The aim of facial rejuvenation is reversing the hands of time and delaying surgery. The secret of facial rejuvenation lies in starting at a young age. We cannot stop the ageing process but we can certainly soften or delay the effects. The most effective method of achieving facial rejuvenation is by combining procedures as there is no one procedure in isolation that is uniformly effective. These procedures may become very expensive thus it is important to space them over time and not abandon them completely. Below follows a list of recommended procedures:


Botulinum toxin is a neurotoxin which paralysis the nerve responsible for contraction of a muscle. Once the frown line has formed due to repetitive muscle action, Botox can no longer prevent the line or the furrow from forming but it can prevent the line from deepening and smoothen it somewhat. Fortunately and unfortunately this effect is not permanent. The secret in Botox lies to start early in your life. Initially you would need Botox every 3 months. If you start early enough you will weaken the muscle over time and thus Botox will be needed at less frequent intervals saving time and money. Some may need Botox as little as once a year.

In facial rejuvenation the greatest effect of Botox is seen in the frown lines, eyebrows, and small lines around the eyes, bunny lines, gummy smiles, fascial asymmetry and neck platysmal bands. Thus the major advantage of Botox lies in the upper part of the face.

Another valuable use of Botox is in patients with hyperhidrosis. Hyperhidrosis is the embarrassing condition of excessive sweating seen under the armpits, hands and foreheads of many patients. Executives or patients involved in public speaking find this tool very useful.

Botox may also be used for muscle spasms, stiffness and undesirable muscle development or contraction. I often use Botox in congenital cases in children associated with cerebral palsy where muscle spasms leading to permanent contractures and deformities, making the use of Botox very important. It can also be used for neck muscle spasm and migraines.

In the fitness and professional bodybuilding industry, Botox prevent the inevitable masculinization seen in female athletes provided it is started early and continued. Thus these ladies are able to achieve greater competitive levels.

The cost of Botox depends on the area being treated. For the forehead this is roughly about R1500 rand

Hyaluronic Acid Fillers

Aging is associated with an inevitable volume loss of the fascial structures. The once triangular youthful appearance shifts to a more square appearing face due to volume loss and the effects of gravity.

In addition to volume loss there is also a change in skin texture, thinning, pigmentation and loss of collagen and elastin.

Hyaluronic acid is a naturally occurring jelly-like substance found in the normal skin. As it does not express any tissue or species specificity it is safe for injection. The jelly like substance is hydrophilic which means it has the unique ability to not only enhance volume on its own but like a sponge absorb surrounding fluid further enhancing the volumizing effect.

Hyaluronic acid has recently been shown to be responsible for the formation of new collagen. This is a revolutionary finding as previously we have not been thought to be able to from new collagen. Thus despite the volume enhancing properties of hyaluronic acid it also seems to have a direct antiaging effect by the formation of new collagen further highlighting the importance of including hyaluronic acid in your antiaging regime. It also seems to have a major effect on lighting pigmentation.

According to the literature the effect of hyaluronic acid lasts about 1-2 years. I do agree with this in terms of the volume effect but I also think there is a permanent structural change in the quality of the skin of patients whom regularly use hyaluronic acid filler.

There are different types of Hyaluronic acid products depending on the thickness of the gel. Roughly it can be understood as having a superficial, intermediate and deep role. The thicker the gel, the more dramatic the effect and unfortunately the more expensive the product. Luckily the thicker the gel the longer it seems to lasts.

The amount of Hyaluronic acid needed depends on the timing of the treatment. Thus the later in life you start the more you will need and the more expensive it will be. The precious jelly comes in 1 or 2 millilitre syringes. The thick gel in a 2 mil syringe can be as much as R5000.00 for the raw product per 2 millilitre syringe.

Thus a 2 millilitre change in your fascial structure can cost a lot of money. Luckily the product draws in fluid giving you a further enhancement.

I do not like to use a lot of filler at once as I do not want the unwanted changes seen in so many ladies, the “duck-like” upper lip. I would recommend to start with one deep and one intermediate thickness filler some weeks apart and augmentation following that as desired or needed.

So what can hyaluronic acid filler do for you? It can give beautiful cheek bones, soften the deep lines from your nose to your mouth, enhance your lips and smile and straighten, lengthen or elevate the nose. There are tons of uses of hyaluronic acid fillers. The changes are subtle but certainly effective.

Botox and filler in facial rejuvenation is like food and water. Basic requirements.

Just a word of caution: There have been incidences of irreversible blindness associated with hyaluronic acid filler injection. This is the most severe and painful complication reported. Other side effect include pain and bruising. The procedure is generally uneventful and you can return to work the same day.

Chemical Peels

In my practice I use TCA (Trichloracetic acid) peels. A TCA peel is a superficial peel that removes the top layer of the skin allowing regeneration of the underlying skin. Dead cells slough off and new cells grow form below. The depth of the peel depends on the concentration or strength of the peel. The stronger the peel the greater the effect but the longer the down time. A superficial peel is associate with a mild tingling sensation slight peeling of skin and return to work the same day, much like a very good facial. The deeper peels are more painful thus I prefer to these in theatre under mild sedation/ general anaesthetic generally in association with other procedures. The peeling is more significant and the downtime about a week.

The TCA peel helps to improve the texture of the skin mainly addressing dull complexion, lighting fine lines and managing pigmentation.


Fraxel is non-invasive laser therapy used to resurface the skin. Laser columns stimulates fractions of skin allowing resurfacing or replacing the superficial layer but also stimulating the underlying matrix to improve skin quality and texture.

Fraxel works best for fine lines and wrinkles, surface scarring, enlarged pores, age spots, hormonal pigmentation, sun damage and post-operative scars.

A local anaesthetic gel is applied for 90 min. The procedure is painful thus I would recommend taking some analgesia before the procedure. There will be significant redness, swelling and flaking after the procedure. I can however apply make-up and return to work the same day. As will all resurfacing procedures direct sunlight should be avoid for about 2 weeks after the procedure to allow regeneration of new sin.

We determine a protocol most suited for your skin.


Thermage is a very advanced treatment addressing sagging skin. It uses radiofrequency technology to tighten loose skin in the face and body. Optimal effects are said to be achieved within 6 months but I find the effect to be immediate.

The main structural component of skin is collagen. Thermage works by tightening the underlying collagen thus lifting sagging skin. The procedure is not very painful, there will be mild swelling a few days later but the instant results are worth it.

I would recommend the treatment every 2 years. Be warned the treatment is expensive.

Facial Fat Fills

Human fat has been used for many years. It was first used in the late 19th century, but did not become common practice until after the invention of liposuction in the 1970’s and 1980’s. Currently facial fat fills have gained major popularity in the use of facial rejuvenation.

Fat grafting is a procedure in which fat is removed from one area of the body and transferred to another. The fat is harvested by liposuction in an area of unwanted or excess fat e.g. the belly, love handles or thighs. It is then carefully injected into an area where the main aim is correct a volume deficit.

Fat grafting is used for volume replacement and correction of contour deformities much as we use hyaluronic acid fillers. Aging results in the triangular youthful appearance of face being replaced by a rectangular sagging form. With fat we are able to restore the youthful appearance. 60% of the transferred fat will remain permanently unlike fillers. Recent literature suggest that fat has numerous added advantages. Fat is rich in pro-inflammatory cytokines, growth factors and stem cells. These stems cells stimulate the growth of new cells which regenerate the underlying skin matrix and form new collagen. The skin appears healthier. Dull, powder-looking skin is restored to youthful healthy glowing skin. The facial rejuvenation allows the softening of fine lines and wrinkles, lightning of dark circles around the eyes and improves pigmentation.

The fat fills do not make you look fat it restores volume with a 60% permanent effect just like, and better than hyaluronic acid fillers. However should you gain weight there will be a growth in the transferred fat.

Fat grafting is most commonly performed as a day procedure with local anaesthetic and sedation or in theatre under a general anaesthesia.

Postoperatively there will be significant swelling and bruising which may remain for 3 to 6 weeks thus the procedure should not be performed near an upcoming event.

In Conclusion

Facial rejuvenation involves a combinations of procedure starting early in life. The ultimate goal is to avoid or at the very least delay a facelift as much as possible. The advantage is the ability to age gracefully, unfortunately at a considerable cost.