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Continued professional growth and updating of skills is key to the development of any specialty, especially in one so dynamic and ever changing as aesthetic medicine. By attending The Aesthetics Conference you can gain valuable CPD points.


The Cosmetic News Expo brings together more key aesthetics manufacturers and suppliers under one roof than any other event in the UK and best of all entry to the exhibition is completely free.


From doctors, nurses and dentists to dermatologists, plastic surgeons and aestheticians, as the UK”s largest aesthetic meeting, the Cosmetic News Expo attracts a wide range of aesthetic practitioners keen to network and share ideas. This is the ideal place to make contacts and get your face out in the industry.


As a delegate you can strengthen your knowledge of the latest developments in the industry and hear from key opinion leaders from the UK, Europe and the US at both The Aesthetics Conference and as part of our free exhibitor workshops.


If you want to keep your practice at the cutting edge then finding out about the latest developments and newest products on the market is key. As the first major event in the UK aesthetics calendar, the Cosmetic News Expo will see the official UK launch of a number of new and exciting brands. See them here first and stay ahead of the competition.


As well as our conference programme in the main auditorium we will be running a series of exhibitor and business workshops on the exhibition floor. Our exhibitors are dedicated to offering continued education and training to professionals working within this exciting and expanding sector and what better way to showcase you their products and services than through a dedicated workshop.


A great thing about the Cosmetic News Expo is that exhibitors are keen to attract practitioners to them and many often offer exclusive show deals. These are the type of deals that can give you great margins and that you wouldn’t necessarily get if you didn’t attend. In tough trading times these are the kind of deals that can really help your business to boom, so make sure you take advantage.


Business can be tough, especially in these hard economic times. By visiting the Cosmetic News Expo you can recharge your enthusiasm by hearing about the latest developments and technologies, sharing ideas and concerns with your peers and being inspired by our exciting and dynamic speakers.

I T ’ S N O T T O O L AT E T O R E G I S T E R W W W. C O S M E T I C N E W S U K . C O M CALL THE TICKET HOTLINE 01268 754 897 M E D I C A L


Gold Standard Customer Services voted as The Best by our customers in 2011 and 2012



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For more information, please contact Merz Aesthetics Customer Services Phone: 0333 200 4140, Fax: 0208 236 3526,

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Editor’s Letter Welcome to the February issue of Cosmetic News. This month sees our annual conference and exhibition, the Cosmetic News Expo and Aesthetics Conference, take place in London. The Expo is the UK’s largest event for the aesthetics industry and we are really looking forward to welcoming everyone through the doors of the Business Design Centre, London, on February 16 and 17. We have a fantastic educational programme taking place over the two days where you can see leading lights from the UK, US and Europe speaking about the hottest topics in aesthetic medicine. Once again we have also received a phenomenal response from the industry with the key manufacturers and suppliers exhibiting at the show. See our fold out cover for all the information you need. There is still time to book your place, simply visit to register for your free tickets to the exhibition or call our booking hotline on 01268 754 897 to reserve your place at the conference or workshops.

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This month is also our Injectables Special (p18-36). As part of this we will bring you an exclusive on the latest product from Allergan, JUVÉDERM® VOLBELLA® with Lidocaine, which will be having its UK launch at the Cosmetic News Expo (p18-19). We also speak to Dr Linda Eve about her experience using Sculptra (p36) and Dr Joanna Ward shares her insights on combining skinboosters with dermal rollering (p24-26). We also give you the latest on the Sir Bruce Keogh Review (p12-14). I hope you enjoy this issue and look forward to seeing you at the Cosmetic News Expo 2013 at the Business Design Centre, London on February 16 and 17.

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VickyEldridgeontheDermalux™Tri-Wav 6 INDUSTRY NEWS

Weroundupthelatestindustrynews 12 NEWS SPECIAL

AsSirBruceKeoghandhisexpert panelrevealthesummaryofthe responsetothecallforevidence,we reportonwhatthismeansforthe industry 16 ON THE SCENE

Outandaboutintheindustrythismonth 16 PEOPLE IN PROFILE

WechattomesotherapyexpertDr GlaaceranMontalabouthiscareerand passion for aesthetics CLINICAL PRACTICE 18-34 [INJECTABLES SPECIAL]

Wetakealookattheworldofcosmetic injectables 18 NEW PRODUCT FOCUS

WegettheexclusiveonAllergan’snew product:JUVÉDERM®VOLBELLA®with Lidocaine 21 CLINICAL STUDY

Wesummarisetheresultsofaclinical studypublishedintheJournalof CosmeticandLaserTherapyonthe benefitsofaddinglidocainetothe hyaluronic acid filler Stylage® 24 COMBINATION TREATMENTS

DrJoWardexploresskinboosters, theirefficacyandcombination applications


Editor’s choice

Dermalux™ Tri-Wave

LornaJacksononthe‘nittygritty’ ofmedicalmicro-needlingdermal rollersandwhetheryouknowwhat you are you really buying?

The Cosmetic News Expo takes place in London this month and one product that will be seeing its UK launch at the event is the Dermalux™ Tri-Wave LED phototherapy system.


Geraldine Flynn on using micropgimentationforalopecia patients PRODUCT REVIEWS 36 PRODUCT FOCUS

Wefindouthowthelatestlaunch from 3D-Lipo, 3D-Skintech, is offeringclinicsfourcuttingedge technologies in one piece of equipment 44 PRODUCT NEWS

Weroundupthelatestproductnews 50 ADVERTORIAL

SkinCeuticalsRednessNeutralizer IN BUSINESS 52 BUSINESS FOCUS

Ed Beardsell on the endless opportunitiesofferedbythose140 little characters on Twitter 54 RETAIL

TayyabAkhlaqonhowtogetmore from high-end retail products 56 A DAY IN THE LIFE OF…

AntoniaMaricondafindsoutwhata typicalDayintheLifehasinstorefor plasticsurgeonAdrianRichards 58 TRAINING NEWS AND DATES FOR THE DIARY

Thelatesttrainingnewsanddatesfor your diary


Leslie Fletcher tells us how she developedthepatentedArqueDerma® Artistic Restoration Lift®

Utilising clinically proven Light Emitting Diode technology the Dermalux™ Tri-Wave will, like its predecessor, deliver excellent outcomes for a wide range of common skin concerns including ageing, acne and pigmentation. It also provides a significant development in the treatment of specialist and problematic conditions such as rosacea, scarring and inflammatory disorders such as eczema and psoriasis. Designed and manufactured in the United Kingdom the Tri-Wave features the three key wavelengths: RED light at 633nm, Blue at 415nm and Near Infra-Red at 830nm. These are the medically proven and accepted wavelengths that guarantee successful outcomes for a wide range of skin conditions and concerns. A unique feature of Dermalux™ Tri-Wave is that all three wavelengths can be delivered either as individual LED treatments or concurrently in any selected combination providing stimulation at a sub-cellular, cellular and tissue level to target multiple concerns in one session for accelerated results. Unlike more invasive procedures, LED phototherapy does not use heat or chemicals to promote change in the skin and therefore offers one of the safest modalities to treat all skin types (I to VI) without incidence of thermal damage, trauma or downtime. Furthermore, LED phototherapy can be used in conjunction with most medication and enables the effective treatment of compromised, reactive and sensitive skin conditions. LED phototherapy is also an excellent adjunctive procedure and can be combined with any existing skin treatment and product range to enhance clinical outcomes. The Tri-Wave can be applied post treatment to reduce redness and inflammation, help to prevent infection and breakouts and improve healing time. It is also effective to prepare and strengthen the skin in advance of invasive procedures which may result in inflammation or trauma. Treatment times are short and the visible effects are immediate. Dermalux™ instantly revives a tired and dull complexion. After just one treatment skin is incredibly hydrated, smooth and radiant and redness and irritation are calmed. A course of treatments offers corrective and lasting improvement in the appearance and health of the skin. Dermalux™ is an affordable option for clients and due to growing awareness of the benefits, is rapidly becoming a highly sought after treatment. LED phototherapy also promotes a feeling of relaxation and wellbeing, helping to relieve the stresses and strains of everyday life! Dermalux™ offer “taster” events for potential purchasers and their clients to demonstrate the benefits of the system. Offering onsite training, bespoke protocols, client launch events, marketing and on-going support, Dermalux™ is a must have for aesthetic practitioners and clinics who want to make the difference for their clients.


Wesummariseachapterfromanew bookbyEricFinzientitledTheFace ofEmotion:HowBotoxAffectsOur MoodandRelationshipslookingat theimportanceoftheeyebrowswhen conveying emotion 34 Q&A

WespeaktoDrLindaEveMBBS,MD ofEvenlinesClinic,Bournemouth, aboutherexperienceusingSculptra®

18-34 [INJECTABLES SPECIAL] We take a look at the world of cosmetic injectables


Vicky Eldridge Editor M: 07940 083 677

Kevin Hogg Publications Manager

Corinne Winkworth Operations Manager

Charlotte Body Publisher

Peter Johnson, Art Director

Sean Rice Senior Designer

Sophie Belcher Events/Production

Carly Mcfarlane Sales and Events Assistant DISCLAIMER

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

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Skin Tighten


A Powerful Three Dimensional Alternative to Liposuction

No other system offers this advanced combination of technologies designed to target fat removal, cellulite and skin tightening without the need to exercise

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Cavitation is a natural phenomenon based on low frequency ultrasound. The Ultrasound produces a strong wave of pressure to fat cell membranes. A fat cell membrane cannot withstand this pressure and therefore disintegrates into a liquid state. The result is natural, permanent fat loss.

Cryolipolysis Using the unique combination of electro and cryo therapy 20-40% of the fat cells in the treated area die in a natural way and dissolve over the course of several months.

Radio Frequency Skin Tightening Focus Fractional RF is the 3rd generation of RF technology. It utilises three or more pole/electrodes to deliver the RF energy under the skin. This energy is controlled and limited to the treatment area. Key advantages of this technology are high treatment efficacy, no pain as less energy is required, shorter treatment services and variable depths of penetration.

3D Dermology Combines pulsed variable vacuum and skin rolling for the effective treatment of cellulite.

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3D-Lipo has delivered this to us’ Dr Mohamed Dewji – GP & Medical Director LasaDerm Ltd (Milton Keynes)

For further information or a demonstration call: 01788 550 440


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Major Distribution Deal for ThermaVein™ Announced

Free adult acne e-book released by Court House Clinics

Tekno-Surgical, a division of SISK Healthcare, has secured the exclusive UK and Ireland distribution rights to ThermaVein™.

Medical experts at Court House Clinics have teamed up with freelance writer Laura Jane Williams to release a free e-book. The witty and entertaining guide is designed as part prevention, part cure, and advice for adults suffering with bad skin.

The deal was secured after a tender process involving a number of interested parties. ThermaVein™ technology was only made available to the aesthetic market in late 2012 after being widely used within the medical Industry for many years. Mark Hawthorn, director of ThermaVein™ said, “We entered into a tender process with a number of large operators who had shown an interest late last year. As we progressed it became clear that Tekno-Surgical have the infrastructure, staff and experience to fulfil the potential of ThermaVein™. We have exclusive Worldwide rights for the product and are already operational in the US. In addition we are in talks with a number of other interested territories and look forward to entering new and exciting markets. We will also be looking to expand our product range across 2013 and have substantial funds available”. Janette McGovern, sales manager at Tekno Surgical said, “Our aesthetic division is growing rapidly with the UK a major focus area for us. When we saw ThermaVein™ being used in a treatment we knew we had to move quickly. Our group has a turnover well in excess of £80m and we expect ThermaVein™ to contribute significantly to growing this number. We are very excited to be involved with this product and are already experiencing strong demand in both the UK and Ireland”.


BAAPS release results of annual audit Audit figures from the British Association of Aesthetic Plastic Surgeons have revealed that, although the number of overall procedures remained static and barely changed at all over the last year, facial rejuvenation treatments in particular are the nation’s favourites with eyelid surgery, fat transfer, brow and face-lifts all experiencing a double-digit rise. The most impressive percentage increase was in male brow lifts, which rose by 19%. Eyelid surgery and fat transfer also proved popular with both genders, showing a rise of 13%, as did face-lifts, up 14%, compared with abdominoplasty (tummy tucks) and liposuction tumbling in demand by 12% and 14% respectively. In all likelihood a result of the ongoing PIP implants crisis, demand for breast augmentation dipped as expected but only slightly by 1.6%, and continued to maintain its place as the most popular aesthetic surgery. On the whole, the number of surgical procedures showed a barely-perceptible rise of 0.2% from 2011 to a total of 43,172, and their order of popularity remained largely unchanged.


Paul Simmonds joins Syneron Candela sales team

According to Rajiv Grover, consultant plastic surgeon and president of the BAAPS, “Every week there are reports of new ‘lunchtime’ or ‘Hollywood craze’ treatments that are here today, gone tomorrow. The growth rates for surgical face-lifting and other anti-ageing procedures showed a double digit rise, despite a double dip recession. Perhaps because of turbulent financial times, patients are looking for tried-and-tested procedures that deliver a reliable, long-lasting result and which have a proven safety record. Whilst there is an undeniable rise in demand for non-surgical treatments of the face; for example Botox® and fillers; once there is actual loose skin in the neck or jowling, only surgery is likely to make a significant improvement and the public seem to be increasingly aware of this.”

Syneron Candela service engineer Paul Simmonds has now joined the company’s sales team. Paul has been visiting clinics across the UK for a number of years as part of the company’s technical and engineering team and will now be a regular point of contact for clinics across the Midlands and further afield. Paul’s in-depth knowledge of the Syneron Candela machines made him the perfect candidate for the role. He says, “I am very excited about the prospect of a new career path in the Syneron Candela team and taking time to help customers choose the right machine for their business.”

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Smooth texture for a natural look and feel


ive them a lift with

LaSting volume – up to 18 months1

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SatiSfaction – 96% of patients would recommend Juvéderm® vOLumA® with Lidocaine to a friend 2 WITH LIdOCAINe

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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


The free guide gives men and women practical advice with a no-nonsense attitude. Chapters include oft-neglected topics such as acne during pregnancy, acne and stress, and diet. The full e-book is available to download from http://

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aesthetic awards 2012-13, triple win for aBc lasers Aesthetic Medical Treatment System

Contact us on: Tel: 0845 1707788,

EquipmEnt Brand of thE YEar aBc lasers

trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)

trEatmEnt of thE YEar (facE)

harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)


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The Consulting Room™ releases 2012 Website Traffic Statistics


The Consulting Room™ has released its 2012 website statistics giving an insight into what the average consumer is researching.

ABC Lasers has welcomed Fiona Doherty to its growing team as London sales and training director. Fiona is an experienced nurse prescriber who has been working in the aesthetics industry for more than seven years. Her work as a lead nurse in a central London clinic has provided her with a unique understanding of how to run a successful clinical business and her training and teaching background, make her a strong addition to the ABC Lasers team. She said, “My past experience has involved the training and mentoring of therapists, nurses and doctors on cosmetic and medical procedures. I believe that the key to finding the best clinical solutions for patients comes from a knowledgeable and confident practitioner who is trained to a high standard. I am looking forward to starting my role with ABC Lasers due to their excellent reputation within the aesthetic industry and the phenomenal brand awareness and demand from patients for Soprano™ pain free Laser, Harmony™ with ClearLift™ and more. I am proud to join the only laser company voted Equipment Brand of the Year gold winner and Treatment of the Year gold winner for two years running at the Aesthetic Awards. This is a very exciting time to join such a dynamic company!”

From January 1 to December 31 2012 just over one million unique visitors came to In total, just under 700,000 of the annual site visitors viewed the Treatment and Product FAQ information on the website.The most popular pages viewed in order were: laser and IPL hair removal; radio-frequency for facial rejuvenation; penile augmentation surgery; laser tattoo removal; dermal fillers;vaginal surgery; fractional laser skin resurfacing; microdermabrasion; ultrasonic body contouring; specialist skin cream; laser and IPL skin rejuvenation; chemical peels; radio-frequency for cellulite and fat; medical skin needling and umbilicoplasty (belly button surgery). The top ten most popular Product FAQs were: Pixel; Teosyal®; Restylane® Vital; Belotero; Accent; Dermaceutic Peel; Thermage CPT; Juvederm® Ultra; Eurosilicone Breast Implants and Restylane® (Perlane & SubQ).


New initiative offers patients preand post-procedure support A new initiative has been set up to offer people undergoing cosmetic or aesthetic procedures support. The Wright Initiative has developed the PaPPS Initiative, a consumer driven programme addressing the emotional, relational and psychological wellbeing of people who are considering or having elective surgical or aesthetic procedures. PaPPS has been pioneered to support both the patient and surgeon ensuring that every aspect has been addressed. Alongside supporting the patients, The Wright Initiative, headed by respected psychotherapist Norman Wright, works with surgeons to ensure that their patients are prepared, mentally and physically, for the changes they will experience after surgery. The specially-devised programme takes the form of focal sessions that are held at TWI’s Nottingham and Harley Street clinics. During the course of a 60-minute assessment, the patient will attain the peace of mind that comes from knowing that their emotional welfare has been addressed by them and their surgeon thus providing an integrated support programme.


Holistic Microneedling book published November has seen the release of the new book by Anthony Kingston. Holistic Microneedling: A Natural Approach to Skin Needling provides a detailed account of how to perform microneedling in a holistic and less invasive way. It focuses on the techniques for treating a variety of conditions and analyses different products that can be applied in different situations. In addition, a thorough study of the history and science behind microneedling is provided and demonstrated through 37 colour photos and diagrams. Anthony began studying skin needling in the form of acupuncture in Australia before continuing to study a wide variety of cosmetic techniques throughout Asia and the west. Together with his wife he founded the first specialist cosmetic skin needling clinic in the southern hemisphere. The book is available through White Lotus Anti Aging and retails at £34.99 for the soft cover book or £19.99 for the e-book.


Syrinx Za International appoints Eurocom Healthcare Communications as its skincare distributor Eurocom Healthcare Communications has been appointed by Syrinx Za International to handle its range of skincare products. Commenting on appointing Eurocom, Ashley Metcalfe, chief executive at Syrinx Za International said, “As a new business launching into the very competitive UK pharmacy market the Eurocom team has given us the opportunity to punch above our weight with innovative and creative designs that show a real understanding of our business, our aims and our aspirations. They have delivered on time, 8

on strategy and most importantly at a budget we can afford.” Tony Chant, managing director at Eurocom said, “The Syrinx Za range is based on pure, natural ingredients, the main one being Zander. It is a truly unique range, which will be welcomed by sufferers of various acute and chronic skin conditions everywhere. We are delighted to be working with Ashley and the team and look forward to developing both print and online digital initiatives for them, to achieve a greater awareness of the Syrinx Za brand.”

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Alma Lasers offers the most advanced technologies for today’s most in-deman

HarmonyXL is a multi-application platform featuring over 70 FDA cleared aesth ClearChoice for Onychomycosis (nail fungus), the popular Laser360iQ rejuvenation iTED, a revolution in ultrasound trans-epidermal delivery. Clinically PROVEN to sa Breakthrough in treating the most in-demand indications: Stretch Marks, Melasma, Sc

aesthetic awards 2012-13, triple win for aBc lasers EquipmEnt Brand of thE YEar aBc lasers

trEatmEnt of thE YEar (BodY) soprano pain free hair removal (aBc lasers)

trEatmEnt of thE YEar (facE) harmony Xl piXel Qs aka the ‘laser face-lift’ (aBc lasers)

Contact us on: Tel: 0845 1707788,,


cosmetic news the uk’s largest trade aesthetics exhibition and conference


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Over 60s spark rise in demand for cosmetic treatments and anti-ageing products A boom in divorcing over 60s has seen a massive rise in older women and men booking cosmetic beauty treatments and buying anti-ageing products. The female ‘silver separators’ are seeking to emulate still-got-it older stars like Dame Helen Mirren, 67, and Susan Sarandon, 66, as they get back out dating. And men may be trying to ape


silver foxes like Pretty Woman star Richard Gere, 63, or Taken legend Liam Neesen, 60. There has been a huge


58% increase in women in their 60s and 70s getting divorced. Many of these women have chosen to leave an unhappy marriage and have sought out cosmetic treatments to improve their image before looking for a new partner. As a result the ‘silver separators’ market has become the fastest growing demographic group for aesthetic clinical treatments and the LoveLite clinic in Harley Street has seen a 250% increase in women of that age seeking treatments. There has also been a significant increase of 160% in treatments for men of the same age. LoveLite clinical director Donnamarie McBride said, “A year or so ago we had very few clients over the age of 60, a handful in a year at most. But recently there has been a massive increase in demand and we’ve seen as many in the past month as we would have done in nearly half a year previously. The over 60s age group is without a doubt the fastest growing area in the non-invasive cosmetic treatment market at the moment. Almost all of the women that come to us have just become separated or divorced, and they are wanting to improve their appearance and get back to their more youthful figure. The Lipoglaze treatment is especially useful because the older you get, the harder it is to shift the fatty areas with gym work and good diet alone.”







Leading Consultant Dermatologist On Mission To Raise Awareness Of Mohs Treatment For Skin Cancer


A leading consultant dermatologist is on a mission to raise awareness of Mohs surgical treatment for non-melanoma skin cancer, which he believes is the most effective treatment available today. Dr Walayat Hussain, who works at Spire Leeds Hospital, is QUICK TO APPLY


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one of only a few doctors in the country trained in the highly specialised technique. He is also the only Mohs surgeon in Yorkshire to be accredited by the world’s leading Mohs institution, the American College of Mohs Surgery. “Mohs surgery, also known as ‘Mohs micrographic surgery’, is one of the most effective and advanced treatments for non-melanoma facial skin cancer today yet most doctors know very little about it’, said Dr Hussain. “When dealing with skin cancer, what you see on the skin can be just the tip of the iceberg. Mohs surgery enables all the roots of the skin cancer to be very precisely removed and by only removing cancerous tissue and sparing normal skin, it can often offer an improved cosmetic result and may work where other treatments have failed. Mohs surgery is considered the ‘gold-standard’ treatment for nonmelanoma skin cancers when it is felt there is a high risk of the cancer returning and especially when the skin cancer is on the face as it allows the hole to be kept as small as possible. This is particularly important around the eyes, ears, nose and mouth. Take the lips for example, it’s vital that a patient’s ability to open their mouth, eat, smile and speak are not affected.”


Cosmeceutical market grows, according to new report The global population grows older while increasing social pressures drive individuals to look younger, and consumer awareness has risen for cosmeceutical products which offer a way to keep up appearances without going under the knife, says a new report by market experts GBI Research. The new report Cosmeceuticals Market to 2018 - Technological Advances and Consumer Awareness Boost Commercial Potential for Innovative and Premium-priced Products states that the market for cosmeceuticals represents the fastest growing segment of today’s personal care industry. Demand is spiraling, driven mainly by anti-ageing products, which offer an alternate to cosmetic surgical procedures, which promise more dramatic results but at a higher cost in terms of time, money and safety. The cosmeceuticals markets in the US, the UK, France, Germany, Italy, Spain and Japan were estimated to be worth $30.9 billion collectively in 2011, with the combined markets expected to reach $42.4 billion by 2018, following growth at a CAGR of 4.6%. Presently, cosmeceutical companies rely on developed nations, but increasing wealth in emerging markets such as Latin America, China and India is expected to see products reach out to an even wider audience in the future.

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



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A GLIMPSE OF WHAT’S TO COME As Sir Bruce Keogh and his expert panel reveal the summary of the responses to the Call for Evidence, we report on what this means for the industry

2012 was a dark year for the aesthetics industry as the safety and regulation of cosmetic procedures came under fire in the wake of the PIP scandal. The widespread media coverage of the incident stretched far beyond the world of implants and brought non-surgical procedures, in particular dermal fillers, under scrutiny as well. This led to the Health Secretary, Andrew Lansley, calling for a major review of the sector to be carried out. The review, led by NHS medical director Sir Bruce Keogh (pictured left), saw an expert panel being formed and, in August 2012, a Call for Evidence was launched, running until October 15, 2012. The Call for Evidence was issued to enable the public, industry and patient groups to give their comments to Sir Bruce and the expert panel before they publish their review and recommendations for the future of the industry in March 2013. The key areas that were being considered by the panel were: •

The regulation and safety of products used in cosmetic interventions;

How best to ensure that the people who carry out procedures have the necessary skills and qualifications;

How to ensure that organisations have the systems in place to look after their patients both during their treatment and afterwards;

How to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice; and

What improvements are needed in dealing with complaints so they are listened to and acted upon.

On New Year’s Eve, December 31, 2012, a summary of the responses to the Call for Evidence was released, outlining what the feeling in the industry and public at large was and giving the industry, for the first time, an insight into what the ramifications of the review may be.

undoubtedly an air of concern spreading throughout the industry over how it could impact the way in which medical aesthetics is practised. In a foreword Sir Bruce stated that the expert panel had had a huge number of responses from the public, practitioners, providers and the industry. 63% of these were classified as ‘individuals’ (either professionals working in the sector or members of the public); 10% were industry bodies, 6% were professional bodies, 4% were charities, 4% were private providers, 4% were regulators, 3% were insurers, 2% were devolved administration, 2% were manufacturers, 1% were lawyers and 1% were membership. [Source:]He highlighted that it was important to acknowledge that people undergoing cosmetic interventions are not only consumers but also patients and said that the current regulatory framework doesn’t do enough to support consumer rights or patient safety. He also reminded people that the summary of responses is not intended to present an indication of the review committee’s emerging recommendations. He said, “The responses to the Call for Evidence send a clear message that the current regulatory framework doesn’t do enough to support consumer rights or patient safety. The supply and demand for procedures in this fast-growing sector has outgrown the existing legislation around the products used, the people providing treatments and the information and advice available to the public. “Over the next few months we’ll be using information gathered from the Call for Evidence alongside our engagement with the sector to formulate our recommendations. I hope what we propose will deliver a cosmetic interventions industry that will lead the world in terms of patient care without stifling consumer choice.”

According to the report the key messages that emerged from respondents were: •

The current regulatory framework was inconsistent and did not reflect the many changes and innovations in such a fast-growing and dynamic sector;

Training requirements were felt by many to be disproportionately weak compared to the potential risks of a procedure and more specialised training was welcomed;

• The review will be pivotal for the future of the industry and could at last bring in some tighter regulations that many have been calling for. But there is also


Dermal fillers and Intense Pulsed Light and laser procedures were highlighted by many as areas where there was insufficient legislation to protect the public

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Dermal fillers and Intense Pulsed Light and laser procedures were highlighted by many as areas where there was insufficient legislation to protect the public

Respondents were concerned about the lack of data being collected on implants, procedures, adverse incidents and outcomes

The review was timely and an important part of restoring public trust in the cosmetic interventions sector following the issues with PIP breast implants

Suggestions that respondents wanted to see implemented came under five key categories: Information, consent and advertising



There was very strong support for the banning of financial inducements, two-for-one type offers or time limited deals promoting the sale of cosmetic interventions. It was also felt that it was not appropriate to offer these procedures as competition prizes and that there should be tighter restrictions around advertising as well as clearer advertising guidelines. Respondents indicated that consultations should be with the person performing the procedure and not a sales advisor and that free consultations for cosmetic surgery should be banned so that people don’t feel obliged to go through with surgical procedures. The possibility of a two stage consent process, so people have time to reflect before making a decision, was also discussed.

Regulation of Practitioners SALON TREATMENT



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Training requirements were felt by many to be disproportionately weak compared to the potential risks of a procedure and more specialised training was welcomed. The issue of whether non-healthcare professionals should be able to administer injectables was split, but the majority of respondents felt that the key issue was training, for both healthcare and non-healthcare professionals. It was felt that local authorities using the Council Special Treatment License scheme would provide an effective way of policing the non-surgical side of the industry.

Regulation of Providers

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Respondents felt that providers should be keeping records of all devices and implants they use and should be required to audit their processes and ensure their practitioners take part in clinical audits. Most responses said that performing laser and light treatments didn’t need to be restricted to medical professionals only, however, these procedures, along with other procedures, such as cosmetic injectables, should not be administered outside healthcare settings.

Medical devices, implants and other products The current regulation of fillers was felt to be inadequate. Many felt that all implants and fillers should be classified as devices. Greater regulation of lasers and light treatments was needed given the potential risks to consumers.

Data and registries Improving data collection and the reporting of adverse incidents should be a priority. Device registries were widely supported and most respondents felt that manufacturers and providers should share the cost of these and they should be extended to all devices and implants, inclusive of fillers. The full report is available at:


The review panel will report its recommendations in March.

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ON TH E S C E N E CLINICAL SKIN SPECIALIST JOANNE GOODMAN KEEPS ANNE HATHAWAY’S SKIN FRESH WHILE FILMING LES MISERABLES She is the movie star of the moment after her critically acclaimed performance in the big screen adaptation of Victor Hugo’s classic novel, Les s_bukley / Miserables, and so it is no surprise that Anne Hathaway wants to look her best. The porcelain skinned beauty kept up with her skincare regime by visiting clinical skin specialist Joanne Goodman in Harley Street for her facials while in the UK for six months filming for the musical blockbuster at Pinewood Studios. Tipped for Oscar and BAFTA success for her sensational role as Fantine in the hit production, Hathaway uses the Epicuren range, as recommended by her dermatologist. The US enzyme based skincare range has been described by Vogue as having “American Beauty Aficionado’s hooked”. Joanne is head of distribution for the range in the UK and uses it on her clients in both Harley Street and Hampshire.

CHELTENHAM COSMETIC SURGEON BACKS NURSE LED CLINIC FOR PATIENTS Cheltenham cosmetic surgeon Dalvi Humzah has joined forces with Nuffield Health Cheltenham Hospital to launch its first dedicated nurse led clinic. Led by registered nurse and independent nurse prescriber Anna Baker, the new clinic offers a range of non-surgical treatments including wrinkle relaxing injections and skincare treatments for patients. At the opening event, consultant cosmetic surgeon Mr Humzah introduced Miss Baker to patients Mr Dalvi Humzah and Anna Baker at Nuffield at Nuffield Health Cheltenham Health Cheltenham Hospital open event Hospital. The event highlighted the latest treatments for facial rejuvenation from Mr Humzah combining surgical and non-surgical techniques, as well as non-surgical cosmetic procedures available with Miss Baker. Mr Humzah’s private practice - Plastic and Dermatological Surgery (PDS) – has been based within the Nuffield Health organisation for over 10 years. He said, “This is great news for patients in terms of safety and choice. It offers much more choice for men and women seeking surgical and non-surgical treatments at Nuffield Health Cheltenham Hospital. It also means patients will be secure in the knowledge that cosmetic treatments are being offered within the framework of the Nuffield Health clinical governance. Importantly, patients can now see a consultant or nurse for cosmetic treatment. Anna and I will work together to refer patients to suit their individual requirements. For example, patients who want to undergo surgical procedures will be referred to my clinic and patients looking for wrinkle reduction treatments can be referred to Anna’s clinic if they prefer.” Miss Baker added, “With a dedicated non-surgical consulting clinic, we can encourage patients to seek treatment in a hospital environment to avoid unnecessary risks others face when visiting non-clinical set-ups.”  

SNOWBERRY LANE CLINIC CELEBRATES 10TH ANNIVERSARY This year sees the Snowberry Lane Clinic in Melksham, Wiltshire celebrate its 10th anniversary. This is a major landmark and tremendous achievement for Dr Rupert Gabriel, his wife Ann Gabriel RGN and their experienced and professional team. Over the last 10 years Dr Gabriel and his team have built up and expanded a highly respected and successful cosmetic clinic which is now at the forefront of modern laser technology and cosmetic surgery. Treatments on offer include a full range of non-surgical treatments to minimally invasive body contouring procedures. Dr Gabriel is registered with the BCAM, GMC and CQC and is a well16

known and respected cosmetic professional. One of the companies Dr Gabriel has worked closely with during that time is Carleton Medical. He recently obtained the new Asclepion NeXT diode laser for hair removal which includes the SmoothPulse mode for super fast hair removal with the extra benefits of working on all skin types and being virtually pain free. Ann Gabriel RGN says, “Our laser hair removal client feedback has been very positive and results are excellent. We are very happy with the new NeXT diode laser and the service from Carleton over the last 10-years”. Nick J Fitrzyk from Carleton Medical said, “The team at Carleton Medical would like to congratulate the whole team at Snowberry Lane and wish them every success for the next 10 years!”

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Title: David Eccleston, Diane K Murphy, Juvéderm® Volbella™ in the perioral area: a 12-month prospective, multicenter, open-label study, Clinical, Cosmetic and Investigational Dermatology, October 2012 Background: Hyaluronic acid dermal fillers are frequently used for lip augmentation, and a new filler has been developed with characteristics especially suited for the lips.

THE SHAPE OF THINGS TO COME We get the exclusive on the latest shape-shifting product from Allergan that looks set to change the way aesthetic practitioners view lip enhancement Since their introduction into the fledgling aesthetic market, you could say dermal fillers have evolved more than any other product on the market. From the advent of biocompatible, resorbable HA fillers to wide-ranging product viscosities and the introduction of lidocaine, the past few years have seen the fillers market become far more diverse than anyone could have imagined in the early days of collagen. One other area in which fillers have also seen huge advances is in the way they are injected, with a move away from simple ‘filling’ to the more artistic and subtle techniques of facial sculpting, volumising and shaping. One company who has always been ahead of the game when it comes to innovations in dermal fillers is Allergan. 18

Since the company took on the JUVÉDERM® range back in 2006 it has propelled the product to new heights, becoming the first to add lidocaine to its formulas and becoming a market leader in this highly competitive field. It is no surprise then that when Allergan announced it was to be unveiling a new addition to the JUVÉDERM® line at the IMCAS meeting in Paris in January that the industry sat up and took note. The product is JUVÉDERM® VOLBELLA™ with Lidocaine, a new treatment for the lips and peri-oral area that is designed not only for gently restoring natural looking lip volume, but also for defining lip contours, treating oral commissures, smoothing fine ‘barcode’ lines around the lips and supporting the ‘marionette’ lines down to the chin.

Methods: Four European sites treated 60 subjects with Juvéderm® Volbella™ injectable gel in the perioral area, and subjects returned to the clinic at 1, 3, 6, 9, and 12 months for follow-up. The primary effectiveness endpoint established a priori was a month 3 responder rate on the 4-point Lip Fullness Scale (LFS) of ≥ 40% and statistically > 0%, where responders improved ≥ 1 point from baseline on the investigator’s assessment of LFS. At follow-up, subjects assessed lip fullness goal achievement, the look and feel of their lips, and their satisfaction with the effects of treatment. Results: The month 3 LFS responder rate was 93.2% (P < 0.0001), so the primary endpoint was met, and clinical effectiveness was demonstrated. The responder rate over time showed that 78.0% of subjects still had improved lip fullness at month 9 and 48.3% at month 12. After treatment 98.3% of subjects reported that their lip fullness goal had been achieved, and this was maintained at 86.4% at month 9 and 56.9% at month 12. At month 1, 81.0% of subjects reported that their lips felt smooth, and 91.4% reported that their lips looked natural (scores of 7–10 on an 11-point scale, where 0 was an unfavourable outcome and 10 was a favourable outcome). Similarly, 96.6% of subjects reported being satisfied (scores between 7 and 10 on an 11-point scale where 0 = very dissatisfied, 10 = very satisfied) at month 1, and by month 12 more than 80% of subjects were still satisfied. There were no severe adverse events related to treatment. Conclusion: Juvéderm® Volbella™ injectable gel is well tolerated and has been demonstrated to provide a smooth and natural improvement in lip fullness that lasts for up to 1 year.

What makes it different from other lip products on the market is its composition and viscosity making it ideal for lip shaping and taking natural looking lip enhancement to the next level. Developed using Allergan’s proprietary VYCROSS technology, JUVÉDERM® VOLBELLA™ with Lidocaine is the only hyaluronic acid dermal filler proven to last up to 12 months in the lips with 1 a single treatment. It is formulated with an innovative combination of low and high molecular weight technology, which improves the cross-linking efficiency of HA chains. This more effective cross-linking allows for a lower concentration of HA to be used, which results in less swelling. The VYCROSS technology also delivers an ultra-smooth gel, which results 2 in a natural look and feel , as well 3 as improved duration and because of its unique viscosity it requires

far less extrusion force, making injection easier for practitioners. A study published in Clinical, Cosmetic & Investigational Dermatology showed that JUVÉDERM® VOLBELLA™ with Lidocaine is well tolerated and has been demonstrated to provide a smooth and natural improvement in lip fullness that lasts for up to one year. In addition, the treatment is associated with high patient satisfaction, with 86% of patients reporting maintained improvement in the look and feel of their lips after nine months and 57% of patients still reporting maintained improvement after one year. Dr David Eccleston, clinical director of MediZen and one of the lead authors on the paper says, “JUVÉDERM® VOLBELLA™ with Lidocaine has been uniquely designed for a natural look, with less swelling compared to other lip

fillers enabling my patients to return to everyday life more quickly. In addition, this is the only dermal filler clinically 4 proven to last up to 12 months in the 1 lips with a single treatment , so it gives a long-lasting effect. I look forward to including it in my portfolio of dermal fillers.” Rajkumar Narayanan, VP and commercial head for medical EAME at Allergan adds, “Recent media trends have shown increasing consumer reservations about cosmetic injectable treatments, with a key barrier to treatment being concerns about an unnatural look. Leading medical aesthetic practitioners in Europe are now looking for treatment options, which give their patients natural looking results with a tailored, individual treatment approach. At Allergan, we are delighted that we’ve been able to respond to this desire through the launch of this innovative new product”.

References 1 Single treatment defined as initial injection with optional top-up after 14 days 2 Allergan Data of File (DoF) (In-Lab) 3 Raspaldo H. J Cosmet & Laser Ther, 2008; 10:134-142 4 Eccleston D, Murphy DK - Clin Cos Investig Derm 2012; 5: 167-172

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THE LATEST ® STYLAGE We summarise the results of a clinical study published in the Journal of Cosmetic and Laser Therapy on the benefits of adding lidocaine to the hyaluronic acid filler Stylage®


lthough the benefits of adding lidocaine are recognised in terms of relieving the pain experienced upon injection (2,6,7), there are still relatively few studies comparing the effectiveness of adding lidocaine to a given product in a given patient or its impact on potential side effects and on the remanence of the product. Initial comparative studies of this kind carried out in recent years (5-7) generally conclude that the two alternatives produce the same results in terms of tolerance and effectiveness, both immediately after treatment and six months later.

appropriate recommended post-injection massage (on a pain scale of one to 10) • Any immediate and delayed side effects (oedema, erythema, redness, bruising, etc.) and the intensity thereof (slight, moderate or severe) •The aesthetic satisfaction achieved after injection: immediately after the injection, five weeks (+ /- one week) later and finally six to eight months later. This satisfaction criterion was assessed on a scale of one to 10, on one hand by the patient himself and on the other hand by the doctor. The practitioner also assessed the ease of injection.

It would appear beneficial to establish the impact of lidocaine within the Stylage® range, the only one to incorporate both an anaesthetic (lidocaine) and an anti-oxidant in the form of mannitol in its cross-linked gel of HA.

The outcome of the study are as follows:

In a study published in the Journal of Cosmetic and Laser Therapy, Bernard Mole and Lyliane Gozlan of the Centre Tourville, Paris, wanted to address the following questions: 1. Does this addition offer a real benefit in relation to the basic gel? 2. Could it be the cause of other incidents directly linked to lidocaine? 3. Could it have an impact on the durability of the result? The single-blind post-CE Marking clinical study included 10 other practitioners. The triple objectives of the study were: 1. To highlight the benefits of adding lidocaine in terms of pain experienced by the patient and for all commonly injected areas of the face; 2. To compare the tolerance of the two products; 3. To compare the degree of aesthetic satisfaction achieved by the cross-linked gel with and without anaesthetic six to eight months after treatment.

R E S U LT S A total of seven different areas were injected among the 84 patients. Unsurprisingly, the distribution of injected areas shows the predominance of nasolabial folds and marionette lines (66% of indications). Stylage® M Lidocaine was just as easy to inject as Stylage® M, confirming that the gel has equivalent physico-chemical properties. The very slight difference observed when using the lidocaine version (90% as opposed to 85% classed as “very easy”) was explained by a reaction specific to some patients who, in just a few seconds after the initial injections, experienced local anaesthesia in the injected areas. The injections, which had been now rendered painless, were more comfortable for the patient and therefore easier for the doctor.


The immediate side effects (experienced a few minutes to a few hours after treatment) were primarily limited to the usual redness or erythema in one third of the cases in both groups, as well as oedemas observed simultaneously. Some indurations were also observed (4-6% of the treated patients). All these side effects were resolved within a maximum of 72 hours after the injection. Bruising, which was more likely to occur when using a gel containing lidocaine, a vasodilator, was nevertheless limited (1 %, or just one patient) and no bruising was observed in the group treated with lidocainefree Stylage® M.

The clinical follow-up was carried out at 11 centres over a period of six to eight months and involved 84 patients aged between 27 and 75 years (with an average age of 50). 96% of them were women. An assessment of the thickness of the skin revealed that 58% of patients had normal skin, 25% had delicate skin and 16% had thick skin. The injected areas had to be symmetrically aligned on each side of the face for purpose of having comparable areas to assess. Any areas commonly treated with hyaluronic acid-based fillers could be injected. The injector was aware of the product type, i.e. with or without lidocaine, and arbitrarily chose which side to inject, the patient remaining unaware of the distribution of the products, The assessment was based on three criteria: • Patient comfort both upon administration of the injection and during the

Haematomas were also found in an almost equivalent percentage for both products (14% for Stylage® M Lidocaine and 18% for Stylage® M), which can be explained by the origin of these undesirable effects: rupture of venules and not due to the product itself. An overview of all side effects experienced shows that in 57% of cases without lidocaine and 60% of cases with lidocaine patients suffered no side effects. Consequently, no significant difference was noticed between the products with and without lidocaine in terms of postinjection side effects. The reported intensity of secondary reactions was low (level 1) in the vast majority of cases (intensities: 1=slight, 2 =moderate, 3 = severe), with only redness being reported as having an intensity of 3 in three patients (two of which had been treated with the lidocaine product and one without), 21


resolved in the hour following the injection, as well as one case of a severe haematoma with Stylage® M. It is also interesting to note that the vast majority of haematomas observed were of low intensity for both products, which tends to confirm the lack of impact of the vasodilatory action of the 0.3% lidocaine in the Stylage® product, as was feared by some. The average intensity of secondary reactions was therefore lower in the lidocaine group. Finally, no delayed undesirable effects (such as nodules, inflammatory granulomas, hypersensitivity, etc.) were reported, even up to 12-14 months of follow-up. The products are therefore equivalent in terms of tolerance, demonstrating only the usual side effects experienced when receiving filler injections, for a combination of cross-linked hyaluronic acid and mannitol, with or without lidocaine. More significant was the assessment of the level of pain experienced. This was self-assessed by the patient on a scale of 1 to 10 and was, unsurprisingly, far lower in the lidocaine group, both at the time of injection, with an average scoring of 3.2 as opposed to 5.7, and during the post-injection massage, with an average scoring of 1.8 as opposed to 4. For the purposes of clearer comparison, the results have been organized by ‘level of pain’ with the following hypotheses: Very low level of pain =scores 1-3 Average level of pain = scores 4-6 High level of pain = scores 7-10 These results show that 60% of patients claimed to have experienced a “very low” level of pain with Stylage M Lidocaine as opposed to only 19% with Stylage® M. Likewise, an analysis of the levels of pain experienced with injections to the lips only, which accounted for 11% of the areas injected, highlights the greatest effect of the anaesthetic when treating this particularly sensitive area; the average level of pain experienced during the injection is 6.7 with Stylage®M as opposed to 3.2 with lidocaine, with respective levels of 4.6 and 1.7 experienced during massage. With regards to the degree of immediate satisfaction experienced this was comparable in both groups and identical for both the patient and the doctor administering the injection. The difference, albeit minor, in favour of lidocaine

(where 81 % were very satisfied as opposed to 72%) for patients could, perhaps, be explained by the lower level of pain and the more ‘relaxed’ feeling of the treated area. No asymmetry of correction was reported by either the doctor or the patient, thus confirming that the physico-chemical and volumizing properties of both products are equivalent. The overall aesthetic satisfaction remains very high six to eight months after the injection (average aesthetic satisfaction score of 9 for doctors and 9.1 for patients), with no asymmetry reported between areas treated with lidocaine and those treated without. In answer to the question “Is there a difference between the two sides treated?”, as was the case five weeks after the injection, the response was “no” in 95% of cases, with one doctor claiming that the difference noted was due to the difficulty of balancing the two sides of the face as a result of the patient’s morphology. This confirms that both products are equivalent in terms of immediate post-injection filling effectiveness and remanence. So, adding lidocaine does not constitute a guarantee of remanence nor indeed of worse results, as some are inclined to think.

CONCLUSION This study shows that adding lidocaine to a cross-linked hyaluronic acid gel: 1. Does not bring about any increased risk of blood extravasation; 2. Affects neither the quality nor the durability of the result. However, patient comfort during the injection means that generally-speaking, no nerve block is required, even when treating the lips, an area which is generally much-dreaded as it is extremely sensitive. Although the few seconds it takes to initially insert the product may be uncomfortable, the rest of the injection is far more tolerable. The correction can therefore be refined under much better conditions. This increased comfort throughout the injection process confirms the notion that the addition of lidocaine is still a key step forward in putting the patient at ease and should be applied without limit to all fillers, particularly as real allergies to lidocaine are currently more of a historical nature than a clinical one.

[References] 1.Mole, Bernard and Gozian, Lyliane, Centre Tourville, Paris, France, Benefits of adding lidocaine to a hyaluronic gel - Stylage® M, Journal of Cosmetic and Laser Therapy 2011; 13: 249-254 2. Wahl Gj. European evaluation of a new hyaluronic acid filler incorporating lidocaine. CosmeL DermaL 2008;7(4):298-303. 3. Lanigan S. An observational study of a 24 mglmL hyaluronic acid with pre-incorporated lidocaine for lip definition and enhancement. J Cosmet Dermatol. 2011;10(1):11-4. 4. Monheit GD, Baumann LS, Gold MH, Goldberg DJ, Goldman MP, arins RS, Bachtell, Garcia E, Kablik J, Gershkovich J, Burkholder D. Novel hyaluronic acid dermal filler: dermal gel extra physical properties and clinical outcomes. Dermatol Surg. 20 10;36(Suppl 3): 1833-41. 5. Lupo MP, Swetman G,WallerW. The effect of lidocaine when mixed with large gel particle hyaluronic acid filler tolerability and longevity: a six-month trial. J Drugs Dermatol. 20 I0; 9(9):1097-100. 6. Levy PM, De Boulle K, Raspaldo H. Comparison of injection comfort of a new category of cohesive hyaluronic acid filler with preincorporated lidocaine and a hyaluronic acid filler alone. Dermatol Surg. 2009;35(Suppl 1):332-6; discussion 337. 7. Brandt F, Bank D, Cross SL, Weiss R. A lidocaine-containing formulation of large-gel particle hyaluronic acid alleviates pain. Dermatol Surg. 2010;36(Suppl 3): 1876-85.


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Best Product InnovatIon 2012

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Dr Jo Ward explores skin boosters, their efficacy and combination applications Dr Jo Ward is a GP with a special interest in dermatology, minor surgery and cosmetic medicine. She is the medical director of The Skin Clinic Sevenoaks and its sister clinic The Skin Clinic Brentwood. Dr Ward is passionate about dermatology and raising dermatology standards in the aesthetics industry and was awarded a distinction in the Diploma in Clinical Dermatology from Queen Mary’s University London. She is also a Hamilton Fraser approved trainer in cosmetic injectables.

Skin boosting is a new and modern concept that gives us the tools to improve the skin’s texture, elasticity, hydration and surface tone. Skin boosters can be synergistically combined with other aesthetic treatments (advanced skincare, micro-needling, toxins, light treatments) to maximise the anti-ageing and collagen stimulating effect. This article explores the current evidence for skin boosters, their various uses and how they can be used to maximise aesthetic and cosmetic results. WHAT ARE SKIN BOOSTERS? Traditionally skin boosting has referred to mesotherapy, a technique invented by French physician Dr Michel Pistor in 1952. Dr Pistor to this day is seen as the founding father of mesotherapy. Mesotherapy refers to the practice of injecting medicine into the mesoderm or middle layer of the skin. Dr Pistor initially used mesotherapy for pain management and rheumatology. Modern day applications of mesotherapy use microinjections of ingredients scientifically designed to stimulate skin rejuvenation, hydration, collagen stimulation, fat breakdown, cellulite reduction and hair regrowth. To this day mesotherapy is commonly practised in France where it is taught in medical school and is recognised as a distinct medical specialty by the French National Academy of Medicine. Mesotherapy is practised by an estimated 18,000


physicians worldwide and is especially popular in France and South America. Mesotherapy has, to date, typically involved nonstandardised and variable blends of vitamins, minerals, low-grade hyaluronic acid, amino acids, plant extracts, homeopathic remedies and collagen stimulating ingredients. There has been some concern in the past about exactly what people use as ‘mesotherapy’ and concern about exactly what is being put into the treatment syringe. This concern over its efficacy resulted in The American Society for Dermatologic Surgery announcing in 2005 that ‘further study is warranted before this technique can be endorsed’.(1) Claims for mesotherapy have often been anecdotal and not always based on well-conducted clinical trials or empirical evidence. Clinical improvements with mesotherapy have been difficult to quantify

The key clinical difference in these skin-boosting products is whether the hyaluronic acid is stabilized or not. The stabilisation process of hyaluronic acid means that the native polysaccharide is made more resistant against natural degradation through a means of chemical cross-linking of a small proportion of the polysaccharide chain. This technology is unique to the Restylane® range of skin boosters and is patented under the NASHA technology. Restylane® has two stabilized, nonanimal skin boosters in its range: Restylane® Vital and Restylane® Vital light. Both stabilized and non-stabilized hyaluronic acid skin boosters have been shown to clinically improve the elasticity and hydration of the skin, helping to minimise the appearance of fine lines and wrinkles and reduce skin surface roughness (8). The difference is that stabilized HA’s have been found to produce a statistically significant improvement in all of these parameters, whereas non-stabilized HA’s show a trend for improvement but this is not statistically significant. and can be hard to capture on camera with an objective before and after. Some studies have suggested that mesotherapy provides ‘little improvement in histology, mucin and elastin stains in post mesotherapy biopsies’. (2) Modern day skin boosters however are a new and scientifically proven approach to the idea of mesotherapy or injections of medicines into the skin. The lack of empirical evidence that has slightly tarred the reputation of conventional mesotherapy has been erased with the advent of products such as Restylane® Vital, where numerous studies have now cited clear, objective and statistically significant evidence for improvements in skin elasticity, surface texture, hydration and skin surface roughness (3,4). Sutherland and colleagues have demonstrated that one gram of HA can bind up to six litres of water. A testament to the hydrating qualities of hyaluronic acids. (5) Commercially available skin boosters include Restylane® Vital, Restylane® Vital Light, Juvederm® Hydrate, Teosyal® Mesotherapy and Teosyal® Redensity. They are all a scientifically improved variation of traditional mesotherapy and are made with a customised and standardised hyaluronic acid base. Restylane Vital has cross-linked, stabilized nonanimal HA of 20mg/ml, Teosyal® Meso is a nonstabilized, nonanimal HA of 15mg/ml and Juvederm Hydrate is 13.5mg/ml non-stabilized HA with 0.9% mannitol. Skin boosters are injected in micro droplets into the superficial (Teosyal®) or mid-dermis (Restylane®) as per manufacturer recommendations. Best results will be seen with a minimum of three treatments placed two to four weeks apart. Clinical studies on skin boosters have mainly involved a minimum of three treatments (6). They can be used generally over the lower face, in the upper and lower lip to address smokers lines, to the décolletage area, to the dorsum of the hands and more recently they have been used in other areas such as the abdomen and the upper arms (7). Vital comes in a 2ml injector pen to ensure that standardised micro droplet amounts are delivered to each injection area. Juvederm® Hydrate and Teosyal® Meso come in prepackaged syringes of 1ml.

Stabilized HA skin boosters have been shown in a study by Dr Stefanie Williams to produce superior and longer lasting results in the skin compared to non stabilized HA skin boosters. In the study Restylane® Vital was injected into the dorsum of the hands and was shown to increase ‘cutaneous elasticity and stratum corneum hydration while reducing skin surface roughness and TEWL’. In this study ‘stabilized HA seemed to exhibit a longer duration of effect and was found to be superior to non-stablised HA according to all parameters at week 12’. Dr Williams chose Restylane´® Vital as the stabilized HA in the study and Teosyal® Meso as the non-stabilized HA as these are two of the most popular commercially available skin booster brands. COMBINATION TREATMENTS Skin boosters play a vital role in improving the hydrobalance, elasticity and texture of ageing skin and can be used in combination with other aesthetic treatments to great effect. Combining skin booster treatments with active skin care, micro-needling, toxins and pigmentation treatments can boost the desired results and dramatically improve areas of cosmetic concern. Perhaps one of the most exciting areas is the combination of skin boosters and microneedling, a new technique dubbed ‘Gel Needle Lifting’. Both techniques are clinically proven to improve the appearance of the skin and pose an exciting new direction for skin rejuvenation. SKIN BOOSTERS AND TOPICAL TREATMENTS Although creams and lotions can help rehydrate and moisturise the skin, there is a limit to how much the skin’s texture and quality can be improved with topical preparations alone. Topical hyaluronic acid is not crosslinked and has a short half-life limiting its longevity. As Hannah John and Richard Price note in their recent paper on HA fillers, ‘in the superficial epidermis (HAs) act as a humectant contributing to (improved) moisture content and reducing transepidermal water loss’ (9). In the deeper 25


dermis hyaluronic acid acts to increase turgidity. Non cross linked hyaluronic acids have a short half life so need to be applied continuously and frequently if the plumping and hydration effects are to be seen. In order to get around this and to achieve a deeper and more lasting dermal hydration within the skin, we can place the HA deeper within the skin with skin boosters. Combining skin boosters with daily topical application of a hyaluronic acid based product will maximize the skin’s hydration and improve the skin’s texture, fine lines and wrinkles.

clinical observation shows the two treatments work synergistically and enhance one another.


Three simultaneous treatments of a skin booster and micro-needling are thought to be deliver the best clinical results. This new combination treatment has been coined ‘Gel Needle Lifting’ and is being used with Restylane® Vital, Juvederm® Hydrate and Teosyal® Meso.

Toxins are one of the most popular aesthetic treatments on the market with an estimated 12 million people using them globally. Toxins complement skin booster treatments as they extend the cosmetic response of the hyaluronic acid through muscle relaxation. This can be used to good effect in the glabellar, crowsfeet, smoker’s lines and neck regions. SKIN BOOSTERS AND MICRO-NEEDLING Micro-needling is a relatively new technique that can be done with or without introducing products transdermally (dry vs wet). Micro-needles are Class 1 medical devices that do not have to be FDA approved. It is therefore advisable to use good quality micro-needles for the best the cosmetic results. There are a number of poor quality imitation roller devices that have inundated the market recently and these have been associated with needle breakages in the skin and unnecessary skin trauma. Micro-needling and skin boosting combined can give dramatic effects on the overall skin outcome. It is a practice that is being used more and more in clinics and anecdotally gives superior results than one treatment modality alone, rather like 1 + 1 = 3. To date there is very little empirical evidence for combination treatments of micro-needling and skin boosters as few clinical studies have been conducted. But both treatments are known to have good clinical outcomes individually and simple

Techniques used include using Restylane® Vital 2ml injector pen 15 minutes prior to a micro-needle treatment. The immediate benefit of this is that the Vital contains lidocaine and helps reduce microneedle discomfort. Other practitioners will place the HA gel over the skin and then roll the booster into the skin rather than inject it prior. This allows transdermal delivery of the skin booster via the roller needles in a mesotherapy like technique.

Clinicians are citing dramatic results as the skin boosters help achieve dermal hydration and plumping whilst the micro-needle treatment stimulates collagen and skin resurfacing. Use of a topical vitamin C and vitamin A will super boost the results as vitamin C is an important cofactor for vitamin A for new collagen production. Optimum needle length has been something of a debate recently but it is generally accepted now that 1-1.5mm is the ideal depth for micro-needling the face as it allows penetration into the papillary dermis to stimulate neocollagenesis but doesn’t over traumatize the skin. Apart from erythema there are few other side effects. The micro trauma holes close almost immediately so post procedure infections do not occur. With all of these treatments it is important to be aware that the better your client’s overall health, hormonal and nutritional state, the better the outcome from any of these therapeutic procedures. General lifestyle and skincare advice should always form part of the initial consultation and will ensure that suitable patients are being chosen for these rejuvenating techniques.

[REFERENCES] (1). Matarasso et al ‘Techonology Report: Mesotherapy’; American Society for Dermatological Surgery; January 2006 (2). Amin S, Phelps R, Goldberg; ‘Mesotherapy for facial rejuvenation: a clinical, histologic and electron microscope evaluation’; Dermatol Surg 2006 Dec 32 (12) 1467-1472 (3). Martina Kerscher, Julia Bayrhammer, Tilmann Reuther; ‘Rejuvenating Influence of a stabilized Hyaluronic acid based gel of non animal origin on facial skin ageing’; Dermatol Surg 2008: 34: 1-7 (4). Dr Stefanie Williams; Changes in skin physiology and clinical appearance after micro droplet placement of hyaluronic acid in ageing hands’; European Dermatology London; 2009 (5). Sutherland I ‘Novel and established applications of microbial polysaccahrides.’ Trend Biotechnol, 1988:16:41-46 (6). Kerscher and Williams studies (7). Fenanda Distante et al ‘Stabilised Hyaluronic acid of non animal origin for rejuvenating the skin of the upper arm’ Dermatol Surg 2009 (8). Dr Stepahnie Williams et al ‘Changes in skin physiology and clinical appearance after micro droplet placement of hyaluronic acid in aging hands’; European Dermatology London; 2009 (9). Hannah John and Richard Price ‘Perspectives in the selection of hyaluronic acid fillers for facial wrinkles and aging skin’ Department of Plastic and reconstructive Surgery, Addenbrooks, Cambridge; July 2009


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Best Newcomer (Pr od uct or tr eatmeN t )

Date of Preparation: February 2012 RES/004/0212


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PATENT IS A VIRTUE As the ArqueDerma® Artistic Restoration Lift® receives its patent, the pioneering nurse behind the methodology, Leslie Fletcher, tells us in her own words about how she developed the technique that has revolutionized the way we think about injecting dermal fillers

Leslie Fletcher is the pioneer of the ArqueDerma® Artistic Restoration Lift®. Leslie developed this revolutionary patented technique for delivering dermal fillers while working with thousands of patients over the last 10 years in her practice as an aesthetic nurse injector, as well as an aesthetic injection trainer.

“On April 6, 2009, I applied for a provisional patent for a procedure that later became referred to as ArqueDerma®, Artistic Restoration Lift®. On August 14, 2012 this 13-page document, which included research of other related arts, six figure schematics, as well as a detailed description of the invention itself, became the first non-provisional utility patent for dermal filler use ever to be issued in the United States. I started working as an aesthetic nurse in 2001 and began my career as an aesthetic injection trainer in 2007. Since then, I have seen and researched many different techniques for administering dermal fillers. What initiated my quest for a different approach, was the dissatisfaction I had with the production outcomes that current treatment modalities were offering at the time. The conventional methods of administering dermal fillers seemed to simply put a band-aid on the wrinkle, fold or overhang, or even worse, overstuff the face in an attempt to eradicate any wrinkles. In addition to dissatisfaction, I felt a need to respond to my patients’ requests. Patients I had been treating for 30

years wanted more than just a ‘fill,’ they wanted a ‘lift.’ These requests inspired my curiosity to look outside the box to fix this gravitational problem. I wanted to be able to offer my patients what they needed in a non-surgical way. Similar to most inventions, ArqueDerma® was born out of a necessity. I’m told every inventor has an “aha” moment, and mine came while observing a scene on the side of a freeway. I noticed that a wall was being supported by strategically placed perpendicular beams. The obvious came to my mind: “If those few beams can hold up an entire wall, surely a few beams could hold up a little hanging skin!” Immediately I tested my theories on family and friends, which produced incredible results using markedly less product. As an educator for several national pharmaceutical companies, I demonstrated this new technique during courses and it often dominated the instruction for the remainder of the class. Several respected colleagues on multiple occasions advised me that what I had “created” was an entire new category for the delivery of dermal fillers. More than

one physician advised me to file a patent for this innovative process. Although patenting a medical technique was the farthest thing from my mind at the time, I was given a referral to an excellent patent attorney who specialised in method patents. I learned that this process could indeed qualify for a utility patent. The requirement for utility patents in the USA is as follows: Under US patent law, a utility patent protects “any new and useful process, machine, article of manufacture, or composition of matter, or any new and useful improvement thereof”. (United States Patent and Trademark Office- USPTO) A “process” is defined by law as an act or method, and primarily includes industrial or technical processes. (A process is the way an invention performs rather than the way it is structured).

A utility patent must fulfill these three requirements: • Must be novel (I had to apply for the non-provisional patent within one year of invention. I also had to prove there was nothing else in the industry like

this technique.) • Must not be obvious (to a person having skill in the area of technology related to your invention) • Must be useful (serve a useful purpose) Additionally, I had to provide the USPTO with a complete description of the actual working invention, as well as descriptions of current techniques used in the relevant industry. These would later be examined, and passed or declined by someone having skill in this field of technology. Once this time-sensitive task was safely in the works, I applied for a copyright of authorship for my training materials, as well as national and international trademarks to protect the brand used to identify and distinguish this service from all other types of aesthetic services. During the next four years, my educational company,

agree that they have never seen anything similar (novel), more innovative (nonobvious), or more effective (useful) than the ArqueDerma® technique. Hence the qualifications were met for all three patent categories. In order to maintain the validity of a patent, patent holders are required to pay maintenance fees throughout the duration of the patents life span. Medical technique patents, although uncommon, are important. They identify a marked position of invention, validate credit for intellectual property, and assign ownership to an individual, or company of an idea that was created, developed, and finally submitted to the medical community.

About ArqueDerma® ArqueDerma® Artistic Restoration Lift® is a revolutionary way of delivering dermal fillers to artistically address the three basic signs of facial aging: loss of volume, lax skin,

needle to create a modest subcuticular undermining effect, ArqueDerma® is postulated to disrupt fragmented collagen strands and replace them with purposeful, vectored strands of promoted neocollagenesis. This effect results in sustaining the desired lift longer than conventional methods of filling. A major advantage of being able to lift and redirect the patient’s now separated tissue is the ability to use the patient’s own lax skin and reposition it upward, lifting it back to its point of origin. ArqueDerma® opens a world of possibilities for difficult to treat areas such as the jowls and marionette lines of the lower face. During treatment, FDA/ medically approved dermal fillers are administered with a deliberate tension using the needle in multidirectional curves, specific to the patient’s needs, beneath the skin’s surface to disrupt and remove damaged, fragmented collagen

Before & After

InjectAbility® Institute, brought on national and international expert trainers in order to purely deliver the ArqueDerma® concept to a wider audience. We now offer training in Canada, United States, United Kingdom, Australia, and potentially soon in Asia. To date, InjectAbility® Institute has licensed this patented technique to nearly 400 medical practitioners in seven different countries. Conceivably, nearly two million patients have been treated using the ArqueDerma® technique since the procedure was introduced to the medical aesthetic community in 2009. In addition InjectAbility® Institute brought on marketing and publicity specialists to offer wider exposure of the technique to practitioners who want to provide this treatment to their patients. We have also initiated very successful consumer-driven campaigns to inform potential patients of the newly patented technique. Answering their need for a non-surgical “lift instead of a fill”. The procuring of the patent has only solidified what I have observed first hand from seasoned injectors in several countries over the years after taking the licensing course. Many trained injectors

and skin deterioration. This is accomplished using a novel technique that corrects more areas, effectively extends the use of filler product by 40% and lasts significantly longer than conventional methods of filling. Unlike conventional volume replacement procedures, the ArqueDerma technique utilises dermal fillers like Juvederm®, Restylane®and Perlane® as a stabilizer to redirect sagging skin toward hollows that have formed, anchoring it in place while newly created collagen forms to sustain the results. ArqueDerma® encompasses an entirely new concept of “blanketing” thin strands of hyaluronic acid dermal filler product, placed in strategic multi- directional vectors, to create an artistic lift of the lax tissues. In this technique, dermal fillers are administered applying a deliberate, controlled force on the tissues stimulating the fibroblasts and causing them to stretch. Based on the controlled injury theory in which type I and type III collagen production occur at accelerated rates post trauma, this mechanical stretching leads to an increase of collagen production. This desired side effect translates into longer-lasting results, and leaves a hydrating effect on the skin’s texture in the treated areas. Using the

strands and replace them with healthy new collagen. This creates a hydrating effect, enhancing the skin’s texture with hyaluronic acid, as well as collagen in the areas treated. Based on the clinically proven controlled injury theory wherein collagen production occurs at accelerated rates post trauma, neocollagenesis begins. Unlike conventional methods that use dermal fillers to “fill” a crease or fold, ArqueDerma uses dermal fillers as an adhesive agent to sustain the lifted tissue back in place until new collagen forms (neocollagenesis). This newly formed collagen stabilizes the effects, resulting in the correction lasting longer than conventional methods. Because collagen production continues for many months as part of the healing process, results will continue to improve over time. This increased collagen stimulation, coupled with improved duration of dermal fillers, result in longer-lasting results (18-24 months on average). To learn more about the technique please visit



We summarise a chapter from a new book by Eric Finzi entitled The Face of Emotion: How Botox Affects Our Mood and Relationships


he world is a looking-glass, and gives back to every man the reflection of his own face. Frown at it, and it will in turn look sourly upon you; laugh at it and with it, and it is a jolly kind companion; and so let all young persons take their choice. —William Makepeace Thackeray

Why do we frown? At first glance, this may seem like an easy question to answer, but as soon as you study frowning in depth, you realize just how complex it can be. First, we frown for many different reasons. Most of the time we frown when we are communicating our emotions to others. We frown when we’re worried, we’re concerned, and we don’t know what to do. But we also frown when we are frustrated or just struggling to understand something. And we clearly frown when we are angry or sad. Second, there are different types of frowns depending on what other muscles in our faces are activated at the same time. The meaning of your frown depends, in part, on how the other facial muscles are recruited to form a facial expression. If the inner part of your eyebrows point upward while frowning, you look sad; if they are drawn together and down while frowning, you look angry. And all of this activity happens so seamlessly, without a hiccup, day after day. Just as your voice carries your emotions as you speak, your facial muscles cooperate to give others an idea of your emotions and feelings.

The frown is naturally like a good director, controlling the movement of lighting and scenery, marking transitions, changing mood and feeling, giving tempo to our conversations

The intensity of facial expressions usually correlates with the intensity of the emotion felt. If you are in a rage, your brow will most likely be tightly contracted—if you are only annoyed, a fleeting and subtle frown may pass over your brow. The frown is an amazingly versatile and subtle form of expression.

The frown is naturally like a good director, controlling the movement of lighting and scenery, marking transitions, changing mood and feeling, giving tempo to our conversations. All of this activity that is happening around our eyebrows is not recognized in a conscious way. Most of it happens so quickly (in seconds) and so fleetingly that we do not remember it. However, in spite of the unconscious and involuntary nature of these emotional signals, our brains are taking it all in, assessing the meaning of the facial expressions of others, and responding in turn with our own facial expressions. Charles Darwin was the first to note that the frown starts early in infancy. Observing his own children, he was able to deduce that a frown came over his child’s brow whenever anything difficult presented itself. He described how, with his own infant, “little frowns . . . may be seen incessantly passing like shadows over its face” when something displeasing happened to him. Darwin noted how his eight-week-old could easily express his annoyance at being fed not straight from the breast, but with cold milk. Clearly, at an early stage in human life, we acquire the ability to frown, suggesting how important this expression must be for our survival. Long before his baby cried, a little frown alerted the caregiver that babies prefer warm milk.


We all instinctively recognise the different ways in which people can express emotion. Body posture and movement are important and the human voice, with its dramatic range of timbre and tonality, can project the ebullience of joy as easily as the depths of despair. It is easier to hide the emotions carried by your voice or body posture but it is much harder for most of us to hide our emotions from our faces. It all happens so quickly—different emotions display themselves on our faces in a second or less—before we are aware of what our faces are doing. Unless you have a lot of training, it will be difficult for you to hide the feelings that your face shows to others. The face thus assumes greater importance in your emotional interactions with others. In addition, the face, with its complex and dynamic interwoven muscle skin layer, can convey a more complex range of our emotions than either the contortion of our bodies or the sound of our voices. The main muscle involved in the facial expressions of sadness and anger is called the corrugator supercilii. The two Latin words that make up the name literally mean “the wrinkler above the eye.” The corrugator muscle, the frown muscle, helps draw the eyebrows together to create a frown. Frowning is a facial expression that usually represents negative emotional feelings. If our smiles tell others that all is good, our frowns do the reverse. With fear, the entire brow is lifted, and the brows are often drawn together. In the frown of sadness, the inside corners of the brow are tilted up, and the upper eyelids are arched up. Each of these frowns carries a distinct meaning, and the intensity of the frown alerts us to the intensity of the emotion. The frown muscle is not the only facial muscle activated in the expression of

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sadness, fear, or anger. For example, in anger the eyelids are tensed and the teeth may be bared. In sadness, the lower eyelid may be raised while the corners of the mouth are drawn down. But just as the smile muscle helps pull the corners of our mouths up and out, and is most associated with smiling and happiness, so the muscle in the eyebrow remains the strongest means of expressing anger or sadness. These two muscles—the frown and smile muscles—represent the yin and yang of facial expressions.The tension and position of frown versus smile groups will help show others what you are feeling inside. That is common sense to most of us. But the relative contractions of each muscle will not only tell others your emotional state—they will inform you, the wearer of the expression, what you are feeling. And not only do these muscles silently speak to you—they help to create the state of your conscious mind. We shall see many examples of how the face you make influences your decisions and preferences. Your face helps you to both optimally sense and express your emotions, and the balance between the activity of these two muscles helps determine how you feel about the world outside and inside of you. From The Face of Emotion by Eric Finzi, MD. Copyright © 2013 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.


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Q& A We speak to Dr Linda Eve MBBS, MD of Evenlines Clinic, Bournemouth, about her experience using Sculptra® Cosmetic News: How long have you been using Sculptra®? Dr Linda Eve: I have been using Sculptra® for seven years and have carried out approximately 1,200 individual treatments. CN: What is the difference between Sculptra® and dermal fillers?

CN: What are the contraindications? LE: The contraindications to Sculptra® are similar to dermal fillers with caution in patients with a history of auto-immune disease, anaphylaxis, keloid scarring or active skin disease. CN: How does the product work?

LE: Sculptra® (poly L lactic acid) ( Left) 57 yr old lady before (Right) 57 yr old lady 10 months after five is a unique product that stimulates Sculptra® vials (plus Botox®, lip augmentation and peri-oral dermal fillers) the fibroblasts in the dermis to create new collagen cells. A course Injections are placed in the deep CN: What other treatments of treatments is normally required dermis or subcutaneous area in does it work well in over a two to three month period order to stimulate the fibroblasts combination with? using a total of two to seven vials. and injections must not be injected LE: I use Sculptra® as my main The number of vials used depends volume replacement treatment on whether just the cheeks are being superficially. I have, over the last 18 months, successfully developed in my clinic but I do combine it treated or the whole face. the use of cannulas with Sculptra® with dermal fillers for peri-oral lip CN: What kind of results can be instead of needles as this has lines and lip augmentation, plus achieved and how long does it allowed me to safely treat a much Botox treatments if they are also take for patients to see a result? wider area of the face. Although required. I also encourage all my CN: What are the indications the cannula technique is more LE: Results are consistently Sculptra® patients to consider for treatment and who are the demanding I consider it a safer excellent with tremendous patient skin conditioning treatments such ideal candidates? technique, which also has huge satisfaction. The gradual growth as micro-dermabrasion, peels, LE: Sculptra® is the ideal benefits to the patients. It rarely of collagen gives optimum results Dermaroller and topical application treatment for using in patients who causes any bruising or swelling and after 10 months following the last of maybe Obagi Nu-derm, antirequire general volume increase allows the patient to return to work set of injections but with early oxidants and Tretinoin creams in in the face such as in the temple, or normal non-strenuous activities changes showing at around three order to improve their overall skin cheeks, lower face and chin areas. immediately. months. The effects of Sculptra® tone. It is not advisable to use it in last on average around two years CN: What do you like about or above the lips nor across the CN: What advice would you when a smaller re-stimulation this treatment? forehead. give to anyone thinking of treatment is required to maintain LE: I consider that Sculptra® adding the treatment to their Sculptra® is suitable for any the collagen lift. If no further is the only product currently clinic menu? patient who has suffered volume treatments are given then the available that can give the most loss from as young as mid 20s LE: If you are considering results achieved will be lost by natural rejuvenation in lift and to even the over 80s. I have incorporating Sculptra® into about three years. volume to the face. It is not a successfully treated a wide age your clinic I would advise an CN: How technique dependent product for chasing lines but an range of patients and achieved official training course with an are results with Sculptra® amazing product that re-grows the expert injector. They will be able excellent results even in the patients own skin with long lasting to teach, guide and support you elderly. It is particularly useful for and what technique(s) do you recommend for injecting? and extremely satisfying results. treating patients with thin skin with the various techniques used My Sculptra® patients stay with and volume loss where a surgical LE: The techniques used to inject and help you gain the best results me for years to ensure that their face-lift could leave them looking Sculptra® have changed over the possible with your patients. gaunt and dermal fillers might years and also between practitioners repeat treatments are carried out Once you have mastered the end up being visible. In these who will find their favourite method, by myself. It is not a treatment that techniques of Sculptra® and seen patients ‘shop around’ for because difficult patients the Sculptra® each of which will give good the results for yourself in your once they see the results they will will give back soft volume and lift results. The Sculptra® is mixed own patients you will wonder how always trust you with their future to the face, which will look very with sterile water and lidocaine 2% you ever managed to run a clinic treatments. natural. several days prior to treatment. without it! 34 LE: Sculptra® is entirely different to dermal fillers. It is a long lasting collagen stimulator called poly L-lactic acid (PLLA) first used in the NHS in 2004 for repairing severe distressing facial lipoatrophy often suffered by HIV patients. Since then it has also been very successfully used in the private cosmetic sector for treating all ages of patients with facial volume loss.

Actual Sculptra Patient ®




THE EFFECTIVE COLLAGEN STIMULATOR For a gradual and natural deep tissue regeneration lasting over 2 years*


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*Clinical trial ended at 25 months. Narins et al. JAAD. March 2010. SPC available on request

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Lorna Jackson on the ‘nitty gritty’ of medical micro-needling dermal rollers and whether you know what you are you really buying?

Lorna Jackson Lorna has been Editor of The Consulting Room™, the UK’s largest aesthetic information website, for a decade. She has become an industry commentator on a number of different areas related to the aesthetic industry, collating and evaluating statistics and writing feature articles, blogs, newsletters and reports for The Consulting Room™ and various consumer and trade publications, including Aesthetic Medicine, Cosmetic News and Aesthetic Dentistry Today.

As more and more clinicians are embarking on offering skin needling to their clients, both in-clinic and at-home, so a myriad of devices has been launched to the UK marketplace. So what we really need to know, is the ‘nitty gritty’ of the difference between the devices, how are they made, what’s good, what’s bad and what do you, as an aesthetic practitioner need to consider when buying rollers to use on your patients.

Design, Manufacture & Quality This is the foundation of a micro-needling device, like anything you buy, a poorly designed and made product, using cheap materials will both not do the intended ‘job’ to the levels that you might expect, but in the worst case scenario could cause harm. Whilst there is no specific definition of a micro-needle, they are generally fine needles with a shaft diameter of between 0.1mm and 0.25mm. Properly designed micro-needling devices require medical engineering, from the materials used to the number of needles created. There are currently two main methods of manufacture; grinding and stamping. Despite their application, micro- needles should in-fact be atraumatic, so a fully validated grinding and construction process is preferred over either a stamping or cutting production in the best quality rollers. Unfortunately we are unable to ascertain the exact needle processes used by each of the individual brands sold to the UK market, however generally it is thought that most needles produced globally are done so by mechanical pressing or stamping, with only a few key brands adopting the grinding method. Grinding of the needles normally requires the stainless steel to go through a tempering/hardening process to enable each needle to be ground to an incredibly fine point, about 2-3μm tip radius, in order to conserve tissue and minimise “tearing” or ripping of the tissue as they enter and leave it when the device is rolled over the skin. Needles used in the needle disk system (such as in the DTS/GENOSYS roller) are stamped from metal sheets approximately 0.16-0.25mm thick. Essentially these are not needles but better described as spikes like those on a cog. The manufacturer makes the claim that the tip of the spike has a “mosquito” diamond shape that enhances penetration but a counter argument is that the fact


that they are stamped and do not go through a secondary hardening and sharpening process means that the points are not considered to be sharp, plus they are also felt to be too close together. This combined with the number of needles (more information on this below), means that their action on the skin is more traumatic as too much pressure is required in application, rather than the less traumatic performance of a ground micro-needle produced system. Testing of needle disk systems by Dermaroller GmbH shows that the metal is softer and bends more easily than the steel used for grinding. Pangaea Laboratories also noted that there have been no trials using this system and that they have concerns over the safety of this device. The needle lengths range from 0.8 to 3.0mm. The cutting edges of such needles can measure 0.16mm plus. This is 50 times wider than the 0.003mm tip radius of a ground, precision micro-needle as illustrated in this image. In many of the imported devices from the Far East, the finish tends to be quite rough and so the needles are often coated or plated and/or polished. This gives a smoother, shinier finish but will give a blunting effect to the needles. There is also uncertainty about the materials used, which can include copper and nickel, which is used to avoid corrosion. Most needles used in the wide range of generic rollers produced in China and India are more like industrial pins than needles. See example images below, for typical examples of rollers manufactured in China and India, which clearly show irregularities in the needle shafts. Below: (left) Image of a disk from a Disk Needle Therapy System (DTS roller); (right) Stamped versus ground needle

Above: A brand from India called DERMAL ROLLER.

Number of needles Contrary to popular belief, having a greater number of needles in a medical skin roller is not beneficial. Having more needles actually requires a greater force to be applied to penetrate the skin; meaning the procedure will be more painful and/or proper needle penetration will be difficult to achieve. It also means that there are a greater number of needles trying to enter and exit the skin at any one time which increases the risk of tearing or shearing of the skin tissues. The main dermaroller brands available on the market do display a variety of different needle configurations but popular layouts include 192 needles, those manufactured from disks tend to have more. It is also critical that every needle is the same length; a lack of uniformity in the length of the needles could lead to an inconsistency in the penetration and a reduction in the efficacy of the treatment. Assessment of a variety of rollers by Dermaroller GmbH has shown that needle length is not always consistent.

Angle of needles The optimum angle to have between each needle on a micro-needling device is between 15 and 20 degrees (for example, the Genuine Dermaroller™ brand has an angle of 20 degrees and the DTS/ GENOSYS device declares an angle of six degrees on their website). At the optimum angle range, minimum penetration force is required as only one needle will be entering the skin at any one time, as shown in the image below.

The picture on the left hand side is a visual representation of a roller with a larger number of needles and consequently with a lower angle of separation between the needles. This angle will require greater force to be applied in order to get all of the needles into the skin. So essentially the greater the angle between the needles and the fewer there are (within reason) the better, as this requires the least pressure to apply treatment and will minimise any potential excessive trauma to the skin.

Materials, construction and quality control All skin needling devices have similar components; a plastic roller and micro-needles, which depending on the method of manufacture are either glued in place or embedded directly into the plastic roller. The preferred solution would be the embedded option as this method is believed to be more secure, in that there

is less chance of the needles becoming loose. Rollers manufactured using the needle disk system separate each of the stamped metal disks with a small disk of plastic.High quality stainless steel is the appropriate material for micro-medical skin needles – alloying elements of chromium, nickel, molybdenum and titanium. The chromium enables the metal to maintain its scratch and corrosion resistant surface and the molybdenum and titanium increases the hardness of the metal and helps to maintain a cutting edge. Chromium and nickel are the primary alloys in the majority of corrosion and heat resistant stainless steels. The nickel is required to stabilise the structure and add to the material’s strength, it is effectively locked in to the structure of the metal so that in most stainless steels there is virtually no risk of nickel allergy. (Care does need to be taken if a needle is “coated” and assurance that this does not contain nickel should be sought.) The molybdenum adds to the hardness primarily as it increases it’s durability under high temperatures which are often required in the tempering/ hardening process. When titanium is used as an alloying agent it is typically less than 1% (0.25 - 0.6%) and enhances the effect of the chromium and therefore corrosion resistance of the stainless steel. This type of steel is ideal for medical instruments as it is strong, easy to sterilise and is resistant to corrosion. In terms of marketing claims, be aware that there is no such thing, from a legal standpoint, as ‘medical grade stainless steel’. Various stainless steel ‘recipes’ have been created and have been used in medical equipment for many years, thus proving their long term safety, but there is no singular steel alloy claimed as medical grade. Any new proprietary formulas must satisfy various standards authorities before being granted a clearance for use in medical applications. The steel needs to go through a strengthening and tempering process to provide the strength needed to enable them to be ground and processed to the required sharpness. This also means that they stay sharp and are not compromised during the procedure. Titanium is stronger than some steels and approximately 45% lighter. Due to its biocompatible nature it is used in a range of surgical tools and surgical implants. Often mixed or alloyed with other metals, these alloys are very strong and tough even at high temperatures. The high cost of the raw materials and their processing make them prohibitive for many applications and industries and also increases the brittle nature of this metal if too much is used. Traders from China often claim that their devices are made from titanium. There is no evidence to prove this and it would seem highly unlikely as the material cost would be far too expensive and very difficult to tool due to breakages. Some products do contain a small percentage of titanium as part of the stainless steel alloy however, but levels do vary. The plastic roller or barrel are made from a number of differing plastics such as ABS and MABS plastic or resin, with the cheaper Chinese or Indian imported rollers using inferior plastic compounds. Many of the higher quality brands use Lexan®. Lexan is the brand name for polycarbonate sheet and resin in a wide range of grades. Lexan is mainly used in things like space and sports helmets, clear high-performance windshields and aircraft canopies, motor vehicle headlight lenses, and bullet-resistant windows! The

Lexan grade of plastic allows for irradiation and other forms of sterilisation without degrading or discolouration so is favoured by leading brands. MABS is widely used in medical and diagnostic products and is also capable of sterilisation by irradiation

Sterility The credibility of claims regarding sterility also needs considering and it is wise to understand and be clear about the difference between cleaning, disinfecting and sterilising. A sterile product is one that is free of viable microorganisms, including spores. The level/dose of the particular process used must be sufficient to eradicate all viable microorganisms and render the item sterile. This should be a validated process in which the known starting bio-burden has been rigorously tested at the process level/dose. The dose would need to also have been tested in the packaging and the format in which it is processed; this is normally done through dose mapping. The packaging seal/closure system around the device also needs to have been tested and validated, as should the claimed shelf life. Once validated, the starting bio-burden, the required dosing throughout the process and the packing configuration should be tested and approved for each batch/lot of production. There are four main methods of sterilisation; irradiation, heat, gas and chemical. The responsible way to perform these treatments, if the roller cannot be re-cleaned by a validated procedure such as cold sterilisation or autoclaving which would mean that the same roller could be reused on the same patient, is in a clinical setting with a sterile, single use medical device by a suitably qualified, experienced and trained practitioner. Home use rollers cause other issues with hygiene as many come with an often untested, proprietary sanitising solution, or offer no solution and suggest consumers use baby sterilising solution. The problem with the latter is that the roller has not been tested with baby sterilising products to ensure either proper cleaning or compatibility. It is widely known that baby bottle sterilising solutions use chemicals which are highly corrosive to metals while being gentle on the plastic of the typical baby bottle. It should be noted that home use roller should be specifically designed for that use and not penetrate beyond the epidermis and thus make contact with dermal tissue or blood supply, needles that are longer than 0.2-0.3mm will do this. Devices that are sold for home use greater than this length and make claims for re-sterilisation at home should be avoided.

Medical device classification and general product safety According to the European Union Medical Devices Directive; ‘medical device’ means any instrument, apparatus, appliance, software, material or other article, whether used alone or in combination, including the software intended by its manufacturer to be used specifically for diagnostic and/or therapeutic purposes and necessary for its proper application, intended by the manufacturer to be used for human beings for the purpose of:

1. Diagnosis, prevention, monitoring, treatment or alleviation of disease


SKIN NEEDLING 2. D  iagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap 3. Investigation, replacement or modification of the anatomy or of a physiological process 4. C  ontrol of contraception and which does not achieve its principal intended action in or on the human body by pharmacological, immunological or metabolic means, but which may be assisted in its function by such means. Medical devices are regulated under the provisions of a number of EU directives, covering different categories of medical device. The 4 categories are: 1. Class I = a plaster, a pair of glasses 2. Class IIa = disposable contact lenses, syringes, micro-needling devices 3. Class IIb = dermal fillers, gastric bands, lasers 4. Class III = breast implants, hip joints A manufacturer of Class I devices can self certify their compliance to the EU directives. All other classes of device need assessment by an independent third-party organisation known as a notified body. A notified body is a private company regulated by the member states competent authority, in the UK the competent authority is the MHRA. With the CE marking on a product, the manufacturer declares that the product conforms to the essential requirements of the applicable EU directives. When certified by a notified body, the notified body’s number will be displayed alongside the CE mark. Medical devices have to comply with ‘essential requirements’. They must be safe and must function in a medical-technical way as described in the manufacturer’s ‘intended purpose’. CE marking is a validated process that documents how a product is manufactured. It also provides batch/lot traceability and ensures consistency across a batch. Having a CE mark should mean that the process of sterilisation and manufacture has been validated by the notified body. Whilst CE marking is a good starting point when looking for a medical device it is neither a definitive solution nor a guarantee of quality. CE marking should assure sterility of the device and consistency through the manufacturing process but it unfortunately does not necessarily determine how good or effective a device or the method of manufacture is. The CE mark is designed to give consumers the absolute assurance of medical quality. Ironically, while the principal of one standard for all of Europe is signified by the CE mark, there is regrettably a variance in standards of the various notified bodies. Some are more lax than others. We have seen recently, failures in the monitoring and surveillance by the notified body and competent authorities with the PIP breast implant scandal. Unlike with medicines, notified bodies or certifying bodies are one step removed from the competent authority in a given country. The MHRA conducts periodic audits of notified bodies; it does not conduct its own assessment of data on safety and effectiveness of devices. Experience has shown that the MHRA essentially takes the position that it has no jurisdiction or control over 38

devices used for ‘cosmetic indications’. This would not be the case for a medicine, which would be classified as such by its ingredients, mode of action and safety and raises questions over how well the supply of devices into the aesthetics industry is policed and how the reliability of suppliers can be guaranteed. If we return to the specifics of skin needling, the MHRA have made it clear they have no interest or jurisdiction if the device is used for ‘cosmetic indications’ regardless of the fact that it is attempting to achieve a physiological and anatomical change to the human body and is thus deemed by many to be ‘medical’. Currently any person can perform a procedure and any device, which does not make a medical claim, can be sold outside of any medical regulatory control. Thus this then falls under General Product Safety Regulations 2005, which requires that a producer does not place a product on the market, supply a product or offer or agree to do so for another entity unless the product is a safe product. This level of general regulation is much harder to police and validate. If we look at the procedure, in-clinic needling requires; surface anaesthesia using a pharmaceutical product, multiple needle penetrations into the dermis, clinical end points including pin point bleeding, a pre-treatment consultation regarding patient suitability and contra-indications and potential management of complications. The treatment goal is collagen stimulation and regeneration, angiogenesis and extra-cellular matrix regeneration. Surely a responsible position is that these activities should be carried out in a clinical setting with a medical device and by a suitably qualified, experienced and trained practitioner. We do however have to remember CE marking is only a starting point and is open to, on occasion, fraudulent or misleading claims. For those that do not carry legitimate CE mark medical device classification there is virtually no policing of claims made by manufacturers. Broad technical and methodological claims can be made without verification. General Product Safety regulation falls under the remit of local authorities and Trading Standards, many argue that it is very questionable as to whether they are appropriate bodies to investigate or monitor these issues. Examples to justify this point of view would be claims regarding the materials of manufacture, the sterility, the methods of use, e.g., which needle lengths are appropriate for home use/professional use, re-use (with or without validated cleaning and sterilisation processes and proof of product quality maintenance), who can use them, as well as the management of potential adverse events and complications. It’s easy to see that this could well be a task too far for Trading Standards. Interestingly, as a comparison, according to the Canadian equivalent of our MHRA regulator, Health Canada, dermal rollers make health claims about what their products do, so that places them in the same class as a medical device requiring a license. They do not consider them to be cosmetic. Thus, a roller without a license from them cannot legally be sold.

The UK market provides a broad range of products to the aesthetic clinician, all with varying degrees of unique claims and presentation. Trusted brands who can demonstrate quality and safety to you when asked and who provide appropriate and adequate levels of training and support should always be favoured over those with vague or unsubstantiated claims. I would urge all aesthetic practitioners to steer clear of cheap Far Eastern imports if you want to keep both your clients and your reputation. To read the full version of this article, including a detailed summary of the main skin roller brands currently available in the UK, as well as new launches for 2013, please register for full membership with The Consulting Room by visiting Use referral code CNUK2013 for one month’s free membership (new members only, valid until 1st March 2013).

Needling devices


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• Unique medigrade Retinol anti-ageing formula • Clinically significant skin improvement after 4 weeks daily use1 • Two strength step-up programme; straight forward to start and easy to continue Ref 1: Gold et al. Data on file (White paper available on request)





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Geraldine Flynn on using micropgimentation for alopecia patients Semi-permanent make-up, also known as micropigmentation, is an advanced technique that should enhance the natural beauty and give the features shape and definition as opposed to giving you a dramatic, false “scouse brow” or artificial looking lips as often seen in the media. It involves implanting hypoallergenic coloured pigments into the upper reticular part of the dermal layer of the skin. The procedure is completely safe and effective and used for a variety of semi permanent cosmetic enhancements including eyebrows, eyeliner and lip liners. The procedure is completed in two steps four to eight weeks apart after an initial patch test. The colour remains visible for several years, however in order to keep the look fresh and natural, a colour retouch is advisable every 12-18 months. Semi-permanent make-up is a fabulous treatment for all for enhancing facial features but more so for ladies suffering from alopecia. After several years in the semi permanent make-up industry I have treated numerous ladies suffering from different strains of alopecia. Living with hair loss can be hard especially if you lose your brows and or lashes, it takes away from your features and you can feel you have a vacant look. Alopecia is an autoimmune disorder. It has been estimated that approximately two million people have some form of alopecia. The disease attacks the hair follicles. The cause is not known. Scientists believe that a person’s genes may play a role. For people whose genes put them at risk for the disease, some type of trigger starts the attack on the

hair follicles. The triggers may be a virus or something in the person’s environment. In some cases, hair loss may be due to a vitamin A overdose, iron deficiency anaemia, a malfunctioning thyroid gland, fever, or pregnancy. I have noticed it is usually after the first pregnancy as opposed to during pregnancy or in later pregnancies that it seems to be more common.There is a slightly increased risk of having the disease if you have a close family member with the disease therefore it can be considered hereditary. Other factors that cause hair loss can include allergies, irritants, toxins, burns, injuries, and infections. We also know that certain medications (especially anabolic steroids), chronic kidney failure, radiation, and chemotherapy can cause hair to fall out. It is safe to have semi permanent make-up whilst battling cancer

“Semi-permanent make-up is a fabulous treatment for all for enhancing facial features but more so for ladies suffering from alopecia... Living with hair loss can be hard especially if you lose your brows and or lashes” 41

“It is safe to have semi permanent makeup whilst battling cancer once your oncology nurse states your blood count is high enough. The difference this can make to a client in easing the loss of their hair is invaluable.” growth areas in the beauty industry recently but it is an established treatment which is both safe and medically approved, when carried out by our experienced and competent technicians. Permanent make-up dates back at least to the start of the 20th century, though its nature was often concealed in its early days. The tattooist George Burchett, a major developer of the technique when it become fashionable in the 1930s, described in his memoirs how beauty salons tattooed many women without their knowledge, offering it as a “complexion treatment ... of injecting vegetable dyes under the top layer of the skin. Facial tattooing has been practised for centuries in many cultures, particularly in Asia. The indigenous people of Japan traditionally had facial tattoos. More commonly seen today in Taiwan, North Africa, Northern Nigeria, the Kurdish people in East-Turkey, and the Maori of New Zealand .

I use only Finishing Touches EU certified approved products supplied directly from them which have been rigorously tested and have individual lot numbers, expiry date and guaranteed sterile needles. Precision plus technology digital machine is the most up to date state of the art technology. Using a sterile cartridge system for better implantation with less discomfort and more accurate results. With a penetration range of 50-150 insertions per second this system allows steady comfortable treatments whilst causing minimal trauma to the skin.


Treating my alopecia clients has been so very rewarding and I look forward to continuing to highlight this superb treatment.

After some research I chose to train with Finishing Touches who are the most respected in the industry and who provide ongoing training and support.

References: Industry Profile Study: Vision 2009


“I have suffered from full alopecia for the last 7-8 years and as anyone with this will know it is a very hard thing to deal with. When it happened to me I completely lost all confidence in myself but through great wigs I managed to scrape a small piece of this back but I was always very aware of how strange I looked without eyebrows!. I had considered semi-permanent make up for many years but was always afraid and put off by the many horror stories that your hear about. It was only this year that I plucked up the courage to ring Geraldine and my only regret is that I didn’t do it sooner, she was amazing from start to finish and after meeting her for the first time within a few minutes I had complete confidence that she was going to make me look and feel wonderful again. I have now had both sessions done and I am completely overwhelmed with how well they look and how it has given me all my confidence back in such a short space of time. I cannot


Many technicians may not be registered with their local city council, anyone offering semi-permanent skin colouring, and the premises they work from, must be registered with their local council under the Local Government (Miscellaneous Provisions) Order 1985.

thank Geraldine enough for how much she has helped me and I would very highly recommend her to anyone.” C Philips, September 2010 “Having just had my eyebrows done by Geraldine I now want to encourage anyone thinking about this procedure to go for it.  I cannot stress enough the difference it has made to my life. I am much more confident and no longer shy away from eye contact with others. The difference eyebrows make to your face really is amazing!!  Geraldine did a fantastic job, she knew exactly what shape and colour would suit my face and I trusted her completely. From start to finish I felt totally at ease.  Geraldine’s professional, caring approach was much appreciated and at no time did I feel embarrassed or self conscious.  My only regret is that I didn’t do it years ago...the painless, procedure was worth every penny.  Thanks Geraldine.”   H Wright, October 2010

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temple medical aesthetics I became interested in Alizonne when I was considering what next to add to our treatment repertoire. Having made the decision to take on Alizonne I do not think I would have ever managed if it had not been for the constant support, advice and guidance that I came to rely upon from Alizonne UK. Alizonne is certainly not an add on, it has become a major part of our core business. An added benefit from providing Alizonne treatment is that the majority of clients learn about the other facilities and treatments available from the clinic when they have lost weight and started to enjoy their appearance. They are then more inclined to consider aesthetic treatments and clearly, having developed a trusting relationship with us, do not look elsewhere for these treatments!

I became aware of Alizonne when a long time friend and client underwent the therapy and lost over 7 stone in just 20 weeks. He was so impressed he decided he wanted to open his own clinic and asked me to help him put a business plan together. Alizonne UK, were fantastic. They took us behind the scenes, provided in depth financial information, shared marketing ideas, materials and costs and gave our clinic the flying start dreams are made of. The clinic has been open nearly eighteen months and turnover has grown consistently month on month. We currently have over 100 clients on our books and continue to receive the full and active support of Alizonne UK .

Having seen the incredible results our Alizonne patients were achieving I couldnâ&#x20AC;&#x2122;t help but be impressed. Patient feedback is incredible as many receive results they could not have dreamed of. We believed that weight loss and body contouring would be one of the largest growth sectors in our industry and we couldnâ&#x20AC;&#x2122;t see any other weight loss products with either the same results or medical supervision. We have now expanded to 6 Alizonne clinics including 2 recent additions in Watford & Bournemouth where we have great hopes for 2013. The treatments fit nicely along with our other therapist business and have allowed us to extend our opening hours and benefit our cosmetic business as well. From my experience Alizonne not only changes your patients' lives but your clinic's finances as well!

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Chris Matthews Managing Director. Silverlink Clinics

Paul Wilkinson. CEO. Courthouse Clinics

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We find out how the latest launch from 3D-Lipo, 3D-Skintech, is offering clinics four cutting edge technologies in one piece of equipment Combination treatments, targeting multiple concerns simultaneously have become part and parcel of everyday modern aesthetic practice. The onesize-fits all approach no longer exists thanks to the plethora of products, treatments and technologies on the market. However, while the value of combining different treatment modalities to achieve the best outcome for your patients/clients is well established, the cost of incorporating a broad range of treatments into your clinic can be significant, especially where equipment is involved.

of concerns. Another factor that will appeal to both clinics and their patients is how time-effective as well as cost-effective the treatment is. A typical treatment using 3D-Skintech would last around an hour: 15 minutes each of microdermabrasion followed by mesotherapy, radiofrequency and then LED light therapy, far quicker than if you did each of these individual treatments separately. Despite the fact that 3D-Skintech combines four technologies in one, Cowley is keen to stress that the efficacy of each individual technology has not been compromised and is of the highest standard available on the market, in its own right. He says: “We haven’t just stuck in a bonus handful of LED lights. Each application is as good as or better than what’s available on the

In hard economic times the business savvy clinic

market as a separate unit.”

needs to think about how it can offer best value to

The technology is also being launched in line with

its clients, without compromising on results and

a range of medical-grade peels and cosmeceutical


without breaking the bank. Step up a new wave of

skincare products, designed to compliment the

The Focus Fractional RF energy penetrates

multi-technology machines, which offer a range of

procedure or to be used as stand alone in clinic or at

the skin layers to selectively heat the skin

different treatments in one piece of equipment giving

home regimes.

tissue and the extra cellular matrix where the

you the ability to not only tailor your treatments to


collagen fibres are embedded. The local heating causes

each individual client’s needs and concerns, but also

Products include the Moisturising Sun Shield, which

an immediate contraction of collagen fibres, and at the

allowing you to offer more than one cutting edge

hydrates the skin while fighting free radicals and offering

same time increases the metabolism of the fibroblasts

technology with only one capital outlay.

SPF 30+ protection; Time Defense Cream which fights environmental and stress-related ageing factors and a

thereby accelerating the production of new collagen and elastin fibres. The concentration of collagen fibres and the

The latest of this new breed of machine is

collection of cleansers and toners. There is also a line of

regeneration of the collagen and elastin deposits, tighten

3D-Skintech from the same company that brought

AHA and BHA peels offering lightening, skin clearing and

the skin layers creating a smoother, healthier and younger

you 3D-Lipo. The sleek, modern and ergonomically

anti-ageing properties.

looking skin.

designed multi-functional aesthetic device was developed specifically for the face. It has four

This means that you can offer a comprehensive and prescriptive approach to your client’s needs covering;

No needle Mesotherapy

individual treatments incorporated in one piece of

Hailed as the next generation following dermal

kit, including microdermabrasion, messotherapy,

rollers electro mesotherapy breaks down the cell

radio-frequency and LED and can address a wide

wall to enable ingredients to be delivered into the

range of common aesthetic concerns from anti-

• Preventative approach (cosmeceutical skincare with

ageing and pigmentation to acne.

actives for the effective treatment of acne/pigmentation

The product has been under development for the

and anti-ageing)

cell where they are needed most.

Full canopy LED

last 12 months and 3D-Lipo managing director Roy

Full canopy LED ensures rapid and effective

Cowley has been closely watching the trends in

• Preventative curative approach (peels combined with

treatment unlike a few LED lights on a handset,

the market during that time so that the machine’s

cosmeceutical skincare to intensify the treatments

which cannot deliver an effective outcome. Each

capabilities mirrors demand from consumers and


colour has a specific weight, temperature, wavelength,

practitioners alike. • Curative approach (combines multiple technologies

density and energy level to stimulate or minimize various metabolic functions. The different colours give off different

The rotational diamond peel microdermabrasion

to accelerate the effects on anti-ageing, acne and

frequencies, which have varied effects on physical and

function of the machine is designed to bring greater


psychological functions.

comfort and results to peeling, while tri-polar radio-

Rotational Diamond Peel Microdermabrasion

frequency technology means skin can be tightened

• Curative + approach (the ultimate result driven

with lower energy, so less discomfort, than mono- or

approach which combines multiple technologies in

bi-polar devices.

conjunction with the relevant peels and skincare)

This latest technology combines the latest Mesotherapy removes the need for needles when

It is this mulit-factorial approach that makes this

vacuum to ensure a precise yet comfortable service without

delivering active ingredients deep into the skin, and

piece of equipment such excellent value for money

the downtime issues commonly associated with crystal

full-canopy LED technology, with red, blue, yellow and

and when times are tough economics are equally as


green wavelengths, can be tailored to treat a range

important as results.

in adjustable, rotational control with variable


A New Dimension in Non-Surgical Technology

see us at

cosmetic news the uk’s largest trade aesthetics exhibition and conference

e xpo

exhibition and conference

1 6 th a n d 1 7 th february

stand 75

A revolution in the non-surgical aesthetic skincare market... is set to create a revolution in the nonsurgical Aesthetic skincare market. Following the success of the award winning 3D-lipo which combines technologies for the effective treatment of fat, cellulite and skin-tightening we are set to launch a phenomenal new multi-functional device for the face. Here are just some of the reasons why 3D-skintech will become the brand of choice in 2013 • Complete treatment portfolio for anti-ageing, pigmentation and acne • 4 technologies ensure a prescriptive & total approach to your clients needs • Used in conjunction with medical peel and cosmeceutical skin care line • Unsurpassed results ensures maximum client loyalty • Highly profitable with a multitude of services to offer • Provides you with a competitive edge in your area • Affordable as package price is under £10,000 with a product starter pack worth £1,000 • Available on 3 Years interest FREE finance for the first 50 machines sold

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

Radio Frequency Tri-polar Radio Frequency is the most advanced technology available for skin-tightening ensuring excellent results without the discomfort associated with mono or bi – polar devices.

Mesotherapy Non-invasive mesotherapy ensures that the active ingredients are delivered where they are needed most without the need for needles.

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

3D-skintech peels and clinical skincare A compact range of medical grade peels and cosmeceutical skincare products complete the Skintech’s unique offering and enables you to both use as a “stand-alone” service or combine with equipment protocols.


For more information or a demonstration please call 01788 550 440


Stylage® now avaialbe with lidociane Stylage® is now available with lidocaine. Stylage® is the first product on the market which contains cross-linked HA (patented IPN-Like Technology), the anti-oxidant mannitol, which provides less swelling and extended longevity, and lidocaine for comfort and safety for both for patients and physicians. A clinical study conducted by French plastic surgeon Dr Bernard Mole confirmed that the effectiveness of the HA was not compromised by the addition of lidociane and that the performance and filling capacity or “volumising effect” of gels with Stylage® lidocaine are the same as those without. The study that was carried out on 84 patients with a clinical follow up over a period of six to eight months, concluded that the product does not bring about any increased risk of blood extravasation and affects neither the quality or the durability of the results (see pages 21-22).



Alma Lasers Receives FDA Clearance for Pixel RF

Carleton Medical launch QuadroStar

Alma Lasers, is pleased to announce the introduction of the new Pixel RF fractionated skin resurfacing module for its Accent family of products. Distributed in the UK by ABC Lasers, the Pixel RF uses proprietary InMotion Refractive Radio-frequency Micro Plasma™ Technology, which both ablates and heats the skin through controlled, focused delivery of energy without using disposables. Healthy skin around the treated area helps to accelerate the healing process thus improving results and reducing patient down time by allowing the need for just the targeted tissue to heal and collagen to strengthen. With its high-energy output, the Pixel RF can achieve in as little as one session what would require multiple sessions with other RF technologies. Not only is it highly effective to use on all skin types (Fitzpatrick I–VI) but treatments can be


administered year-round with no seasonal restrictions. The Pixel RF causes evaporation, mechanical damage and thermal damage deep beneath the epidermis surface providing significant dermal impact with minimal epidermal disruption.


Carleton Medical will be launching the latest offering from Asclepion, QuadroStar, to the UK aesthetics market next month. The system is the World’s first diode yellow light with a 577nm wavelength, which is the highest absorbency wavelength for oxy and deoxyhemoglobin, meaning it is ideal for vascular treatements. In addition to the 577nm wavelngth it also has 532nm, 940 or 980nm wavelengths. The small, compact and light table top device has an iPad interface and a choice of hand pieces as well as a built in scanner and skin cooling for easy handling without cables and there are no running costs. Applications include vascular lesions; pigmented lesions; laser assisted liposuction; endovascular treatments and surgery. It is due to be launched in March 2013.

Healthxchange introduce Obagi® Hydrate™ The latest product from skincare pioneers Obagi is now available form Healthxchange. Obagi® Hydrate™ is a new facial hydrator that features an innovative technology called Hydromanil which captures and assimilates water into the skin both immediately and lastingly due to an advanced multi-capillary process, creating a 2-in-1 response. Clinical results are instant and long-lasting hydration, which helps to enhance skin smoothness, while providing immediate and lasting effects on skin barrier function. In recent clinical trials, the test results reported a 51% improvement in water loss after eight hours and a 92% improvement in the skin’s hydration within two hours (OMP Inc, data on file).





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Uniquely Designed for Hand Rejuvenation For Full & Volumized Hands

exhibition and conference

Saturday 16 February 1.30pm - 2pm: Ellansé™ a Touch of Youth Advanced techniques Presented by Sharon King NIP th

Please come it us on Stand 85a. vis and ring Special offers available du the Conference.

1 6 th a n d 1 7 th february

stand 85a 47

CE Regulatory approved Copyright 2013 AQTIS Medical™ - W188.00




Clinogen Laboratories unveils new eye product

Clinogen Laboratories has unveiled its newest product, Ionic Cellular Repair Eye Crème. Based on naturally derived botanicals the product offers an effective programme to control the visible signs of ageing by improving lymph drainage; stimulating microcirculation; nourishing and strengthening delicate skin; increasing oxygen supply to the dermal and epidermal levels and revitalising the skin’s elasticity. The result is a visible reduction in puffiness and dark circles, and softening fine lines. It is the ideal homecare treatment to lift, smooth and hydrate the fine delicate skin around the eyes. Fine lines and wrinkles around the eyes will appear smoother and the skin brighter.


AQTIS Medical™ launches Ellansé™ Hands

AQTIS Medical™ UK has launched a new filler product designed specifically for hand rejuvenation. Ellansé™ is a polycaprolactone-based biostimulatory filler, which is available in four different longevity options (S, M, L and E), ranging from 12 months up to four years. Ellansé™ Hands has the same particle characteristics as the other products in the Ellansé range, however the viscoelastic characteristics of Ellansé™ Hands have been specifically designed for ease of injectability, moldability and optimal immediate results for this indication. The range supports safe and cost-effective aesthetic treatments through immediate and sustained performance, tunable longevity and total bioresorbability (STAT Technology™). Ellansé™ is a biostimulator, inducing a natural neocollagenesis response leading to longer-lasting volumisation. As all products have identical injection characteristics, physicians choose between the four products options based on the desired longevity. Ellansé™ Hands is available in two versions, Ellansé™ Hands S and Ellansé™ Hands M.

Mesoneddling roller arrives in UK Euromedical Systems Ltd. will be distributing the latest development from Filgora Laboratories, the Mesoneedling roller system, to the UK. The system has been engineered specifically to work in conjunction with Filorga’s mesotherapy products, NCTF 135 and NCTF 135 HA, allowing not only for an easy treatment from the practitioner’s perspective, but also providing much less intimidating alternative to traditional needle injected mesotherapy. Additional benefits include: reduced chair time for larger areas and an improved outcome (the micro punctures are proven to stimulate collagen production). The Mesoneedle is a true class IIB medical device.


Leading dermatologist joins forces with Concept Healthcare Consultant dermatologist Dr Russell Emerson has joined forces with Concept Healthcare to bring a potent anti-ageing duo - Prototype Anti-Wrinkle, Anti-Age Cream and Prototype Softgel Capsules - to the British market. Prototype Softgel Capsules contain resveratrol (which is clinically proven to have an anti-oxidant effect that is 17 times greater than Coenzyme Q) as well as vitamin C and B complex. The capsules provide anti-oxidant protection which is proven to enhance skin texture, reduce wrinkles, age spots and redness whilst supporting new collagen production. One capsule per day when used in combination with PROTOTYPE Anti-wrinkle Anti-age cream will achieve maximum effects.Prototype Anti-Wrinkle Anti-Age Cream combines hyaluronic acid, retinol, Q10 and vitamin E to provide short term rapid tightening of the skin, plus long-term strengthening of the skin’s connective tissue. The efficacy of the product range is backed up with evidence and extensive clinical data. Results can be seen in four to six weeks. 48

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CODE R E D We find out about the latest product launch from skincare pioneers SkinCeuticals – Redness Neutralizer

The colour red has many different connotations from love to danger but when it comes to the skin, redness is generally seen as a bad thing. There are many causes of skin redness or inflammation from environmental factors to foods, stress and medications. As pioneers in the field of cosmeceuticals, SkinCeuticals is always striving to develop and bring to market new, innovative products to target common skin concerns. Redness Neutralizer is its latest. Launched in January 2013, Redness Neutralizer is proven to help prevent and correct the onset of skin redness and flushing by up to 30% from patients suffering from any specific redness inflammation. This includes severe clinical conditions such as rosacea through to advanced aesthetic skin treatments. Redness Neutralizer is a superior cosmeceutical product with high levels of active ingredients. It works effectively on the skin to combat the associated signs and symptoms of skin redness, whilst also being suitable for the most sensitive of skin types. Redness Neutralizer works by helping to protect the skin against environmental triggers, which stimulate the sensory nerve endings, causing the onset of flushing, burning and discomfort for redness sufferers. These environmental aggressors can also impair the skin’s barrier function, leaving the skin feeling rough, tight and irritated and more susceptible to redness. The most common environmental trigger for the onset of redness and flushing is the weather, in particular UV exposure. Other specific triggers include alcohol, spicy foods and stress. Redness can also be prevalent following specific anti-ageing aesthetic treatments including medical needling, non-ablative lasers,

microdermabrasion and chemical peels. Prescription drugs for rosacea often address breakouts and pustules, but in doing so, can overly strip the skin’s barrier, without addressing the redness of the skin. SkinCeuticals subsequently developed Redness Neutralizer to specifically tackle the appearance of skin redness, whilst providing a comforting and soothing product for twice-daily use. Formulated with patent-pending NeuroMed Complex, an innovative combination of biomimetic peptides and natural actives, SkinCeuticals Redness Neutralizer helps to protect against the appearance of redness whilst helping to protect the skin’s barrier.

SUITABLE FOR SENSITIVE SKIN Redness Neutralizer offers a high performance formulation, suitable for sensitive skin types. It contains no alcohol, dyes, parabens or silicones; is formulated in a light texture that’s hydrating but without leaving an oily finish and is dispended in a pump to be sanitary. It is ideal as part of a sensitive skin care regime from SkinCeuticals comprising of Gentle Cleanser, C E Ferulic and Sheer Mineral UV Defense SPF 50.

POST PROCEDURE Redness Neutralizer can also be used postprocedure to help soothe and calm the skin, making it an ideal after-care product for nonablative fractionated laser and chemical peels.

SUITABLE FOR OTHER INFLAMMATORY CONDITIONS Redness Neutralizer has proven to be effective

OBSERVATIONAL STUDIES BY MR CHRISTOPHER INGLEFIELD BSC, MBBS, FRCS (PLAST) Mr Christopher Inglefield undertook his own observational studies with 9 patients over a period of 6 months. Using The Visia Complexion Analysis Machine - an advanced skin analysis tool, he was able to qualitatively assess each client’s skin and compare the results to their peer group for numerous skin concerns including UV damage, skin evenness, wrinkle depth and redness. He was also able to scientifically quantify the impact Redness Neutralizer had had on his patients’ level of redness. Results include a redness level of 2% (severe) decreasing to a redness


at reducing the appearance of redness for inflammatory conditions such as acne lesions, scars, red stretch marks and superficial burns.

CLINICAL TRIALS In a 12-week clinical trial of 48 subjects, conducted by a board-certified dermatologist, Redness Neutralizer provided significant reduction in redness and flushing on mild to moderate sufferers of skin redness. In 12 weeks, the appearance of redness and flushing was reduced by 30% and skin radiance improved by 30% with skin smoothness improving by over 55%. In addition, 96% of users reported immediate overall satisfaction and recognised that skin immediately felt smoothed. 98% of users stated that skin felt smoother immediately after application and 87% of users reported a reduction in the appearance of their redness in just 12 weeks.

level of 21%, which is a 19% improvement and a UV damage level of 33% to 56%, which is an improvement of 23%. Mr Inglefield says: “When I was first introduced to Redness Neutralizer earlier this year, I had an immediate patient who I knew I wanted to trial this on. She has been a regular patient for more than 5 years and has tried many products to treat her redness, with very little success. Within 3 weeks, Redness Neutralizer had proven impactful on her condition, with her commenting, ‘my skin has never felt so calm’. This patient testimonial was the stimulator for me to conduct a small UK observational study to further evaluate the efficacy of the product.”

Announcing the New Highgate Private Hospital for 2013. The Highgate Private Hospital has invested £13 million in an extensive redevelopment and expansion project, allowing one of the UK’s largest private hospital providers for Cosmetic Surgery to further it’s ability to provide aftercare and peace of mind to the thousands of Plastic Surgeons and Medical Aesthetic Professionals throughout the UK. As part of our investment we are delighted to announce the launch of the new Highgate Cosmetic Clinic which will include Cosmetic Surgery, Weight Management, Vascular Surgery, Non-Surgical Clinic and now VASER 2.0 which features improved technology that is excellent for fat transfer procedures as well as improved body sculpting efficiency. Established over 25 years, we are renowned as one of London’s leading cosmetic surgery centres but also offer everything you would expect from a private hospital including outpatient clinics and treatment in most medical specialties, diagnostic imaging, physiotherapy and more. We pride ourselves on our high standards of nursing care, friendly atmosphere and exceptional customer service.

£13 million redevelopment and expansion project. • • • • •

Consulting Rooms: 6 to15 Bedrooms: 28 to 43 (all en-suite) Operating Theatres: 3 to 4 Phase 1 - High Dependency Unit Phase 2 - State of the Art Diagnostics Suite including: MRI, CT, Ultrasound scanners and X-Ray

Offer your patients more with Vaser® Lipo at Highgate Private Hospital Call us today to see how Highgate Private Hospital can enhance your patient offering. | Contact us: 020 8341 4182 or email: Highgate Private Hospital is part of Aspen Healthcare Ltd


THE TWEET SMELL OF SUCCESS Ed Beardsell on the endless opportunities offered by those 140 little characters on Twitter

Whether it’s the guilty procrastination of a quick peek at your Facebook timeline to the couple of cheeky tweets you slip in between appointments slowly but surely social media is creeping into our working life. We’re consistently bombarded with people telling us to get your clinic or business on whatever social media outlet becomes flavour of the month but when you get there you’re often left wondering what value it really brings to your business. The truth is that to establish yourself online and use it to your advantage takes a heck of a lot of groundwork, dedication and perseverance. The pay-off is that the rewards that can come from puncturing the white noise of the social media stream with your unique voice can be massive and it’s getting easier and easier to manage these channels and work them in to your daily routine. WHY TAKE THE PLUNGE? When I started out working for my website Clinic Compare we had barely scratched the surface of social media as we naively thought that nobody wanted to talk about cosmetic concerns online let alone in a public space. How wrong we were. More than 500 followers later we now consider this mass of chatter to be an invaluable part of our marketing strategy and tend to our channels daily. With Twitter, much like any marketing channel, you only get back what you put in to it but the rewards of opening up your brand and getting stuck in to conversation can be endless. ENGAGE THE COMMUNIT Y Get stuck in and start connecting with some of the leading bodies and people at the forefront of the cosmetic industry in the UK. Through following and engaging the

right people on Twitter it could lead to such opportunities as: Guest posting on other websites, a valuable means of boosting your site’s credibility as well as promoting your brand. Receiving offers to provide opinions, comments and blogs posts for our company pages bringing with them a new audience of followers to your site. CREATE A VOICE FOR YOUR BRAND When patients are looking for reassurance that a procedure is right for them or seeking advice about a cosmetic treatment then they won’t gravitate towards the faceless logo constantly tweeting self-promotion. Give your clinic a voice and let your personality shine through. People want to know they are talking to a human at the end of the day and not some automated tweet generator. MONITOR FOR MENTIONS Reputation management is becoming increasingly important as more and more patients take to Twitter to vent their frustration or sing your praise. By creating a dedicated stream looking out for mentions of your brand/clinic with a Twitter management tool such as Tweetdeck you can make sure you catch every opportunity to react. HANDLING FEEDBACK Let’s face it, we work within an industry that divides opinion and not

By setting up Twilert to pick up question driven keywords in your area of expertise you can receive a daily burst of questions that you can help answer. every bit of contact and feedback you receive through Twitter is going to be a golden review singing your clinic’s praises. Twitter gives you an amazing opportunity to handle issues in a public forum and let your clinic be a shining beacon of customer service and response. BE A FORCE FOR GOOD Anyone considering undergoing a cosmetic procedure is more than likely going to have a number of questions even before they consider stepping foot inside a consultant’s office. Twitter is the perfect medium for helping people by answering their questions directly (if qualified to do so) or point them in the direction of a source of information that will. By setting up Twilert to pick up question driven keywords in your area of expertise you can receive a daily burst of questions that you can help answer. Be a force for good in your industry by giving up a few minutes to answer questions each day, it’s a quick and easy way of building your brand and one good deed often leads to another.


Ed Beardsell is the Marketing Manager for, the online clinic comparison service.


Managing your Twitter account doesn’t have to be a daily grind, here’s my top applications which anyone who’s considering marketing through Twitter should use to get the most out of the their daily efforts. TWILERT: This free application allows you quickly and easily set up daily alerts when your brand, a specific keyword or hashtag is mentioned on Twitter. TWEETDECK: Although there’s a number of Twitter management tools out there (Hootsuite, Seemic, Sproutsocial etc.) I find the clean and intuitive design of Tweetdeck allows me to set up personalised feeds with ease and manage the flow of information so that I can easily sift the important stuff from the noise. BUFFER: This handy little application allows users to line-up and time tweets to be posted automatically. An absolutely essential bit of kit however be careful not to turn your account in to a completely automated stream of posts as people will soon lose interest.

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stand 49


The only HA dermal lip filler using Allergan’s proprietary VYCROSS ™ technology. Designed for minimal swelling and a smooth, natural look that lasts.



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


THE END OF THE LINE Tayyab Akhlaq on how to get more from high-end retail products

Selling prescription-ready treatments and clinical beauty products is a lucrative way of boosting sales in the world of professional beauty. However, as trends change and tastes evolve, end of lines can literally choke a spa or clinic. Products have to be stored, tracked on a monthly basis, and protected, just like the rest of your inventory. However, if they’re not making you any money, there’s no point in keeping unwanted products in stock – particularly those that can command a high price tag. The beauty trade is a fast moving beast – with new products coming on the market as quickly as possible – meaning it’s important to turn around goods as quickly as possible. So, what can beauty professionals do to identify, manage and reduce the risks and overheads of unsold stock? In order to ensure that supply chains maintain their value from beginning to end, it’s certainly worthwhile considering online marketplaces. There are many spas and clinics out there that don’t think it’s for them. However, fast-selling sites, such as eBay and Amazon, have the potential to yield vast profits for sellers, so it’s important not to dismiss these channels outright. It’s worthwhile pointing out that the majority of sellers on eBay are businesses selling to consumers, as opposed to consumers selling to other consumers. Indeed, over 65 per cent of items are ‘buy it now’ products not, as many would think, second-hand goods being sold via auctions. This means it’s a viable route for medi spas and private clinics that have stock and don’t know what to do with it.   In terms of maximising your spending, it’s important to take the time to research the market, particularly with regards to pricing. You might think that online marketplaces mean you have to cut your costs, however, that’s not always the case. Look at the prices of similar goods and check you’re not underselling yourself, before taking the plunge. Pictures go a long way in online marketplaces. You wouldn’t go into a spa and expect to part 54

with your hard-earned cash, if they displayed bland pictures. People want to look, touch and feel, and it’s the same with online selling. Spend time investing in your photography – it will go a long way to boosting prices. A question we often get asked is: how do you manage products and still maintain control of your brand? This is particularly important in the world of professional beauty as the products are perceived to be luxurious and aspirational. People think that if they start selling on eBay then they are somehow letting go and that’s difficult for many businesses to do.   However, it’s possible to create an online store front that can mimic not only the look and feel of a website, but also the company’s core values. This way, the essence of the brand can be retained and even enhanced. Selling through this channel means you’re adding another step on your sales journey, which is no bad thing in the current economic climate.   Online marketplaces can also help to dispel negative attitudes to unwanted goods. People using sites, like eBay and Amazon, will often have a product in mind before they go shopping. Indeed, a recent statistic has shown that 90 per cent of sales come from direct search, rather than browsing. In this respect, changing people’s minds about goods isn’t a priority.

More focus should be placed on showing the products you have in the best possible light – clear shop fronts and compelling photography should be optimised to get your products in front of interested buyers. Selling through marketplaces is a great way of freeing up capital to invest in future inventory and get more value from your existing goods. A key benefit is that it has a very low barrier to entry. If you were to open up a spa you would have to look into renting a property, getting it fit for business and employing new staff. However, you could have five products and still be able to open your own eBay store. Indeed, you only have to pay when you sell a product – which means upfront costs aren’t an issue. If you’re using this method to get rid of end of line stock, it’s an easy mechanic for boosting your supply chain! For anyone who is looking to maximise their return on investment, online marketplaces are an attractive proposition. Simply do your research, enhance your shop front and invest in photography, and you could be on to a winner.

Tayyab Akhlaq is the founder and managing director of Genie and the Geek – a leading ecommerce business, which specialises in online marketplaces.

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The S ecret Diar y of Adrian Richards As part of this month’s Day in the Life, Antonia Mariconda talks to plastic surgeon Adrian Richards Adrian Richards, is one of the UK’s much loved consultant plastic surgeons. The surgical director of Aurora Clinics and Cosmetic Courses and senior lecturer at Anglia Ruskin University, talks here about a typcial day in his life. “Home is a small village outside Thame in Oxfordshire. I’m married with four children, eight siblings and 25 nephews and nieces! Phew! (imagine the Christmas card list). I live with my wife, four children and a dog of mixed race called Maisie. I will usually be up at 6am although this varies if it is an operating day. I tend to have nothing for breakfast other than a cup of tea. Four years ago when he came over to visit me from America, my father, in his infinite wisdom, told me I was fat and unhealthy and needed to see a personal trainer! Since then, I see a personal trainer twice a week, play squash, run and have recently completed the Florence Marathon. I tend to do one marathon a year, ideally in an exotic location. Work is split between the Paddocks Hospital in Princes Risborough, the Gatehouse Clinic in Northampton, Harley Street, Milton Keynes and the Shelburne Hospital in High Wycombe. My commute to work tends to vary but is never more than an hour, and is often to our local clinic in Princes Risborough which takes me approximately 10 minutes to get to. I usually listen to podcasts and music in the car, when not using it as a mobile office and talking to people. A typical morning would involve getting to the office before everyone else – like Alex Ferguson, to try and set a good example – followed by an hour and a half of videoing with our video editor. I tend to find this is the best time to do the videoing, when we are fresh. We are highly active in the video field and developing talk show type videos discussing plastic surgery and cosmetic surgery in the New Year. Following this, I have hour meetings with our marketing team, operations team and non-surgical team until 12pm when my clinics start. I do not tend to stop for lunch and, as I’m giving up bread, I try and eat a salad whilst checking e-mails. A typical afternoon would involve seeing patients with my two nurse specialists at one of our 56

Aurora Clinics. This typically takes me until 6pm, when I normally have child taxiing duties, taking the children to a mixture of karate, cubs and tennis. I always knew I wanted to be a surgeon, and decided to be a plastic surgeon the first time I ever saw a plastic surgical procedure performed. The attention to detail inspired me and after seeing a very simple skin graft procedure, I determined that I would be a plastic surgeon. I have a number of mentors, the greatest of which is Mr Brent Tanner who is a plastic surgeon who is very well known in the Brighton and Sussex area. Brent shares many of my ideals, both medically and in his personal life. I’m a very sociable person and my work involves talking and interacting with people all day, whether it is our staff or patients. They say an average man says 2,000 words a day, and an average woman 7,000 words a day but I think my word count would be way above this on most days. Even during operations we do tend to talk almost continuously. The staff helping me with operations I would classify as personal friends and I enjoy the operation days learning and discussing topics with them. Setting up Aurora Clinics and Cosmetic Courses have made me very proud and particularly when members of the staff do perform beyond my expectations as we do try and build a family

atmosphere in both businesses. We are working on large amounts of exciting projects ranging from online TV to developing national and international branches of Aurora Clinics. I work very closely with my business manager, who thinks many of my ideas are off the wall and tries to bring me down to earth. We work very well as a team and we are trying to focus on one exciting project at a time rather than one exciting project a day. I think we need more regulation in the industry, particularly in the area of non-surgical treatments, although this is a very contentious and dangerous issue. I think we should be working towards this. I have a varied interest in music and play bass guitar in a band, which is one of my main forms of relaxation. We are currently putting together a Commitments line up of songs to perform at my imminent 50th birthday party. We’re also planning to perform regularly in other events. I am also a keen squash player and very interested in making films, and have made a number of short feature films with a friend. I am also the chairman of a local medium-sized festival that attracts 15,000 people a year. I often end my day by taking my dog for a walk to the pub 100 yards from my house to have a quick pint with my friends. Before I go to bed, I tend to play my guitar, which I try to do every day, and do try and read - usually non-fiction inspirational books. Generally I try to be happy and positive and my motto would be “Enjoy yourself, it’s later than you think”. My final thought of the day? If you have enough energy, focus and drive, and if you have a dream you should aim for the skies.”

Antonia Mariconda also known as ‘The Cosmedic Coach’ is a health and beauty writer, and author of four books. She is quoted in national and consumer press such as the BBC, Times, Top Santé, The Evening Standard, Daily Mail, and Metro, for her knowledge on beauty and aesthetics, and cosmetic surgery. Antonia also independently advises clients both from the UK and around the world on where and where not to shop safely for cosmetic surgery, beauty, aesthetic medicine, and anti-ageing treatments. Her client list includes A-list celebrities, Royalty and VIPs. Follow Antonia on Twitter @CosmedicCoach or join Antonia on Facebook where you will be updated about events and happenings in the world of health and beauty. www.

Why Do leADINg meDIcAl see us at ProFeSSIoNAlS uSe intraceuticals cosmetic news e xpo oxygen DelivereD treatMents? 16 and 17 the uk’s largest trade aesthetics exhibition and conference

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- a luxury skincare clinic in marylebone specialising in aesthetic treatments. Anna Silsby clinic manager and rgN says;

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facelifts and skin rejuvenation. • The Intraceuticals range complements all of our non-surgical treatments 2 - replenish

andoris complicated a huge hit ProvidesPRP a reservoir of anti- an expensive Producing high • quality has been ageing actives and nutrients • patented, Skin is glowing and hydrated; clients cannot believe the results for such a business, until now…. Our no-compromise, easy-to-use, 3 - protect relaxing, no downtime treatment” GloPRP system gives the and highest quality PRP at an affordable price, • Nourishes protects skin from environmental damage What other people are saying about Intraceuticals giving great results and a very short payback time. Intraceuticals oxygen delivered treatments combine hyperbaric oxygen with professional Full training courses and support available

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“The addition of the Intraceuticals Infusion to our Fraxel™ resurfacing protocols has made the treatment more of a positive experience for the patient and has increased our rebooking and retention. Anyone who experiences a Fraxel™ resurfacing treatment with an Intraceuticals Infusion would never do the treatment without Intraceuticals.”

i t ’s i n t h e s k i n

Dr. Scott Gerrish is one of the most experienced and respected doctors in the DC metro area. As Medical Director of Bellini, Dr. Gerrish leads a team of professionals in his fullservice medical spa. He is the founder of the revolutionary Fraxel® Boost concept which delivers the anti-aging properties of Fraxel® with no down-time. Since 1996, Dr. Gerrish leads the way in offering the most comprehensive collection of anti-aging medically directed cosmetic procedures and is one of the most sought after physicians in the area. As one of the first medical spa doctors in Virginia, he has trained dozens of medical practitioners including doctors, physician assistants, nurses and estheticians in the art and science of medical esthetics.


Thicker/stronger hair Improved coverage




York Medical Technologies Ltd, Unit 12 Brookfield Business Park, Clay Lane, Shiptonthorpe, York, YO43 3PU,, Tel: 01430 803113

GloPRP, the next big thing in non-surgical facelifts and skin rejuvenation. Producing high quality PRP has been an expensive or complicated business, until now…. Our no-compromise, patented, easy-to-use, GloPRP system gives the highest quality PRP at an affordable price, giving great results and a very short payback time.

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Recovery/Preservation of skin tension Bright and younger skin appearance Smoothing of wrinkles and acne scars Wound healing Improves the outcome of other conventional therapies such as mesotherapy and autologous fat injection


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see us at

cosmetic news the uk’s largest trade aesthetics exhibition and conference


exhibition and conference

1 6 th a n d 1 7 th february

stand 8

Unit 12 Brookfield Business Park, Clay Lane, Shiptonthorpe, York, YO43 3PU

TRAINING NEWS BACN RUNS BUSINESS SKILLS WORKSHOP The British Association of Cosmetic Nurses is hosting a business skills workshop. The event will take place on Monday March 11 at The Royal College of Obstetricians and Gynaecologists, in Sussex Place, Regents Park, London and costs £60 for BACN members or £90 for non-members, including refreshments and lunch. The event will include top tips and golden nuggets to move your clinic up a level and to guide you in the aesthetics business. Contact the BACN office for more details.

ROYAL SOCIETY OF MEDICINE’S INTERVENTIONAL COSMETICS GROUP HOLDS 5TH INTERNATIONAL MULTIDISCIPLINARY ANNUAL MEETING The Royal Society of Medicine’s Interventional Cosmetics Group will hold its 5th International Multidisciplinary Annual Meeting at the RSM in Wimpole Street on Monday February 25. The meeting will explore Interventional Cosmetics: New and Controversial Treatments and will feature lectures on New Cosmetic Applications for Botulinum Toxin, Botulinum Misconceptions, Fillers within the Orbital Rim, Blindness and Worse after Filler Injections and Mini-liposuction & Mini-lipofilling of the Face. On Saturday and Sunday, February 23-24, at the same venue The 2nd EADV/ESCAD Fostering Course in Interventional Cosmetics for Trainees/Residents Practical Hands-on Workshop on Botulinum & Fillers for Beginners will also take place.

NEW ONLINE COURSES PROVIDE HIGH LEVEL SKINCARE TRAINING A range of online skincare courses aimed at medical practitioners and professional beauty therapists is being launched by Sally Durant Training & Consultancy. The courses give medical professionals such as doctors, dentists and aesthetic nurses - specific training in clinical cosmetic dermatology which they will not have received as part of their general medical training. The courses also take beauty therapy training beyond its usual NVQ 3 level and provide the higher level training that will enable therapists to build and develop their business. The portfolio includes 13 ‘knowledge based’ courses which are completed fully online. In addition, there are three practical courses in advanced beauty and aesthetic procedures, with the majority of the background study delivered online and supporting practical sessions held either at the client’s premises or at a number of satellite centres conveniently located throughout the country. The courses are certified by the International Institute of Skin, Health and Clinical Aesthetics (IISHCA), and validated by the international awarding body, IQ Industry Qualifications. They are written to achieve full CPD accreditation and accepted by all relevant professional indemnity insurers.

HABIA ANNOUNCES HSA LASER AND LHR COURSES FOR 2013 The Habia Skills Academy (HSA) had announced another series of Laser and Light Hair Removal courses. The intensive courses, which are delivered at Level 4, begin this April with further courses available up until October 2013. All courses take place at The Spa Leamington in Leamington, Warwickshire. Each course lasts four non-consecutive days (two groups of two days) and covers the expert knowledge required for those looking to teach advanced laser and laser hair removal skills to others. The courses, which are being supported by Lynton Lasers and Polaris Medical, will be delivered by Barbara Green and Gill Herrick. Gill said, “The new qualification in Laser and Light systems require educators to be knowledgeable and up to date. This HSA course achieves just this as it revisits the basic principles as well as looking at the treatments from a training perspective.”





cosmetic news the uk’s largest trade aesthetics exhibition and conference


exhibition and conference

1 6 th a n d 1 7 th f e b r u a r y INCORPORATING

• FEBRUARY 2 Aesthetox Foundation Botox and Fillers, Birmingham, 2 Aesthetox Masterclass Botox and Fillers, Birmingham, 4-5 Ultrasonic Lipo-cavitation The non-invasive alternative to Liposuction,CawoodHouse,Sutton,Ely,Cambs, 01353777303/07747696815 5Level2AdvancedToxin:LowerFace,MedexHouse,Loughborough,Leicestershire,www. or 01509 239696 5 Level 2A Advanced Toxin: Easy Switching Between Toxins, Medex House, Loughborough, Leicestershire, or 01509 239696, 6 Ultrasound for Skin Rejuvenation and Wrinkle Reduction, 01353 777303/07747 696815, barbara@academyofadvancedbeauty. com, 7 Diamond Microdermabrasion for Face and Body, 01353777303/07747696815, barbara@academyofadvancedbeauty. com, 8 Advanced Facial Treatment, 01353777303/07747696815,, 9InnomedTrainingChemicalPeelingSystems:ComprehensiveCourseforNewUsers,Central London, 9 Innomed Training Advanced Botulinum Toxin: Lower Face, Neck, Under-Arm Hyperhidrosis, Southampton, 10InnomedTrainingAdvancedDermalFillers:FacialContours,LipFiller,Skin-Hydration, Southampton, 10 Innomed Training Mesotherapy for Fat, Cellulite and Skin Rejuvenation: New Users, Central London, 10 Aesthetox Foundation Botox and Fillers, London, 11 Micro-needling, Boston International Training Academy Ltd, Bayswater, London, 0207 727 1110; 13 Neostrata Training Day Harley Street, London, 01234 313 130; 16 Aesthetox Foundation Botox and Fillers, Birmingham, 16 Innomed Training Botulinum Toxin in Facial Aesthetics: New Users

Obagi Blue Peel Workshop, (14 May), Glasgow, Obagi Blue Peel Workshop, (14 June), London,

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(incl. all major brands), Central London, 16-17 Cosmetic News Expo and Aesthetics Conference 2013,The Business Design Centre, Islington, London, 17 Innomed Training Dermal Fillers in Facial Aesthetics: New Users to Hyaluronic Acid Fillers, Central London, 21 Microsclerotherapy, Medex House, Loughborough, Leicestershire, or 01509 239696 22 Cosmetic Courses Business, Marketing and Managing Complications Seminar, 23 Cosmetic Courses Foundation Botulinum Toxin and Dermal Fillers, 25 Obagi Workshop, London, 25InnomedTrainingSculptraBeginners:Day2(Day1onJanuary21)Southampton,www. 26 Level 3 Toxin Masterclass: Neck, Jawline and Nefertiti Lift, Medex House, Loughborough, Leicestershire, or 01509 239696 28 Cosmetic Courses Dermaroller,


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ABC Laser Contact: Guy Gouldsmit T: 08451 707 788 E: W:

Aesthetic Source Contact: Sharon Morris T: 01234 313 130 E: Services: NeoStrata and Exuviance Innovation in Aesthetics delivered to you.

Aesthetox Academy Contact: Lisa Tyrer Service: Training T: 0870 0801746 E: W:

Allergan - Contact: Customer Service T: 0808 2381500 W:

AZTEC Services Contact: Anthony Zacharek

Service: Exclusive UK distributor for Viora product range T: 07747 865600 E: W:

Bioptica Laser Aesthetics Contact: Mike Regan T: +44 (0)7917 573466 E: W: Services: Core of Knowledge Training and Laser Protection Adviser (LPA) Services.

Boston Medical Group LTD Contact: Iveta Vinklerova T: 0207 727 1110 E: W:

Candela UK Ltd Contact: Michaela Barker T: 0845 521 0698 E: W:


Carleton Medical Ltd Contact: Nick Fitrzyk T: 01633 838 081 E: W: Services: UK distributor of Asclepion Lasers

Lifestyle AestheticsContact: Sue Wales T: 0845 0701 782 E: W:

Chromogenex Service: Laser System Manufacturer Contact: Lauren Roberts T 01554 755444 E: W:

Lynton Contact: Customer Services T: 0845 6121545 E: W:

Eden Aesthetics Contact: Anna Perry T: 01245 227 752 E: W:

Med-fx Contact: Faye Price T: 01376 532800 E: W:

Energist Contact: Andrew Snoddon T: 01792 798768 E: W:

Medical Aesthetic Group Contact: David Gower T: 02380 676733 E: W:

Galderma Contact: Azzalure Sales Team T: 01923 208950 E: W:

Hamilton Fraser Contact: Wai Chan T: 0845 3106 300 E: W:

Merz Aesthetics Contact: Merz Aesthetics Customer Services T: 0333 200 4140 E:

Mesoestetic UK Contact: Adam Birtwistle T: 01746 718123 E: W: Services: Cosmeceutical Skincare Treatment Solutions. Cosmelan. Antiagaing, Depigmentation, Anti Acne, Dermamelan.

Healthxchange Pharmacy Contact: Steve Joyce T: +44 (0)1481 736837 F: +44 (0)1481 736677 E: W: W:

Polaris Lasers Medical Contact: Neil Calder Microdermabrasion T: 01234841536 E:From MATTIOLI ENGINEERING W:

Laser Physics Contact: Customer Services T: 01829773155 E: W:

Q-Med, a Galderma Division Contact: Customer Service T: 01923 208950 E: W:

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SkinBrands Contact: Tracey Beesley T: 0289 983 739 E: W:

Skin Geeks Ltd Contact: Customer Services T: +44 (0)1865 338046 E: W:

Sound Surgical (UK) LTD Contact: Raj Jain T: +44 7971 686114 E: Web:

Zanco Models Contacts: Mr Ricky Zanco T: 08453076191 E: W:

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Cosmetic news february 2013