June 2025: Mid and Upper Face by Aesthetics & CCR

CPD: Reviewing Antiseptic Skin Preparation

Dr Mary Sommerlad discusses nonsurgical body tightening treatments Julia Kendrick outlines the critical elements to prepare for media interviews

Dr Alison Colville explores antiseptic practices in medical aesthetics

Special Feature: Treating the Upper Eyelid with Energy Devices

Restoring the Temple with Dermal Filler

GO BEYOND

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Not an actual patient. For healthcare professionals only. Relfydess™ is indicated for the temporary improvement in the appearance of moderate-to-severe 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.

* 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

† 75% of patients treated for GLs (n=212) and 64% of patients treated for LCLs (n=189) did not return to baseline within 6 months, as estimated from a Kaplan-Meier analysis of time to return to baseline severity on both investigator and patient scales.1–3 GL, glabellar line; LCL, lateral canthal line.

1. Galderma. Relfydess Summary of Product Characteristics. 2024. 2. Galderma Laboratories. MA-47073. Clinical Study Report for Protocol 43QM1901: READY-2. Fort Worth, TX: 2021. 3. Galderma Laboratories. MA-47072. Clinical Study Report for Protocol 43QM1602: READY-1. Fort Worth, TX: 2021. 4. Sundberg AL, Stahl U. Poster presented at: TOXINS 2021 Virtual Conference; January 16–17, 2021. 5. Do M, et al. Poster presented at: TOXINS 2022 Conference; New Orleans, US; July 27–30, 2022.

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.

Contents • June 2025

08 News

The latest product and specialty news

17 News Special: NMC Introduces Ban on Remote Prescribing The implications of the NMC ruling on remote prescribing

19 Restorative Skin Complex: Your Patients’ Antiageing Antidote

Discover Alastin’s Restorative Skin Complex

20 Create Your Community

Join the aesthetics specialty at CCR to learn, share and thrive

CLINICAL PRACTICE

23 Special Feature: Treating the Upper Eyelid Practitioners share their approaches to rejuvenating the eyes

26 CPD: Reviewing Antiseptic Skin Preparation in Aesthetics

Dr Alison Colville analyses antiseptic practices in medical aesthetics

32 Evolving Aesthetics with Nuceiva® Precision, Purity and Performance

35 Restoring the Temple with Dermal Filler

Dr Bethany Rossington explores the ageing temple

38 Using Botulinum Toxin for the Treatment of Rosacea

Dr Kam Lally shares how to use botulinum toxin to manage rosacea

41 Body Tightening Procedures for Skin of Colour

Dr Mary Sommerlad discusses non-surgical body tightening treatments

44 Cutera: A New Energy in Aesthetics

Big announcements coming from aesthetic medical device manufacturer Cutera

46 Non-Surgical Blepharoplasty with CO2 Laser

Dr Alex Parys and Dr Samantha Hills examine periorbital rejuvenation

50 HA-Derma & NAHYCO® Technology: A Decade of Tissue Regeneration

Celebrating 10 years of aesthetic excellence

51 Abstracts

A round-up and summary of useful clinical papers

IN PRACTICE

52 Unlocking the Male Aesthetics Market

Mr Glyn Estebanez provides strategies to address male patient barriers

54 Preparing for Media Interviews

Julia Kendrick outlines how to prepare for interviews with the press

56 Selecting the Best Laser Devices for Your Clinic

Dr Tanja Phillips explores how to choose the right laser technology

58 In The Life Of: Olivia Salmen

Olivia Salmen shares how she balances travelling with patient care

59 The Last Word: Patients Cheating on Practitioners

Dr Sophie Shotter discusses patient loyalty

News Special:

NMC Introduces Ban on Remote Prescribing Page 17

Special Feature:

Treating the Upper Eyelid with Energy Devices Page 23

Clinical Contributors

Dr Alison Colville is an aesthetics doctor, GP and medical director of The Avery Clinic in Leamington Spa. She is a clinical advisor for Clinisept, trainer and brand ambassador for Revanesse and keen educator, mentor and public speaker.

Professor Valerie Edwards-Jones is a UK microbiologist with over 45 years’ experience spanning NHS diagnostics, academic research and consultancy. Emeritus Professor at Manchester Metropolitan University, she specialises in wound infections and antimicrobial resistance.

Dr Bethany Rossington is a dental surgeon and owner of Renavé Clinic in Retford. She is the editor of the Oxford Handbook ofClinicalDentistry7th edition and is passionate about education and increasing safety standards within the aesthetics specialty.

Dr Kam Lally is the medical director of Aestheticology Clinics UK and the RCGP national aesthetic medicine lead. He is a global KOL for a number of aesthetic, skincare and pharmaceutical manufacturers whilst also offering bespoke individual mentorship.

Dr Alexander Parys is an aesthetic doctor and founder of SONÜ Medical Aesthetics in Wilmslow & Hale, Cheshire. He worked within the NHS for nearly a decade as both an emergency medicine and clinical radiology specialist registrar.

Dr Samantha Hills is clinical director at Lynton Lasers. She is on the teaching faculty of the British Medical Laser Association, as well as being an honorary lecturer in the Division of Musculoskeletal and Dermatological Sciences at The University of Manchester.

Dr Mary Sommerlad is a consultant dermatologist based in London specialising in skin of colour dermatology, inflammatory dermatology, paediatric dermatology and photoageing. She practices within the private sector in the NHS and is a British Skin Foundation spokesperson.

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References 1. J.Chenau et al., Secretome: Definitions and biomedical interest 2. Han, G. et al., 2022. The Potential of Bovine Colostrum-Derived Exosomes to Repair Aged and Damaged Skin Cells. 3. Privitera, A. et al., 2024. Nutri Complex 150+: A New and Effective Approach to Facial Rejuvenation. 4. Ferruggia, G. et al., 2024. Effectiveness of a Novel Compound Hair & Scalp Complex on Hair Follicle Regeneration.

Shannon Kilgariff Editor & Event Manager

@shannonkilgariff

Welcome to the June issue of the Aesthetics Journal I can’t believe it’s already halfway through 2025, and summer is now upon us! Isn’t it strange how the years seem to race by faster the older we become?

This month, we’re focusing on the art and science of treating signs of ageing in the mid and upper face – areas that play a crucial role in both rejuvenation and harmonisation. In this issue, our expert contributors share insights on restoring temple volume with dermal filler (p.35) using toxin to treat rosacea on the mid-face (p.38), and a Special Feature on upper eyelid rejuvenation. With the eyes being the ‘window to the soul’, the periorbital zone is a delicate area that can have a huge impact on overall facial appearance (p.23).

Big news across our specialty this month came from the Nursing and Midwifery Council’s (NMC) recent update on remote prescribing practices. Our News Special covers this major development in the regulatory landscape; coming into effect from June 1, independent

Clinical Advisory Board

nurse and midwife prescribers will no longer be permitted to remotely prescribe prescription-only medicines (POMs) for non-surgical cosmetic procedures. Instead, POMs may only be prescribed following a face-to-face consultation.

Looking ahead, we’re gearing up for CCR 2025, and this month’s event preview highlights what to expect. With world-class education, exciting live demonstrations and the return of our Aesthetics Mentoring programme, it’s the perfect opportunity to connect, learn, and feel inspired – make sure to save the date for September 25-26!

We’re also excited to share that our Aesthetics Journal website has a lovely new look and feel following a redesign. When reading breaking news and features online, you’ll experience better functionality and exciting features coming soon – we’d love for you to take a look and get back into the digital side of our community.

Thank you, as always, for reading and for being part of the Aesthetics community. As always, do let us know what you enjoyed reading and tag us on Instagram – @aestheticsjournalUK

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

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

Sharon Bennett, Clinical Lead

Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.

Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS, and is an examiner and fellow of the Royal College of Ophthalmologists.

Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.

PORTFOLIO MANAGEMENT

Shannon Kilgariff • Editor & Event Manager

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

EDITORIAL

Holly Carver • Deputy Editor & Content Manager

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

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

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

DESIGN

Aimee Bish • Senior Graphic Designer

Callum Benyon • Junior Graphic Designer

Kitty Butler • Graphic Design Intern

Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.

Jackie Partridge is an independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.

Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.

ADVERTISING & SPONSORSHIP

Judith Nowell • Head of Sales

T: 0203 196 4352 | M: 07765 407629

judith.nowell@easyfairs.com

Charlotte Norville • Senior Sales Executive T: 020 3196 4418 | Charlotte.norville@easyfairs.com

Imogen Preece • Sales Executive

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

MARKETING

Susana Burguera • Senior Marketing Manager

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

Ella Carey • Marketing Executive

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

Isabell Wise • Marketing Executive

T: 020 3793 5845 | isabell.wise@easyfairs.com

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

Email: editorial@aestheticsjournal.com

Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.

Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.

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

ARTICLE PDFs AND REPRO

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

Talk #Aesthetics

#WigmorePresents2025

Julie Scott

@facial_aesthetics

It’s always a pleasure to be part of Wigmore Presents. A conference rooted in education, collaboration and standards within aesthetics!

#InternationalConference

The Beauty Triangle @the_beauty_triangle

#ClinicLaunch

Dr Ahmed El Muntasar @theaestheticsdoctor

A moment I’ll never forget. Thank you to everyone that attended the official launch day of my new Mayfair clinic!

Here’s to our Beauty Triangle panellists from our ‘Hormonal Health’ event at The Arts Club Dubai. Thank you for everyone who joined us!

#Event

Emma Bracey-Wright @emmabwlondon

What a delightful evening celebrating the launch of S’ABLE Labs with GetHarley.

#SkinCEO

Sciton UK

@Sciton_UK

This weekend we welcomed over 300 international attendees from across the globe to our SkinCEO London event.

Regulatory Framework

Non-Surgical Cosmetic Procedures Bill unveiled in Scotland

The Scottish Government has announced plans to introduce the Non-Surgical Cosmetic Procedures Bill.

The proposed Non-Surgical Cosmetic Procedures Bill seeks to establish a regulatory framework to improve the safety and oversight of non-surgical aesthetic treatments. Under the Bill, such procedures would only be permitted in facilities regulated by Healthcare Improvement Scotland (HIS) or licensed by local councils.

Other key measures include a tiered licensing system based on the risk level of procedures, mandatory practitioner qualifications and the licensing of all treatment premises. The Bill also proposes compulsory insurance, age restrictions for certain procedures and enforcement powers for local authorities.

These proposals stem from the Scottish Government’s public consultation, conducted between December 2024 and February 2025. The consultation outlined a tiered licensing framework based on procedure risk and practitioner qualifications and recommended that all non-surgical treatments be performed in regulated or locally licensed premises. The recent consultation results are expected by the end of June.

The Bill is scheduled to be introduced in the Scottish Parliament in March before next year’s election, and is one of five non-financial Bills outlined in First Minister John Swinney’s Programme for Government on Tuesday May 6.

Public Health Minister Jenni Minto commented, “The Scottish Government is concerned about the resulting undue level of risk for patients. Anyone undergoing cosmetic procedures has a right to expect that they will be carried out by appropriately trained practitioners using reputable products and in hygienic premises. Unfortunately, this is not always the case.”

Legislative Update

Government agrees to protect ‘nurse’

title in law

Following the introduction of the Nurse (Use of Title) Bill by Labour MP for Brent East, Dawn Butler, the Government has announced it will move to legally protect the title ‘nurse’ to ensure it can only be used by those with the appropriate training and registration.

On International Nurses Day, the Department of Health and Social Care (DHSC) confirmed that measures will be brought forward to safeguard the title in law. Until now, individuals struck off the Nursing and Midwifery Council (NMC) register – or those without any nursing qualifications – have been able to use the term.

Under the new Bill, the title ‘nurse’ may only be used by professionals registered with the NMC, along with those qualified as dental, nursery or veterinary nurses. The Government confirmed the changes will be introduced during this Parliament as part of broader reforms to health and care regulation.

Health and Social Care Secretary Wes Streeting said, “The British people hold nurses in the highest regard, and we trust them in our most vulnerable moments, patients need to know they are genuinely being seen by a nurse. Now they will.”

Headline Sponsor

Galderma returns as CCR Headline Sponsor

Galderma has confirmed its return to the Clinical Cosmetic Regenerative Congress (CCR) 2025 for the fourth consecutive year. As Headline Sponsor, the company will host symposiums at the Aesthetics Journal Arena on September 25–26.

Gul Gokyokus, head of marketing at Galderma UK&I Aesthetics, said, “We are thrilled to return as the Headline Sponsor for CCR. It is a privilege to support such an important platform for innovation and education in medical aesthetics. This year, we’re especially excited to have Dr Ana Mansouri and Dr Munir Somji joining us to share their expertise on full-face rejuvenation with Restylane and Sculptra – with a particular focus on the aesthetic considerations following medication-driven weight loss. We look forward to connecting with the community and continuing to shape the future of aesthetic care together.”

Dr Munir Somji and Dr Ana Mansouri are key opinion leaders for Galderma. Veeva reference number: UKI-RES-2500055. DOP: May 2025.

Study

BSF study explores the influence of diet on psoriasis

A large UK-based study funded by the British Skin Foundation (BSF) has explored whether diet may influence the severity of psoriasis.

Drawing on data from over 500,000 people – including 11,000 with psoriasis – the study found no significant differences in overall diet between those with and without the condition.

In contrast, those following a healthier, plant-rich diet were less likely to experience severe psoriasis or related health complications such as heart attacks. While diet alone may not cause or cure psoriasis, the findings suggest it could influence disease severity and long-term health outcomes.

In a joint statement, consultant dermatologist Dr Thivi Maruthappu and professor of nutritional sciences Wendy Hall commented, “The study found that those who ate a healthier diet, with plenty of fruits and vegetables, were less likely to experience heart attacks and high cholesterol levels.”

Education

BDD online conference marks a return

The Body Dysmorphic Disorder Foundation (BDD) hosted its annual conference in partnership with the International OCD Foundation (IOCDF) on May 31.

The conference featured several CPD-accredited sessions, including what clinicians need to know about BDD, available treatment options and effective ways to support individuals affected by the condition. It also featured a recovery panel sharing personal experiences.

Kitty Newman, managing director of the BDD Foundation, commented, “We are excited to have partnered with IOCDF to bring awareness to this underrepresented condition. This conference brought together a global audience, with the chance to hear from leading specialists as well as individuals with lived experience, all sharing their guidance and insights.”

Vital Statistics

Breast augmentation was the most sought-after cosmetic surgery in 2024, with 5,202 procedures performed, marking a 6% increase from the previous year (BAAPS, 2025)

A UK based male study found that 1 in 6 men have considered dermal filler treatment, and 21% are likely to have dermal filler in the future (Teoxane, 2025)

Following a survey of 1,500 participants, 1 in 4 admitted their skin concerns negatively impacted their mental health and social life (Cynosure Lutronic, 2025)

In the UK, 32% of people consider moisturiser the most important step in their skincare routine, compared to 23% who prioritise sunscreen (Face the Future, 2025)

A study analysing 2,000 selfies found that 92% of people have a preferred photo side: 41% favour the left cheek, 31.5% the right and 19.5% face forward (UNILAD, 2025)

Google searches for the term ‘Gut Health’ have increased by 248% over the last five years (Tonic X, 2025)

Events diary

18th-19th September 2025

The BAMAN Autumn Conference

25th-26th September 2025

CCR 2025

11th October 2025

BCAM Conference

13th - 15th November 2025

Aesthetic Dialogue International Symposium

IN THE MEDIA

Calls for stricter regulations after filler complications

Maryum Mohammed experienced a Patient near-fatal complication after a routine chin filler procedure, appearing on ITV News to advocate for stricter regulations. It was later revealed that the substance had entered a blood vessel, obstructing blood flow and leading to tissue necrosis. Naruschka Henriques, a registered mental health nurse prescriber, re-approached Mohammed two days later and administered a dissolving agent to counteract the effects of the filler.

General practitioner Dr Roshan Ravindran stated, “Mohammed’s case was avoidable with quicker treatment. We have to create a specialty that puts patient safety first.”

Katherine Ryan discusses her biological age

In an episode of What’s My Age Again? host Katherine Ryan highlighted the complexities of biological versus chronological age. Ryan reveals that her chronological age is 41, and despite her clean lifestyle, Ryan’s autoimmune condition, lupus, may influence her biological age. Dr Nichola Conlon, a biochemist specialising in cellular ageing, underscored the importance of how one feels over clinical measurements. Speaking to Ryan, she said, “That’s what truly matters. As scientists and doctors, we often focus heavily on biomarkers and tests, but ultimately, feeling well is the best outcome.”

Regulatory Safety

FDA flags finasteride risks

The US Food and Drug Administration (FDA) has issued a new warning about finasteride, a drug commonly prescribed for androgenic alopecia.

The agency highlighted potential risks of serious, long-term side effects, including persistent sexual dysfunction and psychological harm. The updated warning follows a surge in reported cases of post-finasteride syndrome (PFS), with patients alledging symptoms such as erectile dysfunction, genital pain, altered libido and mood disturbances – including anxiety and depression. In severe cases, suicidality has been reported.

One such case, currently circulating in the media, involves 28-year-old Sawyer Hart, who began using a finasteride-based topical gel after receiving a prescription through a telehealth platform. He reported developing erectile issues, testicular pain and panic attacks shortly after initiating treatment. The agency has not approved any topical finasteride formulations and has issued a public warning about compounded versions of the popular hair loss drug sold via telehealth platforms.

The FDA now acknowledges a “potentially serious risk” to the genitourinary system from finasteride, particularly when adverse effects persist after discontinuation. The agency has updated drug safety communications and is reviewing the cumulative post-marketing safety data.

Clinic Closure

Alma UK responds to Laser Aid closure

Following the closure of Laser Aid, a laser device and service company, aesthetic device manufacturer Alma UK has announced a range of support initiatives for affected clinics and former team members.

Acknowledging the disruption caused by the closure, the company aims to provide both immediate and long-term assistance to support continuity across the aesthetics sector. Clinics impacted by the closure will have access to dedicated service support, the continuation of existing service contracts and exclusive discounts on Alma UK’s range of devices. The company shares it is committed to helping practitioners maintain high standards of care and operational continuity. In addition, Alma UK has pledged training and career development support for former Laser Aid staff. Opportunities include guidance for career transitions, specialty training and potential pathways within the Alma network.

Kamran Shibli, general manager of Alma UK, commented, “Our team is ready to step in with both the technology and the human support needed to ensure that the transition is as seamless as possible.”

Artificial Intelligence

Scottish Government pilots AI on injectables

The Scottish Government has trialled an artificial intelligence (AI) tool to analyse public feedback on injectable procedures.

The AI tool, named ‘Consult’, has been piloted to analyse public responses concerning the regulation of non-surgical cosmetic treatments, including botulinum toxin and dermal fillers. The trial invited public views on the need for further regulation of non-surgical cosmetic procedures, the licensing of non-healthcare practitioners performing higher-risk treatments and the regulation of independent pharmacy services offering such procedures outside NHS contracts.

During the public consultation, Consult analysed over 2,000 responses, with key themes reviewed and validated by government analysts for accuracy.

The insights gathered will inform the forthcoming Non-Surgical Cosmetic Procedures Bill, intended to establish stricter safety standards and licensing requirements for aesthetic treatments in Scotland. The Scottish Government plans to publish the full consultation response by the end of June 2025.

What’s trending in the consumer press

Government Debate

MPs sound alarm over rising costs for business owners

MPs gathered in Westminster Hall to debate the economic contribution and mounting financial challenges of the UK’s beauty sector.

Prompted by growing pressure from employers nationwide, the debate was tabled by Julia Lopez, MP for Hornchurch and Upminster. Lopez raised concerns that businesses are being “crushed by the weight of tax demands,” pointing to issues including the end of business rates relief, higher National Insurance contributions and the cumulative burden of VAT. Her intervention follows the Salon Owners and Employers action day on March 17, when hundreds of professionals from across the sector gathered outside Parliament to demand urgent action.

“This is a highly skilled, labour-intensive specialty that’s getting squeezed from all sides,” said Lopez. “We risk losing honest, taxpaying businesses from our high streets, replaced by unregulated operators that evade tax and oversight.”

MP Cat Eccles (Stourbridge) shared testimony from business owner Tim Scott-Wright, who warned that the increased costs associated with National Insurance and wages could force him to stop training apprentices. Throughout the session, MPs emphasised the sector’s economic and social value – estimated at £5.8 billion – and highlighted its heavy reliance on female-led microbusinesses, part-time work and apprenticeship training.

Sarah Gibson, MP for Chippenham, referred to the post-pandemic environment and high tax burden as a “perfect storm.” She warned that some salon owners faced payroll increases of over £40,000 due to NIC rises and called for a more flexible, small-business-friendly apprenticeship levy.

In response, Gareth Thomas, Parliamentary Under-Secretary of State for Business and Trade, acknowledged the challenges faced by the sector but stood by the Government’s fiscal approach. “We’ve made tough decisions,” he said, pointing to Employment Allowance increases and business rates relief for retail as targeted support measures. He added that a forthcoming small business strategy will outline further assistance.

Specialty Research

Survey findings expected on botulinum toxin complications

Organisations have partnered with University College London (UCL) to collect survey results on patient experiences following botulinum toxin injections.

The Joint Council of Cosmetic Practitioners (JCCP), the British Association of Aesthetic Plastic Surgeons (BAAPS) and UCL have collaborated with the aim to strengthen patient safety through evidence-based practice. The survey, made available via the JCCP and promoted across social media, closed on May 31. UCL expects to publish the findings in June to inform the UK Government’s forthcoming consultation on regulating non-surgical cosmetic procedures.

Professor David Sines, chair of the JCCP, commented, “The JCCP is delighted to have again been selected by the UCL research team to participate as a partner. This study aims to gather objective evidence to inform key issues relating to patient safety and public protection that will inform the design and implementation principles for the Government’s proposed upcoming scheme of licensing and regulation for the cosmetic specialty in the UK.”

BAMAN UPDATES

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

INTERNATIONAL NURSES DAY 2025

May was a special month in the BAMAN calendar, as we celebrated International Nurses Day and recognised the dedication, skill and resilience of nurses across the UK. This year, our celebration was even more meaningful, as the UK Government formally confirmed that the professional title ‘Nurse’ will be protected in law. This historic decision reflects years of tireless advocacy by the nursing profession and comes at a time when public trust and patient safety have never been more essential. To mark this, BAMAN launched a digital ‘Meet the Team’ campaign, highlighting the people behind the organisation, including committee members, regional leaders and board members.

FIRST BAMAN BOARD AND SUB-COMMITTEE MEETINGS

May also saw meetings with the BAMAN board of directors and the newly formed BAMAN regulatory sub-committee chaired by BAMAN director Brenda McKibbin. The sub-committee was established by the BAMAN board of directors to provide specialist leadership on regulatory, legislative and policy issues affecting medical aesthetic nurses across the United Kingdom. The sub-committee supports BAMAN’s strategic aim to develop and recommend policy positions on regulation, engage directly with external stakeholders, submit responses on behalf of BAMAN to public consultations and work on issues such as holding prescription medicines as stock.

REGIONAL MEETINGS AND AUTUMN CONFERENCE

Meanwhile, regional meetings are in full swing, with recent events taking place in South West England and South Wales. These sessions continue to play a huge role in creating local hubs of support, education and peer connection across the UK. Looking ahead, we’re excited to invite you to the BAMAN Autumn Aesthetic Conference, taking place on September 18-19 in Birmingham. This two-day, CPD-accredited event is the flagship gathering for BAMAN and will feature expert-led education and live demonstrations, plus the opportunity to network with over 60 exhibitors and 300+ nurse colleagues from across the UK. Book online at www.baman.org.uk/events/ or scan the QR.

This column is written and supported by BAMAN

A weekend of innovation at Wigmore Presents 2025

Event Spotlight: Elevating Skin Health With Key Dermatology Insights

Discover cutting-edge research and clinical advice on skin health and disease from the British Skin Foundation (BSF) at this year’s CCR

Why does skin health deserve to have a central role in medical aesthetic practice?

The skin is the largest organ in the body and it’s often overlooked. At the British Skin Foundation we know how important it is to look after your skin, but it isn’t a one-size-fits all situation. Practitioners should be aware of patients’ individual skin needs in order to reach the best outcomes. Skin diseases can have a huge impact on a person, with two in three suffering from a skin condition at some point in their life, so they must be taken into consideration when treating patients.

What will the BSF be doing in collaboration with CCR as its charity partner?

Whilst primarily set up as a skin disease research organisation in 1996, the British Skin Foundation has grown to become the go-to charity for skin-health information. Although our main mission continues to be funding high quality skin research, we also aim to educate to wider community on all things skin-related. Working with CCR, we hope to share our almost 30 years of knowledge with the medical aesthetics community.

What will delegates take away from the content stream?

During our agenda at the Aesthetics Journal Arena, we’ll call upon our experts to give skin health insights from the perspective of consultant dermatologists. We’re keen to show how our vital skin disease research will have a positive effect on people with skin concerns in the future.

The British Skin Foundation team is looking forward to connecting with different individuals in this space, so we can both share our knowledge and learn from others. Education is key!

The Royal College of Physicians hosted Wigmore Presents on April 24-27.

The three-day event featured specialty-led discussions, clinical updates and peer networking across a broad range of topics in skin health and aesthetics.

Educational highlights included focused sessions on managing skin of colour, aesthetic treatment considerations for the menopausal patient and the intersection of dermatology, psychology and holistic care. There were 40+ speakers at the event, including aesthetic practitioners Dr Mary Sommerlad, Dr Ahmed El Muntasar and Dr Mayoni Gooneratne; anatomist professor Sebastian Cotofana; and nurse prescribers Anna Baker, Sara Cheeney and Alexandra Mills. With 30 exhibitors, delegates also had the opportunity to meet a range of brands within the exhibition space.

The event featured two key product launches: IMAGE Skincare’s VOL.U.LIFT, a topical volumising treatment developed for patients using GLP-1 medications and HydroPeptide’s Collagen ReActivate PM, a night cream-serum hybrid powered by NIMNI Technology and time-release retinol.

Dr Lauren Jamieson, co-chair and clinical lead at Wigmore Presents, commented, “Wigmore Presents 2025 was everything it was intended it to be and more! Unique, future focused and educationally driven, Wigmore Presents was once again an intimate, comprehensive and sociable conference featuring an exceptional international faculty of speakers delivering expert education. Needless to say the commitment to networking abounded along with cowboy hats and boots at the Wild West party! A special event in the medical aesthetics calendar; we look forward to building in 2026.”

Device Launch

Eden Aesthetics introduces JetPeel Ayurveda

Aesthetic distributor Eden Aesthetics has launched JetPeel Ayurveda.

The company shares the new treatment protocol combines traditional Ayurvedic principles with its established transdermal delivery technology.

JetPeel Ayurveda is designed as a non-invasive option for sensitive and reactive skin types, integrating botanical ingredients with modern application techniques aiming to improve absorption and comfort, according to the company.

The treatment consists of a three-step protocol: initial exfoliation using Bacocalmine and Campo Vijaya Sara, intended to cleanse the skin and reduce inflammation; followed by an infusion of a tri-molecular hyaluronic acid complex designed to provide hydration and nourishment; and concluding with an application of Pore Reductyl, a mushroom-derived extract aimed at improving skin texture and minimising pore appearance. Lindsay Gray, managing director at Eden Aesthetics, commented, “JetPeel Ayurveda is an exciting advancement in holistic skincare. It brings together the science of JetPeel’s non-invasive delivery with the time-honoured wisdom of Ayurvedic healing. This treatment is a game-changer for those looking to soothe and restore their skin with natural, clinically backed ingredients.”

Collection Release

ALLSKIN|MED launches new moisturiser collection

Skincare brand ALLSKIN|MED has released a new collection of moisturisers, introducing two newly developed formulations.

Available from aesthetic distributor AesthetiCare, the first moisturiser of the collection is the Barrier Defence Emulsion, an antiageing treatment designed to hydrate and reinforce the skin barrier. According to the company, the lightweight formula also works to reduce inflammation and improve elasticity.

Additionally, the Barrier Recovery Cream is designed to soothe skin post-procedure. ALLSKIN|MED explains that this product aims to reduce the discomfort, dryness and irritation that can accompany in-clinic procedures.

Rebecca Walton, commercial director of AesthetiCare, commented, “We’re thrilled to introduce Barrier Defence Emulsion and Barrier Recovery Cream – two innovative formulas from ALLSKIN|MED that protect, strengthen and restore the skin barrier. Formulated with Reoxderm, a patented technology exclusive to ALLSKIN|MED, they provide antioxidant-rich solutions for individuals with a compromised barrier, to promote hydrated and radiant skin health.”

Clinical Skincare

GetHarley expands range with advanced medical-grade skincare

Skincare platform GetHarley has introduced ALPHASCIENCE to its range of clinical skincare products. According to ALPHASCIENCE, its products are formulated to complement aesthetic procedures, supporting skin preparation and recovery across a range of treatments such as microneedling, laser therapy and chemical peels. The brand aims to enhance outcomes and maintain skin integrity post-treatment.

Karen Evans, sales manager at Dermapure Clinical, commented, “Like GetHarley, we’re incredibly selective about the brands we work with and have seen amazing results from many of our clinics that are already working with ALPHASCIENCE. We’re excited to see the transformations that GetHarley’s experts achieve by adding ALPHASCIENCE products to their expertly prescribed skincare plans.”

On The Scene

Revision Skincare hosts panel event following launch

Aesthetics attended a panel event with Revision Skincare on May 8 in London.

The morning featured a presentation from aesthetic practitioner Dr Sophie Shotter and education manager Olivia Roumain, who shared their reasons for choosing Revision Skincare. They highlighted the brand’s monochrome branding as a deliberate reflection of its scientific roots. Dr Shotter also shared insights from her clinical experience, noting that patient feedback on Revision Skincare for post-procedure care has been positive.

During the session, Roumain discussed the launch of DermProtect Barrier Defense, a new moisturising product aimed at hydrating the skin, specifically targeting dry and mature skin types.

Dr Shotter commented, “Being involved in the Revision Skincare Immersive breakfast event was an honour. Revision Skincare stands out for me in a crowded space as innovative and forward-thinking, with the most incredible formulations. It was a pleasure to discuss the brand in depth with Roumain, and to share my love of the brand with attendees.”

Event Report

Sciton hosts training event

Aesthetic device company Sciton hosted its Skin CEO: Boosted event on May 16-17 at Grosvenor House, London.

Designed as an intensive training experience, the two-day event brought together a global faculty to deliver hands-on workshops and lectures focused on advanced laser and light therapies, injectables and strategies for practice growth.

The agenda featured live treatment demonstrations and educational sessions from an international panel of speakers, including dermatologists, plastic surgeons, aesthetic doctors and nurses and business leaders. Notable presenters included Dr Christian Subbio, Dr Patrick Bitter, Dr Benji Dhillon, Dr Zoya Awan, Dr Jenny Doyle and more, addressing an audience of approximately 250 delegates. Rosalie Nicholson, Sciton EMEA marketing manager, commented, “This was the biggest and most successful event we have had internationally, and the feedback from the guests was fantastic. This event was designed to educate, inspire and entertain; edu-tainment, as we like to call it. The energy in the room was incredible and everyone left armed with business tips, strategy and advanced clinical education and combination treatment protocols, ready to take their practices to the next level.”

AlumierMD reveals new Radiant TXA Peel

Skincare company AlumierMD has released its New Generation Tranexamic Acid (TXA) Peel.

The company shares the product is designed to tackle stubborn pigmentation, as the peel combines 1.95% TXA, 30% lactic acid and white shiitake mushroom extract, aiming to achieve skin brightening and exfoliation. AlumierMD explains that the launch is a response to growing concerns about skin pigmentation. The company cites studies showing that out of 1,500 participants, 23.6% of men and 29.9% of women seek dermatological care primarily to address discolouration.

Aesthetic practitioner Dr Nina Bal commented, “Tranexamic acid is a key player when it comes to professional in-clinic treatments like chemical peels. When incorporated into peels, it accelerates the removal of the pigmented skin cells, while preventing deeper inflammatory responses that can occur as a result of exfoliation. Whether used in at-home skincare routines or clinical treatments, tranexamic acid delivers results.”

Range Expansion

Teoxane releases new exfoliating scrub

Aesthetic manufacturer Teoxane has revealed the Active Microscrub to its Dermocosmetics range.

Teoxane shares that the Microscrub is the brand’s first exfoliating product, designed to remove dead skin cells while supporting skin hydration and barrier function. The product incorporates resilient hyaluronic acid (RHA), a crosslinked hyaluronic acid originally used in Teoxane’s dermal filler range, in order to enhance moisture retention.

Jordan Sheals, medical education and marketing director at Teoxane UK, commented, “We’re thrilled to introduce the Active Microscrub. This new dual-exfoliation product exemplifies our continued dedication to uniting scientific innovation – long established within our dermal filler portfolio – with the highest standards of skincare excellence. As specialists in injectable hyaluronic acid technology, we’re equally dedicated to offering a complementary range of topical solutions that support a holistic approach to skin quality, and this product brings something entirely new to the range.”

This month’s newest clinic openings

A round up of the latest aesthetic clinics opening across the UK

Dermatology nurse Emma Coleman is opening her fourth skin clinic on June 2. The clinic, on Sevenoaks High Street, will offer dermatology consultations for all ages, scar treatments, lesion removal, mole analysis and support for skin cancer concerns. Non-surgical treatments include

Topical Formula

IMAGE Skincare launches VOL.U.LIFT

Skincare company IMAGE Skincare has unveiled a topical formulation targeting facial contouring and volume refinement. The product, available in UK clinics from May 12, is designed to address common facial concerns that can arise with significant weight loss. According to the company, the formulation features IMAGE Skincare’s XOSM technology, a patent-pending delivery system that aims to enhance performance and support the skin barrier using encapsulated antioxidants such as ectoin, vitamin C and astaxanthin. Key actives include L-ornithine for visible plumping, bakuchiol for firming and smoothing, HA silanol for hydration, kangaroo paw extract and plant collagen fragments to improve sagging.

Mr Marc Ronert, reconstructive plastic surgeon and IMAGE Skincare co-founder, commented, “I am seeing the rapid rise in GLP-1 usage among patients and the subsequent long-term side effects that directly impact overall skin health. GLP-1 induced skin ageing is a new phenomenon that is affecting patients in different ways. VOL.U.LIFT is formulated to combat the specific facial changes that result from GLP-1 usage, addressing the appearance of facial deflation, sagging, crepey skin texture, dehydration and wrinkles.”

Laser Device

AMP debuts MultiFrax Laser Technology

Aesthetic Medical Partnership (AMP) has introduced MultiFrax, a portable laser platform combining 1550 nm and 1927 nm wavelengths in a cordless format.

Claimed to replicate the clinical capabilities of larger, fixed systems, MultiFrax integrates both wavelengths via SimulScan technology, allowing simultaneous delivery in a single pass, according to the company. This configuration is designed with the aim to streamline treatment protocols and reduce patient chair time.

AMP shares that the device supports a range of aesthetic applications, including photoageing, acne scarring and textural irregularities – across diverse skin types. Key technical features include adjustable scan sizes (2mm-14mm), variable micro-column densities and onboard SmartSense feedback, offering precision control in a handheld unit.

the EmLift machine, Hydrafacial, IPL Lasers and Morpheus8. Coleman’s clinics, including locations in the South East and Harley Street, provide treatments for conditions such as acne, rosacea and hyperpigmentation.

Independent nurse prescriber Caroline Livingstone has opened the doors to her new clinic, Better You Medical Aesthetics + Skin Clinic, in West Kirby. The clinic will utilise brands

such as Aesthetics, Dermalux, Allergan Obagi Medical, Sculptra and Teoxane. Livingstone states her mission is to deliver safe, results-driven treatments. Livingstone commented, “My passion for skin health, regeneration and healthy ageing led me to open the clinic. I wanted to create a space where patients could access advanced, medically led treatments in a safe, professional and caring environment.”

If you’re opening a new UK clinic soon, let us know at editorial@aestheticsjournal.com

Skincare Launch

Webinar Preview

Galderma to present Relfydess data in June Webinar

On June 24, aesthetic pharmaceutical company Galderma will host a webinar on Relfydess (RelabotulinumtoxinA)*, following its recent UK marketing authorisation. Relfydess is a new, ready-to-use liquid formulation of botulinum toxin type A. Galderma will present findings from a new study, offering further insights into clinical outcomes and practical application.

Developed with proprietary PEARL Technology, Relfydess is designed to preserve molecular integrity, offering a highly active, complex-free neuromodulator. Indicated for glabellar and lateral canthal lines, clinical data from the READY programme show onset of effect from day one in up to 39% of patients and sustained results at six months in up to 75%. The liquid formulation allows for simplified volumetric dosing, supporting consistency and ease of use.

New results from the Phase III READY-4 study further demonstrate the long-term safety and efficacy of repeated injections over 12 months, with adverse events mostly mild to moderate and consistent across treatment cycles. High levels of aesthetic improvement and patient satisfaction were maintained throughout.

René Wipperich, Galderma UK&I general manager, said, “Our commitment to innovation in biologics has positioned us uniquely as the only company offering a comprehensive portfolio of three distinct neuromodulators. This milestone sets a new benchmark in enhancing the lives of patients and healthcare professionals. By leveraging our leadership in the UK through cutting-edge scientific research, the launch of Relfydess proves our dedication to delivering advanced solutions that address the needs of both patients and healthcare professionals.”

Email contact@aestheticsjournal.com to register for the webinar.

Webinar sponsored by Galderma. Content of this feature reviewed for accuracy by Galderma.

To see PI and AE reporting statements, please scan the QR code with your phone.

*This medicinal product is subject to additional monitoring.

GB-REL-2500035. DOP: May 2025

iS Clinical hosts PR launch for new Brightening Peels

Skincare company iS Clinical welcomed press and specialty guests to an intimate breakfast event on May 15 at The Lanesborough Hotel, London.

Head of engagement and relations Katie Hughes-Dawkins introduced the brand’s latest product, Extra Strength Active Peel Brightening System. Guests were then invited to learn more about the Flash Brightening Peel, a new radiance-boosting protocol featuring the new system, presented by skin specialist Nilam Holmes.

Holmes commented, “Hosting the launch event for iS Clinical’s new Extra Strength Active Peel Brightening System and the innovative Flash Brightening Peel treatment protocol was an exciting moment for both myself and my clinic. I’ve been trialling the new Flash Brightening Peel on a range of clientele, and the results have been nothing short of transformative. Clients are seeing visibly brighter, smoother skin with minimal downtime, it’s a game-changer in advanced, results-driven skincare. iS Clinical continues to lead with science-backed innovation, and I’m proud to be at the forefront of introducing these powerful new solutions to the UK market.”

News in Brief

WL Aesthetics named UK distributor for Koru Pharma

Aesthetic distributor WL Aesthetics has been appointed the UK distributor for Koru Pharma, a South Korea–based biopharmaceutical company specialising in medical aesthetics. The partnership enables UK practitioners access to a portfolio of products including medical devices, skin boosters and biostimulators. Koru Pharma’s product range includes the AVALON line of dermal fillers, the MESOHEAL Glow Series and REVERSAL, each designed to support skin regeneration and aesthetic enhancement.

IMAGE Skincare introduces new retinol range

Skincare company IMAGE Skincare has released its new AGELESS+ Retinol collection. The collection includes a series of topical treatments formulated to address common signs of ageing, including fine lines, uneven texture and pigmentation. Each product in the range incorporates varying concentrations of pure or complexed retinol (from 0.1% to 1.2%), designed to enhance retinol delivery and minimise irritation.

AestheticSource appointed as distributor for Rejuvapen NXT

Aesthetic distribution company

AestheticSource has been appointed as the official distributor for the Rejuvapen NXT, a microneedling system, in Ireland. According to the company, the system is designed to allow precise and controlled application.

Lorna Bowes, CEO of AestheticSource, commented, “We are thrilled to bring Rejuvapen NXT to the Irish aesthetics market. This next-generation microneedling device is not only effective, but also user-friendly, comfortable for patients, and highly profitable for clinics.”

Croma Pharma expands Vikki Baker’s role

Aesthetic pharmaceutical company Croma Pharma has confirmed Vikki Baker’s new role as European marketing and strategy lead. Croma Pharma shared that, in addition to her current position as head of marketing for the UK hub, Baker’s expanded role will focus on supporting Croma Pharma’s European affiliates. Baker commented, “I’m looking forward to working closely with the teams across our European markets, and delivering impactful, campaigns that resonate with both practitioners and patients.”

On The Scene

Add a new dimension to your aesthetics education.

Explore our 3D Anatomical Model on MAX. Start today.

FOR HEALTHCARE PROFESSIONALS ONLY

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

M-MA-UKI-3931 Date of Preparation May 2025

NMC Introduces Ban on Remote Prescribing

The implications of the Nursery and Midwifery Council (NMC) ruling on remote prescribing

The NMC has ruled that from June 1, 2025, independent nurse and midwife prescribers will no longer be allowed to remotely prescribe prescription-only medicines (POMs) for non-surgical cosmetic procedures, including treatments involving botulinum toxin and hyaluronidase.1

The regulatory shift follows the high-profile NMC Fitness to Practise case involving 59-year-old registered nurse Heather Hazzard, who faced serious misconduct allegations around remote prescribing and delegation in 2021.1 According to the NMC, Hazzard remotely prescribed and facilitated the distribution of botulinum toxin to unverified individuals posing as beauticians, without appropriate clinical assessment or qualification checks, breaching professional prescribing standards.1 In January 2025, after Hazzard admitted to nine charges including improper prescribing and dishonesty, the panel imposed a striking-off order citing the gravity of the case and its implications for patient safety and public trust.1,2

The ruling caused mounting concern across the aesthetics specialty and broader healthcare community from organisations such as the British Association of Medical Aesthetic Nurses (BAMAN) and the Joint Council of Cosmetic Procedures (JCCP) around the inconsistent regulation of non-surgical cosmetic procedures, particularly involving injectables and other POMs.3,4

NMC guidelines previously permitted remote prescribing of cosmetic injectables if prescribers ensured patient safety, understood patient health and followed professional standards, including adequate assessment protocols.3

However, Hazzard’s case has prompted enforcement of stricter regulatory measures. This regulatory update is expected to have a significant impact on prescribing practices within the UK’s growing medical aesthetics sector, triggering operational shifts for clinics, prescribers and cosmetic businesses alike.3,4

What is the NMC ruling?

The ruling states that from June 1, independent nurse and midwife prescribers will only be able to prescribe POMs in face-to-face consultations.3

A repeat prescription may only be issued remotely if none of the following apply:

a new medicine is being prescribed, the dosage has changed, there has been a change in the patient's medical history, an adverse event has occurred, or more than six months have passed since the last in-person consultation. In any of these cases, a further in-person consultation is required.3

Anne Trotter, NMC assistant director of education and standards, says, “Following our research and engagement, we’re confident that our updated position on the remote prescribing of non-surgical cosmetic medicines is in the best interest of public safety and protection. Nursing and midwifery prescribers provide competent and effective care to people every day. Face-to-face consultations will further improve their ability to assess people holistically and ensure non-surgical cosmetic medicines are prescribed as safely and appropriately. We’ll continue to engage without stakeholders, professionals, employers and the public as we bring this new requirement into effect.”

Consequences of remote prescribing practices

Professor David Sines, chair of the JCCP, discusses the consequences practitioners may face if they are found to be remote prescribing from June 1, stating, “We expect all nurse and midwife prescribers to consistently uphold safe and effective prescribing practices. Nurse or midwife prescribers who do not carry out a face-to-face assessment before prescribing for elective cosmetic procedures may face a fitness to practise investigation for breaching the new ruling.”

The anticipated impact

Aesthetics reached out to BAMAN to discuss the implications of the ruling. Amy Bird, nurse prescriber and chair of BAMAN, explains, “Clinics that have relied on remote prescribing relationships may face logistical and workforce adjustments. For some businesses, this will require restructuring roles or building more formal relationships with prescribers. BAMAN actively supports non-prescribing members through regional networks, education, refreshed bursary strategies and peer-led directions for medical practice (DMP) services.”

Bird adds that this ruling places further emphasis on professional regulation. “Practitioners who are not registered with

a healthcare regulator, and who have previously relied on nurses prescribing remotely, will now face significant barriers. This is a positive step in addressing inconsistencies in patient care and in limiting unsafe delegation,” she says.

Professor Sines suggests that a potential concern is the additional cost associated with obtaining a face-to-face consultation from a qualified prescriber for practitioners who do not hold a prescribing qualification. “This may lead to increased treatment costs and possible scheduling delays,” he says. He added that in the view of the JCCP, the new arrangements should not significantly hinder patient access to professional treatment services. “The NMC ruling merely brings nursing practice in line with the standards already expected of other regulated prescribers, such as doctors and dentists,” he says.

Alignment between medical councils

The General Medical Council (GMC) implemented a similar ban in 2012, prohibiting remote prescribing of injectable cosmetics without prior face-to-face assessment.4

Bird considered the recent NMC ruling an alignment between the two councils, explaining, “The NMC’s update brings aesthetic prescribing standards for nurses and midwives into closer alignment with the GMC’s 2012 policy. This harmonisation is overdue and signals a unified regulatory stance prioritising patient safety over convenience in medical aesthetic treatments.”

Bird states that they anticipate this decision may prompt the development of additional guidance for other prescribing professionals within the field of medical aesthetics.

“BAMAN continues to engage with the Department of Health and Social Care, regulators and stakeholders to promote unified standards and reduce regulatory gaps in this rapidly evolving field,” she says.

The General Dental Council (GDC) and the General Pharmaceutical Council (GPhC) also do not support remote prescribing, making the NMC the last of the regulated healthcare regulators to adopt a clear position.4-6

Moving forward

The recent NMC ruling is expected to promote safer prescribing practices, with clear accountability and serious consequences for those who fail to comply with the regulations.

RESTORATIVE SKIN COMPLEX

Restorative Skin Complex helps improve the appearance of fine lines, wrinkles, and other signs of aging, brightening the complexion for a more youthful glow.

Female, Age 48

ALASTIN Skincare™ Regimen: Gentle Cleanser, Restorative Skin Complex, Restorative Eye Complex and Ultra Nourishing Moisturizer; all products used twice daily.

The Gentle Cleanser is not available in the UK. All other products mentioned are available in the UK.

Reference: Data on file at ALASTIN Skincare™.

Individual results may vary.

Photographs are unretouched. Photos courtesy of Dr. Julia Carroll. Meet the anti-aging multi tasker Purchase exclusively from

UKI-ALA-2500036 DOP May 2025

Advertorial

Alastin Skincare

Restorative Skin Complex: Your Patients’ Antiageing Antidote from Alastin

Discover how Alastin’s Restorative Skin Complex helps visibly improve skin texture, tone and elasticity

Known as the brand of choice for peri-procedure skincare in the US1 and for scientifically-backed daily restorative skincare with over 45 publications in peer-reviewed journals, Alastin has proven popular with consumers and healthcare professionals alike. Outpacing the US economy is no mean feat, yet Alastin is growing at a rate six times that of the American market,2 and its growth story continues.

Since its launch in the UK in October 2023, Alastin has gone from strength to strength, and was recently recognised at The Aesthetics Awards 2025, receiving Highly Commended in the ever-competitive Skincare Range/Product of the Year category.

The

power of peptides

The science behind Alastin, including Restorative Skin Complex, is TriHex Technology – harnessing the power of a proprietary blend of peptides to achieve three things:4

1. Remove – Clear out the old: TriHex Technology supports the skin’s natural renewal process by clearing out old, broken-down elastin and collagen.

2. Rebuild – Room to grow: Supports the skin’s natural ability to produce new, healthy elastin and collagen fibres in the newly created space which results in visible changes to the skin surface.

3. Replenish – Maintain healthy skin: With continued use, TriHex Technology supports the replenishment of new, healthy elastin and collagen to maintain a healthy, rejuvenated appearance.

The benefits of Restorative Skin Complex

Used daily Restorative Skin Complex can help with the following:

· Improving the appearance of fine lines and wrinkles

· Restoring volume to thinning skin and improve elasticity

· Protecting the skin from further damage with antioxidants

· Target dullness and uneven skin tone

Key ingredients

The following powerhouse ingredients help the skin in a variety of ways:

· TriHex technology: A blend of active peptides and key ingredients that works with the skin to help clear out damaged elastin and collagen and support the skin’s natural ability to produce new, healthy elastin and collagen.

· Silver mushroom: Helps to provide and encourage skin hydration

· Palmitoyl dipeptide-5: Aids in maintaining the structural support of the skin.

· Acetyl hexapeptide-38 and L-Ornithine: Support healthy adipose tissue, resulting in more youthful volume.

· Phytoene, phytofluene and niacinamide: Potent antioxidants that also help to address pigmentary concerns.

In a study of 22 participants aged 45-65 using Restorative Skin Complex a gentle cleanser, light moisturiser and SPF for 12 weeks, the following results were observed:5

100% of patients agreed the appearance of their fine lines and wrinkles had improved

· 91% agreed the overall appearance of their skin improved

· 100% agreed their skin looked more youthful

*Individual results may vary. Consent from patients to sue their images obtained.

Before After

Physician endorsed. Patient preferred. Dr Jana Vogt of Mallucci Clinic in Mayfair says, “Our patients have been delighted with the results when using Restorative Skin Complex. We decided to bring Alastin into the clinic due to the science behind the brand – it is rare to find a skincare brand that delivers on a cellular level like Alastin. It is also very easy to pair this product with treatments, such as skin quality improving injectables, to enhance our results even further.”

The advertorial is written and supplied by Galderma UK

Alastin is now available to purchase from ACRE, Get Harley, Healthxchange and Medfx. If you would like to learn more about Alastin please contact regional business manager, Sara Watkins: sarah.watkins@galderma.com

Figure 1: 48-year-old female patient after using Restorative Skin Complex for 10 weeks*

Figure 2: 46-year-old male patient after using Restorative Skin Complex for 16 weeks*

Create Your Community

Join the aesthetics specialty at CCR to learn, share and thrive

In the fast-paced and ever-evolving world of medical aesthetics, success isn’t just built on clinical skill or business acumen – it thrives on connection. While many practitioners operate independently, the most fulfilling and sustainable careers are often those grounded in a strong professional community. Having a network to share knowledge, gain support and spark collaboration is vital – not only for personal development, but for elevating standards across the entire specialty.

That’s where CCR comes in. Taking place on September 25-26 at Excel London, the Clinical Cosmetic Regenerative Congress (CCR) offers a rare and invaluable opportunity to step out of your treatment room and into a buzzing hub of likeminded professionals. Whether you’re a seasoned practitioner or just starting out, CCR is the place to meet peers, reconnect with colleagues and build lasting relationships that will support your growth in the specialty.

Aesthetics Mentoring

Following its successful debut at CCR 2024, Aesthetics Mentoring returns bigger and better for 2025. Expect more mentors, more topics and even more opportunity to connect with clinical experts. One-on-one sessions will focus on delivering actionable insights to help practitioners grow their careers and scale their clinics.

Day 1

1. Meet the mentor 1

2. Meet the women in business mentors

3. Meet the business consultant/coach

Day 2

4. Meet the PR expert

5. Meet the financial advisor

6. Meet the mentor 2

Mentors will be revealed soon! Ensure you’ve registered for CCR early to get the latest updates.

Innovation Trail

Explore the latest breakthroughs in aesthetics, all in one place. The Innovation Trail offers a curated route through the CCR show floor, spotlighting cutting-edge products, services and technologies shaping the future of the specialty. It’s the perfect opportunity to connect with leading and upcoming brands, solidifying new solutions for your clinic.

Injectables Avenue

The Injectables Avenue brings together the specialty’s leading injectable brands in a dedicated space, showcasing the latest in fillers, biostimulators and advanced techniques. It’s a must-visit for practitioners looking to stay at the forefront of aesthetic treatments and learn tips and tricks from the companies themselves.

Catch up throughout the day

Headline and Networking Lounge Sponsor Galderma has created the perfect space for you to relax between the plethora of educational sessions. Enjoy a coffee and meet with friends, colleagues and peers as you catch up on your favourite learnings of the day and share the solutions you might start implementing in your clinic. VIPs will also have the chance to unwind in the VIP Lounge, by invitation only.

Networking drinks

Relax after Day 1 at the CCR Networking Drinks, hosted in the Galderma Networking Lounge. It’s the perfect chance to continue conversations with exhibitors and peers in a relaxed and sociable setting all over a glass of bubbly!

Aesthetics Connect

Start making connections before you even arrive. With Aesthetics Connect, CCR’s official app, you can schedule meetings in advance and message fellow attendees to connect.

Network with practitioners, companies and associations while at CCR and make the most out of your time on site.

Exclusive members drinks

CCR invites all Aesthetics Elite Members for drinks to network with like-minded professionals.

The Aesthetics Journal team will be here for a Meet & Greet and to discuss writing opportunities, trends and research. You can also discover more about our membership platform and get useful tips for writing your Aesthetics Awards 2026 entry.

The power of professional connection

Whether you are looking to learn from thought leaders, meet potential collaborators or simply feel part of something bigger, CCR is where the aesthetics community comes together.

Headline Sponsor Register for free NOW to create your new community in medical aesthetics.

“CCR is really informative, and is very motivating especially for new people into aesthetics. This is the place where we can just see what is available, what's out there, and to network and meet new people”

Angela Kennedy-Macfoy, dermatology nurse, OneWelbeck

“It’s a missed opportunity if you don't come to CCR, especially from a networking perspective. It's great to meet new people across the aesthetic board”

Charlotte Lewis, clinical specialist, Galderma (UK) Ltd

"CCR is one of my key calendar dates of the year. It gives me the opportunity to talk to a wide range of exhibitors under one roof and discover new and emerging products and devices.

It's also lovely to catch up with my old friends and colleagues as well as be introduced to new people – it's work and it's fun too!"

Sharon Bennett, aesthetic nurse prescriber

“I think the main thing about CCR is that it draws in almost everyone from different specialties, and not all shows do that. CCR is considered one of the best and the biggest shows”

Rosalie Nicholson, marketing manager, EMEA, Sciton

boldy copy.

Treating the Upper Eyelid with Energy Devices

Practitioners share their approaches to rejuvenating the delicate skin above the eyes

The periorbital region is one of the first areas to show visible signs of ageing. From thinning skin and volume loss to laxity and pigmentation, patients are increasingly seeking non-surgical solutions to restore a more refreshed and youthful eye area.1 For practitioners, the challenge lies in offering effective yet safe interventions for a region that is notoriously delicate, anatomically complex and highly expressive.

This article explores the clinical considerations, patient presentations and emerging technologies being used to treat the upper eyelid area with energy-based device – highlighting approaches that balance efficacy with safety and natural-looking results.

Understanding periorbital concerns

According to the practitioners interviewed, the most common complaints from patients include hooded or heavy upper lids, skin laxity, fine lines, crepiness, volume loss and pigmentation. “Some are bothered by asymmetry or heaviness that creates a tired or aged appearance,” says aesthetic practitioner Dr Ravi Jain, adding, “Others complain of difficulty applying makeup or believe that their eyelids make them look older than they feel.”

Aesthetic practitioner and pharmacist Mohamed Harb agrees, noting that while patients may not articulate their concerns in clinical terms, they are often deeply aware of the impact on their appearance. “They link the eyelid area very strongly with ageing,” he explains. “Even if they can’t define the problem, they know something’s changed.”

Ms Priya Udani, a consultant ophthalmic and oculoplastic surgeon, observes that these concerns frequently emerge around the perimenopausal period. “As we know, this is when collagen degradation accelerates.2 I see a lot of women at that stage who have experienced sun damage or hormonal skin changes, particularly in Fitzpatrick types II-III,” she says.

“You must evaluate the full upper third – brow, forehead, temple. Only then can you understand what’s driving the eyelid change”

Dr Ravi Jain

Causes of upper eyelid ageing

Ageing in the upper eyelid is multifactorial, Dr Jain explains, “Collagen and elastin breakdown, fat pad descent, skin thinning and bone resorption around the orbit all contribute. Environmental factors – sun exposure, smoking, poor sleep and genetics – also play a role.”3

Ms Udani adds that mechanical influences also accelerate the problem. “Contact lens wearers, those who apply heavy makeup or false lashes, or people with histories of eyelid swelling or allergies – these habits and conditions stretch the tissue. The eyelid isn’t meant to swell or stretch repeatedly, and once that dermal integrity goes, it’s hard to regain,” she says.

Anatomical considerations

The upper eyelid features some of the thinnest skin on the body, ranging from just 0.3-0.5mm. It has little subcutaneous fat and sits close to sensitive structures like the globe, levator aponeurosis and the orbicularis oculi muscle.4

All practitioners interviewed stress the need for precise and thorough clinical evaluation. Harb performs a pinch test to assess skin elasticity and determine if collagen stimulation may help. He notes, “If the skin recovers slowly, we know it’s a collagen and elastin issue – great for energy treatments. But if we’re dealing with excess skin or a prolapsed fat pad, surgery might be the only answer.”

While some anatomical features can be assessed through direct observation, others may require diagnostic tools or imaging devices. Ms Udani uses advanced imaging with OBSERV 520x to assess lid texture, dryness and skin health. “You’ve got to look at everything – the position of the brow, the dermal thickness, even dry eye symptoms. Upper eyelid concerns rarely exist in isolation,” she explains

Dr Jain echoes this, saying, “You must evaluate the full upper third – brow, forehead, temple. Only then can you understand what’s driving the eyelid change.”

Choosing the right treatment modality

Treatment of the upper eyelid requires a multifaceted approach, tailored to both the cause and severity of the concern. Practitioners should also take a full medical history to ensure they rule out any potential contraindications to particular treatments and brands of products. The options span from conservative skincare to surgical intervention, with non-surgical energy-based devices occupying a valuable middle ground.

Topical treatments

Peptides, retinoids and antioxidant-based serums can improve superficial skin quality, particularly when used preventatively or as adjuncts to in-clinic procedures. These can help reduce fine lines, support hydration and prepare the skin for more intensive treatments.5

Injectables

Injectables offer additional tools for rejuvenation. Neuromodulators may be used to subtly lift the brow and relieve downward pull, while dermal fillers can restore lost volume in the upper lid or brow area, improving contour and support.6

Biostimulatory injectables, such as polynucleotides or platelet-rich plasma (PRP), are also used to enhance dermal density and stimulate regeneration.1

Laser resurfacing

Laser resurfacing techniques, including fractional and fully ablative options, are employed to treat skin laxity, texture irregularities and pigmentation. These treatments deliver heat to stimulate collagen production and improve overall skin tone,6 though downtime and risks can vary depending on the depth and modality chosen.7

Radiofrequency

Radiofrequency (RF) devices deliver controlled thermal energy to the dermis, stimulating collagen contraction and neocollagenesis without damaging the epidermis.8 This makes RF suitable for addressing upper eyelid skin laxity, fine lines and mild textural irregularities. Bipolar systems focus energy superficially between two electrodes, while monopolar devices allow for deeper penetration using a grounding pad.8,9

Surgery

In more advanced cases of periorbital concerns, or where anatomical features like fat pad herniation or significant skin excess are present, surgical blepharoplasty remains the gold standard.10 Surgery can deliver more dramatic and lasting results, but many patients prefer to explore non-surgical alternatives first.10

Energy-based devices

It is within this context that energy-based devices have become an increasingly important option. These technologies –such as radiofrequency and non-ablative or fractional lasers – bridge the gap between injectables and surgery. They work by stimulating collagen and elastin synthesis, tightening skin and improving tone and texture,10 often with minimal downtime and low risk profiles.11

With a wide range of energy-based technologies available, selecting the right device and protocol depends on patient needs, skin type and practitioner expertise. Each practitioner emphasises the importance of using devices with a strong safety profile and specific suitability for the upper eyelid.

Here they share how they apply energy-based treatments for upper eyelid rejuvenation – highlighting their preferred approaches, treatment plans and outcomes.

Harb: Sylfirm X

Sylfirm X is a dual-wave RF microneedling system that features both continuous wave (CW) and pulsed wave (PW) modes in a single device.12 This allows practitioners to tailor treatments for vascular lesions and general skin rejuvenation. The microneedles deliver bipolar RF energy at controlled depths of 0.3-4.0mm, inducing thermal stimulation of fibroblasts while preserving the epidermis through precision delivery.13

“It’s the only RF microneedling platform I trust on the eyelids,” says Harb. “Due to the ultra-short pulse duration and stable plasma energy, the thermal spread is minimal and precise – you don’t need eye shields, which speaks volumes about its safety.”12

In practice, Harb performs full-face treatment, including the upper eyelid, with sessions spaced four weeks apart. He begins by prepping the skin with Alastin Skin Nectar, a peptide-based topical designed to support extracellular matrix turnover and fibroblast priming.14 “It clears senescent cells and reduces oxidative stress,” he explains. “That means the skin responds better to energy treatments.”

Immediately post treatment, Harb applies NCTF 135HA skin boosters, which contain hyaluronic acid, vitamins, amino acids and antioxidants. “This boosts hydration

and enhances the regenerative process,” he says. “Patients see improvements in texture, tone and elasticity – especially those who prefer to avoid injectables.”15

He adds that the device’s Selective Regional Regeneration Radio Repeated Pulse (SRRRP) mode is especially beneficial for periorbital skin, delivering energy safely at a lower voltage with fewer side effects.13

Ms Udani: Forma-I

Forma-I is a bipolar radiofrequency device for the treatment of periorbital tissues, including both upper and lower eyelids. Unlike monopolar RF, which requires a grounding pad, bipolar RF delivers current between two closely spaced electrodes, focusing energy in the superficial dermis without penetrating deeply into orbital structures. This eliminates the need for corneal shields during treatment.16

“It’s an incredibly safe and operator-friendly tool,” says Ms Udani. “The real-time thermal feedback ensures we remain in the therapeutic range – typically around 41-43°C for collagen contraction – without risking burns or overtreatment,”16 she adds. Forma-I treatment lasts 10 minutes per eye, and is repeated every two weeks for a total of three to four sessions, followed by six-monthly maintenance.16

Patients typically experience no downtime. “You just apply an inert gliding gel to facilitate conduction,” says Ms Udani, adding, “There’s no prep needed. It feels like a warm massage – many patients even fall asleep during treatment.”16

The main mechanism of action is collagen denaturation and neocollagenesis, resulting in tighter, smoother skin and reduced fine lines over eight to 12 weeks.8

Dr Jain: Cool Laser

Dr Jain’s approach features the Asclepion Dermablate (Cool Laser), a 2,940 nm Er:YAG laser, delivering thermal energy with extremely high absorption in water

Figure 1: Before and after two sessions of Sylfirm X and NCTF treatment. Images show full face and close up of periorbital area. Images courtesy of Mohamed Harb.

Figure 2: Before and after two treatment sessions with Cool Laser – one strong and one mild. Images courtesy of Dr Ravi Jain.

– minimising collateral damage to surrounding tissues.17 Unlike CO2 lasers, which penetrate more deeply and carry a higher risk of pigmentary changes, Er:YAG ablates tissue precisely in micron layers, making it ideal for treating thin, sensitive areas such as the upper eyelid.18

Dr Jain uses both fractional and fully ablative settings depending on patient need. “For light resurfacing, no anaesthetic is needed,” he explains. “But for full ablation, I use 23% Lidocaine and 7% tetracaine from Roseway Labs, along with sterile ocular shields lubricated with chloramphenicol ointment.”

Treatment involves a full pass across the upper eyelid and periorbital area, focused on tightening and textural improvement. “A secondary fractional pass is then conducted to provide deeper remodelling and blending,” says Dr Jain.

Post treatment, he applies Revision CMT Complex to reduce heat sensation and inflammation,19 followed by Neova Copper Recovery Balm to support epidermal healing and barrier repair.20 “I also advise using Alastin Nectar post procedure to accelerate tissue recovery,”21 he adds.

Importantly, the Cool Laser’s minimal thermal diffusion makes it suitable for Fitzpatrick IV–V patients, significantly reducing the risk of post-inflammatory hyperpigmentation (PIH) compared to CO2 systems.22

Expected results and patient feedback

All practitioners report strong patient satisfaction across devices. Dr Jain notes that improvements following Cool Laser continue for up to six months post treatment as collagen matures.17 “Skin is tighter, smoother, with less crepiness and fine lines. Patients often tell me makeup applies better and they feel more confident,” he says.

Harb shares a case of a woman in her 60s who saw significant improvement after just two Sylfirm X sessions, “Her upper and lower lids were visibly firmer. She looked refreshed but completely natural – like herself on a great day.”

Ms Udani finds Forma-I particularly effective in reducing lid heaviness and fine lines in patients with early skin laxity. “It also seems to help with dryness and lid inflammation, so symptomatically patients feel better too,” she adds.

Side effects and risks

The practitioners emphasise that energy-based eyelid treatments are generally well tolerated when applied conservatively and with appropriate training. They explain:

Common side effects include:

· Redness and mild swelling (one to three days)9,12,14

Dryness or flaking8

· Sunburn-like sensation10

Less common risks:

Post-inflammatory hyperpigmentation22

· Scarring or hypopigmentation with excessive settings7

· Eye irritation if ocular protection is inadequate7

· Infection (rare with sterile technique)8

“Always start conservatively,” advises Dr Jain. “Less is more in this area. With the right settings and protocols, side effects are minimal and manageable,” he adds.

Other considerations

The practitioners interviewed shared several important clinical strategies to ensure safe, effective and aesthetically pleasing outcomes when treating the upper eyelid with energy-based devices.

With a wide range of energy-based technologies available, selecting the right device and protocol depends on patient needs, skin type and practitioner expertise

Dr Jain stresses the importance of technique, advising that laser or RF passes should always slightly overlap to ensure smooth blending across anatomical zones. This approach helps avoid visible lines of demarcation and ensures a natural finish.

He also cautions against letting the eyelids dry out during the healing phase. Maintaining a moist wound-healing environment is essential for optimising recovery, reducing discomfort and supporting healthy skin regeneration.

For patients with darker skin types, all practitioners agree that conservative energy settings are critical. Using lower intensities helps minimise the risk of PIH, a concern particularly relevant in Fitzpatrick types IV-VI.22

Another shared recommendation is to counsel patients on the importance of ongoing sun protection. They also emphasise that even the eyelids should be shielded with sunscreen to prevent photoageing and reduce the chance of pigmentation recurrence after treatment.

Ms Udani highlights a vital clinical safety consideration, emphasising the need for practitioners to have a clearly defined referral pathway. “Practitioners need to know their referral pathway – what to do if something goes wrong, and when to involve oculoplastics,” she says. “This is a high-stakes anatomical area.”

Beyond clinical care, Dr Harb underscores the value of patient education and marketing. He encourages clinics to showcase before-and-after imagery and share patient testimonials. “Many people don’t realise non-surgical eyelid options exist,” he explains. “Educating them makes a huge difference.”

Key takeaways

The practitioners agree that upper eyelid rejuvenation requires a nuanced understanding of anatomy, ageing mechanisms and patient goals. Energy-based devices now offer a range of effective, non-surgical solutions for treating this delicate area – but results depend on personalised planning, conservative technique and a multimodal mindset.

As Dr Jain concludes, “It is rarely just about the eyelids. You need to assess the entire upper third – brow position, forehead lines, temple volume and skin quality. Strategic combination treatments deliver the most natural, lasting results.”

Reviewing Antiseptic Skin Preparation in Aesthetics

Dr Alison Colville and Professor Valerie Edwards-Jones explore the role of antiseptic practices in medical aesthetics

The skin and mucous membranes form the body’s protective barrier, and if this defence is breached by pathogens, they can reach subcutaneous tissue, muscle, bone and body cavities.1 With both aesthetic procedures and antibiotic resistance on the rise, good skin disinfection to reduce the risk of infection is more vital than ever. 2-4 Along with ongoing issues with antibiotic resistance, there is a growing need to reduce the risk of microbial-associated complications, so attention to appropriate skin disinfection during all stages of aesthetic procedures is key.5

A recent study showed that Pseudomonas, Staphylococcus and Propionibacterium were all cultured following administration of hyaluronic acid (HA), polyacrylamide gel, poly-L-lactic acid (PLLA) and calcium hydroxyapatite microspheres into the subdermis.5 Various studies referenced throughout this article have also discovered that once a biofilm is established, treatment with high dose antibiotics is often unable to eradicate the infection.6,7

The desirable traits of a good skin decontaminant are that it can effectively remove the contaminant of interest, is readily available, acts rapidly, does not enhance percutaneous penetration or absorption of the contaminant, can be readily removed without residue and does not damage the skin.8

This article will explore the skin microbiome, microbial-linked complications in non-surgical medical aesthetics, the advantages and disadvantages of each antiseptic formulation and the current evidence and recommendations for use in the specialty.

The role of microbes in filler complications

Any injectable treatment, by nature, compromises the skin barrier and therefore risks introducing unwanted bacteria into the subdermal tissues.9 This is of particular concern when placing foreign body devices such as soft tissue dermal fillers into the tissues.10

Complications reported following the application of soft tissue fillers include infection, delayed inflammatory nodule formation, granulomatous reactions, pigmentary changes, hypersensitivity reactions, vascular occlusion and, rarely, blindness.10 As is explained in this article, all of these complications can be further complicated by secondary infection.10

Acute

onset, microbial-linked complications

Infection

There is currently no universal reporting system in place to collate accurate data regarding dermal filler infection rates.11 This is compounded by practitioners’ reluctance to report complications due to the perception that doing so may negatively impact their reputation, giving rise to the likelihood of inaccurate data on infection rates associated with dermal fillers.12

The literature supports the fact that most common infections arise when skin contaminants infiltrate the site of injection during treatment, suggesting that inadequate skin disinfection prior to injecting plays a significant role in the spread of infection.11,13 Symptoms of acute infection typically develop over three to seven

days, and include redness, heat, pain, inflammation and swelling.11

Acute infections can present as a localised skin infection, deeper cellulitis or abscess formation. A nodule or pustule may form, and systemic symptoms of infection may also be present.14

Early infection post dermal filler is typically due to a low-grade bacterial infection from skin microorganisms such as Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium spp. that invade the injection site from the skin.11

Any injectable treatment compromises the skin barrier and risks introducing unwanted bacteria into the subdermal tissues

Delayed onset, microbial-linked complications

Biofilms

There is a growing body of evidence to support that complications once thought to be of an immunogenic nature are in fact related to forms of low-grade infection. To understand this further, we must understand the new concept of the formation of biofilms, which are now thought to be responsible for delayed onset complications after soft tissue filler treatments.5 It is now accepted that a biofilm infection is the leading cause of device associated infections, and not due to allergies or other inflammatory responses.6,15

A biofilm is a group of microorganisms in which cells stick to each other in a three-dimensional structure, on a given surface.6 Usually the biofilm is covered by a self-produced polymeric substance.6 In a biofilm, the cell metabolism shuts down, leaving it in a dormant state, thus making it unresponsive to antibiotics and difficult to culture in vitro.7

Biofilms can contain many different types of microorganisms, such as bacteria, protozoa and fungi, and can exist for a long period of time in a dormant state.6,7 Reactivation of infection can be triggered by trauma such as more dermal filler being injected close to the biofilm, dental treatments, haematogenic infection or iatrogenic manipulation.6 A biofilm may also form around an infection focus, particularly when a patient is administered inadequate doses of antibiotics.7

A recent study testing both temporary (HA) and semi-permanent forms of fillers/biostimulatory agents (PLLA, calcium hydroxyapatite) concluded with ‘solid evidence’ that ‘tissue filler gels support the growth of bacteria into clusters known as biofilms’, and that these might be the cause of most adverse events seen.5

Delayed onset nodules

A delayed onset nodule may be a visible or palpable mass, at or close to the injection site of dermal filler. They may present as nodules, indurations, type 4 delayed hypersensitivity reactions, abscesses or granulomas. Symptoms can present weeks or months post injection.16 Granuloma

Granuloma is considered a form of chronic inflammation that occurs in response to foreign material that cannot be phagocytosed by macrophages.17 Histopathological analysis typically shows a collection of foreign bodies, inside or outside inflammatory cells, surrounded and embedded in a connective and fibrotic tissue.17

Non-granulomatous nodules

Non-granulomatous nodules are an inert accumulation of a foreign body without an inflammatory reaction. Some may present as fibrotic tissues that could be induced by any filler, but their characteristics are different from granuloma.17

Management of delayed onset complications

In a novel mouse study, it was found that even low numbers of contaminating bacteria were sufficient for a tolerant biofilm to form around various forms of dermal filler preparations subdermally.5 Both steroids and late-initiated antibiotic treatments (including combinations) were not effective in eradicating these.5 Therefore, it is no longer recommended to use steroids or NSAIDs unless after a course of antibiotics where reassessed and deemed to be necessary.18 Notably, microbiological cultures are usually negative due to the biofilm being ‘dormant’, surrounded by a polymeric substance.5

A successful therapeutic plan may include broad-spectrum antibiotics like flucloxacillin, ciprofloxacin, amoxicillin or clarithromycin for up to six weeks.18-20 An important therapeutical measure is the use of hyaluronidase to remove the HA. Conforming to the theory of ‘no foreign substance, no biofilm’, the lyses of the HA gel will destroy the mechanical support of the biofilm colony, and therefore the problem will no longer exist.18

To prevent such infections, a strict aseptic technique with thorough skin

decontamination and consideration of antibiotic prophylaxis where appropriate should be practised.5

The skin microbiome

It is important to understand the purpose of the skin microbiome (SM) when considering a skin disinfection formulation, as not all preparations support the microbiome.1

The SM is a diverse community of microorganisms, including bacteria, viruses, fungi and demodex species. 21 Different areas of the human body have a variety of physiological and biochemical conditions (moisture, sebum, hair follicles) and as such create a variation of habitats, thus altering the microbiome and creating specific populations. 21 The density of bacteria in the SM is second only to the gut, with approximately 104 to 106 bacteria per cm2, with more than 200 different genera characterised. 20

The key roles for the SM is maintaining homeostasis, inhibiting pathogens and regulating epidermal differentiation. 22 The SM is usually unique for an individual, and contains microorganisms which do not normally cause infection, known as their commensal or normal skin flora.9 Most of the SM remains stable, however, transient microorganisms can colonise niches when the skin is compromised, such as during injectable procedures. 23

Various procedures and products affecting the skin’s surface within the aesthetics field can change the integrity of the skin microbiome, such as chemical skin peels, microneedling and laser procedures to name a few.9 Maintaining its integrity during topical as well as injectable procedures is crucial to prevent unwanted infections from external pathogens (e.g. Staphylococcus aureus), which can produce virulence factors that mediate invasion into deeper parts of the skin structure.9

Common skin antiseptics in aesthetics

Skin disinfection is a process that involves the topical application of a disinfectant to the entire area, not just the site of injection, to reduce the levels of microorganisms prior to a procedure that breaches the skin.1 It is important to note that it is impossible to entirely sterilise the skin, as 20% of the bacteria is located in the deeper layers. 24

Common antiseptics for cutaneous preparation include isopropyl alcohol, povidone-iodine, chlorhexidine and, most recently, hypochlorous acid (HCOl). 25 It is important to note that sodium hypochlorite is a widely used disinfectant for cleaning inanimate surfaces, but should not be confused with the purified HCOl safe for use on human skin and mucus membranes. 28

Understanding why you choose a specific antiseptic is vital so that your aesthetic procedures are carried out with the lowest risk of complications possible ( Table 1 ).

Alcohol

For use as a skin disinfectant, alcohol is available either as ethanol, or more commonly, isopropyl alcohol.1 This is a structured isomer of propranolol, that can be produced by combining water and propene. 27 It is a clear and flammable liquid that has a moderate evaporation rate.

In the EU, it is approved for use in cosmetics as a solvent, an antifoaming agent, a perfuming agent and a viscosity controller. In light of its antimicrobial activity (which includes multidrug-resistant pathogens, mycobacterium tuberculosis and a variety of fungi), isopropyl alcohol is accepted as a preservative, and as an antiseptic in the clinical environment. 28 It is quick acting and evaporates from the skin rapidly, leaving no residue on the skin.8

Hypochlorous acid acts quickly, often achieving a three-log reduction (99.9% kill) of bacteria within seconds of contact

Alcohol, however, may cause irritation, and has been reported to cause severe ocular burns in the cornea and the thin skin around the eyes. 29 Although frequently used in hand rubs and pre-injection swabs, it is more effective as a pre-procedure skin disinfectant when combined with either povidone iodine or chlorhexidine gluconate.1

Chlorhexidine

Chlorhexidine is a divalent, cationic biguanide antiseptic agent that was first described in 1954. 30 It acts by binding to the negatively charged bacterial cell wall and affecting the osmotic equilibrium of the cell. 31 It is available for use in aqueous form, combined with 70% alcohol, and has been used in preparations for hand cleansing, both general and pre-surgical, for many years.

Chlorhexidine is the preferred choice in surgical skin preparation, offering rapid efficacy against a wide range of gram positive and negative bacteria, yeast, fungi and viruses, and provides a sustained antiseptic effect for up to six hours post application.10 It is also quick drying and easy to apply.10

Unfortunately, it has a number of side effects including allergy and anaphylaxis, dermatitis, corneal damage, respiratory irritation and a risk of deafness with damage to the middle ear.1,25 Although the precise prevalence of chlorhexidine allergy is unclear, the numbers of case reports describing such allergy have recently increased, especially in the peri-operative setting. 33 Adverse reactions to chlorhexidine involve both immediate and non-immediate hypersensitivity, ranging from mild cutaneous reactions to anaphylaxis or death. 34

Iodine

A traditional surgical skin antiseptic, povidone-iodine has a rapid onset and is effective against gram positive and gram negative bacteria, viruses, fungi and spores.1,25 Also advantageous is that bacteria do not develop resistance against povidone-iodine.1

The microbicidal activity of iodine appears to involve the inhibition of vital bacterial cellular mechanisms and structures, and oxidises nucleotides fatty/amino acids in bacterial cell membranes. In addition, cytosolic enzymes are involved in the respiratory chain, causing them to become denatured and deactivated. 2,34 The combination of alcohol and iodine has demonstrated good effectiveness in comparison to alcohol alone, which may be a result of the immediate germicidal action of alcohol and the residual activity of iodine. 2,35

Povidone-iodine is neutralised by contact with blood or sputum which affects the longevity of the antisepsis. It can also cause skin irritation, allergy and excessive staining of skin, hair and clothing.1,25

Hypochlorous acid

Hypochlorous acid is a weak acid and powerful oxidant. It is naturally produced by neutrophils generating HCOl from hydrogen peroxide and chloride, forming an important part of the innate immune response. 23,36

It is a well-tolerated antiseptic, and has demonstrable antimicrobial and wound-healing properties without cytotoxicity. 37 It has a broad spectrum of activity against a range of bacteria, viruses and fungi. 37 It acts quickly, often achieving a three-log reduction (99.9% kill) of bacteria within seconds of contact. 38

HCOl has advantages for skin asepsis, including a well-tolerated non-alcoholic base, efficacy in reducing microbial loads and benefits of specific preparations for perioral and periocular asepsis. 25 It has also been demonstrated to promote re-epithelialisation in wound healing, with low cytotoxicity to keratinocytes and fibroblasts.18

Recent work has highlighted its anti-inflammatory properties via modulation of the NF-kbeta signalling pathway and downregulation of inflammatory cytokines. Reports have discussed its application for the management of various inflammatory skin conditions, including atopic dermatitis and psoriasis.18,38 Dermatologic applications include infection prevention, wound care and scar management, inflammatory modulation, treatment in atopic dermatitis and pruritus.18

A comparison study undertaken in 2018 showed that 0.01% HCOl had equal or greater efficacy compared to povidone-iodine, chlorhexidine gluconate and 70% iso-propyl alcohol against methicillin-resistant S. aureus and S. epidermidis; methicillin-susceptible S. aureus, S. epidermidis and S. capitis; and S. pyogenes, P. aeruginosa, C. acnes, C. albicans and S. xylosus. 37 In another study, it was shown to be less cytotoxic than other commonly used skin preparation products by measuring neutral red uptake by primary human dermal fibroblasts, and also had an improved effect on biofilms. 39

There is concern about the disruption of the skin microbiome following skin preparation. A recent study suggested that with HCOl use, the resident commensal bacteria in the area of skin is not eliminated, unlike other preparations e.g. alcohol/ chlorhexidine.40 There is increasing evidence for HCOl in supporting wound healing.41,42 Therefore, it is likely to support any procedure which impacts the skin barrier e.g. microneedling, laser procedures, chemical peels etc.

Until recently, HCOl faced a problem regarding stability and durability, resulting in a rapid loss of efficacy.43 Production of stable HOCl solution requires formulation in pure water, harbouring concentrations as low as possible of various compounds and ions, as well as storage in dark and cool conditions (<10 0 C) to maintain the concentration of HOCl molecules and microbicidal activity.44 When formulated into a spray, instability through aerosolisation needs to also be considered and factored into an effective product.45

It is important to establish that the brand of HCOl solution you choose is stable. Consider enquiring into the manufacturing process and request the manufacturer's purity and stability data, preferably through independent testing.

Review

of current evidence

In 2020, a consensus group of five UK aesthetic clinicians convened to discuss current best practice for aseptic techniques in aesthetics.10 Following a review of available evidence, they concluded that HCOl solution was ‘advantageous for skin asepsis and has demonstrated benefit with appropriate preparations for perioral and periocular asepsis’.10

Aesthetics Complication Expert (ACE) Group World has made specific recommendations following a review of the advantages and disadvantages of the various antiseptics in use in aesthetics procedures, recommending, ‘skin disinfected with a HCOl based product (before, during and after procedure)’.1

Complications in Medical Aesthetics Collaborative (CMAC) does not recommend any specific type of antiseptic, but recommends considering each patient’s individual case based on the advantages and disadvantages of each preparation.20 The organisation specifically recommends against the use of alcohol alone as an antiseptic when performing dermal filler treatments due to its lack of residual effect.20

With both aesthetic procedures and antibiotic resistance on the rise,

Questions

Test your knowledge!

Complete the multiple-choice questions and email memberships@aestheticsjournal.com to receive your CPD certificate!

Possible answers

1. Which of the following is NOT considered a desirable trait of a skin decontaminant used in non-surgical aesthetic procedures?

2. Which of the following statements best describes a biofilm in the context of dermal filler complications?

a. Rapid action

b. Enhancement of percutaneous absorption

c. Ease of removal without residue

d. Non-damaging to skin

a. A transient hypersensitivity reaction caused by over-disinfection of the skin

b. A visible layer of contaminants on the surface of the skin

c. A dormant cluster of microorganisms encased in a self-produced polymeric matrix

d. A fibrotic reaction to hyaluronic acid caused by immune sensitisation

a. Biofilms are easily cultured in vitro due to their active bacterial metabolism

3. Which of the following statements about biofilms is true?

The most recent and relevant National Institute for Health and Care Excellence (NICE) guidance does not mention HCOl.46 When looking at surgical procedures, it recommends an alcohol-based solution of chlorhexidine as the first choice when deciding which antiseptic preparation, yet highlights that considerations are to be taken into account with chlorhexidine due to hypersensitivity and anaphylaxis, and quoted hypersensitivity as a ‘major concern’.46

Whilst specific research into the use of HCOl as an antiseptic in aesthetics is lacking due to its novelty, it shows good efficacy and safety data thus far.

Promoting safer practice

Aseptic technique is under the control of aesthetic practitioners, and can be modified to minimise the potential for cross-contamination and infection.10 This should be a key consideration in all procedures, particularly those involving breach of the skin’s natural defences and the use of soft tissue filler.10

The introduction of HCOl as a skin disinfectant in the field of aesthetics is a major advance of the 21st century.12 There is a need for specific evidence of HCOl use in the field of non-surgical aesthetics, and subsequently to set robust guidelines for safer skin antisepsis. Following a review of current guidance and evidence, HCOl formulations can be concluded as the recommended choice for skin antisepsis in non-surgical aesthetic procedures.

4. What is the most appropriate management strategy for a delayed onset nodule suspected to be associated with a biofilm?

b. Once formed, biofilms are highly responsive to standard antibiotic therapy

c. Biofilms form only around permanent dermal fillers

d. Biofilms can exist in a dormant state and resist both host immunity and antibiotics

a. Immediate administration of steroids and NSAIDs

b. High-dose antibiotics alone for a minimum of two weeks

c. Hyaluronidase to degrade the filler, followed by broad-spectrum antibiotics

d. Surgical excision of the affected area

a. It is ineffective against gram-positive bacteria

5. Which of the following is a recognised limitation of povidone-iodine in clinical practice?

b. It increases the risk of antimicrobial resistance

c. Its efficacy is reduced in the presence of blood or sputum

d. It has no staining potential on skin or clothing

Answers: B, C, D, C, C

Dr Alison Colville is a GP and medical director of The Avery Clinic in Leamington Spa. She is a clinical advisor for Clinisept, trainer and brand ambassador for Revanesse and keen educator, mentor and public speaker. Dr Colville combines clinical precision with artistic sensibility to champion safe, evidence-based medical aesthetic practice.

Qual: MBChB, MRCGP, PgDipAes

Professor Valerie Edwards-Jones is a UK microbiologist with more than 45 years’ experience spanning NHS diagnostics, academic research and consultancy. Emeritus professor at Manchester Metropolitan University, she specialises in wound infections and antimicrobial resistance. She has contributed significantly to the study of wound infections, antimicrobial resistance and the development of alternative antimicrobial therapies.

Qual: PhD, CSci, FIBMS

Where science meets longevity

Educating healthcare professionals on evidence-based functional, integrative, holistic, lifestyle, and wellness treatments.

Promoting the concept of healthy longevity, emphasising healthspan over lifespan in the specialty.

Shifting the focus from treatment to prevention, supporting longer, healthier, and more fulfilling lives.

Evolving Aesthetics with Nuceiva® (botulinum toxin type A)

Precision, Purity and Performance

Let’s talk about precision in medical aesthetics. Whether you’re an experienced practitioner or new to the field, you know how critical precision is for delivering patient satisfaction.

Discover Nuceiva® (botulinum toxin type A) — a neuromodulator that’s designed for precision. Nuceiva® is indicated for the temporary improvement in the appearance of moderate to severe vertical lines between the eyebrows seen at maximum frown (glabellar lines), when the severity of the above facial lines has an important psychological impact in adults below 65 years of age.1

As readers will know, Nuceiva® should only be administered by healthcare practitioners with appropriate qualifications and expertise in the treatment of glabellar lines and the use of required equipment.

Designed for Precision

It starts with the patented Hi-Pure™ technology. This unique manufacturing process yields a product that is ≥95% pure.2* That’s not just a claim; it’s backed by a rigorous manufacturing method.

See Prescribing Information (QR Code) for Side Effects, Contraindications, Warnings, Precautions and local and distant spread of toxin effects.

Adverse reactions possibly related to the spread of toxin distant from the site of administration have been reported very rarely with botulinum toxin. Swallowing and breathing difficulties are serious and can result in death. Injection of this medicine is not recommended in patients with a history of dysphagia and aspiration. Patients or caregivers should be advised to seek immediate medical care if swallowing, speech or respiratory disorders arise. Keep out of the sight and reach of children.

• The Hi-PureTM technology reduces impurities by utilising a series of anion exchange chromatography columns that absorb process-related and product-related impurities, while allowing the drug substance to flow through for collection2

• The process defines the product: The process combines Hi-PureTM technology with vacuum drying to optimise the final product quality and produce a precise product2

• Nuceiva® is a unique neuromodulator1 As with every botulinum neuromodulator, Nuceiva is unique and not interchangeable1

What’s in the vial?

Each vial of Nuceiva® contains 50 units of botulinum toxin typeA, derived from Clostridium botulinum, along with human albumin and sodium chloride.1 No preservatives, no unnecessary additives — just a simple, precise formula. Simply store unopened vials at 2-8oC to maintain effectiveness (shelf-life 30 months).1

The Nuceiva® PRESCRIBING INFORMATION can be accessed by scanning the QR code below. May 2025 GB-P-2500033

Legal Classification: POM

List price: 50 units powder for solution for injection per vial: £75.50

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It’s all about your precise technique. Neuromodulators require precise intramuscular injection techniques to target the correct glabellar muscles and deliver the desired clinical results.1 Check in with your Evolus team for details of our latest training events.

This is where your skills meet the science to achieve patient satisfaction.

In a study, just over 94% of Nuceiva patients expressed a positive response (improved or much improved) at 30 days after treatment.3 And let’s not overlook safety. According to the label, Nuceiva® generally has a 1% rate of eyelid ptosis.1

As a practitioner, you have options. So why choose Nuceiva®? The answer lies in its combination of precision and patient satisfaction.

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References

1. Nuceiva SmPC (accessed March 2025)

2. Daewoong Method for production of botulinum toxin. Accessed May 2024. https://patents.google.com /patent/US9512418B2/en

3.Rzany B, et al. Aesthet Surg J. 2020;40(4):413-429

*Purity specification of botulinum toxin type A

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Restoring the Temple with Dermal Filler

Dr Bethany Rossington explores the ageing temple and different approaches to restore it

Temple hollowing is a hallmark of facial ageing that is often overlooked, but plays a critical role in the overall perception of youthfulness and facial harmony. Restoration of volume loss in this region with hyaluronic acid (HA) fillers can significantly improve the upper face’s contour, framing the orbital area and balancing lateral facial projection.1

Despite being a high-impact treatment, the temples remain one of the more technically challenging areas to treat safely, requiring a thorough understanding of anatomy, ageing changes and injection technique.2

This article explores current popular temple filler approaches, including practical insights into cannula use, the ‘one up and one over’ (or ‘gunshot’) technique and the emerging role of ultrasound in treatment planning.

Anatomy of the temple

Understanding the intricate anatomy of the temporal region is paramount to performing safe and effective filler injections. The temple is defined superiorly by the temporal suture, inferiorly by the zygomatic arch, laterally by occipital boundary of the temporalis and anteriorly by the lateral orbital margin.3

It is comprised of several layers (Figure 1), which from superficial to deep are:3,4

Layer 1 – Skin

Layer 2 – Subcutaneous fat/superficial fatty layer

Layer 3 – Superficial temporal fascia

Layer 4 – Temporal fat pad/deep fat pad of the temple (continuous with loose areolar tissue of the scalp)

Layer 5 – Deep temporal fascia, divided into superficial and deep layers, containing the superficial temporal fat pad

Layer 6 – Superficial temporal fat pad (located between the two laminae of the deep temporal fascia)

Layer 7 – Deep lamina of the deep temporal fascia

Layer 8 – Deep temporal fat pad (sometimes referred to as the temporal extension of the buccal fat pad or Bichat’s fat pad)

Layer 9 – Temporalis muscle

Layer 10 – Periosteum

The region is supplied by the superficial temporal artery (the smaller terminal branch of the external carotid artery) and the deep temporal artery (a branch of the maxillary artery, the larger terminal branch of the external carotid artery). The superficial temporal arteries and veins reside at the intermediate depth of the superficial temporal fascia. The middle temporal vein also traverses this region and can represent a significant vascular structure during injections. The deep temporal fascia acts as a protective barrier separating superficial structures from the deep temporal fat pad and the temporalis muscle below. The temporalis muscle contains both the anterior and posterior deep temporal arteries above the periosteum. The periosteum contains a rich network of small-sized arteries.1,5,6 Numerous veins drain into the middle temporal vein, which anastomoses with the superficial temporal vein above the zygomatic arch, connecting with the cavernous sinus through the periorbital veins.6 Therefore, in the unfortunate event of intravenous injection, there is a risk of embolisation in the cavernous sinus.6 Key vascular considerations include the risk of intravascular injection leading to embolic events, particularly given anastomoses with the ophthalmic circulation. The superficial temporal artery, despite being a branch of the external carotid artery, anastomoses

Figure 1: Anatomy of the temporal region. Image courtesy of Dr Lee Walker, Dr Raul Cetto, Facial Ageing and Injection Anatomy: A Compendium of Evidenced Based Principles, 2021. 25

with branches of the internal carotid artery.1 A consequence of intravascular injection of this artery could be occlusion of the central retinal artery through retrograde flow.1

Comprehensive anatomical knowledge, combined with appropriate technique selection which will be explored later in the article, is vital to minimising these risks.

Key vascular considerations include the risk of intravascular injection leading to embolic events, particularly given anastomoses with the ophthalmic circulation

The ageing temple

In youth, the temples are flat or slightly convex, becoming more concave with age.1 Ageing of the temporal region is driven by multifactorial changes affecting bone, fat, muscle and skin. Key contributors include:

· Bone resorption of the temporal fossa and lateral orbital rim, resulting in skeletal concavity.7

· Hypertrophy of the temporal fat compartments with redistribution and ptosis of the fat, leading to upper compartmental concavity.8

· Dermal thinning and loss of skin elasticity due to reductions in collagen, elastin and HA.9,10

· Descent of the lateral brow secondary to bony changes, ligamentous laxity and volume redistribution, further accentuating the hollow appearance.11,12

As a whole, the superficial temporal fat compartment increases in mean height and volume with age, whereas the upper and middle thirds of the compartment thin and the lower third becomes thicker.7 These changes result not only in cosmetic concerns for many patients, but also functional changes in facial dynamics and perceived loss of vitality.

A magnetic resonance imaging study has confirmed that the soft-tissue thickness of the temporal region decreases on average 3.4mm in depth throughout adulthood.13 For example, the upper third of the face will appear narrower, with the eyebrow seeming shorter and the tail of the brow dropping.14

Treating the temples can restore structural support, improve brow position, soften skeletal contours and contribute to a more youthful and balanced appearance. The degree of ageing of the temporal region has been classified by the 5-point photonumeric Allergan Temple Hollowing Scale, ranging from ‘0 convex’ (a rounded temple), to ‘4 severe’ (deeply recessed, sunken appearance with marked prominence of temporal fusion line and zygomatic arch).15

Treatment approaches

There are two main treatment approaches for this area, but the technique chosen will depend on the clinicians preference. This is typically based on their experience, the patients anatomy, severity

of temple hollowing, skin quality, availability of ultrasound and their interpretation of any available, relevant evidence.3

Superficial cannula technique

Cannula-based techniques have gained popularity due to their perceived safety benefits, including reduced risk of vascular occlusion and minimised trauma to soft tissues when administering HA fillers.16 Injection using retrograde linear threads with a cannula into the superficial fatty layer of the anterior temple (layer 2) is one approach often favoured among practitioners due to its relative simplicity and ability to visualise depth clearly.3 Additionally, there are unlikely to be any major neurovascular structures in this layer.3

In this treatment approach, a 22G 50mm blunt-tip cannula is typically selected. A cutaneous access point is created in the midportion of the zygomatic arch with a sharp needle. The cannula is advanced within the subcutaneous tissues above the superficial temporal fascia with minimal resistance, with the bevel pointing toward the dermis

(Figure 2). Small boluses (0.05–0.1ml) of HA filler are deposited in a retrograde linear threading or fanning technique, ensuring low pressure.

Advantages

· The plane provides sufficient tissue resistance to support filler.

· Theoretically reduced risk of deep vascular compromise compared to interfascial or deep injections.

· Allows for subtle shaping and contouring rather than over projection.

· Provided positioning of the cannula is accurate, no major neurovascular structures are expected in this plane.1,5,17

Considerations

· Knowledge of variant vascular anatomy is still crucial as there is still a risk of occlusion. If the local skin is thin there may be irregularities after injection.

Overfilling can create an unnatural convexity.1,5,7

· A low G prime product is recommended to reduce the chance of product visibility through thin overlying tissue.18

· Post procedure, patients should be advised to follow routine HA filler aftercare advice including avoiding the application of makeup or touching the skin, delaying any facial massages for at least two weeks post treatment, avoiding heavy exercise for 24 hours and not undergoing any dental treatments for two weeks post procedure.19

A similar technique using the same cannula may be used to place the filler in the interfascial plane (layer 4) rather than superficial, with cutaneous access from the forehead and the bevel pointing toward the periosteum. In this case, care should be taken to avoid injecting parallel to the superficial temporal artery in case the injection is inadvertently changed. The frontal branches of the facial nerve and the middle temporal vein is also expected to emerge in this plane, so this should be kept in mind.17

Figure 3: The intended point of needle entry marked in red, with purple markings measured at 1cm each

Figure 2: A 22G 50mm blunt tipped cannula advancing into the treatment area

One up and one over technique

Also known as the ‘gunshot technique’, this approach involves deep supraperiosteal bolus injections, placing the product in layer 9 of the anterior temple.3 It is designed to create controlled and precise volumisation.3

This method involves the skin being marked 1cm below the temporal suture, and 1cm above the external orbital rim (Figure 3).20

A sharp needle (typically 27G x 13mm or longer) is then introduced perpendicularly to the skin to establish bony contact (Figure 4).1 While injecting, aspirate, inject slowly and do not move the needle during the injection.1,3 Ensure throughout that constant bony contact is maintained. A high G prime product is recommended.18

Advantages

Allows for skeletal restoration and support without unnecessary soft tissue distension.

· Effective for significant volume deficits. This technique may be considered safer due to the temporal arteries not usually flowing through this region, however if there was an anatomical anomaly or error resulting in a large bolus injection intravascularly, the outcome could be more catastrophic.1,5,6

Considerations

· Potentially more bruising and swelling compared to cannula techniques, therefore longer post-injection compression may be beneficial.16

· Requires highly precise anatomical knowledge to avoid deep vascular branches.

· The anterior deep temporal artery is in close proximity to this injection point.1,3,5

· Patients may experience post-injection headache and temporary masticatory discomfort. Patients may manage this as they normally would a headache and could apply a cold compress.3,19

· Post procedure, patients should be advised to follow routine HA filler aftercare advice as with the superficial cannula technique.19

· Combining the gunshot technique with superficial cannula-based contouring can yield highly natural results, addressing both deep structural loss and surface contour irregularities.1

Combining the gunshot technique with superficial cannula-based contouring can yield highly natural results, addressing both deep structural loss and surface contour irregularities

Other techniques have been described such as the high supraperiosteal technique, supraauricular lifting technique and the posterior temporal supra-SMAS technique, however these are not as common practice.3

The relevance of ultrasound in planning treatment

Ultrasound imaging is increasingly being used to offer unparalleled insight into soft tissue architecture and enable precise vascular mapping pre-procedure, significantly enhancing the accuracy and safety of HA filler procedures.21 Its use in temple filler treatments offers multiple

advantages including pre-treatment mapping of major vascular structures such as the superficial temporal artery and vein, and assessment of individual anatomical variation, especially in post-surgical patients or those with facial trauma history.22 These insights may influence the technique opted for by the clinician.22

During treatment, the use of ultrasound imaging allows real-time guidance of cannula or needle placement with verification of filler deposition planes, particularly relevant if injecting the interfascial plane.2,19 Post-treatment ultrasound may aid in detection or confirmation of complications such as vascular occlusion or abnormal filler placement, also enabling targeted management strategies if adverse events occur.23

It may be of particular benefit to employ the use of ultrasound guidance when attempting to deposit filler in the interfascial plane, due to the potential challenge of ensuring injections are performed exactly in this plane. A 2023 study involving seven experienced board-certified plastic surgeons found that upon injecting the temples of fresh frozen specimens without ultrasound (intending to volumise the interfascial plane with coloured dye), 89% of the attempts had been in the wrong layer.24

Mastering a demanding skill

Temple restoration is a nuanced and higher risk treatment within facial aesthetics, however the results can be impactful and noteworthy for patients. Practitioners must combine deep anatomical understanding with tailored technique selection to achieve natural, balanced outcomes while prioritising patient safety. Ultimately, mastery in temple filler treatments requires more than technical skill – it demands a holistic view of facial ageing, patient-specific anatomical variation and long-term maintenance planning.

Dr Bethany Rossington is a dental surgeon and owner of multi award-winning Renavé Clinic in Retford. She is the editor of the Oxford Handbook of Clinical Dentistry 7th edition, and is passionate about education and increasing safety standards within the aesthetics specialty. Qual: MChD/BChd, BSc, MFDS RCPS(Glas)

Figure 4: The 27G 13mm needle contacting bone

Using Botulinum Toxin for the Treatment of Rosacea

Dr Kam Lally outlines how practitioners can use botulinum toxin to manage rosacea

Rosacea is a chronic dermatological condition characterised by facial erythema, flushing and inflammatory lesions. Traditional treatments often yield inconsistent results, prompting exploration of alternative therapies. Botulinum toxin type A (BoNT-A), widely recognised for its neuromodulatory properties, has emerged as a potential off-label treatment for rosacea.1

This article reviews the current evidence on the efficacy and safety of BoNT-A in managing rosacea symptoms.

Understanding rosacea

Rosacea affects approximately 5% of the global population, predominantly impacting individuals with fair skin.2 The condition manifests through persistent facial redness, visible blood vessels and sometimes acne-like breakouts.2

There are four main types of rosacea, each with distinct characteristics:3

1. Erythematotelangiectatic rosacea (ETR)

· Persistent facial redness (erythema)

· Visible blood vessels (telangiectasia)

· Flushing that comes and goes

· Sensitive, dry and sometimes swollen skin

2. Papulopustular rosacea (acne rosacea) Redness with acne-like breakouts (papules and pustules)

· Swelling and irritation

· Often confused with acne, but without blackheads

3. Phymatous rosacea

· Thickening of the skin, especially on the nose (rhinophyma)

· Enlarged pores and a bumpy texture

· Affects the nose most commonly, but can also impact the chin, forehead and ears

4. Ocular rosacea

Affects the eyes and eyelids

· Red, dry, irritated eyes

· Grittiness, burning and sensitivity to light

· Can lead to complications like conjunctivitis or corneal damage if untreated

Some people may have more than one type of rosacea at the same time, although it is difficult to get an exact incidence due to variations in the criteria used for classification.4

The pathophysiology of rosacea is multifactorial, involving dysregulation of the innate immune system, neurovascular dysregulation and environmental triggers. These include sun exposure, stress, spicy foods, alcohol and temperature extremes.5

Standard treatments include topical and oral antibiotics, anti-inflammatory agents and laser therapies. The National Institute for Health and Care Excellence (NICE) provides comprehensive guidelines for the management of rosacea, which are summarised below.6

General management strategies

· Patient education: Inform patients about the chronic nature of rosacea and the importance of identifying and avoiding individual triggers, such as certain foods and beverages, or environmental factors.6

Skincare recommendations: Advise the use of gentle skin cleansers, regular application of high-factor sunscreen (minimum SPF 30) and avoidance of known irritants.6

Pharmacological treatments

Topical therapies

· Metronidazole 0.75% (cream or gel): Applied twice daily for mild to moderate papulopustular rosacea.6

· Azelaic acid 15% (gel): Applied twice daily as an alternative to metronidazole.6

· Ivermectin 10 mg/g (cream): Applied once daily for up to four months for inflammatory lesions of rosacea (papulopustular) in adults. If there is no improvement after three months, treatment should be discontinued.6

· Brimonidine (gel): Applied once daily for persistent facial erythema; it may reduce redness within 30 minutes, reaching peak action at three to six hours.6

Oral therapies

Tetracycline antibiotics: Oral doxycycline or lymecycline are commonly prescribed for moderate to severe papulopustular rosacea.6

· Low-dose doxycycline: A modified-release preparation is licensed in low daily doses for the treatment of facial rosacea.6

Referral

These approaches may not be effective for all patients and can be associated with adverse effects such as irritation, redness and dry skin.7 Practitioners should consider referring patients to dermatology services if they present with:

Severe symptoms: Flushing, persistent erythema and telangiectasia, causing psychological or social distress.

· Refractory cases: Papulopustular rosacea not responding to 12 weeks of combined oral and topical treatment.

· Advanced therapies: Consideration of oral isotretinoin as per British Association of Dermatologists guidance.8

Botulinum toxin as an alternative treatment

There is often a significant wait for a non-urgent NHS dermatology appointment, therefore there is growing interest in alternative treatments, such as BoNT-A.

BoNT-A is a neurotoxin that inhibits acetylcholine release at neuromuscular junctions, leading to temporary muscle paralysis. Beyond its muscular effects, it has been observed to modulate autonomic innervation of cutaneous vessels and eccrine glands, suggesting potential benefits in conditions like rosacea.9

Reduction of neurogenic inflammation

BoNT-A may inhibit the release of neuropeptides such as substance P and calcitonin gene-related peptide (CGRP), which are involved in vasodilation, inflammation and pain signalling.10,11 These neuropeptides are known to play a role in the chronic inflammatory process of rosacea, exacerbating erythema and flushing. By decreasing their release, BoNT-A helps reduce the inflammatory cascade that leads to persistent redness and discomfort.12

Vascular modulation

Rosacea is associated with excessive vascular reactivity, leading to flushing and persistent erythema. BoNT-A has been shown to affect the autonomic control of blood vessels by inhibiting vasodilatory neurotransmitters, thereby reducing excessive vasodilation and improving vascular stability.13 A study of 130 patients by Zhang et al demonstrated that intradermal BoNT-A injections reduced blood flow in treated areas, leading to decreased erythema and improved skin tone in rosacea patients.14

Inhibition of mast cell degranulation

Mast cells play a crucial role in the pathophysiology of rosacea by releasing histamine and other inflammatory mediators that contribute to erythema and flushing. BoNT-A has been shown to suppress mast cell degranulation, thereby decreasing the levels of inflammatory cytokines and reducing skin sensitivity.15 Research by Kim et al. highlighted the ability of BoNT-A to stabilise mast cells, preventing excessive inflammatory responses.16

Sebum and sweat gland modulation

While rosacea is not traditionally classified as a sebaceous disorder, excessive sebum production and sweat gland activity can exacerbate symptoms. BoNT-A has been observed to downregulate sebaceous gland activity, leading to a decrease in skin oiliness and potential improvements in rosacea symptoms.17

A clinical trial involving 152 participants by Lee et al. reported significant reductions in facial oiliness and improved skin texture following injections.18

Evidence supporting BoNT-A for rosacea

Several studies have investigated the efficacy and safety of BoNT-A in treating rosacea.

One systematic review by Alsaati et al. included 17 studies assessing BoNT-A’s role in rosacea treatment. Findings indicated significant improvement in facial erythema and flushing, with symptom recurrence observed three to six months post-injection, necessitating repeat treatments. Adverse events were minimal, with localised erythema (24.6%), ecchymosis (5.1%) and transient facial muscle weakness (4.3%) being the most common.19

Another prospective study by Al-Niaimi et al. evaluated the combined use of pulsed dye laser and intradermal BoNT-A in 20 patients with rosacea-associated erythema and flushing. Results demonstrated a synergistic effect, with significant reductions in erythema and flushing severity scores. The combination therapy was well-tolerated, and patients reported high satisfaction levels.20

A pilot study by Park et al. evaluated 20 patients with recalcitrant erythematotelangiectatic rosacea who received intradermal BoNT-A injections. The treatment led to a significant reduction in erythema and flushing, with effects lasting up to three months. No serious adverse events were reported.21

Another randomised controlled trial by Kim et al. assessed the effects of intradermal BoNT-A injections in rosacea patients with facial erythema. The treated side showed significant improvement in erythema compared to the placebo side, with minimal adverse effects.22

A longitudinal study by Huang et al. followed 50 patients who received BoNT-A injections over a two-year period. The results demonstrated sustained improvements in rosacea symptoms with repeated treatments every four to six months. No cumulative adverse effects were observed, suggesting that long-term use is both effective and safe.23

Finally, a comparative study by Tanghetti et al. compared BoNT-A to traditional rosacea treatments such as metronidazole and ivermectin. The BoNT-A group showed superior reductions in erythema and flushing, with fewer side effects compared to topical agents. The study suggested that BoNT-A may serve as a valuable adjunct therapy, particularly for patients unresponsive to conventional treatments.24

Side effects

The reviewed studies consistently report that BoNT-A is well-tolerated in rosacea patients. Common adverse effects are mild and transient, including localised erythema, bruising and temporary facial muscle weakness. No severe systemic reactions have been documented. However, the temporary nature of BoNT-A effects necessitates repeated treatments, which may have cost implications and require consideration of cumulative exposure.25

Discussion

While current evidence supports the use of BoNT-A for rosacea, several considerations warrant attention:

· Standardisation of treatment protocols: Variations in BoNT-A formulations, dosages and injection techniques across studies highlight the need for standardised treatment protocols to ensure consistent outcomes.26

· Long-term efficacy and safety: Most studies have short follow-up periods. Long-term data are essential to understand the durability of treatment effects and any potential long-term adverse events.27

Cost-effectiveness: Given the necessity for repeated treatments, economic evaluations are needed to assess the cost-effectiveness of BoNT-A in managing rosacea compared to existing therapies.28

A promising treatment

BoNT-A presents a viable and effective option for managing rosacea symptoms, particularly facial erythema and flushing. Its favourable safety profile and patient-reported satisfaction underscore its potential as an adjunct or alternative to traditional therapies. Future large-scale, randomised controlled trials with extended follow-up periods are essential to establish standardised treatment guidelines and confirm long-term efficacy and safety.

Qual: BMBCh (Oxon), BA (Hons), MRCGP, PG Dip Aes Med

Body Tightening Procedures for Skin of Colour

Dr Mary Sommerlad discusses the growing demand for non-surgical body tightening treatments and its customisation for diverse

skin types

In recent years, there has been a rise in interest in non-surgical body conditioning. This is due to improved technologies that address skin laxity and body contouring caused by chronic sun exposure, weight loss and biological ageing.1 Non-surgical body tightening refers to the utilisation of energy-based devices that destroy fat cells and/or induce skin contraction in order to give the skin on the body a firmer, more contoured appearance without the need for surgical intervention.2

Commonly treated anatomical sites include the abdomen, thighs, upper arms and buttocks. These procedures have gained significant traction over surgical alternatives, such as abdominoplasty or lower body lifts, primarily due to their reduced downtime, lower complication rates and the continual advancement of energy-based technologies.3

Skin of colour (SOC) is an imperfect term used to describe individuals with non-white European skin tones, roughly corresponding to Fitzpatrick skin types IV to VI.4 In relation to aesthetic dermatology, the main differences between white European skin and skin of colour in dermatology include a higher density of eumelanin found throughout the epidermis, an increase in eumelanin production in response to trauma and inflammation and a propensity to form hypertrophic and keloidal scars due to more active fibroblasts.5 Non-surgical body tightening modalities are generally considered less likely to cause adverse events as these modalities target fat and/or muscle rather than the epidermis.6 It is important to note that there is a paucity of published research comparing different modalities for safety and efficacy in those with SOC, and that best practice has to be based on manufacturer protocols and guidelines.

This article highlights mainstream body tightening devices and nuances that should be applied when considering the modality for a patient with SOC.

Key considerations for SOC

Body tightening modalities are marketed by their manufacturers as safe in all skin tones when used as per manufacturer guideline, as the target is neither the epidermis nor the melanocyte. However, when treating patients with SOC, considerations such as post-inflammatory hyperpigmentation (PIH), bruising response and rare adverse events remain relevant. Table 1 summarises the mechanisms of action, SOC-specific considerations and commonly used devices available in the UK.

Overview of body tightening technologies

Radiofrequency (RF)

Heat delivered to dermis to induce collagen remodelling

Cryolipolysis Controlled cooling induces apoptosis of adipocytes

HIFEM Magnetic induction stimulates supramaximal muscle contraction, causing fat reduction and toning

HIFU Acoustic energy causes thermal coagulation of fat and collagen

Laser Lipolysis 1060 nm laser induces apoptosis in adipocytes

Risk of PIH from bruising; in SOC, bruising may present as hyperpigmentation

Slightly higher PAH incidence in Hispanic males; devices should prevent dermal overcooling

Low PIH risk; temporary bruising possible with RF combo; bruising more linked to age or medications than skin type

Potential for PIH if inflammation occurs; monitor bruising response

Generally safe in SOC; minimal epidermal impact, but access and expertise may vary

Body Tightening Skin of Colour

Non-surgical body tightening is achieved through various energy modalities designed to induce fat removal and drive neocollagenesis to improve dermal laxity.7

The modalities that are available in the UK are similar to those that are Food and Drug Administration (FDA) approved in the US, and to date include radiofrequency, cryolipolysis, high intensity focused electromagnetic (HIFEM) technology, high intensity focused ultrasound (HIFU) and laser lipolysis.8

Radiofrequency

Radiofrequency (RF) devices with RF alone (e.g. Thermage FLX) or in combination with other modalities (e.g. Morpheus8 which also delivers microneedling), deliver electromagnetic energy in the form of heat to the dermis, causing a controlled thermal injury that then stimulates collagen remodelling in the dermis.8 The advantages of RF are that it is non-invasive so downtime is reduced compared to surgical options. The advantages of RF compared to other non-surgical options will be highly subjective based on clinician expertise and patient preferences of one modality over another.

Thermage FLX, Morpheus8

LIPOcel

The increasing popularity of body tightening procedures necessitates a patient-centric approach that prioritises safety and efficacy, including for individuals with SOC

CoolSculpting

SculpSure

Table 1: Summary of common non-surgical body contouring technologies, their mechanisms of action and specific considerations for patients SOC.

Body Tightening Skin Of Colour

Cryolipolysis

Research exploring the destruction of adipocytes by selective freezing has been in the literature since the 2000s9,10 exploiting the sensitivity of adipocytes (fat cells) to cold temperatures compared to other skin cells, muscle cells or nerves.11 Cryolipolysis uses highly controlled cooling at temperatures of -11°C to 5°C to freeze, and then destroy adipocytes selectively by inducing apoptosis in these cells.11 In the UK, CoolSculpting is a well-recognised cryolipolysis device which uses controlled cooling via an applicator that suctions tissue between cooling plates. However, several other cryolipolysis systems are also available, employing similar principles of selective fat cell apoptosis through cold exposure, with variations in applicator design, temperature control and treatment protocols.

The primary consideration in patients with SOC is the reportedly higher incidence of the rare side effect known as paradoxical adipose hyperplasia (PAH), particularly among Hispanic individuals, most notably middle-aged men.12 In the case series, those with PAH were successfully managed with liposuction and abdominoplasty; the physiological cause for the PAH in Hispanic populations has not yet been identified. The design of a cryolipolysis device should prevent overexposure of the dermis and epidermis to the cold temperatures required to induce cryolipolysis in order to limit exposure of melanocytes, which are temperature sensitive too.

HIFEM technology

HIFEM such as EmSculpt uses magnetic induction to cause muscles to contract approximately 20,000 times within a 30-minute treatment leading to adaptive muscle changes, causing an increase in muscle bulk and a decrease in adipocytes.8 Multiple HIFEM-based systems are available, with varying protocols and applicator designs. As the target here is muscle, the risk of dyspigmentation is low. Combining HIFEM with RF induces both muscle stimulation and fat cell apoptosis. However, the use of RF may sometimes result in bruising, which can appear as temporary darkening of the skin. This is not necessarily more severe in patients with SOC; rather, it appears to be more closely associated with advancing age, anticoagulant use and potentially alcohol consumption.8

HIFU

technology

HIFU uses acoustic energy to induce thermal coagulation in the dermis and subcutaneous fat, which leads to adipocyte apoptosis and the denaturing, followed by contraction and remodelling of collagen.11 The resultant effect is skin tightening and adipocyte loss, without affecting the epidermis.11 Devices available in the UK include Ultherapy and LIPOcel. In patients with SOC, key considerations include the risk of post-procedure bruising and the potential for PIH, especially if inflammation occurs during treatment ( Table 2).

Laser lipolysis

Laser lipolysis utilises a 1060 nm laser which selectively targets adipocytes to induce apoptosis without impacting the epidermis, and is considered generally safe for patients with SOC as the target is adipocytes rather than melanocytes.13 The use of such devices may be limited by factors such as availability and clinician experience.

Defer treatment until resolved; treat skin condition first

and may pigment or scar after thermal or cryolipolysis treatments

Keloid or hypertrophic scar history

Recent sun exposure or tanning

Photosensitising medications (e.g., doxycycline)

Pregnancy or breastfeeding

Uncontrolled diabetes or poor wound healing

Higher prevalence in SOC

Increased melanin activity means a higher PIH risk

Increased risk of thermal damage

Hormonal skin changes causing darkening of skin

Higher PIH and infection risk

Implanted medical devices N/A

History of pigmentary disorders (PIH, vitiligo)

Higher emotional burden and cosmetic concern in SOC

Table 2: Key contraindications and risks for SOC

Thermal or mechanical trauma may trigger abnormal scarring

Laser or energy-based treatments may cause burns or pigmentary changes

Photosensitisation enhances energy absorption in skin

Limited safety data; unpredictable response

Poor vascular response and impaired collagen remodelling

Interference risk with RF or EMF-based devices

Energy-based devices may flare or new pigment changes

Best practices for safe and effective treatment

Avoid high-risk areas (chest/ upper arms); consider less aggressive modalities or avoid treatment

Delay treatment two to four weeks; recommend sun protection pre- and postprocedure

Pause medication if medically safe, or delay treatment

Defer treatment until postpartum/breastfeeding completed

Optimise medical control first; use gentler technologies

Avoid RF-based treatments

Use caution with conservative settings; spot (patch) test at clinician discretion (may not be explicit in manufacturers recommendations)

To ensure optimal outcomes and minimise complications in patients with SOC, it is essential to receive thorough training from clinical educators on the safe and appropriate use of body tightening devices ( Table 3). This includes seeking guidance on how to adjust parameters specifically for SOC patients. Adhering to pre-set protocols designed for SOC and avoiding off-label use of these devices can further reduce the risk of adverse effects. A cautious approach to modifying energy settings is also critical in preventing complications. Each device will have manufacturer derived guidelines on who is an ideal candidate for each procedure; a clinician should always take into consideration whether a potential candidate meets the manufacturer guidelines and whether the patient can follow pre- and post-procedure skin care. This includes avoidance of sun exposure and blood thinning agents, and awareness of potential risks that may arise from aggressive treatment protocols including pigmentation issues.7 Specific to SOC, ensuring your patient is aware of the need to use sun protection is important, along with written advice on what types of sun protection can be used and suggestions (e.g. wide brimmed hat, broad spectrum sunscreen, long sleeves and more).

Contraindication Risk in SOC (Fitzpatrick IV–VI)

Explanation

Possible solution/ management

Active skin infection or dermatitis in treatment area

Increased risk of PIH and delayed healing

Inflamed skin is more reactive

Prior to treatment, it is important to have a detailed discussion with the patient about the potential for bruising which will have individual risk factors on how long it will take to resolve. Equally important is identifying any individual tendency toward hyperpigmentation following mechanical injury, as this plays a key role in informed consent.

Establishing a clear clinic protocol for managing both post-procedure bruising and PIH is strongly recommended for consistency and optimal patient care. For example, have a written and easily accessible document in clinic for practitioners to refer to in how to manage bruising and advice on PIH.

Bruising Suction (e.g., CoolSculpting), mechanical trauma and vascular fragility

Persistent bruising Capillary fragility or unrecognised hematoma

PIH Heat (laser/RF), inflammation or trauma to melanocytes

Apply cold compresses for 10-15 minutes within first few hours. Avoid NSAIDs if possible

Monitor for resolution over seven to 14 days. Avoid contact sports, NSAIDs, massage and alcohol

Topical tyrosinase inhibitors: hydroquinone 2-4%, azelaic acid and strict photoprotection (SPF 50+ daily)

Screen for anticoagulants/ supplements

Educate patients about timeline and reassure regarding resolution

Avoid repeated trauma/ suction.

Use conservative settings in SOC if applicable.

Avoid treating over known PIH areas and inform patient about possible timeline and reinforce sunscreen adherence

Body Tightening Skin of Colour

Inclusive care in body contouring

The increasing popularity of body tightening procedures necessitates a patient-centric approach that prioritises safety and efficacy, including for individuals with SOC. While modalities used for body tightening and adipose reduction are generally considered low risk for PIH or hypertrophic scarring, it is important that practitioners are able to discuss these potential complications with their patients, and to have an understanding of how to manage them if the need arises.

Dr Mary Sommerlad is a consultant dermatologist based in London specialising in skin of colour dermatology, inflammatory dermatology, paediatric dermatology and photoageing. She practices within the private sector and the NHS and is a British Skin Foundation spokesperson. Qual: FRCP BSc MBBS DCH

Table 3: Post procedure complication management

Cutera: A New Energy in Aesthetics

With big announcements coming from California-based aesthetic medical device manufacturer Cutera in recent weeks, we sat down with Taylor Harris, CEO of Cutera, to hear how their new enhanced capital structure positions them well for future growth and innovation

Founded in California in 1998 by Silicon Valley-based laser engineers, Cutera has long been recognized for introducing several first-to-market technologies to advance aesthetic market. From launching the first high-powered Nd:YAG laser for hair removal and vascular treatments – including their signature Laser Genesis skin revitalisation procedure – to more recently introducing the world’s first 1726 nm AviClear laser for the treatment of mild to severe inflammatory acne, the company has consistently led from the front.

following a landmark transition to private ownership in early 2025, the company is turning a strategic corner. Backed by a large consortium of leading investment firms, Cutera has emerged with a stronger capital structure and renewed operational flexibility – giving it the tools to accelerate innovation, expand international operations, and deliver even greater value to clinics and patients alike.

Long-Term Vision

“With an enhanced capital structure and the support and confidence of our new owners, we are better positioned than ever to advance our growth strategy, drive innovation, and deliver industry-leading solutions while supporting our customers all around the globe,” says CEO Taylor Harris.

With an enhanced capital structure and the support and confidence of our new owners, we are better positioned than ever to advance our growth strategy, drive innovation, and deliver industry-leading solutions

“We are incredibly grateful to our employees for their dedication, to our customers and partners for their loyalty, and to our new owners for their partnership in building a global powerhouse in aesthetics and dermatology.”

UK & Ireland: A Growth Market with Strategic Focus

Since launching its direct operation in the UK and Ireland in 2018, Cutera has seen rapid regional growth, supported by a dedicated team and an increasingly engaged customer base. With a strategic focus, the UKI business is entering what Regional Director Sam Keene calls “our most exciting era yet.”

“Practitioners want more than just leading technology – they want long-term partnership,” Keene explains. “We’re investing further in training, clinical support, and technical service to ensure our providers are equipped to thrive, long-term.”

Central to this commitment is the company’s expanded London-based headquarters, which features an education and training centre designed for immersive clinical learning. The centre offers peer-led workshops, hands-on demonstrations, and bespoke training for practitioners at every stage of their journey with Cutera. “We want every clinic that chooses Cutera to feel supported from day one,” adds Keene.

Advertorial Cutera

Practitioners want more than just leading technology – they want long-term partnership

AviClear: Reshaping Acne Treatment

Cutera’s latest innovation credentials were further reinforced in 2024 with the UK launch of AviClear – the world’s first and original FDA-cleared laser for the long-term treatment of mild to severe inflammatory acne. Using a 1726 nm wavelength to selectively target the sebaceous glands, AviClear represents a paradigm shift in acne therapy: a drug-free, device-based, and clinically proven approach.

Since launch, more than 2,000 AviClear treatments have been performed in the UK and Ireland, and uptake continues to grow as 12-month clinical data and patient outcomes are now being reported by early adopters across both regions.

Education-Led Partnership

Central to Cutera’s global strategy is a long-standing belief in practitioner education and collaboration. This ethos is exemplified in CUCF (Cutera University Clinical Forum), a flagship event designed to empower providers through expert-led content, peer networking, and practical insights.

The 2025 edition – scheduled for September 13th in Windsor – is expected to be the company’s largest yet, drawing delegates from across the UK and Europe. “CUCF isn’t just a conference – it’s a community,” Leighannah Ticker, UKI Sales Manager, says. “We have seen the event evolve in recent years to become more clinical and protocol-focused, helping Cutera providers optimize treatment outcomes with Cutera technologies and aesthetic and dermatology professionals come and learn about our market-leading technology.”

Future-Focused, Provider-Led

Witha new structure, a growing UK team, and groundbreaking platforms like AviClear redefining what’s possible, Cutera is not only responding to change – it’s driving it. In a future-focused, provider-driven industry, Cutera stands ready to support practitioners with innovation, partnership, and the tools to lead with confidence.

This advertorial was written and supplied by

For more on Cutera’s technologies, training programmes, and upcoming CUCF 2025 event, visit www.cutera.co.uk

Non-Surgical Blepharoplasty with CO2 Laser

Dr Alex Parys and Dr Samantha Hills examine the role of CO2 laser technology in non-surgical blepharoplasty

With eyes being a focal point of expression and perceived age, it is no surprise that periorbital rejuvenation is one of the most sought-after aesthetic treatments.1 The delicate skin around the eyes is amongst the thinnest on the body, making it highly susceptible to wrinkles, laxity, volume loss due to ageing, sun exposure and lifestyle factors.2

Many patients are seeking non-surgical solutions to restore a refreshed, youthful appearance without the downtime or risks associated with traditional blepharoplasty. Treatments like fractional CO2 laser, radiofrequency (RF) microneedling and injectables can effectively target fine lines, crepey skin and mild ptosis, offering natural-looking, long-lasting results. As the demand for subtle, yet noticeable antiageing interventions grows, periorbital rejuvenation remains a cornerstone of modern aesthetic practice.3

In this article, we will discuss the reasons why fractional CO2 laser can be such a useful tool for periorbital rejuvenation, emphasise the critical role of intraocular protection in preventing ocular complications and present the protocols used to treat a series of patients.

Surgical options

Surgical blepharoplasty is a highly effective procedure for removing excess skin, fat and muscle from the upper and lower eyelids, restoring a more youthful and refreshed appearance. The ideal candidate is generally over the age of 35, in good overall health and does not smoke.4 It is advised that patients with untreated glaucoma or systemic conditions such as diabetes that can affect healing, opt for non-surgical options to reduce the risk of poor healing outcomes.4 It is also recommended that patients with unrealistic expectations are not treated, either surgically or non-surgically.

Upper blepharoplasty is a relatively straightforward procedure, commonly performed to correct drooping or hooded eyelids that may impair vision or contribute to an ageing, tired look. The surgeon makes an incision along the fold of the upper eyelid, excess skin, fat or muscle is removed and the incision is then closed. Any scarring can usually be hidden effectively in the eyelid fold.4

Lower blepharoplasty on the other hand is primarily carried out to reduce undereye bags and puffiness. This procedure helps create a smoother, more youthful appearance by removing or repositioning excess fat, tightening skin and improving eyelid contour. It is performed by making either a subciliary incision (just below the lash line) to address both fat and excess skin, or via a transconjunctival incision (inside the lower eyelid) to remove or reposition excess fat without leaving any visible scarring.4

While effective, lower blepharoplasty carries more risks than upper blepharoplasty due to the delicate anatomy and functional role of the lower eyelid and may result in ectropion. This is where the lower eyelid pulls away from the eye, leading to irritation and an unsatisfactory cosmetic result. Other complications can include haematoma, infection, dry eye symptoms, asymmetry and scarring. Recovery typically involves an initial downtime of five to 10 days, during which swelling and redness are expected.5

Blepharoplasty surgery is commonly carried out with a scalpel, but increasingly, people are using CO2 lasers to make the initial incision and tighten the tissue. Using a laser instead of a scalpel offers several advantages, including reduced bleeding, less swelling and faster healing due to the laser's ability to cauterise blood vessels as it cuts.6

While the results for both upper and lower surgical blepharoplasty are long-lasting and dramatic, any surgical procedure carries risks and many patients seek non-surgical alternatives like fractional CO2 laser or RF skin tightening to achieve skin rejuvenation with less downtime, fewer risks and a more gradual, natural-looking outcome. The risks may include delayed healing, scarring and infection.

Fractional CO2 laser treatment

Whilst surgical blepharoplasty is a generally safe and effective procedure, especially for those with periorbital oedema or pronounced ptosis, many patients want to avoid

surgical procedures and seek less invasive solutions. For those looking to correct fine, crepey skin, skin laxity or crow’s feet and wrinkles, fractional CO2 laser technology is a non-surgical alternative.7

Fractional CO2 laser devices deliver precise beams of laser light to the skin, resulting in narrow columns of microscopic ablation. These zones are surrounded by microscopic zones of thermal damage, which stimulate collagen remodelling and skin tightening while preserving surrounding tissue. This leads to a much faster healing and minimal downtimes compared to traditional CO2 resurfacing.8 Clinical studies have demonstrated significant improvement in periorbital rhytids, skin laxity and eyebrow elevation, with high patient satisfaction rates and low adverse event occurrences (Figure 1).9,10 Patients who have had recent isotretinoin use, and those with recent sun expose or sunburn are contraindicated to treatment. Care should be taken when treating Fitzpatrick skin types IV and VI due to the increased risk of post-inflammatory hyperpigmentation in darker skins.

Ocular safety

One essential consideration when using lasers around the eye is ocular safety. The 10,600 nm wavelength of the CO2 laser is outside the retinal damage region, but inadvertent exposure can still result in severe corneal injury.11 The use of intraocular eye shields is critical in preventing ocular complications, ensuring both patient safety and optimal treatment outcomes. The insertion of intraocular shields and the delivery of any laser treatment in the periocular area does carry risks. The British Medical Laser Association (BMLA) recommends that treatments within the periorbital region are subject to the oversight of clinical professionals and no laser treatment is ever carried out within the periorbital region unless suitable eye shields are worn.12

Figure 1: 47-year-old male patient before and two months after one treatment of non-surgical fractional CO2, SmartXide (DEKA, IT).

Intraocular shields are critical safety devices used to protect the globe during periocular laser procedures or surgical interventions involving the eyelids. Their insertion and removal require knowledge of ocular anatomy, sterile technique and an understanding of the potential risks to the cornea and conjunctiva.13 If placed incorrectly, intraocular shields can cause complications such as corneal abrasions, so their use should be restricted to appropriately trained medical professionals, who can assess the patient's eye health pre- and post-procedure. Care should be taken to never fire the laser directly over the shields to avoid heating the metal shields and potentially causing thermal damage to the cornea.14

The reusable plastic or silicon shields that are available do not protect against the infrared wavelength of the CO2 laser, and instead, metal shields must be worn. These shields are placed directly onto the surface of the eye and must be autoclaved before each use to eliminate the risk of infection.15 To comfortably insert these shields, a numbing agent such as ocular lidocaine or tetracaine should be administered. A lubricant is then applied to the shields to aid with insertion.15 In our practice we use Chloramphenicol ointment due to the additional antibacterial benefit, but other lubricants such as Carbomer can also be used.

Some shields are inserted with the aid of a small rubber suction tool, while others have small handles. In either case, to insert the shields, ask the patient to look down and with one hand, gently retract the upper eyelid and insert the upper edge of the shield under the lid. Then ask the patient to look up, retract the lower eyelid and then gently slide the lower edge of the shield beneath it, allowing the shield to sit comfortably over the cornea.

Case study

A 36-year-old female patient came to clinic presenting with fine, crepey skin around the eyes and laxity of her upper lid (Figure 2). She found that, despite taking care of her skin with medical-grade skincare and SPF, her makeup would ‘clump’ in these lines, making them even more apparent – a complaint I often hear echoed by patients with similar periocular concerns. Otherwise, she was fit and well, with no relevant past medical history and no significant prior aesthetic treatments.

We had a thorough consultation running through various options that may be able to improve the skin appearance in this region, such as botulinum toxin, RF microneedling, HIFU, skin boosters and more, but as the eyelids were a significant concern, I felt that the safest and most effective treatment for this region was fractional CO2 laser treatment; ‘SmartXide Bleph’. As this treatment does entail a degree of social downtime, she was fully counselled on the recovery journey and what to expect.

It's important to note that we performed a fractional rather than fully ablative CO2 treatment. Her skin quality was certainly nowhere near severe enough to warrant a fully-ablative treatment (and the resulting protracted recovery period). I felt the fractional would achieve the results we wanted, with a fraction of the recovery time (re-epithelisation within 48 hours rather than two weeks).8

The patient was treated with the SmartXide Punto laser by DEKA. LMX4 topical anaesthetic was applied 45 minutes before treatment and metal intracorneal eye shields were inserted following administration of 0.5% optical tetracaine. The settings used were Power 8W, dwell time 500µs, spacing 500µm and two stacks, giving a total dot energy of 37mJ.

Her recovery was very typical for a CO2 treatment with the SmartXide, although we have since updated our protocols to use the innovate ‘spray’ mode, which reduced the gridlines seen on day one of recovery. This spray mode intelligently feathers the treatment to result in a more homogenous appearance, improving perceived recovery time.

Typically, patients look (and feel) ‘sunburnt’ straight after the treatment. It’s important to note that although it looks like sunburn, it is controlled thermal injury and the patient is not at an increased skin of skin cancers as they would be with true sunburn. In fact, a review article by Wenande et al., concluded that multiple studies have shown that the risk is lowered following fractional ablative laser treatment.16

There can be some swelling, particularly to the periorbital area, which generally resolves in a couple of days. Microcrusts develop on the lasered areas, often described as feeling a bit like sandpaper to the touch. These typically flake off naturally over the course of three to five days.7

By day six to seven, there’s significant improvement in the recovery journey and the patient can usually apply makeup or a tinted SPF to hide any mild residual redness until they’re fully healed in the following days. Results continue to improve over the ensuing months as the induced collagen is produced.

Optimising results

Periorbital rejuvenation remains a key component of aesthetic practice due to the vulnerability of the periocular region to early signs of ageing. Fractional CO2 laser has demonstrated efficacy in improving periorbital skin quality by addressing fine lines, laxity and textural irregularities. As shown in the cases presented, when appropriately and safely applied, this treatment can offer consistent and measurable clinical improvements.

Disclaimer: Dr Samantha Hills is clinical director at Lynton Lasers.

Dr Alexander Parys is the founder of SONÜ Medical Aesthetics in Wilmslow & Hale, Cheshire. He worked within the NHS for nearly a decade as both an emergency medicine and clinical radiology specialist registrar. He was the author of an aesthetic textbook chapter, Decision Making in Aesthetic Practice, in 2021. Dr Parys was The Aesthetics Awards Winner for Rising Star of the Year 2021.

Qual: MBChB

Qual: PhD, BSc

Figure 2: 36-year-old female patients before and five months after one fractional CO2 laser treatment [SmartXide Punto, (DEKA).

CELEBRATING ANNIVERSARY

PRESCRIBING INFORMATION - UK

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

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

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

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

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

REASONS TO CHOOSE BOCOUTURE

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

• A well characterised safety profile1

• Convenient – no refrigeration needed prior to reconstitution1

Access injection technique videos now

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

PRESCRIBING INFORMATION - IRELAND

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

M-BOC-UKI-0514

Date of Preparation December 2024

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

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

Adverse events should be reported. Reporting forms and information can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd at the address above or by email to UKdrugsafety@merz.com or on +44 (0) 333 200 4143.

Advertorial

HA-Derma

HA-Derma & NAHYCO®

Technology – A Decade Of Tissue Regeneration

Celebrating 10 years of aesthetic excellence with HA-Derma

This year marks a major milestone in medical aesthetics: 10 years since HA-Derma introduced Profhilo to the UK and Ireland, bringing NAHYCO Hybrid Technology to market and pioneering a new category in skin bioremodelling. A decade on, HA-Derma remains at the forefront of regenerative injectables, supporting clinics with science-led innovation, gold-standard training, and a commitment to natural, pro-ageing outcomes.

Beyond Skin Deep: Why Regenerative Injectables Are Redefining Aesthetic Practice

As the aesthetics landscape evolves, so do patient expectations. Increasingly, they seek treatments that don’t just smooth or volumise, but actively improve the health of their skin and tissues. For progressive clinics, this means embracing regenerative injectables that work with the body, supporting long-term cellular wellbeing. At the centre of this shift is HA-Derma, the exclusive distributor of IBSA Derma’s award-winning hyaluronic acid portfolio in the UK and Ireland. Founded by Iveta Vinkler and Hana Te Reo in 2015, HA-Derma’s independent, education-led model has transformed the sector, bringing regenerative injectables to the fore and raising standards across thousands of clinics. Their vision was simple yet ambitious: to introduce a ‘third injectable option’ focused on skin quality, alongside the well-established pillars of toxins and dermal fillers.

Train First, Treat Later

In the infancy of Profhilo’s launch, and to support the brand, HA-Derma insisted that practitioners of all seniority be trained not only in theory, but also in the practical use of the product to understand its unique technology and rheology. Correct usage and placement are key to results, playing a key role in treatment outcomes. Profhilo’s success is down to this consistent, train-first approach – a hype-free strategy where education is the first pillar of Profhilo’s marketing.

Not Just a Distributor – A Driver of Clinical Innovation

HA-Derma has proven that a focused, independent distributor can compete with larger pharmaceutical players. Since launching Profhilo in 2016, HA-Derma has grown IBSA Derma’s once-unknown product line into one of the most recognised portfolios in the UK and Ireland. This success has had an international reach for which IBSA awarded HA-Derma ‘Profhilo Game Changer’ award in 2018, the only distributor ever receiving such recognition. Profhilo became a category-defining product, setting a new standard for regenerative injectables and earning widespread trust from practitioners and patients alike.

That momentum continued with the launch of Profhilo Body in 2021, followed by Profhilo Structura in 2024, both key expansions of the NAHYCO technology range. These innovations were recognised with Profhilo winning Innovation of the Year in 2016 and Best Injectable Product of the

Year in 2022 at The Aesthetics Awards. HA-Derma also won the IBSA Excellence Awards in 2019 and 2021, outshining global partners through consistent delivery and long-term brand leadership.

The company’s commitment to safety and compliance is equally strong. HA-Derma has worked with IBSA Derma, insurers, and the medical community to raise awareness of counterfeit and grey market products, introducing holograms on Profhilo packaging in 2023 to improve traceability. It also provides clinical support via in-house advisor Dr Fab Equizi, along with structured processes for assisting with medical enquiries.

HA-Derma’s impact extends to patient engagement. In 2019, the company launched a consumer-facing Profhilo website with a clinic locator, bridging the gap between public demand and trained clinics. This has helped drive patient enquiries, build trust, and support long-term success.

Celebrating a Decade of Impact

As HA-Derma marks 10 years of regenerative leadership, the future is clear: the next era of aesthetics isn’t about chasing trends – it’s about raising standards. With innovation, integrity, and education as its foundation, HA-Derma is proud to shape a safer, smarter, and more regenerative future for UK aesthetics.

“Practitioners today want more than access to products – they want education, clinical reassurance, and a partner who understands the pressures of modern aesthetics,” says Iveta Vinkler, Director.

“That’s what HA-Derma delivers.”

“As we celebrate this milestone, our thanks go to the medical professionals and clinic partners who’ve grown with us over the last decade,” adds Hana Te Reo, Director.

“We’re equally proud of our passionate team, who live our values every day.

Special thanks to Erika Debono, who leads admin and customer support with care, and to Frank Ward, our National Sales Manager for the UK & Ireland, whose leadership has driven performance and loyalty.”

Clinical Papers Abstracts

A summary of the latest clinical studies

Title: Endoscopic Tear Trough Correction with Fat Graft During Mid-face Lift

Authors: Ufuk Askeroglu, et al

Published: Aesthetic Plastic Surgery, May 2025

Keywords: Endoscopic Facelift, Fat Graft, Tear Trough

The study involved 32 patients with tear trough deformity who underwent endoscopic-assisted fat grafting alongside the mid-face lift procedure for total face rejuvenation. Postoperative assessments included a review of pre- and postoperative photographs, graded using the tear trough rating scale, by two surgeons not involved in patient care. Postoperative assessments revealed successful elimination of the tear trough deformity in all patients, with stable grafts observed after 12 months. The presented technique offers several advantages, including anatomical integrity preservation, precise volumetric restoration and scarless outcomes. Patient selection based on tear trough severity and individual anatomical variations was emphasised, with ongoing attention to potential complications and long-term outcomes. We believe the integration of endoscopic-assisted fat grafting with mid-face lift surgery offers a comprehensive solution for tear trough deformity and provides significant advancements in cosmetic surgery. The technique ensures anatomical integrity, precise volumetric restoration and minimal scarring, boosting patient satisfaction. Patient selection based on tear trough severity and anatomical variations, along with continuous monitoring for complications, emphasises the meticulous approach for optimal outcomes.

Title: Mesotherapy with Hyaluronic Acid Solutions Enriched by Amino Acids in the Neck Area: Open-label Uncontrolled, Monocentric Study

Authors: Antonio Scarano, et al

Published: Journal of Cosmetic and Laser Therapy: Official Publication of the European Society for Laser Dermatology, May 2025

Keywords: Hyaluronic Acid, Diagnostics, Skin Elasticity

The process of face ageing is characterised by nasolabial folds, sagging and hollowing, all of which worsen with age. The present clinical investigation was designed for obtaining further clinical safety and efficacy data for the SKIN R intradermal solution for the treatment of skin damages. The efficacy of the treatments was assessed by measuring the pH, assessment of sebometry and hydrometry. All 15 screened and enrolled subjects were treated with the investigational device at least once. All subjects who were assessed had a neck photo taken at visits one and two. The subjects’ judgment of appearance after treatment changed with time, however, by the termination of the study on day 60, 33.3% of subjects still considered their appearance very much improved, and 46.6% still considered their appearance much improved. The assessment of “satisfaction with treatment” was very high by the majority of subjects. No major adverse event was recorded.

Title: Multi-modal Approach with Dye Laser and CO2 Laser for the Resolution of Vascularized Acne Scars: A Case Series

Authors: Giovanni Cannarozzo, et al

Published: AME Case Reports, May 2025

Keywords: Acne Vulgaris, CO2 Laser, Dye Laser

As a prevalent condition of the pilosebaceous unit, acne vulgaris affects approximately 85% of people between the ages of 12 and 25 years. Among the patients, 47% report having acne scars. Considering the characteristics of the dye laser, we believe that this device can be a feasible solution for treating these facial skin imperfections. Specifically, in this study, we suggest the combination of the 595 nm wavelength with a fractional CO2 laser to ensure skin resurfacing and the best possible result. For this study, 31 patients presenting vascularised acne scars were considered. They ranged between 20 and 35 years old. The therapeutical approach usually started with two dye laser treatments and two CO2 laser sessions. In this study, the dye laser was mainly used for the resolution of skin inflammation and vascularisation, while CO2 was used for skin remodelling. To guarantee the best and safest outcome, a skin contact sensor was included with the device. Using a four-point Global Aesthetic Improvement Scale (GAIS) (none: 0, slight: 1, mild: 2, excellent: 3) to assess the treatment outcomes, 77% of patients claimed it was “excellent”, 16% “mild” and 7% “slight”. The combination of different laser devices can be a promising therapeutic alternative for acne resolution.

Title: A Multifunctional Hydrogel Microneedle Patch for Treatment of Atopic Dermatitis

Authors: Jiayi Pan, et al

Published: ACS Applied Materials and Interfaces, May 2025

Keywords: Atopic Dermatitis, Bacterial Elimination, Hydrogel-based Microneedles

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition caused by immune dysregulation, oxidative stress and bacterial invasion in the pathogenesis. Currently, oral administration of immunosuppressants such as cyclosporine and the topical application of corticosteroids are the primary treatment approaches for alleviating AD symptoms. However, these treatments have limitations associated with therapeutic efficacy and side effects. Here, we develop a functional hydrogel-based microneedle patch using phenylboronic acid-modified hyaluronic acid (HA-PBA) as the matrix and tannic acid (TA)/silver nanoparticles (TA/Ag NPs) as the cross-linker for controlled transdermal delivery of cyclosporine to treat AD. Our findings demonstrate that this hydrogel microneedle patch exhibited good biocompatibility, ROS scavenging, bacterial elimination and ROS-responsive drug-release abilities. Notably, compared to oral cyclosporine, the microneedle-mediated transdermal administration achieved superior therapeutic effects at only 29% of the oral dosage in the MC903-induced AD mouse model. We believe that this multifunctional hydrogel microneedle patch provides a potent therapeutic option for ameliorating AD pathology.

Unlocking the Male Aesthetics Market

Mr Glyn Estebanez provides strategies to address the male patient barriers

Traditionally, the aesthetics specialty has predominantly focused on catering to women. However, a paradigm shift has occurred, with an increasing number of men now seeking non-surgical cosmetic procedures such as dermal fillers and skin rejuvenation procedures.1-4

According to The Future of Aesthetics Report from Allergan Aesthetics, an AbbVie company, men make up 14.3% of the global market for non-invasive procedures. Data from the British Association of Aesthetic Plastic Surgeons (BAAPS) indicates that a third of its members saw an increase in men seeking virtual consultations post-pandemic, with more than 650 dermal fillers and skin rejuvenation procedures performed on male patients between 2022 and 2023.1-4 So, how do we turn this trickle into an avalanche?

This article will explore how a better understanding of male motivations and expectations can better cater for this demographic and tap into the growth opportunity.

Male trends in aesthetics

Interestingly, as men enter their 30s, they often appear to ‘age well’ due to the natural loss of facial fullness, which enhances features like a sharper jawline and more defined cheekbones.5 However, signs of skin ageing, such as crepiness and softening around the jaw, begin to emerge over time.6 As a result, we see more men seeking cosmetic treatments for the first time in their 40s, whereas women tend to consult experts in their late 20s or early 30s. From my experience in clinic, men typically seek subtle, natural-looking results, reflecting a broader shift away from the ‘overdone’ aesthetic that they may feel they have seen in some women. However, their motivations differ significantly. Rather than preparing for a major event like a wedding, milestone birthday or social gathering, I have seen that men are more influenced by life transitions. They often pursue cosmetic treatments during periods of change, such as starting a new fitness or weight loss journey, entering or ending a relationship, or simply seeking a boost in self-confidence.7

Many of my male patients are highly successful professionals who are prepared to invest in improving their ‘personal brand’, but wish to keep it discreet. These patients are aware of looking ‘tired’ and

want to maintain a fresh, vibrant image. Subtlety with the male demographic is key, and my emphasis is on achieving overall harmonisation of the face. They don’t want people to know they have had work, and they are aware of being judged for caring too hard about their appearance, which suggests there is still a great deal of stigma associated with male aesthetics.8

Challenges

Addressing stigma

One of the main challenges practitioners face is breaking down the lingering stigma associated with male patients seeking aesthetic treatments.5 A recent study found that despite the increasing prevalence of treatments amongst male patients, 89% of the 411 respondents reported encountering at least one barrier to having cosmetic procedures done.9 Many men still feel apprehensive about seeking cosmetic procedures due to concerns about societal judgment. In fact, just recently a male patient told me he has not told his girlfriend about his treatment as he feels a pressure to be ‘alpha’, and believes that she will perceive having work as a “sign of weakness.”

Unfortunately, there seems to be a greater awareness in national tabloid media of where work has ‘gone wrong’ rather than success stories.2,3 There are very few ‘flag-bearers’ for the male demographic, with fewer men openly discussing their treatments or helping others navigate the information needed to explore their options.

Tailoring treatments for masculine balance

Men’s faces are structurally different; their facial skeleton is larger and their skin is thicker.10 Whereas women want more softness and fullness, men typically want a sharper, more defined look. Their anatomy is fundamentally different. This requires a tailored approach that respects the distinct needs of male patients. Some practitioners overcompensate by creating ‘hyper masculine’ results to avoid feminisation, leading to cartoonish features that deter many potential male patients.

Males typically have a more pronounced supraorbital ridge, a flatter anterior midface and a more angular jawline and chin. The cheekbone in men tends to appear sharper and less curved than in females, contributing to a more defined and structured look. When

using injectables, it’s important to respect these anatomical differences – in an effort to avoid feminisation, there can be a tendency to overcorrect, leading to excessive widening of the jawline and cheeks, or an overly dominant chin. This can result in a hypermasculine, exaggerated appearance that feels unnatural. A balanced, anatomy-led approach is essential to enhance male features while preserving authenticity and proportion.11

A successful male aesthetic treatment begins with a deep understanding of facial anatomy and the age-related structural changes unique to men. Since many male patients have less awareness of aesthetic possibilities, consultations should be educational and collaborative. A clear, structured plan that explains the value of a full-face, multimodality approach helps build trust and ensures results that are balanced, natural and aligned with the patient’s identity.

Encouraging openness

One technique I find effective in encouraging male patients to open up about their emotional reasons for seeking aesthetic treatments is asking them: “If I had a magic wand and could make you look or feel any way you wanted, what would that be?” This question creates a safe space for patients to share their deeper desires. It often leads to conversations that make full-face harmonisation feel not only logical, but also emotionally meaningful, reframing it as a thoughtful investment in themselves rather than an indulgence.

Raising awareness through social media is crucial – it helps men understand not only the natural, subtle results that can be achieved, but also demystifies the process and what to expect. We can’t rush their readiness to seek help; it’s something that has to come in their own time. Our role is to educate and support. Once they do reach out, understanding their emotional drivers becomes key, and it’s something I place strong emphasis on within my practice.

Patient expectations

Men tend to approach treatments with a more targeted mindset, often focusing on a specific concern like their eyes, frown lines or nasolabial folds. The challenge, however, lies in shifting their focus to treating the entire face and achieving overall harmony. I explain to my male patients that solely addressing one isolated issue can lead to unbalanced results, which can be overwhelming. This may lead to dissatisfaction and reduce the likelihood of them returning or recommending the treatment.

I emphasise that by making subtle, millimetre-level adjustments across the whole face, rather than concentrating on just one or two areas, we can achieve a more

natural and harmonious result. This approach lands in the ‘sweet spot’ – results that are barely noticeable to the conscious eye but deeply appreciated by the subconscious.

Strategies to expand your male patient base

Growing your male patient base requires a focused approach that combines education, technique and tailored communication.

Upskill yourself

More training is needed to address the anatomical nuances between male and female patients – just one millimetre difference in where you inject can give a very different result!

A key challenge is that clinicians cannot receive as much real-life experience or practice as they would with female patients due to the limited number of male patients or models during training programmes. However, there any many ways in which a clinician can upskill themselves in the absence of direct experience, such as:

· Engage with hands-on training and educational programmes, from training academies or aesthetic companies, which aim to upskill healthcare professionals on trending topics including the ‘new masculine’ and how to treat patients who want masculinisation with dermal filler products.

· Attend national and international educational conferences, such as Clinical Cosmetic Regenerative Congress (CCR) and Aesthetics Conference & Exhibition (ACE), which offer the opportunity to network with peers and learn new techniques. This enables practitioners to tailor treatment to their patient, irrespective of gender.

Choose the right products

Men in their 30s are often looking to boost collagen and maintain a youthful, fresh appearance. Treatments like HArmonyCa are an excellent way to stimulate collagen production, providing very subtle, natural rejuvenation across the face. When combined with skin-quality boosters such as Juvéderm Volite or SkinVive, we can further enhance hydration, smoothness and overall skin vitality, helping to preserve a healthy, refreshed look over time.

As patients enter their 40s, various dermal fillers can be used to address age-related volume loss. For example, when male patients visit my clinic seeking facial volume restoration, I often use fillers in the temples, cheekbones and lower face to achieve a balanced, rejuvenated appearance. This is complemented by more superficial collagen stimulation in the lateral cheeks, preauricular area and along the jawline for enhanced definition and skin quality.

Male skin tends to be thicker, and preserving sharper, more defined results is important.10 In some patients, this means I tend to use Juvéderm Volux along the zygomatic arch to achieve greater definition and structure. However, in the anterior mid-face – where I want to avoid creating excessive roundness or fullness – I typically select a slightly lighter product, such as Juvéderm Volift. This allows for subtle volume restoration without overt projection or fullness, which helps to prevent the inadvertent feminisation of the male face.

For men seeking subtle results with minimal downtime, non-injectable treatments like radiofrequency microneedling (e.g. Morpheus8), skin tightening (e.g. Forma or Thermage) and intense pulsed light (e.g. Lumecca) are excellent options. These devices can improve skin quality, firmness and tone without obvious signs of treatment. I generally avoid more aggressive procedures like deep peels or fractional lasers for first-time male patients, as discretion and ease of recovery are often top priorities.

Medical-grade skincare further supports and maintains results. Used together, these treatments allow for precise, natural-looking enhancements.

Tailor your marketing and resources

To effectively engage male patients, professionals must emphasise their ability to deliver subtle, natural and harmonising aesthetic results. This starts with a targeted marketing strategy and extends to tailored educational resources. Use online advertisements, social media, website content and email newsletters to highlight real success stories – especially before-and-after photos that show discreet transformations. Address common concerns and clearly outline what to expect before, during and after treatments to foster trust and transparency.

Men often feel less comfortable discussing aesthetic treatments, so showcasing authentic testimonials – especially from patients willing to go public – can be particularly powerful. Collaborating with influencers or local figures may also resonate, provided you follow ASA guidelines for such partnerships.12

Equally important is the creation of male-focused educational resources. Practitioners should demonstrate their understanding of the aesthetic nuances specific to male facial anatomy, reinforcing their credibility.

Blog posts, infographics, videos and FAQs that explain treatment options and outcomes in a clear, approachable way can make a significant impact. Content such as beginner-friendly guides, short procedural videos and real patient journey stories – especially those that highlight natural-looking results – help normalise the conversation and reduce stigma.

By combining marketing with practical, confidence-building resources, practitioners can better reach and support male patients, ultimately encouraging them to explore aesthetic treatments with confidence.

Incorperate inclusive décor

Your clinic’s interior design and atmosphere play a crucial role in creating a welcoming environment for all patients, including men. A gender-neutral aesthetic with a minimalist and modern feel is ideal, avoiding overtly ornate or feminine touches. Incorporating calming elements like candles, diffusers and soothing music can help reduce pre-treatment stress and anxiety. Thoughtful additions such as comfortable seating, discreet waiting areas and subtle displays of male-orientated skincare and grooming products can make male patients feel more at ease. Providing tailored reading materials on topics like fitness, business or travel further enhances the experience, fostering a relaxed and inclusive environment that appeals to diverse patient needs.

Looking ahead

By understanding the challenges, motivations and preferences of male patients, professionals can develop targeted strategies to expand their market presence and cater to this dynamic demographic. Providing potential patients with access to the relevant information and reassurance will help this growing demographic enhance their self-confidence and achieve their aesthetic goals.

Mr Glyn Estebanez has clinics in London and Cheshire.

Graduating with honours from Liverpool Medical School in 2008, he went on to train as a general surgeon and became a member of the Royal College of Surgeons in 2012. He is an ambassador for Allergan Aesthetics, an AbbVie company, and a faculty member of the Allergan Medical Institute.

Qual: MBChB, MRCS, MBA, BSc

Preparing for Media Interviews

PR and communications consultant Julia Kendrick outlines the critical elements to prepare for successful

interviews with the press

For many, an interview with a journalist represents the pinnacle of public relations (PR) success. It’s the chance to build your profile as a knowledgeable expert or leader in the field, to educate audiences or to deliver an important message.

When managed correctly, a successful media interview can deliver significant visibility and reputational benefits for you as an individual practitioner, or for an associated brand or clinic business. However, many practitioners can find interviews to be nerve-wracking. Common concerns include being tripped up by an unexpected question, or being misinterpreted and having an incorrect (or controversial!) statement go out into the ether.

The good news is that with some simple preparation and techniques which I will share in this article, you can maximise your success with media interviews and establish yourself as a reliable and interesting expert voice.

Types of media interview

Each different interview format – and indeed who is the target audience of each format – will require you to adjust your approach slightly in order to successfully communicate your messages. Also bear in mind your experience level – it’s a good idea to build your confidence with email or phone interviews, before building up to TV or radio.

Interview formats commonly include:

· Print: Either conducted face-to-face or via telephone/video call with questioning from a reporter or journalist, whether this is for a consumer or trade audience. This has been a popular format for introducing brands and experts for decades.

· Social media: Q&A’s and ‘ask the expert’ live streams are increasingly popular on Instagram, TikTok and YouTube. The interviews are often adapted depending on the host’s own unique style or focus. To ensure the interview benefits your own profile-building as much as possible, consider prioritising those platforms on which you are already active.

· Podcasts: This is a digital medium consisting of audio (or video) episodes that relate to a specific theme. Podcasts have increased significantly in popularity in recent years.

· Television: Possibly the most daunting interview format, whether it’s being filmed live or pre-recorded. Locations vary from ‘on location’, such as in your clinic, in the TV studios or from your home/office via digital call.

· Radio: The original audio-only format – recorded either in-studio or via phone. Nowadays, the interview may also be filmed and streamed to social media.

Securing media interviews

Interview opportunities can be secured in a variety of ways. You may have been approached directly by a journalist who is looking to speak with someone about a particular topic or treatment. Incidentally, this is a key demonstration of the power of your

own PR and marketing – if you are already positioning yourself across media channels and online sources as an expert, you are more ‘findable’ for press looking for information and opinions.

In many cases, interview opportunities arise as a result of broader brand or clinic activities, where a PR agency has provided your details to press as part of a particular news story or treatment focus. It is important to highlight that these opportunities are not only accessible through a PR team. Whilst a dedicated PR support will certainly help in terms of frequency and volume of opportunities, there is nothing to stop you independently responding to media enquiries, reaching out with your insights or utilising your own content platforms to showcase your expertise and attract interview opportunities.

Finally, you may have reached out directly to a journalist on a particular issue or story and secured their interest in speaking further. Taking the initiative in this way is often the way to kickstart longer-standing relationships with journalists, as they know they can rely on your responsiveness.

Preparing for an interview

There is always an element of unpredictability when it comes to ‘live format’ interviews like audio and video, but with some preparation and key techniques, you can keep things on track.

Do your homework

Being prepared will help reduce the ‘fear factor’ around the unknown, enabling you to practise your approach whether it’s a brief phone call or a live TV studio interview. Ask the journalist (or organising PR agency) in advance:

· What do they want to talk to you about?

Get as much detail as possible on what they’re looking for and what information they already have about what will be discussed.

What questions do they plan to ask you? Ask for these in an email so you have a written record and can plan out your responses.

Are they speaking to anyone else? If so, research their backgrounds and anticipate what their angles/points of view might be.

· What is the broader context for the interview? It is essential to know the broader context within which your opinion is being framed.

· What format will the interview take and how long will it be? Will it be conducted virtually, face-to-face or via telephone?

· What is the tone of the interview? Are the interviewers looking for serious, academic responses, or is it more light-hearted?

Hone your messages

Remember, you’re not there just to answer the journalist’s questions, you are there to put across your messages at the same time. Consider your top two or three key messages which you can use to have the greatest positive impact on both the consumer and your reputation. These should be short, relevant and repeated throughout your interview to help the audience remember the most pertinent points. Bear in mind that it is never advisable to try and discredit a competitor during interviews, even if this is one of the goals you have in mind; if you want to prove yourself to be trustworthy in comparison to others, let your answers speak for themselves.

The media love to talk in ‘soundbites’ i.e. short, impactful statements, so ensure you phrase your answers in this way and tell the audience something they don’t already know. Where possible, you can include a fact or figure that underpins or supports your position, alongside a call to action – what should people do as a result of your advice. For example, “If you have any concerns post aesthetic treatments, contact your practitioner straight away to ensure any issues are promptly treated.”

It is crucial to remember with public-facing media that the average person does not have in depth knowledge of medical and aesthetics topics, so steer clear of complicated language or jargon so your answers are more approachable.

Remember to stop speaking once you have answered each question. Silence – or ‘dead air’ – is the cue for the journalist to ask more questions, so don’t feel you have to fill the gap as this is the path to rambling or wasting time in which you could be providing more valuable answers.

Practise ‘bridging’

The bridging technique is about how to get yourself from what you’ve been asked, to what you want to say. Importantly, this doesn’t mean ignoring or disregarding the question and ploughing on blindly with your key messages. You should briefly answer the question, and then use a bridging phrase to get to one of your desired talking points, such as:

· “It is important to remember that…” “Let me put that in perspective…”

· “The real issue is…”

· “What I’ve seen in clinical practice is…”

“And that reminds me…”

Bridging technique helps ensure that both participants in the interview get what they need out of it. You get to deliver your messages while answering the journalists’ questions, and bridging can also help you maintain an element of control of the conversation.

Get comfortable

Body language speaks volumes, especially in visual formats, so make sure you have made your environment (and yourself) as comfortable and relaxed as possible before the interview begins. Don’t slouch or appear too rigid, and ensure you have set yourself up in a way that lets you be grounded and calm to minimise fidgeting. You need to portray confidence and authority, so try to keep unconscious movements to a minimum – watch out for jiggling hands or feet. Hand gestures can help you make a point but don’t overdo it; if you tend to ‘talk with your hands’, try folding them in your lap and keep gestures to emphasise important points. It might help to practise being in front of the camera so you can check your body language, background and positioning.

Gentle corrections

If you don’t know an answer, don’t be afraid to say so! You can always bridge to what you do know, or what you can surmise based on your expertise. If the interview is for a written format, reassure the reporter that you will come back to them with a response shortly. It is never a good idea to fabricate responses or embellish upon what you already know so you appear to give a good answer, as this will almost always backfire.

Similarly, it is reasonable to politely correct a journalist if you feel they have made a mistake or put words into your mouth. As soon as you notice the mistake, correct them but be careful not to become defensive in your response. Allowing a misquote or misinformation to go un-checked can negatively impact your professional reputation. With the majority of media content now ‘living’ online regardless of initial format, people can find it, comment on it and share it for an extended period of time, so it’s much better to nip inaccuracies in the bud.

Common pitfalls to avoid

The first mistake you can make when it comes to media relationships is withdrawing from an interview scenario altogether, particularly in a time of crisis or controversy. This can appear evasive and defensive, and gives free reign to others to fill in the blanks on the facts on your behalf. Saying ‘no comment’ is, in fact, giving a comment – it says you can’t be bothered to respond properly, or have not prepared sufficiently.

Similarly, it is not advisable to not answer the questions you’re asked, either through evasion or by getting so lost in thought you do not provide the information required. If the question is a thorny issue, you still need to give a response, then quickly bridge to a message you do want to highlight.

By maintaining a professional and authoritative, yet polite and approachable demeanour in interviews, you will build trust and credibility among a wide variety of audiences. If this is a skill you need support in developing, it’s always worthwhile investing in some PR training and support to equip yourself for these valuable opportunities.

Overcoming self-doubt

The final, yet crucial, thing to bear in mind before diving into the world of media relationships is gaining the confidence to be seen as an authority voice in your relevant specialism, and rejecting any imposter syndrome which may come to the surface. To be able to provide comprehensive, informative and truly personal answers during interviews, you have to be sure of yourself and familiar with the extent of your knowledge. So, embrace the nerves, but do not doubt your abilities, or the fact that you deserve every opportunity that comes your way. This is what will help you come across as comfortable and trustworthy during your interviews.

Building a media profile

Media interviews can be a great way to build your professional reputation, support your business and increase your profile, not only among peers in aesthetics, but also consumer press and the general public. However, the skills and techniques employed in interviews are often not part of a practitioner’s traditional training repertoire. These concerns should not deter you from having a voice in the media, if you follow the simple tips in this article to help you feel prepared.

Julia Kendrick is a business strategy and communications specialist with 20 years’ experience. She is the founder of Kendrick PR – a full-service B2B and B2C specialist agency, working on brands and startups across aesthetics, beauty and wellbeing fields.

Selecting the Best Laser Devices for Your Clinic

Dr Tanja Phillips offers a comprehensive guide to help clinicians choose the right laser technology for their practice

Investing in an aesthetic laser device can be transformative for clinics looking to expand their services and attract a broader patient base. Laser devices are increasingly popular in aesthetic clinics, with research showing a steady rise in their use across the medical aesthetics field.1 However, with a wide range of devices available – each claiming to deliver outstanding results – selecting the right one can be a daunting task. To ensure long-term success and avoid costly missteps, it’s essential to conduct thorough research and make informed decisions.

This article provides a guide for selecting an appropriate laser device for your clinic, and highlights strategies to avoid common pitfalls in the decision-making process.

The role of laser devices in clinical settings

Since the first laser was developed in 1960, laser technology has advanced significantly, establishing a strong safety profile and clinical efficacy when operated by trained professionals.1 Lasers emit concentrated beams of energy at specific wavelengths, targeting skin structures such as melanin, haemoglobin or water.2

This targeted approach makes lasers highly effective for treatments including hair removal, skin resurfacing, pigmentation correction and vascular therapy.2,3 Compared to other energy-based modalities, lasers often produce faster results and typically require fewer sessions.2,3

Key considerations when choosing a laser device

Choosing the right device for your clinic involves more than just comparing specifications. It’s important to consider the types of treatments you offer, your target patient base and the changing demands within the aesthetics specialty.

The sections below outline the key factors to consider and the recommended steps to help guide your decision when evaluating a laser device.

Understanding patient needs and demands

Robust market research informs decisions by identifying what treatments patients actively seek.4 Established clinics can survey their patient base – through questionnaires or appointment discussions – to discover desired services not currently offered. This approach aligns investment with actual demand, not assumptions.

For newer practices, market research provides essential insight into the local population’s characteristics – such as age, skin type and lifestyle – ensuring device compatibility with the patient demographic.

Evaluating nearby businesses can also help identify service gaps. Tools like Google Trends and social media polls offer additional insight into evolving patient interests. Notably, clinics that invest in versatile laser technologies capable of treating a wide range of skin types and conditions have successfully expanded their reach.

Single function versus multi-function lasers

While specialised devices may excel in addressing specific concerns, their narrow application limits flexibility.5 Clinics focused solely on treatments like tattoo or hair removal may benefit from single-function systems. However, most modern clinics aim to diversify their offerings.6

Acquiring multiple devices can quickly become costly and space-prohibitive. Multi-platform laser systems – offering variable wavelengths, pulse durations and adaptable settings – address a broader spectrum of concerns efficiently.3,4

Increased treatment variety also boosts digital visibility and attracts new patients. Patients receiving effective care are more likely to return and refer others, enhancing long-term profitability. Bundling complementary treatments can encourage high-value bookings, improve time utilisation and maximise return of investment (ROI) by generating multiple revenue streams without added consumable costs.

Advanced devices with multi-wavelength capabilities provide clinicians with precise control over treatment variables, offering both ablative and non-ablative options for customised care.7,8 These features not only optimise outcomes but also build patient trust – translating into loyalty, referrals and clinic growth.

Brand reputation and clinical evidence

Reputation and patient safety are key when investing in an aesthetic laser. Choose devices supported by peer-reviewed research and real case studies to ensure reliable results. Look for companies with strong clinical evidence behind their technology, and always request device-specific data – not just brochures or general studies on similar wavelengths.9 Some companies will promote evidence for their device when the research was performed on another device. Others promote clinical evidence that was actually obtained using a different device, which can be misleading. This is because US Food and Drug Administration (FDA) 510k clause allows manufacturers to prove their device is equivalent to a legally marketed one. It’s often used to introduce cheaper alternatives to established brands, so always conduct thorough research.10

When selecting laser devices for aesthetic use in the UK, ensure they are European Conformity (CE) marked or UK Conformity Assessed (UKCA), registered with the Medicines and Healthcare products Regulatory Agency (MHRA) and compliant with UK Medical Device Regulations (UK MDR).10 Class 3B and Class 4 lasers require stricter controls as these are more hazardous and can potentially cause serious injury or harm if not used appropriately.11 Clinics must also adhere to local council regulations and may require Care Quality Commission (CQC) registration for invasive medical treatments.12,13 Always verify the manufacturer’s credentials and request supporting regulatory and safety documentation.

Device reliability and longevity

The long-term success of an aesthetic device depends on its reliability and durability. Daily use places strain on components such as the casing, optical arms, fibres and handpieces, increasing the risk of breakdowns, costly repairs and clinic downtime. Devices constructed from robust materials like titanium or medical-grade

metals are preferable to plastic components, which can degrade quickly. Minimising equipment downtime is essential to maintaining service continuity and protecting clinic revenue.

When investing in a laser device, clinics should prioritise comprehensive warranty coverage and dependable ongoing service support. An effective warranty should include parts and labour for a minimum of one to two years, protecting against manufacturing defects and early malfunctions.14

Equally important is the quality of post-sale support, including access to certified engineers, timely technical assistance and loan devices during repairs. Service contracts should outline response times, maintenance schedules, training, software updates and calibration. Regular servicing and comprehensive warranties minimise downtime, ensure device performance and uphold clinical reliability. Practitioners should request clear information on warranty duration and ongoing maintenance costs.

Training programmes and patient support

Patient safety is paramount when selecting a laser system. Devices equipped with features such as integrated cooling systems, variable pulse durations with advanced pulse characteristics, temperature monitoring and adaptability to different skin types offer enhanced safety and patient comfort.15,16 It is advisable to select a manufacturer with a well-documented safety record, supported by published evidence substantiating performance and safety claims.17

Effective training following the purchase of any device is crucial for optimising treatment outcomes and ensuring patient safety. Due to the variable level of expertise in practice, clinics need access to expert guidance from the training team and key opinion leaders to fully leverage the potential of aesthetic devices. It is important to find a supplier that will not only offer in-depth face-to-face training rather than just web-based training, but also additional support such as accessibility day to day by phone or WhatsApp, online video recaps and resources and 24/7 technical and clinical support to help clinicians stay up to date with best practices.18

Some manufacturers may offer devices on a trial basis; however, this requires stringent oversight, including appropriate clinician training, supervision and insurance coverage, particularly given the complexity of certain devices and treatments.

Consumables and running costs

Many manufacturers offer ROI estimates; however, these are often based on high-level assumptions and may lack relevance to individual clinic operations. For instance, projections such as, “If you charge £X per treatment and see 10 patients per month, you will generate £Y,” can provide a general guideline, however, they often fail to account for clinic-specific factors such as overheads, patient demographics and service capacity. Simplified revenue forecasts do not adequately capture net profit or, more critically, cash flow. It is therefore essential for practitioners to conduct their own financial analysis based on actual costs, pricing strategies and operational models. Reputable companies should support this process, and online ROI calculators can also be useful tools.19 This tailored evaluation offers a more accurate indication of whether a laser investment will enhance treatment capacity and long-term profitability.20

High running costs can significantly impact profitability. Devices requiring costly consumables or frequent replacements may reduce the expected ROI. For instance, some systems demand regular purchases of consumables like pads and tips, while others with reusable components offer a more cost-effective option.21 The lowest initial cost may not always be the most economical in the long term. Investing in devices with lower operating costs supports more sustainable pricing strategies. Additionally, consider features that reduce the need for supplementary

equipment, such as software upgrades for new treatments, added wavelengths, or integrated technologies like cooling systems and tissue temperature sensors, which enhance long-term value and prevent obsolescence.22-24

Future proofing your device

Purchasing a laser device represents a substantial capital investment. Ideally, the selected system should deliver a full or significant ROI within the first six to 12 months and continue to generate increasing returns over time. A well-matched device should be capable of treating a substantial portion of the clinic’s existing patient demographic, reducing reliance on acquiring new patients and facilitating early cost recovery. This, in turn, enhances the financial viability of both the device and the clinic, supporting sustainable business growth.

To future-proof the investment, practitioners should prioritise devices that offer upgradability as new technologies or treatment protocols emerge. This may include periodic software updates or the ability to add supplementary handpieces – options that are typically more economical than replacing the entire system. Furthermore, such upgrade paths promote environmental sustainability by extending the operational lifespan of the equipment.

Common pitfalls in choosing a laser device

• Single-function vs. multi-function devices: Prioritise versatility to expand treatment options.

• Neglecting patient demographics: Ensure the device matches the needs of your patient base.

• Overlooking the evidence base: Verify the clinical evidence supporting the device’s safety and efficacy, and seek clarification when necessary. Be cautious of claims such as “the only device capable of...” or “new technology,” as these assertions can be misleading.

• Ignoring ongoing costs: Consider both initial investment and recurring consumable costs in ROI calculations.

• Inadequate training: Training should be conducted by qualified clinical specialists, not sales representatives, and delivered in person for practical, hands-on learning. The trainers must have daily experience with the devices to ensure they understand their clinical application. Additionally, practitioners should clarify ongoing support availability for follow-up questions.

• Insufficient warranty and support: Choose devices with comprehensive warranties and reliable ongoing maintenance support.

Evaluating the device market

Choosing the right aesthetic laser device requires careful consideration of versatility, reliability, ongoing costs and support. By investing in the right technology, clinics can achieve superior patient satisfaction, long-term growth and a strong ROI.

Dr Tanja Phillips is a laser specialist with over 30 years’ experience in medical aesthetics and is an NHS GP. She is recognised by the Laser and Health Academy as a leading specialist and key opinion leader in laser aesthetics. She owns two clinics under the name Dr Tanja Phillips Medical Aesthetic Clinic, located in Hampshire and Berkshire, and also serves as the Medical Director at The HVN in Knightsbridge. Dr Phillips is also a lead trainer for Fotona.

Qual: BM, MRCGP, DCH, DRCOG

In The Life Of: Olivia Salmen

Nurse practitioner Olivia Salmen shares how she masterfully balances a demanding travel schedule with her commitment to patient care

A typical working day…

As someone who isn’t a morning person, I do my best to stay in bed until it’s absolutely necessary to get up. I wake up at 7:30am and allow myself exactly 30 minutes to get ready for work: 15 minutes for skincare, 10 for makeup and five to pull myself together. Anything more feels pointless – and by the end of the day, I’m usually sweating anyway.

Luckily, my commute only takes 15 minutes, which gets me to the clinic by 8:30am. Controversially, I don’t listen to anything during the drive. I know that might sound strange, but those 15 minutes of silence are sacred. It’s my time to sit with my thoughts, collect myself and mentally map out the day ahead. For longer drives, I love tuning into the Huberman Lab podcast by neuroscientist Dr Andrew Huberman. It dives deep into topics like longevity and regenerative medicine – my kind of podcast!

A typical day in clinic runs from 8:30am to 4:30pm, during which I see around 20 patients. The appointments vary, from a quick 20-minute neurotoxin treatments to hour-long laser sessions. Because of my travel-heavy schedule, I’m usually in clinic about three days a week, depending on where I’m headed for training sessions. It’s a balance I really enjoy!

Not only am I not a morning person, but I’m also not much of a breakfast person. Typically, I don’t eat until lunchtime, relying on electrolyte water and apple cider vinegar to keep me going through the morning. By noon, I usually DoorDash lunch from a local salad bar called Chopt. My go-to order is a chicken Caesar salad, paired with a protein shake for an added nutrient boost.

Reflecting on what’s been happening in the clinic, alongside current trends within the specialty, neurotoxin continues to be a top contender. Honestly, I think botulinum toxin will always hold the crown. One treatment I’m especially excited about is platelet-derived growth factor (PDGF), a sterile, recombinant growth factor that’s gained major traction in the US. Right now, PDGF treatments are my favourite to perform, as they offer a fresh, versatile solution for various concerns to a wide range of age groups, especially areas like the tear troughs, which can be challenging to treat effectively with filler alone.

In the afternoon, I wrap up my appointments and head home. As we enter warmer months, I love taking an hour-long walk after work. My neighbourhood is super walkable, which I really appreciate! It reminds me of my hometown in East Tennessee, where everything revolved around walking and nature. There wasn’t much else to do! While my husband prefers hitting the gym, I love being outdoors. For me, it’s less about exercising and more about connecting with nature.

My evenings don’t follow a strict routine, as frequent travel forces me to be flexible. I live with my husband, and when I’m home, we usually cook dinner together and wind down with a show. One constant, though, is making time to see my girlfriends, which is something that’s become especially important given how busy our schedules are. I typically catch up with them over dinner on Monday or Tuesday evenings, then spend the rest of the weeknights with my husband before flying out again.

Other work commitments…

I tend to spend half of my week travelling for training days and events in the medical aesthetics field. I serve as an international trainer for Revance, which gives me the opportunity to travel domestically and internationally to share my knowledge and experience.

Training sessions range from intimate workshops with just five trainees to large conferences of around 1,000 attendees. I actually prefer the big-stage presentations, as there’s more freedom to cover the topics I choose, such as the power of supplements or the PDGF treatments, and I can reach a much larger audience.

Last year, I was away for 46 out of 52 weeks, and by the end of it I was feeling burnt out. This year, I’ve made a conscious effort to create more balance. Rather than flying out every week, I’m trialling a new approach where I’m travelling two to three weeks each month instead of all four, giving myself a bit more breathing room.

Most memorable day in your career…

I’d have to say it was the first major stage programme I ever did, back in 2021 at the Revance headquarters in Nashville. Like many, I experienced imposter syndrome standing on stage for the first time, but fortunately, I had Dr Lee Walker by my side. He’s been an incredible mentor throughout my career. After pushing myself to get on that stage, the sense of euphoria afterwards was absolutely unforgettable.

What is your dream holiday destination?

I’m thrilled to be visiting Japan later this year!

What is your favourite TV series? It would either be Lost or Breaking Bad – they’re both so captivating. If you could choose a career outside the medical field, what would it be?

I’d love to be a wildlife photographer – I bought my first camera at 13 with every penny I had!

Olivia

· Are we delivering results that speak for themselves?

· Are we educating our patients so they can make informed decisions about their treatments?

· Are we making the patient experience so seamless and exceptional they wouldn’t even consider going elsewhere?

Patients will naturally gravitate towards the practitioner who meets their needs. If that isn’t us, then instead of feeling offended, we should view it as an opportunity for reflection and growth. What can we improve? What feedback are we missing?

Patients Cheating on Aesthetic Practitioners

Dr Sophie Shotter shares why patients switching practitioner should not be viewed as a betrayal

In the world of medical aesthetics, there is an unspoken but undeniable phenomenon – patients ‘cheating’ on their practitioners. They try out different clinics, experiment with other injectors and sometimes return with mixed results, or never return at all. It’s a reality that many aesthetic practitioners face, often with feelings of betrayal, frustration or disappointment. But let’s be clear about one thing – we do not own our patients.

The notion that a patient is ‘cheating’ simply because they have chosen to explore other options is, quite frankly, baseless. It is a mindset that stems from insecurity and a failure to understand the core of our profession. Our role as aesthetic clinicians is not to monopolise patients, but to provide them with the highest standard of care.

If we are truly confident in our skills, our service and the results we deliver, we should welcome comparisons because we will stand out where it matters, based on the skills that each of us focus on and build.

Patients are not bound by loyalty

Aesthetic clinicians are providing a medical service. In any area of private medicine, there is a clinical component and a service component. Like with any service, people will shop around. They are not obligated to remain with one clinician forever, nor should they feel guilt-tripped for seeking alternative opinions or experiences.

Some patients might be curious to see what another practitioner offers. Others might have had a bad experience, whether real or perceived, and want to see if the grass is greener elsewhere. Some are simply lured by cheaper prices, aggressive marketing or enticing before-and-after images on

social media. Whatever the reason, it is their prerogative to make that choice. Our job is not to police their decisions, but to respect their autonomy and ensure that when they do choose us, it is for the right reasons.

Understanding, not ownership

While we may not own our patients, we do have a duty of care. This means that if they return to us after visiting another provider, it is crucial to approach the situation with professionalism and understanding. Instead of reacting with resentment or making them feel judged, we should ask the right questions: What treatments have they had elsewhere? Were they happy with the results? Are there any complications or concerns we need to address?

Patients should feel comfortable being transparent with us. If they hesitate to disclose their history out of fear of being chastised, we have already failed in our role. The goal is to provide safe, effective treatments based on the full picture of their treatment history, not to interrogate them for stepping outside our clinic doors.

Excellence is the best retention strategy

The most effective way to ensure patient loyalty is not through guilt or exclusivity, but through excellence. Patients should want to return to us not because they feel they have to, but because they recognise that we offer something unparalleled. This can be superior results, a deep understanding of their aesthetic goals or an experience that makes them feel valued and heard. Instead of focusing on who our patients have seen before us, we should be asking ourselves:

What makes another clinic more appealing than ours? Sometimes we should accept that we are not the right practitioner for each and every patient, and a colleague will be a better fit.

When patients return

There is nothing more telling than a patient who ventures elsewhere and then comes back. When this happens, it is not an occasion for "I told you so" or passive-aggressive remarks. It is an opportunity to reaffirm why they chose to return. Welcome them back with the same warmth and professionalism you would show any other patient. Address any concerns they might have from their previous treatments, and most importantly, focus on moving forward rather than dwelling on their decision to leave in the first place.

A patient who has tried multiple practitioners and still returns to you is a testament to your skill, care and expertise. It is one of the highest compliments you can receive. But if they don’t return? Let them go with grace. The aesthetics specialty is vast, and not every patient is meant to stay with you forever.

Patients have a choice

Rather than viewing patient ‘cheating’ as a betrayal, we should see it as a reality of our profession. It keeps us accountable. It forces us to stay competitive. Most importantly, it reminds us that excellence is not an endpoint, but a continuous commitment.

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

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

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