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Best Dermatology

Botox

There are 42 muscles on the human face which help us to communicate by expressions. One of the prime reasons for facial aging is lines & wrinkles caused by repetitive muscle movement. Types of lines which are seen on an individual's face depend on the use of different muscle groups. Literally, the expressions we predominantly make in our lives become etched on our faces with age.

Apart from age, appearance of one's face makes the first impression about the nature and personality of a person. Certain expression lines are associated with negative emotions such as anger, grief and anxiety. Presence of such lines affects how a person is perceived in interpersonal and social communications. Human face is meant to express. As anti-aging strategists, we can not expect a person to cease all human expression to prevent facial aging.

Botox' is a brand name of a substance called Botulinum Toxin A which is a purified derivative from a bacteria (likewise many antibiotic medicines including Penicillin are derived from bacteria & moulds). This substance is used to temporarily relax facial muscles to reduce the appearance of lines and wrinkles. It is injected directly into the muscle which needs to be relaxed. Although involving injections, the treatment is very comfortable. Botox'not onlytreats already formed facial lines caused by repetitive muscle movement, but also prevents new lines from forming.

Common injection sites for addressing wrinkles and lines are:

  • Glabella (region between eyebrows - frown lines)
  • Forehead (Worry lines)
  • Eyebrow Shaping
  • Outer corners of eyes (Crow's feet)
  • Nose (Bunny lines)
  • Upper Lip (Gummy Smile)
  • Sides of mid-chin (down-turned mouth - Marionette Lines)
  • Chin (Chin dimpling)
  • Neck (Neck bands or visible cords)
  • Armpits, Palms & Soles (Hyperhidrosis - Excessive Sweating)

Apart from above mentioned uses, Botox is also used medically for squint, blepharospasm (spasm of eyelids) cervical dystonia (severe spasms in the neck muscles), muscle stiffness in the upper limbs (elbows, wrists, fingers), migraine and detrusor overactivity (overactive bladder).
Botox is being used for many decades now for both cosmetic and medical causes. Botox treatment takes 72 hours to take effect after injection and lasts for about six months. In expert hands, Botox is a potent, yet extremely safe treatment for facial lines & wrinkles. Consistent usage of over several decades and well-established safety profile has made Botox treatment popular worldwide. Effective usage of Botox requires thorough knowledge of facial anatomy, correct assessment and understanding of expectations & lifestyle of the individual.At Skinnovation - The world of Aesthetics, we have extensive experience of using Botox for cosmetic and dermatological indications. Doctors who inject at our centre are highly qualified, experienced and skilled at Botox treatments. If you consider yourself a candidate for Botox treatment, visit us for a detailed consultation and expert care.

Dermal Fillers

Ageing face is associated with loss of subcutaneous volume over time. The youthful angles & contours of our face are lost. The skin once taut and clear becomes saggy and wrinkled with age. Like a deflating balloon, the face starts to show wrinkles and lines on what appears to be a sagging material. Especially, the space between the lower eyelid and ‘apple of the cheek’ gets longer and hollowed out. Many deep lines also become more prominent, such as those that run from the nose to mouth (naso-labial lines) and those which run from mouth to chin (mento-labial or marionette lines). This is caused by the descent of the malar fat pad (the fat that sits over cheek area). The descent of volume overtime modifies the face’s complete outline adversely. Other areas where we lose volume with age are the temples and lips.

To replace this loss of volume, a number of substances have been used. Autologous Fat, Collagen, Hyaluronic acid, Polylactic acid, Calcium Hydroxyapatite are some of the substances used as fillers for replacement of the lost volume. Due to predictable nature, proven safety record, superior cosmetic results, Hyaluronic acid has emerged as the overwhelming filler substance of choice globally. Hyaluronic acid is a substance naturally present in the lower layers of our skin. It is has got no immunogenic potential and is naturally degraded by our body’s processes over time. Hyaluronic acid filler material has a gel like consistency and acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to normal ageing. It also brings water to the surface of skin to keep it looking fresh and supple. These are used to fill lines and wrinkles in less than 30 minutes with results that can last from 6 months to more than a year.

Hyaluronic acid gel fillers are available in different consistencies and forms. Depending upon their properties of viscosity and malleability, different fillers are suitable for different areas of face. It requires sound knowledge of facial anatomy as well as skill to manipulate filler materials to obtain best results. In expert hands, fillers can instantly reduce the apparent age of a person’s face. At Skinnovation Clinics- The World of Aesthetics, filler injections are done by doctors highly skilled and experienced in performing them.

Nasolabial Folds - Fillers

Tear Troughs - Fillers

Lip Volumization - Fillers

Vitiligo Surgery - Melanocyte Transplantation

What is Vitiligo?

Vitiligo is a condition in which areas of skin lose their normal pigment andbecome white. It is common, affectingabout 1% of the world's population.Itcan start at any age, but in about halfof people affectedit does so before 20 years of age. Its course is unpredictable,varying fromsingle small patches to total loss of skin colour. In most people,it tends to progress slowly,with periods of stability often lasting several years.

What causes Vitiligo?

The pigment that gives your skin its normal colour iscalledmelaninandis made by cellsknown as melanocytes. In patchesof vitiligo the melanocytesare absent.The reason for thisis not fully understood. However, vitiligo is considered to be an 'autoimmune' condition in whichthe body's own immune system rejects someof its own cells (melanocytes in the case of vitiligo).As a result, thyroid disease and other autoimmune conditionsare more commonin individuals withvitiligo. There are multiple theories regarding causation of vitiligo apart from autoimmunity such as 'Genetic tendency', 'Intrinsic defect of Melanocytes', 'Neural Theory', 'Oxidative Stress' etc. All these theories have some basis and some evidence in favour of them. However, inspite of decades of research, we still don't know the exact causation of melanocyte destruction in vitiligo.

Vitiligoaffects men and women of all races equally, but is more noticeable inpeople with darkskins. It is not infectious. There is no medical evidence of any link between diet and vitiligo.

Is vitiligo hereditary?

Yes, vitiligo has a genetic basis, although onlyabout a fifth of thosewith vitiligo know of someone in their family who also has it. If you have vitiligo, it does not necessarily follow that your children will developit.

Are there different types of Vitiligo?

Yes, two principal types: Segmental Vitiligo and Non-Segmental Vitiligo. These both behave very differently and are practically different phenotypes/diseases.

Segmental Vitiligo or Unilateral Vitiligo

It tends to affect areas of skin that are supplied by a specific nerve root and is most often unilateral. Often seen on a leg, face or arm, they are also associated with whitening of hair. It generally has an early onset, often advances for a year or so and then stops. It generally responds well to surgical treatment as its stability is predictable.

Non-segmental Vitiligo

It could be focal or generalised. Focal is generally the evolving stage of Segmental or Generalised Vitiligo. Generalized Vitiligo or Vitiligo Vulgaris occurs on both sides of the body (right and left). Itmay begin on the hands, fingertips, wrists, around the eyes or mouth, or on the feet. Individuals experience rapid loss of skin colour in the beginning, which then stops after a while, eventually leading to repeated colour loss. This cycle usually continues all through a person's lifetime. During active stage, even trauma to skin might lead to depigmentation (Koebner's Phenomenon). Colour loss tends to propagate, covering larger regions, thus increasing visibility. Acrofacial (involving tips of fingers and face) and Mucosal vitiligo (involving lips, genitalia) are also types of Generalised Non-Segmental vitiligo.

How is Vitiligo treated?

Vitiligo is treated with a combination of topical agents, phototherapy (PUVA or NB-UVB), immuno-modulators and surgery. Therapeutics is targeted at two aspects: Stabilisation of Disease Process (Cessation of ongoing depigmentation) and Re-Pigmentation (Formation of new pigment at the white areas). In stable disease, surgical strategies to re-pigment the white patches are often resorted to.

What is Melanocyte Transplantation?

Melanocyte transplantation is a surgical method which replenishes the melanocytes in the areas devoid of them. A thin, small piece of normally pigmented skin is obtained, usually from patient's buttock/thigh. Through a highly specialised procedure, normal functioning melanocytes are separated from this piece of skin and made into a liquid suspension. This suspension is applied on to the white patches. Melanocytes, then start to proliferate and produce melanin and within a period of weeks to months, natural looking pigment covers the patches, making them indiscernible from the surrounding skin. This procedure is also called 'non-cultured epidermal cell suspension transfer' or 'non-cultured cellular grafting' or 'melanocyte-keratinocyte transplantation procedure'.

How is Melanocyte Transplantation compared to other surgical procedures for vitiligo?

Other surgical procedures for vitiligo are Punch Grafting, Split-Thickness Skin Grafting and Suction Blister Epidermal Grafting. Compared to these methods, Melanocyte Transplantation has the distinct advantages of requiring a small piece of donor skin (about 1/4th to 1/10th the size of recipient patches) and resulting in better colour match than other methods by providing pigmentation similar to that of surrounding skin. Melanocyte Transplantation is a specialised procedure requiring expertise, sophisticated techniques and devices.

Is the procedure of Melanocyte Transplantation painful?

The procedure is done under local anaesthesia where the skin operated upon is temporarily rendered sensation-less and no/minimal pain is felt during the procedure itself. A small piece of skin graft is taken from buttock/thigh (donor area) which is dressed immediately. The white patches are also similarly anaesthetised before they are prepared for application of melanocyte suspension. Thereafter they are covered with special dressing material. The dressing on both donor and recipient regions remain for about 7 days.

Will Melanocyte Transplantation instantly colour the white patches?

Melanocyte transplantation is a process of restoring the cells which produce pigment (Melanocytes) at the white patches of Vitiligo (which are devoid of them). After the procedure, the patches are covered with dressings for seven days. After seven days of healing, the operated area usually appears red. As the redness subsides, it appears white (as before the surgery). With suitable environment, nourishment and stimulation, the newly placed melanocytes start to produce pigment which eventually covers the whole patch. Pigmentation after a melanocyte transplantation typically starts appearing after few weeks. Within a span of four to six months, usually, we expect good coverage of the lesion with pigment. You may be advised certain medicated creams or phototherapy (NB-UVB) after 2-3 weeks of surgery to stimulate melanocytes.

Procedure for Melanocyte Transplantation

Who is the right candidate for melanocyte transplantation?

Patients with stable disease are the right candidates for melanocyte transplantation. We define stability as no new white lesions and no increase in size of old lesions for a minimum of 2 years. Also, features such as Koebner’s phenomenon (depigmentation at sites of trauma on skin), Keloid (large scars) formation should be absent in the ideal candidate. Thorough clinical examination, review of old treatment and photographic records are important for ascertain suitability for melanocyte transplantation. Generally, Segmental Vitiligo patients are known to respond best to melanocyte transplantation. Palms, Soles and Acrofacial Vitiligo (involving fingertips and region around mouth) are difficult to re-pigment.

Why choose us for Vitiligo Treatment?

Our specialist team of dermatologists and plastic surgeon has extensive experience in the field of vitiligo management. Our experts have trained at and performed path-breaking research in the field of vitiligo at centres of excellence in India and abroad. Our approach towards managing a patient of vitiligo is meticulous, evidence-based and in accordance with international guidelines. The therapies, reagents and protocols used by us are of international standards. We are ever-mindful regarding suitability of different treatments for different patients and try to tailor the treatment according to the patients’ needs and lifestyle. Melanocyte transplantation is a highly specialised procedure which requires unique set of skills and expertise. At Skinnovation Clinics-The world of Aesthetics, our team has consistently delivered good results with their standardised technique.