• Results seen as early as 7 days, lasting up to 4 months in upper facial lines1
• A well characterised safety profile1
• Convenient – no refrigeration needed prior to reconstitution1
Scan the QR code to access BOCOUTURE UK and Ireland Prescribing Information
1.BOCOUTURE Summary of Product Characteristics. Merz Pharmaceuticals GmbH: https://www.medicines.org.uk/emc/product/600/smpc (Last accessed October 2025).
Access injection technique videos now
Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk/. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.
06 Celebrating the 2025 Aesthetics Reviewing Panel
Aesthetics recognises the support of our peer-reviewing panel
08 News
The latest product and specialty news
19 News Special: Landmark Case Victory Establishes New VAT Guidance
Aesthetics examines the landmark case victory that helped establish a VAT framework for aesthetic practitioners, providing legal clarity on when treatments may be exempt from VAT
20 Event Preview: Advancing Your Practice
Discover new innovations, dynamic networking opportunities and unmissable education
23 Special Feature: Emerging Trends in Aesthetics
The Aesthetics CAB members reflect on trends and look ahead to 2026
27 CPD: Evaluating Hyaluronidase Use in Aesthetics
Dr Ben Taylor-Davies discusses hyaluronidase and the main considerations
32 Treating Scar Tissue with Polynucleotides
Dr Amy Law presents a case study using polynucleotides for scar healing
35 Case Study: Non-Surgical Refinement of the Cleft Lip
Dr Bonny Armstrong shares a case study using HA filler for cleft lip repair
39 Periocular Rejuvenation and Dry Eye Relief for Menopause
Dr Priya Udani addresses periocular rejuvenation and dry eye relief
42 The Expanding Role of Dermoscopy in Medical Aesthetics
Dr Tatyana Lapa-Enright explores the role of dermoscopy in dermatology
45 Abstracts
A round-up and summary of the latest clinical studies
46 Practical Strategies for Retaining Staff in Clinics
Katie Hughes-Dawkins considers staff retention for clinic growth
48 Reshaping Marketing into Meaningful Connections
Nick Jekyll demonstrates how to effectively market your brand or clinic
53 Advertising Weight-Loss Injections in Aesthetics Practice
A look at the advertising rules surrounding weight-loss injections and other prescription-only medicines
57 In The Life Of: Dr Amy Watson
Dr Amy Watson offers a glimpse into her daily routine and her role working with Alma and Revanesse
58 The Last Word: Prescribing Qualifications for Aesthetic Nurses
Michelle Pickering argues prescribing qualifications are essential for aesthetic nurses
NEXT MONTH: INNOVATION AND KEY TRENDS
• Biostimulants • Acne and Pigmentation • Chemical Peels
News Special: Landmark Case Victory Establishes New VAT Guidance Page 19
Special Feature: Emerging Trends in Aesthetics Page 23
Dr Ben Taylor-Davies is an aesthetics practitioner, and the co-founder and clinical director of The Stockbridge Clinic in Edinburgh. He also works as a national trainer for Acquisition Aesthetics and has a background in NHS Emergency Medicine.
Dr Amy Law qualified as a dentist from The University of Liverpool in 2016. Whilst progressing in her career in dentistry, she realised her true passion lay in medical aesthetics. She successfully heads up her clinic, Dr Amy Law.
Dr Bonny Armstrong is an aesthetic practitioner, medical director and owner of the Dr Bonny Clinic. Dr Armstrong is also a regional expert and faculty member for Teoxane, the owner of the Dr Bonny Academy and co-founder of NEXTGENERATION.
Dr Priya Udani is an oculoplastic surgeon and serves as a key opinion leader and international speaker. Dr Udani is recognised for her evidence-based approaches to ocular surface management and periocular aesthetics.
Dr Tatyana Lapa-Enright is a specialist in cosmetic medicine and cosmetic dermatology, and founder and lead practitioner at Hardwick Clinic. Dr Lapa-Enright holds a degree in Medicine with Clinical in Research from the University of East Anglia.
Since its inception in 2022, the Aesthetics Reviewing Panel (ARP) has brought together a distinguished cohort of leaders in medical aesthetics, each recognised for their significant contributions and commitment to advancing the specialty. Collectively, they embody the scientific integrity and editorial excellence that underpin our publication.
With their deep expertise and discerning judgment, the panel ensures every clinical and CPD article meets the highest standards of accuracy, quality and evidence-based rigor. As we celebrate the milestones of 2025, we extend heartfelt thanks to our panel members for their time, insight and dedication. Their continued
collaboration has strengthened our journal’s reputation as a trusted resource within the aesthetics community.
Looking ahead to 2026, we’re excited to build on this momentum, welcoming new ideas, innovations and partnerships that will continue to shape the future of the field.
Our celebrated panel brings together leading figures from across the medical aesthetics specialty, unified through a shared dedication to advancing best practice within the field. Below, we are pleased to introduce our 2025 panel members.
Looking forward to 2026
As we move forward, we continue to champion high-quality, peer-reviewed content designed to inspire learning and professional growth. If you are interested in joining our reviewing panel or if you are keen to see your name in print and write for the journal in 2026, please get
touch at editorial@aestheticsjournal.com
Shannon Kilgariff Editor & Event Manager @shannonkilgariff
Welcome to the final issue of the Aesthetics Journal for 2025... and what a year it has been. This issue takes a reflective look at the milestones, challenges and innovations that have shaped our specialty over the past 12 months, while also casting an eye forward to what’s coming next.
In our Special Feature this month (p.25), we delve into the biggest trends that defined aesthetics in 2025 and explore what the future may hold. We speak to members of our Clinical Advisory Board, who share their expert insights on evolving patient expectations, technological advancements and the clinical considerations.
Our News Special (p.17) covers one of the most significant legal developments our specialty has seen in recent years: the landmark VAT ruling involving Illuminate Skin Clinic. The clinic has successfully overturned the 2023 First-tier Tribunal decision in a major Upper Tribunal appeal. This judgment has broadened the definition of “medical” extending VAT exemption not only to confirmed
diagnoses but also to suspected diagnoses, and treatments aimed at preventing possible future conditions or diseases. In this article, we unpack what this means for practitioners heading into 2026 and beyond.
Also in this issue, we’re excited to bring you a preview of what’s new at ACE 2026 (p.20). Registration is now open, and this year’s event promises more education, innovation and clinical excellence than ever before, making it a must-attend for anyone looking to elevate their practice as we enter the next chapter of aesthetics.
Speaking of big moments ahead, we’ll be revealing the Finalists for The Aesthetics Awards next month. A huge good luck to everyone who entered; the standard this year has been exceptional. Tickets are now on sale – we can’t wait to celebrate your achievements with you.
As we close out 2025, I want to extend a heartfelt thank you to all of our readers for being such a valued member of the Aesthetics community this year. Your dedication to staying updated and engaged with your field will continue to push our specialty forward. The team and I can’t wait to see what 2026 brings!
Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content
Sharon Bennett is the former chair of the British Association of Medical Aesthetic Nurses (BAMAN), UK lead of the BSI committee for aesthetic non-surgical standards and member of the Clinical Advisory Group for the JCCP. She is a trainer and a registered university mentor in cosmetic medical practice and is finishing her MSc at Northumbria University. Bennett has won The Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.
Sharon Bennett, Clinical Lead
Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.
Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS, and is an examiner and fellow of the Royal College of Ophthalmologists.
Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.
PORTFOLIO MANAGEMENT
Shannon Kilgariff • Editor & Event Director
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EDITORIAL
Holly Carver • Deputy Editor & Content Manager
T: 0203 196 4427 | holly.carver@easyfairs.com
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Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.
Jackie Partridge is an independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.
Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.
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If you are interested in contributing to the journal, get in touch...
Email: editorial@aestheticsjournal.com
Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.
Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.
Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.
Material may not be reproduced in any form without the publisher’s written permission. For PDF file support please email, contact@aestheticsjournal.com © Copyright 2025 Aesthetics. All rights reserved. Aesthetics is published by Aesthetics Media Ltd, which is registered as a limited company in England; No 9887184
Prescription Misconduct
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An incredible moment at the London media launch of Skinvive with the wonderful Cat Deeley, one of the official ambassadors for this groundbreaking treatment.
#Networking
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We welcomed 150 Obagi Ambassadors at The Gherkin! A dynamic evening dedicated to advancing skin health knowledge and celebrating our community.
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Thank you to everyone who attended RAMCE 2025!
#Event
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Showcasing our very own EXOGROW exosome technology! A huge thank you to Dr Andrew Christie and Dr Bilal Malik for sharing their expertise and passion.
British Association of Medical Aesthetic Nurses (BAMAN) @bamannurses
We had a brilliant night on Friday celebrating the achievements of our outstanding BAMAN nurses. Huge congratulations to finalists and winners!
A BBC investigation has revealed that non-medic practitioner Jordan Parke is allegedly selling prescription weight-loss jabs online.
Parke was arrested on suspicion of manslaughter in September 2024 after Alice Webb, a 33-year-old mother of five, passed away at Gloucestershire Royal Hospital after undergoing a non-surgical Brazilian butt lift (BBL) procedure.
To investigate whether Parke was still working within the cosmetic sector, BBC investigators contacted him via Instagram about prescription-only weight-loss injections. After paying £200, the investigators were sent a kit containing needles, mixing agents and a vial of unlabelled white powder – but no instructions. According to the BBC, subsequent lab tests conducted by senior lecturer in pharmaceutical chemistry at the University of Sunderland and charted chemist, Stephen Childs, confirmed the presence of semaglutide, a compound found in the diabetes drug Ozempic and the weight-loss drug Wegovy.
In the UK, weight-loss injections must be prescribed by a specialist weight management service, to patients who have health problems due to their weight, as well as a high body mass index (BMI) score. While Parke is currently still on bail, he has not been charged with the manslaughter of Webb. Police have said that the sale of the weight-loss injections would not breach Parke’s bail conditions.
Ashton Collins, director of the national aesthetic practitioner register, Save Face, commented “I am deeply appalled, though not surprised, to see Parke selling illegal weight-loss injections. Having previously been exposed for causing serious health issues, he continues these dangerous activities without any legal authority to prescribe. Parke sells indiscriminately without assessing suitability or reviewing medical histories, thereby putting both the physical and mental health of his customers at grave risk. The contents of what he is selling remain completely unknown and could potentially be fatal.”
The US Food and Drug Administration (FDA) has issued warnings after serious complications were reported from certain uses of radiofrequency (RF) microneedling devices.
According to the FDA, reported complications from RF microneedling for dermatologic or aesthetic skin procedures included burning, scarring, fat loss, disfigurement, nerve damage and, in some cases, the need for surgical repair or medical intervention.
In a written statement online, the FDA said, “While the evaluation is ongoing, we are asking patients, caregivers and healthcare providers to report any complications related to the use of these devices for dermatologic or aesthetic skin procedures to the FDA. Prompt reporting of adverse events can help the FDA identify, and better understand, the risks associated with medical devices.”
Awards Tickets
Early Bird tickets for the glamorous Aesthetics Awards 2026 ceremony will be available until December 31.
Practitioners, clinic teams and aesthetic companies will come together on March 14 at The Hilton Park Lane, for the standout event in the medical aesthetics calendar.
Early Bird offers a timely opportunity to secure entry at a reduced rate before the busy new-year period begins. The Finalists will be announced in the January issue of Aesthetics, providing an early look at the practitioners, clinics and companies shortlisted across the categories.
For 2026, aesthetic distribution company Healthxchange joins as the Gold Sponsor as anticipation builds for another evening celebrating clinical standards, innovation and achievement across medical aesthetics. Shannon Kilgariff, editor and event director at Aesthetics, commented, “The Aesthetics Awards continue to be a cornerstone of the medical aesthetics community. This ceremony not only recognises clinical excellence but also champions innovation, safety and best practice across the specialty. There’s a unique energy in seeing so many familiar faces, all dressed to impress, coming together to celebrate the year’s standout moments.”
Medical Misrepresentation
The Advertising Standards Authority (ASA) has released rulings on several light-emitting diode (LED) mask adverts which made unauthorised medical claims about improving acne and rosacea.
The companies listed include the retailers of hair and skincare tools Beautaholics Ltd, Project E Beauty and Silk’n as well as retailer of LED therapy tools Luyors Retail Inc, which were found to have made various claims about LED masks, such as that the devices could treat acne, rosacea or scarring in some instances.
These cases, identified through the ASA’s AI-powered Active Ad Monitoring system, ruled these claims as medicinal, and therefore not permitted for unauthorised products.
In response to the advertising watchdogs’ actions, both Beautaholics Ltd and Project E Beauty removed the adverts and updated websites to eliminate any medical claims relating to the healing or treatment of acne and rosacea.
Silk’n stated the video testimonial reflected a user’s personal experience and results. While the company ensures testimonials are realistic, it acknowledged “acne” is a medical claim and has never used the term in its own marketing, only when quoting users.
Luyors Retail Inc said the advert had stopped running three months earlier and that it would revise future ads to avoid implying any medicinal claims. Izzy Dharmasiri, media relations officer at the ASA, commented, “When it comes to skincare and health treatments, it’s important that advertisers don’t blur the line between cosmetic benefits and medicinal claims. The ad rules are clear, products that claim to treat or prevent medical conditions must be licensed or registered with the Medicines and Healthcare products Regulatory Agency. Advertisers also need to have evidence to back up any claims they make in their ads.”
Botulinum toxin is ranked as the top-searched aesthetic treatment in the last 12 months, with 1.5 million monthly searches in the UK (Fresha, 2025)
In 2024, a total of 17.4 million surgical and 20.5 million non-surgical cosmetic procedures were performed worldwide (Statista, 2025)
Reports of racist incidents towards nurses has increased by 55% over the past three years (Royal College of Nursing, 2025)
In the last year, the median age of facelifts dropped from 60 to 55 years old in the UK, as well as there being a bigger uptick in women aged 30-45 (Adoreal, 2025)
Non-surgical procedures now represent 62% of total medical aesthetics treatments worldwide (Business Research Insights, 2025)
The number of nurses working in the NHS has declined compared to last year, with 16,706 in general practice in 2025 - a 1.2% decrease (NHS Digital, 2025)
29th-31st January 2026
IMCAS World Congress
6th February 2026
Menopause in Practice
13th-14th March 2026
Aesthetics Conference & Exhibition (ACE)
14th March 2026
The Aesthetics Awards
1st-2nd October 2026
Clinical Cosmetic Regenerative Congress (CCR)
What’s trending in the consumer press
MP Wes Streeting reacts to investigation into women’s health Research conducted by Good Morning Britain (GMB) reported three in five women have faced reproductive health challenges, with half reporting being misdiagnosed and one in three waiting more than a year for a diagnosis. Appearing on GMB, Health Secretary Wes Streeting pledged to tackle “medical misogyny” as part of the Government’s renewed health strategy. Joining him, TV personality Vicky Pattison – who has campaigned for change – added, “These women are suffering with adenomyosis, endometriosis, premenstrual dysphoric disorder and more. I don’t think it’s too much to ask that they have a bit more support.”
Dr David Jack and Ms Maryam Zamani explore the future of aesthetics
In a recent episode of The Beauty Briefing podcast, aesthetic practitioner Dr David Jack and oculoplastic surgeon Ms Maryam Zamani share their insights into the evolving future of medical aesthetics. Ms Zamani highlighted regenerative medicine as a key area for growth, predicting increased use of laser stacking and injectables enhanced with growth factors, stem cells and exosomes. Dr Jack added, “Biohacking your skin has become very popular, partly due to social media. People are taking far better care of their skin than they did 20 years ago, and among older patients there is a fear around looking like you’ve had work done.”
Prescribing Guidance
The Commission on Human Medicines (CHM) has endorsed changes to the prescribing guidance of isotretinoin.
This comes after the Isotretinoin Expert Working Group (IEWG) and CHM published a report in 2023 recommending several changes to improve safety. Following the report, the Isotretinoin Implementation Advisory Expert Working Group (IIAEWG) was established to implement these changes and report to the CHM its suggestions.
According to the Government website, follow-up consultations do not need to be in person and could be remote if appropriate, however the first appointment should be face to face. Medically-supervised pregnancy testing may be performed remotely with appropriate oversight to ensure tests are performed correctly and safely. Moreover, patients should be asked about sexual function at follow-up appointments.
To support safe prescribing, the Medicines and Healthcare products Regulatory Agency (MHRA) has asked NHS and private isotretinoin prescribers to complete a survey.
The MHRA stated on the Government website, “This data will be used to inform the CHM recommendations on the regulatory requirements of isotretinoin, whilst supporting patient access to treatment across all age groups. It will also provide baseline information to monitor adherence to risk minimisation measures, to ensure the continuation of safe prescribing.”
Regulatory Reform
Cosmetic surgery provider Longevita has released a petition titled ‘Regulate outbound medical tourism: mandatory accreditation, insurance, aftercare’. The petition calls for clear legal standards governing overseas medical providers advertising to UK patients.
Following Longevita’s earlier white paper proposing independent accreditation, mandatory insurance, UK aftercare and stricter advertising, the new petition calls for mandatory clinic accreditation, compulsory complication insurance, UK-based aftercare and a national outcomes database.
Kagan Seymenoglu, CEO and founder of Longevita commented, “Medical tourism is here to stay, but regulation must catch up. We are calling for accredited providers, insured procedures and proper aftercare to protect both patients and the NHS. Clinics advertising to UK patients should meet consistent, verifiable safety standards. This is about ensuring patient safety, transparency and accountability across borders.”
Prohibited Procedures
An investigation by 5 News has exposed human derived exosomes being used in clinics across the UK.
5 News investigators called 50 clinics across Bristol, Cardiff, Glasgow, Liverpool and London to identify how many were using human derived exosomes. 40 clinics openly stated what brand of exosome they use, most of which offered plant-based or salmon derived serums, but almost a quarter admitted to products that were derived from human stem cells, according to 5 News
A spokesperson for the Department for Business and Trade commented, “Cosmetics containing exosomes from humans are banned in the UK. Although we have not seen an increase in reports of non-compliance, we urge anyone with concerns to contact their local Trading Standards department or Citizens Advice.”
Pharmaceutical company Galderma has announced that the US Food and Drug Administration (FDA) has approved Restylane Lyft for the augmentation for the chin region. The company shares that the combination of Restylane Lyft with lidocaine can improve the chin profile in patients over the age of 21 with mild-to-moderate chin retrusion. This approval is based on results from 175 participants who were involved in a 12-month clinical study in the US conducted by Galderma. The study revealed a high proportion of patients agreed that Restylane Lyft delivered natural-looking chin projection, improved the appearance of the lower face and provided a smooth transition from chin to jawline, with satisfaction rates up to 86.3%. Vice president of medical affairs at Galderma US, Bill Andriopoulos, commented, “This approval reinforces our commitment to advancing our injectable aesthetics portfolio – the broadest on the market – to meet the diverse needs of patients. By expanding how innovations like Restylane Lyft can be used, we aim to empower aesthetic practitioners to achieve their patients’ unique aesthetic goals with enhanced flexibility and precision.”
Regulation Breach
A BBC investigation has raised concerns over illegal teeth-whitening treatments being administered in non-sterile settings.
Alongside treatments being delivered in car parks and on doorsteps, the report also highlighted that certain gels, containing bleaching agents at concentrations 500 times the legal limit for over-the-counter products, were being openly sold on social media by beauticians. A BBC reporter obtained a fake teeth-whitening qualification and was advised to practise on friends and family. Laboratory tests on products bought by undercover reporters found hydrogen peroxide levels up to 53%, exceeding the 0.1% limit for general use and the 6% maximum for dentists. Eddie Crouch, chair of the British Dental Association (BDA), commented, The BBC ’s investigation has found that these illegal teeth whitening providers are undeterred by the prospect of a criminal record or a fine. We urge people not to gamble with their oral health and the government to organise a crack-down on these dangerous practices.”
Appointment
Aesthetic distributor ACRE has been officially appointed as the UK&I distribution partner for pharmaceutical company Merz Aesthetics.
According to both companies, ACRE will oversee distribution of the Belotero, Bocouture and Radiesse product ranges. ACRE has also announced plans to develop a comprehensive training roadmap, designed to support clinic growth. The programme will include educational events, product workshops and business support sessions delivered in partnership with the brands and products distributed by ACRE, including Merz Aesthetics. Neil Clarkson, co-founder and director of ACRE, commented, “This partnership marks an incredibly exciting next step for ACRE. As one of our most significant collaborations of the year, it reflects the continued growth and momentum of our business.”
A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses
BAMAN END OF YEAR RECAP
As we head into the final month of 2025, it feels its been a landmark year for BAMAN. A year of big decisions, real progress and stronger connections across our association.
The year started with the election of our new board of directors, chosen for the first time by members.
Behind the scenes, we embedded two new sub-committees, the reformed Education & Training Committee and the Regulatory Sub-Committee, both of which having already influenced key decisions, event content and member development planning for 2026. Additionally, we’ve expanded our team at head office. Tara Hoyland rejoined BAMAN as partnerships and sales manager, bringing stronger opportunities for members to directly engage with the sector’s leading brands.
Annual conferences and regional meetings
In April, our Spring Symposium returned to London with packed sessions tailored to our most advanced nurses – with many sessions led by BAMAN members themselves.
Momentum continued with regional meetings across the UK, offering CPD, peer review and basic life support training, arranged with input from BAMAN’s growing network of regional leaders
The annual Autumn Aesthetic Conference, held in September, was the largest in BAMAN history. With record attendance, the event set a new benchmark for BAMAN’s educational content and on-site engagement opportunities. We wrapped up the year with our first-ever national BAMAN Christmas Party and Awards. It was a full house, with members travelling from all over the UK to celebrate their achievements.
There is already plenty in motion for 2026 already, including local socials, CPD sessions and the next round of regional meetings. Thank you to everyone who helped make this year what it was. We’re proud of how far we’ve come and we’re just getting started.
This column is written and supported by BAMAN
14 March 2026, Hilton Park Lane, London
Winner of Best Clinic Ireland and Northern Ireland 2025 Dr Ahrooran Sivakumar discusses the importance of attending The Aesthetics Awards 2026
Why I believe every clinic should attend I cannot recommend The Aesthetics Awards enough to fellow practitioners and clinic owners. This was my third year at the event and year on year they make this a night not to forget. The event is so much more than a celebration, it is a gathering of the most passionate and forward-thinking people in our specialty. There is a real sense of unity in the room, a shared understanding that while we may all run separate practices, we are collectively raising the bar for the entire profession.
The power of recognition and team spirit
One of the most rewarding aspects of winning Best Clinic Ireland and Northern Ireland was seeing what it meant to my business partner, nurse practitioner Duvessa Cochrane, team and family. Every single person in our clinic contributes to the patient journey from consultation to aftercare and this recognition belongs to all of them.
Events like The Aesthetics Awards are vital for team morale. They give everyone a chance to pause, celebrate and appreciate how far they have come together. In a field that often demands precision, long hours and emotional and financial investment, taking the time to reflect and celebrate success is essential.
Being part of such an event inspires reflection on our practices, what we could do better, our training and the quality of care we deliver. It challenges us to evolve, to innovate responsibly and to continue learning from one another.
For me, the night was not just a celebration of what we have achieved – but a reminder of why I keep doing what I do, to make people feel confident, comfortable and truly themselves.
The US Food and Drug Administration (FDA) has issued warning letters to website owners illegally marketing unapproved and misbranded botulinum toxin (BoNT) products.
Online, the agency stated that it is aware of adverse events associated with unapproved and misbranded BoNT products, including botulism symptoms.
A total of 18 websites were listed by the FDA, including global skincare company Derma Solution, retailer Glam Derma and medical supplier Korea Filler Experts, who were found to be selling unapproved injectable BoNT products for sale, breaking the US Food, Drug and Cosmetic Act that bans selling unapproved or misbranded drugs.
Marty Makary, FDA commissioner, said, “Unapproved and misbranded botulinum products carry serious health risks. Today we’re taking action to protect patients and prevent online entities from selling these dangerous products.”
An independent report commission by the Department for Work and Pensions has revealed that sickness is costing employers around £85bn a year, according to the BBC
The review, led by former John Lewis chair Sir Charlie Mayfield, described the situation as an ‘economic crisis’, citing lost productivity and sick pay as key contributors to the wider financial impact. Sir Mayfield noted that rising sickness levels are being driven by a “surge” in mental health issues among younger people, alongside musculoskeletal problems, aches and joint pain in older workers that are leading many to leave the workforce. Sir Mayfield commented, “For employers, sickness and staff turnover bring disruption, cost and lost experience. For the country, it means weaker growth, higher welfare spending and greater pressure on the NHS.”
As the Government introduces its Employment Rights Bill and calls for greater investment in workplace health, leaders across the aesthetics sector are warning that a specialty already known for its physical and high-pressure demands must prioritise staff wellbeing. Many practitioners perform highly skilled, hands-on work that can contribute to back, shoulder and joint strain.
Sadie Van Sanden Cooke, COO of the British College of Aesthetic Medicine (BCAM), commented, "At BCAM wellbeing starts with genuinely looking after one another. We encourage open conversations, mutual support and a healthy-work life. We keep a close eye on workloads through regular check-ins, open-door communication and a collaborative approach where the support office works together as a true team. If someone feels stretched, we share tasks and adjust priorities so no one feels overwhelmed. A culture of wellbeing at BCAM means feeling valued, supported and included every day."
Aesthetic practitioner and clinic owner, Dr Aggie Zatonska, commented, “In my clinic, we provide additional resources and specific techniques (relaxation, breathing) to use when there are changes in psychical or mental wellbeing since these can be early signs of distress and emotional build-up. For burnout, just like skin health, prevention is key. Management of your mental energy is essential to prevention of burnout. Within our practice, we focus on prevention.”
Announcement
Aesthetic manufacturer Teoxane has introduced Joanna Underhill as new general manager for the UK&I.
Teoxane shares that Underhill joins the company from pharmaceutical company Allergan Aesthetics, an AbbVie company, where she served as general manager in the States of the Arabian Gulf. Prior experience includes roles within pharmaceutical companies Astellas Pharma, Galderma, Merz Aesthetics and Swiss healthcare company Roche.
The company adds that Underhill’s appointment coincides with the announcement that incumbent general manager Sandra Fishlock will be stepping down from her role after 15 years with the company. Teoxane UK&I confirms that Fishlock will remain in the business until December 31, 2025.
Underhill commented, “I’m delighted to join Teoxane UK&I at such a pivotal moment in its journey. The UK&I markets are dynamic and full of opportunity, and I’m excited to build on the strong foundation laid by Fishlock and the team. I look forward to working closely with our talented team and valued partners.”
Conference Report
The International Academy of Advanced Facial Aesthetics (IAAFA) 2025 brought together leading figures for the latest techniques, treatments and technologies.
The conference opened with a speech from Professor Bob Khanna, aesthetic practitioner and president of IAAFA who shared that over the last two decades, IAAFA has trained thousands of practitioners, set new safety benchmarks and raised £404,097 for children’s charities.
Delegates then enjoyed a series of talks from aesthetic practitioners Dr Anjuli Patel, Dr Nina Bal, Dr Alexandra Day, Dr Aamer Khan, Dr Ranj Rai and nurse prescriber Ainé Larkin. Lorna Bowes, CEO of AestheticSource, was also in attendance alongside holistic coach Ariella Indigo and consultant ophthalmic and oculoplastic surgeon Mr Raman Malhotra.
The evening transitioned into the IAAFA Charity Ball and Aesthetic Awards Ceremony which featured seven award categories including the Best Profile Enhancement Award, bestowed to aesthetic practitioner and dentist Dr Kate Teiman, and the Best Mid-Face Rejuvenation presented to aesthetic practitioner and dentist Dr Rehanna Beckhurst.
Professor Khanna shared, “I founded IAAFA with two core objectives: to unite clinicians from around the world in the pursuit of clinical excellence in aesthetic medicine, and to use our collective expertise to give back and create a meaningful social impact. This year’s 20th anniversary conference and charity ball truly embodied that vision. The atmosphere, the camaraderie and the passion for learning were remarkable, and seeing so many clinicians come together reminded me exactly why I started IAAFA.”
Discover the latest gift set collections for this year’s festive season mesoestetic launches limited edition product sets
Aesthetic manufacturer mesoestetic has unveiled three limited edition kits. The Glowing Routine includes the Brightening Foam Cleanser, AOX Ferulic and HA Densimatrix concentrated serums, the Age Element Brightening Cream with vitamin C and a gua sha tool. The Lifting Routine features the same cleanser and serums, paired with the Age Element Firming Cream with peptides and a gua sha tool. The Anti-Wrinkle Routine also contains the Brightening Foam Cleanser and serums, combined with the Age Element Anti-Wrinkle Cream formulated with retinol and biopeptides along with a gua sha tool.
Advanced Nutrition Programme releases Festive 2025 Collection Supplement company Advanced Nutrition Programme (ANP) has unveiled its Festive 2025 Collection, featuring four curated supplement sets. The Skin Youth Synergy Duo combines ANP’s Skin Omegas+ and Skin Youth Biome to support overall skin vitality and gut health. The Skin Clear Synergy Duo pairs with Skin Accumax and Skin Clear Biome to help target acne. The Skin Collagen Support Supersize is formulated to address signs of eye contour and skin elasticity. Finally, the Skintelligent System set includes Skin Moisture IQ, Skin Even IQ, Skin Collagen Synergy and Skin Ultimate.
The Skin Diary introduces The Ultimate Skin Ageing Duo
Skincare company The Skin Diary has launched The Ultimate Skin Ageing Duo, combining the Night Repair Therapy Cream with the Age Defence Moisturising Day Cream. The Night Repair Cream contains bilberry extract, microdispersed lycopene and retinyl palmitate, whilst the Age Defence Moisturiser includes encapsulated sunscreen, DNA repair enzymes and antioxidants.
Sensilis unveils Upgrade Calming & Firming Kit
Skincare company Sensilis has presented the Upgrade Calming & Firming Kit, featuring the Upgrade AR Moisturiser and Upgrade Eye Cream. The moisturiser aims to soothe redness, strengthen the skin barrier and improve firmness, while the eye cream is designed to reduce puffiness, brighten dark circles and enhance firmness.
Patient booking software company Zenoti has launched a new AI platform to enhance its in-clinic booking system. The company shares that the new platform includes AI-powered call answering and a patient engagement feature designed to reduce missed calls, optimise revenue opportunities and help businesses to deliver a more personalised and efficient service.
Zenoti adds that the AI Receptionist is integrated into its AI powered phone service – HyperConnect Voice – and works with existing telephone numbers, guest records, appointment books, membership settings, point of sale and communication tools. Geraldine Fusciardi, Zenoti senior vice president for Europe, commented, “We’re delighted to have launched AI Receptionist to our UK customers. Sophisticated, AI-powered digital receptionist tools such as Zenoti AI-Receptionist are helping to reshape the specialty, improving service and giving businesses the competitive edge.”
Product Launches
Skincare company Revision Skincare has introduced the Tinted YouthFull Lip Replenisher and HA HydraSerum+.
Available through aesthetic distributor AestheticSource, the Tinted YouthFull Lip Replenisher aims to target visible signs of ageing on the lips. According to the company, the product formula features two bioavailable peptides, an amino acid, hyaluronic acid, tetrahexyldecyl ascorbate and green tea.
Accompanying this release is the HA HydraSerum+, which features HydraShield Technology, aiming to deliver deep hydration and support skin elasticity. Revision Skincare explains that the formula combines multi-molecular hyaluronic acid, peptides and antioxidants to enhance moisture retention and support collagen function.
CEO of AestheticSource, Lorna Bowes, commented, “We are proud to announce the launch of the Tinted YouthFull Lip Replenisher, offering patients an all-in-one lip treatment that soothes, hydrates and targets the visible signs of lip ageing. We are also excited to release the HA HydraSerum+, offering an advanced, weightless hydration solution. This innovative serum delivers multi-layer moisture, enhances skin texture and supports collagen production.”
Antiageing Cream Laboratoires
Medical aesthetics company
Laboratoires FILLMED has launched the FILLMED SKIN PERFUSION ARCHITECH PRO CREAM.
The company shares that the cream is formulated with 95% natural origin ingredients and is powered by FILLMED’s SI-HYAL Complex, which includes a blend of two hyaluronic acids and silanol, as well as three Pro-Matrix Actives (mannose-6P, phyto-silybin and biolipids).
Scott Julian, Laboratoires FILLMED business unit director UK&I, commented, “Unlike conventional formulations that focus solely on surface hydration or isolated proteins such as collagen, this innovation works on the entire structural matrix of the skin, targeting four key youth proteins with clinically proven efficacy.”
Evening
Laser device company
Seriderm UK hosted Seriderm Takeover: The Party on November 6 in London.
Held at Horizon 22, the evening acknowledged Seriderm UK’s acquisition of device manufacturer Cynosure Lutronic. The programme featured presentations from plastic surgeons Mr Arash Moradzadeh and Mr Andrei Popa, aesthetic practitioner Dr Saleena Zimri and consultant dermatologist Dr Emma Craythorne. Additionally, aesthetic practitioner Dr Priya Verma was announced as a key opinion leader for Seriderm UK, and Seriderm 360 was introduced as an educational approach centred on learning with field specialists.
Kevin Williams, clinical director at Seriderm UK, commented, “The Seriderm Takeover in London was outstanding, an inspiring blend of education, innovation and specialist insight. It was a privilege to be part of such a high-level event advancing safe, effective aesthetic practice.”
Conference Report
Aesthetics was invited to this year’s Aesthetic Dialogue, held on November 14-15 at Prague Castle, Czech Republic.
The two-day event attracted 360 delegates from 29 countries across five continents, 20 exhibitors and 29 speakers presenting across the Main and Innovation stage.
The conference opened with Prague LAB owners, maxillofacial surgeon Dr Monika Kavková and Eva Osvaldová, followed by Dr Jani van Loghem and Dr Lee Walker’s session titled, ‘Where We Are in Aesthetic Medicine: Improving Quality of Life’. Dr Walker went on to explore ‘Beauty and Attractiveness: Age-Related Treatment Options,’ before Dr Loghem returned to discuss ethnic differences in aesthetic assessment and treatment.
Day one covered a broad spectrum of upper-face topics, including biorevitalisation, structural optimisation prior to filler placement, and the integration of dual-layer regenerative treatments with volume correction. This segment was led by oral and maxillofacial surgeon Dr Yuliya Gusarova. Plastic and reconstructive surgeon Dr Luciano Lanfranchi followed with a live upper-face anatomy demonstration, complemented by Dr Steven Harris’ live ultrasound assessment of the same region.
The afternoon sessions focused on the retinacular cutis and facial ligaments, with Dr Evgeniya Shelemba outlining treatment strategies for these connective structures. Attention then shifted to non-surgical approaches for the periorbital region, with insights from Dr Kyu Ho Yi, Dr Kavková and Dr Loghem. Plastic surgeon Dr Konstantin Frank expanded on considerations for treating both younger and older patient groups.
After the lunch interval, delegates heard from further international speakers including Dr Lim Ting Song, Dr Sonja Sattler, Dr Loghem, Dr Frank, Dr Harris, Dr Andrew R. Christie Schwarz, Dr Panajot Papa and Dr Katinka Pónyai. Topics included ‘Toxin Mastering the Full-Face Lift’, ‘Botulinum Toxin Explain: Structure, Function and Mechanism,’ and live assessments of mid-face patients, covering the tear trough, cheeks, pyriform fossa and nose, alongside discussion of the role of the SMAS in aesthetic procedures.
The panel discussion prompted thoughtful consideration on several topics, including the use of ultrasound as a diagnostic tool for assessing fillers in clinic, and a debate around the term “lifting effect” in relation to hyaluronic acid, questioning whether it fully captures its actual function.
Day two reflected the event’s multidisciplinary nature bringing in speakers for a series of focused sessions spanning injectables, complications, threads, product innovation and medical aesthetic research. Additional speakers included Dr Roshan Ravindran, Dr Omar Haroon, Dr Michael Kim, Professor Sky Wong and Professor Lee Smith.
The morning opened with a series of practical demonstrations centred on nasolabial fold treatment, comparing cannula and needle approaches and examining material behaviour, followed by updates on hyaluronic acid biomodulators and current philosophies in injection strategy. Lip techniques were a strong feature of the early agenda, with speakers presenting contrasting methods for natural shaping, tool selection and aesthetic balance.
Mid-morning sessions moved into full-face assessment, tear trough management and neck rejuvenation, with anatomy and safety repeatedly emphasised across a multi-speaker segment. The morning closed with an overview of evolving treatment standards and risk-aware practice.
The afternoon shifted towards research, complications and correction strategies, providing delegates with evidence-led insights into adverse event recognition and aesthetic revision. Technology integration took centre stage with a session on thread indications supported by VECTRA H2 imaging, followed by a panel discussion exploring practical applications and patient management.
The day concluded with updates on biomodulators for the neck and décolletage, rounding off a programme focused on safe, anatomically grounded practice and emerging innovations in the aesthetic field. Delegates were invited to a gala dinner at National House Vinohrady to reflect on the event.
When asked by Aesthetics about the significance of presenting as a speaker and its impact on the future of the specialty, Dr Schwarz commented, “Aesthetic Dialogue has the versatility and the variety to look at all aspects of regeneration and aesthetics. What I like is that there’s presentations about health of the body, psychology, mindfulness in combination with regenerative therapies and our usual injectables and aesthetic procedures. It is more holistic, taking the modern patient more seriously, becoming less of a money-making machine and more of a journey for both the practitioner and the patient themselves.”
In an exclusive interview with Aesthetics, Dr Kavková reflected on the conference’s emphasis on “dialogue” and what this approach offers delegates. She commented, “The idea behind it was to show the audience every possible perspective in their everyday life and practice. It’s not just about what companies say or what doctors say, but really focusing on open and transparent discussion and dialogue between the best possible experts in the world.”
IMCAS World Congress 2026 is set to stand as the premier international gathering for physicians shaping the future of dermatology, plastic surgery and medical aesthetics. Bringing together a world-class roster of distinguished specialists, the congress will deliver a rigorous, research-based agenda that highlights the latest scientific and technological breakthroughs shaping patient care.
A major highlight this year is the transformative role of artificial intelligence (AI). Sessions will delve into AI-driven diagnostic systems, predictive modelling for treatment outcomes, and sophisticated imaging analysis powered by pattern recognition. Participants will discover how AI is being leveraged to tailor therapeutic strategies, enhancing both safety and clinical efficacy across diverse aesthetic procedures.
True to its reputation, IMCAS continues to champion surgical excellence. In-depth sessions on deep plane facelift techniques will reveal methods designed to preserve natural anatomy while extending the longevity of results. Complementing these sessions, the IMCAS Live Augmented Surgery demonstrations will give attendees a rare opportunity to observe real-time surgical artistry – covering procedural intricacies, tissue handling, and complication management under the guidance of leading international surgeons.
A dedicated segment on longevity and cosmeceuticals will explore how the molecular science of ageing translates into practical interventions. Experts will share the latest findings on bioactive compounds, peptide-based formulations, and regenerative therapies that support cellular function, strengthen the skin barrier, and enhance dermal vitality.
The congress will also spotlight hair science and regenerative trichology, addressing the latest evidence-based approaches in follicular unit transplantation, stem cell therapies, and growth factor modulation. Attendees will benefit from detailed discussions on patient selection, procedural techniques, and long-term outcome evaluation.
Cutting-edge skin imaging and diagnostic sessions will cover technologies such as high-resolution multiphoton microscopy, AI-assisted dermoscopy, and 3D volumetric skin analysis. Physicians will gain practical insight into integrating these tools into aesthetic practice to enhance precision in assessment, treatment planning, and post-procedure monitoring.
No IMCAS event would be complete without its renowned Signature Modules, offering participants unparalleled educational experiences:
· Anatomy on Cadaver delivers simultaneous live anatomical dissections and patient procedures, focusing on facial, cranial, and soft tissue structures under the guidance of expert anatomists and clinicians.
· IMCAS Innovation Tank gives startups the stage to pitch their breakthrough technologies and ideas to an international audience.
· NextGen Derm Awards celebrate the rising stars of dermatology and their pioneering research within the IMCAS community.
IMCAS Alert Complication Management features real-world cases submitted by physicians, with global experts providing proactive insights on prevention, recognition, and management of complications.
· IMCAS Ultrasonography Summit, a newly introduced pre-course, welcomes practitioners of all skill levels to refine their ultrasound-guided aesthetic techniques.
Far more than a conventional conference, IMCAS World Congress 2026 represents a dynamic intersection of science, precision surgery, and next-generation innovation. For physicians devoted to advancing their clinical mastery and achieving superior patient outcomes, this congress is an unmissable event.
Annual Conference
The Regenerative Aesthetic Medicine Conference and Exhibition (RAMCE) held its annual conference on November 8 at the Pullman Hotel, London.
RAMCE 2025 opened with a welcome from content director Chloé Gronow and commercial director Simon Haroutunian. The day followed with a programme led by the Regenerative Aesthetic Medicine Institute (RAMI) Scientific Committee.
Aesthetic practitioner Dr Kate Goldie presented a framework for defining regenerative aesthetics, discussing shared scientific language and emphasising evidence-based standards. Next, Professor Mark Birch-Machin delivered a session on mitochondrial function and its relevance to ageing, resilience and regenerative responses. In the afternoon, aesthetic practitioner Dr John Quinn hosted a practical session on lasers, while aesthetic practitioner Dr Lee Walker closed with new insights on complications in regenerative treatments.
Gronow commented, “Our goal was to curate an agenda that genuinely moves the conversation forward scientifically, ethically and practically. The feedback shows that the community is hungry for this level of depth, and RAMCE is becoming the place where that standard is set.”
Educational Event
Aesthetic equipment supplier Ivanmed invited practitioners to the Medical Society of London on Monday, November 3.
Collaborating with health technology company Map My Mole, the masterclass was designed to educate and inform practitioners on CryoPen application, diagnostic accuracy and risk management. The day was kickstarted with consultant dermatologist Dr Toby Nelson, who introduced Map My Mole and how it supports accurate lesions assessment, alongside types of dermoscopy and various case studies using CryoPen. After lunch, general practitioner Dr Mateen Jiwani explored safe and effective treatment approaches of cryotherapy, whilst considering pigmentation, UV risk and complications. His session concluded with a live CryoPen demonstration.
Simon Ringer, sales director at Ivanmed, commented, “Our CryoPen Masterclass delivered high-level education led by Dr Nelson and Dr Jiwani. It was inspiring to see practitioners so focused on enhancing their knowledge and delivering safer, more confident treatments.”
Publication
Aesthetic practitioner Dr Melis Binbas has released a beginner’s guide titled The Face of Medicine: The Insider Playbook for Medical Aesthetics.
According to Dr Binbas, the book addresses unanswered questions students and professionals often have when entering the specialty. These range from understanding what belongs in an aesthetics toolkit, to learning how to store patient data, to obtaining insurance and establishing your own practice, shares Dr Binbas.
Discussing the release of her book with Aesthetics, Dr Binbas commented, “For years, I noticed that guidance was often passed down by word of mouth, and aspiring practitioners were left navigating a complex and ever-evolving field without a reliable compass. My hope is that this book becomes the steady voice in that conversation, a comprehensive companion that covers the basics, demystifies the fundamentals and empowers the next generation of practitioners to thrive.”
Honouring the legacy of Esse Skincare founder Trevor Steyn
The Aesthetics team extend their condolences to skincare company Esse Skincare following the passing of founder Trevor Steyn. Steyn was widely respected within the sector for his pioneering work in probiotic and microbiome research, having recently shared his expertise in the November issue’s Special Feature. The team had the pleasure of working closely with Steyn on this piece, benefiting from his insights and passion. Our thoughts are with his family, friends and colleagues at this difficult time.
AI tool for aesthetic complications debuts
Aesthetic practitioner Dr Benji Dhillon has launched an AI tool for aesthetic complications called the Injectix Complication Assistant (ICA). The ICA is a self-learning tool that draws on the peer-reviewed medical literature (PubMed) and recorded lectures from global key opinion leaders in complications. Dr Dhillon commented, “Many injectors are left confused and don’t know what to do when thinking about how to deal with complications. I can’t wait for this to help improve patient outcomes and drive injector confidence globally.”
Crown Aesthetics appoints new marketing manager
Aesthetic manufacturer Crown Aesthetics has appointed Joanna Neal as marketing manager for the UK and Ireland. Neal will be leading marketing activity for SkinPen and Biojuve at Crown Aesthetics and has a history working for pharmaceutical company Galderma and aesthetic manufacturer Sinclair. Neal commented, “We have a well-established team in the UK and Ireland who have achieved great success and I hope to bring my experience and expertise from over 10 years in aesthetics to build on that and achieve great things with the team.”
releases two new products
ALLSKIN|MED has expanded its portfolio with two new exfoliating innovations, the Renewal Scrub and Renewal Pads. According to the company, both feature triple-action exfoliation – physical, chemical and enzymatic. The scrub aims to prime skin for procedures or homecare, while the exfoliating pads target congestion, excess oil and dullness, designed to promote clearer, luminous skin.
NUCEIVA® is indicated for the temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at maximum frown (glabellar lines), when the severity of the above facial lines has an important psychological impact in adults below 65 years of age.1
Aesthetics examines the landmark case victory that helped establish a VAT framework for aesthetic practitioners, providing legal clarity on when treatments may be exempt from VAT
Illuminate Skin Clinic has won a legal appeal at the Upper Tribunal (UT) regarding how VAT applies to aesthetic treatments – thus overturning an earlier decision by the First-tier Tribunal (FTT) from 2023.1,2 Until now, His Majesty’s Revenue and Customs (HMRC) has insisted that a diagnosis of an existing medical condition must be present for the treatment to be VAT exempt, as well as the treatment serving the purpose of treating that condition and being performed by a registered healthcare professional (HCP).3
A timeline of events
Illuminate Skin Clinic was founded by aesthetic practitioner of 13 years Dr Sophie Shotter. Dr Shotter shared that after deregistering from VAT in the last quarter of 2016, HMRC began querying the accounts of Illuminate Skin Clinic in 2017, and found that Dr Shotter should have been paying standard rate VAT. In 2019 Dr Shotter appealed this decision on the grounds that the treatments provided were medical. However, in 2023, the FTT dismissed the appeal, concluding that the supplies do not constitute “medical care” and should have been standard rated. Dr Shotter, with the help of Monckton Chambers, who represented the appellant in this case, Veronica Donnelly, chartered VAT advisor for the international advisory group Azets, and Dr John Curran, chair of the British College of Aesthetic Medicine's Regulatory, Ethics and Professional Standards Committee, as well as owner and medical director of Aesthetic Skin Clinic, appealed this decision.
Dr Shotter says, “What I have fought over for the last nine years wasn’t because of the money but because I felt that if I accepted that everything I did was outside of the exemption, that I would be accepting that what we practice isn’t medicine, and that’s something I was not prepared to do.”
The landmark ruling
In October 2025, the UT concluded that the FTT had applied an overly narrow legal testing in assessing whether the clinic’s treatments served a therapeutic purpose, and lowered the threshold for how practitioners should document diagnosis.1,2 The appeal confirms that any treatment may be exempt from VAT if it is administered by a registered HCP, is supported by sufficiently evidenced clinical judgment and its principal purpose is determined to be therapeutic.1,2
Donnelly explains that if a treatment is both therapeutic and cosmetic, it is necessary to identify the principal purpose which must be medical to be VAT exempt. This can be assessed through a multifactorial analysis which can include the patients’ desires, if the clinic is purely advertised as cosmetic online not medical, as well as what services the doctor provides.
“The definition of medical has widened,” Donnelly explains, “A HCP always needed a diagnosis of an existing condition for a treatment to be deemed medical but now they may also suspect a diagnosis, or demonstrate the treatment is for the purpose of preventing a specific future condition or disease.” This could include a risk of future carcinoma where there is evidence of skin damage such as moles, or blepharoplasty to prevent future sight impairment. Donnelly adds that a clinic does not need to be registered with the Care Quality Commission (CQC) to qualify for a VAT exemption; however, being registered may support the application and serve as an element of the multifactorial assessment. The practitioner must however, be listed with an appropriate regulatory body, such as the General Medical Council (GMC).
Dr Shotter explains that many first-tier tribunal judgments have previously gone against practitioners in similar cases. “True clarity,” she adds, “could only come from an upper-tier tribunal – one that rules on points of law rather than the facts of individual cases.”
Dr Curran who has been a lifelong advocate for patient safety and supported Dr Shotter, explains, “The VAT exemption is a matter of law and both the profession and HMRC are obliged to follow the legal rulings. This Upper Tier Court has helpfully set out the guidance for both HCPs and HMRC on how to assess what is exempt and what is non-exempt.”
Donnelly reiterates that practitioners cannot take shortcuts in evidencing medical purpose, but the new guidelines clarify that they no longer need to provide excessive detailed documentation as HMRC previously advised. “You still need to provide details of what the condition or disease is or is suspected to be and why it is the main purpose of what you’re doing, as opposed to the cosmetic outcome,” she says, “as without that, it is still considered cosmetic.” Donnelly adds that the safest way to determine if a treatment provided in clinic may be VAT exempt is if it aligns with an existing or potential diagnosis.
Dr Curran echoes this, saying, “You will need to set out in your records why and how your patient presented, your findings and diagnosis where you are able to, the treatment offered and most importantly indicate the purpose of your management plan. In short, write proper medical style notes as a contemporaneous record of your practice and refer to the test set out in the judgement for a guidance on what is required to support your decision.”
Dr Shotter says, “I do think it’s a massive step forward, and it really strengthens the position of aesthetic and medically led clinics. It is not as simple as what HMRC have been trying to suggest, that all injectables are essentially cosmetic.”
The new framework is now applicable across the UK. Anyone who feels that they may qualify for VAT exemptions under the new guidelines must review their VAT registration status and consider submitting a voluntary disclosure if eligible, which can be backdated up to four years.
It is also important to update future consultation templates to capture suspected or preventative diagnoses, and to identify any previous treatments that were historically standard rated for VAT but for which the clinical notes provide evidence of qualifying diagnoses. In addition, time should be taken to reassess the language used in future documentation to ensure it accurately reflects medical intent.
Dr Curran explains that to date, HMRC have not appealed the judgement of this court of record. This now becomes the guidance on the law which first tier tribunals, HMRC and HCPs must follow.
In the ever-evolving field of medical aesthetics, staying informed, connected and confident in your practice is essential. Practitioners are constantly balancing clinical excellence with business growth, regulatory updates and patient expectations – and finding reliable, practical education can be challenging amid a busy workload.
The Aesthetics Conference & Exhibition (ACE) will return to London’s Business Design Centre on March 13 and 14 2026, bringing together thousands of medical
aesthetics professionals for two days of education, inspiration and connection. Following a record-breaking 2025 event, ACE 2026 is set to raise the bar once again, introducing a host of new features designed to enhance clinical learning, foster valuable business relationships and provide even more opportunities to engage with the very best in the specialty. Whether you’re a first-time visitor or returning, this is your chance to connect with peers, discover cutting-edge innovations and shape the future of aesthetics.
The Cutting Edge Theatre
Leading the charge in innovation, the brand-new Cutting Edge Theatre will debut at ACE 2026, offering an unmissable programme focused on the latest scientific and technological advancements in aesthetics. You can expect to discover next-generation techniques, devices and products, with sessions led by some of the most forward-thinking practitioners and specialty pioneers.
From live demonstrations and data-driven insights to discussions about the future of regenerative aesthetics, the Cutting Edge Theatre will be the go-to destination for those wanting to stay ahead of the curve. This exciting addition aims to bridge the gap between science and practice, ensuring delegates leave with practical knowledge and a deeper understanding of the trends shaping the treatments of tomorrow.
Companies at the stage include:
· Croma Pharma
· Cutera
· Galderma · VIVACY Laboratories
· Plus more!
This year at ACE, the Aesthetics Journal will introduce an intimate Roundtable Series, offering focused, meaningful discussion among leading voices in medical aesthetics. These small-group discussions will spotlight some of the most important topics shaping our sector, including ethics, regulatory developments and both emerging and established practitioner challenges. This format champions collaboration, transparency and shared learning across the profession.
Practitioners who would like to be considered for participation are invited to contact the editorial team to express interest.
After proving a huge success at its sister event, the Clinical Cosmetic Regenerative Congress (CCR) London, the Networking Trail will make its ACE debut in 2026. Designed to help delegates make meaningful business connections and friendships, the trail will guide visitors through a curated route of networking opportunities each offering unique experiences, special offers or interactive activities throughout the show.
By following the trail, practitioners can easily identify peers and companies that align with their interests and explore new partnerships, collaborations and product discoveries. Whether you’re looking to expand your clinic offering, meet potential suppliers or simply get to know like-minded professionals, the Networking Trail ensures no opportunity for connection is missed.
Several new features from ACE 2025 will be returning this year.
Allergan Aesthetics Symposium
Following a successful first year as Headline Sponsor, the Allergan Aesthetics Main Auditorium will once again deliver world-class education from one of the specialty’s leading pharmaceutical companies. Attendees can look forward to expert-led sessions exploring the latest innovations, evidence-based techniques and clinical data surrounding Allergan’s product portfolio.
Known for its commitment to advancing clinical standards and practitioner safety, Allergan’s return promises another year of insightful presentations that blend science, artistry and practical application.
ACE’s Association Theatre will offer educational sessions from leading aesthetics associations and professional organisations. The theatre provides a platform for specialty-wide collaboration, helping to align practitioners and associations on key topics such as regulation, patient safety, ethics, key updates and education.
Delegates can join discussions led by respected voices in the field, gain updates on standards and guidelines and contribute to conversations that help shape the future of medical aesthetics in the UK.
This year the stage has a new location, situated in the Platinum Hall, home to all of the show’s platinum sponsors. This is the perfect location to immerse yourself in
education surrounded by the associations driving progress in aesthetics.
Aesthetics Mentoring, sponsored by Allergan Aesthetics, will return to ACE this year, giving seasoned professionals and those new to the specialty the chance to connect directly with experienced experts in the field. Through one-to-one conversations and small group sessions, attendees can seek tailored advice on topics such as clinical development, business growth, and career pathways.
This initiative embodies ACE’s ongoing commitment to education and community, ensuring practitioners at every level feel supported in achieving their professional goals. Whether you’re looking for clinical guidance, business insight or general advice on navigating the aesthetics landscape, Aesthetics Mentoring will be an invaluable resource.
The Aesthetics Challenge: Pushing the Limits of Cannula
Get your live injection fix at The Aesthetics Challenge on day 2, this year focusing on how cannulas can be used to achieve optimal results in medical aesthetics. This session will feature three expert injectors each demonstrating their distinctive technique to safely and effectively create leading aesthetic outcomes.
As the UK’s leading medical aesthetics conference and exhibition, ACE continues to be the central meeting point for practitioners, brands and educators from across the specialty. Here’s what attendees had to say after last year’s event…
“As anticipated, ACE was a fantastic weekend providing opportunities to learn and network all under one roof. The diverse talks and treatment demonstrations meant I could easily pick relevant ones to my practice and I was able to speak to lots of different companies about a potential device purchase for my clinic.”
Dr Bethany Rossington, aesthetic practitioner and speaker
“I really enjoyed ACE 2025! It felt fresh and exciting, with plenty of new things to discover. I kept bumping into friends and meeting new people, it had such a fantastic buzz!”
Professor Brian Franks, aesthetic practitioner
Celebrate excellence at The Aesthetics Awards 2026
Next year’s Aesthetics Awards will take place at a brand-new venue, Hilton Park Lane, London, on March 14, immediately following ACE. Recognising outstanding achievements across clinical practice, innovation and patient care, the Awards bring the aesthetics community together for an evening of celebration, connection and inspiration. Join your peers to honour the individuals, clinics and companies shaping the future of medical aesthetics. Tickets are on sale now! Take advantage of the Early Bird rates before they end on Dec 31.
Mark your calendars for March 13 and 14, 2026, and get ready for another unmissable weekend of education, innovation and inspiration at the Business Design Centre, London. Join the conversation, grow your network and experience the future of aesthetics at ACE 2026.
Register free now!
What Starfill can do?
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Skin Irritation Test Completed
Post-Procedure Soothing Care
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Soothing & Barrier Renewal
Calms post-procedure skin while supporting barrier and keratin layer recovery
Promotes collagen synthesis in damaged skin, supporting regeneration and reducing inflammation contributing to anti-aging and wrinkle improvement.
Transcriptome analysis demonstrates multi pathway activity across key skin regeneration processes.
1. Madecassic Acid
2. Madecassoside
Soothes and revitalizes damaged skin, enhances conditioning, and improves overall skin tone and clarity.
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Calms irritation, nourishes the skin, improves elasticity, balances oil and moisture, and supports collagen synthesis in the dermis.
Protects skin, minimizes pores, relieves inflammation, soothes irritation, promotes regeneration, and refines skin texture.
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Strengthens the skin barrier, enhances elasticity and flexibility, provides antioxidant protection, and soothes sensitive skin.
The Aesthetics
Clinical
Advisory Board
members reflect
on this year’s key trends and look ahead to what the community can expect in 2026
The UK medical aesthetics sector has experienced notable growth and transformation over the past year, driven by key themes of regulation, patient safety and treatment diversification. Regulatory developments have been significant, with the Government proposing a licensing scheme, the Nursing and Midwifery Council (NMC) restricting remote prescribing and Scotland introducing the Non-Surgical Cosmetic Procedures Bill. These measures have impacted the market, with 152 clinics ceasing botulinum toxin treatments between June 2024 and 2025, predominately unregulated providers.1
In parallel, practitioners are broadening their expertise, with 80% now offering multiple treatment modalities, including lasers and advanced therapies, reflecting a clear trend towards longevity-focused treatments.2 This diversification is evident in the rise of multi-treatment clinics, with three in four now offering more than one treatment type. Together, these shifts mark a dynamic and evolving landscape for medical aesthetics in the UK.
To pause for a moment of reflection and celebrate this year’s innovations and milestones, Aesthetics spoke to four aesthetic practitioners and Clinical Advisory Board (CAB) members on key advances, emerging trends and anticipated innovations that are shaping the field today and setting the stage for 2026.
In 2025, research conducted by independent European data collector Norstat on behalf of aesthetic manufacturer Teoxane surveyed over 2,000 women aged 18 to 75 across the UK, revealing important insights into the value of skin health. Skin quality is understood broadly – not only encompassing visible concerns such as acne or wrinkles, but also the overall health of the skin, including texture, tone to hydration, firmness and barrier function.3
Given the negative impact of stress and poor sleep on collagen production, oil regulation and skin repair, effective dermatological care is crucial in supporting the skin’s natural resilience. Through innovative treatments, advanced ingredients like hyaluronic acid – which is already used by 41% of UK women – and personalised lifestyle advice designed to complement clinical care, dermatology is well placed to meet these challenges.3
Considering these important findings, consultant dermatologist Dr Anjali Mahto highlights how 2025 has been a year of advancement and meaningful progress within the field.
A growth in popularity
Dr Mahto notes that, “The past year has been less about intervention and more about refinement.” She continues to add that one standout advancement is the sebum-targeting 1726 nm laser – such as AviClear – which has transitioned “from early adoption to established practice, providing a meaningful, non-pharmacological option for acne management supported increasingly by real-world data.” Equally noteworthy are improvements in erbium resurfacing, especially at newer fibre wavelengths, adds Dr Mahto, which have “strengthened the safety profile for textural and scar work in skin of colour, addressing a crucial area of demand for safer, more effective treatments tailored to diverse skin types.”
Ultrasound-based tightening technologies, such as Sofwave, have also advanced, with a deeper understanding of pulse density and energy delivery translating into “more consistent mid-dermal lift.”
According to Dr Mahto, these developments signal a maturing specialty that embraces “a more analytical, protocol-driven approach, defined by measurable progress rather than novelty.”
trends
Dr Mahto observes that the most striking patient trend this year arises from the widespread use of GLP-1 receptor agonists. She adds that these medications are creating a new category of aesthetic concerns characterised by “structural and proportional change following rapid fat loss.” Patients affected by this trend often seek “restoration of integrity rather than volume augmentation” and tend to present earlier, with a preventative outlook. Common treatment approaches include Profhilo Structura, Sofwave and Pure Impact. Dr Mahto raises that concurrently, there has been a sharp rise in specifically informed questions from skin of colour patients about “safety parameters, energy selection and pigmentation risk.” These evolving patient needs require a more “medicalised approach to consultations, incorporating baseline imaging, comprehensive planning and sequenced protocols that extend well beyond single treatments,” she says.
What will be big in 2026…
Looking ahead, Dr Mahto anticipates that progress will be “defined by integration rather than invention.” Combination protocols that blend ultrasound, laser and biostimulatory treatments within structured frameworks are set to become standard practice. For instance, she highlighted Sofwave in combination with Ultra Clear Coring to address skin laxity, as well as polynucleotides paired with resurfacing lasers. She states that a new concept gaining traction is ‘skinspan’ – an ambition to preserve skin function, elasticity and repair capacity throughout life – which will increasingly inform both patient education and clinical design. Meanwhile, Dr Mahto believes AI-supported imaging technologies are expected to mature into practical audit tools, allowing clinicians to objectively quantify improvements in tone and texture. The most progressive practices will extend their scope beyond dermatology alone, integrating elements of longevity medicine, nutrition and muscular health to deliver truly preventative, measurable care, predicts Dr Mahto.
Measuring success in clinic
Dr Mahto emphasises the importance of setting expectations early, advising that the most successful outcomes come when patients
regard their treatment plan “as a form of clinical partnership rather than isolated procedures.” She underscores the value of starting every plan with detailed analysis, photography and discussion focused on functional goals such as “restoring strength, balance or texture rather than chasing symmetry.” For those experiencing facial changes due to weight loss, she notes that “pacing matters,” with tissue tightening and collagen regeneration taking priority before any subtle volume restoration. “This approach has created greater continuity, more realistic expectations and a deeper sense of patient ownership,” says Dr Mahto.
The International Society of Aesthetic Plastic Surgery (ISAPS) has released its annual global survey, revealing that plastic surgeons performed more than 17.4 million surgical procedures and 20.5 million non-surgical procedures worldwide. Overall, this represents a 42.5% increase over the past four years.4 Consultant plastic and reconstructive surgeon Mr Naveen Cavale noted that 2025 has seen notable growth in facial procedures alongside a marked decline in breast surgeries, a trend he attributes to the current UK economic climate. He emphasises the rising popularity of combining non-surgical and surgical treatments – such as integrating laser therapies with facelifts – to deliver more comprehensive and aesthetic harmonious outcomes. He recommends the Sciton JOULE X laser which can be combined with facelift surgery. “There is a growing sophistication in the use of dermal fillers and botulinum toxin, which are now are being applied more strategically in synergy with surgical interventions,” he explains, such as combining a facelift with erbium laser treatment under the same anaesthetic.
Mr Cavale observes a rise in earlier patient enquiries, with many individuals exploring dermal fillers while simultaneously considering whether surgery might be a more appropriate option. He views this as a positive development that fosters greater collaboration and synergy between surgical and non-surgical practitioners.
At the same time, however, he also expresses concern over an increase in surgical enquiries from younger patients. He explains, “There are few 35-year-olds who genuinely require facelifts. I believe this trend is largely influenced by social media and certain practitioners promoting treatments such as ‘preventative botulinum toxin’ – an approach I do not consider particularly advisable.”
In 2024, more than half a million British patients left the UK for healthcare overseas, with many returning with post-operative complications that required NHS management.5 Cosmetic surgery provider Longevita has released a petition urging the UK Government to introduce regulation for outbound medical tourism. The petition calls for clear legal standards governing medical providers advertising to UK patients.5
Addressing patient safety, Mr Cavale highlights a concerning trend of patients seeking surgery abroad as a way to reduce costs amid rising living expenses. He cautions, “Even with the best surgeries performed overseas, managing complications upon patients’ return can be extremely challenging. Moreover, many practitioners, clinics and companies offer low-cost deals that may not meet the rigorous stands of care required. It is crucial to remember that, in surgery, you often get what you pay for.”
He emphasises that this trend underscores the need to prioritise quality and safety over cost when considering surgical procedures.
Botulinum toxin remains the most widely administered treatment across the UK, offered by 84% of clinics, followed closely by dermal fillers at 68%. In the last 12 months, botulinum toxin treatments increased by 9%, while dermal fillers saw a 14% rise, confirming their sustained popularity. Nurse prescriber and CAB lead Sharon Bennett explains, “Hyaluronic acid fillers and toxins still and will always play a huge part in our practice. The difference now is that we are beginning to use them more cleverly – in injection techniques and growing anatomical understanding – leading to remarkable natural results.” She adds, “We now understand the importance of caring for patients inside, through wellbeing; outside, with topical skin health and regenerative treatments; and by addressing natural ageing skeletal and structural changes.”
Despite the advances, she warns, “There is a lot of rhetoric without basis,” emphasising the need for evidence-based practice.
Bennett has found regenerative medicine to be a focus of not only many conferences over recent years, but a growing subject which she sees many practitioner colleagues implementing in their practice. She says, “These treatments are attractive to both patient and practitioner in terms of a more holistic approach by harnessing the body’s own biological materials to stimulate healing and rejuvenation from within.”
She highlights the appeal of these therapies, which take a holistic approach by using the body’s own biological materials to stimulate healing and rejuvenation. Platelet-rich plasma (PRP) remains widely used, harnessing concentrated platelets from a patient’s blood to boost collagen and repair tissues. Stem cell treatments, mainly using adipose-derived stem cells delivered through nanofat grafting, are growing in popularity for restoring volume and improving skin quality. Polynucleotides have become common additions in clinics, described as “off-the-shelf” options that may outperform PRP, although they currently face regulatory hurdles and require more research to back up their effectiveness.
Regenerative scaffolds such as injectable biomaterials like poly-L-lactic acid (PLLA) and calcium hydroxyapatite (CaHA) offer longer-lasting results by promoting new collagen production, presenting a biological alternative to traditional fillers, explains Bennett.
When asked about anticipated innovations in injectables over the coming year, Bennett highlighted several developments. “We are seeing the introduction of new toxins to the market, which may offer longer-lasting effects or faster onset,” she explains. Additionally, injectables combining amino acids with adjunct biostimulators are emerging, delivering both immediate results and regenerative benefits.
She expects a rise in collagen-stimulating injectable products, particularly from Korea and China, alongside new injectable or needled cell renewal technologies. While these advances are promising, she cautioned against complacency, stating, “These are exciting times but we must not be cavalier.”
Measuring success in clinic
Emphasising the importance of research, she stressed that measuring success in clinic must be grounded in evidence-based treatments. “By relying on treatments supported by robust scientific research and clinical trials, we protect ourselves as well as our
patients,” she says, underlining the need for rigorous evaluation as the field evolves.
The aesthetics specialty is undergoing a paradigm shift, with wellness and longevity-focused treatments rapidly gaining prominence. According to Rare: this category has now become the third most offered service in UK clinics, adopted by 57% of providers as of June 2025 – a 25% increase compared to the previous year.1
Aesthetic practitioner and founder of Human Health Dr Mayoni Gooneratne explains that the sector is moving beyond a one-size-fits-all approach towards. “Truly personalised approaches that consider the hormonal-metabolic interplay and lifestyle factors across the lifespan, such as using nutrigenomics testing,” she notes. Dr Gooneratne believes that technological advancements have revolutionised the field, with biomarker analysis and AI-driven insights enabling earlier detection of ageing process and more precise personalisation of wellness strategies. She also highlights the growing accessibility of such innovations, noting that “at-home diagnostics and digital health platforms are making it easier to access this vital information.”
Emerging trends
Dr Gooneratne has observed a rising number of patients enquiring about preventative strategies, particularly relating to perimenopause, menopause, gut health and longevity. She notes an increasing openness to integrative approaches, combining evidence-based medicine with nutrition, movement and stress management.
What will be big in 2026…
Dr Gooneratne foresees a growing focus on prevention and early intervention within medical aesthetics. Treatments that support the body’s natural systems to rejuvenate skin at a cellular level – rather than merely masking the signs of ageing – are gaining momentum. For example, biostimulators have risen by 50%, carboxytherapy by 43% and platelet-rich plasma (PRP) therapy by 38%.1
“Looking ahead, there is hope for greater research efforts that authentically represent the diversity of women’s experiences,” she concludes. “Meanwhile, digital tools will continue to advance, with the goal of becoming more accessible and inclusive for all.”
Measuring success in clinic
When discussing how best to respond to these emerging patient concerns, Dr Gooneratne emphasises the importance of taking time to listen and developing a holistic understanding. “I use detailed health mapping to help patients recognise their unique patterns,” she explains, “I advocate for collaborative care, working closely with nutritionists, physiotherapists and mental health specialists when appropriate.” She also recommends reaching out to organisations such as British Association for Nutrition and Lifestyle Medicine (BANT) – with whom we have partnerships through the Medical Longevity Summit, co-located at the Clinical Cosmetic Regenerative Congress (CCR). BANT provide listings of recognised professionals on their website and outline the qualifications required to practice.
As the sector moves into 2026, there is a growing sense that medical aesthetics is evolving beyond its traditional boundaries. The market, expected to grow to 300 billion USD by 2035, is witnessing shifting paradigms with innovation and changing consumer preferences as the catalyst.6
There is a broad recognition across CAB members that regulatory developments will shape the framework within which practices
operate, underscoring the importance of safety, standards and professional integrity.
Looking ahead, 2026 feels poised to be a year of measured progress – where thoughtful integration and clinical rigour take precedence, and where the focus remains firmly on providing patient-centred care that is both effective and responsible.
On the regulatory front, Dr Mahto points to the anticipated UK licensing framework for non-surgical cosmetic procedures as a pivotal development. Under this new system, “high-risk interventions are expected to fall under Care Quality Commission (CQC) regulation, with other procedures licensed locally,” she notes. This regulatory reform will bring much-needed clarity to standards around training, documentation and incident reporting. Clinics already operating within CQC governance stand well-positioned to meet and exceed these new requirements.7 She adds, “For the wider field, the new framework should raise standards across the board and bring a clearer sense of professional parity between medical and aesthetic dermatology.”
Echoing the need for strong regulation, Bennett expressed cautious optimism. She says, “I hope the Government will follow the example set by countries like Scotland, but I do not know with any authority what legislation in this country will look like, and it has been delayed again.”
She emphasises the importance of reframing the language around aesthetic treatments. “Until we take the word ‘cosmetic’ out of the vocabulary and replace it with ‘medical aesthetic,’ the seriousness of penetrative or invasive treatments is not fully realised.” She notes how media and social media shape public perception, often downplaying the risks involved.
Advocating for unified regulation, she argues that “we need one set of regulatory standards written, agreed and overseen by experts drawn from all sectors.” Given how rapidly the specialty evolves – where “orphan” treatments can quickly become standard – she stresses that patient protection must be paramount.
She also believes the regulatory register should be maintained by a medical regulatory body such as the CQC rather than an environmental agency. “Patients have the freedom to make choices, but they should be informed and protected by laws designed to safeguard their health and wellbeing, not economic benefit,” she says. “I look forward to being at the table to support and advise on these matters.”
With the specialty continuing to evolve rapidly, staying informed about the latest advancements is essential.
Attending specialty events remains a vital way to stay ahead. Conferences provide an ideal platform for networking, discovering cutting-edge trends and exploring new product innovations. This year, the Aesthetics Conference and Exhibition (ACE) will take place on March 13 and 14 at the Business Design Centre (see p.20). Be sure to register your interest now – we look forward to seeing how 2026 shapes the future of aesthetics.
SECURE
Dr
Ben Taylor-Davies discusses the use of hyaluronidase in medical aesthetics and the main considerations for practitioners
Hyaluronidase is a prescription-only medicine widely used in aesthetic medical practice for a variety of indications.1 Hyaluronidase is utilised by clinicians in the dissolution and dispersal of hyaluronic acid (HA) fillers, both electively and in an emergency setting.1 Hyaluronidase can also be used in the management of complications arising from non-HA fillers as well as in the management of oedema and heamatomas.2 Despite its use, there is concern about allergy to hyaluronidase, and certain myths prevail within medical aesthetics regarding this.
It is important that in medical aesthetics, practitioners understand the background and science of hyaluronidase, its application in clinical practice and the risks associated with its use including allergy and directions for administration.
Background and science of hyaluronidase
Hyaluronidase is a soluble protein that functions as an enzyme. In the UK, it is only available as a prescription medicine.3 It is used within medical aesthetics for both elective and emergency procedures – namely dissolving dermal fillers – however it has been widely used in medical practice outside aesthetics since 1949.1
It is commonly used in medical fields including anaesthesia and pain, cardiology, radiography, oncology, ophthalmology and plastic
within medical aesthetics is to dissolve crosslinked HA dermal fillers, however it is often also employed in the management of complications from non-HA dermal fillers – this is due to its ability to increase membrane permeability of tissues and there improve tissue perfusion in vascular adverse events.5 It can also be used to improve resistant oedema due to this ability.3
Within aesthetic medical practice hyaluronidase has a range of uses. In the UK, hyaluronidase is available in powder-form from Bovine origin (Wockhardt), with single-dose vials containing 1500u.1 These can be reconstituted with an appropriate diluent (sodium chloride, lidocaine) prior to injection. Dilution volumes are scenario and clinician dependent. For example, when using hyaluronidase in the management of vascular adverse events with dermal fillers, high concentrations with low dilution volumes are recommended – this is to facilitate the delivery of high dosages of hyaluronidase to the area. When using hyaluronidase to electively dissolve dermal fillers that have led to a poor cosmetic result, lower concentrations with higher dilution volumes are often recommended.1
True allergy to hyaluronidase is exceptionally rare. There are four reported cases of allergy requiring adrenaline reported in the literature since 1949
surgery. Within the past 15 years, it has been used in medical aesthetics to dissolve crosslinked HA. It has a diverse range of clinical applications due to its unique ability to facilitate the dispersion and/or absorption of fluids and many medicines it may be mixed with. It has also been used for niche indications such as dissolution of haematomas and treatment of lymphoedema.1
Mechanism of action
Hyaluronidase breaks down complex hyaluronan glycosaminoglycan polysaccharides by a hydrolysis reaction. Hyaluronidase targets the breakdown of the C1 and C4 bond between the glucosamine and glucuronic acid components, causing the complex molecule to unfold and break down.4 The primary function of hyaluronidase
Perhaps the most valuable use of hyaluronidase is its use in the management of vascular adverse events following dermal filler treatment. Whilst rare, this complication can be significant and if left untreated have devastating clinical outcomes including tissue necrosis, scarring and visual disturbance.6
Hyaluronidase can be used to manage vascular adverse events from both HA and non-HA fillers. It is important to note that its use in medical aesthetics for filler dissolving is off-label and patients should be made aware of this at the time of treatment.
When treating vascular adverse events, high concentrations of hyaluronidase (with a low reconstitution volume) are recommended.1 In the Complications in Medical Aesthetics Collaborative (CMAC) clinical guidelines for the management of vascular adverse events, reconstitution volumes of 1-2mls (of bacteriostatic saline or lidocaine) is recommended. This recommendation is echoed in the Aesthetic Complications Expert (ACE) Group World guidelines.7
This treatment can be repeated multiple times (“pulsed hyaluronidase”) until visible improvement in tissue perfusion is seen. It is usually injected into the area that was previously injected with the dermal filler and the tissues in a circumference around this, as well as tissue areas distal to the involved vessels if there is concern about fragmentation of the filler and distal emboli.1
Increasingly, the value of ultrasound guided hyaluronidase to manage these events is understood. Advantages of this approach are lower doses are required, treatment is more targeted and there is less resulting tissue trauma from repeated injection.8
One 2023 paper concluded that using ultrasound-guided hyaluronidase resulted in lower overall doses needed and faster resolution of occlusion when compared to “regional flooding”. This advantage would of course require both access to and proficiency with ultrasound imaging in aesthetic practice.9
Nodules
Nodules in treated areas can appear at any stage following treatment with dermal fillers. These may be simply product accumulation or have an inflammatory component in the form of hypersensitivity reaction, biofilm infection or granuloma.10 Where hyaluronic acid filler was used, hyaluronidase provides an advantage in its ability to dissolve and disperse nodules. Where infection is suspected, antibiotic cover should be considered and if granuloma is suspected then further treatment with anti-inflammatories or immunomodulators may be required.1 Treatment of nodules with an inflammatory or infective competent may be complex and specific guidance is available from complications networks such as CMAC or ACE Group World.11
It’s important to note that hyaluronidase use in medical aesthetics for filler dissolving is off-label and patients should be made aware of this
Poor aesthetic outcome
It is impossible to guarantee satisfactory aesthetic outcomes in clinical practice, however much effort is made. With dermal fillers, a poor outcome may be down to over-filling, product migration, Tyndall effect, contour irregularity or simply a patient’s subjective dislike of the procedural outcome. Judicious use of HA fillers including careful placement and using the lowest amounts possible may help to minimise the risk of these outcomes.12 If HA filler was used for treatment, this may be electively dissolved using hyaluronidase. In this circumstance, lower concentrations and resultant lower doses of hyaluronidase are usually recommended.13 For example, CMAC guidelines recommend using dilution volumes of up to 5ml, compared to the 1-2ml used in the management of vascular occlusion.1
Elective dissolving – even in the case of poor aesthetic outcome – can be emotionally challenging for patients and care should be taken to counsel them properly prior to this procedure. Patients should be made aware that removal of dermal filler may uncover ageing changes they have not been aware of due to overlying filler. Allowing time for them to process this or planning corrective treatment following dissolving may help them navigate these changes and make informed decisions.
The criteria for deciding on elective dissolving vs. other interventions is outside the scope of this article and depends on the specific area of complication.
One 2023 paper concluded that using ultrasound-guided hyaluronidase resulted in lower overall doses needed and faster resolution of occlusion
Hyaluronidase has been shown to speed to resolution of heamatomas, which can occur following medical aesthetic procedures including injectables and minor surgical procedures. It does this by speeding absorption of the heamatoma, increasing membrane permeability due to the breakdown of HA in connective tissues.1
Clinicians are often concerned about allergy to hyaluronidase, particularly type 1 hypersensitivity reaction (anaphylaxis). As a result of this, there is an increasing reliance on intra-dermal testing and potential avoidance of the use of hyaluronidase in clinical practice, potentially unnecessarily. This risks withholding beneficial treatment to patients, whether in an emergency or elective context. It is important to consider the rates of actual reported allergy – both type 1 hyper-sensitivity (immediate, anaphylaxis) and type 4 hypersensitivity reactions (delayed, localised) in aesthetic medical practice.1
Of note, cross-reactivity with allergy to stings from the Hymenoptera family (wasps/bees) can be significant if a patient has a known allergy or anaphylaxis to bee or wasp stings then hyaluronidase should not be used.1
Incidence of allergy
True allergy to hyaluronidase is exceptionally rare. There are four reported cases of allergy requiring adrenaline reported in the literature since 1949. Type 1 hypersensitivity reaction is, therefore, unlikely in clinical practice. Incidence of all allergy is typically quoted to be around 0.1%. It’s important to note this includes both type 1 and type 4 hypersensitivity reactions,
so even if allergic reaction occurs, the reaction may well be localised with no systemic involvement.1 It should also be noted that hyaluronidase is known to cause localised erythema and swelling, especially when it is used to dissolved cross-linked HA fillers. This presentation is transient and does not represent an allergic reaction, however, may be incorrectly interpreted as one leading to unnecessary concern by the patient and unnecessary intervention by a clinician.1
Allergy reactions are also generally reported to be dose-dependent with significantly higher doses (above 100,000 units) leading to more significant type 1 hypersensitivity reactions. Within medical aesthetics – even when managing vascular adverse events – doses are typically significantly lower than this.1
Some clinicians employ the use of ‘intra-dermal’ testing (sometimes incorrectly referred to as a ‘patch test’) to assess for allergy. This is where a small dose of hyaluronidase is injected intradermally into the skin of the forearm, next to a control (usually saline) to assess for allergic response. There is no accepted or validated dose or concentration of hyaluronidase to use for this test and The British Society of Allergy and Clinical Immunology (BSACI) state that ‘skin tests’ must always be interpreted within the appropriate clinical context.14 They advise that these should not be used to screen for drug allergy in the absence of a clinical history compatible with type I hypersensitivity (anaphylaxis). It is also not appropriate for aesthetic clinicians to be performing and interpreting the results of these tests – skin testing is generally done in specialist centres where there is a clinical history of drug allergy.15 It is important to note CMAC and ACE Group World also advise against this.7
Despite this, skin testing is frequently used in medical aesthetics when there is no reason to suspect allergy. In such circumstances it is deployed as a method of ‘reassuring’ the practitioner that the patient will not develop anaphylaxis, which is against BSACI recommendations for appropriate allergy testing.16
In the context of a known hypersensitivity or allergy to the Hymenoptera family, such intra-dermal testing may even precipitate an anaphylactic reaction.
It is also important to recognise that hypersensitivity reaction can occur to the chosen diluent used for the reconstitution of hyaluronidase, rather than the hyaluronidase itself. Bacteriostatic saline, for example, contains benzyl alcohol which has a recognised allergy rate of 1.3% so clinicians must consider this when deciding whether to perform and interpret any intra-dermal testing.17
Topical hyaluronidase is available in the UK in the form of the product Topilase. This is a topical solution designed to “fine tune” superficial HA filler spread in regions such as the undereye. Limited data is published on the use of this product, however case reports have suggested positive results for improving minor filler spread causing poor aesthetic result when the HA filler is sitting superficially.1 Due to limited research, topical hyaluronidase should not be considered an alternative to injectable hyaluronidase for the management of acute dermal filler complications, and more studies are needed in this area.
Aiding the resolution of complications
Hyaluronidase is an important medicine within aesthetic medical practice. Whilst the majority of uses within this field are off-label, hyaluronidase can be used in both elective and emergency
settings to improve a variety of complications and concerns post-procedure including vascular adverse events and poor aesthetic outcomes.
There is significant concern amongst practitioners around the allergy potential however the incidence of this is low and allergy presentation may be due to chosen diluents or to transient, normal local tissue effects of hyaluronidase. Intra-dermal testing is not a reliable screening tool for allergic response and significant caution should be taken in patients with known hypersensitivity or allergy to bee or wasp stings. Otherwise, hyaluronidase is a useful medication and can be safely employed in the majority of cases to aid in the resolution of emergency and elective aesthetic medical complications.
Questions
Test your knowledge!
Complete the multiple-choice questions and email memberships@aestheticsjournal.com to receive your CPD certificate!
Possible answers
a. Breaks the C1 and C4 bond between the glucosamine and glucuronic acid components of hyaluronic acid
1. How does hyaluronidase work?
2. What is the recommended dilution volume for hyaluronidase when managing a vascular adverse event?
3. What allergy has potentially significant cross-reactivity to hyaluronidase?
4. An anaphylactic reaction is which type of hypersensitivity reaction?
5. What is the origin of hyaluronidase in the UK?
b. Breaks the C1 and C2 bond between the glucosamine and glucuronic acid components of hyaluronic acid
c. Breaks the bonds between hyaluronic acid molecules in filler
d. Causes hyaluronic acid to evaporate through the skin
a. 4-5mls
b. 5-10mls
c. 1-2mls
d. 0.5ml
a. Bee and wasp stings
b. Gluten
c. Dairy
d. Pollen
a. Type 1 Hypersensitivity reaction
b. Type 4 hypersensitivity reaction
c. Type 2 hypersensitivity reaction
d. Type 8 hypersensitivity reaction
a. Bovine
b. Porcine
c. Synthetic
d. Human derived
Answers: A,D,C,A,B
Dr Ben Taylor-Davies is an anaesthetic medical doctor and the founder and director of The Stockbridge Clinic. He sits on the CMAC clinical support team within the UK and works as a national lead trainer for Acquisition Aesthetics, as well as being a key opinion leader for Cutera. Outside of medical aesthetics, he works as an NHS emergency medicine doctor. Qual: MBBS, BSc (Hons), AFHEA
Dr Amy Law presents a case study using polynucleotides for self-harm scar healing and considerations for treatment
Self-harm scars present complex challenges that extend beyond the physical, often carrying deep psychological significance for patients. While treatments such as laser therapy and microneedling offer varying levels of success, new approaches — including the use of polynucleotides — are emerging to support skin regeneration and improve scar appearance.1
This article explores a case study involving a 20-year-old female patient who underwent polynucleotide treatment for self-harm scarring. While early results showed promising improvements in skin quality and pigmentation, the patient’s continued self-harming prompted a reconsideration of treatment boundaries. This piece not only examines the clinical outcomes, but also reflects on the ethical and emotional complexities faced when treating patients with ongoing self-harm behaviours.
Case study
Consultation
A 20-year-old female patient presented to my clinic seeking treatment to improve the aesthetic appearance and healing process of open wounds and scars that occurred as a result of her being a repeated self-harmer. Self-harm scars are particularly challenging to treat due to both physiological and psychological factors. Repetitive injury leads to dermal fibrosis, disorganised collagen deposition and impaired vascularisation, resulting in atrophic or hypertrophic scars with poor elasticity. In the case of this patient, the wounds were not properly closing and were infected, with the only wound management available to her via the NHS being regular bandaging. Indeed, the wound healing process for the patient was hindered by compromised closures due to the delayed seeking of NHS services by the patient, which in turn led to the psychological issues she was experiencing due to the appearance of the scars.
As a young woman, she was incredibly self-conscious of how the bandages sat under her clothing and the wounds on her legs, arms and neck meant she felt compelled to cover her body.
During the initial consultation, her medical history was reviewed and expectations were managed, particularly regarding the length of time that had passed since the self-harm incidents, meaning that no firm results could be guaranteed.
I also explained the psycho-social benefits of aesthetically improving her scars, which were felt to be even more significant due to her being a young female. It is recognised the psycho-social positive impacts that effective treatment of the appearance of scars can have.2 A sensitive and thorough approach was taken to assess for any underlying psychological concerns, including signs of Body Dysmorphic Disorder (BDD). We had an open discussion about her mental health history and her current support system. She disclosed that she was receiving therapy and residing in a safe house environment designed to provide ongoing support.
To ensure a holistic and ethically sound approach to her care, I contacted and emailed the manager of the safe house where she is currently staying. This was to inform them of her interest in aesthetic treatment for her self-harm scars and to encourage close monitoring and support from their side, given the emotional nature of the concerns she raised. I emphasised that aesthetic treatment would only proceed if it ran parallel to consistent psychological care, as this was not a standalone solution.
We agreed that aesthetic treatments should complement – not replace – the support from her therapist. All decisions were made with her mental health in mind, and my priority was to ensure any treatments are delivered in a safe, supportive and ethically appropriate way.
There are several treatments available to help treat scarring, such as laser therapy, microneedling and injectables. The patient had not tried any of these prior to attending my clinic.
We discussed that one option would be plastic surgery referral, however there is often a long waiting list for plastic surgery for scarring. As of March 2024, the waiting list for elective treatments reached seven and a half million, with performance
significantly below the 92% standard. 3 Specific waiting times can vary by hospital and treatment type. For example, Pinderfields Hospital in Wakefield reports that 90% of patients wait up to 40 weeks for plastic surgery procedures, which is higher than the national average.4 Of course, should a patient be able to afford it, private surgical revision is an option.
Polynucleotides for healing
Polynucleotides were my recommendation due to their proven ability to modulate inflammation, stimulate tissue repair and enhance collagen production.5 Their high biocompatibility allows them to bind substantial amounts of water, forming a gel that provides continuous hydration to tissues. This hydration is crucial for maintaining skin elasticity and promoting an environment conducive to healing. Additionally, polynucleotides have been shown to influence various cellular processes, including the suppression of neuroinflammation and the promotion of fibroblast proliferation, which are essential for effective wound healing and skin rejuvenation.6
The regenerative properties of polynucleotides have been explored in the treatment of various types of scars and wounds. In a randomised, double-blinded, controlled trial involving 42 patients who underwent total thyroidectomy, those receiving polynucleotide injections exhibited significantly better surgical scar outcomes compared to the control group.7 Polynucleotides have also been shown to accelerate wound healing due to their ability to enhance cellular proliferation, angiogenesis, and extracellular matrix (ECM) remodelling.8
We also wanted to choose a treatment plan which had minimal risk of side effects, which was important considering the patient was also receiving mental health support and we wanted her treatment to be as low risk as possible.9 Polynucleotide treatments are generally considered safe and well-tolerated, with most side effects being mild and temporary. Common reactions include redness, swelling and bruising at the injection site, typically resolving within a few days. Rarely, allergic reactions may occur, especially in individuals with fish allergies, as polynucleotides are often derived from fish DNA. Infections are uncommon but possible if post-injection care isn't properly followed.10
With all this in mind, we mutually agreed that polynucleotides would be the best course of action, with a minimum of three treatments per wound, three to four weeks apart.
While treatments such as polynucleotides can help accelerate scar recovery, it is also important to acknowledge – and communicate to patients – that scars naturally mature and improve over a 12-18-month period, and this should always be documented.
During the administration of polynucleotides with my chosen brand Plinest (other brands are available), I employed two distinct injection techniques. Initially, I delivered intradermal injections around the periphery of the wound. Additionally, I administered injections into the central area of the wound, targeting the subcutaneous layer and the superficial adipose tissue, with deeper injections placed along the wound margins. Where feasible, I concentrated the polynucleotide deposition within the central region to optimise therapeutic efficacy.
Throughout my time being involved with the patient I treated her for several different scars and wounds.
Figure 1 on the left shows a leg self-harm injury which I was presented with between two to three months after injury. The patient originally had staples in her leg but they were removed too soon so the wound did not heal as it should, and kept opening. After the initial treatment of polynucleotides, the wound had almost closed. By the third session of polynucleotides, the wound had fully closed and flattened, and the pigmentation had improved as a result of a reduction in inflammation.
In Figure 2, she came to me two days after the self-harm injury on her arm. Three weeks after administering polynucleotides, the wound had fused.
2:
Figure 3 shows the patient’s neck wound, which she came to me for polynucleotides three days after the infliction. The left side of Figure 3 shows how she presented, and the right shows the result after one administration of polynucleotides.
Going beyond the initial treatment of polynucleotides, which the patient and no side effects from due to the in-depth consultation, I recommended exosomes and microneedling to further flatten scars and improve skin texture.
A key turning point in this case came after the third new wound appeared during the course of treatment. At this stage, I made the clinical – and ethical – decision to discontinue further aesthetic intervention. While I completed a final session using polynucleotides to finish treatment, I explained to the patient that this would be the last. It was essential to avoid unintentionally reinforcing self-injurious behaviour or giving the impression that any resulting scars could always be reversed, which I became concerned I was doing. While the clinical outcomes of polynucleotide therapy in this case were
promising, this experience also highlighted the complexities of treating patients with ongoing self-harming behaviours. As practitioners, we must navigate a delicate balance between offering compassionate support and ensuring that our interventions do not inadvertently reinforce harmful patterns.
Upon reflection, I would approach a similar situation with even greater caution. It is essential to create a safe, non-judgmental space for patients who have self-harmed –and I would never turn someone away solely based on a history of self-injury. However, it became clear that when wounds continue to appear during a course of treatment, a line must be drawn. Continuing aesthetic care in such instances could risk blurring the boundary between healing and enabling. If faced with this situation again, I would ensure full transparency during consultation, explaining that I have previously discontinued treatment for a patient who continued to self-harm during the process. I would also stipulate from the outset that any treatment for scarring must be accompanied by regular psychological support, ideally with the patient already under the care of a therapist or mental health professional who I could speak to before treating to ensure a collaborative approach. Where appropriate, I would actively signpost patients to relevant services to ensure a holistic and ethically sound approach to care.
This case has reminded me that while aesthetic treatments can offer valuable psychological benefits, they are not a substitute for mental health intervention. Recognising when to pause or withdraw from treatment – always with compassion – is a critical part of responsible, patient-centred practice.
While the treatment strategy showed clear clinical success, this case ultimately underscored the importance of treating the whole person – not just the scar –and reaffirmed the need for aesthetic medicine to work hand-in-hand with mental health support.
Dr Amy Law qualified as a dentist from The University of Liverpool in 2016. Whilst progressing her career in dentistry, she realised her true passion lay in medical aesthetics. She successfully heads up her clinic Dr Amy Law, as well as being an advanced aesthetics trainer. Qual: BDS MJDF
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References 1. J.Chenau et al., Secretome: Definitions and biomedical interest 2. Han, G. et al., 2022. The Potential of Bovine Colostrum-Derived Exosomes to Repair Aged and Damaged Skin Cells. 3. Privitera, A. et al., 2024. Nutri Complex 150+: A New and Effective Approach to Facial Rejuvenation. 4. Ferruggia, G. et al., 2024. Effectiveness of a Novel Compound Hair & Scalp Complex on Hair Follicle Regeneration.
Cleft lip and palate are common congenital craniofacial anomalies, occurring in around one in 700 births.1,2 They may involve the lip, palate or both, with presentations ranging from isolated cleft palate to combined cleft lip-palate, reflecting varied structural and functional impact.2
Aetiology and implications
During normal embryogenesis, the upper lip forms between weeks four and seven as the maxillary and medial nasal processes fuse; failure of this fusion results in a cleft.3 This may arise from genetic predisposition, nutritional deficiency, teratogenic exposure or mechanical disruption, leading to incomplete union of the facial prominences.3-5
Clefts range from a small vermilion notch to a complete separation extending into the nostril, and may be unilateral or bilateral, complete or incomplete. When extending through the alveolar ridge into the palate, a cleft lip and palate forms, connecting oral and nasal cavities.3-5,7
Surgical repair begins in infancy, often including cheiloplasty, palatoplasty and later revisions such as lip revision, septoplasty or rhinoplasty.4,5 Despite this, many adults retain lip asymmetry, vermilion imbalance, scar contracture, Cupid’s bow loss and functional issues including altered speech, oral competence and asymmetric smiles.6,7 Psychosocial burden is well documented; in studies totalling approximately 1,300 adults with cleft lip and/or palate, 68-70% reported reduced self-confidence or self-esteem, while around 58-62% described a perceived social or professional impact.8,9
When considering treatment, dermal fillers provide a minimally invasive adjunct to surgery. Among available options, hyaluronic acid (HA) fillers provide greater precision and reversibility than calcium hydroxyapatite or poly-L-lactic acid, as it can be enzymatically dissolved with hyaluronidase in cases of malplacement or vascular compromise.10,11,20,21 Owing to their viscoelastic properties, HA fillers allow subtle, controlled enhancement while minimising the risk of overcorrection or nodule formation.10,11 They also enable precise, staged volumisation, soften scar tethering and redefine lip borders, with the added benefit of reversibility using hyaluronidase if required.10,11
Autologous fat grafting restores durable
volume and can complement surgical revision but requires an operative setting, carries donor-site morbidity, and is irreversible. Microneedling and resurfacing improve scar texture but do not fully address volume or lip projection, acting as adjuncts rather than alternatives to HA filler.4,5,22,23
A 52-year-old woman approached the clinic seeking non-surgical improvement of her upper lip, previously repaired for a unilateral cleft in infancy. Her primary concerns were long-standing asymmetry between the left and right lip segments and an imbalanced upper-to-lower lip ratio. She disliked visible scarring across the white lip and nasal base, felt unable to wear lipstick and described persistent social self-consciousness and low confidence. Her goal was to achieve a more defined vermilion border, improved upper lip projection and overall balance.
Informed consent for dermal filler treatment was obtained, including discussion of potential bruising, swelling, vascular occlusion risk and the reversibility with hyaluronidase.10,12 Alternative options, including further surgical lip revision, fat grafting and microneedling, were reviewed, including the option to do nothing. However, the patient declined seeking advise on further surgery and favoured a reversible, minimally invasive approach with HA filler.
Clinical assessment and planning
The patient had no relevant medical comorbidities, was a non-smoker and had no history of dermal filler or cosmetic interventions. Surgical repair had been completed in infancy, with no subsequent revisions. Examination revealed fibrotic scar tissue of the upper lip, resulting in flattening of the vermilion border and distortion of the Cupid’s bow. Scar tethering caused inversion and narrowing of the middle and left upper segments, while age-related changes contributed to natural inversion of the lower lip.
Palpation confirmed tissue fibrosis, scarring and altered resistance, suggesting unpredictable filler diffusion and vascular displacement consistent with post-surgical changes, including displaced labial arteries, uneven soft tissue planes and localised fibrotic adhesions.13 The use of HA dermal filler was selected over
further surgery, reflecting the patient’s preference for a minimally invasive and controllable approach.13
Safety strategy
Given the altered vascular anatomy, scar tethering and reduced tissue elasticity in cleft-repaired lips, a conservative, layered approach was essential to reduce risks of vascular occlusion, filler maldistribution and unpredictable tissue response.
· Comprehensive assessment: A full medical and allergy history was obtained, including screening for connective tissue disorders, bleeding tendency, autoimmune disease and prior dermal filler reactions. Patients with active infection, severe lidocaine allergy or a history of vascular occlusion would be excluded. Contacting a patient’s previous surgeon or reviewing surgical notes can be valuable if anatomy, grafts or complications are unclear. In this case, I relied on clinical assessment, palpation and patient history, as the repair was completed in infancy with no issues.
· Vascular evaluation: Post-surgical vascular variability was assessed through palpation and visual mapping of scar lines, with attention to blanching or tethered zones indicative of displaced vasculature.14
· Ultrasound consideration: Pre-treatment ultrasound mapping was offered but declined after shared decision-making. The patient chose to proceed following detailed discussion of risks, benefits and emergency protocols, with this decision documented. Enhanced perfusion monitoring and superficial placement techniques were employed.15
· Injection technique: Staged, low-volume injections with slow extrusion and frequent perfusion checks allowed gradual tissue adaptation and minimised intravascular risk.
· Emergency preparedness: Immediate access to hyaluronidase and a clear emergency response protocol were ensured, particularly for the management of suspected vascular occlusion, anaphylaxis or severe vasovagal reactions, in line with published safety guidelines.10,12,16,20,21
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Procedure
Considerations for the treatment include product selection, injection techniques, volume of filler and staging of treatments.
Product selection
The HA fillers used for this case study were Teoysal RHA Kiss and RHA 1, selected based on published evidence supporting their use in mobile perioral regions and post-surgical lips for natural integration and elasticity.17,18,22 Other options, including Juvéderm Volbella and Restylane Kysse, were considered.
RHA Kiss is a medium-G, highly elastic dermal filler, designed for injection into the deep dermal-submucosal plane, offering projection and definition while adapting to lip movement. RHA 1 is a low-G, soft, highly elastic dermal filler for the superficial dermal plane, suitable for blending scars and refining contour.17,18
Topical anaesthesia was achieved using EMLA cream, featuring 2.5% of lidocaine and 2.5% of prilocaine, applied 30 minutes pre-procedure. RHA Kiss was used primarily for upper and lower lip projection and Cupid’s bow definition, while RHA 1 was used in superficial passes along the scar line and white lip to soften irregularities.
Injection technique
· A 30G 1/2inch needle and a 4mm short needle were used to ensure precise placement and control.
· A micro-droplet technique with the 4mm needle was applied along the subdermal vermilion border to refine definition using small, controlled boluses. Linear threading with the 1/2inch needle was then performed within the subdermal lip body to achieve even volumisation and smooth filler distribution.
· Low-pressure boluses into the superficial fat of the lip body to restore projection.
· Intracutaneous blanching of a softer filler along fibrotic scars to release tethering and blend contour.
· Low volumes and slow injection (<0.1 ml/pass) with routine perfusion checks to allow for continuous assessment of capillary refill, colour and patient-reported sensation. This allows for more rapid recognition of complications such as vascular occlusion.10,20
Volume and staging
Treatment was performed in two staged sessions to allow tissue adaptation, scar remodelling and controlled aesthetic refinement.
Session one – RHA Kiss (0.7ml)
· Upper lip: 0.3ml total. 0.1ml injected with a 4mm needle in micro-droplets along the vermilion border to redefine the lip outline and Cupid’s bow. Remaining
0.2ml delivered via linear threading into the left and right upper tubercles (0.1ml each) for projection and symmetry.
· Lower lip: 0.4ml total. 0.1ml applied with micro-droplet tenting to sharpen vermilion border definition. Remaining 0.3ml injected into the lower tubercles (0.1ml each) and central lip body (0.1ml) to balance proportions and maintain natural eversion.
Session two – RHA 1 (0.7ml, eight weeks later)
· Scar and white lip refinement: 0.3ml blanched intradermally along the white lip using a 4mm needle to release fibrotic tethering and smooth surface irregularities.
Volumisation: 0.4ml distributed evenly (0.2ml per lip) via linear threading to enhance projection, hydration and texture.
The patient was observed for one hour post-procedure due to higher vascular risk in cleft lips, where atypical vessel pathways and scar tissue may delay signs of ischemia. Aftercare included avoidance of heat, vigorous exercise and massage for 48 hours, recognition of early vascular compromise (pain, blanching, mottling) and provision of emergency contact information.10,16,20
Post-procedure swelling was mild, confined to injection sites and resolved by day five with minimal bruising requiring no intervention. The patient reported little discomfort and did not need analgesia. The upper lip showed greater projection and improved proportion relative to the lower lip, with a smooth vermilion border and re-established Cupid’s bow. Areas affected by fibrotic scar contracture appeared softer and more pliable, blending naturally with surrounding tissue. Subtle volume restoration created a balanced, harmonious lip profile without over-augmentation.
Follow-up at two and eight weeks confirmed expected mild oedema and bruising resolving within five to seven days, with
visible refinement by two weeks. Outcomes included improved vermilion continuity, symmetry and texture, though results vary with scar density and vascular pattern. No adverse events occurred – no vascular compromise, nodularity or delayed swelling. The staged, low-volume technique with careful monitoring ensured uncomplicated recovery and predictable, natural-looking results.
Ideal candidates are patients with stable, fully healed cleft repairs and no surgical interventions within the preceding 12 months. Caution is advised in patients with a history of hypertrophic scarring or impaired wound healing.
HA filler refinement is contraindicated in the presence of active infection, uncontrolled systemic disease, pregnancy, anticoagulation therapy or unresolved vascular anomalies.2,16,21 Surgical revision should be considered when significant muscle malposition, nasal deformity or functional impairment persists, as filler volumisation alone cannot address deep structural imbalance.4-6,22
Injecting cleft-repaired lips is complex due to fibrosis, scar tethering and altered vascular anatomy.13,14 Filler diffusion can be unpredictable; treatment should therefore be slow, low-volume and staged, with ultrasound mapping where available to identify scar planes and vascular anomalies.15 Key principles include gentle extrusion, perfusion monitoring, staged sessions and readiness with hyaluronidase.10,20,21 Please note that aspiration may be performed where appropriate as part of good injection practice, in conjunction with continuous perfusion and vascular monitoring.
HA dermal fillers are a valuable adjunct even years after primary repair, addressing residual asymmetry, volume loss and scar contracture. Their predictable rheology and reversibility with hyaluronidase ensure safety, whilst refining surgical outcomes, improving lip form, function and patient confidence.
Dr Bonny Armstrong is an aesthetic practitioner, medical director and owner of the Dr Bonny Clinic in Belfast. Dr Armstrong is also a regional expert and faculty member for Teoxane and the owner of the Dr Bonny Academy. Qual: MBChB
Bipolar radiofrequency (RF) has become an increasingly popular non-invasive solution in medical aesthetics, providing a unique blend of functional and cosmetic benefits. When applied to the delicate periocular region, bipolar RF not only addresses fine lines, wrinkles and skin laxity, but has also shown promise in improving symptoms associated with dry eye disease (DED) – a common issue in perimenopausal and menopausal women.1,2
This article explores its underlying technology, mechanisms of action, clinical relevance and patient outcomes, with a special focus on perimenopausal changes.
Periocular ageing in menopause
Perimenopause brings profound changes in hormone levels, most notably an initial fluctuation in oestrogen and androgens.³ ⁴ These hormonal shifts accelerate collagen degradation and reduce sebum and oil production, particularly affecting the thin periocular skin. This leads to visible signs of ageing – crepiness, laxity, fine lines – and ocular discomfort due to DED.⁴
DED is significantly more common in postmenopausal women, with some studies suggesting up to 60% of menopausal women experience symptoms.5,6 The meibomian glands, which produce the lipid layer of the tear film, are androgen-sensitive. As androgen levels drop, lipid production declines, leading to increased tear evaporation and ocular surface inflammation.⁷ The fluctuation and steady decline of oestrogen also affects the viscosity of the lipid, resulting in plugging and the development of chalazia.⁸
From both an aesthetic and functional standpoint, treating periocular ageing in menopausal and perimenopausal patients often necessitates a holistic approach. Bipolar RF may offer a combined effect – tightening the skin while also improving meibomian gland function. This could help address both the cosmetic concerns of fine lines and the functional concerns of dry eye.
The management of DED in the UK is typically handled by the NHS and includes a variety of treatments aimed at alleviating symptoms and improving the quality of
life for affected individuals. Common options include:
· Artificial tears: Used to lubricate the ocular surface and provide temporary relief from dryness.⁹
· Warm compresses: Used to melt thickened meibum and facilitate the expression of meibomian glands and applied to the eyelids.⁹
· Lid hygiene: Aimed at removing debris and biofilm that can accumulate on the eyelid margin and exacerbate inflammation.⁹
Ciclosporin A eye drops: Used to reduce inflammation and improve tear production, though it can take three to six months for noticeable improvement.¹⁰
· Punctal plugs: Used to prevent tear drainage and retain tears on the ocular surface by inserting into the tear ducts.⁹
While these treatments are often effective in managing the symptoms of DED, they typically require long-term adherence and may not provide sufficient relief for all patients.¹⁰ Ciclosporin, while effective, can take several months to show results, and not all patients can tolerate it. Additionally, access to specialised treatments like meibomian gland expression is limited in some areas, and patients may be referred to private or aesthetic settings for more advanced options.¹⁰
Bipolar RF is a form of energy-based therapy that uses two electrodes to deliver controlled thermal energy into the dermis. This heat stimulates neocollagenesis (new
collagen formation), elastin remodelling and increased fibroblast activity – resulting in tighter, smoother and more youthful-looking skin.1,2 Unlike monopolar RF, bipolar RF offers greater precision and depth control, making it ideal for treating sensitive areas like the eyelids and under-eye region.¹ ²
Clinically, this translates into improved skin texture, reduction in fine lines and wrinkles and a subtle lift in sagging tissues.³ RF is a well-tolerated, non-injectable modality with minimal downtime, making it a desirable choice for patients who prefer to avoid neurotoxins or dermal fillers around the eyes.³
Studies have shown that heating the dermal and subdermal layers to 40-43°C can stimulate heat-shock proteins and remodel the extracellular matrix, improving the skin’s structural integrity.4,5 Importantly, this same temperature range also influences the meibomian glands, which are crucial in maintaining ocular surface lubrication – providing an unexpected but welcome improvement in dry eye symptoms.⁶,⁷
One of the features of bipolar RF is its suitability for all skin types. Recent literature suggests that RF is a promising approach for treating meibomian gland dysfunction (MGD) and rosacea-related ocular symptoms without the pigmentation risks historically associated with laser therapies in Fitzpatrick IV-VI skin types.⁸,⁹
Bipolar RF delivers focused thermal energy between two electrodes, producing a bulk heating effect. The controlled heating:11
· Stimulates fibroblast proliferation and collagen contraction
· Enhances elastin synthesis
· Improves dermal hydration and blood flow
· Softens superficial lines and increases skin tautness
The heat generated in the dermis triggers the production of new collagen and elastin fibres, leading to the tightening of skin
From both an aesthetic and functional standpoint, treating periocular ageing in menopausal and perimenopausal patients often necessitates a holistic approach
tissues and the smoothing of fine lines. This process, known as neocollagenesis, rejuvenates the periocular skin by increasing dermal thickness and elasticity.¹² In the context of DED, this heat also helps to melt the stagnant lipids in the meibomian glands, allowing them to express more freely and restore the integrity of the tear film.¹² This dual action – enhancing skin elasticity and promoting meibomian gland function – has been supported by clinical studies showing statistically significant improvements in both aesthetic markers (periorbital wrinkles) and dry eye indicators like tear breakup time (TBUT) and Ocular Surface Disease Index (OSDI) scores.13,14 By addressing both the structural and functional aspects of the periocular region, bipolar RF offers a holistic treatment approach.
Furthermore, bipolar RF has been shown to rejuvenate meibomian glands that are chronically inflamed and under risk of atrophy.¹⁵ This is of particular importance for menopausal patients, as glandular atrophy and reduced lipid secretion can significantly exacerbate dry eye symptoms.¹⁵
A 44-year-old female developed gradually worsening perimenopausal symptoms over a period of four years. During this time, she noticed increasing periocular skin laxity, a tired facial appearance and chronic dry eye symptoms that were unrelieved by artificial tears.
The patient underwent a comprehensive medical, aesthetic and ocular assessment. On examination, she appeared tired with signs of ocular dryness. Her primary goals were to reduce her dependence on lubricating eye drops and to feel more alert and refreshed at work. Her OSDI score indicated moderate dry eye and her TBUT during her ocular exam was measured at five seconds bilaterally.
Images were taken on a skin analysis machine (Observ 520x) to determine whether there were any additional factors contributing to her periocular skin laxity. The patient admitted to wearing contact lenses and frequently stretching her eyelids during insertion, which could have contributed to anatomical changes in the periocular area.
A slit lamp examination was performed to assess lid placement, blink rate, and to rule out any lagophthalmos – none was observed. However, there was evidence of evaporative dry eye associated with meibomian gland dysfunction, although this was not her primary concern; her main focus was the aesthetic change.
When discussing treatment options, she expressed interest in a “natural lifting” approach and declined injectable treatments such as botulinum toxin. One of the advantages of the bipolar RF handpiece (Forma-I) is its suitability for all skin types and absence of contraindications, making it an appropriate choice for achieving a safe, non-invasive aesthetic result.
Prior to commencing treatment, we discussed a simple eyelid care regimen to support the in-office procedure. She was advised to use a Peep wand daily, a heated eye wand for two and a half minutes per eye, an okra-based lid foam and topical lubricating drops selected according to her examination findings.
Given the patient’s concerns and treatment preferences, Forma-I, a bipolar RF modality on the InMode Envision platform, was selected.¹⁶ This device was the preferred treatment option as it was non-invasive, with the energy penetration limited to approximately 3mm – the optimal depth for targeting the area of concern.
The ergonomic design of the handpiece, combined with its bipolar configuration, eliminates the need for grounding plates for energy transmission. The handpiece features a fixed-depth setting that stimulates fibroblastic activity and neocollagenesis within the tissue. Additionally, the device’s bulk heating effect, coupled with real-time temperature feedback, ensures a safe and effective treatment process.
This platform is well-recognised for its ability to achieve both tissue tightening and meibomian gland activation, making it an ideal solution for addressing both aesthetic and functional issues in the periocular region.16
Pre-treatment advice
The patient was advised to discontinue topical retinoids at least three days prior to treatment to reduce the risk of skin irritation.¹⁷ On the day of the procedure, eye make-up was avoided to maintain a clean treatment area and minimise the potential for contamination.¹⁷ In addition, the patient was instructed to avoid anti-inflammatory medication such as ibuprofen or blood thinners before treatment to lessen the likelihood of bruising and to prevent interference with the natural inflammatory healing response.¹⁷
Device settings
RF treatment was delivered in continuous motion mode, targeting a temperature of approximately 43°C. Each eye was treated for a total duration of ten minutes. The application protocol comprised five
sweeping passes over the lower eyelid and crow’s feet area, followed by a single pass over the upper eyelid to ensure even energy distribution and consistent thermal stimulation. The session concluded with gentle meibomian gland expression to enhance treatment efficacy and patient comfort.¹⁶
The patient returned for review two weeks after the initial treatment. At this visit, the TBUT improved from five to eight seconds, and the OSDI score was reduced by 12 points, indicating a notable improvement in both the aesthetic and functional aspects of the treatment. A treatment plan consisting of three additional sessions, spaced two weeks apart, was scheduled to continue progress.
The patient reported that the area around the eyes appeared lifted and smoother, with a notable reduction in burning sensations. She described the improvement as subtle yet highly effective. Additionally, the treatment was well tolerated, with the sensation likened to a hot stone massage, and she consistently reported feeling better following each session.
We discussed the maintenance treatment plan, which depends on symptom progression, the need for intense pulsed light (IPL) therapy to address skin vascularisation, and the longevity of the aesthetic results. The duration of results varies based on skin condition, typically lasting between three to six months. Most patients receiving Forma-I treatment require maintenance sessions every three months.
Bipolar RF is generally considered safe, with minimal risks associated with its use when performed by trained ophthalmic professionals, whether that is an optometry technician, optometrist or ophthalmologist. Currently ocular bipolar RF treatments are performed by these specialists such as optometric or ophthalmic clinicians.
Dry eye disease is significantly more common in postmenopausal women, with some studies suggesting up to 60% of menopausal women experience symptoms
Common side effects
Patients may experience some temporary and generally mild side effects following treatment. These are usually self-limiting and resolve without intervention and include the following:16
· Temporary erythema (redness): Mild redness may occur immediately after treatment due to the heat generated by the RF energy. This typically resolves within a few hours.
· Swelling: A small degree of swelling may occur in the treated area but generally subsides within 24-48 hours.
· Mild discomfort: Some patients report a mild heat sensation or discomfort during the treatment, though it is usually well tolerated.
Rare complications
Although uncommon, certain complications may occasionally arise following treatment. These include:16
· Heat sensitivity: In rare cases, patients may experience heightened sensitivity to heat in the treated area, which can result in discomfort during or after treatment.
· Burns: While extremely rare, improper application of the RF energy or overheating of the tissue could result in burns. This is avoided through precise temperature control and by ensuring the treatment is carried out by a skilled practitioner.
Contraindications
Certain conditions may make a patient unsuitable for bipolar RF treatment. These include:16
· Pregnancy and breastfeeding: RF treatments should not be performed on pregnant or breastfeeding women due to potential effects on the skin and underlying tissues.
· Active skin infections: Any active infection in the treatment area, including herpes simplex, active eczema or other inflammatory skin conditions, may preclude RF treatment.
· Implanted devices: Patients with implanted devices such as pacemakers, defibrillators or cochlear implants should avoid RF treatments in the area near the device.
· Severe rosacea or blepharitis flare-ups: These conditions could be aggravated by the heat generated during RF treatment, and such patients should be carefully assessed before proceeding.
Proper aftercare is essential to maximise treatment outcomes and minimise any risks of side effects. Patients are generally advised to follow these guidelines post treatment:18
Avoid makeup for 24 hours: This allows the skin to heal without the risk of introducing bacteria or other irritants.
· Use sunscreen (SPF) daily: Patients should apply sunscreen around the eyes and on the lids to protect treated skin from UV damage, which can exacerbate skin laxity and wrinkles.
· Delay retinoid use for three to five days: Retinoids can irritate newly treated skin, so patients should avoid their use for several days after RF treatments.
· Artificial tears as needed: For patients experiencing dry eye symptoms, preservative-free artificial tears should be used regularly to maintain hydration and comfort.
Hydration: Patients should ensure they stay well-hydrated to support optimal skin health and tear production.
· Avoid saunas, hot tubs and intense physical activity for 48 hours: Heat exposure and excessive sweating can irritate the skin and interfere with the healing process.
· Continue lid regime and supplements (e.g. omega-3): Maintaining good eyelid regime and taking omega-3 supplements can further support eye health and the tear film.
In the context of the UK’s stretched NHS services, aesthetic clinics are emerging as important contributors to the management of menopausal eye health.¹⁹ These clinics provide services that complement the traditional medical treatment of DED offering a more personalised approach to care.¹⁹ For example, treatments like bipolar RF can be combined with other aesthetic procedures, such as IPL therapy and wellness-focused solutions, such as omega-3 supplementation, to provide a comprehensive approach to managing menopausal symptoms.¹⁹
Bipolar RF offers a holistic, non-invasive solution for menopausal women, addressing both visible periocular ageing and functional challenges like DED. By tightening skin, reducing fine lines and improving meibomian gland function, bipolar RF demonstrates the evolving convergence of medical aesthetic and medical innovation, helping patients look and feel their best both inside and out.
Dr Priya Udani is an oculoplastic surgeon and serves as a key opinion leader and international speaker. Recognised for her evidence-based approaches to ocular surface management and periocular aesthetics, Dr Udani integrates functional outcomes and a holistic approach to patient care.
Qual: BSc (Hons), MBBS, FRCOphth
Dermoscopy was initially utilised by dermatologists and plastic surgeons to examine melanocytic lesions for evidence of malignancy.1 Recently dermoscopy has expanded beyond skin cancer detection and is now widely applied in diagnosing inflammatory conditions, infections, nail disorders and hair loss conditions.4 This evolution has also led to its increasing use in medical aesthetics, where dermoscopy can aid the evaluation of various cosmetic concerns including photoageing, pigmentation disorders, rosacea, alopecia and the assessment of benign lesions for in office removal.11
Dermoscopy is a non-invasive, painless examination technique that enhances the visualisation of subsurface skin structures, improving diagnostic accuracy for a wide range of dermatological conditions.1-4 Originally developed to distinguish between cancerous and benign melanocytic lesions, it has since evolved into a valuable diagnostic tool for inflammatory dermatoses, infections, hair and scalp disorders and conditions commonly encountered in medical aesthetics.1,2,5-8
High-quality evidence supports its diagnostic accuracy and safety benefits. A Cochrane systematic review by Dinnes et al. encompassing over 42,000 lesions, demonstrated that dermoscopy significantly increases both sensitivity and specificity for melanoma detection compared with visual inspection alone.9 This reduced missed melanomas and unnecessary excisions. Similarly, a meta-analysis confirmed that dermoscopy offers excellent diagnostic accuracy for basal cell carcinoma, with pooled sensitivity of 91% and specificity of 95%, far outperforming naked-eye examination. 3,10
This article reviews best practices in dermoscopy, its expanding role in dermatology and aesthetics, and its significance in early malignancy detection and patient safety.
Dermoscopy, also known as epiluminescence microscopy or skin surface microscopy, is an essential tool in dermatological practice.1 It employs a dermatoscope, a handheld magnification device with either polarised or non-polarised light or both, to enable a more detailed examination of skin structures that are invisible to the naked eye.4 The technique is primarily used as part of a comprehensive clinical assessment, where dermoscopic findings are interpreted in conjunction with a patient’s history and clinical examination.
Further examples exploring intense pulsed light (IPL) recommend using dermoscopy before, during and after laser or light procedures to confirm indication, set endpoints and detect untoward effects.12 Other research demonstrates effective use of dermoscopy for diagnosis and monitoring of treatment response in rosacea.13 Finally, studies have showcased the role of dermoscopy in predicting or monitoring melasma therapy across topical and device-based treatments additionally defining key trichoscopic or dermascopic markers in alopecia areata that support standardised diagnostic and follow-up use in the clinic.5,14
Dermoscopy enhances the identification and differentiation of skin lesions, improving the ability to distinguish between benign and malignant growths.6 Key dermoscopic features assist in this process:
· Malignant melanoma: Asymmetry, irregular borders, atypical pigmentation and a blue-white veil are common dermoscopic hallmarks of malignant melanoma.15
· Basal cell carcinoma (BCC): Arborising vessels, ulceration and a translucent appearance.16
· Seborrheic keratosis: Milia-like cysts and comedo-like openings, making it distinguishable from malignant lesions.17 Research shows that dermoscopy markedly improves diagnostic accuracy compared to naked-eye examination, reducing unnecessary biopsies and facilitating early melanoma detection.18 However, diagnostic accuracy remains dependent on the practitioner’s experience and skill of using the dermatoscope. 2 Digital dermoscopy systems allow for the storage, sharing, re-examining and documentation of images, providing opportunity for second opinion and monitoring over time. This can be especially helpful for less experienced and skilled dermoscopist.
Figure 2: Dermatoscope image of seborrheic keratosis featuring multiple milia-like cysts, comedo-like openings and sharp demarcation. Adapted from Dermoscopy in family medicine: A primer 19,20
Many conditions commonly encountered in aesthetic practice, such as rosacea ( Figure 1 ), melasma, dermatitis, sebaceous hyperplasia, warts ( Figure 2) and telangiectasia have unique dermoscopic features, aiding in their diagnosis and management.19-25
Mole removal and lesion excision are increasingly performed in aesthetic clinics in the UK, as NHS guidelines often restrict removal of benign, cosmetic skin lesions. In fact, NHS England’s Evidence-Based Interventions programme categorises “Removal of benign skin lesions” under the interventions which should not be routinely commissioned when the indication is purely cosmetic. 26 In the private sector therefore, where such removals are more commonly undertaken, the use of dermoscopy becomes an essential component of assessment and documentation that supports enhanced lesion evaluation, risk stratification, informed consent and patient safety.
Furthermore, documenting dermoscopic images in medical records serves both medicolegal and clinical purposes as once a lesion is removed, its nature can no longer be confirmed.4 Dermoscopy provides standardised, high-resolution images, which are useful for second opinions and retrospective analysis. Additionally, alopecia, or hair loss, is also a common concern encountered in aesthetic practice. Alopecia presents in various forms, including androgenetic alopecia, alopecia areata and telogen effluvium. 27 Dermoscopy, when applied to hair and scalp evaluation, is specifically referred to as trichoscopy. It has become an invaluable tool in diagnosing, managing and monitoring of hair and scalp
disorders.7 Dermoscopic changes of hair shafts, follicular openings and scalp skin has unique dermatoscopic characteristic of different types of alopecia. 28
For example, a systematic review of 34 studies identifying hallmark trichoscopic findings in androgenic alopecia (hair-diameter variability ~94%, vellus hairs ~66%, peripilar sign ~43%), validating diagnostic and staging accuracy relevant to treatment-selection decisions in aesthetic practice. 29
These guidelines should help practitioners maximise the benefits of dermoscopy while ensuring accurate, reliable diagnoses.
Dermoscopy has evolved from a specialist diagnostic tool for melanoma detection into a multifunctional instrument used across various medical and aesthetic disciplines.4 Its ability to enhance lesion
Dermoscopy has expanded beyond skin cancer detection and is now widely applied in diagnosing inflammatory conditions, infections, nail disorders and hair loss conditions
Adopting best practices in dermoscopy ensures optimal diagnostic accuracy and patient management. Key fundamental principles of dermoscopy include:
1. Use a high-quality dermatoscope with both polarised and non-polarised light modes to assess different skin structures effectively. 30,31
2. Following standardised examination protocols, such as the two-step algorithm or the chaos and clues method, to systematically evaluate lesions.4
3. Employment of digital dermoscopy for image storage, enabling comparison over time and facilitating second opinions from dermatologists when required.
4. Ensuring proper skin contact with an interface medium (e.g. alcohol or ultrasound gel) in contact dermoscopy to minimise light reflection.
5. Integrating dermoscopic findings with clinical history and examination for comprehensive evaluation.
6. Engage in continuous education and training to improve pattern recognition and reduce diagnostic errors.
32
identification, improve diagnostic accuracy and facilitate longitudinal monitoring in general skin, hair and nail conditions makes it indispensable across multidisciplinary settings including medical aesthetics. As research continues to highlight its benefits, the integration of dermoscopy into routine practice in aesthetic clinics will further improve patient outcomes, safety and compliance with best possible practice.
Future research should look towards utilising technology, training and protocols to enhance the integration of dermoscopy into clinical practice as the early detection of melanoma can save lives.
Dr Tatyana Lapa-Enright is a specialist in cosmetic medicine and cosmetic dermatology. She is the founder and lead practitioner at Hardwick Clinic, established in 2013. Dr Lapa-Enright holds a degree in Medicine with Clinical in Research from the University of East Anglia and continues to practice as an NHS doctor. Qual: MMBS, MSc
Title: Non-Surgical Interventions for Reducing Cleft Lip Scars: A Systematic Review and Meta-Analysis
Authors: Neda Eslami, et al.
Published: The Cleft P Craniofacial Journal, November 2025
Key words: Cleft lip, Laser, Scar
This meta-analysis aimed to evaluate the effectiveness of various non-surgical interventions in reducing cleft lip scars. MethodsA systematic search was performed across PubMed, Embase, Scopus, Cochrane, and Web of Science databases up to May 21, 2024. Inclusion criteria encompassed human studies with cohort or randomized controlled trial (RCT) designs that assessed non-surgical interventions for reducing cleft lip scarring following surgery. The reviewed studies primarily focused on botulinum toxin type A (BTA) and laser treatments as non-surgical approaches. Meta-analysis revealed significant improvement in scar appearance with laser therapy (P < .001) but not with BTA (P = .15) when the assessment was conducted by the Vancouver scar scale (VSS). BTA also had no significant effect on scar width reduction (P > .05), but improved scar appearance based on the subjective visual analogue scale (VAS) assessment (P < .001). Based on the VSS index, laser therapy improved scar appearance more effectively than BTA. However, BTA enhanced esthetics as measured subjectively by VAS.
Title: Pilot Study: Efficacy and Safety of Polycaprolactone Collagen Stimulator for Middle Third of the Face
Authors: Martina Ponzo, et al.
Published: Plastic and Reconstructive Surgery, November 2025
Keywords: Collagen stimulation, Facial rejuvenation, Polycaprolactone
Facial aging is a multifaceted process involving structural changes in deeper tissues alongside skin alterations. Dermal fillers, including hyaluronic acid and non-hyaluronic acid variants, have emerged as key tools in addressing these changes, offering safe, effective, and minimally invasive solutions. Polycaprolactone (PCL) is a biocompatible, biodegradable polymer with remarkable collagen-stimulating properties. This pilot study explored the efficacy and safety of liquid PCL-based filler in rejuvenating the middle third of the face in 30 patients during a 6-month period, who underwent 2 treatments with PCL filler using a 25G cannula. The results demonstrate significant improvements in skin quality and volume, with high patient satisfaction rates. Although adverse events were mild and transient, careful injection techniques are recommended to mitigate risks. The gradual dissipation of the PCL-based filler induced the formation of new collagen, ensuring a prolonged volumizing effect in the middle third of the face.
Title: Moose Technique: A New Anatomical Perspective Treatment in Botulinum Toxin
Authors: Nabil Fakih-Gomez, et al.
Published: Journal of Cosmetic Dermatology, November 2025
Keywords: Botulinum toxin, Dynamic wrinkles, Injection technique
The MOOSE technique, developed by the authors, incorporates new insights into muscle interactions to optimize botulinum toxin treatment for brow elevation while minimizing side effects like the omega sign. This study involved 202 patients (89.1% female, mean age 40) treated with the MOOSE technique, focusing on upper third facial wrinkles. Primary outcomes included brow position, forehead line severity, treatment duration, and patient satisfaction. Patient satisfaction was evaluated at both the two-week and four-month follow-up. The MOOSE technique resulted in a significant improvement in brow position, with an average gain of 2 points on the MAS. Patient satisfaction was remarkably high, with 100% of patients reporting a positive outcome at 15 days and 99% at four months. The average botulinum toxin dosage was 66 units per patient (range: 54-78 units). No cases of brow or eyelid ptosis were observed, and only one patient (0.49%) experienced transient edema. Interrater reliability of evaluations was excellent, with intraclass correlation coefficients ranging from 0.94 to 1.00 across all measured outcomes.
Title: Comparative Efficacy and Safety of Platelet Rich Plasma (PRP) versus Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis
Authors: Muhammad Umar, et al.
Published: Aesthetic Plastic Surgery, November 2025
Key words: Androgenetic alopecia, Minoxidil, Platelet-rich plasma
This systematic review and meta-analysis aims to compare and evaluate the effectiveness and safety profiles of PRP versus topical minoxidil for the treatment of AGA. Databases including Scopus, Cochrane, Science Direct, Google Scholar, Embase, and PubMed were searched from inception to July 2024. We included randomized controlled trials (RCTs) that compared PRP and topical minoxidil, enrolling both men and women diagnosed with AGA with no age restriction. A total of 789 articles were screened, and nine RCTs with 451 participants were included in the meta-analysis. Upon comparing the treatment outcomes, PRP and minoxidil showed no significant difference in hair density (odds ratio [OR]: 9.09; confidence interval [CI]: 6.73, 24.91). Patient satisfaction was significantly higher for those receiving PRP therapy than 5% minoxidil (OR: 2.77; CI: 1.53,5.04). Negative hair pull test results significantly favored PRP over minoxidil (82.75% vs. 52.94%, respectively). However, outcomes for moderate to high regrowth and terminal hair count were similar between the two treatments.
In recent months, many specialty colleagues have reached out to me with the same concerns; “We can’t find therapists,” “Do you know anyone looking for work?” “My staff keep leaving and it’s damaging the business.”
Recruitment and retention have become critical challenges in medical aesthetics. A University College London study surveyed 3,667 practitioners across 1,224 UK clinics and found that 68% of those administering cosmetic injections like botulinum toxin are not qualified medical doctors.1 With fewer qualified therapists and more injectors working independently, the talent pool is shrinking.
A 2023 study in The Guardian, questioning 4,500 workers and managers in the UK, shows widespread concern over ‘quality managers,’ with 82% of leaders deemed ‘accidental’, having had no formal training.2 Training is imperative for staff fulfilment, particularly if progression is what motivates them. Your team will become discouraged and uninspired if they are not upskilling regularly and in turn your patients will suffer and diminish.
Recent data shows UK aesthetic clinics are reporting difficulties recruiting and retaining qualified practitioners, particularly experienced injectors and advanced laser and skin therapists.3 Meanwhile, employee turnover across all UK sectors averages at 34% per year.4 In the case of a clinic environment, each staff departure can cost a clinic the equivalent of six to nine months of that employee’s salary. The uncomfortable truth is this: cutting-edge devices, award-winning products and prime clinic locations mean very little if you cannot attract and retain good staff.
This article explores why staff retention is key to sustainable clinic growth and shares practical leadership lessons on improving culture, incentives and keeping teams motivated and profitable.
Aesthetic treatments are inherently personal and require a foundation of trust. In my experience, patients increasingly seek continuity of care and build confidence through long-term practitioner relationships. High staff turnover disrupts this relationship and may erode confidence in the clinic overall.
Recruitment, onboarding and training require significant investment, while constant personnel changes disrupt service standards and patient experience. In contrast, a stable, engaged team sustains higher treatment quality, drives revenue growth and cultivates a positive clinic culture. Staff retention is not merely a human resources
(HR) concern; it is a strategic driver of business performance and long-term profitability.
In my experience, the most effective way to retain staff is to begin by hiring the right people from the outset. Throughout my recruitment process, my guiding principle has always been to prioritise attitude over skill. This does not imply selecting unqualified candidates; rather, once the necessary qualifications are confirmed, the candidate’s mindset becomes the key deciding factor. I employ a relaxed interview approach designed to encourage authenticity, allowing candidates to present their true selves rather than a rehearsed ‘interview persona’. Drawing on my background in human psychology, I strive to understand the individual beyond their CV, often favouring candidates with the right attitude over those with greater experience.
High staff turnover poses risks to your business’s credibility and can cause loss of patient trust, which in turn will lead to poor return rate, negative reviews and loss to revenue.
When staff changes are unavoidable, best practice is to conduct a structured handover consultation, ensuring the patient feels cared for and reassured that their outcomes remain a priority. This will help maintain patient trust, uphold retention rates and provide the patient with a seamless change of their practitioner.
Across the six clinics I managed, I retained the same core team for almost six years, without a single resignation. During that period, revenues doubled and then tripled, with one site achieving £2.5 million annual turnover supported by just three therapists and one injector.
The success was not a matter of chance. It reflected deliberate leadership strategies.
Step 1: Listen before you lead
When inheriting an existing team, many new managers feel pressure to make immediate changes to demonstrate leadership. In practice, this often breeds frustration and division.
Instead, I dedicated my first two weeks simply to listening. I asked my team four key questions:
· What aspects of their work did staff most enjoy?
What caused them the most frustration?
· What motivated them day to day?
· What was their personal “why” for being in aesthetics?
By taking the time to understand before acting, I built authentic trust and gained valuable context. This empathy-driven approach allowed strategy to land effectively and avoided the kind of heavy-handed leadership that can quickly erode morale.
Step 2: Lead like a human
Leadership is not about hierarchy; it is about service. Staff are not just employees; they are people with full lives outside of the clinic. Recognising this reality fosters loyalty, engagement and high performance.
Finding the balance between building strong relationships with your team and drawing boundaries takes finesse. As a leader you can achieve this balance by showing genuine interest in your team’s wellbeing, recognising their achievements and creating an environment where open communication is encouraged. Demonstrating empathy, fairness and consistency builds respect, but it is equally important to use discretion about personal matters. The goal is to be approachable, without over familiarity. This will allow for them to feel safe in your leadership.
Unfortunately, some individuals may perceive a human-centred leadership style as a weakness and attempt to take advantage.
I have encountered this on occasion, however, I addressed
One team member faced a deeply personal crisis when discovering a partner’s infidelity. I supported her by accompanying her to collect her belongings and providing both practical and emotional support. She remained a high-performing, loyal therapist for years, eventually joining me in a subsequent business later in her career.
Another team member experienced the loss of a beloved pet and contacted me distressed. I temporarily covered her patients to give her space to grieve. She returned motivated and continued to deliver exceptional results, consistently generating £25,000 in monthly laser revenue. This equated for 31% of our overall monthly revenue.
These examples illustrates that compassion and humanity are strengths in leadership. By supporting staff through personal challenges, leaders can foster loyalty, resilience and sustained performance.
such behaviour promptly and decisively as soon as it came to my attention. What I found was that, because my overall style was grounded in compassion, when I needed to have serious conversations, they were often received with greater respect and seriousness than if I had frequently expressed disapproval.
Step 3: Lead with purposeful rewards
Staff rewards should reinforce desired behaviours and recognise individual strengths.
I held monthly team meetings to celebrate achievements, review successes and challenges and share ideas for the month ahead. I often showed appreciation through small gestures – sending messages to acknowledge when team members went above and beyond, leaving notes in treatment rooms or bringing coffee and treats. Occasionally, I organised team activities, such as a group karaoke night, to foster team spirit.
More importantly, gratitude was expressed in everyday actions: tidying treatment rooms between patients, stepping in to cover breaks and leading by example.
A business that can’t run without you isn’t successful; it’s a liability
Step 4: Lead from the front
Leadership by example is essential. I trained alongside my staff when we would introduce new treatments and devices. I assisted at the front desk on occasion, and repurposed my office to expand consultation space. By treating patients myself when necessary, I gained direct insight into daily clinic operations, building credibility and fostering respect among the team. Involvement excludes any clinic procedures requiring a qualified medical professional, such as the administration of injections.
Leading by example helps your team feel valued and encourages them to complete tasks willingly, without a sense of an unbalanced hierarchy. They understand that any request made is something you would be willing and able to do yourself.
If you are a non-practicing manager or clinic owner, I recommend completing the same training as your clinical team. For instance,
many brands offer front-of-house staff and non-practicing managers the opportunity to undertake the theoretical elements of their training. This not only builds your confidence and ability to communicate effectively with your team but also ensures you have a solid knowledge base. Additionally, it helps prevent staff from exaggerating details – such as treatment duration or product recommendations – since they know you are equally well-informed. These weren’t always actions I could carry out daily, but having the ability to step in and up when necessary was invaluable and gained me the respect of my team.
When asked how to achieve staff loyalty, I summarise my approach as follows:
1. Train your team to the highest standards, using development opportunities as incentives to build skills and confidence; promote when deserved.
2. Lead by example; punctuality, consistency and reliability matter.
3. Incentivise desired behaviours by praising and rewarding the qualities and attributes you want to see. Track their milestones and provide clear guidance on their path to progression and success.
4. Foster a positive, supportive workplace by creating a safe, judgement-free space where your team can give and receive feedback openly.
5. Remember staff are human beings first, employees second.
In larger businesses, it can be challenging to lead by example consistently. In such cases, I recommend training a member of your team to lead in this manner during your absence. Great leaders develop other great leaders, and having a capable deputy to support you is essential for scaling your practice effectively.
The results
This leadership approach delivered:
· 200% year-on-year revenue growth
· Reinvestment in best-in-class training, new equipment and products
· 100% staff retention rate of a high-performing, loyal team
· A clinic culture described by staff as a “professional family” Ultimately, happy staff created happy patients, driving sustainable, profitable growth and a thriving clinic.
Running successful clinics was demanding – I was often first in, last out and ready to help wherever needed. But a mentor’s advice stayed with me, “A business that can’t run without you isn’t successful; it’s a liability.”
Katie Hughes-Dawkins has more than 25 years’ experience in the aesthetics specialty as a practitioner, consultant and leader. She has successfully grown clinics; trained practitioners worldwide and now advises clinics and builds brand credibility in her role as head of engagement at Harpar Grace International.
In medical aesthetics, brands understandably prioritise safety, efficacy and scientific credibility in their marketing. However, this focus often leads to a clinical conformity, characterised by sterile visuals, overly technical language and messaging that centres solely on product performance. The result is a market where differentiation is minimal, and brand identities tend to blend together.
Effective marketing relies on emotional resonance and the cultivation of shared identity. Beyond functionality, brands engage through feeling – and there is strong evidence demonstrating the effectiveness of emotional marketing.
An overview of marketing in aesthetics
At its core, marketing is about understanding people – acknowledging who you are speaking to, what matters to them and how to connect in ways that inspire both action and affinity. In medical aesthetics, that means recognising the unique dynamics of a category that must engage both business and consumer audiences.
Generally speaking, marketing takes three key forms:
· Business-to-consumer (B2C): Brands sell directly to end users, in this case, patients.1
· Business-to-business (B2B): Businesses market products or services for purchase by other businesses.2
· Business-to-business-to-consumer (B2B2C): A brand sells to another business that, in turn, sells to the end patient. Success depends on influencing both the intermediary and the final customer.3
Within aesthetic clinics, these models intersect. Practitioners typically operate in a B2C environment – marketing their services directly to patients. Their goals are to attract new patients, retain existing ones and build trust through expertise, results and reputation.
Meanwhile, aesthetic brands operate in a B2B2C model. They sell to practitioners, who in turn sell to patients. For example, a botulinum toxin manufacturer markets its injectables to practitioners, who then offer those products as part of a treatment plan. This creates a layered marketing challenge,
as brands must appeal to the practitioner who makes the purchase, but also to the patient who drives demand.
While practitioners drive initial product adoption, patients ultimately wield significant influence. Their preferences shape clinical discussions, inform practitioner choices and generate brand momentum. Recent data highlights this engagement, as out of 1,756 participants, 46% are considering switching to lower-priced aesthetic brands or products.4 Yet despite this cost sensitivity, 52% of patients receiving neuromodulator treatments, such as Botox or Dysport, express a strong desire to remain loyal to their current brand.4 This loyalty suggests emotional investment, as patients are willing to prioritise trust and personal connection to a brand over financial savings, which in turn reinforces practitioner confidence in those products.
Yet, even as brands focus on patients, they must also communicate effectively with practitioners. While efficacy and credibility remain essential, practitioners are still human beings, and are therefore also influenced by emotion. Like any audience, their choices are shaped by how a brand makes them feel – whether it aligns with their professional values, instils confidence or enhances their sense of expertise.
Brands and clinics can use various channels, but strategy matters most. Success depends on connecting emotionally, through capturing attention, conveying feeling and building trust, rather than relying solely on clinical language, sterile visuals or rational claims.
To balance rational credibility with emotional appeal, consider these four factors:
· Lead with insight, support with evidence: Begin with a human truth or patient motivation, then substantiate it with data.
· Include authentic voices: Feature practitioners or patients to humanise technical information.
· Design with warmth and clarity: Balance clinical precision with aspirational, relatable visuals and tone.
· Ensure consistency: Align emotional tone with scientific integrity, avoiding overstatement.
The global medical aesthetics market is projected to grow by 7% annually through 2029, presenting significant opportunities – but also intense competition.5 In today’s market, technical merit alone no longer suffices. While emotional marketing has long defined consumer sectors, the aesthetics specialty has traditionally relied on clinical claims and rational messaging. This is changing as brands recognise that emotional engagement fosters deeper resonance and lasting relationships. Done well, it makes brands “stickier,” embedding them in people’s lives through trust, relevance and shared values rather than mere transactions.
While facts and claims establish credibility, emotion creates connection – and connection drives decisions. Emotional engagement doesn’t necessarily mean sentimentality, it can stem from humour, joy, inspiration, nostalgia or courage, whatever best reflects the brand and resonates with its audience. In medical aesthetics, this is particularly critical. The category is deeply personal, anchored in confidence, self-image and trust. Patients don’t just purchase treatments, they invest in the way those treatments make them feel, with research showcasing that out of 96 patients, 69% report seeking procedures to enhance their psychological wellbeing.6
Patients respond most to emotions such as confidence, empowerment and self-expression – reflecting a desire for authenticity, control and comfort in their own skin. For practitioners, brands that evoke trust, professional pride and partnership resonate most strongly.6
However, it’s important to recognise that emotional marketing in aesthetics must operate within clear ethical boundaries. According to the Advertising Standards Authority (ASA) and Committee of Advertising Practice (CAP) guidance, adverts must not exploit patients’ insecurity, trivialise procedures or give unrealistic expectations.7 Responsible messaging invites patients to feel empowered and informed, rather than pressured or ashamed. For example, emphasising how a treatment might enhance confidence or reflect individual goals is acceptable, but implying that someone must undergo a procedure to feel good about themselves oversteps ethical boundaries.7 A strong example of this is pharmaceutical company Allergan Aesthetics’, an AbbVie company, “See Yourself” campaign for Botox Cosmetic, first launched in 2021.8 The campaign shifted focus from science to emotion, celebrating confidence, individuality and self-expression through the stories of 25 real people. Using a candid, documentary-style approach with
self-filmed diaries and testimonial videos, the storytelling centred on how treatment helped individuals feel more like themselves, framing aesthetic care as self-care and empowerment. Diversity was integral –showcasing varied ages and ethnicities fostered empathy and inclusion.9,10 One featured story highlighted a Black single mother, Monique, as she reflected on her life juggling the needs and hobbies of her children alongside work. Asked what she sees when she looks at herself, she said, “I see a person that’s caring. Sometimes I care too much because I would care about everyone all the time, but it just took me some time to realise that I’m just as important as they are. Now that I’m focusing on myself, Botox Cosmetic is something that I’ve always been interested in trying.”9
Adopting an entertainment mindset
To achieve this emotional connection, it can be helpful for brands to adopt what can be termed an entertainment mindset.
This approach is built on three core principles – earning attention, building emotional connection and sustaining engagement across every touchpoint to drive long-term loyalty. It’s about entertaining your audience rather than selling to them –creating moments people want to engage with, not scroll past.
For example, an injectable brand adopting an entertainment mindset might tap into cultural moments, such as award shows or red carpet events, to stay relevant. It could also present educational content in innovative, discovery-driven ways, using simple Q&A formats to deliver information in an engaging and enjoyable manner.
For brands and clinics seeking to stand out in an increasingly competitive market, understand that people don’t just want information – they want inspiration. Brands that create experiences which move, empower or engage their audiences evolve from being a choice to becoming the preferred choice.
Storytelling to make your brand distinctive
Effective storytelling starts with a clear “why,” reflecting your purpose, values and point of view. Understanding your audience, including their aspirations, fears and desired feelings, is essential. Stories should humanise the science, linking benefits to outcomes like confidence, trust and empowerment, while remaining consistent across all channels. Show rather than tell through visuals and experiences, create content that is shareable and allow the story to evolve over time while staying true to its core.
According to Jennifer Aaker, behavioural psychologist and marketing professor
at Stanford Graduate School of Business, stories are up to 22 times more memorable than facts alone.11 Additionally, neuroeconomist Paul Zak of Claremont Graduate University found that character-driven narratives trigger oxytocin release, enhancing empathy, attention and memory whilst increasing the likelihood of action.12
Storytelling conveys a brand’s purpose and values through authentic, consistent, and emotionally resonant narratives, whether via advertising, social media, or daily interactions. An example of this is VIVACY Laboratories UK launch campaign in 2020.13 When entering the market, French aesthetics manufacturer VIVACY Laboratories chose to lead not with clinical data but with a cinematic story celebrating the bond between Paris and London.
Framed as a love letter between the two cities, the campaign highlighted shared elegance and artistry, blending ballet, landmarks and stylised treatment imagery. Conveying “endless affection” and positioning VIVACY Laboratories at the intersection of science and style, it engaged practitioners and patients across conferences and digital platforms without relying on complex product claims.
Face-to-face events remain one of the most effective ways to engage practitioners. Yet many brands rely on predictable formats – white walls, brochures and product demonstrations. When executed thoughtfully, a more memorable approach doesn’t compromise credibility – it can enhance it.
Over recent years at the Clinical Cosmetic Regenerative Congress (CCR), device company Alma distinguished itself from the conventional aesthetic.14 Its exhibition stand incorporated custom-wrapped devices, a live DJ, a prosecco bar and branded macarons as tools to attract attention and stimulate curiosity. Interactive elements, including a Batak wall reflecting the laser pattern of The Alma Hybrid and a grabber machine, further encouraged engagement. The initiative yielded the Best Stand Hospitality Offering Award, over 1,400 leads and more than 376,000 social media impressions, demonstrating that even in professional settings, thoughtfully designed entertainment can drive meaningful engagement.
Smaller-scale activations can achieve comparable impact by prioritising interaction. Simple yet well-designed elements, such as photo opportunities, gamified data capture or hospitality touchpoints, can foster meaningful connections. The principles
remain the same – only the scale differs. Memorable events do more than capture attention, they build trust and intent. According to Spiro’s Experiential Marketing Impact Report (EMIR), Report, published in 2025, attendees who experienced increased brand trust after a live event were 264% more likely to report high purchase intent.15
Whether you’re building a global brand or running an independent clinic, success depends on consistent, emotionally intelligent marketing.
Define your niche using competitor analysis and audience insight, ensuring all activities support it. Lead with emotion by understanding practitioners’ responses, translate science into human stories and create meaningful moments across exhibitions and digital activations. Measure engagement and sentiment as well as sales.
For practitioners and clinic teams
Use cost-effective digital channels to share educational content, patient journeys and behind-the-scenes insights. Highlight your purpose, collaborate locally, invite reviews and user-generated content and maintain visibility through consistent posting, content repurposing and active engagement to connect with your audience and build trust.
In today’s competitive medical aesthetics market, leading brands are remembered not just for their science but for how they connect. An entertainment mindset doesn’t weaken credibility; it strengthens it, presenting evidence in ways that engage clinicians, patients and culture. In a field built on precision and trust, emotional connection makes a brand unforgettable.
Nick Jekyll is the co-founder and creative director of advertising agency Paradise, based in London. Since founding the business 13 years ago, Jekyll has led Paradise to deliver bold, culturally-driven work across brand strategy, experiential and social for numerous clients, including medical aesthetics brands Alma, VIVACY Laboratories and Prollenium UK, as well as the BBC, Netflix and Stella Artois.
Discover, network & celebrate medical aesthetics
(Disclaimer: Allergan Aesthetics, an AbbVie company is the headline sponsor for the ACE and has part-sponsored this event. This includes provision of a stand, speaker programme, mentors, and topic input into some mentoring sessions. Allergan Aesthetics has had no influence or involvement over the content or topics covered in other parts of the agenda of the ACE main event.)
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Since the start of this year, the Advertising Standards Authority (ASA) has acted against nine advertisers who, against the law and the ASA rules, were seen to be promoting weight-loss medication to the public.1 Between February and June 2025, the ASA uncovered 10,000 adverts from 35 high-priority pharmacies that were potentially problematic. While most of the adverts did not mention a name of a weight loss prescription-only medicines (POMs), 80 were found to directly use or mention a named weight-loss drug name. Many were also seen to use images or strongly implied the use of weight-loss POMs without naming the drug, which is a breach of the Committee of Advertising Practice (CAP) Code Rule 12.12.1
The Medicines and Healthcare products Regulatory Agency (MHRA), in partnership with the ASA and General Pharmaceutical Council (GPhC), released an updated Enforcement Notice in September 2025, reiterating the rules around the advertising of POMs used for weight management.2 In the last year, the MHRA reportedly acted against 25 businesses that promoted to the public POMs for weight loss.2
The rules surrounding weight loss promotion, as well as other POM’s used in medical aesthetics, may be confusing to many. To help you make sense of the advertising rules and protect your business, Aesthetics collated the current guidelines and spoke to the ASA to give some clarity on what you can – and can’t – do.
The ASA is the UK’s independent regulator of advertising across all media. It enforces advertising codes written by the CAP and monitors ads in sectors where there are potential consumer protection issues or societal concerns about specific products.3
The ASA also responds to complaints made by consumers and companies, and it can act on just one complaint – it does not need a case against an advertiser to be made before an investigation begins.3
It is an offence under the Human Medicines Regulations 2012 to publish an “advertisement that is likely to lead to the use of a POM”, as laid out in regulation 284 (1).4 According to rule 12. 12 of the CAP code, POM’s or prescription-only medical treatments may not be advertised to the public.4 This applies to all media, including websites and social media, and any reference to a POM is likely to amount to promotion of it.4 This means you cannot mention a POM in any media, some of which include:5
· Ads on the internet including social media and on companies’ own websites
· Press ads
· Commercial e-mail and text messages
· Posters/billboards
Leaflets and brochures
· Direct mail
However, medicines sold over the counter which include pharmacy products may be showcased to consumers, but only if adverts are accurate and not misleading.6 Moreover using healthcare professionals or celebrities to endorse any medicine breaches rule 12.18 of the CAP Code.7
ASA ruling does not, however, apply to clinic window displays. Although it is still illegal, advertising POMs inside a clinic, such as the clinic window or front desk, window displays fall outside the ASA’s remit and is instead regulated by the local trading standards department.8
Under the guidance, any reference to POMs and POM treatments is prohibited; however, a consultation on the area of treatment is likely to be acceptable.4
As seen above, even if you don’t directly name the POM, an indirect reference is still likely to be a problem. The ASA explains that they often see weight loss medicines presented as “skinny pens” or “skinny pills” which the CAP Compliance team has taken action against as this would be a breach.8 Moreover, indirect references to a condition for which a POM is the only treatment, is likely to be considered an indirect promotion and therefore unacceptable.8
In January 2025, TV personality Gemma Collins posted on social media platform Instagram, promoting the weight-loss service Yazen.9 In a video, Collins said, “I’m starting this year two sizes down, thanks to Yazen’s weight-loss app and medication. It’s quick and easy to get started with Yazen, it has absolutely changed my life… I finally found something that I can actually lose weight on.”
She added, “Yes, there’s reports and stuff. And I’m not telling anyone to go on this medication, but it is prescribed on the NHS.”9
As a result, the ASA issued a ruling in July 2025, as the ad breached guidelines surrounding the promotion of POMs to the public.9 Yazen responded by explaining that the post was supposed to share information about their “holistic, responsible approach to weight loss,” and had not been intended to focus solely on medication.9
The post was later amended and any reference to the POM was removed, with Yazen saying that they would ensure that future posts were compliant with the advertising code. Collins echoed this sentiment and accepted that her posts had promoted the Yazen weight-loss service and app. She said she strives to comply with the advertising code and takes the responsibility she has very seriously.9
With the rise of social media, before and after images have become more prevalent online. However, in the eyes of CAP and the ASA, before and after photos are viewed in the same way as testimonials, and marketers should therefore ensure that they meet the requirements of rules 3.47-3.50 of the CAP Code.10 The photos must not be exaggerated for the efficacy of the product and relevant evidence is needed to prove what the images suggest.10 Finally, those producing the images should hold signed and dates proof that the photos are genuine.10
The ASA is likely to interpret before and after photographs as an advertising claim, which is not permitted for POMs (Rule 12.12).11 It is therefore best practice to avoid featuring any before and after images of POM’s in marketing communications.11
The only time it may be acceptable to use before and after images is if the marketer also promotes non-POM treatments alongside their POM counterparts, but it must be clearly attributed to the non-POM product.11
Marketers must ensure they are not implying that they can offer treatment for obesity by showing “before” images of obese subjects, unless the plan is supervised by a suitably qualified HCP.10
Since 2021, the ASA has utilised its Active Ad Monitoring system, which is powered by AI and machine learning. This system allows the ASA to capture and review adverts at far greater speed and efficiency.12 With the new system, the regulatory authority can now combine large-scale automated capture with human review.12 AI filters the ads, simultaneously highlighting potential breaches which are then presented to investigations in order to achieve swift enforcement.12
The ASA told Aesthetics that this year alone, it has published six rulings against ads for liquid BBLs where the ads irresponsibly pressured consumers into booking, trivialised the risks of liquid Brazilian butt lifts (BBLs) and exploited women’s insecurities surrounding body image. A spokesperson for the ASA added, “In addition to our formal investigations, we carry out ongoing proactive monitoring work for ads in the beauty, aesthetics and medical space. Using our Active Ad Monitoring system to identify potential problem ads, we work with social media platforms to take action against a number of ads every week.”
The seriousness of breaking the rules may be underestimated, but it can have repercussions for your business. If you post an advertisement that breaks ASA rules, you will firstly be asked to withdraw or amend the post. If you don’t comply, then you may receive the below sanctions:13
· Your name and details of the breach, with your advertising, will be added to a dedicated section of the ASA website until you have amended or withdrawn the post. The ASA uses search engine optimisation to ensure those details appear in results when people look up your company or clinic website
· The ASA may ask search engines to remove paid-search ads when those ads contain material which breaks the rules
· The ASA may place their own paid-search ads to highlight the advertiser’s name and non-compliance
· The ASA works with social media companies to have non-compliant content removed from their platforms
In the case of social media influencers, the ASA can:13
· Add their details to the dedicated non-compliant social media influencer page for up to three months
· Run on-platform targeted ads, alerting users when an influencer has repeatedly failed to properly disclose when they are advertising
If these sanctions are not deemed to have brought the advertiser in line, the ASA can refer cases to Trading Standards who investigate unfair trading and illegal business activity. Sanctions from Trading Standards include criminal prosecution which may result in fines or imprisonment, or confiscation of financial assets. Any of the above sanctions can have a serious impact on your business and how you are viewed by the specialty and potential patients.13
✖ DON’T include the names of POMs in ads
✖ DON’T promote a POM by using descriptors or descriptions that are likely to be understood by consumers as referring to a POM, for example: weight loss injection, weight loss pen, obesity treatment jab and GLP-1
✖ DON’T use imagery in ads that is likely to be understood by consumers as denoting a POM
✖ DON’T direct consumers from an ad seemingly for non-POM products or services directly to another ad promoting a POM
✔ DO promote the consultation, not the POM
✔ DO remember that advertising any POM to the public is illegal in the UK
While the consequences of incorrectly advertising weight-loss medicines can have serious effects on both a clinician and their business, there has been encouraging progress. In the past year, 197 non-POM ads were amended or withdrawn, a 91% reduction in January to June 2024.14 However, it remains essential to stay familiar with the rules surrounding advertising POMs and make sure to always double-check your social media posts and other promotional materials before they go out, ensuring you are promoting best practices in the aesthetics specialty.
In The Life Of Dr Amy
Dr Amy Watson offers a glimpse into her daily routine and her role working with Alma and Revanesse
A typical working day…
As any parent with young children will know, days start very early – and for me it is no different. My mornings begin somewhere between 5.30am and 6am, and the first thing I do is head straight to the coffee machine. I like my coffee strong, so I opt for a flat white and usually have two every morning. Breakfast is a signature mix of Greek yogurt, kefir, walnuts and pecans, blueberries, raspberries and almond butter – finished with a sprinkle of some flax seeds – or honey if I’m craving something sweeter. This keeps me fuelled throughout the day, which is lucky as I never seem to have time for lunch! I drop my three daughters off at school and nursery around 8am, but if they attend breakfast club, I’ll fit in an early pilates class at around 7.30am, followed by some work admin before heading to the clinic.
As the owner of Muse Medical, with clinics in both Harrogate and York, my commute varies depending on the location I am working at that day. When travelling to York, I like listening to anything health-related, with my current go-to podcast at the moment being Gary Breka, who always delivers fascinating conversations to start my day. A former morbidity statistician, Brecka has worked out the statistics of why people die and discusses topics such as breath work, biohacking and wellness, often featuring different guests on each episode which I love.
means less risk for my patients and better results.
I work four days a week with Monday and Tuesdays finishing at around 3pm so I can collect my children from school and nursery. We usually have a little snack, chat about their days and then my eldest is at the age now where she gets homework, so we crack on with that before I make tea. After dinner, it’s the classic bath time, play time and bedtime routine – so I usually end up sitting down at around 8pm where my husband and I get to catch up about our days.
When I have a moment to unwind, I love to get lost in a good book, so out the kindle comes! I don’t read anything that is too academic focused during the evening, so stick religiously to fiction, as this is my time to truly unwind and let my mind relax. Other outlets I use to relax are yoga and reformer pilates. As I have a lot of joint pain with my autoimmune disease, I tend to do either one of these, probably four or five days a week, just to try and keep everything supple. It’s a really nice way to do exercise without feeling like you’re over doing it.
work commitments…
I am associated with the aesthetics device company Alma and a trainer for Revanesse, providing six to one or one-to-one sessions, as well speaking for them at events, such as at the Aesthetics Conference & Exhibition (ACE) and Inner Circle. I also have recently attended Alma’s MedX Summit where I participated in panel discussions and spoke about combination treatments with Revanesse dermal fillers as well as the Alma Harmony XL pro machine. Being the only faculty member who uses Revanesse dermal filler and has an Alma Harmony XL PRO, this has allowed me to share my multimodality treatment plans using the whole portfolio that Alma has to offer. I have also been lucky enough to attend Athens and Dubrovnik with the Alma Academy which is always a fantastic experience.
Once I arrive at clinic, I dedicate the majority of my day to my patients. New patients get 60 minutes per consultation, while some of my existing patients get 45 to 60 minutes. These sessions often provide a valuable opportunity to check in, ensuring patients are happy and addressing any new concerns. I perform all injectable treatments, from toxin and dermal filler to polynucleotides and skin boosters, whilst my skin therapist handles all skin treatments such as microneedling and facial lasers. One of our devices in clinic is the Alma Harmony XL Pro which tackles all aspects of facial ageing, redness, acne, retexturing and pigmentation. When it comes to my favourite treatments to perform, I love full facial rejuvenation with dermal fillers. I still think that it’s such a magical treatment and can look harmonious, helping to ‘light up’ my patients’ faces again. One of the latest innovations that I am really enjoying is the long-term collagen stimulator Juläine. I started offering it at the beginning of summer and am now seeing patients post their second treatment, their positive feedback has been very rewarding. I am always looking for the best technology for my patients, and I really appreciate Juläine’s cutting-edge Lasynpro technology. It’s less inflammatory mechanism of action due to the spherical particles,
A particular standout moment for me was my first live injectable demonstration, because I was two months postpartum and still breastfeeding my third child. It was nice to do something that I could probably do in my sleep, but it confirmed to me that ‘I’ve got this and I know what I’m doing’. It was a moment which validated my abilities which was lovely. That demonstration also became an incredible gateway to my collaboration with Alma, who recognised my skills and offered me the opportunity to work with them. It was a memorable day, and I felt so proud of myself – just because I should have still been in my pyjamas!
If you could choose a career outside the medical field, what would it be?
I would have loved to have gone into interior design! What is the best career advice you have received?
Don’t compare yourself to other people, your journey is your journey.
What is one of your guilty pleasures?
Reeses Peanut Butter Cups, every time I’m in a shop I grab some!
Nurse prescriber Michelle Pickering argues that prescribing qualifications are essential for aesthetic nurses
The history of nurse education in the UK is deeply rooted in the establishment of the NHS in 1948.1 It was primarily designed to meet the immediate workforce needs of the health service, focusing on training nurses to deliver care within a hospital-based, medical model.
However, in recent years, the role of nurses, and by extension their education, has been evolving. Nurse education is beginning to shift away from being solely a pipeline for NHS staffing, towards a more expansive model that prepares nurses for diverse roles across healthcare systems, including in private practice. Of course, many choose to utilise the skills gained from the NHS and transfer into medical aesthetics.2 Because of this, I argue it is essential that aesthetic nurses pursue a prescribing qualification.
The introduction in 1992 of the non-medical prescribing (NMP) qualification in the UK has been a significant step in expanding the scope of nursing practice. It has allowed nurses to take on responsibilities traditionally held by doctors, which has enhanced their autonomy and the continuity of care they can provide.4
Previously, I would suggest that the structure of qualification routes has tended to favour nurses from more traditional clinical settings, creating additional barriers, often limiting those from non-NHS sectors such as aesthetics. However, since late 2018, the introduction of the practice assessor and practice supervisor roles for the assessment of students on the non-medical prescribing programmes has shown significant promise to enable more aesthetics nurses to have access to clinical supervision in practice.5 This has ensured they have appropriate support to fulfil the Royal Pharmaceutical competencies, supervised prescribing practice hours and the clinical aspects of the portfolio to be signed off as achieved.6
With increasing numbers of nurses offering non-surgical aesthetic treatments including prescription-only medicines (POMs) as well as the administering of treatments that require POMs to intervene in emergency scenarios, the need for robust training and regulatory oversight to ensure patient safety
and ethical practice is paramount. Given the risks associated with aesthetic treatments, it is imperative that aesthetic nurses in the UK undertake the NMP qualification to enhance patient safety, uphold professional standards and bridge regulatory and educational gaps. Looking ahead, the introduction of the Government’s new licensing scheme for aesthetic practice in England may make it more important than ever for aesthetic nurses to hold prescribing rights.7 Prescriber status not only enables practitioners to respond swiftly and appropriately to clinical needs and complications but also strengthens professional accountability within a regulatory framework. In this context, the NMP qualification represents a critical step towards ensuring patient safety. Without appropriate training in pharmacology, prescribing ethics and clinical governance, there is a heightened risk of complications such as allergic reactions, improper dosing and antimicrobial resistance in aesthetics.8 The NMP programme provides aesthetic nurses with the knowledge and skills necessary to prescribe safely, reducing risks and ensuring patients receive the highest standard of care.
Currently, non-prescribing practitioners in the aesthetics field rely on prescribers to authorise POMs. This introduces potential delays in patient care and may lead to inappropriate remote prescribing, where a prescriber authorises treatment without a thorough face-to-face assessment. The NMP programme also provides a legal and ethical foundation for prescribing practices.9 Furthermore, ensuring that all practitioners who prescribe POMs have undergone rigorous training helps prevent issues such as overprescribing, patient exploitation and unsafe delegation of prescribing responsibilities. By encouraging qualified aesthetic nurses to complete the NMP programme, I believe we create a safer and more accountable system in which the individual administering the treatment is also responsible for the prescription and clinical assessment.
A further question arises as to whether completion of the NMP qualification should become mandatory for aesthetic nurses. Pharmacists, for example, will soon qualify as prescribers upon registration, reflecting a broader move within healthcare towards
embedding prescribing competence as standard practice.10 If pharmacists are expected to carry this responsibility it may be argued that aesthetic nurses should be held to a similar standard.
Addressing the gaps
It is important to acknowledge why some aesthetic nurses may be reluctant, or unable, to undertake the NMP qualification. Time and financial pressures are significant factors. Unlike their NHS counterparts, who are often given paid study leave and supernumerary hours to complete the portfolio and practice elements required by the NMC, aesthetic nurses typically receive no such support. The cost of the university programme itself is considerable, and this is compounded by additional expenses such as securing a Practice Assessor (PA) and Practice Supervisor (PS).
Universities also frequently require that clinical placements are undertaken in Care Quality Commission (CQC) registered premises, with comprehensive audits of placement environments and supervisors. While such measures are designed to protect patient safety and maintain academic standards, they can be a considerable hurdle for aesthetic nurses working in smaller, independent clinics that may not meet this criteria.12 Taken together, these structural, financial and logistical obstacles make the NMP qualification far more accessible to nurses in traditional NHS pathways than those in the private aesthetics sector. Addressing these barriers will be essential if the profession is to close the skills gap.
The NMP represents a crucial step in professionalising the aesthetics specialty, improving patient safety and ensuring ethical practice among aesthetic nurses. I argue that regulatory bodies, educational institutions and professional associations must work together to integrate the NMP programme into aesthetics CPD pathways. This will not only elevate standards but also provide patients with the assurance that they are receiving treatment from well-trained professionals.
Michelle Pickering is a senior lecturer at Liverpool John Moores University, specialising in Non-Medical Prescribing (NMP) and Advanced Clinical Practice (ACP) education. She has practised as an aesthetics nurse since 2016.
Qual: RN, INP, MA (Education), PGcert (Medical and Health Education), FHEA
Your guide to the unmissable companies at the Aesthetics Conference & Exhibition (ACE)
Key Sponsors
Platinum Brands
3D Aesthetics
4T Medical
Acclaro Corporation
Ace Medicine Ltd
Acre Pharmacy
Aesthetic Medical Partnership Ltd
Aesthetic Web
Aestheticare
Allergan Aesthetics
Alma Lasers UK Ltd
Amory London Ltd
Arthrex Ltd
Beautology Laser & IPL Services Ltd
Beauty Expert Korea
BEAUTYEUROPE.EU CO UK Ltd
BTL Aesthetics
Caci International
Candela (U.K) Ltd
Cellap Laboratory UK
CellPRP
Church Pharmacy
Cosmeditech Limited
Cosmetic Courses
Croma Pharma UK
Crown Aesthetics
Cure Medical Limited
Cutera
Dermafocus Ltd
Dermapenworld
Elenzia Limited
EMA Aesthetics Ltd
Energist Ltd
Evolus
Fotona UK
Galderma (UK) Ltd
Genefill UK
Halo Health Technologies Ltd - T/A
Halo IV
Harley Academy
Harpar Grace International Ltd
Hawksley & Sons
Healthxchange
Hydrafacial
HYPO21
IBSA UK
IDENEL Professional
iiaa
InMode
Inspire to Outstand
IVANMED
John Bannon Pharmacy
K-Laser UK
Klira
LPG Systems UK
Lutronic
Lynton Lasers Ltd
Med-Fx UK
Merz Aesthetics
Neauvia
Novus Medical UK
Opatra
Pabau
PRP PURE LTD
PT DERMIS LABS SOFTWARE
Pure Tone Aesthetics
Quad Aesthetics
REGEN LAB SA
Revolve Medicare Pharmacy
RS Risk Solutions Ltd
S.THEPHARM CO.,LTD.
Sata Training Academy
Sciton UK
Sculpt Pro Aesthetics
Shire Leasing PLC
Silhouette Dermalift
skinade
SkinCeuticals
SOFWAVE
Solta Medical
Spring Thread UK
Teleta
The Glow Group
Totally Derma
TSK Laboratory UK
Vivacy Laboratories UK
WIGMORE MEDICAL LIMITED
You Can Clinic
Zenoti
ZO Skin Health
