DERMAL FILLERS DESIGNED FOR bold, expressive
ON YOUR TERMS.
THE REVANESSE® LINE OF HA FILLERS INCLUDES A COMPREHENSIVE COLLECTION OF PRODUCTS DESIGNED FOR MINIMAL PAIN AND SWELLING, EACH PRODUCT CAREFULLY CRAFTED TO HELP YOU ACHIEVE YOUR PATIENT’S LIP ASPIRATIONS
CPD: Skeletal Classifications
Mr James Olding outlines skeletal, dental and tissue patterns for treatment
Expanding Your Clinic With Holistic Care Aesthetics delves into the concepts of medical longevity
Examining Weight Loss Injections
Dr Kam Lally presents weight loss injection considerations
Improving Customer Service
Julie Scott advises on providing exemplary customer service
VOLUME 10/ISSUE 11 - OCTOBER 2023
PN99719 Rev 00 Revanesse® Ultra™+ Clinical Study Report PRO 2018-02: A Multicenter, Double-Blind, Randomised, Controlled Study of the Safety and Effectiveness of Revanesse® Ultra™+ for Lip Augmentation ATTENDCCRTHISOCTOBER19-20
for lip rejuvenation
for lip augmentation
+ for lip architecture
@hydrafacial_uk www.hydrafacial.co.uk 01788 572 007 The future of skin health is here Syndeo ® 12 Treatments in 1 Device Patented Vortex-Fusion Technology Automatic Serum Selection Prompts to Upsell Seamless Gesture Control Custom Backlight Colors Wireless Upgrades Future Business Insights
Powerful Protection.2-5 Pliaglis�
Powerful and lasting local anaesthesia with Pliaglis®, the only licensed topical anaesthetic cream that combines the highest registered concentration of lidocaine (7%) and tetracaine (7%) in a unique self-occluding formulation.*, 1
Pliaglis 70mg/g + 70mg/g cream Prescribing Information Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: 1 gram of cream contains 70 mg lidocaine and 70 mg tetracaine. Indication: To produce local dermal anaesthesia on intact skin prior to dermatological procedures in adults. Dosage and administration: For facial procedures, Pliaglis should be applied by healthcare professionals. For procedures on any other part of the body, Pliaglis may also be administered by patients instructed in appropriate application technique. Posology: For dermatological procedures such as pulsed-dye laser therapy, laser-assisted hair removal, non-ablative laser facial resurfacing, dermal filler injections and vascular access, Pliaglis should be applied onto intact skin at a thickness of approximately 1mm for 30 minutes (approx 1.3 g of cream per 10 cm2). After the required time, the peel must then be removed from the skin prior to the procedure. For dermatological procedures such as laser-assisted tattoo removal, and laser leg vein ablation, Pliaglis should be applied onto intact skin at a thickness of approximately 1mm for 60 min (approx 1.3 g of cream per 10 cm2). After the required time, the peel must then be removed from the skin prior to the procedure. The maximum application area should not exceed 400 cm2. Pliaglis should be used with caution in patients with hepatic, renal and cardiac impairment. Pliaglis is not recommended in children and adolescents. Method of administration: Single patient cutaneous use only. Precautions to be taken before handling or administering: Avoid direct contact with the cream or the skin covered with the cream in order to prevent contact dermatitis. Never apply with fingers. Only be apply with a flat surfaced tool such as a spatula or tongue depressor. Hands should be washed immediately after removing and disposal of the peel. Contraindications: Hypersensitivity to lidocaine, tetracaine, other anaesthetics of the amide or ester type, to paraaminobenzoic acid, methyl parahydroxybenzoate (E218), propyl parahydroxybenzoate (E216) or to any of the other excipients; On mucous membranes or on broken or irritated skin. Warnings and precautions: Contact with eyes should be avoided. Severe corneal lesions were observed in animal testing of similar products. Used with caution in the proximity of the eyes. If Pliaglis comes into contact with the eye, rinse immediately with water or sodium chloride solution and protect until sensation returns. Any remaining peel residue should be carefully wiped with a compress after removing Pliaglis peel. The treated area should not be occluded before removing Pliaglis from the skin. Pliaglis should not be applied for a longer time than prescribed. Rare allergic or anaphylactoid reactions associated with lidocaine, tetracaine or other ingredients in Pliaglis can occur. Tetracaine may be associated with a higher incidence of such reactions than lidocaine. Several local anaesthetics, including tetracaine, have been associated with methemoglobinemia. Risk of methemoglobinemia is greatest for patients with congenital or idiopathic methemoglobinemia. Doses, areas of application, and duration of application must be consistent with those recommended for the intended population. Lidocaine has been shown to inhibit viral and bacterial growth. It is not recommended to use Pliaglis before injection of live vaccines. Use with caution in patients with hepatic, renal or cardiac impairment, and in subjects with increased sensitivity to systemic circulatory effects of lidocaine and tetracaine. Patients must take extra care to avoid inadvertent trauma to the skin whilst under the local anaesthetic effects. Pliaglis contains methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216), which may cause allergic reactions (possibly delayed). Fertility, pregnancy and breastfeeding: Pregnancy: There are no or limited amount of data from the use of Pliaglis during pregnancy. Caution should be exercised when used in pregnant women. Breastfeeding: Lidocaine and tetracaine are excreted in human milk. At the recommended doses of Pliaglis, only low effects on breastfed newborns/infants are anticipated. Pliaglis can be used during breast-feeding as long as Pliaglis is not applied to the breast. Fertility: There are no fertility data for the use
Undesirable effects: Serious side effects: Allergic or anaphylactoid reactions; Other very common side effects: Erythema, skin discolouration; Other common side effects: Skin oedema. For full list of side effects, consult SmPC. Legal Category: POM Pack size and price: 15g (21.25GBP), 30g (36.55GBP) MA numbers: PL 29863/0003, PA0846/003/001 MA Holder: CROMA-PHARMA GmbH, Industriezeile 6, 2100 Leobendorf, Austria Date of Preparation: March 2023 Unique ID number: PLIPI0323UK Adverse events should be reported. Reporting forms and information can be found at: UK - http://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store. IE - HPRA Pharmacovigilance Website: www.hpra.ie. Adverse events should also be reported to Croma Pharma GmbH on 0118 206 6513 ADPL1122UK (7) Date of Preparation June 2023
Contents • October 2023
The latest product and industry news
19 News Special: New Licensing Scheme Causes Conversations
Aesthetics gets industry views on the proposed RAG regulation categories
25 Enhance Patient Satisfaction Through New Techniques
Bring your patients the latest innovations and techniques at CCR 2023
29 The Benefits of HArmonyCaTM In Your Practice
Dr Rashpal Singh outlines the benefits of offering HArmonyCaTM in your clinic
31 Special Feature: Holistic Care in Your Clinic
Aesthetics delves into the concept of holistic medical longevity
35 Restylane® Kysse: Combining Artistry and Science
Galderma unveils high levels of patient satisfaction with Restylane® Kysse
36 CPD: Skeletal and Dental Classifications For Injectables
Mr James Olding and colleagues outline skeletal and dental patterns
40 Get To Know SkinCeuticals: The Pioneers Of Skin Health
Join the leaders in antioxidant research at this year’s CCR
42 Examining Weight Loss Injections
Dr Kam Lally presents considerations before prescribing weight loss injections
47 Treating the Perioral Area
Dr Nestor Demosthenous advises on successful treatment of the perioral area
49 Treating Menopausal Patients with Filler
Dr Raquel Amado shares her approach for treating menopausal women
55 EMFACE in the Changing Aesthetic Landscape
Miss Sherina Balaratnam discusses her experience with EMFACE in her clinic
56 Exploring Fasting Benefits For Aesthetic Patients
Dietician Sascha Landskron provides an overview of the benefits of fasting
61 A Retinol Revolution
Introducing the next generation of retinols from iS CLINICAL
63 Combining Light Therapy with Polynucleotides
Kate Monteith-Ross and Eleanor Turrell share research into PN and LED
68 Examining BDD in Aesthetics
Claire Newman takes a look into the history of body dysmorphic disorder
70 Aesthetic Combination Treatments
Enhancing experiences with Neauvia Smart Combination Therapy Protocols
A round-up and summary of useful clinical papers
72 Integrating Blood Testing Services Into Your Clinic
Dr Natasha Fernando details the benefits of offering in-clinic blood testing
76 Succeeding in Customer Service
Julie Scott advises on how to up customer service and patient satisfaction
78 Growing Your Brand Through Industry Awards
Vanessa Bird discusses why entering awards is a catalyst for growth
80 Celebrating Success with The Aesthetics Awards
As Aesthetics Awards entry opens, we look back on last year’s successes
82 Optimising Short-Form Video Marketing
Alex Bugg advises on how to stay abreast of the consistent rise of TikTok
85 In Profile: Alice Henshaw
Alice Henshaw shares what drives her to skincare and Instagram success
86 The Last Word: Korean vs. UK Aesthetics Market
Dr Jinah Yoo discusses differences between Korean and UK aesthetics
News Special: New Licensing Scheme Causes Conversations
Feature: Holistic Care in Your Clinic
Mr James Olding is a full-time specialist NHS registrar in oral and maxillofacial surgery, and is dual qualified in medicine and dentistry. He is the founder of Interface Aesthetics and was recently awarded The AlumierMD Award for Rising Star of the Year 2023.
Dr Kam Lally graduated from the University of Oxford, went on to qualify as a GP and is the Royal College of General Practitioners national aesthetic medicine lead. He is a global KOL for Teoxane, HansBiomed, AlumierMD and Novo Nordisk.
Dr Raquel Amado has 15 years’ experience as a practising dentist, is a Level 7 qualified aesthetic practitioner and senior clinical trainer for Harley Academy. Dr Amado was Highly Commended for Rising Star of the Year at the 2023 Aesthetics Awards.
Sascha Landskron is a registered dietitian and director of UniNutrition Ltd. Landskron specialises in personalised nutrition, weight management, nutritional genomics, therapeutic ketogenic diets, fasting, food allergies and intolerances.
Kate Monteith-Ross is a registered nurse with a Master’s in adult nursing, and experience in plastic surgery and surgical care. She is the founder and director of The Clinic by La Ross in Kent, Urban Training Academy and The Nurses Network platform.
Eleanor Turrell is a registered nurse with a background in surgical care. She has been mentored by Kate Monteith-Ross for more than 18 months, developing her passions for medical aesthetics and regenerative treatments.
Claire Newman is a mental health nurse prescriber and the director of Soft Touches Aesthetics in Hertfordshire. She is a Level 7 trainer for Derma Medical. She is passionate about mental health, promoting confidence and wellbeing.
Become a Member of Aesthetics! Join the Aesthetics Community as a Full Member to receive the monthly Aesthetics journal, among many other exclusive benefits. Visit aestheticsjournal.com to sign up!
Launching Wednesday 4th October Next-level lifting Advanced anti-aging serum clinically proven to lift and firm the appearance of skin by 60%* — giving you a youthful boost from the inside out. CLINICAL RESULTS STARTING IN 1 WEEK • Visibly fuller skin, with 58% improvement in plumping the look of skin* • Smooths visible lines and coarse wrinkles by 40%* BASELINE + + + AFTER 24 WEEKS *24-week data on file at PCA SKIN. N=47 | Photos are not retouched EXCLUSIVELY AVAILABLE THROUGH ChurchPharmacyUK @ChurchPharmacy ChurchPharmacy.co.uk 01509 357300 email@example.com
Well, hasn’t it been an interesting month!
The aesthetics specialty is buzzing at the moment with fascinating conversations and debates about who should and shouldn’t be performing aesthetic treatments. It all comes following the launch of the UK Government’s public consultation on licensing and the bid to implement an RAG-rating system. After many years of lobbying by industry associations, practitioners, companies and other stakeholders, the UK Government has finally started to act. But what do you think of the suggestions? Will they make a difference to patient safety? We speak to the key industry associations on this topic in our News Special this month on p.19 We will also be doing regular Instagram lives over the consultation period to keep you updated, and we will be discussing this topic at CCR. If you’re keen to participate in the discussion, please do attend. I’d also encourage you all to be active with your industry associations, who are submitting responses on behalf of members, or partake in the consultation yourself. It closes on October 28 and the
Shannon Kilgariff Editor & Event Manager @shannonkilgariff
more evidence the Government receives the better. This month in the journal, our content focuses on a holistic approach to aesthetics and how to implement services into your practice that will improve the overall wellness and longevity of your patients. My personal favourite reads on this topic are how to expand your clinic offering with holistic care (p.31), weight loss injections on p.42, benefits of fasting on p.56, and blood testing in aesthetic medicine (p.72).
You also can’t miss a great article by consultant Vanessa Bird in our business section all about her top tips for entering awards ceremonies! As you know, entry for the Aesthetics Awards is open, and closes on November 6. Don’t leave it to the last minute and enter early. Many of our authors this month are also presenting at CCR on October 19-20! As the UK’s biggest event in aesthetic medicine with 140+ companies, 3,400+ visitors and 120+ speakers, it really is one of the industry’s favourite gatherings. You can find out more on p.25 and register – also check out our Agenda at a Glance leaflet in this issue to start planning your CPD-approved learning experience. Make sure to say hello to myself and the team at the Aesthetics Member lounge –we look forward to seeing you there!
Clinical Advisory Board
Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content
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 over 30 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.
Alison Willis • Director
T: 07747 761198 | firstname.lastname@example.org
Shannon Kilgariff • Editor & Event Manager
T: 0203 196 4351 | M: 07557 359 257 email@example.com
Holly Carver • Deputy Editor | T: 0203 196 4427 firstname.lastname@example.org
Ellie Holden • Journalist | T: 0203 196 4265 email@example.com
Kate Byng-Hall • Journalist | T: 020 3196 4389 firstname.lastname@example.org
Peter Johnson • Senior Designer
T: 0203 196 4359 | email@example.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 independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.
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 firstname.lastname@example.org
Emma Coyne • Senior Sales Executive
T: 020 3196 4372 | email@example.com
Imogen Preece • Sales Executive
T: 0203 196 4367 | firstname.lastname@example.org
• Marketing Manager
T: 020 3196 4370 | email@example.com
Emma Kurzyca • Marketing Executive
T: 020 3196 4306 | firstname.lastname@example.org
Angelica Smart • Content Marketing Executive
T: 020 3196 4419 | email@example.com
Do you have any techniques to share, case studies to showcase or knowledge to impart?
Dr Tapan Patel is the founder and medical director of PHI Clinic, and has more than 20 years’ experience performing aesthetic treatments. He is a KOL for Allergan Aesthetics and Cutera, and is passionate about high standards in aesthetic medicine. In 2023, Dr Patel received The Aesthetics Award for Outstanding Achievement in Medical Aesthetics.
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.
PROGRESS MEDICAL AESTHETICS!
FOR THE JOURNAL
not be reproduced in any form
All rights reserved. Aesthetics is published by Aesthetics Media Ltd, which is registered as a limited company in England; No 9887184 DISCLAIMER: The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.
without the publisher’s written permission. For PDF file support please email, firstname.lastname@example.org © Copyright 2023 Aesthetics.
Aesthetics Aesthetics @aestheticsjournaluk
Follow us on Instagram @aestheticsjournaluk
Treatment focus in the latest issue of Aesthetics –Addressing Signs of Ageing with Radiofrequency.
Alma debuts Opus radiofrequency platform
Aesthetic device company Alma has launched new radiofrequency (RF) device Opus in the UK.
According to the company, Opus is a non-invasive platform for skin tightening and resurfacing using unipolar RF to stimulate collagen production on the face, eye area and body. The RF is combined with fractional plasma technology to boost collagen stimulation. Alma explains that charged metal pins are applied to the skin at a high frequency (over 40 MHz) to produce a new skin surface without the need for invasive needles.
Dr Aggie Zatonska @atelier.dr.aggie
Harley Academy @harley_academy
Welcome to Harley Academy Threadneedle Street! Thank you to everyone who came down to make it a great event.
Teresa Tarmey, facialist and Alma ambassador, commented, “Alma Opus is a dedicated radiofrequency device that delivers a completely tailored treatment for facial skin tightening and resurfacing. It is the first-of-its-kind fractional plasma technology to enter the skin resurfacing market and it is revolutionising treatments with its quick and effective results.”
Alma is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today. Safety
HA-Derma adds new Profhilo hologram stickers
Throwing it back to being awarded Commended for The Hamilton Fraser Award for Best Clinic South England at The Aesthetics Awards 2023!
Frances Turner Traill @frances_turner_traill
What a phenomenal day! Speaking to my fellow BACN members about the importance of being your own entrepreneur.
International pharmaceutical company IBSA Derma, with UK and Ireland distributor HA-Derma, has unveiled a new hologram label on Profhilo products. The company explains that the new label will provide practitioners with assurance that the Profhilo products are original. The hologram sticker will be placed on all Profhilo and Profhilo Body boxes in an effort to safeguard the quality, traceability and authenticity of Profhilo. The holograms will feature both IBSA and HA-Derma logos with text ‘Supplied for UK & Ireland’ and a recorded letters/numbers sequence, notes the company.
Dr Raj Arora
On set with these absolute legends Dr Nina Bal and Miss Elizabeth Hawkes for a Hello Mag panel.
Iveta Vinkler, director of HA-Derma, said, “We are committed to providing quality products with proven safety and efficacy. Counterfeit products can put patients at significant risk, and to help combat this issue, we have created an original hologram label for all packaging across our injectable Profhilo portfolio. We are confident the new hologram will help provide additional reassurance to our customers that Profhilo being distributed in the UK & Ireland is original.”
Practitioners should not purchase Profhilo without the hologram on the box. The new sticker is applied at the HA-Derma warehouse in the UK.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 8
CCR to unite the aesthetics specialty this month
CCR 2023 is set to take place this month on October 19-20 at ExCeL, London. The event will welcome more than 3,400 delegates to unite for two days of learning and networking. The event will host five agendas covering topics from injectables to skin health, medical longevity to business. Aside from learning, multiple networking opportunities will be on offer:
• Headline Sponsor Galderma will provide a space to relax and meet at the Networking Lounge throughout the conference
• A drinks reception will also be held by Deleo at 5pm on Day One to continue networking conversations
• The CCR Diwali After Party at Trinity Buoy Wharf is a chance to celebrate with Dr Tapan Patel and raise money for The Childhood Trust! Supporters of the evening include gold sponsor BTL Aesthetics, plus Ascelpion Lasers Technologies, Cutera and Lira Clinical. Purchase your tickets when you register for CCR, with all proceeds going to charity.
• The British Association of Cosmetic Nurses (BACN) Breakfast at 9am on Day Two will be a great chance for nurses to connect
• Drinks for Aesthetics Full Members and Awards Finalists will round off the conference in the Aesthetics Lounge at 2pm on Day Two
On both days, Allergan Aesthetics will be holding Lunchtime Takeovers on the Symposium Stage between 1 and 2pm – with practitioners Dr Tapan Patel and Dr Manav Bawa. The sessions will include live demonstrations, providing rejuvenating transformations for a mother-daughter duo.
CCR 2023 is the debut of the Medical Longevity Summit, spotlighting how lifestyle and functional medicine can contribute to a healthy human lifespan. The Summit will be supported by charity partner Lifespan.io, and will feature exhibitors including NAD+ at Home, Lifecode Gx and the British Association of Nutrition & Lifestyle Medicine.
This year, CCR will be supported by Complications Partner ACE Group World, Sanitisation Partner Aster International, Clinical Waste Partner Initial Medical and Consumables Partner Wigmore Medical.
An exclusive CCR Product Launches Report will also be published and shared with national press at the event. The Report will showcase a round-up of products released in the last year to provide an overview of the aesthetics landscape. It will be available to read on the CCR website. Shannon Kilgariff, editor and event manager at Aesthetics, said, “I am beyond excited for CCR this month! Every year, it’s an amazing opportunity to get up to speed on the latest trends and developments in aesthetics, and of course to catch up with some familiar faces. I’m excited for delegates to experience our brand-new Medical Longevity Summit for learning on regenerative medicine, alongside excellent content on injectables from Headline Sponsor Galderma. You won’t want to miss all we have in store!” CCR 2023 will take place at ExCeL London on October 19-20. Turn to p.27 to register for free now.
(Cancer Research UK, 2023)
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 9
Of 1,000 inﬂammatory skin condition sufferers, 67% said they cover up to hide their skin even in hot weather
(Prospectus Global, 2023)
Following a survey of 3,750 men, 1 in 2 are considering aesthetic treatments to improve self-conﬁdence
(Curated Digital/RARE: Group, 2023)
Of 13,000 women of colour surveyed, 90% said their skin priority was a healthy glow and even tone
In a survey about hair loss, 35% of 1,500 men said losing hair made them feel less attractive
(Lloyds Pharmacy, 2023)
74% of 500 young people aged 18-40, said they feel pressure for their skin to look a certain way
Health Alliance, 2023)
There are around 2,300 melanoma skin cancer deaths in the UK every year, with a projected 20% increase by 2040
CMAC Global Conference
CCR 2023, ExCeL London
FACExpo and FACExpert Conference
ACE 2024, London
The Aesthetics Awards 2024
ASA issues ruling against hyaluronidase advertisement
The Advertising Standards Authority has issued a ruling against an aesthetic clinic in Birmingham after it advertised hyaluronidase treatments to the public. In April 2023, the clinic in question posted on Instagram with a caption stating, ‘Message us for an assessment if you’re unhappy with your filler currently and we can have a face to face assessment. Check out our highlights for the prices of packages including dissolving.’ This was accompanied by the heading ‘Hyaluronidase,’ and a warning that the treatment is not suitable for those allergic to bee or wasp stings. The complainant drew the ASA’s attention to the content because hyaluronidase is a prescription-only medication (POM), so cannot be promoted to the public. The clinic responded saying they were unaware that promoting POMs was in breach of the CAP Code. They said their intent had not been to promote the medicine itself, but to inform patients that hyaluronidase was a potential allergen.
Nevertheless, the ASA upheld the complaint because the post visibly advertised the POM. The clinic has been told that the same advertisement cannot be circulated again, and they can no longer promote POMs to the public.
Mole checking service launches
Practitioners discuss government licensing scheme on BBC News
The British College of Aesthetic Medicine (BCAM) has been represented on national news following the Government’s announcement of its consultation on a potential licensing scheme for non-surgical cosmetic procedures in England.
BCAM president Dr Catherine Fairris and trustee Dr Sophie Shotter shared information on the current regulation climate in the UK and expressed hope that the upcoming legislative changes can improve and secure patient safety. They emphasised that the consultation will remain open to the public until October 28.
Wegovy’s UK debut discussed on BBC Breakfast
GP Dr Nighat Arif appeared on BBC Breakfast to discuss the recent introduction of weight loss injection Wegovy for prescription in the UK, both in the NHS and private clinics. She shared that the medication can be used to treat the ‘chronic disease’ of obesity, but cannot be exclusively relied upon. Wegovy can be prescribed to patients aged 18-75 who have a BMI of 30+, or 27+ if they also have a weight-related condition like type two diabetes, high blood pressure or heart disease.
A new service Map My Mole is now available in the UK, providing quick screening of potential skin cancer. Map My Mole is an app-based service whereby users are sent a clip on dermoscope, a registered class 1 medical device, to photograph suspicious moles or lesions. These dermoscopic images are then sent to be assessed by a consultant dermatologist, according to the company. The company says that the service will be available for patients to use at home, but clinics can also establish a partnership with Map My Mole to provide their patients with quick cancer checks.
Dr Toby Nelson, consultant dermatologist and co-founder of Map My Mole, said, “The aesthetics industry already does a huge amount to promote good skin care, including the need to avoid excessive sun damage. Practitioners in these clinics are used to looking at people’s skin, and will have a deep understanding about what looks normal and what should be checked.”
Sophie Attwood unveils new brand communications book
Brand communications consultant and Aesthetics Awards winner Sophie Attwood has announced her debut book Beautiful PR: Finding Your Brand’s Heartbeat for Authenticity in Communication. The book details a new approach to forming a communications strategy, evoking emotional connections with each brand’s target audience, leading to greater brand awareness and business growth, Attwood notes. Attwood comments, “In the right place, at the right time, with the right emotional connection at the heart of its message, PR can perform miracles in the most unexpected of ways – I’d love for more brands to experience that. My objective with this book is to help founders and brands to truly enhance their reputation with an honest communications strategy that helps to elevate your brand and take you to that next echelon.”
The book is available to pre-order through various retailers on November 7.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 10
What’s trending in the consumer press Advertising
Sinclair collaborates with Harley Academy for training
Pharmaceutical company Sinclair has collaborated with training provider Harley Academy to offer evidence-based training with anatomist Professor Sebastian Cotofana. According to the company, the programme ‘An evidence-based approach to treating the full-face with soft tissue fillers in 2023’ will combine essential anatomical knowledge with practical skills using Sinclair’s portfolio of products. Held at Harley Academy’s new training campus in London, the course will prepare attendees to safely inject using Sinclair products.
Dr Tristan Mehta, founder of Harley Academy, said, “At Harley Academy, we have strict entry criteria for all of our medical aesthetics training courses. This is one reason we are so pleased to work with companies like Sinclair, who similarly only provide medical professionals with their products. Professor Cotofana’s commitment to research and elevating clinical standards will help equip the next generation of practitioners with these vital skills.”
Sinclair and Harley Academy are exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
Deleo to help build connections at CCR Networking Drinks
A round-up of the latest news and events from the British Association of Cosmetic Nurses
AESTHETIC BRILLIANCE AT BACN 2023
Aesthetic device company Deleo has been announced as sponsor of the CCR 2023 networking drinks.
From 5pm to 7pm on Day One of CCR, which will take place on October 19 and 20, Deleo will host a networking drinks event for all CCR visitors. With complimentary drinks and music, the evening will be an opportunity to catch up with peers, connect with like-minded professionals and meet leading figures in the aesthetics specialty.
André Fournier, chief business officer at Deleo, commented, “We are delighted to sponsor the networking drinks at CCR 2023. We have a lot of exciting news to share! We are looking forward to meeting all of the industry experts, and we hope many participants will come and join us for a great time.”
Visit Deleo at the Skinbrands Pro x ABC Medical stand L30 at CCR 2023. Turn to p.27 to register for free now.
The event bought together more than 280 nurses from all corners of the UK, ready for a jam-packed two days with 20+ speakers and 40 exhibitors –the biggest BACN conference to date!
AESTHETIC CONFERENCE RECAP
Throughout day one, expert speakers unveiled new products and techniques, demystified regulatory requirements, touched on a variety of treatments and strategies for achieving a harmonious balance between professional success and personal wellbeing. On top of all that, BACN nurses wowed the delegates with three live demonstrations.
The annual Thursday night drinks reception was the perfect time to raise a glass to the BACN community, with live music, a selfie-ready flower wall and photobooth (kindly sponsored by Aesthetics).
Day two began with a unique perspective on addressing facial lipoatrophy within the NHS healthcare landscape, followed by more live demonstrations showcasing the power of synergistic aesthetic approaches, a look into the versatility of toxin usage, the potential of polynucleotides and the role of ultrasound in preventing and managing complications. Save the date for next year – see you Thursday 26 and Friday 27 September 2024! The get-together was the perfect way to kick off conference season, and anticipation now builds for the third annual Spring Symposium in London next April! Tickets are on sale now via the QR code below.
This column is written and supported by the BACN
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 11
On September 14 and 15, the BACN Autumn Aesthetic Conference unveiled its 2023 programme at Birmingham’s Eastside Rooms, offering an engaging and enriching glimpse into the specialism of aesthetic nursing.
Celebrate Your Successes
Have you started your Aesthetics Awards entries yet?
Entry for the prestigious Aesthetics Awards opened last month, but if you haven’t already started your entries, don’t worry – there’s still time! You have until November 6 to complete your entries, and if you’re struggling, we’re on hand to help make sure you stand out from the crowd.
Why should I enter?
The Aesthetics Awards is the most recognised and respected awards ceremony in the industry, so becoming a Finalist can excel your career and boost your profile to both patients and aesthetic companies. It’s the perfect way to celebrate you and your team’s successes over the past 12 months, and be recognised for your commitment to aesthetic excellence. Not only that, but it’s a wonderful opportunity to reflect on your career and your business.
So, what are you waiting for?
Top tips for success
If you want to enter but don’t know where to start, here are our top tips for success:
1. Read each question carefully to make sure you address all criteria
2. Include evidence to support any claims made throughout
3. Write clearly and concisely
4. Provide high quality images, especially for case study examples
5. Read your entry more than once, and get an extra pair of eyes over it
To enter the Awards this year, you must be a Full Member of Aesthetics. If you are not already a Full Member, you can sign up now by heading to our website.
Don’t miss out!
The Aesthetics Awards will take place on March 16 at the dazzling Grosvenor House Hotel, London, giving you the chance to enjoy a night of celebration with 1,000+ peers, colleagues and friends. Make sure to get your early bird tickets by December 31 and avoid missing out on the biggest night in the aesthetics calendar!
4T Medical unveils PRP kit
Aesthetic supplier and training provider 4T Medical has launched its new platelet-rich plasma (PRP) kit. According to the company, the kit is designed to provide all the components required for the preparation of autologous PRP to help promote and accelerate the skin’s natural rejuvenation and healing process.
Julien Tordjmann, managing director of 4T Medical, said, “We are offering a high-quality product at excellent value to meet growing demand for PRP treatments in the aesthetics sector. For some time, customers have been asking us about affordable PRP kits, and this decision to launch our own brand reflects our commitment to deliver the best quality products, value pricing and truly excellent service.”
4T Medical is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free.
Purasomes treatment launches in the UK
Italian-based aesthetic company Dermoaroma has introduced the Purasomes line to the UK market. The company explains that the product, delivered through microneedling, contains growth factors and exosomes derived from certified-organic bovine colostrum to trigger cell regeneration. The range includes three formulations: Purasomes NC 150+ Nutri Complex to brighten and protect skin; Purasomes NC 150+ Nutri Complex to address signs of ageing and Purasomes HSC50+ Hair & Scalp Complex to prevent hair loss and promote healthy growth.
Melvin Farrugia, founder and managing director at Dermoaroma Italy, shared, “Purasomes is rapidly becoming one of the fastest growing brands, with more than 80,000 treatments performed by 5,000 practitioners in 40 countries within just four months. We are excited to see the same level of high market acceptance in the UK and are keen to start working with many top British practitioners.”
Dermoaroma is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
iS CLINICAL unveils new retinol serums
Skincare company iS CLINICAL, distributed by Harpar Grace International in the UK, has released brand new retinol products. Retinol+ Emulsion 0.3 and 1.0 are designed to resurface the skin using retinol with botanical origin, according to the company. The retinol is encapsulated with bio-identical lipids to facilitate smooth delivery into the skin. Laura Steventon, iS CLINICAL brand director at Harpar Grace International, commented, “Known for their extensive formulation testing and in-house expertise, iS CLINICAL’s Retinol+ Emulsion incorporates a keratolytic form of retinol, alongside a synergistic blend of botanical ingredients and extremozymes, offering their most advanced results yet.”
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 12
The Aesthetics Awards receives industry trust mark
The Aesthetics Awards has received an Advanced Accreditation from the Independent Awards Standards Council.
The Independent Awards Standards Council is an association dedicated to recognising exemplary awards ceremonies. The Awards have earned this Trust Mark due to exceptional entry processes, judging standards and event hosting.
Shannon Kilgariff, editor and event manager at Aesthetics, comments, “We are thrilled to have received this vote of trust from such a reputable source. At the Awards, we strive to recognise the very best practitioners, results, teams and companies through a stringent process which would be impossible without our esteemed judges. I want to thank them for all their hard work and diligence which makes the Awards the success they are. I am so excited for the 2024 Awards, which promise to be the best yet!”
Entry for The Aesthetics Awards 2024 is open now! You must be a Full Member of Aesthetics to enter. Turn to p.81 to find out more.
BTL Aesthetics debuts new EXION technology
Aesthetic device company BTL Aesthetics has introduced its new device EXION to the UK market. According to the company, EXION treats the face, body and intimate area with four different applicators. BTL Aesthetics highlights the fractional radiofrequency (RF) applicator in particular, combining AI-powered pulse control needling with monopolar RF.
Four applicators are included, including the EXION Fractional RF and EXION Face which induces hyaluronic acid (HA) production through combined RF and ultrasound. EXION Body targets skin laxity and fat loss within one applicator, and EMFEMME 360 uses non-invasive RF to treat vaginal laxity and sexual dysfunction in eight minutes, according to the company. Results from 14 clinical trials conducted by BTL Aesthetics have shown that EXION can induce a 224% increase in HA, 85% increase in skin laxity and 22% in fat reduction.
Zbynek Pistak, BTL Aesthetics’ managing director, said, “The innovation brought to the market by EXION is impressive and incredibly exciting. It not only enhances patient experience and outcomes, but also provides practitioners with multiple treatment possibilities in a single device. EXION is the result of BTL’s extensive expertise in non-invasive technologies, perfectly addressing the industry’s demand for highly effective outcomes with reduced recovery times.”
BTL Aesthetics is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
Reena Sandhu, Head of Marketing & Operations and International Digital Lead at Crown Aesthetics UKI
This is an exciting time for Crown Aesthetics – what’s been happening?
As we prepare to introduce BIOJUVE™ skincare to the UK, Ireland and EU countries, we’re not merely launching a product, but pioneering a transformative experience. Crown Aesthetics’ commitment to innovation and excellence resonates deeply, and the anticipation surrounding BIOJUVE™ is fantastic.
BIOJUVE™ isn’t just a new addition to our repertoire- it’s a testament to our dedication to advancing skincare technology and skin health. The cutting-edge nature of this product reflects Crown Aesthetics’ relentless pursuit of pushing boundaries and setting new industry standards.
What makes Crown Aesthetics’ products unique and different?
Our products represent innovation at their core, seamlessly incorporating the most recent advancements in technology and science.
SkinPen® is an innovative medical device that uses microneedling technology to enhance skin rejuvenation. Its adjustable needle depth provides personalised treatments for various skin concerns. SkinPen® is the first FDA-cleared microneedling device and procedure, with more than 90 validation studies backing its safety and effectiveness for skin remodeling.
BIOJUVE™ is breakthrough skin science that optimises skin health on and below the surface. With its one-of-a-kind living Xycrobe™ Technology, BIOJUVE™ enhances the microbiome for healthier, younger-looking skin.
Can you share why you are passionate about skin health?
My dedication to skin health is reflected in SkinPen® and BIOJUVE™. I was inspired by SkinPen® more than five years ago as an acne scar sufferer, and after a series of treatments, my skin was rejuvenated through microneedling. Now, BIOJUVE™ aligns with my belief in nurturing the skin biome for a radiant complexion, guiding individuals towards vibrant skin that reflects inner and outer vitality.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 13
This advertorial was written and supplied by Crown Aesthetics.
Dr Steven Cohen’s Expert Insights
Dr Steven Cohen is a world-renowned plastic surgeon based in California. With his 30+ years of experience in regenerative plastic surgery, he recently founded the London Regenerative Institute (LRI).
Here, Aesthetics shares some of Dr Cohen’s insights into the future of regenerative medicine…
Why do you feel that regenerative medicine is the next big thing in aesthetics?
The nature of aesthetics is camouflaging ageing, but regenerative medicine addresses it. It goes to the root cause to see if we can prevent cells from ageing, which will affect the appearance of our bodies, facial features and skin. It’s a quantum leap forward in the specialty.
What are your top three regenerative treatments?
Lifestyle adjustments are key. Diet, exercise and stress reduction practices complement any regenerative procedure. Stem cell fat grafting is brilliant for revolumising lost tissue – it’s essentially a natural filler. At LRI, we’ve created an exosome skincare range Morphiya which can replicate laser results.
What are the optimal uses for exosomes?
Exosomes can be used in combination with lots of treatments such as microneedling, as well as radiofrequency like Morpheus8. They can also be used alongside laser procedures for more rapid skin repair; I use Fraxel Dual and Repair, and Ellacor. Advice for optimising non-surgical aesthetics with a regenerative approach…
In my experience, the only reasons people come to aesthetic practitioners for treatment are sun damage, facial volume loss and skin laxity. It all boils down to those complaints. Injectables and devices are the most popular ways to address these, and regenerative approaches can optimise them. Consider implementing a regenerative element alongside your existing offering, and they can enhance each other.
How to learn more about regenerative medicine…
It’s great that the topic is being discussed more and more in medical journals and on conference agendas, like The Medical Longevity Summit at CCR 2023 which I’ll be speaking at. If you want a fundamental understanding, some books aimed at patients might help, such as Lifespan: Why We Age – and Why We Don’t Have To by Dr David A Sinclair.
Sciton to host Rockstars of Aesthetics event
Aesthetic laser company Sciton will be hosting its annual Rockstars of Aesthetics event in October.
The two-day event includes clinical live demonstrations, networking, advanced treatment techniques and emerging industry trends with aesthetic practitioners, plastic surgeons and dermatologists from across the world. Speakers include aesthetic practitioners Dr Benji Dhillon, Dr Nisha Menon and Miss Jennifer Doyle from the UK, as well as Dr Chris Robb, Dr Jay Burns, Dr Joel Cohen and Dr Sherrif Ibrahim from the US.
At the event, Sciton will be showcasing its technologies including the BBL Hero, HALO and Moxi, and discussing laser and light for skin resurfacing and rejuvenation.
For the event, the company will be partnering with Pabau, FILLMED, Epionce (Eden Aesthetics), VISIA by Canfield (Surface Imaging) and Alastin Skincare (Galderma). The event will be taking place on October 27-28 at the Sheraton Grand London, Park Lane Hotel.
Sciton is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
3D Aesthetics unveils new skin remodelling device
Aesthetic device supplier 3D Aesthetics has launched its new 3D EMlift to its portfolio. The company explains that the new device combines high intensity focused electromagnetic energy with radiofrequency to remodel and restore patients’ skin. The high intensity focused electromagnetic energy aims to enhance muscle density and quality, whilst restoring and elevating the support of facial features. The radiofrequency increases the stimulation of collagen production and elastin fibres through dermal heating, 3D Aesthetics explains.
The device can treat the forehead, cheeks, jawline and give the eyebrows a lift, with benefits including a reduction in fine lines and wrinkles and skin tightening. Results can be seen following a one-off treatment, however, a course of three is recommended for optimal results with an annual maintenance treatment once per year to maintain results, the company adds.
Dr Cohen will be speaking on regenerative medicine at CCR’s Medical Longevity Summit on October 19-20 at ExCeL London. Turn to p.27 to register for free now.
Imogen Gosling, national sales manager for 3D Aesthetics, said, “I am beyond excited to finally be able to launch this groundbreaking technology. By providing 3D EMlift and consumables at an affordable price, this ensures wider client access to this in-demand treatment and empowers clinics to make a tangible return on their investment.”
3D Aesthetics is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 14
APG Tech introduces Golden RF treatment
IMAGE Skincare debuts festive sets in time for Christmas
Skincare brand IMAGE Skincare is offering six festive gift sets as part of its 2023 Christmas Collection.
The collection includes three full skincare sets - Hydrate & Glow, Bright & Brilliant and Star Bright - alongside three stocking filler sets: Vital Hydrate, Brighten & Protect and Microbiome Essentials.
Aesthetic device company APG Tech has introduced a new radiofrequency technology, Golden RF. According to the company, the device features four gold-plated applicators designed for use across the face and body. APG Tech notes that gold has very high transmission performance with no oxidation, creating personalised treatment possibilities with zero downtime. The applicators include XS FACE for precision in delicate areas like the eyes and lips, FACE for all other face and neck treatments, BODY for all areas of the body and MATRIX ADVANCED TIP which is geared towards thinner skin by targeting more superficial layers of the epidermis.
Andrea O’Donnell, head of education at Xpert Professional, said, “Unlock the power of radiant transformation with our cutting-edge Radio Frequency machine by APG Tech. Featuring 24K Gold electrodes, resistive mode and hexapolar radiofrequency, it reignites skin’s vitality by addressing skin laxity, improving texture and stimulating deep hydration within the skin. This is a real opportunity for practitioners and clinics to elevate their patients’ beauty journeys with the newest addition to the APG Tech range.” APG Tech will be exhibiting at CCR on October 19-20 at ExCeL, London. Turn to p.27 to register for free.
According to the company, the variety in the sets allows for tailored gifts to address specific skin concerns using naturally nourishing formulae. The different sets are designed to address skin brightening, illuminating and microbiome protection. Leigh Wilson, UK sales manager for IMAGE Skincare, said, “These carefully curated sets serve as a reflection of our unwavering commitment to excellence here at IMAGE Skincare. Crafted under the guidance of our trusted skincare professionals, these gifts provide an effortless way to share some of our best-selling, most-loved products with loved ones.”
The sets will be available to purchase direct from IMAGE Skincare from October 16.
SJ Partnership kickstarts fraud avoidance training
Aesthetic business support company SJ Partnership has welcomed retired detective superintendent Kenny Thomson to provide anti-fraud training.
According to the company, Thomson is a consultant in cyber crime and fraud, so will be able to provide SJ Partnership clients with expertise on protecting businesses against cyber attacks and fraud attempts.
Managing director Sue Thomson said, “We are thrilled to welcome Thomson to the SJ Partnership family. His profound knowledge and experience in cyber crime and fraud bring an exciting dimension to our business resilience team. As we navigate the intricate challenges of the digital age, Thomson’s insights will be instrumental in ensuring our clients within the medical aesthetics industry are informed and betterequipped to protect their valuable assets.”
Training is available now either on a one-on-one, enquiry-based basis, or in a team-learning format.
Alma unveils Kate Hudson as new global ambassador
Medical device company Alma has announced actress Kate Hudson as its new global brand ambassador. With its global educational campaign, ‘Beyond the Trend’ in aesthetics, Hudson and Alma aim to showcase the empowerment of embracing natural beauty, whilst committing to delivering safe, effective and evidence-based solutions, notes the company. Hudson commented, “Partnering with Alma feels
incredibly natural because we share the same passion. I’ve personally experienced Alma’s Harmony and Accent Prime treatments, and what I really like about them is that I could visually see the results on my skin. Alma’s dedication to promoting aesthetic solutions that enhance natural beauty truly resonates with me.” Alma is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 15
News in Brief
SkinCeuticals to offer Christmas Cracker gift sets
Skincare company SkinCeuticals has unveiled three Christmas Cracker gift sets in time for the festive season. According to the company, each cracker will contain a duo of products: Clear + Correct Cracker containing Silymarin CF (30ml) and Blemish + Age Defense (15ml) for oily, blemish-prone skin; Glow + Pump Cracker with C E Ferulic (30ml) and H.A Intensifier (15ml) for dry and ageing skin; and Brighten + Hydrate Cracker including Phloretin CF (30ml) and Hydrating B5 Serum (15ml) for dull and uneven skin. The sets are available at participating SkinCeuticals clinics in the UK and Ireland. SkinCeuticals is exhibiting at CCR 2023 on October 19-20 at ExCeL London, and is sponsoring the In Practice stage. Turn to p.27 to register for free today.
FACExpert unveils event agenda
Speakers have been announced for the inaugural FACExpert educational event in November. Speakers will include facial cosmetic and maxillofacial surgeon Miss Caroline Mills, oculoplastic surgeon Miss Elizabeth Hawkes and consultant dermatologist Dr Derrick Phillips. Founder of FACExpert Mr James Olding, said, “The programme will be expert-led, and is aimed at experienced injectors looking to explore the link between aesthetic injectables and medical, dental or surgical treatments.”
New consumer menopause event
New consumer event Pause Live will be taking place in November, aiming to educate on the menopause. The event will welcome professionals from the fields of menopause, gynaecology, aesthetic medicine, lifestyle and functional medicine and general practice to show women how they can thrive in their menopausal years and beyond. Visitors will be able to watch live demos and attend educational talks, while having the opportunity to meet with a professional in a private consultation.
Clinic climbs mountain for charity
The team at Aesthetically You clinic in Liverpool has climbed Mount Snowdon to raise funds for Facial Palsy UK. The team had a fundraising goal of £5,000, with sponsorship secured from aesthetic companies including BTL Aesthetics, Healthxchange and VIVACY. Michelle McLean, nurse prescriber and clinic owner, said, “At the clinic, I regularly treat patients with facial paralysis and witness its impact on their daily lives. Facial Palsy UK provides a crucial service for those affected by facial paralysis, and the funding they receive greatly improves their quality of life.”
DermaFocus unveils new regenerative conference
Aesthetic distributor DermaFocus has created the Regenerative Aesthetic Medicine Conference and Exhibition (RAMCE). Speakers will include Mr Dalvi Humzah, Dr David Eccleston, Mr Ali Ghanem and Mr George Christopoulos. They will explore topics like skin priming, combination approaches, introducing regenerative aesthetics to patients and the innovations which are set to shape the future of the specialty.
As well as the conference, there will be an exhibition with companies including Rosmetics, InMode, Aesthetic Medical Partners and DermaFocus attending. Executive director of DermaFocus, Milad Bemana, said, “As the demand for regenerative procedures continues to grow, RAMCE offers a unique opportunity to delve into the latest breakthroughs that are shaping the future of aesthetic medicine. Our distinguished line-up of speakers will present their invaluable insight, research findings and real-world experiences at this must-attend event.”
The event will take place on November 4 at the Nobu Hotel, London. DermaFocus is exhibiting at CCR 2023 on October 19-20 at ExCeL London. Turn to p.27 to register for free today.
Harley Academy launch event
On 30 August, aesthetic training provider Harley Academy opened its new educational campus on Threadneedle Street, London. A total of 100 attendees were welcomed into the event with glasses of champagne, and given the opportunity to have a tour around the new centre. Founder of Harley Academy Dr Tristan Mehta then gave a talk on the evolution of the training academy and plans for the future of medical aesthetics. Members of the new faculty Professor David Sines, Dr Tapan Patel and Professor Sebastian Cotofana also gave speeches. The evening concluded with more drinks, canapés and a live DJ to allow for attendees to explore and network. After the event, chief marketing officer Dr Marcus Mehta remarked, “We were thrilled to welcome our graduates and industry partners to the launch event of our brand-new training site. The event was a huge success, with more than 100 people coming to celebrate the opening of our second training site in the City of London. There were talks from our academic director Professor Cotofana, our medical director Dr Patel and our founder and CEO Dr Tristan Mehta about the vision and future for medical aesthetic education.” Harley Academy is exhibiting at CCR on October 19-20 at ExCeL, London. They are also the Getting Started in Aesthetics partner and will be conducting content on this topic at the In Practice Theatre. Turn to p.27 to register for free.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 16
Nurses put in the spotlight at BACN annual conference
On September 14-15, the British Association of Cosmetic Nurses (BACN) hosted its annual Autumn Aesthetic Conference at the Eastside Rooms, Birmingham.
Across the two days, 280 delegates were treated to talks from a variety of top practitioners and industry figures. The first day began with a regulatory update, touching on the government licensing scheme and financial considerations for VAT. Other talks on the first day included aesthetic practitioner Dr Mayoni Gooneratne speaking on perimenopausal patients, aesthetic nurse Tanya Khan delivering a live demo showcasing natural lip results and Dr Tom Decates discussing how genetics can influence late-onset filler complications. The first day was rounded off with a networking drinks reception sponsored by FILLMED, offering an opportunity to build further connections.
Delegates had the chance to capture photos at the flower wall photobooth, sponsored by Aesthetics and CCR. The second day brought talks from aesthetic nurses Sharron Brown and Karen Hunter on treating HIV-related facial lipoatrophy, a panel discussion on off-licence toxin use and marketing expert Alex Bugg speaking on the marketing possibilities if one decides to delete social media.
BACN will be exhibiting at CCR on October 19-20 at ExCeL, London. Turn to p.27 to register for free.
Dr Arthur Swift holds injectable training day in London
On September 9, aesthetic manufacturer Prollenium Medical Technologies welcomed delegates to a one-day training course, conducted by Canadian plastic surgeon Dr Arthur Swift. The day began with Dr Swift detailing his 12 principles of beauty, noting how both sides of the face should be sisters, not twins, with the lips being the only exception. He also discussed the Phi concept and how many famous landmarks around the world contain this ‘golden ratio’ including the Taj Mahal, and Apple and Toyota logos.
After a short break, Dr Swift detailed his techniques for treating different areas of the face including the forehead, mid-face, tear trough, cheeks and chin. He advised practitioners to ‘always treat the cheek first before tear troughs as it can sometimes fix this area.’
After lunch, Dr Swift performed live demonstrations on a male and female patient, detailing his treatment plan and injection techniques using the Revanesse range of dermal fillers.
Natalie Colbourne, general manager at Prollenium, said, “Prollenium UK was delighted to collaborate with the Swift Beauty team at their first event in the UK. Dr Swift is a true thought leader when it comes to his facial assessment and approach to injectables, and to see him using the Revanesse line of dermal fillers was a real privilege. We’re looking forward to our next opportunity to partner with him and his team.”
Cutera pioneers skin health at CUCF learning event
On September 9, aesthetic device company Cutera held its annual Cutera University Clinical Forum (CUCF) event at Hilton London Bankside for 200 delegates. The company used the event to celebrate Cutera’s 25th anniversary, inviting some top key opinion leaders (KOLs) from the US to mark the occasion.
The event’s focus this year was the company’s brand new device AviClear, which is indicated to treat moderateto-severe acne. A number of speakers including Dr Tapan Patel, Dr Jeffery Fromowitz, Dr Maurice Adatto, Dr David Eccleston and Dr Nicole Chiang shared their insights into Cutera’s portfolio, which can be used to treat active acne, post-acne scars,
ageing skin and a number of other skin complaints, according to the company. The event’s afternoon session featured a keynote talk from guest speaker James Cracknell, OBE – sportsman, adventurer and BBC commentator. He delivered an
inspirational address on tackling adversity after his personal battle with a traumatic brain injury.
A portion of all proceeds from the event went towards the company’s partnership with Great Ormond Street Hospital Children’s Charity, with over £5,000 raised. Aesthetic practitioner and delegate Dr Nestor Demosthenous reflected, “I want to say a massive happy birthday! 25 years of Cutera! The UK team has built a brand of respect and trust with clinics; they are great partners and they give us a lot of support. I love the devices and I love the team.” Cutera will be exhibiting at CCR on October 19-20 at ExCeL, London. Turn to p.27 to register for free.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 17
by 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.email@example.com Tel: +44 (0) 300 3035674 WE ARE PROUD HEADLINE SPONSORS OF References: 1. Data on file. MA-43049. 2. Data on file. MA-34483 3. Nikolis A et al. Aesthet Surg J Open Forum. 2020; 2(1):1-12 UKI-RES-2300137 DOP August 2023
New Licensing Scheme
Causes Conversations in Aesthetics
Aesthetics looks at the proposed Red, Amber, Green category scheme for aesthetic procedures in England and gets views from industry associations
September marked a milestone for regulation within aesthetic medicine. The Government has launched a public consultation to seek the thoughts of practitioners and members of the public on how non-surgical cosmetic procedures should be regulated in England.1 The industry will view this as a long time coming. The Keogh Review of the regulation of cosmetic interventions in 2013 stated that the aesthetics specialty, particularly dermal fillers, was a ‘crisis waiting to happen.’2 Ten years later, suggestions for the improvement of the sector are finally being put in place. The changes suggested include introducing new licensing laws for any practitioner and premises offering treatments such as botulinum toxin, dermal fillers and chemical peels, as part of the Government’s response to the Health and Social Care Committee’s Inquiry Report on body image 3 It has also been proposed that it be made illegal to perform any aesthetic treatments on under 18s.1,4
One particular potential change that is causing debates in the industry is the suggestion of a new category system. The Government is proposing that aesthetic treatments become RAG-rated (red, amber or green) depending on how invasive they are deemed to be.1 The consultation allows practitioners to give their perspectives on each colour code; asking for insights on whether they agree with the treatments listed in each category and providing an opportunity for the suggestion of adding, removing, or switching a category for any treatment mentioned.1
Feedback from industry association representatives
David Sines, chair of the Joint Council for Cosmetic Practitioners (JCCP), showed his support for the new RAG system, commenting, “The JCCP considers that the DHSC has appropriately elected to introduce a proportionate and stratified system of risk assessment and risk management in the form of a RAG-rated system. This will determine which procedures require specific and significant oversight, supervision and restriction with regard to the qualifications and governance systems that should oversee and regulate their application. The JCCP has previously advised on the formulation of such a system of risk stratification and recommends its adoption within the context of the finally agreed scheme of licensing in England, in order to better protect members of the public and to ensure patient safety.”
Whilst chair of the British Association of Cosmetic Nurses (BACN) Sharon Bennett and president of the British College of Aesthetic Medicine (BCAM) Dr Catherine Fairris both acknowledge that the above category system is a step in the right direction for greater regulation in the industry, they point out some flaws in the Government’s proposal. Dr Fairris notes, “We at BCAM are sceptical of the categories proposed. There needs to be more guidance on specific procedures and the overall categories will need to be very tightly monitored and evaluated. For example, dermal filler injections are included in the amber category, which allows non-medics to perform the treatment under supervision.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 19
“There is a reason why manufacturers are specific in direction of administration for botulinum toxin, which will will be for both public safety and legal purposes”
Green Green procedures are deemed as those with the lowest complication rate. Both medical and non-medical practitioners are eligible to perform licensed procedures where they meet agreed standards.1
The Government proposes the green category includes the following procedures:1
• Intense pulsed light (IPL) and light emitting diode (LED)
• Chemical peels that involve destruction only into viable epidermis
• ‘No-needle’ fillers
• Micropigmentation including microblading and nanoblading
• Non-ablative laser hair removal
• Photo rejuvenation
The suggested RAG categories
Amber treatments are those deemed to have a medium risk of complications. To perform an amber treatment, the Government proposes that licensed non-medic practitioners must have relevant oversight by a named regulated healthcare professional. Qualified and regulated healthcare professionals will be eligible to perform these procedures without oversight.1
Amber treatments may include:1
• Botulinum toxin injections
• Semi-permanent dermal fillers injected into the face only
• Platelet-rich plasma (PRP)
• Weight loss injections
• High intensity focused ultrasound (HIFU)
• Non-ablative lasers
As well as others.
However, we all know that filler in the nose, for example, is extremely dangerous and has more significant risks associated with complications than perhaps filler placed elsewhere in the face, yet there is no differentiation in the kinds of filler treatment and the risks associated with them, aside from fillers in genitalia.” Bennett agrees, noting that the treatments relating to these categories are not as they should be. She says, “Fillers are no longer just dermal, they are often deep to bone and have the ability to cause life-changing injury. We really need to be precise with the categorisations and look carefully at the risk of each specific treatment and area of treatment.” Bennett adds that the category suggestions also go against the advice of many product manufacturers. She explains, “When looking at reputable and approved fillers for example, you will find that the manufacturers will generally state that the product should only be administered by a healthcare professional. With botulinum toxin, which is a licensed drug and prescription only, the manufacturers state in the Product Specification Literature that it is to be administered by a healthcare professional. Many of the manufacturers I have spoken to recently have confirmed this and are concerned.” She adds that there is reason why manufacturers are specific in the direction of administration for this drug, which will be for both public safety and legal purposes. “So my question is why is the Government unaware of this and placing them in a category for non-medic administration?,” she says. Dr Fairris also believes
These are treatments with the highest complication rate, and can only be carried out by qualified and regulated healthcare professionals working out of Care Quality Commission (CQC) registered premises.1 Suggested red procedures include:1
• All thread lifting procedures
• Hair restoration surgery
• Procedures aimed at augmenting any part of the body, in particular the breast, buttocks and genitals
• Dermal micro-coring
• Hay fever injections
• Combination of ultrasound and large bore cannula for the purposes of liposuction
• Deeper chemical peels such as phenol peels
• Lasers which target the deeper layers of the dermis
As well as others.
Representatives of the surgical community...
"The BAAPS support government measures to increase regulation and to look at risk ratings of aesthetic procedures. We are concerned that some surgical procedures such as liposuction and fat transfer have been listed in a non-surgical consultation document and will feedback accordingly to the consultation. These procedures are surgical not non-surgical in nature and can have serious complications particularly in unqualified hands. An RAG rating for procedures done accurately is a very clear way to impart information and a risk level to patients prior to embarking on surgery. The BAAPS remains very engaged with this topic and will continue our work in this area."
Ms Nora Nugent, vice president of the British Association of Aesthetic Plastic Surgeons
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 20
“There is no differentiation in the kinds of filler treatment and the risks associated with them, aside from fillers in genitalia”
In the ‘amber’ category, the Government states that non-medical licensed injectors must have ‘relevant oversight by a named regulated healthcare professional’ to perform the treatments in this category.1 At this point Bennett notes that the consultation has no definition of what this oversight might be. She says, “It doesn’t explain to us what the supervision might be… is it someone in the room? In the premises? Is it someone text messaging or video calling? It can be extremely problematic if this supervision is not going to be onsite, and also if this isn’t something that will be monitored or enforced adequately. The qualifications required to supervise will need scrutiny.”
Calls for industry-wide response to the consultation
Tracking complication rates
Both Bennett and Dr Fairris explain that the Government has based its decisions for what categories treatments are placed in on their existing complication rates, however this data isn’t fully representative. “When it comes to aesthetic complications, there unfortunately is a real lack of data,” says Dr Fairris, “Because non-medics aren’t liable to anyone, there is no way to track what the rates are from them. Most of these cases are sent to the NHS, and they don’t have a code to monitor aesthetic complications. As such, it can be considered that the basis for the traffic light system is flawed.” She adds that it is also worth noting that there has also been research showing that aesthetic complication rates are underreported even amongst medical professionals.4 It’s important all working within the industry help improve complication statistics by reporting adverse events using the MHRA Yellow Card scheme, or the JCCP reporting card.
Views from the non-medical community
Maxine McCarthy, founder of The Association Cosmetic Practitioners Britain, a charity group which aims to support non-medical practitioners, gave Aesthetics her views on the UK Government’s proposed licensing scheme. She supports the traffic light system, however, hopes to see experienced non-medics offered a course to be able to perform treatments in the red zone. She says, “If you can prove competency, why shouldn’t you be able to perform these treatments but maybe with a higher level of supervision?” She also agrees that the ‘supervision’ side of the consultation is unclear, and in her response will suggest that there should be different levels of clinical/medical oversight for different levels of experienced non-medics in the industry.
Bennett encourages those working within aesthetics to respond to the consultation, but advises against giving an ‘emotional response’, highlighting the importance of taking an informed, diplomatic approach. “When answering your opinions on the new classification system, you clearly need to explain who shouldn’t be doing which treatments, and give solid reasons behind this. You also need to be providing extensive evidence for your answers for the Government to use as a basis, rather than quickly writing out anecdotal responses.” Bennett adds that the BACN will be putting in a response on behalf of its members, which will then be shared with members for them to comment on and then respond individually.
Dr Fairris notes that although the new system is a good start, it doesn’t go far enough. “We need more stringent categorisation, and the system has to be as strict and tight as it possibly can be,” she says. However, she adds that she believes the consultation and opportunity is the best the industry is going to get, so practitioners need to be extremely clear in what they are saying to fully get their points across. “This consultation is the first step of a culmination of events that will conclude in 2025, so we all need to make sure it is done correctly. The deadline is extremely tight and the consultation will only last eight weeks in total, which is in no way long enough, so we all have a duty to take the chance to put our points across before it ends on October 28,” she concludes.
The conversation about regulation will be continued at CCR, with members of the JCCP, BCAM and BACN speaking on October 19&20.
Scan the QR code
1. Department of Health and Social Care, The licensing of non-surgical cosmetic procedures in England, 2023, <https://www.gov.uk/government/consultations/licensing-of-non-surgical-cosmetic-procedures/the-licensing-of-non-surgical-cosmetic-procedures-in-england>
2. Journal of Aesthetic Nursing, Five Years After Keogh’s Review of Regulation, 2018, <https://www. magonlinelibrary.com/doi/full/10.12968/joan.2018.7.5.272>
3. Department of Health and Social Care, Government to crack down on unregulated cosmetic procedures, 2022, <https://www.gov.uk/government/news/government-to-crack-down-on-unregulated-cosmetic-procedures>
4. Aesthetics journal, Cosmetic Injections Illegal to Under 18’s, 2021, < https://aestheticsjournal.com/ news/cosmetic-injections-illegal-to-under-18s>
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 21
5. Holly Carver, Reporting Botulinum Toxin Complications, 2021 <https://aestheticsjournal.com/feature/ news-special-reporting-botulinum-toxin-complications> to
that there needs to be assurance from the Government that new treatments will be considered fully and placed in the correct category, and that there will be the ability to move a treatment between categories when necessary. “When threads first came onto the scene, for example, we didn’t fully appreciate the risks they posed, especially in unskilled hands. However, we now see increasing evidence that they can be incredibly dangerous especially when administered by poorly trained individuals and that’s why they have been placed under the scope of the CQC.”
Dr Catherine Fairris
ALIGNING THE STARS
Ease of use, effectiveness and patient satisfaction all help to make Alluzience a potential star in your practice.1
The recent Star Study noted:1 of investigators strongly agreed or agreed that Alluzience saves time, is easy to use, easy to learn and met their expectations
• 77% of subjects reported improvement in the appearance of glabellar lines at six months
• In 81% of treatment sessions, the investigator preferred to use Alluzience over onabotulinumtoxin-A
Along with these results, Alluzience was well tolerated with mostly mild and transient adverse events, and no ptosis occurred in the study.1
Scan the QR codes now to see the full text of the Star Study and find out how these compelling results could help set your practice apart from the competition.
THIS INFORMATION IS INTENDED FOR HEALTHCARE PROFESSIONALS ONLY • THIS ADVERTISEMENT HAS BEEN CREATED AND FUNDED BY GALDERMA.
Reference: 1. Gerber PA et al. Poster presented at the International Master Course on Aging Science (IMCAS) World Congress, 26 January to 28 January 2023, Paris, France.
THE 1 ST READY-TO-USE *
BOTULINUM TOXIN TYPE-A IN EUROPE AVAILABLE TO PURCHASE FROM MEDFX.CO.UK
Alluzience, 200 Speywood units/ml, solution for injectionPrescribing Information (United Kingdom)
Presentation: Each vial contains 125 Speywood units of Clostridium botulinum toxin type A haemagglutinin complex in 0.625 ml of solution. Indications: Alluzience is indicated for the temporary improvement in the appearance of moderate to severe glabellar lines (vertical lines between the eyebrows) seen at maximum frown in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient. Dosage: Botulinum toxin product units differ depending on the medicinal products. Botulinum toxin units are not interchangeable from one product to another. Doses recommended in Speywood units are different from other botulinum toxin preparations. Paediatric Population: The safety and efficacy of Alluzience in children aged up to 18 years have not been established. The use of Alluzience is not recommended in patients under 18 years. Method of administration: Alluzience should only be administered by a healthcare practitioner with appropriate qualifications and expertise in this treatment and having the required equipment, in accordance with national guidelines. A vial of Alluzience should only be used to treat a single patient, during a single session. Remove any make-up and disinfect the skin with a local antiseptic before administration. The intramuscular injections should be performed using a sterile needle with a suitable gauge. Dosing and treatment intervals depend on assessment of the individual patient’s response. The median time to onset as reported subjectively by patients was 3 days (the majority of patients reported an effect within 2 to 3 days with some patients reporting an effect within 24 hours). An effect has been demonstrated for up to 6 months after injection. The treatment interval should be no more frequent than every 3 months. Administration instructions: The recommended dose is 0.25 ml of solution (50 Speywood units) divided into 5 injection sites, 0.05 ml of solution (10 Speywood units) administered intramuscularly into each of the 5 sites: 2 injections into each corrugator muscle and one into the procerus muscle, near the nasofrontal angle. The anatomical landmarks can be more readily identified if palpated and observed at patient maximum frown. Before injection, place the thumb or index finger firmly below the orbital rim in order to prevent extravasation below the orbital rim. The needle bevel should be pointed upward and medially during the injection. In order to reduce the risk of ptosis, avoid injections near the levator palpebrae superioris muscle, particularly in patients with larger brow-depressor compl–exes (depressor supercilii). Injections should be made into the central part of the corrugator muscle, at least 1 cm above the orbital rim. General information: In the event of treatment failure or diminished effect following repeat injections, alternative treatment methods should be employed. In case of treatment failure after the first treatment session, the following approaches may be considered: • Analysis of the causes of failure, e.g. incorrect muscles injected, inappropriate injection technique, and formation of toxin-neutralising antibodies • Reevaluation of the relevance of treatment with botulinum toxin A. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Presence of infection at the proposed injection sites. Presence of myasthenia gravis, Eaton Lambert Syndrome or amyotrophic lateral sclerosis. Precautions and Warnings: Care should be taken to ensure that Alluzience is not injected into a blood vessel. Injection of Alluzience is not recommended in patients with a history of dysphagia and aspiration. Adverse reactions possibly related to the spread of toxin effect distant from the site of administration have been reported very rarely with botulinum toxin. Swallowing and breathing difficulties are serious and can result in death. Very rare cases of death, occasionally in the context of dysphagia, pneumopathy (including but not limited to dyspnoea, respiratory failure, respiratory arrest) and/or in patients with significant asthenia have been reported following treatment with botulinum toxin A or B. Patients should be advised to seek immediate medical care if swallowing, speech or respiratory difficulties arise. Alluzience should be used with caution in patients with a risk of, or clinical evidence of, marked defective neuro-muscular transmission. These patients may have an increased sensitivity to agents such as botulinum toxin, and excessive muscle weakness may follow treatment. It is essential to study the patient’s facial anatomy prior to administering Alluzience. Facial asymmetry, ptosis, excessive dermatochalasis, scarring and any alterations to this anatomy, as a result of previous surgical interventions, should be taken into consideration. Dry eyes have been reported with use of Alluzience in periocular regions. Attention to this side effect is important since dry eyes may predispose to corneal disorders. Protective drops, ointment, closure of the eye by patching or other means may be required to prevent corneal disorders. The recommended dose and frequency of administration for Alluzience must not be exceeded. Patients treated with the recommended dose may experience exaggerated muscle weakness. Caution should be taken when Alluzience is used in the presence of inflammation at the proposed injection sites or when the targeted muscle(s) show excessive weakness or atrophy. As with all intramuscular injections, use of Alluzience is not recommended in patients who have a prolonged bleeding time. Each vial of Alluzience must be used for a single patient treatment during a single session. Any excess of unused product must be disposed of and specific precautions must be taken for the inactivation and disposal of any unused solution. Antibodyformation: Injections at more frequent intervals or at higher doses may increase the risk of neutralising antibody formation to botulinum toxin. Clinically, the formation of neutralising antibodies may reduce the effectiveness of subsequent treatment. Traceability: In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded. Sodium content: This medicine contains less than 1 mmol sodium (23 mg) per 125U vial, that is to say essentially ‘sodium-free’. Interactions: Concomitant treatment with Alluzience and aminoglycosides or other agents interfering with neuromuscular transmission (e.g. curare-like agents) should only be used with caution since the effect of botulinum toxin may be potentiated. No interaction studies have been performed. Pregnancy, Breastfeeding and Fertility: Pregnancy: There are only limited data from the use of botulinum toxin type A in pregnant women. Animals studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. As a precautionary measure Alluzience should not be used during pregnancy. Breastfeeding: It is unknown if Alluzience is excreted in human milk. Alluzience should not be used during breast-feeding. Fertility: There are no clinical data examining the effect of Alluzience on fertility. There is no evidence of direct effect of Alluzience on fertility in animal studies. Effects on ability to drive and use machines: Alluzience has a minor or moderate influence on the ability to drive and use machines. There is a potential risk of localised muscle weakness or visual disturbances linked with the use of this medicinal product which may temporarily impair the ability to drive or operate machinery. Undesirable Effects: A majority of adverse reactions reported with Alluzience in clinical trials were of mild to moderate intensity and reversible. The most frequently reported adverse reactions were headache and injection site reactions. The incidence of adverse reactions tended to decrease with repeated treatments. Adverse effects related to the spread of toxin effect distant from the site of administration have been very rarely reported with botulinum toxin (excessive muscle weakness, dysphagia, aspiration pneumonia with fatal outcomes in some cases). Adverse Drug Reactions Observed in Clinical Studies were as follows: Very common (≥ 1/10): Headache, injection site reactions (periorbital haematoma, haematoma, bruising, pain, paraesthesia erythema, swelling, pruritus, oedema*, rash*, irritation*, discomfort*, stinging*), asthenia*, fatigue*, influenza-like illness*; common (≥ 1/100 to < 1/10): Facial paresis*, eyelid ptosis, eyelid oedema, brow ptosis, dry eye, lacrimation increased, asthenopia*, muscle twitching (twitching of muscles around the eye)*; uncommon (≥ 1/1,000 to <1/100): Dizziness*, eyelid twitching, visual impairment*, vision blurred*, diplopia*, hypersensitivity (eye allergy, hypersensitivity, rash), rash*, pruritus*; rare (≥ 1/10,000 to < 1/1,000): Eye movement disorder*, urticaria* *additional adverse drug reactions only observed with powder formulation of the same active substance in clinical trials Prescribers should consult the summary of product characteristics for further details.
and Cost: Pack containing x2 vials: £ 160.00 excluding VAT.
MA Number: PL 03070/0009 Legal Category: POM Further information is available from: Galderma (UK) Ltd, Evergreen House North, Grafton Place, London, NW1 2DX. Telephone: +44 (0)300 3035674 Date of Revision: September 2022 Adverse
reported. United Kingdom Reporting forms and information can be found at www.mhra.gov.uk/yellowcardor search for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Galderma (UK) Ltd: E-mail: firstname.lastname@example.org Tel: +44 (0)300 3035674 GB-ALZ-2300048 DOP August 2023
events should be
Enhance Patient Satisfaction Through New Techniques
The aesthetics market is extremely fast-paced, with new products, studies, techniques and protocols coming out every month. But how do you know what’s worth investing in? To help you make sense of all the noise, CCR 2023 will present the latest innovations from the industry, covering everything from skin treatments to brand new injection techniques. The conference will also introduce functional medicine and longevity concepts, as well as look at the holistic approach with Headline Sponsor Galderma. Opening its doors this month on October 19 & 20, CCR is the perfect place to decide what clinical expertise, technology and approaches you want to bring to your clinic to enhance patient satisfaction, further your career and progress your practice.
Explore revolutionary new treatments at the Symposium Stage
World-renowned key opinion leaders will present exclusive evidence-based treatment approaches and new launches, providing you with the ultimate learning experience. Discover the solutions set to take the industry by storm through live demonstrations and expert Q&A sessions, helping you choose the latest technologies to give your patients optimal results. The agenda will include talks from KOLs representing: Allergan Aesthetics, BeautyEurope, DermaFocus, Dermapenworld and FILLMED. This agenda will also include:
• Cutera: Introducing AviClear – The Future of Acne Treatment with Dr Tapan Patel
• Promoitalia: Synthetic Exosome in Regenerative Medicine: Skin Beauty Passes through Cell Communication with Dr Kaywaan Khan
• SkinPen: Advancing Skin Rejuvenation: Discovering the Power of SkinPen Precision and Introducing BIOJUVE Skin Biome Care with Dr Raj Thethi
Boost patient confidence with evidencebased solutions at the Innovation Stage
The Innovation Stage will provide you with the latest products to treat the face and body. Help patients meet their aesthetic goals through watching live demos of leading devices including EMFACE, Morpheus8 and Emerald Laser. Plus, witness a showcase of revolutionary launches and products by esteemed brands such as: Cosmeditech, Cutera, Emblation, Energist, Endospheres, EvoCyte, iiaa, Lira Clinical, Medical Aesthetic Group, Nuchido, Sciton and Sculpt Pro Aesthetics. Among the unmissable talks will be:
• BTL Aesthetics: How to Prevent Ageing with Non-Invasive Facelift EMFACE with Miss Sherina Balaratnam
• InMode: Introducing New Depths with Morpheus8 3D with Dr David Jack
• Lynton Lasers: Ultimate Skin Tightening Using SmartXide CO2 Laser with Dr Wassim Taktouk
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 25
your patients the latest product innovations and clinical techniques
by attending CCR 2023
Join the After Party!
What better way to unwind after a jam-packed day of education than attending the official CCR Charity Diwali After Party?
After last year’s success we are once again hosting the party in collaboration with Dr Tapan Patel, with all proceeds going to The Childhood Trust Charity. You can expect Indian fusion food, free drinks, live entertainment and the chance to network with colleagues and
key industry names. Bring your team, your friends or come to meet fellow practitioners keen to continue networking after CCR! The event will take place at the Trinity Bouy Wharf at 7:45pm, just after the Day One networking drinks! Tickets are £175 - be quick as they’re limited and sold out well in advance last year.
content and live demonstrations. It all takes place in the Aesthetics Arena – here’s what you can expect:
• HITs by Galderma: The Balanced Profile – the AART of balance by treating the nose, lips and chin in combination to achieve a profile to be proud of. Speakers to include: Mr Jeff Downie (chair), Dr Yusra AI-Mukhtar & Dr Lara Watson (speakers)
• HITs by Galderma: Bright Eyes – the AART of performing a combination treatment to rejuvenate and brighten the upper face. Speakers to include: Mr Jeff Downie (chair), Dr Munir Somji & Dr Priya Chadha (speakers)
Delve into the latest business insights
The In Practice Theatre will provide you with all the latest solutions and services to adapt to this competitive industry. Contribute to the success of your clinic as you gain valuable tools to support your business, staff and patients. Some of the key topics include:
Discover pioneering injection techniques at the Aesthetics Arena
This year’s pioneering agenda, brought to you by the Aesthetics journal, features everything from advanced dermal filler techniques and key strategies for success using injectables, to the latest developments in ultrasound technology. This agenda will feature:
• Eyes and Lips: Treating the dynamic duo with Dr Raul Cetto and Professor Francesco Bernardini
• Jowl Sculpting with Mel Recchia
• Treating the Neck with Anna Baker
• Polynucleotides: The latest updates with Professor Syed Haq & Alexandra Mills
Witness a mother-daughter transformation with Allergan Aesthetics
Allergan Aesthetics return with must-see Lunchtime Takeovers at CCR on the Symposium Stage. You can expect both days to cover Analysing Beauty Across Generations with a Live MotherDaughter Transformation by Allergan Aesthetics – Embracing Unique Aging Journeys with Bespoke Treatment Plans with Dr Tapan Patel (injector) and Dr Manav Bawa (moderator).
Explore the holistic approach with world-renowned Galderma KOLs
Over the course of two days, renowned injectable manufacturer and CCR Headline Sponsor Galderma will deliver unmissable
• Getting Started in Aesthetics in collaboration with Dr Tristan, Dr Emily and Dr Marcus Mehta of Harley Academy
• A Spotlight on Body Dysmorphic Disorder with Dr Reena Jasani and Omari Eccleston-Brown
• Women in Business panel discussion with Khatra Paterson, Julie Scott, Dr Lara Watson and Francesca Ogiermann-White
You can also hear from leading companies on their top business tips, including talks from:
• Fotona UK: How to Successfully Introduce a Laser/Device into Your Clinic with Dr Tanja Phillips
• GetHarley: Transforming my Skincare Sales and Patient Outcomes with Dr Sophie Shotter
• SkinCeuticals: Benefits of Partnering with SkinCeuticals –My Career Changing Experience with Dr Ana Mansouri
• SkinCeuticals: Integrating Skincare into a Busy Aesthetic Practice: A Clinical and Business Perspective with Mr Dean Rhobaye
• Zenoti: New Medspa Revenue Tools: How to Succeed With Memberships, Packages and Gift Cards with Amy Douglas
Elevate patient care with functional medicine
The brand NEW Medical Longevity Summit is an exciting addition to CCR where you can learn about forward-thinking treatments and solutions that aim to increase the happiness, health and lifespan of your patients.
The dedicated space and conference agenda will explore
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 26
Connect with leading aesthetic brands –download the app
The CCR event app is back for 2023. It will contain everything you need from the full conference programme and interactive floorplan, to the option to
prearrange meetings and create your own schedule. These features will ensure your time out of clinic is maximised and you build those all-important connections with aesthetic brands and companies. Download the app here to get planning!
evidence-based practice in holistic care and wellness, including functional, integrative, regenerative and lifestyle treatment approaches. Reshape your clinic offering and support your patients in achieving extended and more fulfilled lives. Some of the conference sessions delivered by key brands in this field include:
• Dotolo: Ozone, Super Charged Oxygen: The Essential Antiaging Nutrient with Laura Dinham
• Medichecks: Using Diagnostic Testing in Aesthetics with Dr Natasha Fernando
• Nuchido: NAD Optimisation for Effective Age Management and Its Impact on Skin Health and Cellular Function with Dr Nichola Conlon
• Oxford Healthspan: Inhibiting the Hallmarks of Ageing for Beauty and Healthspan with Spermidine with Leslie Kenny
• Specialist Pharmacy: Bioidentical Hormones for Longevity: A Case Study Success Story with Dr Ghazala Aziz-Scott
• Specialist Pharmacy: Compounding Pharmacies and Their Role in Personalised Medicine: Promoting Medical Longevity with Rizvan Batha
The companies which will welcome you to the Medical Longevity Summit are: Dotolo Europe Ltd, EvoCyte, Lifecode Gx, Specialist Pharmacy, Medichecks, NAD+ at Home, Nuchido, Oxford Healthspan LLC, Roseway Labs and more!
Advance your clinical practice
Attending CCR this month will equip you with all the knowledge you need to make informed decisions about the future of your treatment offering. Discover the latest product launches, techniques and innovations, as well and earn up to 16 CPD points while you’re there! Secure your place today to further your skills and enhance patient satisfaction.
Join Dr Tapan Patel for his masterclass with live demos In this one-day masterclass, the renowned Dr Patel will put yourself into the shoes of your patients. Experience the perfect patient journey and learn best practices for taking a patient from consultation to aftercare including live injectable demonstrations showcasing Dr Patel’s latest techniques. This session will help you build your skills to enhance patient satisfaction at every stage. Join him and his award-winning team: Dr Priya Verma, Dr Marina Daoud, Dr Anneka Shah, Dr Manav Bawa, Sarah Gaughan, Jack Gibson and Dr Amanda Penny. Tickets are limited and are selling out quickly. Purchase via the CCR registration form.* Full Aesthetics Members receive 10% off when booking.
Remember to look out for the CCR Agenda at a Glance leaflet in this issue to start planning your CPD-approved learning experience. We can’t wait to see you all there!
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 27
Headline Sponsor Register
*Paid for session. Please note, due to the nature of the content at CCR, some sessions are open to practitioners on certain medical registers only, so please check before arrival. CPD certificates available to Aesthetics Full Members only.
These handpieces bring new and exciting upgrades to the highly versatile SmartXide Punto.
By offering treatment with ablation that is deeper and more effective than ever, your patients will benefit from a broader range of procedures, which treat the most complex skin concerns.
CO2 JUST GOT BETTER
Introducing μ-SCAR 3 and DERMASCAN handpieces for a deeper and highly effective CO2 laser treatment
μ-SCAR 3 is the ultimate choice in depth, speed, and performance for all types of treatment. It was designed for the remodelling of thick, deep scars, including acne, surgical and burns scars. With 7 scan patterns to reach the deepest layers of the skin, it is suitable for use on all skin phototypes.
DERMASCAN improves the vaporisation potential of conventional freehand handpieces during cosmetic surgery procedures. It features a unique design that provides fast tri-dimensional ablation, offering precise depth control. It is suitable for the surgical removal of a variety of skin lesions in all skin types.
Speak to our experts to find out more about SmartXide today.
Visit lynton.co.uk to find out more. @dekalaseruk
Scan here to find out more about SmartXide Punto!
Supported in the UK by Lynton
This article is based on Dr Rashpal Singh’s personal experience and ultimate decisions regarding patient care lies with the treating Healthcare Professional
I have been using HArmonyCaTM for the past two years, after being involved in the initial clinical trials for the product. I am now a trainer in the UK for the product, and have performed the most patient cases using the injectable. The product combines hyaluronic acid (HA) with calcium hydroxyapatite (CaHA), providing the dual benefit of immediate lifting and longer-lasting collagen stimulation.1-3 Using it has completely changed my practice as it allows me to offer my patient a completely holistic approach, and I can’t imagine treating without it as it has become a staple part of my patient procedures.
The benefits of HArmonyCaTM
HArmonyCaTM is completely unique in its method of action. The CaHA works by supporting the body’s own collagen production, working deep in the dermis to
The benefits of HArmonyCaTM in your practice
Dr Rashpal Singh outlines the benefits of incorporating HArmonyCaTM into your treatment offering
form a scaffold for the internal growth of fibroblasts.4,5 This helps to produce new fibres as early as one week after injection.6 The crosslinked HA creates immediate volume in the lower dermal layer.3 The product is also well tolerated with a low-risk benefit profile, so I have never had any issues when treating my patients.7
Patients often tell me the biggest concern when getting an aesthetic treatment is that people will know they have had work done, so their main goal is to still look natural. I’ve found that my patients are receptive to using HArmonyCaTM because it stimulates their own body to do the work, and develops gradually over many months. Therefore, while patients do get the immediate result from the HA, they can also get a longer more natural outcome from the CaHA.1-3
After treatment, I have found that my patients feel they look healthier, less tired, and receive compliments over how they look without people being able to pinpoint any treatment. When people look their best they feel their best, and HArmonyCaTM has done this for my patients.
Combining with the rest of your portfolio
When treating patients, it’s important to utilise a multitude of different tools for long-term, natural outcomes. I regularly combine HArmonyCaTM with the Juvéderm range of dermal fillers. I find this helps to provide my patients with a full 360 approach as we can treat each layer of the skin. The fillers provide the patient with structure underneath the skin, and HArmonyCaTM improves skin quality by stimulating collagen.1-3
You should always consult a healthcare professional to help you decide if HArmonyCaTM is right for you and provide you with a full list of side effects.
Book a virtual call with Spark: https://calendly.com/allergan/account-manager-4
*Spark is for UK HCP’s only
Sign up to the AMI digital world
*AMI Digital World is For UK HCP’s only
©AbbVie 2023. All rights reserved. Material produced and funded by Allergan Aesthetics, an AbbVie company. www.allerganaesthetics.co.uk
Adverse events should be reported. UK reporting forms and information can be found at https://yellowcard.mhra.gov.uk via the MHRA Yellow Card app, available at Google Play or Apple App stores.
Irish HCPs are asked to report any suspected adverse reactions via HPRA Pharmacovigilance; website: www.hpra.ie Adverse events should also be reported to AbbVie on ProductSurveillance_EAME@allergan.com
1. Sanchez-Carpintero I et al Actas Dermosifiliogr 2010;101(5):381–93.
2. Gonzaga da Cunha M et al Surg Cosmet Dermatol 2020;12(2):109–17.
3. Hee C et al Dermatol Surg. 2015;41(Suppl 1):S373–81.
4. Segal T et al. Post marketing study of safety and efficacy of Crystalys, a calcium hydroxyapatite based filler for facial soft tissue augmentation. Kosmetische Medizin online. Available at: https://www.kosmetischemedizin-online.de/uebersichtsarbeit/ post-marketingstudie-zur-sicherheit-und-wirksamkeit-voncrystalys-einem-auf-calcium-hydroxyapatitbasierendenfiller-fuer-die-weichteilaugmentation-im-gesicht/. Accessed November 2021.
5. Berlin A et al Dermatol Surg. 2008;34(1 Suppl):S64–67.
6. Allergan Aesthetics. Data on File. INT-HAR-2150040. HArmonyCa™ Lidocaine. Collagen stimulation. Jul 2021.
7. Allergan Aesthetics. Data on File. INTHAR-2150007. HArmonyCa™ Lidocaine. Clinical study report. Apr 2021.
29 Aesthetics | October 2023 Advertorial Allergan Aesthetics aestheticsjournal.com
This article is produced and funded by Allergan Aesthetics and is intended for healthcare professionals. UK-HAR-230085 | DOP October 2023 HArmonyCa and this content is intended for adult (>18 years) audiences only.
Figure 1: Patient before and four months after treatment using HArmonyCaTM and Juvéderm dermal fillers. Figure 2: Patient before and one year after treatment using HArmonyCaTM and Juvéderm dermal fillers. You should always consult a healthcare professional to help you decide if HArmonyCaTM is right for you and provide you with a full list of side effects.
Expanding Your Clinic Offering With Holistic Care
The population of the UK is rapidly growing, with people living longer a contributing factor. Since the COVID-19 pandemic, which caused one in five of all deaths in England, people have a newfound focus on wellbeing and are looking for more holistic ways to live a longer, healthier and happier life.1 Increased emphasis on the impact of unhealthy living on long-term health has been shown, with evidence highlighting that changes to lifestyle (diet, nutrition and physical activity) improves body composition, cognitive health and emotional intelligence, immune function and vascular health.2 People are also living two to three decades past their retirement age, highlighting an increase in lifespan.3
With longevity concepts rising in popularity and becoming a new discussion point in aesthetic medicine, we interviewed Emma Beswick, co-founder of Lifecode Gx, a nutrigenomics testing company for health professionals, founder of Human Health and SkinFit Dr Mayoni Gooneratne and plastic surgeon Dr Steven Cohen on the relevance of longevity in aesthetics and the benefits of adding these services into your clinic.
What is longevity and why is it relevant to aesthetic medicine?
Longevity medicine is advanced personalised preventative medicine powered by deep biomarkers of ageing and longevity, which is a fast-emerging field.4 The field encompasses the evolving areas of biogerontology, geroscience and functional medicine.4 An ageing society focuses on changes in the age structure of the population, whilst a longevity society seeks the advantages of longer and healthier lives through changes in how we age.5
Beswick notes that longevity approaches within medicine are already gaining attention in the UK. “The concept is popular in the US with geneticist Dr David Sinclair and longevity specialist Dr Peter Attia publishing books and speaking on podcasts on the topic.6,7 Both authors agree that genetics plays a key role in longevity alongside environmental factors including lifestyle, diet
and exercise. Genetic testing is increasingly available and accessible to enable patients to understand their personal health risks and take preventative action to improve their lifespan and healthspan”, she explains. As a result, personalised nutrition and lifestyle interventions can be implemented to complement the patient’s genetics to compensate for weaknesses and play to their strengths, Beswick notes.
The longevity concept suitably links into aesthetic medicine as patients are already taking care of themselves to look their best, but now want to maintain this from within, notes Dr Cohen. He explains, “Patients may be looking to understand their biological age and could be prescribed supplements for certain deficiencies. If we analysed someone for their pace of ageing and saw it was fast, then we can modify this and add interventions like probiotics or bespoke supplements to address the patient’s needs.”
Dr Cohen continues, “After some time, the patient may see an improvement in telomere lengths, their rate of ageing is slowing and metabolic rate rising. Therefore, we can begin to treat associated metabolic symptoms which ultimately cause death and disease.” He notes that aesthetics is perfect as practitioners already have a high-functioning audience that want to look their best and have the funds available to pay for additional health solutions. Practitioners consult on how the skin ages, how we look, how we gain weight and hormonal changes, influencing our aesthetics, notes Dr Gooneratne. “All of these factors can be modified by using a complementary approach to a patient’s wellbeing. Practitioners may not be able to do it themselves in-clinic, but having an awareness and being able to speak to patients about their health and wellness is important,” she adds.
On a practical level, medical aesthetic practitioners have the appropriate clinical environment to incorporate these approaches in-clinic. “We have medical backgrounds and so should be able to inform patients about their health, even if it’s to say, ‘try and avoid blue screen light for a while’. It’s the same as advising patients on the use of sunscreen – it should be a part of our general conversations in-clinic,” she comments.
Achieving longevity through functional medicine approaches
Functional medicine aligns with the overarching philosophy of promoting longevity and wellbeing. Functional medicine is defined as a systems biology-based approach to healthcare, focusing on
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 31
Aesthetics delves into the concepts of medical longevity and how aesthetic practitioners can implement a holistic, full bodied approach to patient care
identifying and addressing the root cause of disease.8
Dr Gooneratne notes that functional medicine is a facet of longevity, however they are not the same. She explains, “We can use functional medicine to drive longevity. Longevity is the concept of living for a long time, but healthspan is incorporated into this. Patients do not want to live their lives unhealthily, but instead want to live the fullest, healthiest life they can. Therefore, we can use functional medicine as a tool to drive this forward.”
Functional medicine takes a comprehensive approach to prevention, health and wellbeing whilst restoring function through a personalised patient experience. Practitioners can implement services like nutrition, weight management and other approaches to their portfolio to facilitate this, as well as education on how overall health helps aesthetic treatments results.
According to Dr Gooneratne, all our bodily systems are connected and do not exist in isolation. She notes, “We are not just a cardiovascular system or a skin network, they are all connected and influence one another. This is also affected by environmental factors. For example, if someone suffers with diabetes, we will look far back at antecedent triggers and perpetrators, which might have caused them to have the disease. These might be a family history, adverse childhood events, stress, poor nutrition or eating lots of processed and refined foods. These factors could contribute to someone suffering from diabetes.”
There are various areas which fall under the ‘functional medicine’ umbrella, including nutrition, hormones, weight management, and
Regenerative medicine approaches like stem cells, platelet-rich plasma, exosomes and growth factors and others are gaining momentum in healthcare, particularly the aesthetics field where such interventions are being used to increase longevity from a cellular level. Although regenerative medicine does not fall under functional medicine, it can help with longevity.
Dr Cohen has researched and conducted many studies on stem cells throughout his career, participating in a trial on eight patients treated for aesthetic indications
integrative therapies (lymphatic drainage systems, body/skin analysis) to name a few.
Dr Gooneratne prefers to use the visual example of a tree to highlight the different branches of functional medicine (Figure 1). “The leaves symbolise the different areas of modern medicine, such as aesthetics, cardiology, endocrinology and neurology – these deal with the symptoms of the system. For example, a cardiologist might help with heart disease and blood pressure, whilst an endocrinologist helps with hormones. However, the core driving factor is the trunk which symbolises inflammation,” she says. Inflammation drives these diseases and relates back to genetics and our lifestyle, which are shown by the roots of the tree which can be improved to drive longevity, explains Dr Gooneratne.
Nutrition and weight management services
In a survey conducted online by YouGov on behalf of the British Nutrition Foundation on 2,028 adults, 57% say they have made changes to cook more healthily, with 64% noting that they check nutritional information food labels when shopping.9
Despite this, in March 2021, the UK Government announced an additional £100 million of funding over 2021-2022 to support people living with excess weight and obesity to lose weight and maintain healthier lifestyles.10 This highlights that weight and nutrition still needs to be managed effectively across the nation, despite active campaigns promoting healthy living.
Dr Gooneratne notes that nutrition and weight can affect a patient’s overall wellbeing. “We know that nutrition and eating healthily will impact the aesthetics on our patient’s skin. Free radicals are absorbed and can cause damage within the body. Carrying extra fat is pro-inflammatory, affecting overall health,” she comments. Practitioners can therefore introduce a nutritionist, dietician or wellness coach in-clinic or team up with a business for referral.
“When I first started, I slowly adopted these things before taking on external training. I then set up Human Health Affiliates to help practitioners who may not know how to implement into clinic, but they can refer to us for wellness services,” reflects Dr Gooneratne. Adding supplements to your clinic offering is an easy way to start, she adds. “Along with collagen supplements, there are vitamin C, magnesium, NAD which are good to think about introducing and advising to patients,” she explains.
with stem cell enriched fat.12 “If we think about what we find in a plant like digoxin, which is a medical drug for heart failure or in fungus, we find penicillin. So, what are we going to find in the human body?
Lots of amazing things that can help to repair us! Every organ has stem cells –as we age, cells are lost, and stem cells replace them. Small replacements can help regenerate tissue, but then we have more and more cells which age, including stem cells. Therefore, it’s important to maintain a healthy deposit of stem cells,” he notes. Ageing will happen to us all, however,
the rate at which this happens varies between patients, reflects Dr Cohen.
“We can alter this rate of ageing by replacement therapies and treating the tissue with stem and regenerative cells as well as exosomes. They aren’t just making us look better but they are making the cells younger, causing a Benjamin Button effect. If we look into this, it becomes valuable, not just cosmetically but functionally. You are making people beautiful, but you are also making their tissue healthier, which you can’t do with fillers,” Dr Cohen adds.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 32
Figure 1: Link between inflammation and health. Image copyright of Human Health.
Advantages of the holistic approach
Delivering good patient care is essential across all aspects of aesthetics and incorporating functional medicine can elevate this, notes Dr Cohen. “The more effective patient care practitioners deliver, they will want to return back to your clinic. Many practitioners should think about functional medicine as a way of presenting a more holistic approach to aesthetics. I think it’s natural for professionals, many of whom studied internal medicine, to embrace these concepts along with the treatments they are currently using, like dermal fillers and botulinum toxin,” he explains.
Dr Gooneratne notes that practitioners can build their patient retention rates, with some companies offering programmes for returning patients. She notes, “Supplement companies, like Skinade and Nuchido, have these programmes so you will be rewarded for returning patients buying these products, all while improving their internal health. GetHarley is another service that also ensures that retention is occurring for your business.”
Although Dr Gooneratne recognises that many functional medicine and wellness services won’t be a clinic’s main source of income, they can be an added extra benefit, like skincare. “Functional medicine services act as an additional income which sits alongside what you do. There is also an added respect you gain from your patients. I have patients for life because of how we look after them,” she comments.
Considerations of adding these approaches in-clinic
There are many considerations practitioners should be aware of before implementing these holistic health services into their clinic, including training, regulation and managing patients’ expectations correctly.
Dr Gooneratne advises practitioners to become a member of the British College of Functional Medicine (BCFM) association, of which she is a founder, which provides advice and guidance on policy to appropriate bodies on matters related to functional medicine.13 She explains, “In the UK, the functional medicine and longevity concept is emerging and training is difficult to come by. The best way to integrate this into your clinic is by partnering with a professional, such as a functional medicine specialist, who can provide advice for patients instead.”
On a practical level, clinics should also research whether some services may require Care Quality Commission (CQC) or the equivalent regulation as some treatments fall under medical services, such as intravenous drips and weight loss injections. “Be clear with your boundaries. For example, if you are a nurse, do you need to be a prescriber to offer certain services or a doctor with appropraite training? There are many sessions at the Medical Longevity Summit at CCR on October 19-20 where you can find out about it and ask questions to professionals in the industry,” she adds.
Furthermore, Dr Cohen notes that practitioners need to ensure the approaches and products they are using are safe and have numerous clinical studies to support their efficacy. He reflects, “When it comes to products in particular, practitioners need to assess them carefully. If a company claims their product has exosomes for example, this doesn’t necessarily mean the product contains them or it may have a small amount in there. This is why exosomes are given a bad name as businesses and companies want to capitalise on the term. They develop products which are untested and have no data. Human exosome products are not approved yet, so it has become a ‘Wild West’ area.” Dr Cohen notes that if exosome-based products contain large data and safety
records, then he believes practitioners should be implementing these into their clinics immediately as they are a very promising and exciting new approach.
Seek advice from fellow professionals
Seeking advice from colleagues, and functional medicine associations, like BCFM and The London Regenerative Institute (LRI), can help practitioners gain valuable advice on how to implement these services successfully. The LRI is dedicated to regenerative research and combines the latest innovations in longevity with personalised treatment protocols to reverse ageing and enhance healthspan. Dr Cohen explains that practitioners should also attend training courses that are targeted to what they want to add into their clinics. “Practitioners could come to my clinic, see what I do and then go back to their clinics and start practising it!” he adds.
Dr Gooneratne agrees, noting that practitioners should seek mentorship programmes for additional guidance. She says, “These programmes can help practitioners not necessarily implement services in-clinic, but navigate their business and be mindful of how they bring these services in. Practitioners don’t need to add entire wellness services and machines into their clinic but start small! Get to know your local gyms, hypnotherapists, nutritionists and build relationships with them for potential referral pathways.”
Future of longevity treatments
With functional medicine and longevity becoming increasingly popular globally and in aesthetics, practitioners should take time to understand the concept and begin having these conversations with patients in-clinic, reflects Dr Gooneratne.
“I believe that functional medicine is a serious contender in how we manage chronic disease and present serious illnesses. There is a window where we can alter cellular pathways before things get broken. Once broken, you are looking at medication and operations, which have huge socioeconomic implications. None of this is sustainable on an already over-burdened healthcare system. So, this is a new way of managing the nation’s health, whilst adding additional value and services to your aesthetic practice,” she concludes.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 33
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Dr Mayoni Gooneratne, Dr Steven Cohen and Emma Beswick are all speaking at the Medical Longevity Summit at CCR on October 19-20. Scan the QR code to register for free.
Beauty flows through us OVER 100 MILLION SOLD Blunt-tip reduces friction and glides through dermal tissue Ultra-thin cannula wall increases lumen diameter and reduces injection forces Premium quality single-use cannula used by clinical and industry leaders Made in Britain for over 30 years AESTHETIC +44 1527 501480 ● www.sterimedix.com AESTHETIC CANNULA
Restylane® Kysse: Combining Artistry and Science
Galderma unveils how it provides the highest level of patient satisfaction for Restylane Kysse®
The Restylane® brand is synonymous with aesthetic excellence for both aesthetic practitioners and patients themselves. In practice, it is important to ensure that patients are not only satisfied with their result, but they leave happy with the changes they see and also feel good after their treatment.
Whilst skill and artistry are an important skill for any injector, the products used during treatment should also be well selected and designed to support the treatment area. Restylane® offers the world’s most diverse range of fillers1 with each individually developed to address specific concerns and treatment areas from volume loss and fine lines to deep set wrinkles and lips. Treating the lips, in particular, is an area where product selection is key as patients are often nervous about the results in regards to their lips looking and feeling unnatural.
Restylane Kysse® by Galderma is designed for flexible movement and natural-looking volume proven to last for up to one year.2
The OBT™ manufacturing process (Optimal Balance Technology) produces soft and flexible gels, helping create a natural fullness and volume not only at rest but also in animation. The softness and flexibility of the HA gel is tailored to ensure sufficient firmness to retain the desired lip shape over time.
When it comes to patient satisfaction, Restylane® Kysse is a hit –96% of patients agreed that their lips looked natural3 and 100% of patients were satisfied with their results after 12 months when treated with Restylane® Kysse.4 The treatments we provide can also have a positive impact on how our patients feel about themselves and with Restylane® Kysse, 86% of patients report feeling more attractive one month after their treatment5 and 96% advised that they would receive Restylane® Kysse again.6
Dr Priyanka Chadha, co-director of Acquisition Aesthetics notes, “Less is definitely more when it comes to fillers and not all fillers are equal. You need to be aware of which type of filler is being used and how this will look, respond and feel in the tissues! The fillers used for lip treatments should be soft and flexible and have an integrating component to them that allows them to move naturally and effortlessly with your lips as you talk, eat and express yourself. I like to use Restylane® Kysse for lip treatments. For me, this is a unique product within the lip filler market. It injects seamlessly into the body of the lips and their borders – leading to enhancement of the existing lip shape and volume without artificial distortion.”
Explore the Restylane portfolio
To find out more about Restylane® Kysse and how this can compliment your treatment portfolio, speak to your Galderma sales representative or contact sales.UK@galderma.com
Adverse events should be reported.
For the UK, reporting forms and information can be found at www.mhra.gov.uk/yellowcard
Or search for MHRA Yellow Card in the Google Play or App Store. For Ireland, suspected adverse events can be reported via HPRA Pharmacovigilance, www.hpra.ie
Adverse events should also be reported to Galderma (UK) Ltd.
Email: email@example.com Tel: +44 (0)300 3035674
1. Data on file: MA-33939
2. Hilton S et al. Dermatol Surg 2018; 44(2): 261-269.
3. Bertucci V et al. J Cosmet Dermatol 2021; 20(5): 1499-1504
4. Hilton S et al. Dermatol Surg 2018; 44(2): 261-269.
5. Hilton S et al. Dermatol Surg 2018; 44(2): 261-269.
6. Hilton S et al. Dermatol Surg 2018; 44(2): 261-269.
35 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 Advertorial Galderma
Figure 1: Patient before and after Restylane Kysse® treatment.
This advertorial has been funded and developed by Galderma.
UKI-RES-2300151 DOP September 2023
Skeletal and Dental Classifications For Injectables
Mr James Olding and colleagues outline the importance of skeletal, dental and soft tissue patterns in non-surgical facial assessment and treatment planning
Understanding the anatomical basis for a patient’s clinical presentation is fundamental to successful treatment planning and execution in non-surgical aesthetics. Skeletal and dental relationships influence the entire face. Surgical orthognathic treatment planning draws on detailed consultation, psychological assessment, radiographic investigations and orthodontic and maxillofacial expertise over a period of many years. In contrast, many aesthetic practitioners may undertake injectable treatments over the course of their career without affording the skeletal base, and even less so the dentition, the necessary consideration and appreciation. Importantly, injectors must recognise that even patients without age-related concerns may seek treatments for the mid and lower face, and an understanding of genetic diversity in the population is critical for optimal patient care across all ages and backgrounds.
Anteroposterior facial dimension
Both profile and anterior facial examination are critical in the assessment and treatment of the mid and lower face to ensure facial harmony.1 Facial profile analysis includes the anteroposterior position of the maxilla and mandible, with importance attributed to both absolute positions relative to the cranium, as well as relative positions to each other. The position of the chin, nasolabial angle, labiomental angle and relationship of the chin to the submental plane are all influenced by this anteroposterior relationship of the maxilla and mandible.1,2
The facial skeleton and aesthetics
Craniofacial development is a complex process influenced by multiple intrinsic and extrinsic factors.3 Genetics, pre-natal problems, developmental illness and environmental factors have a potential influence. Any alteration in either growth pattern or rate may result in abnormal skeletal morphology of the face and associated dental malocclusion.3 These changes in skeletal and dental features have a profound impact on facial aesthetics, and may be a factor in many of the concerns raised by patients seeking injectable treatments.
Classifying dental and skeletal relationships
The anteroposterior relationship of both the facial skeleton (mandible and maxilla) and the dentition (upper and lower teeth) can be classified into Class 1, 2 and 3. The overarching principles and class grading of both skeletal and dental are similar, and used in orthodontics, orthognathic surgery and, increasingly, in non-surgical aesthetics, to diagnose and treatment plan.5,6,7
Classifications in skeletal assessment
Linked closely with classifying skeletal relationships is the use of radiographic and clinical assessments that are commonly employed in orthognathic treatment planning. The gold standard approach for the assessment of skeletal pattern is using lateral cephalometry, which is a plain radiograph used for the analysis of the facial bones in the true lateral position.11 While lateral cephalometry is unlikely to be used in facial aesthetics, an understanding of the principles determining a patient’s skeletal pattern is highly desirable for injectors. Such an understanding underpins the ability to identify (and potentially treat) a skeletal aetiology for a soft tissue concern. Using landmarks on the lateral cephalogram, we can trace out two key angles that provide information on the position of the maxilla and the mandible relative to the cranial base (represented by S-N), as shown in Figure 1. In practice, this topic alone is extensive, and many analyses exist for the purposes of orthognathic planning –further discussion falls outside the scope of this article, so extra reading is recommended.12
Based on these measurements obtained from lateral cephalometry, we can classify patients into Skeletal 1 (ANB 2-4 degrees), Skeletal 2 (ANB >4 degrees) or Skeletal 3 (ANB <2 degrees, or even negative), as shown in Table 1 11 The impact of the skeletal relationship on the facial profile can be profound, as detailed below in Figure 2, and further outlined in Table 3 2-4 It is important to note that there exists an important degree of diversity among different ethnic groups for mean values and standard deviations in lateral cephalometry (Table 2). This is of fundamental importance when assessing and planning treatments for patients from different ethnic backgrounds, where a solid understanding of diversity on anteroposterior skeletal relationships will promote natural and appropriate results for each individual patient.2-4
ANB (degrees) Class 3 <2 Class 1 2-4 Class 2 >4 Table 1: Classification of ANB3 Table 2:
published research8,9,10 Caucasian Black American Arab SNA 81 +/- 3 87 +/- 5 81 +/- 4 SNB 78 +/- 3 82 +/- 4 78 +/- 3 ANB 3 +/- 2 5 +/- 2 3 +/- 2 Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 36
Cephalometric norms for different ethnic groups based on
Profile Possible clinical findings and considerations
Skeletal 2 Convex
• Retrognathic mandible (+/- microgenia)
• Submental fullness/heaviness
• Facial profile disharmony
• Ensure lower face treatment is considered before any treatment to lips (especially upper) or nose
• Soft tissue advancement of the chin may promote masculinisation in males
Skeletal 3 Flat or concave
• Prognathic mandible and/or retrognathic maxilla
• Flat anterior cheek
• Negative cheek vector
• Under-eye hollowing or concerns, increased scleral show in severe cases
• Facial profile disharmony
• Mid-face anterior projection and upper lip treatment may promote feminisation in females
A useful gross assessment tool involves using the index and middle fingers placed respectively on the A point and B point (intraorally, with a gloved hand). In a Skeletal 1 pattern, the A point (maxilla) would lie around 2-4mm in front of the B point (mandible). Deviation of increased (Skeletal 2) or reduced/reversed (Skeletal 3) distance would indicate a divergence from Skeletal 1 (Figure 2).11 Beyond the use of imaging or gross assessment, individualised aesthetic facial assessment is essential for optimising surgical, non-surgical and orthodontic outcomes. For example, even though a patient may have a Skeletal 3 base, if they already have a broad nasal base and do not wish for further widening, any treatment to advance the maxilla should account for the impact this move could have on the nose. This is relevant for both a maxillary osteotomy and advancement (surgical), as well as the use of hyaluronic-based filler onto the piriform (non-surgical).
In this way, both orthognathic (surgical) and aesthetic (non-surgical) facial assessment can accurately be viewed as an art based solidly on anatomy and science.
Considering dental classifications for optimised injectable outcomes
Turning to the dental component of our assessment, anteroposterior dental relationships are commonly classified with reference to the central incisor, canine and first molar teeth. The British Standards Institute (BSI) classifies Anterior Posterior (AP) relationships based on the upper and lower central incisor teeth.13,14,18,19 In non-surgical aesthetics practice, it is important that all clinicians have a working
understanding of incisor relationship as a minimum, as this has implications for injectable treatment planning. Even more importantly practitioners need the ability to recognise the need for onward referral to an orthodontist or an oral and maxillofacial surgeon. The upper central incisor has a bulge on its palatal (behind the tooth) aspect known as the cingulum, wherein lies a flat area known as the cingulum plateau. Each incisor also has an incisal (or occlusal) edge – a ridge of enamel which is essentially the most inferior part of the upper incisor, and the most superior part of the lower incisor. These landmarks are key in defining incisor Class 1, 2 and 3.13 Other important definitions include overjet, which refers to the anteroposterior distance between the upper and lower incisal edges, and overbite, which refers to the vertical overlap of the upper incisor and lower incisor (a normal overbite being around 2mm).13
References to bite, such as overbite, refer in fact to the vertical overlap of the incisor teeth on biting together. It is important to understand the correct terminology, but equally we must be able to communicate with our patients in language that they understand. References to overbite and underbite are examples of such colloquialisms that are widely understood in the lay population, and as such can be useful when consulting with patients.13
The BSI defines a Class 1 incisor relationship as existing where the lower incisal edge occludes, or bites on to, the cingulum plateau of the upper incisor. The result is an upper incisor that is slightly ahead of the lower incisor, commonly quoted as a 2-4mm anteroposterior distance, representing a positive overjet within normal limits.13
A Class 2 incisor relationship exists where the lower incisal edge occludes posterior to the cingulum plateau of the upper incisor. Within Class 2, there are two subdivisions, each significant for assessment and treatment across dentistry, surgery and aesthetics:13
• Class 2 division 1: Upper incisor is proclined (lower edge is oriented forwards) or normal orientation. The overjet will be increased.
• Class 2 division 2: Upper incisor is retroclined (lower edge oriented
Table 3: Potential correlations between skeletal base and aesthetic wants and needs2-4
Figure 2: Three classifications of skeletal facial profiles
Figure 1: Lateral cephalogram image12
Skeletal Class 1 Facial Profile
Skeletal Class 2 Facial Profile
Skeletal Class 3 Facial Profile
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 37
Class 2 Division 1 incisors
Potential clinical findings and considerations
• Lip incompetency with incisal show at rest
• Pursing of perioral muscles, contraction of mentalis and jaw posturing to achieve lip competency
• Lower lip trap behind the upper incisors, perpetuating this malocclusion and worsening orofacial aesthetics
Class 2 Division 2 incisors
• Propensity to overclose, leading to reduced lower face height and forwards and upwards mandibular rotation
• Deep labiomental crease
• Prominent mentalis and chin point which may be upwards rotated
Class 3 incisors
• May have a prominent lower lip on profile
• May have a lisp on talking
• If edge to edge, may show signs of anterior tooth wear and reduced crown height
backwards, into the mouth). The overjet may be normal. Often, due to retroclination of the upper incisor, the lower incisal edge cannot contact or occlude against the cingulum plateau, signifying a lack of an occlusal stop and consequent overclosing, known as an increased overbite.
A Class 3 incisor relationship exists where the lower incisal edge occludes anterior to the cingulum plateau of the upper incisor. Commonly, this will result in either an edge-to-edge incisal occlusion, or a reverse overjet.13 A reverse overjet arises where the lower incisors lie in front of, or anterior to, the upper incisors upon biting together; colloquially, this is widely referred to as an underbite, but the correct term is in fact a reverse overjet.13 Divergence from a Class 1 incisor relationship can have an important impact on facial aesthetics
(Table 4). Global studies have identified dental Class 1 and Class 2 as the most prevalent. Approximately two thirds of the population have a dental Class 1, the other third being dental Class 2 and a small percentage Class 3.5-7 The highest incidence of Class 1 was seen in African populations. On the other hand, Class 2 malocclusion is most common in European populations.6,7 Puerto Rico, Saudi Arabia and Brazil have the highest frequency of Class 3.6,7
Using dental classifications for enhanced injectable treatment strategies
The first step in treatment planning involves a thorough assessment, and a decision regarding whether the patient would benefit from onward referral. In patients presenting post-surgery (orthognathic, cosmetic, or otherwise) seeking refinement procedures, it is strongly advisable to liaise with the treating surgeon. In many cases, such treatments may be more safely undertaken by area specialists, especially where there are surgical implants in situ (such as following lower jaw orthognathic surgery) and there is a risk of injecting onto, or close to, these implants, where ensuing infection can be disastrous.23 In patients with a history of multiple surgeries, such as those with congenital deformity, cleft or oncology patients, any injectable treatment must be undertaken in a specialist setting with input from a multidisciplinary team and use of imaging. Injectable treatments in these patients can be especially challenging and dangerous due to excessive scar tissue, altered vascular supply and the wider psychological factors at play.24
In patients deemed appropriate for non-surgical treatment, addressing the underlying cause for any aesthetic complaint is fundamental to success. Commonly, and especially in younger patients, the complaint may not be age-related, but instead arise from genetics or development of the jaw.
Based on our clinical experience, lower face treatment to advance and project the chin in Skeletal 2 patients commonly requires multiple sessions and significant product quantities. The patient’s skin quality, age and sex are key considerations when deciding on product choice, volume and placement. There is a lack of studies in this area and further research into which patients are suitable for non-surgical approaches, as well as the efficacy and safety of product volume per session, are required to enhance our understanding of how to treat Skeletal 2 patients.
Women with retrusive lower jaws commonly seek to ‘strengthen’ their lower face through definition and projection of the chin. In this group, care must be taken not to masculinise where a feminine appearance is desired, and injectors must take a careful 3D approach that factors in the transverse (ensuring the chin point is midline and not broad) and the vertical (ensuring the vertical height of the lower face is not elongated, and that the perioral area is factored into any chin treatment).1,21
There is a growing consensus that large boluses onto the bone may be associated with bone resorption at the mentum.15,16 Furthermore, our understanding of tissue planes, chin anatomy and product properties
Table 4: Potential findings and considerations of class 1/2 incisor relationships2-4
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 38
It is important that all clinicians have a working understanding of incisor relationship as a minimum, as this has implications for injectable treatment planning
supports the use of a more precise placement using a cannula across defined anatomical sites to elicit specific outcomes.21 When looking to provide chin projection in a patient with associated deep labiomental crease, our experience supports the use of subcutaneous product placement in the labiomental area. Careful fanning with a cannula can diminish the lower face concavity viewed on profile, while simultaneously increasing the vertical dimension on frontal view.21 When looking to alleviate submental fullness in a patient with mandibular retrognathia, anterior projection can be achieved through cannula placement at the lower anterior chin border, following the lower border of the mandible to the midline. This is commonly combined with treatment in the same approach at the pre-jowl area, resulting in a linear projection in the AP dimension from the jowl area to the midline of the chin.1,21
Products must possess a high cohesivity and elasticity; only a robust hyaluronic-based product will adequately withstand the forces generated on a daily basis in this highly dynamic area, arising from mastication, facial animation and speech.17
Skeletal 3 patients will commonly present with a retrusive maxilla and may also present with infraorbital concerns. Like the lower jaw, product placement in specific layers, with a preference for cannula when depositing at the deep fat layer, is commonly indicated in Skeletal 3 patients.21,22 Products at this layer must possess sufficient elasticity and cohesivity to project, while not being so robust as to create alterations in animation in this highly dynamic area of the face.2,6,7,12
Supraperiosteal bolus placement in the anteromedial cheek can be useful, though in cases with a flat or convex profile arising from both hard and soft tissue, we have found the use of a cannula in the deep fat plane will provide a more homogenous and natural result. It is not uncommon to treat using both techniques in these patients, and addressing this mid-facial retrusion should also be the first step to undertaking any periorbital treatment, particularly in patients presenting with under-eye concerns.
Understanding skeletal and dental relationships
Mr James Olding is a full-time specialist registrar in oral and maxillofacial surgery in the NHS and is dual qualified in medicine and dentistry. He is the founder of Interface Aesthetics and was recently awarded The AlumierMD Award for Rising Star of the Year 2023. He is also an international KOL and trainer for Allergan Medical Institute, and a principal investigator in Clinical Research in Aesthetics.
Qual: MBChB (Hons), BDS (Hons), BSc (Hons), MRCS (England), PG Dip (Aes)
Miss Caroline Mills is a consultant facial, cosmetic and maxillofacial surgeon with special interests in facial deformity, aesthetics, and secondary cleft surgery. She works as a facial surgeon in the NHS and is based at Great Ormond Street Hospital in London. She has undertaken fellowships in both craniofacial surgery and cosmetic surgery.
Qual: FRCS (OMFS), FRCS (Eng), MB FDS, BDS
Zeanab Chaer is a final year dental student at King’s College London. She has been working alongside Mr James Olding within Interface Aesthetics as a mentee for the past three years, including key roles as lead coordinator for the Junior Trainee Mentorship Scheme (JTMS) and FACExpo.
Rahim Feddag is a final year dental student at King’s College London. He has been working alongside Mr James Olding within Interface Aesthetics as a mentee for the past three years, including key roles as lead coordinator for the VTCT Level 7 Diploma and FACExpo.
Test your knowledge!
Complete the multiple-choice questions and go online to receive your CPD certificate!
1. Traced out on a lateral cephalogram, the A point refers to…
2. A class 3 incisor relationship refers to…
a. The deepest concavity on the anterior mandible
b. The deepest concavity on the anterior maxilla
c. The sella turcica
d. The nasion
a. A lower incisor which is 2mm posterior to the upper incisor
b. An increased vertical overlap between the upper and lower incisors (increased overbite)
c. A lower incisor which is anterior to the upper incisor (reverse overjet)
d. A lower incisor which is anterior to the cingulum plateau of the upper incisor, and may or may not be associated with a reverse overjet
3. Which of the following is unlikely to be a clinical finding based on an underlying skeletal 3 base…
4. When considering HA product selection, a more robust product which has higher cohesivity and elasticity to provide volume and projection would be unsuitable in?
Skeletal and dental anatomy impacts greatly on facial appearance, and consequently the aesthetic presentations of many patients. Injectors are generally well informed of the age-related changes that occur in the maxilla and mandible, and how these may impact the soft tissues and facial appearance. Less understood is the importance of genetic and developmental factors on the maxilla and mandible, which may present before the onset of any age-related changes and require specific treatment strategies and special considerations. Given the significant populational dentofacial diversity in the UK and globally, it is incumbent on injectors of all healthcare professions to have a working understanding of skeletal and dental relationships before undertaking treatments. Crucially, injectors must recognise where onward referral to secondary or tertiary care is warranted. VIEW
5. Which of the following patients would not necessarily warrant discussion with other healthcare colleagues before treating with injectables?
a. Submental fullness in a patient with a normal BMI
b. Under-eye hollowing
c. Flat anterior cheek
d. Concave or flat facial profile
a. The sub-orbicularis oculi fat compartment
b. The labiomental crease subcutaneously
c. The piriform supraperiosteally
d. The lower anterior chin subcutaneously
a. Patient currently or previously treated for cleft lip &/or palate
b. Patient with surgical implants in the face at or near the site for treatment
c. Patients with a severe class 2 dental malocclusion
d. Patient with a mild class 3 dental malocclusion
THE REFERENCES AT AESTHETICSJOURNAL.COM
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 39
Get To Know SkinCeuticals: The Pioneers Of Skin Health
Join the leaders in antioxidant research at this year’s annual CCR exhibition
COME & VISIT SKINCEUTICALS
FRIDAY 10 TH MARCH 11.30-12.30PM
DR. ANA MANSOURI
Aesthetic Doctor, KOL & Trainer
An integrated case study optimizing clincial outcomes for active acne, atrophic scarring and PIH.
MR. DEAN RHOBAYE
Facial harmonisation - how to transform faces through soft tissue augmentation by combining injectables with evidence-based skincare.
Meet the team at stand E4 for exclusive business opportunities
INTEGRATED SKINCARE HEROES
CCR ON-STAND DEMONSTRATIONS AND SPEAKER SESSIONS
Thursday 19th October - Symposium (In Practice Theatre)
12:30-1:00pm – Dr Ana Mansouri on the Benefits of Partnering with SkinCeuticals: My Career Changing Experience
Dr Ana Mansouri will share her personal and professional experience of how her partnership with SkinCeuticals changed her career trajectory, and her journey opening a UK SkinCeuticals flagship clinic. She will review various perspectives of practitioner benefits including clinical, marketing and profile building, as well as business development support.
On stand J40 2:00-3:30pm – Combined Microneedling Protocol and Approach with Dr Ana Mansouri
Join Dr Ana Mansouri live on the stand while she demonstrates her VISIA consultation methods followed by her ‘off script’ collagen remodelling techniques featuring the SkinCeuticals GL Peel + Microneedling, Hydrating B5 Serum & LED light therapy.
Friday 20th October - Symposium (In Practice Theatre)
12:30-1:00pm – Dr Dean Rhobaye on Integrating Skincare into a Busy Aesthetic Practice: A Clinical and Business Perspective
C E FERULIC Integrated with ablative laser
PHYTO CORRECTIVE ESSENCE MIST
Suitable post-laser treatment
skin formulae and has gone from strength to strength in providing complete skincare solutions recommended by dermatologists, plastic surgeons and aesthetic doctors worldwide. As part of his research, Dr Pinnell was able to patent the Duke Antioxidant “The Duke Formulation Parameters”, stabilising vitamin C as far back as 1992, which has become a key ingredient in some of the best-selling SkinCeuticals products today and a real anchor ingredient in the antioxidant range. The Duke Antioxidant patent outlines the formulation parameters required for the most effective delivery of the ingredients to the skin.
1. Pure L-Ascorbic acid (vitamin C)
2. An acidic pH within the 2.0-3.5 pH range
3. A concentration between 10%-20%
Continuing this innovative approach, SkinCeuticals has spearheaded the movement of integrating skincare with clinical procedures and protocols, including peels, lasers, injectables and many other aesthetic treatments.
This talk will explore the seamless fusion of skincare services into a hectic aesthetic practice, addressing both clinical and business aspects. With the rising demand for comprehensive skincare solutions, the session aims to equip attendees with valuable insights and practical strategies to optimise patient care and boost practice revenue.
On stand J40 2:00-2:30pm – Patient Journey and Live Consultations with Dr Dean Rhobaye
Join Dr Dean Rhobaye live on the stand while he demonstrates his patient consultation journey using the new VISIA GEN 7 technology for the perfect approach to aesthetic medicine. The SkinCeuticals experts will follow his session with a live demonstration of our Integrated Skincare procedure using a multi-modality approach tailored to the patient’s needs.
At SkinCeuticals, our mission is to improve skin health. We are committed to leading the skincare industry in terms of research and innovation, and we promise to provide advanced skincare backed by science.
On the stand, SkinCeuticals will be offering branded gift bags. Scan the QR code to be the first to receive an exclusive Aesthetics journal subscriber offer when you visit your local SkinCeuticals representatives at stand J40
40 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 Advertorial SkinCeuticals
MEET THE TEAM AT STAND E4 FOR EXCLUSIVE BUSINESS OPPORTUNITIES SCAN HERE TO BECOME A SKINCEUTICALS STOCKIST
Integrated skincare with SkinCeuticals
In an ever-growing industry where patients are regularly using innovative and scientific skin treatments, SkinCeuticals is aiming to bridge the gap where treatments stop, and skincare starts. The company believes long-lasting comprehensive results are achieved by combining state-of-the-art clinical procedures and professional treatments with advanced homecare.
Benefits of integrated skincare
• Professional pre-conditioning and recovery post-treatment helps to reduce downtime and feelings of discomfort
• Advanced homecare aids in prolonging and protecting results due to the additional benefits of antioxidants
Spearheading this movement of integrating skincare, SkinCeuticals’ dermatologically approved, antioxidant-led formulas are crafted to work in synergy with highperforming skin-based treatments, offering patients maximum results post-appointment and prolonging the benefits. Many clinics and practitioners are noticing the need for integrated skincare post- and during treatments more than ever, with patient satisfaction and results heightening with the integration. Adopted by many top practitioners in the UK, SkinCeuticals’ offering of homecare products can be used for pre-conditioning, post-treatment and daily use to ensure longer-lasting results, as well as improved skin health. Products can be used in conjunction with treatments including laser, microneedling, aesthetics and more.
Hydrating B5 Gel
Hydrating B5 Gel replenishes nutrients the skin needs to feel smooth and appear younger. This oil-free moisturising serum combines vitamin B5 with hyaluronic acid, the body’s natural hydrator, to help bind moisture to the skin. It can be used alone or with a daily moisturiser to provide extra hydration and is an ideal moisturiser for blemish-prone skin. It is suitable for all skin types, and can be used in conjunction with
COME & VISIT SKINCEUTICALS
FRIDAY 10 TH MARCH 11.30-12.30PM
DR. ANA MANSOURI
Aesthetic Doctor, KOL & Trainer
An integrated case study optimizing clincial outcomes for active acne, atrophic scarring and PIH.
MR. DEAN RHOBAYE
Facial harmonisation - how to transform faces through soft tissue augmentation by combining injectables with evidence-based skincare.
Meet the team at stand E4 for exclusive business opportunities
INTEGRATED SKINCARE HEROES
C E FERULIC Integrated with ablative laser
PHYTO CORRECTIVE ESSENCE MIST Suitable post-laser treatment
proxylane and wild fruit flavonoids than its predecessor A.G.E. Interrupter, alongside additional complementary ingredients like glycyrrhetinic acid, for visible results.
SkinCeuticals integrated skincare hall of fame
H.A. Intensifier Serum
H.A. Intensifier is a multi-beneficial corrective serum proven to amplify skin’s hyaluronic acid levels. This unique formulation contains a high concentration of pure hyaluronic acid, proxylane™ and botanical extracts of liquorice root and purple rice to support the skin’s hyaluronic acid levels and deliver surface hydration, helping improve the visible appearance of firmness, smoothness and facial plumpness. This hyaluronic acid serum may be used as part of a home skincare regimen after dermal fillers.
SkinCeuticals Phyto Corrective Essence Mist, formulated with a high concentration of botanical extracts and moisturising agents, hydrates and soothes skin. It offers an immediate reduction in visible redness and improvement smoothness and all whilst helping repair the skin barrier function, effectively hydrating skin, even over foundation makeup. It is also clinically proven for all-day hydration, as well as being suitable for post-laser treatment. “In-clinic, we often use energy-assisted devices such as lasers to help resurface the skin, improve its condition and reduce the appearance of pigmentation, fine lines and wrinkles. Regardless of the desired result, one thing is sure, there is usually an element of discomfort or drying in the skin post-treatment, sometimes combined with heat and reddening of the skin. Products that help soothe the skin and allow patients to get on with their day after their appointment are very welcome. Phyto Corrective Essence Mist is a multi-tasking magic wand. It has all
A.G.E. Interrupter Advanced improves the appearance of attributes associated with skin ageing and glycation, including lines and deep wrinkles in multiple facial zones.
Speak to a SkinCeuticals business development manager today for more information. Email contact@SkinCeuticals.co.uk
This advertorial was written and supplied by
41 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 Advertorial SkinCeuticals
“Products that help soothe the skin and allow patients to get on with their day after their appointment are very welcome”
Dr Ana Mansouri
Examining Weight Loss Injections
There has been widespread publicity of various celebrities raving about their weight loss journeys thanks to ‘miracle injections’, with references to them peppered all over the media.1-3 This celebrity ‘endorsement’, together with various viral videos about them on social media, means they have gained popularity and demand has soared. However, they often do not highlight the side effects, ranging from nausea and diarrhoea to gallstones and pancreatitis. In this article, I will investigate the world of weight loss injections and outline some considerations for practitioners within medical aesthetics who are thinking of offering them as part of their repertoire of services.
Physiology of hunger and satiety
Worldwide obesity has almost tripled over the last 50 years due to processed, high energy foods and increased marketing for unhealthy eating habits, with over a third of the world’s adult population falling in the overweight (BMI 25-30) or obese (BMI > or equal to 30) categories.4 The World Health Organization has recognised obesity as a major challenge for sustainable development.4
Before we delve into the world of therapeutics to see what is available to help with this burgeoning problem, we need to look beyond the relatively simplistic ‘energy-balance’ explanation as the causative mechanism. For this, we need to do a little dive into the physiology behind hunger and satiety.
These two interlinked physiological sensations are complex processes involving neural signals, hormones, mechanical triggers, nutrient levels and psychological cues that form a ‘gut-brain axis’ to ensure adequate energy and nutrient intake.5 The main area in the brain that regulates hunger and satiety is the arcuate nucleus of the hypothalamus.5
For this article, I will focus on the hormonal part of this intricate feedback loop:6
• Ghrelin, often known as the ‘hunger hormone’, is produced by the stomach – it rises prior to a meal and falls following food intake.
• Leptin is a hormone produced by fat cells which plays an important part in maintaining long-term energy balance. As fat cells grow and release more leptin, it signals to the body that there is adequate energy on board and thus appetite is reduced, promoting satiety.
• Insulin is produced by the beta cells of the pancreas in response to rising blood glucose levels (usually following a meal). It helps glucose enter cells from the bloodstream, and store excess glucose as glycogen in the muscles and liver. Raised insulin levels can contribute to feelings of satiety as it signals to the brain that the body’s energy needs are met.
• Incretins are a group of hormones released from the gastrointestinal (GI) tract following a meal (particularly the carbohydrate component). They increase insulin secretion and reduce glucagon secretion from the pancreas to lower blood glucose levels.
Incretins reduce gastric emptying, increasing the transit time of food in the GI tract. This impacts the rate of absorption of nutrients, which helps to prevent rapid blood glucose spikes and results in the feeling of satiety. This is known as the ‘incretin effect’.6
There are two main types of incretins:5
Glucagon-like Peptide-1 (GLP-1)
This is produced by the L-cells in the small intestine. Importantly, GLP-1 stimulates the beta cells of the pancreas to release insulin in a titrated, glucose-dependent manner directly related to changes in blood glucose levels. Therefore, the higher the levels, the more the beta cells are stimulated to release insulin. Additionally, there is evidence substantiating
GLP-1’s role in supporting long-term beta cell health.5 It also directly suppresses glucagon production through the alpha cells of the pancreas and has suppressive effects on the appetite centres in the brain. It is easily degraded by the intrinsic enzyme dipeptidyl peptidase 4 (DPP-4) in minutes.
Glucose-dependent Insulinotropic Peptide (GIP)
These are produced by K-cells in the small intestine. GIP works in a similar way to GLP-1 on insulin release, but otherwise its effects are less pronounced than GLP-1.
Products for weight loss
Following this information on hunger physiology, we can now investigate the therapeutic side. From the above, GLP-1 is one of the principal hormones that maintains blood glucose homeostasis. This leads to the formation of a family of medications known as incretin mimetics, and specifically GLP-1 receptor agonists (GLP-1 RAs).7 These were initially licensed solely for the treatment of type 2 diabetes (T2DM) in combination with well-established diabetic therapies. How does this relate to weight loss injections? In the media, they will be referring directly to GLP-1 RAs. However, we need a little more background on the evolution of this category of medications.7
The first GLP-1 RA to be approved by the US Food and Drug Administration (FDA) for the treatment of T2DM was exenatide (Byetta) in 2005, with a twice daily dosing regimen.7 This was followed by an extended-release preparation (Bydureon) administered once weekly, gaining US FDA approval in 2012, and an alternative once weekly compound called dulaglutide (Trulicity) in 2014. These are all manufactured by Eli Lilly.7
Novo Nordisk attained FDA approval (for the treatment of T2DM) for liraglutide (Victoza) administered once daily in 2010, and semaglutide (Ozempic) administered once weekly in 2017. Oral semaglutide (Rybelsus) once daily gained its licence in 2019.7 There is also a once daily preparation manufactured by Sanofi called lixisenatide (Lyxumia) that got FDA approval in 2016.7
Novo Nordisk carried out a large double-blind randomised controlled trial (RCT) looking at the effect of liraglutide on obesity (Satiety and Clinic Adiposity – Liraglutide Evidence: SCALE).8 It showed that liraglutide (used at a higher dose compared to treatment for T2DM) showed clinically significant weight loss compared to placebo. This subsequently
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 42
Dr Kam Lally examines the rise of weight loss injections in aesthetics and presents considerations before prescribing
contributed to liraglutide attaining FDA approval for the medical management of obesity in 2014 under the name Saxenda. The STEP series of trials also carried out by Novo Nordisk (Semaglutide Treatment Effect in People with obesity) showed clinically significant weight loss compared to placebo after administration of semaglutide.9 This attained FDA approval for medical weight management in 2021 under the name Wegovy. This has been a popular treatment due to its once weekly regimen (as it has a half-life of seven days compared to the 13.5 hours of Saxenda).9
Whilst Saxenda was launched in the UK in 2021, at the time of writing, Wegovy has launched in the UK, but with limited stock.10 Launch dates have been pushed back several times due to the unprecedented demand in the US effectively depleting global stock. As a result, practitioners and patients alike have been turning to Ozempic for off-label use due to convenience and have unfortunately caused severe shortages in the UK, significantly impacting diabetic patients.11
Considerations of use
Below is an inclusion/exclusion criteria for Saxenda/Wegovy from the Summary of Product Characteristics (SmPC). This is not an exhaustive list, and practitioners should always consult the SmPC prior to prescribing patients any of these medications:12,13
• A BMI greater than or equal to 27 if the patient has a weight-related co-morbidity
• BMI greater than or equal to 30
• Do not use if there is a family history or past medical history of medullary thyroid cancer
• Do not use in patients with multiple endocrine neoplasia type 2
• Do not use in patients with a history of pancreatitis
• Do not use during pregnancy
• Do not use when breast-feeding
The updated National Institute for Health and Care Excellence (NICE) guidelines use higher BMI parameters to assess whether a patient is eligible for pharmacological weight management therapy.14 This is certainly a questionable strategy, however it could be justified (in the short-term at least) when population economics are taken into consideration in the current financial climate. Further considerations to make when setting up a medical weight management service have been published in a previous
Aesthetics journal article.15 This selection of medications is currently under review by the Medicines and Healthcare products Regulatory Agency (MHRA) after five reports of patients having thoughts of suicide or deliberate self-harm whilst on semaglutide, and 12 reports of similar adverse events in patients on liraglutide (since 2010).
The European Medicines Agency also reported it is investigating GLP-1 RAs after the Icelandic health regulator logged three cases where patients had thoughts of suicide or self-harm.16,17
All adverse events should be investigated thoroughly as the safety of patients is our priority. If you have patients starting such therapies, or indeed patients on established regimens, a mental health assessment is mandatory with regular monitoring whilst patients are receiving treatment. If there are any concerns, the medication should be stopped immediately and reported to the MHRA via the Yellow Card reporting scheme.18 Patients should be supported and referred for appropriate care to mental health services.
The future of weight loss injections
Despite this, the future for this category of medications looks promising, with applications across several medical disciplines. There have also been numerous anecdotal accounts of GLP-1 RAs helping in addictive disorders ranging from alcohol and smoking to nail biting.19,20
Furthermore, there is evidence suggesting that GLP-1 RAs could have the potential to be a ‘magic bullet’ to tackle the unbearable strain obesity and its sequelae will have on global healthcare systems. An example is from the Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity study.21 Preliminary results from this study (a double-blind RCT) showed that a dose of semaglutide 2.4mg once weekly reduced major cardiovascular events (defined as cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) by 20% compared to placebo.21 The global community of epidemiologists, endocrinologists, cardiologists, primary care physicians and politicians await the full results.
The FDA approved Eli Lilly’s tirzepatide (Mounjaro) last year for the treatment of T2DM, marking the first and only compound that acts as a GLP-1 and GIP receptor agonist.22 It is surely only a matter of time before weight loss data is formally presented to attain an additional licence (preliminary reports are promising).
An innovative medication
Obesity is a complex multifactorial chronic disease. Innovations in therapeutics like GLP-1 drugs have the potential to be transformative for both patients and society. They could significantly reduce mortality (from catastrophic cardiovascular events) and morbidity (osteoarthritis) related to obesity. However, this does not address the underlying factors that make modern life such an ‘obesogenic’ environment. These include tackling the emotional and behavioural triggers for over-eating, lack of a tangible government strategy towards obesity prevention, lack of regulation over the food sector to limit or heavily tax energy-dense ultra-processed food and making healthy options more economically viable for all rungs of society. We as healthcare practitioners also have a duty to prescribe medications responsibly and educate our patients adequately. Responsible prescribing ‘on-label’ could have prevented the shortages diabetic patients are having to endure. It is also important to ensure patients who do not fall into the overweight or obese categories are screened for body dysmorphic disorder and made aware that no medication is risk-free no matter your age or perceived fitness levels. These risks include gallstones, kidney problems, pancreatitis and possible thoughts of suicide or self-harm. Patients should be offered education and encouragement to take a global approach to their health rather than looking for a quick fix.
Dr Kam Lally graduated from the University of Oxford, went on to qualify as a GP and is the Royal College of General Practitioners national aesthetic medicine lead. He is a global KOL for Teoxane, HansBiomed, AlumierMD and Novo Nordisk. In addition to being experienced in injectables, he runs a weight management service in his Aestheticology clinics in Coventry and Birmingham.
Qual: BMBCh (Oxon), BA (Hons), MRCGP (UK), PG Dip Aes Med
Dr Kam Lally will be speaking at the Medical Longevity Summit at CCR on October 20. Scan the QR code to register for free.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 43
THE REFERENCES AT AESTHETICSJOURNAL.COM
Uniting the specialty to shape the future of medical aesthetics.
Explore education that supports your medical aesthetic practice
• HITs by Galderma: The Balanced Profile with Dr Yusra Al-Mukhtar*
• Mother-daughter transformation with Allergan Aesthetics with Dr Tapan Patel and Dr Manav Bawa*
• The Power of Polynucleotides with Professor Maurizio Cavallini and Dr David Eccleston
• Cellular Ageing – Dr Nichola Conlon
Unveiling e-Magnescence with Mr Taimur Shoaib
NeoGen Plasma for Your Clinic with Dr Chris Rennie & Dr Raj Thethi
Longevity & Wellness
Ageing & Aesthetic Medicine with Dr Mayoni Gooneratne
Stem Cell Facial Rejuvenation with Dr Steven Cohen
The Power of Psychological Services with Kimberly Cairns
• New Licensing Scheme with Professor David Sines
• Marketing to LGBTQ+ Patients with Dr Vincent Wong
• Women in Business with Khatra Patterson
*Please note, due to the nature of the content at CCR, some sessions are open to practitioners on certain medical registers only, so please check before arrival. CPD points available to Aesthetics Full Members only.
Register free now
Dr Tapan Patel
Dr Yusra Al-Mukhtar
Dr Manav Bawa
Professor Maurizio Cavallini
Dr David Eccleston
Dr Nichola Conlon
Mr Taimur Shoaib
Dr Chris Rennie Dr Raj Thethi
Dr Mayoni Gooneratne
Dr Stephen Cohen Kimberley Cairns
Professor David Sines
Brought to you by Aesthetics
Dr Vincent Wong Dr Khatra Paterson
FEATURED HEADLINERS OCTOBER 27-28, 2023 © 2023 SCITON, INC. 925 Commercial Street, Palo Alto, CA 94303 1.888.646.6999 | firstname.lastname@example.org SHERATON GRAND LONDON PARK LANE PICCADILLY, LONDON, W1J 7BX, UNITED KINGDOM
Aesthetic Doctor ENTRY: £99 PER PERSON (PLUS APPLICABLE TAXES AND FEES) FOR MORE INFO & TO REGISTER
Dr Chris Robb, PhD
Treating the Perioral Area
Dr Nestor Demosthenous provides his advice for performing a successful treatment of the perioral area
This article is based on Dr Demosthenous’ personal experience and ultimate decisions regarding patient care lies with the treating HCP and the patient.
Practitioners should remember that the perioral area encompasses more than just the lips. Focusing solely on the lips can result in a conspicuous ‘done’ look. Instead, we should assess and address other areas like cheeks, chin, marionette lines, mental crease, and nasolabial folds to enhance overall facial support. Lip enhancement should be the final touch to achieve a harmonious result. For effective patient care, conduct thorough consultations to understand their true treatment needs and craft a successful treatment plan accordingly.
Product selection is key to a successful treatment. I love the Juvéderm® Vycross range as it produces longlasting and high-quality results, with proven patient satisfaction.1-4 I choose products based on individual concerns and treatment areas. For the perioral area and lip enhancement, I prefer less viscous, more hydrating options, particularly if the aim is to make the lips look fuller. I don’t disclose the filler quantity to patients because it varies based on individual needs. Patients with less volume may require more product to achieve their desired outcome. After the treatment, I do give patient’s the details of which filler and how much they have had.
A 38-year-old woman came to me for a consultation with concerns of looking tired and sad. After assessing her, I started treating her upper face first, injecting Voluma in the temples, Volux in the cheeks, Volift
in the infraorbital malar area and Volbella in the tear trough. Then, I moved onto her lower face. I worked on the chin due to her class II malocclusion, so I tried to adhere to feminine proportions of having her chin the same width as her nose. This helped to lift the corners of her mouth, adding some structure to the cupid’s bow using Volite (Table 1). I swapped between using a needle and cannula for different areas but treated with a needle in the lips, as in my experience is ideal for the vermilion border. The patient was extremely happy with the end result (Figure 1) and felt a lot more confident in her appearance.
My top tips for performing a successful perioral treatment are:
1. Use the consultation to properly assess the proportions of the face.
2. Perform a clean procedure – just because you are only injecting the lips does not mean you should only clean that area and not remove makeup from the entire face.
3. Have the skillset to be able to utilise both a needle and a cannula so you can choose the best tool for each area.
UK-JUV-230297 | DOP September 2023
Adverse events should be reported. UK reporting forms and information can be found at https://yellowcard.mhra.gov.uk via the MHRA Yellow Card app, available at Google Play or Apple App stores. Irish HCPs are asked to report any suspected adverse reactions via HPRA Pharmacovigilance; website: www.hpra.ie
Adverse events should also be reported to AbbVie on ProductSurveillance_EAME@allergan.com
MA et al Aesthetic Surg J. 2008;28:17–23. 2. Callan P et al Clin Cosmet Investig Dermatol
Murphy DK. Dermatol Surg
2013;39:1602–1612. 4. AbbVie. The highest standards of quality and safety. Available at: https://www.abbvie.com/societal-impact/for-the-well-
[Accessed November 2022].
47 Aesthetics | October 2023
This article is produced and funded by Allergan Aesthetics and is intended for healthcare professionals. Juvéderm® and this content is intended for adult (>18 years) audiences only
Dr Nestor Demosthenous, Allergan Faculty Member
©AbbVie 2023. All rights reserved. Material produced and funded by Allergan Aesthetics, an AbbVie company. www.allerganaesthetics.co.uk
Book Time With a Product Specialist: Sign up to the AMI digital world
Digital World is for UK Healthcare Professionals only
is for UK Healthcare Professionals only
Figure 1: 38-year old patient before and immediately after treatment using the Juvéderm® Vycross range.
Advertorial Allergan Aesthetics aestheticsjournal.com Treatment plan for patient using Juvéderm® range Treatment area MD CodesTM Product Product volume (ml) Left Right Total Zygomatic arch Ck1 Juvéderm® VOLUXTM 0.1+0.1+0.1 0.1+0.1+0.1 0.6 Anterior temple T1 0.2 0.2 0.4 Lateral lower cheek Ck4 0.5 0.5 1.0 Mandible angle Jw1 0.0 0.4 0.4 Anteromedial cheek Ck3 Juvéderm® VOLIFT® with Lidocaine 0.5 0.5 1.0 Tear trough Tt1-3 Juvéderm® VILBELLA® with Lidocaine 0.4 0.4 0.8 Labiomental angle C1 Juvéderm® VOLUMA® with Lidocaine 0.7 0.7 1.4 Chin apex C2 0.3 0.3 0.6 Lower prejowl Jw4 0.2 0.2 0.4 Lower anterior chin Jw5 0.3 0.3 0.6 Lips N/A Juvéderm® VOLITE® with Lidocaine 0.5 0.5 1.0
Treating Menopausal Patients with Filler
Menopause is something that will impact every woman at some point in their lives. The average age it occurs is 51, with perimenopausal symptoms usually starting from the mid-forties – although this can occur earlier in some women.1 Trouble sleeping, brain fog, low mood and anxiety are all some of the psychological challenges women face, while physical changes include vaginal dryness and pain, body shape changes, weight gain, headaches and migraines that are worse than usual, muscle aches, joint pain, hair loss and skin/facial changes.1
As aesthetic practitioners, it’s not unusual for us to see many women within the typical perimenopausal and menopausal age bracket of 45+ who are struggling with what they see in the mirror. Their ageing face can lead to a significant loss of confidence and self-esteem, which sometimes has a knock-on effect to other areas of their lives. Research in 2021 reported that 20% of 1,039 women aged 40-65 said the menopause led to a decrease in their self-confidence2, while a 2022 study of 2,161 women indicated that 67% experienced a loss of confidence in their abilities at work because of it.3
Ensuring we understand the impact that the menopause is having on our female patients is essential for our treatment planning. We need to establish whether an aesthetic treatment is going to have the desired impact and improve their journey through the menopause, or whether psychological help is most appropriate. A carefully planned and investigative consultation is our best tool to help us achieve this.
In my clinic, before a patient comes to me for their consultation, they are sent a medical history questionnaire to complete which also includes questions that explore their motivations for treatment. These ask open questions such as, ‘Why is it important for you to have this procedure at this particular time in your life?’ and closed questions which ask patients to say yes or no to a list of statements. These include things like, ‘I want to feel more confident in my personal and professional relationships’ and ‘I want to feel less self-conscious about my appearance’. By the time the patient enters my clinic, I have a much better understanding of who they are and what they want to achieve. Our one-to-one time then allows me to investigate these answers further, with particular focus on the menopause. I’ll ask them where they are on their menopause journey and what symptoms they have experienced so far. It’s also useful to know whether they are using hormone replacement therapy (HRT) or other treatment methods, and how they have impacted them. As oestrogen is responsible for bone remodelling and collagen stimulation, being on HRT means the patient may get better outcomes from treatment and notice the signs of ageing at a slower rate.4
After carrying out a detailed facial assessment, I then explain to patients how the face ages in general, why this happens at a much faster rate during their perimenopausal/menopausal years, and how this has impacted them personally. Lots
of women tend to feel vain or guilty about spending money on themselves, so I educate them on how a good aesthetic treatment will benefit them emotionally, citing research that backs this up.5 I explain how I can achieve natural-looking results, which will not only make them look better for their age but boost their confidence and self-esteem.
As with any consultation, if I notice any ‘red flags’ such as body dysmorphic disorder or depression that would contraindicate treatment, then I discuss these with the patient and advise them of alternative steps to take. Having referral pathways to other professionals in place is essential in ensuring your patient is treated appropriately. All the patient’s treatment options are then outlined to them, with a discussion of side effects and potential risks, while a two-week cooling-off period gives them time to consider their options.
Menopausal facial ageing
We know that, over time, a decline in collagen and elastin levels leads to thinner skin, sagging and wrinkle formation. Shrinking fat pads in the upper and mid-face leads to a loss of structure and fullness, while the lower face has a heavier appearance. Bone resorption also has a significant impact on facial shape and structure.6 It’s key to remember that ‘bone sets the tone’ when it comes to an ageing face. If we don’t have the scaffolding facilitated by the facial bones, then we will very likely have to use more filler and not get the desired outcome.
During menopause, all these changes are accelerated as oestrogen levels decline.7 While collagen drops by approximately 1% every year in non-menopausal women, menopausal women will lose around 30% in just five years and 2% every year following the menopause.8 The average rate of bone loss throughout the body is around 2% for one to three years before the menopause, which lasts for five to 10 years afterwards. Following this, bone density continues to decrease by about 0.5% each year.9
I often use the analogy cited by renowned anatomist Professor Sebastian Cotofana to describe the ageing process to patients: imagine a table (facial bones) with a tablecloth (skin) over it. If that table gets smaller each year, what happens to the cloth that remains the same size? It hangs downwards and folds appear, as the table no longer gives it support and structure.10 In my experience, using analogies such as this helps patients understand facial ageing and makes them more receptive to treatment plans.
Dr Raquel Amado shares her approach for addressing skin and volume changes in women going through the menopause
Figure 1: First three images show a 49-year-old patient before treatment with a HA filler to treat deep volume loss, followed by a hybrid HA and CaHA dermal filler. The second set three demonstrate results three months later. She was injected with 2ml of Intense, 1ml of Intense LV, 1ml of Intense Flux and 2ml of Stimulate – all from Neauvia. Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023
Before Three months later @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 49
AVAILABLE EXCLUSIVELY TO PROFESSIONAL SKIN CLINICS. Our home-care plans are tailored to target specific skin concerns, while enhancing and prolonging the results of your in-clinic treatments. Get in touch today for more information. 0800 019 5322 email@example.com aestheticare.co.uk/allskin-med @AesthetiCareUK Enhance your treatment results with the ALLSKIN | MED clinically proven skincare range.
My typical treatment approach
As discussed, menopausal patients generally have thinner, sagging skin with more noticeable lines and wrinkles that are rapidly worsened. To address these concerns, we need to consider replacing lost volume and stimulating collagen production for ongoing improvement. We know that dermal filler is essential for volume loss, with the use of hyaluronic acid (HA) based products being the most common approach. For collagen production, there are a number of clinically-proven options available, which include the use of microneedling and energy-based treatments such as laser and radiofrequency. While effective, these often require multiple treatments and will generally need to be offered in a separate sitting to the patient’s HA filler procedure. If you’re looking to provide your patients with injectable options, there are several biostimulators on the market. You can consider calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA) or polycaprolactone (PCL) based products. They all stimulate fibroblasts to produce collagen, generally last between 18-24 months and have excellent safety profiles.11,12 However, while they do have a non-permanent volumising effect, these fillers are not instantly reversible in the way that HA fillers are.
I have found that using a combination of HA and CaHA within a hybrid product is a hugely beneficial option for menopausal patients who are suffering from a rapid decline of both volume and collagen. The HA addresses volume loss in the deeper layers, while the microspheres of CaHA stimulate collagen production in the subcutaneous layer.13,14
While there don’t seem to be any studies exclusively on the use of biostimulators on menopausal skin, there are a number that include female participants of menopausal age. One from 2021 looks at the effects of combining HA and CaHA for mid-facial volume loss in 15 women aged 36 to 47. It found that six participants had ‘very improved’ results and nine had
‘exceptionally improved’ results. The authors reported that all women were highly satisfied dermal thickness had an increased by an average of 11%.15 In another study, 41 female patients with a mean age of 47.5 years were treated again with CaHA and HA in the mid-face and jawline. Results highlighted that 100% of the participants had experienced improvement, supporting the use of the product combination.16 Furthermore, a study looked at the effect of a hybrid HA and CaHA filler on human fibroblasts for 24 hours at increasing concentrations. Increments of collagen product 37.62% and 97.39% at concentrations of 1.25mg/ml and 2.5mg/ ml were considered to be statistically significant compared to untreated cells.17 Of course, there may be some patients who are unsuitable for injectable treatment, for example, if they are allergic to any of the ingredients used within the products, so I won’t recommend this approach and we’ll explore other options. As I don’t offer energy-based treatments at my clinic, if appropriate, I may refer them to one that does.
Choosing what product to use will come down to individual patients. We should consider how much volume loss they have and where, and how much time they are prepared to wait for a result. Of course, an immediate result is visible with HA, but it will take six to eight weeks to start seeing a difference from the CaHA.18
If a patient has deep volume loss, then I will generally use a HA product to address this first, followed by a hybrid filler as ‘the icing on the cake’. Not only can they expect to see an improvement in volume, but they will also notice an improvement in the hydration, firmness and flexibility of the skin.18 I generally perform the two treatments in one sitting, but they can be done separately if this works better for the practitioner and patient. Ensuring patients have realistic expectations of when to expect final results is key – I always advise it will take at least eight weeks for the collagen-stimulating
production to have an impact and book a review for this stage.
As with any injectable treatment, side effects can include redness, swelling, itching and discomfort immediately following the procedure.18 Of course, informing patients of these in advance is imperative to a successful treatment experience.
Offering a holistic service
With all patients, it’s important to provide a holistic approach to treatment. We need to consider every concern and the patients’ treatment expectations carefully, while acknowledging our limitations if there is something we cannot address. Not everything can be fixed with a syringe, so it’s essential to have referral pathways to experienced practitioners who can help with procedures that may be more suitable if necessary. This is particularly the case with menopausal patients who may have a myriad of symptoms that aesthetic procedures alone cannot resolve. Journals, social media, conferences and other events are excellent avenues to connect with fellow professionals. This offers opportunities to gain knowledge and establish valuable relationships with practitioners who can offer support and reciprocate assistance.
Dr Raquel Amado has 15 years’ experience as a practising dentist, is a Level 7 qualified aesthetic practitioner, senior clinical trainer for Harley Academy, key opinion leader for Neauvia and international speaker for AlumierMD. Dr Amado was Highly Commended for the AlumierMD Award for Rising Star of the Year at the 2023 Aesthetics Awards. Qual: LMD
Figure 2: First three images show a 68-year-old patient before treatment with a HA filler to treat deep volume loss, followed by a hybrid HA and CaHA dermal filler. The second set of three demonstrate results immediately after. She was injected with 2ml of Stimulate and 3ml of Intense LV – both from Neauvia.
Before Immediately after
Dr Raquel Amado will be speaking at CCR at the In Practice Theatre on October 20. Scan the QR code to register for free.
THE REFERENCES AT AESTHETICSJOURNAL.COM Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 51
Allergan Aesthetics are delighted to announce that Juvéderm® VOLUMA® is a Finalist for Best Injectable Product at the Safety in Beauty Diamond Awards 2023
Model treated with JUVÉDERM ®. Individual treatments and patient results may vary.
1. Go BC et al. Plast Aesthet Res. 2021;8:39. 2. Lipko-Godlewska S et al. Clin Cosmet Investig Dermatol. 2021;14:169–78. 3. Swift A et al. Aesthet Surg J. 2021;41:1107–19. 4. Juvéderm ® ULTRA 4 DFU. 73663JR10. Revision 2019-09-09. 5. Juvéderm ® VOLUMA with lidocaine DFU. 73650JR10. Revision 2019-09-09. 6. Kapoor KM et al. Clin Cosmet Investig Dermatol. 2021;14:1105–18. 7. Henderson A. Journal of Aesthetic Nursing. 2018;7:191–94. 8. Juvéderm ® VOLUX DFU. 73651JR10. Revision 2019-09-09.
Adverse events should be reported. UK reporting forms and information can be found at https://yellowcard.mhra.gov.uk or via the MHRA Yellow Card app, available at Google Play or Apple App stores. Adverse events should also be reported to AbbVie on ProductSurveillance_EAME@allergan.com Irish HCPs are asked to report any suspected adverse reactions via HPRA Pharmacovigilance; website: www.hpra.ie.
you want to You should always consult a healthcare professional to help you decide if JUVÉDERM® is right for you and provide you with a full list of side effects. JUVÉDERM® and this content is intended for adult (>18 years) audiences only. ©2023 Allergan Aesthetics, an AbbVie company. All rights reserved. Produced and Funded by Allergan Aesthetics, an AbbVie company. UK-JUV-230292 | September 2023
cheek volume and achieve a lifting effect to address concerns about sagging skin around the face with Juvéderm® VOLUMA® and Juvéderm® ULTRA 4.1-6
their lower face with Juvéderm® VOLUX ™ for chin projection and jaw shape.7,8
ENHANCE RESTORE SCULPT
TREAT & TRANSFORM
WORLD LEADING LED PHOTOTHERAPY
EMFACE in the Changing Aesthetic Landscape
Miss Sherina Balaratnam shares her experience of providing exceptional results with EMFACE in her clinic
In recent years, I feel the landscape of aesthetics has been changing. More and more patients are seeking treatments which fit seamlessly into their lifestyles, meaning minimal pain, no downtime and ideally non-invasive options. I’ve found that this is where EMFACE is the ideal choice.
EMFACE is a groundbreaking non-surgical treatment designed to rejuvenate and revitalise the skin.1,2 Through precise application of treatment pads to the forehead and cheeks, EMFACE is the first device to simultaneously apply synchronised radiofrequency (RF) and HIFES energies to improve facial muscle tone and density in just 20-minute sessions.3 Applicators placed on the frontalis create a lifted brow effect, whilst stimulation of the zygomatic major and
minor and the risorius can upturn the corners of the lips for a pleasing effect on patients’ expressions.
A study conducted by anatomist and researcher Professor Cotofana has shown that tighten the connective tissue in the face, as EMFACE does, leads to ligament and muscle tightening, consequently repositioning facial fat and skin to create a lifted and rejuvenated result.3 The device also stimulates the production of collagen and elastin to target common skin concerns such as fine lines, wrinkles, pigmentation irregularities and sagging skin.1,2 Backed by nine clinical studies across five global research centres, EMFACE delivers a 30% increase in muscle tone, 37% reduction in fine lines and wrinkles, 30% increase in collagen, 23% more lift and a double in elastin production.1,2
EMFACE in practice
I’ve had EMFACE in my clinic, S-Thetics in Beaconsfield, Buckinghamshire for almost a year now, and I have been offering it as a treatment option for all my patients. It works well for older patients who want to achieve an overall lift and address volume loss and sagging, but also for patients in their 20s or 30s whose skin can look instantly brighter and tighter.1-3 It has also been a fantastic new option for patients who may be cautious and want to avoid invasive treatments or have a needle phobia. It’s refreshing to be able to offer a completely non-invasive treatment that provides results which some patients feel rivals injectables, or which can be used as a great companion to injectable treatments. The procedure is suitable for all ages and skin types, meaning there are no limitations on who can experience results.1,2 We’ve received 100% patient satisfaction after receiving EMFACE treatments at S-Thetics, and they have reported feeling instantly more confident – those are the kind of results I love.
A new treatment philosophy
EMFACE has taken results across my entire patient base to another level. The tightening and lifting effect of the procedure produces great results in isolation, or as a solid framework for other treatments. It fits in perfectly with my clinic’s very simple philosophy of providing excellent results and experiences.
Miss Sherina Balaratnam is a surgeon and cosmetic doctor who has been specialising in non-surgical aesthetics for the last thirteen years. She practises from her multi-award winning aesthetic clinic S-Thetics in Beaconsfield, Buckinghamshire.
Qual: MBBS, MRCS (Edin), MSc (UCL)
Figure 2: Patient three months after fourth EMFACE treatment. Images courtesy of Dr Yael Halaas.
VIEW THE REFERENCES AT
Miss Balaratnam will be speaking on How to Prevent Ageing with EMFACE at CCR 2023. See her at 4pm on Thursday 19 October at the Innovation Stage. Scan the QR code to register for free.
This advertorial was written and supplied by BTL Aesthetics "Discover more about EMFACE"
Figure 1: 3D image analysis post-EMFACE treatment.
55 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 Advertorial BTL Aesthetics
Images courtesy/copyright of Miss Balaratnam of S-Thetics Clinic, UK.
Exploring Fasting Benefits For Aesthetic Patients
Fasting as a therapeutic intervention dates to the time of Hippocrates. Similarly, ketogenic metabolic therapy (KMT) diets have been used clinically for more than 100 years to reduce seizures in children with epilepsy.1,2 However, both fasting and ketogenic diets fell out of fashion as modern medicines and medical advances were made. Nevertheless, both fasting and ketogenic eating have made a resurgence in the last few decades as researchers, clinicians and patients search for answers to complex mental and physical health problems.
Concerns about safety exist, and these therapies are not suitable for all patients.3 However, the prudent application of these elegant and effective nutritional therapies can help guide and support aesthetic patients in reaching their health and aesthetic goals. In 2021, global management consulting firm McKinsey and Company estimated the global wellness industry to be worth $1.5 trillion USD, with an expected growth of 5-10% annually.4 The aesthetics industry is well-placed to make inroads in the wellness industry. Service users are equipped and ready to consider their own wellbeing and the prevention of ageing, which naturally dovetails with other clinical products and services provided in aesthetic clinics. Nutrition plays an integral part in health and antiageing, but with a plethora of unregulated nutritional advice and products available, care must be taken to ensure patient safety. It is also vital that nutritional advice and products recommended are both cost-effective and efficacious. Fasting and KMT are natural and holistic interventions. Both methods lead to nutritional ketosis, whereby ketones are produced in the liver from the metabolism of fat and used as energy. Ketones are measurable in the blood, breath and urine and have been shown to be neuroprotective, anti-inflammatory and anxiolytic.5,6
When someone chooses not to eat for a period of time, they are fasting. Some people avoid snacking between meals (a three to five hour fast), which is helpful for weight loss as it prevents insulin and glucose spikes.7,8 Some use intermittent fasting (also called time restricted eating) to limit their daily intake to a shorter window, usually 12 hours or less. Others choose to follow longer fasts of 24 hours or more. The longest recorded human fast was 382 days and was medically supervised at the Royal Infirmary of Dundee in 1965: the patient Angus Barbieri sustainably lost 117kg, drinking only water and black coffee or tea and taking a multivitamin alongside electrolytes.9
Longevity services allow individuals to stay fit and healthy for as long as possible whilst feeling and looking the best version of themselves, which is why the concept is intertwined with aesthetics. It can be a useful tool for patients to develop metabolic flexibility if they are struggling with their weight. People fast for various lengths of time and each plan can be personalised to suit the individual. Today, we are fortunate to enjoy continuous access to energy dense and readily available food. Throughout human history there have been long periods of food scarcity, interspersed with periods of plenty. Body fat accumulates during times of plenty, and is ergonomically stored around the waist, hips and thighs, making it a portable energy source.
When there is no available food, a metabolic switch occurs and body fat can be metabolised instead, producing ketones, which have been shown to be a preferred source of energy for the body and brain.10 It makes sense from an evolutionary point of view that ancestors who were hungry or ‘fasted’, and had more energy to seek food and defend themselves, were likely to survive. This helps explain the increase in energy and vitality that people feel when they fast.
When, or how often, we eat may be more important than what we eat. In a recent review in the New England Journal of Medicine, intermittent fasting was reported to be an effective first-line treatment for several chronic conditions including obesity, diabetes, cardiovascular disease and even neurological conditions and cancer.11 The physiological stress of fasting produces positive benefits at a cellular level. Distinct from emotional stressors, the prudent use of physical stressors such as intense workouts, hot and cold therapy, caloric restriction and fasting has been shown to activate longevity genes and extend life – a process also known as hormesis.12
Fasting has been shown to also benefit women for improved reproductive health and cancer prevention.13 Special considerations, however, must be made. Traditionally, scientific research has been carried out largely on men because of the confounding and obfuscating effects of the hormonal cycle.14 It is precisely this hormonal cycle (both endogenous and exogenous) which must be considered when hormetic or physical stressors are applied. Limited studies are available, but clinical experience shows that hormetic stressors are less well tolerated in the late luteal phase.15-19 Therefore, in clinical application, fasting and
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 56
Dietician Sascha Landskron provides an overview of the possible benefits of fasting and ketogenic metabolic therapy for aesthetic patients’ mental and physical health
KMT should be initiated in the first three weeks of a menstrual cycle. Fasting should not be attempted in children, pregnant or breastfeeding women due to increased requirements for growth and development. Studies in humans are limited so more research needs to be conducted in this area. It is also not safe for patients who are underweight or have a history of eating disorders or severe micronutrient deficiencies. The SCOFF questionnaire is a validated tool for detecting eating disorders in a variety of populations and settings.20 Careful medical monitoring is advised for those fasting longer than 24 hours, to ensure safety.21
Ketogenic metabolic therapy
KMT is also called a ‘fasting mimicking’ diet. In essence, it is a diet that is very low in carbohydrate, moderate in protein and high in fat.22 Personalised macronutrient requirements should be determined based on the patient’s age, weight, height, activity level and personal goals such as weight loss, blood glucose control or management of psychiatric or neurological symptoms.23 It is also good practice to include a multivitamin and mineral supplement in any KMT protocol.24 Being in ketosis can lead to a range of health benefits. The use of KMT has been shown to be an effective treatment in metabolic conditions such as type 2 diabetes and complex mental health conditions such as bipolar disorder.5,25 These conditions are closely linked in a bidirectional way. There is an emerging understanding that metabolic function affects both mental and physical health. When metabolic function improves, patients experience improvement in both physical and mental health.6,26 KMT is useful for patients struggling to manage their weight and appetite. Results can be seen within a few weeks, however, several months of KMT are required in those with insulin resistance.6,26 Ketones improve metabolic function at a cellular level, improving mitochondrial function, which increases cellular energy (ATP) production.27 Well-functioning mitochondria also play a part in regulating metabolism, detoxifying reactive oxygen species and eliminating old and damaged cells (autophagy).28-30 Taken all together, KMT can be seen as a pathway to facilitate a variety of health and aesthetic goals. However, this approach is not without risks. As dietary carbohydrates are reduced, circulating insulin levels decrease, which can trigger the kidneys to excrete fluids and electrolytes. This phase can be associated with dehydration or electrolyte imbalance and
is commonly referred to as ‘keto flu’, which describes how it feels, with headaches, muscle aches and irritability.31 This adaptation phase is generally short-lived and can be managed or even prevented by the slow initiation of KMT, adequate fluid intake and electrolyte supplementation.23 KMT should not be initiated in pregnant or breastfeeding women, but one study suggests it may improve fertility prenatally.32 KMT should also be avoided in diabetics taking sodium-glucose co-transporter-2 (SLGT2) medications, due to the increased risk of ketoacidosis.33
Elevated low-density lipoprotein (LDL) cholesterol can occur with KMT. It is not clear if this is a clinical concern, as KMT tends to lower insulin, HgA1c, waist circumference and serum triglycerides, imparting a cardioprotective effect. The elevated LDL is likely an indication of circulating lipoproteins in response to fat being used as a fuel source.34,35 The validated QRISK3 prediction tool can be used to assess and manage patients in ketosis to evaluate and monitor their cardiovascular risk.36 Blood levels of various metabolic and nutritional indicators should be taken at the start and after one to three months of KMT to ensure that the diet is producing the expected benefits i.e. reduced inflammation, triglycerides and HgA1c.36
Intuitively, any eating style that requires close attention to detail and the restriction of certain foods groups (grains, fruits, legumes, etc.) should not be used in patients with eating disorders. Interestingly, KMT has been shown to be an effective treatment in anorexia nervosa.37 The proposed mechanism for the positive response to KMT in AN is the anxiolytic effect of the circulating ketones, which would also be produced in activity-based anorexia.38
Furthermore, there may be a synergistic effect of nutritional ketosis with psychiatric medications.39 Patients with severe mental health issues such as generalised anxiety and eating disorders need specialist psychiatric management and should not present for KMT treatment in an aesthetic practice. It is worth noting, however, that the generalised improvement in anxiety and mood whilst in ketosis is an observable effect in many patients who achieve therapeutic levels of ketones.40
Recommending fasting and KMT to aesthetic patients
Providing patients who are not in any of the contraindicated groups above, fasting and KMT can be used to augment an aesthetic
patient’s clinical journey. Patients may choose to start with fasting between meals, i.e. not snacking. They may also start working towards a 12-13 hour overnight fast. These can be slowly extended by 30-60 minutes each 24 hours, and there are plenty of apps that help record and monitor fasting windows. Furthermore, aesthetic patients may benefit from fasting or KMT if they are looking to lose weight or are undergoing body contouring procedures to help reduce pockets of fat. In one study of 45 women aged between 35-60 years old, fasting has been shown to improve skin quality and texture over the course of 71 days.41
For patients interested in KMT, specialist advice is recommended as the diet is challenging in the first few weeks and months. To test a patient’s interest and ability to follow KMT, they can try eliminating carbohydrates from their breakfast, or the first meal of their day, the one that ‘breaks the fast’. This test meal should be free of carbohydrates, like bread, cereals, granola, muesli and sugar (in all its forms). It should be based on whole proteins, vegetables and healthy fats. If patients try this approach and feel they have better energy and satiety, with fewer carbohydrate cravings, they may be eligible for KMT.
An individualised approach
There are many clinical benefits to recommending fasting and KMT, but some patients may find these approaches challenging. For many patients, optimising their nutrient intake, managing food allergies and intolerances and reducing processed foods and refined carbohydrates can also produce substantial benefits. Any nutritional plan is most effective when personalised to suit the individual. If practitioners are not experienced in this particular area of nutrition, then it would be helpful to partner with a professional who can help your patients or to have a support network in place in case of referral.
Sascha Landskron is a registered dietitian and director of UniNutrition Ltd. She has more than 20 years of clinical experience, working internationally with people of all ages. Landskron specialises in personalised nutrition, weight management, nutritional genomics, therapeutic ketogenic diets, fasting, food allergies and intolerances.
Qual: BSc, MSc, BDA, HCPC
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 57
Designed to treat all phases of aging, hyperpigmentation, acne, couperosis, rosacea, stretch marks and other imperfections. An extensive range of specific peels for creating tailor-made, personalised treatments, session after session, for a progressive result.
Designed to treat all phases of aging, hyperpigmentation, acne, couperosis, rosacea, stretch marks and other imperfections. An extensive range of specific peels for creating tailor-made, personalised treatments, session after session, for a progressive result.
Designed to treat all phases of aging, hyperpigmentation, acne, couperosis, rosacea, stretch marks and other imperfections. An extensive range of specific peels for creating tailor-made, personalised treatments, session after session, for a progressive result.
01625 529 540
mesopeel TCA 35%. General application. Total no. of sessions: 1. mesopeel melanoplus. Focal application. Total no. of sessions: 4 (15 day intervals). 3 months after the last session before 1 month after the last session before that guarantees clinically proven results
mesopeel® advanced dermapeels by mesoestetic® firstname.lastname@example.org www.mesoestetic.co.uk tel 01625
mesopeel TCA 35%. General application. Total no. of sessions: 1. mesopeel melanoplus. Focal application. Total no. of sessions: 4 (15 day intervals). 3 months after the last session before 1 month after the last session before
most advanced range that guarantees clinically proven results
mesopeel® advanced dermapeels by mesoestetic® email@example.com www.mesoestetic.co.uk tel
mesopeel TCA 35%. General application. Total no. of sessions: 1. mesopeel melanoplus. Focal application. Total no. of sessions: 4 (15 day intervals). 3 months after the last session before 1 month after the last session before
most advanced range that guarantees clinically proven results
mesopeel® advanced dermapeels
firstname.lastname@example.org www.mesoestetic.co.uk tel
01625 529 540
Entries for 2024 are open now!
• 6th November 2023
Early Bird ticket sales end:
• 31st December 2023
• 2nd January 2024
• 2nd January 2024
• 1st Feb 2024
• 16th March 2024
aestheticsjournal.com @aestheticsjournaluk aesthetics Submit your entry here
A Retinol Revolution
Introducing the next generation of botanically boosted retinol from iS CLINICAL
iS CLINICAL’s cosmeceutical portfolio expands this autumn, with a groundbreaking retinol innovation powered by two decades of scientific research.
The highly active, fast-acting Retinol+ Emulsion 0.3 and 1.0 are unique resurfacing formulae designed to deliver transformative results and elevate the patient’s skincare journey. Both products feature a retinol of botanical origin that is encapsulated with bio-identical lipids, providing easy delivery to the skin to improve its resilience and long-term condition.
The nourishing Retinol+ Emulsion duo is a comprehensive solution that addresses a multitude of skin concerns. The proprietary blend of bakuchiol, plus powerful botanical boosters, antioxidants and Extremozymes® effectively targets fine lines, deep wrinkles, uneven skin tone, rough texture and blemishes.1,2 Moreover, it works to enhance the complexion by smoothing, softening and brightening, while also promoting improved skin firmness and elasticity. Offering additional practitioner exclusivity, Retinol+ Emulsion 1.0 is a professional-strength formula recommended for use only as advised by a licensed professional.
Why iS CLINICAL?
In an era of positive ageing, the independent and privately owned brand has always pioneered pharma-grade, botanical formulations that are clinically proven to help patients ‘age well’. This new product duo is no different, being backed by science and aligned to aesthetic professional standards.
Retinol+ Emulsion 0.3 and 1.0 are backed by rigorous scientific research and iS CLINICAL’s commitment to evidence-based formulas.1,2 In gene activation studies with a protocol designed to mimic at-home use, Retinol+ Emulsion 0.3 and 1.0 significantly influenced gene expression in the skin when compared to the control.1,2 Differential gene expression was demonstrated for 3,233 genes, positively impacting upregulated processes including wound healing and skin repair, controlled apoptosis, antioxidant activity, skin homeostasis and dermal-epidermal junction (DEJ) maintenance.
Unique botanical blend
Retinol+ Emulsion 0.3 and 1.0 boast a proprietary botanical blend including ascorbic acid, colloidal gold and glutathione 0.5%. This stable vitamin C derivative provides easy epidermal penetration due to a smaller molecular weight, further aiding collagen production. Bakuchiol (1.0%), chlorella vulgaris extract and lecithin (2.0%) synergistically boost the retinol’s performance, whilst preventing fine lines and reducing hyperpigmentation. The unique blend is both keratolytic and anti-inflammatory, able to preserve and improve skin health and integrity.
Controlled delivery system
Retinol+ Emulsion 0.3 and 1.0 deliver an encapsulated stable retinol for controlled release, ensuring maximum efficacy while minimising potential irritation. This provides patients with the assurance of receiving the full benefits of retinol without compromising on comfort.
Purity and safety
iS CLINICAL’s unwavering commitment to purity means Retinol+ Emulsion 0.3 and 1.0 are non-systemic and considered safe for use during pregnancy and nursing, aligning with a dedication to safe and effective treatment.1,2
With the Retinol+ Emulsion 0.3 and 1.0 formulation, it’s easier than ever to integrate into post-procedure regimens, enhancing patient results and satisfaction.
The professional-strength advantage
Distributed in the UK and Ireland by Harpar Grace International, iS CLNICAL’s commitment to in-clinic skincare solutions continues with Retinol+ Emulsion 1.0. The professional strength formula is a catalyst for growth that amplifies clinic sales, complements in-clinic regimens and ushers in a wave of new patient acquisition. Alana Chalmers, founder and CEO of Harpar Grace International, comments, “With extensive research and expertise backing every drop, Retinol+ Emulsion 0.3 and 1.0 are poised to disrupt the vitamin A and retinoid landscape. Powered by science and perfected through research, these formulas will set a benchmark for efficacy, safety and results in the field of cosmeceutical retinol skincare.”
1. ‘Retinol+ Emulsion 0.3 Gene Activation Study’ Science of Skincare (2023).
2. ‘Retinol+ Emulsion 0.3 Dermal Epidermal Junction (DEJ) Effects’ Science of Skincare (2023).
This advertorial was written and supplied by Harpar Grace International.
To discover more about iS CLINICAL’s cosmeceutical portfolio including Retinol+ Emulsion 0.3 and 1.0, please contact Harpar Grace International. www.harpargrace.com email@example.com
(+44) 2038 686242
61 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 Advertorial iS CLINICAL
Discover the wonders of Polynucleotides An Italian cellence ce 1 9 52 OFFICIAL DISTRIBUTOR IN THE UK Visit us today to boost your patient’s results Mastelli® injectable solutions are Medical Devices Class III (CE 0373) – For medical use only
Combining Light Therapy with Polynucleotides
Nurse practitioners Kate Monteith-Ross and Eleanor Turrell share their preliminary research into combining polynucleotide and LED treatments for skin rejuvenation
Skin ageing is a multifactorial process influenced by both intrinsic and extrinsic factors. Various modalities, such as light therapy and regenerative biologics, have been explored for skin rejuvenation. Light therapy, including light emitting diode (LED) and laser devices, have demonstrated efficacy in stimulating collagen synthesis, improving skin texture and reducing signs of ageing. Short DNA fragments called polynucleotides (PN) have shown promise in wound healing and tissue regeneration.1-3
Here, we present three case studies from our preliminary research into these combined modalities. We have found this approach has the potential to be an advanced treatment option for skin rejuvenation.
The use of polynucleotides has shown promising skin enhancement results due to their ability to stimulate cellular repair and regeneration processes. They exert their effects by activating key cellular pathways involved in skin rejuvenation, plus enhancing fibroblast proliferation, promoting collagen synthesis and increasing the production of growth factors.1 Moreover, polynucleotides possess antioxidant properties, protecting the skin from oxidative stress-induced damage and modulating gene expression, favourably regulating the synthesis of extracellular matrix components.1
The brand of polynucleotides used in this research was Plinest (PN-HPT) from Mastelli (distributed in the UK by DermaFocus) as we have been seeing promising results using the product, but there are a growing number of polynucleotide options on the market. In a consensus study of eight practitioners, including plastic surgeons and aesthetic doctors with extensive experience in skin treatments, researchers agreed that as well as offering an excellent stand-alone procedure, polynucleotides can be useful as a ‘skin-priming treatment’.1 They noted that this is especially true when used prior to light therapy, laser, dermal filler, peeling, needling and surgery-based treatments.1
Light therapy, also known as LED therapy, is a non-invasive treatment modality that utilises specific wavelengths of light to promote skin regeneration and rejuvenation. It has gained popularity in the field of aesthetic medicine due to its numerous benefits for the skin, achieved by stimulating the production of collagen – a key structural protein responsible for skin elasticity and firmness.2,3 By activating fibroblasts (the cells that produce collagen), the overall texture and tone of the skin is improved.2,3
The different wavelengths of light used in LED therapy penetrate the skin at varying depths, reaching the mitochondria within cells. This energy absorption stimulates cellular metabolism, leading to increased energy production and improved cellular function.2,3
The enhanced cellular activity promotes skin repair and regeneration, as well as having anti-inflammatory properties that can be beneficial for various skin conditions including acne, rosacea and eczema.2,3 The light wavelengths used in the therapy help reduce redness, swelling and inflammation, thereby promoting a calmer and healthier complexion.2,3
The regenerative effects of light therapy make it useful for accelerating wound healing.
The therapy improves blood circulation, which enhances the delivery of oxygen and nutrients to the skin cells. This facilitates the healing process and can be particularly beneficial for post-surgical wounds, scars and other skin injuries.2,3
The light therapy device used in this research was Dermalux Tri-Wave MD (distributed in the UK by Aesthetic Technology Ltd). We have used this device in the clinic for several years, both as a stand-alone treatment and in combination with other procedures.
We selected three patients to trial this combination treatment. The plan was to treat them with at least four sessions of polynucleotides, with a 28-day window between one another. Two light therapy procedures were to be administered – one immediately after each polynucleotide session, and another in between sessions. Prior to the polynucleotide treatment, we ensured all patients had a 3D Visage skin analysis scan to determine the severity of different factors such as acne, fine lines, wrinkles, surface pigmentation, deep pigmentation and pore size. This was conducted again after the treatment protocol was completed.
All patients were also asked to complete a self-evaluation form before and after treatment, based on a generic scoring parameter that we created – a rating of 1 would signal they were extremely unhappy with the result, with 10 indiciating that their skin looked the best it ever had. They also had full-face photographs taken for medical record documentation, as well as before and after comparison. All patients signed an informed consent form.
All three patients underwent the following treatment protocol:
• 2ml of PN Plinest every three weeks for a total of four sessions, administered to the periorbital, cheeks, nasolabial and jawline via cannula and superficial bolusing
• LED Dermalux light therapy session for 10 minutes after each treatment, with three 20-minute sessions of LED in-between PN weeks
In this article, we outline the case studies, where the combination of light therapy and polynucleotides was shown to synergistically enhance collagen synthesis, elastin production and overall skin quality, leading to improved texture, elasticity and reduction in wrinkles.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 63
Outstanding results for skin and hair ASCE SRLV Dr S. Damree, MD ASCE HRLV Dr I. Defelipe, MD EXOSOMES THE FUTURE OF REGENERATIVE AESTHETICS B e st C o s m etic s E xoCoBioInc A SCEplus HRLV firstname.lastname@example.org www.evocyte.co.uk Phone 020 7830 9702, 07570 060 926 exosomesuk
Case study one
The patient was a 38-year-old female, who had no past medical history, but had previous aesthetic treatments such as dermal fillers, skin boosters and facials to help with her dehydrated skin and acne. We had last injected fillers to her mid-face and chin 18 months prior, which gave a good result, but she was now due more treatment and continued to suffer from hormonal acne that flared in line with her cycle. While we could manage this with skincare, it was difficult to treat the pitting and thick, fibrotic and dehydrated tissue.
Before administering more filler treatment (our plan was to address mid-face fat loss, as well as hollowing in the medial and lateral SOOF), we wanted to improve the patient’s skin quality. We knew it would be difficult to get a great result because the fibrotic tissue was heavy, and she would not be suitable for tear trough treatment due to crepiness in this area.
This is why the patient was selected for the polynucleotides and light therapy treatment –if we could improve these skin concerns, we knew she would get a better filler result. We used a combination of cannula and bolus injection techniques to be as
precise as possible with our delivery of the polynucleotides in order to best manage the fibrotic tissue and improve skin quality. Short-term side effects included erythema and periorbital oedema, however, the patient reported that this did not last longer than 12 hours post-treatment (Figure 1). Skin analysis results demonstrated an improvement in surface pigmentation (55.53%-51.2%), sensitivity (79.2%-65.1%), wrinkles (60.4%-47.8%), pores (65%-61.7%), deep pigmentation (45.9%-42.3%) and acne and inflammation (73.8%-72.9%). The patient completed a perception rating of her results before and after treatment. She scored her upper eyelids as improving from 6/10 to 7/10, tear troughs from 3/10 to 7/10, mid-face from 3/10 to 7/10, jowls from 5/10 to 7/10 and neck from 8/10 to 9/10.
From a practitioner perspective, we felt the results demonstrated exceptional improvement. The LED blue light helped ameliorate the patient’s acne, while an improvement in skin sensitivity and inflammation was also noted. Her skin also felt smoother and more hydrated, and we could feel much less resistance driving the cannula through the skin compared to the first, indicating an improvement in tissue
quality. While we previously felt this patient could not have hyaluronic acid treatments like dermal filler because of the laxity in her tissue, we now feel they are an option following polynucleotide and LED procedures, opening up new treatment options for her.
Case study two
This patient was a 65-year-old female who had concerns with skin texture and laxity. The patient had previous aesthetic treatments, including dermal fillers and skin boosters 12 months prior. She was particularly concerned by her perioral area. She was a smoker, which had impacted this region. The patient said her static and dynamic lines, marionette lines and the length between her alar base and lip bothered her. She also felt as though her skin was almost translucent, noting that it had lost its glow.
Upon assessment, we felt that the issues she was describing were not actually about volume, but about skin and tissue-related issues. We explained this to her, which she understood.
The patient did not suffer with any side effects following treatment (Figure 2). The patient’s skin analysis results showed improvement in surface pigmentation
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 65
After Before After After Before Before
Figure 1: 38-year-old patient’s lower face, periorbital area and full-face before and 15 weeks after combination treatment with polynucleotides and LED therapy. Marked improvement noticeable in acne scarring, skin texture and under-eye wrinkles.
Before After Before After Before After
Figure 2: 65-year-old patient’s full-face before and 15 weeks after combination treatment with polynucleotides and LED therapy. Marked improvement noticeable in skin laxity, tear troughs, jowls and neck.
Conferences | Journal | Digital | Awards New membership coming soon. Join today to benefit from pre-launch prices. Discover, learn, network & celebrate with Aesthetics AESTHETICSJOURNAL.COM @AESTHETICSJOURNALUK Are you contributing to your professional development? Aesthetics offers a constant resource of CPD-certified education, to build your skills and further your career. Join a community of practitioners dedicated to helping patients. Share knowledge with your peers at: 16 March 2024 | Grosvenor House, London
(49.5%-40.5%), sensitivity (81.3%-59.4%), wrinkles (81.6%-67.1%), pores (55%-48.6%), deep pigmentation (41.9%-40.2%), and acne and inflammation (93.8%-81.1%). In her perception rating, she scored her upper eyelids as improving from 5/10 to 7/10, tear troughs from 5/10 to 8/10, mid-face from 5/10 to 8/10, jowls from 4/10 to 8/10 and neck from 4/10 to 9/10.
We noticed that by treating the face, we created not only an improvement in the overall texture and glow of the skin, but also a lift in the lower third and the neck and perioral region. Upon animation, the area did not look as extended as it previously did. There was clear softening in the static and dynamic lines. Our plan moving forward is to treat the patient’s neck with PN to further improve the tightening effect, before restoring lost volume in the mid and lower third of the face.
Case study three
Our final patient is a 68-year-old female who had no past medical history. Her concerns were signs of ageing, dull skin and large pores. She also felt that her lower face and mouth area were very lax. She had previous skin booster treatments and dermal filler to the lateral and medial cheek, as well as the jawline. Her last treatment was 15 months ago and she came to clinic to discuss top-up filler treatments. She mainly wanted to look at treating around her mouth and lower face which she felt was jowling, as well as discussing options for the skin quality on her neck. We performed the first treatment using a cannula, but then moved to a bolus technique which the patient tolerated a lot better. She did not suffer any side effects following treatment (Figure 3). This patient’s skin analysis results showed improvement in surface pigmentation (33.8%-29.8%), sensitivity (71.6%-57.2%), wrinkles (78.5%-52.7%), pores (82.7%-61%), deep pigmentation (61.3%-53%), and acne and
inflammation (61.1%-26.8%). In her perception rating, she scored her upper eyelids as improving from 3/10 to 6/10, tear troughs from 4/10 to 7/10, mid-face from 5/10 to 8/10, jowls from 2/10 to 8/10 and neck from 3/10 to 9/10. From a practitioner standpoint, significant improvement in the patient’s neck and jawline was noted, and we were really happy with the lift in her lower third. The patient chose not to go ahead with filler treatment afterwards, as she deemed that the improvement she saw in her tear trough, jowls and neck fulfilled what she was hoping for. She has instead opted to continue with regular PN and LED treatments to enhance her skin quality.
The preliminary findings of these cases suggest that synergistic effects of combining light therapy with polynucleotides for skin rejuvenation can be attributed to their complementary mechanisms of action. Light therapy stimulates fibroblast activity and neocollagenesis through photobiomodulation, while polynucleotides provide bioactive molecules that promote cellular proliferation, angiogenesis and tissue repair.1,2 Together, these modalities enhance the regenerative processes and optimise skin rejuvenation outcomes.
The safety profile of this combined approach appears favourable, with minimal adverse effects reported in the reviewed case studies. Mild and transient erythema and oedema were the most reported side effects, resolving without intervention.
Limitations and research
Further research is needed to establish the long-term safety and potential contraindications of this combined approach. The main limitation of this study was the size
of the patient cohort. Unfortunately, a number of patients dropped out of our initial sample for a variety of reasons, including breaking the restrictions of not having other treatments and being unable to commit to the time frames required.
In future, it may be worth considering split-face studies, which can determine the impact of light therapy with PN vs. PN alone vs. LED alone. Again, a wider pool of participants would be beneficial.
Another consideration could be trialling the LED before the PN treatments to see if this has any impact. In addition, working with fellow practitioners to peer review results could bolster them and add further credibility to this research.
Novel skin rejuvenation
Combining light therapy with polynucleotides represents a promising strategy for achieving enhanced skin rejuvenation outcomes. This synergistic approach holds potential for improving skin texture, elasticity and reducing signs of ageing. Future research should focus on optimising treatment protocols, investigating long-term safety and exploring the potential use in different patient populations. In our view, the integration of light therapy with polynucleotides has the potential to revolutionise non-invasive skin rejuvenation treatments, providing patients with more effective and personalised therapeutic options.
Kate Monteith-Ross is a registered nurse with a Master’s in adult nursing, and experience in plastic surgery and surgical care. She is currently studying for her independent prescribing qualification. She is the founder and director of a CQC-registered practice The Clinic by La Ross in Kent, Urban Training Academy and The Nurses Network community support platform.
Qual: BA, MSc, PGCE, RGN
Eleanor Turrell is a registered nurse with a background in surgical care. She has been mentored by Kate MonteithRoss for more than 18 months, developing her passions for medical aesthetics and regenerative treatments. Turrell is about to start her independent prescribing course.
Qual: BSC, RGN
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 67
Before Before After After
Figure 3: 68-year-old patient’s full-face before and 15 weeks after combination treatment with polynucleotides and LED therapy. Marked improvement noticeable in skin laxity, tear troughs, jowls and neck.
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Examining BDD in Aesthetics
Mental health nurse prescriber Claire Newman takes a look into the history of body dysmorphic disorder and how it manifests in aesthetics
Body dysmorphic disorder (BDD) is more than a worry or apprehension about appearance – it is a serious and debilitating mental illness. It is characterised by the World Health Organization (WHO) as a ‘persistent preoccupation with one or more perceived defects or flaws in appearance that are either unnoticeable or only slightly noticeable to others’.1 It is important not to confuse current trends, individual perceptions of beauty and societal values with body dysmorphia, although they can certainly play a role. People suffering with BDD have a distorted view of themselves, resulting in extreme self-consciousness, often with ideas of feeling judged and/or that their flaws are being discussed.1 As a result, they may display repetitive and excessive behaviours such as repeated checks of their appearance, extreme attempts to hide the perceived defect, avoidance of situations/triggers that escalate distress about the perceived flaw.2,3 The symptoms are severe enough to cause substantial distress or harm to all aspects of daily living, including personal relationships, family dynamics, social activities, education or occupation.2,3
As a result of this excessively negative self-perception, people may experience
loneliness or isolation, with frequent feelings of embarrassment and guilt which can consequently manifest in a decline in mental health, as well as co-occurring or co-morbid disorders such as depression and anxiety.4 The development of maladaptive coping mechanisms such as anxiety, suicidal thoughts and self-harming behaviour can arise.5 BDD typically starts and is more prevalent in adolescents, although it can start as a young adult.6,7 More research is required regarding BDD in older age groups, as it’s certainly not a condition reserved just for the young. BDD can be influenced by social media, which can generate unrealistic expectations, peer pressure, bullying and cultural pressure and assumptions of beauty.8 BDD varies across cultures, generations, and gender. People are typically at a higher risk of BDD if they have a history of depression, substance misuse, eating disorders, obsessive compulsive disorders or social phobia.9
History of BDD
Dysmorphia was first recorded in 18451850, originating from the Greek term ‘dysmorphophobia’ meaning ugliness or misshapen.10 BDD has existed and been quoted throughout history, but was only
categorised and described as a disorder in 1983.10,17 Italian psychiatrist Guido Morselli first described BDD in 1891.11 He observed a person with no physical deformities but perceived themselves as being ugly; Morselli described this emotion taking over their life, resulting in unhappiness which meant their psychological condition stopped being ‘normal’.11 French psychiatrist Dr Pierre Janet (1859-1947) described BDD as ‘l’obsession de la honte du corps’ (obsessions of shame of the body).12 Dr Janet discussed an instance of a woman becoming housebound for five years due to the belief that she had a moustache.12 She described anxiety, agitation and distress because she felt mocked, believing that her neighbours were shouting ‘hairy, hairy!’12 Ultimately, it was concluded that she had an obsessive-compulsive disorder.12 The most recognised early case of BDD was ‘wolf man’, who was described by psychologist Sigmund Freud in 1909.13 Russian aristocrat Sergei Pankejeff (1886-1979) had a preoccupation that his nose was ugly, preventing him from going out or working. He would constantly check his appearance and carry a mirror around with him. Pankejeff’s preoccupations with his appearance caused him substantial social suffering as he avoided going out in public.14 Over a number of years, he experienced mood fluctuations between depression and elation, believing that initial treatment from Freud worsened his symptoms rather than curing them.14 Pankejeff claimed that he eventually ‘cured’ himself with his own behavioural programme.14
In 1966, author G.A. Ladee theorised ‘dermatological hypochondriasis’, describing cases of preoccupations with a person’s skin and hair.15 In 1980, the American Diagnostic and Statistical Manual (DSM III) was the earliest diagnostic manual to refer to dysmorphophobia, referred to as an ‘atypical somatoform disorder’.16 This was revised in 1983, with the phrase body dysmorphia disorder being used and acknowledged as a separate illness for the first time.17 The 2013 edition classified BDD within the chapter on obsessive-compulsive and related disorders section.18
The concept of beauty
To understand BDD and other anxieties related to appearance, it is important to understand the concept of beauty. The significance of physical appearance in society is not a novel phenomenon and has links to evolutionary theories relating to youth and reproductive abilities.19 According to Darwin’s theory of natural selection, specific physical
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 68
According to the Body Dysmorphic Disorder Foundation…25
• A total of 1-2% of the UK’s adult population is affected by BDD
• 1% of children aged between 5-19 years are affected by BDD
• BDD disproportionately affects young women and girls aged between 17-19, at 5.6% of that demographic
• BDD is associated with a high suicide rate, with 1 in 50 people suffering with the disorder trying to end their life
• There is a high comorbidity with those suffering with BDD with depression, anxiety and eating disorders
characteristics have evolved not because they help with survival, but because of the benefits of attracting a mate for reproduction.20
Perception of youth and attractiveness changes over time and across cultures, with various motivations as the driving force. Philosopher Immanuel Kant noted that beauty is subjective and varies from each person.21 However, his philosophical predecessor Aristotle did not agree with this, considering beauty to be objective, defining it by symmetry and proportions.21 It could be easy for aesthetics to take on an objective slant if patients are treated according to pre-determined criteria symmetry, proportions and ratios, potentially leading to greater patient insecurities if they do not fit this ideal. Patients should be treated individually and holistically, and their treatment plan should consider their own subjective views of what they perceive as being beautiful and how they would like to look. A person may have a certain ‘look’ they want to achieve. It may not fit in with our perception of beauty, but it does not mean that this person is suffering with BDD, particularly if there is an absence of the aforementioned symptoms.
Prevalence of BDD
Available statistics only incorporate those presenting with symptoms of BDD who have sought help from services. It is important to note there are many people with BDD who are not seeking help from mental health services for a variety of reasons.
Approximately 2% of young people suffer with BDD,22 with 50% reporting they want aesthetic treatments.23 BDD may also be overlooked in these patients, and possibly perceived as a phase of adolescence.2 Symptoms can be missed because some do not talk about it due to feelings of embarrassment over their appearance or their state of mind, and concerns about whether others may perceive them as vain.2 According to researchers Schulte et al., 15% of those suffering with BDD have a formal diagnosis.24
Looking to the future
According to researchers Castillo et al., a high proportion of people presenting to aesthetic clinics have BDD.26 The fact that there is awareness of this issue shows that more conversations are being had, but there is a long way to go in actually destigmatising the condition. Whilst there are BDD assessment tools to support clinicians, they should only be implemented by suitably qualified practitioners, and not be solely relied on. Assessment tools should be used in conjunction with a thorough patient consultation and a developing patient-practitioner relationship.27
The National Institute for Health and Care Excellence (NICE) Five Questions are a fundamental requirement for all medical professional when assessing patients who may be suffering from BDD symptoms.28
It is important to note that patients may not be truthful in their responses. They may lack insight, might not feel comfortable divulging information about their concerns or may mask them so as not to be denied treatment. BDD is an anxiety disorder, and depending on a person’s level of distress, patients presenting in clinic may be having a ‘good day’ and their answers could reflect this, thus not providing a truly comprehensive representation of what the patient is experiencing daily. Introducing a 48-hour cooling off period could mitigate the risk of this.
The idea that patients with BDD are more likely to clinic hop, especially if they are declined treatment, needs to be substantiated further. It is my view that this vulnerable patient group may be likely to book treatments at training companies and/or possibly go to non-healthcare professionals for treatment.
Another emerging area of interest is the idea that practitioners may be more vulnerable to body image concerns like BDD as a result of their immersion in the specialty. A recent survey from Aesthetics found that of 62 practitioners, 39% said they felt their job had a negative impact on how they viewed themselves.29 Moreover, 58% said they
believe practitioners are more susceptible to experiencing symptoms of BDD.29 Further research is required here to ascertain what impact this hypothesis may have in the future, but any broad generalisations cannot be made at this stage.
Due to the lack of research into BDD and aesthetics to date, more studies are required so practitioners can understand the mental wellbeing of their patients and themselves. Such research could lead to the development of more valuable and validated assessment tool algorithms.
In my view, going forward, those working in aesthetics should have training covering all aspects of mental illness including BDD. Clinics should have a robust referral process to minimise the risk of triggering a deterioration in a person’s mental health.5 If patients are known to mental health services, you may need to liaise with their care coordinator and/or GP. Mental health support and advice can be obtained via option 2 on the 111 hotline (the mental health 24-hour crisis line),29 and patients can refer themselves via the NHS website for counselling.31 Samaritans information should also be available in clinics.32 If the patient is in crisis and they pose a risk to themselves or others, call 999. Without the correct training, patients with mental illness are liable to slip through the net, causing themselves more harm and distress, and contributing to stigma around the condition. It is the moral and professional obligation of medical practitioners to ensure this does not happen.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 69
Claire Newman is a mental health nurse prescriber and the director of Soft Touches Aesthetics in Hertfordshire. She is a Level 7 trainer for Derma Medical. She is passionate about mental health, promoting confidence and wellbeing. Qual: Bsc (Hons) Psychology, RMN, Msc Nursing Practice, NIP, Level 7 Aesthetic Medicine Injectables
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
At CCR 2023, the session ‘A Spotlight on BDD: Patient and Practitioner Perspectives’ will be taking place at the In Practice Theatre on October 20 at 10:20am. Scan the QR code to register for free.
Aesthetic Combination Treatments
Enhancing patient experiences with Neauvia Smart Combination Therapy Protocols
In the world of medical aesthetics, one trend has taken centre stage: the power of combination treatments. Gone are the days when practitioners relied on singular procedures to address aesthetic concerns. Today, patients seek the synergy of multiple treatments to achieve remarkable results. By harnessing the unique advantages of different procedures, practitioners can customise treatment plans, targeting individual needs and delivering comprehensive outcomes. This approach not only addresses multiple concerns simultaneously, but also minimises downtime and optimises cost-effectiveness.
Smart Combination Therapy
Based on Neauvia’s comprehensive in-house portfolio of products, including fillers, devices and skincare, the Smart Combination Therapy allows for synergistic treatment of different skin layers, delivering clinically proven results.
Neauvia’s fillers, equipped with the unique cross-linking technology ‘Smart Xross Linking’, combine hyaluronic acid (HA) and polyethylene glycol (PEG) to create a network with outstanding mechanical, rheological and thermodynamic properties. This PEG revolution in the filler market ensures optimal outcomes and patient safety.1
Neauvia also offers a range of energybased devices characterised by advanced electromedical engineering. These devices are designed to work in perfect harmony with Neauvia’s fillers and cosmeceuticals.2,3
The Plasma IQ, an electric micro-scalpel, provides precise and controlled skin lesions
for non-invasive surgery. LaserMe utilises non-ablative fractional laser technology for skin resurfacing, while Zaffiro combines hydro-exfoliation and infrared thermo-lifting for brightening and tightening. Sectum is a multi-purpose RF solution with aesthetic and gynaecology modes, and EpilMe features a laser diode for deep penetration during hair removal treatments.
Neauvia’s skincare line, developed based on advanced knowledge and research in dermo-cosmetics, offers solutions for healthy and youthful-looking skin.4,5 These cosmeceuticals are specifically designed to address the needs of patients undergoing aesthetic treatments, boosting natural beauty with safe and effective formulas.4,5 Neauvia’s Smart Combination Therapy protocols provide practitioners and patients with clinically proven solutions for facial, body and intimate rejuvenation. The NLift protocol, a mid-face synergistic protocol, utilises a sequence of filler injections, energy-based device treatments and cosmeceuticals to deliver amplified results. The NBoost protocol targets the epidermis to restore the skin and prevent signs of ageing, while the NRose protocol focuses on intimate rejuvenation, addressing both physical and emotional aspects.
A holistic vision
With Neauvia’s Smart Combination Therapy, the boundaries of medical aesthetics are being pushed, offering a premium experience that integrates seamlessly into a modern and healthy lifestyle. By embracing Neauvia’s comprehensive range of high-end technologies and protocols, practitioners can deliver safe and more effective results for facial, body and intimate rejuvenation.1-5 Neauvia’s vision goes beyond physical beauty, recognising the emotional aspects of aesthetic treatments and their impact on self-esteem and confidence.
Unlock enhanced results with Neauvia’s Smart Combination Therapy and help your patients embark on a transformative journey towards youthful, vibrant and naturally beautiful skin.
To discover more about Neauvia’s portfolio of products and protocols, visit: Neauvia.uk or the Neauvia Education Channel neauviachannel.com
REFERENCES 1. Marino et al., ‘Immune profile of hyaluronic acid hydrogel polyethylene glycol crosslinked: An in vitro evaluation in human polymorphonuclear leukocyte’ Dermatologic Therapy (2020) <https://pubmed.ncbi.nlm.nih.gov/32277559/> 2. Kubik et al., ‘HA PEGylated Filler in Association with an Infrared Energy Device for the Treatment of Facial Skin Aging: 150 Day Follow-Up Data Report’ Pharmaceuticals (2022) <https://pubmed.ncbi.nlm.nih.gov/36355527/> 3. Kolczewski et al., ‘Hyaluronic Acid and Radiofrequency in Patients with Urogenital Atrophy and Vaginal Laxity’ Pharmaceuticals (2022) <https://pubmed.ncbi.nlm.nih.gov/36559022/> 4. Data available on file. 5. Neauvia Cosmeceuticals are cosmetic products according to Regulation 1223/2009
This advertorial was written and supplied by Neauvia
70 Aesthetics | October 2023 aestheticsjournal.com Advertorial Neauvia
A summary of the latest clinical studies
Title: Complications of Toxins and Fillers in Facial Aesthetics
Authors: Samizadeh S, De Boulle K
Published: Primary Dental Journal, September 2023
Keywords: Botulinum Toxin, Complications, Dermal Filler
Abstract: Dermal filler and botulinum toxin injections are among the most performed non-invasive procedures for rejuvenation and contouring internationally. Although most dermal fillers and approved botulinum toxins are welltolerated with a high safety profile, adverse events and/or complications can happen. Injection-related sequelae and side effects are usually rare, mild, transient, and self-limiting in nature. However, devastating and life-changing complications, such as intravascular occlusion, skin necrosis, permanent visual impairment and stroke have been reported. Risk reduction measures include an in-depth knowledge of anatomy, physiology and pharmacology, correct patient selection, correct identification of clinical indications and, fundamentally, the importance of appropriate skill and training. In this paper, some of the complications are discussed and advice on how to minimise adverse events and complications from these injectables is provided.
Title: Investigating the Anti-Ageing Effects of Caviar Oil on Human Skin
Authors: Kim B, et al.
Published: In Vivo, September 2023
Keywords: Anti-Ageing, Caviar Oil, Skincare
Abstract: The use of skincare products containing natural ingredients has become increasingly popular as a way to combat the signs of ageing. Caviar oil is a natural skincare ingredient that has gained attention due to its rich composition of fatty acids, vitamins and minerals. The objective of this study was to investigate the potential anti-ageing effects of caviar oil and to develop a product, Cavi Balm, which could potentially reduce wrinkles and skin sagging. An in vitro model using the 3T3-L1 cell line was employed to assess the effect of caviar oil on adipocyte differentiation. An ex vivo study using human skin tissue was conducted to investigate the impact of caviar oil on collagen and elastin formation and the expression of matrix metalloproteinase-1,2,9 (MMP-1, MMP-2, MMP-9). Furthermore, 102 participants were enrolled in five clinical studies to evaluate the anti-ageing efficacy of Cavi Balm in facial and neck wrinkles, facial and eye area lifting and various skin parameters such as skin moisture, skin elasticity, skin density, skin tightening relief, skin clarity and skin turnover. In vitro, caviar oil enhanced adipocyte differentiation and increased lipid accumulation inside the cells. The ex vivo analysis revealed that caviar oil reduced the expression levels of MMP-1, MMP-2 and MMP-9, and increased the formation of elastin and collagen I and III. Moreover, in the clinical study, Cavi Balm improved skin parameters after one-time use, with more significant effects observed after four weeks of usage. Caviar oil has a substantial impact on mitigating skin ageing and holds potential for application in anti-ageing products.
Title: The Beautification of Men within Skincare Advertisements: A Multimodal Critical Discourse Analysis
Authors: Kenalemang-Palm L
Published: Journal of Aging Studies, September 2023
Keywords: Advertising, Masculinity, Skincare
Abstract: This study draws on the theory of Social Semiotics and the methodology of Multimodal Critical Discourse Analysis (MCDA) to examine the textual and visual design of skincare advertisements targeted towards men. The current proliferation of the market for male-oriented facial products represents an important shift towards the increased attention to the beautification of male bodies in Western societies. Such beautification encourages men to work on and improve the self through intensifying practices of ‘aesthetic labour.’ Aesthetic labour places emphasis on an entrepreneurial self-care and self-control regime that promotes an active late lifestyle fostered through ideas about ‘successful ageing.’ Analysis of advertisements shows that the male face is often constructed as a ‘problem’ to be cured through the use of skincare. The consumption of these products normalises male beauty practices that seemingly encourage men to care for and work on their skin, which can be seen as a feminising practice. Nonetheless, the advertisements employ masculine traits and strategies that link cosmetic products to traditional values of masculinity. The beautification of the male body, thus, turns the consumption of skincare products into a performance through which men can maintain their already privileged status in society, rearticulating the double standard of ageing.
Title: Developing Consensus-Based Guidelines for Case Reporting in Aesthetic Medicine: Enhancing Transparency and Standardisation
Authors: Rahman, et al.
Published: Aesthetic Surgery Journal Open Forum, September 2023
Keywords: Case Studies, Complications, Reporting
Abstract: The authors’ objectives were to develop comprehensive guidelines for Case Reporting in Aesthetic Medicine (CREAM). The study employed a three-phase consensus process, including a literature review, expert interviews and a consensus meeting. A diverse group of 10 expert participants (plastic surgeons, dermatologists, non-core specialists, evidence-based medicine expert, and research scientist) in Phase I and 30 aesthetic practitioners in Phase II contributed to the research. Statistical analysis was conducted to assess agreement levels among participants. The participants represented various specialties, genders, LGBTQ+ identities, and ethnic backgrounds. The research resulted in the development of the CREAM guidelines, consisting of a 16-item checklist. The guidelines covered essential aspects of case reporting, such as patient and practice information, procedure details, clinical assessment and outcomes, adverse events and ethical considerations. Statistical analysis indicated a high level of consensus among participants, as well as significant associations between checklist items. CREAM guidelines represent a step toward enhancing transparency and standardisation in case reporting in aesthetic medicine. Adhering to these guidelines will allow authors to contribute to a robust evidence base, prioritise patient safety and drive advancements in aesthetic medicine.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 71
Integrating Blood Testing Services Into Your Clinic
When it comes to aesthetics, looking good on the outside is one piece of the puzzle. By investigating your patients’ inner health with accurate blood testing, you can uncover insights about the body’s biochemistry and issues that may affect physical appearance. These insights help guide your aesthetic treatments by detecting medical issues that may affect treatment outcomes. They also enhance your treatments by contributing to a more holistic approach.
Blood tests are like a window into the body’s inner health. Our inner health is reflected in many aspects of our appearance, such as the condition of our skin, hair and nails, weight, and overall natural vitality.
As this practice is in its early evolution, there are no specific studies or standardised guidance from authoritative regulatory bodies on the benefit of blood tests in aesthetics. However, there is evidence on how some blood biomarker levels can correlate with conditions that have cosmetic manifestations. For example, one systematic review found that people with acne had lower levels of vitamin D, and severity of acne was inversely correlated with vitamin D levels.1
There is also evidence showing abnormal vitamin B12 levels can cause hyperpigmentation, and hair and nail changes,2 and dermatological issues are common with thyroid dysfunction.3
Health checks can flag various health problems, from vitamin and mineral deficiencies to hormone imbalances and
inflammation. Furthermore, it can have a positive impact on your business – happier patients means more referrals and higher patient retention.
Lifestyle medicine is a developing concept in aesthetics, as it recognises the connection between health, wellbeing, and appearance. Lifestyle factors play a role in determining how successful aesthetic treatments can be. A healthy lifestyle contributes to skin vitality, enhancing the effects of treatments like facials, chemical peels, and laser. It can also enhance patients natural appearance by promoting a radiant complexion, clear skin, and balanced body shape.
Choices like protecting the skin from UV damage, not smoking, and maintaining a healthy weight help prevent premature ageing. Lifestyle practices, such as regular exercise and stress reduction techniques, have shown to positively impact skin health by improving hydration, circulation, reducing inflammation, and promoting collagen production.4-6 A healthy lifestyle can also influence mental and emotional health, impacting how individuals perceive their appearance.
Increasing your business potential through blood testing
Offering blood testing as an add-on service to treatments increases patient longevity and builds brand loyalty. Regular patients can add blood testing to treatment plans, increasing
their annual investment at the clinic. Clinics can also use blood testing as part of an initial health assessment to build treatment plans for various conditions.
Incorporating longevity services can also create additional revenue streams. These include offering nutritional supplements and partnerships with other healthcare specialists, nutritionists, and potentially local gyms for fitness programmes. For more information on longevity services, turn to p.31 to read more. Practitioners can also arrange baseline blood tests of general health markers, as part of a bespoke longevity treatment plan. Professionals can quickly and cost-effectively roll out a blood testing service for patients by partnering with companies with specialist knowledge and experience. These providers manage the whole process, including test kit fulfilment and secure, online results delivery, with the option to have results interpreted by a clinician.
Blood tests help identify issues that can reduce longevity, suppress vitality, or promote ageing. The test profile may include markers for liver, kidney, thyroid, and heart health (cholesterol), as well as for diabetes (HbA1c), inflammation (CRP-hs), vitamin B12, folate, vitamin D, and iron levels.
Using this information, alongside accurate patient data, helps devise a personalised plan of action. Including achievable lifestyle goals that the patient can work towards alongside their aesthetic treatment. Examples of lifestyle goals include increasing daily water intake to stay hydrated, optimising nutrient levels to boost vitality, or a sleep hygiene routine combined with a tailored skincare regimen.
Promoting vitality and longevity
Many patients opt for aesthetic treatments to feel youthful. Natural vitality is a crucial component of this goal and may be equally as important as cosmetic appearance. Vitality is linked with several factors associated with youthfulness, including healthy energy levels, enthusiasm, and a sense of wellbeing. This holistic approach to youthfulness can potentially impact patients’ self-esteem and lead to increased satisfaction with treatments.
Improving safety and risk management
Certain aesthetic procedures, such as dermal fillers or laser treatments, may carry risks, especially for individuals with health conditions like liver disease or taking medications such as anticoagulants. Performing blood tests during consultations
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 72
Dr Natasha Fernando details the benefits of offering in-clinic blood testing as part of a holistic approach to wellness within medical aesthetics
can reduce complications risk, identifying pre-existing conditions like diabetes, chronic kidney disease, HIV, and severe vitamin D deficiency that compromise the immune system during and after treatment. Abnormal coagulation markers can identify those at increased risk of bleeding and bruising.7 Higher risk patients may need to have thorough pre-procedure counselling and increased precautionary measures during procedures. This involves spending additional time detailing the risks and discussing whether these outweigh the benefits. Additionally, there should be an emphasis on safety netting, giving clear instructions to the higher-risk patient on when they should request an urgent review by yourself, or vital medical attention if a complication occurs. By understanding a patient’s health profile through blood testing, you can mitigate potential complications and ensure patient safety.
Optimising treatment outcomes
Blood tests uncover medical factors that could affect treatment outcomes. Commonly, these include endocrine conditions and nutrient deficiencies, which manifest in dermatological and weight concerns. Some conditions affect mental health, impacting self-esteem and body image.
Hypothyroidism is an example of a health issue that, if left untreated, could prevent treatments from having the optimal desired effect.3 The condition causes dry skin, which promotes the appearance of premature fine lines and wrinkles, as well as hair thinning or loss. In addition, thyroid dysfunction influences mood and anxiety, affecting patient wellbeing.3
If you’re offering weight loss management or non-surgical fat reduction treatments, it is valuable to know whether your patient has hypothyroidism, as it can be challenging to lose weight. With appropriate advice on lifestyle choices, you can help your patient maintain a healthy weight.
Thyroid conditions often share symptoms with other health conditions, leading to a misdiagnosis. Blood tests determine the true cause of your patients’ symptoms through tests for thyroid hormone levels, thyroid antibodies, and biomarkers like iron and folate, which can mimic the symptoms of an underactive thyroid.
Vitamin and mineral deficiencies, such as iron and vitamin D, are associated with dry skin, hair loss and thinning.8,9 Vitamin B12 and folate deficiencies can cause skin pigmentation changes in addition to dermatitis.2 For women concerned about acne, hirsutism, weight gain, and irregular periods, practitioners
could suggest checks for polycystic ovary syndrome (PCOS), which various sex hormone imbalances demonstrate.
If you treat hyperhidrosis, it’s vital to ensure that patients have been adequately investigated to rule out underlying medical causes. You should clarify the location, distribution, and symmetry of excessive sweating. If you conclude it is generalised, and there are no known co-morbidities causing this, you should ensure your patient is investigated. Practitioners should encourage patients to arrange a consultation with their GP but could suggest preliminary blood tests whilst they await review. The tests should not delay the review, especially if there’s a concern about serious pathology.
The National Institute for Health and Care Excellence (NICE) advises several baseline investigations if secondary hyperhidrosis is suspected. These include a full blood count, erythrocyte sedimentation rate and/or C-reactive protein, urea and electrolytes, liver function tests, HbA1c, thyroid function, HIV, or tuberculosis (if indicated).2 All can be checked through blood tests in-clinic.
Facilitating a collaborative approach
Offering blood tests gives practitioners the opportunity to collaborate with healthcare professionals and nutritionists. You can share blood test results with these professionals, allowing for interdisciplinary collaboration and treatment plans that consider both aesthetic goals and overall health.
Considerations for blood testing
Lifestyle medicine can be practised by any healthcare professional, and training is available. The British Society of Lifestyle Medicine (BSLM) is an association that offers educational events, conferences, and resources for professionals interested in lifestyle medicine principles.10 The Universities of Winchester and Glasgow also offers master’s degree programmes.
If you want to offer blood testing, there are a few considerations. You will need a phlebotomy-trained staff member who can draw blood. They can be part of your team, or you can work with a company with access to a national network of phlebotomists. Companies providing blood tests usually offer home testing options, which may be convenient for your patients. In this case, the company supplies home kits with clear instructions, and the patient posts the sample direct to the lab.
Afterwards, you need to consider how you interpret the results. If you have an in-house
doctor, they’ll be able to do this, or you can talk to a blood test provider about whether they offer a reporting service. Whilst you won’t need any special registration to offer blood testing, you will need to be CQC registered (or equivalent in your country) to provide a follow-up consultation, diagnostic service, or prescribe medications.11
If you aren’t CQC registered, you need to stipulate in your terms and conditions that the test results and interpretation are for the purpose of information only. You should emphasise that although they may provide a guide to understand health and risk factors for cosmetic treatments, they aren’t intended to constitute a clinical diagnosis or substitute a medical consultation service.
Add blood testing to your practice
Blood testing can be a powerful tool in aesthetics – helping to promote a holistic approach to health and wellbeing. It can enhance your practice by helping create personalised treatment plans, and foster collaboration with other professionals. The decision to offer blood tests should be made in collaboration with qualified medical professionals who can analyse results. This ensures the tests are conducted safely, accurately, and in line with relevant healthcare regulations and guidance.
Disclosure: Dr Natasha Fernando is head of clinical excellence at Medichecks, a UK direct-to-consumer blood testing service.
Dr Natasha Fernando is a practising GP with more than 12 years’ experience within the NHS. Dr Fernando completed her undergraduate medical training at the University of Cambridge and Imperial College London. She has experience working in aesthetics and is a qualified lifestyle medicine practitioner.
Qual: MBBS, MRCGP
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 73
THE REFERENCES AT AESTHETICSJOURNAL.COM
Dr Natasha Fernando will be speaking at CCR’s inaugural Medical Longevity Summit on October 19. Medichecks will also be exhibiting at the Summit. Scan the QR code to register free!
THE NEXT EVOLUTION IN RF MICRONEEDLING IS HERE
Introducing Secret® DUO , a ground-breaking approach that combines dual non-ablative fractional technologies, Secret RF microneedling paired with a 1540 nm erbium glass laser. Treatments like the all-new Secret Glow are ideal for patients requesting less downtime and can easily and quickly target the common signs of ageing, such as pigmentation, texture, fine lines, stretch marks, and scars.
REFERENCES: 1 Tierney, Emily, and William Hanke. “Fractionated Carbon Dioxide Laser Treatment of Photoaging: Prospective Study in 45 Patients and Review of the Literature.” Dermatologic Surgery, vol. 37, no. 9, 2011, pp. 1279– 1290., https://doi.org/10.1111/j.1524-4725.2011.02082.x. 2 Yadav, Savita, and Aashim Singh. “Microneedling: Advances and Widening Horizons.” Indian Dermatology Online Journal, vol. 7, no. 4, 2016, p. 244., 3 Ryu, Han-Won, et al. “Clinical Improvement of Striae Distensae in Korean Patients Using a Combination of Fractionated Microneedle Radiofrequency and Fractional Carbon Dioxide Laser.” Dermatologic Surgery, vol. 39, no. 10, 2013, pp. 1452–1458., https://doi.org/10.1111/ dsu.12268. https://doi.org/10.4103/2229-5178.185468. 4 ASDS Consumer Survey on Cosmetic Dermatologic Procedures 5 ISAPS international survey on Aesthetic/cosmetic procedures, 2021-2022 6 Absolute Reports Pvt Ltd, 2022 BEFORE AFTER BEFORE AFTER Photos courtesy of Michael Sarti MD. Photos courtesy of A Renta, MD.
SCAN THE QR CODE TO FIND OUT MORE ABOUT OUR LIMITED-TIME ‘TRADE-UP’ OFFER ON EDL I N G TEC *Transition from your old equipment and embrace the cutting-edge advancements. Seize this limited-time opportunity to revolutionise your microneedling practice and set a new standard of excellence. In the family of + #thesecretisout @secretbycutera
Improving Customer Service
In your opinion as a practitioner, at what point during a patient’s appointment do your duties stop? Though many may think it’s as soon as they put down the syringe, you are really providing care and earning your fees right up until the patient walks out the door (in addition to any follow-up contact, of course).
Let me explain with an example: I have a dear colleague who is incredibly skilled, with more anatomical knowledge than most in the industry. She impresses me every day with her mastery of aesthetics. Nevertheless, she was with me in-clinic one day and observed me walking my patient out to reception, chatting with her while my front desk staff checked her out and booked her review, and finally handing her a sample pot of face cream. The patient, who had been particularly nervous during her treatment, left feeling completely and utterly cared for. In that extra three minutes I spent with her, she had the opportunity to ask any last-minute questions and have a bit of a friendly, non-aesthetics related chat. What happened in that moment is that a bit more balance was created between patient and practitioner. Instead of feeling like a patient on a conveyor belt, she felt she was the only patient we had that day (when in fact, she was one of 23!). When she left, my colleague turned to me and said “THAT is why people come here. That’s what people pay you for and that’s why they choose you.” Even though the patient had a safe and successful treatment, she later fed back that she expects my skill and expertise, but is always delighted and comforted by how she is made to feel safe and valued.
What I see a lot of in this industry is that when practitioners move over from the NHS, they have experience in patient care and advocation, but don’t understand how different this is from customer service skills. I see new practitioners struggling to grow their practices because of this, and more experienced practitioners missing out on great reviews and increased growth by incorrectly assuming their front-of-house team should handle all the ‘fluff’. On the contrary, when you leave the NHS to enter aesthetics, you still should have your medical hat on, but you have moved over into a service industry as well. So, let me give you four ideas for how to improve your customer service.
Consider their wants and needs
To stand out as a practitioner, you have to offer a full-service experience. This means going beyond meeting the patient’s clinical needs – you must consider their other wants and needs as well. For example, are they having a bad day and need to be
listened to? Do you need to spend a bit of extra time in the consultation to ensure they feel heard? Do you need to have someone hold their hand to help manage their anxiety about needles? Maybe you need to make extra time for numbing cream even though you know they could manage injections without pain relief.
Let me illustrate the power behind this: a new patient came to see me recently who I seemed to recognise. It transpired that she was a model during a training day many years ago, and I was the nurse who held her hand through her anxiety. She remembered this moment, a small gesture from me but a powerful impact on her.
Consider their wants – do they want a cup of tea or a collagen drink while they’re in the waiting room? Would they like a blanket over them while receiving a microneedling treatment? Do they want to try a sample of a product before they buy it?
All of these examples are ways you could look out for your patients beyond meeting their clinical needs, simply by making the time and effort to do so. Every patient has individual needs – I read their body language, and ask questions such as, ‘What are your concerns? Are you anxious about anything? What would be the one priority I could give you today to settle your mind?’ I pause and actively listen to my patient without interruption. This allows me to recognise their requirements and create a tailored, bespoke experience. This effort will pay dividends!
Yes, it could result in spending more time on each patient (though I think you can provide this level of extra service whilst being efficient at the same time), but it will pay for itself in patient loyalty, referrals and patients’ trust in you to administer additional services or products. Due to this extra care I deliver to my patients, they have continued to return for the last 20 years and have happily gone on to recommend me to friends and extended family. Any well-trained practitioner can meet a patient’s clinical needs. It’s only when you go above and beyond that you really gain a patient’s loyalty.
Address the little touches they don’t even know they want
One thing I’ve found again and again in my 20 years of clinic ownership is that providing the unexpected goes a long way. Popping a little sample into the bag of skincare they just purchased, setting up your clinic system to send them a nice message on their birthday, sending an unexpected bouquet of flowers
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 76
Nurse prescriber Julie Scott advises on how to up your customer service and improve patient satisfaction
or annual holiday gift to your most loyal patients – these are the things that will take your clinic the extra mile.
My patients know how busy I am and how full my clinic is, but I still do these extra little things that only take 30 seconds, and the patients then leave the clinic feeling even more valued. As a busy practitioner, I may not feel I have 30 seconds, but I do. We never think we have time, but we need to make time, and it’s imperative for your clinic team to have the same ethos and priorities when it comes to interacting with your patients. The patient’s experience continues with every interaction and is a shared journey throughout your clinic, irrespective of who they are having contact with. Whether it is yourself or a member of your team, your patients deserve 100% undivided attention. Going forwards this is what your patients appreciate and recognise, and what will result in recommendations and referrals. The biggest compliment I’ve been given in my career is, “I’ve seen your journey and that you’ve really grown, but you haven’t changed. You’re still Julie, and I always get the same Julie when I visit for my treatments.” So, no matter how busy you get, make an effort to not lose focus, and still prioritise the little things for your patients.
Learn how to say no
I’ve already mentioned how customer service is entirely different to patient care. This is important to understand, because it can be the difference between gaining and losing a patient time and time again. Let’s look at an example for this one: imagine a patient comes to see you seeking a lip augmentation. In this case, it is a female patient seeking more volume. However, in your opinion, her lips are already overfilled and distorted.
Active listening is crucial. Your patients may come armed with an array of research and a particular treatment in mind. Even when you feel this may not be the most appropriate course of treatment, allow them to express their thoughts. Then go on to use
empathetic language, mirroring their concern and demonstrating that you have heard and understood them. Do not diminish their thought process, but gently guide them to a more clinically indicated path. An example of poor customer service would be dismissing the patient. Even though it is in her best interest for you to refuse treatment, you must carefully consider how you convey it. You may think it’s best to say things along the lines of, “Your lips are too full. If I put any more filler in, it would look even more strange. I’m not putting any more product in and, I need to dissolve your filler.” Although clinically this may be the most indicated course of action, if you’re explaining the situation in this way to patients, you’re not offering a five-star service. You’re putting the patient down and making them feel bad about their past choices and appearance. Instead, try approaching the situation by sitting with the patient. Explore the patient’s ‘before’ photos with her. Educate gingerly about expected proportions but avoid using words like ‘strange’ or ‘normal’. Instead, say something along the lines of, “Your features aren’t in harmony right now, but I know you want them to be, and we can bring harmony and balance to the proportions of your face.” Don’t force your own ideas of how the patient should look on them, but instead, you can ask questions such as, “Shall we take a step back and look at where we started, to where we are now, gain some clarity to enable us to plan how we move forward?”
This requires real delicacy and is a skill I struggled with in the beginning of my practice. However, I learned over the years that it helps to ask questions with the patient at the centre rather than just telling them your thoughts. Another way to think of this is to ask leading questions and get the patient to give you the answers. You don’t want them to feel attacked – you want them to feel listened, supported and in safe hands. Therefore, if you can find a way to say no and protect their best interests, without making them feel like they’ve been rejected or denied, you are on the path to providing excellent customer service.
Listen. Really listen. Did you know that on average, practitioners only let their patients speak for a median of 11 seconds before interrupting? The simplest (but most important) way to improve your customer service is to listen. Allow your patient to be heard and take the time to communicate effectively with them. What you want is for your patient to say that when they’re with you, it’s like they are the most important person in the world. Start with questions such as, ‘What concerns do you have?’, ‘What would you perhaps like to improve? This is your time’. Listening without interrupting, not appearing distracted and maintaining eye contact are all ways to improve your communication, and thus, your customer service. The length of time you allocate to your consultations will be very personal. However, having carried out consultations for more than 20 years, I believe that any less than 45-60 minutes would not be beneficial to you or your patient.
Consultation is a mutual investment, one of which I charge for. I am obtaining valuable information and imparting my knowledge, guidance, direction, care and expertise. Consulting effectively is a skill, no less or more than the treatments I offer, therefore I ensure that the patient receives ultimate value during our first interaction.
Boost patient satisfaction
Whether you’re new to aesthetics or whether you’ve been in the industry a long time, we all stand to be reminded of the importance of customer service – the ‘little’ things, the extras and effective and gentle communication. This is because our customer service skills need to be impeccable in order to find real success in this industry. I’ll leave you with this quote by Mimi Novic: “How you make others feel about themselves says a lot about you.”
Julie Scott is a registered nurse and independent nurse prescriber with more than 20 years’ experience in the aesthetics industry and has worked with leading plastic surgeons in London. She now practices from her Essex clinic, Facial Aesthetics. In 2022, Scott won The SpringPharm Award for Nurse Practitioner of the Year and The Fillmed Award for Best Clinic South England in 2023 at the Aesthetics Awards.
Qual: RGN, NIP
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 77
3 REFERENCES 1. Phillips K, et al., ‘Physicians Interrupting Patients’, 2019, <https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC6816596/>
On average, practitioners only let their patients speak for a median of 11 seconds before interrupting
Growing Your Brand Through Industry Awards
Industry awards are an annual occurrence in every sector, and the aesthetics specialty is no different. Awards are an opportunity to compete against your peers and become the ‘best of the best’. Prestigious titles such as Clinic of the Year, Aesthetic Practitioner of the Year or even Best Clinic Team bestow recognition and gravitas on the winners. The obvious benefits of winning an award – your name up in lights, a trophy and well-deserved recognition from your peers – are enough to attract many of us to enter. Yet it’s not just about winning or trying to increase your ego!
Why are industry awards so important?
When a person or company wins an award, it is in recognition of work well done. Depending on the category you enter, an award acknowledges the hard work of your team, shines a spotlight on an area of expertise you are passionate about and boosts clinic credibility. This recognition gives you gravitas, and when used correctly, is a valuable asset to your business. It can be the dream of every practitioner and clinic to be a finalist, hoping to take that trophy home. But it’s not all about your ego – many practitioners deny themselves the opportunity and avoid entering awards. Instead, they tell themselves, ‘I don’t have time to enter’, ‘I don’t know what category to enter’, ‘I don’t want to appear arrogant or boastful’, or ‘There’s no point. I’ll never win’. Baron Pierre de Coubertin, founder of the modern-day Olympics, famously said, “The most important thing in the Olympic Games is not winning but taking part; the essential thing in life is not conquering but fighting well.”1 We paraphrase this to, ‘It’s not the winning but the taking part that counts’, and this is the message we tell ourselves whenever we fail to achieve our goals. With this in mind, let’s take a look at the reasons why you may want to consider entering industry awards, the opportunities that are there and how you can benefit, regardless of what stage of the process you reach.
Look at the entry process like a clinic audit
Collating and inputting the information needed to submit a quality entry can take a considerable amount of time when done properly. The sooner you begin the process the better, even if the closing date is months away. Why? A good entry takes time, and you don’t want to lose out on a chance of being shortlisted simply because you had to cut corners due to time constraints. At the very least allow a couple of weeks, longer if possible.
You need to reflect on the questions, gather the relevant supporting evidence and succinctly type out your responses. Many practitioners prefer to pass the responsibility over to a junior
team member or decide against entering completely, citing time constraints before dropping out. Yet the entry process itself has hidden value that can positively affect you and your business.
Reframe the entry process and view it as an audit. The questions being asked help you to understand where you currently are with your business as opposed to where you ‘think’ you are. It allows you to measure your progress and plan your future development. The answers you provide can highlight any weak areas you need to focus on for development and growth. As you work through the questions, you may notice that some are easier to answer than others. The most likely reason is because ‘easy questions’ are probably focusing on areas you are stronger in. Whereas the reason you may find some questions more challenging is because they relate to weaker areas or areas you are less experienced in. This way of looking at things helps you quickly identify your own strengths and weaknesses, so use the entry process as a tool to identify and work on key areas. Let’s look at some popular categories. To enter the award for Rising Star of The Year you need to demonstrate your contribution to the industry. One of the questions asks you to provide evidence of professional development and clinical expertise. If you struggle to provide evidence when answering this question, this should be a sign for you to invest more in your training and skills. If you enter a regional Best Clinic category, you will be asked to provide evidence of your commitment to patient safety and care alongside the patient journey. This category must be supported with patient reviews. Do you have any reviews you can share and if so, what are your patients saying about your clinic? Can you learn from the feedback you’ve received (or lack thereof)? If you don’t have enough reviews, this is a weaker area for you and must be worked on if you want to succeed at future industry awards. Practitioner of the Year is the big one in many professionals minds, and recognises outstanding contribution to the profession. You must demonstrate exceptionally high levels of patient care and safety, as well as your own clinical expertise and professional development. You must prove how you make a difference to the lives of your patients, the growth of your clinic and, very importantly, the aesthetics industry as a whole. This award pushes you to be the best and the entry process is challenging, immediately flagging up any weak areas. Furthermore, in many categories, practitioners
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 78
consultant Vanessa Bird provides insights into why entering industry awards can be a catalyst for growth and professional development
Top five benefits from entering industry awards
• Allows you to take an in-depth look at yourself and your business, similar to a clinic audit.
• Enables you to strengthen weaker areas of your business.
• Gives your patients peace of mind they are visiting the best clinic, and can boost enquiries.
• Helps to discover ways to generate positive publicity and coverage.
• May lead to further opportunities such as KOL or brand ambassador roles.
or clinics will be asked to submit customer feedback survey results. All businesses should conduct annual feedback surveys, so if you aren’t already implementing this, it might be good to start.
Regardless of category, sitting down to type out your answers forces you to take an objective look at how well you are doing against an industry benchmark.
Outside of content, there are several other things you can do to help with the entry process. Schedule time in your diary over a few weeks to complete your entry so you don’t leave it until the last minute. Read through the questions and highlight any areas you may need supporting evidence for and, where possible, assign this to team members who can collate it for you. Talk over your answers with a partner or trusted colleague and ask for their feedback on how you can improve your responses.
Share your shortlisting news
By becoming a finalist, you can unlock benefits that showcase who you are and what you do. Use it as a marketing tool and reach out to your patients. By sharing the news, you are demonstrating the success you have achieved simply by reaching this stage. It’s reassuring for patients to know that their practitioner or clinic is in the running for such an accolade. You could even offer your patients a special ‘shortlisted’ celebratory offer to bring them into clinic.
Don’t forget to celebrate being a finalist with your team. Thank them for the part they’ve played and boost morale with drinks, dinner or some other way to reward them. A motivated team is a productive and loyal team, so invite them to the awards as a thank you. Also, share the news with the people who used to visit your clinic in the past as there’s a chance it could trigger renewed interest. Being shortlisted is recognition of the standard of work and services you provide, which is attractive to patients. It is also a perfect example of ‘social proof’, and you and your business can use this to boost bookings and promote what you do.2 If you haven’t been
shortlisted, ask for feedback from the judges so you can improve for next year – it’s free advice!
Boosting your profile
Everyone wants to win. The recognition you receive, the credibility it bestows on you and the amazing feeling of pride propels you forward on a rollercoaster of positivity. Film the moment you are announced as commended or winner and share it on social media so your followers can celebrate with you. Announce the good news to your patients, sharing the professional images on your website, socials and newsletter. This gives your patients peace of mind as well as pride that they visit ‘the best’ in aesthetics. More importantly, it helps drive enquiries.
Add the accolade to your clinic email signature and place your trophy in a prominent position in-clinic. If you are highly commended or commended, this applies to you too. It is a fantastic achievement and worth celebrating. If you have one, contact your PR agency and discuss ways in which this award can boost your profile in the consumer-facing press to positively impact your business. If you don’t have a PR, then a quick Google search should help you discover ways you can use your win to generate positive publicity and coverage.
Professional photographs and video interviews will be published in publications read by industry people. News travels fast, so use your win to open up discussions about key opinion leader (KOL) opportunities and partnerships with industry suppliers. Being successful is ‘on brand’, and companies can benefit from The Halo Effect by partnering with a winner and launching them as an ambassador, KOL or speaker. The Halo Effect is when a positive impression of a person or brand can positively influence our feelings about another area relating to them (for example, the company they are KOL for).3
Where do you want to be this time next year and what do you need to do to ensure you develop and grow? Your profile is now higher
within the industry, so use this to open doors to opportunities and collaborations.
What if you don’t win? There’s no denying that not winning is disappointing, especially after the build-up and excitement of the night. Our industry attracts ambitious high-achievers, so remind yourself that reaching the final is a sign of success and that many winners have entered a year or two prior to their success. Don’t let the disappointment stop you from entering again next year. Ask the awards provider to send you feedback about your entry to help progression, and use it as motivation to drive you forward. Simply by entering, you are learning something. Once the winners are announced, look at what they did to get there. It may be that you have a good relationship with the winners and can approach them to congratulate them and ask for advice on how to strengthen your next entry. Or perhaps you could discuss the winners with colleagues and get a objective view of what they believe the winners excel at that you could learn from and/or adapt yourself. Once you have this information, consider how you can use this to grow on a professional and personal level.
Awards undoubtedly strengthen your reputation
Whatever stage of the awards ladder you reach, there is potential for professional and personal growth, but you need to enter to access these benefits. Entering awards ceremonies help you audit your business to keep you on track. It challenges you to improve your skills, development and level of service, and motivates you to build on your success year on year.
Vanessa Bird is the founder of The Aesthetic Consultant. With more than two decades of sales experience and nearly 16 years in the aesthetics industry, Bird provides bespoke global consultancy with companies, clinics and practitioners helping them increase sales and grow their businesses. Bird was also a Finalist at The Aesthetics Awards in 2022.
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 79
Entry for the Aesthetics Awards is now open and closes on November 6. Turn to p.81 to enter now!
Celebrating Success with The Aesthetics Awards
As entry opens for The Aesthetics Awards 2024, we look back on some of our Commended, Highly Commended and Winning entrants from 2023…
Known across the specialty as ‘The Oscars of Aesthetics,’ The Aesthetics Awards is the most well-recognised and established awards provider of its kind, bringing together the very best in medical aesthetics. It marks the achievements of both new and established clinics, practitioners, manufacturers, suppliers and other aesthetic companies to celebrate the
achievements of the past year, and the time has come again to celebrate! Entry for The Aesthetics Awards 2024 is open now, and we can’t wait to see what you have achieved in the last year. Scan the QR Code at the end of this article of this article to enter now, and get your hands on tickets to the most glamorous night in aesthetics.
Success stories from The Aesthetics Awards 2023
Industry-leading aesthetic practitioner
Dr Tapan Patel, recipient of the Outstanding Achievement in Medical Aesthetics Award 2023, said, “The Aesthetics Awards have given me an honour which I can’t even describe, and I have been on cloud nine since receiving it. This Award is a really proud accolade that I can reflect on, if not the proudest, and it’s something that money can’t buy!”
Aesthetic nurse prescriber Michelle McLean was Highly Commended for the AestheticSource Award for Nurse Practitioner of the Year 2023, saying, “It was an honour to be Highly Commended in my area and recognised alongside incredible individuals who are making a difference in the aesthetics industry. Feedback from judges has given me a great external perspective on where I can better round my presentation. I am excited for next year’s Awards!”
Aesthetic nurse prescriber Julie Scott’s clinic Facial Aesthetics in Essex won The Hamilton Fraser Award for Best Clinic South England 2023. She was awarded The SpringPharm Award for Aesthetic Nurse Practitioner of the Year in 2022, reflecting, “Winning consecutive Awards in 2022 and 2023 was an overwhelming honour, and the impact on our business is truly phenomenal. Being recognised by peers at such a prestigious level, especially against the most amazing clinics, was humbling. My patients still reference the Awards, and six months later I still get that warm glow. I just can’t even describe how it was to win.”
Array Aesthetics in Belfast won The John Bannon Pharmacy Award for Best Clinic Ireland and Northern Ireland 2023, with aesthetic practitioner and co-founder Dr Chris Hutton commenting, “Being recognised as an Aesthetic Awards Winner has been an incredible honour for our clinic, as it has served as a testament to the hard work and dedication of our entire team. Our injectors and wider team have been filled with a newfound sense of confidence and pride in their abilities, knowing that their skills have been recognised by such a prestigious organisation. The Aesthetics Awards have truly opened doors for us, and helped us establish ourselves as a leader in the industry which has led to exciting new opportunities.”
80 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023 The Aesthetics Awards Celebrating Success
Dentist Dr Raquel Amado reflects on being Highly Commended in the AlumierMD Award for Rising Star of the Year category, saying, “Being Highly Commended as the Rising Star of the Year was an incredible honour! It elevated my business in the past year, boosting industry recognition and credibility with patients. The recognition has been a driving force behind our success at my clinic, and I’m grateful for the opportunities it’s brought our way.”
The Aesthetics Awards Celebrating Success
Aesthetic Nurse Software was Highly Commended in the Best Clinic Support Partner/Product category. Co-founder Max Hayward said, “We were so proud to be Highly Commended at The Aesthetics Awards! Our goal has always been to help and support practitioners to run successful clinics, so to be recognised for doing so means a lot to our team. Receiving this Award has also helped to further build trust for practitioners who are thinking about working with us.”
You must be a Full Paying Member of Aesthetics to enter the Awards. As a Full Paying Member, you are entitled to unlimited free entry, alongside access to the Aesthetics journal online and in print for a full year. To become a Full Member, go to aestheticsjournal.com. You must do so before entering any category. If you are already a Full Member, you will have received a free entry code. Non-members, print members, digital members and free subscribers will need to upgrade their subscriptions to enter.
Entries close on November 6, and Finalists will be announced in the January issue of the Aesthetics journal.
If you have any questions, please email the Aesthetics team at email@example.com We can’t wait to receive your entries and see you there! Good luck.
This year is your chance!
Entry for The Aesthetics Awards 2024 is open now!
If you are a practitioner, clinic or company in the aesthetics sphere, even becoming a Finalist at the Awards is an excellent way to boost your profile and prove your credibility and hard work. With 24 categories available to enter, there are numerous opportunities to be recognised. This year’s categories are:
• The Hydrafacial Award for Best New Clinic, UK & Ireland
• Best Clinic Ireland & Northern Ireland
• The Lumenis Award for Best Clinic London
• Best Clinic Midlands & Wales
• Best Clinic North England
• Best Clinic Scotland
• Best Clinic South England
• The Croma Pharma Award for Clinic Team of the Year
• The Allergan Aesthetics, an AbbVie company, Award for Clinic Representative of the Year
• Company Representative of the Year
• The GetHarley Award for Medical Aesthetic Practitioner of the Year
• Aesthetic Nurse Practitioner of the Year
• The AlumierMD Award for Rising Star of the Year
• The Crown Aesthetics Award for Best Non-Surgical Result
• Best Surgical Result
• Best Service & Solution Provider
• Manufacturer of the Year
• Distributor of the Year
• The Prollenium Award for Independent Training Provider of the Year
• The Cosmetic Courses Award for Supplier Training Provider of the Year
• The Silkann Cannula Award for Injectable Product of the Year
• Topical Skin Product/Range of the Year
• Energy Device of the Year
• The DigitRx by Church Pharmacy Award for Best New Product
The Aesthetics Awards 2024 will be held on March 16 at the glamorous Grosvenor House, London, after Day 2 of ACE. Hundreds of members of the aesthetics community will be dressed to the nines, ready to celebrate with flowing bubbly and dancing until late. Scan the QR code to submit your entries before November 6, and get your hands on ticket to attend!
81 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com Aesthetics | October 2023
Optimising Short-Form Video Marketing
Standards Authority (ASA) rules.4-6 It’s always best practice to keep refreshed on these when it comes to areas like prescription-only medicines (POMs), responsible messaging, patient privacy and more, and if anything you create makes you think twice, err on the side of caution.4-6
TikTok has continually made headlines. ByteDance, the Chinese company which owns TikTok and several other apps, has had to squash links between itself and the Chinese Government. It may be worth nothing that TikTok itself is not available in mainland China. Questions have been raised over ‘excessive’ data harvesting from user devices, so much so that the app has been blanket banned in India and is banned from Government-issued devices in the UK, US and European Commission.7
Short-form video describes video content that can be watched in 60 seconds or less.1 With the increase in short-form video consumption, it is now thought that any video up to three minutes long could be considered a ‘short’ video. Typically, short-form video is in a vertical format, made for viewing on a smartphone within social media platforms like TikTok, Instagram, Facebook and YouTube. The average UK TikTok user spends more than 27 hours per month – nearly 54 minutes per day – consuming videos in the app,2 so it makes sense for businesses, including aesthetic clinics, to take to the format to promote their services.
Why short-form video?
Short-form video is seemingly addictive.
The format is engaging because it’s short, sweet and the message is immediate – the fast pace of edits makes it hard to look away as we await the answer or punchline of the video. Users consume it fast and in huge volumes. Over the past three years, the short-form explosion has seen not only a rise in entertainment content, but also the use of a range of platforms to showcase products and services.1
Video-making techniques have been condensed as creators figure out what generates the ‘best’ videos for the social media algorithms, based on user engagement. This has led to a tried-andtested formula, including snappy cuts between shots, bright coloured backgrounds and closed captions (subtitles). In digital marketing, search engine optimisation (SEO) is the process of making a website rank higher in online search results due to the nature of its content. A principle used by Google to rank the quality of content is EEAT: Expertise, Experience, Authority, Trustworthiness.3 I suggest this acronym has broader application in digital marketing and is perfect for the principles behind creating your videos. To successfully market your aesthetic clinic, you want to demonstrate your expertise in the field, show the experience patients get by visiting, display authority when it comes to patient safety and other industry issues and build trust with patients, perhaps before they’ve even visited you for the first time. When your content is medical, it is wise to hold a balance between engagement and medical authority. Obligations to follow GMC/ NMC/GDC/GPhC guidelines on social media extends to videos, as do the Advertising
TikTok users self-declare they are 13 or above, but in April 2023, TikTok was fined £12.7 million by the Information Commissioner’s Office for processing data of ‘up to 1.4 million UK children under 13’.10 Efforts have been taken by TikTok to improve age verification for UK users since. When combining the ages of TikTok users and the potential for algorithmic influence, aesthetic practitioners have an obligation to understand that young people could come across their content, so it should contain responsible messaging.
Nevertheless, TikTok is not banned in the UK, and there is currently no prospect of that occurring. There have been no confirmed security breaches to date in the UK, and there has been no formal advice to stop using it. Therefore, practitioners should not be worried that using the platform would generate any risk.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 82
Digital marketing specialist Alex Bugg advises on how to stay abreast of the consistent rise of TikTok and Reels in the world of marketing
Mastering short-form video
Staying abreast of TikTok trends is easiest if you use the app yourself and follow influencers that resonate with your target audience. This only requires a few minutes a day to stay on top of what content is performing well. Another member of your team can help with this, especially if they are of the generation which engages with short-form video amongst their peers already. Google Trends is a free tool through which you can see what the UK is searching for, allowing you to stay on top of what the nation is talking about. Of course not every news trend is appropriate, but it’s helpful to be informed. Be mindful that your audience is still that of prospective medical patients, so any trends you partake in should not threaten your personal profile or the legitimacy of your clinic. When considering engaging in trends, ask yourself: is this trend centred around something that will resonate with my ideal patient demographic?
Optimise your quality
Sound matters: the ear forgives less than the eye, so if you want to invest in improving your short-form video, I recommend investing in external mics that connect to your phone. You may have seen the square clip-on mics on TikTok videos: these are typically the RODE Wireless Go II which are a simple fix to make your content more professional. If you want to improve the look of your clips, a tripod phone holder and lighting (I prefer using key lights to ring lights) can be sought online.
Stay on the right side of copyright law
If your social account is a business account and not a ‘personal brand’, you should not be using copyrighted music. Using the latest trending sounds on TikTok might be shrewd advice, but this could have consequences which sees, at best, your videos being silent or removed. Business account holders will typically only see sounds and music they
are allowed to use. When adding your own sounds or those that appear as ‘original’ on a platform, you will have to think twice. A common trick you hear on TikTok a lot is sped-up versions of popular songs, but rights holders still own these.11,12
Copyright holders can submit takedowns on TikTok and Instagram, and three strikes for copyright infringement or one strike for trademark infringement can result in an account being banned.11,12 To make it easier for businesses to create content on TikTok, there is a verified commercial music library, open for anyone to use for commercial benefit.
Creating content in batches saves time and effort. Whilst it’s great in theory to create a quick video between patients when in-clinic, jobs always get between you and creating. This is why planning out your video ideas in advance is key. This could be done yourself, within your team or with a professional videographer to handle the technical side for you. This allows you to be safe in the knowledge that your feed is handled while you work.
Engage with useful tools
AI is fast becoming a useful partner for executing ideas. ChatGPT is the tool that is being talked about widely. The platform can be prompted to create ideas for short-form videos if you’re feeling stuck. You need to give ChatGPT as much context about your business as possible to get the best ideas – this could include some details about yourself, your clientele, the treatments you offer and so on. There is no such thing as an original idea when using generative AI tools such as ChatGPT, however, so bear this in mind. These ideas have come from across the internet, so it’s not the best solution if you want to be truly original.
You can make TikTok videos and Meta Reels directly in their respective apps, and the user interface is quite intuitive. Apps such as CapCut and Canva have also made more advanced video creation accessible,
offering options such as adding logos and imagery to your content. These apps contain templates that are easy to paste content into, making the production process quick and easy. These templates can incorporate a combination of video clips and photos, which make great patient story videos. Apps like these are simple to pick up, and great tutorials can be found on YouTube.
Whilst your short-form video content is likely to be centred on patient education and/or selling the products you offer inclinic, there are multiple ways you could execute these goals. Don’t be shy to try new approaches and incorporate a lighthearted element to your videos. Recruit other members of your team to add some variety if you wish, or perhaps inject some humour when discussing less serious topics. This form of marketing is the perfect avenue for building a personable brand, so don’t hold back!
Reaching more patients
Short-form content is engaging (and fun!), but you need to be educated before you start. Understanding how people consume these videos, and best practice for creating them, is often as simple as using the app yourself or employing an in-house or agency marketer and experimenting to see what works. Ultimately, social media marketing in medical aesthetics is about generating bookings rather than achieving thousands of followers and views, but with short-form video at the forefront of social users’ feeds, every clinic should be trying it out.
Alex Bugg has worked with Web Marketing Clinic since 2016 and has a key interest in developing strategies for aesthetic clinics and biotechnology firms across the UK and abroad. Bugg also has a Master’s in chronic disease and immunity from University of Leicester, graduating in 2016.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 83
Short-form video is engaging because it’s short, sweet and the message is immediate
VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Alex Bugg will be speaking on What Does AI-Driven Mean for the Future of Aesthetics Marketing at CCR 2023 on October 19-20 at ExCeL London. Scan the QR code to register for free now.
Introducing Alma Opus™
TAKING RADIOFREQUENCY TREATMENTS TO THE NEXT LEVEL.
Utilising patented unipolar radiofrequency and first-of-its-kind fractional Plasma® technology to provide your clients with refined contours and a youthful glow for the face neck and décolletage Opus™ is revolutionising skin tightening and resurfacing treatment for wrinkles, fine lines, laxity and uneven skin texture and tone
TR E AT S A R ANGE OF SKIN CONCERNS
USTOMISABLE TRE ATMENT
N O INVASIVE NEEDLES OR CONSUMA BLES For more information visit almalasers.co.uk
Alice Henshaw is an aesthetic nurse prescriber and business owner who prioritises positively impacting patients’ lives throughout her practice.
Henshaw was born in Auckland, New Zealand, and was interested in medicine from a young age. Her mother was a midwife and her father was a biologist and medical researcher, so she grew up immersed in the field. Witnessing the positive impact they had on others’ lives inspired her to pursue a career in nursing. “I wanted to work in an industry where I could make a difference in people’s health and wellbeing,” she shares.
Her medical studies began in Auckland, New Zealand, where she undertook a nursing degree. She initially practised as a cardiothoracic and intensive care nurse at Auckland Hospital, before her interest in aesthetics piqued. She took the jump to move to London in 2014, where she gained her nurse prescriber qualification and undertook training in filler and toxin treatments. Her decision to move was fuelled by a desire for personal and professional growth. She says, “The UK has long been renowned for its thriving aesthetic industry. What I particularly appreciate about practising in the UK is the diversity of patients I encounter. London in particular offers a unique blend of cultural backgrounds and aesthetic preferences. This diversity challenges me to tailor my treatments to each individual’s unique needs and desires.”
Becoming part of the lively and collaborative UK medical aesthetic community gave her the knowledge and confidence to open her own clinic, Harley Street Injectables, in 2016. “While there were undoubtedly risks involved, the opportunity to shape my own practice and build lasting relationships with patients outweighed those concerns,” she comments. “I was determined to create a space where patients could receive not only exceptional treatments, but also a warm experience throughout their journey.”
She names dermal fillers as her favourite treatments to perform, saying, “Injectables hold a special place in my heart because they have the power to ignite a deep sense of confidence and self-assurance. They’re like painting a masterpiece on a living canvas. Seeing patients’ faces light up as they look in the mirror and witness the immediate, tangible results is an indescribable feeling.”
Henshaw is also passionate about skin health and topical rejuvenation, which led her to kickstart her own skincare line Skincycles in 2019. It was founded on the principle of holistic skincare throughout the natural turnover cycle of the skin. She shares, “The message is to encourage individuals to establish a consistent skincare routine that focuses on nourishing, protecting and rejuvenating the skin at a cellular level.”
The decision to start her own brand is not one she took lightly. She wanted to ensure the formulation behind every product was evidence-led to meet high standards of quality and efficacy, which she achieved through collaborating with expert researchers. Henshaw shares that this was crucial in developing the brand, alongside “developing a clear brand identity and mission that aligns with your values and resonates with
One way you practise ESG…
Once a month, my team volunteers for Felix’s Green Scheme, giving surplus food to Londonders in need.
Favourite area of the face to treat…
The lips, as enhancing their shape and volume can have a significant impact on the overall face.
Career you would have pursued besides aesthetics…
I always dreamt of being an artist as a child, so probably something related to art or design.
your target demographic. Transparency in ingredient sourcing and formulation integrity is crucial to building trust.”
Henshaw has a thriving social media persona, with more than 450,000 Instagram followers and counting. As well as posting beautiful content, she uses her platform to share knowledge, expertise and insights about treatments, thus attracting and retaining patients. She comments, “In today’s digital age, social media has become a powerful platform for practitioners like myself to connect with a wider audience and build a personal brand.”
Henshaw is also a UK ambassador for pharmaceutical company Galderma, and global key opinion leader (KOL) for Alluzience and Sculptra treatments. She shares that her KOL role allows her to keep abreast of industry developments. She is also a Galderma local mentor trainer, educating practitioners on Galderma’s products through workshops and hands-on sessions. She also engages in a range of clinical studies and scientific publications. She shares that running a clinic and a business comes with its fair share of challenges. “The struggle to find equilibrium between my work and personal life has been a constant battle,” she says. “I’ve come to realise that maintaining a work-life balance is not just a luxury, but a necessity.” She advises other practitioners – who are often just as busy – to take care of themselves and “find joy outside of work” to feel really fulfilled.
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 85
“Injectable treatments are like painting a masterpiece on a living canvas”
Aesthetic nurse prescriber Alice Henshaw shares what drives her towards clinic, skincare and Instagram success
Henshaw will be speaking on Biostimulators in the Aesthetics Arena at CCR. Scan the QR code to register for free
The Last Word
Dr Jinah Yoo discusses the differences between the Korean and UK aesthetics market
Cosmetic surgery and non-surgical aesthetic procedures are booming in South Korea. Last year, it was revealed that its aesthetic market was expected to grow at a compound annual growth rate (CAGR) of approximately 7% between 2022 and 2030.1 This has been put down to factors such as physiognomy, social media and K-pop.1 With such a big interest in the industry, innovation is high. Having trained in both the UK and Korea in the field of dermatology and aesthetics, I have noticed that current trends in the UK aesthetics market have existed in Korea for many years already. For example, within the last year or so, skin boosters have really exploded in the UK, but these have been regularly used in Korea for around 10 years. In this article, I will discuss the differences between the two markets and look at what the UK can learn from the Korean approach.
The current landscape
The main difference between the UK and South Korean aesthetics market is regulation. In Korea, only doctors are allowed to practise, and not even nurses or dentists are seen as qualified enough to be injecting. This is unlike the UK, which sees a range of medical practitioners practising, as well as a huge amount of non-medical lay injectors.
I feel this is a contributing factor as to why Korean doctors are more adventurous in creating new protocols as there is no risk of non-medical injectors trialling these methods. For example, I know of one popular device which is only used in the UK for laser hair removal, however in Korea, doctors have developed their own protocols to use it for lifting the face. Due to the number of non-regulated practitioners in the UK, this would not likely be developed or promoted safely and effectively, and would not be covered by an insurance company. In the UK, it is the standard that the practitioners are following company guidance rather than implementing their own strategies.
Doctors in Korea have a much wider product offering and do not limit themselves to one specific brand or company. In the UK, it is the norm for practitioners to align themselves
with one certain device to become a key opinion leader for that company. I would estimate that on average, a practitioner will have around 20 different energy-based devices in the clinics I visited in Korea. This is because although the treatment price is much lower in Korea than the UK, they see many more patients in a day, having a higher income. For example, one of the clinics I visited saw 200 patients in a day between two doctors. Products and devices are also at a lower price if they have been produced/ manufactured in Korea. I believe this makes the Korean landscape less biased when it comes to treatment and enables the practitioner to select the right device based purely on the individual. Of course, it may not be feasible in the UK, as the landscape is so oversaturated.
Issues in importing products
While I believe that the UK aesthetics industry could learn a lot from Korea, there currently lies a huge problem in relation to product certification. Previously, the UK was part of the European Economic Area (EEA), and as such all medical devices (including dermal fillers) were required to carry the CE mark.2 However, following Brexit, all products required to carry the CE mark in the EEA will need to obtain a new UKCA mark. If the manufacturer wants to have the product on the EU market as well, it will need both the CE mark and the UKCA mark.2 Many Korean companies I have spoken to believe that this is an extremely lengthy process to begin for two different approvals, for what is essentially a very small market. Because of this, I believe many Korean companies which have excellent innovations will be more hesitant to bring their products across to the UK in the future. It’s a shame, as there are many products and devices that have extremely high reputations in Korea which the UK market is completely unaware of, such as the poly-L-lactic acid collagen stimulator McCoom, or needleless drugdelivery injector Curejet.
Since practising in the UK, I have also found that there are a lot of misconceptions about Korean companies and products, with many practitioners believing that they are unsafe or ‘dodgy’. However, it is actually a place of
huge innovation and where a lot of product development is taking place. Unfortunately, this tends to be because of ‘black market’ or counterfeit products being brought over, and these fake devices are tainting the view of an otherwise safe industry. Due to the lack of legitimate products being approved for use and being brought over here, this stereotype unfortunately continues.
Showing an interest in the Korean market
Unfortunately, due to the lack of regulation in the UK, I don’t believe that the UK market can currently reach the level of Korean innovation and development, and it would take time to make changes to our current regulation. However, greater public education on the risks of non-medical injectors, as well as industry collaboration, can help to improve UK industry standards alongside the proposed licensing scheme. I also believe that if Korean companies and practitioners saw a growing interest in their market in the UK, they would be more likely to have a UK presence. Currently, the lack of awareness of the industry has meant that there is less opportunity. So, I encourage all UK-based practitioners to research Korean trends and innovations, which can then help to inform UK practice, and interact with legitimate Korean companies that have brought their products to the market.
Dr Jinah Yoo is a UK-trained consultant dermatologist of Korean descent. She founded Maylin x Dr. Jinah Yoo Dermatology in Harley Street, focusing on innovative Korean dermatology and antiageing approaches. With a strong academic background, she’s an honorary lecturer at the University of Manchester’s Skin Ageing and Aesthetic Medicine course. Her expertise includes cosmetic dermatology, acne and hyperpigmentary disorders. Qual: MBChB, FRCP (UK), PG Diploma, MSc
1. Global Data, South Korea to remain Fastest Growing Aesthetics Market, 2022, <https://www.globaldata.com/media/medicaldevices/south-korea-to-remain-fastest-growing-aestheticsmarket-in-apac-says-globaldata/>
2. Ellie Holden, Controlling Dermal Filler Regulation, 2022, <https://aestheticsjournal.com/feature/controlling-dermal-fillerregulation>
Reproduced from Aesthetics | Volume 10/Issue 11 - October 2023 @aestheticsjournaluk Aesthetics Aesthetics aestheticsjournal.com 86
New for CCR 2023 is the Korea Pavilion, in partnership with the International Beauty Industry Trade Association (IBITA). Scan the QR code to register and learn more.
DERMAL FILLERS. EFFECTIVE. SAFE. BEAUTIFUL RESULTS.
*Actual Patient, individual results may vary. FINALIST FOR THE DIGITAL INFLUENCE AWARD JOIN THE MOVEMENT