FEBRUARY 2025: Regenerative Medicine by Aesthetics & CCR

Our aesthetic lives:

Embracing Uniqueness

THE GALDERMA

AESTHETICS COLLECTION

Advancing dermatology for every skin story

Find the full Galderma injectable and skincare collection at:

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Contents • February 2025

The latest product and specialty news

19 News Special: Keir Starmer announces AI Action Plan

The UK PM has shared an initiative to fuel artificial intelligence growth

CLINICAL PRACTICE

21 The Future of Eyelid Rejuvenation

Lynton reviews the key benefits of SmartXide Bleph

23 Special Feature: Using Polynucleotides to Treat the Body

Three practitioners outline how polynucleotides treat body concerns

27 CPD: Ethnic Considerations for Botulinum Toxin

Dr Souphi Samizadeh discusses treating different ethnic groups with toxin

32 Learn Practical Insights and Master New Techniques

Unlock the future of aesthetics at ACE 2025

36 Understanding Regenerative Ingredients in Skincare

Nurse prescriber Anna Baker outlines regenerative ingredients

38 Considering the Science of Collagen

Lauren Dewsbury explores collagen supplementation for skin health

42 Exploring Optimal Supplement Ingredients

Dr Eugenia Bonelli outlines key ingredients in supplements for the skin

44 Case Study: Holistically Regenerating Skin and Hair

Dr Raquel Amado demonstrates treatments for menopausal skin and hair

46 Enhancing Microneedling Outcomes with Exosomes

Practitioners explore milk exosome solutions for skin regeneration

48 Pushing the Boundaries of Medical-Grade Skincare

Discover the science behind clear, healthy skin with ZO® Skin Health

49 Abstracts

A round-up and summary of useful clinical papers with Professor Sebastian Cotofana

IN PRACTICE

50 Ethical BDD Management Strategies

Clinical Contributors

Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and PGCert in Clinical Education. She is the founder of the Great British Academy of Aesthetic Medicine and a published author of peer-reviewed books and papers in medical aesthetics.

Anna Baker is an aesthetic nurse prescriber, trainer and qualified educator. She is a key opinion leader, BAMAN board member and jointly leads on the BAMAN Education and Training Committee.

Kitty Newman offers strategies for identification and management of BDD

52 Supporting National Healthcare Systems

Dr Sophie Shotter reviews partnerships aimed at enhancing NHS

54 Going Paperless in Your Clinic

Max Hayward shares the benefits of digitising your clinic documentation

57 In The Life Of: Dr Steven Cohen

Dr Steven Cohen explores the advancement of regenerative medicine

58 The Last Word: Reducing Patient Risk in Scotland

Scottish Medical Aesthetics Safety Group representatives argue that Scotland’s proposed regulation is not strong enough

NEXT MONTH: BEST PRACTICE IN MEDICAL AESTHETICS

Lauren Dewsbury is the senior research scientist and ingestible beauty expert at Vida Glow, where she oversees research and clinical trials. She has a background in health science and is currently completing her PhD investigating nutritional and lifestyle medicine.

Dr Eugenia Bonelli combines her expertise in surgery and aesthetics at her Wimpole Street practice. As a member of the Royal College of Surgeons and the JCCP, she seamlessly integrates surgical precision with aesthetic artistry, ensuring safe and personalised treatments that enhance natural beauty.

Dr Raquel Amado graduated as a dental surgeon in 2007. She completed a post-graduate in Dental Sedation and Pain Management at the UCL Eastman Dental Institute in London. She is an affiliated member of ACE Group and CMAC, which aim to improve patient safety in facial aesthetics.

Dr Marcello Poltronieri is a maxillofacial surgeon specialising in aesthetics, with more than 40 years of experience. He graduated in Medicine and Surgery from the University of Naples Federico II and specialised in Oral Surgery and Dental Implantology at the George Eastman Institute in Rome.

Dr Mario Luca Russo is a cosmetic and dermatological surgeon on skin rejuvenation, cosmetic dermatology and minimally invasive facial rejuvenation techniques. With more than 30 years of clinical practice, he is a Member of British Association of Dermatologists and the British College of Aesthetic Medicine.

Shannon Kilgariff Editor & Event Manager @shannonkilgariff

Regenerative medicine is rapidly shaping the future of aesthetics, with more patients than ever seeking natural, long-lasting results that go beyond surface-level enhancements. In this month’s issue, we explore how regenerative treatments are revolutionising the medical aesthetics field, offering solutions that work in harmony to restore and rejuvenate. Our features this month dive into some of the most exciting developments in this space, from regenerative skincare and the rise of exosomes (p.36), to targeted treatments designed to support skin and hair health in menopausal women (p.44). Plus, our Special Feature takes an in-depth look at the use of polynucleotides for body indications. This is an area gaining significant traction among practitioners looking to expand their treatment offerings (p.23).

With the Aesthetics Conference & Exhibition (ACE) 2025 fast approaching, this issue also brings you an exclusive preview of what to expect at this year’s event on March 14-15. From cutting-edge CPD

Clinical Advisory Board

education by leaders in our specialty, to live demonstrations and expert-led discussions, ACE promises to be an essential two days for nurses, doctors, dentists and other professionals in medical aesthetics. Turn to p.32 to find out more and register for free!

We’re also getting closer to one of the most anticipated nights of the year – The Aesthetics Awards! The Winners will be revealed next month at the ceremony on March 15, and myself and the team can’t wait to celebrate with you all. Tickets are selling fast, so make sure to secure yours as soon as possible.

Finally, our Last Word article this month tackles the crucial topic of Scottish regulation. With the consultation deadline looming, now is the time to make your voice heard. This is a pivotal moment for the future of medical aesthetics in Scotland, and I encourage everyone to engage in the discussion and share their views before the consultation deadline on February 14 – read how you can participate on p.58

As always, we’d love to hear your thoughts on this month’s journal –connect with us on social media @AestheticsJournalUK or reach out at editorial@aestheticsjournal.com

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 chair of the British Association of Cosmetic Nurses (BACN), previous 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 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 Manager

T: 0203 196 4351 | M: 07557 359 257 shannon.kilgariff@easyfairs.com

EDITORIAL

Holly Carver • Deputy Editor & Content Manager

T: 0203 196 4427 | holly.carver@easyfairs.com

Kate Byng-Hall • Senior Journalist | T: 020 3196 4389 kate.byng-hall@easyfairs.com

Amer Saleh • Content Writer | T: 020 3196 4270 amer.saleh@easyfairs.com

Mia Sawyer • Content Writer | T: 020 3196 4242 mia.sawyer@easyfairs.com

DESIGN

Aimee Bish • Senior Graphic Designer

Callum Benyon • Junior Graphic Designer

Kitty Butler • Graphic Design Intern

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.

ADVERTISING & SPONSORSHIP

Judith Nowell • Head of Sales

T: 0203 196 4352 | M: 07765 407629 judith.nowell@easyfairs.com

Emma Coyne • Senior Sales Executive

T: 020 3196 4372 | emma.coyne@easyfairs.com

Imogen Preece • Sales Executive

T: 0203 196 4367 | imogen.preece@easyfairs.com

MARKETING

Susana Burguera • Senior Marketing Manager

T: 020 3196 4281 | susana.burguera@easyfairs.com

Ella Carey

• Marketing Executive

T: 020 3196 4410 | ella.carey@easyfairs.com

Isabell Wise • Marketing Executive

T: 020 3793 5845 | isabell.wise@easyfairs.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 Tapan Patel is the founder and medical director of PHI Clinic, and has more than 20 years’ experience performing aesthetic treatments. He is a KOL for Allergan Aesthetics and Cutera, and is passionate about high standards in aesthetic medicine. In 2023, Dr Patel received The Aesthetics Award for Outstanding Achievement in Medical Aesthetics

Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.

ARTICLE PDFs AND REPRO

Material may not be reproduced in any form without the publisher’s written permission. For PDF file support please email, contact@aestheticsjournal.com

Talk #Aesthetics

#Published

Amanda Azzopardi @amandaazzopardiaesthetics

Guess who’s been published in Aesthetics Journal? Me! I discussed radiofrequency and how to integrate the treatment into your clinic.

#Collaboration

Gilbert Saenz @pa_gilbertsaenz

Dr MJ Rowland-Warmann and I have been working on something to help you level up your aesthetic skills and confidence!

#Connection

Dr Sonali Kohli @drsonalikohli

Grateful for the insights, the shared laughter and for showing how medical aesthetics can be practised with both precision and heart!

#ClinicVisit

Dr Dev Patel @drdevpatel1

What a pleasure welcoming Jon Arnold, president EMEA of Hydrafacial, to Perfect Skin Solutions clinic.

#Networking

Croma Pharma UK @cromapharmauk

Hosting a ‘New Year New Start’ coffee morning. Attendees enjoyed an inspiring morning of learning and networking.

Criminal Activity

Gangs lure young women into drug trade with cosmetic treatments

UK charity St Giles Trust has warned that young women are increasingly being recruited into ‘county lines’ drug gangs with treatments like botulinum toxin to groom them.

In the West Midlands of England, teenage girls have reportedly been offered lip fillers and beauty products as an attempt to groom them into partaking in criminal activity. The St Giles Trust has raised concerns about county lines gangs exploiting young women, and the use of beauty treatments to lure girls and young women is of increasing concern among charity workers.

The charity suggests that young women are increasingly being targeted, as they are less likely to be scrutinised by the police compared to their male counterparts. Similarly, young mothers have been manipulated into carrying guns and drugs in their prams to avoid detection. Various charities warn that women and girls continue to fall under the radar, and remain the ‘invisible’ victims.

Jade Hibbert, Midlands regional development manager at St Giles Trust, commented, “We have seen a massive shift across the Midlands of more and more female children being exploited. What they’re being manipulated with is botulinum toxin, fake eyelashes and fillers. It used to be designer handbags or clothes, but what we’re seeing is more perpetrators paying for treatments.”

The Aesthetics Journal reached out to the West Midlands Police for comment, but did not receive a response.

Patient Safety

MHRA urges caution over weight loss medicines

The Medicines and Healthcare products Regulatory Agency (MHRA) is reminding the public not to buy weight-loss medicines without a prescription from healthcare professionals.

The UK regulator has warned individuals against purchasing such medicines from beauty salons or social media platforms, as it poses significant health risks and is illegal.

The MHRA states that its criminal enforcement unit monitors various social media platforms and technology companies to attempt to prevent the illegal sale of weight-loss medicines online. The regulator explains its actions include removing posts and suspending accounts that sell weight-loss medicines without a prescription.

The Times reported that approximately 500,000 individuals in the UK have turned to online platforms to purchase medications like Mounjaro and Wegovy, following the NHS rollout.

Andy Morling, MHRA deputy director of criminal enforcement, commented, “At this time of year, many think about losing weight quickly. However, weight-loss medicines offered without a healthcare professional’s prescription are not cosmetic treatments but powerful medicines. These can only be legally and safely dispensed with a prescription.”

First educational agenda details revealed for ACE 2025

The first sessions of the jam-packed Aesthetics Conference & Exhibition (ACE) 2025 agenda have been unveiled.

Across five stages over two days on March 14-15, ACE will welcome dozens of leading practitioners, business specialists and association representatives to share the latest learnings and techniques from across the specialty.

On the business-focused In Practice Stage, topics including pricing, optimising cashflow, social media success, addressing BDD, regulation and much more will be discussed. On Day 2, Cosmetic Courses will host a Getting Started in Aesthetics agenda, followed by the Women in Business Panel with Francesca Ogiermann-White, before concluding with the Aesthetics Business Blueprint agenda with Rick O’Neill. The theatre will also host sessions from associate sponsors Dermis and Zenoti. Also new for 2025, the Association Zone will shine a spotlight on the specialty’s biggest associations, providing talks on topics including association membership, revalidation, protecting your brand, managing complications and more. Hear from organisations including ACE Group World, BAHRS, BAMAN, BCAM, JCCP and The Nurses Network.

The brand new Aesthetics Mastery Theatre, sponsored by DermaFocus, will be the ultimate destination for live demonstrations, precision techniques and in-depth discussions. Sessions will be hosted by AestheticSource, Alma, Galderma, IDENEL and Neauvia.

Free registration for ACE 2025 is open now, with support from registration and lanyard sponsor Healthxchange.

Shannon Kilgariff, editor and event manager of Aesthetics, commented, “With new additions and more content than ever, I cannot wait to welcome the specialty to ACE for the start of 2025 event season. The educational content we are hosting this year is second to none, and we are excited to reveal even more sessions soon.”

ACE 2025 will be taking place at the Business Design Centre on March 14-15. Turn to p.32 to register free now.

Injectables

Harley Academy debuts GEM injectable guide

Aesthetic training provider Harley Academy has released the Global Evidence Matrix (GEM) guide to injectable procedures.

The company explains that the GEM is a standardised, evidence-based guide to carrying out safe injectable treatments, based on research from Harley Academy’s academic director and anatomist Professor Sebastian Cotofana. The matrix will be rolled out from February onwards at Harley Academy, advising practitioners on enhancing their practice, fostering learning and strengthening safety measures.

Dr Tristan Mehta, founder of Harley Academy, commented, “The GEM represents a pivotal moment for our specialty. It is more than just a framework; it’s a commitment to patient safety, clinical excellence and the consistent delivery of natural, balanced results. By creating a universal standard, we’re not only empowering practitioners to elevate their skills, but also ensuring patients around the world receive the highest quality of care.” Harley Academy will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Vital Statistics

Of 500 individuals surveyed, 90% say acne insecurities impact their day-to-day lives

(AviClear, 2024)

Rochdale is the top UK town determined to lose weight, with 73.33% of residents overweight, and 26,400 weight-loss searches per month

(Second Nature, 2024)

NHS figures show more than five million are not up-to-date with their cervical screening routine check-ups

(NHS, 2024)

UK research reveals Google searches for ‘hair transplant’ have surged 58% in the last 10 years

(Harley Street Hair Transplant Clinics, 2024)

Dundee is revealed to be the best UK area for skin health, factoring in wind speed, precipitation and humidity (Fresha, 2024)

7.7 million people in the UK have had aesthetic treatments in the last 12 months, equivalent to 11% of the population

(Harley Street Skin Clinic, 2024)

Events diary

7th February 2025

Menopause In Aesthetics

14th-15th March 2025

ACE 2025

15th March 2025

The Aesthetics Awards 2025

29th March 2025

Welsh Aesthetic Conference

25th-26th September 2025

CCR 2025

Brooke Shields speaks out about non-consensual vaginal rejuvenation procedure

American actress Brooke Shields opened up after a male surgeon performed vaginal rejuvenation on her without consent. Shields revealed she was having a labiaplasty which had been causing bleeding and discomfort. She followed up with the surgeon post-operation, and he explained that he had “thrown in” a vaginal tightening procedure as a “bonus” which she had neither asked for nor wanted. Shields explained, “It felt like such an invasion – such a bizarre rape of some kind.” She added, “Nothing pointed toward this need to be tighter or smaller, firmer or younger, especially there.” The actress admitted feeling ashamed and took a long time to share the incident with her husband.

Concern as ‘Whoville’ nose job trend sweeps social media

The Who characters from Christmas film The Grinch, known for their distinctive upturned noses, have sparked a new trend, with individuals undergoing surgery to replicate the look. The procedure involves extensive reshaping of the nose, which can result in internal scarring, skin issues and a weakened nasal structure. Plastic surgeon Mr Jerry Chidester addressed this, commenting, “Drastically shortening the nose may cause breathing difficulties, as the nose’s structure plays a crucial role in airflow.” He warns, “Rhinoplasty nose surgery isn’t just about looks, it requires a careful balance of aesthetics and function.”

Regulation Scottish consultation on aesthetic regulation closes this month

The Scottish Government’s public consultation on the future of non-surgical cosmetic regulation is open until February 14.

The Government is seeking public opinion on its suggestion that all non-surgical procedures in Scotland must take place in a Healthcare Improvement Scotland (HIS) regulated clinic, or a premises which is licensed by the local authority. All procedures should also be carried out by a suitably trained and qualified practitioner, or by an appropriate healthcare professional.

The proposed regulation also classifies treatments into three groups dictating who they can be performed by. Within this classification, injectables like botulinum toxin and dermal fillers can be performed by trained non-medics, but such practitioners should be supervised by an appropriate healthcare professional.

The consultation on these suggestions will collect data that could inform final proposals that will be put into legislation, with a view to regulation being implemented this Spring.

Chair of the Joint Council for Cosmetic Practitioners Professor David Sines said, “In my opinion the proposals included in this consultation document will dramatically improve consumer safety and reduce the risk of injury and harm arising from improperly performed cosmetic treatments. Nothing is more important than public protection and patient safety. I would urge everybody to support this move towards sensible and proportionate regulation in this important sector.” The consultation is open to everyone in the UK, head to www.gov.scot to submit your response by February 14.

Education

Merz Aesthetics debuts educational platform

Pharmaceutical company Merz Aesthetics has introduced the Merz Aesthetics Exchange (MAX) platform in the UK and Ireland.

Merz Aesthetics shares that it aims to offer a comprehensive approach to educational and professional development, rooted in science-based aesthetics expertise. The company further explains that the platform is tailored to provide a unique experience for users.

Gillian Kennedy, country manager of Merz Aesthetics, commented, “We are delighted to share the MAX with healthcare professionals across the UK and Ireland. Through a wide range of online courses, in-person meetings and training events, MAX supports healthcare professionals with a drive for lifelong learning.”

Merz Aesthetics will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Mental Health

PREPÆRE mental health service and campaign launches

PREPÆRE has debuted in the UK, campaigning for increased awareness around body dysmorphic disorder (BDD).

The company, which was set up by BDD patient Brea Cannady, explains it has launched the #PREPÆREDforChange campaign to raise awareness of the potentially devastating effects of BDD. The campaign’s ultimate goal is to advocate for legislation which makes BDD questionnaires mandatory before all aesthetic procedures.

PREPÆRE is also operating as a subscription service whereby clinics and practitioners can be provided with bespoke questionnaires to fit their clinic aesthetic, demographic and treatment offerings. These questions are designed to educate patients, with links for extra information and external resources if needed, the company explains.

Cannady commented, “#PREPÆREDforChange is about transforming how mental health is integrated into medical aesthetics. With the incredible support of our ambassadors and community, I’m proud to lead this patient-focused movement, championing more compassionate care and a safer specialty for both patients and practitioners.”

IN THE MEDIA

What’s trending in the consumer press

Vernon Kay returns as Aesthetics Awards host

Television presenter and radio host Vernon Kay has been unveiled as the celebrity host of The Aesthetics Awards 2025.

On March 15, Kay will join the best and brightest in the medical aesthetics specialty for a night of networking, dinner, entertainment and dancing to celebrate the achievements of the sector over the past 12 months.

On the night, 26 individual, clinic and company winners will be named, with accolades awarded in categories including The DermaFocus Award for Best Injectable Result, The Galderma Award for Best Clinic Scotland and The SkinCeuticals Award for Best New Clinic, UK & Ireland.

A brand new accolade for this year is The Aesthetics Awards Best Dressed Charity Competition, sponsored by Cellderma. With proceeds going to Aesthetics Awards charity partner the BDD Foundation, two lucky attendees will be named the most glamorous of the evening, winning a chance to be pictured in the Aesthetics Journal

Limited tickets are still available – visit aestheticsawards.com to buy yours now.

Distribution

Galderma announces new distribution partnerships

Pharmaceutical company Galderma has revealed new distribution partnerships with Healthxchange and ACRE Pharmacy.

Under these partnerships, ACRE Pharmacy, Healthxchange and MedFx will collectively oversee the UK distribution of Galderma’s portfolio, including Azzalure and Alluzience, Restylane, Sculptra and Alastin skincare.

Gul Gokyokus, head of marketing UK and Ireland at Galderma, commented, “We are thrilled to announce these new distribution agreements. These collaborations are vital for ensuring that practitioners receive their products promptly, have access to expert support and can deliver the best aesthetic solutions to their patients. We are genuinely excited about the opportunities the distribution expansion will bring.” Galderma will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Remote Prescribing

NMC strikes off nurse for remote prescribing

A nurse has been struck off the Nursing and Midwifery Council (NMC) register after remote prescribing botulinum toxin for use by non-medical injectors.

50-year-old Heather Hazzard supplied botulinum toxin to beauticians via the Faces app in 2021, advising them to order in bulk – practices that violate established prescribing guidelines. She was exposed by an undercover journalist posing as a beautician; Hazzard told the journalist that her approach was “not the right way to do it,” and incorrectly claimed that toxin could be frozen.

The NMC panel concluded that Hazzard’s actions posed serious risks to patient safety and demonstrated dishonesty, prioritising profit over professional integrity. Sharon Bennett, nurse prescriber and British Association of Medical Aesthetic Nurses (BAMAN) chair, commented, “To ensure prescribing practices align with ethical and legal standards, medical aesthetic nurses must integrate a range of measures into their practice. Nurses should follow the Royal Pharmaceutical Society’s Competency Framework, prioritising safe, patient-centred care.”

BAMAN UPDATES

A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses

BAMAN ELECTIONS AND MANAGEMENT CHANGE

On January 1 2025, BAMAN’s CEO Paul Burgess stepped down after a decade of leadership. In a formal statement, Burgess reflected on BAMAN’s growth from modest beginnings to becoming the UK’s most respected association for medical aesthetic nurses.

As Burgess turns his focus to business interests in Africa and charitable activities, BAMAN thanks him for his dedication over the past 10 years.

With a new BAMAN Board coming into place following recent elections, our association is well-prepared to face emerging challenges and continue its mission of advancing the field of medical aesthetics, while supporting its members across the UK.

SPRING SYMPOSIUM 2025

The BAMAN Spring Symposium returns for its fourth year on April 4 2025 at The King’s Fund in London. Building on last year’s sold-out success, this year’s symposium will be headlined by Teoxane UK.

The day offers a packed agenda with expert-led sessions on anatomy, complications, dermatology, regenerative medicine, wellness and advanced treatments.

With BAMAN committed to providing high-quality education, this is your opportunity to learn from and connect with fellow nurses.

UPCOMING BAMAN REGIONAL MEETINGS SCHEDULED FOR 2025:

· East of England Meeting - Hinxton: February 27 2025

· Scotland Meeting - Glasgow: March 3 2025

· South Coast West Meeting - Bournemouth: March 5 2025

· Yorkshire Meeting - Leeds: March 10 2025

· North West Meeting - Manchester: March 12 2025

· Northern Ireland Meeting - Belfast: April 12 2025

· South Wales Meeting - Cardiff: April 28 2025

· South West Meeting - Bristol: May 12 2025

· London Meeting: June 2 2025

· Central Meeting - Solihull: June 4 2025

This column is written and supported by BAMAN

Event Spotlight: The Association Zone

BCAM president Dr Catherine Fairris discusses the benefits of the new Association Zone at ACE 2025

Why are specialty associations so important?

Medical aesthetic associations play a critical role in ensuring the highest standards of patient care, safety and practitioner professionalism. They provide guidance, promote evidence-based practice and serve as a voice for aesthetic practitioners, advocating for regulation and ethical practices in a rapidly evolving speciality. Associations also foster a sense of community and collaboration, offering members opportunities to learn from each other, stay informed about the latest advancements and maintain their professional development through training, certifications and conferences. In a field where patient outcomes and safety are paramount, associations act as a cornerstone for ensuring practitioners adhere to the highest clinical and ethical standards.

How will the new ACE Association Zone benefit attendees?

The Association Zone at ACE will provide attendees with a unique opportunity to connect directly with leading organisations that shape the aesthetics field. It will serve as a hub for knowledge, where practitioners can learn about membership benefits, available resources, training opportunities and standards in the field. Delegates should take the opportunity to engage in meaningful conversations with representatives, gain clarity on how associations support their professional growth and discover ways to enhance their practice.

ACE is a flagship event in UK aesthetics, that fosters collaboration within the aesthetics community. It provides a platform for practitioners, educators and organisations to come together, exchange ideas and explore innovations in the field. By combining a conference, exhibition and networking opportunities, ACE creates a dynamic environment where delegates can build relationships and share best practices.

What are you most looking forward to about ACE?

I’m most excited about the opportunity to connect with medical practitioners from across the aesthetics community. ACE is a fantastic platform to engage with colleagues, share insights and discuss the latest trends in our specialty. I’m particularly looking forward to showcasing BCAM’s work and sharing the ways we support our members in delivering safe and effective treatments.

Product Launch

Obagi Medical releases new eyebrow serum

Skincare company Obagi Medical has launched its Nu-Cil Eyebrow Boosting Serum.

The brand explains that the product is powered by NouriPlex technology and a combination of ingredients to address the appearance of thinning, patchy or over-tweezed eyebrows. The ingredients listed include biotin and sodium hyaluronate, with the aim to increase the production of keratin and hydrate the density of the eyebrow, according to the company.

Healthxchange will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Device

BTL Aesthetics debuts

EMFACE Periorbital

Aesthetic device company BTL Aesthetics has launched EMFACE Periorbital to target the under eyes. The company explains that the device uses needle-free muscle stimulation to strengthen the lower part of the orbicularis oculi muscles, tackling eye bags, dark circles and crow’s feet. The technology also promotes lymphatic drainage to prevent fluid stagnation, according to BTL Aesthetics.

Zbyněk Pišťák, regional director at BTL Aesthetics, said, “We’re thrilled to introduce the new EMFACE Periorbital Applicators. Last year’s EMFACE Submentum launch drove a 40% increase in device utilisation, so the new Periorbital Applicators present an exciting opportunity for our partners to expand offerings and meet growing demand for advanced non-invasive treatments.”

BTL Aesthetics will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Galderma neuromodulator approved for UK marketing

Pharmaceutical company Galderma has been granted a marketing authorisation in the UK for new liquid neuromodulator RelabotulinumtoxinA (Relfydess).

Developed using Galderma’s proprietary PEARL Technology, Relfydess is a new formulation of botulinum toxin type A. According to the company, the product is designed to deliver fast and sustained results for glabellar and lateral canthal lines. Relfydess was launched to European markets in December, and Galderma shares excitement to bring this neuromodulator to the UK in the near future.

Galderma outlined previous data from the READY clinical trial programme, which highlights that out of 1,900 participants, up to 39% of patients see effects from day one, and up to 75% maintain improvements for six months for frown lines and crow’s feet when treated with Relfydess.

René Wipperich, Galderma’s UK&I general manager, commented, “Our commitment to innovation in biologics has positioned us uniquely as the only company offering a comprehensive portfolio of three distinct neuromodulators. This milestone sets a new benchmark in enhancing the lives of patients and healthcare professionals.”

Botulinum Toxin

Professor Sebastian Cotofana announces anatomy training

World-renowned anatomist Professor Sebastian Cotofana is set to kickstart a bundle of courses entitled Neuromodulator Injection Techniques.

Professor Cotofana explains that the courses – provided through Cotofana Academy – will educate practitioners about the underlying facial anatomy which influences injectable techniques. The sessions will highlight facial layers on a cadaver, before demonstrating injectable approaches.

The courses are tiered, with novice injectors introduced to key concepts like injection biomechanics, aesthetic principles and facial layers. Experienced injectors will have access to more detailed anatomical dissections, while the most advanced level looks into adverse events related to toxins and advanced filler injection techniques.

Professor Cotofana commented, “Facial anatomy is complex, but it does not have to be taught like this. When designing the Cotofana Anatomy platform, I wanted to provide a structured path for the injector community to understand and apply the complex intricacies of facial anatomy to their daily clinical practice.”

Liquid Supplement

Tonic X supplement expands availability to aesthetic clinics

The liquid multi-supplement shot Tonic X is available for clinics to stock. The supplement, developed by public health and aesthetic nurses, combines key antiageing ingredients including astaxanthin, hydrolysed marine collagen, hyaluronic acid, vitamin C, zinc, copper and biotin. The supplement also incorporates essential daily vitamins and minerals, such as selenium and silica, aimed at supporting overall health and skin vitality, according to the co-founders.

Katie Lennick, co-founder of Tonic X and managing director at Femme UK, commented, “Our pioneering, one-shot formula combines potent antiageing ingredients, vitamins and encapsulated probiotics to target ageing from within. Our goal is to simplify and optimise your daily supplement regime along with enhancing and supporting topical treatments.” Partnership

Medik8 to be sold through Healthxchange UK

Skincare brand Medik8 has announced aesthetic distributor Healthxchange as its UK distribution partner.

The company shares Healthxchange will service new and existing Medik8 clinics in the UK and Republic of Ireland for both professional and retail products.

Founded in 2000, Healthxchange has become a prominent distributor for medical aesthetics, skincare and treatments. Medik8 is distributed among thousands of clinics worldwide, and the skincare company explains it is committed to ethical training and enhancing relationships within the aesthetics specialty.

Healthxchange will be exhibiting at ACE 2025. Turn to p.32 to register free now.

CEO of

AestheticSource,

Lorna Bowes

What were your highlights of the past year, and what are you looking forward to in 2025?

The past year has been pivotal for us at AestheticSource. We have focused on consolidating our team while welcoming new talent, driving growth and expanding our portfolio. The key highlight has been launching some phenomenally innovative products, including cutting-edge facial imaging technology, a groundbreaking post-treatment cream that marks a paradigm shift in post-treatment care and recovery, and, most recently, the addition of Sunekos. This latest venture has been particularly exciting, as it reconnects me with my roots as a serial entrepreneur in the injectables field. What trends are you noticing in the specialty? We’re noticing a clear shift in the market towards longevity, wellness and skin fitness. This trend has influenced our move towards a portfolio that empowers clinicians to measure skin health and visualise essential parameters for more effective consultations. There is a growing demand for skin boosters, accompanied by a strong preference for more comfortable procedures. Since repeat business is critical for clinics, ensuring patient comfort has become a top priority in delivering a positive and seamless experience.

What do you love about this field?

A few years ago I faced some health challenges, and the extraordinary support I received from my team and the wider field shaped the way I lead today. My background in nursing has always emphasised putting people first, and it brings me immense joy to see my team embrace that same approach with our customers. Additionally, I’m thrilled by the pace of innovation in this field; there is always something new, whether it’s groundbreaking medical advances or exciting cosmetic developments. This dynamism keeps me energised and engaged.

AlumierMD launches reformulated Retinol Eye Gel

Skincare company AlumierMD has released its reformulated Retinol Eye Gel to promote eye rejuvenation.

The company explains that the eye gel aims to firm, tighten and reduce the appearance of wrinkles. The new formulation is also available without butylated hydroxytoluene (BHT) or polyethylene glycols (PEGs) in an attempt to align with the brand’s clear science mission.

AlumierMD shares that the eye gel contains microencapsulated retinol (0.1%), which is used to improve the appearance of fine lines and wrinkles. The gel also contains niacinamide to hydrate and brighten the skin, along with bisabolol to soothe skin from irritation, according to the company.

Plastic surgeon Mr Ash Soni commented, “Not all retinols are created equally, and with the Retinol Eye Gel, my patients are seeing tangible differences to their undereye area. I look for science-backed formulations, and AlumierMD has invested in innovation and research.”

Devices

Beautology announces Korean device offering

Aesthetic distribution company Beautology has unveiled a portfolio of Korean devices now available on the UK market.

The company shares that it will be the exclusive UK distributor of Dual Accento, Pico Legend and LucidQ lasers, as well as the Antige RF Microneedle System. These will be sold in the UK in collaboration with Bison Medical and AMI.

John Isaac, director at Beautology, said, “We are delighted to announce our partnership with premium manufacturers Bison Medical and AMI. Their unwavering commitment to quality, reliability and exceptional customer support perfectly complements the Beautology portfolio. Together, we are dedicated to delivering cutting-edge solutions that set new benchmarks in the field.”

Beautology is exhibiting at ACE 2025. Turn to p.32 to register now.

Clinical Data

Supplements

Vida Glow releases three new supplement products

Supplement company Vida Glow has launched three new products to address skin health and sleep quality.

The first supplement is Pro Collagen+, which the company explains features a combination of hydrolysed marine collagen tripeptides, hyaluronic acid and digestive enzymes. Vida Glow assures improvements in hydration, elasticity and reduced wrinkle count.

Vida Glow’s second launch is a pigmentation solution, Radiance+.

The product is powered by Mela-tech, which is recognised to address pigmentation issues and regulate melanin production in the skin, the company shares.

The final launch is The Sweet Dreams Set, as Vida Glow partners with wellness company Slip. The set includes a supplement comprised of vitamin B6, passionflower and maizinol, designed to achieve better quality sleep, along with Slip’s sleep mark.

Lauren Dewsbury, senior research scientist at Vida Glow, commented, “We’re continually refining our formulas based on the latest clinical evidence to ensure every product is the most effective it can be.”

Vida Glow is exhibiting at ACE 2025. Turn to p.32 to register now.

Training

Acquisition Aesthetics introduces new Sculptra course

Training provider Acquisition Aesthetics has released its Advanced Sculptra course: The Biostimulator Revolutionising Aesthetics.

The masterclass delves into the science behind Sculptra, with years of clinical data and an exploration of anatomy for targeted treatment areas. The company states that participants will gain insight into reconstituting Sculptra for different anatomical zones, mastering clinical applications and managing complications.

Dr Priyanka Chadha, co-founder of Acquisition Aesthetics, commented, “If I were stuck on a desert island and could only take one product for my delegates, patients and myself, it would be Sculptra. As the original biostimulatory product, it rejuvenates holistically while ensuring natural, not overfilled results. It’s an essential skill for every aesthetic practitioner in today’s market.”

Hydrafacial shares Hydralock HA Booster study

Aesthetic device company Hydrafacial has released the clinical data behind its Hydralock HA Booster.

The company shares that the booster is designed to target sustained hydration and wrinkle reduction. The study involved 38 adult subjects who received one treatment with the booster; assessments were performed before, immediately and 24 hours after treatment.

The data revealed a 455% increase in hydration and 57% reduction in wrinkles instantly after the treatment, and a 338% increase in hydration and 63% reduction in wrinkles 24 hours after the treatment. Additionally, 98% reported a brighter appearance.

Laurine Berard, Hydrafacial marketing director for UK and Ireland, commented, “Hydrafacial unveils Hydralock HA Booster, a clinically proven booster that increases hydration by 3x, firms skin, delivers 24-hour moisture and reduces wrinkles by 63% after one treatment. Featuring Triple Hyaluronic Acid Complex, vitamin B5 and fruit extracts, it combats dehydrated, dull and stressed skin for instant and lasting glow.” Hydrafacial will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Eyecare

Device

Novus Medical introduces Scarlet S RF microneedling

Aesthetic distributor Novus Medical has launched the Scarlet S short-pulse radiofrequency (RF) microneedling device in the UK.

The company shares that the technology evenly distributes RF energy across the skin layers via 25 non-insulated microneedles, creating electrocoagulation of soft tissue. The treatment is designed to provide results in skin tightening, lifting and collagen production. It can be used to treat sagging skin, fine lines, wrinkles, acne scars, enlarged pores, uneven skin texture and more on the face, neck and body, according to Novus Medical.

Jim Westwood, director of Novus Medical, said, “Scarlet S delivers results that are unmatched in the realm of RF microneedling. With its precision and ability to customise treatments, this device will truly change the way medical practitioners in the UK approach skin rejuvenation.”

Learning

PCA Skin releases new educational platform

Skincare brand PCA Skin has launched online learning platform the Academy App for practitioner education.

The company shares that the platform is designed to redefine how stockists and practitioners access training, connect with the community and stay informed. The app is shaped to reflect practitioner feedback, and offers features such as comprehensive e-learning courses, a brand resource library and a live community feed, according to PCA Skin.

Lizzie Shaw, brand manager of PCA Skin UK, commented, “We’re thrilled to unveil the PCA Skin Academy App, our new innovative platform designed to revolutionise how stockists access training, connect with their community and stay informed. Packed with e-learning courses, resource libraries and live community feeds, the app embodies core values – innovation, education and customer support”

Church Pharmacy will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Prfkt Pro launches new sun protection skincare product

Medical aesthetic distributor Medica Forte has released the new Prfkt Pro SPF product Front Cover.

The company shares that the product features glutathione, an antioxidant associated with brightening and reparative properties. Front Cover aims to reduce oxidative stress, reduce pigmentation issues and strengthen cellular defence, according to Medica Forte. The SPF product is designed to be lightweight with a non-greasy texture, featuring UV filters, antioxidants and antiageing peptides.

Kelly Saynor, co-founder and clinical lead at PRFKT, commented, “For years, the skincare specialty has been searching for ways to integrate glutathione into topical formulations, and we’ve succeeded. It’s more than a sunscreen, it’s a complete protective and reparative solution.”

Healthcare

Westfield London announces medical hub

London shopping destination Westfield has released plans to launch a medical and wellness hub within the centre.

Unibail-Rodamco-Westfield Group, owner and developer of real estate assets, shares that the project will dedicate 50,000 square feet to various health services. This is set to include GP and diagnostics, mental health appointments, fertility consultations, dentistry and physiotherapy. The company announces that the laser eye service is now available, and they intend to roll out the remaining services during the summer months.

Constantin Wiesmann, leasing director UK at Unibail-Rodamco-Westfield, said, “Strengthening the health and wellness offerings within Westfield is a natural progression in delivering the best experiences for our communities. Following the successful opening of Betterview at Westfield London and the upcoming launch of Prince Pharmacy, we are committed to

Skincare

Discover the wonder of polynucleotides

Dermalogica

introduces new products at press event

Skincare brand Dermalogica invited the Aesthetics Journal to an exclusive trade breakfast event on January 9 at HIDE, Mayfair to introduce its newest products. Fraser McEwan, marketing director at Dermalogica, welcomed delegates before handing over to Rebecca Cullen-Smith, education director at Dermalogica. The team explained that the Exo Booster, powered by bacterial exosomes, is designed to harness the skin’s natural regenerative processes, enhancing treatment outcomes.

Education manager Candice Gardner shared the effectiveness of the Lactobacillus-based vegan Exo Booster combined with microneedling, highlighting improvements in fine lines, wrinkles, texture, luminosity and overall skin appearance.

The company also introduced its Multivitamin Power Recovery Cream. The product includes key ingredients such as the ACE vitamin complex to neutralise free radicals, freshwater microalgae with astaxanthin to firm and lift skin, and a peptide blend to reduce signs of fatigue, fine lines and wrinkles. Pro-vitamin B5 and niacinamide further help improve tone and elasticity, the company shares.

Tia Rzysko, account manager at Monty PR, said, “Dermalogica’s Exo Booster is an incredible innovation for longevity solutions in the skincare specialty. These exosomes act as cellular messengers, promoting skin regeneration and amplifying the skin’s natural repair processes.”

Dermalogica will be exhibiting at ACE 2025. Turn to p.32 to register free now.

Symposium

Inaugural Welsh Aesthetics Symposium reveals varied agenda

The Welsh Aesthetics Symposium (WAS) will take place on Saturday March 29 at the ICC Wales in Newport.

The CPD-accredited event will feature a diverse programme addressing patient safety, regulatory standards, skin health and business strategies. Morning sessions will highlight best practices in managing complications and adhering to regulatory standards, while the afternoon will focus on cutting-edge developments in regenerative medicine, menopause-related skin changes and early skin cancer detection.

Key speakers will include Dr MJ Rowland-Warmann presenting on complications, and Professor David Sines who will discuss regulatory updates.

Freya Carlsen, regional leader of South Wales at BAMAN, said, “For a long time, Welsh practitioners have had to travel further afield for aesthetic conferences, impacting their time and finances. Now they can access first-class education, hear from prestigious speakers, discover new products and services and network with local peers practically on their door step.”

Conference

Revanesse UK releases Redefine Conference details

Dermal filler range Revanesse has shared that its inaugural Redefine Conference will take place on March 3 at the Ham Yard Hotel in London.

Revanesse explains that the conference aims to provide cutting-edge education in the field of aesthetics, and attendees can expect to experience the latest injection techniques and gain insights into the intersection of aesthetics and business.

Katie Vaughan, business unit lead for injectables at Alma and Revanesse UK&I, commented, “Dr Frank Rosengaus is a world-renowned expert in plastic surgery and non-invasive cosmetic procedures. He is flying all the way from Mexico to share his innovative techniques for achieving beautiful, natural-looking results.”

Alma x Revanesse will be exhibiting at ACE 2025. Turn to p.32 to register free now.

News in Brief

Dermalogica appoints new education director

Skincare brand Dermalogica has announced the appointment of Rebecca Cullen-Smith as education director for the UK & Ireland. With more than 20 years of experience in the beauty specialty, Cullen-Smith’s career began as a beauty therapist before evolving into a leader in education. Cirsten Hannken, general manager at Dermalogica, commented, “We are excited to have Cullen-Smith on board, and are confident that her leadership will propel our education initiatives to new heights.”

Dr Lee Walker awarded honorary professor title

Dental surgeon Dr Lee Walker has been announced as an honorary professor at UCIMED in Costa Rica. Dr Walker also won the Outstanding Achievement Award at The Aesthetics Awards 2024. Dr Walker commented, “I am deeply honoured and profoundly grateful to be appointed as an honorary professor at UCIMED. This recognition fills me with immense pride and joy, reaffirming my commitment to education. It is a privilege to contribute to this esteemed institution.”

Phorest hosts sustainability event Software solution company Phorest held a corporate event at the Dunsany Nature Reserve in County Meath, Ireland, to further its sustainability efforts. In partnership with Irish Trees, Phorest team members participated in planting new saplings as part of the Phorest Forest initiative, which plants a tree for every salon that joins the company. Phorest founder Ronan Perceval said, “Every tree we plant is a symbol of growth, not just for our company but for the planet. By partnering with salons worldwide, we’re building a forest, one tree at a time, to nurture our environment and create greener spaces for future generations.”

LYMA launches online supplement ingredients checker

Laser, skin and supplement company LYMA has released an online tool for verifying supplement ingredients. The company explains that this resource is designed to help individuals demystify the supplements they are consuming, and attempt to advise them on the best formulation and proven dosage. Lucy Goff, LYMA founder, commented, “Rather than spending a lot of money on things that don’t work or hours trawling through the internet to find what does, we’ve created the LYMA Index to help customers navigate the ever-growing category.”

The Impact of Keir Starmer’s AI Action Plan on Aesthetics

Aesthetics investigates what the UK Prime Minister’s 10-year AI growth plan could mean for independent aesthetic clinics

On January 13, UK Prime Minister (PM) Sir Keir Starmer unveiled the AI Opportunities Action Plan, designed to speed up artificial intelligence (AI) infrastructure growth in the UK over the next decade.1

Key areas of the growth plan include the increased use of AI in NHS hospitals to help with pain management and cancer diagnoses, in planning consultations to speed up building plans, in schools to reduce teachers’ admin burden and much more.1

The Labour Government has pledged £25 billion of investment in AI since taking office in July 2024, on top of a £14 billion investment from private tech companies to make the UK’s infrastructure world-leading.2 This investment will go towards building a supercomputer to boost AI computing capacity, a National Data Library to support AI development and an AI Energy Council to ensure technological growth can be achieved sustainably.2

Estimates from the International Monetary Fund (IMF) suggest that if AI is fully embraced, it could boost productivity by as much as 1.5% annually.2 If fully realised, these gains could be worth up to £47 billion to the UK economy each year over a decade.2

During his announcement, Starmer commented, “Artificial intelligence will drive incredible change in our country. In a world of fierce competition, we cannot stand by. Our plan will make Britain the world leader. It will give the industry the foundation it needs and will turbocharge the Plan for Change. That means more jobs and investment in the UK, more money in people’s pockets and transformed public services.”

It is not just public services that could benefit from this – Starmer also mentioned that AI can be used in “supporting small businesses with their record-keeping” and enhancing their planning capabilities.2 Aesthetics reports on the potential upshot of this technological focus on independent aesthetic clinics.

AI usage in aesthetic clinics

Operations and analytics specialist at clinic growth consultancy EQUALS3 Ashley McKenna believes that AI is going to be a “game-changer” in aesthetics if utilised properly. He says, “I talk to so many clinic owners who say they’re up late every night stressed about posting a Reel or completing their accounts or responding to emails. I know there’s an answer there – you can cut that time quite considerably if AI is introduced into your business in the right way.”

Geraldine Fusciardi, senior vice president for software solution Zenoti, shares that there are multiple ways in which AI can be applied in aesthetic businesses. AI can aid in exploring patient behaviours, she says, commenting, “By leveraging data analytics, AI can help to enhance existing knowledge, predict patient preferences, and tailor services and product/treatment recommendations, providing data that professionals can use to personalise services and increase patient satisfaction and retention.” This could also be used to forecast future patient demand by analysing trends in their booking and spending patterns.

Alleviating the administrative burden is another huge area of potential, aiding with bookings and 24/7 communications, increasing convenience and reducing waiting times for patients. McKenna explains that AI-driven chatbots are an “incredibly powerful” yet “simple” opportunity for aesthetic clinics, saying, “You can integrate OpenAI capability directly into your website in the form of a chatbot which is also built with an intimate knowledge of your service offering, giving patients access to specific answers to their questions and concerns.”

Fusciardi also explains that AI can provide assistance in marketing planning through analysing patient behaviours and preferences to ascertain what times are best to schedule social media posts/send emails, and which promotional campaigns might perform best.

She adds, “AI can assist in monitoring inventory levels, predict when products need replenishment and help clinics manage stock effectively, preventing over-ordering or running out of key items.”

Potential pitfalls

Despite these areas of potential, McKenna mentions his concern around the lack of any mention of regulation or ethics in Starmer’s announcement. He says, “Without oversight, I think widespread AI could make current challenges like inconsistent standards and lack of accountability even worse. Given that assurance is everything in the aesthetics sector, we can’t risk undermining that with underregulated tech. The biggest opportunity here will be achieved if there are frameworks, policies and training set up to help elevate the sector while ensuring ethical practice.”

McKenna also points out that aesthetic business owners have to be careful not to alienate their patients, saying, “Aesthetics is a personal business – very face-to-face focused and trust-based. You don’t come across many patients who come to clinics just looking for treatment – a lot of them come for empathy and assurance.” He says that if a clinic does not use AI in their communications, it could work to their advantage as a lot of people are “scared of change” and want to preserve the authentic connection with their practitioners. He concludes, “If people become too over-reliant on the use of AI, we get a homogenisation of output across the specialty, and it starts to become less attractive to consumers than it is now.”

Massive growth potential

The PM’s overt focus on AI emphasises that it is here to stay, and now is an opportune moment for independent clinic owners to consider how they might be able to use it in their businesses, all while maintaining patient trust and responsible practice.

Fusciardi concludes, “As the UK moves closer to an AI framework to support its infrastructure and economy, effective AI solutions will become even more integrated and relevant. It’s therefore worth business owners and key decision-makers investing time in auditing their business and ensuring they have a software solution in place that will support their business with advanced AI, but which also leverages that with the creativity, judgment and empathy of human beings.”

Ashley McKenna will be speaking on the In Practice Stage at ACE 2025 about AI-driven personalisation for sales and marketing.

Zenoti will also be hosting a session on the Stage. Turn to p.32 to register free now.

Coolest The Way to C0 2

From award winning CoolPeel™ to full face ablation with unmatched downtime control.

Results you’ll love, by scientists you trust.

Call one of our experts today on 01477 536 970 or visit lynton.co.uk

In partnership with DEKA

In partnership with DEKA In partnership with DEKA or visit lynton.co.uk

The Future of Eyelid Rejuvenation

Lynton discusses the key benefits of SmartXide Bleph

Transforming eyelid treatments: SmartXide Bleph

Powered by DEKA’s advanced CO₂ laser technology, the SmartXide Bleph is revolutionising eyelid rejuvenation with natural results and minimal downtime. Offering both non-surgical and surgical treatment options, this state-of-the-art solution rejuvenates and tightens upper and lower eyelids. Trusted by experts, SmartXide Bleph is a reliable, safe and effective tool for clinics aiming to deliver long-term eyelid rejuvenation and exceptional patient outcomes.1,2

Raising the bar in eyelid rejuvenation

Key benefits of surgical SmartXide Bleph

Switching to the surgical handpiece elevates SmartXide Bleph to the next level. Unlike traditional blepharoplasty which often involves significant swelling and extended recovery, this laser-assisted method seals blood vessels during surgery, reducing trauma and accelerating recovery.

Mr Ali Ghanem, medical director at Ghanem Clinic London, says, “I have done six blepharoplasties, and the results are unbelievable, with reduction of swelling and bruising – I am loving it and the patients do too.”

· Minimal Downtime: Patients resume daily activities within a week, much faster than traditional techniques.

· Reduced Scarring: Precision reduces visible scarring for seamless outcomes.

· Enhance Outcomes: A unique dual-action approach tightens external skin while also working deeper within the tissue – targeting subdermal layers through the incision site for comprehensive rejuvenation.

The SmartXide Bleph targets the entire surface area of the eyelids to address sagging skin, deep lines and mild to moderate laxity. Non-surgical treatments stimulate collagen production to tighten skin and refine texture, offering a minimally invasive option for patients not ready for surgery. For surgical procedures, the laser delivers precise incisions, reducing trauma, swelling and recovery time, while addressing excess skin and fat with exceptional accuracy.

Key benefits of non-surgical SmartXide Bleph

For patients hesitant about surgery or experiencing early signs of ageing, the non-surgical SmartXide Bleph provides an innovative alternative, stimulating collagen production without the need for incisions.

· Non-invasive rejuvenation: Stimulates collagen to tighten the skin without incisions or stitches.

· Reliable results: Noticeable improvements after just one session.

· Natural-looking results: Enhances skin texture, reduces fine lines and refreshes the eyelids for a more youthful appearance.

Dr Alexander Parys says, “The exceptional results I have been achieving on areas that were traditionally tricky to treat with injectables are a true game-changer that brings renewed confidence and youthfulness to patients.”

The SmartXide Bleph is powered by DEKA’s globally recognised SmartXide CO₂ technology, distributed exclusively in the UK by Lynton. SmartXide technology is evidenced by over 200 peer-reviewed studies validating its efficacy.3,4 The newest addition to the family – Tetra Pro – delivers 40W power and 30% faster treatments with cutting-edge features, enhancing practice outcomes.

Maxillofacial surgeon Mr Rob Laycock of Pinewoods Clinic, an early adopter of the Tetra Pro, says, “The laser’s precision ensures clean, precise incisions with minimal scarring, which is crucial for delicate areas around the eyes. Defocusing the laser allows for contouring of ocular fat and coagulation. The controlled thermal effect also promotes faster healing and seems to reduce post-operative swelling, leading to quicker recovery times and improved patient satisfaction. Overall, the Tetra Pro has become an indispensable tool in my practice, and I highly recommend it for anyone seeking to elevate their aesthetic results in both facial surgery and eyelid procedures.”

Empowering your practice beyond the SmartXide Bleph

The Tetra Pro is not only a game-changer for eyelid rejuvenation but also a strategic asset for clinics wishing to differentiate themselves. Its versatility addresses a variety of aesthetic concerns, including:

· CoolPeelTM

· Deep static wrinkles

· Acne and surgical scars

· Pigmentation

· Hands and chest rejuvenation

· Open pores and textural concerns

· Minor lesions

· MonaLisa Touch intimate health

An excellent clinic addition that is backed by science and endorsed by leading practitioners worldwide – an indispensable tool for forward-thinking clinics.

Figure 1: 63-year-old female patient with one treatment of Non-surgical SmartXide Bleph by Dr Alexander Parys, SONU Medical Aesthetics Clinic

Figure 2-3: One session of Non-surgical SmartXide Bleph. Courtesy of Silvia Bianchi M.D

Special Feature

Body Polynucleotides

Using Polynucleotides to Treat the Body

Three practitioners outline how polynucleotides can be utilised for treating different concerns on the body

Polynucleotides have garnered significant attention in the aesthetics specialty for their transformative effects on the face, but the positive impact their application can have on the body is now emerging.1,2

Showing promising results when treating indications such as stretch marks, scarring and laxity, aesthetic practitioners are starting to use polynucleotides for a variety of concerns –as either a combined or standalone treatment.1

This feature explores the science behind polynucleotides, their indications for body treatments, patient assessment and key considerations for practitioners. Insights are drawn from aesthetic practitioners Professor Syed Haq, Dr Priya Verma and Dr Brendan Khong, who share their clinical experiences and knowledge.

The science of polynucleotides

Polynucleotides are naturally occurring polymers composed of nucleotides, which are the building blocks of DNA and RNA. In medical aesthetics, polynucleotides are derived from purified fish DNA due to its biocompatibility and regenerative properties. These molecules exert their effects through multiple mechanisms. They stimulate fibroblast activity, enhancing the production of collagen and elastin, which are essential for skin firmness and elasticity. Polynucleotides also promote hydration by binding to water molecules, improving skin texture and appearance.3,4

Professor Haq elaborates on the historical development of polynucleotides, noting that they were initially used in burn units in Milan Italy to aid skin repair and regeneration. 5 “Over 20 years prior, their applications expanded to include aesthetic treatments (skin and hair) where they’ve shown remarkable results in rejuvenating and repairing skin across various areas of face and body,” he says.

"Polynucleotides can improve the overall impact and longevity of other treatments by preparing the skin and stimulating its natural repair mechanisms"

Professor Syed Haq

Body indications

Although well-known for treating areas of the face, recent studies have shown polynucleotide efficacy in treating areas of the body for a variety of indications. For example, one study involving 20 patients showed that 85% had a notable reduction in stretch marks, and another study involving 60 patients found that those treated with polynucleotides had significantly improved scar quality and reduced scar width.1,2

Dr Verma discusses the wide range of options, noting, “Polynucleotides can be used across various body areas to help address skin laxity, loss of elasticity, fine lines and wrinkles, stretch marks, pigmentation and scarring. They can also help to boost skin hydration, collagen and elastin production, improve blood circulation and inhibit melanin production to fade pigmentation.”1

All practitioners interviewed agree that currently, skin laxity is the most common body concern they are presented with. Dr Verma says that polynucleotide treatment is particularly popular in her clinic for female patients concerned with abdominal skin laxity and a loss of elasticity following childbirth. “The skin overlying the abdomen suffers significant stretch during pregnancy, which for many women can leave the skin looking noticeably looser in the lower segment than in other areas, giving rise to body confidence issues in the post-partum period,” she says.

Dr Khong says that crepey skin, especially in the abdomen and buttocks, are the most common areas of concern in his clinic. “Many of my patients are extremely active and have incredible muscle tone. However, as we age, there is a decreased ability of skin to contract, which will lead to sagging skin and stretch marks. A course of polynucleotide treatment can often improve the skin quality, improve texture and smoothen out imperfections,” he says.

Professor Haq adds that as well as being used as a standalone treatment to address skin concerns, he has found that polynucleotides can be used preemptively to “prime fibroblasts” before other procedures are conducted to treat skin age-related changes. He termed this as “SET” (Skin Enhancement Technique). Priming prior to surgery, or botulinum toxin, the use of HA dermal fillers, chemical peels or energy-based treatments to optimise outcomes and enhance skin recovery have been well-described and forms part of a consensus set of recommendations. He notes, “When used in this way, polynucleotides can improve the overall impact and longevity of other treatments by preparing the skin and stimulating its natural repair mechanisms.”

Patient assessment

All practitioners interviewed underscore the importance of a detailed medical history to identify potential contraindications to the product. “Patients with known allergies or hypersensitivity to ingredients in the formulation of the product I choose, should avoid getting polynucleotides. For example those with fish/seafood allergy, autoimmune diseases, immunosuppressive treatment, local skin infection, systemic infection, pregnancy, nursing mothers, active cancer, bleeding disorders and other serious medical conditions,” says Dr Khong.

Professor Haq adds that it’s important to consider factors like skin quality and age, as older patients may require more treatments to achieve optimal results. “Practitioners need to manage patient expectations and determine whether polynucleotides should be used as a standalone treatment or in combination with other therapies to enhance outcomes, or to be used in the context of a maintenance or reparative strategy,” he says.

Dr Khong agrees, noting that for laxity, reviewing the degree of crepiness or sagging is important for setting realistic expectations. "For excessively sagging skin, a referral to a plastic surgeon may be necessary so it’s important to be honest about what you think you can achieve," he notes.

To help evaluate this, Dr Verma performs a thorough examination of the body areas. “I always assess skin thickness, laxity and elasticity through pinching the skin and assessing the recoil function,” she says.

Treatment protocols and case studies

Here the practitioners provide examples and case studies of addressing stomach indications using polynucleotides.

Treating stretch marks with Dr Khong

This patient had been troubled with stretch marks on the abdomen for more than 15 years following the birth of her child, and came to me after trying many treatments in the past.

I suggested polynucleotides as they can help to increase cellular turnover, remodel the skin and repair damaged dermis.3 The hyaluronic acid content helps boost hydration which can also help improve texture and the appearance of stretch marks, and the anti-inflammatory properties of polynucleotides can also reduce redness in fresher stretch marks that appear. The inclusion of biomimetic peptides can also help to improve skin quality. In terms of products, I chose Nucleofill Body as it contains polynucleotides which can bind directly to the fibroblast cells to stimulate collagen and elastin.

A total of four treatments were performed, all spaced three weeks apart. The treatment was well tolerated and the patient was delighted with the results (Figure 1).

Treating laxity with Professor Haq

A 56-year-old patient presented to my clinic with skin laxity on the stomach. I treated her on five occasions spaced between three and four weeks apart, using 4ml of product on each occasion (Figure 2).

The product used was PhilArt by Croma. The material was injected after an initial subcision using a 22G cannula over the entire area that required addressing prior to using polynucelotides.

Addressing loose skin and stretch marks with Dr Verma I treated a 34-year-old female with concerns of loose skin and stretch marks in the central abdomen. She underwent two pregnancies to term and was medically fit and well, taking no regular medications. She had never had aesthetic treatments to the abdomen, neither surgical nor non-surgical, and was seeking a confidence boost. On assessment, the central abdominal skin had visible stretch marks,

Figure 1: Patient after two out of four polynucleotide treatments had been performed

Figure 2: Patient before and five weeks after four sessions of polynucleotide treatment

a crepey texture with loss of elasticity on pinch testing, laxity and redundancy to the skin. The patient was Fitzpatrick skin type III.

The protocol recommended to this patient was one of both superficial dermal remodelling using Plinest (20mg/ml) polynucleotide as a skin priming treatment, followed by deep dermal remodelling using laser-assisted skin tightening with Endolift.

The polynucleotide treatment protocol consisted of 4mls of Plinest (20mg/ml) injected using a 30G needle as intradermal blebs across the central abdomen in her areas of concern, across three sessions performed two to three weeks apart. The injections were divided uniformly, with 1ml being injected into each quadrant of the central abdomen each time.

Results (Figure 3) showed improvements in the visibility of the stretch marks, reduction in fine lines, improvements in the smoothness of the skin with less irregularities visible, and overall skin firmness.

Considerations for practitioners

When using polynucleotides to treat the body, there are several considerations practitioners should bear in mind.

Patient budget

In terms of polynucleotides in areas such as the stomach, the surface area to inject will be much larger than facial areas, which means the cost is higher and the injection burden may be greater for patients, says Dr Verma.

Professor Haq explains, for example, that a treatment area of the abdomen at approximately 15 by 10 centimeters might require three to four syringes per session. “This would total about 8ml per session, administered over four to five treatments,” he says. He explains that this means some patients may not be able to afford the treatment plan provided, and they should be made aware of the total cost and the amount of sessions in the consultation. “It’s important to budget accordingly and tailor the treatment plan to the patient’s specific needs and expectations. Chronic conditions, such as burns or

"I always assess skin thickness, laxity and elasticity through pinching the skin and assessing the recoil function"

Dr Priya Verma

scarring, may require additional sessions to achieve optimal results, but the overall approach varies based on individual factors,” he says.

Professor Haq adds that pre- and post procedure management should be explained, using arnica prior to treatment and post procedure, and a week later to initiate vitamin C.

Combining for best results

Professor Haq shares that there are many cases in which combining polynucleotides with other treatments can optimise results. He says, “In cases of chronic scarring, we often combine polynucleotides with other modalities such as microneedling, platelet-rich plasma or laser resurfacing to maximise results. The goal is to stimulate extracellular matrix remodelling and enhance the overall aesthetic appearance of the skin. We also use techniques like subcision to address adhesions and target fibroblasts intradermally. This creates a concerted effort to repair and rejuvenate the skin, resulting in significant improvements in texture and elasticity.”

Dr Verma agrees, explaining that she likes to implement energy-based devices into her treatments. “When a patient presents with skin laxity as well as crepey skin texture, I tend to combine polynucleotides with laser-assisted skin tightening, typically performing polynucleotides prior to laser as a skin priming treatment,” she says.

The importance of research

Dr Haq highlights the importance of choosing reputable polynucleotide products which comply with stringent medical device regulations. “A good support system from the manufacturer ensures safety and efficacy,” he explains.

Dr Verma notes that as polynucleotides fall within the remit of regenerative aesthetics, and despite them being grounded in a long and reliable history of surgical wound healing, the specialty is still understanding how best to use these ingredients to give reproducible and clinically effective outcomes consistently.

“Therefore, practitioners must stay abreast of the latest research through reading scientific literature published on the topic, attending regenerative aesthetic conferences such as RAMCE organised by DermaFocus, ACE and CCR annually, and attending refresher training courses to gain expert insights from key opinion leaders and clinical trainers who can disseminate knowledge on product and protocol updates,” she says. She adds that community is also key here, stating, “Sharing insights with fellow practitioners on their day-to-day experiences of the products can be used to drive clinical efficacy in practice.”

Professor Haq reflects that the uses of polynucleotides on the body have barely scratched the surface and further research will aid wider use. He explains, “Polynucleotides have potential applications beyond skin rejuvenation and repair, with research even starting to explore their use in indications such as joint treatments where there is wear and tear or inflammation, as well as hybrid based technologies.”

An emerging treatment option

According to all practitioners interviewed, polynucleotides are revolutionising body treatments by offering a versatile and effective solution for skin rejuvenation and repair. With proper patient selection, assessment and technique, practitioners can achieve impressive results, improving skin quality and addressing a range of aesthetic concerns.

As Professor Haq aptly puts it, ”Understanding the science and tailoring treatments to individual needs is key to unlocking the full potential of polynucleotides. It has stood the test of time since its inception and will no doubt lead to a myriad of innovative treatment options in the future."

Figure 3: Patient before and two weeks after three sessions of polynucleotide treatment

A Year of Innovation. A Future Full of Promise.

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Photos courtesy of Dr. J. Fromowitz. Results may vary.

Photos courtesy of Dr. L. Zanetti, ARNP. Results may vary.

Photos courtesy of Dr. D. Verma . Results may vary.

Ethnic Considerations for Botulinum Toxin

Dr Souphi Samizadeh reviews considerations for treating different ethnic groups with toxin

The global demand for facial aesthetic treatments, including botulinum toxin (BoNT-A) injections, continues to rise. This increase is evident across a broad spectrum of ethnic groups, each presenting unique anatomical and cultural considerations that impact the choice and application of BoNT-A treatments.1-5

Considering differing ethnic ideals

While traditional aesthetic practices were developed with Western beauty standards in mind, the growing diversity of patients seeking aesthetic care requires practitioners to adapt their approaches. Traditionally, clinical trials for aesthetic treatments, including BoNT-A, have often lacked sufficient representation of non-Caucasian patients. Consequently, much of the knowledge regarding efficacy and safety in these diverse populations has relied on smaller studies about the expertise and clinical experience of practitioners. Ethnic-specific differences in facial structure, skin characteristics and cultural beauty preferences must be accounted for to achieve natural and desirable outcomes.1-5

Different age groups across ethnicities hold unique beauty ideals shaped by cultural heritage and global influences, especially as media, migration and travel introduce international standards. While some patients may be drawn to global beauty trends, others may prefer enhancements that align more closely with traditional aesthetics.

Experienced aesthetic physicians and providers understand that standardised treatment protocols seldom produce optimal results; an in-depth knowledge of anatomical variations is essential. Broad guidelines or general principles that outline ideal proportions or treatment approaches may carry an inherent ethnocentric bias, frequently grounded in Caucasian anatomical standards.1,2,6-8

Anatomical and physiological differences

Increased bitemporal

Increased bizygonial width

Increased bigonial width

Retruded forehead

Retruded orbital rims

Low nasal bridge and deficient anterior nasal spine

Medial maxilla retrusion

Retrusion of pyriform margin

Bimaxillary protrusion

Hypoplastic chin

Asian populations

Facial muscle dynamics

One of the key factors influencing BoNT-A treatment outcomes is facial muscle dynamics, which vary significantly across different ethnic groups ( Table 1).1,2,6-11

Caucasian patients

Caucasian patients often have more pronounced muscle activity in the upper face, especially the forehead, lateral canthal lines and glabella. This may require higher doses of BoNT-A to achieve the desired effect of wrinkle reduction while ensuring natural expression.

Asian populations are a very diverse patient population to treat. The ageing process in Asian patients typically involves a delayed onset of wrinkles, followed by a more rapid increase in fine lines and wrinkle formation between the ages of 40 and 50. They tend to present with stronger lower face musculature, such as the masseters, which are frequently treated for facial slimming rather than wrinkle reduction. BoNT-A is often used in the masseter to contour the lower face, creating a V-shaped appearance that aligns with regional beauty standards. African and Afro-Caribbean patients

On average, African and Afro-Caribbean patients tend to exhibit age-related changes approximately 10 years later than Hispanic and Latino individuals, and around 20 years later than Caucasian individuals. They may have stronger orbicularis oculi muscles, leading to

deeper dynamic lines around the eyes. A tailored approach to dosing is necessary to achieve natural results without causing asymmetry or unnatural softening of these expressive muscles.

Hispanic or Latino patients

Hispanic or Latino patients have a thicker dermis in comparison to Caucasians, which makes the skin less prone to the development of wrinkles. Forehead lines, glabellar lines, eyebrow and eyelid drooping are common early aesthetic complaints in this group.

Skin characteristics

Skin thickness, collagen density and susceptibility to conditions like post-inflammatory hyperpigmentation (PIH) vary across ethnic groups and play a secondary but important role in the effectiveness and aesthetics of botulinum toxin treatments. Although BoNT-A primarily targets muscles, these skin characteristics can influence treatment depth, dosing precision and the overall appearance of the result:1, 2,6-12

Caucasian patients

Caucasian patients generally have thinner skin and lower collagen density, which often leads to an earlier onset of fine lines and wrinkles. This thinness increases the risk of visible over-treatment, particularly in areas like the crow’s feet and forehead, where muscle relaxation can result in a heavy or unnatural appearance if too much BoNT-A is applied. For optimal results, lower doses and shallower injections in these areas are recommended to maintain natural movement and avoid an overly ‘frozen’ look. Exact doses are outside the scope of this article.

Asian patients

Asian patients typically have thicker skin with a higher concentration of collagen, which can delay the formation of fine lines and wrinkles. However, this thicker skin requires careful consideration regarding injection depth to ensure the BoNT-A toxin reaches the targeted muscle effectively without causing unintended effects. Additionally, Asian skin is more prone to PIH following any form of skin disruption, which necessitates cautious post-treatment management to prevent hyperpigmentation. In cases where microinjections are used, the thicker dermal

Skeletal features in Asian populations in comparison with those of Caucasian populations

width

Table 1: Skeletal difference between Asian and Caucasian populations4

layer means the effective area of influence may be smaller than in individuals with thinner skin, making precision critical to achieving balanced results.

African and Afro-Caribbean populations

African and Afro-Caribbean patients often have thicker, more resilient skin with a high collagen concentration, which contributes to a lower propensity for early wrinkling. Although this skin type is less prone to dynamic lines, certain facial areas with strong musculature – such as around the eyes and mouth – require precise injection to avoid uneven texture or unintended volume changes. Thicker skin may also mean adjustments in injection depth to target specific muscle groups effectively without affecting other areas.

Hispanic and Latino patients

Hispanic and Latino patients generally exhibit a combination of skin characteristics seen in both Caucasian and Black populations, often featuring moderate thickness and collagen density. This balance of features means wrinkle formation is typically mild to moderate, with some risk of hyperpigmentation after treatment.

Tailored BoNT-A approaches for Hispanic and Latino patients often involve a careful balance between reducing dynamic lines and preserving natural facial contours, with the goal to prevent over-treatment in areas where muscle relaxation may cause flattening or heaviness.

Bone structure

The bone structure of different ethnic groups has limited direct relevance to BoNT-A treatments, as BoNT-A primarily targets dynamic muscles rather than altering facial structure or contours created by bone. However, understanding bone structure can still be indirectly relevant.3-5,13, 14

Injection placement and aesthetic outcome

Bone structure influences how muscles overlay the face, guiding injection sites to maintain natural facial harmony:3-5, 13,14

· Caucasian patients: More angular facial structures often result in prominent dynamic wrinkles (e.g. crow’s feet, nasolabial folds). BoNT-A treatments in this group typically focus on softening these dynamic lines while preserving the natural angularity that defines their facial character.

· East Asian patients: Flatter mid-face contours mean that over-treating areas like the forehead can disrupt facial harmony.

· African patients: A stronger bone structure, particularly around the zygomatic arch, enhances facial fullness.

· Hispanic and Latino patients: Latino individuals may exhibit a combination of

characteristics, often with moderate bone projection and a fuller mid-face. Injection strategies for this group aim to soften dynamic lines while preserving natural fullness in the mid-face.

Cultural and aesthetic considerations

A patient’s cultural background and beauty ideals play a significant role in shaping expectations and satisfaction with aesthetic treatments. What may be considered an enhancement in one culture could be undesirable in another, highlighting the importance of understanding cultural nuances for patient-centred care.

Practitioners who consider these diverse preferences can deliver more tailored and satisfying results:1-3, 14-17

Caucasian patients

Many Caucasian patients focus on upper facial rejuvenation, targeting areas like the forehead and glabellar. Preferences can vary significantly by region; for example, certain Eastern European patients may prefer a ‘frozen’ look with minimal facial movement, while those in the UK often favour treatments that retain some natural expressiveness, particularly around the eyes. Balancing wrinkle reduction with the desired level of expressiveness allows practitioners to personalise treatments according to regional preferences, ensuring outcomes that align with the patient’s aesthetic goals.

East Asian Patients

East Asian patients often prioritise facial harmony and balance, with a particular focus on achieving a youthful, V-shaped lower face. BoNT-A treatments, such as masseter reduction, are popular for contouring the jawline. However, care must be taken to avoid excessive slimming, as over-treatment can cause hollowing in the subzygomatic area, which is culturally viewed as unappealing and can lead to ptosis in the surrounding tissues, creating an aged appearance. Maintaining subtle volume while enhancing contour helps achieve the culturally preferred youthful look.

Middle Eastern and South Asian patients

Middle Eastern patients often seek a ‘frozen’ aesthetic that maintains strong, well-defined facial features such as prominent cheekbones and a well-contoured jawline. In these cases, BoNT-A treatments are used to reduce wrinkles while preserving or enhancing these striking natural contours. For South Asian patients, preferences typically lean towards a balanced approach that reduces wrinkles while retaining natural expressiveness. Treatments for South Asian patients often involve subtle enhancements to maintain facial movement, particularly around the eyes and mouth, achieving a refreshed yet expressive appearance.

African and Afro-Caribbean patients

Patients from African and Afro-Caribbean backgrounds generally have strong bone structures, with pronounced cheekbones and jawlines, and a cultural preference for maintaining facial fullness, which is often associated with youth and vitality. BoNT-A treatments for these patients focus on achieving subtle wrinkle reduction while preserving natural volume and definition in the mid-face. Over-relaxation of muscles, particularly around the cheeks and jawline, is avoided to maintain the natural contours that are culturally prized. Balancing wrinkle reduction with volume preservation supports a youthful, vibrant aesthetic that aligns with cultural beauty ideals.

Hispanic and Latino patients

Many Latino patients favour a ‘frozen’ aesthetic with well-defined, sculpted features, especially around the jawline and cheekbones. Similar to Middle Eastern and Eastern European preferences, Latino patients often seek a smooth, wrinkle-free appearance that reduces facial movement, contributing to a refined, polished look. BoNT-A treatments typically aim for a high level of wrinkle reduction with precise contouring that enhances facial structure while preserving the desired level of definition and minimising expressiveness.

Additional ethnic considerations

Middle Eastern and North African (MENA) populations, as well as Indigenous and multi-ethnic patients, present unique considerations in aesthetic practice. MENA patients often have characteristics such as thicker skin and well-defined facial structures that influence treatment approaches. Indigenous and multi-ethnic individuals, with their diverse combinations of anatomical and skin characteristics, require personalised approaches to ensure optimal outcomes that respect their unique features. Additionally, South and East Asian populations differ in their aesthetic preferences and anatomical features. Differentiating between these and other groups allows practitioners to account for diverse beauty ideals and deliver treatments that are both effective and respectful of individual and cultural preferences. An inclusive and adaptive approach ensures high-quality care that meets the needs of an increasingly diverse patient population.

Optimising BoNT-A treatments

To enhance outcomes and patient satisfaction, aesthetic physicians should approach BoNT-A treatments with an understanding of both anatomical diversity and personal aesthetic goals. Recommendations for optimising treatment include:

Personalised treatment plans

Assessing each patient’s unique anatomical features, ageing patterns and aesthetic preferences allows for the customisation of BoNT-A toxin treatments.

Cultural sensitivity in aesthetic outcomes

Addressing the patient’s cultural and aesthetic preferences, such as the preference for softer jawlines or rounded contours in Asian populations or the desire to maintain natural skin tension in African-American patients, can enhance outcomes and ensure greater patient satisfaction.

Emphasis on provider experience and training

Aesthetic physicians with extensive knowledge of ethnic variations in anatomy and aesthetics can better adapt standard protocols. Ongoing education and training in ethnic considerations are essential to refining techniques that are inclusive of diverse patient demographics.

Avoidance and mitigation of toxin complications

Complications arising from BoNT-A treatments, while rare, require careful attention to minimise risks and optimise patient outcomes. A retrospective cohort study by Steenen et al. provides valuable insights into complication rates and effective strategies for management.18

Common complications

The study identified a 0.065% incidence of complications from BoNT-A treatments across 200,099 cases, with ptosis, asymmetry, and Mephisto/Spock effects being the most frequent issues. These complications emphasise the importance of precise injection techniques and tailored dosing to reduce adverse events.18

Mitigation strategies

Complications can be mitigated through comprehensive training, adequate patient assessment, injection techniques, and early identification:18

1. Comprehensive training: Adequate training and experience are essential for injectors to minimise complications and manage them effectively when they occur. Steenen et al. highlighted the importance of injector experience in reducing complication rates.

2. Patient assessment: A thorough understanding of patient anatomy, medical history, and treatment goals is critical for avoiding complications.

3. Injection techniques: Employing correct injection depth and avoiding over-dilution of BoNT-A are vital for preventing diffusion-related issues like unintended muscle relaxation.

4. Early identification and management: Prompt identification and treatment of complications, such as ptosis or asymmetry, can prevent progression and improve outcomes. For example, apraclonidine drops are effective for mild ptosis.

Evidence-based practices

The data from Steenen et al. supports emerging evidence that complications in BoNT-A treatments are relatively rare when performed by medically trained professionals. The findings align with global consensus recommendations on managing complications, such as those provided by de Boulle et al. and Goodman et al., which emphasise the importance of evidence-based practice in medical aesthetics.19,20

By combining these insights with ongoing education, practitioners can enhance patient safety and deliver consistent, high-quality results.

Individualised plans

BoNT-A treatments are an effective and versatile tool in medical aesthetics. However, their success relies heavily on the practitioner’s ability to account for ethnic differences in facial anatomy, muscle dynamics and aesthetic preferences. By tailoring treatment to these variations, practitioners can achieve more natural, culturally appropriate results and increase patient satisfaction.

Questions

Test your knowledge!

Complete the multiple-choice questions and go online to receive your CPD certificate!

Possible answers

1. Which ethnic group typically exhibits more pronounced muscle activity in the upper face, particularly the forehead, lateral canthal lines, and glabellar?

2. What is a common aesthetic goal for Asian patients using botulinum toxin treatments?

3. Which ethnic group tends to exhibit age-related changes approximately 10 years later than Hispanic and Latino individuals?

4. In patients seeking jawline contouring with botulinum toxin, which muscle group is most commonly targeted?

5. In botulinum toxin treatments, what is the role of understanding variations in facial muscle dynamics?

a. Asian

b. African and Afro-Caribbean

c. Caucasian

d. Hispanic and Latino

a. Smoothing crow’s feet

b. Slimming the jawline for a V-shaped appearance

c. Reducing dynamic lines around the eyes

d. Enhancing cheekbone definition

a. G prime and cohesiveness

b. Molecular weight

c. HA concentration and degree of crosslinking

d. Complex viscosity

a. Orbicularis oculi

b. Masseter muscles

c. Frontalis muscles

d. Zygomaticus major and minor

a. To determine the number of sessions required for effective results

b. To optimise dosing and ensure natural outcomes

c. To minimise risk of post-treatment skin reactions

d. To standardise protocols for all populations

Answers: C,B,C,B,B

Dr Souphi Samizadeh is a dental surgeon and the founder of the Great British Academy of Aesthetic Medicine. She serves as a faculty member for the MS in Minimally Invasive Aesthetics at University College London and an honorary faculty member in the Faculty of Dentistry, Oral & Craniofacial Sciences at King’s College London.

Qual: BDS, BSc, MJDF RCS (Eng.), PGCert (Clin Edu), MSc (Aesthetic Medicine), FCGDent FHEA

Discover the latest injectable techniques with Headline Sponsor Allergan Aesthetics

Headline Sponsor

Highlights in the Allergan Aesthetics Auditorium include:

• Mastering the art of injecting lips as we age

• Recognising patient individuality

• Live treatment of full facial harmonisation

*AbbVie has part sponsored this event, this includes provision of a stand and/or a speaker program/medical symposium. AbbVie has had no influence over the content/topics covered in other parts of the agenda.

Learn Practical Insights and Master New Techniques

Unlock the future of aesthetics at ACE 2025

Are you looking to find a new technique for administering dermal filler, a different way to combine treatments for optimal results, or discover the latest research on devices? Or, perhaps you want to learn the best ways to improve your clinic revenue stream?

Highlights include:

The Aesthetics Conference & Exhibition (ACE) is the ultimate destination for advancing your knowledge, skills and connections in the aesthetics specialty. Held at the Business Design Centre, London, on March 14-15, ACE 2025 brings together leading practitioners, renowned brands and cutting-edge innovators for two days of exceptional education, networking and inspiration. Whether you’re a seasoned professional or just starting your journey in aesthetics, this event offers plenty of opportunities to elevate your practice.

Here’s what we have in store this year…

Allergan Aesthetics Auditorium

We are delighted to welcome Allergan Aesthetics, an AbbVie company, as the Headline Sponsor of ACE 2025. With a legacy of excellence and innovation, Allergan Aesthetics will deliver an array of dynamic sessions in the Main Auditorium that promise to captivate and educate delegates at every level.

Key highlights from the Allergan Aesthetics auditorium include:

· Lips Masterclass: Mastering the art of injecting lips as we age

· Patient Individuality and Facial Harmonisation: Recognising patient individuality Further sessions and speaker details will be announced soon.

Dive Into the Four Dynamic Theatres

Beyond Allergan Aesthetics' agenda, ACE 2025 offers extensive learning opportunities across four additional specialist theatres.

The Innovation Forum

Step into the future of medical aesthetics at The Innovation Forum, sponsored by SkinCeuticals. Thought leaders will take to the stage to unveil their boldest ideas and cutting-edge innovations, offering you an exclusive look into tomorrow’s top trends.

· Broadband Light with Intelligent Control and Laser Resurfacing Combination Treatment brought to you by Sciton

· From Acne to Ageing: Supercharge Your Aesthetic Results With Skin Nutrition by iiaa

· Beyond One-Size-Fits-All: Personalising Skin Health with HydraFacial

· Liquid Lifting with Fillers: A Comparative Approach for Asian and Caucasian Facial Structures brought to you by S.ThePharm

· A Clinical Case Study in Treating Melasma with ALLSKIN | MED

The In Practice Theatre

Designed to address the business and psychological aspects of aesthetics, the In Practice Zone offers a wealth of practical advice and inspiration.

Key sessions include:

· Pricing for Profit: Liz McKeon shares actionable strategies for optimising clinic revenue.

· The Roadmap to 1 Million Followers: Dr Ahmed El Muntasar outlines how you can gain success on social media.

· AI-Driven Personalisation: Ashley McKenna discusses strategies to optimise your marketing and sales to drive conversion.

Throughout the two days, aesthetics professionals will be gathering to host discussion panels, including:

· The Women in Business Panel, chaired by Tatler 's Health and Beauty Editor-at-Large Francesca Ogiermann-White, will spotlight incredible women who are Finalists at The Aesthetics Awards 2025, discussing their path to success.

· The Overcoming Adversity Panel will welcome brave individuals from across the specialty who have tackled personal challenges in their careers, providing inspiration on how they have overcome obstacles and continued to thrive.

· The Regulation Panel, welcoming Charlotte West (from the Environmental Health department of the City of Wolverhampton Council) alongside the Joint Council for Cosmetic Practitioners (JCCP), to discuss the future of regulating aesthetic clinics on the ground.

The Gloves Off Panel will host representatives from the UK's biggest complications organisations to debate best practice, effective patient safety measures and the best way forward for aesthetic regulation.

The theatre will also see the return of the Getting Started in Aesthetics agenda in partnership with Cosmetic Courses, as well as the Aesthetics Business Blueprint agenda in collaboration with LTF Digital.

Don’t forget, outside the In Practice Theatre is the In Practice Zone where you can meet companies, services and solution providers.

Aesthetics Mastery Theatre

The Aesthetics Mastery Theatre, sponsored by DermaFocus, provides you with the opportunity to immerse yourself in the art and science of medical aesthetics. Highlights include:

· Advanced Anatomy and Techniques: Deepen your understanding of facial anatomy through expert-led sessions and live demonstrations

· Tailored Treatment Approaches: Learn how to customise treatments for different patient demographics and aesthetic goals

· Interactive Q&A Sessions: Engage directly with speakers to gain practical advice and insights

Confirmed companies include Alma, AestheticSource, Galderma, Neauvia and IDENEL.

The Association Theatre

BRAND NEW for this year, ACE is partnering with the specialty’s leading associations to promote development, uphold ethics and safety, and provide support for professionals working within the specialty.

Current confirmed sessions include:

· Benchmarking Your Competence in Aesthetic Nursing with the British Association of Medical Aesthetic Nurses

· Complications and Qualifications with the Aesthetics Complication Expert Group World

· Trends in Medical Aesthetics from the British College of Aesthetic Medicine’s Annual Clinical Review

· Advising Patients on Hair Loss Options with the British Association of Hair Restoration Surgery

· The Implications and Impact of Regulatory Change with the Joint Council of Cosmetic Practitioners

Secure your space

ACE 2025 offers a unique blend of clinical and business content, making it the ultimate event for aesthetic practitioners. Here are just a few reasons to attend:

· Gain up to 16 CPD points through a diverse range of sessions. Learn from top KOLs, award-winning practitioners and leading brands.

· Whether you’re interested in injectables, business growth or cutting-edge research, there’s something for everyone.

· Build connections with like-minded professionals at the DermapenWorld networking drinks.

· Be among the first to discover new products, technologies and trends.

Celebrate excellence in medical aesthetics

Following the second day of the Aesthetics Conference and Exhibition on March 15, The Aesthetics Awards will take place at the dazzling Grosvenor House Hotel, London.

Tickets for the event are selling out quickly, so make sure to purchase yours before it’s too late.

Your ticket will include:

Ø Entry to the most anticipated event in the aesthetics calendar

Ø A glass of sparkling wine upon arrival and drinks at the table

Ø A three course meal

Ø Live entertainment

Ø A live band to continue the party into the early hours

Ø A professional photographer and photo opportunities

We can’t wait to see you all there and celebrate the best the specialty has to offer!

Visit www.aestheticsawards.com

Find more information and register for FREE at www.aestheticsconference.com

PRESCRIBING INFORMATION - UK

BOCOUTURE® (botulinum toxin type A (150 kD), free from complexing proteins) 50/100 unit vials. Prescribing information: Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Presentation: 50/100 units of Clostridium Botulinum Neurotoxin type A, free from complexing proteins as a powder for solution for injection. Indications: Temporary improvement in the appearance of moderate to severe upper facial lines (glabellar frown lines, crow’s feet lines, horizontal forehead lines) in adults ≥18 and <65 years when the severity of these lines has an important psychological impact for the patient. Dosage and administration: For intramuscular use only. Unit doses recommended for BOCOUTURE are not interchangeable with those for other preparations of botulinum toxin. BOCOUTURE should only be administered by an appropriately qualified healthcare practitioner with expertise in the treatment of the relevant indication and the use of the required equipment, in accordance with national guidelines. The intervals between treatments should not be shorter than 3 months. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines: Total recommended standard dose is 20 units. 4 units into 5 injection sites (2 injections in each corrugator muscle and 1 injection in the procerus muscle). May be increased to up to 30 units. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Total recommended standard dosing is 12 units per side (overall total dose: 24 units); 4 units injected bilaterally into each of the 3 injection sites. Injections too close to the Zygomaticus major muscle should be avoided to prevent lip ptosis. Horizontal Forehead Lines: The recommended total dose range is 10 to 20 units; a total injection volume of 10 units to 20 units is injected into the frontalis muscle in five horizontally aligned injection sites at least 2 cm above the orbital rim. An injection volume of 2 units, 3 units or 4 units is applied per injection point, respectively. Contraindications: Hypersensitivity to the active substance or to any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Infection or inflammation at the proposed injection site. Special warnings and precautions: It should be taken into consideration that horizontal forehead lines may not only be dynamic, but may also result from the loss of dermal elasticity (e.g. associated with ageing or photo damage). In this case, patients may not respond to botulinum toxin products. Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Caution in patients with botulinum toxin hypersensitivity, amyotrophic lateral sclerosis, peripheral neuromuscular dysfunction, or in targeted muscles

displaying pronounced weakness or atrophy. BOCOUTURE should be used with caution in patients receiving therapy that could have an anticoagulant effect, or if bleeding disorders of any type occur. Too frequent or too high dosing of botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy unless clearly necessary. Should not be used during breastfeeding. Interactions: Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects: Usually, undesirable effects are observed within the first week after treatment and are temporary in nature. Undesirable effects independent of indication include; application related undesirable effects (localised pain, inflammation, swelling), class related undesirable effects (localised muscle weakness, blepharoptosis), and toxin spread (very rare - exaggerated muscle weakness, dysphagia, aspiration pneumonia). Hypersensitivity reactions have been reported with botulinum toxin products. Glabellar Frown Lines: Common: headache, muscle disorders (elevation of eyebrow).

Crow’s Feet Lines: Common: eyelid oedema, dry eye, injection site haematoma. Upper Facial Lines: Very common: headache. Common: hypoaesthesia, injection site haematoma, application site pain, application site erythema, discomfort (heavy feeling of frontal area), eyelid ptosis, dry eye, facial asymmetry, nausea. For a full list of adverse reactions, please consult the SmPC. Overdose: May result in pronounced neuromuscular paralysis distant from the injection site. Symptoms are not immediately apparent post-injection. Legal Category: POM. List Price: 50 U/vial £90.00, 50 U twin pack £180.00, 100 U/vial £180.00, 100 U twin pack £360.00. Product Licence Number: PL 29978/0002, PL 29978/0005 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100,60318 Frankfurt/Main, Germany. Date of Preparation: April 2024. M-BOC-UK-0540. Further information available from: Merz Aesthetics UK Ltd., Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ Tel: +44 (0) 333 200 4143

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to Merz Aesthetics UK Ltd at the address above or by email to UKdrugsafety@merz.com or on +44 (0) 333 200 4143.

1.BOCOUTURE Summary of Product Characteristics. Merz Pharmaceuticals GmbH: https://www.medicines.org.uk/emc/product/600/smpc (Last accessed December 2024).

REASONS TO CHOOSE BOCOUTURE

• Results seen as early as 7 days, lasting up to 4 months in upper facial lines1

• A well characterised safety profile1

• Convenient – no refrigeration needed prior to reconstitution1

Access injection technique videos now

Merz Aesthetics Exchange (MAX) is a promotional website developed and funded by Merz Aesthetics UK & Ireland.

PRESCRIBING INFORMATION - IRELAND

BOCOUTURE® (botulinum toxin type A (150 kD), free from complexing proteins) 50/100 unit vials. Prescribing information: Please refer to the Summary of Product Characteristics (SmPC) before prescribing. Additional information is available on request. Presentation: 50/100 units of Clostridium Botulinum Neurotoxin type A, free from complexing proteins as a powder for solution for injection. Indications: Temporary improvement in the appearance of moderate to severe upper facial lines (glabellar frown lines, crow’s feet lines, horizontal forehead lines) in adults ≥18 and <65 years when the severity of these lines has an important psychological impact for the patient. Dosage and administration: For inatramuscular use only. Unit doses recommended for BOCOUTURE are not interchangeable with those for other preparations of botulinum toxin. BOCOUTURE may only be administered by physicians with suitable qualifications and the requisite experience in the application of Botulinum toxin type A. The intervals between treatments should not be shorter than 3 months. Reconstitute with 0.9% sodium chloride. Glabellar Frown Lines: Total recommended standard dose is 20 units. 4 units into 5 injection sites (2 injections in each corrugator muscle and 1 injection in the procerus muscle). May be increased to up to 30 units. Injections near the levator palpebrae superioris and into the cranial portion of the orbicularis oculi should be avoided. Crow’s Feet lines: Total recommended standard dosing is 12 units per side (overall total dose: 24 units); 4 units injected bilaterally into each of the 3 injection sites. Injections too close to the zygomaticus major muscle should be avoided to prevent lip ptosis. Horizontal Forehead Lines: The recommended total dose range is 10 to 20 units; a total injection volume of 10 units to 20 units is injected into the frontalis muscle in five horizontally aligned injection sites at least 2 cm above the orbital rim. An injection volume of 2 units, 3 units or 4 units is applied per injection point, respectively. Contraindications: Hypersensitivity to the active substance or any of the excipients. Generalised disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome). Infection or inflammation at the proposed injection site. Special warnings and precautions: It should be taken into consideration that horizontal forehead lines may not only be dynamic, but may also result from the loss of dermal elasticity (e.g. associated with ageing or photo damage). In this case, patients may not respond to botulinum toxin products. Should not be injected into a blood vessel. Not recommended for patients with a history of dysphagia and aspiration. Caution in patients with botulinum toxin hypersensitivity, amyotrophic lateral sclerosis, peripheral neuromuscular dysfunction, or in targeted muscles displaying pronounced weakness or atrophy. BOCOUTURE should be used with caution in patients receiving anticoagulant therapy or therapy that could have an anticoagulant effect, or if bleeding

disorders of any type exist. Too frequent or too high dosing of botulinum toxin type A may increase the risk of antibodies forming. Should not be used during pregnancy. Should not be used during breastfeeding. Interactions: Concomitant use with aminoglycosides or spectinomycin requires special care. Peripheral muscle relaxants should be used with caution. 4-aminoquinolines may reduce the effect. Undesirable effects: Usually, undesirable effects are observed within the first week after treatment and are temporary in nature. Undesirable effects independent of indication include; application related undesirable effects (localised pain, inflammation, paraesthesia, hypoaesthesia, tenderness, swelling, oedema, erythema, itching, localised infection, haematoma, bleeding and/ or bruising), class related undesirable effects (localised muscle weakness, blepharoptosis), and toxin spread (very rare – excessive muscle weakness, dysphagia, aspiration pneumonia). Serious and/or immediate hypersensitivity reactions have been reported with botulinum toxin products (anaphylaxis, serum sickness, urticaria, soft tissue oedema, dyspnoea, swelling, erythema, pruritis, rash). If serious and/or immediate, appropriate medical therapy should be commenced. Glabellar Frown Lines: Common: headache, Mephisto sign. Crow’s Feet Lines: Common: eyelid oedema, dry eye, injection site haematoma. Upper Facial Lines: Very common: headache. Common: hypoaesthesia, injection site haematoma, injection site pain, injection site erythema, discomfort (heavy feeling of frontal area), eyelid ptosis, dry eye, brow ptosis, facial asymmetry, Mephisto sign, nausea. For a full list of adverse reactions, please consult the SmPC. Overdose: May result in pronounced neuromuscular paralysis distant from the injection site. Legal Category: POM. List Price: Ireland 50 U/vial €103.50, 50 U twin pack €207.00, 100 U/vial €207.00, 100 U twin pack €414.00 Market

Authorisation Number: PA 1907/003/001, PA 1907/003/002 Marketing Authorisation Holder: Merz Pharmaceuticals GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt/Main, Germany. Date of Preparation: April 2024. M-BOC-IE-0042. Further information available from: Merz Aesthetics UK Ltd., Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ Tel: +44 (0) 333 200 4143

Adverse events should be reported. Reporting forms and information 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 at the address above or by email to UKdrugsafety@merz.com or on +44 (0) 333 200 4143.

Understanding Regenerative Ingredients in Skincare

Nurse prescriber Anna Baker discusses different

regenerative ingredients that can be used

in skincare

The process of ageing involves an interplay of systemic and extrinsic factors, which leads to a gradual decline in the ability to renew, repair and regenerate at a cellular level.1 Cumulatively over time, these senescent changes can significantly contribute to compromised physiological function.2

Arguably, the function of regenerative medicine can be defined as methods, technologies and/or approaches to replace or regenerate human cells, tissues or organs in order to restore normal function.3 This unique specialism offers a plethora of treatment options for a diverse range of medical concerns and chronic conditions. This article will explore how this is an established and evolving specialism, evidenced by the continued growth of associated medical aesthetic treatments and topical ingredients that can demonstrate regenerative benefits.4

Skin ageing

The skin is a complex organ, with multiple layers and varied architecture across diverse populations.5,6 In light of these structural differences, it is recognised that skin ages differently according to ethnicities which reinforces the need for sophisticated and multi-tasking topical regenerative approaches to deliver cellular antiageing benefits across all populations.7

Intrinsic ageing is a variety of processes which are influenced by genetic, metabolic and hormonal changes, and characterised by reduced sebaceous gland function, decreased blood flow and degradation of collagenous and fibrous extracellular matrices (ECMs). These changes lead to atrophy, reduced lipid content, xerosis and fine lines.8

Recent findings from Arnal-Forné et al. describe outcomes from their histologic and morphometric study outlining new microscopic intrinsic age-related skin changes. These concluded a reduction in epidermis thickness, interdigitation and mitotic indexes, as well as a raised melanocyte count. Furthermore, the papillary but not reticular dermis showed increased thickness with ageing. Specifically, in the papillary layer, mast cells glycosaminoglycans were expanded, whereas the reticular dermis displayed a diminution in glycosaminoglycans and elastic fibres. Moreover, total cellularity and vascularisation of both dermises were diminished with ageing. This morphometric analysis of photo-protected areas reveals that intrinsic ageing significantly influences human skin composition.9

Regenerative topical ingredients

A number of key regenerative ingredients can be used within skincare formulations in order to address intrinsic ageing, including stem cells, exosomes and peptides. These are currently formulated in a variety of different topical preparations, such as serums or moisturisers.

Stem cells

Stem cells have a number of key regenerative roles, and have long been recognised for their self-renewal and ability to differentiate into different cell types, facilitating a host of healing properties.10 These cells have been a recognised and established area of interest within regenerative medicine in light of the expanding

options to repair damaged tissue.11 The mode of action of these cells works by mediating factors that attract host cells to the injury site to support tissue repair and recovery.

Exosomes

Exosomes are extracellular vesicles which are released from cells upon fusion of an intermediate endocytic compartment, and produced through multiple steps: creation of endosomes from the plasma membrane, construction of intraluminal vesicles inside of multivesicular bodies (MVB) and release of internal vesicles.12

Extracellular vesicles are lipid bilayer particles, naturally secreted by cells and can be categorised into three subclasses depending on a number of factors, including their size, surrounding exosomes with sizes ranging from 50-150nm accordingly.13 Exosomes are released during exocytosis and participate in the intercellular communication of various physiological and pathological processes. Studies have shown that exosomes have a number of regenerative functions, such as facilitating wound healing through tissue remodelling, promoting pro-angiogenesis, improving hyperpigmentation and signalling the pathway for collagen 1 and 3 expression of related genes, as well as improving hair loss.14,15

All cells release extracellular vesicles and can be found in all bodily fluids, with exosomes being a subcategory that are smaller and endosomal in origin.16 The range of functions which exosomes can potentially deploy are dependent upon their cell or tissue of origin. A variety of cell sources are reported within the literature, which include plant, human, animal and microbial.17

Exosomes are an emerging powerhouse in cutaneous medical aesthetics in light of their multifunctionality in expanding therapeutic options for many conditions. Medical practitioners should remain mindful of a number of important considerations around the use of exosomes in clinical practice. The sourcing, isolation, purification and identification of exosomes are widely heterogenous and specific mechanisms of action remain largely unclear.16

The use of human-derived biological materials is rigorously regulated in light of concerns surrounding contamination, potential immune reactions and transmission of diseases. Human-derived biological materials are subject to rigorous control and vigilance due to safety concerns. As a result, the use of human-derived exosomes in medical aesthetic procedures is strictly prohibited in the EU and UK under current regulations.

Exosomes represent an exciting avenue of regenerative medicine, and interest has dramatically increased in recent years due to their many unique functions.18 In spite of the number of recent publications, collective understanding of exosomes remains limited by factors that include a lack of exclusive biomarkers, lack of high-resolution visualisation techniques and lack of inefficient separation methods. In addition, limitations in exosome research that relate to isolation, purification and characterisation are equally important to consider when analysing clinical data and published studies.19

Mesenchymal stem cells

Mesenchymal stem cells are multipotent adult stem cells located in a variety of human tissues, and can differentiate into a variety of cells including adipocytes and keratinocytes, among others. Mesenchymal stem cells are stromal cells which have the ability to self-renew and exhibit multilineage differentiation.20 Secretome is an evolving class of technologies for topical application which refers to proteins produced by a living cell into the extracellular space, which includes paracrine substances, microvesicles and exosomes.15 Mesenchymal stromal cells (MSC) can secrete more than 200 different types of cytokines, chemokines, growth factors, interleukins, enzymes and extra cellular (ECM) proteins.

In light of the pro-angiogenic, anti-apoptotic and immunomodulatory attributes associated with fewer ethical concerns, mesenchymal stem cells are gaining considerable interest within regenerative medical aesthetics.13 Mesenchymal cell exosomes elicit their effects through the transmission of their molecules, which includes proteins, messenger RNA (mRNAs) and microRNAs (miRNAs) to target cells that result in a regenerative cascade to support mitochondrial transfers and suppress inflammatory cytokine generation.16

Exosomes derived from human umbilical cord blood mesenchymal stem cells (UCB-MSCs) have been demonstrated to promote cell migration and collagen synthesis of human dermal fibroblasts. These benefits underpin interest in the introduction of exosomes derived from stem cells in conditioned media into the skin rejuvenation space.

Peptides

Peptides are short chains of two to 50 amino acids linked together by peptide bonds.21 Amino acids are the building blocks of proteins, and when they are joined in a chain, they form a peptide. Peptides are smaller than proteins, although specific thresholds may vary. Peptides have invited considerable interest and have been extensively studied due to their multi-tasking, wide-ranging and regenerative effects regarding their regulating and signalling mechanisms.21 These biological cues have consistently demonstrated diverse physiological effects, including antioxidant, antiageing, moisturising, collagen stimulating and wound healing properties, exerting their biological functions in a number of different ways which can be determined in part by their structure.22,23 These functions determine how peptides can be categorised, and it can be useful to consider them in the following ways, according to their mechanism of action:

· Signal peptides: Stimulate collagen and elastin synthesis, as well as keratinocyte and epidermal cell proliferation, and modulate melanogenesis.24

· Carrier peptides: Deliver trace elements to the skin, essential for wound healing and enzyme processes, and improve skin elasticity.25

· Neurotransmitter inhibitor peptides: Inhibit the release of neurotransmitters that cause muscle contraction, thereby reducing fine lines and wrinkles.26

· Enzyme inhibitor peptides: Inhibit the activities of enzymes that break down collagen, supporting the health of skin structure.27

· Anti-microbial peptides: Protect against micro-organisms including bacteria, fungi and viruses by disrupting their membranes.28

Peptide innovation

A number of peptide technologies offer cutting edge innovations in regenerative topical approaches, and individual peptides can be uniquely customised to address individual concerns. A novel and patented example is Myristoyl-pentapeptide-16, which stimulates cutaneous cell renewal utilising cationic lipo-oligopeptides (‘CLOPs’) to form micelles which can further enhance penetration by more than 400%.21 The structure of the peptide allows for effective and targeted penetration due to the chemical structure, which leads to the formation of hydrophilic micelles, functioning as a delivery system.21

This unique and advanced offering facilitates stimulation of growth factors and wound response without inflammation, whilst supporting an enhanced skin barrier function and reduced transepidermal water loss (TEWL). This peptide also encourages increased moisture retention, facilitates active encapsulation for enhanced synergistic ingredient delivery and boosts the skin’s protection against oxidative stress. In addition, this technology promotes gene expression of key keratinocytes that play a role in regulating inflammation and supporting cohesion between the epidermis and the basement membrane. It signals for renewed collagens IV, VI and VII which are fundamental in the structural integrity of the skin. Myristoyl-pentapeptide-16 also demonstrates upregulation of Epidermal Growth Factor Receptor (EGFR), as well as superoxide dismutase and antimicrobial protein expression.

Stability

The stability of peptides is a key consideration, as degradation remains one of the major challenges due to a number of extrinsic influences.29 One of the most common types of modification reported in the literature for enhancing peptide stability

is cyclisation, which involves forming a linkage between the amino and acid carboxy-groups in the N- and C- termini, by forming a linkage between two amino acid chains.30 These methods can offer improved stability to proteolysis, and in some cases enhanced biological activity if the bioactive conformation is stabilised. 30 In addition, conjugation is designed to enhance both permeability and stability utilising either myristic or palmitic acid, as well as encapsulation which utilises lipid vesicles and nanoparticles to facilitate delivery and mitigate degradation.29

Lipinski et al. outlined a number of factors highlighting the properties that are key for formulations to achieve effective delivery, and ultimately results. A key consideration is molecular weight. Specific peptides such as dipeptides and tripeptides have weights below 500 Daltons, which is a key consideration within the specified criteria. Peptides with a larger Dalton size typically exert their mechanism through cell surface receptors.31

A number of ingredients can synergise and enhance peptide efficacy. These include antioxidants such as green tea extract which protects the skin from oxidative stress and supports the reparative actions of peptides.32 In addition, ceramides strengthen the skin barrier and improve hydration to synergise the effects of peptides in supporting a healthy and nourished skin barrier, and can further amplify the benefits of vitamin C, retinol and niacinamide.

Using new technologies

The technologies discussed are not intended to be exhaustive, but outline the current evidence and indications for some of the popular topical ingredients gaining increasing interest in light of their regenerative benefits. Medical aesthetic practitioners are in a strong position to educate around ingredients, as well as procedural recommendations, and tailor product regimens to complement bespoke treatment journeys. The regenerative dialogue has given rise to interest in skin treatments which can improve a variety of ‘skin quality’ concerns, and topical approaches which offer these benefits are likely to continue to rise in popularity.

Anna Baker is an aesthetic nurse prescriber, trainer and qualified educator. She is a key opinion leader, and vice chair of the BAMAN Education & Training Committee and is currently undertaking an MSc in Clinical Dermatology. Qual: BN, RGN, INP, PGCert, PGDip

Exploring the Science of Collagen

Research scientist Lauren Dewsbury explores using collagen supplementation for skin health

In recent years, collagen supplementation has garnered significant attention from the public and the medical community for its potential role in skin health and longevity. With age, natural collagen production decreases at a rate of ~1-1.5% annually, leading to visible signs of ageing such as wrinkles, increased skin laxity and loss of moisture.1 For women, this decline is particularly pronounced during menopause, where oestrogen loss dramatically accelerates skin ageing, resulting in a further 30% loss of collagen in the five years following menopause.2 Beyond the skin, collagen loss also has significant influences on other key tissues implicated in ageing, such as joints, bone and muscle.3

It's clear that supporting endogenous collagen production is critical, however, does the clinical science around oral collagen supplementation stack up? This article will review the latest research on collagen peptides, explore their mechanisms of action, summarise the clinical evidence and provide practical guidance on integrating collagen supplements into clinical practice.

How collagen supplementation works

Collagen supplementation is a safe, non-invasive and affordable strategy for enhancing skin health, quality and appearance.4

Most high-quality collagen supplements use collagen peptides (CPs). Peptides are chains of two-50 amino acids; CPs are bioactive molecules derived from the enzymatic hydrolysation of raw collagen (usually of marine, bovine or porcine origin). Hydrolysation is a process that breaks large proteins down into much smaller chains called peptides, and is a critical determinant of collagen supplement efficacy.5 Not all collagen supplements will use hydrolysed CPs; however, this is important for best absorption. Products using low molecular weight CPs (ranging from 1,000-3,000 Daltons) have optimal efficacy and bioavailability in the body, producing best clinical outcomes.6

In contrast to peptides (which are longer chains of amino acids), tripeptides are chains of just three amino acids, making them much smaller. Specific collagen tripeptides, such as glycine-proline-X (where X can be any amino acid) represent the next generation of collagen supplements. They offer a precision therapeutic approach to skin antiageing due to their ability to promote dermal fibroblast activity and stimulate the synthesis of new collagen.7 The exact mechanisms by which CPs exert their effects are still being investigated, but available evidence suggests they function using several direct and indirect pathways.8

Upon ingestion, di- and tripeptides are absorbed intact through the epithelial lining of the small intestine via specific peptide transporters (PEPT-1) and enter the bloodstream, where they exert systemic effects.9 Tripeptides have been detected in the bloodstream shortly after oral ingestion and are rapidly absorbed, reaching peak blood concentrations within a matter of minutes.10,11 Hydroxyproline (Hyp) is found (in meaningful concentrations) almost exclusively in collagen, and appears to be a critical mediator for therapeutic effects observed.12

The Gly-Pro-Hyp tripeptide appears to have a special affinity for the skin.13 Animal studies using radiolabelled isotopes show these tripeptides are preferentially shuttled to the

dermis, where they bind to receptors on dermal fibroblasts, triggering fibroblast proliferation and the upregulation of collagen fibril production.14 CPs influence dermal metabolism by activating the expression of genes associated with the production of collagen and other important components of the extracellular matrix such as hyaluronic acid.15 By upregulating key enzymes involved in hyaluronic acid synthesis, CPs help to maintain optimal skin moisture levels, contributing to a more youthful and plump appearance.8

In addition, some studies have suggested that CPs may also reduce the activity of matrix metalloproteinases (MMPs) –enzymes that degrade endogenous collagen and further contribute to skin ageing.15 By inhibiting MMP activity, CPs may preserve existing collagen in the skin by supporting its structural integrity.16

In summary, CPs have a multipronged approach to collagen preservation and restoration by:

1. Providing the raw materials (amino acids) required for collagen production.

2. Increasing the number of dermal fibroblasts (machinery) and their rate of collagen production (efficiency).

3. Helping to preserve existing collagen reserves by reducing the activity of MMP enzymes that break collagen down.

Collagen’s clinical effects

Collagen supplementation has been studied extensively in hundreds of randomised controlled trials (RCTs), yielding consistent and reproducible effects. A recent systematic review and meta-analysis by Pu et al. involving 26 RCTs and 1,721 participants specifically looked at the effects of hydrolysed CP supplementation on measures of skin ageing.17 They found that daily oral supplementation with CPs led to clinically significant improvements in skin elasticity and hydration relative to placebo (all effect sizes were medium to large). All studies were conducted in healthy adults (predominantly female) and ranged from two to 26 weeks in duration.

Other noteworthy findings were that marine collagen demonstrated the most robust clinical effects; consistent long-term use (≥ eight weeks) produced best results and 5g of CPs daily was the most consistently used dose. No adverse events were reported in any of the interventions. Benefits appear to be maintained for up to 30 days upon cessation of supplementation, suggesting that on-going, consistent use is key to maintaining optimal outcomes.17

Research has also shown that CPs not only improve the appearance of ageing skin, but may also support underlying skin repair mechanisms and overall dermal health.

Asserin et al. measured echogenicity using high-frequency ultrasound to assess collagen density.18 A significant increase in dermal echogenicity (from as early as four weeks) was observed that persisted after 12 weeks of treatment, indicating a consistent increase in collagen density in the dermis over time. Collagen fragmentation in the reticular dermis was also significantly decreased compared to placebo, suggesting a reduction in collagen degradation.18

Marked reductions in facial wrinkle count, length and depth, as well as improvements in skin texture, have also been observed in a variety of RCTs.19 Individual clinical trials have reported reduced nail breakage and increased hair growth with CPs, however, the strength of the evidence for nail and hair health is much less compelling, so further research is required here.16,20

Acceleration of wound healing is an emerging area of promise for CP supplementation.21 Mechanistic studies in animal models show CP supplementation has significant therapeutic potential for accelerating wound healing via increased vascularisation and epidermal regeneration, as well as fibroblast and keratinocyte migration.22,23 An in vitro study found CPs promoted cutaneous wound closure in primary fibroblasts and keratinocytes obtained from both young and aged individuals, with hydroxyproline concentrations driving therapeutic effects.22 In a rat model of caesarean section, marine CPs were found to enhance the speed and quality of wound healing by upregulating the formation of collagen, smoothing muscle fibres and the expression of connective tissue growth factor at the incision site.23

Few clinical studies have been conducted into collagen supplementation’s impact on burns patients, however, one RCT in 31 patients with 20-30% body surface area burns found that wound healing was 3.7 times greater in the CP group relative to the control after four weeks of supplementation.24 Hospital stay was also reduced (~four days) in the CP group. The consistency of findings across studies underscores the therapeutic potential of collagen supplementation. For practitioners, this means that recommending CP supplements as part of a holistic treatment protocol could significantly enhance treatment outcomes, particularly when combined with other synergistic treatments and procedures at your disposal. As with any supplement, it is essential to select a high-quality collagen supplement from a reputable brand that can provide transparent information about their sourcing, formulation and clinical substantiation.

Incorporating collagen supplementation in practice

Collagen supplementation will not replace the treatments conducted in clinic, but rather offers a holistic way to further optimise patient outcomes and experience.

Holistic treatment approach

Collagen supplementation can be utilised synergistically with other clinical treatments designed for collagen induction such as microneedling, laser therapy, biostimulators, injectables or chemical peels for an inside-out approach. Daily collagen supplementation can help the patient to enhance their results and maintain them for longer due to the way they support overall skin health, texture and integrity.16

Accelerate skin repair and recovery

Collagen supplements can be prescribed to accelerate skin recovery and repair after invasive treatments. Surgical practitioners may also consider including collagen supplementation in their pre- and post-surgical protocols to support connective tissue integrity, minimise scarring and promote accelerated post-operative wound healing. 21

Wider treatment scope

Some patients want to delay or avoid invasive treatments and/or injectables altogether. Collagen supplementation can be an affordable, evidence-based treatment alternative with a great safety profile that can provide excellent clinical results. A high-quality hydrolysed collagen supplement provides additional options, or another entry point for such patients.

Systemic effects

Collagen supplementation offers systemic antiageing effects and enhances skin health and quality systemically, rather than locally at the treatment site. It can also confer additional benefits to patients beyond aesthetics and skin health by potentially supporting bone, joint and muscle health.25

Selecting

supplements

The clinical evidence supports hydrolysed (low molecular weight) and tripeptide collagen supplements as being most efficacious due to their enhanced bioavailability.17 While results can be seen with as little as 2.5g hydrolysed CPs daily, the most frequently used dosed in clinical trials is 5g daily.17

There is very little evidence demonstrating efficacy for ‘vegan’ collagen or collagen ‘boosting’ supplements. Marine collagen appears to be best for skin antiageing indications relative to other sources.17 Look for pure collagen products without the

Supplements

Science of Collagen

addition of artificial sweeteners, fillers or preservatives. Powdered and liquid collagen supplements are best for easy absorption because in liquid form, the body is able to absorb and utilise the collagen much more effectively; these forms are also more convenient for correct dosing compared to capsules.17

Considerations

Clinics with a holistic approach to treatment will likely see the best uptake from the addition of collagen supplements as part of take-home aftercare alongside topical products. When choosing a collagen supplement to stock, it’s important to consider where the brand sources their raw materials, the ingredients in the formulation, quality, purity and scientific substantiation. Not all products are created equal, and there can be significant variation in quality which can impact efficacy and therefore patient outcomes. Look for an established, reputable brand with independent clinical trials and scientific evidence to support their claims. Some brands will also provide practitioners with ongoing training and education to support you in integrating them into your practice.

Enhancing clinical results

Collagen supplementation represents a promising adjunct in aesthetic practice, supported by a robust body of evidence. Practitioners can feel confident in prescribing a collagen supplement for improvements to skin hydration, elasticity and overall skin quality, which can be further enhanced when combined with other aesthetic treatments.

Disclosure: Lauren Dewsbury is a product formulator at the collagen supplement company Vida Glow

Lauren Dewsbury is the senior research scientist and ingestible beauty expert at Vida Glow, where she oversees research and clinical trials, science communication and supports innovation and product formulation. She has a background in health science and is currently completing her PhD investigating nutritional and lifestyle medicine approaches to delay cognitive ageing in women.

Qual: BHSc, MRes, PhD(c)

Lauren Dewsbury will be speaking on collagen supplementation at ACE 2025.

Turn to p.32 to register free now.

Exploring Optimal Supplement Ingredients

Dr Eugenia Bonelli provides an overview of some key

ingredients in supplements for the skin

Regenerative medicine in aesthetics is a revolutionary tool that allows us to stimulate the body’s natural ability to regenerate skin, boost collagen production and repair tissue. Vitamins and supplements play a crucial role in supporting these regenerative processes, providing essential nutrients for skin health, collagen synthesis and tissue repair, as well as contributing to the wellbeing and overall health of individuals.

Supplements can also enhance the results of aesthetic treatments by providing essential nutrients that support skin health and healing.1,2 They work synergistically with procedures like injectables and lasers, boosting collagen production and improving elasticity.3 By nourishing the skin from within, supplements may help support both the immediate and lasting benefits of aesthetic interventions.4

Recent discoveries in this space, especially the role of nicotinamide mononucleotide (NMN) and nicotinamide adenine dinucleotide (NAD+) in improving cellular energy, have revolutionised the treatment of ageing.5 The exciting potential of NMN and NAD+ in reversing the ageing process and the anticipated emergence of senolytics (substances that selectively clear senescent cells from our body) promise new tools to expand the benefits of regenerative treatments.6

This article will explore how various vitamins and supplements can optimise results in regenerative medicine, contributing to improved skin rejuvenation, healing and longevity, as well as enhancing the results of aesthetic and skin treatments.

The role of vitamins and supplements

Oral vitamins and supplements tablets play a crucial role in supporting regenerative aesthetic treatments. They can contain ingredients which enhance skin health, promote faster healing and help maintain the long-term results of these procedures. There is some scepticism in the specialty on this subject due to previously low levels of evidence, but as more research is conducted, the measurable clinical benefits are gradually being substantiated, as this article will indicate.

When taken orally, vitamins and supplements formulated in a liposomal form are absorbed more effectively by the body, ensuring maximum efficacy.1 This advanced formulation enhances bioavailability, allowing the body to make the most of its benefits for skin health, faster healing and sustained results in regenerative aesthetic treatments.7

Supplements can benefit patients looking to enhance the effectiveness of aesthetic treatments, especially those undergoing skin rejuvenation, healing or antiageing procedures. They are particularly recommended for individuals with nutrient deficiencies, patients with slower healing responses or those seeking to maintain and prolong the results of treatments like platelet-rich plasma (PRP) or microneedling.3,4 Additionally, individuals with lifestyle factors that impact skin health – such as stress, poor diet or consistent environmental exposure – can benefit from supplements that support skin repair, reduce inflammation and improve overall skin resilience.1,8

Below are some examples of the most commonly used vitamins and supplements in these instances, and their main mechanisms of action.

Vitamin C: Collagen production and skin repair

Vitamin C is critical in collagen synthesis and essential for maintaining skin structure, elasticity and firmness. It is also a potent antioxidant that protects the skin from free radical damage caused by environmental factors like UV radiation and pollution. Combining vitamin C with regenerative treatments like PRP and microneedling accelerates tissue repair and enhances the skin’s ability to regenerate.9

Liposomal vitamin C, a form of vitamin C encapsulated in liposomes, ensures better absorption, allowing for higher bioavailability than traditional supplement forms. This results in more effective collagen production and skin healing.10

Vitamin A: Skin renewal

Vitamin A, particularly retinoids, is known for its ability to increase skin cell turnover and stimulate collagen production. Retinoids are particularly beneficial after microneedling or PRP, as they enhance the skin’s renewal process and reduce the appearance of wrinkles and pigmentation.11 This is possible because retinoids accelerate the shedding of dead skin cells and promote the growth of new, healthy cells.4 By increasing cell turnover, they help to fade hyperpigmentation and even out skin tone.4

Liposomal vitamin A formulations further improve absorption, enhancing the skin’s ability to repair and rejuvenate.7

Vitamin E: Antioxidant and healing support

Vitamin E is an antioxidant that protects the skin from oxidative stress and promotes healing.5 It is particularly beneficial post treatment, reducing inflammation and supporting tissue repair after procedures like microneedling, PRP or laser treatments.12

Liposomal delivery ensures that vitamin E is better absorbed, improving its ability to hydrate and heal the skin.7

B vitamins: Cellular energy and repair

B vitamins, particularly B3 (niacinamide) and B5 (pantothenic acid) are essential for maintaining healthy skin. Niacinamide strengthens the skin barrier, reduces inflammation and improves skin tone, while pantothenic acid supports wound healing.6 These vitamins are beneficial after regenerative treatments such as PRP and microneedling, promoting faster recovery and improving skin texture.1

Liposomal delivery has been shown to increase the bioavailability of most compounds, including B vitamins, ensuring that the skin receives the full benefits of these essential nutrients.7

By

nourishing the skin from within, supplements help reinforce the benefits of aesthetic interventions

Omega-3 fatty acids: Inflammation control

Omega-3 fatty acids, known for their potent anti-inflammatory properties, are invaluable in controlling post-treatment inflammation.8 After procedures like microneedling or PRP, Omega-3 supplements help modulate the body’s inflammatory response, reducing redness and promoting faster healing.3,8

Liposomal Omega-3 formulations allow for better absorption, ensuring adequate anti-inflammatory support.7,13

Zinc: Wound healing and collagen formation

Zinc plays a vital role in wound healing and collagen formation. Its anti-inflammatory and antioxidant properties support skin repair and regeneration. Zinc supplementation after aesthetic treatments like microneedling or PRP can speed recovery, reduce inflammation and prevent post-procedure complications such as acne or scarring.14

Liposomal delivery ensures better absorption, which is critical for optimal wound healing and skin repair, although it must be noted that specific data on zinc is limited in this aspect.7

NAD+ and NMN: Cellular energy and antiageing

Nicotinamide adenine dinucleotide (NAD+) and its precursor nicotinamide mononucleotide (NMN) have emerged as powerful antiageing and regenerative medicine tools. NAD+ is a coenzyme essential for cellular energy production, DNA repair and mitochondrial health. As we age, NAD+ levels decline, leading to reduced cellular function and slower tissue repair.15

NMN is a direct precursor to NAD+ and can help replenish declining NAD+ levels. By increasing NAD+ levels, NMN improves cellular energy production, supports DNA repair and enhances the body’s natural ability to regenerate tissue. This makes NMN and NAD+ supplementation highly beneficial for patients undergoing regenerative aesthetic treatments such as PRP, stem cell therapy or microneedling.16,17

In medical aesthetics, NMN and NAD+ have been shown to boost the skin’s natural repair processes, improve elasticity and reduce the visible signs of ageing. These supplements may enhance the longevity of regenerative treatments by maintaining cellular vitality and promoting skin rejuvenation over time.5,16

Liposomal NMN and NAD+ formulations ensure these compounds are absorbed more effectively, potentially leading to better results in skin rejuvenation and overall antiageing effects.5,18

Senolytics: Clearing senescent cells for healthier skin

Senolytics are a new class of compounds that selectively target and remove senescent cells – damaged cells that have stopped dividing but remain metabolically active.6 These cells accumulate with age and contribute to various age-related conditions by secreting pro-inflammatory cytokines and other factors that disrupt tissue homeostasis, a phenomenon known as the senescence-associated secretory phenotype (SASP).19

Senescent cells play a significant role in ageing and degenerative diseases by promoting inflammation, impairing tissue regeneration and influencing the behaviour of surrounding healthy cells.17 By targeting and removing these cells, senolytics aim to mitigate inflammation, promote tissue repair and potentially enhance overall skin health, thus contributing to improved longevity and quality of life.6

The combination of senolytics with NAD+ has received growing interest in the field of ageing and regenerative medicine. While senolytics actively clear senescent cells to reduce chronic inflammation, NAD+ (and precursors such as NMN) enhance mitochondrial function and energy production, working synergistically to improve cellular repair.20,21

Senolytic supplements have the ability to enhance aesthetic treatments and combat ageing by targeting and removing senescent cells that accumulate with age.6 These cells disrupt cellular communication and repair processes, leading to inflammation and impaired skin function.19 By clearing out senescent cells, senolytics can improve the skin’s regenerative capabilities, allowing for better responses to treatments such as PRP, microneedling and stem cell therapies. This has the potential to result in faster healing, reduced downtime and more noticeable improvements in skin elasticity, texture and overall appearance, contributing to a youthful and vibrant look.6

Enhancing regenerative aesthetic results

Regenerative medicine in aesthetics has made significant strides by integrating cutting-edge therapies like PRP, stem cell therapy, microneedling and biostimulators.3 Combining these treatments with essential vitamins and supplements such as NMN, NAD+ and senolytics offer a holistic approach to skin rejuvenation and antiageing.4 Liposomal formulations of these nutrients and compounds have been shown to ensure superior absorption, maximising their effectiveness in promoting tissue repair, collagen production and overall skin health.7

This comprehensive approach to treating aesthetic patients helps maintain youthful, healthy skin, but also contributes to the overall health and wellbeing of the individual, extending the benefits of aesthetic treatments and ultimately contributing to better, longer-lasting results. The science behind regenerative medicine continues to evolve as new research and techniques come to light, and more research is needed in this area.3

Dr Eugenia Bonelli combines her expertise in surgery and aesthetics to deliver exceptional results at her Wimpole Street practice. As a member of the Royal College of Surgeons and the JCCP, she seamlessly integrates surgical precision with aesthetic artistry, ensuring safe and personalised treatments that enhance natural beauty.

Qual: MBBS, MRCS, JCCP, PGDip Aesthetic Medicine

Case Study: Holistically Regenerating Skin and Hair

Dr Raquel Amado details how she used regenerative treatments to enhance skin and hair quality in a menopausal patient

The visible decline of skin and hair quality, which many women experience as part of the menopause, can have a significant impact on quality of life. It can lead to an increased perception of ageing and unattractiveness, while also being seen to indicate poor health and wellbeing.1

In a 2018 survey of 1,287 women, 72% reported that they noticed changes in their skin at perimenopause/menopause, while 50% felt they had been insufficiently informed about these symptoms.1

This article examines how aesthetic practitioners can educate women about menopausal skin and hair changes, while highlighting proven solutions.

Pathophysiology of menopausal skin and hair changes

Menopause is defined as the time at which a woman has not had a period for 12 consecutive months. This occurs because of a decline in hormone levels, which also leads to other changes that include skin and hair health. Female pattern hair loss and frontal fibrosing alopecia have both been associated with a reduction in androgen and oestrogen. As well as a loss of hair, it is common for women to develop more brittle, weak hair as they age.2

In relation to skin, a reduction in oestrogen is implicated in an increase in transepidermal water loss, as well as a decline in collagen production. Research suggests that nearly a third of collagen is lost in the first five years after menopause, followed by 2.1% per year for the next 15 years. Other common dermatoses associated with menopause include flushing, dermatitis, acne, rosacea, psoriasis, pigmentation and hyperhidrosis.3

Treatment modalities

There are multiple aesthetic treatment options that can be beneficial for menopausal patients. One approach known for its regenerative potential involves cellular repair.

Among the most effective treatments for cellular repair are polynucleotides, growth factors and exosomes.

Polynucleotides works by promoting a trophic and stimulating action on existing fibroblasts, which increases collagen synthesis, as well as the number and viability

of fibroblasts. This regenerative approach leads to improvements in fine lines and wrinkles, pigmentation, rosacea, scarring, poor tone and texture and dark circles.4

Growth factors are naturally occurring proteins, responsible for cellular proliferation stimulation, inflammation modulation, angiogenesis and cellular bioactivity support. Exosomes are nanovesicles that carry important cell properties to one another, which include growth factors, cytokines, lipids and nucleic acids. Research demonstrates that exosomes delay the ageing process by facilitating intracellular communication through the paracrine effect (which signals for other cells to change their behaviour).6

Patient assessment

As a 53-year-old female menopausal patient was concerned with the significant changes in her face, skin and hair. Her primary issues were under-eye hollows, lateral cheek lines, sagging in the neck and décolletage, marionette lines and noticeable hair thinning.

She was already following a skincare regimen from Evidence Skincare (ESK) alongside using shampoo and conditioner designed for hair loss, but she sought more advanced treatment for facial volume loss, skin texture and hair density.

During a one-hour initial consultation, it was clear that the patient’s skin had suffered from decreased collagen production and increased fine lines, and her hair had been thinning mainly in the hair line. Her concerns were typical of menopausal changes due to hormonal imbalances affecting the skin and hair.2,3

A menopause specialist checked the patient’s thyroid and assessed her for potential vitamin and mineral deficiencies, with results coming back normal. Her diet was also deemed to be healthy and balanced following a nutritional assessment.

It is important to conduct this assessment because it identifies deficiencies in key nutrients like vitamin D, calcium, iron, magnesium and B vitamins, confirmed through blood tests. Dietary recommendations are tailored to address these gaps, with supplements prescribed as needed. For menopause symptoms such as hair loss, fatigue and mood swings, targeted nutrients like biotin, iron and magnesium are recommended.7,8,9

Treatment approach

After a thorough assessment, a holistic 360-degree approach was suggested, aimed at delivering natural-looking results. Our treatment goal was to rejuvenate her face, neck and décolletage, while addressing volume loss and improving her skin tone and texture, as well as addressing hair loss and thickness.

The approach was split into three parts.

1. Skin preparation

The approach began with polynucleotide treatment using Plinest and Newest. Newest contains hyaluronic acid (HA), which is clinically proven to stimulate collagen, HA and elastin, as well as reducing inflammation and pigmentation.4

By first improving overall skin quality with polynucleotides, less filler will be needed later for volume restoration. Enhancing the skin's condition prior to volume replacement results in more natural and longer-lasting outcomes.

The initial treatment plan consisted of four sessions of polynucleotide injections, spaced four weeks apart, targeting the face, neck and décolletage (Figure 1).

For the facial rejuvenation treatment, a total of 2ml of Newest and 4ml of Plinest were used. Under the eyes, 0.8ml of Plinest was carefully administered using a combination of a 4mm 33G needle for intradermal injection and a 38mm 25G cannula for subdermal placement. Moving to the cheeks and lower face, 1ml of Newest and 1ml of Plinest were injected on each side.

Here, a 38mm 25G cannula was used for subdermal injections, while a 30G needle was used for more precise intradermal placements, particularly in areas with deeper lines, like the radial cheek lines.

The combination of needle and cannula techniques was used to balance precision and distribution (needles) with patient comfort and reduced downtime (cannulas).

The neck received 2ml Newest via a 30G needle with an intradermal technique, while the décolletage was treated with 2ml Newest, also using a 30G needle intradermally.

2. Volume replacement

To allow time for the skin health to show improvements, we waited three weeks before going into the second stage of the treatment. In the next session, we introduced New Cellular Treatment Factor (NCTF) 135 HA from Fillmed – a skin revitalisation product designed to hydrate and improve skin quality.

As the skin was treated with polynucleotides prior to the skin booster injection treatment, we had more and better working fibroblasts to enhance the patient’s skin outcome.4 In the same appointment, we used the Fillmed filler range to address the patient’s facial volume loss with the following approach:

· Temples: 0.6ml Fine Lines, delivered with a 25G 38mm cannula in the subcutaneous layer

· Cheeks (apex and zygomatic arch): Small amounts of Volume (0.2ml per point) were injected using a 27G needle to create natural volume and lift

· Piriform fossa: 0.3ml of Universal injected deep with a 25G 38mm cannula to soften deep nasolabial folds

· Preauricular area: 0.6ml of Universal injected with a 25G 38mm in the subcutaneous layer for skin tightening and volume, lifting the jowl region and folds

Marionette lines: 0.3ml on each side with 25G 38mm cannula to the subcutaneous layer to lift sagging corners of the mouth

· Pre-jowl sulcus: 0.2ml injected with 27G needle to for softening the jawline

· Chin: 0.2ml injected with 27G needle for definition and symmetry, plus softening of the jawline

· Upper lip lines and radial cheek lines: Subcision done with 25G 38mm cannula to release adhesions from the skin to the muscle. Fine lines were blended with 2.5ml of NCTF intradermally using a 4mm 33G needle and injected 0.1ml subdermally with a cannula was injected intradermally using a 30G needle

· Mental-labial crease: 0.4ml of Fine Lines injected with a 25G 38mm cannula for a rejuvenated contour

· Undereye and cheek area: NCTF (0.5ml) injected using a 34G 0.6mm nanosoft needle, which ensures precise delivery and minimal risk of bruising for delicate undereye areas

3. Hair restoration

To restore hair quality, a combination of exosomes and microneedling was used. This treatment approach focuses on resetting the health of the scalp and dermal papilla, while optimising the environment for hair follicles to flourish.10 By addressing both scalp health and the biological mechanisms behind hair formation, the treatment approach ensures a long-term solution for hair restoration, creating not only immediate improvements but also sustainable hair growth and quality.6

Microneedling with Purasomes HSC50+ Hair & Scalp Complex was performed using the SkinPen device at 0.5mm depth. Research has suggested this is the best depth for hair restoration as it ensures the exosomes reach the required area efficiently without damaging the hair bulb.10 Purasomes HSC50+ Hair & Scalp Complex contains 200mg of 20 growth factors, 20 billion exosomes, 25mg high molecular weight HA, 25mg low molecular weight HA, seven peptides and eight vitamins.6 Together, these ingredients can reset the strength of the dermal papilla to reactive normal hair growth function, leading to less hair loss, enhanced scalp health and an improvement in hair quality. The patient underwent three sessions, spaced four weeks apart.

Results

By the end of treatment, the patient’s skin showed marked improvements in elasticity, hydration and texture, with a noticeable reduction in fine lines and crepiness, including periorbital skin. The neck skin is less inflamed and the décolletage lines have improved dramatically. It’s important to note that it was summer during the patient’s course of polynucleotides treatments. The volume restoration was subtle yet effective, giving her a refreshed, natural look without appearing overdone. Her profile looks more balanced, marionette lines were significantly diminished and the lateral canthus of her eye lifted, making her look happier (Figure 2).

Additionally, the patient’s hair showed visible signs of regrowth and thickening, with enhanced scalp health.

Holistic rejuvenation approach

By focusing on skin health first through polynucleotide therapy, and then utilising volume restoration with dermal filler and skin booster to further improve the skin, results showed a balanced and natural-looking rejuvenation for this patient. This multi-faceted approach ensured that both her skin and underlying facial structure were optimally treated, resulting in a harmonious, youthful appearance.

Dr Raquel Amado graduated as a dental surgeon in 2007. She completed a post-graduate in Dental Sedation and Pain Management at the UCL Eastman Dental Institute in London. She is an affiliated member of the Aesthetics Complication Expert Group (ACE) of practitioners and CMAC, which aims to improve patient safety in facial aesthetics.

Qual: BDS, Level 7

Dr Raquel Amado will be speaking about polynucleotides on behalf of DermaFocus during their Lunchtime Takeover sessions at ACE 2025. Turn to p.32 to register free now.

Figure 1-2: 53-year-old menopausal woman before treatment and after four sessions of polynucleotide injections (spaced four weeks apart) and NCTF 135 HA administered three weeks after the initial treatment

Enhancing Microneedling Outcomes with Milk Exosome Solutions

Dr Mario Luca Russo and Dr Marcello Poltronieri review microneedling with exosome solutions for skin regeneration

Antiageing, inhibiting hyperpigmentation and preventing hair loss are among patient demands in medical aesthetics. Exosomes are nanovesicles secreted by cells that play an important role in intercellular communication. Compared to drugs, plant and herbal extracts and bioactive molecules, exosomes have the advantage of low immunogenicity, good biocompatibility, targeting specificity and strong tissue permeability.1

This article explores how microneedling with exosome solutions enhances skin regeneration and addresses key aesthetic concerns.

Exosome origins

The collection and purification of exosomes are complex because exosomes from different sources vary in size, composition and function. One of the current challenges is efficiently enriching exosomes, which is vital for their engineering and production.2,3

Bovine milk-derived exosomes are isolated from fresh bovine milk, with diameters ranging from 30nm to 200nm, and an average particle size of 120nm. As bovine milk-derived exosomes (commonly referred to as milk exosomes) maintain the integrity of their contents even when passing through an acidic environmental pH, they can act locally or be transported into the circulatory system.4

Milk exosomes are characterised by the expression of specific transmembrane proteins, such as CD63 and CD9, which specifically target fibroblasts and

keratinocytes. Moreover, milk exosomes carry the endosome sorting complex required for transport (ESCRT), which is essential for sustaining proper cell communication and the delivery of nutrients and growth factors.5

In terms of application, bovine milk-derived exosomes are used as carriers to deliver proteins, polypeptides, nucleic acids and small molecular drugs. They are loaded with more than a hundred types of highly efficient nutrients that help stimulate skin vitality and have significant advantages in antiageing and whitening. Phototoxicity, photoallergy, repeated skin irritation, skin allergies and patch tests have aimed to confirm the safety of milk exosomes for skin application.6

The role of milk exosomes for skin regeneration

The integrity of the skin deteriorates due to chronological ageing, photoageing, hormonal deficiencies and environmental influences. Histologically, this is perceived as a decrease in the thickness of the dermal matrix. This contributes to the formation of wrinkles, which is a key sign of skin ageing. Exosomes often contain biologically active proteins and genetic information, all of which play an important role in delaying cell ageing such as inhibiting the synthesis of ageing-related factors like β-galactosidase, and inhibiting skin photoageing by promoting the synthesis of nicotinamide adenine dinucleotide (NAD+). Studies have shown that NAD+ levels in the circulatory system significantly decrease with age. Additionally, human-induced

pluripotent stem cell exosomes can inhibit UVB radiation-induced damage to human dermal fibroblasts (HDF5). Exosomes may also reduce hyperpigmentation by inhibiting melanin production.4-8

Milk exosome treatment results

Evidence has shown milk exosome treatment for the facial zone, neck, décolleté and scalp can produce the following results:9

· Restoration of type I and III collagen expression after ultraviolet radiation exposure

· Moisture preservation and wrinkle reduction in human skin models

· Increased matrix metalloproteinase 3 (MMP3) expression in skin dermal fibroblasts, resulting in a high MMP3-to-tissue inhibition ratio of matrix metalloproteinases. Exosomes promote skin repair and regeneration through coordinated activities such as cell proliferation, angiogenesis, collagen deposition, tissue remodelling and inflammatory response

Exosomes and active compounds

Exosomes are combined with specific active ingredients (such as polynucleotides, hyaluronic acid (HA), Y-aminobutyric acid (GABA), peptides, glutathione and niacinamide) and used as efficient carriers to deliver these active compounds deep into the skin.12

Native high-molecular-weight HA has structural properties, while HA degradation products (oligomers) stimulate endothelial cell proliferation and migration. HA oligomers modulate inflammatory processes and promote neoangiogenesis during various stages of wound healing. HA exerts its biological effects by interacting with specific cell-associated receptors (CD44 and RHAMM) and promoting the biosynthesis of growth factors like FGF2 and KGF, demonstrating benefits in photo- and chrono-ageing.2,10

GABA stimulates collagen type I expression, elastin synthesis and growth factor expression, inhibits matrix metalloproteinase-1 (MMP-1) and enhances HA production.8 Biomimetic oligopeptides (Oligopeptide-68, Oligopeptide-24) have amino acid sequences identical to physiological peptides. They regulate the synthesis of Ki-67, type I procollagen, AP-1 and SIRT6 in human fibroblast cell cultures, enhancing cell stimulation and contributing to regeneration processes while initiating mechanisms to prevent ageing.

Glutathione (GSH), the most abundant endogenous antioxidant, and niacinamide play a pivotal role in NAD+ synthesis and have clinically proven properties to activate sirtuins, the longevity genes.15

Enhancing product penetration

Currently, exosomes are used in aesthetics through topical application, often via microneedling, as they are only licensed for topical use in the UK and not for injectable use. A dermal microneedling pen with 0.25mm to 0.5mm microneedles may be used to enhance product penetration. At these depths, the active components reach only the superficial layers of the epidermis, so a topical anaesthetic is not required. The main principles of microneedling are based on the processes of neocollagenesis and neovascularisation. This involves stimulating the skin's ability to heal itself by generating new collagen fibres and blood vessels. These processes are initiated by triggering the body's wound healing response through controlled micro-injuries. Exosomes amplify microneedling's effects by enhancing the skin's healing and regenerative processes.16

Material and methods

This study, conducted through the collaboration of both of our clinics, investigates the effectiveness of a microneedling treatment in the facial zone using a sterile solution made from pharmaceutical-grade milk exosomes, combined with PDRN, hyaluronic acid (both high- and low-molecular weight), biomimetic oligopeptides, glutathione, amino acids and niacinamide.

These treatments are typically recommended for patients aged between 30 and 65 years; however, the ideal age range is between 35 and 60 years. After a certain age, the treatments give less evident clinic results due to slowing down of cellular metabolism, but it is wrong to say that the treatment becomes ineffective. The study was conducted on 30 healthy patients (20 females, 10 males), aged between 40 and 60, with Fitzpatrick skin phototypes ranging from II to V. All participants presented with dryness, wrinkles and mild acne. Prior to entering the study, an informative lecture was provided to all participants, and informed consent was obtained. None of the participants had acute skin diseases or other dermatological disorders. Other exclusion criteria included systemic medication with anti-inflammatory drugs or antibiotics, severe disorders such as cancer or post-cancer conditions, skin lesions, herpes, infections and autoimmune pathologies. These conditions normally contraindicate aesthetic treatments.

They received four treatments every 14 days, with 2.5ml of the solution applied per zone. The standard protocol calls for the use of 2.5ml of the solution for one area (e.g. the whole face).

For treatment of the face, neck, décolleté and hands, 5ml of the product is required.

Application protocol

The study showed the following application protocol:

· Cleansing of the face with a facial disinfectant solution Application of a topical solution – up to 2.5ml of exosome solution was applied to the face

· Use of a needling pen; the needle depth was 0.3mm

· After the treatment, the treated area was lightly massaged

· Four treatments were done, two weeks apart based on the aesthetic practitioners’ discrepancy

After the treatment, the patients experiences slight erythema, which is a common response to such procedures and typically resolves within an hour. The skin reactivity of every patient can cause a longer downtime period. Aesthetic practitioners can discern this on the basis of their clinic experience, visual skin analysis and anamnesis of the patient.

Results

Following the treatments, a satisfaction survey was conducted, with participants reporting long-lasting positive effects on their skin such as increased brightness, lifting effects, a feeling of hydration, less visible pores and reduction in wrinkles. Overall, 85% of participants reported satisfaction with the treatment, while 88% expressed interest in undergoing the treatment again in the future. 75% also reported general wellbeing and psychophysical improvement (Figure 1-2).

Figure 3: A 60-year-old female patient, Fitzpatrick Type V, before and after four treatments of microneedling using a sterile solution made from pharmaceutical-grade milk exosomes combined with PDRN, hyaluronic acid, biomimetic oligopeptides, glutathione, amino acids and niacinamide.

Clinical implications

This article demonstrates that regenerative microneedling, when performed according to guidelines, improves skin conditions and quality across various skin types. The treatment involves a solution containing bovine milk-derived exosomes, PDRN, HA (high- and low-molecular-weight), peptides, amino acids and niacinamide.

The procedure can be easily integrated with other medical aesthetic techniques, offering patients a less invasive option that provides long-lasting results when combined with complementary treatments. Microneedling with the milk-derived exosome solution and its active components can be considered a safe and effective approach to addressing various aesthetic skin concerns, with moderate financial investment. Importantly, ethics should always be prioritised in any treatment involving exosomes, ensuring that practitioners adhere to established standards of care.

Dr Marcello Poltronieri is a maxillofacial surgeon specialising in medical aesthetics. He graduated in Medicine and Surgery from the University of Naples Federico II and further specialised in Oral Surgery and Dental Implantology at the George Eastman Institute in Rome. He has worked in hospitals and institutes in Italy, the USA and Brazil, focusing on surgery and minimally invasive aesthetic procedures.

Qual: MD, DDS, PhD

Dr Mario Luca Russo is a cosmetic and dermatological surgeon on skin rejuvenation, cosmetic dermatology and minimally invasive facial rejuvenation techniques. He is in the specialist register of General Medical Council and Ordine dei Medici di Venezia, a Member of the British Association of Dermatologists and the British College of Aesthetic Medicine.

Qual: MD, MSc

Figure 1&2: The graphic represents the subjective evaluation of degree of satisfaction and the possibility of repeating the treatment

Pushing the Boundaries Medical-Grade Skincare

Discover the science behind clear, healthy skin with ZO® Skin Health

Founded by world-renowned dermatologist Dr Zein Obagi, ZO® Skin Health pushes the boundaries of medical-grade skincare. ZO® provides a comprehensive approach to creating and maintaining healthy skin for anyone, regardless of age, ethnicity, unique skin condition or skin type. From correcting sun damage and pigmentation to preventing new damage and protecting against future damage, ZO® is committed to achieving skin health through the power of science.

“We need to improve the skin in totality, and that’s what skin health is,” says Dr Obagi. His philosophy centres on creating products that target skin concerns at the cellular level rather than just treating surface symptoms. This groundbreaking approach ensures optimal skin health for all, regardless of skin type.

“Dermatology is a remarkable specialty that treats the skin, eliminating conditions that affect both appearance and overall health. Restoring the skin to its original, healthy and radiant state is grounded in this comprehensive definition,” he notes.

The problem

Blemishes are caused by a complex inflammatory cascade that begins with excess sebum production and follicular hyperkeratinisation (the abnormal shedding of dead skin cells within pores), which leads to clogging, inflammation and the growth of breakout-causing bacteria. They're compounded by side effects that patients report to be as frustrating as breakouts themselves. Breakouts can lead to physical side effects of post-inflammatory marks, and deeper cysts often cause long-lasting, hard to treat textural scarring. In addition to the physical impacts, psychological side effects have also been noted with reduced confidence and self-esteem.

With the UK ranked top 10 globally for blemish-prone skin concerns, ZO® saw an opportunity for a blemish solution with ingredient technologies that not only target each step of blemish formation, but also minimise the appearance of post-inflammatory spots.

Dr Obagi has personally seen the far-reaching impact of blemishes and their after effects. As he explains, “When I was a teenager, many of my friends developed blemishes, and I saw how psychologically damaging that was to their ego and appearance. Many of them suffered from residual blemish scars on their face. So, the early thinking was, how can I make skin look better, feel better and restore it to its originality, like the baby skin we used to have?”

NEW ZO® Retinol + Blemish Complex

Advancing beyond other treatments on the market, the new Retinol + Blemish Complex is a revolutionary 360° topical that combines cutting-edge ingredient technologies to target every stage of blemish formation, plus its visible after effects.

It is a clinically comprehensive topical to help clear moderate and severe breakouts, help prevent future blemishes and improve the appearance of post-breakout marks and textural scarring.

Formulation

0.25% Microemulsion Retinol

Absorbs rapidly into the skin to offer potent comedolytic properties while improving the appearance of textural scarring.

1. Enhances cell turn over and improves exfoliation to help clear existing impactions and reduce future blemishes.

2. Inhibits the appearance of post-breakout marks and promotes even skin tone and texture.

3. Supports skin's healthy collagen and helps improve the appearance of textural scarring.

Encapsulated salicylic acid

Targets clogged pores and helps prevent future blemishes. Offers a slow release and controlled delivery to provide extended pore-clearing action for maximised benefits. Encapsulated salicylic acid allows the incompatible retinol and salicylic acid combination to live in the same formulation, profoundly improving moderate and severe blemishes for an effective blemish targeting solution.

Additional active ingredients

ZO-RRS2® provides soothing benefits while supporting skin’s resilience. This powerful formula helps clear moderate to severe breakouts, prevent future blemishes and improve the appearance of blemish scars, offering a holistic, tolerable solution for those seeking clear, healthy skin.

Learn more

Discover the science behind clear skin with ZO® Skin Health. We bring the science, you bring the work.

Product note: *Due to regulatory requirements the name and formulation may differ internationally. In the United States it is Retinol + Acne Complex. Across various international regions it is named Retinol + Blemish Complex. In Canada it is named Acne Complex.

A Summary of the Latest Clinical Studies

The latest research highlight from Professor Sebastian Cotofana and The Harley Academy Research Group

World-renowned anatomist Professor Sebastian Cotofana shares a key study influencing the world of medical aesthetics.

Title: Repositioning the Lower Eyelid after Facial Palsy with Facial Suspension Threads: A Retrospective Clinical Evaluation and Anatomical Study

Authors: Sulamanidze M, et al.

Published: Facial Plastic Surgery and Aesthetic Medicine, December 2024

Keywords: Facial Palsy, Lower Eyelid, Threads

Patients suffering from displacement of the lower eyelid following facial palsy, scar retraction or age-related loss of apposition have little-to-few options to receive appropriate care. The reason is not down to the lack of ideas on how to support the lower eyelid, but predominantly due to the consequences of the curative treatment itself. The currently accepted standard of care is a surgical intervention, but a surgery can leave scars, which in the long-term can retract and aggravate the problem even more. In addition, surgical interventions might influence the flexibility of the tissue which is needed for such high-mobile areas such as the lower eyelid.

Title: Autologous Fat Injection for Rhinoplasty: A Systematic Review of Satisfaction, Reinjection and Fat Retention

Authors: Zeng H, Tang S.

Published: Aesthetic Plastic Surgery, January 2025

Keywords: Autologous Fat, Fat Retention, Rhinoplasty

Abstract: Autologous fat injection has been proposed as a potential alternative to traditional rhinoplasty. However, the technique has been criticised for its disappointing retention and the potential complications associated with underfilling. A literature search was conducted on four databases using the keywords ‘rhinoplasty’, ‘nasal tip’, ‘nasal augmentation’, ‘augmentation rhinoplasty’, ‘revisional rhinoplasty’ and ‘nasal revision’ in conjunction with ‘fat’, ‘lipofilling’, ‘lipoinjection’ and ‘adipose graft’. 11 studies with a total of 849 patients were included in the systematic review, and all patients received at least one fat injection. In nine studies that evaluated patient satisfaction, a total of 820 patients exhibited a high satisfaction ranging from 63 to 100%. Complications associated with fat injection are uncommon, with oedema and bruising being the most frequently reported. Three studies measured fat retention, which were <50% (at six months after injection), 44.54% (at three months after injection) and 50.5% ± 7.0% (at six months after injection). A minimum of 18.61% of the 849 patients enrolled underwent one or more injections. At one-year follow-up, the reinjection rate is at least 19.27%. Therefore, autologous fat injection is safe and effective for rhinoplasty. The resorbability of fat requires additional injections in certain noses where deformities are evident.

A recent retrospective study published in the Facial Plastic Surgery and Aesthetic Medicine journal by Sulamanidze et al. from Georgia investigated the implantation of specifically designed facial suspension threads, termed here ‘spacers’. The lower eyelid spacers were implanted via a minimally invasive access and had the shape of two-dimensional coils or springs. They were implanted into the preseptal space, which has as its floor the orbital rim and as its roof the lower tarsal plate.

Due to their flexible nature, the spacers were able to elevate the lower eyelid, and due to the anchoring toward the medial and lateral canthal region, they were able to attach the lower eyelid back to the globe. This effect resulted in significant increase in the height and apposition of the lower eyelid. The patients investigated in this study were all affected by facial palsy, which resulted in weakening of the orbicularis oculi muscle; the latter muscle is crucial for maintaining a correct lower eyelid position. By implanting the lower eyelid spacer, these patients received relief from symptoms like dry-eye syndrome, or were again protected from corneal erosion.

This study is in line with another published by Hartstein et al. in April 2024 in the Journal of Plastic and Reconstructive Surgery, reporting on the benefits of volumising the preseptal space with soft tissue fillers. In their study, the authors used the identical scoring system and observed a significant improvement in lower eyelid height and apposition following filler injection.

Moving into the future, it seems that multiple minimally invasive options exist for treating lower eyelid disorders which are different from a standard surgical intervention.

Title: Risk of Blindness From Temple Filler Injections: Investigating Vascular Anastomoses Between the Deep Temporal and Ophthalmic Arteries

Authors: Sheth N, et al.

Published: Ophthalmic Plastic and Reconstructive Surgery, January 2025

Keywords: Blindness, Dermal Filler, Temples

Abstract: Although uncommon, dermal filler injections in the temples pose a risk of vision loss from embolic occlusion. Guidelines recommend injecting into the supraperiosteal plane for safety; however, the deep temporal arteries (DTAs) in this plane pose a risk. This study investigates potential pathways from the DTA to the ophthalmic artery (OA) and mechanisms of filler travel. Four anastomotic pathways between the DTA and OA were identified, displaying a combination of anterograde and retrograde flow. Case one shows direct DTA-lacrimal artery anastomosis. In cases two to four, the DTA is shown originating from the internal maxillary artery (IMAX) following its anatomical course. Retrograde flow from the DTA into the IMAX can then lead to anterograde flow into branches connecting to the IMAX including the superficial temporal artery, infraorbital artery and middle meningeal artery. These arteries then form collaterals with the OA. This study is the first to elucidate four potential routes for filler-induced OA occlusion originating from DTAs in the supraperiosteal plane. These pathways involve retrograde flow, a mechanism previously suggested for filler-induced occlusion. Notably, the likelihood of these pathways being traversed may be low due to their length and amount of filler volume required; however, it is not impossible.

Ethical BDD Management Strategies

Managing director of the BDD Foundation Kitty Newman offers strategies for the identification and management of BDD

Body dysmorphic disorder (BDD) is a mental health condition characterised by obsessive thoughts about very minor or unnoticeable ‘flaws’. It leads to repetitive behaviours such as mirror checking, reassurance seeking, excessive grooming, intrusive thought patterns, or seeking unnecessary aesthetic or cosmetic interventions. It can lead to avoidance of daily activities and functional impairment, severe levels of psychological distress, isolation and withdrawal. Common areas of fixation include features of the face, such as the skin, nose, eyes, teeth, chin and hair, although concerns can be about any body part.1

Given the common areas of concern, knowledge of the condition is particularly relevant within medical aesthetic treatment. This article will explore how medical aesthetic practitioners can identify and support patients with BDD while ensuring ethical and appropriate care.

Addressing BDD in aesthetics

BDD affects around 1.7% to 2.9% of the population, and recent systematic reviews estimate that around 12% to 19% of individuals seeking aesthetic and dermatological treatments may have symptoms of BDD, presenting significant challenges for aesthetic practitioners.2,3 Research drawn from global studies shows that 71% to 76% of BDD patients seek medical treatments, including surgical, dermatological or dental interventions, to address their perceived flaws.4 This high prevalence is partly due to the disorder’s nature – individuals with BDD often experience a lack of insight into their distorted perception, and are more likely to seek external physical solutions to relieve feelings of internal psychological distress.

Patients with BDD may show disproportionate anxiety over one or more features, fixation on ‘corrections’, a clear difference in perception between the patient and practitioner, or repeated dissatisfaction with previous procedures. These behaviours often stem from deep psychological distress, not ‘fixable’ cosmetic concerns.5

Aesthetic practitioners should be aware that no amount of physical change or intervention can address the underlying issues driving BDD, making identification of the condition crucial.

Unlike the temporary focus shift seen in ‘perception drift’, those with BDD experience a severe form of distorted perception, which occurs long before they even enter an aesthetic clinic.6 Perception drift in aesthetic treatments refers to the gradual shift in how individuals perceive their appearance or results over time, often as they adjust to the change in their image, and can lead to a desire for more treatments. However, research suggests that individuals with BDD experience distortions linked to altered visual processing, where the brain interprets physical features as ‘flawed’.7 It has been indicated that abnormal activity in brain regions responsible for visual processing can contribute to this unreliable self-image.7 This distorted perception is persistent, reinforcing the negative perception of self, distress and desire for repeated treatments.

Global studies show that 71% to 76% of BDD patients seek medical treatments to address their perceived flaws

Non-surgical aesthetic procedures are not recommended to those with BDD as they fail to address the underlying psychological causes of the condition, and pose significant risks of further psychological harm.8,9 Research on dermatology patients with BDD indicates that they are often dissatisfied with, and have a poor response to, dermatology treatments.10

General good practice is having open and honest communication to manage any patient’s expectations

In addition, clinical observations indicate that appearance preoccupations may shift to other body areas following cosmetic treatments.10 In some patients, BDD symptoms may become more severe after such procedures.10 A study showed that patients with BDD often remain dissatisfied with cosmetic treatments, even when those treatments are technically successful.11

Research consistently demonstrates that aesthetic interventions are highly unlikely to alleviate the long-standing preoccupations and distorted perceptions central to BDD.12 Instead, these procedures can exacerbate an ongoing, harmful cycle of treatment seeking, further perpetuating the disorder. In extreme cases, this leads to severe emotional implications to the patient, including heightened suicidal ideation or attempts, as well as potential conflicts with practitioners due to unmet expectations or worsened symptoms.13 Here, we outline strategies for effectively approaching and managing patients with BDD.

Actionable steps

Integrating tools in consultation

Training staff to recognise BDD and identify key warning signs such as excessive preoccupation, frequent dissatisfaction with cosmetic results, an overly critical perception of self or unrealistic expectations is important for an effective patient assessment.14

By understanding the psychological factors that underpin BDD, practitioners can better differentiate between realistic concerns and those stemming from distorted body image. The use of screening tools can help identify potential BDD cases early in the consultation process. The Cosmetic Procedure Screening Scale (COPS) or Appearance Anxiety Inventory (AAI) are widely used options that ask specific questions to reveal signs of distress related to appearance.15,16 This screening process should go beyond just identifying BDD and should include an assessment of patient expectations, goals for change, motivations, choice of timing and understanding of the procedure.

Screening helps identify possible unrealistic

expectations, unhealthy motivations (potentially linked to BDD) and whether patients are fully informed about the risks and benefits. Screening ensures ethical and patient-centred care, as without asking direct questions, it is highly likely that vulnerable patients will be overlooked.

Referral protocols

If BDD is suspected in a patient, practitioners should decline aesthetic treatment and refer them to a qualified mental health professional for further evaluation and treatment. The recommended and evidence-based treatment for BDD is cognitive behavioural therapy (CBT) and/or selective serotonin reuptake inhibitors (SSRI).17,18 Referrals can be made to private CBT therapists, psychologists or psychiatrists who specialise in BDD, ensuring that the patient receives the appropriate care.

Alternatively, access to stepped care within the NHS should be available to address the needs of individuals who have had an unsuccessful treatment or are deemed unsuitable following screening.19

Practitioners can also refer to the BDD Foundation, who offer a range of support services including an e-helpline, support groups, educational resources and a structured recovery programme.20

Most importantly, patients need to be approached compassionately and without blame. Clinics can help prevent tragic outcomes by collaborating with mental health professionals to offer tailored support and education on the potential psychological impact of cosmetic changes. This will vary because what is feasible will differ per clinician, so what services they provide is based on their own initiative. However, the collaboration could encompass training for themselves or their staff, as well as establishing and refining referral pathways.

General good practice is having open and honest communication to manage any patient’s expectations. A transparent discussion about the realistic outcomes, potential risks and benefits of proposed treatment can help set appropriate expectations, reducing the likelihood of disappointment or harm. However, if

screening indicates your patient has BDD, the safest option is to refer or signpost them to psychological support.

Legal considerations

Addressing BDD in aesthetic practices is necessary to be able to safeguard both patients and practitioners. When BDD is identified, ethical practices such as refusing to proceed with treatments, referring patients for mental health support and ensuring informed consent are important to minimise legal risks.

By documenting all decisions, such as screening outcomes or refusal of treatments, practitioners demonstrate a commitment to patient welfare. Such precautions reduce the likelihood of malpractice claims and legal disputes.

Another significant legal and ethical concern for individuals with BDD seeking aesthetic treatments is the increased risk of suicidality. Research shows that rates of suicidal thoughts and attempts are notably high in people with BDD, and in some cases, dissatisfaction with aesthetic procedures can exacerbate these feelings.21,22 In extreme cases, loss of life is a significant risk, and recently led to a prevention of future death report being issued to an aesthetic clinic.23

Practitioners who act ethically and prioritise patient mental health build trust and credibility within the specialty. This not only benefits patients and prevents harmful outcomes, but also increases the likelihood of long-term professional security.

Ethical considerations to BDD management

BDD presents unique challenges in the field of medical aesthetics, requiring a comprehensive understanding of the condition, proactive management strategies and a commitment to patient wellbeing as a priority. By recognising the signs of BDD, using screening tools and focusing on collaborative care with mental health professionals, practitioners can ensure ethical treatment while safeguarding patients both with and without BDD.

Kitty Newman is managing director of the BDD Foundation. As a mental health campaigner, she became a trustee of the charity in 2017 and an employee the following year. Wallace is a qualified psychotherapist, with a MSc in Integrative Psychotherapy from the University of East London (UEL). Her research focused on integrative therapy for BDD.

Qual: MSc

Supporting National Healthcare Systems

Dr Sophie Shotter outlines collaboration efforts with the NHS to establish partnerships aimed at enhancing public health services

In the UK, most healthcare is state funded by the National Health Service (NHS). This means that patients largely receive medical appointments and treatment free of charge, with cost being covered by general taxation.1

Most aesthetic procedures are not typically covered by the NHS.2 Yet, when complications arise following procedures, many patients turn to the NHS for support.3 Several factors may contribute to this, including patients not realising that their aesthetic practitioner can and should be able to help, they cannot get hold of their treating practitioner, they have been turned away as the practitioner does not know how to manage the complication, or the patient has simply lost trust in the practitioner’s abilities.

This article examines how collaboration with the NHS and public health services globally can enhance patient care in medical aesthetics.

Current landscape

The NHS is currently operating under significant strain, with workforce shortages and high patient demand impacting its capacity to manage additional complications arising from aesthetic procedures. NHS practices and hospitals do not routinely stock the equipment necessary to deal with certain complications.

As of June 2024, the NHS reported a vacancy rate of 7.7%, indicating substantial staffing shortages across various departments. The waiting list for hospital treatment rose to a record of 7.7 million in September 2023.4

While there aren’t exact numbers of those experiencing aesthetic complications going to the NHS, there is an idea of the scale of the problem based on statistics from the British College of Aesthetic Medicine (BCAM). The organisation’s annual review identified that 82% of its members (331 doctors and dentists) had treated complications following treatment performed by other practitioners in 2022, with 3,323 complications reported in total.5 Of course, these statistics do not include complications handled privately by non-BCAM members or those seeking help from the NHS.

Unfortunately, with a lack of regulation on who can carry out procedures and no minimum training requirements in the UK, complications will continue to occur, and patients will continue to turn to the NHS for support.6

This problem will only continue to grow, as procedures were predicted to grow globally by 14.3% year on year from 2020 to 2025, based on the Global Aesthetics Market Research Study: XIX.7 Given this growth, it’s inevitable that NHS staff will see more and more complications, regardless of whether it’s appropriate for them to do so or not.

Reducing the strain on the NHS

Creating referral pathways

Medical professionals in the UK do not receive any education in aesthetics when they are training to be a doctor, nurse or dentist, so through no fault of their own, are unlikely to even recognise the treatments offered, let alone how to manage an associated complication.

Challenging the stigma

The aesthetics community should start by aiming to change the negative perception around aesthetics, emphasising that doing so may enable more NHS and public health staff to understand why people seek treatment and have more empathy when things go wrong.

As NHS clinicians, we regularly make decisions that involve risk. For instance, would we refuse to treat someone injured during a bungee jump or a sports game? Patients seeking aesthetic treatments are no different – they are individuals striving for positive change, often feeling vulnerable and in need of support rather than judgement.

In 2023, I organised a free, accredited training day alongside a respected faculty of aesthetic practitioners, dermatologists and plastic surgeons. The course educated NHS colleagues on the range of treatments available, the substances used, how to recognise complications, and – crucially –why patients pursue aesthetic treatments in the first place. A particular emphasis was placed on empathy and understanding, through educating attendees about the types of patient we see in clinic and what their motivations are. These motivations are very rarely vanity based, and tend to have deeper psychological roots.

Promoting the event and securing NHS participation was challenging, highlighting the need to raise awareness of risks and responsibilities in advance.

Many clinicians may simply refuse to see a patient if they present to a GP or Accident & Emergency (A&E) with an aesthetic complication, while others may refer to the dermatology or plastic surgery departments with the hope that someone there may be able to help.

Patients turning to the NHS for support may be met with negativity from staff. Some record aesthetic complications as ‘self-inflicted’ problems and place a lot of judgement on those who choose to have treatment.8

Medical professionals can enhance patient care and professional collaboration by establishing referral pathways with their local A&E departments. Reaching out to initiate discussions and potentially organising local training sessions can build stronger ties and preparedness for handling complications.

For their own professional development, practitioners are encouraged to connect with other local, experienced aesthetic practitioners. Establishing a network where they can seek advice or refer challenging cases ensures better patient outcomes while fostering mutual support within the medical community.

Training in aesthetics could be effectively integrated into existing medical disciplines such as dermatology, plastic surgery, general practice or emergency medicine. While extensive modules may not be necessary, a basic curriculum could cover essential aspects of aesthetics. These include an overview of the field, common treatments and the risks associated with these procedures that medical professionals might encounter in NHS practices.

Structured training programmes, such as those offered by organisations like the Allergan Medical Institute or the International Society of Aesthetic Plastic Surgery (ISAPS), also play a crucial role in advancing clinical excellence. These programmes provide medical practitioners with opportunities to stay informed about the latest treatments, refine technical skills and learn from their peers’ experiences, ultimately improving patient outcomes.

Aesthetic practitioners must also take full responsibility for managing potential complications. Staying updated with the latest research and guidelines is essential for positioning oneself as a safe, ethical and trusted aesthetic practitioner. This can be achieved through attending relevant conferences, including dedicated complications training courses, as well as reading journals and medical literature. A proactive approach of training in complication prevention and management is critical, rather than waiting until issues arise. By embedding this foundational knowledge within standard medical education, healthcare providers can be better prepared to recognise and manage complications arising from aesthetic procedures. This proactive approach would enhance patient care, reduce reliance on the NHS for such issues and contribute to a more informed and empathetic healthcare system.

Working collaboratively

Ethical healthcare professionals in aesthetics have a social responsibility to protect patients from harm and maintain high standards within their specialty. Achieving this starts with ensuring that all aesthetic practitioners have a solid foundation of medical or nursing experience before entering the field of aesthetics. This responsibility aligns with the General Medical Council’s (GMC) guidance to 'make the care of your patient your first concern'. Additionally, the GMC’s Good Medical Practice underscores the principle of 'do no harm', a cornerstone of ethical medical care.9 From an ethical standpoint, the responsibility should always lie with the treating practitioner. Organisations such as Aesthetic Complications Expert (ACE) Group World practice standards state that practitioners should encourage patients to return to the original treating practitioner for management.10 While working independently is valuable, a collaborative approach is essential. Supporting bodies like ACE Group World and the Complications in Medical

Aesthetics Collaborative (CMAC) is crucial as they exist to research management of adverse events and educate practitioners.

Through their prevention and management protocols, both these organisations now have a global reach, enabling those in other countries to contribute and learn too. Becoming members of these organisations not only supports us as individual practitioners, but helps fund further research and educational events to benefit the sector as a whole.

With the specialty projected to grow and UK regulation still pending, there is a likelihood of increased complications, potentially placing additional strain on healthcare systems like the NHS. Bodies like the Joint Council for Cosmetic Practitioners (JCCP), British Association of Medical Aesthetic Nurses (BAMAN) and BCAM are campaigning for tighter regulation. Practitioners can work closely with these organisations by engaging in activities such as participating in consultation processes for regulatory frameworks, attending advocacy events or conferences, contributing to professional guidelines and promoting awareness about the importance of regulation within their networks.11-13

Clear communication with patients is equally vital. Practitioners should inform patients about the risks of treatments, outline complication prevention and management strategies and provide emergency contact details. This transparency reassures patients and reduces unnecessary reliance on public health services.

While some experienced practitioners may volunteer their time to manage complications, not all can or should feel obligated to do so, given the skills, time and liability involved. A collaborative approach within the local medical community can help fill this gap. Practitioners can organise local education days, fostering knowledge-sharing and establishing referral pathways. By doing so, more patients benefit from better-informed care.

A global strategy

Experiencing complications is an inherent aspect of the aesthetics specialty, requiring practitioners to prioritise patient safety and take proactive measures to mitigate risks.

This challenge is not confined to the UK; healthcare systems worldwide encounter their own issues related to aesthetic complications. By pooling resources and collaborating across the specialty, practitioners can work toward improving education and raising standards for the prevention and management of complications on a global scale.

Dr Sophie Shotter is the founder and medical director of Illuminate Skin Clinic in Kent and Harley Street, London. She completed her five-year medical degree at Leeds University, qualifying in 2008, and an additional Bachelor of Science (BSc) in Genetics in Relation to Medicine. Dr Shotter works closely with Allergan Aesthetics as part of their AMI Faculty and Complications Expert Panel.

Qual: MBChB, BSc (Hons), PGDip, PGCert, MBCAM

Dr Sophie Shotter will be speaking on behalf of BCAM in the Association Zone, and AestheticSource in the Aesthetics Mastery Theatre at ACE 2025.

Turn to p.32 to register free now.

Going Paperless in Your Clinic

Software specialist Max Hayward shares the benefits of digitising your clinic documentation

Whether you are just starting out or running a busy clinic, your paperwork quickly starts to pile up. Keeping track of documentation such as questionnaires, consent forms, treatment notes and patient photos can rapidly add pressure to your daily routines.

Professional bodies including the General Medical Council (GMC), General Dental Council (GDC), General Pharmaceutical Council (GPhC) and Nursing & Midwifery Council (NMC) state that patient records must always be stored securely.1,2

Section 119 of the GMC’s code states that practitioners must make sure any personal information about their patients being held or controlled is effectively protected at all times against improper access, disclosure or loss.3

Going ‘paperless’ refers to the practice of using digital systems and electronic documents instead of physical paper for storing, managing and sharing information. This can be more secure than physical paper records because paperless systems can offer encrypted storage, access controls and regular backups, reducing the risk of unauthorised access, loss or damage to patient information.

So, should you be opting for paperless methods in 2025? This article will evaluate

the benefits that clinic software can bring to your business, as well as the factors to consider before taking the plunge.

Features of a paperless approach

A paperless system can support you with various aspects of clinic management, including patient records such as consent forms, medical history, treatment notes and aftercare instructions. It can also manage appointment scheduling, reminders and payments. Additionally, such systems can digitise stock management and include detailed reporting and analytics, enhancing overall clinic efficiency and organisation.

Potential benefits

Compliance

Paperless clinics can take advantage of enhanced data security and privacy measures if data is protected appropriately. Paper records can be easily misplaced or fall into the wrong hands, potentially causing confidentiality breaches which can lead to fines of up to £17.5 million or 4% of your annual worldwide turnover, whichever is higher.4 By transitioning to secure digital systems, you can rest assured that your patients’ sensitive information is protected, promoting trust and confidence among your clientele.

Section 10 of the NMC Code states you must complete all records accurately and without any falsification, and must attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed.5 By using a paperless system that is designed specifically for medical aesthetics, you should have features that automatically date and time stamp your notes, and help you to ensure consistent and thorough note-taking.

Utilising a trustworthy cloud-based software ensures peace of mind that your patient data is secure, preventing unauthorised access to your records. A reliable software typically includes robust encryption, up-to-date security measures like transport layer security (TLS),6 compliance with data protection regulations and dependable customer support. However, even with excellent software, practitioners must also take precautions to ensure data security. This includes using strong, unique passwords and regularly updating them. Additionally, practitioners should ensure that all devices accessing patient records are secure, have up-to-date antivirus protection and are only used on trusted networks. By combining a secure software solution with mindful practices, practitioners can significantly reduce the risk of unauthorised access or data loss.

As medical professionals, your duties do not stop at data protection. You also have a number of record-keeping responsibilities to ensure that every step of your treatments is documented. Insurance provider Hamilton Fraser says that proper documentation is crucial when it comes to protecting yourself against insurance claims, including:8

1. Adverse reactions/complications: Claims may arise from issues like excessive swelling, bruising or infection. Practitioners may have to provide detailed treatment notes, photos, and proof that aftercare instructions were given.

2. Unsatisfactory results: If outcomes don't meet patient expectations, crucial documentation includes consent forms (confirming discussion of realistic expectations), treatment plans and before-and-after photos.

3. Negligence claims: Allegations may involve improper technique, lack of informed consent or failure to follow guidelines. Defending such claims often requires presenting training certificates, adherence to manufacturer protocols and thorough treatment documentation.

Efficiency

Going paperless presents an opportunity to leave behind the paper chaos that has burdened countless clinics for years. Keeping digital records allows you to store all your forms, notes and patient records in a tidy and accessible format, allowing you to retrieve data swiftly when needed. Any existing paper records that you hold should either continue to be stored securely i.e. in a locked filing cabinet, or digitised by scanning onto your computer and saving as a PDF. You can then upload copies into your software as a PDF or image file. Those tedious hours spent manually filling out paperwork and making sure it’s all legible is eliminated, saving you more time. Integrating automation for diary bookings is like having your own personal assistant. With online booking systems in place, you can streamline your booking process and fill up your calendar. These smart tools can send appointment reminders to your patients and allows them to book and rearrange appointments themselves, reducing no-shows and keeping your schedule running like clockwork. Your patients will appreciate the seamless experience and you will have more time to focus on your passion for delivering an excellent service.

Business growth

With a more sophisticated paperless setup, you can gain access to real-time data and analytics that provide invaluable insights into your business. From tracking key performance indicators (KPIs) such as how many new patients you’ve had and what your patient retention rate is, to identifying popular treatments and patient preferences, data-driven decision-making becomes simpler.

Not all software will provide insights and reporting, however, as some systems will simply provide an online booking platform or digital consent forms. Without having a comprehensive system that gives you this information at the touch of a button, you will either spend hours working out spreadsheets manually, or simply run your business with limited understanding of how it is performing. If you want to adopt a basic software, you have to keep this in mind. More advanced insights allow you to make informed decisions about the services you offer, allocate resources wisely and implement targeted marketing strategies, fostering business growth and boosting your clinic's success.

Patient experience

Going paperless opens exciting opportunities to provide a more personalised and memorable patient experience. With digital records, you can

easily access past treatment details, notes and before and after photos, allowing you to tailor each patient’s plan based on their specific needs. It can also be helpful during appointments when reviewing patient progress by creating comparisons of before and after photos.

Personalised follow-up messages and automated aftercare advice demonstrate your commitment to providing care to your patients even after they’ve left your clinic. Keeping in touch with your patients before and after their treatment helps foster long-term loyalty and positive word-of-mouth referrals.

Automated email and SMS messages also enable you to send timely reminders, special offers and personalised communications, nurturing a warm and trusted relationship that keeps patients coming back for more. It’s important to remember there will always be a need for direct communications with your patients at times to avoid your care feeling robotic. In those cases, having a system that allows you to send individual messages to your patients, with a log of the communication sent, is very helpful.

Environmental factors

Embracing a paperless system demonstrates your clinic’s commitment to contributing to a greener and more sustainable planet and being more environmentally conscious. Clinics can be rife with paper waste, so adopting digital systems will help reduce this by ensuring all your documentation is stored securely within a cloud-based software. You can also reduce your carbon footprint by ensuring any devices are switched off while you’re not working; even locking the screen of your phone or tablet can save energy in between uses.7

Considerations

Going paperless in aesthetic clinics offers significant benefits, but it also presents potential challenges that clinics must address. Cybersecurity is a major concern, with risks of hacking and data breaches requiring robust protection measures like encryption, firewalls on your device and regular updates. Unforeseen technical problems, such as software glitches or downtime, can disrupt operations, making it essential that your software provider has reliable technical support and backup systems.

It is also worth considering that when your processes are paper-based, there is an increased risk of patients getting sight of other patients’ data, whether that’s glancing at your appointment book or patient notes. Clinics must have approaches in place to ensure data remains secure. Compliance with General Data Protection Regulation (GDPR) is also critical, ensuring patient data is handled securely and in line with privacy regulations.9

Cost is another consideration, as the transition to a paperless system involves expenses for new software and devices. Some providers also charge for staff training. Software costs vary by provider and can depend on features, business size and add-ons like premium features or support services. Starting prices range from free to £300+ per month, so it’s important to find a solution that fits your budget and your needs. Most companies offer free trials and will give support to make the right choice. Clinics should carefully evaluate these factors, balancing the initial investment against the long-term benefits to ensure a smooth and secure transition to a paperless way of working.

Fuelling progress in your clinic

If you are still running a paper-based clinic or have manual processes that you wish could be streamlined, transitioning to a paperless system could be transformative for your medical aesthetic clinic. Implementing clinic management software can support you in streamlining operations, protecting patient data and delivering a more personalised and efficient service. If the correct software is chosen and used optimally, you will have all the tools you need to power your clinic and make informed decisions that drive your business forward.

Disclosure: Max Hayward is co-founder of clinic management software company Aesthetic Nurse Software (ANS)

Max Hayward, co-founder of Aesthetic Nurse Software (ANS), has over six years’ experience supporting medical practitioners in the aesthetics specialty to streamline their business.

Aesthetic Nurse Software will be exhibiting at ACE 2025. Turn to p.32 to register free now.

In The Life Of: Dr Steven Cohen

Dr Steven Cohen shares how he operates his clinical practice while advancing innovations in regenerative medicine

A typical working day…

As I’ve grown older, I’ve adjusted my routine and wake up slightly later than I used to, around 5:30am. After brushing my teeth and taking my vitamins, I head to the gym which I visit about four times a week. My workouts typically begin with cardio, followed by weightlifting resistance. I particularly enjoy high-intensity, dynamic exercises like burpees and box jumps. After my morning workout, I head home, get ready and meet with friends for breakfast. Our mornings together often feel like a coffee shop talk show!

I allow 15 minutes to drive to work, ensuring I arrive at the FACES+ clinic by 8am. On Monday mornings, our team have a meeting to discuss the week ahead, centring around the question, ‘How are we going to delight our patients this week?’

We have a particular structure in the clinic, with Mondays and Wednesdays dedicated to clinic days. On a busier day, we can see 60 to 70 patients through the door, ranging from aftercare visits to new consultations. Most of the procedures, such as injectables and laser treatments, are performed by our nurses or physician assistants. On Tuesdays, Thursdays and Fridays, I am operating all day, starting from 8:30am. This structure allows me to ease into the week, without heading straight into the operating room after the weekend.

I enjoy performing facelifts as I find them to be a really fun challenge. They’re incredibly artistic procedures that require both precision and creativity, along with a sense of pressure, as most patients don’t want to look drastically different, they simply want to enhance their appearance.

My background is in complex craniofacial surgery; I used to manage children’s hospital programmes and handled a wide variety of bone-related procedures. I love working with the face because I have no real restrictions on either diagnosis or treatment. It allows room for innovation, which makes the work truly enjoyable!

While there are moments when I need to step away and take a five-minute break, my passion for the job helps me maintain balance and stay grounded. I make it a point to have lunch every day, usually opting for healthy options like lentil soup or tuna salad. Occasionally, I’ll treat myself to a turkey sandwich.

I aim to finish work at 5pm at the latest, and on clinic days I try to wrap up earlier. My wife and I usually dine out around four times a week for dinner, occasionally with friends and other times just the two of us. Unlike New York and London, the cities that never sleep, California offers a stark contrast, as residents start and end their days earlier. I find that this lifestyle suits me.

I consider art my main hobby and enjoy expressing myself artistically. In the clinic I love re-painting people’s faces, but at home it shifts to painting on canvas. I need to be in the right mood to start but I usually paint five days a week, sometimes every day. I also hike regularly in La Jolla, taking full advantage of California's beautiful environment.

I usually read before bed, and right now I’m immersed in Klara and the Sun by Kazuo Ishiguro. It’s an incredible read about how artificial intelligence has shaped society.

In The Life Of

Dr Steven Cohen

Other work commitments…

Outside of the clinic, I provide biomedical consulting services globally, and I have co-founded various companies.

In 2000, I helped set up LeonardoMD, a software company specialising in electronic medical records and practice management. I led the company for five years, and it was successfully sold to Azalea Health in 2015. I am the co-founder of the London Regenerative Institute with Dr Tunc Tiryaki, who practises in London. This started in 2006, as we explored the potential of regenerative therapies using fat-derived stem cells. With clinics worldwide and a base at Corinthia London, the institute aims to merge contemporary medicine with personalised treatment to prevent ageing.

Dr Tiryaki and I also co-founded a company called The Mage Group, advancing longevity and regenerative medicine through innovative technologies. We have developed several products, including Lipocube, our precision fat grafting solution, which has been used by more than 200,000 patients and is available in more than 90 countries. Another recognised product is the Morphiya product line, featuring bio-engineered exosomes in a range of serums and creams.

Most memorable day in your career…

One of the most memorable days in my career was when I got accepted into medical school. I always felt like an outcast from my other classmates because I struggled with my grades. However, my writing allowed me to stand out from the crowd, and I was the first pupil to get accepted into medical school out of my entire graduating class, who were very competitive. They were all looking at me as if to say, ‘You got in, and we didn’t?’

What is the best advice you’ve received?

Count to 10 before you open your mouth.

What is your dream holiday destination?

It would have to be France because of its charm!

What is one thing that makes you happy?

I feel most fulfilled when expressing myself artistically, whether it’s during surgery, building a business or illustrating a painting.

Reducing Patient Risk in Scotland

Scottish Medical Aesthetics Safety Group representatives Jacqueline Cooney and James Cooney argue that proposed Scottish aesthetics regulation is not strong enough

In 2013, Sir Bruce Keogh published the lengthy Review of the Regulation of Cosmetic Interventions report, advocating for improvement in the regulation of cosmetic procedures in the UK.1 However, what followed was a twelve-year window of opportunity sustaining the exponential growth of non-medical members of the public injecting prescription-only medicines (POMs), dermal fillers and other unknown imported substances purchased online. In the past year, there has been some urgency towards stricter regulation in this sector, with new legislation promised by Spring.2 However, as representatives of the Scottish Medical Aesthetics Safety Group (SMASG), we argue that the aesthetics licensing scheme proposed by the Scottish Government contains serious flaws and risks.3

The proposed regulation

Like the UK's proposed red, amber and green treatment classification system,4 the Scottish Government's proposal has group options 1, 2 and 3, which delineate treatments by risk into defined categories.2 Under group 2, non-medical practitioners can deliver botulinum toxin and dermal filler treatments of up to 2ml in one site at one time within Healthcare Improvement Scotland (HIS) regulated clinics under the 'clinical oversight' of a healthcare professional (HCP).2 In our view, this might endanger the public, as we believe individuals carrying out injectable treatments without medical knowledge poses a significant risk of complications. Under the premise of clinical oversight, the proposal states that non-medical practitioners would be ‘supervised’ by an appropriate HCP on site.2 They should be responsible for patients’ initial consultations, prescribing any POMs and providing immediate support to intervene in the event of any complications.2

However, we see this as an opportunity for unscrupulous HCPs to wilfully abuse their qualifications in order to facilitate this potentially unsafe practice, prioritising profit over medical responsibility.

The potential problems with this proposal

Non-medics injecting

The muscular and arterial anatomy of the face is incredibly complex, and it can only be fully conceptualised and understood by medical professionals with anatomical training. We argue that this means non-medical injectors cannot be adequately trained to administer injectables. The Government’s proposal seems to try and maintain patient safety by restricting filler delivery to 2ml per area in one session, but a 2017 study by Khan T et al. found that the average entire volume of the supratrochlear artery from the glabellar to the orbital apex is only 0.085ml, meaning that much less than 2ml is needed to cause a significant adverse event.6

Ultimately, we argue that the Scottish Government is blurring the lines between ‘medical’ and ‘cosmetic’, consequently trivialising the potential safety risks involved. Whenever treatments involve injection of a substance under the skin that could possibly cause adverse events, this should be classed as medical in our view.

Clinical oversight

Under the proposal for clinical oversight, it’s our view that non-medical injectors could continue without supervision, potentially endangering the public. Anyone can register an HIS clinic in Scotland; after clearing background checks, you only need a prescribing HCP as the primary contact.5 Once registered, one potential eventuality is that disreputable clinic owners will be able to state that their prescribing HCP has reduced their hours and will only be in on certain days, with no injectable treatments being delivered on the other days. They will be without significant risk of being discovered, as HIS inspections only occur on average in Scotland every three years. In our view, this shows that clinical oversight would not work. Furthermore, if prescribing HCPs are found to be facilitating dangerous practice such as this, we see a risk that they could be investigated and struck off their professional

register, meaning they can no longer benefit wider society through working in the NHS. This would result in the NHS losing a practitioner, but such individuals still being able to work as a non-medical aesthetic injector, meaning aesthetic patients are no safer than before.

In other cases, due to some non-medics’ lack of access to a prescribing practitioner, the extensive financial costs and compliance of setting up a new HIS-regulated clinic, we foresee that many non-medical injectors could potentially move from beauty salons and hairdressers to residential homes, further out of reach of HIS and Environmental Health enforcement. Of course, this could still happen in any eventuality where non-medics are allowed to continue providing injectable treatments, therefore we do not believe they should be permitted to do so under any circumstance.

Protecting the public

The SMASG, consisting of 300 doctors and HCPs in Scotland, demands that the Scottish Government protect patients, HCPs, the NHS and HIS clinical settings by removing all non-medical injectors and clinical oversight from group 2. The British Association of Medical Aesthetic Nurses also holds this view.

The only option to ensure patient safety and preserve the future integrity of our healthcare service in Scotland is to wipe 'clinical oversight' and non-medical injecting off the table.

The Scottish Government’s public consultation on its proposed regulation closes on February 14, and responses are open to anyone living in the UK. Head to www.gov.scot to submit your response.

Jacqueline Cooney is an NMC-registered independent nurse prescriber, owner of HIS-regulated Beautiform Medical Aesthetics Clinic located in South Glasgow and director of the Scottish Medical Aesthetics Safety Group. Qual: BSc Nursing Studies, NIP

James Cooney has dedicated 30 years to the civil service, specialising in social conditioning, communications, quality assurance and risk assessment. He is also a certified web applications developer and co-director of Beautiform Medical Aesthetics Clinic.

Designed for smooth, plump and natural looking lips1-5 8*

Up to 12 months of optimal performance with 20% less product needed than Juvéderm® Volbella5,6 Provides balanced volume and high flexibility6,7 High patient and partner satisfaction5,7

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Imagery is of actual Restylane patient. For Healthcare Professionals Only

*Based on a Global Lip Filler survey8 1. Galderma. Data on File. MA-43049. 2. Öhrlund Å. J Cosmet Dermatol Sci Applic. 2018; 8(2): 47. 3. Bertucci V et al. J Drugs Dermatol 2021; 20: 402-408. 4. Restylane® Kysse EU IFU. 5. Hilton S et al. Dermatol Surg 2018; 44(2): 261-269. 6. Weiss R et al. Dermatol Surg. 2021;47(4):527–32. 7. Bertucci V et al. J Cosmet Dermatol 2021; 20(5): 1499-1504. 8. InCrowd Lip Filler Survey 2024 GB-RES-2500001 DOP January 2025

Adverse events should be reported. For the UK, Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for Yellow Card in the Google Play or Apple App Store. For Ireland, Suspected adverse events can be reported via HPRA Pharmacovigilance, Website: www.hpra.ie; Adverse events should also be reported to Galderma (UK) Ltd, Email: medinfo.uk@galderma.com Tel: +44 (0) 300 3035674 FOR T H E LIPS No. CHOICE INJECTORS