Experts in cosmetic surgery and appearance medicine talk about the latest treatments.

For women wanting extra help with their appearance a trip to the clinic rather than the skincare counter is becoming more common. Resorting to knives and needles isn't for everyone, but advances in outcomes make the end results more enticing.

We ask leading plastic and cosmetic surgeon Stephen Gilbert, appearance medicine doctor Joanna Romanowska and several clinic nurses what is new in their fields. All say people are wanting a natural-looking result, rather than signs of obvious "work".

"A new trend is not just anti-ageing surgery, it is surgery for beauty," says Gilbert. "For instance it is not appropriate for a 50-year-old woman to have a rounded 20-year-old face. What she needs is a subtly sculptured look to the cheeks, together with a smooth jaw line and tidy neck as well as enhancement of her cheekbone area."

Romanowska says the overdone, immobilised, overstretched look is being replaced by a desire for a more natural appearance. "There is much more focus on the health of the skin and, of course, healthy skin looks good."


From facelifts and fillers to the latest with lasers and clinic-only skincare, here are some of the means to that end.

Under the surface

A new trend is to improve the quality of skin by infiltrating a very thin layer of processed fat under the skin at the time of surgery, says Gilbert. "I do this a lot with facelifts. This processed fat will contain stem cells and these have an effect on improving the quality of the skin and may even rejuvenate elastin fibres which are reduced with age."

He is closely following research in Auckland looking at how growing new skin from burns victims has a spin-off in improving the elastin quality of ageing skin. "In future we may be able to infiltrate smaller amounts of this growth factor into the skin and rejuvenate it.

"I am taking a keen interest in this because the holy grail of skincare is to restore the youthful recoil quality, or elasticity of the skin to combat gravity and achieve a youthful fresh look."

Romanowska says the latest development in use at her Clinic 42 in Epsom is platelet-rich plasma, which utilises a person's own platelets and growth-factors to draw the body's own cells to the treated area and stimulate them to make new collagen and elastin." She says this is "a wonderful advance for people who have been saying for years they would never have Botox or surgery, as it is so natural".

The treatment improves the texture and quality of the skin, she says, softening lines and wrinkles and making skin look healthier and more radiant. It works well in areas that are otherwise difficult to treat safely such as the eye area, upper lip - "no trout-pout with this treatment - neck, decollete and chin.

Easy on the needle


Botox is the world's most popular cosmetic procedure. In New Zealand over the past 12 months, Caci clinics alone have performed more than 10,000 treatments. Most responsible practitioners are going easy on its use, to avoid faces frozen into a blank canvas.

Freezing big muscle groups completely creates areas of skin tissue that drop, says Gilbert. "Experienced plastic surgeons have never overdone the Botox because they have a trained aesthetic eye as to what would make the patient look their best, and they know what muscle groups they are injecting into."

Where surgeons do use Botox, is at the time of a facelift to enhance results. "Particularly to reduce frown lines and raise the lateral brow slightly."

Mr Gilbert says fillers are now being used with more subtlety to create the shape of the face that best suits the patient. (This can be done at the time of a facelift to lift the deep tissue to a more youthful level and bring more fullness to the upper cheek area.)

"Instead of just putting large amounts into the face it is much better to enhance the crucial area first, with no more than two syringes of dermal filler."

This can be reviewed in two weeks for other areas of the face that may benefit from volumising, while also refining and blending the original area further. "This is a more artistic, sculpturing of the face. It becomes a partnership between patient and doctor."

The Caci Medispas' clinical adviser, trained nurse Jackie Smith, says dermal fillers which have traditionally been used to treat deeper lines such as those running between the corner of the mouth and nose, are proving effective at treating volume loss in the face, such as the ageing effect of sunken cheeks.

High-tech zappers

Lasers are in widespread use in beauty clinics and though a well-trained technician working with quality equipment can deliver good results, these are powerful devices which can cause damage. Zapping unwanted hair and pigmentation is relatively straightforward and pretty successful on suitable candidates, but intense laser resurfacing should be treated with caution. Make sure you seek out expert medical advice before being left looking initially like a burns victim after ablative lasering. This process uses very high temperatures to vapourise and can harm healthy skin as well as damaged areas, so it involves downtime before skin heals with improved texture.

Laser use to stimulate collagen and create a smoother final appearance - often done in tandem with other treatments such as light therapy and skincare prescriptions - can be hard to quantify. Your practitioner should be able to clearly explain any treatment, its risks and likely results. If you are unsure seek another opinion.

Be aware there are different types of lasers out there and treatments go by various names which can make comparisons tricky. IPL (intense pulse light) and VPL (varied pulse light) are commonly used terms for lasering the likes of hair, age spots and red veins, but proprietary names are sometimes used.

Gilbert has a new to New Zealand laser at his Remuera clinic, Prescription Skin Care. It is called the Cutera Laser Limelight IPL treatment and it is able to selectively target various issues, treating mottled complexions with brown and red sun spots, broken capillaries and spider veins, and diffuse redness - all in one go.

"You do not need different types of treatment, but you may need three treatments, each a month apart, to effectively remove these signs of sun damage. The result is clear, luminous skin."

IPL and VPL treatments should leave few obvious markings on the skin, beyond a little initial redness - which can be covered with mineral makeup - and then some slight flaking.

In between ablative lasering and the commonly used IPL/VPL is Pixel and Fraxel lasering, although, as with the other types, the degree of intensity selected dictates the impact. Experienced and well-trained operators are vital. Fraxel is in use at various clinics, including the About Face chain, and Caci is about to introduce courses of treatment next month. The Skin Institute uses Pixel and offers a full range of other options.

About Face's Fraxel specialist Jackie Hendy says the treatment has shown good results dealing with mild-to-medium acne scarring and hard-to-shift hormonal pigmentation. Most significantly it can be used on olive and darker complexions, on which routine lasering is less effective. It works by microscopic wounding (rather than locking on to pigmentation), and causes soft tissue coagulation, prompting fibroblasts into healing and collagen into regeneration. "You're rebuilding your own integrity of your own skin," says Hendy.

Caci says its fractional laser will target sun damage, lines and wrinkles and acne scarring. It doesn't require the lengthy recuperation some other laser resurfacing treatments do.

"The fractional laser works treating microscopic areas of the skin at a time with a laser pulse that creates a tiny hole on the skin's surface to trigger the growth of clear, new skin," says Smith.

Though lasers can offer impressive results on the right candidates, a word of caution come from some in the skincare sector, who hold to the belief that anything that causes inflammation is in itself likely to age skin.