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From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For October 2012 We’ve been busy cheering ourselves up as autumn starts by adding new Treatment FAQs to the website, see more about linking your clinic to them below. We’re also busy getting ready for the BODY Conference, read about what’s not to be missed this year in our Conferences section. See you there! In this issue of our Member Magazine for October, our Feature Article looks at blunt micro-cannulae for use with dermal fillers, currently all the rage in facial aesthetics and one of the hottest topics. We summarise all the available brands. Our Legislation section is full this month with the EU Commission tabling proposals for a new regulatory framework for medical devices, including breast implants and other aesthetic implants, BAAPS submitting its own CAP Code for advertising standards within the cosmetic surgery industry and IHAS considering the issue of dermal fillers and how best to move forward with their control.

Lorna Jackson

This month’s New Product Reviews features the VI Peel, a new Vitamin A product from the USA called Retriderm and Medik8 peels. As always the magazine is packed with Latest News, Clinical Information, Equipment Sales, our Business Corner and Interesting News Articles and Blogs That You May Have Missed.

Don’t Forget to Visit Our Cosmetic Videos Site With Members Only Content The Member’s Only section of our new 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. 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.

Members Only Featured Video This Month (Log-in required):

Artiste - Ready to Inject A training video showing the variables to consider prior to any injection, including viscosity of the product, gauge of the needle, area to be treated and injection speed and how these variables can be adjusted using the Artiste Assisted Injection System.

NEW Treatment FAQs: Be Sure to Link Them to Your Clinic Profile We are pleased to announce that full details have now been included within our Treatment FAQs pages for the treatments/products listed below which you can now link to your clinic profiles should you offer them to the public.

Treatments Cryolipolysis - a non-invasive fat removal procedure which induces lipolysis through the cooling of subcutaneous fat cells. Also known by the brand CoolSculpting® from Zeltiq Aesthetics Ltd.

Advanced Cosmetic Procedures (ACP) - is a new name for `Advanced Electrolysis`. ACP uses either Short Wave Diathermy or Blend to treat unwanted skin blemishes and benign growths, as well as thread veins.

Products Pellevé® - The Pellevé Wrinkle Reduction System precisely delivers energy to the dermal tissue using advanced radiowave technology to induce collagen contraction without damaging the epidermis.

Agera Rx Skincare - Agera® is a comprehensive range of active skin care products and includes anti-ageing, anti-pigmentary and acne treatments that work together to produce visible results.

Epionce - Founded by Dr. Carl R. Thornfeldt, Epionce is a comprehensive and innovative skin wellness range designed to optimise the appearance and health of the skin by working at the core of the skin`s own protective and reparative systems.

SkinCeuticals – Founded in 1997 by Dr. Sheldon R. Pinell, SkinCeuticals discovers, develops, and delivers innovative dermatology products that improve the overall health and appearance of the skin. More updates coming soon, including more professional skincare brands, devices and treatments. If your clinic offers any of these treatments or products please update your listing so that potential clients can find you using the various searches available within our directory.

Please login to your Member’s Area account and update the details at your earliest convenience, alternatively email for assistance.

Consulting Room™ Adviser Becomes BAAPS President The Consulting Room™ would like to congratulate our esteemed medical advisor, Consultant Plastic Surgeon, Rajiv Grover on the announcement of his becoming the President of BAAPS st on 21 September 2012. This post lasts for two years. Rajiv Grover graduated in Medicine with a triple distinction from London University in 1989. In 1993, he became a Fellow of the Royal College of Surgeons (FRCS) after having been awarded the Hallett Prize and gold medal for achieving the highest score in the UK. He then entered 8 years of higher surgical training in Plastic Surgery during which he was awarded a scholarship from the Royal College of Surgeons to train at Harvard Medical School in Boston, USA. In addition to be being awarded a Doctorate of Medicine (MD) by London University in 1998 he was appointed as a Hunterian Professor at the Royal College of Surgeons. Rajiv has been awarded several national and international prizes. He has authored a number of papers on improving safety and enhancing outcome after cosmetic surgery, and his studies have been widely published internationally. He has been on the BAAPS Council since 2004 and served as Secretary for the Association from 2006 to 2010. “The recent upheavals will hopefully herald a new era of healthier skepticism in the media and public, less ‘fads’ and a more robust regulatory framework for our field. I look forward to continuing to work alongside the dedicated team at the BAAPS and further cement our organisation’s position as the leading, unbiased resource for those considering aesthetic plastic surgery;” said Rajiv following his appointment. Rajiv has always been willing to help and support The Consulting Room™, from our very early days almost a decade ago, with his expert advice on all things surgical so we can’t think of a better man for this honour.

Some Recent Blogs You May Have Missed Is Electrolysis a CQC `regulated activity`? The answer is No by Lorna Jackson Recently we added a new Treatment FAQ to The Consulting Room for Advanced Electrolysis, also now called Advanced Cosmetic Procedures (ACP). The inclusion of this FAQ caused much debate amongst aesthetic industry participants via the social media platform Twitter with regards to whether or not it needed to be performed in a Care Quality Commission (CQC) registered clinic setting.

Cosmetic Surgery Advertising Ban, Don't shoot the messenger by Nigel Poole Q.C. The British Association of Aesthetic Plastic Surgeons (BAAPS) has lobbied for strict controls on advertising for cosmetic surgery. BAAPS has consistently stood up for high standards and its recommendations should be seen in the context of a general campaign to improve services to cosmetic surgery patients. However, some of the recommendations are probably unnecessary, some would be difficult to implement and others are directed to the message about cosmetic surgery services when arguably it is the services themselves which require attention.

Sapheon Venaseal Superglue for Varicose Veins By Dr. Haroun Gajraj FRCS Venaseal™ or “superglue” treatment by Sapheon is a unique nonsurgical treatment that uses a medical adhesive (cyanoacrylate) to safely and effectively treat varicose veins. The technique has been developed over the last 5 years by an American company called Sapheon and last year it was granted a CE mark and it is available in Europe.

How does Clarivein work? By Mr. Eddie Chaloner Treatment of varicose veins has undergone a revolution in the past 10 years. The old ‘high tie and strip’ operation with significant risks of wound infections, post-operative discomfort for 6 weeks and a 30% recurrence rate has been replaced by several ‘minimally invasive options’ such as Endovenous lasers, VnUS closure and the latest Clarivein procedure.

Direct advertising of Botox to the public still prevalent By Lorna Jackson It seems that no matter what the medicines regulations say or how many adjudications the Advertising Standards Authority issue on the subject, the practice of promoting the prescription only medicine of botulinum toxin, Botox® being one of the brand names, to the general public is still very much being done by UK clinics on a daily basis.

Podcasts Podcast: Face Conference 2012 Review - Part 1 of 2 In this podcast Adrian Richards talks to Ron Myers from The Consulting Room. They discuss the recent FACE 2012 Conference, including what is FACE and who is it for, take-aways from FACE 2012, dermal fillers, including differences between FDA regulations and European legislation and new fractional treatments and motorised needling systems.

Podcast: Face Conference 2012 Review - Part 2 of 2 In this podcast Adrian Richards talks to Ron Myers from The Consulting Room. They continue to discuss the recent FACE 2012 Conference, including radio frequency treatments, the culture of facelifts, nerve blocking treatments, regulation anomalies and the forthcoming Body Conference.

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 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. (*Login required.) Prices ex.VAT Botox 100U / 50U Azzalure 2 x 125U (Twin pack) Xeomin 100U / Bocouture 50U

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

Wigmore Medical

Health XChange


N/A £100.00 4+ packs @ £91 each £118.00 / £53.95 10+ Packs @ £107.00 each / 20+ Packs @ £51.00 each £89.50 N/A

£140.00 / £76.01 N/A

£145.00 £95.00



£83.24 £96.88

£98.11 £93.35

Nip & Tuck - Facts & Stats



The rise in demand for cosmetic surgery at Somerset’s Nuffield Health Hospital in the first 6 months of 2012. National stats rose 6%.

of global sales of men’s cosmetics/skincare (a total of $495.5 million) is sold to men in Korea, making it the largest market.

Source: ITV West

Source: ABC News

‘Bagel Head’ latest bizarre beauty trend from Japan’s body modification scene, where a bagel shape is created in the forehead using saline infusions! Source: Daily Mail



The most popular cup size chosen by woman who ‘test drive’ breast augmentation using a padded bra before treatment.

The number of girls aged 16 and under who have had breast enlargements paid for by the NHS in the last five years.

Source: Daily Mail (Mr Mark Henley)

Source: Daily Mail

Latest News Last Chance to Vote… Aesthetic Awards 2012/2013 With a total of 30 categories, the awards have been designed to acknowledge those who have gone that extra mile over the last year. The Aesthetic Awards is the first and premier awards evening in the industry that gives both practitioners and suppliers a chance to celebrate their achievements with their friends and peers. The Aesthetic Awards is being sponsored by Syneron/Candela (Silver Sponsor) and Kelo-cote® (Bronze Sponsor), and will take place at a glamorous st Moulin Rouge-themed event on the evening of Saturday December 1 at The Grand Connaught Rooms in Covent Garden.

Voting is now open at until Monday October 15th. Awards for Manufacturers and Suppliers Best Product Innovation • Dermapen™ • EndyMed™ 3DEEP (AesthetiCare) • Harmony® XL Pixel Q Switch handpiece (ABC Lasers) • Lustre (Ambicare Health) • SkinCeuticals Phloretin CF Gel (L’Oreal) • Stylage® (Medical Aesthetic Group) Best Newcomer (Product or Treatment) • Dermaquest Stem Cell 3D Complex (Dermapure) • eLase Motif laser hair removal (Syneron/Candela) • INTRAcel (SmartMed) • NeoStrata® Skin Active Intensive Eye Therapy (Aesthetic Source) • Restylane® Lip Refresh (Q-Med/Galderma) • Silkann Aesthetic Cannulas (Sterimedix) Cosmeceutical of the Year • Epionce (Eden Aesthetics) • Heliocare (AesthetiCare) • Image Skincare (Skin Geeks) • Medik8 (SkinBrands) • Obagi (Healthxchange) • PRIORI (Cosmeceuticals) • SkinCeuticals (L’Oreal) Injectable Product of the Year • Emervel (Q-Med/Galderma) • Juvederm Voluma (Allergan) • Radiesse (Merz) • Restylane Lip Volume/Lip Refresh (Q-Med/Galderma) • Revanesse (Boston Medical Group) • Stylage (MAG) Treatment of the Year (Face) • AQ Skin Solutions/Dermastamp (Skin Geeks) • e2 Sublime and Sublative (Syneron/ Candela) • Genuine Dermaroller (AesthetiCare) • Harmony XL Pixel QS aka ‘laser face-lift’ (ABC Lasers) • HydraFacial (SkinBrands) • Idebenone Superceuticals Peel (Cosmeceuticals) Treatment of the Year (Body) • Cellulaze (Cynosure) • CoolSculpting® (ZELTIQ) • Genuine Dermaroller (AesthetiCare) • Soprano Pain Free Hair Removal (ABC Lasers) • Velashape (Syneron/Candela) • VaserShape (Sound Surgical) Best Selling Retail Product • Heliocare SPF 50 • Image Skincare Vital C Anti-Ageing Serum • La Roche-Posay Anthelios XL

• Medik8 Retinol 3TR • Obagi Blue Peel Radiance • SkinCeuticals Sheer Mineral Defence • Vitage Skin Defence SPF 30 Equipment Brand of the Year • ABC Lasers • 3D Lipo (Biotherapeutic) • BodyTite (Invasix) • Ellipse • Syneron/Candela Best Weight Loss/Diet Programme/Product • Alizonne • FullFast • Pronokal • Proteifine (Ysonut) • SlimScription Sales Representative of the Year • Deidre MacMahon – Merz Aesthetics • Frank Ward – Galderma • Iveta Vinklerova – Boston Medical Group • Kalvinder Kent – Allergan • Katy Bacon – Cosmeceuticals • Martyn Roe – Syneron/Candela • Paula Dene - Merz Aesthetics • Terina Denny – SkinGeeks Best Customer Service by a Manufacturer/Supplier • ABC Lasers • AesthetiCare • Allergan • Hamilton Fraser • Healthxchange • Med-fx • Merz Aesthetics • SkinBrands • Syneron/Candela Best Advertising Campaign by a Manufacturer/Supplier • Allergan – Quality is Key Campaign • Syneron/Candela – Re-branding • MAG – Stylage • Merz – Belotero • Restylane – Launch of Restylane Lip Volume & Lip Refresh Distributor of the Year • AesthetiCare • Church Pharmacy • Healthxchange • Med-fx • SkinBrands • Wigmore Medical

Awards for Clinics/Practitioners Rising Star  Dr Dan Dhunna  Dr Natalie Blakely  Dr Terry Loong  Dr Sam Bunting  Sharon King Best Clinic Chain  Court House Clinics  Destination Skin  EF Medi-Spa  Sk:n  The Private Clinic Best New Clinic  London Bridge Plastic Surgery (LBPS), Wimpole Street  Medikas Medi-Spa, Bath  Q Clinics, Bristol  Renew Clinic, Nantwich  Skin Associates, Wimpole Street, London  The Skin Clinic, Sevenoaks Best Clinic (four rooms or more)  Dermal Clinic, Edinburgh  Xavier G Medi-Spa, Southampton  Woodford Medical, Danbury, Essex  Face etc Medi-Spa, York  Naked Health, Wimbledon, London Best Clinic (three rooms or less)  European Dermatology, London  Medikas, Somerset  Persona Cosmetic Medicine, Bexley  Temple Aesthetics, Aberdeen  Lumley Aesthetics, Sevenoaks  The Evergreen Clinic, Liverpool Best Cosmetic Dental Clinic  The Kensington Clinic, London  Lubiju, London/Edinburgh  Tracey Bell Clinics, Liverpool/Isle of Man  Visage Lifestyle Clinic, Glasgow Best Mobile Practitioner  Anna Baker  Hannah Orchard  Karen Lockett Aesthetic Nurse Practitioner of the Year  Belinda Done  Emma Davies  Helen Hannigan  Mai Bentley  Marie Dolan  Monica Berrange

Aesthetic Practitioner of the Year (Sponsored by The Consulting Room)  Dr Beatriz Molina  Dr David Eccleston  Dr Lisa Delamaine  Dr Raj Acquilla  Dr Robin Stones  Dr Stefanie Williams  Dr Tapan Patel Cosmetic Dentist of the Year  Dr Emma Ravichandran, Clinetix, Glasgow  Dr Ian Hallam, Meon Facial, Hampshire  Dr Tracey Bell, The Tracey Bell Clinic, Liverpool/Isle of Man  Dr V J Vadgama, Woodbury Dental and Laser Clinic, Tenterden, Kent Best Clinic Customer Service  Dr Xavier G Medi-Spa Clinic, Southampton  European Dermatology, London  CC Kat Aesthetics, Birmingham  LBPS, Wimpole Street, London  Medizen, Sutton Coldfield  Naked Health, Wimbledon, London  Persona Cosmetic Medicine, Bexley, Kent  Skin Associates, Wimpole Street, London Best Clinic Website  Aesthetic Virtue  CC Kat Aesthetics  Clinica Fiore Skin Medica  Destination Skin,  EF Medi-Spa,  The Island Cosmetic Clinic, Speaker of the Year  Dr Beatriz Molina  Dr Raj Acquilla  Dr Tapan Patel  Dr Toni Phillips  Mr Dalvi Humzah Clinic Receptionist of the Year  Kym Pulham, Court House Clinics, Brentwood  Lucia Pawlak, Dermal Clinic, Edinburgh  Rosie Claremont, Aesthetic Virtue, London  Jasmin Byrne, EF Medi-Spa, Kensington  Tina Jobburns, Cosmedic Skin Clinic, Tamworth  Sue Blake, Q Clinics, Bristol Association of the Year  British Association of Aesthetic Plastic Surgeons (BAAPS)  British Association of Cosmetic Nurses (BACN)  British College of Aesthetic Medicine (BCAM - formerly British Association of Cosmetic Doctors)  Private Independent Aesthetic Practices Association (PIAPA)

Special Awards The Baroness Ritchie Award for Services to the Industry (Sponsored by IHAS)  Emma Davis  Mr Dalvi Humzah  Lynne Thomas (Flipside PR)  Ron Myers  Sally Taber Lifetime Achievement Award (Sponsored by SkinCeuticals) This award will only have one recipient who will be announced on the night

Voting is now open at until Monday 15th October.

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: Don’t advertise cosmetic surgery when kids could be watching! A TV advert for cosmetic surgery featured three people holding signs that indicated the treatment they had undertaken. A second sign was then shown that indicated the difference people had noticed in them. The first woman's sign stated “I’ve just had my breasts done ... but the biggest change you’ll see is on my face”. A man's sign stated “I’ve just had liposuction on my chest ... But everyone comments on my smile”. Finally, a second woman's sign stated “I’ve just had my tummy tucked ... But all my friends notice the spring in my step”. The three people laughed and smiled as they held their signs in front of the part of their body that had been treated. Three complainants objected that the advert was scheduled irresponsibly at a time when children might see it because they believed it could have an impact on young peoples’ body image. In response, Transform Medical Group (CS) Ltd said that they had always aired the advert during the daytime when children were at school and the advert would not be shown during the summer school holidays. They said the advert was not socially irresponsible or likely to impact on young peoples’ body image. They also said that they do not consider cosmetic surgery procedures such as liposuction or a tummy tuck to be slimming products or treatments nor is their company a weight control establishment as they do not offer weight loss/weight control or bariatric procedures. The advertiser also said that the medical community would not classify liposuction or a tummy tuck procedure as weight loss or slimming. Clearcast said that consumers would understand that adverts for slimming and weight loss products or slimming establishments involved achieving results over a period of time. Also, weight loss establishments would offer supervised regimes. They said that this was in contrast to cosmetic surgery which had an immediate effect. Because of this differentiation they did not give Transform Medical Group’s advert a timing restriction. The ASA upheld the complaints and noted that the people featured were smiling, did not look underweight and were clearly adults and not children. Because of this they concluded that the advert would not impact negatively on young peoples’ body image. However, they noted the advert was seen around 4.30pm when they understood some children would be at home after school. They also obtained the audience index figures for a programme which featured the advert during the advert break; this indicated that the programme had particular appeal to children under 16 years of age. They also acknowledged Clearcast’s assertion that a cosmetic surgery clinic did not fall under their interpretation of a slimming product. However, they noted that the BCAP Code included “clinics and other establishments” in its weight control and slimming definition. They considered that as some of the procedures advertised resulted in a slimmer appearance, the advert would fall under the Code’s definition. As the advert was shown during a programme that had particular appeal to audiences under 18 years of age, they concluded that the advert was inappropriately scheduled. The advert breached BCAP Code rules and must not be broadcast again without a relevant timing restriction. Specifically, it must not be broadcast in or adjacent to programmes commissioned for, principally directed at or likely to appeal particularly to audiences below the age of 18. Full Adjudication

Merz Aesthetics Gauge Feelings on Tear Trough Treatment at MAPP Meeting At the recent Merz Aesthetics Partnerships in Practice (MAPP) Conference in Cambridge held over the two days of th th 24 & 25 September 2012, a group of nearly 100 Doctors, Dentists, Registered Nurses and Business Managers met to enjoy various seminars and debates on the subject of facial injectables. The ‘Debate of The Day’ held on the final afternoon asked: “Tear Troughs – to treat or not to treat?” Attendees at this workshop, were asked the same question at the start and end of the session and their opinions following the open discussion were compared with some interesting results. Responses before the debate:


Responses (percent) (count) 8.20% 5 80.33% 49 11.48% 7 100% 61


Responses (percent) (count) 21.88% 14 71.88% 46 6.25% 4 100% 64

Tear troughs should NOT be treated under any circumstances Tear troughs are BEST treated with injectable products Tear troughs are BEST treated with surgical procedures

Responses after the debate:

Tear troughs should NOT be treated under any circumstances Tear troughs are BEST treated with injectable products Tear troughs are BEST treated with surgical procedures

The results show a change in opinion with many of those who previously thought that tear troughs are best treated with injectable dermal filler products or surgical procedures moving to the ‘do not treat them camp’, with quite an increase in that school of thought by the end of the hour long discussion. As was noted at FACE 2012, the techniques used and opinions on the treatment of this very delicate area are one of the most hotly debated subjects in medical aesthetics at the moment.

New Product Reviews Introducing Vitality Institute Peels VI Peel is manufactured in the USA by Vitality Institute Products, based in California. The product has been used successfully for over 15 years and Rosmetics is pleased to become the distributor for the VI Peel within UK and parts of Europe.            

QUICK. The treatment takes less than 15 minutes. SAFE. VI Peel can be used on all skin types, even Fitzpatrick 5/6 COST EFFECTIVE. VI Peel costs less than its major competitors, but with the results available, the practitioner can justify top prices. CONVENIENT. No skin preparation products are needed. COMFORT. VI Peel is virtually painless. Sensitive individuals may experience a slight stinging sensation, which is controlled by use of a fan during application. COLOURLESS VI Peel offers the client a clear peel which is applied in the clinic and the client leaves with no visual detrimental effect. The peel is left on for 4 to 8 hours (dependent on skin condition), and removed by the client. MINIMUM HEALING TIME. Your patients will enjoy younger looking, more beautiful skin in about one week. SUPERIOR RESULTS. For anti-ageing VI Peel reverses the effects of sun damage, environmental factors and time, to enhance your skin’s natural beauty. In addition to facial treatments, the VI Peel can also be used to treat sun damage on the décolletage and hands. MULTI USE. Only VI Peel is safe to use on the face, eye area, neck, chest and hands. STIMULATES COLLAGEN VI Peel stimulates collagen and elastin production. FOR ACNE. Highly effective in clearing acne and impurities for patients as young as twelve years old; a series of treatments may reduce acne scars, both product ranges are exclusive to doctors, aesthetic nurses and medical spas. CLINICALLY PROVEN.

The VI Peel is a unique and revolutionary medical grade chemical Peel designed to achieve dramatic results after just ONE treatment. This product is also safe for ALL skin types (Fitzpatrick 1-6). Regular use of the VI Peel (2-4 peels per year), along with proper skin care, reverses sun damage, treats hyper pigmentation including melasma, acne and acne scarring, loss of firmness and rosacea. The Peel is also suitable for the eye area, chest, hands, arms and back. VI Peel consists of the following ingredients: TCA (Trichloroacetic acid), Phenol, Salicylic Acid, Tretinoic Acid (Retin-A), Vitamins (Mainly Vit C), VI Peel Acne is a targeted solution to purify blemish prone skin and clear the scars acne leaves behind. Results can be seen in just 7 days. It contains their original peel formula plus the following 4 powerful ingredients for superior, consistent results for you and your patients. Benzyl Peroxide: removes bacteria, clears the pores and increases cell turnover. Salicylic Acid: causes the cells of the epidermis to shed, opening the clogged pores and neutralising the bacteria within while constricting the pore diameter to prevent further clogging. Vitamin C: a powerful antioxidant that removes toxins from the environment. Kojic Acid: brightens skin and reduces acne scars.

The VI Derm Skin care Line was formulated to work in conjunction with the VI Peel to enhance the peel benefits and provide a complete skin care maintenance regime. VI Derm is a complete system which is easy to use, affordable and used correctly will improve all skin types. It is effective in improving hyper pigmentation, age spots, melasma, acne scars and will also improve the texture, tone and clarity of the skin. Itwill soften lines and wrinkles, and stimulate collagen and elastin for firmer skin. Please contact Clive Shotton from Rosmetics on 0845 5050601 for more information.

Retriderm™ Protein-Rich Skin Serum Vitamin A with Attitude AesthetiCare® is pleased to introduce Retriderm™ Protein-Rich Skin Serum, a new Vitamin A Skin Regeneration range fresh from the USA. Vitamin A is known to be essential to healthy skin; it promotes the production and differentiation of skin cells and is proven to regenerate ageing and sun damaged skin. Tried and tested by internationally renowned dermatologists, Retriderm™ Protein-Rich Skin Serum is clinically proven to fight the visible signs of ageing and sun damage and produce significant improvements in the appearance of the skin. The patent pending, protein rich formula harnesses the natural power of Vitamin A by providing Retinol, a bio-available form of the vitamin that is naturally consumed in our diet and available within our body. This unique formula optimises the stability and bio-availability of the skin-essential Retinol, enabling it to ‘go to work’, regenerating the skin from the surface and within. Retinoic acid (RA), in the form of Tretinoin and Retinol, which is available as a cosmetic, has been shown in clinical studies to reduce the visible signs of ageing and photoageing. Whilst effective, Tretinoin is prescription only and can cause skin irritation; this has led to an increase in interest around the use of Retinol, to treat aged skin. Retriderm™ Protein-Rich Skin Serums deliver the Retinol, in a unique, patent pending, protein-rich formula which is designed to help it ‘go to work’. In recent studies conducted by renowned US dermatologists Dr Michael Gold, Dr Vivan Bucay and Dr Leon Kircik the efficacy of the NEW and UNIQUE Retriderm™ Protein-Rich Skin Serums was tested and clinically proven. Looking at both the 0.5% and 1.0% serums the studies demonstrated that the science and efficacy of Retriderm™ Protein-Rich Skin Serums with their protein-rich formulation containing collagen, elastin, hyaluronic acid and Vitamin E can deliver significant results. Improving facial wrinkles, including those around the eye, skin laxity and tightness, hyperpigmentation and skin brightness. Retriderm™ Retinol 0.5% Protein Rich Serum demonstrated very good skin tolerability and is ideal for those with skin that is more sensitive, younger or with less sun damage. It is also Step 1 in a Retriderm™ Vitamin A Skin Regeneration Programme. For those with more mature or sun damaged skin Retriderm™ Retinol 1.0% Skin Serum provides maximum efficacy and would also be used as Step 2 in a Retriderm™ Vitamin A Skin Regeneration Programme. Step 3 in the programme involves the ongoing use of Retriderm™ Protein-Rich Skin Serum as instructed by an aesthetic practitioner. The Retriderm™ Vitamin A Step-Up Skin Regeneration Programme is recommended to maximise and maintain its regenerative effects. Step 1 - Retriderm™ Retinol 0.5% Skin Serum (SRP £42.25) Step 2 - Retriderm™ Retinol 1.0% Skin Serum (SRP £50.00) Step 3 – Retriderm™ Retinol Skin Serum for ongoing use Ongoing use of either the Retriderm™ Retinol 0.5% or 1.0% Skin Serum will maximise and maintain its regenerative and skin enhancing effects. The client and aesthetic professional will work together to decide which product is best suited to the clients particular skin and skincare regime. For further information, or to try any of the Retriderm™ range, please contact AesthetiCare® on 01937 541122 or visit

Medik8 Solutions Focused Peel Range Medik8 Peels provide an easy-to-choose range that caters to every skincare concern. From natural to superficial to medium depth, Medik8 now has a peel for everyone. Superfacial™ Papa Enzyme Peel with Pomegranate, Blueberry & Kiwi If you have sensitive skin or just want a natural skin pick me up treatment that gives instant brightening without irritation then the new Medik8® Superfacial™ is for you! This natural enzyme peel for skin imperfections, small blemishes and dull complexions is a true ‘lunch-time peel’. Superfacial™ is the ideal option for brighter and clearer skin. You will feel the gentle tingle of enzymes as they soften your skin and refine pores while you are enveloped in its uplifting fruity aroma. Recommended Treatment Price: £60 agePeel, whitePeel, betaPeel and eyePeel A real breakthrough in peel formula development to deliver professional results with limited stinging and limited, if any, down-time. Offering visible results within days, Medik8 indication-specific superficial peels are mild enough to be used by all skin types all year around! The peels are also suitable for other areas of the body including hands, neck, décolletage and the back. agePeel: rich in L-Mandelic acid and Lactobionic acid, this is the perfect peel to eliminate fine lines and wrinkles, fade away imperfections, leaving the skin smooth and renewed. Recommended Treatment Price: £90 whitePeel: The most effective way to achieve a brighter and even skin tone is to eliminate skin cells rich in melanin and prevent the darkening of the new skin cells. whitePeel penetrates the skin’s pigment cells to gently and effectively reduce the appearance of unwanted discolouration, for a more even skin tone. Phytic Acid and high concentration L-Lactic acid have proven de pigmenting properties. Recommended Treatment Price: £90 betaPeel: rapidly brings acne under control and dramatically reduces the risk of future outbreaks. With Azelaic acid combined with high strength Salicylic Acid; betaPeel has a triple action effect, attacking blocked and compacted pores, comedones and inflammation. Recommended Treatment Price: £90 eyePeel: the eye area is the first place to show initial signs of ageing. eyePeel offers an ultra-gentle yet effective solution to treat this sensitive area through enhanced cell turnover and regeneration without causing prolonged erythema. Recommended Treatment Price: £70 For those looking for more dramatic results and accept a degree (albeit reduced level) of down-time, the Medik8 peel range with a Jessner Solution and TCA 30% is the ideal choice. Medik8 Jessner A superior treatment designed to remove the whole of the epidermis. Can be used to target moderate skin damages including acne, light wrinkles and pigmentation. Dramatic results but expect some downtime and peeling. Recommended Treatment Price: £110 Medik8 TCA 30 % Most suitable candidates for this deeper and more active treatment are those with resilient skin who have more moderate to severe wrinkling, sun damage, and acne scarring. Dramatic results with down time and peeling. Recommended Treatment Price: £150 For more information, please contact SkinBrands Ltd on 05603 141 956 or visit

Feature Article The Blunt Cannula – Your New ‘Flexible Friend’? “Is this a needle which I see before me, the handle toward my hand?” it’s a blunt cannula. If facial injectables is your specialty you’d be hard pressed not to have noticed the sudden rise in the use, availability and promotion of blunt cannulae or microcannulas for the administration of dermal filler products (and fat transfer), in place of the more traditional sharp needle. This practice has seen a dramatic rise in the UK, Europe and the USA in the last 2 years. So what is all the fuss about? The attraction in the use of a blunt cannula is the reduction in the risk of ecchymosis (bruising) or swelling, the lessening of pain or discomfort from treatment for the patients due to a single insertion point, and the almost removal of the risk of damaging nerves or injecting into a blood vessel which could cause more severe complications. The lack of sharp edges compared to a needle, makes cannulas a safer option in the eyes of many. Although, bruising at the insertion point (which is made using a sharp needle) is still a consideration, depending on the patient. As well as this there is an argument that the exit point on a cannula allows for a better application of the product within the tissues with more homogeneity of the distribution of the filler gel than is achievable via a conventional needle exit. The flexibility of the cannula itself, compared to the stiff nature of a needle means that generally only one small incision point is needed to treat a given area as the cannula can be bent and threaded within the tissue in a variety of directions through the one entry point, something which isn’t easily possible (without tissue subcision) when trying to do with a non-flexible needle. For example, the mid-face, cheeks and the naso-labial fold could all be treated using a blunt cannula, via a single incision point, to create an overall volumising effect on a patient. Many also believe that the use of cannulas are preferable for treating more sensitive areas of the face which are more prone to trauma and bruising, such as around the eyes (including tear troughs) and the lips. The technique is also being used successfully for hand rejuvenation treatments. In fact many of the leading manufacturers of dermal fillers are now advocating the use of micro-cannulas instead of needles for certain treatment indications using their products. Depending on the indication being treated and the product used, the gauge and length of the cannula are important, along with the depth of delivery, which varies from the mid and deep dermis to the upper subcutaneous fat layer and above the periosteum. Blunt cannulas are however not considered optimum for very superficial injections such as mesotherapy/skin hydration treatments or intradermal injections. It’s also important to use the correct size of cannula to match the viscosity of the product you are using. However, just like riding a bike, the move from needles to blunt cannulas takes practice and all professionals are advised to seek training and further instruction on their best use and protocols. This is also not the death of needles when it comes to dermal filler delivery with many users pointing out that for more precise administration you can’t beat a steady needle, in fact most still use both and will also combine their use when treating an individual patient, particularly if they are looking to touch up or treat finer imperfections towards the end of a session. Dr. Fab Equizi from the Lip Doctor clinic in Liverpool is a huge fan, “Cannulae rule. They have transformed filling out areas like tear troughs, cheekbones and the mid face. No bruising, no risk of vascular occlusion. Needles are still essential though for precision in certain areas; I often combine the two.” Certain skin types and thicknesses may prove difficult to treat though using blunt cannulae, making a needle the preferred option, such as skin with numerous acne scars, or in those people that have undergone injections of past filler products that have induced fibrosis within the tissue.

Clinical Evidence There is plenty of anecdotal evidence out there from cannula converts, many of whom have been offering dermal filler injections using needles for more years and shoulder pads than they care to remember, who now, having tried blunt cannulas would not touch a needle again, but what is the evidence? Following a look at the published clinical papers, I found some interesting notes to share with you. Well known Brazilian Dermatologist Doris Hexsel published a paper in February 2012 in Dermatology Surgery entitled ‘Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds.’ In her study she took 25 patients and injected each side of their face, in the naso-labial folds, with 0.5ml of hyaluronic acid filler using either a needle or a cannula. The side used for each method was randomised. One the day of injection, participants reported fewer side effects, including pain, oedema, redness and bruising with the cannula method than with the needle. This led Dr. Hexsel to report that cannulas are a safe and useful tool to inject HA fillers into the naso-labial region. U.S. Plastic Surgeon Louis M. DeJoseph, writing in Facial Plastic Surgery Clinics of North America in May 2012 said, “With more physicians performing injections to the face in increasingly sophisticated ways, techniques must evolve accordingly. Injectables are no longer mere wrinkle fillers but true panfacial volumizers that are placed in many different planes and tissues of the face, in contrast to fillers of the past used for the dermis. Microcannulas represent a step forward in enhancing surgeons' ability to fill the face with less discomfort, edema, and ecchymosis, with faster recovery. Microcannulas will probably play a role in volume replacement for many years to come.” An interesting paper from Italy, published in Plastic & Reconstructive Surgery in April 2012, where Dr. Davide Lazzeri looked at blindness following cosmetic injections of the face noted that, “Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible.” This all seems very positive, but one must always offer a note of caution that clinical data on the use of blunt cannula for dermal fillers is not as well documented as that with sharp needles, so long term follow-up studies need to be performed to evaluate both the techniques and it’s affect on the long term efficacy and performance of the products themselves; if indeed this differs. The act of dissecting the tissues with the fanning movements of the cannula also causes collagen synthesis and can augment the clinical response of the overall treatment with the chance of less filler actually being required. It would be interesting to see some comparative trials looking at the use of the micro-cannula alone without product versus with product to see just how much difference the technique alone is accountable for. Additionally, we have yet to see any reviews or reports on complications, such as cannula breakage due to excessive extrusion forces which can, in some cases, cause cannulas to break, something which the manufacturers try to avoid through designs which look at the thickness of the cannula walls, the exit point and the Luer-Loc mechanisms between the cannula hub and product syringe. Although a rare complication, this is something which practitioners should be prepared to think about, particularly when selecting the ‘right’ cannula for the product and placement intended. As the practice increases, it id likely we will see more data on this, both independent and manufacturer sponsored to compare and contrast the techniques.

Brands Available As with many devices within the industry, micro or blunt cannulas come in a variety of styles and sizes from a variety of manufacturers all trying to compete on the various parameters which make up a cannula. Essentially these break down to the outside calibre of the cannula, this is what determines its gauge, just like a sharp needle. Add the length of the cannula to this gauge size and you affect the flexibility of your cannula. The length of your cannula is important depending on where you’re treating and the size of the area you are targeting. Finally the internal calibre of the cannula determines the flow of the product, the amount of extrusion pressure needed to push the HA through it, depending on its viscosity. The longer the cannula is also affects this as a longer cannula creates greater resistance for the product as it flows through it for longer before exiting. Much of the manufacturer’s efforts are spent on the thickness of the cannula wall, the difference between the outer and inner calibres, to create a good product flow but not make the cannula fragile or prone to breakage. By creating thin walls this also means that a small enough gauge is inserted into the patient for their comfort. Additionally some are using special coatings inside the steel to help the product to flow.

It seems in most cases that we have the French to thank for the micro-cannula, with many of the devices available in the UK medical aesthetic market stemming from across the channel. This is by no means an exhaustive list of products available as more and more dermal filler manufacturers themselves are producing generic or own branded cannulas, in partnership with suppliers, as adjunctive products, either supplied with or encouraged at point of sale, such as Allergan EasyFlow micro-cannulas available through HealthXchange Pharmacy, Pix’L Micro Cannulas via Q-Med which are widely available through third-party wholesalers and own brand cannulae available direct from Merz Aesthetics. Here are details of some of the more well known brands currently available. Most price ranges quoted are excluding VAT, please contact the suppliers for individual price information.

Merz Aesthetics Cannulae Merz Aesthetics now offer a range of high-tech cannulae to partner their dermal filler portfolio of Belotero® HA products and Radiesse®. This is done in collaboration with TSK Laboratory. According to Merz the cannula stiffness has been carefully developed to provide the optimal balance between maximising product placement precision and flexibility, with an advanced design which includes a larger inner diameter and ultra thin wall for very low extrusion force. They quote lab and clinical tests whereby Merz Aesthetics Cannulae were compared to other brands (details of which are not given) on extrusion force. Utilising a texture analyser at a constant room temperature of 22°C, a chart speed of 50mm per minute and when measured in Newtons, Merz Aesthetics Cannulae demonstrated the lowest extrusion force for both the 25 gauge and 27 gauge cannulae for the delivery of Belotero and Radiesse. Available direct from Merz Aesthetics only, in quantities of 10 or 20+ with a price range from £4.50 to £4.95.

Pix’L™ Micro Cannula Working in partnership with Q-Med (a Division of Galderma), and their range of Restylane® hyaluronic acid dermal fillers, the French company Thiebaud design and manufacture the Pix'L™ Micro Cannula, made from surgical stainless steel. To ensure high quality instruments, Thiebaud maintain that every Pix’L™ needle is precisely tested after every manufacturing step, with a total of 12 test phases as well as a test under microscope. The Pix’L cannula has a blunt tip which does not cut through the tissue but pushes it gently to the side without injuring it. Both the inside and the outside of the cannula are smooth with no notches to make injuries to tissue unlikely. According to QMed a lateral outlet enables the injection to be precise, and a special inner surface layer allows optimum flow of their hyaluronic acid products when the correct cannula size for the corresponding gel particle size of the hyaluronic acid in Restylane is used. See this video which demonstrates the difference in injection performance between a needle and the Pix’L micro cannula using a Restylane NASHA product. Pix’L micro cannulas are available from all the major aesthetic industry pharmacy wholesalers with a price range of £10 - £14 each.

Magic Needles® Magic Needles® or ‘MN’ needles were invented in France by Dr. Bernard Hertzog and are manufactured by Needle Concept. The cannulas are distributed in the UK by Rosmetics Ltd.

Magic Needles® have a rounded tip and a small aperture for the delivery of the product which is located laterally at the extremity of the cannula. According to the developers the rounded tip creates a resistance, to avoid penetration into the deep tissue layers and allows the ‘needle’ to slide under the skin. The cannulas are also characterised by their flexibility and suppleness, which along with the exit hole, allows the user to inject a large number of different products, regardless of the degree of their viscosity. Needle Concept have coined a new injection concept for the use of their Magic Needles called the "SIT” or Single Injection Technique procedure. With SIT the injections are done from a single point, and are always executed in retrograde fashion in that the product is injected while the MN needle is withdrawn either in a fan-shaped pattern or a spoke-wheel pattern. Below are some examples of the common introduction points for SIT, including the naso-labial region, restructuring and volumising and the lips.

Registered Nurse and Independent Nurse Prescriber, Ros Bown runs various clinics in the West Midlands. Ros is a member of BACN and a trainer for various companies including Magic Needles. She told us; “As an aesthetic practitioner for over 18 years, I have experienced a vast array of dermal fillers, having started with Collagen, then Hydra-Fill, Soft Line, Juvederm, Juvederm Ultra, Restylane and more recently Esthelis and Fortelis. Despite the advances that we have seen in dermal fillers over the last 18 years there are still two problem areas that existed when I started and still exist today. The two areas are bruising and pain. Many practitioners state “I don’t have bruising”. In my experience every practitioner who injects runs the risk of bruising a patient, irrespective of their technique or how many patients they inject per day. Pain relief has improved with the application of topical anaesthetic creams, although the time required for any of these creams to take effect can extend the treatment time by 30 to 50 minutes. Consequently the biggest improvement to dermal filler treatment as of today would be the elimination of either or both of these problems. About 18 months ago I was introduced to Magic Needles™. The techniques is to inject a small bolus of 2% lignocaine into the selected site, make a small entry point in the skin with the sharp needle provided, then carefully introduce the blunt needle through the same hole. The filler (irrespective of manufacturer) is then injected through the blunt cannula. Using this technique I have virtually eliminated the risk of bruising for all my patients and pain is not an issue, with over 90% of patients reporting feeling a sensation of the cannula moving under the skin, but not feeling any pain. With a wide variety of sizes available from 22g to 30g, in a variety of lengths from 27mm to 57mm, all techniques can be accommodated, be it lip augmentation, deep cheek filling, jaw definition, tear trough or even glabellar line filling. My practice has changed dramatically since I started using Magic Needles™ and in the last 6 months my use of sharp needles for injecting HA fillers has vastly decreased. Other practitioners have asked me why I have chosen Magic Needles. In my experience the memory of the steel used to make the cannula ensures that the cannula always returns to the original shape, thereby allowing me to know exactly where the tip is.” Magic Needles are available through Rosmetics and Wigmore Medical in boxes of 10 or 20 with a price of £4.50 to £6.00 each.

Silkann Silkann by Sterimedix is designed and manufactured in the UK. Sterimedix have been making and selling single use surgical products for over 20 years, primarily for ophthalmology, and launched the Silkann range for facial aesthetics in December 2011. Silkann products claim to use the highest quality manufacturing systems with state of the art production techniques which produce consistent products, packaged well to maintain their integrity. The design of the cannula is very important with emphasis on the quality of the cannula and the exit point, or port, to ensure consistent results during treatment and the optimum flow of the filler product whilst reducing the force required to inject. In order that the practitioner can be assured of the position of the side port on the cannula, Silkann have added two indicators into the design of the hub which show the orientation of the port during injection, allowing for exact product delivery. Another design innovation that Silkann are proud of is the reduction in the risk of the cannula becoming detached from the syringe of product as a result of the pressures exerted during injection. To combat this potential, the hub on the Silkann cannula has been designed with two particular features; a screw thread to ensure a tight join between cannula and syringe and the use of polycarbonate to make the hub, a material which has a higher frictional coefficient than standard polypropylene which is used more often. Silkann are available in boxes of 40, direct from Sterimedix with a price range of £3.30 to £3.60.

DermaSculpt® DermaSculpt blunt tipped micro-cannulas have been developed and manufactured by CosmoFrance Inc, based in Miami, Florida. In the UK they are distributed by Medical Aesthetic Group (MAG). Available in 7 different sizes, the company claims to have a cannula size for each dermal filler available on the market, ranging from those with low viscosity, through to medium and highly viscous products, along with autologous fat – something of a bold claim for those outside of the USA (and it’s FDA restrictions) when you consider the number of HA products available in Europe. The company markets a Skin Sculpting Technique (SST™) which as well as delivering the dermal filler product also describes the dissection of the dermis with multiple passes of the cannula, which leads to collagen synthesis as well as product placement, which they also claim is reduced in quantity using this method. More clinical studies using the DermaSculpt brand can be found here - DermaSculpt are available in boxes of 20, with a price range of approximately £5 each.

STERiGLIDE The STERiGLIDE from TSK Laboratories in Japan, a company that has been making specialised needle products since the 1907s, is due for its global launch this month (October 2012). Its European distribution arm is based in Holland.

The company already produces a Closed Tip Side Hole (CSH) cannula which features an ultra thin wall and a threaded hub made from a rigid polymer which doesn’t flex, instead of polypropylene, to avoid fixation problems. This cannula is also available in partnership with Merz Aesthetics. The company is launching their next generation product, the STERiGLIDE with the claim that its ‘ultimate gliding characteristics result in up to 50% less penetration force’. This is due to a unique, proprietary surface treatment (a trade secret!) to the cannula which aids the way it moved once within human tissue. The cannula hub also features marks to allow the practitioner to know the orientation of the exit hole. They also boast the ‘nearest to tip’ filler delivery based on the position of their exit port. Equally the company believe the packaging of their cannula is important, noting that it comes in a hard shell capsule which is aimed at making it easier to attach the cannula, with a tight fit, to the Luer-Lock syringe. Upon launch, STERiGLIDE will be available in boxes of 20.

SoftFil® Another flexible micro-cannula to come from a French manufacturer is the Softfil®. Claimed to be used in more than 80 countries and available in 15 different sizes, lengths and calibres, the Softfil range includes the Softfil Classic, (their original cannula) and the Softfil Precision. Within the Classic range the cannulas have either a regular sized internal calibre and regular thickness of the cannula wall or a large internal calibre and a think wall. The Precision range differs by having extra large inside calibres to the cannulas and an extra thin wall. It also has a dot on the hub to indicate the side of the exit hole and graduation every centimetre on the cannula itself. The use of the cannulas is marketed as the Soft Filling Technique®. Available in boxes of 20 direct from the French manufacturer, with a price range of €4 - €5 each, (approx. £3 - £4).

Summary Judging by the number of blunt cannula products now available to those involved in facial aesthetics in the UK, and the number of demonstrations and discussions on their use for dermal filler delivery seen at FACE 2012 and other meetings this year, it’s likely that techniques utilising them will become more widespread and something of a norm. With the use of fillers moving away from the ‘wrinkle and line filling’ of a decade ago to ‘volumising’ and ‘facial contouring’ techniques and associated product placement, it certainly seems that the cannula is the new man for the job, that’s not to say the needle is going into early retirement any time soon! Lorna Jackson Lorna has been Editor of The Consulting Room™, the UK’s largest aesthetic information website, for 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. If you have any comments or suggestions regarding this article, please email

Eye Spy With My Industry Eye BACN 2012 The British Association of Cosmetic Nurses (BACN) held their third annual conference at the IET London Savoy Place on the 6th October 2012. The venue was chosen for its wonderful views over the Thames and beyond to Westminster and the London Eye. They secured a great team of speakers including Lance Stetterfield talking about Medical Needling, Sharon King on Carboxytherapy, Roger Bloxham on Retinol, Dr Haroun Gajraj on Sclerotherapy, Marea Brennan-Thornes on Skin Tightening, Dr Dalvi Humzah on Facial Anatomy and Anaesthetics, Mr Mike Samuels on Before and After Photography, Lorna Bowes on Consultation Skills, Lou Sommereux on the Psychological Approach, Alison Telfer discussing From Free to Fee, some Top Tips from Jackie Partridge and a Professional Update from Sally Taber from IHAS to make this a wonderful, informative day.

Health & Safety Good Practice Guide Many businesses whether they are small, medium or large, often make the same common mistake: they tend not to regard Health & Safety as a high priority, and may not take action until an accident occurs or an inspector highlights areas of non-compliance that could have serious implications. Health & Safety regulation can be a huge burden on businesses so it is understandable why practice owners and managers concentrate their efforts on other areas. However, this does not mean that people can shy away from their obligations and responsibilities. Some of the main recommendations within Health & Safety include:       

Simplifying the Risk Assessment process for low hazard workplaces Establishing a web based directory of accredited Health & Safety consultants Production of clear separate guidance under the Code of Practice by the HSE for small and medium businesses engaged in lower risk activities Consolidating the current raft of Health & Safety regulations into a single set of accessible regulations Re-examine the current Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) Combine Food Safety and Health & Safety inspectors in local authorities Publishing the results of inspections by local authorities in an online database in an open and standardised way

Legal Requirements It is a legal requirement under the Health & Safety at Work etc. Act 1974 and E.U. Directives that you, as an employer, comply with your duty to ensure, as far as is reasonably practicable, the health, safety and welfare at work of all employees. An employer has the duty to:      

Ensure the health, safety and welfare of all your employees including part and full time workers, temporary workers and work experience people Inform, instruct and supply relevant information to all employees Undertake a suitable and sufficient assessment of the risks within the workplace Ensure that the premises are safe to use and that all hazardous processes are either eliminated or adequately controlled Ensure that adequate training is supplied to staff where applicable Ensure the health & safety of others who are not employed by you but may be affected by your undertaking, for example, visitors, contractors and members of the public (your clients!).

The above list is not exhaustive as the management of Health & Safety is a serious and complex area, with many sectors having their own pertinent issues. As a start it may be worth considering the following questions. Considerations       

Do you have a documented Health & Safety policy which includes a signed statement of intent, a traceable organisation chart for those employees who have Health & Safety responsibilities and the arrangements in place for reasons of Health & Safety? Are there suitable and sufficient risk assessments in place to address the known hazards within the workplace? If you have more than one practice, are your standards equally acceptable across all sites? Do you hold team meetings to discuss any issues or suggestions? Are the fire precautions adequate? Are the premises safe to use, for example, access and egress? Are you employing a competent person to ensure you are complying with Health & Safety requirements?

Again, this list is not exhaustive and there is a great deal more to consider. If you need more information on Heath & Safety practice, Citation plc can help. Citation plc is one of the UK’s largest Health & Safety and Employment Law firms, with over 6,500 UK businesses as clients. For further details call 0845 844 1111 or visit

Business Corner New Business Lease A new business lease that will make it easier for small businesses in general has been developed by the Royal Institution of Chartered Surveyors (RICS) working with the British Property Federation. Welcomed by the Department for Business, which will work with the private sector to promote it, the new lease is a development of the voluntary 2007 Code for Leasing Business Premises that is endorsed by the FSB and observed by both commercial and local authority landlords. It is available at:

Private Wheel Clamping to be Banned Wheel clamping without lawful authority was banned in England and Wales from 1st October 2012, with anyone breaking the law facing criminal charges and a fine. The new law will effectively ban most clamping and towing by anyone other the police, local authorities and government agencies.

Google Celebrates its 14th Birthday Google was incorporated in California in September 1998, and hired its first employee, Craig Silverstein, shortly after. The company now employees close to 55,000 staff globally — following its acquisition of Motorola Mobility. In the dark days before Google’s math nerds arrived to tackle the problem of speedily locating relevant data online, web users had to made do with search engines such as Yahoo! and AltaVista. As well as having a stated mission to organise the world’s information (and an implicit one to make pots of money from advertising), an epic quest that has seen Google spread its obsessive-compulsive tentacles from the web as viewed on desktop PCs to the mobile internet via apps and its own OS and beyond, it has also, from time to time, expressed its business philosophy via the phrase ‘don’t be evil’ — an informal slogan that has inevitably been used against it. Over the years Google has launched scores of products, from Gmail email to Google maps to the Chrome browser and the Android mobile OS, shuttered plenty of others, and acquired an epic list of companies. Biggies include YouTube, DoubleClick and, most recently, Motorola. It has also got into a fair few fights — both directly and indirectly – while Mountain View’s (Google headquarters) relationship with governments around the world can best be described as love/hate. However, love them or hate them, Google are the dominant platform that anyone with a website needs to keep happy (from a web optimisations perspective) in order to rank on that all important 1st page when consumers search for your services.

Legislation EU Commission Tables Proposals for New EU Regulatory Framework for Medical Devices th

European Union Press Release, Brussels, 26 September 2012. What are medical devices and in vitro diagnostic medical devices? They cover a huge spectrum of products, from home-use items like sticking plasters, contact lenses and pregnancy tests to dental filling materials, x-ray machines, pacemakers, breast implants, hip replacements and HIV blood tests. There are around 500,000 or more different types of devices on the market. They are classified in different risk classes as outlined in the following table: Medical devices: Risk classification1

class I (low risk)

class IIa (low to medium risk)

class IIb (medium to high class III (high risk) risk)

sticking plasters; contact lenses; dental cardiovascular catheters; hip, X-ray machines; corrective filling materials; shoulder and knee joint urethral stents glasses tracheal tubes replacements; pacemakers 1 According to Directive 93/42/EEC on medical devices and Directive 90/385/EEC on active implantable medical devices Examples

In vitro diagnostic medical devices: Risk classification2

Low risk

Low to medium risk

self-tests for the determination of pregnancy 2 According to Directive 98/79/EC on in vitro diagnostic medical devices Examples

tests for the measurement of cholesterol level in blood

Medium to high risk

High risk

Reagents for evaluating the risk of trisomy 21

reagents for detection of HIV

Why are medical devices different from medicinal products? Medical devices should not be mixed up with medicinal products (often referred to as pharmaceuticals) which are subject to a separate regulatory framework. The main difference between medical devices and medicinal products is the product’s principal mode of action, typically physical for a medical device (e.g. mechanical action, physical barrier, replacement of or support to organs or body functions ...). Why is the Commission proposing new rules? There are several reasons why the Commission is proposing new rules for medical devices and in vitro diagnostic medical devices. ďƒ˜ First of all, the existing EU legislation, dating back to the 1990s, has not kept pace with the enormous technological and scientific progress in the past 20 years and like every regulatory regime dealing with innovative products it needs regular revision. ďƒ˜ Moreover, EU Member States interpret and implement the current rules in different ways which leads to different levels of patient and public health protection in the EU. It also creates obstacles to the single market and thus reduces the benefits economic operators could reap from one of the main objectives of European integration. Currently, it is not always possible to trace medical devices and in vitro diagnostic medical devices back to their supplier. New rules on traceability are therefore needed.

 Last but not least, patients, healthcare professionals and other interested parties do not have access to essential information on how medical devices and in vitro diagnostic medical devices have been assessed, and what clinical evidence there is to show they are safe and effective. Greater transparency is needed. Recent events such as the scandal about fraudulent silicone breast implants and the problems occurring with certain metal-on-metal hip joint replacements have brought the above mentioned issues to the attention of the public at large. The Commission proposes a robust and transparent regulatory framework with the necessary instruments for a sustainable, effective and credible management of the system. Are the Commission proposals a response to the PIP breast implants scandal? The Commission had been working on the revision of the medical device legislation before the PIP scandal occurred. However, the Commission has carefully analysed the PIP scandal in order to ensure that the proposals are robust enough to avoid such problems happening again. What are the main changes proposed by the Commission? The Commission proposes important changes regarding various aspects relevant for the life-cycle of medical devices, such as the scope of the legislation, the pre-market assessment of devices, their control once on the market, the transparency of data concerning marketed devices and the management of the regulatory system by the authorities. The main changes in detail are:          

Wider and clearer scope of EU legislation, extended to include, for example, implants for aesthetic purposes, and clarified as regards genetic tests; Stronger supervision of independent conformity assessment bodies (so called 'notified bodies') by national authorities; More powers for notified bodies vis-à-vis the manufacturers, to ensure thorough testing and regular checks, including unannounced factory inspections at manufacturing sites; Clearer rights and responsibilities for manufacturers, authorised representatives, importers and distributors, including in the case of diagnostic services and internet sales; Extended database on medical devices (Eudamed), providing comprehensive and public information on products available on the EU market; Better traceability of devices throughout the supply chain, enabling a swift and effective response to safety concerns (e.g. recalls); Reinforced rules for clinical investigations on devices and the required clinical data for the pre-market and the continuous post-market assessment of medical devices, including in vitro diagnostic medical devices. Adaptation of the general health and safety requirements, including labelling provisions, to the technological and scientific progress. Introduction of classification rules that divide the broad range of in vitro diagnostic medical devices into four different risk classes as it already exists for other medical devices. Creation of a Medical Device Coordination Group composed of members representing national competent authorities in the field of medical devices to ensure better coordination between Member States, with the Commission providing the necessary scientific, technical and logistic support.

What about medical devices and in vitro diagnostic medical devices imported from outside the EU? Medical devices and in vitro diagnostic medical devices produced in a third country and imported into the EU are subject to the same rules as medical devices produced within the EU. The Commission is actively involved in initiatives for international harmonisation in the field of medical devices and in vitro diagnostic medical devices such as the former Global Harmonization Task-Force ( and the new International Medical Device Regulators Forum ( The Commission proposals incorporate guidelines developed at international level into EU law with a view to converging the regulatory requirements for medical devices and in vitro diagnostic medical devices in major economies. What are the next steps? The Commission proposals will be discussed in the European Parliament and in the Council. They are expected to be adopted in 2014 and would then gradually come into effect from 2015 to 2019.

BAAPS Submits Own CAP Code for Advertising Standards in Cosmetic Surgery Industry, Banning Adverts to Under 18s. At their annual conference, held this year at the Royal College of Physicians in London, The British Association of Aesthetic Plastic Surgeons (BAAPS) announced that they have drafted and submitted a new, strict advertising code to the regulator CAP (the Committee of Advertising Practice), which sets out policies for the Advertising Standards Authority (ASA). Although they are continuing to call for an outright ban on cosmetic surgery advertising in all its forms, the BAAPS says that implementing the twelve measures that they have outlined is the ‘bare minimum’ that should be considered acceptable to help protect the public, in particular teens and young people from what they refer to as ‘unethical practices and unhealthy psychological repercussions’. The list of restrictions demanded by BAAPS includes prohibiting financial inducements, time-limited offers, BOGOFs, discount deals through voucher websites like Groupon and the use of unrealistic imagery such as Photoshopped models. A number of these measures, including financial gain for clinic staff who ‘sell’ procedures, are also currently being reviewed for implementation as standards at an EU level, via the CEN Standard for Aesthetic Surgery Services. Former BAAPS President, Consultant Plastic Surgeon Nigel Mercer, who was involved in drafting the EU standards explained; "Banking regulators have recently banned product incentives, entirely because they can lead to misselling by staff hungry for commissions. Yet the practice of promoting sales of serious medical procedures by providing hard-to-resist financial inducements has been allowed to grow unrestrained." After a meeting with the General Medical Council to highlight their concerns, the BAAPS drafted the following restrictions and submitted them to CAP: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Prohibit all advertising aimed at the under 18s for example the use of young spokespeople such as celebrities that appeal to this age group. Prohibit advertising in public places where children can see these ads, such as posters, billboards, sides of buses and television. Prohibit all forms of discounted offers and financial inducements to encourage people having cosmetic surgery including seasonal incentives such as 'New Year, new body!', 'Summer body',’surgical makeovers' or Christmas gift vouchers for surgery. Prohibit time limited offers e.g., 'book by Friday'. Prohibit targeting vulnerable specific groups such as divorced people, brides to be, women after pregnancy e.g., 'Divorce feel-good' and 'Mummy makeovers' discount packages. Ban the principle of loyalty cards as inducement to have multiple or repeat procedures. Prohibit advertising for combined procedures as inducement such as two-for-ones and BOGOFs. Prohibit recruitment of patients for cosmetic surgery by agent, either in the UK or abroad, whether through publications or websites. Prohibit the use of pictures of models or 'real life' patients that raise unrealistic expectations from cosmetic surgery such as through the use of Photoshop. Prohibit advertising of money-off and discount vouchers such as Groupon as inducement for booking for surgery. Prohibit giving cosmetic surgery as prize in any shape or form. Prohibit encouragement of refer-a-friend schemes in return for discount on surgery.

Earlier this year, a report published by the All Party Parliamentary Group (APPG) on Body Image revealed that half the UK public suffer from negative body image, and girls as young as five now worry about their size an appearance. BAAPS President and Consultant Plastic Surgeon Fazel Fatah said; "For a long time the BAAPS has expressed concern over susceptible patients being at risk through the unrestricted proliferation of cosmetic surgery advertising. It is clear that some providers take advantage of the vulnerability of people who seek surgical treatments for psychological reasons.”

“Cosmetic surgery is often portrayed as a commodity raising unrealistic expectations rather than as a medical treatment that can have life long effect, which is why we have been campaigning for an all-out ban on this type of advertising.” “However, in support of the recommendation by the All Party Parliamentary Group that a separate code of advertising be drawn up for cosmetic surgery, we have submitted for consideration a set of twelve measures which we consider to be the bare minimum that should be implemented to protect vulnerable patients." Consultant Plastic Surgeon, Consulting Room Advisor and BAAPS President-Elect Rajiv Grover said; "The government's review into the sector is underway so this is an ideal time to take action. Posters in the Underground and on the sides of buses, billboards, TV and social media ads promoting cosmetic surgery have become ubiquitous, with no consideration for the psychological repercussions on the children and teens exposed to them. This is compounded by the glamorizing of young celebrities who appeal to this vulnerable age group, making it seem like undergoing aesthetic procedures - whether surgical or non-surgical – is aspirational and easy." It seems that the ASA is already taking note of the opinions of BAAPS as only this month, cosmetic surgery chain Transform was reprimanded by the ASA for showing a television advert, which in itself was deemed to be ‘all above board’ but which had been broadcast at times when it could be seen by children, such as 4:30pm. The clinic chain was told to schedule its TV commercials at more appropriate times in future, when children were unlikely to be able to view them. BAAPS President Fazel Fatah concluded; "We strongly believe that in the absence of a complete ban, the above measures in their entirety are necessary." The BAAPS Annual Scientific Meeting included presentations by surgeons to their peers on a vast number of subjects including new techniques and the latest advances in aesthetic plastic surgery. Some of these include a new facial surgery assessment tool, the results of standardized psychological screening questionnaires, the evolution of the facelift and the longevity of its effects, advances in procedures such as eyelid surgery, cheek and arm lifts, breast augmentation and reduction; ethnic and post-obesity surgery. A study presented at the conference also revealed that cosmetic surgery procedures have increased by nearly 300% in the last decade and that, unlike in the U.S. where the market has matured and 'plateau'd', in Britain demand is closely linked with economic factors such as interest rates.

Time is Running Out, You have Until 15th October 2012 Professor Sir Bruce Keogh is undertaking a Cosmetic Surgery Industry Review; have your say as part of the ‘Call For Evidence’. The call for evidence is asking for people’s views on the regulation and safety of products used in cosmetic interventions; how best to ensure that the people who carry out procedures have the necessary skills and qualifications; how to ensure that organisations have the systems in place to look after their patients both during their treatment and afterwards; how to ensure that people considering cosmetic surgery and procedures are given the information, advice and time for reflection to make an informed choice; and what improvements are needed in dealing with complaints so they are listened to and acted upon. The Department of Health has issued a 71 page document to explain the background behind the review and the areas which is hopes to investigate.

Please read this document (PDF format) and participate in the consultation by completing the questions on the online form. Such an opportunity is unlikely to come along again.

Don’t Miss The Deadline!

IHAS Considers Dermal Fillers What Best to Advise? The Independent Healthcare Advisory Services (IHAS) Executive has considered whether to recommend reclassification of dermal fillers as prescription-only medicines, but has found that this would have many disadvantages. It would be preferable to strengthen the present system in five respects:  Identify what is controlled. Compulsory notification to (National) Competent Authorities (CA) in every EU country, with enhanced data provided so that the CA can carry out its functions of assessment and inspection more effectively.  Know what changes. Clear guidelines defining what is meant by significant changes to risks, applicability, product design and other data created to get the original approval would strengthen governance of medical device manufacture.  Define who may buy them. There are no EU policies controlling distribution of medical devices. While the major UK suppliers and manufacturers responsibly limit distribution of dermal fillers to doctors, dentists or registered nurses along with selected pharmacy distribution, this is voluntary. If the MDD were to define who the products may be sold to, it would have a significant impact on control of distribution to those clinically competent to use them, and expose such as beauty therapists who are not clinically competent.  Define who may use them. Treatments You Can Trust (TYCT) believes that only qualified healthcare professionals trained in facial anatomy, competent to handle injections and responsible for undertaking medical procedures (doctors, dentists or registered nurses) should administer facial injectables including dermal fillers. We call on the Department of Health to safeguard the patient by restricting who can administer these injections.  Increase audit and inspection. Responsible manufacturers and distributors will not fear increased frequency and depth of inspections at both the “legal manufacturer” and the actual producer’s sites. This will lead to a rise in standards, if combined with tougher sanctions. has announced that it will soon be launching a ‘Safe Injectable Campaign’ with Dr Hilary Jones, the consumer representative on the TYCT Governance Board, also well known for his daytime TV appearances. This is a consumer facing campaign educating patients of the danger of visiting inappropriately trained cosmetic injectable providers and highlighting the as way to find a safe provider with Dr Jones’ advice. TYCT are interested to hear from any members if they are aware of any bad practice in their area.

Book Review Get 20% Off* Books From Informa Healthcare With The Consulting Room™! This month's book offer:

Illustrated Manual of Injectable Fillers: A Technical Guide to the Volumetric Approach to Whole Body Rejuvenation, First Edition Edited By: Neil Sadick (Sadick Aesthetic Surgery & Dermatology, New York, NY, USA) Paul J. Carniol (Cosmetic Laser & Plastic Surgery, Summit, NJ, USA) Deborshi Roy (Facial Plastic Surgery, at Sadick Aesthetic Surgery and Dermatology) Luitgard Wiest (Private practice, Munich, Germany)

This highly illustrated book is a refreshingly straightforward guide on how to select and use the right filler for a particular patient. It discusses the limitations and potential complications involved in using fillers, helping you to achieve safe, reliable, aesthetic results and details the newer options available in European markets, keeping you at the cutting-edge of your field. Table of Contents Part I

Introduction Chapter 1: Introduction to volumetric rejuvenation Chapter 2: Overview of injectable fillers Chapter 3: Approach to choosing the ideal filler

Part II

Upper Facial Rejuvenation Chapter 4: Anatomy of the brow and periorbital region Chapter 5: Volumetric approach to periorbital rejuvenation

Part III

Midfacial Rejuvenation Chapter 6: Anatomy of the midface Chapter 7: Volumetric approach to midfacial rejuvenation

Part IV

Lower Facial Rejuvenation Chapter 8: Anatomy of the lower face and neck Chapter 9: Volumetric approach to lower facial rejuvenation Chapter 10: Volumetric approach to the lips

Part V

Other Anatomical Sites Chapter 11: Volumetric approach to rejuvenation of the hands Chapter 12: Volumetric approach to rejuvenation of the buttocks Chapter 13: Post liposuction defects

Part VI

Emerging Products Chapter 14: US Experience Chapter 15: European Experience

Hardback Published: May 2011, ISBN: 9780415476447, 288 pages, 200 colour illustrations.

Discounted Price: £92 / €114 (Normal Price: £115 / €143) Don’t miss out! Special 20% Discount for Consulting Room members and Free Shipping! To order call +44 (0)20 7017 5540 quoting promo code GOCGOLD, or use the order form Enquiries should be sent to For more information and a full catalogue of available titles at this great 20% discount offer, please click here - *Terms & Conditions Apply

Educational Opportunities

Training, Events, Mentoring etc... Ensure that you are kept up to date with all educational opportunities, including webinars, seminars and conferences. 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.

Conferences Dates For Your Diary FACE Conference 2013 SAVE THE DATE! 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: 21st – 23rd June 2013 at the QEII Conference Centre, Westminster London

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

Give Your Aesthetic Business a Competitive Edge & Attend

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. Provisional dates for 2013 include:

Saturday 26th January in Manchester Saturday 27th April in London 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 have a free web evaluation with our professional web designer 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.

For more information, please visit To register your interest please call Danny Large on 01788 577 254 or visit

BODY 2012 – 3rd & 4th November at the Royal Society of Medicine in London The UK’s only Parallel Conference Dedicated to Both Surgical and Non-Surgical Cosmetic Treatments in the Rapidly Evolving BODY Aesthetic Market BODY2012 is the sister conference to FACE - the UK’s largest scientific conference on facial aesthetics. It follows the same format in aiming to provide the highest quality national and international speakers in their respective fields of scientific interest to update your clinical knowledge and explore new market opportunities in the dynamic BODY aesthetics industry. Many practitioners attend events focused around their individual speciality or area of expertise and do not often meet practitioners with different training and backgrounds working in the UK aesthetic industry. BODY provides a broader cosmetic agenda that brings all practitioners and clinic owners together at one meeting to provide a unique opportunity for debate and to learn more about the specifics of the many different market segments that make up the BODY aesthetic market place. BODY2012 is the largest UK congress devoted to the non-surgical and surgical BODY Aesthetics sector of the Cosmetic Market, and is a must attend event for practitioners and clinics operating in or wishing to enter this exciting market segment. Choice of Parallel Agendas and Workshops The BODY conference offers choice and value for delegates with the inclusion of separate parallel agendas providing dedicated scientific content for Plastic Surgeons, Cosmetic Surgeons, Cosmetic Doctors, Dermatologists, Nurses, Clinic Owners, Laser Therapists and other Aesthetic Practitioners, allowing them to choose specific topics that interest them. Surgeons can learn about non-surgical treatments, and non-surgeons have the opportunity to educate themselves about the latest surgical advances in a unique conference covering all aspects of the BODY aesthetic market in detail. Two Day Surgical Conference A unique learning opportunity exploring current topics in body contouring aesthetic surgery. The programme is designed for interactive open discussion amongst the experts and will cover the latest topics related to cosmetic breast surgery, managing PIP patients, traditional versus other methods of liposuction, buttock augmentation, cosmetic genital surgery, abdominoplasty and reconstructive procedures following massive weight loss. Two Day Non-Surgical Conference Saturday 3rd November is dedicated to exploring the wide variety of different effective non-surgical treatment solutions for fat reduction and cellulite in this popular and rapidly expanding market segment. In addition, we will explore the potentially lucrative market for the effective treatment of stretch marks comparing evidence for different scientific concepts for this challenging, but common cosmetic indication. Sunday 4th November will cover a wide range of other topics including tattoo removal, incorporating bio-identical hormone treatments into an aesthetic practice, 3D imaging systems, dermal fillers for the feet, and hand, knee and décolletage rejuvenation. Laser Hair Removal and Skin Treatment Symposium For those businesses specialising in laser and IPL treatments, or for clinics and practitioners wishing to explore this th very popular and profitable market segment, we have another separate symposium running on Sunday 4 November. The morning will explore laser training, treatment of dark skins and dealing with resistant hair removal cases alongside discussing, in detail, the differences between five leading competing laser hair removal systems. The afternoon will review laser skin rejuvenation of the décolletage, laser vaginal rejuvenation and onychomycosis – one of the newest laser indications. Other Conference Features:  Condensed Laser Core of Knowledge Workshop run by Mapperley Park Training  Separate in-depth “dealing with problems” Laser Hair Removal Workshop run by Syneron Candela  Wide range of separate Exhibitor Workshops  Dedicated BODY aesthetics exhibition featuring a range of leading suppliers AND – “An Evening With” Dr Alfredo Hoyos: Plastic Surgeon from Colombia who is an ardent painter, sculptor, and inventor with ten patents to his name and pioneering work in the field of plastic surgery, in particular the art of body sculpting. With a list of patients that includes famous actors, models, celebrities, top athletes and even royalty he also enjoys travelling the world over to lecture and share his unique techniques. Don’t miss out on this unique conference dedicated to the latest scientific information, alongside clinical and practical tips revealed by experts specialising in the BODY aesthetics market. For more detailed speaker and agenda information and to register for the BODY conference online please visit – or to register by telephone call 020 7514 5989.

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Clinical Information

The impact of liposuction cannula size on adipocyte viability. Kirkham JC, Lee JH, Medina MA 3rd, McCormack MC, Randolph MA, Austen WG Jr. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA. Ann Plast Surg. 2012 Oct;69(4):479-81. PURPOSE: Autologous fat transfer ("fat grafting") is widely used in cosmetic and reconstructive surgery, but longterm outcomes remain inconsistent. Each step in the transfer process can cause mechanical damage to the graft tissue. In particular, liposuction breaks aspirated adipose tissue into distinct globules and subjects it to shear forces, both of which can impact subsequent fat graft viability. The optimal size of the liposuction cannula for use in fat grafting is not known. METHODS AND TECHNIQUES: Controlled lipoaspirate samples were collected from adult female patients undergoing elective liposuction of the abdomen and flanks with uniform aspiration pressure (-25 in Hg) and either a 3- or 5-mm standard blunt-tip liposuction cannula. Individual grafts of 1.00 ± (0.01) gram were prepared and injected into the bilateral flanks of nude mice with a 14-gauge catheter. After six weeks, these grafts were explanted and analyzed by weight and histology. RESULTS: At six weeks, fat lobules in the 5-mm group retained 25% more weight than those in the 3-mm group [mean (SD), 0.70 (0.07) vs 0.56 (0.09) g, n = 24/group, P < 0.01). Histologic analysis revealed more intact, nucleated adipocytes in the 5-mm group than in the 3-mm group [4.42 (0.92) vs 3.10 (0.56) on a 1-5 rating scale]. The 5-mm group exhibited both less infiltrate [1.58 (0.17) vs 3.13 (0.70)] and less fibrosis [1.67 (0.45) vs 3.13 (0.89)] than the 3-mm group. CONCLUSIONS: In this controlled model of fat grafting with either a 5- or 3-mm aspiration cannula, the use of a larger aspiration cannula led to improved graft retention and quality. This finding has important implications for clinical applications of fat grafting.

Techniques for the Optimization of Facial and Nonfacial Volumization with Injectable Poly-L: -lactic Acid. Lorenc ZP. Lorenc Aesthetic Plastic Surgery Center, 983 Park Avenue, New York, NY, 10028, USA. Aesthetic Plast Surg. 2012 Aug 28. With the recognition of the key role of volume loss in the facial aging process, injectable dermal fillers and volumizers have become increasingly important treatment options for recontouring and rejuvenating the aging face. While replacement fillers effectively correct individual lines and wrinkles, volumizing agents that replace collagen provide a longer-lasting, volume-based alternative. Poly-L: -lactic acid (PLLA) has been shown to increase dermal thickness and volume for up to 2 years and beyond. Although early clinical use of this agent in patients with HIV-associated facial lipoatrophy was associated with a significant rate of nodule or papule formation, subsequent experience has helped define the proper reconstitution volumes and injection techniques for optimizing results and minimizing nodule/papule formation. While injectable PLLA has been used successfully for rejuvenation of most facial areas, increasing experience suggests that it is a versatile agent capable of providing aesthetic enhancement in multiple areas of the body, including the dorsum of the hands, the décolleté, the neck, the buttocks, the medial ankles, and acne scars. Although the current published experience in these areas is limited, further studies and clinical use of injectable PLLA will clarify the potential of this agent as a minimally invasive alternative and/or adjunct to surgery for restoring volume loss in multiple anatomic areas.

Subjective rating of cosmetic treatment with botulinum toxin type a: do existing measures demonstrate interobserver validity? Conkling N, Bishawi M, Phillips BT, Bui DT, Khan SU, Dagum AB. From the Division of Plastic Surgery, Stony Brook University Medical Center, Stony Brook, NY. Ann Plast Surg. 2012 Oct;69(4):350-5. BACKGROUND: Throughout the literature, investigators have assessed the cosmetic efficacy of botulinum toxin (BT) treatment by using various subjective, qualitative measures, including the Facial Wrinkle Scale (FWS) and Subject Global Assessment (SGA). The widely used FWS and SGA attempt to quantify both the magnitude and duration of cosmetic outcomes as assessed by physician and patient. We sought to determine the interobserver validity of these scales relative to the level of observer experience. METHODS: Botulinum toxin injections were performed to cosmetic effect in 6 patients recruited as part of an institutional review board-approved investigation. Subjects were photographed at rest and during animation (raising eyebrows, frowning, and blinking) before treatment and at 1, 2, 4 weeks, and monthly with follow-up to 6 months. Standardized digital 8″ × 10″ prints were scored using the FWS by board-certified plastic surgeons (n = 5), general surgery residents (n = 3), and medical students (n = 4). Photographs at each time point were then compared to baseline using the SGA. Statistical analysis of observer data was performed using SPSS v19. Cohen κ (FWS) and Spearman ρ (SGA) were calculated for each pairwise comparison of observer data, with a conservative α of 0.01. RESULTS: The FWS observer scores for the upper face overall were generally in agreement, with no negative κ values. The distribution, even among members of a single group, was highly variable. Agreement among plastic surgeons was the greatest (κ, 0.194-0.609). Resident concordance was moderate, and medical students displayed the most variable agreement. Spearman ρ for SGA scores was much higher, with surgeons approaching excellent agreement (κ, 0.443-0.992). In comparisons between members of different groups, agreement was unpredictable for both the FWS and SGA. Comparisons using scores from individual areas of the face were least concordant. CONCLUSIONS: The FWS and SGA represent the current standard of cosmetic outcomes measures; however, when subjected to scrutiny they display relatively unpredictable agreement even among plastic surgeons. Compared to the FWS, the SGA has a more acceptable user concordance, especially among plastic surgeons accustomed to using such scales. The interobserver variability of FWS and SGA scoring underlines the need to explore objective, quantitative cosmetic outcomes measures.

RimabotulinumtoxinB vs. onabotulinumtoxinA for the treatment of forehead lines: an evaluator-blind, randomized, pilot study. Lee DH, Kang SM, Feneran A, Youn CS, Kim JK, Cho S, Won CH, Chang SE, Lee MW, Choi JH, Moon KC. Seoul, Korea. J Eur Acad Dermatol Venereol. 2012 Oct 3. Background Optimum dose ratios of rimabotulinumtoxinB (BTX-B) and onabotulinumtoxinA (BTX-A) have not been determined for forehead wrinkles. Objective To compare the efficacy and safety of BTX-B and BTX-A for the treatment of forehead lines. Methods Twenty-two women (mean age, 40years) with symmetrical moderate to severe forehead lines were randomized to receive single intramuscular injections of BTX-A and BTX-B on either side of the forehead, at a potency ratio of 1:70 or 1:100. Subjects were followed-up for 16 weeks. Four physicians evaluated patients' photographs according to the 4-point Facial Wrinkling Grade (FWG). Clinical Improvement Scale (CIS) was calculated by subtracting FWG score at each visit from that at baseline. Patient satisfaction scores and adverse events were also recorded. Results Both BTX-A and BTX-B were effective for the treatment of forehead lines. At both potency ratios, BTX-A had a longer duration of action than BTX-B, while BTX-B led to faster improvement than BTX-A. There was no significant difference in CIS between 700U and 1000U BTX-B treatments. Adverse effects were mild and transient. Conclusion Both BTX-A and BTX-B were effective and well tolerated for the treatment of forehead wrinkles at potency ratios of 1:70 and 1:100.

Efficacy of intradermal radiofrequency combined with autologous platelet-rich plasma in striae distensae: a pilot study. Kim IS, Park KY, Kim BJ, Kim MN, Kim CW, Kim SE. Departments of Dermatology, Chung-Ang University College of Medicine, Seoul Departments of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, South Korea. Int J Dermatol. 2012 Oct;51(10):1253-8. Background Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post-inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet-rich plasma (PRP) is an effective treatment known for its wound-healing effects. Methods Nineteen Asian female patients with striae distensae were enrolled in this study. Three sessions of intradermal RF (1134-kHz frequency, 12-W power, 26-G electrode size) combined with autologous PRP were performed in each patient at intervals of four weeks. Patients were evaluated subjectively by the investigators and by themselves. Results Evaluation of clinical results at four weeks after treatment showed that only one (5.3%) of the 19 patients achieved excellent improvement, whereas seven (36.8%) demonstrated marked improvement, six (31.6%) showed moderate improvement, and five (26.3%) showed mild improvement. None of the patients showed worsening of striae distensae. A total of 63.2% of patients reported they were "satisfied" or "very satisfied" with the degree of overall improvement. Conclusions Intradermal RF combined with autologous PRP appears to be an effective treatment for striae distensae.

A split-face comparison of a fractional microneedle radiofrequency device and fractional carbon dioxide laser therapy in acne patients. Shin JU, Lee SH, Jung JY, Lee JH. Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine. J Cosmet Laser Ther. 2012 Oct;14(5):212-7. Background: A number of lasers and light-based devices have been reported as promising treatment options for acne vulgaris. Objective: To evaluate the efficacy and safety of fractional microneedle radiofrequency (MRF) device treatment compared to CO(2) fractional laser system (FS) for the treatment of acne vulgaris. Methods: Twenty healthy subjects underwent full-face treatment for acne vulgaris with CO(2) FS and MRF device. For each subject, two passes of CO(2) FS with a pulse energy setting of 80 mJ and a density of 100 spots/cm(2) were used on one side, and two passes of MRF device with a intensity of 8, density of 25 MTZ/cm(2), and a depth of 1.5-2.5 mm were used on the other. Patients were evaluated 3 months postoperatively and were also photographed. Results: Most of the patients improved based on clinical and photographic assessments 3 months after the treatment. No significant differences in physician-measured parameters, patient ratings, or intraoperative pain ratings were found, although downtime was significantly longer for the CO(2) FS treated side. Conclusions: MRF device and CO(2) FS can be used for acne vulgaris patients and MRF device is more convenient than CO(2) FS because of its short downtime.

Assessment of safety and efficacy of a bipolar fractionated radiofrequency device in the treatment of photodamaged skin. Bloom BS, Emer J, Goldberg DJ. Department of Dermatology, New York University School of Medicine , New York, NY , USA. J Cosmet Laser Ther. 2012 Oct;14(5):208-11. Background: A number of devices are available for skin rejuvenation and conventional devices include both ablative and non-ablative lasers. More recently, bipolar fractionated radiofrequency (RF) devices have been introduced. Objective: To evaluate the safety and efficacy of a novel 144 pin high density tip bipolar fractionated radiofrequency (RF) device for skin rejuvenation in Fitzpatrick skin types I-IV. Methods and materials: This single-center, prospective, study enrolled 25 female between the ages of 35-60 years, with mild to moderate wrinkling based on the Fitzpatrick Wrinkle Scale. The subjects were of Fitzpatrick skin types I-IV. Each subject underwent 3 full-face treatments with a 144 pin fractional bipolar RF device at 30-day intervals. All subjects underwent clinical evaluations during the study period to evaluate for any adverse events. Subsequently, all subjects were evaluated for improvement in rhytides, dyschromias and skin texture based on photographic evaluation by blinded investigators at 6 months following the final RF treatment. Results: A statistically significant improvement in rhytides, dyschromias and texture was noted. Adverse events were limited to mild erythema and swelling. Post-inflammatory pigmentary changes were not observed in any subjects. Conclusion: The novel 144 pin high density tip bipolar fractionated RF device is both safe and effective for facial skin rejuvenation in Fitzpatrick skin types I-IV.


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Interesting News Articles You May Have Missed Due to global copyright laws the Consulting Roomâ&#x201E;˘ 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 so we can make every attempt to remedy it.

Scientists baffled by contents of breast implants PIP breast implants contain chemicals which scientists cannot identify, we can reveal. New tests on the now-banned implants, which were filled with industrial grade silicone, have been under way for several weeks. The Government claims the implants are not harmful after it conducted a series of tests. But information seen by the Daily Star Sunday shows experts could not identify some of the chemicals used in them. SOURCE: Daily Star

Twins' Breasts Are Revealing Women wondering how to maintain great-looking breasts may now have more answers thanks to a new study of identical twin sisters. After controlling for genetic factors, investigators from University Hospitals Case Medical Center in Cleveland found that breastfeeding, daily moisturizing, and hormone replacement therapy significantly decelerate the perceived aging of breasts, whereas smoking, drinking alcohol, multiple pregnancies, higher body mass index (BMI), and larger bra and cup sizes contribute to accelerated breast aging. SOURCE: ASAPS

Cosmetic surgery clinics call for tighter regulation Two of the UK's leading private providers of cosmetic surgery are calling for improved regulation. Harley Medical Group and Transform said European regulators' failures over breast implants manufactured by French company Poly Implant Prothese had caused financial and operating issues. The UK's regulator had acted appropriately, but lessons should be learned, the Department of Health said. SOURCE: BBC News

China battles cosmetic surgery craze With botched surgeries topping 20,000 a year, efforts are on to regulate clinics people visit to look sharp and smart. The Chinese government is cracking down on a burgeoning industry involving thousands of illegal "surgeons" tucking in tummies, widening eyes and, more popularly, enlarging breasts of women trying to improve their career prospects or impress potential suitors. SOURCE: Aljazeera

Latisse shows long-term success, according to recent study The first long-term trial of Latisse (bimatoprost ophthalmic solution 0.03 percent, Allergan) shows that daily application of the eyelash enhancer for up to one year is safe and effective for patients with idiopathic and chemotherapy-induced hypotrichosis. SOURCE: Modern Medicine

Injection Warning After Tanning Salon Death Tanning hormones, which are injected to darken skin tone, could have serious side effects, health watchdogs have warned. Jenna Vickers, 26, from Bolton, was found slumped in a tanning shop in the town on Monday. It is believed that she may have injected a tanning drug (Melanotan), which she had bought off the internet. SOURCE: Sky News

Could this stem cell cure for wrinkles end the endless hunt for the perfect skin cream? A British firm is trialling a new method which involves injecting the patient’s own stem cells to restore skin’s youthful elasticity. Researchers believe they will spur the growth of new skin cells, called fibroblasts, which make the elastic ingredient collagen which is produced in large quantities when we are young, but declines as we age. The company Pharmacells, based in Glasgow, plan to begin clinical trials in 12 months, using stem cells harvested from a blood sample from the patients. SOURCE: Daily Mail

50 Years of Silicone Gel Breast Implants What are the important lessons and questions from half a century of clinical use? Few medical devices are still in use nearly 50 years after introduction. Silicone gel breast implants – despite the controversies over the years – are one of the exceptions. Half a century after silicone gel breast implants were first introduced clinically, what are some of the lessons that plastic surgeons have learned about these devices, and what have they yet to uncover? SOURCE: ASAPS

Why women are embracing the lowbrow look Greater equality means high, arched brows are out of vogue, and increasing numbers are turning to surgery. The term "lowbrow" has been an insult until now: in future though, scientists predict, it is likely to be a compliment. A new study by plastic surgeons seeking the perfect female brow found that women's eyebrows are becoming lower, flatter and less arched. SOURCE: The Independent

Woman charged with Botox fraud A Scarborough beautician charged with disfiguring a colleague with an anti-ageing drug turned up for court in a Lady Gaga-style blonde wig. Jamie Winter, 33, was arrested in May and charged with fraud by false representation by claiming to be a person qualified and authorised to administer Botox, which is only available on prescription. SOURCE: Scarborough News

Harmful Virus May Be Able To Treat Acne A harmful virus has been identified as a possible new weapon to fight acne. Scientists at UCLA and the University of Pittsburgh suggest that a virus living on our skin naturally seeks and destroys the bacteria responsible for zits. SOURCE: Medical News Today

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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.    

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Equipment Sales SaveOnKit (formerly Moorgate Consulting) 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 - 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 - 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 - Depilex Multivac Plus suction cup machine with Stand Vacuum for facial treatment to de-congest and improve circulation. Good condition and full working order For Sale at £570 *PRICE REDUCED £380 + VAT* More info - Depilex Dermapeel Professional Microdermabrasion System In good condition, full working order For Sale at £912 *PRICE REDUCED AGAIN £570 + VAT* More info – 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 - Body Ultimate Skincare Facial Toning System In good working order complete with attachments, bands and pads For Sale at £1,500 + VAT *PRICE REDUCED AGAIN £760 + VAT* More info - 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 – Luxury Natural Wood Style beauty treatment table, seat + trolley In pristine condition, top quality natural wood style For Sale at £500 + VAT each (2 available) *PRICE REDUCED £380 ex VAT each* More info - 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 -

E Light IPL Laser Hair removal Rejuvenation Wrinkle Vascular salon beauty System For Sale at £3,800 + VAT More info - 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 – Ultimate Skincare Body Contour System Latest Model Designed to achieve body toning by stimulating nerve endings to improve tone in the muscle tissue. For Sale at £700 + VAT More info - 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 - 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 - 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 - Nemectron Nembrasion Professional Microdermabrasion System In good condition and full working order For Sale at £1,425 + VAT More Info - 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 - 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 - 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 - 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 - 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 - 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 - For a full list of second hand equipment sales, please see:

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The Consulting Room™ Industry Magazine Edition 113, October 2012  

Industry member magazine for subscribed Consulting Room clinics. Edition 113 for October 2012

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