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1) Instructions for use 2) Sulovsky M, Müller D, Prinz V, Moellhoff N, Cajkovsky M, Duschek N, Frank K. A prospective
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 • August 2025
08 News
The latest product and specialty news
17 News Special: UKHSA Issues National Warning for Botulism Cases
Aesthetics examines the recent UKHSA public warning about rising botulism cases linked to counterfeit botulinum toxin
CLINICAL PRACTICE
20 Unlock the Future of Women’s Health
Attend the Medical Longevity Summit at CCR 2025
23 Special Feature: Treating Lower Face Laxity
Three leading practitioners share their approaches to restoring volume, supporting collagen production and rebuilding confidence
26 CPD: Microdosing Botulinum Toxin for Skin Rejuvenation
Three practitioners analyse current literature on rejuvenating the skin using BoNT-A
33 Mastering Advanced Lip Injections
Dr Carol Mastropierro covers the key principles of advanced lip enhancement
38 Clinical Insights to the Lip Flip
Dr Harry James explores the anatomical principles to lip flip procedures
41 Treating the Jowls with Threads
Dr Charlotte Woodward shares her technique to lift the jowls using threads
44 Managing Skin Through Menopause
Dr Ginni Mansberg addresses the dermatological challenges of menopausal skin
46 Innovations Shaping the Future of Aesthetics
Discover the products that took the specialty by storm this year
48 Facial Rejuvenation STYLAGE® Dermal Fillers
Dr Mei-Ying Yeoh provides a case study using HA fillers to treat the effects of weight loss
49 Abstracts
A round-up and summary of useful clinical papers
IN PRACTICE
50 Unlocking Clinic Growth with Varied Demographics
Vanessa Bird explores untapped demographics and clinical growth
52 Establishing Informed Consent in Aesthetic Procedures
Will Marshall provides understanding of how consent is handled
54 Emotional Aftercare in Aesthetics
Julie Scott explores the emotional landscape of regret in aesthetic practitioners
57 In The Life Of: Ms Priyanka Chadha
Ms Priyanka Chadha shares how she balances operating theatre work and parenting duties
58 The Last Word: Debating the Use of Before & Afters
Emmanuel Toni argues it’s time to move on from comparative B&A images
News Special: UKHSA Issues Warning Over Botulism Cases
Page 17
Special Feature: Managing Lower Face Laxity After Rapid Weight Loss
Page 23
Clinical Contributors
Miss Jennifer Doyle is a consultant oculoplastic surgeon and founder of The Clinic at Holland Park. She also works within the NHS as oculoplastic consultant at Milton Keynes University Hospital NHS Trust. She has several years of experience in aesthetic and non-surgical treatments.
Dr Aaminah Haq is an ophthalmology registrar and aesthetic doctor The Clinic at Holland Park, where she provides aesthetic injectables, laser and ultrasound treatments. She uses a variety of pain relief techniques for her patients, both in eye surgery and aesthetic treatments.
Dr Arshi Baig is a resident doctor due to complete her foundation training within the NHS in the Oxford deanery. She is due to commence her fellowship in the field at The Clinic at Holland Park.
Dr Carol Mastropierro is an aesthetic practitioner and the founder of WRINKLESS in Hertfordshire. She specialises in anatomy-led injectables and advanced lip techniques, with a focus on safe, evidence-based practice.
Dr Harry James graduated from Glasgow Medical School in 2016 and has a level 7 diploma in clinical aesthetic injectable therapies. He is an NHS specialty doctor, aesthetic practitioner, ACE Group World faculty member and committee member for the JCCP.
Dr Charlotte Woodward has more than 32 years of clinical experience. Beginning her career working as a GP in 1996, she ventured into the world of aesthetics over 20 years ago and now works exclusively in the aesthetics sector.
Dr Ginni Mansberg is a Sydney-based GP with a special interest in women’s health, dermatology and hormones. She is the founder of ESK Skincare and author of The M Word- How to thrive in Menopause
Shannon Kilgariff Editor & Event Director @shannonkilgariff
As we head towards the end of summer, all eyes are on lips and the lower face – a core area for most aesthetic practices and a focus of this month’s journal. Whether you’re exploring new treatment techniques or refining your artistry, we’re bringing you expert insights, current trends and emerging challenges to consider.
This month’s Special Feature explores the increasingly popular topic of lower face laxity following weight loss – a condition many patients are presenting with, especially as lifestyle interventions and weight-loss treatments become more widespread. It’s also a focus for Galderma, our Headline Sponsor at the Clinical Cosmetic Regenerative Congress (CCR), whose KOLs will delve deeper into this issue at the congress this September 25-26 – don’t miss their take on how to approach this concern.
Inside, we’re covering a wide range of lower face topics, including lip flips, the posterior compartment of the lips and thread techniques for definition and support. We hope you can take away some key
Clinical Advisory Board
learnings to improve your clinical practice.
In the News Special, we address the current media storm around botulinum toxin. The UK Health Security Agency (UKHSA) has issued a warning after 38 confirmed cases of iatrogenic botulism linked to cosmetic procedures were reported between June 4 and July 14 this year. These incidents have occurred primarily across the East of England and East Midlands, prompting widespread concern and a reminder of the importance of sourcing authentic products, verifying prescribers and following safe clinical protocols. We can only hope that the UK Government finally releases its response to its consultation on the licensing of non-surgical cosmetic procedures in England soon. With CCR happening at the end of September, our preview dives into what to expect from the Medical Longevity Summit (MLS), one of the most exciting features of the event. If you haven’t already registered, this is your last chance to secure your place for two days of learning, networking and innovation.
I look forward to seeing many of you in person next month at CCR 2025 – it’s going to be our most exciting congress yet.
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.
If you are interested in contributing to the journal, get in touch...
Email: editorial@aestheticsjournal.com
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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The Merz Aesthetics Benelux COE training experience, where knowledge met community and technique met transformation.
#InModeElevate
Anna Dobbie
@goldyloxxroxx
Fully embracing my InMode era! A fantastic day and evening at InMode’s Elevate event, full of education, connection and celebration!
#Podcast
Vanessa Lana Brown @missvlbrown
On this week’s Late Late Aesthetics Show, I’m joined by the amazing Dr Manav Bawa to dive into conversation about body dysmorphia and BBLs!
#Launch
Dr Victoria Manning @drvix.manning
A few highlights from the launch of L-Nutra. What a great evening, connecting with leaders driving innovation in metabolic health!
#Connection
Dr Priyanka Chadha @drpriya.plastics
A snapshot from meeting and speaking alongside my wonderful colleagues in Australia at GAIN!
National
Insurance
Rising NICs threaten general practice
GPs are facing financial repercussions following an increase in employer national insurance contributions (NICs).
In April 2025, the UK Labour Government increased employer NICs from 13.8% to 15% to strengthen public finances. The British Medical Association (BMA) warned in May that this would cost GP surgeries over £180 million annually, prompting concerns over staffing, investment and viability. By June, many GP partners reported mounting financial strain amid stagnant NHS funding and inflation, leading to low morale and declining interest in practice ownership. According to digital publication GP Online, some practices considered replacing salaried GPs with locums to avoid NIC costs, risking continuity of care.
The BMA also released statistics in June, showing that GP numbers in England are declining, with full-time equivalent (FTE) GPs dropping despite rising patient demand. According to the report, the number of GPs working full-time in practice-based settings has steadily declined since 2017, while part-time working has increased. This shift reflects a growing preference for more manageable workloads, aimed at reducing stress, ill health and burnout, alongside improving work-life balance, according to the organisation. In July, the British Chambers of Commerce reported that 73% of firms cited rising labour costs as their top concern, underscoring widespread economic impact.
Dr Alison Colville, GP and aesthetic practitioner, commented, “The increased financial burden adds strain to an already stretched NHS system. The loss of talent on the NHS undoubtedly places further pressure on already overstretched services. Within the aesthetics specialty there’s a notable rise in competition, as more healthcare professionals enter the field. That’s not inherently negative, as competition can drive standards, but it also raises concerns about saturation and the risk of underqualified individuals entering the space too quickly.”
Regulatory Enforcement
CTSI issues
injectables warning
The Chartered Trading Standards Institute (CTSI) has called for tighter specialty regulation following reports of botulinum toxin and dermal filler being administered in public.
The CTSI states that procedures are being carried out in public restrooms, hotel rooms and high street pop-up shops. The organisation has called for urgent government action to address the growing issue of unregulated and unlicensed practitioner treatments, and the unsafe venues where these procedures are taking place. Trading standard officials also expressed concern about the online sale of unsafe and unregulated dermal fillers, some priced at £20.
The CTSI advised the public to verify the credentials of individuals offering cosmetic procedures, exercise caution with practitioners advertising on social media and refrain from purchasing cosmetic products for at-home use.
Kerry Nicol, external affairs manager at the CTSI, commented, “A logical and immediate first step is the introduction of a national licensing scheme, giving the public a clear indication of who is qualified to carry out these procedures. It’s time the UK takes public safety seriously and weeds out those putting lives at risk.”
Agenda Reveal
Agenda announced for CCR 2025
The UK’s largest medical aesthetics conference, the Clinical Cosmetic Regenerative Congress (CCR), has announced its agenda for 2025.
Hosted at Excel, London on September 25-26, this year’s programme will feature a comprehensive mix of evidence-based education, live treatment demonstrations and business development sessions across its key stages.
Headline Sponsor Galderma returns to the Aesthetics Journal Arena, showcasing cutting-edge science and innovation. Other highlights include a Full-Face Masterclass with live demonstration, a Deep Dive into Psychodermatology in partnership with the British Skin Foundation and the latest clinical insights from the Royal Society of Medicine, among others.
The Innovation Forum returns with a series of 30-minute workshops and live demonstrations. These sessions will showcase the latest products, protocols and techniques from the specialty’s most innovative skincare and device suppliers. The Forum is sponsored by SkinCeuticals and will feature sessions from the following sponsors: Acclaro Corportation, Cutera, BTL Aesthetics, Cure Medical, Hydrafacial, InMode, Korea Meditech, Novus Medical, Sciton, SkinCeuticals, Sofwave and ZO Skin Health.
The Aesthetics Mastery Theatre will present one-hour live treatment demonstrations from leading pharmaceutical and device companies. Across both days, top KOLs will share advanced techniques to help practitioners refine their skills and deliver safe, high-quality outcomes. Sponsors include Beautyform, BNC Global, Dermapenworld, Fotona, Genefill, Klira, Needle Concept and Promoitalia, with DermaFocus sponsoring the Lunchtime Takeover.
As part of the programme, The Aesthetics Challenge hosted on Day 2, will present a dynamic two-hour session focused on the subtleties of dermal filler application. Designed for both experienced injectors and those looking to refine their technique, the session will explore a range of injection styles, how product choice affects outcomes and strategies for achieving remarkable results. Attendees will also benefit from expert critique and guidance throughout the live demonstrations.
The In Practice Theatre, sponsored by Dermis AI, will provide practical business development insights, with sessions on social media strategy, patient relations, marketing, finance and more. Associate Sponsors are Cosmetic Consultant and Phorest.
The Women in Business Panel, sponsored by InMode, returns to the In Practice Theatre to spotlight the perspectives of female leaders across the sector.
The Medical Longevity Summit will explore evidence-based holistic care and wellness for women’s health, offering new ideas for expanding clinic services. With its own dedicated theatre and exhibition, the Summit will highlight functional, integrative, regenerative and lifestyle-focused treatments. Roseway Labs is Associate Sponsor, with educational sponsors including: Halo IV, Human Health Professionals, L-Nutra, Minerva Research Labs, Nuchido, Totally Derma and Yotsuba Japan. Turn to p.23 to register now.
Vital Statistics
The US has been labelled the most expensive country for medical procedures, averaging £31,272 per procedure (William Russell, 2025)
Out of 1,500 participants, 61% of respondents cited “improving confidence” as their main motivation for undergoing aesthetic treatments (Cynosure Lutronic, 2025)
58% of professionals state that they regularly suffer with high stress levels (Robert Walters, 2025)
Research indicates that using a tanning bed before the age of 35 increases malignant melanoma risk by 59% (Cancer Research, 2025)
A recent report revealed that out of 700 participants, 23% of men aged 18-34 have had either botulinum toxin, dermal filler or dental veneers (Teoxane, 2025)
Only 55% of the UK are aware that UVA rays are the leading cause of premature skin ageing, with only 20% strongly agreeing (Face the Future, 2025)
Events diary
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
This Morning shares poll findings on specialty regulation
In an ITV investigation, a poll revealed one in three women would risk unqualified practitioners to save money, and one in four failed to verify qualifications. Appearing on This Morning to discuss regulation, television presenter Ashley James and actress Sarah Jayne Dunn recalled their personal experiences. Dunn discussed being left bruised after salon-administered lip filler, while James suffered jaw paralysis after toxin. James explained, “You sort of assume that if someone is doing injectables, that they have been trained to a level that is of UK standard and obviously the issue is, what is the UK standard?”
Plastic surgeons feature in new Netflix series
Netflix debuted Critical: Between Life and Death on July 23, a six part documentary offering access to London’s Major Trauma Network. The series uses embedded cameras to film real-life interventions in London’s major trauma units. Filmed over 21 days with 40 embedded cameras across four major trauma centres, including King’s College, Royal London, St George’s and St Mary’s, viewers witness emergency 999 calls, high pressure surgeries and patient rehabilitation. Featured clinicians include plastic surgeons Ms Priyanka Chadha, Mr Edmund O’Connor and Mr Vincenzo Ottaviano, who appear in the operating theatre, performing live emergency surgery for the show.
New proposals announced for cosmetic regulation in Scotland
The Scottish Government has published its response to the recent consultation on the regulation and licensing of non-surgical cosmetic procedures. It has confirmed revised proposals ahead of legislation expected later this year.
The consultation, launched in December 2024, sought views on how best to regulate non-surgical procedures, including those involving botulinum toxin and dermal fillers, particularly when delivered by non-healthcare professionals or outside NHS contracts.
A total of 2,207 responses were received, 94% from individuals and 6% from organisations. Most respondents (55%) had no formal ties to aesthetics. Among those who did, 24% worked in regulated settings, such as healthcare professionals or those practising in settings regulated by Healthcare Improvement Scotland (HIS), and 17% in unregulated, such as beauty salons or freelance aesthetic practices. The feedback informed refinements to the Government’s original proposals.
Respondents broadly supported improving safety and regulation in the non-surgical cosmetic sector, though views differed on how to achieve this. Most agreed certain procedures should be performed in licensed settings and that some require healthcare professionals. There was less consensus on procedures restricted to HIS premises but still done by non-healthcare practitioners, with opinions often reflecting respondents’ backgrounds. While safety is a shared priority, some feared the proposals may impose unnecessary restrictions impacting businesses. Support was strong for a dual licensing system, enforcement powers for local authorities and HIS and setting a minimum age of 18 for these procedures.
Key developments following the consultation include plans to introduce a licensing regime for higher-risk procedures delivered by non-healthcare practitioners. Treatments involving prescription-only medicines, or those requiring clinical oversight, are expected to fall under the remit of HIS. The Government is also exploring future qualification requirements and training routes for those working in the field, and a series of impact assessments is underway to consider how the proposals may affect small businesses and protected groups.
The Minister for Public Health and Women’s Health and Member of the Scottish Parliament for Argyll and Bute, Jenni Minto, said, “We need to act in the interests of all those who seek to undergo these procedures and respond to the evidence we have seen that some people have had negative and life changing experiences. In doing so I intend to bring forward robust proposals that allow the specialty to provide procedures as safely as possible. I am satisfied that we will achieve this, and I look forward to working with Parliament to put these proposals into legislation.”
The proposals will inform the forthcoming Non-Surgical Cosmetic Procedures Bill, which is expected to be introduced to the Scottish Parliament during the 2025-26 legislative session.
Prescription Protocol
Nurse prescriber fined for breaching prescription-only protocols
A nurse prescriber has been fined £8,000 after unlawfully supplying botulinum toxin and other prescription-only medicines (POMs) without the required pharmacist oversight.
Nichola Hawes came to the attention of the Medicines Regulatory Group (MRG), part of the Northern Ireland Government’s Department of Health, in November 2022, following a report from a former patient who received unsolicited medication in their name.
UK legislation mandates that POMs must be prescribed following an appropriate medical consultation and dispensed by a registered pharmacist. Any failure to adhere to this process constitutes a criminal offence and undermines the standards of safe clinical practice. Following an investigation, the MRG seized several quantities of POMs from the nurse’s residence including weight-loss pens, hydroxocobalamin and hyaluronidase.
The case, brought before a UK court, involved the nurse issuing POMs without ensuring a qualified pharmacist had conducted the necessary clinical checks, as required under UK legislation. The nurse’s actions were deemed a breach of legal protocols designed to safeguard patient safety, particularly concerning the administration of high-risk injectable treatment.
IN THE MEDIA
What’s trending in the consumer press
BSF announces partnership with UKSKIN
Charity organisation the British Skin Foundation (BSF) has collaborated with clinic group UKSKIN.
The collaboration aims to support the future of skin health, with UKSKIN pledging to donate a portion of proceeds from every skin cancer and lesion treatment to fund research into skin disease. This follows an initial £5,000 contribution made during Skin Cancer Awareness Month in May 2025. Donations will continue throughout the year, with totals reported on a quarterly basis.
Matthew Patey, chief executive officer of the BSF, commented, “We’re incredibly grateful to UKSKIN for their commitment to supporting skin disease research. Their initial £5,000 donation during the recent Skin Cancer Awareness Month, followed by this generous ongoing pledge, not only funds crucial studies but also helps raise awareness of the importance of skin health among patients and the wider public.”
The British Skin Foundation will be exhibiting as the official CCR Charity Partner next month. Turn to p.23 to register now.
UV Protection
Consumer investigation flags sun safety risks
A recent investigation by Which? has raised concerns regarding the reliability of sun protection offered by some popular sunscreen products sold in the UK. Spot-checks were carried out on 26 sunscreen products, assessing both SPF and UVA protection. Three lotions failed to meet the necessary standards in all tests – Calypso Sun Press & Protect Sun Lotion SPF30, Asda Protect Moisturising Sun Lotion SPF30 High and Bondi Sands SPF 50+ Face Sunscreen Lotion. The products fell short in either SPF protection, UVA protection or both, according to the findings. According to regulatory benchmarks, a product must provide UVA protection equivalent to at least one-third of its claimed SPF.
Natalie Hitchins, head of home products and services at Which? commented, “It’s really concerning that widely available sunscreens could be putting families at risk by failing to offer the level of sun protection claimed on the packaging.”
Specialty Report
The British Beauty Council releases annual report
Non-profit organisation the British Beauty Council has issued The Value of Beauty summarising specialty trends.
According to the report, the UK’s beauty and personal care sector surged in 2024, contributing £30.4 billion to GDP, a 9% rise on 2023 and growing four times faster than the wider UK economy. Consumer spending reached £32.4 billion, with professional services such as aesthetic clinics growing 15% to £10.1 billion. The report also found that despite robust domestic growth, UK beauty exports fell to £4.3 billion, hindered by ongoing Brexit related trade barriers. Forecasts predict a slowdown in 2025, with GDP contribution projected to rise by a more modest 3%.
Millie Kendall, CEO of the British Beauty Council, commented, “The drop in beauty industry exports comes as no surprise, given the repercussions of Brexit and the increasing complexity of global trade regulations. That said, there is a clear appetite from brands to focus on their home market, building our reputation in the UK.”
BAMAN UPDATES
A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses
BAMAN AUTUMN CONFERENCE 2025
We announced our flagship two-day conference – taking place on September 18-19 at The Eastside Rooms, Birmingham – back in the spring, and the response has been huge. Hundreds of nurses have already signed up to join BAMAN for two days of networking, professional growth and a packed programme featuring talks, live demonstrations and nurse-led discussions. With shared learning at its core, this CPD-accredited event offers a warm and welcoming space to build confidence, develop your skills and deepen your knowledge, all while connecting with nurses from across the country. Amy Bird, BAMAN chair and nurse prescriber, commented, “We’ve got some new things in place this year. We’ve listened to what members have been asking for over the past few years, and this one is going to touch on every part of medical aesthetics. I’ll try not to give away too much just yet. But honestly, everything you’d hope for in a conference, it’ll be there.”
The agenda is now live, with full details on talks and timings available on the BAMAN Events page. Early booking is highly recommended.
THE FIRST NATIONAL BAMAN CHRISTMAS PARTY
We’re ending 2025 on a high… together! For the first time ever, BAMAN is hosting a national Christmas party at the Alma Studios, and every member is invited to join the festivities.
After a year of hard work, it’s time to take a well-earned break. BAMAN members are invited to One London Wall for a black-tie evening with stunning views of St Paul’s Cathedral. Put on your party best and enjoy a night of signature cocktails, live music and entertainment, all included as part of your BAMAN membership. Join us on November 14 for an unforgettable evening of reflection, recognition and appreciation for the incredible contributions our members have made throughout the year. Spaces are limited, so don’t miss your chance to celebrate with us. Book your place today via the BAMAN Events page.
For more information or to secure your place, visit www.baman.org.uk or via the QR below.
This column is written and supported by BAMAN
Discover the Power of Connection in Medical Aesthetics
Create your network at the Clinical Cosmetic Regenerative Congress (CCR)
In medical aesthetics, success isn’t just about technique. While many practitioners operate solo, those with thriving, long-term careers often have one thing in common: a strong professional network.
That’s where CCR steps in. Returning to Excel London on September 25-26, CCR is the UK’s ultimate meeting point for the aesthetics specialty – a place to step out of your treatment room and into a vibrant hub of like-minded professionals. Whether you’re just starting your journey or are well-established, CCR is your opportunity to meet peers, gain insights and build relationships that can shape your future.
This year’s opportunities…
Aesthetics Mentoring: Taking place across both days, you can meet experts in clinical, business, PR, finance and more.
Galderma Networking Lounge: Enjoy a coffee and meet with friends, colleagues and peers as you catch up on your favourite learnings throughout the day.
CCR Networking Drinks: Connect with likeminded professionals and enjoy free drinks on Day 1 at 5pm.
Aesthetics Connect: With CCR’s official app, you can schedule meetings in advance, and message fellow attendees to connect.
Aesthetics Member Drinks: Elite members of Aesthetics are invited to join an exclusive drinks reception to network and meet the journal team.
Join the aesthetics specialty at CCR
Whether you’re a seasoned practitioner or just starting out, CCR is the place to meet peers, reconnect with colleagues and build lasting relationships that will support your growth in the specialty.
Register for free NOW to create your new community in medical aesthetics.
BAMAN confirms Autumn Aesthetic Conference
The British Association of Medical Aesthetic Nurses (BAMAN) has announced its Autumn Aesthetic Conference.
Taking place on September 18-19 at The Eastside Rooms in Birmingham, this two-day conference entails educational talks, networking opportunities and workshops. The organisation has introduced new aspects to the conference, including Meet the Mentor lunchtime sessions, a Drop-In Content Corner and a Friday afternoon Business Masterclass.
Amy Bird, nurse prescriber and chair of BAMAN, commented, “We hope to see as many of you as possible at the BAMAN Autumn Aesthetic Conference. We have some exciting changes this year to ensure a new and dynamic agenda is being put together, with a range of clinical topics, live demonstrations and crucial updates from stakeholders around prescribing and regulations.”
Following the annual conference, BAMAN invites members and prospective members to CCR next month. Turn to p.23 to register.
Advertising
ASA releases rulings on weight loss medication
The Advertising Standards Authority (ASA) has issued rulings on adverts for weight loss medication.
The ASA has upheld nine complaints against online advertisers promoting weight loss injections, classified as prescription only medicines (POMs), to the public, reinforcing that direct or indirect promotion is unlawful. The ASA clarified that, in addition to prohibiting the naming of weight-loss drugs, the use of claims and imagery that indirectly promote such medications is also forbidden. The rulings target content that used phrases like “Obesity treatment jab,” “weight loss pen,” “GLP-1” and visuals such as injection pens or liquid vials, even when the drug names were omitted.
Jessica Tye, regulatory projects manager at the ASA, commented, “These nine rulings make crystal clear that all injectable forms of weight-loss medication are POMs and can’t be advertised to the public. We’ll be continuing to carry out extensive monitoring and enforcement work in this sector, and will take swift action against any breaches of the rules.”
Swedish healthcare brand Yazen was among the companies recently ruled against by the ASA. Fredrik Meurling, CEO and founder of Yazen, said, “We respect the ASA’s ruling and are open to taking guidance from the ASA in our future marketing efforts for the UK.”
Partnership
Hamilton Fraser unveils new collaboration
Insurance provider Hamilton Fraser has announced a 2025–2026 partnership with training academy Inspired Cosmetic Training. According to Hamilton Fraser, the collaboration forms part of its ongoing effort to support high-standard, face-to-face education for medical aesthetic practitioners, promoting safety and better outcomes across the specialty.
Carolyn Fraser, director of Inspired Cosmetic Training, commented, “Our mission is to improve regulatory standards through exceptional training and a commitment to safe practices. Partnering with Hamilton Fraser aligns perfectly with our values and goals for a safer, more responsible specialty.”
NEOVA introduces new skincare range
Skincare company NEOVA has released its PreJuvenation range.
Available through aesthetic distributor Eden Aesthetics, the skincare line targets proactive patients seeking early intervention against ageing, according to the company. The range aims to prevent visible ageing by targeting damage at a cellular level before the appearance of wrinkles, hyperpigmentation and loss of elasticity. PreJuvenation includes a Microfoliant Cleanser, Cell Renewal Serum, Multi-Active Day Cream, Overnight Repair Cream and 5-Second Daily Peel. Ingredients feature glycolic and salicylic acid, alongside retinol and antioxidants.
Lindsay Gray, managing director at Eden Aesthetics, commented, “PreJuvenation is the new gold standard for preventative skincare. NEOVA’s innovation lies in helping patients stay ahead of ageing. This launch marks a new chapter in skin health, focused on repair, resilience and long-term skin integrity.”
Event Review
Aesthetics attends InMode Elevate UK 2025
Aesthetic device company InMode invited practitioners and press to InMode Elevate UK 2025 on July 3 in London. The event featured three immersive masterclasses focusing on medical aesthetics, surgical techniques and women’s health. Practitioners hosting the masterclasses included aesthetic practitioners Dr Saleena Zimri, Dr Shirin Lakhani and Dr Jonathan Kadouch, alongside plastic surgeons Mr Alfredo Hoyos and Mr Fadi Hamadani. The event concluded with a rooftop celebration, offering attendees the opportunity to network.
Victoria Voysey, managing director of InMode UK and Ireland, commented, “What we witnessed today wasn’t just education, it was transformation. When you see leaders across aesthetics, surgery and wellness share a platform, you realise how powerful our community truly is. At InMode, we don’t just launch technology, we build futures – Elevate UK 2025 captured that spirit perfectly.”
InMode UK has appointed a new UK&I marketing team, led by consultant marketing director Alex Fobbester, alongside marketing manager Anna Dobbie and medical marketing executive Laura Jason.
InMode will be exhibiting at CCR next month. Turn to p.23 to register now.
The Regenerative Aesthetic Medicine Institute launches
The Regenerative Aesthetic Medicine Institute (RAMI) has been launched globally.
The institute is formatted of three programmes aiming to advance standards within medical aesthetics.
These include the Regenerative Aesthetic Medicine Conference and Exhibition, organised for November 8, 2025; the Journal of Regenerative Aesthetic Medicine (JRAM), a peer-reviewed quarterly publication; and the forthcoming RAMI E-Learning Platform, which will provide structured, on-demand clinical education and certification for professionals worldwide.
RAMI’s committee includes plastic surgeon Mr George Christopoulos, aesthetic practitioner Dr Kate Goldie and dental surgeon Dr Lee Walker. The responsibilities include speaking at RAMCE 2025 and publishing content in JRAM.
Chloé Gronow, content director at RAMI, commented, “We’re incredibly proud to launch a scientifically-led organisation that puts education at the heart of regenerative medical aesthetics. The RAM Institute is built to serve professionals at every stage of their journey – from emerging practitioners to global leaders – and to advance learning, standards and innovation across this rapidly evolving field.”
Nutrition Programme
L-Nutra Health releases diabetes remission programme
Longevity nutrition company L-Nutra Health has launched a food-based programme, aiming to support Type 2 diabetes remission and reduce reliance on GLP-1 receptors. The food programme is based on the Fasting Mimicking Diet (FMD), a patented, plant-based, low-glycemic protocol. For type 2 diabetes, multiple FMD cycles support glucose control, insulin sensitivity and visceral fat loss. The company shares that with the rising use of weight loss medication, this launch is designed to offer a non-pharmaceutical approach that targets the root causes of metabolic disease, such as insulin resistance, muscle loss and cellular ageing.
Dr William Hsu, endocrinologist and CMO at L-Nutra Health, said, “For too long, diabetes care has focused on glucose management rather than resolution. At L-Nutra Health, we’re shifting the goalpost to remission. With nutrition at the core of our clinical approach, we’re helping patients not only reduce medications, but reclaim metabolic function and long-term vitality.”
L-Nutra will be exhibiting at the MLS Summit at CCR next month. Turn to p.23 to register now.
mBody Media launches
Future Patient
Event organiser mBody Media invited attendees to the launch of new digital platform and publication Future Patient
Created by mBody Media, organisers of Menopause in Practice and Pause Live, Future Patient is a digital platform and quarterly publication focused on personalised, preventative and longevity-led healthcare, according to the company. Key themes include gut health, metabolic health and mitochondria.
The event, held at Home House on July 8, featured a panel discussion chaired by journalist and copywriter Vicky Eldridge, featuring insights from aesthetic practitioners Dr Mayoni Gooneratne – who also chairs Future Patient – and Dr Nima Mahmoodi, alongside neuroscientist Alanna Kit and others.
Dr Gooneratne said, “The launch of Future Patient was more than just an event – it marked the beginning of a new conversation in healthcare. This platform brings together those insights and the extraordinary professionals who have shaped them. I’m honoured to chair a movement that dares to disrupt, challenge and elevate how we think about health.”
mBody Media is a partner at MLS and will be exhibiting at CCR next month. Turn to p.23 to register.
Clinical Forum
Cutera announces CUCF return
Aesthetic device company Cutera has unveiled details on the Cutera University Clinical Forum (CUCF) 2025 summit.
Set to take place at De Vere Beaumont Estate, Windsor, on September 13, the company explains the event will be co-chaired by consultant ENT surgeon Mr Rishi Mandavia, alongside GP and aesthetic practitioner Dr Tatiana Mandavia. Cutera states the event will feature live demonstrations, in-depth protocol guidance and business growth strategies focused on its technologies, including devices such as AviClear, Secret PRO and XEO+.
Leighannah Tickner, country sales manager for Cutera UK&I, commented, “CUCF has become more than a conference, it’s a hub of community, innovation and clinical excellence. With an incredible line-up of international and UK speakers, CUCF 2025 will deliver more value, insight and inspiration than ever before.”
This month’s newest clinic openings
A round up of the latest aesthetic clinics opening across the UK
Plastic surgeon Mr Paul Banwell officially opened the Pantheons Clinic in London on July 1. The clinic offers a range of procedures, including breast augmentations such as Motiva Preserve and Mia Femtech, upper blepharoplasty and targeted liposuction. Mr Banwell
Collagen Product
DIBI Milano releases new collagen cream
Skincare company DIBI Milano has unveiled its new Collage System Biofermented Collagen Cream.
Expanding on the COLLAGE SYSTEM LAB range, the cream features bio-exosomes, oligopeptide 1 and biofermented collagen. According the company, it is designed to renew and brighten skin while reducing the appearance of blemishes and wrinkles. The formulation includes DIBI Milano’s patented biofermented collagen, produced via a yeast fermentation process, aiming for deeper skin penetration and enhanced effectiveness.
Kathy Wilcox, national educator for DIBI Milano, commented, “Our new COLLAGE SYSTEM LAB Biofermented Collagen Cream is a scientific breakthrough for clinics. It offers patients powerful at-home treatment. This fragrance and preservative-free cream is suitable for all skin types, delivering exceptional, tangible results.”
Scholarship
LTF Digital introduces new initiative
Marketing agency LTF Digital has announced the Leg-Up Foundation, a new global scholarship initiative offering one aesthetic clinic or medspa a full year of complimentary marketing and business support.
The programme will provide this at no cost, with services valued at up to £100,000. According to LTF Digital, eligible applicants must already offer, or commit to offering within three months, at least 5% of treatment capacity to patients affected by cancer, trauma, Bell’s palsy, botched procedures, congenital conditions or domestic violence, on a pro bono or cost-only basis.
The selected clinic will receive a package including website development, SEO, paid advertising, content strategy and business coaching from LTF Digital’s in-house team.
Business consultant and founder of LTF Digital, Rick O’Neill, commented, “This is not for charity sake, we are looking for clinics with clinical skill, community heart and growth potential. We’ll bring the digital firepower; they bring the purpose.”
commented, “I am thrilled to announce The Pantheons Clinic to the world.
After 10 years of the wonderful Banwell Clinic, I felt it was time to unveil the next chapter in innovation and growth within Plastic Surgery.”
Aesthetic physician Dr Joseph Hkeik and aesthetic practitioner Dr Raul Cetto have announced the launch of Le Petit
Saint, set to open in September. The clinic operates under the Saint Clinic Group, founded by Dr Hkeik in 1999, and is located in Mayfair. According to Dr Hkeik, the clinic’s focus extends beyond skin treatments, aiming to deliver a carefully curated experience – from personalised diagnostics and tailored facials to advanced non-surgical procedures.
If you’re opening a new UK clinic soon, let us know at editorial@aestheticsjournal.com
Galderma hosts Beauty Beyond the Surface with Sculptra
Pharmaceutical company Galderma hosted press and specialist guests at The Bulgari Hotel for an exclusive educational event highlighting its bio-stimulator, Sculptra.
The afternoon featured a panel discussion considering the use of bio-stimulator Sculptra and its correlation with consumer trends such as weight loss drugs. The talk was opened by Wojciech Konczalik, Galderma’s medical affairs lead, who provided an overview of the company. Plastic surgeon Mr Ash Soni shared his in-clinic experience with Sculptra. Dermatologist Dr Sabrina Fabi also joined virtually, sharing findings from a study she participated in last year, which revealed a novel, fat-mediated regenerative mechanism of action unique to Sculptra.
On the event, Konczalik commented, “We had an esteemed group of both journalists, influencers and everybody interested in the aesthetics space. And what is more exciting in the aesthetics space than bio-regeneration? This is the future of medical aesthetics, making sure you are reversing the signs of ageing and bringing your patients back to the beginning.”
Galderma will be exhibiting as Headline Sponsor at CCR next month. Turn to p.23 to register now.
Supplement company Advanced Nutrition Programme invited Aesthetics to the launch of its Skin Integrate 28 biome powder in London.
Available through aesthetic distributor iiaa, the company hosted press and practitioners on June 24 to discuss the launch of the new biome powder first hand. The breakfast panel featured aesthetic practitioner and GP Dr Christine Hall, medical director at Advanced Nutrition Programme Dr Gaby Prinsloo and Lorraine Perretta, head of nutrition at Advanced Nutrition Programme. The powder incorporates prebiotics, probiotics and postbiotics, elements that aim to enhance the gut-skin axis. The company reports that the product is backed by 48 clinical studies and is associated with improvements in skin hydration, resilience and brightness. Ingredients include plant fibres, amino acids and vitamin C.
Dr Prinsloo shared on the panel, “Gut microbiome research is rapidly increasing within the wellness sector, as it’s clear that gut health impacts skin health. With our modern-day lifestyles, factoring in stress, lack of sleep and poor diets, a biome-supporting powder plays a vital role in maintaining a healthy gut microbiome.”
Event Report
Skeyndor unveils latest launch at St Pancras Spa
Skincare company Skeyndor hosted a wellness evening event to commemorate its new partnership with the St Pancras Hotel.
The event marked the official launch of Skeyndor’s new suncare line and celebrated the brand’s partnership with the hotel’s spa. Guests were welcomed with an evening punch ritual, followed by indulgent treatments, including a facial featuring the Skeyndor skincare range. As part of this collaboration, Skeyndor also launched the Skeyndor Timeless Treatment, exclusively at the hotel’s spa.
Alexandra Georgio, managing director of Clinic Brands, a supplier to Skeyndor, commented, “We are proud to be at the St Pancras Hotel for the launch of Skeyndor, a luxury, results-driven skincare brand offering innovative technologies and non-invasive solutions to plump, firm and hydrate the skin. Today, we’re delighted to introduce the Skeyndor Timeless Treatment, a London exclusive, delivering 60 minutes of pure indulgence powered by 50 million Damask rose stem cells.”
News in Brief
Dermalux announces two new appointments
Medical device company Dermalux has introduced Zaid Doraid and Aoife Turley as business development managers. The company shares that Doraid, having served as an area sales manager in London for aesthetic device company Cutera, will support growth in London and Turley in Ireland. The role entails market development, client relationship management and sales strategies and execution. Turley has experience in both aesthetics and healthcare, having most recently worked as a national educator for Irish skincare distributor Renaissance Products.
John Bannon Pharmacy celebrates 40th anniversary
Medical aesthetic supplier John Bannon Pharmacy has marked 40 years of service in the medical aesthetics specialty. Founded in 1985, the company provides various services, including injectables, devices and skincare, to various practitioners, clinics and the NHS. Founder, John Bannon, commented, “This milestone reflects not only our team’s dedication but also the trust and loyalty of the practitioners we work with. This anniversary is not just about looking back, it’s about looking forward to the next chapter of excellence and growth.”
The Skin Diary appoints new strategic and clinic lead
Skincare solution provider The Skin Diary has introduced independent nurse prescriber Julie Scott as the new strategic and clinic lead in aesthetics and dermatology. Scott commented, “It is a true honour to join The Skin Diary, a brand founded on clinical excellence and scientific integrity. To collaborate with such distinguished dermatologists and contribute to a shared vision of evidence-based, patient-centred skincare is both a privilege and a deeply exciting next step in my professional journey.”
Dr Preema Vig hosts launch event
Aesthetic practitioner Dr Preema Vig hosted a launch event for fashion collection Preema Aura in Park Lane, London. Dr Vig shares that the collection was created when she couldn’t find the perfect dress for her 50th birthday, so she decided to design it herself. Guests in attendance included aesthetic practitioners Dr Anna Hemming, Dr Beatriz Molina and Dr Sherina Balaratnam, alongside business consultant Vanessa Bird and managing director of Eden Aesthetics Lindsay Gray.
Not only Exosomes… but Secretomes1
Ethically sourced from organic bovine colostrum2
Nutri Complex purasomes NC150+
Stimulates fibroblasts to repair skin damage, boosting collagen production and improving skin elasticity.3
Skin Glow Complex purasomes SGC100+
Reduces oxidative stress and improves the appearance of scars, dull and hyperpigmented skin.
Purasomes + Microneedling Book Training Now
Hair & Scalp Complex purasomes HSC50+
Restores hair follicle function for a healthier scalp and thicker, strong hair.4
Manufactured by Dermoaroma Italy. Exclusively distributed in the UK by DermaFocus. Purasomes products are not medical devices and are not intended to be injected. Please refer to the IFU for face, scalp and body.
References 1. J.Chenau et al., Secretome: Definitions and biomedical interest 2. Han, G. et al., 2022. The Potential of Bovine Colostrum-Derived Exosomes to Repair Aged and Damaged Skin Cells. 3. Privitera, A. et al., 2024. Nutri Complex 150+: A New and Effective Approach to Facial Rejuvenation. 4. Ferruggia, G. et al., 2024. Effectiveness of a Novel Compound Hair & Scalp Complex on Hair Follicle Regeneration.
UKHSA Issues National Warning Following Rise in Botulism Cases
Aesthetics examines the recent UKHSA public warning about rising botulism cases linked to counterfeit botulinum toxin
The UK Health Security Agency (UKHSA) has issued a warning to the public following botulism cases connected to counterfeit botulinum toxin.1
Between June 4 and July 14, 2025, approximately 38 patients became critically ill with botulism, primarily in the East of England and East Midlands.1,2 The UKHSA reported that initial cases were identified in the North East of England, with subsequent cases emerging in the East of England and East Midlands.1,2
The initial cluster of cases was identified when County Durham and Darlington NHS Foundation Trust raised concerns, after several patients presented with neurological symptoms following cosmetic injections.1,2 Reported symptoms include ptosis, diplopia, dysphagia, slurred speech, lethargy and, in severe cases, respiratory distress.1,2
It is suspected that an “unlicensed Botox-like product,” was illegally administered by unqualified beauticians operating in non-clinical salon settings.1,3 The Government confirmed that promoting unlicensed products breaches Regulation 279 of the Human Medicines Regulations 2012.4 The Medicines and Healthcare Products Regulatory Agency (MHRA) has upheld related complaints.4
One patient, Kaylie Marie Bailey, experienced a severe adverse reaction, collapsing from respiratory failure.3 She was resuscitated at Sunderland Royal Hospital and subsequently treated with antitoxin in intensive care.3 Another patient, Nicola Fairley, suffered a severe adverse reaction.5 Within days of receiving the injection, her throat began to close up, one of her eyes swelled shut and she struggled to eat and swallow.5
The UKHSA warning
On July 18, the UKHSA issued a public advisory, urging individuals to be vigilant for symptoms of botulism.1,2
The warning includes national advice to clinicians to ensure that they look out for botulism in patients who may have had a recent procedure, in order to provide them appropriate antitoxin treatment.1 Specific recommendations include maintaining a high index of suspicion for botulism in relevant cases and administering botulinum antitoxin promptly when symptoms are present.1
Clinicians are advised to report all suspected cases to local Health Protection Teams.1 Continued vigilance is essential, as symptoms may take up to four weeks to appear following the initial procedure.1 Additionally, the agency advise individuals to take precautions when seeking aesthetic procedures, including checking if the product being used is licensed.1 As of July 2025, licensed botulinum toxin brands include Alluzience, Azzalure, Bocouture, Botox, Letybo, Nuceiva and Relfydess.6
Public health investigation
The MHRA and Allergan Aesthetics, an AbbVie company and trademark holder for Botox, are jointly investigating the illegal sales and distribution of counterfeit botulinum toxin, reinforcing that botulinum toxin is a prescription-only medication to be prescribed only by licensed healthcare professionals.
A spokesperson for Allergan Aesthetics, an AbbVie company, commented, “There are a growing number of unlicensed toxins flooding the UK market. Allergan Aesthetics has collaborated with the MHRA to combat counterfeit products through the provision of training with trading standards officials for counterfeit identification, whilst our customers and Allergan Aesthetics employees have an important role in signalling suspicious activities to the MHRA enforcement units, customs and law enforcement.”
Specialty voices
Discussing the recent UKHSA warning with Aesthetics, Andrew Rankin, trustee of the Joint Council of Cosmetic Practitioners, notes, “The JCCP reminds all practitioners that they must only use regulated products sourced from legitimate and authorised UK based suppliers. A failure to do so can result in professional and/or criminal sanction.” Offering guidance to
practitioners on managing complications arising from the use of unlicensed toxin, Rankin adds, “The JCCP advises that unexpected local adverse events, such as visual disturbances, warrant monitoring and possible referral to primary care. If systemic symptoms such as dysphagia or breathing difficulty develop, urgent referral for immediate intervention is essential.”
With the outcome of the new Government-proposed licensing scheme expected soon, Rankin says, “The recent botulism incident underscores ongoing risks to public safety in the cosmetic sector and highlights the urgent need for regulation. The JCCP anticipates that forthcoming measures will address these concerns by requiring oversight from accountable healthcare professionals, responsible prescribing and the use of authorised suppliers with appropriate quality checks in place.”
Amy Bird, nurse prescriber and chair of the British Association of Medical Aesthetic Nurses (BAMAN), also explains, “The botulism cases are deeply alarming. This is an unlicensed substance, not a regulated medicine, and it has no place in medical aesthetics.” Bird highlights, “BAMAN has repeatedly warned about the dangers of rogue practice and illegal imports. We urgently call on regulators to crack down on unsafe suppliers.”
Dr Catherine Fairris, aesthetic practitioner and president of the British College of Aesthetic Medicine (BCAM), emphasises patient safety. She says, “Patient safety must be paramount. Without proper regulation and enforcement, we risk more preventable harm and a further erosion of trust in a field that, when practiced safely and ethically, can offer genuine clinical and psychological benefits.”
Supporting safe practice
Safety must remain the foremost priority in medical aesthetics, above financial or practical factors. Bird concludes, “Unregulated practitioners are not accountable to anyone – regulated healthcare practitioners have a duty of care to each and every patient they treat.” Aesthetics will continue to report on any other regulatory updates.
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Unlock the Future of Women’s Health
Attend the Medical Longevity Summit at CCR 2025
For too long, women’s health has been underrepresented in medical research, misunderstood in clinical settings and underserved in healthcare design. From hormonal transitions like perimenopause and menopause, to rising rates of autoimmune conditions, cardiometabolic risk and mental health challenges, the female lifespan presents unique physiological demands that require more than a one-size-fits-all approach. As conversations around personalised, preventative and longevity medicine evolve, the need to place women’s health at the centre of the discussion has never been more urgent.
Curated in collaboration with Dr Mayoni Gooneratne, founder of Human Health Professionals, in association with the Women’s Integrative Health Collective, the Medical Longevity Summit is a hub of insights and evidence-based strategies to support female patients through integrative, regenerative and lifestyle treatments. Alongside a packed educational programme, the dedicated exhibition area will showcase the latest products, services and technologies in women’s health and preventative medicine. From hormone optimisation and sexual wellness to diagnostics, supplements and advanced skincare, visitors can discover innovative solutions designed to enhance clinical outcomes and expand their wellness offering in this fast-growing field. The unmissable agenda
Thursday September 25: The Science of Female Longevity
AM: An Introduction to Women’s Health
PM: Physiology of Women’s Hormones and Ageing
Friday September 26: From Knowledge to Practice – Integrating Longevity into Care
AM: Helping Improve Women’s Health
PM: The Future of Women’s Health
An exclusive preview of some of the sessions
Functional Medicine Approach to Women’s Health
This session explores the functional medicine approach to women’s health, highlighting how it differs from conventional models by addressing root causes rather than isolated symptoms. Grounded in the latest evidence, it focuses on optimising outcomes through personalised care, with a particular emphasis on hormonal health. It will examine key processes such as hormone production, transport, receptor sensitivity, and detoxification, alongside the vital role of nutrition. The session will also critically assess popularised social media narratives around women’s health, separating hype from science to ensure high-quality, clinically sound care.
How Do We Keep Women in Health and in Work
This session takes a down-to-earth look at how we support women living with PCOS, endometriosis, and infertility – not just managing the condition but caring for the whole person. We’re not only treating symptoms; we’re supporting emotional wellbeing, psychological resilience, cultural understanding and spiritual health too. These issues affect every part of a woman’s life, including her ability to stay in work. We’ll explore how early diagnosis, compassionate care and thoughtful workplace adjustments can make a real difference.
The Myco-Code of Longevity: Rewiring Hormonal Health with Medicinal Mushrooms
Explore the powerful intersection of medicinal mushrooms and hormonal health in this forward-thinking session on longevity. This session will delve into how fungi such as Reishi, Cordyceps and Lion’s Mane may support cellular function, immune modulation and endocrine balance – all essential for sustaining energy, clarity and resilience as we age. With a focus on adaptogenic mechanisms and clinical relevance, this talk offers healthcare professionals practical, evidence-informed strategies to enhance long-term wellbeing and extend healthspan through integrative approaches.
Meet the speakers
Speakers at the event include: Corinne Briaud
· Dr Nichola Conlon
· Tracey Dennison
· Emma Dawson
· Dr Wendy Denning
· Dr Felice Gersh
· Dr Mayoni Gooneratne
· Romina Melwani
· Rory Melville
· Andie Siggers
· Dr Meghan Walker
· Dr Michael L Krychman
· Rodrigo de Vecchi
The importance of women’s health
Curator of MLS Dr Mayoni Gooneratne on why women’s health matters in aesthetics
Functional medical professional
Dr Mayoni Gooneratne, a long-time advocate for integrative health and wellness, is bringing her passion and expertise to the upcoming Medical Longevity Summit. She shares why longevity, and particularly women’s health, should be on every aesthetic practitioner’s radar.
“Women’s health is absolutely essential in medical aesthetics,” Dr Gooneratne explains. “Most aesthetic practitioners are clinically trained, and they interact with women – often their ideal patient demographic – on a daily basis. So, even if you’re not the person delivering women’s health services directly, you need to be able to open up that conversation.”
According to Dr Gooneratne, addressing women’s health not only improves patient outcomes but also strengthens the practitioner-patient relationship. “From an aesthetics point of view, this can
enhance results, and from a business perspective, it creates loyal patients who trust you, return to your clinic and refer their friends too.”
The summit is structured across two informative and inspiring days. Day 1 delves into the foundations: anatomy, physiology and the health processes that underpin longevity and wellness. Day 2 shifts focus to implementation – how to introduce services, work with different brands and build offerings that support long-term patient health.
“This summit is for everyone in medical aesthetics,” Dr Gooneratne emphasises.
“Whether you’re on the business or the clinical side, you’ll find immense value. We’ve curated an exceptional line-up of speakers from across the globe – true experts who have been working in this space for years.”
Attendees can expect to leave the summit with practical takeaways they can implement right away. “You’ll come away with real clinical pearls,” she adds. “These are tools that can immediately start making a difference in your clinic.”
Explore the companies that
make it
possible
The Medical Longevity Summit is more than just conference talks, it’s a hub of innovation and collaboration, where pioneering brands bring the latest in longevity and wellness to life.
Companies you can find exhibiting at the event include:
· Body Brilliant
· Building Forensics
· Celluma Light Therapy
· Dotolo Europe Ltd
· Esse Skincare
· Genvive Labs
· Halo IV
· Hifas da Terra
· Human Health Professionals
· L-Nutra
· MAP Health Ltd
· Meciet
· Menopause in Practice
Start your longevity journey
The Medical Longevity Summit will be taking place at the Clinical Cosmetic Regenerative Congress (CCR) on September 25-26.
Register free now to broaden your approach, deepen your knowledge and embrace a future where aesthetics and health go hand in hand.
· Minerva Research Labs
· Nature’s Plus
· NL Vitacare & NAD Medica
· Nuchido
· Nutrition Collective
· Pharmana SA
· Roseway Labs
· Share Swiss
· Skin On You
· Toneko Ltd
· Totally Derma
· Uberlube
· Yotsuba Japan
Unlock an archive of specialty knowledge
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 medical aesthetics professionals
Discover the archive
Managing Lower Face Laxity
After Rapid Weight Loss
Three practitioners share their approaches to restoring volume, supporting collagen production and rebuilding confidence
Over the past two years, aesthetic practitioners have reported a noticeable increase in patients seeking facial rejuvenation following significant weight loss – particularly with concerns around mid-face volume loss, lower face laxity and jowling. A key driver behind this trend is the growing use of GLP-1 receptor agonists, such as semaglutide and tirzepatide, which have transformed weight management and, in turn, reshaped aesthetic demand.1,2 This phenomenon, often dubbed ‘Ozempic face’ in mainstream media, is becoming an increasingly common concern in aesthetic clinics.1
Initially developed for the treatment of type 2 diabetes, GLP-1 agonists mimic the effects of the glucagon-like peptide-1 hormone. They delay gastric emptying, suppress appetite and promote insulin secretion, leading to significant weight reduction in a relatively short timeframe. Clinical research has shown that GLP-1 and dual GIP/GLP-1 receptor agonists – such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) – can lead to average weight loss of 10-15% or more of total body weight in under a year.³
While this is a positive development for many patients’ physical health, the consequences for facial aesthetics can be challenging. As fat compartments in the face deplete rapidly, patients may develop hollow cheeks, sagging skin, jowls and a prematurely aged appearance. A 2024 imaging study showed that for every 10kg of total weight lost, mid-face volume decreased by an average of 7%, impacting both superficial and deep fat compartments.⁴
“No matter what method someone uses to lose weight – whether it’s surgery, medication or something else – it’s never permanent unless they’ve committed to lasting lifestyle changes”
Mr Prash Patel
Recognising the clinical profile
Aesthetic practitioner Dr Ana Mansouri notes that over the last year or so, practitioners have been seeing more patients on GLP-1 medications who are starting to notice these changes early on. “The face becomes gaunter, the skin looser, and this can really affect self-esteem,” she says.
Mr Prash Patel, a bariatric surgeon and aesthetic practitioner, underscores the scale of the issue. “One in four people in the UK has a BMI over 30,5 and with the accessibility of GLP-1 agonists and bariatric procedures, more patients are achieving dramatic weight loss. But when you lose weight, especially after age 35, facial fat tends to go first. That’s when the signs of ageing accelerates,” he says.4
The practitioners explain how this volume loss primarily affects the deep and superficial fat pads in the mid-face, temple and jawline. Ligamentous laxity becomes more apparent, and the skin loses its elasticity, often leading to a ‘deflated’ facial contour.4
“A lot of my GLP-1 patients are also perimenopausal,” adds aesthetic practitioner Dr Victoria Manning. “They’re losing oestrogen, which further reduces collagen and elastin. It’s a double hit. Skin becomes thinner and laxer, and without intervention, it can be really hard to manage.”6
Treatment
planning and patient communication
Across all approaches, the practitioners emphasise that clear communication around expectations, timelines and outcomes is key – particularly as patients may not have anticipated the aesthetic impact of rapid weight loss.
“I always use previous photos to help patients understand where they’ve lost volume and how we can rebuild it in a subtle way,” says Mr Patel. “It’s not about changing their face – it’s about restoring what was lost.”
Dr Manning agrees. She says, “These are patients who often feel great physically, but their confidence takes a hit because they don’t recognise themselves in the mirror. A sensitive, phased plan goes a long way.”
The practitioners all highlight that emotional wellbeing is as important as physical correction, and recommend checking in regularly with patients to adjust treatment plans as weight stabilises.
Supporting collagen production and skin quality
Each practitioner agrees that treatment should be tailored to the individual, with
biostimulatory treatments offering valuable support during active weight loss.
Dr Mansouri begins with proactive regenerative stimulation with Sculptra – a poly-L-lactic acid (PLLA) that promotes neocollagenesis by gradually stimulating fibroblasts.7 “If the patient confirms they’re on GLP-1s, we begin Sculptra treatments right away and continue for every 6kg of weight lost. It allows us to stay ahead of the laxity and volume loss,” she explains. Dr Mansouri typically recommends two to five sessions, spaced around six weeks apart, depending on the patient’s age and the degree of weight loss.
Dr Mansouri adds that the scientific foundation behind Sculptra further supports its use in post-weight-loss facial restoration, by stimulating not just collagen production, but also elastin and white adipocytes, overall supporting skin thickness. “One piece of evidence shows that Sculptra is proven to stimulate type I collagen by 66.5% within three months,” she says, adding, “That’s more than two-thirds of collagen stores rebuilt in that time.”8
She complements this with Restylane Skinboosters – stabilised hyaluronic acid (HA) microinjections designed to improve skin hydration, elasticity and texture – to support hydration and dermal quality.9 Restylane Skinboosters also stimulate the collagen which works in synergy with Sculptra treatment.9 She typically performs two to three sessions, spaced three to four weeks apart, depending on the patient’s skin condition and patient goals.
Dr Manning takes a similarly cautious yet proactive approach. She begins with JULÄINE, a PLLA-based biostimulator that activates gentle collagen regeneration and improves skin tone, texture and firmness.10 It aims to offers natural, progressive tightening without adding bulk, with results typically beginning two to three months after treatment and lasting up to two years.11
She spaces treatments four to six weeks apart and may introduce Ellansé – a polycaprolactone (PCL)-based collagen stimulator that provides gradual, long-lasting volume – later, typically post-stabilisation, when deeper dermal support is required.12 Clinical guidance suggests that typically only one session of Ellansé is needed to achieve immediate correction and long-term collagen stimulation. In select cases, a second session may be considered depending on the treatment area and desired outcome.12
In addition to injectables, the practitioners highlight the role of microneedling as a supportive treatment to improve overall skin texture and stimulate superficial collagen production. Typically performed in a series of four to six sessions, microneedling has been shown to enhance dermal remodelling and improve the appearance of fine lines, pores and skin laxity.13 “A general course of microneedling can be a great adjunct option,” she explains. “It’s superficial, but it’s a nice way to improve skin quality without the discomfort or intensity of deeper treatments,” says Dr Manning. Energy-based interventions are also an option. Mr Patel highlights, “We can provide skin tightening treatments with more invasive devices like Morpheus8, which involves radiofrequency and deeper microneedling.” Dr Manning adds that it can really improve skin quality in patients who are fuller in the face, but advises she doesn’t use it if people don’t have a lot of facial tissue because it can cause fat atrophy if you penetrate too deeply.14
Dr Manning also offers Ultherapy – a focused ultrasound treatment that targets the SMAS layer (superficial musculoaponeurotic system) to stimulate collagen at a foundational level. “Ultherapy is ideal for patients who want a one-off treatment that works beneath the skin to firm and lift. It’s great for improving jawline definition and treating early laxity,” she says. Clinical research supports this, showing that most patients experience progressive improvement in skin firmness over three to six months following a single session.15
Dr Manning notes how ongoing hormonal changes – particularly in perimenopausal or postmenopausal women – may also warrant tailored skincare, nutraceuticals or regenerative therapies woven into their daily routines to preserve results and prevent recurrence of laxity. “I recommend Skinade and Collagen Boost to my patients,” she says, adding, “If people do their due diligence, there’s a lot of good ones out there.”
Restoring volume and facial structure
Once weight has plateaued, all three practitioners turn to structural restoration using volumising fillers or biostimulators.
Mr Patel uses Stylage XL and XXL to rebuild deeper facial volume, particularly in the cheeks, chin and jawline. “If they’re still actively losing weight, I won’t volumise – it won’t hold,” he explains. “When a patient has reached their target weight, we build a bespoke plan.” Stylage – a HA-based dermal filler formulated with mannitol, an antioxidant that helps reduce post-injection inflammation and prolongs product longevity – offers smooth integration and volumising support.16 While clinical data suggests results should last 12-18 months,16 Mr Patel comments that in his experience, improvement can still be seen three years later in some patients. He highlights that it’s important to be aware there is a risk of overfilling if practitioners don’t take a cautious, anatomy-led approach, stating, “We have to respect facial proportions, gender, and age-related changes. The goal isn’t to inflate the face – it’s to restore balance and maintain natural identity.”
Dr Manning offers treatment with MaiLi HA fillers. She observes that “They offer good lift with a soft, natural finish,” making them ideal for mid-face restoration and lower face contour refinement in patients seeking dynamic, expressive results. Clinical evaluation supports MaiLi’s high safety profile and lasting outcomes, with research noting consistent ease of administration and patient satisfaction up to 12 month’s post treatment.17
Dr Manning may also layer Ellansé when deeper dermal support is required. In cases of significant laxity or jowling, she incorporates thread lifting using Silhouette Soft or Mint – absorbable suspension threads designed to reposition sagging facial tissues and stimulate collagen through mechanical anchoring and fibroblast activation.18,19
Dr Mansouri concludes her protocol with harmonisation using light Restylane HA fillers – cross-linked HA injectables designed to restore volume, refine contours and integrate naturally into the surrounding tissue.20 She explains that this can help restore contour subtly and naturally once foundational support is in place.
Figure 1: Patient before and after three sessions of Sculptra and two sessions of HA filler using the Restylane portfolio. Patient still needs one to two more Sculptra sessions. Images courtesy of Dr Ana Mansouri.
Patient safety and risk management
Mr Patel reminds practitioners not to overlook the risks associated with HA fillers, which, while widely used and generally safe, can still lead to complications if not handled correctly. 21 “Vascular occlusion is always a risk,” he explains. “You’ve got to understand your anatomy, inject slowly and stay in the right plane.” He adds that although HA is reversible with hyaluronidase, that shouldn’t lead to complacency. “Yes, it’s dissolvable, but that’s not a safety net for poor technique. The best complication management is prevention.”21
While collagen-stimulating injectables offer long-term benefits, they require a careful approach to patient selection and thorough education around risks. Dr Manning stresses the importance of managing expectations and being transparent about potential complications. “With collagen stimulators, it’s about understanding the product – it’s not reversible. What we do is what they have,” she explains.
Although the risk of vascular occlusion exists with all injectable procedures, Dr Manning notes that complications with products like Ellansé may be less common in practice, “If you look at the data, the risk of vascular occlusion is actually so much less than with HAs, because the people injecting Ellansé tend to be a lot more experienced.”22
Dr Manning adds that patient screening is essential. “I don’t treat anyone with autoimmune conditions – such as Graves’ disease, thyroiditis or psoriasis. It’s just common sense, in my opinion.” This caution reflects concerns around unpredictable immune responses in patients with autoimmune disease, where the biostimulatory mechanism of action may increase the risk of adverse reactions such as inflammation or granuloma formation. 23
Dr Mansouri also highlights the importance of risk communication when using Sculptra (PLLA). “We’ve got the generic side effects and risks of any injection, which are in line with other injectables,” she says, “but the one that’s specific to Sculptra is nodule formation.”24
She notes that while this used to be a more common concern, the nodule formation is now extremely low (less than 0.0002% according to internal data) and updated protocols for reconstitution, placement and aftercare have significantly reduced the risk. 24
Dr Mansouri follows Galderma’s recommended preparation and injection techniques, including diluting the product with 8ml of sterile water, injecting away from dynamic zones, and instructing patients to follow the 5-5-5 massage rule: massaging the treated area five times a day, for five minutes, over five days. She explains, “Nodule formation is a risk that’s important to be aware of and to discuss with patients, but it’s very unlikely if you follow protocol.”25
As with other biostimulators, she advises against treatment in patients with collagen disorders, autoimmune conditions, or those who are immunocompromised, pregnant or breastfeeding. 25
“There are certain safety considerations to keep in mind with Sculptra, as with any other injectable treatment,” she says. “But with appropriate patient selection and good compliance, it’s a very safe and effective product, which is the reason it’s my choice for biostimulation.”
Mr Patel further notes the risks associated with unregulated GLP-1 medications and the role of aesthetic practitioners in identifying and managing it. “Unfortunately, we’re seeing a surge in counterfeit GLP-1 medications being sold online,”26 he warns. “People are often tempted by cheap, quick-fix weight loss solutions, but these unregulated products can be extremely dangerous.”
Mr Patel urges aesthetic practitioners to remain vigilant, especially when treating patients who may be self-prescribing weight loss drugs. He says, “One of the things I say to every patient is: if you had diabetes or high blood pressure, would you buy your medications online? Of course not – you’d speak to a doctor. It should be no different when it comes to GLP-1s.”
He encourages practitioners to refer patients to qualified medical professionals for proper weight management. “If someone’s using these drugs without clinical supervision, it’s vital to recommend they see a doctor or bariatric specialist who understands the risks. Weight loss medications can be powerful tools, but only when used safely,” he says.
Aesthetic restoration as a continuation of care
As GLP-1 therapies become more mainstream, aesthetic practitioners are increasingly part of a wider healthcare journey. This role goes beyond appearance – it involves helping patients process physical transformation, maintain skin health, and preserve facial identity.
The practitioners explain that aesthetic restoration after significant weight loss is about guiding change. By layering collagen stimulation with strategic volumisation and tissue repositioning, clinicians are able to restore harmony and proportion without overcorrection.
Mr Patel also reminds practitioners to consider the bigger picture of weight management. “No matter what method someone uses to lose weight – whether it’s surgery, medication or something else – it’s never permanent unless they’ve committed to lasting lifestyle changes,” he says. “These interventions can be powerful, but they’re not a substitute for healthy habits.”
He encourages patients to focus on consistency rather than drastic shifts. “I always recommend small, sustainable adjustments. Advise patients to be mindful of their sugar intake, understand how much they eat in a day – not necessarily strict calorie counting, but general awareness – and try to live by the 80/20 rule: make healthy choices 80% of the time, but don’t deny yourself joy either,” he says.
Dr Manning concludes, “This isn’t a one-size-fits-all process. It’s about planning carefully, choosing the right tools at the right time and helping patients recognise themselves again.”
Figure 2: 58-year-old patient before and after treatment with 7ml of STYLAGE dermal fillers. Images courtesy of Mr Prashant Patel.
Microdosing Botulinum Toxin for Skin Rejuvenation
Miss Jenny Doyle, Miss Aaminah Haq and Dr Arshi Baig analyse current literature on rejuvenating the skin using botulinum toxin
The uptake of non-surgical methods, such as botulinum toxin type A (BoNT-A), dermal filler and laser to achieve facial rejuvenation, is growing rapidly. At present, non-surgical options account for 90% of procedures and 75% of the market value.1 BoNT-A is the most popular treatment of choice, with the use increasing by more than 1100% between 2000 and 2023. 2,3
BoNT-A was approved for aesthetic use treating dynamic facial rhytids, via intramuscular injection, in 2002 by the US Food and Drug Administration (FDA).4 It can be used off-label for a variety of other treatment indications, with a growing body of research supporting these uses.5
Intradermal use of BoNT-A is becoming increasingly popular due to its positive effects on skin rejuvenation, texture and hydration.6 The dilution for intradermal use is significantly higher than that employed for intramuscular uses, providing a new treatment offering with a potentially relatively lower consumable cost.7
In this article, we explore the uses of BoNT-A for skin rejuvenation, with particular reference to its effect on facial erythema, texture, pore size, sebum production, hydration, skin surface roughness, elasticity and lifting of facial skin.7 In appropriate patients, there is high satisfaction with BoNT-A use to improve skin quality.8
Microtoxin technique and mechanism of action
In traditional use, BoNT-A works via chemical denervation, blocking acetylcholine re-uptake at the neuromuscular junction, this prevents muscle contractions and the dynamic wrinkles they cause.9
This same acetylcholine receptor blockade is thought to decrease sweat production and possibly increase sympathetic response, reducing facial pore size.10 Acetylcholine promotes the differentiation of sebocytes and production of sebum. It is thought that BoNT-A has an inhibitory action on the muscarinic receptors and the arrector muscle of the hair follicle, leading to an overall decrease in sebum production.11
The microtoxin technique is thought to improve skin quality by causing mass atrophy of the sweat and sebaceous glands, creating a smoother and tighter appearance.12 The insertions of the superficial muscles are also weakened, reducing their tethering effect on the skin.12
Vascular dilation and supply are reduced, causing a reduction of facial erythema.13 It has been posited that highly diluted BoNT-A can diffuse into dermal cells, altering the biosynthesis of collagen and inflammatory cytokines such as substance P and procalcitonin, therefore also decreasing erythema.14
Relaxation of superficial muscles at the intradermal layer with BoNT-A leaves deep muscle fibre action intact. This relaxation of the superficial layer causes a reduction of lymphatic drainage, a rise in osmolarity in the dermis and retention of fluid.10 There may also be a mechanical effect related to multiple needle insertions
in the dermis, overall leading to a lifted effect.15
Table 1 summarises the three main areas of injection of BoNT-A and licensed doses from the three commonly encountered products.16
Table 1: Three main areas of injection of BoNT-A and licensed doses from the three commonly encountered products16
Microbotox techniques
Initially termed ‘mesobotox’ and later changed to ‘microbotox’ to better describe the droplet size, the technique involves the placement of a 1cm grid of numerous small, superficial blebs of highly diluted toxin.8 First described by Wu in 2000,17 intradermal injections are placed at the level of the dermis or the interface between the dermis and superficial insertion of the facial muscles, leading to an improvement in skin quality and appearance.12 It was thought that the intramuscular BoNT-A particles diffused into the superficial layers of the skin, thereby affecting elements such as the sebaceous glands.17
This technique has been most extensively studied in onabotulinumtoxinA, where effects typically last for three months but may last as long as six months.12 This is a challenging technique to learn, with small margins for error, as the specific risks of this technique mainly relate to inadvertent deeper administration of toxin, causing more extensive muscle paralysis than desired.8
Technique for intradermal injection
The proposed technique includes:
1. Skin marking
2. Topical anaesthetic cream placed for around 30 minutes
3. 30-32G needle per injector preference
4. An insulin syringe or similar is recommended as small volumes are being delivered
5. Pull skin taut and insert needle bevel down at a degree angle until the bevel is just below the epidermis18
6. Slowly inject; administration of product should have some resistance and should form a bleb
7. Injections that are too deep will not form a bleb and will have a flow that is too easy 10
8. Inject the target area over a 1cm grid8
9. Avoid massage following injection to reduce the risk of unwanted toxin migration.19 Standard aftercare guidance such as avoiding heat and avoiding any touching of the area would apply
If the number of required injections is unacceptable to the patient or practitioner, a microcannula technique can be used; however, this is less accurate in ensuring the correct dose delivery at each point.20
Calibrated autoinjectors can also be used to deliver the BoNT-A; they offer a time-saving alternative that may reduce product wastage and allow for increased precision of delivery. 21 In our practice, this treatment modality does require additional training and advanced technical skills, as the margins for error are small with regards to dosage and injection depth.
Microneedling, followed by a topical application of BoNT-A, is another delivery option. It has been demonstrated to be safe, effective, less painful and with higher patient satisfaction than intradermal injections for the treatment of facial hyperhidrosis; however, it did require an extra treatment. 22
Contraindications
Absolute contraindications
BoNT-A must be avoided in pregnancy; thus far, there have been no reports of teratogenicity; however, the safety profile is yet to be established. Moreover, it is also advised to avoid use during breastfeeding, as it is uncertain if BoNT-A is expressed in human milk. 23 Known allergy to BoNT-A is an absolute contraindication, as a few cases of type 1 hypersensitivity reactions to BoNT-A have been reported. Neuromuscular disorders, such as myasthenia gravis or Lambert-Eaton syndrome, BoNT-A may exacerbate any muscle weakness in these conditions. 23
Relative contraindications
Medications such as aminoglycosides, calcium channel blockers, penicillamine and quinine can enhance the effect of BoNT-A. 23
Skin rejuvenation
Zhu et al. compared two cohorts, with 20 participants in each group; one received intradermal BoNT-A, the second group received intradermal saline. BoNT-A use was associated with an improvement in hydration, skin surface roughness, elasticity and transepidermal water loss (TEWL); each of these parameters was measured using a probe and studied at week 0 and week 12. Patient satisfaction was also measured, plus masked assessment of skin quality by two independent assessors. 24
The scoring was performed using a grading scale that ranges from 0 (<25% or minimal), 1 (26-50%, fair), 2 (51-75%, good), 3 (75-90%, excellent) and 4 (91-100%, clear). At week 12, the group with BoNT-A had a clinical assessment score of 2.30 ± 0.40; this was noted to be significantly higher than that of the control group, 0.70 ± 0.60 (p < 0.05). These results were also seen with the subjective satisfaction score; here, the BoNT-A group scored more than the control group (BoNT-A 2.40 ± 0.50 vs control group 0.75 ± 0.47); all results were statistically significant. 24
BoNT-A use has been associated with an improvement in hydration, skin surface roughness, elasticity and transepidermal water loss
BoNT-A protocol
The recommended protocol from Zhu et al. was:24
· 30 U BoNT-A mixed with 2.6ml saline = 12.5 U/ml
· Injections at 2mm intervals using a multiple needle dermal injector system
· Depth 0.8mm in the upper face and 1mm in the rest of the face
· (0.0025 unit) delivered per injection
Combination treatments for skin rejuvenation
A basic tenet of traditional BoNT-A treatment is that it affects dynamic, but not static, facial rhytids. This is disappointing for patients with photoageing and long, shallow, fine lines. Particular areas of concern include ‘accordion lines’ from the orbit to the neck and temples, as well as periorbital and paracommissural wrinkles.12 The microdroplet technique may be of benefit here, either alone or in conjunction with dermal filler. One study used 0.04 U of microbotox with 0.001cc of microhyaluronic acid;21 the addition of stabilised HA added to the hydration levels of the dermis and lasted up to six months. 990 injections were delivered by the autoinjection system, with an average depth ranging between 0.4 to 0.9mm. The only side effect noted was that of ecchymosis; this settled in three days however it, lasted longer than seven days in 14% of patients in the study, all of whom had thinner skin. Ecchymosis was not observed in those with thicker skin. 21
Mole also employed targeted injections of BoNT-A to address dynamic facial rhytids; participants with a more dehydrated appearance of their skin received the intradermal injection of BoNT-A combined with weak hyaluronic acid. Thin cannulas were used to deliver the injection, especially in harder-to-treat areas such as crow’s feet lines. Here, a single entry point was employed that allowed for targeted delivery and reduced the risk of ecchymosis. The main unforeseen side-effect was the diffusion into the great zygomatic muscle; this led to distortion, more pronounced in the extremes of smile. It was suggested to dilute the BoNT-A up to three times and to deliver it with meticulous detail to precision, particularly when injecting in the paracommissural area. This technique serves as a more favourable alternative, especially when traditional methods have proved ineffectual. 20
In a study of 15 patients treated with full face intense pulsed light (IPL), plus 8 x 0.1ml injections of intradermal Botox vs. saline in a split face comparison, intradermal Botox use has also been shown to be an effective adjunct to IPL use alone for the treatment of wrinkles, fine lines and possibly erythema. 25
Scarring
BoNT-A has shown promising results in reducing scarring when used intradermally along the margins of the scar; alternately, it has also been used in combination with steroids. This is often initiated post-operatively at approximately day seven, often when surgical stitches are removed, and repeated at two monthly intervals until scar resolution.8
Others have used BoNT-A in combination with IPL and intralesional triamcinolone for keloids; here, the microdosing treatment helped reduce the dosage and unfavourable side effects of the triamcinolone along with decreasing the frequency and intensity of recurrence. 26 One session achieved significant wound softening with the use of triamcinolone acetonide (40mg/ml) with BoNT-A at 24 U in 1ml of medytox. 26
Face lifting
Microdroplet treatment in the region of the lateral fibres of the orbicularis oculi and the platysma can lead to an overall lifting effect on the mid-face. 27,28
In this split-face study, two different dilutions of Dysport were used:28
1. Dilution of 7.5ml to give 6.67 U per 0.1ml (100 U in total)
2. Dilution of 15ml to give 3.33 U per 0.1ml (50 U in total)
10 participants received injections in the forehead and the medial and lateral aspects of each brow at 1.5-2cm intervals. They were also injected at 1cm intervals on the lateral face from the angle of the jaw to the temporalis.
Patients were subsequently evaluated at two, four, eight and 12 weeks post treatment. An overall difference in the lifting of the facial skin was observed and sustained at 12 weeks post intervention. There was no statistical difference between the two concentrations, suggesting that, in practice, the more cost-effective high dilution should be used. 28
In another prospective observational study of 30 subjects, Dysport was compared to normal saline. 500 U of Dysport was diluted in 7ml of saline. 0.04ml of the resultant solution was injected into each intradermal point. Patients were followed up for six months, and results were photographed in 2D and 3D modalities, with before and after pictures graded by masked dermatologists. All participants were observed to have an improved contour of the face, with an overall lifting effect being observed and sustained for up to 12 weeks post intervention, the most prominent areas affected were the nasolabial folds and the jawline. Reported side effects were of mild bruising, with no negative impact on the symmetry of the face. 29
Sebum production and pore size
Sebum is a lipid substance produced from the sebaceous glands accompanying hair follicles.14 Sebum provides lubrication for the skin and hair, as well as antioxidants such as vitamin E and coenzyme Q10. 30
Excessive sebum production alone can have a negative social and emotional impact on individuals, as well as contribute to skin conditions such as acne vulgaris, seborrhoeic dermatitis and psoriasis. 31,32
Currently, oral isotretinoin is among the most effective treatment options for overproduction of sebum;14 however, it has an extensive side effect profile, including anaemia, dry eye, skin blistering associated with trauma and arthralgia. 33 This side effect profile limits its patient acceptability.14
Microtoxin treatment has been linked to reduced sebum production.11,34 Shah et al. undertook the pilot study involving 20 patients with enlarged pores and oily skin, who were given one application of Botox to the T zone intradermally. It was
retrospectively observed that 85% of patients noticed an improvement in before and after photographs. There were no adverse events. 34
Rose et al. used a 100 U/ml solution of Dysport and bacteriostatic saline to inject 10 sites on the forehead of 25 patients. 3-5 U were injected to a total of 30-40 U per patient. A subjective reduction in pore size was also noted in before and after photographs. There was a reduction in the production of sebum, measured by a sebumeter, at week one of treatment; this response was sustained and observed at one, two, and three-months post-treatment. Moreover, this translated to a high level of patient satisfaction, with over 90% of patients in this study finding the use of BoNT-A as an acceptable treatment for skin that appeared oily in nature.11
Facial erythema
Inflammatory conditions, such as rosacea, can lead to marked facial erythema on the nasal bridge and cheeks. 35 This condition negatively affects patient quality of life and psychosocial wellbeing, whilst being challenging to manage. 36,37
Current treatment options include photoelectric therapies, topical medications such as ivermectin 1% cream and oral antibiotics like doxycycline. 38,39 These treatments may not be effective and/ or come with side effects, all of which have been summarised in Table 2
Intervention Issues
Photoelectric therapies, including pulsed dye lasers (PDL) and intense pulsed light (IPL)
Tetracycline antibiotics such as oral doxycycline
Beta blockers (of the non-selective type, such as propranolol), especially in patients experiencing facial flushing
PDL and IPL may be of use; however, the evidence supporting their use is moderate to low40 and required multiple sessions41
Side effects such as diarrhoea, nausea and photosensitivity42
Side effects including hypotension, bradycardia and bronchospasm make it essential to ensure the patient is monitored throughout treatment with regular blood pressure, ECG and heart rate43
Topical agents like ivermectin Poor patient compliance44 and localised skin reactions45
Table 2: Current available therapies for use in rosacea and side effects that limit their use 40-45
In rosacea, one study of 26 participants describes dilution of Botox with saline to a concentration of 4 U/0.1ml. This solution was then injected intradermally into the cheeks in a cm grid with a 30G needle. A total of 20-30 U was used per cheek.46 This led to a reduction of facial erythema, with only a mild, temporary exacerbation of erythema at the injection site. Facial erythema was measured using a five-point Clinical Erythema Score (CES) where 0 represented no erythema and 4 was severe. In this study, an average reduction in CES of 1.23 points was recorded by week 12.46 Bloom and colleagues used Dysport intradermally on 15 participants with Fitzpatrick skin types I to IV who had facial erythema of erythematotelangiectatic rosacea. The study used a dilution of with saline to a concentration of 10 U/0.1ml and used a 30G half-inch needle. Participants received between 15 and 45 U, with the dose being based on the level of erythema observed. The intradermal injection protocol involved the nasal bridge, tip and alae; however, this was expanded to involve the cheek, nose, forehead and chin. Ice packs were used in the immediate period following treatment. An independent investigator graded the facial erythema using a grading scale (0=absent, 1=mild, 2=moderate, 3=severe), at baseline and at one, two and three months after treatment. The baseline erythema
score prior to treatment was 1.80 (±0.56), a reduction to 1.00 (±0.38) by month three was observed, with an overall score reduction of 0.80 at the three month follow up.47
Compared with existing options, intradermal use of BoNT-A to treat facial erythema is safe, effective and acceptable to patients in terms of downtime and side effect profile.
Microdroplet treatment in the region of the lateral fibres of the orbicularis oculi and the platysma can lead to an overall lifting effect on the mid-face
Limitations and considerations
The published literature comprises multiple small studies, often with varying treatment protocols and brands of toxin used. More studies are required to delineate the most effective toxin type and treatment protocol for the various indications described above. Studies evidence short term benefits evident for three months, however, long term effects of repeated use of microtoxin protocols are less well understood. 29 One study reviewing five years of intradermal treatment for axillary hyperhidrosis did not identify any side effects such as tachyphylaxis or skin barrier compromise over repeated long-term use. However, this was for a different treatment protocol and cannot be directly extrapolated to apply to high dilution intradermal facial treatments.48
Microtoxin has been studied in conjunction with hyaluronic acid for face lifting and triamcinolone for keloids. It has been shown to be a useful adjunct to IPL treatment for a variety of indications. However, more study is required to clearly delineate microtoxin’s position within the existing treatment armamentarium, to achieve the greatest improvements.
Microtoxin protocols may require additional training to deliver effectively, though the principles will be broadly familiar to current injectors.
An emerging treatment option
The body of evidence supporting the use of microtoxin protocols to improve skin quality is growing. Treatment is safe and effective, leading to high patient satisfaction with minimal and acceptable side effects, such as short-term bruising.
Microdosing intradermal BoNT-A is a newer treatment option that can extend the offering of practitioners already delivering BoNT-A with no further equipment or consumable investment. It is acceptable to an existing BoNT-A experienced patient cohort and cost effective in comparison to doses used for traditional intramuscular treatment.
Given the recent rise in botulism cases linked to counterfeit botulinum toxin, it’s important for all aesthetic practitioners to be mindful of sourcing products from reputable suppliers. Read more on p.17
Miss Jennifer Doyle is a consultant oculoplastic surgeon and founder of The Clinic Holland Park. She also works within the NHS an oculoplastic consultant at Milton Keynes University Hospital NHS Trust. She is a key opinion leader for Ameela, Sciton, Sofwave and Skinstorm.
Qual: BMBCh, MA(OXON), L7Cert, FRCOphth
Dr Aaminah Haq is an ophthalmology registrar at The Clinic Holland Park, where she provides aesthetic injectables, laser and regenerative ultrasound treatments. She trained in Oxford Deanery as a microsurgeon and undertook her Level 7 in aesthetics at Harley Academy.
Qual: MBBS, BSc, L7Cert, FRCOphth
Dr Arshi Baig is a resident doctor due to complete her foundation training within the NHS in the Oxford deanery. She has an interest in oculoplastic surgery and aesthetics and is due to commence her fellowship in the field at The Clinic Holland Park.
Qual: MBChB, BSc
Questions
Test your knowledge!
Complete the multiple-choice questions and email memberships@aestheticsjournal.com to receive your CPD certificate!
Possible answers
a. Epidermis
1. Which layer would the BoNT-A be delivered to achieve skin rejuvenation?
2. Which of the following may be used to deliver BoNT-A intradermally?
3. What scale may be used to assess the severity of erythema in rosacea?
4. When delivering BoNT-A for skin rejuvenation, how far apart are the injections typically delivered?
5. Which is NOT a typical site for injection of BoNT-A for skin rejuvenation?
b. Hypodermis (subcutaneous layer)
c. Superficial dermis
d. Deep dermis
a. 27G
b. 30G
c. 34G
d. 29G
a. Erythema Index (EI)
b. Clinical Erythema Score (CES)
c. Objective Erythema Scale (OES)
d. Erythema Grading Tool (EGT)
a. 1cm
b. 2cm
c. 1.75cm
d. 3cm
a. Frontalis
b. Submental area
c. Periorbital region
d. Glabella complex
25 & 26 September 2025
Excel, London
Shaping the future of medical aesthetics
Grow your community in the specialty
Whether you're new to aesthetics or a seasoned expert, CCR connects you with mentors, industry pioneers, and like-minded professionals who can help shape your next career step.
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Staying connected in the specialty is vital, and I wish I had something like this when I was starting out, where you could speak to mentors and see that there’s no single path to success, as everyone’s journey is different.”
Dr Max Greenfield, Harley Academy
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neostimulation: defying expectations
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mesofiller® nexha
Discover a new generation of hyaluronic acid fillers which combines hyaluronic acid and succinic acid to enhance cellular regeneration without causing inflammation. The advanced dual release™ technology allows the immediate and progressive release of active ingredients, exceeding the expectations of a conventional filler and promoting cell regeneration that rejuvenates and revitalises the skin from within.
Pioneering technology, exclusive production and clinically proven efficacy position neostimulation as the future of medical-aesthetic solutions.
Mastering Advanced Lip Injections
Dr Carol Mastropierro gives a practical guide to advanced lip injections with a focus on the posterior lip compartment
According to the International Society of Aesthetic Plastic Surgery, lip enhancement with fillers ranks among the top five non-surgical procedures worldwide.1 While earlier trends often favoured significant augmentation, today’s patients are increasingly seeking subtle, natural-looking results that restore or enhance the enhance the native structure of the lips.1-3 Delivering these outcomes demands a comprehensive understanding of lip anatomy and dynamic function, moving beyond traditional superficial techniques. Recent anatomical research has highlighted the importance of deeper structures, in providing natural support and volume.
Function
and aesthetic significance of the lips
The lips are one of the most expressive features of the face, playing a critical role in non-verbal communication, facial expression and overall aesthetics. Full, well-defined lips are associated with youthful appearance, while volume loss and thinning represent signs of facial ageing.4 In terms of attractiveness, studies have shown that lip fullness and symmetry significantly influence how individuals are perceived, with fuller lips being consistently rated as more youthful and attractive.5,6
Overview of lip structure
The lips are composed of several layers and anatomical components, each contributing to their overall shape, function and aesthetic appeal.
· Cutaneous lip: The outermost portion of the lips, composed of skin, contains hair follicles and sebaceous glands. It transitions to the vermilion border at the interface between skin and mucosa.7 The philtra columns contribute to define the cupid’s bow, while its width determines lip attractiveness. A short cutaneous lip allows for more tooth show and is considered more feminine. By contrast, a long and flatter philtrum is seen in more mature individuals.7
· Vermilion: The red area of the lip, the vermilion, is a distinct region where the skin’s pigmentation darkens, creating a clear visual contrast with the surrounding skin. The vermilion plays a critical role in the perception of lip fullness and definition.4,5
· Vermilion border: This is the junction where the cutaneous lip meets the vermilion. Its sharp definition is a hallmark of youthful lips, and its fading or loss with age is a key indicator of volume loss and ageing.6,7
· Orbicularis oris muscle (OOM): This circular muscle surrounds the lips, controlling lip movement and contributing to facial expressions such as smiling or pouting. The muscle also provides the foundational support for the lips’ structural integrity.4
· Compartments: Superficial lamina propria and deep loose connective tissue provide cushioning and volume, contributing to the overall shape and definition of the lips.5,7,8 Recent anatomical research has refined our understanding of lip structure by describing distinct interlabial compartments.8
Anterior vs. posterior compartments
The lips can be divided into anterior and posterior compartments. Emerging research identified 24 consistent compartments in total – six anterior and six posterior compartments in both the upper and
lower lips – each symmetrically arranged into medial, middle and lateral sections on either side of the midline, separated by vertical fibrous septa.8
The anterior compartment lies superficial to the OOM, encompassing the dry mucosal layer and the vermillion. This area is more superficial and typically handles aesthetic changes to the lip contour, such as defining the vermilion border or adding a slight volume boost. However, this compartment is less voluminous compared to the posterior compartment and can be prone to overfilling, which may lead to unnatural results.4,8
In contrast, the posterior compartment lies deeper within the lip and contributes more to the overall structural support and volume. It contains the OOM, loose connective tissue and the labial salivary glands and, critically, the labial arteries.4,8 These structures provide the foundational volume and curvature of the lips, particularly in the central portion, which give the lips their youthful shape and projection.
Injection techniques
Both needles and cannulas have a role in advanced lip procedures, and the choice of instrument should be guided by the treatment objective, target compartment and patient-specific anatomy.
Needles are traditionally used for precise placement in the superficial layers of the anterior compartment, allowing for detailed definition of the vermilion border or subtle volumisation of the mucosa. Fine needles (such as 30G) can deliver controlled boluses or linear threads.10,11 However, needle injections carry a higher risk of vascular compromise, particularly near the vermilion border where arteries may course more superficially.4,9,12
Cannulas are often selected for deeper injections, particularly when targeting the posterior compartments. A 22G cannula is commonly used in practice to allow safe navigation through the tissues and minimise trauma to blood vessels.12,13 However, Cotofana et al highlight that larger cannulas may inadvertently cross compartment boundaries, leading to unnatural product distribution and the so-called ‘sausage lip’ effect if care is not taken.8 For a more compartment-respecting approach, smaller cannulas (25G) or careful vertical needle injections may be preferable, allowing the filler to remain within the natural anatomical confines.8,10
Anterior compartment augmentation
The anterior lip compartment is one of the most commonly performed non-surgical aesthetic procedures.1,2,8 Treatment of the anterior lip compartments is typically indicated for patients seeking contour definition, subtle volume enhancement or correction of asymmetries.3,11 This superficial layer plays a key role in shaping the vermilion border, cupid’s bow and overall lip outline. In younger patients or those with minimal structural loss, anterior filler placement can enhance the natural pout, improve definition and create gentle eversion without the need for deeper augmentation.3,5,11
Anterior compartment augmentation is also beneficial in cases of mild asymmetry, early volume loss, or where superficial rhytids (barcode or smoker’s lines) begin to develop around the lip margin.3,5,11,14
Posterior compartment augmentation
Augmenting the posterior lip compartments offers both rejuvenating and corrective benefits, particularly in cases where structural support, projection or natural eversion have diminished.4,8 Patients with congenital malformations, such as M-shaped lips or central hypoplasia, may benefit from targeted augmentation of the posterior middle compartments. This can help balance asymmetries and harmonise the lip contour. In ageing patients, progressive atrophy in the posterior compartments often leads to flattening of the lips and downward turning of the corners. Treating these deeper
Last year, UK clinics lost over in dermal filler revenue. £27,000
planes help restore projection and lip shape while minimising the risk of anterior overfilling, which can create unnatural bulk.4,5,10
Similarly, in patients with post-weight-loss volume loss or generalised facial atrophy, the lips may appear deflated and structurally unsupported. Posterior compartment augmentation provides foundational volume, helping restore natural curvature and definition without excessive surface-level enhancement.10,13
Product selection
The choice of dermal filler for posterior lip augmentation must consider the unique mechanical demands of this deeper plane. Ideal products for structural support should have a medium to high elastic modulus (G’) to maintain lift and shape under dynamic tension and moderate to high cohesivity to remain localised within the intended compartment. They should also have a low swelling profile to minimise the risk of overcorrection or puffiness in this confined space.4,5,15 In my practice I tend to use Neauvia Rheology or Revanesse Outline.
In contrast, the anterior compartments – being more superficial and mobile – benefit from softer, more flexible fillers that integrate well with dynamic tissue to preserve natural movement and expression.11 I find that RHA Kiss or Neauvia Flux work well superficially, hydrating and plumping the lips whilst remaining natural looking. While individual brand preferences may vary, products with firm, supportive characteristics are generally favoured for posterior work, whereas more malleable formulations are ideal for fine-tuning anterior contours.15-17
Before After
Vascular risk awareness
Understanding the vascular anatomy of the lips is essential for avoiding complications during injectable treatments. The labial arteries, which are branches of the facial artery, supply blood to the lips and are most frequently located within the lip’s deeper structures.4,12
The labial artery can vary in its depth within the lips, ranging from 1.5mm to 5mm below the surface, depending on the individual’s age and the region of the lip.4,12 In younger individuals, the artery tends to be deeper, located more centrally within the lip’s body, while in older patients, it may become more superficial due to atrophy of the surrounding tissue.4,12 In 97% of cases, the labial artery lies below the OOM.4 This deep location minimises the risk of inadvertent injury during superficial treatments but also highlights the need for injectors to be cautious when injecting in this region. The risk of inadvertent vascular occlusion or embolism is heightened in areas where the arteries are superficial, particularly around the vermilion border and central portions of the lip.8,12
Inadvertent intravascular injection may lead to vascular occlusion, tissue necrosis, or even more serious complications if filler embolises into larger arterial networks.9 Recognising the clinical signs of vascular compromise – including pain, blanching, livedo reticularis or immediate swelling – and responding rapidly is critical.9
Strategies to minimise risk
Safe injection into the posterior compartments requires a technique that carefully respects both anatomical structures and physiological principles. Tool selection is a critical first step, while blunt-tip cannulas (commonly 22G) are often preferred to reduce the risk of vascular injury.18,19 Depth and plane awareness are equally vital – maintaining injections within the posterior fat compartments and avoiding superficial placement is key, as arteries may lie closer to the surface where soft tissue has atrophied. Slow injection with low extrusion pressure, constant movement of the cannula or needle and careful aspiration techniques are recommended to mitigate vascular risks.8,9,24
Where available, high-resolution ultrasound imaging can be used to map vascular structures and confirm safe injection planes, particularly in high-risk patients or those with suspected anatomical variation.20 Importantly, practitioners must be prepared to manage complications.20 This includes immediate recognition of signs of vascular occlusion, prompt administration of hyaluronidase with appropriate dosing and escalation of care where required.9,21 Mastery of these safety strategies is essential to delivering effective and complication-free outcomes in posterior lip augmentation.
Training and competency
Advanced lip augmentation, particularly involving the posterior compartments, requires a high level of anatomical understanding and clinical precision. While superficial filler techniques can often be taught in basic aesthetics training, deeper, compartment-specific approaches demand more comprehensive education. Practitioners must be confident in identifying anatomical landmarks, recognising vascular variability and adapting their technique accordingly. Participation in cadaver dissection, ultrasound-guided workshops and mentorship under experienced injectors are essential components of continued development.4,8,20 Mastery in this area not only improves results but significantly reduces complication risk.9,21 As anatomical understanding continues to evolve, so must our training standards, ensuring that clinical practice remains both evidence-based and patient-centred.2
A powerful procedure
Respecting the natural compartmentalisation of the lips allows injectors to restore volume in a more controlled, anatomic fashion. Advanced lip injection techniques, particularly those that focus on augmenting the posterior lip compartment, offer practitioners the ability to restore youthful lip projection and support while maintaining natural expression.8 As we continue to prioritise safety, injectors should always rely on sound anatomical knowledge and advanced injection techniques to minimise complications. Training remains paramount to ensuring injectors can confidently address patient needs with the highest level of safety and efficacy. With careful attention to anatomy, product selection and injection methods, advanced lip augmentation can be a rewarding procedure for both patients and practitioners alike.
Dr Carol Mastropierro is an aesthetic practitioner and the founder of WRINKLESS in Hertfordshire. She specialises in anatomy-led injectables and advanced lip techniques, with a focus on safe, evidence-based practice. Qual: MBBCh, Pg Dip, MD
Figure 1: Top lip posterior compartment treated with a 25G 38mm cannula using 0.25ml Neauvia Rheology. Anterior compartment of top and bottom lip plus lip lines were treated using 0.5ml Neauvia Flux using a 30G needle.
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Clinical Insights to the Lip Flip
Dr Harry James explores the anatomical principles as well as the clinical technique and patient selection criteria relevant to lip flip procedures
The lip flip is a minimally-invasive technique of cosmetic lip augmentation. It involves injecting low doses of botulinum toxin type A (BoNT-A) along the vermilion border of the upper lip to relax the orbicularis oris muscle, causing the lip to ‘flip’ outward.¹
The goal is a fuller appearance without injecting filler into the lip tissue, a procedure that comes with its own complications such as filler migration.2 Its popularity has grown in recent years, as patients seek natural-looking lip rejuvenation.¹ Although lip fillers remain more commonly searched and used, interest in lip flips has steadily risen, affirming its role as an alternative method of lip enhancement.2
This article provides a clinical overview of the anatomical rationale, therapeutic mechanism and patient suitability considerations associated with the lip flip technique.
Anatomical overview
The lips consist of the cutis (skin), muscular layer (orbicularis oris) and mucosa, with the vermilion surrounded by the vermilion border. The orbicularis oris is the key sphincter muscle encircling the mouth.³
It comprises two main parts:
· Pars marginalis: Composed of fibres situated nearer to the lip margin, this portion plays a crucial role in defining the vermilion border and enabling fine motor control of lip movements, essential for articulation and facial expressions.³
· Pars peripheralis: Positioned more externally, it is responsible for broader, more forceful movements of the lips, such as puckering or spreading.³
The superficial fibres of these parts – especially those of the pars marginalis – influence the shape of the vermilion border and are primarily responsible for lip closure.³
Ageing causes several characteristic changes in this area, including thinning of the skin, loss of elasticity and atrophy of the orbicularis oris muscle.⁴ A histological study showed significant thinning of the orbicularis oris and degeneration of collagen and elastin in older upper lips.⁴ In practice, this leads to a less projected ‘pout’ and a drooping (ptosis) of the upper lip.⁴ Concurrently, the upper lip often lengthens, resulting in a longer philtrum and the Cupid’s bow flattens.⁵ Repeated contractions of the orbicularis oris muscle contribute to the formation of pronounced vertical perioral rhytids.⁴
These anatomical changes underlie the desire for rejuvenation. A lip flip works by relaxing the superficial fibres of the orbicularis oris, particularly within the pars marginalis, reducing inward muscular tension. This allows the upper lip to gently evert, creating the appearance of a fuller vermilion without actually adding volume.³
Indications Subtle eversion of the upper lip, mild gum show, early perioral lines
Volume enhancement, structural correction, defined lip borders
Longevity Typically eight to 12 weeks Typically six to 12 months
Downtime Minimal; normal activities can be resumed immediately
Volume change No actual volume added; creates appearance of fullness via eversion
Reversibility Not reversible; effect wears off naturally
Risk profile Transient weakness (e.g. sipping, whistling), possible asymmetry if misapplied
Minimal; potential for mild swelling or bruising
Adds volume directly to the lip tissue
Reversible with hyaluronidase
Risk of bruising, swelling, migration; generally well tolerated
lip filler procedures, highlighting key differences in indications, longevity, volume effects, recovery and risk profiles. 2
Patient selection
Ideal candidates are those seeking a subtle lift or eversion of the upper lip rather than substantial volume enhancement. Examples include patients with a mildly inverted upper lip, excessive gum show on smiling or early perioral lines. Lip flips are best for patients who want a natural-looking, temporary improvement.² They are popular among patients seeking slight enhancement without the use of filler. In some cases, patients may have had a previous negative experience with lip filler for example filler migration.³
By contrast, patients to avoid include those who expect dramatic volume increase or long-term correction. When I see cases of severe lip thinning or more pronounced sagging, I find that fillers tend to offer a better solution, since they more effectively address the underlying volume loss. Patients who rely on precise lip function (singers, wind instrument players, speakers, etc.) should be cautious, as even mild paresis of the orbicularis oris can transiently affect articulation or sipping.³
Standard BoNT-A contraindications apply, including pregnancy, breastfeeding and neuromuscular disorders. A thorough patient history is essential, encompassing current and past medical conditions – particularly neuromuscular diseases such as myasthenia gravis or Lambert-Eaton syndrome, which may increase sensitivity to botulinum toxin.6 It is also important to document any history of dysphagia, respiratory conditions or previous adverse reactions to BoNT-A.7
Medication history should cover agents that may interfere with neuromuscular transmission (e.g. aminoglycosides, muscle relaxants).6 Psychological suitability and aesthetic expectations should also be assessed to ensure the patient is an appropriate candidate and understands the temporary, subtle effect of the lip flip, which is intended to enhance form rather than volume.8
Treatment approach
Prior to the procedure, patients should have a thorough medical assessment to confirm suitability, as well as being counselled on the potential risks. Reconstitution of the chosen toxin should be carried out as per manufacturer’s instructions. If preferred, the treatment area can be prepared with a topical anaesthetic cream, before cleaning with sterilising wipes or solution.
A common technique is to inject 1-2 U of BoNT-A e.g. Botox or Bocouture, at five to six equally space points about 2mm above the vermilion border of the upper and/or lower lip.3,9 A fine 30-31G needle (0.3ml syringe) is used for accurate placement.¹ Injections should stay about 1cm medial to each corner of the mouth to avoid
Table 1: This table compares lip flip and
the modiolus and should remain superficial (in the cutaneous lip) to prevent diffusion into deeper sphincters.¹
Recovery is minimal and patients can typically resume normal activities immediately.2 While swelling or bruising is uncommon, it occurs at similar rate to that seen with dermal filler injections.² No special post-procedure care is necessary, aside from avoiding massage of the area on the injection day to minimise the risk of unwanted spread of toxin.¹
Clinical outcomes and efficacy
In appropriately selected patients, lip flips relax orbicularis fibres and create an outward curl of the vermilion that mimics a fuller lip profile.² Clinical case studies report that most patients are pleased with the natural outcome.⁵ A systematic review of 495 papers on lip lift techniques also found ‘good’ satisfaction in non-surgical cases, with no severe complaints.10
Importantly, the lip flip can help reduce fine upper-lip rhytids and mild gingival display without producing bulky augmentation.² However, the results are subtle and temporary, typically lasting eight to 12 weeks,² significantly shorter than the six to 12 months commonly seen with hyaluronic acid (HA) filler. Unlike fillers, the lip flip does not add volume; instead, it everts the existing lip tissue.² BoNT-A injections result in the appearance of fullness achieved by creating a subtle pout, rather than by increasing the actual surface area or volume of the lip.²
As such, the lip flip is best considered a fine-tuning tool rather than a replacement for dermal filler. Many patients also appreciate that it avoids direct injection into the lip tissue itself.² The side effect profiles of both procedures are similar, with potential for mild bruising or swelling at the injection site. However, lip flips generally carry no additional risks beyond the established safety profile of BoNT-A.² Both treatments can be used in combination.³
Treatment longevity
A lip flip can be repeated indefinitely at approximately three-month intervals depending on the brand of toxin used, similar to other BoNT-A treatments. There is limited evidence of resistance, and some practitioners note that very frequent use may induce mild muscle thinning (enhancing the ‘flip’), though this has not been formally studied. Clinically, lip flips have become a common tool in multimodal lip enhancement. Trends data show continuing growth in interest and search analysis demonstrates a steady rise in online interest over the last decade.²
In practice, many practitioners combine lip flips with other treatments. A common strategy is to use HA filler for core volume and a lip flip to perfect the vermilion border or reduce gingival show.³ Relaxing the orbicularis oris through the flip complements HA filler injections and anecdotally may help prolong the effect.³ In multi-step aesthetic protocols, the lip flip may be scheduled before or after filler injection to fine-tune results with minimal additional downtime, ideally scheduling two weeks between treatments to allow time for bruising and swelling to settle.³
Clinically, this integration requires anatomical literacy such as knowing which fibres to target and when fillers are preferable.10 Thus, for long-term planning, practitioners should view the lip flip as a bridge therapy – effective and in-demand, but typically one component of a broader lip rejuvenation strategy. Patients seeking structural enhancement or correction of asymmetries, particularly with longer-lasting and reversible results, may be better suited for dermal fillers. A key advantage of HA fillers is their reversibility through the use of injectable hyaluronidase, which allows for dissolution if the outcome is unsatisfactory.
Ideal candidates are those seeking a subtle lift or eversion of the upper lip rather than substantial volume enhancement
Contraindications and complications
In addition to standard contraindications for BoNT-A such as pregnancy, breastfeeding, active infection at the injection site, neuromuscular diseases and known hypersensitivity to any toxin components, clinicians should be aware that lip flips are considered off-label use.2 Practitioners must clearly inform patients that BoNT-A is not licensed in the UK for perioral use, and appropriate informed consent should be obtained.³
The lip flip is generally safe, particularly when performed by experienced practitioners. Minor side effects include transient bruising, swelling or injection discomfort – similar to dermal fillers.³ However, due to the functional role of the orbicularis oris as a sphincter muscle, patients may experience temporary weakness. Patients may have brief difficulty with activities like whistling or sipping through a straw.³
More noticeable adverse effects may result from excessive dosing or incorrect injection placement, including oral incompetence (e.g. drooling), asymmetry of the smile or loss of Cupid’s bow definition.³ To minimise these risks, clinicians should avoid injecting too laterally or too deeply, ensuring placement remains within the superficial fibres of the orbicularis oris to prevent unintended diffusion to adjacent muscles.³
These effects typically resolve in a few weeks as the toxin effect wears off. No systemic or long-term complications have been reported in limited case series,⁴ and no severe adverse events have been noted in reviews.5
Key considerations for practice
As interest in minimally invasive lip procedures grows, practitioners should maintain a detailed understanding of lip anatomy and ageing. Informed patient counselling is key; explaining that results are temporary, modest and off-label.³ The lip flip embodies a patient-centred approach to lip rejuvenation – combining aesthetic goals with anatomical technique – and is a worthy option in modern UK aesthetic practice.
Dr Harry James graduated from Glasgow Medical School in 2016 and has a level 7 diploma in clinical aesthetic injectable therapies. He is an NHS specialty doctor, aesthetic practitioner, ACE Group World faculty member and committee member for the JCCP. He is the lead trainer at MedAesthetic Academy on Harley Street, where he educates medical professionals in aesthetic injectables. Qual: MBChB, PGDip (CAIT)
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Treating the Jowls with Threads
Dr Charlotte Woodward shares her technique to lift the jowls using threads
As we age, our skin undergoes various changes that can lead to sagging and the development of jowls. These stubborn areas can be frustrating for many seeking a youthful appearance.
This article will explore how threads can lift the jowls, the types of threads available, suitable candidates for treatment and before and after advice.
Causes of jowling
Jowls are a common aesthetic concern associated with ageing. They appear when the skin around the jawline loses elasticity and begins to sag, exacerbated by bone loss and fat pad ptosis.1 This is often due to a combination of factors, including genetics, sun exposure and lifestyle choices such as smoking.2
The ageing process also plays a part, as collagen production decreases over time, our skin becomes less resilient.3 Weight fluctuations can also contribute to this issue by stretching the skin.4
Traditional treatments for jowls
Non-surgical
The options for addressing aesthetic concerns related to the jowls range from non-invasive to more surgical procedures, each with its unique benefits and limitations. Injectables such as botulinum toxin (BoNT-A) to the depressor anguli oris (DAO) muscles and Nefertiti bands, and dermal fillers to the mid-face and jawline, can provide structural support and soften age-related contours.5
Pre-treatment with BoNT-A in the lower face – specifically targeting the DAO and platysmal bands – can help to reduce downward-pulling muscle activity.6 This facilitates a more effective and longer-lasting thread lift by minimising dynamic resistance and improving lift longevity.7
Chin and jawline augmentation with hyaluronic acid (HA) fillers can further enhance results by defining mandibular contours and supporting areas prone to volume loss, such as the marionette lines.8
Skin-tightening treatments such as laser resurfacing, radiofrequency with microneedling and high-intensity focused ultrasound (HIFU), also aid in reducing jowl prominence without surgery. These methods work by stimulating collagen production and promoting firmer skin over time.9
Surgical options
For patients with heavier tissues or significant skin laxity, non-surgical options may not be a suitable solution.10 Unfortunately, thread lifts in patients with advanced laxity are unlikely to provide durable results and may ultimately lead to disappointment for both the patient and practitioner.11
Thread lifts offer significantly reduced downtime compared to surgical facelift procedures.12 Most patients can resume normal activities within a few days, with some returning to work as early as the following day, depending on the extent of swelling or bruising.
In cases of marked tissue descent or redundant skin, a surgical facelift performed by a qualified aesthetic or plastic surgeon is typically the most effective solution. Surgical lifting enables the removal of excess tissue, deeper structural repositioning and more substantial long-term rejuvenation.13
Assessing patient suitability for either surgical or non-surgical approaches is discussed in detail below.
Introduction to thread lifts
Thread lifts have emerged as a popular non-surgical option for those patients seeking to address sagging skin, particularly in the jowl area, with natural results.14 They provide immediate mechanical lifting effects, enhancing facial contours without the need for extensive surgery, allowing patients to return to daily activities within days.15 Clinical research has shown that thread lifts are effective for mild to moderate skin laxity, offering high patient satisfaction rates and improvements in skin firmness and facial contour, especially in the lower face.7
Neocollagenesis from threads causes the skin to tighten, thicken and lift over the three months following the thread lift, with improvement to lines, firmness and tissue texture which lasts for up to two years.16 There are several kinds of threads – polydioxanone (PDO), poly-L-lactic acid (PLLA) or polycaprolactone (PCL) – each offering unique benefits.17 Understanding these options is crucial for achieving optimal results and patient satisfaction.
For patients who are either unwilling to undergo surgery or are contraindicated due to underlying medical conditions, thread lifting presents a safe and effective minimally invasive alternative for facial rejuvenation.18 Combining thread lifting with dermal fillers offers a synergistic approach to facial rejuvenation, particularly in the mid- and lower face.19 Strategic filler placement in the mid-face can restore volume and support the superficial fat pads, helping to reduce soft tissue descent and heaviness in the lower third. This not only improves facial contour but also creates a more stable foundation for thread lifting procedures.20
Thread materials and clinical considerations
The primary difference between thread materials lies in the type of collagen they stimulate and their interaction with different tissue types.17
PLLA and PCL threads primarily induce type I collagen, which is more elastic and better suited for patients with lighter or thinner, soft tissue.18 These threads are often selected when a gradual, biostimulatory effect is desired alongside mechanical lifting. Their degradation timelines range from 12 to 18 months, depending on composition.21
PDO threads, on the other hand, stimulate predominantly type III collagen, which is denser and more fibrotic, offering stronger structural support.17 This makes them particularly useful for patients with heavier or more lax tissues. PDO threads typically degrade in six to eight months, though the collagen remodelling effects persist longer.18
Thread design also plays a role in performance. Moulded barbs or cone-based configurations can increase pull-out strength and mechanical lift.22 Deeper thread placement, such as in the supra-SMAS layer, may be used for more significant tissue repositioning,22 while hypodermal placement can be effective in lighter tissue cases.24
Understanding the characteristics of each thread type – material, degradation profile, collagen stimulation and design – is essential for selecting the most appropriate treatment plan and achieving long-lasting, natural outcomes.
Patient selection
While thread lifts are generally recommended for individuals between the ages of 30 and 60, chronological age is not the primary factor in determining suitability.14 Instead, candidacy is best assessed based on skin quality and facial anatomy.14
Ideal candidates have skin with adequate thickness – typically between – 1-1.5cm – and minimal soft tissue heaviness.25 Skin that is too thin may lack the structural support required for effective thread
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anchoring, while excessively heavy or bulky soft tissue can compromise lift longevity and aesthetic outcome.25
At the initial thread consultation, expectations need to be addressed, along with a full medical history.
Before a thread lift, I advise no non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol for 24 hours to minimise bruising and blood thinning. I also advise arnica 30C tablets for three days in advance to reduce bruising, and to arrive at the clinic makeup free.
I usually advise the use of radiofrequency microneedling (I use Morpheus8), biostimulating injectables (such as Ellansé), polynucleotides or other regenerative treatments prior to the thread lift. Thread lifts should be performed three months after other collagen stimulating treatments. This is especially for patients with excessive laxity who are not suitable for immediate thread lifting, non-surgical treatments that stimulate collagen and improve tissue quality can be used to reduce laxity and enhance candidacy. This approach is often preferred by patients seeking to avoid surgery. Addressing laxity beforehand is crucial, as proceeding with a thread lift in unsuitable tissue can result in a temporary lift that may relapse within two weeks.
Contraindications
Thread lifting is contraindicated in patients who are pregnant or breastfeeding. It should also be avoided in individuals with active inflammation or infection in the treatment area, including cysts, acne, rashes or urticaria.26
Patients with acute illnesses, autoimmune disorders or those undergoing treatment with immunosuppressants are not suitable candidates for this procedure.27 The treatment is not recommended in patients with known allergies or sensitivities to plastic biomaterials, bleeding disorders, cutaneous neurofibromatosis (nerve tumours) or non-absorbable implants (such as silicone) in the intended area of thread insertion.28 Severe allergy history should also be considered a contraindication.
Patients with a predisposition to keloid or hypertrophic scarring should also not undergo thread lifting, due to the risk of adverse tissue response.29 Additionally, individuals currently undergoing chemotherapy are unsuitable, given their compromised immune status and potential for impaired wound healing.30
Carrying out treatment
Planning your thread lift vectors is essential for a good result; these are taught in thread training sessions and are different for every patient and for the type of thread you are using.31 The most common vectors are from the temple region down to the nasolabial and marionette lines. I aways lift the upper face too, as this supports and aids in the lifting of the lower face, especially the jowl region.
Patients are advised they are likely to achieve 1cm lift, and if they require more than this combination treatments are advised for optimum results.
After marking up the face for the procedure, the patient’s face is thoroughly cleansed using a hypochlorous acid solution; I use Clinisept. The entry points are anesthetised with 2% xylocaine and the tracks are infiltrated with 2% lidocaine if using PDO threads. This makes the procedure more comfortable for the patient. The threads are then inserted, tightened and trimmed off. Antibiotic ointment is then applied to the exit points, and the patient is given a bag to take home containing a neck pillow, ice packs and paracetamol.
Aftercare
Essential aftercare advice following thread procedures includes:
· Apply a cold pack immediately after the procedure if required.
· Take analgesia e.g. paracetamol and all low-dose codeine in case of pain. Avoid NSAIDs in the first 48 hours.
· Mineral makeup can be applied gently after 24 hours.
· Sleep face up with head elevated for three to five nights to allow swelling and bruising to settle.
· Avoid over exposure to direct sunlight and tanning beds for at least two weeks, as heat will increase inflammation.
· Avoid high impact sports e.g. running for two weeks to avoid the face moving excessively up and down.
· Avoid excessive facial movements for two weeks as this may dislodge the threads before they have settled into the skin.
· Do not use saunas for two weeks as excessive heat affects inflammation.
· Avoid dental surgery for three weeks to prevent wide mouth opening that may risk dislodging threads.
· Avoid facial massages for three weeks and facial aesthetic treatments for ideally three months until final thread lift results are seen.
Follow-up appointments are crucial. This ensures any concerns are addressed promptly. In my clinic, we follow up with all
thread patients two days after treatment, and schedule in-person reviews at two weeks and three months post treatment.
Potential complications
Common side effects include swelling, bruising or discomfort at the insertion sites or along the threads, which can last up to two weeks.16
Complications associated with thread lifting are often technique-dependent. Threads placed too superficially may result in visible irregularities or puckering of the skin.32 Conversely, if threads are positioned too deeply, they may fail to engage and lift the targeted tissue effectively, and there an increased risk of trauma to deeper anatomical structures. Transient bruising and swelling are common post-procedure effects, typically resolving within one to two weeks.16
Careful technique and thorough anatomical knowledge are essential to minimise risks and optimise outcomes.33,34
To prevent infections prophylactic antibiotics can be given and anyone performing thread lifts should be performing threads regularly to ensure they are safe and up-to-date with the latest techniques.30 Thread lifting should only be performed by medically qualified practitioners. It is essential that clinicians are registered with the Care Quality Commission (CQC), have attended accredited training in thread lift techniques, and have completed at least one supervised procedure prior to independent practice.35
Reinvigorating the jawline
When it comes to treating jowls, thread lifts offer a minimally invasive solution that can greatly enhance patient satisfaction. Thread procedures lift sagging skin in the jowl area to provide immediate results, while also stimulating collagen production over time, leading to improved skin texture and elasticity.
Dr Charlotte Woodward started her career working as a GP in 1996, ventured into aesthetics over 20 years ago and now works exclusively in the aesthetics sector. She is the co-founder of River Aesthetics, has been involved in various clinical research and is a trainer/KOL for Sinclair, Mint PDO Threads, Desirial and Vaginal Revolution.
Qual: MBCHB, MRCGP, MBCAM
Managing Skin Through Menopause
Dr
Ginni Mansberg addresses the dermatological challenges of menopausal skin and offers practical strategies for effective management
As practitioners working in medical aesthetics, it is easy to think of menopause in terms of lines, volume loss and skin laxity. But the hormonal shifts that define this stage of life also drive significant changes in skin health, many of which are inflammatory, reactive and distressing for patients.
From sudden perimenopausal breakouts to postmenopausal sensitivity and visible ageing, understanding what’s happening at a cellular and biochemical level is key to managing these changes safely and effectively.
Distinguishing perimenopausal and menopausal skin
The distinction between perimenopause and menopause is typically based on the time elapsed since the last normal menstrual period. Menopause is clinically defined as having occurred after 12 consecutive months without menstruation. If fewer than 365 days have passed, the individual is considered to be in the perimenopausal phase. It is important to note that the skin alone is not a reliable diagnostic indicator for determining hormonal stage.1
The power of hormones within skin health
Oestrogen plays a critical role in skin health by acting as a powerful anti-inflammatory and supporting the skin barrier through pH regulation. It also promotes ceramide production, enhances hydration, and counteracts the effects of androgens such as testosterone.2-5 Additionally, it helps build collagen and inhibits its breakdown by matrix metalloproteinases (MMPs), particularly MMP-1, which targets type I collagen.6,7
In women with oestrogen deficiency, a result of menopause and the ovaries’ inability to continue to produce oestrogen, skin thickness decreases by 1.13% and collagen content by 2% each year after menopause.8 Type I and III skin collagen drop by around 30% in the first five years after menopause, closely matching the same reduction in bone mass observed in post-menopausal women.6,9 Type I collagen is a coarser fibre that acts as a structural scaffold, maintaining the skin’s strength and structure.10 Type III collagen is a smaller fibre that contributes to skin elasticity.11
As oestrogen levels decline, a cascade of skin changes occurs. Reduced oestrogen impairs the skin barrier’s effectiveness, partly due to its role in promoting ceramide production; when oestrogen decreases, ceramide levels drop, leading to increased skin dryness.4,10 Additionally, lower oestrogen is associated with heightened skin inflammation, which can further exacerbate dryness and irritation.4 This inflammation is thought to result from IFN-d mediated inhibition of Th-17 cells and suppressing TNF-a.12 The skin becomes thinner, drier and less elastic, with a diminished capacity for wound healing.3 This combination creates an optimal environment for the simultaneous onset of breakouts, dryness, increased sensitivity and accelerated skin ageing.
When examining pigmentation in the context of hormonal skin health, there is a well-established link between oestrogen and hyperpigmentation. Increased pigmentation is commonly observed during pregnancy and with the use of oral contraceptives. Currently,
there is no strong evidence to suggest a direct association between menopause itself and increased pigmentation. However, some cases of melasma have been reported following treatment with menopause hormone therapy.13 The underlying mechanisms behind the relationship between oestrogen and pigmentation remain unclear.13
Discussing perimenopausal skin
Skin-related concerns are not limited to menopause – individuals often begin to experience dermatological challenges during perimenopause as well. While acne is often associated with adolescence, perimenopausal acne is increasingly common, affecting many women in their 40s and early 50s.14 A 2006 survey of 1,013 participants found that 26.3% of women aged 40-49 experienced acne, as did 15.3% in their 50s.14
In most cases, the acne is persistent rather than newly developed.15 These breakouts are typically inflammatory, often cystic and tend to cluster around the chin, jawline and lower cheeks.16 However, due to the additional effects of declining oestrogen, as previously outlined, these lesions may coexist with dryness, flakiness or heightened sensitivity.17
Rosacea is another common concern, often appearing for the first time during perimenopause, and continuing after menopause.18
Hot flushes and vasomotor symptoms can aggravate underlying vascular instability, while a compromised barrier makes skin more reactive to known rosacea triggers like heat, alcohol and certain skincare products.18
Primary changes within perimenopause:
· Relative androgen dominance (testosterone unopposed by declining oestrogen).5
· Changes in skin barrier function, allowing greater inflammation.19
· Stress and sleep disturbances common in this life stage.10
· Possible contribution from fluctuating cortisol and insulin levels.10
Navigating skin health through menopause
With declining oestrogen levels, the integrity of the epidermal barrier diminishes.3 This reduction is associated with decreased ceramide production, increased transepidermal water loss and heightened sensitivity of cutaneous nerve endings, as demonstrated in rodent models.4,18,19 This can leave the skin feeling tight, prickly or itchy, and more prone to sensitivity. It may react to common skincare ingredients such as fragrances, formaldehyde-releasing compounds, isothiazolinones, paraphenylenediamine and other dyes.20 Reactions may also occur with certain active ingredients, including retinol and hydroquinone, as well as aesthetic treatments and environmental stressors.21,22
A Dutch study of 278 female participants reported that 70% of peri- and postmenopausal women experienced increased skin sensitivity, with common triggers including shaving, environmental conditions, psychological stress and topical skincare products.23 This sensitivity can affect how we approach everything from topical products to in-clinic procedures. In my experience, the most effective approach is to begin by asking the patient whether they have sensitive skin and if they’ve experienced any reactions to skincare products or in-clinic treatments in the past.
Most patients are forthcoming about their experiences, which allows you to tailor treatments to suit their individual skin needs and concerns. For example, if a patient is concerned about fine lines and wrinkles but also has sensitive or reactive skin, opt for an antiageing regimen that supports the skin barrier, with ingredients like niacinamide and ceramides, while avoiding harsher actives. Swap alpha hydroxy acids (AHAs) for gentler polyhydroxy acids (PHAs) and consider replacing retinol with retinal.
Strategies for managing menopausal skin
With an understanding of the underlying factors driving skin changes during menopause, it is essential to explore strategies for supporting and managing your patients’ skin.
Medical-grade skincare
When providing skincare guidance to menopausal patients, the principles of simplification, support and soothing should serve as the foundation. A ‘less is more’ approach is particularly important when the skin barrier is compromised.
Retinaldehyde, niacinamide, peptides, PHAs and ceramide-rich moisturisers can be used in clinic protocols or home regimens. Cosmeceutical skincare brands that are well tolerated include ESK Evidence Skincare, as it combines skin barrier-supporting ingredients with well-tolerated, evidence-based actives. Additionally, AlumierMD and Dermalogica products are generally well tolerated by most skin types.
Consider a simplified routine post procedure to avoid post-inflammatory flare-ups. It is advisable to collaborate with your skincare supplier to create customised post-treatment protocols. However, avoid applying a one-size-fits-all approach, as each patient’s skin and primary concerns differ. Work closely with your patient to tailor a regimen that addresses their specific needs while ensuring it is gentle enough to prevent irritation.
Key considerations include cleansers, moisturisers, sunscreen, exfoliators and vitamin A.
Cleansers
Gentle, non-foaming, and soap-free cleansers are recommended, particularly during times of increased skin sensitivity.24 Look for formulations with a pH below 5.5 to help support the skin’s acid mantle.24 This is beneficial for all skin types but especially important when the risk of irritation is elevated. It is also advisable to avoid harsh surfactants such as sodium lauryl sulfate (SLS).24
Moisturisers and barrier repair
For those with a compromised skin barrier – whether due to hormonal changes or other factors – ingredients like niacinamide, ceramides and panthenol can be particularly beneficial.25-27 Niacinamide supports barrier repair by boosting the production of ceramides and structural proteins such as keratin and filaggrin, while also reducing inflammation.26 Ceramides help replenish the skin’s natural lipid layer, and panthenol improves barrier integrity by increasing intercellular lipids and the length of lipid lamellae.28 Avoid using overly occlusive creams if the skin is acne-prone.29,30
Sunscreen
When choosing sunscreen for sensitive or hormonally affected skin, broad-spectrum mineral formulations containing zinc oxide or titanium dioxide are the least likely to cause irritation, as they are inert, non-irritating minerals that are less likely to trigger skin reactions.31 For daily use, the Skin Cancer Foundation advises broad-spectrum protection against UVA and UVB rays.32 It’s also best to avoid products with added fragrance or high alcohol content, as these can further compromise the skin barrier.33
Exfoliators
For exfoliants, avoid glycolic acid and other strong AHAs, as these can irritate sensitive menopausal skin.34,35 Instead, choose PHAs like gluconolactone or lactobionic acid, which are gentler and better tolerated.36
Vitamin A
Vitamin A derivatives, such as retinoids, can support skin health, but choice and timing are key. Retinaldehyde (retinal) is more effective than retinol yet gentler, making it suitable for sensitive or hormonally reactive skin.37 However, prescription-strength tretinoin or high-strength retinol should be avoided during flare-ups or
periods of heightened sensitivity, as they can further irritate already reactive skin.37,38
Considerations for skincare
Be cautious with potentially irritating ingredients, especially when the skin is already sensitive. Vitamin C serums, while beneficial, can trigger irritation in reactive skin.39 Essential oils, alcohol-based toners and AHAs may cause discomfort or exacerbate sensitivity.40-42
Any product that stings or burns, such as retinol, hydroquinone, fragrances, dyes or preservatives, should be avoided initially. Prioritise repairing the skin barrier before reintroducing active ingredients.
Aesthetic treatments for menopausal skin
Many menopausal patients seek aesthetic procedures to address visible signs of ageing, but the skin can be more reactive and prone to inflammatory responses.
Injectables
· Botulinum toxin and hyaluronic acid fillers are generally well tolerated, as they act below the level of the skin barrier.43
· Be cautious if there’s a history of rosacea or dermographism. Inject slowly, use small volumes and avoid overcorrection.44
· Delayed hypersensitivity reactions to hyaluronic acid fillers are rare (0.5%-0.8%), usually mild and self-limiting, with even lower risk when using purer, newer-generation products.45
Energy-based devices
· Laser and light-based treatments can improve pigmentation, texture and collagen in menopausal skin.46
· The use of laser treatments on the facial skin of postmenopausal women has not been extensively studied, warranting a cautious and individualised approach.
· Possible adverse effects include post inflammatory hyperpigmentation and prolonged erythema.46
Chemical peels
· Avoid strong peels (trichloroacetic acid, phenol) on anyone with sensitive skin. Ask your patient if their skin is sensitive and about their previous experience with skin peels.
· If there is any uncertainty, it is best to proceed with caution.47 Superficial peels using PHAs or lactic acid may be better tolerated.47
· Always prioritise rebuilding the skin barrier before starting any active treatments. Begin by prepping the skin with barrier-supporting ingredients such as niacinamide, panthenol and ceramides.
· Advise patients to avoid midday sun exposure and ensure they use a broad-spectrum SPF consistently.
Navigating the future of skin quality
Menopausal skin is dynamic, complex and deeply impacted by hormonal shifts, particularly the loss of oestrogen. For aesthetic practitioners, understanding the biochemical changes driving skin sensitivity, breakouts and inflammation is key to offering safe, effective and confidence-restoring care.
Disclosure: Dr Ginni Mansberg is the founder of ESK Skincare
Dr Ginni Mansberg is a Sydney-based GP with a special interest in women’s health, dermatology and hormones. She is the founder of ESK Skincare and author of The M Word – How to thrive in Menopause. She is a regular media contributor and speaker on evidence-based skin and hormone health.
Qual: B.MED, GAICD
Innovations Shaping the Future of Aesthetics
Discover the products that took the specialty by storm this year
The aesthetics specialty is constantly evolving, with innovative products launching each year that shape the future of treatment and patient care. At The Aesthetics Awards, we celebrate the standout innovations making a real impact in the UK and Ireland’s medical aesthetics community. Each year, our expert panel of judges carefully
AviClear
Cutera
Winner of this year’s Best New Innovative Product, AviClear is the first and original FDA-cleared laser for the treatment of mild to severe inflammatory acne vulgaris, and the next-generation solution, delivering lasting improvement. It’s an efficient, powerful in-clinic treatment developed to significantly reduce active, inflammatory acne and prevent future breakouts by treating acne at the source with no medication or downtime. AviClear uses a 1726 nm wavelength that selectively targets and down-regulates the sebaceous glands rather than targeting melanin or water, thus causing minimal damage to the surrounding tissue. AviClear can achieve this with a non-ablative, 100-watt laser, complete with AviCool sapphire cooling to reduce downtime and discomfort without the need for topical anaesthetic. The nature of the technology also means it is safe to use for all Fitzpatrick skin types. AviClear significantly minimises the severity and frequency of acne after three sessions, four weeks apart.
CMT Post Procedure Cream
Revision Skincare
CMT Post-Procedure Cream is a neurocosmetic formulation that enhances the post-treatment recovery experience, helping patients recover better and faster. The product is clinically proven to significantly reduce pain perception and downtime following procedures like chemical peels, microneedling and laser treatments and packed full of pre and post biotics and peptides to speed recovery time.
Suitable for all skin types, the CMT Post-Procedure Cream is ideal for patients seeking a more comfortable recovery. It addresses common post-treatment discomforts, such as redness, itching, burning and stinging, for a smoother post-treatment experience.
considers the entries to recognise the most impressive and influential advancements.
With entries for the 2026 Aesthetics Awards opening on August 4, take inspiration from last year’s Finalists for Best New Innovative Product and discover the cutting-edge technologies that could elevate your clinic offering.
ULTRApulse Alpha
Lumenis
Built upon 50 years of CO2 heritage, and over 100 published clinical studies, the new ULTRApulse Alpha delivers precise, controlled energy for optimal ablation with minimal excess thermal damage, leading to improved results, safety, patient comfort and reduced healing time relative to other ablative platforms, for a wide range of aesthetic skin rejuvenation, textural and scar revision treatments.
The unique ‘UltraPulse’ high speed delivery of powerful 10,600 nm CO2 laser energy in Alpha delivers clean, precise and controllable ablation/vaporisation of soft tissue for a wide range of indications due to its very high absorption in water. The combination of this high speed, high power and enhanced interface, results in safer treatment with lower incidents of side effects and shorter recovery.
Purasomes
DermaFocus
Purasomes comprises three products that each contain AMPLEX Plus – a patented technology created using secretomes, which combines the action of 20 billion exosomes, 20 growth factors and other beneficial properties from the 250+ bioactive elements found in ethically sourced bovine colostrum.
The Klira Special is next-generation prescriptive skincare. It is a bespoke formulation, unique in its level of personalisation and efficacy.
Bringing together both class-1 evidenced medical ingredients with cosmeceuticals to support the skin barrier and delivery of actives into the dermis, each Klira Special is an ‘all in one’ treatment formula containing everything your skin needs for optimum health in a single nightly step. The ingredients are numerous and include tretinoin, azelaic acid, hydroquinone, ivermectin, aloe, shea butter, peptides, ceramides, cholesterol and collagen.
V-Tech Serum
Promoitalia
V-Tech Serum, manufactured in Italy, is a ready to use solution that contains polynucleotides (2%) within a synthetic exosomal structure, enriched with biomimetic peptides and plant stem cells. It is a concentrated formula of highly effective active ingredients that genuinely promote cell regeneration.
This technology enables the encapsulation of substances capable of activating regenerative processes within micro vesicles measuring just 100 nanometers. V-Tech Serum delivers visible improvements in skin texture after just one session. It enhances the thickness of the extracellular matrix, reduces expression lines and firms the tissue. Its vascular-level action enhances oxygenation and tissue perfusion, thereby optimising and stimulating the growth of new cells.
The BBL HEROic is the latest innovation in advanced BroadBand Light (BBL), building on the original BBL HERO (High Energy Rapid Output), the HEROic incorporates Intelligent ControlTM (ICTM) and the unique Skin Positioning SystemTM (SPSTM) for unmatched patient outcomes.
Intelligent Control acts as the system’s ‘brain’, adeptly processing 3D spatial data for precise, automated pulse delivery. This innovation, alongside the new autodynamic pulsing feature, adapts to the operator’s speed, dramatically reducing full body treatment times while ensuring precision and uniform results across treatments.
This next-generation technology treats a variety of skin conditions including pigmented and vascular lesions, acne and general skin rejuvenation, making it ideal for both patients and practitioners in fast-paced aesthetic settings.
Could you be next?
Does your company offer a product that’s truly innovative? Entries for The Aesthetics Awards 2026 open on August 4 – don’t miss your chance to gain specialty recognition and be named a Finalist at the most prestigious event in the aesthetics calendar. Turn to p.xx to find out more.
Tri-Wave MD
Dermalux
The Dermalux Tri-Wave MD delivers optimal energy dosing with uniform light distribution, ensuring consistent, high-performance results across every treatment.
It deploys Blue (415 nm), Red (633 nm) and Near-Infrared (830 nm) wavelengths, together or individually, with up to 240 j/cm² per session. Clinically validated. CE Class IIa-certified. FDA Class II-cleared.
The large, adjustable four-pod head treats full-face, or body zones with precision and speed. Light on skin, completely non-invasive and pain-free, with zero downtime.
Effective across multiple skin concerns such as acne, psoriasis, wound healing and more. Protocol-boosting synergy.
HA Microneedle Eye Patches
PCA Skin
PCA Skin launched the highly anticipated Hyaluronic Acid Microneedle Eye Patches in September 2024. Each pair of under-eye patches uses 1,254 self-dissolving microneedles to deliver 50mg of 4-D hyaluronic acid (HA) and antiageing ingredients into the delicate eye area. The unique formula combines powerful hydrating and brightening ingredients that work together to visibly improve the appearance of wrinkles, dark circles and puffiness. The formula features four types of HA, creating a three-dimensional hydration network that targets various skin layers.
Klira Special
Cutera, DermaFocus, Dermalux, Sciton, Klira and Promoitalia are all exhibiting at the Clinical Cosmetic Regenerative Congress (CCR). Turn to p.20 to register for free now and learn all about the latest innovations in the medical aesthetics specialty!
Facial Rejuvenation Using STYLAGE® Dermal Fillers
Dr Mei-Ying Yeoh provides a case study using STYLAGE® to treat the effects of weight loss
In recent years, an increasing number of patients presenting to aesthetic clinics report facial changes following significant weight loss – whether through lifestyle modification, pharmacological intervention, or surgery. While weight reduction yields broad health benefits, the resulting decrease in facial adiposity and dermal support can contribute to visible volume depletion, particularly in the midface, temples, and preauricular zones. Additionally, patients often report a decline in skin elasticity, turgor, and radiance. Together, these changes can exaggerate bony landmarks and contribute to a tired or prematurely aged appearance. As such, there is a growing demand for combined regenerative and volumising strategies to restore facial balance, skin quality, and youthfulness.
Patient overview
A 42-year-old female presented seeking full facial assessment and rejuvenation following a recent 16-pound weight loss over several months. She described a gaunt appearance and reduced skin vitality. Her medical history was unremarkable; she was a non-smoker with a moderate alcohol intake and had previously undergone botulinum toxin and filler treatments with positive outcomes.
Clinical findings
On examination, the patient exhibited moderate volume loss (Grade 3 on the Ascher Facial Volume Loss Scale), particularly in the preauricular region, where bony landmarks and underlying musculature were visible. The skin showed signs of dehydration, laxity, and diminished luminosity. The patient’s treatment objectives were to restore structure while maintaining a natural aesthetic, and to improve skin hydration and tone.
Treatment plan
A multimodal, layered rejuvenation strategy was proposed. Three formulations of cross-linked hyaluronic acid (HA) were selected based on their respective rheological profiles:
· STYLAGE® XXL Mepivacaine (Mepi) was chosen for deep structural support due to its high elastic modulus and robust volumising capability. The
inclusion of mepivacaine enabled enhanced procedural comfort, eliminating the need for additional anaesthesia and allowing greater technical precision.
· STYLAGE® XL Lidocaine was used for mid-layer volumisation, offering adaptability and smooth tissue integration.
· STYLAGE® HydroMax was selected to target dermal hydration and elasticity, owing to its combination of HA and sorbitol, which supports fibroblast activity and water retention.
All products were delivered using a range of Precision32 microcannulas, selected to optimise flow, precision, and tissue preservation.
Treatment summary
1. Jawline Contouring
STYLAGE® XXL Mepi (1ml per side) with 23G 70mm microcannula using linear micro-bolus (0.02ml increments) in deep subcutaneous (SC) plane from single entry point.
2. Preauricular Volume Restoration
STYLAGE® XXL Mepi (1ml) in deep SC & STYLAGE® XL Lidocaine (3ml) in mid-SC plane over both sides with a 25G 50mm microcannula using a multilayer fanning from the pre-tragal area for contour softening and natural transition.
3. Mandibular Angle Definition
STYLAGE® XXL Mepi (1ml each side) using 25G 40mm microcannula with towering micro-bolus deposits from periosteal to deep SC for defined mandibular contour. A shorter cannula ensured precise placement around angular anatomy.
4. Chin Projection and Contour
STYLAGE® XXL Mepi (1ml) using 27G 13mm needle (periosteal) and 25G 40mm cannula (deep SC) with layered approach for anterior chin projection and 3D blending.
5. Dermal Revitalisation with HydroMax
STYLAGE® HydroMax (2 x 1ml, 2 sessions) using 25G 50mm cannula with deep dermal linear threading in 6 fanning lines per side to boost hydration, elasticity, and skin tone.
· Noticeable improvements in skin hydration and texture
The patient reported high satisfaction, minimal discomfort, and negligible downtime. The anaesthetic component in STYLAGE® XXL mepivacaine significantly improved comfort and facilitated meticulous technique without topical numbing agents.
Conclusion
This case highlights the efficacy of a comprehensive, anatomically tailored approach combining structural and regenerative dermal fillers with carefully selected cannula sizes. The integration of mepivacaine into the volumising filler was particularly impactful in enhancing the treatment experience. For clinicians, this underscores the importance of product selection, rheological understanding, and delivery device optimisation in achieving natural, reproducible outcomes in facial rejuvenation.
Dr Mei-Ying Yeoh’s career spans general dentistry and hospital-based practice, with extensive experience as a core trainee in maxillofacial surgery. Trained by leading experts, Dr Yeoh now focuses exclusively on medical aesthetics and has been educating medical professionals since 2019.
Figure 1&2: Patient before and one month after treatment
This advertorial was written and supplied by
A summary of the latest clinical studies
Title: Botulinum Toxin for Treatment of Synkinesis: Effects on Anxiety and Depression
Authors: Feyisayo O Adegboye, et al.
Published: Facial Plastic Surgery & Aesthetic Medicine, July 2025
A retrospective review of botulinum toxin naïve adults treated with chemodenervation for synkinesis was performed. Validated outcome metrics were compared before the first treatment and >3 months after the final treatment. Clinician-graded assessment used the Sunnybrook Facial Grading System (SB). Patient-reported assessments included the Synkinesis Assessment Questionnaire (SAQ) and Facial Clinimetric Evaluation (FaCE). Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) questionnaires assessed depression and anxiety. Paired t-tests compared scores before and after treatment. Sixty-eight patients aged 54 years (standard deviation ±13.5) were included. Most patients were female, 53/68 (78%). Bell’s palsy was the most common cause, 34/68 (50%), with a median duration of 42 months (ranging from 4 to 730). Twelve participants (17.6%) initially screened positive for depression, and 11 (16.2%) for anxiety. Chemodenervation demonstrated significant improvements in SB (t = -7.14, p < 0.0001), FaCE (t = -2.15, p = 0.041), GAD-2 (t = 2.18, p = 0.03), and PHQ-2 scores (p = 0.016). There was no significant change in SAQ (standardized mean difference = -0.9, p = 0.71). Chemodenervation for synkinesis demonstrated improved patient quality of life and reduced symptoms of anxiety and depression.
Title: 730-nm, 532-nm and 694-nm Laser in the Treatment of Freckles and Solar Lentigines (A Randomized Clinical Trial)
Authors: Lufeng Liu, et al
Published: Lasers in Medical Science, July 2025
Keywords: Picosecond laser, Safety, Solar lentigines
The randomized clinical trial included 42 participants who met the specific eligibility criteria for freckles and solar lentigines. On each participant’s face, three distinct skin areas affected by these conditions were identified and randomly assigned to receive treatment with the 730-nm picosecond laser, the 532-nm picosecond laser, or the Q-switched 694-nm nanosecond laser. Treatments were administered at one-month intervals, with follow-up assessments at 1, 3, and 6 months post-treatment. Evaluation criteria encompassed: (1) the Researchers’ Global Aesthetic Improvement Scale (GAIS) scores, (2) the Subjects’ Self-Rated Satisfaction (SSS) scores, (3) the Visual Analogue Scale (VAS) scores for pain severity, (4) the Lesion Clearance Rate, (5) numerical analysis of Individual Type Angle (ITA°), and (6) histological analysis. Significant improvements in skin clearance rates and individual type angle were observed following the three distinct laser treatments (P < 0.05). However, no significant difference were found in the global aesthetic improvement, participant satisfaction, or individual type angle scores across the three laser types (P < 0.05). In terms of safety, the 730-nm picosecond laser stands out with less histological damage, suggesting it may be a preferable treatment option for pigmentary conditions in future clinical practice.
Title: GLP-1 Agonists in Aesthetic Surgery: Implications for Perioperative Outcomes and Body Contouring Procedures
Authors: Roberta Albanese, et al
Published: Aesthetic Plastic Surgery, July 2025
Keywords: Drugs, Semaglutide, Weight management
This study aims to evaluate the effects of GLP-1 receptor agonists on postoperative complications in patients undergoing 360° lipoabdominoplasty. A prospective cohort of 21 patients treated with semaglutide (Group G1) was compared with a retrospectively selected control group (Group G2). Outcomes including wound healing, seroma, hematoma, bruising, hyperpigmentation, and thromboembolic events were analyzed. Statistical comparisons were performed using an independent samples t-test and Welch’s t-test for unequal variances. No statistically significant differences were observed in major postoperative complications between the two groups. However, hyperpigmentation and bruising were more frequent in the GLP-1 treated group (p = 0.10 and p = 0.09, respectively), suggesting a potential metabolic or vascular effect of the drug.
Title: Bilateral Inferiorly Based Nasolabial Flaps for Full-Thickness Reconstruction of Large Lower Lip Defects Following Tumour Resection
Authors: Mansour Elmoatasembellah, et al
Published: Journal of Stomatology, Oral and Maxillofacial Surgery, July 2025
Using a retrospective cohort study design, we enrolled a cohort of patients with large lower lip squamous cell carcinoma who underwent ablative tumour resection and full-thickness reconstruction with bilateral nasolabial flaps between June 2023 and August 2024. The study included six patients with a mean age of 62.5±10.3 years and a mean body mass index (BMI) of 29.93±1.7 kg/m2. The average tumour size was 4.7±0.8 cm. All patients were male smokers who smoked more than twenty cigarettes per day. Two operations were complicated with partial flap necrosis (33.3%), and three patients (50%) experienced minimal drooling, which improved over time. Only BMI and tumor grade showed a significant relationship with the incidence of postoperative complications (P=0.009, 0.006, respectively). A good aesthetic outcome was observed in all cases. Based on this small cohort, the bilateral inferiorly based nasolabial flap technique is a safe and easily harvested option that provides acceptable functional and cosmetic outcomes, with minimal donor site morbidity, for the reconstruction of large lower lip defects following tumour resection. It could be an alternative to other longer or more aggressive treatment methods, such as microsurgery, for elderly patients or those with medical comorbidities.
Unlocking Clinic Growth with Varied Demographics
Business consultant Vanessa Bird explores the hidden potential of untapped demographics and how to attract them to boost clinical growth
To achieve long-term success in aesthetic clinic ownership, there is a constant need for investment in training, staff development, technology and marketing. Yet, during times of economic challenges, patient habits may change, with this being reflected in their frequency of visits and spending habits. The drop in attendance and revenue can cause significant challenges for aesthetic clinics.
However, there is a new way to unlock revenue for growth without the need for further expenditure, by identifying and targeting new and varied demographics.
Exploring new demographics
When was the last time you researched demographics in your area? Most likely it was when you first opened your clinic. But the area, the population and even your own skillset and team have changed since then, meaning there are untapped opportunities waiting to be embraced. That’s why you need to revisit your demographic annually to stay at the forefront of your field.
Before you begin to explore the new demographics, you need to research what is around you. The easiest way to do this is to visit the Office for National Statistics (ONS).1 This is the largest independent producer of official statistics in the UK that collects, analyses and publishes key data about the economy, population and society at national and regional levels. It holds a wealth of information, which will be explored later, that you can use when you are starting your search.
To apply this information effectively in your business, it is important to understand who you currently treat and what you currently offer.
Step 1: Audit your business first
You may believe you understand what patients want, but when was the last time you reviewed this information? Unless you truly understand the wants and needs of existing patients visiting you, you can never really connect with them, treat them or unlock the true potential in your business.
Patient apathy is common. They may get bored of what you offer, meaning they don’t feel any sense of urgency to book in. They may even start to look elsewhere for something fresh and interesting as your treatments no longer resonate. The result? Their money and loyalty go elsewhere. You need an emotional connection with your patients with a refreshed treatment menu to stop this happening.
Send out a digital questionnaire to your patient database, request feedback face-to-face and ask them to suggest treatments they would like you to provide. Once you have this information, you can start work on creating solutions for missed opportunities among your existing patients before moving onto new ones.
Step 2: Research your area
Having already identified fresh opportunities among your existing patients, it is now time to search outside your usual target audience. This is when the ONS website becomes useful as you can research your local area and any area within commuting distance. 2 By typing in postcodes, you can search through local information on ethnic groups, gender identity, education levels, health, work status and finances. From this, you will be able to spot new demographics you could begin to market towards. Which demographic is most ‘treatable’ based on your current offerings? Start with the most accessible demographic, then add in any smaller ones over the coming months.
Based on your existing skills and treatments, match what you currently offer in clinic with what they need. For example, if you specialise in treating skin of colour and notice there are multiple ethnic groups that do not visit you, flag this as an opportunity and develop packages that resonate with them. Perhaps the information shows there is a large percentage of mid-life men in your local area, and this isn’t something you have noticed reflected in your clinic. How can you cater for their needs and encourage them into your clinic?
Step 3: Exploring alternative demographics
Bear in mind there are also alternative groups that you may not have previously considered. These may include commuters and business travellers attending nearby conferences, or leisure visitors like city-break tourists, or even friends and family of existing patients. These are all new opportunities, and you can create something unique to attract them.
For these alternative demographics, such as the commuters and business travellers, consider what they need. As they are travelling for work, they have limited time, so need quick effective treatments that refresh and revitalise them with no downtime. What do you have in your treatment menu that would be appropriate? Identify where business and holiday travellers stay and approach the hotels. Build guest-friendly packages such as zero-downtime skin radiance facials or jet-lag busters and reward the hotel with a staff discount on selected treatments if they send their guests to you.
Check in with regular patients and invite them to bring friends and family to a special event where both patients and guests can access savings.
Step 4: Creating avatars
Your current patient base likely includes a range of individuals with varying needs and expectations – and you understand them well. When it comes to catering for new demographics, you may not understand them well, so it is beneficial to create avatars to help you envisage their wants and needs more easily. Avatars are semi-fictional detailed profiles of the types of patients you want to attract, based on real data and insights from your local area and websites such as the ONS. When you use avatars, it allows you to tailor your treatments and marketing to attract the right people. Think about what motivates them, their pain-points and challenges. Motivation may include wanting to look less tired, preparing for a wedding or reversing the signs of ageing. Pain-points may be fear of looking unnatural, treatments being too expensive or concerns about downtime. Challenges may consist of time constraints, budget limitations or decision paralysis.
Avatar example
Emma, 42, busy professional with no children and a busy social life. She wants antiageing treatments (motivation) that are subtle yet effective, and to maintain a refreshed appearance. As a busy professional she needs treatments that fit into her schedule (challenges) with minimal-to-no downtime (pain-point). She values expertise, discretion and convenience.
Based on this avatar, you would offer lunchtime and post-work appointments, online bookings for ease and express treatments with zero downtime so she can fit it into her working day. Once this demographic understands that you cater for people like her and that she can access the treatments she needs in a way that accommodates her busy schedule she will be much more likely to book in.
Step 5: Identifying treatments
With your target demographics and avatars defined, the next step is to build treatment packages that directly address their needs. Refer to each avatar and identify targeted solutions for the problems or motivations they have. Take into consideration any pain-points, such as budget constraints, downtime and scheduling difficulties or limited availability, which can affect whether you recommend a one-off treatment or a course involving a weekly commitment.
Also look at what stage of life they are at; what treatments appeal to any significant celebrations or changes they face? This could be instant hydration and glow for younger patients with a busy social life who want to look their best, a programme to improve skin and body for people approaching a significant birthday who need a confidence boost, post-baby packages to rejuvenate after a birth, hormone replacement therapy with hair restoration for men and women in mid-life, or even pre- and post-surgical preparation and recovery package for older patients who opt for surgical interventions. Don’t forget to add in any supplements or skincare that can support the treatments.
Once you have created packages, look at pricing and develop tiered options that add value, so you do not need to discount. If your demographic is identified as affluent with disposable income, include a comprehensive skin analysis with any high-ticket treatments and for an additional fee, bundle in supplements and skincare. For those on a budget who may be searching for solutions to unwanted pigmentation consider packaging up more affordable options such as peels and LED over energy-based solutions. This allows you to deliver results in a cost-effective way for the patient without having to discount, which also protects your revenue.
Step 6: Marketing and creating connections
Now that you have the right solutions for new demographics, it’s time to work on appropriate marketing and communication methods that resonate with each group. You can easily research online the preferred communication styles of different generations. It can also be useful to speak with your digital marketing/lead gen agency to ask for assistance in how to reach out to specific demographics. Think about which avenues or platforms they will engage with your clinic on. Younger patients may prefer social media platforms such as TikTok and will reach out through messaging rather than telephone calls. Mid-life patients may use a mix of social media platforms and online research and fill out forms or email your clinic for details. Older patients may still rely on print advertising and prefer to speak to someone directly to discuss options. Match your communication style to their preferred channel. When promoting your services, always focus on the benefits rather than the features. Benefits create an emotional connection with people, and that’s what spurs them into action.
For instance, when trying to attract busy professionals, talk about how your offering can fit into their schedule. Mention flexible opening hours for patients needing to fit in around childcare. For those approaching big occasions, highlight the confidence boost they’ll experience when they have treatments to reduce pigmentation and erase signs of ageing. Review each avatar and choose two key marketing messages that directly speak to their motivations and concerns.
Considerations
As tempting as it is to actively chase all newly identified demographics, take time to prioritise which are most appropriate. Your first consideration is how much time, money and manpower you must invest. Who can you cater for most easily with minimal investment? Investment could mean new technology or training, increased marketing, a brand-new website or more staff. This should be your priority as it will cost less time and money reaching out to them and treating them. Focusing your efforts in this way also ensures that existing ones will have more options to choose from and be less likely to look elsewhere. If you identify that a specific demographic warrants specialist staff training or new technologies, can this be accommodated? If not, revisit it in six months when you may have the budget. It is better to select one or two new demographics to begin with and onboard them well, than spend too much time and money trying to appeal to everyone.
Fostering a healthier clinic
By identifying opportunities to both embrace new demographics and revisit existing ones, you will generate more enquiries, boost bookings and increase patient spending in clinics. As well as attracting new patients, offering more comprehensive packages mean happier patients, increasing retention rates and a boost in word-of-mouth referrals.
A busier, more profitable clinic is a healthier clinic, and this increased revenue can be reinvested into training and development, more staff, new devices and a long-term future.
Vanessa Bird is a global business consultant with 16 years’ experience working with brands and practitioners. Known for her clarity, warmth and practical insights, she writes for specialty publications and speaks at international conferences, sharing actionable strategies to strengthen skills, increase revenue and achieve lasting success.
Obtaining Consent
Establishing Informed Consent in Aesthetic Procedures
Healthcare insurance specialist Will Marshall outlines how consent is handled within the legal framework
Consent is the foundation of ethical and legal clinical practice. For practitioners in the aesthetics field, understanding when and how to obtain valid consent is not just a legal requirement, it’s a fundamental expression of respect for a patient’s autonomy and rights.
The role of consent in aesthetic practice
Consent is a legal and ethical prerequisite for any procedure or treatment that involves physical contact or any form of interference with a patient’s bodily integrity.1 In the context of aesthetic practice, this encompasses a wide range of interventions, from facial injectables to minor surgical procedures, such as blepharoplasty or lipoma.
Exceptions to the requirement for consent are extremely limited and typically apply only in emergency situations, such as treating an unconscious individual or someone detained under mental health legislation.2 These circumstances are highly unlikely to arise within the realm of cosmetic procedures. As such, consent should be regarded as an essential component of virtually all professional treatments in aesthetic practice.
Consent functions both as a legal requirement and an ethical standard, based on the principle of autonomy. Autonomy is defined as an individual’s right to make informed decisions regarding their own body and medical care.3-5 In legal terms, valid consent demonstrates that the patient has received sufficient information about the proposed treatment and has voluntarily agreed to proceed. Failure to obtain valid consent may result in legal liability for the practitioner, including potential claims of battery or negligence.
The evolution of consent in healthcare
The leading UK legal authority on consent
remains Montgomery v Lanarkshire Health Board (2015), a landmark Supreme Court case now marking its 10th anniversary.6
In the pivotal judgment of Montgomery, the Court clarified the legal standard for what constitutes ‘informed’ consent within a healthcare context.6 The decision significantly shifted both the legal framework and aspects of clinical practice by establishing that practitioners have a duty to take reasonable care to ensure patients are made aware of any material risks associated with a proposed treatment.6
Prior to Montgomery, the leading case governing informed consent in England and Wales was Sidaway v Board of Governors of the Bethlem Royal Hospital (1985).7 This case specified that the standard for consent in healthcare was governed by the Bolam test, which allowed doctors to withhold information if a responsible body of medical opinion supported that approach.7 This paternalistic model prioritised clinical judgment over patient autonomy, limiting patients’ rights to make fully informed decisions about their treatment.7
A risk is deemed material if either:6,7
· A reasonable person in the patient’s position would likely consider it significant
· The practitioner is, or should reasonably be, aware that the particular patient would likely regard it as significant
This means aesthetic practitioners must not only understand the clinical risks associated with the procedure in question, but they must also actively engage with their patient to understand what matters most to them. The gold standard for consent is to support your patient into making an informed decision. This can only be achieved by asking about their expectations, concerns and personal values. Understanding the individual patient is just as important as understanding the procedure being performed.
The three legal requirements for valid consent
In the UK, valid consent must meet three core legal requirements – the patient must have the capacity to consent, and the consent must be both voluntary and informed.8-10
Capacity
The Mental Capacity Act 2005 outlines that for consent to be legally valid, a patient must have capacity, must be adequately informed and must give voluntary consent without coercion.11 A practitioner should ensure the patient understands the proposed treatment, assess capacity where appropriate and create a supportive environment that promotes voluntary decision-making, documenting the process thoroughly.1
While the act requires practitioners to presume capacity unless there is evidence to the contrary, aesthetic practitioners must remain vigilant to underlying factors, such as cultural pressures, low self-esteem or conditions like body dysmorphic disorder (BDD), that may affect a patient’s motivations and compromise truly autonomous decision-making. To safeguard patient wellbeing and ensure professional accountability, the use of validated screening tools such as the PHQ-4 (Patient Health Questionnaire-4) and GAD-2 (Generalised Anxiety Disorder-2) is advisable to help identify symptoms of anxiety, depression or distorted body image.12,13 Where concerns are identified, referral for psychological assessment should be considered prior to proceeding with treatment.
Voluntary
Voluntary consent must be given freely, without pressure or coercion from the practitioner, or the patient’s friends, family or anyone else. Patients must be given the space and freedom to make decisions independently.
Informed
Informed consent requires that the patient is provided with sufficient information to evaluate the risks and benefits of the proposed treatment, consider any reasonable alternatives and decide whether to proceed. The decision does not need to be objectively rational – patients are entitled to make choices that may appear illogical. What is essential is that they are fully informed and understand the implications of their decision – for their own wellbeing as well as the integrity and reputation of your profession and clinic. This can be demonstrated through an information leaflet that provides an overview of the risks, benefits and available alternative treatment options.
Allowing time for consideration
Depending on the nature of the procedure, patients should be given time to consider their decision before proceeding. For more invasive procedures, such as minor surgeries like blepharoplasty, best practice involves a two-stage consent process, as outlined below.
· Initial consultation: At this stage, patients should be aware of any risks, benefits and alternative treatment options are discussed supported by an information leaflet. Patients should then be given adequate time to reflect, ask questions and make an informed decision about whether to proceed. The amount of reflection time required will vary from patient to patient. However, the key is to ensure that each individual is given adequate time and all the necessary information to make an informed decision.
· Consent appointment: A follow-up consultation is held where the patient confirms their understanding of the procedure and provides formal consent, ideally in writing. This session should, wherever possible, be conducted by the practitioner performing the treatment. For minor or low-risk procedures, a formal cooling-off period may not be necessary. However, the underlying principle remains, informed consent is a process, not a one-time event.
Best practices
Within clinical practice, aesthetic practitioners will frequently be in situations requiring consent, such as performing treatments, administering injections, conducting consultations or pre-treatment assessments. But how can you obtain consent?
Written, verbal or implied consent
Consent may be explicit – either verbal or written – or it may be implied, as demonstrated by a patient’s actions, such as adjusting their clothing in preparation for treatment.
Obtaining written consent in aesthetic practice is generally more effective than relying on verbal or implied consent. Since aesthetic procedures are elective, a signed consent form provides clear evidence that the patient was informed of the nature, risks, benefits and alternatives of the treatment. It also offers stronger legal protection in the event of claims, complaints or regulatory reviews, demonstrating compliance with legal standards. Additionally, the written process promotes patient reflection and understanding, supporting ethical decision-making and reducing the risk of disputes arising from unmet expectations or pressured consent.
As a general rule, best practice is to obtain and document written consent prior to initiating any course of treatment, particularly in the following circumstances:
· The treatment is new or differs from previous interventions
· It is required by manufacturer guidelines or regulatory standards
· It is stipulated by the practitioner’s insurance policy
· The procedure is invasive or involves significant risk
· You do not need to obtain explicit consent before every single treatment in a series but if in doubt, documenting explicit consent is the safest approach
Recording consent
Consent must always be recorded in the patient’s treatment records. For more involved procedures, such as minor surgical procedures or injectables, a formal consent form, or a reputable digital consent app, such as Faces Consent, Insync or iClinician, should be completed. This protects both the practitioner and the patient, demonstrating a clear, structured consent process.
A good consent form should include the following:
· Details of the treatment or procedure, such as the full name, the specific location where it was performed and its intended purpose
· A summary of the discussion with the patient, including their motivations, expectations and any concerns they have raised
· Information on the potential contraindications of the proposed treatment, as well as any reasonable alternatives – including, importantly in aesthetics, the option of no treatment
· The patient’s current medical status, including pregnancy, allergies and medications (including herbal or over-the-counter remedies)
· Confirmation of any information leaflets or aftercare guidance provided
· Signatures from both the practitioner and the patient, or completion of the consent process using an approved digital consent app
Permission for use of any patient’s photographs if applicable for marketing or educational purposes
Information leaflets
While well-prepared information and aftercare leaflets are strongly recommended, they should not be viewed as a substitute for meaningful dialogue. Instead, these materials should complement face-to-face discussions that cover the nature of the treatment, reasonable alternatives,
associated risks and benefits and the post-procedure steps required to support a safe recovery.
Practitioner liability and consequences
Failure to obtain valid exposes aesthetic practitioners to significant legal and professional risks. Patients may pursue clinical negligence claims if harmed by procedures without adequate disclosure of material risks or alternatives.14 Registered practitioners risk regulatory action – such as Fitness to Practice proceedings before the GMC, GDC or NMC – that could result in sanctions including suspension or removal from the register for breaching consent standards.15-17 In cases where consent is absent, coerced or obtained through misrepresentation, practitioners may face criminal liability for assault or battery under common law and the Offences Against the Person Act 1861.18
Beyond legal consequences, practitioners also risk severe reputational damage through negative media coverage, critical reviews and loss of patient trust – factors especially impactful in the elective, image-sensitive aesthetics sector. Given these risks, it is vital that practitioners hold adequate indemnity insurance covering the full scope of their practice. This insurance is mandatory for registered doctors and nurses and is expected to become compulsory for all aesthetics practitioners under the proposed non-surgical Aesthetic Licensing Scheme.15,17 Practitioners must ensure their cover is appropriate and sufficient to address their medico-legal exposures.19
Informed consent in clinical practice
Effective consent depends not only on proper documentation but also on strong communication skills.
By ensuring that consent is an active, ongoing process, you’re not only meeting legal standards and reducing the risk of a complaint or legal claim, but you’re delivering safer, more ethical care.
Will Marshall is head of legal and risk management at AlteaPlus. Marshall also hosts the influential AlteaTalks podcast series. Prior to joining Altea, Marshall spent 30 years as a leading lawyer in UK healthcare insurance litigation, based at global insurance law firms, including DWF, RPC and Clyde & Co.
Emotional Aftercare in Medical Aesthetics
Nurse prescriber Julie Scott explores the emotional landscape of regret in aesthetic patients
In aesthetics, we spend a great deal of time preparing patients for the physical results of treatment, but what happens when the emotional response doesn't match expectations? Post-treatment regret is rarely spoken about, yet it’s more common than practitioners might think, and managing it compassionately is a vital part of good medical practice.
This article explores the emotional landscape of regret in aesthetic patients, why it happens and how practitioners can navigate it ethically, safely and supportively.
Case study
While regret doesn’t always stem from a poor outcome, sometimes it does – and these moments often stay with us. One example stands out vividly. A patient sat in front of me, eyes welling up and said quietly: “I have to confess something… I had dermal filler with my nail technician on a whim. Now I’m unhappy with my appearance. Is there anything you can do to fix it?”
This patient was someone I knew well and cared about deeply. I had previously declined to treat her perioral area because I genuinely believed her lips were proportionate and balanced. But in a vulnerable moment, and perhaps swayed by external influence, she had gone elsewhere.
The result was heartbreaking for her. The filler she received created disharmony in her lower-face, and she no longer recognised herself in the mirror, describing her expression as ‘odd’ when she was animated.
The injector had not demonstrated any understanding of anatomy or facial bio-mechanics and had placed product inappropriately and without understanding.
With time, and after gentle support and reassurance, we dissolved the misplaced filler and gradually restored her natural appearance. Her confidence returned as she began to recognise herself again. Later, once trust was reestablished and emotional readiness confirmed, we created a light, carefully tailored plan to soften the lines around her mouth, respecting her facial anatomy and, most importantly, her sense of self. This case reminded me that regret doesn’t just live in the outcome; it lives in the moments where we don’t feel like ourselves. And as practitioners, saying no and educating with kindness is not just protective, it’s powerful.
Understanding regret in aesthetic practice
Regret doesn’t always stem from a poor aesthetic result. In fact, many patients who express regret after a procedure are technically satisfied with the outcome, yet something feels ‘off’. This emotional dissonance may come from unrealistic expectations, social pressure, unresolved psychological concerns or a mismatch between the internal self and the external change.1
Patients who are experiencing major life transitions such as grief, divorce, menopause and trauma, may also be more vulnerable to regretting aesthetic interventions that were initially sought for their perceived emotional reassurance.2 When the emotional 'lift' doesn’t arrive, regret can take root. Recognising this early is key.
We must also be mindful of the fine line between regret and symptoms of Body Dysmorphic Disorder (BDD), where patients fixate on perceived flaws that are minimal or unnoticeable to others. In some cases, what presents as regret may be a deeper psychological concern that requires specialist support.3
The types of regret we might encounter
Regret can manifest in different forms and each of these deserves its own kind of support:4
· Immediate regret: Often tied to post-procedural anxiety, swelling or shock at temporary appearance changes.
· Delayed regret: Typically arises weeks later when expectations haven’t been met or when patients reflect on their motivations.
· Existential regret: Patients begin questioning their identity or the meaning behind seeking aesthetic change in the first place.
Prevention starts in the consultation room
Preventing regret starts with one thing: knowing your patient. A comprehensive consultation is not just about selecting the right product or technique, it is about exploring motivations, expectations and emotional readiness. Open-ended questions, psychological screening tools and allowing time for reflection all play a role.
In addition to the PHQ-9 (Patient Health Questionnaire)5, practitioners may find the GAD-7 (General Anxiety Disorder-7)6 helpful in assessing anxiety symptoms, while the Appearance Anxiety Inventory (AAI) developed by Veale can offer further insights into BDD risk.7
Patients who feel rushed, sold to or influenced by social media trends are more likely to regret their choices. This is why I believe a cooling-off period is essential (typically 14 days – even for my long-standing patients). Whenever I review a patient's treatment plan and discuss new options, I always provide written information and literature for them to take away. I never proceed with new treatments on the same day. By offering education, realistic timelines and a clearly defined cooling-off period, we safeguard their long-term satisfaction and emotional wellbeing.8 This also strengthens the informed consent process by allowing patients the time they need to absorb information and make decisions free from pressure or impulse.
Recognising regret early
There are signs that a patient may be experiencing regret even if they don’t say so directly:
· Repeated contact post treatment, expressing doubt or distress
· Hyper-focus on perceived flaws that weren’t previously mentioned
· Withdrawn behaviour during follow-up
· Expressions of disappointment despite objectively good results9
Some patients may not openly express regret, but instead become quieter, more hesitant or reserved at review appointments. They might hesitate when asked if they’re happy with the result, or struggle to verbalise what feels ‘off.’ Others may begin over-scrutinising, focusing intently on minor asymmetries or areas of concern that were not initially present. This hyper-focus can be driven more by anxiety or emotional distress than by any significant physical change.9
In other cases, regret can manifest as more visible emotional upset, patients might seem anxious, fearful, or even angry. They may express concerns that others will judge them, or report that a comment from someone else has planted doubt. Some may seek constant reassurance, asking repeatedly whether the result will settle, whether it can be reversed or what can be done.
In rare but challenging instances, patients may shift into blame or distrust, questioning your technique, doubting the treatment plan or even asserting that something was not properly explained during consultation. These responses are often emotionally driven and should be approached with empathy and clear documentation. In such circumstances, it may be appropriate to contact your medical indemnity provider early. They can offer guidance on managing communication, documentation and follow-up in a way that protects both the patient’s wellbeing and the practitioner’s professional standing.
Practitioners should treat these signs seriously. Regret is not a complaint; I see it as a manifestation of the patient’s emotional discomfort, and it should be met with curiosity, not defensiveness.
What to do when it happens
When a patient expresses regret, the first step is to listen without judgement. Validate their emotions and avoid the urge to reassure too quickly. Sometimes patients simply need space to feel heard.
From there, a structured approach might include:10
· Acknowledging their feelings and clarifying what is concerning them
· Reviewing the treatment and photographic records together
· Discussing next steps, which may include observation, corrective work or even referral for psychological support
Documentation is crucial, but so is compassion.11 Regret is emotionally taxing, for both the patient and the practitioner. I still question myself when these situations arise, even when I know I’ve acted in the patient’s best interest. But leaning into these moments with empathy, honesty and reflection is what defines thoughtful practice.
The role of aftercare in emotional recovery
Aftercare should never be purely clinical. The emotional wellbeing of a patient is just as vital as their skin health. Follow-up appointments should actively create space to ask how a patient is feeling about their results, not just how they are healing.
Even patients who are ultimately satisfied with their results can experience an emotional dip post treatment. This may stem from temporary swelling, bruising or simply the psychological adjustment to change. One common but often underestimated cause of regret is underappreciating the reality of downtime. Despite clear consultation, patients may not fully comprehend what a few days of swelling or inflammation can feel like emotionally, especially when they see themselves in the mirror before healing completes.12 Practitioners can mitigate this by clearly explaining the full recovery timeline and checking understanding during the consultation.
In our clinic, post-treatment support includes a 24-hour follow-up call and a structured two-week review for all patients. During this appointment, we document and address any abnormal responses, assess results and make adjustments as required. Regular skin analysis and evolving treatment planning ensure patients feel supported beyond a single appointment. To embed emotional aftercare more deeply, we actively seek feedback through anonymous patient satisfaction surveys – sent after treatment and again semi-annually. We also invite reviews on platforms like Google and our clinic website. This feedback loop helps us continually improve and offers patients an additional outlet to reflect on and share their emotional journey. When a patient shares something negative publicly, it is important to remain professional and avoid engaging defensively online. Instead, I recommend reaching out to the patient privately to acknowledge their concerns and offer a follow-up discussion. If the matter cannot be resolved directly, documenting your actions and seeking advice from your indemnity provider ensures any further steps are handled with care, confidentiality and professionalism. What's important is that the practitioner remains a supportive presence, reinforcing that regret does not equate to failure.
Reframing regret
Regret isn’t always a sign that something has gone wrong. At times, it reflects a deeper emotional need or moment of self-questioning.
By acknowledging regret as a normal, human experience, we move the conversation away from shame and into support. This is emotional aftercare at its best, and it is where aesthetic medicine truly meets good medical practice.14
Julie Scott is an independent nurse prescriber, Level 7 qualified aesthetic injector and trainer with more than 30 years of experience in the field of plastics and skin rejuvenation. She is an aesthetic mentor and international speaker, who has won Aesthetic Nurse Practitioner of the Year at The Aesthetics Awards in both 2022 and 2024, and Best Clinic South of England in 2023. Qual: RGN, NIP, PGDip (Aes)
In The Life Of: Ms Priyanka Chadha
Consultant plastic surgeon Ms Priyanka Chadha shares how she balances the operating theatre and parenting duties
A typical working day… My day begins just after 6am. If it is an operating day, I’m usually up before the sun rises, trying to steal a quiet 10 minutes for myself before the chaos begins. That little slice of peace is so important – setting a calm tone for what is inevitably a packed, high-energy day. But with three small children who seem to sense when I’m awake, those minutes are more often an aspiration than a reality. By 6:45am, the household is in full swing. Kisses from the kids, alongside my morning coffee and porridge, are my morning fuel. By 7am I’m usually out the door, already on work calls during the journey to the hospital. I’ll arrive around 8am, and by 8:30am we’re in theatre – knife to skin. Each week, I spend two days operating and two days in clinic. The remaining three are a mix of teaching, training and travel. Clinic days give me a bit more flexibility, as I can wake the children, make breakfast and can be more hands-on with the morning routine. Even then, I’m usually out the door by 8am, with work already underway.
Commuting in London has its own challenges, so I avoid traffic whenever I can, it’s a personal pet peeve. The train and tube are my preferred routes, allowing me to stay connected, take calls and get into the mental space for the day ahead. By the time I reach the Kensington clinic or St Thomas’ hospital, I’ve already been in work mode for at least an hour.
Clinic days are fast-paced and varied, full of consultations, treatments and collaborative decision-making. No two days are ever the same, which I love. We begin with a team huddle to align on the cases and patient flow. The vibe is energetic and united, with lots of cross-referral between specialties. We bounce ideas constantly and always keeping a multidisciplinary lens on every patient. It’s a model we’ve honed over time, and it gives our clinic a unique character.
Our most sought-after treatments include biostimulators, fat reduction, skin rejuvenation procedures and body contouring. My personal passion lies in injectables, particularly facial contouring and skin enhancements. I find these treatments endlessly rewarding, not just in terms of results but because they allow for creativity, precision and long-term rejuvenation. Teaching these techniques is equally fulfilling, and I love seeing clinicians grow confident under our training.
Formal lunch breaks are a rarity for me. Without my amazing team keeping snacks nearby, I’d probably forget to eat altogether. When I do manage a proper lunch, it’s usually a salad or poke bowl. It’s not ideal, but with patients to see, a team to manage and speaking engagements to prepare for, the hours fly by quickly. In addition
to managing administrative tasks for NHS patients, I juggle the demands of family life – meal preparation, children’s clubs and birthday parties. The idea of a slow day feels almost laughable. Above all, the greatest challenge is finding moments to centre myself amid the constant whirlwind.
By 6pm, I’ve usually made my way home in time for my kids’ bedtime routine. Reading stories and tucking them in is sacred and non-negotiable. It is the part of the day that brings everything back into perspective and reminds me why I do what I do. After the kids are asleep, my husband and I reconnect over dinner and swap stories from our days. It’s a short but sweet moment before I dive back into the evening stretch of work from about 8pm to 11pm. I typically use these evening hours to develop educational content or strategise for the clinic and training academy. Ironically, these three hours are often my most productive; no calls or distractions, just focus.
I find brief moments of reset through business audiobooks, such as The Almanack of Naval Ravikant or Shoe Dog, alongside the occasional escape on a family holiday.
Other work commitments…
Outside of family life and my clinical work, I wear a few other hats. I’m a global educator, trainer and the founder of training academy Acquisition Aesthetics. I have been a global trainer for Galderma for the past eight years, delivering advanced education, leading workshops, speaking internationally and serving as principal investigator in multinational trials. Through this work, I have built a global network of like-minded dermatologists and plastic surgeons. I’m a proud business ambassador for Operation Smile, a non-profit organisation that provides life-changing surgical care for children born with cleft lip and palate conditions. As both a cleft surgery specialist and a mother, supporting their mission feels especially meaningful. I’m also currently training for the 2026 London Marathon, running in support for Refuge UK.
Most memorable moment in your career…
One of the most memorable milestones in my career came during a single, unforgettable month. In March 2025, I earned my Fellowship of the Royal College of Surgeons in Plastic Surgery, and was offered a consultant position at St Thomas’ Hospital – one of the UK’s leading centres for plastic surgery.
Ms Chadha will be speaking at the Aesthetics Journal Arena at CCR next month. Turn to p.23 to register.
Who is your role model within the field?
It is aesthetic practitioner Dr Ifeoma Ejikeme. She is simply a wonderful human who is exceptional at what she does!
If you could choose a career outside the medical field, what would it be?
I would choose to be a hairdresser and makeup artist. On some days, I think I am!
What is the best career advice you have received?
A colleague once said to me, “Growth begins at the edge of your comfort zone, dare to step beyond it.”
Priyanka Chadha
Debating Before and After Images
Dermatology nurse practitioner Emmanuel Toni argues against before and after images in marketing
Before and after photographs are the cornerstone of aesthetics marketing. Scroll through any clinic’s social media feed, and you’ll find a parade of transformations –skin clearer, lips fuller, faces ‘refreshed’. Such posts can help showcase some of your proudest outcomes and translate into additional customers. But beneath the glossy surface lies a serious problem. In my view, these images are often misleading, subtly manipulated through lighting or posture, and rooted in a culture of comparison and shame.
The illusion of objectivity
At first glance, before and after images appear to offer objective evidence – a simple ‘then and now’. They are seemingly useful tools for promoting procedures, highlighting how treatment plans progress and, most importantly, tempting patients with the results they could achieve. However, there are no universal standards for how these photos are taken. Small changes in lighting, posture, facial expression, camera angle, image quality or even the use of filters can dramatically skew perception. Though some advanced image technology does come some way in standardising, variation in machines makes comparison challenging. A patient appearing tired under harsh lighting with a neutral expression in the ‘before’ will naturally look more refreshed with a smile, softer lighting and a slight head tilt in the ‘after’, even if the actual intervention was minimal.
The Advertising Standards Authority (ASA) does have guidelines on how before and afters should be posted online in the beauty and cosmetics sectors.1 The ASA states that such images should not exaggerate the efficacy of products and should not be manipulated.1 However, enforcement of rules – especially on social media – is virtually impossible. Without consistent standards, these images remain broadly unreliable and vulnerable to distortion.
Subtle changes, big differences
Aesthetic professionals are trained to recognise subtle differences in people’s appearance, while the general public often
is not. This includes tiny tweaks that can dramatically affect perceived results, such as adjusting the camera angle, switching to more flattering lighting, asking a patient to sit up straighter, or adding a smile or minimal makeup.
Even small, everyday lifestyle changes like drinking more water, using a basic moisturiser or simply having a good night’s sleep can noticeably improve someone’s appearance in a short period, thus having an external impact on after imagery. These influences are not always intentional, but I believe they are misleading. Many photos don’t reflect treatment outcomes – they reflect better conditions, photography or just a well-rested face.
Comparison and shame
While many may feel that before and after imagery is a good way to market their clinic and show potential patients real life results, I feel that these photos thrive on negative comparison. The before image is positioned as tired, flawed or unattractive, while the after becomes the ideal – radiant, put-together and worthy of admiration. This mirrors the toxic media culture of the early 2000s, where women were shamed for weight gain or fashion choices. I feel that these images promote downward social comparison – encouraging viewers to feel better by rejecting the before, even if this tends to reflect their natural appearance. In a world already struggling with appearance-based pressure, especially among women, teens and marginalised groups, I believe that this dynamic isn’t just outdated – it’s harmful. By showcasing only the most successful outcomes and most photogenic angles, these images help redefine beauty standards, resulting in an unrealistic aesthetic baseline.
Like airbrushed magazine models, these curated images suggest transformation is quick, dramatic and universally achievable, but real skin and real outcomes are more complex. Results vary based on age, skin type, anatomy, lifestyle and health history. By hiding this nuance, these images fuel insecurity and push people toward treatments they may not need.
Inherent bias and ethical flaws
In my opinion, before and after images are inherently biased. No clinic posts results they or the patient are unhappy with. We don’t see outcomes where results were modest, expectations weren’t met or where complications arose. This cherry-picking creates a false sense of certainty and downplays the risks involved in treatments, failing to provide the balanced information required for ethical clinical care. Patients deserve honesty about the full range of possible outcomes, not just the highlight reel.
When decisions are made based on idealised imagery, patients are more likely to be disappointed or emotionally affected when their experience doesn’t match the after they were sold.
Toward ethical storytelling
Of course, before and after images still have a role within clinical training and outcome evaluation, particularly when used alongside validated tools and statistical analysis. However, their place should be educational, and not promotional.
So, what’s the alternative? In my view, we don’t need to stop showcasing results – we just need to do so more ethically. Here are some ways I feel the field can build trust and showcase expertise without relying on misleading imagery:
· Patient testimony: Let real patients share their experiences in their own words. Why did they seek treatment? How did it feel?
· Patient journeys: Document progress over time with context. Show changes in a human, holistic way – not just a snapshot.
· Professional commentary: Use your platform to educate. Talk about treatment rationale, expected outcomes and potential limitations.
· Outcome measures: Use validated tools like the FACE-Q to present real data about how patients feel after treatment.2
· Evidence-led content: Promote skin health, safety and informed decision-making by prioritising patient education over aesthetic perfection.
Moving past outdated ideals
In my opinion, before and after photos belong to an era the aesthetics specialty needs to move beyond. When used for marketing purposes they are biased and rooted in shame and unrealistic expectations. In a field built on clinical ethics, consent and patient care, these images no longer serve a responsible purpose.
Aesthetic professionals can lead the change – not by selling perfection, but by embracing transparency, nuance and humanity.
Emmanuel Toni is an advanced nurse practitioner and PhD applicant at UWE Bristol, specialising in dermatology. Passionate about skin health, stigma and public education, he champions dermatology nursing through research, writing and international speaking.
