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Higher Learning by Dr. Nedic

Higher Learning by Dr. Nedic


Dr. Nedic talks about educating aesthetic patients…

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Dr Sly Nedic elaborates on the importance of educating patients on aesthetic procedures.

I often ask myself why some of my medical patients on chronic medication are not concerned about the terrifying side effects of the many drugs they’re on, but are scared of facial injectables (such as fillers and botulinum toxin) instead. When I ask them what it is they are afraid of, the general feedback is that they’ve heard of “horror stories” about the procedures. Yet strangely enough, they are not able to pinpoint exactly what that “horror” is. When I searched for images of botched aesthetic procedures myself, I’ll admit that I too had a fright! However, I realized that majority of the frightening images were not related to facial injectables at all, but rather to plastic surgery in extreme cases. Furthermore, the old-fashioned trend of freezing the facial expression is a passé – and doctors all over the world understand that patients now want a natural look. Unfortunately though, individuals are still stuck in the mind-frame that injectables will leave them looking ‘plastic’, as they have not been educated in what doctors are really striving to achieve. This is evident in the results of a South African-Consumer insight survey conducted in 2014 by Allergan Inc. Juvederm. The research found that out of the internet penetration population estimate of 27, 2 million (ranging from 26-65 years old), only 32.3% were aware of toxins or fillers. However, a minuscule 1.3% had actually undergone some toxin or/filler procedure (see pic 1) Understanding Toxin and Fillers – Procedure and Trends Botulinum Toxin Botulinum toxin is a prescription medicine that is injected into the muscles, and used to temporarily improve the look of moderate to severe wrinkles and frown lines between the eyebrows in adults. There are many off-label uses of the toxin in the face that can still give a natural look, but obviously your doctor needs to be well trained in off-label use. Since the safety of botulinum toxin (the most studied drug of the 21-century) is very well described; the rest is all in making sure that the doctor who performs the procedure is an experienced injector. There are more than 1, 2 million doctors who are allowed to perform facial injectables in the US, but less than 3% are qualified to be expert injectors… and South Africa is no different in this regard. Would you like to have your jabs done at a dedicated practice, by an experienced injector who follows trends and invests in continuous medical education – or simply by anyone who offers this procedure? The choice is yours. A simple checklist to help you feel more confident before choosing an injector is to ask your doctor the following:

How many similar procedures have you performed?

  • Would you please show me your qualifications and training certificates?
  • Could you show me before and after photos of your patients who have agreed to disclose (this is where you can see results, and decide if you want to have the natural look which your doctor offers)
  • What are the risks associated with this procedure – and how often do you see side effects?
  • Do I need any preparation before the procedure?
  • What can I expect after the procedure (recovery time, do’s and don’ts immediate effect, long term effect, etc)


Any reservations or concerns you might have should be pointed out to the doctor, discussed thoroughly and possibly written down and signed in a consent form.


A similar approach applies when choosing a doctor to inject fillers. Obviously, we are talking about hyaluronic acid fillers as they are the most prominent in the aesthetic market. Hyaluronic acid has the ability to hold up to 100 times its own weight in water to maintain moisture, plumpness and youthfulness of the skin. In a recent publication from 2014, The American Society for Aesthetic Plastic Surgery (ASAPS) showed that hyaluronic acid was the second most frequently performed non-invasive procedure after Botox® (and other neuromodulators), with a 31%,5 increase compared to the previous year. Fillers have changed and evolved dramatically over time with regards to longevity, formulation (viscosity, gel hardness, flow etc) as well as the techniques used. In the past few years, the way fillers are used have also progressed. We now use fillers in a three-dimensional perspective, using them to change contours, shadows and volume on the face (and not just for filling wrinkles). This approach can deliver what patients from all over the world want: a natural result. In addition, beautification of the face for any age group becomes an incorporated part of the artistic work of an experienced injector. Understanding the mathematical proportions in the face (known as the Golden ratio) helps to attain the best outcome. (see before and after images above : Beautifiying the face by using the mathematical principles of the Golden ratio and Juvederm® Vycross fillers)

Body procedures

When it comes to procedures on the body, (lasers, fat cryolypolisis, radiofrequences, mesotherapy, etc) the safety issues become more complicated, as non-medical professionals can use some of these devices in South Africa. I am concerned that in the economic crisis of late, patients who desire many of these body procedures will attempt to do it with non-professionals – and with non-approved devices which has many side effects. Assuring that devices are FDA approved in the US, or CE approved in Europe (and is performed in a reputable aesthetic practice under medical doctor supervision), is essential in preventing serious problems. Similar questions as those asked for facial injectebles can also be asked prior to any procedure. Rather than just Googling,guessing and searching for a cheap alternative, meet your doctor first, ask questions and make an informed decision.