Am I suitable for treatment?

If you are healthy and have no serious medical conditions, you may be a candidate for muscle-relaxing injections. If you are pregnant or breast feeding, suffer from myasthenia gravis or other neuromuscular conditions, or take certain antibiotics (eg. Gentamicin), you are not a suitable candidate for treatment and alternatives will be discussed.

Is the treatment painful?

How does it work?

Will my face look ‘frozen’ or expressionless?

Are there any risks?

What happens if something goes wrong?

If the eyebrow position is higher than desired after the treatment, this can be easily corrected with a tiny adjustment about 2 weeks after the initial treatment. If the brow falls or droops slightly, you must wait until it naturally lifts again and this could take a month or two. If the eyelid droops (ptosis) sometimes special eye drops can be prescribed to lift the eyelid until it wears off and the lid lifts on its own. Thankfully these unwanted effects are rare. Finally, these muscle-relaxing injections should always be performed by a qualified doctor so that is something does go wrong, it can be treated appropriately.

How long does treatment take?

Will I see results straight away?

If I decide to stop treatments, will wrinkles return and be more pronounced than before treatment began?

My lines are not that bad yet. Do I need muscle-relaxing injections?

How does chemodenervation for excessive perspiration work?

There are a huge range of fillers available for soft tissue augmentation, both non-permanent and permanent, which help to soften lines and folds, define features and restore volume loss. At Venus Medical Beauty, with safety in mind, only non-permanent fillers are used. Three excellent types of non-permanent fillers used are hyaluronic acid (Restylane, Teosyal), calcium hydroxylapatite (Radiesse) and poly-L-lactic acid (Sculptra).

What is Hyaluronic Acid?

How does Hyaluronic Acid work?

Is the treatment painful?

Which products are Hyaluronic Acid fillers?

What are the side-effects of Hyaluronic Acid fillers?

How long do Hyaluronic Acid fillers last?

What is Calcium Hydroxyl Apatite (CaHA)?

What is CaHA (Radiesse) used for?

Radiesse (CaHA) is used to soften deep lines from the nose-to-mouth, mouth corners and especially to define and enhance features such as cheek augmentation. After injection, the surrounding collagen and tissue is stimulated to grow inwards. As it does, it grows into the scaffolding of microspheres and replaces the gel carrier. Results are seen immediately because of the filling effect of the gel, but this ingrowth and lasting effect takes a few weeks.

What are the side effects of Radiesse (CaHA)?

The same side-effects apply for Radiesse as for HA, such as bruising, swelling, bumpiness and allergic reactions, though again, allergic reactions are uncommon. Radiesse feels somewhat firmer than most HA products and are therefore injected more deeply to augment without causing textural problems.

How long does Radiesse last?

Radiesse (CaHA) tends to last longer than HA fillers--up to a year--and are preferred in certain situations for this reason. However, if you have never had any fillers before, you are usually advised to try HA fillers first.

Poly-L-Lactic Acid (Sculptra)

The main ingredient in Sculptra is Poly-L-lactic acid, a synthetic material that is biocompatible and biodegradable and has been successfully used in surgical operations for more than 25 years.

What is Sculptra used for?

Sculptra slowly and gradually increases facial volume, so it is used to improve the appearance of hollows, sunken cheeks and temples, or for volume loss causing lines and wrinkles.

What does the treatment involve?

A Sculptra treatment involves a series of injections into the deep layer of skin or under the skin, depending in the treatment site. Areas typically injected include the cheeks, under the eyes, the temples, nose-to-mouth lines, jawline and mouth corners. The procedure is tailored for each individual. Local anaesthesia and cold packs are used to numb the area prior to injections.

What happens after the treatment?

Following the treatment you are given some instructions. For example you must massage the area daily for a few days to ensure diffuse distribution of the sustance and minimise side-effects. Usually there is some redness and swelling which subside in a day or two. Bruising can occur as with any injectable procedure.

What are the side-effects with Sculptra?

Potential side-effects will be discussed before the treatment as usual. Though side-effects are uncommon, there have been reported cases of small nodules (bumps) that are felt under the skin after a treatment. This side-effect seems to be reduced with current dilutions and techniques, particularly if the area is massaged as directed afterwards. Allergic reactions can also occur, causing redness, swelling or reddish bumps called granulomas.

How long does Sculptra last?

Reports show that Sculptra can last up to 2-3 years, significantly longer than some other non-permanent materials for soft tissue augmentation. A course of 3 treatments at monthly intervals is usually required for optimum volume enhancement and rejuvenation. Due to the stimulating nature of Sculptra, it is important to remember that the effects of Sculptra take 4-6 weeks, so results will improve gradually over time.

What is a thread lift?

A thread lift is a procedure that uses special sutures or threads to lift tissues of the face or neck. It is a less invasive procedure than a surgical face lift, usually being performed under local anaesthesia, and usually requires only small incisions or punctures. Thread lifts are becoming very popular throughout the world, as people seek less invasive procedures with minimal downtime. There are several different types of thread lifts.

What different types of thread lift are available?

Thread lifts differ in the type of thread material used, whether the threads are absorbable (dissolve) or not, whether there are barbs on the threads, and of course the technique used and tissues lifted. Aptos threads, Contour Threads and Silhouette Threads use polypropylene threads which do not dissolve. The first two have tiny barbs like hooks that branch out from the thin threads, whereas Silhouette sutures have cones instead of barbs. These threads are passed through the fat under the skin of the face and neck and retracted backwards so the barbs or cones catch on the skin and fat and lift it. The entry site of the threads in these techniques requires an incision, usually 2-3cm long. The thread lift technique used at Venus Medical Beauty is very different, and is called the Serdev thread lift.

How is the Serdev thread lift different to the others?

What areas can be lifted with the Serdev thread lift?

What do I look like after the Serdev thread lift?

When can I return to work/normal activities?

What are the potential complications or side-effects?

How long does the Serdev Thread lift last?

Thread lifts are minimally invasive procedures and they do not replace surgery. As such they might not provide a result that lasts as long as open surgery. However, neither procedure is permanent. The longevity of results depends on several factors, including age, quality of tissues, smoking history, general health, sun exposure history and aftercare. Even if the procedure "turns back the clock" by 5 or 10 years, you will continue to age normally following the procedure.

Can the thread lift be repeated?

Yes. It is safe to repeat the procedure to provide a further rejuvenating effect, or lift other areas, to compliment existing lifts at any stage after the initial thread lift.

Chemical peels resurface skin on the face, neck, hands, chest or back, producing newer, younger looking skin.

What's the 'chemical' in a chemical peel?

There are various types of chemical peels, most contain an acid that acts to coagulate and destroy the skin surface at varying depths. They include glycolic acid, lactic acid, azelaic acid, kojic acid, salicylic acid, trichloroacetic acid and phenol. Glycolic acid peels are very superficial, and usually don't cause peeling at all, trichloroacetic acid (TCA) peels are superficial to medium depth peels, whereas phenol is a very deep peel that requires several weeks recovery. We most commonly use TCA peels, sometimes in combination with kojic, azelaic or salicylic acid, depending on the individual requirements.

How do chemical peels work?

When the acid is applied to the skin, it coagulates the proteins in the top layers of skin, such as the epidermis and part of the dermis. This chemical destruction of the skin allows it to peel away over time. Meanwhile, the layers underneath are stimulated to produce new skin cells and a fresh, newer layer of skin. Additionally, collagen growth is stimulated, providing a further rejuvenation as well as skin tightening. The overall effect is a smoother, brighter skin surface with less signs of sundamage.

What do chemical peels improve?

A properly performed TCA chemical peel can reduce pigmentation and sun spots, reduce fine lines, improve skin texture and tightness and improve the overall skin clarity and complexion.

Are there any special steps required before having a peel?

Depending on the peel, you might be prescribed special creams to use at night for up to one month before having the actual peel. These prepare the skin for the peel by removing the rough outermost layer, allowing the peel to be more even. Dark-skinned individuals are sometimes prescribed retinoids and hydrocortisone to lessen the risk of pigment irregularities following the peel. This is discussed during a consultation.

Is the peel itself painful?

This also depends on the type of peel used. When the solution is applied there is a transient burning sensation that lasts just a couple of minutes and then subsides.

How will I look after the peel?

Immediately after the peel there may be some redness, or a greyish discolouration to the skin. Usually the skin begins to peel about 2 days after the actual peel. Peeling typically starts around the mouth, followed by the cheeks, upper face and finally forehead. During the peeling process you will not look your best, and areas of previous brown pigmentation/freckling can darken considerably, and then slowly peel away. Depending on the depth of peel used, the peeling process can take 5-10 days. After this time, the skin recovers and begins to look much better.

What are the potential complications?

TCA peels are generally safe when performed by an experienced doctor. However, potential complications do exist and should be discussed prior to treatment. These include increased or decreased pigmentation in the peeled area, reactivation of cold sores in susceptible people, infection, persistent redness and rarely scarring.

Can I have a second peel if I want to improve the result further?

Yes. Sometimes it is advisable to have a second or even a third peel to give a more dramatic result. For acne scarring, where textural improvement is desirable, several peels over time yield better results. At least 2 months should elapse before repeating the peel to allow the skin recover completely.

What is a laser?

A laser is a device that emits light at a particular wavelength to target something specific, such as pigment. LASER stands for Light Amplification by Stimulated Emission of Radiation. In cosmetic medicine, this amplified light is focused on the skin, targets and destoys pigmentation in a process known as selective photothermolysis. Depending on the wavelength of the light in the laser, different colour pigmentation, or even water, can be targeted and eliminated. The result is less redness, brown pigmentation, or hair, or the heating and stimulation of collagen, leading to clearer, smoother skin, tighter pores and fewer lines.

What kind of lasers are used at Venus Medical Beauty?

At Venus Medical Beauty we use one of the most advanced laser systems in the world: the Cutera long pulse 1064nm Nd:YAG. This is a powerful medical laser capable of removing facial and leg thread veins, smoothing skin, reducing pore size and fine lines and reducing facial redness, as well as removing hair permanently.

Are laser procedures painful?

It depends on the exact procedure being performed. The Laser Genesis procedure for smoothing skin texture and reducing facial redness is not painful, and many find it relaxing as thousands of tiny laser pulses pass into the skin. Thread vein and hair removal require increased energy settings and can give a short, sharp pinch, but they are not particularly painful and numbing is not necessary. After hair removal or thread vein removal, a cold pack or aloe vera gel can be applied for comfort.

What's the difference between a laser and an IPL?

A laser emits light at a specific wavelength, for example 1064nm or 755nm, to target specific chromophores or targets. An Intense Pulsed Light (IPL) is a flashlamp that emits light with a broad spectrum to target several chromophores; for example an IPL might have a wavelength from 560nm to 1200nm or 770nm to 1200nm. Since several targets are hit, IPL offers a more general improvement in skin condition, such as targeting brown and red pigmentation as well as stimulating collagen in the very superficial skin layers. However, IPL is generally not as powerful as laser devices, so their applications are limited. For example, IPL devices are not as effective as lasers at eliminating thread veins, especially larger ones. Also, lasers can penetrate deeper into the skin and target collagen more efficiently than an IPL. A good IPL is excellent at targeting dyschromias (pigment irregularities) in the superficial skin layer. But remember, all IPLs are NOT equal.

Intense Pulsed Light (IPL) technology uses a powerful light source, like a flashlamp, to remove sunspots, freckles, age spots, and for permanent hair reduction. It does this through a process known as selective photothermolysis--heating and destroying target lesions in a controlled fashion. IPL is also used for photorejuvenation, improving the overall appearance and condition of the skin. At Venus Medical Beauty, the most advanced IPL sources available are used, including the Solera Prowave 770 for hair removal, the LP560 for pigment clearance and the new Cutera Limelight for brown and red pigment removal and clearer skin.

What is IPL Photorejuvenation?

This involves the use of IPL devices to clear skin of irregular and unsightly pigmentation and age spots. During the procedure, the very top layer, or epidermis, of skin is targeted. A handpiece with a cold tip is first placed directly in contact with the skin. Then a series of quick pulses of bright light are delivered into the skin. There is usually a short sharp pinch with each flash of light, but the entire procedure takes just a few minutes. Afterwards, the skin may be become slightly red, and pigmented areas such as age spots and freckles darken. Redness disappears in an hour or less, whereas darkened pigmentation can take a few days to slowly fade or flake away. The result is a clearer, brighter complexion. Though complications from IPL are unusual, they can occur, and include increased or decreased pigmentation, prolonged redness or even burns or eye injuries. All IPL and especially laser procedures should be performed by trained practitioners. Eye protection with special goggles is mandatory during laser and light procedures.

How is permanent hair reduction performed?

Permanent hair reduction is one of the most popular cosmetic procedures in the world and there is a huge range of devices available for hair removal. Powerful IPL devices and specialised lasers are suitable for quick, safe and efficient hair removal. There are many weaker IPL devices out there that are inefficient at hair removal, requiring 10 or more treatment sessions and delivering suboptimal results. At Venus Medical Beauty we use the powerful Cutera Prowave 770 IPL for most cases, and the Long pulsed 1064nm NdYAG for dark-skinned complexions or fine resistant hairs. The same principle of heating and destroying a target pigment--dark pigment in the hair follicle--is used to remove hair.

What areas can be treated?

Almost any body part on which hair grows, including arms, underarms, chest, back, abdomen, legs, bikini, face, and above lip.

What happens during the hair removal procedure?

A cool gel is applied to the skin first. Then the IPL or laser is placed in contact with the skin and pulses of light are emittted, that instantly destroy hair follicles. The procedure is quick using powerful technology and pinches just a little as the pulses pass into the skin. Afterwards there is usually a slight redness that settles in an hour or two.

What preparation is required before a hair removal procedure?

It is important that you avoid sun-tanning, sun beds, and even artificial sun-tanning creams for 6 weeks before IPL and laser hair removal. Avoid plucking, waxing and electrolysis before the procedure, since the procedure will only work if there is a hair follicle present in the skin. You should shave the treatment area the day before, or morning of the procedure.

Am I a suitable candidate for laser hair removal?

Your skin and hair type will be assessed before any treatment. A thorough medical history will also be taken; unusual hair growth patterns may reflect an underlying medical condition requiring appropriate investigation. The ideal candidate for hair removal is fair-skinned with dark or black coarse hair. Dark-skinned patients can also be treated successfully though a different laser will be used. Lighter hair and red hair are more resistant to treatment and are likely to require more treatments. Despite sporadic claims, there is no effective hair removal technology available today for removal of white or grey hair, though research in this area is ongoing. Your treatment may be deferred if you are taking certain medications, so it is important to provide your full medical history.

How many treatments does it take to permanently reduce hair?

Using the best lasers and IPL devices, permanent hair reduction usually takes 4-7 treatments, at 4-6 week intervals. Some areas respond more quickly, such as underarms, whereas lower legs tend to take a few more treatments. After the full course, the vast majority of hair is permanently removed, though very fine hairs may grow later, and these can also be treated using the Nd:YAG laser. It takes a few treatments to remove all hair because hair grows in different cycles. Thus, when destroying the hair follicles present, there are others lying dormant that will grow later. Once all the hair in different cycles presents itself, the course is complete.

What is Titan Skin Tightening?

Titan uses infra-red technology to uniformly heat the dermis layer of skin. It was developed in 2003 by Cutera, the world-renowned US laser technology company. In 2004, Titan was declared safe and effective for dermal heating by the FDA. Venus Medical Beauty is the first medical clinic to introduce the revolutionary technology to Ireland.

How does Titan work?

As we age, skin becomes less elastic as collagen fibres are strectched and damaged by sun exposure and environmental pollutants, as well as smoking. The result is drooping, lax skin. Titan addresses this problem by delivering focused beams of infra-red light deep into the dermis of skin where collagen resides. The collagen fibres instantly tighten and contract and fibroblast cells are stimulated to produce more collagen. More collagen means healthier, tighter and younger looking skin.

Is it painful?

No. One of the benefits of Titan over its predecessors is that it is almost painless. A surge of heat is felt that comes and goes as the Titan is passed over the skin, but this can be adjusted depending on tolerance. The Titan tip is designed such that it cools the surface of the skin at the same time as heating the deeper layers to protect the skin and provide more comfort. Sensitive areas like under the jawline are treated with less fluence (energy) to prevent discomfort. Each treatment takes about an hour, but depends on treatment areas.

Are there side-effects or complications with Titan?

Thankfully, unwanted side-effects and complications with Titan are rare. The most common side-effect is a transient redness in the treatment area that fades away within about an hour. Ocassionally, a small blister can form in sensitive areas but this is uncommon and resolves without complications. More serious problems such as pigment changes or burns are extremely rare in experienced hands.

Where can Titan Skin Tightening be used?

Titan is appropriate for any area of the face, neck or body where there are wrinkles or mild to moderate sagging caused by loose, lax skin, including the brow, cheeks, jowls, neck, tummy, and thighs. You will be assessed prior to any treatment to determine if you are a suitable candidate. Titan is also ideal in combination with other laser treatments, as well as the thread lift procedures to provide an instant lift in drooping jowls and neck.

How many treatment sessions are needed?

Typically, three treatments are performed for optimum results, each spaced about one month apart. Once collagen is stimulated and structurally changed, results do not "wear off". Indeed, the results continue to improve for months following the end of the teratment programme. However, since the normal aging process continues, a maintenance Titan procedure (one treatment) is advised once a year to maintain tighter skin.

What kind or results can be expected?

Some patients notice an immmediate improvement following the procedure as collagen fibres contract. However, most of the benefits are gradual as new collagen is laid down in the skin over 2-6 months. This means skin continues to tighten and tone for months even after the course of treatments is complete. About 95% of patients treated repor postiive results from treatment, especially in experienced hands. It is important to remember that Titan is not surgery, however, and excess skin is not removed. With realistic expectations, you can achieve very satisfying results with this new and totaly non-invasive procedure.

What is mesotherapy?

Aesthetc mesotherapy is the practice of injecting one or more compounds into and under the skin at varying depths to produce a variety of benefits, including skin rejuvenation, hair growth, fat and cellulite removal.

How is mesotherapy performed?

Mesotherapy is a quick and relatively painless procedure. A series of short quick injections is made using a special injecting device or Mesogun, which can deliver hundreds of injections quickly and at precise depths.

What is Lipodissolve?

Lipodissolve is a form of mesotherapy in which the aim of treatment is to dissolve or remove stubborn areas of fat. It is ideal for small areas of exercise and diet-resistant fat, such as those on the tummy, love-handles, thighs, arms or chin. The main ingredients in lipodissolve are phosphatidylcholine and deoxycholate. Phosphatidylcholine is a derivative of soy and is licensed for use in the US to dissolve fatty clots in blood vessels. For cosmetic reasons, it is used "off-label" and should only be used by experienced and trained doctors. Our doctor is a member of Network Lipolysis and one of only a few doctors in Ireland who are members of the International Society of Lipolysistherapy.

Are there side-effects with Lipodissolve?

After-effects include redness, swelling, discomfort, itching and sometimes bruising. These effects may last from 1-7 days, depending on the area treated. These are normal sequelae with this procedure and do not represent complications. Complications include increased skin pigmentation, skin breakdown and ulceration or allergic reactions but are rare. A full consultation with a trained doctor is necesary before any treatment.

How much fat can be removed with Lipodissolve?

Lipodissolve is best reserved for small areas of exercise and diet-resistant fat. The reduction of fat is gradual and can take weeks. Typically, 2-5 treatments are required depending on the amount of fat, with 8-week intervals between treatments. For larger areas of body contouring, VASER Liposelection is superior and a more definitive procedure that provides quicker results.

Am I suitable for Lipodissolve?

You will be assessed by a cosmetic doctor before treatment. You are not suitable if you have uncontrolled medical conditions, diabetes, autoimmune or thyroid disorders, a soy allergy, or if you are pregnant or breast feeding.

What is Mesoglow?

Mesoglow is a form of aesthetic mesotherapy that infuses the skin with hydration and nourishment by injecting compounds such as hyaluronic acid, vitamins, and minerals into the dermis. A Mesogun device is used to precisely and quickly inject droplets directly into the dermis at precise depths. Results apppear even after one treatment but best results are seen after a course of 3-4 at 3-4 week intervals. Skin glows and appears more radiant. Maintenance procedures every 4-6 months provide a constant glow.

What is VASER Liposelection?

VASER Liposelection is a cutting-edge new body contouring procedure that is revolutionising the world of liposculpture. Patented ultrasound technology from Sound Surgical Technologies USA breaks up and removes fat in the tummy, love-handles, outer and inner thighs, arms, back, male breasts, chin and jowls.

Why is Liposelection so unique?

Liposelection supercedes all previous ultrasound devices for fat removal because it is much gentler. The ringed titanium probes used to destroy fat are designed such that fat removal is very efficient but damage to surrounding tissues such as blood vessels and nerves is minimised. This translates to beautiful results with almost no downtime. No other technology is as gentle yet effective.

What happens during the procedure?

At Venus Medical Beauty Liposelection is performed purely under local anaesthesia, so you can go home very soon afterwards and have no after-effects or risks of sedation or general anaesthesia. The procedure itself involves 3 steps: 1. A dilute local anesthetic solution is gently infused into the fat to make the entire treatment area numb. 2. The VASER probes are passed forward and back through the fat to instantly "melt" it using ultrasound. 3. The liquefied fat is removed from the body using gentle suction. Finally, a snug compression garment is worn to keep the area nice and smooth and provide comfort.

What happens before the procedure?

If you are a suitable candidate after having an initial consultation, you will return for some more examinations and tests, including a routine blood test, measurements for a compression garment and photographs. The procedure itself will also be discussed in great detail so you know exactly what is going to happen and how to prepare.

What happens after the procedure?

Immediately after the procedure you will be wearing a snug compression garment. You must wear this for up to 4 weeks, removing to bathe and at night. You cannot drive afterwards and will need to be picked up. You will be given aftercare instructions and prescribed antibiotics for a week. You will return to the clinic for a review at intervals after the procedure, including some more photographs.

Will there be scars after the procedure?

The incisions made during the procedure are tiny (about 4mm) and heal up very quickly. They are so small that stitches are not required and they close on their own after a couple of days. They are deliberately left open so that any remaining numbing solution can drain out over 12-18 hours. After they heal, they fade and over time become almost invisible.

Is VASER Liposelection painful?

During the procedure, only a tiny pinch is felt as the local anaesthetic is injected. After this some mild pressure can be experienced as the numbing solution is passed into the fat. Once the anaesthetic solution is in, the area becomes totally numb. After the procedure, pain is minimal and controlled with paracetamol. Stronger pain relief is rarely necessary. This is one of the benefits of VASER Liposelection--a quick recovery with minimal discomfort.

When will I see results?

Usually results after Liposelection can be seen as soon as 7 days! This is because trauma to tissues is reduced and swelling is less than traditional liposuction. Results continue to improve for months after the procedure as tissue heals and skin contracts.

When can I return to work or normal activities after Liposelection?

Unlike traditional liposuction which tends to produce much more swelling, pain and bruising, you can return to your normal activities in as soon as a couple of days. If you experience a little more soreness it might take a week or so, but this depends on how you feel. There are very few limitations, apart from avoiding strenuous exercise or contact sports for 2 weeks.

How does VASER Liposelection differ from other forms of liposculpture?

Liposelection is very different from other forms of fat removal and body contouring techniques. Unlike traditional liposuction, it can provide the same dramatic results, or even smoother, with little of the downtime, trauma and sequelae such as swelling, bruising and pain. It also differs dramatically from Laser Lipolysis (eg. Smart Lipo), in that the ultrasound energy delivered is more efficient at destroying fat. This means larger areas can be treated, more fat is removed, and results tend to be more obvious and are seen much sooner (in days compared to weeks). Both Liposelection and Laser Lipolysis require tiny incisions and can be performed under local anaesthesia.

Professioinal teeth whitening comes in different forms, including controlled teeth whitening using a mould, and laser teeth whitening.

How are teeth whitened?

If you are a suitable candidate, have no gum disease or decay and are not pregnant or breast feeding, an impression of your teeth is first taken using a special alginate clay. A tailor-made mould is then constructed in a dental laboratory and provided to you, with special high strength carbamide peroxide gel. The gel is applied to the mould and fits perfectly over your teeth, and left in place for a few hours per day. Over the course of 7-14 days, teeth whiten gradually. In this way you have complete control over the whitening process. You can discontinue the procedure when they have reached the desired shade of whiteness. Though the carbamide peroxide gel can cause some temporary sensitivity and irritation during the procedure, this has not proved to cause lasting damage to teeth or gums and resolves upon discontinuation. A lower strength gel can be prescribed if you have sensitive teeth. The results of this form of teeth whitening are consistent and reproducible. However, it is important to remember only your own teeth will whiten, and crowns, fillings and veneers will remain the same colour.

At Venus Medical Beauty we provide a range of minor surgery services, such as removal of lipomas, cysts, lesions and moles. All procedures are performed by our surgeon under local anaesthesia.