Common Conditions – How We Can Help



Acne is a common but potentially distressing condition. Boils, open and infected pores show on the face, back and shoulders and can leave scars, redness and pigmentation. The delicate balance of skin microflora changes in favour of oil-metabolising bacteria (Cutibacterium/Proprionobacterium acnes) which infect the pores and sebum glands causing them to become red, inflamed, pus-filled, unsightly and painful. Acne is common at times of hormonal changes but can also occur for seemingly no reason. Underlying stress, trauma, frustration, indignation and anger can also show as acne.

Successful treatment of acne relies on dealing with all the underlying causes; oily skin/excess sebum, inefficient exfoliation, altered skin microflora, hormonal imbalance and mental/emotional status. 

There is increasing evidence that a disturbed intestinal microflora can contribute to acne and other skin conditions. A nutritional consultation can reveal some hidden factors that could be modified for a more stable skin quality.  A pro-inflammatory state caused by the diet can also lead to acne and other skin conditions. Such a pro-inflammatory state can be revealed by careful questioning and if necessary a skin prick blood test. Reducing the inflammation is key to controlling all skin breakouts and this is quite possible with nutritional input. 

Skin care products are the mainstay of sebum regulation and healthy microflora establishment. Stronger products such as peeling and anti-sebum 5ALA can be used. Homeopathic remedies can be used to reduce the effect of mental/emotional troubles on the skin. Dietary changes will reduce the levels of inflammation; supplements can rebalance the skin flora, hormone status, fend off bacteria and strengthen the skin barrier. 

High powered blue light is naturally antibacterial and specifically targets the acne-causing bacteria. 

Complete the treatment with soothing visible red light LED to repair the skin, settle the microflora and stimulate healing.

Treatments for acne

Skin care products reduce sebum production, stabilise the microflora, reduce damage and inflammation.

Peeling reduces surface dead cells on which the acne thrives. Peeling also improves skin quality, complexion and microflora.

5ALA reduces sebum production

Blue light reduces acne inducing bacteria on the skin and in the deeper glands.

Visible red light energises the healing process.

Near infra-red light repairs the underlying support tissues collagen and elastin and reduces inflammation.

A combination of some or all of these treatments over time will achieve the best results. 


Acne can leave scars, as can chicken pox, trauma, damage and surgical interventions. With time the scars tighten, pull on the skin and can distract from the beauty of the face. Shallow scars are easier to treat than so-called ice-pick scars; scars that are tethered to the base of the skin by fibrous adhesions. Any treatment for scars can take time but the good news is that once the skin is healed, it is healed and the scars do not return. 

Treatments for scars

Shallow scars respond well to microneedling, RF microneedling, filler injections, PRP, Plenhyage and peeling. 

Ice-pick scars may need a stronger intervention such as needle subscision. 

Age spots

Should be called “sun spots” since UV exposure is the root cause. Any treatment that removes sun damage can be used to reduce sunspots, such as electrocautery and deeper peeling.

Treatment for age spots

Any treatment that reduces sun damage will reduce age spots in general. Specific treatments include spot peeling or electrocautery.

Sun damage

UVA, UVB and UVC from the sun damage the skin. UVA degrades the underlying collagen and elastic fibres, causing sagging or thickened skin, loss of elasticity, loss of luminescence, pigment changes and open pores. UVB causes the skin to burn creating redness and dilated blood vessels and damages the all-important DNA. UVB is responsible for most non-melanoma skin cancers such as basal cell carcinoma and squamous cell carcinoma.

Early signs of sun damage are freckles, fine lines, complexion changes and open pores. Different skin types respond differently to UV exposure. Even within similar skin types and populations the results of sun damage can be very different. 

Treating sundamage literally turns back the clock. Peeling with gentle naturally-occurring acids such as glycolic, mandelic or azelaic acid slowly exfoliates the skin and stimulates new skin growth. Peeling using medium-depth agents such as TCA will create more of a shock to the skin with more exfoliation but increased new skin growth, skin renewal and tightening. 

Deeper coloured skin types are more fragile. Abnormal pigmentation becomes more of an issue and treatment must be gentle. Skin preparation is essential and the peeling products must be carefully selected. Cosmelan peeling is good for darker types of skin as it contains many pigment stabilising compounds. 

The Dermalux Tri-Wave is an ideal treatment for sundamage as it is non-invasive, pleasant, suitable for most people and totally natural. The healing wavelengths are directed at the skin cells and the underlying support tissues collagen and elastin. The treatment also reduces inflammation which we now understand to be the major causative factor in skin ageing.


We talk loosely of “pigmentation” but it is important to define exactly what we mean. Pigmented spots “sun-spots” or age spots are due to excess sun exposure and occur as dark brown slowly enlarging flattish spots on the face and hands. Sometimes they hide something more sinister; early melanoma so it is important to get these checked out. Don’t remove spots without knowing what they are. Dr Elisabeth Dancey is trained in the use of the dermatoscope so can help identify any nasties. 

Other types of pigmentation occur after direct skin trauma, skin irritation, UV light or excess female hormone at life events such as pregnancy, taking HRT or the oral contraceptive. This type of pigmentation suggests a sensitivity of the pigment-making cells, directing us to a different kind of peeling treatment that aims to calm down the excitability of the pigment cells first and then reduce the visible effects. Gentle peeling combined with naturally-occurring anti-pigment agents such as Arbutin will help over time. We combine gentle peeling with Cosmelan 2 cream for a gentle approach; other stronger approaches would be the Cosmelan peel or the Perfect peel. 

Because the pigment making cells, the melanocytes, are sensitive to the UV light any pigment control treatments need to be followed by constant and consistent sun avoidance. This means avoiding exposure to the sun on the whole body, not just the face. Eventually the melanocytes will settle down, but this may take a full year.

Uneven skin tone

This is a common complaint mostly because it is an early sign of sun damage. Irregular pigmentation, freckles and possibly small visible veins mar a perfect complexion. Gentle peeling, microneedling, RF microneedling, Plenhyage, PRP and fractional skin resurfacing will help to reduce the blemishes.

For those that really don’t want any medical intervention, the Libi and Daughters facial and follow-up products will even skin tone, refresh the skin and achieve results similar if not equal to medical interventions. Libi and Daughters products are 100% natural and are based on age-old remedies combined with modern dermatological ideas and understanding. 

Skin care and sun avoidance will ensure that the results are maintained.

Dull skin

Dull skin lacks lustre. Normal healthy epidermal skin cells are flat and shed themselves regularly. Like an expensive paint they create a flat matt surface to the skin that absorbs the light giving a soft peachy complexion, the pink coming from a healthy blood supply. When the epidermis has ruffles, dry bits, areas of poor exfoliation, lines and wrinkles the light pattern changes and the skin appears dull. Underlying veins cause more redness, or less redness and we describe our skin as dull. 

Dull skin is often due to poor environment, sun damage, poor skin care routines including over and under-exfoliation, poor diet, excess sugar, smoking or a general unhappiness in the skin itself highlighting a need for intervention. It also occurs with age.

Underlying nutrition, lifestyle and emotions will help physical interventions such as peeling, microneedling, RF microneedling, fractional skin resurfacing, platelet-rich plasma, profhilo, nutritional mesotherapy and plenhyage. 

For those that really don’t want any medical intervention, the Libi and Daughters facial and follow-up products will even skin tone, refresh the skin and achieve results similar if not equal to medical interventions. Libi and Daughters products are 100% natural and are based on age-old remedies combined with modern dermatological ideas and understanding. 

Dry skin

In general dry skin is old skin. Aging skin does not exfoliate in a healthy manner; the dead epidermal cells linger on the skin and give the appearance and sensation of dryness. Dryness causes irritation owing to the extra layer of dead skin that can attract an unhealthy skin flora. Redness around the nostrils and eye area often accompanies dry skin. Dry skin responds to exfoliation and nourishment of the skin (gentle peeling, nutritional mesotherapy, NCTF, skin care products). Profhilo is a specific non-cross linked hyaluronic acid designed to spread uniformly under the skin providing hydration and glow. 

Dry skin can be associated with lack of essential oils getting to the skin layers. A diet rich in omega 3 (flax seed oil, fish oil) will help when combined with reduction of pro-inflammatory oils in the diet (vegetable oils, margarine, pastries, cakes and biscuits). 

A nutritional consultation supported by blood tests to reveal the fatty acid status will form the basis of a skin care programme. Sometimes all is needed is to change the diet.

Dry skin can also be part of an eczema or allergy picture. Dietary changes can help as can homeopathic remedies when carefully selected. Elimination of dust, house dust mite, pollens and mould from the home can also be of tremendous value.

For those that really don’t want any medical intervention, the Libi and Daughters facial and follow-up products will even skin tone, exfoliate and hydrate the skin and achieve results similar if not equal to medical interventions. Libi and Daughters products are 100% natural and are based on age-old remedies combined with modern dermatological ideas and understanding. 

Enlarged pores

Enlarged pores are usually due to skin laxity associated with the ageing process. They can also be due to over-enthusiastic poking and prodding of the skin. Sometimes they block with black or whiteheads asking for extraction – only to make the issue worse. These can be treated by medical means of extraction and skin stimulation; gentle peeling, fractional skin resurfacing. 

For those that really don’t want any medical intervention, the Libi and Daughters facial and follow-up products will even skin tone, close pores, exfoliate and hydrate the skin and achieve results similar if not equal to medical interventions. Libi and Daughters products are 100% natural and are based on age-old remedies combined with modern dermatological ideas and understanding. 

Blackheads/Keratosis pilaris

Blackheads are open pores that have become filled with cellular debris. Whilst it is tempting to pick them, a chemical exfoliator applied regularly will achieve better long-term results. Salicylic acid peeling or salicylic based skin care products are our choice. The recent introduciton of Glyco ALA has allowed us to reduce oiliness of the skin and specifically reduce blackheads.


Milia contain little blobs of keratin and sebum and can appear on the face for no reason. Sometimes they occur after surgery or peeling. Some people are more prone to milia, especially those that touch their faces a lot, perhaps spreading dead skin or blocking the pores. In truth we don’t really know. Beauty therapists have a tool that easily removes them. We can remove them as part of any treatment that we perform. 

Excessive perspiration (hyperhidrosis)

We perspire to cool down, and when we do so we don’t find that offensive. It is when we perspire under conditions of stress, anxiety or pain that it becomes unpleasant. The content of the sweat changes altogether.

Neurologists noted that when the nerve supply of any part of the body is blocked the skin becomes dry. It doesn’t sweat. The sweat glands just don’t work. Botulinum toxin acts in the same way but can be carefully placed exactly where the sweating is undesirable; mostly the armpits. 

Hidradenitis suppurativa

Hidradenitis suppurativa, a form of excess sweating with boils and pus can also be relieved by botulinum toxin.

A healthy intestinal flora also reduces the inflammatory load on the skin and moist areas and has been proven to be beneficial in reducing hidranedenitis suppurativa. Checking the diet and inflammatory status will help the underlying factors in this distressing condition and achieve a result.

 Loss of facial volume

Volume loss is part of the ageing process. Ageing can be modified; ageing is accelerated by insults on the body from which it cannot repair such as smoking, sun damage, excess dieting, weight loss, illness, stress, over-activity. The damaging effects are due to free radicals which can be modified by attention to diet, nutrition, relaxation techniques and various therapies. Ideally we maintain a stable weight throughout our lives, since the weight on the face is very sensitive to weight loss and is difficult to replace naturally without gaining on the body.

Young looking faces reflect the light in a uniform manner from the cheeks and the forehead. There is no light scatter. There is a brightness around the eyes and upper face. As the volume diminishes the light is reflected differently, there is more scatter and less light emanating from the upper part of the face and the eyes. 

Furthermore facial volume is accentuated towards the upper parts of the face; the forehead, eyes, cheeks. This gives a harmonious look represented in the arts ancient and modern, sculptures, paintings, pin-ups and caricatures.

Tired eyes, saggy face, loss of the cheeks, nose to mouth lines and eye hollows are all due to volume loss. The general “tired look” is due to volume loss. The sagging skin creates harsh shadows on the face which break up the uniform light reflection and interfere with the general roundness and softness of the facial curves.  

Volume loss can be replaced by volumising techniques. We use hyaluronic acid fillers that replace lost volume or we can use collagen-stimulating fillers that help create new, longer-term, volume. Volume replacement fillers are made from naturally-occurring non-animal derived hyaluronic acid. Products that help re-create lost volume are made from products known to stimulate new collagen and have been used in medicine for many years, often in other disciplines. 

Volume replacement is probably the best anti-ageing treatment that you can chose.


Melasma is hormone-related pigmentation on the face. It is invariably symmetrical around the mouth, on the cheeks and forehead and appears in pregnancy or associated with use of hormone such as the contraceptive pill or HRT. UV exposure causes the sensitised melanocytes to create pigment in an abnormal, clustered manner that appears as a dark mark, stain or unsightly mask on the face. Stress can also be an underlying cause of melasma owing to its effect on hormone metabolism. 

Melasma responds to a mixture of gentle but sustained stabilisation of the melanocytes through specific peeling protocols such as Cosmelan and the Perfect Peel. Maintenance of the results depends on sun avoidance on the whole body for whole season. 

Skin care products that contain plant-based pigment stabilising agents and gentle peeling products also work over a period of time. 

Turkey neck

The skin of the neck can show our age more than our face. Turkey neck refers to the saggy, scraggy excess skin on the neck. This can be due to volume loss but also to excess ageing on the skin of the neck. Sundamage and smoking are the main causes, but oestrogen loss with age is also a major contributor. 

Treatments aim to improve both volume and quality of the skin. A combination of treatments will achieve better results. Improve the skin with microneedling, Exilis RF, RF miconeedling, Plenhyage, peeling, Profhilo, nutritional mesotherapy. Also look at the volume of the face. Sometimes adding volume to the jawline helps to pull up the neck. 

Chin augmentation/weak chin

The chin is an important feature of the face in both men and women. Sometimes we are not endowed with a strong chin. As we age the jawbone recedes making the chin shrink and a horizontal line appear. Walnut chin, dimples and marionette lines are all features of a receding jawline.

Fillers can replace the volume lost into the chin and can reshape the chin where necessary. By adding volume the quality of skin is also improved, reducing fine lines, pores and crinkles (walnut chin). Chin fillers are suitable for all ages to enhance the natural curve of the face.

Jawline rejuvenation

A strong jawline in both men and women that separates the face from the neck is a sign of youth and beauty dating back to Egyptian times. Facial volume loss, alteration in the shape of the jaw bone and skin sagging all contribute to a less well-defined jawline. Treatments aimed at replenishing facial volume in general such as hyaluronic acid fillers and collagen stimulating fillers will help the balance of the face as a whole. More specific fillers aimed at the jawline can restore the shape of the jawbone especially the angle of the jaw and enhance the sharpness of the jawline.  

Treatments aimed at improving elasticity of the facial tissues and reducing laxity of the skin, such as Exilis RF, RF microneedling and nutritional mesotherapy will also help.

Botulinum toxin can relax the tight neck muscles and allow the skin to fall back onto the neck, giving a tighter jawline. 

The Libi and Daughters facial is an anatomical treatment and will relax the muscles and fascia in the neck, jawline and surrounding tissues to help achieve a return to normal jawline. You’ll be amazed how much stress and muscular tension contributes to the quality of the jaw. 

Neck lines

Horizontal neck lines occur when the neck bends; the problem is that the lines remain even when the neck is not bent! These can be treated with a very gentle filler; one that also helps to restore the natural condition of the skin over time. The non-cross-linked HA called MHA 10 is the ideal treatment for neck lines. Profhilo can also achieve a good result in the neck. Exilis RF energy stimulates collagen synthesis and tightens the skin with RF a non-injection treatment.


Jowls are due to a combination of facial volume changes (loss and redistribution) and skin/tissue laxity. Facial volume loss means that the skin of the face is no longer properly supported and begins to sag. As the skin itself loses laxity and elasticity the skin tends to stretch and contribute to the jowls. Volume replacement is the mainstay of treatment but should be combined with treatments that restore skin and tissue elasticity.

Volume replacement will improve jowls: straightforward hyaluronic acid fillers for a fast fix but also collagen stimulating injections such as radiesse or lanluma for longer-lasting volume and tissue quality enhancement. Microneedling, medium depth chemical peeling, Exilis RF,  RF microneedling, nutritional mesotherapy and fractional resurfacing will improve skin laxity. 

Threading can also lift the face successfully. Silhouette threads lift the tissues thanks to their “cogs” and stimulate new collagen thanks to the unique composition of the cogs. Some volume replacement may be necessary to help lift the face before the threads are inserted. 

Heavy jowls can have a fatty component. In this case we can reduce the fat and the fat of the chin with the Cutera Tru-Sculpt ID device or the Exilis RF device. The less fat around the jawline then the easier it is to lift the jowls.

Teeth grinding

Frequently due to stress or a busy brain at night-time the masseter muscle overworks and grinds the teeth. Headaches and jaw ache can result. Sometimes the dentist will notice changes to the teeth as a result of being overworked. The masseter muscle itself can become bigger and stronger (hypertrophy), creating a stronger or square jaw and disturb the look of the lower face. 

Botulinum toxin relaxes the muscle, reduces the power and bulk of the muscle thus improving the jawline silhouette and freeing the teeth from constant grinding. In relaxing the muscles, the subconscious desire to grind will reduce and the problem resolve over time. Teeth grinding is a sign of stress; reduction by means of relaxation, yoga, meditation or simply reducing the workload will benefit your general health. 

Eye Bags

The skin under and around the eyes is delicate and easily damaged by UV light, stretching, trauma and free radicals. At a deeper level the fat pads surrounding and protecting the orbits are also fragile and easily become displaced and distorted. The pads slip forwards and downwards, creating eye bags. 

The eye area is also well-served with delicate lymph vessels which remove tissue fluid. These, too, are fragile and can easily become overwhelmed by free radicals, stress, trauma, dietary indiscretions, alcohol, chemicals, allergens, insufficient sleep, computer and screen usage, eye strain and sun damage. Gradual build-up of fluid is seen under the eyes appearing as eye bags. 

Since eye bags are frequently a combination of fluid, fat and lax skin the treatment approach has to be tailored to the individual.  Improving skin laxity with RF microneedling, nutritional mesotherapy and peeling is gentle and safe for such a delicate area. Results will be gradual and subtle. Manual lymph drainage stimulates fluid removal from the area and will help to reduce fluid retention over time. The Exilis RF device works well for eye bags, crepey eyes and also help to lift and open the eyes in a no-injection treatment. 

Skin redness

Veins in the face are normally not visible but contribute to the peachy complexion in an attractive way. However these veins can become dilated and sensitive due to sun exposure, chemicals, environmental trauma, infection and dietary components. As a result the face, the cheeks, nose or chin can be particularly red or prone to flushing. 

Treatment is aimed to reduce the size of the vessels by light base therapies and then deal with the underlying sensitivity. Evidence is increasing that altered gut microflora can exacerbate or even cause facial redness and flushing, which can be treated with dietary alteration and microbiology support. Infection of the skin such as rosacea or acne can also be a cause of redness; skin care treatments and visible red light LED will be of value. 

Our new Dermalux Tri Wave provides thess essential light wavelengths that address all the features of red veins. Near Infra-red light reduces inflammation and tones the blood vessel walls. Visible red light enhances skin healing and returns the skin to a healthy metabolism. Blue light is a naturally anti-bacterial light that acts on the bacteria that cause acne and rosacea. 

Redness and rosacea can have an underlying nutritional component which can be investigated by our Nutritional team.


This is a specific microbiological disturbance of the skin resulting in redness, whiteheads and spots. There is frequently a crossover between the causes of generalised redness and rosacea; sun exposure, free radicals, altered gut microflora, chemicals and diet being the main aggressors. Treatment relies on maintaining a healthy skin flora, reducing the sensitivity of the veins and dealing with the underlying cause. Skin care products containing azelaic acid are particularly useful in rosacea, as is gentle peeling and red light LED. 

Our new Dermalux Tri Wave provides these essential light wavelengths that address all the features of red veins. Near Infra-red light reduces inflammation and tones the blood vessel walls. Visible red light enhances skin healing and returns the skin to a more healthy metabolism. Blue light is a naturally anti-bacterial light that acts on the bacteria that cause acne and rosacea.


Nasolabial folds

Depending on the shape of the face, the manner in which the face moves and the distribution of fat we can develop nasolabial folds. The smiling gesture works the skin in the same area creating a dynamic line in the skin. With time various effects such as volume loss and skin laxity exacerbate the lines. Gradual sinking of the skin and facial tissues can make the nasolabial lines deeper and less attractive. 

Treatment of the nasolabial folds is aimed at restoring the facial volume using volumising or collagen-creating fillers. These can be placed directly in the line in the early stages. However once a fold has developed the facial tissues need to be elevated with fillers in the cheeks and lateral face. 

We must not overdo the volume and risk altering the face simply to reduce lines. Sometimes we need to add other lifting techniques such as Silhouette threading or Exilis RF, RF microneedling to lift the face and open out the nasolabial folds.

RF microneedling tightens and improves the skin quality, thereby reducing laxity of the skin. RF microneedling can be combined with Silhouette Soft and fillers. The results will take time to show, but they will be natural and durable. The Exilis RF device offers good results without the need for injection or threads, but will take a few months to show.

Premature ageing

Isn’t all ageing premature? There is a level of inherent ageing to everything living and non-living. Our job is not only to minimise the ageing process but to protect and enhance all aspects of your physical being. Ageing shows itself as volume loss, skin laxity changes, skin quality changes, deteriorating complexion, red veins, lumps and bumps, marks and stains. 

Some of the cause is external, or extrinsic ageing, for example UV exposure, smoking, environmental trauma and pollution. Our understanding is now that we also have internal sources of ageing, or intrinsic ageing such as inadequate or inappropriate diet, trauma and stress. Our inheritance counts for less than we thought; perhaps 20%. These factors can also be addressed using a wide range of techniques such as nutrition, supplementation, homeopathy, herbal, Chinese and Ayurvedic medicine. A holistic consultation can lead to some lifestyle changes that will help you get the best out of your life – and looks.


Wrinkles or fine lines develop where the skin is subject to movement and can be dynamic (visible during the period of movement) or static (visible at all times). The more mobile the skin is, the more likely to develop lines and wrinkles. 

Treatment is aimed at reducing the movement that creates the line (for example Botulinum toxin for crows’ feet and frown areas), by improving the skin quality (NCTF nutritional mesotherapy)  or by filling the lines with a soft hyaluronic acid filler. 

The other issue in lines and wrinkles is the loss of support of the skin, in other words volume loss. As facial volume decreases the support to the skin reduces and the skin crinkles more readily. This is almost universal. Treatment is therefore to support the skin again by replacing the lost volume, such as hyaluronic acid fillers or fillers that naturally help create your own collagen.

Crows’ feet 

These are the fine lines around the eyes that appear when we smile. Sometimes they can embellish the face but other times not. They may begin as dynamic lines due to the movement of the muscle around the eye but with time they can become embedded into the skin as it ages and deteriorates. Botulinum toxin is the mainstay of treatment for Crows’ feet since it can stop the muscle movement around the eye without altering the smile. Any treatment that improves skin condition will also help the lines: nutritional mesotherapy, peeling, skin care products, Exilis RF and RF microneedling. 

Age-related volume loss around the eye also causes crows’ feet. Less support of the tissues permits the skin to crinkle. The eye area is so sensitive to volume loss so any age changes are invariably noticed here, first. 

Fine lines

Also known as wrinkles, fine lines develop where the skin is being moved, bent or folded over  like a crease in a piece of fabric. Lines develop gradually over time and can be more evident on the side of sleeping or where movement is more pronounced. Any weakness in the skin can be the fulcrum for a line; scars from childhood, trauma or surgery, facial volume loss from tooth loss, acne and chickenpox scars. 

Treatment of fine lines is directed at limiting the cause; movement, volume loss or improving the quality of the skin. Botulinum toxin, volumising fillers, nutritional mesotherapy with NCTF, Exilis RF and RF microneedling will all help fine lines.  

Forehead lines

Horizontal and vertical lines on the forehead are due to excess movement – raising our eyebrows.. As we age we also lose the volume in the forehead making all lines more prominent. Botulinum toxin is the treatment of choice for both vertical and horizontal lines. With time, complete removal of horizontal lines may not be achievable as there is a risk of the forehead becoming heavy. We also need to be careful when treating men; they, too, can risk heavy foreheads from indiscriminate Botulinum toxin. 

Dark circles under eyes

The skin under the eyes is a fragile area and suffers from a delicate circulation and lymphatic system. It is prone to any minor irritation or dysfunction in the circulation or lymphatic drainage of the eyes.

Having nourished and oxygenated the skin and underlying tissues deoxygenated blood returns to the general circulation via the small veins. If these are under-working, as can be the effect of stress, fatigue, eye strain, dietary indiscretion, then the red blood cells can break down to release their iron-based blood pigments. These are blue-grey- brown, just like a bruise, and can stain the delicate skin, giving the under-eye area a dark appearance. Because of the anatomy of the under eye area the dark area is well identified; the lower margins of the skin are attached to a ligament that clearly defines the orbit and creates the outline of the dark circle. 

Manual lymph drainage will improve the removal of fluid and blood cells from under the eyes. Nutritional mesotherapy will improve the skin quality and dissolve the iron pigment. Skin care products rich in vitamin C will reduce skin staining; added growth factors help to thicken the skin. As usual a combination of treatments will provide the best results.

Sagging skin

Sagging skin can be due to a loss of support or the stretching/loss of elasticity of the skin itself. As facial volume diminishes the level of support diminishes, since it is the volume that is literally holding the face out. Loss of volume means that there appears to be excess skin, which has a tendency to sag. Equally if the skin is stretched/less elastic, through sun damage or ageing, it will have a tendency to sag. Usually volume loss occurs first; early sagging can be treated by replacing lost facial volume with fillers. As time goes on facial volume loss can be complicated by loss of skin elasticity and increased stretchiness, exacerbating the sagging appearance. At this stage a combination of facial volumising fillers and techniques that restore skin quality such as peeling, Exilis RF, RF microneedling and fractional resurfacing will also help to reduce sagging.

Silhouette Soft threads also have an important part to play by lifting and repositioning the tissues and skin of the face without adding volume. 

 Double chin

Fatty deposits under the chin give us a double chin. Monopolar RF energy such as the Tru Sculpt ID device will reduce and remove unwanted fat and tighten the skin. Whilst the Tru Sculpt is a powerful focussed device, the Exilis 360 provides a more generalised result.

It is becoming apparent that the double chin is yet another feature of premature ageing associated with intake of vegetable fats, sugars and artificial products such as those found in fast food, take-aways, packaged food and restaurant foods cooked in vegetable oils. Nutritional advice will steer you in the right direction towards a healthy food intake and a younger-looking jawline.

Marionette lines / mouth corners

The mouth and chin develop differently from the sides of the face and are bound on both sides by a retaining ligament.  Since ageing is the reverse of development we observe that the two areas behave differently. The chin and mouth area remains somewhat static whilst the sides of the face tend to slump on either side, creating mouth corners and ultimately marionette lines, demarcated by the ligaments and muscles either side of the mouth.

Any treatment has to address the sag of the sides of the face (due to volume loss) and the action of the llgament and the downward-pulling muscles. A combination of volumising fillers for the upper face, Silhouette soft for lifting and repositioning the upper face, botulinum toxin for the lower facial muscles and filler into the ligamentous area will all help to soften the look. Sometimes adding volume to the angle of the jaw will also help to pull back the tissue of the sides of the face and lessen the marionette lines. 

Thin lips

There’s nothing wrong with thin lips, just that fuller lips are considered more attractive. Being hormone sensitive they represent youth, fertility and femininity. With age, sun exposure, smoking, free radical damage and the loss of oestrogen they can become thin, lax and less well defined. They can also become dry.  Hyaluronic acid lip fillers are now so sophisticated that you can chose the results you desire – fleshy, well-defined, subtle, natural or something a bit more noticeable… We prefer to remain natural so use gentle fillers that don’t show.

Gaunt cheeks 

Gaunt, drained, washed-out cheeks are a sure sign of facial volume loss, which respond well to adequate volume replacement with fillers. Sometimes lifting threads such as Silhouette Soft can be of value in repositioning the facial tissues.

Facial volume loss

Loss of volume in the face is part of the ageing process and can be accelerated by weight loss, smoking, disease, damage, stress and other free-radical-generating events. 

The amount of volume that we lose is quite substantial over the years – up to 30ml – and the end result on the face compounded by other changes in the face such as skeletal and muscular changes. 

Fillers can replace much of the volume loss. Fillers can be either hyaluronic acid which is a simple, natural replacement treatment or collagen-stimulating fillers that aim to regenerate your own tissue and stimulate new collagen. Exactly which filler we use depends on your age, your desires and the long-term plans that you have for maintaining your appearance. 

Wrinkles on the chest 

The skin of the decollete area is fine and catches the sun as easily as the face. With less padding of fat the chest shows lines, wrinkles and pigmentation easily. In the same way that we treat the face we can treat the face; fillers, nutritional mesotherapy, skin care products.

The Exilis Ultra 360 is a non-invasive RF based device also recommended for reduction of lines and wrinkles on the chest. 


The hands reflect our age more than we dare think. Sun damage shows as brown spots and wrinkly skin. Brown spots respond to electrocautery. Wrinkly skin responds to skin fillers such as Juvederm Volite. Deeper levels of volume loss respond to classical fillers such as Juvederm Voluma.

Hair loss

Our hair is the crown that we never take off. When it falls out, thins or loses quality we are desperate for a solution. We have a bad hair day. Hair is a very active tissue and requires a lot of nutrients for support. It also reflects our emotional state and responds to a change in emotions and feelings. Loss or grief can cause hair loss; anger can cause itchy scalps, stress plays a strong part in hair abnormalities. 

Treatments must address the basic nutritional element identified ideally by a nutritional consultation. Diet and supplements always help as do nutritional injections into the scalp (nutritional mesotherapy). Stimulating treatments aim to wake the hair follicle up; regenerative treatments such as Platelet Rich Plasma (PRP), Plenhyage and Dermalux Tri-Wave visible red light LED. 

Dealing with the emotional aspect can also unblock the healing channels using homeopathy, relaxation techniques or acupuncture, for example.

Moles, lumps and bumps

Most moles, lumps and bumps can be diagnosed using a dermatoscope, a hand-help magnifying device that enables us to identify the nature of the lesion. Most lesions are benign, but it is always worth checking them out and Dr Dancey will do this without charge as part of a consultation or treatment. Any lesions that you don’t like and are benign can be shaved off, such as warts, sebaceous keratoses (dry aging spots), small moles. Flat lesions such as brown marks and sun spots can be peeled off using electrocautery. 

Lesions that are potentially nasty can be referred back to your GP or to a specialist. 

Fluid retention/ puffy eyes

Fluid retention around the eye is a common complaint and may be associated with chemicals, eye strain, bacterial infection, poor diet or fatigue. Most times we are unable to identify the case. 

Manual lymph drainage is a gentle medical massage technique that respects the fragile nature of the under-eye skin and the delicate array of lymph vessels and will reduce fluid retention. Manual Lymph drainage can be used for swelling caused by fluid retention in any part of the body. 


Migraines or headaches can be due to intense muscle activity in the muscles of the head and face. Frowning, eyebrow raising, eye squinting, poor computer posture, jaw clenching are all potential causes of headaches or migraines and can be reduced or removed by relaxing the muscles. Botulinum toxin relaxes muscles and can be beneficial in reducing migraines, headaches and jaw clenching.

Jaw clenching

Stress can be transferred to the jaw; clenching the masseter muscle 24 hours a day can create pain in the face. Such over-activity can also wear down the teeth and bulk up the lower part of the face.

Botulinum toxin will reduce the power and bulk of the muscle but permit normal chewing activity. This simple intervention reduces pain, headaches, migraines, protects the teeth and reduces the square jaw often seen in persistent jaw clenchers.

Square jaw

Stress can be transferred to the jaw; clenching the masseter muscle 24 hours a day can create pain in the face. Such over-activity can also wear down the teeth and bulk up the lower part of the face.

Botulinum toxin will reduce the power and bulk of the muscle but permit normal chewing activity. This simple intervention reduces pain, headaches, migraines, protects the teeth and reduces the square jaw often seen in persistent jaw clenchers.

Skin Laxity

This is our number one request – to reduce the crepey appearance of skin as we age. A combination of skin ageing through sun exposure, natural elastin and collagen deterioration and a gradual loss of volume from the hypodermis causes the skin to look and feel old and crinkly. 

Radiofrequency energy stimulates the creation of new collagen and elastin tissue, tightens existing support tissues and improves the blood supply to the skin. Four treatments from the Exilis Ultra 360 device will help to improve the skin quality and appearance. Best results are seen at three months.

As will all skin improvement treatments a good quality diet rich in collagen-building protein (free-range organic animal remains the best protein), protective vitamins, minerals and plant-derived anti-oxidants together with omega 3 oils will help achieve the best results. Avoiding pro-inflammatory and hence destructive pastimes such as smoking, sun exposure, stress, junk food and self-neglect will also help.