Neil Bulstrode has a wide experience using Botulinum toxins, such as Botox®, Azzalure® and Dysport®, and Fillers such as Juvederm®. He has published papers regarding Botulins in both cosmetic and reconstructive patients in leading Plastic Surgery Journals.
Patients will be seen and assessed for the most appropriate treatment for them.


Topics to be considered and discussed

  • Soft tissue fillers are an exciting way to enhance and rejuvenate areas of the face

  • A hyaluronic acid based filler will be used called Juvederm

  • Hyaluronic acid is found in the connective tissue of the skin

  • The effects last between 6 to 12 months depending on the area that is injected

  • Lip augmentation normally lasts for up to 6 months because it is such a mobile area

  • The effect gained from subsequent treatments can last longer, sometimes up to 8-12 months

  • Injecting Hyaluronic acid can be painful and may require local anaesthetic

  • Areas that can be treated
    - Lip augmentation (producing a fuller pout)
    - Glabellar complex, vertical or transverse frown lines between the eye brows and above the nose
    - Wrinkles around the mouth
    - Acne scarring
    - Mild deformities of the nose
    - Nasolabial fold
    - Marionette lines
    - Chin


Details of the surgical procedure and follow up

  • Careful assessment and planning by a Consultant Plastic and Reconstructive Surgeon

  • Local anaesthetic
    - Injection (like the dentist) 10 mins to work
    - Cream 45 mins to work

  • A calm and relaxed patient sitting comfortably

  • Targeted areas are injected when the face is relaxed

  • Combination treatment may be required eg Botulinum toxin

  • Gentle pressure may be required


Advice for before and after the procedure

  • Patients encouraged to move the muscles that are injected

  • Cooling with ice packs when home

  • Avoid lifting bending or staining for 3-4 hours

  • Unrestricted activities after 4 hours

  • Flying and heat is not thought to have an adverse impact

  • The first effect may be as early as 6 hours and maximal effect is at 14 days


Whilst the chance of risk is very low, it must be discussed and understood

  • Local (Normally resolves quickly)
    - Pain
    - Tenderness
    - Erythema (redness)
    - Bruising
    - Numbness
    - Swelling for 3-5 days

  • Rare complications of infection and granuloma formation

  • Hypersensitivity occurs in 1/2000 patients


Conditions or factors that serves as a reason to withhold a certain medical treatment

  • Previous Hypersensitivity

  • Telangectasia and rosacea (redness) may worsen

  • Tendency to excessive bleeding

  • Thrombocytopaenia (low platelets)

  • Haemophilia

  • Anticoagulation therapy

  • Aspirin


Additional advice provided by the British Association of Aesthetic Plastic Surgeons