Botox Treatment for Hyperhidrosis
admin Botox

Botox Treatment for Hyperhidrosis (excessive sweating)

Botox (botulinum toxin) is an FDA-approved treatment for hyperhidrosis, a condition characterized by excessive sweating that is not necessarily related to heat or exercise. It is commonly used for the underarms, palms, soles of the feet, and forehead when other treatments, such as antiperspirants and medications, are ineffective.

Botox works by blocking the nerve signals that stimulate sweat glands, significantly reducing perspiration in the treated areas. The procedure involves multiple small injections just beneath the skin and typically takes 15 to 30 minutes. Most patients begin to notice a reduction in sweating within a few days, with full effects occurring within two weeks. Results generally last between four to six months, after which repeat treatments are needed to maintain dryness.

Studies show that Botox can reduce sweating in the treated area by up to 80%. Side effects are usually mild and may include temporary discomfort, bruising, or slight muscle weakness in the hands or feet when those areas are treated.

Botox offers a safe and effective solution for individuals struggling with excessive sweating, improving confidence and quality of life. A consultation with Dr Westin can help determine if Botox is the right option for managing hyperhidrosis in an individual case.

Dr Thomas Westin ENT specialist
Assoc. professor

admin Vaccines

Shingrix: The new shingles Vaccine

The new and more effective vaccine against the dreaded disease of shingles has been eagerly awaited in Spain, and has finally become available since August of 2022.

So what is it and what is better about the new shingles vaccine?

The disease

About 99% of people over the age of 40 have had chicken pox at some time, even if they do not recall getting the disease. The virus can hibernate for many years until, in about 1 in 5 people, it is reactivated, causing a burning sensation in one area of the body, followed by a rash of extremely painful blisters. If the rash is around the eye or ear it can damage vision or hearing. It can be triggered by advancing age, stress, illness, certain medications or anything that reduces immunity. 

The rash itself will usually clear after 3-4 weeks, but 1 in 5 people will develop post-herpetic neuralgia.

This is a persistence of the pain which can last months, even years and is a cause of great distress as it is often difficult to treat the pain successfully.

The older you are, the more likely you are to develop post-herpetic neuralgia, and the more severe it is likely to be.

The Shingles vaccine

The Shingrix vaccine prevents shingles 97% of the time, while Zostavax, the previously available vaccine is effective 51% of the time (and is even less effective with increasing age).

Who should receive the vaccine?

It is indicated for anybody over the age of 50, including those already vaccinated with Zostavax or those who have had shingles already. (Having shingles once doesn’t protect you from having it again).

It can also be given to those over 18 who are vulnerable because of low immunity.

How is it given?

It is given like a flu shot in the muscle of the shoulder. A 2nd dose is needed after 2 months. This single course will protect you for the rest of your life.

It is not a live vaccine and can be given at the same time as other vaccines.

If you have had the Zostavax vaccine already you should wait at least 8 weeks before having Shingrix. 

If you had the Zostavax under the age of 70 years and are not at high risk you could wait 5 years before having the Shingrix vaccine.

What about side effects?

These are usually mild and short-lived. The most common are soreness at the injection site, aching muscles, fatigue and headache. Rarely, some people can have an allergic reaction. 

How much does it cost?

Each dose of Shingrix costs 247 euros.

If you would like to book your vaccine please call Atlantic Clinic on 952 81 7425

Vaccines need to be paid for in advance as once ordered they cannot be returned. 

Dr Anthony Crichton-Smith

admin Sexual health

STI (sexually transmitted infections): Fast results

Thinking you may have an STI is bad enough. Waiting for the results is positively nail-biting!

We appreciate how stressful and emotive this situation can be. 

Most of our tests are back within 1-2 working days  (depending on collection time and type of test). This includes the “Gold Standard” PCR tests which in most laboratories can take up to 10 days for the results.

Appointments can be made by phoning the clinic: (+34) 952 81 7425 or online:

Book here

Who should be tested?

  1. If you have symptoms such as a discharge, burning pain on urination, ulcers or lumps on the genitals.
  2. If you think you may be at risk, for example following unprotected sexual contact.
  3. You are starting a new sexual relationship and one or both partners want to be checked.

Which test?

We can do any STI test that you request, but here are some typical packages which can all be booked online. 

If you would like a different set of tests, book a consultation with a GP to discuss this.

Will I receive treatment?

A doctor’s consultation and prescription (if needed) is included in the price.

Click here for our STI testing packages.

When should I be tested?

  1. For routine screening or if you have symptoms: at any time.
  2. If you have no symptoms but are concerned about a recent sexual contact, bear in mind that different infections will show up positive at varying times afterwards. This table shows the normal earliest time to test after sexual contact (incubation period).

How are samples taken?

Men: most tests are done on a urine sample and/or blood sample. If an infection in the mouth or anus is suspected, a swab (like a long cotton bud) is used. 

Women: most tests are done with a vaginal swab and/or blood sample. 

What about herpes, genital warts, mollusca contagiosum?

These are generally best diagnosed by a doctor looking directly at the lesion.

If there is any doubt about the diagnosis, tests can be carried out for confirmation.

How will I receive the results?

The results can be sent by email or collected in person at Atlantic Clinic if you prefer.

Because of data protection rules results cannot be sent by Whatsapp or SMS.

What about confidentiality?

All medical information is kept strictly confidential and will not be disclosed to anybody else without your permission. 

What should I say (if anything) to my partner?

Discussions with your partner about STIs can be difficult and intimidating. It is best to talk to the doctor first so you have all the information you need, and to know how to approach it.

What happens if I need treatment?

The doctor may give treatment on the spot if appropriate, or sometimes a prescription. 

If medication is given to you there will be an additional charge to cover this.

You should not have any sexual contact until your doctor tells you it is safe to do so.

Will the results be in English?

The laboratory provides results in Spanish. Generally these are easily understood by English speakers (eg. “No se detecta” – Not detected) but if you are unsure, you can speak to one of our English speaking staff. They can explain what the results say, but are not qualified to give medical advice. 

If you would like to discuss your results with a doctor it is better to arrange a time to meet in person or speak on the phone.

How accurate are the tests?

No test is 100% accurate. 

In general terms, the PCR analysis is considered the best available test for most STI screening.

Antigen tests are less accurate but the results are very fast (same day). 

Is there anything I should do before testing?

Yes! To improve the accuracy of the tests;

For men: don’t pass urine before testing (ideally 3 hours or more if you can). 

For women: don’t wash the vagina on the day of testing

Appointments can be made by phoning the clinic: (+34) 952 81 7425 or online:

Book here

Dr Crichton-Smith

(10/2022)

admin Vaccines

The pneumonia vaccine: should you have it?

The pneumococcal pneumonia vaccine protects against a serious and potentially fatal infection which can cause pneumonia, blood poisoning (sepsis) and meningitis.

Babies up to 2 years old are routinely vaccinated with the Prevenar 13 vaccine to protect them.

There is a different vaccine, Pneumovax 23, for adults (and some children) which covers more strains.

Who should have the Pneumovax 23 vaccine?

  1. All adults over 65 years should have a single dose. It is normally given at the same time as the flu vaccine, but once only, not every year. 
  2. Those at higher risk (see below) may be given the vaccine at any age from 2 years onwards as a single dose. Higher risk includes:
    1. A long-term respiratory disease, such as chronic obstructive pulmonary disease (chronic bronchitis), smokers
    2. Heart disease
    3. Chronic liver disease such as cirrhosis or alcoholism
    4. Diabetes
    5. Reduced immunity e.g. caused by HIV, radiotherapy, chemotherapy or steroids
    6. A cochlear implant (hearing device)
    7. A history of a leak of cerebrospinal fluid (the fluid that surrounds the brain and spine, often following an accident or surgery)
  3. These high risk conditions may need the vaccine given every 5 years:
    1. Chronic kidney disease
    2. If the spleen has been removed, is not working properly or is at risk of not working properly in the future (e.g. Coelic disease).
  4. These conditions usually require a single dose of Prevenar 13 followed by Pneumovax 23 2 months later:
    1. Severely reduced immunity due to conditions such as leukaemia, multiple myeloma, genetic immune disorders and after a bone marrow transplant.

Is it safe?

These vaccines are both inactivated or “killed” and do not contain any live bacteria, and cannot cause the infection they protect against.

Mild side effects of slightly raised temperature, redness or swelling at the site of injection sometimes occur. 

Severe allergic reactions are extremely rare. 

Is it effective?

In adults and older children, it provides 50 to 70% effectiveness at preventing pneumococcal disease.

I am not sure if I had the Pneumovax. What should I do?

It is safe to have the vaccine even if unknowingly you are repeating the dose.

You can book online your Pneumovax 23 vaccine together with the flu vaccine below or call the clinic on 952 81 7425.

Book here

Dr Anthony Crichton-Smith

admin Aesthetics

Ultrasonic Rhinoplasty (Nose Job)

Rhinoplasty is one of the most frequently performed cosmetic surgery interventions in the world. Due to the great impact that the nose has on beauty and facial expression, a good result after the intervention has a positive effect on both the patient’s health and aesthetics.

When planning nasal surgery, we must bear in mind that aesthetics goes hand in hand with function. In other words, a good cosmetic result that leads to a worsening of respiratory function is considered a poor overall result. For this reason, it is essential to put yourself in the hands of a specialist who knows how to treat both aspects.

What can we treat with nasal surgery?

  • The nasal size in relation to the face
  • The width of the nasal bridge
  • The profile of the nose, with humps or depressions on the back
  • The nasal tip fallen, globular, etc.
  • The lateral displacement of the nose

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In the preoperative consultation, we will make an aesthetic assessment, taking photographs, and developing digital simulations in order to find the result that best suits the patient’s facial characteristics.

At the same time, we will explore the interior of the nose, in order to detect deviations of the nasal septum or increases in the size of the nasal turbinates, in order to correct them during the intervention and maintain or improve the patient’s nasal breathing.

Ultrasonic Rhinoplasty

The conventional rhinoplasty technique uses the hammer, chisel and file to reshape the nasal bones, obtaining very satisfactory results. However, science is rapidly advancing and nasal cosmetic surgery has benefited greatly from these developments. One of the most important in recent years has been the appearance of ultrasonic rhinoplasty.

 

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What is ultrasonic rhinoplasty?

It is an advanced technique for the treatment of the bone part of the intervention, which is carried out with an instrument called an ultrasonic scalpel. This instrument allows work on the nasal bones in a controlled manner under direct vision, allowing a finer action on the tissues.

What are the advantages of ultrasonic rhinoplasty?

By working more precisely, it prevents injuries to nearby structures, producing less post-surgical inflammation and reducing the risk of bruising under the eyes.

  • Greater fabric care
  • Fine and precise work
  • Reduces postoperative pain
  • better healing
  • Long-term stable results

Recovery

The nasal packing that is placed at the end of the surgery is usually removed after 24 hours, if there is no contraindication. The protection splint and stitches are removed after about a week. We recommend keeping the wound clean and doing nasal washes with saline water, to avoid scabs. It is usually a well-tolerated operation and patients do not complain of pain, except for the normal discomfort after surgery.

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Small episodes of bleeding may occur, usually in connection with nasal washes, when blowing the nose. In case of a significant nosebleed, you should go to the nearest health center emergency.

Regarding sick leave, it depends on the type of work that is performed: if it is a quiet activity, for example, office work, a week of rest may be enough, depending on the evolution. If, on the other hand, it is a job that requires physical effort, at least two weeks is recommended. Intense sports activity is not recommended before 3-4 weeks, although you can start with walks at an increasing pace to activate physical fitness. Sports where there is contact (football, basketball, martial arts, etc) are not recommended in any case, before 2 months, in general.

The definitive aesthetic results will begin to be seen at different times in each patient, depending on the type of skin and the speed of the inflammation process. There are people that can see their results at 2-3 months and others in which we have to wait more than 6 months.

admin Vaccines

Influenza (FLU) Vaccines 2021/22

What is New For 2021 ?

A few things are different for this year 2021:

  1. It is expected that this winter’s flu epidemic will be worse than usual because Covid-19 and the lockdown has meant that fewer people have developed a natural immunity to the virus.
  2. The composition of the Flu Vaccine has been updated
  3. All Flu Vaccines are Quadrivalent (four Components) This means they offer protection against 4 variants of the Flu Virus
  4. The Flu Vaccine and the COVID-19 Vaccines can safely be given at the same time. 

 

Why should you be vaccinated against the flu virus?

Influenza is a potentially dangerous virus which can not only lead to feeling very unwell, it leads to hospitalization and in some cases death. Millions of people suffer every year from the ever changing flu virus. People can be affected very differently; from feeling unwell for a few days requiring those days off work,  to more serious symptoms.

Complications of flu include bacterial pneumonia, ear and sinus infections, along with worsening medical conditions such as congestive heart failure, asthma or diabetes.

An annual seasonal flu vaccine is the BEST way to protect against the flu virus.

Vaccination has been shown to reduce the risks of illness, hospitalisation and flu-related deaths. Even if you get a flu-related illness it is likely that the severity will be significantly reduced after vaccination.

 

Who should be vaccinated against the flu virus?

1) If you are over the age of 50 

2) If you have certain health condition such as diabetes, asthma, COPD, heart disease, kidney disease, being very overweight (a body mass index of 40 or above) or reduced immunity (e.g. HIV, receiving cancer treatment, transplant patients)

3) If you are pregnant

4) if you are a Frontline Worker or caring for a vulnerable person. 

 

How quickly does it work?

It can take 10-14 days to provide full protection.

 

Can the flu vaccine give you the flu?

The vaccine does not contain live virus, so it cannot give you the flu. 

Some people have a mild temperature and muscle aches for a day or two after the injection.

 

How Much Does the Vaccine Cost ?

35 Euros Per Person 

 

How Do I Get My Vaccine?

1) Book online

2) Or call the clinic during opening hours (09.30-18.30 Mon-Fri) on 952 81 7425 to fix an appointment

3) Or visit Atlantic Clinic: Calle Califa 8, Nueva Andalucía, Marbella

 

OTHER VACCINES FOR ADULTS.

If you are over 65 years, or are at risk with some of the health conditions above, you should have the pneumococcal vaccine to prevent pneumococcal pneumonia. This is normally given once only, except in high risk patients, when a booster is given after 5 years. The cost is 50 euros

UPDATE 08/10/2021: There is currently a shortage of the pneumococcal 23 vaccine in Spain, and it is not available at present. As soon as it becomes available this blog will be updated to inform you.

 

If you are over 50 years you may be advised to have the shingles (herpes zoster) vaccine even if you have already had shingles or think you have never had chicken pox. You can speak to your doctor about the indications for this. The cost is 200 euros.

 

In Spain it is recommended to have a Diphtheria/Tetanus booster from the age of 65 years. The cost is 40 euros.

All these vaccines can safely be given at the same time, or at different times.

Dr Crichton-Smith (family doctor) Sarah Hartley (nurse)

 

admin COVID-19

Covid testing for travel: FAQs

1. Do I need a PCR or antigen test to travel? The rules are subject to change at any time so check with the government website of the country you are traveling to and get up-to-date advice before booking your test. Here are some  useful links:

 

2. Are Atlantic Clinic Covid tests valid for travel? Yes, our tests satisfy the requirements of the World Health Organization for sensitivity and specificity for travel abroad.

3. Will I get a certificate? You will be given a certificate in English either by email in pdf form or we can print off a hard copy for you.

4. If there is any problem with my certificate is there someone I can talk to about it? Yes, there is somebody available to resolve any problems 24 hours a day: call the clinic number +34 952 81 7425

 

 

admin Aesthetics

Platelet Rich Plasma (PRP) & Mesotherapy

For many decades, Platelet Rich Plasma (PRP) has been used in medicine for its properties that stimulate the proliferation of cells derived from stem cells (such as fibroblasts, platelets, endothelial cells, adipoblasts, …). These cells allow the regeneration of tissues and for this reason, it is frequently used for the healing of wounds and the treatment of joint problems.

Due to their regenerative properties, the usefulness of the use of platelets in aesthetic medicine in particular in facial rejuvenation treatments, scar correction and hair loss, began to be studied.

 

 

What is Platelet Rich Plasma?

Platelets are components of our blood, which in the body have the ability to produce growth or regeneration factors, when they are subjected to inflammatory processes due to damage to blood vessels or tissues.

Platelet Rich Plasma is defined as a volume of plasma with a concentration of platelets higher than what we normally find in our blood, in order to be used as a treatment to regenerate tissues.

Inside platelets, there are structures called alpha granules, these contain many growth factors that will help tissue regeneration. To the tube containing the Platelet Rich Plasma, a substance is added that will activate the platelets so that they begin to produce and release these growth factors from the granules and thus can be injected into the skin of the area to be treated.

 

What is PRP Treatment?

It involves injecting fresh plasma full of growth factors directly where the skin needs it most to stimulate its cell regeneration, collagen production and, thus, improve its quality and appearance: the skin increases its volume, improves its texture, reduces flaccidity and fine wrinkles.

Unlike mesotherapy with heterologous growth factors (manufactured by the pharmaceutical industry), in this case they are extracted from the patient’s own blood (we speak of an “autologous” procedure).

It is used to reverse the aging of the skin on the face, décolleté and hands, and is recommended when it begins to be observed that the skin loses collagen and its capacity for cell regeneration decreases.

The PRP Treatment is used as a preventive measure in young skin or in order to correct the signs of aging in more mature skin. With this collagen regeneration treatment, it is possible to treat the passage of time by means of substances (growth factors) that are found naturally in the body and that help cell regeneration.

This treatment is usually performed on the skin of the entire face, neck and hands. Although it is true that it is used more and more for other areas of the body.

 

How does a PRP session go?

Blood is extracted from the patient and then centrifuged: this process allows separating the plasma (which has a higher concentration of platelets and rich in growth factors) from the rest of the blood and then applying it by means of small punctures in the areas to be treated. .

The entire procedure lasts about 45-60 min, depending on the extent of the areas to be treated.

 

How Many Times Can It Be Done?

The application protocol and the frequency depend on each patient and the degree of skin aging they present.

In general, it is advisable to carry out 2 separate sessions of 2 weeks, 1 or 2 times a year, to enhance tissue regeneration.

Then you can repeat the same routine every year, in order to keep that cell regeneration active.

 

Who is Platelet Rich Plasma Recommended for?

In facial rejuvenation this treatment is useful to improve flaccidity or loss of volume of the skin and wrinkles of the face, stimulating the proliferation of fibroblasts that are responsible for the production of collagen, and in the deepest layer of the skin it can also stimulate, the proliferation of blood vessels and formation of adipose tissue that serves as filling of areas that have lost volume.

In the correction of scars, whether from burns, surgeries or acne, it can improve the quality of the skin by increasing collagen fibers and elastic fibers, it can also be used as a filler in deeper scars, either alone or in combination with other treatments.

Since 2006, it has become a useful tool to promote hair growth, as it stimulates growth factors at the root of the hair, increasing its growth phase. It is often used as part of treatment for people with alopecia (hair loss), whether they are men or women.

 

What happens after the procedure?

After the treatment, you may notice minimal swelling, redness, or bruising in the area, which can appear within the initial 12 to 24 hours. After the application, you can resume your normal life since no marks or scars will appear.

Although it is a simple technique, it carries certain risks such as the appearance of infections in the site that we have treated, allergic reactions (although this is very unlikely since we are using our own blood) or pain in the injected area.

Unlike other treatments, it is not necessary to rest.

 

PRP results

The effects will begin to be visible from the following 4 weeks, which is when the collagen that has been generated with the growth factors of the injected plasma begins to mature. The skin will appear brighter and smoother, with better tone and texture.

Complete collagen regeneration occurs 3 months after the procedure. Daily care with creams and sun protection, and the combination with other treatments such as microneedling and vitamin mesotherapy, can enhance these effects.

If we also combine PRP with hyaluronic acid and / or calcium hydroxyapatite, the correction of the loss of volume will be optimal.

 

Prices:

PRP 350€/ session
yearly PACK ( 2 sessions/ year) 660€ /year
yearly PACK ( 4 sessions/ year, 2 sessions 2x a year) 1229€ /year

 

 

Bérénice Ibarra Ottino

admin COVID-19

Covid Vaccination for ex-pats and foreigners


Even if you are not registered in the Andalucian Health Service you can now receive the Covid vaccine. Here’s how:

  1. Download the application form in Spanish by clicking here.
  2. We have provided a translation in English below.
  3. Fill out the form and take it to your nearest health centre (Ambulatorio). See below.
  4. Remember to bring your identification document (eg passport).
  5. Once entered onto their database you will be contacted when it is time for your vaccine.

Translation of application form (in red)

Finding your nearest health center

  1. You can search for a health center near to you by clicking here 

The site is in Spanish, but an example of a search for health centers in Marbella is shown below.

 

 

 

 

Dr. Anthony Crichton-Smith- GP

admin Aesthetics

Acne scar treatment with Dermapen (microneedling)

More than 90% of teenagers have acne and 1% of the population have acne scars.

Why do they happen? Acne scars are created by the wound healing process that occurs after the acute process of inflammation, follicular rupture, and periphollicular abscess formation.

There are different types of acne scars, 80% of them being atrophic, that is, associated with a net loss of collagen during the remodeling process of the matrix. The rest of the scars are hypertrophic or have keloid formation (see our article “keloids and microneedling”).

 

According to the degree of healing, the following are distinguished:

–Maculae: erythematous hyper or hypopigmented flat spots. They do not have a contour defect but a color problem.

–Mild: scars that are not obvious at social distances of> 50 cm and may be covered by makeup or facial hair.

–Moderate: Moderate scars that are obvious at social distances of> 50 cm and are not covered by makeup or facial hair. The scar can be flattened by manual stretching of the skin.

–Severe: severe scars that are obvious at social distances of> 50 cm and are not covered by makeup or facial hair. The scar does not flatten out with manual skin tightening.

To try to erase or reduce these scars, there are many treatments with their respective adverse effects, the main one being post-inflammatory hyperpigmentation. This is usually more pronounced in darker skin types.

 

Treatment options:

At our clinic, we suggest treating them with microneedling because it leaves the epidermis largely intact. Microneedles are passed through the epidermis and stimulate endogenous collagen production and scar remodeling in the dermis. Of all the treatments, it is the one that presents the lowest risk of post-inflammatory hyperpigmentation and allows you to continue with your normal daily life without problems (you will only suffer some redness in the treated area for a maximum of 48 hours).

However, you should know that they can also be treated with:

1. Chemical peel: they are the ones that give the best results with macular scars. It has variable results with ice picks and rolling scars. Its side effects: hyperpigmentation or temporary irritation.

( This treatment is also available in our clinic )

2. Dermabrasion: Completely removes the epidermis up to the papillary or reticular dermis. It is used to treat ice pick and rolling scars. It presents risks of infection and requires general anesthesia. The recovery time and post-treatment inactivity of the patient is significant. Darker skin can discolor and blotchy.

(Treatment NOT available in our clinic)

3. Microdermabrasion: Eliminates the outer layer of the epidermis. It does not treat deep scars and has the advantage of presenting only rare complications.

(Treatment NOT available in our clinic)

4. Fractional laser treatment: The ablative is more effective than the non-ablative. This treatment provides a measurable improvement of 40-80% in the depth of the scar. To do this, the patient must stop taking isoretinoin. In dark skin there is a risk of post-inflammatory hyperpigmentation, being up to 36% with conventional CO2 laser.

(Treatment NOT available in our clinic )

Prices:

They will depend on the size of the area to be treated

Bérénice Ibarra Ottino

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