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From The Editor's Desk Welcome to The Consulting Room™ Industry Magazine For September 2012 In this issue for September, our Feature Article looks at hyaluronidase, the ‘magic eraser’ for hyaluronic acid based dermal filler complications. Industry awards season is upon us, we’ll be looking at the glam events coming up in our Latest News. Our Legislation section is full this month with details of the ‘call for evidence’ for Professor Sir Bruce Keogh’s review of the cosmetic industry. We look at the questions the review is asking and how you can participate in the golden opportunity to help shape industry standards and best practice. We also get an update on the latest meeting discussing the European CEN standard for the industry. We look at Facebook PPC advertising clickbot issues in our Business Corner.

Lorna Jackson

This month’s New Product Reviews, feature Zytaze, the zinc based product aimed at enhacing botulinum toxins. We first blogged about it in 2011, now it’s available in the UK. As always the magazine is packed with Clinical Information, Equipment Sales and Interesting News Articles and Blogs That You May Have Missed.

Technical Outage Now Resolved It seems that the Gremlins got into our web systems recently and caused havoc, but we’re pleased to announced that the pesky little critters have now been evicted! Some of you will have noticed that we suffered from some technical issues at the end of August which left us with some days where The Consulting Room website (www.consultingroom.com) and our sister sites (www.cosmetictraining.co.uk, www.cosmeticvideos.co.uk, www.consultingroomservices.com and www.consultingroomshop.com) were all offline. Our email was also affected. This was caused by an irrecoverable hardware failure on our dedicated web server provided by Fasthosts. A new server was swiftly commissioned by them and our engineers spent several days setting up all the software and configuration required to reload all our sites from back-ups and reinstall our email programme. We thank you for bearing with us during this unexpected time and we’re pleased to report that we believe that all has been recovered and reloaded. Due to the timely taking of backups though it is possible that you may have updated your clinic listing just before the server outage occurred and before another back-up was taken. We would therefore request that all members log in to their account with us and have a look at their clinic profile pages to make sure nothing is missing. Please pay particular attention to the image section as this is where the backing up of files may not have occurred in the time frame involved. If you notice any errors and are unable to solve them yourself, such as by uploading an image which has gone missing, then please contact admin@consultingroom.com and a member of our team will assist you.


Consulting Room Team Ace ‘Coast to Coast’ Challenge

Some of The Consulting Room Team, including Ron Myers, Martyn Roe, Dan Huxley, Danny Large and st st Danielle Lowe took part in the 145 mile Coast to Coast (C2C) cycling challenge on 31 August & 1 September 2012. They were joined by members of Syneron Candela including Gary Barker, the husband of UK General Manager Michaela Barker, their 13 year old son Jonathan, Paul Simmonds (invaluable mini-bus support driver) and Michaela herself who provided great moral support and encouragement as well as handing out much needed energy drinks to the riders. I’m sure the team would also like to thank the manufacturers of the anti-chaffing cream! The C2C 2012 took two days, riding through the Northern Lakes and over the Pennines. It is said to be the ultimate ride through the heartlands of unspoilt Lakelands – through villages just off the beaten track. From the start in Whitehaven, the team cycled over Whinlatter Pass to Keswick then on to Penrith and then overnight in Garrigill at the 77 mile halfway point. Bright and early the next day they negotiated four big hill climbs as they travelled through Stanhope, Consett and on to Newcastle and Tynemouth where they finished by dipping the front wheels of their bikes in the sea – and of course themselves!

The team were raising money for various charities close to their hearts including Chester Childbirth Appeal and a fund for a specially designed wheelchair for a lady in Rugby who contracted a rare condition called arachnoiditis following complications after back surgery. So far they have raised (including gift aid) £2,002. We’d like to thank all those who supported us in this event, for you donations and words of encouragement! If you still wish to donate and sponsor our crew you can do so by visiting this Virgin Money Giving page. Be sure to include the Gift Aid.


Rumour has it that there could be some cycling in Ireland next year; watch this space!


Some Recent Blogs You May Have Missed CTIA rapped by DWP for claiming government funding for beauty therapist injectable training By Lorna Jackson An organisation set up to campaign for inclusion of beauty therapists in the lucrative facial aesthetics marketplace has been reprimanded for claiming government backing for its cosmetic injectable training courses aimed at beauty therapists. www.consultingroom.com/blog/317

Cosmetic Surgery Litigation - the Impact of Advertising By Nigel Poole Q.C. A claim for damages for injury resulting from cosmetic surgery treatment may be brought in contract and/or tort. The patient may have a contract with the surgeon directly, in which case any claims that the surgeon has made in advertising about his level of skill and expertise may become terms of the contract unless they are obviously "mere puffs". www.consultingroom.com/blog/316

Anti-ageing skincare gets cheaper and cheaper with Wrinkle Stop at Aldi By Lorna Jackson The price for fewer and reduced wrinkles seems to be getting cheaper and cheaper with cut price retailer Aldi now adding an anti-ageing cream to its shelves called Wrinkle Stop at just £4.99 for 10ml. www.consultingroom.com/blog/312

Don’t Forget to Visit Our Cosmetic Videos Site With ‘Members Only’ Content The Member’s Only section of our new specialist video website – www.cosmeticvideos.co.uk 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):

Injecting Local Anaesthetics for Minor Surgery Medical tutorial on how to use local anaesthetic for a good haemostasis; how to calculate the toxic dose for your patients; how to administer local anaesthetics; which technique is best to use; what types of needles are more appropriate for injecting local anaesthetics and what are the general issues surrounding use of local anaesthetics for minor surgery.


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

Med-fx

N/A £100.00 4+ packs @ £91 each £118.00 / £53.95 10+ Packs @ £107.00 each / 20+ Packs @ £51.00 each £89.50 Buy 8 @ £67 each and get 1 Free * N/A

£140.00 / £76.01 N/A

£145.00 £95.00

N/A

£119.90

£83.24

£98.11 Buy 6 get 2 Free*

£96.88

£93.35 *Offer ends 30th September 2012

Nip & Tuck - Facts & Stats

48%

Two Thirds

of women surveyed are concerned that they might look too fake/plastic following a cosmetic procedure.

of people factor cost above anything else, including practitioner qualifications when considering cosmetic treatment/surgery.

Source: YouGov Sixth Sense Survey

Source: Department of Health Survey

3% of the population is affected by Rosacea usually fair-skinned females aged 30-50. Source: Journal of Medical Microbiology

14%

£549

of 16 and 17 year old Italian girls said they would undergo breast enhancement surgery in 2009 which led to a ban on under 18s surgery.

Retail price for the newly launched TRIA Skin Rejuvenating Laser for home use, non-ablative fractional skin treatments.

Source: Independent

Source: Tria Beauty


Latest News And The Award Goes To... The Oscars may not be until the New Year but it would seem that the Aesthetic Industry is gearing itself for its own awards season with the MyFaceMyBody Awards and the Aesthetic Awards in Association with Cosmetic News both coming soon.

The MyFaceMyBody Awards are being marketed as the first consumer awards for the cosmetic, dental and aesthetic industry. The idea being that the public votes for their favourite treatments and products, rather than simply the industry itself.13 categories are now shortlisted for including awards for best products and treatments within both the aesthetic and dental arenas, along with awards for Best TV Documentary, Best Charity Project, Best Online Resource for which The Consulting Room™ is shortlisted. Additionally, our Editor, Lorna Jackson is shortlisted for the Journalist of the Year award. Voting is now open. Visit www.myfacemybody.com/awards_b/Vote/ or click on the image. The awards ceremony will take place at the Landmark Hotel in London on 3rd November 2012.

The Aesthetic Awards 2012-13 in association with Cosmetic News, now in its second year, has a total of 30 categories of industry awards, including those for manufacturers and suppliers of cosmeceuticals, injectables, equipment and retail products with awards available for product innovation, customer service and sales reps. Additional awards are available for clinics and practitioners, as well as industry associations. The Consulting Room is sponsoring the Aesthetic Practitioner of the Year award. Two special awards are included this year; the Baroness Ritchie Award for Services to the Industry to be awarded to an individual who has gone above and beyond in their services to the industry and has been named in honour of Baroness Ritchie of Brompton, the former Chair of the Treatment You Can Trust Governance Board. Five people have been shortlisted for this award including Emma Davis from the BACN, Mr Dalvi Humzah, Lynne Thomas from Flipside PR, our own Ron Myers and Sally Taber from IHAS. Another special Lifetime Achievement Award to recognise the achievements of an individual who has had a long and fruitful career in the aesthetics industry will be announced on the night of the awards. Voting is now open until Monday 15th October. Visit www.cosmeticnewsuk.com or click on the image. st

The awards ceremony will be held at The Grand Connaught Rooms in London on 1 December.


New Product Reviews Zytaze® Enhances Botulinum Toxin Injections? Zytaze®, a nutritional support to enhance the effectiveness of botulinum toxin injections is now available in the UK from Eden Aesthetics. Manufactured by OCuSOFT Inc, an ophthalmic research, development and supply company, Zytaze is a nutritional support formulated with a unique blend of organic zinc and phytase which increases zinc absorption in the body to quicken the onset of botulinum toxin injections. Zytaze optimises the effect of the cosmetic injections so that results for the client remain more consistent throughout the three month period from injection to injection with the additional benefit that the treatment takes impact within two to three days rather than the usual two weeks. According to the manufacturers, the concept behind Zytaze is that for each botulinum toxin molecule to be effective in paralysing a muscle response, it must be associated with a molecule of zinc. Without zinc, the otherwise powerful botulinum toxins have little or no effect. Therefore, if a person has inadequate amounts of zinc in their body, the botulinum toxin will have a significantly decreased effect, producing poor and short term results. It was from this observation that researchers started to look at the zinc levels of patients and consider the concept of supplementation. Dietary trends suggest that achieving adequate levels of zinc through diet alone is becoming increasingly difficult given today’s diet and lifestyle, such as reduced consumption of zinc-containing foods like red meats and an increase in the consumption of substances that inhibit zinc absorption such as phytate-containing foods like whole grains, legumes and alcohol. By supplementing with Zytaze prior to a botulinum toxin injection, the organic phytase in Zytaze neutralises the phytates and aids the absorption of zinc in the GI tract say the makers. An early pilot study*, utilising Zytaze demonstrated that increasing zinc levels for four days prior to a planned botulinum toxin injection resulted in an increase of the effectiveness of the treatment. To view the study please visit www.edenaesthetics.com/zytaze Dr Soparkar, a leading US plastic surgeon based in Houston, Texas, with a PhD in molecular biochemistry and medical degree from the University of Massachusetts is the founder of this breakthrough product. As a referral centre specialist for treating blephrospasms with Botox® he went on to do research into why some treatments worked better than others. “Having performed thousands of botulinum toxin treatments since the mid 1980’s, I frequently found a very varied response in my clients which led to my investigations into creating an enhancement product. Zytaze has been successfully launched in the US, I am delighted UK clients now have the opportunity to see the benefits this product can offer”. Eden Aesthetics are the UK and European distributor for Zytaze and more information can be found on www.edenaesthetics.com/zytaze *Koshy JC, Sharabi SE, Feldman EM, Hollier LH, Patrinely JR, Soparkar CNS. Effect of dietary zinc and phytase supplementation on botulinum toxin treatments. J Drugs Dermatol 2012 Apr 1; 11(4):507-12. Patients should take two capsules daily for four days prior to and on the day of receiving botulinum toxin injections. Each package contains 10 capsules. Trade Price: £22.50 +VAT Suggested RRP: £45.00 inc VAT For further information please contact Eden Aesthetic on 01245 227752.


Feature Article Hyaluronidase – A Magic Eraser? “Oops!”... This is not a phrase any patient wants to hear their cosmetic practitioner say to them, but let’s face it nobody is perfect and mistakes or unforeseen results do occur in all elective, cosmetic situations from time to time. The fewer the better we will all agree, which is why it’s both important to learn how to avoid complications from the treatments that you perform, as well as how to effectively manage any which do, despite your best efforts, occur. Thankfully in the case of hyaluronic acid based dermal filler products there is a solution which can be used to address and manage most complications which can occur with this type of filler material. In this article we will discuss hyaluronic acid, some of the common complications associated with its application as a dermal filler product and how hyaluronidase can help to resolve issues.

What is Hyaluronic Acid? You will see Hyaluronic Acid referred to by various words including Hyaluronan or Hyaluronate. The exact etymology breaks down that the word hyaluronic acid is derived from hyalos (the Greek for vitreous) and uronic acid because it was first isolated from the vitreous humour in the eye and possesses a high uronic acid content. The term Hyaluronate refers to the conjugate base of hyaluronic acid, i.e., the substance formed when an acid, in this case hyaluronic acid, loses a hydrogen ion. It is considered a base because it can gain a hydrogen ion to reform the acid. And because the molecule typically exists in vivo in its polyanionic form, it is most commonly referred to as hyaluronan. I think we’ll just stick with HA for this article! HA is a very important compound in the human body and is a naturally occurring polysaccharide found throughout connective, neural and epithelial tissues. It is one of the main components of the extracellular matrix and contributes to cell proliferation and migration. It is found in many tissues within the body, including the skin. The clever property of HA is its ability to bind 1,000 times it volume in water, much like a sponge. This makes it an ideal natural substance for retaining hydration and thus volume within the skin for example. An average 70kg (11 Stone) person has approximately 15 grams of HA in their body at any given moment, with a third of it being degraded (enzymatically broken down and metabolised) and synthesized every day. It’s estimated that 50% of that 15 grams is within our skin. As we age HA levels reduce, outwardly this shows in the appearance of our skin which can no longer hold the levels of moisture that it once did, thus plump, youthful pillow-like skin is lost. It is for this reason that many people turn to synthesised hyaluronic acids, injected into the skin via dermal filling and mesotherapy techniques as a method of increasing the HA levels and correcting discrepancies caused by ageing. Because of its proliferation throughout the human body HA has been manufactured and developed over the years for a variety of medical and reparative indications. The first hyaluronan biomedical product, Healon, was developed in the 1970s for use in eye surgery. However, through the process of development it was realised that natural hyaluronan molecules have a relatively short shelf life (approximately 24 hours) so different techniques of manufacturing have been tried in order to extend the length of the chain and stabilise the molecule for its use in medical and cosmetic applications, so that it lasts longer before degradation by the action of natural metabolism. Most synthesised HA is produced by bacterial fermentation from streptococci bacteria. The introduction of cross-linking and stabilisation of the chains through chemical agents, such as those pioneered by the Q-Med NASHA® technology paved the way for longer lasting, more predictable products for cosmetic use. The technologies and manufacturing methods used in the last 20 years have meant that there are now a great variety of HA based fillers on the market, all touting different levels of unique attributes based on the way in which the original hyaluronan molecule has been ‘shaped’ into the packaged product; the levels of cross-linking, the agents used in the process (e.g., BDDE) and the recipes which can dictate how much cross-linked HA is mixed


with uncross-linked HA in the final product. All make for varying types of ‘bread’ in the HA bakery shop, in fact some would argue that the ‘shop’ is a little over saturated. Depending on the composition and position of HA based dermal filler products, they can be expected to last between a few months and a few years before the product is metabolised by the body, as it would do with natural HA it had produced.

Complications Apart from the normal side effects one would expect from an injectable treatment such as redness, swelling, bruising, pain or discomfort at the injection site for between 24-48 hours, treatment with HA dermal fillers (in the right hands) is generally considered to be a very safe and predictable procedure. Because of its temporary nature, most complications or undesirable effects with HA based fillers are shortlived and will naturally resolve as the body metabolises the product over time. Although of course more serious complications can occur, mainly due to incorrect product placement and/or infection, necrosis, and in rare cases blindness have occurred. More typical, and more minor complications such as nodule formation (granulomas), asymmetry, overfilling and a blue discolouration under the skin known as the Tyndall effect caused by injecting the product too superficially can be addressed by an experienced practitioner to the satisfaction of the patient using hyaluronidase.

What is Hyaluronidase? Hyaluronidase, better known in the UK by the brand name, Hyalase® is a prescription only medicine from Wockhardt UK (formerly CP Pharmaceuticals) which is licensed for medical use. It is supplied as a 1500 I. U. white, freeze dried powder for solution for injection or infusion intramuscularly or subcutaneously in small ampoules (10 per pack). The powder should be dissolved in 1ml of water for injection immediately prior to use. The full SPC for Hyalase® is available here. Hyaluronidase is a soluble protein enzyme that hydrolyses HA (causes chemical decomposition by reaction with water). It is more commonly used to speed up the dispersion and delivery of other drugs by lowering the viscosity of the hyaluronans in an area of the body to increase tissue permeability, for example when delivering local anaesthetics in ophthalmic surgeries. It also promotes the resorption of excess fluids and blood in tissue so can also assist in resolving oedema. In the case of dermal fillers where extra HA has been added to the body, it can be used to target and hydrolyse this bolus of product, but depending on the amount used and the skill of application it can either simply correct the excess to a desired level (very difficult to do) or degrade the whole lot so you’re back at square one. It’s unlikely to start decomposing significant amounts of natural HA which it finds in the treated region particularly given that the body reproduces HA on a daily basis. Resolution of HA fillers using hyaluronidase can be seen almost immediately or up to approximately 48 hours following application. The use of hyaluronidase for this indication is off-label, however many clinicians will state that it is recommended as a necessary medication to have in a medical aesthetic clinic should the need to address HA dermal filler complications, asymmetries or overfilling arise. As a prescription only medicine this may not be possible for all business models, such as non-prescribing nurses operating as a sole trader providing dermal filler injections. In such cases, it is advisable to look into partnering with a prescribing practitioner so that you can offer this resolution to any patients who return with problems.

Risks Contraindications to and severe adverse reactions from hyaluronidase are rare but some people do have a hypersensitivity to it and allergic reactions and anaphylaxis have been reported, particularly in those people who also have bee sting allergies. As with pre-treatment assessment, a full medical history before considering prescribing hyaluronidase is imperative. Because of this risk it is considered advisable to perform a skin test on the individual before use of hyaluronidase. JL Cohen suggested in a 2008 clinical paper entitled understanding, avoiding and managing dermal filler complications (Dermatol Surg Jun;34, Suppl 1: S92-9) that 0.2ml of hyaluronidase should be injected intradermally into the patient and then they should be observed for 20 minutes. Should the patient demonstrate a


local wheal and flare reaction then a positive confirmation of hypersensitivity has been achieved and the patient should not be given hyaluronidase. However, with the rarity of severe allergic reactions, it’s up to the practitioner to evaluate the need for skin testing on all patients prior to hyaluronidase use, based on thorough medical histories and in-clinic provision to deal with any instance of anaphylaxis, such as on-site epinephrine.

Conclusions Hyaluronidase, although important to have in your clinical setting, should not be seen as a crutch upon which to rely. It’s not a Magic Eraser which allows one to be cavalier with one’s approach to dermal filler treatments, such as by attempting new techniques or experimental product placement thinking that hyaluronidase will make everything better should it not work. There’s no substitute for training (initial and ongoing), as well as building knowledge of both the products which you use and their mechanisms of action within the skin, and the techniques and protocols which you use to deliver them. If you find yourself needing to consider the use of hyaluronidase in a patient, these top tips from Dr. David Eccleston, Medical Director of MediZen Clinic in Birmingham are worth considering: 

Dilution: I add 1ml of saline to 1500 unit vial (of Hyalase), then withdraw 0.1ml and make that up to 1ml again, giving me a concentration of 15 units per 0.1ml. I then inject the same volume of Hyalase as the original volume of HA filler.

Application: I have used it to correct lips, cheek overvolumising and even in one case Macrolane® nodules in the breast.

Technique: I use a 1ml syringe with a 30g needle to inject it, using an ante grade tunnelling technique along the line of the filler or a serial puncture technique. Be careful under the eyes as there are superficial vessels there and stay below the orbital rim to avoid injuring the eye.

Massage: I massage the product thoroughly to maximize spread through the problem area.

Safety: o o o o

Hyalase should never be used without resuscitation facilities being available i.e. adrenaline, oxygen, etc. It is being used off licence, and should only be injected by those trained in the technique and who can prescribe it. It is not appropriate for non-prescribing nurses to administer in a salon or domestic setting. Repeated injection, of what is an enzyme, is more likely to lead to sensitisation and potentially anaphylaxis so repeated use in the same patient is not advised.

And Dr. Eccleston’s biggest tip of all? Get it right first time!

Useful Reading Here is a list (not exhaustive) of some more recent clinical papers looking at the use of hyaluronidase in the resolution of HA filler complications. Hyaluronidase in the correction of hyaluronic acid-based fillers: a review and a recommendation for use. Rzany B, Becker-Wegerich P, Bachmann F, Erdmann R, Wollina U. J Cosmet Dermatol. 2009 Dec;8(4):317-23. Management of impending necrosis associated with soft tissue filler injections. Dayan SH, Arkins JP, Mathison CC. J Drugs Dermatol. 2011 Sep;10(9):1007-12. Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. Kim DW, Yoon ES, Ji YH, Park SH, Lee BI, Dhong ES. J Plast Reconstr Aesthet Surg. 2011 Dec;64(12):1590-5.


Low dose of Hyaluronidase to treat over correction by HA filler--a case report. Menon H, Thomas M, D'silva J. J Plast Reconstr Aesthet Surg. 2010 Apr;63(4):e416-7. Treatment of injectable soft tissue filler complications. Sclafani AP, Fagien S. Dermatol Surg. 2009 Oct;35 Suppl 2:1672-80.

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 clinicarea@consultingroom.com

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


Business Corner Are Facebook Advertisers Really Just Attracting ‘Clickbots’? Those of you currently advertising or thinking of advertising through Facebook may want to consider the following. Facebook adverts, those little boxes that appear down the right hand side when you’re viewing the site, with a small image, a few words and a web link are fast becoming one of the best sources of targeted advertising on the Internet. Pay-per-click (PPC) advertising is nothing new, those using Google Ads could well have been doing so for almost a decade now, yet many commentators say that the unparalleled ability to filter through the demographics of the audience that you wish to target based on sex, age, marital status, location and even interests makes Facebook advertising such an attractive, effective and often more value for money option than Google’s keyword only search targeted PPC.

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But is it all as rosy as it sounds. A recent blog report highlighted one company’s bad experience which showed that 80% of their Facebook PPC traffic turned out to be expensive, invalid traffic from so called automated ‘clickbots’. This public declaration of disappointment with Facebook then sparked more reports from other companies who had experienced similar issues and were less than pleased with the costs that they had incurred for the traffic received. BBC Technology Correspondent, Rory Cellan-Jones also decided to test the effectiveness of Facebook advertising by starting a page for an imaginary business called VirtualBagel and placing adverts designed to get people to "like" it. He targeted the ads widely at users across the US, UK and a number of Middle Eastern and Asian countries. Within 24 hours, VirtualBagel had acquired over 1,600 likes, despite the fact that the page offered no products and no interesting content. Nearly all of the "likers" came from India, Egypt, Indonesia and the Philippines. The in-built advert statistics showed that the page was most popular in Cairo, with 75% of "likes" coming from 13 to 17-yearolds. According to Rory, what was striking was that hardly anyone from the US or the UK appeared to have clicked to like VirtualBagel. When the advert was adjusted to target only the UK, the number of people liking the page dropped to a trickle and the click-through rate - one measure of effectiveness - fell to just 10% of the previous level. This suggests that companies could be wasting large sums of money on broad range adverts to gain "likes" from Facebook members who have no real interest in their product(s) or who could be running fake Facebook profiles using automated computer programs, or bots, on compromised PCs to spread spam. When challenged earlier this summer, Facebook said it had "not seen evidence of a significant problem" nor “evidence of a 'wave of likes' coming from fake users or 'obsessive clickers'”, despite revealing earlier this year that about 5-6% of its 901 million users might be fake, representing up to 54 million profiles! It blamed the poor targeting of ad campaigns and urged advertisers to filter their campaign set-up more narrowly in order to reach their desired audience and thus benefit from better return on investment with a reduced chance of invalid clicks. Yet many security experts claimed to be unconvinced citing that it’s in Facebook’s interest to downplay the problem. With the fear of satisfying investor relations since floating its shares it would seem that Facebook has finally started to pay attention to the fact that advertisers, no matter how big or small, have started to lose confidence in the veracity of its biggest revenue stream. At the end of August, Facebook announced that it is acting to remove likes on pages that ‘may have been gained by means that violate our Facebook terms’, namely fans that have been bought in bulk by companies to make them appear very popular, as well as compromised accounts and those fake profiles generated by spam accounts, malware and other automated systems. “A Like that doesn't come from someone truly interested in connecting with a Page benefits no one. Real identity, for both users and brands on Facebook, is important to not only Facebook’s mission of helping the world share, but also the need for people and customers to authentically connect to the Pages they care about. When a Page and fan connect on Facebook, we want to ensure that connection involves a real person interested in hearing from a specific Page and engaging with that brand’s content;” said Facebook Security. However, in the words of one recently lost to us all, “it’s one small step...”


A Strange Marketing Approach by Canadian Dermatologist! Dr Barry Lycka is a Canadian dermatology specialist and Founder of The Canadian Skin Cancer Foundation and The Ethical Cosmetic Surgery Association. His unusual approach to marketing sees him emailing his clients to tell them about the health benefits associated with smiling and laughter. Dr. Lycka explains that smiling and laughter strengthen your immune system, boost your energy, diminish pain, and protect you from the damaging effects of stress; and best of all, this priceless medicine he is advocating is fun, free, and easy to use. He discusses each of the individual benefits, including the triggering of endorphins, the relaxation of the body and the relief of stress, with helpful tips on ways to help his clients see the ‘lighter side of life’, as he then demonstrates in his attached video.

www.cosmeticvideos.co.uk/Video/Dr+Lycka+To+The+Rescue [Opens in new browser window] What, you might ask, has this got to do with his cosmetic practice? Well, cue the sting in the tail.... Dr. Lycka then becomes the bearer of bad news by reminding his clients that the downside of smiling and laughter (after all those great benefits!) are those ‘pesky laughter lines around your eyes that can make you look older then you feel’. But panic not, dear customers of mine, he assures them; ‘I do have a solution for you that can eliminate that problem and possibly make you look 10 years younger in less than 10 minutes’. The correspondence then starts discussing the benefits of Xeomin, botulinum toxin treatment and how clients can book appointments; the reason for the mail-out. Unusual marketing, most definitely, eccentric, very possibly, novel, yes....recommended? You decide!


Legislation Professor Sir Bruce Keogh Embarks on Cosmetic Surgery Industry Review: Have Your Say With ‘Call For Evidence’ At the end of January 2012, following the fall-out from the PIP breast implant scandal which brought the cosmetic surgery industry to the forefront of public awareness and concerns, the Health Secretary Andrew Lansley asked the Department of Health to investigate the whole industry. This job was given to NHS Medical Director, Professor Sir Bruce Keogh along with an expert panel, and their Scope of Practice was laid down. “I am working with experts from the plastic surgery field to look at what we can do to make sure people who choose to have cosmetic surgery and other cosmetic procedures are safe. I will be looking at all aspects of regulation – at the regulation of implants and fillers, at whether the people who carry out cosmetic interventions have the right skills, at whether the clinics look after the care and welfare of their patients. This would include treatments such as cosmetic surgery, botox injections and dermal fillers and other cosmetic treatments where there is a potential risk to health”; said Sir Keogh at the time of the announcement of the plan for a review. The Secretary of State for Health also requested that the review considers a national implant register, for products such as breast implants and other medical devices. As of 15th August 2012, the review, which will likely see the industry under heavier scrutiny than past Department of Health/Care Standards authority reviews, has now been officially launched with a ‘call for evidence’ to include experiences and views from both the industry and patients in order to assist the inquiry. 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.

Along with Sir Keogh, an expert panel has been convened to assist in the evidence gathering and the making of recommendations to government, based on the criteria being looked at and the results of the public consultation. The members of this expert panel are:        

Andrew Vallance-Owen, former Medical Director of BUPA Catherine Kydd, campaigner on PiP implants Professor Sir Ian Kennedy, Emeritus Professor of Health Law, Ethics & Policy at University College London Trish Halpin, Editor of ‘Marie-Claire’ magazine Dr Rosemary Leonard, GP and media doctor Professor Shirley Pearce, clinical psychologist and former Vice Chancellor of Loughborough University Simon Withey, plastic surgeon Vivienne Parry, writer and broadcaster

Despite representing a broad range of medical and lay people, nursing groups have expressed concern that their specialty is not represented, particularly given their heavy involvement in the provision of cosmetic injectables within the UK marketplace. The same opinion has also been voiced by beauty therapists who equally want to have representation in order to get their voice heard in the debate.


It’s hoped that tighter restrictions on those operating within the cosmetic surgery and non-surgical (cosmetic injectable) markets will result from the findings. The consultation will be open for two months, ending on 15th October 2012. The expert panel and Sir Bruce Keogh will make their recommendations to the government by March 2013. As part of this ‘call for evidence’ 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. We would recommend that all practitioners have a read of this document (PDF format) and also participate in the consultation by filling in the questions on the online form. Such an opportunity is unlikely to come along again. (Note: There is no option to fill in the form, save it and return later so we would recommend writing your replies in a separate document first which you can then use to copy across to submit it via the online form). Here is the list of the questions and key areas under review. We have highlighted those areas which affect the medical aesthetic and injectables arena, and thus most of our members. Regulation of medical devices and implants and other products 1. What are the risks and benefits presented by dermal fillers? 2. What clinical evidence might be required to regulate dermal fillers (with no claimed medical purpose or benefit) under the existing medical devices regulations? 3. Are any further changes needed to the categories of devices and implants subject to regulation in addition to the likely changes set out above? 4. Are there any other areas where additional strengthening of the regulatory system is required that will not be addressed in the forthcoming revision of the medical devices legislation? 5. Earl Howe’s review of the actions of the MHRA and Department of Health in relation to PIP silicone breast implants recommended that this review should ‘examine ways of promoting a stronger culture of clinical governance, clinical audit and reporting in cosmetic surgery. Routine incident reporting and review of outcome data by individual surgeons and providers should be the norm.’ How can health providers, professional bodies, regulators and patient groups promote the best possible understanding of the role of the incident reporting system and ensure that professionals in particular understand what they have a duty to report? Regulation of practitioners 6. Is there evidence that the current requirements for doctors practising cosmetic surgery are insufficient? Should all cosmetic surgeons be required to have specialist training, i.e. be on the Specialist Register? 7. Currently ‘cosmetic surgery’ is not recognised as a specialty for which doctors can train and achieve a Certificate of Completion of Training (CCT) leading to inclusion on the Specialist Register. Is there evidence to suggest a need to introduce a new Specialty for ‘Cosmetic Surgery’ or are there alternatives, such as a different form of training, e.g., credentialing, that would demonstrate competence? 8. Do people who deliver cosmetic interventions like fillers, Botox®, laser treatments or chemical peels, have the appropriate skills to deliver them? How could their performance be monitored? 9. Earl Howe’s review of the actions of the MHRA and Department of Health in relation to PIP silicone breast implants recommended that this review should ‘examine ways of promoting a stronger culture of clinical governance, clinical audit and reporting in cosmetic surgery. Routine incident reporting and review of outcome data by individual surgeons and providers should be the norm.’ How can medical revalidation be used to promote this? 10. Should practitioners be required to ensure that records of all cosmetic interventions are kept? This is generally done for implants but is it reasonable to do for other devices such as dermal fillers?


Regulation of organisations providing cosmetic interventions 11. Is it right that private providers of cosmetic surgery meet the standards expected of the NHS? 12. The CQC registration requirements place a duty on providers to protect their patients from unsafe treatment, but it is not clear how far this extends in the private sector to providing appropriate after-care where a patient has suffered harm as an unexpected consequence of treatment. Do we need to impose a clearer legal requirement on registered organisations to provide after-care to their patients? If so, for how long after the original treatment? 13. Do you think the existing regulation of lasers and lights is proportionate to the risks they present with regard to cosmetic interventions? 14. Should providers of surgical cosmetic interventions be required to audit their processes and ensure that all their practitioners take part in clinical audit? 15. Should providers of non-surgical cosmetic interventions delivered in non-healthcare settings, for example beauticians administering dermal fillers or laser hair removal, be required to audit their processes and ensure that all their practitioners take part in clinical audit? 16. Should providers be required to ensure that records are kept on the implants and devices they implant? If so, for how long? Questions on insurance and indemnity requirements 17. Should providers be required to take out an adequate indemnity arrangement and/or to participate in a bond arrangement such as provided by ABTA in the travel industry? If so, for how long? 18. How could cosmetic surgery organisations make it easier for patients to access their health records? 19. What can be done to protect patients if their provider goes out of business? Questions on consent, information and advertising for cosmetic interventions 20. What more, if anything, is needed to ensure that people have the information and time they need to give informed consent? Is sufficient weight given to the psychological assessment of the individual? 21. Should providers be required to carry out a two-stage consent process (i.e. allowing a ‘cooling-off’ period between consultation and surgery)? 22. Do you think the existing regulation of the advertising of cosmetic interventions is proportionate? 23. Is there evidence that advertising on cosmetic interventions needs to be regulated using a different system used for general products and services? 24. What is your view on the use of incentives to promote the sale of cosmetic interventions (such as time-limited price offers)? A national implant registry 25. How could a national implant registry be set up and funded? Which treatments should it cover? Should participation be a statutory requirement for providers? Should patients have the right to opt out of having their information recorded? Specific sectors/forms of treatment 26. Are there any specific forms of treatment or sectors which you think should be subject to more (or less) regulation than at present? Examples include surgical body modification e.g., tongue splitting; body enhancement implants; cornea tattooing and jewel implants into the cornea.

Take part today and let’s all have a say in making our industry better for patients and practitioners.


European CEN Aesthetic Surgery Services Standards Update: Outcome of CEN TC/403 Meeting in Delft on 24th August 2012 Sally Taber, Head of the Independent Healthcare Advisory Services (IHAS) was part of the UK delegation attending the meeting following the public consultation phase (which ended in April this year). IHAS reported the following. The meeting sought to resolve three main issues of the Standards:   

Clarify scope and title UEMS – Clarification of use Resolve requests for National A-Deviations and comments

Once all the comments are addressed, a revised draft will be issued then a decision on the next step in the process will be made – the decision will be either a formal vote, to have a second enquiry, change to a CEN TS, change to a CEN TR or delete the work item. Decisions will only be taken when comments have been addressed. The title of the Standards was agreed to be changed to 'Aesthetic surgery and aesthetic non-surgical medical services' following a vote which better reflects their scope. The TC officers were due to meet with UEMS (European Union of Medical Specialists) at the end of August and a further communication is now awaited. Ireland along with a small number of UK doctors had already met with UEMS previously. The UK was granted an A-Deviation for 2.10 Practitioner based on the Misuse of Drugs Regulations 2012 and the London Local Authorities Act 1991. National deviation from a European Standard is in relation to that country having primary legislation that would be at odds with all or part of the requirements of the Standard. The term practitioner as defined in the document is likely to be open for interpretation in the UK and that independent nurse prescribers are recognised on the same level as doctors when it comes to prescribing. The use of lasers can be licensed in London, Nottingham and Birmingham. The final wording of the Deviation to be added as an Annex in the standard will be put together by the TC Secretary. The IHAS submission to support the A Deviation was crucial in securing this outcome. The definition of Practitioner has been modified to 'Medical Doctor authorised by national competent authority to practice autonomously’. The UK was unable to influence this further. The tables contained in the standards were agreed to be:   

Aesthetic non surgical medical procedures Minor aesthetic surgical procedures Major aesthetic surgical procedures th

The outstanding comments will be discussed at the next meeting on 30 November in Vienna.


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

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

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

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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

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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

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

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

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Educational Opportunities

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

Cosmetic Training Features:      

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

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

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

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

www.cosmetictraining.co.uk


Conferences Dates For Your Diary BCAM Autumn Conference 2012 Organisers expect a delegation of at least 200 members at this event and this year they are opening it up to members of BACN and BACD (dentist). The event includes the BCAM Open Golf Championship at the famous 2010 golf course on the Sunday. To register your interest and to find out more email: registrations@BCAM.ac.uk or telephone 0845 450 2875. Saturday 15th & Sunday 16th September 2012 at The Celtic Manor Resort, Newport, Wales.

BAAPS Annual Meeting 2012 The programme will include guest speakers such as Fritz E Barton from Dallas Texas who will talk about avoiding problems following lower lid blepharoplasty and his integrated approach to facial rejuvenation surgery. Dr Claude Le Louarn from Paris will speak on body contouring, pan facial treatment with Botox and midface lifting. Dr Alexis Verpaele from Ghent, Belgium will speak on reducing capsular contracture following breast augmentation as well as techniques for fat grafting to the face and modifications of the MACS lift. For more information, please visit: www.baaps.meeting.org.uk 20th – 21st September at The Royal College of Physicians, London

BACN Annual Conference 2012 The BACN are happy to announce their third annual conference being held in London on the 6th October 2012. They have managed to secure a great team of speakers to make this a wonderful informative day with drinks and canapés to allow you to relax, wind down and network before your journey home. Click here for more information. 6th October at the IET London Savoy Place, London

BODY Conference 2012 BODY2012 is the sister conference to FACE – the UK’s largest 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. Detailed agendas will be available soon. For more information, please visit: www.bodyconference.co.uk rd

th

3 & 4 November at the Royal Society of Medicine, London

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


O Ovveerr 55,,000000 cclliinniiccaall ppaappeerr aabbssttrraaccttss iinn oouurr M Meem mbbeerrss A Arreeaa!! Restylane persisting in lower eyelids for 5 years. Dayan SH, Arkins JP, Somenek M., Chicago Center for Facial Plastic Surgery, Chicago, IL, USA Department of Otolaryngology-Head and Neck Surgery, University of Illinois-Chicago, Chicago, IL, USA DePaul University, Chicago, IL, USA DeNova Research, Chicago, IL, USA..

Clinical Information

J Cosmet Dermatol. 2012 Sep;11(3):237-8. The authors report the case of a 58-year-old woman presenting with "puffiness" in her lower eyelids persisting for approximately 5 years. While dark, puffy eyelid circles following hyaluronic acid placement periorbitally are not uncommon, what is so unusual in our case is that it was noted 5 years after treatment with Restylane. It has been our experience that hyaluronic acid within periorbital tissues can result in a negative cosmetic outcome that can persist for years after the treatment.

Prospective study of lidocaine, bupivacaine, and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Swanson E. Leawood, Kan. From private practice. Plast Reconstr Surg. 2012 Sep;130(3):702-22. BACKGROUND: Bupivacaine levels have not been measured in cosmetic surgery patients to establish safety. Blood loss has been underestimated using the small volumes present in the aspirate. The proportion of wetting solution removed by liposuction has not been reliably ascertained. METHODS: To remedy these deficiencies, a prospective study was undertaken among 322 consecutive patients presenting for superwet ultrasonic liposuction and/or abdominoplasty, and other combined procedures, using infusions containing 0.05% lidocaine (liposuction) and/or 0.025% bupivacaine (abdominoplasty) with 1:500,000 epinephrine. Plasma levels of lidocaine, bupivacaine, and epinephrine were studied in a subset of 76 consecutive patients, including hourly intraoperative samples in 39 consecutive patients. Anesthetic levels were also measured in 12 consecutive patients during the 24-hour period after infusion. RESULTS: The maximum lidocaine dose was 3243 mg and the maximum level was 2.10 μg/ml. The maximum bupivacaine dose was 550 mg and the maximum level was 0.81 μg/ml. No clinical toxicity was encountered. Estimated blood loss from liposuction was 217.5 cc + 187 cc/liter of aspirate (r = 0.65). Abdominoplasty added 290 cc of blood loss, on average. The mean proportion of wetting solution removed by liposuction was 9.8 percent. CONCLUSIONS: Bupivacaine may be safely used in cosmetic surgery. A concentration of 1:500,000 epinephrine is safe and effective when administered as part of a wetting solution that is limited to less than 5 liters. Estimated blood loss is higher than previous estimates based on lipocrits. Combination procedures are safe..

Botox® after Botox® - a new approach to treat diplopia secondary to cosmetic botulinic toxin use: case reports. Isaac CR, Chalita MR, Pinto LD. Universidade de Brasília, Brasília, DF, Brazil. Arq Bras Oftalmol. 2012 Jun;75(3):213-4. A new technique for the treatment of diplopia secondary to cosmetic botulinum toxin A use is described. In this interventional case reports, two consecutive patients who developed diplopia after periocular cosmetic use of botulinum toxin A were treated with intramuscular botulinum toxin A injection into the antagonist extraocular muscle. Diplopia resolved in both patients in less than 1 week with no side effects or complications. In conclusion, the injection of intramuscular botulinum toxin A is an encouraging option for treatment of diplopia secondary to botulinum toxin A use for facial lifting.


Permanent hair reduction with a home-use diode laser: Safety and effectiveness 1 year after eight treatments. Wheeland RG. Department of Dermatology, University of Missouri-Columbia, Columbia, Missouri. Lasers Surg Med. 2012 Sep;44(7):550-7. BACKGROUND AND OBJECTIVES: To evaluate the safety and efficacy of a home-use hair removal diode laser (TRIA Beauty, Inc., Dublin, CA) in a multiple treatment regimen. STUDY DESIGN/MATERIALS AND METHODS: Thirteen indicated adults with naturally brown or black hair and Fitzpatrick skin type I-IV received 8 monthly treatments with the diode laser at three fluences, with a fourth area left untreated as a control. Quantitative hair counts were made at each treatment visit and periodically for 12 months after the last treatment. RESULTS: The treated sites exhibited statistically significant hair count reduction that generally increased with each treatment and remained stable during the 1 year follow-up period. The mean percent hair count reduction was 47%, 55%, and 73% at 1 month after the last treatment and 44%, 49%, and 65% at 12 months after the last treatment at fluences of 7, 12, and 20 J/cm(2) , respectively, compared to control. Eighty-six percent (86%) of subjects had greater than 30% hair reduction and 38% had >80% hair reduction at 12 months post-treatment. At the same time point, 31% of subjects reported complete (100%) hair removal and 69% reported that the hair that did regrow was less noticeable due to being finer and/or lighter. The only observed side effects were erythema and edema that were mild, transient, and self-resolving usually within a few hours. CONCLUSIONS: The home-use diode laser was safe and highly effective at permanently reducing unwanted hair.

Induction of different reactive oxygen species in the skin during various laser therapies and their inhibition by fullerene. Fujimoto T, Ito S, Ito M, Kanazawa H, Yamaguchi S. Clinic F, Tokyo, Japan; Graduate School of Science and Technology, Tokai University, Tokyo, Japan. Lasers Surg Med. 2012 Aug 16. BACKGROUND AND OBJECTIVES: The production of reactive oxygen species (ROS) is one of the mechanisms of laser irradiation in the skin, and there are beneficial and detrimental aspects to this reaction. Detrimental side effects after laser treatments, such as redness and pigmentation, can be reduced by using anti-oxidants. MATERIALS AND METHODS: Electron spin resonance (ESR) analysis using a free radical trapping agent revealed that different free radicals, including hydroxyl ((•) OH) and superoxide anion (O 2-) radicals, were generated in the skin of hairless mice by irradiation with intense pulsed light (IPL), plasma, and radio frequency lasers. RESULTS: Generation of O 2- and (•) OH radicals was significantly inhibited in a dose-dependent fashion by fullerene and fullerene did not have any pro-oxidant effects as no radical adduct signal was detected. Although ROS can increase expression of COX-2 mRNA, an inflammatory marker, laser-induced COX-2 expression was significantly suppressed by the antioxidant activity of fullerene. In addition, imaging analysis of human skin has shown that erythema-associated redness caused by laser-induced inflammation is inhibited by fullerene gel. CONCLUSION: These data suggest that laser-induced inflammation is suppressed by the ROS-scavenging activity of fullerene and that application of fullerene is effective against oxidative skin damage caused by laser irradiation. Thus, fullerene has potential as an after-care therapy following laser irradiation of the skin.


Severe acute caffeine poisoning due to intradermal injections: mesotherapy hazard. Vukcević NP, Babić G, Segrt Z, Ercegović GV, Janković S, Aćimović L. Clinic for Emergency and Clinical Toxicology, Military Medical Academy, Belgrade Serbia. Vojnosanit Pregl. 2012 Aug;69(8):707-13. INTRODUCTION: Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. CASE REPORT: A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT) on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L), and a toxicological analysis (liquid chromatography with ultraviolet detection) proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L). On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. CONCLUSION: A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the subcutaneous adipose tissue into the circulation when injected directly into the tiny blood vessels, as evidenced by hematoma formation. Poisoning manifestations were registered in gastrointestinal, CNS (anxiety, somnolence) and cardiovascular (hypotension, ventricular tachycardia and nonsustained PSVT) system. In this era of mesotherapeutic treatment promotion, one should keep in mind toxic prevention, with application being carried out exclusively in a specialized institution.

The Fabi-Bolton chest wrinkle scale: a pilot validation study. Fabi S, Bolton J, Goldman MP, Guiha I. Goldman Butterwick Fitzpatrick Groff & Fabi, Cosmetic Laser Dermatology, San Diego, California, USA Naval Medical Center, San Diego, California, USA. J Cosmet Dermatol. 2012 Sep;11(3):229-34. Up until now, no objective scale has existed to evaluate chest wrinkles and assess the efficacy of treatment. This study was designed to validate a new photonumeric wrinkle assessment scale using standardized photographic methodology to obtain reference photographs. Multiple photographs from 28 volunteer subjects with varying degrees of chest wrinkles were evaluated by a study team of two independent physicians. Photographs of 16 subjects representing the full spectrum of chest wrinkle severity were selected and classified using the Fabi-Bolton (F-B) 5-point wrinkle scale (1 = wrinkles absent; 2 = shallow but visible wrinkles; 3 = moderately deep wrinkles; 4 = deep wrinkles, with well-defined edges; 5 = wrinkles very deep with redundant folds). One representative photograph was chosen by study team consensus for each of the five scale points. A second, independent group of evaluators rated the randomly arranged photographs using the F-B wrinkle scale. The numeric results were then tabulated and compared. The F-B wrinkle scale provided a reproducible and effective method for assessing chest wrinkles with very little interrater variability. The F-B wrinkle scale is a reliable tool for the classification of chest wrinkles and evaluation of therapeutic and cosmetic interventions.

SOURCE: PubMed


Interesting News Articles You May Have Missed Due to global copyright laws the Consulting Room™ is unable to reproduce entire news articles; therefore we provide an abstract and a link to the original news article. Although every effort is made to ensure that these links continue to function, there ar e 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 woul d appreciate it if you would inform us by emailing info@consultingroom.com so we can make every attempt to remedy it.

Fake Bake responds to self-tan health risk claims International tanning brand Fake Bake has responded to the recent claim that women who use fake tan could be placing themselves at an increased health risk. SOURCE: BABTAC

Soft implants preferable for nose augmentation Soft implants are superior to hard implants for dorsal nasal augmentation, research shows. In aesthetic and reconstructive rhinoplasty, soft implants resulted in fewer complications and higher satisfaction rates than hard implants, report investigators. SOURCE: News Medical Net

Strawberries Can Help Protect Skin From UVA Rays A team of Spanish and Italian researchers has discovered that skin cell cultures added with an extract from strawberries protects against ultraviolet radiation, increasing its viability and reducing DNA damage. The findings, featured in the Journal of Agricultural Food Chemistry pave the way for the development of new photoprotective creams made from strawberries. SOURCE: Medical News Today

Southport beautician who illegally offered teeth whitening is fined after investigation Elaine Taylor-Valles of Southport, who described herself as a “fully qualified beautician”, carried out tooth whitening treatments at her Diamonds salon in the town’s Lord Street. Only those registered with the General Dental Council – specifically dentists or dental hygienists and therapists working on a dentist's prescription – can carry out the procedure. Taylor-Valles, of Westminster Chambers, was caught out after a customer complained after having her teeth whitened. She was fined £1,200 at Preston magistrates’ court for unlawfully practising dentistry when not registered with the GDC. SOURCE: Liverpool Echo

Cosmetic surgery 'clean up' to include dentistry Teeth whitening, Botox and dermal fillers are set to be included in a major review of cosmetic surgery and procedures following the PIP breast impact scandal. The British Dental Association and the General Dental Council will submit evidence to The Department of Health as part of its consultation into the cosmetic surgery industry, they confirmed to Dentistry. SOURCE: Dentistry


Surgery to tackle obesity rises five-fold in past five years Gastric bypass operations carried out on the NHS have risen fivefold in the past five years. The procedure, which helps the obese lose weight by re-routing food to a small stomach pouch created by a surgeon, was carried out 5,407 times in England during 2011/12, compared with 858 in 2006/7, according to official figures. SOURCE: The Metro

Fake imported Botox worth millions sold everywhere People seeking beauty treatments, such as Botox injections, are being warned by the Ministry of Public Security to make sure they are buying the real thing after a Chinese company was found to be selling locally-made products as imported ones. The fake foreign brands were sold in every region of the country except the Tibet Autonomous Region. Police in Guangdong, Shanxi and Guangxi have confiscated 20 million yuan ($3.1 million) worth of fake imported cosmetic treatments including falsely labelled Botox. The scam was run by Hongyi Technology Co Ltd, which bought domestic products and repackaged them as foreign brands selling them to beauty salons and plastic surgery hospitals across the country. SOURCE: Gloabl Times

Growing number of young women seeking vaginal rejuvenation The procedure was originally popular with patients suffering from incontinence or sagging of the vaginal canal after childbirth, but now it is widely used for cosmetic purposes to either to enhance the appearance of the genitalia or boost sexual satisfaction. SOURCE: Daily Mail

Rosacea May Be Caused By Bacteria Released By Tiny Mites Living On The Skin Scientists are closer to establishing a definitive bacterial cause for the skin condition rosacea. This will allow more targeted, effective treatments to be developed for sufferers, according to a review published in the Journal of Medical Microbiology. SOURCE: Medical News Today

Tria Beauty, Inc. Announces the UK Launch of New At-Home Skin Rejuvenating Tria Beauty, UK Ltd. announced today the UK launch of the TRIA Skin Rejuvenating Laser for the treatment of wrinkles, skin discoloration and rough skin; now the the effectiveness of professional fractional lasers is made affordable and available to consumers for use at home. SOURCE: PRNewswire


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Lightweight and flexible hose to ensure regulated airflow 20% more cooling airflow power than the current leading system, the Zimmer Cryo 6 and costs around £1,000 less Customisable intensity controlled via a start/stop button Clear digital readout Temperatures of minus 32 degrees Longer manufactures guarantee of 3 years

For more information see ABC Lasers’ website at www.abclasers.co.uk

Great Member Special Offer Receive a Free Pair of NoIR LaserShields® IPL Shade 3 Style 35 Goggles when you buy Yamamoto Patient Eye Safety Guards. *** OFFER EXTENDED! *** This great offer is only available to Consulting Room members. The Yamamoto YL-800w safety eye guard provides high quality protection for your patients eyes when using IPL/Lasers/Radiofrequency and Microdermabrasion. Suitable for combined Radiofrequency/Laser/IPL devices as they do not conduct any electrical current.    

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

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

Take advantage of this great offer!

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


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 - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=506 Chromogenex NLite V Pulsed Dye Laser Hair removal Rejuvenation System In good condition and full working order For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=458 E Light IPL Laser Hair removal Rejuvenation Wrinkle Vascular salon beauty System For Sale at £3,800 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=496 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 - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=536 Depilex Dermapeel Professional Microdermabrasion System In good condition, full working order For Sale at £912 *PRICE REDUCED £760 + VAT* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=537 RVB active 7 touch beauty machine facial toning professional System This unit has had very minimal use and the condition reflects this some items are new in original packaging For Sale at £475 More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=599 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 - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=455 Yperion L900 SR PSR002012 beauty treatment head Brand new, in original box. For use with L900 Hair removal and photolifting beauty machine. For Sale at £912 *PRICE REDUCED £760* More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=539 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 - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=432 Eporex K69 Mesotherapy Cellulite Fat Reduction and Skin Rejuvenation System In good condition and full working order, costs £20,000 brand new For Sale at £8,400 + VAT *PRICE REDUCED AGAIN £3,166 + VAT* More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=446


Cosmopro Eye-O-Matic facial restore & skin rejuvenation Full working order. Helps restore and rejuvenate the face and delicate eye contour maximising product absorbency. For Sale at £285 + VAT More info – www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=598 Lumenis Aculight HR HR655 HR695 HR745 Treatment heads and warranty For Sale at £400 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=145 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 - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=185 Nemectron Noblesse for Face and Body Facelift Wrinkles In good condition and full working order For Sale at £1,500 + VAT *PRICE REDUCED AGAIN £950 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=437 Beauty Scope BS-888 Skin and Hair Analyser Intelligent skin/sebum/moisture/pigment diagnosis system For Sale at £300 + VAT *PRICE REDUCED £237.50 + VAT* More info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=438 Over line Xilia Stim 8 Face + Body Skin tightening System In good working order complete with attachments, cables, user manual and stand. For Sale at £1,400 + VAT *PRICE REDUCED AGAIN £1187 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=434 Nemectron Nembrasion Professional Microdermabrasion System In good condition and full working order For Sale at £1,425 + VAT More Info - http://www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=439 Smart Peel Microdermabrasion with LED Light Therapy professional system In good working order complete with attachments For Sale at £2, 280 *PRICE REDUCED £1,425 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=535 Caci Future-Tec Skin Rejuvenation Beauty Machine In good working order complete with attachments - Vaculase, Microlase, Actuator attachments & foot pedal For Sale at £1,700 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=367 Bio –Therapeutic L.A. Smile Teeth whitening system Cost £12,600 new in 2006. Current model, in good condition, had very little use. For Sale at £3,000 + VAT *PRICE REDUCED £1,900 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=325 Biotec Bioskin LAS Skin Resurfacing Microdermabrasion System Bioskin Las Technology utilises a unique two-element approach to activate skin regeneration. For Sale at £1,425 + VAT More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=344 Nora Bode OxyJet Star Oxyaroma Oxyspray facial and body treatment salon machine In very good condition, had had low usage and in full working order For Sale at £7,500 +VAT *PRICE REDUCED £6,175 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=516 Pollogen ReGen Tripollar Radio Frequency skin body facial beauty machine salon Very good condition, full working order. Unit was removed from a small clinic which closed shortly after it opened For Sale at £8,000 +VAT *PRICE REDUCED £7,600 + VAT* More info - www.consultingroom.com/Services/Equipment-Display.asp?Equipment_ID=515


Classifieds FOR SALE IRIDEX DioLite 532nm Laser for Vascular/Pigmented Lesions Ex-IRIDEX UK inventory/demo item, exceptionally low usage. 8 watt 532nm laser. Treats vascular and pigmented lesions, all skin types. 8KG, portable, table top system. No ongoing maintenance requirements. Choice of precision hand pieces (0.5mm, 0.7mm, 1.0mm, 1.4mm). Price includes 6 month warranty, installation and training. Cost over £25,000 from new.

Price: £10,000 (Excl. VAT) Contact: Carleton Medical Ltd Tel: 01633 838081 Email: njfitrzyk@carletonmedical.co.uk

Soprano NIR Head Soprano ST applies a revolutionary IN-MOTION approach to laser treatment, and thus heats up the deeper layers of the skin in a painless manner. This deep dermal heating is proven over many years of study to effectively stimulate the production of new collagen and improves skin surface texture. Treatments with the Soprano ST system are quick and do not require anaesthesia or a prolonged recovery time. Patients can resume their normal activities immediately. Best of all, Soprano ST provides steady improvement with excellent, long-term skin tightening results. Whilst some patients see results immediately, it is recommended that up to 6 treatments produce the optimum results which are then maintained by quarterly visits. Soprano ST Pain-Free Laser treatments can be performed to treat loose, wrinkled skin anywhere on the body and face. The procedure is frequently used for toning thin, loose and crepe-like skin often found on the aging face, neck, thighs, stomach and under the upper arms. It is also excellent for firming skin on the post-surgical or postnatal abdomen, chest, thighs or breasts.

Price: £2,000 ONO Contact: Health and Aesthetics Tel: 01252 820946 Email: enquiries@healthandaesthetics.com


Lockable Medical Grade Fridge INC Display and Alarm With Displayed Thermometer 1435×600×625 (H×W×D), Free-Standing, 285 Litres. Spark-free Interior, Door Lock, Auto Defrost, Low Energy, Shelves × 5, Displays max/min temperatures, Hi/Lo temperature alarm, Easy to use, Clear digital temperature display

Price: £250 ONO Contact: Health and Aesthetics Tel: 01252 820946 Email: enquiries@healthandaesthetics.com

SkinFirst Super MPL Combi System This clinic grade skin system with medical CE is superb on acne and hair removal and also does the full range of light based treatments in addition to skin tightening and lifting using monopolar and bipolar radio frequency. There are two ex rental models for sale, at £14,000 plus VAT each (normal price £22,950 plus VAT). They can be taken without the tightening and lifting for £12,000 plus VAT. Price includes 2 days training plus a refresher day, a year's parts and labour warranty and full start up kit to commence immediately. Safer and more comfortable than IPL and laser, more effective than IPL especially on darker skin types and lighter hair, and more versatile than laser, this is the very latest technology.

Price: £14,000 +VAT Warranty: 1 Year Contact: www.skinfirstsystems.co.uk Tel: 01925 261650 Email: contact@skinfirstsystems.co.uk

Lynton Luminette IPL Machine Lynton Luminette IPL machine for sale - 16 months old - light use only Been very well looked after and in excellent condition. Has 2 handsets for Hair Removal and Pigmentation, Acne, Skin Rejuvenation, Rosacea and Thread Vein Head Comes with handbooks and 2 large and 2 small pairs of Goggles and trolley to stand on

Price: £10,000 ONO Contact: Heather Willis Email: info@future-beauty.co.uk

For a full list of second hand equipment sales, please see: www.consultingroom.com/Equipment


Advertisement S.A.F.E.™ System Surgical Smoke Evacuation The Smoke Evacuator vacuums the plume created by laser and electrocautery treatments such as hair removal, tattoo removal and erbium procedures and protects physicians and staff performing these operations. The U.S. FDA approved and European CE marked SAFE System smoke evacuator is built to handle any type of surgical smoke. Costs are low to purchase and operate. Application:

The removal and filtration of laser and surgical smoke

Used by:

Hospitals, Plastic Surgeons, Cosmetic Surgeons, and more

Economical:

Due to the real time filter life pressure gauge

Compact:

9" x 9" footprint, 14" high

Quiet:

Less than 52dBA, quieter than the competition

Filtration:

ULPA: 99.999+%@ 0.12 micron

Weight:

24 lbs.

Electrical:

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

Regulatory:

UL, CSA, CE

Tubing:

Vacuum Tubing 7/8" x 8'

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

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The Consulting Room™ Industry Magazine Edition 112, September 2012