For most people, just hearing the word Botox can conjure up visions of plastic-looking faces without the ability to show emotion.

But what was once a taboo practice is now becoming the norm among men and women in Sunraysia, according to Melbourne-based clinicians Dr Hieu Pham and registered nurse Graeme Campbell, who have been travelling to the area twice a month for the past four years to offer Botox and dermal fillers to their ever-increasing Sunraysia clientele.

The advancement in technology and popularity of the cosmetic enhancements assists in slowly shifting the stigma around the practice, as well as the increasing amount of research that confirms Botox can have real benefits for our mental health and well-being.

Aside from offering cosmetic enhancement procedures, Dr Pham is predominately a clinical psychiatrist, and Graeme a psychiatric nurse, and both agree that there is a definite correlation between cosmetic procedures and improved mental health.

“We constantly get feedback from our facial expressions, so when you look sad, you feel sad and it becomes a vicious cycle,” Dr Pham said on a recent trip to Mildura.

“With anti-wrinkle treatment you relax the grief muscles so they do not have that feedback and makes a lot of people who are mildly depressed feel better.”

First used on people in the late 1980s, botulinum toxin (more commonly known as Botox) was first used to temporarily reduce the physical signs of ageing in the face.

The product works by temporarily relaxing the muscles, which prevents the skin from creasing and causing wrinkles.

In recent years, the relationship between the procedure and its benefit on a patient’s mental health has been closely studied across the globe, with almost every study finding evidence to support the theory.

A study on facial feedback from the UK’s Cardiff University School of Psychology found that when someone lowers their eyebrows, their mood becomes more negative, and if eyebrows are raised people become more surprised.

Facial feedback was also the focus of a study conducted in Germany, which concluded that temporary denervation using Botox enhances the facial expression that encourages positive emotions.

And a similar case from the Dermatology and Cosmetic Surgery Associates in Maryland, USA, tested 10 depressed patients with botulinum toxin treatment resulting in nine out of 10 people no longer suffering depression after two months of treatment.

The staggering results of such studies are no real surprise to Graeme – previously a nurse manager at The Alfred Hospital – who notices the almost instant change in his patients after treatment.

“I don’t assess people to see if they are depressed beforehand, but people do give us feedback about how good they’ve felt after they’ve had a treatment,” Graeme said.

“With Botox it’s about seven days before they see a result and that’s when they come back and tell us that it has been magnificently positive for them.”

“It is very rewarding to have someone report back to say that this has made a monumental change.”

Dr Pham and Graeme say some people seek treatment for very subtle skin defects that carry deeper psychological meaning, while adding that the emotional repair they see in their patient’s post-treatment is the most rewarding part of the process.

“Sometimes a scar might be virtually invisible, but it has symbolic meaning psychologically, so when you remove that scar they are surprised at what burden is lifted,” Dr Pham said.

“It’s like you’re literally erasing the trauma that the scar represents.

“It could be something as small as a tiny acne scar that they might have had for years that we treat with a small amount of dermal filler, and it can make a world of difference for them, something so tiny can have such a big impact,” Graeme said.

Treating around 20 patients in Mildura twice a month, Dr Pham offers three cosmetic treatments; Botox, dermal fillers and a new addition, fat freezing.

“Scientists have found that if you freeze fat at -8ºC, 30 percent of the fat cells will die, so stubborn fat can be contoured and we are very excited to be bringing the latest technology to Mildura.”

In terms of Mildura’s cliental demographic, Dr Pham and Graeme agree it is a diverse market that is more widely discussed than it has ever been.

“Certainly people are a lot more relaxed about it, the fact that they spread the word and tell their friends and family what they are getting done is in itself breaking down the stigma, otherwise they wouldn’t admit it to anyone,” Dr Pham said.

“What I found surprisingly refreshing about Mildura is that we have a higher proportion of male patients in Mildura than we do in Melbourne, which I didn’t think that would happen,” Graeme said.

“We don’t just treat office workers, we have miners, farmers, tradies, all sorts of men in Mildura will come for treatment, so in that instance it’s not that conservative.”

Graeme says that the advancement in cosmetic technology, as well as changes in the procedure, have assisted in making treatments look more natural and less invasive than ever.

“The way people have been treated with Botox has altered, so more (product) is not necessarily better. The real art form now is trying to do the most with the least amount of product,” he said.

“Instead of filling someone’s forehead with Botox, it is now a more scattered and considered approach where you might just treat parts of an area.

“So the person still has expression, they almost look like they haven’t had any treatment done but softening of the more prominent creases.”

With the team about to establish a permanent clinic in Mildura, Dr Pham and Graeme said the satisfaction they get from a patient’s response is “a real buzz”.

“I normally deal with distressed people and the best I can do is to bring them back to normal, whereas this population, most feel like their usual self but happier,” Dr Pham said.

“I think that people come and are quite surprised at the results and the outcomes that they can achieve, quite remarkable ones at times, so you see their response to that and as a clinician is very remarkable and fulfilling.”