Transvox - Exploring Aesthetic Medicine and Gender Affirmation with Dr. Oli Curwin

[00:00:07] Hi all and welcome back to Transvox and it's my pleasure this week to welcome a special guest. Dr. Oli Curwin is with us and I think it's fair to say you're going to talk about the dark arts this week Oli. Is that fair? Is the dark arts a good thing or are we straying too far into what used to be the perception of what aesthetics medicine was all about 10-15 years ago?

[00:00:32] Dr. Oli Curwin It's a very good question to start. Firstly thank you so much for inviting me. Is it a dark art? I hope not. I hope it's a really nice, bright, colourful trans flag flying in the sunshine to the bar nowadays. The world of aesthetics often brings up images of people with overdone lips and looking fake and I hope we've moved past that now. Dr. Oli Curwin Interesting. Tell us a bit about yourself before we get started then we can dive into the subject. Dr. Oli Curwin Absolutely. So I'm Oli.

[00:01:01] Dr. Oli Curwin I am a doctor working in London. I run an aesthetics company so it's Dr. Oli Aesthetics and I've been practicing that for about three years or so. Over the last year I have been working a lot more with the trans community and those who are genderqueer or non-binary and have been working alongside them to create a safe space for trans people looking for gender affirming care.

[00:01:29] Dr. Oli Curwin As well as that I still work in the NHS so I'm a full-time surgical trainee so I work in colorectal surgery. Eventually we'll be specializing in treating bowel cancer as well. So I do two different sides of the coin. I do this at the top end and the bottom end as it were. Dr. Oli Curwin I love the contrast and yeah so that's a little bit more about me.

[00:01:50] Dr. Oli Curwin Absolutely fantastic. So why going to the trans? I've got so many questions from that. First question is you've got this national health thing and this aesthetics thing. Is one a commercial thing or one is a passion? How did you get into it? Dr. Oli Curwin I first got into it when it was just after COVID and I was having a bit of a time to reflection on my career to work out do I still want to be in the NHS given how much stress we've all just gone through.

[00:02:17] And I started looking at different avenues and I looked into consultancy and I looked into basically different money makers. I came across aesthetics and I thought you know what it's a bit of medicine but it's also really arty it's really creative and it's a chance to treat people that aren't ill. Which for me is a really interesting sort of psychology of in my day job people only see me when they're ill and they have a problem.

[00:02:48] And actually in aesthetics people look after themselves and they want to come to you to keep looking after themselves. And so it's naturally so much happier and more positive. I started doing it a little bit as a sort of money maker on the side and as I did more and more I fell in love with it more. And to me it still didn't feel like work. It's definitely I love the days I come into my aesthetics clinic. I have a great team and I love just having a chat with my patients.

[00:03:17] And do you have a different set of qualifications to do aesthetics or how does that work? So you have to do various courses. The world of aesthetics is not very regulated in the UK which is why it's a little bit of a minefield still. As a doctor I've got training from the Royal College of Surgeons. I've sat my exams. So I've got that sort of formal backing anyway in terms of my anatomical knowledge and awareness things like that. And then I've done extra courses to eventually become an expert in the field in aesthetics as well.

[00:03:46] Interesting. So why do you think about the trans world? Because trans are non-binary world. What was it about that audience that attracted you? It was coincidence to be honest to start with. I had one patient that came to see me that is a GP who works for the trans community and themselves they are non-binary. And they came to see me not about gender affirming care but for a bit of filler and then we had a chat and then they said,

[00:04:13] I actually think I have a patient that I could refer to you. How do you feel about that? And it's a young trans patient who's transitioning from male to female. Would you treat them? And at first I was like, it's not something I've done before but why not? Let's try it. And actually we got the ball rolling of opening up this world of referral of trans patients who were on hormonal treatments and then those that hadn't started.

[00:04:40] And then that opened into the non-binary and the gender queer section. And it's so rewarding to do these little treatments and it became a little bit addictive. And then I said, actually, why not set myself up as someone who can do this in a safe, relaxed environment? People don't need to explain what transitioning means to me. I've done all the reading. I've done all the research. And so you just come in and we are just people and we're looking at your face and we're making you feel better.

[00:05:10] Yeah. I'm going to ask you for a diagnosis soon, but I think you'll be getting a new summer holiday from my face. But so let me ask what seems a really obvious question. But is aesthetics what we used to call plastic surgery or is that a different thing? They are a different end of the spectrum. Right. So plastic surgery is very much surgical. It is a knife to the skin. And aesthetics is non-surgical, but still with the goal of improving appearance.

[00:05:39] Yeah. So we use I use a combination of injectables. So that is a mix of Botox, fillers, skin boosters, that sort of thing with the aim of either providing an alternative to surgery, an adjunct to surgery or a bit of a trial period before surgery. So we've got three three ways of approaching it. OK. So just take me through the first one.

[00:06:05] So people might try to get a sense of who they may be after surgery. So you can construct a face using aesthetics similar to the effect of having had £25,000 worth of surgery. Exactly. And so why would you bother with the surgery? It's a really good question. I've had patients that have come to me and they go, I'm about to pay £35,000 for feminisation surgery.

[00:06:30] What can we do in the meantime while I build up that money and that funding to make me still feel good about myself and not experience any dysphoria? And we can do things like sins. We can do jawlines. We can do noses, lips. And they are temporary. So they wear off after about a year to two years, depending on the treatment. How as low as that?

[00:06:54] Yeah. And so for people that are waiting to save up, it's a really good way to get that sappy feeling when you see yourself in the mirror. Yes. Before you undergo them. Other people go, you know what? I'm never going to be able to afford that. And actually, this is a far more accessible treatment. Let's just go down this route. I've never thought about it that way. And also some people, before they go, actually, do you know what? I'm going to have a feminising nose.

[00:07:24] And that's a permanent surgical solution that might cost £10,000 or whatever. Why don't we try different nose shapes? Do they? Yes, absolutely. And it's, we can try a nose and then after a year we can dissolve it and we can try a different one until we find actually the shape that you want to settle on. And then you can go to your surgeon and say, I want this nose. And so it's a bit of a trial period. Yes. Okay. Before I get carried away, because I'm going to be asking for a diagnosis in a minute.

[00:07:55] So I'll stop that because I've got a big nose, as you can probably see. So I just, I can't understand how you'd have, you'd make a big nose smaller, but let's come back to that. So let's just stay on the broad side of aesthetics. There's sort of cases of people who get addicted to this sort of procedures, aren't there? So how do you sort of risk, risk manage that? Because I'm guessing people who are transitioning could be slightly more vulnerable about appearance and that need to constantly tinker and get sucked into a cycle of enhancement. I don't know if that's the right word, but I think. Yes, no, I totally agree.

[00:08:25] Yeah, absolutely. The first thing is looking good is addictive. And so if you can go and you can pay for a treatment that you look in a mirror and you look good, people want more and more of it. And then you can develop what we call filler blindness. And so you think that increasing filler makes you look better. And this is when you start seeing people. I know I sit on the train and I judge everybody's face anyway, but it's people who are overdone and people that look like they've had work. Is that the trope out and all that sort of stuff? Absolutely.

[00:08:54] And the big duck lips and the massive jawlines on men that just look heavy and they look like someone's put bricks in their face. And it's definitely there is a role for the practitioner. So someone like me to know when enough is enough. And especially, as you mentioned, in the trans community, these patients may be a little bit more vulnerable, maybe more slightly of the addictive nature to be like, actually, do you know what? I feel good. I want more of this. Yes.

[00:09:24] And for me, the simple answer is I just need to say no. And I decide when to say no to these things. There are some patients that come to see me and we talk through a treatment plan and we have our consultation and it takes 45 minutes or an hour. And at the end, I go, you know what? You don't need me at all. You need a therapist. Sit down and get therapy. And that's not a problem. And I pride myself on saying no to a lot of people that come to see me. Or we say, this isn't right.

[00:09:53] But how about this? Because actually, I think the underlying issue is your relationship with actually this part of your face, not in its entirety. So it's about being very rational in these conversations. One thing that I've been working on with the company that provide my fillers is actually getting discounts for the trans community. And so the filler company, Polenium, they offer me reduced prices just for my trans patients in a way of supporting the community.

[00:10:23] And this is the first time I've come across this happening as a collaboration. Exactly. And someone who's a massive company going, yeah, actually, we'll support your work and we'll do it. And because of that, I like to think that I'm not coming across as someone who feels like I'm going to make a lot of money for me. It's less about money and it's more about providing a nice treatment. And it's a way of giving to a community that have so many hardships in health care.

[00:10:53] Let's make this one really positive. Yeah. Yeah. And I guess you're going to say it's as long as a piece of string. And I'm going to pull out the piece of string and say, here's a piece of string. But how much might something cost? So just ballpark, I know that, I know how much it is for facial surgery. So I've got a quote of 23,000 quid, a bit more now. So are we talking thousands, tens of thousands? Where are we in terms of an average? And I know there's no such thing as an average, but it's an average spend. I think average spend for patients.

[00:11:22] So firstly, masculinizing and feminizing are slightly different. Masculinizing does require a little bit more filler product and therefore is inherently more expensive. Because you are adding more volume and weight to the face. Feminizing, you're looking at how filler can soften a face. So actually you need less product. Feminizing treatments, I would estimate, I'll give a range.

[00:11:48] I would say you could start at around £600 going up to about £2,000. Wow. When are you? This is why it's so much more accessible. And partly all the discount that I get from this filler company, I put straight towards my trans patients. So that's why it is also a lower price than you may find elsewhere on the market. But it is an accessible cost. It's, yes, it's a maximum about £2,500.

[00:12:18] But then these last for about 18 months. So we do need to be mindful that it's not a permanent solution as well. But it's pretty permanent. Yeah, absolutely. And it's, even after it's all worn off, there are still lasting effects from filler. Because the body will naturally want to replace filler as it detects it decreases. So actually we find that we use less product over the years anyway, because the body is trying to replace the filler it knows it's going. Yeah, and that was interesting.

[00:12:46] I was thinking, if you're saying something last 18 months, one assumes it doesn't last at a level and then drops off a cliff. It's finished. It decays? Yeah, so it slowly gets absorbed. Yeah. Absorbed. It just, yeah, it just slowly breaks down. All the fillers I use are products that are naturally found in the body anyway. So we're not looking at injecting horrible plastics into the body. We're using natural proteins. But over time, your body just will metabolize, just like any other part of the body.

[00:13:15] And because of that, it's very variable in each person how long these things last. Some people who I've done their doorlines for, I brought them back at 18 months to go, we need to do another one. Yeah. And I feel their jawline. I go, I can still feel my work. Let's give it another six months and we'll see where we go. So it's not all just five months for this or 15 months for this. There is so much variability. Okay. Let's delve in. Should we look at trans mask people first of all?

[00:13:43] And because I know much less about that, I probably need much more guidance. So what sort of things would a trans mask person, what sort of things may you be looking at doing with them? Yes. So in the masculine face. Yeah, no, it definitely is. It's we, I have to use stereotypes when I'm discussing masculine and feminine faces. I think we know it's a spectrum, but we are going for your classic GQ magazine man's face.

[00:14:11] In which case people are looking really at the lower face. They're looking at your jawlines, you're looking at chins and you're looking at probably the nose as well. So we're looking about creating weight at the bottom of the face, really framing features, that sort of chiseled look, the nice strong jawline. And wider features, typically more masculine, so a broad chin, things like that.

[00:14:38] And so the trans mask patients that come to see me, they're really asking for jawline filler a lot of the time. But we can also do tweaks in the upper face, things like actually flattening quite feminine eyebrows. We can make eyebrows straight using things like Botox rather than a filler. So these are things that we can, we do tiny little tweaks that actually a lot of people don't think about as being particularly masculine.

[00:15:03] But just changing the shape of the eyebrow without the need for makeup or sort of hair growth products. We're just changing how they move and can become more masculine. Yes. Yes, because the eyes are, I was surprised when you said the lower face, actually, because I would have thought you were going to say the brow bossing and all that sort of stuff that you get. But I suppose, and that's the thing, isn't it? It's very hard to think rationally about your own face because you're so used to it.

[00:15:30] And when we have these stereotypes about what cisgendered men and women look like. So I guess it's actually quite hard to do that. So let's have a look at trans femme people. How would that work? So here's the contrast. From trans femme people, we're looking at the upper face and we're looking at the mid face. So if we think about the face split into three areas. So the forehead to the brow is upper, then brow to bottom of the nose is mid, and then the lower face.

[00:15:56] A lot of what we want to do for a feminine face is draw the attention to the lips, the most classically feminine part of the face. And so that's things like narrowing face shape. And so you're looking at reducing the weight of the masseters, the muscle of the jaw. You're making the chin a little bit rounder, a little pointier. So it brings the eye to the midline of the face and not to the sides. From the upper face, we're looking at opening the eyes.

[00:16:25] We think about the belladonna, the big open eyes, the slightly arching eyebrows, which is all easily done with Botox. We can look at forehead and brow slimming and thinning to reduce the musculature of the brow, which again is a Botox treatment. It's quite nice. It takes a little bit of time. It's not immediate, but it works really nice. And then the nose, we want to draw attention to the kiss of the lips, not at the nose.

[00:16:56] And you were alluding to the question earlier of how can you make a big nose smaller? That's something that I see in a lot of trans feminine patients is how do we slimmer nose by adding product? So one thing is that you can use Botox to reduce flaring of the nostrils. So inherently is a little slimmer, but also where it's no longer science, but it's an art is how does light bounce off the nose?

[00:17:26] Is there a round nose that actually, if we put a little line of filler down the middle, we bring the light from being a round circle of light reflection to a narrow rectangle. So actually we are still making the nose a little bigger, but it looks smaller. And do you lift the tip as well? Because that's often the female nose, isn't it? Yes, absolutely.

[00:17:48] So with an injection of filler right at the bottom of the nose, not the most comfortable thing in the world, but it's simple for about 20 seconds or so. It can push the nose away from the face a little bit and it lifts up the tip. We can even recreate a slight ski bump or a slight arch to make it look more feminine. So we call that the pixie nose lift. Wow. Wow.

[00:18:12] But surely all this, isn't all of this stuff, I know you said it's a natural ingredient and I don't really understand what I mean by that at the moment. So come back to that maybe. But you're talking about a heck of a lot of product going into someone's face. So my understanding of Botox, it only lasts about six, six hours, six or seven hours. But you're saying even standard Botox lasts for 12, 18 months. No, so Botox will last shorter. Botox lasts typically around three to four months. Right. What Botox does is it reduces muscle activity.

[00:18:41] So we want to, typically in gender affirming treatments, it's about slimming muscle. So if you imagine your biceps, your arm muscles, if you don't work out, if you don't go to the gym, the muscle will shrink. And so in the face, no one's working out their face muscles, but we need to find ways to reduce subconscious movement of it. So things like the jaw, and that we'll use Botox for.

[00:19:08] So all it does is it stops the muscle working to its full potential, which means it starts to slim. So that's something that you need over time. So you need repeated treatments every three, four months once it's worn off. Right. You're right. Filler, you are putting something into the face. Yeah. So you are putting in a foreign body.

[00:19:28] Now, what I mean by the natural occurring products is if you go into any drugstore, supermarket and look for good moisturizers, you see the term hyaluronic acid everywhere. Yes, you do. And so fillers are just hyaluronic acid. And that's something that our body produces a little bit like collagen. And it's a sort of sugar molecule that absorbs water. And that's naturally occurring. We all have it. We all produce it constantly.

[00:19:57] Moisturizers use it because it adds water retention to the face, which is why it looks soft and hydrated. Fillers, we just have a slightly different version of that same molecule that stays in place and absorbs water. And it will just sit where it is and it doesn't move. And it's just, yeah, eventually gets degraded just like any other protein in your body. Okay. It sounds too good to be true, but I'm guessing it's not too good to be true.

[00:20:25] Because tell me about some of the people you've had come in. And this sounds a bit of a very easy question to answer, but maybe we'll get through this. But tell me some of the results you've had, because I think it's quite nice to know the effect of the work and the sort of reaction you're getting. And I'm guessing there's some people who are disappointed as well. So should we do the good people first? Then start with the good. Yeah, let's start with the good. So sometimes actually it's the smallest treatments which make the biggest difference.

[00:20:53] For example, trans femme patient coming in and just having lip filler. The lip filler can drastically change somebody's face. Just doing a tiny bit of the nose is again, major impact, but tiny amount of product. So I've had, I don't know, I'll give an example of a trans femme and then a trans mask patient. In terms of the good to start with.

[00:21:17] So for trans femme, I had a lovely 19 year old patient who just started hormonal treatments. I'd come in and we had an hour conversation to start with. And we went through the whole face. I do a lot of drawing on people's faces when they first come to see me. And we come up with a plan together. And so we said actually we'd focus on cheek filler, giving more of an apple of the cheek, less of a structured chiseled face. We do a little bit in the chin and we do a little bit of lip.

[00:21:47] Overall, not that much volume. We're probably talking about two and a half milliliters in total. So that's half a teaspoon of filler. Okay. So tiny changes, but actually very important. And when I did her face, it was a couple of weeks after our consultation. I always allow a bit of thinking time and time for someone to ask more questions. Water in and very nervous patient.

[00:22:13] And actually, to be honest, that's something I look forward to because then it just means I can chat more and put someone more at ease. And we probably spent about half an hour doing the treatment. And I always take before and after photos of all my patients. And I actually had to tell her to stop smiling because she'd looked in the mirror and she was just blown away. She was so happy. I said, I need you to stop smiling to take pictures of your lips so we can assess it. And she just wouldn't stop because she was so happy.

[00:22:42] And I have to say, after the treatments, the hugs that I get from my trans patients, as I said, it's all addictive. It's such a rush of joy. So that was her. I had a trans mask patient who I treated in December. It was part of a content filming day. And he was talking to the camera when I was not in the room. And he was saying, actually, I don't look in the mirror.

[00:23:08] I try and avoid looking in the mirror because I don't feel like the mirror reflects what I feel. Yeah. Yeah. And it was very interesting watching the recording of that back. And we did his jawline. And again, a small amount of product, two milliliters. So again, less than a teaspoon of filler. And in our initial consultation, he said, yeah, I just want to look a little bit square, a little bit blockier, a little bit more masculine.

[00:23:38] And I said, isn't it about power? Do you need a power jaw? And he went, yeah, I like that. I like that term. I want, yeah, I want to feel powerful. I want to feel good. And we did his treatment. And he looked in the mirror and he just went, wow. And was just speechless. And these are tiny treatments. In the grand scheme of doing some full faces, some people take up to some 12 milliliters in their face.

[00:24:04] We're using two and creating these wonderful life-changing results. And he went, actually, do you know what? I'm going to look in the mirror now. And that was it. That was the change. So again, that term gender euphoria always crops up and, when we're talking about these treatments. We'll go on to the negative. I'm guessing a lot of this must be about expectation as well. Because I'm just, because it's interesting listening to you talking. I've got this idea that I'll come in and see you and I'll walk out looking 27, a bit like Marilyn Monroe.

[00:24:33] There's a difference between the dream and the hope and probably the reality, I guess, is it? It's all expectation management. Patients who are unhappy, it's because I didn't manage expectations to start with. And I have to say, it's been a long time since I've had someone say they were disappointed. But it's happened. And whenever I do any treatment, we go through the risks of any procedure from various healthcare point of view of risk of pain, risk of bruising, risk of swelling.

[00:25:00] And I always finish with, and the risk of cosmetic dissatisfaction. Whereas actually, we've done a treatment. You look in the mirror and you go, is that it? Like I was expecting something else. And I've never yet had that with a trans patient. But at some point, I'm sure it will come. I think it's expectation management. But it's also really important that when we have our first consultation, we are super realistic.

[00:25:27] So, as I said, I draw on people's faces and I will manipulate, say, for example, you come to see me, I'll manipulate your chin. So, you can see what different chin shapes may look like. But at the end of the day, we have to also be aware of our limits of we're putting product in. I'm not removing anything. I'm not changing your skin quality, your skin type.

[00:25:48] As much as I wish I can turn back the clock on so many trans patients to go, actually, you didn't have the body you're in now 20 years ago. I would love to recreate that. We need to work with what we have. And that's all expectation management, both for the patient, but also for me to know. So, it's not as drastic as surgery. It's very subtle, but it's about the subtleties that just give you that extra little lift.

[00:26:20] Interesting. And that makes a lot of sense. And I was interested because when you were talking about that, you mentioned earlier that you have this sort of, this time, this pause between treatment and the consultation. Now, is that like a conscious thing? I just suddenly was thinking back because I guess there would be some people who come and they'll get so excited about the thought of it that want to start straight away. And I suppose that's part of expectation management, isn't it? To say, let's have a cooling off period. Think about the realities of this. Is that what that's for?

[00:26:50] Yes. A lot of people do come to see me and they book in for a consultation and they want to get treatment straight away. And for fillers, unless you've had fillers before through someone else and you know what they're like, I will not treat on the same day. And so, I'm very conscious that at the end of the day, this is a medical procedure. Yes. It is. While a lot of people think it's like having a haircut or seeing a beautician or whatever, it's not. I'm a doctor performing a treatment.

[00:27:20] And so, we need to take it seriously. And I think we also need to, it's a little bit about having respect as well, about respect for your own healthcare and your own face and not rushing into something because you're suddenly really excited. And it is sometimes a bit disappointing for people when they go, oh, I was hoping we'd start today. But actually, it's so important that then the next time they know exactly what's happening. And actually, we're on the same page.

[00:27:50] These things are not without risks. If you Google filler complications, there is a whole minefield of things that can happen. There are people that have gone blind through filler in the cheeks and in the nose. And while it's a rarity, we also have to, there is a risk. And so, I would hate for someone to rush into a treatment and regret it just because they're excited. Yeah.

[00:28:16] The Royal College of Surgeons actually released guidelines recently of saying you need at least a week between a consultation and going ahead with treatments. I know very few people that stick to that. But actually, I find it incredibly useful. Yeah. It's expectation management. But also, I want people to do research. I actually, I encourage all of my patients that come to see me to find out more about it, speak to other people, fire questions at me. They all get my mobile number.

[00:28:46] They can message on Instagram, email, and just fire questions. Because at the end of the day, it's your face. Knowledge is power. Yeah. I think that's really important, actually, because what you're looking for is informed consent, not just consent. And there's a big difference between those two things. Exactly. And it also, I hope, encourages people to see my treatments as a bit more of a long-term plan. These are not quick fixes.

[00:29:11] Some people, we come up with a plan that takes six months before we actually, we do staged approaches. And the treatment might take six months. And then we need to start again in a year and a half. And it all starts to break down. And it's about knowing that this consultation is the building of a relationship. Yeah. I'm not someone you come to, you get your nails done and you go. And then when your nails start falling off or looking patchy, you go and find someone else on the high street.

[00:29:38] It's about building a long-term relationship where we trust each other. We ask each other questions and we work together. So there's an elephant and it's in the room. And I have to broach this elephant. And you keep talking about injections. And there's a sort of an implication that there's needle. So there's a lot of needle people, needly people who are not keen.

[00:30:02] And this is in part of me thinking, having a needle stuck in me anyway, even for just a blood test, it's pain. So tell me about those two things. How about needle phobia, first of all? Needle phobia is incredibly common. It is not normal to have a needle going into you. And this is what I will tell all my patients. I will ask them, how are you with needles? And if they go fine, I say, okay, you might be fine, but inside you're still dreading it.

[00:30:32] I hate having a blood test taken. I don't like being my Botox done. But it's a no pain, no gain situation. There are people that are incredibly nervous. And we discussed that then openly in our first consultation. So before we even start down the line of treatment. And some people will never want to see the needles. Some people go, actually, it would help to see the needle. And we can take a needle out of the packet.

[00:30:58] And for the vast majority of treatments, the needles I use are the smallest available on the market. So they are significantly smaller than the needles that you get for a blood test. These are needles that we use to do blood tests on newborn babies. So these are, it's like a little wasp sting or a mosquito rather than this big thing plunged into your arm. Yes. To reduce pain, we can use numbing cream.

[00:31:25] It's not always effective, but it just takes the edge off. It takes the pain off. I have to say a lot of this, again, is expectation management. I typically will start with an injection in a good place and then a bad place in terms of sensitivity. And then we do the rest of the face to say, actually, this is what your minimum pain is going to be like. This is how the maximum is. Are you OK? And now we know our range.

[00:31:55] We crack on. I have had people faint in my chair. It's not a problem. The first time it happened, I got a bit scared and it was all a bit unexpected. But actually now I think. If you tell patients, you know what, sometimes people think that's OK. Come and see me. I want you to have had a good lunch beforehand or whatever, a good meal, plenty of hydration. I'll have water available if you need it.

[00:32:22] You tell me if we need to take a break, we take a break. If you want to listen to your own music during it for distraction, listen to music. If you want me to wrap it on to you, I'll do that. If you want us to be completely silent, we can also do that. And it's I encourage people to talk to me during these procedures. Even if there's an evil going in your face, I can deal with a moving target. It is fun. I was going to say, because actually people's faces so mobile, aren't they? You would be surprised that you want people jabbering away.

[00:32:53] If it makes a patient more relaxed, I'm more than happy. I don't know how many thousands of injections I've now done. I don't mind moving targets. If I need you to stop, I will stop you. We do a quick injection and we carry on. It's all about making you feel comfortable. I'm confident in my ability that we can have a good conversation, get you relaxed and still get all the treatments that we need to get in. Okay. So I'm making another terrible assumption here. This time's not an elephant, though.

[00:33:23] It's just an assumption. I'm assuming that young, malleable, hydrated, stretchy, collagen-rich skin is easier to work with. It's got more flex. It's got more... In other words, I'm saying, is there an optimum age for this? I'm sure there's no upper age limit, but I imagine the results are better with younger people or am I just wrong? Please say I'm wrong. I think it depends, which is the frustrating answer. It depends what treatments we're doing.

[00:33:51] The older person somebody is, yes, you're quite right, the skin is slightly more lax. That means that we need to be a little maybe cleverer in our approach to things. We typically will need more product to replace volume that's been lost over time. As we all age, we all lose volume or volume shifts. For example, we know that the mid face sinks and turns into jowls with age.

[00:34:16] And that's just something that we know that we need to replace the volume and provide more scaffolding. I would say that the older somebody is, they need to probably expect to pay more money. Whether or not it means your result at the end is better or worse, I think it's all about expectation management and individual goals. There are some patients whose skin quality is not very good. Now, that's a difference to volume loss.

[00:34:44] To be honest, that's not really age related because I've dealt with people in their late 20s that were absolutely ravaged by acne, for example, as a teenager. That means that their skin is full of scar tissue and it's not flexible and it doesn't move. And then actually we might do a course of acne treatment or skin boosting, skin enhancing treatments before we even start with fillers or Botox about actually improving skin quality.

[00:35:12] And so these are the times when these treatment plans can take a lot longer. But then actually the end result is not just the filler, but actually your skin looks better. Your skin is feel nicer and hydrated and get rid of that sort of crepey skin that we all get again as we start to age. Yeah, interesting.

[00:35:32] And I'm wondering about this because you're talking about expectations and perception and for some people you have the treatment and I'm guessing they see the change, but it's not necessary that other people do. Or is that or does everybody see the change? Again, depends on the treatment. There are some things that are so subtle. We treated a trans femme patient again in December.

[00:35:59] We did chin and nose and I did the nose and looked at it afterwards and went, I know what I've done, but actually should I have done a bit more? Should I made it a little bit more obvious? And he looked in the mirror and goes, that's what I want. And for a nose treatment, I use maximum of one milliliter of filler.

[00:36:27] For her, I probably used 0.4 milliliters, so less than half of what I could use. Would anyone looking at her know that she's ever had any work done? No. But every morning when she washes her face and looks in the mirror, she will know and she will look better and feel better because of it. Yes, interesting. Because I think sometimes it's that perception, a lot of it's in your own head, isn't it? Sorry, I don't mean in your own head because it has been done.

[00:36:56] But sometimes you want to make subtle changes without everybody going, oh, I see you've had your lips done. Absolutely. Because that's the worst thing of all, isn't it? When someone says they can see the surgery. You just want it to be quite natural, don't you? Yes. So I would see it as an insult to my work if one of my patients left the building and someone looks at them on the tube and goes, you've had your lips done. For me, that's an insult. I want to look natural and subtle all the time.

[00:37:23] And you can do that very well and easily with the right treatments. I have patients that sort of, I've had a couple that were about to have a magazine photo shoot and then they said, we want to look better. We need to be natural. And that's the brief and that's everybody's brief. If people come to me and some people do saying, actually, I want X, Y, Z, I want really sharp jawline or I want big lips. I just say, no. And I say, there are plenty of other people out there.

[00:37:52] I don't need to do this for myself and it doesn't fit with my ethics. Yeah. Interesting. And I'm assuming aesthetics are just the face. There's no other bits of the body you work with on it? So skin boosters, we can do better skin quality, particularly on the décolletage area. That sort of chest area is very good because that skin can become quite crepey quite quickly. So after about the age of 40, so we do treat that.

[00:38:21] Again, people's hands, again, people suddenly go, oh, do you know what? My hands are quite wrinkly. We can improve the skin quality and the hydration. I'm a wreck now because you're right. My hands are already wrinkly. Don't tell me anymore. It's going to have to be important. Sorry, go on, carry on. But yeah, I think it's technically the skin boosters can be used on any part of the body. I think it's about having also a reality check. Aging is not something to be afraid of.

[00:38:50] It would look absolutely bizarre if your face looked wonderful and then your hands looked old. And somebody like Madonna became famous probably about 10 years ago because she had the veins stripped out of the back of her hands. And she said, her hands were getting veiny. And I just go, you are allowed to look your age. The key is to look good for your age. Yeah, exactly. And it's the version that makes you feel rested and the version that makes you feel hydrated. And it looks like you've just had a really good night's sleep.

[00:39:18] You shouldn't be able to look at you and go, oh, you've had your lips done. You should go, what lipstick are you wearing? Because just something looks good. Because you're in London by looks of it, on the website. So if I'm sitting in Tudem and Southampton, normally I'm in Newcastle. Do I have to come to London for the consultation or is this going to be done online?

[00:39:41] I would much rather do it in person because then I can actually, we get up close and personal and we, I feel skin quality. Sometimes I do a pre-consultation online to say, actually, let's look at our goals. Let's look at it and see. Also, it's a bit of a, it's a bit of a vibe check. Like, because I also, I'm asking people to trust me with their most pried possession, which is their face.

[00:40:10] And actually, if the chemistry isn't there, I wouldn't want someone staying for a train journey, coming to London, my hospital, like, so a night stay in a hotel. If actually they go, I've met you and maybe it's not right for me or this is just something I want to put on the back burner and not go into. So pre-consultation is very helpful. And I do that for people that live further away. I've had a patient who was looking for skin booster treatment who lived in Canada, went to Amsterdam for one.

[00:40:40] And then she messaged me and we had a quick pre-consultation. Then she flew to London and she flew back to Canada after the treatment. So we can make things work. Yeah. But I would still do a proper consultation. What we would then do is maybe narrow down the thinking time. So we did a pre-consultation talk through the risks and benefits of two weeks, do an in-face consultation. And then maybe the next day we can go ahead with treatment. I see.

[00:41:10] And there's a limit to the number of treatments you do in the day. And I'm just wondering how long one can expect to be there if you had the maximum number of treatments in a day. Everyone takes a different length of time. So there are times when I do a full day and we could do anywhere between six, seven patients to 25, depending on what we're doing. And also depending on how well I know them. There are some people that, do you know what, they come in. I see them every four months for their Botox.

[00:41:38] They take five minutes and then they're in and out. There are other people that I know who I've seen for years that they want to sit down and they want to chat and have a life. So I know that. And so it's all a bit variable. For the gender affirming treatments, I typically like to book an hour just so actually we can be dynamic. And as treatments go along, I always try to undersell. So if we've booked in for, say, four milliliters in the face, we'll stop at two, reassess and go, what do you think?

[00:42:08] Fillers, the results are instant. Oh, really? Yeah. So actually, if we say, do you know what, we've done enough at two, you've just saved yourself a lot of money and I've achieved your expectation. Yes. So why should we put more in? And so I need that extra time. So I'd assume for about an hour. Brilliant. Look, I've just looked at the clock and I'm just seeing we've been chatting for ages. You've got absolutely fascinating. It's such an interesting thing. Okay. So how do people get in touch with you? What's the process? Where are you? Tell us more.

[00:42:38] Absolutely. So I would say either my website, so that's www.droli.co.uk. There's a contact form there to get in touch with me. Alternatively, I'm on Instagram. So droli.aesthetics, where you can get more up to date on my reels and before and after pictures as well. Send me a message, send me a WhatsApp. I will respond typically within about 12 hours to anyone. And you're in North Orly Street in London, are you?

[00:43:09] Orchard Street. So I, Orchard Street. So just behind Selfridges is my main clinic. And then I do some clinics in Soho and Liverpool Street. So wherever some trains get into, basically, it's very easy. Fantastic. Is there something I should have asked you that I haven't asked you? I think I've given you a very easy ride. But you got me far too interested. I was going to thump a fist on the table and say this is a terrible art and people should be allowed to be themselves. But you'll be very clear.

[00:43:38] This is not about anything else than patient choice, informed patient choice, managing expectations. You're talking about doing this in a professional way with people who can be vulnerable. But that's the point of specialising, isn't it? Absolutely. And I think going back to the first question of, is this a dark art? It is in the wrong hands. And the world of aesthetics, I get so many people that come to see me after having had negative experiences with other people.

[00:44:07] It's very difficult to do this properly and do this correctly. And I think actually the best way to do it in a respectful way is time, no pressure, and being as transparent as possible. So it's about informed consent. Yes, I want everyone to be happy with who they look like in the mirror. Yes, I think people should look like themselves.

[00:44:31] I'm only here to do the subtle changes that make you go from not looking in the mirror to looking in the mirror or looking in the mirror and going, oh, I just wish I had a different nose or just wish I had different lips. And just removing that. It's fairly low risk, fairly low cost in the grand scheme of things. Yes, it's a medical procedure, but actually, why shouldn't we have the autonomy to have these little tweaks?

[00:45:03] Well, what can I say? Thank you so much for spending time with us today. That's absolutely remarkable. I've learned so much and that's been fascinating, hopefully useful for our community as well. So as you said, DrOli at dr.co.uk, Instagram. And there's also some information on the site about costs and locations and such and how to put the consultation. Well, thank you for spending time with us today. It's been absolutely fantastic. Thanks so much. It's been a real pleasure. You take care.

[00:45:30] Thanks for listening to this episode of Transvox. It's been a joy to have you with us. If you want to make contact with us, you can contact us at Gillian at transvox.co.uk. And all of our money goes to our nominated charity. And Jen, you've chosen the charity for the next number of episodes. Which one have you chosen?

[00:45:51] Our charity is called Beyond Reflections, which is a charity that provides support and counselling to trans people, non-binary people and their friends and their families across the UK. An amazing charity doing some amazing work. Really important. So please, if you can give. Great. And if you want to go and have a look at Beyond Reflections, it's beyond-reflections.org.uk. But as I say, if you'd like to make a contribution to what we're doing, because we love to help the people who help us.

[00:46:19] Again, if you've got ideas for the show, things you'd like to ask us, questions, comments, applause, or brickbats, feel free to send it all in to Gillian at transvox.co.uk. Until the next time, goodbye. Bye-bye.