Dr Eithne Brenner Aesthetic Medicine

Vaginal Oestrogen: What Every Menopausal Woman Should Know

Hi, let’s chat about local or vaginal HRT.

This post is not sponsored, nor does it offer personalised medical advice. Always speak to your own doctor.

Vaginal oestrogen can help reduce the symptoms of genitourinary syndrome of menopause. That’s where women in perimenopause and menopause can get vaginal dryness and irritation, discomfort with sex, and recurrent UTIs (urinary tract infections), so they’re not insignificant issues. This is a form of local HRT which doesn’t relieve symptoms like flushes and sweats and insomnia, and all the lovely things most of us have gone through. But it really helps local vaginal and bladder symptoms.

There has been a great study, published in the last month, of almost 2 million women, that shows a really strong association between the use of vaginal oestrogen for postmenopausal women in reducing the risk of sepsis, which is a life-threatening condition provoked by infection, and reducing the risk of hospitalisation and significantly reducing the risk of death.

So, women in menopause or perimenopause should consider seeking advice from your GP to see if it’s appropriate for you. There are very few reasons why someone can’t use it.

It’s prescription only in Ireland, and should really be available over the counter. One year of Vagifem use is equivalent to one estradiol oral tablet, so it’s a tiny dose, but it can be very useful.

I was in London recently visiting one of my sons, and I got Gina pessaries (same as Vagifem) over the counter by answering some questions to the pharmacist; it cost me about £30 and would last 3 months, using one twice a week.

I get Vagifem from my GP (I also use systemic/ general HRT; they are fine together) and it’s a little tiny tablet that you pop in vaginally twice a week. You can lubricate the applicator if you need to, or there’s a vaginal ring, or a cream with a reusable applicator. It’s generally considered very safe.

So do get medical advice and ask about it, because it may have a positive impact on your health.

Is Blepharoplasty Right for Everyone?

Hi, is everyone having blepharoplasty these days?

It seems like it from social media!

This is a local anaesthetic or general anaesthetic procedure where a little sliver of excess skin and/or fat is taken from the upper eyelids, lower eyelids, or both. And there are two reasons for considering this.

The first is medical or functional, where the eyelid skin is hanging down and sitting on the eyelashes, where peripheral vision can be affected, because the hooding tends to be worse at the sides, where there’s asymmetry or if somebody’s getting eye strain, or they’re constantly raising their brows to try and keep their eyes open.

And then there are aesthetic reasons if somebody doesn’t like the appearance of it.

But for normal, healthy people who have normal creases in their eyelids, whose vision is fine, and who aren’t bothered by it, don’t feel under pressure to consider it. I don’t do this op; I refer people to colleagues who do it.

I had upper and lower blepharopasty myself, under local anaesthetic, 10 years ago, when I was 51.

For me, it made a really nice difference, because my eyelids were getting heavy, and I had some loose skin under my eyes that wasn’t being corrected with other treatments.

We always want to distinguish between the brows getting heavy, between the lids getting heavy, and assess the symmetry between the two sides. So, it’s an individual choice. If you’re going to consider it, I would always recommend a plastic surgeon or an eye surgeon, who are doing these procedures every single day, and do meticulous work. You don’t want somebody who’s just doing one or two a week.

And as always, stay as safe as you can, get plenty of advice, but don’t feel pressured into doing something for aesthetic reasons.

I’ve posted before that the bleph was just one part of my wellness journey; in my photo, I remember the strain from a bad relationship, stress, and peri-menopause. The bleph helped a lot, as did support from friends and my GP, HRT, an antidepressant, counselling and lots of exercise. Life is so much better these days 🙏🏻

Take care. Eithne

Can Dermal Fillers Be Dissolved?

Hi, if somebody has dermal fillers (hyaluronic acid) and they decide they want to dissolve it and start again, is that possible?

It’s not as simple as that, because dermal fillers, we used to think, lasted maybe 12 months, but now we know that they can last up to a decade or more. Now, that can be fine if it’s in small strategic amounts, if it’s carefully placed at correct depths, if it’s giving you the result that you want, and if the filler is quiet and happy underneath the skin.

But if somebody is unhappy with the result, the dissolving process is not as simple as one might imagine.

There are several factors at play. One is, if the product is hyaluronic acid, it should be amenable to dissolving with a prescription only medicine called hyaluronidase, which is used by injection.

If you dissolve a filler, you lose the filler, you lose the water that that product has drawn into itself over time. And you’re going to lose some volume that the filler and water were creating, you lose a bit of your own hyuronic acid, and that replenishes itself over a short period of time.

Time has passed in the meantime, and people have aged, and then you have to think back to the original reason that you might have had the treatment for, like hollowing or fine lines.

And also, there can be overstretching of the skin, particularly in young girls who have their lips filled and filled and filled again. And there can be damage to the lymphatic drainage. So, it’s not a quick wipe the slate clean and start again.

So, if you’re going to consider a treatment, have a full detailed consultation, and get the best advice, before deciding if it’s right for you.

All appointments can be managed via our booking link: https://www.phorest.com/salon/dreithnebrennerltd or alternatively via the website. 

Availability will only be shown to existing patients who log into their account. 

If you are having difficulty logging into your account, please email [email protected].  Please also be mindful that there is a 48-hour strict cancellation policy that applies. 

We appreciate your co-operation on this and understand that there are exceptions on occasion.  If cancellations are frequent, we will need to charge a deposit.  A waiting list for new patients is now in operation and we want to be fair to all of our patients. 

Important Minoxidil Safety Advice for Parents

Hi, as doctors we get regular safety newsletters from the HPRA (The Health Products Regulatory Authority), and today’s one was very interesting.

It mentioned a topical product that’s applied to the scalp to promote hair growth and to slow hair thinning. This is a product called Minoxidil, that’s available over the counter for adults (men and women) and it is an effective treatment.

There were 11 case reports across Europe, of babies or young children who inadvertently had contact with their parent’s or caregiver’s skin, where that adult was using the product.

The children weren’t prescribed this product themselves, but from skin contact, these very few children developed excessive hair (called hypertrichosis) and it was very rare, and it’s reversible once the parents had stopped using the product, but it’s one just to watch out for.

These products have a really good safety track record for hair loss, and the advice now is just make sure you’ve washed your hands after you’ve applied it.

Allow the product to dry thoroughly before you’ve contact with a baby or an infant.

Don’t share bedding or pillows until your product has completely dried in your scalp, so that you’re not going to transfer it to the child’s skin, and then if you have a baby with any excessive hair growth, seek medical advice.

This issue is very rare, and it’s reversible once the issue is recognised and when the adult avoids skin transfer to the child.

It can happen in babies because their surface area relative to their body weight is really high, their skin is thinner, and they absorb products more readily.

We know there are millions of people using them, and as such, then, rare side effects will come to light.

So, these products are considered safe, but just use them carefully, wash your hands after applying them, and use the advice above to prevent them getting into children’s’ skin.

Hi, how do we treat those little lines around the lips?

We call these smokers’ lines, but they also happen in non-smokers.

Time for some Greek sunshine and Anatomy labs with Evolus tomorrow. It’s always great to meet colleagues and friends and hear about new advances in Aesthetic Medicine 🙌🏻 Eithne

Neck Aging: The Reason Your Neck Ages Faster Than Your Face

Hi, why does the neck age differently to the face?

Some of this is down to the quality of the skin. It is thinner, and it has less collagen, and less elastin, we get gravity effects, we get strong muscle pull down, the ligaments get more lax or weak, and the underlying deeper structures provide less support. The fat can thin out or it can accumulate under the chin.

We pick up a lot of sun damage, and often we’re not putting our SPF or skincare products on our neck.

All of these can contribute to changes, and the important thing is to get an exact diagnosis of what’s going on, because the treatments will vary.

Neck ageing is complex and occurs in many layers.

We always say wear your SPF every single day, or cover your neck, and I use things like SkinPen microneedling, which helps to stimulate collagen, and to help break up some of those tech or necklace lines, as we call them.

If the issue is crepiness in the centre, I’ll often use Profhilo, which is a good hyaluronic acid product that gives some hydration.

I might choose injectable biostimulators like Radiesse, which is calcium hydroxyapatite, or Juläine, which is PLLA, and we fan them out under the skin, using a little blunt tool called a cannula, to get collagen stimulation and improve hydration.

If the issue is pigmentation, we use broadband light (BBL), or some laser treatments, and if the issue is really strong muscle activity, we might choose a muscle treatment.

For some people neck lift surgery might be an option; the main thing is getting an accurate diagnosis because it’s not one size fits all for treatments.

Stay as safe as you can and seek advice from a medical practitioner.

Angelika is available for Skinpen micro-needling, peels and hydrafacials...

Fully trained and using depths that Dr Brenner uses (for maximum results) you can now get an earlier appointment with Angelika for your Skinpen treatment. We love this treatment in clinic and our patients get excellent results.

Not All Wrinkles Are Created Equal: Expression Lines vs. Sleep Lines

Hi, not all wrinkles are created equal.

Some are due to repeated expressions, and some are due to pressure effects.

On one side, we’ve got the repeated expressions that crinkle the skin and cause lines like the crow’s feet lines, expression lines on the forehead and frown lines.

We can get bunny lines, pursing lines around the mouth from orbicularis oris, crinkling at the jawline from DAO (depressor anguli oris) pulling down, and pulling up and puckering of the chin from mentalis, and pulling down of the neck and jawline from platysma.

On the other side, we’ve got the pressure effects, and this is because we spend about eight hours a night sleeping, and we get this shearing force, and those lines are going in a different direction. And they tend to be a bit more asymmetrical, depending on what side you sleep on.

The treatment for both would be preserving your collagen by wearing your SPF every single day (helps to prevent collagen breakdown), and wearing vitamin C and vitamin A products, if you can tolerate them. We might do skinpen micro needling treatment, to help treat both, to help break up fine lines and to stimulate collagen.

We want to treat the cause and not just the crease.

And then, where there’s muscle movement contributing to the expression lines, a muscle treatment could be used.

For the creasing sleep lines, we might use something like a collagen stimulator or biostimulator injectable (Juläine, HArmonyCa, or Radiesse) to help, and, as always, you really want to have a detailed consultation to look at what’s causing the lines and wrinkles.

If you’re not bothered by them, leave them well enough alone, but just help protect your skin against skin cancer with your daily SPF and sun protection measures (sunglasses, hats, seek shade, etc).

If you are bothered by them, seek a diagnosis and get a treatment plan with the medical professional.

Spray SPF: Tips for Better Sun Protection

Hi. If I’m going to use spray SPF, how do I maximise the benefits and the protection from it?

This post isn’t sponsored.

I love these products on the go, especially if you’re in the water or you’re out and about for a long day. I don’t rely on them as my only form of SPF.

In the morning before I get dressed, I’ll put plenty of SPF cream or lotion on my face, including eyelids, lips, ears, nose, hairline, on my hands, on my neck, and any exposed skin. And then if I’m out and about, I’ll use these as a top up. The way I apply these is, I spray it onto my hands, and then rub it into my face. You can spray it directly onto your face if you close your eyes and hold your breath while you’re spraying it, and keep it about 20 centimetres (8 inches approx.) from your face.

Not all of it lands on the skin, so, ideally, do it somewhere that’s not too windy, and then reapply frequently as you need to, if you’re out and about.

I also use other sun protection measures, like a sun hat, sunglasses, shade, UPF clothing, if I’m in the water, especially the rash guards. I think they’re wonderful.

And I avoid the very hot parts of the day. I always avoid sunburn. Yes, I’ve had a few as a kid, but absolutely not anymore, because I want to help protect my 61-year-old skin against the premature ageing and wrinkles and pigmentation from the sun, and also to help reduce some forms of skin cancer.

When we use the UV camera in the clinic, we see most people don’t apply enough SPF, and they often miss ears, eyelids, hairline, lips and hands.

So, stay as safe as you can, enjoy the lovely weather, and try not to get sunburnt!

PS avoid sunbeds too😬🙌🏻

Side Effects vs Complications: What's the Difference?

Hi from Tramore, it’s a beautiful day for a sea swim, so wish me luck 🤗

Let’s talk about the difference between a side effect and a complication.

Because aesthetic medicine treatments are elective, which means they’re planned, we always go into detail about expected side effects, like tenderness or bruising, or a little bit of swelling, because we’re using devices or lasers or needles to effect a change.

Nobody wants a side effect, and we don’t underestimate them, but they’re part of the process of potential issues with treatment. The next are complications, and these are different. These are unexpected or unwanted effects after a procedure. So, for example, if you had a surgical procedure or operation, you know you’re going to get a scar, but a complication could be a wound infection.

We always want to minimise both side-effects and complications, and I always say my videos “See a medical practitioner”.

Now, that doesn’t give us amnesty from complications or side effects. But I do think the risks are lower if you see somebody who’s experienced.

You also want to ask how often somebody’s doing a procedure?

 What is their aftercare?

How they recognise and manage complications?

And how do they keep their risks as low as possible?

All of these procedures have risks. Nobody wants to go home with needle marks or a bruise, but this can be part of the process, and doesn’t mean anything has gone wrong.

We always want to stay as safe as possible, use training, experience, sound knowledge of anatomy, clean careful techniques, handle quality products and devices appropriately and provide aftercare and support as needed.

I recommend a full consultation with a medical professional to discuss all risks and benefits and provide full informed consent, before you decide if you’re going to have any treatment.

Why the Area Around the Mouth Ages So Differently

Hi. Why is the area around the mouth or perioral area so complex?

There isn’t a single cause; there are six.

There are changes happening in all the layers of the face over the years. The skin loses collagen and elastin and gets more creepy and thinner.

We lose a lot of fat around the mouth, especially deep in the pirform fossa, around the lip, and especially at the chin shadows.

And the fact that we do have slides down, creating fatty jowls, and making the nasalabial folds deeper.

There are muscle changes where the depressors or pulling down muscles get more active over the years.

DAO (depressor angiooedema oris) pulls down the corners of the mouth, mentalis is creasing the chin, platysma pulls down the neck, and makes the jawline less distinct.

Also, there are soft tissue and ligament changes. And there’s more soft tissue fall down or concertina effects from gravity. The bone structure and dental support is also changing significantly over time.

We’re losing strength and size in the jawbone (the mandible), and the mid face bone (the maxilla) is shrinking back and rotating. We may lose some dental support.

And to top it all off, the lip itself is changing. The distance between under the nose and the top lip, called the ‘white roll’ lengthens and flattens, and the top lip tends to thin and curl in, and we’re losing fat and hydration, and we’re getting muscle changes in the lips.

So, it’s a complex area!

If you’re concerned, consider a full, detailed diagnosis and then a treatment plan from a medical practitioner. There are lots of solutions but it’s not a single treatment or a single layer to remedy.

We are seeking a highly experienced aesthetic injector with a proven track record in advanced injectable techniques. This is a long-term role, designed for someone who envisions growing with us. Initially part-time, with a view to full-time, you will integrate into our thriving patient base of nearly 4,000.

If you’re dedicated to a long-term aesthetic career and have extensive injection expertise, we want to hire you!