Injectable Cosmetic Treatments


skin booster profhilo Nucleofill sunekos Cheshire


Cheshire Lasers works closely with Dr Teri Johnson of M C Treatments,  Dr Kyra Drinnan, Dr Kathryn Hazlehurst, and Aesthetic Nurse Katey Moulton. Together, they provide a wide range of anti-ageing and aesthetic injectable treatments.

View Dr Teri Johnson’s Blog briefly summarising the benefits of injectable treatments here. 

Dermal Filler Treatments

Dermal Fillers are injectable treatments that plump out and improve fine lines, wrinkles and folds. They also add volume and help improve facial imperfections by lifting and contouring.

At Cheshire Lasers, we use a range of fillers, most commonly Restylane, Juvederm, Teosyal, Stylage and Belotero.

They help with anti-ageing and enhance features, making people feel more attractive.

Dermal Filler Treatments Include:

Lip Rejuvenation Using rejuvenating dermal fillers to reduce smokers’ lines and restore the ageing mouth area.
Lip Enhancement Using dermal fillers with various techniques to achieve the plumper look you require.
The Eight-Point Lift Using dermal fillers in 8 different points creates a lift in the face. Also known as the liquid facelift.
Nose Reshape / Correction We can provide a temporary solution to many nose irregularities using dermal fillers.
Marionette Line Treatment Our specialists use dermal fillers with various techniques to blend in the marionette and jowl area and replace volume loss, one of the biggest causes of marionette lines.
Cheek Augmentation Using Dermal Fillers, Sculptra, and Ellanse
Facial Contouring Adding volume to facial features using dermal fillers or Sculptra.
Hand Rejuvenation Hand rejuvenation can be achieved with collagen boosters or dermal fillers.


Anti-Wrinkle Injections

Anti-Wrinkle Injections such as Botox and Azzalure have many uses in enhancing a person’s appearance. This injectable treatment reduces muscle contractions, which has many benefits, including reducing lines on the forehead, brow and crow’s feet.

Botox can also be used for the following:


Under Eye Treatments

Cheshire Lasers offers a wide range of under-eye injectable treatments, including Nucleophil and light Eyes for hydration, improving dark circles, under-eye wrinkles and skin firmness and Tear Trough Rejuvenation with Dermal fillers to improve deep hollows and PRP.


Skin Boosters

We offer a wide range of Skin Boosters, including  Profhilo and Sunekos, to improve skin texture, signs of ageing and hydration of the skin.


Regenerative Polynucleotide Treatments

Polynucleotide treatments use DNA particles to regenerate, heal and restore skin. They improve signs of ageing, hydration, and skin laxity and can help scars and pigmentation.

Products include Nucleofill, Plenhyage and Plinest. 


Volumising Collagen Stimulators

Alternatives to dermal fillers for giving volume to faces, replacing lost facial contours, and lifting loose skin using a product that stimulates collagen.

View Dr Johnson’s blog summarising the benefits of collagen stimulators here.


Thread Vein Treatment

We provide Thread Vein Treatments for all areas. On the face using IPL and/or Electrocautery and on the legs with Sclerotherapy an injectable treatment 


Hyaluronidase /Hylase Injections

Hyaluronidase is also known as Hylase, a prescription-only injectable treatment for dissolving and removing hyaluronic acid dermal fillers. It can reduce small lumps of fillers, such as those sometimes seen after lip fillers. It can also remove larger volumes of fillers, such as a full lip enhancement.


Blemish Removal

Removal of skin tags, Warts, Seborrhoeic Warts facial blemishes e.g. milia, spider naevi etc with electrocautery or advanced electrolysis. Our Podiatrist also treats verrucas and ingrowing toenails.


 

Jen D’Mellow Counsellor


About Jen D’Mellow

Jen is a person-centred counsellor who can offer a safe space for you to talk without fear of judgement. Jen recognises that talking to family or friends can be difficult at times, which is where counselling can really help to make a difference in your life.

Jen believes that by engaging in counselling and developing a non-judgemental and supportive relationship based on trust, together we can find a way to help you to understand yourself better.

Jen works using the person-centred approach, which is non-directive, and you will work together, as she truly believes that you are the expert in yourself, not her. By working together, Jen hopes that you can gain an understanding of what it is you want to focus on, and start to facilitate change where you can feel empowered to live your life, the way you want to.

Jen has worked for over 20 years in social care, with people with learning difficulties, autism, physical disabilities and the elderly, and loves that she is still able to make a difference to the lives of people in my work as a counsellor.

As well as her private work, Jen also volunteers for an organisation providing counselling to survivors of abuse, predominantly childhood sexual abuse.

Jen is registered with the British Association for Counselling and Psychotherapy (BACP) and works within their ethical framework.


Are you considering booking counselling with Jen?

Jen appreciates that not every counsellor is right for everyone. She, therefore, offers a short introductory call/ video call where you can ask any questions you may have. This gives you the opportunity to see if you feel embarking on counselling sessions with her will work for you, and also allow her to assess if she can offer what you are looking for.


Jen works with the following issues:

  • Abuse
  • Addiction
  • Bereavement
  • Depression
  • Learning Difficulties
  • Post-Traumatic Stress Disorder (PTSD)
  • Relationship problems
  • Self- Harm
  • Stress
  • Suicidal Thoughts
  • Trauma

Jen’s Qualifications

Level 4 Diploma in Therapeutic Counselling
Level 3 Counselling
Level 2 Counselling Skills
BA (Hons) Applied Community Studies


How to book an appointment with Jen?

Please contact Jen directly.

Phone – 07821 369 320

Email – info.yourtimetobeheard@gmail.com

She will arrange a free introductory video/ phone call, where you can ask any questions you may have.


Jen’s Prices

£40 per 50-minute counselling session

Payment via Bank Transfer.


View Jens website:

Website – yourtimetobeheard.co.uk

 

Jen D'Mellow Counselling


 

Emotional Freedom Technique


Emotional Freedom Technique


What is Emotional Freedom Technique?

Emotional Freedom Technique ( EFT) is a very powerful but gentle way of releasing emotional, mental and physical pain.

EFT uses a process that works with the energy meridians of the body, balancing the body’s energy system and removing any disturbance or emotional blocks to the energy flow around the body.

Very simply, EFT is a form of acupuncture, except you use your fingers instead of needles on the energy meridians.

It works by gently tapping on specific meridian points on the face and hands, whilst at the same time using spoken affirmations.

Within a couple of sessions, all negative and pent-up emotions may be released, enabling you to reduce stress, tension or pain.

The process is easy to memorise, and within just one session, you will have the skills to use EFT on yourself for any situation you may find yourself in, and as it is portable, you can use it anywhere.


EFT is effective in treating a wide range of conditions, including:

  • Addictions and cravings
  • Anger
  • Anxiety and panic attacks
  • Headaches and migraine
  • Joint and back pain
  • Phobias
  • Post-traumatic stress disorder
  • Self-esteem and poor self-image
  • Sports injuries and performance anxiety
  • Stress and mental health issues

Who Provides Emotional Freedom Technique at Cheshire Lasers?

Emotional Freedom Technique is performed by  Noah Sisson-Curbishley

Find out more about Noah’s treatments and prices here.


 

Hopi Ear Candling


hopi ear candle Middlewich Cheshire


What is Hopi Ear Candling?

Hopi Candling uses specially produced candles which originate from the North American Indians.

Once lit the candle creates a chimney effect (or vacuum) which gently massages the eardrum and helps to dislodge any wax or impurities.


Hopi Ear Candles can help with:

  • Tinnitus
  • Compacted ear wax
  • Glue ear
  • Sore throats
  • Hay fever
  • Headache and migraine
  • Rhinitis
  • Sinusitis and Catarrh
  • Stimulation of blood and energy flow
  • Regulation of pressure in ears
  • Relaxation in conditions of anxiety and stress

Who performs Hopi Ear Candle treatments at Cheshire Lasers?

Tara Shotton performs Hopi Ear Candling at Cheshire Lasers in Middlewich.


Find out more about Tara’s training, experience, availability, how to book and her prices here. 


What Happens During an Ear Candle Treatment?

During a treatment, Tara will perform an initial consultation to ensure the treatment is right for you. She will then ask you to lie on your side on a therapy bed. Tara will gently insert a candle in the first ear and then the other.

The treatment includes a relaxing facial massage to encourage lymph flow, and you have the option of having some complimentary Reiki to finish.

The treatment lasts approximately 45 minutes.


Advanced Electrocautery


advance electrolysis electrocautery cheshire


Advanced electrocautery has been used for over 100 years as an effective means of permanent hair removal & treatment for skin lesions. It comes with the advantage of being able to target very specific parts of the body and can be used to get remove or reduce skin lesions & skin conditions such as skin tags, moles, verrucas, blood spots, birth marks, seborrheic keratosis, facial thread veins and skin warts. These skin imperfections can cause people to feel very self-conscious, but can usually be removed quickly & easily.


Skin Tags

Skin tags often appear on the body in areas of friction, such as under the arms, around the neck and around the groin. Whilst they don’t post any harm, they can be unsightly and catch on clothing. Advanced electrocautery can effectively remove skin tags with little discomfort.


Warts

A viral infection in the skin causes warts and can appear anywhere on the body. Electrocautery treatment is an effective way to remove warts from the skin.


Moles

Moles are a very common skin condition in people of any age. Whilst they’re not usually harmful, they may be unsightly if they’re in prominent places such as the face. Advanced Electrocautery can remove/shrink moles very effectively.


Verrucas

Electrocautery treatment can effectively treat Verrucas. They appear on the feet and can be uncomfortable; they may spread via communal showers such as those found in gyms or swimming pools.


Blood spots (Campbell de Morgan spots /cherry angiomas)

Electrocautery can effectively treat blood spots. Blood spots are red, vascular blemishes that can occur at any age but are much more common in men than women.


Age spots

Age spots occur because of an accumulation of lipofuscin due to ageing. Electrolysis can remove age spots quickly and effectively in men and women of all ages.


Milia

Milia are hard, white keratin bumps that vary in size often seen around the eyes and cheeks. Electrocautery is effective at treating milia without leaving any marks behind.


Sebaceous hyperplasia

These bumps are the result of damage, which leads to overproduction of sebum by the sebaceous gland. The damaged sebaceous glands can become enlarged or blocked. This turns them into bumps that may be soft or hard, with a white or yellow surface. They respond very well to electrocautery.


Seborrheic Keratosis

Seborrheic keratosis is one of the most common noncancerous skin growths in older adults. A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. The growth has a waxy, scaly, slightly raised appearance & responds well to electrocautery.


Cysts

Cysts can vary in size and can be due to a range of problems. Electrocautery can treat cysts that develop due to sebum build under the skin. Smaller cysts can be treated successfully using electrocautery treatment to dry up the cyst’s contents.


Syringoma

Syringomas are small, flesh-coloured bumps commonly appearing around the eyelids and upper cheeks. Electrocautery can reduce the size of the bumps without leaving any marks behind.


Facial Thread Veins (Spider Naevi and Telangiectasia)

Spider Naevi and Telangiectasia are dilated blood vessels that cause the appearance of redness on the skin. They often appear on the cheeks or over the face. Electrocautery can treat them effectively without damaging the skin.


Scars

Scars are difficult to treat and whilst electrolysis cannot change the shape or colour of a scar, it can sometimes smooth out the skin and remove the raised appearance of scars.


How do Electrolysis and Electrocautery work?

Electrolysis is a permanent hair removal process that works by treating the base of the hair follicle with a tiny amount of electricity and therefore eliminating its ability to grow new hair. A tiny needle is inserted into the hair follicle and the current is applied.

Electrocautery also generates energy to heat & shrink various skin lesions or conditions.


Is Advanced Electrocautery Painful?

Not normally.

Depending on your electrocautery treatment, you may not need any anaesthetic, but we can use topical or an injectable treatment to provide you with an experience that’s comfortable and with minimum pain.


Can Electrocautery treat skin imperfections on any part of the body?

Yes. The only exceptions to this are the nostrils and inner ears.


How many treatments will I need?

This will vary from one patient to the next and also depends on the reason for your treatment.

The number of treatments you need depends on the problem.

A single skin tag is easy to remove in one treatment

However, some problems, such as warts and thread veins, require a course of treatment and can recur at a later date.


What are the side effects?

Side effects of electrocautery are usually minimal to some crusting and redness around the treated areas for a few days. An area may remain pink for a few weeks after treatment.

You can view more information and frequently asked questions about this treatment here. 


Who Performs Advanced Electrocautery at Cheshire Lasers?

Dr Will Allen, Facial Surgeon, and Dr Kathryn Hazlehurst perform Advanced Electrocautery.

Dr Allen removes larger skin lesions and moles, and Dr Hazlehurst removes smaller lesions.

View more information about Dr Allen and his prices here.

View Dr Hazlehurst’s information and prices here.


Before and after image courtesy of Dr Hazlehurst:

before and after electrolysis electrocautery

before and after electrolysis electrocautery of miliabefore and after electrolysis electrocautery of venus lake

 


 

Botox Delays the Brow Ageing Process


botox delays brow ageing Middlewich Cheshire


Consultant plastic surgeon Rajiv Grover confirmed that the long-term use of Botulinum Toxin (Botox) delays the ageing process in the upper face.

The study came about after Grover carried out several consultations with patients seeking a second facelift (some years after having the first with a different surgeon) and began to notice differences between those who had used Botulinum Toxin over several years and those who had not.

Patients who had been receiving Botulinum Toxin injections consistently since their first facelift were far less likely to require a brow lift than those who had not, however, there were no significant differences in the bottom halves of their faces regardless of whether or not they had used Dermal Fillers in the cheek, jowls or neck.

This initial anecdotal evidence led Grover to carry out a formal study on 68 patients who had requested a secondary facelift following a previous one some years earlier. Out of these 68 patients, 24 had received Botulinum Toxin treatment regularly for over nine years.

Grover assessed the effects of ageing on the forehead and brow in three ways:

  • The height of the brow itself above the pupil of the eye was measured
  • Digital imaging software from Canfield USA to measure how much the brow had dropped with age by analysing pictures from youth and comparing these with current pictures
  • The need for a surgical brow lift, as a measure of the ageing process.

What did the study show?

The study reported that the patients who had received over nine years of regular Botulinum Toxin had significantly higher brows than those who had not, with an average difference of over 3mm.

The photograph analysis backed this up, finding that the inevitable drop in brow height caused by gravity and muscle movement during the ageing process was on average significantly smaller in the patients who had received Botulinum Toxin, indicating an alteration of the ageing process.

These results meant that Grover thought fewer of the Botulinum Toxin-treated patients needed a surgical browlift at the time of their facelift surgery than the Non-Botulinum Toxin group. In fact, only two of 24 Botulinum Toxin treated patients (8%) received a brow lift, compared with 24 out of the 44 remaining Non-Botulinum Toxin group (54%).

“This is the first study of its kind to look at the anatomical effects on the ageing process from long-term use of Botulinum Toxin,” said Grover. “By rebalancing the facial muscles it appears that Botulinum Toxin reduces the changes of drooping of the forehead and brow seen with ageing. The aim of this study is not to recommend that people take Botulinum Toxin in a long-term fashion but it is important that surgeons analyse in a scientific way what the long-term effects of treatment are in order improve safety for our patients.”


Find out more about Botox and how it works here.


Find out who performs Botox Treatments at Cheshire Lasers here.


 

What Causes Skin Wrinkles?


The following changes make us prone to skin wrinkles:

  • Excessive facial expressions/smoking create dynamic lines in the stratum corneum and then the dermis
  • Epidermal cell turnover reduces so the very top layer “the stratum corneum” is present for longer subject to the causes of ageing
  • The stratum corneum layer becomes more dehydrated so the lines show more
  • The dermis the supportive structure underneath becomes thin, less vascular and loses collagen.
  • The fat layer under the dermis reduces.

skin anatomy


Facial Expressions

Facial expressions such as pursing the lips cause dynamic lines. These lines are usually seen in people that smoke due to the repetitive movements from the act of smoking. However, smoking also causes other physiological changes making smokers more prone to wrinkles all over.

Interestingly facial expression lines are often are seen around the mouth in non-smokers who have the habit of repeatedly using the muscles for their facial expressions.


Epidermal Cell Changes

The epidermis is the very top layer of skin which acts as a protective barrier. The lowest layer is the “Stratum Basale” this is where new skin cells are made. New skin cells get pushed closer and closer to the skin surface as more cells are made and over time they mature and become flatter and harder due to the keratin within them. When they reach the top layers they die and are eventually shed into the environment. As a result, these cells are found in dust throughout your home.

With age, this epidermal turnover slows down. Cell renewal time is the time a new cell takes to travel from the lowest layer of the epidermis the “Stratum Basale” to the top layer the “Stratum Corneum” and then shed off the skin.

Cell renewal time changes as we age:

  • Babies – 14 days
  • Teenagers – 21 – 28 days
  • Middle age – 28 – 42 days
  • 50 and up – 45 – 90 days

That means that as we age, the top layer of skin cells forming the stratum corneum are around for a lot longer.  These cells have been shown to become more dehydrated with age and have been exposed to more movement and environmental factors.

These changes mean the skin is more prone to developing wrinkles and once they develop they can be harder to treat.

Some people have a thicker stratum corneum layer and these people often need treating differently to those with a thin more hydrated stratum corneum.


Dermal Changes

The dermis the supportive structure underneath the stratum corneum becomes thin, less vascular and loses collagen with age.

The dermal thickness decreases by about 20% and the blood flow reduced by about 60%. Fibroblast activity decreases which leads to a drop in collagen synthesis. The collagen content of the dermis decreases by 1% per year throughout adult life.

The collagen remaining is less effective and loses its ability to regain its shape after deformation and also holds a lot less water.

Research has shown that wrinkles appear not so much due to the degeneration of elastin fibres, as previously thought, but also due to a decrease in the water-holding collagen and mucopolysaccharides.

Sebaceous glands produce less oil as you age. Men are fortunate and don’t experience much of a decrease until their 80s. Women gradually produce less oil beginning after menopause. This can make it harder to keep the skin moist, resulting in dryness and itchiness.

Changes in the connective tissue reduce the skin’s strength and elasticity. This is known as elastosis. It is more noticeable in sun-exposed areas (solar elastosis). Elastosis produces the leathery, weather-beaten appearance common to farmers, sailors, and others who spend a large amount of time outdoors.


Changes in the Hypodermis

The hypodermis consists mainly of fat and acts as an insulator and shock absorber. With age, there is a loss of subcutaneous fat and the skin becomes thinner and less resistant to trauma. The reduced volume of subcutaneous fat means the role of the hypodermis in limiting conductive heat loss is impaired.

When it comes to ageing the loss of fat means you lose the mattress like effect of the fat which plumps the skin out giving it a smooth appearance. As the fat goes the skin is then sat on muscle and other underlying structures which can appear wrinkly.

The mouth is an area which develops lines and wrinkles due to fat loss. This is much more common in women as they gradually lose all the fat around the mouth, whereas men are often more fortunate and keep a layer of fat. Hence why women develop lip lines a lot earlier than men.


 

Radiesse Hand Rejuvenation


Dermal filler hand rejuvenation Cheshire


Dr Kyra Drinnan and Teri Johnson perform Radiesse Hand Rejuvenation at Cheshire Lasers Clinic.

Dr Johnson also performs a range of other hand rejuvenation treatments which you can read about here.


Radiesse

Radiesse can help to improve ageing hands where loss of fat and thin skin has resulted in a bony appearance and unsightly veins.


What is Radiesse and how does it work?

Radiesse is a Dermal Filler launched in the UK in 2004.  It is made up of tiny beads of calcium hydroxylapatite (CaHa). CaHa has been safely used in the body for many years. Radiesse is not a permanent filler, the average effect lasting around 12 months depending on the client and the area treated.
Once injected into your skin, the smooth and spherical CaHA particles form a ‘scaffold’ which stimulates your own cells to produce collagen. The gel carrier dissolves within a few months and are completely metabolised by the body, leaving only the new collagen structure.


What happens during the Radiesse Hand Rejuvenation Treatment?

Dr Teri Johnson will perform a consultation and will discuss what you hope to achieve from the treatment and tell you whether or not these results are achievable. Your medical history will be taken, to ensure that there are no reasons why you shouldn’t have the treatment.

A cannula is used to deposit droplets of the Radiesse gel in the skin evenly over both hand to ensure the hands are equally covered.
Each hand takes about twenty minutes to treat. The hands are then thoroughly massaged firmly to ensure even spread of the Radiesse gel.


What should I expect after treatment?

You can return to work the following day after this procedure. However please avoid exposing your hands to any chemicals or dirty environments where the injection sites could be exposed to irritation or infection. Protection such as gloves would help reduce any adverse exposure.

You may have a few small bruises on your hands for a day or two afterwards.

With clean hands, massage your hands for a few days after treatment.  This will ensure the Radiesse is distributed evenly.


How Safe is a Radiesse Hand Rejuvenation treatment?

There are few reported side effects from clinical trials and actual usage of this product. Common injection-related reactions may occur, such as swelling, pain, itching, discolouration and tenderness at the injection site.
Some lumpiness at the injection site can rarely occur.


How much is a Radiesse Hand Rejuvenation treatment ?

View Dr Drinnan’s Prices here

View Dr Johnson’s prices here


How many treatments will I require ?

The number of treatments usually depends on your age. It also depends on how your hands have aged and the results you want to achieve.

The following is a guide:

  • 55+ you most likely need 2 treatments for a good result 4-6 weeks apart.
  • 45 a single treatment is usual enough.
  • 45 – 55 the amount varies depending on the individual.
Before a Radiesse hand treatment

After a Radiesse treatment.

Semi Permanent MakeUp

Semi permanent cosmetics is an advanced form of cosmetic tattooing and is similar to conventional tattooing but the pigment is not implanted as deep.

The equipment used is much quieter and less traumatic to the skin.

The pigments used are designed to naturally blend with your skin.

The most popular procedures are:

eyebrows

Great treatment for people who have

  • over plucked their eyebrows
  • had chemotherapy
  • alopecia
  • suffered with hair loss
  • people who regularly need to use a brow pencil for sparse eyebrows.

The technique used creates a natural hair stroke design which will instantly give lift and emphasis to the eyes.

 

eyelash enhancement

An ideal treatment if you want to:

  • give the appearance of thicker lashes
  • have more definition
  • improve the shape of your eyes
  • give the illusion of eyelashes ( beneficial for alopecia patients )

This treatment is great for people with poor vision or an unsteady hand. It is also popular with busy people who don’t have time to apply make up daily.

The technique is created in the natural lash line to give the appearance of thicker lashes, bigger eyes and it can enhance the colour of the eyes. The colour can be tailored to suit you and you can choose anything from a subtle touch of colour to a more obvious thick eye liner appearance.

 

lip line and lip blush

This procedure is fabulous and gives definition to the shape of the lips that might have been lost due to the ageing process or to create symmetry.

The lip blush technique is more advanced than the lip liner technique and makes the lips look more natural. The lip line is tattooed on and shaded into the natural lip.

 

Semi Permanent Makeup helps you to look well groomed and attractive whether you have just got out of bed, been to the gym or been swimming.

You will save time applying makeup and enhance and correct your natural appearance.

frequently asked questions

How long does Semi Permanent Makeup last?

Natural rejuvenation of the skin and exposure to uv light will fade the pigments used in Semi Permanent Cosmetics.

The lighter the shade of pigments used the quicker it fades.

We recommend a colour boost procedure every 12 – 18mths to keep you Semi Permanent Makeup looking fresh and as good as new.

Does it hurt?

Semi Permanent Makeup is no more painful than having your eyebrows tweezed.

The Nouveau Contour procedure uses sophisticated equipment that eliminates distress. Some clients have been know to fall asleep during their procedure.

How long does the procedure take?

The procedure will take up to two hours depending on the individual and the treatment they want.

Who can’t have Semi Permanent Makeup?

Patients who have immune disorders such as Systemic lupus erythematosus, keloid or hypertrophic scars, HIV, TB, tumours, growths or cysts.

Clients who have had chemotherapy need to wait until their antibodies are back to normal.

Clients need to wait 6 months after:

  • Roacutance
  • Retin A
  • Steroid treatments
  • Chemical peels
  • Laser

2 weeks after using aha preparations.

When applied by a professionally skilled technician, permanent cosmetic makeup can achieve life- changing, confidence boosting results. The technique is simple safe and will enhance your natural beauty.

The folllowing treatemnts are available at Cheshire Lasers:
Eyebrows
Eyeliner
Lipliner/Blushed Lips
Beauty Marks
Breast And Areola/Nipple
Tattoo following surgery

These treatments are provided Jacqui Rostron from Holmes Chapel who visits our clinic regulalrly to perform her treatments.

 

Find out more about them, their services and prices here:

Find out more about Jacqui Rostron here.

 

To book a consultation or treatment please contact the clinic