At The Marylebone Clinic we understand how important it is for you to know you’re choosing the right place to treat your skin condition.
Having the right dermatologist is important especially when you have a chronic skin condition that will require ongoing treatment. We want you to feel confident that we’re providing you with the best possible care. We also want you to feel as comfortable as possible with your dermatologist.
At The Marylebone Clinic, we have extensive experience of treating a range of skin types and patients of all ages from across the world.
Clinical Dermatology is the treatment of skin disease. In our clinic, we treat many skin disorders such as acne, atopic dermatitis (eczema), contact dermatitis, psoriasis, allergic reactions, vitiligo, hair and nail disorders, moles, skin tags, seborhoeic warts and other infectious skin diseases. We also provide early diagnosis of skin cancer as well as treatment for skin cancer itself.
The common perception is that acne begins in adolescence driven by hormonal changes and by the early twenties it tends to disappear for most and decrease for the remainder. However, acne is a chronic disease and can affect patients of all ages. It is not uncommon to have patients over fifty that develop acne or are still affected by it.
A tailored approach to treatment
For those who are seeking a solution for acne, The Marylebone Clinic achieves excellent results for every age group, using a number of techniques tailored to the specific skin requirements of each patient.
An assessment with Dr Brazzini will determine the best course of treatment – from systemic treatments such as oral antibiotics including Roaccutane, topical treatments through to laser and chemical peels.
N-Lite laser for acne
Dr Bazzini has found that N-Lite laser treatment has produced excellent results when treating patients with all forms of acne. It works by targeting the bacteria that causes acne and works well on all skin types. The N-Lite laser emits a unique light which stimulates the natural repair mechanism of the skin and kills spot-causing bacteria. It also increases the production of collagen, helping to reduce any pitting and scarring. It can be used on the face, neck, back and chest. It produces little or no side effects and there is minimal recovery time after a treatment session.
Clinical trials carried out by Dr Chu, Consultant Dermatologist at Charing Cross and Hammersmith Hospitals, showed that after just one treatment, improvement was usually seen at 2 – 4 weeks. After 12 weeks, 87% of patients had improved substantially with no side effects.
Each N-Lite treatment takes around 30 minutes and most patients require around 3 -4 sessions over a 3 month period though that can vary slightly.
Acne can also be dramatically improved with chemical peeling, often carried out in conjunction with or at the end of, a course of laser therapy.
Chemical peels for acne
Depending on the severity of the acne being treated, patients will usually have either a superficial or moderate peel and may be required to apply some topical ointments a week or two before the procedure begins. Most patients experience a tingling of the skin during the peel and a slight pink or red flush to the area being treated for a few days afterwards. They may also have slightly flaky skin during this time but their normal appearance will be fully restored in around three days.
Please see section on chemical peels for more information
As consequence of acne, the patient can be left with different types of scars: pitted scars, atrophic scars (pitted, rolling & box scars) and/or keloids. Depending on the type of scarring that the patient has, will determine the course of treatment that they will follow but it is likely to include a combination of microdermabrasion, chemical peels, dermal roller therapy and laser treatment. In rare cases, surgical excision may be required.
See section on scars and keloids for more details
Broken veins can be removed from not only your legs but also from your face and other parts of your body. They are caused by many factors including sun exposure, smoking, drinking, hormonal changes, genetic pre-disposition and weight.
The gold standard treatment for small leg veins is sclerotherapy. Laser treatment on leg veins is only performed in a very few, specific cases and only after an examination has taken place to ensure that the patient does not have any underlying varicose veins
For facial broken veins there are numerous effective treatments such as different types of lasers and IPL. With such techniques 2-4 sessions are necessary at one month intervals. After each session the treated area may be red and at times covered with small scabs.
In our clinic we use the very latest vascular laser technology such as KTP, Pulsed Dye laser, long pulse Nd:YAG and IPL. Each patient will be treated with appropriate device according to the specific condition.
Eczema is a common condition that mainly affects children but can continue into adulthood. Atopic eczema or atopic dermatitis as it is also known, is the most common form of eczema. It tends to occur in areas where there are folds of skin such as behind the knees, on the front of the elbows, the side of the neck and around the eyes and ears. Other types of eczema include allergic contact dermatitis and irritant contact dermatitis.
Eczema sufferers are often found to have allergies and frequently are found to have asthma and/or hay fever as well.
The severity of the condition can vary greatly from patient to patient and can be extremely uncomfortable and incredibly painful. Dr Brazzini has found narrow-band UVB phototherapy to be highly effective when used to treat localised areas of eczema but can advise you what the best course of treatment would be according to your symptoms and history.
Psoriasis is a chronic skin condition and it affects around 2% of the UK population. It causes red, flaky, crusty patches of skin covered with silvery scales generally in small areas on the body.
The severity of the condition varies greatly from person to person but for some it can be quite debilitating.
Dr Brazzini has found phototherapy to produce excellent results when treating patients with psoriasis in her clinic. For further information and to book an appointment, please send an email to email@example.com.
Rosacea is a another chronic skin condition that mainly affects the face, beginning with episodes of flushing. Sufferers may experience spots and persistent facial redness. In some cases small blood vessels may become visible and in extreme cases, the skin can thicken and enlarge, on and around the nose.
The exact cause of rosacea is unknown but certain factors are known to make it worse. These include exposure to sunlight, stress, cold weather, hot drinks and certain foods such as spicy food.
Dr Brazzini has many years experience and success in treating rosacea through a combination of methods (topical creams and gels, antibiotics, laser /UVB therapy) and would be happy to discuss a programme with you.
Hyperhidrosis or excessive sweating, is a condition which may cause great emotional distress and compromise a person’s working and social life. This condition can occur in any area of the body but the most commonly affected areas are under the arms, the palms of the hands and the soles of the feet.
How can it be treated?
Hyperhidrosis can be dealt with very effectively through the use of anti-ageing injectables. Anti-ageing injectables block the sweat secretion by the sweat glands because of their anti-cholinergic effects.
Miradry for hyperhidrosis
Miradry is a permanent solution for excessive sweating. It eliminates the sweat glands under the arms through a simple outpatient procedure which delivers controlled electromagnetic energy to the underarm area. It is the only non-surgical procedure to deliver long-lasting results for excessive sweating. The glands do not grow back after the treatment and in a clinical study, patients experienced an average of 82% reduction in underarm sweat. Following the procedure, patients should be able to return to work and resume normal activities right away and can even start exercising within a few days. Some localised swelling or tenderness is to be expected but it will last only a few weeks. www.miradry.com
Melasma, also known as cloasma, is an acquired pigmentation triggered by sun-exposure. It presents as symmetric hyper-pigmented patches mainly localised on the forehead, cheeks and upper lip, but it may occur in other sun-exposed areas.
What causes melasma?
The cause of melasma is still unknown. However, it has a direct relationship with female hormonal activity such as pregnancy and use of contraceptive pill.
Melasma is much more common in women but can also affect men. All skin types can be affected but it is more common in darker skin types (Asians and Hispanics).
The most important factor for the development of melasma is sun-exposure. During the initial phases of the disorder the pigmentation appears immediately after sun-exposure and tends to disappear completely with avoidance of the sun.
After subsequent periods of sun-exposure, the pigmentation becomes darker and does not disappear spontaneously any longer just with avoidance of the sun.
How can melasma be treated?
Melasma has traditionally been a very difficult condition to treat but recently there has been an exciting new development in the treatment of this condition. We are now using injections of a small quantity of tranexamic acid which is delivering great results without any side effects.
Other options still exist including depigmenting creams that if used under strict medical guidance and in conjunction with other treatments such as chemical peels, can improve the condition.
Chemical peels can be effectively and safely performed on patients with melasma and in particular resorcinol peels, pyruvic acid peels and retinol peels (see section on chemical peels for details).
Any patients with melasma need to avoid sunlight completely, use total sunblock and wear sunhats and glasses if they decide to treat the condition.
After a thorough examination, Dr Brazzini will be able to advise you whether removal of your mole (or moles) is required – if it does, you will undergo a quick procedure under local anaesthetic as an out-patient. You may be left with a small scar.
If you have any moles that you consider to be unsightly, make you feel self-conscious or restrict your movement in any way, speak to Dr Brazzini about having them removed – it is a very quick and simple procedure.
We also remove benign and malignant skin lesions – see section on skin cancer for further information.
The increasing rise in cases of skin cancer, including malignant melanoma, should make everybody aware of the importance of an early diagnosis. Cancer prevention and early diagnosis are one of our biggest concerns. Since 90% of skin cancer is caused by excessive sun exposure, the first approach with our patients is to teach them how to deal with the sun.
Early diagnosis is absolutely crucial for malignant melanoma, as treatment for advanced melanoma is rarely effective. Dermoscopy allows us to increase diagnostic accuracy reducing significantly the number of unnecessary excisions of benign skin lesions, sparing time, pain and cost.
For non-melanoma skin cancer (mainly basal cell carcinoma and squamous cell carcinoma) an early diagnosis is sensible, but not a matter of life or death. Early stages of non-melanoma skin cancer manifest as slightly raised red lesions covered by a scab.
These pre-cancerous lesions (actinic keratosis) may develop into basal or squamous cell carcinomas. When diagnosed in this stage, non-surgical treatment (laser treatment, photodynamic therapy, criotherapy) is easy, effective and also cosmetically acceptable (no scarring).
There are many different types of scars:
Atrophic scars: the skin appears to be stretched, thin and usually white. Stretch marks are a typical example, but atrophic scars can also appear as the consequence of acne, recurrent cysts and infections on the body.
Pitted and sunken scars: mainly caused by acne and chickenpox, but also as the result of accidents and surgery. These are the result of the loss of underlying structures supporting the skin.
Hypertrophic scars: often mistaken for keloids, but unlike what happens in the latter, the excess scar tissue remains within the margins of the original lesion. They are red and protruding, and often itchy and moderately painful.
Keloids: pathological scars: ones that grows too much and that usually grow beyond the margins of the original wound. They are raised, red or purple, shiny, hairless lesions often painful or itchy. Most people with keloids have only one or two. However, some people have many, especially if they have come up after acne or chickenpox scars
A keloid can occur after surgery, after major skin trauma but also after very minor skin damage, such as acne spots. It is also possible to develop a keloid even if there has been no obvious damage to the skin at all.
Keloids usually occur on the upper chest and shoulders - particularly over the breastbone (sternum) - and on the earlobes. In dark skinned individuals they very often occur in the beard area and on the scalp.
Asians and dark skinned people develop keloids much more easily than those with a paler skin. A tendency to develop keloids certainly runs in some families.
Is it possible to remove scars?
Unlike what many people think, scars are permanent marks that cannot be eliminated by any surgical technique: they can only be improved upon.
What influences the quality of a scar?
The impact and severity of a scar can be influenced by a number of factors which include whether it is as a result of surgery or an accident, whether you are fair or dark-skinned (if dark, the scar will likely be worse) where on the body it is and how it is treated.
What kind of treatment can be used to improve scars?
First of all the correct care of a wound is essential: topical antibiotics to cure or prevent infections, continuous pressure (if possible), occlusion with silicone gel sheets or daily application of silicone gel for several months. Following this there are a number of cosmetic and surgical procedures that can be used including excision of the scars, intralesional steroid injections, chemical peels and laser treatment.
Atrophic scars: the most difficult type of scar to treat. Chemical peels and laser treatment may some times improve their appearance. Very good results have been obtained with the new fractional lasers which improve both the texture of the skin and the color. If the atrophic scars are very wide it is advisable to perform an excision of the scar.
Pitted and sunken scars: pitted scars due to acne can be improved with chemical peels and laser resurfacing with fractional lasers or surgical lasers. If very deep, they can be treated, like sunken scars, with injections of collagen or hyaluronic acid.
Keloids and hypertrophic scars scars have typically been improved both through medical and/or surgical treatments. Surgical removal would often result in the return of of new and sometimes even larger keloid scars at the site of the incision and the use of steroid injections is really only effective when applied to small keloid scars.
Thanks to an exciting new medical development, we are now treating patients with keloid scars with Cryoshape and seeing remarkable results.
The Cryoshape probe treats keloid and hypertrophic scars by way of direct thermal effect on the deep scar material whilst also causing a softening and normalising of the collagen within and surrounding the scar.
It freezes and destroys deep scar tissue that causes the keloid to develop. The Cyroshape probe treats the scar material and freezes the tissue along the entire scar. Even large keloid scars can be treated in a single session with both volume and the discomfort cause by the scar being significantly reduced.
The treatment is carried out under local anaesthetic and is quick to perform with minimal discomfort for the patient. The patient can leave the clinic immediately after the treatment and will be able to return to work and resume normal activities the following day.
In a study of patients who were treated with Cryoshape, in 97% of cases, no scar recurrence was observed. This is in contrast to other treatments which require several sessions over an extended period of time with sometimes moderately successful outcomes along with the risk of skin atrophy and scar depression and recurrence
Before treatment, the diagnosis must be confirmed by a dermatologist.
Solar lentigo can be effectively treated with medium chemical peels (TCA peels) or Q-switched lasers with no risk of side effects.
We offer the latest rejuvenation techniques for the Skin which including dermal fillers, anti-ageing injectables, PDO thread lift, mesotherapy and Micro-needling. We also offer laser treatment for solar lentigo and vascular disorders (broken veins, angiomas etc.) as well as numerous treatments for acne scaring and keloid scars.
They are most frequently used in the treatment of dynamic lines of the upper part of the face such as glabellar wrinkles (frown lines), forehead lines, crow’s feet and to achieve brow lift. They are also effective for the treatment of the lines around the mouth, lift of the nose tip, the neck area and to decrease the appearance of the lines on the décolleté.
How are the injections administered?
A very fine needle is used to deliver the anti-ageing treatment in very small doses into the areas to be treated. The treatment sessions last 15-30 minutes. Treatment of areas of the face, neck and décolleté is practically painless.
Patients should just be aware of the possibility of injection-related immediate effects such as bruising.
How long does the effect last?
The muscle activity is blocked for three to six months and muscle mobility will recuperate gradually.
How often do treatments need to be repeated?
Every four to six months however, the effects of the treatment do build up. The longer the skin over the muscle is free from stimulation of the underlying muscle contraction, the longer it takes for the wrinkles to become deeper.
There are currently many types of dermal fillers in use and more are being developed every day.
The most important distinction is between permanent (for example silicone, Aquamid and Bioalcamid), semi-permanent (collagen combined with polymethyl methacrylate or hyaluronic acid combined with acrylic hydrogel) and biodegradable (hyaluronic acid and collagen) dermal fillers.
While biodegradable dermal fillers are characterised by a limited short-term durability, requiring repeated injections every three to twelve months (according to age of the patient and severity of the condition), permanent and semi-permanent fillers have safety disadvantages associated with the permanency of their effects such as granulomas and migrating issues and consequently are not used in our practice.
In our clinic we only use hyaluronic acid (Restylane, Perlane, Juvederm, Stylage & Teosyal).
However, chemical peels are not only used to remove layers of the skin, but also to induce collagen formation in the dermis, as antibacterial agents, as regulators of sebaceous gland function and as bleaching agents.
There are many types of chemical peels ranging from superficial peels to deep peels. If you are considering a peel, Dr Brazzini would carry out an extensive examination of your skin and overall health, taking into account factors such as your age, the condition to be treated, the degree of the condition, your expectations and the extent of your exposure to the sun.
Many conditions can be dramatically improved by being treated with chemical peels. These include: acne, acne scars, lines and wrinkles, photo ageing, greasy skin, localized hyper-pigmentation (lentigo - age spots) and melasma.
Depending on the condition we are treating and the skin type of the patient, we use from superficial through to medium peels. These include: Salicylic acid, Retinal acid (yellow peel), Pyurvic acid, Resocinol,TCA, Jessner Solution.
We also offer the VI peel (click here viaesthetics.com/vipeel.com for more information) and find that it is very effective in treating acne scars, ageing, uneven skin tone and sun damage.
Choosing the right peel for your skin
Very superficial peels are used:
• for darker skin types (III-VI) (asian skin and black skin) with very low risk of side effects
• for greasy skin
• to improve skin texture, to make the skin “glow”
• for mild papulo-pustular acne
• for comedonic acne
• for hyperpigmentation in dark skin individuals
• for mild acne scars
• for papulo-pustular acne
• mild to moderate photoageing
• mild to moderate line and wrinkles
• lentigo (age spots)
• moderate acne scars
• moderate acne scars
• lentigo (age spots)
• severe acne scars • severe lines and wrinkles
The duration of the chemical peel itself varies from very few minutes (2-5 minutes) to one and a half hour (resorcinol peel).
After the peel
Very superficial and superficial peels are slightly uncomfortable but not painful. There is slight stinging and burning sensation that ceases as soon as the peel is neutralised. Retinol peels are absolutely painless.
Medium peels cause a quite intense burning and stinging sensation for 2-5 minutes that ceases once the peel is neutralised. Resorcinol peels cause a slight burning sensation once the peel is taken off.
Deep peels instead require local anaesthetic with sedation and are performed in an operating theatre sometimes with one-day hospitalisation.
Post-peel recovery time varies greatly depending on the type of peel a patient has. To find out more, please refer to our FAQ section.
It offers a great alternative to fractional lasers such as fraxel and 1540 fractional Palomar – not only is it considerably cheaper but it also delivers excellent results on all skin types from I to VI.
The dermal roller is a small handheld device consisting of small stainless steel acupuncture needles on a rotating wheel. The needles are all 0.25mm in gauge but differ in length according to the condition being treated:
0.2 – 0.5 mm for skin rejuvenation
1.0 – 1.5 mm for acne scars
2.0 – 2.5 mm for deep scars
After an application of local anaesthetic cream, the dermal roller is applied over the skin in four directions and the fine needles penetrate the surface, causing superficial bleeding. The skin is then cleansed with sterile saline and ice packs are applied to the treated areas.
After the treatment, the skin is slightly red for two to three days. Camouflage make-up can be safely used if required.
The penetration of the skin by the tiny needles of the dermal roller, stimulates a dramatic increase in the production of new, natural collagen and elastin fibers.
Typically three to five sessions are needed for treatment to be effective. The final results are seen around three months after the final treatment.
Dr Brazzini is one of the leading specialists using this technique and has lectured on it in Italy and run a number of training seminars. She has achieved excellent results treating acne scarring with the dermal roller especially on the face and back and has found it to work well when used to revitalise tired or lined skin on the face, neck and chest. She has also seen similarly pleasing results when using this technique on scarred skin as the fine needles on the roller stimulate the production of ‘normal’ collagen as opposed to scarring collagen.
For further information on this treatment, get in touch with us at firstname.lastname@example.org
Laser light is absorbed by the pigment (melanin) of the hair follicle and converted into heat which destroys not only the hair but also the hair matrix and hair bulb at the base of the follicle.
When the hair is in the anagen phase (growing phase) the bulb is connected directly to the matrix of the hair follicle, while during the resting phase (telogen), there is a gap between the bulb and the matrix.
The heat generated by the laser is conducted directly to the base of the follicle if the hair is in the anagen phase, causing the complete destruction of the hair follicle matrix. This is why laser hair removal is mostly effective during the anagen phase.
This also explains why many treatment sessions are necessary: since not all hair follicles are in the anagen phase contemporarily, more treatment sessions are necessary in order to target the all the hair during the anagen phase.
When is laser hair removal effective?
Hair has to be pigmented (brown or black). Blonde, white and grey hair cannot be “seen” by lasers. The pigment has to be in the follicle so coloured hair will not respond to treatment.
Hair needs to be present in the hair follicle, this means that patients cannot wax for at least one month before laser treatment, but may shave.
Which areas of the body can be treated?
All areas can be treated but response is different. In our experience the best results are obtained on armpits and bikini line: hair becomes gradually less, thinner and lighter and the growth is slower. After an average of six treatments there is a reduction of 80-90% of the hair.
In areas such as face, legs and arms the hair becomes significantly thinner, lighter and less dense, but it is rare to see a complete disappearance.
Are there any risks?
In dark skin individuals where the colour of the skin is similar to that of the hair, hypo or hyper-pigmentation may occur. Usually these are temporary effects.
However, it is important to avoid laser treatment when suntanned.
New lasers allow us to treat even darker skin individuals with low risk of side effects.
How many treatments are necessary?
If there is no underlying disease which targets hair growth, an average of six treatment sessions is usually necessary.
The interval between sessions varies from patient to patient and becomes longer as more treatments are performed. It is advisable to perform at least one subsequent treatment session once most of the hair has grown back.
At the Marylebone Clinic, we use fillers (hyaluronic acid) which are injected along the border of the lips and inside the body of the lips with a fine needle. No anaesthetic is required for this procedure which is practically painless, takes a few minutes and any swelling subsides within 24 – 48 hours.
We advise that patients return every nine to twelve months for maintenance treatments.
With the ageing process, circulation decreases and the resulting reduction of oxygen and nutrients leaves the body less able to expel toxins. As a consequence, we see the impact of this ageing process especially in the skin as it takes on a greyish palour.
Mesotherapy is used to nourish and rejeuvenate the skin and to promote the production of collagen and elastin as well as to stimulate the skin’s metabolism.
How is the treatment administered?
A very fine needle is used to administer multiple micro injections just below the skin’s surface, directly into the area requiring treatment.
Vitamins, minerals, anti-oxidants and amino-acids are injected directly into the middle layer of the skin (the mesoderm) and into the problem area requiring the treatment – be that the face, neck, hands or décolletage. Those who have had mesotherapy comment that their skin looks glowing, rested, radiant and even firmer.
For those who experience discomfort from the injections, a topical anaesthetic cream can be applied before the start of the treatment most of which last around ten minutes.
Mesotherapy is also a highly effective treatment for reducing cellulite in the thighs, stomach and buttocks. Weekly injections are required for ten to twenty weeks for the treatment to be effective.
How frequently do I need to have this treatment?
If you are having injections into the face, we recommend once a fortnight for two months and then maintenance sessions as required. For micro-injections into the hands, neck and décolletage, we normally suggest a treatment course of three sessions one month apart then maintenance sessions several times a year.
Can mesotherapy be combined with other treatments and is it safe?
Mesotherapy can be a wonderful complementary therapy to other anti-ageing treatments such as anti-ageing injectables, micro-dermabrasion and the dermal roller but works well as a stand-alone therapy. It is an extremely safe treatment and has been used by the medical profession since the 1950s to treat a range of conditions and is a very well established treatment in the field of cosmetic dermatology.
Here are a few of the treatments we recommend:
Dermal rollers have been taking the world by storm for their incredible ability to rejeuvenate skin, decrease the appearance of wrinkles and improve skin scarred by acne. The penetration of the skin by the tiny needles of the dermal roller, stimulates a dramatic increase in the production of new, natural collagen and elastin fibers.
Typically three to five sessions are needed for treatment to be effective. The final results are seen around three months after the final treatment.
Mesotherapy (vitamin injections) is used to nourish and rejeuvenate the skin and to promote the production of collagen and elastin as well as to stimulate the skin’s metabolism. A very fine needle is used to administer micro injections just below the skin’s surface of vitamins, minerals, anti-oxidants and amino-acids into the area requiring treatment – be that the face, neck, hands or décolletage.
Those who have had mesotherapy, comment that their skin looks glowing, rested, radiant and even firmer.
Superficial peeling is essentially an accelerated form of exfoliation induced by the use of a chemical agent. It can dramatically improve the appearance of the skin – if it’s dull and lifeless it can bring back some vitality to an individual’s appearance and make the skin glow. The idea of a peel is not only to remove layers of skin but also to induce collagen formation in the dermis. Downtime following a peel is minimal.
Call, email or book a consultation with Dr Brazzini who can devise a programme of anti-ageing treatments tailored to you and your skin.
A fine needle is used to introduce the PDO thread into the dermis. The main effect of the threads is tightening of the skin, lifting sagging skin in the cheeks, jowls and neck as well as producing excellent brow lift. The threads also deliver a skin rejuvenation effect through enhancing skin tone.
Other areas of the body can benefit from the tightening powers of the thread lift including the arms, abdomen and thighs.
The procedure typically takes fifteen to thirty minutes depending on the area treated. Bruising will sometimes occur in the days that follow but the patient will be back to their normal routine within a few days.
The lifting effect of the treatment is at its peak six months later when the collagen has formed around the threads and should last for around two to three years.
Tattoos are removed by laser and the duration of treatment required is dependent on the size and type of tattoo.