointment with me, Dr. Harry Singh at Aesthetics in Stevenage, Hertfordshire and we can discuss which facial aesthetic treatments can help. Please call us on 01438 300111.

Bothered by a dimply ‘golf ball’ chin? Find out how to soften it with Botox

Dr Harry Singh explains how Azzalure™, botulinum toxin injections, can be used to relax the muscle in the chin which leads to dimple and wrinkle formation.

The chin is an important area of the face. As well as adding balance to the overall facial profile, achieving markers of beauty and masculinity, it is also involved in the movement and facial expressions made with the mouth area. The chin itself is controlled by one big muscle called mentalis.

If you try to tighten the area by clenching your chin muscles and pushing out your bottom lip, you will be able to feel the effects of mentalis as the area becomes more solid to the touch and has both a dimpled appearance and feel, much like the outside of a ‘golf ball’.

In some people the mentalis muscle can become hyperactive, or overused, and this can lead to the dimples or wrinkles generated from its dymanic action being visible all the time, even at rest, when they are not tightening the chin. Having visible depressions, roughened skin or deep creases in the chin can make a person look sad, doubtful, disdainful or maybe even angry, when they’re not, as these are all emotions where we use the chin to display such feelings. All of this can lead to self-consciousness.

One very unpleasant description for this appearance, which can affect both men and women is ‘scrotal chin’, not very appealing I’m sure you will agree! Thankfully, as with treating other hyperactive facial muscles, such as those involved in teeth grinding or squinting, which can cause crow’s feet, modern cosmetic medicine has a solution – botulinum toxin injections.

I have been practicing facial aesthetics since 2002 and at my clinic in Stevenage, Hertfordshire I prescribe and use the botulinum toxin brand called Azzalure™. Like other brands of botulinum toxin, including Botox®, Azzalure is a prescription only medicine which requires a face-to-face consultation to correctly diagnose and prescribe treatment.

Botulinum toxin injections are most commonly used and licenced as an anti-wrinkle treatment for reducing crow’s feet, frown lines and forehead lines, but the medicine also has many other cosmetic and medical applications to treat over-active or spasming muscles. This means that we can also use it to treat the muscle in the chin to weaken it slightly and reduce the appearance of dimples and wrinkles.

Treating the chin is an advanced technique and should not be done by inexperienced or under qualified practitioners. It is important that you seek out someone with adequate prescribing qualifications, training, experience and understanding of the underlying anatomy and botulinum toxin doses required. Incorrect treatment of this area could lead to over-weakening of the muscles, impacting on jaw movement, and in the worst case, inadvertently affecting your ability to chew properly, or even open and close your mouth.

As a dentist and facial aesthetic practitioner, you can be assured that I am fully qualified to diagnose and prescribe treatment for the chin and mentalis muscle and have a detailed knowledge when it comes to the anatomical structures involved in the mouth and jaw. This means that during a consultation I can advise you whether Azzalure is the right treatment for you based on the concerns that you have and your medical history. Combining other facial aesthetic treatments, such as dermal fillers, may also be an option, depending on the depth of creases around your chin and mouth.

Any treatment with botulinum toxin is not permanent, usually lasting 4 to 6 months before a repeat dose is required to maintain the correction.

If you think you have too many wrinkles or dimples on your chin, then make an appointment for a consultation with me, Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire and we can discuss if botulinum toxin injections are the right thing for you. Please call us on 01438 300111.

How to treat marionette lines with dermal fillers

Dr. Harry Singh explains how to ‘turn that frown upside down’ with Restylane

Marionette lines are vertical skin folds or wrinkles which start from the corners of the mouth and head in a downwards direction, eventually reaching the chin. They get their name from the mouth shape seen in marionettes, string puppets or ventrilloquist’s dummies, where a block of wood opens and closes to simulate speech from the mouth.

As we age, marionette lines will get more and more pronounced, eventually creating this puppet-like mouth appearance in older age, yet women and men in their 30s, 40s or 50s will start to notice the appearance of this ageing effect on their faces, as small creases appear at the corners of the mouth. As well as being a sign of ageing, many people dislike these lines as they have the effect of an down-turned smile or ‘frowny face’, making the individual appear unhappy or sad, even when they are not. This can cause others to comment about their need to ‘cheer up’ or affect an individual’s self confidence, ultimately having an impact on their mental health and perhaps making their emotions match their face through unhappiness or depression.

Marionette lines conincide with a loss of skin firmness, elasticity and volume in the lower face, combined with the evil that is gravity. Restoring lost volume and structure to the face can help define and support areas of laxity, such as the appearance of lines around the nose and mouth. Genetics (natural ageing), sun exposure and smoking can all cause these lines to appear and get worse, often accelerating the effects. Like many other areas of facial ageing, such as nasolabial or nose-to-mouth lines, marionette lines can be addressed effectively with the use of dermal or soft tissue fillers.

In my clinic in Stevenage, Hertfordshire, I use the Restylane range of hyaluronic acid-based dermal filler products which are temporary, clinically proven and effective. Restylane products were first used in the mid-1990s and were originally developed in Sweden. I choose this range because they have such a long history of proven science and clinical trial data which shows how safe they are to use in cosmetic treatments; which I have been performing myself for over fifteen years.

Hyaluronic acid-based soft tissue fillers not only contain a synthesised version of a natural substance that our bodies make daily to keep our skin hydrated, but they come in different thicknesses of the hyaluronic acid (HA) gel which means that they have been created to last much longer in the body compared to our natural HA, which we metabolise daily. By placing different thicknesses or gel derivatives from the Restylane range, I am able to add long-lasting volume, definition or hydration to the areas that need it most, to plump out visible folds and depressions. During a consultation we can discuss the extent of your manifestation of marionette lines and the best treatment approach, in terms of the most appropriate type of Restylane product to use, and the quantity or number of syringes needed to achieve the level of correction of the lines at the corners of your mouth. It may be that a combination of aesthetic treatments or products will achieve the best results.

Restylane HA gels normally last between 6 and 9 months before they are completely reabsorbed naturally by your body, giving you a long-lasting result which we can maintain with additional treatments at repeat clinic visits during the year.

If you are worried about looking sad due to downward lines around your mouth then please call 01438 300111 to book an appointment to see Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

“Gobble, Gobble!”; Treating a Turkey Neck with Botox

Dr Harry Singh explains how botulinum toxin injections, using Azzalure™ can be used to lift and rejuvenate the neck, giving you a look more like Nefertiti and less like a turkey

Ageing is a tricky process that creeps on us. Most of us start to notice fine lines and wrinkles around our eyes, tell-tale crow’s feet, then maybe a frown line or two in between our eyes, all of which signals that our faces are starting to age. You may look at your hands, often regarded as the best way to really know someone’s age, but do you ever look at your neck?

Our necks are hard-working parts of our bodies. They must hold up our head for starters. We stretch them in different directions all day long and they’re at the forefront of most of the sun exposure that we get during a lifetime, often not having all the UV sunscreen protection that would be recommended.

This means that over time, the skin on our neck become less smooth, loses volume and suffers from photo-damage in terms of changes to texture, tone and pigmentation. As this happens, the strong muscular bands that do all the work of keeping our heads up, known as platysmal bands, start to show through the thinning skin layers, giving the characteristic ‘turkey neck’ appearance.

When it comes to ideals of beauty, especially beautiful necks, you can’t help but be in awe of the bust of the Egyptian Queen Nefertiti. Granted, we have no actual ‘selfies’ of the beautiful lady to prove that the artwork done in her name was a genuine representation, but still, it shows what a beautiful, elongated, smooth neck can do for a woman and why Nefertiti was regarded as such a ‘goddess’. Given the choice of a turkey neck or having a Nefertiti lift, I think we know what everyone would choose.

Good news then, at my clinic in Stevenage, Hertfordshire we can reduce the appearance of platysmal bands, restoring a more youthful appearance to the neck, without impacting on function or neck movement, using botulinum toxin injections.

I use the Azzalure™ brand of botulinum toxin, you may also have heard of Botox®. They are both botulinum toxin type A and are also prescription only medicines which must be prescribed for you after a face-to-face consultation with me, Dr Harry Singh. I am a dentist and aesthetic practitioner, who has been performing and prescribing botulinum toxin treatments for cosmetic use for over fifteen years. This is an advanced technique for the use of Azzalure, and thus needs to be performed by a qualified and experience medical practitioner.

During a consultation, I will ask you to clench your teeth together in an exaggerated smile which allows me to see your neck muscles in full action, as well as how prominent your platysmal bands are at rest, when you are doing nothing. This will allow me to determine if this treatment will be of benefit to you. I will also take a detailed medical history to make sure that you are suitable. Depending on the severity of the lax skin, wrinkles or volume loss in your neck, I may also discuss other aesthetic treatments which can be combined for a more complete solution.

If we go ahead with botulinum toxin treatment it will be injected in very small doses into specific points along the neck muscles. The toxin will take about a week to work and will weaken the muscles ever so slightly, so they become less prominent and improve the appearance of your neck. It’s not a permanent solution, as the botulinum toxin does wear off over time, so you will require repeat treatments every 4 to 6 months to maintain the result.

Please arrange a consultation appointment with me, Dr. Harry Singh at Aesthetics in Stevenage, Hertfordshire if you are bothered by the appearance of your neck and we can discuss if Azzalure botulinum toxin injections are suitable for you. Please call us on 01438 300111.

Using dermal fillers to define and contour the jawline

Dr. Harry Singh explains how definition and a ‘strong jaw’ can be restored with Restylane

A strong jawline is an attractive aspect of both the male and female face, but it is one of the first areas where we notice ageing, as characteristically lax skin, in the form of jowls, start to appear. Men lose the strong, chiselled look favoured by cartoon super heroes and women start to look sad as jowls pull downwards at the corners of the mouth.

Gravity is our enemy and it is the jawline where all the volume loss from the mid-face starts to show as skin and tissue head south for the winter of our lives.

But, before you put your head in your hands and have a good blub at the injustices of the ageing process, there is a solution, so ‘chin up’, quite literally, and let us tell you all about jawline contouring with dermal fillers.

We have talked about the mathematical principles of beauty in the face before, the so-called ‘golden ratio’ of Phi, and the jawline is a key structure in the beautiful balance of the face. In our youth, our faces tend to be like an upturned triangle with the point being at our chin, but as we age, this triangle turns up the other way and our chin becomes part of the big baseline across the bottom as jowls take over the triangular point we once had. Redefining the area, giving structure and contouring to the jawline can give rise to a cosmetic improvement that helps bring the triangle back to the orientation we once had, restoring a more youthful aspect and improving self-confidence about one’s face.

I use Restylane which is a range of temporary hyaluronic acid-based dermal fillers at my clinic in Stevenage, Hertfordshire. Having been performing cosmetic injectable treatments since 2002, I feel confident, not only in my technique, but also in the range of products that I choose to use. Restylane is based on Swedish technology and has a safety record going back 25 years. The product range includes hyaluronic acid gel which is available at different thicknesses allowing me to achieve definition, volumisation and hydration wherever we need it, just by using a single or combination of products from the Restylane range. Thicker options such as Restylane Lyft (formerly called Perlane), Volyme and Defyne provide all the options needed to inject along the jawline to create support, restore structure and gift lift where required. The type of Restylane products required and the number of syringes recommended will depend on the levels of correction needed for your individual case, but we can discuss that during a consultation, so you needn’t be worried about coming along to find out more.

Restylane products are made from a non-animal source of hyaluronic acid, which is something that our own bodies make naturally every day. It’s like a natural moisturiser in the skin and helps to keep it hydrated, but as we age we simply don’t produce enough to do the job properly, so the facial skin starts to wrinkle and sag. Putting back hyaluronic acid, in the form of these synthesised gels, which are designed to last for 6 to 9 months, in some cases 12 months, means that we can achieve a lasting correction and help the body to hydrate and plump out the area effectively.

Restylane products also come with added local anaesthetic in the form of lidocaine, which is the same thing that the dentist might give you if you have a filling. This makes the injections into the jawline more comfortable and often pain-free for many people. As mentioned, this is not a permanent fix to the ageing of the jawline, so repeat treatments will be needed, as eventually your body will metabolise all the hyaluronic acid from the Restylane.

If you are bothered by the shape of your jawline and want to know more about using treatment to recontour and redefine it, then please call 01438 300111 to book an appointment to see Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

Correcting a weak chin with dermal fillers

Dr. Harry Singh explains how dermal filler products can be used to treat a recessive or weak chin and improve the overall appearance of the face.

The chin is an important, if often overlooked, part of what makes a balanced facial shape. The relationship between the eyes, nose and chin has been defined in a standard of beauty known as the ‘golden ratio’, based on the mathematical principles of Phi. Put simply, if the chin isn’t how we would expect it to be, it can really make a difference to the appearance of the whole face because the mathematical balance is lost.

Having a weak or recessive chin is very common, in both men and women, and unless it is an extreme malformation – affecting speech or eating – it is generally a cosmetic concern which can be easily addressed with non-surgical, cosmetic solutions, using dermal fillers. Cosmetic improvement in this way can help to restore self-confidence about one’s face.

Having a strong jawline is an attractive feature, in both men and women, but for some the chin doesn’t protrude far enough away from the face, appearing small or sunken back, and affecting those golden ratio beauty lines between the nose, lips and chin. A small chin can often mean that there is no clear definition between the chin and neck which can also make the mouth and lips appear oversized.

Although a minor genetic phenomenon, or a result of injury, the appearance of the chin and jawline can be enhanced by building volume and definition both in the point of the chin and along the jawline or jowl area, to increase its prominence and bring the face back into balance.

At my clinic in Stevenage, Hertfordshire, I like to use temporary hyaluronic acid-based dermal fillers that offer a safe, cosmetic solution to this concern. I’ve been administering fillers to patients for well over fifteen years now and in that time have learnt and perfected advanced techniques such as chin contouring.

Using the Restylane range of hyaluronic acid (HA) gel fillers, which have been clinically-proven for use as cosmetic tissue fillers since the early 1990s, I have a range of different gel thicknesses which means we can build volume and structure where we need it with thicker products, and then define and contour the final shape of the chin and jawline with softer, thinner types of the HA gel.

Hyaluronic acid is made naturally by our bodies every day and is a key component of our skin, attracting water and keeping skin hydrated, with a plump and youthful look. Implantation of synthesised, non-animal-based HA products, like Restylane have also been shown to stimulate the body’s own collagen formation. Restylane will build a support structure which can be added to with repeat treatments every 6 to 9 months, whilst also giving the body a helpful nudge to lay down new tissue in the area to naturally enhance and improve the chin.

Restylane products come with added lidocaine so treatment is comfortable due to the local anaesthetic. They are also temporary, meaning they are fully metabolised by your body over time. This is much better than the solution of old for chin augmentation where either permanent dermal fillers or surgical chin implants made from silicone were used.

The amount of correction needed to improve your chin will determine which Restylane products we use, as well as how many syringes are required to achieve the desired result. Maintenance treatments will be recommended to keep the correction and improvement to your chin.

If you want to discuss if dermal fillers are the right treatment for your chin, then please call 01438 300111 to book an appointment to see Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire.

Treating teeth grinding, clenching and a square jaw with Botox

Dr Harry Singh explains how botulinum toxin injections, using Azzalure™ can be used to treat bruxism, teeth clenching and reduce the appearance of a square jaw.

Our jaw is a pretty clever thing, we move it up and down regularly throughout the day as we talk, chew, bite and yawn. It also plays an important role in creating a pleasing and attractive shape to the human face. A wide jaw, which can create a square-shaped-look to the lower face, is quite a common occurrence, and although desirable in men as a sign of strength and masculine beauty, it is not considered as attractive in a female.

The appearance of a square-like jaw, is caused by prominent masseter or chewing muscles. If you place your hands at the end of your jaw bone, just below your ears and then clench your teeth together you will feel the masseter muscles as they harden under your fingertips.

In the case of a square jaw, the masseter tend to be excessively active muscles, which means that they have become somewhat ‘pumped up’ through additional exercise, usually as a result of teeth grinding or clenching. The medical name for teeth grinding is bruxism, and it is an incredibly common condition whereby you move your jaw, usually whilst sleeping, and grind the surfaces of your teeth together. This has an effect on both wearing down the surface of your teeth, usually corrected through the wearing of a dental shield at night, but also it exercises your masseter muscles making them more bulky and strong, leading to the square jaw appearance. Thankfully though we now have a solution to both – botulinum toxin injections.

I have been using Azzalure™ botulinum toxin, which is a prescription only medicine brand just like Botox®, at my clinic in Stevenage, Hertfordshire for well over fifteen years. Although these products are most commonly used as anti-wrinkle injections for reducing crow’s feet and frown lines, botulinum toxin also has many medical and practical applications where over-active muscles or muscle spasms are causing a problem. In this case, we would use it to treat the masseter muscle to reduce its activity to more manageable levels.

As a dentist, I am very familiar with the anatomy of the jaw and have encountered many hundreds of patients over the years who regularly grind their teeth in their sleep, so I can advise you during a face-to-face consultation if prescribing botulinum toxin to treat your masseter muscles will both reduce the dental implications of your bruxism, as well as improve the square-like appearance of your jawline, if this is of concern.

Treating the masseter muscles with Azzalure is an advanced technique, so it is important that you see someone with experience, training and understanding of the appropriate dosing required and the effect on the anatomical structures. Seeing an advanced practitioner, like myself, means that you will reduce your risk from over treatment which could weaken the muscles too much and impact on the movement of your jaw and your ability to bite or chew properly, or even open and close your mouth.

Treatment for a square jaw and bruxism with botulinum toxin is not a permanent solution but will last for approximately 4 to 6 months. You will require regular, repeat treatments to maintain the correction but you should notice a reduction in the dosing required to maintain the muscle activity at a level which helps you to stop grinding your teeth and brings your face back into a more attractive shape.

Why not arrange a consultation appointment with me, Dr Harry Singh at Aesthetics in Stevenage, Hertfordshire and we can discuss if you have over-active masseter muscles which could benefit from Azzalure injections; please call us on 01438 300111.

Correcting Smoker’s Lines with Botox

Dr Harry Singh explains why botulinum toxin injections, using Azzalure™ could be the right solution for you if you have smoker’s lines around your mouth.

Do you, or have you ever smoked? If the answer is yes, then you’re probably expecting a lecture about how bad smoking is for your lung health, but that’s not what I want to talk about; I want to talk about smoker’s lines.

Smoking is actually pretty bad for your skin too, and is a significant contributing factor to the premature ageing of your skin, alongside sun exposure. The effects of smoking start to show after about a decade of the habit, speeding up normal ageing and leading to the early appearance of wrinkles. This is because the nicotine in the cigarettes causes a narrowing of the blood vessels that supply the surface layers of your skin. This reduction in blood flow means that the skin cells don’t get as much oxygen or vital nutrients needed to support them and keep them healthy. It’s also been shown that many of the other chemicals present in tobacco smoke damage the collagen and elastin found in your skin; these are your skin’s support structures, so when they get damaged skin starts to sag and wrinkle.

Finally, I know, it’s starting to sound like a lecture isn’t it; the physical act of smoking, and the facial expressions made can also lead to the production of certain dynamic wrinkles. As you suck on and inhale from a cigarette, much like a straw, you purse your lips, leading to the formation of straight-line wrinkles in the area which surrounds the top and bottom lips, usually worse above the top lip, under the nose. After many years of smoking, these lines don’t just appear when you smoke, but are present when your face is at rest and you are not moving your mouth. It is these lines which are referred to as characteristic smoker’s lines. Similarly, you may also squint your eyes to avoid the smoke as you inhale and this adds to the formation of crow’s feet and frown lines.

All in, being a smoker will lead to you looking old before your time.

Now, of course I would advise you to quit the habit and your NHS GP can help you with solutions to achieve that, but what I can offer is a solution to the premature ageing and wrinkles associated with smoking.

During a face-to-face consultation with me, Dr Harry Singh, at my clinic in Stevenage, Hertfordshire, I can assess your medical and smoking history, current health and the presence of smoker’s lines. If botulinum toxin injections are the right solution for you, I can prescribe them as a cosmetic treatment. I use a brand called Azzalure™; Botox® is another brand that you may have heard of too. This prescription medicine can be used as an anti-wrinkle treatment for crow’s feet, frown lines, forehead lines, bunny lines around the nose, and smoker’s lines around the mouth. Treating these lines is an advanced technique, so it’s important that it is performed by someone with advanced training and experience. As a dentist, I understand the anatomy of the mouth area and have been performing cosmetic injections for over 15 years.

Azzalure acts by reducing the strength of certain muscles, in this case the large muscle that circles the lips, so that the production of the dynamic lines associated with smoking is reduced, and the overlying skin does not form the lines so readily, allowing it to recover and the wrinkles to reduce in appearance. Because this is a very important muscle for other actions such as speaking, smiling, drinking, chewing and kissing, we use very small doses of the botulinum toxin to reduce the smoker’s lines without affecting anything else. Treatment is not a permanent solution, lasting 4 to 6 months, but with regular injections we can prolong the recovery of the skin in the area and the lines will continue to fade.

If you are concerned about smoker’s lines and want to discuss whether Azzalure injections could be suitable for you, please arrange a consultation appointment with me, Dr. Harry Singh at Aesthetics in Stevenage, Hertfordshire by calling 01438 300111.

What are temple fillers and why do we use them to correct facial volume loss?

Dr. Harry Singh explains why enhancing your temples can improve the cosmetic appearance of your whole face

Wondering where your temples are? You’re probably not the only one as it is an area of the face which doesn’t get discussed all that much, especially when it comes to cosmetic enhancements.

The temples, yes there are two of them, one on either side of your face, are the small flat areas that you will find if you place your fingers just above your crow’s feet area, in line with the tops of your ears, and just below where your forehead starts.

The temporal region, as it’s medically called, is quite bony with little volume in terms of fat compared to say the cheeks where you can pitch a good amount of tissue if you try. Yet, as we age, the temples start to lose the small amount of volume they have, and this affects the overall appearance and youthful aspect of the face.

A youthful face is round or oval, with a ‘full’ appearance to the shape. As we age, the overlying tissue and the bone density of the skull changes and this leads to a loss of this fullness. The easiest way to explain this is that the face goes from a round or oval shape to a ‘monkey-nut’ appearance with a distinct concavity or dent in the shape of the face. This changes the face from a youthful appearance to a more skeletal, aged look.

Correcting the hollowing of the temples due to this volume loss can be done with dermal fillers, the same products often used to augment lips, recontour the jawline, plump up cheeks and correct nose imperfections non-surgically. However, the temple area is also considered to be one of the more complex areas of the face where a good knowledge of the underlying anatomy is paramount, so any practitioner performing temple fillers should have advanced training and experience. I use hyaluronic acid-based dermal filler products at my clinic in Stevenage, Hertfordshire and have been performing cosmetic injectable treatments, including advanced techniques for over fifteen years.

Usually, adding dermal filler products to the temples will not be a stand-alone treatment, but part of an overall facial rejuvenation treatment. The temples also affect the structure around them so adding volume back, which will return the round-ness of the face, can have secondary effects such as lifting the side of the brow area and can also lessen other changes in the lower face affecting the cheek and nose-to-mouth (naso-labial) lines. Often overlooked, you may be surprised to discover how much difference can be achieved with some hyaluronic acid gel to the temporal region.

Hyaluronic acid (HA) is a natural component of human skin and something that our body makes daily. Our bodies need to produce lots of HA because it acts as a natural moisturiser, drawing in water to our skin to keep it plump and hydrated, but our natural HA doesn’t last very long before we metabolise it and then need to make more. Unfortunately, as we age, we are not able to produce as much HA as we did in our youth, so skin becomes dehydrated and less plump. Some clever scientists have synthesized HA from non-animal sources so that it is safe for use in humans. The difference being that the injectable HA is made into a longer-lasting gel, so it stays within the tissue for much longer than our natural hyaluronic acid.

I use the clinically-proven Restylane range of dermal fillers which has been proven to be safe and effective since the early 1990s. Restylane comes in different HA gel ‘thicknesses’ for use in different areas of the face to achieve maximum volume replacement and contouring. It also comes with the local anaesthetic lidocaine for a more comfortable treatment. By using these products in the temporal region, as well as other areas which could benefit from rejuvenation and volume correction, you can expect an improvement in your facial appearance to last between 6 and 12 months. We can then come up with a bespoke treatment plan to maintain the correction with future appointments at Aesthetics in Stevenage, Hertfordshire with me, Dr Harry Singh.

If you want to discuss if temple fillers are the right treatment for you, then please call 01438 300111 to book an appointment.