Aesthetic Procedures - What holds people back?

Are you quietly interested But have worries? read on

Deciding what, if anything to do with your face, is a little bit daunting. There are a myriad of options: laser, fillers, Toxins, peels, face creams, the list is exhausting. On top of that, with the proliferation of information sources, you can't be sure what you are reading is true. There is a lot of fake news. Sometimes two fake news stories saying the exact opposite of each other. Once you have decided what to do, you then are bombarded with a choice of products and practitioners and a menu of prices.

It all boils down to trust. Do you trust the Doctors experience, training and aesthetic eye.

One size does not fit all.  Just because a person can wield a needle doesn't mean you should let them. Also, you tend to get what you pay for.

Do any of these things sound like you?

  • I don't want to look significantly younger or appear to covet youth
  • I have been thinking or will think about this for up to 10 years
  • I am confused and concerned by media stories about treatments
  • I have a real fear I will no longer "look myself" after treatment 
  • I feel embarrassed about wanting treatment - I feel society will judge me as vain and superficial 

You are not alone. In fact, you are perfectly normal. There are millions just like you.

Allergan research shows us that 58.6 million people are interested in non-surgical aesthetic treatments (they counted...). In Ireland we are particularly interested. A recent study from Cork University Hospital (CUH) have discovered we lead the way globally for the number of online searches for lip-fillers, and are third overall for the number of people enquiring about Botox.

This interest in lip fillers is not particularly new, however, as according to Dr Ryan Sugrue, who worked on the study, Ireland has consistently been one of the top five countries searching for Botox and lip fillers since 2004.

While many Irish people are unsure about taking a big step into more significant cosmetic surgery procedures, it’s clear they are very interested in non-surgical facial rejuvenation options.

Yet, it has been found that only 9% of those interested actually go on to have treatment with a facial Injectable*. Only 9%...

Something is holding people back.

Research & Some answers

Allergan, the home of Botox, conducted in-depth consumer research, which revealed some fascinating insights about how people really feel about facial aesthetic treatments. It all boils down to ageing well while keeping expressiveness. See references.

An article in the Journal of Cosmetic Dermatology also revealed that patients' biggest fear was that treatment would cause a disconnect between what the face shows and how they feel inside - and make them lose their expressiveness.(3) Facial expressions convey emotions that form the foundation of interpersonal relationships, and many of these emotions are vital for our social linkages. Hence, the facial ageing analysis and the treatment plan must include knowledge of the facial dynamics and the emotional expressions of the face.

So there is definitely a theme. 

So what do Patients want?

Patients want to be thought of as 'aging well', so they will be less likely judged by society as appearing vain or attempting to be something they're not (2). The vast majority of patients desire natural looking results. But what does 'natural looking' mean for them? Well patients describe 'natural looking' results as subtle enhancements without noticeable modification. They request inconspicuous treatment that take into account their natural facial appearance and expressiveness. (3)

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What does this mean for you?

If all this sounds like you, you need to start thinking of this process as building a relationship with your practitioner. This relationship builds gradually to get you where you want to be. Finding the cheapest person to wield a needle filled with an unknown product is not for you.

Find a person who fits with you. Do they see you? Are they looking? Are they prepared to invest in this relationship? The goal is to look refreshed and rejuvenated as if you were naturally that way.

Check List for picking a Doctor

  • Does your doctor spend time analysing your face?
  • Does your Doctor understand what you are hoping for?
  • Is it a Doctor led clinic? i.e. who is actually doing the injecting once you are in the door?
  • Does your doctor manage your expectations? Have they an interest in your expectations? One size does not fit all. Beware of the practitioner who thinks its all about placing product by a generic formula.
  • Beware of clinics whose marketing materials use unrealistic models. These procedures help bring out the best in you but are no magic wand.
  • There are multiple excellent products from multiple companies like Teoxane, Merz and Allergan. Advances in technology and the FDA approvals process have introduced amazing new products. Don't insist on using old products because you are familiar with the brand. Different products are appropriate for different skin types and the different areas that need treatment. Go to a Doctor who has experience across all products and companies and will chose the best product for you.
  • Do you understand the products that are being used and why they are being used on you? (sometimes the cheapest offers are done using the cheapest products; just because the clinic says it's using Botox (for instance) doesn't mean they are using it on YOU). Price should not be the deciding factor for the doctor or for you when choosing what to get injected into your face.
  • Does your practice take comprehensive, skin-level, before-and-after photos? These are essential for developing a long term plan. They also are invaluable for the patients as often memory can be faulty ;-).
  • Is there a detailed paper trail of what product was used? In what amounts and where on your face was the product placed. Is this information available to you if you want it? This will show that the practice is invested in you and your long term treatment. Products, quantities, and areas can all be tweaked the next time you come in as you make a plan together with your doctor. This can't be done if the record keeping it lax/non-existant.
  • Is your doctor skilled at removing dermal filler if you don't like the result? Sometimes this happens. The result can be excellent but you might not like it. This can happen. The idea of big lips and the actuality of big lips can sometimes come as a shock no matter how prepared you are. Know that your Doctor is happy to, and capable of, reversing the procedure.
  • How much training and education has your Doctor had in the area? Look for constant up-skilling and training. This is a exciting, dynamic field and new products and techniques are always emerging. 

This should be a life-time relationship. You, your skin, your health, your diet, your lifestyle and your age will be in contact flux. Having someone in your corner who has seen and understands the progressive changes in your face will allow you to have the best and most appropriate treatments for you.


The dynamics of Facial expressions

Consideration of facial dynamics is critical with any facial treatment. The expressiveness of the face involves an interplay between the muscles of expression and movement of the soft tissues. Ageing can impact this expressiveness. (3) Understanding individual facial dynamics is crucial to retain the expressiveness of the face.

Correction of 'negative' expression should be balanced with maintenance of normal expressiveness of the face (3). With the onset of ageing changes in anatomical structures of the face can impose unwanted and inappropriate facial expressions that do not match the emotions of the individual, for instance older people can often look cross or sad when how they feel is very different. (3)

Every patient needs an individualised treatment plan.

  • Key correction points should under-pin the plan
  • Every aspect of the face should be taken into account
  • There is an appropriate result for each patient - this needs to be understood by the patient and the doctor.
  • The product chosen should be the correct one for the treatment plan, the patient and be suitable for the preservation of facial dynamics
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Fear of the frozen face

There are millions of people worldwide getting Toxins 3-4 times a year and Dermal Fillers 1-2 times a year. Most of these people look natural, healthy and fresh. Then there are the 'frozen ones'. Obviously they stick out as having had 'work' done and maybe it doesn't appeal to your aesthetic. You are not alone.

Why do people get the frozen faced look?

There are a couple of reasons. By accident or on purpose.

The first, and the one most often blamed is, the practitioner. One who doesn't know where to use the product and how much to use. For the first foray with a new patient it is best to under-treat and have the patient come back in two weeks for a tweak. Maybe the practitioner doesn't want to expend the effort or the time to layer the treatment? Maybe it is a clinic that does high-volume, low cost treatment and whether you come back or not is an after thought? This frozen face is presumed to be an accident.

The second reason is the patient. There are two types of  patient (from an aesthetics point of view).

1. The one who wants to look frozen. They want the maximum amount of botox. They want to see zero wrinkles. Natural expression is irrelevant to this patient. When a wrinkle emerges in 2 months, which physiologically is going to happen no matter how much Toxin was injected because it does wear off and expressions will emerge, the patient claims it didn't work and wants more. This can be a type of body dysmorphia and the practitioner needs to be careful and decide whether to continue to treat. Its is contra indicated to treat within 3 months of the last treatment as patients can build up an immunity to the toxin. This type of patient can become addicted to the frozen look and consequently will bounce around between doctors and clinics and follow special offers. Clearly, no relationship will be formed between Doctor and patient. Chasing a natural expression and a personalised plan are also irrelevant to this type of patient.

This is the most common cause of frozen face. This article is not for these people.

2. A little bit of knowledge is a dangerous thing. This patient gets frozen by accident. They usually insist that they need a heavy dose. They have had it done 'before', and/or they work in the industry/have a relation in the industry/have a friend who says; and will tell the Doctor exactly what to do. They need a heavy dose because they have a fast metabolism or it didn't work for them in the last clinic or it wore off too quickly. They assure the Doctor that they know exactly what they are talking about. However, this type of patient usually doesn't know what product was used previously, how it was mixed and how many units were used. 50 units of Botox, mixed correctly, positioned by an experienced practitioner freezes every muscle in their upper face. These patients are usually traumatised when they get exactly what they asked for. 

Lesson - trust the doctor to decide what is best and start gently with each new practitioner. Aesthetic practitioners aren't as interchangeable as socks.


Why LK Aesthetics?

The fashion in cosmetic skin treatments changes almost as often Over-filled lips and cheeks have now given way to a softer, more natural look. For this we are very grateful. The goal is to look refreshed and rejuvenated as if you were naturally that way. 

lips teoxane.jpg

Dr. Kelleher replaces the volume you have lost recently, not the volume you have lost in the past 40 years. Looking younger after treatments is still a goal but looking good for your age is vital.

Throughout the aging process, bone and fat pads under the skin that act as a scaffolding, start to thin. This leaves the skin to sag like a deflated balloon and appear drawn, tired and wrinkled. Every face ages in different ways. Some notice their cheeks flattening in their 30’s while others keep that desired “apple” roundness well into their 70’s. This is why customized consultations and treatments are essential. Dr. Kelleher, after the initial assessment, will pinpoint where to focus the rejuvenation that is right for you.

Age-related volume loss occurs in many areas of the face, cheeks, temples, tear troughs, lips and beneath the corners of the mouth. Dr. Kelleher injects dermal fillers to rejuvenate the whole face in a balanced, even way.  Different thickness fillers are needed in different areas, giving a natural correction all over.

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One method used to maintain a natural appearance is to first, re-build that lost scaffolding using a thick filler such as Teoxane Ultimate, Juvederm Voluma, or Radiesse. Then, if needed, plumping up the areas closer to the surface with thinner fillers such as Merz Balance, Restylane or Teosyal Global Action which will achieve softer, more refined results. Teoxane also has a range of RHA fillers that are more appropriate to the mobile areas of the face. Then there are specialised dermal fillers designed specifically for Lips or under eye areas.

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By using appropriate amounts of neurotoxins such as Botox, Bocouture or Dysport, lines around the eyes and on the forehead can easily be relaxed. Once again, everyone needs different amount according to the depth of their lines and the strength of each their facial muscles. (Men tend to need higher amounts to treat their stronger, more resistant muscles).

Dr. Kelleher starts with a comprehensive assessment of your skin texture, quality, pigment, volume loss and shape. A detailed treatment plan is produced for you to decide which options to pursue sooner and which later. Comfortable and calm injection techniques are employed to produce a relaxed, refreshed natural look. A follow up visit in two weeks allows balancing and adjustment.

For a natural cosmetic enhancement, it is vital to seek out an experienced Doctor with an aesthetic vision. This will bring out your best features and allow you to look and feel your best. We offer free consultations so come and see if we match your aesthetic and if we are the right clinic for you.


* Percentages are based on the total screened population n=31,383, EU5 population weighted to age, gender, country incidence. 


1. Allergan Data on File. Facial Consumer Market sizing in EU%. Jan 2015

2. Allergan Data on File. Medical Combined DOF 003 - Key Insights. Aug 2014 

3. Facial dynamics and emotional expressions in facial aging treatments. Michaud T, et al. J Cosmet Dermatol. 2015.Mar;14(1):9-21. doi: 10.1111/jocd.12128. Epub 2015 Jan 24.

4. Aesthetic Plast Surg. 2017 Dec;41(6):1473-1474. doi: 10.1007/s00266-017-0915-y. Epub 2017 Jun 27. Has the Quality of Aesthetic Surgery Research Improved over the Last 20 Years? Sugrue CM1,2, Sugrue RM3, Kelly JL3.