Hot and cold
Heating versus freezing for
body shaping and fat reduction
What lies
Anatomy and physiology of the skin
CPD accredited article
The thick of it
The latest methods and procedures
in FUE hair transplant technology
Don’t sweat it
Balancing act
HA Fillers
Dr Patrick Bowler
on new technology
for treating primary
axillary hyperhidrosis
via radio frequency
Wendy Lewis on
how to strike a
balance between
art and science in
clinic marketing
A surgeon’s view
on the use of
Hyaluronic Acid
(HA) fillers in a facial
aesthetics practice
A patient for life,
not just for Christmas
iConsult is the only system that focuses on improving
your patients experience and will improve your retention rate.
iConsult looks after your patient,
your business and your reputation.
Visit www.iconsult-aesthetic.com for more information.
Contents • December 2013
The latest news on products, events and medical research
Out and about exploring aesthetics this month, from seminars
to launches
What powers prevent non-medically trained individuals from
injecting toxins?
Filler performance Page 33
Heating versus freezing for fat reduction
Marketing Page 52
Lorna Bowes on the anatomy and physiology of the skin
Plastic surgeon Stephen McCulley on the use of HA Fillers
This month’s contributors
Looking at the results of a study into the physical properties of
hyaluronic acid fillers and their relevance for clinical performance
Dr Alain Gondinet on combining PRP and organic silicon
Dr Patrick Bowler discusses new technology for sweat reduction in primary axillary hyperhidrosis
Dr Patrick Treacy looks at the latest methods and procedures in
FUE hair transplant technology
Lorna Bowes RGN NIP has trained many
aesthetic professionals in fillers, toxins, medical
needling, skincare and peels, and lectures
regularly on aesthetic procedures.
Stephen McCulley is a cosmetic plastic and
reconstructive surgeon based at Nottingham’s
renowned City Hospital. He is also a member of
Dr Alain Gondinet is an aesthetic medical
doctor and nutritionist specialising in
antioxidative mesotherapy. He is a medical
consultant at Bio Bridge Foundation (Switzerland).
Dr Patrick Bowler is a founding member and
Fellow of the British College of Aesthetic Medicine.
He has featured on GMTV, BBC Radio, Living TV
and Channel 4’s Ten Years Younger.
The latest clinical studies
Dr Patrick Treacy is medical director of Ailesbury
Clinics Ltd and Ailesbury Hair Clinics Ltd. He is an
active member of many international societies and
is a Fellow of The Royal Society of Medicine.
Richard Crawford-Small on branding and archetypes
John Castro on the benefits of blogging for your aesthetic business
Mike Regan is chair of the Aesthetic Surgery
Services Committee (CH403) of the British
Standards Institution and works full time as a
Laser Protection Adviser in the aesthetics sector.
∞ Weight loss and body contouring focus ∞ Intradermal
Botulinum Toxin-A injections for a total facelift
∞ Keogh Review latest ∞ Aesthetics Awards winners
Wendy Lewis on the art and science of clinic marketing
Hayley Hutchings on marketing planning for success
We speak to Debra Robson about running a successful
body-shaping clinic
Mike Regan on the latest from the CEN European Standards for
Aesthetic Surgery and Aesthetic Non-Surgical Medical Service
Subscribe to Aesthetics
Subscribe to Aesthetics, the UK’s only free of charge journal for Medical
Aesthetic Professionals. Visit aestheticsjournal.com or call 01268 754 897.
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Editors’ letters
Welcome to the first issue of Aesthetics, a new
journal marking the constant evolution of the
medical aesthetics arena and of Cosmetic News.
It seems pertinent that as we mark the end of 2013
and move into a new year, we are bidding farewell
Vicky Eldridge
to the past and welcoming in an exciting new phase
both for the Aesthetics brand and myself.
While this will be my first issue of Aesthetics, it will also be my
last. After five years editing Cosmetic News, I am moving on to
pastures new and would like to take this opportunity to thank you,
our loyal readers, and everyone who has supported both myself
and the publication during this amazing time. My thanks also to
the great team I have worked alongside and who will continue to
make Aesthetics the must-read publication for medical aesthetic
professionals. I would also like to wish the new editor, Leah Hardy,
and the team at Synaptiq all the best for the future in taking the
publication and its associated events, The Aesthetics Awards and
The Aesthetics Conference and Exhibition (ACE), to even greater
heights. It has been a fantastic few years and I have very much
enjoyed my time as editor of Cosmetic News.
My best wishes for the festive season and here’s to a happy
and successful 2014.
Editorial advisory board
I’m delighted and proud to be joining as the new
editor of Aesthetics. This is a fantastic time in
the journal’s history, as it evolves from Cosmetic
News with a new name, new design and clear
positioning as the leading journal for medical
Leah Hardy
aesthetic professionals. Some of you may know
me already, as I’ve been writing about aesthetic
procedures for magazines and newspapers and appearing on
panels at conferences for almost twenty years.
It has been a tricky time, with the Keogh Report highlighting
issues that all good practitioners agree were a problem, but also
a positive one, as we rebuild confidence in our industry and see
unprecedented demand for non-surgical treatments. Aesthetics is
here to support you in making your practice even more successful.
With our expert contributors, we aim to bring you the very latest on
products, devices, procedures, ethical and legal issues, business
development alongside CPD approved educational content and
clinical features. Behind everything we do is our common goal of
creating happy, satisfied patients.
From January, Aesthetics will include a letters page where you
will be able to comment on anything in the journal, discuss topical
issues and share your experience. So please start the dialogue by
emailing me, [email protected] I very much look forward
to hearing from you.
We are honoured that a number of leading figures from the medical aesthetic community have joined Aesthetics
journal’s new advisory board to help steer the direction of educational, clinical and business content.
Dr Mike
is a former
current committee member
and Fellow of the British
College of Aesthetic
Medicine (BCAM). He
is on the faculty for the
postgraduate certificate
of Cosmetic Medicine,
an honorary tutor in
cosmetic medicine at
Leicester University and
is an accredited trainer for
advanced Vaser liposuction.
Mr Adrian
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.
is currently
Vice Chair
of the British Association of
Cosmetic Nurses (BACN)
and also medical advisor
for the BSI on their Beauty
Services Sector standard
committee. 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).
Chris Edmonds • Managing Director
T: 01268 754 897 | M: 07867 974 121
[email protected]
Leah Hardy • Editor
T: 01268 754 897 | M: 07880 812 582
[email protected]
Sarah Dawood • Journalist
T: 01268 754 897 | [email protected]
Malcolm Badger • Creative Director
T: 01268 754 897 | [email protected]
Peter Johnson • Senior Designer
T: 01268 754 897 | [email protected]
Chiara Mariani • Designer
T: 01268 754 897 | [email protected]
is a sales and
professional, and was one
of the first nurse injector
trainers in the UK for dermal
fillers. With over 20 years
experience in the industry
in both the UK and Europe,
Amanda has extensive
knowledge of medical
aesthetics and business
Dr Sarah
is an aesthetic
doctor and
previous maxillofacial
surgery trainee with dual
qualifications in both
medicine and dentistry, who
fell in love with the results
possible through minimally
invasive methods. Now
based at Beyond Medispa in
Harvey Nichols, she practises
cosmetic injectables and
hormonal based therapies.
Jenna Earl • Marketing Manager
T: 01268 754 897 | M: 07710 947 842
[email protected]
Suzy Allinson • Brand Manager
T: 01268 754 897 | M: 07500 007 013
[email protected]
Claire Simpson • Events Manager
T: 01268 754 897 | [email protected]
Hollie Dunwell • Sales Manager
T: 01268 754 897 | M: 07557 359 257
[email protected]
Craig Christie • Administration and Production
T: 01268 754 897 | [email protected]
Material may not be reproduced in any form without the
publisher’s written permission. For PDF file support please
contact Craig Christie; [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.
Peter Sissons announced as
chair of ACE Question Time
Former BBC News and ITN Broadcaster
Peter Sissons will be hosting an evening Question
Time session at The Business Design Centre,
London on Saturday March 8 as part of the
Aesthetics Conference and Exhibition (ACE) 2014.
Mr Sissons will be accompanied by a panel of
medical aesthetic experts, who will discuss the latest
topics influencing the industry today. Winner of The
Apprentice, Dr Leah Totton has been confirmed as a
panel member alongside Dr Mike Comins, former president, current committee
member and Fellow of the British College of Aesthetic Medicine (BCAM), Dr
Tracy Mountford, founder and medical director of The Cosmetic Skin Clinic
and Sharon Bennett, vice chair of the British Association of Cosmetic Nurses
(BACN). Prior to the debate there will be a drinks and canapé reception, which
will provide delegates with the chance to network, share knowledge and
communicate their ideas with colleagues. The event will start at 6pm and will
last for two hours.
The event has limited availability and front row seats are offered on a first
come first served basis. Tickets are £39. To avoid disappointment, book
your place online today at www.ace2014.co.uk or call 01268 754 897.
Alma Lasers launches SPEED
hand piece for Soprano
Alma Lasers has launched a new hand piece
for its Soprano laser that allows even faster
hair removal.
The SPEED hand piece enables practitioners to
perform more treatment sessions in less time.
A large spot size applicator of 20x10mm also
allows larger areas to be treated more quickly.
Dermatological clinical studies have proven the
safety and efficacy of the Soprano laser, which is based on Alma’s Super
Hair Removal (SHR) technology.
New garments from
MACOM Medical target
baby fat and cellulite
Compression garment manufacturers MACOM
Medical have just launched a new postnatal
garment as well as cellulite busting hotpants.
MACOM Postnatal binds the lower ribs and abdomen
of women who have just given birth, helping them
to get rid of post-baby fat, restore the abdomen’s
natural shape and support weakened and separated
stomach muscles. MACOM Smooth incorporates
Emana® bioactive crystals, which harness the rays
of infrared heat energy emitted by the surface of the
body to smooth and tone the skin, improve elasticity
and increase recovery time post exercise.
Merz Pharma acquires
Swiss aesthetic medicine
specialist Anteis
Merz Pharma has further strengthened its position
in the aesthetics market by purchasing the Swiss
company Anteis. Anteis specialises in the development,
manufacture and commercialisation of biomedical
products in the area of aesthetics.
The acquisition strengthens the Merz portfolio and
reinforces its market position in the field of aesthetic
medicine while merging the Anteis operations into one of
the leading providers worldwide.
The company has also recently acquired Neocutis, which
specialises in the development of dermocosmetic pre- and
post-treatments for aesthetic procedures.
“The acquisition of Anteis by Merz is a unique opportunity
to strengthen our presence in aesthetic medicine by
bringing innovative solutions to doctors and patients,”
said Philip Burchard, CEO Merz Pharma. “Anteis brings
substantial additions to Merz in terms of products, talent,
geographic presence and manufacturing capabilities. Our
two portfolios complement each other perfectly.”
Since 2005, Merz Pharmaceuticals has distributed the
Belotero® range of fillers, developed by Anteis, which has
become a strong global player in the area of injectable
medical devices based on biopolymer transformation.
The Anteis product lines include Esthélis, Fortélis, Mesolis
and Modélis as well as the Jolidermis range and the Anteis
Injection System.
These products are now available in over 90 countries in
five continents.
TUV Rheinland to pay
compensation following
faulty PIP implants
German company TUV Rheinland is to pay compensation to
hundreds of women after it awarded EU safety certificates
to French breast implant manufacturer PIP.
Six implant distributors and 1,700 women sued TUV Rheinland
for €50million (£42 million). An initial payment of €3000 will
be given to each victim to enable them to have surgery to
remove the faulty implants.
“Of course TUV has some responsibility and should be
held to account. They’re the organisation that gives the CE
certification for safety, and that was what my surgeon relied
on when he gave the implants to me,” said British woman
Jan Spivey, who had PIP implants fitted during reconstructive
surgery after she had breast cancer.
Founder of PIP, Jean Claude Mas, who ordered employees to
hide the sub-standard silicone when inspectors visited
the factory, and four of his executives are on trial for
aggravated fraud in Marseilles. A ruling is expected for
Mas on 10 December.
Aesthetics | December 2013
Blood test could detect skin
cancer spread
Dundee University researchers are pioneering a simple blood test, which
can be used to identify patients whose skin cancer has spread. It is believed
that such tests will lead to faster diagnoses, and help avoid incidents of
cancer misdiagnosis.
According to their presentation during the National Cancer Research Institute
Conference, the blood test measures levels of a gene called TFP12, found in
the DNA in the blood. The landscape of the DNA then helps to identify if the
cancer has spread. It is believed, that such findings could not just lead to faster
diagnoses, but also new treatments.
Particularly difficult to treat, certain skins cancers, such as melanomas, are also
notoriously hard to detect. Dr Tim Crook, study author and consultant medical
oncologist at the University of Dundee said, “By using a blood test, we have
the basis of a simple and accurate way of discovering how advanced the disease
is, as well as an early warning sign of whether it has started to spread. This work
could lead to quicker diagnosis and potentially new treatments, giving patients
and doctors an even better chance of beating the disease. There’s increasing
evidence that the latest treatments are more effective in these early stages and, if
we can identify patients whose cancer has only just started to spread, this would
significantly improve the chances of beating the disease.”
Online booking now open for
The Aesthetics Conference
and Exhibition (ACE)
Booking for The Aesthetics Conference and Exhibition (ACE) is now
available on a new dedicated website - www.ace2014.co.uk.
The website reveals details of the professional development lectures,
workshops, masterclasses, business seminars and customer service
workshops available at ACE, which takes place at The Business Design
Centre in London on March 8-9, 2014. The meeting includes a two-day
conference, where 20 expert speakers from the fields of cosmetic
medicine, plastic surgery, dermatology, nursing, marketing and business
will discuss relevant topics. The event is priced at £89 for a one-day pass,
and £160 for a two-day pass.
To find out more about ACE and to book your place, visit the website at
www.ace2014.co.uk or call 01268 754 897.
Vanquish produces positive
BTL Aesthetics has created a new noninvasive fat reduction treatment for the
abdomen, flanks and thighs.
Vanquish uses radio frequency technology
cleared by the FDA for deep tissue heating.
It is a no-contact device, whereby the patient lies
on a table and a curved panel is placed across
the body area to be treated. Patients undergo
four 30-minute weekly sessions. There is no
pain and patients can return to regular activity
immediately after treatment.
News in Brief
Love handles biggest beauty obsession
A recent survey from British manufacturer BTL has
found that love handles are the biggest beauty
obsession. 38% of the consumers, beauticians and
cosmetic surgeons polled cited this as the number
one hang-up.
Mills Medical Services provide doctors to
salons and clinics
Mills Medical Services is enabling salons
and clinics to offer a range of aesthetic facial
rejuvenation and cosmetic dentistry treatments
nationwide by providing them with fully trained
aesthetic doctors.
Pollogen launches skin rejuvenation device
Pollogen has launched a new medical-grade
device for dermal volumising, wrinkle reduction,
skin rejuvenation and lifting effects. Surgen is
powered by Hybrid Energy Technology. It is also
virtually painless, produces long-lasting results and
is convenient with minimal downtime.
Pulse Light invest in three new lasers
Hair removal clinic Pulse Light has invested in
three new lasers using the Soprano XL laser
hair removal system. “The lasers allow each
treatment to be carefully aligned to the client’s
body and needs,” said Pulse Light senior nurse
M. Maclean. “This precision delivers professional
results, with no discomfort to the client.”
Dr Britta Knoll authors mesotherapy book
Mesotherapy specialist Dr Britta Knoll has
written a book describing the dosages, active
substances, and administration methods used
for the treatment. The Illustrated Atlas of Esthetic
Mesotherapy provides a step-by-step introduction
to the practice of mesotherapy, accompanied by
165 colour illustrations.
Aspect Dr available in UK
Australian skincare line Aspect Dr is available
in the UK. The range is the number one selling
physician-exclusive skincare line in Australia, uses
high concentrations of clinically active ingredients
and is manufactured without harmful preservatives,
parabens, dyes or perfumes.
Meder Beauty Advanced Skincare Line
Meder Beauty has added a premium
cosmeceutical range of skincare products to
its Meder Beauty Science line. The product
formulations work synergistically with Meder
Beauty Science professional treatments to
enhance and maintain the results and achieve
healthier, younger-looking skin.
Aesthetics | December 2013
Winner of the Reader
Survey announced
4T Medical introduce
High Potency
Cooling Fluid
4T medical has launched a new
High Potency Cooling Fluid to
reduce swelling after dermal filler
Strips or masks are soaked in the
solution and placed on the treated
area directly after treatment,
reducing skin irritation, redness
and swelling.
The product is composed of
natural ingredients only, including active Echinacia
angustifolia extract, which has an antiseptic and antiinflammatory effect, and Andographis paniculata leaf
extract, which has a cooling effect.
Collagen strips and masks are available for full face,
glabella, lip, nasolabial, neck and orbital frame.
Medical papers have found that the number of labial reduction procedures carried
out on women has risen five-fold in the NHS over the past 10 years.
Reports from the Royal College of Obstetricians and Gynaecologists (RCOG) and the
British Society for Paediatric and Adolescent Gynaecology (BritSPAG) showed that
over 2000 operations were performed in 2010.
They also stated that little research currently exists about the clinical effectiveness,
positive effects or the risks in female genital cosmetic surgery, and that women should
be provided with accurate information about the variations of female genitalia.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)
has responded to these findings with Tim Goodacre, consultant plastic surgeon
and Head of Professional Standards at BAPRAS saying that they “wholeheartedly
support the research”.
Mr Goodacre said, “Whilst there are some appropriate situations where this
surgery is right for the patient, this increase is worrying as this surgery does not
come without its risks. Some women have reported adverse effects, such as
severe discomfort and ongoing problems with daily function, following the surgery.
It should therefore only be performed when necessary and only ever by a properly
qualified surgeon.”
Lipotripsy launch contact
thermography plates
Spectrum Technology UK has introduced new
contact thermography plates to the Lipotripsy Radial
Wave device that accurately diagnose the grade
of a patient’s cellulite to ensure effective treatment
of the area.
Lipotripsy clients will be provided with the opportunity
to grade their cellulite both before and after a course of
Lipotripsy treatments for complete transparency in the
progress and improvement of their cellulite.
Jim Westwood, MD Spectrum Technology UK, comments on this high-tech
development, “Traditionally aestheticians would not only diagnose the severity of
cellulite by visual assessment, but with a pinch test to diagnose its grade. The new
contact thermography plates ensure a more accurate diagnosis is made to avoid
any errors in grading and to ensure accurate treatment of the worst affected areas.
Whilst these plates have been used widely in medicine since the 1970s, Spectrum
Technology UK is thrilled to be able to claim a UK first for their use in the aesthetic
market with Radial Wave therapy.”
Smooth texture for a natural look and feel1
ive them a lift with
LaSting volume – up to 18 months1
SatiSfaction – 96% of patients would recommend
Juvéderm® vOLumA® with Lidocaine to a friend 2
Talk to your Allergan Product Specialist or to Customer Services on
0808 238 1500
1 ml
Juvéderm® – the world’s no.1 selling
dermal filler 4
References: 1. Raspaldo H. J Cosmetic and Laser Therapy, 2008;10:134–142. 2. Fischer TC.
Poster presented at EMAA, 1–3 October 2009, Paris. 3. Allergan Data on File (DoF), 2011.
4. Allergan Data on File (DoF) Marketing overview, 2011. Instructions and directions for use of
JUvéDeRm® vOLUmA® with Lidocaine are available on request. Lidocaine does not affect the
intrinsic performances of JuvéDERM® vOLuMA® and its
safety profile, therefore, JuvéDERM® vOLuMA® data is
representative of JuvéDERM® vOLuMA® with Lidocaine3
Date of Preparation: January 2013 UK/0008/2013a
Dr Sarah Tonks has been
announced as the winner
of an iPad mini after taking
part in a recent reader
survey. It was conducted
to collect feedback that
has helped to shape the Cosmetic News relaunch as
Aesthetics. Dr Tonks will soon be offering treatments at
Beyond MediSpa in Harvey Nichols, Knightsbridge. She
plans to use the iPad in patient consent and medical
record keeping, and said, “I participated because I think
it’s important that practitioners help shape the direction
in which the industry is heading.” The Aesthetics team
would like to thank all the readers who took part in
the survey. Readers’ views are always welcome and
appreciated: please contact
[email protected] to get in touch.
Labial reduction procedures
have risen five-fold
Survey shows two thirds of
dermatologists don’t refer
to recommended psoriasis
Two thirds of dermatologists do not refer to the recommended
guidelines for managing psoriasis, a recent survey conducted by
medeConnect shows. Additionally, 38% of dermatologists still refer
to guidelines that are over four years old.
The National Institute for Health and Care Excellence (NICE) provides
clear recommendations on the management of psoriasis, to standardise
clinical practice across the UK. Guidelines recommend that dermatologists
should assess their patients’ psoriasis severity regularly using the PASI
(Psoriasis Area and Severity Index) assessment and the impact of psoriasis
on their life using the DLQI (Dermatology Life Quality Index). A 2012 survey
of psoriasis patients showed that only one third of psoriasis patients have a
PASI score, and 87% of patients were unaware of DLQI.
Plastic surgeon suggests
new theory for male hair loss
A plastic surgeon in Ankara, Turkey has suggested a new theory
for male pattern baldness.
Dr Emin Tuncay Ustuner, whose research is published in the journal Plastic
and Reconstructive Surgery, has said that the baldness that men encounter
is due to gravity, i.e. the weight of the scalp on hair follicles. This is in
opposition to it being genetically inherited or due to hormones.
He states that fat tissue keeps hair follicles well-hydrated, and as men age,
fat disappears, causing their hair to fall out.
He also says that declining levels of testosterone contribute
to the decrease of scalp fat. He explains that the shape of the head
can affect hair loss patterns, as different shapes will assert different
scalp pressures. He states that ears resist the effects of gravity
on the scalp, meaning hair loss around the sides of the head is reduced.
A third of Brits undergo
cosmetic surgery abroad
says study
A new study has shown that almost a third of British people who
undergo cosmetic surgery are now having operations abroad due
to the cheaper cost.
19% of women having breast enlargements abroad have chosen to go
to the Czech Republic whilst one in five lip fillers and nose jobs are also
being carried out there. 28% of people having their teeth cosmetically
enhanced abroad go to South-East Asia. 29% choose Switzerland for
face-lifts, 28% for botox and 14% for liposuction. Research also suggests
that over half are unhappy with the results, and 19% have follow-up
treatment in Britain to correct problems, compared to just 6% of those
who had a procedure in the UK. A third of those having a procedure
abroad claim to have caught an infection compared to 9% who said this
happened after a procedure in the UK.
News in Brief
Sinclair IS Pharma announced as ACE 2014
Gold Sponsor
The Aesthetics Conference and Exhibition (ACE)
2014 is proud to announce Sinclair IS Pharma as
a Gold Sponsor for the event. The pharmaceutical
company will offer a masterclass as part of the
events programme. To find out more about ACE
and to book your place, visit www.ace2014.co.uk
or call 01268 754 897.
Maximus offers multi-layered approach to
anti-ageing and body contouring
Pollogen has launched Maximus, an aesthetic
medical device which uses three proprietary
technologies: TriLipo RF (for skin tightening, cellulite
reduction and fat reduction), TriLipo DMA (to
clear released body fat and to ‘lift’ the Superficial
Muscular Aponeurotic System on the face) and
TriFractional (advanced fractional skin resurfacing).
A clinical study of 20 women aged 35-65 who
received eight weekly facial treatments, showed
significant wrinkle reduction, improvement in skin
tonus and dramatic facial skin lift.
New SkinCeuticals hydration treatment
SkinCeuticals have created a hydration treatment
that replenishes depleted moisture levels. The
Hydrating B5 Gel Mask infuses dehydrated and
stressed skin with hyaluronic acid and vitamin B5.
It is a weekly treatment, enhanced with a complex
containing constituents of the skin’s natural
moisturising factor (NMF).
Age-Defying Laser receives FDA clearance
Tria Beauty has received FDA clearance for its
Age-Defying Laser, which uses a proprietary version
of non-ablative fractional laser technology. 76%
of users said they had reduction in fine lines and
wrinkles, and 95% said they had smoother skin and
an improvement in overall appearance. Users
reported visible results in two weeks, and optimal
results in eight weeks.
Dorchester Spa takes on Revitalash
Eyelash conditioner RevitaLash Advanced is now
available at Dorchester Spa. “We are proud to have
the brand held within such prestigious environs,”
said Tracey Beesley, marketing director
of SkinBrands, who
distribute RevitaLash in the
UK. “We are delighted to
support The Dorchester Spa
and we are sure that this
brand will be a
perfect fit to complement
the other services and
products they offer.”
Aesthetics | December 2013
Events diary
7th December 2013
The Aesthetics Awards 2013, London
Twin study shows real impact
of smoking on skin ageing
8th - 9th March 2014
Aesthetics Conference and Exhibition ACE 2014, London
Research published in the journal Plastic and Reconstructive Surgery
comparing identical twins has given more of an insight into the extent
smoking contributes to skin ageing.
70 pairs of identical twins were photographed, either where one was a smoker
and one a non-smoker, or where there was a smoking history difference of five
years between them. Plastic surgeons analysed the photos without knowing
which twin smoked. In the majority of cases, those who smoked had larger
bags under their eyes, sagging eyelids, wrinkling of the upper and lower lips
and sagging jowls. Photographic evidence also found that the ageing effect of
smoking was most prominent in the lower two-thirds of the face. Dr Bahman
Guyuron, lead author of the report said, “Even among sets of twins where both
are smokers, a difference in five years or more of smoking duration can cause
visibly identifiable changes in facial ageing.”
3rd - 5th April 2014
Anti-Ageing Medicine World Congress AMWC 2014, Monaco
Mesoestetic releases new skin
care treatment energy C
30th January - 2nd February 2014
International Master Course on Ageing
Skin - IMCAS Annual Meeting 2014, Paris
20th - 22nd June 2014
Facial Aesthetic Conference and Exhibition
- FACE 2014, London
25th - 26th September 2014
The British Association of Aesthetic Plastic
Surgeons - BAAPS Meeting 2014, London
3rd October 2014
British Association of Cosmetic Nurses BACN Meeting 2014, London
Epionce launch
Intense Defense
Epionce has launched Intense
Defense Serum.
The advanced serum uses
botanically-derived extracts of
Vitamins A, B, C, D and E, which
act as powerful anti-oxidants and
anti-inflammatories to stimulate
skin rejuvenation by helping your
skin function properly. Results
show improvement in visible signs
of ageing, including fine lines and
wrinkles: results can be seen after
just one week.
Mesoestetic has developed a new anti-oxidant skincare treatment.
energy C is formulated with a high concentration of vitamin C, which helps to
prevent skin ageing. This also makes it ideal treatment for fragile skin that has
been subject to excessive sun exposure, smoking, poor nutrition or stress.
When applied topically, vitamin C remains on the skin for 48 hours, so has 30
times the therapeutic effect of oral supplementation.
In vivo and in vitro studies have demonstrated energy C’s anti-oxidant, UVA and
UVB photoprotective, skin brightening and collagen-boosting properties.
A home maintenance line includes an intensive cream, eye contour and energy
c complex. The professional treatment line includes a serum, crystal fibre mask
and an intensive cream.
Hyalual launches Daily Delux
Swiss cosmetic and skincare product company Hyalual have produced the
Hyalual Daily Delux spray. The product has many benefits, which includes
preserving the moisture of the skin, increasing the free water content of the
stratum corneum and helping to reduce water evaporation from the skin
surface. It also provides deep cleansing of the skin, enriches the skin with
minerals, enriches cells with oxygen, removes toxins and promotes rapid
skin renovation. The company is recognised for its innovations in anti-ageing
products for the face and body.
iS Clinical produce new skin
brightening treatment
iS Clinical have produced a skin brightening treatment that is clinically
proven to reduce hyperpigmentation and to lighten skin.
White Lightening Complex contains a blend of proprietary lightening
ingredients and pharmaceutical grade botanicals, including Norwegian kelp
extract, which instruct melanocytes to produce less pigment, resulting in
an improvement of hyperpigmentation in the skin. A study showed a 75%
reduction in the intensity of pigmented areas, 37% reduction in melanin
production after 72 hours and 84% reported overall skin lightening effects.
Aesthetics | December 2013
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On the scene
Syneron Candela
VelaShape III
launch, The Institute
of Physics, London
The Institute of Physics in London was the setting
for the exclusive International launch of Syneron
Candela’s latest innovation – the VelaShape III.
Syneron’s founder and company chairman Shimon
Eckhouse introduced the new technology and talked
about the latest advancements in the body shaping
market as well as talking about changing perceptions
of RF body contouring, presenting new studies and
findings. Dr Grant Hamlet then gave a talk about noninvasive body contouring from the patient perspective
before leading beauty and anti-ageing expert Wendy
Lewis talked about hot new trends and desires from
the USA.
Powered by elōs technology, VelaShape III combines
IR (infrared), bi-polar RF (radio frequency) and vacuum
to precisely heat the tissue up to 3mm and 15mm
depth respectively. The combination of IR and vacuum
coupled RF technologies causes deep heating of the
fat cells, their surrounding connective fibrous septae
and the underlying dermal collagen fibers. Efficient
heating of the adipocytes is achieved by higher output
of the RF. The optimal design of the electrodes and the
concurrent application of vacuum allows for deeper
and faster heat penetration. In turn, this promotes an
increase in circulation, lymphatic drainage, cellular
metabolism and collagen depositing. Furthermore,
it stimulates fibroblast activity and remodels the
extracellular matrix. This results in a localised reduction
in skin laxity, volume and an overall improvement in
skin structure and texture.
Temple Medical clinic launch,
The award-winning Aberdeen based clinic
Temple Medical has quadrupled its business
with a five-figure investment in a prestigious
city centre clinic. Led by Dr Sam Robson, the
new clinic in West Craibstone Street is four
times the size of the previous Cults clinic, to accommodate continued growth in the
business and client base. Dr Robson launched the medical-led business in 2007 and
it now has a fully qualified medical team of 15, with plans to expand to 20 by 2014.
She said, “Opening a substantially larger clinic in the city centre provides us with a
more convenient location, allows us to expand on our treatments and facilities, and
will enable us to achieve our goal of becoming Scotland’s leading medical-led clinic.”
Toskani Mesotherapy Seminar,
Toskani UK welcomed Dr Britta Knoll to
London to lead its Mesotherapy Seminar
last month. Since training with mesotherapy
pioneer Dr Michael Pistor in the ‘80s, Dr Knoll has performed over 20,000
mesotherapy procedures. The event included an overview of the philosophies and
methodologies underpinning mesotherapy, complemented by product descriptions,
protocols and live demonstrations. Toskani also took time to launch the Pistor range
of mesoguns, now available in the UK and Ireland through Vida Health and Beauty.
Absolute Aesthetics Open
Evening, Guildford
Absolute Aesthetics hosted an open evening to coincide with the launch of
its new cosmetic surgery arm, which sees four new plastic surgeons join the
clinic: consultant surgeon Mr Vasu Karri, Mr Amir Nakhdejevani, Mr Peter
Arnstein and Mr John Pereira. They have a host of expertise in breast, head and
neck plastic surgery, hair restoration surgery and reconstructive surgery. They have
also appeared on many high-profile TV shows including Sky’s Extreme Makeover
and Channel 4’s Embarrassing Bodies. Absolute Aesthetics medical director Vicki
Smith said, “The addition of cosmetic surgery to the clinic is an exciting development
for us at Absolute Aesthetics. Since we opened four years ago, we have been at the
forefront of the aesthetic industry. This expansion will enable us to meet the needs of
our clients who are after more than the non-invasive treatments we currently offer.”
World class thought leaders love Belotero
“Belotero is my must have dermal filler for
fine lines and wrinkles” Fredric Brandt, MD1
Superficial application2
Superior evenness3
Not palpable4
Date of Preparation:
August 2013
1. Body Language No. 59 September/October 2013
2. Kuhne, U et al. Five-year retrospective review of safety, injected volumes, and
longevity of the hyaluronic acid Belotero Basic for facial treatments in 317 patients.
J Drugs Dermatol. 2012 Sep; 11(9):1032-5
3. 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.
4. Data on File: BEL-DOF2_001 Belotero Juvederm Study MRZ 90028_4007
Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526
Email: [email protected]
No Sweat. No Smell.
Breakthrough Technology
Quick Treatment
No Pain
No Toxins
High ROI
Please contact us for
further information on
+44 0845 1707788 or
[email protected]
News special report
In the wake of a high profile court case, what laws can
prevent unqualified people from giving botulinum toxin
injections? We investigate a surprisingly complex area.
Stopping the ‘botox’ Cowboys
The case of Jamie Winter, the beauty
therapist who bought botulinum toxin on
the Internet for £70 then injected it into
clients in their homes, has just ended with
her being convicted of fraud. Her offence
in the eyes of the law? Telling her customers
that she had completed a training course,
which she’d actually ducked out of for being
too expensive. Now, many in the industry
are asking why Winter was prosecuted for
fraud: not for injecting someone else with
a prescription only medicine. Initially she
was charged with assault, because one of
her clients suffered swollen eyes after the
injections, but because they consented to
the treatment, those charges were dropped.
Had Winter admitted that she was untrained,
and her clients were willing to go ahead with
the injections, she would not have been
guilty of fraud either. So how does the law
apply to rogue operators? Despite the Keogh
report, it is still legal for anyone – qualified
or not – to inject botulinum toxin. In that
respect, Winter was in the clear. Also, it is
not illegal to buy a licensed medicine over
the Internet, or to administer it in people’s
homes. The only way Winter broke the law
was in acting alone. The Medicines and
Healthcare Regulations Agency (MHRA)
say that botulinum toxin injections should
be done ‘under supervision or under the
directions’ of a medical practitioner. Botox®
is a prescription only medicine (POM), and
The Human Medicines Regulations 2012
makes it illegal to sell, administer or possess
a POM with intent to supply. The offences
carry a maximum penalty of two years
imprisonment or an unlimited fine. Sally Taber,
director of the Independent Healthcare
Advisory Services says, “Botox® has to be
prescribed by a doctor, dentist or nurse
prescriber. If they feel that an unqualified
injector is competent to do it, currently they
can authorise this. But it is certainly not good
practice.” Janet Kettels, director of corporate
affairs and public relations at Allergan
agrees, “These treatments are medical
procedures and should only be given in
the right clinical environment by a qualified
healthcare professional trained in clinical
assessment and patient care,” but this is not a
legal obligation. However, Jeanette Aspinall,
department head of medical negligence and
litigation at Fletchers Solicitors, says, “The
European Committee for Standardisation
published a draft guideline on who can
provide cosmetic procedures and where
these should be carried out, which could be
introduced by autumn next year. Anyone who
flouts it could face prosecution, fines and
possibly imprisonment.” Given the side effects
reported, it seems unlikely that the product
Winter bought for £70 over the internet was
a genuine botulinum toxin injectable, and
almost certainly not Botox®. However, if clients
believed it to be the real thing - the law should
still hold, as the Medicines Act states: “No
person shall, to the prejudice of the purchaser,
sell any medicinal product which is not of the
nature or quality demanded by the purchaser.”
And if Winter was passing off one product
as another she might have been sued for
damages from her own clients. If she claimed
to be providing Botox®, she might be subject
to an infringement claim from Allergan. So
why was she charged with fraud? The MHRA
has special powers to investigate, arrest
and prosecute for medical crimes, however,
a MHRA spokesperson explains, “In legal
terms, fraud is a more serious offence than
medical offences and this explains why the
police brought the prosecution. If we discover
evidence of more serious crimes, such as
fraud, then we will refer our investigation to
the police.” Also, Botox® is a very complex
area. For example, an unqualified person
who bought a drug claiming to be Botox®
via the Internet could claim they were being
paid to supply their services, not the drug.
They would still need to be acting under
the supervision of a doctor, dentist or nurse
prescriber. It comes down to the specific
details of each case and regulatory action can
lie between professional bodies, the Care
Quality Commission (who are responsible for
the regulation of private clinics) and the MHRA
which can make punitive action complex,
and outcomes less certain. Is Jamie Winter
a lone bad apple, or are there others in the
barrel? “There is no data on this, but it is
likely to be far more common than we would
like to believe,” says Emma Davies, chair of
The British Association of Cosmetic Nurses.
While regulation is necessary, no amount will
stop those determined to operate outside
the law. However, exemplary prosecutions
with appropriate sentencing by the MHRA
for medical crimes that are reported in
newspapers may do more to dissuade
cosmetic cowboys and educate patients to
their danger, than any amount of regulation.
When it comes to evidence
you’re safe with Radiesse…
Date of Preparation:
August 2013
FDA approved1
most studied safety profile2
no wonder you
1. Sadick N, et al A Multicentre, 47 month Study of Safety
& Efficacy of Calcium Hydroxylapatite for Soft-Tissue
Augmentation of Nasolabial Folds and Other Areas
of the Face. Dermatol Surg 2007; 33 (Supp 2):
2. DoF-1-001_01
safe & versatile1
Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526
Email: [email protected]
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Tel. 0845 5210698
This is not intended for the U.S. market. ©2013. All rights reserved. Syneron and the Syneron logo are trademarks of Syneron Medical Ltd. and may be registered in
certain jurisdictions. Candela is a registered trademark of the Candela Corporation. UltraSculpt and UltraShape are registered trademarks of UltraShape. PB82801EN
Fat Re
Skin Tighten
A Powerful Three Dimensional Alternative to Liposuction
No other system offers this advanced combination of
technologies designed to target fat removal, cellulite
and skin tightening without the need to exercise
Why choose 3D-lipo?
Cavitation is a natural phenomenon based on low frequency
• A complete approach to the problem
• Prescriptive
• Multi-functional
• Inch loss
• Contouring
• Cellulite
• Face and Body skin tightening
• No exercise required
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.
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.
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
Complete start up and support
package available from under
£400 per month
as less energy is required, shorter treatment services and variable
depths of penetration.
3D Dermology
Combines pulsed variable vacuum and skin rolling for the effective
treatment of cellulite.
What the experts say...
‘As a Clinician I need to know that the treatments we offer are safe, effective,
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
Clinical Practice
Body contouring
Going hot
and cold
We examine the benefits of heating
and freezing technologies in fat
reduction and body shaping
One of the biggest growth areas in aesthetic
medicine in recent years has been the global
body shaping market. Predicted to reach
$2billion by 2017, the market growth is being
largely driven by minimally invasive non-surgical
devices, which offer more cost effective, lower
downtime treatments. All of this makes body
contouring potentially one of the most lucrative
areas of cosmetic medicine and one that
aesthetic clinics cannot afford to ignore.
Advances and developments in technologies have
significantly enhanced the treatment outcomes of
non-surgical devices. While procedures such as
VASER and laser lipolysis have carved their own
niche, bridging the gap between non-invasive
treatments and surgery, it is the more minimally
invasive sector of the market that is seeing
the most growth: there has been a significant
boom in the number of devices available on
the market in recent years. Two technologies
that approach body contouring from opposite
ends of the spectrum are radio frequency and
cryolipolysis, one using heat energy and the other
using cold. Cryolipolysis has undoubtedly been
one of the most talked about treatments of 2013
using freezing rather than heating technology to
destroy fat cells. But does the advent of this new
generation of body shaping treatments mean
RF has had its day or do the two offer their own
distinct advantages and disadvantages?
and UltraShape and the boom in cryolipo devices, which are often more effective in
targeting fat, the radio frequency body market has not rested on its laurels. We have
seen new and improved versions of existing technologies coming to market, such
as the VelaShape III from Syneron Candela and Accent Ultra (ABC Lasers), as well
as new technologies incorporating RF such as Venus Freeze (Ellipse), Vanquish and
Exilis (BTL Aesthetics), i-Lipoxcell (Chromogenex), 3D-Lipo (3D-Lipo Ltd) and Viora
Reaction (AZTEC Services).
RF energy works for body contouring because it is able to penetrate deep into the
dermis and sub-dermal layers of the skin, without damaging the epidermis. It also
increases blood circulation, allowing the fatty deposits to be drained through the
lymphatic system, which is why it also works to reduce the appearance of cellulite.
The first RF body contouring devices that came to market were predominantly RF
only and offered limited results in fat reduction, which were highly dependent on
patient selection, what system you were using and operator technique. As such,
many practitioners only found it useful for body contouring when combined with
other treatments.
Dr Ravi Jain from the Riverbanks Clinic in Harpenden comments, “RF provided
temporary changes in appearance of skin laxity and cellulite but the volume changes
were absolutely minimal at best. I found it often worked in combination with other
technologies such as VASER Liposuction as a post-operative care method to
help massage the treated areas and encourage skin tightening as well as help
minimise fibrosis. One of the biggest problems with RF is that it is extremely operator
dependent and even then results were modest and temporary. We discovered a
high proportion of unhappy patients.”
Dr Kim Singh has been using Accent as a stand-alone treatment since 2005 as well
as to enhance his treatment outcomes from VASER. He says, “Since 2007 when
we started doing VASER we have been adding Accent into our post-treatment care
protocol. It smoothes out the end result and it helps with skin tightening if there
is any lax skin. After VASER you can often get a few small ripples and Accent can
really finish that off nicely.”
Offering the additional advantage of skin
tightening and cellulite reduction, radio frequency
has become one of the most commonly utilised
technologies in aesthetic body contouring
devices. Facing tough competition from
ultrasound assisted treatments such as VASER
The industry has recently seen an influx of next generation RF devices, which
incorporate new technologies to allow for more optimal and consistent results in fat
reduction as well as cellulite and skin tightening. BTL Aesthetics has launched two
RF devices onto the market, which are showing positive results. The first was the
Exilis, a device that claims to be ‘redefining’ radio frequency (RF) technology. The
treatment harnesses its energy through its Energy Flow Control (EFC) system. The
Aesthetics | December 2013
Clinical Practice
Body contouring
installed EFC module controls the energy
flow and automatically eliminates
energy peaks. This process is known
as Square (‘Flat Top’) Spectrum Energy
Profiling and is a unique feature of Exilis
therapy. EFC automatically monitors the
energy distribution on the body through
multiple sensors.
“Exilis is unique in delivering monopolar
RF with a grounding pad, so we know it is
penetrating to the appropriate, therapeutic
skin level - from the epidermis down to the
subcutaneous layer - and the results have
been outstanding,” says Robert Weiss, MD,
associate professor of dermatology, Johns
Hopkins School of Medicine. “The built-in
temperature sensor permits delivery of
enough energy to improve skin without
pain. In fact, our patients liken the heat
sensation to a warm massage. Using Exilis
is like driving a Ferrari with the best brakes.
It is high performance yet very safe, and
you always feel you are in total control of
its power.”
The latest system the company has brought
to the market is the Vanquish. The noncontact device uses selective RF energy
that heats the adipose tissue to the point
of apoptosis. The Vanquish is able to
selectively heat the fat cells to a temperature
of 44-45°C while the surrounding tissue
remains unaffected at 40-41°C. The system
was trialled at San Diego Cosmetic Surgery
Practice Moradi MD for three months, to
reduce fat in the abdomen and flanks of
selected patients. One patient who has
seen improvements says, “After only three
treatments, my abdomen is firmer and
tighter. Where my clothes were tight before,
they now feel loose. Vanquish is truly a
remarkable treatment for anyone who wants
to tighten and firm unwanted midsection fat
on their body.”
As the body shaping market has advanced
we are also seeing the launch of more
combination devices, which combine RF
with other modalities in one device.
VelaShape (Syneron Candela) for example
combines RF with infrared as well as tissue
mobilisation and suction. This has been
proven to enhance results for fat reduction
as well as cellulite reduction. The latest
VelaShape III device, launched this month,
takes this further by incorporating increased
RF power. The higher energy density gives
improved heating in the tissue. This means
that the end point temperature is achieved
much faster, and the treatment time and
number of sessions required to achieve an
optimal result are reduced.
Another combination device launched onto
the market this year was the i-Lipoxcell
(Chromogenex). It incorporates four
technologies for intelligent body fat analysis
and measurement, laser diode fat reduction,
IR Vacuum massage and radio frequency
skin tightening. The system incorporates
both visible red and infrared laser for
bio-stimulation of metabolic pathways
resulting in the release of fatty acids and
glycerol, shrinking fat cells. Results are seen
Another company that quickly realised
the benefits of combining RF with other
technologies was Alma Lasers who
launched the Accent Ultra™ as an update
to the original Accent system. It uses
combined hot and cold selective resonance
ultrasound with high frequency RF. Split into
two modules, the Ultra™ module provides
ultrasound energy for treating cellulite and
reducing fat whilst the UniForm™ module
provides radio frequency energy and
lymphatic drainage for body reshaping and
skin tightening.
Cryolipolysis is undoubtedly one of the
biggest recent trends in body contouring.
Ideal for removing pockets of body fat,
particularly in the stomach area, flanks,
thighs and back, it is proving popular with
patients and practitioners alike because of
its low downtime, minimal discomfort and
impressive results in destroying fat.
Devices utilising cryolipolysis include
CoolSculpting, CoolTech, Lipoglaze
and 3D-Lipo. Like RF, cryolipo is not a
weight loss treatment and is not indicated
for obese patients. Results can be
expected to be visible within four to six
weeks in most cases. Although multiple
treatments may be required there is also
no need for post-procedure massage or
exercise to enhance results. However,
it does not have the additional benefits
of skin tightening, which you get with
RF. Cryolipolysis effectively cools the
subcutaneous fat cells in order to induce
apoptosis and lipolysis, without damaging
any of the surrounding tissues or the skin.
These lipids are then transported by the
lymphatic drainage system to be processed
and eliminated through the body in the same
way that fat from your food is eliminated.
This process is very gradual, meaning that
there is no danger of your lymphatic system
being overloaded.
Dermatologist Dr Penelope Tympanidis says,
“Interestingly, the exposure to cooling is set
so that it causes cell death of subcutaneous
fat tissue without apparent damage to the
overlying skin. The fat cells in the treated
area are gradually eliminated through
the body’s normal metabolic processes.
With a single treatment subjects have a
20% reduction after two months and 25%
reduction at six months in the fat layer as
assessed by ultrasound. The lipolytic effect
VelaShape III
Aesthetics | December 2013
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Clinical Practice
Body contouring
of treatment takes place within about two to
four months. It appears primarily applicable
for limited, discrete fat bulges. As long as
the patient maintains his or her weight with
diet and exercise, long-term results should
remain stable.”
Rajiv Dash, managing director of Aesthetics
of London, has noticed some positive
results. He says, “Cryogenic lipolysis is much
more suitable for pockets of fat. There are
primarily two reasons for this: the first is
cost. It is a more expensive treatment for
the area covered and if a client needed to
repeat treatments or cover multiple areas
the cost can quickly mount up. The biggest
advantage of this treatment is that posttreatment the fat cells undergo apoptosis
and die off, so it is a more permanent
solution. Cryogenic lipolysis is very effective
on clients who are otherwise within their
desired weight range but have small pockets
of fat to lose, the added advantage being
that any fat loss would be permanent.”
The first cryolipolysis device on the market
was CoolSculpting® by Zeltiq, which
set the gold standard for the use of this
technology in body shaping. Over 400,000
CoolSculpting® by Zeltiq treatments
have been performed worldwide. The
CoolSculpting® device is positioned on the
area of the body to be targeted and using
a suction action, draws the fat bulge into
the CoolSculpting® treatment applicator
where two cooling plates are situated. The
list of areas of the body that the system
can now treat is more comprehensive
with the launch of CoolCurve+, a specially
designed and developed applicator for
flanks, and for really slim people who have
stubborn, exercise-resistant areas of fat.
The anatomically shaped curvature of
CoolCurve+ allows for an effective fit to the
body and ultimately improved tissue draw,
making it easier to treat more areas and a
multitude of body shapes. Final results can
be seen in 60-90 days when the frozen fat
cells are gone for good.
Another treatment that has been making
headlines is the Lipoglaze from LoveLite
Ice. The Lipoglaze machine works by first
gently heating and then rapidly cooling
the target area. This causes the fat cells to
crystallise and permanently destroys up to
a third of fatty deposits per session. The
body then naturally eliminates this waste
tissue over the next few weeks. Debra
Robson from LoveLite says, “Our preliminary
clinical studies, due for full publication by
the beginning of 2014, have proven that the
treatment works, is safe and results have
shown from 11% up to a huge 59% reduction
in subcutaneous fat. The difference in results
seems to be based on the thickness in the
layer of subcutaneous fat..”
Dr Ravi Jain uses the CoolTech system. He
says, “I evaluated three systems before
choosing CoolTech. At first I wasn’t sure
if this would work, with claims of results in
just one session. I started to see a few lipo
patients come to me because they’d had
a freezing treatment which had left a large
indentation in their stomachs. To me this
meant that the technology actually did kill
off fat cells in one session, and so the only
improvement needed was to learn how to
feather it better. Also, some of the business
models for other technologies did not suit
my practice profile with very high installation
and running costs. I wanted a technology
that would have low ongoing costs but
be highly effective with pleasing results.
So I invested in CoolTech and we waited
anxiously for the results to come through.
At one month, after a single session, we
saw changes better than an eight-week
course of RF or USS. At three months some
of the results were akin to liposuction. I was
staggered and my patients were thrilled.
Dr Tympanidis believes further studies
are needed but is encouraged by the
outcomes of cryolipolysis for fat reduction.
She says, “Although the mechanism of
action for cryolipolysis is not yet completely
understood, the efficacy and safety of
this non-invasive procedure for fat layer
reduction has been demonstrated in the
studies available to date. Further studies
will assist in identifying the mechanism
and elucidate the full potential of this
technology to perform safe, non-invasive
fat reduction for areas of local fat
If you still can’t decide whether hot or cold
treatments provide the best results then one
system that offers both is the 3D-Lipo. The
system has applications for both cavitation
and cryolipolysis to physically destroy the fat
cells. Added to this, with the combination of
radio frequency and 3D-Dermology (vacuum
skin rolling for targeted cellulite reduction),
you are able to combine an effective skin
tightening application for both face and
body, and also target cellulite.
Dr Martyn King, medical director of
Cosmedic Skin Clinic in Tamworth believes
it is 3D-Lipo’s multi-faceted approach
that offers a key advantage. He says, “It
appealed to us that 3D-Lipo offered a
combination of technologies. We tried it
out and the cavitation and RF seemed to
be a lot better than some other devices we
had seen and tried on the market. At the
same time cryolipolysis was something we
were interested in. There are stand-alone
machines for this but they work out a lot
more expensive and the consumables are
a lot more so having it all in one machine
was the best option for us.”
Aesthetics | December 2013
in in
is set
to create
a revolution
in the
is set
to create
a revolution
in the
of of
non-surgical Aesthetic skincare market. Following success
the success
the award winning 3D-lipo which combines technologies for the
of of
we are
we set
are set
to launch a phenomenal new multi-functional device for the face.
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Clinical Practice
CPD/Anatomy and physiology
one point
Under the
Lorna Bowes on anatomy
and physiology of the skin
Aesthetic practice has evolved and
blended with medical and surgical
practices as well as with non-medical
areas such as beauty. Knowledge of
the structure and function of the skin
is imperative whether dealing with
symptomatic relief of photodamage,
or considering managing or advising
on simple dermatological issues. If
we are to treat dermatological skin
complaints then further academic
study is needed, however we are
constantly facing patients with
aesthetic dermatological concerns
who ask for advice and opinions. This
article is designed as a revision aid to
review the anatomy and physiology
of the skin as it relates to healthy
skin, to intrinsic and extrinsic ageing
processes, and to the ingredients that
are available to us and our patients.
KEY WORDS: Epidermis,
dermis, hypodermis, keratinocyte,
Skin is a major part of the integumentary
system, along with hair, nails, subcutaneous
tissues and various associated glands. The
skin comprises three layers: epidermis,
dermis and subcutaneous tissues
(hypodermis). These layers work both
together and separately as the interface
between the body and the outside world
with its physical and environmental factors.
The skin is the largest organ in the body, and
is responsible for an average 15% of total
average adult human weight, and although
many characteristics are identical throughout
the skin there are variations in terms of
colour, texture and thickness. There is also,
for example, variation in the number of hair
follicles and sebaceous glands per square
centimetre. The skin
has a surface area
of between 1.5-2.0
square meters: over
most of the body it
measures 2-3mm in
thickness, with the
thinnest skin being in
the periorbital area and
thicker skin associated
with the soles of the
feet. The average
square centimetre of
skin holds 100 sweat
glands, 15 sebaceous
The outermost portion of the skin is known as the epidermis,
and as such is a key component of skin from an aesthetic
perspective – few patients would wish for a non-flexible, rough,
dehydrated epidermis. Any changes to the surface of the skin
are immediately apparent, so surface texture must be addressed
in an anti-ageing protocol. It is therefore important to understand
the epidermis and the epidermal changes brought about by the
ageing process.
The epidermis is a multi-layered structure consisting mostly
glands, three blood vessels, nearly 1,000
melanocytes, 10 hairs and more than 150
nerve endings. The skin of the face and
other areas of visible skin, are inextricably
linked with the appearance and perceptions
of youth and beauty. This article looks at the
structure of the skin and at the components
of the skin that are most closely implicated
in the appearance of photo damaged and
aged skin.
Continuing research is teaching us how the
components of the skin respond to extrinsic
and intrinsic ageing. The quest for topical
solutions to the physiological changes
brought about by the ageing process and the
aesthetic appearance those changes produce
will increase our need for understanding how
the skin responds to the ingredients and
therapies we are presented with.
of keratinocytes organised in stratified layers. Cells migrate
upwards from the bottom layer to the outermost layer, the stratum
corneum, in a process leading to cell death, or apoptosis, that
takes 26 to 42 days depending on various factors such as the
age of the person1. The end point of the cells is desquamation,
the shedding of individual or groups of cells from the surface of
the skin.
It is important to note that melanin is not a functional component
of the epidermal barrier, despite its undisputed role in prevention
or reduction of the damage caused by ultra violet (UV) radiation.
The role of melanin is not within the scope of this article.
Aesthetics | December 2013
Clinical Practice
CPD/Anatomy and physiology
Basal layer (stratum basale): The
basal layer comprises stem cells
(10%), amplifying cells (50%) and
postmitotic cells (40%), and forms the
base membrane of the epidermis.
As with other layers the cells are
joined by desmosomes – structures
that create adhesion between the
cells. Epidermal Growth Factor
(EGF) binds to the Epidemal Growth
Factor Receptors (EGFR) in the
stratum basale, activating tyrosinase
kinase activity and this stimulates
proliferation of the cells2. Other
growth factors such as transforming
growth factors and keratinocyte
growth factors affect processes such
as hyaluronic acid formation, and
control of the inflammatory response
in wound healing.
Spinous layer (stratum spinosum):
The first signs of keratinisation can be found in the cells of the
stratum spinosum. Known as lamellar granules, they contain fatty
acids, ceramides and cholesterol as well as various enzymes.
The lamellar granules formed here travel to the skin surface and
are an essential part of the barrier function of the skin.
Granular layer (stratum granulosum):
Profilaggrin crosslinks the keratin filaments and this infers
structure and stability to the cell structure. These cells are known
as keratohyalin granules, and they contain proteins that promote
hydration and crosslinking of keratin.
Clear layer (stratum lucidum): A thin clear layer of flattened
Horny layer (stratum corneum): Comprises mature
keratinocytes that have run the full course of keratinisation, these
anucleated cells are known as corneocytes. The structure of
the stratum corneum is frequently compared to that of a brick
wall with bricks and mortar being the main components. The
bricks are the keratinocytes and the mortar is the intracellular
lipid and other components of the lamellar granules such as
The dermis is the middle layer of the
skin, and as it is the thickest portion
of the skin, is of critical importance to
the aesthetic appearance of the skin.
The depth of the dermis decreases
steadily throughout the ageing process,
and many of the integral structures
deteriorate, leading to many of the
external signs of ageing. The structure
of the dermis is more complex than the
stratified epidermis, although it has two
main components: the papilliary dermis,
which consists of connective tissue,
capillaries, collagen and elastin and the
reticular dermis, which consists of dense
connective tissue, bundles of collagen
proteins. The filaggrin that started in
the granular layer is broken down in
the stratum corneum, and amino acids
are produced. These amino acids form
the Natural Moisturising Factor (NMF),
and the NMF plays a major role in skin
hydration as a powerful humectant,
and in balancing trans epidermal
water loss (TEWL). Therefore, it is of
great importance that only increases
in patients suffering from dry skin
conditions. NMF levels are known
to decrease with age. Lipids play a
role in maintaining the NMF inside
the cells and thereby limit water loss,
as well as the lipids produced the
lamellar granules. Hormones control
the excretion of further lipids from the
sebaceous glands.
The stratum corneum is comprised of
15% water, while the total epidermis
has a water content of 70%. The acidic pH of the skin is part of
the natural defence systems preventing damaging attack by
bacterial, viral and fungal activity. Antimicrobial peptides also
exhibit broad spectrum activity adding to the skin’s defence
against these attacks.
The keratinocytes have standard cell structure with a semipermeable cell membrane and a nucleus containing the DNA.
The keratins in the keratinocytes change as the keratinocyte
migrates from the stratum basale outwards to the stratum
corneum. Furthermore, the stratum corneum is a highly effective
barrier preventing penetration of topically applied drugs and
other substances. Ingredient developers and pharmacologists
continue to develop novel ways to increase permeation and to
find novel routes for penetration of drugs and topical ingredients.
The stratum corneum is also where environmental aggressors
such as metals and of course UV affect their initial damage. The
complex cascade of reactions and production of free radicals
adversely affect the natural processes in the skin, accelerating
the physical signs of photodamage.
fibres and large blood vessels. Within
the dermis are important structures such
as the sebaceous glands, hair follicles
and blood vessels.
Between the epidermis and the dermis
is the Dermal Epidermal Junction (DEJ),
and what is known as the rete pattern
or the rete pegs, finger-like protrusions
of the epidermal tissues that act more
or less like a Velcro fastening to join the
epidermis to the dermis.
The predominant cells of the dermis are
the fibroblasts, and they are responsible
for the formation of matrix proteins
such as collagen and elastin, as well
as enzymes such as collagenase and
Aesthetics | December 2013
Clinical Practice
CPD/Anatomy and physiology
Collagen: Collagen, an abundant
protein, is the main component of
connective tissue and is found in fibrous
tissues, for example the skin, but it
is also found in tendons, ligaments,
cartilage, bones, corneas, blood vessels,
and intervertebral discs. It has been
associated with the aesthetics industry
for many decades, and was the first of the
injectable fillers dating back to the 1980s,
as well as being written about time and
again in the search for topical ingredients,
injectable substances or resurfacing
treatments that increase the production of
or longevity of collagen.
Collagen is a complex of proteins, in a
triple helix pattern. There are 18 known
collagen sub-types, of which 11 are
found in the dermis. Type I collagen is
the predominant dermal collagen, being
nearly 80% of total dermal collagen. It is
responsible for the tensile strength of the
dermis, and has been shown to decrease
with age and interestingly to increase as a
result of dermabrasion3.
Type III collagen, sometimes known
as foetal collagen due to its abundant
presence in embryos, comprises between
collagen structure
10 and 15% of dermal collagen, and
resides close to or surrounding blood
vessels within the dermis as well as just
below the DEJ.
Other collagen types that are relevant in
photo-ageing are types IV, V, VII and XVII.
Craven proposed that Collagen Type
VII is reduced in photoaged skin, and
that it is responsible for the weakened
anchoring fibrils at the DEJ, and this
weakness is in turn in part responsible for
the production of wrinkles4.
During the ageing process, the relative
proportions of collagen also change, as
collagen Type I reduces compared to
Type III.
Elastin: Like collagen, elastin is present
in many structures in the body, not just in
the skin. Elastin only makes up around 3%
of the dry weight of skin, whereas collagen
makes up 70% of the dry mass of skin.
Elastin is also present in abundance in the
lungs and in blood vessels.
Elastin fibres vary from collagen fibres in
that they are present at varying levels of
maturity within the dermis. For example
young elastin fibres are found stretching
vertically from the DEJ to the top of
the reticular dermis and are known as
oxytalan, whereas mature elastic fibres,
known as elaunin, lie horizontally in the
deeper reticular dermis. The most mature
of the elastin fibres are found in the deep
reticular dermis, but are unnamed.
Elastin is known to bind with collagen
and hyaluronic acid, creating a three
dimensional structure, but elastin fibres
are produced in early years, and no
new fibres are produced in adulthood.
Degradation of elastic fibres is associated
with UV exposure, and ellastosis is one
of the key features of photoaged skin.
The fact that new elastin fibres are not
produced is a challenge in aesthetic
dermatology, with much research going in
to stimulation of elastin production.
Glycosaminoglycans (GAGs):
GAGs are well known in the aesthetics
industry, after twenty years of working
with hyaluronic acid (HA) based fillers
from Hylaform, through to Restylane,
Juvederm, Teosyal, Belotero and the
many other injectable forms of HA
available to us. It is easy to forget that
GAGs are simple repeating chains of
disaccharide units that occur naturally in
the dermis, and it is common knowledge
that HA absorbs 1000 times its own
weight in water. HA is in fact the most
abundant GAG, and other GAGs include
heparin and chondroitin sulphate.
The main relevance of HA in ageing skin
is its ability to attract water and thereby to
create volume in the dermis. However HA
also performs other functions such as cell
adhesion, keratinocyte differentiation and
formation of lamellar bodies.
Matrix Metalloproteinases (MMPs):
MMPs are responsible for the breakdown
of the different types of collagen
described above as well as other key
dermal and extracellular components. It is
a logical step for ingredient manufacturers
to look for MMP inhibitors, and there are
many on the market such as the retinoids
and bionic hydroxyacids.
The subcutaneous layer, or hypodermis,
is mainly an area dedicated to fat storage.
It represents 9 to 20% of normal weight
in an average population group. The
dilemma in aesthetic dermatology is the
Aesthetics | December 2013
balance between the desire for a healthy
‘slim’ body shape, and the need for
sufficient adipose tissue for a pleasing,
youthful facial appearance.
We have reviewed the structures and
major components of the skin in relation
to both healthy skin and photodamaged,
prematurely aged skin. There is a
plethora of cosmetic ingredients
available to us, as well as a number of
pharmaceutical options. It is important to
understand how these ingredients may
impact on our patients’ skin and to do
this we need a sound understanding of
the structure of the skin, and of the many
components that make up the epidermis,
dermis and hypodermis.
(1) Oikarinen A. The ageing of skin:
chronoageing versus photoageing.
Photodermatol Photomed. 1990;17;3.
(2) Vrhovski B, Weiss AS. Biochemistry of
tropoelastin. Eur J Biochem, 1998;258:1.
(3) Nelson B, Majmudar C et al.
Clinical improvement following
microdermabrasion of photo aged skin
correlates with synthesis of collagen I.
Arch Derm 1994;1130:1136.
(4) Craven NM, Watson RE et al. Clinical
features of photodamaged human
skin are associated with a reduction in
collagen VII. Br J Derm. 1997;137:344.
With thanks to the invaluable information
in Cosmetic Dermatology: Principles
and Practice, Second Edition, Dr Leslie
Baumann, MD; 2009 McGraw Hill; and
Cosmetic Dermatology;
Products and Procedures, Dr Zoe
Draelos, 2010 Wiley Blackwell.
Lorna Bowes
RGN NIP. As well
as many years of
delivering aesthetic
procedures, Lorna
has trained many
doctors, nurses and
dentists to administer basic and advanced fillers, toxins,
medical needling, skin care and peels, and
lectures regularly on aesthetic procedures
and aesthetic business management.
Lorna is a founding member of The British
Association of Cosmetic Nurses (BACN),
and Consulting Editor for The Journal of
Aesthetic Nursing and so has a unique
understanding of the aesthetic industry.
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Date of preparation: November 2013 UK/SIPSCU/13/0020
Clinical Practice
HA Fillers
A surgeon’s
Stephen McCulley MBChB, FCS(SA)Plast,
FRCS(Plast) on the use of Hyaluronic Acid
(HA) fillers in his facial aesthetics practice
Stephen McCulley is
a cosmetic plastic and
reconstructive surgeon
based at Nottingham’s
renowned City Hospital. He
is on the specialist register
for Plastic Surgery and is
a member of BAPRAS and
I have been combining the use of HA fillers and
surgery in my practice for the last 12 years. As
treatments they complement each other but cannot
replace each other. Therefore, it is important that
a surgeon understands the value of fillers, just
as it is for the cosmetic practitioner to know the
limitations of fillers.
There has been a shift recently in the use of
fillers to a concept of volumising tissues, as
opposed to simply filling lines. This is hardly a
surprising evolution as the connection between
facial youthfulness and volume has long been
recognised. The child’s full cheeks and short
lower eyelid length give the mid-face its youthful
appearance. As we age there is a huge change
in both fat and bone volumes in the face. This
‘volumising approach’ has been part of the face-lift
culture for many years. However, the days of filling
facial wrinkles are far from over! Just as the modern
concepts in breast augmentation have moved
away from being about volume to dimensions,
make no mistake, for many patients it remains
about volume. Similarly in facial fillers as we move
towards ‘volumising’ it remains about wrinkles
for many. There is obviously a place for both to
complement each other. In youth we observe the
movement or mimetic wrinkles such as around the
eyes and forehead that turn into the permanent
dermal creases of age.
Then with time we see the emergence of what I call ‘decent’ or
‘gravity wrinkles’ as the combination of volume loss and skin elasticity
changes create skin folds such as the marionette naso-labial changes
amongst many others.
There is no clear distinction between the role of fillers or surgery.
However, the jowls, jawline and neck laxity remain the main roles of
face-lift surgery. The square jawline created by the descent of the
jowl can only be improved significantly and long term with surgery.
Yet of all cosmetic surgery to the face, the eyes are one of the most
successful and are important to discuss. Many patients I see come
in requesting a face-lift to ‘improve their appearance’. I always ask
them, as we all should with any treatment, what are the aims of
the treatment for them. If they tell me they wish to look fresher or
more youthful, I suspect in over 50% of patients, surgery to their
eyes is probably the single biggest change they can make. This is
very important to recognise as a patient can have all the fillers and
toxin treatments possible, however, if it is the eyes that make them
look tired or older then eyelid surgery should be at least discussed
to augment their non-surgical treatments. Patients and alas some
professionals, are not always that good at assessing what the real
issues may be. Look at the face as a whole. If you are treating
wrinkles alone you may not open your eyes to the whole face.
Similarly, there is no point doing a face-lift when the real issue for the
patient is actually just peri-oral lines.
There are many face-lift techniques. The short scar techniques are
becoming more popular and have real advantages of both shorter
scars and quicker recovery. They are good at managing the jowls
and to a degree the mid-face and neck. However, a full face-lift is still
better at managing large amounts of loose skin and neck laxity. Most
techniques will show good changes to the jowls at five years and
beyond, although changes to the neck do not always maintain as well.
Many of these surgical techniques can improve mid-face fullness and
now with the addition of fat injections this has become even better.
However, reliable mid-face fullness can be elusive with surgery. There
Aesthetics | December 2013
Clinical Practice
HA Fillers
are some areas of the face that surgery will not
impact upon. If one draws a line down from the
inside of each pupil, very little to the midline of
these lines will be changed by surgery.
Therefore, the peri-oral, the inner mid-face and the
glabellar remain the remit of cosmetic treatments in
my practice.
A further useful tool to help assess the potential
role of surgery for a patient is to take a photograph
of them lying down and compare it to a photograph
of them sitting up. This is a reasonable prediction
of what a face-lift, and to a degree eye surgery,
will achieve once it has settled. This can be done
a few weeks following non-surgical treatments. If
there are good changes noted then facial surgery
will have a good additional role to non-surgical
treatments administered. If there is little change
noted with this photograph test then the continued
use of non-surgical treatments remains reasonable.
I think there is also a misconception that there
“There has been a shift
recently in the use of fillers
to a concept of volumising
tissues, as opposed to simply
filling lines. This is hardly a
surprising evolution as the
connection between facial
youthfulness and volume
have long been recognised.”
effect and safely, albeit it is quite expensive to patients.
Skin re-surfacing must also be considered as part of the
regime for a patient particularly around the peri-oral area.
Resurfacing in combination with fillers later
can give excellent results.
So when to use fillers and when to use
surgery? Obviously it is not black and white.
However, when a relatively modest volume
of filler can create changes to the areas
that bother a patient in that corridor of the
face between the pupils then this remains
a good treatment option as surgery is not
going to impact these areas. In my practice
this will be the glabellar lines with toxin and
a combination of toxin and filler if deep; the
peri-oral area, with or without resurfacing;
the lips; small volume changes to the nasolabial folds and marionette lines. The deep
filling of the cheeks is the only exception to
these conservative rules in terms of absolute
filler volume.
should be a choice between surgery or cosmetic
treatments. I tell all my face-lift patients they will
probably still benefit from fillers or toxin injections.
The major difference is they may require less and
the impact of the treatments can be even more
dramatic in terms of eradicating troublesome
areas. When fillers are needed in larger volumes,
particularly in the naso-labial or lower face to
create change then one must at least question
using fillers alone. Indeed the use of large volume
sub-dermal filler is questionable full stop as it
creates skin changes over time. The exception to
this volume rule has come in terms of deep cheek
fillers creating cheek fullness. This concept has
enabled larger volumes of HA to be used to good
However, when the main problems for the patient are the
eyes, the jowls, the neck, marked lateral brow ptosis or
large volumes of filler are required around or particularly
below the mouth then the question of surgery should
be raised. Not to eliminate the need for non-surgical
treatments, but to return them to their ideal role of
providing fine or finishing touches to the face and adding
proportional volume changes without damaging the skin.
Don’t forget the photograph test to assess the impact of
surgery. Of course, look at the face as a whole and always
question what the patient wants to achieve. Finally, always
question yourself, as a surgeon or cosmetic practitioner,
to ensure you are delivering the optimal and tailored
treatments the patient needs.
Aesthetics | December 2013
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Bocouture® 50 Abbreviated Prescribing Information Please refer
to the Summary of Product Characteristics (SmPC). 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) 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. 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.
Not recommended for use in patients over 65 years or under 18 years.
Injections near the levator palpebrae superioris and into the cranial
portion of the orbicularis oculi should be avoided. 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. 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). 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, eye disorder, 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). General; In rare
cases, localised allergic reactions; such as swelling, oedema, erythema,
pruritus or rash, have been reported after treating vertical lines between
the eyebrows (glabellar frown lines) and other indications. 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: FEB 2012. Full prescribing information and further
information is 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 yellowcard.mhra.gov.uk 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. Frevert J. Content in BoNT in Vistabel, Azzalure and Bocouture. Drugs
in R&D 2010-10(2), 67-73
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:
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.
Date of preparation: August 2013 1102/BOC/AUG/2013/LD
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Clinical Practice
Filler performance
We summarise the results of a study
comparing the physical properties
and clinical performance of Varioderm®
with other HA fillers
Hyaluronic acid (HA) is an essential polysaccharide
that is ubiquitous in the human body and has been in
clinical use for over thirty years. Properties of HA make
it an attractive substance for dermal fillers for managing
volume loss in the ageing face, such as its ability to
bind large amounts of water, its natural presence in
the skin and its low potential for adverse reactions.
Three-dimensional facial re-contouring through softtissue augmentation with fillers can provide patients
with a fuller, youthful appearance that softens the
appearance of ageing. There are currently a number
of dermal fillers available on the market based on
injectable HA hydrogel. They differ in the specifics of
their physical properties, and these differences have an
effect on their final clinical performance. The physical
properties of HA dermal fillers are determined by their
HA concentration, cross-linking degree, gel hardness
(elasticity), and injectability. A better knowledge of some
of the physical properties of HA fillers can therefore be
very useful for physicians in choosing the appropriate
HA dermal filler for facial recontouring and/or a specific
indication. In this study, the physical properties of seven
selected HA dermal fillers were evaluated using the
rheological testing method and compared.
Three-dimensional facial
re-contouring through softtissue augmentation with
fillers can provide patients
with a fuller, youthful
appearance that softens the
appearance of ageing.
In the past, scientists and physicians have discussed the effects
that certain properties of dermal fillers might have on the actual
filling effect of a product. It has long been thought that the key
parameters for the clinical application of dermal fillers were the HA
concentration and the size of the gel particles in the product1. The
clinical evaluation of Restylane® and Perlane (two products of identical
chemical composition with a mean particle size of 300 μm and 650
μm respectively) showed however that the particle size does not
affect the time of retention in the body2, 3. For cross-linked HA, its
concentration is the decisive factor for high efficacy (with regard
to filling effect and retention time). This however does not apply to
non-cross-linked HA, as such substances are decomposed in the
body within only a few days4. Table 1 shows the concentrations of the
selected HA dermal fillers and their measured physical properties. The
gel hardness (elastic modulus G’) plays a major role for the efficacy of
a HA filler. This parameter is determined by the HA concentration, the
molecular weight of the HA and the share of non-cross-linked HA in
the end product.
The elastic modulus can be used to determine the suitability of a HA
filler for a specific application. HA fillers with greater elastic modulus
have a better filling effect and a longer retention time in soft tissue.
The measured elastic modulus values (Table 1) indicate that Juvéderm
Ultra 2 is the lowest of the selected HA fillers (G’=75.5 Pa), followed
by Teosyal Global Action (G’=140 Pa), Restylane® Perlane (G’=695 Pa),
Varioderm® Plus (G’=940 Pa) and Varioderm® Subdermal (G’=2190
Pa). The elastic modulus of Varioderm® Subdermal is thus three times
greater than that of Restylane® Perlane, while the elasticity modulus
of Varioderm® Plus is seven times greater than that of Teosyal® Global
Action, and even 12 times greater than that of Juvéderm® Ultra 2 (Figure
1). Given the high elasticity of the Varioderm® fillers, these products can
achieve better volumising effect and a longer lasting augmentation in
the soft tissue5,6. In addition, the high elasticity of these fillers means that
less product is required to achieve the same effect as with less elastic
dermal fillers.
Aesthetics | December 2013
Clinical Practice
Filler performance
Varioderm® dermal fillers are produced by means of
monophasic particle technology (MPT). The tests show
that the Varioderm® fillers offer better injectability than
the other dermal fillers, as the HA gel in the Varioderm®
products are particulated (Figure 2).
The measured extrusion forces (Figure 2) show that
Teosyal® Ultra Deep requires by far the greatest
extrusion force (Fmax = 57.06 N), followed by
Juvéderm® Ultra 2 (Fmax= 32.74 N) and Restylane®
Perlane (Fmax= 19.35 N). In contrast, Varioderm®
Subdermal (Fmax= 17.02 N) and Varioderm® Plus (Fmax
= 10.00 N) require a significantly smaller extrusion force.
The maximum extrusion force of Teosyal® Ultra Deep
is about three times greater than that of Varioderm®
Subdermal and even six times greater than that of
Varioderm® Plus. In addition, curve progression of
Teosyal® Ultra Deep shows that the product does not
possess a homogeneous mixture (Figure 2).
Table 1
Figure 1
HA dermal fillers currently available on the market
have their limitations related to clinical performance,
persistence and ease of injection. Therefore, a better
knowledge of the chemical and physical properties of
HA dermal fillers may help physicians in choosing the
appropriate HA dermal filler for facial enhancements [4].
Figure 2
The results of this rheological study indicate that
seven selected HA dermal fillers possess a range
of physical properties. Varioderm® products have
significantly better elastic properties and are easier
to inject than the other evaluated fillers (Teosyal®,
Juvéderm® and Restylane®). This is mainly due to the
innovative monophasic particle technology (MPT) used
in the production process for the Varioderm® fillers.
The optimised physical properties of the Varioderm®
fillers therefore allow for better clinical results.
Understanding of physical properties of dermal fillers
and their potential impact on clinical performance may
better equip the physicians to select appropriate HA
filler products based on patient needs and desired
Monheit GD, Coleman KM, Hyaluronic acid fillers, Dermatol. Ther., 2006, 19: 141-150.
2. Narins RS, Brandt F, Leyden J, et al., A randomised, double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds, Dermatol. Surg., 2003, 29: 588-595.
3. Carruther A, Carey W, De Lorenzi C, et al., Randomised, double-blind comparison of the efficacy of two hyaluronic acid derivatives, Restylane Perlane and Hylaform, in the treatment of nasolabial folds, Dermatol. Surg., 2005, 31: 1591-1598.
Tezel A, Fredrickson GH, The science of hyaluronic acid dermal fillers, J. Cosmet. Laser. Ther., 2008, 10: 35-42.
5. Weidmann MJ, New hyaluronic acid filler for Subdermal and long-lasting volume restoration of the face, European Dermatology, 2009, 1: 65-68.
6. Alsoufi A, New and innovative developments in hyaluronic acid fillers for lip enhancement and contouring, European Dermatology, 2010, 5: 50-53.
7. Stocks D, Sundaram H, Michaels J, Durrani MJ, Wortzman MS, Nelson DB, Rheological evaluation of the physical properties of hyaluronic acid dermal fillers, J. Drugs Dermatol., 2011, 10(9): 974-980.
Aesthetics | December 2013
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Clinical Practice
PRP & organic silicon
Dr Alain Gondinet on how a
combination of PRP and organic
silicon can rejuvenate the skin
The Keystone
in Regenerative
“Nappage” cell mesotherapy with PRP for
Through the technique of mesotherapy, PRP
is injected in the papillaris dermis, either by
nappage or point-by-point. As this is a highlyvascularised area, there is a slow release of
platelets and growth factors towards the dermis,
where they stimulate fibroblast proliferation
and new extracellular matrix formation. This will
rejuvenate elasticity and the texture of damaged
skin. PRP also benefits the tone and secretions
of the epidermal layer of the skin. This treatment
can be performed in all areas where tissue
regeneration is necessary, such as the face, neck,
back of the hands and arms, hair and décolleté.
The use of thrombin/PRP gel for
remodeling, and treating wrinkles and
dark circles
Like any practitioner working in the field of aesthetic medicine,
skin ageing is the main focus of my practice and its management
is therefore extremely important. One of the safest and most
efficient solutions to targeting skin ageing, in my experience, is
the use of living cells obtained from the patient’s own platelet rich
plasma (PRP), combined with organic silicon.
PRP is produced through centrifugation of the patient’s blood,
obtaining an autologous concentration of human platelets in a
small volume of plasma (4-5ml). This is measured as less than twofold to the native blood level. PRP contains specific selected white
cells (monocytes and lymphocytes), plasmatic proteins (fibrin and
globulins), vitamins, electrolytes and anti-oxidative enzymes.
PRP also contains a concentration (two to three-fold) of growth
factors, which are secreted when platelets are activated and initiate
wound healing. All constituents of PRP are from autologous origin,
meaning that there is no risk of a local immunological reaction or of
transmission of diseases.
PRP is an in-vivo bio-scaffold, which functions by a ‘structure and
signal’ process, consisting of:
The formation of a tri-dimensional (3D) polymerised fibrin
network from fibrinogen, activated by the autologous thrombin
2. The release of growth factors by thrombocytes and leucocytes
in their biologically determined ratios. There are over 80
known growth factors (GFs). In the field of aesthetics, the most
important GFs are EGF, VEGF, PDGF, TBGF, IGF, KGF and FGF.
3. The chemo-attraction of macrophages and fibroblasts
(mesenchymal stem cells).
4. Mitosis (M. Stem cell proliferation), differentiation and new
extracellular matrix deposition.
Aesthetics | December 2013
PRP is combined with autologous thrombin
produced in a dry tube without anticoagulant,
and is injected into deep dermis, forming a gel
texture. This provides a locally dense formation
of the bio-scaffold, which will improve volume
defects. PRP does not act as other cross-linked
fillers, because the aim is to regenerate new
tissue, which is the same as that surrounding
the point of injection, rather than simply fill the
wrinkle with biomaterial. It is autologous, so there
is little bruising and no fibrosis encapsulation.
It is a long-term process, but provides a natural
and smooth result. Three injections at onemonth intervals are necessary to obtain visible
improvements. Following this, one injection
every six to 12 months helps to maintain results.
The organic silicon salicylate monomethyltrisilanol,
has the best bioavailability for the body, and is
the most well-known form of organic silicon used
in therapy. In the aesthetics market, Conjonctyl
from Sedifa is the organic silicon available for
mesotherapy injections. Connective tissue is rich
in silicon when the human embryo develops.
The silicon is then depleted naturally as growth
and ageing occurs. Organic silicon is a bridging
element for the molecules that constitute the
extra-cellular matrix of connective tissue, and is
soft in the skin and dense in the joints.
Injections of organic silicon into the dermis
improve its structure and texture, and can be
injected before PRP in the same session. The
injections can be given in three sessions with
an interval of two weeks, and follow the same
protocol as for PRP injections. Organic silicon can
Clinical Practice
PRP & organic silicon
also be mixed with non-cross-linked hyaluronic
acid and Vitamin C.
By forming links within and between individual
polysaccharide chains, and by linking these
chains to proteins (GAGs, glycoproteins, fibrin),
organic silicon improves structure and texture
by developing the architecture of the fibrous
element and contributing to its structural
integrity. It is mandatory when undertaking these
treatments, that medical doctors use sterile and
authorised medical devices in a safe, secure
way. This includes PRP kits that are CE mark
medical device Class II b and FDA approved,
and organic silicon that is CE mark medical
device class III.
PRP, organic silicon and hyaluronic acid can
be used in the same session to improve the
quality of the skin in terms of hydration, cell
biostimulation and regeneration. As long as
doctors maintain safe, secure, efficient methods
of injection, the combination of PRP with
Organic Silicon will help improve skin quality in
patients needing tissue repair or those wanting
to manage the skin ageing process, and can be
defined as a keystone of skin rejuvenation.
Conjonctyl is currently the only authorised form of injectable silicon organic in
the world. All other forms are for topical, external use only.
It is a small outline specification of silicon organic (Si – C) medical device
class III, trademarked from Sedifa Laboratoire Monaco. It is a sterile solution
of 0.5% sodium monomethyltrisilanol orthohydrobenzoate (i.e a Salicylate
of silanol). The product is stable in aqueous solution. Increased demand to
regain visible youth has encouraged scientists to look more closely at the
extra cellular matrix and to look for products that will produce natural results.
Adding Conjonctyl to treatment will produce significant visible results in terms
of reconstruction of tissues, facial correction and younger skin. The whole
procedure takes only a few more minutes than classical methods, but the glow
of the face is noticeable instantly.
Conjonctyl is now available in UK and Ireland through Synergy Beauty Med UK
Ltd SBM.
Dr Alain Gondinet is an
aesthetic medical doctor and
nutritionist specialising in
antioxidative mesotherapy.
He is a medical consultant at Bio
Bridge Foundation (Switzerland).
GB16983_SIG-ART 15/11/2013 10:27 Page 1
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Clinical Practice
No sweat
Dr Patrick Bowler discusses new technology for
sweat reduction in primary axillary hyperhidrosis
Excessive sweating, or, to give it its medical name, hyperhidrosis, is
a condition that affects millions of people throughout the UK. Until
now, treatment has consisted of medical-strength aluminum chloride
antiperspirant, or Botox® to the sweat glands.
Surgery has been a painful, complicated option too. But the use of non-invasive
bimodal RF technology (Alma SweatX) is safe and effective for long-term (up to
six months) sweat reduction in patients with primary axillary hyperhidrosis and
offers a pain-free and non-invasive solution that could change patients’ lives.
We’ve got over two million sweat glands in the body: tiny, minute glands that
number up to 370 per centimetre squared if you look at the palm of your hand.
Even when we’re not aware of it, we’re sweating constantly, as this is the body’s
way of regulating temperature and cooling us down.
Eccrine glands are a few millimetres under the skin. Apocrine glands are
deeper under the skin’s surface, and sweat from these glands contain
proteins and fatty acids that give a discoloured appearance. This occurs
in the groin and underarm areas. A body at rest simply reabsorbs sweat
produced, but after exertion or exercise, excess sweat makes it to the surface
of the skin to evaporate. When sweat comes into contact with bacteria on the
skin, a smell can occur.
We can produce up to three litres of sweat an hour, but the average is
closer to half a litre a day. However, up to 2% of us don’t produce any
underarm odour at all, proving that everyone experiences sweat differently.
Hyperhidrosis is a medical condition whereby the signals sent to the sweat
glands are exaggerated and so excessive sweat is produced irrespective
of activity levels. Surgical procedures include cutting through the chest wall
to cut the nerve fibres supplying the eccrine glands, or going under the
skin of the armpit and liposuctioning out the glands. With both, there’s a risk
of damage to skin structures. Alma SweatX is non-invasive and pain-free.
It works by using radio frequency. Electric and magnetic energy targets
water molecules in and around the sweat glands, which respond by rotating
rapidly, generating friction and in turn heat. This temporarily deactivates the
glands. In hyperhidrosis the glands contain excess water compared to other
structures and are therefore heated preferentially in the skin.
The treatment occurs in two parts, with the first probe targeting the deeper,
apocrine glands, and the second part working on the more superficial eccrine
glands. Patients experience a mild warming sensation and little else. Clinical
trials support anecdotal evidence. In a trial conducted by Prof. Igor Pinson,
MD, PhD et al, all patients demonstrated sweat reduction at one, three and
six months after their last treatment, as indicated by the iodine-starch test
and hyperhidrosis disease severity scale (HDSS) questionnaire. One month
after the last treatment all patients shifted from HDSS three or four to HDSS
one or two. At a six-month follow-up, 11 patients (55%) reported HDSS=2 and
Aesthetics | December 2013
nine patients (45%) reported HDSS=1. In the control
group, 80% of patients (eight patients) showed
HDSS=2 and two patients HDSS=1 (no change from
baseline). It’s proven to be safe and effective for
long-term (up to six months) sweat reduction in
patients with primary axillary hyperhidrosis. Results
may even last longer but more trials will need to be
done before we know if it offers a more permanent
solution to the problem. Patients notice results in
a few days, with no odour and little dampness. For
clinics, Alma SweatX offers a targeted treatment for
hyperhidrosis and osmidrosis with no disposables
and a user-friendly interface. Treatments are short,
and easy to delegate, ensuring an incredible high
return on investment.
Dr Patrick Bowler is a
founding member and
Fellow of the British
College of Aesthetic Medicine, and a member of the
American Society for Laser
Medicine and Surgery.
He is also the founder of
Courthouse Clinics.
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Clinical Practice
Hair loss
Dr Patrick Treacy, MD of Ailesbury Clinics,
looks at the latest methods and procedures
in FUE hair transplant technology
The hair
and now
Until recently, having a hair transplant was not something you
could do in secret. A Follicular Unit Extraction (FUE) procedure
requires the patient to shave their head prior to treatment and the
strip surgery leaves a large permanent scar. A newly shaved head
or a scar on the scalp leaves it difficult to keep the procedure secret.
We have seen some celebrities trying to keep their treatment, quite
literally, under their hat until their shaved hair grows back, but the
constant wearing of a cap or hat causes questions to be asked too.
Developments in treatment methods, and in particular specialist
skill sets now make it possible to perform an FUE procedure
without shaving the head before treatment. Follicular Transfer is a
modern hair restoration technique where hairs are transplanted in
groups of one to four hairs - exactly as they grow in nature. It is a
major advance over the older hair transplantation procedures that
used larger grafts and often produced a pluggy, unnatural look.
FT technique is actually a two-step procedure where the aesthetic
results mimic the way hair grows in nature and will be undetectable
as a hair transplant. During the first step, also called FUE (Follicullar
Unit Extraction), direct extraction of selected individual follicular units
from the patient’s donor area is performed, allowing the surgeon
to control the potential problem of visibly lower donor area density
after the procedure.
The second part of the procedure is the Follicular Implantation
where the surgeon implants the grafts with a predetermined density,
pattern and angle in a realistic hair pattern. Many clinics now offer
adjunct hair restoration techniques that combine adjuncts such as
stem cell technology, motorised micropunch extraction, anabolic
nutrition or red light phototherapy to shorten the time required for
complete hair growth and increase follicular graft survival. Each
represent a small advance on methods of hair implant technology
currently available by concentrating on a shortened recovery time,
increased graft survival and reduced risk of complications.
Many clinics have been testing the use of platelet–rich plasma (PRP)
in hair transplant surgery since 2009 when Carlos Uebel from Brazil
and Joseph Greco from Florida reported improved healing and
graft survival with use of this method. Platelets, key players in the
body’s wound healing mechanism are activated to release various
hair growth factors that stimulate the healing process. These factors
stimulate new blood vessels to form (angiogenesis) and collagen
to be produced. Cells are stimulated to divide and go into action
surrounding the wound. PRP reduces infection and offers a minimally
invasive surgical procedure that benefits from a shortened recovery
time, increased graft survival and reduced risk of complications.
Many hair implant surgeons prefer small punches
(really sort of a special needle of 0.72 mm diameter)
with a motorised drill to remove individual follicular
units, eliminating the need for excision of skin from
the back of the head. Punch gauges and preferences
can widely vary. Typical ranges are 0.75mm to 1.0mm.
Small punches are great for minimising scarring
but are not really suitable for larger two, three and
four-hair grafts. Using a 0.75mm punch to extract a
triple-hair graft could result in partial or full transection
of the graft. Many clinics feel that something like
a 0.9mm gauge is more suited to a reproducible
outcome. Respectively, using a larger gauge can
preserve yield levels but also create scars larger than
desired and damage surrounding follicles. Words of
wisdom dictates that one size does not fit all.
Hair is made from nutrients in the body, and nutritional
deficiencies can cause hair damage and hair loss. For
example, biotin deficiencies have been linked to hair
loss and skin disorders, and sufficient levels of the
B vitamins are necessary for hair health and growth.
Many Western diets are lacking in nutrients and a
poor diet may contribute to early onset of hair loss
symptoms in people genetically prone to hair loss.
Ailesbury Clinic uses Help Hair™ Shake which contains
nutrients and herbs specifically selected for their
positive effects on hair, including Niacin (vitamin B-3),
Folate, Vitamin B-12, Biotin, Zinc, Manganese, Fo-ti Root
(Ho Shou Wu or Polygonum multiflorum) - a popular
Chinese herb traditionally used to darken pre-mature
grey hair, Kudzo Root - Pumpkin Seed to help regulate
testosterone levels and PABA, Chlorophyll to remove
sebum, which carries DHT. As part of an overall hair
loss program, Ailesbury Clinics put patients on a low
anabolic profile by telling them to consider eliminating
or reducing certain supplements in their diet. This
includes using the SHAPIRO Chart and monitoring the
use of anabolic steroids, creatine, Growth Hormone,
Androstenedione, HCG diet or Whey Protein Isolate
often found in body building additives.
Aesthetics | December 2013
Clinical Practice
Hair loss
The technique uses wavelengths with red light therapy in the range
of 630 to 670 nanometers (nm) immediately post FUE procedure.
Visible red light is capable of being absorbed by the molecules of
the hair follicle and can stimulate the growth or re-growth of the
hair following a natural biological reaction. Red light is absorbed
because of an intracellular enzyme called cytochrome c, which
is responsible for stimulating the hair follicle by sending it certain
signals. Those signals promote gene activity and lower apoptosis
(cell death regulated by the genes) as well as other reactions. This
has been known since 1967 when it was accidentally discovered
by a Hungarian scientist who noticed that exposed, shaved mice
experience faster hair re-growth.
• More than 50% of men over the age of 50 will
have experienced some form of hair loss.
• The average number of hairs on a male human
head is approximately 100,000 - 150,000.
• Men with fair hair actually normally have more
hair on their heads than men with darker hair.
• Hair loss can affect men of all ages, from their
late teens upwards.
• The average FUE hair transplant procedure
takes approximately eight hours to complete
(depending on the number of hairs to be
• The average number of hairs transplanted
in a FUE hair transplant procedure is around
5,000 hairs.
• The U-FUE (Unshaven Follicular Unit Extraction)
hair transplant procedure allows men, now, to
undergo a hair transplant without having their
head shaved - so it is, in effect, undetectable.
Dr Patrick Treacy is Medical
Director of Ailesbury Clinics Ltd
and Ailesbury Hair Clinics Ltd.
He is an active member of many
international medical societies
and is a Fellow of The Royal
Society of Medicine.
GB16982_SIG-ART 15/11/2013 10:24 Page 1
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Reduces the appearance of fine lines
and wrinkles
Leaves skin soft and glowing
Interested to learn how Dermaceutic can add revenue to your practice?
Call for a no obligation demo on 020 8995 7992 or email: [email protected]
Sigmacon (UK) Limited, Heriots Wood, The Common, Stanmore, Middlesex HA7 3HT
Pistor Eliance
Forming an Eliance
The new Pistor Eliance injection gun provides painless, precise penetration
for practitioners and patients alike.
When it comes to mesotherapy, no name
is more synonymous with clinical efficacy
and expertise than Pistor. The original
Pistor injector gun was co-invented by the
founding father of mesotherapy, Dr Michel
Pistor, and the products are now designed
and manufactured in France by MI Medical
Innovation, a world leader in the field itself.
Distributed in the UK and Ireland by Vida Health
and Beauty, MI Medical Innovation’s range of
mesoguns are designed to make mesotherapy
treatments more accessible, comfortable and
effective for patients and practitioners alike and
are seen as the gold standard among leading
meso practitioners across the Globe.
The company’s new generation mesotherapy
gun, Pistor Eliance, is one such innovation.
The ergonomic design of the gun means that
the handset is lighter and allows practitioners
to deliver treatment with enhanced comfort,
and therefore with more efficiency and with
less fatigue. Fatigue is one of the number
one concerns among physicians performing a
significant volume of mesotherapy. Doing several
treatments in one day can be quite demanding
on the hand and wrist, a problem that is
alleviated by the use of mesogun. Not only does
it take away the need for holding a syringe but it
improves consistency.
Practitioners can choose from six pre-programmed
precise injection modes, allowing specificity for
administering different injections. The ergonomic control panel is also clear,
meaning that tactile control management is possible, allowing for fast and
easy specific programming and eradicating product-use confusion.
Unlike older injection guns, there are no cables, meaning it is easy for
practitioners to work around their clients. It is also suitable for injecting
solutions with a high viscosity index, such as hyaluronic acid, which has a
viscosity index of 5500 Pa/s. The gun’s electronics enable easy and precise
adjustments of penetration depth, injection volume and injection time,
and the needle is attached directly to the syringe rather than a catheter
tube, meaning that there is no product wastage. When working with small
quantities of product, the gun also ensures the exact same dosage is
delivered every time. The Pistor Eliance is also fully ambidextrous, so can
be used with the left hand as well as the right. In case of an emergency,
it automatically switches to standby mode in the event of an error in use,
showing that it is a safe product. It is versatile and can be used worldwide, as
the new generation battery recharges on both 220 V/50 Hz and 110 V/60 Hz
power supplies.
For the patient’s benefit, the gun is gentle, quiet and virtually painless, even
in sensitive areas such as the scalp or face, providing the luxury of client
wellbeing that is not achieved by compressor operated guns. All of this
combined makes mesotherapy an exciting and dynamic treatment option to
add to your practice.
Tel: +44 (0)1306 646526
[email protected]
Aesthetics | December 2013
STYLAGE® Lidocaine is the only patented range of cross-linked
hyaluronic acid (IPN-Like technology) dermal fillers which
incorporates both an anaesthetic (lidocaine) and an antioxidant
(mannitol) for safe, comfortable and effective aesthetic
treatments. It can be used for filling and smoothing of
wrinkles, natural lip correction, volume restoration, hydration,
For further information about:
chin remodelling, tear trough correction, neck,
décolleté and hand rejuvenation.
STYLAGE® is perfectly suited for use with a cannula.
Launched in 2008, STYLAGE® by Laboratoires
Vivacy (France) is now one of the world’s fastest
growing dermal fillers.
Contact Medical Aesthetic Group
on 02380 676733
or visit www.magroup.co.uk
Clinical Practice
A summary of the latest
clinical studies
TITLE: The Role of Hyaluronidase in the Treatment of
Complications From Hyaluronic Acid Dermal Fillers
AUTHORS: Cavallini M, Gazzola R, Metalla M, Vaienti L
PUBLISHED: Aesthet Surg J. 2013 Nov 6
KEYWORDS: Cosmetic medicine, dermal, facial skin necrosis,
fillers, hyaluronic acid, hyaluronidase, noninvasive plastic surgery
ABSTRACT: Hyaluronidases, a family of enzymes that are
able to degrade hyaluronic acid (HA), are employed in medicine
to increase drug diffusion and reverse the effects of HA filler
injections. Hyaluronidases are able to dissolve subcutaneous
nodules or to correct excessive quantities of injected filler.
Knowledge of the use, methods of application, and adverse effects
of hyaluronidases is essential for the aesthetic practitioner. The
authors performed an extensive review of the available literature
from 1928 and compared the different enzymes available, recording
each author’s indications regarding usage and side effects.
TITLE: Stylage®: A Range of Hyaluronic Acid Dermal fillers
Containing Mannitol. Physical Properties and Review of the
AUTHORS: Ramos-E-Silva M, Fonteles LA, Lagalhard CS,
Fucci-da-Costa AP
PUBLISHED: Clin Cosmet Investig Dermatol. 2013 Oct 23
KEYWORDS: Fillers, hyaluronic acid, mannitol, Stylage®
ABSTRACT: Minimally invasive dermatological procedures, such
as those using hyaluronic acid injectable fillers, have revolutionised
anti-ageing treatments of the face. By promoting replacement of lost
volume and attenuating grooves and wrinkles, they ensure a more
youthful appearance and recovery of facial aesthetics. The authors
review some of the main physicochemical characteristics of these
dermal fillers, highlighting the product line Stylage®, the manufacture
of which includes mannitol.
TITLE: The Use of Infrared Radiation in the Treatment
of Skin Laxity
AUTHORS: Gentile P, Felici M, De Angelis B, Puccio L, Puglisi
A, Felici A, Cervelli V, Delogu P
PUBLISHED: J Cosmet Laser Ther, 2013 Nov 11
KEYWORDS: Infrared radiation, laser therapy, skin laxity, scars
ABSTRACT: This study examined the use of infrared lights in
treating facial and body skin laxity. Between 2007 and 2011, in the
Department of Plastic and Reconstructive Surgery at the Hospital
S Camillo - Forlanini, 303 patients were enrolled in the study and
underwent laser therapy, operating at wavelengths from 1100 to
1800nm. Areas treated include face, neck, eyebrows, abdomen,
legs and buttocks. Results showed no systemic complications. The
satisfaction degree of patients was 70% ‘very satisfactory’ for facial,
neck and eyebrow lifting and 40% ‘very satisfactory’ for all other
areas. Conclusions indicated that the use of infrared radiation
represents a valid alternative to surgical lifting, but cannot replace
it. The infrared light technique used has turned out to be useful in
contrasting skin laxity of the face and other parts of the body. The
absence of scars and surgical risk makes this technique useable for
a large number of patients.
TITLE: Acne in Patients with Skin of Color: Practical
AUTHORS: Yin NC, McMichael AJ
PUBLISHED: Am J Clin Dermatol. 2013 Nov 5
KEYWORDS: Acne vulgaris, topical retinoids, azelaic acid,
dapsone, antimicrobials, hydroquinone, post-inflammatory
hyperpigmentation, isotretinoin, laser therapy
ABSTRACT: Acne vulgaris is a prevalent and nondiscriminatory condition affecting individuals of all races
and ethnicities. Dermatologic care must evolve accordingly
to address the distinct concerns of people with skin of
color. Patients of colored skin with acne can be particularly
challenging, given their potential for complications including
post-inflammatory hyperpigmentation and keloid development.
A variety of treatments have proved to be effective in preventing
or treating these complications. Topical retinoids are considered
first-line therapy for acne in patients of color; topical
alternatives include azelaic acid, dapsone, and antimicrobials.
Hydroquinone may be used in combating post-inflammatory
hyperpigmentation. For severe acne, oral agents, including
antibiotics or isotretinoin, may be used. Most recently, various
lasers and phototherapies have been suggested for their safety
and efficacy. Recognising the clinical and histologic differences,
as well as the variations in treatment regimens for darker skin
types, will allow for better care and patient satisfaction.
TITLE: Consensus Recommendations on the Aesthetic Usage
of Botulinum Toxin Type A in Asians.
AUTHORS: Ahn BK, Kim YS, Kim HJ, Rho NK, Kim HS.
PUBLISHED: Dermatol Surg. 2013 Oct 11
KEYWORDS: Botulinum toxin type A, BTA in Asians, forehead
lines, glabellar lines, infraorbital wrinkles
ABSTRACT: The use of botulinum toxin has rapidly
expanded into various aesthetic applications. This study
provides consensus recommendations on common aesthetic
problems, which are treated by neurotoxins in Asians. A
panel of experienced Korean dermatologists developed a
clinical consensus on common aesthetic problems involving
the face, neck, and calves in Asians. The recommended final
concentration of BTA was 50U/mL after reconstitution with
physiologic saline. For horizontal forehead lines, the members
recommended nine injections in two rows into the frontalis
with 1U/point. For glabellar lines, the members recommended
three injection points (a total of 8U). For crow’s feet, the
members recommended three injections per side (7 U/side)
at the lateral part of the orbicularis oculi. For infraorbital
wrinkles, one to two points per side in the superficial
subcutaneous space approximately 1cm below the lash line were
recommended (1-2U/side). For nasal flare, one injection point
in the middle of each ala nasi was recommended (a total of
2U). For depressed nasal tip, a single injection deep within the
columella was recommended, with a dose of 3U. This guideline
provides a framework for physicians who wish to perform safe
and efficacious injections of BTA in Asians.
Aesthetics | December 2013
e: [email protected]
t: +44 1782 579 060
In Practice
Brand archetypes
Richard Crawford-Small
on branding
and archetypes
I then remembered the solution to the problem; know what your
brand archetype is and communicate that to the world. A couple
of questions and a Twitter chat later, I was introduced to the
book The Hero and the Outlaw; Building Extraordinary Brands
Through the Power of Archetypes by Margaret Mark and Carol S.
Pearson. So armed with this, I set forth on my mission to create an
extraordinary brand.
your story?
Richard Crawford-Small
Primarily the Creator Archetype,
because he loves making things,
(but a little bit of an outlaw too).
Creator of iConsult & Practice
Twitter @iconsultsoft.
“Tell me about yourself?” This is one of the most difficult
questions in the world to answer. It could be a question asked
between two people who go on to marry; it could be the first
question asked of a new employee who goes on to become the
CEO. Ask the next person you see that question and don’t be
surprised if they struggle to formulate a response.
So why is this question so difficult to answer? Because, arguably,
it is the most poignant question you can ever really ask an
individual. For a company, it is the most important question to be
able to answer as it reveals your core beliefs and philosophies
and ultimately enables you to articulate your identity, or ‘brand’.
When I was creating the brand for iConsult, I’d found it
extremely difficult to extract the core elements from my usually
accommodating mind without coming across as a complete
narcissist or missing out some key elements, I took a break from
the white board and let my mind wander, as my normal thought
processes wouldn’t solve the problem; “What is iConsult? What
makes it special? What is it’s story?”
A massive glass of Cockspur Rum later and my mind drifted to
university and a lecture on screenwriting (my film-making career
was very short). We discussed the key elements of character
creation and the “What is my motivation?” question that actors
need to be able to answer in order to understand the one thing
their character is trying to achieve. That was a bingo moment.
So, what is an archetype? Imprints, hardwired into our psyches,
influence the characters we love in art, literature, the great
religions of the world and contemporary cinema. Plato called
these imprints ‘elemental forms’ and saw them as the idea
structures that formed a template for material reality. C.G. Jung
called them ‘archetypes’. These archetypes are commonplace,
and once you know what they are, you will gain a deeper level of
understanding in not only how some brands communicate to you,
but also how you can improve the effectiveness of your
own marketing messages.
Each of the 12 archetypes has a unique philosophy and identity.
They are a key tool in helping us not only to understand ourselves,
but also to understand our customers and help us to avoid a very
common scenario; the ill-considered rebrand. A rebrand is not
a new logo; that is a refresh. It could be that you have spent a
significant amount of money on marketing to your customers with a
strong safety message (Caregiver), when in fact they would respond
to the latest treatments and techniques (Creator). Do you rebrand to
a Creator? Maybe, if appropriate, but it is definitely cheaper to look
for people who would respond to a Caregiver brand.
Over the next few articles, I want to bring these archetypes to
life. We need to look at some examples of how they relate to real
life people, brands and products and how you can apply this
powerful tool to maximise the impact of your marketing. So, let’s
get started.
The Innocent
Helping you to retain or renew your faith
The Explorer
Helping you to maintain your independence
The Sage
Helping you to understand your world
The Hero
Helping you to act with courage
The Outlaw
Helping you to break the rules
The Magician
Helping you to transform
The Regular Guy
Helping you to thrive, just as you are
The Lover
Helping you to find and give love
The Jester
Helping you to have a good time
The CareGiver
Helping you to care for others
The Creator
Helping you to create something new
The Ruler
Helping you to exert control
Aesthetics | December 2013
In Practice
Brand archetypes
Brands: Disney, Dove, Tellytubbies Characters: Forrest Gump, Princess Leia
Adverts: John Lewis & Coca Cola Christmas Advertising
The new John Lewis advert, an
example of the Innocent archetype
Our first archetype, The Innocent, is a great archetype for use in a medical aesthetics
environment because it embodies many relevant core elements. It’s clean and signifies the
search for paradise, renewal and promise, neutral colours and also anything to do with the
natural environment.
Whether you’re a fan of the new John Lewis advert or not, it has been a big hit. According to Marketing Week, 79% of Facebook posts
referencing the ad have been positive, and John Lewis marketing director, Craig Inglis, echoes the use of archetypes when he says, “Our
ads aren’t about products, they’re about telling a story.”
The link to paradise is interesting as many older people seem to look to a nostalgic past for their ideals of a better time. So being able to
‘restore’ part of that and enable them to enjoy their later life with the freedom associated with youthful looks, could be important. As the
book says, “When the Innocent archetype is active in an individual, a person is attracted to certainty, to positive and hopeful ideas, to
simple, nostalgic images and to the promise of rescue and redemption.”
The Innocent is also strongly associated with Christmas. Coca-Cola are often referred to as an innocent genius brand for getting fizzy
sweet sugary brown water that makes you fat and rots your teeth, connected with Christmas. In 1931, artist Haddon Sunblom created a
series of magazine ads for Coca-Cola based on the 1822 poem The Night Before Christmas by Clement Clark Moore. Because these
images were in print for nearly 30 years and had such a wide audience, the generic depiction of Santa Claus is now as per Sunblom!
Brands: Land Rover, Starbucks, North Face
Characters: The Crew of the USS Enterprise, The Scott Expedition,
Richard Branson. Adverts: Anything to do with freedom and adventure,
Brands: Mayo Clinic, Harvard, BBC News
Characters: Confucius, Yoda, Oprah Winfrey, Bill Gates.
Adverts: The expert, the leading voice.
off road, the outdoors, the Internet
The Explorer
archetype is used
very heavily in
the marketing
and positioning
of products or
services that
help you on your
Land Rover represents the Explorer archetype
quest to ‘find a
better world’, express a narrative or the sense of a journey. The obvious
examples of this are Land Rover, Levi’s, Wrangler and basically any
product that needs to appeal to rugged outdoorsy types that
desire escape.
Science Fiction also tends to draw heavily from this archetype. Star Trek’s
split infinitive “To boldly go where no one has gone before” is a classic
example of an explorer archetype strap line and has endured for over 40
years. Explorer brands can also be web based; an early example being
“Amazon - taking you from A to Z”
However, the best example of an Explorer brand for me is Starbucks. I
love brands that have their identity pulled right through from bottom to
top. The name “Starbucks”, is a reference to the first Mate of the Peaquod
in Moby Dick, (not, as I was disappointed to find out, Dirk Benedict’s
character in Battlestar Galactica), and the logo is very much a goddess of
the sea. The brand experience continues inside the shop, and regardless
of your feelings on the company’s tax dealings, Starbucks has recreated
the expectation of customer experience in a coffee shop. Think back to
the old days of no choice, no WiFi, no seats. Now think Starbucks; blazing
the trail, challenging the status quo, and turning a semi skimmed medium
black coffee into a Skinny Grande Americano.
The final Archetype we will look at for now is The Sage,
another great archetype to use for medical aesthetics.
The obvious positioning for someone in this industry is
to embody that of the expert, who shares their
knowledge with their customers, maximising retention
by creating compelling experiences. Most people
respond well to brands that lead and make them feel
comfortable that they’re
in good hands, and
it’s evident that lots of
software companies
adopt this archetype
to convey a feeling of
security to their users.
Oprah Winfrey is probably
one of the most powerful
Oprah Winfrey, represents the
Sages in America as she
Sage archetype, being wellrespected, highly-acclaimed &
sells records, books,
viewed as an expert in her field
and even has Tom Cruise
jumping on her sofa because people believe what she
says without question. Interestingly Richard Branson is
rapidly moving from an Explorer archetype to the Sage as
he enters his semi-retirement.
This brief introduction to the Archetype concept and
explanation of the first three should have allowed you
to consider the branding of familiar products and begin
to analyse your own marketing. Look at yourself, your
business and your patients and see if you recognise any
of the traits we have identified. Ask yourself: are you
focusing on the correct group?
Aesthetics | December 2013
In Practice
The real task for any aesthetic business is to gain the trust of potential new
clients. Most people feel they do this well in a face-to-face consultation but
how about gaining their trust before this meeting to allow you more
time during the consultation to discuss treatment options and the next
steps? Blogging can help with this because when someone visits your
website they can see it’s up-to-date with relevant and new information
about your industry, treatments, clients experiences etc. This shows you
are putting in that little bit extra to give potential clients as much value as
you can. As human beings we love more, so give more to your website
visitors and start blogging.
the blog
John Castro asks whether you should
be blogging and what the benefits are
to your aesthetic business
85 million unique visitors per month - that is the
number of people who visit the most popular
website blog on the Internet today: The Huffington
Post. Now of course that is an extreme example, but
what it proves is that the world today wants regular
information, they want it in ‘real time’ and they want
to interact with that information too. You may not see
much comparison with a news blogging website like
The Huffington Post but there is a lot to be learned
from this site as they are using the practice of
blogging in the right way. In the information hungry
world we live in today, the internet gives us so much
information: information that is used in many cases
to make buying decisions. As such, a blog gives you
the opportunity to supply relevant and up-to-date
information to the internet-surfing public that will, in
turn, encourage them to buy from you. In this article
I am going to present the opportunities for you as an
aesthetic professional in setting up and running your
own blog. Even though I have used the word ‘running’,
there is no need to panic and think, “Oh no, more time
I have to spend on something”. A blog doesn’t require
the attention or efforts you may think.
With the industry we are in, blogging gives website
visitors more opportunity to engage with you, interact
with you and ultimately build trust in you. This should
be the intention of your blog; to gain trust. Below I
have listed three main reasons to start blogging and
how each will help your aesthetic business bring in
new potential clients.
John Castro is the founder and
director of Website For Cosmetics,
a specialist in Web Marketing
to Cosmetic and Aesthetic
Healthcare Professionals.
Engagement is so under valued. Just look at the word ‘engagement’ for
a second. We use this word in ways that mean commitment. I encourage
you to look at a blog the same way. What a blog does is engage your
audience, which essentially has them commit to you for a specific
period of time. They have taken time to read your information and that
is commitment. You gain their interest by providing them with content no
one else probably is. Do this regularly and you start to see how your blog
posts actually play a big part in generating new leads into your aesthetic
business from your website.
Probably one of the most difficult parts in any blogger’s agenda is to get
the users to interact, but if you get this right you are on to a real winner.
Interaction with the user encourages enquiries. Why? Because you are
essentially asking them to take a specific action related to your blog post,
which means you have all their attention and they are actually listening
to you. The best way to get interaction is to mix it up in your blogs by
adding videos, Facebook ‘like’ buttons, share buttons for all social media
and comment boxes for them to leave their thoughts on your blog. All of
these things get the reader/user interacting and if you keep your blog
posts interesting and informative as well as up-to-date, website visitors will
encourage their community (more potential clients) to read it by sharing it.
Get this right and I promise you people will return again and again to your
website and start sending more and more potential clients your way.
Blogging can play a major part in your website’s ability to generate
new client enquiries. If done correctly, you can really benefit from this
marketing action. Current internet users want new information every day
and the more you can supply them with what they want, the more they
will consider coming to you or telling people about you. The point is be
informative and creative when writing blogs: two to four per month is
enough. Do not think you need to bombard the blog daily. Something to
leave you with:
Aesthetics | December 2013
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John Bannon Ltd supply quality
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We are your one stop shop for all your aesthetic
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how we can help your business grow.
AU5234 Azzalure A4 ad_Layout 1 06/06/2011 14:06 Page 1
Azzalure® Abbreviated Prescribing Information
Presentation: Botulinum toxin type A (Clostridium botulinum
toxin A haemagglutinin complex) 10 Speywood units/0.05ml of
reconstituted solution (powder for solution for injection).
Indications: Temporary improvement in appearance of moderate
to severe glabellar lines seen at frown, in adult patients under
65 years, when severity of these lines has an important
psychological impact on the patient. Dosage & Administration:
Botulinum toxin units are different depending on the medicinal
products. Speywood units are specific to this preparation and are
not interchangeable with other botulinum toxins. Reconstitute
prior to injection. Intramuscular injections should be performed
at right angles to the skin using a sterile 29-30 gauge needle.
Recommended dose is 50 Speywood units (0.25 ml of
reconstituted solution) divided equally into 5 injection sites,: 2
injections into each corrugator muscle and one into the procerus
muscle near the nasofrontal angle. (See summary of product
characteristics for full technique). Treatment interval should not
be more frequent than every three months. Not recommended
for use in individuals under 18 years of age. Contraindications:
In individuals with hypersensitivity to botulinum toxin A or to any
of the excipients. In the presence of infection at the proposed
injection sites, myasthenia gravis, Eaton Lambert Syndrome or
Amyotrophic lateral sclerosis. Special warnings and
precautions for use: Use with caution in patients with a risk of,
or clinical evidence of, marked defective neuro-muscular
transmission, in the presence of inflammation at the proposed
injection site(s) or when the targeted muscle shows excessive
weakness or atrophy. Patients treated with therapeutic doses
may experience exaggerated muscle weakness. Not
recommended in patients with history of dysphagia, aspiration
or with prolonged bleeding time. Seek immediate medical care
if swallowing, speech or respiratory difficulties arise. Facial
asymmetry, ptosis, excessive dermatochalasis, scarring and any
alterations to facial anatomy, as a result of previous surgical
interventions should be taken into consideration prior to injection.
Injections at more frequent intervals/higher doses can increase
the risk of antibody formation. Avoid administering different
botulinum neurotoxins during the course of treatment with
Azzalure. To be used for one single patient treatment only during
a single session. Interactions: Concomitant treatment with
aminoglycosides or other agents interfering with neuromuscular
transmission (e.g. curare-like agents) may potentiate effect of
botulinum toxin. Pregnancy & Lactation: Not to be used during
pregnancy or lactation. Side Effects: Most frequently occurring
related reactions are headache and injection site reactions.
Generally treatment/injection technique related reactions occur
within first week following injection and are transient and of mild
to moderate severity and reversible. Very Common (≥ 1/10):
Headache, Injection site reactions (e.g. erythema, oedema,
irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging
and bruising). Common (≥ 1/100 to < 1/10): Facial paresis
(predominantly describes brow paresis), Asthenopia, Ptosis,
Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching
(twitching of muscles around the eyes). Uncommon (≥ 1/1,000
to <1/100): Dizziness, Visual disturbances, Vision blurred,
Diplopia, Pruritus, Rash, Hypersensitivity. Rare (≥ 1/10,000 to <
1/1,000): Eye movement disorder, Urticaria. Adverse effects
resulting from distribution of the effects of the toxin to sites
remote from the site of injection have been very rarely reported
with botulinum toxin (excessive muscle weakness, dysphagia,
aspiration pneumonia with fatal outcome in some cases).
Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00
(RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP) IRE 2 Vial Pack (2 x
125u) €187.05 (RRP). Marketing Authorisation Number: PL
06958/0031 (UK), PA 1609/001/001(IRE). Legal Category: POM.
Full Prescribing Information is Available From: Galderma (UK)
Limited, Meridien House, 69-71 Clarendon Road, Watford, Herts.
WD17 1DS, UK. Tel: +44 (0) 1923 208950 Fax: +44 (0) 1923
208998. Date of Revision: January 2011.
Seasonal offers
The passage of time
10 x Restylane 1ml Lidocaine + 10 x Azzalure
Twin pk 2X 125units
Innovative medical solutions
that meet the needs of dermatology
patients and physicians:
• P
dermatology research
• S
global research
and development
Galderma (UK) Limited, Meridien House,
69-71 Clarendon Road, Watford, Herts, WD17 1DS.
Tel: +44 (0)1923 208950 Fax: +44 (0)1923 208998.
Copyright © 2011 Galderma (UK) Ltd.
Date of preparation: March 2011
EV5082-Emervel-Corporate Advert.indd 1
• F ocusontherapeutic,
corrective and
aesthetic innovations
to UK
20 x Restylane
1ml Lidocaine
20 x Restylane
0.5ml Lidocaine
20 x Perlane
1ml Lidocaine
The secret to reveal beauty
20 x Vital
1ml Lidocaine
20 x Vital
2ml Lidocaine
Azzalure is a Botulinum
Toxin Type A for aesthetic use.
20 x Emervel Classic 1ml Lidocaine
Adverse events should be reported.
Reporting forms and information can be found
at www.yellowcard.gov.uk. Adverse events should
also be reported to Galderma (UK) Ltd.
Azzalure® is indicated for the temporary improvement in the
appearance of moderate to severe glabellar lines seen at frown,
in adult patients under 65 years, when the severity of these lines
has an important psychological impact on the patient.
• Fast onset of action (median time to
onset 2-3 days)1
• Long duration of action
(up to 5 months)1
FREE Restylane Skincare
with every order.
• High level of patient satisfaction
(93% after 6 months, following one
treatment session)2
1. Azzalure® Summary of Product Characteristics.
2. Ascher B et al. J Am Acad Dermatol 2004; 51: 223-33.
Azzalure® is a registered trademark of Galderma.
an aesthetic choice
Date of preparation: February 2011
06/12/2011 10:38
John Bannon; Service to Surgery tel; 00353(01) 6789766
e; [email protected], www.johnbannon.ie
Follow us on:
In Practice
Wendy Lewis on the art and
science of clinic marketing:
striking the right balance
human behavior. Marketing is about telling your story, building
relationships and giving customers direct value. This is where the
artistry comes in. Marketers must inspire and connect with a target
audience on a deeply personal level. Regrettably, scientists are
not inclined to do that very well. It’s just not in their DNA. Having a
robust online presence and online marketing are vital for growing
a successful clinic today. But some clinics may be overlooking the
benefits of tried and true marketing methods by focusing solely on
their web strategy. So before you sign up for complex and costly
marketing strategies, keep in mind some simple tactics that may
be more cost effective and have always worked. These methods
may include, but are not limited to, eblasts, open house seminars,
loyalty programs, and giving five-star service.
Many marketing experts are all about doing the math. They throw
out countless methods of analytics to test and measure clicks, calls
and ka-ching. They are rather obsessed with outsmarting Google.
They promote the ROI (return on investment) on every strategic
decision. These marketers have a formula that they ascribe to for
promoting a clinic. Some are just passionate about it; but others
are dogmatic that theirs is the only way and nothing else matters. In
my view, these sort of tactics sometimes work for a period of time,
but that is not engraved in stone. Why? Because they are failing to
calculate perhaps the most obviously inconclusive element – the
human factor. Yes, that is right – we are dealing with h-u-m-a-n-s,
i.e., patients! No one can truly predict human behaviour 100% of the
time. There are too many twists and turns to account for. We can
make assumptions, an educated guess, or even base conclusions
on past behaviour. However, this method is just not as foolproof as
SEO experts will lead you to believe.
Social media is a vital tool yet many clinics still have not figured
out how this form of marketing will benefit their business. Those
who are still on the fence about diving into the social space
are missing out on an important channel in which to highlight
their services and products in a unique and creative way. A
strong social media strategy should be an integral part of a
proactive clinic marketing programme in today’s competitive
market. Social media offers up the perfect combination of art and
science. It affords marketers more flexibility to think outside the
box. Facebook, Twitter, and some of the newer key platforms
including Instagram and Pinterest, are a marketer’s dream come
true. Small businesses like solo practitioner clinics in particular
must make the most of every opportunity to promote their brand.
However, there are some obvious forms of marketing that may
be overlooked in the day-to-day operations of a busy clinic. For
example, having a powerful email signature on every email sent
from the clinic, treating every patient professionally, offering good
value for money on popular repetitive treatments, and servicing
patients efficiently and in a timely manner. All of these pivotal
touch points can have a dramatic effect on your bottom line, yet
they are much harder to measure than tracking how many people
clicked on your landing page or how many seconds they spent
on the photo gallery. Social media is all about people. It is a form
of human communication. It cannot just be measured by clicks
and likes. Techs may be brilliant at links, algorithms, writing code
and programming. PRs and writers are good at words, visuals, and
communicating with people. Being creative or artistic dictates a
way of thinking and of viewing the world. Creative people have
been said to use the right side of their brains more than the left.
They tend to be more open-minded thinkers and are often more
emotional. So if you are a right brained sort of person, you will
probably succeed best in a career that allows you the freedom to
go a little crazy. Left brained people, on the other hand, are usually
good at science, math and music. They are more analytical, adept
at tasks that require attention to detail and numbers, and tend to
be more logically minded. Sound familiar? It should. It is widely
accepted that doctors and especially surgeons are often left
brained kind of people.
Marketing an aesthetics clinic properly surely requires skill
and expertise, but it also requires a basic understanding of
What do you want to be - an artist or a scientist? Until you make
up your mind, you won’t be as effective as you could be in your
Among marketers of aesthetic clinics there appears to
be a growing divide. The lingering question is whether
clinic marketing is about art or science. I would argue
that it is really about both, and that striking a healthy
balance is the key to success.
Aesthetics | December 2013
There is a place in
clinic marketing for
the scientist and the
artist. They can co-exist
beautifully. However,
you can only wear one
hat at a time. Figure
out what you are good
at and like to do, and
delegate or outsource
the aspects of marketing
a clinic that do not come
naturally to you.
endeavours. You will probably get frustrated, spin your wheels
in the wrong direction, and go through your budget faster than
you should. There is a place in clinic marketing for the scientist
and the artist. They can co-exist beautifully. However, you can
only wear one hat at a time. Figure out what you are good at and
like to do, and delegate or outsource the aspects of marketing
a clinic that do not come naturally to you. Every clinic can
benefit from a healthy combination of these opposing buckets
of expertise. Understanding what you want to be known for will
shape your entire business from the content you create to the
people you have on board. It will dictate the culture of the clinic
that you are presenting to the community. Decide who you want
to have as customers to create a dialogue that speaks to them.
Don’t try to appeal to every single patient out there, and get
more focused. If you choose too narrow a niche, you may be
limiting your marketing too much. If your target demographic is
too broad, for example, women over 40, it may be too expensive
to reach that group efficiently because it is too big. Identifying
a secondary and even tertiary target audience should also be
considered in your clinic’s marketing plan. Decide what the
solutions are that your clinic offers to your target audience. Listen
to what your patients are already saying about your clinic online
and pay attention to them. At the end of the day, technologies
come and go. Hot platforms get cold and new ones arise to take
their place. But one thing remains constant; people love a good
story. Rather than focusing only on the how, focus on the why,
and let the scientists do their thing.
Wendy Lewis
Wendy Lewis is the president
of Wendy Lewis & Co Ltd, and
Founder/Editor in Chief of
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In Practice
Marketing planning
Hayley Hutchings, aesthetic sales and
marketing manager at Lynton Lasers Ltd
on marketing planning for success
Stick to these three simple sections for an easy to
follow plan:
1. Top Level Goals
2. Bite Size Goals
3. Action Plan
What do you really want from your business
next year? It’s hard to know where to go without
knowing where you currently are so completing a
mini business audit can help lay the foundations
for a great marketing plan. In your audit you’re
asking the question “How are we doing at the
moment?” Analysing various aspects such as
financial performance, conversion rates, target
market, competitors, marketing spend and product/
treatment portfolio can all help to identify areas for
improvement which then relay into next year’s goals.
Best laid
Top level goals will typically be related to the
financial aspects of the business e.g. increase
annual turnover to £240,000 or increase profitability
to 20%. However, you may also have non-financial
goals that you wish to achieve, such as becoming
the market leader in your local area or repositioning
your brand and key messages. Don’t try to do too
much at once: having fewer goals and achieving
them is far better than having seven half-completed
goals. Each goal needs to be achievable and have a
timeframe attached to it.
2013 is rapidly coming to a close and if you’re anything like me you’re
astounded at the speed it seems to have flown by at: it seems such a short
time ago I was working with the Lynton marketing team to set the goals
and objectives for 2013, and here we are again. We like to plan ahead at
Lynton and aim to have an annual marketing plan complete by October for the
following year. You’ll find the most successful cosmetic clinics are also those
that plan ahead to achieve goals and proactively drive the business forward.
If you’re not currently creating an annual marketing plan now is a great time
to start. A marketing plan helps to prevent overspending throughout the
year and allows you to create strategic marketing campaigns in line with
your business objectives, reducing the risk of sporadic or irrelevant
marketing communications.
I understand the immediate reaction that comes into play upon hearing this
suggestion – “I just haven’t got the time!” Don’t worry, this does not need to
be a lengthy laborious project. The first step is to book a few hours out of
your diary: if you are thinking “I’ll wait until I have a quiet spot and fit it in
then,” it will never get done. You have to plan the time to do the planning –
squeeze in a three hour slot and make sure you have a quiet space to work
in when the time comes.
For me it’s all about actions, actions, actions. You can spend a great deal of
time trying to create the perfect text book marketing plan but let’s face it what we really want is something quick, simple and effective. Your marketing
plan should be a guide that you can refer to throughout the year, easy to
follow and designed to keep your business on track.
Aesthetics | December 2013
Taking each top level goal at a time, you now
break this down into several smaller goals that
will help you achieve the end result you desire.
For example if you have a top level goal to
increase profitability you might set the following
bite size goals:
Set aside time to analyse highest margin and
lowest margin products and treatments from
2013 – to be completed by end Jan 2014
Allocate marketing spend to planned activities
throughout 2014 to promote highest margin
treatments and products – to be completed by
end Jan 2014
Identify any cost saving opportunities to
employ in 2014 by end Jan.
Hayley Hutchings has
worked as a business
consultant with a range
of practices from NHS to
single room sites. Hayley
is the marketing manager
at Lynton Lasers Ltd where
she is responsible for the
introduction of new IPL &
Laser technologies into the
Lynton portfolio.
In Practice
Marketing planning
You now take your bite size goals and create a month by month action plan to achieve them. This is really the guts of your annual plan: it’s
a well-planned annual to-do list designed to keep your marketing activities in line with current top level goals, keep your budget on track,
and ensure you get the results you want in the time identified. It will look something like this:
Profitability analysis - identify highest and lowest margin treatments/products
6th Jan
Plan one promotion per month for 2014 that focuses on highest margin retail products
and treatments
Mid Jan
Implement any cost saving opportunities
Mid Jan
Website analysis
Work with website provider to perform Keyword and SEO analysis - set goals for 2014
End Jan
Contact local press about opportunities for editorial in 2014, plan in time throughout the
year to provide content
Mid Feb
Create Facebook and Twitter accounts, target to FB/Tweet every few days
End Feb
Run training session for all employees based on the next promotion
End Feb
Ensure outside of business is communicating the right brand image to increase walk-ins
Mid March
Create and run an eshot campaign to promote specific treatment
Mid March
Spring open day planning for April open event
End March
Ideally your marketing plan should work three months in advance so in January you are completing activities for implementation in
April, February is preparation for May communications, and so on. Creating your marketing plans is a process that will evolve and
develop over the years but is key to successful marketing communications and achieving your key objectives. Start simple just giving it
a few hours a month and see what a difference it can make to you.
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In Practice
In profile
body contouring and fat reduction has been proven to be one of the most
effective methods.”
Debra recognised that getting maximum press coverage for the
treatment would not only boost their distribution of Lipoglaze but make
their own clinic, the LoveLite clinic in Harley Street, a flagship centre for
the procedure. A woman who knows how to create a buzz about the
treatments she offers, Debra’s signature FAME HD micro-pigmentation
system and the much-copied Power Brow treatment have both had huge
amounts of column inches dedicated to them.
The shape
of things
Antonia Mariconda speaks to Debra
Robson about running a successful
aesthetics business
As a pioneer of non-invasive aesthetic treatments,
Debra Robson has always been a savvy marketeer.
Her semi-permanent make-up procedures have
set an industry benchmark, with others following
where she has led. It is no surprise then that
Debra is now making her mark on the industry in a
different way by tapping into the booming market
of body shaping.
Noticing a trend towards non-invasive, body
shaping procedures with minimal downtime,
Debra, and business partner Donnamarie McBride,
sourced and brought to the UK a fat freezing body
system that has since taken the market by storm
- Lipoglaze. She says, “Body contouring is a really
fast growing sector of medical aesthetics. Statistics
show that there has been a huge downturn in more
invasive procedures. Cryotherapy as a method of
It was with this same approach that the LoveLite team made Lipoglaze a
household name overnight. Social media sites were awash with pictures
of the young and beautiful stars of hit shows such as Made in Chelsea
and The Only Way is Essex as well as top beauty editors and journalists
having the treatment and this celebrity endorsement has certainly
worked. Debra says, “Social media is a massive means of marketing these
days and it has definitely worked for us in respect of both journalists
and celebrities coming in and having treatments and getting the word
out there. Before and after pictures have been published and they are
real true results from people who have taken selfies and posted them
themselves on Twitter and Facebook. Because of that the word has
spread very quickly.”
However while celebrity endorsement may get patients through the
doors, Debra realised that to get more physicians on board, serious
scientific data was needed so they set up their own clinical trials, the
data from which is due to be published in early 2014. Initial findings
have shown reductions in subcutaneous fat of between 11% and 59%,
depending on the thickness of the fat.
While fat freezing may be the project of the moment, Debra still harbours
further ambitions. She hopes to create a governing body for beauticians
and non-invasive clinics, granting them a better standing within the
aesthetics industry. She explains, “We need to set clear standards of
quality of care to our customers so that when a client visits a member
clinic they know they are going to be treated well and will undergo an
effective procedure that will deliver great results.”
Antonia Mariconda
The Cosmedic Coach is a beauty writer, author,
and anti-ageing coach. Antonia has written four
published books in beauty, surgery and health and
is a popular blogger and Twitter beauty influencer.
She is currently a beauty presenter for Sky Fitness
and Beauty TV. Follow Antonia @CosmedicCoach
on Twitter. www.thecosmediccoach.com
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Date of Prep: November 2013
References: 1 – Edsman K et al. Dermatol Surg 2012;38:1170-1179.
2 – Narins RS et al. Dermatol Surg 2008;34(Suppl 1)S2-8.
3 – Narins RS et al. Dermatol Surg 2011;37(5):644-650.
In Practice
Standards update
Mike Regan, chair of the BSI Committee CH/403 Aesthetic Surgery Services,
gives us an update on the European Standards
Setting the
For the past three and a half years a new pan European services
standard (EN 16372) for the aesthetics sector has been in
development. This work has been coordinated at the European
level by CEN, the European Committee for Standardisation.
Member States, including the UK, have been placing extensive
input into this work.
Aesthetic surgery is
defined in EN 16372 to
include all highly invasive
treatments such as
face-lifts and liposuction
Within CEN, a specific group, CEN/TC 403 (Technical Committee
403) is leading the project. It had originally been understood that
both aesthetic surgery and also aesthetic non-surgical medical
services were within the scope of CEN/TC 403. Indeed up until very
recently considerable progress on writing the sections for all these
types of procedures was being made by working on them in parallel.
Aesthetic surgery is defined in EN 16372 to include all highly invasive
treatments such as face-lifts and liposuction, whilst the aesthetic nonsurgical medical services sections of the standard were to deal with
treatments such as injectables and also non-invasive laser and IPL
procedures, such as hair reduction.
agreement was reached to proceed on the basis of splitting the
document into two separate standards: one for surgery, and the
other for non-surgical procedures. However this type of scoping
issue needed to be ratified at the top level, and was accordingly
further discussed and in due course agreed at the meeting of
the CEN/BT in mid-October 2013. [CEN/BT is the Technical Policy
Board of CEN]. It is anticipated that the overall content of the two
separate standards will be similar to the draft of EN 16372 that was
put out for public consultation for several months at the start of
2013. A team of experts from within CEN/TC 403 is being set up
to ensure the split is done accurately and efficiently. The current
target dates are to publish the surgery standard in May/June 2014,
with the non-surgical standard expected to be published a few
months later in October/November 2014.
Mike Regan has been actively involved
in the National and International
Standardisation sector since 2001.
This experience ideally positions him
to advise and manage the BSI CH403
Committee from a process point of
view: how standards are developed,
managed, voted on and implemented.
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A few months ago however two CEN Member States raised a
detailed procedural point, that strictly speaking the original scope of
CEN/TC 403 (which was formed in early 2010) only included surgical
procedures. This came as something of a surprise to quite a few
other Members States, including the UK, because we thought there
had been a general understanding that the non-surgical procedures
were also in scope. At the meeting of CEN/TC 403 held in Vienna
in late August 2013 the matter was discussed again, and broad
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Carlton Group Beauty & Spa
+44 01903 761100
[email protected]p.co.uk
ABC Laser
Contact: Guy Gouldsmit
+44 08451 707 788
[email protected]
Merz Aesthetics
+44 0333 200 4140
[email protected]
Contact: Lauren Roberts
+44 01554 755444
[email protected]
Service: Laser System
Aesthetic Source
Contact: Sharon Morris
+44 01234 313 130
[email protected]
Services: NeoStrata and Exuviance
Healthxchange Pharmacy
Contact: Steve Joyce
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+44 01481 736677
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Aesthetox Academy
Contact: Lisa Tyrer
+44 0870 0801746
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Service: Training
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Contact: Louise Taylor
+44 0845 689 1789
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Service: Manufacturer of LED
Phototherapy Systems
Ellipse-Intense Pulse Light
741 1111
(I2PL) &Laser Systems E:T: 0208
[email protected]
Contact: Jane Myerson W: www.venusconceptuk.co.uk
Services: UK distributor of IPL & Laser
Services: UK distributor of Venus
+44 IPL
& Laser 741
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Services: IPL & Laser systems,
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T: 0208 741 1111
Bioptica Laser Aesthetics
Contact: Mike Regan
+44 07917 573466
[email protected]
Services: Core of Knowledge
Training and Laser Protection
Adviser (LPA) Services
W: www.ellipseipl.co.uk
Intense Pulse Light (I2PL) & Laser Systems
Beautylight Technical Services Ltd
Jane Myerson
Ellipse Technical SupportContact:
Contact: Ashaki Vidale
T: 0208 741 1111
Technical E: [email protected]
T: 0208
741 1111
E: [email protected]
Services Ltd
W: www.ellipseipl.co.uk
W: www.technicalsupport.ellipseipl.co.uk/
UK distributor of IPL & Laser
Contact: Ashaki Vidale Services:
Services: Onsite service & repairs of
systems, IPL & Laser training courses
+44 0208 741 1111
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IPL & Venus Radio Frequency systems
[email protected]
Services: Onsite service&repairs
of aesthetic systems. Ellipse IPL&
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Boston Medical Group Ltd
Contact: Iveta Vinklerova
+44 0207 727 1110
[email protected]
As featured on
Energist Medical Group
Contact: Eddie Campbell-Adams
+44 01792 798 768
[email protected]
Skin Geeks Ltd
+44 01865 338046
[email protected]
Sound Surgical (UK) LTD
Contact: Raj Jain
+44 7971 686114
[email protected]
T: 0208 741 1111
E: [email protected]
W: www.venusconceptuk.co.uk
Services: UK distributor of Venus
Freeze and Swan Radio Frequency (RF)
& Magnetic Pulse (MP)2 systems
+44 0845 6121545
[email protected]
Beautylight Technical Services Ltd
E: [email protected]
W: www.technicalsupport.ellipseipl.co.uk/
Services: Onsite service & repairs of
aesthetic systems. UK agent for Ellipse
IPL & Venus Radio Frequency systems
Intense Pulse Light (I PL) & Laser Systems
Contact: Jane Myerson
delivering the promise
Venus Freeze
T: 0208 741 1111
Jane Myerson
[email protected]
0208 741 1111
Services: UK distributor of Venus
Frequency (RF)
[email protected]
& Magnetic Pulse (MP) systems
Services: Venus Freeze and Swan
Radio Frequency (RF) & Magnetic
Pulse (MP)2 systems
Contact: Jane Myerson
T: 0208 741 1111
E: [email protected]
W: www.ellipseipl.co.uk
Services: UK distributor of IPL & Laser
systems, IPL & Laser training courses
and technical support
Contact: James Haldane
+44 02073510488
[email protected]
Carleton Medical Ltd
Contact: Nick Fitrzyk
+44 01633 838 081
[email protected]
Services: Asclepion Lasers
Lifestyle Aesthetics
Contact: Sue Wales
+44 0845 0701 782
[email protected]
delivering the promise
Contact: Jane Myerson
T: 0208 741 1111
Candela UK Ltd
Contact: Michaela Barker
+44 0845 521 0698
[email protected]
needle free
Tracey Beesley
for the delivery of active
+44 0289 983 739
[email protected]
Lawrence Grant
Contact: Alan Rajah
+44 0208 861 7575
[email protected]
Contact: Ashaki Vidale
Tel: 01234 841536
delivering the promise
Contact: Jane Myerson
E: [email protected]
Services: Onsite service & repairs of
aesthetic systems. UK agent for Ellipse
IPL & Venus Radio Frequency systems
FromNeil Calder
+44 01234841536
[email protected]
Laser Physics
+44 01829773155
[email protected]
Intense Pulse Light (I2PL) & Laser Systems
Contact: Jane Myerson
W: www.technicalsupport.ellipseipl.co.uk/
Mesoestetic UK
Contact: Adam Birtwistle
+44 01746 718123
[email protected]
Services: Cosmeceutical Skincare
Treatment Solutions, Cosmelan,
Antiagaing, Depigmentation,
Anti Acne, Dermamelan
Eden Aesthetics
Contact: Anna Perry
+44 01245 227 752
[email protected]
E: [email protected]
Highgate Private Hospital
Contact: Highgate Cosmetic Clinic
+44 020 8347 3871
[email protected]
AZTEC Services
Contact: Anthony Zacharek
+44 07747 865600
[email protected]
www.aztecservices.uk.com TECHNICAL SUPPORT
Beautylight Technical Services Ltd
Service: Exclusive UK distributor
Contact: Ashaki Vidale
for Viora product range T: 0208 741 1111
Medical Aesthetic Group
Contact: David Gower
+44 02380 676733
[email protected]
Hamilton Fraser
Contact: Wai Chan
+44 0845 3106 300
[email protected]
Galderma Aesthetic &
Corrective Division
+44 01923 808950
[email protected]
Contact: Faye Price
+44 01376 532800
[email protected]
Aesthetics | December 2013
Zanco Models
Contact: Ricky Zanco
+44 08453076191
[email protected]
For you..
DXN Technology
British product
Cambridge Medical Aesthetics/
Cambridge Biotech Ltd.
Phone: + 44 01733 396171
Fax: +44 01733 396168
[email protected]
www. umajeunesse .co.uk
F or m e d i u m to d e e p
d e pr e s s i o n s i n clu d i n g
na so - l ab ial F o lds . 1
A highly versatile, injectable gel
using VYCROSS™ technology.1
reference: 1. Juvéderm VOLIFT with Lidocaine DFU, 2013.
Allergan, Marlow International, 1st Floor, The Parkway Marlow, Buckinghamshire SL7 1YL, UK | May 2013 UK/0658/2013