Tinkable Newsletter

Botox gets green light for chronic migraine

2010-07-21T12:29:00.001-07:00

Sew this news article recently and thought you may be interested in reading, certainly the number of treatments for migraine has increased over the last 12 months.

"UK regulators are the first in the world to issue the stamp of approval for the use of Allergan’s neurotoxin Botox as a preventive treatment for chronic migraine.

Specifically, the Medicines and Healthcare products Regulatory Agency has licensed the drug, which is most famous for its anti-wrinkle properties, for adults who have headaches for at least 15 days per month with migraine on at least eight of these days.

The approval is based on a clinical trial programme known as PREEMPT which showed that nearly 70% of patients treated with Botox (botulinum toxin type A) experienced a 50% reduction in migraine days, as well as a significant improvement in quality of life and headache-related disability scores compared with those given a placebo.

Moreover, the treatment was found to be generally well-tolerated in the study, with the majority of side effects mild to moderate and discontinuation rates low in both treatment arms - 3.8% in the patients receiving Botox and 1.2% in those given a placebo.

Welcoming the approval, Dr Andy Dowson, chairman of Migraine Action's Medical Advisory Board, said while he had been using Botox ‘off-label’ for migraine prevention for 10 years, “it is important that we now have the PREEMPT study results to confirm the impression from this clinical practice experience”.

“Botox will give many chronic migraineurs a new lease of life where individuals will be able to make more plans and not be so debilitated by their condition,” added Lee Tomkins, Director at Migraine Action.

One in seven people in the UK suffer from migraine, which costs the economy around £1 billion a year, highlighting the need for new and effective treatments - particularly prophylatic ones - to help combat the condition.

Botox is already a blockbuster pulling in annual revenues well over £1 billion, largely from its cosmetic use but also other medical conditions such as excessive sweating, and its official approval in chronic migraine should give sales a further boost given that it could benefit around 700,000 people in the UK alone."

Hair Removal for all skin types and all hair colours.

2010-07-14T13:04:00.000-07:00

As most of you will be aware our laser treatments are very effective at hair removal, once the hair is black in colour.

For a long time we have searched for a hair removal system that is effective with grey, white, blonde and colour-less hair. Now we feel we have found the perfect solution and it even targets downy fine hair, in those awkward to reach areas.

Alkaline Wash- Treatment for the removal of Downy Hair

This Alkaline Wash is a new and innovative hair removal treatment, which will be available from Tinkable in August.

The Alkaline Wash is an alkaline powder that is mixed into a paste and applied to the desired area. It consists of a much higher pH unlike normal hair removal creams.

The Alkaline Wash solution enters the hair shaft, which damages and weakens the papilla, ( growth cell ). Therefore, this reduces hair re-growth, with continuous treatment the rate of hair re-growth will be reduced to Zero.

Benefits.

• Pain Free
• Does not cause pigmentation
• Suitable for all ethnic skin types
• Hair can be fine without any colour
• Can be used in conjunction with laser
• It removes facial hair, as well as improving the skin texture and colour.

Areas that the alkaline can be used to remove hair:

Face- lip, chin, sides of face and full face
Body- Bikini, underarms, arms, legs, nipple area, buttocks, back and stomach

The treatment needs to be performed ever 4-6weeks (as often as a waxing treatment would take place). As the hair growth weakens , the treatments can be spaced further apart, until such stage as treatment is no longer needed.

Treatments from £30.

Call us on 01384 373734 for more information.

Call us on

2010-05-05T02:05:00.000-07:00

Aussies as young as 20 turning to Botox

2010-04-29 15:00:00

Botox, which is derived from botulism toxin, is no longer a wrinkle-fixer only for those over 40, as it is has emerged that Australians as young as 20 are using it.
Terri-Anne Chapman, 21, a Gold Coast personal assistant from Varsity Lakes, is a regular user of botox, and she says she uses the product to stop lines before they appeared.
"I'm 21 so I don't have wrinkles - I treat it as a preventative so when I do get older I don't have really bad lines," the Courier Mail quoted her as saying.
Chapman first had Botox between her eyes when she was 20 and has had it three times since.
"I had a slight frown-line in between my eyes, which most people couldn't see unless I pointed it out, but it bothered me," she said.
She said the treatments lasted just under six months.
"Botox is very common on the Gold Coast - a lot of my girlfriends have it done regularly," she revealed.
"Taking care of yourself and helping prevent any early ageing signs is important to a lot of people," she explained.
The average cost of Botox per area is about 300 dollars and people usually have one or two areas treated at a time.
Cosmetic doctor Mario Soteriou, of Cosmetic Image Clinics in Brisbane, said Botox was increasingly common for women in their 20s.
"When Botox was first released, it was about getting rid of a line . . . now it's more about preventing," he revealed.
"Lines occur over time because of muscle movement, but by relaxing those muscles you remove the potential for those lines," he explained.
Dr Soteriou said he had three women this week say, "my mother has a line here and I don't want it".
"After treatment they become more positive - they benefit both emotionally and physically," he stated.
But dermatologist and owner of The Skin Centre on the Gold Coast, Michael Freeman, said young women did not need Botox because their skin was elastic.
He said Botox was not unhealthy, but warned if women paralysed muscles in one area, more lines could appear in another.
Dr Freeman said the most popular spot for Botox was above the nose, but most people could train themselves out of using those muscles and therefore it would not be necessary. (ANI)

You need less Botox!

2010-04-28T02:15:00.000-07:00

Botox cosmetic injections reduce wrinkles even with less frequent doses after two years of starting treatment and also have a wrinkle preventing effect, research says. "After two years of treatment at recommended intervals, patients can potentially cut the frequency, and thus, the cost of their Botox treatments by half," said Roger A. Dailey, professor of oculofacial plastic surgery in the Oregon Health & Science University (OHSU). The Botox research effort also demonstrated that the injections have a wrinkle preventing effect. Patients who begin receiving injections between their 30s and 50s are able to prevent wrinkles from forming and eliminate existing wrinkles, said Dailey, head of the Casey Aesthetic Facial Surgery Center . Based on previous studies, doctors advised patients who wished to reduce wrinkles in the area between the eyebrows - that they needed to have Botox injections every three months to maintain the cosmetic wrinkle-smoothing benefits. Such frequent treatment, however, deterred some patients, Dailey said. He studied 50 women aged 30 to 50, who received regular Botox injections for two years. "We found that after the patient receives Botox injections every four months for two years, the frequency of the injections can be changed to every six months and still achieve good results," Dailey said. "This demonstrates that patients have the ability to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost," he added. Botox has been approved for cosmetic use for eight years. In 2008, more than five million patients in the US received cosmetic Botox treatments, according to Allergen, the manufacturer. About 313,000 of those patients were men, an OHSU release said. The results of Dailey's work were presented at a meeting of American Society of Aesthetic Plastic Surgeon last week in Washington D.C. From. The Times of India.

Dark Circle's

2010-02-08T00:58:00.000-08:00

Exfoliation is the body's natural process of flaking away the outer skin cells, revealing a new layer of skin underneath. As we get older, the exfoliation process tends to slow
down. Some people's dark circles are caused by melanin deposits in the layers of skin that can be peeled away. The key here is to speed up the exfoliation process so that the skin renews itself much quicker and reveals the fresher, clearer, smoother skin underneath. This can be accomplished by the following methods:

1. Alpha and beta hydroxy acids.

These are widely available over-the-counter and are the mildest form of fruit acids used to
create a peeling of the skin. They work slowly over time to speed up the exfoliation process.
Alpha and beta hydroxy acids are usually pretty inexpensive and give good results in about 6-8 weeks. The over-the-counter ones range in strength from 5% up to 10%. I recommend the best ones in my book. The stronger ranges (20% and higher) arereserved for more intensive peeling under a doctor's care.

2. Microdermabrasion.

Microdermabrasion improves mild to moderate sun damage, wrinkles, dark circles and other superficial skin problems. A gentle stream of tiny particles exfoliates the outer layer of skin. The particles scrape away the surface layer of skin, which is then brushed off with the microdermabrasion vacuum tool with no need for anesthesia. Many celebrities who don't want the downtime of an acid peel get microdermabrasion. The drawback is this treatment has been widely reported to create a shine on the skin that is hard to cover up--and it's expensive.

3. Peels.

Peels should be administered by trained and licensed professionals because there are risks of infection as you remove several layers of skin, revealing healthy new "raw" skin underneath. Peels are generally safe for the skin around your eyes, but should always be administered by a medical professional to be safe.

4.. Glycolic Acid Peel

This is a very strong version of the alpha hydroxy fruit acid mixture. It works by loosening the dead skin cells. It does not damage or burn any live cells and removes only the outermost layers. It leaves the skin softer, smoother and more even toned and usually takes 2-3 treatments over a period of a month to be noticeable.

5.. TCA Peel.

This treatment does burn the outer layers of skin and carries with it some discomfort and risk of infection. It all but removes the outer layers of skin and there is a healing time of about one and a half to two weeks. This peel has varying strengths and time frames and should only be performed by a certified professional. These peels can give good results but are painful and can be costly. You will, however, get almost immediate results... as soon as the old skin peels off you have very even skin tone and reduction of spots, wrinkles and dark circles.

All of these options are forms of exfoliation. If melanin deposits are the cause of your dark circles, then exfoliation is key to getting rid of them.

Poor diet, including sugar, the wrong kinds of fats, highly processed foods, and low-nutrient foods cause chronic inflammation in the body. This breaks down collagen and elastin--the fibers in the skin that support it and keep it young looking--causing skin to age faster, wrinkle, get thinner, and show the blood vessels and purple muscle under the eyes, causing dark circles. But this effect isn't permanent. We can reverse these effects both by making crucial changes in our diet, and by using certain products that will thicken the skin under the eyes again, reversing the collagen-elastin breakdown. Once we thicken the under-eye skin, it's essentially younger, and our dark circles disappear.

Vitamin C is responsible for the skin's overall functional and most importantly, its ability to repair itself and produce/maintain collagen. You can take Vitamin C easily enough, but you should try to add foods containing high levels of Vitamin C to your diet.

Some examples include spinach and broccoli (both also rich inIron), citrus fruits such as oranges, lemons, and limes (I like toput a slice in my water), and even potatoes which have 25 mgs ofVitamin C.

You can find out exactly how much Vitamin C I recommend for you to take daily by getting my book, but everyone should at a minimum be getting the RDA amount of 60 mgs to avoid deficiency problems like scurvy.

Drinking plenty of water on a daily basis helps to maintain the skin's elasticity, and is simply just essential to the health of your body and skin. One of the main activities of the body's self-healing system is to filter the blood, a job performed mostly by the kidneys, with help from the skin in the form of perspiration.

This self-healing system removes the toxic wastes of metabolizing food and of other harmful substances that get into our bodies one way or another. This purification system operates efficiently only if the volume of water flowing through it is sufficient to carry away the wastes.

Drinking 8 to 10 glasses (64 fluid ounces) of water a day is the recommendation. To reach your quota, carry bottled water with you in your car, your purse, your briefcase -- wherever you go.

Tailor made medical products which are usually available on prescription from Tinkable can carefully chosen to address the individual needs to eliminate dark circles.

Allergies cause dark circles--or make the dark circles you have worse--by blocking your sinus passages and putting increased pressure on the circulation under your eyes. Many people don't even realize they have allergies, whether to pollens, dust mites or foods, and go around futilely trying to treat their dark circles with creams when really they need to be removing the source of their allergies from their environments. The treatment of dark circles is often not simple, but excluding allergies can be a big step in the right direction.

2010-01-16T02:16:00.000-08:00

Study Shows Women Are More Prone to Facial Wrinkles Than Men

New York, NY (December 14, 2009) – Findings from a new study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men. The study, conducted by a team of plastic surgeons from the Netherlands, was presented at the annual meeting of the European Association of Plastic Surgeons last May in Barcelona, Spain.

“The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men,” said the study’s lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands. “If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles.”

Skin surface replicas of the upper lip region in 10 male and 10 female cadavers (age range 75-93) were used to define the amount and depth of perioral wrinkling. To provide additional data, 3 full-thickness lip resections were taken from each of 15 male and 15 female fresh cadavers and were investigated in a blinded fashion.

The study found that all of the following could be contributing factors to the presence of more and deeper perioral wrinkles in women:

Women’s perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).
Women’s perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.
In women, the closer attachment of the muscular fibers surrounding the orifice of the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.

Current treatments for perioral wrinkles include the use of lasers, botulinum toxin injections, and injectable or implantable wrinkle fillers as well as older methods such as dermabrasion and chemical peels. Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.

“We think it's important to consider the reasons why a particular treatment may or may not be effective,“ said Dr. Paes. “Sometimes one has to go back to the basics instead of just moving forward. In the end, having more basic knowledge about a problem can speed up the process of finding the right solution.”

About ASAPS
The 2400-member American Society for Aesthetic Plastic Surgery (ASAPS), founded in 1967, is the leading organization of ABMS-certified plastic surgeons who specialize in cosmetic plastic surgery. With ASAPS active members certified by the American Board of Plastic Surgery, Canadian active members certified by the Royal College of Physicians and Surgeons of Canada, and International members certified in their countries of origin, ASAPS is at the forefront of innovation in aesthetic plastic surgery.

About ASJ
The Aesthetic Surgery Journal is the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS) and is the most widely read clinical journal in the field of cosmetic surgery, with subscribers in more than 80 countries.

SOURCE: ASAPS

A Breast Lift with Botox?

2009-12-19T07:24:00.000-08:00

Botox as a Breast Lift?
Add breast lifts to the growing list of potential uses for Botox. But not all experts think it's worth the trouble.
We already know that this wrinkle eraser can help treat excessive sweating, banish frown lines, and put the brakes on certain eye muscle problems and neck spasms. But it may also give breasts a temporary, mild lift, according to experts at the annual meeting of the American Society of Plastic Surgeons (ASPS) in Seattle.
A Botox breast lift involves injecting Botox into the pectoralis minor chest muscle, which allows the back muscles to compensate by lifting the breast, explains Karol Gutowski, MD, the head of the division of plastic surgery, at North Shore University Health System in Evanston, Ill. The lifting effect lasts only as long as the Botox -- which is roughly three to four months, he says. Botox is not approved for this purpose.
"The Botox breast lift is ideal for a woman aged 30 to 50 with an A or B cup breast size who is looking for a temporary, modest or mild improvement in saggy breasts," he says. "This gives them a little bit of a lift and costs about one to two thousand dollars for both breasts."
On the plus side, there are no scars or surgery with Botox breast lifts; on the minus side, they may not work all that well, he says.
"You can probably get the same effect by altering your posture," he tells WebMD. "The muscle in question, the pectoralis minor, is covered by the pectoralis major and it would be very difficult to target the smaller muscle that is covered by larger muscle," he says. What's more, "other muscles of the shoulder, back, and chest play a role, so it is very hard to believe that just weakening the pectoralis minor would give any type of effect."
"I would give this two thumbs down," Gutowski says.
"Botox is a temporary correction and Botox breast lifts will cost a lot of money because you are now using it for big muscles, not itty-bitty facial muscles," says Walter L. Erhardt Jr., MD, a plastic surgeon in private practice in Albany, Ga., and a past president of the ASPS. "I would go to the gym or take posture lessons before turning to Botox for a breast lift," he says. "The results will be longer lasting and it will be a lot safer."
There have been some reports of people developing various, sometimes life-threatening conditions, including respiratory failure, after receiving Botox injections.
"I think it is safe," Gutowski says. "It is done with very low doses and very unlikely to have any problems."
Cleavage Rejuvenation
Another minimally invasive breast enhancement procedure discussed at the ASPS meeting is cleavage rejuvenation. This involves injecting a filler such as Sculptra into the cleavage to get rid of fine wrinkles. Sculptra is not approved for this purpose. It is indicated for use in the restoration of facial fat loss in people with HIV.
"The initial results look exciting," says Gutowski.
Richard J. Greco, MD, a plastic surgeon in Savannah, Ga., says that soft tissue fillers such as Sculptra can be used to fill just about anything, including cleavage. "It comes down to cost and how long it lasts," he says, noting that the cost of using soft tissue fillers for larger areas on the body may prove prohibitive.

Macrolane Breast Enhancement

2009-12-06T03:27:00.000-08:00

Natalie’s Story Of Breast Enhancement With Macrolane With Treatment Provided By LCAS (M Viel)

Treatments with Macrolane™
Macrolane - the first body shaping treatment using hyaluronic acid.

Macrolane is injected deep into the subcutis under local anaesthetic. Macrolane VRF comes in two formulations that can be injected separately or in combination to ensure full correction and smoothness of the skin surface. The formulation and volume of Macrolane used (either VRF 20 or VRF 30) will be dependant on the individual and treatment area.

Treatments

Macrolane is a product for volume restoration and contouring of body surfaces. The most common areas for which Macrolane is currently being used include;

•Breasts
•Post liposuction concavities
•Calves
•Buttocks
•Male Chest Shaping (Pecs)

For men

Macrolane provides a range of treatments to enhance and shape the body giving a natural look. As treatment is minimally invasive and downtime minimal too, treatment with Macrolane is the first generation in body aesthetics. Following are the most common indications of interest for Macrolane treatments to men;

•Male Chest (Pecs)
•Post Liposuction Concavities
•Buttock Shaping
•Male Enhancement
•Calves Shaping

Macrolane for breast shaping
Macrolane iis currently approved for use of volume restoration and shaping of body surfaces. Many physicians see advantages of using Macrolane for breast shaping as opposed to more invasive techniques.

Women who are considering breast shaping with Macrolane will want to be reassured that the implant will not adversely affect the efficiency of future mammograms and/or the breast tissue itself. In one study, mammography after Macrolane injection for breast augmentation was evaluated. It was concluded that mammograms from these patients were easy to evaluate. Furthermore, routine supplementation of mammography with MRI does not appear necessary in patients treated with Macrolane.1

Q-Med, the manufacturer of Macrolane, is committed to continuous research and development and patient safety is a high priority. A number of physicians are currently working with Q-Med as part of this continued commitment.

1 Breast Augmentation with Stabilized Hyaluronic Acid Gel of Non-Animal Origin: Visualisation of Tissue Behind IMplants - Magnus Tengvar, Per Heden, Michael Olenius (Poster presented at IMCAS January 2008)

The benefits of Smart Lipo

2009-12-03T04:01:00.000-08:00

Laserlipolisi

Laserlipolisi is an alternative technique designed specifically for the removal of excess fat and localised adiposity, thanks to the selective interaction of the laser beam with the adipocytes.
This results in the disintegration of the membranes of the lipocytes and the elimination of the contents.

•The technique is performed by means of an innovative laser specifically developed for this purpose.
•The procedure uses an Nd:YAG Laser with extremely short pulses and very high peak of power, in order to avoid tissues heating. This works safely, effectively and with almost no down time.
•Fatty areas that are normally resistant to dieting and physical exercise can now be treated through this laser assisted lipolysis system with a totally revolutionary minimally invasive approach.
Laserlipolisi

How long does the procedure take?
Around one hour, depending on the treatment area.

Is it safe?
Yes, because Laserlipolisi
Only targets the actions specifically to the adipocytes, and by coagulating the blood vessels reduces blood loss, without damaging nerves or other tissues structures.

How many treatments will I need?
For localised deposits of fat just one session, while for larger areas of fat volum the procedure may be repeated.

When will I get to see the results?
Initial results will be visible fairly quickly, the final result being apparent after three to four months, this allows time for the elimination of the lysate and collagen stimulation to cause skin tightening.

Does is give a permanent effect?
Yes, it does.

How long is the recovery time?
The patient can return to their normal activities almost immediately after the procedure although it is advisable to avoid strenuous sports and sauna fot two weeks and intense massage for four to five weeks. A valuable adjunct to the treatment is by soft Dermodynamic soft massage by using the Triactive System.

•Advantages of Laserlipolisi
•A minimally invasive technique, lunch time surgery
•A straightforward and safe procedure
•Less post-treatment care
•Minimal blood loss;
•Contemporary decontamination of the treated area
•Fast recovery
•Can be repeated if required, after a recovery period, for larger areas
•No major side effects
•Gives a smoother contour of the overlying skin
•Collagen tightening
•Can be safely carried out in a treatment room
Laserlipolisi

Laserlipolisi is a clinically proven procedure. It has been tested for several years and numerous reports have already been published on this technique. The procedures have also been presented at the most important International Congresses and Conferences.

Laserlipolisi had been demonstrated to be less traumatic than conventional liposuction methods. The primary reasons for this are the smaller diameter 91mm) cannula and the effects of the laser-tissue interaction.
The interaction between the laser energy and the adipocytes causes lysis of the cell membranes of the fat cells, resulting in a leakage of their contents then dispersed in the interstitial tissue.
Its major advantages are that the procedure does not cause significant blood loss and also does not damage vessel, nerves or any other tissue structures.
Being a minimally invasive procedure, the only requirement is local anaesthesia.
After the minimally invasive surgery, the patient will not suffer long lasting or widespread oedema, haematomas, bruising or swelling.
This minimal surgery can be repeated on the same area, if required, after a few weeks.

There is no limitation on the area to be treated, even those that were previously considered as unsuitable for traditional liposuction, for example, the face, forearms, upper part of the abdomen, and knees.

Botox Results

2009-12-02T08:03:00.001-08:00

Below you will find an example how how Botox can work for you.

This result is achieved through years of experience by Tinkable’s medical staff. And the specialist protocols for treatment that we have developed over years and years.

To find out more about Botox got to http://www.tinkable.co.uk/botox-injections.asp

So What Is Botox?

2009-11-19T02:27:00.000-08:00

What is a Botox Injection?
It's a muscle relaxant agent, produced from bacteria. Its action interferes with muscle contraction, to enable the product to smooth out lines and wrinkles, with extremely effective and long lasting results.

When and where was a Botox Injections first used?
It was first approved in 1989, in Italy to treat patients with facial spasm disorders, it became increasingly apparent that, crows feet, forehead lines and frown lines were diminishing and softening and in some cases vanishing altogether.

What areas of the face can be treated?
Botox will treat Crows feet, Horizontal forehead lines and frown lines

Can a Botox Injection be used anywhere else other than the face?
In a medical setting and performed by qualified physicians Botox uses are wide and varied. However in a cosmetic setting Botox can also be used under the arms to prevent and treat excessive sweating

Is Botox painful?
No, the procedure is virtually painless due to the fine gauge of the needle and the miniscule amount of the Botox product injected

How long will the Botox treatment take?
The longest part of treatment will be medical consultation and consent, the Botox injections themselves will take a maximum of ten minutes, you should allow for a total appointment time of forty minutes, for your first visit.

Once I've had a Botox treatment how long will it last?
The documented evidence suggests that Botox can last anything from two to six months. However in our own research we are finding that Botox can last longer.

How many Botox treatments will I need?
A perfect result for the majority of people can be obtained in a single session. There are seldom cases where the first treatment did not achieve the effective impressive results.

However, once treated, longevity can be obtained with minor top ups.

How long will it be before I see results?
The results from your Botox treatments will be gradual taking full effect over a period of time lasting anywhere up to 21 Days in some cases.

So who can benefit from Botox treatments?
Younger clients are now turning to Botox as a method of prevention for expression lines and wrinkles. Almost anyone can benefit from the treatment, whether it be a prophylactic measure or just to soften existing wrinkles.

What can go wrong?
Very little, however as with any pharmaceutical product there are potential side effects. However side effects that occur are known to be extremely minor i.e. possible initial reddening at injection site, and of a temporary nature.

Who can perform Botox procedures?
Doctors, Dentists and Nurses are able to perform Botox treatments, however this is not enough alone, professionals must have received training in the particular field of facial injectables, please refer to our practitioner choice guide.

Is there any after care?
At the time of your Botox treatments you will be given the personal mobile number for your injector, who will be available on a 24 hour basis should you feel the need to seek further advice or post treatment care.