Frequently asked questions

Botulinum toxin, commonly known as “Botox,” is a medication that has been used as a muscle relaxant since the 1970s. Botox is a purified protein that temporarily blocks the signal transmission between nerves and muscles. In the 1990s, it was discovered by chance that the wrinkles around the eyes disappeared when treating eyelid spasms (twitching eye). Since then, the use of Botox for cosmetic purposes has skyrocketed, becoming the most performed cosmetic treatment. The majority of Botox is still used by hospitals for medical purposes.

When we consciously or unconsciously contract a muscle, a signal is sent from our brains through a nerve to the muscle, instructing it to contract. When we inject botox into this muscle, the nerve signal is temporarily blocked, leading to a decrease in muscle strength or complete relaxation of the muscle. Facial muscles that cause wrinkles can relax, resulting in the softening or complete disappearance of wrinkles. Botox not only works on muscles but also on glands. It is often used to treat excessive sweating of the armpits.

A very thin needle is used for the injection of Botox. The injections are typically experienced as pinpricks. For a Botox treatment, no anesthesia is necessary. If you find it very nerve-wracking, we can apply a numbing cream.

As Botox is injected through the skin with a needle, there is always a chance of hitting a small blood vessel. A bruise will usually fade on its own within a few days and is often easy to conceal. If you are concerned about this, avoid using blood-thinning agents such as fish oil, vitamin E, aspirin, and ibuprofen in the days leading up to the treatment. The likelihood of bruising is generally small, but it’s worth considering, especially before important events.

After the treatment, it is important for the Botox to ‘settle’ in the muscle where it was injected. During the first 4 hours after the treatment, the Botox is still ‘liquid’ and can theoretically spread. We advise during this period:

1. Not to touch the treated area
2. Avoid sports or other physical activities
3. Refrain from activities that may cause heat
4. Avoid lying down flat

The effect of a Botox treatment usually becomes visible after a few days and reaches its final result after 1-2 weeks. The muscles that pull the skin into a fold relax, causing the skin to smooth out. If the wrinkle has existed for years and has become deep, it may soften but not completely disappear after the treatment. Since Botox also affects sebaceous glands, we often see an improvement in skin quality in the “T-zone” of the face. On average, the effect of a treatment lasts 3-7 months. With repeated treatments before it completely wears off, we observe an increase in the duration of the effect.

Botox is a drug that has been researched for its effectiveness and safety since the 1970s. It has been found that Botox is a safe substance with ‘FDA approvals’ for various medical and cosmetic applications.

Severe medical risks such as an allergic reaction or infection are extremely rare. There are, however, cosmetic risks, which may be equally important. We are all familiar with examples of an unnaturally frozen “poker face” expression, drooping eyebrows, or a left-right asymmetry. These risks are largely mitigated if you choose an experienced cosmetic physician with insight into the natural dynamics and anatomy of the face. In a very exceptional case, a muscle that holds up the eyelid may relax, causing a temporary drooping eyelid. Follow your doctor’s advice after the treatment to further reduce the chance of this happening.

A Botox treatment can, in some cases, be combined with other cosmetic procedures such as fillers. When combining it with a treatment that causes a significant skin reaction or swelling, it is advised to postpone the Botox treatment until the skin has recovered. If you have a treatment scheduled with a beautician or skin therapist, it’s recommended to consult with your cosmetic doctor to determine if it could impact your Botox treatment.

A filler is, as the name suggests, a filler substance. It is a collective term commonly used for temporary fillers applied to the face or body. The most commonly used fillers are made of Hyaluronic Acid, a naturally occurring building block of the skin. In addition to Hyaluronic Acid, collagen-stimulating fillers like Radiesse or Sculptra are also used.

The result of a filler treatment depends on the type of filler used and the layer of the skin in which it is placed. For instance, a ‘firm filler’ in a deeper skin layer can provide a lifting effect on deeper folds, while a ‘soft filler’ in a superficial skin layer can soften a shallow wrinkle. To achieve optimal results, a combination of different types of fillers in various skin layers is often applied.

For a filler treatment, usually only a local anesthetic is applied with a small injection or a numbing cream. Depending on the type of treatment, the most effective option will be suggested for a comfortable procedure. If you find it very nerve-wracking or are afraid of needles, let us know, and we can work together to make the treatment as pain-free as possible.

Fillers like Hyaluronic Acid and Radiesse are naturally broken down by the body over time. On average, results are visible for about a year, after which the effect gradually diminishes. If you prefer to keep track of the result, you can work with the doctor throughout the year to determine where a ‘touch-up’ may be beneficial. In some cases, with more robust fillers, results can last for several years.

The recovery after a filler treatment is generally mild. After the treatment, there may be mild local swelling, redness, or discomfort – this is quite normal and usually resolves on its own within 24-72 hours. Sometimes, a small bruise may occur during the injection, but it typically fades away within a few days. Large bruises are rare.

In general, immediately after the treatment, it is barely visible that you’ve had a procedure done. In the days following the treatment, the filler settles into the skin, and the filler may attract some extra fluid, gradually enhancing the effect. Most people experience the ‘wow effect’ after 2-4 weeks.

A filler treatment has a favorable risk profile compared to surgical procedures. However, like any medical treatment, there are risks to consider. The most common issues are usually not severe and can be easily corrected. If a filler ends up in the wrong layer of the skin, a small bump or swelling may occur. This is often easily corrected, especially with soluble hyaluronic acid fillers, using a solvent. The risk of bumps due to fillers is very low when choosing an experienced cosmetic physician (KNMG). 

In very rare cases, there may be an allergic reaction or infection (less than 0.1%). Also, in extremely exceptional cases, a filler can impede blood vessel flow. In such cases, the physician can usually inject a solvent with targeted ultrasound to restore blood flow. Dr. Brandt has extensive knowledge of complications and has contributed as an author to the Dutch field standard for non-body degradable fillers. If you have any questions, feel free to ask!

Endolifting is an advanced ‘energy-based’ cosmetic treatment that utilizes energy to achieve skin tightening. During Endolift, the subcutaneous layers are stimulated with a cannula that delivers radiofrequency energy. This leads to ‘internal heating,’ prompting the skin to produce new supporting cells such as collagen and elastin during the recovery phase. Dr. Brandt has performed over 500 Endolift treatments with the ‘Innofill RF filler injection system,’ resulting in stunningly natural outcomes.

The Endolift treatment is more intricate compared to a filler treatment. Especially when the treatment is combined with autologous PRP (Platelet-Rich Plasma) or fillers, an appointment can easily take 1-2 hours – please keep this in mind. Generally, Endolift is not perceived as painful. If you find it very exciting or are afraid of needles, let us know in advance, and we will work together to make the treatment as pain-free as possible.

The Endolift is a natural way to tighten the skin without scars or prolonged recovery. After a few weeks, the results become visible: the skin feels firmer and looks visibly healthier. For optimal results, the treatment is combined with autologous PRP for even more skin improvement or with fillers for an additional lifting effect from the support points of the face. The results of a treatment are visible for years.

The recovery after Endolifting is generally mild and is comparable to a filler treatment. After a treatment, there may be mild swelling, redness, or discomfort locally – this is quite normal and usually resolves on its own within 24-72 hours. Sometimes, a small bruise may occur during the injection, which typically fades within a few days. Significant bruising is rare. Overall, it is hardly noticeable immediately after a treatment that you have had one. The optimal result of the treatment is visible within 4-8 weeks. 

The Endolift treatment has been extensively tested and deemed safe for cosmetic applications on the face and body. Endolift is not recommended for individuals with a pacemaker or any other implant that emits a rhythm. The treatment is performed using a cannula (flexible tube) from several strategically chosen entry points on the face. At these points, the skin may become warm and, in rare cases, may cause a small temporary burn. This typically heals completely. Dr. Brandt has already performed over 500 Endolift treatments with the ‘Innofill RF filler injection system,’ and the results are remarkably natural.

During a PlexR treatment, plasma energy is used, which is known from static energy or lightning, for example. In a PlexR treatment, controlled energy pulses are applied to the skin. Upon contact with the skin, the energy is converted into heat, causing the upper skin layer to evaporate, and a new skin layer forms over the course of the next few days. In the deeper layers of the skin, cell renewal is stimulated, and a contraction of collagen and elastin fibers occurs, resulting in tighter skin.

A skin-renewing ‘resurfacing’ treatment can be sensitive, depending on the treated area. For this reason, we use local anesthesia with cream or an injection. After the treatment, the skin may feel a bit tingling, “as if you’ve been in the sun for too long.” This sensation typically subsides within 24 hours.

Immediately after the treatment, small holes are present in the superficial skin layer. In the first days of recovery, there is usually mild to moderate swelling, and scabs form, which naturally fall off after a few days. For optimal results, it’s important to let the scabs fall off naturally. This typically occurs on its own within 4-6 days. After this, new pink skin emerges. It’s crucial to protect the skin from the sun by applying sunscreen (SPF 30 or higher) as long as the skin still has a pinkish tint. The color difference will naturally fade away over time.

The advantage of plasma treatments over techniques such as lasers and electrical devices is that the energy pulses are confined to the surface of the skin without penetrating into the deeper layers where they could cause damage. This makes the treatment safe, and issues such as scarring and pigment disturbances are less likely to occur when performed by an experienced physician. After the treatment, the healing skin is extra sensitive, so it’s important to provide adequate protection against the sun.

The results of a PlexR treatment are considered ‘semi-permanent.’ This means that the skin-tightening and smoothing effects are long-lasting, but over time, the impact becomes less noticeable due to new skin aging. On average, the results of a treatment remain visible for up to 2 years.

PRP is an abbreviation for ‘Platelet-Rich Plasma.’ PRP consists of filtered plasma from your own blood, hence the nickname ‘Vampire Facelift.’ PRP is extracted from your own blood and contains, among other components, platelets. The platelets contain more than 30 bioactive proteins, many of them active in blood clotting and wound healing. After injection into the skin, the platelets are activated, releasing stimulating signals to the cells in the skin. The use of PRP leads to improved blood circulation in the skin and stimulates the formation of collagen. The effect of growth factors is described as ‘an espresso shot for the skin.’ Platelets lack a cell nucleus and are therefore unable to multiply, making them safe to use.

In a PRP (Platelet-Rich Plasma) treatment, platelets are filtered from your own blood. It doesn’t involve stem cells that develop into new cells; instead, it focuses on growth factors that stimulate existing cells to produce new building blocks such as collagen and elastin.

PRP is autologous, meaning it is derived from your own body, eliminating the risk of allergic reactions. The injections themselves may cause mild skin reactions or a bruise, similar to other types of injections.

A PRP treatment stimulates the skin to produce new cells, making the skin more elastic and firmer. Additionally, new blood vessels are formed, improving the skin’s circulation. The result is a beautiful natural ‘glow’ that becomes visible in the days to weeks following the treatment.

The policy regarding the Coronavirus has been entirely relaxed outside of healthcare institutions. Even within independent clinics, a reduction of measures is now deemed appropriate.

Patients and staff are not obligated to wear face masks.Maintaining distance in the clinic is not a requirement.Patients are personally responsible for staying home and getting tested if they have respiratory symptoms.Unchanged are: 1. Good basic hygiene. 2. Sneezing/coughing into the elbow. 3. Good hand hygiene. 4. The continued avoidance of handshakes.

Dr. Brandt specializes in Botox and filler treatments and has performed over 10,000 procedures. As a trainer for Merz Aesthetics, he stays informed about the latest developments in the field.

We use high-quality Botox and filler products extensively tested for safety and effectiveness in wrinkle treatments. All our products are supplied by recognized pharmaceutical companies (Merz, Allergan, Galderma) and are approved by the U.S. Department of Health (FDA).

Wrinkles result from various causes, such as skin laxity, gravity, and facial expressions. Extrinsic factors like UV damage and smoking, as well as intrinsic factors such as genetics and aging, intensify wrinkles. Due to these factors, the skin experiences a reduction in moisture, hyaluronic acid, collagen, and elastin, leading to diminished firmness and elasticity. Additionally, the skin’s ability to regenerate decreases with aging. Besides changes in the skin, specific areas experience a decrease in subcutaneous fat tissue, and bone tissue gets absorbed, causing a general loss of volume in the ‘support pillars’ beneath the skin.

‘Dynamic wrinkles’

These are caused by repeated contractions of specific muscles. These wrinkles can be effectively treated with botulinum toxin, commonly known as ‘Botox.’ To visualize the treatment effect, you can pull the skin to reduce dynamic wrinkles.

Gravity lines/folds

Gravity lines result from skin slackening, combined with reduced volume beneath the skin and sagging due to gravity. This is exacerbated by the decline of collagen, fat, hyaluronic acid, and water due to aging. Possible treatment options include volume restoration with fillers or skin tightening with procedures like Endolifting or PlexR.

Sleep lines

Sleep lines occur due to the ‘creasing’ of the skin during sleep. These lines become visible by placing a hand on the side of the face and moving the hand toward the nose, emphasizing the sleep lines. Often, one side of the face is more wrinkled than the other, usually the side one sleeps on. Possible treatment options are similar to gravity lines: volume restoration with fillers or skin tightening with procedures like Endolifting or PlexR.