Acne laser treatment CPD Article

Transcription

g
in
15 ok
20 Bo er
E rly Off
ACd Ea unt
ite co
m is
Li D
VOLUME 2/ISSUE 1 - DECEMBER 2014
WELCOME TO THE FUTU
E
powered by
The first online prescription service
offering a full range of aesthetics products.
FAST. EFFICIENT. SECURE.
Sign and pay online. No posting of scripts necessary.
Acne laser treatment
CPD Article
ChurchPharmacy-DecCover-Revised.indd 1
Dr Firas Al-Niaimi explores the use of laser
and light treatments in acne management
18/11/2014 19:00:19
Technology
in Aesthetics
Hand
Rejuvenation
Power of
Branding
A discussion of
incorporating
digital devices
into your practice
Dr Carolyn Berry
details treatment
methods for
ageing hands
Gary Conroy on
why branding
is crucial for
business success
Syneron Candela Launches
Breakthrough Technology. Again.
Introducing PicoWay.
PicoWay is a remarkably innovative dual wavelength
picosecond laser from Syneron Candela, the most trusted
brand in lasers. With both 532nm and 1064nm wavelengths,
PicoWay can treat a very broad range of pigmented lesions
and tattoo types and colors on any skin type.
PicoWay has the highest peak power and the shortest pulse
duration of any picosecond laser for superior efficacy, safety
and comfort. Proprietary PicoWay technology creates
the purest photo-mechanical interaction available to most
effectively impact tattoo ink and pigmented lesions, without
the negative thermal effects of other lasers.
And, PicoWay has the reliability physicians want.
www.syneron-candela.co.uk | [email protected] | Tel. 0845 5210698
©2014. All rights reserved. Syneron and the Syneron logo are registered trademarks of Syneron Medical Ltd. and may be
registered in certain jurisdictions. PicoWay and Candela are registered trademarks of the Candela Corporation. PB85961EN
Contents • December 2014
INSIDER
06 News
The latest product and industry news
14 On the Scene
Out and about in the industry this month
CLINICAL PRACTICE
Laser and Light
Treatments in Acne Page 26
16 News Special
A review of aesthetics in 2014
19 Aesthetics Conference and Exhibition Preview
An insight into the ACE 2015 Business Track agenda
CLINICAL PRACTICE
21 Special Feature: Technology
Practitioners address the use of technology within clinics
26 CPD Clinical Article
Dr Firas Al-Niaimi explores the efficacy of laser and light treatments for acne managment
32 Advertorial: Church Pharmacy
Introducing new online prescribing service DigitRx
34 25 Years in Aesthetics
Amanda Cameron, Dr Tracy Mountford and Dr Patrick Bowler reflect on the past 25 years in the industry
37 Eyelash and Eyebrow Growth
Michelle Washington reveals the science behind eyelash and eyebrow serums
40 Injectable Delivery Systems
Leading practitioners discuss their preferred tools for administering injectables
44 Hand Rejuvenation
Dr Carolyn Berry outlines treatment methods for ageing hands
48 Abstracts
A round-up and summary of useful clinical papers
IN PRACTICE
50 Evolution of Business
Pam Underdown highlights the importance of adapting to change
55 Power of Branding
Gary Conroy on investing in brand building
59 Using LinkedIn
Paul Jackson explains how to take full advantage of LinkedIn
62 In Profile: Dr JJ Masani
We speak to leading aesthetic practitioner Dr JJ Masani
64 The Last Word: How Young is Too Young?
Dr Raina Zarb Adami on the controversy surrounding age in aesthetics
Subscribe to Aesthetics
Subscribe to Aesthetics, the UK’s leading free-of-charge
journal for medical aesthetic professionals.
Visit aestheticsjournal.com or call 0203 096 1228
IN PRACTICE
Evolution of Business
Page 52
Contributors
Dr. Firas Al-Niaimi is a consultant dermatologist
and laser surgeon. He trained in Manchester and
subsequently did a prestigious advanced surgical
and laser fellowship at St. John’s Institute of
Dermatology at St. Thomas’ Hospital, London.
Michelle Washington is a skincare specialist and
business development manager based in New
Zealand. With a particular interest in mandarosis,
she has conducted extensive research into hair loss
treatments, alongside aesthetic practitioners.
Dr Carolyn Berry grew up and trained as
a general practitioner in Belfast. In 2008 she
founded the Firvale Clinic in Southampton, with
the aim of bringing a level of excellence to the
medical aesthetics industry.
Pam Underdown is the owner of Aesthetic
Business Transformations. She works to help
aesthetic business owners improve their
marketing, increase their profits, reduce their costs
and build a long-term sustainable business asset.
Gary Conroy is co-founder of bespoke skincare
supplier, 5 Squirrels. Previously, he was the sales and
marketing director at Ambicare Health, as well as
head of aesthetic dermatology for Sanofi-Aventis.
He has more than 12 years industry experience.
Paul Jackson is a senior marketing consultant
at Reload Digital, specialising in social media and
online marketing for the aesthetics industry. As a
chartered marketer and Google certified partner, Paul
regularly speaks at marketing events across the UK.
Dr Raina Zarb Adami is a surgeon whose private
practice, Aesthetic Virtue, is dedicated to facial
aesthetic medicine. She is the medical director
of The Academy of Aesthetic Excellence, which
provides foundation and advanced training courses. NEXT MONTH
• IN FOCUS: Weight loss and body contouring
• Special Focus: Weight management
• Prescribing • Buying a laser
Aesthetics Conference
and Exhibition
7-8 March 2015
aestheticsconference.com
The Science of Great Skin
NeoStrata:
Scientifically advanced, clinically proven
dermatologist developed skincare
to target specific patient needs.
NeoStrata professionals:
Leading medical aesthetic clinics.
Practitioners requiring effective skincare.
Building successful business solutions.
Aesthetic Source:
Multi award winning UK distributor.
World renowned proven skincare options
for professional aesthetic clinics.
We deliver:
Comprehensive training and support.
Focussed marketing and PR campaigns.
Skincare you and your clients will love:
Meeting the needs of your business, delivering high satisfaction to your patients
Call us on 01234 313130 [email protected]
www.aestheticsource.com
Editor’s letter
Well the Aesthetics Awards 2014 are nearly
here! Saturday 6th December is the date
and the Park Plaza Westminster Bridge
Hotel is the place to be. The Aesthetics
Awards is a unique occasion, bringing the
whole industry together to recognise the
Amanda Cameron
Editor
best in medical aesthetics and celebrate
the achievements of the past year. Winners will be announced
in 21 specially chosen categories and awards will be presented
to those who strive to represent the highest standards in clinical
excellence – from manufacturers and distributors, to clinics
and individual practitioners. We are exceptionally proud of the
importance that the industry places on winning one of these
coveted awards and the tension is tangible amongst the finalists.
Promoting education, safety and ethical practice are at the heart
of everything we produce at Aesthetics, hence these awards are
a fantastic opportunity for us to highlight success in our field and
provide a positive and aspirational event for the industry. I look
forward to seeing those of you that are attending, for what is sure
to be a very special evening.
As 2014 draws to a close, this issue of the journal looks back.
Our in-depth news report reviews the past year, speaking to
practitioners and industry leaders regarding the major events and
advances that took place in medical aesthetics during the last
12 months. Dr Patrick Bowler, Dr Tracy Mountford and I share our
experiences and insights in a unique discussion of the changes
to the industry over 25 years. Patrick and Tracy were two of the
very first pioneers of the industry to move from general medicine
to aesthetic medicine, and I am delighted to have watched them
both become extremely successful over those 25 years.
Our special feature this month focuses on the way that
technology is used within the profession to enhance both
the patient and practitioner experience. We also feature an
informative article on the advances in filler delivery systems, and
business consultant, Pam Underdown, explores the evolution of
the sector from a commercial perspective.
Additionally, this issue includes a comprehensive CPD article,
explaining the use of lasers to treat acne by Dr Firas Al-Niaimi and
a detailed discussion from Dr Raina Zarb Adami, who argues for a
cautious and bespoke approach to treating younger patients.
As usual, we are interested to hear your thoughts and comments on
the issue - so get in touch on @aestheticsgroup to have your say.
Editorial advisory board
We are honoured that a number of leading figures from the medical aesthetic community have joined Aesthetics journal’s
editorial advisory board to help steer the direction of educational, clinical and business content
Dr Mike Comins is fellow and former president of the
British College of Aesthetic Medicine. He is part of the
cosmetic interventions working group, and is on the faculty for
the European College of Aesthetic Medicine. Dr Comins is also
an accredited trainer for advanced Vaser liposuction, having
performed over 3000 Vaser liposuction treatments.
Mr Dalvi Humzah is a consultant plastic, reconstructive and
Dr Raj Acquilla is a cosmetic dermatologist with over 11 years
experience in facial aesthetic medicine. UK ambassador, global
KOL and masterclass trainer in the cosmetic use of botulinum toxin
and dermal fillers, in 2012 he was named Speaker of the Year at
the UK Aesthetic Awards. He is actively involved in scientific audit,
research and development of pioneering products and techniques.
aesthetic surgeon and medical director at the Plastic and Dermatological Surgery. He previously practised as a consultant plastic
surgeon in the NHS for 15 years, and is currently a member of the
British Association of Plastic, Reconstructive and Aesthetic Surgeons
(BAPRAS). Mr Humzah lectures nationally and internationally.
Dr Tapan Patel is the founder and medical director of VIVA
and PHI Clinic. He has over 14 years of clinical experience and
has been performing aesthetic treatments for ten years. Dr
Patel is passionate about standards in aesthetic medicine and
still participates in active learning and gives presentations at
conferences worldwide.
Sharon Bennett is chair of the British Association of
Cosmetic Nurses (BACN) and also the UK lead on the BSI
committee for aesthetic non-surgical medical standard. Sharon
has been developing her practice in aesthetics for 25 years and
has recently taken up a board position with the UK Academy of
Aesthetic Practitioners (UKAAP).
Mr Adrian Richards is a plastic and cosmetic surgeon with
12 years of specialism in plastic surgery at both NHS and private
clinics. He is a member of the British Association of Plastic and
Reconstructive Surgeons (BAPRAS) and the British Association of
Aesthetic Plastic Surgeons (BAAPS). He has won numerous awards
and has written a best-selling textbook.
Dr Christopher Rowland Payne is a consultant
Dr Sarah Tonks is an aesthetic doctor and previous
dermatologist and internationally recognised expert in cosmetic
dermatology. As well as being a co-founder of the European
Society for Cosmetic and Aesthetic Dermatology (ESCAD), he was
also the founding editor of the Journal of Cosmetic Dermatology
and has authored numerous scientific papers and studies.
maxillofacial surgery trainee with dual qualifications in both
medicine and dentistry. Based at Beyond Medispa in Harvey
Nichols, she practises cosmetic injectables and hormonalbased therapies.
PUBLISHED BY
EDITORIAL
Chris Edmonds • Managing Director
T: 0203 096 1228 | M: 07867 974 121
[email protected]
Suzy Allinson • Associate Publisher
T: 0207 148 1292 | M: 07500 007 013
[email protected]
Amanda Cameron • Editor
T: 0207 148 1292 M: 07810 758 401
[email protected]
Betsan Jones • Journalist
T: 0207 148 1292 | M: 07741 312 463
[email protected]
Chloé Gronow • Journalist
T: 0207 148 1292 M: 07788 712 615
[email protected]
Hazel Murray • Journalist
T: 0207 148 1292
[email protected]
ADVERTISING
Hollie Dunwell • Business Development Manager
T: 0203 096 1228 | M: 07557 359 257
[email protected]
Rachel Barry • Administration and Production
T: 0203 096 1228 | [email protected]
Andrew Grant • Administration and Production
MARKETING
Marta Cabiddu • Marketing Manager
EVENTS
Helen Batten • Events Manager
DESIGN
Peter Johnson • Senior Designer
Chiara Mariani • Designer
FOLLOW US
@aestheticsgroup
Aesthetics Journal
Aesthetics
ARTICLE PDFs AND REPRO
Material may not be reproduced in any form without the
publisher’s written permission. For PDF file support please
contact Andrew Grant; [email protected]
© Copyright 2013 Aesthetics. All rights reserved. Aesthetics
Journal is published by Synaptiq Ltd, which is registered
as a limited company in England; No 3766240
DISCLAIMER: The editor and the publishers do not necessarily agree with the views
expressed by contributors and advertisers nor do they accept responsibility for any errors in the
transmission of the subject matter in this publication. In all matters the editor’s decision is final.
Insider
News
@aestheticsgroup
aestheticsjournal.com
New speakers announced
for ACE 2015
#Dermatology
PsoriasisAssociation / @PsoriasisUK
#Psoriasis can occur on any area of the body
including the scalp, hands, feet & genitals.
Different types tend to occur on different areas
#Teaching
Beautoxology / @dee_hadley
A great day teaching facial aesthetics...
Great delegates #Allergan
#Botulinum toxin
Emma Davies / @daviesemma5
Botox at home? Good lighting for the injector?
Good positioning? Convenient yes, but surely
safer in a treatment room #whyriskit?
#Facialaesthetics
Dr Askari Townshend / @Dr_AskariT
Heading to @UCLan to give a days teaching
on facial volumisation for MSc facial aesthetics
course. Art + science = safe beautification
#Conference
Dr Tapan Patel @drtapanp
Can’t wait to catch up with the talented doctors
and dear friends @imcascongress @goa
To share your thoughts follow us on Twitter
@aestheticsgroup, or email us at
[email protected]
Aesthetics
Conference
Talk Aesthetics
#Education
Dr Johanna Ward @DrJohannaWard
Looking forward to getting my copy of
@DrStefanieW book ‘Future Proof Your Skin’..
#anti-aging
Aesthetics Journal
More speakers for the Aesthetics
Conference and Exhibition (ACE),
to be held on 7 and 8 March 2015,
have been announced for the
live demonstration Expert Clinic
programme. The agenda, set to take place in the Business Design Centre,
Islington, will see a variety of industry leaders educating delegates on
clinical practices. A range of topics will be addressed, from radiofrequency
technology to chemical peels.
Dr Sotirios Foutsizoglou, founder and director of SF Medica, will present
an expert view on facial anatomy in aesthetics, which will incorporate a live
facial mapping session. He said, “I will utilise my experience to offer advice
on how to avoid serious complications when injecting the face and neck,
based on my sound knowledge of the relevant facial anatomical structures.”
Dr Yoram Harth, board certified dermatologist and originator of the use of
blue light to treat acne, as well as an expert in radiofrequency technology,
will present his demonstration on Saturday morning. “I am really excited
about presenting at the Expert Clinic for ACE in March,” he said. “I’ll be talking
about energy-based rejuvenation technologies, with a particular focus on
radiofrequency.” Dr Harth’s emphasis will be on the role of radiofrequency
in the modern aesthetic clinic, and how selecting the right platform can help
to treat multiple rejuvenation indications, with excellent results and minimal
patient down time. Other speakers announced for the Expert Clinic agenda
will include consultant plastic surgeon and founder of Cosmetic Courses,
Mr Adrian Richards, who will present a combination treatment of filler
and toxin for optimal results. Lorna Bowes, director of Aesthetic Source,
will provide an expert talk on chemical peels alongside a live treatment
demonstration. ACE 2015 will feature a huge range of engaging and
educational sessions, masterclasses, and business seminars across the
weekend from renowned experts in the field of medical aesthetics.
Visit www.aestheticsconference.com to keep up to date with the latest
developments and book today.
Competency
BACN’s updated edition of competencies
receives accreditation
The Royal College of Nursing (RCN) has accredited the British
Association of Cosmetic Nurses’ (BACN) updated edition of
industry competencies.
The Integrated Career and Competency Framework for Nurses in
Aesthetic Medicine was initially published and accredited by the
RCN in 2013. The updated 2014 edition has now also received
accreditation, which includes the RCN’s own educational and
specialist recommendations. The RCN highlight the importance of
patient consultation and psychological care, as well as competency
recommendations for the use of local and topical anaesthesia.
The remainder of the competencies, created by the BACN, relate
to the use of dermal fillers, lasers and IPL, and chemical peels. They
also cover chemical denervation, skin health and rejuvenation, and
the learning and development of aesthetic nurses.
Aesthetic nurse practitioner and leader of the BACN’s competency
6
development group, Adrian Baker, explained it is believed that,
The Integrated Career and Competency Framework for Nurses in
Aesthetic Medicine is the only set of aesthetic nursing competencies
available in the world.
He said that publications released by the BACN would now be
mapped against the standards addressed in the framework and be
used by universities, and in training, alongside Health Education
England’s (HEE) educational framework. “It is especially important
as NMC validation is coming into effect in 2015 and could assist and
guide in the mapping of their professional competence,” he added.
Chair of the BACN, Sharon Bennett, said, “The competencies will
allow nurses to clearly see the level of knowledge and education
expected from them in order to practise aesthetics.”
Electronic copies of the document will be available to BACN
members by the end of this year.
Aesthetics | December 2014
@aestheticsgroup
Aesthetics Journal
Aesthetics
Lasers
Insider
News
Standards
Lynton launches
YouLaser MT
‘Aesthetic Surgery Services’ to be
published as a European Standard
UK aesthetic equipment supplier, Lynton Lasers,
has released a new product that it claims will
revolutionise laser treatment and results. By
combining non-ablative GaAs (1540nm) and ablative
CO2 (10600nm) laser wavelengths, practitioners are
told to expect quick and dramatic results from this
new product.
The YouLaser MT aims to maximise the advantages
of each laser wavelength, providing stronger
results and less ‘down-time’ than single wavelength
lasers. Non-ablative resurfacing using GaAs targets
minute sections of the skin’s surface, allowing the
surrounding unaffected areas of skin to aid the
natural healing process, while the small columns of
thermal damage aim to enhance collagen renewal.
According to Lynton Lasers, ablative CO2 skin
resurfacing takes on a more dramatic effect, similar
to non-ablative resurfacing but causing more
trauma to the tissue. The CO2 laser still operates in
fractional mode, so the untreated surrounding areas
again promote rapid healing of the skin with less
down time. Post-treatment, the skin appears tighter
due to the process of collagen shrinkage and the
long-term stimulation of fibroblasts that will usually
produce new collagen for the next six months.
Dr Tony Downs, consultant dermatologist at
Exeter Medical, said, “Independent treatment
databases and manual settings allow you to safely
treat specific problems and lesions, or create
bespoke treatment parameters depending on
your own level of experience and expertise. This
platform has been a welcome addition to our
laser and aesthetic portfolio.”
As this product contains mixed technology,
the practitioner is able to provide specialised
treatments depending on the patients needs as
the Gold Standard lasers (CO2 at 10.6um and
GaAs at 1540nm) can be used independently,
simultaneously or sequentially.
The European Committee for Standardisation (CEN) and British Standards
Institution (BSI) have announced that the ‘Aesthetic Surgery Services’
document will be published as a European Standard. After a successful
voting period, the document was approved for publication in June 2014,
however a couple of CEN member states (not the UK) subsequently raised
some procedural issues. The CEN Technical Board discussed these issues at
a meeting on October 28 and made the decision to publish ‘Aesthetic Surgery
Services’, as originally planned. The contents of the document (EN 16372)
addresses, amongst others, general requirements and recommendations
for procedure rooms and operating theatres, hygiene standards, continuous
professional development (CPD) and continuous medical education (CME).
Mike Regan, chair of the BSI committee, explained that the Standard provides
recommendations for procedures for clinical treatment, including the ethical
framework and general principles, according to the clinical services provided by
all aesthetic practitioners. It does not include dentistry, reconstructive surgery
or non-surgical aesthetic procedures. A public consultation throughout Europe
(including the UK) on the Non-surgical Aesthetic Standard is planned take place
in January 2015.
Associations
Society of Mesotherapy UK
announces partnership with IMCAS
The Society of Mesotherapy UK (SOMUK) has announced that it has become a
scientific partner of IMCAS, Paris, set to take place in January 2015.
The collaboration means that members of the society will be offered access to
the Anti-Ageing Teaching Course at a discounted price. SOMUK confirmed that in
2015 they are also set to partner with other aesthetic conferences. President of the
society, Philippe Hamida-Pisal, explains that the SOMUK aims to incentivise academic
institutions in the United Kingdom to include mesotherapy as a key alternative
treatment in their syllabus. He said, “We have achieved this by becoming a scientific
partner of a number of important aesthetic congresses. Not only does this provide
our members with an international reference and access to expert knowledge
where the practice of mesotherapy is more prevalent, but also benefits our members
by providing access, at the reduced fee, to the respective congresses where the
SOMUK is scientific partner, improved networking as the Society grows from strength
to strength, and access to expert advice through the society and network in the UK.”
Not all HA dermal fillers are created equal.
Intelligent manufacturing technology creates a variable density
gel1 resulting in...
Optimal tissue integration2
Greater dermal compatibility3
Superior cosmetic results4
High patient satisfaction5
Injectable Product
of the Year 2013
Contact Merz Aesthetics NOW and ask for Belotero.
1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fillers in human skin: a histological study.
Dermatology DOI:10.1159/000354384. 3. Taufig A.Z. et al., J Ästhet Chir 2009 2:29 – 36. 4. Prager W et al. A Prospective,
Split-Face, Randomized, Comparative Study of safety and 12-Month Longevity of Three Formulations of Hyaluronic Acid
Dermal Filler for Treatment of Nasolabial Folds. Dermatol Surg 2012, 38: 1143 – 1150. 5. Buntrock H, Reuther T, Prager
W, Kerscher M. Efficacy, safety, and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic
nonanimal stabilized hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105.
MZ011 Banner AD Not ALL HA are Equal 75x215.indd 1
Tel: +44 (0) 333 200 4140
Email: [email protected]
www.belotero.uk.com
BEL093/0314/FS Date of preparation: March 2014
14/04/2014 15:43
Insider
News
@aestheticsgroup
Industry
Aesthetics
Skincare
Large study finds
minor cosmetic
procedures to be
‘exceedingly safe’
Swiss company launches
new skincare range in the UK
A study by an American university has found that
minor cosmetic procedures lack risk of serious adverse
events. The research, conducted by Northwestern
University and published in the JAMA Dermatology
Journal, is believed to form the first major study to
analyse the number of adverse events among tens of
thousands of cosmetic procedures performed across
the US. It found that fillers, neurotoxins, laser, and energy
device procedures were exceedingly safe.
“The message for patients is that if you are thinking of
getting one of these procedures, you are not indulging in
something drastic or high risk,” said Professor Murad Alam,
a member of the university’s dermatology department.
“The take home is these procedures are very safe and can
be mixed and matched to give the individual a significant
cosmetic benefit, rather than getting one big cosmetic
procedure that might be risky.”
The research came from the results of 20,339 procedures
conducted by 23 board-certified dermatologists at eight
centres around the country, over three months, and
staggered across seasons.
Side effects such as bruising, redness, swelling and
bumpiness, or skin darkening, were found to clear up
on their own, and occurred in fewer than 1% of patients.
While fillers were found to have a slightly higher (though
still extremely low) adverse rate than other procedures
included in the study, the authors claim this is to be
expected, as fillers are slightly more invasive than other
minor cosmetic treatments.
This comes at the same time as research presented by
the American Society of Plastic Surgeons (ASPS) at a
conference in October showed that older men and women
have no more complications than younger patients when
undergoing cosmetic procedures. Through an extensive
review of information from May 2008 to May 2013 from
the CosmetAssure database, it was found that elderly
patients had a complication rate of 1.94%, whilst younger
patients’ rate averaged 1.84%. Researchers suggested that
given the greater-than-average presence of health-related
indicators among older patients, the similar complication
rate is surprising, especially as the results showed a higher
Body Mass Index (25.4% to 24.2%) and increased incidence
of diabetes (5.7% to 1.6%) among the elderly patients. Dr
Maksym Yezhelyev, from the department of Plastic Surgery
at Vanderbilt University, Nashville, said, “I am convinced
that we will continue to witness increasing demand for
cosmetic procedures among the elderly. “Careful selection
of surgical candidates by plastic surgeons should result in
better aesthetic outcomes, more satisfied patients and thus
would benefit the entire field of plastic surgery.”
8
Aesthetics Journal
Skin Concept AG, a Swiss skincare company, has released their new
Swisscode collection of concentrates formulated from plant stem cells.
The Swisscode Pure collection is made up of seven concentrates, which
Skin Concept claim each address specific skin needs.
The trio of Swisscode Bionic serums, designed for use alongside the
Swisscode Pure concentrations, are also produced from the organic stem
cells and aim to combat symptoms of ageing skin. The use of the cells was
derived from the plants’ natural defence mechanism that protects them
against environmental stress and limits harm. These formulations are also
ISO certified, therefore free from alcohol, parabens, and preservatives, in
order to reduce the chance of skin irritation.
“These unique plant stem cells do not interact with human stem cells;
claims to that effect are not only misleading but potentially dangerous,”
says Wolfgang Mayer, chief operating officer of Medena AG, Skin Concept’s
parent company. He said, “What they do is provide the highest levels of
protection, including antioxidant protection, that cosmetic scientists have
been able to achieve. The data supporting results in terms of improved
moisture and collagen retention, the reduction of fine lines and wrinkles
and overall restructuring of the skin are impressive.”
Two or three drops of the concentrate are to be applied to the face and
neck before moisturising. Each concentrate is specially formulated for a
specific part of the face, or particular problem area, and can be combined
with others to tackle multiple issues.
Weight-loss
Study finds weight-loss surgery
reduces risk of diabetes
A recent study published in the Lancet Diabetes and Endocrinology Journal
has found that weight-loss surgery can limit risks of developing diabetes
later on. Over 4,000 British adults were assessed for effects of bariatric
surgery on diabetes development in obese people over several years. Those
who had undergone bariatric surgery were found to have an 80% reduction
rate in the development of type 2 diabetes. 2,167 patients who had the surgery,
and 2,167 who had not, were matched according to BMI, age, sex, index year,
and HbA. Electronic health records were extracted across eight years, and
analyses adjusted for matching variables, including cardiovascular risk. The
study suggested that, “bariatric surgery could be a highly effective method for
prevention of diabetes in patients with severe obesity.”
@aestheticsgroup
Aesthetics Journal
Aesthetics
Insider
News
Vital Statistics
Campaign
Allergan launches
#THISISME campaign
Allergan has begun a consumer campaign, dubbed ‘#THISISME’, aiming
to empower women to embrace their age in the way that they want to.
From extensive qualitative and quantitative research, it was found that the
female population are now much more positive about getting older than
in previous years. While 20% of women say they want to look 5 years
younger, 41% just want to look fresher and more radiant.
Another finding highlighted the social stigma attached to facial fillers,
which makes women less willing to take the next step after considering
treatment. 24% of women waited a year or more before committing to
having treatment.
“The anti-ageing category currently presents younger models as an
aspirational, but unattainable, goal rather than reflecting the women’s
desire simply to look their best for their age. We’ve learnt that women
want to positively embrace their hard-won signs of getting older but they
still want to choose the way they age,” said Allergan’s vice president and
managing director, Caroline Van Hove.
“Our bold campaign, #THISISME, features women of all ages and
backgrounds encouraging other women to continue to embrace the
positives about getting older, but empowering them to make their own
treatment choices and not be ashamed, so they can age as they want to.”
The campaign features six ordinary women, all who have been treated
with Allergan’s Juvéderm filler.
Allergan hope is that, by promoting #THISISME, and launching an
enhanced clinic locator tool on their product website, patients will feel
more confident to contact local practitioners and seek professional advice.
When choosing a
surgeon/practice, cost
is a deciding factor for
71% of patients
(American Academy of Facial Plastic
and Reconstructive Surgery)
On average, people
spend around £8,000
in a lifetime to remove
unwanted body hair
(Transform Cosmetic Surgery Group)
77% of psoriasis sufferers
describe it as a ‘problem’
or ‘significant problem’
impacting their quality of life
(Psoriasis Association)
Injectable wrinkle-relaxers
in America have a 93%
satisfaction rate
(American Society of Dermatologic Surgery)
Wrinkle treatment
New Smart Tip launched for
iovera treatment
Myoscience has launched a 1x55mm Round Smart Tip for iovera, a toxinfree wrinkle-reducing treatment now available in the UK. Myoscience
claims the treatment can be expected to provide noticeable results within
20 minutes; effects can last up to three months. London-based plastic
surgeon, Ms Angelica Kavouni, said, “The protocol changes have made
a big difference, and now the treatment takes less time, provides instant
results, and improved patient comfort.” Smart Tips, designed for use with
the Focused Cold Therapy (FCT) delivery system, uses liquid nitrous oxide
delivered through closed-end needles. Gaseous nitrous oxide is then
expelled into the device, aiming to leave nothing behind in the body.
Working in a temperature range allegedly incapable of causing permanent
nerve injury, it uses the body’s natural reaction to the cold to smooth wrinkles,
allowing practitioners to selectively treat specific nerves for precise results.
Before iovera°
One in five men feel that they are
expected to remove their chest hair
to get a smooth, preened torso
(Mintel)
The use of soft tissue fillers
increased by 13% between
2012 and 2013
(American Society of Plastic Surgeons)
Low vitamin D status was evident
in 23% of adults aged 19-64 living
in the UK from 2008-2012
(Public Health England)
Immedeately Post Treatment
60% of patients considering
aesthetic tweaks now get
their information about
plastic surgery online
(American Academy of Facial Plastic
and Reconstructive Surgery)
9
Insider
News
@aestheticsgroup
Events diary
6th December 2014
The Aesthetics Awards 2014,
London
www.aestheticsawards.com
29th January - 1st February 2015
International Master Course on
Ageing Skin - IMCAS Annual
Meeting 2015, Paris
www.imcas.com/en/imcas2015/
congress
7th - 8th March 2015
The Aesthetics Conference and
Exhibition 2015, London
www.aestheticsconference.com
26th - 28th March 2015
13th Anti-Aging Medicine World
Congress, Monte Carlo
www.euromedicom.com/amwc-2015/
index.html
Aesthetics Journal
Aesthetics
Industry
Aesthetic Source expands its team
Specialist medical aesthetics distributor, Aesthetic Source, has announced
the appointment of two new additions to their team in order to support their
growing customer base. Caroline Gwilliam has been recruited as the new business
development and sales manager for London and the South East, whilst Kathryn Avery
will acquire the same role for the South West.
Gwilliam said, “Aesthetic Source supports a true passion and drive to provide a
premium service to its customers, and I am looking forward to working with the awardwinning NeoStrata cosmeceutical range and skin fitness products in the Aesthetic
Source portfolio.”
Both Gwilliam and Avery will be aiming to improve and develop new partnerships
through excellent customer service that will include in-clinic training. Avery said, “I am
delighted to join Aesthetic Source and work with evidence-based skin fitness products.
It is an exciting time with a number of
exciting brands coming on board.”
In light of this expansion, Aesthetic
Source director, Lorna Bowes, said,
“Aesthetic Source is totally customercentric with the right systems and
people in place to deliver a high quality
bespoke service. It is an exciting time
for Caroline and Kathryn to join us with
many new products in the pipeline.”
Business
Actavis to acquire Allergan for $66 billion
Global pharmaceutical company Actavis has confirmed that it will
acquire Allergan for $66 billion, or $219 per share.
The agreement sees Actavis purchase the Botox-maker for a
combination of $129.22 in cash and 0.3683 Actavis shares, for each
share of Allergan common stock. “This acquisition creates the fastest
growing and most dynamic growth pharmaceutical company in global
healthcare, making us one of the world’s top 10 pharmaceutical
companies,” said Brent Saunders, CEO and president of Actavis.
He added, “We will establish an unrivalled foundation for long-term
growth, anchored by leading, world-class blockbuster franchises and
a premier late-stage pipeline that will accelerate our commitment to
build an exceptional, sustainable portfolio.”
The transaction was unanimously approved by both boards of
directors and supported by both management teams. It is anticipated
that the joining of the two companies will result in annual cost savings
of $1.8 billion. “Today’s transaction provides Allergan stockholders
with substantial and immediate value, as well as the opportunity
to participate in the significant upside potential of the combined
company,” said David Pyott, chairman and CEO of Allergan. “We
are combining with a partner that is ideally suited to realise the full
potential inherent in our franchise.”
Allergan explain that whilst Saunders will head the combined
company, the integration will be led by senior management teams of
both companies – with the aim of providing a smooth transition. Two
members of the Allergan Board of Directors will also be invited to join
the Actavis Board of Directors following the transaction.
Ship
ped Syri
ng
es
dwide
o rl
W
MILLION
beautifully matured
RADIESSE®
The unique CaHA collagen stimulating dermal filler
RA-INT054_5Milionen_Aufkleber 5_NEU.indd 1
FDA Approved
10 years’ experience with 5 million syringes sold
no wonder you
Best Customer Service
Winners in 2011, 2012, & 2013
RAD122/0914/LD Date of Preparation: September 2014
Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526
17.06.14 18:10
@aestheticsgroup
Aesthetics Journal
Aesthetics
Lasers
LoveLite launches fat reduction
machine that combines laser
treatment and cryo-therapy
Lovelite has launched
CrioLase, a fat-reducing
treatment, which aims
to revolutionise current
weight loss treatments.
The machine will combine
laser treatment and
cryo-therapy to provide a
single-treatment solution,
using a low-energy laser
to melt fat and, followed
by cryo-therapy, freeze
the area. This combination
is claimed to have
remarkable results in
contouring and toning fatty
tissue. LoveLite clinical
director, Debra Robson, said, “This is the most exciting advance in non-invasive
fat reduction in the past 10 years. The combined effects of first melting, and then
quickly freezing the treatment area, makes a vast difference in the effectiveness of
the cyrotherapy. The effect has been dubbed the ‘Super Contour Effect’ because
the results are really incredible.” LoveLite says that the non-invasive procedure
involves a low-energy bio-stimulation, causing fat cells to shrink and lose their
round shape, and releases intra-cellular fat to allow the flow of tri-glycerides into
the interstitial space.
The body then naturally processes the fat as a source of energy, and once cryotherapy has been used to freeze the fat cells (causing them to crystallize and die),
they naturally waste away through the body’s metabolism.
According to LoveLite, areas that can be treated by the new CrioLase include
facial areas such as the chin, neck and cheeks, and other body parts such
as the buttocks, calves, and inner knees. They also claim conditions such as
gynecomastia can be treated with the technology.
Digital
WhatClinic.com and The Pronto
Network announce strategic
platform integration
WhatClinic.com and The Pronto Network have announced their platform
integration that they claim will provide benefits to both clinics and patients.
The strategic partnership will integrate TM2 and PPS practice management,
online software programmes for patient and practice administration, with
WhatClinic.com’s site functionality. For aesthetic clinics, the partnership will allow
them to book patients more easily, saving time on scheduling and confirmation.
WhatClinic.com claim that patients will feel the benefits by being able to search,
compare, and book an appointment all on one site. Kyle Lunn, director of Blue
Zince, the creator of the Pronto Network, said, “This integration allows us to add
an extra layer of value to our product, and helps our clients reach more patients,
which is a key advantage in today’s increasingly digital health environment.”
Insider
News
60
Wolfgang Mayer, chief operations
officer of Swisscode
What is Swisscode?
Swisscode products apply
expertise in raw materials and
formulation techniques, to the
development of high-value,
new-generation brands. They
comprise a selection of concentrated formulations
to target specific skincare needs, utilising only the
purest ingredients that are both revolutionary and
results driven.
Why does Swisscode have two ranges?
Swisscode Pure is a collection of seven
concentrates, which each address specific skin
needs. Ingredients such as hyaluronic acid,
genistein and kiribirth are featured in such high
concentrations that they give their name to the
product. Swisscode strips away all the extraneous,
potentially irritating ingredients and focuses
solely on the active elements in their purest
recommended form.
Swisscode Bionic capitalises on the protective
capacity of plant stem cells to set standards for
combating symptoms of ageing skin, enabling it to
retain its youthful tone, texture and appearance.
Combining the principles of bionics with advanced
meristem (stem cell) biotechnology, the trio of
high-intensity concentrations provide protection
that allows skin cells to thrive and rejuvenate.
Why is the technology ground-breaking?
These unique plant stem cells do not interact with
human stem cells; claims to that effect are not only
misleading but are potentially dangerous. They
provide the highest levels of protection, including
antioxidant protection that cosmetic scientists
have been able to achieve.
How successful has your presence been
internationally?
Skin Concept is a multinational corporation with
operations spread across Europe, Asia and the
Middle East. From the beginning, we decided to
take a pioneering approach to the market. From
its conception, Skin Concept has been on a fasttrack to developing skincare products based on
cutting-edge formulations.
What does the future hold?
Skin Concept UK’s partner, Pure Swiss Aesthetics
has recently been appointed as the UK’s
exclusive distributor. Pure Swiss Aesthetics
specialise in the branding and
distribution of high quality,
innovative, niche brands, both in
the organic and cosmeceutical
sectors, with a focus on
personalised customer service.
11
Insider
News
News in Brief
Christmas skincare gift set
released by SkinCeuticals
American skincare company, SkinCeuticals,
has released a gift set containing two
of their anti-ageing products. The A.G.E
Interrupter is specifically formulated to
improve mature skin, and the Retexturing
Activator aims to improve surface
exfoliation and hydration. SkinCeuticals
claim the combination of the products will
help skin to feel smooth and firm.
Belnatur launches skincare range
Professional skincare brand Belnatur has
launched a skincare range in the UK,
which claims to rehydrate dull-looking
skin. Belnatur explain the products, as part
of the ‘Oxygen Range’, work by increasing
the skin cells’ oxygen consumption, which
can be affected through stress, as well as
pollution and other environmental factors.
The technology is said to favour the
oxygen’s transport and diffusion, helping
the cells to maintain energy production
and vital functions.
MP raises regulation issues in
Parliament
Ilford South MP Mike Gapes has
questioned health minister Jeremy Hunt
on the regulation surrounding cosmetic
laser treatments. His concern comes after
a woman in his constituency claimed
she suffered scarring after undergoing
a laser hair removal procedure, without
being given a patch test. Gapes, who is
waiting for a response, asked Hunt, “What
steps he plans to ensure more effective
regulation of providers of cosmetic laser
treatments, and whether it is his policy to
introduce a register of such providers.”
4T Medical launch peeling gel
A new peeling gel has been launched by
4T medical, who claim the product is just as
effective as regular chemical peels.
With multi-action enzymes, which peel
and help to uncover a smooth, fresh
complexion, the Silky Clear Peeling Gel
aims to smooth and soften even the most
sensitive skin. 4T medical believe the gel is
an effective alternative to chemical peels,
which they say can cause undue stress to
skin. The company suggest the product
should be used to prepare skin before
dermal fillers, mesotherapy, and wrinklerelaxing treatments.
12
@aestheticsgroup
Aesthetics Journal
Aesthetics
Injectables
New Teosyal Pen wins AMEC award
A new cordless device, specifically designed
to inject hyaluronic acid into delicate areas,
has received an award at the 2nd Anti-aging
Medicine European Congress (AMEC), in
Paris. The Teosyal Pen, from Juvaplus, won
the 2nd Anti-aging & Beauty Trophy award
at the AMEC for Best Aesthetic Device.
Juvaplus have now collaborated with Teoxane
Laboratories to market the product worldwide
in the first quarter of 2015.
Valérie Taupin, founder and chairwoman
of Teoxane Laboratories, said, “Teoxane is
constantly looking for the best solutions to
improve patients’ comfort and to reduce recovery time, as well as the latest innovations
to inject hyaluronic acid in a more precise way. That is why the Teosyal Pen totally met
our expectations. Mr Bernard-Pierre Legrand, CEO of Juvaplus, and his team have
invented a device (the Teosyal Pen) which significantly reduces injection pain and
minimizes side-effects.”
The product is the first motorised and cordless device specifically created to inject
hyaluronic acid. The Swiss companies claim the Teosyal Pen will allow practitioners to
focus on the more ‘artistic aspect’ of their work.
The pen works on two programmes, which are used to control pressure, three speeds,
and product quantity. Teoxane suggest that it will be particularly valuable when aiding
delicate oral, peri-oral and peri-orbital areas where it is crucial to use high precision.
“Two of the most important aspects in effective and safe dermal filler injections are
accuracy and precision. Teosyal Pen has been designed to offer injectors accurate
placement of precise amount of dermal fillers,” said Dr Kieren Bong, clinical lecturer
and cosmetic doctor in dermatology. “The majority of my patients found the level
of discomfort during injection much lower than the conventional syringe. This is not
surprising as the gentle and more even flow of dermal fillers during injection mean
there is less pressure exerted on the tissue, and this translates into a more comfortable
experience for patients.”
Research
Study shows photosensitive patients
are vulnerable to low vitamin D
levels all year
A study has found that photosensitive patients are at a high risk of year-round low
vitamin D status. The study, part-funded by the British Skin Foundation, focused on
53 patients with moderate to severe photosensitivity and compared them with healthy
adults. It measured sunlight exposure, photo-protective behaviour, oral vitamin D intake
and vitamin D levels in the blood.
The research found that the main cause for year-round low vitamin D status is
photosensitive patient behaviour. Professor Lesley Rhodes, from the Institute of
Inflammation and Repair at the University of Manchester, said, “Photosensitive patients
are disadvantaged in many ways, through their need to avoid sun exposure. This study
is the first to examine vitamin D levels in photosensitive and healthy people side by side
throughout the year.”
She added, “A key finding is their high risk of year-round low vitamin D levels,
contrasting with seasonal lows in healthy people, with potentially greater negative
impact on health. National guidance on vitamin D supplements should specifically
mention this at-risk group, in order to alert these patients and their doctors.”
Unlimited Options. One Easy Choice
1 Platform. 70 FDA Approved Treatments.
Featuring ClearLiftTM
celebrity’s choice:
“Hollywood Facelift”
HarmonyTM Laser360°
The most complete
anti-ageing innovation
IMPACTTM Deep Ultrasound
clinically proven to improve
skin texture including lines,
wrinkles and scars
0845 170 7788
www.abclasers.co.uk
[email protected]
INNOVATION. RESULTS. SUCCESS
www.abclasers.co.uk | 0845 170 7788
Insider
On the Scene
Sinclair IS Pharma
Masterclass, London
International pharmaceutical company, Sinclair
IS Pharma, held a masterclass event at The Royal
Society of Medicine on October 21.
The day consisted of expert presentations and
live demonstrations from speakers that included
Dr Vincent Wong, Dr Askari Townshend and Mr
Christopher Inglefield.
Andrew Morris, country operations director,
explained that the purpose of the event was to
introduce Sinclair’s first-class training and inform
practitioners of the company’s strategy to build a
successful collagen stimulation portfolio.
He told delegates, “We provide quality brands and
are focused on training practitioners to use them
appropriately. All of our products are supported with
strong training and aftercare. We have knowledge,
expertise and an ambition to be your partner. Our
products provide solutions to the needs of patients.
We want to help all aesthetic practitioners look after
their regular patients and satisfy new ones.”
With an excellent turnout and great feedback,
aesthetic account manager, Claire Williams, said
the masterclass was a success. “I have had many
people wanting to sign up for training across all our
product lines and all attendees will be followed up
personally to make sure they get what they want
from the meeting.” Aesthetic practitioner, Dr Daina
Jones, said, “I already work with some of Sinclair’s
products and the masterclasses give us practitioners
all the tools to use the products safely and correctly.
I especially enjoyed Dr Townshend’s lecture
on infection control as there is never too much
information, advice and precaution to be had as
an aesthetic practitioner.” She added, “It was great
to have an interactive evening as it is so useful to
share the experience amongst fellow doctors.”
14
@aestheticsgroup
Aesthetics Journal
Aesthetics
National Aesthetic Nursing
Conference, London
The Journal of Aesthetic Nursing held
their third National Aesthetic Nursing
Conference at the Cavendish Conference
Centre in London on November 3.
The one-day event, ‘Clinical excellence
in cosmetic medicine’, opened with the
theme of introducing a new era for aesthetic
nursing. The event aimed to send delegates
away with both expert knowledge and
practical ideas for implementing better practice in the future.
The morning clinical sessions saw the Chair of the northwest branch of the British
Association of Cosmetic Nurses (BACN), Karen Burgess, discuss the triple effect of
radiesse, which was sponsored by Merz Aesthetics. Later, a video demonstration on
rejuvenating the tear trough was presented by Helen Collier, aesthetic practitioner
and director of Skintalks. In the afternoon Lorna Bowes, director of Aesthetic Source,
and Eva Escofet, director and co-owner of Aneva Nutraceuticals Ltd, presented their
talk titled ‘Skin Fitness – combining cosmeceuticals and nutraceuticals for optimal
skin fitness’, sponsored by both Aesthetic Source and Aneva Nutraceuticals Ltd.
Bowes said, “This is our third year exhibiting at the Journal of Aesthetic Nursing. It’s
always nice to catch up with nurse colleagues, and we would like to thank everyone
for their great interest in our study, which was presented as the European Academy
of Dermatology and Venereology earlier in October this year.”
Other topics covered throughout the conference included discussions on the
appropriate clinical setting for performing non-invasive cosmetic treatments,
and the best approach to acne management.
REVIV, London
The global market leader in
intravenous hydration, REVIV,
held their UK launch in London
on October 29. REVIV claim that
through applying innovative western
medicine to an eastern philosophy
of balance, they can restore
equilibrium through vitamin-infused
IV therapies. President of REVIV
Global, Sarah Lomas, explained that the IV treatments could be used to combat
dehydration, fatigue and illness. She said, “For me, the message I want to send
about IV hydration is that it should be used for preventative health – not as just
a hangover cure as it is sometimes reported.” The company now has exclusive
clinics in Cheshire and London, with an express clinic (as part of another clinic)
situated in Newcastle.
Dr Martin Kinsella, aesthetic practitioner and medical director of REVIV, said, “I’ve
been giving intravenous vitamin infusion and anti-oxidant infusions for about three
years. They have always been popular so I decided to take that forward with
REVIV as I think the product has been well developed and well researched. REVIV
has conducted clinical trials both in the US and the UK and has had very positive
results.” Lomas explained that for practitioners to be able to administer REVIV, their
clinics would need to go through a stringent approval process. “If an aesthetic
clinic is interested in offering REVIV treatments, then a full review of their premises
and an assessment from our medical team will be carried out.” REVIV are hoping to
open another 50 exclusive clinics in the UK within in the next three months, as well
as clinics in Canada, Continental Europe, South Africa and Australia.
The Multi-Award Winning
New Innovation of The Year
Soprano ICETM Alexandrite for
unrivalled efficacy & SPEEDTM
The ONLY laser ever to
double clear by the FDA
1. All skin types (I-VI)----2. Treats sun tanned skin
ONLY SopranoTM will
treat ALL year round
INNOVATION. RESULTS. SUCCESS
www.abclasers.co.uk | 0845 170 7788
News Special
A Year in Review
@aestheticsgroup
Aesthetics Journal
Aesthetics
lip shapes.” He adds that the 8-point facelift has helped achieve
this, as patients are focussing less on single areas and more on
creating a balanced look and improving their skin overall.
The development of skin and subcutaneous tightening is also
something that Dr Rowland Payne has recognised. He believes
that the technology to treat this is continuing to improve. Dr
Johanna Ward, however, believes that the technological issue
of IPL and laser regulation has been completely ignored in 2014.
“These powerful machines remain unregulated and are therefore
potentially able to cause harm. Cheap machinery continues to flood
the aesthetics market with few safety standards and little empirical
evidence of efficacy,” she says.
As 2014 draws to a close, Aesthetics
speaks to practitioners working across
the UK to reflect on the developments,
achievements, and problems
faced by our ever-changing industry
A Year in Review
Aesthetics is the most exciting medical field to be involved in
at the moment, according to Dr Christopher Rowland Payne.
He says, “Innovation, research and development are mirrored
by growing public interest.” Dr Raj Acquilla agrees, claiming
that medical education in aesthetics is the best he has seen in
a decade. “Our understanding of facial anatomy, and therefore
injection strategy, has never been better,” he says. “This further
optimises aesthetic outcomes and reduces adverse events.”
One of the key developments that Dr Acquilla has noticed this year
is the advancement in Hyaluronic Acid (HA) filler technology. This
thought is echoed by Dr Britta Knoll, who says one of her favourite
tools of 2014 is a filler delivery system, which she claims allows
her to inject deep volumes of HA very comfortably. Dr Acquilla
adds, “Low molecular weight products with high cohesivity allow
for superior tissue integration and lifting capacity using low volume
injection. This generates excellent results whilst minimising risks
to the patients.” Dr Rowland Payne explains that this year, he has
preferred administering filler with cannulas rather than needles. He
says, “Flexible fine cannulas (e.g. 27 gauge) offer safety advantages
over needles as they greatly reduce the risk of arterial embolization.
They also offer improved possibilities for soft filling of the cheeks,
as well as other sites.”
Dr Rowland Payne also notes that thread lifting, although not a
substitute for a facelift, is a major advancement in the non-surgical
domain and is becoming increasingly accessible. Dr Sarah Tonks
agrees, explaining, “They are a great alternative to dermal fillers
if there is more tissue descent than you would correct with filler
alone.”
2014 has been the year of the “natural look”, according to Mr Adrian
Richards. He says, “Our clients are asking us to help them look
naturally fresher and we have noticed a trend towards more natural
16
Whilst there have been many positive developments this year,
regulation is still a substantial issue amongst practitioners, with
some agreeing with Dr Ward that not enough has been done since
the Keogh Review took place last year. Dr Rita Rakus explains
that, for her, the rise in certain discount websites is a problem for
the safe regulation of the industry. She believes that the lack of
consultation with an appropriate practitioner is not acceptable.
“A consultation will ensure that the customer is booking in for the
correct treatment that will address their concerns – otherwise the
desired results will not always be achieved.” Dr Rakus explains that
aftercare is also an important part of any procedure. “Due to the
treatments being booked through a third party, if there is a problem,
it can be hard for the customer to communicate this with the correct
person.”
Dr Tonks believes that the Health Education England (HEE)
proposed educational and training framework for their report:
Non-surgical Cosmetic Interventions and Hair Restoration Surgery,
has been a missed opportunity to implement tighter regulation.
“Although we now have a training structure, in my opinion, we are
going to be training the wrong people. The field has been opened
up to anyone without a medical background to start performing
procedures, which is pretty much where we are at the moment
anyway.” Sharon Bennett, however, argues that the HEE framework
is a step in the right direction. “It is hoped that some form of
control will be put on those who are non-medically qualified when
delivering non-surgical treatments,” she says.
In addition, Dr Ward argues that misadvertising has continued in
2014 and there is lot of consumer confusion as to what treatments
are safe and effective. “Practitioners have a duty of care for patients
and need to be offering neutral, unbiased advice about treatments
that help guide patients to make sensible and educated decisions
about aesthetic treatments,” she says. “There is still a lot that
individual practitioners can do to raise standards in the industry.
Most importantly, we can all insist on buying products, treatments
and machines that are of the highest quality to ensure patients are
receiving the best possible aesthetic care.”
Despite the negative aspects of the industry, Dr Sam Robson
celebrated the fact that appraisal and revalidation will be extended
to aesthetic nurses next year. She says, “Having been appraised
every year since 2004 has really helped me focus my education
and practice so that I remain safe, accountable and up-to-date.” She
argues that introducing the regulation, set out by the Nursing and
Midwifery Council (NMC) as mandatory practise, will ensure that
@aestheticsgroup
Aesthetics Journal
Aesthetics
the consequences for not engaging with its content cannot fail to
improve standards.
Dr Knoll explains how, for her, the highlight of 2014 was the Monte
Carlo Anti-Aging Medicine World Congress (AMWC). “There was a
huge number of international visitors with plenty of new products
and techniques for minimally-invasive aesthetic procedures
“My wish for 2015 is that
there is more practical
training available in
congresses; not only
for selling activities but
to offer practitioners
good, scientific, clinical
education. Economic
success yes, of course,
but safety comes first!”
News Special
A Year in Review
available,” she says. “My wish for 2015 is that there is more practical
training available in congresses; not only for selling activities but
to offer practitioners good, scientific, clinical education. Economic
success yes, of course, but safety comes first!”
Sharon Bennett agrees, saying, “The fantastic conferences and
expos throughout the year are a constant source of education and
networking, and our specialism is at last being recognised,” She
adds, “The requirement and hunger for research and evidence –
in all we do – has triggered the imagination of many and we are
now starting to see a trickle of well researched, evidence-based
papers, and consensus on areas such as complications, becoming
available.” In regards to 2015, Bennett suggests that the biggest
area of change will be a stronger focus on health and wellbeing.
“Today’s men and women want to feel healthy as well as looking
good. Our work won’t just be with fillers, toxins and lasers, I believe
there will increased demand for supportive anti-ageing medicine,
bio-rejuvenation and hormone management.”
It is clear that, despite its challenges, this year has been an
educational, exciting, and enthralling year for everyone involved in
medical aesthetics. As we look toward the new year, we hope that
it will bring further success and happiness to both practitioners and
patients. To conclude, Dr Ward expresses her hope that aesthetic
practitioners continue to work tirelessly to deliver standards of
clinical excellence for all patients. She says, “I hope that we can all
come together and work towards a more ethical, regulated and
clinically sound industry in 2015.”
FINALIST
Dermatologist Developed
Independent Clinical Trials
Botanical Based Formulas
Paraben and Fragrance Free
To discover what sets Epionce apart
contact Episciences Europe LLP
on 01245 227788
epionce.co.uk
[email protected]
NOW IN PARTNERSHIP WITH
IREJUVENATE & RESOLVEI
THE LEADING
LIGHT IN LED
PHOTOTHERAPY
Harnessing the power of pure light to naturally
stimulate skin rejuvenation and resolve
problem skin conditions
TARGETED AND CONTROLLED
Evidence-based red, blue and near-infrared
wavelengths used at a skin-enhancing intensity and dose
ADVANCED
High-quality, precisely controlled LEDs give the
option to deliver all three wavelengths concurrently
FLEXIBLE
Standalone treatment or used to enhance
other treatments; excellent results and great
return on investment
SAFE AND COMFORTABLE
A non-invasive treatment for all skin types no pain or downtime
The Dermalux® is affordable, quick and easy to
use, has no downtime and has a high patient
satisfaction rate. Deciding to purchase the
Dermalux® is a no brainer!
DR REKHA TAILOR Health + Aesthetics, Farnham
FOR FURTHER DETAILS, SCIENTIFIC & CLINICAL INFORMATION PLEASE CONTACT AESTHETICARE ®
0800 0195 322
© AesthetiCare® 2014 6730/09.14
dermalux.aestheticare.co.uk
[email protected]
@aestheticareuk
facebook.com/aestheticareuk
@aestheticsgroup
Aesthetics Journal
Aesthetics
Building success at the
Aesthetics Conference
and Exhibition
With the commercial demands of the aesthetics industry
growing constantly, the ACE 2015 Business Track will
help you to stay one step ahead of the competition.
Alongside the interactive main conference
programme, live demonstration Expert
Clinics and product and treatment
Masterclasses, the Aesthetics Conference
and Exhibition 2015 will also feature a
comprehensive Business Track agenda
where expert speakers will share invaluable
guidance on building, sustaining and
growing a practice in medical aesthetics.
During the two days of sessions, industry
leaders will educate and advise attendees
on a vast range of topics including how
to make their business more efficient and
cost-effective, successfully marketing to
customers and practising within the current
regulatory market framework. Zain Bhojani,
co-director of Church Pharmacy, who are
sponsoring the Business Track and will also
be providing two sessions within the agenda
providing support to practitioners in using
their new e-prescribing system DigitRx, says,
“All healthcare practitioners need to have a
business hat on to some extent or another.”
He continues, “We started as a very small
company, and we know the kind of challenges
that people face when they’re trying to scale
a business, especially when they don’t have
people resources and it’s literally just one or
two people running the show – so we’re very
excited to be sponsoring and we can’t wait
for ACE.” Sessions taking place during the
Business Track include a discussion from Dr
Sarah Tonks, who will share her experience
in making the transition from full-time dentist
to established aesthetic provider. Dr Tonks
will advise on the range of treatments that a
practising dentist can easily and appropriately
incorporate into their existing business, along
with potential pitfalls and how to overcome
these successfully. VAT advisor, Veronica
Donnelly, will be utilising her extensive 26
years of experience to inform visitors on the
complicated issue of how to manage VAT
in aesthetic practice, whilst Gilly Dickons will
share insights and tips on how to create an
excellent first impression with potential and
existing customers. As founder of specialised
aesthetic call-handling and enquiry company
Aesthetic Response, Dicksons is ideally
placed to advise on the significance of this
positive experience in adding value to your
clinical offering. This year, UK industry and
media attention has been focused on the
need for increased regulation within the
aesthetics industry, an issue which has yet
to be resolved at a government level. Brett
Collins recently formed Save Face, a body that
has been set up in light of the Keogh Review
to help consumers find well-accredited
practitioners for non-invasive procedures.
“The aesthetic market is moving forward,
which is why it is now so important that we
come together as a collective industry, with
our prime focus on patient safety,” says Collins.
“Whilst endlessly interesting and rewarding,
the industry can prove challenging to navigate
whilst maintaining a healthy and safe balance
between the ethics and standards we hold as
healthcare professionals, and the competitive
forces of a thriving and fast paced market
place.” As part of the Sunday agenda, Collins
will present an independent perspective
on why it is so important for practitioners
and clinics to become part of a professional
association, and the necessity for statutory
regulations, given the growing aesthetics
industry. The Business Track will also feature
a host of sessions centred around marketing,
sales and branding; business essentials in
the competitive aesthetics market. During
her two sessions, US based author and
business consultant Wendy Lewis will be
focusing on the use of social media and
multimedia content within business marketing
strategy, drawing on her two decades of
experience in medical aesthetics. Essential
guidance on brand building will be provided
by Gary Conroy, director of 5 Squirrels Ltd; a
company offering customised skincare to the
UK aesthetics industry. Conroy will explore
how businesses can develop their branding
to establish and promote their identity to
ACE 2015
Business Track
potential customers and cement their position
in the market. A sales workshop with the
managing director of Advance and company
director of Fitzwilliam Transformation Clinic,
Anna Louise Kenny, will advise practitioners
and front of house staff on how to maximise
selling opportunities within a clinical
environment. Additionally, Dan Travis, director
of The Marketing Clinic, will lead a Sunday
afternoon session revolving around the
concept of critical business numbers. “These
numbers are the lifeblood of your business,”
he says. “Most business owners do not know
their business numbers and suffer directly
as a result.” Travis adds, “This session is far
from being a lesson in accountancy. Once
you begin to grasp your business numbers,
you will be far better placed to grow your
business.” Providing an excellent platform for
attendees to increase their understanding of
how to build and boost a successful aesthetic
clinic, the Business Track is the perfect
opportunity to learn valuable business skills
whilst networking with other professionals.
The content is ideal for both practitioners
and individuals in management, front of
house and administration roles, working
within an aesthetic practice. The Business
Track is just one of the agendas on offer at
the Aesthetics Conference and Exhibition,
taking place on March 7 and 8 in Central
London. Free exhibition registration will also
include sponsored Masterclasses and Expert
Clinic live demonstration sessions, along
with Business Track workshops. This year,
ACE features a brand new main conference
agenda format, the first of its kind for the
medical aesthetics profession. Delegates will
be able to choose to attend individual three
hour learning experiences on body and fat,
injectables expert sessions parts I and II, or
skin health. Alternatively they can choose
to attend the full two day programme for
the complete learning package in medical
aesthetics. Each of the four main conference
agenda sessions are priced at £95 including
VAT, with a cumulative discount for the more
sessions booked. Book now for an additional
10% limited early booking discount.
Visit www.aestheticsconference.com
for the full agenda and to register.
19
A New Dimension in Non-Surgical Technology
Sponsorship
Partner
A revolution in the non-surgical aesthetic skincare market...
Rotational Diamond Peel Microdermabrasion
is set to create a revolution in the
non-surgical Aesthetic skincare market. Following the success of
the award winning 3D-lipo which combines technologies for the
effective treatment of fat, cellulite and skin-tightening we are set
to launch a phenomenal new multi-functional device for the face.
Here are just some of the reasons why 3D-skintech will become
the brand of choice in 2013
• Complete treatment portfolio for anti-ageing,
pigmentation and acne
• 4 technologies ensure a prescriptive & total
approach to your clients needs
• Used in conjunction with medical peel and
cosmeceutical skin care line
• Unsurpassed results ensures maximum
client loyalty
• Highly profitable with a multitude
of services to offer
• Provides you with a competitive
edge in your area
• Free product starter pack
• Affordable finance packages
available
IT’S ALL YOU WILL EVER NEED…
For more information or a demonstration
Please call 01788 550 440
Utilising the latest technology available you can work in conjunction
with topical skincare to ensure that hydration and comfort are not
compromised whilst delivering excellent peeling results.
Radio Frequency
Tri-polar Radio Frequency is the most advanced technology
available for skin-tightening ensuring excellent results without the
discomfort associated with mono or bi – polar devices.
Mesotherapy
Non-invasive mesotherapy ensures that the active ingredients are
delivered where they are needed most without the need for needles.
LED
Full canopy LED ensures both rapid treatment time and excellent
results are achieved. Available wavelengths Red (640nm - 700nm),
Blue (425nm - 470nm), Yellow (590nm) and Green (520 - 564nm)
ensures effective treatment for anti-ageing, pigmentation, acne and
detoxification.
3D-skintech peels and clinical skincare
A compact range of medical grade peels and cosmeceutical skincare
products complete the Skintech’s unique offering and enables you
to both use as a “stand-alone” service or combine with equipment
protocols.
‘To compliment our core injectable business the 3D-skintech has added an array of
new result driven facial services to our clinic’s menu as well as the combination services
for our more curative patients. We recognized that this device offered the stand alone
quality of each technology in a unique machine that will ensure that we both deliver the
results but equally can make money from the start due its affordability. As a clinician
too many times in the past we have invested huge sums of money in a single concept
that has proven difficult to profit from. In my opinion this type of system represents the
future in our industry.’ Dr Martyn King – GP and Clinical director Cosmedic Skin Clinic
www.3d-skintech.com
www.3d-lipo.com
@aestheticsgroup
Aesthetics Journal
Aesthetics
Special Feature
Technology
for an appointment that might only take a few minutes. Instead,
they can send a photograph of themselves to Dr Patel via text,
WhatsApp, or email – whichever method they prefer – and in a
matter of seconds he can view the photo, assess the patient’s
condition, and respond with the appropriate course of action. It
also saves Dr Patel time: “With a few strokes of the keyboard I can
communicate with 10 or 12 patients a day, who otherwise would
have to come in for reviews. They will always have the choice to
come and see me if they’re uncomfortable sending a selfie. But
pretty much 100% of the time, they would rather share a photo.”
Technology
in aesthetics
Allie Anderson speaks to practitioners
about their experience of adapting
technology to their clinics
In the 21st century, technology pervades every aspect of our
existence. We conduct our business and social lives on handheld
devices, communicating digitally and accessing information about
others and ourselves in a virtual space, all at the tap of a keyboard or
the swipe of a screen.
The aesthetics industry has arguably been behind the curve when it
comes to adopting and embracing new technologies to streamline
treatment processes and push the boundaries of results. Slowly but
surely, however, the use of pioneering software, programmes and
apps is becoming less the reserve of the trailblazers, and moving
more into the domain of everyday clinical practice.
Picture perfect
The last few years have seen the influence of the selfie become
unescapable. In 2013, ‘selfie’ was named Oxford Dictionaries’ ‘Word
of the year1 and more recently, with the help of social media, the
‘no makeup selfie’ movement racked up £8 million in donations to
Cancer Research in just six days.2 For cosmetic dermatologist Dr
Tapan Patel, there is a place for the trend in aesthetic practice too.
Historically, when patients came to him for laser resurfacing, the risk
of post-treatment reactions and infection meant he had to follow
up with the patient in person in the days and weeks immediately
following the procedure. Now, he asks patients to send a ‘selfie’
from the comfort of their own home, so he can assess their
progress remotely without them needing to come to clinic.
“With a photograph, I can see easily if there is an area of redness
or an area that’s taking longer to heal,” he explains. “I can then ask
them to send a more detailed photo of that area, ask them how it’s
feeling, and follow up with them as necessary. They’ll typically send
one photo of themselves a day, I assess it and if everything looks
OK, I simply tell them to come back in one month.”
The benefits to the patient are clear; it’s saving them the time and
expense of making a journey – often a long one – to the clinic
Interactive relationships
The advancement of technology has itself bred an expectation
that we ought to be able to interact with the people we come into
contact with in creative ways. As a result, gone are the days when
the doctor-patient relationship was restricted to telephone calls,
clinic appointments and letters sent through the post – sending the
practitioner a photograph via WhatsApp is one example of that.
“More interconnections between doctors and patients will
be necessary; they want to be followed up and taken care of
personally, even some months after they visit our clinic,” says
Dubai-based aesthetic practitioner, Margaret Lorimer. “Doctors
need the latest technology for the benefit of patients and clinics.
Patients are all using smartphones to plan appointments, store
photos, sharing on social networks – they all interact. So it’s logical
that they can interact with their favourite clinic.”
To that end, Lorimer uses Sygmalift, a tablet and smartphone app
that enables clinicians to store data and images and automatically
conduct patient follow ups, as well as managing a number of admin
functions. Patients can also use the interface, so they can view
before and after photos shared by their clinician, access clinic
news and updates, and contact their practitioner by email. The app
streamlines the consultation process, too. “You can have a patient
file handy with pre and post-treatment photos done immediately.
There is no need to download the photos from your camera
and put them on your PC to compare and resize them, etc. The
Sygmalift app does it all automatically.”
The app has the advantage of saving precious time for patients
who lead busy lives and need to minimise the time spent in clinic,
offering remote ‘pre-clinic’ and aftercare advice to speed things
along when they come in for the procedure. According to Lorimer,
this form of communication between patients and practitioners is
essential. “We propose a tailor-made service to patients and this
interconnection can lead us to follow patients’ skin evolution and
give preventative advice for long-lasting results. I see the future of
clinics is to offer interactive medical advice to patients, in order to
offer a better service.”
Optimising patient involvement
There is a degree of scepticism about the aesthetics industry in the
UK, according to aesthetic practitioner Dr Raj Acquilla. He believes
it is propagated by patients not feeling in control of any aspect of
their treatment journey. Using technology to enable patients to
interact with doctors and clinics, and learn more about procedures
and outcomes, is crucial to breaking down barriers. “You’re giving
[patients] a level of involvement, so they can take ownership of a
significant part of that process,” says Dr Acquilla.
Used in a clinical setting, the Allergan Facial Anatomy app helps to
do just that. The app uses a computer-generated, three-dimensional
image of a face with multiple layers that can be removed one by
21
Special Feature
Technology
@aestheticsgroup
Sygmalift (Image courtesy of Medixsysteme)
one to reveal the anatomical structures beneath the surface. Its
primary patient-facing use is to demonstrate, for example, the exact
positioning for botulinum toxin injections, as Dr Acquilla explains:
“You mark little dots on the 3D image – and you can use different
colours for different products – and then you can peel away the
skin to show the fat, then peel away that to see the muscle, take
away the muscle to show the nerves and blood vessels, and
then the facial skeleton.” The marks remain in position on each
layer, allowing you to see and show the patient the impact of the
treatment far below the surface of the skin. “You can recheck
your injection sites and see what dangers and pitfalls lurk in the
background,” says Dr Acquilla, “but also, you’re showing the patient
that there’s a rationale for where you’re placing the needle to
generate the most positive effect and to avoid any adverse event.
Patients love anatomy – they love to know how everything works –
so it gives them a sense of control.”
Dr Acquilla also uses the Allergan app as an educational resource
in a training environment. “I recently used it at a conference with
around 2,000 delegates. I could stream it wirelessly to a huge
screen so I could show what was going on with the anatomy. It’s
fantastic for that, and as a reference tool,” he comments. “Even the
most advanced clinician can never know too much anatomy, so you
can have it open during clinic to refer back to.”
Enhancing objectivity within consultancy
One of the most important factors in optimising the results of a
treatment or procedure is to ensure that both parties are on the
same page when it comes to what the patient wants and expects,
and what the practitioner can deliver. Patients, however, can be
shy and embarrassed when discussing their perceived flaws and
problem areas. “In consultations,
when people do things the oldfashioned way of looking in the
mirror, they tend to put their best
side forward. They make little
tweaks to their face, to perhaps
make their lips fuller or puff their
cheeks out a little,” says aesthetic
nurse, Nikki Zanna. “I use the
iConsult app to capture real-time
images of the client, which we
can look at and identify concerns
together. It makes it much more
holistic, as you’re looking at the
face as a whole, rather than them
honing in on one line or one part of
22
Aesthetics Journal
Aesthetics
their face that bothers them.”
Patients get a more objective and accurate appraisal of their
needs, while practitioners are better able to present various
treatment options, bringing obvious benefits to their business.
“Selling doesn’t even become an issue,” Zanna adds, with
increased patient spend and consistent cross-selling both integral
aspects of the solution. As an early adopter of this technology
and having used it since its launch around 18 months ago, Zanna
has seen the app go through stages of development and evolve
into a patient management system that simplifies all aspects of
the treatment process, including record keeping, data capture,
consent, medical notes and visual representations of treatments.
It also enables product selection and mapping, recording of batch
numbers and expiry dates, and various admin tasks such as diary
management and financial reporting.
One of the most compelling functions of iConsult is that, in
providing a structured process for consulting, it also effectively
puts in place safeguards – there are compulsory fields that
the clinician must complete before they can move forward,
which means, as Zanna says, “you can’t miss anything”, thereby
protecting the patient and the practice.
Security concerns?
With the advancement of various technologies come inevitable
questions about privacy and the security of personal data. With
solutions like iConsult, the user has an account with robust
registration procedures and a personal login, which is used to
access the tablet interface. “Nothing is held on your iPad – it’s all
kept on a secure server,” says Zanna. “Even if your iPad was lost
or stolen, nobody can access those patient notes because you
have to log in to see everything.”
But what about digital assets that are in the public domain? When
a patient shares a photograph with Dr Patel, he instantly deletes
it once he has viewed it and decided on an appropriate course
of action. As Dr Patel points out, there is no more an issue with
privacy as there is with anyone placing a photo in the public
domain by sharing it on a social network. “We don’t use the
photos afterwards, and we treat patients’ selfies with the same
confidentiality we treat any patient photo,” he comments.
However, issues arise when assets – such as photos, videos
and personal data – are broadcast and made publicly available
without a person’s clear consent, or even their knowledge.
This is the basis of concerns about Google Glass,3 a ‘wearable
technology’ that allows users to take videos and images, commit
iConsult (Images courtesy of Richard Crawford-Small)
duction
Fat Re
lipomed
ng
Skin Tighteni
A Powerful Three Dimensional Alternative to Liposuction
Cellulite
No other system offers this advanced combination of
technologies designed to target fat removal, cellulite
and skin tightening without the need to exercise
This NEW advanced device is dedicated
exclusively to the clinical market
Why choose 3D-lipomed?
• A complete approach to the problem
• Prescriptive
• Multi-functional
• Inch loss
• Cellulite
• Face and Body skin tightening
• Highly profitable
• No exercise required
• National PR support campaign
• Clinician use only
Cavitation (Overall Circumference Reduction)
Cavitation is a natural phenomenon based on low
frequency ultrasound. The Ultrasound produces a
strong wave of pressure to fat cell membranes. A fat cell
membrane cannot withstand this pressure and therefore
disintegrates into a liquid state. The result is natural,
permanent fat loss.
Duo Cryolipolysis
(Superficial Targeted Fat Removal)
Using the unique combination of electro and cryo therapy
20-40% of the fat cells in the treated area die in a natural
way and dissolve over the course of several months.
Two areas can now be treated simultaneously.
Complete start up and support package
available from under £660 per month
Before
Treatment
of the Year
3D Lipomed
After
Before
Equipment Supplier
of the Year
3D Lipo Limited
Radio Frequency (Skin Tightening)
Focus Fractional RF is the 3rd generation of RF
technology. It utilises three or more pole/electrodes
to deliver the RF energy under the skin. This energy
is controlled and limited to the treatment area. Key
advantages of this technology are high treatment
efficacy, no pain as less energy is required, shorter
treatment services and variable depths of penetration.
After
The Pinnell Award for
Product Innovation
3D Lipomed
3D Dermology RF
(Cellulite Reduction)
The new 3D-lipomed incorporates 3D
Dermology RF with the stand alone
benefits of automated vacuum skin
rolling and radio frequency.
What the experts say...
‘As a Clinician I need to know that the treatments we offer are safe,
effective, scientifically based and fit in with our ethos of holistic care for
our clients. 3D-Lipo has delivered this to us’ Dr Mohamed Dewji – GP &
Medical Director LasaDerm Ltd (Milton Keynes)
For further information or a demonstration
call: 01788 550 440
www.3d-lipo.com
www.3d-skintech.com
Special Feature
Technology
@aestheticsgroup
them to their personal files and share them with others, through a
head-mounted frame: think a tiny camera hidden in the frames of
a pair of glasses, with built-in access to the Internet.
Google Glass is still in its infancy and it is currently only available
in the US (a UK user would have to buy them in the States and
import them), but one London practitioner is using the technology
in everyday practice to push the boundaries of what’s possible.
“It allows me to harness the power of the Internet or Wi-Fi, and
have anything streamed to that Glass [device], so I can see that
information while I’m doing other things,” explains facial cosmetic
surgeon, Dr Julian De Silva. “In surgery, I can access a patient’s
folder [via the Glass device] and see all the information about that
patient, access photographs of their face in different positions,
view X-rays and compare all
Google Glass (Image courtesy
of Dr Julian De Silva)
of that in real time with what
I’m looking at during the
surgery. That is all incredibly
useful.”
Particularly fascinating
is the capacity to use a
photograph or computer-generated image and superimpose
it onto the patient’s own face. Glass also enables Dr De Silva
to take photos and videos during the procedure to share with
the patient afterwards, for example, to demonstrate problems
encountered or how the surgery went. All files and images are
automatically saved to the user’s Google Drive account, so they
can be accessed later via a computer or other device. Moreover,
the user can connect to the Internet or Wi-Fi and stream photos or
videos captured from the surgeon’s perspective, giving viewers a
unique view of exactly what the surgeon is looking at.
The Google Glass technology has very clear and useful
applications in this setting; privacy is not a concern because
patient consent would be required for taking photographs during
surgery in any case. “If you find something during the surgery and
you need to document that, there is no privacy issue because
it’s a medical record,” Dr De Silva adds. “It’s only a consideration
if you’re going to share that information.” As such, aesthetics is
DigitRx (Image courtesy of Church Pharmacy)
24
Aesthetics Journal
Aesthetics
Google Glass enables
Dr De Silva to take photos and
videos during the procedure
to share with the patient
afterwards to demonstrate
problems encountered or
how the surgery went
arguably the ideal arena for Google Glass, as its users – doctors
and practitioners – are already bound by legal and moral
obligations over patient privacy and consent.
A prescription for the future
Records generated on automated systems can be secured by the
use of personal logins, which identify that users have appropriate
authorisation to access that data. Developers at Church Pharmacy
have built on this concept to establish DigitRx, a free online
prescription system that enables practitioners to create original scripts
online securely, without needing to post them. Dr David Bowden, an
aesthetic practitioner who has been using DigitRx since its launch in
October, explains how it has streamlined the process of prescribing,
saving time and resources.
“The old process of having to fax or email the prescription meant we
were effectively sending a picture – usually a poor quality one – of
the prescription to the pharmacy for them to process,” he says. “That
created problems in itself, because the dispenser might not be able
to read it properly, or they might have questions about the quantities,
so you’d end up speaking on the phone several times to clear things
up. You would also then have to send the original version, with your
signature, through the post as well.” DigitRx users are subject to a
robust and thorough registration and are provided with a four-digit
pin, which is unique to that prescriber in the same way a signature is.
As such, an original script is generated online with the prescriber’s
unique pin, negating the need for the paper version to satisfy
regulatory requirements. The online prescriptions go automatically
to the pharmacy, where they are processed by a qualified dispenser.
The system has safeguards in place to flag up erroneous data, such
as particularly high quantities of certain products or contraindications
with other medications a patient is taking. Dr Bowden says, “It can pick
up human error, like a typo for example, but there is also a function that
allows you to give an explanation if the product you’ve prescribed is
marginally over the usual dispensing limit. It gives you the control, but
at the same time there’s zero margin for error.”
Traditionalists and sceptics may still need to be convinced about
whether technology in these forms has a place in aesthetic practice.
But there is no doubt that it is beginning to permeate the industry in
many and varied ways: the question therefore may be when, rather
than if, the masses should join the ranks of the pioneers and fully
embrace the shift.
REFERENCES
1. ‘Selfie’ named by Oxford Dictionaries as word of 2013 (London: bbc.co.uk, 2013) <http://www.bbc.
co.uk/news/uk-24992393> [accessed 12/11/2014]
2. No-makeup selfies raise £8m for Cancer Research UK in six days (London: theguardian.com, 2014) <http://www.theguardian.com/society/2014/mar/25/no-makeup-selfies-cancer-
charity> [accessed 12/11/2014]
3. Arthur, C, Google Glass: is it a threat to our privacy? (London, theguardian.com, 2013) <http://www.
theguardian.com/technology/2013/mar/06/google-glass-threat-to-our-privacy> [accessed 12/11/2014]
Not all HA dermal fillers
are created equal.
Intelligent manufacturing technology creates
a variable density gel1 resulting in...
Optimal tissue integration2
Greater dermal compatibility3
Superior cosmetic results4
High patient satisfaction5
Contact Merz Aesthetics
NOW and ask for Belotero .
OPTIMAL
TISSUE
INTEGRATION
1. BEL-DOF3-001_01. 2. Tran C et al. in vivo bio-integration of three Hyaluronic Acid fillers in human
skin: a histological study. Dermatology DOI:10.1159/000354384. 3. Taufig A.Z. et al., J Ästhet Chir 2009
2:29 – 36. 4. Prager W et al. A Prospective, Split-Face, Randomized, Comparative Study of safety and
12-Month Longevity of Three Formulations of Hyaluronic Acid Dermal Filler for Treatment of Nasolabial
Folds. Dermatol Surg 2012, 38: 1143 – 1150. 5. Buntrock H, Reuther T, Prager W, Kerscher M. Efficacy,
safety, and patient satisfaction of a monophasic cohesive polydensified matrix versus a biphasic nonanimal
stabilized hyaluronic acid filler after single injection in nasolabial folds. Dermatol Surg. 2013; 39(7):1097-105.
Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product Characteristics
(SmPC) before prescribing. 1162/BOC/AUG/2014/PU Presentation 50 LD50 units of Botulinum toxin type
A (150 kD), free from complexing proteins as a powder for solution for injection. Indications Temporary
improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown
(glabellar frown lines) and lateral periorbital lines seen at maximum smile (crow’s feet lines) in adults under
65 years of age when the severity of these lines has an important psychological impact for the patient.
Dosage and administration Unit doses recommended for Bocouture are not interchangeable with those
for other preparations of Botulinum toxin. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines:
Intramuscular injection (50 units/1.25 ml). Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each
corrugator muscle and 1x procerus muscle. May be increased to up to 30 units. Injections near the levator
palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines:
Intramuscular injection (50units/1.25mL). Standard dosing is 12 units per side (overall total dose: 24 units);
0.1mL (4 units) injected bilaterally into each of the 3 injection sites. Injections too close to the Zygomaticus
major muscle should be avoided to prevent lip ptosis. Not recommended for use in patients over 65 years or
under 18 years. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to any of the excipients.
Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Presence of
infection or inflammation at the proposed injection site. Special warnings and precautions. Should not
be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration.
Adrenaline and other medical aids for treating anaphylaxis should be available. Caution in patients receiving
anticoagulant therapy or taking other substances in anticoagulant doses. Caution in patients suffering from
amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction. Too
frequent or too high dosing of Botulinum toxin type A may increase the risk of antibodies forming. Should not
be used during pregnancy unless clearly necessary. Should not be used during breastfeeding. Interactions
Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants
should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed
within the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness,
itching, swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal reactions
associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or tinnitus, may occur.
Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10); uncommon (≥ 1/1000,
< 1/100); rare (≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Glabellar Frown Lines: Infections and infestations;
Uncommon: bronchitis, nasopharyngitis, influenza infection. Psychiatric disorders; Uncommon: depression,
insomnia. Nervous system disorders; Common: headache. Uncommon: facial paresis (brow ptosis), vasovagal
syncope, paraesthesia, dizziness. Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision,
Tel: +44 (0) 333 200 4140
www.belotero.uk.com
BEL141/1014/LD Date of preparation: October 2014
blepharitis, eye pain. Ear and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon:
nausea, dry mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity,
dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of eyebrow),
sensation of heaviness. Uncommon: muscle twitching, muscle cramps. General disorders and administration
site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness, Influenza like illness,
fatigue (tiredness). Crow’s Feet Lines: Eye disorders; Common: eyelid oedema, dry eye. General disorders
and administration site conditions; Common: injection site haemotoma. Post-Marketing Experience; Flu-like
symptoms and hypersensitivity reactions like swelling, oedema (also apart from injection site), erythema,
pruritus, rash (local and generalised) and breathlessness have been reported. Overdose May result in
pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent
post-injection. Bocouture® may only be used by physicians with suitable qualifications and proven experience
in the application of Botulinum toxin. Legal Category: POM. List Price 50 U/vial £72.00 Product Licence
Number: PL 29978/0002 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer
Landstraße 100, 60318 Frankfurt/Main, Germany. Date of revision of text: August 2014. Further information
available from: Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire WD6 3SR.
Tel: +44 (0) 333 200 4143
Adverse events should be reported. Reporting forms and information can be found at
www.mhra.gov.uk/yellowcard Adverse events should also be reported to Merz Pharma UK Ltd
at the address above or by email to [email protected] or on +44 (0) 333 200 4143.
1. Bocouture 50U Summary of Product Characteristics. Bocouture SPC 2014 August available from: URL:
http://www.medicines. org.uk/emc/medicine/23251.
2. Prager, W et al. Onset, longevity, and patient satisfaction with incobotulinumtoxinA for the treatment of
glabellar frown lines: a single-arm prospective clinical study. Clin. Interventions in Aging 2013; 8: 449-456.
3. Sattler, G et al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared with
another botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010; 36: 2146-2154.
4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily
practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58.
5. Data on File: BOC-DOF-11-001_01
Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.
1181/BOC/OCT/2014/LD Date of preparation: October 2014
CPD
Lasers and Acne
one
point
@aestheticsgroup
Aesthetics Journal
Aesthetics
photochemical effect on the superficially-located P. acnes. Both
visible and ultraviolet light sources have been reported to result
in a reduced number of lesion counts.4 Endogenous porphyrins
within P. acnes are thought to absorb light at specific wavelengths
which then produce phototoxic effects in the form of singlet oxygen
production resulting in bacterial destruction.5 Current hypothesis
regarding infrared lasers is that they are thought to momentarily
damage sebaceous glands via thermal effects, detailed in Table 1.6
This article explains the effectiveness of laser and light therapy in
the treatment of acne. The article does not cover the treatment of
acne scarring with laser and light devices.
Laser and light treatments
in acne: in search of the
evidence
Abstract
Acne vulgaris is a common condition which remains challenging
to treat in some cases. Laser and light-based therapies offer
an alternative to medical therapies with the advantage of high
compliance and relatively low side-effects. Light-based therapies
in acne exert their effects through photochemical, photothermal, or
a combination of both mechanisms. This article explains the mode
of action for each light-based modality and examines the current
evidence in this field.
Introduction
Acne vulgaris is one of the most prevalent skin disorders,
which often occurs in a large number of individuals during their
adolescent years. It has the potential to cause significant scarring
and psychological impact.1 There are a large number of treatment
options available to patients at present, however, these are not
without side-effects. In many cases the disease can be resistant
to therapy, hence the desire for additional, alternative treatment
options. Non-compliance, the lack of desire for systemic therapy,
coupled with the desire for the use of modern technology has led to
an increase in the demand for alternative non-medical therapies in
acne. Of late, interest in lasers and other light-based treatments has
increased. One of the main advantages of the use of lasers in acne
is the high degree of compliance and the negligible rate of potential
systemic adverse events.2
The mechanisms of light-based therapies in acne could be divided
into: photochemical effects (with or without the use of exogenous
photosensitizer), photothermal effects, or the combination of
both. An alternative approach is to divide the effects of lightbased therapies on specific targets in the skin; namely the
Propionibacterium acnes (P. acnes), the follicular infundibulum, or
the sebaceous glands. It is worth mentioning here that therapies
directed at either of these targets will have a degree of antiinflammatory effects, leading to an overall improvement in the
treatment of acne.
UV phototherapy is not often used in the treatment of acne
due to the carcinogenic potential. Its mechanism of action is
likely to be related to the production of superoxide anions, as
well as membrane damage and single strand breaks in DNA.3
Desquamative effects are also likely to play a role as well as a mild
26
Blue and red light:
Low-level light in the form of continuous, non-coherent blue and/
or red light-emitting diodes (LEDs) were known to be used in acne
treatment because of their photochemical effects. With pulsed
systems, low fluences can exhibit similar photochemical effects
depending on the tissue oxygen availability and may require
an extrinsic photosensitizer or multiple passes in comparison
to the continuous-output LEDs. Although blue light has poor
skin penetration (less than 100 micron), with a wavelength of
407-420 nm it exhibits the strongest porphyrin photo-excitation
co-efficient and thus is the most effective wavelength to photoactivate the endogenous porphyrins contained in P. acnes.7 The
coproporphyrins, the main porphyrin produced by the P. acnes acts
here as a chromophore. An in vitro study demonstrated that blue
light activation of porphyrin led to structural membrane damage
in P. acnes, suggesting cell death.8 Culture growths were indeed
decreased 24 hours after one illumination with intense blue light at
407-420 nm. Growth was reduced 4-5 orders of magnitude further
with second and third illuminations of light.8
One of the main limitations of blue light is its poor penetration and
a degree of loss, secondary to scattering or melanin absorption.
Its main target is therefore likely to be in the follicular infundibulum.
Red light however penetrates the skin at a deeper level,
reaching up to the sebaceous gland. It is thought to have antiinflammatory properties by influencing the release of cytokines from
macrophages, as well as photothermal effects directly aimed at the
sebaceous glands.9 There have been a number of studies involving
both blue and/or red light in the treatment of acne. Most were
open-labelled with few split-face comparative studies. The sample
sizes were relatively small (20-50 patients) and all studies noted an
improvement in acne lesions. One study looked at red light alone
and found that, when used in a split-faced randomised controlled
trial; there was a significant improvement in both inflammatory and
non-inflammatory lesions.10
In summary, blue and red light may act synergistically in the
treatment of acne through bactericidial effects (blue light) and antiinflammatory effects (red light).
Pulse dye laser (PDL):
The 585/595 nm PDL targets oxyhaemaglobin and results in
selective photothermolysis of the dilated vessels that form a part
of the inflammatory process in inflammatory acne.5 Additional
mechanisms possibly include a photochemical effect on the
porphyrins produced by the P. acnes. Porphyrins are activated via
the delivery of yellow light, which results in phototoxic effects.5,7
Fourteen studies using PDL to treat acneiform lesions have
been reported throughout the literature available. There were
significant methodological differences between the studies; six
@aestheticsgroup
Aesthetics Journal
Aesthetics
used PDL therapy alone and five used PDL therapy combined
with topical agents (5-aminolevulinic acid, methylaminolevulinic
acid, clindamycin, or benzyl peroxide). In the studies that used
PDL in combination with topical agents, four cases reported an
improvement in inflammatory lesions ranging from 30-80%. In cases
of PDL used alone, three cases reported a significant reduction
(53-86%) in inflammatory lesions. PDL did not significantly reduce
the number of non-inflammatory lesions in any of the cases. Three
studies reported PDL to have no significant change in the number of
lesions when used alone or in combination with topical agents.
One study by Seaton et al suggested that PDL had no effect
on P. acnes colonization or sebum production (measured using
the application of absorptive tape).11 They did however note
upregulation of transforming growth factor B (TGF-beta). Given
that this is a potent inhibitor of inflammation, the finding suggests
that this laser may act through anti-inflammatory effects. It has
also shown to inhibit CD4+ T-lymphocyte mediated inflammation.
TGF-beta may also induce keratinocyte growth arrest, which could
possibly interfere with comedone formation. Sami et al compared
PDL/Intense pulsed light (IPL) and LEDs in the treatment of 45
patients with moderate to severe acne. They found that a clearance
of 90% of inflammatory lesions was achieved quicker with the use of
PDL over IPL, which was more effective than LED.12
The exact mechanism of how PDL works appears to be
multifactorial. The photothermal effect on the sebaceous glands is
achieved partly by heating the dermal microvasculature, secondary
to the oxyhaemoglobin absorption. It is hypothesized that the
generated heat leads to the induction of heat shock proteins, such
as HSP70, which in turn could play a role in TGF-beta production.
In summary, although the exact parameters are not yet established,
and the studies have shown conflicting and inconsistent results,
PDL is likely to work due to both photochemical and photothermal
effects. The debate on the true efficacy and role of PDL in acne
treatment is ongoing.
CPD
Lasers and Acne
Infrared lasers
1450 nm and 1540 nm lasers: Infrared lasers penetrate deep into
the dermis targeting water as their main chromophore. Water is
the dominant chromosphere in the sebaceous gland, thus infrared
lasers are thought to arrest the production of sebum and eliminate
acne. Both the 1450 nm and 1540 nm lasers have been used in
this manner.15 Seventeen studies reported the use of these lasers,
12 were open-label and five were randomised. The 1540 nm laser:
The 1540 nm Erbium glass laser is a mid-infrared laser and has
effectively been used to treat acne lesions in four studies. A 78%
reduction in acne lesions was observed in 25 patients after four
treatments at four weeks interval.16 Kassir et al noted a similar
reduction (82%) at three months in 20 patients who received
treatments twice a week for four weeks.17 Angel et al demonstrated
the longest clearance effects of the 1540 nm laser (two-year follow
up).18 The mean percentage reduction of 18 patients treated with
four treatments at four-week intervals was 71%, 79% and 73 % at six,
nine and 24-month follow-up respectively. Inflammatory acne was
shown to improve by 68% in 15 patients with moderate to severe
acne treated four times at two-week intervals; however there was
no reported change in sebum production.19 Virtually no side-effects
were reported with the use of this laser. It is likely that this laser
exhibits its effects through non-selective heating of the sebaceous
glands.
The 1450 nm laser: This laser was first used in a study of 19 patients
with inflammatory acne in which traditional therapies had failed.
A fluence of 14 J/cm2 was used in three treatments at four to six
week intervals and a 37% and 83% reduction in lesion count was
observed after the first and third treatment respectively. Side effects
included transient erythema and oedema.20 A randomised split-face
trial was carried out to compare two treatment fluences by Jih et
al. Twenty patients received three treatments at three to four week
intervals, after one treatment the percentage reduction in mean
acne lesion count was 43% (14 J/cm 2) and 34% (16 J/cm2), patients
were followed up for 12 months and the reduction in lesion count
was 76% (14 J/cm 2) and 70% (16 J/cm).21 Acne scarring and sebum
production also improved.
The 1450 nm diode laser heats the upper mid dermis to a depth
of 500 micrometres and can result in thermal coagulation of the
sebaceous lobule and the follicular infundibulum.5 It is thought
to improve acne lesions via heating the sebaceous gland and
reducing its activity. Perez-Maldonado et al displayed an 18%
reduction in sebum production (measured by sebutape scores)
in eight patients treated with the 1450 nm diode laser for three
treatments over a period of six weeks.22 Contrasting results were
Potassium titanyl phosphate (KTP):
This 532 nm laser emits green light pulsed laser therapy, which
penetrates deeper than blue light. It activates porphyrins, which
target P. acnes, as well as causing non-specific thermal injury to
the sebaceous gland. It therefore exhibits a photochemical as well
as mild photothermal effect. It has been shown to have short-term
results on acne lesions with few side effects. Four open-label studies
have assessed the effectiveness of the KTP laser in the treatment
of acne. In a split-face, prospective controlled trial of 26 patients
with moderate acne, Baugh et al reported that KTP laser was a
safe and effective method of treating acne
Table 1: Target chromophore of laser/light in the treatment of acne
lesions.13 Results lasted up to four weeks after
treatment, with a 21% reduction on lesion count
at four weeks versus a 35% reduction at one
Target
Laser/light device
week. Bowes et al carried out a prospective,
split-face study of 11 patients and noted a 36%
UV, blue light, red light,
reduction of mild to moderate acne lesions in
P. acnes
blue/red light combination
comparison to 2% in the control side. Yilmaz
et al also supported the use of this laser in
Infrared lasers (1064 nm
the treatment of mild to moderate acne in 38
Sebaceous glands
Nd:YAG, 1320 nm, 1450
patients. Their findings showed that there was
nm, 1540 nm), and PDT
no difference between once or twice weekly
applications.14 Despite these studies, the results
Combination of P. acnes
KTP, PDL, IPL, and PDT
are generally short-term and this laser is not
and sebaceous glands
often used in the management of acne.
Mode of action
Photochemical
Photothermal
Photothermal and
photochemical
27
CPD
Lasers and Acne
@aestheticsgroup
seen in fourteen healthy subjects (without active acne), with this
laser showing no significant reduction on sebum production.23 A
split-face bilateral paired study treated 11 patients with the 1450 nm
diode laser at a fluence of 11 J/cm2. One half was treated with a
single pass consisting of stacked double pulses and was compared
to a double pass treatment of single pulses. The stacking of pulses
was more effective in reduction of acne lesion count compared to
the multi-pass technique.24 Lower fluences elicit less pain whilst still
effectively treating inflammatory lesions. Single pulse multiple pass
methods may have a reduced chance of cryogen-induced transient
hyperpigmentation in comparison to the standard high fluence
techniques.
Yeung et al supported that multiple pass/lower fluence can still
retain efficacy but reduce post-inflammatory hyperpigmentation.25
Bernstein et al performed a randomised split-face trial of six patients
with papular acne, comparing single pass high-energy treatment
(13-14 J/cm2) and double pass low-energy treatments (8-11 J/cm2) for
four treatments at monthly intervals. Single pass high energy had
greater reduction in lesion count reduction (78% vs 67%), however
pain score was greater in the single pass group (5.6 vs 1.3).26 The
1450 nm diode laser in combination with the 585 nm laser has
been shown to be effective in the treatment of inflammatory acne,
acne scarring and post inflammatory erythema in 15 patients. The
addition of microdermabrasion to the 1450 nm diode laser showed
no significant benefit for treatment effectiveness or pain in a
randomized split-face trial of 20 patients.27
Despite the results of the aforementioned studies, this laser is
associated with a relatively high degree of pain and discomfort and
is no longer considered a laser of choice in the treatment of acne by
many laser dermatologists worldwide.
Photodynamic therapy (PDT)
PDT involves the use of a photosensitizer, which is taken up by the
pilosebaceous unit and undergoes metabolism through the haemsynthesis pathway and results in the production of protoporphyrin
IX.28 The activation of this pathway leads to the production of free
radicals and singlet oxygen, which are cytotoxic. Accumulation of
this in the epithelium and pilosebaceous unit lead to elimination
of the P. acnes and modulation of the sebaceous gland and
infundibulum. P. acnes cultures grown in the presence of ALA
led to a 5-fold decrease in culture viability after 3 illuminations
of high intensity blue light. For PDT to be effective, light, oxygen
and a photosensitizer are required: 5-aminolevulinic acid or
methylaminolevilunate (MAL), Indocyanine green (ICG) and Indole3-acetic acid are used as photosensitizers. A light source can be
a light emitting diode, fluorescent lamps, lasers, sunlight, xenon
flash lamps, arc lamps and filtered incandescent lamps. P. acnes
photo-inactivation can be altered depending on the concentration
of porphyrins which is governed by the type of acne lesion, effective
fluence, wavelength of the photons emitted and the temperature.29
Twenty studies using PDT in acne were published, (11 randomised
trials and nine open-label). Intense Pulsed light (IPL) source was
used in four studies (one randomised split-face, open-label; one
randomized open-label study, and one split-face pilot study).
Aminoluevelunic acid (ALA) was used in four cases and MAL in one
case. Yeung et al noted a 65% reduction in inflammatory lesions
after 12 weeks following PDT in comparison to 23% reduction when
using IPL alone.30 Similar findings were found by Rojanmatin et al
at 12-week follow-up in a split-face trial.31 The PDT side had 87%
reduction in lesions in comparison to 66% reduction with IPL alone.
28
Aesthetics Journal
Aesthetics
P. acnes photo-inactivation
can be altered depending
on the concentration
of porphyrins which is
governed by the type of acne
lesion, effective fluence,
wavelength of the photons
emitted and the temperature
Another split-face trial using ALA with IPL was conducted by Santos
et al, which assessed 13 patients. Ten out of 13 patients using the
combination treatment showed marked improvement in comparison
to the IPL alone group. Different modalities were compared by Taub
et al, which compared IPL, IPL and bipolar radiofrequency (RF) and
blue light for activating ALA-induced protoporphyrin IX. ALA-PDT
activation with IPL provided the greatest and longest lasting effects
in comparison to RF-IPL and blue light.32 Five studies used longpulse PDL, (one randomised controlled split-face single blinded
trial, one cross-sectional comparative controlled prospective study,
one split-face open-label study, and one prospective randomized
study). MAL was used in conjunction with long-pulse PDL in two
studies Haersdale et al33 saw a significant reduction in lesion count
in the PDT-treated areas. A reduction in both inflammatory and noninflammatory lesions was noted; however erythema and oedema
were reported as significant side effects.
An interesting study by Hongcharu et al34 with ALA followed by
irradiation with red light showed histological evidence of sebaceous
gland hypotrophy with glandular destruction. Furthermore, ALAPDT decreased P. acnes fluorescence, a marker for bacterial
colonization, as well as sebum secretion post therapy. Despite such
encouraging findings, some studies using ALA followed by red light
have failed to show any significant reduction in sebum production or
P. acnes colonization.34
Of 18 patients studied by Taub et al, 11 were noted to have a 50%
improvement and five to have a 75% improvement.32 Side-effects
included erythema and peeling. Goldman et al followed-up 22
patients for two weeks and noted an improvement in lesion count
with no reported side effects. There was a greater response in the
ALA-blue light group compared to the blue light group alone.35 The
same author used short contact ALA of one hour with either an
IPL source or blue light with relative clearance of the inflammatory
lesions. Gold et al also used short contact ALA of 30-60 minutes
in combination with blue light in moderate-to-severe inflammatory
acne and noted a response rate of 60%. Blue light was also used
in combination with ALA in two studies. Itoh et al used halogen light
with a filtered band of 600-700 nm in combination with ALA in 13
patients. All patients showed an improvement in their inflammatory
component.36
MAL is a lipophilic derivative of ALA and may therefore have better
penetration. Its use as a photosensitizer in acne therapy was used
in two European studies. The first by Wiegell and Wulf37, the second
study by Horfelt et al.38 Both studies showed a modest improvement
in acne lesions with occlusion time of three hours.
New e-Pharmacy coming soon
Simple Ordering
Best Market Price
Top Service
Leading Products
V YCROSS
The best formula for your clinic
Award winning, clinically proven products and outstanding service
healthxchange.com
aqualyx.co.uk
[email protected]
obagi.uk.com
intraceluk.com
+44 (0)1481 736837
CPD
Lasers and Acne
@aestheticsgroup
Key points
• Laser and light-based therapies offer an alternative
to the currently available medical therapies in the
treatment of acne vulgaris
• The mode of action in light-based therapies is achieved
largely through photochemical, photothermal, or the
combination of both mechanisms
• The current literature provides conflicting and
inconsistent results with most of the evidence in favour
of blue/red light and photodynamic therapy
• Intense pulsed light and pulsed dye laser are useful
adjuncts in the treatment of – predominantly –
inflammatory acne with associated acne erythema
• Photopneumatic therapy is an exciting novel therapy in
acne with evidence in it’s use in mild-to-moderate acne
cases
Intense pulsed light (IPL)
An IPL device delivers an intense source of light, the wavelength
of which can be modified via the use of filters. The generated
pulsed light is polychromatic and non-coherent and the emitted
light can be tailored to the treatment by alteration of the filtered
light, pulse duration, and fluence. IPL technology works in singleand burst-pulse modes. In the single-pulse mode, the fluence
will be delivered in single shot, whereas in burst-pulse mode
fluence is divided into series of pulses with a delay between each
one. The theory of treating acne lesions with IPL is based on the
photochemical and photothermal (higher settings) effects on the
bacterial-derived porphyrins, as well as the inflammatory cells
that mediate an inflammatory cascade, heating of the sebaceous
glands, and small vessels associated with the process.39 The
photochemical effects are likely to occur due to the blue and red
range of light emitted by the IPL, whereas the infrared range of
light has more of a photothermal effect on the sebaceous glands
and dermal vasculature. IPL was used in nine studies with mixed
results. Elman et al used 430-1100 nm source in patients with
moderate acne and saw a 74% and 79% reduction in inflammatory
and non-inflammatory lesions, respectively, following twice weekly
therapy for four weeks.15 Lee et al carried out a split-face control
trial in patients with mild to moderate acne and noted a significant
reduction in both inflammatory and non-inflammatory lesions in
comparison to no treatment.40 A further split-face trial with the use
of Benzoyl peroxide with or without IPL did not show a significant
difference in comparison to using IPL alone. Dierickx et al
demonstrated a clearance rate of 72% at six months post therapy.41
IPL was combined with RF and results showed that the mean lesion
count was reduced by 47%; it was suggested that this reduction
was due to reduction in sebaceous gland size and decreased perifollicular inflammation. Their findings were based on post treatment
skin biopsies. 42 In comparison with other modalities, IPL has been
found to be less effective than PDL but more effective than blue or
red light.
Photopneumatic therapy
Photopneumatic therapy (PPX) combines pneumatic energy and
broadband light (400-1200 nm) encompassing the blue wavelength
410 nm, which is the wavelength that is greatest for porphryin
absorption. The suction acts to lift the contents of the dermis
bringing them closer to the skin surface, thus making energy
transfer more effective. The epidermis, and therefore melanin in
30
Aesthetics Journal
Aesthetics
the epidermis, is spread out and the photo pneumatic treatment
reduces adverse effects on the epidermis such as pigmentary
changes.43 In addition, the suction applied due to negative pressure
may help to rid comedones of their contents. The action of PPX
therefore involves a combination of thermal and vacuum-related
mechanical effects. A number of studies have used this technology
in the treatment of acne. Fifty-six patients with mild to severe
acne were treated with PPX and were reported by Shamban et
al to have a 50% clearance of lesions after one session and 90%
after four sessions.43 Omi et al observed ultrastructural changes
to the pilo-sebaceous unit after PPX treatments.44 Histologically,
the authors were able to observe extrusion of comedone
contents from the infundibulum and thermal injury to the bacteria
and pilosebaceous apparatus, supporting the theory that PPX
decreased sebaceous gland activity. No adverse effects were
reported. Gold and Biron demonstrated efficacy with PPX in seven
patients treated with a total of four treatments at three-week
intervals.45 A larger study by Wanitphakdeedecha et al involving
20 patients who were treated at two-week intervals demonstrated
modest improvement in acne lesion counts.46
In a prospective, multicentre, clinical trial involving 41 patients with
mild-to-moderate acne, Narurkar et al reported a 69% reduction
in the inflammatory component, in contrast to 41% reduction in
the non-inflammatory component of the disease.47 There were
no adverse effects caused by the treatment, with mild discomfort
and transient erythema being the most reported side-effects. In
my experience, this treatment is effective in the mild to moderate
cases of acne and in combination with topical therapy.
Discussion
The treatment of acne vulgaris often requires combination therapy
and a tailored treatment regimen, specific to each case. Despite
advances in our understanding of the disease and the wide array
of topical and systemic therapies available, in many cases the
disease can still be resistant to medical therapy and hence lightbased treatments may offer an alternative or act as adjuncts. Lightbased technologies can largely be based on their photothermal
effect, predominantly on the sebaceous glands and their
associated dermal vessels, or on their photochemical effects by
targeting the coproporphyrins produced by P. acnes, leading to cell
death. The photochemical effects can be produced with or without
the application of a photosensitizer such as ALA, although most of
the current evidence points toward the PDT-mediated effects of
therapy on acne. This is particularly the case when a sustainable
duration of the results is taken into consideration. Unfortunately the
side effects with PDT appear to be the main limiting factor for their
use in the treatment of acne in the majority of the cases.
• Blue and red light therapy in the form of LEDs has shown efficacy
with the former exhibiting a photochemical effect and the latter a
predominantly immunomodulator and anti-inflammatory effect, in
addition to some photothermal effects. These effects appear to
be superior again when combined with a photosensitizer (i.e PDT
effect as opposed to LED alone).
• IPL has shown to be effective with its broadband range having
a combination of photochemical and photothermal effects,
although again the studies have shown that IPL combined with a
photosensitizer is superior to IPL therapy alone. Furthermore, when
compared against PDL, the latter showed a superior effect.
@aestheticsgroup
Aesthetics Journal
Aesthetics
Despite the large number
of studies published
utilising light-based
technologies in acne,
the results are mixed and
firm conclusions are
difficult to draw
• Studies using the PDL in acne showed conflicting results too,
and although evidence of TGF-beta upregulation has been
shown, this does not appear to be sufficient in controlling the
disease in many cases. Both PDL and IPL have a place in acne
treatment today, particularly in the cases where it is associated
with acne-induced facial erythema. This is similarly the case
with the KTP laser. Infrared lasers are less widely used for acne
treatment nowadays, due to the associated pain and discomfort.
• PPX is a relatively new technology in the treatment of acne and
appears to be effective in mild-to-moderate cases combining both
photochemical effects with mechanical extrusion of comedonal
contents in addition to a mild photothermal effect.
• Despite the large number of studies published utilising light-based
technologies in acne, the results are mixed and firm conclusions
are difficult to draw. Many studies were open-labelled or lacked
optimal methodological qualities and involved a relatively small
number of patients. Lack of objective assessment of outcome
further contributes to the somewhat tempered enthusiasm of the
use this technology in acne. Larger, randomized, controlled trials
with clear objective outcome measures and consistent agreed
settings (which vary hugely among the published studies) would
be needed.
Conclusion
Laser and light based therapies may act as alternative treatments
for patients that have not responded or are not suitable for medical
therapy. The effects of light-based therapies rely on photochemical,
photothermal, or the combination of both. For light-based therapies
to be effective, ideally targeting both the P. acnes, as well as the
sebaceous glands, appears to be the best approach. To date,
most of the studies were underpowered or showed inconsistent
results with relatively small number of patients involved. Optimal
parameters are yet to be established. In my opinion, light-based
therapies often offer very effective treatment when combined with
medical therapies in selected patients.
Dr. Firas Al-Niaimi is a consultant dermatologist
and laser surgeon. He trained in Manchester and
subsequently did a prestigious advanced surgical and
laser fellowship at the world-renowned St. John’s Institute
of dermatology at St. Thomas’ Hospital in London. He has
authored more than 80 publications including chapters of books and
is on the advisory board for a number of respected journals.
CPD
Lasers and Acne
REFERENCES
1. Webster GF. Acne vulgaris. BMJ. 2002;325(7362):475-9.
2. Jih MH, Kimyai-Asadi A. Laser treatment of acne vulgaris. Semin Plast Surg 2007;21(3):167-74.
3. McGinley KJ, Webster GF, Leyden JJ. Facial follicular porphyrin fluorescence. Correlation with age and density of Propionibacterium acnes. Br J Dermatol. 1980;102:437-41.
4. Papageorgiou P KA, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br J Dermatol. 2000;142:973-8
5. Rai R NK. Laser and light based treatments of acne. Indian J Dermatol Venereol Leprol. 2013;79(3):300-9.
6. Lloyd J R MM. Selective photothermolysis of the sebaceous glands for acne treatment. Lasers Surg Med. 2001;31:115-20.
7. Elman M SM, et al. The effective treatment of acne vulgaris by a high-intensity, narrow band 405-
420 nm light source. J Cosmet Laser Ther. 2003;5(2):111-7.
8. Ashkenazi, H., et al., Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. FEMS Immunol Med Microbiol, 2003. 35(1): p. 17-24.
9. Leyden JJ MK, et al Propionibacterium levels in patients with and without acne vulgaris. J Invest Dermatol 1975. 1975;65(4):382-4
10. Na JI SD. Red light phototherapy alone is effective for acne vulgaris: randomized, single-blinded clinical trial. Dermatol Surg. 2007;33(10):1228-33
11. Seaton ED MP, et al Investigation of the mechanism of action of nonablative pulsed-dye laser therapy in photorejuvenation and inflammatory acne vulgaris. Br J Dermatol. 2006;155(4):748-55.
12. Sami NA AAea. Phototherapy in the treatment of acne vulgaris. J Drugs Dermatol. 2008;7(7):627-32.
13. Baugh WP KW. Nonablative phototherapy for acne vulgaris using the KTP 532 nm laser. Dermatol
Surg. 2005;31(10):1290-6.
14. Yilmaz O SN. Evaluation of 532-nm KTP laser treatment efficacy on acne vulgaris with once and twice weekly applications. J Cosmet Laser Ther. 2011;13(6):303-7.
15. Elman M LG. The role of pulsed light and heat energy (LHE) in acne clearance. J Cosmet Laser Ther 2004;6(2):91-5.
16. Boineau D AS, et al Treatment of active acne with an erbium glass (1.54 micron) laser. Lasers Surg Med 2004;16(1):55.
17. Kassir M ND, et al. Er: Glass (1.54 mm) laser for the treatment of facial acne vulgaris. Lasers Surg Med 2004;34:s65.
18. Angel S BD, et al . Treatment of active acne with an Er:Glass (1.54 microm) laser: a 2-year follow-
up study. J Cosmet Laser Ther. 2006;8(4):171-6.
19. Bogle MA DJ, et al. Evaluation of the 1,540-nm Erbium:Glass Laser in the Treatment of Inflammatory Facial Acne. Dermatol Surg. 2007;33(7):810-7.
20. Friedman PM JM, et al. . Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study. Dermatol Surg. 2004;30(2):147-51.
21. Jih MH FPea. The 1450-nm diode laser for facial inflammatory acne vulgaris: dose-response and 12-month follow-up study. J Am Acad Dermatol. 2006;55(1):80-7.
22. Perez-Maldonado A RT, Krejci-Papa N. The 1,450-nm diode laser reduces sebum production in facial skin: a possible mode of action of its effectiveness for the treatment of acne vulgaris. Lasers Surg Med. 2007;39(2):189-92.
23. Laubach HJ AS, et al. . Effects of a 1,450 nm diode laser on facial sebum excretion. Dermatol Surg. 2009;35(8):1181-7.
24. Uebelhoer NS BMea. Comparison of stacked pulses versus double-pass treatments of facial acne with a 1,450-nm laser. Dermatol Surg. 2007;33(5):552-9.
25. Yeung CK SS, et al. Treatment of inflammatory facial acne with 1,450-nm diode laser in type IV to V Asian skin using an optimal combination of laser parameters. J Drugs Dermatol. 2009;8(3):239-41.
26. Bernstein EF. A pilot investigation comparing low-energy, double pass 1,450 nm laser treatment of acne to conventional single-pass, high-energy treatment. Lasers Surg Med. 2007;39(2):193-8.
27. Wang SQ, Counters JT, Flor ME, Zelickson BD. Treatment of inflammatory facial acne with the 1,450 nm diode laser alone versus microdermabrasion plus the 1,450 nm laser: a randomized, split-face trial. Dermatol Surg. 2006;32(2):249-55.
28. Pollock B TD, et al . Topical aminolaevulinic acid-photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Br J Dermatol. 2004;151(3):616-22.
29. Riddle CC, Terrell SN, Menser MB, Aires DJ, Schweiger ES. A review of photodynamic therapy (PDT) for the treatment of acne vulgaris. J Drugs Dermatol. 2009;8:1010-9.
30. Yeung CK SS, et al comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin.Lasers Surg Med. 2007;39(1):1-6.
31. Rojanamatin J CPT. Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5-aminolevulinic acid: a pilot study. Dermatol Surg. 2006;32(8):991-6.
32. Taub AF. A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. J Drugs Dermatol. 2007;6:1010-6.
33. Haedersdal M, Togsverd-Bo K, Wiegell SR, Wulf HC. Long-pulsed dye laser versus long-pulsed dye laser-assisted photodynamic therapy for acne vulgaris: A randomized controlled trial. J Am Acad Dermatol 2008;58:387-94. 34. Hongcharu W, Taylor CR, Chang Y, et al. Topical ALA-photodynamic therapy for the treatment of acne vulgaris. JID 2000;115(2):183-92.
35. Goldman MP BS. A single-center study of aminolevulinic acid and 417 NM photodynamic therapy in the treatment of moderate to severe acne vulgaris. J Drugs Dermatol. 2003;2:393-6.
36. Itoh Y NY, et al Photodynamic therapy of acne vulgaris with topical delta-aminolevulinic acid and incoherent light in Japanese patients. Br J Dermatol. 2001;144:575-9.
37. Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled study. Br J Dermatol. 2006; 154 (5):969-76.
38. Horfelt C, Funk J, Frohm-Nilsson M, Wiegleb Edstrom D, Wennberg AM. Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study. Br J Dermatol. 2006; 155(3):608-13.
39. Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med. 2010;42(2):93-104.
40. Lee EJ LH, et al An open-label, split-face trial evaluating efficacy and safty of photopneumatic therapy for the treatment of acne. Ann Dermatol. 2012;24(3):280.
41. Dierickx CC. Treatment of acne vulgaris with a variable-filtration IPL system. Lasers Surg Med 34(S16):66 (2004).
42. Prieto VG ZPJ. Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. J Cosmet Laser Ther. 2005;7(2):63-8.
43. Shamban AT EM, et al Photopneumatic technology for the treatment of acne vulgaris. J Drugs Dermatol. 2008;7(2):139-45.
44. Omi T MG, et al .Ultrastructural evidence for thermal injury to pilosebaceous units during the treatment of acne using photopneumatic (PPX) therapy. J Cosmet Laser Ther. 2008;10(1):7-11.
45. Gold M, Biron J. Efficacy of a novel combination of pneumatic energy and broadband light for the treatment of acne. J Drugs Dermatol. 2008;7:639:42.
46. Waniphakdeedecha R, Tanzi E, Alster T. Photopneumatic therapy for the treatment of acne. J Drugs Dermatol. 2009;8:239–41.
47. Narurkar VA, Gold M, Shamban AT. Photopneumatic technology used in combination with profusion therapy for the treatment of acne. J Clin Aesth Derm. 2013;6(91):36-40.
31
Advertorial
Church Pharmacy
@aestheticsgroup
Aesthetics Journal
Aesthetics
THE DIGITAL REVOLUTION
IN PRESCRIBING
Zain Bhojani, co-director of Church Pharmacy, introduces DigitRx, a secure online prescription
ordering system that makes the entire process fast, easy and convenient.
“Having a secure, online way of
prescribing is extremely important.
Eventually, all prescriptions will be
done this way.”
If you are not an existing Church Pharmacy customer, you can register with us on our website
www.churchparmacy.co.uk where you can sign up for DigitRx
Contact us on 01509 357 300 or email [email protected]
32
powered by
@aestheticsgroup
Aesthetics Journal
1. HOW TO USE DIGITRx
Create a
Digit Rx
For a full user guide and demo, please contact [email protected]
Shopping
Cart
or a Signed/
Stock order
Advertorial
Church Pharmacy
Aesthetics
Select your
delivery
details and
Double check
your order
Checkout
carriage
2. SPECIAL FEATURES: My Drafts
3. SPECIAL FEATURES: My Account
Details
of your
drafts
are
shown
here
Click View to launch a pop up window
with the details of your draft order
Here, you can
view or print a
copy of your
invoice
Your tracking
number will
appear here
Shows the status
of your delivery
Click here to add your draft to the Shopping
Basket and proceed with checkout
4. SPECIAL FEATURES: Patient History
Click here to view the Patient History
Click here to
repeat your
previous
prescription
33
Clinical Focus
25 Years in Aesthetics
@aestheticsgroup
Aesthetics Journal
Aesthetics
25 years
in aesthetics
Aesthetics editor, Amanda Cameron, reflects on
25 years of medical aesthetics with industry
pioneers Dr Tracy Mountford and Dr Patrick Bowler
I first started working in the aesthetic
medical market in 1989 when, apart from
surgery, chemical peels and some lasers,
there was only one injectable for wrinkle
correction – bovine collagen.
Whilst I worked for Collagen Corporation
as a sales and training manager, I met
innovators who were moving into the
world of non-surgical rejuvenation. At
the time it was deemed as a significant
move away from other medical specialities. I soon became used to
dealing with questions from those who found injecting a substance
into the face – for what appeared to be reasons of vanity – a very
strange subject.
Reflecting on the number of products and services available to
improve the appearance of the face and body, the number of
practitioners offering those services, as well as the number of
companies involved in the manufacturing and distribution of aesthetic
products, it is clear that the industry has come a long way in the past
25 years.
In those early days, two of my
first customers were Dr Tracy
Mountford and Dr Patrick
Bowler, who I am delighted to
say remain my friends today.
They saw the potential of
the market and worked hard
to gain the knowledge and
skills required to practise aesthetics. I need not tell you about the
success they have achieved, as I am sure that most of you will
know them well! Patrick is the founder of Courthouse Clinics (now
a chain of 11 clinics nationwide), whilst Tracy is the founder of The
Cosmetic Skin Clinic and is about to open her second in London
later this year. Patrick also founded the British College of Aesthetic
Medicine (BCAM), formerly the British Association of Cosmetic
Doctors (BACD), which was the first non-surgical professional
group for doctors working in this field. I am delighted that they
have both managed to take some time out of their busy schedules
to catch up and reflect on the changes we have seen within the
industry in the last 25 years.
Both Dr Bowler and Dr Mountford agree that patients’ perceptions
of aesthetics have evolved significantly since 1989. “Initially it
was challenging trying to communicate to people what these
treatments involved,” explains Dr Bowler. “When Botox was
34
launched it was like trying to persuade patients that we wanted
to inject a poison into them. Now though, patients come in and
say ‘I want Botox’, rather than, ‘Is it going to cause me any harm?’”
Dr Mountford agrees, saying, “They are more aware of what is
available and have become ‘mini experts’ – sometimes rightly,
sometimes wrongly.” Both argue that the internet and celebrity
culture has had an influence on patients’ increased knowledge.
“The internet is a double-edged sword, as patients can be well
informed but can also interpret information inappropriately,”
explains Dr Bowler. He advises that offering a thorough
consultation before procedures will better inform patients and
ensures that they have realistic expectations of results. “Managing
expectations is a priority in our clinics, as I’m sure it is with most
practitioners,” he says. “It’s a continuous reinforcement through
our consultations to make sure we don’t end up with disappointed
patients.”
Patient demographics have also noticeably evolved since the
aesthetics industry began. “When we first started we barely ever
saw a man from one year to the next,” explains Dr Bowler. “Within
the last five years there has been a big increase in the numbers of
men we see.”
In addition to this, it seems patients are getting younger. Dr Bowler
says, “There has been a noticeable shift towards younger patients
and, these days, it seems patients are more concerned about
maintenance of looks rather than reversing the signs of ageing.”
Courthouse Clinic statistics reveal that laser hair removal is particularly
popular with younger women. He suggests that the rise in social
media over the last five years has had a significant impact on their
demographics.
Dr Bowler does admit that, although he hasn’t seen any official
statistics, he has noticed a rise in patients suffering from body
dysmorphic disorder (BDD). “There seems to be more young women
in that group rather than our usual patient demographic of 40-50
year olds,” he says. He does note, however, that we are a lot better
equipped to recognise and deal with the problem than we were 25
years ago. “Whatever treatment we offer will make no difference to
their perception of themselves. We are able, however, to refer them to
a psychologist to help treat their issues.”
With so many new technologies available, Dr Mountford believes it
is little wonder that practitioners are achieving continually improving
results. She says, “Treatments are more refined with a more
comfortable experience for the patient; we can now sculpt, contour
or rejuvenate parts of the body we couldn’t have dreamed of nonsurgically 25 years ago.”
Being aware of which products are worth purchasing is also
essential to running a successful practice. “This just comes down to
@aestheticsgroup
Aesthetics Journal
Aesthetics
Clinical Focus
25 Years in Aesthetics
“There has been a noticeable
shift towards younger patients
and, these days, it seems patients
are more concerned about
maintenance of looks rather than
reversing the signs of ageing”
experience,” says Dr Mountford. “You should watch how a product
or technology develops in the market place before jumping on
the bandwagon. Generally speaking, using only FDA approved
products is crucial to this.” She adds, “I always say, ‘new does not
always mean better.’”
With the advent of new treatments and technologies, along with
high quality consultations and injectable products, the financial side
of business has also improved, says Dr Mountford. “Some patients
may save £10 a week to finance their treatment, whilst others have
unlimited budgets. The average spend has gone up significantly.”
Some would argue that working in aesthetics in 2014 comes with new
challenges that weren’t necessarily around in 1989. As the market
grows, there has obviously been an increase in other practitioners
opening clinics. However, Dr Mountford advises, “By remaining
focused on the practice and patients’ needs and not looking sideways
at potential competitors, you can fend off any competition.”
Discussing regulation within aesthetics, both agree, as many others
do, that the industry is not monitored as well as it should be. “The
Keogh Report and its findings should be very useful to help clarify
what is appropriate best practise,” says Dr Mountford. “I would,
however, have expected more legislation to be in place by now.”
Dr Bowler says, “I am uncomfortable with beauty therapists being
able to give injection treatments, which may well happen if the
current educational framework from HEE gets implemented. In the
European Union, the idea of beauty therapists giving Botox injections
is laughable.” On a more positive note, however, Dr Mountford adds,
“All we can do is forge forward with our own self-regulation, and help
to educate the public further.”
Educating the public is important to both practitioners, and Dr
Mountford often takes up PR and television opportunities. “They are
useful as they can help educate the public in some way,” she explains.
“I always view them with a healthy degree of caution and only tend to
give interviews to journalists who I respect, to ensure that I give the
T H E A R T O F FA C I A L R E J U V E N AT I O N
public the right message.”
Continued aesthetic training is also vital to the
pair, with both explaining that they regularly attend
lectures and conferences to keep up-to-date with
all of the scientific developments. “We are lucky
now as we have training updates on site for all
the team,” says Dr Mountford. Reflecting on their
quarter of a century working in aesthetics, I wonder
if my colleagues have any regrets. Dr Mountford
says, quite simply, no she doesn’t, but Dr Bowler
notes that, looking back, he would have got more
involved in the politics of aesthetics. “My only real
regret is that I wasn’t strong enough when I was
in the BACD.” He explains that he would have pushed the General
Medical Council (GMC) harder to implement tighter regulation and
stress its importance to create a safer industry. “At the time though,
there wasn’t enough interest,” he says. “Now there is a much bigger
interest. I look at how well the nurses and the beauticians have
organised themselves and think the doctors have been a little bit
slow on the uptake.”
Entering the world of medical aesthetics is challenging for any
practitioner, whether it was 25 years ago when the industry was
unknown to patients and bovine collagen was the only product on the
market, or today, when patient awareness and product development
is at the highest level we have seen it. Either way, advice for
newcomers remains the same. “Start small and hone your craft,” says
Dr Mountford. “If you are good, patients will come. Keep your level of
training high, regularly attend conferences and share with colleagues
ideas and concepts regarding best practise.”
For Dr Bowler, having excellent business acumen is also essential.
“The impression that some newcomers have is that it is an easy
revenue generator. A small clinic run from home premises can be
profitable but, if you start to grow your business by expanding and
moving to new premises, your overheads and staffing levels will
increase, which can be a game changer.”
He explains that the jump from working in an aesthetic clinic to
opening your own clinic is also a big hurdle. “Quite a few businesses
fail because they underestimate the running costs and the importance
of marketing. My advice is, whilst clinical education and training is
very important, it needs to be accompanied by strong business skills,
which are vitally important if you want to be successful.” Dr Mountford
concludes, “It’s a tough, highly competitive industry, but the rewards
are there if you are truly passionate about your craft and truly love
enriching people’s lives.”
Why are Doctors and Nurses switching
to VARIODERM HA Dermal Fillers?
• Made in Germany to the highest of standards
• Clinical trials show that it outperforms other major brands for elasticity, longevity
and performance
• Dynamic product range for various indications
• Very competitive pricing
• Very high level of patient satisfaction
Contact [email protected] for further info and pricing.
Adare Aesthetics Ltd, 26 Fitzwilliam Square South, Dublin 2, Ireland.
Mob: +353 (0)85 711 7166 | Tel: +353 (0)1 676 9810
Email: [email protected] | Skype: ivanlawlor | Web: www.adareaesthetics.com
Aneva Derma
TM
Advanced Nutritional SKIN Beverage
Anti-Ageing from Within
www.aneva.co.uk
Tel: 01234 313130
Distributed in the UK by Aesthetic Source
[email protected]
@aestheticsgroup
Aesthetics Journal
Aesthetics
Eyelash and
Eyebrow Growth
Michelle Washington reveals the science
behind eyelash and eyebrow serums
Throughout history, eyelashes and
eyebrows have been at the forefront of our
concept of beauty. In modern times, the
beautification of the eye area is as popular
as ever. Trends in the shape and style of
eyelashes and eyebrows have changed
significantly over the decades, from the
Marlene Dietrich skyscraper arches to the
Cara Delevingne power brows. Despite
this, long lashes and strong eyebrows
have remained an intrinsic factor to many
patients’ perceived idea of femininity
and attractiveness, as well as playing an
important role in improving their overall
confidence.
Practitioners continue to hear patients
bemoan the fact that their brows and lashes
no longer give them the ‘wow’ factor. Age,
hormones, illness, stress and genetics all
influence the growth and density of lashes
and brows, while some patients suffer from
madarosis, the clinical loss of eyelashes
and eyebrows,1 which can have a range of
causes that include the menopause and
systemic disorders such as hypothyroidism,
lupus and alopecia areata.1
Options for artificially improving the
appearance of lashes and brows include:
tinting, micro pigmentation, fake eyelashes,
fibres, mascara and eyelash extensions.
In extreme cases eyelash transplantation
surgery is undertaken, which involves
follicles being taken from the back of the
scalp and implanted into the lid margin.
Artificial enhancements are not everyone’s
first choice of treatment, for a variety of
reasons. In the case of surgery, the hair
resulting from implanted follicles needs
maintenance and is cost prohibitive to a lot
of people, with significant risks involved.2
Similarly, the use of eyelash extensions
has fallen because users have reported
undesirable side effects after lengthy use.3
Since the development of glaucoma eye
drops in 2001, patients and practitioners
have reported, anecdotally, that a side effect
of glaucoma treatment is an increased
thickness, darkening and lengthening of the
lashes. It was found that the key ingredient
promoting the side effect of thicker, longer
lashes was the Prostaglandin analogue (PG)
Bimatoprost. There are different types of
PGs used clinically, but those with the index
F2 have captured the attention of lash serum
manufacturers.4 Given consumers’ desire
for long, natural lashes, Over The Counter
(OTC) preparations were developed. In
2003, The Dermatology Online Journal
published a paper, ‘Prostaglandin analogs
(PGs) for hair growth: Great Expectations’5
Treatment Focus
Eyelashes and Eyebrows
anticipating the growth of OTC products in
the cosmetic industry. In my experience, I
have noticed a significant increase in OTC
eyelash conditioning serums since 2005.
Since then, cost barriers have reduced and,
from my experience, it seems that many
women now regard them as mandatory
items within their daily grooming products.
In 2012, the estimated revenue of the whole
US cosmetic market was $54.89 billion5
and, with the advent of internet-based
cosmetic companies, this is anticipated to
increase even more.6 PG’s are hormonelike lipid compounds, which work locally
as messengers between cells stimulating
eyelash growth on the lid line. Testing
of PGs for eyelash growth has been
undertaken in both animals7 and humans8
showing the efficacy for hyportrichosis.
Some countries, such as Sweden and
Australia regard all PGs as medicines, thus
they are banned from OTC preparations.9
Incidentally, research undertaken in Sweden
in 2013 found that some manufacturers
were not declaring the inclusion of a PG as
an ingredient.9
Nowadays, consumers have a huge choice
of OTC products to choose from with
a price range that varies just as widely.
Commercially available serums fall into
two basic categories: those with PGs and
those without. The only Food and Drug
Administration (FDA) approved PG for
eyelash growth is Bimatoprost, attained in
Since the
development of
glaucoma eye drops
in 2001, patients
and practitioners
have reported,
anecdotally,
that a side effect
of glaucoma
treatment is an
increased thickness,
darkening and
lengthening of the
lashes
37
Treatment Focus
Eyelashes and Eyebrows
LiLash Set 1 before
LiLash Set 1 after
@aestheticsgroup
Aesthetics Journal
Aesthetics
LiLash Set 2 before
LiBrow Set 1 before
LiBrow Set 2 before
LiBrow Set 1 after
LiBrow Set 2 after
LiLash Set 2 after
Images courtesy of Dr S Wasserman
2008 following clinical trials.10 The common
practice nowadays is for manufacturers to
use non-prescription PGs, in conjunction
with additional ingredients (e.g. peptides,
vitamins, conditioning agents and minerals)
as part of OTC formulations, to assist in
the conditioning of the newly formed hair.
Many of these OTC growth serums are not
subject to FDA premarket approval and
the strict regulations of pharmacological
assessment and, as a result, it could be
considered that their efficacy remains to be
clinically substantiated. The OTC products
are not marketed as growth serums and
avoid government regulatory agencies.
Instead they are marketed as conditioning
serums and thus, treated as cosmetics. It’s
important to understand that the eyelash
and eyebrow follicle cycle differs from scalp
hairs; the anagen phase is significantly
shorter, with a longer telogen phase. The
PG works to extend the growth cycle of the
lash follicle and is believed to increase the
percentage of active follicles. Daily application
of growth/conditioning serums is typically
recommended throughout the active growth
phase, followed by a maintenance dosage to
preserve the results. Typically, the application
of a maintenance dosage would be every
other day. Some products require new sterile
applicators daily. In my experience, this is to
preserve the integrity of the solution. The
majority of OTC serums, however, are applied
in the same method as liquid eyeliner. There
are also a number of potential risks associated
with the use of PGs, which include, but are
not limited to, ocular irritation, hyperemia,
iris colour change, macular edema, ocular
inflammation, hyperpigmentation of the iris
and lash line, erythema, contact dermatitis,
dry eye, fungal infections, and interference
with glaucoma therapy.11 In addition, PGs for
ophthalmic use are currently classified as
Pregnancy Class C. This classification means
that there have been no human studies of the
drug, but that animal studies have revealed
some potential abnormalities.11
When consulting patients in the use of these
products, following manufacturers’ instructions
is of the upmost importance. Common
safety guidelines include: application to
clean dry skin, do not overdose, do not
use on broken or irritated tissue, and avoid
cross contamination with makeup and facial
products. It is also important to increase
awareness amongst consumers of counterfeit
products, with unknown manufacturing
standards and potential issues.
In summary, eyelash and eyebrow
conditioning serums containing PGs are
more likely to give patients visible results
compared to those serums containing purely
vitamins and conditioners. For safety reasons
I believe that these products should be
purchased from reputable clinics where you
should provide a consultation and address
potential side effects. Patients can then have
their expectations managed accordingly
For safety reasons I believe that these
products should be purchased from
reputable clinics where you should
provide a consultation and address
potential side effects.
38
and enjoy the experience of thicker, longer
lashes and brows. Overall, we find that
improved eyelashes and eyebrows can be
a highly enjoyable and safe experience for
most patients.
Michelle Washington trained
as a skincare specialist in New
Zealand, before opening a clinic
in Auckland. Her interest in
hair loss solutions began after
treating patients suffering from mandarosis.
After conducting extensive research and
working alongside aesthetic practitioners,
Michelle is now a business development
manager for hair growth products, based in
New Zealand and the Middle East.
REFERENCES
1. A Kumar, and K Karthikeyan, ‘Madarosis: A marker of many Maladies’, International Journal of Trichology, 4 (2012) http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3358936/[accessed 2 October 2014] (p.3-18).
2. M Dalton, Eyelash Transplant Surgery Poses Serious Risks (US: Eyeworld, 2007) http://www.eyeworld.org/article.php?sid=3786 [accessed 2 October 2014]
3. O Avitzur, Eyelash extensions can pose health risks (US: Consumer Reports, 2013) http://www.consumerreports.org/
cro/2013/05/eyelash-extensions-can-pose-health-risks/index.
htm. [accessed 7 September 2014]
4. K Kamal, A Mubarak, A review of prostaglandin analogs in the management of patients with pulmonary arterial hypertension (Science Direct, 2014) http://wwwsciencedirect.com/science/
article/pii/S0954611109002479 [accessed 2 October 2014]
5. R Wolf, H Matz, M Zalish, A Pollack, E Orion, ‘Prostaglandin analogs for hair growth: Great expectations’, Dermatology Online Journal, 9 (2003) http://escholarship.
org/uc/item/4hz1f3rr [accessed 4 September 2014]
6. Statistics and facts on the cosmetic industry (US: The Statistics Portal, 2013) http://www.statista.com/topics/1008/cosmetics-
industry/ [accessed 5 September 2014]
7. AT Giannico, L Lima, H Russ, F Montiani-Ferreira, Eyelash growinduced by topical prostaglandin analogues, bimatoprost, tafluprost, travoprost, and latanoprost in rabbits (US: National Library of Medicine National Institutes of Health, 2013) http://
www.ncbi.nlm.nih.gov/pubmed/23981234 [accessed 5 September 2014]
8. K Beer, Latisse (Bimatoprost .03% Opthalmic Solution) for the treatment of hypotrichosis of the eyebrows: Latisse versus placebo (US: Clinical Trials, 2012) http://clinicaltrials.gov/show/
NCT01387906 [accessed 5 September 2014]
9. Pharmaceutical ingredients in one out of three eyelash serums (Sweden: Lakemedelsverket Medical Products Agency, 2013) http://www.lakemedelsverket.se/english/
All-
news/NYHETER-2013/Pharmaceutical-ingredients-in-one-
out-of-three-eyelash-serums/ [accessed 5 September 2014]
10. Drugs development approval process (US: FDA, 2012) www.
fda.gov/downloads/drugs/developmentapprovalprocess/
developementresources/usm415322.pdf [accessed 1 October]
11. EducatedEsty, ‘Déja Vu all over again for prostaglandin based eyelash growth serum’, www.educatedesthetician.com (2011) http://educatedesthetician.com/2011/04/deja-vu-all-over-again-
for-prostaglandin-based-eyelash-growth-serum/ [accessed 5 September 2014]
Skin Care Management
System MD
This revolutionary, multi-award winning system utilises
synergistic layered technology to comprehensively
address all the skin’s needs for measurable improvement
in the appearance of common skin conditions such as:
• Acne
• Fine Lines and Wrinkles
• Hyperpigmentation
• Rosacea
The Skin Care Management System was designed for prolonged use
with little to no irritation or acclimation. The System is easy and intuitive
to use for the patient with immediate improvement observable from
the first application. Over time skin will appear noticeably smoother and
healthier. By following the daily regimen, results will be sustained and
improved over time.
20
13 A A R D
W
20
14 A A R D
W
From a portfolio of products exclusively
designed for the clinic environment.
Not available online.
See us at Face 2014 Stands 67 and 68
020 8868 4411
www.jmsreurope.com
Clinical Practice
Delivery Systems
@aestheticsgroup
Aesthetics Journal
Injectable
delivery systems
Ruth Donnelly speaks to aesthetic practitioners
about their preferred injectable delivery tools
Aesthetics
2011. Consisting of a control unit with a foot pedal
and four colour-coded syringe handpieces, which
attach to the control unit via a lead, the system uses
carbon dioxide to apply a more consistent pressure
than can be achieved by hand alone, and claims to
offer improved injection control with reduced hand
fatigue for the practitioner.
Dr Martyn King, co-founder of the Cosmedic Skin
Clinic, has been using the Artiste system in his
practice and says, “People get better results with
this system and less pain, because it injects slowly,
which sends out fewer pain receptors, and you can
inject very small, consistent amounts so there’s less
risk of causing lumps.”
Dr King also offers injectable training courses
and has found the system to be of great help in
demonstrating the ideal injection flow. “If you get
people to inject onto a piece of card to try and
create one line of the same thickness all the way
down, even with quite experienced injectors the
line will get thicker and thinner, which is to do with
how hard they press and how quickly they move
their hand,” he explains, “whereas with the Artiste,
you get a nice, consistent flow.” Mr Humzah agrees
to a point, and says, “The Artiste is a good system
and occasionally I still use it, but it’s cumbersome
loading it up. The new systems are more portable,
which is better for the cosmetic world.”
Injectables have come a long way since collagen injections were first used
in the 1970s, and it’s not just the products themselves that have changed;
injection techniques and the devices we use to administer treatments
are evolving all the time. Syringes have been adapted to become more
comfortable for the practitioner to use and now produce a smoother flow and,
more recently, automated systems that assist in the injection process itself have
become available.
“The fillers are all different now, with different properties, so the pressure you
use when injecting has to be adjusted accordingly,” says consultant plastic
surgeon, Mr Dalvi Humzah. “I think that’s what has led to the development
of these mechanically-aided delivery systems. They started off as rather
cumbersome machines, but they did seem to work and were particularly good
for delivering in large volumes, which I do a lot of in my reconstructive work.”
The U225 Mesogun
Artiste
In the short time that these systems have been available in the UK, even
these have seen great change. The Artiste Controlled Injection System, from
Nordson Micromedics, was launched in the UK and parts of the US in May
40
The Frenchmade U225 Mesogun is one example
of these more portable devices. It has been
available in the UK for longer than Artiste, and
is really only suitable for mesotherapy, rather
some dream
of success
others make
it happen
Combining practical demonstrations and interactive training
from world-class experts with the latest innovation from
leading suppliers, the Aesthetics Conference & Exhibition
will power your success in 2015 and beyond. For more
information and to register for the UK’s premier aesthetics
conference, visit www.aestheticscconference.com
SPONSORED BY
Clinical Practice
Delivery Systems
@aestheticsgroup
than filler injection. Using pneumatic pressure generated by
an air compressor, the U225 has two basic modes: continuous
injection or intermittent injection. In intermittent mode, the user
can vary the frequency, from one injection every three seconds
to 300 per minute. Independent nurse prescriber, Ros Bown,
founder and CEO of the Rosmetics clinic chain, favours the U225
gun for mesotherapy, claiming that it is, “easy to set up and
operate, allowing me to use many different products, including
non-cross-linked hyaluronic acid, mesotherapy products,
multivitamins, platelet rich plasma (PRP) and even botulinum toxin
for hyperhidrosis.” Dr Jamshed Masani, founder of the Mayfair
Practice, has been using the mesogun since 2007 and says he
bought it because, “it was well designed, it was pain free owing
to the design of the device (no vibration) and the special 32G
needle it uses.”
Aesthetics Journal
Aesthetics
Dr Linda Eve, founder of
EvenLines in Dorset, has
been impressed. “The new
SmartClick syringes offer
increased precision and
control of injections,” she
says. “A micro-droplet, 10µL
in size, is produced with
every subtle click of the
syringe, and this helps the
injector spread the product
across a wider area and
allows you to concentrate
on your injection technique,
rather than worrying about
the amount of product you
are injecting. The 1ml syringe
delivers approximately 100
doses of micro-droplets, and yet the syringe can very easily
be switched back to normal injection mode with needles or
cannulas – thus giving the injector a choice of techniques.”
The TSK 3dose syringe
Aquagold fine touch
Another mesotherapy delivery system, Aquagold fine touch, is
a single-use microneedle applicator that delivers product to the
dermis through 20, 0.6mm long, 0.13mm wide, microneedles. Dr
Steven Fagien, an ophthalmologist and aesthetic practitioner
based in Florida, has found the device to be useful in tackling the
issues associated with mesotherapy.
“Previously, many practitioners who administered this sort of
treatment used standard needles to deliver multiple injections
to the skin. This can be painful and time consuming, whereas
a delivery device that can deliver many injections at once
can accomplish mesotherapy treatment in a very efficient
and acceptable manner.” Unlike the U225, Aquagold is not
a pneumatically-powered device, but rather a disposable
applicator. It contains a reservoir that can be filled with the
substance of your choice – Fagien favours vitamins, or microquantities of botulinum toxin or hyaluronic acid – and is then
applied gently to the surface of the skin, “much like a rubber
stamp on paper,” he explains.
Restylane Skinboosters SmartClick
Not so much a filler as a skin hydration therapy, Restylane
Skinboosters treatments – Restylane Vital and Vital Light – are
microinjections of hyaluronic acid, delivered at a precise point in
the dermis with the aim of reducing the appearance of lines and
improving skin texture. The SmartClick system, which recently
won the prestigious Red Dot design award, is an ergonomically
designed syringe with an audible dosage indicator, which when
activated generates a clicking sound. The sound is automatically
generated during the injection as a metallic plate is pressed over
grooves on the surface of the plastic piston.
42
TSK Laboratories launched its 3dose syringe,
specifically designed for botulinum toxin injections,
at the Aesthetic and Anti-Aging Medicine World
Congress (AMWC) 2014 meeting in Monaco. Similarly
to the Restylane SmartClick system, the 3dose
syringe has an adjustable clicker system, which
provides a precise dose injection of 0.025ml, 0.04ml
or 0.05ml. Each syringe comes packed with two
33G 13mm needles, which are 22% thinner than a
standard 30G needle and aim to reduce discomfort
for patients. Dr King, who has used the syringes,
says, “The TSK syringes are very nice, I like them.
You can tell when you are using a quality needle,
compared to a cheaper one.”
Teosyal Pen
Not yet available in the
UK, Teoxane laboratories
have recently bought the
rights to the Teosyal Pen
from JuvaPlus, a motorised, cordless device. It has an adjustable
flow speed and the choice of small, medium or large drops,
which the manufacturers claim optimises product use, increases
precision and ease of application, and produces a more natural
result than manual injection alone.
Dr Sabine Zenker, a dermatologist in Munich, Germany, has
used the Teosyal Pen in her clinic. “I am always curious about
developing and discovering new approaches, new ideas, new
ways and the best methods to develop my skills and improve
my work,” says Dr Zenker. “It is important for me to always serve
my patients at my very best. This means reducing side effects
such as pain and swelling and increasing precision and quality.
In using filler delivery systems [such as the Teosyal Pen], I
have experienced a clear improvement in the overall aesthetic
outcome.”
“If you’re going to go
down the route of these
mechanical devices
there is going to have
to be some kind of
standardisation”
mct injector
Delivery systems versus manual injection
If filler delivery systems continue to improve at the current rate,
are we likely to enter a world where cosmetic injections are
administered by machine, while practitioners sit back and watch?
According to those we spoke to, probably not. Whilst they all agree
that delivery systems have a place in aesthetic practice, there
are reservations. Independent nurse prescriber, Andrew Rankin,
owner of Regenix Medical Aesthetics Clinic in Malvern, has his
concerns. “Any system that provides a level of control which can
minimise bruising and pain, thus enhancing the patient experience,
has evident value. However, no system can remove the need for
correct product placement, particularly in terms of depth, and it is
important not to lose sight of this as a priority when learning about
dermal fillers,” Rankin warns. “Further, when the clinician is new to
dermal fillers, I believe it is necessary for them to develop a feel
for the filler that they are using. To my mind, therefore, a dermal
filler delivery system is something of use to the more experienced
practitioner, rather than something which may be relied on by the
novice.” Mr Humzah’s worry is that filler manufacturers will use
these devices to hold their customers to ransom. “If you’re going
to go down the route of these mechanical devices there is going
to have to be some kind of standardisation, otherwise all the filler
companies will bring out new delivery systems specific to their
particular syringe,” he asserts. “As a sector we should be saying,
we’re not going to tolerate this. It’s great having these things, but it
is a delivery system and not a right of a particular product or brand.”
What does the future hold?
In terms of the ideal, Dr King would like to see a device that is semiautomated, “so you could choose to either inject yourself, or get
the machine to do it for you,” which, in his opinion, would resolve
some of the issues mooted by Rankin. Mr Humzah has his own
blueprint for the perfect injection system. He says, “In the future
what I’d really like to see is one or two ergonomically designed
devices into which a filler could fit in like a dental cartridge, where
you have a fixed syringe and you just drop the cartridge in, then
you would be able to choose the needle or cannula, screw it onto
the body of the syringe, then use the machine to gradually inject
it at the right pressure.” He continues, “And all that would come
in a small, handheld, battery-powered unit, without leads trailing.
It would be very cost effective for the filler companies, because
they could just produce cartridges, without the cost of producing
syringes.” It seems that there is still room for improvement in the
world of assisted injection, but with new devices being released at
a rapid rate (and if aesthetic practitioners do take a stand in favour
of standardisation), it might not be long before Mr Humzah’s dream
becomes a reality.
mct injector is a unique injection gun that combines two
complementary techniques in a single device: mesotherapy
and carboxytherapy. This convenient, versatile medical
device includes high technology features (touch sensitive
wheel, high definition colour display, 20 hour battery life,
illumination of the treated area, micromassage, portable CO2
cartridges) to guarantee optimal control during treatment.
Used in combination with mesohyal™ , the most
comprehensive, extensive range of intradermal medical
devices, therapists have a precise tool for safely and efficiently
correcting the aesthetic facial and body concerns of each
individual patient.
medical-aesthetic devices
www.mesoestetic.co.uk
tel: 01625 529 540
[email protected]
Techniques
Hand Rejuventation
@aestheticsgroup
Aesthetics Journal
Aesthetics
Hand
rejuvenation
Dr Carolyn Berry considers rejuvenation
techniques for the ageing hand
Hands are exposed, both to the elements and to public scrutiny,
and their appearance often reflects how well they have been cared
for, as well as the general lifestyle of their owner. Nowadays, it
seems that we are entering an era of hand rejuvenation and, in my
experience, patient demand for treatment is increasing. This could be
because we are dealing with a more informed population, as patients
are now able to research potential treatments online and read
about their results in the media. Facial rejuvenation is considered by
aesthetic practitioners to be very successful, however this is difficult
to evaluate.1 Patients realise that they no longer have to endure hands
that look older than their face. As aesthetic practitioners, for a holistic
approach, it is important to take the ageing hand into consideration
and assess how best to achieve patients’ desired results.
The skin on hands, like skin elsewhere on the body, undergoes
both intrinsic and extrinsic ageing. Extrinsic ageing is caused
by environmental factors such as sun exposure, chemicals and
smoking. This will affect the epidermis and dermal layers leading
to uneven pigmentation, solar lentigines, actinic keratosis, punctate
hypopigmentation and solar purpura. Intrinsic ageing is affected by
genetics and nutrition, also by disease processes such as diabetes,
peripheral arterial occlusive disease, autoimmune disorders and
medication, including chemotherapy. The capillary microcirculation of
the dorsal hand differs between healthy individuals and those of the
same age with diabetes or PAOD,2 hence why taking a full medical
history is of paramount importance.
Intrinsic changes alter the deeper soft tissue planes, decreasing skin
elasticity, loss of the subcutaneous tissue (dermal and fat atrophy)
and dermal vascularity. The skin becomes paper-like and thin, whilst
veins become more prominent. Distal pip joints swell and tendons
become more apparent. Hand ageing can be graded in a five point
system. Carruthers et al published a validated grading scale for
assessment of the ageing hands,3 whilst others use the Busso hand
volume severity scale.4
It is important to
take the ageing hand
into consideration
and assess how best
to achieve patients’
desired results
44
If we address the patient’s concerns, we will get the best patient
satisfaction rates. According to one study, 5 it seems that patients
are most concerned by prominent veins and view these as the most
ageing feature of hands. Therefore, I would suggest that reducing the
appearance of veins should form part of the treatment plan. Treating
the veins directly, or altering the soft tissue volume around them, can
alter their appearance and make them less prominent.
Treating the veins of the hand with sclerotherapy (the injection of an
irritant liquid which causes vein walls to inflame and stick together)
requires a higher concentration of sclerosing agents than is used for
leg veins and often results in a tender phlebitis cord. Another option
to consider is phlebectomy (the surgical removal of veins). Studies
have investigated an endovenous laser technique (introduction of
a laser probe into the vein) to abolish unwanted hand veins.6 All
patients were satisfied with the outcome but there were adverse
events including the swelling of hands for two weeks and one case of
skin burn.
Rejuvenation of hands should be considered as a successful
reversing of the three-dimensional process of ageing.7 Hand ageing is
a three dimensional process that involves osseous and subcutaneous
structures as well as the skin. Often only one modality of treatment is
considered and this will seriously limit the outcome. Hand anatomy
is of paramount importance when considering treatment. Bidic et
al studied 10 fresh cadaveric hands.8 Specimens were evaluated
microscopically after histologic staining. They also used Doppler
ultrasound on eight living hands to explore lamination of the dorsal
hand fat. They showed three distinct fatty laminae separated by thin
fascia. The large dorsal veins and dorsal sensory nerves resided
within the intermediate lamina. The extensor tendons were found in
the deep lamina. Eight to 10 perforating vessels travel within fascial
septae traversing the laminae. In my opinion, consideration of this
may improve results of treatment.
In my experience, patients have previously been concerned with
extrinsic ageing, complaining of pigment changes and age spots
in particular and have often requested laser treatments to remove
pigment spots. A common theme is that they know that they don’t
like the look of their hands but they don’t know how to correct it. As
practitioners, we have responded by treating hands with chemical
peels, microdermabrasion, tretinoin, IPL and 5- fluorouracil.
Intense pulsed light (IPL) has also been used very successfully to treat
extrinsic ageing, showing excellent results in treating solar lentigines
and improving skin quality.9 In Goldman et al’s study, patients were
treated with four IPL sessions at three to four week intervals. There
was a very high patient satisfaction with no significant side effects.
Various lasers have been used to improve skin quality, including
Training workshops
are available.
For more information
please email:
ellansetraininguk@
sinclairpharma.com
Ellansé™ for natural, youthful
and longer-lasting results
Ellansé™ dermal fillers provide immediate lift
for the correction of wrinkles and folds and stimulate
the generation of the body’s own collagen
Ellansé™-S
1 year
Ellansé™-M
2 years
Ellansé™-L
3 years
Ellansé™-E
4 years
www.ellanse.com
For more information please contact us at Sinclair IS Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street. London W1T 2RQ. United Kingdom
Telephone +44 (0) 207 467 6920 www.sinclairispharma.com
Date of preparation: November 2014
Techniques
Hand Rejuventation
@aestheticsgroup
CO2 fractional laser and 1320-nm Nd:Yag. Sadick et al showed an
improvement with Nd:Yag,10 but they were only able to show mild to
moderate improvement and one could argue that this is insufficient to
make it a treatment of choice.
Plasma skin regeneration has shown promising results on the face
and many patients favour this type of less invasive treatment. Alster et
al evaluated face, chest and hands treated with PMR and discovered
clinical improvements of 57%, 48% and 41% respectively. There was
significant reduction in wrinkle severity and hyperpigmentation, with
increased skin smoothness.11
Volume restoration dramatically improves the appearance of the
ageing hand by minimising the appearance of veins. A method
favoured by surgeons is autologous fat injections, where fat is
harvested and then injected into the hands. The fat is generally taken
from the abdomen or thighs. This is an invasive procedure but can be
combined with liposuction at the patient’s request. If fat is centrifuged,
this is associated with better results.12 Giunta et al studied fat grafting
with 3D surface laser scanning, which permits evaluation of the
permanent volume over time and were able to show 69% of initial fat
volume was present at six months, and this seems to be the amount
integrated as a graft.13
Another method of treatment involves using hyaluronic acid (HA).
The ageing process results in depletion of endogenous HA, which
has an important role in the dermal extracellular matrix for hydration,
biomechanical integrity and oxidative stress protection.14,15 Crosslinked HA is not degraded as quickly as native HA and has been
shown to enhance the production of collagen.16 Native HAs will
increase the thickness of dermis but don’t last as long. Biphasic HA
needs to be injected sub-dermally to prevent the Tyndall effect,
a preferential scattering of blue light, giving a bluish appearance.
One has to treat the very aged hand, with thin and papery skin, with
great care, as it is less forgiving of a poor technique. Adverse events
can include papule development, which are hard, circumscribed,
elevated skin lesions. Hyaluronic acid fillers have been favourably
compared to collagen.17
Calcium hydroxyapatite (CaHa) has become popular for the treatment
of hands in recent years, with considerable success. The volume
of CaHa injected, as well as the amount of lidocaine used for the
mixture, varies according to the practitioner’s preference.18 It can
also be injected with lidocaine as a bolus technique. In one study,
at 12 months post-procedure, 60% of subjects rated their results
as “satisfactory” or “better”.19 The opacity of CaHa blends well with
the skin and conceals veins and tendons. Long-lasting results may
be attributed to the neocollagenesis, which in laboratory studies
Before
46
Aesthetics Journal
Aesthetics
continued up to 72 weeks.18
Another option for treatment is poly-l-lactic acid (PLA), which can
be successfully used to rejuvenate hands. It requires careful
patient selection as they will need multiple injections and several
treatments. Results cannot be appreciated immediately but can last
up to 24 months.21 In a study of three clinical practices using PLA,
no papules or nodules were reported.19 Patients were very satisfied
with the results and experienced only minor adverse events such as
bruising, swelling and pain. One author,22 recommends it for patients
requesting longer lasting results. The results by Redaelli et al were
evaluated by a definitive graduated score (1 to 10) and ranged from
4 to 9 (av 6.55).23 There was one case of unnoticeable nodulations.
Nodules can be minimised by using 7mls of diluent per PLA bottle
and massaging daily for one month post-treatment.
Polycaprolactone (PCL) is a relatively new treatment emerging at the
moment. This consists of microspheres suspended in an aqueous
carboxymethylcellulose gel carrier. Due to the gel carrier, there is
an immediate volume replacement and improved appearance.
The gel carrier is gradually resorbed by macrophages over a
period of several weeks. The smooth PCL microspheres stimulate
neocollagenesis to replace the carrier. The PCL microspheres
become coated with a monolayer of macrophages and a scaffold of
new collagen. The PCL microspheres are bioresorbed into non-toxic
degradation products and excreted into CO2 and H2O. Satisfaction
among patients has been high in studies, 24 and rated as 82% at 24
weeks, with 88% of patients saying they would be likely to return for
repeat treatments.
Some patients may opt for surgical intervention. This is particularly
beneficial if a patient has a lot of excess skin on the dorsum of their
hands. One option is a minimal-scar hand lift.25 This technique limits
scar size and visibility by locating the incision in a unique position
on the ulnar side of the dorsum of the hand. This involves skin
flap advancement and rotation and can be performed under local
anaesthesia and sedation. Satisfaction amongst patients was high in
the study cited.
It would appear that the treatment selected would depend very much
on the individual patient’s requirements. It is very advantageous and
cost effective for the patient to select a treatment that will provide
them with both volume restoration and neocollagenesis. Maintenance
has to be part of the regime; very few patients will think of applying
SPF to their hands. Patients who are treated for pigmentation need
to be counselled that if they do not protect hands in the sun, their
pigmentation will return. Some feel staying out of the sun and using
high SPF is too high a price to pay and will opt for volume restoration
After
@aestheticsgroup
Aesthetics Journal
and live with their pigment spots.
So what does the future hold? We
need studies to compare modes of
volume restoration, for efficacy, and for
length of action. The message to use
high factor sun cream on the face is
gradually getting through to patients,
but they have, as yet, to care in the
same way for the rest of their body.
I find it amazing that patients would
rather have solar lentigines than give
up a tan, particularly when the bottled
tans are so good. Neocollagenesis
seems to be of key importance but I
am extremely interested to follow the
mixing of growth factors with platelet
rich plasma and we need to see more
research conducted in this area.
Dr Carolyn Berry is
the medical director and
founder of Firvale Clinic
in Southampton. She
completed her medical
training at Queens University,
Belfast, before working as a general
practitioner. With a keen interest in
aesthetics she founded her clinic in
2008 and now splits her time between
both specialties. Aesthetics
Techniques
Hand Rejuventation
REFERENCES
1. Kosowski et al, ‘A systematic review of patient-reported outcome measures after facial cosmetic surgery and/or nonsurgical facial rejuvenation’, Plastic Reconstructive Surgery Journal, 123 (2009), 1819-27.
2. Kraemar R, Kabbani M, Sorg H, Herold C, Branski L, Vogt PM, Knobloch K, ‘Diabetes and peripheral arterial occlusive disease impair the cutaneous tissue oxygenation in dorsal hand microcirculation of elderly adults:implications for hand rejuvenation’, Dermatol Surg, 38 (2012), 1136-42.
3. Carruthers A, Carruthers J, Hardas B, ‘A validated hand grading scale’, Dermatol Surg, 34(suppl 2), (2008), s179-s183.
4. Busso M, Moers-Carpi M, Storck R, ‘Multicenter, randomized trial assessing the effectiveness and safety of calcium hydroxyapatite for hand rejuvenation’, Dermatol Surg, 36 (2010), 790-797.
5. Bainss RD, Thorpe H, Southern S,, ‘Hand aging: patients opinions’, Plast Reconst Surg, 117(7), (Jun 2006), 2212-8.
6. Shamma AR, Guy RJ, ‘Laser ablation of unwanted hand veins’, Plast Reconstr Surg, 120(7), (2007 Dec), 2017-8.
7. Jakubietz RG, Kloss DF, Guenert JG, Jakubietz MG, ‘The ageing hand. A study to evaluate the chronological ageing process of the hand’, J Plastic Reconstr Aesthet Surg, 61(6), (2008 Jun), 681-6.
8. Bidic SM, Hatef DA, Rohrich RJ, ‘Dorsal hand anatomy relevant to volumetric rejuvenation’, Plast Reconstr Surg, 126(1), (2010 Jul), 163-8.
9. Goldman A,Prati C, Rossato F, ‘Hand rejuvenation using intense pulsed light’, J Cutan Med Surg, 12(3), (2008 May-Jun), 107-13.
10. Sadick N, Schecter AK, ‘Utilization of the 1320-nm:Yag laser for the reduction of photoaging of the hands’, Dermatol Surg, 30(8), (2004 Aug), 1140-4.
11. Alster TS, Kanda S, ‘Plasma skin resurfacing for regeneration of neck, chest and hands:investigation of a novel device’, Dermatol Surg, 33(11), (2007 Nov), 1315-21.
12. Butterwick KJ, ‘Rejuvenation of the aging hand’, Dermatol Clin, 23, (2005), 515-27.
13. Giunta RE, Eder M, Machens HG, Muller DF, Kovacs L, ‘Structural fat grafting for rejuvenation of the dorsum of the hand’, Handchir Mikrochir Plast Chir, 42(2), (2010 Apr), 143-7.
14. Presti D, Scott JE, ‘Hyaluronan-mediated protective effect against cell damage caused by enzymatically produced hydroxyl(OH) radicals is dependent on hyaluronan molecular mass’, Cell Biochem Funct. 12, (1994), 281-8.
15. Toole BP, ‘Hyaluronan: from extracellular glue to pericellular cue’, Nature Reviews Cancer, 4(2004), 528-39.
16. Wang F, Garza LA, Kang S, Varani J,Orringer JS, Fisher GJ, ‘In vivo stimulation of de novo collagen production caused by cross linked hyaluronic dermal filler injections in photodamaged human skin’, Arch Dermatol, 143, (2007), 155-63.
17. Man J, Rao J, Goldman M, ‘A double blind, comparative study of nonanimal-stabilised hyaluronic acid versus human collagen for tissue augmentation of the dorsal hands’, Dermatol Surg, 34(8), (2008 Aug), 1026-31.
18. Edelson KL, ‘Hand recontouring with calcium hydroxyapatite(Radiesse)’, J Cosmet Dermatol, 8(1), (2009 Mar), 44-51.
19. Sadick NS, ‘A 52 week study of safety and efficacy of calcium hydroxyapatite for rejuvenation of the aging hand’, J Drugs Dermat, 10(1), (2011 Jan), 47-51.
20. Alam M, Gladstone H, Kramer EM, Murphy JP, Nouri K, Neuhaus, ‘ASDS guidelines of care: injectable fillers’, Dermatol Surg, 34(suppl 1), (2008), s115-48.
21. Sadick NS, Anderson D, Werschler WP, ‘Addressing volume loss in hand rejuvenation: a report of clinical experience’, J Cosmet Laser Ther, 10(4), (2008 Dec), 237-41.
22. Rendon MI, Cardona LM, Pinzon-Plazas M, ‘Treatment of the aged hand with injectable poly-l-lactic acid’, J Cosmet Laser Ther, 12(6), (2010 Dec), 284-7.
23. Redaelli A, ‘Cosmetic use of polylactic acid for hand rejuvenation: report on 27 patients’, J Cosmet Laser Ther, 12(6), (2010 Dec), 284-7.
24. Figuerido VM, ‘A five patient prospective pilot study of a polycaprolactone based dermal filler for hand rejuvenation’, J Cosmet Dermatol, 12(1), (2013 Mar), 73-7.
25. Handle M, Bonfatti-Ribeiro LM, Barcaro-Machado BH, ‘Minimal scar handlift: a new surgical approach”, Aesthet Surg J, 31(8), (2011 Nov), 953-62.
Abstracts
Clinical Papers
@aestheticsgroup
Aesthetics Journal
Aesthetics
A summary of the latest
clinical studies
Title: Aesthetic analysis of the ideal eyebrow shape and position
Authors: Yalçınkaya E, et al
Published: European Archives of Oto-Rhini-Laryngology,
October 2014
Keywords: eyebrow, eyelids, lifts
Abstract: Eyebrows and eyelids, vary among different races,
ages and genders. It is considered to be of primary importance
in facial expression and beauty. For the modern acceptable
concept of the ideal brow, the medial brow should begin on
the same vertical plane as the lateral extent of the ala and the
inner canthus and end laterally at an oblique line drawn from
the most lateral point of the ala through the lateral canthus.
The medial and lateral ends of the brow lie approximately
at the same horizontal level. The apex lies on a vertical line
directly above the lateral limbus. Individual perceptions and
expectations also differ from person to person. The brow should
over lie the orbital rim in males and be several millimetres
above the rim in female. Male tend to have a heavier, thicker
brow with a little arch present. There are some pitfalls in brow
aesthetics. Overelevation creates an unnatural, surprised look
which is the most common surgical mistake in brow lifting.
Medial placement of the brow peak would create an undesired
‘surprised’ appearance. Moreover, a low medial brow with a
high lateral peak induces an angry look. Overresection of the
medial brow depressors may lead to widening and elevation of
the medial brow, which creates an insensitive look and can also
lead to glabellar contour defects. It is impossible to define an
ideal eyebrow that is suitable for every face. However, one must
consider previously described criteria and other periorbital
structures when performing a brow surgery.
Title: Cosmetics for acne: indications and recommendations
for an evidence-based approach
Authors: Dall’Oglio F, et al
Published: G Ital Dermatol Venereol, October 2014
Keywords: acne, cosmetics, agents
Abstract: The aim of this review was to evaluate, by a
thorough revision of the literature, the true efficacy of currently
available topic and systemic cosmetic acne agents. The
efficacy of currently available cosmetic acne agents has been
retrospectively evaluated via thorough revision of the literature
on matched electronic databases (PubMed). All retrieved
studies, either Randomized Clinical Trials or Clinical Trials,
controlled or uncontrolled were considered. Scientific evidence
suggests that most cosmetic products for acne, if correctly
used, may enhance the clinical outcome. Cleansers should
be prescribed to all acne patients; those containing benzoyl
peroxide or azelaic/salicylic acid/triclosan show the best efficacy
profile. Sebum controlling agents containing nicotinamide
or zinc acetate may minimize excessive sebum production.
Cosmetics with antimicrobial and anti-inflammatory substances
such as, respectively, ethyl lactate or phytosphingosine and
nicotinamide or resveratrol, may speed acne recovery. Topical
corneolytics, including retinaldehyde/glycolic acid or lactic
48
acid, induce a comedolytic effect and may also facilitate
skin absorption of topical drugs. Finally, the use of specific
moisturizers, photoprotective agents, shaving, and camouflage
products should be strongly recommended in all acne patients.
Cosmetics, if correctly prescribed, may improve the therapeutic
outcome, whereas wrong procedures and/or inadequate
cosmetics may worsen acne. The goal of a cosmetological
algorithm should be to allow clinicians to make informed
decisions about the role of various cosmetics and to indentify
the appropriate indications and precautions, choosing the
most effective product, taking into consideration the ongoing
pharmacological therapy and acne type/severity as well.
Title: ACELIFT: a minimally invasive alternative to a facelift
Authors: Sarnoff DS, Gotkin RH
Published: Journal of Drugs in Dermatology, September 2014
Keywords: ACELIFT, non-surgical, facelift
Abstract: Cervicofacial aging is often characterized by a
combination of skin and subcutaneous tissue laxity, midfacial
deflation, an accumulation of excess submental fat, an obtuse
cervicomental angle, jowls, and rhytides of the face and
neck. Traditional treatment, and the “gold standard” against
which other treatments are compared, is a facelift. Objective:
Demonstrate that a combination technique called ACELIFT - an
acronym for the Augmentation of Collagen and Elastin using
Lasers, Injectable neurotoxins, Fillers, and Topicals - in selected
patients, is a viable, safe, and effective alternative to a facelift.
Ten healthy women, ages 50-62 (mean age = 58), with cervical
and facial stigmata of aging were enrolled in a prospective study
conducted in the authors’ private practice. Patients underwent
a two-step procedure; the first step was laser lipolysis of the
submental and anterior cervical areas with a pulsed 1440 nm
Nd:YAG laser with a side-firing fiber (PrecisionTx, Cynosure,
Westford, MA). Three months later, the patients were treated
in a single session that combined injectable neurotoxin, fillers,
and fractional (Fx) CO2 laser resurfacing delivered in a novel
“hammock” distribution. After two weeks, following complete
re-epithelialization, the patients were started on a topical
regimen that included daily use of sunscreen and antioxidants
and nightly use of retinoids and peptides. This regimen was
continued for a period of six months when all patients returned
for final evaluation. Nine months following the initiation of
treatment, all patients were evaluated by the following: Global
Aesthetic Improvement Scale, cervicomental angle scale,
physician, and subject evaluation. Clinical improvement was
evident, and often marked, for all subjects. Both physician
and subject satisfaction scores were high, indicating overall
satisfaction with the procedure and the outcomes. Sideeffects were mild and transient; there were no incidents of
adverse scarring, thermal injuries, permanent nerve injury, or
dyschromia, hematomas, seromas, or infection. Subjects were
likely to recommend the procedure to a friend. In properly
selected patients, the ACELIFT proved to be a safe and effective,
minimally invasive alternative to a facelift.
There is one supplier that does it all....
100
0’s
C
,
s
o
Peel Ageing s & A nsum of
cce able
Anti- smetic
sso s
o
ries
&C
Pharmac
y
&
S
e
rvice
rs
e s Fre
l
l
i
F xin
e
NextTo
day
Delive
ry *
28
Cr da
Te edit y
rm
s†
From specialist aesthetic products to general consumable items,
Med-fx offers massive choice and outstanding value-for-money.
Add to this free next-day delivery,* a full pharmacy service, 28 day
credit terms† plus our special promotions and you can see that
Med-fx really does have it all.
The one-stop
aesthetics shop
0800 783 06 05
medfx.co.uk
Med-fx Limited, Unit 3, Perry Way, Witham, Essex CM8 3SX
Tel: 01376 532832 Fax: 01376 532801 Email: [email protected]
*Excludes Saturday deliveries. All prices are subject to VAT. †Credit terms subject to status.
Genuine Dermaroller™ therapy products available from Med-fx!
Dermaroller
Sterile, single-use medical device
for natural skin regeneration
and scar repair
MF8/MS4
£53.75 1 x 1.5mm
Dermaroller
Dermaroller
HA Ampoules Recovery
Mask
£41.66
£65.50
Hyaluronic Acid in 1.5ml ampoules
Dermaroller with LMX4,
Aftercare Pack & UV Pack
£84.63 Each!
Only
30 x 1.5ml
Only
Enhances and hydrates the skin.
Pack 10
Commercial Development
@aestheticsgroup
Aesthetics Journal
The evolution of
business in aesthetics
Pam Underdown highlights the importance of
adapting to change in order for your clinic to thrive
in the ever-changing aesthetics industry
For the aesthetic businesses that were
established before the global recession,
memories of the marketplace being ‘easier’
in those days frequently spring to mind.
A decade ago you really didn’t have to try
too hard to fill up your appointment book
with high-spend patients. You opened your
doors and the patients really did come
flooding in. Credit was readily available,
consumers were spending, and increased
curiosity about the celebrity lifestyle and
reality TV made it possible for everyone
to believe that they could have a new
life with cosmetic enhancement. Having
been involved in the medical aesthetics
business for nearly a decade, I have seen
first-hand how the industry has evolved.
When I opened my first aesthetic business
in 2005, things were very different. Today
it’s certainly not easy; business owners are
frequently contending with increased public
scrutiny and changing consumer behaviours.
Competition is everywhere, with deals and
discounts flooding the high street. Changes
in legislation have affected the livelihood of
many practitioners and a growing number
of business owners feel like their business
is running them, instead of the other way
around. The pace of change also seems to
be ever quickening.
50
Despite this, there continues to be a growing
number of health professionals quitting
their day job and setting up their dream
anti-ageing business. And who can blame
them? For many, the appeal of the aesthetics
industry can be glamorous and far more
exciting than shift work, sickness and death.
Health professionals can combine their
keen judgment, with their clinical skills and
creative eye. All they need to do is learn facial
aesthetics, practice on some friends then go
and get a logo and a website – right? Well no,
it is not that easy. This is a highly competitive
and demanding industry and just having great
clinical skills does not guarantee success. So
is the “dream” a good enough reason to risk
everything and start again as you hope to
claim your slice of the aesthetics pie?
What about those established businesses,
the ones who did survive the global
recession? Whilst we should never
underestimate the power of being first, that
power only helps you if you have continued
to evolve, innovate and change. Regrettably
a number of businesses did not evolve; they
played it safe, remaining comfortable and
complacent. However, they are now starting
to learn the hard way that playing it safe
is a dying strategy. The world is changing,
business is changing and change really is
Aesthetics
essential if you want to progress in medical
aesthetics.
So, how can businesses thrive when faced
with these challenges? Certainly not by doing
nothing, or ‘playing’ at change. The world
has turned upside down, you can’t hide and
you can’t keep repeating the things you’ve
been doing, hoping that it will be sufficient
to cope in the future. Whilst most people
are determined to avoid change, it’s key to
remember that change and evolution are the
very essence of life. So for those business
owners who wish to not only survive, but also
thrive, there is no option to ignore change.
However, change on its own is insufficient;
continuous improvement, innovation and ongoing education are essential. Successfully
running and operating a small business in
today’s dynamic world is not easy. Aesthetic
business owners really do have to do it all.
Delivering treatments, dealing with day-today operations, staffing issues, finances,
marketing, and keeping up to date with the
latest techniques and technologies can be
hectic and overwhelming. As time goes
on, the growing realisation of what it takes
to make a business run can shatter many
dreams and bring reality crashing down.
As the global economy continues to improve,
the business of aesthetics continues to be
flourishing, with no end in sight. Cosmetic
intervention is fast becoming a cultural norm,
however, the expectations and demands of
patients are on the rise and the perception
of aesthetic medicine among the general
population has changed. Today, we see more
and more young patients in consultation
rooms wanting to hold back the ageing
process, just like their favourite celebrities and
just like their parents. So what can you do to
stay one step ahead? For a start, it’s time to
throw away any old rules or beliefs that won’t
help you in today’s evolving marketplace.
What worked six years ago, or even six
months ago, won’t necessarily work today.
Resourcefulness and innovation combined
with continuous evaluation and improvement
will enable you to stay one step ahead.
Consistently educate yourself
In the words of the late Nelson Mandela,
“Education is the most powerful weapon
that you can use to change the world”. Our
growth, evolution and happiness depend
upon the continued development of our
knowledge and skills. Keeping up to date
with both clinical and business skills is
essential. For better or worse, both sets of
knowledge and skills are measured in our
bottom line results.
Botulinum toxin and its applications a day course
Thursday 29 January 2015
Royal Society of Medicine, London
RSM member rates from £539
Non member rates from £599
Dermal fillers course
Friday 30 January 2015
RSM member rates from £599
Non member rates from £699
Botulinum toxin and dermal fillers course intermediate
Thursday 22 to Friday 23 January 2015
Manchester Conference Centre
RSM member rates from £539 - £999
Non member rates from £599 - £1,199
For more information about these courses and to
register online, visit www.rsm.ac.uk/courses
Early bird rates expire Monday 5 January 2015
Botulinum toxin and its applications - a day course.indd 2
11/5/2014 4:22:21 PM
I M C A S 1 7 th A N N U A L W O R L D C O N G R E S S
The leading subjects on aesthetic surgery and cosmetic dermatology
« This is the most enjoyable and the best teaching conference I can remember. The
cadaver workshop is spectacular. I can not remember a meeting with more positive and
enthusiastic feedback from the audience. So many people told me how much they have
learned and have enjoyed this meeting. This is a wonderful learning experience. »
Dr Joel Pessa, Plastic Surgeon from the United States
« I truly think it is the meeting at which I learn the most and become inspired about how I
treat my patients. Each year I take home innovative new techniques to improve my
skills. I have always found IMCAS to provide the most exciting professional learning
experiences. It is an honor to be a part of this conference. »
Dr Susan Weinkle, Dermatologist from the United States
« Congratulations for this excellent academic conference. You did a fabulous job. You
have built and organized a meeting which is truly impressive. I continue to be impressed
by your meeting, in organization, scope, and quality. »
Dr Jonathan Sykes, Facial Plastic Surgeon from the United States
« I congratulate you all for the commitment in the organization of the congress and care of
the details. I must say your meeting is an example of professionalism and seriousness
for the sake of science in the aesthetic field. »
Dr Alessandra Nogueira, Dermatologist from Brazil
« By not attending IMCAS on an annual basis, every aesthetic physician/surgeon would be
starving him/herself of the most valuable updates available. The most illuminating
tool and up-to-date conference on aesthetics that one can attend. It can never be taken
away. An absolute MUST! »
Dr Hugo Kitchen, Cosmetic Surgeon from the United Kingdom
IMCAS Annual World Congress
JAN 29 to FEB
2015
NOVEMBER
14 to1,16,
2014
PARIS fRAnce
Feedbacks taken from the IMCAS World Congress previous edition.
2_ad_imcas.indd 1
10/8/14 4:29 PM
Commercial Development
Disrupt or be disrupted
Leaders disrupt because they continually
innovate. If you are not innovating, if you
don’t keep asking yourself, “How do I
differentiate myself?” there is very little
chance you will ever succeed. If you don’t
disrupt the market, you will eventually be
surpassed by someone who will. Apple
disrupted Microsoft. Apple made a larger
screen on their iPhone, now Samsung
are disrupting them. Netflix disrupted
Blockbuster. Amazon disrupted traditional
bookshops.
Gut-based decisions
Every leader makes decisions fast. In my
opinion, there are three ways to think:
mind, heart and gut. The more you think
about doing something, the more reasons
you are going to find not to do it. This is
commonly known as analysis by paralysis,
which can often be the killer of budding
entrepreneurs. The second way is to think
with the heart. In my experience, many
people have been burned doing this
because their emotions get in the way and
they start to ask the ‘what if’ scenarios:
‘what if it doesn’t work?’ ‘What if I fail?’ or
even, ‘What if I succeed, how will I cope?’
However, in my experience, when you
make a decision with your gut, you are
usually right. So the key is to make a quick
decision and then re-evaluate it. If it’s right –
great, if not – learn from it and move on.
@aestheticsgroup
Aesthetics Journal
challenges. In reality it is usually a lack
of clear communications, expectations
and detailed marketing knowledge – all
of which are the responsibility of the
business owner. The key is to master the
marketing and understand it before you
outsource or delegate it – even when you
know you won’t be carrying out the day-today actions yourself – you must take the
time to really understand exactly what the
marketer is doing with your money. Every
skill is learnable, so take the necessary
time to truly understand marketing, learn
how to articulate what you want and
then outsource or delegate the day-today ‘doing’ of it to someone who clearly
understands your vision, your needs and
your expectations. Trust me, it will be worth
it in the long run.
If you are not getting the results you
expect, think: are you still marketing the
same way you did a decade ago? If so, it
is time to launch yourself into modern-day
transparent and authentic social media
marketing. Without a doubt, social media
provides everyone with a phenomenal
capacity for interacting and engaging
with existing patients, whilst at the same
time, reaching out to prospective patients.
With social medial we are all living in the
public eye, so don’t forget: if you don’t
manage your online brand and reputation,
someone else will take it away from you.
Be unique
Master marketing
If you really want to stay ahead of the
pack, marketing is a critical piece of the
puzzle. I have spoken to a number of
clinic owners who have outsourced their
marketing or social media production
to someone else, paid them a lot of
money but had little results in return. So,
why is this? There are possibly many
reasons: Perhaps the marketing person
has not been given clear guidelines,
expectations, branding information,
ideal patient profile, unique selling
proposition or other useful information.
They therefore may end up secondguessing the requirements and not really
understanding the individual business
needs or the aesthetic marketplace.
Perhaps they didn’t grasp the business
vision, so they couldn’t get the messaging
right. Or maybe the clinic owner found it
difficult to explain what they were looking
for and assumed the marketing person
would create something wonderful
that would solve all of their marketing
52
How many times have you visited somebody
else’s website or seen another practice’s
marketing and thought to yourself – that
looks just like my marketing? The infamous
stock models are everywhere. So, do you
want the same images that everybody else
uses to represent your brand? If not, then
use real patients to brand your business.
Use their pictures, their results and their
stories. There is nothing more powerful than
the word of the patient.
Keep your patients at the forefront of
your mind
In too many cases, marketing efforts fail
because businesses identify themselves
as the “beneficiary” of the end goal. I can’t
stress enough how important it is to keep
your patient in mind. What is it that the patient
wants? Will they benefit from your promotion?
Does it appeal to them? Always make sure
to identify these things and speak their
language. Constantly put yourself in your
patients’ shoes and keep asking, “WIIFT –
what’s in it for them?”
Aesthetics
Use visual content
A great way for your prospective patients
to feel connected to you before they even
meet you is by using video. According to
an article in Forbes Magazine,1 people are
more likely to watch a video than they are to
read an article. Use videos for testimonials, to
breakdown complicated surgical procedures,
and to introduce you and your team when
you are marketing your business. It is not only
a great way of building trust, but as YouTube
is the number two search engine in the world
– it can also help to drive new patients to your
website.
Stay current
Responding to changing demands will grow
your business and keep it current. Helping
your patients to reach their goals requires you
to be up to date with the latest products, the
latest devices, and the latest technologies.
Protect your patients and your
business
Client information is no longer stuck in the
computer locked in your office, but accessible
on your smartphone or tablet, enabling you
to take a call about your patients’ concerns
no matter where you are. While technology
provides ease and convenience however,
it also adds to your exposure and can
become a double-edged sword. Your online
payment account or tablet could be hacked
and all of your patients’ medical history
information obtained. As your business
evolves, your insurance coverage must keep
up with it and continued compliance with
the Data Protection Act and the Information
Commissioner’s Office (ICO) is essential.
The good news is that the clinic owners who
take all of this on board will ensure that their
business not only survives, but thrives. They’ll
be the ones who attract the best staff and
have their appointment book consistently
packed with top patients.
Pam Underdown is a business
growth specialist and the
owner of Aesthetic Business
Transformations. She works
exclusively to help medical
aesthetic business owners improve
their marketing, increase their profits,
reduce their costs and build a long-term
sustainable business asset. Pam has over 25
years of business development, sales and
marketing experience, including nine years
in the aesthetics marketplace.
REFERENCE
1. Sean Rosensteel, Why Online Video Is Vital For Your 2013 Content Marketing Objectives (US: Forbes, 2013) http://www.
forbes.com/sites/seanrosensteel/2013/01/28/why-online-video-
is-vital-for-your-2013-content-marketing-objectives/ [6/11/14]
Advanced
Non-Surgical Aesthetics
Body Face Couture Is Live!
Body Face Couture has launched the next
generation of aesthetic treatments directly
to the public, with a price point for everyone,
making aesthetic treatments accessible at
the click of a button. Consumers can now
buy aesthetic treatments online and under
a national brand with assurance of quality
and efficiency. The aesthetics product
range is characterised by low cost, high
impact results.
Join The Revolution!
Want to become a Body Face Couture
clinic? The accreditation process is vigorous
to ensure only the best clinics can operate
under the Body Face Couture brand.
The company is seeking positive and
like-minded business owners to
represent the forward-thinking brand.
For more information visit
www.bodyfacecouture.com
Treatments that
deliver results in
less than 1 hour to
suit any budget!
Before
After
We now have 116
catchment areas left
available. Follow us on
Twitter to count down
as new clinics sign up.
www.bodyfacecouture.com
116
Catchment
areas left
@bodyfacecouture
bodyfacecouturelondon
Introducing
Signature Skincare
With over 30 years collective experience in working
with UK medical aesthetics partner clinics 5 Squirrels
Ltd was formed to support clinics to develop their own
label skincare range.
•
•
•
•
Low introductory cost
All regulatory, registration and certification included
Peer reviewed published evidence
All branding, point of sale, patient information leaflets,
training and marketing supported
• Full project management
• Made in UK
Why not introduce your own brand skincare now?
UK Medical Aesthetics preferred partner in
Signature Skincare development
[email protected]
www.5squirrels.com
...we wish you a
Very Happy Christmas
and thank you for
your support and
custom in 2014
Christmas Offers
Buy 10 Get 2 Free on
Aneva Derma
Buy 4 Get 1 Free on any
NeoStrata retail product
Buy 4 Get 1 free on
any Exuviance product
Call: 01234 313130
[email protected]
Offer avaialbe while stocks last
@aestheticsgroup
Aesthetics Journal
Aesthetics
Business Process
Brand Building
It is clear that the top three listings may have excellent search engine
optimisation (SEO) to appear on the first page, however, looking at
their proposition objectively, it is not often clear why new patients
would choose one clinic listing over the other.
The Secret Power
of Brands
Gary Conroy talks about why it is
important to invest in your brand equity in
the ever-commoditising aesthetic market
The current UK medical aesthetics market place is awash with
treatment options for patients. Pop-up clinics, discounters, GP
surgeries, dental practices, chiropodists, dermatologists, beauty salons,
national chains, department stores, ‘Botox parties’, hen packages, and
home treatments are just some of the options available. With the huge
influx of healthcare practitioners, as well as less qualified individuals,
developing their skills and starting new businesses in medical
aesthetics, we may now be at a pivotal point in the market place
when supply begins to outstrip demand. The global increase in sales
of professional aesthetic products in 2012 from 2011 was 7.5% – with
average patient retention rates estimated at 10-30% and an estimated
doubling of healthcare professionals delivering services.1,2
A simple Google search will list a wide range of similar sounding clinics
offering similar services at various prices with little explanation of price
rationale or service differentiation. It is no wonder that many patients
find themselves in a ‘Goldilocks’ scenario in their search for an optimal
aesthetic outcome. Let’s take the example of the Google search term
‘Wrinkle treatment clinic London’:
Figure 1: Google search for ‘Wrinkle treatment clinic London’ - Google and the
Google logo are registered trademarks of Google Inc., used with permission
What is a Brand?
We have come a long way from the original meaning of brand,
initially, the word ‘brand’ meant, “an identifying mark burned on
livestock or (especially in former times) criminals or slaves with a
branding iron.” 3 This then developed over time to form more tangible
assets suitable for different media, such as logo’s and trademarks
designed to identify the source of manufacture. Nowadays however,
the word ‘brand’ has grown to mean a lot of different things to a lot
of different people. It comes as no surprise that many businesses
are poorly differentiated and their external service proposition
(ESP) leaves patients confused. It is therefore crucial that time and
money is not wasted in developing a weak brand or one which
does not properly communicate your business strategy, leaving your
proposition lost amongst competitors on search engines. Brands are
highly valuable intangible assets and should be taken as seriously,
and have the same investment consideration, as even the most
expensive piece of capital equipment. Investment education site
Investopedia discuss the worth of ‘intangible assets’ by explaining,
“While intangible assets don’t have the obvious physical value of a
factory or equipment, they can prove very valuable for a firm and
can be critical to its long-term success or failure. For example, a
company such as Coca-Cola wouldn’t be nearly as successful were
it not for the high value obtained through its brand-name recognition.
Although brand recognition is not a physical asset you can see or
touch, its positive effects on bottom-line profits can prove extremely
valuable to firms such as Coca-Cola, whose brand strength drives
global sales year after year.”4 I will now break down the process of
brand development into five clear parts, relevant to a service-based
market such as medical aesthetics.
Brands are highly valuable
intangible assets and should be
taken as seriously as even the
most expensive piece of capital
equipment
1. The Brand Promise
Fundamentally your brand is your ESP: your promise to your
patients. It is what you are telling patients they will receive when
they purchase a product or service under your brand umbrella.
It is very important that the promise or proposition is delivered
consistently at each point of customer contact, time after time.5
This also includes the feelings that patients get when they use
your products and services. In medical aesthetics it is important
to consider what differentiates your promise to your patients from
what your local competition is promising. What emotions or feelings
do your existing loyal patients have and how do you consistently
communicate these to new patients Customer experience
specialists Smith+Co argue that, “A strong brand promise is one
that connects your purpose, your positioning, your strategy, your
people and your customer experience. It enables you to deliver
your brand in a way that connects emotionally with your customers
and differentiates your brand.”6
55
Business Process
Brand Building
@aestheticsgroup
It is even more
important in a medical
environment that
your brand promise is
realistic and that you
never over-promise
to set unrealistic
expectations
Aesthetics Journal
Aesthetics
Brand Development Checklist
Define internally what your brand objectives are.
Where would you like to be?
What is your staff’s view of the current service
proposition?
What are your current and lapsed patients view of
(conduct primary qualitative research):
• Your external service proposition?
• Your brand persona?
• Expectation v. Promise?
What gaps exist between your customer’s and
staff’s perceptions and your own?
Develop tactics to address these.
2. The Brand Perceptions
A brand is what is produced when a product or service promise
meets the consumer’s expectations. Exploring the thoughts,
feelings and emotions that your existing or lapsed patients have
about your brand equates to your brand perception, regardless
of what you were hoping your brand perception was. Due to the
patients’ emotional involvement in the product you are offering
them, as well as their overall perception of your services, your
aesthetic brand is built by your patients’ response. We live in a
world where feedback is gathered easily through quantitative
surveys, usually based on a five-point scale of satisfaction with
the intent of using these results for further marketing. In order
to truly understand your brand perception, primary research is
required to openly gather qualitative feedback about how your
brand is currently perceived. This will allow you to determine if your
promise is being met or not and help to support development and
improve brand perception. Ari Jacoby, CEO of advertising agency
Solve Media, says, “The most accurate composite of a brand’s
true identity seems to come from a consumer’s first gut reaction
to it. Complex brand memories are created over time, and the first
word(s) or image(s) that spring to mind are really the sum total of a
consumers experiences with a brand, in its marketing and use.” 7
3. The Brand Expectations
It is even more important in a medical environment that your brand
promise is realistic and that you never over-promise to set unrealistic
expectations. Not only is this unethical, but patients who part with
their hard-earned cash will feel disappointed and turn away from
your brand. This may not be because the results or service were
necessarily bad, but because they will feel the brand does not live up
to its promise. They may instead turn to competitors because your
brand has lost value for them.
4. The Brand Persona
Primary research with existing and lapsed patients will truly allow
you to explore your brand persona. Your brand persona means its
personality; for example in terms of its mannerisms, behaviour, integrity,
age, and style. How it makes people feel will be the deciding factor
on whether people will transact or continue to interact with the brand.
Whilst you may have set out with a particular idea in mind of the brand
persona you wanted to create, patients are the only ones who can tell
you what you have actually created.
56
5. The Brand Elements
Brands are represented by the above intangible elements as well as
tangible elements, such as:
Brand Logo: Recognition, consistency, individual, reflects brand
promise
Messaging: Promise, differentiation, meets consumer needs
Packaging: Advertising, social media, information leaflets, website
consistency
Consultation: Relevant, thorough, discreet, consultative
Staff Interaction: Knowledge, personality, empathy, gratitude,
consideration
Premises: Comfort, cleanliness, location, accessibility, parking
Pricing: Fair, value, competitive, sustainable, affordable
All of these elements must be consistent, complementary, and
supportive of your brand promise. They will help shape brand
perception, meet brand expectations and define your brand persona.
“Ultimately, brand is about caring about your business at every level
and in every detail, from the big things like mission and vision, to your
people, your customers, and every interaction anyone is ever going to
have with you, no matter how small.” 8
Gary Conroy is co-founder and director of 5 Squirrels
Ltd, which delivers products and services to UK medical
aesthetics industry. Previously, Gary was the sales and
marketing director at Ambicare Health, and formerly
the head of Aesthetic Dermatology for Sanofi-Aventis.
With more than 12 years experience of aesthetics, he has an in-depth
understanding of the financial and clinical aspects of the industry.
REFERENCES
1. [Reference on file via The Consulting Room]
2. [Reference on file via The Consulting Room]
3. Oxford University Press, Brand (Oxford: Oxford Dictionaries, 2014) http://www.oxforddictionaries.
com/definition/english/brand [Accessed 12 November 2014]
4. Investopedia, Intangible Asset (California: Investopedia, 2014) http://www.investopedia.com/terms/i/
intangibleasset.asp [Accessed 12 November 2014]
5. Brad VanAuken, What is a brand? (California: Brand Strategy Insider, 2011) http://www.
brandingstrategyinsider.com/2011/03/what-is-a-brand.html#.VFt0pfmsX4s [Accessed 12 November 2014]
6. Smith+Co, Workshops Brand promise definition (London: Smith+Co, 2013) http://www.
smithcoconsultancy.com/workshops/brand-promise-definition [Accessed 12 November 2014]
7. Ari Jacoby, A Common Sense Approach To Measuring Brand Perception (New York: Forbes, 2012) http://www.forbes.com/sites/ciocentral/2012/05/14/a-common-sense-approach-to-measuring-brand-
perception/ [Accessed 12 November 2014]
8. Dan Pallotta, A logo is not a brand (Massachusetts: Harvard Business Review, 2011) https://hbr.
org/2011/06/a-logo-is-not-a-brand/ [Accessed 12 November 2014]
some dream
some
dream
of success
of success
others
make
others make
it happen
happen
Combining practical demonstrations and interactive training
from world-class experts with the latest innovation from
leading suppliers, the
TheAesthetics
AestheticsConference
Conference&&Exhibition
Exhibition
will power your success in 2015 and beyond. For more
information and to register for the UK’s premier aesthetics
conference, visit www.aestheticscconference.com
SPONSORED
SPONSOREDBY
BY
Dr Rita Rakus
Ulthera Ultra Award Winner 2014
“I am proud to have
Ultherapy in my clinic,
it’s my best selling
treatment”
CoachHouse Medical Ltd
are the official UK distributor for Ultherapy
For further information:
Telephone: 01302 352293
www.coachhousemedical.com
@aestheticsgroup
Aesthetics Journal
Aesthetics
Link Augmentation:
LinkedIn for the
Aesthetics Industry
Paul Jackson explains how the utilisation
of LinkedIn can make a difference to your
business and industry reputation
With 313 million members worldwide and three million registered companies,
LinkedIn presents outstanding opportunities for businesses in any sector.
But how can you maximise its benefit for both your clinic and for yourself
as a professional?
What is LinkedIn?
LinkedIn is a social network for professionals in any industry, offering a huge
potential to network, strengthen relationships, develop thought-leadership, and
further career and business development. It is the online equivalent of your CV,
your little black book of business connections and a networking event all rolled
into one. Based in California, LinkedIn was officially launched in 2003 after its
creation in the living room of co-founder Reid Hoffman in 2002. The company
boasts almost 6,000 employees across 30 offices around the world, and staff
numbers have almost tripled in the last two years. LinkedIn is now increasingly
putting efforts into growth, innovation and customer service in order to hold onto
its title of the internet’s largest professional network.
Every LinkedIn member has a personal page. This allows you to outline your
profession, experience, honours and awards, publications, and the type of person
with whom you would be willing to connect and network with. From here, users
can connect with their peers, friends, colleagues, industry professionals and
anyone else of interest in order to build their network. However, unlike social
media sites such as Twitter, other LinkedIn users can only view your full profile
and interact with you once you have accepted their invitation to connect. This
allows you to control your network and to ensure that your connections are
relevant to your business and its aims. You can specify whether or not you
are interested in approaches from other groups of users (such as business
connections and recruiters) to ensure that you only receive connection requests
from relevant users who will help your business grow. As with Facebook, LinkedIn
users have the ability to post news, updates and interesting content. This content,
Marketing
Using LinkedIn
however, should have a professional focus – so you
certainly shouldn’t see any cat videos or nomination
challenges on this platform! This is a fantastic way to
share your experience and to learn from others, as
well as keeping up to date with your connections,
the businesses you choose to follow, and even your
competitors.
As well as personal pages for individuals, LinkedIn
allows businesses to create pages for themselves.
This has proved so successful that LinkedIn is
now responsible for 64% of social media visits to
corporate websites. LinkedIn business pages have a
different format and focus to those of individuals. A
business page should focus on outlining your
services and specialisms, connecting the staff within
your business, and allowing you to update your
business’s followers and stakeholders with all the
latest news and developments.
LinkedIn also offers Group pages. These groups are
discussion hubs for specific topics and professions
to share knowledge, experience and ideas. For
example, there is a group for ‘Aesthetics & Beauty’
that currently has more than 16,000 members and
features many active discussions each week.
If you haven’t already, the starting point for using
LinkedIn is to set up an individual profile for
yourself…
Using LinkedIn as an aesthetic
practitioner
At first glance, LinkedIn can appear like nothing
more than an online record of your employment
history. However, there are countless features
(some of which go almost unnoticed) that you can
use to raise your profile and promote yourself as
a practitioner, industry expert and an exceptional
employment candidate. The following tactics will
take your personal presence to the next level:
Networking – Connection Building: In the
aesthetics industry, having a strong network
can be of huge value. Three quarters of UK
LinkedIn users use LinkedIn to network with other
professionals. Once you’ve created a LinkedIn
profile, you will probably see that many of your
colleagues, peers and fellow practitioners are
already signed up. To help you connect with them
as quickly as possible, you can synchronise your
LinkedIn account with your email address to show
you which of your email contacts already have
LinkedIn profiles. Connect with the members you
want to stay in touch with, get back in touch with, or
establish contact with in order to build your network,
keep up to date with them and make to it easy for
them to contact you.
Career Development – Recommendations &
Endorsements: If you’re looking to further your
career in aesthetics, LinkedIn is a key social network.
59
Marketing
Using LinkedIn
@aestheticsgroup
Your profile acts as an online resumé which allows you to record
(and potential employers to see) your progress, achievements,
qualifications and interests. Recruiters are increasingly searching
LinkedIn to find candidates and to view the profiles of applicants.
You never know what might come of a connection you make on
LinkedIn, and you’ll be amazed at the number of people you know
that are also connected to other people in your contact list – this
can be a great conversation starter.
Two LinkedIn features that are often overlooked are
‘Recommendations’ and ‘Endorsements’. ‘Recommendations’ are
short written referrals about you from other users. You can ask
other users directly to write you a recommendation, or you may
receive them spontaneously from your connections. Meanwhile,
‘Endorsements’ are votes of confidence in specific skills that you
have. Listing your core skills on your profile will enable others
to endorse you with a single click to confirm that you excel in
these areas. Having a high number of recommendations and
endorsements will show that you are well regarded within the
aesthetics industry.
Industry Leadership – LinkedIn Groups: For leading aesthetics
professionals, LinkedIn is an effective place to demonstrate your
knowledge online, and to establish yourself as a thought-leader in
your industry. There are now over 1.5 million LinkedIn groups and
81% of LinkedIn users belong to at least one. Be selective and get
involved in industry-related LinkedIn Groups to join discussions,
have your say and make new connections. Follow the companies,
organisations and industry bodies that are of interest to you
in order to keep up to date with the latest news, ideas, trends,
events and opinion in the industry. If you have a particular interest
or specialism that you would like to discuss with others and to
demonstrate your knowledge, why not start your own LinkedIn
Group?
Spread the Word – LinkedIn Publisher: As well as being able to
post short updates on your personal profile, LinkedIn has recently
made their article-writing feature available to all users. Previously
this tool was only available to well-known businessmen such as
Richard Branson and James Caan, but now any user can write
and publish an article on LinkedIn. Your connections will receive a
message notifying them that you have published something online,
so it is an effective way to demonstrate your industry knowledge,
experience and opinion to your connections. You can even include
links within your article that direct readers to your business website
in order to help boost your online traffic.
Having a high number
of recommendations
and endorsements will
show that you are well
regarded within the
aesthetics industry
60
Aesthetics Journal
Aesthetics
Using LinkedIn as a Clinic or Business
Being an established and active LinkedIn user will probably
not lead to droves of new clients heading your way overnight,
but the incremental, medium-term benefits for your business,
brand, image and reputation could see you gain new and repeat
business.
Attract the finest employees – LinkedIn Careers: To attract the
best talent, it is just as important for you to sell your business to
candidates as it is for them to convince you of their employability
and experience. A complete and detailed business page will
show that your business is credible, involved with the latest media
channels, and has pride in its achievements. Highlight your Services – Showcase Pages: ‘Showcase Pages’
allow you to display your business’s core products and services
in order to demonstrate your expertise and capabilities in certain
areas – whether this is broad, such as ‘Aesthetic Treatments’ or
more specific, such as ‘Laser Cellulite Treatments’. These pages
will reassure potential clients of your expertise in specific areas of
aesthetics.
Be Findable – LinkedIn Integration: As with all social networks, it
isn’t a case of ‘build it and they will come’. You have to be findable
and you have to let people know that you are there in order to
build up a sizeable following for your business on LinkedIn. This
then creates a captive audience for you to provide with updates
and content via your business page.
Include links to your LinkedIn business profile on your website, on
your other social media profiles, in your email signature, on your
business cards, and in any other online publications. Images to use
as links are available in the business section of LinkedIn, and these
make it easier to drive people to your LinkedIn profile, where you
can then develop an ongoing relationship with them. Once another
LinkedIn user becomes a connection, you can keep in touch with
them more easily, and continue to remind them of everything you
have to offer long after they have left your website.
These are just some of the multitude of opportunities on LinkedIn.
The key activities to remember are to keep your personal
profile and business page up to date, to be proactive in locating
connections, to get involved in relevant industry LinkedIn Groups,
to post regular updates and publications, and to present both
yourself and your business in the best possible light. What’s
more, as LinkedIn is a free platform, the only cost is a small
amount of your time.
Paul Jackson is a senior marketing consultant at
Reload Digital and specialises in social media and online
marketing for the aesthetics, beauty, cosmetics and
fashion industries. As a chartered marketer and Google
Certified Partner, Paul can be seen speaking at marketing
events across the country. Always hard at work, Paul feels he may
soon need some wrinkle fillers…
REFERENCES
1. Marcus Fergusson, LinkedIn users are more interested in your company (London: Econsultancy, 2013) https://econsultancy.com/blog/63616-linkedin-users-are-more-interested-in-your-company-sta ts#i.6etd4ifefdmg11 [10/11/2014]
2. Jorgen Sundberg, LinkedIn? Yes Please, We’re British (London: Jorgen Sundberg, 2012)
http://jorgensundberg.net/linkedin-yes-please-were-british-uk-facts-and-stats/ [10/11/2014]
3. Stephanie Frasco, How To Use LinkedIn To Promote Your Professional Services (USA: Convert with Content, 2013) https://www.convertwithcontent.com/linkedin-promote-professional-services/ [10/11/2014]
Join Aesthetics online to get all
the latest news in medical aesthetics.
With daily social media and website updates and
a weekly newsletter round-up, we provide you
with product news, event reports and industry
developments as they happen.
www.aestheticsjournal.com
The Aesthetics website delivers engaging online content
to more than 2,200 visitors every month
In Profile
Dr JJ Masani
@aestheticsgroup
Aesthetics Journal
Aesthetics
“Trivia makes perfection,
but perfection is not trivial”
With extensive experience across plastic surgery and
general practice, Dr Jamshed (JJ) Masani describes
his journey into the aesthetics industry
Dr JJ Masani began his medical journey 41
years ago in Southern India. He now runs
the Mayfair Practice, a combined GP and
aesthetic clinic, and is well known across
the industry as one of the leading aesthetic
doctors to specialise in mole-removal.
In 1974, as a recently qualified doctor, Dr
Masani went on holiday to Zambia, which
was an experience that would truly kick-start
his career in medicine. After early work as
a government medical officer (similar to a
GP) in ‘the bush’, he started practising plastic
surgery – which was very different to his
current aesthetic practice. “With a war taking
place, plastic surgery was very rudimentary
in the sense that it was nothing to do with
aesthetic care. I would treat around 80
patients a day,” he says. “Mainly for animal
bites and war injuries – someone would lose
half their face and you would have to try to
reconstruct it.”
Dr Masani describes how he grew up in the
snow-clad mountains of the Himalayas and
attended an English public school. Initially,
he became a teacher, a skill that he still
loves to incorporate into his practice today
whilst training new practitioners. His passion,
however, was medicine. As a child he
would steal plasters to give to the children
of his family’s domestic staff when they
were injured. Unfortunately, he struggled
for three years to get accepted to Kasturba
Medical College, in South India. “I was very
poor academically, so whenever I told my
teachers I wanted to be a doctor, they would
laugh,” he recalls. “If you ask my friends and
colleagues now, they are amazed.”
Eventually he qualified and, after working
in Zambia, he moved to the UK in 1978. Dr
Masani tried to enter general practice but
found that, as an older doctor from abroad,
the competition was particularly stiff. So in
1984 he decided to open his own clinic. “I
saw a gap in GP practice, which was that
many patients came to London from abroad
and they had no GP. At that time, it seemed
that no National Health Service (NHS) GP
would take them on.”
To ensure the successful running of his
62
clinic, Dr Masani also worked two
nights a week at the renowned Harley
Street Clinic, assisting Mr Donald Ross,
a leading thoracic surgeon, Mr Freddie
Nichol, a well-respected plastic
surgeon and internationally-reputed
cardiologist, Dr Tony Rickards. This
experience was very valuable for
Dr Masani and he explains that he
learnt a lot from these mentors.
The next 20 years were an era of
first, and then my aesthetic patients.” On a
continuous hard work and dedication to
personal note, Dr Masani is not one to shy
his passion. He says, “From 1984 to 2003, I
away from fun. He collects hats as hobby
never had a single day off – no holidays, no
and, with more than 100 to choose from, tries
Christmas, no sickness leave. If I was sick, I
to wear a different one each day. As well
worked through it.”
as this, at a recent conference he dressed
Upon the introduction of Collagen filler in
as ‘Chief Mole-gone’, in an attempt to grab
1989, Dr Masani began to administer minor
delegate’s attention and encourage them to
aesthetic treatments in his practice. In 1999
attend his lecture on mole removal, which
however, he read an article on the use of
was scheduled for the end of the day. He
botulinum toxin in aesthetics by Professor
teaches daily, and is inspired in his work by
Jean Carruthers. He was impressed with her
work and keen to learn from her so attended artists such as Michelangelo, who famously
said, “Trivia makes perfection, and perfection
her first London masterclass. “In the year
is not trivial,” – a phrase that Dr Masani aims
2000 I started using Botox on my patients,
to reflect in all his work.
but in a very limited fashion,” he explains. It
wasn’t until 2003 that he started
to use the product regularly, and
Q&A
by this time he had also become
interested in skin rejuvenation
Do you have an industry pet-hate?
with the help of lasers. By 2008
I have to say one thing I dislike is when I see patients
he had purchased his first hair
on the streets who look odd, who don’t look natural.
removal treatment, and was
What particular aspect of aesthetics do you think
also offering treatments to
you enjoy most?
help reduce cellulite and assist
I love every minute. There is nothing that I would say I
weight loss.
get bored of.
Dr Masani believes that being
honest is paramount to running
a successful clinic. In 30 years
of clinical practice and almost
25 years of aesthetic practice,
he says he has not received
one complaint. “I don’t treat it as
a business, I treat my patients
as patients, and they are known
as ‘patients’ and not ‘clients’,”
he explains. “They become
my general practice patients
Do you have any particular career advice?
Be truthful to yourself and be truthful to your patients
would be my first and foremost piece of advice.
What is the most important thing to be aware of
as an aesthetic doctor?
Safety is the most important thing to be aware of –
then then results.
What do you think your biggest achievement is?
I would say becoming a doctor is my biggest
achievement and, even more importantly, becoming
a good doctor.
RESERVE YOUR
SEAT AT OUR SOFT
SURGERY TRAINING
COURSE
RSM ICG-7 Interventional
cosmetics: New and
controversial treatments
Why I should take part at this training day?
Friday 27 to Saturday 28 February 2015
If you are involved in Aesthetic medicine and Cosmetic Surgery
and you want to perform high standard Aesthetic treatments with
excellent result and no contraindications, the Soft Surgery is the
latest innovation in Aesthetic industry.
Already 1700 doctors around the world are using the Soft Surgery
technique having extraordinary results.
Call for abstracts:
The organising committee welcome
abstracts for posters to be presented
during the conference in February.
Abstracts can be on any subject within
the area of interventional cosmetics,
whether medical, surgical, laser,
injection, scientific or biological, for
example: trials or projects, exciting
innovations or recent advances, new
techniques and/or equipment, case
reports or report of experience of
useful treatments.
What I have learned at the end of this course?
• Soft Surgery technique
• Soft Surgery applications (Blepharoplasty, scars, skin marks,
xanthelasma, treatment for acne and acne scaring , face and
body lifting, virtual thread lift, increase lip and cheekbone volume
and... Much more...
• World-wide studies and medical cases showing the remarkable
results obtained with Soft Surgery
• During the training you will have the opportunity to perform the
treatments in our models.
Abstracts should be no more than 500 words
and sent to [email protected] by
Thursday 29 January 2015.
For more information or to register online at:
www.rsm.ac.uk/rsmicg7
Register at www.fusiongt.co.uk
Tel: 0207 481 1656 | [email protected] | fusiongt.co.uk
RSM ICG-7.indd 1
11/4/2014 3:44:13 PM
The Last Word
How Young is Too Young?
@aestheticsgroup
Aesthetics Journal
The last word
How young is too young? Dr Raina Zarb
Adami argues for case-by-case evaluation
of younger patients
Medical aesthetics is encumbered with its fair share of
controversy. There exists a common concern that a significant
percentage of young adults and teenagers are choosing to
undergo cosmetic procedures. Is this really the case? And is there
a real cause for concern? The expanding scale and visibility of the
aesthetic industry has led, to a certain degree, to a normalisation
and acceptance of the practice and it is a commonly known
fact that young women are under increasing pressure to look
attractive. This is largely due to media and advertising challenging
their self-esteem.1
The president of the British Association of Aesthetic Plastic
Surgeons (BAAPS) has reported that in the UK, we are seeing more
young people seeking cosmetic procedures.2,3 A recent study
showed that half of young women aged 16-21 now say they would
consider undergoing cosmetic treatments, while more than one
in 10 girls aged 11-16-years-old would consider cosmetic surgery.4
There is a paucity of data on the number and profiles (including
age and gender) of people undergoing surgical and non-surgical
cosmetic procedures in the UK. Only indicative data is available,
primarily from small-scale surveys conducted by professional
bodies, market research companies and cosmetic procedure
providers.5 In the US, non-invasive procedures accounted for 71%
of all cosmetic procedures in the 13-19-year-old age group. While
injectables were very popular, laser hair removal was the most
popular procedure in this cohort. Interestingly, the number of both
surgical and non-invasive interventions in both age groups fell by 1%
from 2012 to 2013.6 This decreasing trend in the US is reassuring.
It would be interesting to see whether this is because less patients
are seeking treatments or because medical professionals are
turning such patients away and refusing to perform requested
treatments.
Medical aesthetics can be roughly classified dichotomously into
rejuvenation and beautification or enhancement procedures.
The latter is seen more in our younger patients, and therefore
procedures involving dermal fillers are more common than those
involving toxins. The most common procedure in the US is lip
enhancement.6 It is pertinent to explore the various factors that
motivate younger people who choose to subject themselves to the
64
Aesthetics
needle or knife in order to modify or improve their
outward appearance. There exists little research on
the psychological characterisation of adolescents
who seek plastic surgery and, similarly, a relative
scarcity of literature surrounding the appropriateness
of performing these procedures on individuals whose
bodies and body images are still developing.7,8
According to The American Academy of Facial
Plastic and Reconstructive Surgery (AAFPRS)
69% of children and teens undergoing cosmetic
interventions do so as a result of bullying, while 31%
do so to prevent being bullied.9 Another worrying
rising trend has been observed, where parents gift
cosmetic intervention to their children. It is therefore
hardly surprising that this pressure to conform to
peers, family and society is a significant driving force
behind the increasingly youthful face of cosmetic
medicine and surgery. All these issues, together with
the pressure of the media through its promotion of
unattainable perfection in body imagery, fuel this
desire in younger patients to seek out aesthetic
services. 10,11
We, the medical professionals, are to a certain extent responsible
for stalling this desire in the young to seek our treatments, and
measures to make them less easily accessible should be put in
place. The Keogh report, published last year, highlighted flaws
in the industry where many cosmetic firms are seen to make
aesthetic procedures seem alluring to patients and even going as
far as incentivising them through discounts, finance schemes and
‘refer a friend’ type offers.12
39% of AAFPRS members surveyed were under the impression
that this increased demand of cosmetic interventions by younger
patients presenting for rejuvenation treatments is reflective of a
belief that non-surgical cosmetic procedures will delay invasive
facial surgery down the line, a concept that has been affectionately
coined ‘pre-rejuvenation’.9 To my knowledge, there are no
PubMed studies to show evidence for this “nipping it in the bud”
approach. While the basis of this hypothesis is plausible, as there
is no robust science to support this theory as yet, it is not one that
should be used to ‘sell’ or incentivise patients. By definition, youth
encompasses inherent factors such as immaturity, vulnerability,
impulsiveness and trivialisation of certain issues. Quick-fix
measures are found especially attractive in this age group. Young
adulthood and teenage years already have to contend with
building a sense of identity, dealing with the significant physical
changes, associated body image fluctuation and the tumultuous
mood changes, along with evolving dynamic peer relationships.13
Teenage years and early twenties are the years during which
individuals often seek to engage in risky and impulsive behaviour,
often without appreciating the long-term consequences.14
Bringing cosmetic interventions into the mix is creating a potential
slippery slope and should be handled with great caution and
under professional direction. There exists a gulf between ‘need’
and ‘want’. Maturity tends to lend to an understanding of the
difference between the two. A patient may want to undergo
a lip enhancement procedure but a practitioner should delve
deeper into the patient’s motives behind such a request and try to
appreciate the psychological factors contributing to this perceived
need, and find alternative ways to help them address the problem.
@aestheticsgroup
Aesthetics Journal
Aesthetics
Wanting to look like a celebrity is not a healthy motivation. Nor is
a desire to relieve some deep-rooted psychological problem or
as the sole response to bullying. Individuals who pursue aesthetic
treatments for reasons purely associated with external appearance
may be at an increased risk for poor psychological outcomes.15
Obsessions with body image concerns may be indicative of
body dysmorphic disorder (BDD). The sufferers obsess about
differences between their actual and their ideal selves. When it
occurs alongside depression or anxiety, it can significantly impair
a young person. Dysmorphophobia, together with many other
mood disorders and psychiatric afflictions most often starts in
adolescence.16 As concerns and changing opinions pertaining
to self-image are normative during adolescence and into the
early twenties, it may be challenging to diagnose BDD during
this developmental period.8 As medical professionals operating
in the field of aesthetics, the ability to probe and detect patients
suffering from this disorder is a reflection of our clinical acumen.
It is indeed often deleterious to the patient’s condition to perform
any such cosmetic intervention.17 It is important to assert that the
patient’s desire for cosmetic interventions is not a reflection or
manifestation of an underlying psychological problem that requires
professional counselling.
Non-invasive procedures, such as those involving toxins and
dermal fillers, tend to be considered entry level and, taken at face
value, appear to be benign enough. Most of us can recall a few
patients who started off with a little bit of toxin to that stubborn
glabella, who over time requested a sample of everything we had
to offer. It is our responsibility to recognise such vulnerabilities and
not fuel a burgeoning addiction. Cosmetic interventions should
never become the proverbial “crutch” to maintain self-esteem.
Equally it certainly isn’t fair to assume that every young patient
presenting to our clinics is inappropriate for treatment and must
have some underlying psychological morbidity. In situations
where the size or shape of a feature really does not conform to
the ideals of beauty or is objectively disproportional to the rest of
the face, and the patient’s reaction to that feature is rational and
has a significant and profound negative impact on the person’s
well-being and self-image, I don’t think age (or its lack thereof) is a
contra-indication to treatment. There does exist a small number of
teenagers and young adults for whom cosmetic procedures would
be appropriate and would yield beneficial results. Such examples
include deformities of the nose or the ears. In cases where the
patient has a large dorsal nasal hump that is disproportionate to
their other facial features, and this affects their self-esteem to a
degree proportionate to the deformity, they will, in all likelihood,
regain their self esteem and benefit from a rhinoplasty procedure.
A successful aesthetic procedure can have a positive influence
on a mature, well-motivated younger adult or teenager, while the
same intervention on a psychologically unstable individual can be
damaging.18
I am of the opinion that, if you have no static rhytides, you are too
young for any sort of rejuvenation procedure. I am, however, an
advocate of aesthetic treatments as long as they are employed
in the right circumstances, performed on the right individual who
has the right grasp on the situation, and to achieve an appropriate
and realistic result. The impetus to go forward must ultimately
belong to the patient. As long as I can ascertain myself that this
is the case, and not the result of bullying, peer pressure or an
unreasonable motive, I am happy to proceed.
In truth, the only reason we continue to debate the issue of “how
The Last Word
How Young is Too Young?
young is too young?” is because a clear-cut answer does not,
nor will ever, exist. The real answer is, “it depends”. As clinicians,
regardless of the indication, a patient is a patient, so we need to
take a history, perform an examination and devise a management
plan accordingly. The need for intervention must be evaluated
on a case-by-case basis as teenagers and young adults mature
physically and emotionally at varying rates. Cosmetic intervention
to correct disfigurement should not be discounted but the idea
of using it as a cosmetic social enhancement should not be
endorsed. Ethically, medical professionals should be mindful of
the principles of beneficence and nonmalfeasance19 and are duty
bound to always act in the best interest of the patient. It is also
our responsibility to point out to the patient that it is impossible
to predict or control how others will respond to their altered
appearance.8
No such thing as a ‘cosmetic emergency’ exists. The procedures
we perform are elective. This means that time is on our side
to adequately assess our patient’s suitability for a procedure
and ensure they have all the necessary information, including
alternative treatments, to choose to undergo the treatment.
It is very likely that in most cases where young people present to
our clinics for cosmetic interventions, there are less invasive, more
appropriate avenues they should be exploring outside Harley
Street and the likes. It is our duty to recognise these cases and
steer them well away from our expert hands, with clear instructions
on how to avoid us for a fair few years ahead. More often than
not, the answer to a young person requiring our expertise is: “A
generous dollop of sunscreen and a pair of big sunglasses”.
Dr Raina Zarb Adami is a surgeon whose private
practice, Aesthetic Virtue, is dedicated to non-invasive
facial aesthetic medicine. She is the medical director of
The Academy of Aesthetic Excellence, which provides
foundation and advanced training courses. REFERENCES
1. http://baaps.org.uk/about-us/press-releases/1321-get-em-off-ban-cosmetic-surgery-ads-in-
public-places.
2. http://www.bbc.co.uk/newsbeat/27110306.
3. ReviewofRegulationofCosmeticInterventions:ResearchamongtheGeneral Public and Practitioners (2013), Creative Research
4. Girlguiding UK (2011) Girls’ Attitude Survey. Retrieved from http://www.girlguiding.org.uk/
system_pages/s mall_navigation/press_office/latest_press_rel eases/3rd_march_2011_-_
gyac.aspx
5. http://www.parliament.uk/briefing-papers/POST-PN-444.pdf
6. http://www.plasticsurgery.org/news/plastic-surgery-statistics/2013.html
7. Sarwer D B, Infield A L, Crerand C E. Washington, DC: American Psychological Association; 2008. Plastic surgery for children and adolescents; pp. 341–366.
8. Crerand C, Magee L. (2013). Cosmetic and Reconstructive Breast Surgery in Adolescents: Psychological, Ethical, and Legal Considerations. Seminars in Plastic Surgery. 27 (1), p72-8.
9. http://www.aafprs.org/
10. Tan KB. Aesthetic medicine: a health regulator’s perspective. Clin Governance. 2007;12:13–25.
11. Pearl A, Weston J. Attitudes of adolescents about cosmetic surgery. Ann Plast Surg. 2003;50(6):628–630.
12. https://www.gov.uk/government/publications/regulation-of-cosmetic-interventions-
government-response.
13. Cash T F. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006. Body image and plastic surgery; pp. 37–59.
14. Steinberg L. Risk taking in adolescence: new perspectives from brain and behavioral science. Curr Dir Psychol Sci. 2007;16(2):55–59.
15. Honigman R J, Phillips K A, Castle D J. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004;113(4):1229–1237.
16. Kessler R C, Amminger G P, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün T B. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359–364.
17. Crerand C E, Franklin M E, Sarwer D B. Body dysmorphic disorder and cosmetic surgery. Plast Reconstr Surg. 2006;118(7):167e–180e.
18. McGrath M, Schooler W. (2004). Elective plastic surgical procedures in adolescence. Adolescent medicine Clincis. 15 (3), p487-502.
19. Laneader A, Wolpe P R. Philadelphia, PA: Lippincott, Williams, & Wilkins; 2006. Ethical considerations in cosmetic surgery; pp. 301–314.
65
Directory
For less than £35 per month, you can list your company details here. For more
information contact Aesthetics - 0203 096 1228 [email protected]
a
ABC Laser
Contact: Guy Gouldsmit
+44 08451 707 788
[email protected]
www.abclasers.co.uk
Carleton Medical Ltd
Contact: Nick Fitrzyk
+44 01633 838 081
[email protected]
www.carletonmedical.co.uk
Services: Asclepion Lasers
Aesthetic Source
Contact: Sharon Morris
+44 01234 313 130
[email protected]
Services: NeoStrata and Exuviance
Chromogenex
Contact: Lauren Roberts
+44 01554 755444
[email protected]
www.chromogenex.com
Service: Laser System Manufacturer
Medico Beauty
Contact Name: Andy Millward
+44 (0) 844 855 2499
[email protected]
www.medicobeauty.com &
www.medicobeautyblog.com
HydraFacial UK – Skin Health for Life™
www.hydrateyourbusiness.co.uk
Contact: Ron Myers
01788 577254 or 07734 101274
@Consulting_Room
facebook.com/TheConsultingRoom
l
MedivaPharma
01908 617328
[email protected]
www.medivapharma.co.uk
Service: Facial Aesthetic Supplies
Laser Physics
+44 01829773155
[email protected]
www.laserphysics.co.uk
d
DermaLUX
Contact: Louise Taylor
+44 0845 689 1789
[email protected]
www.dermaluxled.com
Service: Manufacturer of LED
Phototherapy Systems
Aesthetox Academy
Contact: Lisa Tyrer
+44 0870 0801746
[email protected]
www.aesthetox.co.uk
Service: Training
Merz Aesthetics
+44 0333 200 4140
[email protected]
Lawrence Grant
Contact: Alan Rajah
+44 0208 861 7575
[email protected]
www.lawrencegrant.co.uk/
specialist-services/doctors.htm
WELLNESS TRADING LTD –
Mesoestetic UK
Contact: Adam Birtwistle
+44 01625 529 540
[email protected]
www.mesoestetic.co.uk
Services: Cosmeceutical Skincare
Treatment Solutions, Cosmelan,
Antiagaing, Depigmentation,
Anti Acne, Dermamelan
e
Allergan
+44 0808 2381500
www.juvedermultra.co.uk
Eden Aesthetics
Contact: Anna Perry
+44 01245 227 752
[email protected]
www.edenaesthetics.com
n
AZTEC Services
Contact: Anthony Zacharek
+44 07747 865600
[email protected]
www.aztecservices.uk.com
Service: exclusive UK distributor for the
Lutronic and Viora product ranges
b
Lifestyle Aesthetics
Contact: Sue Wales
+44 0845 0701 782
[email protected]
www.lifestyleaesthetics.com
Energist Medical Group
Contact: Eddie Campbell-Adams
+44 01792 798 768
[email protected]
www.energistgroup.com
Lumenis UK Ltd
Contact: Nigel Matthews or
Mark Stevens
+44 020 8736 4110
[email protected]
www.lumenis.com
f
Bioptica Laser Aesthetics
Contact: Mike Regan
+44 07917 573466
[email protected]
www.bla-online.co.uk
Services: Core of Knowledge Training and
Laser Protection Adviser (LPA) Services
Flawless Aesthetics and Beauty
Flawless Aesthetics & Beauty
01400
281902
[email protected]
Flawless Mineral Bronzer is just an invitation for
www.flawlessaestheticsandbeauty.co.uk
achieving a seductive and show-stopping look.
Services:
Mineral
Makeup and Skincare
The sheer and soft texture will add that touch of
[email protected]
Tel: 01400 281902
www.flawlessaestheticsandbeauty.co.uk
colour that will leave skin healthy and radiant.
Boston Medical Group Ltd
Contact: Iveta Vinklerova
+44 0207 727 1110
[email protected]
www.boston-medical-group.co.uk
Fusion GT
0207 481 1656
[email protected]
www.fusiongt.co.uk
g
c
Candela UK Ltd
Contact: Michaela Barker
+44 0845 521 0698
[email protected]
www.syneron-candela.co.uk
Services: Adviser (LPA) Services
Cosmetic Insure
Contact: Sarah Jayne Senior
www.cosmeticinsure.com
0845 6008288
[email protected]
66
p
Polaris
Lasers
Medical
Microdermabrasion
From
Contact:
Neil Calder
MATTIOLI ENGINEERING
+44 01234841536
[email protected]
www.polaris-laser.com
Lynton
+44 01477 536975
[email protected]
www.lynton.co.uk
Mineral Makeup and Skincare
Luxury 100% Natural Mineral Makeup, Hypoallergenic, Vegan, Halal, Made in the UK
Training Accredited by Leading Aesthetic Insurance Companies
CPD Points
Soft luminous powder blends effortlessly
Youthful sun kissed glow
Works for all skintones
Neocosmedix Europe
Contact: Vernon Otto
+44 07940 374001
www.neocosmedixeurope.co.uk
[email protected]
As featured on
s
m
needle free
Mesotherapy
for the delivery of active
substances.
Silhouette Soft
Tel. 020 7467 6920
Contact: Emma Rothery
www.silhouette-soft.com
[email protected]
MACOM
Contact: James Haldane
+44 02073510488
[email protected]
www.macom-medical.com
Galderma Aesthetic & Corrective
Division
+44 01923 208950
[email protected]
www.galderma-alliance.co.uk
Tel: 01234 841536
www.polarismedicallasers.co.uk
Med-fx
Contact: Faye Price
+44 01376 532800
[email protected]
www.medfx.co.uk
Sinclair Pharmaceuticals
[email protected]
0207 467 6920
www.sinclairispharma.com
h
z
Healthxchange Pharmacy
Contact: Steve Joyce
+44 01481 736837 / 01481 736677
[email protected]
www.healthxchange.com
www.obagi.uk.com
Medical Aesthetic Group
Contact: David Gower
+44 02380 676733
[email protected]
www.magroup.co.uk
Zanco Models
Contact: Ricky Zanco
+44 08453076191
[email protected]
www.zancomodels.co.uk
COMPOSED • CONFIDENT • MY CHOICE
INDICATION
PURIFIED1• SATISFYING2,3,4 • CONVENIENT5
Now approved for
crow’s feet lines
Bocouture® 50 Abbreviated Prescribing Information Please refer to the Summary of Product
Characteristics (SmPC) before prescribing. 1162/BOC/AUG/2014/PU Presentation 50 LD50 units of
Botulinum toxin type A (150 kD), free from complexing proteins as a powder for solution for injection.
Indications Temporary improvement in the appearance of moderate to severe vertical lines between
the eyebrows seen at frown (glabellar frown lines) and lateral periorbital lines seen at maximum smile
(crow’s feet lines) in adults under 65 years of age when the severity of these lines has an important
psychological impact for the patient. Dosage and administration Unit doses recommended for
Bocouture are not interchangeable with those for other preparations of Botulinum toxin. Reconstitute
with 0.9% sodium chloride. Glabellar Frown Lines: Intramuscular injection (50 units/1.25 ml).
Standard dosing is 20 units; 0.1 ml (4 units): 2 injections in each corrugator muscle and 1x procerus
muscle. May be increased to up to 30 units. Injections near the levator palpebrae superioris and
into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Intramuscular
injection (50units/1.25mL). Standard dosing is 12 units per side (overall total dose: 24 units); 0.1mL
(4 units) injected bilaterally into each of the 3 injection sites. Injections too close to the Zygomaticus
major muscle should be avoided to prevent lip ptosis. Not recommended for use in patients over
65 years or under 18 years. Contraindications Hypersensitivity to Botulinum neurotoxin type A or to
any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton
syndrome). Presence of infection or inflammation at the proposed injection site. Special warnings
and precautions. Should not be injected into a blood vessel. Not recommended for patients with
a history of dysphagia and aspiration. Adrenaline and other medical aids for treating anaphylaxis
should be available. Caution in patients receiving anticoagulant therapy or taking other substances in
anticoagulant doses. Caution in patients suffering from amyotrophic lateral sclerosis or other diseases
which result in peripheral neuromuscular dysfunction. Too frequent or too high dosing of Botulinum
toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless
clearly necessary. Should not be used during breastfeeding. Interactions Concomitant use with
aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used
with caution. 4-aminoquinolines may reduce the effect. Undesirable effects Usually observed within
the first week after treatment. Localised muscle weakness, blepharoptosis, localised pain, tenderness,
itching, swelling and/or haematoma can occur in conjunction with the injection. Temporary vasovagal
reactions associated with pre-injection anxiety, such as syncope, circulatory problems, nausea or
tinnitus, may occur. Frequency defined as follows: very common (≥ 1/10); common (≥ 1/100, < 1/10);
uncommon (≥ 1/1000, < 1/100); rare (≥ 1/10,000, < 1/1000); very rare (< 1/10,000). Glabellar Frown
Lines: Infections and infestations; Uncommon: bronchitis, nasopharyngitis, influenza infection.
Psychiatric disorders; Uncommon: depression, insomnia. Nervous system disorders; Common:
headache. Uncommon: facial paresis (brow ptosis), vasovagal syncope, paraesthesia, dizziness.
Eye disorders; Uncommon: eyelid oedema, eyelid ptosis, blurred vision, blepharitis, eye pain. Ear
and Labyrinth disorders; Uncommon: tinnitus. Gastrointestinal disorders; Uncommon: nausea, dry
mouth. Skin and subcutaneous tissue disorders; Uncommon: pruritus, skin nodule, photosensitivity,
dry skin. Musculoskeletal and connective tissue disorders; Common: muscle disorders (elevation of
eyebrow), sensation of heaviness. Uncommon: muscle twitching, muscle cramps. General disorders
and administration site conditions; Uncommon: injection site reactions (bruising, pruritis), tenderness,
Influenza like illness, fatigue (tiredness). Crow’s Feet Lines: Eye disorders; Common: eyelid oedema,
dry eye. General disorders and administration site conditions; Common: injection site haemotoma.
Post-Marketing Experience; Flu-like symptoms and hypersensitivity reactions like swelling, oedema
(also apart from injection site), erythema, pruritus, rash (local and generalised) and breathlessness
have been reported. Overdose May result in pronounced neuromuscular paralysis distant from the
injection site. Symptoms are not immediately apparent post-injection. Bocouture® may only be used
by physicians with suitable qualifications and proven experience in the application of Botulinum
toxin. Legal Category: POM. List Price 50 U/vial £72.00 Product Licence Number: PL 29978/0002
Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100,
60318 Frankfurt/Main, Germany. Date of revision of text: August 2014. Further information
available from: Merz Pharma UK Ltd., 260 Centennial Park, Elstree Hill South, Elstree, Hertfordshire
WD6 3SR.Tel: +44 (0) 333 200 4143
Adverse events should be reported. Reporting forms and information can be found at
www.mhra.gov.uk/yellowcard Adverse events should also be reported to Merz Pharma UK Ltd at
the address above or by email to [email protected] or on +44 (0) 333 200 4143.
1. Bocouture 50U Summary of Product Characteristics. Bocouture SPC 2014 August available from:
URL: http://www.medicines. org.uk/emc/medicine/23251.
2. Prager, W et al. Onset, longevity, and patient satisfaction with incobotulinumtoxinA for the
treatment of glabellar frown lines: a single-arm prospective clinical study. Clin. Interventions in
Aging 2013; 8: 449-456.
3. Sattler, G et al. Noninferiority of IncobotulinumtoxinA, free from complexing proteins, compared
with another botulinum toxin type A in the treatment of glabelllar frown lines. Dermatol Surg 2010;
36: 2146-2154.
4. Prager W, et al. Botulinum toxin type A treatment to the upper face: retrospective analysis of daily
practice. Clin. Cosmetic Invest Dermatol 2012; 4: 53-58.
5. Data on File: BOC-DOF-11-001_01
Bocouture® is a registered trademark of Merz Pharma GmbH & Co, KGaA.
1180/BOC/OCT/2014/LD Date of preparation: October 2014
PURIFIED1• SATISFYING2,3,4 • CONVENIENT5
Botulinum toxin type A
free from complexing proteins
Experience all the benefits of VYCROSS™ technology.
Treat various areas of the face using only 3 products.
It’s that versatile.
Instructions and directions for use are available on request.
Allergan, Marlow International, 1st Floor, The Parkway Marlow, Buckinghamshire SL7 1YL, UK
Date of Preparation: August 2014 UK/0880/2014

Acne laser treatment CPD Article

Transcription

Similar documents

Brilliant photo documentation from head to toe

RAVLIN CONGREGATE CENTER

View our Medical Spa Brochure

See here for more details

“I`ve found that when I ask women with beautiful skin what they do to

LILT - BioFlex Laser Therapy

Botinol This clinically proven, four step treatment effectively reduces

psychodermatology march 15.cdr

Sublative™ Acne Scar Treatment FAQ , s

For more information and pricing, read our aesthetic services brochure