Project Description







Clostridium botulinum bacteria produce a class of chemical compounds known as “toxins”.

The Botulinum Type A Toxin (BOTOX) is processed and purified to produce a sterile product suitable for specific therapeutic uses.  Once the diluted toxin is injected, it produces a temporary paralysis (chemodenervation) of muscle by preventing transmission of nerve impulses to muscle.

The duration of muscle paralysis generally lasts for approximately three to five months.

Botulin Toxins on the market

  • Botox (USA)
  • Dysport (UK)
  • Xeomin (Germany)

Botulin Toxins have been approved to treat certain non cosmetic conditions: migraine headaches, colorectal disorders, excessive perspiration disorders of the armpit and hands, and musculoskeletal pain disorders.

Botulin Toxin injections are customized for every patient, depending on his or her particular needs.  These can be performed in areas involving the eyelid region, forehead, and neck.  BOTOX cannot stop the process of aging.

It can however, temporarily diminish the look of wrinkles caused by muscle groups.

Botulin Toxins injections may be performed as a singular procedure or as an adjunct to a surgical procedure.

Botox : results appear between 7 to 14 days after injection

Dysport: results appear between 4 to 12 days after injection


Alternative forms of management include : not treating the skin wrinkles by any means.  Improvement of skin wrinkles may be accomplished by other treatments or alternative types of surgery such as a blepharoplasty, face or brow lift when indicated.   Minor skin wrinkling may be improved through chemical skin peels, lasers, injection of fillers, or other skin treatments.


Every procedure involves a certain amount of risk and it is important that you understand these risks and the possible complications associated with them.

In addition, every procedure has limitations: Botox is not magic …. It can’t do everything.

Although the majority of patients do not experience any complications, you should discuss each of them with Dr. Federico to make sure you understand risks, potential complications, limitations, and consequences of botulin toxins injections.

You will receive further informations during your consultation with Dr. Federico Di Francesco.


Incomplete Block:

It is possible to not experience a complete block of desired muscles.  Additional injections to reach the desired level of block can be performed until the goal is achieved, two weeks after the first treatment.


The human face and eyelid region is normally asymmetrical with respect to structural anatomy and function.  There can be a variation from one side to the other in terms of the response to botulin toxins injection.

Drooping Eyelid (Ptosis):

Muscles that raise the eyelid may be affected by botulin toxins, should this material migrate downward from other injection areas (uncommon).


Discomfort associated with Botox injections is usually of short duration ( few minutes to few hours ).

Migration of Botulin toxins:

BT may migrate from its original injection site to other areas and produce temporary paralysis of other muscle groups or other unintended effects.

That’s why is indicated for 6 hours after the treatment to refrain from physical activities, touching the treated areas, bending the head down.

Bleeding and Bruising:

Bruising in soft tissues may occur. Aspirin, anti-inflammatory medications, platelet inhibitors, anticoagulants, Vitamin E, ginkgo biloba, and other “herbs / homeopathic remedies” may contribute to a greater risk of a bleeding problem.  Do not take these for 3  days before or after Botulin toxins injections.

Allergic Reactions:

As with all biologic products, allergic and systemic anaphylactic reactions may occur.  Allergic reactions may require additional treatment. Not suitable in patients with egg allergy ( Botox only), in these patients is indicated Dysport.

Neuromuscular Disorders:

Patients with peripheral motor neuropathic disorders (amyotrophic lateral sclerosis, myasthenia gravis, and motor neuropathies) are not indicated for Botulin toxins treatment.

Migraine Headache Disorders:  

Botulin Toxins has been used to treat forehead, temporal, masseter muscle groups that are involved with the migraine headache condition.  Patients are advised that results for migraine headaches may be variable and improvement in this disorder may not occur following treatments.

Unsatisfactory Result:

There is the possibility of a poor or inadequate response from injection.  Additional injections may be necessary.  Surgical procedures or treatments may be needed to improve skin wrinkles including those caused by muscle activity.

Long-Term Effects:

Subsequent alterations in face and eyelid appearance may occur as the result of aging, weight loss, weight gain, sun exposure, pregnancy, menopause, or other circumstances not related to BOTOX injections.  BOTOX injection does not arrest the aging process or produce permanent tightening of the eyelid region.  Future surgery or other treatments may be necessary. 

Pregnancy and Nursing Mothers:

It is not known if BOTOX can be excreted in human milk.  It is not recommended that pregnant women or nursing mothers receive BOTOX treatments.


 Fat Transfer has been used since many years as filler for large areas (buttocks , breast)  and small areas ( face, lips, scars) . Fat has also regenerative capacities : is used in tissues post radio therapy, post burn, scars and ageing tissues.

The evolution of the standard fat transfer (macrofat) is fat harvested with smaller cannulas (microfat) and eventually treated (Processing consisted of emulsification and filtering of the lipoaspirate in a thick fluid yellow product) and transformed in Nanofat.

Adipose-derived stem cells were still richly present in the nanofat sample.

Nanofat injections might become a new concept in the lipofilling area.

In clinical situations, it seems to be suitable for skin rejuvenation purposes.

Nanofat can be injected alone or in a cocktail (golden mix) with jaluronic acid, Vitamin C, Botox and other components.

The procedure is done under sedation.


Prices for botulin toxin, fillers, nanofat, PRP can vary if  treatments are performed by plastic surgeons, dermatologist or GP.  A plastic surgeon’s cost may be based on his experiences, the type  of product  used, the technique and geographic location.

Your satisfaction involves more than a fee:

When choosing dr. Federico Di Francesco – Eklund , your plastic surgeon for a Cosmetic medicine treatment, remember that his experience and your comfort with him  are just as important as the final cost of the  surgery .

Plastic surgery involves many choices.

The first and most important is selecting a Board Certified Plastic Surgeon, an ASPS (American society of Plastic Surgeons) or ISAPS ( International Society of Aesthetic Plastic  Surgeons) member surgeon you can trust.

ASPS/ ISAPS member surgeons meet rigorous standards:

  • Board certification by the Official medical university in Plastic Surgery.
  • Complete six years of medical training following medical school with 5 years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety each year
  • Perform procedures in accredited Center.

Do not be confused by other official sounding boards and certifications.

Please remember that There is no certifying board with “cosmetic surgery” in its name.

By choosing a Corresponding member of The American Society of Plastic Surgeons, or an          ISAPS Member you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified .

My website it is not a substitute for a thorough, in-person consultation with dr. Federico  Di Francesco – Eklund , Consultant plastic surgeon.



The injection will utilise a stabilized hyaluronic acid used to smooth moderate to severe facial wrinkles and folds, to fill lips, to enhance chin, jawline and cheekbone contour, tear trough. Fillers don’t remove dark circles.

Is it possible today to achieve, with the new fillers generation, outstanding outcomes, but the patient needs to be ready to have an higher number of syringes injected.

Fillers cannot stop the process of aging.

Filler injections may be performed as a single procedure, in combination with other treatments such as Botulin toxins, or as an adjunct to a surgical procedure.  Filler injections  need anesthetic cream application to diminish discomfort.

Soft tissue fillers produce temporary swelling, redness, and needle marks, which resolve after a few days.

Continuing treatments are necessary in order to maintain the effect of fillers over time. Once injected, fillers will be slowly absorbed by the body.  The length of effect for injections is variable.

It is better and wise not inject in the same area different fillers until the first one has not been absorbed. Unplanned reactions can be triggered.

In specific circumstances some fillers can be removed injecting Hyaluronidase, an enzyme that melt the hyaluronic acid.


Bleeding and Bruising:

It is possible, though unusual, to have a bleeding episode from a filler injection used during the procedure.  Bruising in soft tissues may occur.  Should you develop post-injection bleeding, it may require emergency treatment.  Aspirin, anti-inflammatory medications ( Ibuprophen, Diclofenac, Naproxen), platelet inhibitors, anticoagulants, Vitamin E, ginkgo biloba and other “herbs / homeopathic remedies” may contribute to a greater risk of a bleeding problem.

 Do not take any of these for 2 days before or after filler injections.


Swelling (edema) is a normal occurrence following the injections.  It decreases after a few days.  If swelling is slow to resolve, medical treatment may be necessary.


Discomfort associated with injections only is normal and usually of short duration.

Needle Marks:

Visible needle marks from the injections occur normally and resolve in maximum a few days.

Skin Sensitivity:

Skin rash, itching, tenderness and swelling may occur following injections.  After treatment, you should minimize exposure of the treated area to excessive sun or UV lamp exposure and extreme cold weather until any initial swelling or redness has gone away.

If you are considering laser treatment, chemical skin peeling or any other procedure based on a skin response after filler treatment, or you have recently had such treatments and the skin has not healed completely, there is a possible risk of an inflammatory reaction at the implant site.


Although infection following injection of tissue fillers is unusual, bacterial, fungal, and viral infections can occur.

Herpes simplex virus infections around the mouth can occur following a tissue filler treatment.

This applies to both individuals with a past history of herpes simplex virus infections and individuals with no known history of herpes simplex virus infections in the mouth area.

If you have an history of herpes infection specific medications must be prescribed and taken both prior to and following the treatment procedure in order to suppress an infection from this virus.

Remote infections, infection in other part of the body ( dental abscess, urinary treat infection ) may lead to an infection in the treated area.

Migration of Filler:

The filler substance may migrate from its original injection site and produce visible fullness in adjacent tissue or other unintended effects.


It is very unusual

Is related to intra arterial fillers injection in the nose, glabella, tear trough.

Should this complication occur, additional treatments may be necessary.

For these reasons in certain area I prefer to use cannulas instead of sharp needles.

Allergic Reactions and Hypersensitivity:

As with all biologic products, allergic and systemic anaphylactic reactions may occur.  Fillers should not be used in patients with a history of multiple severe allergies, severe allergies manifested by a history of anaphylaxis, or allergies to gram-positive bacterial proteins.  Allergic reactions may require additional treatment.


Fillers should not be used in patients with known susceptibility to keloid formation or hypertrophic scarring.  The safety of patients has not been studied.

Unsatisfactory Result:

Filler injections alone may not produce an outcome that meets your expectations for improvement in wrinkles or soft tissue depressions.  There is the possibility of a poor or inadequate response from filler injection(s).  Additional injections may be necessary.

Combination of Procedures:

In some situations, botulin toxin injections or other types of tissue filler materials may be used in addition to hyaluronic acid filler in order to specifically treat areas of the face or to enhance the outcome from tissue filler therapy.

Pregnancy and Nursing Mothers:

It is not recommended that pregnant women or nursing mothers receive hyaluronic acid filler treatments  as well as Botulin toxins.

Long-Term Effects:

Hyaluronic acid filler injections should not be considered as a permanent treatment for the correction of wrinkles and soft tissue depressions.  Over time, the hyaluronic acid filler material is slowly absorbed by the body and wrinkles or soft tissue depressions will reappear.

Continuing hyaluronic acid filler treatment (injections) is necessary in order to maintain the effect of hyaluronic acid filler.

Hyaluronic acid filler injection does not arrest the aging process or produce permanent tightening of the skin or improvement in wrinkles.

Healing Issues:

Patients with massive weight loss may have a healing delay. Patients with diabetes or those taking medications such as steroids on an extended basis may have prolonged healing issues. Smoking will cause a delay in the healing process.

Patients with significant skin laxity  will continue to have the same lax skin after fillers treatment. The quality or elasticity of skin will not change and recurrence of skin looseness will occur.

Skin Discoloration / Swelling:

Some bruising and swelling will normally occur.


Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features.  Most patients have differences between the right and left side of their bodies before any treatment is performed.  Additional injections may be necessary to attempt to diminish asymmetry.

Sun Exposure :

The effects of the sun are damaging to the skin.Exposing the treated areas to sun may result in colour changes, and poor healing. The damaging effect of sun exposure occurs even with the use sun block or clothing coverage. Ask Dr. Federico for sun exposure timings

Permanent Fillers

Please don’t use them. They can create severe complications also after many years.

It is very difficult, sometimes impossible , to remove them.

In many countries they are banned.

The products I usually have chosen for my patients are:

There are more than 50 different types of fillers on the market, with different qualities

Juvederm®  Volift , Voluma, Volux, Volite ( Allergan Medical ) injectable gel are a colorless hyaluronic acid gel that are injected into facial tissue to smooth wrinkles and folds,  to create projection, contour and volume. Each one of these products has specific indications and areas of treatment.

Hyaluronic acid is a naturally occurring sugar found in the human body.  The role of hyaluronic acid in the skin is to deliver nutrients, hydrate the skin by holding in water, and to act as a cushioning agent.

 ___Restylane Filler® – Restylane is a naturally occurring substance that is found within all mammals.  It is a material that is contained in various soft tissues.  Restylane can be synthetically produced from a process of bacterial fermentation, chemically stabilised, and purified for use as an injectable soft tissue filler (non-animal, stabilised hyaluronic acid, Medicis Aesthetics).  The hyaluronic acid in Restylane is biocompatible and is a totally non-animal product;


Is really important to understand the volume of the fillers you will have injected. One syringe (1 ml of product) is a very small amount of product. So if I will plan for you 2,3,5 syringes, to be injected also in different sessions, don’t be surprised.