A2 magazine – Dr. Nedic explains eye area rejuvenation, Dermagenetic tests for healthier looking skin and talks about her own anti-aging regime
Our Expert Panel
A2’s professional contributors
Dr Sly Nedic MBChB(Bel) Aesthetic and Anti-Ageing practitioner
Dr Nedic is a founder of the 8th Sense medi-spa in Sandton, where she passionately combines aesthetic makeovers with anti-ageing medicine, bioidentical hormone replacement therapy and preventative genetic testing .This makes the practice unique as it offers treatments for ageing on the inside as well as out, for both women and men alike. She is a board certifi ed doctor of WOSAAM (World Organization Society Of Anti-Ageing Medicine), a member of IHS (International Hormone Society) and A4M (American Academy of Anti-Ageing Medicine). She has more than 20 years of medical experience where she is an accredited expert for the Thermage medical procedure, and an accredited doctor for advanced fi ller techniques, Botox and mesotherapy (France), as well as Master courses (Paris). She is also an accredited doctor by Laboratories Reunis-Europe for comprehensive genetic testing (diploma in Genetics from the Reunis academy). Dr Nedic is an author of many articles and is a lecturer at the international and local anti-ageing congresses. Dr Nedic has extensive knowledge in all aesthetic treatments, non-invasive facial rejuvenation and body sculpturing – as well as anti-ageing medical treatments through World Congresses and Workshops – which she attends regularly.
Dr Vernon Ching Plastic & Reconstructive Surgeon MBBCh (Wits) FCS (SA)
MBBCh (Wits) FCS (SA) Dr Ching is a Specialist Plastic Surgeon who completed his undergraduate and postgraduate training at Wits University. He has been in private practice since 1995. Dr Ching is the Director of Precision Aesthetics based at the new Waterfall City Hospital in Midrand. It offers the complete aesthetic solution, combining non-invasive treatment modalities with cosmetic surgery. Dr Ching pioneered the use of Thermage and Slimlipo laser liposuction in South Africa. He also has a special interest in post-bariatric surgery reconstruction, which is associated with the Centre of Excellence for Metabolic Medicine and Surgery at Waterfall City Hospital.
Dr Nerina Wilkinson, MBChB(Stell) FCS(SA)Plast
Plastic and Reconstructive surgeon, Dr Nerina Wilkinson has a full time private practice at the holistic anti-ageing Renaissance Body Science Institute in Cape Town. She is a member of the Association of Plastic and Reconstructive Surgery. She has also presented scientifi c papers at congresses and publishes in health related magazines. Dr Wilkinson has a major interest in aesthetic surgery of the face, breast and body, closely integrating surgical with other non-invasive procedures.
Dr Anushka Reddy Aesthetic Physician MB BCh (Wits)
Dr. Anushka Reddy is a medical doctor and an Anti-Ageing and Aesthetic treatment specialist. She owns the Medi-Sculpt group of treatment centres, which specialises in non-invasive and non-surgical cosmetic treatments and procedures. She has more than 15 years medical experience, including seven years of non-surgical cosmetic experience. Her qualifi cations and professional experience include the following: MB BCh (Wits), an Allergan accredited training in Botox® and dermal fi llers and International Master Course on Ageing Skin in Paris (amongst others). Dr Reddy is also the President of the South African Association of Cosmetic Doctors (SAACD) She constantly keeps abreast of international anti-ageing and aesthetic treatment trends, and regularly attends specialist conferences and seminars abroad that cover the latest developments in these fields.
Dr Riekie Smit Aesthetic Physician MBChB (UOFS), Msc Sports Medicine (Pret)
Dr Smit is an Aesthetic and Sports Physician in South Africa – with a private practice and medical spa in the northern suburbs of Pretoria. Her focus of her practice is aesthetic and anti-ageing treatments. Dr Smit is the president of the Aesthetic and Anti-ageing Medicine Society of South Africa, and is also the president member of the International Union of Aesthetic Medicine for the past 4 years. She is the chair organizer of the Aesthetic Medicine Congress of South Africa – and is the author of many articles and scientifi c publications. Her fi eld of expertise is facial shaping and rejuvenation with Botulinum toxin and fi llers, chemical peels, mesotherapy, lasers and especially, peri-orbital rejuvenation.
Dr Gabriel Doucas, Plastic Surgeon MBChB (UFS), F C Plastic Surgery (SA)
Dr Gabriel Doucas graduated from the University of the Free State with a Bachelor of Medicine and Bachelor of Surgery. He then went on to specialise as a Fellow of the College of Plastic Surgeons of South Africa, through the University of the Witwatersrand. Dr Doucas runs his private practice out of the Netcare Linksfi eld Hospital in Johannesburg, where he focuses his work on cosmetic surgery and skin lesion-related surgeries. He is also an active academic member of the University of the Witwatersrand where he practices and teaches Plastic Surgery at Chris Hani Baragwanath, and Charlotte Maxexe Johannesburg Academic Hospitals. In the academic sector, his specialty lies with head and neck reconstruction surgery.
Eye of the beholder
In the quest for ageless eyes, the search can be endless when faced with all the new advancements in the aesthetic world. Dr Sly Nedic makes simple the art of eye rejuvenation through an expert eye.
The eye is the mirror of the soul, but nevertheless beauty and youth are generally measured by the appearance of the eye region (Peri-orbital region). A youthful eye area is a full and open look, with no hollowness around the eyes. The upper eyelid fold is localized approximately 8mm from the edge of the eyelid eyelash, and without excessive skin. The eyebrow is also slightly convex, and the lower eyelid is toned with a good exposure to conjunctiva.
The signs of eye ageing appear differently in different people – and generally occur around age of 40 – while stabilizing at the age of 60. There are many anatomical structures involved in ageing eyes and peri -orbital area, and even supporting structures can influence the appearance of eye youth (such as cheeks and temples). Peri -orbital ageing is multifaceted and each anatomical structure will require different techniques, often requiring the combination of treatments.
What are the signs of the ageing eye area?
Excess skin of the upper eyelid can be wrinkled and lax, sometimes even interfering with vision. It can also make the application of eye make-up quite tricky. With ageing, the position of the eyebrows is often changed, leading to ptosis (droopiness). This is the second most common complaint of the ageing woman. The eyes are also protected by a layer of fat, and with ageing this fat can atrophy and create the appearance of hollow eyes. They can also protrude, which is a hallmark of ageing eyes… and needless to say, is not aesthetically appealing.
The muscle which closes the eyelid (orbicularis) actually becomes more prominent as the structure above rapidly ages, creating crows feet wrinkles. These wrinkles become very visible when one smiles, and what seems to be pretty at a younger age can become destructive at a more mature age. Laxity of the lower eyelid is a very obvious sign of ageing. Lower eyelids elongate with ageing and can also show bulging fat, creating low eyelid “bags”. In the lower eyelid the tear troughs deform further, complicating lower eyelid appearance.
The cheek may be flattened with age which creates a sad look. However, the dynamic of the patients smile can give the appearance of youth by shortening of the lower lead and mid cheek. In addition, sun damage and age related pigmentation, vascular lesions and skin texture problems (such as roughness and dullness) further complicate the eye region.
What can we do to rejuvenate the eye area?
When we decide on a treatment, the predominance of the anatomical structure of the most aged area is normally the first one to start with. Complexity of the eye region will need a combination of techniques to activate the most youthful results.
Skin laxity and sagging are best treated with monopolar RF like Thermage®. The new CPT hand will deliver results which are deeper, more effective – and painless – thereby assuring the patients comfort. The aim is to stimulate new collagen production over a period of time, creating less sagginess and smoothing wrinkles. This can be achieved in a single treatment without any downtime or surgery.
The dynamic peri -orbital wrinkles or crows feet are treated with a Botulinum toxin, carefully delivered in an optimal dose so as to not cause excessive swelling for patients who are prone to this condition. Botox® can also help with brow lifts, completing that younger look. For lower eyelid wrinkles, Botox® is sometimes used if there is no excessive laxity when checked by a snap-back test.
For improvement of texture and mitigation of fine lines, gentle methods such as traditional phototherapy, pulse light or fractional lasers are usually used. However in more severe cases, more ablative treatments such as CO2 lasers, LED resurfacing, ER: YAG lasers and even 30-40% TCA peels should be used. These treatments should always be performed with good eye protection and by experienced physicians.
The recent trend in creating the youthful eye look is in mastering filling techniques with hyaluronic acid fillers. Instant youthfulness can be achieved by adding a filler in the malar area, leading to shortening of the lower eyelid, peri-orbiatal hollowness and tear troughs. Fillers should be done by an experienced injector who avoids over correction and superficial deposits, as this leads to a poor outcome. But if this is done correctly, it will result in a total disappearance of the hollowness, creating a beautiful youthful appearance.
For peri-orbital fat atrophy, fillers can be injected behind the eyes (retro- orbitaly), thus creating more of a youthful look. A small amount of filler can be deposited just under the outer eyebrow, creating an eyebrow lift which every woman desires.
Mesotherapy treatments combined with a different concentration of non-cross linked hyaluronic acid can be used for peri -orbital rejuvenation. This can be used for mild cases, or as an addition to combination techniques.
To achieve successful rejuvenation of the eye area, it is necessary to use a combination of techniques. One must have perfect anatomical knowledge of this region, as well as advanced training and an artistic eye.