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Cynosure –Elite MPX- laser Hair removal treatment

Launched in spring 2011, this is the first such treatment to treat all skin types, including back and Asian skin. 

The machine emits two wavelengths allowing the surgeon/Laser therapist to optimise the delivery of heat energy based on the individual skin type. 

By choosing a laser you allow for less damage to the surrounding skin. The laser beam is absorbed by the hair follicle and transformed to heat which destroys it.

From £125 per session (three to six sessions recommended).

Available from the London Medical & Aesthetic Clinic, W1G 9QD 

Tel: 020 8342 1100. www.Lmaclinic.com

Achieving longer lasting cosmetic outcomes, safely and economically, Ellanse from AQTIS Medical (Utrecht, The Netherlands) has proven it’s self as a strong competitor among more established dermal filler products.  In addition to its ideal deep tissue filling and volume replacement qualities, the creation of dimples is a new and exciting indication for Ellanse, further underscoring its versatility in the aesthetic field.

Dimples are visible indentations of the skin that form on some people’s cheeks, especially when they smile.  They are considered a sign of good luck, prosperity and beauty in some cultures, and particularly in Asian and Indo-ethnic sub groups, dimples are viewed as a sign of attractiveness and veracity.

‘From the aesthetic plastic surgery point of view, dimples create a natural folding and three dimensional appearance in the cheek area which incites a natural attraction to the observer’, said Ayham Al-Ayoubi, M.D, M.S., D.L.O.R.C.S (London), an ear, nose and throat specialist and facial plastic and laser surgeon at London Medical and Aesthetic Clinic in London, UK.

According to Dr Al-Ayoubi, many patients will request a procedure to create dimples in their cheek area.  Traditionally, this can be performed with special surgical techniques that consistently achieve good results; however, not every patient is willing to go under the knife in order to create dimples.  In Dr Al-Ayoubi’s experience, Ellanse, a poly-caprolactone (PCL) dermal filler, is ideal for this increasingly popular cosmetic indication.

‘I have been using Ellanse for approximately two years now to create dimples in the cheek area in my patients, quickly, safely and painlessly.  I have achieved excellent aesthetic outcomes without needing to perform surgery,’ Dr Al-Ayoubi said.

In this pioneering technique, Dr Al-Ayoubi uses Ellanse’s M strength product, strategically injecting 0.3 ml – 0.5 ml of product in a ring formation into the target area.  Ellanse, along with the stimulation of neocollagenesis at the target area, will help create the rim of the dimple itself.  At the four – five week follow-up, Dr al-Ayoubi may re-inject with more Ellanse to fine-tune and enhance the depth of the dimple, depending on the specific cosmetic goals of the patient.

‘I chose to use Ellanse for this indication because of its ideal viscosity and longevity out to three years – much longer than other dermal fillers- but also because it stimulates neocollagenesis at the treatment site, which can be best appreciated approximately four weeks after the treatment,’ Dr Al-Ayoubi explained.  ‘The stimulation of the patient’s own new collagen helps to naturally enhance the final aesthetic outcome.’

A natural dimple forms at the junction between two adjacent lying muscles connected only by the fascia at the cheek area when the patient smiles.  Dr Al-Ayoubi advised that the ideal area to create a dimple with Ellanse is at this junction where these two muscles meet.  ‘The physician needs to accurately assess where the interface of the two adjacent lying muscles is.  Once this very important point is established, the technique is very easy to perform.  If the product is placed in the right area, the dimple created will appear absolutely natural when the patient smiles’, said Dr Al-Ayoubi.

Should a general practitioner with a special interest in aesthetic medicine be allowed to perform complex surgical procedures like liposuction?  A panel of mixed disciplines discuss the issue

Mr Ayham Al-Ayoubi, ENT and facial plastic surgeon, London

Whatever our surgical or medical background, we start out doing what we were trained to do.  I trained in ENT through an intensive programme at the Royal College of Surgeons of England.  Halfway through this, I started to do facial plastic surgery.

I have always had an interest in lasers, so from lasers for middle ear surgery and throat cancer, I moved to SmartLipo.  The technology is laser lipolysis.  I treated more than 500 patients in two years on the chin and small areas with good results.  I moved onto larger areas, and then laser-assisted liposuction.  I tighten the skin, laser the fat and suck it out.  But I never went beyond two litres of fat in one session.

During this period, laser technology evolved from small machines with limited energy to those that give much more energy.  Radiofrequency evolved and Bodytite came onto the scene and now what we are doing is proper liposuction.

Who should do this procedure?  An ENT surgeon who has never performed traditional liposuction after adequate training?  There is no training available from a proper academic establishment.  This is a very grey area.  Training is the crucial point, it’s not about qualifications.

The cosmetic surgery industry is evolving haphazardly, it’s not structured. 

SmartLipo Triplex is a revolutionary new fat reduction and body sculpting treatment from global aesthetic leaders Cynosure.  This procedure introduces a third wavelength to its dual wavelength technology to break down fat mechanically, as well as thermally. 

Creating twenty times more absorption in adipose tissue, this translates into a more powerful treatment for surgeons.  Bodysculpting treatments have been one of the most requested procedures in my clinic since 2010, but with the new generation triplex machine I can offer patients a far quicker treatment time, improved fat reduction results and end up with sixty two per cent skin tightening – greater than any other laser on the market.  Cynosure have also created a new thermal sensing technology called ThermaGuide, providing more accurate treatment doses and a higher degree of safety.  This delivers more reliable removal of tissue and formation of new skin.

For many people diets don’t work and trying to lose weight can be demoralising.  This is an exciting new treatment launch; its technology is significantly advanced, not only in terms of results, but more importantly in terms of safety.

Did you know, according to a study carried out by Cynosure, more than 85 percent of women over the age of 20 are affected by cellulite? A new type of minimally-invasive laser treatment promises long-lasting cellulite removing results.

Cynosure’s Cellulaze treatment uses a 1440nm Nd:YAG wavelength and unique side-firing laser to attack the fat. Inserted through small incisions in the skin, the laser is first placed just underneath the top layer and pointed down to melt excess fat lying beneath the epidermis. Next it is pointed horizontal to cut through the stiffened fibrous bands, releasing the valleys that cause the orange peel effect. Finally, the laser is placed in the up position to thicken and elasticise the top layer of skin, smoothing out the surface for tight and toned skin.

A study carried out by leading US plastic surgeon Barry E. DiBernardo, demonstrated that a single treatment with the Cellulaze 1440-nm pulsed laser improved the appearance of cellulite, with results increasing up to one year later.  Cynosure’s new Cellulaze laser system is a minimally invasive surgical procedure for cellulite, with long-lasting, clinically-proven results. In the months post-treatment, it’s thought that collagen regeneration leads to thicker and more elastic skin.

Cellulaze case study below was performed by Dr DiBernardo – ‘after’ results two years post treatment.

Cellulaze is currently being performed by Dr Ayham Al-Ayoubi at the London Medical & Aesthetic Clinic, lmaclinic.co.uk.

Every night millions of Britons are engaged — often obliviously — in a snoring chorus of rumbles, rasps and grunts while their suffering partners lie awake beside them.

A recent study found many of us lose the equivalent of three weeks' sleep every year because of our other halves' snoring.

"It's a widely under-reported problem that can have a significant impact on people's well-being and relationships," says Douglas Keay, an Ear Nose and Throat (ENT) surgeon at the BMI Kings Park Hospital in Stirling.

A recent study found many of us lose the equivalent of three weeks' sleep every year because of our other halves' snoring "I have seen two people who said they would have to cancel their engagement if their partners' snoring couldn't be fixed."

There are potential risks to the snorer's health, too, as certain types of snoring make you prone to high blood pressure, diabetes and even stroke. 

An estimated three million Britons snore regularly. The causes range from allergies to a late-night tipple and being overweight. Pinpointing the root of the problem is key to finding the right treatment. 

"In the majority of cases, simple lifestyle changes can have a big impact," says Myles Black, an ENT surgeon at East Kent Hospitals University NHS Foundation Trust.

Sometimes, however, the problem may require surgery.

 So how can you — or your long-suffering partner — work out what's behind your snoring? 

Here the experts reveal the different types of snoring, and how to tackle them...

NASAL SNORER

SOUNDS LIKE: The classic 'snore' — a low-frequency fluttering or rumbling noise.

"It sounds like someone doing an impersonation of someone snoring, or Darth Vader," says Marianne Davey, from the British Snoring and Sleep Apnoea Association. 

THE CAUSE: If your nasal passages are partially blocked, more air is forced through the mouth while you sleep.

This extra pressure causes the soft and dangling tissue of the throat to collapse. When it's collapsed, the soft tissue vibrates as air rushes past it, emitting the characteristic snoring sound. 

A common cause is an allergy or sinus infection which causes inflammation and swelling of the lining tissues. 

Deformities of the nose such as a deviated septum (where the wall of cartilage that separates one nostril from the other is crooked) or nasal polyps (fleshy, non-cancerous growths) can also cause obstruction and sleep problems. 

TAKE THE TEST: Stand in front of a mirror, holding one nostril closed and breathe in. If the open nostril tends to collapse, try propping it open by holding the outer rim with the clean end of a matchstick. 

Now, with your mouth closed, try breathing in through your nose — if breathing is easier with the nostril propped open, you could be a nasal snorer.

Allergies can be seasonal, such as hayfever. However, if your nose is blocked all year round, this suggests a structural problem with the nose rather than an allergy, says Mr Keay.

Other symptoms to look for include a dry mouth, bad breath or headaches caused by dehydration, explains Mr Black.

The saliva dries in the open mouth as the air rushes to the back of the throat. Without saliva, the bacteria that cause bad breath can flourish.

"If you snore and you need to constantly sip a glass of water by your bedside through the night, some form of nasal obstruction could be to blame."

WHAT YOU CAN DO: Breathe Right nasal dilator strips — special plasters you put on the outside of the nose which stretch the nostrils open — can provide extra external support to improve airflow, explains Mr Black.

"In extreme cases we can perform surgery to insert small rods, or silver rings, which keep the airways open," he says. 

If you have a deviated septum, an operation to straighten it, known as a septoplasty, is also possible.

Polyps can be surgically removed with total resolution of the snoring. If you think allergies may be to blame, ask your GP for testing. 

"Using a mattress cover and man-made fibres for duvets and pillows can eliminate dust and house mites, a common cause of nasal congestion, and using nasal steroid sprays for a minimum of two months can help," adds Mr Black.

TONGUE SNORER

Drinking alcohol just before bed can exacerbate the problem of tongue snoring by relaxing the muscles that support the tongue

SOUNDS LIKE: A high-pitched snore that comes in fits and starts, and stops when you roll on your side.

"The sound made by a tongue-based snorer is often higher pitched as it's more focused on the denser tongue muscle rather than the flappy palate," says Marianne Davey. “It also tends to be in shorter bursts rather than the continuous flapping vibration of the soft tissue in the throat."

THE CAUSE: Roughly 30-50 per cent of snorers are tongue-based snorers,' says Mr Black. 

"Here, the tongue is in the wrong position, blocking the air flow through to the throat — perhaps as a result of a small lower jaw; or else the supporting muscles are too relaxed, allowing the tongue to fall back when you lie down, or you could simply have an overly-large tongue."

Drinking alcohol just before bed, sleeping pills and other medication such as antihistamines can exacerbate the problem by relaxing the muscles that support the tongue.
Men in particular suffer from tongue-based snoring because they tend to put on weight around the neck, explains Mr Black, and this can cause “a build-up of fatty tissue around the base of the tongue, constricting the airways".

TAKE THE TEST: Stick your tongue out as far as it will go and grip it between your teeth, says Marianne Davey. Now try to make a snoring noise. If the snoring noise is reduced with your tongue in this forward position, then you are probably what is known as a "tongue-base snorer". 

WHAT YOU CAN DO: If your tongue is falling too far back, a bespoke mandibular advancement device (MAD) has been shown to be effective in the majority of users, says Mr Black. 

This is in effect a plastic mouth guard that pulls the lower jaw and in turn, the tongue forward to open the airways. A low-tech solution to prevent the tongue falling into the back of the throat is sewing a tennis ball into the back of your pyjamas. “This simply prevents you sleeping on your back," he says.

Losing weight and avoiding night-caps and smoking (which irritates the throat and nasal linings) are also important.

MOUTH SNORER

Mouth snorer: Low-frequency rumbling, similar to nasal snoring

SOUNDS LIKE: Low-frequency rumbling, similar to nasal snoring. You snore whether on your side or back.

THE CAUSE: One of the most common causes of snoring is breathing through the mouth. This causes the soft tissues of the palate or the uvula (the dangling tissue in the back of the mouth) to bump against each other and vibrate, triggering the snore. This is known as “palatal" snoring.

TAKE THE TEST: Open your mouth and make a snoring noise, says Marianne Davey. Now close your mouth and try to make the same noise.

If you can only snore with your mouth open then you are a “mouth breather". 

You could also look at the soft tissue towards the back and top of the mouth, says Mr Keay.

"There should be an open passageway for air to travel through — if the tonsils are clearly visible, or if the palate hangs down, this could well point towards mouth snoring — it's like a sheet flapping in the wind."

WHAT YOU CAN DO: Maintaining a healthy body mass index, limiting alcohol intake and stopping smoking can all help prevent palatal snoring by tightening the neck muscles and pulling up any soft tissue responsible for the noisy vibrations.

"The surgical solution I advocate in this situation is pillar implants that support the palate," says Mr Keay. These plastic rods are inserted into the soft, floppy part of the palate in a 15-minute procedure.

A NICE study three years ago found 67 per cent of cases had a reduction of at least 50 per cent in their snoring compared with none in the placebo patients. 

Other surgical options include trimming the uvula using laser or electrical forceps, or radiowaves to scar and so stiffen the tissue in the palate.

SLEEP APNOEA

SOUNDS LIKE: A crescendo of loud snoring followed by silence lasting from a few seconds up to 20, and then coughing, gasping or spluttering (your partner will describe it as if you are choking or gasping for air).

THE CAUSE: Obstructive sleep apnoea, which occurs as a result of narrowing of the airways. An estimated 4 per cent of men and 2 per cent of women are affected. During sleep, airway muscles relax too much and, as a result, tissue blocks the passage of air.

Partial blockage results in snoring, but in a total blockage — apnoea — the patient can stop breathing for up to 20 seconds at a time. When air is completely cut off, the brain sends an emergency signal, causing the airway muscles to contract. 

This reopens the airway, allowing the sufferer to take in a big gulp of air. 

The whole process is repeated, sometimes hundreds of times a night. 

"In most cases, the sufferer has no recollection of the events, but will wake up feeling exhausted," says Ayham Al-Ayoubi, Ear, Nose and Throat surgeon at Barnet and Chase Farm Hospitals NHS Trust and North Middlesex University Hospital. 

Left untreated, sleep apnoea can increase the risk of high blood pressure, stroke and diabetes.

TAKE THE TEST: This is the same test as for mouth snoring, says Marianne Davey, but the determining symptom of sleep apnoea is daytime exhaustion. 

"Sufferers regularly find it impossible to stay awake while seated, especially driving, wake up feeling exhausted and often put on weight as they eat sugary snacks to temporarily boost concentration and energy levels," says Mr Al-Ayoubi. 

WHAT YOU CAN DO: "One of the most effective therapies is continuous positive airway pressure (CPAP), a mask worn at night where air is pumped continuously to keep the airways open," says Mr Al-Ayoubi. 

"However, a large number of sufferers find a CPAP intrusive or invasive and many don't continue with it."

Surgery to remove the excess floppy tissue can help, but less drastic measures include losing weight and eliminating other lifestyle factors such as drinking or smoking.

Dr Ayham Al-Ayoubi was the first surgeon to introduce Ellanse to the UK. Here he explains why this ground breaking new filler is so special and talk us through a couple of unique treatments he can offer using the product.

Dermal fillers are one of the biggest growth areas in facial aesthetics, as women are starting to realise that you don’t necessarily need to have a facelift to knock several years off your age. Ever since collagen first hit the market in the early 1990s and was found to be effective- if a little problematic- in the battle against ageing, pharmaceutical companies the world over have been embroiled in a race to create the perfect filler.

Since the launch of Restylane in 1996, the majority of dermal fillers have been made from hyaluronic acid- a substance naturally produced within the body, which breaks down over time. HA fillers have many advantages: you don’t need to perform a skin test prior to treatment, as you did with collagen, and they can be easily dissolved if you don’t like the effect.

However, although hyaluronic acid is much more durable than collagen, it still only lasts for six to nine months, which is great when you’re trying a treatment for the first time, but can get expensive over the course of a few years.

I’m keen to offer my patients as wide a choice as possible, so in my clinic I offer all the major filler brands, as well as the injectable volumising treatment, Sculptra, and am always on the look-out for the next big thing. In March last year, I discovered Ellanse, brand new dermal filler that offers all the benefits of HA but lasts for up to five years.

Breaking boundaries

An advanced version of current options on the market, Ellanse is the first filler of its kind to treat under-eye bags and dark circles, which are not usually treated with dermal fillers. Not only are the results instant, but this all-natural, water based anti-ageing treatment also stimulates the body’s own collagen production to deliver smoother, plumper looking skin and long lasting, natural looking results.

Made of poly-caprolactone (PCI), a well-known totally bioresorbable soft medical polymer, Ellanse retains its volume of between three and five years, before totally resorbed and removed from the body, with no residues of any kind left behind.

I was so impressed with the results possible from Ellanse that I decided to introduce it to my practice, and I have had great success with it since. Because of its unique contouring and sculpting capacities, I realised that you can do things with it that are not possible with other dermal fillers, and so I started to experiment with new ideas.

Dimple creation

Dimples are caused when the facial muscle is shorter than normal; it pulls on the skin and forms an indentation when smiling. They are genetic trail, so you either have them or you don’t, but over the past few years, with celebrities such as Cheryl Cole hitting the spotlight, they have become a very desirable facial feature.

If you know facial anatomy very well- my background is as a facial plastic surgeon- then it is possible to create an impression of a dimple through non-surgical means, and Ellanse is the ideal product with which to do this.

First of all the patient to perform a series of facial manoeuvres, such as whistling, clenching and smiling, while I study the face to see where the muscles are sited and how they move. This shows me where to create the dimple.

I then inject Ellanse around the area to create a circular ring deep in the dermis. An indentation forms in the middle of the ring, which mimics the effect of a dimple. If you did this with HA fillers, they would just dissolve with facial movement, but Ellanse’s make-up means that it will become more defined with the process of inflammation.

“Ellanse is the first of its kind to treat eye bags and dark circles”.

Non-surgical facelift

The non-surgical facelift is pretty much the holy grail of facial aesthetic treatments.

Realistically, at the moment, the effect can only be created with a combination of temporary dermal fillers and injectable volumisers, such as Sculptra, but the problem is that the effects of Sculptra, whilst impressive, take a few months to show, by which time the wrinkle-filling benefits of HA filler will have worn off, so you have to start again.

I have found that Ellanse is the perfect partner for Sculptra to create a true injectable facelift: Ellanse instantly gives a dramatic improvement in the treatment of fine lines and wrinkles on the face, whilst Sculptra will work over a period of months to significantly enhance the shape of the jaw line and the volume of the face.

Because the effects of Ellanse are long lasting, wrinkles are still filled when Sculptra starts to take visible effects, and because both products work to stimulate your own collagen production they perfectly, giving you an incomparably plumper up, dewy-looking glow, which will last for an astonishing four to five years.

Facing the future

I will continue to seek out the best new treatments to offer my patients, because I want to be able to provide a truly exceptional service and give patients the face and body they have always dreamed of. For now, I think Ellanse is the best product on the market to provide both instant and lasting results, without the pillow-face effect.

“I grew up really envious of my mum’s gorgeous lips-mine were thin and unnoticeable in comparison. So when I read about fillers in a magazine, I knew I wanted to try them. 

I went along to a local dentist who also offered cosmetic procedures and had my lips injected with collagen. But I wasn't happy with the results-instead of looking sexy and plump, they just looked unnatural.

I made it my mission to find an experienced doctor to correct them well and finally I found an amazing surgeon in London, Dr Ayham Al-Ayoubi (www.Lmaclinic.co.uk). He warned me I was quite young to be getting into the habit of using fillers, but I insisted that he helped m out.

At 23, I asked Dr Ayham Al-Ayoubi to also give me Botox. I was concerned about my frown lines-I loved skiing and cycling and I thought the sun had damaged my skin –and felt I needed to correct the lines between my eyebrows and the crows’ feet around my eyes. 

The first dose of Botox cost me £300, and the results lasted for four months. I loved my new frown-free forehead so when I saw the first wrinkle return, I went straight back to the doctor for more. 

Since then i have had 5 sets of lip injections and 9 doses of Botox. I have spent more than £3,500 on treatments and I can’t see the cycle ever stopping. 

The problem is that once I’d started the injections, I didn’t want to stop. In some ways I wish I’d waited until I was older. As my features are so flawless now, some people do think that I am older than 25.They assume I must be older to have needed so much work!    

I keep my Botox habit secret from my boyfriend. I know that once I tell him about it, he’ll start looking for lines and that worries me. My parents aren’t happy as they loved me just the way I was. But Botox is a part of me now and I can’t see myself stopping soon.”

I’m the sensible sort. I wear sunscreen. I vote. I care about the state of the nation and about what those five-inch Louboutins might do to my feet. But I still dream that one day I might look like Lara Stone (from the neck down only; I was never meant to be blonde). We all need to enter the world of beauty with sense of perspective. Booking any treatment while thinking – or even hoping – you will turn into someone elsse, someone younger prettier, will only lead to disappointment, then possibly to kind of obsession that ends up turning you into Heidi Montag. You can only ever make the best of what you’ve got.

Having said that, after two years as ELLE’s Beauty Extremist – that’s two years exploring the frontiers of science and vanity testing more treatments than any other editor – I know what will work. More importantly, I also know what’s a total waste of money is. I’ve tried countless things in order to find out, from the weird to the wonderful, via the undignified and excruciating, from the truly life-changing to those that defy both common sense and medical credibility. I’ve tried Botox, Restylane, Perlane, Juvederm, Sculptra, Mesotherapy, platelet-replacement therapy, intense …

ON FACE

£15.165

RESTYLANE VITAL (from £250 x3),

And Sculptra (£400 x3sessions), all

With Dr Ayham AL-Ayoubi at London Medical and Aesthetic Clinic

Sculptra has also firmed and plumped my skin in a way that’s much more natural – looking than most injectable fillers.

The problem

At 40 years old, excessive exercise has kept my body fairly fit but my face is fading fast. My once plump cheeks are like deflated balloons and I want to turn back the clock a few years or two without going under the knife.

The Sculptra treatment

The room is clinical without even a whiff of a scented candle. I sit in a dentist-style chair under the glare of a spotlight while cold topical anaesthetic cream is smothered on my face. I’ve got 10 minutes to wait for to numb my senses- time to contemplate leaving- but I remain put, least I be branded a coward. As the cream is wiped off, I close my eyes and flinch in anticipation.

Jab goes the first needle, then the next, and the next. Each time the needle pierces my skin, a small amount of liquid (Sculptra powder mixed with sterile water) is injected before an ice pack is quickly applied.

 To be honest, the pain isn’t that bad and I’ve endured worse at the dentist under of an overenthusiastic hygienist, but this is my face and I’m a little nervous.

The surgeon Mr Ayham Al-Ayoubi is deft and agile, however. The 12 or so injections- I’m holding my breath and not keeping count- take less that 10 minutes and is followed by a deep massage- not exactly a relaxing facial, but now that the needles are gone, I’m overjoyed.

The outcome of Sculptra

The surgeon Dr Ayham Al-Ayoubi offers me the mirror and tentatively I take it. Frankly I’m amazed at my rosy, plumped-up cheeks, even if they are speckled with small pin pricks and the odd smear of blood.

The next morning small bruises have developed, but I vigorously massage my face for five minutes as instructed, and do so for the next five days, morning and night. After several days, the water disperses and my plumped-up cheeks seemingly revert to normal.

So what’s the point? The Sculptra powder, a collagen stimulator rather than filler, remains in place, working its magic gradually and causing only subtle improvement over time. This is treatment slightly more relaxed and, after three, I’m done, properly plumped for the next three years. I haven’t got a pillow face and I like the fact that there isn’t an instant transformation: no-one knows my secret, except you!

THESE four women have one thing in common – they are all 45.

And to keep the wrinkles at bay and look as young as they do, they all take care of their skin. One makes her own beauty products, another swears by laser treatment.

A third stays out of the sun and the fourth believes that putting aside your worries helps you to look more youthful.

Their yearly spend on anti-ageing products ranges from £50 to £2,500.

According to a recent QVC survey, women spend an average of £653.64 a year on beauty products – making the industry worth £2billion.

While some swear by expensive face creams others are convinced budget products and a good diet are just as effective.

Here Karen, Frankie, Sarah and Cathy reveal to LAUREN NAYLOR the secrets behind their youthful looks.

Sarah Jane Hulbert

MUM-OF-TWO Sarah Jane, an events administrator, lives in Cobham, Surrey, with her children Luke, eight, and Ella, 13. Her secret lies with fillers and Botox. She says:

“I aged quite well but when I hit 40 I thought I needed a beauty boost. I went to see Dr Ayham Al-Ayoubi in Harley Street who used Cynosure-Performa laser treatment to smooth out wrinkles, fine lines and re-surface my skin.

I‘ve also tried Sculptra, an injectable, to treat anti-ageing and acne scaring, followed by Botox and dermal fillers. Friends don’t know what I’ve done but say I look well.

I always use hand cream, have my nails done every three weeks, cleanse, tone, exfoliate and always use eye cream.

I eat a lot of salads and soups. I don’t do exercise but I run around after my children.

Elle Macpherson (46) and Sharon Stone (52) are my heroines. If they’ve had anything done, it’s very subtle.”

BEAUTY SPEND: Botox – £500; chemical peels – £600; anti-ageing laser treatment, Cynosure Performa laser, £800; Ellanse fillers – £400; skin care – Celgenics moisturiser and eye cream – £200.

SPEND OVER A YEAR: £2,500

Leading international facial laser and plastic surgeon Dr Ayham Al-Ayoubi has been raving about Cynosure’s new laser-the Performa.

Dr Ayoubi, who is medical director of the London Medical and Aesthetic Clinic on Harley Street, has described the system as the ‘next generation in anti-ageing skin treatments’. He says, “The Cynosure- Performa is a newer, much more advanced fractional CO2 laser, which I introduced in to the UK in December 2010. I recommended it to my patients for treating skin conditions such as photo-aged skin, fine lines and wrinkles, severe acne scarring and surface lesions. In some cases it can even be used to treat burns patients at the later stages. Fractional technology allows for skin to treated with small micro-ablative areas. Areas for untouched tissue allows for much quicker healing times and decreased risk profile, with patients experiencing only a couple of days of slight redness and swelling.

“Whilst previous CO2 lasers were affective when they were first launched many years ago, they caused unbelievable redness of skin and thermal damage. The advantage was significantly tighter skin with a dramatic reduction in wrinkles and fine lines but damage to surrounding areas of skin was quite shocking. A lot of celebrities are seeing great results with the Cynosure- Performa CO2 laser in the US. I believe it is going to be huge in the UK for 2011 as we venture further into the realm of non-surgical laser surgery.”

The pursuit of beauty has never been easy. Throughout the ages, women have subjected themselves to all society’s view of what beautiful women should look like. In 10^th century China small feet were deemed attractive and highly desired, so much so that girls as young as five would go through the agonising pain of having their feet broken at the arch to stop it from growing. Such barbaric methods are no longer practised but women are still finding new ways of torturing themselves, all in the name of beauty.

Psychologist Phillip Hodson and spokesperson for The British Association for Counselling and Psychotherapy (BACPS) explains: “The reason for society’s obsession with beauty goes back for society’s obsession with beauty goes back centuries when women were value for their looks over their abilities. It didn’t matter if you were a good homemaker or a good cook- beauty was a prized aspect for women. “And with images of beautiful women thrown at us at every surprisingly, India fourth (where cosmetic surgery has experienced a 15 % growth in the past three years). ASAPS predicts that more people will spend money on Botox, breast implants, liposuction and even burn implants. With this growing demand there are now procedures to correct any flaw, whether you want a bigger bum or smaller waist.

The pursuit for beauty usually begins with the perfect body. More women are shunning the traditional methods of exercising and eating well, opting instead for quick fixes like tummy tucks and liposuction.

“Sometimes there are professional reasons for having cosmetic surgery,” explains Dr Al-Ayoubi, opportunity, from billboards and new stands to televisions and computer screens, the pressure to look beautiful is stronger than ever.

“We live in a world of mirrors where pictures of beautiful women are easily accessible,” explains Hodson. “The modern world has now discovered High Definition, which means we can get a closer look at our favourite celebrities. It makes us envious and we want to mimic them.”

These days beauty is a big business. Research by Co-operative Insurance found that the average woman will spend approximately £180,000 on beauty products during her lifetime. Another survey but luxury beauty brand Crème de la Mer found that over two third of women felt their confidence comes from how good they look. Previous studies have also shown that beautiful extreme beauty. What lengths would you go to, to get the perfect face and body?

“The other day I treated two models who had beautiful bodies, maybe a size 10-12, but they had areas of fat around the hips and bottom they wanted removed. They told me how they were losing jobs because they couldn’t shift the weight and there were specific measurements they had to fit. These girls were fit and healthy, going to the gym regularly, but this fat just wouldn’t shift. I used Smart Lipo to shave and sculpt the fat from the hips completely.”

But for some women a toned tummy and perky breasts simply aren’t enough. With new, more extreme treatments and procedure cropping up all the time it has become easier to change your body than it ever was before.

Limb lengthening is one such procedure, allowing women to alter their height and help them achieve the perfect modelesque figure. The controversial procedure is now available at the Ilizarov Scientific Centre in Russia, and involves women are more likely to be rich and successful than a plain Jane.

“The standard of beauty is higher now that it’s ever been,” says Hodson. “This makes most of us feel interior and more susceptible to trying out the latest “miracle treatment that promises beauty”.

But Dr Ayham Al-Ayoubi, plastic surgeon and Medical Direct of the London Medical & Aesthetic Clinic on Harley Street (www.lmaclinic.com) argues that “women want to feel confident in their own skin. They often have surgery to boost their confidence and for their own self esteem.”

Along with the latest lotions and potions comes the surge in cosmetic surgery. The British Association of Aesthetic Plastic Surgeons (BAAPS) found last year that the number of surgical procedures had risen by 6.7%, breast augmentation being the most popular procedure. According to the International Society of Aesthetic Plastic Surgery (ASAPS), the USA remains the world’s top spay for cosmetic surgery with Brazil coming in second, China third and, most having the shin bone broken and then attached to a mental frame. This excruciatingly painful treatment can take up to a year and costs tens of thousands of pounds, but patients are comforted by the promise of up to one foot of extra height.

Women are also turning to surgery for a designer vagina. The procedure known as labiality has gained popularity within the last few years.

“Excess skin can make the labia hang down and look unnatural, which can be uncomfortable when pulled during sex,” says plastic surgeon Angelica Kavouni (www.cadoganclinic.com) which specialises in labiaplasties. “It’s because very popular. I see 4-5 women a week and I operate on 2-3 a week. ”surprisingly, Angelica claims that many of her clients are south-Asian, although most are unwilling to speak about it openly, due to the sensitive nature of the operation. For some procedure like this can seem unnecessary bizarre even, but Angeluca argues that there are psychological benefits: “The procedure is not medically necessary, however, these women are affected psychologically especially in terms of relationships, so for them, the procedure is imperative for a healthy sex life.”

Achieving the supermodel body might be within the average woman’s reach now but such extreme procedures are not without risk. Earlier this year Lidvian Zelaya died from complications after having a butt lift. She had travelled to a Florida clinic after vowing to “look good” for the New Year. Another shocking example of cosmetic surgery gone wrong in US reality TV star, Heidi Montag, who came close to death after undergoing ten surgical procedures in one day.

The perception of beauty varies from culture to culture, but there is a set of rules that are universal to beauty- big eyes, a small chin, high cheekbones and full lips. Scientists even go as far as to claim that beautiful people have a perfectly symmetrical face. The Asian community also hold the belief that beauty is connected to light skin and light eyes. Aishwarya Rai, dubbed the most beautiful women in the world, is known for her light blue eyes. Many women attempt to recreate her look with coloured contacts but a new operation now allows you to change your eye colour permanently. The procedure, which isn’t licensed in Europe, costs around £5000 and is exclusively available in a clinic based in Panama. It involves inserting a coloured lens inside the eye, over the iris. Although the results are instant, there are several risks.

Shenise Ferrell, thought to be the first person in the UK to undergo this treatment, suffered from blurred vision and sight problem after having the implant in her eyes. Once back to the UK, Farrell was immediately sent to hospital where surgeons battled to save her sight.

There is also a growing number of people who are using surgery to conceal their ethnicity. According to statistics released by the ASAPS, ethic cosmetic plastic surgery procedure are the fastest growing trend and have increased by 11%. One example of this can be found among east-Asian who are opting for a blepharoplasty (eyelid surgery), which involves creating a more prominent, “western looking” eyelid. It’s also become the most popular procedure in Asia. For south- Asians, skin colour is still a big issue with many people still conforming to the idea that paler skin is more beautiful. Today, the skin lightening cosmetic industry is a multi-million pound business. Most products are sold on the black market as their ingredients have been banned across Europe and Asia. Yet despite the obvious health risks, women are flocking to buy into the skin lightening trend.

Dr Al-Ayoubi is sceptical about such extreme procedures. “I’m not a big fan of extreme radical changes because you are completely changing the look of the face and there are occasionally psychological issues involved. In very extreme cases where patients come to see me wanting huge changes, I may refer them to a special psychiatric clinic first. My philosophy is enhancing but preserving natural beauty.”

And in a bid to keep up with the western world, demand for plastic surgery has surged in south- Asia. Dr Abdul Babar, a plastic surgeon based in Pakistan, Lahore, notes a growing demand for people who seek nose jobs and tummy tucks: “During the last few years there’s been a tremendous increase in the number of patients seeking cosmetic surgery in Pakistan,” he says. “Some want to enhance their chances of marriage and finding a better life partner, other for a better job opportunity.” Dr Babar explains a need to keep up with the times as a big factor when his patients come to him. “Like anywhere else in the world there is an increase in demand due to better awareness through the media and internet, but there is a conflict with religious beliefs”.

Society is obsessed with beauty and appearances. Men and women alike are forever pursuing ways to improve themselves, whether it’s something as simple as brushing your teeth to keep them looking clean or something more extreme like a facelift.

“We can’t all be beautiful,” argues Hodson. “It’s the luck of the draw and the luck of whether fashion trends match your look at the particular time.”

But if there are now ways to permanently beautify ones self shouldn’t we take advantage of that? “Since the ancient times people have tried to make themselves look beautiful,” says Dr Kavouni.  “Today, it’s easier, safer, quicker and cheaper.”

If beauty equates happiness then surely we should all be going under the knife. Dr Kavouni is hesitant to declare surgery as a road to happiness. “Something like happiness is difficult to define. But surgery can certainly make you more confident. “Hodson also argues: “Everyone wants to look beautiful. It can make you more successful, but what we forget is that the ageing process can close all the doors.” Even with all the anti-ageing treatments and procedures out there Hodson maintains that to achieve true beauty we should start with our minds: “It’s the biggest thing in the universe and if we use our brain to change the way we think we wouldn’t need surgery. Start with your personality and develop skills to like yourself. Surgery is risky and develops skills to like yourself. Surgery is risky and betting that it’ll make you happier is a bad idea. If you’re not beautiful- get a personality.”

Even though she was swathed in bandages, Lisa Hanson couldn’t stop smiling as she regained consciousness.

Naturally, after two hours on the operating table having a tummy tuck as well as liposuction on her thighs and hips, the 40-year-old accountant was in some pain. And her bank balance was £2,500 lighter, too.

But so desperate was Lisa to reinvent herself after her husband’s adulterous affair and her subsequent divorce,

she didn’t even need to see the results to know that the surgery was worth every penny.

‘Under the bandages, I knew there was a new me waiting to emerge,’ says Lisa, who lives in Altrincham, Cheshire.

‘The surgery was very much a reaction to my divorce — I wanted to re-invent myself and get my revenge after the way my ex made me feel about myself.’

And Lisa didn’t stop at one operation. She’s now the proud owner of perky new breasts, thanks to an enlargement and uplift. She’s blitzed her wrinkles and plumped up her cheeks with Botox and injectable fillers. Then there’s the glamorous nail extensions, the radical haircut and the wardrobe full of fashionable new clothes to showcase her youthful figure.

‘I’m virtually unrecognisable from the woman who went through such a bitter divorce four years ago,’ she admits. ‘With each procedure, I felt my confidence increasing. I have never felt so unattractive and hurt as I did the morning my husband sat me down and told me that he’d met someone else.

‘But having this work done was as if I were putting a metaphorical two fingers up to the man who had all but destroyed my life.’

‘Now, I have this fantasy that I will meet him walking down the street and he won’t recognise me — then, when he does, he will be astounded. The thought of that happening puts such a smile on my face.’

Undergoing such a dramatic transformation certainly gives new meaning to the old platitude ‘making a fresh start’. But Lisa is not the only divorcee making a date, on the rebound, with a plastic surgeon.

In a phenomenon that is being dubbed ‘vengeance surgery’, divorcees now make up more than a quarter of business, according to figures released last month, with many admitting they are having surgery to make their ex-partners jealous.

This is clearly a lucrative, niche market. Stateside, some clinics are already offering divorce packages to men and women seeking surgery after a break-up.

But while there is no doubt that cosmetic work can boost self-esteem, how wise is it for women to undergo surgery — with all the health risks this entails — when they are clearly in an emotionally distraught state? Are clinics not guilt of taking advantage of this unhappiness?

While Lisa, who doesn’t have children and is now happily settled with a new partner, insists that she has no regrets, she admits she felt vulnerable and emotionally crushed when her husband confessed to an affair after eight years of marriage.

‘We were childhood sweethearts,’ she says. ‘I met him when I was 15 and I thought that we would be together for ever.

‘But when he had an affair with a woman he met on a training course, it pulled the rug completely from under my feet. I admit I had let myself go a bit — but then, we both had. As we both loved our food, there were plenty of cosy nights in and shared bottles of wine. I just never imagined he would ever go off with someone else.’

Once Lisa knew the truth, however, there was no going back. ‘I filed for divorce the following week,’ she says.

But her self-confidence was shattered. ‘I thought that no man would ever look at me again,’ she admits. ‘For months, I buried myself in my work, and wouldn’t even go out with friends. Then, one evening, I took a long hard look at myself in the mirror. I saw a dowdy woman who had let herself go and was looking older than her years.‘Was this the real me? Was I ever going to feel good about myself? It was at that moment I thought: “Right, I am really going to do something about this.” So I did.’

Due to the stress of the break-up, Lisa had already lost a considerable amount of weight but she says that, naked, her body ‘was a disaster’. ‘I had so much loose skin, my stomach was sagging and my breasts seemed to have disappeared.

‘I had started going to the gym and felt as if I had more energy, but I loathed the way my body was sagging,’ she says. ‘I am not the sort of person who would normally think about cosmetic surgery — my mother was horrified — but I couldn’t think of any other route to take.’

Lisa booked a consultation at a clinic and says the consultant took her fears seriously.‘I thought I might just have my breasts made firmer, but in the end I had a tummy tuck, liposuction on my thighs and breast implants.

‘I spent about £5,000 — but, to me, this was money well spent. It was my perfect revenge: to reinvent myself as a beautiful and sexy woman.’

‘In years gone by, changing your hair, dieting and re-vamping your wardrobe was the quick fix, but now plastic surgery is more affordable and so very available, it’s the next choice on the list,’ she explains.

‘However, the real change needs to be an inside job. Once you learn more about who you are and how you operate in a relationship, you begin to realise that what’s on the outside does not need changing much at all.’

‘In today’s culture, many people equate looks with happiness but it’s important to solve the issues you have with yourself first, rather than going straight for a cosmetic procedure you may regret later,’

But not all surgeons are so scrupulous. Charlotte Marshall, 29, a former air hostess who lives in Lincolnshire, admits she may have rushed into surgery too quickly.

To save money, she flew to Brazil for her post-divorce boob job and has been left with some scarring as a result.

Even so, such was the depth of her self-loathing, the experience didn’t put her off having further work done to her face on her return to London.

For here is the sad truth: Charlotte was attractive before she opted for surgery, she just didn’t know it. The years she spent in an unhappy relationship left her convinced she was ugly and worthless.

‘My ex basically eroded my self-confidence,’ she says.

‘I never knew where he was or who he was with. He loved to go out partying and dancing, whereas I was always tired from my long shifts as a member of Virgin Atlantic cabin crew.

‘I became so anxious about our relationship that I stopped eating, and became thinner and thinner.

‘I desperately wanted to keep my marriage together, but I was working long hours and, with his career, we hardly saw each other.’

Charlotte discovered two years ago that her husband was seeing someone else. ‘To this day, I don’t know who it was, but I presume it was someone he met while he was out partying,’ she says.‘Our split was acrimonious and left me feeling very scarred and hurt. For a long time, I felt so weak and destroyed by what happened.

‘But I wanted to salvage something from the wreckage of this relationship. I didn’t want that time in my life to have been pointless, so I decided that the “vengeance” I would take would be to re-invent myself.

‘I hated my face? Fix it. I hated my breasts? Fix them.

‘Today, I think we are lucky to be able to have cosmetic surgery. It isn’t cheap — I spent well over £5,000 — but it has made the world of difference to me.

‘My ex-husband thought he’d destroyed me as a woman, but he hasn’t. If he saw me now, he wouldn’t recognise me.

‘I am bursting with confidence and feel the sexiest and healthiest I have ever been.

‘I am dating again, have bought a new wardrobe of clothes and feel as if I have my life back.

‘I suppose, in a way, I have created a new person from the shadow of the woman I had become.’

Many of the divorced women opting for vengeance surgery are hoping to buy back the body they had before childbirth.

This is certainly the case for Miri Jackson, who discovered not long after giving birth to their daughter that her husband was having an affair with a woman ten years younger.

‘Having just had a baby, my sense of self-worth was very low. I was a dress size 16, my boobs were sagging and I did not feel at my most attractive,’ says the 33-year-old, the manager of a freight company, who lives in Burbage, Leicestershire.

‘I thought long and hard about what I could do to get even,’ she says.

‘I knew I didn’t want him back — but I wanted to feel as if I was worth something again. I wanted to feel good about myself.

‘I wanted to wear beautiful clothes, look in the mirror and feel like an attractive woman.

‘I certainly did not want him to feel that I was sitting at home pining for him.

‘So I decided to have cosmetic surgery. I decided to have my breasts enlarged, as they were the thing I hated most about my figure.

‘Now I don’t feel old, or neglected, or cast off — I am my own woman again.

‘I see my ex-husband quite often, obviously, because of our daughter. He is still with the woman he had an affair with, but when I drop off our daughter, I often seeing something in his eyes which looks suspiciously like regret.

 'Revenge is definitely the best medicine after you have been so very badly hurt.'

As Lea Michele showcased her slimmer-than-ever figure, insider claim she’s tormented by body demons

Her wholesome character Rachel Berry rises at dawn to run on her treadmill in pursuit of perfection, and Glee star Lea Michele is believed to be equally determined in real life.

In the 18 months since she found fame on Glee, 5^th 2in Lea has dropped to a slender size 6- shedding more than a stone- and the 24-year-old actress insists it’s all down to her new healthy vegan diet.

However, friends fear that the star’s long-running battle with her body demons and the pressure she feels to conform to the Hollywood stereotype could be behind the dramatic weight loss she has undergone since the show launched in September 2009.

“Lea is always comparing herself to other actresses and she feels that she is under huge pressure to diet all the time,” said a source who, like many of Lea’s friends, fears the star is overdoing it.

Now Lea, who is dating actor Theo Stockman, has cut all meat and dairy o of her diet. She also practises Bikram yoga every day- which she finds “calming”- as well trail running, hiking and rock climbing.

But Lea admits that she often feels like the odd one out:

“Sometimes I can’t help but feel insecure here (in Hollywood), it really plays with your head,” said the actress, who has now confessed to being unhappy with her looks for years, especially as she struggled to make it on screen.

“I was told by agents and casting directors that I wasn’t right for TV. I was always told I wasn’t right for TV. I was always told I was too ethic or not pretty enough or too much this or not enough of that,” she said.

Lea grew up New Jersey as an only child to her mum, Edith, an Italian American, and dad, Marc, who’s Spanish/Sephardic Jewish. She struggled to fit in at school.

“I grew up in a community where what I looked like wasn’t considered beautiful,” she said.

Pals say Lea is also haunted by memories of being bullied over the size of her nose as a child, and being rejected at auditions because of the way she looked. And friends are also concerned she will be tempted to take her transformation too far and go under the knife.

“Everyone’s worried she may well to surgery, which would be a huge shame because she’s such a beautiful girl”, revealed a source close to the star. “She looks amazing but complains there are parts of her body she doesn’t like, particularly the size of her nose and her boobs.

“She could well get a couple of things done-that would be awful because she’s stunning just the way she is.”

Lea once joked she was the only girl in her school year not to have a nose job and she has also hit back at the running joke on Glee about the size of her breasts. The actress confessed: “I mean, they’re not that big but they always talk about how small they are.”

Insider also says that she worries about her outer thigh area and could be tempted to use Cynosure-Triplex laser to contour her already amazing figure.

We think Lea looks incredible on the red carpet. Let’s just hope she can finally put her demons to be and embrace her beauty.

Read more at www.lmaclinic.co.uk

Graving glowing skin? Good news- it’s possible to pep up your complexion and banish fine lines and sun damage at the same time with an amazing new ice-cold laser from the States.

Cynosure- Performa CO2 uses a new laser frequency which makes it super powerful and massively effective for targeting heavy-set wrinkles, even smoothing acne scarring and fading pigmentation from sun damage. And because it uses an air-cooling system before and after the laser, there’s less bruising and redness. The laser strength can be adjusted to suit each person’s skin type and what’s more, it helps stimulate new collagen to give you plumper skin for at least three years. It cost from &400 – visit www.lmaclinic.com

London Medical & Aesthetic Clinic

SECRET WEAPON: LASERS

What it is: Laser lipo has been around for a while, using heat to melt fat cells which can then be extracted via a tiny incision. Large fat cells resisted this as the laser couldn't safely get hot enough to deal with them. The Cynosure-Triplex laser uses three wavelengths to break down these tough cells, which can then be melted and removed.

Our tester says: ' I was awake during the procedure, but was heavily sedated and didn't feel any pain. The doctor made a tiny incision (there were no stitches and three months later there's no trace of it) and inserted a metal bar to laser the fat, which was then sucked out through the same hole. There was no recovery time- I'd booked the next day off in case but felt so perky I went shopping. There was an instant difference to my hips and back. My stomach initially looked bigger due to swelling but that went in a couple of weeks.'

Best for: Those who need a major kick-start over a large area, but don’t want the pain or recovery time of traditional lipo.

What is it?

Mentoplasty, sometimes referred to as genioplasty, is a type of cosmetic surgery used to reshape the chin to make it either more or less prominent via augmentation or rounding.

What does it involve?

Chin reduction, carried out under general or local anaesthetic, often involves making an incision and either removing some of the bone or repositioning the chin forward, backwards, upwards or downwards and securing with screws or wires. Making the chin more prominent or lifting a drooping, aged chin often involves inserting an implant under general anaesthetic and securing it using sutures or a small metal screw. Usually an incision is made in the lower gum of the lip, so it’s hidden inside the mouth. The chin may be strapped for several days and bruising or swelling may take a number of weeks to subside. Prices for this type of chin surgery start from around £4500 at the London Bridge Plastic Surgery.

Are there any non-surgical procedures?

Dermal fillers that are either collagen-based (Evolence, for example, is derived from pigs tendons) or hyaluronan-based (Restylane, for instance) can be used for non-invasive reshaping and contouring. A local anaesthetic is first applied to ensure the treatment’s as comfortable as possible before the fillers is injected into specific point of the chin to improve the shape, profile, projection and symmetry. This procedure typically only takes around 15-20 minutes. Evolence fillers tend to last for round 12 months while Restylane last for 6-10 months, after which you can have top-ups.

Is it painful?

Relatively pain-free with minimal discomfort.

How much do the treatments cost?

Prices for injectable fillers range from about £200-£800depending on what is being used, how much of the filler is injected and the area being treated.

Are there any alternative that are longer lasting?

Dr Ayham Al- Ayoubi, medical director of the London Medical & Aesthetic Clinic (LMA), recommends injectable fillers, such as Ellanse, for the chin. The results are instantaneous but get better and better after three to four weeks, and can last a total of four years – longer than traditional dermal fillers. He also offers Sculptra, a bio-stimulator for the face typically used for anti-ageing, wrinkles and acne scarring that can last for up to five years, with more gradual results.

Tips for getting your chin reshaped

Do your research and discus at length the choice of fillers available to you. While hyaluronan (hyaluronic acid) filler will only last for around six to nine months, they look natural and can be removed with hyaluronidase if you’re not satisfied with the final outcome. Facial fillers of this kind should never be used by mothers who are breastfeeding.

If you have saggy jowls or a severe double chin, consider a minimally invasive, non-aggressive procedure such as Cynosure’s SmartLipo Triplex which can be performed without general anaesthetic and won’t require stitches or create much bruising, if any at all. Priced from around £2000 at the LMA clinic in London.

Sometimes a nose job complements chin augmentation as it rebalances facial features. London’s Knightsbridge Laser Clinic offers a 15- minute non-surgical rhinoplasty involving the injection of hyaluronan filler for around £350.

CHEMICAL PEELS

What are they?

Resurfacing agents used to remove the top layers of aged and a damaged skin, to open the pores and stimulate collagen production. Peels are typically used on the face, neck, chest, hands and arms, and are also used to treat skin complaints such as uneven pigmentation and fine lines. Peels come in three different strengths: mild, medium and deep.

What does a peel involve?

A solution- often a prescription-strength trichloroacetic acid- is applied to the skin by a qualified dermatologist. The solution exfoliates the top layers of cells, causing them to dry on and peel off over a period of severe days. This exposes a new layer of undamaged skin, which has a smoother texture and more even tone. It also stimulates collagen and elastin production, making the skin look younger and fresher. A full face peel takes around 15 minutes. Depending on which strength of chemical peel is recommended to you, this may vary from a one –off deep peel to a course of several medium or mild peels. When applied, you’ll experience a burning, tingling sensation for around two to three minutes.

Is it painful?

Deep peels can take three to four weeks of recovery: few people choose this option as there’s risk of scarring. Medium and light peels are relatively painless, but the skin may look sunburn with itchiness and occasionally blisters.

What’s the downtime?

Most people take several days to heal from a medium peel, which usually requires two sessions every four weeks. If you’re self-conscious about your appearance, you may wish to stay at home or opt for a light peel that requires three to six visits over the course of around six months.

How much do the treatments cost?

Mild peels start from around £100 with at least three sessions required. Medium peels at the LMA cost from £850 for two peels plus reviews and home kit.

Any alternatives?

Other resurfacing procedures include microdermabrasion, which uses a stream of crystals or a diamond-tip wand and suction to exfoliate the skin. Also consider new lasers such as the Performa CO2 laser, manufactured by Cynosure and launched in November. Dr Ayham Al- Ayoubi, medical director of the LMA, says one treatment, priced around £400, can have noticeable results.

Tips for facial peels

Anyone who has had a peel is more sensitive to sunlight for at least six to eight weeks afterwards, which is why winter is a good time to consider the treatment. Whatever the season, you should use a sunscreen that blocks both UVA and UVB rays and has an SPF of 20 or more.

Don’t mix and match chemical peels with microdermabrasion due to the ‘double-peeling’ effect.

Don’t have a chemical peel if you’re pregnant or breast feeding.

For a less harsh natural treatment, opt for a glycolic acid peel made from fruit acids or alpha hydroxy acids (AHA) derived from sugar. Popular natural peels performed at salons include The Organic Green Peel (around £300) using pure plant ingredients and herb without chemical additives.

It is no exaggeration to say that over the past year, the former Mrs Ashley Cole has become the nation’s sweetheart, with the press poring over her every move. And whilst there is no denying that Cheryl is beautiful, there is one aspect of her face that would not always have been considered so desirable.

Dr Ayham Al-Ayoubi, of the London Medical & Aesthetic Clinic, says he has a method to create dimples without the use of a scalpel.

“If you know facial anatomy very well then it is possible to create an impression of a dimple through non-surgical means. My background as a facial plastic surgeon means that I’m well equipped to do this.”

“First I ask the patient to perform a series of facial manoeuvres such as clenching and smiling, and study the face to see where the muscles are and how they move. Then I know where to put the dimple.

“I then inject filler called Ellanse around the area to create a circular ring deep into the dermis so it doesn’t create any lumps- an indentation forms in the middle of the ring that mimics the impression of a dimple. If you do this with HA fillers they will dissolve with the facial movements, whereas Ellanse will become more defined with the process of inflammation.”

Dimple me up:

www.lmaclinic.com

Nothing stays in the beauty biz. Mr Ayham Al-Ayoubi of the London Medical & Aesthetic Clinic explains how Cynosure, suppliers of the latest SmartLipo MPX laser, has responded to the demands of both practitioners and patients to create Triplex, the next generation laser with even greater fat removal and skin tightening capabilities

1^st generation

I introduced laser lipolysis into the UK IN 2006. The very first machine was based on one laser that targeted the fat cell membrane; the cell was fractured and it drained out of the lymphatic system. These procedure great results in small areas, but it also had many limitations.

It actually produced bad results when used on large areas and it took a long time for the fat to dissolve so you weren’t providing the instant results that patient demanded, and you were also relying on the patients to stick to a strict diet and exercise regime to produce the best outcome.

To combat some of these problems, I introduced gentle suction to the procedure to remove about 40 to 50 per cent of the fat.

2^nd generation

In 2008 Cynosure launched the SmartLipo MPX. This consisted of two lasers; one targeting the fat cell membrane and one that targeted blood vessels and water.

This introduced a significant amount of controlled heat to tighten the skin so practitioners were now able to do multiple or large areas.

“It is possible to get tissue tightening of up to 62 %, which is more than any other laser on the market”.

3^rd generation

I n terms of the patients who present for this procedure, there became a need for a more powerful machine to tackle large areas of fat. However, the problem with any laser treatment is that you have to introduce heat. The more powerful the laser, the greater potential to overheat the tissue and that can cause burns. So the risk here was to introduce another wavelength that didn’t produce heat.

 The Triplex machine is composed of three lasers; the first laser targets the fat cell membrane, the second targets blood vessels and water, and the third tackles the fat tissue itself. The third laser works on a cold laser wavelength so you’re able to melt the large fat cells without introducing any extra heat.

This is great for patients who are unable to diet and exercise and it is possible to treat up to a dress size 18 or 20, but you have to explain to patient that they might need two sessions and you must definitely combine the procedure with gentle suction otherwise it won’t give great results.

Take it from me

It is important to realise that the suction we apply after the laser lipolysis procedure is different from traditional liposuction, which can be very aggressive.

To perform fat removal without the application of energy, either in the form of laser, radiofrequency or ultrasound, you usually have to insert fluid and hen suck out the fat and fluid together.

With traditional liposuction there is no increase in temperature so this is solid fat couple with quite a lot of blood. The downsides of traditional liposuction are that it can cause bruising, is usually quite painful and you have to wear a pressure garment for the next four weeks to avoid a build-up of blood or fluid.

By using laser or any other form of energy, you are fractioning the fat cell membranes, heating the fat tissues, stopping a lot of the bleeding that occurs and you’re not damaging the nerve tissue as it is not affected by laser wavelengths.

The voice of experience

Cynosure has introduced two very important safety precautions to assist practitioners and make the procedure as safe as possible for patients.

Firstly, SmartSense; this is a special sensor which measures the energy applied every microsecond. If the movement slows down the machine will cut out, so you don’t apply too much energy in one particular area. As well as ensuring the tissue isn’t damaged, SmartSense also means that equal results are produced all over, which is very important when you’re doing a large area.

The second safety innovation is the ThermaGuide. This is a microsensor that sits in the tip of the cannula and measures temperature. It alerts the practitioner when you’re approaching the maximum temperature and the shuts off laser output when a higher limit is reached.

Cynosure works hand in hand with clinics and hospitals so they know what their needs are. However, I would still advise practitioners that they gain experience in smaller areas before tackling large areas.

They have to be knowledgeable of the body’s different fat structures; the fat that is present in the hips, lower back, under the chin and arms is different to the fat situated in abdomen. They also have to be aware that women may have had previous operations or caesareans so there may be scar tissue present in the abdomen.

The market leader

The skin tightening capabilities of Triplex are great because you have three lasers firing at the same time; studies have demonstrated that it is possible to get tissue tightening of up to 62 per cent, which is greater than any other laser on the market. Bodysculpting is now the most requested procedure in my clinic and it is fantastic to be able to offer my patients what I consider to be the safest and most effective treatment.

Triplex: three lasers, three benefits

The unique combination of three different lasers in one machine means that Triplex can tackle a range of different problems from smaller areas within one treatment.

 CS&AG

Available from: For more information on Cynosure and their lasers visit cynosureuk.com or call 01628522252. For a full list of all the procedures that Mr Al-Ayoubi performs and to book a consultation with the London Medical & Aesthetic Clinic visit www.lmaclinic.com or call 020 8342 1100

In recent years she has been as famous for her age-defying appearance as her acerbic put-downs. But time seemed to have caught up with Anne Robinson as she stepped out last week.

Wearing a fur coat, the television presenter looked less than fresh-faced. And although she appeared younger than her 66 years, lines were clearly visible around her eyes and mouth.

The Weakest Link and Watchdog presenter was characteristically frank about the £9,000 facelift which transformed her appearance six years ago, saying: ‘Anything that allows women to feel better about themselves is worth the money.’

She admitted to maintaining her wrinkle-free look with regular Botox injections but has laughed off reports of further surgery to turn back the clock, saying it would be ‘unfair’ to women her age if she had a second operation and denied it. Two years ago, she also denied having fillers injected into her upper lip to make it fuller after she was pictured with the lip appearing suspiciously plumped up.

According to experts, her latest look – spotted as she walked down the street in Knightsbridge, West London – is just a classic long-term effect after having a facelift.

Surgeon Alex Karidis said: ‘Anne’s face has loosened since her surgery, which will always happen. A facelift will tighten the skin and lift the muscles, but afterwards it will only remain as tight as the skin will allow. Skin continues to age after a facelift, loosening and sagging as people age.

‘She also looks a little strange around the mouth area, which I think is the result of injectable fillers around her lips.’ Surgeon Ayham Al-Ayoubi added: ‘It looks like some of her soft tissue was removed along with skin during her facelift, and now she has lost more collagen through ageing.’

A former alcoholic, Anne gave up drinking in 1978, and says she has not smoked for more than 20 years.

Her efforts to remain youthful include a strict exercise regime and organic diet. She divorced her second husband John Penrose in 2007 after 27 years of marriage. She returned to Watchdog in September last year, having fronted the programme for eight years until 2001.

Expert worry the star could be on the brink of ruining her natural beauty wit one treatment too many

She’s one of Hollywood’s most stunning actresses, but Jennifer Aniston has been told she risks throwing it all away by having more plastic surgery. The actress, 41, has admitted to a nose job, but it’s rumoured she’s had not one, but three boob jobs, and she is now considering having a face-lift, brow lift and further breast augmentation to shape up to nude scenes in her raunchy new movie Wonderlust.

Tellingly, Jennifer revealed earlier this year: “Those lines are getting deeper every day!”

According to her close pals, the strain of working in an industry obsessed by youth and looks is taking its toll. They fear Jen may risk her girl-next-door good looks in the quest to keep up with her younger actress rivals.

“Jen has been complaining about having a wrinkled cleavage from sunbathing,” an old friend tells Look.” So she wanted her breasts enlarged by one size to make them look firmer on camera, but we told her that they looked amazing already.

“Then again, she’d only ever consider very natural-looking work, as she is one of the most naturally beautiful stars in Hollywood.

“Jen first discussed having a boob job shortly after she landed the part of Rachel in Friends in 1994. At the time, she was really worried about her looks and lost 20lb, which left her flat-chested.

“Then, after she split from Brad Pitt in 2005 and Vince Vaughn, we believe Jen was left feeling insecure about her looks and we heard she went to see Hollywood surgeon Dr Raj Kanodia to talk about the possibility of having something else done. “

According to Look’s plastic surgery expert, Dr Ayham Al-Ayoubi, medical director of the London Medical and Aesthetic Clinic, these conversations may have borne fruit, too.

“In my opinion she looks like she’s had a breast augmentation,” says Dr Al-Ayoubi. “If you look closely at the inner cleavage, that side of her breast looks more prominent and defined than it was. The distance between her nipples and the centre of the inner cleavage also seems much bigger.”

The star has also admitted trying Botox, but claims she used it once and didn’t like it.

Despite this, it’s rumoured that Jen has regular courses of “Botox light”, which involves having small doses of Botox injected every two months, so she gets the benefits of wrinkle-free skin, but can still move her face.

At the same time, a close friend of Jennifer’s- who has known her for over 15 years- confesses that she’s no stranger to other non-surgical cosmetic trends doing the rounds in LA either, saying: “She gets facial peels before she has a red-carpet event.”

After analysing Jennifer’s face, Dr Al-Ayoubi agrees: “I think she may have had skin laser resurfacing, which is very popular in the US, as the latest generation of Performa lasers are gentle and allow you to function the next day. Previously, you were out of action for at least four days- often longer.

“This laser improves the skin by stimulating the patient’s own collagen. It looks like she’s had this done under her eyes because it’s brighter there, which you can’t do with make-up.”

Dr Al-Ayoubi also thinks Jen may have had a face-filling injection known as a Sculptra, which smoothes deep lines and restores facial volume.

“When she smiles, she still has large, defined cheekbones,” he adds. “Plus, it looks like she has had some Botox in her forehead as she literally has zero lines above her eyes when she smiles.

“I believe she has had something done to her upper lip, too, because there is a line of definition that stops halfway through the upper lip, and then starts again. That suggests she’s most likely had some gentle fillers applied to the edge of her lip.”

Just like Jennifer’s friends, Dr Al-Ayoubi believes Jennifer has now reached the position where she needs to stop before it’s too late.

“She is at a turning point where any more treatment will ruin her natural beauty,” adds Dr Al-Ayoubi.”She looks beautiful at the moment. But id she has more work, the public will start to notice.”

The question is whether Jen can fight Hollywood’s peer pressure and obsession with youth for the rest of her life.

“It’s very hard to find anyone in Hollywood who doesn’t have some form of plastic surgery these days “adds Jen’s pal. “They all have over-tight foreheads and big puffy cheeks. Instead of looking younger, they just look like they’ve had too much plastic surgery. It would be terrible to see Jen do the same, as she looks fantastic and everyone marvels at how she looks better now than she did 10 years ago. I think ultimately, she realises it’s better to look as natural as she can, even if that means embracing the odd wrinkle here and there.”

We just hope it stays that way.

We love the way you look, Jen!

'Pillow face' is the curse of skin-plumping treatments. So the arrival of a new, gentler midi filler that actually promotes collagen growth for a natural result is causing a major buzz in the beauty world.

Dr Ayham Al-Ayoubi says, 'Ellanse stimulates collagen growth for up to four months after treatment. Then the filler is absorbed and passed out of the body, leaving no residue. Because you grow your own collagen, it's a very natural look — no "pillow face"!' The filler plumps sagging cheeks, rehydrates the skin, fills out dark circles and smoothes wrinkles. And it's safe, too: water-based Ellanse contains poly-caprolactone (PCI), a soft medical polymer that has been used for decades in medicine. It has passed safety tests to become approved by the tough US Food and Drug Administration.

Dr Al-Ayoubi says this is the perfect time to try Ellanse. 'Dermal fillers mean you have to avoid the sun, but dull autumn weather is great for a speedy recovery.' Because Ellanse lasts for up to five years, it's vital to find a doctor who is very experienced with fillers and can help you achieve a natural look.

From £500, www.Lmaclinic.com

It's not just Stephanie who's sporting a fuller bust

She is widely acknowledge as one of the most slender actresses in Hollywood so we were a little confused when Renee Zellweger was spotted out in Santa Monica with noticeably larger breasts. But she doesn't appear to have gained any curves elsewhere. Has our favourite former singleton treated herself to a cheeky boob job as she prepares to marry her actor boyfriend Bradley Cooper?

"Renee was a perfectly respectable 34B, but she wanted a boost for her wedding day," reveals a source close to the 41-year-old actress. "And it looks as if she has taken the plunge. She's already started updating her wardrobe with clingier tops and wrap dresses to flatter her new figure. She's already started updating her wardrobe with clingier tops and wrap dresses to flatter her new figure. She's happier than ever and it's shows."

Plastic surgeon Dr Ayham Al-Ayoubi thinks the actress has gone under the knife:"I think she's probably had breast augmentation, because her breasts are projecting forwards and it's unlikely a change of bra would produce such a dramatic change in shape," he said > Renee, who has been dating Hunky Bradley for almost a year, is notoriously proud of her slender frame and is said to be relieved that plans for the third Bridget Jones film have stalled because she said found fattening up for the role "horrible".

The actress maintains her lean physique with strict diet and gruelling workout regime, which regularly sees her running in the punishing LA heat. Sources say her dedicated dieting could be the reason she has turned to implants, "Renee decided her breasts looked saggy and as a result was considering implants," the source said. "Her thinking was that they'd create a more womanly shape. But a good bra can also given an amazing boost, so maybe she's just bought some padded underwear!!

"Whatever the case, Renee looks great. She has a gorgeous boyfriend and a gorgeous figure."

The star, who has previously dated Jim Carrey and was briefly married to country singer Kenny Chesney, hooked up with Valentine's Day star Bradley in 2009. He moved into her Bel Air mansion earlier this year, and the couple have been inseparable ever since, with rumours of a wedding set for early next year. Should we buy a hat?

Yet another star from The Hills decides to enhance their assets by going under the surgeon’s knife

It looks like Stephanie Pratt has taken a leaf out of her sister-in-law Heidi Montag’s book and paid a visit to a plastic surgeon. We spotted the Hills star with a significantly fuller bust last week, suggesting she’s had a little surgical help.

Wearing a plunging black corset top teamed with a gorgeous metallic jacket to the Cirque du Tacori event at the Viceroy Hotel in Santa Monica, her suddenly ample bosom was on full display.

“Stephanie has been known to take dieting to extremes,” said a source. “And she’s always complaining about her boobs disappearing when she loses weight. She talked about a boob job being the answer, so maybe she decided to finally go for it.”

Dr Ayham Al-Ayoubi, medical director of the London Medical & Aesthetic Clinic, thinks Stephanie has definitely gone under the knife. “She has had a boob job because her inner cleavage is more defined- it’s asymmetrical now,” he says. “You can see that her right breast looks very straight and the left is curved- she has more definition in both breasts. I think she has gone with silicone and a breast augmentation.”

Stephanie, 24, joined the cast of The Hills during season three in 2007 to star alongside her brother Spencer. She has since told how appearing on the hit TV show led to her feeling insecure about her body and admitted she has suffered from bulimia.

“I was horrified,” she said last year. “I remember saying:”I can’t believe how huge I look walking over to Lauren. “The producers never put pressure on us to lose weight, but its embarrassing working with skinny girls.”

Stephanie isn’t the only star from The Hills to boost her assets dramatically since appearing on the reality show, which ended in July. Audria Partridge and Kristin Gavallari have been accused of having boob job, although they both deny having work done.

And Stephanie has always been supportive of Heidi having a nip and tuck, even when she had 10 ops in one day. “If she feels better, I’m so happy. When a woman feels good about herself, that’s the best feeling,” Stephanie said.

But pals are worried she might go too far like Heidi. “Stephanie loves her new figure,” our source said. “But let’s hope she doesn’t have so much work done that she doesn’t look real any more. She looks lovely as she is”.

She admitted having a nose job in the past, but has Cameron Diaz taken cosmetic surgery a step further?

She is universally considered one of Hollywood’s most beautiful actresses, but Cameron Diaz was almost unrecognisable stepping out on the set of her new movie last week. With a swollen face, the 38-year-old star’s famous cherry grin and fabulous cheekbones were nowhere to be seen.

The actress, who is in LA filming new romantic comedy Bad Teacher alongside her ex-boyfriend Justin Timberlake, was learning her lines on set when these Shocking Photos were taken. With her boyfriend of eight months, baseball star Alex ‘A-Rod’ Rodriguez, in New York playing for the Yankees, Cameron was looking far from her usual cheerful self, but never before has her face looked so puffy.

Insiders say that like most celebs she’s determined to stay looking young and sexy, but her strangely plump face suggests she’s fallen victim to the ‘pillow face’ look, a cosmetic procedure popular with the Hollywood A-List, where fillers are used to give the appearance of high cheekbones. A source said: ‘’ Her face looked very different. Cameron usually has such a glow about her and such a gorgeous big smile. But on set her face looked very bloated and swollen d her cheeks looked much more pronounced.’’

Cameron has been open about having a corrective nose job, having broken her it several times – the last of which was in 2006 in asking accident. ‘’S**t just finds my face – it’s crazy!’’ she admitted last year. However, the star has always said she would be reluctant to go under the knife for the sake of vanity, insisting she is happy to age naturally. ‘’I don’t have a problem with growing older,’’ she said. ‘’I really don’t. It’s wonderful. Thanks God we get older – because if we’re not getting older, we’re dead.’’

But judging from this latest public appearance in LA last week, Look’s expert suggests she may have changed her mind and started to use fillers.

Dr Ayham Al-Ayoubi, Medical Director of the London Medical and Aesthetic Clinic, explained: ‘’In my opinion, based on experience and those pictures, it looks as if Cameron underwent a dermal filler injected into the cheeks – most likely hyaluronic acid, which is naturally occurring substance in your skin that helps add volume and hydration.’’

So why does it look as though her face has somewhat sagged?

‘’In my view it wasn’t injected high enough on her cheekbones,’’ says Dr Al-Ayoubi. ‘’It looks as if her face has slightly dropped and it has deepened her nasolabial fold [the two creases that run from the bottom of your nose to the corners of your mouth]. It’s likely they put too much in.’’

Dr Al-Ayoubi has seen similar case where fillers have been injected too low in the cheeks. He added: ‘’This is very common treatment , but in this instance it look as if they haven’t injected the acid correctly , making her face look puffy and actually older than she looked before. This is one of the unfortunate side effects when you put large amount of hyaluronic acid or dermal filler in the wrong part of face.  Thankfully, the effect shouldn’t last too long – her face should be back to normal within a few months.’’

The treatment costs up to £800 in the UK, depending on the type of filler used. It’s usually a one-off session, lasting no more than 30 minutes, giving instant results with no scars or bandages. If Cameron has indeed had the procedure, it’s rare for patients face to seemingly ‘drop’. Dr Al-Ayoubi says if the treatment was done properly, patients can go back to work straight after.

Thankfully, if Cameron wanted to reverse the procedure, Dr Al-Ayoubi says it’s possible: ‘’If Cameron came to my clinic, I would firstly try to sort out the prominence of her cheeks,’’ he says. ‘’I’d strongly recommend a long-lasting, clinically proven non-invasive stimulating injectable treatment designed to smooth out and soften soften lines and wrinkles, restore facial volume and contour the face in a natural way. Othervise fillers like the type she seems to have had in her cheeks would need to be regularly maintained every few months.’’

Cameron’s friends say they support any procedure she may want, saying she s under huge pressure to appear youthful and is much more afraid of ageing than she lets on. ‘’Believe me, Cameron knows her time as a sexy young thing in Hollywood is ticking,’’ reveals a source. ‘’Her work is based on looks. Yes, she’s a great actress, but roles are few and far between for older-looking woman. We tell her there’s no shame in using this stuff to look your best. It’s really a job requirement for her. She has to do whatever it takes to stay looking young and stunning for as long as she can.’’

Surgeons say woman’s cheeks begin to sink at around age 38 as collagen production naturally starts to decline, and fillers are the latest A-list phenomenon growing in popularity due to the trend for non –invasive cosmetic surgery. The plumped –out high cheekbone look has replaced the ‘wind tunnel’ results of a facelift or the ‘frozen’ Botox look. Fillers are popular solution for slim celebrities who can appear hollow-cheeked and gaunt as they age. It also isn’t as restricting as Botox when it comes to facial movements and expressions – a common complaint among Hollywood directors such as Martin Scorsese and Baz Luhrmann, who says: ‘’Their faces can’t really move properly .’’

Like any 38 –year old actress, friends say Cameron sometimes struggles with the loss of her youthful heyday.  When she exploded onto the big screen in the mask in 1994, she was instantly claimed as one of Tinseltown’s hottest stars. ‘’It’s not easy for Cameron,’’ says the source. ‘’She‘s gorgeous and is the second highest –earning actress in the world, but it’s tough in Hollywood. There’s always someone new and hotter on the scene. She’s one of Hollywood’s most talented and funniest stars, but for any actress in her 30s, the transition from sex symbol to respected veteran actress, like Helen Mirren has made, is hard.

‘’But Cameron’s talent will always win through, and she‘ll always be gorgeous. I just hope she realises it.’’

Dr Al-Ayoubi, facial plastic and laser surgeon at London Medical and Aesthetic Clinic, (www.Lmaclinic.com), says;

Pros

Local anaesthetics can numb larger areas of the body now than they used to, minimisinf blood loss and bruising.

Locoal anaesthetics is good for tweaks rather than drastic makeovers - using techniques such as lasers for face, which give more natural results.

Cons

Some clinics offer these ops because they don't have a license to use general anaesthetics. Check out the surgeon and clinic.

It's no less risky - there could still be complications.

Eyelash extensions, injectable fillers and freckle burning are all in a day's work for this beauty adventurer.

As Elle's 'Beauty Extremist' columnist for the last two years, I've tried and tested countless cosmetic-medical treatments - from the weird to the wonderful, via the undignified and excruciating. I don't have a problem with self-esteem or body image: I don't feel pressured to conform to any kind of beauty ideal and I don't even mind getting older really. Call it reckless but I just enjoy these adventures. The desire for self-modification is surely the oldest of biological impulses, so I explore the frontiers of my vanity with fearlessness - I'll take whatever science can offer, shamelessly, even enthusiastically. Thus far, no regrets.

WEEK 1

Monday: I'm a little nervous of injectible fillers. A touch too much and it's either pillow-face or porno lips. But I agree to try out Restylane Vital - a new product which is fine enough to be used to hydrate and rejuvenate the delicate under-eye area. Dr Ayham Al-Ayoubi, who I've seen for other treatments, injects it in tiny little drops. It doesn't hurt and I don't look weird, just a bit less tired. I do develop a huge bruise, though. The Future Husband, usually sanguine about my beauty adventures, is sympathetic - until I confess it's self-inflicted. Then he calls me silly. Sometimes it's hard to argue.

Will British women really be flocking to have fatter bottoms? Dr Ayam Al Ayoubi, a Harley Street cosmetic doctor, says: ‘I have seen a 50 per cent increase in demand for Macrolane in the bottom, though it is normally South American or Afro-Caribbean women wanting it done, as the look is desirable in their cultures.

She’s no stranger to the scalpel, and, in truth, is the least likely candidate to be hailed for her beauty efforts (note the slapdash online make-up tutorial earlier this year). So when pictures emerged recently of bad gal rocker Courtney Love, 47, looking breathtakingly youthful — smooth of skin and plump of cheek — talk turned to the stem-cell facelift, an innovative procedure credited with transforming the rock’n’roll bad gal’s partied-out looks.

So how does the facelift work? “It uses a person’s own fat and adult stem cells to rejuvenate and plump their face,” says Dr Sam Rizk, the New York surgeon who performed the procedure on Love. “New PureGraft technology allows us to separate adult stem cells and fat, before injecting each into the face in different layers. Unlike a traditional facelift, which seeks to lift loose jowls and skin on the neck, this procedure addresses volume, collagen production and even discolouration in the skin.”

The tide is turning against obvious plastic surgery — the pinched nose and overinflated cheeks, once a sign of work done well, are no longer considered desirable or attractive. “The new trend is for the natural look,” says Dr Ayham Al-Ayoubi, medical director at the London Medical & Aesthetic Clinic.

“Now that we can all spot rhinoplasty from afar, your eye automatically assumes she has had everything done because she looks artificial. Now the desire is for any work to appear totally natural, invisible even.”

So could the understated effects of the stem-cell facelift be the definitive vehicle for turning back the clock? Rizk is optimistic. “It’s a significant breakthrough in our understanding of ageing, probably the biggest to date. Stem cells hold the future for anti-ageing — although we don’t fully understand their mechanisms yet, we can see the beneficial effects.”

Still in its infancy, the procedure carries with it a serious risk.

“There is no official clinical study into the stem-cell facelift,” Al-Ayoubi warns. “I’m reluctant to perform any procedure where I don’t have 100% control. If there is a reaction, there is no way back.”

Indeed, just how perilous such procedures can be became apparent when the National Confidential Enquiry into Patient Outcome and Death recently published a report that found, shockingly, that more than half of those offering complex surgeries, such as breast reduction, perform these operations fewer than 10 times a year. Nigel Mercer, president of the British Association of Aesthetic Plastic Surgeons (Baaps) says: “There is an absolute need for statutory regulation in this sector. Aesthetic surgery needs to be recognised as the multi-million-pound speciality it is and not just a fragmented cottage industry. Your cosmetic practitioner should be a fellow of the Royal College of Surgeons, and have further specialised studies in plastic surgery. Check that they are on the General Medical Council specialist register, and a BAAPS member.”

For all the cowboys out there, though, there are surgeons who can be trusted.

And with them, they bring some promising new procedures that not only aim to deliver results, but do so with a minimum of pain and recovery time. Make sure you’re with the good guys.

CHIN IMPLANT

The current Hollywood obsession, this procedure elicits the most “Has she, hasn’t she?” comments, directed towards, among others, Megan Fox, Chelsea Clinton and Lindsay Lohan. Despite its relative subtlety (a good chin job will go unnoticed), it can completely transform the dimensions of the face to create a more classically attractive appearance. “I’ve seen a 25% increase in demand for chin implants recently,” Al-Ayoubi says, “mainly because there is a new, less invasive procedure that involves inserting a small, manufactured silastic product into the chin. The previous implant used cartilage taken from the patient, but it was a big procedure with a long recovery time.” The consultant plastic surgeon Lucian Ion agrees. “I’m very much in favour of chin implants, but I don’t use silicone ones. There is a fair amount of evidence that they erode the bone underneath.”

Al-Ayoubi says there is a growing tendency to use dermal filler to inject into the chin. “I use hyaluronic acid, which is already present in the body, so reduces the risk of reaction — you can inject large quantities safely. The statistics show that 70% of chin patients are going with fillers now. Only those with a severely retracted chin bone were opting for the implant.”

No matter how exotic the location, Henrietta Callum always looks the same in her beach snaps. The 26-year-old telesales executive from Southampton sports a bikini top – but with a sarong to cover her hips and thighs.

CELLULITE

What is it?

For many women, cellulite is one of the biggest bugbears with the dreaded orange peel look particularly affecting thighs, buttocks and the stomach. Caused by a combination of water, fat and toxic waste, the body is unable to eliminate, the septae (fibrous bands of connective tissue) stiffens and pulls down, creating a dimpling effect.

Are there any non-surgical remedies?

The good news is most cellulite treatments are virtually painless. The bad news is there doesn’t seem to be a universal cure. One of the latest products is The Vacustyler, a chamber that removes atmospheric pressure and returns it in rhythmical cycles. Developed by NASA to improve the circulation of astronauts in zero gravity, it's been adapted to reduce cellulite by stimulating the lymphatic system.

What does the treatment involve?

Lying on a bed, your lower body is placed in the chamber. After 30 minutes you complete a short Power Plate session. Powertone Studios in London say two sessions a week can improve cellulite and also reduce the appearance of spider and varicose veins.

Is it painful?

Not at all.

How much does the treatment cost?

From £35 per session. Ten sessions cost from £295.

Are there any alternatives?

VelaShape combines bi-polar radiofrequency, infrared light energy, plus vacuum and mechanical massage to manipulate and smooth the skin reducing the appearance of fat tissues. A combination of VelaShape and more holistic lymphatic drainage massage, is also available The London Medical &Aesthetic Clinic (LMA).

CONTACTS

www.Lmaclinic.com

We headed to The London Medical & Aesthetic Clinic to trial a serious cellulite shifter that is proven to oust the orange peel effect by tightening and toning your tush

Other than cellulite creams, of which we spend a whopping £56 million on a year according to research, there's not a lot we can do to blitz those dimples on our derrieres, right? Wrong. If you're serious about transforming your tush and have the cash to splash at it, we've found a treatment that delivers results.

 Cellulite is one of those pesky problems that are near impossible to avoid - it's thought that over 80% of women aged over 20 have it regardless of weight or size. It is graded by visibility, grade one being invisible and grade four being clearly visible when standing and lying down.

 In my consultation at The London Medical & Aesthetic Clinic the doctor told me I had grade two on my bum (it wasn't visible when standing but you could see an orange peel effect when clenched or pinched) and none, yet, on my legs and stomach - also common areas to find cellulite.

 Whilst mine wasn't at all severe, my behind has always been one of those cover-up areas and with my girlie holiday looming any help to boost bikini confidence was welcome.

 I have used tush toning creams daily for years and certainly believe in their benefits. Whilst they help promote the surface - tightening the skin, increasing lymphatic drainage, they can't realistically break down deeper fatty deposits which cause the orange peel effect in the first place. However the daily massage application, I believe, helps and I continued to use them in conjunction with this treatment.

 The clinic I visited uses a Velashape which is essentially a machine emitting radiofrequency or light energy to heat the skin and increase oxygen diffusion in cells.

 Whilst you're lying on your front the doctor massages the hoover-like device over your behind which works to flatten out the fatty deposits, shrinking the cells by increasing the metabolism of stored energy to leave a smoother area for the surface.

 Although the treatment's non-invasive it's definitely not the most comfortable experience. I had four 15 minute sessions, roughly a week apart, and during each treatment I cursed myself for forgetting to take some pain killers beforehand. The suction is powerful and sometimes pinches, subsequently I had slight bruising after one session and was advised to take Arnica to help rid it quickly. Neither the pain or the bruising were enough to put me off though - the treatments were quick and, I came to realise, totally worthy of the ‘no pain, no gain' tag.

 Whilst I needed more treatments than initially advised (after the third I was told a forth would make it ‘perfect' and that I should come back in six months for ‘maintenance'), the results were noticeable. My now ‘grade one' bum felt smoother, less bumpy and lifted and I was totally comfortable bearing my perkier posterior in a bikini - a first for me.

 I would definitely recommend it to anyone who is really serious about ousting the orange peel but remember it doesn't come without a price and some pain.

 Prices for The Bikini Body Booster at The London Medical & Aesthetic Clinic (0208 342 1100) start at £150 per session. See more information and more before and after examples like the one pictured at lmaclinic.com

Keepin up appearances

As we age, gravity starts to work against us as everything ­faces, bottoms and breasts - start to head south. Dr Ayham AI-Ayoubi of the London Medical & Aesthetic Clinic, one of the UK's leading laser surgeons, introduces a brand new concept in breast reshaping utilising cutting-edge laser technology

Although breast augmentation is the most requested surgical procedure in the UK, many women actually need a breast uplift to regain the youthful shape once age, pregnancy or weight loss has impacted on their cleavage.

That sinking feeling

In your early thirties you begin to lose elasticity as levels of collagen and fibroblasts in your skin begin to deplete. Pregnancy and breast feeding can make process work much faster it is very rare to see a woman who has had children has escaped intact.

Weight loss is another factor that contributes to sagging breasts as you commonly lose fat from the face first, secondly from the breasts and, only then, the buttocks. There is also a hereditary element - if a mother or grandmother has a tendency to sagging breasts it is very rare for a woman to avoid her genetic fate.

The surgical option

Breast uplift (also called mastopexy) surgery is usually required to correct this problem but it is a very serious operation that often results in more extensive scarring than results from breast augmentation procedures. During the operation, the breast is lifted by removing excess skin, tightening the muscle and recontouring the breast. The nipple can also be repositioned to a more aesthetic position. The advantage of surgery is that it can deliver great - and permanent - results. In about 60 per cent of cases, implants are inserted to ensure a permanent shape.

But there are disadvantages; this is major surgery under general anaesthetic and the recovery period is tremendous ­three to four weeks of total rest. It is also not suitable for women who still wish to have children so it is usually done on older patients.

Another problem is the risk associated with all major surgery, such as infection or scarring, which is often a big stumbling block for women contemplating this procedure.

Over the years, surgeons have tried many different techniques to improve breast uplift and surgical techniques are continually evolving. Smaller incisions were attempted but the problem is that the more you try to lessen the scar, the less you're able to achieve in terms of the uplift

The energy effect

A small incision is made under the arm, which will not be visible afterwards, and then the patient lies on her side and we insert a small amount of local anaesthetic. Laser energy is applied, piercing the fat cells in the deep fat without damaging the tissue and then the setting is changed and we target the superficial fat under the dermis. By applying a large amount of laser energy we can produce a skin tightening effect through the process of inflammation and this lifts the breasts.

I have done 38 cases so far and I have managed to achieve a lift between a minimum of three cm and a maximum of six cm, With the patient in an upright position, I measure the difference between the nipple and the clavicle bone -I measure it before the procedure, straight after, three weeks later and, finally, three months on, In most case, a lift of approximately 2 cm is achieved immediately and then further lifting takes place over the next few months.

Safety rules

I use the Cynosure machine because I like to deliver the best to my patients. It is a very safe laser with special devices that protect the patient; Smart Sense measures the amount of energy used so even an inexperienced surgeon cannot introduce too much laser energy that could cause burns or other side effects. Another safety feature is the thermal guide - at the end of the cannula a thermal device measures the temperature under skin so the moment you reach a certain temperature the laser cuts out.

Achieving symmetry

Two patients presented with difference in nipple height and we were able to achieve symmetry by introducing more laser energy on the side that needed it, In terms of ensuring balance for patients where there is no pre-existing asymmetry, this is not possible to guarantee 100 per cent, We introduce the exact same amount of energy to both breasts to ensure the breasts are raised to the same degree but sometimes tissue can react differently. I did have one case where there was a small difference present at three weeks, but the patient hadn't even been aware of it herself and at three months it had corrected itself.

Long-term forecast

I have been doing the procedure for fifteen months and all my patients still have the same uplift. I believe the results should last for a few years unless pregnancy, breast feeding or further weight loss occurs. However, what is great about this procedure is that it can be repeated.

This is a great procedure for younger women and can achieve fantastic results for women with an A to C cup, With much larger breasts it can have some effect but for them a breast uplift/ reduction surgical option is probably best. As always, patient selection and the consultation process is crucial so the patient is not left disappointed.

Available from: For a full list of all the procedures that Dr Ayoubi performs and to book a consultation with the London Medical and Aesthetic Clinic visit www.Lmaclinic.com or call 0208 342 1100

Lisa Turner, 34, an advertising account manager from Windsor, had Macrolane injected into her bum this year...

"I'd always loved my bottom because it was voluptuous like J.Lo's. But, after I had a baby and lost two stone, it lost all its volume.

Then, at the London Medical and Aesthetic Clinic, O found out about a filler called Macrolane, which could give me a fuller bum. It didn't look too invasive so I had the procedure the following week. I took an old picture of me in a bikini and said, "I want to look like that!"

Twenty minutes later, after the injections, I walked out with a new bottom, I couldn't feel a thing because of the local anaesthetic.

Afterwards, my bottom felt tender but, two days later, I flew to Las Vegas and was by the pool in a bikini. I didn't have any bruising, and there were no scars as the needle went into the crease under each cheek.

I couldn't feel happier with the results. The top of my bottom feels bouncy and squishy, while the sides are firmer and more toned. It lasts for up to two years and, when it starts to fade, I'll be back for more."

My countdown has begun – there are just four weeks to the annual family holiday. The beach may be English, but among the South Coast yummy mummies in fashionable West Wittering, West Sussex, the pressure to look good in swimwear is no less fierce than if we were in St Tropez.

So how can I turn my white, scruffy legs into taut golden limbs worthy of promenading the beach? Let alone tame the tummy and lose a stone…

After frantic research, here are 10 new ways to get bikini-ready. My body is now a work in progress – but with all this help, it could just be enough.

See you on the beach.

Home Liposuction

Who hasn’t prayed for a machine that could melt away love handles o muffin tops?

A full liposuction cosmetic surgery costs thousands of pounds and requires a recovery period of months. But the new Evita Slimsonic “body wellness system” promises to do the same thing within the comfort of your home and at a fraction of the cost. Using ultrasound, massage and heat therapy, it claims to reduce spot fat and smooth contours. It works by targeting intense heat to shrink the fat cells that lie under the skin, melting the fat inside.

At the same time, massage stimulates muscles, and encourages lymphatic drainage to improve the skin’s appearance.

Does it get results? Cosmetic surgeon Dr Ayham Al-Ayoubi, medical director at London Medical & Aesthetic Clinic, says the methodology is sound, but the level of heat needed to work would be unbearable.

“The skin is tough,” he explains. “By the time you were using enough heat, you would risk burning it.”

The machine doesn’t produce enough heat to burn, and settings can be adjusted for comfort. The makers say Slimsonic requires daily use for about four weeks. The jury is still out on whether my curves are being tamed.

By VelaShape at the London Medical & Aesthetic Clinic

Price: £150 per session (which lasts around an hour)

Stockist: The London Medical & Aesthetic Clinic (0208 342 1100)

Best for: Stubborn cellulite on the thighs, butt and abdomen

Claim: “This breakthrough treatment is perfect to hone your bikini body and is proven to significantly improve the appearance of cellulite by tightening, toning and smoothing the skin.”

Pros: It’s pain free, doesn’t involve a needle and is actually quite pleasant. And you can feel it working. The VelaShape looks a lot like a big Dyson vacuum cleaner – but with a thousand times the suction power.

The nurse covers your “problem areas” – in my case from belly downwards – with a gel, and then runs the device over the aforementioned areas repeatedly. It works by heating the skin with light energy and infrared, which helps increase oxygen diffusion in the body. Combines with a lymphatic drainage massage, it helps shrink fat cells, break them down, and so your body can get rid of them, leaving your skin smoother, less dimply, and tighter.

Cons: You need about six sessions to see results and it helps if you make an effort to combine treatments with a mild detox – more water, less wine, fewer chips, more exercise. I only saw a difference after session number four, when I realized that my bum seemed to fit a little more comfortably into my bikini bottoms. So it’s not really an instant fix.

Verdict: There’s definitely a marked difference in the dimples (they took before and after shots to prove it) and my skin feels smoother and a lot tighter. It also helped sort the horrid water retention around my knees, which I was always paranoid about. It’s a bit of a hassle, it takes six sessions, but I think it’s worth it. I’m booking in some more, anyway.

What is it?

If your skin is less than perfect, you may dread going make-up free on the beach, but this treatment promises to give you a naturally glowing complexion. Tiny crystals are sprayed across the face to remove the first layer of skin. Next a laser smoothes fine lines by heating the skin, creating a mild inflammation which stimulates your body to produce collagen.

Pros/Cons:

Unlike other microdermabrasion/laser treatments, which can take weeks to show results, you’ll notice the difference the next day. Effects last up to six months. It may feel uncomfortable, plus you’ll need to wear SPF 50 and avoid sunbathing for one session.

Cost?

From £800 for one session.

Where can I get it?

The London Medical & Aesthetic Clinic, www.Lmaclinic.com.

Tester Verdict:

“The first stage stung a bit, and the laser was quite hot. Afterwards my face felt like I had sunburn, but it died down quickly. The next day my skin was glowing, radiant and firmer. After a few weeks, the effects faded, so I’ve been back for more treatments. I hate wearing foundation in summer, but this year, I won’t need to.”

We all want the perfect body but we also find it difficult to stick to a rigid exercise and diet regime and, even if we do manage to achieve our perfect weight, we're often plagued by stubborn pockets of fat that just won't go.

Dr Ayoubi of the London Medical & Aesthetic Clinic, one of the UK's leading laser surgeons, talks us through the history of fat reduction, from surgical procedures through to Smartlipo

The Future

Currently, Smartlipo MPX provides an alternative to liposuction and non-surgical techniques to remove fat but I feel that in the next five to ten years it will become a viable alternative to many surgical procedures, for the neck, knees, buttocks, even as an alternative to the breast lift by applying it to the area above the breast and utilising its skin tightening effect. Every week I train visiting plastic surgeons from all over the world; they are very experienced in all that liposuction and surgery have to offer, but they realise that this is the future.

Available from: For a full list of all the procedures and to book a consultation with the London Medical & Aesthetic Clinic visit www.Lmaclinic.com or call 020 8342 1100

Wrinkles. Cellulite. Even stretch marks. There’s a laser treatment to beat just about anything. So do they work - and does it hurt?

Zap! Lasers can now treat just about any beauty problem - if you can afford it

But stretch marks are only the latest in a long line of imperfections that can be zapped away by laser.

From body hair and acne to excess flab and spider veins -whatever the problem, there is a laser procedure designed to help.

A laser is an intense beam of light that can transfer its energy through the skin to a specific part of the body. The strength of the laser, and the frequency of the light used differs depending on the type of tissue it must target.

Treatments are often painful, and tend to be expensive as the machines are pricey, but Dr Ayham Al-Ayoubi, from The London Medical & Aesthetic Clinic, says: ‘I have used lasers in cosmetic medicine for more than 20 years, and you can achieve results that are simply just not possible with other technologies.

DON’T SWEAT IT

Excessive sweating can be very embarrassing and often doesn’t respond to antiperspirant - but laser treatment can end the misery.

Dr Al-Ayoubi, of the LMA clinic, uses the Smartlipo MPX laser to destroy fat cells under the skin, which also damages the sweat glands just below the skin in the armpit area providing a permanent solution.

It takes around 30 minutes under local anaesthetic and costs £2,000. There will be some pain during the procedure and swelling and tenderness afterwards.

(www.Lmaclinic. com, 0208 342 1100.)

LASER BODY LIFTS

A scar-free breast lift?

That’s the promise from Dr Ayham Al- Ayoubi, who uses lasers to get a perkier look using the Smartlipo MPX laser system.

For the breast lift, Smartlipo is used to remove fat from the sides of the upper back and just below the armpit area. The heating effect of the laser also stimulates collagen production to tighten and tone the skin, pulling and lifting the breasts.

The treatment is not suitable for bigger breasts and the result is best described as ‘subtle’:

Dr Al-Ayoubi uses a similar technique to remove fat under the chin for a neck lift.

The laser breast lift costs £2,000.

(www.Lmaclinic.com, 0208 342 1100.)

What is Botox?

Botox is actually the trade name for botulinum toxin, which is a protein produced by a specific type of bacteria. It's been used in cosmetic procedures for 20 years to reduce wrinkles caused by muscles contracting. When injected, it blocks a chemical called acetylcholine (this chemical is what causes the impulses that make our muscles contract). The Botox is injected (using a really small neddle) directly into those muscles, resulting in a localised, temporary paralysis and wrinkle-free, younger-looking skin.

'Cosmetic treatments like Botox are getting more popular with younger girls in their 20s, and one of the reasons is celebrity influence,' says Dr Ayham Al-Ayoubi, leading cosmetic surgeon for the London Medical & Aesthetic Clinic. 'It's proven to be preventative and will soften the lines you may see in your 30s and 40s, if you start using it at a younger age.' And other experts in the field agree that Botox is now being used by much younger women.

But if you're considering having Botox or if you're curious about it, here are the facts you need to know before you contemplate going under the needle...

The Pros and Cons

Pros

1- You won't need any localised anaesthetics, so you can get it done in your lunch hour and then carry on with your day.

2- Botox was first tested as a cosmetic treatment 20 years ago and has had a substantial amount of research - it's not a new fad treatment that we don't know the side effects of.

3- As well as treating wrinkles, Botox can also be used to treat excessive sweating in your armpits and hands.

4- It's not permanent, so should you feel it's not right for you, you're not committed to a lifetime of no frown lines.

Cons

1- It can reduce wrinkles from muscle contractions, but it won't reduce wrinkles caused by sun exposure. So wear SPF.

2- Relying on Botox too much can lead to your bodybuilding up a resistance to it, giving you a 'frozen' look (like you may have seen on certain celebs).

3- It's rare, but Botox can weaken muscles, which means they become too thin. You can't visibly see this though.

4- Botox only lasts for four months, meaning costly appointments a minimum of three times a year if you want to keep up with the results.

Cynosure Smartlipo MPX™ delivers fast, efficient results

Demi Moore is rumoured to have had her knees done and now with Cynosure Smartlipo MPX™ you can resolve the problem of lumpy, bumpy and dimply knees with laser knee sculpting.

Cynosure Smartlipo MPX™ Laser Knee Sculpting is the most recent application of Smartlipo technology. Fast, effient, with permanent results, Laser Knee Sculpting works by introducing pulsed laser energy through a cannula to liquefy fat, which is then removed from the body. The laser energy also coagulates the tissue, thereby sculpting body contours and tightening the skin. The procedure generally causes less bleeding, swelling and bruising than traditional liposuction, resulting in fewer complications and faster recovery.

Taking around 1 hour for the total process (both knees), the treatment takes place under a local anaesthetic which results in minimal downtime for the client. On average, around 100-150 ml of fat is removed from each knee. Many clients are advised to wear a support garment for up to 10 days after the procedure to ensure maximum results. Clients can return to work within a few days, the gym after about a week and swimming – about 10 days.

Dr Ayoubi was the first person in the UK to perform this procedure using the Smartlipo system and has completed more than 40 of these specific procedures on clients.

Cynosure Smartlipo MPX™ is the only FDA-cleared, dual-wavelength laser system, designed to efficiently liquefy fat and tighten skin through collagen remodelling.

A superior alternative to liposuction with many benefits:

·         Less bruising and swelling (compare to traditional liposuction)

·         Less downtime, returning to work the within 1-2 days

·         Improves sagging skin and cellulite

·         Immediate results

·         Local anaesthetic only

·         Single treatment areas completed in a lunch hour

·         Also targets stomach, back fat, double chins, bingo wings and “cankles” (fat calves and ankles)

Average cost of Cynosure Smartlipo MPX™ Laser Knee Sculpting: from £1700

Dr Ayham Al-Ayoubi is an ear, nose and throat specialist who practises in London

When I fly, I get a severe headache. What can I do?

You could have a sinus problem, so talk to your GP. Also, try taking decongestion drops like Otrivine before, during and after the flight, and especially before landing. Paracetamol also helps. Sinus problems may lead to ear pain while flying. A good tip is to chew gum to relieve pressure on the middle of the ear.

Let’s face it, we all have some cellulite

It’s cellulite season again — that tiresome time of year when celebrities fear the flash-bulb-up-the skirt and when magazines are fit to burst with draconian advice on how to “banish orange-peel thighs”. From dry-brushing to mud wraps to full-on medical intervention, the options are many and varied, and usually quite expensive. In bedrooms and bathrooms across the nation, countless women do that frowny-looking-over-the-shoulder thing as they gaze at the dimples on their thighs in the unforgiving morning light, sigh deeply — and prepare to part with their cash.

It is, almost exclusively, a female problem. This is because a) men are physiologically less prone to dimply fat and b) they’re not expected to show as much flesh as women. It is practically part of the contract now for famous actresses to attend all red carpet events dressed in little more than their underwear, while their male counterparts get to cover up with a well-cut suit. Under such circumstances, the reverberations in a person’s inner thighs take on a new — and disproportionate — meaning.

The truth is, very few women get past puberty without developing a bit of cellulite. Only those with extremely low levels of body fat are immune (marathon runners, for example). Unless you’re prepared to hone your physique to the standards of an athlete and never eat another slice of Battenberg, you just have to accept that bits will wobble where you would rather they didn’t.

This is easier said than done in a culture that expects all women’s bodies to be box-fresh, regardless of how many babies they’ve had or how old they are. One she passes 40, a woman is not judged by the children she’s raised or the work that she does — but by whether or not she can wear a sleeveless dress. If she can’t, well — what on earth is the point of her?

I exaggerate slightly for effect, of course, but part of me means it. This obsession with cellulite is nothing more than a way of making a person feel inadequate and worthless. It’s also an excellent revenue stream for those clever enough to convince the public that their product really works.

Personally, I’ve never found a cellulite cream that works. Last week, Biotherm’s D Code (from www.boots.com) caused a bit of a storm — but I have yet to try it, and I’ll leave it to you to decide whether you can afford £37 to find out (if you do and it works, drop me an e-mail and I’ll gladly tell the nation). There are some reasonably effective medical treatments, such as Velashape (a vacuum heat treatment), but they tend to be very expensive, not to mention sometimes painful — and the results vary wildly. Besides, can you be bothered so spend hours in paper pants having your bottom vacuumed by a total stranger?

So what can you do? Well, dress appropriately, for a start: wear a sarong on the beach, keep your skirts on the knee and judge your sleeve length. A woman doesn’t have to be half-naked to be beautiful: only the other night I was watching Joanna Lumley wafting up the Nile Delta for TV in floaty trousers and a long shirt: she looked gorgeous, and was showing virtually no flesh at all.

Elsewhere, don’t run in direct sunlight. Keep skin exfoliated and moisturised — and, if you can, use a light self-tan, since a bright white bottom looks worse than a brown one. Don’t clench the muscles in your rear — a soft stance shows up cellulite less. Most of all, don’t worry too much. Because I can guarantee you that every other woman feels the same way.

What is it?
A treatment for legs, bums and tums, the LBD Fix uses a combination of light energy and infra-red light. A handheld massage gadget heats the skin to shrink fat cells and increase oxygen production. It also tightens and tones, banishing lumps and bumps and helping to alleviate the appearance of cellulite.

Pros/Cons:
Skin feels tighter and smoother very quickly, and it's non invasive so there are no needles or scarring. At least three 20-minute sessions are recommended with a week-long gap between each, so it's not instant. You must maintain the effects with a healthy diet and exercise.

Cost:
Around £150 per area per session.

Where can I get it?
The London Medical & Aesthetic Clinic, www.lmaclinic.com, London.

Reader Verdict:
"After three sessions, my fat and cellulite began to disappear, but I think you'd need a few more sessions to notice a huge change."

Dr Ayoubi is an international leading surgeon in Smartlipo and Sculptra.

Known as the 'King of Smartlipo', for his legendary laser body sculpting, he is the leading Smartlipo MPX trainer surgeon in the UK. Dr Ayoubi uses his own advanced techniques in various aspects of laser surgery many of which have now been adopted by numerous plastic surgeons and cosmetic doctors including scar free breast and neck lifting.

Cellulite, the dimply, fatty deposits usually found in the thighs and buttocks, are hard to shift. For non-invasive procedure, try VelaShape, a combination of radio frequency and infrared light that heats the skin. As it's rolled over the skin, it increases lymphatic drainage, giving a smoother look.

There are no major side effects, but you'll need a few sessions to benefit.

See www.Lmaclinic.com for details. /p>

You’ve woken up on the ward after the operation and, while the surgeons have done their best, you’re not feeling great.

You’ll probably be discharged fairly promptly (to free up that bed) with a prescription for painkillers and perhaps some antibiotics or physio. But otherwise you’ll be pretty much left to get on with it.

With 4.2 million operations a year carried out on the NHS alone, VICTORIA LAMBERT asked the experts - from sur­geons and anaesthetists to therapists and dietitians - for their tips on how to boost recovery after surgery. Don’t go into theatre without reading these first...

EAT GREEN ALGAE

Take 6 to 10g of powdered sun chlorella (a type of green freshwater algae) every day after surgery, says Randall Merchant, professor of anatomy and neurobiology at Virginia Commonwealth university in the U.S. ‘Chlorella has been the subject of clinical trials which have found it useful in helping the body heal after trauma.’

It’s rich in nucleic acids, the building blocks needed for replacing injured and dead cells. Recent studies sug­gest it restores the normal functioning of genes which were turned off by cell injury. It can also help reduce inflammation, according to a paper presented to the Japan Society for Bioscience, Biotechnology, and Agro­chemistry.

AVOID ASPRIN

‘To prevent excessive bleeding, avoid aspirin, ibuprofen or neurofen within the week before surgery,’ warns plastic surgeon Abel Mounir, of the Transform Cosmetic Surgery Group. ‘And don’t take any of these medications within the two-week period after surgery. You may, however, take paracetamol.’

SING

Anyone who’s had an abdominal injury, a hysterectomy for example, needs to get movement and strength back into the area to aid recovery. ‘Breathing well is the best way to do this - try regular breathing exercises or singing,’ says hector Wells, of the British Osteopathic Association.

SNACK

Your appetite might be diminished, particularly after bowel surgery and cancer operations, suggests Simon Cole, con­sultant surgeon at Dr Gray’s hospital, elgin. ‘It needs to be stimulated by eating favourites, and healthy eating rules can go out of the window. I tell patients to expect to “eat like a horse” when their appetite returns, although bear in mind that some foods, for instance a thick chocolate milkshake, might be unsuitable for anyone with a condition such as diabetes.’

Sian Porter, of the British Dietetic Association, says postop it’s perfectly legitimate to follow your body’s prompting and snack on food. ‘If you have a poor appetite, eat little and often.’

KEEP MOVING

It is not a good idea to be ‘wrapped up in cotton wool’, says Mr Cole. Many people avoid moving the area operated on because they’re afraid of doing damage,’ adds osteopath hector Wells.

‘If you’ve had a hip replacement, for example, your natural reaction will be to avoid putting weight on it while walking. By overcompensating this way, you can strain the healthy hip, which can cause new problems there and elsewhere.

‘After the surgeon has discharged you, engage in gentle, but constant, movement in the ten to 14 days after any opera­tion. Gentle movement that does not cause pain is the best guide.’

Then, under the supervision of your physiotherapist, start to exercise - ‘swimming and cycling are very good and will drain fluids away from the area, which helps reduce scarring and encourages the new tissue along the natural move­ment lines,’ he says. ‘Get your surgeon’s permission before swimming.’

DRINK TEA

You can boost your immune system and help to minimise post-operative infections by drinking a cup of tea a day. Re­searchers at Brigham and Women’s hospital, in Boston,

u.S., found it contains an amino acid called L-theanine which might help strengthen the body’s immune system response when fighting off infection.

BUY A CHAIR

After you return home from some operations, such as a knee replacement, you won’t find it easy to get in and out of soft, low sofas,’ says Mike haytone, a consultant orthopaedic hand surgeon at Alexandra hospital, Cheadle, Cheshire. he suggests buying a higher chair before you go, in preparation.

Make sure you have the rest of your furniture ready: such as a bed on the ground floor

TAKE ARNICA

DON’T BE HEROIC

WEAR YOUR OWN CLOTHES

TAKE VITAMIN B

EAT PRUNES

‘You may be sent home with morphine or codeine-based painkillers which can cause constipation and you really don’t want stomach pain on top of everything else,’ says surgeon Mike haytone. eat lots of fibre before and afterwards.

An alternative to conventional breast lifting using Smartlipo has been practised by Dr Ayham AI-Ayoubi. He discusses his technique and results

As people age, body parts begin to sag or droop owing to the loss of elasticity in the skin. This can also occur with significant weight loss. Breasts are no exception - a woman's breasts often change over time, losing their youthful shape and firmness.

These changes can resuIt from pregnancy, breast-feeding, weight-loss, ageing, gravity and be heredity. Women often seek breast-lift treatments to restore the breasts' firm and youthful appearance. Breast lifts, also known as mastopexy, raise and firm the breasts by removi ng excess skin and tightening the surrounding tissue to reshape the contour.

Masropcxy raises and reshapes sagging breasts by removing excess skin and repositioning the remaining tissue and nipples to a more perky position. If desired, the size of the areola can be reduced during the procedure. After the surgeon removes excess skin, the nipple and areola are shifted to a higher position, and the areola is usually reduced in size. The nipple and areola remain attached to the underlying tissue, preserving the sensation.

In some cases, breast implants may be inserted at the same time to give the breasts a fuller, rounded and natural appearance.

But masropexy does not significantly change the size or roundness of a patient's breasts. If the breasts are desired to look fuller or smaller, breast augmentation or breast reduction surgery should be a considered option. The abiIity to breast-feed may be preserved but it's not guaranteed.

There are many variations to the design of the incisions for breast lifting, such as the size and shape of a patient's breasts or even the use of breast implants to enlarge and fiII the breasts. These factors will help us as plastic surgeons to determine the best technique for the patient.

Fortunately, significant complications from breast lifting surgery are infrequent. Every year, many thousands of women undergo successful breast lifts without experiencing any major problems and are pleased with the results.

But no surgical procedure is completely risk-free. There are potential complications associated with any surgical procedure involving anaesthesia, including complications such as bleeding, infection, permanent or noticeable scarring and mismatched breasts. Some patients may complain of sores or numbness around the nipple areas.

Perhaps the most common risks are the quality of healing and patients' acceptance of the resulting scars. Undoubtedly, this is what led to the less-invasive laser breast-lift technique, which doesn't require knives or needles. Instead, it uses a combination of laser-lipolysis and lasers to lift and tighten.

The skin-tightening effect results from the heat of the laser reaching 38-40°. The technique does not require an overnight stay and produces minimal scarring. The variation of the quantity of fat that one can remove is between 50-100ml of fat from each side of each breast, giving a minimum of 3cm and a maximum of 8cm breast lift. This can be achieved in one session without the requirement of a revision treatment.

There are no limitations; however, I have to ensure myself that I do not remove too much fat tissue. I emphasise that the suction is used with care to ensure not too much fat tissue is removed so there are no indentations formed on the breast.

A Smartlipo scar-free breast lift is the most recent application of Smartlipo technology. Fast, efficient, with permanent results, with a greater effect on slightly droopier breasts caused by breast feeding ageing or weight loss. But it is not a treatment for big breasts-a size D or larger.

Patients with larger breasts should, and are advised to consider breast reduction or traditional liposuction, as there will be a risk of indentation around the breast area once the fat is removed.

Smartlipo MPX technology works by introducing pulsed laser energy through a cannula to liquefy fat, which is then removed from precise sites in the breast area. Fatty deposits are removed from the arm pit area and the treatment boosts collagen production. The laser energy coagulates the tissue, thereby tightening the skin and in turn providing a lifting effect.

It is a safe procedure, as the Smartlipo MPX utilises Smartsense, a safety feature built into the machine that regulates the laser energy delivered corresponding to the speed the headpiece is being moved. This provides constant, uniform energy throughout the treatment.

At first I found it difficult to predict the results of the treatment, as there was no previous technique to use or results to go by. I had to rely on my experience and techniques of Smartlipo.

Another challenge I had to overcome was the asymmetrical results of the breast, whereby I found that applying equal amounts of energy and suction managed to achieve the symmetrical resuIts for both breasts.

The management of patient expectations is another challenge for every surgeon. I have made it my policy to ensure patients are accepted only if they are realistic about the results that can be achieved.

The complete scar-free breast lifting procedure takes one hour. The treatment takes place under a local anaesthetic. There is no need for a general anaesthetic or an overnight stay. This procedure can be conducted on patients not suitable for general anaesthetic.

There are no stitches required, as only small incisions are made that immediately heal after treatment. This results in minimal downtime for the patient. Patients can return to work within two days and can conduct gym activities after about a week or two weeks.

Plastic surgeons have recognised the high demand for less-invasive cosmetic procedures, and patients are willing to have Smartlipo treatments as it provides good results with less scarring. However, it is stressed that this is no short time procedure and patients should be advised that a proper procedural technique is required.

Dr Ayham Al-Ayoubi, London Medical and Aesthetic Clinic. 4th floor, I Harley Street, London, WIG 9QD, calf 0208 342 1100 or email us info@Lmaclinic.com

Dr Ayoubi of the London Medical & Aesthetic Clinic believes that wonder product Sculptra really does provide a non-surgical facelift and here he explains how

Our preoccupation with the body beautiful means that we are increasingly body conscious and determined to stay fit and healthy for longer but while losing weight can be good for our waistband and it isn't so good for our face .

The pattern to losing weight is that you first lose it from your face, then your breasts and lastly the buttocks but when you put it back on the very last place you put it back on is your face that lost plumpness can age you quicker than anything else. I’m not advocating that you should start eating junk food but people with plumper faces tend to have fewer lines generally than thinner people.

This is compounded by the collagen Ievels in our skin depleting as we age. It is collagen that gives that glow and soft plumpness we associate with youth. From about the age forty, collagen goes into sharp decline.

I perceive that there are three routes of treatment to lackle the signs of ageing in the face.

Invasive facial surgery

This is actually contrandicate for those who've lost a lot of fat or collagen as facelifts will actually make the problem worse. Incisions are made either in front or behind the ear and then the skin is drawn back so you're actually losing tissue in the area where it needs more -the mid face. Facelifts are reaIIy great for people who have excessive skin droopiness due to gravity.

Dermal fillers

Mainly based on hyaluronic acid, dermal fillers give instant results, are very safe and improve the area you're treating in predictable ways.

But the disadvantages are that they only last for six to nine month maximum and they only improve the area that they are injected in - they don’t have any effect on the rest of the face.

It is suitable for use all over the face except the forehead or upper lip. The technique is totally different to fillers which are injected superficially into the area you 're treating - the depth depends on the fold being filled - whereas Sculptra is injected very deeply undemeath the dermis into the facial muscles.

It also differs from dermal fillers because there are no instant results - in the first day or two after the treatment there is a plumping effect due to the fluid which has been injected but this dissolves over the next two or three days. This is when Sculptra starts to work.

The magic of Sculptra

Sculptra falls in the class of a stimulatory product that creates its effect through encouraging neocollagenesis when injected. It differs from traditional static fillers such as hyaluronic acid and collagen, because as a stimulatory product it causes the growth of fibrous tissue or collagen within the body, which then results in volume restoration gradually.

Available from: For a full list of all the procedures that Dr Ayoubi performs and to book a consultation with the London Medical & Aesthetic Clinic visit wwvv.Lmaclinic.com or call 020 8342 1100

Pity poor Carla Bruni. When she swept Nicolas Sarkozy off his dainty little feet, she probably had no idea quite how far into the public consciousness their romance would pitch her. The prospect of being the most photographed woman in France may even have appealed to her — she is, after all, a model and singer, both professions that thrive on press exposure. But politics is a vicious game: the scrutiny is unrelenting.

Last week, after speculation that she and her husband were both having affairs, she was photographed looking distinctly tense. Crucially, Bruni herself appeared quite unlike her normal, dewy self. Her smile seemed frozen, her gaze positively glacial, her complexion strained. Was this just a sign of the pressure she was under; or were there other forces at work?

It is, literally, impossible to say — nor, in some ways, does it really matter whether she’s got a forehead full of Botox or whether she’s as natural as the day she was born. But it does raise an interesting question about modern attitudes towards women and ageing, and the pervasiveness of the burgeoning youth industry, with all its promises and expectations. The messages are distinctly mixed, but there is only one thing that everyone seems to agree upon: we should contrive to age gracefully.

Easier said than done. In our grandmothers’ day, a woman who aged gracefully was someone who faded obligingly into invisibility around the age of 40. By this time her useful purpose as a wife and mother had generally been exhausted, and all that remained for her to do was to find a nice hat for her daughter’s wedding. Now, 40 is not an unusual time to be starting a family, so it follows that the age at which women continue to see themselves as sexually attractive has moved back several years, at least into their sixties, if not beyond.

The idea that women should strive to improve their appearance is not a new one — but never before has it been possible to do so in so many different ways, and to such a radical extent. The so-called anti-ageing options available to the average woman today are many and varied, from moisturiser to multivi­tamins, from laser to liposuction. The technology is constantly evolving. Current thinking around the use of Botox, for example, is centred not on using it to freeze large areas of movement, but in injecting it in tiny doses to simply switch off a small part of the muscle action, giving a much more subtle effect. And its use extends well beyond the areas traditionally associated with it.

A number of cosmetic doctors are now injecting Botox into the muscles of the jaw to help to stave off droop.

For some, however, Botox is already a thing of the past. Other ideas centre around the principle of cor­recting underlying muscle tone. The theory is that wrinkles are not the whole picture when identifying what makes a person look old. The general deterioration in the firmness of the muscle layer that sup­ports the skin, and uneven pigmentation, count too. Since collagen is what lends skin that lovely plump, youthful appearance, the aim is to stimulate the body’s own natural production of the stuff. One way of achieving this is to deliver a trauma to the surrounding tissue, which will in turn trigger the body’s repair process.

The idea is that the body will respond by intensifying production of collagen in the area, which in turn has an overall plumping effect on the surface of the skin. This is the basis for treatments such as Sculptra, in which lactic acid is injected deep into the face. Other techniques include removing fat cells from one part of a patient’s body, treating them with the latest stem-cell technology in a lab, then injecting them into areas of the face that are traditionally prone to sagging.

Lorraine Candy, Editor-in-Chief of Elle, who at the age of 41 has yet to succumb to the blandishments of the cosmetic surgeon, advocates a degree of caution. “We are very harsh to judge because we feel threatened by women who don’t look as old as they ought to,” she says. “We need to back away from that and be more supportive of each other. We should also be very careful about being too influenced by celebrity. There are some women who just look great at any age; people need to understand that genes play a huge part. When we put Helena Christensen on our cover earlier this year, that was the least retouched cover we’ve ever done. And yet she drinks, she goes out — that’s just what she looks like. There’s absolutely no point in someone like me being jealous of someone like her.”

It’s one thing to have a little judicious Botox here and there, but what if things get out of control and you end up not looking like your radiant 20-year-old self, but like an only slightly less scary version of the now-ghoulish Faye Dunaway or Cher? These women don’t look young, they just look like they’ve had a lot of plastic surgery.

The make-up artist Bobbi Brown has strong views on the issue. “The danger of plastic surgery is that some women see it as a way to feel better about themselves and the truth is that self-esteem has to start from within and not with a scalpel. It makes no sense to obsess that you don’t look 30 now that you’re 40, because at 50 you’ll look back at photos from 10 years ago and realise how young and fresh you looked. Instead of fighting the body you have, accept it and make the most out of it. Be who you are. There’s something incredibly beautiful about a woman with lines in her face. Lines are proof that we’ve lived life. We get them when we show emotion, when we laugh, and when we express ourselves.”

If fat was a feminist issue in the 20th century, the obsession with anti-ageing should arguably be our preoccupation at the dawning of the 21st. At least fat is, to an extent, something that women can control. Growing old, on the other hand, is not. To create a culture in which women are made to feel inadequate and full of self-loathing over an unavoidable biological process is not just absurd, it is positively psychotic.

Mrs Sarkozy does not look under par because she is old; she looks that way because she’s a woman of 42 who is expected to look like she did in her early thirties. She can’t, and she shouldn’t — and neither should the rest of us.

The Smartlipo MPX system is used to tighten and lift the neck.

HOW DOES IT WORK?

A small incision is made under the chin and a combination of lasers is inserted under the skin. This breaks down fat celss, dissolving them into a liquid which is then sucked away. Smartlipo helps reduce a double chin and makes your neck look more taut.

IT COSTS from £2000.

For more details contact Dr Al-Ayoubi at the London Medical & Aesthetic Clinic ( 020 8342 1100; www.Lmaclinic.com).

After years ofworrying about her 'turkey neck', Karen Morgan wanted a permanent solution

I became very conscious of my neck in my early thirties because  I had what looked like a fat bulge under my chin. When I found an ad in the paper for chin lifts, I thought I'd book myself in, but the doctor said my neck was beautiful and to come back in five years' time. He said it wouldn't make that much difference.

Gradually, though, as I suspected, I got a turkey neck. The skin began to sag and I lost all definition around my jawline. When I spoke, I'd keep my chin down, and I'd look at the ground when I walked because I was so conscious of everyone staring at it.

Every morning I'd give myself a five-minute chin massage with the backs of my fingers, which worked to some extent. I spent thousands on neck creams, but they didn't have much effect, and I would always ask my beautician to work on my neck -this did tighten it slightly, but then it would relax the following day. I also went for a non-surgical treatment every month using a CACI machine, which uses microcurrents to lift the muscles. The lift would last two days, then drop again.

In the end, I decided I might as well have surgery to remove the fat and tighten up the excess skin. So, five years to the day when I first saw the doctor, I borrowed £2,500 and went back to see him.

The procedure was painless. After having a local anaesthetic, the laser went in through a tiny incision. I didn't experience any trauma or scarring and the treatment only lasted about 20 minutes.

In less than half an hour, I came out a new woman. Now my neck is taut, tight and I actually have a jawline. I'd have paid ten times the amount for this, without a doubt.

Two months on and I still have a laser treatment called VelaShape that tightens the skin on my neck even more. Six ofthese sessions should do the trick for good.

I talk to people with confidence now, and I don't hold my head down. I would never actually go under the knife, but this is certainly the best thing I've ever done.

Laser neck lifts: the facts

WHAT The neck is resistant to diet and exercise, so people are increasingly turning to the Scarless Laser Neck Lift . Rather than using the Smartlipo MPX system for fat reduction, which is its traditional purpose, laser surgeon Dr Ayham AI-Ayoubi  uses it as a tightening and  lifting treatment for the neck.

HOW A small incision is made under the chin and the laser inserted. The thermal energy produced by the laser melts the fat, which is sucked away. The process stimulates the patient's own collagen to tighten and tone the area. The heat causes the skin to tighten and contract, which then gives the lifting effect.

RESULT An instantly smoother, toned jawline and neck area, giving a more youthful appearance, with little or no pain or bruising.

COST From £2,000.

Contact Dr AI-Ayoubi at the London Medical and Aesthetic Clinic on 020 8342 1100 or visit www.Lmaclinic.com.

LASER LIPOLYSIS

The advent of loser lipolysis enabled non-surgically trained practitioners, such as cosmetic doctors, to start performing fat reducing treatments in their cliniCS under local anaesthetic, offering patients on alternative to more invasive surgical liposuction for the Arst time. Deka's Smartlipo system was the first on the market and has since been followed by a plethora of other devices including: Smartlipo MPX (Cynosure). Slim Lipa (Eden). ProLipo Plus(Scrton), OSYRIS Phoraon Loser Lipolysis System and the Fotona XP2 (AMBETech).

Loser lipolysis works by using loser energy (delivered by inserting a Fibre-optic probe under the skin) to break up and liquety the fat cells. The liquefied fat can be left to be naturally eliminated by the body however experience has shown that for superior results are gained by also using aspiration.

Dr Ayham AI-Ayoubi comments, "The most important thing to remember is that for loser lipolysiS treatments, such as Smartlipo MPX to be effective in a weight loss patient. they must use all medical, surgical and wellness tools available to them, which includes strict help from a dietiCian. The Smartlipo MPX will get rid of excess fat from the problem areas however the patient must also accompany this with a strict diet ond exercise regime. The benefit of Smartlipo MPX for weight loss is that it gives on immediate boost to patients to continue to keep the weight off as you can see immediate results. Combined with a good healthy diet from a dietician it's a healthy woy to lose weight but it can't be used alone and the patient must understand this. They must work hard with medical team and be sent to a specialised doctor to make sure any underlying medical problems are under good control. e.g diabetes. To summarise, make sure ony underlying health problem is under control before using Smartlipo MPX os a treatment for weight loss and it needs to be combined with all tools available -medical. surgical and diet. wellness to be effective."

SMARTLIPO MPX

Smartlipo MPX (Cynosure) is the first and only FDA approved dual wavelength laserlipolysis workstation on the market. The Smartlipo MPX allows the physician to customise treallment protocols based on the patients needs. It allows each wavelength to be used individually and sequentially in a 'blended fashion ' for optimal results. The Smartlipo MPX utilises beth the 1 064nm and 1 320nm wavelengths. Each of these wavelengths brings unique haracteristics to the laser lipolysis procedure. One is better suited for liquefying and coagulating and the other is more aggressive and suited for targeted tightening. The l064nm wavelength has a greater affinity toward oxyhemoglobin, but demonstrates less abserption in water, which produces a larger scattering effect than the 1320nm wavelength. Due to this strong scattering effect with the 1 064nm wavelength, the laser energy would be distributed in a more homogenous manner (broader region)  in fat tissue. The l064nm wavelength alse has a more diffused distribution of the laser energy which will help to safely heat the collagen bundles in dermis, resulting in tissue tightening.

The 1320nm wavelength has strong abserption and less scattering in fat tissue: therefore, most of the laser energy is deposited into a small 0ocalised) region near the laser fiber tip in the subcutaneous layer. This results a high efficiency toward heating the subcutaneous layer and disrupting fat cells with the 1320nm wavelength. This blending of wavelengths is actually called Multiplexing (MPX). Multiplexing or blending wavelengths gives you the ability to maximise safety, effectiveness and overall patient outcomes and satisfaction. It allows the physician the option to blend these wavelengths to achieve optimal results.

I've got a new body and face

Lisa Turner, 34, is a businesswoman and mum to eight‑year-old Samuel. They live in Beaconsfield, Bucks. Lisa had a breast lift and facelift after her fiancé left her for another woman last Christmas. She says:

About two weeks before last Christmas I discovered that Samuel’s father, my fiancé, had been having an affair with a 24-year-old woman. It made me feel doubly awful that she was nine years younger than me.

Christmas Day was horrible. I’d got a houseful of family and friends, my oven decided to stop working and I was so upset about facing the new year as a singleton again at 33.

My little boy caught me in tears in the kitchen preparing the turkey and when he asked why I was crying I had to
tell him it was because I’d been chopping onions.

But somewhere amid my misery I decided to take action – there was no way I was going to have another Christmas as sad as that one.

For starters I sold the house because I wanted to get away from the bad memories. Then I turned my attention
to my appearance.

While I was breastfeeding Samuel my breasts had gone up to a GG-cup.

Eventually they settled down to a D-cup but they were never as pert and I always said that one day I’d get them lifted. So this year I did. I went to the London Medical and Aesthetic Clinic (www.lmaclinic.com) where cosmetic surgeon Dr Ayham Ayoubi told me the most effective way to get the breast lift I wanted was to have Smart Lipo, where a tiny laser is inserted into fatty tissue to melt it before it is sucked out.

He performed this just around the sides under my armpits where there was a little bulge over my bra strap. Then as the area healed and contracted the breasts lifted. I was absolutely stunned when they lifted an entire 12 centimetres in the weeks after the procedure which cost around £2,500.

I now have fantastically pert breasts. I had it done under local anaesthetic on August 16 and went out the same night to celebrate a friend’s birthday.

Next I was on a mission to sort out my face. Dr Ayoubi suggested the Double V Knifeless Facelift at a total
cost of £1,800. He injected Sculptra, a filler that stimulates natural collagen production, into the jowl lines and
in the V-shape that covers the eyebags and upper cheekbones. I had three lots of treatment four weeks apart, the last one just a few days ago. Even though the effects will increase as more collagen is produced already so many people keep telling me I look great. The Double V Facelift should last up to five years. This Christmas I feel transformed.

I’ve got rid of my eye bags

Lesley Walsh, 60, is a retired hairdresser and lives alone near Manchester. She has had her eye bags removed, an eyebrow lift and a full facelift. She says: I look younger now than I did in photos taken at Christmas 20 years ago. Last Christmas I didn’t go out as I looked so old. I’d got these awful eye bags and my neck had begun to sag.
I’ve always been a sun worshipper so my skin suffered.

I turned 60 in January this year, too, so I thought it was a good time to think about having some surgery.

I had a consultation at Surgicare (www.surgicare.co.uk) in Manchester which recommended an eyebrow lift, blepharoplasty (eyebag removal) and a full facelift. I had the eyebrow lift first which was painful – the surgeon made tiny holes at either edge of my eyebrows into which he inserted a metal rod then literally pulled the muscle up and
secured it into place. I had to allow my face to settle and recover from that before having any more work done.

My family said I was mad and my children told me I looked fine as I was. But I didn’t feel good about myself. Two months later I went back to the clinic for the facelift and eyebag removal. I also had the hoods of skin removed from the tops of my eyelids to open up my eyes again. I was in theatre for about three or four hours but I didn’t have any pain afterwards, only a bit of discomfort and swelling. The whole lot cost £8,000 but it was worth it. Even my children agree I look great.

I look and feel younger than I did 20 years ago. The trouble with surgery is that it makes you scrutinise other parts of your body. At the moment I’m having the preparatory work for teeth implants in the new year so that my smile is as
youthful as my new face.

This Christmas I intend to find all the parties I can. I want to make the most of my new confidence instead of feeling that people would point and say: “Look at that old woman over there!”

Singing a solo in front of her peers and parents at her school Christmas concert, aged 16, should have been a wonderful treat for Emma Hardy.
However, rather than enjoying her moment in the limelight, she gritted her teeth and counted down the minutes until it was over.

Wearing a white blouse and with all eyes on her, she couldn't hide the fact she was drenched with sweat.

'It was vile,' says Emma, now 43. 'I was sweating so much it looked as if I was taking part in a wet T-shirt competition.'

Unfortunately for Emma, this was not a one-off; it happened because she suffers from hyperhidrosis, or excessive sweating. And she isn't alone. Indeed, it's estimated that around 1.5 million people in the UK are affected by the condition.

Sweating is the body's natural way of cooling itself down. But not only do we sweat when we're hot, we also sweat in response to certain emotions, such as stress or anxiety.

In those with hyperhidrosis, it's believed that for some reason the sympathetic nervous system, which controls sweating by stimulating the sweat glands, is overactive or more sensitive than normal, says Dr Ayham Al-Ayoubi of the London Medical & Aesthetic Clinic.

Dr Ayoubi is pioneering the use of the Cynosure Smartlipo MPX system to treat hyperhidrosis in the UK. It is a laser treatment usually used to remove fat. In this case, though, the laser is used to destroy the fat cells just beneath the layer of skin in the armpit, destroying the sweat glands.

According to Dr Ayoubi, there are three types of hyperhidrosis. The most common is primary idiopathic focal hyperhidrosis, which means that excessive sweating occurs in a 'focal' place such as the armpits, palms of the hands, soles of the feet, or face. It is believed there may be a genetic factor involved and it typically develops under the age of 25.

Secondary focal hyperhidrosis, which isn't common, again means that the excessive sweating occurs in a particular part of the body. But it is generally because of an underlying illness or condition.

 No sweat: The laser machine
Finally, there is generalised hyperhidrosis, where you sweat more than normal all over. It is uncommon and usually caused by an underlying medical condition, such as anxiety disorders, heart problems, overactive thyroid gland or an infection.

'There are various treatments for axillary [underarm] hyperhidrosis, including surgery to cut the nerves in the chest that lead to the affected sweat glands.

'It is a permanent solution and has been proven effective, but it's a very invasive procedure and carries the usual risks of going under general anaesthetic,' says Dr Ayoubi.

'Also, patients will be left with scarring and bruising and often have to take time off work. The beauty of the Smartlipo MPX treatment - the first dual-wavelength laser system - is that it is quick, is performed under local anaesthetic, and recovery times are short.

'Working together, the light and energy from the lasers liquefy the fat cells and targets sweat glands. At the same time, the laser energy seals the small blood vessels, thereby preventing bleeding, and it also stimulates collagen to tighten the skin.

Dr Ayoubi will make a 1 to 2mm incision under a patient's arm, in which local anaesthetic is injected. The optical fibre of the laser is then inserted through a fine cannula (a small tube) into the same incision at a precise angle, directly reaching the sweat glands beneath the skin.

Afterwards the damaged tissue is sucked out through a fine tube. The whole procedure takes around 30 minutes.

'Patients have no bleeding or bruising, no damage to the nerve endings and no scarring,' says Dr Ayoubi. 'They can go back to work the next day and results are instant.

'I've carried out the procedure on 13 patients and, in theory, it should last forever. It's a revolutionary breakthrough.'

Emma, who runs an online beauty business and lives with her husband and two children in South-West London, has suffered from the embarrassing condition for 30 years.

'After puberty I was sweating all the time,' she says. 'I'm a confident person so it really knocked me. It made me miserable, so I talked to my mum about it and we bought every antiperspirant we could. But nothing worked. I had to accept I was going to have to live with it. Luckily I didn't have odour problems too.

'It was a pain because I had to think about it all the time. I always made sure I carried antiperspirant and a couple of spare tops and I could never wear anything tight or pale in colour.'

Emma even spent £1,000 having Botox injected under her arms to freeze the nerves that stimulate the sweat glands. While initially effective, the results lasted only a couple of months before she needed a top-up treatment. Emma had the laser procedure in September this year and is delighted with the results.

'The treatment was really quick. I was a little tender afterwards, but it was not painful,' she says.
'The results are amazing. It's so liberating not having to think about my armpits. I bought a boob tube to wear to a Christmas party - something I never would have been able to wear before.'

www.lmaclinic.com

Hyperhidrosis, or excessive sweating, is a serious medical condition that affects millions of people around the world -approximately three per cent of the population. Dr Ayoubi of the London Medical & Aesthetic Clinic explains how Smartlipo MPX from Cynosure could be the answer

When your body heats up — from weather, exercise or stress — your brain sends the message that your system is overheating. The message travels to nerves that lead to the more than 2 million sweat glands that lie under your skin. And that's when they send moisture through the sweat ducts to your skin's surface.

In some people, the body's mechanism for cooling itself is overactive — so overactive that they may sweat four or five times more than is necessary, or normal. When sweating is this extreme it can be embarrassing, uncomfortable, anxiety-inducing, and disabling. It can ruin relationships, affect career choices and damage your self-esteem.

Options to treat this condition

Traditionally, people would apply perfume or products to disguise the problem but this is a superficial treatment that doesn't affect the production of sweat.

The surgical solution was to make an incision under the arm, lift the skin and then damage or destroy the glands. The problems with this procedure are that it obviously leaves a large scar and there is a long recovery time. Also this is a very sensitive area with a strong nerve supply so you can risk doing unnecessary damage. The sweat glands are so small that it is hard just to tackle them and not damage other important tissue or muscles.

Botox is a more well known treatment for hyperhidrosis. A starch test is performed to locate the sweat glands and then a small amount of Botox is injected into approximately 12 to 15 places under each arm. The poison blocks the action of the nerves in the sweat glands - sweat slowly returns as nerve ending grow back in six to 12 weeks and a new treatment is usually required after seven months. This is the main disadvantage of Botox; it is only a temporary solution so can be expensive if you're having regular top ups.

The focus then turned to other various non-surgical procedures to see if one of them was suitable for dealing with hyperhidrosis in a permanent way.

The search for a solution

Radiofrequency was explored but this didn't work well for a very simple reason. Radiofrequency works by applying heat to the surface of the skin, so you risk damaging or scarring the surface of the skin before you even reach the glands. You're also working blind and have to go through vascular and fat tissue before reaching your target so you risk overheating this tissue on the way through.

This is where laser came into the spotlight. SmartLipo's main function is for body contouring because it damages the fat cells but what sets it aside from other treatments and why it is so good at removing superficial, vascular fat is that it also cauterises the blood vessels at the same time. And it is this function that we bring to use in the dealing with hyperhidrosis.

How SmartLipo works

The glands in the armpit that produce sweat are all dependent on a blood supply. The SmartLipo cuts the supply of blood to the glands and, like any tissue, it dies. The procedure is very simple. We make a small 1mm incision, which you will not see after the procedure, and through this incision we insert the local anaesthetic. I use a small spinal needle which is very precise and delicate so the patient doesn't feel the injection. We use extremely diluted local anaesthetic as you don't want to numb the area too much or otherwise the patient will feel that numbness in their hands.

Then we insert the laser through the same incision under the skin and laser the sweat glands. The structure under the arms is skin, a layer of fat, the sweat glands, another layer of fat, then muscle. The only downside to this procedure is that you may laser some fat cells which is not a bad thing in itself. Then I use very gentle suction to suck out the local anaesthetic, the damaged gland and any little bit of fat.

The results

We have had great permanent results with this procedure. I have been offering it for over two years and patients see a significant improvement in their condition. Some of my earlier patients had a reoccurrence of the problem but at a much lesser level than before - at the beginning I was more conservative as this was such a new procedure. Over time I have gained in experience and I know how much local anaesthetics and laser energy to apply.

So, if excessive sweating is ruining your life then there is a way to deal with the problem, permanently.

Available from: For more information on Cynosure and their lasers visit www. cynosureuk.com or call 01628 522252.

For a full list of all the procedures that Dr Ayoubi performs and to book a consultation with the London Medical & Aesthetic Clinic visit www.lmaclinic.com or call 020 8342 1100

I have a fat face. There's no polite way to put it. I don't possess the kind of bone structure the sculpted cheekbone sweeping lines — that has traditionally added up to true beauty. It's always been the way. But then, a year or so ago, something odd happened. Suddenly, somehow, countless a, celebrities seemed to share my plump, pillowy features. Their bodies were as taut and toned as ever, but their faces were puffed out, filled in. It was quite hard to figure out what they'd done. Frankly, I didn't care. Finally, I had a fashionable face. The thing is, my fat face is genetically inherited. But these women paid for theirs.

It has become known as `Pillow Face' — a derisory term for the over-stuffed cheeks and plumped-up skin and plush lips that, after a certain age, can only be achieved with the help of a syringe. In the beauty industry, it's called 'volumising'. If cosmetic surgery is about the battle to outwit time, then this is its latest weapon: the fullness of a youthful face, literally and liberally injected into an older one.

It's a slippery slope: some Botox to stop the wrinkles developing and smooth things out, some filler to hide the lines that are already sliding in. Then more filler to reshape and define. And, before you know it, the face you see in the mirror, or splashed across the pages of Us Weekly, isn't what it was. It's not younger looking, really; although it doesn't have any of the signs associated with ageing. It's mostly just... fatter.

`I would be astonished if there was a single Hollywood celebrity over the age of 30 who wasn't having filler injected into her face,' says Dr Marc Armangue, who works as an aesthetic physician at south-west London's Hurlingham Clinic. `It's a standard procedure nowadays.'

Cosmetic surgery once meant using a scalpel to tighten a sagging face — cutting and hauling up the skin and, by doing so, making the face smaller. Now doctors understand that what makes us look old is the loss of volume, and the way to reverse that is to actually make the face fatter. This is where filler comes in.

From the patient's own body fat to bovine-derived collagen, from permanent silicone to synthetic hyaluronic acid, there's an ever-growing array of substances that can be stuffed into a face. Some of them are household names: Restylane, Perlane, and Juvederm. Injected almost painlessly by the syringeful, these wrinkle-fillers provide instant gratification, have few side-effects and gently deflate in less than a year. `If it's done well, nobody should notice,' says Dr Armangue. `Not even your husband.'

The trouble for me is that even a fat face ages. By the time we're 21, our collagen has started to disappear. By the early thirties, nasolabial lines have appeared. These are the chasms that yawn between the mouth and nose, and are the first thing most of us notice as we grow older. Getting rid of them is a simple and unobtrusive job. That is, if you can resist also adding filler to the cheeks andjawline while sitting in the surgeon's chair.

Over the past few months, I've talked with several cosmetic doctors for various articles I've been researching. At the end, just before I leave, I always ask what they would do to my face. It's partly professional curiosity, partly personal vanity, but mostly it's window-shopping. I now think I see the slow creep of those nasolabial lines. Could I get rid of them? Could I be improved? And in what way?

Although all these doctors are eminent professionals within their field, their recommendations differ. One want