Hannah Shale | The Face Place

Dr Cat’s November Update

by Hannah Shale | Nov 5, 2024 | Dr Cat

I got a shock. The results from the mastectomy were definitely not what I expected.

You may recall that last month I was recovering from my second mastectomy and reconstruction, purely as a precaution because they found high grade pre cancer in the breast at a biopsy in August, just before I flew to Denver and Galapagos for 5 weeks to celebrate my 50th birthday.

I was looking forward to having all the breast tissue out, and with no more breast tissue, a very low risk of having a nasty surprise with more breast cancer. It’s already nearly 5 years since the first breast cancer diagnosis in January 2020.

Except the nasty surprise came now.

Seeing my breast surgeon’s demeanour when I walked in gave me a clue. She looked sorrowful as she broke the news to me…

“We found 3 invasive cancers in your breast… each a slightly different type….” (Oh, sh*t, that means radiotherapy)

“… and a macro-metastasis of 2.2mm in your sentinel lymph node” (Ufff, that means chemo and radiotherapy)

“Cat… two of the 4 cancers are hormone receptor positive and HER2 negative” (The air goes out of me, they’ll want me to try the hormone blockers again. I had the worst 1% of side effects with Tamoxifen, and they’ll want to hit me with something stronger 😔)

I click into my usual ‘I’m calm and going to ask lots of questions’ state that I usually go to when I get bad news, and then when she steps out of the room, I dissolve into tears. Not only is this NOT the end of the journey, I know it’s now the beginning of the hardest journey I’ve had to face so far.

With the Auckland Half Marathon just raced this weekend, I have used the analogy of my one and only experience of being talked into running it: “You run all the way around the North Shore, and then you get to the highlight of the run – the Auckland Harbour Bridge – as you start running up it, you realise it’s a lot steeper than you expected, and it’s kind of challenging… then you get to run down the other side and it’s fun and easy, and you can hear and see the finish line at Victoria Park. You keep running towards Vic Park and you hear the crowds cheering as other runners cross the finish line… there is relief coursing through your body, you’re nearly there….

… and then just as you are about to get to the park, you have to turn the corner and run another 2km through the Silo Park. That last 2km is the hardest, because in your mind you were already finished, and you are sooo tired from running around the north shore and across the bridge, it takes every ounce of resilience to keep going. Luckily, I was running with a friend, and when we hit that point, I kicked into cheerleader mode: “we’ve got this, not far now, we can do it” . Quite honestly, I was doing the cheering for me more than her. If she wasn’t there, I would have stopped 🤷‍♀️

When I see the oncologist the next day, she recommends I have further surgery to remove the rest of the lymph nodes in that armpit. But I know that the operation has a high risk (30%) of permanent and often debilitating condition called lymphoedema. And it’s my dominant hand – my injecting arm. My oncologist would ideally like me to have the surgery, then chemo, followed by radiation therapy, and then (gulp) hormone blockade – which could mean multiple drugs, or could mean removing my ovaries.

I’m prepared to go on the hardest form of chemotherapy to avoid surgery and hormone blockers. And another factor I’m stuck on – I’m due to fly out to Mexico on 15 November (ironically the 3rd anniversary of my first mastectomy) for my mum’s 70th. If I do what they want me to do, there is no way I can go 😔

We’ve been planning mum’s 70th for months, my brother will be joining us in Mexico for the first time, and I had originally planned to have the mastectomy in December, after I get home… as every time I have visited mum in Mexico so far, I’ve been recovering from surgery. (Although with this news, I’m so grateful I didn’t delay the surgery to December… )

I still REALLY want to go to Mexico, and although it’s not the ideal course, I’m convincing my medical team that it’s important enough to me that we work my chemo treatments around it.

About an hour after getting home from my appointment, Mercy Breast Clinic calls. My breast surgeon would like to talk with me. “You’re a very complicated case…” she tells me – something no doctor ever wants to hear about themselves “…and Karen (my oncologist) REALLY thinks you should have the lymph node surgery, both to get any further tumours out of your body, and to help us decide what the best treatment pathway is for you”.

I don’t want to hear it. I don’t want lymphoedema. It’s my injecting arm. (It will also mean I can’t go to Mexico, although I don’t use that excuse outright). I’m finding every reason to justify not having the surgery, and I know what medical people need to hear, so I’m convincing both of us (I think). I get off the phone exhausted, and decide to go to the movies to have a mindless break from having to make decisions and be in this reality.

As I get out of the movies, I message a girlfriend who has recently just been through almost exactly the journey I’m about to embark on. “Tell it to me straight, how bad is chemo REALLY?” I ask her. It sounds pretty awful as she had all the worst side effects, but she also has great suggestions. At the end she says to me “Babe, I’m not going to tell you what to do, but if it were me, I’d have the lymph nodes removed – I had it done and it’s way easier than you think. You want to get as much cancer as you can out of your body NOW”.

Damn. She’s right. I call two of my dear doctor friends who I trust to tell it to me straight. They confirm that the surgery is more important than Mexico or my injecting arm. Chemo will destroy my ovaries anyway and throw me into menopause (which my oncologist was happy about) so what’s to lose with just trying the hormone blockers? It might be better this time?

Simone suggests I start antidepressants asap to see if they can support me through the worst of the symptoms from losing my hormones… what a great suggestion. And then, the clincher. “Babe, it’s not worth risking your health to go to Mexico, the best birthday present you can give your mum is to stay alive and be healthy in 5-10 years time – but why don’t you bring her to you instead?” Inspired! So the next morning I call my breast surgeon and say that I’ll do the surgery. I message my oncologist and say I’ll give it my best shot to do everything. And I call my mum and ask her to come as soon as she can after her birthday.

I’m booked for surgery 6 November (probably just getting out of surgery now) and will start chemo around the 28 November once mum arrives. I’ve started the antidepressants (which make me nauseous and spacey, but hey, there’s worse to come, get over it, it’s not forever). I’ll work with Erin O’Hara, our science-based Naturopath at our Takapuna clinic to help support me with symptoms of my treatments and maximise the chance of getting cancer out of my body permanently. She has already made some great suggestions about fasting on the chemo days and adjusting my supplements slightly.

We are about to start offering Vitamin C infusions at The Face Place, so I’m the perfect person to trial them and work out the appropriate timings and protocols for cancer patients. We plan to combine the Vitamin C infusions with Healite LED and a gentle head and neck massage to take the focus away from ‘another needle’ for cancer patients, so I’m excited to trial those in my ‘good weeks’ from chemo (the week after chemo is a ‘bad week’ and then you have two ‘good weeks’ before starting again).

Now I have a plan, I am so much calmer.

I’m going to continue to share my journey publicly, the good and the ugly. Just like during the Auckland Half Marathon, it helps me to cheerlead other people, and gives the journey purpose.

I am so grateful for our incredible team at The Face Place, who have done such a wonderful job of continuing to run the business so beautifully while I’ve stepped back the last couple of years. I’m also grateful for the continued support of our patients as I then don’t have to worry about the business or financials. It means I can focus fully on my journey to become healthy and cancer free.

When I finished the Auckland Half Marathon I was so proud that we had just kept running… I felt like I could have run the marathon! And because of our consistency and determination to keep going, we did a really good time (with almost no training) of 2h 10min.

So although this next 6-9 months is going to be challenging in so many ways, I’ll keep looking for the gifts from the journey. When I look back at my life, every challenging period had wonderful gifts that it gave me (if you want to see a great clip that helped me understand this, check out The Hindsight Window by Eric Edmeades)

As I said to a friend the other day, “Every challenging period has gifts, and every gift has challenging periods”.

I have a mantra I look at in the mornings which starts ‘Today is a brand new day..’ which reminds me of what’s important on a daily basis. After hearing the news about my results I got really triggered by the phrase about halfway down which states ‘healthy is happy’ – I just burst into tears as I’m not going to be fully healthy for a while. But after sitting in meditation, it came to me, and I wrote beside it with a pen “Happy is healthy”. And this is my focus as I go through my treatments. I will feel the feels and the emotions, as I don’t want to have toxic positivity or be false; and I will also look for the happy moments of joy, fun, love and gratitude to help me through the tough times and be both happy and healthy.

I’m looking forward to being on the other side of this journey, healthy, happy and cancer free. Thank you all so much for the support you may have already shown me and our team, and for your continued support of our business over the next phase of the journey….

With much love and gratitude.

What are Skin Boosters and how do they help facial rejuvenation?

by Hannah Shale | Nov 5, 2024 | Injectables

There is a growing trend towards boosting skin health for facial rejuvenation, and this is something we have always encouraged here at The Face Place.

What are skin boosters?

Skin boosters are injectable treatments designed to enhance skin health by delivering deep hydration to the dermal layers, while stimulating your bodies natural collagen and elastin production to restore skin health for a more radiant, rejuvenated complexion. The brands of skin boosters we currently offer are Profhilo, Skinvive, Viscoderm and Sunekos.

How do skin boosters work?

Micro droplets of hyaluronic acid are injected into the top layers of the skin to replenish hydration, improve light reflection, and smooth the canvas of the skin without adding volume or changing the structure of the face. Hyaluronic acid is a moisture magnet and naturally occurs in our skin. As we age, both hyaluronic acid and collagen levels gradually diminish, and our skin becomes lax, dehydrated and dull. Skin boosters contain hyaluronic acid, and a blend of amino acids, anti-oxidants, vitamins and minerals to provide deep hydration and nourishment to the skin on a cellular level.

How are skin boosters different to traditional dermal fillers?

While both dermal filler and skin boosters are both made from hyaluronic acid, skin boosters are a lot more fluid and are injected superficially over a large area of the skins surface in multiple small injections to restore hydration, improve skin quality and skin health. Dermal fillers are thicker gels injected into a deeper layer in specific areas to restore volume, definition and contour.

What areas can be treated?

The most common areas to treat are the face and neck, but skin boosters can also treat the décolletage, upper arms, abdomen, hands and knees.

What skin boosters do:

Improve skin texture
Enhance skin hydration
Give a radiant complexion
Improve fine lines
Stimulates collagen and elastin

What skin boosters do not do:

Minimal lifting capacity
Cannot contour the face
Unable to correct asymmetry
Do not add volume

Skin aging is an inevitable, complex process that is influenced by both genetic and environmental factors. Skin boosters, especially when coupled with active skincare and advanced treatments, can contribute significantly to enhancing your skin health and decelerating the skin aging process. As Cosmedicine nurses and doctors, we work closely with our clients for a holistic approach to help you achieve the best results.

**Janny-Lee Brussow**, Cosmedicine Nurse

All medical devices and treatments carry risks and benefits. Individual results will vary. Speak to one of our qualified Cosmedicine Doctor’s or Nurse’s to see what might be right for you and to explain the possible side effects.

The Face Place.

Understanding UV damage to DNA: what happens when the sun hits your skin?

by Hannah Shale | Nov 5, 2024 | Skin

We all know that too much sun exposure can lead to sunburn, wrinkles and even skin cancer.

But have you ever wondered what happens to your skin at a deeper level when you are out in the sun? The answer lies in DNA damage caused by ultraviolet (UV)rays from the sun.

Let’s break it down in simple terms so you can understand how the sun can affect your skins DNA and why it’s important to protect yourself.

What is DNA?

DNA ( Deoxyribonucleic acid ) is the instruction manual that contains all the information needed for our bodies to function. It tells our cells how to grow, reproduce and repair themselves. It’s a blue print for building and maintaining our body. Unfortunately it is susceptible to damage and therefore needs to be protected and repaired where possible.

What causes DNA damage?

There are many things in our environment and in our bodies that can damage DNA. Here are a few common causes, but UV is one of the major causes.

UV Light: The sun’s ultraviolet (UV) rays can cause breaks or lesions in the DNA strands, which is why too much sun exposure can lead to skin cancer. The cells have some ability to repair these lesions, but when the damage is too much these mutations are repeated in new cells.

Invisible ultraviolet (UV) radiation from exposure to sunlight has long been linked to skin cancer. This is because even physiologic UV exposure can generate up to 100,000 DNA lesions per cell per day, making UV exposure the most prevalent external source of damage to our DNA, even higher than cigarette smoke.

The wavelengths of UV light fall between those of visible light and gamma radiation and are classified into three subtypes, A, B, and C. Long-wavelength UVA can pierce deep into the dermal layer of the skin, generating reactive oxygen species that can damage DNA indirectly, whereas DNA damage from UV exposure is often linked to UVB, whose photons are directly absorbed by DNA.

Radiation: X Rays and other types of radiation can penetrate cells and cause DNA damage.

Chemicals: Some chemicals like cigarette smoke or pollution can interact with DNA and cause harm.

Normal Cellular activities: Even basic processes like cell division and metabolism can lead to mistakes in the DNA. Sometimes oxygen molecules in our cells can cause small changes, leading to damage.

What happens when DNA is damaged ?

Damaged DNA can block cell replication or transcription, so for survival it has the ability to repair itself by, in basic terms, cutting and replacing part of the damaged strand via apoptosis which is programmed cell death, so the mutation cannot be repeated in a new cell. This is not a fool proof system and mutations do occur and are repeated in the replication of new cells. Changes are made in the genetic code and these mutations can sometimes lead to skin cancer or other diseases if they occur in important genes that control cell growth or function.

Why should we care about DNA damage?

While our bodies are pretty good at repairing DNA, repeated or severe damage can overwhelm our repair systems leading to disease or cancer. That’s why protecting our DNA by limiting exposure to harmful substances like UV is crucial.

When it comes to protecting your skin, sunscreens are critical, but antioxidants are equally important. They help protect your skin against sun damage by neutralising the free radicals (damaging unstable molecules that create oxidative stress and potential cell mutations.) Although your skin cells produces these naturally to defend itself, it can’t always cope with demand put on it from repeated or long term exposure. Vitamin A,B, C and many other antioxidants need to be applied to the exposed skin to maintain good skin cell health.

Most people are aware that sunscreen is necessary to help protect the skin, but not all sunscreens are equal in their efficacy. They may have the same SPF rating and still not give you an equal level of protection

All sunscreens need applying regularly, after 2 hours efficacy drops dramatically.
Apply liberally for good coverage – you should have enough product that you have to work it into the skin.
Cover up as much as you can – this is the best form of protection: wide brimmed hats, long sleeves and high necks
Apply antioxidants to the exposed areas morning and night.

**Lauren Harding**, Medical Skin Team Leader

Role of topical vitamin A application

by Hannah Shale | Oct 8, 2024 | Skin

Vitamin A is the greatest deficiency in the world, most people are unaware they suffer from a chronic, localised deficiency of vitamin A. As vitamin A is light sensitive, it is destroyed everyday in our skin and that is the main reason why we develop photoaging. You could say that the skin is constantly in need of vitamin A” -Dr Des Fernandes

In 1930 scientists first suggested that aging skin is caused by a vitamin A deficiency. This sparked ongoing trials and research that has now become the “gold standard” of results driven skincare, particularly with aging, acne and photodamage.

What is Vitamin A?

Vitamin A can be an ester, alcohol, or acid (depending on the form) and belongs to a family of organic chemicals called retinoids. Retinoids are something your body naturally produces, and is closely linked to vision in the retina of our eyes.

The different forms of vitamin A found in skincare (in order of bioavailability) are retinyl palmitate, retinyl acetate, retinyl propionate, retinol, retinaldehyde, and retinoic acid to name a few.

All forms of Vitamin A applied to the skin go through an enzymatic process to be transformed into retinoic acid, the more pathways the vitamin A has to go through (e.g retinyl palmitate), the longer it’ll take to see visible results, however sensitive skins may benefit more from a weaker form of vitamin A due to less irritation.

Vitamin A is the most essential molecule for maintaining healthy skin.

Everybody is exposed to UV light, whether that’s intentional or not. This exposure damages the vitamin A naturally found in our skin.

The more abundant our skin is in vitamin A, the more protected it will be against UV light.

It is essential that vitamin A is replenished on a daily basis to promote healthy looking skin, as well as minimize the effects of photoaging.

How does Vitamin A benefit our skin?

Our stratum corneum (the outermost layer of our skin) becomes more compact and smooth. This strengthens our skin barrier function, improving our skin’s first line of defence against environmental factors.

The Langerhan cells (responsible for our skin’s immunity) become far more effective, efficiently dealing with any foreign invaders such as microbes and pathogens that may be harmful to the health of our skin.

The effectiveness of our fibroblasts are improved, meaning healthier collagen and elastin are produced.

Melanin becomes more evenly distributed, making hyperpigmentation less noticeable.

Abnormal cells are normalised through DNA repair, and a process called cell apoptosis occurs. This means that skin cells that are no longer helpful, or are damaged beyond repair are programmed for cell death. This also plays a crucial role in preventing skin cancer.

Normalises sebaceous gland activity, this makes vitamin A particularly helpful for people concerned with acne/congestion.

With this we can conclude that Vitamin A deficiency is the main cause for hyperpigmentation, loss of elasticity (saggyness), wrinkles, roughness, irregular pigmentation, sallow skin, elastosis and breakouts. By topically applying vitamin A daily, we can improve the appearance of all these symptoms mentioned.

**Tegan O’Brien**, Medical Skin Therapist

Our Comprehensive Learning Platform: Preparing You for Safe and Confident Practice

by Hannah Shale | Oct 8, 2024 | TFP Academy

At TFP Academy, we believe that mastering the foundations is crucial before learners move on to practical, hands-on training. That’s why we’ve designed a comprehensive learning platform that our learners will utilise prior to any face-to-face training. This platform serves as the cornerstone of our training program, providing all the essential theories, knowledge, and detailed explanations needed to establish a strong foundation in aesthetic medicine.

So, what should you expect from our learning platform? Our platform is structured into multiple modules, each carefully crafted to cover the most important aspects of aesthetic treatment, including the science behind botulinum toxin, complex anatomy, patient safety, and many more essential components and fundamental factors.

We also understand that everyone learns differently, which is why our courses are designed to be both engaging and adaptable. The learning platform combines videos and theoretical content, ensuring that students with varying learning styles, whether visual, auditory, or reading-based, can fully absorb the materials provided. This blend of media makes the content not only useful but also highly interactive and engaging, catering to all types of learners.

By the end of each module, students will complete an assessment or examination to ensure they fully understand the basics before moving on. We aim for a 100% score on these assessments, as this is a critical step to ensuring learners are well-prepared for the next stage of their training.

We don’t believe in simply issuing certificates upon completion of coursework. Instead, our mission is to ensure every student who passes through our academy is equipped with the knowledge and skills needed to practice safely and confidently. As trainers, it’s our responsibility to craft not just certified practitioners, but well-informed and capable professionals who can work independently with 3c’s – competence, confidence and compassion.

What Happens After the Modules?

Once learners have completed the theoretical modules and passed all assessments, they will then proceed to the next phase of their journey – the face-to-face practical training. This is where theory meets practice. Learners will engage in hands-on training focused on the safe application of botulinum toxin, working under direct guidance to develop real-world skills. With the support of our expert trainers, learners will gain the practical experience and confidence needed to perform these procedures safely on their own clients.

We’ll be with our learners every step of the way – supporting, guiding, and ensuring they feel fully prepared before they begin practicing independently.

At TFP Academy, safety and confidence are our top priorities, and we look forward to supporting our learners on their journey to becoming skilled aesthetic practitioners.