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T H E A E S T H E T I C AWA R D S 2 0 1 3 , 7 D E C E M B E R 2 0 1 3 . B O O K Y O U R T I C K E T N O W !







Belotero® now approved by the FDA • One of only 3 HA approved by the FDA currently promoted in the US • Optimal integration1 for superior evenness2 • Minimal local for sustained patient satisfaction4

voted as The Best by our customers in 2011 and 2012

Call Merz Aesthetics Customer Services now to find out more or place your orders: Tel: +44(0) 333 200 4140 Fax: +44(0) 208 236 3526 Email: 1 Histological examination of human skin (eyelid dermis layer). Courtesy Dr. J. Reinmüller, Wiesbaden, Germany 2 Prager W, Steinkraus V. A prospective, rater-blind, randomized comparison of the effectiveness and tolerability of Belotero Basic versus Restylane for correction of nasolabial folds. Eur J Dermatol 2010;20 (6):748-52. 3 Taufig A, et al. A new strategy to detect intradermal reactions after injection of resorbable dermal fillers. J Ästhetische Chirurgie 2009; 2: 29-36 4 Reinmüller J et al. Poster presented at the 21 World Congress of Dermatology, Buenos Aires, Argentina, Sept 30 – Oct 5, 2007. Thereafter published as a supplement to Dermatology News: Kammerer S. Dermatology News 2007; 11: 2-3. Merz Pharma Uk Ltd 260 Centennial Park, Elstree Hill South Elstree, Hertfordshire, WD6 3SR Tel: +44(0) 333 200 4140


Gold Standard Customer Services


Editor’s Letter Welcome to the August issue of Cosmetic News. The aesthetic industry was struck by the sad news last month that both SkinCeuticals’ founder, Dr Sheldon Pinnell, and Gayle Brinkenhoff, the inspiration behind Revitalash, had passed away. Having interviewed both of these inspirational people for the magazine in the past, I am personally and professionally saddened by this news and send my condolences to their families and colleagues, by whom I am sure they will be sorely missed. See page 12 for our tribute. We will also be dedicating two of this year’s Aesthetic Awards to them to mark their contributions to the industry. Entries for the awards have now closed and we will shortly be announcing who the finalists are. Voting will be opening on August 15 so make sure you visit to cast your votes. Turn to page 40 to find out what will be happening on the night. On to this month’s issue... One thing that has caused a bit of a stir in the market recently is Dr Leah Totton winning this year’s series of BBC1’s The Apprentice. As part of a special report, we find out why this ambitious young doctor’s plans to enter the market with business partner, Lord Alan Sugar, has caused such a strong response (p14-16). We will also be exploring the topic of mesotherapy from choosing the right cocktails to techniques and indications. (p22-23). I hope you enjoy reading this month’s issue and as always welcome your feedback. Just email me at

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Vicky Eldridge on ENERPEEL®SA-CB

We talk to Joe Lewis about his latest skincare innovation using DNA repair enzymes



We round up the latest industry news 12 IN TRIBUTE

We Pay tribute to SkinCeuticals’ founder Dr Sheldon Pinnell and Revitalash’s Gaye Brinkenhoff 14 THE BIG DEBATE

We find out the industry reaction to Dr Leah Totton winning BBC1’s The Apprentice with a business plan to start an aesthetic clinic chain 18 NEWS SPECIAL REPORT

Dr Richard Brighton-Knight on the ClearLift treatment 38 PRODUCT NEWS

We round up the latest product news IN BUSINESS 40 AESTHETIC AWARDS

With the shortlists soon to be announced, we tell you why you should attend the Aesthetic Awards 42 INSURANCE

Are ‘botched body’ TV shows negatively impacting our industry?

Eddie Hooker from Hamilton Fraser takes us behind the scenes of an insurance claim



Out and about in the industry this month 26 BODY PEELS

Dr Penelope Tympanidis on body peels

John Castro from Websites for Cosmetics on why your home page is so key 46 PSYCHOLOGY

Patient selection and support


22-23 [SPECIAL FEATURE] MESOTHERAPY We examine mesotherapy treatments from finding the right cocktail to indications and techniques



Dr Patrick Treacy explains the science behind ageing

Lawrence Grant on a recent landmark tax tribunal on business travel expenses




Antonia Mariconda meets the first female CEO of a breast implant company, Ayse Kocak



Dr Neil Walker talks to us about the Venus Freeze

Editor’s choice

ENERPEEL®SA-CB It has been given the delightful nickname ‘backne’ but spotty backs are no laughing matter for many people. We often think of acne as something that just affects the face but for many men, and women, acne can be equally as debilitating on the body. With this in mind, SkinMed has just launched a new product, ENERPEEL®SA-CB spray, which is specifically designed to treat back and chest acne. The ENERPEEL® SA-CB is a medical treatment combining salicylic acid and specific acne treating ingredients such as triethylcitrate, ethyl linoleate and GT-peptide-10. Enerpeel SA carriers contain 30% salicylic acid and the same ingredients in the OSK spray, delivering a massive ‘infusion’ of bacteria killing, calming, oil reducing ingredients into the hair follicle duct. The chemical exfoliation is specially formulated for controlling hyperkeratinisation of the pilosebaceous duct and the removal of the horny plug. The treatment is also indicated for controlling the inflammatory phase characterised by the presence of papules and pustules. Triethyl Citrate and Ethyl Linoleate is delivered with the peel to control bacterial colonisation (changes the environment which creates a specific action against Propionibacterium acnes) and also the inflammatory process. The latter process, induced by free fatty acids released from the hydrolysis of triglycerides by bacterial lipases is inhibited. A sequence of these Enerpeels along with the use of SkinMed’s supporting creams containing the same ingredients make it possible to influence sebum lipid metabolism (reducing inflammatory triggers and bacterial colonization) while effectively reducing p.acnes bacteria. Five university hospitals treating acne unresponsive to prescription agents achieved 77% symptom resolution utilising Enerpeel systems interspersed with Tebiskin OSK spray over 56 days, making it a great option for clients suffering from body acne. CONTACT THE COSMETIC NEWS TEAM ON 01268 754 897

Charlotte Body Publisher | M: 07903 944 666 |

We find out what the industry has been saying on Twitter this month

Vicky Eldridge Editor | M: 07880 812 582 |


Peter Johnson Art Director | 01268 754 897 |

The latest dates for your diary

Hollie Dunwell Sales Manager | M: 07557 359 257 |


The editor and the publishers do not necessarily agree with the views expressed by contributors and advertisers nor do they accept responsibility for any errors in the transmission of the subject matter in this publication. In all matters the editor’s decision is final.

“I’M LIVING MY LIFE IN COLOUR” When I fulfil my potential, my personality shines through

Galderma (UK) Ltd, Meridien House, 69-71 Clarendon Road, Watford, Hertfordshire WD17 1DS Galderma Switchboard: 01923 208950 Email: For more information visit

RES/006/0313 Date of prep: March 2013





Chromogenex open up direct market in Asia Pacific

BACN announces details of its 2013 annual conference

Chromogenex has opened a new Hong Kong office. The company will continue to focus on the high growth export markets of Brazil, the Far East, India and South Africa and established markets of Europe and North America, but this new move will enable it to open up a direct market in Asia Pacific. Headed by Uri Michaelis, director of sales and marketing, the team at the brand new Hong Kong offices will be responsible for the distribution of the full Chromogenex product range in Asia including Regenlite, Phaser EPL, Fusion SLRand i-Lipo, as well as the launch of the latest body contouring and fat reduction system – the i-LipoXcell. This continued rapid growth, despite the current challenging economic climate, follows substantial sales in top selling slimming product, i-Lipo. This safe, non-surgical slimming device accounts for over 60% of the company’s total sales.


Landmark’s ThermaVein® expands global network Landmark Investments Group, the Bolton-based investment firm, has agreed terms for the exclusive distribution of its ThermaVein®product in the Middle East, Holland, Australia and New Zealand, with a combined minimum contract value of £7.4million. Landmark acquired worldwide rights for the medically-acclaimed treatment to remove facial veins in 2012. The business announced an £8.6million exclusive distribution rights deal with Tekno-Surgical (part of the SISK Group) in the UK and Ireland earlier this year and is on track to expand its global network over the next 12 months.Distribution rights have been agreed with global company, Medistat International, for the Middle East - including Lebanon, Kuwait, Libya and UAE, as well as in Holland – over a five-year contract. SSA has been selected to distribute ThermaVein® in Australia and New Zealand, also over a five year contract. Jonathan Cresswell, sales manager at SSA, commented, “We are delighted to be adding ThermaVein® to our growing aesthetics division. We expect ThermaVein® to be very successful in the Australian market where our culture and climate has created a growing demand for skin treatment technology.” Mark Hawthorn, managing director of Landmark Investments Group, added, “Working with established and experienced global partners is bringing about rapid expansion of its sales network and allowing us to invest in new product ranges to meet the growing demand for skin treatments across several continents.” Landmark is in detailed discussions with a number of US and Far Eastern organisations and expects to announce further distribution agreements in the next few months.


The British Association of Cosmetic Nurses will be holding its annual conference at the Renaissance City Centre Hotel, Manchester on Friday October 4 and Saturday October 5. Friday’s programme will see workshops from Galderma, Allergan and Merz. Key speakers on the agenda will also include Mr Chris Inglefield, who will be giving a toxin masterclass, and barrister Kate Hill who will be talking about consent. Saturday’s programme will include lectures by Suzanne Armstrong, Dr Lance Setterfield, Dr Stephen Barratt and Andrew Rankin. The event is sponsored by Allergan, Galderma, Merz Aesthetics and Jan Marini Skin Research. A gala dinner dance will be held on the Friday evening with the theme ‘Born to Be Blondie’. An amazing tribute for any Debbie Harry fans, guests will be able to relive 1970’s new wave, punk scene sound while singing along to all the greatest hits, ‘Heart of glass’, ‘Maria’, ‘Atomic’ and more.


SkinMed welcomes new recruits SkinMed has welcomed two new recruits to its team. Sarah Jayne has extensive practical experience of delivering training for peels, skincare and devices including laser and IPL and has directly assisted with the launch of key products into the UK market including Agera, Epionce and the Dermagensis.. Lisa O’Neil qualified as a RGN in 1993. She previously worked for Sk:n Liverpool and ran her own aesthetic clinic. SkinMed MD Peter Roberts said, “We are pleased to have recruited two highly experienced new members to our team. We expect to recruit two more in the near future.”

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References: 1. Raspaldo H. J Cosmetic and Laser Therapy, 2008;10:134–142. 2. Fischer TC. Poster presented at EMAA, 1–3 October 2009, Paris. 3. Allergan Data on File (DoF), 2011. 4. Allergan Data on File (DoF) Marketing overview, 2011. Instructions and directions for use of JUvéDeRm® vOLUmA® with Lidocaine are available on request. Lidocaine does not affect the intrinsic performances of JuvéDERM® vOLuMA® and its safety profile, therefore, JuvéDERM® vOLuMA® data is representative of JuvéDERM® vOLuMA® with Lidocaine3

Date of Preparation: January 2013 UK/0008/2013a


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Contact us on: Tel: 0845 1707788, © 2013 Alma Lasers, Ltd. All rights reserved. Alma Lasers Ltd., its logos and Soprano, are trademarks or registered trademarks of Alma Lasers, Ltd. Product specifications are subject to change without notice.

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New Book Unmasks the Evolution of Plastic Surgery and Why Looks Matter

The Consulting Room™ Launches New Website For Cosmetic Classified Adverts

World-renowned plastic surgeon Dr Bryan Mendelson has peeled back layers of history and skin to reveal the meaning and evolution of facial plastic surgery. Jargon-free and written in an accessible, chatty style, his new book In Your Face explains why politicians with strong chins are more likely to win elections and how as humans we are ‘wired’ to reward good looks. Interspersed with case studies sharing experiences in his patients’ own words, the myriad reasons why people undergo beautification and rejuvenation surgery are unveiled.

The Consulting Room™ has announced the launch of Cosmetic Classifieds – – a dedicated online resource for sourcing second hand and ex-demonstration aesthetic devices, equipment and products for businesses involved in the UK cosmetic industry. Cosmetic Classifieds was created following the success and rising demand for the listing of sales adverts within the ‘Equipment Sales’ section of The Consulting Room™, which has been running for over seven years now.

Whilst written entirely for the public, the book now forms part of the reading curriculum for trainee surgeons undertaking the world’s first-ever cosmetic surgery degree at Anglia Ruskin University in Essex. In Your Face is also being recommended by one of America’s most renowned plastic surgeons, Dr Bill Little, for patients considering aesthetic facial treatments. According to Dr Mendelson, who has performed over 2,500 facelifts and is a former President of the International Society of Aesthetic Plastic Surgeons (ISAPS), “Beauty is a source of delight. Humans are profoundly affected by it, moved to create songs and poetry, as well as do battle in its name. When we look at beauty we undergo as much as a 10% increase in blood flow to certain parts of the brain – even babies when they’re only two months old, will look for longer periods at attractive people.But we feel contempt for the notion that we judge people by their looks alone. “Appearance discrimination is a burgeoning issue but it’s not new; workplace security was one of the earliest motivations for rejuvenation surgery in both men and women, as the first-ever female plastic surgeon Suzanne Noël recorded in her own Paris salons in the 1920s. She observed that patients not only looked less tired after surgery but were better able to deal with real tiredness when it occurred, as a result of the new ease they felt in themselves. As a feminist and suffragette Noël even saw rejuvenation as complementary to women’s freedom.” One of the book’s case studies poignantly expresses the judgment surrounding their choice to undergo cosmetic surgery, “Those of us who are born with the wrong ticket in the aesthetic genetic lottery suffer twice”, says Dr Mendelson. “Firstly, we are judged by those who find us visually lacking. Then, when we do something about it, we are judged again. Judged by the very people who see no contradiction when they straighten their teeth, colour their hair and wear contact lenses, makeup and brassieres. Surgery, no matter how good, obviously can’t substitute for a life poorly lived or values that simply don’t lead to happiness. But in general, I have found that if people have a specific problem from which they want relief, and their expectations are aligned with surgical reality, the chances are high that they will feel happier as a result.”


“With more and more new clinic businesses tentatively looking to embark on treatments with an entry level device, at low capital expenditure, and other more established clinics looking to upgrade and divest of older equipment, to free up capital, we wanted to create a place where the transfer of ownership of aesthetic equipment, products, services and businesses can take place with minimal effort”, said Consulting Room™ Director, Ron Myers. Not only does the site feature items such as lasers, IPLs or RF devices for sale, but also has the capacity to list short dated product stock, clinic furniture and accessories, and even rooms to rent or entire aesthetic businesses up for sale. Whatever you want to sell, buy, rent or lease for your aesthetic business, you can do so via this website. The site can also host wanted adverts for anyone looking to source a specific item to be able to put the word out that they are in the market to buy it.


LPG Endermologie® supports Marie Claire’s #TakeAGoodLook Campaign LPG Endermologie is supporting the #TakeaGoodLook campaign, an initiative launched by Marie Claire UK to raise awareness of the implications of the growing, yet unregulated, aesthetic industry. The #TakeAGoodLook initiative was launched in the wake of the PIP breast implant scandal, in order to empower and inform women about the associated risks of cosmetic procedures. The campaign demands better training for practitioners, a register for procedures, and for women to be better informed and offered victim support as well as a ban on advertising that may influence vulnerable women. “This issue is a real concern in the cosmetic industry and totally ties in with our beliefs and core brand values that are inbred in our company and employees. Since its creation in 1986, LPG has been dedicated to finding natural aesthetic solutions for women that are long-term and give excellent results,” comments Edouard Hastings, UK Sales Manager for LPG. “We strongly support the #TakeaGoodLookCampaign, and would urge women to fully research all their options before deciding on any cosmetic procedure. LPG offer highly researched, alternative treatments which are non-invasive and non-aggressive yet extremely effective.”

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Record numbers of men seeking treatment reports MYA

Kline Sees a Whole Body of Potential within the Global Athome Beauty Devices Market

Figures from the clinic show a steep incline in demand for PowerX Vaser Liposuction, an ultrasonic technology powerful enough to target multiple large areas of fat whilst being gentle enough to treat delicate areas of the body. Historically, 90% of MYA’s fat removal patients are female, but in the first 6 months of 2013 have seen a 100% rise in male enquiries for PowerX Vaser Liposuction. Vaser can target more than one area at once, meaning many patiends have several parts treated simultaneously. 82% of all men opting for PowerX Vaser Liposuction have multiple body parts treated during a two-hour treatment. The procedure removes up to four litres of fat, and patients can drop up to two shirt sizes by losing up to five inches on some body parts. The introduction of PowerX means much higher quantities of fat can be removed in a shorter amount of time when compared to traditional liposuction. The procedure is carried out under local anesthetic in a clinic setting, with no overnight stay and a quick recovery period. Over half of men opt for silhouette-slimming flank or lower abdomen fat removal, and 20% seek treatment on their chest. Another fifth go for and upper abdomen treatment. 7% of men have Vaser on their chin.


Top customer service award for Mr Humzah Leading cosmetic surgeon Mr Dalvi Humzah has scooped a top award for Customer Service from users worldwide. Based at The West Midlands Hospital (Halesowen), Mr Humzah’s private practice, Plastic and Dermatological Surgery (PDS) has been recognised for its ‘excellent service’ and ‘superior satisfaction record’ based on feedback from users during the last twelve months. Patients rated PDS highly for how well they were treated, how quickly they were contacted and seen, and how happy they were with the treatment. Member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), Mr Humzah has been treating patients for surgical and non-surgical procedures throughout the UK and worldwide for over 15 years. “It’s always fantastic to be acknowledged for your customer service, and even more so when the award is based on real customer feedback,” commented Mr Humzah, medical director of PDS. He said: “We are very pleased that this has been recognised by which leads the way in helping patients find, review and choose the best clinics all over the world. “Patient care has, and will always remain our top priority. Transparency around treatment and respect for patients is fundamental in cosmetics and all other medical fields. That is why we pride ourselves on providing only the highest levels of care for our patients.” lists over 100,000 clinics worldwide and aims to help patients find and compare private clinics. More than one million people use every month to help choose a clinic across a variety of elective healthcare services including cosmetic, medical, dental and fertility treatment. CEO Caelen King congratulated PDS and said: “We’re delighted that Mr Dalvi Humzah and the team at PDS have received our 2013 award and hope that they keep up the great work and qualify again next year. “The first step of a patient’s journey towards treatment is contacting a clinic. The initial impression the clinic makes fundamentally influences their decision which is why we highlight clinics that get it right time after time with our annual customer service awards.”


Despite growing almost 22% globally in 2012, the at-home beauty devices market’s potential is still being realized, according to the recently published Beauty Devices: Global Market Analysis and Opportunities by worldwide consulting and research firm Kline & Company. Given the global diversity concerning consumer awareness, regulatory requirements, purchase channels, and device availability, a genuine wealth of unrealized potential awaits marketers of at-home beauty devices. Launching devices in some countries differs significantly with some national authorities, such as South Korea’s KFDA, China’s CFDA, and the FDA in the United States establishing particularly strict acceptance criteria for devices using specific types of technology or addressing specific skin care concerns. In a recent interview with Kline, Kevin Appelbaum, CEO of Tria – manufacturer of the only FDA-cleared laser available for home use – counseled that the substantial time and resource investments in clinical testing to meet these requirements ultimately serve the consumer’s health and safety, and further legitimize the industry. Seeking new markets, several well-established brands in the United States, including No!No!, Tria, and Clarisonic, are intent on replicating their success throughout Europe, while Clarisonic is also expected to launch in South Korea in 2013. 

The expansion of sales channels and distribution networks will also continue to be one of the crucial factors to positively affect future market growth. Here too the disparity between regions affords both insight into market positioning and product perception, and reveals much untapped potential. For instance, mass-market outlets generate over 50% of sales in Europe and 45% in Japan, with the latter including home appliance stores and chain electronics stores, such as Yamada Denki, Biccamera, Eden, and Tokyu Hands. By contrast, within the United States the mass market channel is enhanced little, but direct sales is the leading channel of distribution, representing near 50% of total sales. Another growth opportunity has been observed in Japan where electronic home appliance marketers are partnering with cosmetic marketers to offer topical products and kits. This synergistic idea is well illustrated by Panasonic recommending Shiseido cosmetic products for use with its devices. These mutually beneficial and savvy ventures combine the traditional and proven, with the latest skin care technology. L’Oréal’s purchase of Clarisonic may yield a similarly astute marketing marriage and inspire more of these arrangements wherein new-to-market tech brands can enjoy the cachet and reach of established cosmetics brands, while the latter can benefit from potentially brand-enhancing cutting-edge diversification. Essentially, the global at-home beauty devices market is likely to see a greater tendency of mergers and acquisitions activity as large established marketers acquire smaller marketers to gain market share and intellectual capital in this relatively avant garde segment.


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Allergan’s newest innovation is designed for the lips and peri-oral area. It combines the soft and visibly smooth consistency of the JUVÉDERM® range with less swelling and up to 12 months’ duration in the lips with just a single treatment.1 Ask your local Allergan Representative for more information about JUVÉDERM® VOLBELLA® with Lidocaine today. Reference: 1. Eccleston D, Murphy D. Clinical, Cosmetic and Investigational Dermatology 2012:5 1–6. Allergan, Marlow International, 1st Floor, The Parkway Marlow, Buckinghamshire SL7 1YL, UK | January 2013 UK/1296/2012



IN TRIBUTE Last month the industry was saddened by the loss of two people who have significantly impacted the market in different ways – SkinCeuticals’ founder Dr Sheldon Pinnell and the inspiration behind Revitalash®, Gayle Brinkenhoff. Here we pay tribute to them Loss of a legend As the founding father of SkinCeuticals, an internationally eminent scientist, dermatologist and educator and longtime Duke University professor, few people have had such a profound impact on topical skincare than Dr Sheldon Pinnell. Dr Pinnell passed away on July 4 after battling carcinoid cancer for almost 10 years. He was 76. As SkinCeuticals’ founding scientist, Dr Pinnell changed the face of topical anti-oxidants with his pivotal research. He was a pioneer in the discovery Dr Sheldon Pinnell and development of the role of topical anti-oxidants for the prevention of sun damage to skin and his Duke anti-oxidant patent has been a driving force at SkinCeuticals since the company’s inception. He also made many other milestone discoveries along the way. Dr. Pinnell’s skin science research garnered him 10 patents over the past three decades and he published more than 200 scientific articles about topical vitamin C, anti-oxidants, collagen synthesis, and photodamage in peer-reviewed dermatology journals. Pinnell received his undergraduate degree from Duke University and his medical degree from Yale University School of Medicine. In 1973 he returned to Duke to join the medical school faculty, where he remained for his entire academic career. From 1973-1980, he was named a prestigious Howard Hughes Medical Institute Investigator. He was the J. Lamar Callaway Professor of Dermatology and Chief of Dermatology at Duke from 1982 to 1997. A visionary leader, Pinnell developed and implemented strategic initiatives that facilitated the growth and prominence of Duke University’s Division of Dermatology and culminated in the establishment in 2009 of the nationally recognised Department of Dermatology. During his tenure, he trained more than 100 residents, 22 research fellows, and left a legacy of 22 dermatologists, including seven current department chairs, residency program directors and associate department and vice chairs. In 2013, Duke University Medical Center recognised Pinnell’s distinguished career with the establishment of the Sheldon R. Pinnell Center for Investigative Dermatology. This year, he also received honorary membership into the Society of Investigative Dermatology. He was also a founding scientist of Fibrogen, SkinCeuticals and the Skin Science Institute and served as SkinCeuticals’ chief medical advisor. Pinnell is survived by his wife, Dr Doren Madey Pinnell; three sons, Kevin, Alden, and Tyson; and five grandchildren. A small private family ceremony was held. A memorial service will be held in Duke Chapel in the Autumn to celebrate his life, in conjunction with the formal dedication of the Pinnell Center for Investigative Dermatology. 12

A courageous fight Cosmetic News was incredibly saddened to hear the news from Flipside PR and SkinBrands that on Friday July 12, Gayle Brinkenhoff of Revitalash® had lost her long and courageous 25-year battle against metastatic breast cancer. It was her battle with this devastating disease that led her ophthalmologist husband, Dr Michael Brinkenhoff to create Revitalash® as a special gift for his wife who had lost her eyelashes during chemotherapy. The brand has since become a global phenomenon and Gayle was an integral part of the company’s success as well as a tireless supporter of cancer charities, to which the company donated thousands over the years from sales of its products. Tracey Beesley from SkinBrands, the UK distributor of Revitalash® said, “Gayle showed that it is possible to live a full, meaningful, passionate life, even in the face of a fatal diagnosis. Her courage, her empathy, her authenticity and her sense-of-humour will be painfully missed by all who knew and loved her.”

Cosmetic News editor Vicky Eldridge said, “Having interviewed Gayle, Michael and their daughter Dariel for Cosmetic News on a couple of occasions, I experienced first hand what a uniquely close, positive and inspirational family they were, so I was incredibly sad to hear that Gayle had passed away after such a long and courageous fight. She had an infectious enthusiasm and her selflessness in helping others while she herself was battling this disease is a testament to what an amazing person she was. My thoughts are with her family at this time.” We will be dedicating one of this year’s Aesthetic Awards to both Brinkenhoff and Pinnell to honor their contirbutions to the industry.

Dr Gayle Brinkenhoff and Michael Brinkenhoff

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When glamorous Irish doctor Leah Totton won a £250K investment from renowned business mogul Lord Alan Sugar on BBC1’s reality TV show, The Apprentice, her business plan to launch a chain of aesthetic clinics in the UK raised more than a few eyebrows in the industry. We find out why this young doctor’s ambitious plans to enter the sector have caused such a stir…


ust when we thought the media storm surrounding the aesthetics industry had started to dissipate in the wake of the Keogh review, the sector was dragged firmly back into the spotlight, this time by the surprise victory in The Apprentice by 25-year-old doctor Leah Totton who plans to take the aesthetics industry by storm.Whether it was her perceived arrogance, claims of expertise in a field she had not yet started practicing in, suggestions that this was a unique business model that no one had ever thought of or overzealous profit projections for making big bucks that ruffled feathers, or maybe even a touch of the green eyed monster, the industry has had more than a few things to say about the programme with social media going wild on the night of the final. A WIN N I N G F O R M U L A ? This year’s series of The Apprentice really captured the attention of the aesthetics industry, for all the wrong reasons, after it was revealed that the business plan being proposed by finalist Dr Leah Totton, was to launch a chain of aesthetic clinics offering botulinum toxin, fillers and chemical peels. In the series 9 finale, Dr Totton and fellow candidate Luisa Zissman battled it out with the help of their former Apprentice team mates, and worked over the course of three days to produce launch campaigns for their businesses: crafting a brand, a website and a promotional video to present to 100 industry experts. Despite airing his reservations about the morals, ethics and safety of the market Lord Sugar said: “The devil in me has got to take the risk, Leah you are going to be my business partner”. Speaking about Leah, he added, “She’s a


very determined young woman, and it’s a very interesting industry, and she’s the most interesting candidate, and she has the most interesting business proposition.” Dr Totton said, “To have Lord Sugar show this faith in me is absolutely unbelievable, it’s amazing. I had much less experience than the other candidates in business coming in to the process and I really can’t believe that I have got this far and that I’ve actually won it! I’m really going to do everything that I can to prove that he has made the right decision and I won’t let him down.” Dr Tracy Mountford, medical director of The Cosmetic Skin Clinic and one of the experts who appeared on the show said, “There is no doubt that Lord Sugar’s decision to appoint Dr Leah Totton as his business partner was going to be a controversial one. There is also no doubt that she is a bright fiercely ambitious young woman albeit very inexperienced and naïve regarding the cosmetic industry, but Lord Sugar knows this. It was her overconfidence and underestimation of just how difficult and demanding it is to run a professional ethical practice with excellent clinical expertise that stirred everyone up. Lord Sugar is aware of the moves in the industry for regulation and on a positive note his involvement with Leah Totton should help raise awareness regarding this all round. It will be interesting to see how this relationship develops.” T H E T W E E T S M E L L O F S U C C E SS After hearing the news of Dr Totton’s visitor Twitter and Facebook were awash with opinions about the programme, most of which were quite brutally critical of Lord Sugar and his new business partner. Here we collate some of the views from key players in the industry…

Eddie Hooker,

Hamilton Fraser Cosmetic Insurance “The result of Dr Leah’s Apprentice win has got the cosmetic industry buzzing, with opinions divided on her medical skills and knowledge of the industry. Industry experts have raised concern that she lacked the requisite medical skills to carry out the procedures she’d proposed in her business plan and the majority of journalists and social media influencers responses towards Dr Leah’s victory were negative. However, those supporting the Derry doctor are encouraging the industry to give this young, and clearly very bright girl, the chance to prove herself in this cut-throat world before passing judgment.”

Mr Rajiv Grover, consultant plastic surgeon and BAAPS President

Dr Johanna Ward “I am sure with Lord Sugar’s backing Dr Leah Totton’s business idea will be a success but I think that her business model will need considerable modification. It’s simply impossible to run a successful aesthetic clinic offering just three facial treatments. Clients nowadays like to combine treatments and like to try all the latest cutting edge technology. If Dr Totten and Lord Sugar fail to offer a wide variety of treatments that clients can choose to combine then they will be missing out on a huge amount of potential income.I don’t think anyone can train clinic managers or injectors in just four months and expect them to deliver the standard of clinical excellence that Dr Totton wants. This is especially true if they are new to the aesthetics industry. Clinical excellence comes with years of experience and ongoing training. I have had over five years of specialist aesthetic, dermatology and injectables training and I am still learning all the time. The aesthetics industry is an exciting and dynamic one but the safety aspect of this industry has long been a cause for concern. To date the cosmetic medicine industry has been very poorly regulated and this needs to be urgently addressed otherwise patients will be put at risk. Lets hope Alan Sugar’s input into this industry is a positive one. Clinics put together in a hurry or with little thought will not survive.”

“What this debate needs is a strong injection of common sense – if Dr Leah Totton were training to be a GP she would not be able to work unsupervised for another four years after qualifying. Yet in the private sector she is setting herself up to train others. Having a stab at running a business shouldn’t be taken literally.”

Mr Graeme Perks,

president of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) “At a time when all professionals are collaborating with Sir Bruce Keogh to improve cosmetic surgery practice and protect the vulnerable, it is a concern that a very junior doctor can make claims to be an authority in this field and provide the direction and clinical judgement that only comes with experience. The results of The Apprentice provides yet another demonstration of why Parliament must act fast.”

Sue Ibrahim,

aesthetic nurse and member of the BACN “We all had to start somewhere, but I had a long background in dermatology before I opened my medical skin clinic. I encourage all doctors and nurses to obtain at least two years mentoring with an experienced doctor or nurse before going it alone. Alan Sugar should appreciate this as he is a mentor in the business sector. I only hope he realises that Leah is still only a very junior doctor who needs support. Failure to do this could put the public at risk.”

Richard Crawford-Small, RCS “The Apprentice is a TV show, therefore it has very little to do with reality. I’m sure Lord Sugar has taken advice and if he did I’m surprised that no one told him that the NHS medical director, Sir Bruce Keogh, released a report into Cosmetic Interventions. The report begins; “The cosmetic interventions sector is growing rapidly. The existing regulatory framework has not kept pace with changes and it does not provide enough protection against many of the potential risks from cosmetic procedures”. How does Dr Totton’s business model help this? My industry colleagues and I seem surprised, as her business model of an inexperienced doctor training inexperienced doctors to perform injectable treatments is a little risky. There may be a little bit of envy around, but the good news is Lord Alan Sugar is about to pump loads of money into direct to consumer marketing! Bonus.”

Paul Wilkinson CEO of Courthouse Clinics “If Lord Alan Sugar puts his weight behind legislation it could help the industry as the government will not push through bills for regulation unless there is a political vote winning reason to do so. Whilst Court House only use experienced doctors we hope Lord Sugar will use his profile to ensure that legislation is tightened up in our sector so that only suitably qualified doctors are allowed to administer injectables in medical premises.” 15



Nigel Mercer, consultant plastic surgeon Dr Patrick Bowler, and former president of the British Association of Aesthetic Plastic Surgeons “At [Dr Totton’s] level of training, she will have a basic knowledge of immunology and some knowledge of anatomy. She may have done a few weeks’ training in aesthetic medicine, but that is simply not enough. It may not be quite as dangerous as putting a hairdresser in charge of cosmetic surgery, but it is still putting patients at risk.There is widespread agreement in the industry that doing a short course does not make you qualified to perform cosmetic procedures. She is using Lord Sugar as a marketing tool to get her business going. This industry is very saturated, and this show has just given her a big leg up.”

Daron Seukeran, Consultant Dermatologist at sk:n “Medical aesthetics is a highly skilled area of practice which takes years to master. Shortfalls in government regulation have meant many ‘cowboy’ practitioners have entered the industry, often tarnishing the reputation of the more reputable, experienced providers. Following the Prof Sir Bruce Keogh report, important regulations are hopefully on the way, but these don’t cover the amount of experience a client should expect their practitioner to have. My concern is that whilst Dr Totton seems dedicated to abiding by the spirit of the report, her simple lack of experience in the field would cause concern as it can take several years of training to become an expert in this area, which of course could have a negative impact on patient safety”

BACD and Court House Clinics “For years the cosmetic treatment industry has been subject to too many unregulated procedures from cowboy cut-price clinics that give the rest of us a bad name. But I don’t think Dr Leah is going to be one of those cowboys. Or, at least, I hope not. With such a massively high profile, and already so many naysayers and critics, Dr Leah and Lord Sugar will certainly have to ensure that their service is tip-top. With Lord Sugar’s media presence and business savvy, I’m hard pushed to imagine that, if anything, Dr Leah’s clinics won’t actually go even further. Instead of providing cheap treatments that endanger patient safety, this is actually an opportunity for Dr Leah to raise the bar of average standard within the cosmetic treatment industry to prove her haters wrong. If Dr Leah wants, as reported, to add up to eight clinic locations to her portfolio over the next five years, eventually selling an empire for about £8million, she’ll need a service that stands the test of time. Best business sense suggests that this would mean hiring only the most credible doctors, making sure all correct legislation is in place, and leading by customer service example when it comes to safety. Maybe the example set by Dr Leah will actually help the reputation of clinics, like mine, Courthouse Clinics, who work hard to provide outstanding training, service, and facilities, and truly separate the wheat from the chaff- the great clinics from the dodgy salons. If Lord Sugar is half the businessman The Apprentice would have us believe he is, Dr Leah’s Botox empire can only go one way: to the top. And it will take the rest of us good guys with it.” See page 52 for more responses from Twitter.

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SHOW & TELL We examine the trend for ‘botched body’ TV shows and ask, do they have a serious negative impact on the industry?


“Have you had botched cosmetic surgery? Has it left you with lumps, bumps, scarring and unsightly and painful body parts?” So begins a Channel 5 advert seeking contributors for a programme on cosmetic surgery gone wrong. Such adverts are hardly unique either: a plethora of programme-makers are currently engaged in similar recruitment drives for such shows as Last Chance Salon and Botched Up Bodies. It’s a hot topic and it seems that just about everybody is talking about cosmetic surgery right now in the national press and media; bad cosmetic surgery, that is. Never mind the thousands of successful procedures and interventions that pass off without incident, but then again, they don’t make for great television, do they? The world demands ‘epic fails’ and horror stories, that’s what broadcasters relish in, high viewer ratings and no producer ever achieved that by playing it ‘safe’, so when it comes to reporting on the cosmetic interventions industry, gory, shocking and extreme is exactly what the world is going to get.The question is, should such programmes be encouraged? Is there not a case for arguing that these shows are doing the cosmetic industry irrevocable harm? After all, no one is disputing that surgery can go wrong on occasions, but in focusing on such isolated incidents, is the public being presented with a skewed image of the cosmetic interventions industry? While these are legitimate questions that should be raised, the cosmetic industry industry is divided in opinion, there are those that uphold the belief that there is nothing intrinsically wrong with such programming, providing that they are produced responsibly. Botched Up Bodies-style documentaries can help victims seek redress for the trauma they have suffered. On one hand there are members of the industry who feel that such programmes place too much emphasis of the negative cases experienced, whilst totally disregarding the positive cases, which are believed to far outweigh the negative. The Cosmedic Coach, Antonia Mariconda says “I have worked closely with selected TV shows over the


last two years to shed light on industry malpractice. I run a support group on social media where I regularly post TV programme opportunities for people seeking help, or corrective surgery in exchange for their story being ‘aired’, the programmes offer a much needed avenue of help to those that have no other solution, help or redress, to me that is a very positive opportunity that I fully welcome, after all if a TV programme proactively helps a person then surely that is something to be celebrated?” One support group member who jumped at the chance to have cosmetic surgery on a TV programme was Melissa Austin Foreman from London, who after having been left with extensive loose skin after weight loss surgery proclaimed on a Facebook support group “I got the call today that Discovery wants me for their show. I am seeing [the surgeon] for my first consultation on Friday!” Melissa, who was otherwise stuck in a financial rut and unable to address her physical post weight loss concerns, says “the TV show has offered me a lifeline that I very much needed”. When surgery goes wrong and complications develop, these can be – and must be – remedied for the physical and psychological benefit of a patient. Programmes such as Last Chance Salon, and Botched Up Bodies help the industry enhance its reputation by showing that patient care is more important than turning a quick profit, provided they present a balanced view of the cosmetic industry and proactively help the victims of shoddy surgery, these programmes seem to have the full support of the public, however, the cosmetic industry has yet to fully accept them.

“I think it makes people more aware of how important it is to research properly for a reputable surgeon but then again no surgery is risk free no matter who your surgeon is” Becky Walton, Surrey “It actually puts more people off than encourages them. These shows are highly scare mongering in my opinion, they spend more time on the gory details rather than explaining and educating the public on exactly the right routes to take and exactly what is safe” Dr Dan Dhunna, West Midlands “These shows are NOT sensationalising anything!!! When surgery goes wrong it’s HEARTBREAKING for the patient” Jo Sandford, Bedfordshire “I think the shows provide insight into what happens and other people’s experiences” Preet Kaur Gill, Birmingham, “As a non surgical clinic, I can only think It is a ‘Positive’ and would like to think it is educating the public on the dangers of going to unregulated, unqualified clinics/ salons. However it still does not ‘In my opinion’ bother people as to where they go as long as it is ‘cheap’. I think some people will still go for the cheaper option regardless of what can happen” The RE-NU Skin Clinic Medical Cosmetics, Scotland

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ON T HE SC E N E Out and about in the industry this month

MEDIA VISIT TO JUVÉDERM® MANUFACTURING FACILITY, PRINGY, FRANCE Cosmetic News editor Vicky Eldridge goes behind the scenes at Allergan’s manufacturing facility in Pringy, France to find out about the latest additions to the JUVÉDERM® portfolio and why quality is so key to this global aesthetic leader Dermal fillers have been under the firm scrutiny of the public eye recently. In the wake of the Keogh report the press has been shining a probing spotlight on to our industry, hungry for stories of ‘treatments gone wrong’. With the safety, efficacy and outcomes of one of the aesthetic market’s bread and butter treatments receiving such negative publicity it was about time someone gave a more balanced view of the situation to the UK’s beauty press. As one of the key players in the aesthetics market, pharmaceutical giant Allergan took up the charge and invited key influential beauty and health journalists on a whistle stop tour of its JUVÉDERM® manufacturing facility in Pringy, France. Keen to lay some of the misconceptions about dermal fillers to rest, the focus of the visit was why choosing quality products and practitioners can help safeguard the public in this still unregulated sector. Educational, evidence-based and even hands on, the visit was a unique opportunity to get up close and personal with one of the world’s market leading dermal filler brands and to see not only the stringent manufacturing processes that are in place at the facility but also the extensive investment in and level of dedication to R&D. Dan Stewart, Allergan’s medical business unit director for the UK and Ireland, opened the day’s proceedings by giving an overview of the company’s history, heritage and mission. The team from the Pringy facility then explained the extensive steps of the manufacturing process for JUVÉDERM® and the standards that the company complies with to ensure the safety and quality of its products. This point was reiterated by Dr David Eccleston, medical director of Medizen, who travelled over with the journalists and was on-hand to answer questions throughout the visit. He shared his extensive experience with dermal fillers and gave his well-balanced and sensible views on the Keogh report, steering away from sensationalism and focusing instead on the facts. His presentation was both thought provoking and inspiring and really gave a better level of understanding to the journalists, many of whom were still, like many of us, confused by what the implications of Keogh will actually be. We were then introduced to some of the latest products in the JUVÉDERM® portfolio – the VYCROSS™ collection – including VOLUMA®, VOLBELLA® and VOLIFT®. As lips are one of the areas that receives the most negative press the focus was on the newly launched JUVÉDERM® VOLBELLA® with Lidocaine which has been designed 20

specifically to give natural looking lips and move aware from the ‘trout pout’. Dr Eccelston talked about his use of the product and showed some impressive, subtle case studies that showed lip enhancement does not have to be ‘obvious’. Dr Eccleston explained how the new treatment results in less swelling compared to other lip treatments, enabling patients to return to their daily life more quickly following treatment. He said, “New patients are often concerned about having an unnatural result from a lip treatment – like the ‘trout pouts’ or ‘duck lips’ we sometimes see in the media. JUVÉDERM® VOLBELLA® with Lidocaine is different - it gives an ultra-smooth, natural look and can be used to tailor or enhance your smile. In addition, this is the only dermal filler clinically proven to last up to 12 months in the lips with a single treatment, so it gives a long-lasting effect for my patients.”The product has been formulated with an innovative combination of low and high molecular weight technology, which delivers an ultra-smooth gel resulting in a natural look and feel, as well as improved duration. It comes through the needle almost like water yet still has the properties of a gel and stays in place. After lunch it was time to don our safety goggles and protective clothing as we took a walk round the non-restricted areas of the manufacturing facility before spending time with Allergan’s amazing R&D scientists in their labs where we got to see the hyaluronic acid in its raw form, peek under the microscope at the products to examine their make-up and inject the different viscosities of JUVÉDERM® into tester breast implants using different syringes, including those designed by Allergan’s R&D team, to see how all these different factors effect the ease of injection of the products. The trip was an interesting and eye opening insight for many of the journalists, including me. Despite the fact I have been writing about dermal fillers for 10 years it reinforced the importance for practitioners of choosing

quality brands and showed why not all fillers are created equal. One thing I will always respect Allergan for is that they always acknowledge the place in the market the other leading fillers, their competitors, have. The trip was not about a marketing promotion for JUVÉDERM® it was more of an educational exercise on the importance of choosing safe and ethical brands and practitioners, but just urging the press to caution their readers about other over the internet products or cheap alternatives which may not be safe or following the same kind of processes as they and the other market leaders do. It was also a fantastic opportunity to speak with the scientific minds behind the brand and to see how much goes into producing these products that are being used in aesthetic clinics up and down the country every day. 1 Eccleston D. Clin, Cosmet & Investig Derma, 2012; 5:1-6 2 Allergan Data on File (Dof) Study report (Ref#DF6) ‘CHLA HA Filler Study’ – Fig 1, Appendix 3 3 Philipp-Dormston, WG et al. Poster presented at IMCAS, 31/01/13

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ON THE SCENE | ILIPO CENTRE OF EXCELLENCE LAUNCH, AESTHETIC SKIN CENTRE, LONDON The Aesthetic Skin Centre has become the first clinic in the UK to launch the new advanced non-surgical fat reduction and body shaping system, i-LipoXcell. The clinic will be the UK ‘Centre of Excellence’ for the Chromogenex™ i-LipoXcell. The nurse-led clinic is owned by Trudy Friedman, a well -respected figure in the world of cosmetic medicine. She gave a presentation and demonstration of this breakthrough non-surgical fat reduction and body shaping system, supported by Sam and Hannah from Chromogenex’s Clinical Training division, to a team of assembled clinicians and members of the public. She said,

“From the feedback, we know that i-LipoXcell is the platinum standard of next-generation body treatments. We also welcomed our new nurse Luisa who we are thrilled to have on our team” The i-LipoXcell uses patented third generation technology, incorporating four ‘smart’ scientific platforms which analyses body dynamics. Low-level lasers, delivered through treatment pads, target specific areas of fat to help reshape and redefine the bodyline. A combined laser/massage is then used to enhance lymphatic drainage, improve circulation and create more effective pathways for the lasers to reach the fat cells in order tackle stubborn cellulite and stretch marks.


Cosmetic News contributor Antonia Mariconda spent a day in London filming for her new TV show Celebrity Beauty Secrets. In her role as The Cosmedic Coach, Antonia has become the go-to expert for consumers interested in aesthetic treatments and will be uncovering celebrity beauty secrets as part of the show on Sky 282.

SKIN CLINIC 1ST BIRTHDAY PARTY, BRENTWOOD The cast of the hit reality TV show, The Only Way is Essex, joined Dr Johanna Ward and her team to celebrate the 1st birthday of the Skin Clinic in Brentwood. TOWIE favourites Chloe Sims, Gemma Collins and Billie Faiers, all of whom are also local business owners in Brentwood, were there to toast a successful first year in business for the clinic, which has also appeared on the show. The Skin Clinic Brentwood is Dr Ward’s second boutique skin clinic established after her huge success in Sevenoaks, Kent.


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MIXOLOGY Mesotherapy has proved to be effective in a number of indications by delivering a cocktail of active ingredients directly to where they are needed. We examine its evolution and applications

When it comes to treatment options, not many procedures offer the variety of indications and methods of administration that mesotherapy does. The treatment can be used for both fat and cellulite reduction and to address skin ageing and can be performed using either manual syringes, specialised mesotherapy guns or via no-needle alternatives, which use an electrical current, rather than a needle, to push the products through the skin.

In France and in other countries such as Italy and Spain its use is very wide spread, in fact it is even taught in medical schools in France and is used in both general and cosmetic medicine.

Although it is still a fairly new concept in the UK, mesotherapy has actually been used elsewhere in Europe – both in general medicine and in the aesthetics industry – for decades. Yet despite its wide spread use on the continent mesotherapy is still little talked about in the UK. While some aesthetic practitioners are hard and fast advocates of the treatment, it has proven to been a somewhat controversial topic here with many doctors questioning its effectiveness.


Mesotherapy can be defined as series of microinjections of a cocktail of vitamins, serums, medications or amino acids into the middle layer of the skin. Its purpose is to heal and reverse skin ageing and damage. The concept is that it is better to deliver medications directly to the area being treated than to ingest them through a tablet. When small amounts of medications are injected into the skin, the blood flow automatically increases to the treated area, bringing with it increased nutrition and oxygen, thus improving lymphatic drainage and removing toxins in the skin.

The term mesotherapy comes from the Greek mesos, “middle”, and therapeia, “to treat medically”. The technique was first developed in France in the 1950s by Dr Michel Pistor. It was first used to treat such conditions as rheumatism, sports injuries, and for the improvement of blood circulation however its use now encompasses aesthetic applications and it is in this area that its popularity is growing worldwide.

Traditional mesotherapy involves a series of very small (micro) injections into the area being treated. The treatment is done using a very fine hand-held needle or a ‘meso-gun’ and is virtually painless. The practitioner will inject measured amounts of different medications just under the skin. Puncturing the skin with microinjections is also thought to induce new




collagen production in the skin. For body treatments active ingredients that help to break down cellulite and localised trapped fat and improve circulation, lymphatic and venous drainage are used. The treatment takes around 30-45 minutes, depending on the size of the treated area. A course of up to eight treatments is usually required at one to two weekly intervals.In recent years however there has been an influx of no-needle mesotherapy treatments. With no needle mesotherapy the cocktail of ingredients are applied directly onto the skin. An electrical current is then used to ‘push’ the ingredients through the skin. This treatment is virtually pain free and is ideal for people who don’t like needles. The procedure takes about half an hour and

Mesotherapy can be defined as series of microinjections of a cocktail of vitamins, serums, medications or amino acids

a course at weekly intervals is usually required to achieve the full effect. The side effects of the treatment are relatively minor so patients can return to their normal daily routine or work afterwards.

I N D I C AT I O N S For skin rejuvenation, the aim is to replace minerals, vitamins and amino acids that are found in lower levels in skin as we age. One of the main aims is to boost levels of hyaluronic acid in the skin. As the skin ages, levels of hyaluronic acid decrease, and it is claimed that injecting more hyaluronic acid into the dermal layers (just below the surface of the skin) helps to stimulate more collagen production, which, in turn, improves skin tone and helps to reduce fine lines and wrinkles. One of the most popular uses of mesotherapy in aesthetics is for the treatment of fat and cellulite. The fluid injected is a cocktail of vitamins and different medications designed to break down fat. The treatment is particularly good for dealing with cellulite but can also minimise fat on the stomach, thighs, chin and love handles. The ideal candidate for fat reduction treatment would be near or at their ideal body weight with small areas of stubborn, localised fat that cannot be shifted with diet and exercise. Mesotherapy is now also being used to treat hair loss.

MIX YOUR OWN? Mesotherapy cocktails can be tailored for specific patients and indications. While some experienced practitioners still mix their own preparations the trend has been increasingly towards buying pre-prepared mesotherapy cocktails manufactured and distributed by a number of companies in the UK and Europe. The worry is that in inexperienced hands, as with any aesthetic treatment, the practitioner is taking a lot of responsibility by mixing their own preparations. For many buying products from reputable manufacturers and suppliers takes away this risk and is a safer way of offering these treatments, especially when the control of products in the UK is so unregulated. There have been a number of papers published, which show the risks associated with using the wrong concentrations or mixtures of products in mesotherapy cocktails from caffeine poisoning1 to infections2-3 and complications arising from the use of unknown substances4. One study said: “The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.”5 As with any treatment, practitioners should make sure they have adequate training and understanding of the procedure and are using safe and efficacious products. If you are thinking of introducing mesotherapy treatments to your clinic there are a number of companies in the UK, such as Medical Aesthetic Group, Toskani, Boston Medical Group and Wellness Trading who have led the way in this field and offer comprehensive training and advice on how to not only get results but to make this treatment work for your clinic. By taking these steps you can introduce a treatment with a broad range of indications that can, when used properly, give you high margins and excellent treatment outcomes.

[References] 1. Vukcević NP, Babić G, Segrt Z, Ercegović GV, Janković S, Aćimović L. Severe acute caffeine poisoning due to intradermal injections: mesotherapy hazard. Vojnosanit Pregl. 2012 Aug;69(8):707-13. 2. Quiñones C, Ramalle-Gómara E, Perucha M, Lezaun ME, Fernández-Vilariño E, García-Morrás P, Simal G. An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy. J Eur Acad Dermatol Venereol. 2010 May;24(5):604-6. 3. Da Mata Jardín O, Hernández-Pérez R, Corrales H, Cardoso-Leao S, de Waard JH. Follow-up on an outbreak in Venezuela of soft-tissue infection due to Mycobacterium abscessus associated with Mesotherapy. Enferm Infecc Microbiol Clin. 2010 Nov;28(9):596-601. doi: 10.1016/j.eimc.2009.08.003. Epub 2010 Jan 27.

4. Ramos-e-Silva M, Pereira AL, Ramos-e-Silva S, Piñeiro-Maceira. Oleoma: rare complication of mesotherapy for cellulite. J.Int J Dermatol. 2012 Feb;51(2):162-7. 5. Galmés-Truyols A, Giménez-Duran J, Bosch-Isabel C, Nicolau-Riutort A, Vanrell-Berga J, Portell-Arbona M, Seguí-Prat B, Gumá-Torá M, Martí-Alomar I, Rojo-Arias MÁ, Ruiz-Veramendi M. An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy. Enferm Infecc Microbiol Clin. 2011 Aug-Sep;29(7):510-4. 6. Jayasinghe S, Guillot T, Bissoon L, Greenway F. Mesotherapy for local fat reduction. Obes Rev. 2013 Jun 25. doi: 10.1111/obr.12049. [Epub ahead of print] 7. Konda D, Thappa DM. Mesotherapy: What is new? Indian J Dermatol Venereol Leprol. 2013 JanFeb;79(1):127-34. doi: 10.4103/0378-6323.104689.


BOD Y OF E V I DE N C E Dr Penelope Tympanidis on body peels Some people still think of chemical peels as causing horrible face burns that heal in weeks! This is wrong. Peeling is the core of skincare our days. Forget about the “cleance, tone, moisturize” slogan of the eighties. The way ahead for a healthy beautiful skin is “peel and sunblock”. Peels are also not only for the face but for every corner of the skin. You can make the décolletage and neck more youthful looking, make stretchmarks less visible, make pimples and spots everywhere (arms, legs, buttocks) disappear.


Peeling is a physiological function of our skin. Cells of the epidermis mature and ascend from the basal layer to the surface of the skin to then die and exfoliate. We do not see this happening of course, what we see is a smoother skin surface, when we scrub the skin or apply a mild, “over the counter” peeling agent. As we age our physiological peeling pace slows down as a reflexion of the general slow down of ageing. A chemical peel may promote exfoliation and bring the skins’ own renewal pace to a faster “younger” pace. This happens only temporarily, depending on the strength of the peel. There is a peel for everyone!

The beauty of the chemical peel is its versatility. It could be tailor-made to everybody’s’ need, lifestyle, skin type, skin problem etc. Chemical peeling is the most common yet sophisticated way to treat a multitude of skin problems from acne, to acne scarring, skin ageing, melasma, wrinkles, keratosis pilaris, ingrown hair, stretch marks, oily skin dilated pores etc. There are at least a dozen of acids and at least five different potencies of each acid. If you consider that we mix and match different acids in different strengths, creating peeling cocktails tailormade to each individuals needs, you realize how versatile and targeted the peeling treatment may be.

We may actually perform the “lunch time “ peel, favourite to a lot of professional people who just go back to their work right after the peel! What happens here is an invisible exfoliation. Your skin tightens slightly, for a couple of days. It feels smooth looks brighter and more healthy. That is what you experience macroscopically. Microscopically though what happens is that instead of losing 100 dead cells per day, your skin exfoliates a few thousands of dead cells. Usually the deeper/ stronger the peel, the better the end result. This however, means longer down time straight after the peel. However even with the strongest of peels the downtime never exceeds a seven to 10 day recovery. One cardinal point here is getting your patients into the habit of applying sunblock all year round. All peels may render the skin more sensitive to the sun. This is why they should always apply sunblock (or any product with SPF30 and above) after the peel. Applying sunblock all year round instead of any other “day care cream” will protect the skin from actinic ageing and will render the peeling results longer lasting.

Dr Penelope Tympanidis Dr Penelope Tympanidis is a consultant dermatologist and the owner of the Dermaperfect clinic on Harley Street. Recognised by the European Board of Dermatology, she is one of London’s leading dermatologists and has been a pioneer in minimally invasive anti-aging techniques for the last 13 years, having been featured in Tatler magazine, the Telegraph, Vogue, the Financial Times Weekend supplement as well as the Channel 4 programme, Make Me Perfect. Dr Tympanidis trained at Tufts, Boston and UCL and has worked as a Consultant in Dermatology at Mayday University Hospital in London, as a Clinical Research Registrar at the Department of Dermatology at UCL and the Royal Free/UCL Medical School Campus as well as in various busy dermatology units in Liverpool and Glasgow. She has gained first-hand experience in general dermatology, photo-dermatology, allergy and patch testing, pediatric dermatology, skin cancer clinics, laser treatment sessions, and teaching students and General Practitioners. She now trains junior plastic surgeons, on minimally invasive cosmetic procedures, and junior dermatologists on cutaneous surgery. 26

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THE SKIN AND BONES OF IT Dr Patrick Treacy on the science of facial ageing

Dr Patrick Treacy Dr Patrick Treacy is Medical Director of Ailesbury Clinics Ltd and Ailesbury Hair Clinics Ltd. He is Chairman of the Irish Association of Cosmetic Doctors and is Irish Regional Representative of the British Association of Cosmetic Doctors. Dr Treacy is a renowned international guest speaker and features regularly on Irish breakfast television (TV3), RTE and as an expert panelist with the BBC World Service. He had a series on Discovery Health and the Discovery Channel (New York) filmed a programme about his work. He is an active member of many international medical societies and is a Fellow of The Royal Society of Medicine.

Beauty and ageing are intrinsically linked neither dependent on each other. While beauty is a concept that is ethnically, racially and culturally determined, the ageing process is slow, relentless and irreversible. Ageing occurs at different rates from individual to individual as well as in each person at any given time. It is related to a combination of loss of bone, fat, collagen and elastin, each of which is directly related to genetic composition and environment. During the course of this ageing process the general outline of the face changes from a triangle with the apex pointing downward to a trapezoid or rectangle due to sagging skin and downward descent of the cheek soft tissues. This change in geometry is more evident in the female face. It appears to be unrelated to general physical activity unless one is very ill and bed ridden. General changes that occur with facial ageing include: FAT LOSS For many years we thought that the human face aged uniformly. We now know from the work of Dr. Pessa that fat disappears from different fat compartments in the face at differing rate. Most cosmetic doctors

now agree that the rate of fat disappearance is directly related to how the face ages. COLLAGEN LOSS Loss of collagen and elastin from the skin of the face. Skin elasticity decreases and the skin become thinner. Lifestyle choices such as diet and sun exposure have an impact on the rate these factors come into play. Areas with thin epidermis (eyes and lips) receive wrinkles first. BONE LOSS Facial bones lose density and thickness. This causes some minor changes in facial shape. Loss of bone along the bony rim under the eye and in the region of the nose-cheek junction. The remaining upper and lower jaw bones do not change as long as teeth remain intact.

TH E AGE I NG PR O CE S S IN D ECA D ES 20-30 YEARS • Fat begins to disappear from under the eyes. Dark shadows cause us to look older and tired. Correction: Hyaluronic acid to lower eye area • Collagen levels start to fall resulting in crow’s feet and frown lines. Correction: Botox to frown lines and around eye area. Retinol or Vit-C • Little effect of bone loss seen in this age group. No correction required.


30-40 YEARS • Malar fat pad descent begins. Nasolabial lines appear. The result is wrinkles and jowls in the face. Those due to muscle motion are referred to as dynamic wrinkles while those that are merely due to ageing of the skin are referred to as adynamic wrinkles. Correction: Hyaluronic acid to nasolabial line to hold malar fat pad in place. lower eye area • Collagen and elastin levels continue to fall resulting in edge of brow drooping. Extension of nasolabial folds. Lips begin to thin. Glabellar (between the eyebrows) and forehead wrinkles appear. With advanced filling techniques we tend to look at changes that are occurring in the mid face and lower face. Correction: Botox to most of upper face and to elevate eyebrows. Hyaluronic acid such as Restylane, Juvederm or Teosyl to enhance lips and nasolabial lines to hold malar fat pad in place. Sculptra and resurfacing lasers • Base of nose gets bigger. Some changes seen in chin area. Correction: Enhance facial contours with hyaluronic acid to change nasolabial line to marionette ratio. 40-50 YEARS • Cheek begins to flatten. Malar fat pad descent becomes more obvious. Nasolabial lines deepen. Facial fat atrophy or wasting becomes evident with concavity of the surface contour in the temple area and cheeks appearing. In some individuals the eyes become sunken as a result of fat atrophy rather than forming eyelid bags. Correction: Hyaluronic acid such as Sub-Q, Evolence or Radiesse to central face to hold malar fat pad in place and achieve voluminisation. Fat grafting such as autologous fat transfer. Marionette lines and jowls now appear. Double chin appears. Correction Vaser LipoSelection, SmartLipo or Lipodissolve • Collagen and elastin levels continue to fall resulting in eyelid bags and lines start to appear in upper and lower lips. Forehead wrinkles deepen. Gravity and the pull of muscles cause drooping or sagging of the skin and deeper structures from areas of deeper attachment. Correction: Hyaluronic acid fillers to upper lip. Botox to upper face. Radiofrequency skin tightening treatments such as Polaris, ReFirme and Thermage. Infrared skin tightening such as Titian and LuxIR. Resurfacing skin lasers such as ActiveFx. • Collagen and elastin levels continue to fall resulting in eyelid bags and lines start to appear in upper and lower lips. Forehead wrinkles deepen. Gravity and the pull of muscles cause drooping or sagging of the skin and deeper structures from areas of deeper attachment. Correction: Hyaluronic acid

fillers to upper lip. Botox to upper face. Radiofrequency skin tightening treatments such as Polaris, ReFirme and Thermage. Infrared skin tightening such as Titian and LuxIR. Resurfacing skin lasers such as ActiveFx. • Collagen and elastin levels continue to fall resulting in eyelid bags and lines start to appear in upper and lower lips. Forehead wrinkles deepen. Gravity and the pull of muscles cause drooping or sagging of the skin and deeper structures from areas of deeper attachment. Correction: Hyaluronic acid fillers to upper lip. Botox to upper face. Radiofrequency skin tightening treatments such as Polaris, ReFirme and Thermage. Infrared skin tightening such as Titian and LuxIR. Resurfacing skin lasers such as ActiveFx. • Chin area continues to enlarge. Eye sockets begin to widen. Correction: Many cosmetic doctors feel the changes are to subtle to require correction. 50-60 YEARS • Menopausal effects. Fat hangs in saggy skin. Nasolabial and marionette lines substantially deepen if not corrected. Marionette lines and jowls become more obvious. Double chin and ‘turkey neck’ appears. Correction Short scar facelift. MACS facelift. Anterior neck lift. Excess fat appears under eyes Correction Blepharoplasty • Menopausal effects. Fat hangs in saggy skin. Nasolabial and marionette lines substantially deepen if not corrected. Neck wrinkles. More of the eyebrow droops. The nasal tip droops. The lips thin so there is less dry vermillion (pink area where lipstick is applied) showing. Perioral wrinkles deepen. Platysmal banding appears in the neck. Correction: Hyaluronic acid fillers to upper lip. Botox of diminishing effect. Face lift, Brow lift, Blepharoplasty or Neck lift often required. • Menopausal effects. Bone density gets less as combination factors such as reduced growth hormone and oestrogen levels occur. Correction: Many cosmetic doctors feel the changes are too subtle to require correction. 60-70 YEARS • Facial skin thins. Skin pigment cells increase in number and size in a blotchy pattern giving rise to brown spots of the back of hand and face (senile lentigo). Correction: IPL lasers. Skin cancer screening 29


CUSTOM MADE We find out about the PRESCRIBEDsolutions™ [CUSTOMIZED SKINCARE] range from AesthetiCare Skincare is big business but with so many products for so many indications it can be hard for clients to budget for and prioritise what they need. Customised skincare is one solution to that problem. Brought to the UK by AesthetiCare® PRESCRIBEDsolutions™ [CUSTOMIZED SKINCARE] is a new customisable range of medi-grade skincare products from the USA which are designed to prepare, protect and repair the skin against the daily challenges it faces. Using products with primary skin enhancing effects such as exfoliation, high-level anti-oxidant protection, DNA repair and anti-glycation, the aesthetic practitioner can then go much further. Based on their client’s skin condition and concerns at that particular point in time, the primary medi-grade home-use products are then customised specifically for their client with one of the specially formulated PRESCRIBEDsolutions™ boosters. Available for indications as diverse as skin lifting or brightening and acne control, all boosters contain key, evidence based, botanical ingredients to support and complement the prescribed skincare regime. By following the simple three-step process outlined below, clinics are able to provide a range of multi-tasking products that are specific to the individual:

THE PRODUCTS THE CLEANSERS • Starting Up/Face™ Glycolic anti-oxidant cleanser Ideal for patients with normal to oily and spot-prone skin and/or impaired skin texture and pigmentation as the exfoliating actives will accelerate cell turnover and remove dead skin cells and oils from the skin surface helping to minimise spots and blemishes. • Surface Improvement™ Exfoliating polish cleanser Ideal for patients with normal to dry skin, especially those with visibly flaky skin and is also great for body areas on the arms and thighs. The mechanical exfoliant will remove dead skin cells and surface impurities and bring new cells to the skin surface. • Don’t Be So Sensitive™ Post Procedure/Sensitive Skin cleanser Ideal for patients with sensitive or inflamed skin or post-procedure. It provides gentle daily cleansing whilst soothing the skin and providing additional anti-oxidant protection. Natural skin conditioning agents aid in the recovery and healing process of the skin, particularly after

Step 1 – Consult and Diagnose The first stage in the process is to perform a consultation in order to assess the patients’ skin and their needs. Their primary concerns and indications can then be diagnosed alongside a discussion regarding their secondary skin indications and concerns.

Step 2 – Prescribe and Customise Following the initial consultation and diagnosis a decision will be made about which PRESCRIBEDsolutions™ cleanser and treatment serum and/or cream is best suited to the patient and their primary concern and indication. This will then be customized using a specially formulated booster, which will help address their secondary indications and concerns.

Step 3 – PREPARE. PROTECT. REPAIR The patient will now have a complete PREPARE. PROTECT. REPAIR product and/or regime that is specific to them and individualized to their needs at that point in time. The aesthetic practitioner will now work with the patient and their skin as things change. The primary products and boosters can be adapted over time so that they stay specific to them and the needs of their skin. The patient will have received high-level customer service and personal care, adding value to client relationships and to the individual business.

medical aesthetic procedures, and provide antibacterial with soothing benefits. Additional anti-oxidant protection helps to reduce erythema.

THE SERUMS • Radical Results™ Anti-oxidant serum C+E Idea for protecting younger skin or skin with lower level UV damage at times of high-level UV and ROS risk as a core treatment serum. It provides high-level UV photo-damage and skin-ageing free radical anti-oxidant protection in addition to a reduction in pigmentation and skin blemishes and spots and enhancement of new collagen production. • Line Subtractor™ Anti-ageing serum C+AHA Ideal as a core treatment serum for patients protecting younger skin or skin with lower level UV damage and who also have spot-prone skin or skin with impaired texture and tone. Also ideal to use in SKIN SYNERGY™ to enhance skin regeneration regimes where spot-prone and/or texture tone problem skin conditions are a concern. It provides powerful anti-oxidant UV and age-induced free radical protection in addition to epidermal exfoliation, stimulation and skin blemish repair. • Urbane Renewal™ Triple action anti-oxidant serum Provides effective evidence-based repair of damaged DNA such as pyrimidine dimers caused by UV and free-radical damage. This is combined with powerful broadspectrum anti-oxidant


protection against environmental induced free radicals and evidence-based repair of the mitochondrium and mitochondrial DNA to enhance energy production by the cell. Anti-glycation activity also protects against glycation end products, which induce premature ageing • Bolt of Lightening™ Skin brightening serum A skin lightening serum for problem skin with UV induced pigmentation. Evidence-based Hydroquinone-free skin brightening ingredients can help brighten and lighten areas of UV-induced pigmentation. Additional anti-oxidants also help to reduce the stimulation of new pigmentation formation. Gentle exfoliants help clear and brighten the epidermis.

THE CREAMS • Stop the Clock™ Triple action anti-ageing day cream. A triple-action anti-ageing day cream with UV photodamage sunscreen and anti-oxidant protection, DNA repair and skinfirming enhancement. Ideal for patients with younger, less damaged skin and those with busy lifestyles adverse to multiple morning-use regimes. It provides effective protection from UV-induced free radicals with SPF50 broad-spectrum sunscreen and anti-oxidant action. Evidence based ingredients provide repair of damaged DNA such as pyrimidine dimers caused by UV and free-radical damage. • Cream – No Sugar™ Triple action antiglycation night cream A triple-action anti-glycation night cream providing protection from Glycation-induced ageing with DNA repair and intense moisturisation. Ideal for patients with younger, less damaged or regenerated skin as a core treatment night-cream.

THE BOOSTERS Specifically formulated and compatible Boosters that are used to customize the primary productsn based on the patient’s problem skin concerns.

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Rotational Diamond Peel Microdermabrasion Rotational Diamond Peel Microdermabrasion

Utilising thethe latest technology available you can in conjunction Utilising latest technology available you work can work in conjunction with topical skincare to ensure that hydration and comfort are not with topical skincare to ensure that hydration and comfort are not compromised whilst delivering excellent peeling results. compromised whilst delivering excellent peeling results.

Radio Frequency Radio Frequency Tri-polar Radio Frequency is the most advanced technology Tri-polar Radio Frequency is the most advanced technology

available for skin-tightening ensuring excellent results without the available for skin-tightening ensuring excellent results without the discomfort associated with mono or bi – polar devices. discomfort associated with mono or bi – polar devices.

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Full canopy LED ensures rapid treatment time and excellent results are achieved. Availableboth wavelengths Red (640nm - 700nm), Blue (425nm 470nm), Yellow (590nm) and Green (520 - 564nm) results are-achieved. Available wavelengths Red (640nm - 700nm), ensures effective-treatment anti-ageing, acne and Blue (425nm 470nm), for Yellow (590nm)pigmentation, and Green (520 - 564nm) detoxification. ensures effective treatment for anti-ageing, pigmentation, acne and detoxification.

3D-skintech peels and clinical skincare A compact range ofpeels medicaland gradeclinical peels and cosmeceutical skincare 3D-skintech skincare products complete the Skintech’s unique offering enables you skincare A compact range of medical grade peels andand cosmeceutical to both use as a “stand-alone” service unique or combine withand equipment products complete the Skintech’s offering enables you protocols. to both use as a “stand-alone” service or combine with equipment protocols. ‘To compliment our core injectable business the 3D-skintech has added an array of new result driven facial services to our clinic’s menu as well as the combination services for ‘Tomore compliment our coreWe injectable business thedevice 3D-skintech hasstand added an array our curative patients. recognized that this offered the alone qualityof new driven facialinservices our clinic’s menu as well combination services for of result each technology a uniqueto machine that will ensure thatas wethe both deliver the results but equally makepatients. money from the start due itsthis affordability. As a clinician tooalone manyquality our more can curative We recognized that device offered the stand times in the past we have investedmachine huge sums in that a single concept thatthe hasresults of each technology in a unique thatofwillmoney ensure we both deliver proven difficultcan to profit from. In myfrom opinion system represents future intoo our many but equally make money the this starttype dueofits affordability. As the a clinician industry.’ Martyn – GP and Clinical director Cosmedic Skin times inDrthe pastKing we have invested huge sums of money in Clinic a single concept that has proven difficult to profit from. In my opinion this type of system represents the future in our industry.’ Dr Martyn King – GP and Clinical director Cosmedic Skin Clinic



We speak to Dr Neil Walker about the Venus Freeze system and how it helped him move his dermatology practice into the aesthetic arena comfortable for the patient and very safe for us to use so

more of an uphill struggle. It very much is a treatment

that is why we went with it rather than any of the other

that is working on supporting the skin so it works well

devices. It is also a very versatile system.

in combination with other treatments. Sometimes you may need to do a little bit of volume enhancement

CN: Can you explain how the treatment

with fillers or you may be doing laser treatments or IPL


for overall skin quality. As a dermatologist admittedly

NW: I think most people now understand how radio-

it is the face I have been more interested in and the

frequency works. It is basically heating the supporting

aesthetic patients I tend to see are more for things like

layers of the skin and causing the stimulation of new

age related skin concerns or acne scarring but we have

collagen and tightening of the tissues. It is that heating

certainly been discovering the benefits of the body

that produces the benefits which is a well understood

handpiece particularly as a circumferential reducer. Our

mechanism. The magnetic pulse technology is more

experience with the body is relatively limited however we

interesting because that is something I wasn’t really

have seen some patients who have been delighted with

aware of until I started looking at this machine. That

the response.

technology has been used by orthopedic surgeons for a while and is recognized as a physical well of stimulating

CN: What are the advantages of this

tissues to heal and produce new blood vessels and

treatment for patients?

improved quality tissue. The two are combined in the

NW: I think it is safe, very tolerable in terms of the

Venus Freeze to deliver this warming effect, which is

actual treatment and it is effective so those are three big

what the patients feel.

plus factors for patients.

CN: If the treatment works by warming why

CN: Are their any particular treatment protocols you

is it called the Venus Freeze

would advise using to get the best outcomes?

Cosmetic News: What attracted you to the

NW: I asked that question myself as it may be

NW: It is pretty straight forward and they have got their

Venus Freeze System?

confusing! Particualry as a dermatologist we use

protocols pretty well worked out. Occasionally you may

Dr Neil Walker: I recently set up my own stand-alone

freezing a lot for treating things! As far as I understand it

need to go a bit more gently if the patient is finding it a

clinic in Oxford so we were looking for new devises to

is was because it helps to ‘freeze’ time.

bit warm but that is quite unusual. You can turn down

bring into that facility to expand our range of treatments.

the RF if you want to but we tend not to stray from their

We were looking for something that was effective

CN: What indications do you get the most

but that was safe and easy to use so that we were

effective results with?

comfortable about using it in a safe way that wasn’t

NW: The treatment works really well for people who are

CN: How has this treatment fitted into your

going to cause problems for patients. It has certainly

starting to become aware of a little bit of loss of volume


filled that niche for us.

in the lower half of the face. It works particularly well

NW: We have found it a very useful adjunct to what we

for early jowling and loss of tightness tightness in the

wanted to do in terms of moving into the aesthetic side

CN: How does it compare to other

jawline as well as for patients who are beginning to see

of the business. Patients will come in with other issues

technologies on the market?

a bit of flatness in the neck. For these patients you can

and when they hear about it they want to try. We have

NW: We looked at five different machines and

achieve a really worthwhile result. Those are certainly

found we have had people coming in and asking to have

of the machines that we looked at we felt that the

the patients we have been tending to concentrate on. It

it done without us saying ‘this is something we think is

Venus produced a worthwhile improvement, was very

will work when the changes are more marked but it is

going to be a benefit to you’.

We have found it a very useful adjunct to what we wanted to do in terms of moving into the aesthetic side of the business 32

protocols because they are well organized.

Dr Neil Walker, FRCP is Consultant Dermatologist at The Lister Hospital, SW3, Stratum Clinic and Churchill Hospital, Oxford. He specialises in dermatological, aesthetic and laser treatments and with areas of special interest being skin cancer surgery, hair and nail disorder, acne, rosacea, birthmarks, cosmetic dermatology, injectibles, peels, skin rejuvenation, laser hair removal, tattoo removal and IPL.


HERE COMES THE SCIENCE We talk to one of the leading scientific minds in skincare, Joe Lewis, about his ‘Protect with SPF, Protect with antioxidants, and Correct with DNA Repair Enzymes””, philosophy and his plans to create the ultimate hero product incorporating DNA repair, SPF and anti-oxidants _EPF® Environmental Protection Factor currently being used by the brand PRIORI® and Prevage®.

Joe Lewis’ passion for the science of skincare is infectious. One of the leading lights in this field Joe is responsible for developing and launching the world’s first glycolic acid AHA product and is a pioneer in the field of anti-oxidants having introduced novel new antioxidants for skincare therapy, such as CoffeeBerry® whole fruit extract and Idebenone, and developing the concept of quantification of oxidative stress protection capacity for topical anti-oxidants. A renowned cosmeceutical research scientist with a career spanning 25 years, Joe lives and breaths skincare and his latest product line PRIORI® MD marks yet another groundbreaking discovery. We are all familiar with the need to protect our skin with sunscreen and anti-oxidants to reduce the effects of environmental damage, but no product is 100% effective and damage can still occur. This is when the need for correction and repair at a cellular level is required and it is this concept that has lead to the launch of Lewis’ latest innovation – Clinical Recovery Serum part of the new PRIORI® MD line. New scientific research has revealed that DNA Repair Enzymes play a critical step in cellular repair against ageing. DNA gives our cells essential instructions on how to function and is present in our nucleus and mitochondria (the power house of the cell); it is a very vulnerable structure, so the ability to repair the DNA reduces premature ageing and skin 34

imperfections dramatically. PRIORI® MD Clinical Recovery Serum mimics the skin’s own repair enzymes to normalise and repair the cell. It is the highest strength professional product to contain exclusive DNA Enzyme Complex™ which utilises three powerful enzymes from natural sources such as blue green algae and mustard seed. Here Vicky Eldridge speaks to Lewis about the role of DNA repair in skincare and why combining this with sunscreen and anti-oxidants gives the ultimate protection/skin health. Cosmetic News: For years we have thought that using sunscreens and anti-oxidants was enough, how has our understanding of this now changed? Joe Lewis: Sunscreens have been around for 50 years. When they were originally created the purpose was to prevent sunburn and what causes

sunburn? UVB. We came up with fabulous UVB absorbers and everyone ran around and didn’t get sunburn – of course they were totally overlooking the fact that the UVA rays were longer and penetrated deeper so people were still getting skin cancer and skin ageing because we were missing half that spectrum. If you look at the radiation spectrum you have UVC, which is the shortest, UVB, UVA, Visible Light and then Infra Red. All of these are irradiant energy from the sun. We spent a lot of time just protecting from UVB. It has only been since December last year that you have had to include UVA protection in the US which is amazing because we have known about UVA damage for 20 years! The other problem is that sunscreens are not anti-oxidants, that is not how they work, you either have chemical blockers or physical blockers. Chemical blockers like oxybenzone and avobenzone, absorb UV energy and change it to heat energy before it causes problems in the skin, whereas physical blockers like zinc and titanium block UV light before again before it causes fee radicals and problems in the skin. No sunscreen is 100% effective and people don’t wear them right. Most people only apply 25-50% of the recommended amount of sunscreen and they don’t apply them the way they are tested in the lab. I always tell people

back stop. The catcher is the sunscreen, the back stop is the anti-oxidants. These molecules are scavenging toxic free radicals caused by this type of insult. Sunscreens are pretty good at stopping UVB and with UVA they are getting better but there is still a lot of UVA getting through. There was a study that shows that sunscreen only blocks 50% of free radicals caused by UVA radiation, so you have got to have this secondary screen. Also sunscreen is not blocking any of the free radicals from infra red light. We now have powerful anti-oxidants which scavenge these free radicals but again no anti-oxidant is 100% efficient, some little free radicals sneak through, and this is the ultimate problem. CN: So why is DNA repair so important? JL: Most people don’t quite get the whole picture when it comes to damage. Beautiful skin means beautiful DNA. We now know that the formation of stress lesions on the DNA causes mutation and skin cancer. There was a great new publication out which showed that these CPD lesions which are formed on the DNA strand are the leading cause of melanoma. The good news is in your cells you have the ability to repair. ‘protect your skin with sunscreen, you have got to have it, but it is like protecting your skin with Swiss cheese – it’s got holes in it’. You have got to have a backstop. It is like in baseball you have a catcher and if he misses it you have a

Sunscreen is protection, antio-xidant is protection but now you need a repairer once this damage occurs you need something to come in and fix it. We can get these DNA repair enzymes from things like mustard seed, blue green

The ultimate goal is to create a skincare product that is the hero product, the ultimate environmental protection in the world and that every consumer on the planet needs to use

algae and bacteria and microbial sources. There are three different kinds of DNA repair enzymes in the products. People say ‘are these the same as the DNA repair enzymes in the human body?’ well no, they are not exactly the same, but all DNA is the same whether it is in an earthworm or you or a bird or plant. It is the sugar phosphate double backbone and these four base pairs. The entire code for life on earth is determined by four different base pairs – guanine, cytosine, adenine and thymine – it is unbelievable really to think that the entire code for every living organism on the planet is the arrangement of these four simple bases. Every time there are two pyrimidines (e.g thymine) sitting next to each on the DNA strand they have this wonderful ability to hook to each other and free radicals and UV light causes that. When they hook to each other they break away from the bond across the chain and it causes a little bump on the DNA, known as a CPD lesion, and that is not good. There is another type of lesion that occurs when you oxidize, guanine, it is not as bad as these CPD lesions, but nevertheless it is not good. The culmination of these lesions can lead to premature skin ageing, mutation and skin cancer. We are trying to protect against this. CN: How do anti-oxidants fit into the picture? JL: We have a study that we published in 2009 in the Investigative Dermatology journal that shows that anti-oxidant molecules like CoffeeBerry® whole fruit extract provide an incredible defense against CPD lesions. They have a different mechanism of action – the anti-oxidants prevent the CPD lesions from forming in the first place; the DNA repair enzyme fixes the problem after it’s formed. CN: Do you have anything else exciting in the pipeline? JL: Absolutely! We have a landmark study that we are going to publish at the end of this year and a tidal wave of new products coming! 35


IN T H E CLEAR We talk to Dr Richard Brighton-Knight about the ClearLift Q-Switched Laser from Alma Lasers that has been dubbed the ‘lunchtime laser face-lift’

Dr Richard BrightonKnight Dr Richard Brighton-Knight is an experienced aesthetic doctor who has performed more than 10,000 aesthetic treatments since 2006 including Botox, Juvederm and Sculptra. He is a recognised Sculptra Trainer and has worked for several years with Court House Clinics. He is experienced in using medical micro-needling, strong chemical peels and using the latest lasers to rejuvenate the face.He has been working with Alizonne weight loss therapy since 2009 which has enabled people to achieve and maintain a great weight loss. Dr Brighton-Knight’s additional qualifications in life coaching and hypnotherapy add to his medical success. He believes that honesty is the best policy and will tell you if he does not think that a treatment is worth while or if you would get better results from something else.


hen it comes to aesthetic treatments the phrase ‘lunchtime procedure’ has been bandied around a lot and oftentimes without being a true representative of what the treatment it is referring to actually does (who can forget ‘lunchtime lipo’). Finding a true lunchtime procedure that actually offers results seems to have been somewhat of a grail hunt but Alma lasers may have finally done it with the ClearLift. The Harmony™ Clear Lift™ Laser is the world’s first fractional nonablative 1064 nm laser. Unlike traditional fractional or pixelated laser skin resurfacing treatments, this brand new technology divides up the laser light in to multiple fractions that go deeper into the dermis and cause regeneration from underneath with absolutely no injury to the skins surface, leaving no redness or tell tale signs. The treatment encourages the growth and re-building of new collagen fibres at a deeper level making it an ideal preventative as well as corrective treatment for lifting and tightening. And what’s more it’s a universal treatment for all ages and skin types. The technology claims to be able to give patients a more youthful looking appearance in less than 30 minutes and with no pain to boot. Sounds too good to be true doesn’t it? Well if the media hype surrounding the so called ‘lunchtime laser face-lift’, especially inHollywood , is anything to go by this may be one occasion when the marketing spiel may actually be more than just that. Some doctors are even describing it as the ‘first real alternative to a face-lift’ but can a non-surgical treatment really ever fulfill those kinds of promises? Dr Richard Brighton-Knight, a respected and experienced aesthetic practitioner who has been using the treatment while working with Court House Clinics, has been getting impressive results for certain indications and says the short downtime and minimal recovery is definitely an appeal to patients, particularly men. He says, “In terms of other lasers this is one of the safest lasers that we use. People may get a little bit of swelling for about an hour and it can be a bit red but that is it. Sometimes men are less keen to go down the injectables route but with ClearLift no one is going to know they have had anything done However while Dr Brighton-Knight does see the treatment as something that can be done in the lunch hour he has a slightly different view on it providing a ‘face-lift’. He says, “My experience has been that it is more of a collagen stimulator so you will get thickening of the skinI’m uncertain as to how much lift we are going to get, as it is still early days in terms of my own clinical experience with the treatment. The improvement in skin thickness provides some lift and there may be additional lift over a course of treatments as the tissues tighten up.”It increases the amount of


collagen in the skin so you get ‘bouncier skin’. What that means is certain areas like backs of hands and neck look younger and if you are doing it on fine lines it will give you a bit longer before you need Botox or fillers.” For certain patient groups the ClearLift offers many advantages and this is where Dr Brighton-Knight believes it comes into its own. “This is especially good for the younger age group who are getting a few lines but who want to avoid having injectables”, he says. “It is a little booster. It is particularly good for fine lines on the lower cheek. These are quite difficult to treat with fillers because they are too fine. I have seen these improve quite significantly ClearLift - the reduction is quite nice and you have not got the same level of risk as you have with injectables or ablative laser” Aside from being a good alternative to fillers for male clients, the treatment is proving particularly popular with men because they usually see more dramatic and faster results than women.

In terms of other lasers this is one of the safest lasers that we use Dr Brighton-Knight explains. “Men have got thicker skin so their collagen has a better response than you get with women. Because we have got high levels testosterone we have got more collagen in the skin so if you are doing a collagen stimulation treatment which is effectively what this is, men will get a faster response than women.” For women Dr Brighton-Knight has been impressed with the results he can get on the backs of the hands and neck where the collagen stimulation promotes “much springier skin. “Its also nice to have a pain free treatment that busy women can fit into their schedules without worrying about having marks afterwards. The feedback from clients about the plumping effect around the mouth is that it gives them an instant confidence boost without drama.” Perhaps the term ‘lunchtime collagen booster’ is not as headline grabbing as ‘face-lift’ but one thing is for sure the ClearLift is providing a low risk, low downtime alternative as well as an adjunct to other popular aesthetic treatments opening up the door to those patients who want to dip a toe in the non-invasive rejuvenation pool but for whom the thought of pain, needles or downtime has previously been a turn off and that can only be good for business!


Indicated for painful topical treatments on large surface skin areas up to 900cm2*

Effective pain control from 30 to 60 minutes*

Well tolerated with low incidence of erythema†

A division of Ferndale Pharmaceuticals Ltd.



0800 0195 322 INFO@AESTHETICARE.CO.UK PRESCRIBING INFORMATION LMX4 Lidocaine 4% w/w Cream is a topical anaesthetic containing 4% w/w Lidocaine in a liposome base. Indication: Venous cannulation or venipuncture: Adults including the elderly and children over one month of age. Local anaesthetic for topical use to produce surface anaesthesia of the skin prior to venous cannulation or venipuncture. Dose and method of use: Apply 1 to 2.5g of LMX4 Cream to the area of the skin where the procedure will occur. No more than 1g of cream should be applied to children under 1 year of age, 1g of cream equates to approx. 5cm of cream squeezed from the 5g tube or approximately 3.5cm of cream squeezed from the 30g tube. The LMX4 Cream should remain undisturbed on the skin and can be covered with an occlusive dressing to prevent disturbance. Adequate anaesthesia should be obtained after 30 minutes, but the LMX4 Cream can be applied for up to 5 hours under a dressing. Shortly before starting the procedure the LMX4 Cream should be removed with clean gauze and the procedure site prepared in the usual manner. Maximum application time for 1 year and above should not exceed 5 hours. Maximum application time for 3 month up to 12 month infant should not exceed 4 hours and maximum application time for 1 month up to 3 month infant should not exceed 60 minutes. Indication: Painful topical treatments on larger surface areas of intact skin: Adults, including the elderly. Local anaesthetic for topical use to produce surface anaesthesia of the skin prior to painful topical treatments on larger surface areas of intact skin. Apply approx. 1.5g to 2g LMX4/10cm2 of skin up to a maximum of 900cm2. Apply until response is achieved which is generally between 30 to 60 minutes. Typical estimated quantities are 30-40g/200cm2 (approx.

© AesthetiCare® 2013 6156/07.13

10cm x 20cm or covering a face), 45-60g/300cm2 (approx. 10cm x 30cm or covering an arm), 135g-180g/900cm2 (approx. 30cm x 30cm, or covering torso or back). The LMX4 Cream should be applied evenly at the specified dose with a uniform thickness across the area where the treatment will occur. Measures may be taken to ensure the cream remains undisturbed. Shortly before starting the topical treatment the LMX4 cream should be removed and the site for treatment prepared in the usual manner. Contraindications: Hypersensitivity to Lidocaine, or any of the amide-type local anaesthetics, or any of the excipients. Precautions and warnings: For external use only. Do not apply to irritated skin or if excessive irritation develops. Avoid contact with eyes. Do not use in large quantities or for longer times than those recommended. LMX4 Cream should not be applied to wounds, mucous membranes, or on atopic dermatitis as there is no clinical data relating to its use on such areas. Lidocaine should not be used in any clinical situation in which its penetration or migration beyond the tympanic membrane into the middle ear is possible. Repeated doses of Lidocaine may increase blood levels of Lidocaine. Patients with severe hepatic disease are at greater risk of toxic plasma concentrations of Lidocaine. Production of surface anaesthesia can block all sensations in the treated skin and trauma to the treated area such as exposure to extreme temperatures should be avoided until complete sensation returns. Interactions: Lidocaine should be used with caution in patients receiving Class 1 anti-arryhthmic drugs. Pregnancy and lactation: LMX4 should be used during pregnancy only if clearly necessary. Caution should be exercised when LMX4 is administered to a nursing mother.

Undesirable effects: Application of Lidocaine can cause transient local blanching followed by transient erythema and other effects can include irritation, redness, itching or rash of the skin. In rare cases local anaesthetics have been associated with allergic reactions including anaphylactic shock. Systemic toxicity is unlikely but signs of systemic toxicity are blurred vision, dizziness, difficulty breathing, trembling, chest pain or irregular heart beat. Basic NHS Price: LMX4 5g £2.98, LMX4 30g £14.90. Legal classification: P MA number and holder: PL 20685/0034, Ferndale Pharmaceuticals Ltd, 12 York Place, Leeds, LS1 2DS. Prescribers should consult the Summary of Product Characteristics for further information. Date of revision: July 2013. Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to Ferndale Pharmaceuticals Ltd. contact details below Ferndale Pharmaceuticals Ltd, Unit 740 Thorp Arch Estate, Wetherby, West Yorkshire, LS23 7FX, Phone: 01937 541122, Fax 01937 849682, email

REFERENCES * LMX4 Summary of Product Characteristics (Date of Revision 28 June 2013) † Taddio et al, CMAJ 2005;172(13) 1691-1695 Date of preparation: July 2013 Item code: LMX4ACare0713



Lynton introduces new multifunctional ProMax Lipo

LMX4® Cream approved for new indication by MHRA

Lynton has introduced a new multi-functional product into its aesthetic technology portfolio - the ProMax Lipo. The system has been designed to offer the three most popular body treatments: cellulite reduction, inch loss and skin tightening. This brand new multi-functional device can treat all areas of the body, including the face. The ProMax Lipo utilises not just one, but three different technologies to target several concerns and ensure that maximum clinical results are achieved during every treatment. The system is compact, non-labour intensive and extremely versatile; using a combination of ultrasonic cavitation, multi-polar radio frequency and vacuum, and bi-polar radio frequency and vacuum. There are six different applicators, which allow treatment of every area of the body, including the arms, thighs, stomach, hips, knees, ankles and the face; so a business can introduce several options to the treatment menu and maximise its return on investment. There are also no consumables.


Medixsysteme patented technology enables faster treatment times of larger surface areas with SygmaLift Medixsysteme has developed and patented a HIFU emitter that can deposit energy in focal lines. This enables the clinician to treat larger surface areas resulting in faster treatments with maximum precision of energy placement. Powered by state-of-the-art technologies, SygmaLift features probes that emit lines instead of dots HIFU; 635 nm low level laser, which is ideal for fat removal, and chin and jawline remodeling; as well as Trimicro focal ultrasound for skin tightening, which results in a smoothening of wrinkles and youthful, rejuvenated skin and more vibrant looking skin. Previously HIFU energy was emitted by depositing ultrasonic energy at fixed points in the treatment area but Medixsysteme’s patented HIFU emitter can deposit energy in focal lines. “SygmaLift’s non-invasive lifting ability is very special”, noted Rafael Nunes, MD a plastic surgeon and clinical director of Dr Laser Advanced Laser Center in Rio de Janeiro, Brazil. “I have achieved excellent results in my patients who desire a no downtime procedure that is performed quickly and easily.” 38

LMX4® Cream is now approved by the MHRA for topical use in adults for surface anaesthesia prior to painful topical treatments on larger surface areas of intact skin. The recent update to the LMX4® marketing authorisation states application of the cream can be applied at a dose of 1.5g to 2.5g per 10cm2 up to a maximum area of 900cm2. Typical quantities and areas would be 30g - 40g per 200cm2 approx. covering a face, up to 135g -180g per 900cm2 approx. covering a torso or back. LMX4® Cream should be applied with an even thickness across the treatment area and measures can be taken to ensure the cream remains undisturbed until adequate analgesia is achieved, this is generally between 30 to 60 minutes in clinical studies. Roger Bloxham, managing director of Ferndale Pharmaceuticals Ltd and AesthetiCare®
says “LMX4® Cream is unique as the only approved topical anaesthetic to use liposomal technology. Using liposomes to facilitate and enhance the rate of lidocaine penetration not only facilitates the onset of action but also enhances skin tolerability as it enables only lidocaine, the local anaesthetic recognised as having the best safety profile and tolerability to be used, avoiding the need to combine lidocaine with other local anaesthetics which is required in alternative eutectic combination formulations. Widely used in the UK and around the world to enhance the patient experience when undergoing painful procedures on the skin, LMX4® has a proven and established track record of efficacy and safety, this includes in children, where it is used in many leading hospitals before painful cannulation procedures, through to adults and larger areas of skin.” LMX4® Cream, a Ferndale Pharmaceuticals product, is classified as a P medicine and as such is available without a prescription. It is available in 5g and 30g tubes the latter ideal for use on larger skin surface areas.


Clinogen launches Youki complete post cosmetic wound healing Clinogen has lauched wound healing product Youki into the aesthetics market. Youki is a CE marked Class 1 Medical Device advanced biotechnology skin healing system. Originally developed for the treatment of chronic wounds, Youki’s use has been extended to postcosmetic procedures It comprises two products which aid the recovery of your clients’ skin following advanced skin procedures, including micro-needling, laser/ IPL hair removal, fractional laser resurfacing, chemical peeling, advanced electrolysis, injectables and fillers and permanent make-up. Youki Spray spray-on dressing is applied as a post-treatment dressing for open wounds/ traumatised skin to calm and heal the treated area, this is followed by Youki Skin Repair Cream which the client will also use at home to help to strengthen the skin and minimise scarring.



DMK introduces eye tone DMK skincare has unveiled its latest product – eye tone. The primary focus of eye tone is to revise the skin around the eyes to encourage it to function like it did when it was young. eye tone is designed to target dark circles, fine lines, redness and puffy bags under the eyes to have you looking fresh, rested and youthful. eye tone helps to promote normal cellular proliferation, while revising wrinkles and fine lines. Key ingredients include Beta glucan to stimulate and re-educate traumatised tissue; Ascorbyl glucoside a stabilised form of vitamin C; Hyaluronic acid hydrates tissue and promotes healthy cellular function; Rutin assists in decreasing capillary fragility; Squalane helps to reduce swelling; Seabuckthorn oil a nutrient-rich oil known for its healing properties and ability to revise fragile capillaries.

Vitage® launches Body Shield SPF25 Vitage®has launched a new SPF designed specially for the body which not only offers all year round, daily broad spectrum UV protection but contains super boosting actives that are anti-inflammatory, healing and extremely hydrating to the skin. Vitage® Body Shield SPF25 is a light formulation for all skin types that quickly absorbs into the skin, providing maximum daily UVA protection. The water resistant formula makes it ideal for sports, outdoor activities and holiday skincare. The product contains PhytoTerra® Organic Maté (also known as Brazilian Green Tea)a naturally active botanical that offers powerful antioxidant protection against premature ageing which also offers anti-inflammatory action and Rosehip Oil, which restores the lipid barrier and conditions the skin, leaving it super hydrated. This ingredient is also good for healing burns and scarring. It also contains Sodium Hyaluronate, a powerful skin hydrator, Aloe Vera to sooth and moisturise the skin and Ethylhexyl Methoxycinnamate, Diethylamino Hydroxybenzoyl Hexyl Benzoate, Zinc Oxide to provide broad spectrum UVA/B protection.


Laser Physics releases Aloe Vera Gel for in-clinic use Laser Physics UK has released a new Aloe Vera Gel designed for clinic use. The Aloe Vera Gel works to provide a smooth hydrated surface whilst providing medicinal properties. Produced from pure Aloe Vera inner gel it maximises the nutritional activity of the plant and can be used during laser, waxing and epilation treatments. The product moisturises, softens and helps restore dry and damaged skin.

With its natural calming properties it cools and soothes leaving a light refreshing feeling for even the most sensitive skin. It can be applied to stretch marks, scars, dry chapped skin, sun burn, skin irritations and minor burns, or to help soothe skin following cosmetic treatments. The Gel is available in one litre containers and costs £17.

Training dates available:

RegenLab RegenLab are the leading provider of a patented technology to produce Autologous Platelet Rich Plasma and other cell concentrates in an enclosed system, ensuring ultimate sterility and patient safety


14th September 5th October 9th November 7th December Training runs from 10am - 4pm and includes: PRP - The Science PRP - Clinical Applications PRP - Marketing & Business Case


Terry Loong

UK Clinical Trainer

Carol Barker Cellular Biologist

01923 234 600



With all the entries in and the short lists being complied, places for this year’s Aesthetic Awards are booking up fast. Here we tell you why you can’t afford to miss the most prestigious event of the aesthetics calendar

There is no better feeling than having your achievements and successes acknowledged and revered in front of your peers and for the aesthetic industry the Aesthetic Awards is the event that affords the practitioners, products and people at the top of their game this opportunity. good but excellent practice and those whose credibility and commitment to quality and standards makes them stand out from the crowd.

The Aesthetic Awards is the premier awards evening for the aesthetics industry and has quickly become the most eagerly anticipated event in the social calendar. This year’s event will be marked by a classy black tie Winter Wonderland ceremony at the luxurious Grange Hotel in London on December 7. The glamorous event, sponsored by Syneron Candela, is the perfect opportunity to celebrate the achievements and innovations of our exciting and dynamic industry at the same time as enjoying a sophisticated evening surrounded by the cream of the aesthetic industry crop. In a market that has been under scrutiny is the wake of the Keogh report, it is more important than ever that we come together as an industry to acknowledge not just 40

The evening will begin with a champagne reception, which is the perfect opportunity to soak up the buzz of excitement in the air as the anticipation of who will win the coveted trophies builds. The pre-awards drinks reception is a wonderful opportunity to network with your peers and fellow nominees. A decadent threecourse dinner will then ensue with entertainment to warm up proceedings before the awards presentation. Now in its third year, the Aesthetic Awards is going from strength to strength with new judging and voting processes and criteria being

introduced this year. We will also be merging some of the categories to focus on recognizing real excellence in service and product innovation. The Aesthetic Awards are a unprecedented chance to celebrate the successes and achievements of your business whether you are a clinic, solo practitioner, manufacturer or supplier. Being a winner or even a shortlisted finalist in the awards is a powerful marketing tool, enabling you to show your clients that you are committed to the highest standards and have gone that extra mile. The Aesthetics Awards is always a sell out event so, to make sure you don’t miss out, on what promises to be a night to remember. Book your tickets today by contacting our events team on 01268 754 897.

HAVE YOU GOT YOUR TICKET? Don’t miss your chance to attend the most prestigious event in the aesthetic calendar. Join us in celebrating our industry’s achievements at this glamorous event being held at the luxury Grange Tower Bridge Hotel in the heart of central London.







The claim before the storm Eddie Hooker from Hamilton Fraser Cosmetic Insurance takes us behind the scenes of an insurance claim


Eddie Hooker has been involved in the insurance industry since 1985. He worked with many large insurers such as Legal & General and AXA Insurance prior to setting up his own insurance business, Hamilton Fraser Insurance, in 1996. Eddie and Hamilton Fraser Insurance first started to insure cosmetic practitioners as early as 1996 when they became involved with nurses practising in collagen injections. Hamilton Fraser launched the UK’s first ‘aesthetic specific’ medical indemnity insurance policy in 1998 and now insure over 3,500 individual practitioners and businesses within the sector, growing by over 100 new practitioners every month.

t’s one of your worst nightmares. You’ve met with a patient, discussed meticulously all relevant information, medical records and treatment protocols ... and afterwards they are upset and utter those dreaded words: “I’m calling my lawyer!”. That’s why you have your Medical Malpractice Insurance, of course – and because of the nature of your business (treating patient’s faces and bodies) a claim for damages will almost certainly happen to even the very best in the industry at some point during their career. So you pay your insurance premiums year in, year out, but what actually happens if you need to use the policy? What happens behind the scenes during the process of an insurer settling a claim? Julie Charlton, senior associate for Bevan Brittan, Hamilton Fraser Cosmetic Insurance’s appointed medical solicitors, helps uncover the mystery. “Once a claim is reported, it’s looked at and analysed for its merits,” says Julie. “The solicitor looks over the papers and asks ‘is this a legitimate claim and how will it need to be settled?’ This initial assessment will be done as quickly as possible to try and resolve the claim immediately for the benefit of both parties. Many claims never end up in court and are settled by an offer of compensation or further treatments. Legal costs have a habit of spiralling!” But what if the claim can’t be settled quickly and proceedings are moved to court? “The court introduces a timetable,” says Julie. “Firstly, you will be served with documents containing the allegations about the treatment received. The claim is then formally investigated - patient information is collated - which will contain all the medical records, the notes you made when you met the patient, sheets or leaflets you gave the patient at the time and also the manufacturers’ leaflets that are available in relation to any equipment you used.”

is serving a witness statement – your statement about how you treated the patient.If an independent report is required, that too will be served and the claimant will probably do this too. The experts will then meet to see whether issues can be narrowed regarding claim. At this point it will move to trial.” Many cosmetic surgery experts hate the thought of a claim, not least because of the feeling that it somehow tarnishes your reputation. It is worth remembering that only about 5% of claims ever get to trial so a court appearance is very rare. Most claims are settled by both parties informally and your insurance will cover the cost involved. Settling this way does not have to include an admission of guilt either. The important thing is that you have kept excellent patient records and that your insurance is at a level high enough to cover both the actual damages plus the costs of legal representation. In our experience, many practitioners opt for a lower level of cover to save premium costs, which means that if there is a claim to be settled they will have to pick up some – or all – of the costs from their own pocket. Read your policy carefully and be aware of any claim contributions you may be required to pay e.g. policy excess.

Don’t let this happen to you. Remember: 1.


3. Your appointed solicitor will then put your defence document together. This is your opportunity to respond to the allegations that have been made when it goes to court. So what happens then? “The court holds an initial hearing,” says Julie. “Your solicitor will attend on your behalf and a series of orders will be made, including releasing all the information you have. The next step 42



Ensure that your Medical Malpractice Insurance covers all the treatments you offer. If you introduce new treatments into your clinic let your insurer know. Keep meticulous patient records. Document everything, take photos and explain the risks of a treatment thoroughly. Use a robust consent form and get the patient to sign it. If possible, allow them to take it away to study before they proceed with the treatment. Select your patients carefully. Price conscious patients or requests for unrealistic results generally will cause you future problems. Deal with an insurance provider that understands the cosmetic industry and recognises the difference in treatment styles and procedures. 01829773155

PATIENT & PRACTITIONER PROTECTION Laser Physics specialise in providing safety and treatment products for light based therapies. therapies • Laser & IPL Eyewear • Facemasks • Laser Surgery Instruments • Laser & IPL Gel • Laser & IPL Treatment Products • Laser Safety Equipment


Intraceuticals is an elite line of results based skin treatments, and complementary skin care range, founded on innovative and unique technology. The intraceuticals treatments deliver instant visible results and dramatic accumulative results. We are a Global company founded in Australia. Due to expansion we have an exciting opportunity for

SALES ACCOUNT MANAGER NORTH • Must have a successful track record in field sales, and have covered a large territory • Demonstrate New business sales success • Experience of selling skin care and or beauty/aesthetic equipment to beauty salons, spa’s, medical aesthetic clinics • Minimum 3 years field sales experience • Able to work autonomously, in a dynamic target driven environment

Excellent basic salary and package, and excellent career prospects, please send covering letter and CV to

The Medical Professional’s First Choice for Insurance Providing a first class service for Doctors, Dentists and Nurses since 1996 ✓ Specialist medical indemnity and surgery insurance ✓ Free advice from our industry experts ✓ 89% of customers renew with us every year due to the service they receive* You were always available when we need to have some guidance from you by phone as well as email. We appreciate your high level of care and professionalism. Mr Shailesh Vadodaria

Call free on 0800 63 43 881 and quote: CR01, or visit us online at Hamilton Fraser Cosmetic Insurance | Kingmaker House | Station Rd | New Barnet | Herts | EN5 1NZ Hamilton Fraser Cosmetic Insurance is a trading name of HFIS plc. HFIS plc is authorised and regulated by the FSA. (*Figure from June 2012)


Home is where the start is John Castro from Websites For Cosmetics on 5 things you should include on the home page of your website


revious research has told us that you have less than 30 seconds to convince a visitor to stay on your website. Today, due to the growth in activity on the web and the amount of information that is actually thrown at us when browsing the internet, recent research says you have less than 10 seconds to impress your visitor or they are off! So how do we get visitors to interact with our website or actually do what most of us want, which is for them to make an enquiry? Well, within the aesthetic business it is predominantly about gaining the visitors’ trust and giving them enough information visually and textually, so that they feel they can make an enquiry. Here are my five things you should include on your home page:

1. Have case studies This is imperative for any clinic wanting to use their website as means to getting enquiries. Do not bombard your home page with before and after pictures, but pick maybe one or two case studies that you can show case on the home page. Then provide the visitors with a ‘See More’ option, which takes them to a dedicated page for the rest of your before and after pictures. However, do not just have pictures, have the client’s testimonial next to it too AND if you can have a picture with the client too, do so. It shows real trust and rapport between you and the client.

2. Your telephone number I know this sounds silly doesn’t it? But you would be surprised to know how many websites my team and I come across each day where the website has no emphasis on the telephone number. You may as well say “bye bye, go call my competitor for a consultation” if this simple


element is not in place. Put the number in the top right corner and do not supply a 0800 or 0845 number. Everyone uses their mobile phones today and those 08 numbers can be costly to call from a mobile. Sounds silly? Believe me, I have tested it. It hardly converts visitors into callers.

Do not let anyone leave your website without the opportunity to leave their details

3. News, blogs and events

5. Be visual and textual

Having information and news on your website is a great way to keep visitors informed and let them know your website is up to date. However, make sure you are not leaving items from 2003 on there under “Recent News”. A blog is the best way to do this, so if you haven’t got one ask your web developer to add one and also add a recent blog feed on your home page showing users snippets of the three most recent news items.

This one is fairly important. Most websites I come across in the clinic world will have either too many sliding images so you just do not get all the information you want quick enough OR they will have strolls of text talking about how long they have been establish and what university the surgeon studied at etc. It is also important to have a small area that gives an introduction about you. Do not have more than a couple of sentences, leave that to the About Us page. Have images in a banner slider with text and strap lines in them, but do not have more than two to three maximum. No one is going to wait 20 seconds for your images to finish fading in and out. They will be gone by the time the third one is there.

4. Lead generation form This is so important! Do not let anyone leave your website without the opportunity to leave their details. The most effective way to do this is offer them something in return for their information. Please do not just have ‘Enquiry Form’ and expect people to leave you their details. Most clinics today offer a ‘Free Consultation’. Just offering this isn’t enough today. Everyone from your neighbour is offering this. Be creative, give them more... I have found some sort of advice literature works like ‘The guide to Botox®... what to look out for and when to say no’. This has the visitor intrigued and has them wanting to know what you have to say. The great thing is they will pass this to friends, colleagues, family. You just make sure you have branded that literature with your contact details on every page.

Although I have focused on improving your website homepage here, take some of these tips and apply them to your entire website. The more you can engage your website visitors and give them what they want within seconds the more you will increase your enquires, which in turn will increase your ROI. John Castro is the founder and director of Website For Cosmetics, a specialist in Web Marketing to Cosmetic and Aesthetic Healthcare Professionals.

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A meeting of minds Why patient selection and support is so important in cosmetic interventions

As aesthetic surgery becomes increasingly popular, proper patient selection becomes even more important to the entire surgery process. Aesthetic surgery or interventions are unique because, unlike any other surgical procedure or treatment, they are initiated by the patient and not the physician. In addition, aesthetic surgery and interventions elicit a more acute reaction from patients than any other type of surgery. When it comes to ‘psychologically’ preparing a patient for cosmetic surgery and procedures the question must be asked: “what is the industry doing to address the emotive and psychological aspect of cosmetic interventions? There are two main issues concerned with this question: firstly there is psychological assessment; this pertains to the actual selection of ‘suitable patients’. Secondly there is the issue of patient support whereby help is needed or must be offered to prepare, guide and provide sustenance to that patient. “My personal experiences as a cosmetic surgery patient as well as the feedback from hundreds of patients that I have dealt with, have led me to seriously question this aspect of cosmetic surgery, it’s a subject I feel is too easily over looked over or brushed aside. Up until recently very few resources existed for proper patient selection, and also patient support”, says Antonia Mariconda, founder of patient support group When Cosmetic Surgery Goes Wrong. A report by the National Confidential Enquiry into Patient Outcome and Death found many centres in the UK offering cosmetic surgery were failing to assess and care for patients properly, including


psychological evaluations.Former BAAPS president Nigel Mercer has said: “People considering aesthetic surgery should also be properly assessed before treatment and we have helped develop tools and checklists to ensure that patients are properly screened psychologically, which are now part of every patient’s assessment”. Plastic Surgeon Adam Searle states: “Plastic surgeons need to be alert to the possibility that some patients may have an underlying psychological disorder: they may express distorted ideas about their body, becoming preoccupied with an imagined defect in appearance. A slight physical anomaly can cause the patient significant concern, impairing social and occupational functioning. In these cases, the preoccupation cannot be accounted for by another mental disorder. If Body Dysmorphia is suspected, surgeons may require that patients undergo further psychological evaluation. Ultimately, a reputable practitioner will use his or her best judgment, perhaps in consultation with a mental health professional, to determine whether or not a particular patient can reasonably be expected to benefit from aesthetic surgery.” When it comes to patient support, it is good to see many professional services now cropping up

and playing a significant role within the cosmetic industry. The Wright Initiative are specialists in the field of therapeutic support in both pre and postoperative evaluation of patients, helping ensure that a patient’s ERP well-being is considered and supported through their surgical journey Founder of TWI, Norman Wright says “In light of the Keogh review it is essential that surgeons, practitioners and clinics see the person behind the patient by supporting their Emotional, Relational & Psychological (ERP) well-being before, during & after their procedure. If you have pride in caring for your patients you will give your patients the opportunity to address their ERP issues and concerns in specific regards to their chosen procedure. I encourage every surgeon to integrate this into their patient’s journey and experience”. Patient Shari Green, from Wales explains her experience of patient support with TWI: “The PaPPS service that The Wright Initiative offer patients pre and post procedure is a breath of fresh air. All aspects of this service are truly fantastic, it gave me the direction that I need without being judgmental in anyway. It’s a service that is paramount when making such huge changes to your body from having surgery.” At the heart of a proper patient consultation lies fully informed consent; conveying the elements of medical and psychological assessment, treatment options, providing a realistic idea of likely outcome and possible risks is essential. What concerns some patients is that some surgeons and practitioners can too easily ‘forget’ the person behind the patient and the likely impact that any procedure will have on their emotional, relational and psychological well-being. 47


A taxing issue Following a recent landmark Tax Tribunal where a doctor was denied a tax deduction for travel costs, Alan Rajah from Lawrence Grant, explains why you shouldn’t be claiming for your journey to work You may have read recently about a landmark tax tribunal where a doctor lost his case to obtain a tax deduction for the cost of travelling between his home, where his private office was located, and the private hospitals where he regularly held consultations and oversaw patient care. The first-tier tribunal ruled that Dr Samadian’s business mileage claims were not wholly and exclusively allowable expenditure. To rub further salt into the wound, he was also denied a deduction for the costs of travel between the NHS hospital where he was employed, and the private hospitals. Dr Samadian works in the NHS, (and like so many other typical practitioners), also has a private practice, using his own home and principally, working at two nearby private hospitals. In an enquiry that had lasted the best part of seven years, the HMRC challenged the doctor’s claim that 65% of his mileage was for business purposes by questioning if the travel between his home office, the NHS hospital and the private hospitals was actually business related. Whilst Dr Samadian argued that he had a dedicated office in his home for his private practice, HMRC did not accept the home office

Travel costs from home to work are not an allowable expense 48

could be a starting point for calculating private practice business mileage. Neither did journeys between NHS and private hospitals qualify. HMRC did accept however, that Dr Samadian had an office at home and that it was used in his selfemployment, but sought to distinguish between journeys that were regular or routine - like those to the private hospitals, and those that were irregular, like attending to a patient at their home, or a meeting engagement with his bank manager. What could now turn out to be a landmark decision in the interpretation of ‘wholly and exclusively’ business expenditure, this decision may be appealed by the doctor and we could see further developments as a consequence. So what does this mean? When you are selfemployed you can only claim the entire cost of a business expense if it is incurred ‘wholly and exclusively for the purpose of the trade’ if the expense is of a ‘revenue’ nature, rather than a ‘capital’ purchase. Allowable costs would include, for example, hiring of an operating theatre or paying an anaesthetist. However, if expenditure relating to your selfemployment is for both private and business use, you cannot claim a deduction unless you can separate the business element. Travel costs from home to work are not an allowable expense, however, if home is also your base of operations, the position becomes rather more complex. Accountants will need to adjust their thinking on wholly and exclusively in situations where self-employed professional clients work at home, but also deliver their expertise at another location on a regular basis. This case could set a precident so it is important that self-employed aesthetic practitioners, particulalry those who are working from home or are mobile, fully understand the tax laws so that they do not find themselves in the same situation as Dr Samadian.

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aking it to the top in business requires ambition. Making it to the very top requires talent, ambition and an unrelenting work ethic. So what does it take to make it to the top as a woman in a male-dominated industry? Two words: Ayse Kocak. In February 2013, the Mexicobased businesswoman was appointed CEO of the UK’s only breast implant manufacturer, Nagor, the industry’s first ever woman in this role. She says, “I think our industry is male dominated, but which industry isn’t? This is changing however and I am a living proof of that. I think being a woman gives me and my company an edge in understanding. To be honest, I love being the only female CEO in our industry!” While her appointment may be notable, it should come as no surprise. For several years now, Kocak has been tipped for the top, however it has not been an easy ride. She explains, “My last professional challenge was to move to Mexico to start a pharmaceutical company. Moving to a new country and starting all over again is difficult. It was the worst economic conditions of the last 70 years and I did not know anyone in Mexico or speak any Spanish. I still had my determination, optimism and my high energy, though!” Despite these challenges, in less than three years the company became one of the top 500 companies in Mexico and, in 2011, Kocak found herself featured in CNN Expansión Magazine’s 100 Most 50

We speak to Ayse Kocak, the first female CEO of a breast implant company about her ambitions and plans for the future

Powerful Women in Mexico. Two years later, she made the coveted list again. In between, Kocak kept herself busy with an appointment to the Honorary Trade Council of Turkey in Mexico as well as vice-presidency of the Mexico-Turkey Committee of Comité Empresarial Mexico. Over the course of a 13-year career with the pharmaceutical giant, Kocak served in the US, Europe, Latin America, Africa and the Middle East, helping to commercialise products such as Lipitor and Viagra along the way.Upon assuming the role of CEO of Nagor, Kocak had already served a year on the board of directors of parent company GC Aesthetics. Making the transition to CEO of Nagor was, it seems, all but inevitable. The breast implant manufacturer, which has facilities in Cumbernauld and Ashby De La Zouch, employs 125 skilled staff. With over 30 years’ experience, the firm is proud to offer a lifetime guarantee on all implants, which will no doubt be reassuring to women in the wake of the PIP crisis. Talking about the PIP scandal, Kocak says, “I think it is very unfortunate that our industry had to go through such a shocking event and I do hope nothing of that magnitude is ever repeated. The quality and safety of our products at GCA comes first and foremost. We have established brands that have been in the market for over 30 years serving the physicians and the patients and we want to see our products in the market for many years to come, which is why we’re working hard at understanding women’s needs and the psychology behind

breast procedures. Although our implants are not (and never have been) faulty or unsafe, as a breast implant manufacturer we have been able to see the devastating effects that this scandal caused across the entire industry and the helplessness that women felt. That is why we offered free replacements to those with ruptured PIPs and that is why we are rebranding with a completely new outlook – we are communicating now directly to women so that they can feel comfortable knowing as much as possible on implants and surgery and build relationships with other women through our social networking platforms and factory tours.” With such a high-powered career you would think Kocak would have time for little else but as a mother, having a work life balance is very important to her. “My work is part of my life, not separate from it”, she says. “I focus on balancing all in my life to achieve a healthy, happy state of being. I am married and had my first child eight weeks ago. She is wonderful and has enriched my life. My career has a great positive impact in my family life. My job keeps me happy and therefore the whole family as well! I love being close to people who have the aura of ‘everything is possible. It is perhaps her positive outlook and love of people that has kept Kocak so grounded in her climb to the top, a philosophy that is echoed when she quotes the words of George Bernard Shaw: “‘Life is not about finding yourself. Life is about creating yourself.”




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The word on the Tweet

Social media has become an important communication tool and Twitter is rapidly becoming one of the key mechanisms for doing this. We find out what the industry has been tweeting about this month





3 Aesthetox Foundation Botox and Dermal Fillers, Birmingham, 3 Mesotherapy, Wigmore Medical 21 Wigmore Street, London, 5-6 CIBTAC ENDORSED Ultrasonic Lipo-Cavitation, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 7 Physical and Chemical, Rejuvenation and Remodelling and Complete Automated dermal needling training with the DermaPen – Session includes practical - Sandon House Clinic, Wyder Court, Millennium City Park, Preston, PR2 5BW - 7 Advanced facial treatment (Combined Course), Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 8 CIBTAC ENDORSED Diamond Microdermabrasion for Face and Body, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 9 Infrared for weight loss and detoxification, Ely, Cambridgeshire, 01353 777 303/0774 769 6815, Barbara@, 9 Platelet Rich Plasma (PRP), Wigmore Medical 21 Wigmore Street, London, 10 BioSlimming, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 12 CIBTAC ENDORSED Ultrasound for skin rejuvenation and wrinkle reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 12 Medik8 Dermal Roller, Wigmore Medical 21 Wigmore Street, London, 12 Agera and Microdermabrasion Training, Danbury, Essex, 01245 227 752,, 13 Epionce Training, Danbury, Essex, 01245 227 752,, 13 Skincare & Chemical Peels, Wigmore Medical 21 Wigmore Street, London, 13 Pressotherapy for lymphatic drainage and cellulite reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 14 Advanced Non-Surgical Facelift, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 14 Intro to Toxins, Wigmore Medical 21 Wigmore Street, London, 15 Intro to Dermal Fillers, Wigmore Medical 21 Wigmore Street, London, 15 CIBTAC ENDORSED Cosmetic thermotherapy and Cryotherapy, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 16 CIBTAC ENDORSED Cryotherapy Induced Lipolysis, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 16 Business Development, Wigmore Medical 21 Wigmore Street, London,

17 August Masterclass Aesthetox Botox and Dermal Fillers, Birmingham, 19 Hair Removal Masterclass, The Lynton Clinic, South Manchester, 01477 536975, 20 Epionce Training, Upper Wimpole Street, London, 01245 227 752,, 21 Physical and Chemical, Rejuvenation and Remodelling with practical section - 58 South Molton Street, London, W1K 5SL 22 Complete Automated dermal needling training with practical session for the genuine DermaPen - 58 South Molton Street, London, W1K 5SL. 23 Advanced Toxins & Fillers, Wigmore Medical 21 Wigmore Street, London, 27 Epionce Training, Raddison Blu Hotel, Glasgow, 01245 227 752,, 28 Agera and Microdermabrasion Training, Raddison Blu Hotel, Glasgow, 01245 227 752,, 31 Aesthetox Skin Health and Chemical Peels, Birmingham, 31 Microsclerotherapy, Wigmore Medical 21 Wigmore Street, London,


2 CIBTAC ENDORSED Diamond Microdermabrasion for Face and Body, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 2 ZO Medical, Wigmore Medical 21 Wigmore Street, London, 2 Epionce Training, Macdonald Hotel, Manchester, 01245 227 752,, 3 Agera and Microdermabrasion Training, Macdonald Hotel, Manchester, 01245 227 752,, 3 Sculptra, Wigmore Medical 21 Wigmore Street, London, 3 CIBTAC ENDORSED Ultrasound for skin rejuvenation and wrinkle reduction, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 4-5 CIBTAC ENDORSED Ultrasonic Lipo-Cavitation, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 6 Advanced Non-Surgical Facelift, Ely, Cambridgeshire, 01353 777 303/0774 769 6815,, 6 CPR & Anaphylaxis Update, Wigmore Medical 21 Wigmore Street, London, 7 Botulinum Toxin in Facial Aesthetics: new users - includes all major brands, Birmingham, 7 Advanced Botulinum Toxin: lower face, neck, under-arm hyperhidrosis, Central London, 8 Advanced Dermal Fillers: facial contours, lip refinements, skin-hydration, Central London, 8 Dermal Fillers in Facial Aesthetics: new users to hyaluronic acid fillers, Birmingham,

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onfidence is Reliable1,2 Rewarding 3 Performance 4,5 BOTOX® is licensed for the treatment of moderate to severe glabellar lines Delivers long-lasting patient satisfaction, time after time 2,3 Has been used for over 20 years in over 26 million treatment sessions worldwide6 Is the world’s first and most studied botulinum toxin*7

Botox® (botulinum toxin type A) Abbreviated Prescribing Information Presentation: Botulinum toxin type A (from clostridium botulinum), 50 or 100 or 200 Allergan Units/vial. Indications: Temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at frown (glabellar lines), in adults <65 years, when the severity of these lines has an important psychological impact for the patient. Dosage and Administration: See Summary of Product Characteristics for full information. Do not inject into blood vessels. Doses of botulinum toxin are not interchangeable between products. Not recommended for patients <18 or >65 years. Use for one patient treatment only during a single session. Reconstitute vial with 1.25ml of 0.9% preservative free sodium chloride for injection (4U/0.1ml). The recommended injection volume per muscle site is 0.1ml (4U). Five injection sites: 2 in each corrugator muscle and 1 in the procerus muscle: total dose 20U. Contraindications: Known hypersensitivity to any constituent. Infection at proposed injection site(s). Warnings/Precautions: Relevant anatomy and changes due to prior surgical procedures must be understood prior to administration. Serious adverse events including fatal outcomes have been reported in patients who had received off-label injections directly into salivary glands, the oro-lingual-pharyngeal region, oesophagus and stomach. Do not exceed recommended dosages and frequency of administration. Adrenaline and other anti-anaphylactic measures should be available. Reports of side effects related to spread of toxin distant from injection site, sometimes resulting in death. Therapeutic doses may cause exaggerated muscle weakness. Caution in patients with underlying neurological disorder and history of dysphagia and aspiration. Patients should seek medical help if swallowing, speech or respiratory disorders arise. Clinical fluctuations may occur during repeated use. Too frequent or excessive dosing can lead to antibody formation and treatment resistance. The previously sedentary patient should resume activities gradually. Caution in the presence of inflammation at injection site(s) or when excessive weakness/atrophy is present in target muscle. Caution when used for treatment of patients with peripheral motor neuropathic disease. Use with extreme caution and close supervision in patients with defective neuromuscular transmission (myasthenia gravis, Eaton Lambert Syndrome). Contains human serum albumin. Procedure related injury could occur. Pneumothorax associated with injection procedure has been reported. Interactions: No interaction studies have been performed. No interactions of clinical significance have been reported. Theoretically, the effect may be potentiated by aminoglycoside antibiotics or other drugs that interfere with neuromuscular transmission. Effects of administering different botulinum toxin stereotypes simultaneously, or within several months of each other, is unknown and may cause exacerbation of excessive neuromuscular weakness. Pregnancy: BoTox® should not be used during pregnancy unless clearly necessary. Lactation: Use during lactation cannot be recommended. Adverse Effects: See Summary of Product Characteristics for full information on side effects. Based on controlled clinical trial data, the proportion of patients that would be expected to experience an adverse reaction after treatment is 23.5% (placebo: 19.2%). In general, reactions occur within the first few days following injection and are transient. Pain/

burning/stinging, oedema and/or bruising may be associated with the injection. Frequency By Indication: Defined as follows: Very Common (> 1/10); Common (>1/100 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <1/1,000); Very Rare (<1/10,000). Infections and infestations. Uncommon: Infection. Psychiatric disorders. Uncommon: Anxiety. Nervous system disorders. Common: Headache. Uncommon: Paresthesia, dizziness. Eye disorders. Common: Eyelid ptosis. Uncommon: Blepharitis, eye pain, visual disturbance. Gastrointestinal disorders. Uncommon: Nausea, oral dryness. Skin and subcutaneous tissue disorders. Common: Erythema, Uncommon: Skin tightness, oedema (face, eyelid, periorbital), photosensitivity reaction, pruritus, dry skin. Musculoskeletal and connective tissue disorders. Common: Localised muscle weakness, Uncommon: Muscle twitching. General disorders and administration site conditions. Common: Face pain, Uncommon: Flu syndrome, asthenia, fever. Adverse reactions possibly related to spread of toxin distant from injection site have been reported very rarely (exaggerated muscle weakness, dysphagia, constipation or aspiration pneumonia which can be fatal). Rare reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Rare reports of serious and/or immediate hypersensitivity (including anaphylaxis, serum sickness, urticaria, soft tissue oedema and dyspnoea) associated with BoTox use alone or in conjunction with other agents known to cause similar reaction. Very rare reports of angle closure glaucoma following treatment for blepharospasm. New onset or recurrent seizure occurred rarely in predisposed patients, however relationship to botulinum toxin has not been established. Needle related pain and/or anxiety may result in vasovagal response. NHS Price: 50 Units: £77.50, 100 Units: £138.20, 200 Units £276.40. Marketing Authorization Number: PL 00426/0074 Marketing Authorization Holder: Allergan Pharmaceuticals (Ireland) Ltd., Westport, Co. Mayo, Ireland. Legal Category: PoM. Date of preparation: December 2012.

Adverse events should be reported. Reporting forms and information can be found at Adverse events should also be reported to Allergan Ltd. or 01628 494026. References: 1. De Almeida A et al. Dermatologic Surgery 2007;33:S37–43. 2. Carruthers A et al. J Clin Res, 2004;7:1–20. 3. Stotland MA et al. Plast Reconstr Surg, 2007;120:1386–1393. 4. Beer KR et al. J Drugs Dermatol, 2011;10(1) :39–44. 5. Lowe et al. Am Acad Dermatol, 2006;55:975-980. 6. Allergan data on file. BoTGL/001/SEP 2011 7. Allergan Data on File VIS/006/JUL2011. *Allergan botulinum toxin type A. Global figures. Launched in 1989 in the US. UK/0008/2013 Date of Preparation: January 2013

Cosmetic news august 2013  
Cosmetic news august 2013