Injectables
Botulinum
Botulinum is a safe method that has been used in aesthetic dermatology since the 1990s to relax facial wrinkles and treat excessive sweating, especially in the armpits.
Botulinum is a natural protein that is produced by special bacteria (Clostridium botulinum) and obtained from these bacterial cultures. In humans, this protein temporarily prevents the transmission of the messenger substance acetylcholine from the nerve to the muscle or to the sweat gland. The muscle no longer receives the information to contract and the sweat gland no longer receives a signal to produce sweat. This causes a relaxation of the facial muscles and leads to a relaxation of the facial wrinkles or, in the case of the sweat glands, to a significant reduction in perspiration. This is a reversible process, because the protein is completely broken down by the body after a few months. The effect lasts for approx. 3-4 months on mimic wrinkles, and even up to 9 months on the sweat glands.
- Frown lines
- Horizontal forehead wrinkles
- Crow’s feet (wrinkles on the side of the eyes)
- Bunny lines (wrinkles on the bridge of the nose)
- Marionette lines (negative corners of the mouth)
- Cobblestone chin (uneven appearance of the chin)
- Platysma strands (vertical neck lines)
- Axillary hyperhidrosis (excessive sweating in the armpits)
- migraines (attack-like headaches)
- Bruxism (grinding of teeth)
- Dominant masticatory muscle (M. masseter)
- Pregnancy and breast feeding period
- Local infection at the injection points
- Therapy with aminoglycoside antibiotics or spectinomycin and muscle relaxants
- Neuromuscular diseases (e.g. myasthenia gravis, Lambert-Eaton-Rooke syndrome)
- Amyotrophic lateral sclerosis (Lou Gehrig syndrome)
After thorough disinfection of the treatment area, punctures are made with a very fine needle and tiny amounts of the substance are injected into the skin and muscles. Depending on the location, the injections are more or less noticeable, similar to acupuncture. At the injection sites there may be slight swellings, comparable to a mosquito bite, which last for up to 1 hour. Tiny bruises rarely appear after the treatment.
In general, it is a very well tolerated and effective treatment method. Nevertheless, undesirable side effects rarely occur, which, like the intended effect, recede completely. Temporary headache is by far the most common side effect. On the other hand, there are many patients whose chronic headaches or migraines get better after a botulinum treatment.
In the first hours after the treatment, the active ingredient botulinum diffuses from each injection point and binds to the corresponding, closest nerve endings.
The following rule applies in the first 24 hours after the procedure: don’t apply any pressure on the treated areas, for example during a cosmetic treatment or a massage (forehead support), we also recommend not to wear a headband or helmet, etc., sport or other physical exertions should also be postponed by 24 hours.
After about 4 hours, make up or skincare can be reapplied, the face can also be carefully cleaned.
The onset of the botulinum effect is often observed after 1-2 days. The maximum effect will be visible after about 14 days. Until then, it is very likely that certain “irregularities” or minor “side differences”, will even out by themselves. Therefore, a check-up and possible follow-up treatment only makes sense after 2 weeks.
Dr Gieres is happy to answer any further questions regarding the treatment during a private consultation.
Hyaluronic Acid
Treating wrinkles and loss of volume
Dr Gieres is a regular speaker and trainer for hyaluronic acid fillers at international congresses in Munich.
Hyaluronic acid is a naturally occurring sugar chain in the human skin with a high water-binding capacity. When we’re ageing, the hyaluronic acid concentration, thus the skin’s capacity to bind water and stay moisterized decreases. Commercially produced hyaluronic acid obtained from bacterial cultures (streptococci) has an identical structure to that of humans.
In a filler treatment with hyaluronic acid, cross-linked hyaluronic acid products with different viscosities and consistencies are used to compensate for a loss of volume within the skin (dermis) or in the subcutis, depending on the indication. They rebuild the missing tissue.
It is a filler material that is completely degradable by the body. The various hyaluronic acid products are no longer detectable in the tissue after varying periods of time and are completely absorbed. This makes filler treatments with hyaluronic acid very safe in the hands of a trained doctor and individually adaptable to the aging process and patient requirements.
- Sunken cheeks
- Defenition of the cheekbones
- Jawline
- Nasolabial folds
- Marionette lines / corners of the mouth
- Tear troughs
- Eyebrows
- Lips
- Lip wrinkles
- Skinboosters to improve the skin quality
- Atrophic scars
The product selection is determined by the areas to be treated, the current skin condition and the volume situation on the patient’s face. Dr Gieres uses high-quality fillers from the Juvéderm brand (market leader in this field) and selects the hyaluron fillers from the Juvéderm portfolio that are tailored to the individual needs of the patient during a personal consultation. By combining different products, very natural treatment results can be achieved. However, this usually requires several sessions.
A treatment takes about 30-60 minutes. After a thorough disinfection and a careful marking of the areas to be treated, the hyaluronic acid gel is carefully injected using fine, pointed or blunt cannulas. To make the treatment as pleasant as possible, the hyaluronic acid products contain a lidocaine additive (local anesthetic). Existing allergies or intolerance to local anesthetics should therefore be ruled out before treatment. However, during the injection, you may occasionally feel a slight stinging sensation. After the treatment, tenderness, redness and swelling, as well as bruising are temporarily possible. Treatment should therefore be planned in relation to professional and private activities.
Make-up should not be applied for 12 hours after the treatment. An antiseptic cream should be applied to the entrypoints of the needle/cannula twice a day for 1-2 days. Sunsvreen SPF 50 should be applied daily for 4 weeks. Physical activity should be postponed 24-48 hours. Sauna, steam baths or cold chambers are to be strictly avoided for 2 weeks.
The results of the hyaluronic acid treatment are immediately visible and last about 12 months, even up to 18 months, depending on the product used. A “touch-up” is possible after 2-4 weeks at the earliest.
- Pregnancy and / or breastfeeding
- Allergies to lidocaine or other product ingredients
- Local infections or open wounds in the treatment area
- Ongoing immunotherapy
- Tendency to develop hypertrophic scarring
- Pretreatment with permanent, non-absorbable fillers
Dr Gieres is happy to answer any further questions regarding the treatment during a private consultation.
Radiesse
Radiesse contains the synthetically produced active ingredient calcium hydroxylapatite (Ca2 + HA), which occurs naturally in the human body. Ca2 + HA stimulates the cells in the skin that are responsible for the production of new collagen, namely the fibroblasts.
- Neck
- Décolletage
- Back of the hand
A treatment takes about 30-60 minutes. After a thorough disinfection and a careful marking of the areas to be treated, Radiesse gel is carefully injected using fine, pointed or blunt cannulas. To make the treatment as pleasant as possible, Radiesse products contain a lidocaine additive (local anesthetic). Existing allergies or intolerance to local anesthetics should therefore be ruled out before treatment. However, during the injection, you may occasionally feel a slight stinging sensation. After the treatment, tenderness, redness and swelling, as well as bruising are temporarily possible. Treatment should therefore be planned in relation to professional and private activities.
Make-up should not be applied for 12 hours after the treatment. An antiseptic cream should be applied to the entrypoints of the needle/cannula twice a day for 1-2 days. Sunsvreen SPF 50 should be applied daily for 4 weeks. Physical activity should be postponed 24-48 hours. Sauna, steam baths or cold chambers are to be strictly avoided for 2 weeks.
The full effect of the treatment can only be seen after 3 months, as the build-up of new endogenous collagen, stimulated by a Radiesse treatment, takes time. Usually one treatment is sufficient, the effect lasts for approx. 1 year.
- Pregnancy and / or breastfeeding
- Allergies to lidocaine or other product ingredients
- Local infections or open wounds in the treatment area
- Ongoing immunotherapy
- Tendency to develop hypertrophic scarring
- Pretreatment with permanent, non-absorbable fillers
Dr Gieres is happy to answer any further questions regarding the treatment during a private consultation.
Sclerotherapy
Spider veins are small, branched veins that run in a very superficial network on the skin of the legs and can sometimes form larger collections. They can be light red, dark blue or violet in appearance. Although of little medical importance, they are a major cosmetic problem for many people.
Sclerotherapy of spider veins is usually combined with a vascular laser treatment (Link vascular laser).
An alcoholic solution (polidocanol) in different concentrations (0.25% – 0.5% – 1.0%) (active ingredient: polidocanol) has been in use for several decades in sclerotherapy. For some years now, the treatment has also been carried out as microfoam sclerotherapy, making it even more effective. The solution is injected into the spider veins with a very fine needle and causes a slight inflammation of the vein’s wall. This causes sclerosing, of the vessel, through which blood can no longer flow. Immediately after sclerotherapy, the vessel is more visible, but is then replaced by connective tissue and disposed of by the body in the next few weeks. This is a normal and necessary process.
A sclerotherapy treatment takes about 30-45 minutes. As many spider veins are treated in each session as is medically justifiable.
After a thorough disinfection, the sclerosing solution is precisely injected into the lumen of the vessels. A slight burning sensation can usually be felt with each puncture. However, this is hardly noticed by some patients. Immediately after the treatment, you can usually see redness, mosquito-bite-like swellings and also minimal bruises on the skin.
We recommend a short walk (about 20 minutes) immediately after the treatment and avoiding long periods of standing, sitting or lying down for the next few hours. Sports should be avoided in the first 24 hours. Wearing compression stockings for 2 weeks is recommended.
Sauna, whirlpool, steam bath, tubs and hot showers should be avoided for 2 weeks in order not to jeopardize the success of the treatment. Normal showering is possible as usual on the day after the treatment.
It is also important to avoid UV exposure in the treated area for at least 4 weeks in order not to provoke hyperpigmentation (brown discolouration).
The reaction to sclerotherapy varies from person to person. There are people in whom almost all of the spider veins have disappeared after just one session. In other people, however, the spider veins can be very persistent, have to be obliterated several times or do not respond adequately to the therapy.
Experience has shown that up to 80% of the spider veins can be “stuck together” and thus made to disappear through a sclerotherapy cycle – approx. 2-3 sessions, every 6 weeks. A vascular laser is often additionally used for treatment.
- Pregnancy and / or breastfeeding
- Open wounds or injuries in the area to be treated
- Condition after recent thrombosis
- Illness with being bedridden or restricted mobility
- Known allergy to Polidocanol
Dr Gieres is happy to answer any further questions regarding the treatment during a private consultation.
Hyperhidrosis – excessive Sweating
Sweating is a physiological and necessary process, it helps to thermoregulate the human body. Humans have up to 2 million sweat glands on their bodies. These are mainly found on the forehead, armpits, hands and feet. Sweat is actually odorless, the smell only arises through bacterial colonization.
Excessive sweating (hyperhidrosis) can be psychologically very stressful and stigmatizing, patients are ashamed of sweat stains, some even always have a second shirt with them to change during the day.
Secondary hyperhidrosis, i.e. excessive sweating due to an existing illness, has always to be ruled out prior to treatment. In this case the underlying disease must be treated by the respective specialist.
In primary hyperhidrosis, sweating can be treated directly.
Basically, if you suffer from hyperhidrosis, you should avoid too much coffee, tea or alcohol, as these stimulants worsen the condition. Furthermore, synthetic clothing should be avoided and cotton underwear and socks should be worn.
The drug therapy includes deodorants with aluminum chloride and botulinum.
Aluminum chloride clogs the ducts of the sweat glands, initially it is used daily on the armpits, hands or feet, in the course the application is reduced to every 3-4 days.
Therapy with botulinum is very popular as a therapy for hyperhidrosis because it lasts for up to 6 months and reduces sweating up to almost 100%. The therapy is low in pain as it takes place with prior application of an anesthetic cream. The effect starts after 1 week and is based on preventing the production of sweat.
Sweat production is an important protective function of the body. But just under two percent of the sweat glands are under the armpits.
Dry armpits do not prevent the patient from producing sufficient amounts of sweat secretion. The process is restricted only to the treated areas and not to the entire body. The body can still cool itself down if too much heat builds up in it.
Dr Gieres is happy to answer any further questions regarding the procedure during a private consultation.