botox legal requirements

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the medico legal aspects providing this service.
Regulation – Currently there is no regulatory body or any formal process of regulation regarding the administration of botox. However this will be changing. With the completion of the Keogh report and the Governments response to this together with the European Aesthetics Surgery regulatory standards gaining CEN (European Committee for Standardisation)approval, it will be wise to be prepared and ready for any imminent regulation.

Who can perform botox procedures – As mentioned above, since there is no regulation in place currently, in theory anyone can perform non surgical facial aesthetic procedures. However the indemnity providers will only insure certain medically trained professionals such as; dentists, medical doctors and medical nurses.

Indemnity – There are various options regarding indemnity (mandatory) to allow you to be covered and perform these procedures. This information is correct at the time going to press, but terms and conditions may change, so it is advisable to regularly check with your indemnity provider.

– MPS – You may be able to be covered for facial aesthetics as long as certain requirements are meant, such as, but not limited to; cap on earnings per year from aesthetics, areas to treat (mainly neck and above), registration with ‘Treatments you can trust’/IHAS scheme

– DDU – You may be able to have this included as part of your dental indemnity as long as you have evidence of training and competence in the areas you will be treating.

– HFIS – Hamilton Fraser Insurance Services. I personally use this company. There is no limit on your earnings and what areas are covered (as long as you can prove you have been adequately trained).

Other specialist indemnity providers include Cosmetic Insure and HISCOX.
Training – You will need to attend an approved botox training programme (such as www.botoxtrainingclub.co.uk) and provide evidence of a certain level of competence before you will be allowed to carry out these procedures.

Pharmacy – Botox® is a P.O.M (Prescription Only Medicine) therefore only prescribers can order this and subsequently you can only order it from a pharmacy. You will need to set up a Pharmacy account before you order the toxin. Currently Dermal Fillers are not classified as prescription only medicines, so you can order either from a pharmacy (to save on the VAT) or directly from the filler companies.

Premises – You will require suitable premises to provide botox treatments. If you are providing aesthetics within your Dental Practice, then it will come under CQC remit. If you are providing these services away from your premises, then currently it will not come under the CQC remit.

***A word of warning here, if you are treating hyperhidrosis (excessive underarm sweating) , irrespective of the premises, the CQC may feel it comes under their remit due to the fact that this is because, the condition of hyperhidrosis is classed as a disorder which must be diagnosed and then it can be treated. It is further defined as such by the NHS. This makes it a ‘regulated activity’ with the Care Quality Commission (CQC) in England (with similar requirements in Wales, Scotland and Northern Ireland).

 

For more information about botox hertfordshire, please call us on 01438 300111.

Botox® reviews

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and many of his patients testimonials.

Debbie I have always received a professional and helpful service from Aesthetics. The staff are always kind and friendly and i would highly recommend them to all my friends and family.

Tanya Very professional service for botox

Christine I always recommend this botox clinic as I want my friends to share the experience of such great care and expertise.

Sita Having recently met Harry and his extremely professional team on a superb botox course presented by harry,i would not hesitate to have treatment in the practice knowing the high standards of care that Harry excels in and the attention to detail in all aspects of facial rejuvenation

James I can’t recommend Aesthetics enough. Every visit you get great service, from friendly staff in a relaxing clean environment. It could not be better.

siti excellent botox clinic and excellent results

Juli Great service, friendly professional staff and relaxed atmosphere.

Kang I am so happy with my botox treatment and have told all my friends to visit them, keep up the good work.

Mark Fantastic botox clinic, professional and friendly staff. Excellent service and aftercare

Jas Highly recommended. Great customer care and an equally great atmosphere within this amazing botox clinic.

Preeti Their fantastic service and standard of care puts them in a league of their own.

yasmin Excellent practice with welcoming staff. I use this practice with confidence and have recommended lots of friends for botox who have also been extremely pleased with they’re results!

Rebecca Starr The botox treatment, on a personal and professional level is the highest I have experienced. Hence why I still travel the 45mins to appointments rather than get someone more local. Would highly recommend to anyone!
Nicky The whole team at Aesthetics make you welcome from the moment you walk into the botox clinic. I feel completely relaxed and know that Dr Singh provides my treatment as an individual and not as a routine prescription.

 

 
For more information about botox hertfordshire, please call us on 01438 300111.

botox for eyes

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and how to treat the eyes.

Botox® around the eyes is one of the 3 most commonly treated areas, together with the frown and forehead. Lines around the eyes are also known as crows feet or smile lines.

Broadly speaking there are two types of smilers and we would have a different approach with botox with each one.

The first group are known as eye smilers. In this group the lines appear quite high up and can stretch as far as the patients eyebrows. In these cases, we would inject the botox evenly across the lines and at least one centimetre away from the orbital rim (bony part of the eye).

The second group of are known as cheek smilers. In this group the lines appear from the midline of the eye and sweep downwards towards the cheeks. With this group of patients we need to be careful when injecting botox. If we inject too low or too much of botox, we will over free the cheek area. This will cause extra lines and scrunching of the skin under the eyes when the patient smiles. Therefore we would use a reduced dose of botox when injecting towards the cheeks.

For more information about botox hertfordshire, please call us on 01438 300111.

Botox® – before, during and after

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and what to expect before, during and after your botox injections.

This blog will help anyone know what they should and should not do before, during and after a Botox® treatment to get the best results and experience.
Before a Botox® treatment:
1, Select a doctor that is board certified, experienced, reputable, specialises in facial anatomy and has successfully administering Botox® for several years. Fantastic Botox® application is dependent on the skill and technique of the doctor.
2, Be transparent with your doctor. Tell the doctor all about your medical history, allergies, previous medical treatments, fears of needles, and the current medication you are receiving including any off the shelf medication.
3, Make sure Botox® is the correct treatment for you. There are other treatments available that may well be more suitable for you, such as fillers.
4, Make sure you and your doctor are clear about what facial areas you want to be treated, how you want them fixed and the final result you would like to achieve.
5, Have a realistic expectation of what Botox® treatment can do for you.
6, Avoid drinking alcohol for a few days for your Botox® treatment to be successful.
During the Botox® treatment:
1, Remove all make-up for good treatment session.
2, Stay extremely still and listen to the instruction the doctor gives you to get the result you want.
3, Use an ice pack, this will help reduce any potential signs of bruising.
After Botox® treatment:
1, Do not touch, rub or massage the area that has been injected for at least 24 hours, this will prevent the Botox® from spreading to other unintended muscles.
2, Avoid intense physical activity.
3, Avoid consuming large amounts of alcohol.
4, Avoid having facials, chemical peels, micro-dermarasion for a least 24 hours.
5, If you have any bruising in the injected area use topical vitamin K and arnica to help you.
6, Go back to your doctor for top ups of you are unsatisfied with your results.
7, Seek medical attention from your doctor immediately if you experience any side effects or complication from your Botox® treatment.

For more information about botox hertfordshire, please call us on 01438 300111.

Botox® side effects

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the potential side effects.
Botox® treatments are well tolerated and have very few side effects.

Botox® injections are extremely safe when undertaken by an experienced and qualified partitioners. The most common side effects reports by individuals include some swelling or bruising around where the injection was applied, headaches or flu-like symptoms. If the Botox® injections are not applied correctly, the toxin may spread to surrounding tissues and causing the following problems:

Eyelid droop
Cockeyed eyebrows
Crooked smile
Dry eye or excessive tearing

There have also been a number of other side effects that can potentially occur, such as:

Mild injection discomfort
Swelling around the injection or treatment area
Numbness around the injection area
Headache
Malaise – general feeling of uneasiness or ‘being of sorts’
Mild nausea
Temporary upper lid or brow ptosis
Weakness of the lower eyelid
Neck weakness or stiffness
Diplopi – known as double vision
Bleeding in the area where the injection was administered
Blurred vision
Drooping of the eyelids
Decreased eyesight
Dry mouth
Fatigue
Rashes
Wheezing or difficulty breathing
As always, if you are worried please call your botox practitioner immediately.
For more information about botox hertfordshire, please call us on 01438 300111.

Botox® in lower third of face – Part 2

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox in the lower third of the face.

Corners of the mouth

Some patients have a reverse smile where the corners of the mouth are going downwards. This is the result of an over active Depressor Anguli Oris (DAO) which is responsible for lowering the corners of the lips and subsequently Marionette lines. The DAO is a triangularly shaped muscle. The easiest way to locate this muscle is to get the patient to do a sad face and you will see the muscle contracting just above the jaw line. It can also normally be found by drawing a line from the corner of the nose down to the corner of the mouth and continue this line just above the jaw. I inject 10 botox units per side, perpendicular to the muscle and superficially.

Complications can occur if you inject too medially. The toxin can potentially diffuse into the Depressor labii inferiors and cause a protrusion of the lower lip, known as a Gomer Pyle appearance. if you inject too laterally, the toxin can diffuse into the Buccinator, causing the patient to bite and traumatise the buccal mucosa.

 
Gummy smile

This is the result of an over active Levator Labii Superioris Alaeque nasi (LLSAN) muscle. By administration toxin into the LLSAN you can lengthen the upper lip. You are looking to inject in the naso facial groove which is adjacent to the Ala. I inject at 45 degrees, deep and 5 botox units per side.

It is worth being in mind Rubin’s 3 classifications of smile patterns:
Mona Lisa smile – dominated by the Zygomaticus Major which elevates the oral commissures as the highest point of the smile. Do not treat with botox as this will exaggerate the Mona Lisa smile pattern.
Canine smile pattern – dominated by the Levator Labii Superioris where the highest part of the smile is the central upper lip.
Gummy smile – excessive display of the upper gingival when smiling

I will sit the patient down and will get them to look at a mirror at eye level. then i will push the upper lip down by 3/4mm to show then the expected result and if agreeable, then will carry out the procedure.

Masseter

Over activity of this muscle can cause a square jaw look and potentially bruxism. I would get my patient to clench their teeth and observe where the bulk of the muscle contracting and bulging. I normally give 3 injection sites per side and would start of with 15 botox units per injection site and then review in 2 weeks for any top ups. Over dosing can reduce their biting force. I would inject deep into the belly of the muscle at 30 degrees to the muscle.
Chin

The Mentalis is responsible for pushing out the lower lip and contributes to chin wrinkles, also known as ‘orange peel’. This appearance is more common amongst gummy smilers and in anterior open bites. Even though the Mentalis is a pair of muscles, my preferred injection technique is for one injection site in the midline, very deep at 90 degrees. I would normally inject 10 botoxunits.
Neck

Contraction of the Platysma can lead to bands and premature ageing of the neck region. Toxin is rarely used in isolation in this area and normally treatments to improve the skin complexion such as mesotherapy will yield the optimal results for the patient. Ask the patient to contract their neck via clenching their teeth and then mark along the bands. I would normally inject between 4/5 sites per band and 10 botox units per site very superficially whilst the non injecting hand is pulling out and squeezing the band.
In conclusion,I would rather under dose and get the patient back for any necessary top ups than be over optimistic on the first visit and over dose causing complications. By baby stepping in the lower third of the face you will greatly reduce the risks and have a happier patient and less sleepless nights.

For more information about botox hertfordshire, please call us on 01438 300111.

Botox® around the eyes

Dr Singh who runs his botox clinic in Stevenage, Hertfordshire, in his latest blog shares his thoughts on botox and the eyes.

Botox® can be used to treat the lines around the eyes which appear when you smile. These lines are either known as smile lines or Crows feet.

Before we use botox injections to treat these smile lines, we must first assess what type of smile you are. There are broadly speaking two types of smilers.

The first type use their eyes to smile and they will have lines that are high up in the upper third of the eyes.

The second type are cheek smilers and they will have smile lines in the lower third of the eyes and across their cheeks.

You maybe asking so what, what difference does this make.

With eye smilers and the lines high up, we can be confident of either reducing or eliminating these lines with our botox treatments. However the cheek smilers we need to be much more careful when treating with botox. We do not want to over freeze with botox in the border area of the eyes and cheeks. If we over freeze with botox in this area, when the patient tries to smile, the cheek will resist and cause unwanted lines across the cheek or even scrunching of the skin under the eyes

in addition to varying the dose with botox when injecting lower down, we must also inject away from the eye at least 1cm away. Botox® can spread up to 1cm, so we want to avoid the delicate and important structures within the orbital rim.

Botox® can work very well in treating unwanted lines around the eyes, but a detailed assessment of the patient is mandatory before any botox treatments is started.
For more information about botox hertfordshire, please call us on 01438 300111.

The majority of patients seeking treatment for fine lines and wrinkles will be mainly concerned initially with the upper third of the face, notably the forehead, frown and eye areas. In my experience once they have experienced your clinical and patient skills they will seek additional areas to be corrected with Botulinum Toxin A.

In this article I will look at the areas we can treat in the lower third of the face. Before we look at specific areas, I need to draw your attention to the slightly different approach we have for treating the lower third of the face compared to the upper third.

In the upper third of the face the muscles are large and generally independent of each other, therefore we are not overly concerned with the spread and diffusion of the toxin. However, in the lower third of the face, the muscles are generally much smaller and in close proximity to a number of other muscles. Therefore we need to be wary of the diffusion and spread of our toxin much more. I practice the technique of baby stepping when treating the lower third with toxin. I would rather they come back fro a review appointment and administer any top ups than over dose and cause unwanted side effects in neighbouring muscles.

* When discussing specific units, I will be referring to Azzalure® and Speywood units in the following examples.

Bunny Lines

Not technically in the lower third of the face, but I thought it would be advantageous to talk about this area. These lines appear on the side of the nose when the patient scrunches their nose. The lines are the result of the contraction of the naslis muscles.

I would normally inject 10 Speywood units on each side at a superficial level no more than 4mm depth maximum. you don’t want to go to deep since you will hit bone and this will be painful to the patient. You would inject where the biggest mass of muscle is.

 

Smokers lines

These are vertical rhytides that occur in the upper lip and lower lip region. These lines occur from the contraction of the Oribcularis Oris. This is a circular muscle around the lower and upper lip. It is responsible for the closure of the lip and pushing the lips forward (puckering/pouting). it is common, but not limited to smokers.

There are 3 ways to treat these lines:

toxin only
dermal fillers only
combination of both

My criteria for treating with toxin only is if the lines are superficial, worsen when the patient pouts their lips and the patient does not want any fillers to increase the size of their lips. I do warn these patients that we cannot guarantee to eliminate the lines. The toxin is placed very superficially and I would place as a starting point no more than 5 Speywood units per injection site. I avoid the philtrum area and inject close the the vermillion border. I warn the patient that they may feel numb and find it hard to whistle or say certain letters for a couple of days post procedure.

Dermal filers would be used in isolation if the patients main concerns are the lack of volume in the lips, lack of definition of the vermillion border and they do not want any toxin placed.

If the lines are very deep and do not worsen when they pout their lips, then I would sue a combination of toxin and dermal fillers. The toxin will help relax the muscle and the dermal filler will increase the volume of the lips/borders to help stretch the skin and reduce the appearance of these lines.

I always tell my patients that we cannot guarantee to eliminate the smokers lines and they may need additional treatments such as laser skin resurfacing.

For more information about botox hertfordshire please click the link or call us on 01438 300111