MAY 2023: The Body Issue

Examining Lip

Supporting Weight Loss Patients Implementing supportive services into clinics

Case

Becoming

Contents • May 2023

The latest product and industry news

16 AMWC 2023, Monaco

Aesthetics reports on the highlights from the 21st AMWC in Monaco

17 News Special: Surgery Stats Champion Natural Results

Aesthetics examines the latest BAAPS statistics on cosmetic surgery

CLINICAL PRACTICE

19 Spotlight On: NEWEST

A look at the UK’s first polynucleotide and HA combination product

21 Innovations in Aesthetics

Highlighting the innovations celebrated at The Aesthetics Awards 2023

25 SkinPen Precision Celebrates Five Years of FDA Clearance

Discover how SkinPen Precision became a global leader in skin remodelling

27 Special Feature: Supporting Patients Through Weight Loss

Practitioners provide advice on implementing weight loss support in-clinic

30 CPD: Exploring Lip Anatomy in Different Ethnicities

Dr Elle Reid and Dr Bryony Elder examine lip anatomy in varying ethnicities

36 Why Juvéderm?

Delivering predictable outcomes and patient satisfaction

38 Treating Abdominal Skin Laxity

Dr Jo Mennie outlines treating post-partem abdominal skin laxity

41 Case Study: Lifting and Tightening the Face with EMFACE

Michelle McLean presents a full-face rejuvenation case using EMFACE

44 Exploring Keratosis Pilaris

Two dermatologists introduce a variety of treatments for keratosis pilaris

46 AviClear™: The Future of Acne Treatment?

Cutera introduces AviClear™ for treating mild, moderate and severe acne

49 Case Study: Achieving Natural Full-face Rejuvenation

Dr Sana Sadiq presents a full-face case study using both toxin and fillers

53 Lumenis ULTRApulse® Alpha makes UK Debut

WOW patients and providers with versatile technology from Lumenis

54 A History of Breast Implants

Mr Taimur Shoaib outlines the development of breast implants

56 The Launch of the Teoxane Roadshow

Teoxane is taking its biggest event on the road in 2023

57 Abstracts

A round-up and summary of useful clinical papers

IN PRACTICE

58 Becoming an International KOL

Four global key opinion leaders share their advice on going global

60 Utilising Social Media Collaborations

Lianne Sykes provides tips for making the most of online collaborations

62 Working with Distributors and Manufacturers

Simon Haroutunian shares his advice on working with the right companies

65 In The Life Of Dr Kam Lally

Dr Kam Lally shares a day as a practitioner, KOL and trainer

66 The Last Word: Biological Ageing in Aesthetics

Dr Natalia Spierings debates why dermatologists are well-placed in aesthetics

News Special: Surgery Stats Champion

Natural Results

Page 17

Special Feature: Supporting Patients Through Weight Loss Journeys

Page 27

Clinical Contributors

Dr Elle Reid is an aesthetic practitioner and dental surgeon. Dr Reid has a background in maxillofacial surgery, hospital and practice-based dentistry, and is the lead trainer in Newcastle-upon-Tyne for Acquisition Aesthetics and director of Paragon Aesthetics.

Dr Bryony Elder is an aesthetic practitioner based in Newcastle-upon-Tyne. She teaches aesthetic medicine, alongside dental emergency management and anatomy at Newcastle University. She is the Level 7 Diploma lead for Acquisition Aesthetics.

Dr Jo Mennie has more than 12 years’ experience working as a plastic surgery doctor in the NHS. She has completed a PhD in Women’s Health, for which she received a research fellowship. She is a lead aesthetic doctor at David Jack Clinic.

Dr Kohei Matsumoto qualified from UCL Medical School and completed further medical training in the North West Deanery. He is currently a Dermatology Clinical Fellow in Liverpool University Hospital NHS Trust.

Dr Derrick Phillips is a consultant dermatologist with specialist interests in inflammatory skin disease, benign lesions and skin cancer. He is actively involved in clinical research and has published results widely. He is an official spokesperson for the British Skin Foundation.

Dr Sana Sadiq is an aesthetic practitioner and cosmetic dentist. She acquired a Bachelor of Dental Surgery from King’s College London with distinction, winning the University of London Gold Medal. She is co-founder and medical lead of By Design Academy.

Mr Taimur Shoaib is a consultant plastic surgeon with more than 30 years’ experience. Mr Shoaib is an honorary clinical senior lecturer at the University of Glasgow and a faculty member of the Allergan Medical Institute, alongside his own surgery Le Belle Forme.

For face, neck, décolletage, hands and scarring

For eye contour, eyelids and superficial wrinkles

For mature and dehydrated skins – face, neck, hands and scarring

Shannon Kilgariff Editor & Event Manager @shannonkilgariff

With the sun starting to shine, we are all taking off the layers and remembering what our bodies look like! At this point in the year, you will likely start to see more patients wanting to improve the appearance of their overall body, which is why we have focused the May issue on just that!

Our body issue has some great articles to update you on ways you can help patients with their aesthetic goals. Our Special Feature interviews practitioners on how they support their patients in their fat and weight loss journeys (p.27) and we have a case study on treating the post-pregnancy body on p.38. Keratosis pilaris is an interesting common skin condition on the body affecting 40% of adults, so it’s useful to become familiar with this to support your patients (p.44). For women, a huge part of their body is their breasts, so this month we also cover the latest BAAPS cosmetic surgery stats showcasing a rise in both implants and breast reduction (p.17), and we provide a history of breast implants on p.54 – a fascinating read!

Clinical Advisory Board

This month, we are also hosting a webinar on body sculpting and fat loss. It’s being held in partnership with Erchonia on May 11 and featuring Dr Munir Somji – I’m really looking forward to tuning in and being updated in this area – read how to register free on p.10 There have been lots of events lately that the team and I have been going to. In March, we went to AMWC in Monaco (p.16), which was a great opportunity to meet and learn from international practitioners, not to mention enjoy some warm weather! We also went to the BACN Spring Symposium and Wigmore Presents in April, the highlights of which we will be reporting on in our next issue so stay tuned!

I think it’s so important to be going to face-to-face events to network and make vital industry connections, stay updated and share information and best practice. Our next event – CCR – is on October 19-20. We have started planning, but I am really eager to hear from you – our Aesthetics journal readers – about what you want to learn! Send me an email with your thoughts, or if you would like to be considered as a speaker, turn to p.12. I look forward to hearing from you!

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

Sharon Bennett is chair of the British Association of Cosmetic Nurses (BACN), previous UK lead of the BSI committee for aesthetic non-surgical standards, and member of the Clinical Advisory Group for the JCCP. She is a trainer and registered university mentor in cosmetic medical practice, and is finishing her MSc at Northumbria University. Bennett has won the Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.

Sharon Bennett, Clinical Lead

Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.

Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS and is an examiner and fellow of the Royal College of Ophthalmologists.

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 a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

PUBLISHED BY

PORTFOLIO MANAGEMENT

Alison Willis • Director

T: 07747 761198 | alison.willis@easyfairs.com

EDITORIAL

Shannon Kilgariff • Editor & Event Manager

T: 0203 196 4351 | M: 07557 359 257 shannon@aestheticsjournal.com

Holly Carver • Senior Journalist | T: 0203 196 4427 holly.carver@easyfairs.com

Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.

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 Souphiyeh Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.

ADVERTISING & SPONSORSHIP

Judith Nowell • Business Development Manager

T: 0203 196 4352 | M: 07494 179535 judith@aestheticsjournal.com

Chloe Carville • Sales Executive

T: 0203 196 4367 | chloe.carville@aestheticsjournal.com

Emma Coyne • Sales Executive

T: 020 3196 4372 | emma.coyne@easyfairs.com

MARKETING

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

Email: editorial@aestheticsjournal.com

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 Anti-Ageing Experts. Dr Patel is passionate about standards in aesthetic medicine.

Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.

ARTICLE

Material may not be reproduced

without

publisher’s written permission. For PDF file support please email, contact@aestheticsjournal.com

Aesthetics Media

Ellie Holden

• Journalist | T: 0203 196 4265 ellie.holden@easyfairs.com

Kate Byng-Hall • Journalist | T: 0203 196 4265 kate.byng-hall@easyfairs.com

DESIGN

Peter Johnson

• Senior Designer

T: 0203 196 4359 | peter@aestheticsjournal.com

Aimee Moore • Marketing Manager

T: 020 3196 4370 | aimee.moore@easyfairs.com

Emma Kurzyca • Marketing Assistant

T: 020 3196 4306 | emma.kurzyca@easyfairs.com

Talk #Aesthetics

Follow us on Instagram @aestheticsjournaluk

#AestheticsAwards

Dr Sophie Shotter @drsophieshotter

Took my award to Maya Bay with me yesterday! Such a proud moment to be Medical Aesthetic Practitioner of the Year

Advertising

CAP updates influencer marketing guidelines

The Committees of Advertising Practice (CAP) has issued updated guidance on how influencers are able to promote products and services on social media. The updated guidance is designed to ensure influencers are aware that any advertisements or sponsorship posted in association with brands must be explicitly disclosed to social media users so they can easily see that content is paid for.

In the guidance, CAP notes that the main rules for influencers are the Consumer Protection from Unfair Trading Regulations 2008 (CPRs), and the UK Code of Non-broadcast Advertising and Direct & Promotional Marketing (the CAP Code).

#AMWC2023

Shannon Kilgariff @shannonkilgariff

Lovely to see Dr Raul Cetto and Dr Lee Walker at the Teoxane stand at AMWC!

#LaunchParty Hydrafacial @hydrafacialuk

We had an incredible evening celebrating the launch of Syndeo – a massive thank you to Cherry Healey for hosting!

The guidance states, ‘The CPRs make ‘unfair commercial practices’ against the law. These include using editorial content in the media to promote a product where a trader has paid for the promotion without making it clear in the content or by images or sounds clearly identifiable by the consumer (advertorial).’

It continued by stating that other unfair practices including false claims or giving the impression that an individual is acting outside of their business purposes or falsely representing themselves as a consumer; failing to identify commercial intent behind a social media post; and omitting or hiding ‘material’ information (e.g. that you are an ambassador for a brand whose product you have posted about).

Patient care

NHS holds private healthcare data consultation

The National Health Service (NHS) is holding a consultation on how patient data from private healthcare providers is shared with the NHS to uphold patient safety.

#Training

Dr Catherine Fairris @skinwessex

I had the pleasure of spending the weekend updating my anatomy knowledge in Edinburgh with friends

#Radio Sophie Attwood @sa_comms

Our amazing Dr Elizabeth Hawkes speaking all things eye health on BBC Radio 2 with Jeremy Vine!

The consultation is evaluating a proposed system whereby NHS-funded and private healthcare data is collated in one place for the first time, enabling a more holistic picture of a patient’s procedures and potential health conditions. According to the NHS, the consultation was called after the Paterson Inquiry recommended compiling healthcare data on all consultant activity in one place. This followed the conviction of breast cancer surgeon Ian Paterson for performing harmful and unnecessary surgery on hundreds of patients across both NHS and private settings.

Pilot projects by the Acute Data Alignment Programme (ADAP) has suggested that such a system would provide deeper insight into areas such as NHS admissions following complications experienced after private healthcare procedures.

James Austin, director of data strategy and policy at NHS England, said, “NHS data already plays an important role in how we provide high quality patient care and monitor safety reporting systems across the NHS. This vision of a single repository of healthcare information, combining NHS and private healthcare, will help provide better insights and lead to improved care and treatment for all patients across both the NHS and private healthcare sectors.”

Recognition

ACE wins Best Trade Show at events ceremony

ACE 2022 has been awarded Best Trade Show under 2,000 square metres at the Exhibition News (EN) Awards 2023. The EN Awards mark the best of the best in the UK events industry. ACE’s parent company Easyfairs UK also picked up two other awards on the night, with Paris Packaging Week being awarded Best International Trade Show. The Aesthetics portfolio also celebrated two further nominations, with CCR up for Best Trade Show over 2,000sqm, and event director Courtney LeBorgne nominated for Best Event Director. Reflecting on the win, LeBorgne said, “The whole team is absolutely ecstatic. ACE is an event we are all extremely proud of, and it’s a pleasure to provide the aesthetics specialty with top-quality education and networking year on year. I have to thank all our delegates, exhibitors and sponsors for making ACE such a success, and to the Aesthetics team who put in so much hard work to bring it together. ACE 2023 was the best yet, so bring on the next Awards!”

Regulation

ABPI suspends Novo Nordisk membership

Pharmaceutical company Novo Nordisk has been suspended as a member of the Association of the British Pharmaceutical Industry (ABPI) for two years.

The action has been taken by the ABPI Board following an investigation and appeals process conducted by the Prescription Medicines Code of Practice Authority (PMCPA). The Board found Novo Nordisk to be in breach of the ABPI Code of Practice, including Clause 2 which deals with actions ‘likely to bring discredit on, or reduce confidence in, the pharmaceutical industry’. The suspension is the eighth occasion in the past 40 years the Board has issued a significant sanction. The company will continue to be subject to the ABPI Code and the jurisdiction of the PMCPA, but it will not be able to access the wider benefits of the ABPI membership, which includes access to any ABPI information and briefings, and it will be removed from all ABPI groups and the Board.

The Board has stipulated additional actions to demonstrate a return to industry compliance standards, including further audits of Novo Nordisk’s compliance performed by the PMCPA in late 2023 and 2024. These audits will need to show clear, significant and sustained improvement in industry standards in order for the Board to consider allowing the company to resume engagement with the ABPI at the end of the two-year suspension. A spokesperson at Novo Nordisk has said, “Whilst we are disappointed with this outcome, we accept the decision. We will continue to strengthen our existing compliance framework and remain committed to following the ABPI Code of Practice and maintaining the highest possible standards required by the pharmaceutical industry. We continue to focus our efforts on achieving better outcomes for, and improving the lives of, patients living with serious chronic conditions.”

Vital Statistics

In the UK, 32% of 33-40 year olds are considering botulinum toxin treatment in the next 12 months

(RARE Group, 2023)

70% of British people have visible skin conditions or scars that affect their confidence

(British Skin Foundation, 2023)

Of 1,000 people surveyed, 91% would not consider nonsurgical treatment from a non-medical professional (Cosmetic Surgery Solicitors, 2023)

Almost half (47%) of 1,000 British women surveyed take fewer precautions against sunburn at home than when on holiday

(Hada Labo Tokyo, 2023)

In 2022, Save Face received 118 complaints regarding thread lifts – a 30% increase from 2021 (Save Face, 2023)

There are almost 17,000 new cases of melanoma skin cancer and around 2,300 preventable deaths every year

(Cancer Research UK, 2023)

Events diary

23rd May

BAS Conference 2023

www.bassclerotherapy.com/events

9th-11th June

SEASON Conference

www.seasonaesthetics.org

14th-15th September

BACN Autumn Aesthetic Conference

www.bacn.org.uk/events

19th-21st September

BDNG Annual Conference

www.bdng.org.uk/annual-conference

30th September

BCAM Conference 2023

www.bcamconference.co.uk

6th-7th October

CMAC Global Conference 2023

www.cmac.ac.uk

19th-20th October

CCR 2023

www.ccrlondon.com

Dr Munir Somji to host webinar with Erchonia

Laser manufacturer Erchonia will be hosting a webinar with Aesthetics on body sculpting and fat loss.

The webinar, presented by aesthetic practitioner Dr Munir Somji, will discuss how the Emerald non-thermal laser can assist with inflammation, as well as stubborn pockets of fat. The device has been US Food & Drug Administration (FDA) cleared for patients of up to 40 BMI to treat overall body circumference without damaging the endocrine system, which controls hormones, energy levels, stress and hormones. The webinar will take place on May 11 at 6:30pm GMT.

Charity

Medik8 supports ocean protection projects

Skincare company Medik8 has partnered with charity PADI AWARE Foundation to support ocean protection projects and initiatives. According to the company, the partnership falls under its Social Investment pillar as part of its wider sustainability strategy.

As part of the partnership, Medik8 is set to sponsor four of PADI AWARE Foundation’s Community Grant Recipients to help restore and protect the planet’s most productive ecosystem, and help tackle some of the biggest issues facing the ocean today. The goals of the project are to significantly increase the seagrass meadows, increase biodiversity through associated species that are reliant on seagrass beds and to advance protection measures for the wider Ionian sea, explains Medik8.

This Morning highlights dangers of Turkey surgery

ITV daytime TV show This Morning has presented the potential perils of bargain medical tourism by speaking to a patient who travelled to Turkey for a £4,000 tummy tuck, only to have a Brazilian Butt Lift performed without her knowledge. Plastic surgeon Dr Riccardo Frati joined her to emphasise surgeons’ duty of care and the importance of thorough and tailored surgical consultations. This follows stats from the Foreign and Commonwealth Office’s showing that 22 British nationals have died following medical tourism in Turkey since January 2019.

BBC Scotland puts spotlight on cosmetic clinics

BBC Scotland has released new documentary Facelift, which follows aesthetic practitioner Dr Darren McKeown and his husband and clinic manager Tom. The show follows the pair in the day-to-day running of their clinic in Glasgow, and their efforts to build a cosmetic hospital. The series highlights the struggles of juggling different aspects of a career in aesthetics, especially as interest is booming.

Alexandra Florea, head of sustainability at Medik8, said, “Working with grassroots organisations who understand exactly what is needed on the ground will mean we can generate the greatest positive impact on our shared planet. We chose PADI AWARE Foundation as our first charitable partner because they put science at the heart of everything they do to bring about positive results.”

Body image

New campaign on body image launches

Pharmaceutical company Sinclair has unveiled a new global campaign with creative marketing agency Smyle. According to the company, the campaign called My Power champions women by encouraging them to ‘Say No To Judgement’ and authentically express their power. On behalf of Sinclair, Smyle commissioned a survey of more than 10,000 women, demonstrating that 97% believed women face judgement for their appearance, and 61% had faced negative comments or abuse for their choice to have dermal filler.

Following the study, Smyle worked with MaiLi to create the campaign covering social media channels, influencer marketing, PR and an updated brand website.

Lee Anne Evans, global head of brands, injectables and threads at Sinclair, said, “We’ve found a good partner in Smyle, helping us think beyond what MaiLi does into what the brand authentically stands for. The My Power campaign is about a conversation that truly matters to this team and, we believe, to the world.”

Allergan Aesthetics unveils new Infinity Series

Aesthetic pharmaceutical company Allergan Aesthetics has launched its Infinity Series in London. According to the company, the event will be open to more than 1,000 healthcare professionals across four days. The agenda includes sessions which cover injection training and clinical photography to the full patient clinic experience and clinic engagement, explains Allergan Aesthetics. Djamshid Ghavami, UK&I general manager at Allergan Aesthetics, commented, “At Allergan Aesthetics, we are passionate about advancing medical education, which is why we’ve organised the first of our ‘Infinity Series’ training events to support healthcare professionals.” The event will take place at the Pullman Hotel from the week commencing May 22.

Development

Jan Marini Skin Research joins Healthxchange Group

Aesthetic supplier Healthxchange Group has added skincare brand Jan Marini Skin Research (JMSR) to its portfolio. According to the company, JMSR was developed by dermatologists to treat various common skin conditions with evidence-based treatments. The range is suitable for all skin types and manages concerns such as signs of ageing, acne, sun damage and skin discolouration. As well as skin concerns, JMSR helps to enhance the outcome of in-clinic treatments such as IPL, microneedling, chemical peels and plasma pen.

Hyperpigmentation

Study reveals benefits of medical-grade skincare for discolouration

A new clinical study has revealed the benefit of medical-grade, at-home topical skincare for treating discolouration on the skin. The study, investigated by AlumierMD, examined the company’s Prep & Enhance: Discolouration collection, looking at its effectiveness in both stabilising and improving redness and discolouration before an in-clinic treatment. The multi-country, multi-site study was conducted on 24 patients with Fitzpatrick skin types I-VI, including four men and 19 women, aged between 20-60.

After four weeks, results included a 70% improvement in brown spots, 58% improvement in redness, 58% improvement in pores, 54% improvement in wrinkles and 45% improvement in skin texture. Dr David Eccleston, founder of MediZen Clinic and one of three practitioners involved in the study, said, “It is well recognised that patients seeking in-clinic treatments from an aesthetic practitioner are at risk of potential undesirable effects, post-inflammatory hyperpigmentation and increased downtime.”

BACN UPDATES

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

BACN SPRING SYMPOSIUM 2023

The BACN extends its heartfelt gratitude to all the delegates who joined us at our second annual Spring Symposium on April 21!

The Symposium was an overwhelming success, bringing together professionals from the medical aesthetics specialty to share insights, knowledge and expertise at the prestigious Royal Society of Medicine. The venue was the perfect backdrop as we welcomed 150 guests for a jam-packed day of learning, networking and growth.

We want to offer a huge thank you to all the speakers and exhibitors who came along for their invaluable contributions in making the Symposium a memorable and meaningful experience. We especially want to thank Church Pharmacy who were our Headline Sponsor for the event. After the success of our Spring Symposium, we’re now gearing up for our next big event – the BACN Autumn Aesthetic Conference, Birmingham in September! Tickets for the conference were launched at the Symposium, with general sale tickets now available to purchase on the BACN website.

REGIONAL MEETINGS

As we move past our spring event and into the second quarter of 2023, we’d like to remind everyone about the upcoming BACN Regional Meetings. These meetings are a great opportunity to catch up with colleagues in the local area, hear the latest updates from the BACN and share experiences and insights with peers.

May’s first meeting will be held in Southampton on May 15. This meeting promises to be a fantastic event, with a range of interesting and informative presentations on the latest trends and developments in aesthetics.

Our South West/Wales meeting will be held in Newport (just off the M4) on May 22. A close-knit community, this is a great opportunity for our South West and South Wales members to connect and learn from one another. London, Birmingham and Leeds dates have also been confirmed for June 2023, and are bookable on the BACN website now. All dates, agendas and travel info can be found by scanning the QR code below. We hope to see you there!

This column is written and supported by the BACN

RegenLab unveils brand new skincare line

Have Your Research Featured at CCR

Swiss aesthetic manufacturer RegenLab has announced the launch of new skincare line Regen4D.

Be a part of the UK’s leading conference for non-surgical and surgical practitioners

On October 19 and 20, the non-surgical and surgical medical aesthetic communities will once again unite at CCR for two days of discovery, networking and learning. Featuring the newest injectable, device, longevity and business content, CCR is the perfect place to further your skills and techniques to really expand your business. As well as being able to collect 16 CPD points to further your academic career, CCR will also be hosting networking opportunities, hundreds of incredible products and services and another glamourous after party with all your industry peers and colleagues. Be sure to save the date!

Join the CCR 2023 speaker line-up

If you’ve been working hard over the last 12 months researching a concept, technique or innovation, now is the perfect time to share your knowledge and expertise with the rest of the medical aesthetic community. CCR is now accepting abstracts for papers, giving you the chance to speak at its headline conference the Aesthetics Arena later this year! The abstract should discuss the aims and outcomes of your research, demonstrating why it’s important for the aesthetic specialty. CCR brings together different professions across the industry from all across the country, so it really is the perfect place to share your learnings, establish yourself as an aesthetics leader and really grow your personal brand.

Submit your abstract

Simply scan the below QR code to submit your research findings, new techniques, case study or innovation that you think deserves to be shared with the aesthetics community. A member of the editorial team will be in touch if it’s a good fit for our Aesthetics Arena conference at CCR 2023.

Registration for CCR 2023 will be open soon. In the meantime, keep an eye out for updates on social media and save the date for your next Aesthetics event. 19 & 20 October 2023, ExCeL London.

According to the medical device and platelet-rich plasma company, the new skincare range contains products designed for pre- and post-skin treatments, optimised with the brand’s patented 4D hyaluronic acid (HA) formulation which combines varying lengths of HA to both penetrate and protect the skin.

The collection includes the RegenSkin Deep Hydrating Facial Cream, RegenSkin Deep Hydrating Eye Cream, RegenSkin Hydrating Eye Cream, RegenLift Serum, CellularMask Hydrating Mask and RegenSkin Deep Hydrating Lotion.

Deputy director of RegenLab, Carlo Turzi, commented, “The Regen4D collection is a breakthrough when it comes to post-procedural skincare. The unique blend of ingredients, combined with our 4D hyaluronic acid formulation guarantees skin penetration at each level, whilst supporting overall treatment efficacy, addressing skin concerns and helping to improve overall skin health.”

Skincare

mesoestetic launches new resurfacing gel

Pharmaceutical company mesoestetic has introduced blemiderm resurfacing gel to its portfolio. The company explains that blemiderm – part of the Anti-Blemish Solutions line – is suitable for combination, oily and acne-prone skin, and aims to refine pores, purify and retexturise the skin. The product also aims to reduce excess sebum, decongest pores and regulate action on acne triggering factors to prevent the appearance of blemishes on the skin, adds mesoestetic.

Adam Birtwistle, managing director at mesoestetic said, “mesoestetic is excited to launch its new product, blemiderm resurfacing gel for oily, combination or acne-prone skin. Its new formula regulates the action on the main acne triggering factors to prevent the appearance of blemishes. Its action helps to renew, purify and retexturise the skin, reduce excess sebum and decongest the pores. This is the first in the range of new blemiderm products we are launching this year.”

Cutera to host webinar on AviClear

Aesthetic device company Cutera will be holding a webinar in partnership with Aesthetics.

The webinar, hosted by clinical professor of dermatology and former director of laser research and Mohs surgery at New York’s Mount Sinai School of Medicine Dr David Goldberg, who will discuss AviClear, the first FDA-cleared laser treatment for mild, moderate and severe acne. During the session, Dr Goldberg will focus on AviClear’s innovative technology and how it has been a great fit into his practice. He will also present case studies and discuss treatment experience, results and patient satisfaction using AviClear 1726 nm. Dr Goldberg has published more than 190 peerreviewed manuscripts and is the author and/or editor of 15 books on non-invasive aesthetic treatments. The webinar will be taking place on May 25 at 7pm GMT.

Injectables

SuneKOS unveils new injectable

SuneKOS, the aesthetic division of Professional Dietetics, has introduced a new amino acid injectable.

The company explains that SuneKOS Performa aims to stimulate the skin’s own collagen and elastin production, enabling extra cellular regeneration to restore skin elasticity and natural volume.

SuneKOS Performa also combines a new concentration of low molecular weight hyaluronic acids (HA) with hydrophobic amino acids to slow the breakdown of HA, decreasing the degradation rate by 40%, adds the company.

The injectable can be used up to the lash line for tear troughs, improving fine lines and dark circles around the eyes.

Dr Mark Holmes, SuneKOS global key opinion leader, said, “With ageing we get a disruption of the homeostasis of the extra cellular matrix (ECM). In particular, we get a reduction in the number of fibroblasts and their activity, which means less collagen and elastin. By restoring the ECM with SuneKOS, we can counteract this process.”

Research

NIHR to investigate testosterone benefits for the menopause

The National Institute of Health Research (NIHR) is seeking funding for potential research on the risks and benefits of testosterone for menopausal women. The trial, which is being proposed by a team of clinicians, researchers and women in menopause, would compare testosterone treatments to placebos in an attempt to gauge the hormone’s effect on menopausal symptoms which may include concentration, cognition, energy and mood.

Consultant gynaecologist and researcher Dr Haitham Hamoda has explained that there have been many anecdotal reports of testosterone improving menopause symptoms, but he says, “I think it’s important, whatever the study shows, to get an answer that goes further than anecdotal feedback. Medicine and medical treatments should always be evidence-based, and that’s what we want to prioritise.”

He continued, “Our preliminary surveys have shown huge interest from both women and practitioners in the potential results of this study – there is great interest in the area.”

The study, if accepted, would begin in 2024, with results expected in 2025.

Melissa French, medical sales manager at Dermalogica Pro

What makes Dermalogica Pro Power Peel different?

The ability to bespoke each service to your patients’ concerns, by mixing, layering or multi-layering additional peels. The three main skin concerns we see are: hyperpigmentation, breakouts and excess oil production, as well as fine lines and wrinkles. Pro Power Peel combination can tackle all of these concerns, in one go.

What are the benefits for practitioners?

Having the option to mix and layer a peel allows for optimal customisation to maximise results and always stay in control. As the skin shows more resilience during a course of peels, your professional judgement will allow you to determine if you can begin to mix and layer.

Mixing is the perfect way to introduce an acid such as glycolic acid, which has a low molecular weight and is less tolerated on the skin. Layering a peel allows you to treat the patient’s primary concern, and in each service, you can introduce extra layers as tolerated, or multi-layer to add additional benefits of combined acids using our three Pro Power peel blends.

Bespoke procedures are on the rise and patients want to be able to treat a multitude of concerns through one treatment plan.

What’s your favourite part of being able to mix and layer a peel?

Being able to spot treat! This feels like a perfectly targeted and results-driven service for the patient. You may decide to treat your patient with a certain peel, but they have an area of dermal pigmentation or some post-inflammatory pigmentation you wish to treat. By spot treating with an additional peel, you are on track to treat the desired clinical outcome.

This advertorial was written and supplied by Dermalogica Pro Or

For more information, please scan here:

Dr Bob Khanna’s Expert Insights

Cosmetic dental surgeon and facial aesthetic practitioner Dr Bob Khanna is an internationally renowned practitioner, medical trainer, educator and key opinion leader in the aesthetics field.

Here, Aesthetics shares some expertise from his 27 years in the specialty…

What body treatment is requested the most by your patients?

Fat reduction and skin tightening are popular for both men and women. I combine T-Shape 2 (low level laser, radiofrequency and vacuum massage) with non-thermal Emerald laser for the stomach and flanks, creating profound and long-term results due to shrinking fat cells rather than destroying them, preventing irregular fat cell regeneration.

How do you ensure patients’ mental wellbeing is sound beforehand?

Apart from conducting a comprehensive medical and treatment history, I ask patients specific questions about how important their appearance is to them, such as how often they think about it, if they lose sleep over it, if it impedes on their social life or if it has ever triggered suicidal thoughts.

What are your top devices for treating ageing skin on the body?

I love the Dual Hi for a relatively painless and powerful HIFU treatment with varying depth penetrations for the body, and Artemis for fractional RF and RF microneedling of the dermis. Both machines are excellent for denaturing the collagen fibres uniformly without causing significant pain.

What areas of the body respond well to muscle toning?

The stomach works well if stimulated correctly; I use the multi programme function with the B-Force machine which works on a 3.0 Tesla magnetic field intensity and a pulse duration of up to 400 microseconds, ensuring intense supra maximal contractions.

How do you combine a wellness approach with body treatments?

Holistic diet and lifestyle advice is crucial. In addition, I use non-thermal visible light therapy via EVRL, FX405 and Emerald lasers to optimise global mitochondrial efficiency and cellular ATP production. These devices can also stimulate the vagus nerve to help improve gut health.

What are the best ways to enhance learning on new body treatments?

It is essential for clinicians to attend globally-recognised conferences such as ACE, AMWC or CCR, alongside dedicated masterclass training, such as those we run through the Dr Bob Khanna Training Institute and other reputable training providers to really hone and optimise those skills.

Wellness

InMode releases new technology Empower RF

Aesthetic device company InMode has launched new technology Empower RF, designed to aid women’s intimate health. According to the company, Empower RF combines radiofrequency energy with intravaginal electrical muscle stimulation to treat a range of concerns, including neuromuscular re-education for weakened pelvic floor muscles, plus relief from urinary incontinence and vaginal atrophy. Consultant gynaecologist, Mr Vivek Nama, commented, “Women’s wellness is quintessential to the wellbeing of society. Now, with increasing awareness, more women are seeking help. Empower RF is designed with women’s wellness at the forefront, incorporating radiofrequency and electromagnetic stimulation, allowing us to treat both collagen and muscle to improve vulvovaginal health.”

Advertising

ASA rules against botulinum toxin advertisements

The Advertising Standards Authority (ASA) has issued a ruling against aesthetic treatment comparison site Glowday, stating it advertised botulinum toxin to the public. The ASA found that in September 2022, the site posted an ad promoting ‘The Best Botox in London’, linking to pages of practitioners who performed toxin injections. Another post was entitled ‘Back to School Botox’, which featured an image of a woman and a child, with the caption, ‘Booking a back to school treatment for you? Find a clinic near you who is trained, checked, insured and qualified on Glowday.’ The ASA ruled that botulinum toxin is a prescription-only medication (POM) that cannot be promoted to the public. It also ruled that the ads focused on mothers seeking antiageing treatments and were exploiting women’s insecurities. In response to the ruling, founder of Glowday, Hannah Russell, said, “We disagree that we were advertising Botox, as consumers can neither purchase or book Botox on Glowday. The wider issues that need to be addressed by the ASA is the obvious flagrant breach of advertising standards by key industry players.” The site was warned not to advertise POMs again, and the ads were removed. Visit the ASA website to view the full report.

Education

The Aesthetic Consultant offers new media training

The Aesthetic Consultant Vanessa Bird has partnered with national broadcast journalist Chris Golds to train aesthetic practitioners in the media skills required to succeed in TV and radio appearances.

The private sessions will focus on speaking skills and confidence building to help practitioners grow their media profile and contribute to aesthetic headlines. Bird commented, “Many practitioners want to provide expert commentary to TV or radio channels but don’t necessarily have the skills or confidence needed to go live. This coaching ensures practitioners speak eloquently and with authority on their chosen subject.”

Digital

Aesthetic Nurse Software releases new feature

Patient management system Aesthetic Nurse Software (ANS) has introduced a new feature to its platform.

The feature allows practitioners to record the medical diagnosis for a treatment, using International Classification of Diseases (ICD-11) codes. The update aims to make it quick for practitioners to assign ICD codes to support their treatment notes. The ICD codes are used by healthcare professionals to record diseases, symptoms and other elements of a diagnosis. The company adds that for practitioners who are CQC and VAT registered, the update will help them to be compliant and ensure they have thorough records.

Co-founder of ANS Max Hayward said, “This update will make life easier for our practitioners when documenting their treatments which they deem to be medical procedures. We are delighted to offer another tool that helps practitioners streamline their record-keeping and comply with professional requirements.”

Research

New hypothesis proposes Nasal Muscle Imbalance Theory

In a new hypothesis published in Facial Plastic Surgery, it has been proposed that botulinum toxin can be used alongside septorhinoplasty procedures to help correct the appearance of a crooked nose.

The Nasal Muscle Imbalance Theory (NMIT) hypothesises that following septorhinoplasty, the septum is liable to deviate back to a pre-operative position as the surgical procedure does not alter the long-standing muscle imbalance, and the nose can be pulled back into a crooked position through muscle contractions.

The researchers concluded, ‘We believe that post-septorhinoplasty botulinum toxin injections can be used as an adjunct in rhinoplasty surgery to effectively block the pulling actions of the stronger or over-acting nasal muscles by speeding up the atrophy process, allowing patients’ noses to heal and stabilise in the desired position.’

The authors acknowledge that further research and case studies are required to substantiate their hypothesis.

Injectable DermaFocus unveils new polynucleotide

Aesthetic distributor DermaFocus has introduced its first polynucleotide and hyaluronic acid (HA) combination product to its portfolio. NEWEST enables practitioners to treat damaged and aged skin whilst regenerating fibroblasts for improved skin quality. Created by Italian manufacturer Mastelli, NEWEST can be used on the face, neck and décolletage. Meanwhile, new product NEWEST One is designed for use on the body, and will be available soon. NEWEST combines polynucleotide technology, known as PN-HPT, with non-crosslinked HA and mannitol, increasing collagen and elastin production whilst hydrating and revolumising the skin, adds DermaFocus.

Kamran and Milad Bemana, co-founders of DermaFocus, said, “It is a privilege to introduce this innovative new brand to practitioners in the UK. There is currently nothing like NEWEST on the market, so practitioners can benefit from having a regenerative tool effective for their patients.” To read more about the new polynucleotide, turn to p.19.

News in Brief

CCR opens registration in June

CCR 2023 will return on October 19-20 at ExCeL, London with registration opening in June. Featuring the latest injectables, devices, wellness and business content, CCR is the ideal place to learn, network and build your skills in aesthetics. If you are interested in speaking at CCR, whether that’s about a new technique, innovation or research, submit your abstract via the CCR website now or turn to p.12 and scan the QR code to submit. A member of our editorial team will be in touch if it’s a good fit for the Aesthetics Arena conference at CCR 2023.

Celluma Light Therapy receives MDR certification

BioPhotas, the manufacturer of aesthetic device company Celluma, has received certification with the European Council Medical Device Regulation 2017/745 for low level light therapy devices. The company explains that BioPhotas is the first low-level light therapy device manufacturer to be certified to the new MDR standards, designed to guarantee clinical safety through a stringent regulation process. Patrick Johnson, chief executive officer of BioPhotas, said, “This certification represents a major milestone for BioPhotas and means that the Celluma RESTORE for hair restoration will be available in the European Union and other countries that rely on certification to the MDR.”

Medik8 unveils new eye product

Skincare company Medik8 has introduced a new Crystal Retinal Ceramide Eye to its portfolio. According to the company, the product is targeted for undereye rejuvenation and is available in three strengths to deliver visible results in one evening step. The product helps to reduce the appearance of crow’s feet, wrinkles, crepiness and puffiness whilst remaining gentle on the delicate eye area, according to the company. In a clinical study of 38 participants conducted over 12 weeks, 94% showed an improvement in the look of wrinkles around the eyes.

Acquisition Aesthetics offers new marketing course

Training provider Acquisition Aesthetics has launched its new digital marketing course. The new course aims to bridge the gap between completing training in facial rejuvenation treatments and navigating the successful operation of an aesthetic clinic. Delegates will also learn about effective ways to identify and capture target audiences and website and search engine optimisation practices which align with current guidelines, explains the company. The course will be available on the Acquisition Aesthetics digital learning platform.

AMWC 2023, Monaco

Aesthetics reports on the highlights from the 21st Aesthetic & Anti-Aging Medicine World Congress

On March 30-April 1, the annual AMWC meeting was held in Monaco, inviting more than 15,000 delegates from 140 countries globally. The highly anticipated meeting welcomed more than 300 international speakers to 75 scientific sessions and 67 sponsored symposiums, for delegates to learn about the latest evidence-based research and cutting-edge innovations emerging in the aesthetics specialty.

360 approach with Allergan Aesthetics

The Allergan Medical Institute (AMI) Symposia offered two days of jam-packed content with top international speakers taking to the stage to introduce the Allergan Aesthetics 360 approach to practice, products and patients. The first day began with Dr Tapan Patel discussing the patient-centric approach. During his talk, Dr Patel showcased some interesting statistics from his own clinic which highlighted a change in patient age demographic in the last nine years. In 2014, patients seeking aesthetic treatments were between 55-64 years, but this has changed to 25-34 years. He noted that it was important for practitioners to both recognise the trend and react to it. Following this, Dr Shannon Humphrey spoke on patient care, noting that many patients don’t feel listened to during a consultation. She added that practitioners should be active listeners, create a comfortable environment, ask open-ended questions and explain treatments clearly. The session continued with a live demonstration by Dr Sylwia Lipko-Godlewska on a 39-year-old Persian female patient, and concluded with a panel discussion including

Dr Reha Yavuzer and Dr Marcel Vinicius Menezes on what 360 means to them. Day two focused on unlocking your patient’s individuality and welcomed Dr Mauricio de Maio to the stage. Dr de Maio looked at treating patients across generations and how his famous MD Codes could be used on patients without results appearing the same. The session concluded with a detailed live demonstration performed by Dr de Maio on a female patient, addressing multiple facial areas including the temple, chin, tear trough and lips, followed by a rapturous standing ovation.

Djamshid Ghavami, general manager at Allergan Aesthetics UK&I, said, “At Allergan Aesthetics, our purpose is to ‘empower confidence’, creating the products and technologies that drive the advancement of aesthetic medicine. Our presence at AMWC was a true testament to this ethos.”

Insightful education

Throughout the three-day congress, there was a plethora of educational content, new innovations and research presented and showcased for delegates to implement into their own practices.

Galderma discussed lifting the heavy face with top practitioners Professor Sebastian Cotofana, Dr Andreas Nikolis, Dr Kay Durairaj, Christine Guarnieri, Dr Frank Rosengaus and Dr Stephanie Lam. The symposium explored the aesthetic journey as a long-term endeavour using Galderma’s Holistic Individualised Treatments (HITs). As well as the two-hour session, Galderma also presented new data on the Sculptra Cheek Wrinkle study which demonstrated the

long-lasting results over a 24-month period for cheek wrinkle correction with improvements in firmness and radiance. Data from the Alluzience STAR study was also showcased, demonstrating sustained improvement in glabellar lines up to month six.

Teoxane was also offering delegates some interesting content with the audience having 3D glasses. Dr Benji Dhillion showed how RHA gel moves under the skin in 3D, whilst Dr Patrick Trevidic led a 3D cadaver dissection of the perioral area and mid-face. Other educational content on offer featured diversity and inclusion in aesthetic medicine, treating facial expressions, threads for the eyebrows, eyelid ptosis after toxin treatment and gut health. The future of aesthetics was discussed with regenerative medicine as a key trend in the specialty, looking at treatments such as exosomes, stem cells, gene therapy, injectable gels and membranes, as well as platelet-based therapies.

An evolving industry

The congress was also an optimal opportunity to speak to exhibitors and leading companies about the latest innovations developing in the specialty. APTOS announced the upcoming launch of Visage, a new thread with multidirectional, specially designed barbs. Swiss manufacturer RegenLab launched a new skincare line Regen4D, containing products designed for pre- and post-skin treatments. Aesthetic company EMA Aesthetics has also developed and trademarked the Sustainable Facial with its Préime DermaFacial, which launched at AMWC last year. The technology has partnered with 4Ocean, an ocean cleaning company, which allows the company to offset four times its plastic footprint and pay for the organisation to clean the oceans. 4Ocean has produced a range of collaborative bracelets with beads made from recycled ocean plastic.

27-29,

Your next unmissable aesthetics meeting will be CCR on October 19-20, 2023 at ExCeL, London. Register your interest by scanning the QR code!

AMWC will be returning on March

2024, at the Grimaldi Forum in Monaco.

Surgery Stats Champion Natural Results

Aesthetics examines the latest BAAPS statistics on cosmetic surgery in the UK

The latest national statistics from the British Association of Aesthetic Plastic Surgeons (BAAPS) show an uptick in cosmetic surgery during 2022, with the popularity of procedures performed indicating a shift towards a more natural look.

The BAAPS figures show that in 2022, 31,057 cosmetic procedures took place in the UK – a 102% increase from 2021.1 According to the association, this is the highest annual rise in procedures since the audit began in 2004, but this will be greatly influenced by delays caused by the COVID-19 pandemic.1 Since then, the figures also suggest patients are favouring a more natural look, as this article will discuss. Aesthetics spoke to consultant plastic surgeon and president of BAAPS, Mr Marc Pacifico, and consultant plastic surgeon and UK representative of the International Society of Aesthetic Plastic Surgery (ISAPS), Mr Naveen Cavale, to get their perspective on how the world of cosmetic surgery may be shifting.

Is cosmetic surgery booming?

The cosmetic surgery specialty took a hit during the COVID-19 pandemic. In 2020, cosmetic surgery levels fell by 24% to below 20,000, then dropped even further to just below 15,500 procedures in 2021.2,3 In contrast to this drop, the 102% procedure increase in 2022 is a rapid recovery.1 Mr Pacifico reacts to this, saying, “We often see trends, but this post-pandemic boom was really sustained. I think for a lot of people, the pandemic changed their perspective – they might have felt more confident or determined to go ahead with procedures they’d been considering.”

However, looking back 10 years, levels were hitting 50,000 surgeries a year, and have been dropping since 2016 (Figure 1), perhaps due to the rise in popularity and awareness of non-surgical options.4 Mr Cavale says this drop might actually be down to an increase in the quality of surgery, as there may be fewer cut-price options available. “In the past, a lot of people chose cheaper surgical options,” he explains, “but I think people now are willing to pay more for top quality procedures – there might be slightly fewer patients opting for breast augmentation, but I feel the quality is higher.” Mr Pacifico recognises the changes in the field in the last decade, but feels an increase in numbers could be possible in future after the cost of living crisis wanes, saying, “There are so many factors that go into the numbers. You can’t separate the economic situation from these trends. I suspect if the economy improves and if people feel a bit more confident, the figures could go up even more.”

A more natural trend

The BAAPS statistics also break down which types of surgery were most popular. In 2022, the five most popular procedures for women were breast augmentation, breast reduction, abdominoplasty (tummy tuck), liposuction and blepharoplasty (eyelid surgery).1 Although the two breast procedures were at the top of the list, the growth in their popularity is not consistent – breast augmentation increased by 67% since last year, while breast reduction saw a huge 122% uptick.1 Looking back over the past decade, augmentation was always much

more sought after, but the gap is closing rapidly (Figure 2).4

Mr Pacifico and Mr Cavale agree this could reflect a move towards a more natural look. Mr Pacifico commented, “In my personal practice, I’d say I’ve had 100% more requests to look incredibly natural. For example, women who’ve finished having their families often see surgery as a restorative option, and one that looks completely natural. Breast reduction also offers functional benefits, such as for back pain.”

Mr Cavale adds that a rise in breast reduction can be down to multifarious factors, including seemingly depleting stigma for functional reductions, but that natural aesthetic results are an overwhelming priority. He reflects, “In the past, people have been scared off by plastic surgery because they think it’s going to make them look weird and overdone, but what they have come to realise is that they can undergo cosmetic surgery and it’s unnoticeable; the majority of my patients are asking for results which are completely natural, and they are seeing that it is achievable.”

Mr Pacifico and Mr Cavale agree this could reflect a move towards a more natural look. Mr Pacifico commented, “In my personal practice, I'd say I’ve had 100% more requests to look incredibly natural. For example, women who’ve finished having their families often see surgery as a restorative option, and one that looks completely natural. Breast reduction also offers functional benefits, such as for back pain.”

Mr Cavale adds that a rise in breast reduction can be down to multifarious factors, including seemingly depleting stigma for functional reductions, but that natural aesthetic results are an overwhelming priority. He reflects, “In the past, people have been scared off by plastic surgery because they think it’s going to make them look weird and overdone, but what they have come to realise is that they can undergo cosmetic surgery and it’s unnoticeable; the majority of my patients are asking for results which are completely natural, and they are seeing that it is achievable.”

He concludes by saying the symbiotic relationship between surgical and non-surgical aesthetics is blooming, and looks set to continue. “It makes no sense that filler, toxin and devices is the answer to everything, or and it makes no sense that surgery would always be the only answer either,” he says. “It makes total sense that a bit of both, combined cleverly and safely, provides great results. Practitioners are becoming more and more aware of that fact, and it can only be a positive.”

//INSERT CHARTS – along the bottom of the page//

He concludes by saying the symbiotic relationship between surgical and non-surgical aesthetics is blooming, and looks set to continue. “It makes no sense that filler, toxin and devices is the answer to everything, and it makes no sense that surgery would always be the only answer either,” he says, adding, “It makes total sense that a bit of both, combined cleverly, safely and naturally, provides great results. Practitioners are becoming more and more aware of that fact, and it can only be a positive.”

Number of cosmetic surgeries performed in the UK since 2013, according to BAAPS National Audit Statistics4

Figure

Figure 1: Number of cosmetic surgeries performed in the UK since 2013, according to BAAPS National Audit Statistics4

Figure 2: Number of cosmetic breast surgeries performed in the UK since 2013, according to BAAPS National Audit Statistics4

Figure 2: Number of cosmetic breast surgeries performed in the UK since 2013, according to BAAPS National Audit Statistics4

References

REFERENCES

1. ‘Cosmetic Surgery Boom’ BAAPS Media Releases (UK: BAAPS, 2023) <https://baaps.org.uk/media/press_releases/1872/cosmetic_surgery_boom >

1. ‘Cosmetic Surgery Boom’ BAAPS Media Releases (UK: BAAPS, 2023) <https://baaps.org.uk/media/ press_releases/1872/cosmetic_surgery_boom>

2. ‘Analysis of BAAPS Audit 2019-2020’ BAAPS Media Releases (UK: BAAPS, 2021) <https://baaps.org.uk/_userfiles/pages/files/2020_audit_results_for_2021.pdf >

2. ‘Analysis of BAAPS Audit 2019-2020’ BAAPS Media Releases (UK: BAAPS, 2021) <https://baaps. org.uk/_userfiles/pages/files/2020_audit_results_for_2021.pdf>

3. ‘Analysis of BAAPS Audit 2020-2021’ BAAPS Media Releases (UK: BAAPS, 2022) <https://baaps.org.uk/_userfiles/pages/files/2021_audit_results_for_2022_release_final.pdf >

3. ‘Analysis of BAAPS Audit 2020-2021’ BAAPS Media Releases (UK: BAAPS, 2022) <https://baaps. org.uk/_userfiles/pages/files/2021_audit_results_for_2022_release_final.pdf>

4. BAAPS Annual Audit Results’ BAAPS Media Releases <https://baaps.org.uk/baaps_annual_audit_results_.aspx>

4. ‘BAAPS Annual Audit Results’ BAAPS Media Releases <https://baaps.org.uk/baaps_annual_audit_ results_.aspx>

1:

Spotlight On: NEWEST

A look at the science behind the UK’s first polynucleotide and hyaluronic acid combination product

The UK’s first polynucleotide and hyaluronic acid (HA) combination product is now being introduced to the market. NEWEST is a polynucleotide-based product that also contains HA – enabling practitioners to improve damaged and aged skin, while regenerating fibroblasts for continuous improvement in skin quality.1 Created by Italian manufacturer Mastelli and distributed exclusively by DermaFocus in the UK, NEWEST can be used on the face, neck and décolletage, while there is also a separate product – NEWEST One – designed specifically for use on the body.1

number of cells in the PN-HPT area after 96 hours and after one week (p<0.001) (Figure 1).3 Using PN-HPT alone was also compared to using HA alone. Results indicated that tissue repair was better in the PN-HPT group.3

Combining polynucleotides with HA

Understanding polynucleotides

Polynucleotides are natural, highly-purified DNA molecules, usually extracted from fish gonads. Presented as an injectable gel, they are generally administered to patients over a number of sessions help repair tissue by stimulating fibroblasts, which leads to cell turnover, improved elasticity and boosted collagen production. They also calm inflammation and rebalance melanocyte activity to create an even and refreshed skin tone.1,2 Mastelli has trademarked highly-purified polynucleotide technology, known as PN-HPT. In vitro research indicates that PN-HPT improves skin wellbeing and enables steady self-repair. Fibroblast viability levels were significantly higher in the presence of PN-HPT compared with control after 96 hours and after one week (p<0.001).3 It also revealed that there was a visibly higher

So, what happens when you combine PN-HPT with HA? A study published in the Journal of Cosmetic Dermatology in 2022 treated the mid-face of 40 women over three months. They used NEWEST and Mastelli’s singular PN-HPT product PLINEST.4 NEWEST is formulated as an intradermic gel with 20mg of PN-HPT and 20mg of HA in each 2ml syringe. Mannitol (200mM) is also included, as this acts as a potent free radical scavenger and has been shown to reduce the degradation of the HA by 34%.1 Similarly, PLINEST uses 40mg PN-HPT in each 2ml syringe, but of course does not contain the HA.1 At the first treatment session, all subjects received treatment with NEWEST intradermally.4 After three weeks, they had treatment with PLINEST, followed by a second NEWEST procedure after a further three weeks (six weeks after the baseline session). Supplemental treatment with specially-formulated PLINEST (7.5mg per ml) was used around the eyes in 23 patients, requiring more localised treatment. Patients were advised to use nucleotide-based creams at home, along with taking PLINEST Care In, which is an antioxidant nutritional supplement.

Results

At the end of the treatment cycle, the individual satisfaction score was 8.0 ± 0.87 out of 10. Results also showed that skin elasticity improved by 39.6%, skin brightness was enhanced by 51.1% and wrinkles and skin roughness declined by 17.1% after the three treatments. Additionally, in the 15 women who had post-acne scars, severity

decreased from 7.6 ± 1.32 to 4.2 ± 2.13.4 Results are expected to last six to nine months. Out of the 40 women, 11 observed minor side effects including mild transient discomfort, irritation or pain at the injection site. No serious adverse events were reported. The study authors commented, “The overall skin quality and texture improved significantly from baseline until the third treatment session and after six to eight further weeks. In women with baseline Goglau skin ageing scores >4, improvements were invariably significant or highly significant for every overall skin quality and texture determinant.” Further studies also support the use of NEWEST. One examined its efficacy when treating nasolabial folds (NLFs). Results described that it was a ‘valuable and effective option to rapidly improve the skin dermis texture and quality in individuals with moderate to severe NLFs’.5 Another looked at its wound-healing success in gingival fibroblasts, finding that it significantly increased the expression of collagen 1a1 and 3a1.6

Practitioner perspective

Consultant plastic surgeon and aesthetic practitioner Dr George Christopoulos, who has been using the product, said, “The recent introduction of polynucleotides to the UK has taken the aesthetic market by storm. Patients’ growing awareness of regenerative treatments is driving demand in clinics across the country. NEWEST is an exciting biostimulation tool that has seen huge success abroad and is likely to help us transform skin quality here in the UK too.”

The evolution of injectables

Research indicates that combining HA and polynucleotides into a single syringe can simultaneously regenerate fibroblasts and help boost hydration and revolumise skin. Addressing both in this combination can be an additional treatment option for the ageing patient, particularly those who are now demanding regenerative treatments instead of, or in addition to, typical aesthetic procedures.

Figure 1: First image shows control cells, while second image shows cells stimulated with PN-HPT polynucleotide technology.

Figure 2: Patient before treatment, after the third and final treatment, and at their six-week follow-up appointment.

Welcome to the future of Hybrid Injectables

HArmonyCa™ is a Hybrid Injectable that combines hyaluronic acid (HA) with calcium hydroxyapatite (CaHA), which may give your patients the benefits of an immediate lift effect from HA and sustained collagen stimulation associated with CaHA, for a new way to facial harmony.1–3,*,†

Produced and funded by Allergan Aesthetics, an AbbVie company. Please see HArmonyCa™ IFU for the full list of contraindications, warnings and precautions.1

* Results from a pre-clinical animal study of HArmonyCa™ with results demonstrated over 12 weeks.2 † Results from a pre-clinical animal study of HArmonyCa™ with results demonstrated over 8 weeks.3 HArmonyCa™ Lidocaine is referred to as HArmonyCa™. HArmonyCa™ is a dermal filler intended for facial soft tissue augmentation and should be injected into the deep dermal and sub-dermal layers.1

For use in patients ≥ 18 years old only. ©AbbVie 2023. All rights reserved.

References

Adverse events should be reported.

Reporting forms and information can be found at:

UK adverse events reporting https://yellowcard.mhra.gov.uk/

Adverse events should also be reported to Allergan Ltd.

UK_medinfo@allergan.com or 01628 494026

Irish adverse events reporting https://www.hpra.ie

Adverse events should also be reported to Allergan Ltd.

UK_medinfo@allergan.com or 01628 494026

Innovations in Aesthetics

Take a look at some of the innovative products celebrated at The Aesthetics Awards 2023

The aesthetics specialty is ever-changing in an effort to provide patients with even more effective and safe treatments. In the last year, these products have been game-changers in the field, marking them as Finalists for The DigitRx by Church Pharmacy Award for Product Innovation of the Year at The Aesthetics Awards 2023.

HArmonyCa™

Lidocaine – WINNER

The science

Allergan Aesthetics, an AbbVie company, has released its first hybrid injectable, HArmonyCa – the only dual effect product containing hyaluronic acid (HA), calcium hydroxyapatite (CaHA) and lidocaine for patient comfort. It is designed to improve skin architecture through innovative dual action in one product, providing an immediate lift from HA and a sustained lifting effect from new collagen production associated with CaHA. According to the company, the product is intended for facial soft tissue augmentation via injection into deep dermal and sub-dermal layers.

Topilase – HIGHLY COMMENDED

The science Topilase is the first natural topical hyaluronidase which can be administered through massaging into the skin without injection. The product can enable filler treatment adjustment and dissolving in the face without injections, minimising over-correction and HA degradation. According to Prollenium, Topilase is made of a combination of enzymes – protease, lipase and hyaluronidase – concentrated within a dispersing agent, helping it permeate the skin successfully to break down HA chains.

Letybo – COMMENDED

The science Letybo

(Letibotulinumtoxin A) is a newly registered neuromodulator for the treatment of glabellar lines, licensed for treatment in patients aged between 65 and 75 years. It has proved successful in temporarily improving moderate to severe vertical lines between the eyebrows in more challenging cases, including mature patients.

Our esteemed judges assessed them for innovation or advancement in enhancing outcomes and safety, all backed up by sound evidence. Following the announcement of the Winners, we’re casting a spotlight on these innovations and finding out the science behind them to help you choose the latest innovations to boost your clinic success.

The results In a study of 163 participants, more than 90% reported an improvement in the general appearance of facial areas following treatment, with high levels of satisfaction sustained up to 19 months after treatment.1 In a further study of 48 patients, 86% out of 85 regions treated with HArmonyCa showed clinically significant improvement.1

What practitioners say Recent winner of The Dermalogica PRO Award for Medical Aesthetic Practitioner of the Year at The Aesthetics Awards 2023 Dr Sophie Shotter commented, “I am delighted to see HArmonyCa with this well-deserved Aesthetics Awards win for Product Innovation of the Year. HArmonyCa is a true innovation in the injectable space and is the first product in what I believe will be a new category of injectable products – hybrids. Both my patients and I have been delighted with the results HArmonyCa delivers, and it is a must-have within my treatment plans.”

The results A study of 17 female patients receiving one to three treatments with Topilase found that two to four weeks after final treatment, physician-assessed contour improvement was 8-10/10 for seven patients, 5-7/10 for six, 1-4/10 for three and 0/10 for one patient. Fifteen patients evaluated their skin as more uniform (5/10 to 10/10). Satisfaction scores were 7-10/10 for 13 patients, 6/10 for two and 0-1/10 for two.2

What practitioners say Dr Sandrine Sebban, French aesthetic practitioner, commented, “Topilase allows me to sculpt the faces of my patients, and for the first time ever, offers doctors the power to adjust their results thanks to a risk-free cosmetic care.”

The results In a clinical trial with 355 subjects and a 94% response rate, 48.5% of patients who had severe glabellar lines achieved no or minimal lines by the fourth week post-treatment. The median onset time was three days, with almost one out of four patients reporting a ≥1-point reduction in lines within the first 24 hours after injection.3 The mean time until first retreatment was required was 127 days (around 19 weeks).3

What practitioners say Aesthetic practitioner Professor Syed Haq commented, “Letybo has looked at a broader age range than ever before – adult patients up to and including 75 years old, as well as a significant number of male patients. As the global population increases in age, we now have an increased ability to manage and treat patients with a product registered to treat mature patients.”

Alluzience

The science

Alluzience is the first and only ready-to-use neuromodulator that avoids any calculations to reconstitute the product from powder to liquid. It is approved for treatment of moderate to severe glabellar lines.12 It provides long-lasting duration (up to six months) and rapid onset (visible results within 24 hours).12 It is the first neuromodulator available in the UK with proven uplift in patients’ psychological wellbeing stated on label.12

The results

A study of 372 patients with moderate to severe glabellar lines who were treated with either Alluzience (n=250) or placebo (n=122) demonstrated that more than 50% of patients reported an effect within two to three days, including 23% of patients within one day.12 At month six, 27% of patients had a ≥1 grade improvement in glabellar severity by subject assessment.12

What practitioners say

Facial aesthetic surgeon Dr Kuldeep Minocha said, “As the first ready-to-use anti-wrinkle injection, Alluzience marks a new era in treatment innovation for glabellar lines. Like many aspects of physical appearance, glabellar lines can have a significant impact on patients’ confidence and wellbeing. With its innovative liquid formulation, the availability of Alluzience BoNT-A liquid toxin will allow me to consistently optimise precision and results.”

The science

Biretix is a clinically proven skincare range designed for oily and spot-prone skin. The Biretix Tri-Active Gel contains RetinSphere Technology – a unique combination of retinoids exclusive to its makers Cantabria Labs –combining hydroxypinacolone retinoate (a retinoic acid ester) and retinol, encapsulated in micro-sponges for high efficacy and tolerability. It also contains BIOPEP-15, a unique anti-microbial, botanical complex that reduces the proliferation of acne-causing bacteria. Its other active ingredients include glycolic acid, salicylic acid and niacinamide.

The results

A study of 21 patients between the ages of 15-30 was carried out. The patients had mild acne with active lesions and some scarring and/or hyperpigmentation. They applied Biretix Tri-Active Gel twice daily for 28 days and 95% reported a more uniform skin texture, 90% saw fewer imperfections, 86% had a much more even complexion and 81% had fewer spots.4

What practitioners say

Doctor and haematologist Dr Massimo Milani said, “The combination of retinoids and anti-bacterial agents are considered a first-line treatment approach in mild to moderate acne. This innovative solution is a powerful tool in the treatment and management of mild to moderate acne symptoms when used alone or as adjuvant to alternative acne treatments.”

The science

The three-stage Cyspera Intensive System of Cyspera Intensive, Cyspera Neutralise and Cyspera Boost skincare system are the first products to contain the proprietary molecule Cysteamine Isobionic-Amide Complex. This activates a synergistic action for pigment correction and skin health. The combination of cysteamine and isobionic amide is clinically proven to be fast and effective against hyperpigmentation without the safety concerns of corticosteroids, retinoic acid and hydroquinone.5

The results

Of 100 patients studied after 16 weeks using Cyspera Intensive System, 81% noticed improvements in the skin complexion, 71% found their skin more luminous and radiant and 94% found the products easy and pleasant to use.6 Clinical results show the Cyspera Intensive System is well tolerated for long-term use and doesn’t cause photosensitivity.5

What practitioners say

Consultant dermatologist Dr Jinah Yoo commented, “The Cyspera Intensive System is an exciting and innovative launch as it offers a long awaited, clinically proven alternative to hydroquinone. The three-step system delivers impressive results on persistent epidermal pigmentation to even out the skin tone. Its suitability for long-term use makes it a game-changer in pigmentation treatments.”

Cyspera Intensive System

Biretix Tri-Active Gel

GF5 Bio-Regenerative Growth Factor Serum

The science

CellDerma GF5 is a multifaceted serum which delivers an innovative combination of growth factors (biomimetic peptides) and neuropeptides in one product. The product’s formulation includes five unique growth factors (in supra-therapeutic concentration) identical to those found in the human placenta. When applied topically, these are designed to help reverse the ageing process and repair existing damage for all skin types.

The results

Of 12 females aged 43-50 who used Growth Factor Complex in GF5, after four weeks’ use, demonstrated improvement in skin elasticity by 47%, hydration by 64%, reduction in crow’s feet lines by 21% and under-eye wrinkles by 46%.10 A retrospective study was conducted looking at healing following ablative skin resurfacing comparing two consecutive 12-month periods, the first using a conditioned stem cell media and growth factor cream and the second using GF5. This observed a 92% drop in reported concerns with GF5.11

What practitioners say

Aesthetic practitioner Dr Rashpal Singh said, “For the past 15 months we have been particularly astounded with the results that we have been achieving with GF5 from CellDerma. GF5 has helped us to plug a gap in our ‘sensitive skin’ patients to help repair their barrier function when, historically, they may not have been able to safely tolerate certain treatments due to downtime and risks. We utilise GF5 after any invasive procedure and we have personally found an improved healing time in more than 500 patients as well as reduced complication rates.”

Revox Line Relaxer

The science

Revox Line Relaxer is a serum specially designed to be paired with a neuromodulator to enhance the reduction of expression lines. The product utilises LineRelax Technology featuring five potent peptides plus gamma-aminobutyric acid (GABA). According to studies, the serum substantially reduces the appearance of horizontal and vertical expression lines in the forehead and glabellar lines, crow’s feet, under-eye lines, nasolabial folds, marionette and vertical lip lines.7,8

The results

A 12-week clinical study of 55 subjects using Revox Line Relaxer as a stand-alone treatment for fine lines showed that 15 minutes post-application, 97% showed an improvement in the appearance of expression lines and under-eye lines, and 45% showed an improvement in the appearance of wrinkles. After eight weeks, there was a 29% average reduction in the appearance of expression lines and under-eye lines, increasing to 38% by the 12-week mark. There was an improvement in the appearance of radiance, texture and overall appearance.9

GlycoAla

The science

GlycoAla is the only product combining photosensitising drug 5-aminolevulinic acid (5-ALA) and hyaluronic acid (HA). It uses unique Glycosphere nanotechnology to deliver both 5-ALA and HA into the skin where an enzymatic process converts the 5-ALA into potoporphyrin lX (PPIX), a photoactive chemical. Activation using a red LED light source leads to a photodynamic response, producing oxygen free radicals to treat oily skin, inflammatory and comedonal acne, sebaceous hyperplasia and photodamage.13

The results

GlycoAla is a nanotechnology delivery system for 5-ALA. It has not yet been peer-reviewed. However, its encapsulation of a low strength 2% 5-ALA to create a photodynamic response has proven both safety and efficacy by reducing the surface effect of higher percentages of ALA.14,15 Nanotechnology is rapidly becoming a new method for the delivery of active ingredients into the skin, minimising epidermal irritation and maximising treatment effect.

What practitioners say

Aesthetic practitioners Dr Jan Birch and Dr Robin Stones said, “We have been using GlycoAla within the clinic for a while now and found it to be a safe and effective treatment for acne and photodamage. The results have been very pleasing and patient feedback excellent. It can be used in all skin types and repeated as necessary with consistently good results. It fits nicely into our aesthetic portfolio.”

What practitioners say Ophthalmologist, oculoplastic and reconstructive surgeon Miss Rachna Murthy remarked, “The Revox Line Relaxer from Revision Skincare is a game-changer. It visibly reduces under-eye expression lines and crow’s feet, delivering great results on its own as a stand-alone product, especially in areas where injectables can’t be used. It’s even better when combined with injectables as it works synergistically to improve longevity of treatments, and support and optimise the quality of skin for maximum results.”

See the latest innovations at CCR! CCR is back on October 19-20 at ExCeL London, bringing you even more game-changing innovations! Register your interest by scanning the QR code!

RESTYLANE ® SKINBOOSTERS ™

THE ORIGINAL AND LONG-LASTING SKIN CARE INJECTABLE WITH RESULTS THAT LAST FOR UP TO 12 MONTHS AFTER THREE TREATMENTS1-8

Adverse events should be reported. For the UK, Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for Yellow Card in the Google Play or Apple App Store.

For Ireland, Suspected adverse events can be reported via HPRA Pharmacovigilance, Website: www.hpra.ie; Adverse events should also be reported to Galderma (UK) Ltd, Email: medinfo.uk@galderma.com Tel: +44 (0) 300 3035674

Imagery is of actual Restylane patient. For Healthcare Professionals Only

UKI-RES-2300061 DOP April 2023

by

1. Restylane® Skinboosters™ VITAL EU IFU. 2. Restylane® Skinboosters™ VITAL LIGHT EU IFU. 3. Wu Y et al. J Cosmet Dermatol 2020; 19(7): 1627-1635. 4. Gubanova E et al. J Drugs Dermatol 2015; 14(3): 288-299. 5. Dierickx C et al. Dermatol Surg 2018; 44 Suppl 1: S104-S18. 6. Lee B et al. Arch Plast Surg 2015; 42(3): 282-287. 7. Ribé A et al. J Cosmet Laser Ther 2011; 13(4): 154-161. 8. Kim J. Arch Aesthetic Plast Surg 2014; 20(2): 97-103.

Crown Aesthetics is celebrating five years since its medical grade device SkinPen Precision – the microneedling category leader in dermatology and aesthetics – became the world’s first FDA-cleared microneedling device and procedure, which is both CE-marked and ISO-certified.

SkinPen Precision has been a trusted microneedling choice for more than three million patients since it was first introduced in the US. SkinPen is the superior US engineered skin remodelling device, with worldwide distribution in 43 countries and backed by more than 90+ validation studies for quality, safety and performance.1-3

What is SkinPen Precision?

SkinPen Precision is a microneedling device that triggers the natural wound-healing process of the skin to treat acne scars and help improve the appearance of fine lines and wrinkles, surgical scars, stretch marks and enlarged pores. SkinPen Precision is also helpful in improving the cosmetic appearance of pigmentation conditions (dyschromia) by returning the skin to normal pigmentation activity. SkinPen Precision utilises collagen induction therapy to deliver medical aesthetic treatments through controlled micro-injuries to the skin, creating up to three million micro channels in a 30-minute treatment, eliciting the body’s natural wound-healing cascade. This process begins with injury/inflammation, progresses to tissue proliferation and

SkinPen Precision Celebrates

Five Years of FDA Clearance

Discover

ultimately results in tissue remodelling, including new collagen and elastin.

SkinPen offers a natural and non-surgical collagen boosting treatment, suitable for all skin tones and types all year round. It is a minimally invasive procedure performed by qualified medical practitioners in-clinic with little to no downtime.

With a patented, single-use advanced cartridge unit that is FDA-cleared and CE-marked, housing only sterile medicalgrade needles, this offers the best protection for cross-contamination and provides the highest safety and quality microneedling procedures. SkinPen continues to hold its position amongst healthcare providers, patients and celebrities as the world’s leading skin remodelling microneedling brand.

With unrivalled technology that medical professionals and patients can trust, more than 90+ validated studies were met for the SkinPen Precision System’s device and cartridge. SkinPen’s patented disposable microneedle cartridge has an in-built reciprocating device for precise calibration when treating the skin.

The mechanism of action

The treatment involves creating controlled micro-injuries in the skin, eliciting the body’s natural wound healing cascade. SkinPen is validated (FDA clinical trials) to create 1,600 micro-channels per second in the skin.1-3

Patient suitability

The SkinPen microneedling treatment is a safe and effective treatment for men and women for the face and body. It is safe and effective to treat all Fitzpatrick skin tones and types.1-3

Expected results

Patients can expect improvements between four to six weeks, allowing time for the body’s natural production of collagen and elastin. Patients may notice improvements as early as seven days post-procedure, with improved skin tone and texture. Proper skincare and maintenance are required to sustain desired results. Michael McKenna, general manager and executive vice president of Crown Aesthetics commented, “Crown Aesthetics is fully invested in creating viable solutions to address the needs of our providers and their patients. We have several incredibly exciting innovations in our pipeline that we can’t wait to launch over the coming months. Our celebration of SkinPen’s fifth anniversary is just the beginning of a very exciting time for this revolutionary brand.”

This article was written and supplied by Crown Aesthetics UKI

For more information on the device, visit www.skinpenuk.com

REFERENCES

1. Wamsley C, et al., ‘A Single-Center Trial to Evaluate the Efficacy and Tolerability of Four Microneedling Treatments on Fine Lines and Wrinkles of Facial and Neck Skin in Subjects With Fitzpatrick Skin Types I-IV: An Objective Assessment Using Noninvasive Devices and 0.33-mm Microbiopsies’ (2021).

2. Chopra V, ‘Microneedling of Immature Scars Is Safe and Improves Scar Esthetics’ Aesthetic Abstracts (2019).

3. Alqam M, et al., ‘Efficacy and tolerability of a microneedling device for treating wrinkles on the face’ Journal of Cosmetic Dermatology (2022).

4. Claytor R, Sheck C, Chopra V. ‘Microneedling Outcomes in Early Postsurgical Scars’ Plastic and Reconstructive Surgery (2022) Volume 150: Issue 3.

how the SkinPen Precision device became the world’s first FDA-cleared microneedling system, and a global leader in skin remodelling

Figure 1: A female patient, brachioplasty scar six weeks postoperatively before first microneedling treatment, and brachioplasty scar eight weeks after third and final microneedling treatment. Treatment performed by Dr Richard Claytor with a SkinPen. This is a published study.4

Supporting Patients Through Weight Loss Journeys

The

Three years ago, the COVID-19 pandemic hit, and people’s perceptions of the importance of health and wellbeing were renewed. Since then, there has been a growing interest in weight loss, fat reduction and management, with a survey of 5,000 adults revealing 39% planned to lose weight as a result of the pandemic.1 This has been reflected in the medical aesthetic industry, with practitioners reporting a growing number of patients requesting treatments to help support them along their weight loss journeys. As a result of this interest, we spoke to three aesthetic practitioners to find out the different ways you can implement weight loss and fat reduction methods in your clinic and provide patients with the right treatments.

Pre-treatment

All practitioners interviewed agree that prior to providing any treatments supporting weight or fat loss, patients must be provided with education on lifestyle changes to help them kickstart their journey. Aesthetic practitioner Dr Mayoni Gooneratne notes, “Everything I offer in terms of weight loss is performed as part of a wider programme through my Human Health Clinic, where I start by providing patients with solutions that incorporate lifestyle medicine and focus on diet and exercise. This is to help with the maintenance of weight loss and to make our patients healthier internally as well as externally.”

Aesthetic practitioner Dr Olha Vorodukhina agrees, stating, “If a

patient presents to my clinic struggling with their weight, the first thing we do is perform a consultation and advise them of any lifestyle changes that will help, like improving healthy eating and exercise.” She also recommends reducing alcohol intake and stopping smoking. She says, “This is because if we perform a treatment but they are still living unhealthily, results of the treatment will be lost and the weight could be put back on quite easily, so it’s important they are already on a regime.”

Aesthetic practitioner Dr Nestor Demosthenous advises that in order to provide the best services for your patients, you should always consider a wide variety of factors rather than looking to provide them with a quick fix treatment. He says, “Only in the last few years I think that we are starting to get a better understanding of what really leads to excessive weight and obesity. Genetics and epigenetics (determined by our environment, nutrition, stressors, sleep health and gut microbiome) all play an important role. Education on nutrition and exercise, as well as addressing stressors, quality of sleep, reducing or eliminating toxins is the best way to individually help patients.”

Treatments to support weight loss

If your patients are already embarking on their weight loss journey and have shown evidence of improved lifestyle factors, there are many treatments you can add to your clinic offering to help support them and enhance their results. While there are other treatments available such as radiofrequency and laser technology, the practitioners we interviewed personally utilise fat dissolving injections, carboxytherapy, weight loss injections and muscle stimulating devices.

Fat dissolving and carboxytherapy

Dr Vorodukhina chooses at her clinic to offer fat dissolving injections and carboxytherapy to help treat localised fat. She notes, “If the patient is adhering to diet and exercise regimes but finds there are still stubborn areas of fat that will not budge, despite them doing all the right things, we offer aesthetic treatment. This is typically on areas such as the jowls, chin, abdomen or thighs.” Dr Vorodukhina explains that her clinic’s resident plastic surgeon Dr Tracy Xu can then perform injection lipolysis with Deso Body or Deso Face injections, or she can perform carboxytherapy. Injection lipolysis works by targeting localised excess fat pockets, with the mechanism leading to the lysis of local adipocytes, resulting in contouring.2 One study of 221 selected patients presented with various forms and degrees of localised fat showed there was a treatment success in 93.5% of cases when using intralipotherapy treatments.3 Carboxytherapy works by increasing oxygenation in the treated area, increasing circulation and stimulating localised metabolic activity of the tissues.4 In a clinical audit of 101 women who underwent CO2 therapy for localised adiposities on the abdomen, it was found that there was a significant reduction in upper, mid and lower abdomen circumference.5

rise of weight loss and fat reduction treatments in aesthetic medicine and advice on implementing support in-clinic

Weight loss injections

Recent media coverage of weight loss injection Ozempic has caused a noticeable rise in requests, with Dr Vorodukhina noting that despite not offering the injections in her clinic, she has had a large number of patients asking her to perform the treatment. Dr Gooneratne offers the weight loss injection as part of her wider weight loss programme, after diet and exercise have been implemented. These work by stimulating the production of insulin, which regulates blood sugar levels, in turn slowing the emptying of the stomach and signalling to the brain a feeling of fullness. As a result, this can reduce appetite and food intake. She notes, “Medical weight loss injections are a fantastic way for motivated patients to kickstart weight loss when they are supported by our clinical environment. There is also evidence that they can reduce inflammation which is key to chronic disease. So, there is a multi-pronged approach when talking to patients about the advantages. Of course, they all need careful medical monitoring.” One study of 1,961 participants who received semaglutide, alongside implementing lifestyle interventions, found they had a mean weight loss of 14.9% from baseline.6

Despite increased interest, Dr Demosthenous has personally decided against offering weight loss injections in his clinic for the time being. He says, “I do not feel adequately qualified to be performing them. These are all still relatively new treatments and while they have been approved for both diabetes and weight loss, there has been recent evidence to suggest that when patients come off these injections, they can put a lot of the weight back on in the first year. Dr Peter Attia has reported this on his patient population where he started Ozempic and carried out DEXA scans. He found that patients were predominantly losing lean mass rather than fat mass.”7

However, Dr Demosthenous does believe that as long as they are not used as a quick fix or stand-alone treatment, they can still be implemented positively in aesthetic medicine. He notes, “There are several great aesthetic clinics who have invested heavily in their own education, as well as structuring a framework of science-based nutritional advice, exercise regimes, input from a psychologist, all paired with weight loss injections to therefore educate their patients and help them on their journey. In my opinion, this is how a service needs to be set up to fully provide our patients with the best care and outcomes possible.”

Devices

To aid his patients on their weight loss journey, Dr Demosthenous instead advocates for implementing devices such as the truSculpt Flex and truSculpt ID to help further their results. The former helps to tone and build muscle, while the latter has an average of 24% fat reduction 12 weeks after treatment.8 He explains, “Body contouring

devices are intended for people who are already following a good diet and are exercising. It’s for those who are of the mindset of wanting to push themselves further and heighten their results. These treatments are great adjuvants to their established regime, and herald excellent outcomes.”

There are many other well-researched and reputable body contouring devices on the market. Dr Gooneratne chooses to implement cryolipolysis using the CoolTech device, designed to treat subcutaneous fat in multiple body areas by freezing away fat cells. She adds, “It is great for removing focal areas of fat, but it is not suitable for global fat reduction as this needs to be achieved through a healthy diet and regular exercise.” One review of 19 studies on cryolipolysis noted that the average reduction in fat ranged from 14.67% to 28.5%.9

Considerations for implementing weight loss support

Patient demand

According to Dr Gooneratne, the decision to implement weight and fat loss services in her clinic was a direct response to patient needs and wants. She explains, “Before adding any treatments to your clinic you need to establish whether your target demographic is going to invest in these treatments and therefore whether it will have a positive or negative impact on your business.” Dr Gooneratne says one way to do this is to do a survey of your patients or directly ask them when they are in clinic. She adds, “I had a lot of people asking me regularly about lifestyle changes and wellbeing following the pandemic and this is when my weight loss services started to grow. I really felt like this was something I could support them with as an aesthetic practitioner, as people want to go somewhere they trust and where they can rely on aftercare and best practice.”

She adds that if the patient demand is already there, marketing efforts and costs will be relatively low. She explains, “All these people are already going to be on your database, so you don’t necessarily need to do any big or expensive campaigns – just keep communicating with who you already know. We have patients who have known about the programme for a long time before enquiring and engaging. So, keep messaging the people who already follow you, and keep it simple!”

Figure 1: Patient before and three months after fat dissolving injections.

Image courtesy of Dr Tracy Xu

“Before adding any treatments to your clinic you need to establish whether your target demographic is going to invest in these treatments and therefore whether it will have a positive or negative impact on your business”

Dr Mayoni Gooneratne

Patient suitability

Dr Gooneratne implements strict criteria for those wanting to embark on a weight loss journey. “All interested patients have a discovery call prior to starting, so that we can identify those who are not appropriate, for example if they have medical reasons to avoid weight loss services,” she explains. She adds that following that call, all patients then have a medical consult to determine their mental and physical health, how motivated they are to achieve the results to ensure commitment, their reasons for weight loss, whether they have attempted weight loss through other treatments and whether any surgical intervention is required.

For treating localised fat, Dr Vorodukhina explains that the decision of whether to implement carboxytherapy or fat dissolving injections for each patient depends on the area, the commitment of the patient and the price. “Fat dissolving is for more moderate cases and takes between three to five treatments for results. Carboxytherapy, on the other hand, can take up to 20 treatments for full results, so it depends if they are willing to be patient and wait for the end result to be achieved slowly,” she says, adding, “Of course, the more sessions the more expensive the treatment is, so committing to carboxytherapy might not be feasible for a lot of patients.”

External support

Dr Gooneratne advises that if you’re looking to implement services for weight and fat loss, you need to look at whether it might be a good idea to partner with professionals with different areas of expertise. She explains, “There are certain things that we as aesthetic practitioners might not be experts in – for example nutrition or exercise – so you will need to approach people in those fields to help. Personally, I work with a weight management coach, a personal trainer, a functional health specialist and a physiotherapist. You also need to consider extra things like whether you need someone to do the admin for that particular programme, or a call centre to be able to answer people’s questions.”

Dr Vorodukhina also has a referral pathway and utilises her own patient base to find the right people. She notes, “I work in conjunction with a dietician and personal trainer. Having this pathway in place is helpful for the people who aren’t quite ready for fat dissolving or carboxytherapy yet, as I can help them kickstart their journey using people who specialise in that area.”

Dr Vorodukhina adds that you also need to complete additional training for any new products or services and investigate what

support you might get from the companies you’re considering using. She explains, “Before we implemented Deso Body and Face, for example, we spoke to a large number of colleagues who had experience with the injection and utilised their positive feedback to inform our decision. We also looked into what training and support the company offered, as it’s important to know that if you need any help or experience any complications, there will be someone to guide you.” She adds that although she doesn’t personally perform fat dissolving injections as they are administered in-clinic by her colleague, she still attended the training so that she was fully equipped to recommend the treatment to her patients and provide advice.

Offering weight loss injections

Dr Gooneratne explains that if you are looking to offer weight loss injections in your clinic, it is also important to consider whether you are required to be registered with the Care Quality Commission, Healthcare Improvement Scotland, Healthcare Inspectorate Wales, or the Regulation and Quality Improvement Authority Ireland. The CQC states that you must be registered in order to perform or supervise advice or treatment in a clinic, including prescribing medicines, for the purposes of weight reduction.10

The CQC interprets this to include:10

• Using a medicine prescribed for this purpose

• Supervising patients’ treatment for obesity with a medicine prescribed for this purpose

• Treating people in a clinic or through an online web-based service

A clinic that offers diet plans or nutritional advice does not need to register, unless they also prescribe weight loss injections.10

Providing the right services

Dr Vorodukhina says that if you can get the right treatments for your patient base, weight and fat loss support services can be an extremely rewarding route to go down. She concludes, “Weight loss and fat reduction are gaining more and more traction and there is no sign of that slowing down any time soon. I’ve noticed the personality change you can achieve by helping your patients tackle their insecurities and it’s amazing, so as long as you manage expectations and provide a rounded approach to the individual, you can get great results and make a difference. Of course, only start to implement these treatments if you feel there is a real demand from your specific demographic. If there is, I would really recommend exploring this possibility to ensure you can meet their needs.”

REFERENCES

1. GOV.UK, Seven in 10 Adults Motivated to get Healthier in 2021, 2021, < https://www.gov.uk/ government/news/seven-in-10-adults-are-motivated-to-get-healthier-in-2021-due-to-covid-19>

2. Dr Olha Vorodukhina, Fat Dissolving Complications, 2022, <https://aestheticsjournal.com/feature/ case-study-fat-dissolving-complications>

3. Robert Amore, Evaluations of Safe and Effectiveness of Injectable Solution Acid Deoxycholic, 2018, <https://pubmed.ncbi.nlm.nih.gov/30276043/>

4. Dr Ohla Vorodukhina, Introducing Carboxytherapy, 2020, <https://aestheticsjournal.com/feature/ introducing-carboxytherapy>

5. Georgia SK Lee, Carbon Dioxide Therapy in the Treatment of Cellulite: An Audit of Clinical Practice, Aesthetic Plast Surg, 2010

6. John Wilding, 2021, Once weekly Semaglutide in adults, <https://www.nejm.org/doi/full/10.1056/ NEJMoa2032183?query=pfw&jwd=000020100690&jspc=>

7. Kristine Belonio, Ozempic Users Lose Muscle Mass, 2023, < https://www.medicaldaily.com/ozempicusers-lose-muscle-mass-alarming-rates-468494>

8. Sasaki G, Cryolipolysis for fat reduction, 2015 <https://pubmed.ncbi.nlm.nih.gov/26017594/>

9. Amy Taub, MD ASDS 2017 Poster Presentation, 2017, <https://cutera.co.uk/trusculptiD>

10. CQC, Scope of Registration, 2022, < https://www.cqc.org.uk/guidance-providers/scope-registrationregulated-activities#tddi>

“Education on nutrition and exercise, as well as addressing stressors, quality of sleep, reducing or eliminating toxins is the best way to individually help patients”

Dr Nestor Demosthenous

Exploring Lip Anatomy in Different Ethnicities

Dr Elle Reid and Dr Bryony Elder discuss the differing anatomy of the lips in a variety of ethnicities

The lips play a significant role in the overall symmetry and aesthetics of the face, thereby being a defining factor in a person’s overall facial attractiveness. A full lip, well-defined borders and a clear cupid’s bow have been well associated with both youth and beauty.1,2 The lips are also a hugely functional aspect of the face, playing an essential role in speech, mastication, tactile sensation and conveying emotion.1,2 When considering augmentation of the lips, a thorough understanding of anatomy and fundamental rules of measurement will help enable the practitioner to create an aesthetically pleasing result with reduced risk of errors.

Much of the literature available focuses on anthropological measurements of Caucasian patients, however, when taking into account the evaluation of beauty, consideration needs to be made to the ethnic differences of what ‘ideal’ proportions are appropriate for each individual patient.3

The popularity of lip augmentation

Cosmetic surgery and non-surgical interventions using hyaluronic acid (HA) based fillers to enhance the lips have gained considerable popularity in recent years.3,4 Many believe that reality star Kylie Jenner has been the catalyst for the explosion in the popularity of HA lip filler.5 When analysing Google trends on the popularity of search items, an increase in the number of people searching lip fillers could be seen worldwide on May 5 2015, the same day Jenner told the world she had undergone the procedure.5 In the UK, clinics reported a 70% increase in enquiries surrounding the procedure in the first 24 hours after Jenner’s announcement, with patients reportedly contacting through the night requesting to book in.5 According to online consumer data platform Statista, as of January 2021, lip filler procedures were the most popular cosmetic treatment searched online in the UK, with a monthly search volume of 40,500.6

Anatomy

When considering the full anatomical landmarks of the lips, the upper lips start at the alar base of the nose superiorly, extending down to the vermillion border inferiorly, and are bound laterally by the

nasolabial folds.3 The lower lip starts superiorly at the superior free vermillion edge and extends down to the mandible inferiorly, bound laterally by the commissures.3 The vermillion is the ‘red’ part of the lip that is covered with a specialised stratified squamous epithelium, which is in continuity with the oral mucosa of the gingivolabial groove.1,3 At the border where the vermillion meets the skin, there is a fine line of pale skin that accentuates the colour difference between normal skin and vermillion. On the upper lip, two paramedian elevations with a central depression make up the philtral columns.1,3 In the lower lip lies the labiomental crease, a U-shaped crease that corresponds intraorally to the depth of the gingivolabial sulcus (Figure 1).1,3

Musculature

Lips are composed of several muscles that control their movement and shape. When assessing a patient for lip augmentation, it is crucial to understand the anatomy and function of these muscles to achieve natural-looking results which enhance the overall facial features of the patient.

Muscles can be divided into three main groups:1,7

1. Muscles acting on the angle of the mouth – orbicularis oris, buccinator, levator angular oris, depressor angular oris, zygomaticus major, risorius

2. Lip elevators – zygomaticus minor, levator labii superioris

3. Lip depressors – platysma, mentalis, depressor labii inferioris

Figure 1: Lip boundaries and soft tissue lip anatomy1,2,7

Vasculature

The lips are supplied by the superior and inferior labial arteries that arise from the facial artery. An analysis of the literature has revealed that the labial arteries display great variability with respect to their distribution, location and presence.8 The origin of the superior labial artery is described in relation to the oral commissure with the distance between the two as ranging from 1.5mm to 15.5mm.4,8 There is consensus in the literature that the superior and inferior labial arteries follow a tortuous course. In many cases (77%) the vessels run deep to the orbicularis oris muscle in the submucosal plane, followed by intramuscular in 18% and superficially in the subcutaneous plane in 2%.8 A study by Loukas et al. has reported no differences in the morphological, topographical or morphometric parameters, particularly of the superior labial artery according to age, race, sex or region.9

The golden ratio

Though an attractive face is easy to identify, quantifying what makes a face beautiful can be challenging. Both the shape and size of a person’s lip in males and females are well documented as being of great importance in the perception of beauty.3

The golden ratio is also known as ‘the divine proportion’.1,2,4 It is an irrational number to the order of 1.618033988 and is widely considered to be a numerical description of beauty, and believed to be the key to attraction and aesthetics.3 With regards to the lips, the golden ratio is described in aesthetic literature as being the beauty standard, with the upper lip height in front view between a ratio of 1 to 1.6 of the height of the lower lip.3,10 However, this commonly quoted ratio is seen as the ideal for Caucasian lips and does not account for variations in lip anatomy and perceived ideals across different ethnicities.

Lip variations across ethnicities

Anthropometry is the study of proportions in the human body using scientific measurements.11 The following section discusses research on anthropometry with regards to variation of lip anatomy in relation to the face. It is pertinent to refer to available research to objectively consider the differences in lip anatomy across ethnicities. Firstly, focusing on ethnicities reported in the research available. There is little to no research focusing on the UK population relating to anthropology of lip anatomy across ethnicities. Currently, the UK is 82% white with 18% belonging to a black, Asian or mixed/other ethnic group.12 For the

purposes of this paper, Table 1 highlights collated research across a number of sources focusing on Caucasian, black, Asian/Indian, Asian/ Chinese and Asian/Korean backgrounds.13-19

Height of the vermillion

It is highlighted that black ethnicities have the largest measurement of a mean upper lip height with 9.8mm, and the smallest is Caucasian with a mean upper lip height of 7.3mm.13 The mean lower lip is the greatest in black ethnicities with 12.3mm, and smallest in Asian/Indian ethnicities with 9.15mm.13

Ratio

As previously discussed, the ratio of upper to lower lip height is not reflected in the measurements recorded in various populations. Asian/Korean ethnicities have the greatest ratio of upper to lower lip vermillion height with 1:5.6, and Asian/Chinese ethnicities have the smallest ratio and therefore the smallest disparity between the upper and lower lip height with 1:1.25.18,19

Protrusion

Not only are lips assessed from the frontal view, they are also assessed laterally. Therefore, discussing protrusion is important for lip assessment. Protrusion can be assessed using cephalometric assessments of soft tissues. Cephalometrics are used in orthodontic and surgical planning for objective measurements of the face and skull.19

1: Measurements collated from research of soft tissue measurements and cephalometric measurements of various ethnicities13-19

As of January 2021, lip filler procedures were the most popular cosmetic treatment searched online in the UK, with monthly search volume of 40,500

Nasolabial angle

This measurement demonstrates the protrusion of the lower lip in relation to the nose. The most obtuse nasolabial angle is recorded in Asian/Korean ethnicities as 92 degrees, and the most acute angle recorded in Caucasians of 110 degrees.15,16

Rickett’s line

This measurement relates to how far the upper and lower lips are from the E-line. The Rickett’s line was developed in 1969 by American orthodontist Robert Ricketts.20 The measurement was designed to assess the development of facial and cranial growth patterns.20 With regards to the lips, it is important to assess the distance of the upper and lower lips in relation to the nose and chin as this builds up the lateral profile of the patient.

Upper lip distance to Rickett’s line (E-Line)

In Asian/Chinese ethnicities the average upper lip sat beyond the Rickett’s line as -1.5mm.15 The furthest average measurement of upper lip distance to the Rickett’s line was recorded in black individuals with 5.76mm.13 The lower lip distance to the Rickett’s line was greatest in Asian/Chinese ethnicities with 0.9mm, and least in black individuals with 4.71mm.14

Lip width

Anthropometric measurements of lip width are from the lateral commissures or cheilion of the lip (Ch – Ch); this records the objective width of the lips. The greatest width recorded is in black ethnicities with 55.7mm,13 and the narrowest in Asian/Indian ethnicities with 44.28mm.15

Practical application

A variety of methods are available to augment the lip, including autologous fat transfer and lip implants, however, HA dermal fillers dominate the UK market. They are favoured for their non-immunological status, longevity and reversible nature via the ability to be depolymerised using hyaluronidase.7,21

A thorough consultation prior to any treatment is important to establish the patient’s goals and suitability for treatment.4,10 The consultation can be broken down into:

• Medical history

• Social history

• Verbal consultation

• Assessment of the lips

A verbal consultation is important to determine what the patient wants to achieve from treatment, past treatment history, their own perception of the balance between their upper and lower lip and what they would like to improve. Often patients have a clear idea of what they wish to achieve from lip augmentation. A physical assessment of the lips can determine the ratio of upper and lower lip, tonicity of the lip, protrusion and presence of any scarring or asymmetries.

The lips should be observed from every angle in both static and dynamic states to help detect any asymmetries. In cases where patients have previously undergone lip augmentation, the lips should be assessed for any existing lumps or migration.

Complications, incidence and detection across ethnicities

Complications from dermal fillers can include oedema, bruising, infections, asymmetry, lumps/bumps, hyperpigmentation and skin necrosis.22,23 There is little in the literature regarding the rate of complications in varying skin tones or with specific ethnicities.24

As with lighter skin tones, bruising is the most common adverse event when treating skin of colour (SOC) with dermal fillers.24 Factors including the location on the body, patient age, age of the bruise and skin colour can contribute to how easily a bruise can be observed under normal lighting conditions.25 In ethnicities with darker skin tones, visible discolouration or irregularities in the skin may not be as noticeable due to the higher melanin content which can mask discolouration, however, this is apparent when trying to determine the age of a bruise by detecting the yellow tones.26

Clinical trials of various fillers have not shown that there is any greater risk of hypertrophic or keloid scarring in patients with SOC, although the eligibility criteria for these trials excluded patients with a history of keloid scarring.24,27

Post-inflammatory hyperpigmentation (PIH) occurs after cutaneous inflammation or injury causing acquired hypomelanosis, and is noted as a risk of treatment with dermal fillers.22,28 PIH can arise in all skin types, however, pigmentary changes are seen more commonly and with increased severity in patients with SOC.28 It is also important to note that risk of hyperpigmentation may be influenced by other factors such as the type of filler used and individual patient characteristics.28 It has been proposed that techniques using fast injection and serial

The golden ratio is described in aesthetic literature as being the beauty standard for lips, with the upper lip height in front view between a ratio of 1 to 1.6 of the height of the lower lip

puncture techniques may result in a higher risk of PIH.24,29 However, there is no conclusive evidence in the literature linking SOC or any specific ethnicities with an increased risk of PIH following facial or lip fillers. Furthermore, studies on small groups comparing the safety and effectiveness of HA fillers in SOC have shown dermal fillers to be well tolerated by all skin types.30,31

Tissue necrosis which is defined as ‘the death of most or all of the cells in an organ or tissue due to disease, injury or failure of the blood supply’, is one of the most serious complications that can arise from lip augmentation.32

Albeit not specific to aesthetic medicine, studies have shown that ischemia, which is the restriction of blood supply to tissues, may be less visible on SOC.33 This is attributed to the fact that the reduced blood flow may not cause the skin to appear pale, which is a characteristic sign of ischemia, but instead appear as a dusky ‘aubergine’ shade.33 The literature regarding this is limited and does not link specific ischemia cases with the use of dermal fillers. It is, therefore, essential that practitioners have a comprehensive understanding of the full range of symptoms that arise from causing a vascular occlusion that could lead to soft tissue ischemia.32

It is clear from the studies and literature available that more needs to be done with regards to research into the prevention and detection of complications that may arise when treating ethnicities who fall into darker Fitzpatrick skin tone categories.

Appreciate individual lip anatomy

It is important to have an appreciation that beauty standards, popularity of treatments, anatomy and presentation of complications can vary across ethnicities. When treating the lips, variation in parameters across ethnicities, patient preferences and individual lip shape should be respected. By promoting cultural competence and awareness of the varying anatomical features among different ethnicities, medical practitioners can provide more comprehensive and effective care to their patients.

Lip augmentation treatments should never be standardised or based on preconceived notions of what is considered ‘ideal’. Instead, practitioners should approach these procedures with a patient-centred mindset and strive to create customised treatment plans that consider the individual’s unique anatomy, ethnic background and aesthetic goals.

Dr Elle Reid is an aesthetic practitioner and dental surgeon graduating from Newcastle University. Dr Reid has a background in maxillofacial surgery, hospital and practice-based dentistry and is the lead trainer in Newcastle-upon-Tyne for Acquisition Aesthetics and director of Paragon Aesthetics.

Qual: BDS, MFDS (Edin)

Dr Bryony Elder is an aesthetic practitioner based in Newcastle-upon-Tyne. She teaches aesthetic medicine alongside dental emergency management and anatomy at Newcastle University. She is the Level 7 Diploma lead for Acquisition Aesthetics and the director of Ametrine Aesthetics and AM Mindset Coaching.

Qual: BChD

Test your knowledge!

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

Possible answers

Questions

1. In what proportion of patients does the labial artery run in the intramuscular plane?

2. The orbicularis oris, buccinator, levator angular oris, DAO, zygomaticus major and risorius muscles are categorised as muscles which are…

3. What anatomical landmark is used to measure the width of the lip?

4. What best describes the Rickett’s line?

5. From the quoted research, which ethnicity has the greatest upper to lower lip ratio?

a. 12%

b. 15%

c. 18%

d. 22%

a. Lip elevators

b. Acting on the angle of the mouth

c. Lip depressors

d. Involved with cheek elevation

a. Vermillion border

b. Cheilion

c. Philtrum

d. Modulus

a. Assessment of lip protrusion

b. Assessment of the nasolabial angle

c. Measurement of gingival display

d. Degree of nasal protrusion

a. Caucasian

b. Asian/Korean

c. Black

d. Asian/Chinese

Answers: C,B,B,A,B

There is little to no research focusing on the UK population relating to anthropology of lip anatomy across ethnicities

All

Headline Sponsor

Co-located with

Why Juvéderm?

Delivering consistent outcomes and high patient satisfaction1-11

Juvéderm is the world’s leading hyaluronic acid (HA) dermal filler band.12-13* Perceived by healthcare professionals as the most requested brands by consumers,14** the Juvéderm portfolio consists of products that provide patients with high satisfaction2-10 and delivers on high-quality,15 individualised and long-lasting results with duration approximately 9 to 24 months depending on which product you use in the range.16-21†

The range has proven consistent outcomes and an acceptable patient satisfaction rate,1-11 as well as a versatile profile of products22-30 that produce natural-looking results.19,31-35 Key to the value of Juvéderm is the level of quality delivered in each and every syringe.15,36-38

High-quality design and manufacturing15,36-38

After launching in 2004, more than 100 million Juvéderm syringes have been manufactured to date, delivering consistent treatment experiences across the globe.15,36-38 Each syringe is individually checked by 40 people and must pass eight different tests to check for purity.38 Before the syringe leaves the factory, it must also pass a final visual inspection.38

Miss Sherina Balaratnam says, “High-quality design and manufacturing through constant innovations is integral for everything we do. In my view, it helps us deliver safe treatments, and this is the fundamental aspect of the Juvéderm Vycross portfolio.”

An enhanced injection experience39,40

As of 2022, there have been seven evolutions to the Juvéderm syringe, with each driven by feedback from practitioners to support improvements in injection technique.41 The latest evolution, the Juvéderm innovative ergonomic syringe, has been designed with comfort in mind for improved ease and reduced muscle fatigue for the injector.39,40 The new design has consistently rated an improvement over the previous design, as it lowers the exertion required.39,40‡

Product Indications

Juvéderm Volux • Define the lower face by lifting or shaping the chin and jaw area.

Juvéderm Volite • Enhance skin quality around the face, hands, neck and decolletage.

Juvéderm Volbella • Reduce signs of ageing around the forehead lines, periorbital lines, glabellar lines, lips, and perioral lines.

Juvéderm Volift • Fill lines and shape features around the forehead lines, eyebrow, cheeks, nasolabial folds, lips and perioral lines, marionette lines and chin.

Juvéderm Voluma • Correct mid face volume to the temple, cheeks, and cheekbones.

The products within the Juvéderm Vycross portfolio22,24-27

Miss Balaratnam says, “I have watched the Juvéderm syringes evolve over my 14 years in medical aesthetics, and they have become better for our patients and practice. Ultimately, the syringe design impacts the patient’s experience, influencing their comfort, supporting administration and treatment from their practitioner. So people might think – it’s just a syringe – but it’s more than that!”

Raising ethical standards42,43

The Allergan Medical Institute (AMI) provides healthcare professionals with evidence-based, expert-led medical education, both digitally and face-to-face.42,43 The AMI offering includes:

• AMI digital world offers on-demand access to world-leading teaching accessible via mobile

• Consultation and treatment planning app available via app store and android

• Industry-leading faculty and team of Clinical Specialists delivering progressive and cumulative learning journeys designed to enhance injector capabilities at all experience levels.

*The AMI Digital World discusses Allergan Aesthetics products and is for UK HCPs only.

Miss Balaratnam says, “Education is the currency to our future. We always say knowledge is power – if we don’t understand what’s in the product, for example, we won’t understand how or where to use it. AMI helps practitioners to continue to pursue their education for optimum outcomes and progression within the field.”

Predictable outcomes and patient satisfaction1-11

Over the last 15 years, 32 clinical studies have demonstrated that the Juvéderm portfolio has consistent, results that are measurable by objective assessments.1,2,11 This has led to a consistent rate of patient satisfaction, namely between 87%†† and 98%‡‡ 2-10 Within the Juvéderm portfolio each product is designed specifically to meet varied patient and practice needs,22-30 and is demonstrated to integrate with tissue as early as one week.31,32 By week four, tissue is highly integrated,31,32 giving patients natural-looking results.31,33,35***

Miss Balaratnam says, “Patients have expectations, and practitioners need to aspire to deliver predictable and natural looking outcomes to meet these expectations. I do this through imaging, excellent consultations and of course, selecting and using high-quality products. The products and the protocols we use need to ensure that patients and practitioners have great, longterm predictable outcomes, time and time again.”

This article is produced and funded by Allergan Aesthetics and is intended for healthcare professionals. UK-JUV-230073 | Date of preparation April 2023

Advertorial

Allergan Aesthetics

©AbbVie 2023. All rights reserved. Material produced and funded by Allergan Aesthetics, an AbbVie company. www. allerganaesthetics.co.uk

Adverse events should be reported. Reporting forms and information can be found at: UK adverse events reporting https://yellowcard.mhra.gov.uk/ Adverse events should also be reported to Allergan Ltd. UK_ medinfo@allergan.com or 01628 494026 Irish adverse events reporting https://www.hpra.ie Adverse events should also be reported to Allergan Ltd. UK medinfo@allergan.com or 01628 494026.

*Based on HCP tracking market research involving over 1,700 HCPs from 16 international markets.

** Data from 2021 and Q1 2022. SURVEY OF 1,620 HCPs from 15 countries worldwide. Sample included HCPs from Australia, Brazil, Canada, China, France, Germany, Italy, Japan, Mexico, Russia, Spain, Taiwan, Thailand, Turkey and United Kingdom.

†Juvéderm® VOLUMA has been shown to last up to 24 months in the malar region of the face.20,21 ‡Studied in simulated applications by experienced professionals (N=20). 40

†† In a clinical study of 192 patients treated with Juvéderm® VOLUMA for correction of chin volume deficit, 87.3% of patients (n=110/126) rated their own appearance as improved or much improved 6 months after treatment.8 ‡‡ In a clinical study of 60 patients treated with Juvéderm® VOLBELLA for lip enhancement, 98.3% of patients (n=58/60) felt they had achieved improved lip fullness after 1 month.4 *** Integration with tissue can take just one week, demonstrated by Juvéderm® ULTRA XC, Juvéderm® ULTRA PLUS XC, Juvéderm® VOLBELLA, Juvéderm® VOLIFT and Juvéderm® VOLUMA at 4 weeks in animal in vivo studies.31,32

REFERENCES

1. Santorelli A and Marlino S. Aesthetic Plast Surg. 2020;44(3):919–926.

2. Ogilvie P et al Dermatol Surg. 2019;45(10):1294–1303.

3. Ogilvie P et al J Cosmet Dermatol. 2020;19:1065–1070.

4. Eccleston D and Murphy DK. Clin Cosmet Investig Dermatol. 2012;5:167–172.

5. Ogilvie P et al Dermatol Surg. 2020;46:376–385.

6. Demosthenous et al. Cosmet Medicine. 2022;4:1-7

7. Philipp-Dormston WG et al J Cosmet Laser Ther. 2014;16:171–179.

8. Beer K et al Dermatol Surg. 2021;47:80–85.

9. Dayan S et al Dermatol Surg. 2015;41(Suppl 1):S293–301.

10. Lanigan S. J Cosmet Dermatol. 2011;10:11–14.

11. Allergan Data on File. REF-100197. JUVÉDERM® Allergan/AbbVie sponsored clinical trials

12. Allergan Aesthetics – HCP Dermal Filler Tracker. Q4 2022. International markets REF-100463

13. Allergan Aesthetics Market Research – US DF AMT report. Final report December 2022. USA REF108642

14. Allergan Data on File. REF-99471. JUVÉDERM® VALUE PROPOSITION, COMMERCIAL CLAIMS MESSAGE DOCUMENT.

15. AbbVie. The highest standards of quality and safety. Available at: https://www.abbvie.co.uk/societalimpact/for-the-resilience-of-our-business/quality-and-safety.html [Accessed April 2023].

16. Liew S et al. J Cosmet Dermatol. 2020;19:296–302.

17. Gutowski KA. Clin Plast Surg. 2016;43:489–496.

18. Allergan Data on File. ALL-ABBV-211159. Corporate value practical guide.

19. Pinsky MA et al. Aesthet Surg J. 2008;28(1):17–23.

20. Callan P et al. Clin Cosmet Investig Dermatol. 2013;6:81–89.

21. Jones D and Murphy DK. Dermatol Surg. 2013;39:1602–1612.

22. Juvéderm VOLUMA with lidocaine DFU REF 58175.

23. Juvéderm® ULTRA 2 DFU. 73661JR10. Revision 2019-09-09.

24. Juvéderm® VOLITE DFU. 73655JR10. Revision 2019-09-09.

25. Juvéderm VOLIFT with lidocaine DFU REF 58007 (v1.0)

26. Juvéderm® VOLUX DFU. 73651JR10. Revision 2019-09-09.

27. Juvéderm VOLBELLA with lidocaine DFU REF 67882

28. Juvéderm® ULTRA SMILE DFU. 73664JR10. Revision 2019-09-09.

29. Juvéderm® ULTRA 3 DFU. 73662JR10. Revision 2019-09-09.

30. Juvéderm® ULTRA 4 DFU. 73663JR10. Revision 2019-09-09.

31. Hee CK et al. Dermatol Surg. 2015;41(Suppl 1):S373–381.

32. Allergan Data on File. ALL-JUV-210477. JUVÉDERM® tissue integration images.

33. Goodman GJ et al. Clin Cosmet Investig Dermatol. 2011;4:197–205.

34. Baumann LS. Dermatol Surg. 2007;33(Suppl 2):S128–135.

35. Goodman GJ et al. Plast Reconstr Surg. 2015;136(5 Suppl):139S–148

36. Allergan Aesthetics. Data on File. REF-96563. FILLERS GLOBAL NUMBER OF SYRINGES. May 2022.

37. Stephens H. 2000. Allergan’s first fifty years.

38. Allergan Data on File. INT/0185/2015. JUVÉDERM® MANUFACTURING PROCESS. REF-91541

39. Costello K et al. In-field assessment of the perception of smoothness when dispensing different filler formulations. International Master Course on Aging Science (IMCAS), 3–5 June 2022, Paris, France. <https://abbvie1.outsystemsenterprise.com/GMAEventPublications/Assets.aspx?ConferenceId=299>

40. Costello K et al. A new dermal filler syringe with improved ergonomic performance to enhance end-user experience. International Master Course on Aging Science (IMCAS), 3–5 June 2022, Paris, France. <https://abbvie1.outsystemsenterprise.com/GMAEventPublications/Assets. aspx?ConferenceId=299>

41. Data on File. Allergan Aesthetics Juvéderm Timeline Email. 2022. REF-98485.

42. Allergan Data on File. REF-99675. JUVÉDERM® VALUE PROPOSITION_ EDUCATIONAL CLAIMS MESSAGE DOCUMENT.

43. Allergan. Allergan Medical Institute. https://eu.allerganmedicalinstitute.com/AGN_AMI_Landing_ Page?country=GB&lang=en_GB [Accessed April 2023].

Spark by Allergan Aesthetics

“For

Treating Abdominal Skin Laxity

Dr Jo Mennie outlines an approach to treating abdominal skin laxity in the post-partum patient

In recent years, we have seen a huge increase in the number of machine-based technologies being sold and marketed to practitioners 1 This has followed the rise in demand and awareness for minimally-invasive treatments worldwide.2

The majority of body treatments have long been focused on fat reduction or cellulite, however, for the post-pregnancy patient, it is often an isolated skin laxity issue that they struggle with. For these women, the skin laxity is commonly not severe enough to warrant a surgical approach, whilst for some, if further pregnancies are planned, this would not be an option. For this cohort of women, radiofrequency-based technology alongside supplemental nutrition offers one solution.3 4

Pregnancy and skin

During pregnancy, the increase in relaxin and progesterone softens ligaments to make space for the baby. However, they also soften the small structural elastin skin fibres within the dermis. This softening of the scaffolding of the dermis makes it more likely to break under pressure. As the abdomen increases in circumference it puts more pressure on the elastin, weakening the dermis and its potential for elastic recoil.5

Post-partum is a period when there are a number of systems within the body recovering, and the ability to regenerate

collagen and elastin in the skin can be limited as women find themselves in a post-natal depletion state.6 During this stage of life, sleep is often disrupted, which further compounds the issue due to the huge impact sleep has on the body’s ability to regenerate and recover.7 This often makes it difficult for women’s bodies to address skin laxity issues during the post-partum period.

A combination approach

For treating post-partum patients, I prefer to use a combination approach by combining supplemental nutrition and radiofrequency microneedling (RFM) to achieve optimal results. Supplemental nutrition ensures adequate building blocks to optimise collagen production throughout treatment and for the healing journey. RFM assists in aiding skin laxity rather than targeting fat reduction.

Supplemental nutrition

To facilitate new collagen growth, we need to ensure systemically that the body has adequate amino acid building blocks and co-factors. In those seeking body treatments, the larger area being treated and the fact there is often damage to the current skin structure makes supplemental nutrition a key component to their treatment pathway. Specifically, we first need to look at glycine, which plays a key role in

collagen turnover alongside providing structural support.8 Second, proline and its derivative hydroxyproline also have a key role in creating collagen’s strength.9 10 Lastly, the co-factor of collagen synthesis, vitamin C, is essential for successful utilisation of amino acids, as well as bringing antioxidant properties to the repair journey.11 Depending on the patient’s preference, the additional amino acids can be acquired through bovine or marine collagen supplementation or from a vegan source, but the traceability of ingredients is key. Heavy metals from supplements have been shown to exert estrogenic activity, and in the post-partum patient in particular, we want to minimise any ingredients disrupting hormone levels.12 13

Radiofrequency biostimulation

RF surface body technologies have been available to practitioners for many years and I believe they can deliver good results. However, in the post-partum abdominal skin where there has been such damage, personally, results are not as efficacious. In recent years, however, there has been the development of delivering RF within the dermal layer and advancements in the process of RF delivery. This so-called RF microneedling is one of the most advanced fractional technologies to effectively target loose skin through stimulation of collagen synthesis and strengthening the fibro septal network.14 A greater healing cascade is triggered through the process of thermal heating from the RF and microinjuries.15 16

Case study

A 37-year-old fit and healthy patient presented to clinic 15 months after the birth of her second child, following an uncomplicated pregnancy. Despite a regimented exercise routine, she expressed dissatisfaction at not being able to improve the appearance of her abdominal skin, specifically the elastic recoil. Both her children were born around the 40th centile for weight, and she had gained an average amount of weight during pregnancy. Her weight loss post-partum had been steady. On examination she had Fitzpatrick skin type IV, little fat, and excellent abdominal muscle strength with minimal divarication. However, as is common in the post-partum stomach, she had a large degree of horizontal skin laxity. Her skin was also thin and crepey, in particular above the umbilicus centrally. Having talked through the various options, the patient opted for supplemental nutrition alongside RFM

technology. Supplemental nutrition was started on the first day of treatment in the form of a vegan powder-based supplement containing glycine and proline, with an additional high-dose vitamin C supplement. This was continued daily throughout the treatment and for three months following her last RFM session.

RFM was chosen to help improve her skin laxity concerns. There are many suitable RFM technologies available on the market; I prefer to use Morpheus8. The technology allows for the fractional RF to be delivered in the sub-dermal layer of skin through coated pins that are programmable to various depths.

In the headpiece, it is only the tips of the microneedles that pass the current once in the skin. The pins are spaced out, leaving islands of skin untreated which reduces recovery time.17 The pins on the headpiece are all positively charged compared to other fractional RF machines that have positive and negative pins. This means that in the headpiece, the current has further to travel and does not concentrate between the pins. This allows the injury to be more controlled and refined, staying within a zone of coagulation and reducing the chances of creating a zone of necrosis.17 The stimulation becomes less about inflammation and more about activation of the post-inflammatory collagenases, elastogenesis and angiogenesis response.18,19

There is also the ability to fix the pins during treatment, meaning several bursts of RF energy can be stacked in quick succession. I have found that this is useful in body treatments where the elastic properties of the skin have been severely damaged, as higher doses of RF tailored to the individual patient’s issues can be precisely delivered without damaging the skin.

Before performing the RFM treatment, I chose

to numb the area with local anaesthetic injections to help with pain management, as well as allow the energy to be delivered at a high level and skin depth.

A total of three Morpheus8 sessions were performed under local anaesthetic, spaced four weeks apart. The 40 pin Body Tip was used during each session. The depth of pins was set at 5mm, except around the umbilicus, during which we dropped down to 4mm. Energy was set at 25kW and fixed for one stack during the first session, 25kW for two stacks during the second session and 30kW for two stacks in the third and final session. The more cautious approach was employed in consideration of the patient’s skin type to avoid risk of hypopigmentation, as RF is chromophore independent.17 Post-procedure, there were some minor side effects, which were expected, including bruising for five days and erythema, which lasted for 24 hours. The pin sites developed some small pin-point scabbing which lasted seven to 10 days, again as expected. I advised against saunas and swimming pools during the first week of recovery, and to avoid any fragranced body wash or cream as the skin can have some mild sensitivity after. Sun should also be avoided during the treatment pathway. From day three, a non-fragranced moisturiser was applied in the evening until the scabbing disappeared.20

In this patient’s case, I have successfully restored strength to the dermis and improved collagen levels to a localised area of damage post-pregnancy (Figure 1). The results are permanent, but subject to the natural ageing process. While this treatment would not be indicated again for several years, there is the option for this patient to boost their collagen production annually with injectable biostimulators.

Continuing treatment through injectable biostimulators

Injectable biostimulators are commonplace among our facial treatment offerings, and also hold value for patients seeking body skin tightening. My plan with this patient is to assess them at the one-year mark and see whether biostimulators may be necessary. There are certain brands which have created specific body versions of their biostimulators; one such example is Profhilo Body, which is what I will be recommending to my patient. Whichever biostimulator the practitioner chooses, the principal centres around local stimulation of fibroblasts to increase the expression of collagen and elastin.21 Comparative to the face, 50% more product and one further treatment session are usually needed to account for the large area and additional skin damage.14 For those patients with even more marked skin damage post-partum, combining the injectable biostimulators and RFM simultaneously is an option which can be performed at the same time.

Restoring the skin

The post-partum patient can present a challenge owing to the degree of skin laxity and structural damage, compounded by the potential for post-natal vitamin and mineral depletion. In these patients, ensuring a foundation of adequate supplemental nutrition alongside targeted fractional RF microneedling can generate effective results. RFM allows a high dose to be delivered safely and the settings to be tailored precisely to the individual, making it an excellent choice in this patient group where the elastic properties of the skin have been severely damaged.

Dr Jo Mennie has more than 12 years’ experience working as a plastic surgery doctor in the NHS. She has completed a PhD in Women’s Health, for which she received a research fellowship award from the Royal College of Surgeons of England and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). She is a lead aesthetic doctor at David Jack Clinic.

Qual: MBChB, MRCS, MSc, PhD (Women’s Health)

Figure 1: 37-year-old patient before and six months after three treatments using Morpheus8 radiofrequency microneedling technology

100 MILLION

We have reached a significant milestone, the manufacturing of 100 million JUVÉDERM® syringes.1,*

While we are proud of this achievement, reaching this milestone means so much more than a number.

For us, it represents so many patient experiences, because we craft every JUVÉDERM® treatment to highlight our patients’ individuality. Since our launch in 2006, the JUVÉDERM® brand has experienced a remarkable evolution that is still ongoing today.

We couldn’t have reached this landmark without the collaboration between Allergan Aesthetics, the expert skill of practitioners… and of course the JUVÉDERM® experience that you continue to share.

It is because of these partnerships that so many patients have been able to achieve their unique aesthetic goals.

Although 100 million syringes is a significant milestone for us, we recognise that our journey continues and there is so much more to come.

At JUVÉDERM®, we believe that with our holistic treatment approach to individual beauty, combined with strong partnerships between Allergan Aesthetics and physicians, we can go beyond 100 million syringes.

Adverse events should be reported. Reporting forms and information can be found at:

adverse events reporting https://yellowcard.mhra.gov.uk/

Case Study: Lifting and Tightening the Face with EMFACE

EMFACE is the first device on the market to simultaneously apply synchronised radiofrequency (RF) and HIFES energies to the face. Clinical studies have shown that the simultaneous emission of these energies reduces the effects of the facial ageing process.1,2 Patients undertaking a course of four treatments can expect a 37% reduction in facial wrinkles, a 23% lifting effect and a 30% increase in muscle tone.1,2

Innovative new technology

EMFACE is a needle-free, non-invasive procedure stimulation to lift and tighten the face and brow. Synchronised RF remodels and smooths the skin by heating the dermis, increasing collagen by 26% and doubling the amount of elastin in the tissue.1,2 HIFES is a patented technology that uses high-intensity electrical fields to restore and elevate facial tissues by selectively contracting muscles and increasing the density and quality of muscle structure.

In EMFACE, three facial applicator pads simultaneously emit both synchronised RF and HIFES energies, causing stimulation on the elevators of the facial muscles – the frontalis, the zygomaticus major and minor and the risorius muscles. The frontalis muscle elevates the brow area causing a lifting effect and reducing the appearance of hooded eyes. The zygomaticus major, minor and risorius muscles elevate the corners of the mouth and lift the mid-face, softening the

nasolabial folds and marionette lines. RF has been designed to avoid the side effects of fat loss in the superficial fat compartment by focusing on superficial tissue. EMFACE naturally addresses the ageing mechanism with wrinkle reduction and volume gain through modelling of dermis collagen rather than muscle paralysis (toxin) or additional volume (dermal fillers). The non-invasive approach makes EMFACE an effective alternative for those who wish to avoid more invasive options. Clinical research by BTL shows that patients show positive treatment effects one year after an initial course of four treatments.1,2

Since I introduced EMFACE into my clinic in December, we have treated patients from single sessions to courses of four treatments. All patients have seen tangible results immediately after the first treatment. Results in the clinic have typically shown a significant lift in the brow area, a reduction in the appearance of static forehead lines (sometimes diminishing completely), a plumper cheek and midface lifting effect, a significant decrease in the nasolabial folds and an indirect improvement of jawline laxity, with better overall skin texture and quality. In some cases, we have opted for a combination approach using EMFACE with other treatments for submental fat reduction and improvement of chin and jawline definition. Most patients are currently choosing to postpone injectable approaches as EMFACE is providing a natural alternative.

At the clinic, we treat many male patients who are typically more averse to injectable treatment paths, and EMFACE has been a popular option for them as the treatment is less invasive and still allows full natural movement of the face.

Case Study

A 42-year-old female patient presented to my clinic with concerns about signs of ageing,

volume loss in the mid-face, hooded eyelids and prominent nasolabial folds. The patient had previously accessed toxins around the eyes and forehead. After a thorough consultation, an initial course of four EMFACE treatments was recommended at intervals of seven days.

Reviews were scheduled at key points of the treatment plan, allowing for discussion of patient expectations and evaluation of results. Immediately after the first session, a visible reduction in the nasolabial folds and increased midface volume were apparent. As we progressed through the treatment plan, a reduction in the nasolabial folds continued to improve. By session four, a significant lift in the brow was apparent, with an increased amount of the eyelid now visible. Static lines across the forehead have diminished, and the overall skin texture and quality have improved.

A revolutionary treatment option EMFACE is changing how we address signs of ageing for patients. Instead of immediately considering neuromodulators or dermal fillers to paralyse or add volume, we can address the foundations of signs of ageing naturally by working to strengthen the elevator muscles and increase the density and quality of muscle structure, providing a natural lift. With clinical trials showing positive effects one-year post-course, EMFACE is proving to be an effective non-surgical alternative to more invasive anti-ageing treatments.1,2

Michelle McLean is the founder and medical lead for Aesthetically You, a ‘good’ rated CQC clinic in the Northwest. She has 12 years’ experience in the industry and is a regional leader for the BACN and currently completing a second Masters in Cosmetic Medicine.

Qual: RGN, INP, MSc, BSc (Hons), DIP/HE

This advertorial was written and supplied by BTL Aesthetics

Contact us to find out more about EMFACE at: https://btlaesthetics.com/en/request-info or find the nearest EMFACE at: https://btlaesthetics.com/en/ clinics-near-me

TO VIEW THE REFERENCES GO ONLINE AT WWW. AESTHETICSJOURNAL.COM

Advanced nurse practitioner Michelle McLean presents a case study showing full-face rejuvenation using EMFACE

Figure 1: 42-year-old patient before and after four treatments using EMFACE

the NEW depigmenting solution by mesoestetic®

NEW from the world leader in depigmentation treatments

now you can correct pigmentation imperfections and improve the quality, turgor and appearance of the intimate area in a single clinical session.

This is the latest innovation in pigmentation treatment brought to you by mesoestetic® through over 35 years of research and development.

Developed in collaboration with specialised gynaecologists.

Treating Keratosis Pilaris

Dermatologists Dr Derrick Phillips and Dr Kohei Matsumoto introduce a variety of treatment options for keratosis pilaris

Keratosis pilaris (KP) is a common skin condition which causes abnormal follicular keratinisation, producing a characteristic papular rash on the extensor surfaces of the upper arms, upper legs and buttocks.1 It may also affect other areas such as the face and trunk.1 KP typically presents in early childhood, and affects 50-80% of adolescents and approximately 40% of adults.1 It is thought to be a genetic disorder, and most cases fit an autosomal dominant pattern of inheritance with variable penetrance.17

The cause of KP is not fully understood, however, it has been associated with mutations in the FLG gene encoding the key epidermal protein filaggrin.1 KP is benign and usually asymptomatic.1

However, in our experience, it can be a source of considerable distress, due to the cosmetic appearance. Although there is no cure, there are effective treatment options available to manage this condition.

Clinical features

Patients with KP are usually asymptomatic, and most complaints are due to its cosmetic appearance, the feeling of rough-textured skin and occasional mild pruritus (itching). This may in turn lead to psychological distress affecting patients’ quality of life. KP typically presents as keratotic follicular papules involving extensor aspects of proximal arms, legs and buttocks, with variable erythema.2 It may also involve the

face, trunk and distal extremities.2 Variants of KP include keratosis pilaris rubra (KPR); where there is marked perifollicular redness, which may manifest as a violaceous hue or hyperpigmentation in skin of colour. The papules of KP can also appear greyish white without erythema, which is termed keratosis pilaris alba (KPA).2 Keratosis pilaris atrophicans faciei (KPAF) is an uncommon form of KP with associated scar-like follicular depressions and gradual loss of hair on the lateral aspects of the eyebrows.3 KP tends to improve with age, although it may be more prominent and inflamed during winter months as it is often exacerbated by cold.4

KP commonly occurs in the setting of atopic eczema and ichthyosis vulgaris, both of which are associated with fillagrin mutations.1 It can be seen in scarring hair loss conditions and is prevalent amongst patients with diabetes mellitus and obesity.1 KP is also associated with some genetic conditions including cardio-fasciocutaneous syndrome, ectodermal dysplasia, keratitis-ichthyosisdeafness (KID) syndrome, prolidase syndrome and trisomy 21.1

The diagnosis of KP is clinical, and it is based on findings of spiky keratotic papules in the typical distribution. Therefore, skin biopsy is not usually necessary unless there is concern about one of the scarring subtypes. However, a classical histopathological finding would be the distension of the follicular orifice by a keratinous plug that may contain one or more

twisted hairs.5 Although KP tends to improve with age, for some patients the condition may persist, become particularly widespread or have intense erythema.18 There is no cure for KP, but there are various treatments available to improve cosmesis and symptoms. KPAF often requires more aggressive treatment, although the options remain the same.

Emollients and keratolytics

Patients with KP should be encouraged to avoid practices that dry out the skin, such as use of detergent soaps and having hot baths or showers.4 Emollients can alleviate mild KP by tackling dryness, particularly if they contain keratolytic ingredients such as urea, lactic acid and salicylic acid.2

Topical retinoid

Topical retinoids (such as Tretinoin, Adapalene, Tazarotene and Trifarotene, all of which are prescription treatments) is a treatment option that can be considered when moisturising with emollients has failed. Retinoids are vitamin A derived compounds that are effective at treating follicular disorders such as acne and KP. Retinoids act to normalise desquamation by reducing keratinocyte proliferation and promoting differentiation. They can cause dryness and irritation, making them unsuitable for patients with sensitive skin or active eczema. They are also teratogenic, therefore are not to be prescribed for pregnant women.6

Topical corticosteroid

Short courses of mild to moderate potency topical steroid can be used in cases where KP lesions are particularly inflamed.2 Topical corticosteroids can be prescribed by any doctor or prescribing nurse, but dermatologists may prescribe more potent steroids. Treatment is discontinued once inflammation improves, usually within seven days.2

Systemic retinoids

Treatment with oral retinoids (for example, Isotretinoin) may be considered when there is no improvement with topical measures. Isotretinoin reverses abnormal follicular keratinisation, but also shrinks the sebaceous glands, leading to dryness of the skin and mucous membranes.7 Extra care must be taken when prescribing retinoids in female patients of childbearing age as

they are teratogenic, leading to harm to the unborn foetus. It must be avoided in pregnant patients and contraception must be recommended in women of childbearing age.6 Treatment with oral retinoids can also preclude the use of ablative lasers and mechanical dermabrasion for six months.8

Laser and light devices

Treatment with lasers and intense pulsed light (IPL) can be considered when there is a lack of improvement with conventional therapies. They have emerged as an attractive treatment option as they can address the erythema and skin texture that is characteristic for KP. In our experience, a tailored approach is required for the best cosmetic outcome. A cautious approach is required when using energy devices in skin of colour to avoid post-inflammatory hyperpigmentation.9

Quality switched Nd:YAG lasers

QS Nd:YAG laser therapy is a selective photothermolysis device which targets haemoglobin, melanin and water within the dermis, improving pigmentation, erythema and skin texture/roughness. Due to the longer wavelength compared to other lasers, it may reach deeper dermal structure such as the hair follicles, leading to resolution of follicular plugging through exfoliation and destruction of hair follicles. The slow heating of large blood vessels also promotes coagulation and contraction of the surrounding collagen. This causes skin tightening, leading to improvement of skin texture in KP.10 Potential side effects include a stinging sensation during treatment, post-treatment erythema, reactivation of herpes simplex and scarring.11 QS Nd:YAG lasers have a reduced risk of these side effects compared to traditional lasers as they have shorter pulses which means the temperature in the target molecules (or tissues) rises and rapidly falls, reducing damage to surrounding tissues.12

Diode laser 810 nm

Diode lasers have minimal effect on skin erythema but are particularly effective in the non-erythematous variant of KP, keratosis pilaris alba. Side effects include transient post-inflammatory hyperpigmentation.13

CO2 laser

CO2 lasers are a 10,600 nm laser targeting the absorption peak of water.14 Full and fractional ablation can be used to destroy lesions and resurface affected areas,

improving skin texture and dyspigmentation in patients with KP. Side effects include erythema and dyspigmentation.9

Pulsed dye laser

PDL induces apoptosis of vascular endothelial cells and may also lower vascular endothelial growth factor levels, helping improve erythema. It is generally well tolerated, but reported side effects include pain, dyspigmentation and purpura.15

Intense pulsed light

IPL relies on selective photothermolysis, and through optical cut off filters, emits various ranges of wavelengths which reach the target chromophores. This results in effects on the follicular papillae and hair bulge, erythema and hyperpigmentation. Side effects include pain, superficial burning and transient erythema. It should be noted that IPL emits a large range of wavelength that also induces absorption by melanin. This may pose a risk of permanent damage to melanocytes leading to persistent hypo- or depigmentation.

Contraindications to laser and light treatment

There are numerous contraindications to be considered with light and laser treatments. These include patients taking photosensitising medications (such as Amiodarone or tetracyclines) and use of oral retinoids within six months before treatment. Photodermatoses (like porphyria or xeroderma), anticoagulation, active skin infections, recent unprotected sun exposure, pregnancy and light triggered epilepsy are also contraindications to laser treatment. Specific UK guidance is set by the British Medical Laser Association.8

Consider a variety of treatments

KP is a common skin condition which is frequently overlooked, with some patients not even being aware that they can seek treatment for it. It is benign and usually asymptomatic, but patients can find its appearance distressing. Most cases of KP can be effectively managed with topical keratolytics and retinoids, but severe cases may warrant treatment with oral retinoids or lasers.

Dr Kohei Matsumoto qualified from UCL Medical School and completed further medical training in the North West Deanery. He is currently a Dermatology Clinical Fellow in Liverpool University Hospital NHS Trust. He manages patients with various skin conditions in a clinic setting, as well as carrying out dermatological surgery such as excisions of skin cancers.

Qual: MBBS Bsc, MRCP

Dr Derrick Phillips is a consultant dermatologist with specialist interests in inflammatory skin disease, benign lesions and skin cancer. He is actively involved in clinical research and has published results widely. He is also an official spokesperson for the British Skin Foundation and regularly features in print and online media.

Qual: MBBS BSc (Hons), FRCP (Dermatology)

REFERENCES

1. Thomas M and Khopkar U.S. ‘Keratosis pilaris revisited: Is it more than just a follicular keratosis?’ International Journal of Trichology (2012) <https://doi.org/10.4103/0974-7753.111215>

2. Hwang S, Schwartz RA. ‘Keratosis pilaris: a common follicular hyperkeratosis’ Pediatric Dermatology (2008) <https:// cdn.mdedge.com/files/s3fs-public/Document/September-2017/082030177.pdf>

3. Fekete G, et al. ‘Keratosis pilaris Atrophicans faciei: An observational, descriptive, retrospective clinical study’ Experimental and Therapeutic Medicine (2021) <https://doi.org/10.3892/ etm.2021.10766>

4. Poskitt L and Wilkinson J.D. ‘Natural history of keratosis pilaris’ British Journal of Dermatology (1994) <https://doi. org/10.1111/j.1365-2133.1994.tb03406.x>

5. Panchaprateep R, Tanus A and Tosti A. ‘Clinical, dermoscopic, and histopathologic features of body hair disorders’ Journal of the American Academy of Dermatology (2015) <https://doi. org/10.1016/j.jaad.2015.01.024>

6. Leyden J, Stein-Gold L and Weiss J. ‘Why topical retinoids are mainstay of therapy for acne’ Dermatology and Therapy (2017) <https://doi.org/10.1007/s13555-017-0185-2>

7. Melnik B. ‘Isotretinoin and FOXO1’ Dermato-Endocrinology (2011) <https://doi.org/10.4161/derm.15331>

8. Treatment Guidelines for the use of LASER and intense pulse light devices for hair reduction and treatment of superficial vascular and benign pigmented lesions, British Medical Laser Association, March 2019.

9. Stangl S, Hadshiew I and Kimmig W. ‘Side effects and complications using intense pulsed light (IPL) sources’ Medical Laser Application (2008) https://doi.org/10.1016/j.mla.2007.11.008

10. Maghfour J, et al. ‘Treatment of keratosis pilaris and its variants: A systematic review’ Journal of Dermatological Treatment (2020) <https://doi.org/10.1080/09546634.2020.1818678>

11. Prohaska J, Hohman MH. ‘Laser Complications’ StatPearls (2023) <https://www.ncbi.nlm.nih.gov/books/NBK532248/?report=classic>

12. Park J, et al. ‘A pilot study of Q-Switched 1064-nm nd:YAG laser treatment in the keratosis pilaris’ Annals of Dermatology (2011) <https://doi.org/10.5021/ad.2011.23.3.293>

13. Ibrahim O, et al. ‘Treatment of keratosis pilaris with 810-nm diode laser’ JAMA Dermatology (2015) <https://doi.org/10.1001/jamadermatol.2014.2211>

14. Omi T and Numano K. ‘The role of the CO2 Laser and Fractional CO2 Laser in dermatology’ LASER THERAPY (2014) <https://doi. org/10.5978/islsm.14-re-01>

15. Schoch J.J, et al. ‘Successful treatment of keratosis pilaris rubra with pulsed dye laser’ Pediatric Dermatology (2016) <https://doi. org/10.1111/pde.12892>

AviClear™: The Future of

Acne Treatment?

Cutera introduces AviClear™, the first and original FDA-cleared energy device for the treatment of mild, moderate and severe acne

Acne is considered one of the most common dermatologic conditions affecting approximately 742 million patients globally,1 with roughly four out of five moderate to severe acne sufferers reporting that they have missed major life moments due to their acne.2

The emotional impact of acne on patients

“Acne is the most common skin disease in the United States,” explained Jeffrey Dover, MD, F.R.C.P.C., dermatologist and director of SkinCare Physicians. “It can cause poor self-image, anxiety and depression, and have a negative psychological impact.”

Dr Billie Casse is a board-certified dermatologist at Reno Tahoe Dermatology and sees firsthand how acne impacts her patients. “The best way to describe acne and how it affects people is ‘life changing’,” she said. “It alters your self-esteem; it often leads to depression and can interfere with your daily routine and activities.”

According to a survey conducted on behalf of Cutera, Inc., nearly 80% of moderate to severe acne sufferers admit that acne holds them back from living their lives the way they want.2 Michael H. Gold, MD, and founder of Gold Skin Care Center, shared with us that this survey is in line with what he sees in his practice. “Despite many people having a psychological impact from years of acne, most physicians agree that compliance with current treatments is often challenging.”

year, with access to the ‘gold-standard’ pharmaceutical-led treatment for severe acne, Isotretinoin, taking an average of nine to 12 months. Long waiting times for access to this oral medication are almost entirely due to a shortage of registered consultant dermatologists in the UK, the only physicians technically able to prescribe this drug to patients. This, combined with patients not wanting to take an oral medication with its extensive side effects and treatment plan, means they often ultimately seek alternative treatment options for their acne.

David J. Goldberg, MD, JD, medical

director at Skin Laser & Surgery Specialists, has experience with the issues many patients face. “Compliance is a huge issue in acne patients,” he shared. “Taking medications every day, applying topical medications twice each day, along with blood and/or pregnancy tests, and iPledge documentation for Isotretinoin patients can be an exhausting process, sometimes with little patient reward.”

Changing the acne treatment paradigm

Missed moments survey

Acne has both a physical and emotional impact on those who suffer from it, and the survey revealed information that is in line with what physicians hear from their patients every day. According to the survey, 90% of moderate to severe acne sufferers said having clear skin would change the way they live their lives, including things such as:2

• Engaging in more social activity

• Spending more time with friends and family

• Wearing less or no makeup

• Going on dates

The survey also found that two in three sufferers wish they could relive moments they missed.2

The

hurdles of current acne treatments in the US and UK

Patients suffering from acne are often on a variety of medications and over-the-counter products throughout their acne journey. Even with new medications on the market, the treatments remain cumbersome, can include serious side effects and often do not fit into the busy, active lifestyles of patients. Patients also experience frustration with the lack of chemical-free options and the high probability of acne rebound when the treatment is stopped. In England, more than 1.62 million treatments are prescribed by the NHS each

Access to long-term treatment solutions for acne patients of all ages and acne severities is evolving with the novel AviClear treatment by Cutera. “AviClear is safe to use on all skin types and patients of all ages with minimal discomfort – and it works,” exclaimed Dr Goldberg. “Moderate and severe patients often require years of antibiotics or Isotretinoin with a risk of side effects, but now we have another treatment option with AviClear. Patients can now trade all this for three simple 30-minute AviClear treatments without the risks associated with oral medications,” he concluded. Dr Dover agrees that acne patients have new hope. “AviClear has the potential to give durable responses after a series of three well-tolerated treatments,” he said. “In the studies performed, 93% of patients had a > 1+ IGA (Investigators Global Assessment of Acne Severity 0-4) improvement after the final treatment session, and 73% had > 2+ IGA improvement at 12 months.” According to Dr Gold, this technology may be an important new option for many suffering from acne who want a prescription-like effect without taking the medicines. “It’s a huge advantage; neither patients nor doctors like iPledge, and most would prefer therapies without having monthly labs done or pregnancy tests for the women who go on Isotretinoin,” he shared. “This drug-free treatment resolves active acne without a prescription.”

Michael H. Gold, MD

Jeffrey Dover, MD, FRCPC

Dr Billie Casse, MD David J. Goldberg, MD, JD

AviClear technology

Overproduction of sebum by the sebaceous glands is one of the leading causes of acne.5

AviClear’s 1726 nm wavelength laser is designed to treat acne at the source by selectively targeting sebocytes to suppress sebum production. “AviClear is different than anything we have ever had in treating acne,” Dr Casse reported. “Increased sebum excretion from the sebaceous gland is a major factor in the pathophysiology of acne, but there are other sebaceous gland functions associated with the development of acne, including sebaceous pro-inflammatory lipids; inflammatory cytokines produced locally; peri-glandular peptides and neuropeptides, such as corticotrophin-releasing hormone, which is produced by sebocytes; and substance P, all of which are involved in the acne process. So, being able to inactivate the problem at the source is vital to the long-term treatment of acne. I feel the most impressive part of this technology is that they have found a wavelength of light that specifically targets the sebaceous gland,” added Dr Gold. “This has not been an easy task, and with proper cooling, they have shown it to be safe and effective for our patients.” AviClear was engineered with patient comfort in mind, and has proven to be well-tolerated, comfortable and requires no pain mitigation. Together, the AviCool™ sapphire contact cooling technology and sensory controls help maintain the skin’s temperature at a cool two degrees which enhances the treatment experience while maintaining a high safety margin. According to the AviClear pivotal study, 93% of patients responded to the treatment and 92% saw at least half their acne cleared with three, 30-minute sessions.4 Results continue to improve over time, with select patients showing long-term clearance two years after their treatment series.2

Summary of AviClear benefits

AviClear is a drug-free, prescription-free treatment that is safe for all skin types, and requires no lab work or daily routine. Three simple 30-minute appointments fulfil the treatment plan, making compliance much easier and the treatment process more convenient than most standard acne treatments. AviClear has redefined the treatment of acne and gives patients another option with hope. In Dr Casse’ experience, the results are as good or better than current treatments. “People with acne are looking at months to years of acne topicals, prescriptions or oral medications like antibiotics and sometimes Isotretinoin, regardless of severity. However, there are multiple factors that cause acne, and the current regimens are not curing the acne, but decreasing the acne breakouts or holding them off. In most cases, if the patient stops the regimen, the acne returns,” she explained.

AviClear - The future of acne treatment

It’s clear that AviClear will change the future of acne treatment. “AviClear will add

another sound method to improve patients’ skin, and cosmetic practices that focus only on aesthetics will have an opportunity to add a tool that will bring more patients to them,” Dr Gold reported. “When new acne patients go to an aesthetic practice for acne treatment, they may eventually convert to other procedures, as they receive an amazing self-confidence boost.” Where other acne treatments have remained stagnant, AviClear is paving the way to treat acne by targeting sebaceous glands; a technology that has not been available in the past as proven by the common and current treatments. Physicians can determine if their patients’ current treatments are still viable or if they need an update. AviClear may be used alone or in combination with other treatments, even further adding to the physician’s treatment armamentarium.

Dr Goldberg shared that he envisions a new patient for physicians and their practices. “Five years from now very few patients will use Isotretinoin. The majority of those using chronic antibiotics will now have a safer and effective alternative in

AviClear,” he exclaimed.

According to Dr Dover, the AviClear laser can be used by a variety of providers including general dermatologists and those who treat acne on a regular basis. Also, physicians with device-based practices can add AviClear, giving them the potential to treat significant acne with durable responses in a non-medicationbased approach.

Practices and physicians will have the opportunity to greatly improve patient outcomes as they help change the face of acne treatments. “We finally have a medication-free option to get rid of acne for the long-term,” said Dr Casse, who added, “It is another tool we can offer patients that will save time, money, missed moments because of anxiety and depression induced by the disease. This is life-changing.”

AviClear is not currently available outside of North America, but a much-anticipated UK launch is expected in late-2023.

Register your interest here and be kept up to date with all the latest news on AviClear.

REFERENCES

1. Global Acne Market Report 2016-2026.

2. J Clin Aesthetic Dermatol. 2018 Jan; 11(1): 21–25. 3. JAAD Vol. 58, issue1, Jan. 2008

3. American Academy of Dermatology Association, ‘Skin Conditions by the Numbers’, <https://www.aad.org/media/ stats-numbers#:~:text=Acne%20is%20the%20most%20 common,to%2050%20million%20Americans%20 annually.&text=Acne%20usually%20begins%20in%20 puberty,experience%20at%20least%20minor%20acne.>

4. Cutera Inc, Data of file.

5. Brownstone N, ‘Meeting the Challenges of Acne in Adults’, Dermatology Times, 2022, <https://www.dermatologytimes.com/ view/meeting-the-challenges-of-acne-in-adults>

6. Data on file, FDA clearance study. Cutera, Inc.

7. O’Neill AM, Gallo RL. Host-microbiome interactions and recent progress into understanding the biology of acne vulgaris. Microbiome 2018;6: 177.

8. https://pubmed.ncbi.nlm.nih.gov/33688239/#:~:text=Stress%20 is%20one%20of%20the,increases%20lipid%20synthesis%20 in%20sebocytes.

This advertorial was written and supplied by Cutera.

For more information, please contact Lutronic

Case Study: Achieving Natural

Full-face Rejuvenation

Dr Sana Sadiq presents a full-face rejuvenation case study using both botulinum toxin and dermal fillers

In my experience, women in their 20s and 30s frequently request ‘tweaks’ or ‘tweakments’. It has become increasingly apparent through my detailed consultations that ‘tweakment’ is being used to mean ‘natural’ results, with patients considering unnatural results to be caused by ‘too much’ filler. Although many undesirable results seen on television and social media are partly a product of over-administration of dermal fillers, the volume of filler is not the sole cause.1 Personally, as practitioners we should always seek to administer the minimum level of treatment to achieve the maximum results, but we must also educate patients about the fact that 1ml of the wrong filler placed poorly may give a more unnatural result than 8ml of appropriate filler placed effectively.2 In my opinion, it is therefore our responsibility to educate ourselves about detailed facial anatomy as well as physical and chemical properties of the fillers on the market. Through a detailed assessment and collaborative treatment planning, I believe that patients may understand the multifactorial cause of their concerns and the value of a holistic treatment strategy. I have found that a patient-led consultation, jargon free discussion and mirror-aided visual education improves patient understanding of the treatment process.

Consultation

A 32-year-old Caucasian female presented with concerns about deepening nasolabial folds and wrinkles between her eyebrows. She felt she looked tired and older than she would like with makeup no longer concealing the lines and shadows on her face. Using a handheld mirror, I asked her to clarify the areas of concern. She had never had any aesthetic treatments before and there was no previous medical history. I agreed that her concerns were valid and reassured her that these were common concerns I treated amongst her age demographic.

Assessment

A detailed physical assessment was carried out on the patient at rest and animated. She was assessed upright in a frontal, oblique and sagittal view to gain full appreciation of the facial structures under gravity. She presented with fine lines across the forehead as well as faint ‘11’ lines in the glabellar region. Upon animation, these lines deepened and did not fully resolve upon relaxing. She also had heavy lateral eyebrows which did not elevate markedly on engaging frontalis. She was very slim, with significant loss of volume in the lateral and medial cheek, with the appearance of nasojugal and mid-cheek grooves bilaterally (Figure 1). There was fullness and descension of nasolabial fat compartments creating undesirable light reflection lines, and emphasis on the nasolabial fold. The fold consisted of loss of volume in the pyriform fossa creating shadow at the alar base, as well as folding skin due to poor support from the mid-face. The skin of the nasolabial fold carried a deep rhytid from the nasolabial to the marionette and mental crease which did not resolve when stretching the skin. I informed the patient that these lines were unlikely

to resolve completely from filler alone, and a combination of treatments may be required such as chemical peels and microneedling. Her chin was retrognathic on a skeletal class II base, with high mentalis activity causing chin dimpling when speaking. In general, her facial structures were set marginally superiorly on her left and she had stronger muscle pull on her left oral commissure. She also had an ‘M’ shaped upper lip with a convex upper cutaneous lip and philtrum flattening. Her nasolabial angle was reduced at 90 degrees where a more open angle up to 115 degrees would appear more feminine.3

The nose had a mild dorsal hump and supratip break with broad light reflection on the alar cartilages. I showed the patient any significant findings pertinent to her concerns in the mirror and demonstrated by gently manipulating her tissues how the depleted mid-face impacted the heaviness, shadows and wrinkles of her lower face.

I explained the nature of dermal fillers and botulinum toxin and their roles in treating the signs of ageing and disproportions. I advised that she would likely need multiple millilitres of dermal filler to restore the loss of volume in her face. I reassured her that I would only administer as much filler as necessary, with natural results in mind. I explained the risks associated with treatments, for example, brow ptosis from toxin, and bruising, infection, vascular occlusion and blindness from dermal filler.4

Treatment planning

The aim was to restore youthful proportions and light reflection points to the face, whilst maintaining her natural character. Mid-face restoration and chin contouring with a multi-layered approach would give maximal indirect support for the nasolabial fold/mental crease complex and allow little volume. I recommended subtle enhancement of the nose to create the illusion of a more lifted nasal tip with narrower light reflection points which would add to a youthful appearance.5

I suggested lip and perioral filler to help evert the upper lip and shorten the philtrum whilst providing definition, however she opted against this treatment as she liked how her lips looked. Botulinum toxin of the upper face would be administered last, including treatment of frontalis, glabellar complex and lateral eyebrows. I did this last, so the bumps left immediately after injection and didn’t distort the appearance before adding volume. I advised the patient that my estimated volume of filler would range between 8-10ml of varying viscosity gels to achieve

Figure 1: Frontal assessment showing areas of loss of volume with loss of volume (blue triangles), nasojugal and mid-cheek groove (black line), nasolabial fat pad fullness (red circle), rhytids (black dashed lines), nasal tip reflection points (yellow circles), lateral brow heaviness (green dashed lines) and philtrum length (pink arrow).

Figure 2: Patient with treatment technique mapped out with superficial linear threads in blue, toxin injection in red, superficial boluses in yellow, subcutaneous fat layer linear threads in orange and deep boluses in purple.

significant resolution of her concerns, as well as harmonise the full-face. I reassured her that should the tissues respond more to filler, we would use less volume. Skincare recommendations, such as vitamin C, retinol and SPF30-50, were given to enhance the results and reduce the appearance of ageing.

Technique

The patient was numbed topically with ice packs and advised of stop signals which could be used anytime during treatment if the patient wished to pause. Skin was disinfected with hypochlorous acid and relevant markings drawn on the face (Figure 2).

The mid-face was approached first with deep supraperiosteal boluses using a vector bisecting the alar-tragal and lateral canthus-oral commissure line. I used Teosyal Ultra Deep with a 27 gauge needle as a high G’ filler was required for structure.6 Other brands/products are available to use. Slow aspiration was employed to help assess for inadvertent intravascular needle placement.7-9 Augmentation of the SOOF and deep medial cheek fat compartments created support for subsequent superficial cheek augmentation with Teosyal RHA 4.10 A 38mm 25 gauge cannula was used to fan retrograde linear threads, enhancing the anteromedial and lateral superficial cheek without inadvertent augmentation of the nasolabial fat compartment. Care was taken to avoid inadvertent intravascular injection into the infraorbital, zygomaticofacial, transverse facial or angular artery by keeping injections lateral to medial limbal lines and administering all injections in appropriate planes.11 Although volumes of filler were not administered prescriptively, and decided by their physical effects on the tissues, no boluses larger than 0.3ml were delivered at a time. The pyriform fossa was approached by deep supraperiosteal bolus with Teosyal Ultra Deep. Boluses were deposited supraperiosteally under mentalis in the midline and two paramedian points to aid in profiloplasty, lower face frontal contour and myomodulation.12 The superficial aspect of the nasolabial fold was approached in two ways:

1. Superficial fanning of Teosyal RHA 4 with a 25 gauge cannula in the crest of the nasolabial fold at the level of the subcutaneous fat. A linear thread injection technique of no more than 0.05-0.1ml were placed conservatively to help avoid vascular occlusion.13,14

2. Placing small linear threads of Teosyal RHA 3 over the rhytid in the descending portion of the nasolabial folds. The filler provided moderate G’ and elastic modulus to support but still integrate with the nasolabial fold naturally.15 The orientation of the threads was perpendicular to the course of the rhytid topographically, rather than the traditional approach where filler is placed in threads parallel to the fold.16 The technique used was a slight variation of the already established Fern technique.17

Intermittently, the patient was asked to smile in order to assess the improvement in dynamism as well as static position.18 A combination of Teosyal RHA 4 and RHA 3 was used to place retrograde linear threads in a subcutaneous fat plane, from an entry point just lateral to the pre-jowl sulcus. Fanned threads extended to the chin, mental crease, marionette area and oral commissure. Although the patient did not suffer with sagging in the marionette area, adding structural support in an angle crossing the dynamic smile lines at approximately 90 degrees helped support the skin from creasing in both a static and dynamic mode. Non-surgical rhinoplasty with 0.15ml of Teosyal Ultra Deep was performed with a 30 gauge needle. Deep supraperiosteal and supraperichondrial microbolus technique was employed in the radix and supratip respectively, and subdermal microboluses in the nasal tip midline. Injections were kept in the midline to reduce the risk of vascular occlusion of the lateral and dorsal nasal arteries.19 A total of 9.6ml of varying fillers was used. Toxin (Botox) was administered to the glabellar complex (22.5u) and frontalis (12.5u), avoiding treatment of the inactive lateral parts of frontalis. The tail of the brows was also treated (1.25u per side) to prevent brow ptosis, appearing to open the eyes. Post-procedure instructions were provided, and support given in the form of a 24-hour online review and communication via phone.

Two-week review

The botulinum toxin effects were very satisfactory, requiring no further dosage. Assessment showed natural movement of the glabellar complex and frontalis, with her lateral brows being slightly elevated revealing a fresher appearance.

The filler results had settled well with no tenderness, bruising or significant swelling. There was some residual swelling on palpation in the nasolabial area which I advised was normal and may take a few weeks to settle. The nasolabial folds had less shadow at the crest, and rhytids of the descending fold appeared smooth at rest, with minimal folding when smiling. The mid-face light reflection, volume and contour was improved. Her profile was harmonised in terms of nasolabial angle and the relationship of pogonion to subnasale.20 The convexity of the philtrum and the slightly deficient lip volume and contour was still present, however, in relation to the appearance of the surrounding features, the perioral area did not concern the patient.

Manage expectations

It is an encouraging trend to see that natural results are becoming more desirable amongst younger cohorts, however, expectations should be managed with regards to filler volume and placement. It is important that patient selection, bespoke assessment and patient education is employed. Observation of the tissues perioperatively will influence the volume delivered in a single sitting, but when in doubt of the tissue capacity, caution is advised.

Dr Sana Sadiq is an aesthetic practitioner and cosmetic dentist. She acquired her Master’s in Chemical Research followed by her Bachelor of Dental Surgery from King’s College London. She graduated with distinction, winning the highly prestigious University of London Gold Medal. She has since become co-founder and medical lead of By Design Academy, providing advanced facial aesthetics training to medical professionals.

Qual: BDS (hons) MSc AKC BSc (hons)

Figure 3: Patient before and two weeks after full-face natural rejuvenation treatment

Redefining the science and aesthetic of facial anatomy

Time to level up

Elevate your business with an injection of innovation

Since its global launch in 2021 KYSENSE®, the innovative CE marked HA dermal filler has helped elevate patient satisfaction with 90% patients saying they still had an improvement 12 months post treatment.

*KYSENSE® is:

Comfortable for the patient Ergonomic and easy to use 20%-30% less product needed High patient satisfaction Results last 12 months Soft supple and highly elastic Highly volumising and highly projecting Virtually undetectable BDDE Excellent tissue integration Each box contains 4 x 1ml syringes

As a Tear Trough enthusiast I am very cautious about which filler products I will use to avoid delayed swelling, nodules or Tyndall effect. KYSENSE® Precise has changed my practice by widening my patient inclusion criteria and given me increased peace of mind that my treatment outcomes won’t be corrupted by the product I’m using. It’s the most unhindered I’ve felt in treating tear troughs since I begun half a decade ago. Times have move forward and so too has Tear Trough treatment.

Dr Uche Anaigwu KYSENSE ® is strictly only available to medical professionals.

A History of Breast Implants

Body implants have been used for thousands of years to modify the human body in various ways, from improving physical features to helping those with medical conditions. The first use of body implants extends back to the 16th century in places like North America, in which metal skin implants were used alongside body piercings and tattoos to identify social status and to mark important life events.1 During the same time period in China, body implants were used to help improve physical features such as the shape of the nose, cheeks and chin.1 During the 19th century, implants became more commonplace in Europe and the US.2 In 1845, the first dental implant was created by dental surgeon Dr William Morton, allowing dentures to be securely attached to the jaw, and in 1895, US surgeon Dr August Bier performed the first successful breast augmentation surgery, using implants made of paraffin and rubber.2 The 20th century saw the development of more sophisticated body implants, such as pacemakers and cochlear implants. In 1958, the first pacemaker was successfully implanted in a human patient, allowing them to regulate their heart rate, whilst the first cochlear implant was also developed in the 1970s, allowing those with hearing loss to better understand sound.3 The 21st century has seen a surge in the development of body implants, with a wide range of medical and cosmetic uses. These implants are all made from silicone and are used for nasal and testicular reconstruction as well as being available for calf, jawline and cheek augmentation in cosmetic practice.

The most common implant used in aesthetic surgery these days is the breast implant. According to the American Society of Plastic Surgeons, in 2020, there were more than 299,715 breast augmentation procedures performed in the US.4 Extrapolating this data to the rest of the world over a period of a few decades, and with personal discussion with breast implant manufacturing companies, it is thought that around 40 million breast implants have now been inserted globally, although this figure is impossible to verify.

The origin of breast implants

Breast implants have been used since the late 19th century to enhance the appearance of the female body. The history of breast implants is complex and has evolved over time, with different types of implants being developed and used. In the late 1800s, fat injections were the first breast augmentation technique.5 This is where doctors would take fat from another part of

the body and inject it into the breasts to make them appear larger. At the time, the technique was seen as a way to restore breasts lost to mastectomies, as well as to restore breast shape that had been lost to pregnancy or weight loss. In the early 1900s, paraffin injections started to become popular.6 While this technique had some success, the results were often inconsistent and posed a risk of infection. The first silicone breast implants were developed in the 1960s, and these had advantages over earlier techniques as they provided a more natural look and feel, as well as a lower risk of infection. The popularity of silicone implants grew, and they became the most popular form of breast augmentation by the 1970s. In the 1990s, saline-filled implants became available which are filled with a sterile saline solution, and have a number of differences from silicone implants, including the ability to be filled to the desired size after they are inserted. However, they feel less natural than the softness which silicone confers.7

Breast implants available today

From discussions with manufacturers, it is generally accepted that the most popular type of breast implant is the cohesive gel silicone implant, which became commonplace in the early 20th century. These implants are filled with a gel-like material that is designed to maintain its shape and not leak. Cohesive gel implants are available in a variety of shapes and sizes, making them customisable for each patient.

The two shapes available are round implants and anatomic shaped implants, also described as tear drop shaped implants. Breast implants now also come in different sizes – round implants have two different dimensions and anatomic implants have three different dimensions. Round implants have a base diameter as one of their measurements, and projection as a separate measurement.8 Often manufacturers will have three different projection options for a single diameter of a breast implant (Figure 1). These projections are classed as low, medium or high, but manufacturers will refer to the projections as medium profile, high profile and extra high profile, or similar descriptions. Some manufacturers will use a fourth profile in their implants and these implants are extra low profile implants which are somewhat flatter in nature. With anatomic implants, the third measurement is the height of the implant, and anatomic implants allow the greatest degree of personalisation in deciding which implant to use.8 It is generally accepted that anatomic

Mr Taimur Shoaib provides an overview of the development of breast implants over the years

implants, however, fail to provide projection to the upper pole of the breast, whereas round implants give more fullness to the upper cleavage. The surgeon will make a decision with the patient as to which implant will be best suited to them.

In addition to the different types of implants, there have been several advances in implant technology over the years. These advances have included the development of textured implants, first designed in the 1970s to have a rougher surface than smooth implants so as to promote tissue in-growth and reduce the risk of capsular contracture.8

Controversies

Over their history, breast implants have had controversies associated with them. Breast implants have been associated with illnesses, rare cancers and strange patient symptoms.

Anaplastic large cell lymphoma

Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin’s lymphoma (NHL) that is associated with textured breast implants. The first case of ALCL associated with breast implants was reported in 1997. Since then, the number of cases has steadily increased. As of 2020, there have been more than 600 reported cases of ALCL in women with breast implants. It is estimated that the overall risk of developing ALCL related to breast implants is approximately one in 24,000, though no one really knows the true risk of this.9

It is thought that only textured implants are associated with ALCL and the disease is more associated with highly textured implants.9 The rougher surface of textured implants can increase the risk of inflammation, which can lead to the formation of a biofilm. This biofilm can act as a breeding ground

for bacteria, which may play a role in the development of ALCL.9 The exact cause of ALCL is still unknown, but researchers believe that a combination of genetic and environmental factors may be involved. In particular, some studies have suggested that the immune system’s reaction to breast implants may play a role in causing ALCL.9 ALCL is treatable, and the vast majority of patients make a full recovery after treatment which involves surgery to completely remove the implant and the surrounding capsule. Early diagnosis is key to successful treatment, and women with breast implants should be made aware of the signs and symptoms of ALCL. These include breast enlargement, pain, lumps and fluid accumulation around the implant.9

In recent years, the US Food and Drug Administration (FDA) has taken steps to reduce the risk of ALCL associated with breast implants. In 2019, the FDA issued a statement recommending that all breast implant manufacturers transition to smooth implants.10 Additionally, the FDA recommends that women considering breast implants should be aware of all potential risks, including the risk of ALCL.10

Breast implant illness

Breast implant illness (BII) is a term used to describe a range of symptoms that some women with breast implants have reported experiencing.11 The symptoms are varied and can include fatigue, joint and muscle pain, brain fog, memory loss and autoimmune-like symptoms, among others. The exact cause of BII is not fully understood, and some believe that it may be a result of the body’s immune system reacting to the implant or to the materials used in the implant.11 The symptoms may develop soon

after the implants are inserted or may appear years later. Some women with BII report improvement in their symptoms after having their implants removed, although this is not always the case.11 Some medical professionals caution that there is not enough evidence to definitively link breast implants to BII, and that some of the symptoms may be due to other underlying conditions. There are no known diagnostic criteria to diagnose BII, but it seems that these symptoms are more common in women who have tattoos. Of course, tattoos contain pigment, metals and some chemicals within tattoos are known to be toxic.12

Rare cancers

In September 2022, the US FDA informed the public about reports of rare (non-ALCL) cancers associated with breast implants.13 Less than 20 cases of squamous cell carcinomas and less than 30 cases of various lymphomas in the capsules around breast implants were reported to the FDA, which is extremely minimal compared to the number of women who have had implants.13

A safer form of body modification

Body implants have been used for centuries and, in aesthetic surgery, the most common implants used are breast implants for cosmetic breast augmentation. Implants have changed considerably over the years, with changes to both the shell and the filling material over the generations of breast implants. Nowadays we have the most safety data available compared to the information we had in the past, and women are, more than ever, able to make informed decisions about what type of implant to have if they are considering breast augmentation surgery.

Mr Taimur Shoaib is a consultant plastic surgeon with more than 30 years’ medical experience. He qualified from the University of Glasgow in 1992, before establishing his cosmetic surgery practice, La Belle Forme, in 2014. Mr Shoaib is an honorary clinical senior lecturer at the University of Glasgow and a faculty member of the Allergan Medical Institute.

Qual: MB ChB, FRSCEd, DMI(RCSEd), MD, FRCSEd(Plast)

Figure 1: The three different projection types of round implants. Images courtesy of GC Aesthetics

the TAC roadshow to make the event even more accessible to all of their customer base, regardless of where they are located. There is a demand for events like this to be offered regionally, and the TAC roadshow will do just that!

Emma Riley, Training and Events Manager for Teoxane, commented, “We are always looking for ways to elevate and improve our educational offerings for our customers, and this event gives the opportunity for everyone to access medical education, regardless of geographical location. We are excited to bring TAC to a wider audience and to reach nearly double the amount of practitioners as we did last year, making this our biggest ever UK educational event!”

The Launch of the Teoxane Roadshow

Teoxane is taking its biggest event on the road in 2023, and it’s going to be bigger than ever

For almost 20 years, Teoxane has continued to grow and push the boundaries of aesthetic medicine and dermocosmetics. After seven years of running academy conferences and expert days, Teoxane is returning in 2023 with a brand-new roadshow to keep practitioners up-to-date with the latest innovations and techniques, as well as bringing together leading speakers to provide guests with new techniques and tools to add to their clinics.

The Teoxane Academy Conference

Teoxane created the Teoxane Academy Conference (TAC), previously Teoxane Expert

Day (TED), in 2016 to give practitioners the opportunity to learn from their world-leading faculty of experts and come together as a community. Since then, TAC has grown over seven years, leading up to the biggest event to date in 2022, catering to over 300 delegates.

The Teoxane Roadshow

In 2023, Teoxane will be expanding this even further by taking TAC on the road. Visiting multiple locations throughout the UK over a two-week period in mid-October, they will be offering large-scale education in a way that they have never done before. Each date will comprise of a full day of education led by their award-winning faculty including educational talks and live demonstrations, as well as cadaver dissections. Teoxane will also be inviting experts from outside the industry to provide insights and different points of view to elevate delegates’ approaches to patient assessment and consultation.

Teoxane decided to create

More details to follow

There will be more information to follow in the coming months and bookings will be available through the dedicated Teoxane Partner Platform, so stay tuned to find out more about locations, speakers and topics. In the meantime, please reach out to your local product specialist for more information on all of the educational content that Teoxane has to offer.

A summary of the latest clinical studies

Title: 3D Volume Assessment as an Objective Tool in Breast Asymmetry Management

Authors: Makram M, Noaman A, Abozeid M.

Published: Plastic and Reconstructive Surgery, April 2023

Keywords: Breast Asymmetry, Breast Surgery, Breast Volume

Abstract: Throughout history, the female breast has been a universal symbol of femininity. Female breasts are not perfectly symmetrical by nature, and minor differences in shape or volume are common. This can be psychologically distressing for patients and affect their perception of their bodies. Aesthetic breast surgeons strive to minimise these differences in order to make them more acceptable to patients. This study aimed to provide an objective and practical strategy for effectively managing breast asymmetry. All patients had volumetric breast assessment using a three-dimensional (3D) imaging system (3D LifeViz, Quantificare system), and MRI breast volumetry was done preoperatively in all patients. The patients were managed with different single-stage surgical procedures depending on the objective assessment of the volume differences between their breasts. Breast volume assessment using the 3D camera was done preoperatively and postoperatively. The preoperative mean volume difference was 159.45cm and the postoperative mean difference was 16.75cm, with an overall reduction in mean volume difference of 89.5%. The 3D technology is a useful objective tool to augment the surgeon’s experience. It helped achieve an 84.57% reduction in volume difference in managing breast asymmetry with a single-stage procedure.

Title: Clinical Efficacy and Safety of Targeted Injection of PRP with Skin Booster in the Treatment of Aging Face

Authors: Shen J, et al.

Published: Biotechnology and Genetic Engineering Reviews, April 2023

Keywords: Platelet-Rich Plasma, Skin Ageing, Skin Boosters

Abstract: Platelet-rich plasma (PRP) with skin booster is a popular treatment for improving skin quality and reducing the signs of ageing. This study aimed to evaluate the clinical efficacy, adverse reactions and follow-up results of targeted injection of PRP with skin boosters. The study included 80 patients treated from July 2022 to February 2023. The doctors compared the changes of the patients’ facial skin indicators, quality of life and satisfaction with their appearance before and after treatment, and analysed the clinical efficacy, adverse reactions and follow-up results of the patients after treatment. After one course of treatment, the patients’ facial skin indicators, quality of life and satisfaction with their appearance improved significantly, with P < 0.05. The total clinical effective rate was 88.75%, and the incidence of adverse reactions was 6.25%. After half a year of follow-up, 48.75% of the patients were willing to receive further treatment, and their facial soft feel, natural expression and self-feeling comfort had significantly improved. Targeted injection of PRP with skin booster is an effective and safe treatment for improving facial skin symptoms such as coarse pores and wrinkles in patients with ageing face. The results of this study provide evidence for the clinical use of PRP with skin booster in aesthetic medicine.

Title: Collagen-Based Dissolving Microneedles with Flexible Pedestals: A Transdermal Delivery System for Both Anti-Aging and Skin Diseases

Authors: Gao N, et al.

Published: Advanced Healthcare Materials, April 2023

Keywords: Collagen, Microneedling, Skin Ageing

Abstract: Biocompatible polymer microneedles (MNs) are emerging as a promising platform for transdermal drug delivery, especially for facial treatments. The MN patch in this study used hydrolysed collagen (HC) contained in skin cells as the main raw material, and adopted a two-step cast method to develop a rapidly dissolving microneedle (DMN) patch to deliver collagen in a simple and minimally invasive way, allowing the release of the encapsulated drug in the skin. By optimising the formulation and proportion of HC and auxiliary support materials, the mechanical strength required to pierce the skin was obtained, while the soft pedestal allowed for flexibility in application. The DMNs could dissolve completely in the skin within 15 minutes and release within about eight hours, and would not cause toxicity or irritation when applied. In contrast to the ineffectiveness of oral and external application, and the high risk of dermal injection, drug-loaded HC DMNs overcome the drawbacks of traditional methods with direct penetration, enabling efficient and safe treatment. The successful preparation and research of HC DMNs have innovative and practical significance in this field, and it is expected to become a simple, effective and popular transdermal drug delivery platform for cosmetics.

Title: Non-surgical Chin Augmentation Using Hyaluronic Acid: A Systematic Review of Technique, Satisfaction, and Complications

Authors: Ou Y, et al.

Published: Aesthetics Plastic Surgery, April 2023

Keywords: Chin Augmentation, Dermal Filler, HA Filler

Abstract: Non-surgical chin augmentation using hyaluronic acid (HA) has become a common procedure in cosmetic practices. This is offered to patients who prefer a non-surgical, temporary method for correcting underdeveloped or retruded chin, and restoring volume loss. This systematic review highlights the main HA injection technique and associated patient satisfaction and complications of chin augmentation to further guide practitioners. A systematic review was performed according to PRISMA guidelines. PubMed, Embase and Web of Science were searched using the appropriate keywords. Data collected from each study included patient satisfaction and complications, in addition to injection protocol and technique. A total of 1305 studies were found based on search criteria, and eight studies were included. A total of 917 patients underwent HA chin augmentation, with different injection protocols. Most patients were satisfied with the results, and there were only two relatively major complications reported. The most common adverse events were local responses at the injection sites (swelling, bruising, pain, redness and itching). There were no reports of vascular complications. HA filler is an effective temporary method to correct chin retraction and absorption for chin augmentation, with a high degree of patient satisfaction and a low risk of severe complications.

Becoming an International KOL

Progression – it’s something which all practitioners working in aesthetics are striving towards. Whether that’s through opening your own clinic, completing further training or educating others, all healthcare professionals are constantly working towards progressing their careers and abilities to help patients look and feel the best version of themselves. For some, becoming a key opinion leader (KOL) might be an aspiration for the future, wanting to help progress, teach and inspire a new generation of aesthetic practitioners, as well as further developing your own skillset. A definition of a KOL is ‘a trusted, well-respected influencer with proven experience and expertise in a particular field.’1-3 In the aesthetic medicine landscape, the role of KOLs usually involves representing a company through activities like speaking at conferences or events, participating in clinical trials, publishing research in medical journals, being a board member within an organisation, training others, or even treating or diagnosing a high number of patients in a specialty area.1-3 They can also play a role in assisting pharmaceutical, medical device and similar companies in making informed decisions across the product lifecycle, such as clinical research, regulatory compliance and drug development.4 With aesthetic medicine being a fast-paced, progressive industry, it can be difficult to know where to start or what company to represent when becoming a KOL. It is another challenge to know how to develop this to become internationally acclaimed.

Getting started

Where do you begin? Firstly, it is important to take time to evaluate yourself and your practice. Before you embark on this journey, you should consider: where does your deepest knowledge and skillset lie? What are you passionate about? Miss Balaratnam notes that this first stage is pivotal to determine if you are ready to represent a brand. “When I began working in aesthetics, my purpose was to deliver excellent patient results that could be seen and celebrated. I would perform the treatments and really focus on outstanding outcomes. This was something that really excited me.” Miss Balaratnam says that once you are experienced in utilising the technology with great demonstratable results, a good next step is to build relationships with companies. She reflects, “I went to my supplier colleagues and asked for feedback on my achieved results and ways in which I could drive my patient results further. This is how I became better connected with companies in the industry and developed strong interpersonal relationships which is a crucial first step in the journey to becoming a KOL for a company.” Miss Balaratnam adds that building relationships with companies is vital as they can train, educate and help you understand your product portfolio, as well as further advance your results for the patient. Miss Balaratnam says, “With increased teaching and training from the Allergan Medical Institute for example, I became an expert in understanding and using their product portfolio which enabled me to be in a good position to train others. I began representing the company through smaller, intimate in-clinic events, progressing to larger conferences such as ACE and CCR. Over time, this slowly grew to representing the brand internationally.”

During ACE 2023 in March, aesthetic practitioners and established global KOLs Miss Sherina Balaratnam, Dr Raul Cetto, Dr Tapan Patel and Dr Lee Walker took to the stage to discuss their personal experiences in becoming global KOLs, as well as offering their advice for practitioners looking to take a similar step in their careers. These practitioners represent a range of companies internationally, including Allergan Aesthetics, BTL Aesthetics, Cutera, iS Clinical and Teoxane, as well as many others throughout their careers.

Dr Walker notes that KOLs, particularly those with the ambition to develop their careers internationally, should develop and learn new skills, such as how to teach. “My drive was teaching, but what I found frustrating in the beginning was not knowing how to do this effectively!” he reflects. To become more confident and desirable to potential companies, Dr Walker undertook a teaching qualification. He notes, “I attended the Royal College in Glasgow to do some clinical teaching, and then Dr Cetto and I went to the University of South Wales to complete post-graduate qualifications in medical education, teaching ourselves to be teachers. I recommend other KOLs and aspiring KOLs to consider undertaking this in their own careers.” Dr Patel agrees that teaching skills are a

Dr Lee Walker

Dr Tapan Patel

Dr Raul Cetto

Miss Sherina Balaratnam

Four global key opinion leaders share their advice on how they progressed their careers to represent companies internationally

Dr Tapan Patel’s five top tips for international success as a KOL…

1. Find your passion – is there a particular field of aesthetic medicine which you love or enjoy researching and learning about? Delve in and become an expert in this area with excellent demonstrable results, independent research and publications.

2. Contact companies – who are you interested in working with? Request more in-depth training or help with research for example. Let them know you are interested in being their KOL.

3. Remain authentic and credible – ensure you have a genuine interest, passion and experience in a particular company’s treatments and products.

4. Become a confident leader – get training and experience in educating others and speaking to an audience, from intimate groups to large crowds.

5. Find a balance – once you become a KOL, know that international travel means a busy diary. You might need to start juggling some plates; it is important to still have a work/life balance to avoid burnout!

necessity, and practitioners can start by teaching or being a mentor for a colleague in their own clinics. He adds, “Bring in your nurse, clinic manager, therapist and practise teaching them something like the anatomy, and you will soon realise if you enjoy it or not. If you do enjoy it, then being a KOL could be a good career path for you and there are so many directions you can take. You might be thinking, ‘Hang on, all these opportunities are so saturated, I don’t have a chance!’ I think the opposite. If you want to get involved in education, then becoming a KOL is a very nice and secure future.”

Miss Balaratnam highlights that learning never stops when you become a KOL. She often asks companies to train and teach her so she is constantly updated, enabling her to be an expert in the latest sciences, technology or technique. “When I speak to the senior leadership teams, I learn from them about how they like to take the treatment further. I always say, ‘Don’t sell to me and then leave me.’ Instead, train me, educate me and help me grow because when ‘I’ get better, my patients will get better results. This also allows me to translate my knowledge and research onto other aspiring practitioners,” she says.

Remain authentic

When becoming a KOL, practitioners usually decide to represent a company and become the ‘face’ of a particular brand, treatment or product. Miss Balaratnam advises to carefully consider the brands you choose to associate yourself with. “If I get invited to become a KOL just by purchasing a device, for example, I say ‘no’. I don’t believe this lends any credibility to either party to place any practitioner on stage to present on a new technology if they haven’t properly used it, tested it, seen their own results or covered the evidence-based research and clinical trials,” she shares.

Dr Patel agrees that it is important to choose the companies you represent wisely and remain respectful of other brands. He also believes it’s important to note that KOLs are free to use whichever products they choose in their private practice and teaching. He comments, “I’ve used a lot of different brands in the past. Using different products allows us as practitioners to have a more rounded approach to treating patients, and ensures we are utilising the best products to achieve optimal results and remain credible to our peers.”

Overcoming challenges

Despite the new opportunities that becoming a KOL brings to your profile and business, it can be difficult to find a balance. Running a clinic, treating patients, speaking at conferences and conducting research as well as having a personal life are some of the challenges which may be faced. Dr Cetto advises deciding on how much time you want to dedicate to KOL duties. “There is a lot to manage, and it can take up a lot of your time. Therefore, you need to find a balance early on and decide how much time you want to dedicate. Companies can offer you an abundance of opportunities which you can agree to, however, if you take on too much, you’ll suddenly find yourself travelling for months, and not spent any time in your clinic or with your family,” he says.

For Dr Patel, travelling internationally may seem glamorous but it can come with its downfalls, especially if you agree to all opportunities. Dr Patel reflects, “The diary was empty during the pandemic, so I began saying yes to everything as the world began to open back up. However, this quickly caught up with me and I realised I was burning out. Before I knew it, I had travelled to 38 cities and done 76 flights as well as running my

clinic and I wasn’t really enjoying it.” Dr Patel notes that as well as numerous flights, there is a lot of prep work that needs to be completed beforehand, such as calls, briefings and creating presentations, which can take time. Dr Walker agrees, noting that discovering what you are passionate about should be your main driving force. He adds, “Being a KOL is extremely rewarding, but comes with its own challenges and obstacles which you need to be prepared for. If you are dedicated and driven though, it will work! A lot of people believe that you have this wonderful lifestyle but it’s far from it. You usually work with jet lag, with people you’ve never met, have to deal with language barriers and translators, and sometimes, countries don’t have the same standards of medical care, which are all difficult to deal with.”

Looking to the future

So, where is the future of KOLs heading? It can take years to develop a KOL status, let alone global success, taking time, effort and ongoing commitment. Although most people interpret being a KOL as representing a company, it doesn’t have to be. Practitioners can speak at events/share their knowledge and research with the industry independently. In fact, this might be a suitable place to start to get your name out there. If you are still unsure about becoming a KOL, Miss Balaratnam concludes that mentorship is key in the industry and being able to ask fellow colleagues for their advice and recommendations is fundamental. She reflects, “10 years ago, I wouldn’t have known who to turn to or have the confidence to ask questions to peers. However, by attending conferences, training days, workshops or events, you are able to ask others about how they became a KOL, how they improved their portfolio and what being a KOL involves. This way, you receive real advice from colleagues who have been through their own obstacles and are more than willing to help develop future practitioners in aesthetics.”

CCR is taking place on October 19-20, 2023, at ExCeL, London. If you are interested in speaking, scan the QR code now to submit your abstract.

Utilising Collaborations on Social Media

PR creative director Lianne Sykes provides tips for making the most of collaborations with your peers on social media

Social media has revolutionised the way businesses operate in the modern world. Medical aesthetic professionals are no exception to this trend, and as the industry continues to evolve, it’s becoming increasingly important for these professionals to engage with their peers and audiences online. Collaborating with others on social media can be an effective way to build upon credibility, grow an audience, and ultimately boost a business. In this article, I will explore the benefits of online collaboration in the medical aesthetics industry and examine how collaborating with peers can help you expand your offerings, establish yourself as a leader and gain exposure for your clinic.

The importance of collaboration

Collaboration has always been a key element of success in any business, as collaborating with your peers allows you to share knowledge, skills and resources, while also building meaningful relationships with other professionals in your industry. Collaboration is particularly important in medical aesthetics, as it’s an industry that is constantly evolving.

It is important to note that collaborations differ from partnerships. Collaborations usually refer to a less formal business relationship in which two or more parties work together on a specific project or goal to

promote broader interests. Partnerships are typically a longer-term contractual agreement between two or more parties having specified and joint rights and responsibilities, as well as split financial outcomes.1

Ways to collaborate online

Social media platforms like Facebook, Instagram and LinkedIn have become essential tools for medical aesthetic professionals to connect with their audience, peers and potential patients. These platforms offer a unique opportunity to showcase your work, share your knowledge and engage with your audience. One of the crucial benefits to remember is that you can

Influencer collaborations

save a ton of money when you do a brand collaboration. It has been reported that brand collaborations are actually 25 times cheaper than using digital adverts.2 Collaborating with your peers on social media can help you reach new audiences, increase your visibility and grow your following. By partnering with other professionals in your industry, you can leverage their online following and reach a wider demographic by utilising several different features, such as:

• Live interviews and conversations through Instagram or Facebook Live, where both parties can join the video and both sets of followers get alerted that the stream has begun

• Static images or videos posted to your grid can be shared as a collaboration through the ‘add a collaborator’ function, meaning that the post will be shown on both the poster and collaborators’ profiles. This can be done for two profiles via Instagram or up to 50 on Facebook

• Promoting content such as the blog posts, articles and media features of your peers that may be of interest to a wide audience by resharing to your own profile

The benefits of social media collaboration

Building credibility

In the medical aesthetics industry, building credibility is crucial. Patients are looking for experienced and knowledgeable practitioners who can provide them with the results they want. Collaborating with other professionals in the industry can help to establish yourself as an expert in your field. By working with others who are respected and trusted within the industry, you can leverage their credibility and expertise to enhance your own. As an experienced professional, you have the opportunity to

Alongside collaborating with peers and colleagues, it’s common for practitioners to be approached to work with influencers. While many collaborations do not involve contracts, having them in place is crucial for collaborations involving financial or treatment exchanges, in order to mitigate the risk of significant loss for both parties. For instance, in cases where ambassadors are provided with a treatment in exchange for a social media post, contracts can ensure that both parties uphold their commitment, despite the treatments and marketing features being carried out at different times. It’s important to note there has been a specific guide released by the ASA in regards to paid for collaborations, noting that if you give an influencer a payment, any posts then promoting or endorsing the brand or its products/services become subject to consumer protection law. So, it must be made clear to their audience that the post is an advert.3

Practitioner spotlight…

Our client aesthetic nurse Khatra Paterson recently hosted a series of Instagram Live sessions in collaboration with specialists who offered support and guidance beyond her own expertise. As a medical aesthetic practitioner, Paterson has daily conversations with her patients about the menopause, with one topic coming up repeatedly – the difference between hormone replacement therapy and bio-identical hormones. To provide her audience with the correct information and provide a more qualified answer, she collaborated with Dr Laura Clark and Dr Katie Hilton of The Lifestyle Clinic to host two informative sessions on the topic and allow her audience to engage with them directly in the comments section. These sessions have received great feedback from her following, highlighting the value of collaboration and providing expert insights to a wider audience.

support newer practitioners by discussing important topics such as patient safety, ethical practice, new product launches, and skincare must-haves. Collaborating encourages good practice and fosters healthy discussions with alternative points of view. Every collaboration with a peer presents the opportunity to reach a new online audience. By sharing your expertise and experiences, you can help to elevate the standards of the profession and contribute to the growth of the industry as a whole.

Growing your following

One of the biggest benefits of collaborations is the potential to grow your online audience. By working with others who have a similar target following, you can tap into their audience and expand your reach. This can help you attract new patients who may not have discovered your business otherwise. By cross-promoting each other’s services, you can drive traffic to each other’s websites/ online profiles and increase the chances of conversion. Additionally, by working with other professionals in your industry, you may discover new opportunities for collaboration and business growth. By partnering with a practitioner who specialises in a complementary field to your own, you can open the door to potential referrals between one another for specific treatments. For example, an aesthetic clinic that specialises in skin rejuvenation and scar reduction could partner with a cosmetic surgeon who specialises in surgical treatments that benefit from post-surgery skin procedures to enhance results. Similarly, the surgery clinic can also benefit from referrals of patients who require more invasive procedures that fall outside their scope of practice, such as body contouring, breast augmentation, or rhinoplasty. By establishing a mutually beneficial partnership, both the surgeon and the aesthetic clinic can expand their services

and cater to a wider range of patient needs, while also increasing their revenue and growing their business.

Finding the right collaboration

Finding the right people to collaborate with in the medical aesthetics industry can be a daunting task. However, there are several strategies you can use to identify potential collaborators and ensure they are the right fit for your business.

One of the best ways to find people to collaborate with is to attend industry events such as conferences, seminars and workshops. These events provide an excellent opportunity to meet other professionals in your industry, learn about the latest trends and techniques and identify potential collaborators through networking or joining industry associations. You can also use social media platforms like LinkedIn, Facebook and Instagram to connect with other professionals in the specialty and find out more about their ethos. Joining online groups and communities can be a great way to network and identify potential collaborators. Once you’ve identified potential collaborators, it’s essential to determine whether they are the right fit for your brand. Look for professionals who share your values and vision, and who have a similar target audience to your own. You should also consider their level of expertise and experience in the industry, as well as their reputation and track record. Before committing to a collaboration, it’s also important to have a meeting to establish clear goals and expectations. Make sure that both parties are aligned in terms of what they hope to achieve through the collaboration, and that there is a clear understanding of each person’s role and responsibilities.

Ending a collaboration

While collaborations can be a great way to build your business and grow your network, there may be times when you need to break off a collaboration. Perhaps the collaboration is no longer serving your needs, or there are differences in opinion or direction that cannot be resolved. When considering ending a collaboration, it’s important to approach the situation carefully and professionally. Start by having an honest conversation with your collaborator about your concerns and reasons for wanting to end the collaboration. In some cases, it may be possible to transition the collaboration to a different format or structure that better meets your needs. For example, if you are collaborating on a project that is no longer working, you may be able to pivot to a different one that is more aligned with your goals.

Find your collaboration

Collaborating with peers on social media can be a powerful tool to build credibility, grow your audience and ultimately boost your business. Through collaboration, you can share knowledge, resources and skills, expand your offerings and establish yourself as a key industry figure. By attending industry events and networking through social media platforms, you can identify potential collaborators who share your vision and values. However, it’s important to carefully consider potential collaborators and establish clear goals and expectations before committing to a collaboration. In the event that a collaboration no longer serves your needs, it’s essential to approach the situation professionally and respectfully.

Lianne Sykes is a marketing professional with more than 15 years’ experience in sales and marketing. As the co-founder and CEO of Quirky Frog, she specialises in working with medical aesthetic practitioners to help them raise their brand identity and credibility through effective social media management, events, and PR.

Working with Distributors and Manufacturers

Business consultant Simon Haroutunian shares his advice on working with the right companies to promote

Choosing which products to offer your patients is a key aspect of your business, as well as the services you provide.

The aesthetics market is booming, and there are multiple products and companies out there vying for your attention. Whether you attend a brand’s masterclass, re-evaluate your next patient consultation, attend a conference or meet company representatives, the number one priority is patient safety. After 14 years in the industry, I’ve not yet been challenged on this opinion.

I hope most of you, if not all, would agree with this statement. We would like to think that all manufacturers and distributors have the same values too. So why the need to take a deeper dive into the decision-making process regarding products?

Having worked for a pharmaceutical company who manufactures toxins and a range of dermal fillers, I hosted and organised many medical educational training and meeting events. When asked on our pre-event survey which products the practitioners currently use in their clinics and why, the overwhelming majority answered, “I use product ‘x’, because that is what I was first trained on when I entered aesthetics.” One year may have passed for some, 15 years for others.

The decision to use a product continuously on your patients is customarily based on an initial training course which most likely stipulated which products to use on the

day. If you are content with the product in hand, you have patient satisfaction and most importantly patient safety at the forefront of your practising values, you are on the right path. However, I feel it is unequivocally worthwhile to consider what product you are using and what support you should be getting from the manufacturer or distributor to continue your development as a practitioner and aid your patient safety journey.

Evaluating choice in a big market

In the UK, we have an undeniably wide range of fillers, devices and skincare products on the market. In the past 12 months, even the toxin marketplace has doubled in size for the first time in about 15 years. There is a lot of choice out there. However, with choice comes multiple marketing avenues, numerous representative visits and a range of hard selling and relationship-building sales pitches.

Since the COVID-19 pandemic, the landscape of our industry has changed for the better in some areas. Online delivery of medical education was not really established pre-2020. If you wanted education, it was in the form of conferences and in-person events only. While I personally believe face-to-face networking and peer support is unchallenged, sometimes there is a need for online education. We now have the opportunity to learn even more, in our own time, from the comfort of our own homes. There are certain manufacturers and distributors within our field who have evolved about a decade in the past two years.

I recently asked Rick O’Neill, digital consultant to the medical aesthetics industry and founder of award-winning digital marketing agency LTF, his thoughts on the digital arena within aesthetics. He told me, “As competition increases and digital expectations are at an all-time high, it is only the manufacturers and brands that can offer truly valuable and accessible business and clinical education, in an omni-channel fashion, that is worthy of your custom and loyalty. Those that offer this to all, regardless of spend, show a commitment to raising education and digital experiences for the whole market, not just their key accounts.”

We only need to look at recent in-person events like ACE and CCR to see how many companies are exhibiting their products. Across areas including injectables, skincare, devices and many more, there were 150+ companies exhibiting.1-3 Just recently in Monaco, the AMWC conference hosted more than 230 companies at its annual congress (turn to p.16 to read a report on the event).4 Therefore, we need to ask ourselves: what are we looking for in a company if we are going to invest our time and money into their products? Surely, we won’t be lured in by a few impressive before and after images on their marketing materials.

clinic success and patient safety

The aesthetics market is booming, and there are multiple companies out there vying for your attention

What and who should you say yes to?

Naturally, there is no set-in-stone answer, but it is worth considering the following:

• Have you been assigned an account manager/representative to support you and answer any questions which might arise?

• Are you offered continued medical education and product training support?

• Do you have easy access to online learning videos to advance your understanding of best practice using your products?

• Are you being offered clinic business support?

• Are other employees in your clinic, not just the medical practitioners, supported?

• Are clinical papers and evidence on the product readily available from the company so you can ensure efficacy and patient safety are being upheld?

• Do you feel you have the right support should you ever need to report an adverse event?

• Do you understand their company values, and do they align with yours?

• Are you being supported with marketing materials to help promote your services?

It is also worth thinking about where you are on your career journey. The above points are relevant to all practitioners, but if you’re just starting out, making sure you get the right support when reporting an adverse event should be absolutely critical, and if you are well-established and have aspirations for more advanced teaching and learning, a company who can provide this may be higher up your list.

Maintaining the relationship

As we well know, companies and representatives change, and more often than not, these changes are not communicated with you. Therefore, it is vitally important that you build a strong, trusting relationship with your account manager/representative from that company. It is good practice for the company representative to reach out to you for regular meetings and check in on your business. However, remember that they are your representative, so make sure you also contact them should you have the need to. A reputable and credible company’s account managers will be available to assist you across all medical, marketing and sales related questions. If you feel like you are nothing more than a profit margin for them, it might be worth cutting ties early on. This cannot be stressed enough when thinking

Practitioner perspective

Of course, I am not in the shoes of a day to day, practising medical aesthetic practitioner, and I wanted to get the thoughts of one who is. I asked Anna Baker, an award-winning aesthetic nurse prescriber, trainer and qualified educator, what she believes is crucial support right now in our industry.

According to Baker, “Ongoing and consistent support is a key attribute which I would consider as fundamentally important when it comes to manufacturers and distributors. In particular, the level of support, notably with regards to medical concerns over potential adverse events. I would also place value on commercial and educational support, as well as timely responses to queries and questions.”

about any products, more so if you are currently considering investing a significant sum of money in an expensive device. The stronger your initial relationship with a company, the smoother any transition should be because of mutual trust.

Discover what support and growth you desire personally as a practitioner, and see if the manufacturer/distributor can help guide you on that journey. Aesthetic practitioners come in many forms. Some are content with seeing their local patients and running a successful clinic, while others wish to run clinic chains up and down the country and aspire to take to the stage at national and international events as brand key opinion leaders and ambassadors. Most practitioners are somewhere in the middle, with a balance of personal and professional ambitions for high quality medical education development, and trying to incorporate good practice in everything they do. Whenever I talk with practitioners, this philosophy seems to be at the heart of everything we do. Good practice, ethics and patient safety is always the number one priority, so make sure you take time to research the company and don’t be afraid to challenge the representative and get a true understanding of what their values are.

Exploring your options

I appreciate that one of the biggest challenges we can have when contemplating using a different product, distributor or manufacturer is loyalty. Sometimes, it is difficult to leave something or someone familiar that you have been working with

for a long time. Often you will not be forced to leave, but if they are not ticking all the boxes, could you potentially be missing out on developing your career and offering your patients more?

Putting your patients first does not mean buying your products at the cheapest price. As a business owner, price points are important, but ensure that this is just one of the criteria you consider in what a manufacturer or distributor can and should offer you. Whilst maintaining its roots and foundations, the industry provides its professionals with so much more than it did 20 years ago. I urge you to go forward and explore the options and opportunities available to you from manufacturers and distributors and take the time to analyse the question: what is best for my patients as well as me and my clinic?

Simon Haroutunian is the director of SHine Medical Consulting Ltd. Haroutunian founded the company in 2022 to act as a business consultant to the pharmaceutical and aesthetic industries in medical education, training and events, strategy and employee/ team development. His previous working experiences have been at Wigmore Medical, FACE, Euromedicom and Merz Aesthetics.

REFERENCES

1. Byng-Hall K. ‘Return of ACE Brings Top Class Education and Networking’ Aesthetics (UK: Aesthetics, 2023) <https:// aestheticsjournal.com/feature/return-of-ace-brings-top-classeducation-and-networking>

2. ‘Exhibitor List’ ACE 2023 <https://www.aestheticsconference. com/exhibitor/>

3. ‘Exhibitor List’ CCR 2022 <https://www.ccrlondon.com/ exhibitor/>

4. ‘Exhibitors’ AMWC 2023 <https://www.amwc-conference.com/ en/exhibit/exhibitors-list.html>

Putting your patients first does not mean buying your products at the cheapest price

In The Life Of Dr Kam Lally

Dr Kam Lally shares a typical day in his clinic, as well as juggling KOL, training and family responsibilities

A typical working day…

Mornings are my biggest challenge, but I have no choice in getting up at 6:30am with a six- and seven-year old! I spend time with them in the mornings alongside having a masala chai (tea) and a couple of pieces of wholegrain bread and marmite (controversial, I know). On days where I need an extra boost, I treat myself to a bowl of Lucky Charms or Chocolate Shreddies instead.

I head into my clinic Aestheticology at around 9:30am, with my first patients arriving at 10am. I know when I work best, so I prefer to work later rather than start earlier – my patients also appreciate that as they can come in after work to fit their treatments around their schedules. Some days, I pop out to the gym at around lunchtime in the perpetual fight against the dad-bod. I offer botulinum toxin, dermal filler, biostimulator, skin booster and thread treatments predominantly in my clinic. Fillers and threads have to be my favourites! There’s nothing quite like seeing a patient get that immediate gratification and walk out of the clinic looking instantly refreshed and happy. I also provide medical weight management solutions in my clinic as this is an area I’m really passionate about. I’m a GP at heart, so helping patients holistically to improve their overall health and longevity by reducing the risk of obesity-related disease is important to me.

I leave clinic around 7-8pm, and rush home to spend some time with my kids. I enjoy putting them to bed as it gives my wife a break, and their unwinding process helps me unwind also. That is, except on Thursdays which are dedicated to playing football. I’ve been an Arsenal fan for over 30 years, and I stick with them through thick and thin (fingers crossed for the rest of the season)!

Other work commitments…

Outside of running my own clinic, I’m very dedicated to training other practitioners. Continued education in any field is crucial

and I find being a trainer not only allows me to help others, but it also solidifies my own knowledge as you need to understand a concept thoroughly to teach it well. I love when students suddenly understand a concept or technique, the penny drops, and they can start creating great results as well.

I’m grateful to train on dermal fillers with Teoxane, on MINT PDO threads with Hansbiomed, on weight loss solutions

Career if you weren’t a practitioner…

My original ambition was to study astrophysics and work at NASA!

Country you’d move to…

I’d have to say Canada – it’s got a great combination of cities and amazing outdoor spaces.

Your guilty pleasure food you’d eat every day…

I love any fried carbs – nachos with all the toppings are a go-to cheat meal.

with Novo Nordisk and on skincare with AlumierMD as a global key opinion leader. This has allowed me to travel all around the world to share my knowledge: from the Middle East to Macedonia, from Italy to India, and most recently Monaco at AMWC 2023. I feel really lucky to have all these opportunities to travel, teach and spend time with some amazing peers.

I’m also the Royal College of General Practitioners (RCGP) National Aesthetic Medicine lead, representing aesthetics amongst GPs. This role gives aesthetic medicine a voice, and I’m open to enquiries from GPs who might want to venture into aesthetics, or those who are seeking aesthetics-related advice. With the specialty growing so rapidly, I’m glad I can keep up this role with the RCGP so we have much-needed representation in official channels. Through all these commitments, it’s super important to me to maintain a decent work-life balance. Organisation and planning ahead are the key to protecting this – I’m already taking bookings for November to make sure I don’t get overwhelmed! You need to weigh up all the opportunities you get offered and make sure enough time is left for you and your family. If you can get a personal assistant to help you out even for a couple of hours a week, that really helps.

Most memorable day in aesthetics…

I thought it would be difficult to come up with my most memorable day, but it sprang to mind immediately. It was at last year’s AMWC Congress in Monaco when I was asked to inject live to open the first symposium. It didn’t quite go to plan as my assistant didn’t speak English so we ended up having a filler ‘malfunction’ with a loose cannula! Apart from causing some temporary embarrassment, it didn’t impact the patient’s safety and I managed to create a great result in the end. It was such a privilege to be asked to present and inject on the aesthetic world’s biggest stage. It was definitely a ‘wow’ moment for me.

The Last Word

Dr

Human beings are deeply concerned with their appearance. As a dermatologist, I see the struggles of those who suffer with skin issues daily and, thankfully, I have the privilege of helping many of them whilst seeing the impact an improvement in their appearance can have on their day-to-day lives.

A study published in 2021 of 624 patients found that the majority requested ‘rejuvenation’ rather than ‘correction’ as the goal of seeking treatment.1 In another study of 72 patients, almost one-third had experienced a major life event in the preceding year and were seeking treatments to positively impact their appearance, with over a quarter stating that ‘pressure to look younger in the work setting’ was the most important factor in their decision-making.2

Though these reasons are valid, clinicians often have conflicting or mixed views about treating these patients. I’m sure that any reader of this journal is happy to perform a myriad of treatments to improve patient appearance, I would be surprised if there was not a moment where we stopped and thought: ‘Hold on, I am a practitioner, trained to diagnose and manage diseases, as well as promoting the active prevention of disease. Should I be performing aesthetic treatments?

Is this what I spent years in medical school and training to do?’

Many consultant dermatologists in the UK do not perform any aesthetic treatments at all, and there is an air of superiority to this: we will leave other healthcare professionals to provide these ‘trivial’ services while we treat ‘real’ skin diseases and ‘help’ people. So should consultant dermatologists be performing aesthetic treatments, or instead focus on diagnosing and treating skin diseases?

Dealing with disease

I believe that dermatologists should offer evidence-based aesthetic treatments to patients and be the leaders in aesthetic medicine, but how do I justify this when the waiting list for skin cancer treatment is extensive? There is a shortage of

dermatologists globally, and in 2007 it was noted that the median waiting time for a neurotoxin injection for wrinkles with a dermatologist in the US was eight days, compared with a waiting time of 26 days for evaluation of a changing mole.3 It is currently not documented what these statistics are for the UK. However, this is almost certainly due to financial reasons, but it still begs the question: should dermatologists be doing aesthetic treatments at all, when there is an increase in actual disease for us to deal with? What if there is evidence that aesthetic treatments provide benefits to patients beyond psychosocial ones? What if ‘looking young’ was not only important for an individual’s mental health and self-esteem as they grow older, but also vital to biological health?

Predicted age vs. biological age

It is agreed that individuals can age slowly or rapidly. Although many people ‘look their age’, we can probably all name someone in middle or late adulthood who appears to be ageing more slowly (or more rapidly) in terms of physical appearance.

Determining someone’s ‘rate of ageing’ is tricky; it is difficult to assess ageing by quantitative means. For example, noting down parameters that are associated with ageing, such as blood pressure and physical strength and then combining these mathematically with actual age. This creates a figure that estimates the biological age of the individual.

Is there another way to assess the rate of ageing for an individual that could be more reliable? Borkan et al. controversially proposed that it may be possible that the difference between visually estimated age and actual age is a useful indicator of biological age in adulthood.4 The query raised was: are those who look old for their stated age biologically older when evaluated in terms of physiological functioning? If a 70-year-old looks 50, are they physiologically younger and vice versa? The answer seems to be yes.

Increasing longevity

Biological or intrinsic age can be correlated with physical appearance. Those who look old are, in fact, older as measured by physiological losses. The most compelling evidence comes from a longitudinal study of 1,086 adult males receiving annual check-ups at the Baltimore Gerontology Research Center over a 20-year period.5 They found that men who looked older visually were found to be biologically older on many key parameters (like blood pressure, cholesterol, type 2 diabetes, arthritis) and the younger looking participants lived longer.5

Is it possible that ‘youthful looks’ are not only associated with good health but also contribute to longevity? Is it possible that appearance can become a matter of life and death? If this is the case, if we ‘artificially’ change someone’s appearance to look younger, does the relationship between apparent age and biological age still hold?

I think this is the billion-dollar question that as far as I am aware has not been conclusively answered. Does it justify my work as a consultant dermatologist doing aesthetic treatments? Perhaps this is how I rationalise what I do, but it is an intriguing question that may never have a clear answer.

Dr Natalia Spierings is a UK-trained consultant dermatologist and fellowship-trained Moh’s micrographic surgeon, with practices in both London and Dubai. She has a Master’s in Aesthetic Medicine from Queen Mary, University of London. Dr Spierings recently published her first book, Skintelligent: what you really need to know to get great skin, to help people navigate the world of skincare. Qual: BSc, MBBS, MRCP(UK), MRCP(Derm), MSc, MBA

REFERENCES

1. Ramirez SPB, Scherz G, Smith H, ‘Characteristics of Patients Seeking and Proceeding with Non-Surgical Facial Aesthetic Procedures’, Clin Cosmet Investig Dermatol, 2021.

2. Sobanko JF, Taglienti AJ, et al., ‘Motivations for seeking minimally invasive cosmetic procedures in an academic outpatient setting’, Aesthet Surg J, 2015.

3. Resneck JS Jr, Lipton S, Pletcher MJ, ‘Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists’, J Am Acad Dermatol, 2007.

4. Borkan GA, Bachman SS, Norris AH, ‘Comparison of visually estimated age with physiologically predicted age as indicators of rates of aging’, Soc Sci Med, 1982.

5. Borkan GA, Norris AH, ‘Assessment of biological age using a profile of physical parameters’, J Gerontol, 1980.

Natalia Spierings debates why consultant dermatologists are well-placed to offer aesthetic treatments and the potential impact on biological ageing

Uncompromised

Exclusive PSD® technology allows professionals to choose the right pulse for any skin type, condition, and treatment area.

Perfect Match Between Downtime and Results

Trust in Expertise

Deliver impressive skin rejuvenation with little to no downtime CO2 ... but cooler! Supported in the UK by Lynton Visit lynton.co.uk to find out more. @dekalaseruk