We are a doctor owned and operated specialist cosmetic surgery clinic, specialising in skin cancer detection and cosmetic surgery, and offer a wide range of facial treatments, chemical peels, anti-wrinkle injections and dermal fillers.

Dr Fred Fotouhi specialises in combining non-surgical and surgical treatments to rejuvenate your face for a natural looking improvement; no one will be able to tell you’ve had ‘work done’, you’ll simply look refreshed and younger. We also offer a highly qualified screening for skin cancer and removals.




It all started when...


The signs of aging creep up over time, and are contributed to by a number of things. Lifestyle, genetics, smoking, alcohol consumption, diet and exercise, rest, recreation and sun exposure all leave their mark.

In Australia we have appalling sun-damage and this is reflected in the rate of melanoma's and other skin cancers that doctor's treat. 

There is a number of ways that the face will express the aging process and it is important to understand the aging process to understand how to maximize the modern technology available to the patient. A full rejuvenation program may include a number of different techniques.


Skin quality and texture

The most cosmetically obvious changes to skin quality include:

  1. Dyschromia/pigmentation changes

  2. Telangesica (broken capillaries)

  3. Sebaceous hyperplasia (open pores)


Often individuals are unaware that there is more than one contributing factor to the way that their skin looks and feels as it ages. But by identifying each contributing factor, appropiate treatment can be tailored to counter each problem.

Skin changes can be further defined according to the layer of skin in which they reside. The epidermis is the outermost skin layer and epidermal changes include:


  • Mottled pigmentation, pseudo scarring, textural roughness and thickened skin

  • Seborrhoeic keratoses

  • Dyschromia

  • Fine lines


Dermal changes are deeper within the skin and include:

  • Ingrained static and motion induced wrinkles

  • Melasma and cholasma (often experienced as increased mottling pigmentation appearing during pregnancy, but can also be cause by certain anti-biotics and the oral contraceptive pill);

  • Elastosis, collagen degradation and skin cancer genesis in response to UV radiation


Collagen changes become evident in the Australia population from about the age of 30 years. The rate of progression is dependant on genetics, diet, lifestyle and sun exposure. Lifestyle habits, such as smoking, greatly contribute to the aging process (toxin pollution and micro-vascular constriction), and the activity has no redeeming qualities – if you smoke, cease, the health and anti-aging benefits will be worth it! 

When you are young your collagen has tensile strength, and therefore is able to maintain the skin position overlying the facial muscles – some of which actively pull the face in a downwards direction as part of their job making facial expressions. 

As the skin ages and the nature of the collagen changes, it is no longer able to provide the tensile strength and it begins to sag downward and outward. The individual muscles of the human face are quite unique, in that their origin and insertions are into the flesh of the face rather than anchored to bones via tendons. Their weight is believed to also contribute to the sag as the skin looses tensile strength.


How an individual's face will "sag" is dependant on the basic anatomical features of that person's face and their genetic pre-disposition. For example, patients will often describe hooding (upper eyelid ptosis) as a "family thing", that is they have notice one or both of their parents or grandparents having the same condition. Broken capillaries are another trait that appears to run in families, though the exact pathogenesis has yet to be defined.

Obvious outcomes of collagen changes that lead to contour changes include:


  • Brow ptosis (hooding)

  • lower lid festooning

  • Sagging of cheeks and jowls

  • Drooping of the nasal lip

  • Loss of the lip volume

  • Neck cragginess and

  • Forehead slump



One of the greatest contributing factors is poor sun (UV A and B radiation) protection. It is estimated that 80% of aging is due to sun-damage, with UV A greatly contributing to pigmentary changes). Sun-damaged skin means that perceived age is considerably over-estimated for the chronological age. In Australian this trend means that Australian’s look “older” than their actual age.

Any cosmetic remediation or procedure needs to address the basic changes that have caused the aging face. Each aging “dimension” needs to be appropriately treated. A program of remediation and rejuvenation should aim to stimulate your collagen, rebuild volume in areas where it has been lost, and remediate skin quality issues.

For a consultation with Dr Fotouhi phone (3) 5911 7014 or click here.