Aesthetics Journal July 2025 Skin Health and Dermatology
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multicentre study evaluating
tissue filler in the correction of lateral canthal and perioral lines. J Cosmet Dermatol. 2022 Jan;21(1):191-198. doi: 10.1111/jocd.14460. Epub 2021 Sep 24. PMID: 34559948 3) Succi, I. B., Da Silva, R. T. & Orofino-Costa, R. 2012. Rejuvenation of periorbital area:
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Contents • July 2025
08 News
The latest product and specialty news
16 Advancing Personalised Prescription Skincare: The Klira Pro Model
A progressive shift in the landscape of prescription skincare
17 News Special: The Correlation Between Botulinum Toxin and Mental Wellbeing
Aesthetics draws on findings from a recent study to explore the relationship between botulinum toxin and mental wellbeing
CLINICAL PRACTICE
18 Sharpen Your Skills and Stay Ahead in Medical Aesthetics
Experience five educational theatres at CCR 2025
22 Special Feature: Treating Dermatitis in Aesthetic Practice
Miss Jenny Doyle, Dr Sonia Khorana and Dr Ahmed El Houssieny share approaches to treating dermatitis
28 CPD: Exploring Menopause and Acne
Dr Hazel Parkinson discusses managing menopausal patients
35 Meeting the Growing Demand for Dyschromia Treatments
Dr Bhavjit Kaur and Sue Thomson consider dyschromia treatments
40 Laser Technologies for Non-Surgical Skin Rejuvenation
Dr Kashini Andrew presents laser techniques for rejuvenation
43 Swiss Innovation Meets British Skincare
Stratpharma brings its next-generation wound care solutions to the UK
44 Ethnic Considerations in Rhinoplasty
Dr Nizar Hamadeh analyses rhinoplasty techniques and ethnic identity
49 Implementing HA for the Skin Barrier
Dr Pamela Benito explores the role of HA in enhancing skin quality
News Special: BoNT-A and Mental Wellbeing Page 17
52 Where Technology Meets Skincare: The New GetHarley Era
GetHarley delivers smarter skincare with AI-driven tools
53 Abstracts
A round-up and summary of useful clinical papers
IN PRACTICE
54 Understanding Regulatory Frameworks for Injectables
Professor Steve Davies and Dr Anish Kotecha explore current regulation for injectables
56 Utilising Social Media to Boost Patient Growth
Nefise Tasdelen considers social media and patient engagement
58 Navigating Fear in Business
Hollie Evans addresses overcoming fear in business
61 In Profile: Michelle McLean
Michelle McLean on merging aesthetic practice with facial palsy work
62 The Last Word: Sterile Clinical Tools
Mr Apostolos Vlachogiorgos argues why practitioners should consider using single-use sterile markers
Special Feature: Treating Dermatitis Page 22
Clinical Contributors
Dr Hazel Parkinson is a GP with a specialist interest in dermatology, women’s health and aesthetics. She divides her time between her NHS role within the Warwickshire Primary Care Gynaecology Service, supporting women with menopause and other health concerns.
Dr Kashini Andrew is a UK-trained dermatologist with a special interest and training in lasers. He completed his Undergraduate Medical degree in Bachelor of Medicine and Surgery in 2012 and a Master of Science in Human Physiology in 2017, both at the Ahmadu Bello University, Medical School, Zaria, Nigeria.
Sue Thomson is managing director of SJ Partnership and international sales leader with a background in the pharmaceutical and medical device specialty. She has supported clients in achieving award-winning product development and commercial goals while building and leading sales teams.
Dr Bhavjit Kaur has been a qualified medical practitioner since 1993, with over 15 years of experience in medical aesthetics.
Dr Kaur is the co-founder of the Health & Aesthetic Clinic, SkinSutra clinic and founder of Tuhi Clinic in London.
Mr Nizar Hamadeh is a facial plastic surgeon with a special interest and extensive experience in rhinoplasty procedures. He holds a degree in head and neck surgery from the Université Libre de Bruxelles, Belgium. Mr Hamadeh is dedicated to understanding the complex nuances of nasal anatomy across diverse populations.
Dr Pamela Benito is an aesthetic practitioner, serving as a regional expert for Teoxane UK. Dr Benito studied at New York University, and her facial aesthetics career progressed as she trained at the Royal College of Surgeons in various aspects of medical aesthetics. NEXT MONTH:
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As we step into the height of summer, our focus this month is on the foundation of every great aesthetic outcome – skin health and dermatology. From barrier protection to managing chronic conditions, we’re shining a spotlight on the techniques, tools and knowledge that help practitioners care for skin in a truly holistic way.
Our Special Feature this month on p.22 explores the treatment of dermatitis – a challenging and increasingly common concern in aesthetic practice. You’ll also find insightful clinical articles on managing dyschromia (p.35), acne and menopause (p.28) and a fascinating look at how HA injectables can help support and protect the skin barrier (p.49).
In our News Special (p.17 ), we delve into the ongoing conversation about the link between botulinum toxin and mental health, including the ethical considerations surrounding this evolving area of research. I was also excited to attend the exclusive launch of a new botulinum toxin this month – a milestone moment for the UK market. You can read
Clinical Advisory Board
all about it in our On the Scene pages, and make sure you’re at Clinical Cosmetic Regenerative Congress (CCR) this September, where the official full-market UK launch will take place!
Speaking of CCR, our event preview on p.18 breaks down the exciting educational talks you can expect from each theatre, from clinical breakthroughs to business-building sessions and practice safety updates. One of the biggest announcements so far is that the world-renowned aesthetic nurse and lip expert Julie Horne will join us in London as an international keynote speaker.
Her session, Mastering the Art of Lip Augmentation with Julie Horne Academy, will include a theoretical framework and a live model demonstration showcasing her signature vertical injection technique. This is an opportunity to learn from one of the most influential figures in aesthetics – be sure to register early so you don’t miss out!
As always, thank you for reading this issue of the Aesthetics Journal and for being part of our incredible community of doctors, nurses, dentists and other medical professionals working in medical aesthetics.
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 the former chair of the British Association of Medical Aesthetic Nurses (BAMAN), 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 a 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.
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 Souphi 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.
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Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.
Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.
Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.
ARTICLE PDFs AND REPRO
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Three days of education and inspiration at the Master Injector conference in Toronto – what an experience!
#PACE2025
Dr Jordan Faulkner
@drjordanfaulkner
#Relfydess MiCosmeticsUK @micosmeticsuk
Had a spectacular time with my fellow Essex crew at Galderma’s Relfydess event
An incredible weekend at PACE in Athens, whoever said ‘don’t mix work and play’ got it all wrong if you ask me!
#InternationalConference
Alma Lasers
@alma.lasers.international
A beautiful time in Dubrovnik, unveiling the Alma IQ and plenty of networking. Alma Academy is not just a gathering, it’s a movement!
#Event
Mr Ash Soni
@thesoniclinic
Just touched down in NYC for an unforgettable AlumierMD experience. Glowing skin and great conversations all around!
Unlicensed Practice
Court issues nationwide ban on unlicensed BBL injector
Manchester Civil Justice Centre has issued a court order, following civil action led by Trafford Council, prohibiting Ricky Sawyer from conducting cosmetic procedures in England and Wales until May 2028.
This comes following the court’s review of extensive evidence documenting serious harm to multiple individuals as a result of unsafe injectable procedures, including the liquid Brazilian butt lift (BBL). The evidence presented included graphic photographs and video footage showing complications such as sepsis, tissue necrosis and permanent disfigurement.
Sawyer, who is not a registered medical professional, had been carrying out high-risk aesthetic treatments without recognised clinical training or regulatory oversight. The injunction prohibits him from performing or facilitating any invasive cosmetic procedures and from possessing surgical instruments or prescription-only medicines associated with such treatments, unless they are prescribed for his personal use. A power of arrest was attached to key provisions of the order, allowing for immediate enforcement if he breaches its terms. This case was supported by the October 2024 Guidance for Enforcement by Local Authority Authorised Officers, which classifies procedures such as buttock, breast and genital augmentation using dermal fillers or autologous fat as surgical in nature. The guidance makes clear that such treatments fall outside the scope of standard non-surgical cosmetic interventions and should only be performed by regulated medical professionals in clinical environments. Andrew Rankin, trustee of the Joint Council of Cosmetic Practitioners (JCCP), commented, “This outcome is testament to the hard work and commitment to public safety of Environmental Protection Officers nationally, and it demonstrates the value of the coordinated approach that was necessary in this instance.”
Botox receives MHRA approval for
platysma treatment
The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved Allergan Aesthetics’ Botox to treat platysma bands.
The MHRA approval allows for the temporary improvement in the appearance of moderate to severe platysma prominence. The condition must be observed at maximum muscle contraction and have a significant psychological impact to qualify for treatment. According to the company, this approval marks the first non-surgical neurotoxin treatment in the UK specifically authorised for this indication.
Aesthetic practitioner and advisory board member for Allergan Aesthetics, an AbbVie company, Dr Nestor Demosthenous commented, “This is an extremely important time with the approval of moderate to severe platysma prominence treatment with Botox. This allows us to effectively treat a new concern non-surgically, which patients have been wanting for years, backed by strong scientific evidence and MHRA approval.”
Botulinum Toxin
Keynote Speaker
International Speaker Julie Horne announced for CCR
For the first time at the Clinical Cosmetic Regenerative Conference (CCR), world-renowned nurse practitioner and lip augmentation expert Julie Horne will lead a two-hour symposium.
In this keynote session on Day 2, she will present her theoretical framework before conducting a live assessment and single injection demonstration on a model. Drawing on the latest anatomical research into lip compartments, Horne will explore why vertical injection techniques may be preferred in certain cases and how this knowledge can inform both assessment and treatment planning.
Key learning outcomes include an understanding of the anatomical principles of lip compartments and their clinical relevance in aesthetic treatments. The session will also cover how to recognise when vertical injection techniques are most appropriate and the benefits, they can offer in achieving natural results. Delegates will learn how to carry out a detailed lip assessment to inform safe, effective and tailored treatment plans.
This session will offer clinical insight into one of the most in-demand lip techniques from a widely respected practitioner in the field.
Julie Horne will speak at the Aesthetics Journal Arena on September 26 at CCR. Turn to p.18 to register now.
Annual Report
JCCP releases its Annual Report
The Joint Council of Cosmetic Practitioners (JCCP) has issued its 2024-2025 Annual Report.
The report outlines milestones in its efforts to improve patient safety within the aesthetics sector. Within the report is the advancement of the JCCP’s public protection agenda, including a marked increase in practitioner registrations and the strengthening of its Code of Practice. The Council reported a 20% year-on-year growth in accredited registrants.
The report also highlights the JCCP’s involvement in government consultations on aesthetics regulation, contributing specialist advice on practitioner licensing, education standards and patient safeguarding. In addition, the JCCP continued its collaboration with the Advertising Standards Authority (ASA) to address misleading advertising practices in the aesthetics specialty.
Professor David Sines, chair of the JCCP, commented, “Our Annual Report demonstrates the significant progress that the organisation has made in influencing and shaping Government policy in the interests of patient safety and public protection.”
Vital Statistics
65% of surgeons report greater confidence in clinical outcomes when using artificial intelligence (Gitnux, 2025)
A UK based male study found that out of 700 participants, 52% of men discovered their aesthetic practitioner through social media (Teoxane, 2025)
In the UK, 45% of people do not apply SPF daily (Face the Future, 2025)
In 2024, women accounted for 93.5% of all cosmetic surgeries, totaling 25,663 procedures – a 6% increase from 2023 (BAAPS, 2025)
84% of UK employers have noticed a decline in employee morale (Robert Walters, 2025)
Following a survey of 1,500 participants, including 990 women, only 6% of females reported having ‘no concerns’ about their skin (Cynosure Lutronic, 2025)
Events diary
11th–13th July 2025
IMCAS China 2025
5th September 2025
RSM Congress
18th-19th September 2025
The BAMAN Autumn Conference
25th-26th September 2025
CCR 2025
11th October 2025
BCAM Conference
22nd November 2025
Interface Expo
IN THE MEDIA
TV personality Olivia Attwood recently opened up about her evolving approach to aesthetic treatments. On the podcast What’s My Age Again? Attwood affirmed a shift from traditional procedures to regenerative treatments. She discussed hyperbaric oxygen therapy, stating, “I do this for skin health and also in between cosmetic procedures.” Attwood explained that it delivers pure oxygen at higher-than-atmospheric pressure to promote healing and collagen production. Reflecting on her past, she admitted, “I wasn’t trying to look younger, I was trying to look like a sex doll,” adding she now admires, “women who aren’t slaves to cosmetic surgery.”
Dr Sara Kayat discusses creatine supplementation
Appearing on This Morning, NHS general practitioner Dr Sara Kayat highlighted growing evidence that creatine offers benefits beyond fitness. She explained, “There is emerging evidence to suggest that it may benefit cognitive function.”
Dr Kayat discussed one standout study, that found a single 3.5g dose helped reduce fatigue-related cognitive decline in sleep-deprived individuals. Dr Kayat also cited research indicating that creatine, when taken during menopause alongside resistance training, can help maintain lean muscle mass and reduce the loss of bone mineral density.
Regulatory Change
AHPRA issues new aesthetics safety measures in Australia
In response to growing concerns over unsafe practices in the cosmetic sector, the Australian Health Practitioner Regulation Agency (AHPRA) has introduced new requirements for dentists and nurses.
Those performing non-surgical cosmetic injections must now complete additional education and training before administering treatments such as botulinum toxin and dermal fillers. New rules mandate a minimum of one year’s nursing experience outside cosmetic procedures and prohibit influencer testimonials and targeted advertising towards minors. Registered practitioners must also be named in all promotional material.
These measures come after reports of unlicensed providers using substandard products, including a case in which three women were hospitalised in Sydney with suspected botulism, believed to have received unregulated anti-wrinkle injections. Regulators warn that non-compliance will result in enforcement actions starting September 2025.
Justin Untersteiner, CEO of AHPRA, commented, “There will be others who have to modify their business models and their practices to meet these guidelines. This is a growing specialty, and what we do see in some cases is that there are people out there putting profit before patient safety.”
Parliamentary Review
Parliament launches UV safety inquiry
The British Beauty Council, alongside policymakers and specialty leaders, has introduced the UK’s first parliamentary inquiry into UV safety.
The All-Party Parliamentary Group (APPG) for Beauty & Wellbeing announced the initiative during Sun Awareness Week, aiming to tackle rising rates of UV-related health issues including melanoma, now the UK’s fifth most common cancer.
Millie Kendall, CEO of the British Beauty Council, commented, “Brands and businesses across the beauty sector have long been doing great work when it comes to increasing UV safety and access to SPF. However, we can only drive real change when we collaborate to achieve a shared vision. With rates of melanoma increasing and stats showing that three in four neglect to address sun damage. The Council is thrilled to have support from this initial group of leading retailers and brands and is excited to accelerate cross-industry participation over the coming years.”
Webinar
Aesthetics collaborates with LTF to present webinar
Aesthetics is partnering with LTF Digital to host a new webinar, The 10 Uncomfortable Truths About Marketing in Medical Aesthetics, taking place on July 9.
Designed for clinic owners, practice managers and in-house marketers, the session will explore key areas often overlooked in digital strategies, including underperforming websites, ineffective lead management and misaligned performance metrics. With a focus on practical application, the webinar aims to guide attendees in identifying the root causes behind poor marketing ROI and provide actionable solutions to address them. Topics included rethinking digital benchmarks, improving website functionality and establishing trust through brand consistency. Participants will also receive an implementation checklist to support immediate improvements in patient acquisition and retention.
Business consultant and founder of LTF Digital, Rick O’Neill, commented, “Most clinic owners are drowning in generic advice. But in the run-up to CCR, the clinics that grow are the ones that think strategically. We’re showing them how to step back, audit what’s really working and fix the blind spots that most agencies won’t even mention. This session is designed to prepare clinic owners to have serious conversations with suppliers, teams or investors, based on real data, not guesswork.”
Olivia Attwood explores regenerative treatments
What’s trending in the consumer press
Business Transition
Cutera announces its transition to private ownership
Aesthetic device company Cutera has unveiled its transition to private ownership as part of a financial restructuring initiative.
This transition means that the company’s shares are no longer publicly traded, with ownership now held by private individuals and entities. According to the company, the transition is designed to strengthen its financial foundation, enhance customer support and drive long-term growth.
Taylor Harris, CEO of Cutera, commented, “We’ve built a strong legacy over the past 25 years, and with this new chapter, we are even better equipped to serve the dynamic needs of the global aesthetics market. With the support of our new ownership group and a stronger financial foundation, we are primed to deliver cutting-edge technology, exceptional service and unparalleled value to our partners around the world.”
Training Programme
BAD-approved dermatology training launches in Boots
A new dermatology training programme developed by consultant dermatologist Dr Justine Hextall, in partnership with L’Oréal Groupe, has been formally approved by the British Association of Dermatologists (BAD).
The initiative aims to enhance front-line support for common skin conditions within pharmacy settings. The training covers conditions including acne, rosacea, atopic dermatitis, psoriasis, keratosis pilaris and hyperpigmentation, alongside modules on melanoma, scalp health, the skin microbiome and broader dermatological principles.
It is currently being delivered to Boots pharmacy teams in over 200 locations across the UK, with further roll-out planned. The move is intended to expand access to basic dermatological advice in a community setting, without the need for clinical referral.
Partnership
Healthxchange named new training partner for Profhilo
Aesthetic distribution company Healthxchange has been announced as an authorised training provider for the Profhilo product range.
The collaboration, confirmed by Profhilo’s exclusive distributor HA-Derma, comes ahead of the launch of Profhilo Structura training in late June. The addition of Healthxchange aims to meet growing demand for regenerative injectables and structured training in the aesthetics sector, according to HA-Derma.
Training will be delivered at Healthxchange Academy locations and will include theoretical and practical components. With this development, standard Profhilo, Profhilo Body and Structura training will now be available from HA-Derma’s authorised partners, including Harley Academy.
Iveta Vinkler, sales and marketing director of HA-Derma, commented, “Patients and practitioners know and trust Profhilo by name alone. By working with exceptional, ethical, medically trained providers like Harley Academy and now Healthxchange, we help to set educational benchmarks in the aesthetic community that improve patient safety and satisfaction.”
Simone Shoffman, head of education for Healthxchange, said, “Our clinical team are elated to add Profhilo Structura to our wide repertoire of in academy training, across all academy sites. The training will be structured to ensure that busy healthcare professionals are trained theoretically and practically.”
BAMAN UPDATES
A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses
BAMAN
AUTUMN CONFERENCE 2025
First and foremost, a huge thank you to everyone for your response to this year’s annual conference. Tickets are well and truly flying off the shelves, and we can’t wait to see so many new faces at this year’s event.
Once again taking place at The Eastside Rooms in Birmingham, the BAMAN Autumn Conference will run over two education and fun-filled days: September Thursday 18 and Friday 19.
After the incredible feedback from 2024, we’re aiming even higher for 2025 and we can’t wait to show you what’s in store. There will be plenty of opportunities to meet your regional leaders and board of directors during registration, lunch breaks and the Thursday night drinks reception.
WHAT’S NEW FOR 2025?
We’re pulling out all the stops to make this year’s conference our best yet, with brand-new features, workshops and opportunities including:
Meet the Mentor lunchtime sessions
An informal way to connect with BAMAN nurse practitioners in a relaxed setting. Ideal for those who are after 1-2-1 time or advice from a longstanding, experienced member.
Drop-in Content Corner
Your space to capture headshots, photos or social media reels for your own social media channels. We’re so excited to have partnered with the Cosmetic Content Club who specialise in providing high quality content to medical aesthetic practitioners.
Friday afternoon Business Masterclass
We know you’ve got the clinical knowledge – but what about VAT, legal risk and business protection? This session will cover the essentials for business support whether you’re just getting started, scaling your business up or starting to think about an exit strategy.
Hotel rooms are almost sold-out with three months to go – the earliest we’ve ever seen! Demand is high, so don’t leave it too long. Book your tickets online now at www.baman.org.uk or via the QR below.
This column is written and supported by BAMAN
Event Spotlight: The Latest Developments in Regenerative Procedures
Mr Tunc Tiryaki tells us about the upcoming Regenerative Aesthetic Surgery Symposium
What is the purpose of hosting the Regenerative Aesthetic Surgery Symposium?
The Regenerative Aesthetic Surgery Symposium exists to unite leading global voices in regenerative surgery, from pioneers to emerging innovators, to share transformative techniques, technologies and clinical research. As regenerative surgery evolves rapidly, the symposium provides an essential forum for knowledge exchange and surgical collaboration that advances global standards of care. In such a dynamic and developing field, continued education is not just beneficial, it is vital. Staying informed ensures that practitioners can responsibly harness the latest advancements, driving better patient outcomes. Why have you chosen to collaborate with CCR?
CCR is a specialty-leading platform that perfectly aligns with our mission to promote international collaboration, innovation and continuous education in regenerative surgery. By hosting the symposium within the framework of CCR, we bring together surgical and non-surgical communities, encouraging the kind of cross-disciplinary dialogue that is essential for progress. This partnership amplifies our impact, offering greater visibility for regenerative surgery within the wider aesthetic and medical community and enhancing opportunities at every level.
How will attending the Symposium benefit practitioners?
Delegates will gain invaluable exposure to the latest developments across both surgical and minimally invasive regenerative procedures. Both days provide a comprehensive understanding of the full spectrum of regenerative medical aesthetics, empowering practitioners to refine their skills, adopt emerging best practices and elevate their standard of care in a fast-evolving discipline.
RASS at CCR
25 & 26 September
Early bird price: £190 + VAT Scan the QR Code to find out more and get your ticket today!
Educational Event
FACExpo announces rebrand as Interface Expo
Medical aesthetics event FACExpo has introduced its transition to Interface Expo following three annual events.
Founded in 2022 by oral and maxillofacial surgery registrar Mr James Olding, FACExpo was an educational and networking event in non-surgical aesthetics for doctors, dentists, nurses and surgeons. Mr Olding shared that the rebrand aims to reflect Interface Aesthetics’ mission to promote progress through education, innovation, research and talent development.
The 2025 edition of Interface Expo will feature a full-day programme with specialist speakers including nurse prescriber Julie Scott, aesthetic practitioner Dr Priya Verma and consultant oculoplastic surgeon Miss Elizabeth Hawkes. Mr Olding commented, “Interface Expo is about pushing the boundaries of education in medical aesthetics, and bringing injectors together to learn, share and lead with evidence-based practice. I’m proud to be leading this pioneering event into its fourth year, now integrating mentorship, training and education more than ever as it comes fully into the community.”
MHRA Guidance
MHRA updates guidance on GLP-1 use and contraception
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued updated guidance for women using GLP-1 receptor agonists.
Women are advised not to use these medicines during pregnancy, when trying to conceive or while breastfeeding, due to limited safety data on potential risks to the fetus. The MHRA states that those who become pregnant while on treatment should discontinue use and consult a healthcare professional.
In particular, the MHRA notes that tirzepatide (Mounjaro) may reduce the effectiveness of oral contraceptives in individuals with a higher BMI. A secondary, non-oral contraceptive method is recommended during the first four weeks of treatment and after any dose escalation.
The guidance follows growing concerns about inappropriate use of GLP-1 medicines outside licensed indications and without sufficient clinical oversight. The MHRA is also encouraging healthcare professionals and patients to report suspected adverse effects or counterfeit products via the Yellow Card scheme.
Dr Alison Cave, MHRA chief safety officer, said, “Skinny jabs are medicines licensed to treat specific medical conditions and should not be used as aesthetic or cosmetic treatments. They are not a quick fix to lose weight and have not been assessed to be safe when used in this way. Our guidance offers patients a ‘one stop shop’ for our up-to-date advice on how to use these powerful medicines safely.”
GetHarley collaborates with Meder Beauty
Skincare platform GetHarley has partnered with skincare line Meder Beauty to launch the new Meder Quatre-Peptide Mask. GetHarley shares the mask is made from plant derived sheet material, designed to hydrate the skin and address fine lines, wrinkles and loss of elasticity. The mask incorporates epidermal growth factor for skin renewal, Matrixyl-3000 to target ageing and photo damage, Syn-Ake to relax facial muscles and Skinasensyl to soothe sensitive skin by reducing nerve inflammation.
Dr Tiina Meder, cosmetic dermatologist and founder of Meder Beauty, commented, “This latest mask is a powerful mask, and one that clinicians can recommend to their patients via the GetHarley service. I will be holding a webinar for GetHarley practitioners to showcase new peptide studies and developments and to delve deeper into the creation of this new formulation.”
Conference Report
Skin Booster
Hydrafacial unveils new skin booster
Aesthetic device company Hydrafacial has introduced its new HydraFillic with Pep9 Skin Booster.
The company explained that the booster incorporates nine peptides, aiming to target fine lines and wrinkles, hydrate and strengthen the skin barrier. Hydrafacial conducted clinical trials in conjunction with its booster treatment, involving 30 participants. Results showed that 96% reported a noticeable glow, 93% experienced smoother skin and 83% observed a reduction in the appearance of fine lines and wrinkles.
Marla Beck, chief executive officer of Beauty Health, company, owner of Hydrafacial, commented, “The HydraFillic with Pep9 Booster reflects our ongoing commitment to science-backed innovation and high-performance skincare. As aesthetic trends increasingly emphasise longevity and skin concerns emerging from GLP-1-associated weight loss, consumers are seeking non-invasive treatments that deliver results. Powered by peptide science, our newest booster is clinically proven to visibly address signs of ageing – delivering firmer, more youthful-looking skin.”
Aesthetics attends Alma Academy 2025
Aesthetics attended the eighth Alma Academy on Thursday May 22-23 in Dubrovnik, Croatia.
The event gathered nearly 400 physicians and partners from over 46 countries, marking one of Alma’s largest global educational event to date.
This year’s summit featured 19 international speakers, including Professor Ofir Artzi, Dr Pina Panchal, Dr Fatima Aguero and Dr Chytra Anand. In line with this year’s theme, ‘The Art of the Patient’, the topics covered skin ageing, pigmentation, scarring, skin tightening and rejuvenation. In an exclusive conversation with the Aesthetics Journal, Lior Dayan, Alma CEO, and chief marketing officer, Talta Burgan, shared insights into the company’s latest Alma IQ technology and how it aims to reshape digital consultations within the aesthetics space. During the interview, Aesthetics posed questions about Alma IQ’s features, its clinical value and its role in supporting the specialty’s move towards personalisation and non-invasive treatments.
Explaining what differentiates Alma IQ from other digital consultation tools, Dayan said, “It’s preloaded with a very complicated clinical metric, which generates the personalised aesthetic recipe for each on the patients.” According to the company, the system incorporates patented light-filtering technology intended to capture skin topography and accommodate a range of skin tones, including darker phototypes. According to Dayan, the design of the light
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distribution contributes to the accuracy of visual assessments made through the device.
Alma IQ aims to support real-time clinical decisions by suggesting appropriate treatment pathways – such as the correct laser or energy-based applicator – based on both visual data and patient-reported factors. “It’s about giving the doctor better tools to succeed,” said Burgan. “Not just showing a before-and-after photo, but guiding the next step of treatment.”
The technology also aims to support operational efficiency. “It allows the doctor to be very precise, but also to delegate,” Dayan explained. When asked how Alma IQ fits into Alma’s long-term strategy, Dayan hinted at a broader ecosystem in development. “Soon, you’ll be hearing about injectables and skincare that will also connect to the AI. Everything will talk the same language – clinically and technologically.”
This ambition reflects wider trends across the aesthetics sector, particularly the growing demand for non-invasive, personalised solutions. “Patients today are very different,” said Burgan. “They want treatments tailored not just to their skin, but to their lifestyle –how much downtime they can take, how much pain they’re willing to tolerate.”
Alma’s approach, they explained, is rooted in the belief that innovation must align with both clinical value and practical usability. “It’s not enough to just put technology in the basket,” said Dayan. “You have to connect the dots — operationally, clinically and across the patient journey.”
Neuromodulator
Galderma throws exclusive launch for Relfydess
Aesthetic pharmaceutical company Galderma hosted an event at The Gherkin for the UK launch of its new neuromodulator, Relfydess, on June 3.
The event featured expert insights from Dr Javier Murillo, Miss Priya Chadha, Dr Wojciech Konczalik, Mr Ash Soni and Dr Kuldeep Minocha. Described by speakers as a long-acting botulinum toxin, Relfydess is reported to provide results lasting up to six months, with a rapid onset of action observed in some cases in under 24 hours. The product is indicated for the treatment of glabellar lines and lateral canthal lines. Relfydess has been in development for over 15 years and was launched in Spain six months ago. It incorporates what the company refers to as ‘pearl technology’, though further details on the mechanism are yet to be disclosed. Significant investment has gone into the research and development of the product, with sustainability also forming part of its strategic positioning. According to the brand, efforts have been made to minimise waste and improve recyclability across packaging and production processes.
More information on clinical data and UK availability is expected in the coming months and Relfydess will be a key topic of discussion at CCR.
Galderma will be Headline Sponsor at CCR on September 25-26. Turn to p.18 to register.
Patient Safety
UKHSA urges patients to test for bloodborne virus
The UK Health Security Agency (UKHSA) is urging patients of a Wolverhampton aesthetic clinic to come forward for free blood tests. This follows concerns about potential exposure to bloodborne viruses linked to platelet-rich plasma (PRP) treatments, commonly known as ‘vampire facials.’ Individuals who have received a PRP treatment at Olivia’s Aesthetics, Wolverhampton, are being advised to contact the UKHSA West Midlands Health Protection Team. The call for testing follows a joint investigation by UKHSA, City of Wolverhampton Council, and the Black Integrated Care Board (ICB), which identified inadequate equipment cleaning practices during PRP treatments at the clinic.
Consultant plastic surgeon Mr Dalvi Humzah, commented, “All due care and protocols should be followed in order to keep patients safe, adhering to protocols as straight-forward as those involving the National Infection prevention and control policies to ensure all procedures keep cleaning and aseptic techniques to the highest standards. Patient safety must be kept as the primary priority.”
This month’s newest clinic openings
Aesthetic practitioner Dr Tara Francis has announced the launch of her new clinic, located in Ealing, London. Clinic services include neurotoxin injectables, dermal fillers, polynucleotides and skin boosters. In addition to injectables, Dr Francis offers a variety of facial
Summer Symposium
FILLMED hosts annual Summer Symposium
Medical aesthetics company Laboratories FILLMED hosted its Summer Symposium on June 6 at the Fitzroy Hotel, London.
Speakers included Dr Ash Labib, Dr Lisa Dinley, Dr Raquel Amado, Mr Amar Ghattaura, Dr Baldeep Farmah, Dr Tim Eldridge and Poppy Pilram, who shared their own treatment approaches, clinical outcomes and product layering.
JUVELOOK, a regenerative hybrid dermal biostimulator, joins FILLMED’s established range of injectables and skincare solutions, including NCTF 135HA, ART FILLER and the SKIN PERFUSION line. The collaboration signals an expansion of the brand’s multi-modal approach to skin quality, offering practitioners a new tool to support dermal remodelling and rejuvenation, the company explains.
Scott Julian, Laboratories FILLMED business unit director UK&I, commented, “Our latest collaboration with JUVELOOK is one of our most exciting and ground-breaking collaborations to date. As part of this exciting alliance, co-branded FILLMED x Juvelook packaging will go into production at the end of 2025, signalling a long-term commitment to innovation, clinical excellence and synergy between both brands.”
Product Debut
Obagi Medical releases its Refining Night Cream
Skincare company Obagi Medical has announced the launch of its Retinol + PHA Refining Night Cream.
Now available through aesthetic distributor Healthxchange, the cream is formulated with 0.3% retinol and Polyhydroxy Acid (PHA) to promote a more even-looking complexion, according to the company. Obagi Medical has shared clinical trial results indicating that, out of 30 participants, 90% observed a reduction in the appearance of blemishes within four weeks, with a 10% visible improvement in skin tone evenness.
Simone Shoffman, head of education at Healthxchange, commented, “Obagi Medical is renowned for retinols that cause minimal irritation with maximum proven clinical results, this is due to an elegant microencapsulation formulation. This balanced formulation offers an effective yet tolerable entry point for retinol newcomers as well as those who are more hesitant due to skin sensitivity.”
treatments, such as carbon laser facials, LED light therapy and Morpheus8 radiofrequency microneedling. Medical skincare clinic group sk:n is set to open its Northern Ireland clinic in July 2025, located in Belfast. The facility will offer sk:n’s full portfolio of medical-grade treatments, including
dermatology, injectables and laser hair removal. David Moulsdale, chairman and CEO of sk:n, said, “We are incredibly proud to be opening our first clinic in Northern Ireland. Our investment reflects our long-term commitment to improving skin health and accessibility to dermatological care across the UK.”
If you’re opening a new UK clinic soon, let us know at editorial@aestheticsjournal.com
Medik8 welcomes guests to Renewal and Radiance Retreat
Aesthetics joined skincare company Medik8 at a retreat experience to mark the launch of the new C-Tetra Advanced Serum and Crystal Retinal Age-Defying Facial. The two-day experience was hosted by founding partner Daniel Isaacs, and included educational discussions and networking opportunities. Aesthetics had the opportunity to speak with Laura Ford, head of education at Medik8, about the brand’s launches. Ford revealed that Medik8 has enhanced its existing C-Tetra Luxe formula by introducing 20% vitamin C combined with phyto-exosomes, with the goal of strengthening the skin barrier.
The presentation also highlighted the launch of the Crystal Retinal Age-Defying Facial, designed in collaboration with skin health specialist Michella Bolder. Ford explained that the massage techniques are designed to support and enhance the absorption of Crystal Retinal, while also aiming to sculpt facial contours and promote lymphatic drainage to reduce puffiness and lift and firm the skin.
Ford commented, “I’m thrilled to introduce some of our latest innovations – both within and beyond the treatment room. Leading the way is our C-Tetra Advanced Gel Serum, featuring groundbreaking advancements in skincare science. Complementing this is our Crystal Retinal Age-Defying Facial, which brings our renowned vitamin A expertise into the treatment room for transformative results.”
Symposium Report
3D Aesthetics holds Symposium
Aesthetic device supplier 3D Aesthetics hosted its Symposium of Skin Science & Industry Innovation on May 30.
The agenda included sessions on facial anatomy, menopause-related skin changes, regenerative medicine and software-driven strategies for patient engagement. Speakers included Mr Dalvi Humzah, nurse prescriber Anna Baker, Dr Parisha Acharya and representatives from Hamilton Fraser and Vagaro.
Attendees also heard updates on the evolving landscape of aesthetic regulation and protocols integrating device-led treatments with topical skincare. Topics such as microneedling radiofrequency (RF), exosomes and consultation tools were explored in the context of improving clinical outcomes and practice growth.
The event concluded with a panel discussion addressing innovation, regulation and patient experience, followed by a networking reception.
Skincare
The Skin Dairy debuts night cream at Wigmore Medical
Skincare solution provider The Skin Diary launched its Night Repair Therapy through aesthetic distributor Wigmore Medical.
According to the company, the product is designed to reverse skin damage and prevent signs of ageing. Dr Clare Kiely, consultant dermatologist and chief medical officer of The Skin Diary, presented at Wigmore Presents 2025, showcasing the scientific foundation behind the brand’s skincare innovation. The company also noted that the product was evaluated in double-blind, placebo-controlled clinical studies on human skin, conducted by the skin-ageing research team at the University of Manchester.
Professor Chris Griffiths, consultant dermatologist and chief scientist at The Skin Diary, commented, “Wigmore Medical’s commitment to evidence-based translational skincare products aligns perfectly with our philosophy at The Skin Diary. Our partnership reflects a shared dedication to innovation and efficacy.”
News in Brief
Acclaro Medical appoints new UK&I sales director
Aesthetic device company Acclaro Medical has introduced Lee Brine as new sales director for UK&I. In his role, Brine will oversee Acclaro Medical’s sales operations, with a focus on accelerating the growth of its portfolio, including the laser UltraClear device. Brine commented, “I’m excited to be joining Acclaro Medical at such a pivotal time. I look forward to working with the team to expand our reach and support practitioners in delivering outstanding results for their patients.”
Skeyndor launches new sun care range
Skincare company Skeyndor has introduced AGE PHOTO DEFENSE 365days. The new range is formulated to defend against UVA/UVB, infrared and high-energy visible (HEVis) light while supporting skin’s vitamin D function, according to the company. Skeyndor shares that the line features [D+] TECH technology, combining physical and chemical filters with botanical extracts from chicory and beetroot to reactivate vitamin D receptors. Additional ingredients such as Carnosine and Crambe Maritima aim to support hydration, regeneration and barrier integrity.
UK Regenerative Aesthetic ExoCoBio Summit held in June
Aesthetic distributor Cure Medical welcomed aesthetic professionals to the 17th UK Regenerative Aesthetic ExoCoBio Summit on June 16. Taking place at the Royal Society of Medicine in London, the agenda featured conference talks from oculoplastic surgeon Mrs Sabrina Shah-Desai and aesthetic practitioners Dr Juliah Tbarani and Dr Mehmet Cimen. The CEO of biotechnology company ExoCoBio Mr Byong Cho also spoke at the summit, providing an analysis of the proteins, microRNAs and lipids present in exosomes.
W-Wellness announces new appointments
Wellness platform W-Wellness has announced the appointment of Helen Elldred as chief marketing officer, alongside Belinda Aloisio as director of strategy and sales consulting. Elldred is responsible for driving brand growth, advancing customer acquisition and retention and enhancing partner engagement. Aloisio will lead the business development team and develop initiatives to cultivate and strengthen key relationships. Each brings nearly 20 years of specialty experience to their respective roles.
Advancing Personalised Prescription Skincare: The Klira Pro Model
A progressive shift in the landscape of prescription skincare
Personalised skincare is redefining how clinicians approach chronic dermatological concerns. At the centre of this evolution is consultant dermatologist Dr Emma Craythorne, founder of Klira – a prescription-only skincare system delivering targeted, evidence-based treatments that respond to the skin’s evolving needs. Rooted in clinical experience and research, Klira was developed to overcome the limitations of conventional skincare typologies. Instead of labelling patients as
“dry” or “oily,” the Klira model evaluates nuanced parameters such as epidermal barrier function, pigmentation pathways, vascular reactivity, and sensitivity – providing a more precise framework for treating acne, rosacea, pigmentation, and photoageing. Klira Pro extends this model to registered prescribers, enabling them to deliver The Klira Special – a customised topical formulation tailored to each patient’s skin profile. Treatments are dispensed via a cartridge system providing one month’s supply of accurately dosed actives. Formulations can be adapted over time to support efficacy and long-term tolerability. This approach bridges dermatology and aesthetics, offering a regulated, personalised treatment system with built-in clinical oversight. It also addresses sustainability: the refillable cartridge system reduces the environmental impact of multi-step regimens. Dr Craythorne notes, “Our goal is to ensure patients receive precisely what their skin needs – not a trend-driven solution, but a treatment grounded in evidence and experience. Klira Pro enables that level of care to be delivered consistently by professionals across the UK.”
With its clinician-led foundation and adaptable pathways, Klira Pro marks a
progressive shift in prescription skincare. Join the growing network of prescribers transforming how we treat chronic skin concerns through personalised, prescription-based care.
Discover what KLIRA PRO can do for your patients.
For more information, contact: dermteam@klirapro.com
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The Correlation Between Botulinum Toxin and Mental Wellbeing
Aesthetics explores the relationship between botulinum toxin and mental wellbeing
A recent retrospective study explored how botulinum toxin type A (BoNT-A) may influence mood by acting on facial muscles and altering neuromuscular feedback mechanisms.1 Published in the Journal of Cosmetic Dermatology, researchers conducted a literature review via PubMed using the search terms “botulinum toxin” and “emotion.”1 The aim of the study was to evaluate the potential relationship between BoNT-A treatment and emotional regulation.1
Researchers found that BoNT-A may improve patient wellbeing, suggesting possible therapeutic applications alongside its established aesthetic use in clinical settings.1
Key findings from the study
The review analysed 46 relevant studies, deemed suitable from the use of keywords, and found that BoNT-A may disrupt negative facial feedback loops by inducing targeted facial muscle relaxation, thereby enhancing emotional wellbeing.1 Injections in the glabellar region were found to modulate amygdala activity, reduce symptoms of depression and anxiety and improve emotional resilience.1 This region is particularly significant, as it is most closely associated with frown lines and plays a key role in the facial feedback mechanism.2 Additionally, studies suggest that BoNT-A injections targeting the perioral muscles may improve the expressiveness and emotional impact of smiling.3,4
Overall, the findings indicate that BoNT-A may have potential effects on mood regulation.1
The Medicines and Healthcare products Regulatory Agency (MHRA) does not currently approve the use of BoNT-A for the treatment of emotional wellbeing.5 Its approval is limited to specific medical conditions, such as cervical dystonia, chronic migraine and muscle spasticity.5 While off-label applications, such as the treatment of bruxism and masseter hypertrophy, are acknowledged, the agency advises to approach with caution and patient consent.5
Exploring the use of BoNT-A and patient wellbeing
Dental surgeon and Clinical Advisory Board Member of the Aesthetics Journal Dr Souphi Samizadeh notes that patients with BoNT-A treatment in the glabellar region appear more content. “Patients often report a subtle but noticeable lift not only in appearance, but also in emotional tone. The attenuation of frowning capacity appears to disrupt the negative feedback loop associated with sadness, anxiety or irritability,” she says. Beyond the glabellar region, Dr Samizadeh highlights the use of BoNT-A in treating masseter hypertrophy and chronic bruxism, particularly in patients experiencing persistent jaw tension. “By reducing hyperactivity in the masseter muscles, we not only reshape the lower face, but relieve physical and emotional strain that many carry unconsciously during sleep or stress,” she explains.6
Despite evidence showing BoNT-A having a positive effect on mental health, aesthetic practitioner and GP Dr David Eccleston emphasises that it shouldn’t be viewed as a singular solution. “It will not paper over the cracks in individuals experiencing mental health challenges or general dissatisfaction with their lives,” he says.
Aesthetics also discussed with Kimberley Cairns, a psycho-aesthetic consultant and board member of the Joint Council for Cosmetic Practitioners (JCCP), who also has concerns, noting that there have been cases of negative emotional changes following toxin.7 She shares, “Not all emotional changes are positive or anticipated. Some patients report feeling ‘disconnected’ from their expressions, or experience anxiety when their post-treatment reflection doesn’t align with their sense of self.”
Psychological screening and referral pathways
Although the literature suggests that BoNT-A may have a positive impact on emotional wellbeing, it should not be regarded or promoted as a solution for underlying emotional or psychological issues. Dr Eccleston advises that in severe cases, practitioners should consider it their professional duty to refer any concerns to the patient’s GP, provided appropriate consent has been obtained. He says, “Unfortunately, the NHS is massively
overwhelmed, and the chances of getting the patient counselling within a relatively short time scale are next to nothing.”
Dr Samizadeh underscores the PHQ-4 (Patient Health Questionnaire-4) and GAD-2 (Generalised Anxiety Disorder-2) as tools to clock emotional dysregulation, adding, “They can open meaningful dialogue without disrupting the flow of consultation.”8,9 Dr Samizadeh also refers to the BDDQ (Body Dysmorphic Disorder Questionnaire) as a tool to identify patients at risk.10 She brings to attention the NHS self-referral pathway, sharing, “Patients can access support directly, without needing a GP referral. This normalises psychological support as part of holistic care, not as an obstacle.”
Similarly, Cairns notes, “No practitioner should ever proceed if the patient’s emotional safety is at risk. BoNT-A may improve mood for some, but we are not providing therapy via syringe, and to suggest otherwise would be irresponsible.” She points to the importance of meaningful collaboration between practitioners and psychologists to enhance patient care, proposing, “Aftercare sessions and psychologically informed consultations are effective ways to collaborate.” Cairns also suggests joint workshops as a means of working together.
Supporting at-risk patients
Dr Samizadeh highlights the need to differentiate between cosmetic seekers and those with underlying emotional distress. She notes, “A patient seeking a tweak will often describe a clear, realistic goal. A patient in distress may present with vague dissatisfaction, shifting targets or despair beneath their words.”
Cairns emphasises, “Validate the person, not automatically the desire. This is particularly vital when working with vulnerable groups such as neurodivergent, transgender and gender-diverse individuals.” She elaborates, “These individuals may seek treatment as a way to reduce sensory discomfort, reclaim bodily autonomy or feel safer socially –which can all be valid. But without thoughtful consultation, there’s a risk of unintentionally reinforcing shame or deepening emotional reliance on appearance-based reassurance.”
Maintaining practitioner ethics
Managing patient expectations is vital in medical aesthetics, involving ethical and professional responsibilities. The interviewees advocate the use of screening tools, careful consultation procedures and collaboration with psychological specialists.
Sharpen Your Skills and Stay Ahead in Medical Aesthetics
Experience five educational theatres at CCR 2025
In a specialty that never stands still, staying informed and inspired is essential for delivering safe, effective treatments, building patient trust and achieving long-term success in aesthetic practice.
This autumn, you have the chance to engage with cutting-edge education designed to elevate clinical confidence and support professional growth.
Taking place on September 25-26, at the Excel London, Clinical Cosmetic Regenerative Congress (CCR) offers a range of education from expert-led talks and in-depth masterclasses to the latest clinical insights and practical demonstrations. The event offers a comprehensive learning experience tailored to meet the needs of all levels – from newcomers to seasoned professionals. Attendees will have the chance to earn up to 16 CPD points and explore innovative techniques, stay updated on emerging trends and connect with thought leaders who are shaping the future of medical aesthetics.
Medical Longevity Summit
Uniting healthcare, functional medicine, wellness and aesthetics, this year’s Medical Longevity Summit (MLS) will focus on the concept of women’s health.
Throughout the two days, the MLS will provide you with news ways to support your female patients, curated alongside Dr Mayoni Gooneratne, founder of Human Health Professionals. Sessions will look at the physiology of women’s hormones, the pathology of women’s hormone health, practical ways to improve women’s health and an exploration of what’s needed in the future.
Session topics include:
· Cardiometabolic Risk in Women – Missed Signs, Better Solutions
· A Functional Medicine Approach to Women's Health – Creating a Women's Health Protocol
· How Do We Keep Women in Health and in Work – PCOS, Endometriosis, Infertility
Sexual Longevity and Pelvic Health – The Final Frontier
There will also be sessions from MLS partners Nutrition Collective, the British College of Functional Medicine, and Women's Integrative Health Collective.
Aesthetics Journal Arena
If you are looking to stay updated on the latest scientific research and innovative techniques in the field to improve clinical outcomes; the Aesthetics Journal Arena is the place for you.
Education will include:
· A Full Face Masterclass with a live injectable demonstration
· Skin Health and Dermatology agenda in partnership with the British Skin Foundation
· Anatomy Updates with a live injectable demonstration
· Advanced Lip Masterclass with a live injectable demonstration
· Regenerative Medicine Agenda
World-renowned nurse practitioner Julie Horne will lead a two-hour symposium on Day 2, showcasing her signature approach to creating balanced, natural-looking lips. The session will include a theoretical overview, live model assessment and a single injection demonstration, with a focus on lip compartments and when vertical injection techniques are most appropriate. Delegates will gain practical insights into anatomy-based assessment and treatment planning from one of the specialties most respected experts.
This theatre will also be host to the Galderma Headline Sponsor sessions, focusing on full-face rejuvenation using Restylane and Sculptra. These sessions (12:00-13:00 on both days) will have a particular focus on the aesthetic considerations following medication-driven weight loss and will feature live demonstrations.
In Practice Theatre
While clinical skills are essential, running a successful aesthetics practice requires
much more than hands-on expertise. With little to no formal business training in most medical careers, practitioners are often left navigating marketing, finance and compliance on their own. The dedicated In Practice agenda situated in the new In Practice Zone, offers practical, actionable advice to help bridge that gap – supporting professionals in building sustainable, ethical and profitable clinics. The theatre is supported by In Practice Zone Sponsor Dermis AI.
Topics this year include:
· Exploring the World of Artificial Intelligence
· Mental Health in Aesthetics
· The Latest in Aesthetics Regulation
· Getting Started in Aesthetics, in partnership with Harley Academy
· Gloves Off Panel: Aesthetic Treatments
– Trendy or Timeless?
· Women in Business Panel
This theatre will also see the launch of the annual Trends Report, covering the top trends of the aesthetics specialty from 2025, shared by founder of RARE Consulting Ben Pask. The report also features a comprehensive list of dozens of products released in the UK aesthetics field over the past year, covering devices, injectables, skincare, skin treatments and regenerative and wellness approaches. You can get your hands on a copy by attending Pask’s session on Day 1 at 14:00.
The Innovation Forum
The Innovation Forum provides attendees with an in-depth guidance for developing their clinic offerings through 25-minute
talks and live demonstrations. In these sessions, you can discover the latest products, protocols and techniques from the specialty’s most innovative device and skincare suppliers. The Forum is supported by Stage Sponsor SkinCeuticals. Attendees can expect sessions from:
· Acclaro
· BTL Aesthetics Cutera
· Cure Medical
· Hydrafacial
· InMode
· Korea Meditech
· Novus Medical
· Sciton
· Sofwave
· SkinCeuticals
Aesthetics Mastery Theatre
This platform features the specialty’s leading brands presenting one-hour live treatment demonstrations, as well as the popular and unmissable Aesthetics Challenge. Across both days, top KOLs will showcase the latest techniques, helping you elevate your knowledge, skills and confidence to deliver safe, high-quality results for your patients.
Companies hosting educational sessions include:
· Fotona
· Beautyform
· DermaFocus
· Dermapenworld
· Promoitalia
· Klira
With more to be announced soon!
Regenerative Aesthetic Surgery Symposium
New to CCR 2025, The Regenerative Aesthetic Surgery Symposium (RASS) aims to bring together global pioneers, innovators and thought leaders in regenerative surgery. They will share groundbreaking techniques, technologies and research which is redefining the future of cosmetic, aesthetic and reconstructive surgery. Through collaboration and knowledge exchange, the symposium aims to advance the standard of care and inspire surgical excellence worldwide.
Day 1
A full-day agenda dedicated to the latest developments in regenerative surgery, offering delegates a deep dive into surgical advancements and forward-thinking practices.
Day 2
Access to the CCR Congress, where the regenerative medicine programme on the Aesthetics Journal Arena will focus on minimally invasive techniques that complement and enhance surgical approaches. Super early bird tickets for the symposium are available until July 31. Scan the QR code to get yours now!
Get inspired
Whether you're looking to enhance your clinical expertise, strengthen your business foundations or simply reconnect with peers who understand the unique challenges of aesthetic practice, this year's education programme promises something for everyone. With insights you can apply straight away and ideas that will shape your longer-term growth, it's an unmissable opportunity to invest in both your patients and your professional future.
Go to the website to see the full agenda out now!
25 & 26 September 2025 Excel, London Register for
REASONS TO CHOOSE BOCOUTURE
• Results seen as early as 7 days, lasting up to 4 months in upper facial lines1
• A well characterised safety profile1
• Convenient – no refrigeration needed prior to reconstitution1
Scan the QR code to access BOCOUTURE UK and Ireland Prescribing Information
1.BOCOUTURE Summary of Product Characteristics. Merz Pharmaceuticals GmbH: https://www.medicines.org.uk/emc/product/600/smpc (Last accessed June 2025).
M-BOC-UKI-0633
Date of Preparation: June 2025
Access complimentary training resources
Merz Aesthetics Exchange (MAX) is a promotional website developed and funded by Merz Aesthetics UK & Ireland.
Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk/. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/ about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.
Treating Dermatitis in Aesthetic Practice
Practitioners
share their approaches to supporting patients with dermatitis using advanced skincare, regenerative therapies and light-based devices
Dermatitis refers to a diverse group of inflammatory skin conditions that disrupt the epidermal barrier, including atopic, contact and seborrheic forms.1
While traditionally managed within general practice and dermatology settings, medical aesthetic practitioners are increasingly encountering patients with undiagnosed or subclinical dermatitis – especially in the context of post-treatment sensitivity, inappropriate product use or cosmetic procedures gone awry.1
According to recent literature, rates of sensitive and reactive skin are on the rise, particularly following increased consumer experimentation with at-home acids and retinoids.2,3 This has led to a growing subset of aesthetic patients who present not only for rejuvenation but for reparative care. Given that many of these conditions are exacerbated by impaired barrier function and chronic low-grade inflammation, aesthetics clinics can play a crucial role in their management.
Here we explore the foundations of dermatitis care, the importance of barrier repair, and how innovative modalities such as polynucleotides and light-emitting diode (LED) phototherapy can safely support skin recovery when used in tandem with evidence-based skincare.
Understanding dermatitis
Dermatitis broadly refers to inflammatory skin disorders characterised by redness, itching, scaling and impaired barrier function.4 It’s important to identify and diagnose the difference between dermatitis and sensitive or reactive skin. Literature explains that sensitive skin is a condition characterised by unpleasant sensations (stinging, burning, itching or tightness) in response to stimuli that typically do not provoke such reactions.1 It lacks visible signs of inflammation and is not classified as a dermatologic disease. In contrast, dermatitis refers to a group of clinically diagnosable inflammatory skin conditions (discussed below) that present with visible signs such as erythema, scaling and oedema, and often involve an immune-mediated component.1
Key subtypes include:
· Atopic dermatitis: A chronic condition often rooted in genetic predisposition and characterised by low ceramide levels and heightened type 2 immune activity.5
· Contact dermatitis: Caused by direct exposure to irritants or allergens, which remains a leading cause of periocular and perioral dermatitis.6
· Seborrheic dermatitis: Usually associated with Malassezia yeast and/or the body’s immune response; presents as greasy scales on the scalp, brows, nasolabial folds and chest.7
Accurate diagnosis is the cornerstone of effective dermatitis management. While many presentations may appear similar at first glance – dryness, redness and scaling – it is critical that practitioners assess the complete clinical picture. This includes understanding the patient's medical history, skincare use, environmental exposures and any existing dermatologic diagnoses.
"Sometimes what looks like a mild irritation is actually a more complex presentation of contact or atopic dermatitis," explains consultant oculoplastic surgeon Miss Jenny Doyle. "Without a structured assessment process, including appropriate referrals when needed, you risk treating the symptom instead of the root cause."
According to the practitioners, useful assessment tools include the Eczema Area and Severity Index (EASI), SCORing Atopic Dermatitis (SCORAD), Patient-Oriented Eczema Measure (POEM) and the Dermatology Life Quality Index. Each have unique purposes and methods of measuring the skin’s condition, which aids appropriate diagnosis.8-11
In aesthetic practice, Miss Doyle highlights that practitioners may often encounter periocular dermatitis, particularly in female patients. The periocular skin is extremely thin, so anything too active – retinol, fragrance, preservatives –can easily trigger a flare, notes Miss Doyle.12 She says, “It’s very common and often linked to contact with cosmetics or eye drops. Typical triggers include preservatives (e.g. methylisothiazolinone), fragrances, harsh cleansers and expired or contaminated makeup.”13
The impact on patients
The practitioners interviewed explain that the clinical presentation of dermatitis extends beyond physical symptoms. For many patients, particularly those with visible or chronic facial involvement, the psychological burden is considerable. Studies show that individuals with dermatitis often report reduced quality of life, poor self-esteem and increased levels of anxiety and depression.14-17
Dr Sonia Khorana, a GP and aesthetic practitioner with a special interest in dermatology, highlights that it’s a condition that affects sleep, confidence and the ability to go about daily life. She notes that effects may include:
· Persistent itching, often disrupting sleep and leading to fatigue14
· Pain and discomfort, particularly when the skin is cracked or inflamed15
· Risk of secondary infection due to barrier compromise and scratching15
· Unpredictable flare-ups, creating frustration and emotional distress15
· Self-esteem issues, especially with facial or hand involvement16
· Social withdrawal or anxiety in public settings17
· Stress and mental health challenges, which may perpetuate flares15
· In children, disruptions to school, play or mood regulation16
· Lifestyle changes – including avoidance of certain skincare, fabrics or environments17
· Frequent medical appointments, ongoing costs and treatment burden15
This underscores the importance of holistic, empathetic care. The practitioners emphasise that addressing not just the skin, but also the psychological and lifestyle impact, is essential to achieving long-term control and improving quality of life.
“Without a structured assessment process, including appropriate referrals when needed, you risk treating the symptom instead of the root cause”
Miss Jenny Doyle
The role of the aesthetic practitioner
While medical diagnosis and pharmacologic intervention remain under the remit of GPs and dermatologists, aesthetic professionals have a clear role in:
· Early identification and triage of reactive skin concerns
· Barrier repair and maintenance using evidence-based skincare
· Adjunctive in-clinic support with non-invasive tools
Crucially, aesthetic settings often allow for closer follow-up and a more holistic approach to skin health.
“Aesthetic practitioners are often a significant point of contact for patients with undiagnosed skin sensitivity or barrier dysfunction,” says aesthetic practitioner Dr Ahmed El Houssieny. He explains, “We’re in a unique position to identify early warning signs, offer targeted barrier repair strategies and provide ongoing support that complements dermatologic care alongside aesthetic treatment. With regular follow-up and a holistic mindset, we can really enhance outcomes for these patients. Of course, having a referral plan in place for patients we can’t treat is essential.”
Skincare strategies
Examine patient history
According to Miss Doyle, effective skincare is a vital component in the management of dermatitis. She stresses the importance of identifying the underlying cause before reaching for topical solutions. As an oculoplastic surgeon, here Miss Doyle gives specific advice relating to dermatitis around the eyes.
“The skin around the eyes is incredibly thin and reactive, but often what you’re seeing is a secondary effect of something else – whether it’s a reaction to makeup, expired skincare or even an underlying eye condition like allergic conjunctivitis or medication-related dermatitis,” she explains.
Miss Doyle advises starting with a meticulous patient history. This includes not only skincare and cosmetic use, but also allergy history, recent product changes and any prescription eye drops. “For example, patients with glaucoma frequently develop periocular dermatitis because the medications used can leak onto the skin and trigger a reaction,” she notes.
In cases where symptoms suggest allergic eye disease or there’s diagnostic uncertainty, referral to an ophthalmologist is essential. “It’s about ruling out whether the eye itself is involved,” says Miss Doyle. “You need to know if there’s an internal driver behind the external inflammation.”
Carefully manage steroid use
Topical steroids are a traditional treatment for dermatitis, but Miss Doyle emphasises the need for caution – particularly when treating the delicate skin around the eyes.
“Steroids can be very effective at settling inflammation quickly, and I do use them in the short term,” she explains. “But it’s important to remember that you’re dealing with very thin skin, and there’s also the risk of increasing intraocular pressure if used too liberally or for too long.”
Miss Doyle notes that some patients experience rebound symptoms once steroids are stopped, adding another layer of complexity to treatment planning. For this reason, she advocates only using steroids where necessary and considering gentler, non-pharmacologic options.
Offer hydrating and nourishing products
“In the perioral area I favour gentle, hydrating formulations that help restore barrier function without triggering further irritation,” says Miss Doyle.
Her preferred products for this sensitive area include:
· Optase LIFE Sensitive Eye Makeup Remover: This preservative-free, ophthalmologist-approved cleanser is specifically formulated for sensitive eyes. It utilises patented ionised water technology to gently remove makeup, including waterproof mascara. Enriched with hyaluronic acid (HA), pro-vitamin B5 and Manuka honey, it aims to hydrate and nourish the delicate periocular skin while maintaining its natural moisture balance.18
“With dermatitis, I avoid actives like retinol or salicylic acid as they can irritate dermatitis further. You want products that are soothing and protective – more physical than chemical in nature”
Dr Ahmed El Houssieny
· Optase HYLO Night Eye Ointment: This preservative-free ointment aims to provide long-lasting overnight relief for dry and irritated eyes. It forms a protective film over the ocular surface, locking in moisture and promoting hydration. The formulation includes white petrolatum, lanolin and light mineral oil, which work to relieve dryness and protect against further irritation.19 AlumierMD AluminEye: A moisturising eye cream that aims to diminish the appearance of fine lines, dark circles and puffiness. It combines tremella mushroom extract, niacinamide and murumuru butter to provide deep hydration. Rich in peptides and vitamins, AluminEye can also lighten the appearance of under-eye darkness. 20
· Alastin Restorative Eye Treatment with TriHex Technology: An eye cream designed to reduce the appearance of puffiness and dark circles while smoothing fine lines and wrinkles. It includes TriHex Technology to support the production of new, healthy elastin and collagen, along with niacinamide and tetrapeptide-30 to brighten and even skin tone. 21
Miss Doyle also highlights the need for managing expectations appropriately. She says, “These reactions don’t settle overnight, but once you identify and eliminate the trigger, the skin often improves within a few weeks, depending on severity.”
While conventional treatments such as emollients and steroids remain foundational in dermatitis care, some patients may either not respond adequately, or could be wary of side effects such as allergy thinning skin, telangiectasia, rosacea, delayed wound healing and hyperpigmentation.4 Some people may have an allergy to steroids or particularly thin skin making them unsuitable.4 In these cases, Dr Khorana highlights that regenerative therapies like polynucleotides offer a promising, non-steroidal alternative.
Understand the science of polynucleotides
“A number of patients struggle with steroid use – either due to sensitivity or concern about long-term risks. Polynucleotides have given us a way to calm inflammation and support repair without those downsides,” says Dr Khorana.
Polynucleotides are DNA fragments with regenerative, anti-inflammatory and moisture-retentive properties. 22
“Polynucleotides have given us a way to calm inflammation and support repair without downsides”
Dr Sonia Khorana
They work by:
Modulating cytokine activity to reduce inflammation22
· Stimulating fibroblasts to increase collagen, elastin and HA 23
· Improving extracellular matrix quality, enhancing hydration and barrier function24
· Reducing oxidative stress and accelerating cellular repair25
Dr Khorana notes a significant improvement in symptoms such as redness, flakiness, tightness and itching, especially in periocular and sensitive facial areas. “Skin feels softer, more elastic and patients often notice a visible improvement in hydration and resilience after just a few sessions,” she explains.
Choose clinically-researched products
“I use Plinest with 20mg/ml,” she says, explaining, “It is great to be able to offer patients an effective option for treating concerns around the eyes – an area which is generally regarded as challenging to treat. I have found polynucleotides to be an excellent addition to clinical practice as they can be used as a standalone treatment or in combination with others.”
Her treatment protocol typically involves:
· Topical anaesthetic (EMLA) applied for 30 minutes pre-procedure
Intradermal microinjections using a 30G needle and 2ml syringe
· Plinest (20mg/ml) used over four sessions spaced two to three weeks apart
· Maintenance sessions recommended every six months
Dr Khorana adds, “Plinest is generally considered very well-tolerated and safe, particularly when used for skin regeneration and inflammatory conditions like dermatitis.”25 Other polynucleotide brands are available however, while the premise may be the same, no anecdotal evidence currently exists for their treatment of dermatitis.
Adverse effects are typically minimal – mild swelling, bruising or redness – and correct injection technique is key to avoiding lumps or uneven texture, explains Dr Khorana. 25
Manage patient expectations
Dr Khorana also emphasises the importance of patient education. She says, “Polynucleotides aren’t volumisers – they work at a cellular level to improve tone, texture and function. Patients will need a course of treatment, followed by maintenance. Results take several weeks to develop and are subtle, skin-deep improvements.”25
Figure 1: Before and two months after twice daily use of Alastin Restorative Eye Treatment. Note: patient also underwent upper lid surgery, but the lower skin improvement is purely from product use.
Polynucleotides as a regenerative approach
2: 63-year-old female patient with atopic dermatitis before and after four periocular treatments, spaced three to six weeks apart, with Plinest polynucleotides. Images courtesy of Dr Sonia Khorana.
Light therapy as a non-invasive option
Non-invasive and well-tolerated, LED phototherapy is gaining traction as a supportive treatment for patients with dermatitis – especially in aesthetic settings where gentle, regenerative interventions are valued.26-31
Dr El Houssieny and his team frequently uses LED as part of their skin-calming protocols. “I prefer LED for dermatitis because it’s non-invasive, gentle and works with the skin rather than against it,” says Dr El Houssieny. “It’s ideal when the barrier is compromised and you want to reduce inflammation without adding anything topical that might aggravate things further.”
Consider the relevant research
A growing body of research supports LED's application in inflammatory dermatoses. A 2023 clinical trial demonstrated that full-body blue light therapy significantly improved atopic dermatitis symptoms, including reductions in Eczema Area and Severity Index (EASI) and SCORing Atopic Dermatitis (SCORAD) scores, without significant side effects.28 Another study confirmed blue light’s ability to modulate immune responses and improve barrier integrity,29 while further research found full-body blue light therapy led to a 54% reduction in EASI scores over six months. Patients also reported decreased pruritus and improved sleep quality, with a notable reduction in corticosteroid usage.31
Select an evidence-based device
Dr El Houssieny uses the Dermalux Flex, a portable and FDA-cleared LED phototherapy device that delivers clinically proven wavelengths of red (633 nm), blue (415 nm) and near-infrared (830 nm) light. While both the Flex and the more advanced Tri-Wave MD utilise the same three wavelengths, the key difference lies in intensity and treatment speed.32-35
“The Flex is more accessible and versatile for day-to-day use – it takes a bit longer per session compared to the Tri-Wave MD, but still delivers excellent anti-inflammatory results,” he explains. “It’s perfect for treating localised dermatitis and fits well into an aesthetic clinic setting. Patients can also purchase the device for at-home use.”
The Tri-Wave MD delivers a higher irradiance and can complete treatments in as little as 10 minutes, whereas the Dermalux Flex typically requires 20–30 minutes per session. Despite the difference in output, both devices are supported by clinical evidence and are safe, non-invasive options for sensitive skin.32-35
“There’s a lot of science behind it, and we find it especially helpful during flare-ups or post procedure when the skin barrier is already compromised,” says Dr El Houssieny.
Follow recommended protocols
He explains that a typical treatment protocol involves two to three sessions per week for five weeks to calm active inflammation,
followed by one to two maintenance sessions per month depending on the individual concern and treatment goals.
Dr El Houssieny highlights that the therapy is painless, non-invasive and requires no downtime. “On the face, patients just need to wear eye protection. Other than that, it’s a very straightforward treatment,” he explains.
It should be noted that patients with photosensitivity disorders, epilepsy, active skin cancer or suspicious lesions and pregnant women are contraindicated to treatment.35
Combine with supportive skincare
As with all treatments, Dr El Houssieny combines LED therapy with a barrier-focused skincare regimen. “With dermatitis, I avoid actives like retinol or salicylic acid as they can irritate dermatitis further.36,37 You want products that are soothing and protective –more physical than chemical in nature,” he explains. Dr El Houssieny cites SkinCeuticals and ZO Skin Health as his preferred brands for calming, repair-oriented formulations.
In particular, Dr El Houssieny highlights that the SkinCeuticals Epidermal Repair is formulated specifically for compromised or post-procedure skin, noting that the cream helps support the skin's natural barrier function. It contains beta-glucan and centella asiatica to soothe and protect sensitive areas.38 Additionally, he adds that the SkinCeuticals Emollience is a rich, restorative moisturiser that nourishes and hydrates dry and sensitive skin.39
From the ZO range, Dr El Houssieny recommends using the ZO Skin Health Hydrating Creme, which is recognised by the National Eczema Association for its intense hydration and relief for severely dry and irritated skin.40 For a cleanser, he suggests trying the ZO Skin Health Hydrating Cleanser, which is sulphate free and hydrates while soothing sensitive skin.41
A holistic future for dermatitis care
The practitioners interviewed agree that aesthetics clinics are uniquely positioned to offer holistic care that goes beyond symptom management. With time to listen, opportunities for follow-up and access to barrier-restoring skincare and regenerative technologies, practitioners can address both the physical and emotional burden of chronic inflammation.
The practitioners further emphasise that, crucially, this care must begin with accurate diagnosis – misinterpreting or overlooking the underlying cause can lead to prolonged flares, inappropriate treatments and patient frustration. They add that if you are unsure of diagnosis or believe that the patient’s concern is outside your scope of practice, then it is essential that you refer to an appropriately qualified and experienced practitioner.
By integrating evidence-based treatments with empathetic, personalised care, aesthetic practitioners can play an increasingly valuable role in helping patients move from flare to long-term repair.
Figure
Figure 3: Before and after 14 treatments of Dermalux LED light therapy spaced over eight weeks. Images courtesy of Dr Ahmed El Houssieny.
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Unveiling the Connection Between Menopause and Acne
Dr Hazel Parkinson discusses the effects of menopause on acne and procedural options for menopausal patients
Acne is often perceived as a concern primarily of adolescence, but it is increasingly recognised as a condition that affects adult women, particularly during the menopausal transition.1 This stage of life is associated with profound hormonal changes that impact skin physiology, often leading to persistent or newly emerging acne in women who may not have experienced it since youth, or at all.2
This article explores the multifactorial influences of menopause on acne, and discusses tailored treatment approaches suited to this unique clinical population.
Why menopause can cause or exacerbate acne
Acne pathophysiology centres on four main processes: excessive sebum production, abnormal follicular hyperkeratinisation, colonisation by C. acnes and chronic inflammation.3,4 The onset and exacerbation of acne in menopause stem from complex hormonal and physiological changes.
Hormonal imbalances
Menopause brings about a significant drop in oestrogen levels, creating a hormonal imbalance where androgen levels remain comparatively high, or at least fall at a much more gradual rate. This state, known as ‘relative hyperandrogenism’,5 increases sebaceous gland activity, leading to excessive sebum production – a key factor in acne development.6
Androgens, including testosterone and dihydrotestosterone (DHT), stimulate the sebaceous glands, causing them to enlarge and produce more oil.6 This creates a pore-clogging environment that promotes acne. Additionally, endocrine changes like insulin resistance, which reduces sex hormone-binding globulin (SHBG) levels, allow for more free androgens in the bloodstream, further driving acne onset and exacerbation.7
Impact on sebaceous glands and skin microbiome
Sebaceous glands in menopausal women tend to be more responsive to androgens.8 With increased sebum production due to higher androgenic influence, the skin becomes more susceptible to acne.6 The
shift in the hormonal environment also alters the skin microbiome,9 specifically influencing Cutibacterium acnes (C. acnes) populations.6 Rather than an overgrowth, specific strains of C. acnes (such as the IA1 subtype) can increase inflammation in the skin, while the diminished presence of beneficial bacteria like Staphylococcus epidermidis may further disturb microbial balance.6,10 This imbalance, combined with inflammation triggered by androgen-driven sebum production, significantly increases the likelihood of acne in menopausal women.6
Additional endocrine and lifestyle factors
Several additional factors compound the effects of menopausal hormonal changes on acne. Thyroid abnormalities, hyperprolactinaemia and insulin resistance are common in menopausal women and can influence androgen levels, directly affecting acne.6,11 Lifestyle factors such as increased stress, irregular sleep and dietary habits also contribute to acne’s persistence and severity. Stress, in particular, triggers the release of corticotrophin-releasing hormone (CRH), which raises adrenal androgen production and further stimulates sebaceous activity.12-14 A high-glycaemic diet and dairy foods, common in Western lifestyles, can also increase insulin and insulin-like growth factor-1 (IGF-1) levels, which further exacerbate acne.15 Elevated levels of insulin and IGF-1 increase androgen receptor activity, leading to enhanced sebum production. Additionally, free IGF-1 can stimulate excessive proliferation of keratinocytes.16,17 A large-scale epidemiological study has demonstrated that individuals with obesity exhibit higher TEWL values, which may be linked to adipokines and leptin.18 Moreover, diet and obesity can influence the skin microbiome.19
Inflammatory mechanisms and skin sensitivity
Menopausal skin is often more sensitive, with compromised barrier function and increased transepidermal water loss. This sensitivity can lead to microtears and skin irritation, triggering an inflammatory cascade that affects not only lesional, but also perilesional skin.20,21
This chronic inflammation, enhanced by immune system activation and androgenic stimulation, creates a feedback loop that can lead to persistent redness, pigmentation and scarring, especially in ageing skin.6
Clinical features
Menopausal acne typically presents as a distinct subset of adult female acne, manifesting with a variety of lesion types and distributions. While adult female acne is traditionally characterised by inflammatory papulopustular lesions on the mandibular and chin areas,2,14,22,23 recent studies indicate menopausal acne has a more diffuse presentation.24,25 Lesions may include mixed comedones and inflammatory papules across facial zones, with truncal involvement in up to 50% of cases.20
Women with menopausal acne frequently experience heightened skin sensitivity, leading to increased rates of post-inflammatory erythema, hyperpigmentation and scarring.6 These cosmetic concerns often contribute to psychological distress, and negatively impact quality of life.2,26 In some cases, signs of hyperandrogenism such as hirsutism, androgenetic alopecia and acanthosis nigricans, may accompany the acne.2,6
Differential diagnoses
Accurate diagnosis of menopausal acne requires distinguishing it from other acneiform and pustular conditions. Key differentials include:
· Rosacea: Presents with inflammatory papules and pustules on an erythematous background with telangiectasia. The absence of comedones differentiates it from acne.27
· Drug-induced acne: Triggered by medications like corticosteroids, androgens, hormone replacement therapy, lithium, some progestins and certain vitamins (B1, B6, B12).6,28 Drug induced acne often occurs at atypical ages and present abruptly.
· Gram-negative folliculitis: Can appear as monomorphic pustules on the perioral, mandibular and neck areas, commonly linked to prolonged antibiotic use.6 Morphology depends on subtype. Type II gram negative folliculitis manifests
as a nodular acneiform rash due to involvement of deeply penetrating organisms such as proteus species.
· Favre-Racouchot syndrome: Characterised by comedones and cysts related to chronic sun exposure.29
A thorough history of medication use, lifestyle factors and skin habits is essential. Specific triggers like cosmetic misuse, steroid use or prolonged antibiotic treatments should be explored. The presence of comedones remains a hallmark of acne, aiding differentiation from other conditions such as rosacea or folliculitis. Dermoscopic examination can also reveal features like telangiectasia, which can be indicative of steroid-induced acne or photodamage, which is prevalent in this patient group.
Topical therapies
Topical therapies are the mainstay of acne management,2,6,30 and their careful application can enhance treatment adherence, improve outcomes, and boost patient satisfaction.31 Additionally, topical treatments offer the added benefit of addressing concomitant signs of photoageing, which are frequently observed in the menopausal population.26,32
Skincare and cosmeceuticals
A proper skincare routine should be carefully selected to avoid irritation and dryness caused by topical medications. Washing the face twice daily with a gentle cleanser or benzoyl peroxide wash is recommended, avoiding over-washing to prevent impaired barrier function.6 For patients with oily skin, salicylic or glycolic acid-based washes may be beneficial. Moisturisers and sunscreens should be noncomedogenic and hypoallergenic.6
Patients should avoid harsh scrubs, picking at lesions, using oil-based cosmetics and tanning.6 This includes both sun exposure and the use of sunbeds, as ultraviolet (UV) radiation from either source can exacerbate post-inflammatory hyperpigmentation (PIH), worsen inflammation and impair skin barrier repair, particularly in ageing or acne-prone skin.33,34 UV exposure may also paradoxically increase sebum production and follicular hyperkeratinisation, contributing to acne persistence.35 Cosmeceuticals, including ingredients like retinoids, alpha-hydroxy acids and botanical extracts,36 may help reduce sebum and inflammation and support barrier repair, making them useful for managing mild-to-moderate acne in older patients.2,6,37
Retinoids
Topical retinoids, including prescription options like trifarotene, adapalene38 and tretinoin,2,39 as well as non-prescription retinols and retinaldehyde, serve a dual purpose – improving acne by preventing comedone formation and mitigating signs of skin ageing.6 Given that menopausal skin is often more sensitive, well-tolerated formulations are preferred. Products such as SkinVital Retimitate A.C.E. Advanced 3% by SkinMed and the AlphaRet range by skinbetter science are beneficial due to their patented formulations designed to minimise reactions, while delivering results comparable to topical tretinoin (other reputable products and brands are available).40,41 For those using tretinoin, starting at a low concentration (e.g. 0.025%) twice weekly and gradually increasing to daily use can help minimise irritation.42
Benzoyl peroxide and azelaic acid
Benzoyl peroxide’s antimicrobial properties make it effective for inflammatory acne,43 while azelaic acid is especially useful for patients experiencing PIH.44 Starting with lower concentrations (e.g. 2.5% benzoyl peroxide) can help prevent excessive dryness, which is a common complaint among menopausal patients.6
Combining benzoyl peroxide with retinoids or antibiotics can offer a more comprehensive approach to treating both comedonal and inflammatory acne.45 For patients with sensitive skin, practitioners
might consider alternating days for each product,46 or applying them to different areas of the face to reduce irritation.47
Topical anti-androgens
Topical anti-androgens, such as clascoterone, represent an emerging class of acne therapies that specifically target androgen receptors in sebaceous glands. Clascoterone cream 1%, approved by the US Food and Drug Administration (FDA), acts locally to inhibit androgen receptor activity, thus reducing sebum production and inflammation that contribute to acne. Clinical trials have demonstrated significant efficacy in reducing both inflammatory and non-inflammatory acne lesions with minimal systemic side effects, making it a promising therapeutic option, particularly for menopausal acne where androgenic influence is heightened.48,49 Further research is needed to fully evaluate its efficacy in the menopausal demographic and to assess long-term safety.
Systemic therapy
Antiandrogens, hormonal therapy, isotretinoin and systemic antibiotics are indicated for moderate-to-severe acne or resistant or recurrent acne in older women.
However, it is crucial to note that many aesthetic practitioners cannot prescribe systemic treatments, making collaboration with dermatologists, gynaecologists or general practitioners crucial for cases that require hormonal or oral interventions.
Spironolactone
Spironolactone, an oral anti-androgen medication, is effective for managing androgen-driven acne by blocking androgen receptors.50 It is worth bearing in mind that this requires careful patient selection due to side effects like menstrual irregularities, fatigue, increased diuresis, headache, dizziness, menstrual irregularity, breast pain and hyperkalaemia.51
Oral contraceptives
Oral contraceptives that combine ethinylestradiol with anti-androgenic progestins (such as drospirenone, cyproterone acetate or dienogest) are particularly effective in managing acne in perimenopausal and menopausal women. These formulations help regulate hormonal fluctuations, reduce sebum production and control inflammation.52-54 Not all oral contraceptives have the same effect on acne; those containing androgenic progestins (e.g. levonorgestrel or norethisterone) may actually exacerbate acne symptoms.55 The use of combined oral contraceptives comes with notable risks, particularly in older women, including an increased risk of cardiovascular disease, hypercoagulability and endometrial and breast cancers. As such, oral contraceptives are only recommended following a thorough risk assessment and regular follow-up.56
Continuous combined HRT
Ultra-low dose continuous combined hormone-replacement therapy (HRT), such as 0.5mg estradiol and 2.5mg dydrogesterone, has shown effectiveness in managing menopausal symptoms, including acne.57 This therapy helps balance hormones and reduces androgenic effects contributing to acne. While clinical studies show that this combination is generally well tolerated,58 it does carry a slightly increased risk of breast cancer.58-60 Synthetic HRT should only be used after a careful evaluation of the individual risk-benefit profile, with ongoing monitoring for potential adverse effects. These may include breast tenderness, irregular bleeding or spotting, bloating, headaches, mood swings and nausea.57 More significantly, long-term use has been associated with thromboembolic events (such as deep vein thrombosis and pulmonary embolism), cardiovascular disease and stroke, particularly in older women or those with additional risk factors.60
Transdermal oestrogen and body-identical progesterone are considered the gold standard for menopausal hormone replacement due to their safer profiles.61 Although there is limited research on their impact on menopausal acne, body-identical progesterones like micronised progesterone may also improve acne by inhibiting 5-alpha reductase and subsequently reducing dihydrotestosterone.62
Oral antibiotics
Oral antibiotics, such as doxycycline and lymecycline, are used for moderate to severe inflammatory acne when topical treatments fail.63 Current guidelines recommend limiting the duration to around three months to reduce the risk of antibiotic resistance.64 Tetracyclines are preferred, and they should be combined with topical benzoyl peroxide to minimise resistance.65 Treatment failure is more common in older patients as they have a higher likelihood of antibiotic resistance,66 highlighting the need for careful evaluation and management.2
Oral isotretinoin
Oral isotretinoin remains the gold standard for severe acne treatment, particularly where other treatments have failed. Isotretinoin acts by targeting multiple pathogenic factors of acne, including reducing sebum production, decreasing follicular hyperkeratinisation, and exerting anti-inflammatory effects.67 Common side effects include significant dryness of the skin and mucous membranes, muscle and joint pain, elevated cholesterol and triglyceride levels and potential liver function abnormalities. Given the risk of teratogenicity, strict contraception is required for female patients of childbearing potential. Recent Medicines and Healthcare products Regulatory Agency (MHRA) guidelines mandate regular pregnancy testing, monthly monitoring of liver function tests and lipid profiles, and specific prescriber certification through the Pregnancy Prevention Programme to ensure patient safety and effective monitoring.67
Aesthetic procedures
Aesthetic procedures often serve as effective adjuncts to topical or systemic therapies. However, it's important to note that aesthetic treatments alone are unlikely to fully resolve acne, particularly inflammatory or hormonally driven types, and should therefore be integrated into a broader acne management strategy.68
Chemical peels
Chemical peels, such as salicylic acid, mandelic acid, glycolic acid and retinol peels, can be valuable adjuncts in managing active acne.6 These peels offer comedolytic, keratolytic and anti-inflammatory benefits,
while glycolic and retinol peels also help address pigmentation, scarring and signs of photoageing.6
Selecting the appropriate peeling agent involves careful consideration of patient age, skin type and ethnicity. For instance, younger patients with oily and acne-prone skin typically benefit from salicylic acid or mandelic acid peels, which are gentler yet effective.69 Patients with mature skin or signs of photoageing might achieve better outcomes with glycolic or pyruvic peels due to their additional rejuvenating properties.70 Darker skin types (Fitzpatrick types IV–VI) are more prone to PIH and should be treated cautiously with milder, superficial peels such as mandelic acid that have lower risks of irritation and pigmentation changes.70,71
Laser and light therapy
Laser and light therapies can be useful adjuncts to topical and oral treatments, as they typically have minimal undesirable effects. Nevertheless, potential complications can include erythema, oedema, discomfort or pain during treatment, transient pigmentary changes (hyper- or hypopigmentation) and, rarely, blistering or scarring, especially with higher energy settings or inappropriate use on darker skin types.72,73
Pulsed dye lasers (585 and 595 nm) and potassium titanyl phosphate (KTP, 532 nm) lasers primarily reduce inflammation by selectively targeting haemoglobin, resulting in the photocoagulation of blood vessels and decreased inflammatory mediators.74,75 The 1450 nm diode and 1540 nm erbium glass lasers penetrate more deeply to thermally disrupt sebaceous glands, significantly reducing sebum production and consequently improving inflammatory lesions. Intense pulsed light (IPL) delivers broadband visible light, targeting haemoglobin, melanin and porphyrins to reduce inflammation, sebum production and bacterial load, thus improving inflammatory acne and associated erythema.75-77 Radiofrequency devices generate controlled dermal heating, reducing sebaceous gland activity and enhancing dermal remodelling, making them effective for acne and associated scarring.78
Low-intensity blue (around 415 nm), red (around 633 nm) or green (around 532 nm) LED lights work through photodynamic mechanisms, targeting endogenous porphyrins produced by Cutibacterium acnes.6 This process generates reactive oxygen species, causing oxidative damage to bacterial cell membranes, thereby reducing bacterial colonisation and inflammation.79 Additionally, the novel 1726 nm laser (AviClear) selectively targets sebaceous glands, effectively reducing sebum production and providing
significant improvement in acne lesions, with minimal downtime and side effects.80 These therapies are gentle and generally well-tolerated but require multiple sessions for optimal results.
Microneedling
Microneedling can help with scar reduction and stimulate collagen, improving skin texture. This minimally invasive procedure involves controlled mechanical injury using fine needles, triggering a wound-healing response, increasing collagen and elastin production and promoting skin remodelling.81 Suitable candidates should have well-managed acne, meaning active inflammation or infection is minimal or controlled, to avoid complications such as infection or delayed healing.82
Lifestyle and preventative care
Diet and lifestyle play significant roles in managing menopausal acne, and practitioners may want to consider working alongside a nutritional therapist or wellness coach to optimise patient outcomes. A diet high in refined sugars, carbohydrates and dairy products, particularly cow's milk and whey protein, has been linked to increased acne severity due to their impact on insulin and IGF-1 levels, which can stimulate sebum production and inflammation.15 Encouraging a balanced, low-glycaemic diet rich in fruits, vegetables and omega-3 fatty acids can help reduce acne severity and promote overall skin health.83
Sleep is another critical factor, particularly as sleep disturbances and insomnia are common during menopause, often linked to declining progesterone levels. Poor sleep can exacerbate acne,84 and societal pressures, balancing work, career, family and the impact of social media can further lead to sleep deprivation. Strategies to improve sleep hygiene, such as establishing a bedtime routine, reducing screen time and managing stress, are essential to support skin health.
Stress management is crucial, as stress can lead to increased cortisol and androgens, which in turn exacerbate acne.85 Techniques such as mindfulness, yoga and ensuring adequate sleep can help modulate stress levels, reducing the frequency and intensity of acne breakouts.86,87
Emerging research in menopausal acne
While traditional acne treatments have primarily targeted adolescents and younger adults, there is growing recognition of the unique challenges menopausal acne poses, prompting new directions in research and treatment strategies. Recent research has highlighted the significant impact of the skin microbiome on acne severity during
menopause. Studies are exploring probiotic and microbiome-based interventions to modulate inflammatory responses and restore microbial balance.
Early evidence suggests that certain probiotics can reduce inflammation and sebum production, potentially offering a more holistic approach to managing menopausal acne.88,89 For instance, a clinical trial by Kang et al. found that topical application of a lotion containing Enterococcus faecalis significantly improved pustule-type acne lesions after eight weeks compared to placebo.90 Another trial demonstrated that topical Nitrosomonas eutropha administered twice daily for 12 weeks notably reduced acne severity and inflammatory lesions compared to controls.91
Additionally, oral probiotics have shown promising results; a 2013 study by Jung et al. using a probiotic mixture of Lactobacillus acidophilus, Lactobacillus delbrueckii bulgaricus and Bifidobacterium bifidum achieved a 67% reduction in lesion count after 12 weeks, rising to 82% when combined with minocycline.92 Similarly, Kim et al. reported a 33.2% reduction in total acne lesions with oral Lactobacillus bulgaricus and Streptococcus thermophilus over a 12-week period.93 A comparative study by Irshad et al. further demonstrated that oral probiotics have equal efficacy to azithromycin in acne treatment, and their combination provided synergistic effects, achieving a 90.3% reduction in acne lesions after three months.94 These findings suggest significant potential for probiotic treatments in managing acne through modulation of the skin-gut axis, though more robust clinical trials are required to validate these outcomes comprehensively.
Given the heightened sensitivity and barrier dysfunction of menopausal skin, there is increasing interest in targeted therapies aimed at improving barrier integrity. Current investigations are evaluating ingredients like ceramides,95 niacinamide96 and hyaluronic acid to enhance barrier function, reduce transepidermal water loss and alleviate inflammation associated with acne.97
Hormonal therapies specifically designed to address menopausal skin concerns also represent a significant area of growth. While conventional HRTs have focused on systemic symptoms of menopause, newer research is investigating their targeted dermatological benefits. It examines safer, lower-dose regimens and topical hormone delivery methods that mitigate systemic risks while effectively addressing acne and other dermatological conditions.98 Such topical products without systemic effects could play a role in the treatment of menopausal skin. However, they are not currently approved because there is insufficient data on their safety and efficacy.95
Finally, the role of nutraceuticals and dietary supplements is being actively explored, particularly those targeting hormonal balance and inflammation such as omega-3 fatty acids, phytoestrogens and anti-inflammatory antioxidants like curcumin and resveratrol.99,100 Early trials suggest these may offer complementary support to traditional treatments, although further robust clinical studies are needed to fully establish their efficacy.101
Addressing a unique skin challenge
Menopausal acne presents unique challenges for patients and practitioners, driven largely by hormonal shifts and increased skin sensitivity. A tailored approach encompassing topical, systemic and procedural treatments, along with lifestyle modifications, can help achieve optimal results. By understanding the intricacies of menopausal acne based on emerging research, aesthetic practitioners can enhance patient satisfaction and contribute to long-term skin health.
Questions
Test your knowledge!
Complete the multiple-choice questions and email memberships@aestheticsjournal.com to receive your CPD certificate!
1. Which hormone primarily decreases during menopause, leading to relative hyperandrogenism and acne exacerbation?
Possible answers
a. Testosterone
b. Progesterone
c. Oestrogen
d. Cortisol
2. Menopausal acne typically presents with which combination of lesions?
3. Why is micronised progesterone potentially beneficial for menopausal acne?
4. Which statement regarding aesthetic treatments for acne is correct?
5. Which of the following dietary factors is most likely to improve menopausal acne symptoms?
a. Exclusively comedonal lesions on the forehead
b. Mixed comedones and inflammatory lesions across facial zones, often with truncal involvement
c. Papules, pustules and comedonal lesions confined to perioral area
d. Papules and pustules without comedones
a. It significantly increases free testosterone
b. It inhibits 5-alpha reductase, reducing dihydrotestosterone production
c. It stimulates sebaceous glands directly
d. It decreases skin sensitivity through oestrogen suppression
a. Aesthetic treatments alone are sufficient to completely clear menopausal acne
b. Chemical peels are generally too harsh for menopausal skin
c. Laser and light therapies typically work by reducing inflammation, sebum production and bacteria
d. Microneedling should only be used in patients with active, uncontrolled acne
a. Consuming high levels of Whey protein to support muscle maintenance
b. Increasing intake of foods rich in omega-6 fatty acids for skin barrier function
c. Adopting a balanced diet focused on low-glycaemic foods and omega-3 fatty acids
d. Regularly including iodine-rich foods such as seaweed and dairy to improve skin health
Answers: C, B, B, C, C
Dr Hazel Parkinson is a GP with a specialist interest in dermatology, women's health and aesthetics. She divides her time between her NHS role within the Warwickshire Primary Care Gynaecology Service, supporting women with menopause and other health concerns, and her private aesthetics and wellness clinic Dr Hazel Skin Solutions. In private practice, Dr Parkinson provides advanced non-surgical aesthetic treatments, specialising in perimenopausal and menopausal skin concerns.
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M-MA-UKI-4007 Date of Preparation June 2025
Treating Dyschromia
Dr Bhavjit Kaur and Sue Thomson discuss the rising patient demand for dyschromia treatments
The global pigmentation market is projected to soar to US $10.22 billion (£8,229 billion) by 2026, demonstrating a strong compound annual growth rate (CAGR) of 8.4%.1 This surge highlights the increasing demand for pigmentation treatments and raises a crucial question: is the UK medical aesthetics sector prepared to meet this rising demand both clinically and commercially?
Dyschromia
Dyschromia refers to abnormal or uneven skin pigmentation, where the skin tone deviates from its usual colour. It can appear as either hyperpigmentation (dark spots or patches) or hypopigmentation (light spots or patches), or sometimes a combination of both.2
In cases of hyperpigmentation – such as melasma or post-inflammatory hyperpigmentation (PIH) – the production of melanin increases in response to triggers like UV exposure, hormonal changes or inflammation. Interestingly, the number of melanocytes (the cells that produce melanin) does not increase; rather, these cells become more active, leading to the formation of dark patches.2
Melanocyte numbers remain fairly consistent across different skin types, averaging about 1,000 per square millimetre.3 However, the size, distribution and packaging of melanosomes (the structures that store melanin) differ significantly between lighter and darker skin tones.4,5 In lighter skin, the predominant pigment is pheomelanin, which appears yellow, red or light brown. In darker skin, eumelanin is the main pigment, giving a black or dark brown appearance.
Skin of colour (SOC) tends to have higher tyrosinase activity, resulting in almost double the melanin production compared to lighter skin. In SOC, melanosomes are larger, dispersed individually and degrade more slowly. They can reach the stratum corneum (the outermost layer of the skin), while in lighter skin, melanosomes typically remain within the stratum spinosum (a deeper layer).6
The dermis (the deeper skin layer) is generally thicker and more compact in darker skin tones. The stratum corneum, although similar in thickness across different skin types, is denser in darker skin, with about 20 layers compared to 16 layers in lighter skin.7 The lipid content in the epidermis is highest in Asian skin, followed by black, then white skin. Additionally,
cellular cohesion (the strength of cell-to-cell attachment) is greater in black skin compared to Asian or white skin, while chemical sensitivity is higher in Asian skin than in black skin.7
The lightest skin types, typically found in European, Chinese and Mexican populations, have roughly half the amount of melanin compared to the darkest skin types, such as those seen in African and Indian populations.6
In hypopigmentation disorders like vitiligo or PIH, melanocytes may be damaged or destroyed, leading to a reduction in melanin and the appearance of lighter skin patches.8
The impact of dyschromia
Thierry Passeron et al. conducted the first large international survey on the worldwide prevalence and impact of pigmentation disorders. The survey, which included 48,000 participants from 34 countries, revealed that 50% of the population reported having at least one pigmentation disorder. The conditions included solar lentigo (27%), axillary hyperpigmentation (18%), (PIH) (15%), periorbital hyperpigmentation (15%), melasma (11%) and vitiligo (8%).9
According to the Dermatology Life Quality Index (DLQI), 28% of patients with pigmentation disorders scored over 10 out of 30, indicating a significant impact on their quality of life.9
The need for knowledge
To assess clinicians' confidence and understanding of dyschromia, we conducted a survey of 49 aesthetic practitioners on their understanding and treatment of dyschromia within their own clinics.
Survey results
The results of our survey revealed that 24.49% of respondents were not confident at all in their understanding of the underlying causes of dyschromia, and 44.90% were only moderately confident (Graph 1). These findings underscore the necessity for greater access to knowledge and training. Furthermore, when asked about their satisfaction with the results of existing treatments for hyperpigmentation, 44.90% of respondents were only moderately satisfied, while 24.49% were not satisfied at all. Despite the availability of many treatment options, these results suggest that clinicians may be unaware of these options or
reluctant to treat these patients – highlighting an opportunity for suppliers and distributors to provide better support. The survey also demonstrated that 90.91% of respondents had a desire to learn more about dyschromia (Graph 2), reinforcing the need for ongoing education and training in this area.
On a scale of 1 to 5, how confident are you in your understanding of underlying causes of dyschromia?
Not confident at all
Slightly confident
Moderately confident
Very confident
Extremely confident
Graph 1: 0% of 49 practitioners were extremely confident in dyschromia treatment options
Would you like to learn more about how to manage dyschromia?
Graph 2: 90% of practitioners want to know more about dyschromia management
Dyschromia treatment options
Existing treatment modalities for these conditions fall into broad categories, including photoprotection, topical and systemic therapies, chemical peels and laser or light-based therapies.
Topical treatments
Hydroquinone
How it works: Hydroquinone is a commonly used depigmenting agent that inhibits tyrosinase, an enzyme crucial for melanin production. By reducing melanin synthesis, it helps fade dark spots and patches.11
Considerations: Hydroquinone is effective for treating hyperpigmentation disorders like melasma, but long-term use can cause skin irritation and potential ochronosis (a bluish-black discoloration). It is often recommended for short-term use and should be avoided in sensitive skin types.11,12
Retinoids
How they work: Retinoids support the metabolism and renewal of keratinocytes, reducing melanosome transfer and accelerating melanin breakdown.
They also improve the skin's outer layer (stratum corneum) permeability, enhancing the absorption of other topical treatments.13
Considerations: Retinoids can cause skin irritation, redness and peeling, particularly in sensitive skin or when first introduced. They may not be suitable for all skin types.14
Vitamin C
How it works: Vitamin C is an antioxidant that reduces melanin production by interfering with melanin synthesis; reduces oxidized dopaquinone, disrupting the oxidation of 5,6-dihydroxyindole-2-carboxylic acid (DHICA), and binding to copper ions at the tyrosinase active site. It also provides photoprotection, helping to prevent further UV-induced pigmentation.15
Considerations: It is generally well-tolerated across skin types but may cause mild irritation in some users. Vitamin C is often combined with other treatments for enhanced efficacy.16
Chemical peels
How they work: Chemical peels use agents like glycolic acid, salicylic acid or trichloroacetic acid (TCA) to exfoliate the outer layers of the skin. By removing damaged, pigmented skin layers, chemical peels help reveal new, evenly pigmented skin.17
Considerations: The choice of peel strength and type depends on the severity of dyschromia and the patient's skin type. For darker skin tones, milder peels are often recommended to reduce the risk of PIH or scarring.17
Laser treatments
How they work: Laser treatments, including non-ablative fractionated resurfacing lasers and ablative fractionated resurfacing lasers (such as CO2 and erbium lasers), as well as non-laser high-intensity light sources like intense pulsed light (IPL), work by targeting melanin within the skin. They break down excess pigment particles, which are then naturally removed by the body's immune system.18
Considerations: Darker skin types are at higher risk for adverse effects, so selecting the appropriate wavelength and energy level is crucial. Patch testing is often recommended before full treatment. These therapies can accelerate the reduction of melasma-related hyperpigmentation; however, they are not definitive cures for melasma. Additionally, they carry a risk of PIH or triggering a rebound flare of melasma.18 IPL is not recommended for skin types IV to VI.18
Microdermabrasion
How they work: Microdermabrasion involves using tiny crystals or a diamond-tipped wand to exfoliate the most superficial layers of the skin (stratum corneum).19
Considerations: These treatments are generally suitable for lighter skin types and mild hyperpigmentation, but may not be effective for deeper pigmentation issues. Careful assessment of skin type is necessary, as darker skin may be more prone to PIH following abrasive treatments.19
Microneedling
How it works: Microneedling involves creating controlled micro-injuries to the skin using tiny needles. The expression of matrix metalloproteinases induced by microneedling is believed to contribute to the reduction of hyperpigmentation.20
Considerations: Microneedling is versatile and can be combined with topical treatments for enhanced penetration and effectiveness. It is generally safe for most skin types but requires careful handling in darker skin to minimise the risk of PIH.21
Tranexamic acid
How it works: Tranexamic acid (TXA) is an antifibrinolytic medication commonly prescribed to manage bleeding. Additionally, it is used off-label as a treatment for melasma.22
Considerations: TXA can be used topically, orally or via mesotherapy. Oral formulations may have systemic side effects.23
Photoprotection
How it works: Sunscreen prevents further pigmentation by blocking harmful UV rays that can trigger melanin production and worsen existing dyschromia.24
Considerations: Sunscreens with SPF30 and above, and a minimum 4 UVA stars with additional HEVL and infrared protection, are essential for all skin types, particularly for those undergoing treatment for hyperpigmentation.24
Considerations for treatment selection
1. Skin type: Fitzpatrick skin type (I-VI) should guide treatment choice, as darker skin is more prone to PIH. Less invasive options may be preferred for sensitive or darker skin types to minimise the risk of complications.25
2. Type of dyschromia: Hyperpigmentation often benefits from treatments that reduce melanin production or remove pigmented cells, while hypopigmentation may need therapies that promote repigmentation or camouflage.26
3. Severity and depth of pigmentation: Superficial pigmentation can be treated effectively with topical agents or light chemical peels, while deeper pigmentation may require more aggressive treatments like laser therapy.27
4. Patient's medical history: Conditions like melasma, a history of keloids or active skin infections can influence the choice of treatment. Patients with hormonal influences may require tailored approaches.27
5. Expected downtime: Some treatments may involve downtime and post-procedural care. Patient lifestyle and willingness to adhere to aftercare protocols are important factors to consider.28
6. Long-term maintenance: Dyschromia often requires ongoing maintenance to prevent recurrence. Consistent use of sunscreen and periodic touch-ups may be necessary to sustain results.29
Meeting the demand
The escalating demand for dyschromia treatments presents both a challenge and an opportunity for the UK medical aesthetics sector. By prioritising practitioner education and leveraging technological advancements, the sector can not only meet the growing patient needs but also drive innovation and excellence in dermatological care.
Dr Bhavjit Kaur has been a qualified medical practitioner since 1993, with over 15 years of experience in medical aesthetics. Dr Kaur is the co-founder of the Health & Aesthetic Clinic, SkinSutra clinic and founder of Tuhi Clinic in London.
Sue Thomson is managing director of SJ Partnership, and is an accomplished international sales leader with a background in the pharmaceutical and medical device specialty. She has supported clients in achieving award-winning product development and commercial goals.
Laser Technologies for Non-Surgical Skin Rejuvenation
Dr Kashini Andrew provides an introductory overview of the laser techniques practitioners can use to rejuvenate the skin
Skin ageing is a complex process involving a combination of stages and factors. This process can lead to the formation of wrinkles, skin laxity, enlarged pores and dyspigmentation. With the rapid change in aesthetic standards, there is a growing demand for skin rejuvenation using energy-based devices.1
In 1963, consultant surgeon, Professor Leon Goldman pioneered the use of lasers in dermatology. In the mid-1970s, Italian researcher Dr Sesti explored non-surgical laser applications in wound healing, successfully treating a pressure sore in 1976.2 These early advancements paved the way for modern laser dermatology.
Photoelectric and ultrasonic technology play a crucial role in dermatology. In recent years, it has achieved remarkable results in improving skin ageing and body contouring. It is widely favoured for its fast, effective and minimally invasive nature. The main principle of photoelectric and ultrasonic technology is based on the thermal effect produced in tissues by converting various energies into heat.1,3
This article explores advanced skin rejuvenation techniques using lasers and energy-based devices, focusing on safety, effectiveness and treatment options ( Table 1).
A wide range of lasers are available in dermatology, including the CO2 (10,600 nm) and Erbium:YAG (2,940 nm) lasers, which are widely used for skin resurfacing and lesion removal. Vascular lasers, such as the Dye (595 nm) and Nd:YAG (532 nm, 1064 nm) lasers, are valued for their safety and effectiveness in treating vascular lesions.3 Q-switched lasers, with ultra-short pulses such as Nd:YAG (1064 nm), are ideal for pigmented lesions and tattoo removal.3 Given the variety of energy-based technologies, it is imperative to give this overview of the most suitable devices for skin rejuvenation.
Fractional lasers
Fractional lasers are an important group of lasers for skin rejuvenation. In 2004, Manstein et al. introduced fractional photothermolysis (FP), a technique that creates microthermal zones (MTZs) to selectively ablate skin columns while leaving surrounding tissue intact, allowing for faster healing.4 Unlike traditional ablative resurfacing, FP reduces downtime and enhances skin rejuvenation.4
Fractional lasers, both ablative and non-ablative, are effective for mild-to-moderate wrinkles, melasma, photodamaged skin and acne scars, with multiple sessions required for optimal results.5 Ablative lasers remove the skin’s outer layers to stimulate collagen production and promote new skin growth, particularly for rhytides, fine lines and dyschromia,5 whereas non-ablative fractional lasers (NAFL) targets deeper layers without disrupting the surface, encouraging skin tightening and remodelling.6
Recent studies suggest FP may help improve striae, though further research is needed.7,8 FP is safe for all skin types, including darker skin (Fitzpatrick IV-VI), but caution is required in those prone to pigmentation or keloids.5 Pre-treatment with depigmenting agents and sunscreens, along with lower initial fluences, helps minimise risks in these patients.5
Non-ablative fractional lasers
NAFLs are widely used in skin rejuvenation due to their established safety, efficacy and versatility. These devices operate in the mid-infrared spectrum (1320–1940 nm), targeting water as the primary chromophore for facial rejuvenation. Among them, the 1927 nm fractional thulium fibre laser (FTL) has been shown to improve superficial signs of photoageing, including dyspigmentation, fine lines and actinic damage.8 This would be effective in all skin types with photoageing, post-acne dyspigmentation and individuals seeking treatment for fine lines. Common complications include post-inflammatory hyperpigmentation (PIH), milia, erythema and skin infections. It is contraindicated in active skin infections and recent isotretinoin treatment.9
While initial reports support its safety and effectiveness, clinical data on FTL remains limited. Compared to ablative fractional lasers, which offer faster results but involve higher risks, longer downtime and extended recovery, non-ablative systems provide a lower complication rate and are suitable for a broader patient population. The average downtime for non ablative lasers is around five days, while for ablative lasers, this could be as long as 14 days. However, achieving optimal outcomes may require multiple treatment sessions.9
In a pioneering South Korean study, FTL showed encouraging results in Asian skin, and a subsequent study by Wu et al., reported that FTL was more effective than intense pulsed light (IPL) or Nd:YAG (1064/532 nm) lasers for improving wrinkles and skin laxity.10 In that study, skin retraction time – a measure of skin elasticity – was significantly reduced a month post treatment, indicating enhanced skin tightening and rejuvenation.10
Table 1: A summary outlining key laser systems, indications, benefits and skin type suitability.
Picosecond lasers
Picosecond lasers emit ultra-short pulses (300–900ps) that generate intense photomechanical effects, breaking down pigment particles through acoustic shock waves and causing minimal thermal damage. The mechanism involves laser-induced optical breakdown (LIOB), creating microinjury zones that trigger wound healing and dermal remodelling, improving conditions such as wrinkles, enlarged pores and acne scars.11,12
When used with diffractive optical elements (DOE), the laser produces a grid of high-fluence microbeams surrounded by low-fluence areas, resulting in intraepidermal and dermal vacuoles. This focused delivery promotes collagen production through cytokine and chemokine release from keratinocytes. First approved by the US Food and Drug Administration (FDA) in 2012 (PicoSure), picosecond lasers are now used for tattoo removal, melasma, photodamage, benign pigmented lesions and skin rejuvenation.11,12 Studies show results comparable to fractional CO2 lasers but with a safer profile and suitability for all skin types, marking a major advancement in aesthetic dermatology.11,12 These lasers are contraindicated in active skin infections, pregnancy, recent isotretinoin use, malignancy in the skin area, history of keloids, sun exposure and photo dermatoses. Potential complications include blistering, folliculitis, PIH, hypopigmentation and allergic reactions to certain tattoo pigments released during the procedure.11,12
Laser-assisted drug delivery
In recent years, laser-assisted drug delivery (LADD) has emerged as an innovative technique in skin rejuvenation, offering a novel method for enhancing transdermal drug absorption. Ablative fractional lasers (AFLs), such as erbium-doped yttrium aluminium garnet (Er:YAG) CO2 lasers, produce microscopic treatment zones (MTZs) surrounded by coagulated tissue and intact skin columns. The depth of these vertical channels is directly influenced by the laser’s fluence. By selectively disrupting the epidermis and dermis, these microchannels facilitate enhanced penetration of topically applied therapeutics such as botulinum toxin A, hyaluronic acid, retinoids, antioxidants and tranexamic acid.13
Multiple studies have confirmed the efficacy of LADD in managing photoaged skin, with notable improvements in skin texture and pigmentation.12,13 More recently, LADD has gained traction for the delivery of skin quality boosters (SQBs), particularly in facial rejuvenation, further expanding its role in non-invasive skin rejuvenation.13,14
A systematic review evaluated the effectiveness of LADD for facial rejuvenation and melasma. Among the topical treatments used, tranexamic acid and kojic acid were the most frequently studied for melasma. Fractional CO2 lasers were the most common laser, mainly for facial rejuvenation, while Er:YAG lasers were used for melasma and as adjuncts in rejuvenation. In facial rejuvenation, LADD showed modest improvements in skin texture and pigmentation but limited effects on laxity and wrinkles. Patient-reported outcomes across studies indicated high satisfaction, especially with skin radiance and wrinkle improvement, supporting LADD’s potential in skin rejuvenation.14
Most studies included in the systematic review reported only mild and short-lived side effects from LADD, such as pain, redness and crusting. Less common complications included irritation, dryness, scaling, PIH, swelling, tingling, stinging, mild discomfort and acne flares. These complications were infrequent and showed no significant difference between treatment types, reinforcing the overall safety profile of LADD.14 However, findings remain variable, emphasising the need for larger, standardised trials to confirm clinical efficacy and optimal agent-laser combinations.14 LADD is contraindicated in individuals with active dermatologic disease, poor wound healing, keloid tendency, cutaneous malignancy,
autoimmune conditions, pregnancy, photosensitivity and recent use of retinoids or other sensitising treatments, Fitzpatrick skin type VI and those with recent cosmetic procedures or systemic conditions impairing skin recovery.14
Hybrid laser resurfacing
Hybrid laser resurfacing marks a significant advancement in aesthetic dermatology by combining ablative and NAFL technologies in a single treatment. This dual-wavelength approach allows for tailored procedures that address a wide range of skin concerns – such as fine lines, wrinkles, acne scars and sun damage – while minimising downtime and side effects.
By integrating both, hybrid lasers offer more comprehensive and effective skin rejuvenation than either modality alone.8 Patients benefit from quicker recovery, reduced discomfort and sustained improvements in skin texture and tone. One study demonstrated long-term efficacy and high satisfaction following hybrid laser treatments for photodamaged skin among 19 women, reinforcing their value as a versatile and efficient skin resurfacing option.6 The risks and complications are those of the individual lasers that make up the hybrid lasers.
Safe laser practices
Laser-based skin rejuvenation for ethnic skin has progressed significantly, offering safer and more effective solutions tailored to darker skin tones. Modern technologies such as Nd:YAG, picosecond and fractionated lasers are designed to minimise complications like post-inflammatory hyperpigmentation by targeting deeper dermal layers while preserving the epidermis.8 These systems stimulate collagen production and improve conditions like acne scars, fine lines, wrinkles, textural irregularities and melasma, with fewer side effects.8 Researchers have emphasised the need for a nuanced approach, highlighting key factors for successful outcomes: appropriate device selection, conservative treatment settings, proper patient selection, realistic expectations and diligent use of broad-spectrum sunscreen.9
Fractional lasers, which create microthermal treatment zones while sparing surrounding tissue, promote faster healing and safer treatment in melanin-rich skin.15 Nd:YAG lasers, with wavelengths less absorbed by melanin, and picosecond lasers, with ultra-short pulse durations that limit thermal damage, are especially suitable for ethnic skin.15
Effective clinical practices
The safety and success of laser skin rejuvenation hinges on a comprehensive, individualised approach that prioritises patient assessment, appropriate laser selection and diligent post-treatment care. Practitioner expertise, conservative treatment parameters – particularly for darker skin tones – and appropriate follow-up are essential in minimising risks. Modern rejuvenation methods reflect an evolution toward safer, more effective clinical practices in aesthetic dermatology.
Dr Kashini Andrew is a UK-trained dermatologist with a special interest and training in lasers. He completed his Undergraduate Medical degree in Bachelor of Medicine and surgery, in 2012 and a Master of Science in human physiology in 2017 both at the Ahmadu Bello University, Medical School, Zaria, Nigeria. He completed his dermatology residency in the West Midlands region of the United Kingdom, obtaining the MRCP and a CCST in Dermatology in 2025. Dr Andrew is a member of the British Medical Laser Association.
Qual: MBBS (ABU), M.Sc, MRCP
Previous issues of Aesthetics Journal offer valuable clinical insights, trend analysis, expert advice, and educational content that remain essential resources for staying informed and inspired. The monthly resource for
Swiss Innovation Meets
British Skincare
Stratpharma brings its next-generation wound care solutions to the UK, combining Swiss precision with clinically backed innovations in skin healing
Stratpharma launches advanced wound care range in the UK Stratpharma is a Swiss company based in Basel, which specialises in innovative topical medical devices.
Our mission is to use innovative methods to focus on delivering medical solutions in the fields of aesthetic medicine, dermatology, plastic surgery, wound care, women’s health, anti-infectives and oncology.
Stratpharma is powered by our collaborative R&D projects and an ambitious pipeline in topical dermatology. We are dedicated to improving unmet needs in patient care and the aesthetics and healthcare industry.
Stratpharma products are all film-forming gels, a unique type of “wound dressing” that start as a gel and then dry to form silicone gel sheets while on the wound. This promotes moist wound healing that allows the skin to heal itself.
Our lead Aesthetics Product Stratacell is an advanced dressing for fractional procedures and reduces client downtime and can be covered with suncream or cosmetics.
Strategy announcement
As part of our UK launch plans, we are delighted to announce that we have a strategic partnership with 3D Aesthetics. Each order for 3D's new medical range will come with a Stratpharma aftercare pack, training credits and protocols. There will also be support for all customers with introductory Stratpharma packs, protocols and training credits along with introductory offers for clinics and patients.
Stratpharma products are easy to use and easy to apply, all products are backed by clinical trials, help reduce downtime, accelerate healing and can be used at home.
For more information about becoming a stockist please email: UK.inquiries@stratpharma.com
UK.inquiries@stratpharma.com
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Figure 1: Post-procedure, start of treatment with Stratacel
Figure 2: After 16 days of treatment with Stratacel
Ethnic Considerations in Rhinoplasty
Dr Nizar Hamadeh explores how rhinoplasty techniques adapt to diverse nasal anatomies
The nose serves as a key element of individuality and cultural identity. Anatomical variations among ethnic groups significantly influence both the aesthetic and functional outcomes of rhinoplasty procedures. A comprehensive understanding of these is crucial for safe, effective, and culturally sensitive care.1,2
Ethnic anatomy
Nasal anatomy exhibits considerable diversity influenced by genetic, environmental and evolutionary factors. Understanding these variations is critical for achieving optimal surgical outcomes. While we cannot create a fine-tuned categorisation for every nationality, patients typically fall into five to six main categories.1
Caucasian noses
Caucasian individuals often present with a higher nasal dorsum and a well-defined nasal tip. The skin tends to be thinner, allowing for more pronounced contours. The nasal bridge is often narrower, and the columella may exhibit more significant projection. Surgical techniques for this group may focus on reduction of the bridge or refinement of the tip through osteotomies or cartilage grafting, or removal or combination of removal and grafting depending on individual aesthetic goals.3 For non-surgical rhinoplasty, hyaluronic acid (HA) fillers can augment the nasal bridge for a straighter profile and subtly refine the tip for improved definition and lift. Superficial injections enhance contour, while deeper planes provide structural support.4
African noses
African noses are characterised by broader bases, lower bridges and a more rounded tip. The skin is thicker, which can affect scar healing and overall aesthetic outcomes. Rhinoplasty techniques may involve reducing the width of the nostrils (alar base reduction) and augmenting the bridge to create a more defined profile. Understanding the unique healing patterns associated with thicker skin is essential for
managing post-operative complications.1 For non-surgical rhinoplasty, thicker fillers are used to elevate the nasal bridge and subtly contour the base while maintaining ethnic harmony. Deeper injections provide structural support, with careful modulation to preserve natural width and definition.5
Asian noses
East Asian populations often exhibit flatter nasal profiles with lower bridges and less pronounced tips. The nasal skin is typically thicker, complicating surgical refinement. Techniques such as dorsal augmentation with silicone implants or cartilage grafts are commonly employed to elevate the bridge and define the tip, while preserving the characteristic softness of the Asian nose.6 For non-surgical rhinoplasty, fillers can enhance the nasal bridge and subtly increase tip projection. Superficial injections are preferred for the bridge, with deeper placement at the tip for structural support, ensuring facial harmony.4
Middle Eastern noses
Middle Eastern noses often feature a prominent dorsal hump and a rounded tip. Surgical interventions typically focus on reducing the dorsal prominence while maintaining ethnic identity through careful contouring. Grafting techniques may be used to enhance the tip or provide structural support, ensuring the result reflects the patient’s cultural background.7 For non-surgical rhinoplasty, cohesive fillers are used to augment the bridge and subtly refine the tip. Both deep and superficial injections are employed to achieve balanced, natural results.8
Hispanic noses
Hispanic noses may vary widely but often present with a broader base and a moderately flat bridge. Rhinoplasty in this demographic typically aims to refine the tip while maintaining a broader base to respect ethnic identity. Techniques may include lateral crural strut grafting to enhance tip projection while preserving the overall nasal width.3 For non-surgical rhinoplasty, fillers enhance the bridge and soften the tip, with subtle nasal base contouring. Superficial injections aid contouring, while deeper injections provide structural support.5
South Asian noses
South Asian noses often have significant projection and a broader base. Patients may request refinement of the tip or reduction of width while preserving the distinctive projection. Surgical strategies may include tip plasty and dorsal reduction, with careful consideration given to the patient’s cultural expectations.2 For non-surgical rhinoplasty, fillers elevate
the bridge with a smooth transition to the tip, where subtle projection is achieved. Superficial injections are recommended to maintain a natural look.4
Surgical approaches
The choice of surgical approach must be tailored to both the individual anatomy and aesthetic goals of the patient.
Open vs. closed rhinoplasty
Open rhinoplasty provides greater visibility and access to underlying structures, making it advantageous for complex cases. Closed rhinoplasty, while less invasive and associated with reduced visible scarring, may limit access in more intricate procedures.3
Cartilage grafting techniques
Cartilage grafting is a cornerstone of rhinoplasty, particularly for ethnic noses where structural support may be necessary and in secondary rhinoplasty. Common sources for grafts include the septum, auricular cartilage and rib cartilage. Surgeons must carefully select graft type and placement to enhance aesthetic outcomes while preserving the patient’s unique nasal characteristics.9
Potential complications
Rhinoplasty can carry inherent surgical risks that must be carefully managed:
· Postoperative complications such as infection, excessive bleeding, septal haematoma and intranasal adhesions, which may necessitate medical or surgical intervention.
· Aesthetic deformities, including pollybeak, saddle nose, inverted-V deformity, hanging or retracted columella, bossae, alar retraction, and a pinched or asymmetrical nasal tip.10
· Structural and functional issues, often requiring grafting or revision surgery, such as open roof deformity, rocker and step deformities, nasal valve collapse, persistent deviation, and vestibular stenosis.11
· Other potential complications including septal perforation, nasal obstruction, altered sensation (including anosmia or dysosmia), cerebrospinal fluid (CSF) leak, lacrimal duct injury, and thromboembolic events.
· Graft-related problems, such as migration, extrusion, cyst formation or granuloma, which may require further surgical correction.
· Revision surgery, which is required in approximately 10% of cases due to persistent functional or aesthetic concerns.12
Contraindications to rhinoplasty
Not all patients are suitable candidates for rhinoplasty. A range of factors can increase surgical risks or compromise outcomes:
· Active substance use: Causes vasoconstriction, tissue necrosis and poor wound healing, increasing postoperative risk.13
· Uncontrolled medical conditions: Poorly managed diabetes, hypertension or cardiac disease raise anaesthetic and surgical risk.13
· Bleeding disorders or anticoagulant therapy: Heightened risk of bleeding and septal haematoma requires careful evaluation.14
· Severe mental health issues: Psychological assessment is recommended to ensure realistic expectations.15
· Smoking: Nicotine-induced vasoconstriction impairs healing and increases infection and scarring risk.16
· Obstructive sleep apnoea: Raises perioperative risk and complicates anaesthesia.17
Non-surgical treatment options
The most common approaches include dermal fillers and toxins.
HA filler
HA fillers can be used in non-surgical rhinoplasty to augment and straighten the nasal bridge or refine and lift the tip. This method allows for immediate visual enhancement and is particularly useful for patients desiring subtle changes without the commitment of surgery. Careful anatomical consideration is necessary to ensure that results align with ethnic aesthetics or the desired modifications.18
Selecting the ideal filler involves evaluating several key properties. These include viscosity and cohesiveness for stability, moderate elasticity for natural movement, optimal cross-linking for longevity, uniform small particle size for smooth injection, and proven biocompatibility to minimise adverse reactions. Practitioners should use fillers approved by regulatory bodies such as the US Food and Drug Administration (FDA), which emphasise safety and biocompatibility standards to reduce risks associated with HA use.4,5,19,20 Many practitioners prefer the cannula technique due to its safety profile and ability to minimise complications. One study published in Journal of Cosmetic Dermatology indicate that the cannula technique is associated with fewer adverse events compared to needles.21 Practitioners should tailor the injection plane based on the treatment goals and the anatomical characteristics of the patient. Another study published in the Aesthetic Surgery Journal
recommends a layered approach, starting with deep injections for structural support followed by superficial layers for refinement.4
Dosage recommendations:
· Caucasian patients: Typically, a dosage of 1-1.5ml may be sufficient for enhancing the nasal bridge and tip.
· African patients: Due to broader nasal structures, higher volumes of 1.5-2ml may be needed to achieve desired results.
· Asian patients: A focus on building the nasal bridge with 1-1.5ml, ensuring a harmonious profile, is often preferred. However, despite their minimally invasive nature, HA fillers carry significant risks that both practitioners and patients must understand and mitigate.
Vascular complications
The nasal region contains a dense and complex vascular network. Improper injection technique may result in vascular occlusion, potentially causing ischemia, tissue necrosis, vision loss or stroke.7 Embolisation can occur either via direct intravascular injection or retrograde flow, leading to blockage of critical arteries, including the ophthalmic and central retinal arteries.7
· Blindness: Occlusion of the retinal or ophthalmic arteries can result in irreversible vision loss, particularly when injections are performed in the glabella or forehead. The retina’s sensitivity to ischemia makes even brief interruptions in blood supply dangerous.7
· Skin necrosis: Reduced perfusion can lead to necrosis, especially in the nasal tip. This may result in discolouration, ulceration and secondary infection requiring intervention.7
Infection risk
Given the proximity of nasal structures to the sinuses and a rich vascular supply, filler injections pose a risk of infection. Complications include cellulitis, abscess formation and possible scarring.22
Asymmetry and irregularities
Achieving perfect symmetry with HA fillers is technically challenging. Overcorrection or uneven distribution can result in lumps, distortions or an unnatural appearance, necessitating corrective procedures.18
Filler migration
HA filler can migrate over time, altering the intended outcome. Migration may require further intervention and complicate aesthetic results.23
Dangerous injection zones
Certain nasal regions are particularly prone to complications due to their vascular anatomy. High risk injection zones include:
· Glabella: Close to the supratrochlear and
supraorbital arteries; associated with high risk of vascular occlusion and blindness.24
· Nasal dorsum: While commonly targeted for augmentation, improper technique can affect nearby vasculature, resulting in delayed complications.25
· Nasal tip: Highly vascularised; improper injection can lead to necrosis and scarring.26
· Alar region: Contains multiple terminal vessels; misplacement of filler in this area may result in significant tissue loss.27
Botulinum toxin
Botulinum toxin (BoNT) can address functional issues such as nasal flare or asymmetry. By selectively relaxing specific muscles such as the dilator naris, nasalis and levator labii superioris alaeque nasi, practitioners can achieve a more harmonious nasal appearance while maintaining the integrity of the underlying structure.28
A prospective single-blind study demonstrated that 3 units of onabotulinumtoxinA injected into the alar base region significantly reduced nasal flare and mobility, with no reported complications and high patient satisfaction.29 Standard dosing ranges from 2–3 units per side, delivered using a 30G needle intramuscularly or subdermally depending on muscle depth.30,31 Onset is typically within three to seven days, with peak effect by two weeks and duration of three to four months.32
Complications are rare but can include transient bruising, tip ptosis or unintended diffusion causing upper lip weakness. Conservative dosing and anatomical precision are critical to minimising risk, particularly in post-surgical patients or those with thin, soft tissue coverage.33
Accepting diversity
While there is a strong emphasis on preserving ethnic identity, it is equally important to acknowledge and respect patients’ desires to alter or minimise these features.
Mr Nizar Hamadeh earned his medical degree in 1997, followed by and a residency in Otolaryngology - Head and Neck Surgery at university hospitals in Paris and Brussels. In 2004, he received an ENT degree and later obtained several sub-specialty qualifications in ENT and Plastic Surgery.
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Implementing HA to Improve the Skin Barrier
Dr Pamela Benito
explores the role of hyaluronic acid in enhancing skin quality
As patients continue to prioritise their general skin health as opposed to targeting specific issues, skin quality has become increasingly important to patients when considering aesthetic treatments and desired outcomes.1-3
This article examines methods for assessing skin quality, the use of hyaluronic acid (HA) to enhance it, relevant treatment techniques and key clinical considerations.
What is HA?
Suitable for all Fitzpatrick skin types (FST), HA is a glycosaminoglycan that is a significant component of the skin’s extracellular matrix.4 Classified as a humectant and hygroscopic in nature, it has a powerful capacity at retaining water, with the ability to hold up to 1,000 times its weight.5,6 Approximately half of the body’s HA is found in the skin, as it plays a crucial role not only in maintaining tissue hydration, but also in cellular processes such as keratinocyte proliferation, differentiation and the inflammatory response.7-15
The earliest therapeutic use of HA appears to be in 1968, when a burn was treated with purified HA. Since then, it has been applied in almost every field of medicine.16 Numerous studies support HA as a well-tolerated and effective ingredient for enhancing skin hydration and promoting rejuvenation.17,18 Its versatility and humectant properties make it a valuable molecule in cosmetic dermatology, particularly in the treatment of skin dehydration, wound healing and signs of ageing, as well as to address related conditions such as scarring, eczema and wrinkles.19-26
Understanding the significance of skin quality
There is no consistent, objective definition of skin quality; however, it is generally accepted to mean skin that appears healthy, undamaged and youthful.26 Multiple factors influence skin quality, broadly classified as intrinsic (internal biological influences) and extrinsic (environmental and lifestyle-related elements).27
The combined effects of intrinsic factors such as oxidative stress, ethnicity and hormonal changes, alongside extrinsic factors including sun exposure, air pollution, stress and lifestyle habits, can cause gradual and irreversible changes to the skin.28 These changes impact its structure, texture and radiance, contributing to premature ageing and deterioration of skin quality.29
The significance of skin quality transcends more than visual appearance, playing a significant role in an individual’s emotional health and wellbeing.30 Multiple studies have found that patients with visible dermatologic skin conditions have lower quality of life and psychosocial functioning scores than those who do not have such conditions.31-33 Research also links unhealthy skin to an increased risk of age-related diseases, as skin inflammation may drive systemic inflammation. It may also signal underlying conditions such as Parkinson’s disease and type 2 diabetes.34
Skin quality is therefore of paramount importance – not only in the context of aesthetics and ageing, but also as a reflection of an individual’s overall health status.35-37
Measuring skin quality
Understanding skin quality is essential for accurate assessment and personalised treatment. Traditionally, assessments relied on inconsistent terminology and subjective evaluation.38,39 To address this, a global Skin Quality Advisory Board comprising dermatologists and aesthetic physicians established standardised parameters based on four emerging perceptual skin quality categories (EPCs), each linked to recommended measurement techniques.40,41 These EPCs support more targeted and effective treatment planning.42
Firmness
Skin firmness is a key effectiveness measure, reflecting structural integrity and resistance to laxity through parameters such as elasticity, tightness and hydration.43-46 It can be assessed using instruments like the SkinFibrometer, Cutometer and Corneometer, as well as visual and manual methods such as the skin turgor test.47-49
Texture smoothness
Skin texture is a measurable aspect of skin quality, with smoothness, roughness and pigment evenness indicating ageing and photodamage.50,51 Erythema, linked to increased blood flow, is more pronounced in FST I–III.52 Assessment typically involves visual inspection and imaging tools such as VISIA, Observ 520, Opatra and Zemits.53-56
Skin glow
Skin glow, unlike other EPCs, has no defined parameters or standardised measurement tools.57 It is described using terms such as radiance, luminosity and brightness, and is typically assessed visually, with hydration being a key contributing factor.58 Radiance is widely regarded as a visible indicator of overall skin quality.58
Tone
Evenness and tone are critical to overall skin appearance and should be evaluated during a comprehensive skin assessment. This includes examining pores, lines, wrinkles and scars – features influenced by factors such as dehydration, muscle movement and previous skin injury. Although no universal scoring system exists, practitioners typically use a combination of visual assessment, colorimetric analysis and grading scales to objectively assess tone and pigmentation uniformity.59,60
Alongside the assessment, dermal imaging devices and AI-based tools like VISIA and Perfect Corp’s AI Skin
Analyser are increasingly used to enhance accuracy in skin assessment by identifying irregularities and supporting early intervention.53-56 Treatment options depend on individual assessment outcomes and the specific concern. Erythema may be managed with corticosteroids or antihistamines; pigmentation with peels, lasers or topical agents; and textural issues with microneedling, laser or radiofrequency therapies.61-63
Different forms of HA
HA is available in topical, oral and injectable forms. These forms may be employed independently based on clinical indication or integrated as part of a combined treatment therapy.
Topical HA
Topical HA is available in cream, gel and serum preparations, and provides surface hydration and improved skin appearance in the epidermal layer of the skin.64 One study suggests that topical HA in a serum formulation can increase skin hydration by 55%, as measured by corneometry.65
Topical HA can be used as an independent dermocosmetic treatment or in combination with other modalities, such as injectable HA treatments, to protect the skin and contribute to treatment outcomes. Its hydration, regenerative and anti-inflammatory properties can contribute to faster healing and improved skin appearance including glow, tone, evenness and firmness.66 It is generally well tolerated by all patient demographics, with minimal adverse effects.67
Topical HA refers to medical-grade formulations with optimised molecular weights and delivery systems, such as encapsulation, to enhance skin penetration. Techniques like microneedling may improve absorption but should be tailored to individual needs and brand protocols. Patient suitability for any HA treatment
this case, the technique remains consistent across brands; however, practitioners should consult brand-specific guidelines to ensure best practice.74,75 A sample approach using non-crosslinked high molecular weight hyaluronic acid (HMW-HA) is outlined below:76
· Injection depth: Subdermal to Recommended injection technique:
· Maintenance regimen: One session every nine to 12 months, or as clinically indicated.78
· Clinical considerations: Stretch the skin during injection to minimise the risk of superficial lumping. Avoid overcorrection, as dermal filler integrates naturally into the tissue over time.78
Considerations for using HA
2–3ml per session, per treatment area.76
Conducting a comprehensive skincare consultation, in conjunction with the aforementioned skin quality analysis, is essential to assess each patient's suitability and needs. Encouraging a holistic approach to treatment by making necessary lifestyle adaptations is also highly recommended. This might include improving sleep, incorporating regular exercise and maintaining a balanced diet.72
One session every three
elastin modulation. It helps restore dermal expression of collagen I and the formation of a new extracellular matrix, all with minimal
formulations tailored to specific aesthetic
tailored to each patient’s individual needs, and in accordance with product guidelines, an example approach to treat the signs of
wrinkles using a blend of crosslinked and non-crosslinked high molecular weight HA is crosshatching. A 30G needle or blunt-tip combination of both is often ideal for optimal precision and tissue integration.78
When selecting which options to use, conduct thorough research and due diligence to ensure they deliver the best possible outcomes for both you and your patients. Choose evidence-based products and brands backed by clinical research with excellent safety records and evidence of clinical outcomes – these should be available from individual brands, as well as looking at reviews from other practitioners. Additionally, when considering injectable HA, it is crucial to select products that target specific aesthetic concerns such as volume loss, skin quality and structural support, while preserving the natural dynamics and expressions of the face.73 Formulations with tailored rheological properties – such as stretch, strength and structural integrity – specifically designed for targeted indications and anatomical treatment areas are considered optimal, as they support outcomes that are both natural-looking and long-lasting.74
Optimising HA protocols
With growing evidence supporting its multifunctional benefits, HA remains integral to personalised, minimally invasive aesthetic strategies aimed at optimising skin quality and improving patient outcomes.
Dr Pamela Benito is an aesthetic practitioner, serving as a regional expert for Teoxane UK. Dr Benito studied at New York University, graduating as a dental surgeon in 2006 and finishing her postgraduate in 2009. Her facial aesthetics career progressed as she trained at the Royal College of Surgeons.
Qual: DDS, MSc
Sessions spaced
Where Technology Meets Skincare: The New GetHarley Era with Founder & CEO Charmaine Chow
GetHarley delivers smarter skincare with AI-driven tools and personalised support for busy, results-focused practitioners
Can you give me an overview of the changes you’ve made at GetHarley over the last few years and why?
In 2023 we got a large investment of $52 million, mostly from venture capital firm Index Ventures. Index Ventures is widely regarded, known for its strong track record, founder-first philosophy and global investment reach. The firm backed household names such as Deliveroo, Net-a-Porter and Glossier.
With the funding we set out to do two things; make our offering more compelling to practitioners and expand internationally. This meant revamping our technology architecture to make it more effective, efficient and scalable for practitioners.
Since the investment, the industry may not have noticed changes, but we have been working very hard behind the scenes, planning, researching, restructuring, hiring and investing in the right people and technology.
We've gathered extensive feedback from practitioners on how to enhance our platform, with a clear focus on empowering them and improving patient outcomes – and before the year ends, the industry will see meaningful, visible changes.
We’ve established a new office in the US with a dedicated team in place, and in time, we’ll be inviting our UK practitioner community to actively engage with and support our US operations.
How specifically have you utilised technology and artificial intelligence (AI) to give practitioners a better service?
We have listened to our practitioner community and made changes so they can deliver more consistent, personalised care, in less time.
We’ve developed some nifty new features such as a pre-approved product alternatives tool and a custom templates
option. Over the years we have noticed that most practitioners have specific skincare templates for different patient archetypes and journeys. Utilising the templated plan option will mean a plan can be created in one click. Perfect for practitioners who have no time to spare in their busy clinics.
We also have a new AI function coming that means you can make custom note edits and quickly change abbreviations to full sentences. It will automatically spell patient names and product names correctly. In addition, voice notes on plan creation or custom notes for patients will automatically be transcribed, which takes instantaneous personalisation to the next level.
These features were designed to make clinic operations smoother, and it will soon be possible to make a skincare plan in five seconds!
We are incorporating and utilising more AI within every team at GetHarley – marketing, sales and operations, to improve our service to practitioners and their patients. More AI power will mean that more human power is available for those high touch scenarios. GetHarley will always marry tech with the power of the human touch, and moving forward the human touch will be more specialised.
We’ve utilised data from the last six years to revamp our inventory model, to offer the best selection of brands and products to our community.
Have you made any recent internal changes to strengthen your service and operations?
As with the evolution of many businesses, after six years there is often a need to restructure to accommodate investments and developments, especially when more AI and technology is implemented.
We have made some significant hires, with the recruitment of Ollie May, Vice President of Revenue, and Sahil Arora, Head of Account Management and more specialists in particular fields, all aligned to serving practitioners better. The one thing we will never change is our mission, culture and values.
A very exciting operational development we have made is building our own warehouse. We will soon switch from using a third-party company, to having our very own GetHarley warehouse. We look forward to tightening our operations, through more control.
What can practitioners new to GetHarley expect for their patients?
A skincare service that truly delivers, whilst supporting them to deliver the best patient care.
We’ve invested in the patient experience to ‘surprise and delight’ with new personalised touches, sustainable merchandise and thoughtful gifts. We’ve elevated the brand by incorporating more of the practitioner into the marketing material, reinforcing the practitioner-patient relationship.
Who benefits most from the GetHarley service?
There is now a vastly improved, intuitive onboarding and value partnership in place for practitioners.
GetHarley is best suited to forward-thinking practitioners who care deeply about offering a holistic patient experience, beyond injectables.
Practitioners who run a busy or growing clinic are motivated to regularly recommend skincare to existing patients and are invested in working with GetHarley properly to leverage our expertise, can benefit from elevated patient care, additional revenue and passive income.
We have a white glove onboarding that is very streamlined based on our experience of working with over 1,500 practitioners. After onboarding you we're coming in, we're observing your patient journey and your consultation flow and we're helping you implement our service.
Practitioners who believe in the power of skincare and want to provide a holistic service to their patients, will reap the benefits.
What does the future hold for GetHarley?
More innovation, service developments, whilst always staying ahead of industry trends.
We’re just getting started!
Practitioners interested to book a GetHarley demo please visit: getharley.com/book-demo/
This advertorial was written and supplied by
A summary of the latest clinical studies
Title: Fractional Microneedle Radiofrequency with the Application of Vitamin C, E, and Ferulic Acid Serum for Neck Skin Rejuvenation: A Prospective, Double-blinded, Split-neck, Placebo-controlled Trial
Authors: Jemin Kim, et al.
Published: The Journal of Dermatological Treatment, June 2025
Keywords: Ageing, Microneedling, Radiofrequency
This study aims to evaluate the efficacy of fractional microneedle radiofrequency (FMR) combined with topical antioxidant serum (vitamin C, vitamin E and ferulic acid) compared to FMR alone for neck rejuvenation. This prospective, randomised, double-blind, split-neck trial included 31 participants aged 30-65 years with visible signs of neck ageing. Subjects underwent two FMR treatments at four-week intervals. Immediately post-treatment, participants applied antioxidant serum to one randomly assigned side of the neck and placebo to the contralateral side daily. Efficacy was assessed by Fitzpatrick Wrinkle and Elastosis Scale, Global Esthetic Improvement Scale (GAIS) and biophysical skin parameters. Histological analyses evaluated elastin production and markers of senescence. At week 12, the antioxidant-treated neck side showed significantly greater reductions in wrinkle severity (29.9% vs. 18.0%; p < 0.001), increased elasticity (12.9% vs. 2.3%; p < 0.001) and higher GAIS improvement (87.5% vs. 14.3%). Histologically, antioxidant-treated areas exhibited increased elastin and reduced cellular senescence markers (p16 and γ-H2A.X). Combining FMR with topical antioxidant serum substantially enhances neck skin rejuvenation, demonstrating superior clinical and histological outcomes. This approach effectively addresses neck aging, highlighting antioxidants as valuable adjunctive therapies.
Title: Observation of Safety and Efficacy of Botulinum Toxin Type A in the Treatment of Tear Troughs and Mild Yelid Bags
Authors: Siyuan Zhou, et al.
Published: The Journal of Cosmetic Dermatology, June 2025
This study included patients with tear troughs rated as Grade 1-2 on the Barton Aesthetic Scale, who were treated between September 2023 and September 2024. These patients underwent intradermal injections of Botulinum Toxin Type A (BTX-A). Doctors conducted pre- and post-procedure assessments of the severity of tear troughs using the Barton Scale and TTRS (The Tear Trough Rating Scale). VISIA skin image analyser was utilised to compare the number of wrinkles, and facial scores and percentiles were calculated for objective evaluations before and after treatment. Additionally, doctors employed the Fitzpatrick Scale to assess periorbital wrinkles. This investigation was conducted as a prospective single-centre study. All 42 patients completed the study. After treatment, there was a significant improvement in VISIA-measured wrinkle count, facial scores and percentiles. Additionally, there were significant reductions in Barton, TTRS and Fitzpatrick scores. One case of pseudo-eyelid bags was observed post-treatment, while no other complications such as diplopia, lower eyelid skin laxity or other adverse effects were reported.
Title: Retrospective Review of Skin Laxity Improvement After a Single Acoustic Subcision Treatment for Cellulite Appearance
Authors: Elizabeth Tanzi, et al
Published: Dermatologic surgery: official publication for American Society for Dermatologic Surgery, June 2025
Noninvasive acoustic subcision uses rapid acoustic pulse (RAP) treatment to disrupt subdermal and dermal fibrous tissue, thereby improving cellulite appearance. A prior multicentre study showed that one RAP treatment improved cellulite appearance 12 weeks after treatment. The aim of this study is to evaluate whether treatment with acoustic subcision improved skin laxity appearance in participants with skin laxity seeking treatment for cellulite appearance. This retrospective study used images collected from a prior study that evaluated adult participants ( n = 51) with severe cellulite on ≥1 thigh and/or buttock at baseline and 12 weeks after 1 RAP treatment. Outcomes included proportion of participants who achieved clinical improvement in skin laxity appearance via correct identification (≥60%) of blinded, randomised pretreatment and post-treatment photos; Global Aesthetic Improvement Scale (GAIS) responder rates ("improved" or "much improved") for skin laxity by ≥2 of three physician reviewers 12 weeks post-treatment. Among 51 participants, the mean age was 43 years. At least two of three physicians correctly identified 90.2% of photo sets (pretreatment vs week 12 post-treatment; 95% CI: 78.6%-96.7%). GAIS responder rate was 80.4% (95% CI: 66.9%-90.2%). RAP treatment targeting cellulite also improved the appearance of skin laxity.
Title: Ethnic Variations and Surgical Outcomes in Rhinoplasty: A Systematic Review
A comprehensive literature search was conducted across major databases, including PubMed, Embase and Scopus, covering publications from 2000 to 2023. Studies were included based on their focus on ethnic rhinoplasty outcomes, patient satisfaction or unique surgical techniques. The methodological quality was assessed using the MINORS scale for non-randomised studies. Of the 558 studies initially identified, 14 met the inclusion criteria. Analysis revealed that for Asian rhinoplasty, grafting techniques and minimally invasive approaches were commonly employed to achieve refined yet natural results. Hispanic rhinoplasty often addressed specific structural and aesthetic concerns, such as managing the nasolabial angle. Across studies, patients reported high satisfaction with outcomes, with lower complication rates associated with graft-supported techniques.
Understanding Regulatory Frameworks for Injectables
Professor Steve Davies and Dr Anish Kotecha explore what aesthetic practitioners need to know about the aesthetic products they are injecting
The rapid expansion of the aesthetics specialty in the UK has seen an influx of a variety of aesthetic products from non-UK/European Union (EU) sources.1 Yet, the provenance of all these products is not readily clear.
Estimates suggest that over 160 dermal filler brands are currently available in the UK market.1 Despite not claiming a medical purpose, these products are potentially injurious to the patient if they do not meet relevant regulatory standards. The growing number of injectable brands with a lack of regulatory requirements makes it challenging for the aesthetic practitioner to be confident regarding compliance and safety. The issue is highlighted by the recent report of more than 400 ‘non-compliant’ dermal fillers being seized in a raid by the Medicines and Healthcare products Regulatory Agency (MHRA).2 The onus is on the practitioner to ensure the products they use are licensed, approved and intended for use in the UK.2
In a Freedom of Information request, the MHRA reported approximately 200-400 adverse reactions annually to dermal fillers between 2019 and 2022,3 which in itself may be an underestimate due to under-reporting.4 It is alarming that there is no concrete information regarding the precise number of these products available in the UK market, nor formal tracking of these adverse events.
This article will provide an overview of the regulatory framework involved in certifying reputable injectable products for use in the UK. Adherence to the use of aesthetic products that comply with these regulations should improve patient safety.
Regulatory classification
In the UK, some dermal fillers, mesotherapy (e.g. skin boosters), threads and other injectable aesthetic products (e.g. polynucleotides) are classified as Class III medical devices under the UK Medical Device Regulations 2002 (SI 2002 No 618, as amended)5, which aligns with the EU Medical Devices Regulation (MDR) 2017/745.6 Dermal fillers, including those without a medical indication under recent regulation (Annex XVI products) are classified as Class III, the highest risk category, due to their invasive nature and the associated risks they pose (e.g. vascular occlusion and infection). Therefore, an aesthetic practitioner needs to be aware of the regulatory requirements with which dermal fillers should comply, and ensure that the injectable product they intend to use adheres to this checklist. However, where no medical claim which would necessitate an MDR classification is made, many of these products are subject to much lower levels of regulation and, therefore, safety – a point first made by Sir Bruce Keogh in his 2013 review of the cosmetic sector.7 The MDR specifically outlines the regulatory requirements and obligations that manufacturers and UK distributors should adhere to when introducing a new dermal filler to the UK market, and which aesthetic practitioners need to be aware of before using unfamiliar aesthetic products.8 The Medicines and Healthcare products Regulatory Agency (MHRA) has indicated that there are no current plans to reclassify dermal fillers to a lower risk category. The classification as Class III is consistent with international practices and reflects the invasive nature and potential risks associated with these products.9
CE marking and UKCA marking
Manufacturers must undergo a conformity assessment to demonstrate that their products meet the requirements that would precede them obtaining the Conformité Européene (CE) or UK Conformity Assessed (UKCA) mark. The process entails a clinical evaluation supporting the product’s safety and efficacy; risk management, identifying and mitigating any potential risks associated with the device; and implementing and maintaining a Quality Management System compliant with ISO 13485:2016 standards.10 This conformity assessment
is undertaken by an independent and designated ‘Notified Body’ or an ‘Approved Body’ in the UK.11
The MDR stipulates that once the manufacturer has achieved the requisite conformity assessment, they can then apply for a CE mark in the EU or UKCA in the UK. Together with the above, the manufacturer also presents the technical documentation for their device (aesthetic product), which includes device description, intended use and indications, design and manufacturing information and labelling. For a dermal filler to be marketed in the UK, it must bear the UKCA marking, demonstrating conformity with UK regulations or, subject to transition arrangements post Brexit, a CE mark.12 If the device is also intended for the EU market, it must bear the CE marking. Therefore, aesthetic practitioners in the UK should ensure that their aesthetic product has a UKCA or CE mark.
The role of the responsible person
As a class III medical device, aesthetic products such as dermal fillers also require the identification of a responsible person (RP) for that product.13 Manufacturers based outside the UK must appoint a UK-responsible person (often regulatory people from the pharma industry) who acts as the intermediary between the manufacturer and the MHRA.13 This person is responsible for ensuring regulatory compliance, in addition to keeping technical documentation and facilitating communication between the MHRA and the manufacturer, including reporting complaints or feedback from healthcare professionals, patients and users to the manufacturer. Again, the manufacturer needs to ensure the clear identification of a RP and that contact details are available to the aesthetic practitioner. The Public Access Registration Database (PARD) of the
Before using any medical device, make sure it meets these key safety and compliance checks:
Ask to see CE or UKCA certificates
Report adverse reactions 1. 2. 3. 4. 5. 6. 7.
Verify the IFU is in English and includes intended use
Check the manufacturer is listed on the MHRA’s PARD
Confirm presence of a Responsible Person (RP)
Look for a Unique Device Identifier (UDI).
Ensure post-market surveillance (PMS) is in place
MHRA provides a useful register of manufacturers, their devices types and RPs, although it may not give practitioners all the information they need.14 This can help the practitioner search for products or devices that they may wish to use and determine if they are compliant as detailed above.
The role of manufacturer and distributor
The MHRA distinguishes between manufacturers and distributors based on their roles in the supply chain and the regulatory requirements they must meet. Manufacturers create or assemble products, while distributors handle their distribution, storage and transportation. However, both parties must meet the MHRA regulatory oversight to the same degree ensuring they meet specific quality standards and safety requirements throughout the supply chain.15
Understanding post-market surveillance
Whilst many manufacturers achieve the above, the MDR has significantly strengthened its legal requirements that the manufacturer or UK distributor also establish and maintain a post-market surveillance (PMS) system to monitor the ongoing conformity, performance and safety of the dermal filler once on the market.16 This is a crucial public protection feature which allows the manufacturer and the MHRA to respond effectively to emerging concerns. These responses are typically in the form of Field Safety Notices or MHRA device safety information circulars which set out new information and the actions required.
To achieve this, a two-pronged approach is taken. When an adverse event has, (or may have), occurred, practitioners and members of the public can report it through the MHRA’s Yellow Card Scheme.17 This provides the MHRA with up-to-date data from which it can identify previously unknown risks, and work with the manufacturer to take corrective action where necessary. In parallel to this, the manufacturer has to be able to collect and review data from post-market clinical follow-up (PMCF) and then report these, together with adverse events to the MHRA. Furthermore, the manufacturer or distributor needs to be able to implement any preventive or corrective actions when required. Examples of typical corrective and preventative measures are outlined in Table 1
Corrective actions
Product recall (partial or full), safety alerts or field safety corrective actions (FSCAs)
Labelling changes to clarify warnings or instructions
Root cause analysis followed by design or manufacturing process changes
Updating training materials for healthcare professionals or users
Preventative actions
Trend analysis of complaints or adverse events to spot early signals
Design improvements based on feedback or emerging risks
Supplier audits or tighter quality control processes
Enhanced post-market testing or inspections
Pre-emptive updates to instructions for use (IFU)
Warning labels and additional user training or outreach sessions
Table 1: Examples of corrective and preventative actions in product safety management
Manufacturers must also produce Periodic Safety Update Reports (PSURs) and trend reports, summarising surveillance data and actions taken.18 The MHRA further stipulates that manufacturers and distributors have to report death or serious deterioration in health within 10 days of the event and events that could have led to death or serious deterioration within 30 days.19 Therefore, the aesthetic practitioner should ensure that the manufacturers of the products they use have appropriate PMS systems in place, and where adverse events arise with a product, that this is reported both directly to the manufacturer and to the MHRA.20
Instructions for use and unique device identification
The practitioner must check that the aesthetic product complies with the labelling and instructions for use (IFU) because, if this is omitted or is not in English, it would suggest the product is not compliant.20 The labelling and IFU must comply with regulatory standards, providing clear and comprehensive information to ensure the safe and effective use of the device. This includes a description of the device, its intended use, instructions for proper use, storage and handling, information on potential risks and side effects and, importantly, batch number and expiry date.
Recent evidence suggests that practitioners are not always familiar with the IFU’s contents, and in particular the intended use, leading to high-risk practice where a filler is unintentionally used off-label.18 This highlights the importance of the IFU as a regulatory and patient safety requirement, and the need for practitioners to undertake their due diligence in this respect. Furthermore, manufacturers are obliged to implement a unique device identification (UDI) system.21 This system works alongside new requirements for manufacturers, importers and distributors to enhance product identification, traceability and safety. These critical components are particularly targeted in field safety correction actions during post-market surveillance activities.
Preserving safety and legitimacy
There are now legions of injectable aesthetic products entering the UK market, yet the aesthetic practitioner community is not always entirely clear about their regulatory status, provenance and safety. Whilst the MDR may not apply to the entire spectrum of aesthetic injectable products, patient safety is ultimately the responsibility of the practitioner. Practitioners should, where possible, choose regulated medical devices over products not regulated by the MHRA, and they should undertake the due diligence required to confirm this.
In the absence of clarity in this sector, it falls upon us as healthcare professionals to apply appropriate standards. Whilst reputable manufacturers do ensure that they adhere to these quality standards and help by making it easier for the aesthetic community to check that their products comply, many do not. Thus, it becomes incumbent on the practitioner to ensure the appropriate safeguards are in place, and to report non-compliant products to the MHRA.
Professor Steve Davies is a consultant endocrinologist, aesthetic trainer and medical director at the You Can Clinic, Cardiff. He has more than 100 peer review publications and is the founder of Learna, which delivers postgraduate diploma and MSc courses in aesthetic medicine.
Qual: MD FRCP
Dr Anish Kotecha is a general practitioner, the head of medical education at Learna as well as the medical director and clinical safety officer at Device Link. He has experience in clinical governance, oversees healthcare technology compliance with regulatory standards and has several publications in medical aesthetics.
Qual: FRCGP FAcadMEd
Utilising Social Media to Enhance Patient Acquisition and Retention
Digital marketing specialist Nefise
Tasdelen examines the role of social media in enhancing patient engagement and retention
The way patients engage with aesthetic clinics has fundamentally changed. Since the COVID-19 pandemic, the initial interaction between patients and healthcare providers has increasingly shifted from the consultation room to online platforms. Recent statistics indicate that 68% of patients prefer healthcare providers who offer educational content online, and more than 50% of Gen Z and Millennial patients actively seek health information through social media platforms such as Instagram and TikTok.1
This article will guide aesthetic practitioners into embracing a humanised, educational approach to social media to cultivate trust, improve patient experiences and drive retention.
Redefining the patient journey
The rise of social media has redefined how aesthetic businesses attract, engage and retain patients. For clinic owners, these platforms have become powerful tools not just for visibility, but for building trust and showcasing expertise.
Traditional marketing funnels, which follow a linear path from awareness to conversion, no longer reflect how patients interact with providers. Today’s patients seek transparency, control and real-world insight when choosing a provider. They engage with multiple digital touchpoints, looking for authentic, educational and relatable content that helps them feel confident and informed. These formats offer a level of immediacy and emotional connection that traditional marketing – such as TV or radio commercials, billboards or print advertisements – simply can’t match.
A recent 2024 study of over 2,000 respondents found that 74% of consumers expect a consistent digital experience from brands, including healthcare providers. This includes intuitive website navigation and mobile responsiveness, meaning the site automatically adjusts for easy viewing across all devices, including smartphones and tablets.2 It also involves consistent, personalised interactions across all digital touchpoints and social platforms. Examples include tailored appointment reminders, targeted content based on patient interests and customised follow-up messages. These features facilitate easy access to services and information, supporting a smooth patient journey.2
Practitioners can enhance engagement by identifying common patient questions and concerns from consultations, then adapting complex medical information into clear, accessible formats such as infographics, short videos or Q&A posts. Using relatable language
that addresses both emotional motivations (e.g. confidence, reassurance) and clinical facts increases connection. Segmenting content by patient demographics (pre- vs. post-treatment, younger vs. older) also boosts relevance.
Different social media platforms appeal to different age groups, so tailoring content by platform is crucial. Instagram and TikTok attract Millennials (29–44) and Gen Z (13–28) with short, visual, authentic posts. TikTok, in particular, has become a leading platform for healthcare content due to its viral trends and personalised algorithm. Facebook is preferred by Gen X (45–60) and Boomers (61–79), suited for detailed updates and posts. YouTube reaches all age groups and is ideal for in-depth videos, such as clinical explanations and patient journey stories, which build credibility.
Relying on outdated marketing tactics focused solely on conversion, like generic email blasts or print ads without follow-up, misses the opportunity for long-term engagement and trust-building.
Strengthening patient trust through social media
In the context of private healthcare, where patients frequently bear the cost of treatment themselves, establishing trust is paramount. Patients in private healthcare often seek reassurance that their practitioner understands both their aesthetic goals and personal concerns, as treatments in this setting are typically elective, emotionally significant and financially invested. Establishing trust enables patients to feel secure throughout the treatment journey, fostering open communication and contributing to long-term satisfaction.
Clinics that consistently share genuine content, such as patient testimonials, behind-the-scenes footage and practitioner-led Q&As, experience stronger engagement and a 33% increase in patient retention.5 These authentic touchpoints humanise your brand, build emotional connection and establish credibility. Patients trust people, not logos, and when they see the personalities, values and professionalism behind a clinic, they’re more likely to book and return.
Platform-specific content strategies
Instagram and TikTok are ideal for visual storytelling as both platforms are built around highly visual, algorithm-driven content. Both platforms prioritise short-form, engaging videos, such as behind-the-scenes clips, quick tips or patient journeys, often delivered through short-form video formats such as Reels or TikTok videos, which align with user behaviour and platform algorithms. In contrast, LinkedIn is better suited for sharing professional insights, clinic milestones and thought leadership content.
YouTube allows for more in-depth educational content, including clinical explanations and full patient journey videos, which help establish credibility and build trust.
By tailoring content to each platform’s strengths, practitioners can engage a broader audience more effectively.
Q&A sessions
Real-time engagement can help patients feel seen and valued. You can use Instagram Live to answer common treatment questions, introduce new procedures or talk through skincare routines in an interactive format. During these live sessions, followers can ask questions directly, creating an authentic dialogue that builds trust and demystifies treatments.
Interactive tools such as polls, quizzes and 'Ask Me Anything' boxes are also effective in encouraging followers to share questions, opinions or feedback. These features promote two-way communication and demonstrate the clinic’s openness and commitment to patient involvement. Regularly hosting Q&A sessions not only educates patients but also strengthens the clinic’s online community, turning passive followers into engaged advocates.
Reviews and testimonials
Online reviews, patient testimonials and stories significantly impacts decision-making. A recent survey of 1,426 participants found that 84% are influenced by online reviews when selecting a healthcare provider.6
Clinics can leverage positive reviews by incorporating them into branded posts, story highlights or video testimonials to build trust and social proof. Showcasing these across social media platforms or as website banners offers prospective patients relatable experiences and reassurance before booking.
Encouraging patients to voluntarily share their treatment journeys adds authenticity and helps expand the clinic’s online reach. Videos or photos showcasing multi-step journeys, from consultation through to recovery, provide transparent and relatable insights into what patients can expect.
User-generated content (UGC) is especially valuable, allowing clinics to reshare photos, testimonials or video clips from real patients who tag your clinic or consent to be featured. This approach strengthens social proof, demonstrates real results and helps prospective patients feel more connected and confident.
Educational posts
Clinics that prioritise patient education often see measurable business benefits. In a survey of 1,034 healthcare consumers, 68% said they are more likely to return to a provider who offers educational content, while 94% expressed a desire for ongoing access to such materials.⁶
Effective formats include quick tips, myth-busting posts and 'Did you know' which highlight expertise while building trust. Clincs can create videos or carousels featuring practitioners explaining treatments, debunking myths or sharing recovery tips. This helps demystify procedures and provides ongoing value to both new and returning patients.
Managing your resources
Aesthetic clinics are notoriously busy, but practitioners don’t need to let time or resource constraints stop them from having a good digital presence. Clinics can strengthen digital engagement by tailoring their strategy to their available time, team structure and capacity.
Balancing content creation with a full-time clinical role can be challenging. To avoid burnout, it is essential to set realistic goals – such as posting once or twice per week, repurposing FAQs, focusing on one primary platform or sharing the workload.
For independent clinic owners, this may include delegating tasks like content capture, scheduling to administrative staff or
outsourcing to trusted freelancers while maintaining clinical oversight.
Independent practitioners
For clinics led by one provider, with minimal or no administrative support:
· Start a digital series: Launch a simple recurring content series like “Skin Tip Saturdays” or “FAQ Fridays” to reduce decision fatigue and build consistency with minimal planning.
· Focus on one platform: Choose one platform, (often Instagram) and focus your efforts there. Instagram Stories, Reels and Q&As can offer visibility without overwhelming output.
Small clinic teams
Clinics with basic admin or clinical support but limited marketing resources:
· Build a content library: Create a bank of reusable content (e.g. treatment visuals, post-care tips or seasonal reminders) to streamline the content process long-term.
· Empower staff to contribute: Encourage trusted team members to assist with content, whether appearing in 'day in the clinic' videos or leading post-care walkthroughs). This eases the content load.
Medium to large clinic teams
Multi-provider practices or clinics with dedicated marketing support:
· Develop a structured content calendar: Plan weekly content themes such as educational, testimonial and team features mapped across key platforms for consistency and coverage.
· Experiment with multi-format content: Explore diverse formats like Reels, YouTube Shorts and patient journey spotlights to engage different audience segments and meet varied objectives.
Reviewing social media behaviours
Staying current with digital trends and evolving social media behaviours allows practitioners to maintain momentum and remain visible in a fast-moving market. One simple way to adapt is by regularly reviewing trending audio, hashtags and treatment topics to keep content fresh and relevant. By integrating social media analytics such as engagement rates, comment sentiment and keyword trends, clinics can better understand patient concerns.7 For example, if Instagram comments frequently ask about downtime after a procedure, that signals an opportunity to create focused posts explaining recovery expectations. For a deeper dive, tools like Meta Insights, Sprout Social or Hootsuite can help track this data and translate it into an actionable content
strategy.8 This not only improves the patient experience but also strengthens brand positioning. However, under the General Data Protection Regulation (GDPR), any use of personal data from social media must be done transparently and with consent, ensuring that privacy is protected throughout the process.9
Adhering to guidelines
While social media offers valuable opportunities for visibility and engagement, it also carries regulatory responsibilities. Practitioners must comply with the Advertising Standards Authority (ASA) guidelines to uphold patient trust and maintain professional standards.10 This includes clearly labelling all sponsored or gifted content (e.g. using terms like 'gifted' or 'advert'), avoiding exaggerated or misleading claims about treatments (such as promises of permanent results or dramatic transformations) and steering clear of promoting unrealistic body ideals or heavily edited imagery. All content should reflect achievable, medically accurate outcomes and include appropriate disclaimers where necessary. Clinics must not oversimplify treatments or use absolute terms like 'painless' or 'no downtime' as that could mislead patients about potential risks. Full written consent is also essential for any patient images, videos or testimonials shared online to meet both ethical and legal obligations.10
Collaborations with micro-influencers can be a valuable tool to increase awareness and engagement. Practitioners should ensure that all influencer content is accurate, avoids exaggerated claims and includes the proper disclosures and disclaimers as required.11
Building a digital strategy
In a rapidly evolving digital world, aesthetic clinics should view social media not just as a marketing platform, but as a vital part of the patient experience. By focusing on authenticity, education and engagement, clinics can build trust before a patient even walks through the door.
Nefise Tasdelen is the founder of Social Island UK. With expertise in digital marketing and UGC, she helps aesthetic clinics elevate their online presence, build patient trust and drive retention through authentic, strategy-driven content and innovative digital engagement.
Qual: BA Hons
Navigating Fear in Business
Nurse practitioner Hollie Evans shares how she overcame feelings of fear when opening her aesthetic business
In business, we don’t talk openly enough about the complex emotions that come with starting something new –uncertainty, doubt and the weight of responsibility. Whether it is stepping away from a secure full-time job or building a brand and culture from scratch, these challenges are real and demand resilience. Sometimes, this pressure can lead to self-doubt and even fear of diving into being a business owner.
I believe most of us, no matter how long we’ve been in business, have felt these worries at some point. It’s part of the journey, but there are ways to overcome them. This article will share some of the insights and lessons I have learned about managing fear and embracing vulnerability in business.
Embracing fear as part of the journey
Fear is a natural part of starting and running a business. It shows you are stepping outside your comfort zone to build something meaningful. I remember worrying, “Will anyone book in? Will this actually work?” Those fears didn’t disappear overnight, but I’ve learned to see them as opportunities for growth.
That said, not all fear should be ignored. Some fear signals growth, while other fear is your intuition saying, “Pause.” I’ve come to recognise the difference: fear feels anxious and overwhelming, while intuition feels calm and grounded – even when it says “not yet.”
Before opening my clinic, I spent years shaping my vision – researching treatments, studying demographics and creating a business plan rooted in integrity and clinical care. That clarity grounded me when doubts crept in. I encourage anyone in the planning phase to define their version of success.
Ask yourself: What kind of space do I want to create? Who is my ideal patient? What values matter to me? Then set measurable goals to stay on track.
The night before my clinic launch, I asked my husband, “What if no one comes?” I had no existing patient base, and I was terrified. But people showed up. The phone rang. I treated my first patient the next day. That experience taught me that fear doesn’t always tell the truth.
Behind that moment were months of groundwork – building a website, promoting locally on social media and connecting with nearby businesses. These small steps built early momentum and a sense of community.
Today, when fear arises, I no longer ignore it or try to power through. I try to understand its source. Is it triggered by comparison? A lack of direction? Or is it a sign I need to slow down and re-align with my goals? Once I understand what’s behind it, I can respond intentionally – whether that means adjusting a strategy, asking for advice or simply taking a step back to breathe and reset.
Finding clarity in business growth
Managing finances, creating brand awareness and navigating comparison to others in the field can weigh heavily on business owners, especially in a field like aesthetics. Social media, while a brilliant tool for connection and marketing, can also trigger self-doubt. We scroll through highlight reels of flawless clinics, packed diaries and perfectly curated branding, and it’s easy to fall into the trap of wondering if we’re doing enough.
Over time, I’ve realised how important it is to protect my mindset when it comes to social media. I refrain from spending too much time online, and I’m very intentional in only following business owners, clinics and practitioners who I find inspiring – those who uplift me rather than trigger comparison. I also avoid searching for other local clinics near me. This isn’t about ignoring what’s around me, but about staying focused on my own business.
The internet offers an overwhelming number of options and influences, but what makes you and your brand unique is exactly what attracts the right patients. If someone doesn’t connect with what you offer, that’s okay – it doesn’t mean you need to change. Accepting this is crucial for maintaining a positive mindset and building a business that truly reflects who you are.
The power of emotional intelligence
Developing emotional intelligence has been a pivotal moment for me as a business owner. Self-awareness and the ability to regulate my emotions have helped me navigate the highs and lows of entrepreneurship. It’s allowed me to better understand what triggers fear, and how to move through challenges in a more grounded and intentional way.
Saying yes to everything for fear of missing out, especially when you’re also running your own business, can lead to burnout. You end up stretched too thin, your energy pulled in too many directions and your focus diluted. Opportunities that once felt exciting can begin to feel like burdens. This mental load can leave you feeling exhausted and disconnected from the passion that drove you to start your business in the first place.
Mentorship helped me learn a range of communication techniques, how to lead with confidence and how to approach difficult conversations constructively
There have been days where I’ve needed to completely step back – where I’ve let my assistant manager know I needed a full day to myself, switched off my phone, taken my dog for a walk and allowed myself the space to process what I was feeling.
Those days are powerful. They allow me to reset, feel grounded and return to work with clarity. As business owners, we juggle so much, and it’s easy to overlook the one thing everything else depends on – our wellbeing.
I’ve learned that my best decisions come when I’m emotionally balanced and well-rested. When I honour my energy and stay aligned with what truly matters to me, I show up better for my business, my patients, my team and myself.
Building a supportive network
One of the most valuable lessons is the importance of surrounding myself with a supportive network. My family, coach and peers in the field have been instrumental in helping me navigate my fears and uncertainties, and in realising that I’m not alone. In fact, many of the business owners I admire have faced similar challenges.
At one point, I was really struggling with the team dynamic within my practice. I found it challenging to manage certain behaviours and wasn’t sure how to handle the conversations that needed to happen. Around that time, I attended the Clinical Cosmetic Regenerative Congress (CCR) and listened to a talk from a business mentor that really resonated with me. I spoke to her after the session, and ended up setting up a series of one-to-one sessions focused on leadership development. That mentorship journey was a turning point for me. I learned a range of communication techniques, how to lead with confidence and, most importantly, how to approach difficult conversations constructively. I had complete trust in my mentor – she understood my values and the pressures of the specialty, which allowed me to be completely open, both professionally and personally. To this day, I continue to use the tools she taught me in my business. These include preparing thoughtfully for difficult conversations, reflecting on different leadership styles with my team and becoming more emotionally aware – recognising when I need to take time to myself to pause and process. I now make space at the end of each day to reflect, even if it’s just for five minutes. It helps me understand what worked, what didn’t and what my next steps should be. I also talk openly to my loved ones about what I’m navigating. That support, combined with the self-awareness I’ve built through mentoring, has helped me manage challenges more constructively.
I have also found huge value in being part of professional forums and WhatsApp groups with other practitioners who offer
similar treatments. These communities are places where I can ask clinical questions, share advice or simply talk through day-to-day challenges. Becoming a member of the British Association of Medical Aesthetic Nurses (BAMAN) and Aesthetic Complications Expert (ACE) Group World has also helped enormously through their guidance on navigating complex or high-pressure situations.
Embracing fear and vulnerability as strength
One of the most transformative shifts I have made is reframing fear as a motivator. For a long time, I believed that showing vulnerability would make me appear less competent. But I’ve come to see it as a strength. Being honest about my fears and doubts has deepened my relationships with my team, patients and peers. That said, it’s important to maintain boundaries – especially with patients. I always ensure that my vulnerability never overshadows professionalism. If I share something personal, I only do so when it’s relevant, such as explaining how I started the clinic or the challenges I overcame to get here. These stories can create connection, but they’re always shared with care and never in a way that would compromise the trust my patients place in me. It is also important to bear this in mind when speaking within the team, as boundaries are key to maintaining professionalisms.
Practical strategies for overcoming business challenges
• Fear of financial struggle: Fear around money is common, especially in the early stages. Create a clear, realistic budget and review your finances regularly to reduce uncertainty. Seeking advice from financial professionals or using bookkeeping tools can bring clarity and control, helping ease anxiety around financial decisions.
• Fear of not standing out: When you’re unsure how to position your business, go back to your values. Building a brand rooted in authenticity helps cut through the noise and attract the right patients. The more aligned you are with your mission, the less room fear has to grow.
• Fear of leading others: Managing a team can be daunting. Foster open communication and prioritise emotional safety within your team. When your people feel supported, you’re less likely to fear conflict or leadership challenges, and more likely to grow in confidence as a leader.
• Fear of not being good enough: Self-doubt creeps in when we forget our progress. Keep a record of wins, positive feedback or thank-you notes from patients. Revisiting these reminders during moments of fear or imposter syndrome can restore perspective and belief in your ability.
• Fear-based decision-making: Fear can cloud judgment and lead to reactive choices. When pressure builds, pause. Give yourself space to reflect, speak with someone you trust and avoid making decisions from a place of panic or urgency.
• Fear triggered by comparison: Scrolling through curated snapshots of others’ success can feed insecurity. Limit your time on social media and be intentional about who you follow. Curate your feed to inspire, not intimidate – your mindset is a powerful asset in managing fear.
• Fear of putting yourself out there: Confidence comes with aligned action. Say yes to opportunities that feel right, but don’t be afraid to say no to things that pull you off course. Every time you honour your vision over external pressure, you strengthen your trust in yourself.
• Fear of doing it alone: You don’t have to. Seek out mentors, business coaches or professional groups who understand your challenges. Talking through fears with those who’ve been there can be one of the most grounding, reassuring things you do.
The beauty of the journey
Starting and running a business has been one of the most challenging and rewarding experiences of my career. It has pushed me to grow in ways I never imagined, and has taught me so much about resilience, adaptability and connection. Fear will always be part of the journey, but I’ve come to see it as a reminder that I’m moving forward and stepping into something meaningful.
Hollie Evans is a registered nurse with a specialist background in dermatology, surgical nursing and medical aesthetics. She is the founder of clinic Balance
Wellness in Cornwall, where she blends clinical expertise with holistic care. Evans is a 2025 Rising Star of the Year Finalist and two-time Best Clinic South England Finalist at The Aesthetics Awards. Qual: BSc, NMC
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“Great practitioners are defined by their mastery and confident pursuit of their craft”
Nurse prescriber Michelle McLean on merging aesthetic practice with facial palsy work
Michelle McLean is a Liverpool-based aesthetic nurse prescriber committed to outstanding clinical results.
Born and raised in the suburbs of South Liverpool, McLean developed a strong sense of responsibility she felt from an early age. She recalls, “I’m the eldest of four, so naturally, I took on the role of looking after my younger siblings. I was always checking in on people and making sure everyone around me was okay.” McLean shares that it was her early exposure to caregiving –stemming from her aunts nursing career and her grandfather’s words of encouragement, that played a pivotal role in guiding her path into healthcare.
McLean began her Diploma of Higher Education in Nursing at Liverpool John Moores University in 1998. By 2001, McLean had qualified as a nurse at 21 years old, launching her career in the Liverpool Cardiothoracic Centre as a surgical staff nurse, where she spent 12 months. McLean became the youngest community matron in the UK at the age of 26.
Following her graduation, McLean’s academic journey progressed through a series of advanced qualifications. In 2006, she completed a Bachelor of Science degree in Nursing at Liverpool John Moores University, alongside several Level 7 modules. She went on to earn a Master’s in science in Advanced Healthcare Practice from the same institution in 2011.
McLean expressed her transition into aesthetics as a practical necessity. She says, “I was a full-time community matron and I had three young children. Nearly all my wages were gone as soon as they came in.” Seeking additional income, McLean completed her aesthetics training with training provider Cosmetic Courses in May 2011, and began offering aesthetic treatments during evenings and weekends. She recalls, “I remember walking around beauty salons across Liverpool, asking to leave posters in the windows and trying to book in satellite clinic days. Anything to get my name out there!” In 2011, McLean officially began practising aesthetics and in 2015, decided she would make the leap and open her first clinic. “It was definitely scary at the time, but it was also the most empowering decision I’ve made,” she shares.
Renowned for her work on facial palsy cases, McLean shared her personal experience, revealing that six weeks before her wedding, she woke up with facial paralysis and was subsequently diagnosed with Bell’s palsy. She says, “You never really consider the impact something like that can have until you experience it yourself. It changed my perspective and made me appreciate how much our physical appearance can impact how we show up in the world.”
Discussing her passion for treating facial palsy patients, McLean explained how she felt she could make a difference for these cases. She notes, “Many of the patients I treat who are affected by facial paralysis have told me that they don’t feel accepted by society, and I can fully relate to that.” She expressed it provided her a “deep empathy for what people experience long-term.”
At the start of her career, McLean focused on antiageing treatments like toxin and dermal fillers to address fine lines, wrinkles and volume loss – an area that remains a central part of her practice today. Gradually, her focus shifted towards regenerative techniques. “Recent advancements in aesthetic technology and a deeper understanding of regenerative medicine have greatly influenced the treatments I now provide,” she explains.
In Profile Michelle
McLean
Outside the clinic, McLean serves as a key opinion leader (KOL) for pharmaceutical company Galderma and device company BTL Aesthetics. Her role centres on education, training and advocacy, sharing knowledge and live demonstrations through masterclasses and workshops. “Working in aesthetics can sometimes be isolating. Being recognised as a KOL helps bridge that gap as you’re working with various individuals regularly,” she notes.
Her role with both companies has also supported her facial palsy pro bono efforts. “The support I’ve received from both Galderma and BTL Aesthetics has been instrumental in helping me provide treatments to individuals who may otherwise struggle to access care due to financial constraints,” she says. Advising new practitioners into the field, McLean recommends, “Take the long route. If something seems like a shortcut or a fast track, it’s often that way for a reason. Great practitioners aren’t defined by doing everything, they’re defined by doing what they do extremely well, with confidence.” She added that within her career, she realised that growth comes from reflection. “Progress comes from being open to learning, staying humble and constantly striving to do better for yourself and for your patients,” she notes.
A recent milestone came when McLean won The Crown Aesthetics Award for Best Non-Surgical Result at The Aesthetics Awards 2025. “It was a significant moment for me, both professionally and personally,” she said. Emphasising how meaningful this Award was, she adds, “It’s not just recognition of a great result, it’s recognition of a patient group that is often overlooked. This award really allowed me to appreciate the impact of the work I’ve been doing.”
Do you have a mantra you stick to?
Educate with purpose.
If you could choose a career outside the medical field, what would it be?
I’d become a yoga or pilates instructor – I’ve come to deeply value wellness and balance! What is your favourite holiday destination? It would have to be Croatia!
Incorporating Sterile Clinical Tools in Aesthetic Practice
Mr Apostolos Vlachogiorgos argues why all practitioners should use single-use sterile markers in their practice
We’re all aware that every aesthetic procedure carries a risk of complications. In recent years, concerns have arisen that inadequate regulation, coupled with the growing accessibility of dermal fillers and increased patient exposure, has contributed to a rise in complication rates.1
In 2024, members of the British College of Aesthetic Medicine (BCAM) reported experiencing 1,913 complications from their own procedures over the previous 12 months. In addition, they treated 3,547 complications caused by procedures performed by other practitioners.2 In reality, it is widely believed that underreporting means the actual number of complications is significantly higher.1,3
Yet, despite the ever-increasing number of reported issues, many practitioners continue to overlook a simple but critical element of infection control – the sterility of clinical tools.
Understanding risks of infection
Research further indicates that inadequate infection control is giving rise to the development of injectable complications, with the Aesthetics Complications Expert (ACE) Group World highlighting that there is ‘a substantial body of evidence to support that most complications of an infectious nature begin at the time of injecting due to inadequate infection control’.3
ACE Group explains that the most common infections arise when ‘skin contaminants infiltrate the site of injection at the time of injection’.3 As one would expect, sources of infection can be the patient, staff or the environment. In fact, it is reported that multiple pathogens can be found on inanimate objects, and can survive up to four years.3 It is unsurprising, then, that advice to minimise the risk of infection centres around thorough disinfection and aseptic techniques.2,3
I believe many clinics fail to implement the most stringent precautions. If we are serious about safety, we must stop cutting corners.
Following best practice infection control
As trained medical professionals, there is no excuse for neglecting basic infection control. Specialty guidance is clear – aseptic technique is non-negotiable.
The most widely referenced advice includes:1,3,4
· Use of PPE
· Bare below the elbows
· Short and clean fingernails
· Thorough hand washing
· Patient and practitioner hair tied back
· Makeup removal prior to treatment
· Clean-on uniform/scrubs
· Hypochlorous skin disinfection
Furthermore, guidance recommends ensuring that only uncontaminated equipment and products come into contact with susceptible treatment areas, and the number of devices used for an aesthetic procedure is kept to a minimum.2,3 For those high-touch items that have to be used, it is advised that particular attention should be paid when cleaning them.2 Take a moment to consider the equipment that touches a patient’s skin during an injectable procedure:
· Gloves
· Gauze swabs
· Skin markers
· Cleansing solution
· Numbing cream
· Needles/cannulas/syringes
Among these, skin markers are the only tools we use that are not traditionally sterile and are being used multiple times on many different patients.
Sterile single-use markers
While non-sterile gloves and gauzes can be used, it is easy to get hold of sterile versions. Numbing cream such as Emla is sterile until opened,5 while all needles and cannulas are also designed to be sterile upon opening.6,7 Additionally, there is plenty of guidance on choosing effective cleansing solutions that are appropriate for skin asepsis.1,3
In terms of skin markers, it is common knowledge that we have tended to rely on makeup pencils, whiteboard markers and generic alternatives. These tools were not designed with sterility in mind. That is why I’ve moved to using a sterile marker, and would urge others to do so.
Sterile markers are specifically designed to support aseptic procedures. The one I use (FMD1 Skrybe marker) uses non-toxic ink, offers fine-tip precision, and, most importantly, comes pre-sterilised and individually packaged. This significantly reduces the risk of cross-contamination and eliminates the need for time-consuming sharpening and disinfection before and after each treatment. We are in a specialty where every second matters, and any efficiency gain is a bonus. But even more crucially, we must eliminate every avoidable infection risk. Using sterile markers is a simple, effective and logical step forward in infection prevention.
Some argue that single-use tools increase waste and cost but, in my opinion, the added protection they offer makes them the more responsible and cost-effective choice.
Building confidence in safety protocols
As the demand for aesthetic procedures continues to rise, so too does the need for rigorous infection control measures. It is crucial that practitioners adhere to best practices, including the use of sterile tools and strict hygiene protocols.
Since adopting sterile skin markers in my clinic, it has become a no-brainer to me that other practitioners should do the same. In my opinion, anything we can do to improve infection prevention should be welcomed by everyone. By integrating high standards that involve using sterile tools and following established guidelines from organisations like ACE Group World and CMAC, we can enhance patient safety and reduce the risk of complications.3,4
Ultimately, prioritising infection control safeguards both practitioners and patients, ensuring the continued success and credibility of the aesthetics specialty.
Mr Apostolos Vlachogiorgos is a consultant plastic surgeon based at UKSKIN’s Harley Street clinic in London. Mr Vlachogiorgos has lived and worked in the UK since 2012, joining the GMC’s specialist register for plastic surgery in 2020. He has a Master’s in Reconstructive Microsurgery with Distinction.
Qual: MD MRCS, MSc
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