Procedures on Aesthetics Academy

How to store and reconstitute Botox

Sat, 11 Jul 2026 00:00:00 +0000

Botulinum toxin type A is supplied as a lyophilised or vacuum-dried protein complex requiring reconstitution before use. It is a biological product, and the properties that make it effective — a large, conformationally sensitive protein — are the properties that make its handling consequential.

Cold chain

Manufacturer storage specifications for the unopened vial, and for the reconstituted product, are stated in the summary of product characteristics for each individual product and differ between them. The underlying principle is that the active moiety is a protein whose activity depends on its three-dimensional structure, and that structure is degraded by heat, by freeze-thaw cycling and by mechanical agitation. A product that has been outside its specified conditions may look identical and be substantially less active, and there is no bedside test for potency. The practical implications are unglamorous: monitored, dedicated refrigeration with a recorded temperature log; documented handling of any excursion; awareness that transport and delivery are part of the chain and not exempt from it; and a stock system that respects expiry.

How to reconstitute hyaluronidase (Hyalase)

Thu, 02 Jul 2026 00:00:00 +0000

Hyaluronidase is an enzyme that hydrolyses hyaluronic acid, breaking the glycosidic linkages of the polymer chain and reducing tissue viscosity. In aesthetic practice it is the only agent capable of degrading hyaluronic acid filler, and it therefore occupies a position no other product does: it is both the correction tool for an unsatisfactory elective result and the emergency treatment for vascular occlusion. It is supplied as a lyophilised powder and must be reconstituted with a diluent before use.

Platysmal bands and turkey neck

Tue, 23 Jun 2026 00:00:00 +0000

Vertical cords running down the anterior neck, prominent on speaking, grimacing or straining, are the free medial borders of the platysma. The colloquial description of a “turkey neck” conflates several different findings — banding, skin laxity, submental fat and loss of the cervicomental angle — and the first task in assessment is to separate them, because only one of them is muscular.

Relevant anatomy

The platysma is a broad sheet within the superficial cervical fascia, arising over pectoralis major and deltoid, ascending obliquely across the clavicle and neck, and inserting into the inferior border of the mandible, the modiolus, the lower lip depressors and the skin of the lower face. It is innervated by the cervical branch of the facial nerve.

Bunny lines on the nose and the perinasal danger map

Mon, 08 Jun 2026 00:00:00 +0000

Two quite separate subjects meet at the nose. One is a minor dynamic line pattern of the nasal sidewall; the other is the second most dangerous territory on the face for injected filler. They are discussed together only because they share an anatomical region, and confusing the risk profile of one for the other is itself an error.

Bunny lines and nasalis

Bunny lines are the oblique rhytids that appear across the nasal dorsum and sidewalls on wrinkling the nose. They are produced chiefly by the transverse part of nasalis, which arises from the maxilla lateral to the nose and passes across the dorsum as an aponeurosis continuous with its fellow, compressing the nasal aperture. The procerus and the levator labii superioris alaeque nasi contribute at the root and the alar base respectively.

Nefertiti lift: the neck and jawline treatment

Sat, 30 May 2026 00:00:00 +0000

The Nefertiti lift is a descriptive name for a pattern of botulinum toxin placement along the upper platysma and the lower mandibular border, intended to sharpen the definition of the jawline. The name refers to the sculpted jaw of the well-known bust; the technique itself rests on a straightforward antagonist argument.

Relevant anatomy

The platysma is a broad, thin sheet of muscle in the superficial cervical fascia, arising from the fascia over pectoralis major and deltoid, ascending the neck and inserting into the mandible, the modiolus, the lower lip depressors and the skin of the lower face. Its fibres decussate variably across the midline; anatomical studies describe several patterns of decussation, which is part of why banding presents so differently between individuals.

Smokers lines and perioral rhytids

Sat, 09 May 2026 00:00:00 +0000

Perioral rhytids — the vertical lines radiating from the vermilion border, colloquially and inaccurately called smokers’ lines — arise from the interaction of repeated sphincteric contraction, dermal thinning, photodamage and loss of underlying support. Smoking accelerates them but is not required to produce them; they occur in lifelong non-smokers and are strongly associated with sun exposure and with skin phototype.

The muscles around the lip

Orbicularis oris is the sphincter itself, encircling the mouth. Into it insert the muscles that move the lip, and one of them answers a question that comes up constantly: the muscle that surrounds the upper lip, elevates it and dilates the nostrils is the levator labii superioris alaeque nasi. Its name describes the action exactly: elevating the lip of the upper jaw while dilating the wing of the nose — the longest muscle name in the body, and the reason a gummy smile and a flaring nostril are related problems.

Hyperhidrosis treatment and cholinergic blockade

Fri, 24 Apr 2026 00:00:00 +0000

Primary focal hyperhidrosis is sweating in excess of thermoregulatory requirement, confined to discrete sites — most often the axillae, palms, soles and scalp — without an identifiable systemic cause. It is a functional and social problem rather than a cosmetic one, and its physiology explains why a neuromuscular agent is effective against a glandular complaint.

Relevant physiology

Eccrine sweat glands are innervated by postganglionic sympathetic fibres, but unlike most sympathetic effectors these fibres are cholinergic: they release acetylcholine onto muscarinic receptors on the glandular epithelium rather than noradrenaline. Botulinum toxin type A cleaves SNAP-25, a component of the SNARE complex required for vesicular release of acetylcholine at the presynaptic terminal. The block is therefore not specific to the neuromuscular junction; it applies to any cholinergic terminal the toxin reaches. Intradermal placement in a hyperhidrotic field interrupts acetylcholine release at the sudomotor terminals, and sweating in that field falls until terminals regenerate.

Hand rejuvenation using calcium hydroxylapatite

Mon, 06 Apr 2026 00:00:00 +0000

Calcium hydroxylapatite (CaHA) is a semi-permanent injectable consisting of synthetic microspheres suspended in an aqueous carboxymethylcellulose carrier gel. It behaves differently from hyaluronic acid in two ways that matter for the dorsal hand: it produces both immediate volume and a delayed stimulatory response, and it cannot be dissolved.

Dual mechanism

The carrier gel provides the volume seen at the point of treatment. Over subsequent weeks the gel is resorbed and the microspheres remain, acting as a scaffold around which fibroblast activity and neocollagenesis occur. The eventual result therefore reflects the tissue response rather than the material volume, and the appearance at treatment is not the appearance that persists. This time course is a source of confusion for both practitioner and patient, because early settling can be read as failure and later stimulation as delayed overcorrection.

Hand rejuvenation using hyaluronic acid

Fri, 13 Mar 2026 00:00:00 +0000

The dorsum of the hand ages differently from the face. The dominant change is loss of the subcutaneous fat layer that once concealed the extensor tendons, the dorsal venous network and the intermetacarpal spaces, combined with thinning and photodamage of overlying skin. The result is a surface in which the underlying structures are read directly, and the hand is one of the few areas where observers reliably estimate age independently of the face.

Downturned corners of the mouth and the DAO

Wed, 04 Mar 2026 00:00:00 +0000

A downturned oral commissure is one of the most commonly reported perceptual complaints in the lower face, because a mouth resting with the corners below the horizontal is read by observers as sadness or disapproval regardless of the mood of the person. The presentation is usually a combination of two things: active depression of the corner by muscle, and loss of the structural support that previously held the commissure and the tissue immediately lateral to it.

Chin filler and mentalis: projection and texture

Fri, 20 Feb 2026 00:00:00 +0000

The chin presents two distinct concerns that are frequently conflated in assessment. The first is skeletal and soft tissue projection: how far the chin point sits forward relative to the lips and the mandibular border, and how that reads in profile. The second is surface texture: the pitted, dimpled or “cobblestoned” appearance of the chin pad at rest or on animation. These have different anatomical causes and respond to different classes of intervention, and treating one when the presenting complaint is the other is a common source of disappointment.

Frown lines and the glabellar complex

Sat, 14 Feb 2026 00:00:00 +0000

The glabella is the region between the eyebrows, above the root of the nose. Vertical and transverse lines here are produced by repeated contraction of a small muscular complex, and the area is treated more often than almost any other in aesthetic practice. It is also the most dangerous single region on the face for injected material, and those two facts sit uncomfortably together.

Relevant anatomy

The corrugator supercilii arises from the medial supraorbital rim and passes superolaterally to insert into the dermis of the mid-brow, drawing the brows medially and downward and producing the vertical lines. The procerus runs from the nasal bones and upper lateral cartilage to the skin of the lower forehead, pulling the medial brow down and creating the transverse line across the root of the nose. Depressor supercilii and the medial fibres of orbicularis oculi contribute further depression, and frontalis opposes all of them.