July 2026: Face and Neck

FACE AND NECK July 2026 | VOLUME 14 - ISSUE 8

The Resource for Medical Aesthetics Professionals

CPD: Exploring CaHA in Regenerative Aesthetics Dr Ben Taylor-Davies reviews the use of CaHA-based injectables

Special Feature: Injectables for the Décolletage Understanding Facial Bone Resorption

ALSO IN THIS ISSUE

Mr Sotirios Foutsizoglou outlines a submental fullness case study Alan Adams explains ethical and sustainable pricing

STEP INTO THE

FUTURE OF NEUROMODULATION WITH

RAPID ONSET

HIGH LEVEL OF SATISFACTION

RelfydessTM can deliver fast results starting from Day 1 for up to 39% of patients.*1–3

71% preferred Relfydess™ compared to previous neuromodulators they had been treated with†4

(Not based on head-to-head data)

LIQUID SIMPLICITY

NEW LEVEL OF PURITY

Designed for aesthetic use, RelfydessTM is a ready-to-use liquid neuromodulator optimised for simple volumetric dosing.3

RelfydessTM is free of complexing protein and human- or animal-derived components.5,6

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.3 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.3 *39% of patients treated for GLs (n=223) and 34% of patients treated for LCLs (n=230) saw an onset of effect by Day 1, as estimated from a Kaplan-Meier analysis of patient diary card response for the first seven days following treatment. Median time to onset was two days.1,2

90% (GLs) and 88% (LCLs) at Month 6 agreed or strongly agreed with the statement ‘I would recommend this treatment to others’.2,3 GL, glabellar line; ITT, intention-to-treat; LCL, lateral canthal line.

Based on the Subject Treatment Questionnaire completed by all ITT patients treated with Relfydess™ in the RELAX study (n=99). Patients agreed or strongly agreed with the statement ‘I prefer to be treated with this study product than with other neuromodulators I received in previous treatments’.4 FLTSQ, Facial Lines Treatment Satisfaction Questionnaire; GL, glabellar line; ITT, intention-to-treat; LCL, lateral canthal line.

References: 1. Shridharani SM, et al. Aesthet Surg J.2024 June. Epub ahead of print. doi:10.1093/ asj/sjae131; 2. Galderma. Data on file. REF-24764; 3. Galderma. Relfydess™ Summary of Product Characteristics. January 2026; 4. 4. Galderma. Data on file. REF-24747. 5. Do M, et al. Poster presented at: TOXINS 2022 Conference; New Orleans, US; July 27–30, 2022. 6. Sundberg AL, Stahl U. Poster presented at: TOXINS 2021 Virtual Conference; January 16–17, 2021. 7. Galderma Laboratories. MA-47073. Clinical Study Report for Protocol 43QM1901: READY-2. Tables 14.2.12.4. 8. Galderma Laboratories. MA-47072. Clinical Study Report for Protocol 43QM1602: READY-1. Tables 14.02.11.04 and 14.02.12.02. Fort Worth, TX: 2021.

Based on the Facial Lines Treatment Satisfaction Questionnaire from the READY-1 and -2 studies. 98% (GLs, n=218) and 93% (LCLs, n=226) of patients treated with Relfydess™ at Month 1 and 90% (GLs, n=210) and 86% (LCLs, n=223) at Month 6 agreed or strongly agreed with the statement ‘I would have this treatment done again’. 98% (GLs) and 93% (LCLs) at Month 1 and

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.

†

‡

A NATURAL, REVITALISED LOOK PATIENTS WOULD RECOMMEND1,6,8 90%

83%

MONTH 6

MONTH 6

Up to

98% MONTH 1

would return for treatment and would recommend RelfydessTM after 1 month, with up to 90% agreeing through to 6 months‡1,7

94% MONTH 1

“I look natural when I make expressions”†8 94% at Month 1 and 83% at Month 6

Step into the future of neuromodulation with a natural look

QR code to prescribing information and adverse event reporting.

Galderma portfolio available at our distribution partners

medfx © 2026 Galderma S.A. All rights reserved.GB-REL-2600071 | April 2026

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

14 Restylane SkinboostersTM: Beyond Just Hydration, Improving Skin Quality From Within Galderma explores the role of Restylane SkinboostersTM

15 JCCP Issues New PRP Guidance for Hair-Loss Treatments Aesthetics explores the implications of the new PRP Guidance

CLINICAL PRACTICE 16 Event Preview: Future Proof Your Practice With Metabolic Medicine Discover how understanding metabolic health can transform outcomes

News Special: JCCP Issues New PRP Guidance for Hair-Loss Treatments Page 15

21 Special Feature: Reviewing Injectables for the Décolletage Three practitioners discuss clinical protocols for décolletage rejuvenation

25 CPD: Exploring CaHA in Aesthetics Dr Ben Taylor-Davies reviews the use of CaHA-based injectables

28 Understanding Facial Bone Resorption Dr Steven Land outlines how facial bone resorption affects the ageing process

33 Treating Submental Fullness Mr Sotirios Foutsizoglou outlines a case study treating submental fullness

39 A Clinical Approach to Neck Rejuvenation with Injectables Dr Rupert Critchley explores treatments for neck rejuvenation

43 The Power Stack Eleanor Hartley explains how to achieve structural excellence through integrated skincare

45 Treating Vascular Occlusion in the Chin Three practitioners present a case study on vascular occlusion in the chin

48 Introducing Tor-Bac

Special Feature: Reviewing Injectables for the Décolletage Page 21

Clinical Contributors Dr Ben Taylor-Davies is an aesthetic doctor with a background in emergency medicine. He sits on the clinical support team for CMAC, is a key opinion leader for Cutera and

Alison Stevenson explains why this single dose product has grown in sales year-on-year

SkinCeuticals and is a national trainer for Acquisiton Aesthetics. Dr Steven Land is the owner of Novellus Aesthetics. His medical training in emergency medicine eventually led him to a

49 Abstracts The latest research highlights from Professor Sebastian Cotofana

passion for medical aesthetics, where he found a unique way to empower individuals by enhancing their appearance.

IN PRACTICE

Mr Sotirios Foutsizoglou is an aesthetic surgeon

51 Retailing Skincare For Clinic Growth

College of Surgeons of England and the European Board of

who has worked as a consultant and a Fellow of the Royal

Specialty figures detail a strong retail strategy for aesthetic clinic growth

54 Considering the Social Media Confidence Trap Fiona Macaskill examines how practitioners can create profitable businesses

Plastic Reconstructive and Aesthetic Surgery. Dr Rupert Critchley is a medical aesthetics practitioner, GP and clinical director of VIVA Skin Clinics. He specialises in advanced injectable treatments with a particular focus on antiageing and regenerative aesthetics.

56 Tackling the Tricky Task of Increasing Prices Alan Adams explains how UK clinics can price confidently

58 In Profile: Dr Nasha Winters Dr Nasha Winters shares how a terminal cancer diagnosis led her to functional health

59 The Last Word: Can Soft Tissue Fillers Truly ‘Lift’? Dr Jani Loghem argues whether the term ‘lift’ fits clinical reality

Dr Maisie Bishop is a general practice specialty registrar and aesthetic practitioner with a Diploma in aesthetic injectables. Her interests lie in holistic, patient-centred care, helping patients achieve natural results. Kelly Turner is an aesthetic nurse practitioner and owner of Biológica Aesthetics Clinic. She adopts a holistic, patientcentred approach to medical aesthetics. Her work emphasises natural-looking results and tailored treatment plans. Dr Jordan Faulkner is a cosmetic practitioner and the owner of Allo Aesthetics in London Bridge. He is the founder

NEXT MONTH: INJECTABLES

of Unite Aesthetics Initiative, and he holds faculty roles at

• PRP for the periocular • PLLA and skin boosters • Amino acid case study

DermaFocus, Interface Aesthetics and Revanesse.

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Editor’s letter As we move into the height of summer, the July issue of Aesthetics turns its focus to the most visible areas of our practice – the face and neck. In the CPD, we explore the evolving role of calcium hydroxyapatite in regenerative aesthetics, looking at how its biostimulatory Holly Carver Editor & Content properties can be harnessed safely and Manager predictably in everyday practice. Our Special Feature shifts attention slightly lower, to injectables for the décolletage – an area where patient demand is rising, but where skin quality, sun damage and anatomical nuance require careful consideration. In our clinical features we examine the latest approaches to managing submental fullness, strategies for neck rejuvenation and the impact of facial bone resorption on treatment planning. We also look at the recognition and management of vascular occlusion in the chin – a rare but serious complication that every injector must be prepared to diagnose and treat rapidly.

Make sure to read this month’s Event Preview about the fourth edition of the Medical Longevity Summit (MLS) at the Clinical Cosmetic Regenerative Congress (CCR) 2026 (p.16). Patients are looking beyond discrete treatments towards long-term healthspan, function and appearance – and MLS is designed to help clinicians navigate this shift with evidence-based insight. With CCR taking place on October 1-2, now is the perfect time to register and start planning your visit. If you have a case study you are particularly proud of, the Aesthetics Results Awards are your opportunity to showcase your outcomes, celebrate your team and contribute to raising standards across the specialty. Entries close on July 31, so make sure to enter now and share your best work – your experience can both inspire and educate colleagues. Find out more on p.10. Finally, I hope you find time over the coming weeks to step away from clinic, recharge and enjoy the summer, however busy your diary may be! As always, please get in touch with me or the team if you are interested in writing for the journal or would like to share your thoughts on recent issues – we would love to hear from you.

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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© Copyright 2026 Aesthetics. All rights reserved. Aesthetics is published by Aesthetics Media Ltd, which is registered as a limited company in England; No 9887184

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Compliance

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

Peptide Insights The i Paper explores growing peptide interest The i Paper published ‘The Dark Truth About Peptides,’ examining its growing use beyond skincare. The article notes that peptides are most commonly associated within medical aesthetics, with aesthetic practitioner Dr Ahmed El Muntasar claiming they are valued for supporting collagen production, repairing the skin barrier and reducing inflammation. Dr El Muntasar explains them as “WhatsApp messages between cells telling them what to do.” However, the interviewees urge caution. Aesthetic practitioner Dr Sophie Shotter says peptides are “an interesting area of medicine that may have a future role with proper research and regulation,” but they are not none are licensed for injectable use. Printed by The i Paper

Patient Misconceptions Mr Ash Soni addresses biostimulator myths Plastic surgeon Mr Ash Soni has taken to social media to challenge common misconceptions surrounding biostimulators, particularly Sculptra. Addressing facelift concerns, he states, “Myth 1: You can’t have a facelift after having Sculptra – this is false.” Mr Soni explains that successful outcomes depend on an experienced practitioner who understands facial anatomy, surgical planes and appropriate product dilution. He also responds to concerns about reversibility, noting that while Sculptra cannot be reversed, its plant-derived microparticles are absorbed and stimulate collagen production, leading him to question why reversal would be necessary. Patient concerns raised by @thesoniclinic

Cosmetic Costs Alice Hart-Davis explores aesthetics amid inflation In a reflective article for The Times, ‘How Britain Became a £3 Billion Botox Nation – I Should Know,’ journalist Alice Hart-Davis examines the continued growth of the aesthetics sector despite economic pressures. Citing an estimated £3.2 billion annual spend on tweakments in the UK, she notes that treatments have evolved from a luxury to a mainstream form of maintenance. Hart-Davis highlights demand from Gen X women, younger patients described as the ‘Love Island generation’ and “Youngsters striding into their clinics armed with treatment plans conjured up by ChatGPT.” Despite the cost-of-living crisis, she adds that while some patients are spacing out treatments, very few are giving them up. The tweakment economy highlighted by @alicehartdavis

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Warning issued on promoting newly licensed POMs The Medicines and Healthcare products Regulatory Agency (MHRA), Advertising Standards Authority (ASA), and the General Pharmaceutical Council (GPhC) have released a warning to businesses against promoting newly licensed medicines and products that have not yet been licenced. In a statement, the MHRA said it has identified companies advertising pipeline products, including new oral and injectable formulations for weight-management treatments, with some also operating wait lists for them. The agency adds that it has also seen references to newly licensed oral glucagon-like peptide-1 (GLP-1s) medicines, which are classified as prescription-only medicines (POMs). According to the MHRA, because these products are either still under regulatory review or are classed as POMs, referencing them by name or using language such as ‘GLP-1 tablets,’ ‘Oral GLP-1s’ or ‘The new weight-loss tablets’ is likely to breach the UK Code of Non-broadcast Advertising and Direct & Promotional Marketing (CAP Code). The agency said that this restriction also extends to advertising waiting lists for such medicines. Julian Beach, MHRA executive director of Healthcare Quality and Access, said, “It is vital that those who are responsible for marketing of treatment services understand the rules in place to protect patients and remember their professional duty to safeguard healthcare consultations and decision-making.” Muscle Preservation

New drug aims to combat muscle loss in GLP-1 patients A new investigational drug called apitegromab is being explored to preserve muscle mass in adults receiving glucagon-like peptide-1 (GLP-1) receptor agonists for obesity. A study published in Nature Medicine describes a US phase II trial in which 102 adult participants received the GLP-1/glucose-dependent insulinotropic polypeptide agonist tirzepatide for obesity. Those given the monoclonal antibody apitegromab in addition to tirzepatide preserved around 1.9kg, or 55%, more lean mass than the placebo group, while still losing fat. Lean mass accounted for 14.6% of total weight loss in the apitegromab group compared to 30.2% in the placebo arm. Developed by biotechnology company Scholar Rock, apitegromab is administered by intravenous infusion and is currently available only within clinical trials. It targets a protein involved in muscle breakdown and is also being studied in other muscle-wasting conditions. Aesthetic practitioner Dr Vix Manning commented, “Myostatin is a key regulator of skeletal muscle homeostasis, and systemic suppression has potential implications for tendons, connective tissue, bone remodelling and cardiac muscle that we do not have long-term data on yet. The drug may hold the muscle, but only the lifestyle builds it. Apitegromab may well prove to be a useful tool. But it is a tool, not a shortcut, and certainly not a quick-fix drug to compensate for the side effects of another.”

Aesthetics | July 2026

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CCR

New dentistry association launches at CCR The Association of Dentists in Aesthetic Practice (ADAP), a new organisation founded by Paul Burgess, will debut at the Clinical Cosmetic Regenerative Congress (CCR).

Vital Statistics Among 300 people surveyed, 45% had already undergone a non-surgical aesthetic procedure (Spate Popularity Index, 2026)

The Association will curate the Day 1 programme on the new Dentists in Aesthetic Practice stage, offering a forum for dentists already working in, or exploring, medical aesthetics to access discipline-specific education and peer support.

The global beauty market has grown 10% year-on-year, with E-commerce expanding six times faster than in-store sales

The agenda is intended to support clinicians at all stages of their aesthetics careers, from those considering their first treatments to practitioners looking to expand and formalise established services. Sessions will feature dentist and aesthetic practitioners Dr Narjes Hawisa, Dr Rehanna Beckhurst and Dr Zainab Al Muktar, among others, who will share practical guidance on entering the aesthetics sector, structuring and growing a sustainable business, and staying current with emerging clinical developments and best practice. Burgess, ADAP director, commented, “ADAP, the new professional association for dentists in aesthetic practice, is delighted to be working in partnership with the Aesthetics Journal on its launch at CCR. This new project is supported by aesthetic distributor Harpar Grace, its first founding sponsor and many great dentists in aesthetics.” Turn to p.31 to register. Dentistry

JCCP clarifies GDC Scope of Practice Guidance

(NielsenIQ, 2026)

61% of Britons express concern about the safety of ingredients used in cosmetics, with 32% switching to products they perceive to be more “natural” or “clean” (YouGov, 2026)

Nearly one in five UK workers, out of 1,896, now use AI tools daily, a rate that has tripled since 2024

The Joint Council for Cosmetic Practitioners (JCCP) has issued a clarification on the role of dental professionals in non-dental cosmetic procedures, following concern over recent changes to the General Dental Council (GDC) Scope of Practice Guidance. As previously reported in Aesthetics’ May News Special, the JCCP says it has received a number of enquiries and expressions of concern from dental professionals and others about how the revised GDC Scope of Practice Guidance affects non-dental cosmetic procedures. In its new statement, developed in collaboration with the GDC, the JCCP confirms that cosmetic procedures, such as botulinum toxin and dermal filler injections, are not considered the practice of dentistry and therefore fall outside the GDC’s direct regulatory remit. The GDC has removed explicit reference to non-dental tasks, including “providing non-surgical cosmetic injectables,” but dental professionals must still act within the broader GDC framework. The JCCP records dentists, dental hygienists and dental therapists on Part A of its Professional Standards Authority-accredited register. These practitioners may continue to offer non-surgical cosmetic injectables where they can evidence appropriate training, competence and indemnity, either via a JCCP-approved qualification (Category 1) or self-declaration against the JCCP Competency Framework (Category 2). Dental nurses are listed on Part B as professionally unregulated for this work.

(Accenture, 2026)

Out of 1,000 employees across Europe, over half experience imposter syndrome, even while acknowledging their achievements stem from their own skills (MyPerfectCV, 2026)

The JCCP advises practitioners to consult the GDC Scope of Practice 2025 and notes it will share fitness to practise information on dental registrants with the GDC under an existing Memorandum of Understanding.

Based on 504 aesthetic clinics in the Republic of Ireland, 83.9% offer botulinum toxin (Rare, 2026)

The JCCP will be exhibiting at CCR 2026. Turn to p.31 to register. Aesthetics | July 2026

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Study Implications

Events diary

GLP-1 research emerges

24th-25th September 2026 BAMAN Autumn Aesthetic Conference

Developing research highlights the clinical impact of glucagon-like peptide-1 receptor agonists (GLP-1RA), including their potential role in cancer risk reduction and skin ageing.

1st-2nd October 2026 Clinical Cosmetic Regenerative Congress (CCR) and Medical Longevity Summit (MLS)

A study published in Annals of Oncology displayed that GLP-1RA usage was associated with a significantly lower short-term incidence of obesity-associated cancers among obese, nondiabetic patients. After matching more than 80,000 GLP-1 users with a similar number of patients who received diet and exercise counselling, researchers reported a 41% lower risk of obesity-associated cancers over a median follow-up period of two years.

7th November 2026 RAMCE 14th November 2026 IAAFA 21st November 2026 Interface Expo

Separately, a study published in Dermatologic Surgery examined subcutaneous adipose tissue in GLP-1 patients. Analysis of 10 baseline adipose tissue samples demonstrated a statistically significant, approximately four-fold reduction in adipose-derived stem-cell counts (ADSCs) in the GLP-1 group compared with controls. Authors describe this as the first in vivo human study to demonstrate a marked reduction in ADSCs in GLP-1-treated patients, suggesting that selective ADSC depletion of may contribute to accelerated skin ageing changes in this population.

13th-14th March 2027 Aesthetics Conference & Exhibition (ACE) 14th March 2027 The Aesthetics Awards Neck Rejuvenation

Regulatory Collaboration

MHRA and FDA unveil international partnership

Skinvive obtains FDA approval Pharmaceutical company Allergan Aesthetics, an AbbVie company, has received US Food and Drug Administration (FDA) for Skinvive. The company shares that this authorisation marks Skinvive as the first FDA-approved hyaluronic acid injectable indicated to reduce the appearance of neck wrinkles and retain hydration. According to the company, the approval was accompanied by a randomised, multicentre, evaluator-blinded, controlled pivotal clinical study. Out of 105 participants, 74.8% treated in the neck with Skinvive saw clinically significant improvement at one month. Additionally, 66% of 97 participants maintained ≥ 1 point improvement in neck lines at six months. Darin Messina, senior vice president and global head of aesthetics research and development at AbbVie, said, “The submission of Skinvive to treat neck lines demonstrates our continued focus on developing new indications for comprehensive lower face and neck treatment as part of our market-leading portfolio of products, including Botox Cosmetic and SkinMedica.”

The UK Medicines and Healthcare products Regulatory Agency (MHRA) and US Food and Drug Administration (FDA) have announced a new liaison programme. The agencies share that the programme aims to enhance day-to-day collaboration, support scientific exchange and enable faster, more coordinated approaches to emerging regulatory challenges and decisions. Both parties explain the initiative formalises co-operation between the two agencies across key focus areas, including innovative medicines, medical devices and emerging technologies such as AI. According to the MHRA and FDA, both agencies will maintain full regulatory independence. Grace Graham, FDA deputy commissioner, said, “American patients and innovators benefit when regulators collaborate, as aligning on regulatory science can speed access to medical products and reduce time to markets both here and in the UK. We’re excited to launch this new initiative improving the global oversight of drugs, biologics and medical devices as we look to secure supply chains and ensure appropriate standards for clinical research.” The MHRA will be exhibiting at CCR 2026. Turn to p.31 to register.

Organisation

Regenerative association launches Aesthetic practitioners Dr Mayoni Gooneratne and Dr Kate Goldie have announced the formation of the Society of Integrative Aesthetics (SIA). The association aims to explore the relationship between aesthetic outcomes, regenerative medicine, tissue health and systemic resilience. The founders share that planned activities include literature reviews, clinical audits, consensus statements, practice surveys, research collaborations and original studies. SIA is set to host its inaugural congress in 2027 at the Royal College of General Practitioners in London, featuring an exclusive masterclass on April 15, followed by a full-day congress on April 16. Dr Gooneratne commented, “Integrative aesthetics is not anti-injectable, anti-device or anti-conventional aesthetics. It is the next layer of clinical reasoning. We want to help clinicians understand how systemic health, regenerative medicine and aesthetic interventions work together to support better patient outcomes.” 8

Aesthetics | July 2026

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CCR Awards

Last chance to enter the Aesthetics Results Awards Aesthetics has issued a final call for entries to the Aesthetics Results Awards, which will take place at the Clinical Cosmetic Regenerative Congress (CCR). Practitioners practising in the UK are encouraged to submit case studies across four categories, including Full Face Transformation, Skin Rejuvenation, Body Contouring and Most Challenging Aesthetic Case. The deadline for submissions is July 31, with shortlisted Finalists invited to present their work live at CCR 2026 before the Winners are announced on site.

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

BAMAN AUTUMN AESTHETIC CONFERENCE 2026 Tickets for this year’s event are now available to book! We’ll be returning to The Eastside Rooms in Birmingham on September 24-25, 2026.

Holly Carver, editor and content manager at Aesthetics, commented, “We know there is outstanding work happening across clinics every day, but it is not always visible beyond the treatment room. These Awards are about surfacing those stories – the complex cases, the cautious decisions, the honest conversations with patients – and celebrating practitioners who put ethics and evidence at the centre of their practice.”

The agenda is currently taking shape and has been heavily influenced by member feedback, ensuring the programme builds on the success of previous conferences.

The Awards will take place on the Aesthetics Mastery Theatre on Day 2 of CCR 2026. Head to the CCR website to enter.

Peer mentoring spaces: Dedicated areas for both structured and informal connection, supporting peer discussion, regional networking and one-to-one mentoring.

Unlicensed Medicine

MHRA seizure results in two arrests The Medicines and Healthcare products Regulatory Agency’s (MHRA) Criminal Enforcement Unit has arrested two individuals following a suspected illegal weight-loss drug operation. The arrests took place after officers raided a country estate near Northampton and recovered 12,000 doses of unlicensed weight-loss medicine. During the raid, officers arrested two 29-year-old men on suspicion of offences under the Human Medicines Regulations 2012. Investigators believe the property was being used as a large-scale facility for the manufacture, assembly and distribution of unlicensed weight-loss medicines, including retatrutide and tirzepatide, as well as peptide products. Andy Morling, head of the MHRA’s Criminal Enforcement Unit, said, “Medicines regulation isn’t discretionary – it exists to protect people. That’s why we continue to target the traffickers who seek to bypass that protection – taking down the infrastructure that supports them and creating a hostile environment for their exploitative and harmful trade.” The MHRA will be exhibiting at CCR 2026. Turn to p.31 to register. Acquisition

Bridgepoint Group acquires Obagi Medical UK investment firm Bridgepoint Group has announced its agreement to obtain skincare company Obagi Medical from investment fund Waldencast. The companies outline that Waldencast co-founders Michel Brousset and Hind Sebti are leaving the company to lead Obagi Medical and develop a strategic commercial partnership with aesthetics manufacturer Laboratoires VIVACY, another company under the ownership of Bridgepoint Group. Jack Curran, CEO of Healthxchange, UK distributor of Obagi Medical, commented, “This milestone reflects the strength of the Obagi Medical brand and the significant opportunity ahead. Healthxchange will continue as Obagi Medical’s exclusive distribution partner in the UK and Ireland, and we look forward to continuing to support the brand’s next phase of growth under Bridgepoint Group’s ownership.”

What’s new for 2026?

Content creation station: Back by popular demand and expanded for 2026, now including on-site video content creation with support from specialist social media professionals. Wellbeing and productivity sessions: Time built into the programme to help you reset, with practical tools to support focus, resilience and day-to-day productivity.

THE ANATOMY & INJECTION EXPERIENCE This November, BAMAN is bringing Professor Sebastian Cotofana to the UK, as we launch The Anatomy & Injection Experience at the Royal College of Surgeons of Edinburgh. Designed with BAMAN nurses in mind, but open to the wider sector, there are two routes to experience the programme: Day one only: The Anatomy & Injection Experience – an auditorium-based educational experience where delegates will observe live cadaver dissection alongside real-time injection demonstrations, with expert commentary from Professor Cotofana and faculty throughout. Full two-day programme: Advanced Cadaver Masterclass – the complete day one programme plus a rare opportunity to participate in a hands-on cadaver dissection led by Professor Cotofana and expert faculty, with small-group teaching and direct faculty guidance throughout. Scan the QR code below to visit the BAMAN events page and secure your slot at one of our upcoming events today.

This column is written and supported by BAMAN

Healthxchange will be exhibiting at CCR 2026. Turn to p.31 to register. Aesthetics | July 2026

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Device

Million Dollar Facial unveils microneedling system Treatment and skincare brand Million Dollar Facial has launched microneedling system Bio-Cell Trinity+.

Event Spotlight: Aesthetics Results Awards Entry Open Now

According to the company, the microneedling system combines biodegradable spicules, plant-derived exosomes and vegan polydeoxyribonucleotide within a single-treatment protocol, designed to support skin resurfacing. The company says the protocol uses DermaChannel Spicules alongside niacinamide and arbutin.

Celebrating safe, ethical and exceptional outcomes in medical aesthetics

Founder of Million Dollar Facial, Jenna Unwin, commented, “Bio-Cell Trinity+ represents an exciting evolution within the professional bio-microneedling category, working alongside traditional microneedling approaches to deliver progressive skin rejuvenation.”

Have you got an exceptional patient case study you want to show off? New for CCR 2026, the Aesthetics Results Awards will spotlight the most impressive patient transformations from the past 12 months, with a strong focus on safe, ethical and evidence-based practice. This is your chance to gain recognition for the meticulous planning, technical skill and patient care that sit behind every great result.

Million Dollar Facial will be exhibiting at CCR 2026. Turn to p.31 to register. Specialty Data

As well as a prestigious platform at CCR, shortlisted practitioners will be fast-tracked into becoming Finalists at The Aesthetics Awards – giving you powerful additional exposure across the wider medical aesthetics community. Which categories are available? There are four categories designed to recognise a broad mix of case studies and treatment approaches: 1. Best Full-Face Transformation Using Injectables 2. Best Skin Transformation 3. Best Body Transformation 4. Most Challenging Aesthetic Case Study Each category rewards not only the quality of the aesthetic outcome, but also the clinical reasoning behind it. Entrants should submit before-and-after photography that meets Aesthetics Journal guidelines, alongside answers to six structured questions. Entries are open now and close on July 31, with Finalists announced in August. What will happen at CCR? The Awards will culminate in a dynamic two-hour live session in the Aesthetics Mastery Theatre, hosted by judges Mr Dalvi Humzah, Sharon Bennett and Dr Catherine Fairris. The judges will reveal a top three for each category on stage, who will then present their case study in a concise five-minute slot. After a live deliberation, the judges will crown the Winners on stage – offering Finalists invaluable visibility, peer recognition and a powerful story to share with patients and colleagues.

Scan the QR code to enter the Aesthetics Results Awards

Rare. launches healthcare data Consulting company Rare. has opened its Healthcare Insights library to free access. The platform is divided into three categories; Market Insights, Market Stats and Brand Amplification. Market Insights features articles exploring key specialty developments using data and analysis. One article examines the recent acquisition of Obagi Medical by Bridgepoint, and questions whether an injectable-led strategy is the right approach for the UK market, drawing on clinic data that suggests a stronger cross-sell relationship with energy-based devices than injectables. Market Stats presents findings from Rare.’s specialty audits. In April 2026, the company audited 24,937 UK medical aesthetics clinics and found that injectable treatments continue to dominate the sector. According to the data, 85.5% of clinics offer botulinum toxin treatments, 70.9% offer dermal fillers and 55.7% offer skin boosters. Brand Amplification focuses on brand visibility and market presence. Recent reports include an analysis of the UK hyaluronic acid dermal filler market, which identified Juvéderm as the most-mentioned brand among clinics, followed by Restylane and Teosyal. Advertisement Regulation

ASA bans LED mask advert The Advertising Standards Authority (ASA) has issued a warning for beauty retailer Beauty Pie’s LED face mask advert for misleading claims. The ASA shares that the advert featured an image of an individual wearing an LED mask, claiming, “Clinically proven to reduce wrinkles in four weeks.” The ASA stated that Beauty Pie did not provide enough evidence to support this claim. Beauty Pie said the device was sold solely for cosmetic use, and therefore was not required to carry a UK Conformity Assessed (UKCA) medical device marking. Beauty Pie added that the mask had been tested by 28 people aged 30 to 65 over a four-week period. However, the ASA described this as a “relatively small” sample size. The ASA said, “This ruling is a reminder that if advertisers make strong claims like “clinically proven,” they need solid evidence to support them. People are likely to take these claims to mean that a product has been scientifically shown to deliver the results being advertised.” Aesthetics reached out to Beauty Pie for a comment, but the company did not respond by the time of publication.

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Aesthetics | July 2026

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Panel Discussions

Alma holds educational academy Aesthetic device company Alma invited clinic owners to its Alma Academy at Kings Place, London, on June 8. The morning featured talks from aesthetic practitioners Dr Hen Ifrach, Dr Munir Somji and Dr Marcus Mehta, nurse practitioners Eleanor Hartley and Claire Emmerson, plastic and aesthetic surgeon Dr Frank Rosengaus, and skin and beauty specialist Nilam Holmes. Across a series of panels, speakers explored topics including the use of imaging systems such as Alma IQ for skin analysis, a holistic approach to glucagon-like peptide-1 receptor agonists and treating the periorbital region through a combination of non-ablative lasers and hyaluronic acid dermal filler. The afternoon continued with specialist-led sessions, featuring aesthetic practitioner Dr Mihaela Gulyas, consultant plastic surgeon Miss Rebecca Rollett and aesthetic practitioner and general surgeon Dr Tino Solomon. Alma will be exhibiting at CCR 2026. Turn to p.31 to register. Supplements

Totally Derma hosts regenerative panel Nutraceutical collagen drink company Totally Derma, in partnership with the Regenerative Aesthetics and Wellness (RAW) Council, hosted a collagen panel event in London on June 11. The panel featured gut health and consultant surgeon Mr Lorenzo Garagnani, nutrition specialist May Simpkin, advanced facialist Smita Ahluwalia and women’s health specialist and aesthetic practitioner Dr Sophie Bracke. During the panel discussion, the Council emphasised the importance of consistent use and the holistic benefits of collagen, including its role in gut health and joint mobility. The discussion also touched on the importance of collagen for skin health, particularly in managing menopausal symptoms and improving skin hydration and resilience. Anita Eyles, owner and director of Totally Derma, commented, “The RAW Council represents a deliberate step toward a collagen brand grounded in clinical expertise and longevity thinking. It was a delight bringing together journalists, practitioners, wellness and longevity specialists for an intimate evening of education, energy and fun.” Totally Derma will be exhibiting at CCR 2026. Turn to p.31 to register. Regenerative Aesthetics

Lynton Lasers debuts exosomes Aesthetic device company Lynton Lasers has announced the launch of DEKA Exosomes. The company shares that DEKA Exosomes tap into the body’s natural communication network to support skin recovery and renewal. Used as a standalone treatment or alongside procedures such as laser treatments and microneedling, Lynton Lasers claims they can help improve skin tone, texture and overall skin quality while supporting the skin’s natural recovery process. Hayley Jones, commercial director at Lynton Lasers, commented, “We’re excited to bring this innovation to the UK market and support clinics in delivering excellent patient outcomes with confidence.”

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Victoria Millerchip, training manager at AestheticSource You recently transitioned from business development into training – what inspired that move? Working in business development gave me a real insight into the day-to-day challenges clinics face, and one thing stood out to me – confidence and competence are deeply rooted in education. I often saw practitioners invest in great products or devices but not feel fully equipped to maximise their potential. Moving into training felt like a natural step, as it allows me to support practitioners more holistically – not just in growing their business, but in building their clinical confidence and ultimately enhancing patient outcomes. What’s the biggest mistake clinics make when investing in aesthetics treatments? Focusing on the product rather than the education behind it. Even the most advanced treatments won’t deliver results if the practitioner doesn’t feel confident using them or understanding how to integrate them into a treatment plan. When training is overlooked, it can lead to underutilised products, inconsistent results and missed revenue opportunities. Clinics that prioritise high-quality training tend to see stronger patient outcomes, increased retention and ultimately better return on investment. How does high-quality training translate into commercial success for clinics? It comes down to confidence and consistency. When practitioners feel well-trained, they’re more comfortable recommending treatments, tailoring plans and exploring combination approaches. That naturally leads to higher patient trust, better results and increased repeat business. Training also gives clinics the tools to differentiate themselves in a competitive market – patients are becoming more informed, and they’re actively seeking practitioners who are not only qualified, but continuously educated and supported. Practitioners can join our training community to explore how the SuneKOS injectable portfolio and leading skincare brands such as Senté and Revision Skincare are supporting the evolution of skin rejuvenation through integrated injectable and skincare approaches. This advertorial was written and supplied by AestheticSource.

Looking to build your clinic through a results-driven portfolio and education-led growth? Contact training@aestheticsource.com to find out more.

Lynton Lasers will be exhibiting at CCR 2026. Turn to p.31 to register. Aesthetics | July 2026

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Non-invasive Treatment

Latest Appointments

BTL Aesthetics unveils EMFUSION Aesthetic device company BTL Aesthetics has announced the launch of facial management device EMFUSION, debuting at CCR 2026. According to BTL Aesthetics, EMFUSION is a non-invasive treatment that aims to support long-term skin health through restoration of the skin barrier. The company states that the treatment is designed to address skin ageing by focusing on skin function rather than solely on surface-level improvements. BTL Aesthetics explains EMFUSION incorporates its DYNAM IQ technology, which aims to help rebalance and strengthen the epidermal barrier. The company claims that this may support the skin’s defence against environmental stressors and visible signs of ageing. According to BTL Aesthetics, EMFUSION can be used before other procedures, alongside combination treatment protocols or as part of ongoing maintenance programmes. James Carr, BTL sales and marketing director, commented, “EMFUSION represents a landmark advancement in multi-layered in-clinic skin treatment. As the first treatment to utilise DYNAM IQ technology, EMFUSION is specifically designed to restore the skin barrier and help protect the skin against the visible signs of ageing, supporting long-term skin resilience and function.” The official release to the UK market will be taking place at CCR 2026. Turn to p.31 to register.

Aesthetics rounds up the latest company appointments announced within the aesthetics community Aesthetic device company Cutera has expanded its team across London, the Midlands, the North and Ireland. In London, Crystal Silver has been appointed as area sales manager, focusing on clinic growth and technology expansion. Practice development manager Niky Reihs joins the regional team to enhance post-purchase support and help practices maximise their investment. Rachel McInnes joins as area sales manager for the Midlands and North of England. Cutera shares that she brings more than 30 years of medical aesthetics experience and a strong track record of supporting clinics and driving regional growth. In Ireland, Rebecca Gannon has been appointed as key account manager for Ireland and Northern Ireland. Based in Dublin, the company shares she will support commercial growth, clinical training and treatment protocol development across the region. The British Association of Medical Aesthetic Nurses (BAMAN) has announced nurse prescriber Leah Folkard as regional leader of the South West of England, covering Bristol, Gloucestershire and Wiltshire. BAMAN shares that the role of regional lead aims to support and strengthen the local aesthetics community through professional networking, education, collaboration and member engagement. Skincare solution brand CACI has announced aesthetic practitioner Dr Hansel Misquitta as its latest key opinion leader for the multi-technology platform, CACI Rejuva Med. In her new role, Dr Misquitta will serve as a CACI Rejuva Med spokesperson, providing media commentary on the new system, contributing to content creation and speaking at events, the company shares. BAMAN, CACI and Cutera will be exhibiting at CCR 2026. Turn to p.31 to register.

Education

Sofwave holds immersive training day Aesthetic device company Sofwave hosted an education and experience day for UK Sofwave professional providers and clinics on June 5.

Technology

Zemits debuts cold plasma device Aesthetic equipment brand Zemits has launched Zemits EvoPlasm in the UK.

The educational programme featured Sofwave CEO Louis Scafuri, as well as a panel discussion featuring aesthetic practitioners Dr Ahmed El Houssieny, Dr Galyna Selezneva and Dr Nikita Adatia. Sessions examined Sofwave technologies, clinical studies, the platform’s evolving role in the post-glucagon-like peptide-1 landscape, and Sofwave treatment integration with comprehensive face and body portfolios. The agenda continued with Sofwave outlining its global and UK marketing strategy, alongside presentations from public relations agencies Kendrick PR and Quirky Frog on how the brand is supporting clinics and how practitioners can further drive consumer awareness and education.

According to Zemits, the cold plasma device serves as an addition to advanced facial and skin rejuvenation treatments. The technology can be integrated with treatment modalities including hydrodermabrasion, oxygen therapy, LED, chemical peels, radiofrequency-based procedures and restorative facial protocols, the company explains.

Lina Omari, chief digital officer at Sofwave, commented, “The conversations reflected the continued evolution of medical aesthetics towards regenerative, non-invasive treatments. The level of engagement throughout the event reinforced the strength of our community and the exciting future ahead for the specialty.”

Ulyana Danyleyko, Zemits UK director, said, “Today’s aesthetic practitioners are not only looking for powerful technologies, they are looking for intelligent systems that integrate seamlessly into their existing protocols. Zemits EvoPlasm was selected for the UK market because it offers versatility, treatment compatibility and a sophisticated approach to skin support. It allows practitioners to enhance the value of their services while responding to patient demand for non-invasive, results-driven care.”

Sofwave will be exhibiting at CCR 2026. Turn to p.31 to register.

Zemits will be exhibiting at CCR 2026. Turn to p.31 register.

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Skincare

AlumierMD unveils new cleanser Skincare company AlumierMD has released its Gentle Foaming Cleanser. AlumierMD shares that the cleanser is targeted for both post-procedure and at-home use, developed to support compromised, sensitive skin. The product aims to cleanse effectively while maintaining hydration and barrier balance, whilst the formulation removes daily impurities and makeup without stripping the skin, according to the company. The company shares key ingredients include a combination of ceramides including camellia sinensis leaf extract and chamomile flower extract, aimed at supporting the skin’s moisture barrier. Giselle Curcio, chief brand and innovation officer at AlumierMD, commented, “Our new Gentle Foaming Cleanser was developed with a barrier-first philosophy, recognising that cleansing is often the first opportunity to either support or compromise skin resilience. The product delivers an elevated sensorial experience, leaving skin feeling refreshed, comfortable and clean.” Overseas Regulation

TGA releases advertising restrictions for POMs Australian regulatory authority, the Therapeutic Goods Administration (TGA), has published new Guidance on advertising restrictions for prescription-only medicines (POMs). The regulator states that the guidance is intended to help individuals and businesses comply with Australia’s regulatory requirements. The TGA notes that unlawful advertising of POMs may include the use of restricted or prohibited representations without approval; with restricted representations including disease and condition, and prohibited representations featuring sexually transmitted diseases, neoplastic diseases and mental illness. Other unlawful advertisement includes implying Government endorsement through claims such as “TGA approved” and promoting products for off-label uses not included in the Australian Register of Therapeutic Goods. The Guidance also reiterates that advertising POMs or substances is prohibited under subsections 42DL(10) and 42DLB(7) of the Act, except in limited circumstances, including advertising directed exclusively to healthcare professionals, information shared by a healthcare professional with a patient or advertising authorised or required by the Government. The TGA further advises businesses to assess whether content constitutes advertising and to remove references to POMs from advertising materials to avoid unlawful promotion. Conference

Sciton hosts symposium Aesthetic device company Sciton presented leadership development programme UP Xchange. Sciton shares that more than 300 attendees joined, as well as 10 key opinion leaders alongside Sciton leadership teams from the US and Europe, the Middle East and Africa (EMEA). The agenda featured multi-specialty presentations, live laser and injectable demonstrations as well as breakout sessions, according to the company. Speakers included consultant oculoplastic surgeon Miss Jenny Doyle, aesthetic practitioner Dr Zoya Awan and digital consultant Rick O’Neill. David Higham, European sales director at Sciton, commented, “UP Xchange created an environment where clinic owners and practitioners could step away from the day-to-day demands of practice and focus on learning, sharing ideas and considering patient outcomes. The result was an event that delivered real value, real connections and plenty of ideas that attendees can take back and implement immediately.”

News in Brief Skin Diligent releases new vitamin C Skincare company Skin Diligent has unveiled its new Vitamin C Serum-in-Oil. According to the company, the formulation features Ascorbyl Tetraisopalmitate, a lipid-soluble derivative of vitamin C selected for its stability profile and compatibility with skin. The serum also contains cocoa extract, pomegranate, moringa, hemp, camelina and other botanical oils and aims to enhance collagen support and improve elasticity. Skin Diligent states that the product is intended to support the skin barrier and provide antioxidant support against environmental factors associated with warmer seasons, including UV exposure, heat and pollution. mesoestetic launches menopause-focused range Aesthetic manufacturer mesoestetic has unveiled a woman care solutions range. The company shares that the woman care solutions have been developed in collaboration with private healthcare centre Dexeus Mujer and is intended to support the holistic management of menopause with the aim of improving women’s quality of life. According to mesoestetic, key products include skincare formulas to improve skin density, elasticity and barrier function, alongside solutions to help manage hot flushes and enhance daily vitality. NHS hosts aesthetics study day The Gloucestershire Enhance Programme held the ‘Aesthetics – The Pros and Cons’ study day at Cheltenham General Hospital. The programme included discussions focused on patient safety, complications management and governance. Dr Colville commented, “As the field continues to grow, improving awareness, education and collaboration is vital to creating a safer environment for patients and supporting better regulation and standards across the sector.” Marketing podcast launches Aesthetics marketer Elly Makinson has released a new podcast, The Contraindication. Makinson shares that the platform explores commercial and marketing realities behind running an aesthetic business, from patient behaviour and clinic growth to brand positioning, technology and specialty change. The podcast features a short weekly series called Marketing Mondays, offering practical five-minute marketing insights for clinic owners and aesthetic professionals.

Sciton will be exhibiting at CCR 2026. Turn to p.31 to register. Aesthetics | July 2026

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Advertorial Restylane SkinboostersTM

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Restylane SkinboostersTM: Beyond Just Hydration, Improving Skin Quality From Within Galderma explores the role of Restylane SkinboostersTM in structured treatment cycles for deep hydration and sustained skin quality improvement This advertorial is sponsored by Galderma For many patients, ‘good skin’ is no longer just about smoothing a line or filling a fold. Increasingly, they are asking for healthier looking, more radiant skin that looks fresher in any light and from any angle. This shift has pushed skin quality to the forefront of aesthetic practice, creating demand for treatments that go beyond short-term glow to deliver meaningful, measurable change in the skin’s structure. Restylane SkinboostersTM are positioned within this evolving landscape as hyaluronic acid (HA) injectables designed specifically to improve skin quality, rather than to provide traditional volumising or contouring. Using SB NASHATM technology, they aim to provide deep, continuous hydration and support for the extracellular matrix over an extended period.1-4

Skin quality as a core treatment goal Patients often describe their concerns in terms such as “dull,” “tired” or “crepey” skin, particularly on the face, neck, hands and décolletage. For many, these issues sit alongside, or even ahead of, discrete lines and wrinkles. Restylane SkinboostersTM have been studied for their impact on skin quality parameters including hydration, elasticity and texture. Out of 100 participants, 91% of patients reported that their skin quality had improved for up to 15 months following treatment, and 84% felt their skin looked more radiant compared to before treatment over the same period.5 In another study, 100% of patients were assessed as having facial improvement at 12 months on the Global Aesthetic Improvement Scale.6 These findings underpin the role of skin boosters as a tool for practitioners who want to address skin quality systematically, rather than relying solely on surface level interventions.

Mechanism: biorevitalisation and SB NASHA technology Unlike traditional volumising fillers, Restylane SkinboostersTM are formulated to work via biorevitalisation of the extracellular matrix. The SB NASHATM technology is based on high molecular weight, stabilised HA designed to closely mimic natural HA in the skin.1,2 By creating a more favourable environment within the extracellular matrix, SkinboostersTM are reported to support improvements in collagen and elastin quality over time.4 The aim is to provide 24/7 deep hydration from within while gradually enhancing the structural components associated with smoother, more even and more luminous skin.5,6,7,8,9 14

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Treatment protocol and duration of effect Restylane SkinboostersTM are delivered as micro droplet injections placed deep in the dermis.10-13 Optimal outcomes are typically achieved with an initial treatment cycle of one to three sessions spaced approximately four weeks apart. A reboosting treatment is then recommended every six to twelve months, depending on the patient’s skin and treatment goals.5,11,12 Data suggest that the effects of SkinboostersTM on skin quality can last for up to 15 months,5,11,12 with published evidence indicating a longer duration of improvement compared to some other HA skin quality injectables.5,14,15 In practice, this may support treatment plans that combine an initial intensive phase with less frequent maintenance, which can be helpful when counselling patients around expectations and scheduling.

Precision delivery: the SMARTCLICK syringe One of the technical features that differentiates Restylane SkinboostersTM is the SMARTCLICK syringe system. This bespoke delivery device incorporates an audible dosage indicator designed to support precise micro droplet placement and consistent dosing of ~10 Ug.10-13

Clinical experience Dental surgeon and aesthetic practitioner Dr Jaskaren Midha says skin quality has become one of the most important priorities for patients. “Increasingly, people are looking beyond simply replacing volume. They want healthier, more radiant skin that looks refreshed without appearing ‘done,’” she explains. “Restylane SkinboostersTM allow me to address hydration, elasticity and overall skin quality in a predictable and natural way “They complement traditional fillers exceptionally well because they improve the skin itself rather than changing facial contours,” says Dr Midha. She adds, “The versatility of Restylane SkinboostersTM means they suit a broad range of patients,” stating, “In younger patients, they are ideal for maintaining hydration and healthy skin quality, while in patients in their late 30s, 40s and beyond, they can improve texture, elasticity, crepiness and dull or photoaged skin.” “I generally recommend an initial course of three treatments spaced around four weeks apart, followed by maintenance every six to 12 months,” she adds. Dr Midha concludes, “I position skin boosters as complementary treatments, allowing a more holistic approach to facial rejuvenation.”

Practical considerations and next steps With more than 18 years of clinical use and a well-established safety profile,16,17 Restylane SkinboostersTM can be considered by clinicians aiming to widen their skin quality treatment portfolio.

Speak to your local Galderma Rep to know more about Restylane Skinboosters 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 Helen Coombs is a Galderma KOL

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New PRP Guidance Released for Hair Treatments Aesthetics explores the implications of the new PRP Guidance for hair restoration The Joint Council for Cosmetic Practitioners (JCCP) has published new Guidance for platelet-rich plasma (PRP) procedures confirming that the treatment of hair loss caused by, for instance, androgenetic alopecia, is a medical procedure.1 PRP is therefore regarded as a medicinal product where medicinal claims are made.1 The Guidance, aimed primarily at Local Authorities that identify businesses or receive complaints relating to PRP procedures, was developed by a panel of health protection specialists and healthcare professionals (HCPs) at the request of the JCCP, in collaboration with relevant regulators.1

Regulatory overview Within the proposed licensing scheme for non-surgical cosmetic procedures in England, PRP therapy for cosmetic purposes is provisionally within the Amber category, which is classified as including procedures with a medium risk of complications.2 However, the consultation response published in August 2025 noted that PRP was among the procedures identified by respondents as warranting reclassification to the Red category. This would require treatments to be carried out by qualified and regulated HCPs working out of Care Quality Commission (CQC)-registered premises.2 In the recently published JCCP Guidance, the CQC confirms that hair restoration procedures constitute a regulated activity when carried out by a regulated HCP.1 The MHRA states, “Claims to reverse permanent hair loss, cause hair growth or re-grow lost hair are medicinal claims, so the claims to stimulate and promote new hair growth, increase blood flow to the follicles and that the product is an alternative to transplant, are medicinal.”1 The MHRA advises that practitioners and suppliers who are not legally entitled to possess wholesale stock medicines must not promote the use of PRP for medical purposes. The Guidance continues, “We note the recommendations in UK devolved administrations to restrict the PRP procedures to regulated HCPs. Given the current and emerging understanding of the risk attached to the procedure, we support this position and recommend that similar positioning is considered in England.”1

Wider implications The Guidance claims, “Any PRP procedure for hair loss, the treatment of joints or wherever a medical claim or diagnosis is made, is restricted to doctors and dentists operating within CQC-registered facilities.”1 Hair transplant surgeon Mr Greg Williams believes it still remains unclear which HCPs will be legally permitted to carry out the various stages involved in procuring, manufacturing and administering PRP. He states that, unlike other prescription medicines, the centrifuge step constitutes the ‘manufacturing’ of the medicine and would therefore require a manufacturing licence, which Mr Williams explains doctors and dentists are exempt from.3 Andrew Rankin, acting co-chair of the JCCP explains that context is important, particularly since a definitive answer remains to be determined. This is because there are two areas of medicines legislation to understand. He explains that manufacturing requires a doctor, a dentist or an MHRA license. The second is the wholesale supply of unlicensed medicines, where the doctor is supplying an unlicensed medicine in a way that a pharmacy normally would, against a prescription. This is not allowed across different organisations, but it may be permitted within the same organisation, though yet to be determined. In regard to whether nurses and pharmacists will be able to administer PRP for medical purposes, Rankin, explains, “I expect that nurses and pharmacists might be able to administer PRP for medical purposes when it has been prepared by a doctor or dentist within the same practice setting. Such practitioners would be accountable for administration without supervision. Assuming that they are trained and competent, and they would be accountable for their actions. The question is, are nurse or pharmacist independent prescribers administering it against the directions of the doctor, or are they requesting supply from the doctor for autonomous administration (without direction).” However, he adds that this is subject to MHRA determination. Aesthetics | July 2026

News Special PRP Hair Restoration Practical implications in clinic Dr Shirin Lakhani, chair of the working group that developed this guidance, sees the potential requirement for CQC registration as one of the most significant aspects of the Guidance. She notes, “Its implications are substantial because they involve governance, quality assurance, patient safety, record keeping, incident reporting and ongoing accountability.” Dr Lakhani believes an immediate priority is equipment, with clinics required to demonstrate that centrifuges, tubes and consumables are appropriate for PRP. “These should be sourced through legitimate suppliers, maintained in accordance with manufacturer instructions and supported by appropriate infection-control processes,” she notes. She continues, “Providers should review their governance arrangements, standard operating procedures, consent processes, adverse-event reporting pathways, patient identification procedures and emergency preparedness.”

Marketing ramifications Under the Guidance, treating hair loss can constitute a medical claim. Dr Lakhani warns, “The distinction is important because the way a treatment is presented can have significant regulatory implications. The line is crossed when marketing moves beyond describing the procedure itself and begins making claims about treating a medical condition or producing a specific physiological effect.” Mr Williams notes that in the UK, prescription medications cannot be advertised. He explains, “If PRP injected for a medical purpose, such as for hair loss, is to be considered a prescription medication, then it would no longer be legal to advertise it.”4

Potential repercussions Rankin notes that the key question is how independent prescribers will operate in practice, adding, “The JCCP has further work to do to understand this detail. In the meantime, anyone wishing to provide PRP alongside a medical or dental practitioner is advised to seek advice from the MHRA in relation to their particular circumstances.” Rankin shares that the MHRA can take action for medicines enforcement issues. He continues, “The Guidance allows Local Authority Officers to assess risk, and they may serve improvement or prohibition notices depending on the findings and the extent of the risk.” VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 15

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Future Proof Your Practice With Metabolic Medicine Discover how understanding metabolic health can transform outcomes in aesthetics at CCR 2026

Today’s aesthetic clinics are no longer only focusing on injectables and devices – the most forward-thinking practitioners are embracing a 360° approach to ageing. Metabolic health and longevity are becoming central to this, because they directly influence the elements aesthetic professionals care most about: skin quality, pigment and redness, facial fat distribution, tissue integrity, healing and the longevity of results. When you add a metabolic lens to your practice, you stop treating lines, laxity or volume loss in isolation and start joining the dots between hormones, mitochondrial function, stress, lifestyle and environment. For patients, that means moving beyond short-lived fixes and towards healthier, more predictable ageing. For practitioners, it opens the door to more effective, evidence-informed treatment plans – and a more differentiated, future-proof aesthetic clinic. The Medical Longevity Summit (MLS) at the Clinical Cosmetic Regenerative Congress (CCR) is built around that idea. Spanning over two days, on October 1-2, you can explore metabolism and mitochondrial health from the lab bench to the treatment room, across two stages. Plus, you can discover a show floor packed with innovators in diagnostics, nutrition, skincare, devices and more.

Day 1: foundations, frameworks and first steps On Day 1 at the Future Health Forum the sessions set the scene and build the

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foundations. Expect to explore:

· Why metabolism matters – how

mitochondrial function, cellular bioenergetics and nutrient sensing pathways underpin cardiometabolic, neurodegenerative and oncologic disease, and what that means for aesthetics, wellness and mainstream medicine · Cellular bioenergetics in real life – grounding concepts like ATP production, redox balance and reactive oxygen species in the kinds of cases you actually see: fatigue, stubborn weight, early insulin resistance, accelerated skin ageing and post-treatment recovery. · Metabolic signalling and ageing – deep dives into mTOR, AMPK, sirtuins and circadian biology, and how to use this understanding to make smarter decisions around fasting, nutrition, exercise and pharmacology · Mitochondrial flexibility – exploring biogenesis, mitophagy and mitochondrial dynamics, and how they translate into ‘metabolic flexibility’ and resilience in your patients · Measurement and assessment – what metabolomics, lipidomics and genetic insights can already offer in clinic, and how to create a pragmatic metabolic and mitochondrial assessment framework using accessible tests (from fasting insulin to VO2 and body composition) You will also look at how environmental design, trauma, stress and lifestyle shape

Aesthetics | July 2026

metabolic outcomes, and how to weave these into your assessments and treatment plans without overwhelming patients. Alongside this, the Discovery Stage introduces you to companies actively working in medical longevity and metabolic health. Across fast-paced, 15-minute sessions you can:

· Hear from brands like Halo IV, Nuchido, Skinzo, Totally Derma and WOW Facial

· Compare different philosophies – from

collagen supporting nutraceuticals to NAD supporting products, barrier repair programmes and multi-step facial systems · Ask direct questions about evidence, indications, contraindications and integration with your existing treatments Because the talks are short and focused, Day 1 becomes a rapid fire immersion: robust concepts on the clinicians’ stage, then straight into seeing how specialty is translating those concepts into tools you can deploy, trial or critically evaluate.

Day 2: risk, oncology and therapeutic strategies Day 2 on the Future Health Forum moves into application, complexity and future direction. Themes include:

· Redefining metabolic dysfunction

– going beyond the textbook ‘metabolic syndrome’ to updated frameworks for insulin resistance, dyslipidaemia, NAFLD/MAFLD and cardiometabolic risk clustering

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· Metabolic health and cancer – exploring

what the current evidence really shows about metabolic dysfunction and cancer risk, and where metabolic strategies might support oncologic care · Body composition as risk and resilience – understanding obesity, sarcopenia and sarcopenic obesity in relation to outcomes, recovery and aesthetics, and how to integrate body composition into your assessment and planning · Therapeutic strategies – nutrition, fasting, pharmacotherapy (from GLP-1s and SGLT2 inhibitors to emerging mitochondrial targets), exercise, sleep and circadian aligned interventions, plus how to sequence and combine them · Complex, multimorbid patients – case based discussions around metabolic syndrome, NAFLD and overlapping conditions, focusing on staging, prioritising and communicating an intervention roadmap · The future of metabolic and mitochondrial medicine – horizon scanning across therapies, digital tools and research directions, and what that means for your next three to five years in practice On the Discover Stage, Day 2 continues with another wave of company sessions, giving you:

· Deep dives with brands such as Skinzo,

Wild Nutrition · Quick, practical spotlights on protocols, combination treatments and in clinic implementation – ideal if you want to see how a concept might realistically fit into your workflow More sponsors and partners will be revealed soon.

On the show floor: where ideas meet innovation Beyond both stages, the show floor is a dedicated longevity hub where you can slow down, compare options and get hands on:

· Speak directly to companies working in

metabolic diagnostics, functional testing, skincare, nutraceuticals, IV therapy and regenerative technologies · See and feel products, devices and protocols you have just heard discussed on stage · Build referral and collaboration pathways with labs, brands and service providers that align with your clinical approach Combining, the clinician led summit stage, the company focused specialty stage and the wider CCR event floor creates a genuine ecosystem for medical longevity: rigorous enough for sceptical clinicians, practical enough for busy practitioners and dynamic enough to keep pace with a rapidly evolving field.

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Connecting longevity and medical aesthetics

Event Preview MLS Ready to rethink ageing in your practice? Register now for the MLS at CCR and secure your place at the heart of this rapidly evolving field. Whether you are just starting to explore this area or are already integrating wellness into your clinic, the summit will give you fresh insight, tangible tools and valuable connections you can take straight back to practice. Scan the QR code below to register.

Clinical lead of the MLS scientific committee, Dr Mayoni Gooneratne, explains why metabolic health is an important consideration in medical aesthetic practice Why is metabolic health becoming increasingly important? We are focusing on metabolic health because it sits at the very heart of longevity, prevention, ageing and even aesthetic outcomes. When we talk about ageing well, we cannot separate the external from the internal. Insulin resistance, chronic inflammation, mitochondrial dysfunction, poor body composition, blood sugar dysregulation, fatty liver, hormonal shifts and stress physiology all influence how we age, how we feel, how we heal and how we look. For me, metabolic health is one of the most important clinical conversations of our time. We are seeing rising rates of obesity, diabetes, cardiovascular risk, hormonal disruption and inflammatory conditions, often in people who may still appear outwardly well.

How does this relate to those working in medical aesthetics? The aesthetics sector is in a unique position because we often see patients earlier, before they enter the conventional disease pathway. That gives us a powerful opportunity to educate, intervene and support prevention. There is also a clinical responsibility. With the growth of weight-loss medications, hormone optimisation, regenerative treatments and longevity testing, practitioners need to understand the science, the safety considerations and the appropriate scope of care. Wellness and longevity are no longer fringe topics. They are becoming central to modern medical aesthetics.

Aesthetics | July 2026

01 & 02 October 2026 Excel, London

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Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk/. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/reportan-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.

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Special Feature Décolletage Common patient concerns

Reviewing the Use of Injectables for the Décolletage Three practitioners discuss clinical protocols for décolletage rejuvenation The décolletage presents a unique treatment challenge due to its thin skin, limited adnexal structures and cumulative exposure to ultraviolet radiation.1,2 While topical skincare and energy-based devices (EBDs) can improve surface pigmentation and stimulate collagen production, they may offer limited correction of the dermal thinning, crepiness and loss of structural integrity that characterise ageing in this region.3-5 Injectable treatments, such as biostimulators and hyaluronic acid-based (HA) therapies offer preventative and restorative benefits, by directly targeting skin quality with the dermis, supporting tissue remodelling and improving hydration.6-11 Aesthetics spoke with dentist and aesthetic practitioner Dr MJ Rowland-Warmann, aesthetic practitioner Dr Tetiana Teslya and independent nurse prescriber Susie Byass to explore indications, suitability and protocols for décolletage rejuvenation.

Evaluating recent literature Calcium hydroxylapatite (CaHA) is a studied biostimulatory injectable for non-facial rejuvenation, with research demonstrating significant improvements in décolletage skin quality and wrinkle severity following treatment with hyperdiluted CaHA.12,13 In a prospective multicentre study, published in the Journal of Drugs in Dermatology, utilising CaHA (Radiesse; 1:2 CaHA:saline), 73.5% of patients achieved at least a one-point improvement in décolletage wrinkle severity 16 weeks after their final treatment.13 Recent European Union Medical Device Regulation (EU MDR) approval for décolletage treatment further supports its role in body rejuvenation.12 In another prospective clinical trial published in the Journal of Drugs in Dermatology and involving 20 female participants, hyperdiluted CaHA (1:2 dilution) was used to treat the chest and décolletage area.14 Significant improvements in décolletage wrinkle severity were observed as early as six weeks after treatment and were

maintained for 360 days, with high levels of patient satisfaction and a favourable safety profile.14 While several poly-L-lactic acid (PLLA) products are approved for facial indications, Sculptra received EU MDR certification in December 2025 for use in multiple body areas, including the décolletage.15 A clinical study published by Galderma to support certification demonstrated progressive improvements in décolletage skin quality, firmness and wrinkle severity.15 By nine months, visible wrinkle reduction was reported in 93% of patients, alongside high levels of satisfaction with skin texture and firmness.15 Additional research published in the National Library for Medicine, highlights the use of PLLA. In a prospective open-label study involving 30 women with moderate-to-severe décolletage wrinkles, PLLA (Sculptra) was used to treat the décolletage and chest area using two different reconstitution volumes.16 The primary outcome was improvement in wrinkle severity, measured by the Galderma Décolletage Scale, with treatment success defined as at least a one-grade improvement from baseline at nine months. Patient- and investigator-assessed aesthetic improvement were also evaluated.16 A prospective, single-centre clinical study, published in the Journal of Cosmetic Dermatology, evaluated a HA skin booster in 81 volunteers with signs of ageing affecting the face, neck and décolletage.17 Participants received three intradermal treatment sessions at three-week intervals and were followed for up to six months.17 Significant improvements were observed in hydration, elasticity, firmness, wrinkle depth, smoothness and skin uniformity.17 Aesthetics | July 2026

Dr Rowland-Warmann outlines the most common concerns presenting in clinic are crepey skin, fine lines and wrinkles, pigmentation resulting from cumulative sun exposure, thinning of the skin and loss of elasticity.18-20 She explains, “Many patients notice a mismatch between a well-treated face and an untreated neck and décolletage. They want the quality of the skin on the chest to match the improvements they have achieved elsewhere through aesthetic treatments.”21-23 Dr Teslya notes the growing impact of ‘texting neck,’ which she says, “Refers to prolonged periods spent looking down at phones, which places repeated strain on the neck, while allowing the muscles beneath the jawline to become increasingly lax.”24-26 She states that, unlike other muscle groups that are regularly exercised, this area is often under-used, contributing to loss of definition on the neck and décolletage.24-26 Dr Teslya adds, “Some patients also express concern about more pronounced horizontal neck lines, often referred to as Venus rings.”27

Examining patient suitability Dr Rowland-Warmann notes that there are factors that influence treatment outcomes.28,29 “For example, post-menopausal patients who are not receiving hormone replacement therapy may experience a reduced regenerative response compared with pre-menopausal patients or those whose hormones are optimised, owing to the effects of menopause on collagen production and skin repair,” she says.29-31 Dr Rowland-Warmann identifies active infection or inflammation within the treatment area, alongside autoimmune conditions, as contraindications.20 She continues, “Relative contraindications include significant ongoing sun exposure, smoking and recent treatment with another biostimulator within the previous six to 12 months, where caution is warranted.”32,33 Dr Teslya emphasises the influence of diet, lifestyle and hormonal health on skin quality. She notes, “For décolletage rejuvenation specifically, diets low in protein and high in processed convenience foods may compromise collagen synthesis and dermal integrity in this already delicate area, limiting the skin’s ability to respond to treatment.”5,29-31 Dr Teslya points to the use of a detailed medical history before recommending treatment, stating, “Patients with a history of cancer or active cancer are generally not suitable candidates for this particular treatment and require careful assessment before any aesthetic intervention is considered.”34 She also notes breastfeeding, 21

Special Feature Décolletage blood disorders and uncontrolled diabetes as patient contraindications.35 Dr Teslya adds, “In some cases, patients with thyroid disorders may still be treated under the supervision and approval of their treating physician.”36 Byass describes a broad range of patients seeking décolletage treatment, most commonly within the 30-60 age group.37,38 She notes, “Presentations broadly reflect a spectrum of photoageing severity, from early textural change in younger patients to more advanced laxity and photodamage in older cohorts, with a smaller subset of patients over 60 demonstrating established, advanced signs of ageing.”37-39 According to Byass, “The main cohort I’m seeing is the second and third category, reflecting the natural ageing process.” She attributes this to diminishing collagen and elastin production, reduced fibroblastic activity and cumulative UV exposure. “Together, these intrinsic and extrinsic influences contribute to visible skin ageing, making older patients the most common candidates for treatment,” she adds.40-43 Byass advises against treatment in the presence of conditions such as acne, psoriasis, dermatitis or skin infections affecting the décolletage, stating these should be resolved before proceeding.44-47

Outlining assessment protocols Dr Rowland-Warmann says assessment begins with evaluation of skin quality, skin thickness and the amount of underlying supportive tissue present. She enquires on factors such as age, hormonal status and general health, as Dr Rowland-Warmann states they influence regenerative capacity.48,49 Additionally, visual assessment of skin-specific characteristics, such as pigmentation, wrinkling, crepiness, skin thickness and underlying tissue support, is essential for treatment planning, according to Dr Rowland-Warmann.48-50 Dr Teslya highlights the use of both photography and videography. “Before starting a treatment course, and prior to each individual session, I document the treatment area with both photographs and video recordings,” she says. Dr Teslya also performs a skin pinch test on video, adding, “This allows me to objectively assess skin quality and monitor improvements over time.”51 In her assessment, Byass considers dermal thickness, skin crepiness, wrinkle depth and orientation, as well as Fitzpatrick skin types and the degree of photoageing. She also references structured scoring systems such as Rejuva and Glogau.52 “Anatomical considerations are equally important, including the presence of breast implants and overall breast health,” Byass states, 22

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Dr Teslya favours amino acid-based skin boosters that combine specific amino acids with both low- and high-molecular-weight HA to create a synergistic regenerative effect.61 She highlights, “Formulations containing glycine, L-proline, L-leucine and L-lysine work together to stimulate fibroblasts and enhance endogenous collagen and elastin production in these delicate areas.”61,62

Before

After

Figure 1: A 43-year-old female patient. Four sessions of Jalupro HMW + Classic (5.5ml protocol, combining both products in one vial) were performed at three week intervals. Images courtesy of Dr Tetiana Teslya.

stressing the importance of reviewing mammogram history in eligible patients to ensure appropriate screening status.53,54 Byass emphasises the significance of assessing sleeping habits during consultation.55 She notes that chronic side sleeping can repeatedly compress the chest tissue, contributing to the formation and worsening of vertical décolletage lines.55,56 According to Byass, these characteristic “sleep lines” are often visible during assessment and should be considered when planning treatment.55,56

Illustrating protocols The practitioners outline their décolletage-focused protocols, including product selection, technique and sequencing. Product selection For treatment of the décolletage, Dr Rowland-Warmann favours a combined approach using PLLA and skin boosters.57-59 She explains that PLLA works by stimulating collagen production, increasing elastin content and upregulating dermal white adipose tissue.57-59 “This means the dermis, hypodermis and dermal white adipose tissue all contribute to tissue regeneration and improved skin quality,” she says.57-59 Dr Rowland-Warmann adds, “The resulting tissue remodelling leads to thicker, healthier skin with enhanced elasticity, greater structural support and a reduction in fine lines and laxity.”59 Selecting PLLA for its biostimulatory properties, her product of choice is Sculptra for the décolletage.15,57 Dr Rowland-Warmann typically begins her protocol with skin boosters for skin hydration and quality improvement, opting for Restylane Skinboosters, and selecting either Vital or Vital Light depending on skin thickness.60 Aesthetics | July 2026

According to Dr Teslya, the protocol is designed to enhance collagen stimulation and support dermal remodelling, as she notes this formulation provides a more intensive biostimulatory stimulus, promoting overall skin rejuvenation.61,62 While high-molecular HA offers enhanced hydration alongside collagen stimulation, she says, “Low-molecular HA product is often selected when there is a need to really push collagen production.”61,62 In some cases, the amino acid content may also contribute to an overall brightening effect and help improve uneven pigmentation, according to Dr Teslya.62 She typically uses Jalupro Classic, Jalupro HMW or a combination of both depending on skin quality and photoageing. Dr Teslya explains, “Combining the two can enhance hydration, structural support and the skin’s regenerative response.”63 Byass uses hyperdiluted CaHA, explaining “It provides a subtle, immediate smoothing effect while stimulating fibroblasts to produce new collagen and elastin, helping to improve skin quality and firmness over time.” Byass selects Radiesse as her product of choice.64-66 She continues, “CaHA should be hyperdiluted with saline when treating the décolletage, as the goal is not to add volume but to stimulate tissue regeneration.” She says by diluting the product its volumising effect is minimised, stating, “Allowing it to act purely as a skin booster in a regenerative, biostimulatory capacity.”64-66 Technique and clinical protocols Describing skin booster administration, Dr Rowland-Warmann states, “Treatment is performed in the subdermal plane using a 25G cannula and the SmartClick delivery system, which enables predictable dosing and even product distribution.”67,68 She explains that up to three sessions, spaced four weeks apart may be administered to optimise hydration and overall skin quality, before introducing biostimulatory treatments.69 For PLLA administration, Dr Rowland-Warmann uses a 22G cannula and places the product in the subdermal plane using a fanning technique. She states, “Treatment extends across the chest to the clavicles while avoiding breast tissue.”70-72

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Dr Rowland-Warmann uses a dilution of 20ml for PLLA, elaborating, “One vial is typically sufficient for a treatment session, although patients with significant wrinkling, pigmentation or advanced photodamage may benefit from an additional vial per session.”73,74 She adds that, in general, two to three décolletage sessions, six weeks apart, for are required.74 When more intensive treatment is required, Dr Teslya employs the 5.5 protocol, in which low- and high-molecular-weight HA products are combined within a single syringe to create a total treatment volume of 5.5ml.75,76 She notes that this volume is sufficient to treat the neck, submental region and décolletage, extending to the breast area.76 Dr Teslya states she uses a micropapular technique with superficial intradermal injections.67,68 “I do not drop under the dermis. All the injections should be very superficial because we work particularly with skin quality,” she adds, noting that the product naturally diffuses once placed. She typically uses a 4mm needle to ensure precision and optimise improvement in skin texture.67,68 Treatment is typically delivered as a course of four sessions at three-week intervals. Dr Teslya explains that this schedule is based on the collagen synthesis cycle, adding, “Collagen production is building on 21 days after treatment, making repeated stimulation at this point important for optimising results.”77-79 According to Dr Teslya, combining both products is particularly beneficial for patients presenting with marked skin ageing, saying, “A lack of firmness and elasticity, very dry, dehydrated, wrinkly and loose skin is most suitable, particularly use in women aged over 40 and those who are perior post-menopausal.”43 Byass explains that she uses a 25G, two inch blunt-tip cannula rather than a needle. She states several advantages, noting, “Cannula use requires only two-to-four entry points across the entire chest, thereby reducing vascular risk, minimising patient discomfort and decreasing the likelihood of bruising and social downtime.”46,59 Byass illustrates that she employs a retrograde fanning technique, depositing microscopic ribbons of product (approximately 0.05-0.1ml per pass) in horizontal and diagonal cross-hatched patterns across the vertical wrinkle lines, while avoiding large bolus injections.67,80 Byass outlines that the product is placed within the superficial subcutaneous plane, just beneath the dermis. She emphasises the importance of accurate depth, explaining, “The cannula should be faintly visible beneath the skin as it advances.”46

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Patients are positioned in a semi-reclined posture at approximately 30-45 degrees, allowing the décolletage to stretch naturally while maintaining visibility of static sleep lines, shares Byass.59,81 “Following the application of topical anaesthetic for around 20 minutes, two to three lateral entry points are marked, typically near the anterior axillary line and upper breast border,” she adds.81 Before

Special Feature Décolletage Dr Rowland-Warmann recommends reviewing patients every nine to 12 months, saying, “I’ll perform a further Sculptra treatment as required, which is one to two vials.”82 Dr Teslya outlines, “Patients are advised to avoid intense physical exercise and gym activities for 48 hours. They should also refrain from visiting saunas, steam rooms, hot baths and tanning beds for one week.”46,83 Dr Teslya explains,” Patients may undergo a maintenance session every three months, or repeat the full course after six to eight months if required.” She notes that patients with chronic medical conditions, including cardiovascular disease, may experience more rapid collagen depletion and are often better suited to repeating the full treatment course after approximately six months.43,62

After

Figure 2: A 64-year-old female patient before and 24 weeks after 4.5ml of Radiesse, diluted 1:2 with 0.9% sterile saline. Images courtesy of Merz Aesthetics.

The initial treatment course and sequencing is determined by the patient’s age, baseline skin quality and wrinkle severity. 37-39 Byass states that patients with mild-to-moderate ageing (35-45 years), typically require a single session. 37-39 For moderate ageing (45-60 years), she recommends two sessions spaced four to six weeks apart. 37-39 Patients with severe laxity and advanced photoageing (aged 60+) generally undergo a staged course of three treatments at four- to six-week intervals to gradually rebuild dermal architecture without overwhelming fragile tissue. 37-39

Establishing aftercare and maintenance Detailing the aftercare protocol, Dr Rowland-Warmann refers to the 5-5-5 method, which involves massaging the treated area for five minutes, five times per day, for five days following treatment. “This helps ensure even distribution of PLLA particles and minimises the already very low risk of nodule formation,” she explains.82 She further recommends maintaining good nutritional habits, avoiding smoking and practising diligent sun protection to support treatment outcomes.83 Aesthetics | July 2026

Post treatment, Byass applies a clinical lubricant or arnica gel and performs a firm manual massage across the treated area. She explains, “This helps to smooth any product irregularities and distribute the CaHA particles evenly throughout the tissue.”64,65,69 For patients who habitually sleep on their side, Byass recommends measures to reduce chest compression during the healing phase, including the use of a chest support pillow and, where possible, sleeping on the back to help optimise treatment outcomes.79 “I advise patients to continue massaging the treated area at home for three to seven days, ideally during their usual skincare or moisturising routine,” says Byass.65,69 She states, “Annual maintenance is required for all patients to preserve firmness and smoothness, with a single maintenance treatment typically needed every 12-18 months.”65,69

Treating the décolletage Byass concludes, “We are moving away from short-term fixes and towards a cohesive full-body approach. Patients want a regenerative reset.” Interviewees agreed that through careful patient selection, tailored protocols and understanding of anatomy, practitioners can effectively address this area, achieving improvements in skin quality, texture and overall appearance. VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM 23

Boost your patients’ collagen production to work against skin ageing from within RADIESSE is an injectable dermal filler used to enhance the facial area and back of the hands. RADIESSE is available for smoothing moderate and severe wrinkles of the décolleté.

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Actual RADIESSE® patient.

Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.

©2026 Merz Aesthetics UK Ltd – All rights reserved. MERZ AESTHETICS and RADIESSE logos are trademarks and/or registered trademarks of Merz Aesthetics UK Ltd in the United Kingdom. Registered in England No. 14506945. Merz Aesthetics UK Ltd. Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ. www.merz-aesthetics.co.uk.

M-RAD-UKI-0570 Date of Preparation: February 2026

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CPD CaHA

Exploring Calcium Hydroxylapatite in Regenerative Aesthetics Dr Ben Taylor-Davies reviews the evolution, mechanisms and practical use of CaHA-based injectables in contemporary regenerative aesthetics Regenerative aesthetics has emerged as one of the defining trends within contemporary medical aesthetics. It reflects a broader shift away from simply replacing lost volume toward improving tissue quality, structural support and long-term skin health.1 Increasingly, patients seek treatments capable of delivering natural-looking rejuvenation whilst also supporting the biological function and integrity of ageing tissues. Within this evolving landscape, biostimulatory injectables have become central to many treatment strategies, offering clinicians the ability to combine immediate aesthetic correction with longer-term tissue remodelling. Amongst these agents, calcium hydroxylapatite (CaHA) occupies a unique position due to its extensive clinical history, favourable safety profile and dual mechanism of action.2 Although widely recognised within medical aesthetics as a volumising and regenerative injectable, CaHA has been utilised across multiple medical specialties for decades prior to its adoption for facial rejuvenation.3 Its biocompatibility, structural properties and ability to stimulate extracellular matrix (ECM) remodelling have established CaHA as one of the most versatile injectable biomaterials currently available in aesthetic practice.4 Over the past two decades, understanding of CaHA has evolved considerably. Initially regarded primarily as a long-lasting volumising filler, subsequent histological and clinical research demonstrated that CaHA exerts significant biostimulatory effects through fibroblast activation, neocollagenesis, elastogenesis and angiogenesis.5 These findings have transformed its role within modern medical aesthetics and expanded its applications far beyond traditional volumisation alone. Contemporary CaHA treatment strategies now encompass facial contouring, skin quality improvement, tissue tightening and regenerative treatment of both facial and extra-facial ageing concerns.6 This CPD explores the history, science, mechanism of action and practical use of CaHA-based injectables within medical aesthetics. It also reviews the currently available CaHA products on the UK market, their differing rheological properties and injection techniques, as well as the clinical outcomes and safety considerations associated with their use.

Calcium hydroxyapatite use in medicine CaHA is not a synthetic invention – it is the principal inorganic component of bone (60-70% by weight) which underpins its biocompatibility and adoption for clinical practice.7 It is biocompatible (recognised by the body) and therefore has a low immunogenicity profile. This property established its safety for human use within medical practice long before medical aesthetics used CaHA for rejuvenation.8,9 Prior to use in medical aesthetics, CaHA was used in the 1970s-80s as a substitute for bone material in grafts, and in the 1980s-90s as a coating for dental implants to improve

osseointegration (integration into the bones of the face).10 At this initial stage, CaHA had been identified for its strong mechanical and biocompatibility properties however its regenerative properties in the modern aesthetic sense were not yet known. A key innovation in the early 2000s – which paved the way for the widespread use of CaHA within aesthetic practice today – was the suspension of CaHA microspheres in a gel carrier, forming a product which allowed CaHA to be injected within soft tissue for augmentation.11 Early medical indications for use of this novel injectable product were vocal fold augmentation, treatment of stress urinary incontinence and the first use for aesthetic medical purposes – treatment of human immunodeficiency virus (HIV)-associated facial lipoatrophy.12-14 Facial lipoatrophy (the loss of facial fat) is a stigmatising effect of advanced HIV and older anti-retroviral drugs. Historically, patients faced significant social stigma due to this and early CaHA-based injectables offered a novel solution to this.15

Mechanism of action In medical aesthetics, CaHA-based fillers are most commonly formulated as a mixture of smooth CaHA microspheres, typically 25-45 μm in diameter, suspended within an aqueous carboxymethylcellulose (CMC) gel carrier.16 This biphasic structure underpins both the immediate volumising properties and the longer-term regenerative effects of CaHA fillers. Some available products in the UK are a combination of CaHA microspheres suspended in hyaluronic acid (HA) gel, rather than CMC. Following injection, the gel carrier (CMC or HA) provides immediate correction through mechanical volume replacement and tissue expansion. This initial volumisation is responsible for the early aesthetic improvement seen directly after treatment. However, the carrier gel is gradually degraded over several months, during which time the CaHA microspheres remain at the implantation site and begin to exert their principal biological effects.17 The regenerative effects of CaHA are mediated through a controlled and subclinical foreign-body response. Following implantation, the CaHA microspheres stimulate recruitment of macrophages and fibroblasts without provoking significant chronic inflammation or granulomatous reaction under normal conditions.18 Fibroblasts surrounding the microspheres become activated and initiate neocollagenesis, producing increased amounts of type I and type III collagen. Type I collagen contributes to tensile strength and structural support, whilst type III collagen is associated with early tissue repair and dermal regeneration.17,18 Histology has demonstrated progressive collagen deposition surrounding individual CaHA particles, creating a supportive fibrovascular matrix that persists after gradual degradation of the microspheres themselves.19

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CPD CaHA

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In addition to collagen induction, CaHA has also been shown to stimulate elastin production and angiogenesis. Increased elastin synthesis may contribute to improvements in skin elasticity and resilience, whilst angiogenesis enhances local vascular supply and tissue metabolism. Together, these processes contribute to broader dermal remodelling rather than simple volumisation alone.19,20 Importantly, the newly synthesised tissue gradually replaces the CaHA microspheres as they undergo slow degradation into calcium and phosphate ions, which are subsequently metabolised through normal physiological pathways. This progressive replacement of filler material with native connective tissue helps explain the prolonged duration of clinical effect often observed with CaHA fillers.20,21

CaHA used in medical aesthetics Following the identification of a CaHA-based dermal filler as efficacious for the treatment of facial lipoatrophy, Radiesse became the first non-HA dermal-filler approved by the US Food and Drug Administration for facial volumisation in aesthetic practice.22 Radiesse is a product composed of 30% CaHA spheres (by weight) suspended in a 70% CMC gel.23 Radiesse offered a key differentiation in terms of the available injectable product portfolio at the time – key differentiators vs. available HA fillers were a higher elastic modulus (G’ prime) and longer duration of effect (up to 18 months) offering both patients and clinicians alike more transformative and longer lasting injectable results.24 The rheological properties of CaHA further contribute to its clinical behaviour. CaHA fillers possess relatively high viscosity and elastic modulus (G’), allowing them to provide substantial structural support and lifting capacity compared with many softer HA fillers. This makes CaHA particularly suitable for deep supraperiosteal or subdermal placement in areas requiring contouring and structural reinforcement, such as the jawline, cheeks, chin and temples.25 More recently, dilution and hyperdilution techniques have expanded the role of CaHA from a purely volumising filler to a regenerative injectable used for skin tightening, dermal thickening and improvement in skin quality across both facial and extra-facial indications, including the neck, décolletage, upper arms, abdomen and buttocks.26,27 The recognition of CaHA as both a volumising implant and a regenerative biostimulatory agent has significantly influenced modern approaches to facial rejuvenation. Rather than replacing lost volume, contemporary CaHA treatment strategies increasingly aim to restore tissue quality, improve structural support, and stimulate long-term ECM regeneration as part of a broader regenerative aesthetic paradigm. Whilst CaHA had initially been adopted primarily as a volumising filler, early experimental and histological studies soon demonstrated that its mechanism of action extended beyond simple space occupation.28,29 In addition to providing immediate soft tissue augmentation, CaHA was shown to exert a significant biostimulatory effect within treated tissues. Histological analyses of biopsy specimens from treated areas demonstrated increased fibroblast activity, neocollagenesis, neoelastogenesis and angiogenesis following implantation of CaHA.30 Specifically, studies identified upregulation and deposition of both type I and type III collagen fibres, alongside increased elastin production, suggesting that CaHA contributes not only to volumisation but also to broader dermal remodelling and restoration of ECM integrity.30,31 The recognition of these properties significantly influenced the subsequent evolution of CaHA use in facial rejuvenation, including hyperdilute applications, skin quality improvement and off-face indications targeting dermal laxity and structural tissue support.32 26

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The UK market and product use CaHA-based fillers currently available on the UK market include HArmonyCa, Neauvia Stimulate, Novuma and Radiesse. Although they all utilise CaHA microspheres to induce neocollagenesis and tissue remodelling, their differing carrier gels and rheological profiles influence their injection techniques and clinical applications. For volumisation and contouring, Radiesse is commonly placed in the supraperiosteal or deep subdermal plane using either a needle or blunt cannula (22G or 25G). Common techniques include supraperiosteal bolus placement over the zygoma, chin and mandibular angle, as well as retrograde linear threading and fanning within the subdermal plane for jawline contouring and skin tightening. 33 Hyperdilute and dilute CaHA techniques have subsequently emerged for regenerative indications, typically involving dilution ratios ranging from 1:1 to 1:6 with lidocaine and saline, allowing more superficial subcutaneous placement over larger treatment areas such as the neck, décolletage, abdomen, upper arms and buttocks. 34 Increasingly, hybrid filler techniques are being utilised by some clinicians, with Radiesse being blended with HA fillers of different rheologies. Advantages of this technique include bespoke customisation of the rheological properties of the end product injected, whilst maintaining the hybrid action of immediate volumisation followed by long-term biostimulation. 35 Novuma is a more recent addition to the UK market. Like Radiesse, it contains CaHA particles suspended in a CMC carrier gel, but with a higher CaHA content of approximately 55-60% CaHA by weight. Novuma is indicated for supraperiosteal and deep dermal injection to the face using both needle and cannula techniques. 36 Similar to Radiesse, suitable cannula size would be 22G or 25G. However, further clinical studies are required to establish optimal injection techniques. HArmonyCa differs from Radiesse and Novuma by combining CaHA microspheres with cross-linked HA, producing both an immediate volumising effect and delayed collagen stimulation. Due to its hybrid rheology and greater lifting capacity, HArmonyCa is generally injected within the deep subcutaneous or supraperiosteal plane using cannula-based vectoring techniques (22G or 25G). 37 Common indications include lateral cheek, prejowl and mandibular contouring. The product is typically delivered using retrograde linear threads or fanning patterns to optimise tissue support whilst minimising the risk of nodularity. 37 Neauvia Stimulate similarly combines CaHA with HA-based carrier systems, although their rheological characteristics differ from both Radiesse and HArmonyCa. This product is generally injected more superficially within the deep dermal or subcutaneous plane to improve skin quality, laxity and structural support, whilst maintaining a softer tissue integration. 38 Cannula techniques are frequently preferred to permit broad distribution and reduce the risk of focal product accumulation. 39 Linear threading and fanning techniques are commonly employed based on clinical experience, particularly in areas such as the jawline, lateral face, neck and lower face. As with other CaHA products, excessive superficial placement should be avoided to reduce the risk of visibility, nodularity or inflammatory complications.40

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CPD CaHA

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Clinical outcomes, safety considerations and contraindications Beyond the immediate volumising effect seen at the time of treatment, CaHA-based fillers are associated with progressive improvements in skin quality and tissue support over subsequent months due to biostimulation. Patients often develop gradual enhancement in skin firmness, elasticity and texture, alongside softening of fine lines and improvement in mild-to-moderate skin laxity. Clinically, this may manifest as improved facial contour definition, tightening of the jawline and lower face, enhanced skin density and an overall healthier and more rejuvenated appearance of the treated tissues. In hyperdilute applications, patients may additionally notice improvements in crepey skin texture and dermal thinning in areas such as the neck, décolletage, upper arms and abdomen.41

augmentation and longer-term tissue remodelling distinguishes CaHA from many traditional dermal fillers, and aligns closely with the broader movement toward regenerative aesthetic treatment paradigms. As the UK market continues to expand, with multiple CaHA-based products possessing differing rheological characteristics and carrier systems, clinicians must maintain a clear understanding of product selection, injection depth, tissue behaviour and safety considerations to optimise outcomes. Used appropriately, CaHA injectables provide versatile, long-lasting enhancement that complements the wider shift toward regenerative, biology-led facial rejuvenation.

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Clinical results are long lasting with patients reporting noticeable improvement in both facial volume and tissue quality for up to 24 months.42

Although uncommon, vascular occlusion remains the most serious complication associated with CaHA fillers.45 Inadvertent intra-arterial injections can result in tissue ischaemia, skin necrosis, and in severe cases, visual impairment or blindness.46 Unlike HA fillers, CaHA products are not directly reversible with hyaluronidase, which presents additional management challenges. Prevention therefore remains critical and relies on thorough anatomical knowledge, careful patient selection, appropriate injection planes, slow, low-pressure injection, aspiration where appropriate, and consideration of blunt cannula techniques in higher-risk areas such as the temple and nasolabial fold. Early recognition and prompt intervention are essential to optimise outcomes in vascular compromise.47 Detailed management of complications from CaHA products are beyond the scope of this article. Absolute contraindications to CaHA treatment include known hypersensitivity to any product component, active local infection, or inflammation at the treatment site and the presence of significant skin disease in the intended treatment area. Treatment should be postponed in patients with acute systemic infection. Relative contraindications include pregnancy and breastfeeding, immunosuppression, uncontrolled autoimmune disease, bleeding disorders and unrealistic patient expectations. Caution is also advised in areas with previous permanent filler placement due to the potential for unpredictable tissue responses. As with all injectable treatments, patients with a history of severe allergic reactions, impaired wound healing, or a predisposition to hypertrophic scarring should be assessed carefully. Comprehensive medical history taking, informed consent and adherence to evidence-based injection techniques are fundamental to minimising complications and optimising outcomes.48

Evolution of CaHA CaHA has evolved from a biomaterial originally valued for its biocompatibility and structural properties into one of the most important regenerative injectables within modern medical aesthetics. Its ability to provide both immediate structural

Questions

Possible answers a. Upregulation of collagen type I b. Upregulation of collagen type I and III

1. What are the biostimulatory effects of CaHA?

c. Collagen type I and III, and elastin production d. Upregulation of collagen type I and III, elastin production and angiogenesis e. Upregulation of collagen type IV and VII a. 1970s

2. When was CaHA first used in medical aesthetics?

b. 1980s c. 1990s d. 2000s e. 2010s

3. What is the average diameter of CaHA microspheres used within injectable products?

4. How many CaHA containing injectable products are currently available on the UK market?

5. The first facial indication for CaHA injectable products was:

a. 25-45 μm b. 50-70 μm c. 100-200 μm d. 0.1mm e. 5-10 μm a. One b. Three c. Four d. Five e. 10 a. Treatment of HIV-associated facial lipoatrophy b. Treatment of nasolabial folds c. Contouring of the jawline d. Chin enhancement e. Improvement of skin quality Answers: D,D,A,C,A

Overall, CaHA fillers demonstrate a favourable safety profile when used appropriately by experienced injectors. Common early adverse events are typically mild and transient, including oedema, erythema, bruising, tenderness and swelling at the injection site. Nodules represent the most frequently reported delayed complication and may occur secondary to superficial placement, excessive product deposition, poor product distribution or injection into highly dynamic areas. Most nodules are non-inflammatory and may resolve spontaneously, although persistent or inflammatory nodules may require massage, intralesional therapy or surgical excision in rare cases.44

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 Acquisiton Aesthetics. Qual: MBBS, BSc, AFHEA

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27

Facial Ageing Bone Loss

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Understanding Facial Bone Resorption

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Before

After

Dr Steven Land outlines how facial bone resorption affects the ageing process When we think of ageing, our minds naturally go to the visible and more familiar signs. Fine lines forming around the eyes, sagging skin on the jawline or that sense of hollowness in the mid-face that patients often describe as ‘tired’ or ‘drawn.’ The aesthetic field has long focused on what can be seen on the surface, including skin texture, pigmentation, wrinkles and the redistribution of fat. Yet one of the most profound, and frequently under-discussed, contributors to facial ageing lies much deeper, within the skeletal foundation itself.

Facial bone resorption Facial bone resorption is a silent, subtle process, which means it rarely features in the first conversations patients have with their practitioners. By the time patients begin noticing substantial changes in their facial appearance, usually around their 40s or 50s, the bones of the face have already been undergoing slow but steady remodelling for decades. For aesthetic practitioners aiming to provide natural, long-lasting results, this deeper anatomical knowledge is essential. The process of craniofacial bone loss tends to start in the late 20s or early 30s. This early onset is often under-recognised, particularly, as the changes at this stage are almost undetectable to the untrained eye. However, beneath the skin and soft tissue, the facial skeleton is undergoing structural changes that will ultimately influence the shape, symmetry and overall balance of the face.1 These changes follow specific anatomical patterns and are influenced by factors ranging from genetics and hormonal changes to lifestyle and mechanical stress. Genetically, individuals vary in baseline bone density, craniofacial morphology and the rate of bone remodelling. For example, those with inherently lower peak bone mass or narrower skeletal frameworks may exhibit earlier or more pronounced structural resorption.2,3 Hormonal influences are also significant. Declining levels of oestrogen, particularly in women, during the peri-and post-menopausal periods are strongly associated with accelerated bone resorption, making females generally more susceptible to earlier and more rapid craniofacial bone loss compared to males.4,5 In contrast, the gradual decline of testosterone in men tends to produce a slower, more prolonged pattern of skeletal change.6 Lifestyle factors further modulate these processes. Chronic smoking has been shown to impair osteoblast function and reduce blood supply to bone, while excessive alcohol consumption may be associated with an increased risk of fractures.7,8 Nutritional deficiencies, especially insufficient intake of calcium, vitamin D and protein can compromise bone maintenance.9 Additionally, low levels of mechanical loading, such as reduced chewing force from soft diets or tooth loss without replacement, may contribute to localised bone resorption in the jaw. Sleep quality and chronic stress via elevated cortisol also play indirect roles by influencing systemic metabolic and hormonal balance.10-12 28

Figure 1: A 50-year-old female patient at baseline and two months after two sessions of Neauvia Intense, Zafirro IR and LaserMe skin resurfacing.

Causes of skeletal remodelling One of the driving forces behind facial skeletal remodelling is the principle that bone adapts to mechanical forces. Known as Wolff’s Law, this concept suggests that bone will remodel itself in response to the stress placed upon it.13 In areas where there is less pull from muscles or ligaments, resorption tends to occur more rapidly. The orbits, for instance, particularly in the superomedial and inferolateral areas, gradually enlarge over time.14 This widening results in the hollowing of the under-eye area, contributing to the sunken appearance and deep tear troughs that many patients cite as early signs of ageing.14 Further down the face, the maxilla (particularly around the nasal aperture and the anterior mid-face) also loses volume. As this happens, the support structure beneath the cheeks weakens, leading to a flattening of the mid-face and accentuation of the nasolabial folds.15 The zygomatic arch, which gives the cheek its forward projection, diminishes as well, worsening this downward shift in soft tissue. The mandible also experiences changes, with a loss of bone at the angle of the jaw, the ramus and the chin area.16 This results in a weaker jawline, less chin projection and eventually, the emergence of jowls. For patients with missing teeth, changes can become even more complex. The alveolar bone, which depends on the mechanical stimulation of chewing to remain robust, quickly recedes without dentition, dramatically reducing support for the upper lip and mid-face.11 These anatomical shifts underpin a lot of the aesthetic concerns patients bring to the clinic. The nasolabial folds deepen not just because of fat pad descent or skin laxity, but because the underlying maxillary bone is shrinking.14 Similarly, when a patient describes their face as appearing ‘saggy,’ this perception is partly attributable to reduced projection in the cheek and zygomatic areas, creating less resistance to the pull of gravity.17 The jawline loses definition not only because of skin redundancy but also due to progressive resorption of the underlying bone that previously contributed to mandibular contour.17 Even the nose appears to change with age, as bone loss at its base can contribute to widening and mild inferior tip descent.17

Approaches to treatment The common approach in medical aesthetics has traditionally been to address these changes from the outside in. Practitioners lift sagging tissue with energy devices, soften lines with injectables and plump hollow areas with dermal fillers. But without considering the foundation that these tissues rest on, there is a risk of creating results that look unnatural or even distorted. Over-filling the mid-face in an attempt to ‘lift’ soft tissue without restoring deep bony projection often results in a

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bloated or puffy appearance. Similarly, correcting tear troughs superficially without acknowledging the expanded orbital aperture can lead to shadowing or migration of product.18 From a preventative perspective, there is limited scope to fully prevent facial bone resorption, as it is largely a physiological consequence of ageing. Several lifestyle factors may play a role in slowing the process. Maintaining good bone health through adequate intake of vitamin D and calcium, avoiding smoking and excessive alcohol and exercising can support the overall skeletal system, which includes the facial bones. In women, hormonal changes during the peri-menopausal and menopausal stages accelerate bone loss, highlighting the importance of early intervention and monitoring.4 While some medications are being studied in this context, as of yet there are no easily available, proven treatments. Practitioners should also consider the patient’s dental health. The alveolar bone relies heavily on functional stress from teeth.20 Tooth loss, particularly in the upper jaw, can precipitate rapid and dramatic resorption, which not only affects oral function but significantly impacts mid-face aesthetics. Dentures, implants and other similar interventions can play a pivotal role in maintaining bone volume and should be considered part of an integrated approach to facial preservation.

Treatment planning An effective treatment plan starts with a comprehensive facial assessment. Detailed analysis enables practitioners to move beyond standardised protocols and individualise treatment according to each patient’s individual anatomy and ageing pattern. Assessment A comprehensive facial assessment is performed using a structured, multi-layered approach to gather detailed diagnostic information. It typically begins with standardised clinical photography, capturing frontal, profile, oblique and dynamic views under consistent lighting and head positioning to establish a reliable and reproducible baseline. 21 This is followed by visual inspection of facial anatomy, assessing skeletal projection, soft tissue distribution, facial symmetry, proportions and overall skin quality, including signs of photodamage and laxity. Palpation techniques, including the pinch test, are then used to evaluate dermal thickness, elasticity and subcutaneous volume, while also helping determine the depth, adherence and mobility of tissues. Factors such as recoil time, resistance to deformation, and the presence of crepiness or laxity are carefully noted.22 A dynamic assessment should then be performed during facial expressions like smiling, talking, brow elevation and squinting. This provides insight into muscle activity, compensatory movement patterns, ligament laxity and patterns of tissue descent that may not be visible at rest. In some cases, adjunctive technologies like 3D imaging or skin analysis devices may be used to objectively quantify volume, symmetry, hydration, pigmentation and elasticity.21 An additional important step is the assessment of dental and occlusal status, such as bite alignment (occlusion), tooth loss history, prosthetics or implants and vertical dimension of occlusion, as these influence structural support and lower facial proportions.23 Structural restoration and product selection Although facial bone resorption cannot be fully prevented, treatment plans can be designed to acknowledge and adapt to its effects. The most effective way to do this is by thinking of facial volume not as a single plane, but as a three-dimensional construct built upon a scaffold. This scaffold, the bone, must be considered in all volume restoration procedures. By placing

Facial Ageing Bone Loss

dermal filler deeply directly onto the periosteum, practitioners can mimic lost skeletal structure. For example, restoring cheek projection at the zygomatic arch or augmenting the chin can significantly improve facial harmony without adding bulk to the superficial tissues. In these cases, higher G′ fillers with greater stiffness and a higher crossover strain, such as Neauvia Intense, Teosyal RHA 4 and Stylage XXL, are typically preferred because they better resist deformation and maintain their shape under mechanical stress, providing structural support and projection while being less likely to spread. Restoring the maxilla through injectables can subtly lift the nasolabial region and improve mid-face contour. Similarly, recreating the angle of the jaw with targeted filler can restore a youthful silhouette without the heaviness that comes from overfilling superficial fat compartments. It is also important to note that the specific technique and tool choice are highly practitioner-dependent and are typically guided by individual anatomical assessment, experience and preference. Integrating soft tissue and energy-based modalities Skeletal-focused filler treatment should not be viewed in isolation. Optimising soft tissue is still vital. Skin quality, elasticity and dermal thickness all affect how well the underlying structure translates into surface aesthetics. Technologies like radiofrequency (RF) microneedling, high-intensity focused ultrasound and fractional laser treatments can tighten and remodel the dermis, providing improved support for repositioned soft tissues.24 RF microneedling has long been shown to consistently improve skin laxity and texture.25 Microfocused ultrasound also demonstrates tightening effects, and combining it with RF-based devices may even offer additive clinical benefit compared with monotherapy approaches.26 Likewise, fractional laser resurfacing targets the epidermis and superficial dermis, improving skin texture and reducing dyschromia. 27 Alongside these energy-based modalities, biostimulatory injectables, polynucleotides and hyaluronic acid-based skin boosters also play a complementary role by enhancing hydration and stimulating collagen production, refining texture and tone while maintaining natural contours.28,29 All these interventions require long-term monitoring and maintenance to preserve treatment outcomes, assess tissue response over time and adapt protocols in line with the progressive nature of facial ageing.

Treating the ageing structure Facial bone resorption is a core component of the ageing process – quiet, gradual and invisible to most until its cumulative effects become unavoidable. It begins earlier than expected and affects all aspects of facial harmony, from the position of soft tissue to the shape of the jawline. By acknowledging the skeletal foundation of the face and integrating this understanding into our daily practice, practitioners elevate both results and standards of care. The face is not just skin deep, and neither should our treatments be. Dr Steven Land is the owner of Novellus Aesthetics in Newcastle Upon Tyne. His extensive medical training, spanning over two decades in medicine, more specifically emergency medicine, eventually led him to a passion for medical aesthetics, where he found a unique way to empower individuals by enhancing their appearance. Qual: MBBS, MRCEM, MBCAM

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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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Case Study Submental Fat

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Treating Submental Fullness

Liposuction remains the gold standard for surgical treatment, but is not without limitations.4 If performed too aggressively or superficially, it can damage the dermal matrix, preventing adequate skin retraction and leading to contour irregularities.4

Mr Sotirios Foutsizoglou outlines a case study treating submental fullness using both surgical and non-surgical procedures

Patient background

Submental fullness, also referred to as ‘double chin,’ is a common aesthetic concern. The American Society for Dermatologic Surgery Consumer Survey indicated that 70% of 3,527 survey respondents, were bothered by excess fat under their chin.1 Other literature highlights the psychological impact, with many individuals avoiding video calls and photographs due to dissatisfaction with their submental area.2 Multiple factors contribute to submental fullness, including weight gain, genetics, skin laxity, atrophy and bone resorption. Retrogenia, under-developed mandible, hormonal fluctuations and photodamage can exacerbate the issue.3 The success of post-surgical skin remodelling for this indication depends on age, skin quality, previous trauma, medications and overall health. Given this complexity, treatment requires a multi-modal approach. This case study demonstrates an approach integrating both surgical and non-surgical applications to target the submental fat.

Exploring patient options Submental fat can be addressed through both surgical and non-surgical modalities, depending on severity, anatomy and patient goals. Practitioners should be familiar with appropriate treatment and referral pathways to ensure optimal outcomes. Table 1 outlines common clinical presentations alongside recommended management routes, including both in-practice treatment and surgical referral options. Non-surgical treatments such as deoxycholic acid injections, mesotherapy, polycaprolactone (PCL) or poly-L-lactic acid (PLLA) collagen stimulators, polydioxanone (PDO) threads, calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) fillers can provide temporary improvement. Energy-based devices like radiofrequency (RF), high-intensity focused ultrasound (HIFU) and cryolipolysis offer skin tightening and fat reduction. However, no single modality consistently achieves optimal outcomes.

A 32-year-old female presented with a primary concern of submental fullness (Figure 1). She had previously undergone various non-surgical treatments, including lipolytic injections and PDO threads, with limited success. She also reported a family history of similar concerns, with her mother and grandmother experiencing persistent submental fullness despite maintaining a healthy body mass index (BMI). The patient was otherwise fit and healthy, with an unremarkable medical history other than recurrent herpes simplex virus type 1 (HSV-1), presented through cold sores. She was a non-smoker and consumed alcohol socially. Her BMI was within the normal range (20), and her weight had remained stable for several years. Despite her objectively minor submental fullness, the patient expressed significant distress. This prompted an evaluation for body dysmorphic disorder (BDD), as patients with BDD often derive minimal satisfaction from aesthetic interventions. BDD would be an absolute contraindication to having cosmetic surgery, as a literature review featuring several studies has demonstrated that nearly 98% of the individuals suffering from BDD had no benefit from elective interventions, with perceived worsening of their image at 16%.5,6 The Body Dysmorphic Disorder Questionnaire-Dermatology Version was used, which is a validated, self-reported screening tool that can be easily used in dermatology and aesthetic surgery settings.7,8 The test demonstrated a negative result, confirming her suitability for treatment. Clinical examination revealed: •

Moderate submental fullness (2.8cm thickness on pinching)

•

Mild skin laxity

•

Bilateral mandibular body hypoplasia

•

Deficient mental protuberance

•

Fitzpatrick skin phototype II with mild photodamage and residual acne scarring

However, there was no exaggerated overjet or overbite and her micrognathia was not associated with any facial asymmetry.

Patient presentation

Most appropriate pathway

Reasoning

Mild localised submental fat, good skin quality, stable weight and realistic expectations

Non-surgical treatment may be reasonable

Gradual improvement may be acceptable and downtime can be minimised

Mild laxity without significant fat or skin excess

Energy-based or collagen-stimulating options may be considered

Treatment is aimed at skin quality and subtle tightening rather than major contour change

Weak chin or poor mandibular definition with only minor fat excess

Chin/jawline dermal filler may be considered, or referral for a skeletal/chin augmentation assessment

The apparent submental fat may be driven by deficient skeletal support rather than fat

Moderate-to-severe submental adiposity or repeated failed non-surgical fat reduction

Non-surgical practitioners should refer to a surgeon

Liposuction or surgical contouring may be more predictable

Fat plus mild-to-moderate laxity

A collaborative surgical referral may be considered

Combination treatment may address both volume and skin contraction

Significant skin redundancy, platysmal bands, jowling or poor cervicomental angle

Referral for opinion and assessment of neck lift, platysmaplasty or lower facelift surgery

Non-surgical tightening is unlikely to correct structural laxity adequately

Disproportionate distress, unrealistic expectations or suspected BDD

Do not proceed; assess, document and refer appropriately

Psychological or psychiatric input should be sought before proceeding with treatment

Table 1: Practical decision-making guide for non-surgical medical practitioners

Aesthetics | July 2026

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Case Study Submental Fat

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with less tissue trauma and faster recovery than traditional suction-assisted liposuction. It is also associated with fewer complications and contour irregularities than traditional liposuction, and has a faster recovery time.11 Helium plasma RF skin tightening Renuvion J Plasma is indicated for skin phototypes I-III on the Fitzpatrick classification to improve the appearance of lax skin in the neck and submental region, and is the only device that is US Food and Drug Administration cleared for use after liposuction. Renuvion J Plasma delivers a combination of RF energy and cold helium plasma to subcutaneous collagen-rich tissues, promoting protein coagulation and contraction of connective tissue of the stromal matrix.12,13 This contraction draws the skin closer to the underlying muscle, thereby improving the appearance of the skin and reducing its laxity.14

Figure 1: A 32-year-old-patient before treatment with submental fullness, moderate skin laxity and deficient mental protuberance.

Treatment plan A month later, at the second consultation, the non-surgical and surgical options were revisited in greater detail, including likely degree of improvement, limitations, type of anaesthesia, complications, downtime, aftercare and alternative pathways. Given her stable BMI, genetic component of her submental fullness, previous non-surgical treatment failure, mild laxity and desire for a longer-lasting result, a combined approach was recommended. The plan would involve conservative VASER-assisted liposuction to the submental region, lower face and upper neck, combined with helium plasma RF skin tightening (Renuvion, Apyx Medical, Clearwater, FL). The aim was to reduce the adipose component while helping the skin envelope contract more closely to the new contour. Liposuction alone was considered less suitable because the skin laxity could have persisted and compromised the aesthetic result. The treatment plan proposed: 1.

Liposuction: Removes excess fat and contours the submental and lower face region.

2.

Renuvion J-Plasma: Enhances skin contraction and collagen remodelling to address laxity.

Options explored both non-surgical and surgical treatments, including collagen stimulation, dermal fillers for the jawline, RF microneedling, HIFU, osseous genioplasty and alloplastic augmentation. From previous experience of treating similar aesthetic complaints, liposuction alone cannot address skin laxity, leaving patients dissatisfied with their result. The patient was also made aware of the fact that Renuvion results start to manifest at around three months, with a peak of around six months. Studies have shown that improvement of skin elasticity, new collagen formation and tightness continues up to twelve months post treatment.9,10 Following a cooling-off period, the patient made the informed decision of proceeding with the proposed treatment plan. The treatments were to be carried out in the same sitting. Fat reduction A gentler form of liposuction – VASER – was utilised. This technique selectively emulsifies fat while preserving nerves, vessels and dermal architecture, reducing the risk of contour irregularities.11 Fat removal was performed systematically, avoiding over-aggressive extraction, which could compromise skin retraction. By using ultrasonic energy to target adipose tissue, VASER allows controlled fat removal with reduced disruption of vessels, nerves and the superficial subdermal fat layer. Additionally, it may be associated 34

Renuvion may also be used as a standalone minimally invasive skin-tightening treatment in carefully selected patients with mild-to-moderate skin laxity. In a prospective multicentre evaluator-blinded study of Renuvion used alone in the neck and submental region, 82.5% of 63 patients demonstrated improvement at 180 days, with no serious adverse events reported.15 This distinction is important. When Renuvion is used as in the present case, with VASER-assisted liposuction, the overall treatment is surgical. When it is used alone, it should still not be described as a simple non-surgical or transcutaneous treatment. The subdermal technique requires small access incisions, creation of a subcutaneous treatment plane, insertion of the APR Handpiece, electrosurgical safety measures and controlled helium gas egress. It is therefore better described as a minimally invasive, non-excisional, subdermal energy-based procedure that bridges the gap between surface-based non-surgical treatments and excisional surgery.16 While liposuction is a surgical procedure, Renuvion J-Plasma may, in certain settings, be used by appropriately trained medical aesthetic practitioners working in non-surgical practice environments. Its relevance is therefore twofold; where appropriately trained and permitted within scope, it may form part of a practitioner’s treatment offering; where it is outside scope, practitioners still play an important role in patient selection, recognising when non-surgical modalities are insufficient, and referring to or co-managing care with surgical colleagues. Where undertaken, practitioners must be suitably registered, trained in manufacturer-approved device protocols and competent in subdermal energy-based techniques and relevant neck/submental anatomy. Practice must remain within professional scope, follow the current instructions for use and be supported by appropriate indemnity, governance and clear emergency and referral pathways. In England, standalone Renuvion J-Plasma subdermal procedures performed by healthcare professionals require Care Quality Commission registration due to the insertion of instruments or equipment for cosmetic purposes.17-20

Treatment The patient was given oral diazepam to calm her anxiety prior to treatment. Patient markings including insertion sites for the Renuvion J-Plasma APR Handpiece and the areas to liposuction were carried out in a sitting position, and were done in a topographic manner using indelible marking pens of different colours. Sites of maximum removal and depressions or valleys were also appropriately noted. Photographs taken with the markings in place were used to confirm the surgical plans with the patient and served as documentation of what was treated. The main points of the procedure including its purpose, downtime and potential complications were recapped before signing her consent form. She was then accompanied into theatre and comfortably positioned supine on the operating table with her neck slightly extended. Proper

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Case Study Submental Fat

grounding of the patient via a disposable split grounding pad (neutral electrode) was applied to ensure safe use, as with any monopolar electrosurgery devices.15 The treatment area was prepped with antiseptic, followed by the injection of tumescence anaesthesia into the subcutaneous tissue of the lower face, submental region and neck (anterior to sternocleidomastoids).

The patient was advised on salicylic acid-based products and a topical retinoid and asked to come back to clinic in six weeks. By that time all aesthetic complaints had resolved whereas a significant improvement of the treated area was noted.

In total, three incision sites were used, one submental (mental crease) and two at the junction of earlobe and cheek, creating some space around the insertion sites to allow a pathway for excess gas egress. To minimise scarring, the same incisions were used as access sites for both the liposuction cannulas and the 15cm Renuvion J-Plasma APR Handpiece. It is also important to establish tunnels between each of the insertion sites undermining the subcutaneous tissue with a small blunt liposuction cannula to ensure room for gas to escape. The Renuvion J-Plasma APR Handpiece is too flexible and can be damaged if used for tissue tunnelling.

At three months postoperatively, the patient exhibited flattened submental contour with no residual fullness, improved jawline definition with enhanced cervicomental angle and tighter, more youthful skin with continued collagen remodelling (Figure 2).

From each incision site, continuous strokes of the Renuvion J-Plasma APR Handpiece in a fanning pattern 2-3cm apart on both antegrade and retrograde direction at a pace of 3cm per second were used.16 The handpiece must always be in motion when activated. Multiple planes between SMAS/Platysma and skin were also used in order to effectively treat the subcutaneous fibral septal network (FSN).16 However, overlapping or crosshatching adjacent treatment areas without allowing for thermal relaxation should be avoided.16 Overheating can result in burns, scarring, permanent pigmentation changes and unacceptable cosmetic result. Over-treatment, particularly in the superficial plane (e.g. less than 5mm below the dermis) can result in fibrosis, depressions and wrinkly skin.16 Since treatment strokes of the handpiece converge at the incision sites, the device should be deactivated when the proximal white ‘tip distance indicator’ line on the shaft becomes visible at the incision site to avoid over-treatment of the area.16 Any retained excess gas in the tissues was milked towards the incision sites at the end of the treatment, and one or two 5-0 interrupted non-absorbable sutures were used to close the incision sites.16

Final results

She reported high satisfaction, with no visible scarring present as incision sites were well-hidden. Skin quality improvements and new collagen formation continued, with reduced pore size and a healthier glow. Before

After

Figure 2: 32-year-old patient before and three months after procedure. Images demonstrate flattening of submental fullness, jawline definition, sufficient skin retraction and even skin tone.

Combining modalities

Post-operative course The patient was monitored for three hours postoperatively. She received clear instructions regarding wound care, activity restrictions and the importance of wearing the compression garment continuously for the first week, then as convenient (e.g. resting at home) for an additional three weeks. She was advised to avoid strenuous activity for three to five days, sleep with her head elevated, change dressings regularly, clean incision sites with chlorhexidine and avoid sun exposure until healing was complete. On postoperative day two, the patient reported intense pruritus, patchy erythema and tenderness. Differential diagnoses included: 1. Thermal burn: Unlikely given the controlled energy settings.21 2. Allergic reaction: Possible due to garment material.22 3. HSV-1 reactivation: More likely given her history of cold sores.23 Empirical treatment included oral antihistamines for pruritus, topical mupirocin to prevent bacterial colonisation, oral clindamycin for prophylaxis because of her penicillin allergy and oral aciclovir for suspected viral reactivation.24-27 By day five, the itchy rash had started to resolve whereas the vesicles started to coalesce in a honeycomb-like pattern. At two weeks, most of the rash had gone other than a persistent small erythematous submental patch. However, there was an obvious eruption of blackheads particularly in the previous distribution of the vesicles and rash associated with mild post inflammatory hyperpigmentation. The latter observation prompted consideration surrounding superficial folliculitis of either bacterial or viral origin as the most likely diagnosis.

Non-surgical treatments play an important role in managing submental fullness, particularly in patients with mild anatomical concerns, good skin quality and a preference for subtle improvement with minimal downtime. However, no single modality can reliably address all causes or severities of submental fullness, making appropriate patient selection and treatment planning essential. For non-surgical practitioners, the priority is not choosing between technologies, but recognising when non-surgical intervention alone is unlikely to achieve the desired outcome. In selected cases, treatments such as Renuvion-only procedures may be appropriate when performed by suitably trained practitioners within their professional scope, supported by appropriate governance and regulatory compliance. Equally important is recognising treatment limitations and maintaining clear referral pathways with surgical colleagues to ensure patients receive safe, effective and comprehensive care. Mr Sotirios Foutsizoglou was the 2023 Winner at The Aesthetics Awards for Best Surgical Result. He is an aesthetic surgeon who has worked as a consultant in both the NHS and the private sector, and is also a Fellow of the Royal College of Surgeons of England and the European Board of Plastic Reconstructive and Aesthetic Surgery. Qual: MBBS, FRCS(Eng), FEBOPRAS, BSc(Hons), MSc(Biostats), PGDip(Micro), EBOPRAS

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A Clinical Approach to Neck Rejuvenation Dr Rupert Critchley provides guidance on injectable neck rejuvenation and multi-modal treatment strategies Facial rejuvenation remains the primary focus of aesthetic practice, with well-established treatment frameworks and predictable outcomes. However, the neck is frequently under-treated despite being one of the earliest areas to demonstrate visible ageing. The aesthetic concern is clinically relevant because the face and neck are usually viewed as a continuous unit, and disharmony between the two can make even well-executed facial rejuvenation appear incomplete.1,2 This often results in a discordance between a rejuvenated face and an untreated neck, which can undermine overall aesthetic outcomes. Increasingly, patients are presenting with concerns specific to neck ageing, including skin laxity, platysmal banding, submental fullness and changes in skin quality.1,2 The neck presents distinct anatomical and physiological challenges. The skin is thinner, sebaceous activity is reduced and structural support is limited compared to the face.3 As such, treatment requires careful planning, detailed anatomical understanding and appropriate patient selection.

Anatomy and ageing of the neck The ageing neck is influenced by a combination of dermal, muscular, adipose and skeletal changes. A structured assessment helps clinicians identify whether the dominant concern is skin quality, dynamic muscle activity, localised fat, structural laxity or a combination of these factors.1,2,4 The platysma muscle plays a central role, extending superficially from the clavicle to the lower face. With age, separation and increased visibility of the medial fibres can contribute to vertical banding, particularly during animation.5,6 Platysmal hyperactivity may also exacerbate downward pull on the lower face, contributing to loss of jawline definition.4,5 Intrinsic skin ageing and photoageing are associated with progressive collagen and elastin changes, matrix degradation and reduced dermal resilience, leading clinically to thinning, laxity and crepey skin texture.3,7 The neck also has fewer pilosebaceous units than the face, which may reduce its ability to tolerate repeated irritation and may contribute to slower recovery following resurfacing or inflammatory procedures.1 Submental fat accumulation and redistribution of volume within the jowl and lower face compartments further contribute to loss of definition. Perceived submental fullness may reflect superficial adiposity, deeper anatomical structure, skin laxity or a combination of these, so assessment should not assume fat is the sole driver.4,8 External factors, particularly chronic ultraviolet exposure, smoking and lifestyle factors, accelerate photoageing and dyspigmentation.3,7 Clinically, patients often present with a combination of skin laxity, platysmal banding, submental adiposity, dyschromia and photodamage.1,2 Understanding the dominant contributing factor is key to effective treatment planning.

Assessment and indication criteria Successful neck rejuvenation begins with accurate assessment of the dominant ageing mechanism. Patients rarely present with a

Neck Rejuvenation Injectables

single isolated concern, and treatment planning should therefore differentiate between dermal ageing, muscular activity, submental adiposity and structural skin laxity.1,2 Clinical examination should include assessment of skin laxity and crepiness, presence and severity of platysmal banding. As well as cervicomental angle definition, distribution of submental and lower face adiposity, skin hydration, dyschromia, dynamic versus static change, and any previous treatment or scarring history. Standardised clinical photography is useful to support treatment planning and longitudinal review, while grading of the cervicomental angle may help document baseline severity and response.4,9 Assessment should also include patient age, expectations, medical history and suitability for non-surgical intervention. Patients with early-to-moderate change and realistic expectations are generally more suitable than those with marked skin redundancy, significant tissue descent or unrealistic expectations of surgical-level correction.1,2

Treatment selection and sequencing In clinical practice, treatment sequencing is guided by the dominant presenting feature. Fine crepiness and superficial dehydration are typically addressed with superficial hyaluronic acid (HA) skin boosters to improve dermal hydration and texture.13 Dynamic platysmal banding is managed with targeted botulinum toxin injections to reduce muscle activity and soften anterior neck bands.5,6 Mild-to-moderate laxity without significant skin redundancy may benefit from biostimulatory agents such as poly-L-lactic acid (PLLA), aiming to induce neocollagenesis and gradual tissue support.1,10

“The face and neck are usually viewed as a continuous unit, and disharmony between the two can make even well-executed facial rejuvenation appear incomplete” Where localised submental adiposity predominates, lipolytic treatment may be indicated before collagen-stimulating therapies to improve contour and reduce lower-face heaviness.8 In patients with marked tissue descent or redundant skin, surgical intervention is often more appropriate and should be discussed or considered via referral.1,4 Careful patient selection is essential, as over-treatment or inappropriate modality selection may worsen heaviness, irregularity or laxity.1,2

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Neck Rejuvenation Injectables

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Role of injectables in neck rejuvenation Injectable treatments may offer targeted approaches to the different mechanisms contributing to neck ageing. However, successful outcomes depend on careful patient selection, realistic expectations and an understanding of the limitations of non-surgical intervention.1,2,6 Biostimulators Biostimulatory agents such as PLLA may be used to stimulate fibroblast activity and neocollagenesis, improving dermal support and skin laxity over time.1,10 PLLA is generally most suitable in patients with early-to-moderate laxity. It may be particularly useful in patients with diffuse laxity and skin thinning where volumising HA filler could risk worsening lower-face heaviness.1,10 Other regenerative and biostimulatory approaches are increasingly being explored within neck rejuvenation. Polynucleotides may support tissue repair, hydration and dermal quality through regenerative signalling pathways, while hybrid injectable products combining calcium hydroxyapatite (CaHA) with HA, such as HArmonyCa, may provide both immediate structural support and longer-term collagen stimulation.11,12 However, evidence and treatment protocols continue to evolve, particularly within the neck where tissue characteristics differ significantly from the mid-face. Treatment protocols vary according to product, patient age, tissue quality and severity, although common approaches involve reconstitution volumes of approximately 8-12ml per vial. The product is typically delivered within the superficial subcutaneous plane using either cannula or needle techniques. It is administered over two to four treatment sessions, spaced approximately four to eight weeks apart.1,10 Results are gradual, often becoming more apparent several months after treatment as collagen stimulation progresses.10 Contraindications include pregnancy, active infection, autoimmune flare states and known hypersensitivity to product components. Potential adverse effects include bruising, oedema, tenderness and delayed nodule formation, particularly when the product is placed too superficially, inadequately diluted or insufficiently dispersed.1,10 HA injectables

“Perceived submental fullness may reflect superficial adiposity, deeper anatomical structure, skin laxity or a combination of these, so assessment should not assume fat is the sole driver” Lipolytic treatments Injectable lipolytic agents such as deoxycholic acid may be considered in patients with localised submental fat deposits.8 Deoxycholic acid disrupts adipocyte cell membranes, producing adipocytolysis and gradual fat reduction over time.8 Assessment should determine whether fullness relates primarily to adiposity, skin laxity or deeper structural anatomy, as treating perceived fullness without confirming the underlying cause may worsen heaviness or skin redundancy.4,8 Treatment typically involves multiple sessions spaced approximately four to eight weeks apart, depending on response and adipose volume.8 Contraindications include pregnancy, active infection and significant skin laxity without adiposity. Common adverse effects include swelling, tenderness, bruising, induration and numbness. Temporary marginal mandibular nerve paresis has also been reported and should be included within the consent process.8 Neuromodulators

HA-based skin boosters may improve hydration, elasticity and superficial skin texture.13 These treatments are generally most appropriate in patients presenting with early dermal thinning, dehydration and crepey skin texture, rather than significant structural laxity.6,13

Botulinum toxin remains an effective treatment for platysmal banding through temporary neuromuscular blockade.5,6 By reducing platysmal contraction, treatment may improve visible neck banding and mitigate the downward pull affecting the lower face and jawline.5,6

Protocols vary between products, although treatment commonly involves superficial intradermal or immediate subdermal micro-aliquots delivered across the neck, typically over two to three sessions spaced approximately four weeks apart.6,13 Lower-viscosity HA formulations, such as Juvéderm Volite, Teosyal Redensity 1 and Restylane Vital, may be utilised where the primary treatment objective is improvement in skin quality and hydration, rather than volumisation.

Treatment protocols vary depending on severity and product used, although conservative dosing across visible platysmal bands is generally recommended to minimise complications.5,6 Neuromodulators are most suitable in patients with dynamic platysmal activity rather than significant skin laxity or excess adiposity.5

HA boosters may be used in younger patients or as adjunctive treatment alongside biostimulatory or energy-based approaches when skin quality is a dominant concern.13 Contraindications include pregnancy, active infection and known hypersensitivity. Adverse effects are generally mild and include erythema, oedema, bruising and injection-site tenderness, although intravascular injection remains a theoretical risk with all injectable treatments.6,13 40

Contraindications include pregnancy, neuromuscular disorders and infection at the treatment site. Potential adverse effects include dysphagia, dysphonia, speech disturbance, asymmetry and neck weakness, particularly following excessive dosing or poor injection placement.4,6

Alternative treatment options In addition to injectable modalities, topical therapies and energy-based devices (EBDs) may also be considered as alternative or adjunctive treatment options, depending on the clinical presentation and practitioner scope of practice.1,2

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Neck Rejuvenation Injectables

Adjunctive energy-based treatments for skin tightening Adjunctive treatments including microneedling and EBDs such as radiofrequency (RF) may support dermal remodelling and skin tightening.14,15 EBDs may play an important role in non-surgical neck rejuvenation, particularly in patients where skin laxity, dermal thinning and textural change are dominant concerns. Modalities including RF, fractional laser resurfacing, ultrasound-based tightening and RF microneedling aim to stimulate collagen remodelling and improve tissue tightening through controlled thermal injury.14-16 These treatments may be particularly suitable for patients with mild-to-moderate laxity who are seeking non-surgical improvement in skin firmness and texture, either as standalone intervention or in combination with injectable therapies. Device selection should be guided by skin type, downtime tolerance, degree of laxity and risk of post-inflammatory hyperpigmentation (PIH).14-16 Protocols vary according to device and treatment indication, although multiple sessions spaced several weeks apart are commonly required to achieve progressive improvement. Combination approaches may be utilised depending on the dominant ageing mechanism and patient suitability.14-16 Contraindications may include active infection, impaired wound healing, recent isotretinoin use, pregnancy and certain inflammatory skin conditions. Potential adverse effects include erythema, oedema, discomfort, bruising and PIH, particularly in Fitzpatrick skin types IV-VI or where overly aggressive settings are used.14-16 Before

After

“Careful patient selection is essential, as overtreatment or inappropriate modality selection may worsen heaviness, irregularity or laxity” Lipolytic treatment was performed first to reduce submental and lower face adiposity prior to progressive collagen stimulation and tissue support. PLLA was selected over volumising HA filler because the patient demonstrated tissue laxity and lower-face heaviness rather than volume deficiency. A collagen-stimulating approach was therefore considered more appropriate. Improved jawline definition, reduced submental fullness and enhanced skin quality were observed. No complications were reported aside from expected transient tenderness and localised erythema following treatment. Standard aftercare included massage protocol guidance, avoidance of intense heat and exercise for 24 hours and monitoring for delayed inflammatory nodules. The patient was advised that maintenance treatment may be required approximately every 12-18 months depending on ageing progression and lifestyle factors. Treatment was undertaken with a staged approach to minimise adverse effects and allow progressive tissue response, in line with current recommendations for biostimulatory injectables.1,10

Integrating neck rejuvenation into holistic aesthetic planning Figure 1: 48-year-old female patient before and three months after a staged combination treatment with PB Serum and Sculptra.

Case study A 48-year-old female patient presented with concerns relating to lower face heaviness, reduced jawline definition and early neck laxity (Figure 1). Clinical assessment demonstrated mild-to-moderate skin laxity, submental fullness and volume redistribution within the jowl and buccal compartments. The patient had no significant medical contraindications, no previous neck surgery and realistic expectations regarding non-surgical treatment outcomes. Treatment plan PLLA treatment was performed using Sculptra reconstituted to 10ml per vial. One vial was administered per session across two sessions spaced six weeks apart, using a cannula technique. The treatment was delivered in the superficial subcutaneous plane to support gradual collagen stimulation and improve dermal support.1,10 Lipolytic treatment using PB Serum was also performed, targeting the buccal, jowl and submental fat compartments over two sessions, spaced two weeks apart.

Neck rejuvenation is an increasingly important component of aesthetic practice. Outcomes remain highly dependent on patient selection, anatomical understanding and a multi-modal treatment strategy.1,2,6 In advanced cases, surgical options may be more appropriate and should be discussed when non-surgical treatment is unlikely to meet the patient’s goals.1,4 Successful treatment requires a comprehensive approach considering the face and neck as a unified aesthetic unit. By assessing the dominant ageing mechanism, selecting appropriate modalities and sequencing treatments carefully, clinicians can improve safety, manage expectations and achieve more balanced, natural outcomes. Dr Rupert Critchley is a medical aesthetics practitioner, GP and clinical director of VIVA Skin Clinics in London and Kent, with more than 13 years of experience. He specialises in advanced injectable treatments with a particular focus on antiageing and regenerative aesthetics. He is also an educator through Viva Academy. Qual: MBBS, MRCGP

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The Power Stack Eleanor Hartley, MSc Clinical Dermatology, explains how to achieve structural excellence through integrated skincare Clinical objectives in medical aesthetics have fundamentally evolved. While neuromodulators remain the gold standard for dynamic lines, monotherapy often falls short of meeting modern demands for comprehensive skin rejuvenation. Today’s patients reject the over-treated, “frozen” look, demanding natural movement paired with exceptional skin quality. As clinicians, we must address a critical limitation: traditional muscle-relaxing injections cannot correct static surface imperfections, progressive pore elongation, or dermal laxity.

Advertorial SkinCeuticals

Patient response further confirms this value: in clinical selfassessments, 95% of participants observed that their overall skin quality was visibly improved, reporting skin that felt significantly smoother with a transparent, high-performance radiance.

From Protocol to Practice: The Hart Medical Real World Case Studies At Hart Medical, I conducted a split-face case series to see how this Power Pair performed when integrated with professional treatments. In my first study (a 65-year-old patient receiving upper-face BoNT-A, with no injections in the lower face or neck), P-TIOX Serum was applied across the full face — but P-TIOX Cream was added exclusively to the active side. The Serum alone delivered a strong foundation, but the addition of P-TIOX Cream amplified results significantly. Visible pore reduction was evident on the Cream treated side, alongside impressive instrumental data. By Week 8, neck elasticity improved by 34.4% (compared to 11.8% on the Serum only side), proving that the Cream, layered over the Serum, is the essential second step to maximise patient results.2 Baseline Day -14

VISIBLE RESULTS | LOWER THIRD *no BoNT administered in lower third of face

Week 4 post BoNT Week 6 topical regime

When skin lacks structural integrity, dynamic expressions quickly settle into permanent, static wrinkles. This requires a paradigm shift, moving away from isolated treatments toward an evidence based “Power Stack.” This dual-therapy methodology stacks in office clinical procedures directly with high-performance topicals to medically reinforce the skin’s architecture. In practice, we build this “Power Stack” by pairing in-clinic treatments with the daily, combined use of P-TIOX Serum and Cream. This integrated approach elevates the scientific standard of daily practice, providing the skin with the structural resilience required to handle constant facial movement and extend treatment outcomes without structural breakdown. P-TIOX Cream is the essential concluding step of this restorative stack.

The Blueprint of Resilience To achieve this level of composure, we must look beyond hydration to engineer structural resilience. P-TIOX Cream is powered by patent-pending technology featuring 10% Myrixin™ and a 2% Tripeptide complex. This peptide modulates the visible effects of muscle contraction, reinforcing the skin’s structural ability to handle expression lines without them settling into permanent, deep set static wrinkles. To deliver a high-functioning finish, the formula incorporates 1% Crystalide™ Micropeptide to optimise light reflection and translucency. This is paired with 5% Niacinamide plus LHA for deep pore correction, and Zinc PCA to normalise sebum. This is all delivered via Multi-layer Lamellar Technology, featuring Melting Micro-droplets that provide rapid, non greasy absorption.

Results shown at 6 weeks — with no BoNT administered in the lower third of the face, pore reduction is attributed solely to the P-TIOX topical regimen.

In my second study, a split-face evaluation of a 32-year-old male patient undergoing full-face microneedling, P-TIOX Cream was applied to the active side versus a Placebo Cream on the control.3 By Week 8, the Griffiths Global Photoaging Score improved by 31.7% on the active side compared to 25% on the placebo side, with superior barrier recovery and enhanced hydration further reinforcing the result - establishing P-TIOX Cream as an essential addition to any microneedling treatment plan.

Conclusion: The New Gold Standard Integrated Skincare represents the new frontier of aesthetic medicine. By merging procedural precision with the daily power of P-TIOX Cream — and elevating it further with P-TIOX Serum — we move beyond simply smoothing lines. We are reinforcing, amplifying and sustaining clinical results. A face that looks as structurally refined as the treatment behind it is no longer aspirational. With the P-TIOX Power Pair, it is the new gold standard. This advertorial was written and supplied by SkinCeuticals

Global Proof: The Evidence of High Performance The efficacy of this protocol is backed by clinical studies. While the underlying peptide technology is already validated in peer reviewed literature, the P-TIOX Cream finished formula has demonstrated remarkable standalone results. In 12 week clinical studies, the cream achieved statistically significant correction across the targeted zones, including up to a 21% reduction in crow’s feet, a 20% reduction in under-eye lines, and a 16% reduction in neck lines.1 Beyond line correction, the impact on skin quality was profound, with a 24% increase in smoothness and a 21% reduction in pore size (p < 0.001).

Scan to explore the full Hart Medical real-world case study results

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Complications Chin Augmentation

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Treating Vascular Occlusion in the Chin Dr Maisie Bishop, nurse practitioner Kelly Turner and Dr Jordan Faulkner examine the identification and treatment pathway for a vascular complication Chin augmentation with hyaluronic acid (HA) dermal filler is a popular non-surgical treatment used to improve the length, projection, contour and shape of the chin.¹ It can restore facial balance and harmony in patients with retrognathia, microgenia, asymmetry, cleft chin and those with age-related changes, including bony resorption of the mandible, soft tissue descent and volume loss.2,3 One of the most feared complications associated with HA filler is vascular occlusion (VO). There are encouraged steps to mitigate the risk of VO including in-depth knowledge of vascular anatomy, aspiration and placement of filler at specific anatomical depths.⁴ The chin has been widely regarded as one of the safer areas to inject.⁵ Herein we describe a case of VO in a patient with atypical anatomy of this region.

may form anastomoses with the lingual, deep lingual or sublingual arteries via perforating branches through the mylohyoid muscle, contributing to the vascular supply of intraoral structures.13 When determining the most appropriate injection technique for chin augmentation, the most clinically relevant vessel to consider is the terminal branch of the submental artery, known as the ascending mental artery.14 The ascending mental artery emerges from the submental area and crosses the mandibular margin approximately 6mm lateral to the midline, coursing at a depth of 2-6mm within the muscular plane, in a paramedian fashion.14 Facial a.

Facial a. Superior labial a.

Vascular anatomy of the chin The chin is a distinct anatomical region delineated superiorly by the labiomental groove, laterally by the labiomandibular grooves and inferiorly by the submental ligaments (Figure 1).6 It is characterised by a rich arterial plexus, formed from extensive anastomotic connections between the mental, submental, inferior labial and labiomental arteries.7 The main arterial blood supply to the chin is derived from the mental arteries. These vessels exit the mental foramina in the lateral chin at the second premolar, roughly along the midpupillary line.8 The mental arteries are terminal branches of the alveolar arteries, which themselves arise from the maxillary artery.7 The horizontal labiomental arteries may branch from either the facial artery or the inferior labial artery.7 They traverse between the depressor labii inferioris and the orbicularis oris muscles before emerging superficially to occupy a submucosal position in the lower lip.9 Similarly, the inferior labial artery, also arising from the facial artery, runs deep to the depressor anguli oris, then perforates the orbicularis oris muscle to reside within the submucosal plane along the vermillion border of the lower lip.10 The submental artery, the largest cervical branch of the facial artery, travels anteromedially after passing through the submandibular gland.11 It courses beneath the mandible along the surface of the mylohyoid muscle, crossing the mandible near the mandibular symphysis.12 Along its trajectory, the submental artery

Inferior labial a.

Facial a.

Inferior labial a.

Labiomental a. Transverse mental a.

Ascending mental a. Figure 1: Vascular anatomy of the chin.¹⁵

Implications for non-surgical intervention Given the paramedian, mid-depth nature of the ascending mental artery, it is generally considered low risk to use a needle to deposit boluses of filler onto the periosteum along the mid-line at the pogonion, gnathion and menton – typically an avascular plane.¹⁶ Conversely, when injecting in the paracentral region, the preferred tool is a 25G or larger bore cannula to avoid vascular injury to the ascending mental artery.¹⁷ Plastic surgeon Mr David Freytag et al., described placing filler deep onto bone using microcannula as the optimal technique.17

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Complications Chin Augmentation

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However, superficial placement of a high G-prime filler in the labiomental crease and at the apex of the chin has been described to achieve both projection and myomodulation.¹⁸ When blending the contour between the chin and jaw, the subcutaneous plane is considered lower risk along the mandible, as there are no major vessels subdermally or within the subcutaneous fat overlying the platysma.¹⁷ The arterial supply to the submandibular region, oral cavity, lip and lower chin is highly complex, marked by a dense network of anastomoses and significant variability in both vascular pattern and depth.⁸ Consequently, post-procedural assessment of skin perfusion should not be limited to the mentum alone, particularly when large volumes of filler are used. Clinicians must also evaluate the submandibular region and intraoral structures for ischemic changes, which may be suggestive of retrograde filler emboli through the interconnected vasculature.¹⁹ Although rare, this vulnerability has been demonstrated by multiple contemporary case reports and case series.1,20-23 It is not uncommon for grossly over-simplified graphics, such as that shown in Figure 2, to be used in teaching materials. Although they can help novice injectors appreciate relative risk of the nose/glabella compared to the mid-face, for example, these types of imagery do not reflect the reality that VO risk is dependent upon precise location, depth of injection, method of administration and many other factors.

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During treatment, injections should be slow, under low pressure and in small aliquots.²⁸ If an arterial occlusion were to occur, this would limit the amount of dermal filler that inadvertently enters the vessel, would limit potential retrograde flow and therefore minimise the potential extent of ischemic injury.²⁹ The application of digital pressure over arterial pathways may further impede the retrograde movement of filler.⁵

“The chin is a distinct anatomical region delineated superiorly by the labiomental groove, laterally by the labiomandibular grooves and inferiorly by the submental ligaments”

VERY HIGH

HIGH

MODERATE

LOW

Figure 2: A typical diagram demonstrating relative safety of HA filler injection in different areas of the face.⁵

It is also considered best practice to instruct patients to immediately report any altered sensation, pain or visual disturbance while injecting, indicating potential impending ischemia.⁴ Upon discharge, patients should be educated on the warning signs of a VO and be provided with a reliable means of contacting the practitioner should concerns arise. Clinicians must also remain vigilant to the possibility of complications involving adjacent vascular territories. The aforementioned case reports and series documented instances in which, in addition to classic signs of intra-arterial injection such as pallor, pain and livedo reticularis, patients also experienced impaired speech and dysphagia, suggesting more extensive involvement beyond the injection site.1,20-23,30

Case study Mitigating the risks of a vascular occlusion Even when adhering to recognised low-risk injection techniques, the risk of vascular occlusion cannot be entirely eliminated. Such techniques are based on expected anatomical norms. However, individual variation is well documented.²⁴ In this instance, ultrasound imaging revealed an atypical course of the ascending mental artery, located deep on the periosteum at the midline. As the risk of VO can never be fully removed, practitioners should therefore adopt every safety step at their disposal to create additional safeguards to mitigate against it. Ultrasound is potentially a useful tool to map the location of nearby vessels, but is dependent upon the knowledge and skill of the user.²⁵ Furthermore, portable ultrasounds typically used in medical aesthetics are expensive, and clinicians at the outset of their careers may not have the desire or financial means to procure such a device. Prior to treatment, clinicians are advised against the use of lidocaine with adrenaline as this may mask the blanching produced by the occlusion, and should avoid priming their needle with dermal filler to increase the likelihood of a positive aspirate on initial injection.26,27 46

A 29-year-old Caucasian female presented to clinic requesting chin augmentation. She was fit and well with no pre-existing medical history or regular medications except a known penicillin allergy. Previous non-surgical interventions were uncomplicated botulinum toxin to the upper face and masseters. She denied any previous surgical intervention or trauma to the face and had no contraindication to treatment. The patient had undergone an orthodontic assessment which described a class II malocclusion but she had decided not to proceed with orthodontic intervention. She wished instead to explore the option of HA filler as a less invasive option to address the appearance of retrognathia. After joint decision making with the patient and appropriate consent, we proceeded with non-surgical augmentation of the chin with the primary aim of improving anterior projection. In the first session, a total of 0.8ml of high G-prime HA filler was placed in the midline on the periosteum via 27G needle. Injections were placed at the pogonion and gnathion. Aspiration was performed before each injection, as a means to minimise VO risk, even though its reliability is debated.4 This treatment was uncomplicated with a satisfactory result.

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The patient returned 12 weeks post procedure seeking further projection. A repeat treatment was performed, with a higher viscosity filler, at the same anatomical points using the same technique. After a negative aspirate, an initial 0.2ml of filler was injected onto periosteum at the gnathion. At the second injection point, a positive aspirate occurred. No filler was injected and the needle was immediately withdrawn. Around 60 seconds after the original injection, the skin overlying the central portion of the chin became progressively pale and cool to touch. On assessment, capillary refill time (CRT) was over three seconds. Pallor began to spread superiorly and the patient was informed of diagnosis of a suspected vascular occlusion. Emergency management for VO protocol was initiated. Hot compress was applied while hyaluronidase was reconstituted. 1500iu of hyaluronidase was dissolved in 2ml normal saline. The whole 2ml solution was administered at the site of filler injection followed by further warm compress and firm massage. CRT remained over three seconds and so a further 1500iu of hyaluronidase was injected to the same site. On further assessment, capillary refill returned to less than two seconds indicative of re-established perfusion. Approximately 45 minutes later, moderate swelling and pallor developed and the case was discussed with a colleague. Consensus was reached to repeat hyaluronidase injection with the aim of removing doubt around incomplete resolution. Again, CRT returned below two seconds. The patient was sent home with clear instructions on how to respond to red flag symptoms – such as cyanosis, pallor or worsening pain – and planned follow-up organised for the next morning. After liaison with another colleague, we arranged follow-up at their clinic with the assistance of ultrasound assessment. The follow-up appointment existed to serve as a second pair of eyes and extra reassurance for the patient. Ultrasound was performed for academic reasons, rather than as a medical necessity at this point. Vascular assessment using the Clarius handheld, portable ultrasound scanner showed that the ascending mental artery was deep lying on the periosteum with a tortuous course, intermittently sitting at the midline. The chin remained well perfused and a small bruise had developed. No further intervention was required at this point. Clear aftercare advice was provided. Red flag symptoms were reiterated as previously discussed, and the patient was advised to contact the clinic if any signs of infection or herpetic lesions develop.

Access to a professional support network Collaborative management enhanced clinical problem-solving and allowed for the division of responsibilities. One clinician was able to focus on administering the high-dose pulsed hyaluronidase protocol, while the other ascertained potential anterograde and retrograde filler migration pathways, considered additional adjunctive therapies and could organise onward referral if necessary. Furthermore, access to a colleague with expertise in facial ultrasound was found to be highly beneficial. Given the complex nature of facial vascular anatomy and the potential for embolic migration of filler material beyond the initial injection site, areas of ischaemia may be extensive and continue to evolve over time.⁵ In such cases, ultrasound imaging enables real-time visualisation of the filler, allowing for targeted administration of smaller, more precise doses of hyaluronidase and to ensure complete resolution of the bolus.³¹ This approach not only enhances treatment accuracy, but also reduces patient discomfort and procedural trauma compared to the traditional reliance on clinical signs and the use of large, repeated volumes of hyaluronidase.⁵ As with all medical emergencies, clinicians who are inexperienced or uncertain should seek experienced peer guidance.⁴ In the absence of such support, membership with professional bodies such as the

Complications Chin Augmentation

Complications in Medical Aesthetics Collaborative, or the Aesthetic Complications Expert Group World is strongly recommended to access timely expert advice. Furthermore, practitioners should establish clear referral pathways to local specialists in advance, enabling rapid escalation of treatment if needed.³²

“Even when adhering to recognised low-risk injection techniques, the risk of vascular occlusion cannot be entirely eliminated” Understanding aesthetics complications VO is one of the greatest complication concerns for clinicians and patients alike, owing to the potential long-term sequelae of an unresolved event. This case demonstrates that, despite the implementation of all mitigating steps, a VO was not avoided. Anatomical variations mean that even complete anatomic knowledge does not entirely protect the clinician from the risk of causing an adverse vascular event.33 Pre-treatment vascular mapping with the use of ultrasound might have prevented the complication in this particular case, but ultrasound does not come without limitations.33,34 Induction and training can be a costly investment for clinicians, and efficacy is user- and device-dependent.33 More evidence is needed to support the use of ultrasound in reducing the rates of VO via pre-treatment vascular mapping or ultrasound-guided injections.33 Dr Maisie Bishop is a general practice specialty registrar and aesthetic practitioner with a diploma in aesthetic injectables. Actively practising within the NHS, she brings a strong foundation in evidence-based medicine to her aesthetic work. Her interests lie in holistic, patient-centred care, helping patients achieve natural results that enhance confidence, wellbeing and overall quality of life. Qual: BMBS, BSc, OTHM Level 7, DFSRH Kelly Turner is an aesthetic nurse practitioner and owner of Biológica Aesthetics Clinic in Marylebone, London. With a strong focus on patient safety, skin health and evidence-based practice, she adopts a holistic, patient-centred approach to medical aesthetics. Her work emphasises natural-looking results and tailored treatment plans that support long-term patient wellbeing. Qual: BN (Hons), PGDip, MSc Dr Jordan Faulkner is a cosmetic practitioner and the owner of Allo Aesthetics. He is the founder of Unite Aesthetics Initiative and holds faculty roles at DermaFocus, Interface Aesthetics and Revanesse. He is the co-owner of Myokine, and Dr Faulkner was crowned Rising Star of the Year at The Aesthetics Awards 2025 and Most Influential Speaker at ACE 2026. Qual: BMedSci, BMBS, PGDip(Aes)RH

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Advertorial Tor-Bac

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A D V E R T O R I A L

INTRODUCING TOR-BAC

Tor-bac as a 5ml SINGLE use ampoule is both easy to use and to transport between clinics. As a highquality product manufactured within a Medicines and Healthcare products Regulatory Agency (MHRA) approved facility within the UK, it is designed to maintain sterility and prevent bacterial growth in multidose settings3. A 5ml single dose Tor-Bac ampoule is favoured by practitioners for both its ease of use as a diluent with botox and other dry powder presentations for reconstitution. This single dose product provides the confidence in all practitioners who use Tor-Bac to know due to the high quality of manufacture, traceability. Its single-dose usage makes this a natural product safety feature as it negates any fear of cross contamination which cannot be said of any multi dose saline product on the market. Alison Stevenson Managing Director & Head of R&D at Tor-Bac explains why this single dose product has grown in sales year-on-year since it’s inception 2018 to the UK market Stevenson explains, “Practitioners offering injectable procedures are familiar with using bacteriostatic saline to reconstitute medicinal products for intramuscular or intradermal injection.” Tor-bac is a preserved bacteriostatic saline solution, containing both sodium chloride 9mg with 0.9% (9mg/ml) benzyl alcohol, which provides both bacteriostatic protection and reduced injection site pain, compared to ordinary saline1. Indeed, evidence supports that since 1928, there have been more than 60 studies which have reported in favour of bacteriostatic saline for significantly lower pain scores when there has been benzyl alcohol present in saline2.

INFLUENTIAL Women in Business 2025 Alison Stevenson TOR GENERICS

Further evidence supports the use of preserved saline (Tor-Bac), for periocular injections including botulinum toxin type A and local anaesthesia. The evidence for the lowered pain scores using bacteriostatic saline in delicate areas of skin around the eyes and eye lids also take this product into other areas of medicinal preparations which also cannot be overlooked, we have supported this sector and continue to see growth in it. This is also true in the male health sector, as well as continued growth in aesthetics usage generally4. An interesting fact about benzyl alcohol itself is that it is a naturally occurring aromatic alcohol, found in plants such as Jasmine and is also present in foods and cosmetics. It has both anaesthetic and bacteriostatic qualities, contributing to its’ effectiveness in reducing pain and maintaining sterility during injectable procedures. Aesthetic nurse prescribers feedback has been very positive over the years since we introduced Tor-Bac, stating, “Since a single patient treatment rarely requires more than 5ml of saline to reconstitute a single vial of toxin, either practitioners of wasting 5ml or 25ml or they are in breach of regulations by reusing multi dose vial on multiple patients. As such Tor-Bac SINGLE dose offers a valuable solution!”

Please visit www.tor-generics.com or scan the QR Code to find out more about Tor-Bac and other high grade aesthetic products. To find out more, get in touch with: Tor Generics: 07785 311873 tor.genericsltd@btconnect.com

REFERENCES 1.

J Aesthet Nurs. 2012;1:(5)246-249

2.

Samantah vicki Hunt MPCID: PMC8749351 PMID:35017698

3.

PMCID: PMC10217790 PMID 36839885

4.

REF Eye The scientific Journal of the Royal College of London Eye (lond) 2022 Jan 11 Samantah vicki Hunt MPCID: PMC8749351 PMID:35017698

This advertorial was written and supplied by Tor Generics.

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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 providers educate themselves most frequently via social media i.e. Instagram and TikTok

· High volume accounts on social media aka. influencers do not necessarily have a large scientific portfolio

· The number of followers on social media does not correlate with the scientific output questioning the validity of advice receiving from social media influencers

Title: The Role of Social Media in Aesthetic Medicine Education - A Global Analysis of Publication Habits and Scientific Impact

Authors: Giovanni Buzzaccarini, et al. Published: Journal of Cosmetic Dermatology Keywords: Social media, Education, Medical aesthetics The New York Times reported in May 2026 about a new social media investigation conducted by the Pew Research Center. The title of that study was: Moms, Coaches, Doctors, Entrepreneurs: Who are America’s Health and Wellness Influencers? and it investigated who the health and wellness influencers in the USA are and what the educational behavior in the USA currently is. The study revealed that 50% of adults under the age of 50 get their information from health and wellness influencers. Of those influencers, only 3% were researchers in the medical field; the rest were coaches, entrepreneurs, authors, athletes, activists, and some kind of health professionals incl. dieticians, nutritionists or mental health care workers. In addition to this investigation, an international group of researchers lead by Giovanni Buzzaccarini from Italy, conducted a simple but very profound investigation: They investigated 901 social media accounts from health care professionals in the aesthetic field, which had a running and active aesthetic medical

practice. The used publicly available data from Instagram, TikTok, Pubmed, and Google Scholar to perform a unique correlation analysis: does the number of followers on social media correlate with the number of scientific publications or with the H-Index. (the H-index is a complicated parameter to measure the scientific relevance of each researcher; the higher the better; a department chair has a mean H-index of 20 for reference). The results of that study showed that the highest number of scientific manuscripts indexed in the Pubmed database was published by physicians (12.3), followed by dentists (2.8) and nurses (0). Of the 901 investigated social media accounts 659 (73.1%) had zero scientific publication indicating that the majority of social media influencers in the aesthetic medical field did not publish or conduct medical research. The bivariate correlation supported this trend and showed no statistically significant correlation between number of followers and number of scientific publications of the magnitude of their H-index for both Instagram (rp = 0. 013 with p = 0.695) and for TikTok (rp = 0. 009 with p = 0.849). This low correlation coefficient indicates that the number of followers on social media which would indicate a certain degree of importance and relevance to the aesthetic medical field, does not originate from their scientific output. It would rather indicate that their popularity is the result from other factors like great drawing skills, or unique dancing moves, or from other eye-catching social medial expressiveness; anything else but from scientific work. This raises the questions whether such social media influencers are reliable sources for medical education and should be trusted for medial advice? Of course, someone can have a good advice and not publish scientifically…like grandmas when they provide advice about how to dress or what to eat when the tummy is upset. There is always truth in everything but in the days of scientific progress especially of a new medical field like medical aesthetics, every new direction should be based on science and evidence-based rigor and not on who has the best dancing moves. We are at the beginning of medical aesthetics and the future is bright. This abstract was supplied in partnership with Cotofana Academy.

Aesthetics top picks · Title: Biostimulatory Injectables for Collagen Stimulation. Author: Michael T Somenek. Published: Facial Plastic Surgery · Title: Evaluating the Use of High-Intensity Non-Focused Ultrasound Treatment to Improve Skin Laxity and Facial Wrinkles in Asian Patients. Authors: Martin M H Chung, et al. Published: Lasers in Surgery and Medicine. · Title: Aesthetic Concerns and Nonsurgical Treatment Trends in Patients With GLP-1 Agonist-Associated Weight Loss. Authors: Sabrina Fabi, et al. Published: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery.

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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

Explore the products at CCR 2026:

Headline Sponsor

#

3D Aesthetics

Genefill UK

Novus Medical UK

A

Acclaro Corporation

GLANZEN

Novasonix

ACE Group World

H

Acmedi Korea Co.,Ltd

Hanun Medical

Acquisition Aesthetics

Harley Academy

ACRE Pharmacy

Hawksley & Sons

Aerolase

Amory London Ltd

Hydrafacial

Aura Reality

HYPO21

Beautology Laser & IPL Services Ltd

HYUNDAE MEDITECH CO., LTD.

Rein PRP

Ibita (Korea-International Beauty Industry Trade Association)

RELIFE UK

I

iiaa International Academy of Advanced Facial Aesthetics (IAAFA)

British Association of Medical Aesthetic Nurses (BAMAN)

Interface Aesthetics

CACI International

IVANMED

Caromed Italia srl

J

ClearCourse Health Cliona Tech Ltd Core Connect Accountants Cosmetic Courses

Skinzo Ltd Skymedic Sofwave Medical UK Limited Sons SOOVIA CARE LTD T

The Cosmetic Consultants The Nutrition Collective

Lavderma Limited

Toneko Ltd

Libera

Totally Derma

LW Aesthetic Solutions Ltd

TWIQK

M

Lynton Lasers Ltd

U

Uberlube

MAP Health Ltd

V

VF PHOTONIX UK LTD Vida Glow

Map My Mole

Visionmed Ltd

Med&Skin SRL

Derma Institute Dermapenworld Dotolo Europe Ltd

Medicines & Healthcare products Regulatory Agency (MHRA)

W

MedivaPharma

Z

Menopause in Practice

EMA Aesthetics Ltd Energist Ltd

Million Dollar Facial

EQUILABO LONDON LTD

My Compliance Clinic My Vital Metrics

EVIE KOREA Co., Ltd.

GC Wellbeing

Skin on You Ltd

L

Deleo

Galderma (UK) Ltd

Shire Leasing PLC

Klira Pro

Cutera

Fotona UK

Share Swiss

K

CTN CURENEX

Sciton, Inc. Seriderm UK

JJ Meditec

JY Medicine Co,. Ltd

Cosmetic Insure Cure Medical Limited

Roseway Labs S

Joint Council Cosmetic Practitioners (JCCP)

CellPRP

REGEN LAB SA

Renaissance

InMode

BTL Aesthetics

QUAD UK Quarter Latin

R

Initial Medical

British College of Aesthetic Medicine (BCAM)

Candela (U.K.) Ltd

PRP PURE LTD Q

IBSA UK

BNV Biolab

G

Phorest PromoItalia UK

Human Health Professionals

BioHA Laboratory

F

Pabau

Alma Lasers UK Ltd.

Belle Health Ltd

E

Opatra P

Healthxchange

Beautyform Medical

D

One Planet

Alfa Medical

BEAUTYEUROPE.EU CO UK Ltd

C

O

HE Interiors

Aesthetic Web

B

Nuchido

Halo Health Technologies Ltd - T/A Halo IV

N

NEEDLE CONCEPT Nicoya Ninaveli London

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

Wild Nutrition Ltd WOW FACIAL LTD Zemits UK Ltd Zenoti ZO Skin Health

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Retail Sales Strategies

For aesthetic clinics, developing revenue streams that are not directly dependent on practitioner time is increasingly important for long-term resilience. As injectable treatment margins face pressure from rising product costs and competitive pricing, retail sales can provide a valuable source of stable, recurring income. A well-developed retail portfolio, whether offered in-clinic, online or through a third-party provider, typically delivers significantly higher margins than clinical services. Retail skincare products can generate margins of 55-80%, compared with 5-20% for labour-intensive clinical treatments.14 Beyond improving profitability, retail sales help clinics diversify income, reduce reliance on repeat procedures and maintain patient engagement between appointments, strengthening loyalty and supporting sustainable business growth. Improving treatment outcomes

Retailing Skincare For Clinic Growth Dr Kam Lally, skincare retailer co-owner Paul Thompson and chemical engineer Cigdem Kemal Yilmaz outline a strong retail strategy for clinic growth A total of 7.7 million people had an aesthetic treatment in the UK in the past 12 months, with a further 13.9 million considering treatment within the next 12 months.1 Although the UK aesthetics sector remains predominantly treatment-driven (with data suggesting injectables account for as much as 65% of total clinic revenue), retail represents a significant yet underexploited growth area.2-4 The UK professional skincare market is valued at around £1.2 billion and is growing, driven by increasing demand for high-quality, effective and professional-grade products.5 One study involving 13,377 individuals found that patients who purchased skincare products generated more revenue from both non-surgical and surgical treatments over time – in comparison to those who did not, suggesting skincare as an important adjunct to the clinic offering.6 Other data indicates that repeat patients spend up to 67% more than first-time buyers and are substantially more likely to return following tailored product recommendations, reinforcing the role of retail in driving long-term clinic loyalty.7-10 Despite these statistics, many practitioners continue to overlook this critical component of sustainable clinic growth, limiting their ability to increase profitability and scale up their business globally.

Why retail matters in aesthetics There are several elements to why retail within aesthetics, including a diverse portfolio, a structured post-treatment plan and strengthening patient trust and results. Diversifying revenue streams in a competitive market There is no single register of aesthetic practitioners in the UK, making it difficult to determine the exact size of the sector. However, Care Quality Commission data indicates that 6,117 registered clinics currently offer aesthetic procedures, while the British College of Aesthetic Medicine estimates there are around 25,000 aesthetic providers operating nationwide.11-13

A strong retail strategy extends beyond financial performance and plays a key role in clinical safety and treatment efficacy. When integrated appropriately, ethical retail can support post-procedure recovery, with evidence suggesting that suitable topical skincare can reduce adverse events, minimise downtime and improve overall treatment outcomes.15,16 However, in the absence of widely established best-practice guidelines for combining aesthetic devices with topical products, practitioners are responsible for developing their own personalised post-treatment protocols based on the safest and most effective ingredient choices for skin health.17 A structured retail approach, supported by scientifically supported skincare and a thorough consultation process, enables practitioners to build more comprehensive, evidence-based treatment plans. This can enhance patient trust, encourage adherence and support longer-term practitioner-patient relationships rather than one-off interventions. Ensuring patients follow appropriate skincare as part of their treatment pathway also helps maintain clinical results and meet expectations through continued care. In addition, clinics may benefit from partnering with third-party retail providers to expand product access. This can offer patients a broader range of clinical-grade options across different budgets while reducing inventory and capital costs, and supporting wider reach and operational flexibility. Increasing patient lifetime value and visit frequency Understanding patient lifetime value (LTV) or customer lifetime value (CLV) is a key metric when developing a retail strategy. It refers to the estimated total revenue a business can expect from a single patient over the full course of the relationship.18 It also helps assess how effectively treatment offerings are meeting patient needs and highlights gaps in service provision, providing a clearer view of long-term business health.19 In aesthetic practice, average LTV is difficult to define due to variations in treatments, retail mix and patient demographics, although some reports estimate a range of £3,000-£5,000 over two years, or around eight to 12 times a patient’s first transaction.20 Evidence also suggests a relationship between retail purchasing and visit frequency, with patients who buy two retail products showing a 60% likelihood of returning, compared with 10% for those who buy none.21 Integrating skincare retail into the patient journey therefore creates more frequent touchpoints between treatments, supporting engagement and retention. Structured aftercare, replenishment reminders and subscription models can further reinforce purchasing behaviour, positioning retail not just as an additional revenue stream, but as a core retention strategy that supports long-term clinic sustainability and consistent income.

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Retail Sales Strategies

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Strengthening brand authority and patient trust

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· Overcomplicating product ranges: Clinics often attempt to

Specialist guidance matters to patients. One report found that out of 225 individuals, 60% were more likely to try a product recommended by a professional, while 52% trusted products purchased in a professional setting because they were “approved by experts.” A further 51% said they were more likely to remain loyal to products bought in this environment.22 Personalisation has also shifted from a trend to an expectation, with 61% out of 2,000 beauty patients preferring products tailored to their skin type.23 When delivered by an aesthetic practitioner in a clinical setting, skincare retail becomes an extension of clinical care – enhancing transparency, building trust and reinforcing high standards of safety and patient care.

“The clinics that perform best are those that integrate retail seamlessly into their treatment philosophy – where every product recommendation is intentional, evidence-based and aligned with the patient’s individual journey” Common retail mistakes in clinics Despite its importance, many clinics struggle to see a meaningful return on their retail investment. These failures typically stem from the following common mistakes.24

· Passive product displays without team engagement: One

of the most consistently missed opportunities in aesthetic practice is the passive approach to retail. Products are often displayed well, but without meaningful team engagement or integration into the patient journey, they become decorative rather than functional. · Focusing on sales over patient need: Another key error is the assumption that product recommendation equates to ‘selling.’ In reality, failure to recommend appropriate skincare (particularly in pre- and post-procedural settings) can compromise outcomes, delay recovery and reduce treatment efficacy. Retail should therefore be reframed as an extension of clinical care rather than a commercial add-on. 52

Aesthetics

cater to full brand portfolios, price points and trends, resulting in diluted messaging, staff confusion, inventory management issues and information overload for patients. A crowded shelf rarely converts, a curated one does. · Lack of staff training and confidence in recommendations: Lack of team alignment is a critical barrier. If practitioners and front-of-house teams are not confident in product rationale, usage and outcomes, retail becomes inconsistent and opportunistic rather than structured and repeatable. · Failing to recognise financial inclusivity: The inability to cater to diverse patient budgets, often leading to lost sales and fractured trust. Building a financially tiered product portfolio that aligns with a patient’s financial comfort, ensures accessibility without compromising efficacy. By respecting potential patient budget constraints, clinics can significantly improve the likelihood of product purchase, turning potential lost sales into tangible revenue. It also fosters financial inclusivity, ensuring that every patient, regardless of their budget, can access a personalised, scientifically supported skincare routine, that deepens trust and expands the clinic's patient base.

How to formulate a retail strategy An effective retail strategy begins with clarity of identity. Clinics must define their positioning and ensure that product selection reflects this consistently. Misalignment between brand positioning and product offering creates cognitive dissonance for patients and weakens trust.24 Curation is essential to avoiding any potential misalignment. A tightly monitored, evidence-based portfolio outperforms a broad, trend-led selection. Products should be chosen based on mechanism of action, clinical compatibility with in-clinic treatments and patient compliance – not solely brand recognition or margin.25-28 The long-term commercial resilience of each product and brand should also be taken into account and researched thoroughly by the practitioner prior to onboarding using the same principles used when researching credible, safe and effective treatments. Caution should also be adopted when choosing brands so that over-dependence on a single brand can be avoided. Reliance on a single brand could expose the clinic to risks that could adversely affect treatment continuity, profitability and patient trust. This can include pricing fluctuations, formulation changes, supply-chain issues and changes in distribution. Additionally, retail should be embedded into the clinical pathway. Recommendations should be protocol-driven rather than discretionary. For example, standardised pre-conditioning and post-treatment regimens that are linked to specific procedures. This removes variability and reinforces clinical credibility.29-32 Data utilisation is often under-leveraged. Clinics should routinely track conversion rates (consultation to product purchase), average transaction value, repeat purchase intervals and product lifecycle and ‘hero’ products that almost sell themselves. These metrics allow clinics to move from assumption-based decisions to evidence-informed retail optimisation, identifying both gaps and high-performing products.33-36 Many clinic management software systems now include sophisticated retail analytics tools that automatically generate sales data at both patient and practitioner level. This is the most time and resource efficient approach, although the process can be emulated manually, by the implementation of structured patient follow up processes, a re-order reminder system, implementation of treatment-linked retail protocols and quarterly inventory checks.

Aesthetics | July 2026

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“Recommendations should be protocol-driven rather than discretionary” Operational considerations Operational discipline underpins successful retail integration. Inventory management should balance availability with efficiency. Over-ordering ties up capital and risks product expiry, while understocking disrupts continuity of care and can result in missed sales opportunities. Inventory ordering is typically based on forecasted demand, with consideration given to historical sales data, seasonality, promotional activity, patient bookings, supplier lead times, and a buffer for unexpected demand. Stock is then replenished when it reaches a pre-determined threshold. Clinics using management software often benefit from automated inventory systems that use historical data and AI-driven forecasting to predict stock requirements. For those managing inventory manually or with limited storage capacity, outsourcing stock management to a third-party provider may be a practical alternative. Strong supplier relationships are equally important. This is not just from a pricing perspective, but for education, training support and exclusive access to pipeline.37-40 Budgeting should be approached strategically rather than reactively. Investment in fewer, high-performing products, supported by team training and patient education, typically yields greater returns than broad, underutilised stock. Clinics should also account for hidden costs, including staff training time, storage and potential wastage.49-52 A collaborative approach based on consistent and transparent communication, commercial expectations and long-term strategic alignment will help practitioners negotiate favourable commercial terms and clinical support.

Retail Sales Strategies

framework is essential to ensure compliance with professional standards and to protect patient trust. Guidance from the General Medical Council and the Nursing and Midwifery Council requires that patient welfare remains the primary consideration, with financial or commercial interests not influencing clinical judgement.58,59 The Advertising Standards Authority reinforces the need for accurate product representation.60 Ethical restraint in sales practices ensures retail supports clinical outcomes rather than commercial targets, strengthening long-term patient confidence and adherence to treatment plans.61,62 An ethical framework, such as Cleanse Protect Treat, prioritises essential and minimalistic skincare routines, starting with the core pillars of skin health and only adding complexity as the patient’s skin and commitment level allow. 63-66 The consultation process is a key element of an effective retail strategy in medical aesthetics because it functions as the primary point of clinical assessment, trust-building and evidence-based product recommendation. Research shows that recommendations made within a trusted clinical consultation significantly improve patient adherence and purchasing decisions, particularly when they are framed as part of a treatment pathway rather than a standalone sale. Consultation quality also directly influences perceived credibility and long-term loyalty, with structured, personalised advice increasing both compliance and satisfaction. In medical aesthetics, this aligns retail behaviour with clinical governance by ensuring product selection is need-led, standardised and ethically justified.67-71

Effective retailing In summary, integrating a retail strategy into medical aesthetics clinics is most effective when positioned as a clinically integrated, ethically governed component of patient care rather than a standalone commercial activity. Evidence shows that structured, evidence-based skincare retail enhances treatment outcomes, improves protocol adherence and strengthens long-term patient retention when partnered with consultation-led, protocol-driven pathways.

Incentivisation requires careful handling. While financial incentives can drive engagement, they must be structured in a way that protects clinical integrity. Overemphasis on sales targets risks eroding patient trust. Instead, incentives should align with patient outcomes, education and adherence to treatment protocols.

Financially, retail provides a high-margin, scalable revenue stream that supports clinic resilience in a competitive market, while also increasing CLV. However, its success is dependent on operational discipline and ethical governance, ensuring patient-first principles, transparency and minimalistic, evidence-led prescribing remain central to all retail decisions.

Realistic targets should be data driven and be based on current patient demand, historical sales performance, clinic capacity, conversion rates and growth objectives. Targets should be ambitious enough to drive growth, but achievable within the constraints of clinic capacity and local demand. Growth will vary between clinics, but regular review of data should take place to ensure that decision making is evidence based.41-44

Dr Kam Lally is an Oxford university-trained GP, medical director of Aestheticology Clinics, global key opinion leader across aesthetic modalities and medical aesthetics medicine lead for the Royal College of General Practitioners. He advises brands and organisations on clinical education, product positioning, protocol development and evidence-informed practice, with a focus on raising standards and improving outcomes.

Merchandising and clinic experience design are often under-estimated. Product placement should be intentional i.e. integrated into consultation rooms, treatment pathways and post-care discussions, rather than confined to a static retail area. The most effective clinics create a seamless transition from diagnosis to treatment to homecare where product use feels like a natural continuation of care.45-48 Ultimately, retail in aesthetics should not be viewed as a revenue stream alone, but as a clinical responsibility. The clinics that perform best are those that integrate retail seamlessly into their treatment philosophy – where every product recommendation is intentional, evidence-based and aligned with the patient’s individual journey.53-57

The ethical framework In UK medical aesthetics clinics, maintaining an ethical retail

Paul Thompson is a business leader and co-owner of Face the Future, a UK-based online skincare retailer known for its expert-led, and education first approach. With a background in business, holding both a degree and a masters, he plays a key role in shaping the company’s strategy and growth. Cigdem Kemal Yilmaz is a chemical engineer, skincare scientist, consultant and founder of Skin Masterclass, a CPD-certified skincare education and consultation platform for skin practitioners. With more than 15 years of experience across formulation, manufacturing, education and consultation, she supports practitioners in growing their skincare business.

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Social Media Practitioner Confidence

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Considering the Concept of the Social Media Confidence Trap Aesthetics business coach Fiona Macaskill examines how practitioners can rebuild confidence and create profitable businesses through data driven decision making Social media is now central to the aesthetics landscape. For many clinicians, it is the primary bridge between their practice and potential patients. Social media platforms, such as Meta and TikTok, have levelled the playing field, allowing independent practitioners to compete with larger, more established businesses through authenticity and relatability. This is largely because these platforms favour short-form, informal content – clinicians speaking directly to camera, explaining treatment decisions and showing real patient journeys. Patients are no longer just assessing outcomes, but the practitioner themselves – how they think, communicate and whether they feel trustworthy. Yet visibility is not the same as stability.1 In the rush for digital success, many aesthetic businesses begin to equate high engagement with commercial resilience, assuming likes or followers reflect patient loyalty and long-term financial health. This misperception is the confidence trap, when digital validation, quick and measurable, begins to outweigh genuine business performance as the foundation of confidence. This article explores how aesthetic practitioners can build stronger, more confident businesses by focusing less on social media validation and more on the numbers, systems and patient experience that drive sustainable growth.

The confidence trap in practicality The confidence trap develops when online performance becomes the primary measure of business success. A practitioner may begin to feel confident when engagement is high and discouraged when it falls, regardless of what is actually happening within the clinic. This can influence business decisions, leading clinicians to prioritise content creation, trending treatments or online visibility over patient retention, consultation quality and operational improvements. In practice, a clinic may experience record engagement on social media while consultation bookings, treatment uptake and repeat appointments remain unchanged. Over time, confidence becomes linked to digital validation rather than the metrics that genuinely drive sustainable growth.

From vanity metrics to business metrics In reality, some of the busiest and most commercially successful practices often have relatively modest social media platforms, but excellent consultation processes, strong retention and highly loyal patient bases. Clinics should therefore be reviewing business metrics alongside their online activity to understand whether visibility is genuinely converting into sustainable growth. At a minimum, a simple weekly dashboard should include:

· Follower growth vs. consultation bookings: Are new followers turning into consultations and paying patients, or simply passive engagement?

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· Engagement vs. enquiry conversion: How many people who

message or enquire go on to book? Formula: Consultations booked ÷ enquiries received. · Content reach vs. local demand: A post reaching 100,000 people nationally may generate less revenue than a locally targeted post reaching 2,000 people within the right demographic and location. · New followers vs. repeat patient revenue: A growing audience does not always reflect patient loyalty or business stability. Formula: Repeat patient revenue ÷ total monthly revenue.

· Viral posts vs. profitability: High-performing content does not

always attract the right patients. Clinics should assess which treatments, campaigns or platforms are producing profitable, retained patients rather than short-term attention. While ‘good’ will vary between clinics and there is no universal benchmark, healthy growth is typically reflected by strong consultation conversion, repeat business and increasing patient value over time, rather than follower growth alone. This is because performance can vary significantly depending on factors such as clinic maturity, treatment focus, lead source and business model. The goal is not to compare your numbers with those of other clinics, but to ensure your own figures are moving in the right direction. Tracking these key performance indicators (KPIs) alongside social media analytics gives a far clearer picture of business health than engagement metrics alone.

Social media as an asset not a strategy Social media enables patient education, democratises access to credible information and provides a low-cost means of showcasing expertise.1 Well-curated content supports transparency, disrupts misinformation and helps normalise conversations around aesthetic treatments. However, marketing metrics, such as follower counts, post reach or engagement percentages, should not replace true commercial indicators.4 High engagement does not necessarily reflect commercial health. At a minimum, clinics should be prioritising the following as part of their business strategy:

· Enquiry-to-consultation conversion rate: This measures how

effectively enquiries are being handled and whether potential patients are moving into booked consultations. Low conversion rates can indicate issues with response times, consultation confidence, lead quality or follow-up systems. · Rebooking rate: A strong rebooking rate often reflects patient trust, satisfaction and treatment planning. Clinics with higher retention typically create more stable revenue and are less reliant on constantly attracting new patients. · Average revenue per patient: This helps practitioners understand the true value of each patient relationship rather than simply focusing on appointment numbers. Increasing average patient spend often comes from stronger consultations, treatment planning and patient experience rather than more aggressive marketing. · Treatment profitability: Not all popular treatments are commercially beneficial. Clinics should understand the actual profitability of treatments after factoring in product costs, clinician time, overheads and follow-up requirements. · Percentage of revenue from repeat patients: A high percentage of repeat revenue usually indicates stronger patient loyalty and a more sustainable business model. Heavy reliance on new patient acquisition can create instability, particularly when marketing performance fluctuates. Don’t rely on constantly chasing new patients or viral visibility, especially if enquiries remain vague, non-local, heavily price-led or fail to convert into consultation. This probably means they

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are nowhere near the buying stage, just in the ‘scrolling’ stage. Your content is generating attention, rather than genuine buying intent. Content focused on patient concerns, treatment decisions, realistic outcomes and consultation conversations is often more effective at attracting prospective patients who are actively considering treatment.

Fix your infrastructure before you chase visibility Visibility often highlights weaknesses. A post can double enquiry volume overnight, but if the underlying systems are undeveloped, the effect can be destabilising.⁵ In practice, a large quantity of lower quality leads from non-local sources often means slower response times for meaningful leads, lower consultation conversion, increased no-shows and staff hours wasted. Strong infrastructure includes clear local positioning, defined treatment messaging, efficient enquiry handling, robust consultation processes, deposit policies, follow-up systems and consistent patient communication. Alongside a clear understanding of where enquiries are coming from and how they convert into paying patients. This local positioning often involves becoming known for a particular treatment approach, patient demographic or outcome within a specific geographical area, guided by the treatments patients enquire about most, the services that convert most consistently and the types of patients the clinic is best placed to serve. Without these foundations, increased visibility can quickly become overwhelming rather than commercially beneficial. A clinic might experience an influx of enquiries yet fail to convert if the marketing reaches the wrong audience or consultations are not handled confidently. Over time, this can negatively impact practitioner confidence, creating the perception that marketing is not working, when in reality the issue often lies in conversion systems, patient targeting or consultation processes. Instead of improving these conversion mechanics, many clinicians double down on producing more content. However, the most efficient clinics align marketing exposure with operational readiness. Before increasing visibility, they test how quickly enquiries are responded to, if consultations convert consistently, if follow-up systems are working effectively and whether their marketing is attracting the suitable of patients within their local area. Automated responses, structured enquiry processes and clear consultation pathways can help ensure potential patients receive effective communication, even during busy clinical periods. For clinics receiving high numbers of non-local or low-intent enquiries through social media, filtering processes become increasingly important. Simple measures such as enquiry forms, location-based questions, deposit requirements and clear treatment information can help identify patients who are genuinely considering treatment. Combined with locally targeted messaging, such as location-specific treatment content, local patient stories and community collaborations, this can improve lead quality and reduce time spent managing enquiries unlikely to convert.

Build stable lead sources beyond the algorithm Social media should be one layer of marketing, not the entire strategy. Clinics that rely solely on algorithm-driven visibility often experience fluctuations in enquiries, inconsistent bookings and unnecessary pressure to constantly create content simply to maintain momentum. More stable clinics typically build multiple lead sources that continue working even when social media engagement drops. This includes strengthening local search visibility through an optimised Google Business Profile, consistent patient reviews and website content targeting location-specific treatment searches, alongside building email databases. Creating collaborations with complementary businesses and professionals, such as dentists,

Social Media Practitioner Confidence

pharmacies, women’s health practitioners, all increase your exposure in the local community and therefore ensure you are targeting your geographic area. Practical actions clinics can take include updating their Google Business Profile weekly with new images, treatment updates, patient reviews and business posts. They should also be requesting reviews consistently, reactivating previous patients through email or SMS campaigns, improving website treatment pages for local search terms that prospective patients are actively searching for and introducing simple referral pathways for existing patients. Clinics should also assess where their best patients are already coming from. In many cases, retained patients, referrals and Google-based searches produce higher quality consultations than viral social media content alone. A more balanced marketing strategy not only creates stronger commercial stability but also reduces the pressure many practitioners feel to constantly perform online.

Align your content identity with your clinical identity Aesthetic practitioners build their careers on medical ethics, patient trust and treatment outcomes. Yet the constant demand for content can influence priorities and decision-making over time. When content identity diverges from clinical identity, two risks emerge. The first is reputational confusion, where patients begin to perceive a clinic as specialising in whatever it posts most frequently, regardless of the practitioner’s true expertise or preferred patient demographic. The second is clinical drift, a gradual bias towards treatments that perform well online rather than those most aligned with the clinic’s long-term strategy or patient needs. Over time, this can negatively affect practitioner confidence, particularly if clinicians begin feeling pressured to follow trends that do not reflect their clinical strengths or values. A simple way to avoid this is to regularly assess whether content reflects what the clinic genuinely wants to be known for clinically and commercially, then remain consistent with that positioning over time. Instead of constantly chasing trending content designed purely for engagement, clinics may build stronger trust and more suitable patient demand through educational content around consultations, skin health, treatment planning, regenerative approaches or realistic outcomes. Maintaining alignment between digital persona and clinical ethos is not simply a branding exercise — it is a matter of professional ethics and regulatory compliance.⁹

Reconsidering the reference point Ultimately, social media should support a clinic’s growth, not define its success. Sustainable businesses are built on patient loyalty, profitability and operational clarity, ensuring practitioners develop not only a visible brand, but a resilient and commercially stable practice. Fiona Macaskill is an aesthetics business strategist and coach with more than 25 years’ commercial experience spanning media, entrepreneurship and the medical aesthetics sector. Her background includes work as a television producer and director, alongside business ownership, consultancy and senior commercial leadership within the aesthetics specialty. She works closely with medically-led clinics and advanced skin professionals on business strategy, systems, marketing and patient growth.

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Business Costs Treatment Pricing

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Tackling the Task of Increasing Prices Business coach Alan Adams explains how UK clinics can price calmly, ethically and sustainably With ongoing cost-of-living pressures, rising business rates and increased patient scrutiny, many clinic owners feel stuck between the fear of losing patients, and the realities of running an increasingly expensive medical business.1 Business costs are increasing across various fields, and with an overwhelming majority of aesthetic businesses being small and medium-sized enterprises (SMEs) or sole traders, they’re even more highly sensitive to cost increases such as rent, insurance, consumables and energy.2 Pricing decisions are then often anchored to the wrong reference points – competitor fees, local averages or what they assume patients will tolerate. Confident, strategic pricing does not start with numbers; it starts with vision. Clarity on where you want the business to be in three to five years allows you to work backwards, defining the pricing, positioning and operational changes required today to reach those goals.

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2.

Overheads – rent, utilities, energy, insurance, marketing and staff

3.

Regulation and compliance – professional memberships, training, CPD and insurance

4.

Owner – owner’s salary, pension contributions, tax liabilities, reinvestment and profit margins

Tightening regulations in the UK aesthetics sector, including new licensing requirements and increased scrutiny of non-surgical procedures, adds both operational cost and responsibility.3 Pricing that accounts for these requirements is not just fair, but it signals to patients that you take your professional obligations seriously.

Pricing as a reflection of clinical value Pricing sends a powerful psychological signal. If pricing is too low, you don’t attract value-led patients, you attract price-driven ones. In medical aesthetics, where patients often have limited ability to assess clinical quality before treatment and outcomes are highly visible, price may therefore function as an important proxy for perceptions of competence, safety and professional standards.4 In a high-trust, high-stakes field such as aesthetics, fees must be sufficient to support safe, high-quality patient care. When prices are set too low, clinics may come under pressure to compensate elsewhere, whether through shorter consultation times, reduced follow-up care, inappropriate delegation of clinical tasks, or the use of lower-cost products and consumables. While these measures may help maintain profitability in the short term, they can compromise patient experience, clinical standards and patient safety.

This article will delve into how practitioners can understand the true costs of their businesses and begin building an ethical pricing model with confidence.

Sustainable pricing enables clinics to invest in the elements that underpin good practice, including practitioner training, regulatory compliance, appropriate staffing levels, quality products and adequate time for patient assessment and aftercare.

Understanding the true costs

Confidence in your pricing helps attract patients who value your expertise, understand the rationale behind your fees and are committed to a long-term, trust-based therapeutic relationship. Ultimately, this alignment between price, value and standards of care benefits both patients and the business.

Before you can price with confidence, you need an honest picture of your costs. This includes going beyond products and rent, and including all of the associated costs of running your business and keeping your doors open. This means including the value of your time, your clinical commitments, your indemnity insurance, your Continuing Professional Development (CPD), your regulatory compliance and the physical and emotional labour of delivering safe, excellent outcomes. A good place to start is to start breaking down all the costs under these four categories: 1.

Direct treatments – injectables, skincare, clinical waste disposal and personal protective equipment

How to pre-qualify patients Practitioners should start by clearly demonstrating why their clinic is worth choosing over lower-cost alternatives, across every channel patients use to research them.

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Communication Clear, proactive engagement with patients, whether they are new, existing, returning or future patients, is generally received far more positively than reactive communication or explanations that come across as apologetic after the fact. This proactive approach ensures you control the narrative of your price changes, reassures them without apologising and reinforces the rationale behind the changes. The best way to do this to ensure complete consistency of messaging is via email, newsletter or even a physical letter to your database. be used to understand patient expectations and gently filter price-driven enquiries before they reach the diary.

It is recommended that practitioners update their website and social media to display their qualifications, training history and professional memberships clearly. By making expertise visible, patients are better able to understand what differentiates services and why pricing reflects more than just the treatment itself. It reflects the knowledge, training and professional standards that support safe, effective care and outcomes.

It is also important to train your front-of-house team to confidently explain pricing rationale. Ensure patients understand how fees reflect clinical expertise, regulatory compliance, appointment time and product quality, so they can redirect discount enquiries with warmth and clarity. This training may be informal with the owner, or on an external course specifically focused on patient communication. Either way, it should be covered during onboarding and reinforced through regular refresher training every three to six months to maintain consistent, value-led communication.

Practitioners should also include a ‘what to expect at your appointment’ page that walks patients through consultation length, follow-up protocols and what is included in your fee. Pre-treatment questionnaires or consultation intake forms can

Lastly, consider how you display pricing. Packages vs. individual treatment prices can shift perception significantly, with packages often conveying greater value and encouraging longer-term commitment.

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Business Costs Treatment Pricing

How to communicate clearly and what to avoid

Treatment plans

A reactive explanation might sound like, “I’m so sorry, I know this is more expensive than before, but costs have really gone up and we had to do something.” This undermines confidence. Whereas a proactive, confident version sounds like, “While we’ve managed to absorb a percentage of rising costs, we’re updating our pricing model to ensure we continue to uphold the very highest standards and safety.” Same message, but an entirely different effect.

Locking in pricing through treatment plans gives patients stability while supporting continuity of care. The language matters enormously here. Phrases like “Secure your current price” or “Price protection plan” position the advance purchase as something done in the patient’s interest, not as a sales promotion. Compare:

Clinics that provide clarity about pricing, communicate it with confidence and apply it consistently are far more likely to activate the psychology of predictability and safety. When notifying patients of a pricing update, the following approach works well across all channels: •

Lead with the value you are protecting, not the increase itself. “We’re investing in [new equipment/additional training/ enhanced protocols] to ensure you continue to receive the standard of care you expect.”

•

Open the diary further in advance and confirm three to six months’ worth of follow-up appointments proactively – this can help create continuity and stability in patient commitments before new pricing is introduced.

•

Send written treatment plans with itemised costs ahead of each appointment, so patients are never surprised at checkout.

•

Avoid discounting as a first response. For patients who express unhappiness, acknowledge their concern restate your value clearly and offer a short consultation to discuss their treatment plan as it reinforces the price-led dynamic you are trying to move away from.

Contrast theory Contrast theory is a well-established behavioural principle that describes how people evaluate information differently, depending on what it is presented alongside.5 When it comes to pricing, a £100 item placed next to a £320 item could make the £100 item feel more appealing and affordable. When presented with three prices, statistically, the middle option is the most commonly chosen, known as the decoy effect.6 Rather than leading with the increase, emphasise the efficiency improvements, expanded service offering or enhanced availability that accompany it. •

“Our new evening appointments means you no longer need to take time off work,” then introduce the revised fee schedule

•

“We’ve added a dedicated follow-up call to every treatment – included in your fee,” before mentioning any increase

This creates a comparison that helps patients perceive the clinic as acting in their interests, even when an increase is unavoidable. When cost comparisons come up, resist the urge to justify your prices against a competitor. This removes comparison framing and re-anchors the conversation in value transparency rather than price competition: •

“I can’t speak to what another clinic includes in their fee, but I can walk you through exactly what ours covers.”

Retention and stability in a price-sensitive market In a price-sensitive market, retention is about reassurance, not incentives. When finances feel tight, predictability and trust matter more than short-term savings.

•

Promotional framing: “Buy three sessions and save 10%,” this attracts price-sensitive patients and signals that discounting is available if they push. Particularly if it’s botulinum toxin or dermal filler, time-limited offers or bundles are not only attracting price-driven patients, but it’s also not in line with the Advertising Standards Authority (ASA) guidelines.6

•

Price protection framing: “Lock in your current fee for the next three sessions – we’re reviewing our pricing in the autumn, and this secures your rate,” this creates urgency without discounting and appeals to the patient’s desire for stability.

Common pricing mistakes and considerations •

Setting prices by benchmarking competitors rather than calculating your own true costs

•

Absorbing cost increases silently and then making sharp adjustments – gradual, well-communicated changes are far better received

•

Leading with apology when discussing price – this signals insecurity and invites negotiation

•

Discounting as a first response to patient price pushback – it rewards the behaviour you are trying to reduce

•

Failing to ensure the whole team is aligned before communicating externally – inconsistent messaging is one of the fastest ways to erode patient trust

Membership models Memberships add another layer of reassurance, offering predictable costs for patients and a steady income for clinics. When designed well, they reduce decision fatigue. If you are considering a membership or VIP club model, ensure the structure and pricing are compliant with the ASA guidelines, which require that membership benefits are clearly stated, that any savings claims are accurate and that cancellation terms are transparent.8 This is not just a legal requirement; it is a trust signal that patients notice.8

Final thoughts Start with an honest review of your costs, regulatory obligations and long-term sustainability. Once decisions are made, prepare calm, confident messaging that acknowledges wider pressures while clearly explaining the rationale. Track patient behaviour, retention rates and treatment uptake, adjusting based on evidence, not fear-based assumptions. Alan Adams is a profit coach and author, and has published a series of books focused on helping businesses achieve the ultimate sustainable growth. He was named as one of the UKs Top 50 Advisors by Enterprise Nation in the Sales category in 2020 and 2021. He was also recognised by Global 100 as Best Business Consulting and Services Firm of 2023, and a Finalist in The Aesthetics Awards’ Best Service and Solution Provider category in 2024.

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In Profile Dr Nasha Winters

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Winters is still here three decades after her diagnosis, saying, “I was drawn to longevity Dr“I learned to listen differently to my body, my history and the soil I was growing in.” Today, Dr Winters supports her health through a combination of sunlight exposure, breathwork, clean in an attempt to extend water, fresh air, nutrient-dense food, fasting, a low-carbohydrate diet, H2 inhalation therapy, magnesium supplementation and low-dose naltrexone. my own”

Medical Longevity Summit (MLS) Keynote Speaker Dr Nasha Winters shares how a terminal cancer diagnosis led her to functional health Functional health specialist and naturopathic oncologist Dr Nasha Winters grew up in rural farming country in Kansas, US. That early proximity to soil, weather, animals and the people who lived close to all three shaped Dr Winters, and she credits this landscape for the way she thinks about the body now. Just days before her 20th birthday, and a sophomore in college working towards her bachelor’s degree, she received a terminal cancer diagnosis. Dr Winters recalls, “The symptoms had been brewing for months, filed under earlier labels I’d been given, such as irritable bowel syndrome, polycystic ovary syndrome and endometriosis.” This diagnosis reshaped the kind of doctor she wanted to become. “Moving through the medical system from the inside out, a patient, student, advocate and sceptic all at once, taught me with painful clarity what was missing in the rooms I was being seen in,” she reflects. Discussing her journey into oncology, Dr Winters confesses it was never what she intended to study or practice. “I hid my diagnosis when I applied to medical school, and I kept it hidden during my training, convinced that if anyone knew, they wouldn’t let me in or wouldn’t allow me to finish,” she recalls. In 1996, Dr Winters enrolled at what is now Sonoran University of Health Sciences, Arizona for her Naturopathic Doctorate (ND) and, concurrently, at the International Institute of Chinese Medicine for her Diplomate in Oriental Medicine and Acupuncture in 1997. Three years into her naturopathic training, she took a leave to finish the parallel track in Oriental Chinese Medicine. Graduating with her Doctorate in Oriental Medicine and as a licensed acupuncturist in December of 2000, she returned to complete the final year of her ND programme in 2003. “The universe, as it tends to do, had other plans,” she reflects. During her first week in private practice, a man was wheeled into the clinic with end-stage glioblastoma. He had been referred to Dr Winters for pain management because she was known in the neighbouring neurology and orthopaedic wards as the clinician they turned to when standard treatments had been exhausted. It was this case that pulled her back into her medical longevity and functional health, as she used a therapeutic ketogenic diet as well as a variety of homeopathic remedies, such as Nux Moschata, Staphysagria and Carbo Veg, on top of daily acupuncture to help him. Reflecting on her work within medical longevity and functional health, Dr Winters notes that since her early 20s, the lens of vitalistic medical practices has been her ethos. “I was drawn to longevity in an attempt to extend my own,” she reflects. 58

After completing her studies, Dr Winters moved to Durango, Colorado, where she took over her mentor’s clinical practice and ran it until 2015. She then transitioned to a virtual practice, continuing to live in Colorado until 2018. From there, she embraced a nomadic lifestyle until 2021, before eventually settling in Nayarit, Mexico. “I stopped direct patient care in 2018 and consulted only with doctors and the training of clinicians, allied healthcare professionals and advocates until the end of 2025. Only recently have I started consulting with a handful of highly motivated, and well-resourced individuals,” she explains. In practice, Dr Winters shares that her approach to patient care includes a thorough, comprehensive intake. She collects 54 pages and counting, as well as a written biography from the patient to see how their life has shaped their biology. Followed swiftly is the methodology Dr Winters has developed over her career: Test, Assess, Address, Don’t Guess. Dr Winters leads with the labs, imaging, questionnaires, tongue and pulse, wearable data and diet diaries. “It is understanding the patterns through the assessment step, that allows you to choose the right address: the right timing, the right dose, the right duration, the right combination of therapies,” she explains. Turning the lens to aesthetic practice and looking at how the longevity and medical aesthetics fields are connected, Dr Winters says aesthetic practitioners can help the outside sync with the inside. “Skin issues are rarely limited to the skin, and hair thinning is seldom about the hair. The hollow under the eyes, the dullness, the puffiness, the premature crepiness, the slack along the jawline. These are all expressions of inflammation, hormonal dysregulation, blood sugar dysfunction, microbiome imbalance, mitochondrial fatigue, nutrient depletion and unprocessed emotional load. The same drivers behind chronic disease are the drivers behind what shows up on the surface,” she explains. If you could choose a career outside the medical field, what would it be? A regenerative farmer, beyond my little backyard garden. What is the best career advice you have received? You are the medicine. Favourite holiday destination? Anywhere with a beach. I want the negative ions, the giant Epsom salt bath of the ocean, the foot exfoliation of the sand and the sun!

01 & 02 October 2026 Excel, London

Dr Winters is the international Keynote Speaker for MLS at the Clinical Cosmetic Regenerative Congress (CCR) 2026, giving a seminar on the importance of metabolic health, as well as a talk specific to metabolic health and cancer. Turn to p.16 to register.

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The Last Word Lifting Effect

Scientific limitations of the term Despite these observations, the term ‘lift’ or ‘lifting effect’ remains scientifically problematic. Surgical lifting involves clear anatomical repositioning and fixation. STFs act through volume replacement, changes in soft tissue tension and temporary alterations in tissue mechanics. Even with biostimulators, results are time limited and biodegradable.7

Can Soft Tissue Fillers Truly ‘Lift’ Facial Tissues? Dr Jani Loghem argues whether the term ‘lift’ fits clinical reality and how practitioners should discuss patient expectations The term ‘lifting effect’ is widely used in medical aesthetics when describing outcomes following soft tissue filler (STF) treatments, including hyaluronic acid (HA), calcium hydroxyapatite and poly-L-lactic acid. It resonates strongly with patients, evoking the appealing concept of reversing gravitational descent and restoring youthful contours. Notably, ‘lifting effect’ terminology has gained acceptance in peer-reviewed aesthetic literature when describing outcomes achieved through anatomically-informed injection techniques that target underlying structural changes.1 While STFs demonstrably improve facial contours and reduce signs of sagging, whether their mechanism genuinely constitutes a ‘lift’ in any meaningful mechanical sense remains debated. In my view, the term still has a place in aesthetic practice, but only when it is used precisely, is anatomically grounded and accompanied by careful expectation management.

Clinical evidence supporting the term Strategic placement of STFs, particularly HA in deep compartments combined with biostimulatory agents near retaining ligaments, can produce observable elevation of facial structures. An international consensus panel has established guidelines for optimal product selection and injection technique across specific facial indications, emphasising that each filler’s physical properties should be matched to particular anatomical layers and treatment goals.2 Three dimensional imaging has documented measurable surface displacement following volumising treatments, suggesting that filler injections can induce not only localised contour changes but also tissue repositioning extending beyond injection sites. This has been interpreted by some as objective evidence of a lifting effect.3 One proposed biomechanical explanation involves retaining ligament reorientation. Volumisation can reorient ligaments from more vertical to more horizontal vectors, creating upward tissue displacement and improved structural support. High elastic modulus STFs also create a structural scaffold that helps counteract gravitational forces.4,5 In practice, when biostimulators are placed along key ligament lines in the mid-face and jawline, many clinicians see lasting improvements in contour and tissue firmness for 12-24 months.5 Combining immediate HA volumisation with biostimulator driven collagen and tissue tightening (building over two to four months) produces outcomes that feel, in the clinic room, much closer to a lift than simple volumisation alone. That is the clinical experience behind much of the ‘lifting effect’ language.6

In addition, some of what patients perceive as lifting may be optical rather than mechanical. By changing contours, shadows and light reflection, fillers can make tissues look lifted without large scale anatomical repositioning.8 Ageing is also more than sagging. Fat deflates, ligaments stretch, bone resorbs and the skin deteriorates.9,10 Fillers and biostimulators can meaningfully improve parts of this, but they cannot reverse skeletal resorption or permanently reset ligament length and position. Apparent ‘lifting’ on 3D imaging may therefore reflect superficial remodelling, soft tissue redistribution or transient oedema, rather than true structural repositioning.

Using the term honestly in practice I believe that ‘lifting effect’ terminology carries a clear risk of unrealistic expectations. Patients may expect surgical level results and longevity, despite the temporary nature of fillers. Unmet expectations are a major source of dissatisfaction and complaints. For that reason alone, precise language is ethically essential. Rather than abandoning the term ‘lifting effect,’ it may be more useful to use it in a qualified, anatomically grounded way. Within that context, practitioners might say, “We create a lifting effect by restoring volume and structural support with strategically placed injections, which improves the skin’s position and reduces the appearance of sagging.” Rather than, “If you don’t want a facelift, we can treat you with fillers to give you the same result.” This keeps the language familiar while making it clear that we are creating an effect through support and contouring. Valid informed consent requires patients to understand, in practical terms, what a treatment will and will not do. If we use the word ‘lift’ without qualification, we risk importing a surgical mental model into a non-surgical context, and any consent based on that misunderstanding is, at best, fragile. Communicating mechanisms Communication tools are crucial. Visual aids such as 3D imaging, anatomical diagrams and honest before-and-after photography help patients understand what is happening, and what is not. Transparency about timeline is equally important.

Using the term ‘lifting effect’ responsibly Ultimately, good practice lies not in avoiding the term, but in how we use it. Qualified use of ‘lifting effect’ requires practitioners to review and, where necessary, update their consultation scripts and marketing materials so that claims are anatomically and mechanistically accurate. I believe this transparency will heighten patient trust and manage expectations accordingly. Dr Jani Loghem is an aesthetic physician, educator and international speaker specialising in facial anatomy and injectable treatments. He is founder of UMA Academy and has published extensively on filler safety, regenerative mechanisms and evidence-based injection protocols. His work focuses on anatomically-informed techniques and improving clinical outcomes through rigorous scientific methodology. Qual: MD, PhD, MSc

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Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk. Reporting forms and information for Republic of Ireland can be found at: https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143. All BELOTERO products referred to in this infographic contain lidocaine, as BELOTERO without lidocaine has been discontinued, with the exception of BELOTERO Revive designed without lidocaine. For your information, BELOTERO lidocaine and non-lidocaine share the same product specifications with the key difference being the inclusion (or absence) of lidocaine. © 2026 Merz Aesthetics UK Ltd – All rights reserved. MERZ AESTHETICS and the BELOTERO logos are trademarks and/or registered trademarks of Merz Aesthetics UK Ltd in the United Kingdom. Registered in England No. 14506945. Merz Aesthetics UK Ltd, Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire HP2 4TZ. www.merz-aesthetics.co.uk M-BEL-UKI-2038 Date of Preparation January 2026

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