SKIN QUALITY AND COLLAGEN June 2026 | VOLUME 14 - ISSUE 7
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The Resource for Medical Aesthetics Professionals
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CPD: Clinical Causes of Facial Erythema Dr Rehanna Beckhurst explores facial erythema
Special Feature: Optimising Skin Quality with Skin Boosters Treating Facial Burns with Hypochlorous Acid
ALSO IN THIS ISSUE
Michelle McLean explores the regenerative role of PLLA Vanessa Brown-Ofoedu outlines the implications of counterfeit devices
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
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1.BOCOUTURE Summary of Product Characteristics. Merz Pharmaceuticals GmbH: https://www.medicines.org.uk/emc/product/600/smpc (Last accessed January 2026). M-BOC-UK-0591 Date of Preparation: January 2026
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Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk/. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/reportan-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.
17/02/2026 11:15 10:36 05/02/2026
Confidence beyond the *1 mirror SOCIAL CONFIDENCE 1 MONTH AFTER RELFYDESSTM* 1
96%
93%
91%
"I feel confident when I meet a new person"
“I feel confident when I participate in group situations”
“I feel confident in new social situations”
Percentage of patients who ‘somewhat agreed’ or ‘definitely agreed’ with the statement.
QR code to prescribing information and adverse event reporting.
Galderma portfolio available at our distribution partners
medfx
Relfydess™ is indicated for the temporary improvement in the appearance of moderate-tosevere glabellar lines (GLs) at maximum frown and moderate-to-severe lateral canthal lines (LCLs) at maximum smile alone or in combination, in adult patients under 65 years, when the severity of these lines has an important psychological impact on the patient.2 *Based on the percentage of patients treated with RelfydessTM for moderate-to-severe GLs present at the Month 1 visit (n=98) of the Phase IIIb RELAX study who ‘somewhat agreed’ or ‘definitely agreed’ with the individual questions in the FACE-Q Social Function questionnaire related to feeling confident at Month 1.1
GL, glabellar line; LCL, lateral canthal line. References: 1. Moradi A, et al. Poster presented at: IMCAS; Paris, France; January 30–February 1, 2025; 2. Galderma. Relfydess™ Summary of Product Characteristics. January 2026. 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. © 2026 Galderma S.A. All rights reserved. GB-REL-2600072 April 2026
Contents • June 2026 08 News The latest product and specialty news
19 BAAPS Annual Audit Highlights Changing Male Aesthetics Landscape Aesthetics explores the factors behind last year’s overall decline in male cosmetic and non-surgical procedures
CLINICAL PRACTICE 20 Event Preview: Making Networking Work for You Step into the conversations that shape CCR 2026
22 Special Feature: Optimising Skin Quality with Skin Boosters Four leading practitioners consider the role of skin boosters in skin health
26 CPD: Facial Erythema in Aesthetic Practice Dr Rehanna Beckhurst explores the dermatological and systemic causes of facial erythema
News Special: The Changing Male Aesthetics Landscape Page 19
33 Presenting an Overview of Biostimulating Treatments Dr Paul Charlson outlines a comprehensive review of biostimulators
37 The Role of Poly-L-Lactic Acid in Body Rejuvenation Michelle McLean examines the regenerative role of PLLA in rejuvenation
41 More, More, More: Embedding Sun Safety into Everyday Aesthetic Practice The British Skin Foundation (BSF) promotes a simple, consistent approach to sun protection
43 Treating Facial Burns with Hypochlorous Acid Dr Ambreen Ayaz and Dr Helen Whyte address facial burns with hypochlorous acid
46 Assessing and Managing Infraorbital Hollowing Alice Henshaw considers patient concerns surrounding the periorbital area
Special Feature: Optimising Skin Boosters Page 22
48 Regeneration Evolved: Extending Sculptra From Face to Body Harnessing Sculptra Body to address skin quality concerns beyond the face
Clinical Contributors Dr Rehanna Beckhurst has advanced qualifications
49 Abstracts
in dermatology and aesthetics, she specialises in natural, ethical
A round-up and summary of the latest clinical studies
rejuvenation and the care of anxious patients. Dr Beckhurst leads
IN PRACTICE
ifab Clinic with a focus on safety, integrity and evidence-based result.
50 Driving Retention Through Structured Consultations
and dermatology. He is a founder member of the Joint Council for
Dr Alison Colville explores patient retention through consultation
Cosmetic Practitioners and BSAEA. He currently instructs Juvelook
Dr Paul Charlson has a background in general practice
52 Understanding the Importance of Strong Governance Tracy Green labels strong governance as the unseen driver of high-performing aesthetic clinics
54 Identifying and Avoiding Counterfeit Devices Vanessa Brown-Ofoedu breaks down the implications of counterfeit devices in aesthetic practice
57 In The Life Of: Dr Jessica Halliley
and Lenisna as part of the FILLMED faculty. Michelle McLean holds a bachelor of science with honours in nursing, a postgraduate certificate in cosmetic medicine, and a master’s in advanced healthcare practice, and is an independent and supplementary prescriber. Dr Ambreen Ayaz is a consultant dermatologist and clinical director of dermatology at an NHS Trust in Greater Manchester. She also serves as the immunobiologics lead and audit lead within
Dr Jessica Halliley shares a day in her life as a clinic owner and KOL
58 The Last Word: Are PN Myths Affecting Compliance in Aesthetics? Rian Seo argues why leftover polynucleotides can compromise sterility, ethical practice and regulatory compliance
the department. Dr Helen Whyte graduated with a Bachelor of Dental Surgery from the University of Wales College of Medicine in 2005. Dr Whyte also co-founded The Aesthetic Treatment Rooms, where she focuses on cosmetic treatments. Alice Henshaw is the founder and medical director of Harley Street Injectables, a qualified nurse prescriber registered in the UK, Australia and New Zealand and a key opinion leader for Allergan
NEXT MONTH: FACE AND NECK • Injectables for Decolletage • Neck Rejuvenation • Treating Melasma with LED
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Be confident in your patient care AviClear completely saved my skin. I was struggling until I found AviClear. I will get a pimple here and there but my skin has calmed down so much. I'm no longer constantly worried about having acne all the time. I am so happy now to wake up in the morning and see my skin"
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Editor’s letter With summer now underway, many patients are focusing on how their skin looks and feels in brighter light and warmer weather. It is therefore the ideal moment to examine, from a clinical perspective, what truly underpins confident, natural results: high-quality skin and effective collagen stimulation.
Holly Carver Editor & Content Manager
Our Special Feature examines the evolving role of skin boosters in medical aesthetic practice, turn p.22 to read more. We also explore several topics in this month’s clinical articles, including an exploration of biostimulating injectables and how they can be integrated into structured treatment plans to support gradual, long-term collagen remodelling. We also include practical, peer-written guidance on best practice for PLLA treatment, detailed considerations for safely managing the tear trough and clinical strategies for improving the appearance of burns. In our Last Word, we turn to polynucleotides and address a practical clinical question currently generating debate: should you microneedle
the final remainder of the product into the skin at the end of treatment, or not? Make sure to let us know your thoughts. Looking ahead to the Clinical Cosmetic Regenerative Congress (CCR), our Event Preview explores why in-person networking remains so important. Beyond the scientific sessions and live demonstrations, CCR offers opportunities to discuss challenging cases, share complication management strategies and build multidisciplinary referral networks. We are also delighted to introduce our brand new Aesthetics Results Awards, taking place on Day 2 of CCR. Entries are now open, giving you the opportunity to present your clinical outcomes, recognise your work and gain well-deserved acknowledgement for the detailed, patient-centred case studies taking place in your clinic every day. Turn to p.21 to find out more information. If you are interested in contributing clinical articles, case studies or opinion pieces in future issues, please do get in touch with the editorial team at editorial@aestheticsjournal.com – we are always keen to hear from practitioners who would like to share their experience.
Clinical Advisory Board
Leading figures from the medical aesthetic community have joined the Aesthetics Advisory Board to help steer the direction of our educational, clinical and business content
Sharon Bennett is the former chair of the British Association of Medical Aesthetic Nurses (BAMAN), UK lead of the BSI committee for aesthetic non-surgical standards and member of the Clinical Advisory Group for the JCCP. She is a trainer and a registered university mentor in cosmetic medical practice, and is finishing her MSc at Northumbria University. Bennett has won the Aesthetics Award for Nurse Practitioner of the Year and the Award for Outstanding Achievement.
If you are interested in contributing to the journal, get in touch... Email: editorial@aestheticsjournal.com
Sharon Bennett, Clinical Lead Mr Naveen Cavale has been a consultant plastic, reconstructive and aesthetic surgeon since 2009. He has his own private clinic and hospital, REAL, in London’s Battersea. Mr Cavale is the national secretary for the ISAPS, president of the Royal Society of Medicine, and vice-chair for the British Foundation for International Reconstructive Surgery.
Dr Mayoni Gooneratne (MBBS, BSc, MRCS, MBCAM, AFMCP) was an NHS surgeon before establishing The Clinic by Dr Mayoni and founding Human Health – an initiative combining lifestyle with traditional and functional medicine to provide a ‘cell-up’ regenerative approach to aesthetics. She is also the co-founder of The British College of Functional Medicine.
Dr Sophie Shotter is the founder & medical director of Illuminate Skin Clinic in Kent and Harley Street, London. Her passion is for natural treatments delivered with utmost attention to safety. She works closely with Allergan as part of their UK and International Faculty.
Miss Elizabeth Hawkes is a consultant ophthalmologist and oculoplastic surgeon. She is the lead oculoplastic surgeon at the Cadogan Clinic, specialising in blepharoplasty and advanced facial aesthetics. Miss Hawkes is a full member of the BOPSS and the ESOPRS, and is an examiner and fellow of the Royal College of Ophthalmologists.
Jackie Partridge is an independent nurse prescriber. She is the clinical director and owner of Dermal Clinic in Edinburgh and a KOL for Galderma. She holds an MSc in Non-surgical Aesthetic Practice and a BSc in Dermatology. Partridge is a stakeholder group member with Scottish Government/HIS, Honorary BACN member and JCCP Fitness to Practice Nurse.
Dr Anjali Mahto is one of the UK’s leading consultant dermatologists. She is a Fellow of the Royal College of Physicians, member of the Royal Society of Medicine and a spokesperson for The British Skin Foundation. In 2023 Dr Mahto opened Self London, a dermatology and lifestyle clinic aimed at managing skin conditions holistically.
Mr Adrian Richards is a plastic and cosmetic surgeon with over 30 years’ experience. He is the clinical director of the aesthetic training provider Cosmetic Courses and surgeon at The Private Clinic. He is also a member of the British Association of Plastic and Reconstructive and Aesthetic Surgeons and the British Association of Aesthetic Plastic Surgeons.
Dr Souphi Samizadeh is a dental surgeon with a Master’s degree in Aesthetic Medicine and a PGCert in Clinical Education. She is the founder of the Great British Academy of Medicine and Revivify London Clinic. Dr Samizadeh is a Visiting Teaching Fellow at University College London and King’s College London.
Dr Stefanie Williams is a dermatologist with a special interest in adult acne, rosacea and aesthetic medicine. She is the founder and medical director of multi-award winning EUDELO Dermatology & Skin Wellbeing in London, and creator of Delo Rx skincare. She is the author of three books and has published more than 100 scientific articles, book chapters and abstracts.
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In the Spotlight... A monthly snapshot of the people, products and ideas generating real time buzz in aesthetics
Digital ethics Specialty figures raise concerns over celebrity critique content Olivia Falcon, journalist and founder of The Editor’s List, recently sparked conversation on social media after calling out the rise of celebrity critique content in aesthetics. In a video post, Falcon states, “When a doctor or surgeon starts critiquing celebrity faces on Instagram for likes, with no consent and very little context – that’s not expertise, that’s content chasing,” adding that practitioners should instead focus on showcasing their own results. The post drew support from practitioners including Dr Shino Bay, Dr David Jack, Dr Nina Bal and Dr Yusra Al-Mukhtar, with nurse prescriber Khatra Paterson describing the trend as “content at someone else’s expense.” Online conversation with @theeditorslist
Latest trends Dr Sophie Shotter outlines her verdict on wellness trends Aesthetic practitioner Dr Sophie Shotter shares her thoughts on current wellness trends on Instagram – from monitoring glucose levels and cold plunges to the gut–skin axis, nature exposure, nervous system regulation, protein intake and specific supplements. If there is one concept that underpins almost everything in health and skin, Dr Shotter believes it is nervous system regulation, labelling it as “foundational.” She suggests that meditation has strong evidence behind it, citing studies that show it can lower cortisol levels and improve heart rate variability. Wellness culture addressed by @drsophieshotter
GAIN by Galderma addresses menopausal treatment options Galderma Aesthetic Injector Network (GAIN) brought together aesthetic practitioners and dermatologists Dr Doris Day, Dr Malda Aldaoudi and consultant plastic surgeon Miss Priyanka Chadha to share insights they wish their menopausal patients had understood sooner. “Many patients come to me and say, “My face just fell apart,” to which I tell them that this is perimenopause and advise on when we should start our aesthetic routine,” says Dr Day. On product selection, Dr Malda cites Restylane Skinboosters for hydration and Restylane HA fillers for volume restoration and facial structure. Galderma will be exploring this topic in more depth during a dedicated session at the Clinical Cosmetic Regenerative Congress (CCR) 2026.
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The Advertising Standards Authority (ASA) has banned an advert promoting a serum from skincare company Eucerin. The advert, which appeared on a billboard at Balham tube station in London, received a complaint in November 2025. The advert claimed that the Eucerin Hyaluron-Filler Epigenetic Serum was ‘clinically proven,’ based on a study of 160 participants who used the product for four weeks, before being asked how much younger they believed they looked. The ASA raised concerns following a complaint that questioned whether the claim “Look up to five years younger” was misleading and whether it had been adequately substantiated. Beiersdorf UK, which is responsible for the marketing, sales, supply chain and brand management of Eucerin in the UK, stated during the investigation that the claim reflected a genuine maximum result rather than a typical outcome. Gemma Allwood, investigations executive at the ASA, commented, “Advertisers should make sure that claims implying measurable or clinically proven results are supported by robust evidence. In this case, we considered the claim that the serum was clinically proven to give a more youthful appearance of up to five years to be an objective one. Because we hadn’t seen sufficient evidence to substantiate this efficacy claim, we found that it was misleading.” Aesthetics reached out to Eucerin, and a spokesperson commented, “We acknowledge and respect the ASA’s ruling regarding this specific UK billboard execution and have co-operated fully. We are confident in the scientific evidence underpinning our products and the claims we use in our advertising and marketing materials. All of the studies we cite are carried out in line with specialty standards.” Peptides
BCAM issues warning over peptide injectables The British College of Aesthetic Medicine (BCAM) is urging the public to exercise caution over the increasing promotion of injectable peptide treatments.
Treatment spotlight
Menopause highlighted by @gainbygalderma
ASA issues ruling on skincare advert
BCAM emphasises that “peptide therapy” is an umbrella term encompassing compounds with differing evidence bases, legal statuses and safety profiles. BCAM warns that many products marketed online as “research peptides,” including BPC-157, TB-500 and melanotan, may not have been assessed by the Medicines and Healthcare products Regulatory Agency for quality, safety or efficacy for human use. It also notes that UK medicines regulations prohibit the advertising of unlicensed medicines and prescription-only medicines to the public. BCAM stresses that unregulated peptide products may carry risks including inaccurate dosing, contamination, uncertain purity and a lack of pharmacovigilance. Sadie Van Sanden Cooke, chief operating officer for BCAM, says, “Patients are being exposed to highly marketed injectable treatments that appear scientific and innovative, but which may have very limited evidence, unclear legality and unknown long-term risks. Online product promotion does not mean it is safe, regulated or medically appropriate.”
Aesthetics | June 2026
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Vital Statistics
Galderma returns as Headline Sponsor for CCR
More than 20,000 NHS jobs in England could be cut by 2028, as trusts manage a combined deficit of over £1.1 billion
Pharmaceutical company Galderma has been announced as Headline Sponsor for the Clinical Cosmetic Regenerative Congress (CCR) 2026. Galderma will have a presence across the scientific programme and exhibition floor, providing delegates with opportunities to engage with the company’s portfolio, clinical data and educational initiatives. As Headline Sponsor, Galderma will support key elements of the educational programme, including faculty-led sessions and live demonstrations, with an emphasis on evidence-based protocols and real-world treatment planning. Speaking at the Aesthetics Journal Arena, Galderma will focus on menopause on Day 1, with Day 2 dedicated to skin, lips and skin boosters. The company’s presence will also spotlight its portfolio, including Restylane, Sculptra and ALASTIN. Confirmed speakers include aesthetic practitioners Dr Yusra Al-Mukhtar, Dr Jessica Halliley and nurse prescriber Mary Irving.
(Unison, 2026)
Out of 2,000 UK adults, one in five rarely wear SPF, 7% never do and 77% see it as seasonal, mainly for summer (Face the Future, 2026)
Gul Gokyokus, head of marketing at Galderma UK&I, commented, “We’re proud to return as Headline Sponsor for the fifth consecutive year and to deliver a strong, science-led educational programme for healthcare professionals at CCR. This year we’ll be sharing the latest aesthetic trends and clinical data, with a particular focus on menopause and skin quality as the foundation of effective, natural-looking outcomes, alongside regenerative approaches and more personalised, holistic treatment planning.”
87% of red-light technology users and 81% of blue light blocking users in the UK have started using them within the past two years
Announcement
FDA reviews regulatory status of peptides The US Food and Drug Administration (FDA) has announced it will re-evaluate the regulatory status of several widely discussed therapeutic peptides, including BPC-157, KPV and Semax. Under current US compounding rules, pharmacies and outsourcing facilities may only compound medicines using active pharmaceutical ingredients (bulk drug substances) that form part of an FDA-approved medicine, appear in an official United States Pharmacopeia or National Formulary monograph, or are included on the FDA’s bulk drug substance list.
(BON CHARGE, 2026)
Searches for “exosomes” have reached around 528,000 per month, up 162% year-on-year (Fresha, 2026)
As these peptides are not licensed medicines and lack monographs, their use has depended on their categorisation within the FDA’s evolving bulk substances framework. In 2023, many popular peptides were placed in Category 2 – substances for which the FDA has identified significant safety concerns – effectively restricting their compounding. In a letter, the FDA confirmed that nominations for several peptides had been withdrawn and that these substances would be removed from Category 2 from April 22. However, they will not automatically move into Category 1, where the agency has stated it would generally not take action against compounders. The peptides will be reviewed by the Pharmacy Compounding Advisory Committee (PCAC), with consideration scheduled for the meeting on July 23-24, 2026 or by February 2027. Until the PCAC has issued its recommendations and the FDA has updated its bulk drug substances list, US compounding pharmacies will remain unable to use these peptides routinely in compounded preparations.
One in four out of 2,000 UK males are considering a hair transplant in 2026 (Elithair, 2026)
31% of Brits now spend on health and wellness weekly, rising to 45% among Gen Z (Westfields, 2026)
Aesthetics | June 2026
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Events diary
Aesthetics
Evolus debuts HA gel collection
th
1st-2nd October 2026 Clinical Cosmetic Regenerative Congress (CCR) and Medical Longevity Summit (MLS) 7th November 2026 RAMCE 14th November 2026 IAAFA Aesthetics Conference 22nd November 2026 Interface Expo 13th-14th March 2027 Aesthetics Conference & Exhibition (ACE) 14th March 2027 The Aesthetics Awards
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Hyaluronic Acid
24 -25 September 2026 BAMAN Autumn Aesthetic Conference th
Aesthetics
Pharmaceutical company Evolus has announced the launch of injectable hyaluronic acid (HA) gel collection Estyme in Europe. The company shares that the collection features four injectable HA gels; the debut of Estyme Lips and Estyme Sculpt, accompanied by Estyme Smooth and Estyme Form, which are currently marketed in the US under the brand name Evolysse. Evolus explains that the gels cover a wide range of applications, including preserving the natural structure of the HA molecule aiming to provide long-lasting, natural-looking results. David Moatazedi, president and chief executive officer of Evolus, commented, “We are especially excited to introduce Estyme Sculpt to practitioners, a product we believe has the potential to become a leader in mid-face volumising treatments. By pairing this innovative technology with the commercial strength we’ve built with Nuceiva, we are uniquely positioned among several companies with a neurotoxin and filler portfolio.”
Topical
Sun Damage
ALASTIN releases new vitamin C-based topical Skincare company ALASTIN, from pharmaceutical company Galderma, has launched C-Radical Defense Antioxidant Serum. According to the company, the formulation uses an encapsulated form of sodium ascorbate within a proprietary liposomal delivery system, rather than traditional L-ascorbic acid. Laboratory work cited by ALASTIN suggests this approach may help neutralise free radicals while conserving elastin, with the aim of maintaining skin resilience over time. The serum incorporates a complex of 14 antioxidants, including lactoferrin, ergothioneine, green tea extract, ectoin and coenzyme Q10, to provide broad spectrum protection against UV, pollution and other environmental stressors, shares the company. Rene Wipperich, general manager of Galderma UK&I, said, “This launch marks the next step in delivering visible results with trusted ingredients, responding directly to evolving consumer expectations while reinforcing our commitment to quality, efficacy and overall long-term skin health.”
APPG launches report on UV safety in Parliament The All-Party Parliamentary Group for Beauty, Hair & Wellbeing (APPG) has published its report on UV safety strategies in Parliament, following a year-long inquiry conducted across the UK. Titled A Preventable Crisis: The Case for a National UV Safety Strategy, the report identified several key barriers to improving UV safety nationwide, including online misinformation, limited public education surrounding the risks of UV over-exposure and a lack of awareness around the importance of sun protection. The report follows the launch of the APPG’s UV Safety Inquiry in May 2025, supported by the British Beauty Council in its role as Secretariat. Chaired by Carolyn Harris MP, the cross-party inquiry explored the root causes of UV damage in the UK. Presented in Parliament, the report outlined six key recommendations, including improving public awareness campaigns and introducing mandatory UV safety education in both primary and secondary schools. It also proposed removing VAT from high-factor children’s sunscreen products and classifying SPF30+ sunscreen as a preventative healthcare item. Additional recommendations included greater protections for outdoor workers by recognising sun protection as essential PPE, stronger regulation surrounding sunbeds, and tougher action against misinformation online and within advertising.
Study
ECO reveals weight-loss research The European Congress on Obesity (ECO) highlighted that GLP-1 users lose a greater proportion of muscle and bone compared to conventional dieting. The research was developed at the University of Copenhagen, where the team analysed data from 1,334 individuals who have lost weight either with weight-loss injections, through bariatric surgery or diet and exercise. The study found that for individuals who used exercise and diet control to reduce their size, muscle and bone loss accounted for 14% of the weight they shed, in comparison with 32% for those who used weight-loss injections. The researchers also highlighted that people who lost a significant amount of muscle were at a heightened risk of regaining weight once they stopped utilising injections, as they outlined that muscle was more metabolically active than fat. 10
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Event Awards
CCR reveals new Aesthetics Results Awards Aesthetics has announced the launch of the Aesthetics Results Awards, to be held at the Clinical Cosmetic Regenerative Congress (CCR) 2026.
BAMAN UPDATES A round-up of the latest news and events from the British Association of Medical Aesthetic Nurses
AN OVERVIEW OF 2026
The new initiative is designed to celebrate safe, ethical and exceptional patient outcomes over the past 12 months. The Awards will offer a prestigious yet relaxed platform, with a focused two-hour programme on the Aesthetics Mastery Theatre stage on Day 2 of CCR. Entries are now open with practitioners invited to submit detailed case studies across four categories, including best full-face transformation using injectables, best skin transformation, best body transformation and most challenging aesthetic case study.
As we approach the halfway point of 2026, it’s clear to see a real sense of momentum and community across BAMAN this year. Now we are firing on all cylinders as we prepare for our remaining regional meetings, June’s Cadaveric Dissection Course and our Autumn Aesthetic Conference.
Cases will be judged on robust, evidence-based practice, high-quality clinical photography aligned with Aesthetics Journal guidelines, and comprehensive reporting on consultation, treatment planning, delivery, adverse event management, aftercare and patient feedback. Following shortlisting in August, Finalists will have the chance to bring their results to life at CCR, presenting live in front of peers and specialty leaders before the Winners are revealed on stage.
ANATOMY MASTERCLASS TO COMMENCE
Holly Carver, editor and content manager at Aesthetics, commented, “CCR has always championed ethical, evidence-based practice, and the Aesthetics Results Awards are a natural extension of that ethos. We wanted to create a platform that celebrates real-world outcomes, where practitioners can showcase not only great results but also their commitment to safety, transparency and patient-centred care.” Trends
Report outlines patient perceptions AI-powered solutions provider Perfect Corp has launched The Modern Aesthetics Consumer report. Amongst the 300 patients surveyed, 80% of respondents expressed positive sentiment toward procedures such as botulinum toxin, dermal fillers and advanced skin treatments. Additionally, 45% reported having already undergone a cosmetic procedure, while a further 44% said they are actively considering treatment. The report cites date from Spate Popularity Index that searches related to “Age management” increased by 151.6% year over year, while interest in “Skin barrier” rose 41.1%, “Cellular senescence” increased 35.6% and “Skin microbiome” climbed 34.1%. The findings further underscore growing demand for personalisation and reassurance prior to treatment. 84% of respondents said AI-generated treatment previews would increase their confidence in trying procedures such as botulinum toxin or dermal filler, while 87% said AI visualisation technology would strengthen trust in a provider. Healthcare Indemnity
New insurance broker launches Specialist insurance broker Whetstone has entered the healthcare sector. According to the company, it aims to provide GPs and consultant surgeons working in private practice with stronger, contractual protection against litigation. Whetstone adds that it addresses growing specialty concerns, including legal and financial risks being amplified by AI-assisted complaints, heightened patient scrutiny and fragmented working patterns, all of which are contributing to a rise in complex negligence claims, according to the company.
The BAMAN x The A-List Cadaveric Dissection & Facial Anatomy Masterclass taking place at the Royal College of Surgeons in Edinburgh is one of the most in-depth educational opportunities BAMAN has ever offered. Led by internationally recognised nurse practitioner Julie Bass Kaplan, delegates will spend two full days in the labs on June 12-14, with a maximum 4:1 delegate-to-specimen ratio. Teaching is supported by facial plastic and reconstructive surgery Mr Jory Kaplan and consultant oral and maxillofacial surgeon Mr Jeff Downie. This course is designed for BAMAN nurses who want to move beyond basic anatomy. The learning will refine how you approach botulinum toxin and dermal filler treatments, so you leave working with greater precision and confidence. You’ll also build your ability to prevent, recognise and manage complications effectively.
BAMAN AUTUMN AESTHETIC CONFERENCE 2026 Delegates can now book their place at the BAMAN Autumn Aesthetic Conference 2026. We are returning to The Eastside Rooms in Birmingham on September 24-25, but for the first time, we’ve secured the entire hotel. This gives us the chance to create a much more connected experience across the two days. The programme is currently being shaped by your feedback, with a clear focus on practical, relevant content and more CPD opportunities. As always, it’s about making sure you leave with something you can take straight back into clinic. Tickets are now LIVE and can be purchased through the QR code below.
This column is written and supported by BAMAN
CEO of Whetstone Kevin Culliney commented, “We deal with good people trying to do the right thing, but mistakes do happen occasionally, and when a clinician or hospital group comes to Whetstone, they are looked after by people absolutely on their side.” Aesthetics | June 2026
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Professional Development
New mentorship programme launches Event Spotlight: The Key Pillars of Metabolic Longevity Dr Mayoni Gooneratne shares the highlights of this year’s Medical Longevity Summit
Aesthetic nurse prescriber Michelle McLean has outlined the development of a mentorship programme. According to McLean, the programme extends beyond injection techniques to include clinical decision-making, business strategy, pricing, branding and professional development, as well as activities such as publishing, awards participation and speaking opportunities. McLean states that the programme runs over six months for a small cohort of four delegates, describing the format as combining monthly mentorship days, in-clinic shadowing, case-based teaching, access to standard operating procedures, and clinic resources and ongoing remote support. McLean commented, “The mentorship programme is about bridging the gap between knowing how to perform a treatment and having the confidence, business understanding and clinical judgement to build a long-term, respected career around it.”
What is the theme of MLS for 2026? This year, the Medical Longevity Summit has a strong metabolic theme. We are focusing on metabolic health because it sits at the very heart of longevity, prevention, ageing and even aesthetic outcomes. We are seeing rising rates of obesity, pre-diabetes, diabetes, cardiovascular risk, hormonal disruption and inflammatory conditions, often in people who may still appear outwardly well. The aesthetics sector is in a unique position because we often see patients earlier, before they enter the conventional disease pathway. That gives us a powerful opportunity to educate, intervene and support prevention. Why should aesthetic professionals pay attention to wellness and longevity? It is more important than ever because patient expectations are changing. People no longer want to simply look younger. They want to feel better, function better, recover better and age with confidence. There is also a clinical responsibility. With the growth of weight-loss medications, hormone optimisation, regenerative treatments and longevity testing, practitioners need to understand the science, the safety considerations and the scope of care. What can delegates learn? This year, we will be covering the key pillars of metabolic longevity, including metabolic health, body composition, insulin resistance, inflammation, nutrition, hormones, mitochondrial function, weight management, GLP-1 therapies, biomarkers, skin ageing, regenerative medicine and the role of lifestyle medicine in prevention. Ultimately, the message is simple: the future of aesthetics is not just about looking younger. It is about ageing better, living better and helping patients build health from the inside out.
MLS takes place on October 1-2 at CCR. Turn to p.30 to register.
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Partnership
Roseway Labs collaborates with patient charity UK-based charitable organisation Mast Cell Action is partnering with compounding pharmacy Roseway Labs in recognition of Mast Cell Activation Syndrome (MCAS) Awareness Month. The formal partnership follows a year of collaboration between the two organisations and reflects a shared focus on supporting individuals living with mast cell disorders, including MCAS. The agreement aims to strengthen collaboration, expand joint activity, and support awareness and understanding of mast cell conditions such as MCAS, Hereditary Alpha Tryptasaemia and mastocytosis among both prescribers and patients through education, awareness initiatives and clinical support. Roseway Labs CEO and co-founder Elizabeth Philp commented, “Many patients with MCAS experience sensitivities to standard medicines and have unique clinical needs that require a more tailored treatment approach. Our pharmacy compounds medicines free from common allergens and irritants that may trigger reactions, supporting clinicians with bespoke solutions for underserved patient groups.” Distribution
Alma enters partnership with ExoCoBio Aesthetic device company Alma has announced its exclusive UK distribution for South Korean biotechnology company ExoCoBio. The partnership aims to expand Alma’s UK portfolio beyond energy-based technologies and injectables to include regenerative aesthetic solutions powered by exosome-based treatments. By integrating ExoCoBio’s technology into its offering, Alma aims to help aesthetic clinics enhance treatment outcomes, support faster recovery and deliver a more comprehensive patient experience across the UK and Ireland. Adam Bashier, managing director for Alma UK&I, said, “At Alma, we are committed to continuously evolving our offering to meet the changing needs of modern aesthetic practice. This collaboration with ExoCoBio represents a natural progression towards a more complete treatment ecosystem to deliver better outcomes for both practitioners and patients.” Aesthetics | June 2026
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Technology
Sofwave unveils muscle stimulation device Aesthetic device company Sofwave has announced the UK launch of Pure Impact VIP. According to Sofwave, the muscle stimulation platform is designed to improve muscle tone, strength and structural support alongside skin quality, as the company notes compatibility with GLP-1 patients. Sofwave shares that the platform delivers synchronous supramaximal muscle contractions across multiple treatment areas, including the abdomen, buttocks and thighs. The device, powered by proprietary Plyopulse technology, aims to complement collagen remodelling procedures, enabling clinics to combine muscle stimulation and dermal treatments within a single appointment, the company shares. Libby Mousa, Sofwave director of marketing EMEA, commented, “We’re seeing growing demand from both practitioners and patients for more holistic treatment strategies that address muscle tone, structural support and tissue rejuvenation together, particularly in the context of GLP-1-associated weight loss and preventative ageing. The launch of Pure Impact VIP reflects our commitment to clinically grounded innovation that supports both patient outcomes and clinic efficiency.” Initiative
Totally Derma introduces council group Nutraceutical collagen drink company Totally Derma has unveiled its new Regenerative Aesthetics and Wellness (RAW) Council. According to the company, the initiative aims to support clinics with evidence-based patient education and strengthen the role of nutraceuticals within regenerative and longevity protocols. The RAW Council features gut health and nutrition specialist May Simpkin, consultant surgeon Mr Lorenzo Garagnani, advanced facialist Smita Ahluwalia and women’s health specialist and aesthetic practitioner Dr Sophie Bracke. Mr Garagnani said, “From both an orthopaedic and aesthetic perspective, connective tissue health is fundamental. Collagen peptides combined with hyaluronic acid offer a relevant adjunct to support joint function, recovery and long-term tissue resilience, particularly in active or ageing patients.” Distribution
ALASTIN and GetHarley reveal collaboration Skincare company ALASTIN and skincare platform GetHarley has announced an official partnership for the ALASTIN range. GetHarley shares that the collaboration with ALASTIN, developed through pharmaceutical company Galderma, aims to support skin regeneration within clinic, optimise procedure outcomes and improve overall skin health. The company specifically spotlights ALASTIN’s proprietary TriHex Technology, and aims to clear out damaged proteins and produce new, healthy matrix components. Rene Wipperich, general manager of Galderma UK&I, commented, “ALASTIN skincare is only sold through authorised clinicians and healthcare professionals (HCPs) and this market access strategy aligns perfectly with GetHarley. We hope that by partnering with GetHarley, more HCPs will have access to recommending our products to their patients in a risk-free, effortless and uncomplicated way, that also supports repeat purchasing for improved patient loyalty and compliance.” Aesthetics | June 2026
Insider News
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Glenn Compton, founder and director of Medical Fabrica What is so unique and innovative about the AnyHairPro solution you are bringing to the global market? Hair removal has never really evolved. Laser technology has improved greatly whilst electrolysis has remained commercially unviable for the majority of clinics. Laser hair removal has rapidly become one of the most in-demand aesthetic treatments, but conventional systems rely on pigment to target the follicle, meaning they struggle with white, grey, blonde or red hair, and cannot be used safely over tattooed skin. For these patients, electrolysis has been the only option, but it is slow, labour-intensive, invasive, known for side effects and impractical for larger areas. AnyHairPro introduces a new alternative, enabling clinics to treat all hair colours and all skin types, including over tattooed areas. This is the unique solution that that will remove any hair colour on any colour of skin. How does the solution work? AnyHairPro uses a combination of LED light energy and high-frequency waves to target the hair follicle. This process delivers controlled microcurrents via the hair shaft, gradually weakening the hair bulb and reducing its ability to produce new hair over time. Unlike traditional laser systems, the technology does not rely on pigment, allowing it to treat light-coloured hair effectively. AnyHairPro progressively reduces follicle activity until the hair is permanently removed, while protecting the surrounding skin. The solution is unique, will it be cost prohibitive for the majority of clinics? No. AnyHairPro is brought to market and is accessible to all. We developed a financing model offering pay per month costing, training and dedicated support included. The product is affordable and priced so that any clinic can be a partner. The inclusion of all hair and skin types is new revenue which also offers a new client opportunities i.e. upselling additional treatments. This advertorial was written and supplied by Medical Fabrica
Join the Medical Fabrica partner network http://www.medicalfabrica.com
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Insider News
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Symposium
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Event Report
VIVACY hosts regeneration symposium Aesthetics manufacturer VIVACY held the European launch of its polynucleotide range with The Regeneration Roadshow at One Great George Street, London. The day opened with a two-part scientific symposium in the Telford Theatre, where speakers explored the science and clinical application of REJURAN polynucleotides, and introduced the VIVACY B.A.S.E biological framework for combination protocols with polynucleotides, calcium hydroxylapatite and hyaluronic acid fillers. The faculty included Professor Hassan Galadari, Dr Steven Liew, Dr Michael Kim, Dr Zunaid Ali and Dr Jasmin Taher. Following the conference programme, attendees were welcomed into the venue’s Great Hall for a drinks reception. Guests were offered a signature ‘Glow Up Margarita’ and a selection of canapés, and the space included branded photo points and product displays throughout. Brianna Broadbridge, general manager of VIVACY UK, said, “The Regeneration Roadshow marked a pivotal moment as we launched REJURAN across the UK and Europe. The launch exceeded expectations, with strong engagement, valuable knowledge exchange and clear enthusiasm for integrating REJURAN into clinical practice, firmly positioning VIVACY at the forefront of regenerative medicine in Europe.” HQ Visit
Aesthetics attends Teoxane headquarters The Aesthetics Journal joined an exclusive press trip to aesthetic manufacturer Teoxane’s headquarters on April 20-21, in Geneva, Switzerland. The two-day programme centred around the company’s new injection technique, babyGLOW by Teoxane, and took place at Teoxane Laboratories, parent company of Teoxane UK. Delegates were welcomed with an evening dinner on day one at the InterContinental Hotels, offering the chance to preview the agenda and meet fellow press from France, Germany, Italy and the UK. According to the company, the new injection technique uses four anatomical landmark lines and eight selected facial injection points. Teoxane shares it is designed to optimise production diffusion and maximise surface light reflection. Day two opened with an introduction from CEO and founder Valérie Taupin, who shared the story of Teoxane’s origins, and its focus on developing hyaluronic acid (HA) dermal fillers and skincare. This was followed by a guided tour of the laboratories, during which delegates were able to learn about the science underpinning the brand’s portfolio, with specific emphasis on its HA skin booster, 14
Aesthetics
Medik8 celebrates new product release Aesthetics attended the launch of skincare company Medik8’s new Exo-PDRN Prismatic+ Pro Concentrate. Hosted at the Frameless Immersive Art Experience, the event introduced Medik8’s latest launch, available through aesthetic distributor Healthxchange. Dan Isaacs, co-founder and chief product officer of Medik8, shared that the Exo-PDRN Prismatic+ Pro Concentrate is designed to enhance in-clinic results after treatments such as microneedling, chemical peels, laser treatment and as general aftercare. Isaacs also outlined the key ingredients including Prismatic Polydeoxyribonucleotide, Triple Exosome Complex, Dual MiniProtein, adenosine triphosphate precursor and amino acids. Following this, a panel discussion took place, chaired by Simone Shoffman, clinical and education director at Healthxchange featuring aesthetic practitioners Dr Sophie Shotter, Dr Bibi Ghalaie, Dr Tara Francis, along with independent nurse prescriber Nina Prisk. The panel discussed how they use the product in clinic and presented individual case studies. Shoffman commented, “Medik8’s Exo-PDRN Prismatic+ Pro Concentrate is setting a new benchmark for in-clinic rejuvenation. Designed exclusively for skincare professionals, it delivers bioengineered vegan PDRN in a concentrated formula, giving practitioners a powerful tool to address the growing patient demand for targeted, longevity-focused outcomes that go beyond a core routine.” Teosyal PureSense Redensity 1. Teoxane representatives explained that the non-crosslinked HA acts as a humectant, binding large amounts of water. According the company, babyGLOW by Teoxane involves placing the product in the hypodermis, in contrast to previous, more superficial approaches. Teoxane added that the fluid consistency is intended to diffuse through the tissue, drawing moisture into the skin to support a rejuvenating effect rather than adding bulk. After lunch, delegates joined a practical masterclass on babyGLOW by Teoxane, led by aesthetic practitioner Dr Silvia Caboni. She outlined how the eight-point injection entry approach is designed to reduce the appearance of micropapules, with the intention of limiting downtime for patients. Dr Caboni also highlighted the importance of a two minute-massage following treatment. The technique was then demonstrated live by Dr Meral Saglam, allowing attendees to see the protocol in real time. The trip concluded with the group taking part in a multi-sensory session at Perfum Ateleir, where they were invited to create a bespoke fragrance while sampling collagen drinks. Charley Clewely, senior brand manager at Teoxane UK, shared with Aesthetics, “Patient expectations are constantly evolving, and it’s essential that practitioners and brands alike, evolve with them. Advancing techniques is not just about innovation for innovation’s sake, but about delivering more refined, natural, and consistent results that align with patient demands. At Teoxane, this mindset underpins everything we do, and babyGLOW by Teoxane is a clear example of how technique evolution can elevate treatment outcomes. It reflects a commitment to improving skin quality in a way that aligns with both practitioner expertise and patient demand for subtle, radiant and immediate results with little-to-no downtime.”
Aesthetics | June 2026
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Education
Merz Aesthetics hosts Anatomy Masterclass
Latest Appointments
Pharmaceutical company Merz Aesthetics delivered a specialist masterclass for practitioners at The Memoir Club, London. Hosted by consultant plastic and reconstructive surgeons Mr Dalvi Humzah, Mr Thomas Pidgeon and Ms Nathalie Cain, the event brought together clinicians for a full-day educational workshop. Merz Aesthetics collaborated with anatomy workshop organisation Surgical Sculpture to deliver the masterclass. The session introduced a hands-on learning format centred on surgical sculpture techniques, as delegates engaged with a 3D-printed half skull model, wax, sculpting tools and pliable 3D-printed neurovascular structures. The workshop included focus groups on various regions, such as sensory nerves, eyes and periorbital region, temporalis and masseter region, as well as facial vessels. Alongside the interactive sculpting session, surgeons presented cadaveric dissection footage to further illustrate and deepen understanding of anatomy. Speaking with Aesthetics, Mr Humzah said, “The Anatomy Masterclass series has been brought together to deliver an innovative approach to aesthetic anatomy education. Delegates acquire knowledge through active participation and peer discussion, building facial anatomy hands-on. This model provides a rigorous, cost-effective alternative to human cadaveric tissue, resolving both the financial and ethical challenges associated with traditional anatomical teaching.”
Aesthetics rounds up the latest company appointments announced within the aesthetics community The British College of Aesthetic Medicine (BCAM) has announced aesthetic practitioner Dr Rebecca Norman as its latest vice president. The organisation shares that Dr Norman will support the president, as well as the board, in advancing BCAM’s strategic objectives, governance and member engagement. The role is intended to provide leadership continuity, contribute to the development of key initiatives and represent the College across its educational, professional and stakeholder activities. Additionally, the organisation has announced aesthetic practitioner Dr Tahera Bhojani as its new appraisal lead. BCAM explains that Dr Bhojani’s role is central to ensuring meaningful appraisal experiences, and maintaining the highest standards across the College’s appraisal and revalidation processes. Medical device company Dermalux has introduced Rachel Hand as a new territory business manager for Ireland. Hand’s new role will focus on expanding Dermalux’s market presence across Ireland. Her responsibilities will include managing new clinic partnerships, product demonstrations, staff training and revenue growth, while strengthening ties with dermatologists, aesthetic practitioners and medi-spas. Aesthetic distributor DermaFocus has announced that aesthetic practitioner Dr Hannah Chapman has joined the DermaFocus faculty. Dr Chapman commented, “Becoming part of the faculty is an incredibly exciting step for me. I’ve always admired their focus on education and innovation, and I’m looking forward to sharing knowledge, supporting fellow practitioners and helping elevate standards across the specialty.”
Product Launch
SkinCeuticals unveils moisturiser
Community
Skincare company SkinCeuticals has announced the launch of its P-TIOX Cream, set to debut on June 15. The company states that the P-TIOX Cream is a wrinkle-and texture-correcting moisturiser, designed to target the appearance of deep-set lines, reduce visible pore size and provide immediate hydration. According to SkinCeuticals, the formula contains a patent-pending complex featuring 10% Myrixin and 2% tripeptide technology, which is developed to target visible signs of ageing, enlarged pores and uneven skin texture. SkinCeuticals further shares that the product includes niacinamide, lipohydroxy acid and tetrapeptide, which aim to improve skin moisture, radiance and overall skin quality. Oliver Pearce, medical events and communications manager at SkinCeuticals, commented, “We are delighted to announce the launch of our next innovation, P-TIOX Cream. Building on the success of our peptide technology, this new addition to the P-TIOX family is designed to complement professional results and empower patients with total skin confidence.”
Tweakments Live 2026 commences Tweakments Live, the aesthetics and beauty event hosted by The Tweakments Guide, took place at The Columbia, London. Guests explored stands from a range of aesthetic and skincare brands, including Jalupro, Meder Beauty and Skinvive. Across two stages, talks and panel sessions featured insights from The Tweakments Guide founder Alice Hart-Davis; aesthetic practitioners Dr Sophie Shotter, Dr David Jack and Dr Brendan Khong; and consultant ophthalmologist and oculoplastic surgeons Miss Maryam Zamani and Miss Elizabeth Hawkes. Topics ranged from regenerative treatments, skincare and supplements to treatment vs. surgery, blepharoplasty and hypochlorous acid. Discussing the event with Aesthetics, Hart-Davis said, “It was brilliant to meet so many people seeking the best advice on skincare and procedures, and to introduce them to brands and practitioners I truly admire. My mission has always been to cut through the noise with independent, honest advice, while connecting people with the specialists and products that can help them most. However much we can do online, bringing people together in real life still feels special, so huge thanks to all our sponsors and to the Future Publishing events team for making it all happen.”
Aesthetics | June 2026
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Boost your patients’ collagen production to work against skin ageing from within RADIESSE is an injectable dermal filler used to enhance the facial area and back of the hands. RADIESSE is available for smoothing moderate and severe wrinkles of the décolleté.
Scan the QR code to speak to an Account Manager for more information
Actual RADIESSE® patient.
Adverse events should be reported. Reporting forms and information for United Kingdom can be found at https://yellowcard.mhra.gov.uk. Reporting forms and information for Republic of Ireland can be found at https://www.hpra.ie/homepage/about-us/report-an-issue. Adverse events should also be reported to Merz Aesthetics UK Ltd by emailing UKdrugsafety@merz.com or calling +44 (0) 333 200 4143.
©2026 Merz Aesthetics UK Ltd – All rights reserved. MERZ AESTHETICS and RADIESSE logos are trademarks and/or registered trademarks of Merz Aesthetics UK Ltd in the United Kingdom. Registered in England No. 14506945. Merz Aesthetics UK Ltd. Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire, HP2 4TZ. www.merz-aesthetics.co.uk.
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Research
Study differentiates sensitive skin syndrome from rosacea New research from the George Washington (GW) University School of Medicine and Health Sciences suggests sensitive skin syndrome (SSS) is biologically distinct from rosacea. Published in the Journal of the American Academy of Dermatology, the pilot study found that hallmark rosacea drivers, including Demodex mite overgrowth and heightened innate immune activity, were not present in patients with SSS. The study observed that two antimicrobial peptides commonly elevated in rosacea, cathelicidin and dermcidin – were significantly reduced in participants with sensitive skin syndrome. According to the university, the findings suggest that the inflammatory pathways central to rosacea may not drive SSS. Adam Friedman, professor and chair of dermatology at GW and senior author of the study, commented, “This distinction matters because it can help clinicians avoid treatments that may not benefit sensitive skin patients and instead focus on over the counter and prescription therapies better aligned with the biology of the condition.” Anniversary Conference
BCAM welcomes members to annual conference The British College of Aesthetic Medicine (BCAM) hosted its 25th Anniversary Conference at the Pullman London St Pancras. The conference opened with a networking and sponsor exhibition, followed by a full-day scientific programme featuring keynote presentations, panel discussions and future-focused debates with nurse prescriber Julie Scott, and aesthetic practitioners Dr Rashpal Singh and Dr Steven Harris. Sessions explored advancements in injectables, regenerative medicine, patient safety, complications management and business evolution. The event also included interactive discussions with founding BCAM members, aesthetic practitioners Dr John Curran, Dr Mike Commins, Dr Paul Cronin and consultant plastic surgeon Mr Rajiv Grovner. Sadie Van Sanden Cooke, chief operating officer at BCAM, commented, “The BCAM 25th Anniversary Conference was an opportunity not only to celebrate how far medical aesthetics has come over the last quarter century, but also to challenge and inspire the future of the field. Bringing together experienced clinicians, emerging voices and specialty leaders created meaningful conversations around patient safety, innovation and raising standards.” Post-procedure
Jane Iredale hosts masterclass Aesthetics joined mineral-based makeup brand Jane Iredale for the launch of Skintuition Brightening Under Eye Concealer with Active Peptide Complex. Held at Eccleston Yards, the event was hosted by aesthetic distributor Healthxchange, which supplies Jane Iredale to clinics across the UK. The programme began with aesthetic practitioner Dr Ana Mansouri and makeup artist Adeola Gboyega discussing the role of mineral formulations and targeted under-eye solutions within aesthetic practice. During the event, Dr Mansouri discussed the role of post-procedure makeup in clinical settings, while Gboyega demonstrated a step-by-step application routine on a live model. Dr Mansouri explained that the formula is especially suitable following treatments such as polynucleotide therapy, microneedling or laser procedures, due to its peptide complex. Education and clinical director at Healthxchange Simone Shoffman commented, “We are delighted to bring you the new Jane Iredale Skintuition Brightening Under Eye Concealer, which combines an Active Peptide Complex, niacinamide and bioactive marine extract. With impressive clinical results, this is a product designed to counteract the visible signs of fatigue and ageing in one of the most delicate areas of the face.” Aesthetics | June 2026
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News in Brief Tweak platform partners with BCAM and BAMAN Aesthetics platform Tweak has collaborated with the British College of Aesthetic Medicine (BCAM) and the British Association of Medical Aesthetic Nurses (BAMAN). The collaboration will see BAMAN and BCAM members join Tweak’s verified practitioner community and contribute directly to patient educational content, helping patients understand what it truly means to choose a qualified, safety-focused professional. Founder and aesthetic practitioner Dr Kat Bennett commented, “Together, we are building something the specialty has long needed, a space where standards aren’t optional, they’re the foundation.” DIBI Milano launches new biostimulating cream Skincare company DIBI Milano has debuted a Biostimulating System Lab Intense Biostimulating Cream. The company shares that this at-home treatment is a water-in-oil emulsion that utilises a transformative reverse-phase texture, as the formula aims to prolong cell vitality and stimulate adenosine triphosphate production. DIBI Milano adds that the formula features pure sonicated hyaluronic acid and fermented mineral complex, which aims to support hydration levels, barrier function and growth factors. Prollenium debuts training platform Medical technology company Prollenium has launched the PACE Training & Educational Portal. Developed in collaboration with UK training provider Harley Academy, Prollenium explains that the PACE Training & Educational Portal features a library of resources that includes evidence-based education on the Prollenium portfolio and clinical insights to support consultations and treatment planning. 5 Squirrels releases SPF drops Private label skincare manufacturer 5 Squirrels has announced the launch of Protect 50+ Drops Lightweight Hyper-Fluid Drops. George Gibbens, general manager of 5 Squirrels, said, “We’re thrilled to launch Protect 50+ Drops. It’s a game-changer for clinics looking to offer their patients high-performance sun protection that doesn’t compromise on efficacy or convenience.”
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News Special Male Aesthetics
Men are also less likely to undergo aesthetic treatments because the specialty has historically been marketed predominantly towards women, according to aesthetic practitioner Dr Sina Salimi, who sees around 10-15% of male patients in his practice. He elaborates, “Many male patients still perceive cosmetic treatments as something not designed for them, or associate them with stigma, vanity or loss of masculinity.”
How the specialty can better engage male patients
BAAPS Annual Audit Highlights Changing Male Aesthetics Landscape
The aesthetics specialty should create a more gender-inclusive environment, according to Dr Salimi, through male-focused education, neutral branding, realistic marketing and consultation approaches tailored to male patients to ensure continued growth within this demographic. He elaborates, “At the moment, much of the marketing is centred around highly polished, airbrushed men with square jaws and a very ‘perfect’ or metrosexual image. In my opinion, this does not represent the majority of male patients.”
Aesthetics explores the factors behind last year’s overall decline in male cosmetic and non-surgical procedures
Dr Salimi explains that the focus should instead be on everyday people such as working professionals, fathers, tradesmen and men from all age groups who simply want to look fresher, healthier or more confident. He continues, “An advert could show a group of friends meeting at the pub, where one casually mentions having had a facial treatment or anti-wrinkle treatment, leading to an open and positive conversation among friends. I believe this type of representation would make male aesthetics feel more approachable, inclusive and socially acceptable to a much wider audience.”
The British Association of Aesthetic Plastic Surgeons (BAAPS) has published its annual audit, revealing that cosmetic surgery among men remained stagnant in 2025, with procedures declining by 10% overall. Based on data submitted by 237 BAAPS members, the audit found that rhinoplasty procedures fell by 18%, otoplasty by 17% and liposuction by 7%.1 Non-surgical treatments also declined, with botulinum toxin procedures decreasing from 438 in 2024 to 409 in 2025, while dermal filler injections dropped from 178 in 2024 to 141 in 2025.1,2 The recent findings continue a broader downward trend in male cosmetic procedures seen over the past five years. Men accounted for 8% of all cosmetic procedures in 2020, before stabilising at around 7% from 2021 to 2023.3-6 In 2024, that figure fell further to 6.5%, then to 6.1% in 2025, marking the lowest proportion recorded in recent years.1,2 Aesthetics spoke to specialty professionals to explore why men still only represent a small percentage of cosmetic procedures compared to women, and how the medical aesthetics community can adapt its education, marketing and representation to better cater for this patient base.
Understanding male hesitancy towards aesthetics Historically, male patients have accounted for a small proportion of cosmetic procedures, according to Ms Nora Nugent, plastic surgeon and president of BAAPS. Referring to the decline in procedures taking place in 2025, she explains, “This doesn’t necessarily signal a major shift in attitudes. It more likely reflects normal year-to-year variation influenced by wider economic factors and evolving patient priorities.” Ms Nugent argues demand is not disappearing, but evolving toward more discreet, regenerative and longevity-focused treatments. She explains, “This is part of a broader shift or increase in facial rejuvenation surgery due to more awareness, lessening of the fear of ‘looking done’ or having tell-tale signs of having a facelift due to advances in modern facelifting and a shift in preference towards procedures with greater longevity.” Consultant ophthalmologist and oculoplastic surgeon Miss Elizabeth Hawkes, whose male patients make up 35% of her patient base, adds that men are less likely to seek aesthetic treatments than women due to the fear they will look like they have had work done. She explains, “It’s not like they don’t want to have the treatments; they do. But a lot of it is fear that they may look unnatural.”
Building on the assumption that many men are fearful of “looking done” – something that may act as a barrier to seeking treatment – Miss Hawkes finds that male patients are typically drawn to her practice through strong clinical reviews, realistic before-and-after images and word of mouth. “In my marketing, I always talk about how I do very natural work, and when doing patient analysis, it’s clear this is what draws men into the clinic the most,” she says.
Anatomical differences and education In educational environments such as conferences or training courses, male aesthetics should be taught as a dedicated area of medical aesthetics, focusing on male anatomy, ageing patterns, masculine proportions, consultation styles and avoiding feminisation, says Dr Salimi. He notes, “This should include live male models, male case studies, as well as specific treatment planning and practical teaching tailored specifically to male patients.” Miss Hawkes highlights that the courses should also move away from just the stereotypical male model used, typically someone in their 20s-30s only undergoing jaw definition, but also representation of 40-60-year-old men with a diverse range of needs, to show greater diversity in treatment. “I use a lot of Sculptra, Profhilo and botulinum toxin, as well as dermal fillers, but not just to enhance the jaw – also for the mid-face, as not all men want that sharp jaw look, especially the older cohort,” she says.
The future of male aesthetics Overall, despite Miss Hawkes explaining she has seen more men attending clinics, a genuine fear of ‘looking done’ has potentially contributed to a lack of growth in this area overall. According to Miss Hawkes, “They want to look less tired, they want to look fresh. But the key thing is they want a natural look.” Dr Salimi concludes that once men understand that treatments can be discreet, natural-looking, and specifically tailored to male anatomy and masculine features, “they become far more comfortable seeking advice and treatment.” VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Aesthetics | June 2026
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Event Preview CCR
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Making Networking Work for You Step into the conversations that shape CCR 2026 The low hum of conversation, the familiar names on badges, the quick smiles between people who have not seen each other since last year. Someone is talking to a peer about a difficult case they managed last month. At a nearby stand, a practitioner is asking a brand representative, “What patient results have been seen in clinic?” Two colleagues who have only met virtually are finally shaking hands. It does not feel like a room full of strangers. It feels like a community mid-conversation. Your experience of the Clinical Cosmetic Regenerative Congress (CCR) is shaped less by a list of sessions and more by the people you meet; the doctor who shares a practical tip you wish you had known last year, the nurse who has quietly managed with the same complication that still occupies your mind, and the exhibitor who explains a product in a way that suddenly makes everything click. CCR gives you the space to do all of this under one roof. Here is how you can prepare and structure your day to make the most of those moments.
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Connect before you arrive
All day: your base on the show floor
A lot of the connections start before you even step into in the venue.
From the moment the doors open, the Galderma Networking Lounge on the show floor is there whenever you need it.
From the moment you register, the event app allows you to:
· Build a short profile so others can see who you are and what you do
· Browse who is attending, from clinicians and clinic owners to suppliers and media
· Send and receive connection requests · Set up meetings in advance, threading them around key sessions and networking moments Once CCR begins, the app helps you keep track of meetings, note key points after conversations and follow up quickly. It does not replace chance encounters; it simply makes it more likely that the people you most want to meet do not pass you by.
Aesthetics | June 2026
You might use it as:
· A meeting point for people you have arranged to meet through the app
· A place to sit and reflect between theatres · A neutral space to introduce colleagues to new contacts The atmosphere is relaxed but purposeful. Around you, short conversations spark about techniques, staffing, new devices and patient expectations. Just beyond the lounge, the wider show floor becomes an extension of those conversations:
· You stop at exhibitor stands you already
know, catching up on what has changed and how products are evolving · You discover new companies and products, and can ask detailed, candid questions on the spot
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· You watch on-stand live
demonstrations, compare options side by side and hear how peers are using the same tools By the end of day one, the show floor feels less like a marketplace and more like a landscape of ideas and relationships.
Morning: clinical minds, shared challenges In the morning, dedicated gatherings on the BAMAN and BCAM stands brings clinical professionals together for doctors’ and nurses’ networking hours. Here, conversations focus on:
· How colleagues are interpreting
evolving regulation and guidance · Approaches to complex cases and complications · Balancing patient expectations with safety and ethics · Navigating a lone-working specialty You might leave with a new way of structuring consent conversations, a tweak to your follow-up protocol or simply a new friend.
Afternoon: inside the Aesthetics community At 4pm, the focus shifts to the Aesthetics community drinks. Aesthetics Journal readers, contributors and the editorial team come together. It is a chance to:
· Share topics and themes you want to see explored
· Learn how to turn cases, audits or ideas into published content · Connect with peers who are interested in education, research and thought leadership You may leave with a clearer idea of how to present your work, a contact on the editorial team or the seed of a future article or session.
For VIPs, there will also be networking drinks taking place in the VIP lounge across both days. From a casual morning coffee to bubbles in the afternoon, this is a key area for those who have been in aesthetics for years to reunite.
Evening: event-wide networking drinks From 5-7pm, the first day culminates in CCR’s official networking drinks, open to all delegates, speakers, exhibitors, press and partners. By this point, your day’s conversations start to link:
Top 5 networking tips for CCR 2026 1. Set one or two clear networking goals Decide whether you are prioritising clinical connections, new products, speaking and publishing opportunities, or partnerships – and let that shape how you spend your time. 2. Use the Networking Lounge as your anchor Arrange to meet new contacts in the Galderma Networking Lounge. It gives you a reliable, calm meeting point in the middle of a busy show floor. 3. Protect the key moments Keep your diary free for: · BAMAN and BCAM doctors’ and nurses’ networking hours in the morning · Aesthetics members’ drinks at 4pm · Official networking drinks from 5-7pm 4. Have a simple introduction and two questions ready A straightforward introduction and a couple of open questions (for example, “What are you hoping to take back to your clinic from CCR?”) make conversations easier, especially if you are not naturally extroverted. 5. Follow up within 48 hours Use the CCR or notes app to record who you met and why it mattered. A short follow-up message within two days often turns a good conversation into an ongoing professional relationship.
· Reconnect with people you met that
morning at BAMAN and BCAM stands
· Follow up with exhibitors who impressed
Event Preview CCR Across four categories – from full-face transformations and skin results to body work and most challenging cases – practitioners are invited to share the journeys behind their best results from the last 12 months, not just the final photographs. The focus is on:
· Clear, consistent clinical photography · Thoughtful assessment and treatment planning
· Honest discussion of complications and how they were managed
· Post-procedure care, follow up and patient feedback Entries are now open, with Finalists announced in early September.
The Aesthetics Results Awards will run as a two-hour live feature in the Aesthetics Mastery Theatre. For each category, the top Finalists will be announced on the day and will have to present a short case overview before the judges announce the Winners live on stage. Expect strong visuals, practical learning points and plenty of inspiration for your own practice. Scan the QR code to find out more details and enter now.
Register for CCR 2026 Join the conversations that will shape the next year in medical aesthetics. Visit the CCR website to register, download the CCR app and start planning your networking journey.
01 & 02 October 2026 Excel, London
Headline Sponsor
you on the show floor
· Introduce new contacts to colleagues and friends
· Discuss your key learnings from the day’s scientific sessions
The atmosphere is informal and sociable, but it is also where many of the most useful introductions happen – the “you two really need to meet” moments that can change the way you work in the year ahead.
Aesthetics Results Awards New for 2026, the Aesthetics Results Awards bring real patient stories to the stage, shining a spotlight on outcomes achieved through safe, ethical and evidence-based practice. Aesthetics | June 2026
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Special Feature Skin Boosters
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Optimising Skin Quality with Skin Boosters Four practitioners consider the evolving role of skin boosters in skin health optimisation Skin boosters are injectable formulations, most commonly based on non or lightly cross-linked hyaluronic acid (HA), designed to improve skin quality rather than alter facial contours. Unlike volumising fillers, which target structural support and shape, skin boosters are placed more superficially with the aim of enhancing hydration, elasticity and surface texture through restoration of the extracellular matrix and increased dermal water content.1,2 Aesthetics spoke to aesthetic practitioners Dr Asad Naqvi, Dr Raul Cetto, Dr Aneesha Ahmad and plastic surgeon Miss Jonquille Chantrey to discuss the clinical use of skin boosters for skin quality optimisation, including patient selection, product choice and injection techniques used to achieve these outcomes.
Available literature Emerging clinical data supports the role of HA skin boosters in skin quality optimisation. Among the studies frequently cited by clinicians is a randomised, multicentre, evaluator blind trial published in the Journal of Cosmetic Dermatology, which evaluated a HA based 'skin quality' treatment for dorsal hand rejuvenation over a 15-month period. In this split-hand, no-treatment-controlled study of 100 subjects, three treatment sessions with a HA gel (Restylane Skinboosters) delivered clinically relevant improvements in Hand Grading Scale scores and biophysical measures of elasticity, roughness and hydration, with benefits persisting in most patients at 15 months (P < 0.0001).3 Additional evidence published in Pharmaceutics supports the use of HA-based 'skin quality' injectables. In a retrospective study of 20 women treated with a single cannula-delivered mid-face injection of a non-stabilised HA bioactive hydrogel (Teosyal PureSense Redensity 1), high-frequency ultrasound demonstrated a 92.7% increase in skin density at three to four weeks compared with no significant change in untreated controls (p < 0.001), with high patient satisfaction and only mild, transient adverse effects reported.4 More recently, prospective data has also been published for calcium hydroxylapatite (CaHA) used in a diluted or hyper-diluted form for skin quality indications. In a split-face study in the Journal of Cosmetic Dermatology, diluted CaHA was compared with a control treatment for facial skin rejuvenation, demonstrating improvements in parameters such as fine lines, texture and overall skin quality, with an acceptable safety profile.5 22
A prospective, single-arm study published in Clinical, Cosmetic and Investigational Dermatology evaluated a crosslinked HA injectable gel, VYC-12 (Juvéderm Skinvive), designed to improve skin quality attributes such as surface smoothness and hydration. In this study, 131 subjects with moderate-to-severe cheek skin roughness received intradermal VYC-12 injections to the cheeks, with optional treatment of the forehead and/or neck, followed by an optional touch-up at 30 days and repeat treatment at nine months. The primary endpoint, Allergan Skin Roughness Scale (ASRS) responder rate (≥1-point improvement from baseline in cheek roughness) at month one, was 96.2%, with sustained improvements at months four (76.3%) and six (34.9%), and 87.1% after repeat treatment. Instrumental assessments demonstrated statistically significant improvements in skin hydration through month nine (P < 0.01).⁶
Patient suitability Patient suitability depends on the facial area being treated, according to Dr Naqvi. He explains that patients with malar bags, for example, may not be appropriate candidates for skin booster treatment. “The fat pads under your eyes tend to retain more water, and the anatomy of that area is genetically different. Injecting a skin booster there is only going to emphasis these lines and put more water into that area, making the patient look more tired and aged,” he notes.7
“I want the product sitting just under the skin, so it can improve elasticity and skin quality without being visible on the surface” Dr Raul Cetto
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Commenting more broadly on indications, Dr Cetto believes that most adults can benefit from HA skin boosters, provided appropriate screening and expectation management are in place. “It is something that almost anyone can benefit from, unless there is a medical contraindication,” he says.8 However, he stresses the importance of being realistic about outcomes in older patients. “It is fine to treat someone in their 70s or 80s with an HA skin booster but the improvement is likely to be more limited than in someone in their 30s or 40s,” adds Dr Cetto. Miss Chantrey stresses the importance of screening and exclusion. “I defer patients with active infection, inflammatory dermatoses, unrealistic expectations, unsupported dysmorphia, highly unstable pigmentation or keloid scarring,” she says.9,10 “I take a careful medical history to understand inflammatory and autoimmune history, and if a patient has had aggressive energy-based procedures, I delay treatment until healing is complete,” adds Miss Chantrey.11
Special Feature Skin Boosters
explains.17 In his practice, these formulations provide more durable results and permit targeted line correction. “With a lightly cross linked product, I address individual lines – for example, smokers’ lines, crow’s feet or fine neck lines – by injecting directly into the area to lift the skin and deliver water into that area,” he notes.18 Dr Naqvi’s product of choice is Restylane Vital. Miss Chantrey emphasises matching product to dermal deficit rather than structural change. “Skin boosters are best for dermal quality deficit, so I choose product according to tissue intention,” she explains.19 “I use cross-linked HA for lasting intradermal hydration and smoothness, rather than projection, lift or contour. The rheology must respect dermal thickness while also giving duration,” she adds. Miss Chantrey's product of choice is Skinvive.
Dr Ahmad notes that product selection is guided by patient factors and the underlying mechanism of action required. “I prefer to use CaHA in diluted or hyper-diluted form in patients for which Assessment it is suitable,” she notes. Dr Ahmad explains that CaHA acts as a Dr Ahmad believes assessment of skin quality should be systematic. biostimulatory agent and this promotes neocollegenisis, elastin ] “I usually look at the clinical evaluation and combine this with patient . production and dermal remodelling. She adds, “It is particularly . centric factors, such as hydration, elasticity, fine lines, texture, useful in patients who have dermal thinning, laxity or more advanced pigmentation and overall dermal integrity,” she notes. Facial Assessment Report skin ageing.”20 Facial Assessment Report Miss Chantrey similarly emphasises a structured approach. “I assess Eva Walder Eva Walder skin quality as a biological phenotype, not a cosmetic complaint. Before After Hydration, texture, smoothness, reflectivity, elasticity, pigmentation, pore visibility and inflammation are all important contributors,” she explains.11 “I also use validated tools including the Allergan Skin Roughness Scale, FACE-Q, Glogau, Fitzpatrick typing and digital skin imaging,” adds Miss Chantrey.13, 14 Dr Naqvi begins with a simple pinch test. “You want to assess the recoil of the skin. When you pinch it and it bounces back, that’s a good sign,” he says. If, however, the skin hangs after pinching, he notes that a skin booster is unlikely to have any meaningful effect. “That skin needs surgical excision,” explains Dr Naqvi.15
“I assess skin quality as a biological phenotype, not a cosmetic complaint”
standard Figurephoto 1: 50-year-old female patient at baseline standard photoand six months after
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Radiesse and Belotero Revive mixed with 0.5ml saline. Procedure repeated copyright © 2002-2019 Canfield Imaging Systems page 1 ofagain 1 .t in six weeks. Images courtesy of Dr Aneesha Ahmad.
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Dr Ahmad typically uses a tailored combination of products for this indication. “For this protocol, I combine 1.5ml of CaHA with 1ml of HA glycerol skin booster and 0.5ml of saline,” she explains. This blend, she says, enables her to deliver 1.5ml per side. Her products of choice are Radiesse and Revive.
Miss Jonquille Chantrey
Product selection When it comes to product selection, Dr Naqvi explains that different skin booster technologies are suited to different patient needs. For patients who are primarily seeking glow and hydration, and who do not present with malar bags or puffiness, Dr Naqvi favours low or non-cross-linked HA skin boosters. “As these products integrate well and spread within the tissue, the HA molecules draw in water efficiently – the less cross linking, the more water is attracted,” he says.16 For other patients, slightly more cross-linked HA skin boosters may be indicated, notes Dr Naqvi. “With some products that have more cross linking, you achieve both hydration and improved longevity,” he
Dr Cetto highlights the importance of aligning product choice with patient phenotype and main concern. “If someone has pigmentation under the eyes, I will reach for a skin booster that not only hydrates but also contains amino acids to help address pigmentation,” he explains.21 “If I am targeting fine lines and photodamage, I prefer products that include additional ingredients designed to support that concern. By contrast, for seasonal changes where skin simply needs more hydration, I may use a purely HA-based skin booster,” says Dr Cetto.22 His product of choice is Teosyal PureSense Redensity 1.
Contraindications When discussing contraindications, Dr Naqvi distinguishes between absolute and relative factors. “Absolute contraindications include any local infection – such as cellulitis, abscesses or active dental or herpes simplex virus – as well as known allergy to product components like HA or lidocaine, pregnancy or breastfeeding,” he states.23
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Special Feature Skin Boosters
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Miss Chantrey also highlights functional and behavioural factors. “Relative contraindications include autoimmune instability, poor wound healing and scarring, uncontrolled acne or rosacea flare, and patients seeking unrealistic transformation rather than subtle refinement,” she notes.23
Injection techniques Dr Ahmad predominately uses a cannula-based approach. “Using a 25G, 50mm length cannula, I deliver the product in the subdermal plane, this enables a more even distribution across larger treatment areas, reduces the risk of vascular injury and improves patient comfort with fewer entry points,” she notes. Dr Ahmad uses a fanning or retrograde linear threading technique, depending on the anatomical area and degree of skin laxity. Miss Chantrey highlights the importance of uniform intradermal placement. “I favour microdroplet intradermal placement – because the purpose is uniform dermal hydration,” she explains. Dr Naqvi explains that he uses both needles and cannulas for skin booster treatment, “Ideally, you want to be in the deep dermis,” he says, adding, “You can achieve this with either approach, but I find a needle gives slightly more accuracy.” For line-focused work with lightly cross-linked HA, he prefers a 26-30G needle. Product rheology also guides Dr Naqvi’s technique. With non-cross-linked HA, he typically uses fewer injection points (for example, five points in the face) as the product will diffuse. With cross-linked HA, he may use a cannula in multiple linear threads placed approximately 1cm apart to achieve even coverage. Before
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Dr Cetto typically uses a short 4mm, 30G needle and varies the injection angle according to facial subunit. “I want the product sitting just under the skin, so it can improve elasticity and skin quality without being visible on the surface,” he explains. Adding that this approach helps him avoid visible papules and minimise unnecessary social downtime.27
“With some products that have more cross‑linking, you achieve both hydration and improved longevity” Dr Asad Naqvi Anatomical considerations When considering anatomy for skin boosters, Dr Naqvi emphasises that the main risk relates to how superficial key vessels are in the treatment area. He notes that regions such as the glabellar complex, lips and periocular area carry higher risk because superficial vessels can connect to the ophthalmic circulation, with a theoretical risk of blindness in the event of a vascular occlusion. “The arteries in the glabella can be unpredictable in course and depth, and the vessels around the lips and eyes are relatively superficial,” he explains.26
After
By contrast, Dr Naqvi describes the nasolabial fold and parts of the nose as somewhat lower risk for skin boosters, as the main vessels are usually deeper than the intended plane of injection. “However, you still have to be extremely cautious, because anatomical variation can significantly alter the risks in any given patient,” says Dr Naqvi. He also highlights the temple as “a key area of concern” due to its vascular connections with the ophthalmic artery.26 Figure 2: 50-year-old female patient at baseline and three months after two sessions of Restylane Vital, spaced one month apart. Images courtesy of Dr Asad Naqvi.
Dr Naqvi also highlights the value of delivery-control features in some devices. He notes that systems with an audible “click” per micro deposit allow him to deliver very small, standardised volumes. “Because skin boosters are placed so superficially, too much product can cause lumps,” he explains.24 Dr Cetto advises first clarifying the primary goal – for example, pigmentation versus crepey, thin skin – then deciding whether a needle or cannula is more appropriate. He notes that the choice between needle and cannula should reflect both the structure being treated and the desired outcome. “Needles are more likely to cause bruising, haematoma or a vascular adverse event, whereas cannulas appear less likely to cause vascular injury but may cause more swelling,” he says.25 Dr Cetto similarly emphasises the importance of precise placement, particularly in delicate areas such as the periorbital region. “We do not want to inject product into a blood vessel or disrupt the delicate lymphatic system, particularly under the eye, where drainage is already slow and becomes slower with age,” he explains.26 24
Miss Chantrey reiterates the need for regional nuance. “Anatomically, the practitioner must exert dermal judgement – thin periorbital and neck skin, the mobile lower face, sebaceous mid-face and the photodamaged cheek all behave differently,” she cautions.26
Treatment protocol and maintenance On treatment protocols, Dr Naqvi notes that manufacturers’ recommendations are “guidelines rather than law” and that he adapts his approach to the product and patient. For non-cross-linked HA skin boosters, he typically performs an initial course of two sessions. “I will treat once, then repeat at four weeks,” he says, followed by maintenance roughly every six months, explaining these products are broken down more quickly due to the lack of cross linking. With minimally cross-linked HA skin boosters, he tends to use a longer induction phase. “I do a course of three sessions, one month apart,” he explains, adding that, in his experience, results can last around 15 months. Miss Chantrey stresses that protocols should reflect both product characteristics and skin biology. “Many evidence-based HA skin booster protocols involve a series of treatments, with outcomes
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typically assessed from around four weeks onwards,” she notes.28 In her practice, she positions skin boosters as an ongoing skin quality maintenance tool rather than a single, stand-alone intervention. “Most patients benefit from scheduled review and repeat treatment based on clinical response and product duration,” she says. Miss Chantrey adds that longevity is enhanced when the dermis is supported with sunscreen, retinoids, antioxidants, barrier care, good sleep, nutrition and inflammation control.29 Dr Cetto highlights the flexibility of non-cross-linked HA skin boosters in ongoing care. After completing an initial course, he may repeat treatment ahead of a special event, or at seasonal transitions when patients notice their skin feels drier and needs extra hydration. Before
After
Special Feature Skin Boosters
Beyond functional complications, Dr Naqvi highlights aesthetic issues such as the Tyndall effect. “If you inject too superficially in areas where the skin is thin, like the neck or the eyes, you are going to see a bluish tinge,” he says.32 Dr Ahmad notes that, in her experience, most patients experience only mild and transient side effects. “Common side effects include bruising, swelling and erythema at the injection sites,” she explains.26
“Infection, delayed-onset nodules and inflammatory reactions are all possible, although they are rare” Dr Aneesha Ahmad
Figure 3: 34-year-old female patient at baseline and four weeks after two sessions of Teosyal PureSense Redensity 1. Images courtesy of Dr Raul Cetto.
Dr Ahmad explains that she usually begins with an initial course of two sessions, spaced approximately six to eight weeks apart. This staged approach, she says, helps to build results gradually while giving her the opportunity to assess the patient’s response and adjust the plan as needed. “Most patients will then return for a maintenance treatment at around 12 months,” she notes, adding that a third session may occasionally be required if clinically indicated.
Dr Ahmad adds that more serious adverse events are uncommon but important to recognise. “Infection, delayed-onset nodules and inflammatory reactions are all possible, although they are rare,” she notes.26 When discussing CaHA injectables, Dr Ahmad highlights the importance of correct technique. “The risk of nodularity with biostimulators can be slightly higher if the product placement is too superficial or if the product is not diluted appropriately,” she cautions.6,20 Before
After
Treatment limitations Dr Naqvi cautions against describing them as true collagen stimulators. “They do not produce substantial collagen, so if patients are specifically looking for a collagen boosting treatment, there are better options,” he says.30 Dr Cetto emphasises that HA skin boosters should be seen as one tool within a broader treatment portfolio. He notes that facial ageing affects all layers of the face, so it is unrealistic to expect skin boosters alone to address every concern. “I still use HA dermal fillers and other biostimulators, energy-based devices for tightening or debulking and lasers for resurfacing,” he explains.31
Safety and complications Dr Naqvi identifies vascular occlusion as one of the most significant complications associated with injectable treatments. “The consequence of that is you can get skin necrosis, and that needs to be treated with higher-level interventions such as hyaluronidase (Hyalase), aspirin, massage, warm compress, and including agents like glyceryl trinitrate,” he says.26 Miss Chantrey notes that most adverse effects are mild and self-limiting. “The real safety standard is not complication management alone. It is ethical indication, anatomical precision, consent, documentation and early review if the skin behaves unexpectedly,” she cautions.
Figure 4: 35-year-old female patient at baseline and one month after a single session, with a total of 4ml Skinvive. Images courtesy of Miss Jonquille Chantrey.
Subtle role in holistic rejuvenation While acknowledging the benefits of skin boosters for skin hydration and elasticity, Dr Cetto emphasises that they are not a substitute for volumisation procedures. “Used in combination with a wider portfolio of treatments, they are best positioned as one component of a comprehensive, individualised rejuvenation plan,” he concludes. VIEW THE REFERENCES AT AESTHETICSJOURNAL.COM
Aesthetics | June 2026
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CPD Erythema
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Facial Erythema in Aesthetic Practice Dr Rehanna Beckhurst explores the dermatological and systemic causes of facial erythema Facial erythema is a common concern within aesthetic practice (with rosacea alone affecting an estimated 5.46% of the global adult population), an umbrella term for a spectrum of transient and chronic dermatological conditions.1 While often perceived as a cosmetic issue, persistent erythema may indicate underlying inflammatory, vascular or barrier-related dysfunction.1 For the practitioner, accurate recognition of underlying factors is essential to ensure safe treatment and follow appropriate referral pathways when necessary. This article critically examines the primary dermatological causes of facial erythema. This article does not cover treatment options or management – only recognition for diagnostic purposes.
Understanding facial erythema Facial redness is a multifactorial presentation that varies from flushing or sensitivity to chronic inflammation. Patients often seek treatments to calm the skin or improve skin tone, without finding out the underlying cause.3 Erythema is defined as superficial redness, caused by increased blood flow in the capillaries, often resulting in red, flushed skin areas or patches. It is a common sign of inflammation, infection or vascular dilation.4 Facial erythema is quite visible, and as the underlying causes remain hidden for most people, the red face often causes embarrassment, decreased self-esteem and, in some cases, is wrongly associated with alcohol consumption.4 While facial erythema may reflect sensitive skin or barrier disruption, it can also indicate a range of underlying dermatological conditions. For accurate differential diagnosis, thorough history-taking is a critical component of the patient assessment.5 A dermatological history should include the following:
· Basic demographic details: Age, sex, country of origin and
residence as certain conditions have a predilection for certain demographic groups.6 · History of the presenting complaint: The SOCRATES acronym (Site, Onset, Character, Radiation, Associated Symptoms, Time Course, Exacerbating or Relieving Factors and Severity) is a useful tool for exploring patient’s existing concern.7 · Previous episodes and previous treatments.6 · Personal and family history or other skin conditions (atopic dermatitis associated with personal and family history of asthma and hay fever).6 · Past and present medical history and medications (including herbal and homeopathic).6 · Social history (work, hobbies, sun exposure, alcohol, smoking, travel, sexual life).6 · Psychological history as facial redness can have a big impact on patient self-esteem, and in return, stress can aggravate the condition.7 · Systematic enquiry, can be relevant in case of psoriasis and psoriatic arthritis, Sezary syndrome, systemic Lupus.6 A detailed clinical history enables practitioners to identify patterns, recognise associated features and correlate symptoms with potential triggers or systemic involvement, thereby supporting informed clinical decision-making.7,8 26
Dermatological causes In aesthetic practice, facial erythema most commonly arises from chronic inflammatory dermatoses (Table 1). Frequently encountered causes include rosacea, acne vulgaris with associated post-inflammatory erythema, and eczematous conditions such as allergic contact dermatitis, irritant dermatitis, atopic dermatitis, seborrhoeic dermatitis and photosensitive dermatitis. Psoriasis and Demodex folliculitis are also important considerations in the differential diagnosis.3 Less frequently, facial erythema may be associated with underlying autoimmune or lymphoproliferative disease, including cutaneous lupus and cutaneous T-cell lymphoma (CTCL).3
1. Rosacea Rosacea is a chronic rash involving the central face that most often starts between the age of 30 and 60. It is characterised by centrofacial erythema and visible blood vessels affecting the cheeks, forehead, nose and chin. This may be transient (flushing) or permanent. Flushing is exacerbated by stress, heat, alcohol and certain foods, such as spicy foods or coffee.8 Skin becomes sensitive to sunlight, and lesions are inflammatory, however, absence of comedones is a distinctive feature from acne. Major phenotypes of rosacea include papules and pustules, flushing, telangiectasia, ocular rosacea with lid margin telangiectasis, interpalpebral conjunctival injection, spade-shaped infiltrates in cornea, scleritis and sclerokeratitis.9 Minor phenotypes include burning or stinging, oedema and dry appearance.9 Subtypes of rosacea Rosacea encompasses several clinical subtypes, including:
· Ocular rosacea affects the eyelids, conjunctiva and cornea, and
is characterised by red, sore or gritty eyelid margins including papules, styes and sore or tired eyes. It can also cause dryness, itching, burning, tearing, gritty sensation, light sensitivity and blurred vision.9 · Erythematotelangiectatic rosacea is characterised by persistent redness, frequent blushing or flushing, and/or prominent visible blood vessels (telangiectasia) in the central part of the face.10-12 · Phymatous rosacea is characterised by thickened skin and prominent pores (sebaceous hyperplasia). This subtype is more common in men.9 It can affect the nose (rhinophyma), causing the skin to appear swollen and red with enlarged pores, the chin (gnathophyma), ears (otophyma), eyelids (blepharophyma) and forehead (metophyma).9,12 · Papulopustular rosacea is characterised by red papules and pustules on the nose, forehead, cheeks and chin. There are no blackheads, whiteheads or nodules.9-12
2. Acne vulgaris and post-inflammatory erythema Acne vulgaris is a highly prevalent presentation in medical aesthetics, characterised by a mixed eruption of inflammatory (papules, pustules and nodules) and non-inflammatory skin lesions (comedones and pseudocysts).13
Aesthetics | June 2026
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The key distinctive element for differential diagnosis from similar macular-pustular conditions is distribution (with adolescent acne being in sebaceous or T-zone, and adult acne affecting chin and jawline) and age of onset (acne vulgaris starts in adolescence, and sometimes persists into adulthood. Acne starting in adulthood has typical chin/jawline distribution), as well as types of lesions: mixture of both comedones and inflammatory lesions.14 Secondary lesions are excoriations from picking and post-inflammatory erythema, often turning into macules, especially in Fitzpatrick III-VI.13
3. Dermatitis Dermatitis refers to a group of itchy inflammatory conditions characterised by epidermal changes.15 It may be classified by cause (atopic, allergic, photosensitive), by clinical appearance (discoid, hyperkeratotic, pompholyx) or site of spread – hand dermatitis, eyelid dermatitis or lower leg dermatitis.16 This article will only explore the types affecting the face. Atopic dermatitis Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. AD affects individuals of all age groups and ethnicities.17 The pathophysiology is complex, involving a strong genetic predisposition, epidermal barrier dysfunction and dysregulated immune responses, particularly T-cell mediated inflammation.17 Although type-2 mechanisms predominate, emerging evidence suggests that the disorder involves multiple immune pathways.19-21 Despite the absence of definitive cure, recent studies in the understanding of AD pathogenesis have led to the development of novel targeted therapies such as biologics and JAK inhibitors.19-21 These innovations offer promising opportunities for improved disease control, particularly in patients with moderate-to-severe or treatment-resistant disease. This review explores current insights into the underlying mechanisms of AD and discusses their implications for prevention strategies, clinical management and future research directions.16 AD typically presents with symptoms of intense pruritus and eczematous lesions, often involving other anatomical sites. In adult patients, lesions are frequently lichenified, reflecting chronicity and repeated scratching. The distribution and morphology may vary, but facial involvement is not uncommon and can contribute significantly to patient distress. A thorough clinical assessment is essential and should include a detailed personal and family history of atopy, as well as a comprehensive review of previous treatments and the patient’s response to those interventions.16 This information is critical in guiding appropriate management strategies and identifying potential triggers or patterns of disease recurrence.16,21 Clinical impact and holistic management AD represents a significant global health burden from skin disease, both in terms of prevalence and impact on quality of life, it remains the leading cause of disability-adjusted life years among skin diseases worldwide.18,22,23 AD carries considerable psychological implications (due to it being chronic and relapsing) for patients and families. It is associated with increased risk of multiple comorbidities, including food allergies, asthma, allergic rhinitis and mental health disorders, reflecting it systemic and multifactorial nature.17 From an aesthetic perspective, patient counselling and education play a central role in management. Emphasis should be placed on maintaining skin barrier integrity through consistent use of emollients, gentle skincare practices and avoidance of known irritants.15 During disease flares, short-term use of low-potency topical corticosteroids may be indicated; however, such interventions should remain within professional scope, with referral to a consultant
CPD Erythema
specialist when necessary.24 Allergic contact dermatitis Allergic contact dermatitis (CD) is a common inflammatory dermatosis associated with considerable occupational, psychosocial, and healthcare burden worldwide. Recent Global Burden of Disease analyses have identified contact dermatitis as a major contributor to the global burden of skin disease.22,25 It is caused by an immune reaction to an allergen, often the substance that the patient has been exposed to many times previously without problem. The rash usually occurs one to several days after the contact with the allergen. This can make it difficult to identify the cause of the dermatitis. Allergic CD involves a delayed hypersensitivity reaction (also called type IV hypersensitivity) and involves immune memory cells.25 A patient would present with shorter history of contact with allergen (except those with atopic dermatitis, who are more prone to developing contact dermatitis), correlating to distribution of rash, periorbital oedema is a frequent common sign in cases of allergic dermatitis.26 Allergic contact dermatitis commonly presents as an erythematous, pruritic, eczematous eruption localised to areas of allergen exposure. Chronic cases may become dry, fissured, and lichenified. Distribution often reflects the source of exposure, with the face, eyelids, neck and hands frequently affected.26 Irritant contact dermatitis Irritant CD is a form of dermatitis caused by contact with substances that damage the skin barrier. Unlike allergic CD, this type can affect anyone with sufficient exposure to the irritants, and those patients with AD are more susceptible due to disrupted skin barrier.27 Irritant CD is often the result of cumulative impact of multiple irritants and is typically confined to the site of contact with the irritant. Although presentation and distribution can be similar to allergic CD, the exposure to substance is longer, and so is duration of symptoms.26 For example, wearing latex gloves at work, over time would worsen the symptoms, the longer and more consistent the contact, confined to area of contact.25,27 Eyelid dermatitis Eyelid dermatitis (ED) is an inflammatory reaction involving the eyelid skin that is caused by contact with a trigger substance, can involve upper, lower or both eyelids, or one or both sides can be affected. The patient may report itching, stinging or burning, and the lids are red and scaly, eyelids may swell.28 With persistence of dermatitis, the eyelids become thickened with increased skin markings (lichenification). The eyelid margins may become involved, leading to blepharitis. The skin on the eyelids is particularly sensitive to irritants and allergens, and is, therefore, prone to develop contact dermatitis. Contact with the same trigger on other areas of skin may not even lead to a rash.28 As ED is typically triggered by contact with allergen or irritant, it is important to recognise common exposures such as emollients, eye creams, suncream, makeup, cleansers, fragrances, jewellery, eyelash curlers, false eyelashes, eye drops and rubber goggles. Indirect transfer from the hands may also precipitate dermatitis.28 In allergic eye CD, airborne allergens (aeroallergen) should also be considered.27,29 Perioral/periorificial dermatitis Periorificial dermatitis (POD) is a relatively common chronic inflammatory skin eruption. It preferentially targets cutaneous orifices i.e. around the eyes, nostrils, mouth and occasionally, the genitals. Periorificial dermatitis may be limited to a single orifice, where it is more appropriately termed (i.e. perioral, perinasal or periocular).29 It is not a true dermatitis, and the exact cause of is not understood.
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CPD Erythema
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Condition
Differential diagnosis
Distinguishing features of the condition
Features of erythema
Acne vulgaris
Acne conglobata, acne fulminans, folliculitis, perioral dermatitis, rosacea, tuberous sclerosis and sebaceous hyperplasia
The presence of open and closed comedones; lesions along the jawline in the adult women
Erythema clustered around the open and closed comedones; erythematous papules; Post-inflammatory erythematous macules
Rosacea
Acne vulgaris, SD, CD, lupus erythematosus, sarcoidosis, steroid acne, DM and keratosis pilaris rubra
Central area of the face – glabellar area, nose, malar areas and chin; the absence of open and closed comedones, telangiectasias, flushing, skin sensitivity, hypopigmentation; granulomatous-perioral; and periocular papules
Macular erythema (flushing) along with telangiectasia
SLE
Rosacea, eczema, CD, DM, erysipelas, cellulitis, SD, lupus pernio, lupus vulgaris and pellagra
Malar area of the face, spares the NLF, absence of scale, history of burning and flare when exposed to the sun, photosensitivity, Raynaud’s, alopecia
Pink to violaceous macular; erythema or erythematous patches
Discoid lupus
Sarcoidosis, cutaneous leishmaniasis, granuloma faciale
Atrophic scarring, seen on scalp, ear, face, nose
Erythema often an indicator of active disease, presenting alone or distributed centrally within plaques, or along periphery of plaques; can be violaceous
SCLE
Psoriasis, DM, mycosis fungioides, nummular eczema
Annular, polycylic lesions that favor sun exposed areas (face, neck, upper chest, upper back)
Erythematous plaques usually annular associated with scale
CD
Urticaria, atopic dermatitis, nummular dermatitis, dyshidrotic dermatitis, SD, rosacea, psoriasis and fixed drug eruption
Itching, burning and stinging of the skin
Prominent pink-red patches (acute)
SD
Rosacea, psoriasis, atopic dermatitis, tinea capitis and SLE
Scaling in the eyebrows, perinasal creases and ears, history of dandruff with scalp involvement, annular lesions hypopigmentation
Light erythema underneath scale and flaky skin
Psoriasis
Atopic dermatitis, CD, lichen planus, SD, tinea, cutaneous lupus erythematosus, sarcoidosis and pityriasis rosea
Involvement of the scalp, elbows and knees; thick silvery and violaceous plaques; nail changes; Koebner phenomenon
Light to dark brown; erythematous to violaceous plaques covered with gray/white powdery and/ or thick scale
DM rash
SLE, eczema of the eyelid, discoid lupus, SCLE, rosacea and sarcoidosis
Violaceous heliotrope rash, muscle weakness
Light pink-red to brown or violaceous erythema
Postprocedure erythema
Sunburn, CD
Occurs immediately after a procedure -laser, light and energy-based devices, chemical peels, electrodessication
Soft pink-red erythema or violaceous erythema
Table 1: The main conditions and their comparison for differential diagnosis.1
However, the use of topical corticosteroids, either directly on the area or indirectly (for example, via fingers that have applied steroid cream elsewhere), is a causative factor in many cases.30 The rash may also be induced by cosmetics, moisturisers and sunscreens. The condition predominates in younger women, and it can be itchy or sore.30 Nasolabial erythema can be the first sign, followed by perioral or periocular skin involvement with erythema and monomorphic small papules and pustules, occasional scaling. It can resemble rosacea, but there is no facial flushing or telangiectasia.29
· Photo-aggravated atopic dermatitis · Idiopathic chronic photosensitivity dermatitis
Seborrheic dermatitis
· · ·
Seborrheic dermatitis (SD) is a common relapsing inflammatory dermatosis with UK prevalence estimates of approximately 3-5% in adults.31 This form affects the sebaceous regions. Typically, the scalp, face (especially creases around the nose, behind the ears and the eyebrows), flexures and upper trunk. The diagnostic clue is the distribution in sebaceous areas, as symptoms fluctuate and the condition may last for years. There are occasions when it can be difficult to differentiate facial psoriasis from SD (for example, in the absence of additional signs elsewhere on the body). Such patients are sometimes termed as have ‘sebo-psoriasis.’32 Photosensitive dermatitis Photosensitive dermatitis occurs in response to exposure to electromagnetic radiation, mainly sunlight. It can affect all skin types.33 There are several recognised causes of photosensitive dermatitis:33
· Contact photo-irritant or photoallergic dermatitis · Drug-induced photosensitivity eruptions 28
A key distinguishing clinical feature is the distribution, with eruptions predominantly confined to photo-exposed areas. Commonly affected sites include:33
· Face: With sparing of the retroauricular regions, subnasal area, ·
eyelids and hairline (cosmetics may provide relative photoprotection Neck: Sparing of the submental region, often with involvement forming a V-shaped pattern over the anterior chest Dorsum of the hands: Sparing of the interdigital web spaces Forearms: Showing a well-demarcated cut-off at the cuff line Feet: Involving the dorsum, with sparing corresponding to sandal strap marks
Contact photoirritant and photoallergic dermatitis Chemicals that induce irritant reactions may also act as allergens. Irritant (toxic) reactions are typically sunburn-like and frequently followed by marked hyperpigmentation, whereas allergic reactions more closely resemble acute or chronic eczematous dermatitis.34 As both types may be caused by the same substances, recurrent or chronic eruptions are best distinguished by patch testing. The most common photoirritants and photoallergens include:34
· Psoralens (present in plants; associated with phytophotodermatitis) · Antiseptics (e.g. in antibacterial soaps) · Tar derivatives (caution required when combined with UVA in phototherapy)
· Fragrances (associated with berloque dermatitis) · Sunscreens (now less frequent due to lower concentrations and avoidance of PABA)34
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4. Psoriasis Facial psoriasis involves erythematous scaly plaques, often requiring special care due to sensitive skin. Patients will often have a known history of psoriasis, classically presenting as well-demarcated erythematous plaques with adherent silvery scale on extensor surfaces and the scalp.35 They will have lesions elsewhere; scalp, ears, umbilicus, elbows and knees. Often there are nail changes such as oil drop sign, pitting. History gathering is key, especially family history, because the condition has a strong genetic predisposition. Patients with a first-degree relative affected by psoriasis are at significantly increased risk of developing the disease themselves.36,37 In severe cases, a Psoriasis Area and Severity Index (PASI) score assessment is necessary to explore biologic treatment eligibility.35
5. Demodex Demodex refers to mites that inhabit human hair follicles and feeds on keratinocytes, commonly found on the face, including the forehead, cheeks, nose, eyelashes and ear canals.38 Demodex folliculorum clinical presentation is often non-specific, including follicular scaling, erythema, sensitivity and pruritus.38 Manifestations may include macules, papules, folliculitis, and eczematous changes.38 Ocular involvement may occur, presenting as blepharitis, eyelid irritation, scaling, and, in some cases, madarosis or conjunctival inflammation. Increased mite density is associated with conditions such as rosacea and perioral dermatitis. Pityriasis folliculorum presents with rough, sandpaper-like skin and heightened sensitivity to topical products.38 Diagnosis is supported by dermoscopy, revealing characteristic spiculated structures within follicular openings.39 This condition may occur alone, but in many patients, it will co-exist with rosacea or POD, particularly if it is not treated early.38,39
Cutaneous lupus Cutaneous lupus is a connective tissue disorder with facial involvement, most notably a ‘butterfly’ rash presenting as violaceous erythema across the cheeks and nose, often with sharp lateral margins.40 Lesions typically resolve without scarring but may leave telangiectasia. Additional features include photosensitivity, mucosal erosions, diffuse hair loss with brittle shafts, and vascular changes such as livedo reticularis.29 Systemic involvement may occur, including arthralgia, fatigue, pleuritis, pericarditis, renal disease, neuropathy and haematological abnormalities. Overlap with other connective tissue diseases, such as dermatomyositis (heliotrope rash, Gottron’s papules) and scleroderma, may be seen.40 Subtypes include acute (ACLE), subacute (SCLE), intermittent (lupus tumidus) and chronic (CCLE). Lupus tumidus presents as smooth erythematous plaques on sun-exposed areas and resolves without scarring. Discoid lupus (DLE), the most common CCLE form, presents with scaly plaques on the scalp and face, often leading to scarring and dyspigmentation.29,40
CTCL Sézary syndrome is a rare leukemic variant of CTCL. Abnormal T-cells attack the skin, causing rashes, patches and growths.41 Defined by the triad of erythroderma, lymphadenopathy and atypical malignant Sézary cells in the skin, blood and lymph nodes. It is a chronic, usually slow-growing disease that primarily affects older adults. Often mistaken for eczema or psoriasis, it requires a skin biopsy and blood works for diagnosis.41,42
Referral Practitioners should consider referral to dermatology services when patients present with persistent, severe, treatment-resistant, atypical or diagnostically uncertain skin conditions, particularly where there
is concern regarding autoimmune disease, skin cancer, significant psychosocial impact or complex inflammatory dermatoses.24,43 Referral pathways may include NHS primary care referral to community dermatology services, or secondary care consultant dermatology clinics, with urgent ‘two-week wait’ referrals when suspected malignancy. To support evidence-based practice and patient education, practitioners can use reputable dermatology resources including the British Association of Dermatologists (BAD), the Primary Care Dermatology Society (PCDS), National Institute for Health and Care Excellence (NICE) and DermNet.24,29,43
Integrating clinical judgement Facial erythema is a multifactorial presentation requiring careful clinical assessment and an evidence-based, patient-centred approach. For medical professionals in aesthetics, management should prioritise barrier restoration, inflammation control and patient education, while avoiding unnecessary or potentially aggravating interventions.
Test your knowledge! Complete the multiple-choice questions and email memberships@aestheticsjournal.com to receive your CPD certificate!
Questions
Possible answers a. Sensitivity, burning and stinging
1. Clinical signs of rosacea are:
b. Flushing and telangiectasia c. Erythema d. All of them
2. Main factor to differentiate acne from papulopustular rosacea is:
a. Presence of comedones b. Papules and pustules c. Distribution d. Size of lesions a. Age of onset
3. The measure of the severity of psoriasis is:
b. PASI score c. Thickness of lesions d. Strength of steroids
4. Which statement about Periorificial dermatitis is correct?
5. The most distinctive feature of facial cutaneous lupus is:
a. It’s clinical presentation and symptoms is exactly like rosace b. It should be treated with steroids c. It is more common in children d. It is a poorly named condition as it is not a dermatitis a. Butterfly rash b. Dryness of skin c. Photosensitivity d. Papules and pustules Answers: D,A,B,D,A
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Dr Rehanna Beckhurst combines clinical precision with a holistic approach to healthy ageing. With advanced qualifications in dermatology and aesthetics, she specialises in natural, ethical rejuvenation and the care of anxious patients. Dr Beckhurst leads ifab Clinic with a focus on safety, integrity and evidence-based result.. Qual: DDS, MBA, MSc ANSI, PGDip Derm (RCPI), PGCert Aest
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Presenting an Overview of Biostimulating Treatments Dr Paul Charlson outlines a comprehensive review of biostimulators A biostimulator is defined as an injectable substance that stimulates the body’s natural regenerative processes, by encouraging collagen production.1 The global bioregenerative injectable market is projected to grow from £1.20 billion in 2025 to £2.83 billion by 2033, with biostimulatory injectables representing the largest segment of this growth. This is due to their ability to promote tissue regeneration and improve skin quality, rather than simply providing immediate volumisation.2 This article focuses specifically on injectable biostimulator products within this category, including polylactic acid (PLA), calcium hydroxyapatite (CaHA), poly-ε-caprolactone (PCL) and hybrid biostimulators.
Exploring the context The use of biostimulators in aesthetics dates back to the late 1990s, when poly-L-lactic acid (PLLA) was first used to treat lipodystrophy in patients with Human Immunodeficiency Virus.3-5 CaHA and polycaprolactone were introduced later (mid-2000s to late 2000s/ early 2010s, respectively), followed by the development of hybrid products.6 Evolving dilution protocols have played a key role in enhancing both safety and clinical outcomes.7 Greater dilution enables more uniform distribution of the product within tissue, particularly when administered via cannula, thereby reducing the risk of focal accumulation and subsequent nodule formation.7 Dilution also influences the intensity of the inflammatory response, promoting a more controlled and even stimulation of fibroblasts.7 This leads to smoother, more predictable collagen deposition and a more natural aesthetic outcome.7
Mechanism of action Ageing involves a wide range of issues but two are particularly important; disorganisation of collagen in the skin and breakdown of the extracellular matrix (ECM) that supports it.8 It is the fragmentation of the collagen fibres which impairs its interaction with the fibroblasts, inducing modification of the cell morphology, thus reducing mechanical forces.9 Collagen decrease is accompanied by an increase in metalloproteinase levels.9 Biostimulators induce neocollagenesis of both types I and III collagen production drive dermal or subcutaneous remodelling through a controlled, subclinical inflammatory response triggered by their interaction with host tissue.10 Treatment planning should be individualised, considering patient age, skin quality, degree of volume loss and desired outcomes.11,12 Biostimulators are often delivered as part of a staged treatment approach, with intervals allowing for progressive collagen remodelling.11,12 Combination protocols with other modalities, including energy-based devices and skin boosters, may further optimise outcomes.11,12
Biostimulators Collagen Production
Polylactic acid PLA is a synthetic alpha hydroxy acid polymer that is biodegradable, biocompatible and immunologically inert.13 It stimulates neocollagenesis by triggering a controlled foreign body reaction to the injected material, resulting in a mild cellular inflammatory response that activates fibroblasts to produce autologous collagen.13 This process leads to gradual dermal remodelling and semi-permanent correction of facial volume loss associated with ageing.13 PLA is a broad term describing a family of biodegradable synthetic polymers derived from lactic acid.13,14 PLLA consists solely of the L-isomer and is characterised by slower degradation and prolonged collagen stimulation, while poly-D,L-Lactic acid (PDLLA) contains a racemic mixture of D- and L-isomers, resulting in a more amorphous structure, faster degradation profile and potentially more homogeneous tissue integration.14 PLLA is well studied, showing gradual polymer degradation, collagen deposition, dermal thickening and improved tissue quality.13 PDLLA demonstrates similar regenerative effects with potentially better tissue integration.13 Optimal dilution varies, and over-concentration may increase nodule risk.14 A number of PLA products are currently available in the UK, with further products being introduced. Products include Sculptra, Lanluma and JULÄINE (PLLA), as well as Lenisna and Juvelook (PDLLA).15-20 Patient suitability and treatment protocols Careful patient selection is essential when considering PLA treatments.13 Ideal candidates present with diffuse volume loss, reduced skin thickness and declining skin quality, particularly in the mid- and lower-face.13 PLA is well suited to patients seeking gradual, natural-looking improvement rather than immediate volumisation, and to those willing to undergo multiple sessions and follow post-procedure protocols.13 Clinical indications include facial lipoatrophy, age-related volume loss – commonly from the 40s onwards – and skin laxity where a regenerative approach is preferred over traditional space-occupying hyaluronic acid (HA) fillers.13 PLA may be particularly beneficial in patients with thinner skin or those requiring global facial rejuvenation rather than focal correction.14 Clinically, thinner skin may present with reduced dermal thickness, translucency, crepiness and diminished soft-tissue support, with ultrasound assessment used selectively.21 PLLA and PDLLA are typically reconstituted and delivered using either a needle or cannula depending on the treatment plane.22 For placement within the deep dermis, a needle is generally preferred to allow more precise intradermal deposition, commonly using a 25G-27G needle.22 In contrast, treatment within the subcutaneous plane is often performed with a 22G-25G cannula using a fanning or cross-hatching technique to promote even product distribution and reduce the risk of focal accumulation and nodule formation.22 Cannula-based delivery in the subcutaneous plane may also minimise tissue trauma and bruising compared with repeated needle injections.22 Adequate dilution and reconstitution time are essential to maintain a uniform particle suspension and reduce the risk of papules or nodules.23 Treatment usually involves two to four sessions at intervals of four to eight weeks, depending on the product, treatment area and degree of volume loss. Post-treatment massage remains important to support even distribution.10 Traditional PLLA protocols commonly recommend massage for approximately five minutes, five times daily, for five days following treatment (5-5-5 rule).13,23 Alternatively, newer PDLLA formulations, such as Juvelook and Lenisna, incorporating HA typically do not require massage due to improved particle dispersion.14,18,19 Patient compliance with aftercare protocols remains important in optimising outcomes and reducing complications.13
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Biostimulators Collagen Production
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Limitations
Limitations
PLA may be less suitable for patients seeking immediate correction, as results develop gradually through collagen stimulation.13 In these cases, HA dermal fillers may provide a more appropriate option for immediate volumisation and structural support.6 Outcomes are also technique-dependent, with incorrect dilution, injection depth or placement increasing the risk of adverse events such as nodule formation.10
Despite its regenerative and structural applications, CaHA is less suitable for very superficial placement because of the risk of product visibility, palpability or irregularity when injected too superficially.24 In these cases, HA-based fillers or injectable skin boosters may represent more appropriate alternatives due to their greater reversibility, adaptability and safety profile in superficial planes, particularly when treating fine lines, thin skin or delicate anatomical areas.6
Calcium hydroxyapatite
In addition, its effects are less readily reversible than HA-based fillers, which may limit its suitability in patients where treatment adjustability is important.32
CaHA-based injectables consist of CaHA microspheres suspended within a carrier gel and act through a dual mechanism of immediate tissue support and longer-term biostimulation.24 The carrier gel provides initial structural support, while the CaHA microspheres stimulate fibroblast activity and neocollagenesis through a controlled inflammatory response.25 As both components are gradually resorbed, newly formed collagen contributes to ongoing dermal remodelling and tissue reinforcement.25 Diluted and hyperdiluted CaHA techniques are increasingly utilised to reduce volumising effects while enhancing regenerative and biostimulatory outcomes, particularly in the management of skin laxity and dermal thinning in areas such as the neck and décolletage.24,26 Consensus guidance commonly describes dilution ratios ranging from 1:2 to 1:6 depending on treatment indication, tissue quality and desired clinical effect.24,26 Radiesse remains the most extensively studied CaHA product in the UK, although alternative CaHA-based and hybrid formulations continue to emerge.24-26 Patient suitability and treatment protocols CaHA is selected for patients with mild-to-moderate volume loss, skin laxity or reduced dermal quality where structural support, biostimulation or regenerative improvement are desired.24 Undiluted formulations are commonly used to provide structural support and contour enhancement in areas such as the mid-face and jawline, whereas diluted or hyperdiluted formulations are increasingly employed for collagen stimulation and skin quality improvement in regions including the neck and décolletage.25 CaHA may be injected using bolus, linear threading or fanning techniques depending on treatment indication and anatomical site.27 Structural treatments are commonly performed with a needle for precise supraperiosteal or deep subcutaneous placement, while hyperdiluted formulations intended for diffuse skin quality improvement are frequently delivered via cannula within the subcutaneous plane to facilitate even product distribution and reduce localised accumulation.27 Neocollagenesis typically begins within a few weeks of treatment and becomes clinically evident from approximately four to six weeks post-injection, continuing to develop over a period of three to six months.28 Some studies have demonstrated ongoing dermal remodelling for up to nine to 12 months following treatment.29,30 In many clinical protocols, a single treatment session may be sufficient to achieve biostimulatory effects, although some patients may benefit from a second session at three to six months depending on baseline tissue quality, degree of laxity and treatment goals.31 Maintenance intervals are variable and typically range from nine to 18 months depending on individual response, treatment area and injection technique.27,31 Longevity is influenced by factors including dilution ratio, baseline tissue quality, metabolic activity and the extent of neocollagenesis achieved.27,31 Areas of higher mobility or thinner skin may demonstrate more rapid reduction in clinical effect, whereas structurally supportive regions such as the mid-face may show more prolonged benefit.27,31 34
Outcomes remain highly technique-dependent, with dilution ratio, injection depth and product distribution all influencing both efficacy and safety.27,31 Appropriate patient selection, product preparation and placement technique are therefore essential to optimise regenerative outcomes while minimising the risk of contour irregularities, overcorrection or nodule formation.27,31
Poly-ε-caprolactone PCL is a biocompatible, biodegradable and bioresorbable polymer, classified as an aliphatic polyester within the poly-α-hydroxy acid group, alongside polylactic and polyglycolic acids.33 PCL fillers are associated with prolonged ECM remodelling and long-lasting regenerative effects, which are thought to result from slower polymer degradation and sustained mechanical stimulation of surrounding tissues.34 A 24-month randomised, controlled trial using 40 participants and focusing of a PCL-based filler (Ellansé) demonstrated sustained aesthetic improvement and favourable safety outcomes.35 In the UK and wider EU market, PCL-based biostimulators are primarily represented by Ellansé, with emerging formulations such as Gouri and Miracle L also described in the literature and clinical practice.33,36-38 These products vary in their delivery format (including injectable gel composition and degree of immediate volumisation) and rheological properties, which influence handling characteristics and initial tissue expansion.33 However, they share a common mechanism of sustained collagen stimulation through gradual polymer degradation and dermal remodelling.33 Patient suitability and treatment protocols PCL is selected for patients with mild-to-moderate facial volume loss seeking long-lasting structural improvement alongside dermal quality enhancement.39 It is particularly useful where sustained neocollagenesis and prolonged clinical effect are desired, with gradual and durable improvements in skin firmness and elasticity.39 PCL is generally placed in the deep dermis or subcutaneous plane using linear threading or depot techniques, with careful attention to placement due to its longevity.36 Treatment is typically performed in a single session, with clinical improvement becoming apparent after eight to 12 weeks and continuing over three to six months.36 Results may last 18-24 months depending on product, technique and patient factors, with maintenance treatments usually required every 18-24 months.7 Limitations Limitations include delayed onset of visible results, reduced suitability for patients requiring immediate correction and less flexibility for reversibility.40,41 As such, the prolonged duration of effect necessitates precise placement and careful patient selection, as suboptimal outcomes may be difficult to modify.41-43
Hybrid biostimulators Hybrid biostimulators represent a category designed to combine immediate volumisation with longer-term biostimulatory effects,
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offering a dual-phase mechanism of action.44 While this can be advantageous in patients requiring both structural support and dermal quality improvement, treatment choice should remain indication-led rather than product-led.44 The primary advantage of hybrid formulations is their ability to deliver immediate aesthetic improvement while simultaneously stimulating collagen production over time.40 This can be particularly useful in patients seeking faster visible change without compromising regenerative benefits.40-44 Combinations of cross-linked HA dermal fillers with PLA are also used to provide immediate volume and enhance skin quality.45 More recently, copolymerisation technology has produced microspheres combining PLLA and ethylene glycol (PLLA-b-PEG), resulting in a more controlled inflammatory response and noticeable volumisation during the first six months.45 In the UK, HArmonyCa – a hybrid injectable combining HA and CaHA – is a prominent example of this category, demonstrating significant improvement in facial volume and skin quality at approximately nine months.46 Hyperdiluted CaHA (Radiesse) may also be considered within the broader biostimulatory or hybrid paradigm, although its immediate volumising capacity is reduced at higher dilution ratios.31 In practice, the closest UK alternative to HArmonyCa is a combined or layered approach using CaHA and HA fillers to achieve both structural support and regenerative effects.47 In clinical practice, hybrid biostimulator treatments are often combined with liquid skin boosters, such as NCTF 135 HA, and/or fine or medium cross-linked HA fillers, though product choice remains a matter of practitioner preference.40,45,48 Patient suitability and treatment protocols Hybrid biostimulators require precise depth control to balance immediate volumisation with longer-term collagen stimulation, often favouring cannula-based delivery.45 Hybrid biostimulators are typically selected for patients requiring both immediate aesthetic improvement and longer-term dermal biostimulation.40 They are particularly suited to individuals with mild-to-moderate volume loss who prefer a single-product approach combining structural support and regenerative benefit.45 The decision to use a hybrid product is often prompted by the need for faster visible correction alongside progressive collagen stimulation, particularly in patients with time-sensitive aesthetic goals.49 Treatment is usually two to three sessions, with results evolving over several months as biostimulation develops.46 Maintenance is typically required at 18-24 months depending on ageing trajectory and clinical response.46 Contraindications and limitations Limitations include reduced flexibility in tailoring volumisation versus biostimulation independently. As with all biostimulators, outcomes are highly dependent on patient selection, anatomical considerations and clinician experience.40,46
Side effects and safety profile Biostimulatory injectables are generally considered safe when appropriately used, although complication profiles differ from HA fillers, particularly regarding delayed inflammatory reactions and reversibility.50,51 Common early reactions include bruising, erythema, oedema, tenderness and transient discomfort, which are typically mild and self-limiting.50 Contraindications amongst the treatments discussed above include active infection, hypersensitivity to components, pregnancy or breastfeeding, and caution in patients with autoimmune disease or a history of granulomatous or delayed inflammatory reactions.50
Biostimulators Collagen Production
Nodule formation is the most clinically relevant complication and may occur with all biostimulators, although it is more frequently associated with PLLA and PCL.13,52 These nodules are often non-inflammatory and may resolve spontaneously over a period ranging from three months to three years.13,52 Contributing factors include excess product placement, incorrect injection depth or technique, inadequate dilution, insufficient post-treatment massage, injection into highly mobile areas or muscle and injector inexperience.50 PDLLA is often considered to demonstrate more uniform tissue integration and may carry a lower risk of nodule formation; however, optimal outcomes with all biostimulatory products depend on appropriate patient selection, correct reconstitution and meticulous injection technique.13,31,50 Late-onset complications are more common than immediate reactions, with approximately 60% occurring beyond the first month post-treatment.50,51 These are typically related to technique, dilution and individual inflammatory response rather than procedural factors alone.50,51 Reported late complications include delayed-onset nodules (inflammatory or non-inflammatory), induration or palpable irregularities, persistent oedema, asymmetry and, rarely, granulomatous reactions.50-53 Management is guided by clinical presentation. Non-inflammatory nodules may be managed conservatively with observation and massage, while inflammatory lesions may require intralesional corticosteroids or systemic anti-inflammatory therapy.13 As these products are non-HA based, hyaluronidase is not indicated; treatment is therefore primarily anti-inflammatory. Infection should be excluded where clinically indicated.24 Early recognition, accurate diagnosis and a stepwise management approach are essential to optimise outcomes.53 Although vascular adverse events linked to biostimulators appear uncommon, inadvertent intra-arterial injection can lead to vascular occlusion, tissue necrosis and irreversible ocular complications, including blindness.54,55 Risk is highest in anatomically sensitive areas such as the glabella, nose, temple and periocular region, making thorough anatomical knowledge and careful injection technique essential.56,57 In selected cases of persistent irregularities following PDLLA treatment, adjunctive use of energy-based devices such as radiofrequency (RF) may be considered.56-58 This is based on the lower glass transition temperature of PDLLA compared with PLLA, which may allow increased polymer mobility under controlled thermal conditions.58 RF evidence remains limited, and its use should be reserved for carefully selected cases after exclusion of inflammatory or infective causes.58-60
Utilising biostimulating agents The use of biostimulators in medical aesthetics is expected to grow as new products enter the market. Choice of product should be guided by a range of factors, including treatment goals, patient characteristics and clinician experience. Dr Paul Charlson has 25 years of experience in aesthetics, general practice and dermatology. He is past president of the British College of Aesthetic Medicine and a founding member of the Joint Council for Cosmetic Practitioners. Dr Charlson was previously part of the Merz Aesthetics and Galderma faculties and currently instructs Juvelook and Lenisna as part of the FILLMED faculty. Qual: FRCGP, FBCAM, DPD, DRCOG, DOccMed
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Aesthetics | June 2026
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Case Study Poly-L-Lactic Acid
aestheticsjournal.com
The Role of Poly-L-Lactic Acid in Body Rejuvenation
In these areas, treatment objectives extend beyond volumisation to include improvement in skin laxity, enhancement of dermal quality and reduction in the appearance of cellulite.5
Independent nurse prescriber Michelle McLean explores the regenerative role of PLLA in body rejuvenation and its application for improving skin quality
These regenerative principles are particularly relevant in areas such as the upper arms, where dermal thinning and structural laxity frequently contribute to the characteristic ‘crepey’ appearance of ageing skin.5 Emerging evidence indicates that PLLA may improve dermal quality in the medial upper arms, with reported outcomes including improved skin texture and a reduction in skin laxity. Early clinical improvements have been observed within the first month following treatment.3
The demand for non-surgical rejuvenation of the face and body has grown considerably in recent years.1 This has been driven in part by an ageing population seeking minimally invasive treatments that support a youthful appearance, while avoiding the risks and recovery associated with surgical procedures.2 The upper arm is a frequently treated area in body rejuvenation, particularly in women over the age of 40, due to dermal thinning, collagen loss and reduced structural support, leading to laxity and a characteristic ‘crepey’ appearance.3,4 These changes often require treatments that address both skin quality and underlying tissue integrity.5 As facial aesthetic outcomes have advanced, patients are increasingly seeking comparable rejuvenation in the body to maintain overall harmony.⁴ Traditional management strategies have included surgical procedures such as brachioplasty or energy-based technologies such as radiofrequency aimed at tissue tightening.6 This article will explore the regenerative properties of poly-L-lactic acid (PLLA), its expanding role in body rejuvenation and a case study illustrating its use to improve dermal laxity and skin quality in the upper arms.
Understanding dermal laxity and tissue quality Concerns relating to dermal laxity, thinning skin and crepey texture in areas such as the upper arms, abdomen, thighs and buttocks are becoming increasingly common in aesthetic practice.2 These changes are largely attributed to age-related degradation of collagen and elastin fibres, reduced fibroblast activity and disruption of extracellular matrix (ECM) architecture, all of which contribute to diminished dermal thickness and reduced tissue resilience.7 Upper arm skin laxity is recognised as a challenging aesthetic concern due to the relatively thin dermis in this region and the effects of gravitational forces on tissue support.5 Loss of collagen and elastin within the dermal matrix contributes to reduced elasticity and structural integrity, resulting in the characteristic crepey appearance often observed in this anatomical area.5
PLLA as a regenerative collagen biostimulator PLLA is a well-established collagen biostimulator that induces a controlled local inflammatory response following injection. This response is characterised by macrophage recruitment and fibroblast activation, initiating a cascade that stimulates type I collagen synthesis and progressive remodelling of the ECM.7,8 Over time, the deposition of newly organised collagen fibres contributes to increased dermal thickness, improved structural support, and enhanced skin firmness as well as elasticity within the treated area.7 Histological and clinical evidence supports its role as a bioactive scaffold that initiates a controlled regenerative cascade.8,9 Through stimulation of type I and III collagen synthesis, PLLA promotes organised collagen deposition, contributing to improved dermal thickness, enhanced tissue biomechanics and restoration of structural support within treated areas.7
PLLA treatments are associated with minimal downtime, with most patients returning to normal activities within 24-48 hours.5,10 Outcomes may also be variable, particularly in relation to scar quality, contour irregularities and patient-specific healing responses, with results influenced by factors such as skin quality, degree of laxity, baseline dermal thickness, treatment technique and dosing.5,9 Consequently, there has been growing interest in regenerative injectable treatments that target the underlying structural mechanisms of dermal ageing.10,12,13 Before
After
Recent evidence suggests that the role of PLLA extends beyond collagen stimulation alone, functioning as a more comprehensive regenerative agent.8 In addition to increasing dermal thickness, PLLA has been associated with stimulation of elastin production and modulation of adipocyte activity. Emerging data indicates a potential influence on adipogenesis, which may contribute to improvements in tissue volume and structural support in areas such as the buttocks and hips.8,9 These findings suggest that PLLA may support restoration of underlying tissue architecture, rather than solely providing superficial skin tightening.8,9 PLLA in body treatments While facial rejuvenation remains the most widely recognised indication for PLLA, its use in body treatments is expanding.10 Patient suitability and assessment for body indications require a distinct approach, with greater emphasis on skin quality, laxity, tissue thickness and contour irregularities across larger treatment areas.3,5 Clinical evidence highlights increasing utilisation across areas such as the buttocks, decolletage, arms and thighs.5,8,11 Aesthetics | June 2026
Figure 1&2: 55-year-old female at baseline and six weeks after three treatment sessions of Sculptra
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All BELOTERO products referred to in this infographic contain lidocaine, as BELOTERO without lidocaine has been discontinued, with the exception of BELOTERO Revive designed without lidocaine. For your information, BELOTERO lidocaine and non-lidocaine share the same product specifications with the key difference being the inclusion (or absence) of lidocaine. © 2026 Merz Aesthetics UK Ltd – All rights reserved. MERZ AESTHETICS and the BELOTERO logos are trademarks and/or registered trademarks of Merz Aesthetics UK Ltd in the United Kingdom. Registered in England No. 14506945. Merz Aesthetics UK Ltd, Ground Floor Suite B, Breakspear Park, Breakspear Way, Hemel Hempstead, Hertfordshire HP2 4TZ. www.merz-aesthetics.co.uk M-BEL-UKI-2038 Date of Preparation January 2026
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“Recent evidence suggests that the role of PLLA extends beyond collagen stimulation alone, functioning as a more comprehensive regenerative agent” Case study Assessment A 55-year-old female presented with concerns regarding progressive laxity and textural deterioration of the upper arms (Figure 1). Her primary complaint was the development of “crepey” skin along the posterior medial and inner aspects of the arms, particularly noticeable when the arms were elevated or during natural movement. The patient reported that the changes had gradually developed over several years despite maintaining a stable weight, regular physical activity and consistent skincare use. She expressed reluctance to pursue surgical intervention and specifically requested a treatment option that would provide gradual improvement while maintaining natural tissue movement. Clinical examination utilising the GAIN framework followed the AART methodology: Assessment, Anatomy, Range and Treatment. This structured approach provides practitioners with a clear pathway for evaluating each patient, beginning with a thorough assessment of their concerns, medical history and aesthetic goals. It then progresses to detailed anatomical analysis, consideration of the most appropriate product range or modality, and finally the sequencing of treatments in a safe and effective manner.14 Clinical examination revealed: · Moderate dermal laxity affecting the inner, medial and posterior upper arms · Visible crepey texture with fine wrinkling of the skin surface · Reduced dermal thickness on palpation Given the patient’s desire for a non-surgical approach and the predominance of dermal thinning rather than excess adipose tissue, treatment with PLLA collagen biostimulation was proposed. Treatment plan A staged collagen biostimulation protocol using PLLA was implemented to improve dermal density and structural support within the upper arm tissue.
Treatment consisted of: · Three treatment sessions, spaced four to six weeks apart · Four vials of Sculptra (two vials in the first session followed by one vial in the second and third session) Each vial was reconstituted to a final dilution of approximately 18ml (16ml of sterile water for injection and 2ml of 2% lidocaine) to allow broad distribution across the treatment area. A 23G, 70mm cannula was used to deliver the product within the subcutaneous plane using a retrograde fanning technique to achieve uniform coverage and minimise tissue trauma.15 The injection pattern followed the natural contour of the upper arm, with careful avoidance of neurovascular structures.5 Product was distributed evenly across the inner, medial and posterior arms dividing the regions to be treated into four quadrants to stimulate diffuse collagen production rather than volumisation.5,13 After treatment, vigorous massage was performed on the treated area and patients were instructed to use the same massage technique utilising the 5-5-5 rule, gently massaging for five minutes, five times a day, for five consecutive days.16,17 Outcomes Clinical review was performed six weeks following the third treatment session (Figure 2). The patient demonstrated: · Noticeable improvement in dermal firmness · Reduction in visible crepey skin texture · Improved skin smoothness during arm elevation · Greater cohesion of the upper arm contour · Improved tactile dermal thickness on palpation Photographic comparison confirmed improved tissue quality and smoother skin appearance across the treated area. Importantly, results appeared gradual and natural, with no visible irregularities or nodularity. Aesthetics | June 2026
17:34 16:14
Case Study Poly-L-Lactic Acid The patient reported high satisfaction with the treatment outcome, highlighting a renewed confidence when wearing sleeveless clothing, which she had previously avoided for several years. She described the results as subtle yet meaningful, aligning with her preference for a natural, non-surgical approach and appreciating the gradual, progressive improvement.
PLLA within regenerative aesthetic practice The evolution of medical aesthetics reflects a broader shift toward regenerative, structurally informed practice.4 Increasingly, success is defined not by dramatic transformation, but by the restoration of tissue integrity, preservation of natural movement and optimisation of skin quality across both facial and body indications. The clinical case presented illustrates how a staged, collagen biostimulatory approach can achieve gradual yet meaningful improvements in dermal quality while preserving natural contour and movement. Such outcomes align closely with contemporary patient expectations, with evidence demonstrating high levels of satisfaction alongside measurable improvements in skin quality and elasticity.7,12-14 Together, these findings reinforce the role of regenerative aesthetic approaches in supporting both facial and body rejuvenation, highlighting the importance of evidence-informed, anatomy-led practice in delivering natural, patient-centred outcomes within medical aesthetics. Michelle McLean is the founder and medical lead of Aesthetically You. With more than 14 years’ experience in the aesthetics field, McLean is a key opinion leader (KOL) for Galderma and BTL Aesthetics. She holds a Bachelor of Science with Honours in Nursing, a postgraduate certificate in cosmetic medicine, a master’s in advanced healthcare practice and is an independent and supplementary prescriber. McLean was the Winner of Crown Best Non-Surgical Result at The 2025 Aesthetics Awards for an outstanding facial palsy patient outcome. Qual: RGN INP MSc BSc, PGCert Cosmetic Med, DIP/HE
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More, More, More: Embedding Sun Safety into Everyday Aesthetic Practice The British Skin Foundation (BSF) promotes a simple, consistent approach to sun protection Skin cancer is the most common cancer in the UK, yet it is largely preventable. For aesthetic practitioners, this presents a clear opportunity to influence patient behaviour in a meaningful and lasting way. The British Skin Foundation (BSF) promotes a simple, consistent approach to sun protection – one that moves beyond seasonal messaging and becomes part of everyday skin health.
Understanding the impact of UV exposure Ultraviolet (UV) radiation is the primary preventable cause of skin cancer. It damages the DNA within skin cells and contributes not only to the development of skin cancer but also to premature ageing. Importantly, this damage builds over time. Both short periods of intense exposure and long-term cumulative exposure increase risk.
More clothing The British Skin Foundation advises that clothing should always be the first line of defence against sun damage, with individuals encouraged to cover as much skin as possible, particularly areas like the shoulders that burn easily. The BSF also recommends considering protective clothing even when in the water, especially for children and those with lighter skin types – who are prone to burning. In addition, a hat is an important part of protection, with a wide-brimmed or legionnaire-style design being most effective as it helps shade the head, face, ears and neck.
The BSF’s guidance is clear: no single method of sun protection is sufficient on its own. Sunscreen plays an important role, but it should not be relied upon in isolation. Instead, effective protection comes from combining multiple strategies to reduce overall UV exposure.
To support better understanding and adherence, the BSF introduced its ‘More, More, More’ campaign. Built around three key actions – more clothing, more sunscreen and more shade - the campaign simplifies sun safety into a memorable and actionable message.
SPF stands for ‘Sun Protection Factor’ and refers to the level of protection against UVB radiation, linked to skin cancer. Look for a 4 or ideally 5 star UVA rating on the bottle which will help protect from UVA radiation, associated with skin ageing. Check the expiry date of your sunscreen, as out of date sunscreen will not be as effective and you risk burning. Don’t forget to protect your lips – using a SPF30+ lip balm.
More shade Keeping cool in the shade is a good way of protecting yourself from the sun, especially if you are very fair skinned. Just 10 minutes of strong sunshine is all it takes to burn pale skin. Find some shade whenever possible, but especially in the middle of the day, between 11am and 3pm, when the sun is at its strongest. Always keep babies and toddlers in the shade.
Supporting awareness and early detection
Aesthetic practitioners are often in a unique position to observe changes in the skin and can play an important role in encouraging patients to seek further assessment when needed.
A consistent, layered approach to protection
‘More, More, More’: A simple framework that works
it more often. Remember using a towel or lying back on a fabric sunbed can rub the sunscreen off.
Alongside prevention, the BSF encourages individuals to become familiar with their skin and to monitor for any changes. Noticing new or changing moles and seeking medical advice promptly can make a significant difference. Early detection remains a key factor in successful treatment.
Sunburn is a clear sign of skin damage, and even a single episode can have lasting effects. The BSF highlights that protecting the skin from UV radiation is essential at all ages, reinforcing that sun safety should be a lifelong habit rather than a reactive measure.
For patients, this message removes the pressure of perfection and replaces it with achievable, repeatable behaviours. For practitioners, it provides a clear framework for patient education that is easy to communicate and reinforce.
Advertorial British Skin Foundation
Make it simple, make it routine Make sun protection part of every consultation. Encourage patients to adopt small, consistent habits – more clothing, more sunscreen and more shade.
More sunscreen No sunscreen provides absolute protection, so it should be used with the other lines of defence, and not alone.
By reinforcing these simple behaviours, practitioners can help reduce the risk of skin cancer while supporting healthier, more resilient skin over the long term. This advertorial was written and supplied by
Generously apply sunscreen with SPF30 or more to all areas of skin exposed to the sun. A water resistant sunscreen is better, even if you are not swimming, as it protects you better if you sweat. Apply the sunscreen 20-30 minutes before going outside, and at least every two hours. If you swim or sweat a lot, use Aesthetics | June 2026
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mesohyal® redenx A skin booster specifically indicated to target moderate ageing, loss of density and skin sagging. Beyond collagen stimulation, its action supports dermal regeneration, extracellular matrix reorganisation, and deep, long-lasting hydration. Formulated to act through a noninflammatory pathway and address the skin’s structural and functional needs. Its specific formula containing biomimetic peptides and biorevitalising ingredients are designed to enhance the skin’s repair, build more collagen and increase skin firmness and vitality. Developed with short chains of amino acids designed to perfectly mimic the natural signaling sequences found in the body. Working with the skin’s biology, because skin quality isn’t one-dimensional, so your treatments shouldn’t be either.
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Case Study Facial Burns
Treating Facial Burns with Hypochlorous Acid
can delay healing and worsen outcomes.6 Over weeks to months, collagen deposition and vascular remodelling occur, determining the quality of scar formation. Unregulated collagen production may lead to hypertrophic or keloid scars.4
Dr Helen Whyte and Dr Ambreen Ayaz discuss treating facial burns and consider the use of hypochlorous acid
Assessment
Burn injuries, especially on the face, present complex challenges for both acute management and long-term aesthetic care. The delicate facial skin, its high vascularity and constant exposure to environmental factors make it particularly susceptible to scarring and pigmentary changes after injury.1 The psychological impact of facial burns must not be underestimated, especially when the affected area is constantly visible to both the patient and those around them. As with any skin condition, when injury alters the appearance of the face, it can profoundly influence a person’s sense of wellbeing, self-confidence and emotional recovery. With advances in both wound care and medical aesthetics, practitioners are increasingly called upon to support not only the physical healing but also the restoration of skin appearance and texture. This article draws on clinical expertise and a recent case experience to examine burn classification, treatment modalities and a novel approach using pure hypochlorous acid (HOCI) formulation.2
Types of burns Burns are traditionally classified by the depth of tissue damage, each degree reflecting different clinical appearances and healing potentials. Superficial burns, affecting only the epidermis, appear red and dry without blistering and tend to heal within a week or so without scarring.1 Partial-thickness burns extend deeper into the dermis, presenting with painful, moist, blistered skin. These may heal over two to three weeks but carry a risk of scarring depending on severity.1 Full-thickness burns destroy the entire epidermis and dermis and may even affect underlying tissues, often appearing white, leathery and dry. Due to nerve damage, these burns may paradoxically lack pain and typically require surgical intervention, with scarring and contractures common outcomes. Fourth-degree burns, which extend into muscle and bone, represent life-threatening injuries necessitating extensive reconstructive procedures.3 The face’s unique anatomy makes it particularly vulnerable to the consequences of burns. Its rich blood supply fosters rapid inflammatory responses, which while essential for healing, can amplify risks of hyperpigmentation, especially in individuals with darker skin types.4 Patients with Fitzpatrick skin types III and above, particularly types IV, V and VI, are more prone to developing pigmentation changes following a burn, due to a higher concentration of melanocytes in the skin.4 This makes ethnic and individual skin variation a key factor to consider when planning treatment pathways for facial burns. Furthermore, the thinness of facial skin and constant movement from expressions create tension on healing wounds, increasing the likelihood of hypertrophic scarring or contracture formation.5 Moreover, the face’s high exposure to ultraviolet (UV) light can exacerbate pigmentary changes in regenerating skin.4 Following a burn, skin healing progresses through several overlapping phases. The initial inflammatory response recruits immune cells to clear debris and pathogens, but excessive inflammation can trigger cytokine cascades that overstimulate melanocytes and fibroblasts, leading to pigmentation changes and scarring.4 In the subsequent re-epithelialisation phase, keratinocytes migrate to restore the epidermal barrier.4 This process is optimal when the basement membrane remains intact; disruption here
Early intervention is critical in modulating these healing phases to optimise aesthetic results. Minimising inflammation soon after injury reduces melanocyte hyperactivity and prevents excessive fibroblast stimulation.4 Maintaining hydration and protecting the skin barrier supports keratinocyte function and prevents transepidermal water loss, enhancing epithelial regrowth. Avoiding UV exposure with sunscreen is paramount to reduce melanogenesis in the healing skin.7 Additionally, timely application of topical agents like silicone gels or corticosteroids and advanced therapies such as laser treatments, can significantly improve scar texture and pigmentation if applied within appropriate windows.3
Treatment and recovery The initial priority when managing a facial burn is ensuring the patient receives urgent medical care. Immediate concerns include assessing burn depth, managing pain, preventing infection and stabilising the patient.8 Only after acute care can aesthetic practitioners safely consider interventions to address the cosmetic sequelae. Delayed or incorrect treatment can prolong inflammation, invite infection, worsen pigmentation and increase the risk of permanent scarring.8
Topicals and skincare Inappropriate topical products, such as those containing irritants or photosensitising agents, may exacerbate skin trauma and delay recovery. Ingredients such as retinoids and exfoliating acids, which are inherently proinflammatory, should be avoided in these cases, as they may provoke further reaction, sensitivity and delay in recovery.9,10 When managing patients with higher Fitzpatrick skin types during recovery, it is essential to approach treatment with caution to avoid triggering post-inflammatory hyperpigmentation (PIH). Choosing interventions that help to inhibit melanocyte activity, such as topical agents containing tranexamic acid or azelaic acid (AzA), can significantly reduce the risk of reactive pigmentation.11 This consideration becomes especially important when using laser therapy or other treatments that may provoke further irritation or inflammation in already compromised skin.12
“Minimising inflammation soon after injury reduces melanocyte hyperactivity and prevents excessive fibroblast stimulation”
Aesthetics | June 2026
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Case Study Facial Burns
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“The initial inflammatory response recruits immune cells to clear debris and pathogens, but excessive inflammation can trigger cytokine cascades that overstimulate melanocytes and fibroblasts, leading to pigmentation changes and scarring”
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They deliver controlled micro-injuries that break down dense scar tissue while stimulating collagen production in the deeper dermis. This helps to improve both texture and tone, but these treatments require downtime and may not be suitable for all skin types or tones.24 Microneedling combined with PRP is another effective option, especially for atrophic or mature scars. The mechanical stimulation from microneedling triggers collagen remodelling, while PRP accelerates healing and improves the appearance and elasticity of damaged skin. However, results may take up to six sessions and depend heavily on the quality of the patient’s platelet concentration.24
Hypochlorous acid Recently, HOCI has gained attention as a valuable adjunct in wound and post-trauma skin care. Produced naturally by the body’s immune system, HOCl offers antimicrobial, anti-inflammatory and tissue-repair benefits without cytotoxicity.25 However, not all HOCl products are suitable for delicate burn wounds. Many mass-produced solutions contain impurities or unstable concentrations that can irritate healing tissue. Clinically validated, high-purity formulations provide a safe, pH-balanced and effective option that mimics physiological immune responses, promoting microbial control and reducing inflammation while supporting skin regeneration.26
Exosomes Managing inflammation is central to preventing long-term damage. The release of pro-inflammatory cytokines stimulates pigment-producing cells and collagen-producing fibroblasts, so controlling this response through cold compresses, anti-inflammatory medications such as silver sulfadiazine cream, and topical corticosteroids such as hydrocortisone cream (used judiciously) can reduce adverse outcomes.13-15 Maintaining a moist wound environment with dressings like hydrogels and using barrier-protective moisturisers encourages optimal re-epithelialisation.16 Once the wound has closed, interventions shift to scar prevention with silicone gels and pigmentation regulation using gentle agents like azelaic acid or niacinamide.17,19 When addressing scarring, pigmentation and textural changes following burns or trauma, several advanced treatment options can be considered, each with their own mechanisms and limitations.20 AzA is a topical agent especially effective for PIH and mild scarring. It works by inhibiting melanin production, calming inflammation and reducing redness.18 These are all crucial for post-burn or acne-related skin damage. It’s also gentle enough for rosacea-prone or sensitive skin types.21
Devices Choosing an invasive treatment like ablative laser on skin that has experienced facial burns can inadvertently stimulate melanocyte activity, prompting increased melanin production. In some cases, this can exacerbate post-inflammatory pigmentation and worsen the appearance of scarring rather than improve it.22 However, once the skin has fully re-epithelialised and the inflammatory phase has subsided, laser-based treatments can become a valuable tool in the management of post-burn sequelae.23 Fractional lasers, such as CO2 or Erbium:YAG, are more suitable for deeper, hypertrophic scars. 44
Exosomes are also emerging as a promising adjunct in burn recovery in the UK, particularly those derived from bovine sources such as colostrum.27 A bovine colostrum-derived exosome preparation (for example, as used in some proprietary formulations) may help support skin repair by delivering bioactive molecules that reduce oxidative stress in keratinocytes, suppress melanin production in melanocytes and stimulate collagen in fibroblasts, all potentially useful for managing pigmentation and texture changes after facial burns.28
Case study A practical illustration of these principles is seen in the case of a 32-year-old patient who sustained a partial-thickness facial burn from a barbeque accident when her hair caught fire. Immediate action involved extinguishing the flames, ambulance assessment within 15 minutes and pain management with morphine. Upon hospital arrival, a hydrocolloid-soaked dressing was applied to the affected facial area, which showed redness, blistering and significant pain consistent with a second-degree burn. The hospital prescribed flamigel and discharged her without scheduled follow-up. Concerned about her healing trajectory, the patient reached out within 72 hours of the incident for further guidance. Initial symptoms included marked blistering, swelling and discomfort, though by the time of consultation, swelling and pain had begun to subside. Dr Whyte’s assessment was guided in part by the medical advice the patient had already received from the hospital, which included a conservative approach to healing – keeping the area clean, protected and avoiding any potentially sensitising products. In addition to following her GP’s guidance, the patient was encouraged to incorporate HOCl into her routine to support skin recovery and minimise inflammation. Dr Whyte incorporated HYPO21 into the treatment plan, recognising its suitability for early burn management due to its pure hypochlorous acid composition and gentle action.
Aesthetics | June 2026
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A multicentre clinical investigation into HYPO21 Skin Spray in December 2023 further reinforces its utility as a safe and effective therapeutic option in managing inflammatory skin conditions.26 The 12-week study, with a participant size of 100, demonstrated consistent improvements, with up to 85% of participants showing a significant marked decrease in inflammatory markers such as IL-1, IL-6 and TNF-alpha. Importantly, 85% of patients also reported improved skin comfort and appearance, with minimal adverse reactions – only 4% experienced mild, self-resolving irritation. The study confirmed that the spray supports skin barrier function, reduces microbial load and improves quality of life across a wide demographic range.26 HYPO21 was applied three to four times daily starting upon initial consultation, 72 hours after the burn. It was used in conjunction with ongoing hospital advice and not as a replacement. The patient reported immediate relief upon application, noting the reduction of burning sensations and a soothing effect on the skin. By day three post-burn, the skin ceased weeping and began scabbing, while redness diminished noticeably. At one week (Figure 1), scabs were flaking and the skin’s redness continued to reduce; the patient experienced only mild tightness and dryness without burning or pain.
Case Study Facial Burns
If a patient presents weeks after a burn, the skin is usually re-epithelialised, but dermal remodelling is still ongoing.32 Topical treatment remains essential to hydrate, reduce inflammation and support collagen organisation.33 Silicone may be introduced once the wound is fully epithelialised to promote scar maturation and reduce hypertrophic changes, while AzA can be safely used after the inflammatory phase to manage residual hyperpigmentation, and retinoids can be introduced to enhance epidermal turnover and melanocyte modulation.9,17,18 Regenerative options such as microneedling, low-energy fractional laser or LED therapy may begin around six to eight weeks post-injury, once the skin is stable and initial dermal remodelling is underway, to optimise collagen remodelling and pigmentation outcomes.25,34 Before
After
Photographic follow-ups on day 10 showed continued improvement. The skin exhibited residual redness and slight roughness in texture, but importantly, no hyperpigmentation or hypopigmentation was evident. This outcome is significant given the patient’s skin type (Fitzpatrick II), which typically is prone to pigmentary disturbances after inflammatory insults. Skin type is typically assessed using the Fitzpatrick Scale, which predicts response to sun and risk of pigmentation.29 Skin type is also evaluated (genetic) and current condition (e.g. dehydration or acne), which can fluctuate.30 Patch tests were used to check for irritation or post-inflammatory pigmentation risk.31 The residual redness was fading by day 11, and the skin’s surface appeared healthier than expected for such an injury timeline. The patient returned 29 days from initial incident, for regular follow-ups three times a week for 14 weeks post incident, allowing Dr Whyte to closely monitor the skin’s progress and evaluate when it might be appropriate to introduce further treatment to target PIH. By the three-week mark post incident, the skin showed no signs of raw areas or open wounds, prompting Dr Whyte to initiate exosome therapy using Purasomes by Dermoaroma. The patient had four sessions of exosomes (NC150+ Nutricomplex), three to four weeks apart. Following advice from the manufacturer, the first two treatments were only topical applications. The second two treatments were microneedled at 0.3mm. The aim was to address residual pigmentation and support skin regeneration. By five and a half weeks, dryness and flaking had fully resolved, with only a slight degree of pigmentation still visible. At eight and a half weeks post incident, the patient presented with no scarring and complete resolution of hyperpigmentation, an outcome achieved through the combined benefits of HOCI and exosome therapy.
Optimising post-burn care This case highlights how early targeted intervention with a medically registered HOCI solution can positively influence the healing process in facial burns. The anti-inflammatory and antimicrobial properties of HYPO21 supported wound healing while helping to prevent the common complications of extreme pigmentation and scarring.
Figure 1: Patient before and seven days after treatment using HYPO21
Early intervention As medical aesthetics evolves, incorporating scientifically supported wound care products into post-procedure protocols will help practitioners deliver safer, more effective treatments with superior cosmetic results. Ultimately, the future of facial burn management lies in combining traditional medical care with innovative aesthetic solutions, ensuring patients recover with health intact and changes to appearance minimised. Dr Helen Whyte graduated with a Bachelor of Dental Surgery from the University of Wales College of Medicine in 2005. She practised as a general dentist for 15 years, developing a strong foundation in comprehensive patient care. Dr Whyte also co-founded The Aesthetic Treatment Rooms, where she focuses on cosmetic treatments with a special interest in botulinum toxin. Qual: BDS Dr Ambreen Ayaz is a consultant dermatologist and clinical director of dermatology at an NHS Trust in Greater Manchester. She also serves as the immunobiologics lead and audit lead within the department. Dr Ayaz has been practicing dermatology since 2013, with extensive experience in clinical dermatology, including skin surgery and the management of skin cancer. In addition to her clinical and leadership roles, she contributes to continuing professional development as a CPD reviewer for the Royal College of Physicians (RCP). Qual: FCPS MCPS MRCP SCE
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Periorbital Area Treatment Protocol
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Assessing and Managing Infraorbital Hollowing Nurse prescriber Alice Henshaw considers common patient concerns and treatment protocols surrounding the periorbital area A frequently reported concern in aesthetic practice is the perception of fatigue despite adequate rest and general wellbeing.1 While this complaint is subjective, it is consistently associated with structural and qualitative changes in the infraorbital region.2 Discrepancy between perceived internal state and external appearance can have a measurable psychosocial impact, underscoring the importance of accurate diagnosis and appropriate treatment planning.3 This article outlines a framework for evaluating infraorbital hollowing and related presentations, with emphasis placed on accurately differentiating underlying aetiologies and appropriately aligning treatment modalities – specifically hyaluronic acid (HA) fillers and polynucleotides (PNs).
Defining the under-eye area The periorbital skin is the thinnest in the body, with a high-frequency ultrasound study published in the Journal of Clinical Medicine reporting thicknesses of approximately 0.5mm, compared to around 2mm elsewhere on the face.4 Beneath this thin skin lies a layered structure comprising a dense vascular network, the orbicularis oculi muscle, discrete fat compartments and the bony orbital rim.4 In youth, these structures exist in balance, producing a smooth lid-cheek junction and effectively concealing underlying vasculature.5 Ageing disrupts this equilibrium through multiple mechanisms.5 Fat compartments undergo atrophy and descent, while progressive bony resorption enlarges the orbital aperture, as demonstrated in a review in Aesthetic Plastic Surgery, which identified significant changes particularly in the superomedial and inferolateral orbital rim.6 Concurrently, collagen degradation leads to further dermal thinning, and ligamentous structures become more apparent as surrounding tissue volume diminishes.6 Clinically, these combined changes manifest as infraorbital hollowing.7 Importantly, this is not a single entity but the visible outcome of multiple underlying processes, each requiring distinct diagnostic consideration and treatment planning.7
Patient indications Patients presenting with infraorbital hollowing typically range from their late 20s, where early volume loss and shadowing first become apparent, to over 60, where progressive skeletal remodelling and soft tissue descent contribute to deeper tear trough formation.8 Common presenting concerns include tired appearance, persistent shadowing and visible under-eye concavity that does not improve with sleep or hydration.9,10
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descent of mid-face tissues.13 Clinically, this presents as a persistent shadow independent of lighting, hydration or fatigue.14-18 Careful patient selection is essential. HA filler may be appropriate where volume deficiency is clearly defined and tissue quality is adequate.7 However, isolated tear trough correction without addressing mid-face support can increase the risk of contour irregularities or persistent shadowing.5,19 In many patients, lateral cheek augmentation provides indirect improvement by restoring structural support and reducing the appearance of infraorbital hollowing.5,19 Most patients demonstrate a combination of volume loss, skin thinning and age-related tissue change, therefore treatment planning should be individualised and approached conservatively.5 Sequential correction and optimisation of surrounding structures often produces more predictable and natural outcomes.20-22
Treatment modalities For the tear trough, there are two separate and commonly used treatment pathways – one is HA filler, and the other is PN treatment. These are distinct modalities rather than combined treatments. A 2025 review concluded that polydeoxyribonucleotide (PDRN) and PNs have shown significant potential in skin regeneration due to their capacity to stimulate cellular repair and tissue regeneration.23 Similarly, HA tear trough filler remains a well-established, minimally invasive treatment for infraorbital hollowing, demonstrating high patient satisfaction, effective volume correction and favourable safety profiles when performed appropriately.24 HA filler The ideal candidate for tear trough filler presents with well-defined structural hollowing, minimal infraorbital puffiness and sufficient skin thickness and elasticity.7,25 Adequate mid-face support is also important to ensure a smooth lid-cheek transition following treatment.7,25 Careful patient selection is essential, as outcomes are highly dependent on underlying anatomy.5 Contraindications include significant fat pad herniation, where additional volume may exacerbate convexity; markedly thin or crepey skin, which increases the risk of product visibility or surface irregularities; and a predisposition to oedema, given the hydrophilic nature of HA fillers.7,26,27 Patients seeking correction of pigmentation or fine lines – primarily skin quality concerns – are also unlikely to benefit from volumisation alone.9,28 A cannula-based technique is commonly preferred for tear trough treatment to reduce vascular risk and minimise bruising.29,30 Most practitioners use a 25-27G cannula; 25G is favoured for firmer HA fillers and deeper control, while 27G suits softer products and delicate tissue planes. Conservative dosing is essential, following the principle that ‘less is more.’29,30 Typical total volume is 0.2-0.5ml per side, per session, delivered in microdeposits of 0.01-0.05ml. Many clinicians intentionally under-correct initially (approximately 70-80%) because of swelling and delayed fluid shifts, with reassessment recommended after two to four weeks, before further treatment.31,32
Structural volume loss
Product selection is critical in tear trough treatment, with low-viscosity, low-hydrophilicity, cohesive fillers preferred to minimise oedema and contour irregularities in thin periocular tissue.32 Commonly used products include Juvéderm Volbella for subtle correction and reduced swelling risk, Restylane Eyelight for balanced tissue integration with low puffiness risk and Teosyal PureSense Redensity 2, which combines soft HA rheology with skin quality support. These are generally preferred over higher G’ volumising fillers in the periorbital region.32
True tear trough deformity is characterised by a concavity extending inferolaterally from the medial canthus.13 It develops through a combination of deep fat compartment loss, orbital rim resorption and
Risk management relies on anatomical precision, deep supraperiosteal cannula placement, slow micro-aliquot delivery and conservative dosing.31,32 Potential complications include the
Baseline assessment should include clinical examination, photography, standardised assessment tools such as the tear trough I-III classification scale and evaluation of mid-face support and skin quality.11,12
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Tyndall effect, persistent oedema, asymmetry, lumpiness and, more rarely, vascular compromise involving vessels such as the infraorbital artery.31,32 For patients with persistent tear trough hollowing after optimising skin quality, conservative filler correction may be considered.31 Filler should be placed in a plane deep to the orbicularis oculi in the pre-periosteal/supraperiosteal plane using a cannula, with small lateral-to-medial micro-aliquots (≤0.1ml per pass), while avoiding infraorbital and canthal danger zones to reduce vascular risk, oedema and contour irregularities.29,31 Polynucleotides and polydeoxyribonucleotide PNs and PDRN are DNA-derived biostimulatory agents, commonly sourced from salmon, that promote tissue regeneration when injected intradermally.33,34 PDRN consists of shorter DNA fragments with primarily anti-inflammatory and wound-healing effects, while PNs form a hydrating dermal scaffold that promotes longer-term biostimulation.33-35 In UK practice, PNs are commonly used for under-eye skin quality and support, whereas PDRN is associated more with tissue repair.33,34 Evidence suggests PDRN stimulates collagen synthesis in a dose-dependent manner.33,34 In the periorbital region, PNs may increase dermal thickness, reduce vascular show-through and improve infraorbital darkness, texture and skin resilience.33,34 For this region, these properties are particularly advantageous. PNs can increase dermal thickness, thereby reducing vascular show-through and improving infraorbital darkness associated with skin translucency.33 They also enhance texture and resilience, providing a more stable foundation for subsequent treatments where indicated.34
Periorbital Area Treatment Protocol
Spotting common clinical errors Several recurring issues are observed in patients presenting for corrective treatment. Overfilling The under-eye area requires very small amounts of filler, typically 0.3-0.5ml per side, and often less in patients with mild hollowing, thin translucent skin, pre-existing oedema or adequate mid-face support.7 Excess HA filler can create swelling, heaviness, puffiness and bluish Tyndall discolouration, often mistaken for under-eye bags.7 Management involves conservative hyaluronidase correction, lymphatic support and avoiding further filler until swelling resolves and the underlying anatomy is reassessed.38 Wrong product Using fillers designed for the cheeks or lips in the tear trough can cause complications because these products are often too firm, volumising and hydrophilic for the thin under-eye skin.29 This may lead to ridging, persistent oedema and bluish Tyndall discolouration.7 High G’ fillers, which are more highly cross-linked, provide structural support in areas like the mid-face but can overwhelm delicate periorbital tissues.22 Softer, lower cross-linked fillers integrate more naturally and reduce the risk of swelling and contour irregularities.22 It’s important to note that, for many years, Teosyal Redensity 2 was the only HA filler widely recognised and specifically licensed for use in the tear trough area in the UK.39 More recently in 2022, Juvéderm Volbella’s indications were expanded to include the infraorbital region.40 No follow-up plan
PN periocular protocols typically utilise 30-32G needles for intradermal microdroplet placement, delivered into the superficial to mid-dermis using serial puncture or grid-based techniques, as described in product monographs and clinical injection protocols.36
Tear trough filler requires ongoing assessment, maintenance and sometimes adjustment. Patients who have filler placed once and then never return for review are the ones most likely to end up with accumulated product that gradually makes the area worse over time.
In aesthetic practice, PNs are also used as a skin-conditioning or preparatory treatment prior to HA filler, with the aim of improving dermal quality, tissue integration and aesthetic predictability in thin periorbital tissue planes.37
Ignoring the mid-face
Clinically, a course of two to four sessions at three- to four-week intervals is typically recommended. Outcomes are gradual, with cumulative improvements in skin quality rather than immediate volumetric change.35 In practice, PNs are increasingly used as a first-line or preparatory treatment, allowing for reassessment prior to considering adjunctive interventions such as dermal filler, which may then integrate more predictably and naturally.35 Commonly used products include Ameela, Rejuran and Plinest.
Mid-face support should be considered when there is malar flattening, loss of cheek projection, deepening nasolabial folds or increased lid–cheek junction shadowing, indicating that tear trough hollowing is structurally secondary rather than isolated.29
Contraindications for both PNs and PDRN include active infection or inflammation at the treatment site, known hypersensitivity to components and uncontrolled systemic illness or autoimmune disease flare, where immune modulation may be unpredictable.22 Caution is also advised in pregnancy, lactation and patients with a history of poor wound healing or keloid tendency, where clinical response and safety data are limited.22 For most patients, protocol is to start with PNs. This addresses skin thinning, improves hydration and microcirculation and gives the practitioner a better baseline from which to assess what structural correction, if any, is still needed. After completing a course of PNs, the patient is invited back to clinic for a thorough reassessment. For patients who still have a meaningful tear trough after skin quality has been optimised, practitioners should then consider tear trough filler, placed conservatively, deep to the muscle, using a cannula. Because the skin above is now thicker and healthier, the filler integrates more naturally and the risk of visible irregularities is lower.
Volume loss in the mid-face directly contributes to the appearance of the tear trough – the tissue above has descended, deepening the groove below.5
Overtreating the tear trough without addressing this can lead to puffiness, lymphatic oedema and unnatural contouring, whereas restoring mid-face volume first provides more stable and anatomically balanced correction.25
Addressing infraorbital hollowing The perception of fatigue in the absence of systemic causes is frequently rooted in infraorbital anatomical and physiological changes. Effective management depends on accurate diagnosis, differentiation of underlying factors and selection of appropriate interventions. Alice Henshaw is a registered nurse prescriber in the UK, Australia and New Zealand, founder and medical director of Harley Street Injectables and a key opinion leader for Allergan Aesthetics, an AbbVie company. Henshaw holds aesthetic training, including Level 7 qualification in injectables from Harley Academy, and a background in clinical nursing studies completed at Auckland University, New Zealand. Qual: RN, NMP
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Advertorial Sculptra Body
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Regeneration Evolved: Extending Sculptra from Face to Body Harnessing Sculptra body to address skin quality concerns beyond the face Sculptra is made with the unique PLLA-SCA™, its proprietary form of poly-L-lactic acid (PLLA).1,2,3 Slow degradation of Sculptra’s PLLA-SCA™ provides continuous regenerative biostimulation, characterised by early onset of tissue response, for more than two years.4-8 With the launch of Sculptra Body indications in the UK and Ireland, practitioners can now apply the same regenerative principles to key body areas, supporting patients who present with skin quality concerns beyond the face.
Clinical rationale Commonly affected regions may include:9 · Gluteal area · Upper arms · Posterior thighs · Décolletage
· Primary indication: Skin quality
changes (texture, firmness, cellulite appearance) rather than large‑scale volumetric augmentation · Expectation management: Emphasis on gradual onset, a series of treatments and long‑term remodelling rather than immediate, dramatic change · Treatment course: Clear explanation of the likely need for multiple sessions, spaced several weeks apart For areas such as the upper arms and décolletage, which are particularly popular in his clinic, Dr Salimi emphasises the importance of a comprehensive consultation. “This includes assessing the patient’s general health, discussing whether they are premenopausal or postmenopausal, and carefully evaluating expectations and treatment goals,” he says. He believes that time spent building rapport is central to success. “In my opinion, spending time understanding the patient and building rapport is one of the most important parts of the consultation process. Proper patient understanding and expectation management account for a large proportion of treatment success,” he adds.
Article sponsored by GALDERMA
Treatment approach for body areas
In Dr Sina Salimi’s clinic, the typical Sculptra body patient is over 40 and generally health conscious. “These patients are usually healthy, fit and active individuals who are looking to improve skin texture and firmness in areas such as the upper arms, buttocks and décolletage,” he explains.
While exact protocols will vary between clinicians and patient presentations, several common principles can guide Sculptra use in body indications. “I always explain clearly that Sculptra body treatment is a course of treatment rather than a single‑session procedure,” says Dr Salimi. “Patients need to commit to the process in order to achieve optimal outcomes.”
He notes that gluteal cellulite and upper arm crepiness are especially frequent concerns. “One of the most common issues is cellulite appearance in the gluteal area, as well as crepey skin and laxity in the upper arms,” he says. “Décolletage rejuvenation is also highly requested, particularly by patients aged over 40, who feel that the neck and chest area no longer match the youthful appearance of their face,” adds Dr Salimi.
Patient selection and consultation Appropriate patient selection is central to successful outcomes with Sculptra body. Key selection and consultation considerations include: 48
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Safety and practical considerations “Important considerations include general health assessment, allergies to lidocaine or PLLA components, and screening for body dysmorphic disorder or unrealistic expectations,” says Dr Salimi. From a technical perspective, he stresses the importance of protocol adherence. “Practitioners must respect the treatment protocol and avoid overtreatment. Proper spacing between sessions – ideally four to six weeks – is very important.”
Integrating Sculptra body into practice For clinicians new to Sculptra body, Dr Salimi highlights three priorities. “My first and most important advice is correct patient selection,” he says. “Practitioners should spend enough time understanding the patient, their concerns and their expectations.” He also emphasises the need for clear communication. “It is essential that patients understand they are committing to a course of treatment rather than expecting results after a single session.” His final recommendation is to integrate Sculptra within a broader toolkit. “My second piece of advice is to combine Sculptra body treatments with other energy‑based modalities available within the clinic when appropriate,” he explains. “Combination approaches can significantly enhance patient satisfaction and overall results.” He encourages practitioners to document their cases carefully, build before‑and‑after portfolios and gradually develop their Sculptra body practice through experience and patient education. This advertorial was written and supplied by Galderma.
His standard protocol typically includes:
· A minimum of two treatment sessions · Up to four sessions depending on indication and severity
· Intervals of four to six weeks between
To learn more about incorporating Sculptra for face and body into your practice, speak to your local Galderma representative. UKI-SCU-2600100 DOP May 2026
sessions, with a preference for six weeks
Outcomes and follow up “The most consistent improvement I see is in skin quality,” comments Dr Salimi. “Almost all patients notice improvements in skin texture, quality and overall appearance, and this is often the outcome patients are happiest with.” He finds that décolletage and upper arms are particularly rewarding indications when patient selection and indication are correct. Aesthetics | June 2026
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Clinical Papers Abstracts
A summary of the latest clinical studies Title: A Comprehensive Evaluation of Patient Satisfaction and Clinical Outcomes in Poly-L-Lactic Acid Treatments-A Randomized, Interventional, and Comparative Clinical Study
Title: PLLA and PDLLA Fillers: Linking Crystallinity and Mechanical Stability to Aggregation, Redispersion, and Collagen Formation
Authors: Victor R M Munoz-Lora, et al.
Published: IN VIVO, May 2026
Published: Journal of Cosmetic Dermatology, May 2026 Keywords: Facial anatomy, Poly-L-lactic-acid, Ultrasound To evaluate the impact of PLLA formulation and injection depth (subcutaneous vs. supraperiosteal) using objective and subjective assessments. This randomized clinical trial with split-face and parallel components included 20 participants. Each participant received a single PLLA formulation of PLLA-SCA (Sculptra) or PLLA-ELL (Elleva), while the injection plane was alternated between hemifaces. Dermal thickness was assessed using ultrasonography at baseline, 60, and 120 days. Patient satisfaction was evaluated using the Global Aesthetic Improvement Scale (GAIS). Dermal thickness increased over time but showed no significant differences between products (p = 0.78) or injection planes (p = 0.83). GAIS scores were positive at 60 days but declined significantly at 120 days (p = 0.031), particularly for PLLA-ELL (p = 0.022). No significant correlation was found between dermal thickness and GAIS scores at 60 (ρ = -0.038, p = 0.819) or 120 days (ρ = 0.016, p = 0.927). Injection depth did not significantly influence PLLA outcomes. However, differences in patient satisfaction between PLLA formulations highlight the role of physicochemical properties in treatment longevity. These findings emphasized the need to integrate objective and subjective measures in assessing bio-stimulatory treatments.
Authors: Jinyoung Jang, et al. Keywords: Poly-D,L-lactic acid, Poly-L-lactic acid, Aggregation Poly lactic acid/sodium hyaluronate composite fillers were analyzed by scanning electron microscopy, nuclear magnetic resonance, differential scanning calorimetry, and micro-compression. Dispersion-aggregation-redispersion in saline was quantified over 3 days by optical microscopy with circularity-based analysis. In SKH mice, 100 μl filler was injected subcutaneously. Projection volume was measured at baseline (day 0) and at 2, 4, 8, and 12 weeks post-injection using phase-shift rapid in vivo measurement of skin (PRIMOS). Tissue response was observed at the same time points using hematoxylin and eosin, Masson’s trichrome, and macrophage immunofluorescence. PLLA crystallinity and mechanical robustness support re-dispersibility and more homogeneous collagen remodeling, whereas PDLLA aggregation is linked to heightened inflammation and reduced collagen deposition. Collectively, these findings suggest that maintaining microsphere integrity and dispersion is a key, actionable determinant of more uniform biostimulatory outcomes in PLA-based fillers. Title: Proportion of Adverse Events of Injectable Collagen Biostimulators After Facial Aesthetic Treatment: A Systematic Review Protocol Authors: Lia Rosana Honnef, et al.
Title: Combined Ultrasound and Power-Assisted Liposuction Improves Outcomes in Lipedema: A Retrospective Study Authors: Agostino Bruno, et al. Published: Aesthetic Plastic Surgery, May 2026 Keywords: Lipedema, Power-assisted liposuction, Ultrasound-assisted liposuction Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat deposition, primarily in the lower extremities, leading to pain, functional impairment, and reduced quality of life. While Power-Assisted Liposuction (PAL) is the standard surgical approach, the integration of Ultrasound-Assisted Liposuction (UAL) with PAL has been proposed to enhance fat removal and improve patient outcomes. To compare the clinical efficacy, postoperative outcomes, and complication rates of PAL alone versus UAL + PAL in patients with Stage II and III lipedema. A retrospective cohort study was conducted on 60 female patients diagnosed with lipedema (Stage II and III). 30 patients underwent PAL alone, while 30 received UAL followed by PAL. Primary outcomes included the volume of fat aspirated, circumferential reduction, and postoperative pain, measured at multiple time points over a 12-month follow-up. Secondary outcomes assessed patient satisfaction, time to return to daily activities, and complication rates. UAL + PAL offers significant advantages over PAL alone in the surgical management of lipedema, providing superior fat removal, reduced postoperative pain, faster recovery, and improved patient satisfaction.
Published: Journal of Clinical Medicine, May 2026 Keywords: Collagen biostimulator, Complications, Systematic review With the increasing demand for non-surgical facial rejuvenation, injectable collagen biostimulators such as poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), polycaprolactone (PCL), poly-D,L-lactic acid (PDLLA) and powdered polydioxanone (PPDO) have become widely used by facial aesthetic practitioners. This study aims to synthesize current evidence on the proportion of adverse events linked to injectable collagen biostimulators. The systematic review will include clinical studies involving adults undergoing facial aesthetic procedures with PLLA, PDLLA, CaHA, PCL and PPDO that report adverse events during or after treatment. The search will be conducted in six main databases: CENTRAL, EMBASE, LILACS, PubMed, SCOPUS and Web of Science. No restrictions will be applied regarding language or publication date. The screening process will occur in two phases: first, two independent reviewers will assess titles and abstracts against the eligibility criteria; second, the same reviewers will conduct full-text evaluations. Data will be synthesized narratively, with a meta-analysis of proportions performed if appropriate. Additionally, sample characteristics, treatment protocols, study design and main findings will be reported. The risk of bias will be assessed independently by two reviewers using appropriate tools, based on the study design, with the support of artificial intelligence. PROSPERO registration number: CRD420251062785.
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Consultation Patient Retention
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Driving Retention Through Structured Consultations Dr Alison Colville explores how a structured, four-phase consultation approach can improve patient outcomes and long-term retention The medical aesthetics landscape has shifted rapidly, with non-surgical treatments now dominating global demand.1 Almost 38 million aesthetic procedures were performed worldwide in 2024, with non-surgical treatments accounting for 20.5 million of those, a 42.5% increase on 2020 figures.¹ At the same time, patients increasingly arrive influenced, and often misinformed, by social media, where unrealistic outcomes and simplified messaging shape expectations and drive dissatisfaction.2,3 A structured, consultation-led approach – focused on clarity, trust and achievable results – not only improves clinical outcomes but also strengthens patient loyalty and long-term engagement.4
Understanding the modern aesthetic patient Patients presenting for aesthetic treatment rarely articulate their concerns in anatomically precise terms. Instead, they describe generalised perceptions, such as looking tired, feeling heavy, or appearing older than they feel. These subjective complaints typically reflect underlying structural and physiological changes, including volume loss, fat pad descent, dermal thinning and skeletal remodelling, rather than isolated superficial issues.5 What makes the modern aesthetic patient particularly complex is the breadth of motivations driving their decision to seek treatment. A prospective multicentre study of 511 patients found that motivations extended well beyond aesthetic appearance. The study found that 67.2% sought procedures to improve psychological wellbeing and quality of life, 61.3% wanted to treat themselves and 54.8% were motivated by professional appearance.6 In 90% of cases, the decision was internally generated rather than driven by external pressure. Yet these same patients are simultaneously shaped by social media content that showcases curated results, omits recovery expectations and creates a growing gap between what patients believe is achievable and what is clinically deliverable.2 50
The result is a frequent mismatch between patient perception, underlying pathology and optimal treatment strategy. The practitioner’s role, therefore, extends well beyond technical delivery. It encompasses interpretation, education and the careful management of expectations rooted in clinical reality.
Common consultation errors Despite increasing awareness of patient-centred care, several recurring pitfalls continue to undermine both patient outcomes and long-term practitioner success. Patient-led treatment planning When consultations allow patients to direct treatment choices based on social media trends or peer influence, the result is frequently suboptimal. While patient autonomy is essential, clinical responsibility requires the practitioner to guide decisions based on anatomical assessment and physiological reasoning. Data in medical aesthetics emphasises that practitioner-guided care, rooted in clinical evidence, leads to safer and more effective outcomes.7 Patient autonomy is essential, but it should operate within a clinically guided framework. In practice, this means the patient chooses from treatments the practitioner has recommended based on clinical expertise and evidence, rather than arriving requesting a specific treatment by name. Redirect patients from treatment-led statements to concern-led ones; if a patient says ‘I think I need filler here,’ gently respond with ‘Tell me what’s been bothering you.’ This allows the practitioner to address the root cause rather than the perceived solution.7 Starting with low-impact treatments A common approach is to begin cautiously with lower-impact interventions such as skincare, microneedling or regenerative therapies. While these have clear evidence-based value, initiating them when the concern will not be adequately addressed risks delivering minimal visible improvement and thus, impacting trust. Treating a structural tear trough hollow with polynucleotides, for example, is unlikely to lead to satisfaction. Aesthetics | June 2026
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Beginning cautiously is often driven by patient fear rooted in misinformation, commonly fear of dermal filler, or neuromodulator treatments. An honest conversation dispelling misinformation and explaining why a different approach is more likely to deliver results will always produce a better outcome.⁴ Effective communication and perceived treatment efficacy are both strongly correlated with patient satisfaction and continued engagement.4 When early results fail to address the core concern, the trust required for longer treatment journeys is difficult to build. Overwhelming the patient Presenting multiple treatment options or a comprehensive long-term plan at an initial consultation triggers choice overload, reducing decision-making confidence and engagement.8 Limiting the initial recommendation to one or two clearly reasoned treatments consistently produces stronger uptake and better patient experience. A useful approach is, “Based on what you’ve told me, I’d suggest we start with X, and then review your results before moving onto your other concerns, here’s why.” Informing without directing A consultation that provides thorough information but no confident clinical recommendation leaves patients without a clear path forward. Patients come seeking clinical guidance, and providing it is both an ethical responsibility and a practical necessity for long-term retention. It is possible to educate a patient thoroughly and still leave them without a clear path forward. Providing a clear recommended plan is not a commercial act, but the correct clinical response, leaving the patient with the autonomy and education to make their own informed decision.⁹ Research confirms that high-trust patients showed adherence rates of 43.1% compared to 17.5% in low-trust patients, and were five times more likely to express complete satisfaction (Figure 1).⁹
A structured four-phase consultation model I apply a four-phase approach in my own practice, drawing on empathetic conversations, exploring concerns, educating individuals and treatment planning.
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Consultation Patient Retention informed investment. Value must always be established before budget is discussed. Equally, avoiding cost altogether can suggest a treatment is beyond their reach. The ideal approach is to introduce cost seamlessly after the clinical rationale has been established, stating the investment clearly without pressuring a commitment.¹³
Figure 1: The impact of physician-patient trust on adherence and satisfaction. High-trust patients showed adherence rates more than twice those of low-trust patients and were five times more likely to report complete satisfaction
Phase one is connection
Phase four is treatment planning
Empathic behaviour has been shown to positively influence trust and treatment adherence. Creating this foundation early is essential for open dialogue and long-term engagement.10
Finally, concerns should be clearly linked to cause and then to intervention. Presenting this as a logical clinical progression reinforces professional authority and removes any perception of commercial motivation. This aligns with standards required by the General Medical Council (GMC), the Nursing and Midwifery Council (NMC) and the General Dental Council (GDC), all of which require informed patients, collaborative decisions and evidence-based recommendations.¹²
The consultation should begin with unhurried conversation to establish rapport and psychological safety before patients articulate their concerns. Asking about home life, work and interests and finding common ground is a powerful trust-builder that signals you see the whole person.¹⁰ Phase two is exploration Invite your patient to identify and prioritise their concerns, often using a mirror. This ensures the consultation is anchored in the patient’s own perspective, avoiding assumptions and clarifying what matters most to them. Subsequently, summarising their concerns back to them offers a verbal cue that you’ve listened and understood. In the case of multiple or complex concerns, consider collaboratively prioritising the key issues that will have the most impact for them if addressed first. Phase three is education Explain the underlying mechanisms of the patient’s concerns and create a clear foundation for why your recommended solutions will work. I offer a take-home booklet that we talk through together including simplified facial anatomy, ageing physiology, skincare basics and a guide to each treatment we offer in clinic. When patients understand the physiological reasons behind what they see, they are more likely to trust the plan, commit to it and feel satisfied with the outcome. It also demonstrates that recommendations are clinically motivated, not commercial. Improving patient health literacy is consistently linked to better understanding, decision-making and satisfaction.¹¹
Ethical responsibility Practitioners have an ethical obligation to recommend treatments based on clinical need, rather than perceived patient preference, cost sensitivity or ease of discussion.¹² This includes setting realistic expectations, making clear that non-surgical treatments will not achieve surgical results, encouraging caution when viewing before-and-after images on social media, and asking whether patients would be satisfied with, for example, a “20-50% improvement rather than complete resolution.” For many regenerative treatments, meaningful improvement rather than elimination is the honest and realistic goal. Clear, transparent communication is central to this. This approach reduces pressure, encouraging deliberation and prioritising clinical honesty and increases patient confidence and commitment over time.
Financial framing and perceived value Cost discussions are frequently mishandled, either introduced too early or avoided altogether. Framing cost as an investment in outcomes, rather than a negotiation, leads to more constructive conversations and better alignment.13 Asking a patient their budget before they understand the value of a treatment will produce a misleading answer – they will name a figure based on comfort rather than Aesthetics | June 2026
Patients who see meaningful early improvement are more likely to continue treatment, whereas lower-cost interventions that fail to deliver visible change erode trust.¹⁴ Initial plans should remain focused, with one or two clearly explained interventions and a built-in review. Presenting full long-term costs too early can create unnecessary anxiety before the clinical rationale has been established.
Managing expectations Encouraging a cooling-off period reinforces patient autonomy and reduces any perception of commercial pressure. During this period, providing access to further information, recommended reading or an open invitation to ask questions demonstrates a non-pushy approach and strengthens trust. This is consistent with the GMC, NMC and GDC guidance, all of which frame consent as a process of ongoing communication rather than a single moment.¹⁵ Practitioners should avoid absolute claims and ensure patients understand that results vary depending on anatomy, skin quality and lifestyle. Language should emphasise improvement over perfection and progress over immediate transformation.¹⁶
Enhancing patient retention In medical aesthetics, the consultation is not a preliminary step – it is a clinical intervention in its own right. By prioritising results, aligning treatments with underlying causes and communicating with transparency, clinics can improve both patient satisfaction and retention. Dr Alison Colville was this year’s ‘DermaFocus Award for Best Injectable Result’ Winner at The Aesthetics Awards. She is the founder of The Avery Clinic in Leamington Spa. With 10 years’ experience as a GP, and nine years in medical aesthetics, Dr Colville is a KOL, clinical advisor for the JCCP and the global research lead for Clinisept+. Qual: MBChB, MRCGP, LF(Hom), PGDipMedAes
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Clinical Governance High Performing Clinics
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Understanding the
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Where governance failures manifest Governance in aesthetic practice is often reduced to policies and checklists, rather than recognised as the infrastructure that makes clinical standards measurable, accountability visible and decision-making defensible – protecting patients, staff and the clinic’s reputation.
Importance of Strong Governance in Clinics Governance and compliance specialist Tracy Green explains why strong governance is the unseen driver of safe, profitable and high-performing aesthetic clinics Governance rarely feels urgent – until something goes wrong. In medical aesthetics, where much of the sector remains unregulated and patient expectations are high, many clinics underestimate the strategic value of robust governance systems.1 Poor organisational processes, unclear accountability and weak clinical documentation contribute to a significant proportion of complaints and litigation.2 Yet governance is still often viewed as administrative rather than fundamental to safe, ethical and sustainable care. This article explores the risks of weak systems and the behaviours of high-performing clinics, outlining practical steps to strengthen governance. It also defines how emerging regulation will make good governance not only a compliance requirement, but a powerful differentiator.3
Real world repercussions Medico-legal analyses repeatedly highlight that many claims arise not just from clinical outcomes, but from inadequate consent, procedural errors and poor documentation – all governance issues.4 Defence organisations similarly report that weak records can severely undermine a clinician’s ability to demonstrate safe decision-making, continuity of care and informed consent.5 Unlike clinical complications, governance failures are often invisible – until the consequences become impossible to ignore. Clinics can lose income through disrupted services, expenditure on urgent legal or consultancy support, and absorbing the costs of refunds, compensation and re-treatments. Staff become demoralised or anxious about safety and oversight, making recruitment and retention harder. Governance gaps also make clinics less attractive to insurers, investors and buyers. Insurers may increase premiums or restrict cover; buyers and lenders may reduce valuations or walk away when they cannot see clear systems, records and accountability. Even without a single big incident, weak governance quietly limits growth, partnership opportunities and long-term sustainability. For clinics pursuing Care Quality Commission (CQC) registration, weak governance remains one of the primary barriers to achieving compliance.6 It becomes a barrier because it prevents clinics from evidencing the core controls CQC needs to see, which are leadership, oversight, risk management, assurance, learning and sustained compliance. When governance is strong, registration becomes a structured process. When it is weak, the clinic is left trying to catch up across multiple areas at once – often under time pressure and with limited evidence to demonstrate readiness. 52
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Governance failures often manifest in a variety of ways from poor documentation to unclear policies, weak leadership and inconsistent practices. Poor documentation Incomplete consent forms, missing batch numbers, inconsistent clinical notes and failure to record complications can expose clinics to avoidable legal and regulatory risk. Documentation remains one of the most cited weaknesses in CQC inspection reports and specialty audits.7 However, this is an issue that is easily combatted, as seen in high-performing clinics. Batch numbers, doses, treatment rationales, photographs, aftercare and complication management plans are always documented to a defensible standard. To follow in the steps of high preforming clinics, a strong audit programme is essential – which usually includes clinical audits such as long-term condition management, infection control and medicines management, as well as operational/quality audits such as complaints handling, recruitment files and patient records. Policy review calendars are also a massive asset which can be utlised as they cover clinical policies, workforce and HR policies, governance and quality policies and operational safety policies.
“Governance gaps make clinics less attractive to insurers, investors and buyers. Insurers may increase premiums or restrict cover” Unclear or outdated policies Many aesthetic clinics are running on ‘off-the-shelf policies’ that bear little resemblance to how they actually operate. This isn’t just an inspection risk; it’s a patient safety risk. A consistent theme across CQC inspection reports is the gap between what’s documented and what’s done – policies on paper that aren’t embedded in practice. When staff are uncertain about escalation pathways, infection prevention expectations, treatment protocols or how to report an incident, avoidable errors follow. The clinics that perform well and demonstrate that performance to regulators maintain policies that are live, clinic-specific and aligned to current legislation and professional standards. A robust clinic policy should be clearly tailored to the individual service and setting, not read like a generic template. Each document needs clinic specific identifiers, such as a named lead for every policy area, site specific escalation contacts, the exact locations of emergency drugs and details of the nearest accident
Aesthetics | June 2026
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Clinical Governance High Performing Clinics
Myth
Reality
“Governance is only needed for CQC regulated services.”
All aesthetic clinics benefit from strong governance, and insurers increasingly expect it.
“It’s just paperwork.”
Governance is an active process that prevents harm, improves efficiency and protects reputation.
“Small clinics don’t need formal systems.”
Size does not reduce risk – solo practitioners are often more exposed.
“Good governance slows the business down.”
It speeds up decision-making and increases efficiency.
“Policies alone equal good governance.”
Without implementation, training and audit, policies have no value.
Table 1: Governance myths vs. reality
and emergency department. It must also contain treatment specific content, as filler complications protocol is not the same as a laser safety protocol – each section should accurately reflect the procedures that are actually offered.
There is no single CQC document that prescribes this specific list of named leads for aesthetic clinics; this is synthesised from the combined requirements across multiple regulations from the CQC.
Policies should be explicitly anchored in regulation, with clear reference to the CQC Fundamental Standards, relevant Joint Council for Cosmetic Practitioners and Health Education England frameworks, and where applicable, guidance from the appropriate Royal College or professional body. They should define roles in staff referenced sections – who does what, under which qualification and within what scope of practice, rather than relying on vague phrases such as “the practitioner.”
CQC Mythbuster 64 on governance arrangements states that governance should be led by senior members of the practice who understand their responsibilities and are accountable for practice performance.8 Whilst this refers to GP practices, the arrangements will remain across and health and care provider.
Every policy needs live version control, including a review date, version number and named reviewer; anything undated or unsigned immediately looks unmanaged. Consent and assessment processes must be integrated so that the policy points directly to the real consent forms and pre treatment assessment tools in use, not generic or theoretical templates. Escalation and safeguarding routes should be specific to the clinic’s geography and provider network, not just national helpline numbers copied in at the end. Inconsistent clinical practice Variation in procedural techniques, the management of complications, infection prevention practices and follow-up arrangements can lead to an inconsistent patient experience and increase clinical risk. To ensure safe, high-quality aesthetic care, services should implement standardised protocols and consistently applied pathways for delivery, escalation and aftercare. A two-cycle audit, which is a quality improvement process where you measure current practice against an agreed standard, make changes based on the findings, should also be implemented. This can demonstrate measurable improvement and should cover; complications, record keeping, infection control, consent and medicines alongside management. Weak leadership accountability To demonstrate compliance across the CQC’s five key questions which asses if the clinic is safe, caring, responsive, effective and well led – in particular for safe and well-led – the following named leads are recommended as minimum good practice.
· Registered manager
(or governance accountable lead) · Clinical lead/medical director · Safeguarding lead · IPC lead
· · · · ·
Medicines lead (if applicable) Governance/quality lead Health and safety lead IG/data protection lead Complaints lead
Consistent with CQC inspection findings under Regulation 13, published guidance for aesthetic clinics specifically flags the absence of a designated safeguarding lead as a common compliance issue. It also identifies a lack of staff trained to recognise signs of abuse or unclear reporting procedures as frequent inspection failures.9 Documentation toolkits for aesthetic clinics recommend that safeguarding policies include a designated lead, local safeguarding board contacts and reporting procedures – and that core policies specify designated leads at each site.10 Good practice guidance recommends appointing both a registered manager and a nominated individual (for organisations), along with documentation covering safeguarding, medicines management, infection control, consent and complaints.10
Future-ready clinics are governance-led Governance is not the ‘hidden admin’ of aesthetic practice – it is the foundation of safe, ethical and high-performing clinics. Governance in aesthetic clinics matters now more than ever because the sector is growing fast, expectations are rising and the risks are higher – clinically, legally, reputationally and commercially. Patients are more informed, regulators are sharpening their focus, and one safety incident, complaint, poor consent process or social media story can escalate quickly and damage trust overnight. Strong governance gives you control with clear standards, safer practice, consistent outcomes, compliant documentation, confident staff and evidence that you’re delivering high-quality care – not just great results. It also enables growth, supports team development and prepares clinics for the regulatory changes ahead.10 Tracy Green is a governance and compliance specialist supporting healthcare and aesthetic clinics to build safe, effective and inspection-ready services. She launched CQCFIT to help providers strengthen clinical governance, patient safety, policies, audits and evidence frameworks, ensuring confident regulatory assurance and sustainable growth.
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Aesthetics | June 2026
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Devices Regulatory Compliance
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Identifying and Avoiding Counterfeit Devices Aesthetic clinic founder Vanessa Brown-Ofoedu discusses the implications of counterfeit devices and how to avoid purchasing one The UK aesthetics sector is entering a critical phase of regulatory transition; however, this sector growth has significantly outpaced regulation. As a result, a fragmented landscape has emerged, creating not only clinical challenges but also commercial imbalance. Currently, aesthetic devices fall under broader UK medical device legislation, requiring compliance with UKCA or CE marking and registration with the Medicines and Healthcare products Regulatory Agency (MHRA). However, this framework is largely focused on manufacturers and market entry, rather than how devices are distributed, marketed or resold within the aesthetics sector.1 As a result, gaps remain at the clinic procurement level, particularly where devices are sourced through informal or unauthorised channels. From a device perspective, inconsistencies within regulation also creates an environment where counterfeit and non-compliant technologies can easily enter the market. Where oversight is focused primarily on practitioners rather than procurement and supply chains, responsibility shifts to clinics to verify authenticity and compliance. This article seeks to support aesthetic practitioners to audit their current devices and injectables for regulatory compliance, identify common red flags when approached by new suppliers, and implement a simple procurement checklist and documentation process.
How counterfeit products enter clinics Counterfeit products rarely enter clinics through clear illegitimate routes. Instead, they are often introduced through supply chains that appear credible at first glance. In practice, this can include suppliers using legitimate marketing images, clinical data or branding from recognised manufacturers to present their product as equivalent or identical, despite having no verifiable link to the original company.2 These include:
· Online marketplaces and social media platforms: These often
present as direct messages on Instagram or WhatsApp, offering discounted devices or consumables, sometimes accompanied by limited-time offers or claims of ‘exclusive stock.’ · Unauthorised distributors presenting as official suppliers: These suppliers may use branding, logos or documentation that closely resembles legitimate manufacturers, but cannot be verified through official distributor lists. In practice, clinics should cross-check suppliers against the manufacturer’s website, contact the manufacturer directly or request written confirmation of authorised distributor status before purchasing. · Grey market imports bypassing UK regulatory controls: Products may be genuine but sourced from outside authorised UK channels, often lacking clear import records, regulatory approval or consistent storage and handling standards. · Peer-to-peer resale between clinics: Devices or consumables may be sold second-hand between clinics without full-service history, documentation or traceability, increasing the risk of faults or non-compliance. Guidance from insurers highlights that products sourced through these routes often lack traceability, verified storage conditions and regulatory compliance, increasing both clinical and legal risk.2 54
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Warning signs Clinics can reduce the risk of counterfeit or unauthorised products by being aware of several common warning signs.
· Pricing significantly below market rate: While discounts
can occur, legitimate products are priced within a relatively consistent range due to regulatory, training and support costs. Significantly lower pricing may indicate counterfeit origin or unauthorised supply. · Lack of verifiable supplier credentials: Authorised suppliers should be traceable through manufacturer networks and able to provide formal company and regulatory details. If this cannot be confirmed, the risk of non-compliant sourcing increases. · Missing batch numbers or incomplete documentation: Traceability is essential for both patient safety and insurance. Without batch numbers or proper documentation, products cannot be tracked in the event of complications or recalls. · No access to manufacturer training or support: Genuine devices are supported by training, servicing and warranty provision. The absence of this support is often a sign that the product has not been supplied through an authorised channel. However, identifying risk is only one part of the solution. Clinics must also implement internal controls to prevent exposure in the first place.
Insurance, liability and documentation Where products are sourced from unauthorised suppliers, claims may be rejected or policies invalidated, leaving clinics financially exposed.2 In practice, this could mean a clinic being required to cover the full cost of corrective treatment, legal fees or compensation without insurer support. Rising complication rates are also influencing insurer behaviour. Clinics using unverified or non-compliant devices significantly increase their exposure to claims, and in some cases, cover may be invalidated entirely where appropriate due diligence has not been carried out. This is particularly relevant where a clinic cannot demonstrate that it followed recognised procurement and verification processes. Substandard devices and unsafe practices often result in complications, corrective treatments and reputational damage – ultimately impacting patient retention and lifetime value. For example, inconsistent treatment results or device malfunction may lead to repeat appointments, refunds or negative reviews, all of which carry both financial and reputational cost. These cases reinforce a key commercial reality: short-term cost savings from non-compliance often lead to long-term financial, legal and reputational loss. However, mitigating this risk is not solely about avoiding counterfeit products – it requires robust documentation and proactive engagement with insurers.
What clinics should check before buying Guidance from the MHRA states that all medical devices placed on the UK market must meet compliance standards, including UKCA or CE marking and MHRA registration.1 Clinics should verify: Device regulatory status This can be checked via MHRA guidance and, where applicable, by confirming UKCA or CE marking on the device and accompanying documentation. Clinics should also request confirmation that the device has been registered for the UK market and that a UK Responsible Person is in place where required. Authorised distributor relationships Clinics should cross-check suppliers against the manufacturer’s
Aesthetics | June 2026
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official distributor list, either via the company website or by contacting the manufacturer directly. Any discrepancies should be treated as a potential risk. Batch traceability and documentation
Devices Regulatory Compliance
A clinic introducing a new energy-based device should notify its insurer in advance, rather than assuming it is automatically covered under an existing policy. Failure to do so could result in gaps in cover if a claim arises.
Each product or device should be supplied with clear batch or serial numbers, invoices and instructions for use. Clinics should retain this documentation as part of their records to ensure traceability in the event of a complication, recall or insurance claim.
Guidance from Hamilton Fraser also highlights that insurers may request evidence such as purchase invoices, batch numbers and supplier details when assessing claims and that products sourced outside authorised channels may not be covered.
Training, servicing and warranty provision
The financial impact on clinics
Authorised purchases should include access to formal training, ongoing technical support and a documented warranty. Clinics should confirm what is included at the point of purchase, including servicing schedules and contact points for support. Practical controls to reduce counterfeit risk To reduce the likelihood of inadvertently purchasing counterfeit or non-compliant products, clinics should introduce structured procurement policies, including:
· Restricting purchasing authority to named staff with clearly
The financial implications of counterfeit devices extend far beyond any initial cost saving. In practice, complications can trigger a cascade of costs – from corrective treatments and product replacement to refunds, legal claims and increased insurance premiums.3 Clinics may also face loss of revenue through downtime, particularly if a device is seized, fails mid-treatment or prompts an investigation.4 Reputational damage can further reduce patient bookings, while chargebacks and complaints increase administrative burden.2
defined approval levels · Requiring multiple quotes for high-value device purchases to benchmark pricing · Prohibiting ordering via direct messages on social media or personal email accounts · Maintaining a verified ‘whitelist’ of approved suppliers, reviewed at least annually · Logging unsolicited offers, including screenshots of messages or advertisements for traceability In addition, clinics should adopt a clear internal rule: if the origin and authorisation of a product cannot be fully verified, it should not be purchased or used. Embedding these controls into day-to-day operations helps translate awareness into governance, reducing both clinical risk and commercial exposure.
There are also hidden compliance costs – working with non-compliant devices can invalidate insurance cover, expose clinics to regulatory action and, in some cases, lead to fines or enforced closure.3 Staff retraining and protocol reviews add further unplanned expense.
Essential documentation and audit trail
How manufacturers can support clinics
Clinics should maintain a clear documentation pack for each device or product used in practice. This should include:
Manufacturers play a key role in strengthening supply chain integrity.
Purchase invoice and proof of payment Supplier details, including company registration and UK address Device serial numbers and batch or lot numbers Copies of UKCA/CE certification or manufacturer declarations, where available · Training certificates for all clinicians using the device · Maintenance and servicing records · Incident and complication logs linked to the device or product If a device fault results in a patient complication, being able to link that incident to a specific serial number, supplier and servicing record allows the clinic to demonstrate due diligence and respond appropriately, in line with regulatory traceability requirements and insurer expectations.3,4
Best practice includes:
· · · ·
· · · ·
Proactive engagement with insurers In addition, clinics should take a proactive approach to their insurance arrangements. This includes scheduling regular reviews with their insurer to:
· Confirm that all devices and treatments are fully declared · Check whether any products, procedures or suppliers are excluded from cover
· Clarify what documentation and evidence would be required in the event of a claim
In practical terms:
· Always verify supplier legitimacy and device registration (e.g. UKCA marking)
· Keep batch numbers, invoices and audit trails for all devices · Avoid ‘grey market’ pricing that seems significantly below market rate
· Ensure your indemnity insurance explicitly covers the devices you use
Authorised distributor networks Product verification systems Clinical training and onboarding Adverse event reporting support
Verification programmes demonstrate how manufacturers can support clinics in maintaining authenticity and building patient trust.5
Looking ahead Regulation in aesthetics is no longer solely a clinical issue; it is a commercial imperative. For clinics, it defines procurement risk, liability and sustainability. For manufacturers, it shapes innovation, pricing and market positioning. Those who prioritise compliance, traceability and governance will be best positioned to succeed as the UK market continues to evolve.6 Vanessa Brown-Ofoedu is the founder of VL Aesthetics and host of The Late Late Aesthetics Show podcast. She is an entrepreneur and she is recognised for her work in patient safety, regulation and education, offering insights on specialty standards and the commercial realities shaping clinics across the UK and internationally. Qual: MAHons
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In The Life Of Dr Jessica Halliley
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In The Life Of: Dr Jessica Halliley Dr Jessica Halliley illustrates a typical day as a clinic owner alongside mentoring work and KOL duties A typical working day… My day starts with uniforms, packed lunches and the school run. With two children under 10, I am on the go from the moment I wake up and I don’t usually have breakfast. As soon as my children are ready to go, I race out the door to drop them off at school before I arrive at my clinic, Your Beauty Doctor in Nottingham, for 9am. My working day begins with preparing all the products I will be using throughout the day. At the same time, I also make sure to review all my patient forms and familiarise myself with who I’ll be seeing what treatments they’re booked for, and any relevant medical history or prior concerns I need to be mindful of. Within clinic, we take a full-face approach to aesthetics, focusing on overall balance and harmony rather than treating isolated areas. As a result, treatments such as Azzalure and Relfydess for botulinum toxin, Restylane for dermal fillers and Sculptra for biostimulation are among the most popular for my patients. From a personal perspective, I particularly enjoy administering dermal fillers because it requires a careful balance of precision and intuition, tailoring each treatment to enhance natural features while maintaining harmony and proportion.
Once everything is squared away, usually around 9pm, there is nothing I enjoy more than switching off with my guilty pleasure, The Real Housewives. Before heading to bed at 10pm, I also always make time to read a few pages of my book, as it has become a ritual that I have stuck to for years. At the moment, I am reading We All Live Here by Jojo Moyes.
Other work commitments… I am very passionate about education and am honoured to be a key opinion leader (KOL) for skincare brand ALASTIN – distributed by Galderma – alongside Ameela, Galderma, SkinPen and SuneKOS. These positions involve regular teaching days, where I travel across the UK delivering training events, teaching delegates how to use the different products in the portfolio, as well as attending specialty events in an educational capacity. This year I will be speaking at the Clinical Cosmetic Regenerative Congress (CCR) with Galderma where I will be delivering a talk on Restylane Kysse and skin boosters. Alongside these positions and my educating roles, I provide private mentoring for doctors, dentists and nurses looking to upskill their full-face filler results and improve multi-modality consultation conversions. In these sessions, I also cover business mentoring on how practitioners can grow their clinic, raise their specialty profile and increase their profits.
Most memorable day in your career… I cannot single out one most memorable day, but I do feel that I am currently in the most memorable period of my career. I’ve recently purchased my own premises in Nottingham, just around the corner from our current location. I am currently in the process of renovating it ready for my clinic to move into the new space.
A typical day in my clinic is very fast-paced, and as I tend to see around 15 patients back-to-back, I like to practise grounding myself to avoid feeling overwhelmed. To do this I have been prioritising breath work at various points throughout the day and particularly enjoy Rob Rhea’s tutorials. Lunch is often a casual affair for me, and I only have time for a quick 30 minute break before I jump back into the swing of the day. We do not have many food options close by, so I usually enjoy some home-cooked leftovers, typically a traybake or chicken and rice. I leave the clinic at around 6pm, although on days with later bookings I may finish closer to 8pm, before heading home to my family. My evenings are a balancing act between spending quality time with my children and catching up on admin once they are asleep. After we’ve shared dinner as a family and I’ve settled them, I’ll often return to emails to tie up any loose ends from the day. This can include preparing for upcoming training events, as I teach for the pharmaceutical company Galderma, and deliver training for injectable brands SuneKOS and Ameela, as well as host webinars for the microneedling device company SkinPen. I also use this time to develop presentations and teaching materials for my own independent training and private mentoring programmes.
This feels particularly monumental because I started my business in the spare room of my house. When I later moved into a rented premises, I remember signing the lease and thinking I was taking a huge risk. To be in a position where I am expanding and purchasing my own space feels like a significant achievement, and it genuinely gives me goosebumps when I reflect on how far I have come. At the new site, we are going to have a large space dedicated to teaching, so I can host more training sessions from my clinic. My advice for those who also dream of opening their own clinic one day is to be prepared to put the hours in, and accept that footfall can be slow at the start. Also remember to delegate, you cannot do it all!
If you could choose a career outside the medical field, what would it be? A journalist, as my undergraduate was supposed to be in French and Journalism, before I changed to Medicine. Best piece of advice you have ever received? Don’t compare yourself to others. Dream holiday destination? I would love to do a safari in South Africa.
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The Last Word Polynucleotides
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Are Polynucleotide Myths Affecting Compliance in Aesthetics? Clinical educator Rian Seo argues why ‘training room myths’ regarding leftover PNs can compromise sterility, ethical practice and regulatory compliance The UK aesthetics market is currently defined by a ‘regenerative gold rush,’ with recent specialty data indicating a 25% year-on-year surge in demand for biostimulatory treatments.¹ Polynucleotides (PNs) have moved from a niche South Korean import to a cornerstone of British clinical practice, largely due to a consumer shift away from ‘over-filled’ aesthetics toward cellular-level repair.² However, this rapid scaling has created a dangerous gap between commercial enthusiasm and clinical discipline. When attending clinical education sessions, I frequently hear the same piece of advice, “If you have product left in the syringe, don’t bin it; just microneedle it into the skin as an add-on.” It is often presented as sensible product stewardship. However, I believe this is a scientific fallacy that undermines the integrity of the treatment and blurs the line between evidence-based medicine and theatre. This article argues that for PNs to maintain their clinical credibility, we must dismantle the ‘training room myths’ that encourage off-label repurposing and instead pivot back to the rigorous safety and molecular standards defined by manufacturer’s Instructions for Use (IFU).³
Eroding scientific value From a formulation perspective, using high-density PN topically is an inefficient use of a medical-grade resource. The skin barrier is governed by the 500 Dalton rule, which dictates that molecules larger than 500 Da cannot meaningfully penetrate the stratum corneum.⁴ Most high-density PNs have a molecular weight of ≥ 1,500 kDa.⁵ These long-chain polymers are simply too large to bypass the epidermis, rendering the supposed ‘bonus’ treatment largely performative.⁶ The active biopolymer remains on the surface, delivering at best transient, superficial hydration while the patient is led to believe they are receiving a meaningful biological signalling intervention that, in this context, cannot occur.⁷ Moreover, these polymers are engineered for integration within the deep dermal layers, not for survival or efficacy within the acidified, enzyme-rich environment of the skin’s surface.6,7 To repurpose them as a topical ‘extra’ is not innovation; it is a misapplication that risks diluting both scientific rigour and patient trust.
Manufacturer responsibility and the UKCA mark When a trainer suggests microneedling leftover product, they are effectively encouraging practitioners to step outside established safety protocols, specifically Aseptic Non-Touch Technique (ANTT) and the mandates governing Single-Use Devices (SUD), for the sake of convenience and perceived value.8,9 PNs are typically registered as Class III medical devices in the UK, with a specific indication for intradermal injection.¹⁰ The moment a practitioner moves off-label by applying that product topically or via microneedling – particularly once the syringe 58
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has already been used for injection – they assume full legal and professional responsibility for that decision. This raises a critical ethical question regarding informed consent: I s this ‘add-on’ transparently presented as an off-label use? I believe it is likely that patients are not informed that the secondary application deviates from the manufacturer’s validated safety profile, nor are they warned of the increased risk of cross-contamination. Valid consent must be specific to the technique and the product’s intended use; without this transparency, the practitioner is not providing a ‘bonus,’ but is instead exposing the patient and their own indemnity to undocumented risk. Repurposing the remaining contents for a secondary procedure, even on the same patient, invites cutaneous flora into the product, which can then be driven back into the skin with each microneedle pass.11,12 This ‘secondary intention’ use significantly elevates the risk of biofilm formation, granuloma development and persistent inflammatory responses.¹¹ As we navigate the post-Brexit regulatory landscape, practitioners need to look beyond marketing narratives and focus on what is documented in the UKCA or CE mark.13,14 Manufacturer IFUs are not suggestions; they are the end point of clinical evaluation, stability testing and sterility validation, designed to demonstrate both safety and efficacy.13,14
Standardising excellence If practitioners want to move beyond theatrical outcomes and towards verifiable regeneration, we have to anchor claims in objective data. Advanced multispectral skin analysis now allows clinicians to quantify changes in dermal density, vascularity and texture, providing hard evidence of PN-driven biostimulation through validated skin scoring systems.¹⁵ The path forward requires a deliberate tightening of practice:
· IFU alignment: Training must align strictly with MHRA-registered
manufacturer guidance, mirroring the indications, techniques and treatment intervals set out in the IFU.¹⁶ · Aseptic integrity: Leftover product should be discarded as clinical waste, preserving the sterile chain and maintaining a defensible audit trail. · Advanced education: We must move away from informal training-room tips and instead embrace peer-reviewed injection protocols that optimise product placement, distribution and efficacy.6,17 · Critical evaluation: Practitioners should feel both equipped and obliged to challenge any teaching that contradicts basic barrier science, such as the 500 Dalton rule, or established sterility protocols.4
Safeguarding the regenerative future of aesthetics To preserve the integrity of regenerative medicine, we must draw a firm line between clinical innovation and regulatory negligence. Practitioners must immediately cease the ‘off-label’ topical application of leftover injectable PNs, while trainers must remove these unvalidated ‘tips’ from their curricula to prevent the further propagation of deviance. Instead, we must recommit to the gold standard, using high-density PNs strictly as intended by the manufacturer, via validated intradermal techniques, in a sterile environment, and with explicit patient consent that reflects the science, not the sales pitch. Rian Seo is a dual-qualified scientist with a bachelors in neuroscience and a masters in cosmetic science. A specialist in regenerative tissue science, he has served as an overseas sales and education manager and assistant manager within the medical aesthetics sector.
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Aesthetics | June 2026
Brand Directory Your guide to the unmissable companies at the Clinical Cosmetic Regenerative Congress (CCR) Key Key Sponsors
Medical Longevity Summit
Awards Finalist
InPractice
Explore the products at CCR 2026:
IBITA Korea Zone
#
3D Aesthetics
F
Fotona UK
A
Acclaro Corporation
G
Galderma (UK) Ltd
ACE Group World
GC Wellbeing
Acmedi Korea Co.,Ltd
Genefill UK
Acquisition Aesthetics ACRE Pharmacy Aesthetic Web
Hanun Medical
Alfa Medical
Harley Academy
Alma Lasers UK Ltd.
Hawksley & Sons
Amedica Group
HE Interiors
BEAUTYEUROPE.EU CO UK Ltd
HYPO21
Beautyform Medical I
BioHA Laboratory
InMode
BTL Aesthetics
IVANMED JJ Meditec
Caromed Italia srl ClearCourse Health
JY Medicine Co,. Ltd
Cliona Tech Ltd
K
Core Connect Accountants
Klira Pro
L
Lavderma Limited LW Aesthetic Solutions Ltd
Cosmetic Insure Cure Medical Limited
MAP Health Ltd Map My Mole
CURENEX
Med&Skin SRL
Cutera
Medicines & Healthcare products Regulatory Agency (MHRA)
Deleo Derma Institute
MedivaPharma
Dermapenworld
Million Dollar Facial
Dotolo Europe Ltd
My Compliance Clinic
Energist Ltd EQUILABO LONDON LTD EVIE KOREA Co., Ltd.
Skin on You Ltd Skinzo Ltd
Skymedic Sofwave Medical UK Limited Sons SOOVIA CARE LTD T
N
My Vital Metrics NEEDLE CONCEPT Ninaveli London Novus Medical UK
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The Cosmetic Consultants Toneko Ltd Totally Derma
TWIQK U
Uberlube
V
VF PHOTONIX UK LTD Vida Glow
Lynton Lasers Ltd M
Sciton, Inc.
Shire Leasing PLC
Interface Aesthetics
Joint Council Cosmetic Practitioners (JCCP)
EMA Aesthetics Ltd
Roseway Labs S
Share Swiss
British College of Aesthetic Medicine (BCAM)
Cosmetic Courses
E
RELIFE UK Renaissance
Initial Medical
Candela (U.K.) Ltd
D
Rein PRP
IBSA UK
J
REGEN LAB SA
Seriderm UK
iiaa
CTN
Quarter Latin R
Ibita (Korea-International Beauty Industry Trade Association)
British Association of Medical Aesthetic Nurses (BAMAN)
CACI International
QUAD UK
HYUNDAE MEDITECH CO., LTD.
BNV Biolab
C
PRP PURE LTD Q
Hydrafacial
Beautology Laser & IPL Services Ltd
Belle Health Ltd
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Human Health Professionals
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Pabau Phorest
Healthxchange
Amory London Ltd
One Planet Opatra
P
Halo Health Technologies Ltd - T/A Halo IV
Aerolase
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Nuchido O
GLANZEN H
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Z
Zemits UK Ltd Zenoti ZO Skin Health
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References: 1. Sculptra. IFU. 2. Widgerow A, et al. Poster presented at IMCAS World Congress. 01-03 February 2024. Paris, France. 3. Huth S, et al. J Drugs Dermatol. 2024 Apr 1;23(4):285-288. 4. Galderma. Date on File (MA-60875). 5. Zhang Y, et al. Regen Biomater 2021;8(5):rbab042.
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