The Consulting Room™ Industry Magazine Edition 117, February 2013

[COVER]

From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For February 2013 So what’s the hot topic again this month?.. Can you guess yet?...Regulation, Regulation, Regulation! With the Keogh Review happily moving along and meeting up with more industry stakeholders to discuss key topics such as dermal fillers and appropriate administrators thereof, it’s been another month of more legislative/regulatory related announcements. This month’s Legislation section is again packed with the report from the Royal College of Surgeons on Professional Standards for Cosmetic Practice aimed at all doctors, dentists and nurses involved in cosmetic practice, and the news that the UK Parliament is now debating a proposed Cosmetic Surgery (Minimum Standards) Bill with a view to a formal Act of Parliament, following due process. One to watch...

In this February issue of our Member Magazine our Feature Article delves into the hot topic of Regenerative Medicine and its applications.

Lorna Jackson

Our Latest News includes the acquisition of the VASER® Lipo brand by Solta Medical, the global company behind brands including Fraxel®, Thermage® and Liposonix®, making a body shaping giant! And our Food For Thought section details an interesting case study of a hyaluronic acid filler revision in the lips.

As always the magazine is packed with our Business Corner, New Product Reviews, Clinical Information, and Interesting News Articles and Blogs That You May Have Missed. Also, don’t miss 6 pages of classified adverts featuring a host of different aesthetic devices for sale in our Equipment Sales.

Action Taken Against Unsolicited Email Generated Through Consulting Room Systems We have become aware that some of our members were recently in receipt of some unsolicited e-mail from an individual or company wishing to engage in business negotiations with their clinic, such as selling products or devices or looking for employment. This was generated through our client referral system for the clinic listing(s) which you all have with us.

We would just like to let you know that we take the misuse of our online contact systems very seriously and have made every effort possible to avoid automatically generate spam. It is a much more difficult issue to stop individuals, sales reps etc. from using it as a sales contact tool. We do contact all those who misuse the system in this way and request that they cease and desist in the first instance. This is usually enough to prevent a repeat offence, although it does not of course guarantee that another person will not choose to do the same on a separate occasion, so you may receive more than one email of this nature. Should we encounter persistent offenders, we will take the matter in hand with legal measures.

We trust that this will put your mind at rest that we are aware of this unfortunate practice and do our best to reduce and eliminate it so that you only receive genuine client referrals from us. Should you have any questions or wish to highlight anything to us in relation to this matter, please feel free to email admin@consultingroom.com or telephone our offices on 01788 577254 during office hours (8am – 6pm, Mon-Fri) and our team will be happy to help.

Some Recent Blogs You May Have Missed Are women recently favouring a more masculine eyebrow?

by Patrick J. Treacy According to a newly published study, the arched brow is becoming a thing of the past. It appears analysers at the University of Southern California examined the brows of models and women in fashion magazines from 1946 onward and found an interesting trend: not only have eyebrows gotten progressively fuller, but the peak of them has moved further from the nose; in other words, women are taking on a more masculine look. www.consultingroom.com/blog/353

Are Dentists allowed to call themselves Doctors?

No, say the ASA.

By Lorna Jackson Dentists have long been accustomed to being able to call themselves by the title Dr. or Doctor, something which their own regulator permits; but the Advertising Standards Authority continues to chastise those who do so in advertising materials as they believe the title is misleading. www.consultingroom.com/blog/352

Optifit Bras Using 3-D Bra Measurement System Based on Plastic Surgery Principles

By Lorna Jackson An experienced NHS bra fitter who would cut and re-stitch together bras to properly support clients’ breasts is introducing a new and radically different bra design, utilising plastic surgeons’ own multi-dimensional, anatomical measurements for breast surgery. www.consultingroom.com/blog/351

Smilorexia: the Dangers of Cosmetic Dentistry Addiction

By Lily Sharpe Addiction to cosmetic surgery has been featured heavily in the news over the course of the last few years. However the majority of the media attention has been directed towards those who are addicted to having surgery to make their bodies look better, which has meant that cosmetic dentistry addiction has been widely underreported. www.consultingroom.com/blog/350

Children aren`t influenced by Cosmetic Surgery Advertisements so why a call for a ban?

Turf Wars!

By Dr. Mervyn Patterson Recently the British Association of Aesthetic Plastic Surgeons called for a ban on cosmetic surgery advertisements.

Banning the relatively small number of cosmetic adverts within this tsunami of perfect body imagery will not make the slightest difference. If on the other hand we accept the need to ban these ads - just what would we ban? www.consultingroom.com/blog/349

The Consulting Room™ 3rd Annual Golf Challenge Day Whether you're an amateur or experienced golfer join us to eat, drink, play, relax, network and play a round of golf. After the success of the last two Consulting Room Golf Days in 2011 and 2012 we are pleased to announce the th date for our 2013 tournament: 18 May 2013 at Old Thorns, Surrey.

We will be looking for clinics to enter a team of two and to compete for the Consulting Room Challenge Cup. If you can't find a partner, we'll aim to find one for you on the day, which will be a great opportunity to enjoy a round of golf - with a competitive edge, whilst networking with industry colleagues and friends. Spa options are available for non-golfing partners!

For more information and to reserve your place, please visit www.consultingroomgolf.co.uk

Looking For Best Prices on Toxins & Fillers? This Month’s Deals The Consulting Room™ Product & Price Comparison Charts for Dermal Fillers and Botulinum Toxins have been recently updated with some of the head line products highlighted below. Located in the Product Comparisons section (login required) within our Members Area you can compare the prices and bulk deals available through direct purchase from manufacturers/distributors or through the major third party wholesalers and pharmacies such as Wigmore Medical Ltd, Health XChange Pharmacy and Med-fx.

Prices ex.VAT Botox 100U / 50U Azzalure 2 x 125U (Twin pack) Azzalure 1 x 125U (Single) Xeomin 100U / Bocouture 50U

Restylane 1ml Juvéderm Ultra 2 (2 x0.55ml)

Wigmore Medical

Health XChange

Med-fx

N/A £100.00 4+ Packs @£91.00 each

£140.00 / £76.01 N/A

£145.00 £95.00

£118.00 / £53.95 10+ Packs @ £107.00 each / 20+ Packs @ £51.00 each £89.50 N/A

N/A

£64.50 £119.90 / £53.00

£83.24 £95.50

£72.00 £93.35

Nip & Tuck - Facts & Stats

65%

Over $3billion

The increase in enquiries to Transform about various cosmetic procedures in 2012, compared to their 2011 figures.

Value of the U.S. market for cosmetic surgery, facial aesthetics and medical laser devices in 2012; increase of almost 10% from previous year.

Source: Transform

Source: Research and Markets

19.9% The percentage of global surgical procedures that are for liposuction, making it the most performed cosmetic surgery in the world.

Source: ISAPS

$410 Million

38.1%

The estimated value of the European facial injectable market by 2017.

The percentage of global non-surgical treatments performed that are for botulinum toxin type A (Botox, Dsyport etc.).

Source: Millennium Research Group

Source: ISAPS

Latest News ‘This is Not Just Any Home Use Device’... ‘This is a Marks & Spencers’ Sold Home Use Device’!

It seems these days that Marks & Spencers, or good old M&S as most of us know it, isn’t just a place you can go to procure nice undies and a ‘2 dine for £10’ meal deal, indeed, no...these days M&S is selling a variety of ‘professional’ skincare ranges and not-so-cheap home use devices, through their online shop at least.

Laboratoires Filorga, of Paris no less, now sell their range of retail skincare through the hundred year old retailer, (their medical ranges of peels, fillers and mesotherapy formulas are distributed through Euromedical Systems Ltd).

Of particular interest are two items which carry a fairly substantial price tag and are aimed at meeting the demands of the growing home-use or at-home treatment trend started with laser & IPL hair removal devices. Boots the Chemist have been selling a range of high-end, high-cost home use hair removal systems for a number of years now, and are also moving into the skin rejuvenation targeting market, but it looks like M&S could be beating them to it.

First up is the Filorga Lumitherapist LED, which at £274.00 claims to be ‘the first cutaneous photo-regeneration device made of 13 latest-generation LEDs, 7 times more powerful than traditional LEDs, with 3 light waves (blue, red, yellow) for 3 photo-regenerating facial programmes (firmness, flaw-free skin and anti-fatigue radiance), directly inspired by the light-therapy protocols used in medicine’. Instructions tell the user to apply the LED -BOOSTER® skincare product which accompanies the device, select one of the LED device's three programmes and move it across the entire face for 8 minutes, concentrating on problem areas.

The second at-home offering is the Filorga Mesotherapist Roller & Spray, priced at £118.00. This package or ‘treatment programme’ claims to be ‘directly inspired by the anti-ageing mesotherapy protocols used in medicine, to restore the skin's suppleness, radiance and youth’. The sale pitch goes on to say, ‘the roller stimulates the skin deep-down thanks to the micro-needles on its rotating head; it acts in synergy with the sterile poly-revitalising NCTF® solution, a star ingredient used in aesthetic medicine, and promotes its diffusion into the heart of the skin to revitalise the skin tissue’. The instructions note that this is an intense 3-week treatment to be carried out every other day in the evening. Users are to spray the solution onto their cleansed face, roll the rotating head over the skin using very light pressure, spray again and let the solution penetrate the skin without spreading or tapping it and then preferably finish off with the application of one or several other skincare products from the Filorga retail range.

Who knows what we’ll see next, coming to a high street or online shopping cart near you!

Solta Medical Acquires VASER® Lipo Manufacturer to Expand Presence in Body Contouring Market Solta Medical, Inc. has announced that it has entered into a definitive agreement to acquire privately-held Sound Surgical Technologies LLC. Under the terms of the agreement, Solta will acquire Sound Surgical for $25.5 million in Solta common stock and $5 million in cash. Solta expects to close the transaction during the first quarter of 2013.

Solta Medical, Inc. currently offers six aesthetic energy devices to address a range of issues, including skin resurfacing and rejuvenation with Fraxel® and Clear + Brilliant™, body contouring and skin tightening with Liposonix® and Thermage® and acne reduction with Isolaz® and CLARO™.

Sound Surgical Technologies manufactures surgical and non-invasive body shaping products including the VASER Lipo®, VASER® Shape, PowerX®, TouchView®, Origins™ and the VASERsmooth™ targeted to treat cellulite by heating fatty tissue in conjunction with lymphatic massage.

Stephen J. Fanning, Chairman, President and CEO of Solta Medical said; "Sound Surgical provides Solta with a complementary, diversified product portfolio targeting the over $500 million body contouring market segment and the transaction meets our key acquisition criteria. In combination with our rapidly growing Liposonix product line, the acquisition presents significant cross-selling opportunities to plastic surgeons and dermatologists, as well as expanded international sales potential."

Daniel S. Goldberger, CEO of Sound Surgical said; "Solta has demonstrated a unique ability within our industry to build brands, create cross-selling opportunities and foster international adoption. We believe that by combining our sales organization with Solta's, we will enhance market penetration of our highly differentiated technologies with plastic surgeons and dermatologists."

Mr. Goldberger has agreed to stay on as a consultant for a period of six months upon close of the transaction.

CCR Expo Survey Reveals an Urgent Need for More Dialogue Among The Surgical & Non-Surgical Sectors Findings unveiled by a pre-event survey carried out by the Clinical Cosmetic & Reconstructive Expo (www.ccrexpo.com), taking place this October at London Olympia showed that two-thirds of clinicians including surgeons, doctors and nurses believe that the lines between non-surgical (such as lasers and injectables) and surgical procedures (such as breast lifts and tummy tucks) have become dangerously blurred; and a whopping nine out of ten say the public has very little understanding of practitioner qualifications.

The survey also reveals that nearly three quarters of medical professionals worry that ‘plastic’ and ‘cosmetic’ surgery have become interchangeable terms in the public’s mind; and whilst nearly two thirds agree that the advertising of surgical procedures needs to be curtailed, 57% say the practice should be banned outright.

Well over two thirds support the reclassification of dermal fillers – currently requiring only a CE mark – as medicines. 59% of practitioners have come across beauty therapists performing these procedures, 20% have seen hairdressers doing so, and one in ten have witnessed members of the public offering them. A staggering majority (85%) believe that current systems for regulation, such as the Government-backed voluntary register TreatmentsYouCanTrust do not protect patients from unscrupulous practices and 57% say the Government were wrong to deregulate lasers.

According to consultant plastic surgeon and Chairman of the Expo’s Medical Advisory Board Norman Waterhouse, who is also a former President of the British Association of Aesthetic Plastic Surgeons (BAAPS): “Whilst it is reassuring to note that so many of us in the sector are ‘on the same page’ regarding the lack of regulation and the need for tighter controls, the results of this survey nonetheless present an alarming picture.

What I do find encouraging is that the vast majority of us agree there needs to be more dialogue in this field. In the aftermath of the PIP implant scandal and Sir Bruce Keogh’s review into cosmetic surgery, never has there been a more timely opportunity to bring the surgical and non-surgical communities together.”

For more information on the Clinical Cosmetic & Reconstructive (CCR) Expo, please visit: www.ccr-expo.com

Groundbreaking Botox® Research by U.S. Dermatologist Could Change our Understanding of Depression...Forever A new book by Eric Finzi, MD, president of two dermatology practices and faculty member of the Dermatology Department at Johns Hopkins Medical Centre in America is making cosmetic practitioners and those involved in mental health research, rethink both the physical anatomy of the face and the relationship with neurological pathways when it comes to emotions, but also the role that botulinum toxins, such as Botox®, can have in affecting our mood and relationships with others.

This is Dr. Finzi’s first book, although he has authored over 20 research publications to date. The Face of Emotion is the result of two decades of clinical experience and original research that has shown that changing a person’s face using Botox can dramatically alter their relationships not only with others, but more crucially, with themselves.

They say a face can tell a thousand words and it is universally accepted that facial expressions portray our inner most feelings and reveal our deep-seated emotions to others. But what if the reverse were just as true? What if our facial expressions were actually the cause rather than just the consequence of our moods? It is this question that inspired Dr. Finzi, to investigate this claim further.

“Generally, we assume that our facial expressions reflect rather than direct our emotions of the moment. Yet much evidence suggests that our facial expressions are not secondary to, but rather a central driving force of, our emotions”; writes Dr. Finzi.

Our fascination in the correlation between human emotions and expressions dates back to the musings of philosopher René Descartes and the research of Charles Darwin. Dr. Finzi too understands the intricacies of the face as well as the manifold uses and benefits of Botox.

Through different pathways, the brain is able to track even the smallest changes in our muscle health and body positioning. If this is the case, Dr. Finzi argues that the brain also monitors our emotional state when facial muscles are activated through the same pathways.

If the brain recognises that when we frown, we are unhappy, could we alter the feedback the brain receives by manipulating those facial muscles that are activated and prevent unhappiness?

“I began to suspect that Botox could help control the flow of negative emotions, quieting the facial muscles that really express negativity, the muscles between the eyebrows that help create the frown. Could I change moods and help depression simply by preventing a negative facial expression?”; he explains.

Through his pioneering research Finzi has been able to alleviate many patients from their clinical depression, simply by injecting Botox into the ‘corrugator’ frown muscles. Many of the patients in initial trials didn’t even present with visible frown lines before treatment, thus removing the argument that they felt happier and less depressed post treatment because they looked better.

The Face of Emotion is a fascinating and bold examination of the power facial expressions have over our interior moods and a dramatic departure from the neuroscience based school of thought that views emotions solely as the result of neurotransmitters in the brain. Dr. Finzi challenges us to rethink the causes of unhappiness and offers an alternative treatment approach which could radically change the way we think about and treat depression in the future, as well as the emotional effect that cosmetic Botox treatments have on our everyday patients looking for anti-ageing solutions.

For those interested in reading more, you can purchase Face of Emotion by Eric Finzi, MD (Palgrave Macmillan) for £16.99 RRP from Amazon, (currently reduced to £10.87).

BAAPS 2012 Annual Statistics: Male Brow Lifts up 19% Despite a gruelling ‘double-dip’ recession, a breast implant scandal and an ongoing government enquiry into the sector, Britons were able to maintain a poker face as demand for anti-ageing procedures soared. Audit figures from the British Association of Aesthetic Plastic Surgeons reveal that although the number of overall procedures remained static and barely changed at all over the last year, facial rejuvenation treatments in particular proved the nation's favourites with eyelid surgery, fat transfer, brow and face lifts all experiencing a double-digit rise.

Perhaps inspired by last year’s Olympic feats, it was back to the gym for GB as body-shaping ops (such as liposuction, tummy tucks and ‘man boob’ reductions) fell out of favour quite dramatically in comparison to facial anti-ageing procedures. The most impressive percentage increase was in male brow lifts, which rose by 19%.

Eyelid surgery and fat transfer also proved popular with both genders, showing a rise of 13% - as did facelifts, up 14%, compared with abdominoplasty (tummy tucks) and liposuction tumbling in demand by 12% and 14% respectively. In all likelihood a result of the ongoing PIP implants crisis, demand for breast augmentation dipped as expected but only slightly by 1.6%, and continued to maintain its place as the most popular aesthetic surgery. On the whole, the number of surgical procedures showed a barely-perceptible rise of 0.2% from 2011 to a total of 43,172, and their order of popularity remained largely unchanged.

Highlights:         

43,172 surgical procedures were carried out by BAAPS members in 2012, a 0.2% increase from 2011, when 43,069 were performed Women had 39,070 procedures, up from 38,771 - just a slight rise of about 1% The most popular procedure was still breast augmentation (‘boob jobs’) but numbers dipped by 1.6%, from 10,015 in 2011 to 9,854 in 2012 All anti-ageing procedures experienced a double-digit rise including face (up 14%) and brow (up 17%) lifts, eyelid surgery and fat transfer (both up 13%) Male brow lifts went up by an impressive 19% from 125 to 149, facelifts up 14%, eyelid surgery by 11% and even fat transfer procedures to the face (to restore lost volume) by 10% Women had more fat-injecting than fat-removing procedures for the first time, with 2,641 fat transfer procedures compared with 2,638 liposuction ops In contrast, demand for body-shaping procedures such as liposuction and tummy tucks tumbled by 14% and 12% respectively, for both genders combined Male breast (or ‘moob’) reduction surgery, possibly shunned in favour of new non-surgical approaches, was down by 18% - yet still maintained its place as the third most popular procedure for men Male surgery overall fell by 4.5%, from 4,298 ops performed in 2011 to 4,102 in 2012, but men still account for roughly one in ten of all cosmetic surgery patients

According to Rajiv Grover, consultant plastic surgeon and President of the BAAPS; “Every week there are reports of new ‘lunchtime’ or ‘Hollywood craze’ treatments that are here today, gone tomorrow. The growth rates for surgical facelifting and other anti-ageing procedures showed a double digit rise, despite a double dip recession. Perhaps because of turbulent financial times, patients are looking for tried-andtested procedures that deliver a reliable, long-lasting result and which have a proven safety record. Whilst there is an undeniable rise in demand for non-surgical treatments of the face; for example Botox and fillers; once there is actual loose skin in the neck or jowling, only surgery is likely to make a significant improvement and the public seem to be increasingly aware of this.

The considerable drop in body-shaping procedures such as liposuction and tummy tucks may well be due to people choosing to head back to the gym (perhaps inspired by an unforgettable summer of Olympic golds!) or the fact that there are now many less-invasive options to target problem areas, such as for gynaecomastia or ‘man boobs’. Interestingly, for the first time we see a greater number of women having procedures to re-insert fat (known as fat transfer, to add volume to the face) than to remove it, in the form of liposuction. The growing appreciation that facial ageing is more than just about the effects of gravity, combined with scientific advances the rejuvenating qualities of stem cells contained within fat help explain this trend. The Nobel prize for medicine in 2012 being awarded to research in the field of stem cell physiology suggests this may be an area of continued growth in the future.”

For a full list of the BAAPS figures please visit: www.consultingroom.com/media/media-statsdisplay.asp?id=57

Round-Up of ASA Health & Beauty Adjudications The Advertising Standards Authority polices the content of Health & Beauty advertising through all mediums in accordance with rules set out in the CAP (Committee of Advertising Practice) code. This month we did a quick round-up of the naughty advertisers in our industry, in the hope that we can all learn a thing or two:

Make sure you can substantiate the efficacy of products that you advertise!

A national press advert, for Transformulas EyeLifting Gel, featured a photograph of a woman's face which had been divided into "Before" and "After 30 seconds" sections. The eye in the "After 30 seconds" section of the face appeared lifted and showed a higher eyebrow than the "Before" section of the face. Text beneath the photograph stated "Instant benefits Essential relief for tired eyes Skin feels tighter and firmer".

The complainant challenged whether the "After 30 seconds" section of the image misleadingly exaggerated the efficacy of the advertised product, because they believed the result was the effect of a raised eyebrow and not the product.

Transformulas provided the original 'before' and 'after' photographs and said they had not been digitally enhanced.

They said the lift on the eyebrow was the result of using the advertised product and not a facial movement. They provided a trial on the advertised product and a summary of a trial using Kigelia africana, a constituent ingredient.

The ASA upheld the complaint. They examined the original 'Before' and 'After 30 seconds' photographs sent by Transformulas and noted the overall appearance of the woman's face, and in particular, the area around the eyes did not appear significantly different, aside from the fact that the 'After 30 seconds' photo included fewer shadows.

Furthermore, they noted the 'Before' photographs already showed the models left eyebrow higher than the right.

They also noted the 'Before' and 'After 30 seconds' sections of the image in the advert were of opposite sides of the woman's face and therefore did not provide a representation of the effects of the product on the same area. They were therefore concerned that the "After 30 seconds" section of the image misleadingly represented the efficacy of the advertised product. They were also concerned that the trial of the product itself and of Kigelia africana, did not show the effect of the product after 30 seconds.

Because the "After 30 seconds" section of the image misleadingly represented the efficacy of the product and because the trials submitted were not sufficiently robust to demonstrate the efficacy of the product, they concluded that the advert was likely to mislead.

The advert must not appear again in its current form. The ASA told Transformulas to ensure 'before' and 'after' photographs accurately represented the efficacy of the advertised product in future.

Full Adjudication An e-mail advert for a body cream was headlined "Get a body to die for with 50% off body sculpture for 24 hours".

The advert showed an image of the actress Mila Kunis in her underwear and further text stated "Get Mila Kunis' Esquire look with this intensive formula that helps reduce the appearance of cellulite fast. Simply enter Code xxxxx at the checkout & streamline your bum, thighs and tummy with this A-list must have!".

The complainant, who believed the advert implied that Mila Kunis' figure had resulted from using the 'body sculpture' cream, challenged whether the advert exaggerated the results that were likely to be achieved from using the product.

Rodial Ltd provided product information on two of the active ingredients in the product which they believed substantiated the efficacy claims for the product. The ASA however upheld the complaint and considered that most consumers would understand from the claim that consumers who used the product would be able to reduce the appearance of cellulite and tighten and smooth their bottom, thighs and tummy. Evidence presented consisted of information about two active ingredients within the body sculpture product which made reference to in vivo trials on those ingredients. However, the trials themselves were not supplied. Because robust evidence was not presented to demonstrate the implied efficacy claims for the product or that Mila Kunis had achieved the look featured in the photo as a result of using the product, they concluded that the advert was misleading.

The advert should not appear again in its current form. The ASA told Rodial not to make efficacy claims without holding robust evidence.

Full Adjudication

New Product Reviews Stylage® – Now With Lidocaine According to Medical Aesthetic Group, Stylage®, the award winning longer lasting filler, is now available with Lidocaine. Stylage®, is the first product on the market which contains cross-linked hyaluronic acid (patented IPNLike Technology), antioxidant (Mannitol) that provides less swelling and extended longevity AND Lidocaine for comfort and safety for both for patients and physicians.

A clinical study conducted by French plastic surgeon, Dr Bernard Mole confirms that the effectiveness of the hyaluronic acid (HA) is not compromised by the addition of Lidociane and that the performance and filling capacity or “volumising effect” of gels with Stylage® Lidocaine are the same as those without. The study that was carried out on 84 patients with a clinical follow up over a period of 6-8 months, concluded that the product does not bring about any increased risk of blood extravasation and affects neither the quality or the durability of the results.

Stylage® boasts a 12–18 month longevity with minimal swelling including the mid-range medium viscosity products. Stylage® can be used to fill and smooth wrinkles, natural lip correction, volume restoration, hydration, chin remodelling, tear trough correction, neck, décolleté & hand rejuvenation.

Benefits of Stylage:       

Minimal swelling – average 2 hours for lips Extended duration of results even for softer fillers in the range Prolonged results for cheeks and temples Uses smaller needles than comparative fillers – less pain and trauma Better results achieved in stressed, free-radical loaded skin e.g. smokers Lidocaine Hydrating and mesotherapy range also long-lived.

For more information please contact Medical Aesthetic Group on 02380 676733 or visit www.magroup.co.uk

At a loose end this weekend? Need something to do?....

Why not visit our sister site www.cosmeticvideos.co.uk and check out all the great videos, including Member’s Only content!

The Member’s Only section of our specialist video website contains videos that are more instructive and aimed at purely at medical professionals, relating to detailed explanations of concepts, techniques, procedures, protocols and dealing with problems.

If you haven’t accessed this section already, it’s quick and easy to do so...

Simply Register using your Consulting Room membership information (username or email address and password) and if everything matches you will be authorised automatically and you can then log in to the Cosmetic Videos Members Only Area whenever you like; all free of charge to Consulting Room members.

www.cosmeticvideos.co.uk

Feature Article Regenerative Medicine – Is It The Way Forward?

One phrase we have been hearing a lot about lately and undoubtedly will hear mentioned more often as the year unfolds is ‘regenerative medicine’.

According to the Medical Research Council, regenerative medicine is defined as: “... an interdisciplinary approach that seeks to repair or replace damaged or diseased human cells or tissues to restore normal function, which holds the promise of revolutionising patient care in the 21st century.”

Sounds impressive; even to the layman. The MRC note that it may involve the transplantation of stem cells, progenitor cells or tissue, the stimulation of the body's own repair processes, the use of cells as deliveryvehicles for therapeutic agents such as genes, cytokines and small molecules or cell engineering and synthetic biology.

In the field of aesthetic medicine the quest for ‘make your own face-lifts’ and ‘take the fat from my bum to give me bigger boobs’ ideals have been around for many years but perhaps now is when these concepts are just beginning to become achievable as learning and development of techniques has moved on a pace.

The MRC summarises it nicely by stating; “all regenerative medicine strategies depend upon the harnessing, stimulation or guidance of endogenous developmental or repair processes”. Aesthetic medicine is looking to ‘harness’ valuable cells, be they platelets, fibroblasts or stem cell rich adipose cells, ‘guide’ them to the area needing treatment and hope that the ‘stimulation’ of new tissue such as collagen and elastin is achieved to ‘repair’ ageing or atrophic tissues without the need for synthetic substances or invasive tissue manipulation.

We are starting to achieve some of this via two forms of regenerative medicine, the autologous treatments, using a patient’s own cells harvested from themselves and cultivated or refined in some way, or by allogeneic means by using healthy, cultivated cells from a donor human source as seen with many growth factor treatments. In this article, I hope to look a little deeper into the growth of autologous and allogeneic applications now becoming more mainstream in aesthetic medicine.

Autologous Treatments Platelet Rich Plasma (PRP) Therapy Platelet Rich Plasma or PRP therapy has been around in the aesthetic marketplace for seven or eight years now, but momentum has increased for its widespread use in the last two. It has also been marketed (and trademarked in America) as the Vampire Facelift™ (this also uses hyaluronic acid as part of the ‘facelift’) and Dracula Therapy. Somewhat scary and sinister sounding names, but as the treatment involves the extraction of a small amount of the patient’s blood, to get at the platelet rich plasma which is the ‘liquid gold’, because of its yellow colouring, for reinjection into the skin, the term seems appropriate, even in the eyes of the general public and mainstream media, surprisingly!

The mechanism of action of the treatment is the release of cytokines and growth factors from the platelets once injected into the dermis as part of the wound healing process in the targeted area of introduction. The process is

scientifically complex and is said to accelerate tissue regeneration by chemoattraction and deposition of extracellular matrix. The result of this tissue stimulation is the enhancement to the texture and tone of the skin.

Many different systems now exist to facilitate the process of extraction of the plasma from the red blood cells by the practitioner including brands such as MyCells, Regen, Selphyl and GLOPRP. The general concept involves the use of a centrifuge to separate out the elements of the blood, done in the clinic environment whilst the patient is present for treatment. Differing brands of devices claim differing techniques to achieve this more reliably than their competitors, with a variety of equipment sizes and centrifuge parameters.

Additional developments (both medical and cosmetic) have resulted in techniques such as the Platelet Rich Fibrin Matrix (PRFM) from Selphyl which is a substance created when the PRP is added to calcium chloride which turns the PRP into a gel like matrix, more commonly used in medical applications of PRP such as facilitating the closure of leg ulcers. The advantage in an aesthetic indication is said to be that the gel like substance means that the platelets will remain in the site of injection and get to work releasing growth factors in the desired location for treatment without the chance of migration.

PRP is being used for a variety of aesthetic indications, from facial cosmetic rejuvenation for lines and wrinkles in the crow’s feet, nasolabials, marionette lines etc., to the rejuvenation of the backs of the hands and the décolletage. In fact anywhere that there is a crepey or slight wrinkling to the skin, including knees, elbows etc., PRP can be employed as it is of course derived entirely from the person who is in receipt of it.

The issue which can cause some problems with patients is the lack of immediate results, unlike with dermal fillers for example, they will need to wait several weeks to a couple of months for noticeable improvements to become apparent; hence, no doubt why the trademarked Vampire Facelift™ chooses to combine with HA to appease the consumer expectation.

Although the combination of PRP and HA also has advantages which are slightly less cynical. Dr. Daniel Sister enlightened us all at the BODY 2012 conference with his approach to non-surgical breast and décolletage rejuvenation where he uses hyaluronic acid placed just sub-dermally in the breast (not into the gland) and naps over it with PRP (or combines the two in the same syringe) for improvement to the cleavage area, correcting inverted nipples and breast asymmetry (natural or after breast reduction surgery).

Stem Cell Rich Fat Transfer Fat transfer, fat grafting, fat transplantation or micro-lipoinjections are just some of the names used to describe the procedure of removing some adipose cells from a patient, refining them and then reintroducing them into a target area on the same patient to achieve a volume restoration. This is not a new concept; in fact it’s been around a lot longer than you might think with the first published results for a procedure dating back to 1893 when a German doctor used fat from a patient’s arm to correct a skin defect on their face.

According to the American Society of Aesthetic Plastic Surgeons (ASAPS), the percentage change in its own member statistics for 2011 versus 1997 for autologous fat transfer procedures is an increase of 82.6%, with even 2011 versus 2010 showing a 29.8% increase in the number of procedures performed. Similarly, the British Association of Aesthetic Plastic Surgeons (BAAPS) have reported in their 2012 members audit, an increase of 13% for fat transfer procedures compared to the previous year. It would seem that dermal fillers might perhaps need to start on the worry beads as more and more, plastic surgeons at least, are turning to fat transfer as the volumiser of choice.

What has changed and improved are the techniques for harvesting, processing and re-introducing the fat cells to achieve a better chance of survival of the adipose, post implantation, leading to increased long term viability and desired results for the intended procedure. This includes things like reductions in the speed of centrifuge used to separate the fat cells from the other liquids recovered during the liposuction harvesting, studies and research have shown that lower G-forces exerted during centrifuge processes reduce the likelihood of fat cell destruction.

The additional discovery which has augmented the usefulness and success of fat transfer procedures is the concept of using stem cell enriched adipose tissue for reinjection.

Often referred to as the ‘building blocks of life’ or ‘mother cells’; stem cells have the ability to become any type of cell within the human body, from bones and skin to blood and muscles. By extracting adult stem cells along with the fat, and reintroducing them during transplantation, the theory is that the cells will become healthy new fat cells as well and augment both the results and their longevity.

One leading company involved in this marketplace and pioneering clinical trial work for reconstructive and cosmetic indications is Cytori. The company’s Celution system was granted a European CE Marked in January 2006 for the

‘extraction and concentration of stem and regenerative cells from adipose tissue for autologous re-implantation or reinfusion’. It is not yet available in the United States as FDA approval is pending.

The system enables the automated extraction, washing and concentration of a patient’s own adult adipose-derived stem and regenerative cells or ADRCs. Having been introduced in European and Asia into the reconstructive surgical market a variety of physicians have undertaken trial work using ADRCs to enrich fat transplantations for a number of cosmetic applications including breast reconstruction and augmentation post-mastectomy, as well as for facial rejuvenation and buttock augmentation. Levels of patient satisfaction in the breast trials (known as RESTORE 1 and 2) were high at over 70% in both trials. The company also notes that the procedure can be used for other soft tissue defects such as those caused by disease and trauma, liposuction complications and congenital defects or asymmetries.

The company also produced the Puregraft™ system which allows the physician to wash and purify the fat in preparation for fat grafting in only 15 minutes. This received FDA clearance in January 2010 and European CE Mark approval in July 2010. The combined use of the two systems (Puregraft and Cellution) lowers the processing times and increases the volume of stem cell rich adipose for fat transfer treatment.

Studies are also being undertaken by the manufacturers of Selphyl to look at the combination of Platelet Rich Plasma treatment with autologous fat transfer to establish whether PRP will complement and improve on the results achievable with the fat transplant.

Autologous Fibroblast Injections Hands up if you remember Isolagen®? Well it’s still here, but wearing the emperor’s new clothes!

Back in 2006, I covered the Rise and Fall of Isolagen (Autologous Cell Therapy) in a feature article. The concept behind the treatment was a good one, the company’s rapid expansion following UK, European & Australian launches, combined with poor practitioner training and the marketing to the public and press was an exercise in what not to do, the company simply ‘ran’ with their product before the product could really ‘walk’.

While all this was going on the company was running trials in an effort to gain American FDA approval for the process, which involved harvesting a skin sample from behind a patient’s ear, cultivating the fibroblast cells over a period of weeks and shipping them back to the practitioner for reimplantation into the patient for facial skin rejuvenation and acne scare reduction.

Yet, the cost of this production process spiralled out of control and the company were forced to restructure and close many of the newly opened facilities including a complete pull-out from the UK. The American parent company later faced other financial difficulties and declared bankruptcy.

But like any good phoenix, it rose from the ashes of Isolagen at the end of 2009 and the company Fibrocell Science Inc. was born, along with a new name for the product, now known as azficel-T. This is now marketed in the USA as Laviv™ following FDA approval for the treatment of moderate to severe naso-labial fold wrinkles in June 2011.

Hindsight is a wonderful thing and I’m sure that those behind Isolagen/Laviv have learnt the value of taking a product to market slowly. Only U.S. board certified dermatologists and plastic surgeons who have completed a Fribrocell approved training programme are permitted to use the product now, a stark contrast to the broad range of UK practitioners using it when the product was launched here as Isolagen.

As for the treatment itself, this was always in debate. As Isolagen there were those UK doctors who loved it and those who felt it showed no real rejuvenation results. Many argued that the time window for treatment was restrictive in terms of getting patients back in for treatment when the cells were ‘ready’ and others that so much of the success of the treatment relied upon pin point placement of the cells in the ‘correct’ place, which with a hefty price tag for the patient was too much of a gamble when the cells simply died and produces no results.

It seems that with Laviv, the situation is still a little uncertain; despite the FDA approval the regulator and Fibrocell point out that to date the efficacy of Laviv beyond six months has not been established, this puts it at a disadvantage when dermal filler longevity is increasing more and more. The recommended treatment is to inject the autologous cellular product at 0.1 millimetre per linear centimetre into the nasolabial fold during three treatment sessions spaced by 3 or 6 week intervals. A single vial of Laviv contains approximately 18 million fibroblasts. Those interested in it can read more in the package insert (PDF document) available from the FDA website.

The company is now in Phase II clinical trials to assess the potential of azficel-T for treating restrictive burn scars. It seems that there are no immediate plans however to return to market it across the pond.

Personalised Stem Cell Skincare A U.S. company called Personal Cell Sciences launched a unique, autologous stem cell enriched skincare product line called U Autologous in the summer of 2012.

The product uses a small quantity (60cc) of adipose tissue (and the stem cells within) extracted by a plastic surgeon and shipped off to their laboratory. The stem cells (mesenchymal) are extracted from the fat, grown and some stored for future use and the rest cultivated to produce a blend of growth factors, cytokines and other proteins, which they call Autokine-CM™ and which are then the main ingredients in a daytime moisturiser, night time firming serum and eye cream set along with other ingredient including caffeine and green tea extract.

Consumers can expect to pay $3,000 for the ‘set-up’, to include the harvesting, storage, cultivation and creation of the first round of skincare products. After that it’s $1,500 a month to receive new batches of the creams based upon the original set up and stored cells. Possibly the most expensive skincare range on the market currently!

The jury is still out in terms of efficacy and safety though as so far the only studies available are unpublished, company sponsored trials which are difficult to rely upon.

Allogeneic Treatments Allogeneic Fibroblast Injections VAVELTA®, produced by Intercytex was launched in 2008 as a skin repair and rejuvenation product, designed to restore and repair skin damaged by the ageing process or scarring.

The product, which also goes by the production name of ICX-RHY for medical applications, contains a suspension of 20 million human dermal fibroblasts per ml in cell storage medium contained in a sealed vial for injection into the skin. The fibroblasts used are allogeneic, that is, sourced from a human donor, in this case using neonatal cells.

Under current European Union regulation, the production is regulated under the European Human Tissue Directive on setting the standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells, and as such, Intercytex is licensed by the UK Human Tissue Authority.

The company faced financial difficulties in 2009 but new investment a year later saw renewed activity and clinical trial work.

A Phase I trial, conducted in collaboration with Professor Nicholas Lowe at the Cranley Clinic, London, consisting of a placebo-controlled safety and tolerability study in ten healthy volunteers, has been completed. Each volunteer received a course of three injections given into the skin of the upper arm. VAVELTA was shown to be very well tolerated; no serious adverse events were reported and all adverse events were transient and resolved without treatment.

A Phase II dose-escalation trial of VAVELTA in nasolabial folds, also conducted at the Cranley Clinic, London has been completed. In this trial, six subjects received a low dose of VAVELTA and a second group of ten subjects was treated with a higher dose. All subjects have been being followed out to six months post-treatment. The average satisfaction scores for both groups, as assessed separately by both patients and the investigator on a scale of one to ten (ten being the highest), were 7.8 and 7.6 eight respectively. In addition, the investigator measured an improvement in wrinkle severity in 12 subjects (75%).

A second Phase II trial, for the use of VAVELTA in acne scarring, conducted by Dr David Eccleston at MediZen in Birmingham, has been completed. Subjects were followed out to six months post-treatment. The average satisfaction scores for the treatment, as assessed separately by both subjects and the investigator on a scale of one to ten, were 6.8 and 6.3 respectively.

No serious adverse events have been observed and the product has been well tolerated in both Phase II trials. To date, over 100 patients have been treated for a variety of skin damage including acne scarring and wrinkles.

However, when it was first developed in 2008 the MHRA agreed with Intercytex that it didn’t require a marketing license. The regulatory situation in the rest of the EU member states concerning whether cell therapies were Medicinal Products or not was not clear and in order to provide a coherent regulatory system throughout the whole EU the Advanced Therapy Medicinal Product (ATMP) legislation was developed. This classified VAVELTA as a “Tissue Engineered ATMP” as it was “administered to human beings with a view to regenerating, repairing or replacing a human tissue”.

As a Tissue Engineered ATMP, it will require a full marketing license from the European Medicines Agency (EMA) from December 30th 2012. The company have noted that this will take time for them to obtain and will involve them carrying out a series of additional clinical trials and other studies. Until it is able to obtain a license, Intercytex will not be able to advertise, promote or market VAVELTA, but can continue to manufacture the product for its own clinical studies.

This is of course a set back, but having faced adversity before, we doubt this will halt progress and expect to see them commercialising the product again very soon.

Human Growth Factors in Topical Skincare Products Growth factors in skincare have been one of the hottest trends to hit topical cosmeceuticals over the last decade.

Unlike growth factor released from a patient’s own platelet cells, growth factors in topical products are extracted from laboratory cultured cells from donor human skin (e.g. cadavers or baby foreskins and placentas).

Growth factors are naturally occurring proteins which act as chemical messengers between cells, enabling them to turn on and off a variety of cellular activities. They can play a role in cell division, new cell growth and the production and distribution of collagen and elastin.

The term ‘human growth factors’ therefore covers a wide variety of different types or families of growth factor proteins, all with different jobs to do. Examples of human growth factors which are now being used in some cosmeceuticals include: transforming growth factor-beta (TGF-beta), which plays a role in tissue regeneration, fibroblast growth factor (FGF), involved in wound healing, keratinocyte growth factor (KGF) which stimulates the growth of cells in the surface layer of skin, and epidermal growth factor (EGF) which plays an important role in cell growth and proliferation.

Human growth factors applied topically have been used widely in the medical industry for treating wounds and have been shown to produce faster and more complete healing, and some research (mainly manufacturer backed) into the cosmetic use of human growth factors has shown that they can improve skin elasticity, uneven skin tone and thinning of the epidermis.

Skinmedica’s TNS Recovery Complex®, a top five best selling cosmeceutical skincare brand in the USA for some time now, was one of the first to adopt the use of human growth factors and uses a patented ingredient called NouriCel® which is derived from bioengineered human skin, in this case an original donor baby foreskin.

This NouriCel® technology was originally developed by the manufacturers to treat burns and other wounds, before being developed for cosmetic skin rejuvenation. The composition of human growth factors used in the TNS Recovery Complex® includes TGF-Beta, KGF and vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), the latter of which stimulate new blood vessel formation.

As of last summer (2012), a new player emerged in the shape of ReGenica, manufactured by Histogen Inc. and marketed in the USA by Suneva Medical. ReGenica is a skincare system comprised of three products which have a Multipotent CCM Complex™, developed by the inventor of the key ingredient in SkinMedica’s TNS, Dr. Gail K. Naughton. The company states that it is clinically proven to help reverse the signs of ageing and aid in scarless wound healing and they believe represents the next generation of growth factor skincare.

They note that their proprietary complex is created by growing fibroblasts, in a simulated embryonic environment, and then harvesting the naturally secreted proteins, growth factors and other synergistic bioproducts that are produced. ReGenica products contain a diverse mixture of active ingredients, including human growth factors such as Keratinocyte Growth Factor, soluble human ECM proteins such as collagen, and embryonic proteins which support the epidermal stem cells that renew skin throughout life.

In one study, ReGenica Day & Night Repair have been shown to reduce the appearance of fine lines and wrinkles, improve skin tone and generate smoother skin over a ten week period, and in two published studies, ReGenica Facial Rejuvenation Complex Post Procedure has been found to improve healing and more rapid reepithelialization as early as three days post procedure.

Conclusion So, should you all be throwing away your synthetic, cosmetic products and devices and getting set up to extract tissue and cells from your patients instead, so you can provide a complete DIY rejuvenation?

Well, the answer is clearly, not just yet. Techniques and technologies are improving and much research is ongoing (both in the medical arena as well as the cosmetic) to understand the exact mechanisms behind the application of regenerative medicine techniques to repair, replace, restore and regenerate human tissues and cells.

We’re not there yet, so the combination of treatment options and products available to the aesthetic practitioner will be required for sometime to come to produce the natural and long lasting results demanded by the consumer of anti-ageing treatments.

However, there will be those who shun or fear the man-made options you have in your armament to date, so the attraction of regenerative medicine will grow as the science improves and the long term clinical data shows both safety and efficacy of some of these pioneering concepts.

A note of caution is always needed in any line of medicine, and just because these treatments revolve around using your own cells or other human cells to facilitate improvement, doesn’t by default make them safe and nor should it make you complacent in their use.

A recent report in Scientific America, detailed the case of a woman who presented at the office of a cosmetic surgeon in California in 2009 complaining that she could not open her right eye without considerable pain and that every time she forced her eye open she heard a strange click, likened to a tiny castanet snapping shut. The surgeon, Allan Wu is said to have considered that the woman was making up stories but upon examination he could see that something was indeed wrong, he just wasn’t quite sure what.

He operated on the woman’s eye area which appeared swollen and with a drooping eyelid and removed small chunks of bone from her eyelid and the tissue surrounding her eye. The bone fragments were scratched but largely intact, so the tiny castanet was in fact bone on bone grinding sounds from the fragments as she opened and closed the eye.

A story to make you cringe indeed, but why had this happened? According to the report, three months prior the woman had received a ‘face-lift’ treatment using her own adult stem cells, harvested from abdominal liposuctioned fat. It is believed the doctor had extracted mesenchymal stem cells from the adipose tissue, which can turn into bone, cartilage or fat, amongst others. These cells were then reinjected into her face, particularly around the eye area.

It is thought this would not have been a problem as an individual treatment but the practitioner combined the stem cell application with calcium hydroxylapatite dermal filler, Radiesse™. This mineral encourages mesenchymal stem cells to turn into bone. The practitioner was apparently unaware of this and thus fragments of bone began to develop in the treated area, later to be removed by Dr. Wu. We know that the human body, and the body of different patients can react in a variety of ways to the introduction of any foreign objects and substances, it is therefore always worth a practitioner bearing in mind the patient history when it comes to recent and even historical product applications and procedures in the same targeted treatment zone. The potential for undesirable reactions allied with the introduction of autologous and allogeneic therapies is something yet to be documented in the clinical literature, but no doubt more rare cases as highlighted above are as yet unknown.

Lorna Jackson Lorna has been Editor of The Consulting Room™, the UK’s largest aesthetic information website, for over nine years. She has become an industry commentator on a number of different areas related to the aesthetic industry, collating and evaluating statistics and writing feature articles, blogs, newsletters and reports for The Consulting Room™ and various consumer and trade publications, including Aesthetic Medicine, Cosmetic News and Aesthetic Dentistry Today.

Eye Spy With My Industry Eye SMART IDEAS 2013 Following the success of our SMART IDEAS events during 2012, and with the support of two leading aesthetic industry suppliers, Syneron Candela and Merz, we were again able to hold another event in 2013. We kicked off th this year’s programme with a meeting in Manchester on 26 January at the Radisson Blu Hotel at Manchester Airport.

Despite the snow, a considerable number of practitioners from all over the North and The Midlands attended the event, which this year saw two parallel agendas, one on business topics and one on clinical topics. As well as presentations from a variety of medical speakers and members of The Consulting Room™ team, delegates also had the opportunity to speak to a dozen exhibitors representing device manufacturers, distributors for facial aesthetic products, training companies and insurance providers. The Consulting Room™ team were also on hand to carry out website reviews and answer aesthetic business related questions when approached. The intimate nature of the event meant a great opportunity for learning, questioning, networking and general interaction which is not always possible with the scale and time restrictions of larger events.

Topics covered in the business agenda talks included medical indemnity insurance, reducing risk when buying aesthetic equipment, avoiding common advertising mistakes which could land you in hot water with the ASA, web design and internet marketing strategies, including optimising keywords and building a communication platform with email, blogs and social media, how to maximise referrals and profitability in business and improve consultation outcomes, plus increasing profits by avoiding common telephone mistakes and receptionist training. The clinical presentations included the versatility of LED phototherapy, the myths and science of hair removal, modern concepts in non-surgical body shaping, the challenges of removing pigmented and vascular lesions with laser and light and a review of dermal fillers, followed by a live injection workshop.

Our next event will be held in London on Saturday 27th April. For more information on the agenda and to register for that event, please visit: www.smartseminar.co.uk

Give Your Aesthetic Business a Competitive Edge & Attend

Following the success of our Manchester meeting; register Today for the next one!

Practical Business Strategies & Product Ideas to Increase Your Profits in 2013 The Consulting Room™ are again hosting several special SMART Ideas events during 2013, in conjunction with the world’s largest laser and radiofrequency device manufacturer - Syneron Candela, and cosmetic injectables manufacturer – Merz Aesthetics.

Saturday 27th April 2013 in London This unique seminar includes a full day business agenda, featuring the very latest practical business and marketing tactics related to running an aesthetic clinic, alongside a parallel agenda devoted to the latest devices, injectable aesthetic techniques and other concepts that you can incorporate to increase your clinic's profits during 2013. CPD Points applied for and Registration from just £15 inc. lunch.

See details of the two agendas here: www.smartseminar.co.uk/agenda The SMART Ideas format provides an opportunity for you to explore the very latest product innovations, alongside reviewing core business principles related to running an aesthetic clinic.

SMART ideas provides an informal and friendly opportunity for you to explore unique new products, have personal demonstrations, discuss your business model and network with industry colleagues all in one day! A range of industry exhibitors will also be attending the events.

Delegates attending these unique seminars will learn the very latest information related to practical use of cosmetic injectables for total facial contouring; lasers and RF devices for hair removal and skin rejuvenation; topical skin lightening treatments; and web marketing and business development techniques.

To register your interest please call Danny Large on 01788 577 254 or visit www.smartseminar.co.uk/Register/

Still Undecided About Attending?

Watch this short video of comments from delegates who have attended past SMART IDEAS Seminars to hear what they gained from the day. www.youtube.com/watch?v=qA67ncb4a3I

Food For Thought Case Study: Report on The Reversal of Uma Jeunesse

This is a case study of a 26 year old lady who presented to me two weeks after having 0.5ml of dermal filler, in this case the Uma Jeunesse brand injected into her top lip.

She was upset by the lumpy appearance of her lip, especially when she smiled.

It looked to me like the filler had been injected in a crude bolus fashion and placed too superficially in the lip.

The filler had integrated into the epithelium and could not be expressed.

Normally the injection of a small amount of hyaluronidase would get rid of hyaluronic acid filler in 48 hours.

After a satisfactory allergy test I injected 1000 units of hyaluronidase into the lumps, but to my dismay they were still very much evident one week later.

I repeated the procedure and this was the appearance at the second review (still there).

For a third time I injected with more hyaluronidase and this time it had all gone.

On this occasion I refilled the top lip with 0.5ml of Emervel Lips, and this is the final result.

I have reversed many poor lip augmentations with various HA fillers but I have never encountered such a difficult reversal as with Uma Jeunesse.

Had it not been for the fact that the filler had only been in for 2 weeks I would have considered the possibility of a granuloma.

It’s worth mentioning that a granuloma from a hyaluronic acid filler often resolves with hyaluronidase alone and in the sort of time scale that the above case did.

Dr Fab Equizi Dr. Fab Equizi (http://lipdoctor.co.uk) has 13 years experience in Aesthetics. He is an ex GP and now full time Cosmetic Doctor. Fab is also in the second year of a Masters degree in non-surgical facial aesthetics at the University of Central Lancashire.

Business Corner ‘Interesting’ Clinic Marketing Methods: Is Comedy a Step Too Far? It seems that most clinics are now realising the power of using video and video hosting sites like You Tube™ to promote themselves as an expert as well as market their clinic and service provision. With so many physicians around the world taking to sitting in front of a camera to educate and inform potential patients on the world of medical aesthetics and cosmetic surgery, there comes a point where saturation occurs and people start to think of unique ways in which to differentiate themselves and ultimately ‘stand out’ in the crowded online world.

Well one clinic in America has taken a stance not often used in this industry…comedy!

MyShape Lipo is a liposuction specialty clinic in Las Vegas, a city not known for taking itself too seriously at the best of times; they state in their press release; “Most people take medical procedures very seriously. For great comedy, there is usually a little truth to the joke.

Liposuction patients all have different expectations of how the procedure will change their life. MyShape Lipo uses experience to create a comedy sketch portraying various patient expectations.

The use of comedy in respect to cosmetic procedures is unprecedented in the industry. The team at MyShape try to have fun with their job and make the whole experience enjoyable for their patients. ‘None of our patients are sick or dying, we are removing fat,’ says Liposuction Specialist Trevor Schmidt PA-C. ‘It’s easier to laugh at yourself when you know things will be better.’”

The clinic admits that their video is in unchartered territory and it is yet to be seen how the general public will accept the comical nature of it. Being a serious medical and cosmetic procedure, there is of course a fine line between using comedy to relax and engage with an audience and the likelihood of trivialising a treatment which carries inherent health risks and should be considered accordingly. Is comedy really the right thing to use?

“Some patients have totally unrealistic expectations of their liposuction procedure,” says Trevor Schmidt. “I thought it would be entertaining to poke a little fun at these dreams. In the dream world, anything is possible, which leaves it wide open for some really funny situations.”

Watch the video here and make up your own mind!

http://youtu.be/8SA_flRgrVE

Yell Become hibu Did you know? No, we didn’t either.

The rebranding of Yell to hibu (pronounced High-Boo) happened last summer but you can be forgiven for not noticing as the Yellow Pages™ and Yell.com services and branding still exist and are as evident as they always were. It’s simply a case of ‘what’s under the bonnet’ having changed.

In August 2012, Yell Group plc became hibu as part of a major restructuring of the debt-laden business. The new corporate identity has been launched as the company works to shift its business from print to digital media.

The name change was originally announced in May 2012, when Yell posted a £1.4 billion full year loss, and was agreed by shareholders at the company’s annual general meeting.

Chief executive officer Mike Pocock said at the time; “I am delighted that our shareholders have voted overwhelmingly in favour of our new company name hibu. This gives us a dynamic, new and consistent group brand that identifies us to merchant customers and consumers as we redefine our presence in the digital services marketplace.”

A decline in advertising revenue and increasing use of the internet by consumers has hit the directory company hard in recent years. The company is now in the midst of a major restructuring programme, expected to last four years, which will see digital products becoming 75% of its business with print accounting for just 25% in an effort to turn around the business following dramatic changes in their marketplace.

Continuing Personal or Professional Development and the CPD Certification Service, What’s it All About?

Continuing Personal or Professional Development (CPD) is the term used to describe; “the undertaking of a structured and planned approach to ‘post-qualification further learning’ throughout the career path, and ‘lifelong learning’ which describes the continuous building of skills and knowledge throughout the life of an individual through both formal, structured education and informal, unstructured experiences.”

CPD is a formal requirement for anyone who is a member of a professional body. It ensures that our skills and knowledge are up to date which helps our own careers and the growth of our organisations. For some institutions undertaking CPD is mandatory and linked to a licence to practice, for others it’s obligatory. By ensuring that their members undertake CPD, the professional bodies seek to ensure that professional standards, legislative awareness and ethical practices are maintained.

The General Medical Council (GMC) state that Good Medical Practice requires doctors to keep their knowledge and skills up to date throughout their working life and to maintain and improve their performance. Continuing professional development is a key way for doctors to meet these professional standards and is one of the sources of information required for appraisal and revalidation. They issued new guidance on continuing professional development for Doctors in the summer of 2012.

The Nursing and Midwifery Council (NMC) states that nurses and midwives must maintain their NMC registration by meeting a continuous professional development standard including undertaking at least 35 hours of learning activity relevant to their practice every three years, maintaining a personal professional profile of their learning activity and complying with any requests to audit how they have met these requirements; failure to do so can result in a lapse in their registration and ability to practice.

Many aesthetic and cosmetic industry focused events and training courses now also quote CPD point accreditation; so what’s it all about and how might it be applicable to you perhaps as a training provider to your peers?

Founded in 1995, the CPD Certification Service is an independent body which works alongside relevant Government sponsored organisations and professional bodies. It operates on a pan-industry, multi-disciplinary basis and has certified thousands of CPD activities across all industry sectors both in the UK and overseas.

CPD can be undertaken through a variety of different training and learning activities; from formal education to work based learning and self-directed learning. The most common activities for providing CPD are through conferences, presentations, training courses and literature. In addition, online activities such as webinars and podcasts, or work based events such as mentoring, work shadowing, site visits and workshops are also popular.

A CPD scheme lists a precise number of CPD hours that individuals must achieve within a given time period, usually based on time i.e. 1 CPD point = 1 hour of learning.

The use of technology for undertaking and recording CPD activities has become increasingly popular, particularly with the growing use of ‘smart phones’ and mobile computing. Mobile Learning is an emerging trend where individuals are using otherwise wasted time, on train or commuter journeys, to undertake their CPD. Watching YouTube™ broadcasts, downloading and reading PDF documents and listening to podcasts are all relevant CPD activities. In addition, blogging, tweeting and stimulating debates on social networking sites such as ‘LinkedIn’ are useful ways to reflect on specific issues and to invite others to comment.

The CPD Certification Service recommends that any provider of CPD activities seeks to consider including online training activities as part of their portfolio, since this trend is forecast to increase in the future.

Displaying the CPD Service’s logos underscores the credibility of the training provider, and the inherent value that independent CPD certification adds to training propositions.

The ‘Member’ symbol can be used in any context, whilst the ‘Certified’ symbol indicates to your target audience, and the world at large, that the particular CPD item has been independently certified as being suitable for CPD purposes and may ONLY be used on material relating to that particular item. The annual subscription fee to the CPD Certification Service is currently £1850.00 per annum (+VAT), and this covers the certification of up to 15 topic submissions.

You do not necessarily need to be a training or events company in order to provide CPD certified activities however.

Through its services, you and your organisation will be an expert in its field, and has much to contribute to an individual undertaking CPD as they will want to learn from you. Activities that are appropriate for CPD certification must be generic and have educational benefits, therefore brand-related or sales materials are not suitable for CPD purposes.

Independent certification gives third party endorsement that your messages have been certified as conforming to industry-wide CPD principles – that the time someone spends attending your events and seminars, or reading your literature, can be counted towards their CPD requirement. It gives guidance that the subject is important enough to be related to CPD and reassurance in that the message, whilst coming from a commercial organisation, is properly appropriate for inclusion within a CPD record.

When preparing activities for CPD certification you need to ensure that they will provide a clear learning value and educational benefits for those participating in them. To achieve this they should have a clear structure, learning objectives and should not contain any sales related materials.

Training activities for CPD certification are carefully considered by the CPD Certification Service against criteria outlined in a structured and standardardised checklist. The process takes an objective view of the further learning structure and value, and ensures that the content of the activity concerned conforms to universally accepted CPD principles. It is not within the remit of the CPD Certification Service to challenge ‘technical’ content, but instead consider the CPD value that the activity delivers. Assessments take up to 14 working days to complete.

For more information, please visit: www.cpduk.co.uk

Legislation Royal College of Surgeons Publish Professional Standards for Cosmetic Practice Guidelines for Consideration by Keogh Review The Royal College of Surgeons of England (RCS); an organisation committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care has published what it calls ‘landmark’ professional standards for cosmetic practice, and not just for surgeons either.

Ahead of the well anticipated Department of Health (government) cosmetic intervention review being undertaken by Sir Bruce Keogh, which is due to publish its findings in March, the RCS has chosen to publish a 44 page document entitled Professional Standards for Cosmetic Practice aimed at all doctors, dentists and nurses involved in cosmetic practice. The comprehensive report focuses on the behaviour and competencies medical professionals should be expected to demonstrate when providing cosmetic procedures; it maintains that all cosmetic procedures, surgical or non, should be performed by those with medical training only. Various standards, as summarised below, were developed by the Cosmetic Surgical Practice Working Group made up of key professionals including surgeons, psychiatrists, psychologists and dermatologists.

Professor Norman Williams, President of the Royal College of Surgeons, said: “While the Colleges and professional organisations involved in cosmetic practice are neither regulators nor legislators, the profession has a responsibility to provide standards to which we would expect our members to work.

We have serious concerns that not all those who offer cosmetic procedures are adequately qualified, or that patients are getting accurate information prior to treatment. We hope these standards will feed into the ongoing review of the industry led by the NHS Medical Director, Sir Bruce Keogh, and improve quality of care for patients going forward.”

The working group cites 2010’s National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report On the face of it, which revealed a lack of consistent professional standards in cosmetic surgical practice, as the impetus for these standards.

Mr Ian Martin, NCEPOD Clinical Co-ordinator, said: "In 2008 we identified poor regulation, low volume practice, and deficiencies in training. We also identified poor standards of consent and unrealistic advertisements which had tended to stress the benefits of surgery without dealing sufficiently with potential side effects. The lack of standards and systematic audit was also highlighted. We are very pleased to note that the Department of Health and Royal College of Surgeons are now taking steps to address these deficiencies in cosmetic surgical practice and support the report published today."

In the main the standards or guidelines amount to a recommendation that only surgeons should provide cosmetic surgery, i.e. only those who have qualified as a medical doctor and undertaken post-graduate surgical training should carry out invasive procedures such as breast surgery or liposuction; and only licensed doctors, registered dentists and registered nurses who have undertaken appropriate training should provide non-surgical cosmetic treatments such as lasers and cosmetic injectables (‘Botox’ and dermal fillers). Currently certain cosmetic treatments can be administered by anyone, anywhere with no medical training. They also highlight that all cosmetic procedures should be carried out on licensed premises with resuscitation equipment readily available in the event of an emergency. The concept of ‘Botox parties’ or ‘filler parties’ are entirely at odds with these standards they note.

BAAPS President and advisor to The Consulting Room™, Consultant Plastic Surgeon Mr Rajiv Grover noted; “The regulation of which practitioner can carry out which procedure needs clarification: EU law has some bearing on this and direction is due from a Europe-wide CEN committee in which the UK and BAAPS has representation.”

According to a survey of clinicians including surgeons, doctors and nurses carried out by the Clinical Cosmetic & Reconstructive Expo, ahead of the event taking place at London’s Olympia this October, three in five practitioners

have come across beauty therapists performing these procedures (cosmetic injectables), one in five have seen hairdressers doing so, and one in ten have witnessed members of the public offering them. A staggering majority (85%) believe that current systems for regulation, such as the Government-backed voluntary register TreatmentsYouCanTrust, do not protect patients from unscrupulous practices.

The RCS guidelines also state that as standard practice, practitioners should discuss relevant psychological issues (including any psychiatric history, eating disorders etc.) with the patient to establish the nature of their body image concerns and their reasons for seeking treatment. They should not at any point imply that treatment will improve a patient’s psychological wellbeing. They note that practitioners have a duty to manage a patient’s expectations of how they will feel after treatment. They should not imply that patients will feel ‘better’ or ‘look nicer’, and should instead use unambiguous language like ‘bigger’ or ‘smaller’ to describe what that patient is trying to change. All practitioners should consider whether they should refer a patient to a clinical psychologist before proceeding with further consultations or treatments.

The standards also lay out the professional duty practitioners have to their patients, including the need to ensure they have a clear understanding of the risks of the procedure, outlining consequent aftercare and being transparent about costs from the outset.

Finally, they touch on the promotion of cosmetic procedures and state that financial inducements or deals such as time limited offers and discounts should be banned. The standards also outline the importance of having a cooling off period between the initial consultation and treatment – giving at least two weeks for invasive surgical procedures to allow patients to reflect on their decision.

Mr Steve Cannon, Chairman of the Cosmetic Surgical Practice Working Group and RCS council member, said: “As the majority of cosmetic procedures are not available on the NHS, we must ensure that commercial interests do not compromise patient safety. With the demand for cosmetic surgery and non-surgical treatments rising year on year, it is crucial that the highest level of professionalism is maintained amongst practitioners.”

The British Association of Aesthetic Plastic Surgeons , the only organisation based at the Royal College of Surgeons has welcomed the publication of the Professional Standards for Cosmetic Practice report but would like requirements to go further than the document states, particularly in regards to patient consultations and advertising.

Mr Rajiv Grover noted; “At the BAAPS we welcome the Royal College of Surgeons’ appreciation of the urgent need for stricter controls in the cosmetic sector. This report is a step in the right direction and its content will have fed into the call for evidence of Sir Bruce Keogh’s review. At the heart of a proper patient consultation lies fully informed consent; conveying the elements of medical and psychological assessment, treatment options, providing a realistic idea of likely outcome and possible risks is essential. For consent to really qualify as “informed consent” however, the BAAPS would go a stage further than this report and unambiguously specify that the consultations must only ever be with the surgeon who will actually carry out the procedure.”

Rajiv stresses that protecting the public is nothing more than ‘Hippocratic’, and argues that advertising does not contribute to patient safety. He said; “The protection of the public at large is nothing more than the duty of the medical profession: to adhere to the Hippocratic Oath which states first do no harm. The marketing and advertising of cosmetic procedures is neither educating nor informing, but an exercise squarely aimed at achieving sales. This clearly puts economics ahead of patient care. Although the RCS report suggests tighter control of marketing in this area with a ban on such strategies as time-limited offers, again at the BAAPS we feel there is a need to go even further - the only way to fully protect the public is to have an outright ban on advertising, as seen in some European countries and which is also applicable to prescription medicines.”

The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), which represents Plastic Surgeons on behalf of the Royal College, is a member of the Cosmetic Surgical Practice Working Party.

Tim Goodacre, Head of Professional Standards at BAPRAS and a leading consultant plastic surgeon, said: “We welcome the report and hope it will start to address our concerns over inconsistent professional standards within cosmetic surgical practice. The report provides a good overview of existing standards which, if rigorously enforced, would help protect patients from unscrupulous practitioners. We now need to focus on the creation of a robust mechanism for reporting surgical outcomes, both good and bad, in order to trace the ‘how, where and why’ surgeries go wrong and who is responsible. We would also like to see a more rigorous training path mandated for all those carrying out cosmetic surgery procedures and a mechanism of evaluating credentials for surgeons visiting from overseas, to ensure the highest standards of patient safety and care. Professionalism and patient safety are our foremost concerns and BAPRAS is at the forefront of driving the highest standards of cosmetic surgical practice. We look forward to the publication of Sir Bruce Keogh’s cosmetic surgery report, which we have also been

closely involved in developing, to provide guidance on ensuring a gold standard in plastic surgery safety and care, including developing training, ongoing education, standard setting and research into better practice.”

No one can deny that the cosmetic surgery and medical aesthetic industry is in for some serious changes this year.

In the last decade, various published reports and recommendations have come and gone, from reports by the then Healthcare Commission to the more recent NCEPOD analysis, all of which have failed to leave any lasting legacy; yet the quantity and quality of input and evidence received by the government from the public, practitioners and representative bodies, along with the levels of anticipation for Sheriff Keogh’s hard hitting clean up strategy for our Wild West Aesthetic Industry is unprecedented. The entire aesthetic and cosmetic sectors are in for a considerable upheaval as we all seek to establish a long term strategy for better regulation of the industry, improved medical practice and greater protection of the public at large from rogue practitioners, rogue practices and rogue products. I think I’m looking forward to the day the recommendations are published more than anything else this year, including my birthday and Christmas; that’s how important they’re likely to be for us all!

The full report (in PDF format), Professional Standards for Cosmetic Practice is available from here.

Mapperley Park Submissions to the Keogh Review Lobbying the Review into cosmetic procedures (including lasers and injectables) has reached its cut-off now with findings due to be published at the end of March. In this, IHAS has come down firmly on the side of the status quo – being voluntary regulation with some kind of ‘better mandates’ to support the current, marginal uptake of the voluntary registration scheme known as Treatments You Can Trust, due to be extended to lasers & light this year.

At the same time, the Royal College of Surgeons has plumped for a doctor/dentist/nurse-only position that would require legislation and would enforce a medical closed-shop in a sector that currently includes other health-care professionals, beauty therapists and also those that are entirely unqualified.

Both positions are problematic for providers such as ourselves, for with 20 years of daily experience in both delivery and in training, we believe that the malaise in our sector requires statutory regulation in order to get a grip on the wilder outreaches (Keogh’s ‘grubby practices’) without agreeing that general medical qualifications are in themselves adequate with respect to procedure specific competence. It is this competence that we believe to be the point.

Our own submissions to the review looked to provide statistical evidence from our corner. We first showed that training in this sector has become an entirely voluntary matter and that in a recession, volunteers vote with their wallets; unsurprisingly, the demand for non-statutory laser training appears to have all but collapsed, a factor the review panel found to be of great interest.

We were subsequently invited to return to the review with what evidence we could raise on the harm that we could see being done. We then analysed a significant tranche, being our own most recent consultation forms and we noted references to previous treatments and we found that 30% of our new arrivals were looking for solutions to the problems caused by other providers rather than treatment for the primary condition. This is fairly evenly split between medical practitioners (23% of the problems reported to us), beauty therapists and tattooists (30% each), with chain providers making up the balance. This seems to be a recent, and accelerating, problem, with third-party issues being almost unknown when we opened in 1993 and much lower only 5 years ago. And, of course, problems do not relate to whether the provider has a medical qualification or not but as to whether they are capable. The evidence from both training delivery and in provider problems is that expertise is a reducing resource in our sector, driven as it is by celebrity endorsement, internet data harvesting and the hard-sell, with consumers increasingly unable to differentiate between the good, the bad and the downright scary among the noise of modern marketing.

So, where is Keogh going to go with all this – and how will Government respond? We believe that Keogh will recommend universal, statutory regulation of some form but will not seek to enforce a medical closed-shop, for the genie is long escaped from that particular enclosure and Human Rights legislation enshrines the right to the fruits of an honest labour. In the end, the matter will lie with Government, but also with the public. If they remain uninterested, a Levenson style fudge will be available and IHAS may get their way, as this aligns most closely with anti-regulation interests both inside and outside Government. However, it might not be so easy for politicians, or for our industry to ignore the tens of thousands of people, chiefly women, who have been and will continue to suffer at the hands of unscrupulous and sometimes dangerous providers. It is our belief that these voices should and will be the most influential in guiding a public policy that can ensure safety and quality of care in cosmetic procedures.

Written by Paul Stapleton and Jo Martin

Cosmetic Surgery (Minimum Standards) Bill Calls For OffCos Regulator A private member's bill, entitled Cosmetic Surgery (Minimum Standards) Bill 2012-13 to ‘establish minimum standards for the practice of cosmetic surgery, including non-surgical procedures; and for connected purposes’ was introduced to Parliament on 17th July 2012 under the Ten Minute Rule by MP Ann Clwyd.

The Ten Minute Rule allows an MP to make his or her case for a new bill in a speech lasting up to ten minutes. An opposing speech may also be made before the House decides whether or not the bill should be introduced. If the MP is successful the bill is taken to have had its first reading.

The Cosmetic Surgery (Minimum Standards) Bill 2012-13 was due to have its second reading debate on 1st February 2013, but the bill was never reached in the time allowed on the parliamentary agenda, being 7th on the st list, so this has been rescheduled for 1 March 2013.

In summary, the bill covers a variety of areas including the setting up of an implant registry, the creation of a regulator entitled The Cosmetic Surgery Regulatory and Standards Authority (OffCos) which will also regulate non-surgical providers, a prohibition of advertising of cosmetic surgery and cosmetic intervention procedures, along with details of offences for doing so. The proposed name for an Act, should it become law would be the Cosmetic Surgery (Minimum Standards) Act 2013 to cover England, Scotland, Wales and Northern Ireland.

BAAPS President, Mr Rajiv Grover has written to Ann Clwyd MP to state that the British Association of Aesthetic Plastic Surgeons ‘officially and publicly endorse’ her bill and that she can ‘count on their support 100%’.

The full draft of the bill as currently proposed is listed below: 1. Implant registry (1) There shall be a body corporate known as the United Kingdom Implant Registry (“the Registry”).

(2) The Registry will record details of implants, including— (a) (b) (c) (d) (e) (f)

the date that the surgery occurred, the manufacturer, the model, where and when the implant was manufactured, the details of the person who underwent the implant procedure, the name and location of the clinic where the surgical procedure was undertaken, the name of the clinic where the person who underwent the surgical procedure received consultation services, and (g) the name and details of the practitioner who carried out and oversaw the surgical procedure.

(3) Details of each implant will be updated to allow for monitoring of clinical outcomes.

(4) The information held by the Registry, except the name and address of the person who underwent the surgical procedure, will be publicly available.

(5) The information described in subsection (2) will be available to the person who underwent the surgical procedure or a medical practitioner on their behalf.

(6) The Registry may issue a safety warning about an implant, manufacturer or practitioner.

(7) In the event of such a warning being issued the Registry will contact all the persons affected.

2. The Cosmetic Surgery Regulatory and Standards Authority (1) There shall be a body corporate known as the United Kingdom Cosmetic Surgery Regulatory and Standards Authority (“OffCos”).

(2) All practitioners of cosmetic surgery will be required to register with OffCos. (3) No practitioner not registered with OffCos shall undertake cosmetic surgery and cosmetic intervention procedures.

(4) OffCos will be responsible for issuing licences to practitioners and for licensing surgical premises, and may withdraw licences if it considers practitioners and premises to be unfit.

(5) OffCos, in conjunction with the Care Quality Commission in England, the Care and Social Services Inspectorate Wales, the Regulation and Quality Improvement Authority in Northern Ireland, and the Care Commission in Scotland, will be responsible for inspecting and licensing cosmetic surgery practitioners and premises.

(6) OffCos will operate a financial guarantee scheme which practitioners will be required to join.

3. Prohibition of advertising cosmetic surgery and cosmetic intervention procedures (1) A person who in the course of a business publishes a cosmetic surgery or cosmetic intervention procedure advertisement, or causes one to be published, in the United Kingdom is guilty of an offence.

(2) A person who in the course of a business prints, devises or distributes in the United Kingdom a cosmetic surgery or cosmetic intervention procedure advertisement which is published in the United Kingdom, or causes such a cosmetic surgery or cosmetic intervention procedure advertisement to be so printed, devised or distributed, is guilty of an offence.

(3) Distributing a cosmetic surgery or cosmetic intervention procedure advertisement includes transmitting it in electronic form, participating in doing so, or providing the means of transmission.

4. Offences A person guilty of an offence under section 2 or 3 is liable on summary conviction, to imprisonment for a term not exceeding 6 months, or to a fine not exceeding level 5 on the standard scale, or to both.

5. Non-surgical cosmetic intervention procedures All non-surgical cosmetic intervention procedures, including practitioners and products will be regulated and licensed by OffCos. 6 Financial provisions There is to be paid out of money provided by Parliament— (a) any expenditure incurred under or by virtue of this Act by the Secretary of State, and (b) any increase attributable to this Act in the sums payable under any other Act out of money so provided.

7. Short title, commencement and extent (1) This Act may be cited as the Cosmetic Surgery (Minimum Standards) Act 2013.

(2) This Act comes into force at the end of the period of 1 year beginning with the day on which it is passed.

(3) This Act extends to England and Wales, and Scotland and Northern Ireland.

The progress of the bill can be tracked and monitor by visiting: http://services.parliament.uk/bills/2012-13/cosmeticsurgeryminimumstandards.html.

For those interested it is also possible to subscribe to receive updates by email from that page.

MHRA Want Your Help With Foreign Dermal Filler Sales I’m sure, like The Consulting Room™ Team, not a day goes by when you don’t get an email, normally from China, trying to sell you their ‘very good, generic hyaluronic acid dermal fillers’ for a fraction of the price of well established commercial products available in the UK supply chain.

Well, perhaps in light of all the recent investigations into medical devices which include dermal fillers by the Keogh Review, the Medicines and Healthcare products Regulatory Agency (MHRA) want to do something about this growing marketplace to tackle it before more generic and counterfeit products enter the country and put patient safety at risk.

Tracy Murray, Head of Compliance and Enforcement at the MHRA, can be sent emails received from overseas offering dermal fillers (of any kind) for sale in the UK. Tracy will reply to the email you send and explain what compliance means to the vendor and threaten them with enforcement.

Please email: tracy.murray@mhra.gsi.gov.uk

Educational Opportunities

Training, Events, Mentoring etc...

Ensure that you are kept up to date with all educational opportunities, including webinars, seminars and conferences. www.cosmetictraining.co.uk is a focused directory that brings together key training opportunities and events. The dedicated and unique reference site will provide information about all areas of the Aesthetic business:

Cosmetic Training Features:      

Conferences & Meetings Bespoke Training and Mentoring Cosmetic Industry Qualifications Training Venues for Hire Training Courses & Webinars Business Related Seminars

With over 40,000 Procedures performed in Britain in 2010 we are constantly seeing emerging trends, new innovations, new products and new procedures. Therefore it’s important for you and your staff to keep constantly updated on all the changes in this fast paced business.

Receive a FREE monthly email update on the upcoming and latest events and opportunities.

For those members who offer training/mentoring or rooms for hire we also offer a range of competitively priced advertising options - including listing of training courses in our directory, targeted banner advertising in our training search results pages and opportunities to sponsor our monthly training update e-newsletter. Click on the image to learn more.

www.cosmetictraining.co.uk

Conferences Dates For Your Diary Cosmetic Expo 2013 Incorporating The Aesthetic Conference 2013 The Cosmetic News Expo is the UK’s largest aesthetic conference and exhibition. Entry to the exhibition and workshops is free but there is a charge for the conference. For more information and last minute booking visit: www.cosmeticnewsuk.com th

th

16 & 17 February 2013 at the Business Design Centre, London.

Aesthetic Medicine 2013 Aesthetic Medicine 2013, within Professional Beauty, offers a dedicated exhibition and conference for both surgical and non-surgical professionals and brings together national and international experts that will share their clinical and market knowledge. There are more than 350 exhibitors and a two tier programme covering 4 agendas for surgeons, doctors, nurses, clinic owners and qualified professionals who are considering offering aesthetic medical treatments in the UK. For more information please visit: www.amevent.co.uk 24th & 25th February 2013 at the ExCel in London

SMART IDEAS Seminar: Proven Business Strategies and New Product Ideas to Increase Your Profits in 2013 This unique seminar, organised by The Consulting Room , includes a full day business agenda, featuring the very latest practical business and marketing tactics related to running an aesthetic clinic, alongside a parallel agenda devoted to the latest devices, injectable aesthetic techniques and other concepts that you can incorporate to increase your clinic's profits during 2013. CPD points applied for. For more information on the two agendas and to register, please visit: www.smartseminar.co.uk Saturday 27th April 2013 (London)

FACE Conference 2013 FACE 2013, the UK’s premier medical aesthetic conference and exhibition is moving to a larger venue in 2013 to help accommodate the growing lecture programmes. For more information as the agendas unfold, please visit: www.faceconference.com 21st – 23rd June 2013 at the QEII Conference Centre, Westminster, London

Clinical Cosmetic & Reconstructive (CCR) Expo A business-to-business event that will bring the international surgical and non-surgical community together under one roof. The expo will showcase over 120 international exhibitors: from cutting edge surgical equipment and supplies through to non-invasive products, business services, training and consultancy. There will be 14 days of Continuing Professional Development (CPD) content, including workshops, conferences and live demonstration theatre. For more details, please visit: www.ccr-expo.com 11th – 12th October 2013 at the Olympia, London

For details of all upcoming UK and Non-UK conferences and exhibitions please visit our Cosmetic Training website.

BACN - Business Skills Workshop Improve your Aesthetic practice - New ideas and concepts, business planning and implementation, misconceptions and understanding the bottom line - leading to better results and increased profits.

Held at the Prestigious Venue:

Royal College of Obstetrics and Gynaecology 27 Sussex Place Regents Park London NM1 4RG

Monday 11th March 2013 9.30am - 5pm Special Delegate Rate ÂŁ60 for BACN members only ÂŁ90 non-member Rate includes 2 course hot lunch and refreshments throughout the day.

Presentations Include: Richard Crawford Small - Exclusive BACN Launch - New iClinic. Access to your clinic, patients, photo gallery, consent, treatments charts, CPD all from your personal cloud, wherever you are - the way forward for 2013 Dr Jason Williams - Exclusive BACN Launch - "Psyche" up your profits - A whole new concept in ethically improving

profitability Jack Cottle - Climbing the Google ladder and blogging Lorna Bowes - Customer loyalty - the 20 year patient Emma Davis - Nurses that Sell (What are we selling?)

Alison Telfer - "Smart Stockings" - How to intelligently select and stock products to improve your practice Marcus Haycock - Improving your practice with key reports and measurement indicators Lorna Jackson - Advertising - the Do's and Don'ts, Can's and Can'ts in websites and print Ron Myers - Web Marketing strategies and discounting decisions Peter Roberts - Business models that work and putting them into action.

Limited spaces available Bookings being taken by Liz de Pass in BACN office Contact 01749 836 328 to book now Booking closes Friday 1st March and bookings on first come, first served basis For additional information contact sharonbennettuk@gmail.com

O Ovveerr 55,,550000 cclliinniiccaall aabbssttrraaccttss iinn oouurr M Meem mbbeerrss A Arreeaa!!

Clinical Information

Massive Subcutaneous Emphysema After Carbon Dioxide Mesotherapy.

Calonge WM, Lesbros-Pantoflickova D, Hodina M, Elias B. Department of Medicine, Clinique de Genolier, Switzerland.

Aesthetic Plast Surg. 2013 Jan 8.

The authors report the observation of a 43-year-old woman with severe pain on her right upper abdominal quadrant. Differential diagnoses included acute cholecystitis, spontaneous pneumothorax, perforated appendicitis and a recidive of renal calculus. CT-scan showed a huge subdermal gas bubble along her right flank and anterior abdominal wall up to the submammary fold. Only at this point, the patient admitted to have undergone a carboxytherapy procedure on both thighs one day before onset of pain in a paramedical facility. As some of the injection trajects were still patent on CT-scan, she received prophylactic antibiotic coverage. Though there was a complete resorption of gas after 10 days, dysesthesias and muscle contracture persisted for 3 weeks. To the authors' knowledge this migration and coalescence of injected gas in a single bubble has not been previously reported.

Efficacy and safety of a novel botulinum toxin type a product for the treatment of moderate to severe glabellar lines: a randomized, double-blind, active-controlled multicenter study.

Won CH, Lee HM, Lee WS, Kang H, Kim BJ, Kim WS, Lee JH, Lee DH, Huh CH. Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

Dermatol Surg. 2013 Jan;39(1 Pt 2):171-8.

BACKGROUND: A new botulinum toxin type A (NBoNT) produced from the same strain of Clostridium botulinum as onabotulinumtoxinA (OBoNT) is widely used in Asia.

OBJECTIVES: To compare the efficacy and safety of NBoNT and OBoNT for moderate to severe glabellar wrinkles.

METHODS: A double-blind, randomized, active-controlled, phase III study was performed. Three hundred fourteen patients were randomized at a 1:1 ratio to receive 20 U of toxin. The primary end point was the responder rate according to investigator live assessment at maximum frown at week 4. Secondary end points were responder rates according to investigator live assessment with frowning and at rest at weeks 8, 12, and 16, with additional photographic assessment by a panel of blinded raters 4 weeks after injection. Subjective satisfaction scores were also evaluated.

RESULTS: Four weeks after treatment, responder rates for maximum frown were 93.7% (133/142) in the NBoNT group and 94.5% (138/146) in the OBoNT group. For secondary end points, there was no significant difference between the two groups for any variable at any time point. Noninferiority of NBoNT was confirmed. There were no serious adverse effects with either toxin.

CONCLUSION: NBoNT is equally as effective as OBoNT for the treatment of glabellar frown lines. Both toxins were well tolerated.

Mycobacterium chelonae Facial Infections Following Injection of Dermal Filler.

Rodriguez JM, Xie YL, Winthrop KL, Schafer S, Sehdev P, Solomon J, Jensen B, Toney NC, Lewis PF. Aesthet Surg J. 2013 Jan 18.

A cluster of 3 facial Mycobacterium chelonae infections occurred after cosmetic dermal filler injections at a plastic surgery clinic. Pulsed-field gel electrophoresis showed that M chelonae isolated from the clinic tap water were identical to the patient wound isolates. Review of injection procedures identified application of nonsterile ice to the skin prior to injection as a possible source of M chelonae. Surveys of regional laboratories and a national plastic surgery listserv identified no other cases related to the injection of this brand of dermal filler. This is the first report of cutaneous M chelonae infections following the injection of dermal fillers. It adds to a growing body of literature on postinjection M chelonae infections and reinforces the importance of optimal skin disinfection steps prior to percutaneous procedures.

Nitroglycerin: a review of its use in the treatment of vascular occlusion after soft tissue augmentation.

Kleydman K, Cohen JL, Marmur E. Division of Dermatologic and Cosmetic Surgery, Department of Dermatology, Mount Sinai Medical Center, 5 East 98th Street, New York, NY 10029, USA. Dermatol Surg. 2012 Dec;38(12):1889-97.

BACKGROUND: Skin necrosis after soft tissue augmentation with dermal fillers is a rare but potentially severe complication. Nitroglycerin paste may be an important treatment option for dermal and epidermal ischemia in cosmetic surgery.

OBJECTIVES: To summarize the knowledge about nitroglycerin paste in cosmetic surgery and to understand its current use in the treatment of vascular compromise after soft tissue augmentation. To review the mechanism of action of nitroglycerin, examine its utility in the dermal vasculature in the setting of dermal filler-induced ischemia, and describe the facial anatomy danger zones in order to avoid vascular injury.

METHODS: A literature review was conducted to examine the mechanism of action of nitroglycerin, and a treatment algorithm was proposed from clinical observations to define strategies for impending facial necrosis after filler injection.

RESULTS AND CONCLUSIONS: Our experience with nitroglycerin paste and our review of the medical literature supports the use of nitroglycerin paste on the skin to help improve flow in the dermal vasculature because of its vasodilatory effect on small-caliber arterioles.

Independent evaluation of low-level laser therapy at 635 nm for non-invasive body contouring of the waist, hips, and thighs.

McRae E, Boris J. 117 S. Saunders St., Boerne, Texas 78006.

Lasers Surg Med. 2013 Jan;45(1):1-7.

INTRODUCTION: The non-invasive body-contouring segment continues to exhibit uninhibited growth, a trend that has provoked the emergence of numerous body-contouring devices. One particular device, low-level laser therapy at 635 nm (LLLT-635), has exhibited promising clinical results. We performed an independent, physician-led trial to evaluate the utility of LLLT-635 nm for non-invasive body contouring of the waist, hips, and thighs.

METHODS: Eighty-six participants were retrospectively assessed at an individual clinic in the United States. A multi-head laser device was administered every-other-day for 2 weeks. Each treatment consisted of 20 minutes of anterior and posterior treatment. Patients received concurrent treatment of the waist, hips, and bilateral thighs.

Circumferential measurements were evaluated at baseline and one week following the 2-week treatment administration phase.

RESULTS: Compared with baseline, a statistically significant 2.99 in. (7.59 cm) mean loss was observed at the post-procedure evaluation point (P < 0.0001). When analyzed individually, the waist, hips, and thighs each reported a statistically significant reduction of -1.12, -0.769, and -1.17, respectively. Furthermore, linear regression analysis revealed a weak linear dependence (r = 0.179) between the reported weight and circumference change.

CONCLUSION: These data further validate the clinical efficacy and safety of LLLT at 635â&#x20AC;&#x2030;nm.

Concomitant use of an infrared fractional laser with low-dose isotretinoin for the treatment of acne and acne scars.

Yoon JH, Park EJ, Kwon IH, Kim CW, Lee GS, Hann SK, Kim KH, Kim KJ. College of Medicine, Hallym University, Dermatology, Hallym university sacred heart hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang, Gyeonggi-do, Anyang, Gyeonggi-do, Korea..

J Dermatolog Treat. 2013 Jan 22.

Background: Acne scarring has lifelong sequelae. Fractional photothermolysis (FP) has been shown to provide fast recovery from acne within a short period, thereby aiding skin rejuvenation. Isotretinoin is a well-known, effective drug for the treatment of severe recalcitrant acne. This study investigated the safety and the efficacy of infrared fractional laser treatment in conjunction with low-dose isotretinoin for the treatment of acne and acne scars.

Materials: A 1550 nm Erbium-doped fiber laser was used to treat 35 patients with acne scarring. All the patients had taken isotretinoin (10 mg/day) for more than one month prior to the commencement of the fractional laser treatment.

Results: There was no aggravation of acne scars, hypertrophic scars, or keloids. Most of the patients (33 patients) received reduced microthermal damage zone (MTZ) treatment. Eighty percent of the treated patients (28 patients) demonstrated more than a fair improvement. The total average score on the global acne scarring classification before treatment was 13.5, and the score after treatment was 11.2.

Conclusion: Acne and acne scars can be treated more effectively by concomitant use of an infrared fractional laser with low-dose isotretinoin with reduced MTZ densities. Most patients showed more than a fair improvement, and there was no aggravation of the scars.

Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: a randomized, double-blind, prospective trial.

Saeedi M, Hajheydari Z, Morteza-Semnani K, Soltani A. Faculty of pharmacy, Pharmaceutics, p.o.box 48175-861, Khazar road, Sari, Mazandaran, Iran.

J Dermatolog Treat. 2013 Jan 22.

Background: Topical retinoids are considered first line therapy in the treatment of acne vulgaris, yet can be associated with cutaneous irritations. Combination therapy with natural preparations could be effective in treatment and decreasing adverse events.

Objective: The aim of this study was to compare the efficacy and safety of the combination of tretinoin cream (0.05%) and Aloe vera topical gel (50%) with tretinoin and vehicle.

Methods: The randomized, double blind, prospective 8-week trial evaluated inflammatory and noninflammatory lesion scores and tolerability in 60 subjects with mild to moderate acne vulgaris (Global Acne Grading System scale).

Results: Several formulations of Aloe vera leaf gel were prepared and the most stable one was selected for clinical study based on physicochemical evaluations. The combination therapy showed superior efficacy to tretinoin and placebo. Tretinoin/Aloe gel was significantly more effective in reducing noninflammatory (P=0.001), inflammatory (P=0.011), and total (P=0.003) lesion scores than control group. The highest percentage of adverse cutaneous effect was reported for scaling. At the end of study erythema in the tretinoin/Aloe gel treated group was significantly less severe (P=0.046).

Conclusion: The combination tretinoin/Aloe gel was well tolerated and significantly more effective than tretinoin and vehicle for the treatment of mild to moderate acne vulgaris.

SOURCE: PubMed

Interesting News Articles You May Have Missed Due to global copyright laws the Consulting Room™ is unable to reproduce entire news articles; therefore we provide an abstract and a link to the original news article. Although every effort is made to ensure that these links continue to function, there are occasions when third party websites will remove or archive the news article, leading to a broken link. We apologise if you find such a problem, and would appreciate it if you would inform us by emailing admin@consultingroom.com so we can make every attempt to remedy it.

Lloyds TSB credit card compensation for PIP women Women who paid for faulty PIP breast implants on Lloyds TSB credit cards are to receive "full, proper compensation". Lawyers representing 600 women say they have reached an agreement with Lloyds TSB but are still negotiating with 23 other card issuers.

SOURCE: BBC News

Fake doctor jailed after jabbing strippers at Botox party A serial con man who pretended to be a plastic surgeon and injected bikini-clad strippers with fake Botox at a Surfers Paradise party was jailed yesterday but could be free within six months.

David Robin Douglas, 48, who has legally changed his name to O'Cean, admitted he pretended to be Los Angelesbased "Doctor Ocean" in 2010 when he enticed a strippers-for-hire company into booking him for a Botox injection party in Surfers Paradise.

SOURCE: Courier Mail

IAPS is concerned over plastic surgery adverts The Irish Association of Plastic Surgeons (IAPS) is concerned by what it has described as the growing number of doctors who are either advertising or being quoted in the media claiming they are plastic surgeons when they are not.

SOURCE: Irish Medical Times

Surgeons offer clear-cut solution to 'Fly-In-Fly-Out' problem With increasing reports of patients experiencing problems trying to track down and secure compensation from surgeons who ‘fly in, fly out’ (ie are not permanently based in the UK), the British Association of Aesthetic Plastic Surgeons, presents a clear-cut and cost-neutral solution. The scale of the problem is hard to estimate, they say, as many surgeons from abroad do not have indemnity policies based in this country.

SOURCE: BAAPS

BMA Poll reveals opposition to plastic surgery ads A BMA survey has revealed opposition to the advertising of cosmetic surgery to the public.

In response to the BMA website poll question ‘should advertising cosmetic surgery directly to the public be banned?’, 225 people said yes and 101 said no. Another 22 people said they did not know. The survey results mirror the findings of the Department of Health Review of the Regulations of Cosmetic Interventions: Call for Evidence, to which the BMA responded.

SOURCE: BMA

Regulator Of Skin Aging Despite progress in regenerative medicine, with age, the skin loses its properties in an irreversible manner. The ATIP-Avenir team "Epidermal homeostasis and tumorigenesis" directed by Chloe Feral, an Inserm researcher at the French Cancer and Aging Research Institute (Inserm/CNRS/Universite Sophia Antipolis), has just defined the cellular and molecular mechanisms involved in maintaining skin cells and skin healing in advanced years.

SOURCE: Medical News Today

An Essential Step In The Skin's Response To UVA Light The new discovery, published the week of Jan. 21 in the Proceedings of the National Academy of Sciences, is that human melaoncyte skin cells rely on an ion channel called TRPA1 to allow a flood of calcium ions into the cells when they are exposed to UVA light. The resulting abundance of calcium ions signals the cell to begin making melanin, the pigment responsible for the tanning response in people.

SOURCE: Medical News Today

Rise in cosmetic surgery for over-60s as 'silver separators' want to look younger to find new love A generation of 'silver separators' are booking cosmetic surgery and buying more anti-aging products as they return to the the dating game in their retirement years.

The number of couples divorcing in their 60s and 70s has risen dramatically in the last decade and now these newly single men and women are looking to enhance their image in their quest to find fresh romance.

SOURCE: Daily Mail

Health Canada: New Labelling Information for all Botulinum Toxin Products: Botox/Botox Cosmetic, Dysport, Xeomin/Xeomin Cosmetic and Myobloc In order to help prevent medication errors with the use of botulinum toxin products currently available on the Canadian market, Health Canada will be requesting that all manufacturers of these products revise their product labels to reflect that each product has its own individual potency and as such, is not interchangeable with other botulinum products.

SOURCE: Canada Newswire

Botox Injections In The Stomach Do Not Promote Weight Loss Despite conflicting data in support of the practice, some overweight Americans looking for an easy fix have turned to gastric botox injections to help them lose weight. This month in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association, researchers from the Mayo Clinic publish a definitive study finding that Botox doesn't promote weight loss.

SOURCE: Medical News Today

Medics `scaremongering` to influence aesthetics review, says Babtac Babtac (British Association of Beauty Therapy and Cosmetology) has accused medical associations of "scaremongering" by feeding biased misinformation to the media during the critical stages of the government review into cosmetic procedures.

SOURCE: Professional Beauty

Advertisement ABC Cryo Premium The most powerful cooling system on the market The revolutionary cryogenic skin cooling device from ABC Lasers hygienically cools the epidermis, before and after treatment, and dramatically reduces pain for a wide range of aesthetic treatments including IPL, Laser Tattoo Removal, Botox®, Injections, Fractional CO2 Laser therapy, Skin Resurfacing and more ablative IPL procedures.      

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Great Member Special Offer Receive a Free Pair of NoIR LaserShields® IPL Shade 3 Style 35 Goggles when you buy Yamamoto Patient Eye Safety Guards. *** OFFER EXTENDED! *** This great offer is only available to Consulting Room members.

The Yamamoto YL-800w safety eye guard provides high quality protection for your patients eyes when using IPL/Lasers/Radiofrequency and Microdermabrasion.

Suitable for combined Radiofrequency/Laser/IPL devices as they do not conduct any electrical current.    

Colour of eyecup: white Detachable and adjustable rubber strap Comes with nose bridge size medium (can be interchanged with small and extra large bridges included for tailored patient comfort) Softcase included

Purchase these superb Yamamoto patient eye safety guards for only £105.75 (inc. VAT) – that’s a saving of £17.63 on non-member prices already - and receive the NoIR IPL Shade 3, Style 35 goggles (worth up to £52.88) absolutely free!

Take advantage of this great offer!

For more information on the products and to discuss this and other great laser/IPL eye protection deals, call us on 01788 577254.

Advertorial Laser Servicing & Repairs Expansion Cosmetic Laser Servicing are proud to announce that they have teamed up with Lasertronics, one of the most experienced service organisations in this specialist area, to deal with the ever increasing number of requests for laser servicing and repairs.

Lasertronicsâ&#x20AC;&#x2122; team of seven operate nationwide through strategically placed Laser Engineers in the North, Midlands and South to offer an on demand, speedy service cover at a competitive price. Lasertronics is now in its 20th year of operation and has mostly gained experience through maintaining a fleet of over 250 lasers for national chain sk:n clinics. They are now expanding their operation to work with Cosmetic Laser Servicing.

David Base, Director of Engineering ensures that his engineers are kept up to date with training from a variety of major manufacturers. This ensures that the team are able to look after a wide range of equipment in order that Lasertronics can act as a â&#x20AC;&#x153;one stop shopâ&#x20AC;? for clinics operating various makes of lasers, cryo-cooling devices, cold air blowers and microdermabrasion equipment.

Service Manager, Paul Allen is the principle contact for service calls. His aim is to ensure that faulty equipment is back up and running with minimal delay and that clinic operators are kept up to date with repair progress. He also schedules the team to complete routine maintenance and other support tasks. Paul has access to loan equipment such as Zimmer Cryo 5 and 6 machines so can quickly resolve a problem with equipment failure.

Lasertronics have an extensive range of spare parts. Many of these are no longer available directly from the manufacturer, thus enabling Lasertronics to repair equipment that may otherwise be obsolete.

Lasertronics aims to project a professional engineering service second to none that compliments that of the clinics it supports. To this end a customer satisfaction survey is conducted at the end of each visit to ensure that objectives are met.

For more information or to book a visit please go to www.cosmeticlaserservicing.co.uk or telephone on 01788 577254

Equipment Sales SaveOnKit pride themselves on excellent customer service. They stock a large inventory of high quality medical, dental and beauty equipment at vastly reduced prices. They are very pleased to offer a high quality service for all your equipment needs. All orders are processed quickly and sent to UK addresses free of charge; they will ship worldwide.

Below are the various devices that they currently have for sale.

Lutronic Mosaic non-ablative Fractional Laser Er:Glass skin-resurfacing System In good condition and full working order For Sale at £14,000 + VAT *PRICE REDUCED £13,300 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=506 Chromogenex NLite V Pulsed Dye Laser Hair removal Rejuvenation System In good condition and full working order For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=458 Lynton Lumina IPL Laser Hair Removal + YAG Skin Rejuvenation Acne Beauty System In very good condition and full working order For Sale at £9,500 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=651 Depilex Dermapeel Professional Microdermabrasion System In good condition, full working order For Sale at £912 *PRICE REDUCED AGAIN £570 + VAT* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=537 RVB active 7 touch beauty machine facial toning professional System This unit has had very minimal use and the condition reflects this some items are new in original packaging For Sale at £475 More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=599 Yperion L900 SR PSR002012 beauty treatment head Brand new, in original box. For use with L900 Hair removal and photolifting beauty machine.

For Sale at £912 *PRICE REDUCED £760* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=539 Eporex K69 Mesotherapy Cellulite Fat Reduction and Skin Rejuvenation System In good condition and full working order, costs £20,000 brand new For Sale at £8,400 + VAT *PRICE REDUCED AGAIN £3,166 + VAT* More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=446 E Light IPL Laser Hair removal Rejuvenation Wrinkle Vascular salon beauty System For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=496 Cosmopro Eye-O-Matic facial restore & skin rejuvenation Full working order. Helps restore and rejuvenate the face and delicate eye contour maximising product absorbency.

For Sale at £285 + VAT More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=598 Nemectron Noblesse for Face and Body Facelift Wrinkles In good condition and full working order For Sale at £1,500 + VAT *PRICE REDUCED AGAIN £950 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=437 Beauty Scope BS-888 Skin and Hair Analyser Intelligent skin/sebum/moisture/pigment diagnosis system For Sale at £300 + VAT *PRICE REDUCED £237.50 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=438

Over line Xilia Stim 8 Face + Body Skin tightening System In good working order complete with attachments, cables, user manual and stand.

For Sale at £1,400 + VAT *PRICE REDUCED AGAIN £1187 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=434 Nemectron Nembrasion Professional Microdermabrasion System In good condition and full working order For Sale at £1,425 + VAT More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=439 Smart Peel Microdermabrasion with LED Light Therapy professional system In good working order complete with attachments For Sale at £2, 280 *PRICE REDUCED £1,425 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=535 Caci Future-Tec Skin Rejuvenation Beauty Machine In good working order complete with attachments - Vaculase, Microlase, Actuator attachments & foot pedal For Sale at £1,700 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=367 Bio –Therapeutic L.A. Smile Teeth whitening system Cost £12,600 new in 2006. Current model, in good condition, had very little use.

For Sale at £3,000 + VAT *PRICE REDUCED £1,900 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=325 Biotec Bioskin LAS Skin Resurfacing Microdermabrasion System Bioskin Las Technology utilises a unique two-element approach to activate skin regeneration.

For Sale at £1,425 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=344 Nora Bode OxyJet Star Oxyaroma Oxyspray facial and body treatment salon machine In very good condition, had had low usage and in full working order For Sale at £7,500 +VAT *PRICE REDUCED £6,175 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=516 Pollogen ReGen Tripollar Radio Frequency skin body facial beauty machine salon Very good condition, full working order. Unit was removed from a small clinic which closed shortly after it opened For Sale at £8,000 +VAT *PRICE REDUCED £7,600 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=515 No+Vello IPL Laser Hair Removal & Skin Rejuvenation Treatments Beauty System In very good condition and full working order. Supplied new in 2010 For Sale at £6,650 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=638 Beau Visage Facial Skin Imaging Diagnosis Treatment Beauty Therapy System In very good condition and full working order For Sale at £3,800 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=640 CACI Flash 1 IPL Hair Removal & Skin Rejuvenation Acne Treatments Beauty System In good condition and in full working order For Sale at £4,000 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=649 New Meridian Lapex BCS Pro 2000P Liposuction Cellulite Fat Laser Beauty Machine New in original packaging. Supplied to a clinic which closed shortly after opening in Late 2011. Unit never used.

For Sale at £9,500 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=677 Biorem Skin Master Plus Multi-functional Ultrasonic Beauty Treatment Machine In good condition and full working order For Sale at £1,330 + VAT More info - www.consultingroom.com/services/equipment-display.asp?equipment_id=678

Visit www.consultingroom.com/services/equipment.asp for a full list of classified sales.

Classifieds FOR SALE OXYjet Basic (Oxygen generator and OXYjet in one unit) Rated as the A List Facial and producing a beautiful soft radiance to the skin, the Oxyjet facial has a great reputation and is a favourite facial treatment to offer to clients. Refurbished machine, in excellent working order.

OXYjet Basic allows clients to experience a more advanced range of anti-ageing treatments targeting muscle tone, eye bags and fine wrinkles to tired, dull and lifeless skin with great results for deep cleansing, acne, pigmentation, body treatments and lymphatic drainage. Medical experience shows that vaccines, anaesthetics for children and insulin could be delivered into the skin by applying a high degree of pressure. The same techniques have been applied to advanced cosmetic care and are used in the Oxyjet treatment.

The Nora Bode OXYjet Basic is an oxygen therapy system created by NORA BODE company in GERMANY. Oxyjet is a laboratory tested and scientific proven treatment that rejuvenates skin affected by fine lines, frown lines, crows feet, loss of skin tone and elasticity, dehydration and general sun damage. It is one of the most advanced methods of restoring lost moisture and stimulating collagen renewal at a cellular level.

Operating Voltage: 230/115 V 50/60 Hz Operating Temperature: 10º to 40º C Power Consumption: 350/400 W Weight: 31 kg Measurements: 900 x 350 x 520 mm Warranty: 2 years Flow Setting: 0,5 to 6 litre/min Treatment Pressure: max. 2 bar Oxygen Performance: to 3 litre/min. 95% O2 ± 3%, to 4 litre/min. 95% O2 ± 3%, to 5 litre/min. 90% O2 ± 3%, to 6 litre/min. 85% O2 ± 3% Safety Certification: CE This item would need to be collected in person or I am willing to drive up to 50 miles to either deliver or meet you at no charge. Courier would be about £60.

Prices: Offers over £999 (£3,599 new) Contact: Alison Taylor, 01242 234707, info@skindetox.co.uk

Electric York therapy couch Two section electric couch. Buyer to collect

Price: £185

Polus Dental teeth whitening machine State of the art machine - Can be seen working. Perfect working order. Buyer to collect.

Price: £990 Contact: Carol Laskey, carol.laser@hotmail.co.uk

Aesthera ISOLAZ Laser (Intense Pulse Light) Laser Type: Used for treating acne with deep pore purification, hair removal, skin rejuvenation, light based skin rejuvenation, hair removal, vascular lesions and vascular pigment lesions Manufacturer Date: 11/2007 - The laser was purchased new by London Bridge Plastic Surgery Serial Number: Z6002 Total shot count: 22687 Other: 230 Volts Supply Required Last Serviced: 18/10/2012 Condition: The laser is in good working order and good condition.

Included: Skin Rejuvenation Filters - small x 1 box (10 per box) Skin Rejuvenation Filters - mixed small and medium x 1 box (10 per box) Pore Cleanse Acne Treatment Filters – small x 1 Pore Cleanse Acne Treatment Filters – medium x 1 box (10 per box) + 4 individual 6 x Cans Tip Spray

Laserscope LYRA i Laser System Laser Type: Long Pulse ND, YAG for hair removal/Leg Veins Manufacturer Date: 03/2006 – The laser was purchased new by London Bridge Plastic Surgery Serial Number: L6430 Part Number: 10-8890 Fluence Range: 5-50 J cm2 Spot Size: 10mm Other: System is air cooled and requires a 20amp power supply, 240 Volts Last Serviced: 18/10/12 Condition: The laser is in good working order. The only visible wear of the machine is to the hand piece tubing which has been protected.

Included: 1 x Power Lead, Interlock 1 x Tray and Pole 1 x Water Fill Kit 1 x Operator Manual 1 x Cart/Chiller 10mm VersaStat I

Laserscope Aura i Laser System Laser Type: Used for treating Telangiectasia, Spider Navei, Vascular lesions, Capillary Malformation, small thread veins Manufacturer Date: 09/2004 –The laser was purchased new by London Bridge Plastic Surgery Serial Number: A1471 Part Number: 10-8990 Fluence Range: 5-900 J cm2 Spot Size: Variable Spot 1 – 5 mm Last Serviced: 18/10/2012 Other: 230 Volts Supply Required Condition: The laser is in good working order. The only visible wear of the machine is to the hand piece tubing which has been protected.

Included: 1 x Power Lead, Interlock 1 x Tray and Pole 1 x Operator Manual 1 x Cart/Chiller 5mm VersaStat I Variable Focus Headpiece

Delivery: Pick up only for all devices.

Prices: Offers accepted on all devices.

Contact: Vanessa Inglefield , 0207 487 0900, Vanessa@lbps.co.uk

Lynton’s Skin Abrasive Medical Microdermabrasion Machine Lynton’s Skin Abrasive System is an easy to use and incredibly reliable microdermabrasion system offering two grades of crystals. It is a light weight desktop base and ergonomically designed treatment handpiece. Includes crystals and tips. Excellent condition and full working order

Price: £500

Lynton Lumina MF (Medical Flashlamp), IPL System LOW USE AND EXCELLENT CONDITION FULL WORKING ORDER The Lumina Medical Flashlamp system is a platform onto which a whole range high intense pulsed light or laser handpieces can be attached. The Lumina System is designed to be versatile and up-gradable, allowing multiple applications now and in the future. The software control automatically detects the handpiece attached and sets suitable parameters to work to.

This particular Lumina is in excellent condition has had low use and a full service history by Lynton Lasers. The Lumina platform for sale includes the following handpieces: 650 advance handpiece for treating skin types 1-3 hair removal, latest technology offers enhanced performance and greater flexibility in the selection of treatment parameters. Great for fine, fair and resistant hair.

650 handpiece for skin types 1-5 hair removal.

650 handpiece also for skin rejuvenation treatments.

585 handpiece for treating acne, pigmentation, vein/ roscea treatments and port wine stains.

Protective eye wear x 4 for clients and practitioners.

Quartz blocks x 4 for all body areas.

Canon IXUS digital camera – for before and after photos.

IPL policies and protocols.

Treatment information leaflets.

Consultation and consent form and after care sheets.

Lynton's comprehensive service history for IPL.

Price: £18,000.00

Zimmer Cryo 5 cooling system An indispensible cooling system for use with IPL and Laser treatments.

Excellent condition and full working order

Price: £2,000

Clinic for sale in South East Kent Sadly due to personal reasons. To include equipment as described above, PLUS: Database of 280+ clients.

Currently working out of GP premises.

Recent CQC inspection available on their website and excellent local reputation.

Lucrative buisiness, even as part time venture.

Price: £25,000 Contact: Julie Kenyon Vaughan, 07505 635 226, enquiries@pureskinclinic.co.uk

Chromogenex, Chromolite S IPL Laser Hair Removal Complete System White Chromogenex Chromolite S with stand and Accessories. This unit is in very good condition with just very very slight markings to the white case. This machine has been used within a clinic setting for hair removal. It comes complete with all accessories and includes: Training Manual, Eye Protection x 2, Rollers, Service History, Filters and Chromolite S stand.

This system will be routinely serviced at the end of January, and therefore can be used from day 1. Your item has also been PAT tested. This system can be demonstrated at the clinic and change of ownership at the time of purchase.

Inspections are more than welcome before purchase. For more information please contact, we can also provide further images and technical information on the unit.

The Chromolite-S delivers more than 25% energy than the standard Chromolite system, now has a sapphire waveguide, and has increased its flash-lamp warranty to 300,000 shots. The new pure sapphire waveguide (the largest on any IPL system) reduces radiated heat thus improving patient comfort to new levels never before experienced. The sapphire waveguide is also easier to keep clean of hair debris. The Chromolite-S has been re-engineered to deliver nearly a 50% increase in energy, this helps deliver even more impressive results for vascular and pigmentation treatments. The Chromolite-S has no other hidden consumable costs. This product can be used for: Epilation/Hair Removal, Skin Rejuvenation, Photo Rejuvenation and much more.

Price: £6,699 (close offers are welcome) Contact: Tim Millinder, 01962 877 899, info@redwoodhealth.co.uk

UltraShape Version 3 Pulsed, focussed Ultrasound and bi-polar RF for fat cell destruction/body contouring. Exdemonstration model of the very latest UltraShape Version 3 from Carleton Medical Ltd, the former distributor before UltraShape was sold to Syneron. Low usage, with the latest VDF technology and 33,000 shots remaining on the transducer (36,000 max).

UltraShape utilizes patented focussed, pulsed ultrasound to selectively destroy fat cells with an average circumference reduction of between of 4 and up to 10cm cm after three treatments of the stomach, thighs or flanks. Non invasive, no downtime procedure. Clinically proven as the most effective body contouring technology.

Full training, installation and support available. Warranty is negotiable.

Price: £42,500 plus VAT Contact: Nick Fitrzyk, 07827 298399, nf@carletonmedical.co.uk

Harmony IPL & Laser Platform System The machine is 5 years old, in excellent condition and has been regularly serviced.

We have 4 Hand pieces Blue, Yellow, Red and Green which are for Hair Removal, Skin Rejuvenation, Acne, Rosacea, Vascular & Pigmented lesion which are included in the sale. You can buy and add to Harmony platform Yag Laser (for deep leg veins & fine wrinkles), Pixel Laser and dark and light tattoo removal laser, & skin resurfacing laser.

They are not part of this sale.

Price: £9,500 Contact: Nicky Shearer, 07530 183831, nicky.shearer@hotmail.com

Advertisement S.A.F.E.â&#x201E;˘ System Surgical Smoke Evacuation The Smoke Evacuator vacuums the plume created by laser and electrocautery treatments such as hair removal, tattoo removal and erbium procedures and protects physicians and staff performing these operations.

The U.S. FDA approved and European CE marked SAFE System smoke evacuator is built to handle any type of surgical smoke. Costs are low to purchase and operate.

Application:

The removal and filtration of laser and surgical smoke

Used by:

Hospitals, Plastic Surgeons, Cosmetic Surgeons, and more

Economical:

Due to the real time filter life pressure gauge

Compact:

9" x 9" footprint, 14" high

Quiet:

Less than 52dBA, quieter than the competition

Filtration:

ULPA: 99.999+%@ 0.12 micron

Weight:

24 lbs.

Electrical:

100-120 VAC, 50/60 HZ 220-240 VAC, 50/60 HZ

Regulatory:

UL, CSA, CE

Tubing:

Vacuum Tubing 7/8" x 8'

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For more information, please contact Martyn Roe on martyn@abs4u.co.uk or telephone 07734 101275

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