Face facts: you want to look perfect, beautiful, the real you. And that wrinkle or that frown line is just getting in the way. This often has nothing to do with how healthy your skin is or what your complexion’s like, but rather the facial muscles and structure of your skin and face. In this case, you’ve probably heard of or considered, if not tried, Botulinum toxin (BTX) or dermal filler.
We’ve spoken to a few noted doctors and professionals, and here’s the skinny on the subject.
“BTX can make a dramatic difference if you start before thirty, when the youthful elevator muscles are still very dominant in the face; after that, the drooping depressor muscles start taking over.”
A note on Botox®
The product we all know colloquially as Botox® is actually a brand name (think Sellotape vs sticky tape). But there are several brands producing this kind of product, and in fairness we should refer to it as Botulinum toxin, which is a bit long, so we’ve shortened it to BTX in this article.
What is BTX?
BTX blocks acetylcholine neurotransmitters in muscles, which reduces muscle contraction in an area. It was initially used in medicine to treat a variety of muscle overactiveness or stiffness disorders.
In cosmetics, it helps stop overactive facial muscles from making unwanted lines in the face for up to four months.
What are dermal fillers?
Several substances may be used (like collagen or hyaluronic acid), but all dermal fillers are injected into the skin to plump it up, to give it body (fill). This plumping up helps get rid of finer lines, wrinkles and creases in the face for three to six months.
It can also be used to plump up lips for an Angelina Jolie pout.
1. Do some research and know your rights – it’s up to you!
Everyone we spoke to emphasised the importance of doing your homework and finding the right, reputable practitioner to perform the treatments.
“It’s really a case of buyer beware,” explained Dr Maureen Allem, Exco member of the Aesthetics and Anti-ageing Medicine Society of South Africa (AAMSA) and founder of Skin, Health and Body Renewal. “Perhaps a little more so with fillers, because they’re not regulated by law yet, but even with BTX things can go wrong. And it’s your face, so it’s crucial you find the right, experienced practitioner at a reputable clinic. And know what you are entitled to.
“You have the right to know how many patients a doctor or practitioner has injected, which product they are using and how many units of the product is being used. If the practitioner doesn’t tell you, ask them.
“Be wary of therapists who do it on the side and so-called “gypsy” practitioners who travel from place to place to perform treatments,” Dr Allem continued. “Remember that, if something goes wrong, you need to be able to go to someone directly, someone you can hold accountable.
“I’d go as far as to say that, after having done over a thousand injections, the practitioner is still learning. The greater their experience and the better their training, the better and safer for you.”
2. Find the right practitioner and build a relationship
Dr Jonathan Toogood, owner and founder of Somerset Surgery, believes working by referral is key. “Get a good referral from your GP or a trusted friend who has had it done and always go to a qualified doctor or plastic surgeon at a reputable practice. You should be able to form a relationship of trust with your practitioner and tell him or her what you liked or disliked about your last treatment so that, together, you can create your perfect injectable recipe.”
Dr Maureen Allem, Executive Council of AAMSA and founder of Skin, Health and Body Renewal
Dr Jonathan Toogood, owner and founder of Somerset Surgery
“BTX takes about seven to ten days to take effect, so if you want your BTX to be effective for a specific date, plan accordingly.”
Dr Margaret Fockema, BTX and filler specialist at Global Aesthetic Centre, says that “Botox parties” are a reality, and advises to avoid them. “Shop around and make sure that you go to a reputable doctor. Your friends might be having treatments done, so if you decide that you like the outcome of their treatments, you can find out who their doctor is. It is important to choose someone who regularly injects and not to let an unqualified person inject you.”
“As we age, we lose volume. Fillers are used to put volume back into the face. They are very effective, but need to be individualised to each person’s needs.”
Dr Margaret Fockema, BTX and filler specialist at Global Aesthetic Centre
3. Ask to see the box
There are two types of medical council-approved BTX in South Africa: Botox® and Dysport. And though there are more brands overseas and locally, note that most of these have not been fully approved for use on all areas of the face in South Africa. “Bocature, for example,” Dr Allem says, “is in the process but not yet a hundred percent approved for all areas of the face in South Africa. A doctor can use it "off-label", but only if they inform you.”
It’s the same with fillers: not every brand is approved for use everywhere. A doctor may again use a product “off-label” (see point 5), but only if they inform you and get your consent.
“You have a right to know what you’re being injected with, so ask to see the box. What brand is it? Is it being used "off-label"? Also, how many units of the product are being used?” Dr Allem advises.
Hang on …
dermal fillers are
NOT REGULATED?
4. Ask how many units you are getting
Ideally, you should be paying per unit of the product. “Some clinics might charge you per area inject, which is fine, but you must still know exactly how many units are being injected into that area,” Dr Allem advises.
BTX often comes as a powder that needs to be mixed by the practitioner with a saline solution into a liquid. It needs to be diluted correctly, because you are mainly paying for the BTX product.
“BTX lasts for about four months, for example. If it’s not lasting, you might have been injected with too little,” Dr Allem explains.
5. Know what “off-label” means
For both BTX and dermal fillers, a practitioner may use a brand on you even if that product is only approved for another part of the face (because it should theoretically be safe), but only if you are fully aware of the fact and agree to it.
This is called “off-label” use and it’s worth repeating that the practitioner must make you aware of this.
6. Neither BTX nor fillers will make your skin healthy
As we said right at the beginning, these treatments are merely for plumping or reducing the activity of facial muscles. And all our experts agree.
“Do not rely on BTX or filler to improve the quality of your skin. It won’t do anything for pigmentation, pore size or the texture or tone of your skin. A good skincare routine including sunblock, vitamin A, fruit acids and antioxidants will do your skin a lot of good,” says Dr Toogood.
“You will look better and younger for a while after BTX or a filler, but the quality of your skin won’t improve. A good skincare regimen with the right products and professional treatments is essential. Don’t forget to use a sunblock to protect your skin from the harmful rays of the sun. A healthy lifestyle including exercise and lots of fresh fruit and vegetables goes a long way to ensuring a glowing skin,” Dr Fockema concurred.
For keeping your skin healthy, see these articles:
• Free radicals and oxidation in your body
• Refreshing facts about staying hydrated
• Fitness apps that motivate you to exercise
– dr Maureen Allem
– dr Jonathan Toogood
– dr Margaret Fockema
ingredients
+ 4 slider buns
+ 2 tbsp chicken liver pâté
+ 2 tbsp (30 ml) Japanese Kewpie mayo
+ 1 cup (200 g) pulled pork, warmed
+ ½ cup (75 g) quick pickled carrots & daikon*
+ 8 sprigs cilantro (coriander)
+ 1 jalapeno, sliced
method
1 First, toast the slider buns.
2 Spread the pâté on the bottom bun and the
mayonnaise on the top bun for each sandwich.
3 Top the bottom buns evenly with the pulled pork,
carrot and daikon.
4 Add cilantro and jalapeno slices to taste.
5 Add the top bun and serve immediately.
ingredients
+ 4 slider buns
+ 2 tbsp chicken liver pâté
+ 2 tbsp (30 ml) Japanese Kewpie mayo
+ 1 cup (200 g) pulled pork, warmed
+ ½ cup (75 g) quick pickled carrots & daikon*
+ 8 sprigs cilantro (coriander)
+ 1 jalapeno, sliced
method
1 First, toast the slider buns.
2 Spread the pâté on the bottom bun and the
mayonnaise on the top bun for each sandwich.
3 Top the bottom buns evenly with the pulled pork,
carrot and daikon.
4 Add cilantro and jalapeno slices to taste.
5 Add the top bun and serve immediately.
6 Botox
and filler facts everyone should know
We’ve tried the treatments and spoken to the
professionals: and here’s what you should know before injecting anything into your face.
ALL-WHITE CHOCOLATE ROCKY ROAD
MAKES 16 SQUARES
300 g white chocolate
5 ml vanilla extract
80 g desiccated coconut
90–100 g white mini marshmallows
Line a 17x17-cm cake tin with baking paper. Melt the white chocolate in a double-boiler on the stovetop or in a microwave. Stir in the vanilla extract. Mix the coconut and marshmallows together in a bowl. Add the melted chocolate and stir to coat all. Tip the mixture into the prepared cake tin and flatten it out with a spatula. Leave to cool to room temperature before removing and cutting into squares.
Recipe from Sam Linsell’s Sweet,
published by Struik Lifestyle
CHOCOLATE CUPCAKES WITH WHITE CHOCOLATE BUTTERCREAM
MAKES 24
CAKE
180 g butter
400 g granulated brown sugar
3 free-range eggs, room temperature
5 ml instant coffee granules
10 ml vanilla extract
280 g cake flour
250 ml cocoa powder
10 ml bicarbonate of soda
375 ml buttermilk
WHITE CHOCOLATE BUTTERCREAM
200 g white chocolate
170 g butter
5 ml vanilla extract
60 ml milk
390 g icing sugar, sifted
Preheat the oven to 180C. Line 2 x 12-cup muffin tins with paper liners. For the cake, cream the butter and brown sugar together until light and fluffy. Add the eggs, one at a time, mixing well after each addition. Dissolve the coffee granules in the vanilla extract, then add to the mixture. Sift together the cake flour, cocoa powder and bicarbonate of soda. Add the buttermilk and sifted dry ingredients to the creamed sugar and coffee mixture in 3 parts, alternating. Do not overmix. Using a spring-release ice-cream scoop, fill the muffin cups with the mixture, two-thirds full. Bake for 20 minutes until springy to the touch and cooked through. Leave to cool in the tins before turning out. To make the buttercream, melt the chocolate in a double-boiler, then leave to cool. Add all the ingredients, including the cooled melted chocolate, to the bowl of an electric mixer and whip until light and fluffy. Ice the cooled cupcakes and decorate according to preference.
Recipe from Sam Linsell’s Sweet,
published by Struik Lifestyle
45-SECOND CHOCOLATE PUDDINGS WITH SALTED CARAMEL
MAKES 2
3–5 ml quality instant coffee granules
45 ml milk
60 ml self-raising flour
60 ml granulated brown sugar
45 ml cocoa powder, plus extra for dusting
2 ml salt
1 egg, beaten
15 ml sunflower oil
3 ml vanilla extract
10–20 ml readymade caramel (eg Nestlé® Caramel
Treat or dulce de leche) with a pinch of salt
fresh cream or ice cream, for serving (optional)
Dissolve the coffee granules in the milk, then place all the ingredients, except the caramel with a pinch of salt, in a bowl and mix by hand until well combined. Divide the mixture evenly between 2 small bowls, teacups or ramekins. Drop 1–2 teaspoons of salted caramel into the middle of each pudding; it will settle down towards the bottom. Microwave each individually on full power for 45 seconds. At this stage the pudding will be firm,
but still a bit gooey in the centre. If it is too undercooked or too gooey (all microwaves are different), simply microwave for a few more seconds until you are happy with the degree of firmness. Serve with fresh cream or ice cream and dust lightly with cocoa powder.
Recipe from Sam Linsell’s Sweet,
published by Struik Lifestyle
SPICY SALTED CARAMEL POPCORN
MAKES 10–12 CUPS
125 g corn kernels
10 ml coconut oil, or any other neutral oil
5 ml ground cumin
5 ml ground cinnamon
3 ml paprika
5 ml salt
2 ml bicarbonate of soda
150 g butter
200 g granulated white sugar
30 ml golden syrup
5 ml vanilla extract
Preheat the oven to 120C. Line a baking tray with silicone or baking paper.Make the popcorn any way that you prefer. (I like to use a large skillet with a glass lid.) Transfer the popcorn to a large, deep bowl; it should only half fill the bowl, allowing space to toss the sauce. Mix all the spices and bicarbonate of soda together. In a medium-size, heavy-based pot bring the butter, sugar and syrup to the boil. Continue to let it bubble, stirring continuously, until the mixture turns golden-brown and reaches the hard crack stage of 155C. Add the vanilla extract and spice mix and stir vigorously for a few seconds, then remove from the heat. Pour the hot caramel over the popcorn and toss to coat. Spread the caramel-covered popcorn evenly on the prepared baking tray and bake for 15 minutes. Remove it from the oven and toss to ensure it’s evenly coated. Return it to the oven for a further 15 minutes, then remove, toss again and leave to cool. Once cool, break it up and store in an airtight container.
Recipe from Sam Linsell’s Sweet,
published by Struik Lifestyle
Hang on … dermal fillers are not regulated?
While BTX is a schedule-four medicine, regulated by South African law (meaning the manufacturers and their laboratories have to be approved by the Department of Health and only registered medical practitioners may be in possession of it), dermal fillers are not.
According to Dr Allem, dermal fillers are a bit of a grey area, as they are not seen as a medicine, but as a medical device. The difference means that the law does not regulate dermal fillers.
“Dermal fillers are classified as medical devices. Medical devices are not currently regulated in South Africa. There are, however, draft regulations out for comment. It is uncertain at this stage when these regulations will be implemented,” explains Liezel Fourie, Healthcare Compliance at Allergan Pharmaceuticals.
Being unregulated means their manufacture and possession, buying and selling have not yet been approved by our medical council. Again, it is very important that you know and trust the practitioner providing the treatment.
What can go wrong?
“You have to know that if the practitioner injects the product one millimetre to the right or left, or too deep, things can go wrong. That’s why you want to get treatment from an experienced professional.”
– Dr Maureen Allem
BTX
Because BTX interferes with muscle contraction, injecting it in the wrong place often means drooping:
• Skew mouth
• Eyebrow droop – often called “Jack Nicholson brow” or “Spock brow”
DERMAL FILLERS
These are often much more serious. There are a few things that can go wrong with fillers:
• Bio films – a thin film of microorganisms that may become attached to the filler, calcifying or causing an infection-like, pus-filled (though painless) lump on the skin
• Vascular occlusion (blindness) – there are two very important arteries for vision in your skull, sometimes near the forehead. If a dermal filler gets in there by accident, it causes blindness
• Skin necrosis – whatever you do, do not Google “skin necrosis from fillers”. Necrosis means the skin dies – imagine that happening on your face. Fillers, incorrectly injected, may block the blood supply to that part of skin. The skin will first become white (blanched), and then die.
