August 2026: Injectables

INJECTABLES August 2026 | VOLUME 14 - ISSUE 9

Your trusted voice in the aesthetics specialty

Re-Awaken Skin from Within.

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f el s e . ur t u f your

* Models are actual RADIESSE® patients M-RAD-UKI-0646 Date of Preparation July 2026

CPD: Managing Dermal Filler Complications Miss Jenny Doyle and Dr Arshi Baig explore dermal filler complications

Special Feature: Mastering Precision Injectables in the Periorbital Zone Combining Biostimulators and Skin Boosters for GLP-1 Patients

ALSO IN THIS ISSUE

Dr Olivia McCabe-Robinson examines injectable amino acid formulations Thomas Terranova outlines how accreditation drives growth

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Editor’s letter Injectables remain the bread and butter of medical aesthetics. They are the treatments that have shaped the sector, continue to drive patient demand, and require practitioners to balance technical expertise with sound clinical judgement every day.

In this August issue, we put injectables firmly in focus. As treatments advance and patient expectations continue to rise, staying informed on both technique and complication management is essential. That is why this issue includes a valuable CPD article on dermal filler complications, offering key insights into prevention, early recognition and appropriate management.

Holly Carver Editor & Content Manager

We also present a Special Feature on mastering dermal filler in the periorbital zone – an area that demands particular care, anatomical understanding and a conservative approach.

Our News Special covers a new governance framework giving eligible aesthetic practitioners access to emergency medicines during urgent

complications. It addresses a long-standing issue for non-doctor clinicians, including nurses, who can treat complications but cannot legally hold emergency stock on their own. Read more on p.15.

Elsewhere in the issue, we look ahead to the Clinical Cosmetic Regenerative Congress (CCR) 2026, taking place on October 1–2, with a preview of the overall agenda and a closer look at the programme through the lens of delegates’ differing ambitions. Whether your focus is clinical excellence, business growth or professional development, CCR promises something for every stage of your career – so be sure to register via p.17 if you haven’t already.

We are also pleased to announce the return of the Aesthetics Awards, which opens for entries on August 10. If you are considering entering, do not miss our event spotlight on p.10, where last year’s Winner of Medical Practitioner of the Year shares practical advice and insight on making your submission stand out.

With exciting months ahead, we cannot wait to come together with you all soon. Until then, do get involved, stay in touch and share your thoughts with us.

Clinical Advisory Board

Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content

Sharon Bennett is the former chair of the British Association of Medical Aesthetic Nurses (BAMAN), UK lead of the BSI committee for aesthetic non-surgical standards and member of the Clinical Advisory Group for the JCCP. She is a trainer and a registered university mentor in cosmetic medical practice, and is finishing her MSc at Northumbria University. Bennett has won the Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.

If you are interested in contributing to the journal, get in touch...

Email: editorial@aestheticsjournal.com

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.

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.

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.

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.

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 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.

Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience.

He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

Dr 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.

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.

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Contents • August 2026 06 News The latest product and specialty news

15 News Special: New Framework to Address Access to Emergency POMs Aesthetics explores a new framework for treating complications

CLINICAL PRACTICE 16 Event Preview: Shape Your Future Decide your next step at CCR 2026

19 Special Feature: Mastering Precision Injectables in the Periorbital Zone Practitioners discuss dermal fillers for treatment of the periorbital area

News Special: New Framework to Address Access to Emergency POM’s Page 15

23 PROFHILO® STRUCTURA™ Understanding Facial Changes Associated with Weight Loss: Looking Beyond the Skin

25 CPD: Managing Dermal Filler Complications Miss Jenny Doyle and Dr Arshi Baig explore dermal filler complications

32 Platelet-Rich Plasma in the Periocular Area Dr Bhavik Shah and Dr Munir Somji discuss PRP in the periocular area

36 Addressing Menopausal Patients with Injectables Dr Oscar Redman outlines PLLA with HA dermal fillers for menopause

40 Exploring Injectable Amino Acid Therapy Dr Olivia McCabe-Robinson examines injectable amino acid formulations

43 Summer Skin Glow - The Dual-Action Path to Radiant Skin Sculptra® and Restylane® SkinboostersTM can help patients achieve summer skin

44 Combining Biostimulators and Skin Boosters Dr Catherine Denning considers PLLA with HA skin boosters for weight-loss side effects

46 Restoring Facial Volume Following GLP-1–Associated Weight Loss Dr Ben Taylor Davies presents a combined Belotero® and Radiesse® approach The latest research highlights from Professor Sebastian Cotofana

the NHS as an oculoplastics consultant at Milton Keynes University Hospital NHS Trust.

Dr Arshi Baig is a resident doctor who has a keen interest in oculoplastic surgery and medical aesthetics and has undertaken a fellowship in this field at The Clinic at Holland Park. In August 2026, Dr Bhavik Shah holds a bachelor’s degree in dentistry and a masters in cosmetic and aesthetic medicine. He has undertaken a

Dr Munir Somji is a cosmetic surgeon and co-founder of

Veronica Donnelly discusses financial control and protection

52 Supporting Clinic Growth Using Accreditation Thomas Terranova outlines how accreditation drives growth

the DrMediSpa clinic group and Dr Somji Pro-Active Skincare. He is a KOL and educator having lectured at King’s College London and global specialty conferences including CCR 2025.

Dr Oscar Redman is a radiologist and aesthetic practitioner; clinic director of the Newcastle based, Dr Redman Aesthetics. Dr

54 Understanding CRM in Aesthetic Practices Jared Rohrer explores customer relationship management systems

57 In The Life Of: Dr Alison Colville Dr Alison Colville illustrates a busy clinic career alongside movement mindfulness

58 The Last Word: Are Prescribing Qualifications Enough?

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and founder of The Clinic at Holland Park. She also works within

at the DrMediSpa clinics.

48 Outlining Financial Risk for Clinic Owners

• Peptides • Dermal filler complications • Hyperpigmentation

Miss Jennifer Doyle is a consultant oculoplastic surgeon

year of Maxillofacial training and now works as an aesthetic doctor

IN PRACTICE

NEXT MONTH: TOPICALS

Clinical Contributors

she will begin her ST1 ophthalmology training post.

47 Abstracts

Rebecca Mansell debates prescribing competence

Special Feature: Mastering Precision Injectables in the Periorbital Zone Page 19

Redman draws on his diagnostic imaging background to inform a precise, anatomy-led approach to treatment.

Dr Olivia McCabe-Robinson trained as surgeon in the NHS and is a currently a PhD candidate at the University of Manchester. She is founder of the National Wellness & Aesthetics Research Group and Aesthetics Research Collaborative.

Dr Catherine Dennings combines a background in anatomy, plastic surgery and global research with rigorous, evidence-based practice. She is a KOL for Curel, Galderma, Icona and Obagi Medical.

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Patient Safety

MHRA issues warning for botulinum toxin products

In the Spotlight...

A monthly snapshot of the people, products and ideas generating real time buzz in aesthetics

Hormonal Acne Marie Claire investigates the effectiveness of spironolactone for acne Beauty publication Marie Claire explored whether spironolactone deserves its reputation for curing hormonal acne, or if the online enthusiasm is overblown. The article explains that the drug, originally developed to treat high blood pressure and heart failure, is now commonly prescribed by consultant dermatologists for hormonal acne and female pattern hair loss due to its antiandrogen effects. Aesthetic practitioner Dr Christine Hall emphasises that spironolactone should only be used under medical supervision, warning that blood tests are often needed to monitor potassium levels, as elevated levels can cause serious, potentially life-threatening heart complications.

Acne treatments printed by Marie Claire

The ‘Mirror Shock’ Independent nurse prescriber Julie Scott shared an Instagram Reel exploring the concept of ‘mirror shock.’ “One day, patients feel the same, then the next day a wrinkle or grey hair jumps out at them,” she explains. Scott examines the psychology behind medical aesthetics, discussing the hypothesised theory of ‘identity dissonance,’ more commonly referred to as ‘mirror shock.’ She suggests the brain rarely notices gradual changes, saying, “But the moment something stands out, it grabs our attention.” Scott concludes that patients have not aged overnight, despite often feeling that way in consultations; Instead, “The body has slowly changed, and the mind only just decided to pay attention and catch up.”

Psychological perception addressed by @nursejuliescott

Skin Cancer Dr Dev Patel calls for ban on sunbeds In the wake of the UK Government’s announcement of a consultation for tighter regulation of commercial sunbeds in July 2025, aesthetic practitioner Dr Dev Patel questions if the proposed measures go far enough. Dr Patel points out that sunbeds are classified as a Group 1 carcinogen, placing them in the same category as tobacco and asbestos. Referencing Australia’s regulatory enforcement approach, where commercial sunbeds were banned in 2015, Dr Patel suggests the UK should consider adopting similar legislation. “Let’s not put this temptation out there, particularly for young, vulnerable people in our society who are constantly exposed to influential content on social media,” he says.

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The MHRA explains that, in very rare cases, BoNT-A can spread beyond the injection site and cause potentially life-threatening botulism. The regulator shares that it has worked with manufacturers to update product information and patient information leaflets to better communicate this risk. The MHRA additionally notes that the likelihood of adverse reactions may be increased in patients with underlying neurological disorders, a history of dysphagia or aspiration, when high doses are administered, or when products are used outside their licensed indications or injected into unapproved sites.

Dr Alison Cave, MHRA chief safety officer and pharmacologist, commented, “These strengthened warnings are an important reminder that, in rare cases, serious side effects can occur. It is vital that healthcare professionals and patients are aware of the symptoms of botulism and act quickly if they arise as this is a medical emergency.” The MHRA will be exhibiting at CCR 2026. Turn to p.17 to register now.

Study Insights

Julie Scott explores the science of self-perception

Dangers of sunbeds addressed by @drdevpatel1

The Medicines and Healthcare products Regulatory Agency (MHRA) has raised a safety warning following reports of rare cases of iatrogenic botulism associated with botulinum toxin type A (BoNT-A) products.

GLP-1RA research on cardiovascular and thrombotic risk New research suggests glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with fewer cardiovascular and thromboembolic events in adults with obesity and autoimmune diseases.

Researchers analysed electronic health record data from 26,409 adults, treated within the OneFlorida+ Clinical Research Network between 2014 and 2024. The study, published in the Journal of the American Heart Association, compared cardiac and vascular outcomes among patients taking a GLP-1RA with those who were not.

Among adults with obesity and at least one autoimmune disease, GLP-1RA use was associated with a 44% mortality reduction, a 31% lower risk of venous thromboembolism, a 21% lower risk of emergency department visits, and a 17% lower risk of pulmonary embolism compared with non-use.

The research outlined only a modest decrease in stroke/transient ischemic attack risk, a nonsignificant trend for myocardial infarction, and no significant difference in coronary revascularization. This contrasts with multiple meta analyses and randomised controlled trials that have illustrated a robust association between GLP-1RA use and major adverse cardiovascular event reduction, particularly in those with type 2 diabetes and established cardiovascular disease.

Aesthetic practitioner Dr Vix Manning, who regularly treats GLP-1 patients in clinic, commented, “This article adds to a growing body of evidence that GLP-1s offer benefits well beyond sugar and weight control. As ever, the modest findings for stroke and MI remind us these are adjunctive, not standalone, tools within a broader inflammatory and metabolic strategy.”

Aesthetics | August 2026

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Agenda Reveal

CCR announces educational conferences The Clinical Cosmetic Regenerative Congress (CCR) will bring together a two-day educational programme spanning multiple stages and formats.

Sessions will take place across The Innovation Forum, the Dentists in Aesthetic Practice Stage on Day 1, the Hair, Scalp & Skin Stage on Day 2, the Aesthetics Mastery Theatre, the In Practice Theatre, the Aesthetics Journal Arena, and two stages within The Medical Longevity Summit (MLS).

Vital Statistics A survey of 2,000 people highlighted scepticism towards AI in healthcare, with 31% saying they would not be happy to use AI for any doctor-related communications (Moneypenny, 2026)

At The Innovation Forum, there will be sessions from KOLs representing leading brands such as Amedica, BTL Aesthetics, Candela, Fotona UK, Hydrafacial, Novus Medical, Sciton and Sofwave. In the Aesthetics Journal Arena, delegates can expect content from Headline Sponsor Galderma, alongside The Aesthetics Challenge, curated by the Aesthetics Journal. This session will be chaired by Dr Tahera Bhojani-Lynch and Mr Richard Scawn, with aesthetic practitioner Dr Asad Naqvi taking part as one of the injectors.

The Aesthetics Mastery Theatre programme features Lunchtime Takeover Sponsor IBSA, alongside sessions from Amedica, Beautyform, Cutera and RELIFE. Within the MLS, sponsored sessions are set to come from Altheome, BIOguided, Halo IV, iiaa, Nuchido, Skinzo, Totally Derma and Wild Nutrition.

The Future Health Forum will present independent content curated by aesthetic practitioner Dr Mayoni Gooneratne, looking at metabolic health.

Meanwhile, the In Practice Theatre will host sponsored sessions from Phorest and UNTIL, as well as a Getting Started segment partnered with Harley Academy. Independent panels and further content will also run across both days, with consultant plastic surgeon Ms Priyanka Chadha hosting an entrepreneurial panel and professor Bob Khanna chairing The Regeneration Debate.

UK patients search for non-surgical aesthetic treatments more than 444,000 times per month across 30 treatments (Glowmi, 2026)

West Bromwich experienced the largest rise in searches for ‘weight-loss surgery abroad,’ increasing by 1,000% year-on-year (Tonic, 2026)

Turn to p.17 to register.

NHS staffing levels have continuously grown, with the number of doctors increasing by 24% and nurses by 22% over the past five years

Womens Health

Rapid endometriosis tests approved for NHS use

(NHS Digital, 2026)

Two new tests designed to accelerate the diagnosis of endometriosis are to be made available on the NHS in England and Wales.

The newly National Institution for Health and Care Excellence (NICE)approved tests, EndoSure and Endotest, are intended to help identify the condition earlier without the need for invasive surgery, according to the organisation. Endotest uses a saliva sample to detect biological markers called microRNAs, which indicate presence of endometriosis. EndoSure measures electrical signals in the gut using sensor pads placed on the abdomen. According to NICE, patients must fast for six to eight hours prior during the 45-minute test and are asked to drink water until full, helping the device record gut activity accurately.

In a survey of 6,105 employees across the UK, Australia and New Zealand, 77% reported symptoms linked to poor mental health (Sonder, 2026)

NICE has approved the tests for use over an initial three-year period while further evidence is collected.

Gynecologist and aesthetic practitioner Dr Sima Al Asad said, “If these tests prove accurate and are backed by strong clinical evidence, they could become a valuable tool in both the NHS and private practice. They should not replace detailed consultation or clinical assessment, but they may help identify women who need earlier referral, further investigation or specialist care. No test should replace listening to the patient.”

Aesthetics | August 2026

Nearly three-quarters of people worldwide say they would like to be their own boss (Remitly, 2026)

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Events diary 24th-25th September 2026 BAMAN Autumn Aesthetic Conference 1st-2nd October 2026 Clinical Cosmetic Regenerative Congress (CCR) and Medical Longevity Summit (MLS) 7th November 2026 RAMCE 14th November 2026 IAAFA Aesthetics Conference 21st November 2026 Interface Expo 12th-13th March 2027 Aesthetics Conference & Exhibition (ACE) 13th March 2027 The Aesthetics Awards

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Distribution

ACRE announces new partnerships Aesthetic distributor ACRE has revealed distribution partnerships with pharmaceutical company IBSA Derma and skincare brand ZO Skin Health.

IBSA Derma shares that ACRE’s pharmaceutical expertise, trusted service model and deep understanding of the medical aesthetics sector make them a valued partner in expanding access to education, training and the IBSA UK&I regenerative portfolio across the UK. Alex Stuart, head of IBSA Derma UK&I, said, “As a company committed to advancing regenerative medicine through scientific innovation and clinical evidence, it’s important to work with partners who share our commitment to quality, professionalism and practitioner support.”

ACRE announces that it has become the exclusive UK pharmacy partner for ZO Skin Health, designed to provide clinics with a seamless service while maintaining continuity for practitioners and their patients. Brett Vye, general manager UK&I at ZO Skin Health, said, “As our business grows, it’s important that we invest in partners who can support our long-term goals while maintaining the high standards of service our clinics and patients expect. ACRE shares our commitment to clinical excellence and patient care, and we’re delighted to welcome them as our new pharmacy partner.”

ACRE, IBSA Derma and ZO Skin Health will be exhibiting at CCR 2026. Turn to p.17 to register now.

Pre-Consultation

Panel Discussions

Merz Aesthetics launches educational website

Twiqk hosts inaugural event

Pharmaceutical company Merz Aesthetics has debuted its first dedicated UK patient website for calcium hydroxylapatite-based filler brand Radiesse.

The company shares that the website was created to support patient education and informed decision-making, by offering accessible, easy-to-understand content designed to help prospective patients learn more about Radiesse. According to the company, a key feature of the new platform is an integrated clinic locator, enabling potential patients to identify Radiesse providers across the UK. Merz Aesthetics adds that the locator will continue to evolve as new clinics are added, helping improve access to treatment information and qualified practitioners nationwide.

Sophie Charretour, country manager UK&I for Merz Aesthetics, commented, “By connecting patients with trained and experienced providers through our practitioner locator, we are helping ensure that individuals can make informed decisions and access treatment from qualified professionals.”

Merz Aesthetics will be showcasing Radiesse at The Injectable Experience at CCR 2026. Turn to p.17 to register now.

Verification and consumer education platform Twiqk welcomed specialty guests to its inaugural Twiqk Preview event at Stationers’ Hall in London.

Sponsored by Japanese wellness brand Yotsuba, the event featured panel discussions exploring innovation, patient care and preventative health. The first session, ‘The Future of Aesthetic Medicine,’ was chaired by Professor Dr Patrick Treacy. The talk explored scientific advances, emerging technologies and evidence-based practice. A second panel, ‘Longevity and Wellness,’ was chaired by Twiqk editor Anna Dobbie and highlighted preventative medicine, personalised healthcare and restorative treatments.

Josh Sim, founder and CEO of Twiqk, said, “Bringing together leading specialists for these conversations reflects exactly what the platform embodies – collaboration, education and a common commitment to elevating patient safety.”

Twiqk will be exhibiting at CCR 2026. Turn to p.17 to register now.

Global Survey

Galderma survey highlights concern over skin quality A global survey supported by pharmaceutical company Galderma has found that nine in 10 people report concerns about their skin quality.

The survey included more than 11,000 respondents across 11 countries in Europe, Asia and the Americas. According to the findings, 85% said skin quality influenced their quality of life, while more than a third reported feeling self-conscious, insecure or anxious because of poor skin quality. The data also suggested that the facial area was most affected, followed by the neck, legs and upper arms. Galderma shares that the findings informed the development of the Skin Quality Assessment Scale, a tool designed with specialist input to support more comprehensive evaluation and personalised long-term treatment planning in clinical practice.

Bill Andriopoulos, head of global medical affairs at Galderma, commented, “At Galderma, we don’t believe in one-size-fits-all solutions, we strive to be a trusted partner to people throughout their skin quality journey by offering comprehensive solutions to meet their diverse and evolving needs. This commitment begins with truly understanding these needs, which is why we conducted the world’s most extensive profiling survey to date.”

Galderma will be returning as Headline Sponsor for CCR 2026. Turn to p.17 to register now.

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Injectable Experience

BAMAN UPDATES

CCR announces new educational feature

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

The Clinical Cosmetic Regenerative Congress (CCR) 2026 will introduce The Injectable Experience, a new educational feature designed to give healthcare professionals practical insight into injectable products.

In a controlled hands-on setting, delegates will be able to handle syringes, explore rheology and discuss product characteristics with brand representatives and experienced practitioners. Companies will present product science, clinical use and practical considerations, while delegates gain a closer understanding of performance, handling and best practice in everyday clinical settings. Brands including Ameela, Merz Aesthetics and Teoxane will showcase their standout injectable products currently making an impact in the medical aesthetics sector.

Other new features at this year’s event include the launch of the new Dentists in Aesthetic Practice Stage on Day 1 of CCR, reflecting the growing number of dental professionals entering or expanding within the medical aesthetics sector. Designed as a dedicated forum, the stage will provide discipline-specific education, expert insight and peer support for dentists already working in aesthetics, as well as those exploring opportunities in the field.

Shannon Kilgariff, event director and publisher at Aesthetics, commented, “The Injectable Experience has been created to give delegates a practical way to engage with injectable products, ask technical questions and better understand how different products perform in clinical settings, helping support more informed decision-making in everyday practice.”

Also new to the programme is the Hair, Scalp & Skin stage on Day 2, which will shine a spotlight on one of the most rapidly evolving areas of medical aesthetics.

The morning will feature independent educational content exploring the latest trends, clinical updates and developments in hair and skin health. The theme will then continue throughout the day with sponsored sessions dedicated to hair, scalp and skin.

Turn to p.17 to register for free now.

Neurotoxin

Allergan Aesthetics receives approval for Boey Pharmaceutical company Allergan Aesthetics, an AbbVie company, has announced the European Commission has approved trenibotulinumtoxinE ‘Boey’ in Europe.

The company shares that Boey is the first rapid-onset and short-duration botulinum neurotoxin serotype E approved in Europe for the temporary improvement of glabellar lines in adult patients.

The company shares results may be seen as early as eight hours after treatment and typically wear off within approximately two to three weeks. Allergan Aesthetics, an AbbVie company, adds that Boey offers a differentiated treatment option for patients who are curious about facial injectables. This European approval follows approval in Canada in June 2026.

Darin Messina, senior vice president and global head of aesthetics research and development at AbbVie, commented, “The EU approval of Boey marks an important step forward for our development programme and builds on the momentum we’ve established with Health Canada’s approval earlier this year. This milestone reflects the scientific rigor behind Boey and reinforces our commitment to advancing innovative options as we work to bring this treatment to healthcare professionals and consumers around the world.” Aesthetics will provide further updates once Allergan Aesthetics, an AbbVie company, receives marketing approval in the UK. Aesthetics | August 2026

INTRODUCING NEW BAMAN REGIONAL LEADERS Behind every great BAMAN region is a passionate regional leader, and we’re delighted to have welcomed several new faces to the team this year.

· Kat Cane · Kirsty Eastland · Claire Emmerson · Rachel Ball · Emma Anderson · Gary Seaton

· Mitchell Richards · Christina · · · ·

Murray Twinn Leah Folkard Paula Madigan Rhi Affleck Tracey Dennison

Over the coming months, they will be bringing members together through local events, networking and peer support. We encourage you to get involved and be part of our growing community.

WHAT’S GOING ON AT BAMAN? In just over one month, we’ll be welcoming delegates back to the Eastside Rooms in Birmingham on September 24-25 for the BAMAN Autumn Aesthetic Conference 2026!

For the first time ever, celebrations will continue into the evening of the 24th as we host the BAMAN Awards & Gala Dinner.

The night gives us a much-needed chance to recognise the nurses who continue to raise standards across our profession, while enjoying an evening of great food, entertainment and catching up with colleagues away from the clinic.

The two-day agenda is shaping up nicely, and we’re thrilled to be welcoming internationally renowned anatomist Professor Sebastian Cotofana to the BAMAN stage. The conference will mark the start of our collaboration with Cotofana Anatomy, ahead of The Anatomy and Injection Experience at the Royal College of Surgeons of Edinburgh on November 21-22.

The weekend offers a rare opportunity to learn directly from Professor Cotofana in an immersive, hands-on setting.

Whether you’re a BAMAN member or a medical professional based in the UK or overseas, we’d love to welcome you. Tickets for all of these events are now on sale and can be booked via the BAMAN website today.

This column is written and supported by BAMAN

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Advertising

ASA issues ruling against Kind Patches advert 13 March 2027, Grosvenor House, London

Event Spotlight: Becoming an Aesthetics Awards Winner Last year’s Winner of Medical Aesthetic Practitioner of the Year, Dr Anna Hemming, gives her advice on how you can become an Aesthetics Awards Finalist How can people write an Aesthetics Awards entry that stands out to the judges?

My biggest tip is to be really honest about what makes your work different. Don’t just list treatments, devices or achievements – tell the story behind them. Judges need to understand your purpose, your standards, your patient journey and the impact your work has had.

Use evidence wherever you can for example, patient feedback, clinical results, business growth, service development, education, governance, team achievements and patient satisfaction.

I would also say: give yourself enough time. It is worth writing the entry, leaving it, coming back to it and making sure it really represents you and your clinic.

What did winning mean for you and your clinic?

Winning was incredibly meaningful, both personally and professionally.

The paid-for Facebook ad, seen in March 2026, described the product as a way to “take control of your cravings and metabolism” and included claims such as “reduce hunger naturally,” and “stay fuller for longer.” The video ad showed a woman applying a supplement patch from a packet labelled “GLP-1 Patches,” with the on-screen text reading, “POV: you’re a breastfeeding mum who wants to get snatched but can’t use those weekly injections.”

The ASA challenged whether the ad suggested that the product delivered the same medicinal effects as glucagon-like peptide-1 (GLP-1) agonist medication. As the patch did not hold the necessary authorisation from the Medicines and Healthcare products Regulatory Agency or European Medicines Agency, the regulator concluded that the ad breached the Committee of Advertising Practice Code on medicinal claims. The ASA outlined a second issue, stating the ad was irresponsible because it appeared to promote the product to breastfeeding mothers without appropriate medical consultation and suggested that women should prioritise weight loss during the post-partum period. Kind Patches said the product had been withdrawn from sale and that the post had been created by a third-party affiliate. The company said it had since removed the content and revised its internal approval procedures.

Speaking with Aesthetics, the ASA said, “It’s important that ads don’t blur the lines between licensed medicines and other products. If an ad creates the impression that a product works in the same way as a prescription medicine, consumers are likely to see it as making a medicinal claim.

Unless the product is appropriately licensed, those claims are likely to break the rules. More broadly, advertisers should make sure that ads for weight-loss products are socially responsible and don’t exploit people’s insecurities or vulnerabilities.”

Aesthetics contacted Kind Patches for comment but did not receive a response by the time of publication.

For the business, it gave the whole team a huge boost. Awards recognition reassures patients that they are choosing a clinic with high standards, strong governance and a genuine commitment to care.

Platelet-rich Plasma

Internally, it was just as powerful. It validated the years of training, investment, patient support, innovation and commitment that go into delivering safe, exceptional care every day.

What would you say to someone who is thinking about entering but doesn’t feel confident?

Awards are not only about winning. The process itself is valuable because it makes you stop, reflect and recognise how far you have come. It encourages you to look at your patient journey, your results, your standards, your team and your growth.

My advice would be to back yourself, be authentic and enter with pride. You may be doing far more than you realise.

Entry for the Aesthetics Awards 2027 opens on August 10.

The Advertising Standards Authority (ASA) has upheld a ruling against supplement company Kind Patches over an advert its “GLP-1 Patch”.

PRP Pure unveils two new injectables Platelet-rich plasma (PRP) training provider PRP Pure has announced two new injectables to officially launch at the Clinical Cosmetic Regenerative Congress (CCR) 2026.

The first launch taking place is EXOBIOFILLER, an autologous biofiller designed as an alternative to conventional dermal fillers. PRP Pure shares that it combines autologous PRP, injectable exosomes and patient-derived regenerative components to promote natural-looking volumisation and tissue rejuvenation. The second release is EXOPRP, a PRP treatment enhanced with autologous injectable exosomes, the company shares.

The technology combines PRP with patient-derived exosomes to support regenerative and aesthetic applications, according to PRP Pure.

Specifically discussing EXOBIOFILLER, George Brankov, CEO of PRP Pure, commented, “This innovative procedure harnesses the power of a modified autologous exosome solution to stimulate natural skin rejuvenation while delivering subtle, filler-like volume. By using the patient’s own regenerative cells, the treatment enhances skin quality, improves texture and elasticity and restores a refreshed, youthful appearance with naturally beautiful results.”

PRP Pure will be exhibiting at CCR 2026. Turn to p.17 to register now.

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Scientific Programme

CQC-registered medical cannabis clinic opens A new Care Quality Commission (CQC)-registered medical cannabis clinic called Medecan has debuted in the UK.

The British Association of Dermatologists gather for Annual Meeting The British Association of Dermatologists (BAD) hosted its 106th Annual Meeting at the Manchester Central Convention Complex from June 30 to July 2.

The clinic is co-founded by NHS GP and chief medical officer of Medecan, Dr David Eccleston, chief executive officer David Waller, chief resources officer Laura Eccleston and supported by a patient care co-ordinator and operations manager. The company shares that Medecan provides a fully regulated, transparent and clinically robust pathway for patients living with a range of conditions, including chronic pain, cancer, inflammatory and neurological disorders, gastrointestinal conditions, women’s health concerns, post-traumatic stress disorder, anxiety and sleep disorders.

Dr Eccleston commented, “Like many clinicians, my early experience of cannabis was shaped by only seeing the harms of high tetrahydrocannabinol (THC) recreational use. It was only after seeing the science, regulation and patient outcomes associated with medical cannabis that my perspective completely changed. It’s about carefully balanced, reproducible medicine that can transform quality of life.”

Insights

Researchers publish new botulinum toxin findings New research highlights both the therapeutic potential of botulinum toxin type A (BoNT-A) in scar prevention and the widespread misconceptions.

A new study published in Plastic and Reconstructive Surgery indicates that BoNT-A reduces the formation of pathological scars and generates high levels of patient satisfaction, without serious adverse effects. The review included 19 studies involving a total of 686 patients and consisted of randomised controlled trials and cohort studies identified through searches of PubMed, Scopus, Embase and Web of Science. Overall, patients treated with BoNT-A were approximately 83% more likely to be satisfied with their scar outcome compared with those who did not receive the treatment.

Separately a comprehensive review, Botulinum Toxin A Myths, Evidence, and Global Media Narratives, published in Aesthetic Plastic Surgery has highlighted public misconceptions on BoNT-A. Researchers analysed 513 English-language sources published between 2000 and 2024, including 186 academic studies and 327 media reports. Media coverage was predominantly negative, with safety and toxicity misconceptions appearing 3.2 times more frequently than in peer-reviewed literature.

The event brought together dermatologists, researchers, scientists and healthcare professionals to present the latest clinical research, discuss advances in skin science and share best practices.

The meeting featured poster presentations, educational sessions, and invited lectures and panel discussions on topics including photodermatology, cosmetic dermatology, skin cancer, AI, paediatric dermatology, psychodermatology and skin ageing.

Within the scientific programme, Dr Amber Khalil alongside consultant dermatologist and founder of skincare brand Klira, Dr Emma Craythorne, presented a study examining whether adding targeted antioxidant protection to a high-SPF formulation could help reduce mitochondrial DNA damage caused by UV exposure.

The 41-participant trial took place over 12 weeks, and compared The Dayscript, a broad-spectrum SPF 50 formulation containing antioxidant technology with a matched vehicle control. Using non-invasive cheek swabs and validated qPCR analysis, researchers found improved mitochondrial DNA integrity among participants using the active formulation, while the control group showed a decline.

Simultaneously, charity organisation the British Skin Foundation unveiled its Psychodermatology & Me Survey, which revealed that across the 1,100 participants questioned who suffer from a skin condition, 80.6% say they feel more anxious or depressed when their skin condition flares up. Furthermore, 73.1% say healthcare professionals have never discussed the mental health impact of their skin condition, while nearly two-thirds (63.6%) say their skin condition affects their mental health every day.

Simon Morrison, chief executive officer of the BAD commented, “This year’s Annual Meeting welcomed a record number of attendees and had a real sense of energy throughout. The breadth and quality of the programme were excellent, reflecting the strength and diversity of dermatology today. The exhibition was also a great success and contributed to the positive atmosphere across the event.”

Steroid Injections

BCAM issues warning over hay fever relief The British College of Aesthetic Medicine (BCAM) has urged patients to prioritise safety when considering steroid injections for hay fever relief.

BCAM shares that, following reports of growing popularity, some clinics are promoting the injections to relieve symptoms such as sneezing, itchy eyes and runny noses, but warns that their use raises concerns about patient safety, informed consent and whether patients fully understand the risks. BCAM adds that long-acting steroid injections containing triamcinolone acetonide are not licensed in the UK specifically for hay fever treatment and are not considered a routine first-line option.

Dr Rebecca Norman, vice president of BCAM, said, “We understand why patients suffering with severe hay fever are attracted to the idea of a single injection that appears to solve the problem for months. However, many patients are unaware that this is a powerful steroid medication that circulates throughout the entire body, not just the nose or eyes where symptoms occur. Patients should be fully informed of both the benefits and the risks before agreeing to treatment.” BCAM will be exhibiting at CCR 2026. Turn to p.17 to register now.

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Exclusive Event

Vivorum hosts introductory event

Galderma holds Open Clinic

Science-led beauty and longevity brand Vivorum welcomed specialist guests to The Beaumont Mayfair on July 16.

Pharmaceutical company Galderma welcomed press and content creators to a healthcare practitioner-led Open Clinic at The Londoner Hotel.

The company said the intimate dinner was held to introduce Vivorum’s debut antiageing supplement, Cellular Renewal, while also offering guests an exclusive preview of the brand’s product pipeline for the year ahead.

Guests were invited to undergo a personalised skin analysis conducted by consultant plastic surgeon Ms Priyanka Chadha’s team, which identified areas of concern and provided tailored recommendations for patients.

This was followed by private one-to-one consultations with plastic surgeon Mr Ash Soni and aesthetic practitioner Dr Ana Mansouri, where attendees could ask burning questions about their own concerns as well as those of their readership.

Gul Gokyokus, head of marketing at Galderma, commented, “The Galderma Open Clinic event for journalists and content creators allowed us to showcase and educate on the treatment offering across Sculptra and Restylane, including presenting the new Sculptra Body protocol. We were joined by Mr Soni and Dr Mansouri, who shared specialist advice, treatment recommendations and clinical insight to the day.”

Galderma will be returning as Headline Sponsor for CCR 2026.

Turn to p.17 to register now.

UK Launch

Teoxane UK officially introduces babyGLOW

by Teoxane Aesthetic manufacturer Teoxane UK officially launched its new babyGLOW by Teoxane treatment aboard a boat on the River Thames.

Teoxane UK general manager Joanna Underhill opened the evening, followed by an introduction to babyGLOW by Teoxane from aesthetic practitioner Dr Raul Cetto. The programme also featured a patient perspective discussion with aesthetic practitioner Dr Bibi Ghalaie and television personality Millie Mackintosh, who shared her treatment experience.

The event concluded with the Teoxane babyGLOW Awards, recognising outstanding clinics and practitioners across the UK and Ireland. Winners included independent nurse prescriber Fiona Moss for Best Before & After and nurse practitioner Leigh Law for Rejuvenation. Additionally, Trikwan Aesthetics was named Top Teoxane babyGLOW Clinic across the UK and Ireland.

The event began with a networking reception, followed by an introduction from aesthetic practitioner and clinical advisor to Vivorum, Dr Vix Manning. Co-founder and CEO Balazs Farkas-Jenser followed with a presentation on the brand and its new supplement. During the presentation, Farkas-Jenser discussed the biological benefits of Cellular Renewal and its unique formulation, as well as revealing plans to conduct its own observational and Phase II studies to further explore the synergistic effects of Cellular Renewal’s ingredients and deepen understanding of the product’s potential benefits. The event concluded with a Q&A session for delegates.

Farkas-Jenser commented, “Our first clinician evening brought together some of the most forward-thinking founders and practitioners in UK aesthetics, and the response was superb. What excites me most is turning that into real clinic partnerships; people who share our conviction that beauty outcomes should be built on science and measured properly.”

RF Microneedling

Healthxchange introduces Potenza Aesthetics attended aesthetic distributor Healthxchange’s official UK&I launch of Potenza at Bacchanalia in Mayfair.

The evening featured Potenza key opinion leaders international dermatologist Dr Íñigo de Felipe and aesthetic practitioner Dr Catharine Denning alongside Simone Shoffman, education and clinical director at Healthxchange. The faculty explored the science behind radiofrequency (RF) microneedling, discussing the latest treatment approaches, patient demand for regenerative procedures and the role of technology in achieving consistent clinical outcomes.

Distributed exclusively by Healthxchange in the UK&I, Potenza combines RF-induced thermal stimulation with advanced microneedling. Offering monopolar and bipolar modes at both 1MHz and 2MHz, the platform enables practitioners to tailor treatments for superficial skin resurfacing through to deeper volumetric heating, according to the company.

Underhill commented, “Beyond officially introducing babyGLOW by Teoxane to the market, this event was an opportunity to bring the field together, strengthen connections and celebrate the power of community within aesthetics.”

Jackie Tuzee, chief marketing officer at Healthxchange, commented, “We are delighted to officially launch Potenza in the UK&I. Potenza is a fantastic addition to our portfolio, creating new treatment opportunities for clinics while meeting the growing demand for effective, energy-based treatments.”

Teoxane will be showcasing babyGLOW at The Injectable Experience at CCR 2026. Turn to p.17 to register now.

Healthxchange will be exhibiting at CCR 2026. Turn to p.17 to register now.

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Post Procedure

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Launch Event

et al. releases Versatile Bronze Shade + Sculpt

Aesthetics attends SkinCeuticals breakfast Skincare company SkinCeuticals hosted press and practitioners to present its newly launched P-TIOX Cream and the next generation of PHYTO CORRECTIVE on July 14.

Aesthetics attended the launch of Versatile Bronze Shade + Sculpt by skincare makeup brand et al., distributed by International Institute for Active Ageing (iiaa), at The Beauty Edit Mayfair on July 16.

According to the company, the new bronzer collection has been developed to redefine the traditional powder bronzer, drawing on 30 years of skin health science to deliver a formula tailored to patients’ needs. The range has been designed to meet growing demand for skin-conscious makeup that supports overall skin health, shares iiaa.

The company explains that the talc-free formula features skincare ingredients including squalane for hydration, aloe vera leaf powder to soothe and smooth the skin, and vitamin E to provide antioxidant protection.

Dr Gaby Prinsloo, medical director at iiaa, commented, “With Versatile Bronze Shape + Sculpt, the focus was on keeping the formula simple but considered. We wanted to create a powder that sits comfortably on the skin and works with it, rather than disrupting it. By carefully selecting ingredients, the formula supports skin health while delivering a smooth, refined finish.” iiaa will be exhibiting at CCR 2026. Turn to p.17 to register now.

Presentation

Evolus debuts new HA filler portfolio to the UK Pharmaceutical company Evolus hosted an event at the Everyman Cinema for the launch of injectable hyaluronic acid Estyme on July 6.

Opening the event, Dallas Waltham, marketing manager at Evolus UK&I, introduced the Evolus brand and outlined the evening’s programme before welcoming the specialist faculty to the stage. Maxillofacial and facial plastic surgeon Ms Natasha Berridge explored the role of Nucevia, a botulinum toxin type A, in clinical practice, focusing on the significance of neurotoxin-associated proteins and their contribution to clinical performance. Nurse prescriber Amy Bird followed with an introduction on the new hyaluronic acid (HA) injectable portfolio, Estyme, highlighting the versatility of the portfolio and outlining its four injectable HA products; Form, Smooth, Sculpt and Lips.

Aesthetic practitioner Dr Jennifer Owens followed with clinical case studies demonstrating her experience using the Estyme portfolio across a range of treatment indications. The event concluded with a panel discussion, during which the faculty explored key anatomical considerations, including deep facial fat compartments and vascular anatomy.

Waltham commented, “It was wonderful to have so many existing and new partners, alongside friends and colleagues from across the field, all under one roof to celebrate the launch of Estyme.

The energy in the room, the conversations and the opportunity to learn together made it a really special evening.”

The morning opened with David McNulty-Ringshaw, regional sales manager south at SkinCeuticals, who introduced nurse practitioner Eleanor Hartley to the attendees. Hartley explored the P-TIOX Cream in detail, discussing its key ingredients, target patient demographics and commercial opportunities. She also outlined product-stacking strategies tailored to different treatment indications.

Holly Spencer, senior education and academy manager, then introduced the next generation of PHYTO CORRECTIVE, featuring biotechnological polydeoxyribonucleotide (PDRN). SkinCeuticals shares that it combines an 8% phytobotanical complex, including thyme, olive leaf and cucumber, with tripeptide-8 to help soothe the skin and reduce sensations of irritation; adding that the product has been tested for use alongside professional procedures, including microneedling, laser treatments and chemical peels.

Ollie Pearce, medical events and communications manager at SkinCeuticals, commented, “Launching P-TIOX Cream gave us the opportunity to bring practitioners together, not just introduce a product, with our power stack series reflecting SkinCeuticals’ continued investment in supporting and educating the aesthetic community across the UK and Ireland.”

On The Scene

Candela hosts educational event Aesthetic device company Candela invited practitioners to The Art of Radiance event.

The event opened with a welcome from Victoria Worship, assistant vice president for the UK, Ireland and Iberia, who outlined portfolio developments.

Independent nurse prescriber and dermatology specialist Yobany Valencia introduced the Matrix radiofrequency (RF) platform, discussing its role in skin renewal through RF microneedling, sub-ablative resurfacing and non-invasive wrinkle treatment.

This was followed by a presentation from aesthetic practitioner Dr Saleena Zimri on the benefits of combining facial treatment Glacē Microdermabrasion with Hydro-Infusion in a single treatment.

After lunch, delegates attended a session on the PicoWay advanced picosecond laser system led by Valencia, before aesthetic practitioner Dr Kamran Amjed explored consultation strategies and the role of technology investment in supporting clinic growth.

Dianne Burkhill, senior marketing manager UK&I at Candela, commented, “Candela have a heritage rich in medical aesthetics, and we wanted to ensure we reflected this together with the quality, innovation and diversity of our device portfolio technology through our UK&I activities.”

Candela will be exhibiting at CCR 2026. Turn to p.17 to register now.

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Post Treatment

News in Brief Medik8 unveils cleansing gel Skincare company Medik8 has released its Total Moisture Daily Cleansing Gel. Medik8 explains that the cleanser is formulated with Moisture Magnets to replenish hydration instantly and help maintain moisture levels, alongside its Smart Surfactant System which aims to effectively cleanse without stripping the skin. The formula also features prebiotic inulin to help support the skin microbiome and minimise disruption during cleansing, alongside fermented rice extract, which is high in natural amino acids to support the complexion, according to the company.

AlumierMD releases skincare travel collection Skincare company AlumierMD has introduced a curated collection of travel-sized products to help patients maintain their routines while away from home. The collection features five products formulated to address a variety of skin concerns, including MicroDerm Polish, SensiCalm Cleanser, Clear Shield Broad Spectrum SPF 30, Bright & Clear Solution and Purifying Gel Cleanser.

Solta Medical debuts learning platform Aesthetic device manufacturer Solta Medical has launched an on-demand digital learning platform called the Solta Medical Academy (SOMA).

Designed for medical professionals, the company explains that SOMA brings together expert-led content within one on-demand platform. Practitioners can log in from any device and access a library of recorded lectures, clinical procedure videos and live webinars with leading international specialists.

5 Squirrels unveils Gel Masque Collection Private label skincare manufacturer 5 Squirrels has introduced of three treatment-focused masks. 5 Squirrels shares that Retinova Gel Masque is an advanced rejuvenation treatment combining retinol and collagen-stimulating peptides to support skin renewal, improve firmness and reduce the appearance of wrinkles.

Illuminate Gel Masque serves as a targeted brightening solution designed to reduce pigmentation, even skin tone, and enhance overall radiance through melanin-regulating actives. Lastly, the Quench Gel Masque is an intensive hydration treatment engineered to restore moisture, strengthen the skin barrier and reduce transepidermal water loss.

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Ameela releases PDRN mask Medical aesthetic company Ameela has debuted its Wild Salmon PDRN Mask, designed as a bioactive post-procedure sheet mask for in-clinic use.

Available through aesthetic distributor Amedica, Ameela shares it aims to deliver immediate cooling, intensive hydration and bioactive renewal support to freshly treated skin. The company shares that the formula features polydeoxyribonucleotide, and is for single-use, with a 10-to-15-minute leave-on time.

Founder of Ameela, Linn Emilie, commented, “We couldn’t be prouder to launch the Wild Salmon PDRN Mask at CCR 2026. This formulated with 20mg of pure Wild Salmon polynucleotides to cool, hydrate and support the skin’s natural renewal.

It’s the considered finishing step after microneedling, laser and skin booster treatments; instant cooling comfort, intensive hydration and a calming botanical complex that helps reduce the look of redness.”

Amedica will showcase Ameela at The Injectable Experience at CCR 2026. Turn to p.17 to register now.

Weight Management

Roseway Labs unveils weight-loss programme Compounding pharmacy Roseway Labs has launched a new specialist-led weight loss programme called Statera.

The pharmacy explains Statera is a 12-week, education-led weight management programme developed by Roseway Labs alongside a collective of nutritionists and pharmacists with decades of combined experience. Designed to address often-overlooked aspects of medical weight management, the programme covers topics including nutrient depletion, gut health and the emotional relationship with food.

Co-founder and CEO of Roseway Labs, Elizabeth Philp, commented, “Rather than focusing solely on calorie restriction, Statera helps patients build the knowledge and practical skills needed for sustainable lifestyle change. It supports them in understanding their bodies, their relationship with food and the underlying factors that influence weight management.”

Roseway Labs will be exhibiting at CCR 2026. Turn to p.17 to register now.

Launch

VIVACY Laboratories introduces biostimulatory injectable Aesthetic manufacturer VIVACY Laboratories hosted an event at its headquarters to mark the debut of its new calcium hydroxylapatite (CaHA) injectable, Novuma.

Delegates attended an afternoon of networking alongside faculty members including aesthetic practitioners Dr Zunaid Alli, Dr Cemal Kavasogullari and Dr Thuha Jabbar, among others. During the event, Dr Alli carried out a live demonstration of Novuma outlining the protocol, injection technique and product volume used as part of the treatment.

Katie Hughes-Dawkins, sales director at VIVACY Laboratories, commented, “As our next-generation CaHA technology, Novuma has been developed to meet immediate aesthetic improvement and long-term tissue regeneration. We are so proud to bring this innovative solution to practitioners and further strengthen our premium VIVACY Laboratories portfolio of regenerative medicine and hyaluronic acid solutions.”

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News Special Emergency Medicine

New Framework Addresses Access to Emergency POMs

while non-prescribing members must obtain PSD authorisation from an ACE approved prescriber or the ACE Group Clinical Helpline before any emergency medicine is administered.”

In this exclusive coverage, Aesthetics explores a new framework for treating complications

In an emergency such as vascular occlusion, eligible ACE Group members can invoke the EDICT pathway and access ACE Group owned emergency medicines under ACE Group’s governance and indemnity to treat that specific complication. However, King is clear that if those medicines are used outside the defined emergency indications, for example, elective dissolving, the practitioner would breach the framework, lose indemnity and potentially face regulatory consequences.

A new governance framework has been launched to help eligible aesthetic practitioners access specified emergency medicines during time-critical complications. Called the Emergency Direction for Immediate Complication Treatment (EDICT), the pathway has been developed by complications group Aesthetics Complications Expert (ACE) Group World as a lawful mechanism for certain practitioners to obtain and administer emergency medicines in defined situations, without changing existing prescribing law.

The framework is intended for use in acute complications such as vascular occlusion, where treatment delays can have serious consequences. It aims to address a long-standing issue in aesthetics, particularly for nurses and other clinicians who may be trained to manage complications but are not legally permitted to hold emergency stock independently.

To explore what the framework means in practice, Aesthetics spoke to nurse prescriber and director of ACE Group World, Sharon King, as well as Sharon Bennett, nurse prescriber, former chair of the British Association of Medical Aesthetic Nurses (BAMAN) and lead of the Aesthetics Clinical Advisory Board.

The emergency medicines gap According to King, EDICT will operate within existing medicines legislation and professional regulation, and incorporate prescribing oversight, Patient Specific Directions (PSDs), medicines governance, audit and accountability through a formal Service Level Agreement (SLA).

Bennett adds that this has been a real and recognised tension for years. “A nurse could be fully competent but still be constrained by prescribing law rather than clinical ability. That gap has left nurses uncertain about liability, indemnity cover, and open to Nursing and Midwifery Council (NMC) scrutiny if they acted outside the current rules – even when acting in the patient’s best interest,” she says.

BAMAN had previously called for reform of the Human Medicines Regulations 2012, arguing that the inability for nurses to hold emergency stock undermines standards of care in emergencies and limits their ability to provide safe and effective treatment when it is needed most.3 King argues that while PSDs, Patient Group Directories and collaborative arrangements can support medicines use in planned care, they are often inadequate in emergencies because they depend on named patient authorisation and real time prescriber access.

“While EDICT cannot change the Medicines Act or fix the wider problem immediately, it provides ACE Group World members with a lawful, governed mechanism to access and administer emergency medicines during genuine emergencies, addressing the most significant patient safety gap in current practice,” King says.

What EDICT changes in practice

ACE Group World states that access to this emergency medicine framework is restricted to members whose professional regulators permit them to administer prescription only medicines under a PSD. Practitioners whose regulatory framework does not allow PSD-based administration are not eligible to undertake this aspect of the SLA.

The framework was developed to align with guidance from the Care Quality Commission (CQC) and the Medicines and Healthcare products Regulatory Agency (MHRA), alongside input from insurance provider Hamilton Fraser and aesthetic distributor ACRE. It is embedded within ACE Group World’s CQC registered governance system, allowing practitioners to use the framework safely within their own clinical environments while ensuring emergency medicines are accessed and managed in line with medicines management requirements.

King says the pathway is intended to tackle what she sees as a major patient safety and governance gap affecting nurses and other healthcare practitioners who cannot legally hold stock. In her view, this gap exists because the Medicines Act 1968 and the Human Medicines Regulations 2012 have not kept pace with the increasingly autonomous role in modern clinical practice.1,2

King notes “Under the EDICT governance system, authorised prescribers complete the clinical assessment and generate the PSD electronically via the ACE Group World website or app. Both the prescriber and the practitioner must be signed up to the SLA. Prescribing members may issue PSDs whether treating their own patient or acting on behalf of a non prescribing member, Aesthetics | August 2026

Bennett believes that EDICT will benefit both practitioners and patients. She continues, “For the practitioner, it will provide faster and lawful access to the right medicine at the point of need, with less dependence on reaching a prescriber mid-emergency, and a clearer governance trail, such as protocols, accountability and documentation if things go wrong and are later reviewed.”

Limits and future implications King explains that EDICT does not create new prescribing rights or apply to routine practice, but instead sets out a governed route for emergency access to a limited number of medicines in specific circumstances. She emphasises that practitioners must continue to comply with the Human Medicines Regulations 2012, professional prescribing standards, scope of practice boundaries and all legal requirements governing the supply and administration of medicines.1 “Fitness to practise expectations, duty of candour, documentation requirements and clinical governance obligations all remain the same.

Practitioners remain fully accountable to their regulator,” she says.

Bennett notes that wider reform is still needed, including statutory regulation of the non-surgical aesthetics sector, which remains largely unregulated in the UK. “There needs to be consistency across different professional and membership bodies, rather than each operating its own model, and for clearer national guidance from the NMC and MHRA so practitioners are not reliant on individual associations to fill a legislative gap,” she says. Bennett concludes, “EDICT shows that patient safety and legal compliance don’t have to trade off against each other if the right clinical oversight is built in.”

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Shape Your Future

No matter what stage you’re at in your career, you can discover your next step at CCR 2026 Professional development in medical aesthetics rarely stands still.

Whether you are at the start of your career or well established in practice, there is always something to build on: stronger foundations, sharper technique, a better understanding of emerging areas or more confidence in the decisions that shape patient outcomes. What people need from an aesthetics event changes throughout their career too. For some, the priority is clarity and context; for others, it is highly focused education that can be applied straight away.

This year’s Clinical Cosmetic Regenerative Congress (CCR) brings together a broad mix of education across injectables, medical longevity, business, dentistry, hair, scalp and skin, giving delegates plenty of ways to shape their time around what matters most to them.

So, what do you want your next step to be?

Ambition 1: build stronger foundations For delegates still building confidence in aesthetics, or those looking to revisit the basics with a fresh perspective, the In Practice Theatre offers a useful starting point. Many sessions here are designed to help newer practitioners understand both the realities of the sector and the practical considerations involved in entering it well.

That begins with the 2026 Trends Outlook, in which founder of Rare, Ben Pask, presents the annual Aesthetics Journal Trends and Product Launches Report. For practitioners at an earlier stage, this kind of session can be especially helpful in making sense of the wider market: what is changing, which treatment areas are attracting attention and how products and patient expectations may be evolving. Other sessions on Day 1 include Managing Online Complaints, Treating Transgender Patients Ethically and Communicating Value and Pricing with Confidence.

Getting Started in Aesthetics on Day 2, delivered in partnership with Harley Academy, draws on the experience of teaching thousands of medical professionals, providing a grounded perspective on what entering aesthetics involves. Rather than treating the move into aesthetics as straightforward, it suggests a more realistic discussion around preparation, progression and early decision-making.

One of the more notable developments in this year’s event is the inclusion of a dedicated stage for dentists on Day 1, bringing together 16

the world of dentistry and medical aesthetics and providing a platform for dentists to kickstart their aesthetics career.

Founder of the newly launched Association of Dentists in Aesthetic Practice (ADAP), Paul Burgess, looks at how dental professionals are contributing to the future of aesthetics, addressing the need for collaboration across disciplines, education and specialty, while marking the official launch of ADAP. This is followed by sessions such as Dentists in Medical Aesthetics: How to Succeed at Every Stage of Your Journey, From Smile to Skin: Integrating Facial Aesthetics into Everyday Dental Consultations, and Building a Memorable Clinic Brand.

Another useful strand for those building confidence in the sector is the Aesthetics Awards Rising Stars Live Seminars, where the leaders of tomorrow share what is shaping the future of aesthetics today.

For delegates at an earlier stage of practice, this offers a slightly different kind of learning: not just clinical insight, but perspective from practitioners who are still relatively close to the challenges of getting established, building credibility and developing their own approach.

Ambition 2: expand into new areas of practice For others, the next step is not about starting out, but about broadening the scope of their work.

The brand new Hair, Scalp & Skin Stage on Day 2 speaks to a growing area of expansion within medical aesthetics. With sessions on hair transplant surgery, updated platelet-rich plasma guidance on hair loss treatments and hair conditions in skin of colour, it brings together dermatologists, aesthetic practitioners and trichologists around topics that are increasingly relevant to many clinics. There will also be sessions from companies EMA Aesthetics, Million Dollar Facial and Sons. For delegates considering whether hair and scalp health has a place in their own practice, this stage offers both clinical insight and a clearer understanding of the specialist knowledge involved.

The Innovation Forum adds another dimension for those thinking about growth. With conferences involving companies such as Amedica, BTL Aesthetics, Candela, Hydrafacial, Fotona UK, Novus Medical, Sciton and Sofwave, is likely to be one of the more

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useful places to compare what is emerging and what may have practical relevance.

Ambition 4: see how outstanding outcomes are achieved

Delegates interested in the science underpinning newer areas of practice may also find a strong foundation at the Medical Longevity Summit. With sessions on why metabolism matters, NAD biology, metabolic signalling, mitochondrial flexibility, metabolomics and mitochondrial genetics, the emphasis is clearly on understanding and interpretation. For practitioners looking to move beyond medical aesthetics and introduce something new to their clinic, this part of the event offers a good introduction to the scientific ideas increasingly shaping the field.

Some of the most valuable learning in aesthetics comes from seeing how experienced practitioners approach complexity in real life. Not every educational opportunity comes in the form of a lecture or live demo; sometimes the most useful insight lies in understanding how a clinician assessed a challenging case, weighed different treatment options and arrived at the final result. For delegates interested in that kind of thinking, the Aesthetics Results Awards could become one of the more interesting sessions in this year’s programme.

Hands-on learning for ambitious injectors New for CCR 2026, The Injectable Experience will give healthcare professionals the chance to explore injectable products in a more practical and interactive way.

Set in a controlled hands-on environment, the feature will allow delegates to handle syringes, explore rheology and discuss product characteristics with brand representatives and experienced practitioners. The aim is to give attendees a better understanding of how different products perform, feel and function in everyday clinical practice.

Alongside the opportunity to examine product science and clinical application in more detail, delegates can also gain insight into handling, formulation and the practical considerations that shape treatment decisions.

Brands include Ameela, Merz Aesthetics and Teoxane.

Ambition 3: refine your injectable technique For experienced injectors, the goal is often less about learning something entirely new and more about improving precision, consistency and judgement. In that respect, the Aesthetics Journal Arena stands out as a stage built around applied learning.

Taking place on the Aesthetics Mastery Theatre, the format brings Finalists’ case studies to the stage as part of a live Awards presentation. Practitioners will talk through real patient journeys, outlining the rationale behind their treatment plan, the challenges they encountered and the outcomes they achieved, before the judging panel deliberates live and announces the Winners.

Categories include Best Full Face Transformation Using Injectables, Best Skin Transformation, Best Body Transformation and Most Challenging Aesthetic Case Study.

Also on the Mastery Theatre will be some of the specialties biggest brands, showcasing how exceptional results can be achieved using their products. Companies include: Amedica, Beautyform, Cutera, Klira, Relife, and Lunchtime Takeover Sponsor IBSA.

Start with your ambition, then build your day The breadth of the programme means most delegates are unlikely to have just one priority. Some may want to strengthen their foundations while also exploring a new treatment area. Others may come for advanced injectable education but leave with new ideas about business, longevity medicine or adjacent specialisms. The value lies partly in that flexibility.

Use the CCR website and app to explore the stages, shortlist sessions and start planning a day that reflects where you are now and where you want your practice to go next.

Sessions include ‘One Face. Three Experts. One Live Injectable Demonstration,’ led by Ms Priyanka Chadha, Dr Lara Watson and Dr Lee Walker. Using one patient, the three clinicians will work through facial assessment, anatomical considerations, planning, product choice and injection technique.

Professor Bob Khanna will also be on the stage, demonstrating a full‑face profiloplasty approach tailored to the GLP‑1 patient. He will treat one half of the face on stage, sharing his detailed assessment, treatment planning and choice of modalities in real time. While the second half is treated off‑camera, parallel talks from invited faculty will explore complementary techniques and clinical considerations.

01 & 02 October 2026 Excel, London

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That emphasis on careful decision-making is taken further in The Aesthetics Challenge: Mastering Precision Injectables in the Periorbital Zone. The periorbital area is one of the most demanding in clinical practice, and the session reflects that by focusing on structured assessment, patient selection, consent, dosing, injection planes and risk recognition. Three injectable demonstrations by top injectors will be assessed live on stage by chairs Dr Tahera Bohjani-Lynch and Mr Richard Scawn.

Additional live demonstrations from Headline Sponsor Galderma will take place on this stage across both days.

Day 1: Dr Jessica Halliley & Dr Yusra Al-Mukhtar will be discussing treatment for menopausal patients

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Day 2: Dr Natalie Ball & Mary Irving will outline treatment of the perioral area using Restylane and Restylane Kysse Aesthetics | August 2026

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Special Feature Periorbital Area in the treatment of infraorbital hollows with HA fillers. The authors emphasise that natural-looking results often depend on first addressing mid-face volume loss before directly treating the infraorbital area and recommend conservative correction using small filler volumes placed at the supraperiosteal level. Both needle and cannula techniques are described as appropriate when used carefully, with the choice guided by anatomy and injector preference. The review also stresses that fillers used in this area should be smooth, malleable and have low hygroscopicity to reduce the risk of visibility, irregularities and oedema, underlining the need for a cautious, individualised approach in this anatomically delicate region.5

Selecting optimal candidates

Mastering Precision Injectables in the Periorbital Zone Three practitioners discuss the use of dermal fillers for treatment of the periorbital area The periorbital region is a complex aesthetic unit encompassing the brow, superior sulcus, upper and lower eyelids, and the medial and lateral orbital regions.

Ageing-related change in this region is multifactorial and may include brow descent, volume loss of the superior sulcus and temple, changes in skin quality, altered muscle balance and, in some patients, eyelid hooding or true ptosis. This can contribute to a tired, heavy or aged appearance, making this an increasingly common area of concern for patients seeking aesthetic treatment.1,2 Treatment of this region remains technically demanding. The complex anatomy of the periorbital area – including its intricate vascular network, delicate soft tissues and functional relationship with the brow and eyelid – requires a detailed understanding of anatomy, careful patient assessment and precise injection technique to achieve safe and predictable outcomes.3 Aesthetics spoke with ophthalmologists Dr Tahera Bhojani-Lynch and Miss Jennifer Doyle and aesthetic practitioner Dr Asad Naqvi to discuss the latest evidence, practical considerations and clinical decision-making involved in treating the periorbital area with hyaluronic acid (HA) dermal filler, with particular attention to anatomy, patient assessment, treatment protocols and complication prevention.

Emerging evidence A multicentre, randomised, evaluator-blinded study published in Aesthetic Surgery Journal assessed HA dermal filler (Restylane Eyelight) for the correction of moderate to severe infraorbital hollows in 333 patients.

The study found a significantly higher responder rate at month three in treated patients compared with untreated controls, with 87.4% achieving at least a 1-point improvement on the Galderma Infraorbital Hollows Scale versus 17.7% in the control group. Outcomes were comparable whether product was delivered by needle or cannula, suggesting both approaches can be effective when used appropriately.4 The study also reported sustained aesthetic improvement over time.

Investigator-rated improvement remained high through month 12, while patient-reported satisfaction scores were markedly better in treated patients than controls. Efficacy persisted through 12 months for a substantial proportion of patients, and through 18 months in those who received retreatment at month 12.

Adverse events were reported as typically mild, although the authors noted a higher rate in the cannula group than the needle group.4 A 2025 review in Aesthetic Surgery Journal Open Forum highlights the importance of anatomy, patient selection, injection technique and product choice Aesthetics | August 2026

Dr Naqvi is clear that strict patient selection underpins safe outcomes.

According to him, a key screening step is skin quality, and he advises clinicians to pinch the skin and watch its recoil. “If it’s thin, if it doesn’t recoil or takes time to recoil, they are not suitable for tear trough fillers,” he says. Dr Naqvi adds, “I wouldn’t treat any patients with festoon or malar bags as they typically have a lot of water retention, and you are going to make that worse.”6 Miss Doyle highlights that in her experience, the ideal patient has good skin quality, minimal skin laxity and is not prone to periorbital oedema. “For tear trough filler, I am looking for true volume deficiency resulting in genuine tear trough deformity, rather than pseudo-hollowing caused by prolapsed fat or swelling,” she notes.7 Dr Bhojani-Lynch agrees that candidate selection depends on understanding what is truly driving the under-eye concern.

“Most of the hollowing under the eye comes from ageing changes to your sub-orbicularis oculi fat (SOOF),” she says, adding, “Your medial and lateral SOOF deplete in volume as you get older.”

Dr Bhojani-Lynch explains that it is the loss of the deep fat pads that will contribute to the appearance of infraorbital hollowing.8 Miss Doyle adds, “Contraindications include pregnancy and breastfeeding, active infection, active herpes simplex virus, inflammatory skin disease within the treatment area, known hypersensitivity to product components, unrealistic expectations and patients with significant oedema or untreated lower eyelid pathology.”9 19

Special Feature Periorbital Area Clinical assessment Dr Naqvi emphasises that clinical examination in three dimensions is essential, rather than relying on devices or two dimensional photography. He states, “The only way you can do it is to stand at the patient’s side, not from the front.”10 Instead, he advocates a structured, anatomy-led assessment. First, he positions the patient in neutral head position with primary gaze. “You stand at the patient’s side, ask them to look straight without rotating the eyes upwards. This is because when you rotate your eyes upwards, your orbit bulges and it pushes down the lower lid, making the patient’s tear trough look worse,” he says.10 From this lateral view, Dr Naqvi analyses the lid-cheek junction and the key grooves around the medial canthus and infraorbital rim.11 “The practitioner should assess for a nasojugal groove, also referred to as the tear trough deformity, characterised by a curved depression extending from the medial canthus to the medial infraorbital rim,” he notes. Dr Naqvi adds that this assessment differentiates true volume loss from orbital fat prolapse, helping guide whether mid-face augmentation is more appropriate than direct infraorbital injection.11 Before

After

Figure 1: 31-year-old female before and after one session of Restylane Eyelight using 0.5ml needle.

Images courtesy of Dr Asad Naqvi.

Miss Doyle shares that she assesses her patients visually, saying, “My assessment includes skin quality, tear trough severity, lower eyelid support, mid-face volume, dynamic muscle activity and lymphatic function. I assess the entire upper- and mid-face rather than looking at the tear trough in isolation.” She also cautions practitioners without formal oculoplastic training to ensure anatomy precision. Miss 20

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Doyle stresses, “One of the most common diagnostic errors I see is confusing orbital fat prolapse with oedema. If the patient has prolapsed orbital fat, the prominence is usually present throughout the day with little diurnal variation. It also becomes more obvious on up-gaze, as the globe pushes the fat forwards.”11,12 Dr Bhojani-Lynch says several grading scales can help guide assessment. “If they’ve got a medial tear trough, it is a Grade 1. If they’ve got a medial and lateral, it is a Grade 2 and if they are notched down into the malar, it’s a Grade 3,” she says, referring to Barton’s tear trough grading scale as guidance.13,14 Dr Bhojani-Lynch also uses dynamic examination to distinguish skin laxity from underlying fullness. “If you stretch the skin, it flattens very easily, whereas if there is prolapsed fat or even old filler, you stretch it and it bulges more,” she notes.13,14

Product selection and rheological considerations Dr Naqvi prioritises minimal hydrophilicity and high G’ to reduce tissue oedema and palpebral puffiness. 10,15 “You need a product that’s going to minimise water uptake. Excess fluid retention may elevate the overlying skin, resulting in puffiness, overcorrection or an unnatural contour.

In some patients, it may also aggravate pre-existing malar oedema or malar bags, thereby exchanging one aesthetic concern for another,” he says.10,15 Restylane Eyelight, is Dr Naqvi’s preferred product in this area. “Due to its the high G’, it also brings in the least amount of water,” he says.16 Dr Naqvi emphasises that the goal is subtle dermal–subdermal tenting rather than bulk augmentation, adding, “You don’t want to volumise this area; it’s too delicate. You want to lift the skin and hold it up. If you volumise it, you are going to bring water in.”4,15,16 Dr Bhojani-Lynch similarly says, “Product choice is most important. If you use the wrong product, and you administer it in the wrong layer of the face, it will not remain localised at the site of placement, and it will not maintain the result that you expect.”17 She cautions that immediate post-treatment appearance in the periorbital region may be misleading, as the result observed with the patient upright may differ significantly from the appearance at four weeks.17 Dr Bhojani-Lynch continues, “An ideal product should have low expansile potential and sufficient cohesivity to remain stable and localised following placement.”17,18 She adds that the product should require a relatively low extrusion force to allow controlled placement Aesthetics | August 2026

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in this anatomically sensitive area.17,18 Dr Bhojani-Lynch’s preferred product is Teosyal PureSense Redensity 2 which she states is specifically designed for this area. Dr Bhojani-Lynch also adds, “Volume selection is critical. In this area, 0.2-0.3ml per side should be more than sufficient.”

Miss Doyle echoes the rationale in choosing a filler with relatively low G’, good tissue integration and minimal hydrophilicity.10,15 She explains that because the periorbital region is in constant motion, with blinking and facial expressions, filler initially placed deep to the orbicularis muscle may gradually be displaced anteriorly forwards over time. “As a result, longer-lasting fillers have a greater opportunity to migrate superficially, increasing the risk of Tyndall effect or contour irregularities in the months following treatment,” she notes.19 Miss Doyle’s preferred product of choice is Revanesse Revise.

Injection techniques and treatment protocols Dr Naqvi explains that the most important factor in tear trough treatment is the depth. He highlights that this is the key reason behind his preference for a 25G needle. “Only a needle can reliably reach the bone,” Dr Naqvi says. He adds, “With retrograde cannula treatment, you end up coming off the bone and entering the next layer, which will be the fat compartment or the orbicularis oculi muscle. For that reason, it is not guaranteed.”15,17 Miss Doyle adds that she uses a 25G cannula with two entry points. “This allows me to address both the medial and lateral aspects of the tear trough while minimising tissue trauma,” she notes. Miss Doyle highlights that the filler is placed in the deep plane along the tear trough hollow using slow, controlled retrograde deposition.10 “Although I would rarely exceed 0.6ml per side, most patients require approximately 0.3-0.4ml to achieve a natural correction. I deliberately under-correct at the initial appointment as it’s easier to assess the outcome and add a small amount at a follow-up appointment than to manage an overcorrection,” she says.

Dr Bhojani-Lynch also advocates a conservative approach, centred on indirect support rather than direct medial filling. “When treating a patient with both a medial and lateral tear trough, the infraorbital hollow should be mapped from medial to lateral alongside the malar groove, creating a Y-shaped treatment pattern. The point where these lines converge is identified as the ‘Y point’,” she explains.20,21

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Before

After

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Miss Doyle notes that patients should be counselled regarding common adverse effects. “This includes bruising, swelling and temporary tenderness; alongside less common complications including contour irregularities, Tyndall effect, delayed oedema and infection,” she says.30 Dr Bhojani-Lynch emphasises that this is an advanced treatment area requiring strong anatomical understanding and experience. “When people talk about advanced treatments, I think successfully doing the periorbital area is the last bastion of safety. Practitioners must know how to safely and effectively use hyaluronidase,” she adds.32

Figure 2: 39-year-old female patient before treatment and two weeks after a single 0.7ml session of Revanesse Revise. Images courtesy of Miss Jennifer Doyle.

Dr Bhojani-Lynch continues, “You can deposit 0.1-0.2ml of your chosen product as close to bone as possible.” She argues that whether this is done with a 30G needle or 25G cannula, the principle is the same.

“Use very small volumes, remain in a deep plane and reassess the patient in the upright position after each deposit to allow accurate evaluation of the result,” she says.

For upper orbital hollows, her preference is different. Dr Bhojani-Lynch notes, “For this area I will use a 25G cannula with a lateral entry point. You are going as deep as you can, and depositing small amounts of product in the supraorbital hollow.”11,12

Understanding the periorbital anatomy Dr Naqvi stresses that effective treatment starts with a precise appreciation of anatomy. He cautions, “The skin is the thinnest part of the entire body, which means light can penetrate through. If you put any dermal filler superficially, you’ll see it as a tinge. This occurs because light scatters as it passes through the filler, causing the area to appear darker.” He also highlights the minimal subcutaneous fat and the presence of the orbicularis oculi muscle, which can make eyes appear darker and more hollow.8,17,23 Miss Doyle echoes this sentiment. “There are multiple fat compartments, retaining ligaments, important vascular structures and a delicate lymphatic drainage system. A treatment that is appropriate for one patient may worsen another if the underlying diagnosis is incorrect,” she warns.23-25 Dr Bhojani-Lynch also underlines the importance of understanding the orbicularis oculi in detail. She explains, “The orbicularis oculi and is a large muscle that extends from above the eyebrow to below the tear trough.”23-25

Special Feature Periorbital Area

On the implications for filler placement, Dr Bhojani-Lynch warns, “Your orbital orbicularis is attached very tightly to the bone below. This is why when you think you are advancing the cannula beneath the muscle, you are often not under the muscle, you are just deep intramuscular.” She notes that this matters anatomically due to filler migration.

“Product trapped in the muscle may become displaced over time as a result of ongoing orbicularis activity. Consequently, filler that was initially placed where you intended may, over time, present as a bulge in the medial groove,” explains Dr Bhojani-Lynch.3,24,27 Dr Naqvi highlights that, in terms of safety, vascular anatomy is his primary concern when injecting in the tear trough region.

“When you’re injecting the medial canthus area, which is the main region that most practitioners inject for tear troughs, practitioners must be careful of the angular artery, which passes by that.1,28,29 As he moves more inferiorly along the inferomedial orbital rim, Dr Naqvi is equally mindful of the infraorbital vascular bundle.

“This becomes especially relevant when managing upper mid-cheek volume in patients with orbital fat prolapse or herniation,” he adds.1,28,29 Dr Naqvi notes that as treatment moves to the inferior medial periosteum near the tear trough, the infraorbital vascular bundle lies just below, making aspiration essential.

“When you are treating a patient who has prolapsed fat or fat herniation from the under-eye area, you are injecting below to smooth the transition,” he says.29-31 Beyond these two key arterial territories, he considers the risk of catastrophic vascular events relatively limited, explaining, “Any other complication if you inject in these areas will most likely be the Tyndall effect, the malar oedema, lumps or fullness. They are all reversible.”3,24 Aesthetics | August 2026

Optimising periocular treatment All practitioners agree that the periorbital area remains one of the most anatomically complex regions to assess and treat, but also one that can effectively address significant patient concerns when approached appropriately.

Dr Bhojani-Lynch concludes, “Injector competence is built through practice and progressive learning, and no technique should be considered entirely without risk.

Even with strong anatomical knowledge some approaches are safer than others, making careful technique selection essential in the periorbital region.”

01 & 02 October 2026 Excel, London

The Aesthetics Challenge on Mastering Precision Injectables in the Periorbital Zone will be at the Aesthetics Journal Arena on Day 2 of the Clinical Cosmetic Regenerative Congress from 14:00-15:45.

Chairs include Dr Bhojani-Lynch and consultant ophthalmologist and oculoplastic surgeon Mr Richard Scawn. Injectors include Dr Naqvi, with more injectors to be announced soon.

Turn to p.17 to register now.

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 21

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PROFHILO® STRUCTURA™ Understanding Facial Changes Associated with Weight Loss: Looking Beyond the Skin The increasing use of GLP-1 medicines has transformed the way many people approach weight management. Alongside significant weight reduction, some individuals report noticing changes in their facial appearance, including increased hollowing, reduced facial support and alterations in facial contours.1 While weight loss can bring substantial health benefits, changes in facial structure may occur as fat compartments throughout the body reduce in volume. The face is no exception.

As adipose (fat) tissue changes, some individuals may perceive a loss of facial fullness, particularly within the mid-face and cheek area, contributing to a more hollow or less supported appearance.2

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PROFHILO® STRUCTURA™ and Adipose Tissue Restoration PROFHILO® STRUCTURA™ is indicated for facial treatment and restoration of adipose tissue. It contains hybrid cooperative complexes of high- and low-molecular-weight hyaluronic acid produced using IBSA’s proprietary NAHYCO® Technology.4 The product was developed specifically to address adipose tissue, making it distinct within the PROFHILO® portfolio.

According to IBSA materials, PROFHILO® STRUCTURA™ forms part of a broader bio-remodelling approach that considers deeper facial structures alongside skin quality.4 Treatment suitability should always be determined by an appropriately trained healthcare professional following a full consultation and assessment of the individual patient.

The Importance of Individual Assessment Not every patient experiencing facial changes following weight loss will have the same concerns or treatment goals. Factors such as age, facial anatomy, degree of weight loss and overall tissue quality can all influence treatment planning.

For this reason, a comprehensive consultation remains essential.

Healthcare professionals should assess facial structure, tissue characteristics and patient expectations before recommending any treatment approach.

Increasingly, practitioners are considering how both skin quality and deeper structural support contribute to overall facial appearance, recognising the importance of a tailored and patient-centred approach.

Clinical Evaluation PROFHILO® STRUCTURA™ reported a statistically significant increase in tissue thickness three months following treatment within the evaluated study population.

The study reported an increase of 23% compared with baseline measurement. Ninety-five percent of participants reported feeling improved or very improved following treatment.4

Understanding the Role of Facial Adipose Tissue Facial ageing and facial contour changes are influenced by multiple anatomical structures, including the skin, muscles, ligaments, bone and adipose tissue. Clinical understanding increasingly recognises that adipose tissue plays a significant role in maintaining facial support, shape and contour.3 Changes in facial fat compartments can contribute to a reduction in cheek projection, a flattening of facial angles and changes in overall facial definition.2 These changes may occur as part of the natural ageing process and may also be observed following significant weight loss.2 As a result, healthcare professionals are increasingly evaluating facial concerns through a multi-layered anatomical assessment rather than focusing solely on skin quality.

These findings relate to the study population evaluated and should not be interpreted as a guarantee of outcome. Individual results may vary and treatment suitability must always be determined through clinical assessment.

This advertorial was written and supplied by

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Aesthetics | August 2026

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CPD Complications

Managing Dermal Filler Complications Miss Jenny Doyle and Dr Arshi Baig explore the prevention and management of dermal filler complications, with a focus on vascular occlusion and contemporary evidence-based practice Dermal filler treatments have become one of the most frequently performed non-surgical aesthetic procedures worldwide, with hyaluronic acid (HA) fillers accounting for the majority of injectable soft tissue augmentation treatments due to their versatility, reversibility and favourable safety profile.1,2 Global demand for minimally invasive facial rejuvenation continues to rise, driven by increasing patient awareness, advances in filler technology and a growing emphasis on preventative and regenerative medical aesthetics.3

develop months or years after treatment and include inflammatory nodules, granuloma formation, filler migration and chronic oedema.10 An alternative severity-based classification (Table 1) may be more useful clinically, distinguishing mild aesthetic concerns requiring reassurance from serious vascular and ophthalmic emergencies requiring immediate intervention.8

Although dermal fillers are widely regarded as safe when administered by appropriately trained practitioners, complications remain an unavoidable aspect of clinical practice.4 Most adverse events are mild and self-limiting, including bruising, swelling and transient discomfort. However, severe complications such as vascular occlusion, tissue necrosis, visual impairment and cerebrovascular injury can occur and may result in permanent morbidity.5,6 Recent evidence has highlighted the potentially devastating consequences of filler-induced vascular events. The American Academy of Ophthalmology (AAO) Ophthalmic Technology Assessment reviewed 198 published cases of filler-induced vision loss and reported that vision remained unchanged in approximately 70% of affected patients despite treatment.6 Furthermore, concurrent cerebral infarction was identified in nearly one-fifth of reported cases, emphasising that filler embolisation may affect both the ophthalmic and cerebral circulation.6 In parallel with these developments, the Aesthetic Complications Expert (ACE) Group World and a multidisciplinary UK steering group recently published consensus recommendations for the management of tissue filler-induced vision loss, advocating improved complication preparedness, structured emergency referral pathways and explicit discussion of blindness and stroke during the consent process.7 These recommendations reflect an evolving understanding that successful complication management begins long before treatment is performed.

Contemporary management of dermal filler complications extends beyond emergency intervention and increasingly focuses on prevention, anatomical expertise, patient selection, informed consent and emergency preparedness.2,8 Practitioners must not only understand how complications occur, but also maintain the knowledge, equipment and clinical pathways required to manage them effectively should they arise.

Classification of dermal filler complications Dermal filler complications may be classified according to their timing of onset, underlying pathophysiology or clinical severity.4 Complications are commonly divided into immediate, early and delayed presentations. Immediate complications occur during treatment or within the first few hours and include pain, bruising, oedema, erythema, hypersensitivity reactions and vascular compromise.9 Early complications typically arise within days to weeks and include infection, herpes simplex virus reactivation, filler malposition and the Tyndall effect.10 Delayed complications may

Classification

Examples

Immediate

Pain, bruising, oedema, erythema, vascular occlusion

Early

Infection, herpes simplex virus reactivation, Tyndall effect, filler malposition

Delayed

Delayed inflammatory reactions, granulomas, biofilm-associated reactions, filler migration

Severe complications

Vascular occlusion, tissue necrosis, visual loss, stroke

Table 1: Classification of dermal filler complications.

Prevention The most effective strategy for managing dermal filler complications is prevention.8 Patient selection A comprehensive medical history should be obtained before treatment to identify factors that may increase complication risk.3 Particular attention should be paid to:

· · · · ·

Previous filler treatments Previous filler complications Autoimmune disease Immunosuppression Active infection

· Dental infection · History of herpes

simplex virus · Previous hypersensitivity reactions

Patients presenting with active bacterial, viral or fungal infection at or near the treatment site should generally defer treatment until the infection has resolved.10 Likewise, untreated dental disease may increase the risk of delayed inflammatory complications through bacterial seeding and should be addressed before treatment where possible.9 Psychological assessment forms an equally important component of patient selection. Unrealistic expectations, body dysmorphic disorder and excessive treatment-seeking behaviour have all been associated with dissatisfaction and poorer patient outcomes.8 Anatomical knowledge Detailed understanding of facial vascular anatomy remains one of the most important determinants of safe filler practice.11 Most severe filler complications arise secondary to vascular injury or inadvertent intravascular injection, making anatomical expertise fundamental to risk reduction.5 The extensive anastomotic network between branches of the internal and external carotid arteries explains how filler emboli

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may travel retrogradely and subsequently enter the ophthalmic circulation.11 Particular caution should therefore be exercised when treating high-risk anatomical regions including the glabella, nose, forehead, temple and nasolabial fold.5 The AAO review demonstrated that the nose accounted for 40% of reported cases of filler-induced blindness, followed by the forehead (25%), glabella (12%) and temple (9%).6 These data reinforce the importance of anatomical awareness when treating the upper and central face.

Injection technique Although no injection technique completely eliminates the risk of vascular injury, several evidence-based strategies have been proposed to minimise the likelihood of inadvertent intravascular injection or reduce the severity of vascular compromise should it occur.3,8 Slow injection Injecting filler slowly reduces injection pressure within the syringe and surrounding tissues, decreasing the force required to propel filler into the vascular system should inadvertent intravascular placement occur.8 Experimental studies suggest that lower injection pressures are less likely to overcome arterial systolic pressure and generate retrograde embolisation, thereby reducing the risk of distal vascular occlusion.5,12 Low extrusion pressure Excessive thumb pressure during injection increases the force delivered through the needle or cannula and may facilitate retrograde movement of filler within the arterial tree.13 Maintaining gentle, controlled extrusion pressure may therefore reduce the volume and distance of embolisation should vascular entry occur.3 Small-volume aliquots Delivering filler in small incremental aliquots rather than large bolus injections limits the amount of product deposited at any one time.1 If inadvertent intravascular injection occurs, a smaller embolic volume is theoretically less likely to occlude multiple arterial branches and may reduce the extent of tissue ischaemia. Small aliquots also reduce bolus pressure, which is a key determinant of arterial entry.2,3 Continuous needle or cannula movement Injecting while continuously withdrawing or advancing the needle or cannula reduces the duration for which the tip remains within a single anatomical location, thereby decreasing the likelihood of depositing a large volume of filler directly into an artery.8 Although this technique does not prevent vascular entry, it may reduce the total intravascular filler load if penetration occurs.4 Appropriate depth selection Knowledge of facial anatomy allows practitioners to inject within tissue planes where major vessels are less likely to be encountered.11 However, vessel depth varies considerably between facial regions and individuals, meaning no injection plane can be considered completely risk-free.3,11 Careful selection of injection depth should therefore be combined with other risk-reduction strategies rather than relied upon in isolation.

Avoidance of large bolus injections in high-risk areas Large bolus injections may generate higher local tissue pressures and deliver greater filler volumes into the vascular system if inadvertent arterial cannulation occurs.13 High-risk anatomical regions, including the glabella, nose, forehead and temple, contain direct or indirect anastomoses with the ophthalmic artery, increasing the risk of retinal embolisation and vision loss.5,6 Incremental filler placement with repeated reassessment is therefore recommended in these areas.8 Needle vs. cannula Blunt-tipped cannulas are often advocated because they may 26

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displace vessels rather than penetrate them, potentially reducing the incidence of arterial cannulation in selected anatomical regions.14 Nevertheless, vascular occlusion has been reported following both needle and cannula injections, demonstrating that neither technique completely eliminates risk.5 Informed consent Informed consent represents a critical component of complication prevention and patient-centred care.2 Patients should be counselled regarding common adverse effects such as bruising, swelling, tenderness and transient discomfort, as well as less frequent complications including infection, delayed inflammatory reactions, vascular occlusion and tissue necrosis.4,5 Recent UK consensus guidance has recommended that all patients undergoing filler treatment should be informed of the rare but potentially devastating risks of blindness and stroke during the consent process.7 Although these complications remain exceptionally uncommon, their severity warrants explicit discussion prior to treatment.6 The AAO review identified concurrent cerebral infarction in approximately 19% of reported cases of filler-induced vision loss, highlighting the potential for both ophthalmic and neurological injury following inadvertent vascular embolization.6 Consequently, consent discussions should include the possibility of visual impairment, permanent blindness and cerebrovascular complications.

Patients should also be advised to report any severe pain, blanching, visual disturbance or neurological symptoms immediately following treatment, as early recognition may improve outcomes.7

Emergency preparedness and clinical governance Complication preparedness is increasingly recognised as a core component of safe aesthetic practice.2 Every practitioner performing dermal filler treatments should maintain a structured complication management protocol, such as the ACE Group World Guideline and have immediate access to appropriate emergency medications and equipment.15,16 Traditional emergency kits focus primarily on vascular occlusion and typically include hyaluronidase, sterile saline, aspirin and written treatment algorithms.16 However, recent UK consensus recommendations have expanded preparedness requirements to include ophthalmic emergencies.7 Clinics performing filler treatments should consider maintaining a dedicated vision-loss emergency kit containing.7

· · · ·

Timolol 0.5% eye drops Aspirin 300 mg Written emergency protocols Paper bag for rebreathing

· Hyaluronidase (minimum 7500 IU available)

· Emergency department and ophthalmology contact details

Practitioners should establish predefined referral pathways to facilitate immediate transfer of patients with suspected visual compromise to the nearest emergency department.7

Vascular occlusion and contemporary management Vascular occlusion remains the most serious acute complication associated with dermal filler treatment because delayed recognition may result in tissue necrosis, permanent scarring, blindness and, in rare cases, cerebrovascular injury.5,8 Although the overall incidence remains low, the growing number of filler procedures performed worldwide means that all injectors should be prepared to recognise and manage vascular compromise promptly.16 Vascular compromise may occur through either direct intra-arterial injection or external compression of blood vessels by filler material and associated tissue oedema.4 Intra-arterial injection is generally associated with more severe outcomes because embolic obstruction may completely interrupt distal tissue perfusion.17

Aesthetics | August 2026

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Recognition of vascular occlusion Early recognition remains the single most important determinant of successful treatment.16,18 The classical presentation includes:2,16

· Immediate blanching · Severe or

disproportionate pain · Delayed capillary refill

· Cool skin temperature · Reticulated livedo pattern · Progressive dusky discolouration

The pattern of skin change often corresponds to the vascular territory involved and may extend considerably beyond the original injection site.16 Importantly, pain may occasionally be absent and should not be considered a prerequisite for diagnosis.2 Any suspicion of vascular compromise should prompt immediate intervention rather than observation.18 Capillary refill assessment Capillary refill assessment remains one of the most valuable clinical tools during management of suspected vascular occlusion.16 Gentle pressure is applied to the affected skin until blanching occurs, after which the clinician observes the speed of colour return. Delayed refill suggests ongoing tissue hypoperfusion and may indicate persistent vascular obstruction.18 Repeated assessment throughout treatment provides an objective measure of response and helps guide decisions regarding repeat hyaluronidase administration.16 Immediate management Once vascular compromise is suspected: 1. Stop injecting immediately 2. Assess the extent of tissue involvement 3. Mark and photograph the affected area 4. Assess capillary refill 5. Commence hyaluronidase treatment without delay 6. Apply adjunctive measures 7. Arrange close follow-up

CPD Complications

treatment typically involves infiltration of 450-1500 IU throughout the affected tissue and along the course of the involved vessel. Massage and local heat are recommended adjunctive measures, followed by reassessment after one hour. If capillary refill remains impaired, repeat treatment may be administered at hourly intervals for up to four cycles.16 These recommendations closely align with CMAC and international consensus guidance advocating repeated high-dose treatment based upon clinical response rather than arbitrary maximum dosing.7,16,18

Adjunctive therapies Adjunctive therapies are commonly incorporated into the management of vascular occlusion.

Massage and heat Massage and the application of local heat continue to be recommended as adjunctive measures in the management of HA filler-induced vascular occlusion.16,18 Massage is thought to mechanically disperse filler material and facilitate redistribution of embolic product within the affected tissues, while local heat may promote cutaneous vasodilatation and increase regional blood flow.8,13 Despite their widespread inclusion in consensus protocols, robust clinical evidence supporting the independent effectiveness of either intervention is lacking. No prospective or randomised studies have demonstrated that massage or local heat alone improve tissue survival or reduce the incidence of necrosis following vascular occlusion.2 Contemporary guidance consistently emphasises that these measures must not delay or replace prompt administration of high-dose hyaluronidase, which remains the cornerstone of treatment for HA filler-induced vascular compromise.16,18 Aspirin

Hyaluronidase Hyaluronidase is an enzyme that hydrolyses HA through cleavage of glycosidic bonds within the HA polymer.19 It remains the only targeted pharmacological treatment capable of directly reversing HA filler-induced vascular compromise.8 Mechanism of action Hyaluronidase degrades both endogenous and exogenous HA, reducing filler volume and facilitating restoration of blood flow when vascular obstruction is caused by HA filler.19 Enzymatic activity occurs rapidly, although repeat administration may be required due to the persistence of highly cross-linked filler products and the relatively short tissue half-life of the enzyme.16 Timing of administration Current evidence supports the earliest possible administration of hyaluronidase when vascular compromise is suspected.18 Treatment should not be delayed while awaiting progression of symptoms because irreversible tissue injury may occur within hours of arterial occlusion.3,13 Numerous case reports have demonstrated successful tissue salvage following prompt intervention, even in extensive vascular occlusions.16

Aspirin is frequently included in treatment algorithms due to its antiplatelet effects and theoretical ability to reduce secondary thrombosis.8 Most contemporary protocols recommend administration of 300mg provided no contraindications exist.16 Important contraindications include hypersensitivity to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), active gastrointestinal ulceration or bleeding, bleeding disorders (including haemophilia and thrombocytopenia), severe hepatic impairment and aspirin-exacerbated respiratory disease, and concurrent anticoagulation where the risk of bleeding may outweigh potential benefit.20 Clinicians should also exercise caution in patients with uncontrolled hypertension or a history of haemorrhagic stroke because of the increased risk of bleeding.21 Nitroglycerin paste Nitroglycerin was historically advocated due to its vasodilatory properties.13 However, recent guidance no longer recommends routine use because vasodilatation alone does not address embolic obstruction and theoretical concerns remain regarding distal embolisation.2 Ultrasound-guided management High-frequency ultrasound is increasingly being incorporated into aesthetic practice and complication management.22 Ultrasound allows:

ACE Group World and CMAC recommendations

· Visualisation of filler location · Identification of

The ACE Group World protocol recommends reconstituting Hyalase using 1-5ml diluent, with dilution in 2ml bacteriostatic saline commonly used during management of vascular compromise. Initial

Ultrasound-guided dissolution may improve treatment precision and reduce unnecessary filler degradation.22

vascular structures

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· Assessment of nodules · Guidance of

hyaluronidase treatment

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CPD Complications

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Ophthalmic complications and vision loss Vision loss remains the most feared complication of dermal filler treatment because it is sudden, potentially irreversible and frequently associated with profound psychological distress for both patient and practitioner.5,7 The AAO Ophthalmic Technology Assessment reviewed 198 published cases of filler-induced vision loss and represents the largest evidence synthesis currently available.6 HA accounted for 83% of reported cases, whilst autologous fat accounted for 15%.6 Clinical presentation Patients may present with:7

· Sudden visual loss · Blurred vision · Visual field defects

· Diplopia · Ocular pain · Loss of colour vision

Ptosis and ophthalmoplegia are also common features.7 Approximately 19% of reported cases demonstrate concurrent cerebral involvement, highlighting the need to assess for stroke-like symptoms.6 Immediate community management The 2026 UK Consensus Guidelines recommend immediate transfer to the nearest emergency department without delay.7 While awaiting transfer, clinicians may initiate:

· Ocular massage · Timolol 0.5% eye drops

· Aspirin 300mg · Paper-bag rebreathing

Provided these measures do not delay definitive assessment.7 Clinics should maintain a dedicated vision-loss emergency kit and ideally have access to at least 7500 IU of hyaluronidase.7 Role of hyaluronidase for retinal arterial occlusion Unlike cutaneous vascular occlusion, evidence supporting hyaluronidase for retinal arterial occlusion remains limited.6 A systematic review underpinning the 2026 UK Consensus Guidelines identified 17 published cases in which retrobulbar hyaluronidase was administered for filler-induced vision loss. Of these, only three patients (17.6%) demonstrated any improvement in visual function, while 14 patients (82.4%) experienced no measurable visual recovery, highlighting the limited evidence supporting this intervention.7 Consequently, retrobulbar hyaluronidase cannot currently be recommended as a reliably effective treatment for filler-induced retinal ischaemia.

Nevertheless, the UK consensus group concluded that periocular or retrobulbar hyaluronidase may still be considered in carefully selected patients. However this should be performed by clinicians with specific training and experience in periocular or retrobulbar injection techniques, such as ophthalmologists or oculoplastic surgeons, as the procedure carries relatively low procedural risk and isolated cases of visual recovery have been reported.7

Delayed complications Delayed complications are defined as adverse events presenting weeks to months after dermal filler injection.

Delayed inflammatory reactions Delayed inflammatory reactions (DIRs) are among the most diagnostically challenging filler complications because they may occur weeks, months or even years after treatment.10 Patients typically present with swelling, erythema, tenderness and inflammatory nodules affecting previously treated areas.9,10 The pathogenesis remains incompletely understood but is thought to involve a complex interaction between filler material, host immunity and bacterial contamination.10 Triggering events may include 28

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systemic infection, dental treatment, trauma, vaccination and other forms of immune activation.23 The emergence of delayed inflammatory reactions following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccination has further highlighted the immunological basis of these complications.23 Management begins with differentiation between inflammatory and infective causes.

Hyaluronidase frequently forms part of treatment because removal of the triggering HA substrate may reduce ongoing inflammation.4 Where infection is suspected, broad-spectrum antibiotics should be considered before corticosteroid therapy is initiated.10 Nodules Nodule formation is a recognised delayed complication of dermal filler treatment.

Non-inflammatory nodules Non-inflammatory nodules are typically caused by superficial filler placement, product accumulation or overcorrection.9 Patients generally present with visible or palpable lumps in the absence of tenderness, erythema or swelling.10 Management options include observation, massage, needle disruption and targeted hyaluronidase administration where HA fillers are involved.4 Inflammatory nodules Inflammatory nodules are characterised by erythema, tenderness, swelling and induration.10 Differential diagnoses include delayed hypersensitivity reactions, granuloma formation and infection.9 Current consensus guidance recommends a staged approach involving exclusion of infection, selective use of antibiotics and consideration of hyaluronidase where appropriate.10 High-frequency ultrasound may assist diagnosis and treatment planning by identifying filler location and differentiating inflammatory from non-inflammatory pathology.22 Infection and biofilms Infectious complications are uncommon but potentially serious adverse events associated with dermal filler treatment.9 Clinical features may include:

· Pain · Erythema · Warmth

· Swelling · Fluctuance · Abscess formation

Most infections result from bacterial contamination during injection, although haematogenous spread from distant sites has also been described.10 Biofilms are structured communities of microorganisms embedded within a protective extracellular matrix and have been proposed as a potential mechanism underlying some delayed filler complications.9 Although their precise role remains debated, biofilms may explain recurrent inflammatory episodes occurring months or years after treatment.10 Management depends upon clinical severity and may include antibiotics, drainage, microbiological investigation and hyaluronidase where indicated.3 Hypersensitivity reactions True allergic reactions to modern HA fillers remain uncommon because HA is highly conserved across species and exhibits low intrinsic immunogenicity.19 Clinical presentations range from mild localised swelling to diffuse oedema and, rarely, angioedema.4 Mild reactions may be managed conservatively with observation and antihistamines, whereas more significant reactions may require corticosteroid therapy and specialist review.3 Although exceedingly rare, clinicians should remain prepared to recognise and manage anaphylaxis in accordance with established emergency protocols.4

Aesthetics | August 2026

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CPD Complications

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Tyndall effect and product misplacement The Tyndall effect occurs when superficially placed HA filler scatters light through thin overlying skin, producing a characteristic blue-grey discoloration.9 The tear trough is the most commonly affected anatomical region owing to its thin skin and limited soft tissue coverage.4 Prevention relies upon appropriate product selection, correct injection depth and conservative volumisation.3 Once established, hyaluronidase remains the treatment of choice because it directly removes the causative filler material.19

available within medical aesthetics when administered by appropriately trained clinicians.1 Nevertheless, the increasing recognition of vascular, ophthalmic and neurological complications highlights the importance of prevention, anatomical expertise and emergency preparedness.6 Prevention remains the most effective strategy for reducing adverse outcomes and begins with careful patient selection, detailed anatomical knowledge, informed consent and meticulous injection technique.2

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Future directions in complication management The management of filler complications continues to evolve alongside advances in imaging technology, anatomy research and emergency care pathways.11 Ultrasound-guided practice High-frequency ultrasound is increasingly being integrated into routine aesthetic practice.22 Beyond complication management, ultrasound may facilitate safer injections through improved visualisation of facial vasculature and filler placement.22

Questions 1. Which of the following is the most appropriate first action when vascular occlusion is suspected during filler treatment?

Artificial intelligence and digital planning

Three-dimensional facial imaging systems, including stereophotogrammetry and structured-light scanners such as the Vectra 3D Imaging System (Canfield Scientific), enable detailed assessment of facial morphology and volume changes before and after treatment. These technologies may improve procedural planning by quantifying facial asymmetry, identifying age-related volume loss and facilitating objective outcome assessment.11 More recently, high-frequency ultrasound has emerged as one of the most promising technologies for improving patient safety. Beyond complication management, ultrasound allows real-time visualisation of facial vasculature, filler location and tissue planes, enabling clinicians to identify high-risk anatomical structures before injection and perform ultrasound-guided filler placement or hyaluronidase administration where appropriate.22 Machine learning algorithms capable of integrating facial imaging with anatomical datasets have also been proposed to predict high-risk injection zones and assist clinicians in selecting safer injection planes, although these technologies remain largely investigational and require further clinical validation.11 While many of these technologies remain in the early stages of clinical adoption, their integration into routine aesthetic practice has the potential to improve procedural planning, enhance patient education, standardise outcome assessment and further reduce the incidence of treatment-related complications.

Standardised emergency pathways The publication of the UK Consensus Guidelines for tissue filler-induced vision loss represents an important step towards standardised complication management.7 Future development of national referral pathways, emergency kits and complication training programmes may further improve patient outcomes.

The importance of prevention Dermal fillers remain among the safest and most versatile tools

2. According to the AAO review, which anatomical site was most commonly associated with filler-induced blindness?

3. What is currently considered the cornerstone treatment for HA filler-induced vascular occlusion?

a. Apply ice immediately b. Administer antibiotics c. Stop injecting and assess tissue perfusion d. Arrange a review in 24 hours e. Inject additional filler a. Lips b. Temple c. Nasolabial fold d. Nose e. Chin a. Hyperbaric oxygen b. Aspirin c. Corticosteroids d. Hyaluronidase e. Nitroglycerin paste a. Bruising

4. Which complication may occur months or years after treatment?

b. Vascular occlusion c. Delayed inflammatory reaction d. Immediate hypersensitivity e. Acute infection

5. According to the UK Consensus Guidelines, patients should be specifically consented regarding the rare risks of:

a. Hyperpigmentation and bruising b. Blindness and stroke c. Swelling and tenderness d. Herpes simplex virus and oedema e. Tyndall effect and asymmetry Answers: C,D,D,C,B

Advances in digital imaging, artificial intelligence (AI) and three-dimensional (3D) facial analysis are expected to play an increasingly important role in medical aesthetics over the coming decade. AI-assisted facial assessment software is already being explored for automated facial landmark detection, volumetric analysis, facial symmetry assessment and objective treatment planning, providing clinicians with reproducible baseline assessments and treatment simulations.11

Possible answers

Miss Jennifer Doyle is a consultant oculoplastic surgeon and founder of The Clinic at Holland Park. She also works within the NHS as an oculoplastics consultant at Milton Keynes University Hospital NHS Trust. She has several years of experience integrating aesthetic and non-surgical treatments into her practice. She is a key opinion leader for Ameela, Sciton, Sofwave and Skinstorm.

Qual: BMBCh, MA(OXON), L7Cert, FRCOphth Dr Arshi Baig is a resident doctor who completed her foundation training within the NHS in the Oxford Deanery. She has a keen interest in oculoplastic surgery and medical aesthetics and has undertaken a fellowship in this field at The Clinic at Holland Park. In August 2026, she will begin her ST1 ophthalmology training post within the East of England Deanery.

Qual: MBChB, BSc

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Case Study Periocular PRP

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Platelet-Rich Plasma in the Periocular Area Dr Bhavik Shah and Dr Munir Somji explore the effectiveness of PRP in the management of the periocular area Skin health is of particular interest to clinicians and patients within the field of medical aesthetics as it represents a key marker of ageing. Skin ageing has a dualistic effect on our general health in that it serves as a physical barrier to external factors, and has a direct impact on one’s self esteem, mental status and overall quality of life as a result of its visibility.1,2 Statistics show that the demand for skin rejuvenation and regenerative treatments continues to grow year on year, encompassing the use of skin boosters (+8%), polynucleotides (+63%), biostimulators (+14%) and platelet-rich plasma (PRP +6%) therapies.3,4 In addition to this, there has been a rise in patients seeking ‘natural’ alternatives to the ‘synthetic’ products on the market, in particular the ability of certain treatments to modulate the body’s own cells to improve both skin and hair conditions.5 Periocular (PO) skin is notably thinner than skin in other facial regions and contains fewer sebaceous and sweat glands, which reduces its capacity to retain moisture and predisposes to impaired barrier function.6 Consequently, PO skin is more susceptible to the early manifestations of cutaneous ageing.6

Periocular ageing Periocular ageing (POA) and its associated rejuvenation (POR) remains one of the most sought after areas to have treated by patients. It represents a complex and dynamic region of the face which is directly linked to one’s quality of life (QoL) and self-perception.6-9 Early signs of POA can include rhytide formation, loss of elasticity of skin, darkening and hollowing of the PO, with volumetric changes in fat pads becoming apparent in moderate-to-severe cases.9-11 A brief overview of POA starts with changes to the bony infrastructure of the orbit, over time resorption is observed in the inferiolateral and superiomedial direction.12 This leads to reduced support of the overlying fat pads, retro orbicularis oculi fat pad (ROOF) and sub orbicularis oculi fat pad (SOOF), musculature (orbicularis oculi) and the skin itself.10 The musculature (orbicularis oculi) within the region becomes more active, leading to the production of lateral canthal lines, initially dynamic in nature and eventually static.6 The skin undergoes both intrinsic and extrinsic ageing9 with hallmark features including a thinning of the epidermis, reduction in fibroblast density, increase in melanocyte activity and reduction of glucosaminoglycans (GAGs) within the extracellular matrix (ECM) and associated loss of collagen production leading to the quintessential early symptoms of POA – formation of rhytides, loss of elasticity and hydration.13-15

Mechanism of action PRP refers to a solution derived from the platelet fraction of autologous blood, obtained via centrifugation to isolate in high concentrations (higher than baseline) platelets, their associated growth factors (GFs) and platelet-derived exosomes (PDEs) with the inclusion/disclusion of leukocytes and fibrinogen depending on the system used and treatment indications.16,17 32

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Platelets are cytoplasmic fragments present within the blood stream containing a host of bioactive proteins primarily involved in the wound and tissue repair response. GFs such as platelet-derived growth factor (PDGF), transforming growth factor (TGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), transforming growth factor (TGF-β), vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1) are amongst the most potent and important bioactive proteins found within PRP concentrates.16,18,19 It should be noted that PRP concentrates contain ~ 3-5x GFs than whole blood (WB) due to an enhanced platelet concentration and activation. The downstream effects of GF release are angiogenesis, increased fibroblast migration (up to 200%) and ECM remodelling being relevant features to POR.20-22 PDEs function as intracellular nano vesicles that can aid in the transport of GFs at high concentrations across the ECM where the therapeutic effects of PRP can be propagated within the treatment region.16 The selective inclusion of fibrinogen maturing into a fibrin mesh within the treatment site can perpetuate fibroblast migration to the area by up to 350%.20,23 Certain evidence has demonstrated the ability to mediate periocular hyperpigmentation (POH) via the downregulation of tyrosinase activity however the evidence base for this particular indication remains weak.24-26 The culmination of these mechanisms being an improvement in the surface texture and tone of skin whilst reducing the appearance of wrinkling, an effect owed to GFs ability to stimulate collagen synthesis and angiogenesis.27

Current interventions Current POR interventions are aimed as monotherapies or conjunctive treatments to address all layers of the PO depending on the severity of symptoms.28,29 Fat pad atrophy requires volumisation via the use of hyaluronic acid (HA)-based dermal fillers or autologous fat transfers whilst increased muscular activity can be modulated via the use of botulinum toxin type A (BoNT-A) injections.2,8,28,30 However, the skin can be treated by the use of energy-based devices (EBDs) or injectables, with combination therapies showing the most promise.8,29,31,32 Suitable injectables for POR include non-crosslinked HA skin boosters (Sunekos 200, Croma Revitalis, Teosyal Redensity 1), polynucleotides (PolyPhil/Plinest) and PRP (Exprecell/Arthrex/Meta Cell Technology (MCT) discluding volumising agents.12,28,33 Recent notable advances in PRP therapies include Fluid PRF (Exprecell System) and Photothermal-Bioactivated PRP (MCT system). Fluid PRF incorporates inactivated fibrinogen to create a liquid, injectable form of PRF that matures in situ after injection.23 This allows fibrin formation at the treatment site, enhancing fibroblast migration and delaying the initial GF release, resulting in longer-lasting, sustained release profile that appears beneficial for skin rejuvenation.30,34 PTBA-PRP involves photothermal activation of the PRP solution proposed to condition the media and increase protein synthesis, GF production and enhance exosome secretion without cytotoxic effects.35,36

Patient assessment and protocols Noteworthy assessment scales that complement clinical photography include, but are not limited to, FACE-Q Eye Module and Photonumeric Under-Eye Line Severity Scale (PULS) alongside digital imaging tools such as VISIA and Alma IQ.37,38

Aesthetics | August 2026

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Patients presenting with mild topographical symptoms of photoageing, wrinkling and uneven skin texture benefit the most from monotherapy. In addition to this, those seeking maintenance of their current skin profile can benefit from the antiageing effects of PRP.14,16,23,24 For the purpose of POR, PRP can be effectively used as a monotherapy to treat mild rhytides and POH.9,24,25,27 It is important to understand the underlying cause and to disclude tear trough hollowing as volume replacement in this region is best served by HA-based dermal fillers or autologous fat transfers.39 Moderate-to-severe ageing of the PO involving increased aperture of the orbit and/or herniation of the ROOF/SOOF requires a combination approach.8,10,22 Prospective evidence-based protocols outline the following:24-26,41-45

· · · · ·

Venepuncture: ~ 10-20ml of WB

Case Study Periocular PRP

The most noted adverse effects are localised oedema and ecchymosis,50,51 both of which are self-limiting and subside readily, appropriate patient assessment and injection technique can help mitigate these effects.42 Absolute contraindications to PRP therapies include critical thrombocytopaenia, haemodynamic instability and anti-coagulation therapies.51

Case study A 43-year-old female patient presented with mild crepiness and photoageing in the PO with no history of injectable interventions.

Treatment plan Before

After

40

Centrifugation depending on system (RPM x Minutes) Technique: Subdermal cannula26,42 or intradermal nappage25,43,45 Volume injected: 2-4ml25,42 Frequency of treatments: Three sessions spaced four weeks apart initially41,42,45

· Maintenance window: Therapeutic window of three to six months25,44,45

Evidence base The evidence base surrounding the use of PRP and its analogues for POR remains promising, ranging from Oxford Centre for Evidence-Based Medicine levels 2-4 with the majority of primary studies (including split-face randomised controlled trials) demonstrating statistically significant improvements in skin wrinkling, skin texture and POH.24,25,42-44 Both the use of single and multi-session protocols have been described with both demonstrating statistically significant improvements to photoageing parameters, the latter showing superior efficacy and an extended therapeutic window.43,45,46 Within the literature, stand-alone studies do exist that counter these results, stating that no significant differences have been observed.44,47 However, they are based on subjective reporting on clinical photography as opposed to histological and digital based parameter measurements.

A recent META-analysis encompassing 19 primary studies summarised that PRP for POR demonstrates histological improvements in photoageing parameters whilst scoring highly on patient satisfaction questionnaires.25,44,47,48 The lack of long-term follow-up periods within these studies, often limited to six months at a maximum, does make it difficult to infer the true therapeutic window of PRP treatments. In addition, the lack of standardisation in protocols, including the volume of PRP injected, the injection plane and technique and the preparation system used, may confound the assessment of treatment efficacy.27 Variations in PRP preparation remain a confounding factor with centrifugation speed, time and temperature all having a distinct effect on the final composition.8,41,48 As a result PRP system classifications can aid clinicians in their judgement and choice of device whilst helping to standardise PRP production.49

Safety and contraindications PRP is immunologically neutral and poses little risk of foreign-body reactions, hypersensitivity (often owed to components of the device itself) or allergies. Sterile technique is always required when carrying out venepuncture and PRP preparation with aseptic technique during the treatment itself.27

Figure 1: 43-year-old female patient at baseline and five months after three sessions of Exprecell Fluid PRF.

The treatment was initially planned as monthly sessions; the first two were delivered four weeks apart, with the final session performed at five months due to patient availability. A total of 2ml Exprecell Fluid PRF was injected per eye at each session, using a combination of subdermal cannula (25G 38mm) placement with intradermal nappage. Baseline and follow up clinical photographs (January to May) and VISIA scans were obtained. VISIA imaging demonstrated a reduction in deep rhytide formation around the PO area, while clinical photography showed an improvement in mild PO hollowing and static rhytides (Figure 1). Maintenance treatments were scheduled at four-to-six-month intervals.

Standardising protocols PRP and its analogues remain a viable regenerative treatment.

Contention remains around standardising protocols to achieve reproducible results with appropriate patient assessment and choice of system being the cornerstone of success.

Dr Bhavik Shah holds a bachelor’s degree in dentistry and a masters in Cosmetic and Aesthetic Medicine. He has undertaken a year of maxillofacial training and now works as an aesthetic practitioner at the DrMediSpa clinics. His clinical practice encompasses combination therapies with a focus on periocular rejuvenation.

Qual: BDS, MSc Dr Munir Somji is a cosmetic surgeon and co-founder of the DrMediSpa clinic group and Dr Somji Pro-Active Skincare. He is a key opinion leader and educator having lectured at King’s College London and global specialty conferences including CCR 2025.

Qual: BSc, MBBS, MRCS, PGCert, MISHRS

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P OW E R E D

BY

THE DISRUPTIVE INNOVATION IN HA INJECTABLES IN THE LAST DECADE* Better preserves the long-chain HA structure1 Proven Safety Profile2 Consistent Outcomes3,4,5,6 Natural-looking Results3,4,5,6

*An innovative technology, first-generation cold technology HA developed by Symatese since its last innovation launched.

REFERENCES 1. Data on file. SY-CLIN-031. SY-CLIN-032. SY-CLIN-033. SY-CLIN-034 / 2. IFU Estyme® SMOOTH, IFU Estyme® LIPS, IFU Estyme® FORM, IFU Estyme® SCULPT / 3. Kaminer, M.S. et al. Long-term Safety and Effectiveness of Cold-Crosslinked Hyaluronic Acid Fillers: Multicenter, Randomized, Controlled, Double-Blind Study. Aesthet Surg J. 2025 Jul 15;45(8):842-849 - CLIN 2101/ 4. Lheritier, C. et al. Efficacy of a New Hyaluronic Acid Dermal Filler on Nasolabial Folds Correction: A Prospective, Comparative, Double-Blinded Clinical Trial. Dermatol Surg. 2024 Aug 1;50(8):746-751 - CLIN 1701/ 5. Converset, S. et al. Lip Enhancement and Perioral Area Correction With New Hyaluronic Acid Dermal Fillers: A Prospective Safety Study. Aesthet Surg J Open Forum. 2025 Aug 29;7:ojaf101 - CLIN 1901/ 6. Munavalli, G., Cosmetic Boot Camp 2025 Presentation, Aspen, CO

SCAN FOR MORE INFORMATION

Actual patient. Results may vary.

INDICATIONS AND IMPORTANT SAFETY INFORMATION ESTYME® is indicated for non-medical purpose (aesthetic use only). ESTYME® shall only be administered by appropriately trained healthcare professionals who are qualified or accredited in accordance with national law in injection techniques for the modification of facial anatomy. ESTYME ® SMOOTH is indicated to correct nasolabial folds and perioral lines. ESTYME ® SMOOTH is injected into the dermis to hypodermis. ESTYME® LIPS is indicated to correct the volume and the shape of the lips. ESTYME® LIPS is injected into the dermis, hypodermis and labial mucosa. ESTYME® FORM is indicated to correct nasolabial folds. ESTYME® FORM is injected into dermis to hypodermis. ESTYME® SCULPT is indicated to restore cheek volume loss. ESTYME® SCULPT is injected into hypodermis and supraperiosteal. ESTYME® is used in adult patients excluding pregnant and breastfeeding women. ESTYME® is not to be used in persons who are less than 18 years old. Note that due to limited clinical data, caution should be exercised when planning to use ESTYME® on: Male. Population aged from 18 to 24 years old and older than 83.

Adverse events should be reported to Evolus International Ltd at medicalinformation@evolus.com or 08000541302.

The most common side-effects are injection site reactions (swelling, tenderness/pain, firmness, bruising, lumps/bumps, redness, itching, discoloration). Most of these reactions disappear spontaneously after a few hours or days without any treatment. To learn more about serious but rare side effects, or if you are concerned about any risks, contact your healthcare professional.

Evolus, Inc., 520 Newport Center Drive, Suite 1200, Newport Beach, CA 92660 ©2026 Evolus, Inc. All rights reserved. All trademarks are the property of their respective owners. June 2026 I GB-P-2600073

Menopause Combined Protocol

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Aesthetics

Addressing Menopausal Patients with Injectables Dr Oscar Redman outlines a protocol of PLLA and HA fillers to treat menopausal patients Menopause is associated with a profound and measurable decline in skin quality, driven primarily by falling oestrogen levels and the subsequent loss of collagen, dermal volume and hydration.1 Within this evolving landscape, there has been a notable and sustained increase in demand for regenerative and collagen-stimulating treatments.2 Modalities such as polynucleotides (PDRN/PNs), radiofrequency microneedling and biostimulators – including poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) – have gained considerable traction, precisely because they target the root cause of menopausal skin deterioration – the loss of collagen, dermal density and tissue vitality.2 Alongside these, hyaluronic acid (HA) dermal fillers continue to play an integral role in addressing the volumetric deficit and structural changes that oestrogen withdrawal precipitates, particularly in the mid-face and perioral region.3

Menopause-related skin changes Menopause represents one of the most significant physiological transitions in a person’s life, typically occurring between the ages of 45-55 and defined clinically as the cessation of menstruation for twelve consecutive months.4 At its core, menopause is driven by a marked decline in ovarian function and the subsequent reduction in circulating oestrogen and progesterone.4 While the systemic effects are well-documented, including vasomotor symptoms, mood disturbance and changes in bone density, it is the cutaneous consequences of this hormonal withdrawal that are of particular relevance to the aesthetic practitioner.5 Oestrogen plays a fundamental role in the maintenance of skin integrity.1 It stimulates fibroblast activity, supports collagen and elastin synthesis, promotes dermal hydration through the upregulation of HA production and contributes to the regulation of sebaceous gland function.1 As oestrogen levels fall during the periand post-menopausal periods, the skin undergoes a cascade of structural changes.1 Studies have demonstrated that approximately 30% of dermal collagen is lost within the first five years following menopause, with a continued decline of around 2% per year thereafter.6,7 36

Clinically, this manifests as increased skin laxity, pronounced fine lines, reduced dermal volume, diminished skin thickness, impaired barrier function and a loss of the skin’s characteristic luminosity.8 Patients frequently describe their skin as appearing dull, crepey or deflated – a presentation that is both physiologically driven and emotionally significant.9 As the evidence base matures and the field calls for more deliberate research into outcomes stratified by menopausal and hormone-replacement therapy (HRT) status, practitioners are encouraged to approach this growing patient group with the rigour and individualisation that defines best practice across all areas of aesthetics.9

Patient suitability and treatment indications The standard patient presenting with skin changes and concerns surrounding menopause typically falls within the 45-60 age range. This encompasses both the peri- and post-menopausal phases, though individual variation in the onset and severity of hormonal change means that chronological age alone is an insufficient guide to suitability.

Menopausal patients who have only minor volume loss and/or have retained firm, bouncy and radiant skin may not require a full combined approach, and this should be assessed on a patient-by-patient basis.

No two patients presenting with menopausal skin changes are the same, and the extent of skin concerns, laxity, volume loss and tissue quality can vary considerably depending on factors such as age, time since menopause, lifestyle and use of HRT.10 As HRT helps maintain oestrogen levels, it may influence the degree of collagen preservation and tissue quality observed in post-menopausal patients. Consequently, clinicians should consider both the timing and duration of HRT use when assessing skin ageing and determining treatment suitability, as patients who commenced HRT early may present differently from those who have not received HRT and may therefore have experienced greater collagen loss.9

Assessment A thorough clinical assessment should consider the patient’s menopausal status, duration of oestrogen deficiency, current Aesthetics | August 2026

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or prior use of HRT, skin quality, degree of volume loss and the presence of any concurrent medical considerations.

Although it does not include skin changes specifically, the Menopause Rating Scale is a widely used tool to assess the severity of menopause generally and could be employed in this context.11 Of equal importance is a realistic appraisal of treatment areas, as not all regions of the face and body are affected equally or at the same pace. The mid-face, including the cheeks, temples and periorbital region, tends to show the earliest and most marked signs of hormonal volume loss, as fat compartment deflation and dermal thinning converge to produce a characteristic sunken, skeletonised appearance.2 The perioral region, jawline and neck follow, with progressive laxity, deepening folds and loss of mandibular definition becoming increasingly prominent in the post-menopausal years. The décolletage and hands, though often overlooked, are also highly susceptible to oestrogen related collagen loss and skin thinning and represent areas of growing clinical interest.12

Combining HA dermal fillers and biostimulators The aesthetic management of menopausal skin has evolved considerably, with treatment strategies increasingly focused on restoring tissue quality rather than addressing volume loss alone. As declining oestrogen levels contribute to reductions in collagen, elastin and HA, alongside impaired fibroblast activity and extracellular matrix (ECM) remodelling, regenerative treatments may be used to target these underlying biological changes.1 PNs support tissue repair by modulating inflammation, stimulating fibroblast activity and promoting ECM regeneration, making them well suited to improving skin quality and resilience. HA skin boosters restore dermal hydration and improve elasticity through replenishment of the ECM, while microneedling induces controlled dermal injury to stimulate neocollagenesis and elastin production via the wound-healing cascade.13 The rationale for combining HA dermal fillers with biostimulatory agents in patients experiencing menopausal skin changes is grounded in their complementary, yet distinct, mechanisms of action. HA fillers provide immediate structural support and volume restoration while improving tissue hydration, whereas biostimulatory agents such as PLLA stimulate endogenous collagen synthesis and ECM remodelling to restore dermal architecture progressively.14

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PLLA provides gradual, diffuse collagen stimulation and structural support through neocollagenesis, whereas HA fillers offer immediate volume restoration, hydration, and targeted contour correction. Although clinical studies specifically evaluating this combination in menopausal women remain limited, the biological rationale is compelling, as menopause is characterised by accelerated collagen loss, reduced endogenous HA, dermal thinning and facial volume depletion. Consequently, combining PLLA and HA fillers may provide a comprehensive approach by addressing both the underlying structural changes associated with oestrogen deficiency and the visible manifestations of menopausal facial ageing.15,16 To note, this shouldn’t be treated as a standard protocol, but rather as an example of one possible approach.

HA dermal fillers HA dermal fillers, which remain one of the most widely used injectables in aesthetic practice, act primarily through physical volume replacement, restoring structural support, improving facial contours and providing immediate, visible correction of volume deficit.17 It has been shown that they can be implemented in menopausal patients and give good clinical outcomes with high patient satisfaction.18 Crucially, however, their benefit extends beyond simple space-filling. Research has demonstrated that cross-linked HA injections stimulate fibroblast elongation and activation, resulting in measurable increases in type I collagen deposition that persist for up to a year post treatment, a secondary regenerative effect of particular relevance in oestrogen depleted skin where fibroblast activity is already compromised.19 Biostimulatory injectables Biostimulators, by contrast, exert their primary effect through the deliberate induction of neocollagenesis rather than volumisation. PLLA is often considered a valuable biostimulatory treatment option for menopausal patients. It works by triggering a controlled macrophage-mediated inflammatory response around its microparticles, stimulating fibroblast recruitment and the progressive synthesis of new collagen over a period of weeks to months.20 There is promising early evidence that shows PLLA use in menopausal patients induces gradual collagen and elastin remodelling.21 CaHA, meanwhile, stimulates fibroblast activity through direct interaction between its microspheres and surrounding tissue.

This process upregulates collagen type III expression and promotes elastin production, supporting gradual dermal remodelling.

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Literature suggests that the extent of neocollagenesis is driven more by the degree of fibroblast activation than by product concentration alone.22 In the context of menopause, where the skin’s intrinsic capacity for collagen synthesis is significantly diminished, these regenerative effects offer a targeted and scientifically grounded therapeutic approach. Rather than simply improving the visible appearance of ageing skin, Biostimulator treatments work to restore elements of the underlying structural architecture that has been progressively compromised by oestrogen withdrawal.

Example treatment protocol The following case illustrates one example of a staged treatment protocol designed to address the structural and biological changes associated with oestrogen-related facial ageing.

A 51-year-old female patient presented to clinic reporting heaviness and descent of the lower face. She was slim and physically active, with no significant medical history, and had been taking combined HRT for the preceding 12 months. Clinical assessment demonstrated mild-to-moderate skin laxity with moderate structural volume loss, most notable at the anterior cheek, temples and pre-auricular area — a pattern consistent with oestrogen related fat compartment deflation and dermal thinning.

The convergence of these changes had produced loss of mid-face support with relative lower-face heaviness, which the patient identified as her primary concern.

Following a thorough consultation, the patient was guided through a comprehensive assessment that highlighted the broader structural and skin quality deficits underlying her presenting complaint.

Treatment commenced with a course of three PLLA sessions performed at monthly intervals. Product was administered via a 25G 70mm cannula at standard dilution, delivering 5ml per side across the full face in the deep dermis and superficial subcutaneous plane. A useful clinical indicator of correct placement was clear visualisation of the cannula beneath the skin surface during treatment.

Six months after completing the PLLA course, allowing sufficient time for neocollagenesis to occur, clinical reassessment demonstrated meaningful improvements in skin quality and reduced laxity, consistent with the expected biological effects of PLLA.20 Residual structural volume loss remained in the cheeks, temples and pre-auricular area.

Targeted HA dermal filler was subsequently introduced using a combination of needle and cannula techniques to Aesthetics | August 2026

Menopause Combined Protocol restore facial support on the collagen-rich biological foundation established by the PLLA treatment.

At two-week review following filler treatment, the patient demonstrated improved skin quality alongside restoration of facial structure, producing a natural, youthful result with visible improvement across the regions most affected by hormonal ageing. Ongoing maintenance with PLLA was recommended annually or biannually, depending on individual response and skin quality, with future structural correction guided by clinical reassessment. This staged sequencing prioritises rebuilding dermal architecture before correcting residual volume deficits, helping address both the collagen depletion and volumetric changes associated with oestrogen withdrawal.2,23

Clinical and safety considerations Dermal thinning, reduced vascularity and impaired wound healing render menopausal skin more susceptible to bruising, haematoma formation and prolonged recovery, all of which should be discussed during the consent process.9 Adverse events associated with combination treatment include erythema, bruising and nodule formation, with rare but serious complications including granulomas, most commonly reported in the perioral region, and vascular occlusion.9,23 Hyaluronidase must be immediately available, anatomical knowledge must be thorough and blunt cannulas should be considered where possible and appropriate, to reduce intravascular risk.24

Outlining a framework Menopause represents a distinct and clinically meaningful context within medical aesthetics — one that demands more than a cosmetic lens. A combined modality approach, integrating the regenerative capacity of biostimulators with the structural correction offered by dermal fillers, provides a framework that is both scientifically rational and clinically practical.

Dr Oscar Redman is a radiologist, aesthetic practitioner and clinic director of Dr Redman Aesthetics in Newcastle. Dr Redman draws on his diagnostic imaging background to inform a precise, anatomy-led approach to treatment with a keen interest in ultrasound and bespoke patient-led care.

Qual: MBBS, BSc

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 37

Relfydess™ is indicated for the temporary improvement in the appearance of moderate-tosevere glabellar lines (GLs) at maximum frown and moderate-to-severe lateral canthal lines (LCLs) at maximum smile alone or in combination, in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient. * Based on the Natural Expressions Questionnaire completed for all patients treated for moderate-to-severe GLs in the Phase III READY-1 study (n=223) and all patients treated for moderate-to-severe LCLs in the Phase III READY-2 study (n=230) with Relfydess™. 94% (GLs) at Month 1 and 83% (GLs) at Month 6 agreed or strongly agreed with the statement ‘I look natural when I make expressions’. 93% (LCLs) at Month 1 and 82% (LCLs) at Month 6 agreed or strongly agreed with the statement ‘I look natural when I smile’.4, 5 † Based on individual item responses from the FACE-Q Psychological Function Questionnaire completed by all patients treated with Relfydess™ for moderate-to-severe LCLs in the READY-2 study (n=230). 91% of patients at Month 1 and 83% of patients at Month 6 somewhat or definitely agreed with the statement ‘I feel attractive’.5 ‡ Based on the FLTSQ completed by all ITT patients treated with Relfydess in the READY-1 and -2 studies. Data was based on the number of patients with a non-missing assessment at each time point, which remained above 93% of the number that initially received Relfydess™ and 88% of the number that initially received placebo for both studies. 97% (GLs, n=223) and

92(%) (LCLs, n=230) at Month 1 and 88% (GLs, n=223) and 85% (LCLs, n=223) at Month 6 felt satisfied with how natural their face looked after treatment.3,4 Based on AEs reported after one treatment with Relfydess™ in patients receiving ≥50 units across placebo-controlled studies.1

††

References: 1. Galderma. [Relfydess] Summary of Product Characteristics. January 2026.

2. Shridharani SM, et al. Aesthet Surg J. 2024;44(12):1330–40. 3. Ablon G, et al. Dermatol Surg.

2025;51(3):277–83. 4. Gold MH, et al. Aesthet Surg J. 2025;45(8):828–35. 5. Grunebaum L, et al.

Poster presented at: AMWC, Monaco; March 27–29, 2024 6. Stahl U, et al. Toxins. 2025;17:501 The majority of adverse reactions reported after one treatment with Relfydess in subjects receiving ≥ 50 units in all placebo-controlled studies in the development program were of mild to moderate intensity. The most frequently reported adverse reactions were injection site reactions and headache occurring in approximately 7% and 5% of subjects, respectively.††1

This medicinal product is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions.

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Help your patients look and feel their best 3-5 82%

83%

>85%

MONTH 6

MONTH 6

MONTH 6

94%

93%

≥92%

“I look natural when I make expressions”§4

“I look natural when I smile”§5

“I am satisfied with how natural my face looks after treatment”††3,4

MONTH 1

MONTH 1

MONTH 1

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Injectables Amino Acids

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Exploring Injectable Amino Acid Therapy in Skin Biorestoration Dr Olivia McCabe-Robinson examines the clinical rationale behind injectable amino acid Medical aesthetics is undergoing a philosophical reorientation. Where volumisation and neurotoxin relaxation once dominated clinical conversations, the field is increasingly oriented around tissue quality.

A category of treatment referred to as biorestoration has begun to crystallise within medical aesthetics. It is distinct from biostimulation in a mechanistically important way. Rather than triggering a wound-healing signalling cascade, biorestoration aims to replenish the raw metabolic substrates that make regeneration physiologically possible.1 As fibroblast activity declines with age, the availability of essential substrates required for collagen and elastin synthesis becomes increasingly limited and this reduction in amino acid availability contributes to impaired dermal architecture.1

Understanding amino acids The structural integrity of the dermis depends fundamentally on a well-maintained extracellular matrix (ECM), composed primarily of type I collagen, type III collagen, elastin, hyaluronic acid (HA) and an array of proteoglycans and glycosaminoglycans (GAGs). In human skin, type I collagen makes up 80-90% of the total collagen, while type III makes up 8-12% and these fibrous proteins provide mechanical support and structure throughout the dermis.2 The synthesis and maintenance of this matrix is amino acid-dependent at every stage of the process. The primary amino acid sequence of collagen is characterised by a repeating glycine-X-Y pattern, where every third amino acid is glycine and the collagen molecule is formed by three chains wound into a triple helix. The process of collagen synthesis occurs mainly in fibroblasts, which are specialised cells with the primary function of synthesising collagen and stroma.3 The structural dependency has quantifiable implications. Glycine residues occupy one third of amino acid residues in collagen protein and the supply of glycine can be a limiting factor for collagen synthesis.4 Glycine, proline and lysine play a special role in collagen structure, and their insufficient availability could make collagen synthesis and regeneration difficult.4 Although glycine has been traditionally classified as non-essential because human metabolism can synthesise it from serine, 40

the glycine synthesis pathway has a strong stoichiometric restriction that limits its production independently of enzyme capacity and regulatory mechanisms.5 During ageing, fibroblast-ECM interactions become disrupted due to fragmentation of collagen fibrils. This disruption causes loss of fibroblast spreading and mechanical force, leading to an aged phenotype characterised by reduced ECM protein synthesis and increased production of matrix-degrading metalloproteinases (MMPs). This imbalance of ECM homeostasis further drives collagen fibril fragmentation in a self-perpetuating cycle.1 The age-related decrease in collagen-synthetic activity is demonstrable in vitro, with lower production of type I procollagen documented in dermal fibroblasts isolated from older individuals (56 ± 8 ng/ml) compared with those from young adults (82 ± 16 ng/ml; P < 0.05).6 This functional decline occurs not in isolation but within the broader context of substrate depletion – fibroblasts that retain some synthetic capacity may nonetheless fail to produce adequate ECM because the necessary amino acid substrates are insufficiently available in the local dermal microenvironment.6 Beyond structural amino acids, branched-chain amino acids (BCAAs) including L-leucine, L-isoleucine and L-valine play a distinct role in supporting cellular anabolism, supporting protein turnover and optimising the microenvironment required for tissue repair and regeneration.1 L-cysteine contributes to glutathione synthesis and redox balance. L-serine and L-alanine provide biosynthetic precursors for a range of anabolic reactions within the fibroblast. The rationale for multi-amino acid formulations therefore rests on the principle that collagen synthesis is not rate-limited by a single substrate in isolation but by the coordinated availability of multiple interdependent metabolic inputs.5,7,8

Amino acids in medical aesthetics In some patients, skin quality decline may be driven less by insufficient signalling and more by reduced biosynthetic capacity. Rather than volumising or altering facial contours, injectable amino acid formulations are designed to support dermal regeneration through targeted amino acid Aesthetics | August 2026

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replenishment and optimisation of the extracellular environment. This approach aims to improve skin quality by supporting the metabolic requirements of fibroblasts involved in ECM maintenance.9 Injectable amino acid formulations are generally indicated for fine lines, wrinkles, dehydrated or dull skin, uneven texture, early to moderate chrono- or photoageing and prejuvenation,10 making them suitable for patients seeking regenerative skin quality improvement rather than structural augmentation. Unlike cross-linked HA fillers, amino acid-based formulations do not introduce a volumising polymer into the dermis, resulting in a treatment approach focused on tissue support rather than contour modification. The mechanism of action is based on substrate provision to support ECM synthesis, which may offer a more physiological pattern of dermal remodelling.8,11 The most relevant clinical evidence for this treatment class comes from a 2024 study by Scarano et al., published in the Journal of Ultrasound, which investigated a formulation of low molecular weight HA fragments and amino acids (HAAM) delivered via intradermal injection.12 The study, which included 20 patients, reported improvements in dermal and epidermal facial skin structure, alongside enhanced epidermal hydration, suggesting increased moisture availability for normal physiological processes.12 HA fragments containing 20 to 30 monomers can activate fibroblasts by binding to CD44 receptors, thereby promoting the production of reticular collagen type III, though this phenomenon is contingent on the availability of precursors, enzymes and cofactors involved in the biosynthesis of this structural protein.12 The HA fragment provides the fibroblast activation signal via CD44, while the co-delivered amino acids provide the substrate pool to fulfil that activation. Amino acid-only formulations target the substrate component of this mechanism directly, without the addition of HA.12

Treatment protocol Injectable amino acid formulations are administered intradermally, typically using a mesotherapy technique. The target delivery depth is approximately 1-2mm into the dermis, using a fine-gauge needle (30-32G) at a 30-45° angle, consistent with standard intradermal mesotherapy practice.13 A standard treatment course typically comprises three-to-four sessions at two-to-four-week intervals, followed by maintenance treatment every six-to-nine months according to clinical response.

Techniques employed may include retrograde linear threading, nappage (multiple superficial punctures) or a

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combination of both, depending on practitioner preference and the treatment area. The full face, neck and décolletage are the most commonly treated regions.14 Practitioners should note that no single standardised protocol exists across all amino acid injectable products, as formulations vary in their amino acid composition, concentration, and whether they contain adjuncts such as HA fragments or vitamins.

Protocol guidance should therefore be followed on a product-specific basis and within the scope of the practitioner’s training and competency.

Before

After

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treatment site, known hypersensitivity to any component of the formulation, pregnancy and breastfeeding, active autoimmune conditions and immunosuppressive therapy.

Caution is warranted in patients with active inflammatory skin conditions such as rosacea or eczema, where the injection-site response may be exaggerated.16,17 Adverse effects mirror those of mesotherapy-class injectables and include injection-site erythema, bruising, oedema and transient papulation. These are self-limiting.18

Synergy with other regenerative treatments The theoretical case for combining amino acid therapy with existing regenerative modalities is compelling but requires careful clinical reasoning.

Polynucleotides

Figure 1: 34-year-old female post-pregnancy, with nutritional depletion, treated with three sessions of Celora Vita at three-week intervals.

Patient suitability Optimal candidates include patients in the prejuvenation category (typically 25-40) who present with early chrono-ageing and seek physiological skin maintenance.

In this group, fibroblast function remains relatively intact, and the limiting factor is more likely to be substrate availability than cellular senescence.15 Patients aged 40-60 with early-to-moderate photo- and chrono-ageing presenting with skin dullness, loss of elasticity and superficial texture changes represent the core indication group where amino acid replenishment can work alongside preserved fibroblast activity.6,13 Patients who are nutritionally depleted or follow restrictive diets with very low protein intake, including those on GLP-1 receptor agonist therapy, may also represent a strong indication, where systemic amino acid availability directly affects the local dermal substrate pool.5,8

Contraindications and adverse effects As CE-marked injectable medical devices intended for intradermal administration, amino acid formulations share the standard contraindication profile for all intradermal injectables. These include active infection or inflammation at the

Polynucleotides (PNs) stimulate fibroblast proliferation and support angiogenesis. The combination with amino acid replenishment is mechanistically rational. PNs increase the number and activity of fibroblasts, while amino acid substrates provide those fibroblasts with the raw materials to produce ECM. Importantly, the fibroblast– myofibroblast–fibrocyte complex represents only one component of a broader tissue remodelling environment. This environment also includes vascular and lymphatic endothelial cells, monocytes/macrophages, lymphocytes and non-cellular elements such as the ECM.9 Their anabolic processes need to be continually balanced by catabolic processes and cellular recycling, all under the control of signalling molecules ranging from free radicals to cytokines and growth factors.9 Biorevitalisers and injectable HA skin boosters Non-cross-linked HA biorevitalisers improve skin hydration and fibroblast mechanotransduction.19 Combining with amino acid therapy could address the substrate gap that HA alone does not fill. A staged approach rather than same-session layering is advisable to manage procedural burden and injection-site reaction risk.

Energy-based devices Thermal and mechanical injury from energy-based devices (radiofrequency (RF), high-intensity focused ultrasound, microneedling with RF) generates a fibroblast activation response and upregulates TGF-beta signalling.10 Treating with amino acid replenishment alongside energy-based device sessions is a biologically plausible protocol; however, this sequencing has not been validated in clinical trials and remains theoretical at present.

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Injectables Amino Acids Biostimulators PLLA and polycaprolactone-based agents generate a prolonged fibroblastic response.20,21 Amino acid supplementation could theoretically support the quality of the fibroplasia response, though no clinical data supports this specific protocol at time of writing.

Safety and evidence The biochemical rationale for amino acid supplementation in collagen synthesis is well-supported by primary peer-reviewed literature; however, this is a rapidly evolving area of aesthetics with ongoing publications to specialty-specific gaps. Glycine, proline and hydroxyproline contribute to 57% of total amino acids in collagen, which accounts for one third of proteins in animals and, as the most abundant protein in the body, collagen is essential to maintain the normal structure and strength of connective tissue.11 Metabolic Control Analysis applied to the procollagen synthesis cycle demonstrates that the main cause of procollagen cycle inefficiency is protein misfolding mainly due to glycine scarcity, as well as a moderate deficiency of proline and lysine for collagen synthesis.8 These are substrate-level limitations that are biologically real and mechanistically coherent.

A 2026 systematic review and meta-analysis on HA and amino acid formulations noted that the concentration of studies from overlapping research groups, particularly Scarano et al., and the disclosure of specialty associations by several authors, may have introduced sponsorship bias and the evidence base may over-represent the experience of specific research groups.10

Integrating into clinical practice Injectable amino acid formulations may support skin quality through a more biologically informed approach to regeneration rather than volumisation.11 While the mechanistic rationale is compelling, the clinical evidence remains encouraging but preliminary, with further product-specific randomised controlled trials still needed.

Dr Olivia McCabe-Robinson trained as a surgeon in the NHS and is a currently a PhD candidate at the University of Manchester researching Advanced Biomaterials. She is founder of the National Wellness & Aesthetics Research Group and Aesthetics Research Collaborative.

She is a KOL and part of the Clinical Advisory Group for the JCCP, is a KOL for Neogen and faculty for DermaFocus.

Qual: MBChB, MRCSEd

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 41

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References: 1. Sculptra. IFU. 2. Widgerow A, et al. Poster presented at IMCAS World Congress.

01-03 February 2024. Paris, France. 3. Huth S, et al. J Drugs Dermatol. 2024 Apr 1;23(4):285-288.

4. Galderma. Date on File (MA-60875). 5. Zhang Y, et al. Regen Biomater 2021;8(5):rbab042.

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Summer Skin Glow The Dual-Action Path to Radiant Skin A dual approach with Sculptra® and Restylane® SkinboostersTM can help patients achieve smoother, brighter and more resilient-looking summer skin by addressing both dermal structure and skin quality This advertorial is sponsored by Galderma Summer is often associated with healthy, luminous skin, yet the season can also amplify many of the factors that compromise skin quality. Increased ultraviolet exposure, heat, transepidermal water loss, travel, air conditioning and changes in routine can all contribute to dehydration, dullness and visible photodamage.1,2 As patient demand continues to shift towards natural-looking outcomes and regenerative aesthetic treatment strategies, combination approaches are becoming increasingly relevant in clinical practice. In particular, pairing Sculptra® with Restylane® SkinboostersTM offers a complementary strategy to support both dermal structure and skin quality, helping patients achieve a refreshed summer glow through a more comprehensive treatment plan.3-5

Advertorial Combination

they offer a dual-action strategy that addresses both the deeper and more superficial contributors to a healthy summer glow.

This may be especially relevant in GLP patients, where weight loss-related facial changes can include both loss of support and a decline in visible skin quality. In these patients, a combination approach may help address structural changes while also improving hydration, smoothness, elasticity and radiance, leading to a more balanced and natural-looking outcome.22

Practitioner insights Aesthetic practitioner Dr Ana Mansouri highlights the versatility of the treatment, explaining that it can be adapted for different ages, concerns and treatment goals. “This combination is suitable for a wide range of patients because the injection technique, product quantity and number of sessions can be tailored to the individual,” she notes. Dr Mansouri identifies differences between patient groups adding, “A lighter approach can work beautifully for younger patients seeking hydration, radiance and a healthy summer glow. More mature patients may benefit from additional product or sessions to address more visible changes in firmness, elasticity, texture and overall skin quality.”

For patients experiencing facial changes following GLP-1-assisted weight loss, Dr Mansouri notes that combining the two products enables practitioners to address both structural support and skin quality in a single appointment. “Because the products are administered in separate anatomical areas, they can be performed during the same appointment without interfering with one another. This makes the combination particularly effective for addressing both facial deflation and reduced skin quality in a natural and balanced way,” she adds.

Restylane® SkinboostersTM are designed to revitalise the skin from within, going beyond deep hydration to improve multiple dimensions of skin quality. Clinical evidence has shown benefit across six key aspects of skin quality: hydration, smoothness, surface evenness, skin tone evenness, reduced fine lines and wrinkles, and reduced scarring in selected cases. This broader concept of skin quality enhancement is particularly relevant in patients seeking brighter, smoother and more radiant skin rather than volumisation alone.6-13 From a clinical performance perspective, Restylane® SkinboostersTM have demonstrated durable outcomes. Patients have reported improved skin quality for up to 15 months, with high levels of satisfaction and radiance reported following treatment.6-17 Optimal results are typically achieved with an initial treatment cycle of one to three sessions spaced four weeks apart, followed by maintenance treatment every 6-12 months according to skin condition and patient goals.6,16,17 Mechanistically, this effect is linked to NASHATM technology, a high molecular weight stabilised hyaluronic acid designed to closely mimic natural HA. By revitalising the extracellular matrix, Restylane® SkinboostersTM support continuous improvement in natural skin structure and quality. Evidence also suggests optimisation of the extracellular environment with benefits to collagen and elastin quality, helping support overall skin health.18-20 In patients with reduced dermal support, skin laxity or signs of volume depletion, radiance alone may not be sufficient to create a healthy, refreshed appearance. Sculptra® works by supporting the skin’s underlying framework and stimulating collagen production over time, making it a valuable option for patients who would benefit from progressive, longer-term improvement.21 Together,

This advertorial was written and supplied by Galderma.

Speak to your local Galderma Rep to know more about Restylane® SkinboostersTM GB-RES- 2600014 DOP JULY’26 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 References available upon request Dr Ana Mansouri is a Galderma KOL

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43

Skin Quality GLP-1

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Combining PLLA and Skin Boosters for GLP-1 Patients Dr Catherine Denning considers PLLA with HA skin boosters for weight-loss side effects The increasing use of glucagon-like peptide-1 (GLP-1) receptor agonists for obesity management has transformed weight-loss outcomes for many patients.1-3 While GLP-1 medication can deliver metabolic benefits, rapid weight reduction is also associated with skin laxity, volume loss and accelerated ageing.4,5 These changes are increasingly recognised as consequences of alterations in both subcutaneous and dermal adipose tissue compartments.5,6 As aesthetic practitioners encounter growing numbers of patients receiving GLP-1 therapies, there is a need for evidence-informed treatment protocols that address the biological consequences of weight-loss-associated facial ageing.7-9

Pathophysiology In healthy, youthful skin, dermal adipose tissue is characterised by numerous small, metabolically active adipocytes that support adipose-derived stem cell signalling and exert predominately anti-inflammatory effects.10 By contrast, ageing adipose tissue typically contains fewer, larger adipocytes that demonstrate a more pro-inflammatory profile, promoting tissue degradation and contributing to chronic low-grade inflammation within the skin.10-12 GLP-1-associated weight loss affects multiple facial tissue layers, with the greatest changes occurring within the subcutaneous fat compartments and dermal white adipose tissue (DWAT), resulting in volume depletion, reduced structural support and impaired tissue homeostasis.1-3 Secondary changes within the dermis, including age-related reductions in collagen, elastin and hyaluronic acid (HA), further compromise skin elasticity and resilience.4,5 Together, these multilayer changes contribute to the characteristic laxity, hollowing and deterioration in skin quality observed following significant weight loss.5 Choosing PLLA and biostimulators The associated effects outlined have important implications for treatment selection. Poly-L-lactic acid (PLLA) remains one of the most extensively studied biostimulatory injectables, with more than two decades of clinical evidence.7,8 Research suggests that PLLA stimulates 44

type I and III collagen production, elastin synthesis and endogenous HA production.7,8 Recent research has further highlighted the interplay between adipose tissue health, skin quality and weight-loss-associated ageing, reinforcing the value of regenerative strategies that address not only collagen, elastin and HA, but also the broader tissue environment.6,12 Although no clinical studies have specifically evaluated HA skin boosters for GLP-1-associated facial ageing, substantial evidence supports their ability to improve dermal hydration, elasticity and extracellular matrix (ECM) quality in ageing skin.

Consequently, their use in GLP-1-treated patients is supported by biological rationale and extrapolation from established skin quality literature, rather than direct clinical evidence.13 Energy-based devices, including radiofrequency and ultrasound, stimulate neocollagenesis and tissue contraction, improving skin firmness in mild to moderate laxity.8,9 Topical skincare supports skin health and maintenance throughout GLP-1 treatment.10 However, injectable therapies remain the preferred approach, addressing skin quality change associated with GLP-1 therapy.

Patient suitability PLLA is most appropriate for individuals seeking regenerative, longer-term improvements in skin quality and tissue integrity, rather than immediate volume replacement.7,8 HA skin boosters may be beneficial for patients experiencing dehydration, reduced skin quality, fine lines or textural changes associated with weight loss.9,14 They may also be used to support overall skin health and hydration throughout the weight-loss journey.

Patients actively undergoing GLP-1-associated weight loss are often appropriate candidates for regenerative treatments, including biostimulators and skin boosters. Clinicians should consider that GLP-1 medications remain in the body for approximately five to six weeks following the final dose.1 Patients do not need to discontinue GLP-1 receptor agonist therapy before undergoing aesthetic treatment.

However, treatment planning should Aesthetics | August 2026

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consider whether weight loss is ongoing or has stabilised, as continued changes in facial volume may influence outcomes and the need for subsequent interventions.

Phase one: PLLA treatment Biostimulatory agents are first administered within the deep dermis or subcutaneous plane to initiate architectural remodelling of the ECM.7,8 Its mechanism of action promotes neocollagenesis and supports long-term tissue regeneration.7,8 Treatment intervals Treatment is typically delivered as a course, with sessions spaced at approximately six-week intervals.7,8 The number of sessions and vials required depends on factors such as tissue quality.

For example, some patients may achieve satisfactory correction with two sessions, using two vials per session, six weeks apart.8 Others, particularly those with more pronounced weight-loss-associated changes, may require up to six sessions, also spaced six weeks apart, with two vials used at each appointment.7,8 In general, greater weight loss tends to be associated with the longer treatment course and higher product requirements.

However, initiating treatment earlier in the weight-loss journey may reduce the degree of correction required and can help minimise the overall course.5 Once the initial protocol is complete, maintenance is usually straightforward.

Many patients require a top-up treatment approximately once a year, with the aim of sustaining collagen stimulation.7 Injection technique Injection technique should be individualised according to facial anatomy and treatment goals.

A commonly utilised approach involves a 22G cannula measuring approximately 50-70mm in length.7,8 This allows broad distribution of product while reducing the risk of vascular injury compared with multiple needle punctures.

Whilst addressing GLP-1 side effects, PLLA is reconstituted with 7-8ml of sterile water and 2ml of lidocaine.8 The product is typically placed in the deep subdermal plane using a fanning technique, allowing even distribution across the treatment area rather than concentrating product within isolated defects. Uniform placement encourages balanced collagen stimulation and more natural-looking outcomes.

In patients with GLP-1-associated facial volume loss, the temples, pre-auricular region, mid-cheek and periocular areas often demonstrate the greatest degree of deflation.4,5 Practitioners should ensure to

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follow guidelines for individual products when considering treatment areas. For example, the periocular region commonly exhibits volume loss, but is contraindicated for some PLLA products, namely Sculptra.7 As DWAT extends throughout the face, small amounts of product should also be fanned through the buccal region to promote a more diffuse regenerative response.6 This broader distribution is intended not only to restore volume but also to stimulate fibroblast activity, ECM production and adipocyte differentiation.11 The aim is to increase dermal thickness and improve the characteristic ‘accordion’ lines that many patients undergoing GLP-1-associated weight loss notice when smiling.6 Practitioners should possess a thorough understanding of facial anatomy and maintain meticulous attention to injection depth and tissue planes.

Aftercare Successful PLLA treatment depends not only on injection technique but also on patient adherence to aftercare protocols.

A commonly recommended post-treatment regimen consists of five minutes of massage, five times per day, for five consecutive days (5-5-5). This protocol assists with uniform product distribution and may reduce the likelihood of nodule formation.7,8 Compliance with aftercare should be emphasised during the consent process, as inadequate aftercare may compromise outcomes.

Phase two: HA skin boosters After approximately six to eight weeks – or once early collagenesis and matrix remodelling are underway – HA skin boosters are introduced to enhance superficial hydration and refine surface optics.9,13 The next phase focuses on increasing tissue hydration, improving skin barrier function, enhancing dermal quality, preparing the skin for subsequent regenerative treatment and supporting tissue resilience during active weight loss.9 Treatment intervals Patients typically undergo a course of three HA skin booster treatments to improve skin hydration, elasticity and overall skin quality.9 The treatment schedule is as follows:9

· Session one: Initial (baseline) treatment. · Session two: Four weeks after the first treatment.

· Session three: Four weeks after the second treatment.

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This allows for gradual, cumulative improvements while keeping the treatment schedule manageable.

Once the initial course is complete, maintenance treatments are generally recommended every six months to help sustain results and support ongoing skin health.9 Injection technique The exact injection technique should be adapted according to individual anatomy and product selection. However, several general principles apply.

For diffuse skin quality improvement, treatment may be delivered in a grid-like distribution across areas of concern. In patients demonstrating early signs of weight-loss-related skin laxity, attention should be directed toward regions prone to tissue collapse and creasing.

Mirroring the PLLA protocol, a 22G, 50-70mm cannula facilitates broad, even product distribution through a single-entry point while remaining within the intended subdermal plane and minimising tissue trauma and vascular injury. Needle-based techniques may be particularly useful in areas characterised by superficial wrinkling or ‘accordion lines,’ where precise product placement can improve tissue hydration and elasticity.7,8 Aftercare Patients should keep the treatment area clean and avoid strenuous exercise, excessive heat exposure and alcohol consumption for at least 24 hours following treatment.9 Beyond these general recommendations, aftercare requirements may vary depending on the specific product or brand used. Patients should therefore follow any additional guidance provided for their individual treatment protocol to ensure optimal results and recovery.9

Contraindications Patients with autoimmune disease should only be treated if their condition is stable and well controlled, as inflammatory flare-ups may increase the risk of complications. Patients with diabetes should have satisfactory glycaemic control before treatment. A comprehensive consultation, including medical history, medication review and informed consent, is fundamental to safe practice.11,12,15 Particular caution is advised in patients taking anticoagulant or immunomodulatory medications, those with significant allergies, immunocompromise, pregnancy or breastfeeding, and those with active skin infection or inflammation in the treatment area.

Aesthetics | August 2026

Skin Quality GLP-1 Clinicians should adhere to manufacturer guidance, on-label indications and product-specific injection techniques.

Appropriate injection depth, placement and product selection are essential to minimise complications, including superficial product visibility, the Tyndall effect with HA and nodule formation following biostimulatory treatments.11 Transient erythema, oedema, tenderness and ecchymosis are common and usually self-limiting. More significant complications, including delayed inflammatory nodules or granulomatous reactions, require prompt recognition, appropriate investigation (including ultrasound where indicated) and management according to established product-specific protocols.7,15 Before

After

Figure 1: 69-year-old patient before and after treatment following three months of GLP-1 use. Case comprises two sessions of two vials of Sculptra administered six weeks apart and three sessions of Restylane Skinboosters Vital administered at two-week intervals.

Integrating a combination approach As the use of GLP-1 medications continues to rise, clinicians are increasingly encountering patients seeking treatment for facial volume loss, hollowing and skin laxity following significant weight reduction.

A carefully designed treatment protocol can deliver meaningful aesthetic and psychological benefits.

Disclaimer: This is not a dedicated protocol exclusively for GLP-1 patients. Rather, it is a suggested approach based on interim findings from two ongoing investigator-initiated trials, which indicate that PLLA and HA skin boosters may help address aesthetic changes linked to weight loss medications.16

Dr Catherine Dennings is GMC-registered with more than a decade of experience in medical aesthetics and cosmetic dermatology. Founder of Marylebone Skin Clinics across London and Sussex, she is a key opinion leader for Curel, Galderma, Icona and Obagi Medical.

Qual: MBBS, BSc (hons) MRCS PgCAP

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Restoring Facial Volume Following GLP-1–Associated Weight Loss

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further 0.6 mL per side was distributed along the mandibular ramus in the subdermal plane using a cannula and retrograde linear threading technique.

Dr Ben Taylor Davies presents a combined Belotero® and Radiesse® approach A 41-year-old male patient presented to clinic seeking advice regarding facial changes that had become apparent following significant weight loss achieved with GLP-1 receptor agonist therapy. While pleased with the health benefits of his weight-loss journey, he reported feeling that his face appeared more tired and aged than before. His primary concerns included increased prominence of the nasolabial folds, volume loss through the cheeks and under-eye region, and a general sense that facial tissues had “‘dropped” following weight reduction.

The patient had no previous history of aesthetic treatments and was otherwise fit and well.

Clinical assessment revealed age-related volume loss throughout the upper, mid and lower face, likely accentuated by weight loss. This manifested as temporal hollowing, flattening of the midface, deepening of the nasolabial folds and reduced definition of the lower face and jawline. The treatment objective was to restore structural support and facial harmony while preserving a natural, masculine appearance.

A multimodal treatment plan was developed using a combination of Belotero® hyaluronic acid fillers and Radiesse®+. Belotero® Volume, a high G-prime hyaluronic acid filler with high elasticity, viscosity and cohesivity, was selected where structural support and deep volumisation were required.1,2 Belotero® Balance, characterised by a low G-prime, low viscosity and high cohesivity profile, was chosen for treatment of the infraorbital region due to its favourable tissue integration characteristics. Belotero® Intense, with moderate G-prime, viscosity and cohesivity properties, was selected for direct correction of the nasolabial folds.3 Radiesse®+ was used as both a structural filler and biostimulator; as a calcium hydroxylapatite-based injectable it possesses exceptionally high G-prime, viscosity and cohesivity, providing immediate support and projection, while also stimulating longer-term tissue remodelling through the regeneration of collagen types I and III, elastin, angiogenesis and other extracellular matrix components.4-8 Following a cooling-off period, treatment was performed in a single session.

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All treatment sites were assessed with Doppler ultrasound prior to injection to confirm vascular anatomy and optimise procedural safety.

Upper Face Temporal hollowing was addressed with 1 mL of Belotero® Volume per side, placed at the supraperiosteal level using a 27G needle in a “one up, one over” technique to restore upper facial support and improve overall facial balance.

Image 1&2: Patient before and immediately after treatment.

Midface

In total, 5 mL of Belotero® hyaluronic acid fillers and 3.9 mL of Radiesse®+ were used.

The lateral cheek was treated with 0.75 mL of Radiesse®+ per side at the supraperiosteal level using a nano-bolus technique. This approach, first described by Dr Kate Goldie, involves depositing multiple small aliquots of product along the zygomatic arch, creating a smooth and uniform contour while avoiding the interrupted appearance that can occur with larger bolus injections. Importantly, the technique helps preserve masculine cheek architecture by enhancing projection and support without creating excessive zygomatic width or feminisation.

Comparison of the baseline and post-treatment photographs demonstrates a meaningful restoration of facial volume and definition. Improvements in temporal hollowing, cheek projection and infraorbital support reduced the tired appearance that initially concerned the patient, while enhancement of the chin and jawline improved lower facial contour and profile. At two-week review, the patient reported that he “looked like himself again” - perhaps one of the most rewarding outcomes we can achieve in aesthetic medicine.

The medial cheek was augmented with 0.5 mL of Belotero® Volume per side within the deep medial cheek fat compartment using a 25G, 40 mm Precision32 cannula.

While immediate improvements were evident, the incorporation of Radiesse®+ is expected to provide ongoing benefits through neocollagenesis and tissue remodelling, supporting skin quality, structural integrity and overall facial rejuvenation in the months following treatment.

To further soften the transition between the midface and lower face, the nasolabial folds were treated directly with 0.5 mL of Belotero® Intense per side in the subdermal plane using a 25G, 50 mm cannula.

Lower Face Chin projection and lower facial support were restored using 1 mL of Belotero® Volume placed supraperiosteally at the pogonion. Five 0.2 mL boluses were deposited in a lateralised pattern to enhance anterior projection and improve lower facial proportions.

The transition into the lower face was blended using 0.3 mL of Radiesse®+ per side in the pre-jowl and marionette region.

Product was placed in the subdermal plane using a 22G, 50 mm Precision32 cannula with retrograde linear threading in a fanning pattern.

Further jawline definition was achieved through a multilayering approach. The gonial angle was augmented with 0.3 mL of Radiesse®+ placed supraperiosteally, while a Aesthetics | August 2026

Dr Ben Taylor Davies is an aesthetic doctor with a background in emergency medicine. Based in Edinburgh, he is the founder of The Stockbridge Clinic where he has a particular interest in regenerative medical aesthetics and complication management. He sits on the clinical support team for CMAC, is a KOL for Cutera and SkinCeuticals and is a national trainer for Acquisition Aesthetics.

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Clinical Papers Abstracts

A Summary of the Latest Clinical Studies The latest research highlights from Professor Sebastian Cotofana Key Takeaways

· Aesthetic lip injections with soft tissue fillers are widely accepted and popular

· Cases of minor and major adverse events have been reported, including blindness and tissue loss following such treatments

· The upper lip is more often affected than is the lower lip; this

can be attributed to the widely unknown ‘Steal Phenomenon’ of the upper lip

Title: The Blood Supply of the Lips: A Systematic Review and Meta-Analysis

Authors: Patryk Ostrowski, et al., Published: Aesthetic Plastic Surgery Journal Keywords: Lip volumisation, Labial arteries, Medical aesthetics, Steal phenomenon The increasing reports about severe adverse events like blindness and soft tissue loss due to necrosis have sparked the trend of ‘filler fatigue’. However, despite the filler fatigue, labial volumising procedures are still highly popular, and the trend is constantly increasing. Increasing the volume of the lips or highlighting the contour between vermilion and ergot rid are frequently requested procedures and a staple of every aesthetic clinic.

When soft tissue fillers are administered into the lips, it must be kept in mind that the product needs to be administered superficially, i.e. between the dry mucosa of the red lip and the orbicularis oris muscle. This is crucial to avoid the deeper-located labial arteries, which travel between the

orbicularis oris muscle and the wet oral mucosa. Understanding that the labial arteries travel deep allows practitioners to deploy soft tissue filler products superficially, regardless of whether a needle or a cannula is being used.

A recent investigation, conducted by Ostrowski and his colleagues, pointed out a relevant clinical observation: the upper lip is more often affected by adverse events than the lower lip following aesthetic injections. The authors conducted a meta-analysis of the current world literature and reported on an interesting anatomic fact: the nose steals arterial blood from the upper lip. This might sound arbitrary, but when the upper lip vasculature is analysed, their theory seems plausible.

If soft tissue fillers are injected into the upper lip and the tissue perfusion is compromised, the tissue does not necessarily have the oxygenation resources it would need to overcome the vascular compromise. If the tissue has sufficient arterial reserves, the tissue can adapt, and the potential adverse events remain silent and do not become clinically relevant or visible. However, if the nose ‘steals’ arterial blood from the upper lip, the upper labial tissue does not have the resources to fight the vascular compromise, and a clinically visible and apparent adverse event is the consequence.

This phenomenon was termed the ‘steal phenomenon’ of the upper lip and provides a viable explanation for clinical observation in which the upper lip is more frequently affected by adverse vascular events than the lower lip. For the daily clinical practice, no change in treatment behaviour is suggested following the ‘steal phenomenon’ instead, this anatomic observation provides an explanatory mechanism of why the upper lip is more often affected by adverse events than is the lower lip (if equal treatment frequencies are assumed).

This abstract was supplied in partnership with Cotofana Academy.

Aesthetics top picks · Title: Longevity and Volume Expansion of Hyaluronic Acid Dermal Fillers: A Cross-sectional 3-dimensional Magnetic Resonance Imaging Study. Authors: Alia Issa, et al., Published: Plastic and Reconstructive Surgery. Global open, July 2026. · Title: Autologous Fibroblast Therapy for Facial Rejuvenation: A Randomised Open-Label Controlled Study Author: Pietro Gentile.

Published: Journal of Plastic, Reconstructive and Aesthetic Surgery, July 2026. · Title: Platelet-Rich Plasma Versus Platelet-Poor Plasma for Treating Facial Photoaging: A Double-Blind Randomised Controlled Splitting Face Study Authors: Ya-Wen TsaI, et al., Published: Aesthetic Plastic Surgery, July 2026. · Title: A Multilayered Gradient Approach to Calcium Hydroxylapatite for Enhanced Full-Face Contouring and Biostimulation.

Author: Irene Gladstein. Published: Plastic and Aesthetic Nursing, July 2025.

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Finance Tax Protection

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Outlining Financial Risk for Clinic Owners Chartered tax advisor Veronica Donnelly discusses financial control and long-term wealth protection for clinics Running an aesthetics business is a balancing act. As your clinic grows, so do your compliance obligations and the complexity of your personal finances.

Increasingly, the two are closely connected, as staying on top of tax and regulatory requirements provides the foundation for stronger long-term financial planning.

This article explores the key compliance developments currently affecting aesthetic practitioners, known as Making Tax Digital (MTD) for Income Tax and the McCloud Remedy for those with NHS pension history.1,2 Consequently, this article considers how these obligations can be used as a springboard for wider wealth planning.

Making Tax Digital for Income Tax MTD is His Majesty’s Revenue and Customs (HMRC) programme to modernise income tax reporting for individuals who currently complete Self Assessment and have income from self-employment and/or property.1 It had been implemented for VAT since 2022, but is now extending to income tax. This has an impact on anyone in the aesthetics sector who earns over the thresholds set by HMRC. Instead of relying on paper records or standalone spreadsheets, those in aesthetics must:1

· Keep digital records such as income from treatments and

services, clinical and treatment costs, rent or room hire, salaries, training and continuing professional development (CPD), general business costs as well as sales records, bank transactions and business running costs · Use MTD compatible software · Submit information to HMRC quarterly for each in scope income source, not just once annually · Complete an end-of-year Final Declaraton, confirming your full income tax position. This is not simply ‘doing your tax return online’ – it is a fundamental change to how you report your income to HMRC Who is affected and when?

MTD for Income Tax has a phased approach for qualifying income, which includes income from self-employment and property, but not employment, partnership or dividend income:1

· From April 6, 2026: Individuals with qualifying income over £50,000

· From April 6, 2027: Individuals with qualifying income over £30,000

· From April 6, 2028: Individuals with qualifying income

over £20,000 This will impact those in medical aesthetics who have multiple income streams, such as dividends from a limited company for clinic operations, self-employed seasonal income, partnership income and rental or other property income.

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A practical compliance checklist To keep MTD manageable:1 1. Confirm when you are in scope: Identify qualifying income sources and map them against the thresholds.

2. Choose the right software: Spreadsheets alone will not be sufficient; you will also need a software bridging tool to collate the data and make the MTD submission to HMRC. The best option is to start using fully MTD compatible software such as Xero to maintain your accounting records.

3. Build a “little and often” record keeping habit: Aesthetic businesses often have high volume transactions and meaningful cost categories. Whilst this is not specific to aesthetic businesses only, it is certainly relevant to all aesthetic businesses. Frequent record keeping avoids backlogs.

4. Set your quarterly deadlines early: Deadlines are fixed, and returns must be submitted quarterly, with penalties potentially applying for late or missed submissions. Most MTD-compatible software will prompt you when updates are due, making it easier to stay on track. Setting internal deadlines ahead of HMRC’s submission dates can further reduce pressure and help avoid a last-minute rush. Data capture tools can also streamline the process by scanning purchase invoices directly into your accounting software.

5. Plan for the year end finalisation: MTD adds in year reporting but does not remove the need to finalise your overall tax position.

The upside MTD done properly can provide better visibility over cash flow and profitability, early awareness of likely tax liabilities and fewer year‑end surprises.

With the right setup, many aesthetic businesses may find that their financial management improves, and access to real-time financial information can help them make informed business decisions such as pricing, investment decisions, growth planning and so on. This is especially useful to aesthetic practitioners as small businesses can benefit from understanding profit and costs throughout the year, as well as tax forecasts, and it allows them to manage cash flow more effectively and plan major purchases or plan for more staff.

McCloud Remedy While MTD focuses on how clinic income is recorded and reported, it is not the only compliance change currently affecting aesthetic practitioners. For many clinicians with NHS pension history, the McCloud Remedy also requires careful attention, with implications for both tax compliance and long-term financial planning.

The McCloud Remedy is a legal and administrative solution to solve age discrimination identified in the transitional protections applied when public service pension schemes were reformed in 2014-2015.2 Older members were allowed to remain in legacy schemes, while younger members were moved to new schemes.

The courts found this discriminatory. The remedy is designed to place affected members in the position they would have been in without that discrimination. HMRC has confirmed that, where tax has been overpaid as a result of McCloud, refunds will be made, and NHS Pensions will reimburse the reasonable costs of correcting affected tax positions.2 If a clinician receives a Remediable Pension Savings Statement (RPSS), then they must consider the McCloud Remedy by using the HMRC online tool.

Further details on this point are provided below.

Aesthetics | August 2026

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Why this matters in the aesthetics sector Many aesthetic professionals are clinicians who have built NHS pension benefits earlier in their career, continue NHS sessions alongside private work or have moved in and out of NHS employment. The McCloud Remedy can affect the value and structure of pension benefits for the remedy period or historic pension tax calculations, including annual allowance tax liabilities.2 Some individuals could be entitled to refunds of pension tax charges that arose only because the original pension treatment was later found to be discriminatory. For clinicians balancing NHS history with private aesthetics income, this can have a material impact on overall wealth and retirement planning. Keep in mind that it is also possible that additional tax liabilities may arise, but these are usually the result of improved pension entitlement in retirement.

The remedy period For most public service schemes, including the NHS Pension Scheme, the remedy period is from April 1, 2015, to March 31, 2022.2 You may be affected if you were a member of a public service pension scheme before April 1, 2012, and you continued to accrue benefits during the remedy period.2 For NHS Pension Scheme members from April 1, 2022, all active members accrue benefits in the 2015 scheme.2 For service between April 2015 and March 2022, affected members will be offered a choice of which scheme’s benefits apply to that period.2 What can aesthetic practitioners do now?

The NHS Pension Scheme will contact members who are affected by McCloud and provide a Remediable Pension Savings Statements (RPSS).4 Practical steps worth taking:4

· Confirm whether you have public service pension membership · Ensure your contact details are up to date · Seek professional advice to correct any affected tax positions If you receive a RPSS, act as soon as possible and review it carefully to ensure you understand the McCloud recalculated figures.4 You can use HMRC’s online calculator to determine if you need to adjust your tax position if you have been affected by the McCloud Remedy.4 McCloud is a pensions issue, but it becomes a wealth planning issue once you factor in retirement timing, income needs and how pensions interact with business and personal assets.4 This is particularly relevant in the aesthetics sector, where many practitioners have mixed income streams (e.g. NHS, private clinics, self-employment or partnerships). The McCloud Remedy can influence decisions around when to draw pension benefits, how to balance clinical and private work and how to structure long-term income alongside business growth and exit planning.4

Future proofing wealth Although MTD and the McCloud Remedy address different aspects of financial compliance, they highlight the same underlying principle. Good financial management is about more than meeting regulatory requirements. Once compliance is under control, practitioners are in a much stronger position to make informed decisions about cash flow, pensions, investments and the long-term value of their business.

Practical steps to improve your financial position Small actions taken today can have a significant long-term impact. Reviewing pension contributions, making use of available

Finance Tax Protection

tax reliefs, investing regularly and reassessing retirement goals can all help strengthen future financial security. It’s also worth reviewing how profits are extracted from the business and ensuring both business and personal finances are regularly monitored and aligned.

Building wealth beyond the clinic Relying on the clinic as the primary source of future wealth can create concentration risk. A useful question to consider if this risk applies to you is whether your financial security depends largely on the continued success or eventual sale of the business. If so, it may be worth considering whether more diversification is needed.

Good diversification means building wealth across a range of assets rather than relying on a single source of value. The aim is not to reduce investment in the business itself, but to balance it with other assets that can provide financial security and flexibility.

A diversified approach can help protect wealth, reduce risk and provide more options when planning for retirement, succession or an eventual business exit.

Joining business and personal planning A common risk is having most wealth tied up in the clinic, with limited diversification. A balanced approach considers:

· Business value: Build and track value through clear financial

reporting, scalable processes and reducing reliance on the owner (e.g. documented protocols, employed clinicians, recurring revenue models) to support a future sale or exit. · Pension funding: Make regular, tax-efficient contributions alongside business growth (e.g. monthly or annual funding aligned to profits), rather than relying solely on a future sale to fund retirement. · Personal liquidity and investments: Take a structured approach to extracting profits (salary/dividends), building cash reserves and investing outside the business (e.g. ISAs, diversified portfolios), ensuring access to funds without needing to draw on or sell the clinic. Consider whether to hold the ownership of your trading property personally or in a separate company so that you can continue to have rental income if you sell the trading business.

Aligning pensions with retirement timing Where NHS pensions exist, remedy choices can affect retirement income expectations. Even without NHS membership, private pension decisions should align with your clinical workload reduction or exit plans. For example, a practitioner planning to reduce clinic hours over the next five to 10 years may choose to increase pension contributions now and phase access to benefits to replace lost income, rather than relying solely on a future clinic sale.

Final remarks As the aesthetics sector continues to evolve, practitioners who take control of both compliance and financial planning will be better equipped for the future. Staying ahead of changes such as MTD for Income Tax and the McCloud Remedy can help reduce risk, improve visibility and support more informed decisions around pensions, investments and business growth.

Veronica Donnelly is a VAT partner at Azets, a chartered tax advisor, associate of the Institute of Indirect Taxation and a leading adviser to the aesthetics sector. With over 40 years’ experience she offers planning and compliance advice on VAT, tax advice for clinic structures and transactions and ensures support with personal tax and wealth management questions.

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13 March 2027, Grosvenor House, London

Entries for the 2027 Aesthetics Awards open on August 10 aestheticsawards.com @aestheticsjournaluk

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The Aesthetics Journal Award for Outstanding Achievement in Medical Aesthetics Rising Star of the Year Aesthetic Nurse of the Year Aesthetic Dentist of the Year (NEW) Aesthetic Doctor of the Year

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Clinic Growth Accreditation

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Supporting Clinic Growth Using Accreditation US-based compliance specialist Thomas Terranova outlines how accreditation drives growth More than half of approximately 35 million aesthetic procedures performed globally are now non-surgical, and the global aesthetics market is projected to grow substantially over the coming years.1,2 However, regulatory oversight has not always kept pace with this expansion. The Royal College of Surgeons has highlighted variation in regulation, practitioner qualifications and education across countries, contributing to inconsistencies in clinical practice, governance and patient safety.3

Defining accreditation Across all specialties, accreditation is an external quality assessment through which an independent non-governmental organisation, dedicated to standards development and oversight, evaluates an organisation against established standards for safety, quality and operational performance. In healthcare, the process focuses heavily on patient safety principles.4 Effective accreditation should be proportionate to the risks associated with the services provided, delivering safety standards comparable to or exceeding those found in hospitals without imposing unnecessary hospital-level requirements.

How accreditation supports clinic growth Although accreditation may seem unfamiliar to some aesthetic providers, its underlying principles – standards, accountability and continuous improvement – are fundamental to the future development of the sector. Beyond validating safety and quality, accreditation can deliver tangible business benefits.

Patient safety and risk management Evidence continues to highlight preventable harm within the aesthetics sector, including vascular occlusions and complications linked to inadequate emergency preparedness.5 Accreditation requires clinics to implement appropriate policies, training programmes and emergency resources to identify, escalate and respond effectively to adverse events. The aesthetics market grew by more than 40% between 2019 and 2022, with many treatments now delivered by non-physicians and unlicensed practitioners.1,6,7 In the UK, more than 80% of providers appear to be 52

operating in breach of at least one existing regulation, while adverse events remain significantly underreported.8,9 Inconsistent training and poorly defined emergency protocols can allow manageable complications to develop into severe and potentially permanent injuries.4 Accreditation promotes a culture of preparedness, ensuring clinics have systems in place to respond effectively when incidents occur.

Public trust and increased patient conversion An independent third-party research group found that patients value transparency, professional qualifications and independent validation. Two-phase research, with qualitive information gathered from 60 participants and a quantitative data collected from 601 patients, demonstrates that when patients are informed about accreditation, 80% report increased trust, confidence, and positive perceptions of quality, compassion and emergency preparedness.10 Accreditation information was also shown to improve overall perceptions of a practice by 20%.10 Importantly, accreditation addresses many of the concerns that discourage prospective patients from seeking elective treatment outside traditional healthcare environments.

More than half of patients from the study discussed above, who would otherwise be unlikely to pursue treatment in a non-hospital setting, describe accreditation information as essential to influencing their decision.10 Research suggests that the patient journey increasingly begins online, with most aesthetic patients consulting multiple websites before booking a consultation and online information playing a greater role than in general healthcare.11 Promoting accreditation across clinic websites, Google Business Profiles and patient-facing platforms, alongside educational content on safety and quality, can strengthen digital visibility and trust.12 Because accreditation reflects recognised clinical standards, it also enhances credibility, supports patient acquisition and fosters long-term patient loyalty.13 Consistency and operational efficiency The same accreditation frameworks that improve consistency also function as structured risk management. By reducing variation in clinical and operational Aesthetics | August 2026

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processes, they help minimise the likelihood of adverse events.14 Although malpractice data within aesthetics remain limited, peer-reviewed research consistently demonstrates that accreditation improves patient safety, standardisation of care and process reliability.9,15 These improvements contribute to stronger organisational performance and may support more favourable insurance considerations.

Through day-to-day communications, clinics frequently report that preparing for accreditation leads to measurable gains in efficiency and team alignment. Tasks that once varied according to individual preferences become standardised, creating greater clarity, accountability and coherence across the organisation. Increased efficiency, consistency and alignment maximise profitability through reduced waste, errors and time costs and smarter purchasing policies, thus facilitating healthier profit margins.

Recruitment and retention of high-quality practitioners A clinic’s reputation plays a crucial role in attracting and retaining talented professionals. Increasingly, qualified clinicians seek employment within organisations that demonstrate a genuine commitment to safety, quality and professional standards.16 Clinics that invest in systems supporting safe and effective care are often better positioned to meet the priorities of their teams. Research suggests that organisations which address employees’ psychological needs experience higher performance, greater profitability, increased job satisfaction and lower rates of staff turnover and workplace incidents.17

Integrating accreditation into practice Achieving accreditation requires planning, commitment and engagement from the entire team. Understanding the accreditation process and selecting an appropriate accreditation body are important first steps.

A range of healthcare accreditation organisations offer programmes for outpatient and ambulatory healthcare services, assessing areas such as governance, patient safety, infection prevention, medication management and quality improvement. Some accreditation bodies also provide programmes tailored to specific clinical specialties, including medical aesthetics and wellness, with standards that address the unique procedures, technologies and risks associated with these settings.

When selecting an accreditation provider, practices should consider factors such as

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the scope and relevance of the standards, the credibility and recognition of the accrediting organisation, the assessment methodology, ongoing support and whether the programme aligns with the services they provide and their long-term quality objectives.

Step-by-step implementation Based on experience in accreditation and standards development, once a facility decides to pursue accreditation and begins evaluating accreditation organisations, it is important to consider the following factors:

· Independence, objectivity and rigour:

Look for recognised standards and governance, including recognition by government bodies and international organisations (e.g. ISQua and IEEA), where applicable. · Transparency: Standards, criteria and fees should be clearly published and freely accessible online. · Resources and support: Strong programmes provide practical support, including webinars, educational materials, vetted vendors and ongoing guidance throughout accreditation and renewal. · On-site assessment: Regular in-person surveys (e.g. every three years) provide a more accurate assessment than remote or desk-based reviews alone. · Proportionate standards: Requirements should support appropriate levels of safety and quality without imposing unnecessary hospital-level infrastructure. · Remediation support: Accreditation should include clear guidance to address findings, supporting education and continuous improvement.

Once an accreditation provider has been selected, the first step is to obtain and thoroughly review the standards. This process often reveals gaps that have become invisible through familiarity with day-to-day operations. Many clinics find it helpful to conduct an internal mock assessment, led by a detail-oriented team member, to identify areas requiring improvement before formally engaging with the accrediting organisation.

Following this initial review, clinics should develop an implementation plan to address any deficiencies. Depending on internal resources and expertise, organisations may choose to manage the process independently or engage an external consultant. Both approaches can be effective, provided sufficient time and leadership commitment are allocated to the project. Throughout the process, clinics should make full use of the resources, templates and guidance offered by the accrediting body.

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Preparation typically involves developing or refining policies and procedures, auditing records and documentation, and ensuring staff understand both the standards and their responsibilities.

Training should extend beyond clinical teams to include administrative and support staff, particularly in areas relating to governance, communication and emergency preparedness.

Organisations that approach findings as opportunities to strengthen systems and processes generally achieve the greatest long-term benefit. Post-survey recommendations should be embraced as part of a continuous improvement cycle designed to enhance safety, quality and operational performance.

The accreditation process for an average facility takes 96 days from processed credential paperwork to the approval letter.18 Regulation, licensing and certification Accreditation complements existing regulatory, licensing and certification frameworks by providing a comprehensive assessment of how they are implemented within day-to-day practice.4 These components can be broadly defined as:

· Regulation: Simply means the legal

framework established by government agencies that impact a business, these could include labour, environmental, waste disposal, advertising and other practices governed by bodies such as the Advertising Standards Authority.4 · Licensing: The authorisation of practitioners or facilities to provide specific services, including medical or nursing licenses as well as health ministry or Care Quality Commission approvals.4 · Certification: Evidence of competence in a particular skill, specialty or area of knowledge, such as Certificate of Completion of Training and relevant Royal College designations.4 Each plays a distinct role. Accreditation brings them together by promoting compliance, ensuring documentation remains current and evaluating whether systems are in place to support safe and consistent care.

By encouraging regular audits, drills and performance reviews, accreditation helps maintain readiness and reduce the risk of complacency.

Maintaining accreditation Maintaining accredited status requires regular policy reviews, staff training, governance activities and continuous monitoring of performance.

Aesthetics | August 2026

Clinic Growth Accreditation A structured programme of audits aligned to key emergency preparedness requirements – such as fire response, shelter-in-place protocols, cardiac arrest management and allergic reaction procedures – alongside ongoing quality improvement initiatives helps ensure that standards remain effective and relevant as services evolve.

Without strong maintenance practices, clinics are subject to the whims of the staff and risk underperforming on assessments and having to continually repeat remedial corrective actions every three years.

Considerations Clinics must dedicate time to policy development, documentation, staff training and implementation activities. The scale of the project will vary depending on the size, complexity and maturity of the organisation.

For well-established teams, creating missing policies and procedures may require only a modest investment of time, with ongoing maintenance often limited to periodic reviews and updates. Governance activities and emergency preparedness exercises are typically conducted quarterly or annually, depending on the specific requirements established in each standard.

Emergency preparedness should never be limited to a single individual or department.

Whenever patients are present, the entire team should be equipped to respond appropriately, ensuring that care does not rely on any one staff member who may be off duty or unavailable.

Confidently integrating accreditation As Professor Sir Bruce Keogh observed, “Given the known risks, it is not appropriate that the public has no more consumer rights when receiving dermal filler injection than when buying a toothbrush.”19 As the sector continues to grow, robust governance is increasingly important. Accreditation provides a structured framework for patient safety and long-term credibility.

Thomas Terranova is chief executive officer of healthcare accreditation company QUAD A. With a background in law, healthcare administration and organisational leadership, he advances patient safety and quality improvement, including overseeing the launch of QUAD A’s aesthetics and wellness accreditation programme, developed with UK, US and UAE specialists.

VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 53

Lead Management CRM systems

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Understanding CRM in Aesthetic Practices Digital marketing specialist Jared Rohrer explores customer relationship management systems One of the most common challenges within aesthetic clinics is not lead generation, but the process that follows once a lead has been generated. Research by healthcare analytics platform Liine, drawn from an analysis of 278,000 leads, found that fewer than 40% of marketing-sourced enquiries ever result in a booked appointment, suggesting that for most clinics, the greater opportunity lies in how leads are managed, not how many are generated.1 This article will explore how customer relationship management (CRM) systems can help when a clinic is experiencing lost leads, and how to identify whether your clinic or practice may have outgrown its current processes.

What is CRM? A CRM is software designed to manage what happens after someone expresses interest in your clinic.2 Marketing earns you attention; your website, ads and social channels then collect contact information, and finally, the CRM manages the transition from audience member to booked patient.

In an aesthetic practice, a CRM organises lead intake and follow-up so that no opportunity is left to chance. The CRM does all of that through these core functions:

· Pipeline management: Allowing you to track each lead by stage,

from first contact to booked appointment and beyond. · Two-way communication: Including email and text messaging, so conversations can be managed and documented in one place. · Sales cycle visibility: Showing how long it takes leads to convert and where the drop-off occurs. · Conversion tracking: Such as lead to appointment and patient metrics. · Team accountability: Ensuring follow-up standards and response times are consistently met.

When used correctly, a CRM does not replace human interaction but instead supports it by creating clarity around the process and removing guesswork.3

How CRMs can benefit aesthetic clinics A CRM system allows clinics to reinvest more efficiently by creating automated follow-up and marketing systems, such as automated emails when a new lead comes in, or an automated text message series when a prospective patient fills out an inquiry. These automations and follow-up systems allow aesthetic practices to stop worrying about tracking conversations and follow-ups and start focusing on patient care and producing strong, consistent patient outcomes.

Conversion rate optimisation When you get a brand-new inquiry to your clinic, your staff’s goal is to get that inquiry to book an appointment at the most efficient rate possible. A general healthy inquiry to booking rate should be around 55% or more.1 When clinics do not use a CRM or fail to track new inquiries, the lower performing clinics currently get around a 20% booking rate.1 54

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Aesthetics

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When a clinic owner successfully implements a CRM and starts tracking new inquiries as well as following up consistently, it can very feasibly get their booking rate back up to a healthy range at 55% or more, nearly tripling performance.1 Operational efficiency When a CRM handles routine follow-up tasks automatically, your team gets time back. For a small or growing clinic, this is significant, as instead of hiring new employees to handle more volume; the system absorbs that load.4 The front desk becomes less reactive and more intentional, and the overall patient experience improves because your team isn’t stretched across administrative tasks that a CRM can handle in the background.

Here are some examples of routine follow up tasks:

· Appointment reminders: When a patient finishes a treatment,

there’s a recommended time that they have their next appointment, with a CRM you can make this automatic instead of trying to remember.

· Inquiry follow-up sequences: When a prospective patient

inquires about a service like dermal filler but doesn’t actually book an appointment, you can have a series of emails and texts that educate the patient and nurture the relationship so that, when they’re ready, you’ll be their choice.

· Internally inquiry follow up reminders: Instead of having sticky

notes everywhere, or a notebook with reminders to call patients back, a CRM has a pipeline that allows you to track inquiries and take notes on each interaction. Including the ability to remind your staff that they have a lead waiting.

Outgrowing manual systems You don’t have to be a large, multi-location practice to use a CRM. Nor do you need a large technical team or background. On the contrary, smaller practices often see some of the greatest benefits. But knowing when you’ve outgrown your current process is the first step.

In my experience of working with clinics across North America, the warning signs tend to follow a pattern. It usually starts with volume. When a clinic is seeing a handful of enquiries per week, a spreadsheet and a good memory can hold things together. Once that volume climbs, typically somewhere around 20-30 new enquiries per week, the cracks start to show. Follow-up becomes inconsistent.

Leads that came in on a busy Friday don’t get contacted until Monday, and some don’t get contacted altogether.

For smaller or growing practices, a CRM can act as an extension of the team. It automates reminders, organises communication and creates structure around patient engagement before complexity sets in. As the clinic grows, those systems scale naturally rather than needing to be rebuilt later. The clinics I’ve seen scale most successfully didn’t wait until they were overwhelmed – they implemented structure early and grew into it.

In a busy clinic, enquiries arrive through multiple channels simultaneously. A potential patient fills out a form on the website. Another sends a direct message on Instagram.

A third calls the front desk while a fourth emails through the contact page. Without a structured system to capture and manage all those touchpoints in one place, follow-up becomes inconsistent at best and non-existent at worst.

Some leads get a same-day response, others wait days and some are never followed up with at all.

Aesthetics | August 2026

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Lead Management CRM systems

Data-driven decisions

Implementing new systems successfully

Without a CRM, most clinic owners are making decisions based on perception instead of raw data. A CRM shines a light on which marketing channel is bringing in patients, which staff member is converting enquiries, and where leads are dropping off. Rather than guessing where to invest your next marketing budget or how to coach a team member, you have visibility into exactly what’s working and what isn’t. It does this through tracking ‘lead source’, when a new lead enters your system, the CRM can automatically note the source so that you can see the volume of leads per marketing channel. Rather than guessing where to invest your next marketing budget or how to coach a team member, you have visibility into exactly what’s working and what isn’t.5 Over time, that data compounds, you get sharper at spending, faster at identifying problems, and more confident in the decisions you make for your clinic’s growth.6

Starting simple and focusing on your clinic’s immediate needs will make implementing a CRM manageable. The goal is to enhance operations without adding unnecessary complexity.

Understanding the patient journey Most aesthetic patients don’t book on first contact – and that’s not a sign of low intent. Research suggests the average aesthetic patient considers a procedure for two to six months before committing.7 A lead going quiet is rarely a lead saying no. More often, it’s a lead that needs more time, more information or simply the right follow-up at the right moment.

Trust plays a significant role in this. Patients who ghost and return months later often do so because something shifted – they saw a result they connected with, received a timely reminder, or simply felt ready. The clinics that capture those patients are the ones that stay present through consistent, low-pressure communication rather than writing them off after a single unanswered message.

Patient experience and continuity of care The impact on no-shows is also measurable. Automated appointment confirmations and reminders reduce the likelihood of a patient simply forgetting. Fewer no-shows mean more predictable schedules, less wasted provider time, and a smoother experience for every patient on the books. For patients who experience anxiety ahead of a procedure, a simple pre-appointment message, checking in or reconfirming what to expect can meaningfully reduce that stress, which in turn makes for a better in-clinic experience on the day.

CRMs not only benefit the clinic, but they also have many benefits for your patients as well. These might include:

· Personalised care: Patients receive tailored recommendations

and follow-ups based on tags and previous appointments such as receiving a promotion for the clinics skincare line after an appointment where the patient mentioned that they were wanting a better skincare routine. A patient considering their first treatment needs different communication than one who has been coming to you for three years. When follow-up feels relevant rather than generic, patients feel seen, and that directly influences both trust and retention. · Convenient communication: Patients can reach your clinic through a single, consistent channel regardless of whether they sent an email, text, WhatsApp message or a direct message on Instagram. · Improved outcomes: Automated post-procedure follow-up ensures patients receive the right aftercare instructions at the right time, without relying on them to remember a verbal briefing from their appointment. · Trust and transparency: Secure, compliant handling of personal data signals to patients that your clinic takes their privacy seriously. Patients are sharing sensitive information about their appearance, their concerns and sometimes their insecurities.

1. Identify your needs: Determine what you want to achieve, whether it’s better scheduling, improved marketing or enhanced patient communication.

2. Choose a user-friendly CRM: Look for platforms with intuitive interfaces and essential features that match your needs.

3. Train your team: Ensure that all team members receive proper training and that you hold your team accountable to key performance indicators, like appointment booking rate.

4. Integrate gradually: Start by using basic functions like inquiry pipeline management, e-blasts and text blasts before exploring advanced features like automation and analytics.

There are also a few considerations specific to aesthetic clinics that are worth thinking through before you commit to a platform.

First, make sure the system fits around your consultation workflow. A CRM that works well for a retail business or a dental practice may not map cleanly onto the way an aesthetic clinic manages enquiries, patch tests, consultations and treatment bookings.

Second, decide early on who owns lead follow-up in your team.

This is one of the most common points of failure in CRM adoption.

Assigning a clear owner, whether that’s a dedicated patient coordinator, a senior receptionist or the clinic manager, ensures accountability from day one.8 Third, consider whether the CRM can integrate with your existing booking or practice management software. Duplication of data entry is one of the fastest ways to kill team adoption. The more seamlessly your CRM connects with the tools your team already uses, the more likely they are to actually use it.

Finally, set your key performance indicators before you go live, not after. Decide what a successful first 90 days looks like. That might be a target enquiry-to-booking conversion rate, a maximum response time to new leads, or a reduction in no-shows. Without defined metrics, it’s difficult to know whether the system is working, or whether it simply needs better adoption.

Consistency and relationship building When used correctly, a CRM creates stronger relationships with your patients through consistent follow-up. It also creates stronger relationships within your team by bringing clarity, accountability and mutual expectations to the patient booking process. Importantly, it gives you peace of mind and a clearer vision moving forward, knowing that your growth is supported by systems.

Jared Rohrer is a consultant, educator and strategist in the medical aesthetics specialty with more than a decade of experience working alongside clinic owners, physicians and practice managers. He is the founder of Aesthetic Conversion, a growth and analytics-focused agency that helps aesthetic clinics build high-converting websites, improve patient acquisition and implement data-driven systems for sustainable growth.

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Aesthetics | August 2026

55

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52-year-old female. Results following SuneKOS 1200 & Performa full face protocol (3 sessions).

Images courtesy of Elain Wood, NY Skin Clinic.

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In The Life Of: Dr Alison Colville

In The Life Of Dr Alison Colville

Instagram to answer common questions or share insights based on conversations I’ve had with patients that day. Otherwise, I’m catching up on clinical notes and other administrative tasks before seeing my next patient.

Dr Alison Colville shares her busy clinical career alongside movement, mindfulness and quality time with her family A typical working day…

As a natural early riser, I usually wake up between 5-6am, and the first thing I do is grab a hot cup of good-old breakfast tea. Following this is what I call my “power hour” – a period of uninterrupted time for meditation, journalling, planning and reading – a moment to centre myself before the day picks up pace.

I’m currently reading The Diary of a CEO, which provides the perfect dose of inspiration before the day begins, and concludes my power hour session.

Some mornings I’ll make myself a protein smoothie for breakfast and other mornings I’m grabbing crumpets from the freezer because I’m running late. I will then feed my Labrador Retrievers Cleo and Luna, and head off to the gym, as exercise is an essential element of my morning. Cardio has never really been my thing; I would much rather spend 45 minutes lifting heavy weights in the morning.

My clinic day begins at 10am, but no two clinic days are ever quite the same. Some are focused on lengthy consultations, while others are treatment-heavy. My work largely centres on full-face filler treatments, which are often detailed and time-intensive, alongside a growing number of regenerative procedures. I am known for my one-hour consultations and regularly lecture on the importance of taking the time to truly understand each patient. A key part of my approach is educating patients about the ageing process and the full range of treatment options available to them, empowering them with the knowledge and confidence to make informed decisions.

This emphasis on patient education, trust and personalised care is central to the way I practise.

I’m fortunate to work with a fantastic skin specialist nurse colleague who manages our skin health, regenerative and device-based treatments including Morpheus8, Lumecca IPL and cryotherapy, allowing me to focus on what has really become my passion, which is complex full-face filler work. I’m also supported by an incredible team, including another injector colleague. I have several go-to products in the clinic, but as a member of its faculty, I particularly love working with pharmaceutical company Galderma. We use a lot of Restylane and Sculptra, and were one of the first clinics in the country to introduce Sculptra Body.

For lunch, I try to prioritise protein and nutritious meals where possible, but the odd ready meal definitely features when clinic overruns. During my lunch break, I’ll usually catch up with colleagues and check in with the team. If I have some extra time, I might go onto

My favourite treatment to perform in clinic is dermal filler as it fuses medicine and anatomy, and the anatomy of ageing, with the artistry of being able to soften and create something. Before becoming a full-time general practitioner I trained in orthopaedics, and this has given me a deep comfort with anatomy and mechanics. In aesthetics, I use that knowledge artistically in my patients’ faces.

After a busy day in clinic, I usually don’t get home until around 7pm.

My partner and I have dinner together and, during the summer months, we like to take the dogs for a walk around the village and often into the fields to enjoy some time outdoors before the evening draws in. Once we’re back home, we tend to collapse onto the sofa and switch off with some easy television. At the moment, we’re watching America’s Sweethearts: Dallas Cowboys Cheerleaders, which has become our current guilty pleasure. By around 9pm, we’re ready to call it a day and head upstairs for an early night, giving ourselves the chance to recharge before doing it all again tomorrow.

Other work commitments…

Alongside my clinical work, I am a key opinion leader (KOL) for the Joint Council for Cosmetic Practitioners (JCCP) and serve on its Clinical Advisory Committee. This role involves contributing to podcasts, attending clinical advisory meetings and collaborating with fellow committee members to discuss regulatory developments, patient safety concerns and wider issues affecting the specialty.

With the JCCP I recently ran an NHS educational day at Cheltenham hospital educating NHS staff on medical aesthetics and complications.

In addition, I work closely with the British College of Aesthetic Medicine, where I have had the privilege of presenting for them at the Aesthetics Conference & Exhibition (ACE). I am also the global head of research for hypochlorous acid technology company Clinisept+, as well as one of the company’s clinical advisors and KOLs, which involves supporting lead research into hypochlorous acid and its applications within aesthetic practice. Alongside these professional commitments, I launched my first podcast last month, The Applied Aesthetic Podcast, which aims to provide a platform to discuss developments in medical aesthetics clinical practice, patient safety and the wider issues shaping the specialty.

Mostly I speak independently too, educating on complications, contraindications to treatment and consultation skills.

Most memorable day in your career…

Winning the DermaFocus Award for Best Injectable Result at The Aesthetics Awards 2026 was an incredibly significant moment for me. It was an accolade I had always aspired to receive because, in my view, it represents clinical expertise at its highest level. The judging is based on the strength of a case study, including the clinical decision-making, treatment planning, technical execution and patient outcome, which makes it particularly meaningful. Therefore, receiving the Award felt like the culmination of a long-held professional goal.

Favourite movie?

Mean Girls.

Dream holiday destination?

I’d love to visit Maldives one day.

Best piece of advice you have ever received?

Comparison is the thief of joy.

Aesthetics | August 2026

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The Last Word Qualifications

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Aesthetics

Are Prescribing Qualifications Alone Enough for Aesthetic Practice?

Nurse prescriber Rebecca Mansell argues that prescribing competence shouldn’t be conflated with competence in independent medical aesthetics practice Medical aesthetics has experienced rapid growth in the UK, driven by increasing demand for minimally invasive procedures and technological advances.1 The global specialty is estimated to be worth £31.2 billion, with around 900,000 botulinum toxin treatments performed each year.2 Alongside this rapid growth, an increasing number of prescribers are moving into independent aesthetic practice, often at pace.3 A prescribing qualification undoubtedly carries weight. It provides legal authority, pharmacological knowledge and a framework for safe decision making.4 However, aesthetic practice differs from traditional healthcare environments. It is characterised by off-label prescribing, consumer-driven demand and delivery within a largely private sector where governance frameworks can vary.5 In my view, this raises an important – and perhaps uncomfortable – question: while prescribers are qualified to prescribe, are they truly prepared for the realities and risks of independent aesthetic practice?

Where qualification and practice diverge Prescribing qualifications equip prescribers with essential knowledge, skills and legal authority to prescribe medications safely and they support competent, accountable practice in line with national professional standards.6 Many treatments in medical aesthetics remain off label. Botulinum toxin is licensed for certain cosmetic indications, yet much of its use in practice remains off label.7 Hyaluronidase is widely used to dissolve dermal fillers and manage complications, it is a critical safety tool but its use in aesthetics is also off-label.8 In addition, some practitioners use bacteriostatic saline to reconstitute botulinum toxin for reduced injection discomfort, despite the manufacturer’s recommendation that botulinum toxin be reconstituted with preservative-free 0.9% sodium chloride injection, making the use of bacteriostatic saline an off-label practice in many settings.9,10 58

A prescribing course may explain the legal framework for off-label use, but I do not believe it prepares clinicians for an environment where off-label prescribing is the rule rather than the exception. The burden of justification falls squarely on the prescriber, who must be able to robustly evidence their prescribing decisions, communicate nuanced risks clearly, and ensure that consent is genuinely informed in a setting that can often feel more commercial than clinical.11 Governance is another key difference.

In traditional healthcare environments, prescribers typically work within established structures supported by multidisciplinary teams (MDT), clear escalation pathways, robust incident reporting, policies for managing rare but serious complications, and defined leadership and accountability.12 In contrast, aesthetic practice is often delivered in the private sector, where these structures can vary. For example, adverse incidents in healthcare organisations are reported through established governance systems to support investigation and organisational learning. By contrast, independent aesthetic practitioners are responsible for establishing appropriate reporting and governance processes within their own practice.13,14 I believe that without consistent multidisciplinary support, this could increase both professional responsibility and clinical risk.15

The role of structured support There is concern that introducing structured pathways could be overly restrictive. Aesthetic practice is highly fragmented, with few restrictions on who can perform procedures and no nationally recognised training standards.16 I understand the argument that a rigid, one-size-fits-all model could limit flexibility and create barriers to entry. Professional accountability is also central; prescribers are expected to recognise their limits and practise within their competence.17 However, I believe the profession must also ask whether we are doing enough to support them in reaching that competence in the first place.

Aesthetics | August 2026

Aesthetics

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Bridging the gap from qualification to competence Transition pathways can support prescribers in developing the additional competencies required for safe and independent aesthetic practice.

Mentorship is a key part of this. Access to support through accredited training providers, professional organisations, conferences, networking events and established aesthetic clinics offering supervised clinical experience provides not only guidance, but also reassurance and real-world insight.18 Aesthetic-specific training is essential.

Areas such as complication management, off-label prescribing, psychological assessment and governance in private practice are not always fully covered in prescribing programmes.

Further education through recognised postgraduate or Level 7 aesthetic training programmes can help practitioners develop these additional competencies.19 Rather than imposing a rigid model, I would argue a flexible, competency-based approach would offer the right balance. It would allow prescribers to develop at their own pace while still supporting clearer and more consistent minimum standards across the profession.

From prescribing to practice In my view, prescribing qualifications provide a strong and necessary foundation for safe clinical practice, but they do not fully prepare practitioners for the specific realities of independent medical aesthetics. The field presents challenges that go beyond traditional prescribing roles, so I believe prescribers entering aesthetics should actively seek mentorship from experienced practitioners, alongside aesthetic-specific education and supervised clinical experience.20 In my opinion, a more structured transition into practice is essential to help ensure that practitioners are not only qualified to prescribe, but also properly prepared to practise safely, ethically and confidently.

Rebecca Mansell is an academic and NMC-registered independent nurse prescriber with a master’s degree in medical and healthcare education. She teaches prescribing in higher education and has a particular interest in prescribing education, evidence-based practice, clinical governance, patient safety and medical aesthetics.

Qual: MSc, PGCert, INP, FHEA

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Brand Directory Your guide to the unmissable companies at the Clinical Cosmetic Regenerative Congress (CCR) Key Key Sponsors

Medical Longevity Summit

IBITA Korea Zone

In Practice Zone

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Injectable Experience

# A

3D Aesthetics Acclaro Corporation ACE Group World Acmedi Korea Co.,Ltd Acquisition Aesthetics ACRE Aerolase Aesthetic Web Alfa Medical Alma Lasers UK Ltd.

Genefill UK Ghent University GLANZEN H

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Galderma (UK) Ltd GC Wellbeing

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Directory is correct as of time of print. Updates may be made before the event.

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