January 2021: The Wellness Issue by Aesthetics & CCR

! S W IC O ET S H RD S N ST A ET AE AW CK TI

VOLUME 8/ISSUE 2 - JANUARY 2021

OUR ANTIOXIDANT ANSWER

S I LY M A R I N C F E N VIR O NMENTA L PROTECT I O N FO R O ILY, BLEMISH- PRONE S KI N. FIG H TS AGA INST V ISIBLE S KI N AG EI N G.

C L I N I CALLY P ROV E N TO R E D U C E O I L OX IDAT ION BY UP TO 76 % *

*CLINICAL STUDY 35 SUBJECTS (CHINA 2020)

REDUCES OILINESS

Lesser-Known Vessels CPD

Dr Emily Swift explores the face’s vessel anatomy for safer injectable treatments

REFINES SKIN TEXTURE

Introducing Nutrition

Practitioners detail the nutritional services they offer to enhance patients’ overall health

IMPROVES SKIN CLARITY

BDD from a Patient’s View

Dr Reena Jasani reflects on a patient’s experience with body dysmorphic disorder

Writing a Case Study

Dr Zunaid Alli shares tips on having your work published in respected journals

Contents • January 2021 06 News

The latest product and industry news

18 News Special: Breaking the Male Stigma in Aesthetics

Practitioners explore why men are afraid to enter clinics

20 Advertorial: The EMSCULPT Revolution in Body Shaping Dr Rita Rakus and Dr Tracy Mountford share their experiences using

EMSCULPT

21 Associations in 2021

Aesthetics catches up with the two of the largest UK associations for medical professionals – the BCAM and the BACN

News Special: Breaking the Male Stigma Page 18

22 Meet the Trainer: The Kings

Dr Martyn King and Sharon King tell Aesthetics what you can learn from a masterclass with ReLife

CLINICAL PRACTICE 25 Special Feature: Adding Nutritional Service to Your Clinic

Practitioners explain the types of nutritional services they offer patients

31 CPD: Understanding Lesser-Known Vessel Anatomy Dr Emily Swift explores the vasculature for safer injectable treatments 38 Advertorial: SkinCeuticals launches Silymarin CF Discover what makes Silymarin CF antioxidant serum unique 41 BDD From a Patient’s Perspective Dr Reena Jasani interviews a patient with body dysmorphic disorder 44 Advertorial: Galderma

What really matters when selecting toxin

47 Antidepressants and Skin Pharmacist Amish Patel discusses the impact antidepressants can have on

skin and how to manage concerns appropriately

50 Understanding Vitamin D

Dr Simi Adedeji shines light on the benefits of vitamin D on skin

53 Abstracts

A round-up and summary of useful clinical papers

IN PRACTICE 55 Distinguishing Yourself as a Practitioner Dr Uche Aniagwu outlines his four steps to success in aesthetics 60 Improving Time Management

Adding Nutritional Services to Your Clinic Page 25

Clinical Contributors Dr Emily Swift is a dental surgeon and has been working in aesthetics for four years. She works at Dr Yusra Clinic, Liverpool and is the clinical lead at City Aesthetics in Chester and Hidden Gem, Chorley. Dr Reena Jasani is an aesthetic practitioner at City Skin Clinic in London, at SkinSmiths in Surrey and is the director of her own clinic based in greater SW London. She also has seven years’ experience in dentistry and works as associate dentist. Amish Patel is an aesthetic practitioner at the Intrigue Cosmetic Clinic, Kent. Patel graduated from King’s College London and completed his independent prescribing qualification after training at the Royal College Of General Practitioners. Dr Simi Adedeji graduated from Imperial College London. She is working as a GP partner and aesthetic practitioner. Dr Adedeji has more than 13 years’ post graduate medical experience and is the founder and medical director of Dr Simi Medical Aesthetics.

Nurse prescriber Natali Kelly shares her tips for improving clinic time

62 Writing a Case Study

Dr Zunaid Alli provides advice for getting your case study published

65 Hosting an Event During the COVID-19 Pandemic PR consultant Jenny Pabilla explains how to host a launch event 69 In the Life Of: Dr Bessam Farjo The co-founder of the Farjo Hair Institute tells us about his daily routine 70 The Last Word: Managing Menopause Dr Shirin Lakhani calls for urgent help in how menopausal symptoms are

managed successfully

NEXT MONTH In Focus: Marketing • Enhancing Instagram Engagement • An Intro to Marketing • Utilising Email Broadcasts

BOOK AESTHETICS AWARDS TICKETS NOW! AE STHE TICSAWARDS.COM

THEIR LOOK

*Juvéderm® offers a range of facial fillers to answer a variety of needs, each of which is administered at a different dermal layer. We believe the most natural-looking, long lasting results are achieved by enhancing your client’s features, not changing them. That’s why this year we’ll be launching a striking new campaign to educate your clients about our Juvéderm® Vycross® range. In fact, our versatile range of fillers includes five tailored products, each designed to benefit a specific area of the face at the optimum dermal level. Which means you can offer your clients a more bespoke and tailored treatment to suit their needs.

To find out why Juvéderm® could work for your clinic on every level, visit juvederm.co.uk

Produced and Funded by Allergan Aesthetics. UK-JUV-2050405 October 2020 ©2020 Allergan. All rights reserved. Model treated with Juvéderm®. Individual patient results may vary. Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to Allergan Ltd. UK_Medinfo@allergan.com or 01628 494026.

Editor’s letter Happy New Year! After the most challenging 12 months for all in recent history, we’re very much looking forward to a fresh start in 2021. For us at Aesthetics, the pandemic has meant postponing our much-loved Chloé Gronow Aesthetics Conference and Exhibition (ACE), Editor & Content CCR and the Aesthetics Awards multiple Manager times, but with the new vaccine being rolled @chloe_aestheticseditor out across the country, we have more faith than ever that ACE and the Awards will now go ahead on May 28 and 29. Registration for ACE will open soon and you can book your Awards tickets now, so do visit our website for more information. We had also hoped to launch our new magazine for patients – Beyond Beauty – this month. Unfortunately COVID-19 lockdowns have put a hold on that too, but, don’t worry, you’ll have it by the Spring! Make sure you’re following @beyondbeauty_mag on Instagram for all the latest updates.

Now, onto what you can learn this month! This issue focuses on Wellness – for you and your patients. While we have a plethora of fantastic articles on enhancing positive mental and physical health, the piece I have particularly enjoyed working on is Dr Reena Jasani’s interview with a gentleman suffering from body dysmorphic disorder (BDD) on p.41. As this journal is for aesthetic practitioners to share knowledge amongst peers, we don’t often include the voices of patients. This article, however, demonstrates how valuable it can be to learn about lesser-understood conditions and concerns from a patient’s perspective. Dr Jasani shares her conversation with 32-year-old Omari EcclestonBrown, who has suffered with BDD since the age of 16. She then reflects on what she has learnt, while sharing advice for other practitioners to screen, recognise and successfully approach patients experiencing BDD. I would urge you all to read and share your own experiences of treating BDD patients with us by emailing editorial@aestheticsjournal.com or tagging us on Instagram @aestheticsjournaluk.

Clinical Advisory Board

Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content

WE WANT TO HEAR FROM YOU!

Mr Dalvi Humzah is a consultant plastic, reconstructive and aesthetic surgeon with more than 20 years’ experience and is director of P&D Surgery. He is an international presenter, as well as the medical director and lead tutor of the multi-award-winning Dalvi Humzah Aesthetic Training courses. Mr Humzah is founding member of the Academy of Clinical Educators at the Royal College of Physicians and Surgeons of Glasgow. Mr Dalvi Humzah, Clinical Lead

Do you have any techniques to share, case studies to showcase or knowledge to impart?

Dr Raj Acquilla is a cosmetic dermatologist with more than 12 years’ experience in facial aesthetic medicine. In 2015 he won the Aesthetics Award for Aesthetic Medical Practitioner of the Year and in 2012 he was named Speaker of the Year. Dr Acquilla is a UK ambassador, global KOL and masterclass trainer for botulinum toxin and dermal fillers.

Sharon Bennett is chair of the British Association of Cosmetic Nurses (BACN) and the UK lead on the BSI committee for aesthetic nonsurgical medical standards. She is a registered university mentor in cosmetic medicine and has completed the Northumbria University Master’s course in non-surgical cosmetic interventions.

Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon at the Cadogan Clinic in Chelsea. She specialises in blepharoplasty surgery and facial aesthetics. Miss Hawkes was clinical lead for the emergency eye care service for the Royal Berkshire NHS Foundation Trust. She is an examiner for the Royal College of Ophthalmologists.

Jackie Partridge is an aesthetic nurse prescriber with a BSc in Professional Practice (Dermatology). She has recently completed her Master’s in Aesthetic Medicine, for which she is also a course mentor. Partridge is a founding board member of the British Association of Cosmetic Nurses and has represented the association for Health Improvement Scotland.

Dr Tapan Patel is the founder and medical director of PHI Clinic. He has more than 16 years’ clinical experience and has been performing aesthetic treatments for more than 14 years. Recently, he was listed in Tatler’s Top 30 AntiAgeing Experts. Dr Patel is passionate about standards in aesthetic medicine.

Mr Adrian Richards is a plastic and cosmetic surgeon with 18 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

Dr Souphiyeh Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the clinical director of Revivify London, an honorary clinical teacher at King’s College London and a visiting associate professor at Shanghai Jiao Tong University.

Dr Stefanie Williams is a dermatologist with special interest in aesthetic medicine. She is the founder and medical director of the multi-award winning EUDELO Dermatology & Skin Wellbeing in London. She lectures in the Division of Cosmetic Science and has published more than 100 scientific articles, book chapters and abstracts.

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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.

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Forehead

Talk #Aesthetics Follow us on Twitter @aestheticsgroup and Instagram @aestheticsjournaluk

#DermalFillers Dr Raj Acquilla @rajacquilla Awesome final rehearsal before my live show with the one and only @juliehornelips. We are so honoured that a record number of delegates from around the world have registered! #Education Dr Lee Walker @leewalker_academy Fabulous week teaching and filming @teoxanemena in Dubai with my dear friend @drcetto #Teoxane #RHA #UAE

AbobotulinumtoxinA efficacy confirmed in phase 2 study Global pharmaceutical company Galderma has received top line results for its phase 2 study in the US on the efficacy and safety of a single dose of abobotulinumtoxinA versus placebo for the treatment of moderate to severe glabellar lines. Researchers treated 401 subjects aged 18 to 65 with moderate to severe glabellar lines at maximum frown using Dysport – also known as Azzalure in the UK. Study participants were randomised 4:1 to receive a single dose of Dysport or placebo and followed for nine months. Results showed that the study met its primary endpoint, with significantly more subjects treated with Dysport at all four doses achieving a composite two-grade improvement responder rate compared to those treated with placebo at one month. Dr John Joseph, investigator for the study and director of The Clinical Testing Center of Beverly Hills said, “We are encouraged that these study results demonstrate that a single dose of Dysport has a rapid onset, long-lasting effect and is well tolerated. At all doses tested in the trial, Dysport had a strong safety profile, including very few cases of eyelid ptosis.” Skincare

#Celebration BCAM @britishcollegeofaestheticmed Another Zoomtastic BCAM meeting involving our new trustees @drbhavjitkaur & @atelier.dr.aggie, planning next year’s incredible 20th anniversary celebrations – 20 years of innovation, education and raising standards! #Aestheticsjournal Lauren Thompson @aestheticswithlauren Always learning! The Aesthetics journal is such a brilliant read every time. It keeps me up to date with the newest trends and educates its readers with the latest articles. Knowledge is power. #Complications Dr Amber Woodcock @cosmeticsdoctor Keeping my skills and knowledge up to date. To keep patients safe! Looking forward to seeing you all soon in clinic. @acegroupworld

AestheticSource launches three new products Aesthetic distributor AestheticSource has launched three new products as part of the Exuviance range. According to the company, the Retinol Eye Cream is designed to brighten the undereye area, and contains 0.05% retinol, 4% neoGlucosamine, dual peptide blend, and vitamin E. The Retinol Serum aims to reduce the appearance of wrinkles, and contains 0.3% stabilised retinol, 4% neoglucosamine and hyaluronic acid. The Radiance Peel is designed to exfoliate the skin, containing 1% retinol, 4% citrafill, vitamin E, and bisabolol, explains AestheticSource. The company is also launching two new sheet masks, the professional RESTORE Polyhydroxy Biocellulose Sheet Masque and the professional HYDRATE Hyaluronic Acid Biocellulose Sheet Masque. Nikki Jones, training and key accounts manager, commented, “The launch of the new Exuviance Professional Radiance Peel enables our customers to extend their treatment offering for new and existing Exuviance patients with an effective, clinically-proven Retinol peel with minimal downtime. The new Retinol Night Serum and Eye Cream also offer a results driven, home-use tretament exclusively available through clinics.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Events

ACE and the Aesthetics Awards postponed to May The Aesthetics Conference and Exhibition (ACE) has been postponed until May 28 and 29, with the prestigious Aesthetics Awards now taking place following the second day of the conference on May 29. To deliver an event where the entire medical aesthetics specialty can reunite in the safest and most successful possible way, and to celebrate their achievements after a tough year, Easyfairs, the company behind ACE and the Aesthetics Awards, decided to postpone both events. Alison Willis, divisional director of Easyfairs’ aesthetics portfolio, said, “Following the heartening news of the Prime Minister’s recent announcement regarding the reopening of the events sector, the progression of rapid testing and multiple effective vaccine trials, we are excited to welcome back our exhibitors, sponsors, delegates and partners. However, with capacity restrictions in place until April, to reunite as many medical professionals as possible safely and successfully, we have decided to postpone a further two months. Although Easyfairs remains confident that we could deliver a safe event to extremely high standards, we want to deliver ACE and the Aesthetics Awards to the best possible standard.” Currently, the capacity limits in place only allow 1,000 people within a venue space indoors at any one time, or 50% capacity, whichever is lower. With 2,000 delegates attending ACE each year, the organisers wanted to give as many delegates as possible the chance to come together to learn and network face-to-face. Willis added, “To continue to provide top education for our delegates, we have been working with manufacturers and suppliers to offer a series of exclusive virtual takeovers, which will launch in January 2021. The takeovers will include educational webinars, social media takeovers and editorial coverage allowing practitioners to dip in and out of content. Clinicians can learn from brands and hear from their KOLs, to get a real feel for a company’s ethos and continue their education in the lead up to conferences and events.” For further information about ACE, virtual takeovers, or to vote for winners or book tables for the Aesthetics Awards, visit aestheticsjournal.com. Industry

Cynosure announces Mr Benji Dhillon as KOL Laser manufacturer Cynosure has appointed cosmetic surgeon Mr Benji Dhillon as a new key opinion leader (KOL) for its Potenza radiofrequency microneedling device. The company explains that Mr Dhillon will be offering Potenza treatments at his Beaconsfield-based practice Define Clinic and using them alongside other treatments as part of his signature combined approach. Mr Dhillon commented, “Unlike a lot of other radiofrequency microneedling devices currently on the market, with Potenza you are able to adjust a number of settings to customise the treatments to different faces or different body parts. I believe the best area for treatment is the neck and jawline where it can make substantial improvements to loose skin in this area, however it can also improve acne scarring and spots, dull facial skin or skin around the eyes, or on the body such as above the knees and stomach. The beauty of radiofrequency is that it is suitable for all skin colours and tones – it’s a true innovation.”

Vital Statistics Almost half of 533 women surveyed were unaware of how aesthetic treatments work (Étre Vous, 2020)

23% of 1,500 patients said seeing their skin on video calls has negatively impacted their mental health (Medovie, 2020)

58% of 2,000 consumers said they are more likely to buy from a store that offers an online quiz-like experience to recommend the right products to fit their unique needs (Nosto, 2020)

54% of the 60-andover population group report they are still using prescription therapies that were the first-ever developed and approved products for rosacea (National Rosacea Society, 2020)

One in three of 1,250 doctors have suffered verbal or physical abuse from patients or their relatives during the COVID-19 pandemic (Medical Protection Society, 2020)

61% of 506 surveyed adults feel negatively about their body image most of the time (UK parliament’s Women and Equalities Committee)

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Events Diary

2MAY 8 & 28 9 & M2 A 9, Y 2 2 1 |/ LOND L O N DON ON 20 02 AESTHETICSCONFERENCE.COM

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Digital

AlumierMD establishes e-commerce platform Skincare brand AlumierMD has launched a new e-commerce platform. The company explains that following face to face, or virtual consultations, the new portal allows skincare professionals to exclusively register their patients to their own online shop. Patients can then access a dedicated prescription pad, where their treatment provider shares personalised product recommendations. The prescription pad is paired with a library of continually updated, digital resources. According to AlumierMD, practitioners can view all their patients’ product purchases, monitoring compliance, and offering guidance to patients if they require assistance. The products are then posted directly to the patient, without the skincare professional needing to hold stock or manage the postage and packing. Daniel Hopkins, managing director for AlumierMD Europe commented, “The AlumierMD e-commerce portal exists to both protect and enhance the relationship that exists between skincare professionals and their patients, meaning that every sale of an AlumierMD product is under the control of a professional and they are always financially rewarded for their work.” Radiofrequency

Media

BCAM appoints communications coordinator The British College of Aesthetic Medicine (BCAM) has appointed former BBC journalist Claire Britcher as its new communications coordinator. The association explains that Britcher will spearhead the charity’s 20th anniversary celebrations in 2021 and raise awareness of the key priorities such as regulation and education. BCAM president Dr Uliana Gout said, “I am absolutely thrilled to welcome Claire to BCAM! We have a plethora of exciting initiatives in view of our 20th anniversary celebrations in 2021 and we are all excited that Claire will be spearheading them with us. As a charity our key objective is to educate and support the general public, and with Claire’s breadth of consumer outreach experience we are delighted to further our voice as leaders in aesthetic medicine.” On her new role, Britcher commented, “I’m thrilled to be joining BCAM at such an exciting time in the College’s history, and I look forward to celebrating the 20th anniversary with some creative events in this new virtual environment following the success of the first online conference.”

InMode Evolve launches in the UK Medical device manufacturer InMode has released a new radiofrequency device called Evolve to the UK market after being released in the US early in 2020. According to the company, the non-invasive hands-free workstation is designed to remodel skin, treat adipose tissue, and tone muscles using radiofrequency (RF) and electrical muscle stimulation (EMS). The company explains that the device is founded on a three-dimensional approach to tissue remodelling, deploying three proprietary technologies – Tite, Trim, and Tone – allowing for customised treatment for a variety of body types. Neil Wolfenden, InMode UK managing director, said, “Evolve is the first and only non-surgical body contouring platform using RF and EMS for fat reduction, skin tightening and muscle toning: total tissue targeting. We are proud to be the industry leaders in innovation and this is yet another example of this, following hot off the footsteps of Morpheus8, and we are excited to launch it in the UK.” Training

MATA to offer business mentorship Aesthetic training provider Medical Aesthetic Training Academy (MATA) has announced the launch of its business mentorship scheme. The company explains that the business mentorship will cover the core elements of business, from creative marketing and branding strategies to careful financial management, and easily implemented business models. According to MATA, the package can benefit those who are brand new in the industry, as well as those who already operate an aesthetics business but want to expand their business and elevate their success. Ian Duncan, director of MATA, said, “We believe our new service will help delegates progress their journey into aesthetics. Our new offering will benefit delegates at all stages of this journey.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Antiageing

SkinCeuticals introduces new antioxidant Cosmeceutical company SkinCeuticals has added the Silymarin CF to its antioxidant range. SkinCeuticals explains that the product is formulated using vitamin C serum for daytime use. Enriched with 15% pure vitamin C (L-ascorbic acid), 0.5% ferulic acid, 0.5% salicylic acid and 0.5% silymarin. According to the company, the Silymarin CF is formulated specifically for oily and blemish-prone skin to help prevent free radical damage and target visible signs of ageing. Dermatologist Dr Emma Craythorne, commented, “Cutaneous photo-protection mechanisms triggered by silymarin are numerous and demonstrate their ability to reduce and suppress harmful effects of solar UV radiation, such as UVinduced oxidative stress, inflammation, immune responses and DNA damage. I can’t wait to see what there is in store for this chemical for acne throughout 2021.” To learn more about Silymarin CF, turn to p.38.

Enhancing Brand Clarity

Photographer Hannah McClune’s monthly tips on how to strengthen your business through branding Your brand is what distinguishes your clinic from others and shows your customers what to expect if they choose you. Here are the three steps simplified:

Step 1. Your brand strategy

This is the foundation. Decide who your target audience is and how you want to be seen by them. What are your clinic’s core values? What is your business direction and your goals? Once these are defined it will lead into step two.

Melanoma

Cosmo Pro launches training for recognising skin cancer Aesthetic distributor and manufacturer Cosmo Pro has launched the MASCED Pro online training programme developed by skin cancer charity Skcin. According to the company, the platform provides, professionals with an effective tool with which to develop their knowledge of the early signs and symptoms of melanoma and non-melanoma skin cancers. The course is included as part of the Cosmo Pro chemical peel training or can be taken as a stand-alone course. Cosmo Pro explains that all of the funds received from the training programme will be given to the charity. Liz Cowan, business and training director at Cosmo Pro, commented, “The lack of knowledge and awareness means that cancerous lesions are not detected by patients or practitioners, delaying treatment which can result in poor prognosis. We are honoured and delighted to support Skcin and their incredible work.” Acne

Abrocitinib shows efficiency for atopic dermatitis treatment According to results presented at the European Academy of Dermatology and Venereology virtual congress, patients with moderate to severe atopic dermatitis had a greater improvement with abrocitinib 100mg or 200mg than with placebo. A phase 2b and two phase 3 randomised, double-blind, placebo-controlled monotherapy trials, including 391 patients, evaluated the effect of oral abrocitinib using the Eczema Area and Severity Index in four body regions: head and neck, trunk, lower limbs and upper limbs. Trunk, lower limb and upper limb subscores responded with greater reductions at weeks four, eight and 12 compared with head and neck scores. The upper limbs saw the larger response at week 12. Dr Jonathan I. Silverberg, one of the study authors, commented, “In this post-hoc analysis, patients with moderate to severe atopic dermatitis treated with abrocitinib 200mg or 100mg had greater improvements – reduction – in the extent of disease and severity of atopic dermatitis signs in all body locations than patients treated with placebo.”

Step 2. Your brand identity

Next comes the visuals for your company. They need to align with your strategy. The colours, textures, logo, fonts, packaging, photographs all being consistently recognisable. It also plays a big part in brand voice, the type of language you choose from the wording on your website to the tone of your social media captions.

Step 3. Your brand marketing

Finally, how you market yourself. The channels you choose – whether that is the social media platforms, advertising, your website, newsletters, the type of blogs and magazines you feature in – every medium needs to fit in with your initial brand strategy. Then how you appear in each place needs consistency in look and feel. This column is written and supported by Hannah McClune, owner of brand photography company Visible by Hannah www.visiblebyhannah.com

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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BACN UPDATES A roundup of the latest news and events from the British Association of Cosmetic Nurses

In 2021, the BACN will be focusing on a different theme that interests members and encourages talks and discussions. The first month’s theme will be ‘Aesthetic Nursing in 2021’ and the BACN is offering a range of events to members.

‘IN CONVERSATION WITH’ The BACN will be hosting its first ‘new look’ events structure in January, with the first In Conversation With taking place on Tuesday January 12. BACN Chair Sharon Bennett will be speaking with BACN Events Manager Tara Glover via Instagram Live to discuss the new digital programme for 2021, the latest developments from the BACN, and taking part in a Q&A session about aesthetic nursing more generally.

NATIONAL DIGITAL WEBINAR BACN Board Member Anna Baker will be speaking to members concerning the revised BACN Code of Conduct and the BACN medical model, to which all members will be encouraged to utilise in their practice in 2021. BACN Treasurer Jonathan Bardolph will be discussing all things VAT, along with more general accounting advice, and BACN Honorary Member and Regional Leader for London and the South East Constance Campion will be championing all things medical aesthetics, and the speciality of aesthetic nursing within that, and how it will look for the year ahead and beyond. The webinar will be available to all members and is bookable through the BACN website.

PEER-TO-PEER REVIEW AND SOCIAL BACN Board Member and Regional Lead representative Lisa Niemier will be hosting the first National Peer-to-Peer Review and Social on Tuesday January 26. Lisa will be on hand to discuss any topics, concerns, or worries that members have starting 2021, and will be a chance for all members to network and meet one another, albeit digitally. Details on how to book can be found via the BACN Events page and members are encouraged to attend. This column is written and supported by the BACN

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Health

New supplement range launches Consultant plastic surgeon Mr Paul Banwell has launched a new range of supplements called ARTIS London. Banwell explains that the supplements are aimed at general wellbeing but also focus on optimising recovery following surgical or nonsurgical aesthetic procedures. Banwell explains that the Post Surgery Complex aims to promote collagen formation, enhance surgical recovery, optimise scar healing and skin health, as well as providing potent antioxidant support and boosting immune function. The principal components of this formulation include a potent blend of hyaluronic acid, marine collagen and vitamins C and E. The Nootropic Complex is designed to help mental wellbeing, with the formulation including l-theanine, guarana extract, caffeine, phosphatidylserine, black pepper extract, ginkgo biloba extract, L-tyrosine, green tea extracts, L-arginine, L-carnitine and grape seed extracts. Mr Banwell notes that other products in the ARTIS London range include the Breast Complex and the Photo-Immune Complex. These can be combined with Post Surgery Complex and Nootropic Complex following breast surgery or skin surgery, respectively, or used in isolation. ARTIS London also has plans to release Nourish Complex, Skin, Hair and Nail Complex, Probiotic Complex and Omega Plus Complex later in 2021. Mr Banwell commented, “We have been overwhelmed by all the positive support for ARTIS and have had amazing feedback from patients and colleagues alike. Already ARTIS is being stocked in a number of clinics and are being sold individually and part of treatment packages.” Safety

SkinPen receives CE Certification Microneedling device SkinPen Precision has been awarded a Class IIa CE Certification mark by the British Standards Institution (BSI). Holding a Class IIa CE Certification means that the device conforms to the requirements in the Medical Devices Directive, as well as the Medical Devices Regulations. Joe Proctor, president of Crown Aesthetics the owners of SkinPen manufacturer Bellus Medical, commented, “This new and expanded certification further validates SkinPen’s safety and usage claims in the EU. With SkinPen’s advanced microneedling technology, we continue to set a higher standard in patient care, and it firmly establishes the industry benchmark for safety. This essential certification allows us to continue offering best-in-class technology to our physician partners, and their patients, and solidifies the company’s growing presence in the global market.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Laser

Lynton offers new anatomy qualification 28 & 29 MAY 2021 / LONDON

NEW DATE S F O R AC E ACE will now take place on 28 & 29 May 2021, with a fantastic line up of education including two full days of free CPD sessions from our headline sponsor Teoxane. The decision to postpone a further two months means we can deliver the event safely and successfully, giving as many medical professionals as possible the chance to learn from leading KOLs in the unmissable educational programme. The Aesthetics Awards will now take place on 29 May 2021 following the second day of ACE, where the medical aesthetics industry can come together to celebrate their achievements at this glamourous event.

MA NAGI NG CO M P LIC ATIO N S Allergan has confirmed their KOLs who will speak on managing complications with Hyaluronic Acid Fillers in their masterclasses on 29 May. Aesthetic practitioner, Dr Sophie Shotter, will discuss how to recognise, minimise, and manage complications with HA filler, followed by consultant oculoplastic and aesthetic surgeon, Miss Rachna Murthy who will give an overview of the latest evidence on HA filler related complications and how to mitigate and manage complications of this nature.

Laser manufacturer Lynton will be offering a new Level 3 Qualification in Anatomy and Physiology in 2021. According to the company, this knowledge-based qualification will be taught over a three-day fully interactive virtual course via Zoom with Lynton’s training academy manager, Kirsty Turnbull. Turnbull commented, “Understanding how the body works is a crucial part of the job for any aesthetic practitioner, and this Ofqual-regulated Level 3 VTCT qualification will provide knowledge about the various anatomical structures and physiological functions within the body. This should help practitioners bring a higher quality of assessment and consultation for patients, as well as advice around the best treatments for their concerns.” Lynton also recently announced that Dr Mark Dickinson (PhD), deputy director of the Photon Science Institute and also the faculty assistant vice dean for research (impact) at the University of Manchester, will be the new lecturer for its Core of Knowledge course. Dr Dickinson commented, “This one-day theory course provides a fantastic opportunity for delegates to receive world-leading educational content and interact with lecturers from an institute of higher education. This course will allow you to obtain insurance for laser and IPL systems as it covers the fundamentals of laser safety, regulations and light-tissue interactions.” Injectables

New aesthetic mentorship scheme available

GET TIN G BU SIN E SS B AC K O N TRAC K The Business Track agenda at ACE will provide practical advice to help clinicians establish a successful practice and stand out from the crowd. With regulations and advertising standards constantly changing, along with new safety measures and rapidly developing technology, it is becoming increasingly challenging to manage a successful clinic or practice. As such, the Business Track, sponsored by Enhance Insurance, will cover advice on PR, marketing, software, social media and more helping clinics to get back on track for a successful 2021!

Register your interest on the ACE website to be first to know when registration opens. WWW.AESTHETICSCONFERENCE.COM HEADLINE SPONSOR

Aesthetic practitioner and founder of VIVA Skin Clinics, Dr Rupert Critchley, has launched a new training programme for aesthetic injectors. The Aesthetic Mentors will allow practitioners to access oneto-one guidance and in-depth feedback from Dr Critchley and aesthetic practitioner Dr Sarah Tonks. Dr Critchley explains that the programme will be subscription based and split into three tiers, allowing flexibility for mentees. Depending on which tier is chosen, training will involve one-to-one Zoom meetings, injecting technique feedback and hands-on in-clinic training. Dr Critchley commented, “With a lack of ongoing support and feedback available through regular aesthetic courses, we identified the need to provide injectors with the ability to access expertise and knowledge from some of the most renowned and experienced injectors in the industry. The virtual world has never proven more important than throughout 2020, so there couldn’t be a better time to change the face of aesthetic mentorship and lend support to those looking to take their skillset to the next level. Our primarily virtual platform allows injectors to access training and guidance from leading aesthetic doctors from anywhere, at a time that suits them.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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New aesthetic training programme launches Consultant plastic surgeon Mr Paul Banwell and aesthetic nurse prescriber Nina Prisk have partnered to launch a new aesthetic training school. The Accelerated Aesthetic Training Programme will feature personalised anatomy teaching, injecting skills, mentorship and business acumen, according to Mr Banwell. He explains that the course will be based in Harley Street but will have courses also running in the South East and South West of England. Mr Banwell and Prisk commented, “We believe that arming our delegates with expert technical skills and a wealth of product information is not the only recipe for success in aesthetic medicine – the Banwell.Prisk philosophy goes far beyond training days and aims to support our graduates long-term. Providing support, mentorship, business skills and a deep understanding of the patient experience are also essential educational pillars for us.” Product range

ProFacial UK to supply Seoulin Medicare Product distributor ProFacial UK has become the official supplier for Seoulin Medicare products in the UK and Ireland. This product range includes Profacial, Plasma BT. Plason, and Intima RF. Nik Kane, product specialist at ProFacial UK said, “I am thrilled to announce that I am now the sole distributor for these devices, especially as I sourced and introduced them to the UK aesthetics industry back in 2016. They offer clinics cost effective solutions to today’s modern clinic demands with low consumables costs and high customer and patient satisfaction.”

AlumierMD launches new hydration kit Skincare brand AlumierMD has launched the @Home Hydration Kit to help patients continue their skincare routines outside the clinic. According to AlumierMD, the kit is suitable for all skin types, tones and conditions and contains the Aqua Infusion Mask, the Bright & Clear Solution, the Single Unit – Eye Rescue Pads, the AlumierMD Pro Peel Brush, and the AlumierMD vegan leather skincare bag. Lizzy Hossain, strategic marketing director for AlumierMD Europe, said, “This kit is the perfect way for AlumierMD professionals to offer their patients in-clinic hydration results at home. By providing patients with the perfect kit to prep for future in-clinic treatments, we hope to build and maintain crucial relationships between aesthetic professionals and their patients.” Blepharoplasty

New postoperative recovery eye band launches Manufacturer Qualiteam has released a postoperative eye band with cold packs included for use after blepharoplasty and rhinoplasty. The company explains that the band has been designed to provide light compression and cold treatment after procedures or injuries in the eye region that requires cold therapy and to aid patient recovery. Doris Hjorth, president of Qualiteam, commented, “The Calla Postoperative Eye Band will promote ‘beautiful right from the start’ which any clinic can benefit from. When the goal is to improve a person’s appearance, they will feel better if they receive an effective and pretty compression product immediately after surgery instead of a less appealing product.” Qualiteam products are distributed by Pharmed UK. Education

Interface Aesthetics hires new trainers Aesthetic training provider Interface Aesthetics has appointed two new trainers, Dr Davina Wilson and Dr Michael Daroglou. Dr Daroglou has a background in advanced aesthetic dentistry and now works full-time in facial aesthetics (ClinicM, based in Bloomsbury). He will be a Level 7 clinical mentor in addition to training delegates on the Foundation, Advanced and Masterclass courses. Dr Wilson has a background in General Practice, and established her clinic Look Lovely in St John’s Wood over eight years ago. She will be working on all training courses currently run at Interface. Dr James Olding, director of Interface Aesthetics, commented, “They both believe firmly in better regulating training and practice with the aim of making cosmetic treatments as safe as they can be for patients. Expanding the team has made the training journey even richer for our delegates, with the faculty able to draw on expertise from across medicine, surgery and dentistry to give healthcare professionals looking to start out or progress in the field the best possible experience.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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LED

Déesse Pro Express mask launches UK aesthetic product distributor Harpar Grace International has launched the Déesse Pro Express LED mask. The company explains that using 633nm red and 830nm near infrared light wavelengths, the silicone mask increases the production of collagen and elastin, helps spot-prone skin, supports discolouration, and can improve inflammation. Alana Marie Chalmers, director of Harpar Grace International, said, “The Déesse Pro Express LED light therapy mask is designed to offer the maximum flexibility and professional results in the comfort of home or on the go and is beautifully designed with a pull-out box and branded drawstring reusable bag. It also includes multicountry plug attachments and an information care and usage card, making it the perfect at-home use protocol to offer patients.” Digital

Video consultation software introduced by Phorest Business management software company Phorest is launching a video consultation feature to help clinics conduct full appointments, pre-appointments and retail consultations in an online setting. According to the company, this software will allow you to book face-to-face appointments online, sell retail by professional consultation, see patients on any device with mobile-friendly technology, and prep for appointments while staying socially distant. Phorest explains that with everything integrated into the Phorest system, patients can book their video consultation online and will receive a reminder with a unique link to their service provider by an automated SMS. Celia Rose, UK and Ireland country manager, commented, “With Zoom reporting 300 million daily meeting participants, and Google Meet more than 100 million, our clients are used to being online with video conferencing software as part of daily lives. Combine this with the restrictions in travel, a natural progression for our industry is to offer video consultations. Providing greater working flexibility and productivity for practitioners and an easy time efficient welcome option, it’s a win-win for all!” Skin

Dermatology TV show to air The British Skin Foundation (BSF) and ITN Productions Industry News will be coproducing a new TV programme looking at skin stigma, skin disease and mental health, misinformation and developments in dermatology. The foundation explains that ‘More Than Skin Deep’ will give honest accounts from experts in skin disease, as well as the people living with skin conditions, and look at the connection between skin and mental health issues. Matthew Patey, CEO of the British Skin Foundation, said, “At the British Skin Foundation our mission is to help find cures and treatments for common conditions like acne and eczema, through to potential killers like melanoma skin cancer. We’re looking forward to working with the talented ITN Productions team to help amplify our voice and tell the stories of those who are affected by skin disease and those who are fighting to beat it.” The programme will launch at the British Association of Dermatologists’ Annual Conference taking place from July 6-8 2021 at the ICC, Birmingham.

News in Brief IBSA Derma hosts Virtual Congress Pharmaceutical company IBSA Derma held its 2nd Virtual Congress with a spotlight on Profhilo on November 28. The congress was held on a digital platform, where attendees were able to create an ‘avatar’ to visit virtual booths. There was also a live symposium, which included talks from Professor Chiara Schiraldi, Mr Dalvi Humzah, and Dr Antonello Tateo. Iveta Vinklerova, director of UK and Ireland distributor HA-Derma, said, “It was a pleasure to attend the second edition of the IBSA Derma Virtual Congress with our practitioners. The congress illustrated how Profhilo has acquired brand recognition and growing demand from patients internationally.” Galderma appoints new PRs Global pharmaceutical company Galderma has appointed Kendrick PR and Mantlepiece PR as its new UK representatives. The PR programme will be focusing on the Galderma injectables portfolio, including Sculptra, Restylane and Azzalure. Julia Kendrick, founder of Kendrick PR, commented, “We are delighted to be bringing together the best of Kendrick and Mantelpiece. This will be a comprehensive PR programme for a marketleading company and given our respective years of expertise and strong networks, head of Mantlepiece PR Kate Zadah and I felt it was the ideal opportunity to work collaboratively to deliver some exciting and thought-provoking campaigns. Watch this space!” VIVACY Learn reaches 10,000 subscribers Aesthetic product manufacturer VIVACY has reached 10,000 subscribers on its online learning platform for healthcare professionals. VIVACY Learn showcases 120 videos available in French, English, Russian, Polish, Arabic and Spanish. Camille Nadal, country director and creator of the project, said, “We created this platform to help practitioners improve their injection technique skills, because we believed that digital learning and ongoing professional development had to be made available for busy practitioners at any point, any time.” Dr Lara Watson opens new clinic Aesthetic practitioner and co-founder of Acquisition Aesthetics, Dr Lara Watson, has opened a new medical aesthetics clinic in London called SW1 Aesthetics. Dr Watson explains that SW1 Aesthetics is the sister company of the SW1 Dental Studio. She commented, “We are so thrilled to have launched SW1 Aesthetics and opened the door to a fantastic range of aesthetic services to new and existing patients of the SW1 group. Our focus is delivering personalised and holistic care.”

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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my treatment room the other day and come running straight back, because he couldn’t believe he’d seen another man in the waiting room. He thought he was the only one! You can imagine his surprise when I told him I treat about one man a day. If men understood that other men do have these treatments, they wouldn’t feel as embarrassed, so I think showcasing male results is really important.”

Breaking the Stigma for Male Treatments Practitioners explore the reasons why men are afraid to attend aesthetic clinics, and how the industry can combat the stigma The interest in male aesthetic treatments is on the rise, with almost two million men in Britain now considering getting a cosmetic treatment.1 While this seems positive, recent statistics produced by digital consultation platform Étre Vous have indicated that almost half of the 600 men surveyed feel uncomfortable visiting an aesthetic clinic for advice, and over 60% of men prefer to speak to doctors online about aesthetic treatments to avoid having to go into a clinic.2 These results suggest that it’s not the treatments themselves which men are afraid of, but rather the clinic environment. Aesthetic practitioners Dr Tahera Bhojani-Lynch and Dr Armand Abraham believe that clinics need to adapt their marketing and treatment styles to make aesthetics more inclusive of all genders.

Why is there a stigma? Dr Abraham believes that the problem lies in society viewing aesthetic treatments as stereotypically feminine, stating, “It’s a deeper problem than we think – it’s to do with masculinity in society as a whole. When something is presented to us as being for females, men don’t want to go near it or investigate. With aesthetics being viewed as a predominantly female thing, men don’t want to seem less masculine by dipping their toes into the pool. So, it’s something they either avoid or don’t want other people to know they’re having done.” He continues, “I have had male patients ask me not to mention to anyone that they’ve been in for a procedure. Of course I would never do this anyway due to patient confidentiality, but it just shows they have a real fear of anyone finding out. I find that this is more for lip or cheek injections, as they’re typically viewed as being more female. Getting botulinum toxin injections seems to be more accepted.” Dr Bhojani-Lynch notes that one of the main problems is that men don’t realise other men are having treatments, because it isn’t often spoken about. She says, “I had one man leave

However, while Dr Bhojani-Lynch acknowledges that there is a stigma against men, she believes this can be linked to misconceptions about the industry as a whole. “It’s important to remember that 10 years ago even women getting aesthetic treatments done was a hush-hush thing.” She says, “Nobody wanted people to know. Now, pretty much every woman has had, or thought about having, some form of treatment. There’s been progress in making aesthetics more normalised, but so far this is more for women than men. I think that in another ten years, this too could change.”

Adapting your marketing Dr Bhojani-Lynch suggests that one key way of encouraging men to go to aesthetic clinics is to post more before and after images of your male treatments. She comments, “I think including more male images in your marketing and social media strategies will be hugely beneficial, and it’s something I need to start incorporating myself. I market mainly to women because they mainly show interest,

“We all have a responsibility to show the full range of what aesthetics can do, and make it clear it isn’t a womanonly thing” Dr Armand Abraham

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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but if we don’t make it inclusive to men then they’ll never be interested. I think that if you did a photo ratio on Instagram of 50% men and 50% women, men would be more encouraged to investigate and less inclined to consider your clinic as a female-orientated environment.” While Dr Armand agrees that there needs to be more male-oriented content for potential patients, he also encourages fellow practitioners to write more educational articles on the topic. He comments, “Whether it’s consumer media or business media, if all the content is about women it’s hard for men to think about where they can fit in. Case studies, journal articles, research, studies – the more information that is out there for practitioners will help us feel more comfortable treating the male face. We all have a responsibility to show the full range of what aesthetics can do, and make it clear it isn’t a woman-only thing.”

“Showcasing your own work and promoting your successful results on men is so important” Dr Tahera Bhojani-Lynch

Changing your treatment approach Dr Armand believes that it is down to the industry to make aesthetics a more male-oriented specialty. He says, “If you look at training courses, there are little to no programmes specifically designed for the male face. We practitioners have become so comfortable and confident with treating female faces, and many don’t know how to adapt their treatment approach for men. This can result in the men who do get aesthetic procedures coming out looking feminine or unnatural. Training providers need to consider the importance of running courses that teach practitioners about the male face, so that we can treat men effectively and subtly.” Dr Bhojani-Lynch agrees, stating, “I know men that get put off by bad examples in the media – a lot of the male celebrities who are known to have had plastic surgery or fillers end up looking very feminine. I think this is because a lot of injectors aren’t aware of how to adapt their techniques for different faces. You can’t treat a male jawline or lips the way you would a woman, and vice versa! So it’s important for practitioners to really hone their skills and learn how to judge each individual patient’s face. Of course, there are men in the public eye who have had work done that is subtle and attractive, but people don’t talk about that because nobody notices. Again, this is why showcasing your own work and promoting your successful results on men is so important.”

If you’ve had any amazing male case study results, share them with us! You can tag our Instagram @aestheticsjournaluk or email us at editorial@aestheticsjournal.com

Dr Linea Strachan, aesthetic practitioner & trainer How did you go from a dentist to launching your own aesthetic academy? I have always been passionate about aesthetics and I wanted to achieve more for my patients. I attended my first toxin and filler course in 2007 and knew instantly that I wanted to further my aesthetics career. I treated aesthetic patients alongside dentistry and also attended every course and conference I could, with the aim to gradually transition into aesthetics full time. I eventually established my own aesthetic business which rapidly grew, and I also gained experience in teaching. I worked with Teoxane for two years teaching cannula techniques to intermediate and advanced practitioners and I now work with Vivacy as a brand ambassador and teach for them. I am excited to be launching my own training academy in 2021! What advice would you give to those new to aesthetics? Follow your passion. If you don’t do it for passion, don’t do it at all! Success will come if you do what you love and love what you do. Remember that practice makes perfect – the more you do, the better you get – and a gradual transition is important. Good knowledge and understanding of human anatomy and physiology would also be beneficial to drive you forward within aesthetic medicine and remember that the learning process never stops. How will the medical aesthetics industry develop in the next 10 years? I think that aesthetic medicine will progress further into treating the face as a whole, rather than just focusing on one feature. I hope there will be a more holistic approach to aesthetics, treating each individual to be themselves (the best version of) rather than using a paint by numbers technique that gives everyone the same look. I really hope patients will seek more natural results, rather than fake, over-enhanced features or trying to look like celebrities. Hopefully, patients will be more educated on this new holistic and individualised approach and realise that being unique and being yourself is something more worth celebrating. This column is written and supported by

REFERENCES 1. Uvence, 2020, data on file. 2. Etre Vous, 2020, date on file.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

Advertorial BTL Aesthetics

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The EMSCULPT Revolution in Aesthetic Body Shaping Dr Rita Rakus and Dr Tracy Mountford share their experiences using EMSCULPT and why they are confident to offer it to their patients What is EMSCULPT? Since its launch in 2018, EMSCULPT, from leading aesthetic device manufacturer BTL, has led the field in delivering both muscle increase and fat reduction in a single procedure. Projecting high-intensity focused electromagnetic (HIFEM®) waves deep into the tissue to reach whole muscle groups together, for example on abdomen, buttocks, arms and legs, treatments are fast and cost effective. The non-invasive HIFEM technology in EMSCULPT induces approximately 20,000 forced muscle contractions per 30-minute session. These ‘supramaximal’ contractions are not normally achievable through voluntary muscle action and result in muscle hypertrophy (growth) and hyperplasia (multiplication of myofibers). The intensity and duration of these supramaximal muscle contractions triggers cascaded lipolysis and fat cell apoptosis.1 Dr Rita Rakus says, “Prior to EMSCULPT, we only had machines targeting fat or skin. When we introduced EMSCULPT, we observed improved results immediately by treating muscle and fat together, and we were able to treat a wider BMI range. We could also treat our slimmer and more athletic patients with a small to moderate amount of fat who also wanted to get fitter. It also brought more men to the clinic, and the studies showing visceral fat improvement make it great for our male clients. The great thing also is that this is an intense, but comfortable treatment with no side effects.” Dr Tracy Mountford adds, “Our clinic has been a dedicated user of CoolSculpting for the last seven years, achieving excellent results, so it may be questioned why we have invested in EMSCULPT?” There is no doubt EMSCULPT is the leading system in the ‘muscle + fat’ treatment space. It is very well backed by clinical research and published studies (20 to date), which for me is key in giving me confidence to offer this to my patients. EMSCULPT has shown consistently impressive results and is used by leading physicians worldwide. It also has high level of brand recognition amongst the public, which is the sign of a leading technology that I am happy to put my name behind, in striving for optimal patient outcomes.”

Launching the new EMSCULPT Neo Autumn 2020 saw BTL launch the latest EMSCULPT system – the EMSCULPT Neo, with the addition of radiofrequency (RF) delivered simultaneously with the HIFEM® technology to produce even more impressive results for both muscle growth and fat layer reduction. This unique combination of RF + HIFEM is an engineering breakthrough and opens up treatment to higher BMI patients than previously possible.2 The first two systems delivered in the UK were to the Dr Rita Rakus Clinic and Dr Mountford’s Cosmetic Skin Care London clinic. Dr Rakus says, “I have been working with BTL for 13 years and I find they always have more studies than anyone else. One of their original areas of expertise over many years is RF and they have combined

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this expertise with their industry leading HIFEM technology to create EMSCULPT Neo. Having EMSCULPT Neo gives us even more impressive results for fat reduction and muscle growth and we also expect to see significant skin tightening as well.” Dr Mountford says, “We were really excited to launch EMSCULPT Neo in our London clinic. We had been very impressed with EMSCULPT in the efficacy and consistency of results and we love that such a wide range of body areas, patient body shapes on both male and female patients can be treated with no downtime. Body contouring is about three predominant tissue layers – muscle, fat and skin. Some patients need to address just one of these issues, but most need to address two or three. With EMSCULPT Neo technology, we can address all three of these layers with one device in the same 30-minute treatment. EMSCULPT Neo is now the industry benchmark for reduction in fat layer, muscle growth and strengthening, with more impressive figures than even stand-alone noninvasive technologies.” In EMSCULPT Neo, the RF heating of the muscles allows for a more intense workout whilst the fat is targeted from two directions – from the RF heating and also from the supramaximal muscle activity. This synergistic effect results in more fat reduction and more muscle growth than any single procedure. Upon launch, seven clinical studies had already been completed supporting an average of 30% fat reduction and 25% increase in muscle mass from a course of four weekly treatments.2,3 In addition, an average reduction in abdominal separation (diastasis recti) of 18.8% and an average 5.9cm circumferential reduction was shown.2 This advertorial was written and supplied by

For more information on EMSCULPT, EMSCULPT Neo and other BTL body shaping, skin tightening and female health treatments, visit www.btlaesthetics.com/en or email info@btlaesthetics.com

REFERENCES 1. Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: Safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping: MRI evaluation of electromagnetic therapy. Lasers Surg Med. 2019 Jan;51(1):40-46. 2. Jacob, C, Kent, D. Efficacy and safety of simultaneous application of HIFEM and synchronized radiofrequency for abdominal fat reduction and muscle toning: a multi-center MRI evaluation study. Presented at the Annual Meeting of the American Soc for Derm Surg., 2020 Virtual Meeting 3. Denkova, R. Ultrasound evaluation of the simultaneous RF and HIFEM treatments on human fat tissue. Source: U.S. FDA. 510(k) Premarket Notification: K192224. Published online Dec 5, 2019.

Aesthetics | January 2021

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Associations in 2021 Aesthetics catches up with the two of the largest associations for medical professionals in the UK 20 Years of BCAM 2021 promises to be an exciting time for the British College of Aesthetic Medicine (BCAM), the UK’s foremost membership association for aesthetic doctors and dentists, as it embarks on 12 months of celebrations marking its 20th anniversary. Aesthetic medicine has faced a multitude of challenges during the COVID-19 pandemic and BCAM has been at the forefront, offering advice to its members to help them make informed decisions about their practices and patients. Sadly, physical events are currently on pause but BCAM is planning conferences, an array of virtual member briefings and various anniversary celebrations throughout 2021 to mark its 20year history. BCAM has charity status and is committed to advancing the effective, safe and ethical practice of aesthetic medicine. The College started life as the British Association of Cosmetic Doctors in 2001, when pioneers Dr Rita Rakus, Dr Patrick Bowler and Dr Mike Comins got together to share their experiences and unite colleagues who were starting to practice aesthetics. The inaugural meeting was held at the Law Society on 2 October 2001 with 27 attendees and since then the College has grown both in size and stature, now regularly providing information and data to the Department for Health and Social Care and Health Improvement Scotland, plus officially commenting on behalf of the medical aesthetics profession. BCAM’s anniversary celebrations will kick off on January 1 2021 with the launch of the College’s first new logo for 20 years, which has been devised by an internal creative team to reflect the medical, educational and aesthetic elements of the College’s work. This will be followed by the launch of a new website in April which will completely modernise and streamline the College’s processes, enabling members to access their accounts and manage the public information they share. The application process for new members will also be brought online, making it easier and more straightforward, and the site will be mobile friendly and responsive. Dr Uliana Gout, who celebrates her first year as BCAM President as the celebrations get underway in January, said, “This is possibly the most exciting time in the College’s 20-year history, as we put plans in place to modernise everything from our logo and website to the membership process. BCAM has really proved its worth to members in 2020 with a constant stream of advice and information that has allowed them to have confidence in the decisions they have made about their clinics and patients.” She continued, “We have liaised closely with the DHSC, receiving detailed information specific to our sector, and engaged a QC on three occasions to ensure the advice we were sharing was based in fact not opinion. This has been crucially important in such uncertain times, and our members have been grateful to BCAM for taking the initiative. We look forward to celebrating with them in 2021!”

New BACN Campaigns In 2020, the BACN held all its regional meetings online which allowed members to network with other nurses in their area, listen to talks and demonstrations from strategic partners, and keep up to date with the latest information and guidance. For 2021, the BACN is establishing a more dedicated national event structure which run on a new monthly format. In Focus months will focus on a number of different topics/themes that appeal to BACN members, and the BACN will be working with a range of strategic partners to deliver these campaigns via all BACN digital channels. Each month there will be at least three BACN events that members have access to as part of their membership: • A national digital webinar focusing on the monthly In Focus theme, with talks and demonstrations from strategic partners, BACN members, and KOLs within aesthetics. These webinars will each have an educational focus and be tailored to fit the diverse membership of very experienced aesthetic practitioners and those who are newer. All events will also be archived in the BACN member’s area for post event access to content. • A live ‘In Conversation With’ interview between BACN Event Manager Tara Glover and a KOL whose expertise collates with the campaign month topic. • A national peer-to-peer review and member social led each month by a BACN Regional Leader and comprising different discussions, issues, and concerns, along with a friendly social to encourage networking and to be a welcoming platform for new members to introduce themselves. Members will still have access to more local meetings that will be arranged by their regional leader and will be online for the present, with physical meetings taking place once it is safe to do so. Aside from the new event structure, work has also been carried out on reviewing the BACN Code of Conduct and outlining the BACN’s position on the medical model. The major BACN programme in 2021 will be the launch of the BACN Competency and Career Framework for Aesthetic Nurses. This is a ground-breaking initiative leading to accreditation of BACN nurses, new linked qualifications and training programmes, assessment centres and a lot more. Although delayed due to COVID-19, the BACN Education and Training Committee has reconvened and will be looking to complete a first draft of this framework for peer review in the first quarter of 2021. Once the peer review has been completed the BACN will consult its members prior to establishing the framework. During this time, the BACN will also be consulting and looking to gain support for the framework from key partners including the NMC and the RCN, identifying and sourcing the expertise to carry out the assessment procedures that will form part of the project moving forward, and reviewing the impact of any proposals on BACN membership categories. The BACN will also be heading towards a milestone in membership numbers during 2021, and plans are underway to recognise this exciting achievement!

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

Advertorial Meet the Trainer

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Why did you decide to work with RELIFE?

Meet the Trainers: Dr Martyn King and Sharon King Dr Martyn King and nurse prescriber Sharon King tell Aesthetics what you can learn from a masterclass with RELIFE How did you become an aesthetics trainer? Dr Martyn King: I first gained a medical degree at Leicester University and then trained to be a GP. After doing some courses in aesthetic medicine, I opened the Cosmedic Skin Clinic – that was almost 20 years ago now. What I’m most passionate about in my career is raising industry standards, and one of the main reasons I wanted to become a trainer was to to help further the aesthetic speciality. As we all know, anyone can attend a one-day course with someone who isn’t correctly qualified and then be told they can go off and inject, and this causes a lot of problems. We want to provide practitioners with the highest training standards and support to ensure they are conducting their procedures in the safest possible way, which is key in preventing poor patient outcomes. Sharon King: I completed my adult nursing qualification at Wolverhampton University in 1999. After taking some filler and toxin courses I started my career in aesthetics, and I’ve since worked as a trainer and clinical lead for companies including BioForm Medical, Merz Aesthetics, Aqtis and Sinclair Pharma. Like Martyn said, training companies and individual trainers should have a duty of care for patient health and safety.

Aesthetics | January 2021

Sharon King: We wanted to help introduce RELIFE to the UK market. I knew that the Menarini Group – the company behind RELIFE – is very well established globally. I also know a lot of people who work for the company so I know that as a pharmaceutical company they enlist the highest standards. In terms of the products, the new RELIFE Definisse Range comes in three forms: peels, fillers and threads. These can be used alone or together, so that the right combination can be found for each individual. In 2021 I’ll be training delegates in the RELIFE Filler range, which I personally love because it’s a really nice premium glass syringe to work with, in addition to the plunger, making a smooth transition emitting the hyaluronic acid. It comes in three different consistencies to meet the needs of what procedure your patients need. The fillers use a unique Excellent Three-Dimensional Reticulation (XTR) Technology to deliver the perfect mix of viscosity and elasticity, providing predictable, balanced results with minimal migration. Dr Martyn King: From a practitioner’s point of view, I became interested in RELIFE because of the thread structure. To me, they are the best thread range I have experienced to date for certain procedures. The thread range uses a unique combination of poly-L-lactic acid (PLLA) and caprolactone p(LA-CL) and has bidirectional and convergent barbs. The threads also use a unique ‘J-Stitch’ method which provides immediate, slippagefree results that alleviates sagging and tightens the overall appearance of the skin, resulting in a natural-looking, more youthful appearance for patients. From a training perspective, the main thing that I like about the company is how RELIFE offers a huge amount of support to practitioners during and after training – which is so important. We also both love how passionate the group is.

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What can people expect from one of your masterclasses? Sharon King: RELIFE offers exclusive monthly opportunities to learn specialist techniques from a renowned faculty of trainers, which will help practitioners get the best results from the Definisse range. Prior to the masterclass, RELIFE will send delegates information on the products for them to study. I would highly recommend delegates read up on the products beforehand, have a look at data and all the science behind it to really make the most of the training. On the day, courses will run from 10am-5pm. I’ve never been a fan of training large groups because I think it’s very important for each delegate to get enough attention and help. For that reason, our training will be conducted in very small groups of four to six, with six being the absolute maximum. This does mean that there will only be limited spaces available for each masterclass. Dr Martyn King: Throughout the day there will be a 50:50 split between theory and practical

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we will be providing them with support while they’re in clinic. They can send us photos of the treatments and results that they’ve achieved, and ask for our advice or opinions.

What outcomes can practitioners expect? Sharon King: Alongside Martyn and I, RELIFE has some very experienced and wellrespected trainers, including internationally acclaimed Dr Vincent Wong and Dr Simon Zokaie. Collectively we offer delegates a wealth of knowledge, which will enable them to provide a high standard to their patients and become confident in themselves. From a business level, practitioners will be able to give their patients incredible results and better their reputation.

Who can attend training? Dr Martyn King: People who attend the masterclasses should already have some degree of experience in the aesthetics field.

Meet the RELIFE Range RELIFE’s Definisse™ range is made up of three different product categories and leverages three therapeutic areas, the 3Rs: Reshape (facial curves and lines), Restore (volume); and Resurface (skin texture): 1. RELIFE Definisse Peels: to resurface 2. RELIFE Definisse Filler: to restore 3. RELIFE Definisse Threads: to reshape

training so clinicians can practise their patient assessment and treatments. I think it’s very important for all attendees to receive enough hands-on experience on the course, so that they can be confident enough to do it alone. Important lessons practitioners will learn is correct patient and product selection. Multitreatment solutions are the way forward and it is reassuring to know that all three products come from a single company and will interact without any issues or complications. So, while injecting filler is something that delegates are normally quick to master, understanding which filler, peel and thread to use is more complex. So along with techniques, the understanding of the brand and what each product can do is very important. At the end of each session, we will give time for attendees to ask us any questions to ensure they are comfortable with everything they have learnt. For the month following the course

Training for Definisse threads and peels is for doctors and dentists only, and the clinic needs to be CQC registered. Definisse Fillers must be carried out by qualified doctors, nurses or dentists.

What post-training support does RELIFE offer practitioners? Once practitioners have been trained, they get exclusive access to events and training slides on an online platform dedicated to clinicians, which provides a continuous training and educational program with highquality content built around the well-being of patients. RELIFE also offers in-house training, to ensure that clinic staff are up to speed on products and uses of the Definisse range from RELIFE, so that they can talk confidently and knowledgeably about the whole product range to patients.

Aesthetics | January 2021

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Adding Nutritional Services to Your Clinic Practitioners explain the types of nutritional services they offer patients to help provide a well-rounded treatment approach and expand their product offering Aesthetics is changing. While it was once common for a clinic to focus purely on the outside appearance of their patients’ concerns such as lines and wrinkles, many are now also looking at overall

wellness and how the skin and body might be helped from within. Here, practitioners detail what nutritional-based services they offer in their clinics and share tips for successful integration into business.

Miss Mayoni Gooneratne chooses skin and wellbeing supplements Skin is the largest organ in our bodies, so of course it’s going to be directly influenced by nutrition. I believe that as medical professionals, it’s important we are holistic practitioners and treat our patients as a whole. I like to consider patients as an entire person, rather than just the frown line they are concerned Miss Mayoni Gooneratne, surgeon and aesthetic about. practitioner, The Clinic by Offering nutritional services is just one Dr Mayoni part of what I do in my clinic to offer a holistic service. When I have a consultation with a patient, I will talk to them about many things surrounding their health and lifestyle as well as any cosmetic concerns they have. Along with other treatments, I will discuss nutritional supplements and integrate them as samples into my treatment plans and packages. I have found that this has been a successful way to get patients accustomed to using supplements and once they start to see a general benefit in their skin, they continue to purchase them; especially my patients with acne. In my clinic I recommend Advanced Nutrition Programme supplements and I choose these because they are evidencebased, which I believe is important for any treatment or product you integrate into your practice. I have many patients who are in the peri or menopausal stage, so I will often advise them on supplements that can help their symptoms. I particularly like to recommend Nutri Advanced supplements with vitamin C, vitamin

D, melatonin and magnesium – what I suggest really depends on the particular symptoms of the individual. For vascular hot flushes we would advocate zinc, phytoestrogens, black cohosh and ginseng, for example, or for sleep it would be magnesium.

“We also carry out genetic testing for patients” To assist us in our supplement recommendations, we also carry out genetic testing for patients. This is a service that involves taking a swab, which will be sent to the lab to create a whole in-depth genetic breakdown for patients, such as what food groups they are most suited to, and it can help us advise on the supplements that are more likely to be needed to help with their skin and general wellness, which is really important. If practitioners are thinking about introducing this service to their clinic, it’s important to know that some genetic companies will store and sell on patient data to third parties so be mindful of this before choosing. Although I believe that medical professionals can successfully incorporate skin and wellbeing supplements into their clinics, the next step is to work alongside a nutritionist. Having a functional nutritionist on the team has been invaluable for my clinic because it links really well with the bio-identical hormone therapy work we do and is also especially helpful in supporting resistant-acne patients.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Mrs Sabrina Shah-Desai recommends nutraceuticals I really do believe in the inside-out approach to optimising skin. Aesthetic practice isn’t complete without skincare and, for my clinic, nutraceuticals form a part of skincare. When nutraceuticals came to market a few years ago, I along with many colleagues were quite hesitant about Mrs Sabrina Shah-Desai, consultant aesthetic them as early studies were not very oculoplastic surgeon, robust. But now I believe more and Perfect Eyes Ltd more good evidence is emerging that supports hydrolysed collagen, along with other vitamins, for neocollagenesis and to promote wound healing. It’s important to know that collagen drinks need other components such as vitamin C and zinc at high doses to be effective for improving lines, wrinkles, hydration and skin quality. I began incorporating nutraceuticals into my practice after personal experience. I started going through the menopause and found that after six months of drinking Skinade I saw a

significant improvement in my skin hydration, fine lines and wrinkles around my eyes, while my hair and nails also improved. So, I started sharing this experience with my patients. I stock both Skinade and Totally Derma in my practice. Initially I would speak to patients about them or have fliers in the clinic, however just over a year ago we started giving patients a Skinade or Totally Derma drink if they wanted it, instead of other drinks we had in the fridge. This has really helped increase sales because patients get to taste it and they engage with the product much more. They want to know why the clinic offers it and how it might help their skin journey. I choose to have two different brands because it gives patients more choice. Some people won’t like the distinct taste of a particular nutraceutical or perhaps the sugar content or the type of packaging that it comes in will put them off. For example, Totally Derma has a totally different flavour to Skinade, it comes in a powder to be mixed in water or sprinkled onto food, whereas Skinade comes in a bottle or a liquid sachet. It’s important that practitioners understand how they can use nutraceuticals to help their patients before they bring them into their practice. Patients need to be educated in how results are achieved and understand that they are an extension to skincare, not a replacement; they can optimise the results that will be achieved through aesthetic treatments such as microneedling or lasers. I think the key target patients for nutraceuticals are peri or menopausal women, as they are more likely than millennials to see results to their dehydrated skin, lines and wrinkles. I definitely believe more studies are needed in this area; we need to look at how long the products need to be taken in different age groups to see beneficial effects, as well as the longevity of the results once you stop taking it, and potential adverse effects. I think nutraceuticals are good to help support the in-clinic treatments that we do as well as to enhance surgical results; they’re all about optimisation. In my opinion nutraceuticals do give the skin an inside-out approach – I think it’s like putting good oil in the engine for great performance!

“It’s important that practitioners understand how they can use nutraceuticals to help their patients before they bring them into their practice”

Dr Arun Ghosh utilises IVNT and vitamin injections

Dr Arun Ghosh, GP and aesthetic practitioner, Ghosh Medical Group & The IV Clinic

I have been offering intramuscular (IM) vitamin injections in my practice for at least 10 years and intravenous nutrient therapy (IVNT) for more than five. It’s always been part of our medical approach to look at people’s vitamins and mineral levels, but this nutritional therapy has really evolved into its own area of our practice. IM injections, or vitamin shots, such as vitamin B12 or vitamin D, are high-concentration vitamins and offer a slow release into the blood. IVNT usually involves several different types of vitamins, minerals or amino acids at larger doses which are infused directly into the blood, so is a faster way to deliver the nutrients at a better absorption rate.

We should be eating a balanced diet and getting all the vitamins and minerals we need from it, but the reality is that many of us are nutritionally poor. While I do always advise my patients to follow a healthy diet, I have found IVNT is helpful for our aesthetic patients. This is because these people are really aware of when their skin is behaving poorly due to things like alcohol, stress, or changes in diet from perhaps exploring vegetarianism or veganism. Also, from a medical point of view, we are seeing more patients come in after gastric surgery and are deficient in certain nutrients, which is when IVNT can help.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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We often combine nutritional therapy with aesthetic procedures to help enhance the results. For example, we will use IVNT with plateletrich plasma treatments to boost the blood’s nutrients. When we take the blood and put it back into the skin the added nutrients can really further enhance the overall skin tone. I have found that IVNT following treatments like chemical peels can also help with recovery time, as the skin is better hydrated, which can further better the results. In surgical patients, a multivitamin drip can be performed as soon as straight after discharge and may help with recovery from things like grogginess and tiredness from anaesthetic and post-surgical recovery. My advice to those looking at integrating nutritional therapy into their practice is to start small. Begin with IM injections first, perhaps B12 and vitamin D, and then grow with increased demand. Seek training from a respected company that can provide you with ongoing support and buy your vitamins through a reputable pharmacy – you need to use really good pharmaceutical-grade products. Know what the treatment involves – there is more regulation in this area than people think. It’s good practice to be associated with bodies such as the Association of Intravenous Micro-nutrition and Supplementation (AIMs). This is so that practice in IVNT is standardised

and practitioners get support in the event of any issues, share information, and keep abreast with regular updates and training. Ideally, I personally believe you should be CQC registered, although it’s not compulsory if you are using IVNT for ‘general wellness’ and just sticking to vitamins, minerals and amino acids. This becomes compulsory if you are using intravenous nutritional drug therapy. In regard to marketing, be careful not to make false claims.1-3 These are wellness drips to improve patients’ wellbeing and enhance aesthetic results, which won’t have medical outcomes – you don’t want to oversell it! One useful approach for IVNT treatments is to do vitamin drip days, where people can come in and sit together and have tailored drips. Of course, we have stopped this due to COVID-19, but it really capitalises your time and space while making it more of a social experience for patients, so I think it will be useful for many clinics once things return back to normal. There are a few interesting developments on the horizon such as the use of peptides or hormones and vitamins all together in shots, which, in my opinion, will be the next big thing. People are also looking at transdermal applications for those who don’t like needles. This is very much an evolving area in aesthetics so watch this space!

Dr Salinda Johnston emphasises the business benefits of IVNT and vitamin injections We find that IVNT and vitamin shots are a great addition to our product offering and the biggest draw for patients is that the vitamins are going directly into the body. We offer quite a few different IVNT and vitamin injection options for patients. Dr Salinda Johnson, aesthetic practitioner, The Our most popular treatments are London Cosmetic Clinic the biotin shot, which helps to promote hair health, the glutathione drip or injection for skin brightening, and the B12 injection, which is very beneficial and popular with our vegan patients as it helps energy levels. One of our most popular IVNT drips is called the Wellness Myer, named after Dr John Myers who was the pioneer of vitamin cocktails, and it aims to help improve general wellbeing, energy levels, metabolism and overall digestive health. We often recommend that patients try our IVNT or vitamin shots to complement other treatments they might be having in clinic. For example, we might combine the diet and detox drip,

which aims to help with fat burning and detoxification, with our body contouring treatments. From a business perspective, we find that because many of our patients might already be getting these services elsewhere, it’s more convenient for them to come to our clinic and include it with another treatment they might already be having. It’s less hassle for them and a good additional revenue generator for us. For some services, like vitamin B12 injections, it also means they are visiting the clinic more regularly, sometimes once a week, depending on their treatment plan. We have a few patients who come for a biotin or glutathione shot every week too! My advice for anyone looking to integrate IVNT or vitamin injections into their clinic would be to really consider if you have the space in your clinic, as well as the time for training. You need to ensure you consult patients well and avoid those with allergies, medical conditions or other contraindications. In terms of marketing, we have found that practitioner recommendations work best, as well as flyers in clinic.

Do your research Before you consider adding a new service or treatment to your offering, it’s important to consider the different brands and products available. Miss Gooneratne says, “Ensure you do your research. There are many treatments in aesthetics with very little evidence so when I am looking for

a new product or service, I look at the evidence for the end result and its specific formulations. If there is no or little evidence, I find it really difficult to justify recommending it to my patients and ultimately would rather choose not to.” Practitioners should also be aware and knowledgeable about the

REFERENCES 1. ASA, Advertising Codes, 2020. <https://www.asa.org.uk/codes-and-rulings/ advertising-codes.html> 2. ASA, Food, drink and supplements, 2020. <https://www.asa.org.uk/topic/

advertising rules on nutritional services set by the Committees of Advertising Practice and regulated by the Advertising Standards Authority.1 This is particularly noteworthy for IVNT and supplements, as many adverts have been banned for breaching the codes.2,3

food_drink_and_supplements.html> 3. ASA, Enforcement Notice: Advertising claims for IV drips (Covid-19), April 27 2020, <https://www.asa.org.uk/resource/enforcement-notice-advertisingclaims-for-iv-drips-covid-19.html>

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Understanding LesserKnown Vessel Anatomy Dr Emily Swift explores the infrequentlydiscussed vasculature associated with soft tissue for safer injectable treatments Anatomy underpins the safety and predictability of dermal filler procedures. A three-dimensional knowledge of head and neck anatomy is critical in order to carry out lower risk treatments. The face is highly vascular in nature and understanding the location, depth and typical branching patterns of blood vessels is crucially important to reduce the risk of necrosis, blindness, central nervous system complications and even fatality during a vascular occlusion.1 Vessel distribution is highly variable; however, depth is more consistent amongst individuals. The more educated injector understands and applies these core principals in order to visualise facial layers and structures in 3D. This enables the technique and product to be selected accordingly. The facial artery is often discussed in depth within publications and at conferences. It supplies a large proportion of facial skin and its path usually crosses many commonly injected areas. It arises from the external carotid artery and emerges on the face at the anteroinferior angle of the masseter muscle. It has a variable path, but usually runs upwards and forward, winding a tortuous course to the nasolabial line where it becomes the angular artery and passes up the side of the nose.2 Occlusion of arteries via soft tissue filler emboli causes infarction of skin, muscle, gland or organ, including the eye. Blindness can ensue if an embolus of filler occludes the ophthalmic artery (supplying the optic nerve).3,4 The central retinal artery (CRA) is part of ophthalmic artery and thus, the internal carotid system. Any arteries branching from this system have a higher risk of CRA occlusion due to the possibility of retrograde displacement of filler. This occurs if injection pressure exceeds arterial or venous blood pressure and the product moves backwards against the direction of blood flow. When the pressure of

the plunger is released, the filler moves forward again and creates an embolus blockage in a collateral artery branch.3,4 Therefore, any artery branching from the internal carotid artery has the potential to cause blindness if occluded, but also from the external carotid system due to several significant anastomoses between them (Figure 1 & 2).3,4 The equation for the volume for a cylinder (π2h) tells us that just 0.01ml of product would be enough to fill 5cm of a 0.05cm diameter vessel, which explains why very small amounts of filler can cause necrosis or loss of vision.5 Literature covering injectable vascular anatomy often focuses on arteries located in common treatment ‘danger zones’, however, all areas of the face should be classed as a danger zone, as no area is guaranteed to be ‘safe’.6 This article will focus on the lesser discussed vasculature associated with soft tissue in the areas of the most popular procedures.

Zygomatic and lateral orbital zone Cheekbone enhancement involves volume replacement below and lateral to the lateral canthus in the zygomatic zone to enhance the zygomaxillary point and create an attractive ogee curve. Tear trough rejuvenation is often requested due to soft tissue changes around the eye; the palpebromalar groove in the lateral zone creates a sunken, fatigued appearance. These two zones house significant arteries, knowledge of which is crucial to establishing safer procedures. Zygomaticofacial (cutaneous branch of the lacrimal artery) The internal carotid artery gives rise to the ophthalmic, then the lacrimal artery (Figures 1 & 2). This runs forward at the junction of the orbital roof and the lateral wall of the orbit. Here, it gives off the

Arteries and their branches in the face (purple originates from the external carotid artery and orange originates from the internal carotid artery):

17.1

17.2

21 22

24 17

25 9

12 6 3

4 2 1

1. Common carotid a. 2. External carotid a. 3. Internal carotid a. 4. Facial a. 5. Submental a. 6. Inferior labial a. 7. Superior labial a. 8. Lateral nasal a. 9. Angular a. 10. Posterior auricular a. 11. Maxillary a. 12. Inferior alveolar a. 13. Mental a. 14. Buccal a. 15. Infraorbital a.

16. Transverse facial a. 17. Superficial temporal a. (17.1 frontal branch, 17.2 parietal branch) 18. Ophthalmic a. 19. Supraorbital a. 20. Supratrochlear a. 21. Dorsal nasal a. 22. Anterior ethmoidal a. 23. External nasal a. 24. Lacrimal a. 25. Zygomatic a. 26. Zygomaticofacial a. 27. Zygomaticotemporal a.

Figure 1: The carotid systems: internal and external. Image adapted from von Arx T et al.23

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Vascular supply of the face (purple arteries originate from the external carotid artery; orange from the internal carotid artery; green represents arterial anastomoses):

1 A2

8.2

8.3

1.1

8.4 8.1

2.1

1.2

3.1

3 A3

A11 9

20.1

19.1 A7

10 20.3

20.2

18.2 18.1

17.1 17

A10

17.2 A6

21 13.1

1. Supraorbital a. (1.1 horizontal frontal branch, 1.2 superior palpebral branches) 2. Supratrochlear a. (2.1 superior/inferior palpebral branches) 3. Dorsal nasal a. (3.1 central a.) 4. Superior/inferior palpebral branches from lacrimal a. 5. Zygomaticotemporal a. 6. Zygomaticofacial a. 7. External nasal branch from anterior ethmoidal a. 8. Superficial temporal a. (8.1 temporoorbital branch, 8.2 frontal branch, 8.3 transverse frontal branch, 8.4 parietal branch) 9. Anterior auricular a. 10. Transverse facial a. 11. Posterior auricular a. 12. Facial a. 13. Submental a. (13.1 vertical labiomental a.) 14. Masseteric branch from facial a. 15. Inferior labial a. 16. Horizontal labiomental a. 17. Superior labial a. (17.1 inferior alar branch, 17.2 septal branches) 18. Lateral nasal a. (18.1 superior alar

branches, 18.2 nostril branches) 19. Angular artery (19.1 medial palpebral branch) 20. Infraorbital a. (20.1 inferior palpebral branch, 20.2 nasal branch, 20.3 superior labial branches) 21. Mental a. 22. Buccal a. Arterial anastomoses between: A1. Supraorbital a. & frontal branch of superficial temporal a. A2. Supraorbital a. & supratrochlear a. A3. Dorsal nasal a. & angular a. A4. Lateral nasal a. & external nasal branch from anterior ethmoidal a. A5. Superior labial a. & lateral nasal a. A6. Bilateral superior labial a. A7. Facial a. & infraorbital a. A8. Inferior labial a. & mental a. A9. Bilateral inferior labial a. A10. Facial a. & transverse facial a. A11. Anterior & posterior auricular a.

Figure 2: The carotid systems: internal and external and their anastomoses. Image adapted from von Arx T et al.23

zygomatic artery, which subdivides into the zygomaticotemporal and zygomaticofacial artery.7 The zygomaticofacial foramen varies in position but can be found on the vertical line of the outer margin of the lateral orbital rim at about 0.5-1.0cm below the horizontal line of the lateral canthus. The artery passes along the inferior border of the suborbicularis oculi fat (SOOF).7 The frequency of the zygomaticofacial foramen is varied from being single to as many as four foramina, as well as absence of the foramen completely.7 Where the zygomaticofacial artery exits the foramen, it immediately supplies the skin of the malar region in the surrounding area. In cases where the inferolateral portion of the orbicularis oculi muscle extends over the zygomaticofacial foramen, the artery moves superficially and pierces the muscle to reach the subcutaneous tissue.8 The zygomaticofacial foramen and artery are close to the orbital margin where bolus injections onto periosteum (palpebromalar groove) may be carried out for periorbital rejuvenation. It is also close to the zygomatic eminence, where a bolus may be injected in the anteromedial cheek, to create the ‘ogee curve’, a point of maximum bulbosity forming an aesthetically pleasing mid-face.9 The artery moves from the SOOF (deep plane) to the subcutaneous tissue (superficial plane).8 It is usually advised around the orbit that deep injection below the muscular layer or superficial injection above it are the lower risk options, compared to intramuscular injections, because the arterial plexus in periocular muscles are intimately connected to the muscle; they are dynamic and very active, therefore highly vascular.10 However, medially in the tear trough, this is not practical as the muscle is bound tightly to the periosteum.10 In my personal experience, I have therefore found that gentle massage of filler into this medial area from a more lateral position via cannula deposition is an alternative. Zygomatic orbital The zygomatic orbital artery originates either directly from the superficial temporal artery or one of its branches, such as the middle

temporal artery, and is inconsistently present. The artery bifurcates from the external carotid, moves sharply superiorly and crosses the zygomatic arch anterior to the porion. Subsequently, it tracks toward the lateral canthus horizontally and divides into the palpebral and superficial orbital arteries. The mean diameter is 2.52mm, and the average length is 8.50cm. The mean depth is 5.61mm – a superficial/ muscular plane.11 This artery is inconsistently present but is often a major artery of the lower temple. Along with the zygomaticofacial artery, the zygomatic orbital supplies the skin overlying the palpebromalar groove and the orbicularis oculi muscle.12 There are several anastomoses in this area between the external carotid system and the internal carotid system. The zygomaticofacial (internal) anastomoses with the transverse facial (external). The zygomaticofacial also anastomoses with the zygomatic orbital.11 Zygomaticotemporal As shown in Figures 1 & 2, the temple receives supply from the zygomaticotemporal artery, arising from the lacrimal artery (discussed previously). The zygomaticotemporal branch supplies the lateral aspect of the forehead. The foramen was located at an average of 6.70mm lateral to the lateral orbital rim and 7.88mm cranial to the nasion-lateral orbital rim line on the lateral wall of the zygomatic portion of the orbit.13 The multi-layered depth of these arteries in the zygomatic and lateral orbital zone has clinical implications when treating the tear trough or mid-face – in my opinion, it would therefore be prudent to use a cannula in the lateral zygomatic and orbital zone instead of a needle. Deep temporal arteries The deep temporal arteries (anterior and posterior) are branches of the maxillary artery. They arise from the maxillary artery after it has branched from the external carotid and run between the two heads of the lateral pterygoid to reach the infra temporal fossa.14 The deep temporal arteries then ascend between the temporalis and

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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the pericranium. They anastomose with the middle temporal artery, which supplies the middle portion of the temporalis muscle and the intermediate fascial layers.15 The anterior deep temporal artery supplies the anterior portion of the temporalis, the posterior deep temporal artery supplies the midportion, and the middle temporal artery supplies the posterior portion.15 The anterior deep temporal artery communicates with the lacrimal artery (internal carotid system) by means of small branches, which perforate the zygomatic bone and great wing of the sphenoid.16 Middle temporal vein The middle temporal vein (MTV) runs along the line between 52mm lateral from the bony lateral canthus and 12mm medial from the external auditory canal (Figure 3).17 The MTV displays a high variability in its diameter – width varied between 0.5 and 9.1mm in various studies.18 It has a consistent depth and course within the fat pad enclosed between superficial and deep layers of the deep temporal fascia. The MTV has been described as a venous sinus found constantly wrapped by the deep temporal fat pad between the layers of the deep temporal fascia. It is formed by the joining of multiple intramuscular veins from the temporalis muscle at the level of the temporal process of the zygomatic bone, after which it pierces the deep layer of the deep temporal fascia to lie within the intermediate temporal fat pad.18 As the MTV passes laterally, it pierces and runs for several millimetres on the surface of the superficial layer of the deep temporal fascia.18 There is much debate by injectors as to the correct plane of injection for the

Temporalis muscle

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Tips for Injecting38 1. Know three-dimensional anatomy well – the depth and location of facial vessels and the common variations. Injectors should understand the appropriate depth and plane of injection at different sites. 2. Inject slowly with minimal pressure – this will help to prevent high pressure and possible formation of retrograde embolus. 3. Inject in small increments – any filler injected into the artery can be flushed by the arterial system peripherally before the next injection. This prevents a column of filler traveling retrograde and perhaps subsequently anterograde. The maximum amount of filler injected at one time should be 0.1ml. 4. Aspirate before injection – it may not be possible to get flashback into a syringe through fine needles with thick gels. Facial vessels are also small sized and may collapse, which limits the efficacy. 5. Use a small-diameter needle – this necessitates slower injection and is less likely to occlude a vessel. If a sharp needle is being used, then a perpendicular injection directly in contact with the bone is recommended. Injecting into a deeper plane may avoid vessels, depending on location. 6. Use smaller syringes – a large syringe may make it more challenging to control the volume and increases the probability of injecting a larger bolus, therefore smaller syringes are preferred. However, decanting filler material from its original syringe is not recommended. 7. Inject with a cannula – a 25 gauge cannula or greater bore size are less likely to pierce a blood vessel. This is especially useful in the medial cheek, tear trough, and nasolabial fold. 8. Consider past surgery or trauma – a patient who has undergone trauma or a previous surgical procedure in the area will have altered vessel anatomy, therefore extreme caution when treating these patients is necessary. 9. Seek appropriate training – competency in the management of complications and being adequately trained using an appropriate product are essential. Ensure a thorough education of treatment techniques for the treatment area. 10. Consider vessel compression – compressing important vessels connecting the external to the internal carotid system is a technique used to attempt to prevent embolism of filler whilst injecting. This is done by placing a finger on the approximate location of the arteries and applying pressure. Important vessels to compress are located on the inferior-medial orbital rim (supratrochlear and supraorbital arteries) and the side of the nose (dorsal artery).

Temporal skin Subcutaneous fat

Temporoparletal fascia

Temporal fat pad

Superficial temporal vein Deep layer of deep temporal fascia

Superficial layer of deep temporal fascia

Middle temporal vein (MTV) Zygomatic bone

Temporal extension of buccal fat pad

Figure 3: The middle temporal vein17

correction of temporal hollows. Injection in either a superficial or deep plane has its associated risks. The superficial temporal artery and vein course in a superficial plane, giving off a frontal branch that leads up toward the superior lateral orbital rim, eventually anastomosing with the supraorbital artery. Deeper injections risk injury to the middle temporal vein, which lies just deep to the superficial layer of the deep temporal fascia, running just inferior to the zygoma.19 A suggested point for deep injection for the temple is ‘one up, one over or gunshot technique’ 1cm superiorly along the temporal fusion line from the superior lateral bony rim, and 1cm inferior to this point. Care should be taken to avoid the anterior and posterior deep temporal arteries, and to stay a finger’s breadth above the superior border of the zygoma in order to avoid the middle temporal artery and vein.20 In a case study, self-administered hyaluronic acid filler to the proximal temple caused hearing loss in the left ear, blanching over the left side of the face, and severe pain. It was postulated that an embolus of filler affected the tympanic and deep auricular arteries branching from the external carotid due to initial occlusion of maxillary artery in the infra temporal fossa. This demonstrates the importance of understanding the branching of the arterial system in diagnosing the origin of an occlusion.21

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Columellar a. Angular a. Inferior labial a.

Mental a.

Superior labial a.

Vertical labiomental/ ascending mental

Horizontal labiomental artery

Submental artery

Figure 4: Anatomy around the perioral area23,34

Mid-face zone Cheek augmentation is an incredibly popular and a highly requested procedure. However, we find significant vessels within this region. In the lateral cheek, this section will focus on the transverse artery and in the medial cheek, the infraorbital artery. Transverse facial Just below the ear, the superficial temporal artery sends a branch forward as the transverse facial artery branching from within the parotid gland. It travels forward immediately below the zygomatic arch. The transverse facial artery supplies the superoposterior skin of the cheek: the pre-auricular and lateral (pre-masseteric) regions. The important large cutaneous perforator of the transverse facial artery is located approximately 3cm lateral and 3.5cm inferior to the lateral canthus and provides the main direct blood supply to this area.22 It also supplies the parotid gland, the parotid duct, the facial nerve, and the masseter muscle.23 In 70% of cases, the transverse facial may arise as one branch and, in the rest, as two or three. It travels in a subcutaneous plane a finger’s width below the zygoma.24 Variation of the path of the transverse artery may produce a high risk when augmenting the zygoma and creating a ‘cheekbone’ for a patient. In my view, the use of a cannula in the submalar and preauricular areas should be considered by injectors to decrease the risk of vascular complications, and this is also recommended by Arsiwala.25

A sign of vascular occlusion of the labiomental artery may be pain during swallowing due to ischemia of these arterial branches to the digastric, mylohyoid and platysma muscle

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Infraorbital artery The infraorbital artery arises from the third part of the maxillary artery (external carotid system – Figures 1 & 2). It supplies the inferior rectus and inferior oblique muscles, the nasolacrimal sac and the anterior superior alveolar artery, and sometimes the middle superior alveolar artery. It exits to the face, through the infraorbital foramen on the vertical line of the medial pupil at about 0.6-1.0cm below the orbital rim. Here, it lies under levator labii superioris muscle and very quickly divides into its lower lid, nasal, and superior labial and cheek branches.22,26 In 43% of cases within a study of 30 hemifaces of 15 Thai embalmed cadavers, the palpebral branch of the infraorbital artery was the majority of arteries closest to the inferior margin of the tear trough. The location of this artery therefore also needs to be considered when treating the tear trough.27 Within this area, anterior mid-face injection points may be close to the infraorbital artery.28 The infraorbital artery (external carotid) anastomoses with the ophthalmic artery (internal carotid) within the orbit.29

Chin and pre-jowl zone The chin is frequently projected to improve the facial profile. The pre-jowl area is also often treated to improve the appearance of the jowls in older patients, often by injecting a bolus of filler. There are two important arteries to be aware of in this area. Submental and vertical labiomental The facial artery gives origin to the submental artery behind or at the superior edge of the submandibular gland. The submental artery (Figure 4) runs antero-medially below the mandible and then runs superﬁcial to the mylohyoid muscle (extending from the mandible to the hyoid bone) to reach the chin. The submental artery gives off a vertical branch which is the vertical labiomental (also known as the ascending mental). There is also a horizontal labiomental artery, which extends anteriorly towards the midline from the inferior labial artery.23 A study into the anatomy of the ascending mental artery involving 31 embalmed cadaveric faces found a variation in size between the two opposite ascending mental arteries (right and left). There were 19 dominant ascending mental arteries on the right and 12 on the left. The dominant ascending mental arteries enter the chin paracentrally, approximately 6mm from the midline, 70% within the muscular plane, and at a depth of 4.15 ± 1.95mm from the skin. The other 30% travel subcutaneously.30 The ascending mental artery may be a branch that continues directly from the lingual artery (external carotid) or communicates with a branch of it, often forming an anastomosis with the sublingual artery, within the floor of the mouth.30 The labiomental artery gives off branches to the submandibular gland and perforating branches to the platysma and mylohyoid muscles. A sign of vascular occlusion of this artery may be pain during swallowing due to ischemia of these arterial branches to the digastric, mylohyoid and platysma muscle. Pain in the mandible and gingiva could be due to ischemia in periosteal arterial branches. In a case study, livedo reticularis in a patient extended from the mental crease down to the upper cervical area with skin overlap on the left side across the midline, demonstrating vascular interruption in the skin supplied by the submental artery.31 Tongue and mouth floor infarction following filler injections for chin augmentation is a rare, but increasingly recorded

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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The columellar arteries’ location and anatomy are especially important if increasing the nasolabial angle and treating the tip of a nose

Conclusion A fundamental knowledge of 3D anatomy involving depth and distribution of lesser-discussed vessels of the face is essential to provide patients with lower risk dermal filler treatments. This article has discussed some of these arteries/veins in the more commonly injected areas of the face, however it is by no means exhaustive and the treating physician should ensure they have a thorough understanding of the approximate location and depth of important vessels in the area they wish to treat, to ensure the risk of complication minimised.

Test your knowledge!

Complete the multiple choice questions below and go online to receive your CPD certificate!

complication, due to more HA filler treatments being carried out in recent years.32 Due to the multilayer plane of all these arteries, I personally advocate the use of cannula in the chin and pre-jowl zone due to the multilayer presence of the vasculature.

Questions

Philtral zone

Superficial and deep ascending columellar arteries The superior labial artery gives off the superficial and deep ascending branches. The superficial ascending arteries are located on either side of the philtrum. The columellar arteries are the continuation of superior labial artery and become a part of the vascular plexus of the nasal tip. The deep septal branches supply the mucosa and ascend in the philtrum toward the nasal septum.33 The columellar forms the visible fleshy portion between the two nostrils – it is the most anteroinferior portion of the nasal septum (Figure 4). The columellar artery (CoA) runs posteroinferiorly within the columella of the nose to reach the tip of the nose and supplies the adjacent tissue. Here, it forms the arterial plexus with the vessels from the dorsum or alae of the nose. Mostly, the distances between the skin surface and the superficial CoA vessels ranged from about 1.5-2.5mm.34 Columellar arteries were defined in all types of facial artery except for the hypoplastic type. In a study, the columellar artery was single and straight in 24 of 49 specimens (48.9%). There were two straight columellar arteries in 19 of 49 (38.7%) and it was of a forked type in six of 49 (12.2%).35 The columellar arteries’ location and anatomy are especially important if increasing the nasolabial angle and treating the tip of a nose (both popular amongst Asian patients).36 Vascular occlusion of the columellar artery may cause necrosis of the nasal alae, the tip of the nose, but also a mucous cyst may form, thus degenerating the shapes of the columella and philtrum.34 The superficial and deep ascending arteries are by definition, multi-planal. Columellar arteries usually have two branches – one subdermal, and the other submucosal. It has therefore been recommended that any treatment in this zone is carried out with a cannula where possible.37

a. b. c. d.

Internal carotid External carotid Both carotid systems Neither carotid systems

2. The transverse facial artery travels in which plane below the zygoma?

a. b. c. d.

Epidermal Dermal Periosteal Subcutaneous

3. The intraorbital artery lies on the vertical line of the medial pupil, how far below the orbital rim?

a. b. c. d.

0.3cm-0.4cm 0.6-1cm 1cm-2cm 2-5cm

1. The zygomaticofacial is a branch of which arterial carotid system?

a. Zygomaticofacial, 4. Which arteries should you compress to reduce the chance of visual disturbances/ blindness due to embolism of filler via their route?

zygomaticotemporal, middle temporal b. Supratrochlear, supraorbital, dorsal nasal c. Submental artery, sublingual artery, ascending mental d. Superior labial artery only

5. The collumella arteries location is especially important if treating which areas?

a. b. c. d.

Lateral aspects of the chin Forehead Lateral portion of the zygoma Nasolabial angle and tip of nose

Answers: 1. a, 2. d, 3. b, 4. b, 5. d

Residing centrally in the upper cutaneous lip is the philtral zone. Few patients request philtral column augmentation, but in the case of older patients, this area may be very flat, and an augmentation often complements treatment to the lips. Traditionally, it has also been thought to shorten the upper white lip, another benefit to older patients with excessively long nose to lip length. A more frequent procedure is treating ‘smoker’s lines’ on the upper lip. Filler may be placed intradermally or subcutaneously to treat this issue. There are several important vessels to be aware of in this area.

Possible answers

Dr Emily Swift is a dental surgeon and has been working in aesthetics for four years. She works at Dr Yusra Clinic, Liverpool and is the clinical lead at City Aesthetics in Chester and Hidden Gem, Chorley. She has a passion for research into complications arising post dermal filler and neurotoxin treatment. Dr Emily Swift is currently working on a paper to produce evidence-based, best practice management for the aesthetic practitioner following vision loss due to central retinal artery occlusion. She also enjoys mentoring clinicians new to the field. Qual: BDS

VIEW THE REFERENCES AND RECIEVE YOUR CPD CERTIFICATE BY GOING TO WWW.AESTHETICSJOURNAL.COM/CPD

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

Introducing… EDUCATING AND INSPIRING THE PUBLIC TO MAKE SAFE AND ETHICAL CHOICES IN AESTHETIC MEDICINE

ith the medical aesthetic market set to be worth $15.9 billion by 2025, we know it is a fast-evolving specialty, booming with new products and treatments, life-changing procedures and revolutionary science. Yet, unfortunately, there is a lack of quality education on what’s available and media coverage can be largely negative; leaving patients and consumers misinformed, afraid of complications and hesitant to talk openly about aesthetic treatments and procedures. This is where Beyond Beauty comes in. The ground-breaking new magazine, with four issues a year, will be filled with educational content that is factual, informative and engaging. We’ll also be hosting an experiential event for consumers – Beyond Beauty Live – in early 2022, so stay tuned!

EXCLUSIVE DISCOUNTS FOR SUBSCRIBERS • All Aesthetics journal subscribers sent a complimentary copy • Option to purchase multiple copies for your patients at a discounted rate

EN H AN C I N G

K N OWL E D G E

B U IL DIN

LAUNCH

T RUST

PRO M OT I NG

I NG S O O

P OS I T I VI T Y

Advertorial SkinCeuticals

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SkinCeuticals launches Silymarin CF Discover what makes Silymarin CF antioxidant serum unique and what clinically-proven benefits it brings to oily and blemish-prone skin Words: Catherine Hufton

Leaders in antioxidant research With four generations of topical antioxidant formulations, 10 patents, and more than 200 studies published in prestigious medical journals, SkinCeuticals is an undisputed trailblazer in antioxidant science. The results-driven brand is dedicated to improving skin health with ground-breaking research and innovation, that’s backed by science. It also upholds a philosophy that comprises three main pillars: Prevent, Correct and Protect. Together, each of these pillars ensures that every SkinCeuticals product delivers and maintains healthierlooking skin and effective anti-ageing results. In terms of products, SkinCeuticals is most revered for its range of potent serums including C E Ferulic and Phloretin CF – potent daily antioxidants proven to effectively neutralise skindamaging free radicals and provide the skin with eight times the environmental protection. These ground-breaking daily serums were created by the brand’s founding scientist, Dr Sheldon Pinnell after 30 years of pivotal research into topical vitamin C serums. His work was instrumental in establishing SkinCeuticals as an antioxidant authority and continues to inspire and inform the brand’s pioneering research.

This potent antioxidant is designed to reinforce the skin’s natural protection against free radical damage with a unique combination of active ingredients including 15% pure vitamin C 38

SkinCeuticals’ latest breakthrough Fast forward to 2021, and SkinCeuticals is still at the forefront of antioxidant research. Its latest innovation is the pioneering, next-generation Silymarin CF: its first ever vitamin C serum for oily, blemish-prone skin. As with C E Ferulic and Phloretin CF, this potent antioxidant is designed to reinforce the skin’s natural protection against free radical damage with a unique combination of active ingredients including 15% pure vitamin C (L-ascorbic acid), 0.5% ferulic acid, 0.5% salicylic acid and 0.5% silymarin. Why is this important? Growing research has shown a causative link between the formation of blemishes and oil oxidation. Oxidative stress such as lipid peroxidation can contribute to inflammation in the skin which diminishes antioxidants, creating the ideal environment for bacteria to grow. SkinCeuticals’ research shows that those with blemish-prone skin actually have lower levels of antioxidants and higher levels of sebum production. This, in turn, leaves the skin at greater risk of damage but by applying antioxidants topically, lipid peroxidation is prevented, and the formation of blemishes is decreased.

Silymarin: the antioxidant answer for blemish-prone skin Sourced from milk thistle, Silymarin is known for its detoxification properties that are believed to have a number of holistic benefits such as supporting healthy liver function. When applied topically to the skin, it’s clinically proven to provide protection against environmental damage and free radicals while improving visible signs of ageing. Most significantly, its ability to significantly reduce Aesthetics | January 2021

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How to use Silymarin CF in a routine As a powerful antioxidant, Silymarin CF is designed to be part of a protective morning routine. SkinCeuticals’ recommended routine comprises four steps to help significantly regulate sebum levels, reducing the potential for breakouts on the skin. Step 1: Silymarin CF After cleansing with Blemish + Age Cleanser, Silymarin CF should be the next step in a morning skincare routine for oily and blemish-prone skin types. This daily vitamin C antioxidant serum is formulated to help reduce oil oxidation caused by free radical damage during the day. So, by applying directly to dry, clean skin, it ensures the skin can fully benefit from its protective antioxidant benefits. Step 2: Blemish + Age Defense Next, apply a few drops of SkinCeuticals Blemish + Age Defense. This oil-free serum is clinically formulated to improve the appearance of blemishes, fine lines and wrinkles which makes it an effective partner to Silymarin CF. Formulated with 2% dioic acid and alpha-hydroxy and beta-hydroxy acids, it helps to control the appearance of excess sebum and clears and refines the look the open pores. Step 3: Metacell Renewal B3 (optional) An optional third step is SkinCeuticals Metacell Renewal B3. Formulated to help promote cell turnover and strengthen the skin’s moisture barrier, it’s clinically proven to improve radiance and luminosity while hydrating the skin to enhance skin volume and firmness and improve the look of fine lines and wrinkles. Step 4: Advanced Brightening UV Defense SPF 50 The final step is SkinCeuticals Advanced Brightening UV Defense SPF 50. This dualaction, lightweight sunscreen is enriched with 1% tranexamic acid and 2% niacinamide to protect the skin against UV-induced discolouration. When applied each morning, it will protect the skin from broad-spectrum UV damage while brightening overall skin tone.

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Advertorial SkinCeuticals

oil oxidation makes it incredibly effective at treating oil and imperfections. During the process of creating Silymarin CF, SkinCeuticals tested a number of antioxidants to see how well they prevented lipid peroxidation. Vitamin E, for example, is considered one of the most effective ways of preventing lipid peroxidation in the skin, but its oily and viscous texture makes it more suited to drier skin types. Silymarin, on the other hand, was originally recognised by Dr Pinnell for its antioxidant potential, ability to reduce oil oxidation and lightweight texture. Armed with this knowledge, SkinCeuticals secured a patent on its use to combat photoageing and skin inflammation.

Clinical results In a 12-week study conducted in Brazil in 2020 with 60 women, 15% of participants saw a reduction in oiliness and 24% saw an improvement in the appearance of fine lines and wrinkles. Additionally, in a study in China undertaken in 2020, 35 of the subjects studied saw a 76% reduction in oil oxidation. As a result, participants found their skin texture and clarity was also improved, and the appearance of pores and blemishes was also reduced. Clinical study 35 subjects (China 2020) • Reduces oil oxidation by up to 76% • Reduces the appearance of pores • Reduces the appearance of blemishes • Reduces excess sebum/oil by up to 15%

12-week clinical study, 60 women (Brazil 2020) • Improves appearance of fine lines and wrinkles by up to 24% • Improves skin texture • Improves skin clarity 8-week clinical study, 55 women (US 2019) • Refines skin texture and improves skin tone • Reduces oiliness by up to 15%

A complete antioxidant range The SkinCeuticals antioxidant range now comprises three vitamin C serums: C E Ferulic for dry and mature skin, Phloretin CF for hyperpigmented skin, and Silymarin CF for oily and blemish-prone skin. This potent trio will allow SkinCeuticals consumers to find the most suitable formula for their skin type and achieve the best possible results.

This advertorial was written and supplied by SkinCeuticals Email: maddy.lewis@loreal.com

Aesthetics | January 2021

hydrafacial bringing the glow london back to the capital... POP-UP

Let’s be frank, 2020 was not, in most ways, a good year! It was a huge challenge for everyone, and the aesthetics industry has been no exception. It was a year where good news didn’t come along very often and we all hope for a better 2021.

have experienced a free HydraFacial Signature treatment and had the long-term benefits of personalised skin health delivered through HydraFacial explained to them. And of course, each of them has the potential to be your customer in the future.

That’s why we were genuinely delighted to be able to open our Flagship HydraFacial London Pop Up Experience Event in December. Located at a fantastic venue in Marylebone and running through until the end of January, it’s been an exciting experience, showcasing all the latest from HydraFacial.

So, as we all look forward to a hopefully more positive 2021, it’s great to be able to share this fantastic, fun, educational and exciting event with you!

Highlights include the new HydraFacial Elite System, Keravive our ground-breaking scalp health treatment and demonstrating the endless possibilities for skin health personalisation with our unique in-house and partnership booster range.

The event is running to the end of January 2021 and if you’d like to know more about the event visit www.hydrafacial.co.uk/pop-up. And even if you can’t join us keep an eye out for more exciting events coming from HydraFacial in 2021 – the fun is only just beginning!

Our audience has been wide and diverse, engaging both business and the media and most importantly of course will be bringing the brand to the public. By the end of the event, we will expect to have seen over 1000 consumers come through our doors and each will

To discuss bringing HydraFacial into your business or to arrange a demonstration at the London Pop Up Event (or anywhere else that suits you) contact us today:

T: 01788 572 007 | w: hydrafacial.co.uk | e: infouk@hydrafacial.com COVID SAFETY: With the risk of COVID-19 still active, please rest assured that we have taken additional steps to keep our in-store staff and visitors safe during visits.

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Understanding BDD from a Patient Perspective Dr Reena Jasani interviews a patient with body dysmorphic disorder and reflects on how his experiences can inform clinicians’ consultation approach It is estimated that among those who undergo cosmetic procedures, around one in eight suffer from body dysmorphic disorder (BDD).1 BDD is a mental health disorder where a person has a distorted view of how they look and obsessive thoughts over their perceived flaws, which affects their ability to lead a normal life. In this article, I interviewed Omari Eccleston-Brown who has BDD.

Dr RJ: Tell us a little bit about yourself OEB: I am 32-years-old living in London, founder of Believe in Learning and I tutor English, Maths and Spanish. I have had BDD for more than 15 years, but was unaware of it for a long time. It was only when my mother showed me an article she came across on BDD and Michael Jackson that I realised I had something similar, and it was from there I self-diagnosed my BDD and went to my GP requesting a referral for cognitive behavioural therapy (CBT). I was later officially diagnosed with body dysmorphic disorder in 2012 by a clinical psychologist at the Maudsley Hospital’s specialist centre for anxiety disorders and trauma.

I came across Omari when I was researching into how the illness can impact a person’s life, and stumbled across an article written by him on his experience with BDD. Omari has his own tutoring business based in London and is a speaker for mental health issues. In this interview he explains what it is like to have BDD, and highlights why it is so important for an aesthetic practitioner to know about it.

Dr RJ: How did your symptoms of BDD first present? It started when I was about to turn 16 – my dad surprised me for my birthday with a photoshoot because at the time, I wanted to be a model! A few weeks before the photoshoot I started to have negative thoughts about my eyes – I felt I looked tired all the time, that I had bags under them. I would be constantly checking the mirror and trying different things to help. The morning of my photoshoot I locked myself in the bathroom. I reached out for my mother’s makeup bag thinking to myself, “Am I really going to do this?”. I had never worn makeup before, and even though I knew I had my very traditional father waiting for me downstairs, I felt I had to put on makeup to cover my eyes, so I did.

Dr RJ: How has BDD impacted you? OEB: It’s impacted my life hugely, particularly at university where the thoughts became all consuming. I used to always wear glasses to try and cover my eyes, and I never took them off in front of people. Socially, I appeared to be very confident and outgoing, but on the inside, I was anxious about what people were thinking of me. I couldn’t do sports I enjoyed, I couldn’t have any relationships. Sometimes I used to go to the meadows alone just to scream and let it out, as I had no other outlet. At the time I didn’t have awareness of mental health, so I didn’t know what was going on. Dr RJ: What types of thoughts and feelings do you get with having BDD? OEB: It varies really. There have been times

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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where I’ve spent hours looking in the mirror. Other times I can be doing something, but thoughts on how I look always remain at the back of my mind. Often my thoughts are that my eyes look ‘abnormal’ or ‘freakish’ and there would be an immediate compulsion to do something to fix it. There was a period where I was convinced that it was because of water retention, so I used to sleep sitting up! I used to think that if I walked into a restaurant, people would be put off their food because of being repulsed by how I looked, so I felt like it was my duty not to go. That’s how extreme it can get. Dr RJ: What were/are your triggers? OEB: I suffered from a dry-eye condition before university, which triggered my BDD and after that, it never went away. Typically for BDD patients it tends to be a traumatic event or illness related to their perceived flaw, or as a result of bullying. What continues to trigger my BDD is anything that makes me feel socially anxious or when I feel like I’m not in control of my appearance. One example is going on a long-haul flight – I don’t like falling asleep on the plane and then waking up with tired eyes surrounded by people as it triggers the anxious thoughts. Dr RJ: Does the BDD apply to any other areas of your body or just the eyes? For

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example, if you gained weight, would this influence BDD around your body shape, or would that not be an issue? OEB: It’s my understanding that it is common for BDD concerns to affect many features or body parts at the same time or for it to move from one specific feature to another – for example, following cosmetic surgery, the person may then go on to fixate on another part of their body. For me personally though, the thoughts have always been about my eyes. I guess what has varied slightly is that at first I was only concerned about the bags under my eyes, but then as I started to wear glasses to try and mask this, I went on to developed a secondary concern that I had caused my eyes to become weak and ‘beady’ as a result of wearing my glasses too often. With regards to other body features, or any weight changes, I have the usual concerns. Sometimes I might be displeased by something and even grumble about it, but it never leads to obsessive behaviours or intrusive thoughts. Dr RJ: What has helped you with BDD? OEB: I have found that CBT specifically targeted for BDD helps me a lot. I’m currently undergoing my fourth round of CBT treatment. My first session was general CBT between 2010-2011. It was okay, but it was missing a lot of the techniques that you get when you have CBT targeted for BDD.

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I then signed up to a trial of CBT in 2012 at the Maudsley for 12 sessions weekly, and that really helped. In 2019 I had a 20-week online structured support group led by other people with BDD and I’m currently undergoing CBT for BDD at the Maudsley again. I also take a high dose of SSRI (anti-depressant) medication which is what is recommended for BDD and have been taking it for the last four months. I have been on SSRIs twice before, and have also come off them, without any side effects. Dr RJ: What are your thoughts on aesthetic treatments? OEB: I think generally they can help people’s confidence. For someone with BDD, however, I think it can be dangerous. It’s very common for people with BDD to do hours of reading on fixing their problem, including cosmetic treatments. I’ve had appointments with two different practitioners to have cosmetic treatment for my eyes (fillers). The first person I didn’t like very much, the second person was really honest and didn’t think it would benefit me. I really appreciated that, and I didn’t have treatment in the end. The thing with BDD is that you just don’t have an accurate sense of how you look. Even now when I look in the mirror, it can be as intense and as distorted as it was 16 years ago, and sometimes it still makes me feel really sad and vulnerable.

Body Dysmorphic Disorder Questionnaire – Dermatology Version (BDDQ-DV) which can be used in aesthetic treatment consultations5 1

Are you very concerned about the appearance of some part of your body, which you consider especially unattractive? If no, thank you for your time and attention. You are finished with this questionnaire.

If yes, do these concerns preoccupy you? That is, you think about them a lot and they’re hard to stop thinking about?

What are these concerns? What specifically bothers you about the appearance of these body parts?

What effect has your preoccupation with your appearance had on your life?

Has your defect often caused you a lot of distress, torment or pain? How much? (circle best answer) 1. No distress

3. Moderate and disturbing but still manageable

4. Severe, and very disturbing

5. Extreme and disabling

Has your defect caused you impairment in social, occupational or other important areas of functioning? (circle best answer) 1. No limitation

2. Mild, and not too disturbing

2. Mild interference but overall performance not impaired

3. Moderate, definite interference, but still manageable

4. Severe, causes substantial impairment

Has your defect often significantly interfered with your social life?

5. Extreme incapacitating y

If yes, how?

Has your defect often significantly interfered with your school work, your job, or your ability to function in your role?

Are there things you avoid because of your defects?

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Reflection This interview gives insight into a patient’s personal experience of BDD, and how challenging it can be to live with. It also highlights how common it is for BDD patients to seek cosmetic treatments, often because they believe their perceived flaw requires fixing.2 Prior to diagnosis, Omari struggled for many years without knowing his condition. With BDD being a very under-diagnosed3 and a compulsive disorder, it is incredibly important for aesthetic practitioners to be aware of BDD, how it affects the patient, and decide the appropriate care pathway. One recommendation is to start off with screening all patients at the initial consultation. Pre-treatment screening is now considered to be a crucial part in the practitioner’s role in providing appropriate care and treatment.4 Let us take Omari as an example of a patient we may come across in a clinical setting. If a pre-screening questionnaire is presented to him in the first instance, it would raise a concern in the practitioner’s mind. A standard questionnaire such as the Body Dysmorphic Disorder Questionnaire – Dermatology Version (BDDQ-DV) is relatively quick and straight forward to complete and could easily be implemented in practice.5 You may consider alternative screening tools for BDD such as the Body Dysmorphic Disorder Questionnaire (BDDQ),6 the Cosmetic Procedures Screening-Questionnaire (COPS),7 or the Body Image Disturbance Questionnaire(BIDQ).6 Figure 1 shows the BDDQ-DV.5 To screen

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positive for BDD, patients must report both the presence of ‘preoccupation’ and a score of three or higher to the questions on distress/impairment in functioning.5 In such cases, a referral for psychological assessment would be an appropriate step to take. This has to be handled with care and support, as it can be a distressing and confusing time for patients. The key is to understand, listen to the patient’s concerns regarding their appearance, and give enough time to explain to them the reasons for referral. To date, the vast majority of studies suggest that cosmetic treatments for individuals with BDD are associated with poor outcomes.8 This is because BDD patients are often dissatisfied with the treatment, or they can develop new appearance preoccupations.9 Violent behaviour towards the practitioners can also be a possibility. In addition, patients can often become litigious after ‘failure’ to resolve their defect.10 More recently, however, there have been suggestions that patients with mildto-moderate BDD with no significant impairment in overall functioning and realistic psychosocial expectations may benefit from certain cosmetic treatments.11 Case selection is of utmost importance. The provider should be able to meet the patient’s expectations, as the degree of satisfaction with the cosmetic treatment outcome is associated with the perception of the patient’s body image.3 The BDD should be well controlled, and the patient should be on appropriate medication if required. This should be in conjunction

with a multidisciplinary approach, involving psychiatric/mental health support for the patient prior to treatment and for aftercare. Whichever pathway you choose for the patient, it should always be in their best interest. BDD can be a devastating illness, where the patient suffers with endless tormenting thoughts on their appearance. I conclude this article with a quote from Omari, leaving you with some final thoughts: “It’s important for aesthetic practitioners to be aware that for those who have BDD, their concern goes far deeper than a mild dissatisfaction with their features. They believe the flaw defines them as a person, and their own sense of self-worth.” Dr Reena Jasani is an aesthetic practitioner at City Skin Clinic in London, at SkinSmiths in Surrey and is the director of her own clinic based in greater SW London. She also has seven years’ experience in dentistry and works as associate dentist. Dr Jasani has a special interest in antiageing treatments and also provides non-surgical profiloplasty treatments to harmonise the appearance of her patients. Qual: BDS (KCL) 2013, MFDS (Glasgow)

VIEW THE REFERENCES BY GOING TO WWW.AESTHETICSJOURNAL.COM

VO T E N OW AESTHETICSAWARDS.COM Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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What Really Matters When Selecting a Toxin The importance of choosing a toxin that delivers consistent, predictable results with fast speed of onset, long duration of results, an established safety profile and high patient satisfaction cannot be underestimated. Repeat business and referrals are an essential part of a successful aesthetics business and it’s vital that patients come away satisfied with the speed of onset and the duration of results.

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Consistently high patient satisfaction Patients

Physicians

100 Individuals satisfied with treatment, %

Advertorial Galderma

0 Cycle 1 (n=945)

Predictable levels of patient and physician satisfaction Consistently high levels of patient and physician satisfaction are seen after treatment with Azzalure® (AbobotulinumtoxinA) and this satisfaction remains consistent when treatment is repeated multiple times.1,2 In one study of 945 patients more than 96% of patients were satisfied with the effect after treatment with Azzalure® (AbobotulinumtoxinA) and satisfaction levels remained high on the fifth cycle of treatment.1,2

The importance of choosing a toxin that delivers consistent, predictable results with fast speed of onset, long duration of results, an established safety profile and high patient satisfaction cannot be underestimated. Azzalure® is a toxin you can trust

Cycle 2 (n=945)

Cycle 3 (n=945)

Cycle 5 (n=553)

Figure 1: Predictable patient and physician satisfaction over repeat treatments with Azzalure®

Predictable speed of onset Patients are looking for a treatment which starts to work quickly, especially if they are accustomed to dermal fillers where the results can be seen immediately. Patients who have been treated with Azzalure® usually see results within two to three days, but some notice a difference as quickly as 24 hours after treatment.1,2

Predictable duration of response Patients are also looking for a treatment which lasts for several months. Patients report that Azzalure® injections significantly reduce the severity of glabellar lines for up to five months.1 The treatment interval observed in one retrospective study was 5.9-6.5 months.2 Maximum frown before Azzalure® treatment

Maximum frown 10 days after Azzalure® treatment, according to label

Key factors to consider • Use a product which has robust clinical data, a well-established safety profile and proven efficacy • Have a good understanding of the anatomy of the face and any facial asymmetry • Use the orbital rim rather than eyebrow position as the major reference for corrugator injections and follow the recommended treatment protocol • Attend an accredited training programme to ensure that you follow correct reconstitution and injection techniques

Cycle 4 (n=715)

Aesthetics | January 2021

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Long-lasting efficacy with Azzalure®: up to five months in glabellar lines 100

BoNT-A: investigator’s assessment BoNT-A: patient’s assessment Placebo: investigator’s assessment Placebo: patient’s assessment

Responders %

Advertorial Galderma

Azzalure® shows no loss of efficacy across multiple cycles

Consistency across repeat treatments

Since treatments need to be repeated to maintain the results, having a neurotoxin which provides predictable, consistent results is essential. Azzalure® shows no loss of efficacy across multiple cycles with similar duration of effect and onset of action seen throughout.2

50 40 30 20 10

A well-established safety profile

0 0

100

125

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***

No increased risk of eyelid ptosis or neutralising antibodies

*** ***

***

* *

10 0

AbobotulinumtoxinA has been used in a clinical setting for more than two decades and in the field of aesthetics for more than ten years. It is manufactured in the UK.1 The safety profile of Azzalure® has been established in 11 clinical studies involving more than 4,000 patients and 12,000 treatments.1,2

Study week

Figure 2: Efficacy persists for up to five months in glabellar lines and four months in lateral canthal lines after treatment with Azzalure®

Azzalure Prescribing Information (UK & IRE) Presentation: Botulinum toxin type A (Clostridium botulinum toxin A haemagglutinin complex) 125 Speywood units of reconstituted solution (powder for solution for injection) Indications: Temporary improvement in appearance of moderate to severe: • Glabellar lines seen at maximum frown, and/or • lateral canthal lines (crow’s feet lines) seen at maximum smile in adult patients under 65 years, when severity of these lines has an important psychological impact on the patient. Dosage & Administration: Azzalure should only be administered by physicians with appropriate qualifications and expertise in this treatment and having the required equipment. 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 using a sterile suitable gauge needle. Glabellar lines: recommended dose is 50 Speywood units divided equally into 5 injection sites, 10 Speywood units to be administered intramuscularly, at right angles to the skin; 2 injections into each corrugator muscle and one into the procerus muscle near the nasofrontal angle. Lateral canthal lines: recommended dose per side is 30 Speywood units divided into 3 injection sites; 10 Speywood units to be administered intramuscularly into each injection point, injected lateral (20 - 30° angle) to the skin and very superficial. All injection points should be at the external part of the orbicularis oculi muscle and sufficiently far from the orbital rim (approximately 1 - 2 cm); (See summary of product characteristics for full technique). Treatment interval should not be more frequent than every three months. The efficacy and safety of repeat injections of Azzalure has been evaluated in Glabellar lines up to 24 months and up to 8 repeat treatment cycles and for Lateral Canthal lines up to 12 months and up to 5 repeat treatment cycles. 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: Care should be taken to ensure that Azzalure is not injected into a blood vessel. 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. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery.

There is no increase in risk of eyelid ptosis with abobotulinumtoxinA and the percentage of patients reporting eyelid ptosis was less than 3% in all single-treatment studies and less than 4% in repeatedtreatment studies.2 Injection technique is the most important factor in decreasing the risk of eyelid ptosis.2 Neutralising antibodies were not detected in more than 1,700 patients after more than 4,800 treatments with abobotulinumtoxinA.2 REFERENCES 1. Azzalure Summary of Product Characteristics, Galderma, September 2018. 2. Rzany B, et al. J Eur Acad Dermatol Venereol 2010:24(Suppl 1)1-14.

Interactions: Concomitant treatment with aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curarelike agents) may potentiate effect of botulinum toxin. Pregnancy, Lactation & Fertility: Not to be used during pregnancy or lactation. There are no clinical data from the use of Azzalure on fertility. There is no evidence of direct effect of Azzalure on fertility in animal studies Side Effects: Most frequently occurring related reactions are headache and injection site reactions for glabellar lines and; headache, injection site reactions and eyelid oedema for lateral canthal lines. Generally treatment/injection technique related reactions occur within first week following injection and are transient. Undesirable effects may be related to the active substance, the injection procedure, or a combination of both. For glabellar lines: Very Common (≥ 1/10): Headache, Injection site reactions (e.g. erythema, oedema, irritation, rash, pruritus, paraesthesia, pain, discomfort, stinging and haematoma). Common (≥ 1/100 to < 1/10): Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites, predominantly describes brow paresis), Asthenopia, Eyelid ptosis, Eyelid oedema, Lacrimation increase, Dry eye, Muscle twitching (twitching of muscles around the eyes). Uncommon (≥ 1/1,000 to <1/100): Dizziness, Visual impairment, Vision blurred, Diplopia, Pruritus, Rash, Hypersensitivity, Eye movement disorder. Rare (≥ 1/10,000 to < 1/1,000): Urticaria. For lateral canthal lines: Common (≥ 1/100 to < 1/10): Headache, Temporary facial paresis (due to temporary paresis of facial muscles proximal to injection sites), Eyelid ptosis, Eyelid oedema and Injection site disorders (e.g. haematoma, pruritus and oedema). Uncommon (≥ 1/1,000 to <1/100): Dry eye. Adverse reactions 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). Prescribers should consult the summary of product characteristics in relation to other side effects. Packaging Quantities & Cost: UK 1 Vial Pack (1 x 125u) £64.00 (RRP), 2 Vial Pack (2 x 125u) £128.00 (RRP), IRE 1 Vial Pack (1 x 125u) €93.50, 2 Vial Pack (2 x 125u) €187.05 (RRP) Marketing Authorisation Number: PL 06958/0031 (UK), PA 1613/001/001 (IRE) Legal Category: POM Further 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: September 2018 Adverse events should be reported. For the UK, Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. For Ireland, Suspected adverse events can be reported via HPRA Pharmacovigilance, Earlsfort Terrace, IRL - Dublin 2; Tel: +353 1 6764971; Fax: +353 1 6762517. Website: www.hpra.ie; E-mail: medsafety@hpra.ie. Adverse events should also be reported to Galderma (UK) Ltd.

AZZ19-04-0027 DoP: April 2019

Aesthetics | January 2021

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For more product and training information visit www.sinclairpharma.com Sinclair Pharma. 1st Floor Whitfield Court, 30-32 Whitfield Street, London W1T 2RQ. 0207 467 6920 Date of preparation: February 2020

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Examination

Exploring Antidepressants and Skin Pharmacist Amish Patel discusses the negative impact antidepressants can have on the skin and how to manage them In 2018, almost one in six adults were prescribed antidepressants,1 with the number of prescriptions for antidepressants in England nearly doubling in the past decade.2 Antidepressants treat a range of conditions and, for the majority, the benefits far outweigh the potential side effects. However, for a few, this medication can affect their skin and bodies in unexpected ways. It is estimated that skin reactions caused by psychotropic drugs are twice as frequent as those caused by other drugs.3 For these patients, it can be particularly troublesome because they are already feeling low in themselves. It is also important to consider body dysmorphic disorder (BDD) patients who are frequently prescribed antidepressants and likely to be severely impacted by any such side effect.4 As such, it is important for aesthetic practitioners to be aware of the best ways to assess and treat patients on antidepressants who may present with skin concerns.

Skin complications Adverse cutaneous drug reactions (ACDRs) are usually mild, although life-threatening reactions can also occur. Factors such as female gender, increased age, AfricanAmerican ethnicity, use of multiple

medications, and the presence of a serious illness can all increase the risk of an ACDRs.5 Mild skin complications linked to antidepressants are dry skin, acne, urticaria and itching. Severe skin complications associated with antidepressant use, which are rare, include photosensitivity, erythema multiforme, Stevens-Johnson syndrome, Lyellâ&#x20AC;&#x2122;s Syndrome, acute generalised exanthematous pustulosis and drug-induced hypersensitivity syndrome.4 These severe skin conditions may result in prolonged hospitalisation, substantial disability, and even death.6 The most common conditions experienced are dry skin and acne. Antidepressants, particularly tricyclic antidepressants, have a strong anticholinergic effect.7 In blocking acetylcholine, it can lead to general dehydration, making the mouth, lips and skin cry out for moisture. There is very little literature which details precisely how acne is caused by antidepressants. Most articles focus primarily on selective serotonin reuptake inhibitors (SSRIs) as being a drug of cause.8,9 It is suggested that acne may be related to induced high activity in the serotonergic system at the dermal and epidermo-dermal junction area.8,9

When considering the best treatment for skin complications caused by antidepressants, it is imperative to carry out a thorough examination to determine severity in the first instance. Treatment of ACDRs should be symptomatic as long as the patient shows no other significant signs of a reaction. Any of the severe skin complications mentioned above would usually require a change in the offending medication and continued observation or referral to a dermatologist.5 When thinking about the treatment of mild ACDRs due to antidepressants, three key features should be considered: 1. Distribution: Determine if the dry skin or acne is limited to areas of the face or more widespread across the body. 2. Severity: Most medical professionals use their clinical judgement to define the severity, but in terms of dry skin, the specific symptom sum score (SRRC) is a moderately reliable tool,10 and acne may be classed as mild, moderate or severe according to the number of comedones and lesions.11 3. Complications: Whilst dry skin is usually harmless, when not treated, it can lead to atopic dermatitis and/or infections.11 With acne, scarring and pigmentation can occur in those with deep lesions, who delay treatment or who pick and squeeze their spots.

Treatments It is important to take a holistic approach to treatment, as often, the resolution can be found with non-prescriptive and nonpharmacological interventions. If medical intervention is required, topical therapies are generally the preferred treatment option for mild ACDRs of antidepressants, whilst oral therapy may be necessary for severe cases. Treatment for dry skin â&#x20AC;˘ Bathing and showering practices: Long showers or baths and hot water remove the natural sebum oils from the skin. I always advise my patients to limit their shower or bath to five to 10 minutes and use warm, not hot, water. Avoid harsh soaps, i.e. those containing detergents, fragrance, sodium lauryl sulfate and have a high pH, which dry the skin. Instead use those which have added oils and fats, which will leave a protective barrier on the skin to help moisturise.12 I also advise patting the skin dry. Letting the

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

B O O K YO UR T I CKET S FOR TH E AWA RD S TO CEL EBR ATE T H E ACH I EV EMENTS AN D D E D IC ATIO N O F A L L T HO SE WO RKIN G IN MEDI CAL AE STHE TIC S

A ES THETICS AWAR DS.CO M

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water evaporate from the skin will cause a higher loss of transepidermal water, so it is recommended to apply moisturiser shortly after bathing or showering to lock in the moisture.12,13 • Cleanser: It is essential to understand the importance of using a cleanser over an exfoliator. Whilst exfoliators have a role in removing old and dead skin, they also effect the skin barrier, leaving it dry and unprotected. Using a premium cosmeceutical cleanser should be at the heart of any skincare routine. These cleansers are well designed to rid the skin of the days’ build-up of makeup, bacteria, dead skin cells, dirt and excess oil without stripping it of those essential oils and keeping the skin hydrated. Avoid those containing the same ingredients found in harsh soaps. • Moisturiser: Different moisturisers have different ingredients, and each may have a different mode of action. A well-designed moisturising product for damaged and dehydrated skin will contain a combination of occlusives, humectants and emollients.14 The use of a moisturiser is pivotal and systematic use will reduce the need for corticosteroid creams. • Topical steroids: Topical steroids are usually introduced in the treatment regime after lesions do not respond to good skincare and regular use of moisturisers as monotherapy.13 The choice of topical steroid will depend on the person’s age, how severe it is and which area of the body is affected. It is important to remember that when using a topical steroid cream, advise the patient to use a moisturiser or emollient 15 minutes prior, and if using a topical steroid ointment, then to apply the ointment 15 minutes after a moisturiser or emollient.13 Treatment of acne • Non-pharmacotherapy: It is important to advise patients to avoid over-cleaning the skin (which may cause dryness and irritation), as the acne is not caused by poor hygiene. They should avoid picking and squeezing spots as this increases the risk of scarring and pigmentation.15 • Phototherapy: The use of light in the treatment of acne is increasing, as these modalities are safe, effective and associated with no or minimal complications when appropriately used.16 It is also reported that light therapy can affect brain chemicals linked to mood

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and sleep, therefore easing symptoms of various type of depression.17 Therefore, serious consideration should be given to phototherapy in ACDRs from antidepressants, as it can have a positive impact on both the cause and reaction. Benzoyl peroxide (BPO): BPO is the most widely used topical acne treatment with significant antibacterial, antikeratolytic and comedolytic activity. Unlike antibiotics, no bacterial resistance has been noted.18 Retinoids (topical): Topical retinoids such as tretinoin and adapalene work by causing the skin cells to turn over and die. This increase in skin cell turnover creates exfoliation, helping the pores stay clear and removing dead skin cells from the surface of the skin, preventing them from building up within hair follicles.19,20 It can also help reduce oily skin and pigmentation. Azelaic acid 20%: Azelaic acid has antimicrobial and anti-inflammatory properties. It can also help to reduce pigmentation, so it is particularly useful for darker-skinned patients for whom acne spots can leave persistent brown marks.21 Oral therapy: Before starting systemic therapy, a discussion of risk vs. benefit should always be taken with the individual. As acne caused by antidepressants is thought to be linked to increased activity of the serotonergic system and found to subside following discontinuation of the antidepressant, it may be more prudent to consider changing the antidepressant.8 Oral antibiotics: Tetracyclines are considered first line. Macrolides should generally be avoided due to high levels of resistance, but can be used if tetracyclines are contraindicated, for example, in pregnancy.15 Oral retinoids: Oral retinoids have the same benefits as topical retinoids. They should only be considered if the patient has not responded to two different courses of antibiotics, or if they are starting to scar. Refer to a dermatologist for initiation.15

Benefits All that said, it should be noted that antidepressant agents can play an essential positive role in the management of a wide range of dermatologic disorders.22 Some of the psychiatric disorders that are usually comorbid with dermatological disorders and respond to antidepressants include major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder and social phobia. In such cases, cutaneous symptoms may be the feature of a primary psychiatric disorder, such as cutaneous body image problems, or may be comorbid with a primary dermatological disorder, such as social phobia with psoriasis.23 SSRIs are also effective in some cases of body dysmorphic disorder, often seen in patients with cutaneous concerns, and posttraumatic stress disorder, which underlies some self-induced dermatoses.22

Conclusion Presenting complaints such as dry skin and acne are common with antidepressant use, and whilst treatment is symptomatic, it is always important to take a full medical history and take time to get to know and understand your patient. In doing so, it can help establish the best possible treatment plan, taking into consideration both pharmacological and nonpharmacological options and advice. Patients presenting with aesthetic concerns are experiencing some degree of psychological impact, and in those taking antidepressants, it can make the treatment plan that bit more challenging. Amish Patel is an aesthetic practitioner at the Intrigue Cosmetic Clinic, Kent, and an independent prescribing pharmacist at his own community pharmacy. Patel graduated from King’s College London and later completed his independent prescribing qualification in the field of medical aesthetics after training at the Royal College Of General Practitioners. Qual: MPharm, IP

Review I always like to arrange a follow-up with patients four to six weeks after starting treatment. It allows for a review on how the treatment is progressing, ensures the patient is tolerating the treatment plan, ensures adherence and gives the patient the opportunity to feedback and ask questions. Following this, follow-ups are arranged according to the patient’s response and outcomes.

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Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Understanding Vitamin D Dr Simi Adedeji shines light on the benefits of vitamin D on skin With the easing of lockdown restrictions over the summer, many of us took the opportunity to enjoy the outdoors, or even take a short break to a hot country to enjoy the sun. Interestingly, the British Skin Foundation suggested that even through the first UK lockdown many were getting more sun than usual, spending more time on balconies, in gardens, outside queuing for shops, or taking exercise.1 So most of us will have topped up our vitamin D levels for this winter. Did you know that as well as being important for calcium and bone metabolism, vitamin D has important benefits on skin health and the maintenance of a healthy skin barrier? In winter, problems of skin barrier compromise present more frequently to us in our clinics and in our patients. In this article we explore the important role of the ‘sunshine vitamin’ on skin health.

Vitamin D, vitamin D2 and vitamin D3: one vitamin? Vitamin D is not a true vitamin. It is more accurately described as a steroid prohormone due to the fact that vitamins are defined as organic (carbon-containing) chemicals that must be obtained from dietary sources because they are not produced by the body’s tissues.2 Vitamin D is primarily produced in the keratinocytes of the epidermis of the skin. Very few foods contain vitamin D (namely egg yolk and fish) so it is difficult to get sufficient amounts from our diet, hence why some foods in the UK (for example soya drinks, cereals and some fat spreads and orange juices) are fortified with vitamin D.3,4 Vitamin D exists in two forms: cholecalciferol (vitamin D3) which is produced by the skin and found in animalderived dietary sources, and ergocalciferol (vitamin D2) which is obtained from plant-derived dietary sources.5 Both forms need to be converted by the body before use and both forms have near identical functions, so they are often referred to under the umbrella term ‘vitamin D’.

Vitamin D synthesis and the epidermal machinery In the presence of exposure to UVB radiation,6 7-dehydrocholesterol (7DHC) which is found primarily in the keratinocytes of the stratum basale and spinosum cells,7 is converted to vitamin D3 (Figure 1). Both vitamin D3 and dietary vitamin D2 enter the bloodstream and are transported to the liver by a vitamin D binding protein.7 In the hepatocytes, extra oxygen and hydrogen molecules are added to vitamin D and it is hydroxylated to form 25-hydroxyvitaminD.2,5,6,8 This form of vitamin D is the major circulating form of vitamin D and is what is measured to determine vitamin D status.9 25-hydroxyvitaminD is still inactive and requires a second hydroxylation step in the kidney to convert it to the active 1,25 dihydroxyvitaminD (calcitriol). Calcitriol then acts on vitamin D receptors (VDR) throughout the body to exert its effects.9 Keratinocytes are unique in that they are the only cells in the body that can synthesise vitamin D from its precursor 7-DHC and also convert this vitamin D into its active form.9

Effects on keratinocytes Vitamin D synthesised in the keratinocytes acts to regulate keratinocyte growth, differentiation, apoptosis (programmed cell death) and skin immune responses.9 Vitamin D inhibits keratinocyte proliferation and promotes their differentiation as they migrate towards the stratum corneum.9 These processes are important in the maintenance of a healthy skin barrier as the more mature keratinocytes in the upper layers of the epidermis produce lipids, glucosylceramides and proteins, which help to form the physical barrier of the skin, protecting it from entry of microorganisms and toxic chemicals. Research has demonstrated the safety and efficacy of vitamin D analogues such as calcipotriol in treating plaque psoriasis, a condition in which there is disruption of

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the skin barrier.10,11 In vitro studies have also shown vitamin D to reduce squamous cell carcinoma by inhibiting cell proliferation, by apoptosis and by promoting repair of UVB radiation-induced DNA damage.12,13

Effects on skin immune system Vitamin D modulates the immune system and plays a role in defence against opportunistic infections. Various cells that act as part of the immune system of the skin such as monocytes, T and B lymphocytes and Langerhans cells express both VDR and the enzyme that activates vitamin D. Vitamin D inhibits activation and function of antigen-presenting cells (APCs) which dampens the immune response and therefore promotes immune tolerance.9,14 Vitamin D increases the production of antibacterial proteins cathelicidin and B defensin by keratinocytes.6,7 Antimicrobial peptides have antibacterial, antifungal and antiviral effects, attract immune cells to the site of injury and are important in wound healing.14,15

Effects on hair biology The keratinocytes of the outer root sheath of the hair follicle express VDRs. Activation of these via vitamin D promotes differentiation of the keratinocytes and inhibits their proliferation which affects progression of the hair cycle.16 Studies with mice that lack the VDR receptors have been shown to suffer from alopecia, suggesting that vitamin D is important for hair growth.17,18,19

Effects of vitamin D on skin health The effects of vitamin D in skin health are better understood by studying skin disorders. There are now several studies available which have linked vitamin D deficiency to a variety of skin disorders including: psoriasis, atopic dermatitis, ichthyosis, acne, hidradenitis suppurativa, vitiligo, systemic lupus erythematosus, polymorphic light eruption, alopecia areata, melanoma and non-melanoma skin cancers.5 Factors affecting vitamin D synthesis Factors that affect the ability of the skin to produce vitamin D include:6,8 • Latitude: people living at higher latitude (where the intensity of sunlight is lower) synthesise less vitamin D in their skin compared to those living nearer the equator.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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UK recommendations for vitamin D supplements

solar UV-B (290-315 nm) radiation Stratum Corneum

LOCAL PRODUCTION OF ACTIVE FORM CYP27A1 7-DHC

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24,25(OH)2D3

Figure 1: Vitamin D synthesis and pathway

• Time of day: more vitamin D is synthesised in the keratinocytes during the hours of 11-3pm when the sun is at its most intense. • Fitzpatrick skin type: melanin competes with 2-DHC for the absorption of UVB radiation, therefore there is reduced synthesis of vitamin D in darker-skinned individuals compared to lighter-skinned individuals exposed to the same amount of UVB radiation. • Age: with age, the skin produces reduced amounts of 7-DHC. There are reduced numbers of VDR on intestinal cells and the body’s ability to hydroxylate vitamin D in both the liver and kidneys is also reduced, leading to increased likelihood of vitamin D deficiency.5 • Amount of skin exposed: the larger the surface area of skin exposed to sunlight, the greater the amount of vitamin D synthesis for a given period of time. Skin of colour and vitamin D Melanin in skin of colour absorbs UVB rays, thereby reducing the amount available for vitamin D synthesis in the epidermis. As a result, individuals with naturally darker skin tones require at least three to five times longer UVB exposure to make the same amount of vitamin D as individuals with fairer skin.20 Therefore,

vitamin D deficiency is more common in skin-of-colour patients. As aesthetic practitioners, we should advise our skinof-colour patients of an increased risk of vitamin D deficiency and advise that they follow Public Health England (PHE) guidance regarding the consideration of oral supplementation all year round. We may also offer advice or sign post to resources which detail food that are rich in vitamin D.

Vitamin D deficiency and implications of using sunscreen SPF in sunscreen refers to how much UVB is blocked. UVB is also responsible for the generation of vitamin D by keratinocytes so one can see how it can be concluded that sunscreen use could lead to vitamin D deficiency. However, several studies have now shown that whilst there is the theoretical risk of vitamin D deficiency with sunscreen use, in practice, the risk is low, and sunscreen use in real life is not associated with vitamin D deficiency.21-23 This is largely because people tend to apply less sunscreen than they should. As a rough guide an average sized adult would need to use 2mg/cm2 of sunscreen which is about six teaspoons (36g) to cover the whole body or approximately half a teaspoon to cover the face/neck/ears.24

PHE advises that in the autumn and winter (October to early March) when there is less sunlight, people living in the UK should consider taking daily vitamin D supplements as it is difficult to meet these requirements by eating food naturally containing or fortified with vitamin D.14 PHE also advises that people who have little or no exposure to sun, for example people with dark skin, skin which is always covered or who live in care homes, should consider taking vitamin D supplements all year round.14 The recommended doses are:14 • Adults and children age one and above: 10mcg/day (400iU/day) • Children under one year: 8.5-10 mcg/ day (340-400iU/day) unless the child is consuming >500mls of formula milk a day as this is already fortified with vitamin D Vitamin D supplements may not be suitable for those who have an allergy to vitamin D, sarcoidosis kidney stones, hypercalcaemia, hypervitaminosis D, reduced kidney function, or liver disease.25,26

Conclusion Vitamin D is mainly made by keratinocytes in the skin. As well as the commonly discussed role in bone health and calcium metabolism, it also has an important role to play in skin health. The role of vitamin D in skin biology and skin immune function is complex, however, what is clear, is that vitamin D is essential for the maintenance of a healthy skin barrier and it plays a role in several common dermatological conditions. Dr Simi Adedeji graduated from Imperial College London with a Bachelor of Medicine, Bachelor of Surgery and Bachelor of Science. She is a former surgeon, working now as a GP partner and aesthetic practitioner. Dr Adedeji has more than 13 years’ post graduate medical experience and is the founder and medical director of Dr Simi Medical Aesthetics. She has a special interest in treating skin of colour and also has a diploma from the faculty of sexual and reproductive health. Qual: MBBS, BSc, MRCS, MRCGP, DFSRH

VIEW THE REFERENCES BY GOING TO WWW.AESTHETICSJOURNAL.COM

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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A summary of the latest clinical studies Title: An Evaluation of the Efficacy of a Single-Session 577 nm Pro-Yellow Laser Treatment in Patients with Post-Acne Erythema and Scarring Authors: Gulbahar S, et al. Published: Dermatologic Therapy, December 2020 Keywords: Pro-yellow Laser, Post-acne Erythema, Acne, Acne Scarring, Vascular Laser Abstract: Erythema and scarring are among the most common complications of severe inflammatory acne. In this study, we aimed to share our experience with pro-yellow laser and document the efficacy and safety of this treatment in post-acne erythema and scarring. The study included 40 patients, 24 (60%) females, and 16 (40%) males with a mean age of 29.5 ± 8.16 (min. 18 years, max. 57 years). The pro-yellow laser was applied to all patients as a single session with irradiation of 22 j/cm2. Improvement in post-acne erythema and scars were evaluated after the treatment. The study included 40 patients, 24 patients (60%) were females and 16 patients (40%) were males with the mean age of 29.5 ± 8.16 (ranged between 18-57 years old). A total of 21 patients (52.5%) had good improvement (51-75% regression), 10 patients (25%) had excellent improvement (76% -100% regression), and a moderate improvement (26-50%) was detected in 9 patients (22.5%). Also, there were mild improvement (1-25%) in 20 patients (76.9%) and a moderate improvement (26-50%) in 6 patients (23.1%). We found that pro-yellow laser is highly effective in the treatment of post-acne erythema, while its effectiveness was mild to moderate in atrophic acne scars. Title: Cryolipolysis (CLL) for Reduction of Localized Subcutaneous Fat: Review of the Literature and an Evidence-Based Analysis Authors: Bishara A, et al. Published: Aesthetic Plastic Surgery, December 2020 Keywords: Body Contouring, Cryolipolysis, Lipocryolysis Abstract: In recent years, cryolipolysis (CLL), a noninvasive approach based upon the inherent sensitivity of adipocytes to cold injury, has emerged. However, it is not clear whether available evidence to date about its efficacy justifies aggressive marketing and extensive widespread application by many practitioners without well-defined indications or objectives of treatment. A systematic search of PubMed and Scopus computerized medical bibliographic database was conducted with the search terms “cryolipolysis”, “lipocryolysis”, and “cool sculpting.” Selection criteria included all matched reports with the search terms in their titles. Thirty-two reports matched the inclusion criteria of this review. Five experimental studies were identified and included to further supplement the discussion. Most reports about CLL included in this review lacked rigorous scientific methodology in study design or in outcome measurement. Further research should be encouraged to prove with methodological rigor positive effects of this treatment modality and to determine categories of patients in whom most favorable outcomes might be expected.

Title: Evaluation of Physicochemical Properties Following Syringeto-Syringe Mixing of Hyaluronic Acid Dermal Fillers Authors: Goldman M, et al. Published: Dermatologic Surgery, December 2020 Keywords: Dermal filler, Injection, Hyaluronic Acid, Abstract: Historically, soft-tissue hyaluronic acid (HA) fillers have been mixed with agents to reduce pain or alter physicochemical properties. The purpose was to evaluate the impact of dilution and mixing on HA filler physicochemical properties. Crosslinked HA filler (VYC-20L, 20 mg/mL) was diluted to 15 mg/mL using saline through 5 or 10 passes between 2 syringes connected using a luer connector. Extrusion force, rheological properties, and microscopic appearance were assessed. Undiluted VYC-15L (15 mg/mL) served as the control. Average extrusion force was higher for diluted VYC20L versus the control, with an increase in slope for gel diluted using 5 passes (0.65) and 10 passes (0.52) versus the control (<0.1). For diluted samples mixed with 5 or 10 passes, the rheological profile was different between the 2 halves of the syringe, with the second half more elastic than the first half, compared with the consistent profile of undiluted samples. Microscopically, diluted VYC-20L samples seemed more liquid near the luer and more particulate near the piston compared with the control, which was smooth throughout. In addition to potentially introducing contamination, diluting or mixing soft-tissue HA fillers yields a heterogeneous product with physicochemical characteristics that vary substantially throughout the syringe. Title: Choosing the Right Partner: Complementing Prescription Acne Medication With Over-the-Counter Cleansers and Moisturizers Authors: Lain E, et al. Published: Journal of Drugs and Dermatology, December 2020 Keywords: Dermatology, Acne, Skin, Skincare Abstract: Acne is the most common dermatological disorder. An impaired barrier function in acne vulgaris has been reported, as well as decreased amounts of epidermal ceramides. Also, many of the systemic and topical medications prescribed for the treatment of acne exacerbate these skin barrier disruptions and can lead to irritation and dry skin conditions. The review explored the importance of maximizing adjunctive skincare, such as over-thecounter products for managing acne and avoiding adverse effects. A literature review was conducted and included clinical acne guidelines, clinical studies, and review articles on acne prevention, treatment, and maintenance. Two clinicians manually reviewed selected publications. Seventy-four articles were included in the analyses. Lipid-free cleansers were found to be the most appropriate type of cleanser for acne-prone skin as they were associated with a low risk of skin irritation, and a near-physiological stratum corneum pH. Moisturizers typically included ingredients such as humectants, emollients, oil absorbers, and those with anti-inflammatory and/ or barrier replenishing properties. Given the various adjunctive products available, decision frameworks were created for clinicians to use when selecting over-the-counter cleansers and moisturizers for acne-prone patients.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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possess with an effective, straightforward guide to build influence, you’ll be well on your way. Now, let’s have a look at the four key steps to distinguishing yourself as an aesthetic practitioner.

1. Finding a niche

Distinguishing Yourself as a Practitioner Dr Uche Aniagwu outlines his four steps to success As human beings, our brains are conditioned to spot those things that stand out in a crowd; it is an important survival instinct we all share. But while our days as predator-or-prey are long behind us, we’ve continued developing this knack for noticing outliers and have even learnt how to use others’ skills of perception to our advantage. Survival on the modern savannah – our global economy – is predicated upon a business’s ability to stand out amongst the competition. This market force holds especially true in the world of aesthetics, where the difference between thriving enterprise and withering on the vine often comes down to distinguishing yourself from the competition. But for many of us with medical backgrounds, the practice of standing out goes against the grain in which we were trained, and for good reason: the standardisation of our training is meant to ensure replicable quality of service. With this in mind, it’s no surprise that many aesthetic practitioners are struggling to lean into what sets them apart. Our colleagues’ responses to a recent questionnaire truly highlighted these struggles:1 • 60% of the 350 practitioners questioned felt their greatest challenge was increased competition within the aesthetics industry • 54% of practitioners believed marketing was their greatest struggle

The fascinating, and revealing, thing about those two statistics is their inextricable link. Fear of increased competition is directly correlated with a lack of confidence in effectively marketing oneself. But should we practitioners be more confident? The answer is no, for most, often because we make a crucial mistake. Many practitioners market themselves as businesses would, when our true value proposition lies almost entirely with our medical skills and knowledge. So, in order to effectively market, and thus distinguish, yourself, you must apply strategies that play to those strengths and cement your status as a person of influence: someone with a transformational idea in their field of expertise. In doing so, you will separate yourself from other offerings and break competition-driven price resistance, increase foot traffic, and open opportunities for multiple income streams. Distinguishing oneself successfully as an aesthetic practitioner may come naturally to some, but for those of us where it doesn’t, there is a method that can be replicated to near certainty: put simply, divide and conquer your target audience. Once you have partitioned your audience, these new sects will be looking for leadership – that’s where you come in. Modern-day marketing and influencebuilding really are that simple! By supplementing the knowledge you already

This step is number one for a reason. Finding your niche is crucial for identifying the subgroups that you are most likely to attract, with an ultimate goal of shaping the identity of this group and its consumption habits. For example, at some point nonsurgical aesthetics existed within the broader cosmetics group, until someone decided that these people needed their own sect. Nowadays we see more of this funnelling happening and even within subgroups – like the lip ‘Kings and Queens’ of non-surgical cosmetics, or to go another step deeper, those focussed on natural lip results. Drilling down to your core niche will help you distinguish yourself in two very important ways. First, it helps define who you are and what your sphere of influence is, just as you’ve done with your audience. A welldefined niche should be self-explanatory, thus making your marketing as organic as possible. Secondly, your niche will attract those who have long been grouped with others similar to them, but who have yearned for a community more focused on their (and your!) specific interest. By helping to create this space, you will be well-positioned to lead and establish your authority. Invariably the toughest part of finding this niche is actually finding it. But the most straightforward way I’ve found to approach it is by listing all the different types of patients you have and analysing some of their distinguishing features: treatment type, presentation or specific demographic are all great starting points. From there, choose one of those subgroups and ask yourself, ‘how can I best serve them?’ It’s worth noting that your niche of choice should be an area where you are already professionally comfortable. For some of you that maybe a type of skin treatment or a subset of filler patients. However, if you find you are drawn to niche where you do not feel you have total command then it is sensible to focus solely on enriching your knowledge in the area, be that through research or training. Oh, and if you’re afraid of alienating other existing patients, consider creating new social media accounts and patient-facing platforms that demonstrate your new focus.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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You’ll know that you’ve nailed your niche when your influence in the space begins to expand and your message begins to resonate with those whom you’ve attracted. You also now know where to focus the majority of your attention.

2.Creating a pitch Once you have discovered your niche, you’ll now need to communicate your value and vision to the group. Straightforward right? Actually, no. The challenge here is to succinctly state what you can do for your target audience, but with an eye for what distinguishes you from other practitioners vying for their attention. There are multiple places where you can pitch that allow you to distinguish yourself from your competitors. The first place that this should happen is your website or your shop front if you like. Besides that, everywhere you interact with the public, especially your potential audience, is an opportunity to pitch yourself. That could be in magazines, professional events, LinkedIn and other forms of social media. The aim here is to become known for your area of expertise and be the at the forefront of people’s mind when they consider your niche. The underwhelming reality is that if you browse the Instagram bios of most aesthetic practitioners, you’ll find nothing that communicates how what they do is any different from the rest. In fact, without the photo, most profiles would come off exactly the same. How then can you be at the forefront of anybody’s mind in a hyper competitive market. Furthermore, your customer acquisition cost will be far higher than the practitioner who is well distinguished and has customers approaching them. Use the following pitch formula in all scenarios to leave a lasting impression: A good pitch combines what + how + who; for example: What = under-eye enhancement How = non-surgical Who = people with puffy eyes

3. Publishing Publishing in the world of aesthetics serves the very important purposes of expanding your reach and establishing yourself as a thought leader in your newfound niche. Putting your ideas to paper will boost what I like to call your ‘trust score’, like a credit score for your professional credibility. And as your trust score grows, so too does your influence and marketability within the space. More

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often than not, practitioners fail to publish because they have no area of focus; they’re generalists who rarely possess a sub-topic on which they feel like an authority. But if you’ve mastered the previous two steps, you already possess the focus and confidence required to transition from a consumer to a sharer of knowledge. Publishing in this sense can mean anything from articles in a magazine to releasing a book. I advise practitioners to publish books where possible as this is the most credibility-enhancing type of publication. I can appreciate that releasing a book may seem daunting, but it really comes down to the message you want to communicate and to whom. The beauty of writing is that there is no right or wrong way of doing it. Furthermore, publishing a book today is straightforward; Amazon Kindle Direct Publishing allows for writers to self-publish with all the required guidance provided. Remember the content of your book can take any format from ‘tips and tricks’ to even a picture book. In the case of magazine articles, ensure you stay focused and specific in your written pieces, and be sure to have your pitch at the forefront when you approach the editors. While you may have less creative expression in what you produce, the only true way to tailor your content appropriately is to have a conversation with the editors of your chosen magazine. Always remember your audience. These original pieces will further distinguish you from the pack and help to begin turning the tides of competitive market pricing in your favour. Most of us know celebrated aesthetic practitioners; they are often the ones publishing books and articles, because they know just how important thought leadership is for building a brand. And while their service prices are always far-higher than the industry average, their businesses will continue to thrive.

4. Creating a product The final step in distinguishing yourself as an aesthetic practitioner is to create a product that leverages your knowledge and services a specific need of individuals in your niche. As with the target audience itself, there are boundless possibilities for the size, scope and purpose of your creation; successful products can come in the form of treatment instruments for other practitioners, skincare products sold directly to the consumer and even online courses for colleagues and laypeople alike. A product speaks directly to your authority and expertise in an area, so make it personal,

and, if applicable, something you yourself would use. Building a successful line of products will bring you into the coveted realm of multiple income streams, but more importantly, it will further establish your brand and continue to distinguish you amongst your peers. Surely, launching a product must be massively time consuming and expensive? Well, on the contrary, it can be relatively fast and cheap depending on your approach. There are many white label products that can be customised to meet your needs and often these production centres provide the guidance to ensure your product meets all the necessary standards to be sold. Furthermore, depending on your aspirations, I suggest producing only 250 or fewer units of your chosen product and using the data from those sales to drive investment externally into your product. This allows you to scale faster and without too much cost. This stage of your career is best executed when you have successfully completed the other steps and distinguished yourself enough such that you have a dedicated following within your target audience.

Take the first steps So to the majority of aesthetic practitioners – those who say they are struggling to stand out – rather than fear growing competition in the industry, see it as the opportunity that I believe it is. If you follow the steps that I’ve laid out, you will have no problem distinguishing yourself, even as more practitioners enter the field. You see, as an established authority in your space, two sets of patients will begin to emerge: the general public who want to purchase your products and your peers who will be keen to learn from you. For those who invest in their influence, the possibilities are endless. Dr Uche Aniagwu is an aesthetic practitioner specialising in under-eye rejuvenation. He is a resident injector at Beyond Medispa, Harvey Nichols, as well as the founder and clinical lead of the Under Eye Masterclass training programme. Since the release of his second title, The Modern Healthcare Professional, Dr Uche has aimed to support many healthcare professionals to distinguish themselves, thereby building their medical influence and businesses within aesthetics and other private fields. Qual: MBBS, BSc, Msc REFERENCES 1. Fraser, H. Hamilton Fraser Cosmetic Insurance Annual Survey (UK: Hamilton Fraser, 2020) <https://hamiltonfraser.co.uk/ knowledge/hamilton-fraser-cosmetic-insurances-annualsurvey/>

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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2. Enhancing personal development

Improving Time Management to Increase Revenue Nurse prescriber Natali Kelly outlines her five steps to better utilise clinic time When running a busy clinic, we are often juggling all aspects of the business, from bookings, consultations, treatments, aftercare, sales, admin, accounts, brand awareness, PR and marketing. All of these tasks can be time consuming, and it’s often hard to manage your time effectively. This was the case for me when I started my business 10 years ago. This article will discuss the solutions and tips I have developed in order to manage my time effectively and increase my revenue.

1. Planning ahead Diary management is paramount to running a successful clinic. We use the Pabau CRM system to manage the daily bookings and I’ve hired a clinic coordinator to oversee the effective handling of all of the practitioners’ diaries. We have no online booking system, preferring the personalised service of booking over the phone or email, which the clinic coordinator handles. While this may take a little longer, I believe it’s essential to building strong relationships with patients because it’s much more personable, which keeps them returning to clinic and ultimately enhancing your revenue. For me, to be as productive as possible, I prefer to use Mondays as my admin day: ensuring stock is up-to-date (which I accomplish with my clinic coordinator), setting weekly goals, developing my brand and planning social media. I am quite hands-on with the social media as I feel it’s more authentic if it’s conceived by me personally, but the clinic coordinator also assists. I have tried several applications to make the scheduling easier: Later.com and Hootsuite both had their benefits, but I prefer an app called Planoly which allows you to schedule posts for the week and review engagement, meaning that we can get it all done at once and keep on top of maintaining a very visible presence across my social platforms. Furthermore, I try to have any meetings and in-house training sessions (on clinic systems and treatment protocols) on Mondays, so as not to interrupt my clinic days and my focus on patients. We have put in place many different changes to conform to COVID-19 protocols and, whilst we inherently are able to get fewer patients through the door, the positive is that it has allowed me to coordinate strict appointment times, which has given me the chance to perform very detailed consultations, as well as allowing me to upsell and to ensure patient satisfaction. I imagine many others are doing similar but, if you’re not, I would highly recommend it.

Do not underestimate the importance of investing in your own expertise. I allow time each week to enhance my skills, whether this is CPD, online studying, reading, training courses or teaching, as well as attending educational talks. Not only is this a great opportunity to learn but also to network and increase your support system. These talks have included business management education which has taught me about focal points and priorities, as well as many more specific elements of running your own business. From a networking point of view, these have really helped me to build links with practitioner with whom I can cross-refer and perform activities such as Instagram Lives, which help to build my brand and patient base. From a time-management perspective, these elements really help as they facilitate the brand to grow organically whilst I focus on my craft.

3. Recruiting a team Employing and training a team can be challenging, in particular trusting others to deliver the same standard of care that I do. For this reason, I have been an independent practitioner for a long time. Nevertheless, I now realise the limitations of this and am expanding my team and moving my clinic to a three-story townhouse with three treatment rooms and a wellness lounge. I will collaborate with a small team in-house and work with established visiting practitioners to provide a 360 approach to aesthetics, beauty and wellness. Delegation is one of the most important things I have learnt as, now I have brought new people in, I can focus on the treatments I love and feel that I excel in. Furthermore, I have invested in people who specialise in very different fields so as to expand my clinic’s offerings. If you don’t yet have the budget to recruit new team members, I would recommend looking at ways to upskill your existing team. For example, is there a social media course that your receptionist could attend? Or perhaps you could train your therapist how to take bookings or offer a new skin treatment? And if it’s just you working in your clinic, consider outsourcing other tasks to support partners, as detailed next. Doing so can save you time, help to build revenue and be more cost effective than employing new staff!

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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4. Investing in support partners I work with digital skincare platform Get Harley which helps me to carry out virtual skincare consultations with existing and new patients. It is a great service, combining technology and skincare with global delivery, and this really assists us in managing stock as they organise product logistics. It also saves us time by giving our patients amazing postconsultation care and service through 24/7 support and auto-sales, which help to scale my time and increase my turnover. As mentioned previously, Pabau has proven to be a Godsend when it comes to organising the day-to-day business. I also work with PR and marketing agency Mantelpiece PR who take off some of the burden when it comes to promoting the brand and helping to gain press coverage, while I outsource my legal and financial issues to an accountant and a law firm who have special expertise in these areas.

5. Making time for yourself I believe it is imperative to have a support system in place including family, friends and colleagues, while it’s also vital to take

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time for yourself. As an energy healer and empath, I can find the job of an aesthetic clinic owner and practitioner to be quite energy draining. I take aromatherapy hot salt baths after every clinic, as well as often using Palo Santo wood sticks and crystal healing in and out of clinic to cleanse my space. My brand’s ethos incorporates wellness, so for me, using meditation, exercise and a healthy diet allows me to perform at my best, to destress and to retain a positive and calm manner. Doing so allows me to better manage my time, which has a beneficial impact on my patients and, thus, leads towards increased revenue opportunities.

you the security and balance to keep you grounded to perform at your best. This continued level of excellence will no doubt result in increased revenue. I hope that incorporating some of the proven solutions discussed will increase your profitability and happiness. Natali Kelly is the founder and medical director of Natali Kelly Clinic. She has more than 10 years of experience in the industry and specialises in facial contouring. Kelly has set up successful collaborative clinics and has now launched her own flagship clinic in Chelsea. Qual: RGN, INP, PGCert ODP (Anaesthetic)

Summary I think it is important to implement strategies and solutions to ensure you are working efficiently. Being an aesthetic practitioner and owning your own clinic can be a very rewarding role emotionally, mentally and financially, if you can manage your time effectively. Being committed to managing your time, investing in yourself and having a support system will give

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www.sciton.co.uk 020 3318 1108 Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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Writing a Clinical Case Study Dr Zunaid Alli provides his tips for getting your case studies considered for academic publication The practice of aesthetic medicine in the UK is made up of a wide range of medical professionals. In a review of backgrounds of presenters at an international conference related to aesthetic medicine, the author noted 83% of the speakers had not contributed to any peer-reviewed literature that was relevant to the subject of their presentation.1 They concluded that the results might fall below the threshold deemed acceptable for practitioners presenting themselves as experts in a branch of medicine and might reflect a critical dearth of evidence-based practices in aesthetic medicine. As the evidence-base for aesthetic medicine continues to grow, it should be noted that there are challenges to publication due to the subjective nature of outcomes.2 Through my experience in training aesthetic practitioners in the UK, I believe these barriers may include: • English may not be the practitioner’s first or main language or perhaps not the medium of study of primary medical degree or qualification • Scientific or clinical research design, analysis or academic writing may not have been taught during tertiary study • Post-qualification, there are very limited amounts of taught courses in medical academic writing • Most aesthetic practitioners work as lone clinicians with a lack of senior support or mentorship • Aesthetic treatments are often not deemed ‘medical’, so practitioners are often not hired or sponsored to conduct clinical research In this context, case studies may be helpful in providing data for this level of evidence. Case studies are ways to explain, describe, or explore phenomena.3 They are based on in-depth investigation of a single individual, group or event to investigate the causes of underlying principles.4 There is important applicability for lone practitioners in aesthetic medicine as case studies may help in clinical decision making about best patient care in evidence-based practice. The scope of this article is to assist aesthetic practitioners with some tools and tips to be able to use their own clinical experiences, as well as to work through the barriers that they may face, in order to be able to write a case study for academic publication and help progress the aesthetics field.

Journals and submission criteria As a general rule for publication to journals, a prospective author needs to be aware that a submission for one particular case study needs to be made to one journal at a time. It is not recommended to submit the same article to multiple journals and to await the first accepted submission. It may be feasible for the prospective author to submit the case study to subjectspecific journals first, followed by specialty or subspecialty specific journals as a second and wider subject specific journals thereafter. Prospective authors need to be made aware that each journal will have their own criteria for Guidelines/protocols/ clinical advice

Poor industry regulation/ ethics/advertising guidelines

Management of haematoma and bruising: NSAID drugs, steroid therapy, vitamin K creams, heparin, tranexamic acid, arnica

Poor quality dermal fillers

Poor patient care & follow up

Bruising and haematoma formation following hyaluronic acid lip filler augmentation

Make dermal fillers POMs/MHRA regulation of medical devices

Difference between vascular occlusion and haematoma

Figure 1: Brainstorm of possible areas of focus in order to formulate a research question/ statement which will be the focus of your case study

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submission of articles and that there may be limited place within an edition to include a case study. Some journals will accept articles that are already written, while others may prefer to work with the author to outline their specific requirements first, as is the case with the Aesthetics journal. Images form an important part of a case study, so authors should ensure that if images are submitted with the case study, that they are of exceptionally high quality and with high resolution. Any before and after pictures need to have consistent parameters. As a general rule, I have found that a case study generally consists of 800-1,500 words in the main body of the article and it is acceptable to allow for at least six to 10 references per 500 words. This is dependent on the subject area and the availability of published references on the topic. Authors should ensure that all work is appropriately referenced and paraphrased to avoid plagiarism. The case study article should be thoroughly referenced according to the guidelines set forth by the editors of the journal. The format for the referencing will usually be according to generally acceptable academic formats such as the Harvard method of citation, American Medical Association, American Psychological Association, Modern Humanities Research Association or footnote referencing, Modern Language Association and the National Library of Medicine. While submission to most journals is free, prospective authors should be aware of underlying costs such as submission fees, editorial costs or publication costs, which they may be made aware of prior to publication. Examples of journals and publications for aesthetic medicine include: Aesthetics journal, PRIME journal, Journal of Aesthetic Nursing, Aesthetic Medicine magazine, Journal of Cosmetic Dermatology, The Journal of Aesthetic and Clinical Dermatology and Plastic and Reconstructive Surgery – Global Open, to name a few. Note that not all of these are peer-reviewed, however may still be very useful for sharing knowledge and experiences.

Case study writing First you should think about the topic of the article or case study. Most journals like to publish cases that are unique or different to what has been published before, showcase excellent clinical outcomes, or have interesting findings or learning outcomes. One example could be the resolution of

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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an aesthetic dermal filler complication of a patient presenting with bruising and haematoma. You should formulate a research question or statement based on the presentation of the patient. I find that a brainstorming session is key to direct the focus of the case to choose one or more suitable areas as the main focus of the case study (see Figure 1 as an example). Following this, a detailed literature search would be done to enable detailed scientific analysis of the case. Literature review For the purposes of this article, the research statement chosen as a focus from Figure 1 would be the management of bruising and haematomas following dermal filler injection for lip augmentation. A detailed search for evidence-based publications should follow. You should sift through these articles for the most relevant and updated ones to help support the research question. A period of appraisal and analysis of the articles will allow for a detailed summary of the major themes identified, such as conclusions or outcomes, that support or contradict the findings/management. The references for each of these will now start the compilation of the reference list. It is best to use larger and authenticated search engines such as PubMed, Embase, Google Scholar, BMJ Best Practice, ACE Group (for guidelines and protocols), or other published source in aesthetic medicine. NICE guidelines may also be used and referenced if appropriate. In terms of search terms or medical search words, it is recommended to use the Boolean search strategy to help streamline the results found. This is using words such as AND (narrows search results), OR (broadens search results), and NOT (narrow search results by eliminating specific words or phrases).5 Using a PubMed Central search or a keyword search may also be helpful. Most search engines will have capability to search an authorâ&#x20AC;&#x2122;s surname if it is known or between a date range, for example. It is helpful to include American spelling of medical terms, such as haematoma vs. hematoma, to allow for a more detailed search. The results will need to be manually evaluated and appraised for content in relation to the research question/statement. The structure and writing up The blurb or the modified abstract would come first, but as case studies are usually word restricted, they are not always required.

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This section provides a short snapshot of the details of the study so as to capture the attention of the reader. It may be used on the inside cover of a journal, contents page or index, or on social media posts. Introduction The introduction needs to be short and to the point. Consider, why is this article being written, what makes it different and unique? What has the author learnt from it or what is the reader likely to learn from it? Set the scene by giving the clinical background of this case in paragraph form. For a case study, your intro should include: the age of the patient, why they presented to clinic and their concerns. Body The body of the article brings the clinical scenario to light and explores your research question and literature search together. It should also provide a linkage as to what published articles or guidelines say versus the clinical management of the patient. This section is advised to make up at least two thirds of the entire word count. It should include details about the consultation, treatment plan, pre and post procedure approach, as well as any side effects or complications, and the patient outcome and follow-up. Conclusion The conclusion is also succinct and aids in summarising the main points and findings. As this is a clinical case, summarise what went well, what could have been done better and include some information on further learning. You would usually not require referencing in your conclusion unless you are bringing to light new information, which you generally should have done in the sections above. It is advised that both the introduction and conclusion share roughly one third of the word count.

Submission It is useful to note that most journals are strict on word counts and any deviation from the agreed counts should be stated with explanation on submission. Allow for time to proofread and allow for colleagues or peers to critique with enough time allocated for editing. Following this, each journal will have their own process to follow after submission. Do not expect editors to correct errors in sentence construction or word use. If any editing is suggested, be prepared to take constructive criticism on board and use this to rework your article. This needs to be done beforehand

to ensure that a well thought out and written article is submitted. Do not be disappointed if your article is not published, as some journals may decline for publication after submission of a piece of work that you have worked on for a while. As previously described, re-edit and submit to the next journal on your list. Ensure that submission dates and deadlines are adhered to at all costs. Editors usually have strict deadlines and if there are any problems with editing and submission, it is important to communicate this with your editor. If you are submitting to a peer-reviewed journal, expect that the process may be significantly longer due to submission of the case study to multiple researchers for comment, followed by ratification and discussion and then re-editing before publication.

Summary The writing of a case study for publication is an excellent way for prospective authors to get started with academic writing. It is important to keep focused on the research question and to search for current best evidence using search terminology to support the clinical subject area. Write up the article using clear, understandable language and be prepared to do a fair amount of retrospective editing on the article before publication. Dr Zunaid Alli is an aesthetic practitioner with a background in general medicine, emergency medicine and oncology. Dr Alli is a key opinion leader and masterclass trainer for VIVACY UK and is the lead clinical trainer for Glow Aesthetic Training. Dr Alli is an associate at The Banwell Clinic. Qual: MBBCh, BSc, BScHons (Psychology), MBA

Want to write for the Aesthetics journal? We are always looking for interesting and unique articles to be published in Aesthetics to further the learning of practitioners ChloĂŠ Gronow Editor & Content and to progress the Manager aesthetics field. If you have ideas for us to consider for publication, contact editorial@aestheticsjournal.com.

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

Empowering confidence. Allergan Aesthetics, an AbbVie company, is going further than ever before to drive the advancement of aesthetic medicine. We continue to create whatâ&#x20AC;&#x2122;s next in the industry, making sure our customers are supported, so they can focus on achieving the desired outcomes for their patients. We believe in the power of confidence â&#x20AC;&#x201D; and the remarkable impact it can have on the businesses, lives, and careers of those we serve. United by our commitment to making every practice our purpose, we build lasting, productive relationships with our customers. To empower confidence.

Produced and funded by Allergan Aesthetics. Date of preparation: November 2020 UK-NON-2050306

Learn more at allergan.co.uk

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Hosting an Event During the COVID-19 Pandemic PR consultant Jenny Pabila explains how to host a successful launch event when social distancing restrictions are in place Hosting a live event offers the opportunity to showcase your brand or products to the press and potential patients, as well as engage in conversation with them, and develop and strengthen beneficial relationships. Given the current COVID-19 pandemic restrictions, it can be quite overwhelming to consider planning and hosting an event that needs to meet the requirements of social distancing and ensure that attendees feel safe and secure, whilst also abiding by local regulations. Whether you are a practitioner, clinic owner, distributor or brand founder, this article will share advice on all the basics you need to consider for your live event to run smoothly, despite the ongoing pandemic restrictions.

Event planning Once you have identified the purpose and date for your event, which I discuss in more detail in a previous article published in Aesthetics,1 it is important to invest time in planning it in exact detail. Attention to detail increases event success, particularly in the current landscape. It can be useful to create tools to help stay organised, such as a table outlining the schedule of the day down to the minute, together with a critical path covering all the event production planning. A critical path is a dated to-do list detailing everything that needs to be done by everyone in the run up to an event/campaign.2

Use virtual technology where possible By utilising virtual technology, you will be able to schedule meetings with all stakeholders involved in the event, such as product distributors and external PRs. It’s important that all parties are included in the event schedule planning, particularly so they are aware of your COVID-19 social distancing policies and where physical interactions might be taking place to limit this as much as possible. Consider your guest list With the current COVID-19 pandemic restrictions, you should calculate the maximum number of attendees that can be accommodated throughout the launch event duration, to ensure that the optimal social distancing is observed. This will depend on the spacing and logistics of

each individual clinic/location. In addition, when curating your guest list, consider researching the geographic location of your attendees and if the event location is accessible by walking or personal transport, thereby minimising their exposure to public transport. By keeping open, transparent and honest communication, you can share your care and concern to maintain social distancing for guests to travel to attend your event, without compromising their safety, that of your team, the location staff and anyone else that will be involved in the event. When running a press event, if your attendees are based nationally, then another option would be to consider a virtual event instead. I would also currently recommend a virtual event if the topic or reason for the event can be successfully communicated digitally. For example, if you just want to invite people in for an event to showcase your general services, perhaps now isn’t the right time, and an interim virtual event or a physical press launch held later in the year would be more appropriate. On the contrary, if you are the first clinic to be launching a new product in the UK, then it might be necessary to have the event sooner. This was the case for a recent launch event I helped organise with Dr Preema Vig and Cutera to introduce the truSculpt flex device to the UK market. It was crucial to have a live event for this launch to secure public awareness and success of the treatment in the clinic. Communicate well with attendees Send out digital ‘save the date’ notifications, and then proper invitations a few weeks later. In these you should communicate the processes and procedures that will be in place at the event, such as temperature checks and hand sanitisation, to make sure that guests feel comfortable to attend and know what is expected of them to

Visualise and make note of the ‘walkthrough’ of the event, and any preevent activity where you are required to attend physical locations or be around other people

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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keep others safe. In addition to providing key information about the event to your attendees, utilising e-communication like emails and digital apps like WhatsApp and Instagram can form part of your engagement and relationship building journey, with the added benefit of being instant in real-time. From my experience I find that some press are more responsive on WhatsApp or Instagram DM, so I normally email and then

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people in your event location, which can also eradicate further deep cleaning or sanitising for their attendance.

Plan the attendees’ walk-through It’s important for clinics to visualise and make note of the ‘walk-through’ of the event, and any pre-event activity where you are required to attend physical locations or be around other people. Dr Vig conducted a virtual press tour for me

Take delivery of all supplies four to 10 days in advance so items can be isolated and sanitised try one or the other platform to keep in touch with them. I’ll use this to ask if they have all the event details, whether they need anything else and let them know that I am looking forward to seeing them. While this may not be appropriate when hosting an event for potential patients, you should consider ways to market the event successfully on these platforms. This can also impart some warmth to what may feel like a sterile and clinical experience with the current COVID-19 social distancing guidelines. In addition, it enables you to maintain an ongoing conversation about a forthcoming event and potentially engage their interest and commitment to attending. A friendly warm reminder four to five days pre-event, and again in the morning of your event, can serve to reassure attendees. By being responsive and informative, you can put your guests at ease and address any nerves or fears they may have attending an event, reinforce your relationship with them and maximise the success of your event.

Make sure staff are on board As well as the attendees, it is important that the staff are confident and comfortable. They should be well informed before the event, as any uncertainty and hesitation on the day can sometimes be communicated through body language and may make press or attendees uneasy. If a staff member does not feel comfortable about the event, reassure them, explore their concerns, or perhaps ask another member to step in. You can also consider executing the production of the event yourself on the day to minimise additional

and the Cutera team to help us plan out the logistics of our recent live launch event with precision. For us, pre-event planning included calculating the maximum and minimum time it would take a guest to navigate through the clinic and to then co-ordinate running two rooms. This amounted to 90-120 minutes for each person from arrival to departure. You should divide your event location into zones and plan one-way routes to minimise physical contact and effectively carry out social distancing. In addition, you should ensure the sanitising or deep cleaning of these zones once they have been accessed and left by an attendee are allocated and confirmed as the responsibility of the clinic staff or the brand/PR press launch team. If the launch event is taking place in an existing clinic with a CQC accreditation, they may already have protocols in place. It is worth reviewing these alongside your event production schedule to assess that it adheres to social distancing protocols. Consider your event supplies Take time to plan the third-party support aspects of the event that need to be factored in, such as anyone that needs to deliver any heavy equipment, stock, event resources or are attending to set up on-site. If you decide to manage it without physical third-party attendees then you may be taking delivery of physical items required for the launch. Where possible, take delivery of all supplies four to 10 days in advance so that items can be isolated, sanitised, collated and then stored. Ensure

there is surplus stock of PPE for all event attendees, the location staff, any brand representatives and your team. If you wish to give attendees gifts, it’s worth having pre-packed kits and readyassembled products for less physical handing on the day. You can also send press releases and other paperwork electronically instead of giving out hard copies and post gifts directly to a designated address following the event. Invite guests for post-event treatments To further keep attendees engaged with your event and new product, you should look to invite them to have a complimentary treatment. In terms of press, we found this particularly beneficial with the Cutera truSculpt flex launch and gained coverage from the likes of Alice Hart-Davis. You can either invite people to have their treatment on the same day as the launch event, or at a time of their convenience afterwards, always ensuring you are adhering to social distancing and other COVID-19 protocols.

Conclusion Together with some strategic planning pre-event, careful launch activity execution, and combining the implementation of virtual tools, it can be possible to host successful launch events despite the current COVID-19 restrictions. Ensure you are abiding by local restrictions at all times and always consider the safety of your attendees, staff and self as a priority. Jenny Pabila is an independent aesthetics and beauty public relations consultant with more than 25 years of experience in public relations, marketing communications and brand building. Having personally executed launches in London, Ireland, Europe, Dubai and New York, Pabila has developed key press relationships globally to support international brand communication. REFERENCES 1. Jenny Pabila, Aesthetic Launch Events, 2017. <https:// aestheticsjournal.com/feature/aesthetic-launch-events> 2. Project Manager, The ultimate guide to the critical path method, <https://www.projectmanager.com/critical-path-method> Further reading · Association of event organisers, 2020, <https://www.aeo.org. uk/covid-19> · ICFH Events, 2020, Event Risk Assessment, <https:// cdn.asp.events/CLIENT_AEO_6F6DAB1E_5056_ B739_5434FCD30E5F9143/sites/AEO/media/covid19/RiskAssessment---Managing-the-risk-of-Coronavirus.pdf>

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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In The Life Of: Dr Bessam Farjo

The hair restoration surgeon and co-founder of the Farjo Hair Institute tells us about his daily routine My morning starts with… I’m an early riser! I think you have to be with this job. I get up at the latest by 6am, leave the house by 6:45am and start seeing my hair transplant patient as early as 7:30am. My days are different to most other people who work in aesthetics, as I will only work with one patient per day. Once they’ve arrived, I’ll prepare them for the transplant before going into the operating room. Then I proceed to give the patient the local anaesthetic injections, followed by removal or harvesting of the donor hairs. When this is done, I go to the recipient area and create the slits or holes in the scalp that will each receive an individual hair graft. The technical assistants then continue with the work and will place the grafts into the sites (cuts) I pre-created. I’ll continue to be involved in the procedure as I’ll be getting updates from the team throughout and I go in to check on the patient several times. If I took on more than one person each day I don’t think that they would receive the right amount of attention needed when undergoing a surgery like this. In between checking on the patient I’ll be carrying out consultations over Zoom, which typically takes about 30-40 minutes each. I allow this amount of time because I like to make sure they have all the information they need and it also lets me work out whether I can give them what they want. I’ve noticed a significant rise in the number of people who are interested in both surgical and non-surgical hair transplants following COVID-19, and we are receiving a much higher number of enquiries. Although people are saying it’s because of the ‘Zoom Boom’, for hair transplants I think it’s simply because people are having more time at home. After the surgery, there is a long recovery time and now people have more opportunity to do this privately. Because a lot of the people that contact us aren’t suitable for the procedure/ don’t require a doctor’s opinion, we have a team who speak to these potential patients and screen them before they can then have a consultation with me, in which I ensure they are suitable for the transplant.

Once the transplant is finished… The procedure can take up to eight hours, and once the transplant is complete I will

Working with my partner…

My wife, Dr Nilofer Farjo, is also a hair restoration surgeon and co-founded the Farjo Hair Institute with me. She is the clinic director and we tend to work together a lot throughout the day. It’s good for me personally, because it means that we get to spend more time together than we would otherwise!

On the weekends…

We’ve got a big garden, so I usually do some gardening or outdoor activities. My son and I love football, and we’re big Manchester United supporters. My wife and I usually like to see our friends for drinks or a meal, so we’ve been missing that throughout lockdown – we did start doing cocktail Zoom parties, but I think everyone’s gotten a bit bored of that now!

What would you change…

In an ideal world I would like to finish work a bit earlier and be home before 6pm so that I could spend more time with my children, but it’s difficult to do that in the industry that we’re part of. We have to give each patient the time that they need and deserve, so we can’t risk rushing the job.

go in and double check that everything has been done correctly. Specifically, I’ll be making sure that the hair placement and angles are correct, and ensuring that the patient has no pain or bleeding. My staff will then give the patient post-procedure instructions and I like to personally walk them out of the building, so that they can ask me any questions and I can make sure they are okay. I also always give them my personal phone number so that they can contact me if they’re concerned about anything, but we do always schedule a routine follow-up. On a good day, the patient will end up leaving at around 5:30/6pm, but we then have to sort out all the paperwork and tidy everything up, so I don’t usually finish work myself until around 7pm. Once I get home, I like to chill out, have dinner, watch TV and just be with my wife and kids. I tend to keep the evenings as relaxed as possible so that I can unwind after a busy day, and I typically go to sleep at around 11pm.

My Mondays are different… Two years ago, we made the decision to only be in theatre and doing operations from Tuesday to Friday, simply because of how time consuming it is. I still work on Monday, but I dedicate the day solely to business matters, for example seeing accountants and lawyers – or speaking to the Aesthetics journal! It means I can focus on these things properly. Knowing that I have a more relaxed Monday makes Sunday night much more enjoyable too! I’m also involved with lots of other projects aside from my work at the Farjo Hair Institute, for example being co-founder of the International Trichology Congress, managing biotechnology company HairClone, or being involved with hair biology research which requires a lot of meetings. I’m constantly looking for advancements in the sector that can benefit our patients, and it’s something that’s important to me personally. I experienced hair loss when I was younger, but at the time the quality and level of techniques used for hair transplantation were nowhere near what they are today, and it did little to help me. Although it was hard to come to terms with, it helps me now to put myself in my patient’s shoes and relate to them.

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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The Last Word: Menopausal Management Many women are being prescribed antidepressants first line as their hormones shift but Dr Shirin Lakhani calls for urgent change Let’s talk about menopause. Defined as the permanent cessation of menstruation and reproductive capability, it is an inevitable consequence of growing older and ultimately affects almost every woman.1 Yet, while menopause is a natural stage of life, it’s often not spoken about and, in my opinion, education is lacking. The consequences of the menopause can be absolutely devastating – one in four women will experience debilitating symptoms that can last up to 15 years.2 With the population now living longer, healthier lives, women can spend up to one third to half of their lives in the peri and post-menopausal period. The average age of onset in the UK occurs at 51, with variations between race, ethnicity, demographic and lifestyle, and those at onset of the perimenopause is 47.5 years.3,4 The average duration of vasomotor symptoms (hot flushes) also vary between ethnicities but can last more than seven years.5 For young women who find themselves catapulted into instant menopause due to surgery, medical treatment or a diagnosis of primary ovarian insufficiency (POI), the menopausal chapter can extend even further.

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are overlooked or diminished.4 I’ve found that many are either told that this is a normal part of life and they should just put up with it until the symptoms pass, or are prescribed antidepressants to treat the associated symptoms of the menopause rather than treating these symptoms head on. In my experience, hormone replacement therapy (HRT) is still regularly feared by some healthcare professionals who can actively discourage their patients from taking it, rather than having a balanced discussion, considering up-to-date evidence instead of older flawed studies. In the early 2000s, the results of two large studies (The Women’s Health Initiative in the US and the Million Woman Study in the UK) raised concerns about the safety of HRT, particularly with regards to breast cancer and heart disease, causing widespread panic and confusion amongst patients and doctors alike.8,9 Newer long-running research has found that women taking progesterone plus natural oestrogen does not raise a risk of heart disease or cancer.10

Antidepressants for menopausal management Unfortunately, I believe doctors are often too quick to treat patients with selective serotonin reuptake inhibitors as a quick-fix alternative; putting a band aid over the issue as opposed to treating it head on. While low

The misunderstandings of menopause

I believe doctors are often too quick to treat patients with SSRIs as a quick-fix alternative

Lost amongst the myriad acute illnesses and chronic diseases, post-reproductive health does not garner much attention in medical school or post-registration training. In addition to the characteristic hot flush, there are many related symptoms that can have a significant impact on a patient’s quality of life, such as nausea, joint aches, an increase in allergies, memory loss and palpitations, to name but a few.6 The lack of awareness regarding menopausal symptomatology may result in needless anxiety for patients and a feeling of helplessness. An additional challenge is the impact menopause has on long-term conditions such as diabetes,7 an area that is vastly under-researched. More concerning still, while many women are now finding the confidence to come forward to speak about their health with their GP, thousands of women are finding that their symptoms

dose antidepressants such as SSRIs and SNRIs have been shown to improve the vasomotor symptoms of menopause11 and may be useful in women who are unable or unwilling to take HRT, in my experience treating with antidepressants like this can instead result in side effects that are similar

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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I strongly believe that this is a complete disservice for the 13 million women in the UK going through the menopause and more needs to be done to those associated with the menopause. This includes problems with concentration, problems with sleep and a decreased libido.12 We are forgetting that it is often these symptoms of the menopause that can have resulted in patients suffering with depression and anxiety in the first instance.13 Furthermore, whilst their use may be beneficial in a small cohort of patients, they do not address the actual cause of the symptoms or provide the multiple benefits that other treatments such as HRT would, in my opinion. I strongly believe that this is a complete disservice for the 13 million women in the UK going through the menopause and more needs to be done.14

My experience treating menopausal patients Over the years, I have encountered numerous cases that demonstrate the need for increased competence in the management of menopause within both primary and secondary care. One patient I cared for recently had suffered from a plethora of menopausal symptoms including mood swings, hot flushes and insomnia, along with debilitating vaginal atrophy. The pain associated with the patient’s vaginal atrophy had ended any intimacy with her husband, pushed the patient to cancel her gym membership and, at its worst, left her struggling to walk. She became incredibly distant from family, had ceased socialising with friends and dreaded going to work in her job as a civil servant, fearing that she would experience a hot flush. Incredibly unhappy and in pain, she visited her GP who advised against HRT and instead suggested citalopram, which this particular patient refused. After consultation I suggested bioidentical hormone replacement therapy to address

the hormone imbalance that was causing the majority of the symptoms. In September she visited my clinic for radiofrequency tightening with Ultra Femme 360. The patient noticed instant results and now, a few months later, her menopausal symptoms have improved dramatically and, most importantly, her entire outlook on life has completely changed. She provided the following testimonial to encourage other women to seek alternative treatment to antidepressants, “Most of my menopause symptoms have disappeared or improved dramatically and I want to urge other women like myself not to continue suffering in silence. If you feel like you’ve got nowhere to turn don’t give up. I’m proof that no matter how bad your menopause symptoms are, it doesn’t need to end with antidepressants – there is hope.” As a woman who hears these stories on a weekly basis, this is yet another heartbreaking instance where menopausal women have been failed due to the lack of specialist knowledge.

Aesthetic practitioners can help In our industry, where many of our patients are reaching, or are at menopause, they can look to us for improvement not only in their appearance, but also with functional issues. Aesthetics is no longer just about neuromodulators and dermal fillers, but with more practitioners taking an interest in the holistic wellbeing of the patient, there has been an increase in clinics broadening their offering to meet the medical needs of postreproductive women. I believe with thorough training and understanding, menopausal management is a holistic service that many aesthetic clinics can add. If we do not, I believe we are doing not only our patients a disservice, but also ourselves.

Menopause isn’t a disease, nor is it something that should cause fear, but it can cause untold misery. In a rapidly evolving specialty, not subject to the same constraints as the NHS, we are now lucky to have so many innovative treatments and effective medical interventions available to us that women needn’t spend this chapter of their lives in pain or despair. The 13 million women in the UK suffering with the menopause deserve better, don’t they? Dr Shirin Lakhani is a former GP and now aesthetic practitioner with a specialist expertise in intimate health for both men and women. She appears regularly on television and in the press as well as speaking at medical conferences worldwide. With a Diplomate of the Royal College of Obstetricians and Gynaecologists, Dr Lakhani consults on every aspect of intimate health, including dermatological issues such as lichen sclerosus, feminine tightening, incontinence, as well as aesthetic rejuvenation and sexual performance enhancement for both men and women. Qual: MBBS, MRCGP, DRCOG REFERENCES 1. Women’s Health Concern, Menopause, 2017. <https://www. womens-health-concern.org/help-and-advice/factsheets/ menopause/> 2. Nuffield Health, One in four with menopause symptoms concerned about ability to cope with life, 2017. <https://www. nuffieldhealth.com/article/one-in-four-with-menopausesymptoms-concerned-about-ability-to-cope-with-life#about> 3. Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425-440. 4. NICE, Women with symptoms of menopause should not suffer in silence, 2015. <https://www.nice.org.uk/news/article/women-withsymptoms-of-menopause-should-not-suffer-in-silence> 5. Avis NE, Crawford SL, Greendale G, et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Intern Med. 2015;175(4):531–539. 6. Santoro N, Epperson CN, Mathews SB. Menopausal Symptoms and Their Management. Endocrinol Metab Clin North Am. 2015;44(3):497-515. 7. Paschou, S.A., Papanas, N. Type 2 Diabetes Mellitus and Menopausal Hormone Therapy: An Update. Diabetes Ther 10, 2313–2320 (2019). 8. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials. JAMA. 2013;310(13):1353–1368. 9. The Million Women Survey, <http://www.millionwomenstudy.org/ introduction/> 10. Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Estrogen-progestagen menopausal hormone therapy and breast cancer: does delay from menopause onset to treatment initiation influence risks? Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2009 Nov;27(31):51385143. 11. Stubbs C, Mattingly L, Crawford SA, Wickersham EA, Brockhaus JL, McCarthy LH. Do SSRIs and SNRIs reduce the frequency and/ or severity of hot flashes in menopausal women. J Okla State Med Assoc. 2017;110(5):272-274. 12. Healthline, A Guide to Common Antidepressant Side Effects, 2020. <https://www.healthline.com/health/antidepressant-sideeffects#ssr-is> 13. Bener A, Saleh NM, Bakir A, Bhugra D. Depression, Anxiety, and Stress Symptoms in Menopausal Arab Women: Shedding More Light on a Complex Relationship. Ann Med Health Sci Res. 2016;6(4):224-231. 14. Local Government Association, Menopause factfile, 2020 <https://www.local.gov.uk/our-support/workforce-and-hr-support/ wellbeing/menopause/menopause-factfile>

Reproduced from Aesthetics | Volume 8/Issue 2 - August 2021

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