Consulting Room Magazine | Volume 7: Issue 1 | January - March 2024

“SKINNY” JABS

The rise of medical weight loss

SKIN DISCOLOURATION

The inflammationpigmentation connection

IN THIS ISSUE: AESTHETIC TRENDS SPECIAL

REGENERATIVE TREATMENTS For the menopause

ACNE INNOVATIONS

The latest tech to tackle acne

WELCOME TO THE AESTHETIC TRENDS ISSUE OF THE CONSULTING ROOM MAGAZINE FOR WINTER 2024

Welcome to the first edition of the Consulting Room Magazine for 2024.

The start of a new year is always a time for reflection and looking ahead, and from a market perspective, it’s a time when key trends for the future are identified. Right now is an exciting time in aesthetics because we are on the precipice of some major shifts driven by consumer demand and emerging new areas.

We are seeing a move away from the terms “anti-ageing” and towards wellness and longevity. Consumers want to age well, and as such, regenerative treatments and prerejuvenation are emerging as trends. We are also seeing traditional standards of beauty being replaced by individualisation and treatments that honour identity.

As part of our trends special, we have rounded up some of the key industry reports looking at the latest shifts in the industry. From Hamilton Fraser’s annual survey (p8-9) to The Galderma NEXT report (p20-23) and the Menopause in Aesthetics trends report (p24-26), we’ve got the latest insights covered.

As well as this, we take a look at some of the latest trending treatments, from polynucleotides (p29-30) and weight loss injections (p3234) to our CPD article on regenerative treatments for menopause (p40-45) and exosomes (p58-61). What’s more, Dr Patrick Treacy gives his insights into a worrying new trend for dermal filler complications (p48-52).

We hope you enjoy this issue of the Consulting Room Magazine. Let us know what trends you are most excited about for 2024.

Vicky Eldridge

40

REGENERATIVE TREATMENTS FOR THE MENOPAUSE

There are few certainties in life but one is that all women will at some point go through the menopause. The only variable is when this happens and the degree to which it affects us.

38

58

EXOSOMES - MY PERSONAL VOYAGE OF DISCOVERY

48

INFLAMMATORY NODULES

Dr Patrick Treacy asks, what is causing dermal filler inflammatory nodules?

SAFE PRACTICE STAY SHARP

We chat to Dr Raquel Amado about safety in aesthetics.

Q1 TOPICALS ROUND-UP

Some of you may have seen price hikes from USA-imported brands as the most major overhaul of the regulations in nearly 100 years came into effect in Dec 2023.

Martyn Roe, co-founder of Aesthetic Medical Partnership, shares his journey with exosomes.

Nanopass Micronjet Nanoneedles - A radical improvement in skin injectable delivery.

04

13

14

18

36 - 55

56

64 - 71

72 - 81

82 - 85

PUBLISHED BY

The UK’s largest and longest running aesthetic industry information website and business portal. Consultingroom.com Ltd

E: admin@consultingroom.com

© Copyright 2018-2022 Consulting Room

WEIGHT LOSS

The rise of Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonists for obesity, more popularly known by their brand names Ozempic, Wegovy and Mounjaro, has been a fascinating and transformative development in healthcare, with some suggesting that they could be solution to the obesity epidemic.

Advertising & Memberships

Dan Huxley | Sales Manager

E: admin@consultingroom.com

T: 01244 346 569

Marketing & Supplier Relations

Danielle Lowe | Marketing Manager

E: danielle@consultingroom.co.uk

Customer Support & Subscriptions

Material may not be republished or reproduced in any form which removes attribution to Consulting Room, without the publisher's written permission. Press clippings can be obtained from the Editor. The publishers accept no responsibility for the information transmitted by contributors or advertisers through publication in the Consulting Room magazine. Inclusion of advertisements does not imply endorsement of the products or services advertised. The Editor's decision is final in all matters.

Published by Consultingroom.com Ltd, registered as a limited company in England; No. 4617405.

Membership Support Team

E: admin@consultingroom.com

E: craig@consultingroom.co.uk

Recruitment

Sabrina Haynes | Recruitment Specialist

E: sabrina@consultingroom.co.uk

T: 07734 203 105

Editor

Content Manager

E: editor@consultingroom.co.uk

Please

Shutterstock/Douglas Cliff

EDITORIAL BOARD

Consulting Room has a long history of working with key figures within the global medical aesthetic community, many of whom are advisers on our website. We are honoured to welcome many of them, and others, to the Editorial Board of our quarterly magazine Without their wealth of knowledge and expertise in this diverse sector, we would not be able to provide the levels of educational content on clinical, nutritional and business topics that you will find within this magazine.

Dr David Eccleston

20 years in Medical Aesthetics and a Private GP. Clinical Director at MediZen. Local Country Ambassador for Allergan and lead investigator in many clinical trials.

Ron

Business Coach, Director of Aesthetic Business Partners LLP, former Director of HydraFacial UK and Co-Founder of The Consulting Room Group.

Dr Patrick Treacy Founded the Ailesbury Clinic based in Dublin. Named Top Aesthetic Practitioner in the World (2019) and Top Aesthetic Medical Aesthetic Practitioner (Irl) 2023.

Martyn Roe A Specialist Business Consultant and Co-Founder of The Consulting Room Group. Martyn is the co-founder of Aesthetic Medical Partnership (AMP).

Dr Uliana Gout Educator & Speaker. British College of Aesthetic Medicine Former President & Int. Peeling Society Board. Founded London Aesthetic Medicine Clinic & LAM Academy.

Veronica Donnelly VAT partner at Azets. She has been a VAT adviser for 30 years, and heads up the Specialist Aesthetic accounting team for the firm.

Mr

and endovenous surgery.

with a Masters (ANutr) in Human Nutrition from University of Aberdeen; an Association for Nutrition accredited course.

Transplant Surgeon at the Farjo Hair Institute with a special interest in the regulation of Hair Restoration Surgery in the UK.

Director. Nurse specialising in cosmetic medicine since 1998. Co-founder and pastChair of the British Association of Cosmetic Nurses.

Pam

Business coach, trainer and mentor working exclusively with aesthetic professionals through her business Aesthetic Business Transformations.

doctor and entrepreneur. CEO & Founder of Harley Academy, founded to combat the lack of standardised medical training in aesthetic medicine.

Dr

Sydney-based aesthetic and restorative surgeon with international registrations. Senior trainer for pharma in Australia. Director of Harley Academy.

Mike

Laser Protection Adviser and Chair of the Association of Laser Safety Professionals. Actively involved in laser safety and CEN standards.

Chartered Institute of PR. Awardwinning business strategy & comms expert. Founder of Kendrick PR & E.L.I.T.E Reputation Programme™

Emma Davies NIP Save Face Clinical

Niro Sivathasan

Myers

Underdown

Regan Certificated

Prof Mark Whiteley Consultant Venous Surgeon & Founder of The Whiteley Clinic. Internationally recognised expert in venous disease

Madi Myers Biological Science graduate

Greg Williams Hair

Dr Tristan Mehta Medical

Julia Kendrick Member of

DR RAQUEL AMADO PROF FRANK JOSEPH

Dr Amado has 15 years of experience as a dentist. She is a Level 7 qualified aesthetic practitioner, senior clinical trainer for Harley Academy, opinion leader for Neauvia and international speaker for Alumier MD. Her expertise lies in a holistic approach to fullface rejuvenation.

PAAVEN PATEL

Paaven Patel is Operations and Quality Assurance Pharmacist at Specialist Pharmacy, which produces custom-made medications. Specialist Pharmacy is a full-service pharmacy with over 25 years of combined expertise and unrivalled experience.

DR PATRICK TREACY

Dr Treacy is known for his significant contributions, achievements, and humanitarian efforts. His research has strongly influenced this specialist area where he has developed global protocols relating to dermal filler complications and wound healing.

Professor Joseph is an experienced Consultant Physician in Endocrinology, Diabetes, and Obesity Management, specialising in Type I and Type II diabetes. He leads a clinical trials unit with top national recruitment for studies on obesity and diabetes therapies.

DR AMY LAW

Dr Law qualified as a dentist in 2016. After originally practising dentistry, she found that her passion lay within medical aesthetics and has since moved into this field full-time. She is both an experienced practitioner and an advanced aesthetics trainer.

MARTYN ROE

Martyn is the co-founder of Aesthetic Medical Partnership (AMP), the exclusive distributor of Jovena, EXO|E, and AquafirmeXS products in the UK and Ireland. AMP provides ongoing marketing support, device training, and therapist training to enable them to provide the best treatments and results.

VICKY ELDRIDGE

Vicky is an award-winning journalist and editor who has specialised in aesthetics for almost 20 years. She is founding editor of Aesthetic Medicine and edited five supplements for The Times. In 2015, she won a Safety in Beauty Award for supporting standards within the industry.

LORNA BOWES

Lorna is an experienced business owner, aesthetic nurse and trainer, having worked in aesthetics since the early 1990s. With an in-depth understanding of the global aesthetic medical market, she trains and lectures regularly on procedures and business management in aesthetics.

GARY CONROY

Gary is the founder and CEO of 5 Squirrels, which helps skincare professionals launch their own brand skincare products. Gary is also a consultant to the Society Of Cosmetic Scientists, which promotes education and research to advance the science of cosmetics.

www.consultingroom.com

WHAT’S TRENDING

Hamilton Fraser annual survey reveals insights into aesthetic industry trends

Hamilton Fraser has revealed the results of its annual survey, which provides unique insights into current aesthetic industry practices and trends.

The survey garnered insights from more than 300 practitioners based across the UK and Ireland.

Respondents were fairly evenly spread in terms of where they operate from, with the highest percentage (17%) being based in London, followed by the North West (12%), South East (11%), North East (10%) and Yorkshire and The Humber (9.5%).

Nurses made up the largest group (43.5%), followed by doctors/cosmetic doctors (22.5%), dentists (13.1%), dental therapists (2.6%) and plastic surgeons (2.6%). 74.8% were female and 24.8% were male.

Most practitioners worked solo, with 55.2% saying they worked alone. 19.9% said they worked alongside a nurse, while

5.9% said they worked with a doctor.

An attractive prospect

Many practitioners stated they still worked for the NHS (50.7%) or in other jobs and did aesthetics part-time, with 69.6% saying aesthetics was not their main source of income.

Of those who had left the NHS, 24.8% said they would not consider returning, citing factors such as work-life balance, antisocial hours, lack of flexibility and stress.

Interest in non-surgical cosmetic treatments was cited as the main reason for moving into aesthetics, with 59.8% giving this as the top answer. A new challenge and flexible working hours were the next biggest motivators, with 53.9% and 53.3% saying this was what drew them to the field.

Job satisfaction also came in high, with more than half (50.3%) stating this as

their reason. Financial reasons were listed by 32%.

When asked if their motivations for joining the industry had been met, 33.3% said “completely” and 52.9% answered “mostly”.

Treatment trends

When asked what treatments they provided, unsurprisingly, it was injectables that topped the poll, with 79.7% of respondents naming botulinum toxin as a treatment they offered and 76.1% saying they performed dermal fillers.

Skincare ranked next, with 56.9% saying they offered it and 47.1% saying they performed chemical peels.

In terms of the treatments most commonly requested by patients, the top choice was treatments to counter the signs of ageing. There was also a fairly high demand for skincare solutions,

Shutterstock/oatawa

followed by preventative ageing treatments. Treatments for menopause symptoms were an area where there was currently a lower demand but growing popularity.

In terms of trends, the greatest interest was in aesthetic regenerative procedures, with 64.1% stating this was an area they were interested in. ‘Prejuvenation’ (treating younger patients with preventative treatments) was also popular, with 58.2% of those who responded citing it as a top trend.

Practitioners were also excited about new applications for RF microneedling (43.1%) and weight loss injections (34.6%).

Complications and complaints

Reassuringly, 80.7% of those who took part in the poll said their patients had never experienced an infection following a treatment. 19% said this had happened once or twice, and only 0.3% admitted to infections occurring more than twice.

Infection control strategies were widely used, with skin disinfection (93.8%), hand hygiene/glove usage (92.5%), environmental disinfection (89.9%) and aseptic technique (84%) being named as the top practices.

In terms of identifying red flags and saying no to patients whom they deemed unsuitable for treatment, the majority had done so on more than one occasion, with 30.7% saying they had turned a patient away once or twice, 30.7% saying they had said no to treating unsuitable patients at least three times and 24.8% saying they had said no to treating unsuitable patients more than three times. Only 13.7% said they had never turned a patient away.

When asked if they had ever regretted treating a patient, it was almost a 50/50 split, with 48% saying “yes” and 52% saying “no”. Of those who answered “yes”, the main reason given was that they felt the patient had unrealistic expectations of treatment. Practitioners also stated body dysmorphia, patients wanting treatments for low costs, difficult or demanding patients and gut feelings as other reasons to say “no”.

Encouragingly, 91.5% said they were routinely looking out for patients displaying any mental health problems, in particular, body dysmorphia, with questionnaires and screening during consultation being the main methods of analysis.

Optimistic for the future: Plans for growth and expansion

Despite the current economic climate, many of the survey respondents said they had plans to expand their businesses, and the majority said they felt “fairly optimistic” (51.6%) or “optimistic” (36.3%) about their business prospects in 2024, with 80.1% saying they were on track to meet their objectives.

Of the 52% of people who had a business plan, 70.4% said it had changed from the previous year due to business growth, expansion, moving premises and increased economic benefits.

Interestingly, others said they had changed their business plans due to moving direction, with a move towards wellness being

cited as one new avenue for business.

Only 30.1% said they had received funding for their business, and of those, the majority had used personal savings (46.7%). Bank loans made up 31.5%, followed by borrowing money from family and friends at 26.1%. A total of 18.5% said they had used angel investors, while 13% had used crowdfunding and the same number for venture capital. 12% had accessed a small business administration loan, and 10.9% had used a credit card or overdraft to fund their business.

Eddie Hooker, Founder and CEO of Hamilton Fraser, comments, “Our annual survey sheds light on the evolving landscape of aesthetics and serves as a compass for us as we evolve with the industry, ensuring that our services safeguard practitioners, their patients, and the integrity of the care they provide.

“Highlights for me included the growing demand for regenerative procedures and preventative treatments, and we are committed to tailoring insurance solutions that align with these emerging trends.

“We have a long history of working closely with the Joint Council for Cosmetic Practitioners (JCCP), and so I was pleased to see that the survey results reflected a commitment to patient safety, with 80.7% reporting no post-treatment infections and practitioners turning away unsuitable patients based on criteria like body dysmorphia and unrealistic expectations.

“I am also pleased to see that 91.5% of practitioners are actively monitoring for mental health issues, emphasising our collective responsibility for holistic care.”

Shutterstock/oatawa

JCCP and CPSA release their public narrative for 2024

The Joint Council for Cosmetic Practitioners (JCCP) and the Cosmetic Practice Standards Authority (CPSA) have released their Public Narrative statement for 2024.

The JCCP’s Clinical Advisory Group will continue to work with the CPSA and key partners to develop new and revised standards to assist in the design of a new and responsive model for licensing, and to identify emerging procedures that may warrant inclusion in the Government’s proposed new licensing scheme in in England.

The JCCP will operate its PSA-approved Practitioner Register under the same terms and conditions as currently used and continue to campaign for the full implementation of the JCCP 10 Point Plan as part of the licensing scheme.

In addition, the JCCP will further develop its Education and Training Register for providers and qualifications in association with DHSC proposals.

The organisiation also set out its intention to continue to build on those areas where it is seen as having a major strategic role in the sector, such as influencing members of the public, government, regulators and other stakeholders, complaints handling, standard setting, licensing and education and training. In terms of complaints, the council will continue to develop and promote its consumer complaints platform in the interests of public protection and patient safety.

Clearer definition regarding medical, medically related, and cosmetic procedural interventions will be called for and priority will be given to grow and develop the JCCP Corporate Membership Scheme for commercial partners in the aesthetics sector. Finally, the JCCP will continue to engage with research partners to contribute to the evidence base to inform safe and effective aesthetics practice and governance.

90% of men under 50 worried about cost-of-living stress ruining their looks

A new survey has revealed that nine out of 10 men are worried about the effect cost-of-living stress is having on their appearance. Perhaps surprisingly, the age most affected is men between 18 to 24 years old, with a staggering 40% worrying ‘a lot’ about it.

The research, conducted by independent survey company OnePoll on behalf of SafeAP, a downloadable app founded by two NHS doctors to help people find qualified cosmetic practitioners, surveyed 1,000 UK males aged 18-50, breaking the results down by age and region.

Nine out of 10 (90%) of the survey cohort admitted being worried about their appearance, with their concerns directly related to the stress of the cost-of-living crisis. 30% of men worried ‘a lot’ about this impact, with the majority (41%) at least ‘somewhat’ concerned – only 10% were ‘not at all’ worried. The top five were weight/fitness (40%); skin quality (25%); teeth appearance (23%); with eyebags (19%) and hair loss (19%) tied for fourth place – other areas included muscle tone and wrinkles. Even among the least worried age group; those aged 4650; nearly one in five (19%) had substantial concerns. In the battle of the North, 43% of men on the North East were the most worried, compared to a more chilled out 23% in the North West where 14% were ‘not at all’ worried.

With such an overwhelming majority highlighting the impact of the stress, experts are worried that men will start seeking cheap aesthetic treatments from unsafe practitioners in an attempt to maintain their appearances. This concern is substantiated by news reports highlighting the dangers of men seeking cut-price procedures abroad to restore hair loss, prompting plastic surgery societies to issue international warning guidelines. A previous study by SafeAP showed that while more than half of women cite fear of complications as a factor preventing them from seeking procedures such as wrinkle-relaxing or filler injections and non-surgical liposuction, only just over a third of men (36%) claim having this concern, and only 27% feel put off by horror stories they might see in the media. This has prompted the team behind SafeAP to warn that men could be particularly vulnerable to predatory marketing tactics.

Maxillofacial surgeon Sieuming Ng who, along with Dr Subha Punj, pioneered SafeAP to ensure that non-surgical aesthetic procedures are delivered by qualified healthcare professionals in a safe environment, said: “It is evident that the physical impact of the cost-of-living crisis is prompting significant worries, and the survey responses paint a vivid picture of some of the surprising fears men are having. What’s particularly worrying is the potential for a rise in the uptake of unsafe non-surgical aesthetic treatments, prompted by cost-cutting measures. While cheap, quick fixes may be tempting, they come with significant risks. We encourage men to make informed choices, seeking qualified practitioners to safeguard both their appearance and wellbeing.”

‘No active plans’ to introduce legislation for the aesthetics industry in Northern Ireland says minister of health

Northern Ireland’s Health Minister Robin Swann said there are “no active plans” to introduce legislation around NI’s aesthetics industry.

It comes after Mark H Durkan, a member of the legislative assembly (MLA) for the Social Democratic and Labour Party (SDLP), compared parts of the sector to the ‘Wild West’. Durkan suggested a ‘Zoom boom’ – where people saw themselves on screen more regularly as online meetings increased during Covid – had led to increased demand.

He raised the issue in the Assembly after the Belfast Telegraph reported that more patients are suffering “life-altering” injuries from botched and unregulated aesthetics processes, like botulinum toxin and dermal fillers.

The SDLP MLA called on Mr Swann to introduce a licensing scheme and standardised qualifications for practitioners carrying out nonsurgical cosmetic procedures (NSCPs). But Mr Swann said his department is “currently operating within a constrained budget”, adding: “In that context, work on the review of the regulation is currently paused to allow for other priority projects to progress. As such, there are no active plans to bring forward legislation in this area.”

In 2022, in the absence of an Executive, Mr Durkan commissioned a comparative research paper from the Assembly Research and Information Service (RaISe) into NSCPs in Northern Ireland and Great Britain.

Durkan said, “It’s not my intention to impact the many practitioners and businesses out there who pride themselves on their high standards but rather this is about the system they’re working in. Registered healthcare professionals performing NSCPs are required to meet the competency standards set by regulatory bodies such as the General Medical Council, the major problem here is that there is no such requirement for non-medical practitioners. This creates a Wild West scenario where essentially anyone can practise cosmetic procedures without a proper screening process for customers.”

Mr Durkan urged Mr Swann to issue a public consultation on a mandatory licensing scheme for NSCPs.

Quarter of a million people need CBT for anxiety, depression, OCD and Body Dyspmorphia

The NHS has revealed that 227,816 courses of Cognitive Behavioural Therapy (CBT) were given to people in England in 2022/23, accounting for 41.3% of all courses of therapy given in the year.

This figure is up 12% in just three years, when 202,223 people were given CBT courses in 2019/20, just before the Covid-19 pandemic. The UKAT London Clinic’s analysis of today’s NHS data shows that 60% (136,418) of those accessing all CBT courses do so due to a diagnosis of anxiety. This figure is up significantly (25%) since before the pandemic, when 109,339 people were diagnosed with anxiety back in 2019/20. Depression is the second most popular diagnosis where a course of CBT therapy is prescribed – accounting for 33% (77,167) of CBT courses given to people in this country last year. Back in 2019/20, CBT courses were given to people with depression 67,595 times, meaning a four year rise of 15%.

The UK Addiction Treatment Group’s London Clinic’s analysis of this NHS data has shown a concerning rise in CBT courses issued to people suffering with body dysmorphia. Back in 2020/21, CBT therapy was given to just 17 people diagnosed with body dysmorphia. New figures show that this has risen by a staggering 1,847%- up to 331 courses in 2022/23.

Lee Fernandes, lead therapist at the UKAT London Clinic, a mental health treatment facility commented: “Today’s figures prove that we’ve become an incredibly nervous nation. Rates of anxiety and other anxiety-related disorders such as OCD, body dysmorphia and agoraphobia are rising at alarming rates since the global pandemic, which is likely a significant cause.

“It’s only now that we’re truly seeing the mental health fall-outs of the Covid-19 crisis, and unfortunately, we believe that these NHS figures only tell part of the story. We know that there will be even more people out there struggling with confusing symptoms and dark thoughts, and we’re here to say that help is available. It’s time to prioritise your mental health and get the support that you need, no matter what your condition.” Shutterstock/William Barton/Microgen

Sixth Alma Academy held in Barcelona

Alma Lasers hosted the sixth Alma Academy in Barcelona in March, with nearly 400 physicians from 37 countries around the world in attendance.

The global summit brought together 16 world-class experts from across the industry to discuss the latest news, insights, and share real case practices.

Among the speakers were Prof Ofir Artzi and Prof Moshe Lapidot (Israel), Dr Munir Somji (UK), Dr Sachin Dhawan (India), and Dr Tiago Baptista Fernandes (Portugal). Topics ranged from skin rejuvenation to addressing challenging skin conditions, scars, and body contouring.

The event also included live demonstration sessions with Alma’s award-winning products such as the flagship Harmony XL Pro, , Alma Hybrid and Alma PrimeX.

The UK does not follow sun safety guidance new survey data finds

Face the Future, launched its 366 Days of SPF campaign with a YouGov survey, which highlighted that the UK population is not adhering to SPF guidelines, putting their skin health at risk.

A large proportion of people said they found SPF expensive (64%) and only 22% of the 2,000 participants said they applied SPF daily. The fear of getting sunburn was greater than that of skin cancer and almost half of the population were not worried about getting skin cancer, nor were they familiar with the symptoms.

Nearly a third (31%) of the population said they actively seek a tan to look more attractive (53%) and confident (56%). Despite this, only 22% were concerned about the risks. Almost half of the UK population said they didn’t follow medical advice on wearing SPF daily. 45% said they disagree/strongly disagree with the medical advice to wear SPF every day, indoors and during winter, with over half only applying when it is sunny outside. Around one in seven said they never apply SPF.

The 366 Days of SPF campaign is backed by Amy Callaghan MP, whose VAT Burn campaign calls on the UK government to remove VAT from sunscreen products that have a health benefit.

She said, “Too many people still don’t protect their skin from the sun. It’s high time the UK government took note of these stats and enacted meaningful action to reduce deaths from melanoma and other skin cancers.”

Young mum dies days after Turkish BBL op

A 26-year-old British mum-of-three tragically died after getting a Brazilian bum-lift operation in Turkey. Demi Agoglia, 26, from Salford, Greater Manchester, is thought to have suffered cardiac arrests after returning to the clinic in Istanbul for a check-up following the surgery, The Sun reported in January.

The British Association of Aesthetic Plastic Surgeons have previously raised concerns about cosmetic surgery tourism and the risks of BBL procedures and patient safety guidelines drawn up by BAAPS in November may become the international standard in guidelines for cosmetic tourism.

NEWS IN BRIEF STORIES

Medik8 Joins the BCorp Community

Medik8 has become B Corp certified, making it one of only 66 beauty manufacturers in the 8000-strong B Corp community worldwide to be recognised. The certification process is rigorous, with applicants required to reach a benchmark score of over 80 while providing evidence of socially and environmentally responsible practices relating to energy supplies, waste and water use, worker compensation, diversity and corporate transparency. Medik8 obtained certification with a score of 89.9 points.

Harley Academy receives £8 million investment

Private equity firm Rockpool

Investments has invested £8 million into aesthetic training company

Harley Academy. The investment will be dedicated to advancing Harley Academy’s curriculum, to provide trainees with evidence-based medical education. The funds will also support the training provider’s efforts to attract educators and industry experts and invest in technology and develop digital resources, adds the company.

Dr Derrick Phillips announces BioLite residency

Leading consultant dermatologist, Dr Derrick Phillips, has announced an ongoing residency at prestigious Dubai wellness clinic BioLite Clinic. Dr Phillips’ work is universally recognised within the dermatology and aesthetic industry by the likes of the British Skin Foundation, whom he works alongside in skincare research. Dr Phillips is also a specialist in adult female acne.

Scotland named ‘worst in Europe’ for risky fillers

Healthcare professionals, including members of the British Association of Cosmetic Nurses (BACN), have raised concerns about the lack of regulation in the aesthetics industry, particularly in Scotland. BACN Honorary Members, Jackie Partridge and Francis Turner Traill, spoke to BBC Journalist Georgina Hayes to warn that unqualified individuals are administering cosmetic treatments like dermal fillers, leading to potential harm for consumers. Read the full BBC article at: https://www.bbc. co.uk/news/articles/c3gejz2n7nro

Searches for ‘Glass skin products’ are skyrocketing by 202%

People are turning to research to achieve the perfect dewy skin with searches for ‘glass skin products’ skyrocketing by 202% in the past five years. The hashtag #glassskin is also trending on social media and has accumulated 3.9 billion views on TikTok alone worldwide.

Glass skin, which is a trend known for its clear, dewy and reflective appearance, is a Korean beauty term which has now caught on globally. Social media users are searching for to achieve the look, with #koreanskincare gaining 6.8 billion views on TikTok. Google searches also show searches for ‘Korean skincare’ have exploded to an all-time high over the past five years by 258%.

A new finding from beauty and wellness marketplace Fresha has also revealled that online searches for ‘glowy skin’ have exploded by 178% globally. At the same time, TikTok has seen 9,000 posts with the hashtag #cleangirl and 61 million views from users in the UK. The ‘clean girl’ aesthetic going viral is known for its emphasis on natural beauty look.

Ihya House of Aesthetics opens in Edgbaston

Ihya House of Aesthetics has opened its doors in Edgbaston, Birmingham. The name Ihya is rooted in Arabic and translated as ‘revival.

The exclusive launch event took place on January 25, 2024, with welcome drinks, a ribbon-cutting ceremony, guided tours, live demonstrations, exclusive evening offers and guest speakers covering topics such as optimal skin health and revolutionary body treatments. Guests could also get a VISIA Skin Analysis and take part in the raffle

The treatment menu includes the multi-modality platform HydraFacial Syndeo; non-surgical face-lifts using minimally invasive, needle-free technology, such as radiofrequency and HIFES; non-invasive body sculpting; cellulite reduction; hair restoration; skin rejuvenating treatments and peels; laser hair removal; skin boosters and intimate rejuvenation treatments. The doctor-led clinic also offers psychology services.

Surgeon highlights concerns over viral Lemon Bottle trend

Mr Naveen Cavale, a distinguished plastic and reconstructive surgeon at REAL clinic, has expressed his concern regarding the rapid rise in popularity of Lemon Bottle.

The treatment has garnered widespread attention on platforms like TikTok, amassing millions of views under the hashtag #Lemonbottle. Data from Google suggests that interest in Lemon Bottle is surpassing interest in traditional procedures such as liposuction and other fatdissolving methods. The procedure involves numbing areas of concern, typically the chin, stomach and thighs, then injecting the solution directly into the fat cells.

Despite being hailed as the fastest fat dissolver, Mr Cavale cautions that there is a lack of substantial clinical evidence to support such claims.

“It’s being touted as the fastest fat dissolver there is, but it doesn’t appear to have clinical evidence behind it to lay claim to this,” states Mr Cavale. “My advice would be don’t rush in for it. It still needs assessing and regulating before it would appear on my personal roster of treatments. It might turn out to be great, it might also be a disaster, so I would personally say it’s not worth rolling the dice.”

Mr Cavale concludes by cautioning individuals about the transient nature of TikTok trends, citing previous viral phenomena like buccal fat removal and the Barbie Botox trend. “Trends come and go, so I would personally advise caution to anyone thinking about Lemon Bottle injections,” he remarks.

NEWS IN BRIEF STORIES

Teoxane receives Medical Device Regulation Certification

Teoxane has announced that it has been granted with the Medical Device Regulation (MDR) certification. This makes it the first company that manufactures sterile, injectable, hyaluronic acid-based products specifically to treat wrinkles to have its entire product portfolio (TEOSYAL® PureSense and TEOSYAL RHA®) recognised for the safety and quality of its therapeutic and aesthetic properties.

Nearly half of UK adults report stress-related skin conditions

Nearly half (42%) of the UK population believe stress has had a negative impact on their skin and hair. Dry skin tops the list of stress-related beauty concerns, affecting three in 10 people, according to new stats from wholesaler Capital Hair & Beauty. The most common hair and skin conditions Brits struggled with in the last year were: Dry skin (29%); hair thinning and loss (22%); acne and breakouts (19%); inflammation (12%) and eczema (11%).

Virtual Clinic Manager launches in the UK

Virtual Clinic Manager (VCM) has launched in the UK, providing fast, automatic responses to clinic enquiries via email, calls and social media. It has been developed by aesthetic nurse prescriber and clinic owner Rebecca Hopkinson, who says the system has increased revenue by 50% in the first year of implementation in her own clinic.

SIAB and ABC Conference announce partnership

Success in Aesthetic Business (SIAB) and Aesthetics Business Conference (ABC) have formed an aesthetic business support partnership. SIAB is run in partnership with DSL Consulting Ltd and DH Training who have run a series of business support days for practitioners on enhancing their business skills. Hamilton Fraser, the owners of ABC, has also provided business support to the industry and its clients. The collaboration aims to offer comprehensive access to industry specialists in business skills across all regions. It will unfold over a 12-month period, culminating in the ABC event in October, 2024.

MENOPAUSE IN AESTHETICS, BUSINESS DESIGN CENTRE, LONDON

The Consulting Room team headed to London in February for the second annual Menopause in Aesthetics (MiA) conference.

New for 2024 were additional speakers and a pre-event workshop on ADHD alongside the conference and exhibition. MiA aims to equip aesthetic professionals with the necessary tools and knowledge to provide optimal support to women undergoing menopause.

Dr Ginni Mansberg, Dr Shirin Lakhani, Miss Anne Henderson and Tracey Dennison chaired the day with topics covering everything from testing and safeguarding to hormones and intimate health treatments.

Alma Studios Launch, St Paul’s, London

Alma launched Alma Studios, its cutting-edge new training hub, in February.

Centrally located in London’s St Paul’s, the first-of-its-kind training hub, has been designed in a stylish, elevated environment, featuring the highest spec touch-points and comprising two clinical training suites.

Lior Dayan, Alma CEO, says “It’s a proud moment for Alma to introduce Alma Studios: an important brand pillar to support our ongoing mission to elevate trust, industry standards and cultivate enduring relationships. With Alma Studios, we aim to provide a dynamic facility where education, innovation and collaboration converge to empower our valued partners and shape the future of aesthetics.”

Kamran Shibli, Alma general manager UK & Ireland, adds “Alma Studios is the first-of-its-kind experience centre designed to take Alma customers to the next level. Our state-of-the-art clinical training facilities allow practitioners to refine their craft whilst the studios clinic marketing content set-up is dedicated to generating patient demand. Alma Studio is testament to our ongoing commitment to developing long-term partners with our clinics.”

Alma Studios will offer brand partners a range of resources and facilities, including:

• Advanced training programmes: Alma Studios will host training sessions led by visiting industry experts, covering the latest techniques, applications, and best practices in laser aesthetics.

• Technical support and consultation: Partners can expect to receive dedicated services to help with maximising their clinic operations and patient results.

• Networking and collaboration: The studios will facilitate networking events, workshops and collaborative projects, enabling partners to connect, share insights and forge mutually beneficial relationships.

• Marketing tools and content creation: Alma Studios can act as a space for creating polished content with studio-quality green screens, professional cameras and Alma medical-grade devices onsite to support clinics in driving interest in their treatment offering.

www.consultingroom.com

The Tweakments Guide Live, London

In February, The Tweakments Guide, founded by Alice Hart-Davis, hosted a live event in collaboration with aesthetic practitioner Dr Sophie Shotter to provide tweakment-curious consumers with information and top tips on aesthetic treatments, including a range of medical devices and skin care.

The event was also supported by Mr Marc Pacifico, Dr Catharine Denning, Dr Stefanie Williams, Dr Manav Bawa, Dr Elizabeth Hawkes, Dr Laura Milligan, Dr Priya Verma, Dr Ariel Haus and Dr Sohère Roked.

Premium ticket holders had the opportunity to book exclusive 15-minute chats with these top practitioners, guiding them towards tailored treatment plans.

Throughout the evening, guests were also treated to informative talks from practitioners and key brands. These ranged from ‘How to balance your hormones’ from Dr Sohère Roked to ‘Total Skin Solutions’ from Lutronics.

To finish, guests left with goodie bags, which included products from Medik8, Absolute Collagen, and Cellcosmet, valued at over £250.

AESTHETIC TRENDS

SPECIAL

In this section:

Galderma’s NEXT report

MIA trends report

Polynucleotides

Weight loss injections

NEXT IN LINE

Galderma issues report outlining key trends that are shaping the future of aesthetics

Galderma has unveiled a forward-looking industry report on the global aesthetic trends that are anticipated to shape the future. NEXT is the product of research commissioned by the company in collaboration with leading trend forecasting agency WGSN and co-created with a global network of renowned aesthetic practitioners and influencers. It presents the movements and trends that may impact the future demand for aesthetic treatments.

Aesthetics is increasingly becoming part of our holistic beauty and well-being routines, which, in turn, are expected to drive the category’s projected growth. By 2028, the aesthetics market is predicted to nearly double in value and reach $25.9B.1

The report outlines three core macromovements that support this growth, from which Galderma has identified six trends that are driving aesthetics towards the next phase.

Each trend is supported by data and insights from industry influencers and leading aesthetic practitioners across the world, indicating how each trend will shape tomorrow.

The Macro Movements

1. Increasing accessibility

More convenient

The rise of less invasive treatments, termed ‘tweakments’, as coined by journalist Alice Hart-Davis, illustrates the desire for convenience, minimal downtime and (often) immediate results. Additionally, patients now have greater access to aesthetic treatments via new treatment locations and options. Over the past five years, more than 400 aesthetic clinics and care centres collectively raised $3.1B from investors, making this segment the fastest-growing of the aesthetics industry.2

More affordable

Affordability still has a significant influence on the accessibility of aesthetics. The availability of more affordable pricing

options in recent years has widened the pool of people who are able to access treatments. Furthermore, beauty is being treated as a right instead of a choice in countries such as Brazil, where the government subsidies nearly half a million plastic surgeries every year.3

More inclusive

The typification of aesthetics ‘for women’ is moving to ‘for all.’ The inclusivity that has reshaped the beauty industry at large is predicted to have equal influence within the world of aesthetics. Notably, change in gender expressions has invoked an openness to men participating in beauty, which is evidenced by the fact that the American Society of Plastic Surgeons saw a 182% increase in treatments in men from 2000-2020.4

2. Advancements in science and technology

The rise of aesthetic tech has expanded not only the variety of treatment options available but also their appeal. Take, for example, augmented reality and face editing apps, where people can share visuals with their aesthetic doctors as part of the consultation process.

A 2020 survey completed by an artificial intelligence app that enables users to preview cosmetic procedure results suggests there is a rising trend in aesthetic tech; it found that 55% of adults would be interested in an app or website that allows them to see how aesthetic procedures affect their faces or looks in a medically accurate way.5

In addition, new innovations are improving existing products – for example, by expanding indications and offering longerlasting efficacy. We are also seeing new innovative product developments. Such advancements provide practitioners with more options to address the patient’s wants and needs

3. Social community

Awareness and understanding of aesthetic treatments have increased through social media.

Aesthetic practitioners are using social media to garner sizeable followings, highlighting that the world of aesthetics has a far-reaching platform of increasing influence.

Indeed, Californian facial plastic surgeon Dr Kay Durairaj, who has 400K+ followers on TikTok, notes that 80% of her patients come from social media.6 Aesthetic treatments are not only being normalised but also popularised online with patients using social networks for guidance, advice and knowledge.

The NEXT trends

The six future trends that are emerging as a result of these macro movements and are anticipated to shape the future consumer demand for aesthetic treatments are:

1. Proactive beauty

The rise of ‘prejuvenation’ treatments, which focus on ‘prevention’ rather than ‘correction,’ reflects the zeitgeist of today. For aesthetics, this means a move toward early intervention.

Today’s consumer is invested in preparing for a future where they can prolong their youthful appearance for as long as possible, rather than how their DNA and external factors dictate. This is supported by the fact that 47% of U.K. adults agree that social media has made getting nonsurgical procedures more commonplace. It has become ‘the new normal’ for us to think ahead about how aesthetics can intervene on the signs of ageing.7

Looking forward, effective ways to stimulate collagen and elastin production are likely to emerge. So, too, will solutions that more widely restore what is lost with age: developments addressing bone loss and hair thinning are afoot.8,9,10 As proactive beauty becomes established, we will likely see multi-modal treatment plans combining several aesthetic interventions with skincare, nutrition, as well as long-term health and wellness to make prolonging youthful appearance a reality.11

2. Mindful aesthetics

The ethos of mindful beauty has reached the aesthetics market. Consumers are increasingly embracing products with minimal environmental impact that align with their ethical values and provide natural-looking results. The statistics speak for themselves: the global natural and organic beauty market is projected to hit $22B by 2024 and is one of the fastestgrowing categories in the personal care sector.12

Additionally, there is demand for products that seamlessly integrate with the body, indicating a push-back against artifice.

As a society, we are increasingly aware that what we put into our bodies can impact our health and beauty. Today’s consumer expects transparency and accountability regarding ingredients, as well as sustainability and ethical impact. In addition, ‘Skinimalist’ consumers are actively celebrating wearing less makeup. We will also see more sustainable packaging solutions.

3. Fast aesthetics

The fact that trends in the fashion world rise and fall is nothing new. But the addition of aesthetics is a recent – and noteworthy – development. “What we [as humans] perceive to be beautiful is actually quite fickle because…we can influence what we perceive as beautiful.

Approximately half of beauty-interested Gen Zs and Millennials use social media to follow celebrity performers.13 Yet, while today’s trends are often instigated by celebrities, their growth is enabled by viral social media trends.

Here today, gone tomorrow – consider these recent examples of treatments, which have increased and decreased in popularity quickly.

• Buccal fat removal

• Brazilian butt lift (BBL) surgery

• Fox eyes

• Russian lips

Aesthetics intersecting with immediacy isn’t going away; for consumers it’s about satisfying novelty but for practitioners, it’s more complicated. It’s about how to know if a look is ‘fast’ or here to stay – and how to safely react to the mindset of ‘disposable looks.’ In the future, we may see treatments designed for temporary life states (i.e. a wedding, a vacation) as well

as a continuation of treatments that can be safely reversed. Practitioners highlight a responsibility to bust myths about how easily treatments can be reversed while ensuring that patients are fully informed about the ‘trends’ they are asking for; spending more time in consultation and considering a stepwise approach to treatment will become key.

4. Beauty fandom

There’s a new and more extreme take on fandom and stardom at play in the aesthetics world today. This trend indulges in fascination with niche idolisation – from cultural icons to digital filters, anime and beyond – which is leading to a desire for metamorphosis.

This trend reflects how the world of aesthetics responds to the culture of fascination with metamorphosis and mimicry that is fuelled by digital communities that explore unique beauty ideals. How practitioners respond to this consumer trend is a controversial and delicate topic, bringing questions of ethics and where the limit sits for physicians facing such requests.

Social media has enabled niche fan groups to connect, especially on TikTok, while constant exposure to famous faces has triggered an aspiration that also impacts consumer demand. Digital filters can seamlessly morph real faces into those of animated characters, cueing aesthetics with the possibility of bridging the gap between fantasy and reality, as well as prompting how practitioners can manage patients’ potentially unrealistic expectations.

5. Expressionality

There is a greater interplay between a sense of self and self-expression. We live in an era that encourages people to embody and own their individuality in fashion, styling, hair, makeup and now aesthetic treatments. Who you are and who you want to be; it’s all open to exploration in a trend that celebrates every aspect of self and that links to our personal worlds and cultural communities.

Beauty standards are increasingly a thing of the past; empowerment to be yourself leads the charge. Indeed, eight in 10 Gen Z and Millennials claim that ‘being yourself’ is the phrase that fits their definition of beauty14, and one in five people in the UK augment their appearance as a form of identity expression.15

Personality, culture and gender are all open to being redefined with aesthetic treatments. The need to go beyond a ‘one-size-fits-all’ approach will grow, with consultations that consider all patients’ desired outcomes, even if they differ from typical beauty standards.

6. Cancelling ageing

Consumers are cancelling expectations of what certain ages should ‘look like,’ as consumers employ aesthetics to express their ageless attitude. The vital attitude shift is towards ‘preservation.’ Nearly 72% of women globally said that they want to focus on looking healthy rather than young, and 63% of women globally agree that ageing is no longer something to fear.16

As stem cell technologies, wearable diagnostic tech and biotechnology are gaining momentum. At the same time, Silicon Valley billionaires invest in DNA editing, cellular rejuvenation technology and human ailment reversal. As a result, consumers are expecting longer, healthier lives – with the faces to match. The notion of ‘age appropriateness’ is also becoming old-fashioned, and language is pivoting away from reversal-focused ‘anti-ageing’ and towards preservation focused terminology such as pro-ageing, age management and agelessness.

References

1. Markets and Markets (2023) Medical aesthetics market by product (botox, filler, peel, implant, liposuction, microneedling, hair removal, laser resurfacing, RF, phototherapy), procedure (surgical, nonsurgical), end user (hospital, beauty clinic, spa), region – global forecast to 2028. Available at: https://www.marketsandmarkets. com/Market-Reports/medical-aesthetics-market-885.html. [Accessed: 8 December 2023]

2. McKinsey & Company (2021) From extreme to mainstream: The future of aesthetics injectables [Online]. Available at: https://www. mckinsey.com/industries/ life-sciences/our-insights/from-extreme-to-mainstream-the-future-of-aesthetics-injectables. [Accessed: 8 December 2023].

3. Quartz (2018) The dark side of Brazil’s “right to beauty” [Online]. Available at: https://qz.com/quartzy/1269028/plastic-surgery-in-brazilthe-dark-side-of-theright-to-beauty. [Accessed 8 December 2023].

4. American Society of Plastic Surgeons (2021) Plastic surgery statistics report 2020[Online]. Available at: https://www.plasticsurgery.org/ documents/News/Statistics/2020/cosmetic-procedures-men-2020.pdf. [Accessed: 8 December 2023].

5. AEDIT (2021) AEDIT survey reveals how 2020 altered the aesthetic landscapeforever [Online]. Available at: https://aedit.com/aedition/ aedit-survey-reveals-how-2020-altered-aesthetic-landscape.[Accessed: 8 December 2023].

6. WGSN (2022) WGSN x Galderma. The future of aesthetics. Galderma internal report. Unpublished.

7. Mintel (2021) Attitudes towards Cosmetic Procedures – UK [Online]. Available at: https://www.mintel.com/ [Accessed: 8 December 2023].

8. Dr. Debbie Norval (2023) Bone aging in aesthetic medicine [Online]. Available at: https://drdebbienorval.com/boneaging. [Accessed: 8 December 2023].

9. British Vogue (2023) Why rosemary oil makes hair grow faster and thicker (and all the best products to use) [Online]. Available at: https://www.vogue.co.uk/gallery/best-rosemary-oil-for-growth. [Accessed: 8 December 2023].

10. TikTok. (2023) #Rosemaryhairoil trending hashtag on TikTok [Online]. Available at: https://ads.tiktok.com/business/creativecenter/ hashtag/rosemaryhairoil. [Accessed: 8 December 2023].

11. The Aesthetic Guide (2018) Bespoke treatments: A new standard of customized holistic patient care. [Online]. Available at: https:// www.theaestheticguide.com/aesthetic-guide/bespoke-treatments-new-standard-customized-holistic-patient-care. [Accessed: 8 December 2023].

12. Statista (2016) Global natural and organic beauty forecast market size 2016-2014 [Online]. Available at: [Accessed: 8 December 2023].https://www.statista.com/statistics/750779/natural-organic-beauty-market-worldwide/ [Accessed: 8 December2023].

13. Real Chemistry (2023) Galderma global trends – staggering stats per market. Additional Galderma internal pptx report. Unpublished.

14. Paramount (2019) How Gen-Z is changing the face of modern beauty [Online]. Available at: https://www.paramount.com/news/ audience-insights/how-gen-z-ischanging- the-face-of-modern-beauty [Accessed: 8 December 2023]

15. Foresight Factory (2021) Looking good = feeling good, UK [Online]. Available at: https://www.foresightfactory.co/ [Accessed: 8 December 2023]

16. Avon (2022) The power in ageing: Future of beauty report [Online]. Available at: https://www.avonworldwide.com/beauty-innovation/ innovation-centres/future-of-beauty/power-in-ageing. [Accessed: 8 December 2023].

Shutterstock/Subbotina Anna

MENOPAUSE IN AESTHETICS TRENDS REPORT 2024

Menopause has emerged as one of the key focuses of aesthetics in recent years and at its 2024 event, Menopause in Aesthetics revealed the drivers behind the market

Self-awareness, self-referral, and self-education

Menopause awareness grew significantly in 2022 and 2023, with more women taking charge of their bodies and demanding better support and understanding in the workplace, media and at a government level.

In 2024, women are increasingly using their own initiative to access effective menopause care. Miss Anne Henderson, Consultant Gynaecologist from GynaeExpert.co.uk, said: “In my practice, I’ve noticed that the key trends in menopause care are self-awareness, self-referral, and selfeducation. Women are no longer following the traditional referral pathways through their GP. The vast majority of women self-refer due to awareness of the failings within the NHS and the inability to get decent quality advice.”

Aesthetic clinics becoming firstresponders

Aesthetic clinics regularly treat women in their 40s and 50s and are meeting a gap in the market for menopause care.

Jackie Knight, a registered nurse and

Principal Practitioner at A New You clinic in Brighton, said: “In the last decade, it is apparent there are ongoing ways for the public to have access to menopausal advice in order for them to make an informed decision about their care during the perimenopause, menopause and post-menopause stages. We are best placed as aesthetic clinics to be able to integrate this advice and education into our practices.”

Personalised hormone replacement therapy

Compounding pharmacies work with menopause specialists to develop and dispense bespoke compounded and bioidentical formulations to treat menopausal symptoms and maintain women’s hormonal health.

Elizabeth Philp Chief Executive Officer and Founder of Roseway Labs, said: “Compounded Bio-identical Hormone Replacement Therapy (BHRT) can offer advantages to patients and prescribers. Bio-identical hormone powders are originally sourced from wild yam and then synthesised in a laboratory to create molecules that are molecularly identical to women’s natural

hormones. These active ingredients are compounded to create BHRT precisely targeted at the patients’ needs.

“Personalised medication can ease women’s menopause symptoms, improve their wellbeing and restore their hormonal health.”

Testosterone treatment

Increasingly, women are asking about testosterone treatment as part of their hormone replacement therapy. In 2023, data analysis by The Pharmaceutical Journal showed a ten-fold increase in the number of women prescribed testosterone over the past seven years, with the sharpest rise following Davina McCall’s menopause documentaries.1 Looking forward to 2024, this is likely to be an increasing trend.

Dr Masud Haq, a highly respected consultant in diabetes and endocrinology, said: “There’s been a significant interest in menopausal treatment over the last few years. This has probably been driven by social media and celebrities raising awareness of menopause. This is certainly very welcome, and we should be doing our level best to treat as many women as possible with HRT to improve their quality of lives.

“There are significant benefits with giving testosterone in appropriate women who have features of Hypoactive Sexual Desire Disorder or HSSD. The benefits are an improvement in sexual function, mood and emotional symptoms.”

Testosterone is a male hormone but many women also have good circulating blood levels, which often decline during menopause. Testosterone replacement can help treat certain symptoms, including fatigue, loss of muscle tone and energy, reduced sex drive, low mood and brain fog. However, it should only be added once other hormones, particularly oestrogen, have been stabilised at optimum levels.

Testosterone treatment for women in the UK is off-licence and should only be prescribed by experienced specialists who have the ability to closely monitor blood levels and ensure that treatment is carried out safely within recommended parameters.

The British Menopause Society is campaigning for change, but that still looks like some time off. In the meantime, anyone considering testosterone therapy should consult an experienced and accredited

menopause specialist, endocrinologist or specialist GP.

Menopause, incontinence and bladder health

Urinary incontinence affects more than 50% of postmenopausal women, with the number of women suffering increasing every year. Incontinence impacts selfesteem, quality of life and sexual function.2

Dr Shirin Lakhani, women’s health advocate and founder of Elite Aesthetics, said: “It is vital that the impact urinary incontinence has on women’s lives is more widely talked about so they no longer need to suffer in silence. Many women don’t even realise they have incontinence. They don’t understand that any involuntary loss of urine is incontinence. Their symptoms are often played down.

“The other aspect is that they are told it’s normal – it is part of having children or getting older, and it’s just something they have to get used to.

“The condition can be life-changing for some women. It can affect their social life and cause anxiety, depression and stress due to the worry and embarrassment associated with

the condition. An overactive bladder can also affect sleep, as they may find they are waking up many times in the night to go to the toilet. It can make women feel like they have lost control over their bodies and could affect intimacy with a partner if you are worried about leaking during sex.

“In recent years, we have had all these amazing developments with non-invasive treatments that can really improve a woman’s quality of life, but the information doesn’t get to them. We need to start telling women that if it bothers them, it is something they can seek help for. It’s not something that just has to be brushed under the carpet.”

Genes and the menopause

Women’s genes can affect their hormonal health, menopause and reproductive life span. Researchers have found nearly 300 genetic signals associated with the age at which a woman enters menopause.

Experts in medical genetics also report that a woman’s DNA can significantly affect her symptoms during perimenopause and menopause.

Dr Mansoor Mohammed is a pioneer in medical genomics. He works with Dr Alessia

Shutterstock/27SaturnO

Corrieri at the Precision Health Clinic to optimise health using knowledge of an individual’s genetic make-up.

Dr Mohammed states that the symptoms of menopause are different for women with different genotypes: “Using genomics helps us predict how women will experience menopause and how they will respond to treatment.”

It’s important to take each individual’s genetic profile into account before starting medications and other types of therapy to optimise women’s hormonal health.

Dr Corrieri said: “Before starting PHC and studying genomics, I utilised the normal NHS guidelines where all women are prescribed pretty much the same protocol irrespective of how their body produces or metabolises hormones. This approach also ignores the impact of other factors, such as insulin and vitamin D, on sex hormone regulation. Utilising knowledge of the patient’s genetics helps us produce a much more successful patient journey without the trial-and-error approach of generalised protocols.”

Menopause differences in ethnic minority women

Menopause is a significant health transition for women, influenced by biological, psychological, behavioural, and social factors. Despite the UK’s diverse population, there is limited research on menopause experiences in British ethnic minority women, with much information sourced from overseas studies.

In October 2023, the British Menopause Society published a report emphasising the importance of understanding the differences in biological and hormonal

References

changes in women of different races and ethnicities.

“A better understanding of these similarities and differences will improve the delivery of culturally appropriate care that may help with symptoms and increase the quality of life for midlife women of all ethnicities and races.”

Different racial groups show variations in menstrual patterns and oestradiol changes at the time of menopause. In women of Afro-Caribbean origin, the mean age of menopause is 49.6 years. Women typically experience a longer duration of menopause transition, and they are more likely to suffer vasomotor symptoms, which tend to last longer and be more severe. In contrast, South-east Asian women are less likely to complain of debilitating vasomotor symptoms but may suffer from forgetfulness and musculoskeletal pain.

The mean age of menopause in South Asian women is 46.7 years, much lower than women in Western countries who experience menopause at 51 years on average. Premature Ovarian Insufficiency has a prevalence of 1.5% in this population, so it needs to be carefully considered.

In addition to the biological differences, ethnic minority women also face many challenges in accessing effective and appropriate menopause care. These include cultural stigmas, a lack of open discussions about menopause, and an expectation that women remain silent about their ailments. The lack of knowledge and awareness about menopause, coupled with language barriers, further complicates the situation.

The Oxford Menopause 2023 survey showed that non-Caucasian women and/ or those of lower socioeconomic status are

currently less likely to be diagnosed with menopause, contributing to large health inequalities and missed opportunities.5 Looking forward to 2024 and beyond, we can do better. We need to consider the differences between races, offer information in a culturally sensitive manner and provide resources in multiple languages to help all women transition through menopause and optimise their midlife physical, emotional and cognitive health.

Nutrition, supplements and nutraceuticals

Women are increasingly using supplements and nutraceuticals to optimise health, control symptoms, and take control of their personal menopause journey.

Registered dietitian Nigel Denby advocates for women to take care of themselves and look at the evidence behind the treatments. Nigel has specialised in supporting women through the menopause transition for over 25 years and is the author of 10 nutrition books.

He says: “Good nutrition is the cornerstone of good health. This is never more true than during perimenopause and menopause. Consensus grows daily that effective symptom management and a healthy diet and lifestyle are essential for menopause.

“The increased dialogue around menopause has seen a surge in product development to support this life phase. Many of the new products are little more than bandwagon jumpers. Two areas of interest which, with a little more robust evidence, could become more mainstream are CBD oil and collagenwatch this space!”

1. https://pharmaceutical-journal.com/article/feature/testosterone-for-menopause-why-women-face-difficulties-accessingtreatment#:~:text=On%2017%20February%202023%2C%20data,about%20the%20menopause%20in%202021

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/#:~:text=Urinary%20incontinence%20is%20the%20main,%2C%20 urological%2C%20and%20sexual%20implications.

3. https://journals.lww.com/menopausejournal/abstract/2021/08000/genetic_variants_predictive_of_reproductive_aging.8.aspx

4. https://www.nature.com/articles/s41586-021-03779-7.epdf?sharing_token=Rei8159SsZ8QOdVtF8iZa9RgN0jAjWel9jnR3ZoTv0PS1-dN p_32UFksaZfcXaP3aXMkXALyAKO0nPcpbC39KeKlkBRzHI0ynfECm0hGGDLDphchLvY3DRC_

5. https://www.dovepress.com/getfile.php?fileID=94350

DARK CIRCLES: POLYNUCLEOTIDES CASE STUDY

Dr Amy Law shares a case study treating dark circles with polynucleotides in a 50-year-old female patient

Infraorbital dark circles represent a common and multifactorial challenge in aesthetic practice.1 “Dark circles” is not a formal medical term but a widely used term that collectively indicates symptoms of dark areas under the eyes.2

The delicate skin around the eyes is prone to various factors that contribute to the development of dark circles.1,4 Common factors include:

• Hyperpigmentation: Excessive melanin production in the periorbital area can lead to pigmented dark circles. This can result from genetics, sun exposure, or post-inflammatory hyperpigmentation. Infra-orbital dark circles are more common in patients with allergic conditions such as atopic dermatitis or allergic contact dermatitis, where rubbing the area causes post-inflammatory hyperpigmentation (PIH) around the eyes.2

• Vascular issues: Dilated blood vessels beneath the thin skin around the eyes can contribute to a bluish tint. Factors such as poor circulation, fatigue, and hereditary predisposition can exacerbate vascular-related dark circles.5

• Volume loss: Age-related loss of fat and collagen in the under-eye area can create a hollow appearance, known as the “tear trough”, casting shadows and intensifying the appearance of dark circles.2,6

• Skin thinning and wrinkling: The skin around the eyes is delicate and prone to thinning over time, revealing the underlying blood vessels and contributing to the overall appearance of dark circles.1

Dark circles can significantly impact an individual’s perceived attractiveness and overall facial aesthetic, with patients reporting

they make them look tired, older and even sad.1-4

Treatment options

Addressing infraorbital dark circles necessitates a tailored, multidimensional approach. Commonly utilised treatment modalities may include topical treatments, dermal fillers, peels, laser and light-based treatments and even surgery.1 Polynucleotides are now presenting a new option for aesthetic practitioners.7

Case study

A 50-year-old female patient came into the clinic concerned about her dark circles, which she said she had had since she was young. She complained of never being able to leave the house without wearing concealer and said that the dark circles made her feel really “old” and “tired”.

She wanted to find out what her options were because filler hadn’t worked for her in the past. In addition, because she had a history of fluctuating puffiness throughout the day, we agreed that filler wasn’t the way forward and that we needed to explore other options to improve the problem.

On assessment, she had quite deep pigmentation underneath the eyes, a fairly deep teardrop hollow, and slightly poor skin laxity. The main issue for me was the pigmentation, so managing her expectations was extremely important as you don’t always know what level of improvement you’ll get periorbitally.

I felt polynucleotides could work for her, but I couldn’t charge her Shutterstock/Anton Mukhin

TRENDS SPECIAL

for a treatment where I couldn’t predict the outcome, so I said, “We can provide this treatment for you at no charge. We would just love to see what results you get. If it works, we’d love to potentially show this and publish it.” She was really on board with that.

We used Plinest Eye with anti-radical complex (a treatment that helps counter free radicals and brightens and awakens skin and tissue) for the first three sessions, and she really started to see an improvement from that. At the fourth session, we used Plinest Eye without the anti-radical complex. I kept the appointments at fourweek intervals.

For the first two sessions, I used a 25G 40-millimetre cannula in the tear trough (deep and superficial). Then, I did intradermal blebs around the periorbital region and the upper and lower periorbital regions. With the anti-radical complex, I treated that intradermally. I did 0.2mls in the medial tear trough under the orbicularis oris muscle. Then I did 0.2mls above the muscle and 0.1mls into the lateral groove below the muscle and 0.1mls above the muscle. I did a 0.4ml intradermal bleb underneath the eye, bringing it over superorbitally as well. Then, I used the anti-radical complex. I placed 0.6mls under each eye and across the periorbital region intradermally, and for the remaining 3.4mls, I placed intradermally across the face.

In the third session, I used the Plinest intradermally. In the fourth session, I used the Plinest Eye intradermally, micro-bolusing it around underneath the eye and above the eye.

It took about four months to complete treatment. I reviewed her six weeks after her last session, and she had seen a huge, huge

improvement. I would probably say from her third session, we really started seeing improvement in the under-eye hollow, the brightening effect underneath the eye, and the improvement in skin quality.

To maintain her results, I gave her the Obagi Professional-C 10% vitamin D serum, and she’s been using that throughout. I also asked her to use a Heliocare SPF every day, and she’s been continuing to use it. I advised her to come back between six and nine months for just one booster session with the Plinest underneath the eye.

She was over the moon. There was still some pigmentation, and she obviously still had an under-eye hollow, but it was much less significant than it was when she initially presented. The fact that she said she could now go out without any concealer on and wasn’t self-conscious about it showed that it made a massive improvement to her quality of life and her overall confidence. One thing she also mentioned was the anti-radical complex really helped improve her skin texture, brightness and hydration. She really rated the anti-radical complex and really saw an improvement. Overall, she was really, really pleased with the results.

Conclusion

Infraorbital dark circles pose a significant cosmetic challenge, but polynucleotides are now offering a new and effective way to treat them.

References

1. Vrcek, Ivan & Ozgur, Omar & Nakra, Tanuj. (2016). Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. Journal of Cutaneous and Aesthetic Surgery. 9. 65. 10.4103/0974-2077.184046.

2. Park KY, Kwon HJ, Youn CS, Seo SJ, Kim MN. Treatments of InfraOrbital Dark Circles by Various Etiologies. Ann Dermatol. 2018 Oct;30(5):522-528. doi: 10.5021/ad.2018.30.5.522. Epub 2018 Aug 28. PMID: 33911473; PMCID: PMC7992473.

3. Nguyen HT, Isaacowitz DM, Rubin PA. Age and fatigue-related markers of human faces: An eye-tracking study. Ophthalmology. 2009;116:355-60.

4. Freitag FM, Cestari TF. What causes dark circles under the eyes? J Cosmet Dermatol. 2007 Sep;6(3):211-5. doi: 10.1111/j.14732165.2007.00324.x. PMID: 17760701.

5. Huang YL, Chang SL, Ma L, Lee MC, Hu S. Clinical analysis and classification of dark eye circle. Int J Dermatol. 2014 Feb;53(2):16470. doi: 10.1111/j.1365-4632.2012.05701.x. Epub 2013 Jul 24. PMID: 23879616.

6. Haddock NT, Saadeh PB, Boutros S, Thorne CH. The tear trough and lid/cheek junction: anatomy and implications for surgical correction. Plast Reconstr Surg. 2009;123:1332–1340. discussion 1341-1342

7. Cavallini M, Bartoletti E, Maioli L, Massirone A, Pia Palmieri I, Papagni M, Priori M, Trocchi G. Consensus report on the use of PN-HPT™ (polynucleotides highly purified technology) in aesthetic medicine. J Cosmet Dermatol. 2021 Mar;20(3):922-928.

Images provided by author.

NOT ABLE TO FULFIL YOUR CLINIC'S TRUE POTENTIAL WITH APPOINTMENTS?

MISSING OUT ON THE FULL EARNING POTENTIAL WITHIN YOUR CLINIC?

STAFFING ISSUES CAN BE A STRESSFUL CYCLE THAT CAN BE AVOIDED!

Here at Consulting Room we have helped thousands of individual clinics and clinic chains since 2003 build their business using our services and now we’re here to take the e ort out of finding sta for your clinic. Using our recruitment service saves you time and ensures you get the best quality candidates, leaving you to focus on building your clinic's success.

WHY CHOOSE CONSULTING ROOM FOR YOUR COSMETIC RECRUITMENT?

 Time-saving proven strategies to short-list the most qualified and suitable candidates

 Quick turnaround on filling vacancies

 Advanced candidate screening tools help you make better hiring decisions

 Expert help with benchmarking salary brackets

 Maximum exposure and improved e ciency: Adverts will be posted on thousands of other job sites including award-winning recruitment sites such as Indeed and Adzuna

 Access to recruitment agent with expert aesthetic knowledge of current legislation and relevant requirements and qualifications for high-quality, fully trained candidates

 Option of pre-interview vetting of your chosen candidates by trained recruitment agent

FIND THE RIGHT STAFF FOR YOUR AESTHETIC BUSINESS

BY CHOOSING CONSULTING ROOM AS YOUR RECRUITMENT SPECIALIST

For tailor-made packages to suit your needs contact Sabrina: sabrina@consultingroom.co.uk or call 07734 203 105

TRENDS SPECIAL

WEIGHT LOSS

The Size of the Problem

Since 1993, the number of people living in the UK with obesity (BMI ≥ 30 kg/m2) has doubled, from 14.9% to 28%, and that number continues to rise. The health risks of obesity are staggering. They include: diabetes, heart attack, stroke, sleep apnoea, and arthritis. Death from any cause is far higher in those living with obesity, with associated comorbidities piling enormous strain onto an increasingly challenged NHS. Public health initiatives thus far have done little to tackle the root cause of obesity. The rise of Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) agonists for obesity, more popularly known by their brand names Ozempic, Wegovy and Mounjaro, has been a fascinating and transformative development in healthcare, with some suggesting that they could be solution to the obesity epidemic.

What are Ozempic, Wegovy and Mounjaro?

The prescription medication Ozempic is an injectable medication taken once a week approved to help control blood sugar in individuals with type 2 diabetes but Ozempic has developed brand name recognition and almost cult status for its weight loss effects. The main ingredient in Ozempic is semaglutide, which is now also approved under the brand name Wegovy to treat

obesity and overweight in individuals with co-existing, weightrelated risk factors such as high blood pressure, high cholesterol and type 2 diabetes. Mounjoaro is the latest in the line of these effective medications with the main ingredient, Trizepatide, which is approved for both the treatment of type 2 diabetes as well as chronic weight management and has been shown in some clinical trials to have a greater impact than Ozempic on glucose control and weight. The weight-loss benefits of these medications have become so evident, their increasing approval and use for chronic weight management across the globe has been phenomenal.

These medications mimic the effects of these naturally occurring hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), collectively known as incretins due to their role in stimulating insulin secretion after meals. They help regulate blood sugar, and how quickly your body digests food and how quickly your stomach empties. They help reduce appetite and increase satiety, thus controlling hunger and cravings. They assist with portion size control and how much you eat, leading to decreased calorie intake.

There are also other effects at a cellular level at the liver, the pancreas, and different types of fat cells especially the visceral fat cells often considered to be the “bad” fat cells. These effects are also known to support weight loss and their beneficial effects.

Shutterstock/MauricioSPY

Why are weight loss injections rising in popularity?

There are several reasons for the increasing use of these medications. Compared to earlier weight-loss drugs, these agents offer significantly higher average weight loss (15-25%). Studies suggest they can also improve diabetes control and reduce cardiovascular risks associated with obesity and improve health outcomes in people with type 2 diabtes. More recently, the SELECT trial demonstrated a 20% reduction in the risk of heart attack, stroke, and cardiovascular death with semaglutide in individuals without diabetes and these medications could play a significant role in preventing cardiovascular events in a wider population, not just those with diabetes. The weight loss likely contributed to the observed cardiovascular benefits alongside improved metabolic markers like blood sugar and cholesterol levels.

These newer generation agents are injected weekly offering a simpler regimen than older medications. There is also shifting public perception and growing awareness of obesity’s health impact and acceptance of medical interventions for weight management contribute to the increase in demand.

However, its impact on aesthetics has also garnered significant attention, sparking discussions about both positive and potential negative changes. Weight loss can result in a slimmer overall physique, which some may find aesthetically pleasing. In some cases, weight loss from these agents can accentuate facial features by reducing puffiness and highlighting bone structure. Defined jawlines, cheekbones, and even sharper noses can be perceived as aesthetically desirable. Weight loss and perceived improvements in appearance can positively impact self-esteem and confidence. Even more importantly, the positive mental health impact from increased energy levels, improved mobility, decreased arthritic pain and the restoration of the ability to do day to day things that could not be done due to carrying excess weight cannot be underestimated. The significant weight loss achieved by some can be life changing. They offer powerful

weight-loss potential and could change how we approach managing obesity which is a complex and widespread condition.

The Challenges

As with all things there are challenges and these include cost and access. These medications can seem expensive but patients report that the resulting appetite control can have an indirect positive financial impact as people find that they eat less and indulge less. This often offsets the cost of the medical therapy meaning that these treatments are often more affordable than people realise. Most people that do pursue medically supported weight loss are very motivated and see this as investing in their own health.

The high demand for these medications has caused a ripple effect across various facets of healthcare, society, and even the economy. The popularity of these medications has attracted excessive media attention and potentially led to unrealistic expectations regarding their efficacy and ease of use. This has in some instances fuelled misinformation and unhealthy weight loss practices. The illegal sale and use of GLP-1 agonists and other fake products has also become a serious public health concern with numerous FDA and MHRA warnings. Black market versions have been identified as being diluted, ineffective, or even dangerous, containing harmful contaminants or incorrect dosages. The ease of purchasing medications online, often through unregulated websites, makes it easier for individuals to unknowingly acquire fake products and many people are not aware of the dangers of fake medications or how to identify them, making them vulnerable to scams. It is important that people only obtain these medications from healthcare providers and not buy medications online from unknown or unregulated websites. If a deal seems too good to be true it probably is.

While generally well-tolerated, nausea, vomiting, and gastrointestinal issues can occur. Without proper medical monitoring and support, individuals may experience severe side

effects from improper use or interactions with other medications. Most side effects are transient occur at the time of initiation and dose escalation and can easily be managed with the right clinical support. For further information read our FAQs page at www.drfranks.co.uk and from the Summary of Product characteristics for Wegovy and Mounjaro.

Along with health headlines and celebrity chatter of semaglutide’s weight loss effects has come the observation that losing weight rapidly can lead to changes in facial appearance – colloquially called “Ozempic face.” The term refers to the effect that rapid weight loss can have on a person’s face. These medications can cause effective and rapid weight loss and this happens across the entire body where any stores of fat are, including the face and can result in the skin appearing to be sagging and hollowed out. It is the weight loss and the rate of weight loss, rather than the medication itself, that causes changes in a person’s facial appearance and it is not something that happens to everyone and should be avoidable if the weight loss is more gradual and supervised. There are numerous aesthetic interventions that have become popular in helping with these changes. Afterward, the term “Ozempic butt “followed, which is used loosely to describe various changes in the buttocks associated with weight loss from these medications. These changes could include a flatter or deflated appearance due to reduced fat in the buttocks and sagging skin, particularly in individuals with pre-existing laxity or older age. Genetics, pre-existing body composition, and overall weight loss amount can play a role. While the aesthetic impacts are a valid topic of discussion, it’s crucial to approach it with nuance and caution. Ultimately, the most important aesthetic impact should be a healthier and happier you.

Doing it right

The significant, beneficial effects of these medications aren’t absolute. They provide a powerful initial push, but long-term weight loss depends on learning and maintaining healthy eating and exercise habits. People can still overeat if they don’t develop healthier eating habits. So how does the body react to the sudden removal of these medications? Research suggests that patients regain their weight back after the medication is stopped suddenly and if insufficient behaviour and lifestyle changes have not been

made. For sustainable results behaviour change is crucially important when using these medications for obesity management, and successful weight loss hinges on this integration. Learning portion control and healthy food choices can minimise nausea, vomiting, and other digestive issues that sometimes lead to the side effects that are associated with GLP-1/ GIP agonists. Patients often discontinue treatment at an early stage when side effects occur and they cannot get the support and advice they need to manage what are often transient side effects that disappear after they are stabilised on a higher maintenance dose. This is one of the downsides to some online services that do not have a human interface.

Behavioural changes, like adopting a nutritious diet and regular exercise, lead to better long-term health outcomes beyond weight loss, including managing diabetes and cardiovascular risks and developing skills for self-regulation and making positive choices can boost self-confidence and emotional well-being. Examples of helpful behaviour changes include dietary modifications like prioritising whole foods, vegetables, fruits, and lean protein while reducing processed foods, sugary drinks, and unhealthy fats. Mindful eating practices are a significant part of a person’s weight loss journey with medical interventions. Practicing slow, mindful eating to recognise satiety cues and avoid overindulging are a path to success. Using smaller plates, planning meals, and learning appropriate serving sizes are key.

One cannot emphasise enough some form of regular physical activity such as even engaging in moderate-intensity exercise for at least 150 minutes per week. Finding healthy coping mechanisms for stress, which can trigger emotional eating are also very relevant in those that seek help with obesity. Working with a team of medical professionals with dietitians, nutritionists, health coaches can provide personalised guidance, motivation, and accountability. Joining support groups or online communities can offer inspiration and connection with others on similar journeys. Remember these medications are a tool and not a quick fix. Behaviour change is the key to unlocking their full potential for sustainable weight management and improved overall health.

Overall, the high demand for these medication presents a complex picture with both benefits and challenges. While it’s encouraging to see these medications improving health outcomes for many, at a societal level ensuring equitable access, managing costs, and addressing broader issues such as food insecurity, systemic inequalities, and lack of access to healthy environments remain crucial considerations to fully harness the potential of newer therapies to tackle the global obesity epidemic.

...the SYNERGISTIC approach

Age-related anatomical changes are most effectively managed through the combination of science and technology. To achieve this goal, Neauvia research designed SMART COMBINATION THERAPY that combines different restorative therapies and grants clinically proven superior results.1,2 This has been possible thanks to the in-house portfolio of products FILLERS, ENERGY BASED DEVICES and COSMECEUTICALS - developed to work synergistically with each other and organically with the body.

1: Fillers A REVOLUTION IN HA FILLER MARKET

Neauvia’s PEG-HA dermal fillers are based on a unique SMART CROSSLINKING TECHNOLOGY – SXT – which is an innovative and advanced technology that combines HYALURONIC ACID and PEG.

PEG is a well-known polymer in the pharmaceutical market, due to its versatility and safety profile. 1, 2

Neauvia R&D designed monophasic and cohesive hydrogels with distinctive properties and gel consistencies, offering healthcare practitioners the appropriate tools to provide patients with made to measure results.

2: Devices

THE BEST RESULTS WITH MAXIMUM SAFETY

Neauvia provides a range of energy-based devices for the aesthetic, gynecological and surgical treatments. Neauvia devices are characterized by advanced electromedical engineering, ensuring maximum patient safety.

They are based on specifically designed and integrated technology; they can be combined with Neauvia’s PEG-HA fillers and aesthetic cosmeceuticals. 1, 2

3: Aesthetic Cosmeceuticals

THE PROMISE OF AMPLIFIED AESTHETIC RESULTS

Based on advanced knowledge and research on active ingredients, Neauvia Aesthetic Cosmeceuticals offer professional and exclusive skincare range. High quality and scientifically based, they are suitable for skin preparation, post-treatment and home care, designed to work in synergy with aesthetic treatments.

CLINICAL SECTION

In this section:

Safe practice

Regenerative treatments for the menopause

PEG fillers

Filler complications

Abstracts

SAFE PRACTICE

We chat to Dr Raquel Amado about safety in aesthetics

Consulting Room: Do you agree with current aesthetic safety regulations, and how does an absence of strict regulations affect patient safety?

Dr Raquel Amado: I feel there is a lack of regulation regarding aesthetic treatments, which can impact public safety. The absence of strict regulations can

significantly affect patient safety in various ways.

• Unqualified practitioners: Without strict regulations, there may be a higher likelihood of unqualified individuals performing aesthetic procedures. This lack of professional training and expertise can lead to increased risks for patients, causing

Shutterstock/VALUA

potential complications like permanent blindness.

• Unsafe practices: In the absence of regulatory oversight, practitioners may engage in unsafe practices, such as using unapproved or substandard products, neglecting proper sterilisation and infection control measures, or performing

procedures without adequate patient assessments.

• Inadequate informed consent: Strict regulations often mandate thorough informed consent processes, ensuring that patients are fully aware of potential risks, benefits, and alternatives before undergoing a procedure. The absence of such regulations may result in inadequate or incomplete informed consent procedures.

• Substandard facilities: Regulatory frameworks typically include standards for the facilities where medical procedures are performed. In the absence of strict regulations, there may be a lack of oversight regarding the safety and hygiene standards of aesthetic clinics and facilities.

• Product safety concerns: A lack of regulations may lead to the use of untested or unregulated products in aesthetic procedures, increasing the risk of adverse reactions or complications for patients.

• Misleading marketing and information: The absence of strict regulations may allow for misleading advertising and misinformation about the safety and effectiveness of aesthetic procedures. Patients may be misled about potential outcomes, risks, and the qualifications of practitioners.

• Delayed detection of complications: Strict regulations often include requirements for monitoring and reporting adverse events. In the absence of such regulations, the detection and reporting of complications or adverse reactions may be delayed, compromising patient safety.

• Lack of accountability: Regulatory frameworks provide a system of accountability, allowing for the investigation and sanctioning of practitioners or facilities that fail to meet established standards. The absence of strict regulations may result in a lack of accountability for substandard practices.

• Ethical concerns: Regulatory frameworks often address ethical considerations in healthcare. Without clear guidelines, practitioners may engage in unethical practices that compromise patient well-being.

In summary, strict regulations play a crucial role in ensuring patient safety by setting standards for qualifications, practices, facilities, and the use of medical products. They provide a framework for accountability and contribute to maintaining ethical standards within the healthcare industry, including the field of aesthetic procedures. The absence of such regulations can lead to increased risks and potential harm to patients.

CR: Do you think, within the aesthetics industry, that there is enough screening for people with self-image conditions such as body dysmorphia?

RA: Unfortunately, not, especially when we talk about non-medics performing these treatments.

CR: Do you think stricter regulations could positively improve self-image?

RA: Stricter regulations can have a positive impact on self-image in several ways.

• Personal accountability: Stricter regulations encourage practitioners to adhere to ethical and legal standards. Knowing that there are consequences for unethical or harmful behaviour can lead to a greater sense of personal accountability. This can contribute to a positive self-image as individuals align their actions with societal expectations.

• Sense of purpose: Regulations are often implemented to address issues that impact public welfare, safety, and the environment. Adhering to these regulations can provide individuals with a sense of purpose as they contribute to the well-being of society. This sense of purpose can positively

influence self-esteem and self-worth.

• Community trust: Stricter regulations promote transparency and fairness. When individuals and organisations comply with these regulations, it builds trust within communities. Being perceived as a trustworthy and responsible member of society can enhance an individual’s self-image and contribute to a positive reputation.

CR: From your experience, what are the biggest concerns in terms of lack of regulation, and what measures do you believe should be put in place?

RA: My foremost priority revolves around ensuring patient safety across all domains. This encompasses not only the safety of the treatment itself but also recognises that refraining from or denying treatment, in certain instances, may prove more advantageous than proceeding with interventions. It is crucial to acknowledge that non-medical professionals lack the authority to prescribe, and consequently, they may lack the necessary knowledge and experience to address potential complications. This leaves patients unattended, vulnerable to the risk of enduring long-term or even permanent deformities.

I advocate for a strategic approach that involves categorising and restricting the administration of injectables to practitioners possessing a robust educational foundation, ideally at a Level 7 qualification. I firmly believe that acquiring this advanced level of education equips practitioners with the requisite skills to administer treatments safely and adeptly, thereby minimising the potential for adverse outcomes and ensuring the overall well-being of the patients in their care.

CR: How would you like to see the future of safety in aesthetics?

RA: I would like to see stricter regulation, which would include:

• Injectables to medics only – the Level 7 in Injectables qualification –marking out medical injectors from lay practitioners.

• Regulation in the premises

Heavy fines for prescription drugs administered by non-medics.

REGENERATIVE TREATMENTS FOR THE MENOPAUSE

There are few certainties in life but one is that all women will at some point go through the menopause. The only variable is when this happens and the degree to which it affects us. It is only recently that there has been an open discussion on menopause and its treatment, with regular articles and TV shows discussing symptoms and treatment. In 2022, the number of prescriptions for HRT had doubled, from five years previously, mainly due to increased awareness and the willingness to now talk about it. With increased awareness has come an increase in research into treatments for menopause and the symptoms associated with it.

One symptom that has become the focus of research is the Genito Urinary Syndrome of Menopause (GSM). This is also called post-menopausal vaginal atrophy. The number of articles being published in the medical press has increased significantly, and the awareness generally has increased consultations and referrals to health care practitioners.

GSM is a very technical definition for serious and debilitating symptoms that can affect more than 50%-70% of women who have gone through menopause. To some extent. Everyone accepts a degree of change as they age, but historically, GSM has been undiagnosed and rarely treated.

Signs and symptoms of GSM

Genital

Vaginal dryness

• Irritation/burning/itching

• Leukorrhea

• Thinning/graying pubic hair

• Vaginal/pelvic pain and pressure

• Vaginal vault prolapse

Sexual

• Dyspareunia

• Reduced lubrication

• Post-coital bleeding

• Decreased arousal, orgasm, desire

• Loss of libido, arousal

• Dysorgasmia

Urinary

Dysuria

Urgency

Stress/urgency incontinence

Recurrent urinary tract infections

• Urethral prolapse

• Ischemia of vesical trigone

Women suffer to different degrees and not all will have the full symptoms. Vaginal dryness is the main symptom, with over 90% of women who have gone through menopause suffering from this symptom. The obvious treatment for this is to put oestrogen back into the body and or directly into the vaginal lining of the mucosa. This can be done via HRT, but up until recently, the mainstay of treatment for GSM has been locally applied oestrogen.

This appears to be effective, but not all patients can have oestrogen and also there are some side effects associated with local oestrogen such as uterine bleeding, breast pain, perineal pain, and endometrial overstimulation.

The cause of these symptoms is a decrease and then a lack of oestrogen. This causes the vaginal lining to ‘atrophy’, which can be seen clearly in biopsies as an irregular collagen and fibrin pattern.

In the UK, local oestrogen treatments can be bought directly over the counter from pharmacists, but as well as increase in awareness of the condition and symptoms associated with GSM, there is also now an increased awareness of the available treatments. The majority of these new treatments have become available through the private sector as the NHS still does not allow a lot of the treatments to be available through FP10 prescription or recommendations.

There are four types of treatment to address the loss of connective tissue of the vaginal lining due to ageing: preventive, restitutive, curative and palliative.

Restitutive treatments are procedures aimed to restore normal function and metabolism to connective tissue. The most important restitutive treatment is bio-stimulation, which consists of a series of procedures that biologically activate fibroblast anabolic functions, and particularly enhance the production of type III collagen, elastin and hyaluronic acid from their precursors.

Bio-stimulation is not the same as biorestructuration, which is the variation of the components of the affected derma to achieve aesthetic improvement, albeit while damaging the physiology of the connective tissue. Many stimuli can promote bio-stimulation and, as a consequence, elastin fibres, collagen formation, and re-organisation of ground matrix, including thermal, biochemical, magnetic, ultra-sonic, and pulsed electrical fields. Of these, the most studied has been the thermal effect of a carbon dioxide laser applied intravaginally, which produces improvements in vaginal health following collagen and ground matrix remodelling

due to the induction of heat shock proteins. The most important pathway for events leading to vaginal epithelial proliferation is the induction of growth factors.

Most of the new treatments for GSM symptoms occur outside the NHS. This is mainly due to the variability of the available data. For example, CO2 laser treatment, in various reviews, showed a similar symptomatic relief as local oestrogen, but without some of the side effects that are seen with oestrogen treatment. Recent data, though, suggests that there is no long-term benefit from the use of lasers as the long-term outcome is no different than no treatment. This is mainly due to a lack of follow up for the treatments and cost associated with the treatments.

For some patients, treatment of vaginal dryness is sufficient for symptomatic relief. There are many vaginal moisturisers available, and it is in fact one of the biggest categories on Amazon. This is sufficient for those lucky patients who do not need further treatment. The reality is that the symptoms will progress and get worse as patients age. At some point, for the majority of women, there will be the need for further intervention and yet the choices of treatment are limited by availability (ie not available on prescription), cost or, most commonly, a lack of awareness of available treatments for these debilitating symptoms.

There are now many treatments available in the private sector for the treatment of GSM and its symptoms, but awareness continues to be low and cost continues to be high. Truly effective treatments require a large capital investment by the clinic or healthcare practitioner which is reflected In high prices to the patient. The conundrum therefore for patients and healthcare professionals wishing to provide the best treatments to the majority of people is, firstly increasing awareness of the availability of treatments and secondly, having proven treatments that can be affordable and thus bring new patients into the clinic.

Recent studies have shown that there is a potential solution to this dilemma with the evolution of proven regenerative treatments for GSM and its symptoms. A study was published recently that demonstrated that the use of single growth factors have an effect on the vaginal mucosa. This study and others have shown that it is possible to treat

the vaginal mucosa and thus improve symptoms by understanding the signalling process of the body and, in particular, of the regenerative process necessary to improve the atrophy of the vaginal lining when the patient has gone through menopause.

The use of growth factors, for the treatment of aesthetic conditions, has been evolving over the last 10 years. The full potential has never really been realised due to variability of results. The main issue is that the growth factors extracted from a human source and manufactured using human materials, has varying concentrations of grow factors and different types of growth factors for every extraction. In addition the expense and cost of this extraction and manufacturing has limited the use of growth factors.

Many of these issues have now been overcome by the use of technology that, when first developed won a Nobel prize in chemistry. The use of human recombinant growth factors, that are extracted and bioengineered to produce the growth factors that the body recognises and can be used

a signalling molecule, allows a focussed and targeted approach to the improvement of the relevant condition.

Growth factors are signalling molecules that stimulate cells to produce other cells. In wound healing, this is proteins such as collagen and fibrin that start the wound healing process. The specific growth factors that are involved in this process can be bio-engineered and put into treatments for various conditions. The specific growth factors that are used in the regeneration of the vaginal mucosa have been developed and studied to evaluate the potential improvement in GSM symptoms.

The growth factor based gel (SkinGenuity VR), was evaluated initially to measure the effectiveness in the symptomatic relief using quantitative and qualitative analysis.

The first step was to trail the product in patients to see if the growth factor based gel could provide symptomatic relief for the patients suffering with GSM. The initial study has shown real promise for the gel with a significant improvement in the symptomatic relief using standard indices, that is comparable with laser therapy.

In addition biopsies were taken throughout the process to see if there was a significant improvement in the histology of the vaginal mucosa. The data clearly showed that there was a normalisation of the collagen.

Visual Analogue Scale (VAS) Treatment Satisfaction –Patient’s subjective reduction in GSM symptoms from 7.1 to 2.3 by week 12.

Vaginal Health Index (VHI) scores – Patients VHI score had a significant increase from baseline at week 12.

Vulvar Symptoms Questionnaire (VSQ) – Patient’s VSQ score significantly decreased from 7.0 to 1.8 in the 12-week study demonstrating excellent efficacy.

Images provided by the author

The indices used are standard for evaluating the symptomatic improvement following treatment and are well established comparative methodology.

The overall conclusion of the study is that the “results with the application of topical growth factors suggest that this treatment is safe and tolerable and can offer patients an important means to counteract vaginal atrophy in GSM.”

Further use of the product worldwide has backed up this conclusion, with SkinGenuity VR, now one of the mainstays of treatment for symptomatic relief for debilitating postmenopausal vaginal atrophy.

Further studies are, of course, being completed into the use of Growth Factors and GSM. Better treatments can be developed as we understand the cause and pathogenesis of GSM. The most frequent symptoms are related to vaginal dryness and dyspareunia; traditional treatments such as vaginal moisturisers fail to address improvement and relief of symptoms, indeed can become bothersome due to hyperosmotic properties of most of these types of compounds available in the market . Genital and urological complications such as urinary infections and vaginitis are related to ph alkalinisation that leads to the replacement of normal vaginal microbiota by pathogenic anaerobic bacteria. The ovulatory cycle influences vaginal microbiota, according to the action of estrogen and progesterone on the vaginal

To

epithelium, due to an increase in thickness and glycogen production.

Lactobacillus population alteration is common in 50% of post-menopausal women with higher serum levels of folliclestimulating hormone and lower estrogen levels .

Available treatments are targeted to improve dryness and dyspareunia, but few reports on the management of vaginal microbiota dysbiosis are available in the scientific literature, mainly because there is a poor understanding of the pathophysiological scenario of a healthy vaginal environment.

Normalisation of the Ph and the vaginal microbiota could leave to a long term solution to the treatment of GSM without the requirement for hormonal or other physical interventions.

Overall, the awareness of menopause and hence the GSM symptoms has improved significantly over the last 10 years. People are willing to talk discuss symptoms such as painful sex, leakage and vaginal dryness. With this increased awareness has come an increased expectation that the symptoms that the majority of women suffer from, can now be treated. Unfortunately it is

only in the private sector that treatment options and availability has increased. With an increase evidence base and more affordable, less invasive treatments there is the potential to now treat more patients who would otherwise suffer in silence. One such product is SkinGenuity VR and with an increase in evidence and awareness it offers a significant addition to the treatment protocols for symptomatic relief of GSM.

Histological analysis of the vaginal mucosa by modified Masson’s trichrome staining. (Left) Pre: Dense and disorganised collagen and atrophy (4x). (Right) Post: Epithelium with several layers of cells of stromal maturation with an increase in collagen (4x).

Resources

• Editorial, Menopause; A turning point for women’s health; Lancet VOLUME 10, ISSUE 6, P373, JUNE 2022

• Moral E, Delgado JL, Carmona F, et al ;Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Climacteric. 2018;21:167–173

Alexander Muacevic and John R Adler ; The Genitourinary Syndrome of Menopause: An Overview of the Recent Data; Cureus. 2020 Apr; 12(4): e7586; Published online 2020 Apr 8. doi: 10.7759/cureus.7586

J Suckling 1, A Lethaby, R Kennedy; Local oestrogen for vaginal atrophy in postmenopausal women; Cochrane Database Syst Rev 2006 Oct 18

Prignano F, Campolmi P, Bonan P, et al. Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair. Dermatol Ther 2009;22(Suppl 1):S8–15.

• Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO2 laser on atrophic vaginal tissue: an ex vivo study. Menopause 2015;22:845-9.

• Yeu-Chai Jang, MD, 1 Chi Yan Leung; Comparison of Severity of Genitourinary Syndrome of Menopause Symptoms After Carbon Dioxide Laser vs Vaginal Estrogen TherapyA Systematic Review and Meta-analysis; JAMA Netw Open. 2022 Sep; 5(9): e2232563.

• Chen R, Wang JY, Lv K. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Vaginal Symptom Severity in Postmenopausal Women. JAMA. 2022;327(3):283. doi:10.1001/jama.2021.22305

• Simona Ceccarelli 1, Sirio D’Amici,;Topical KGF treatment as a therapeutic strategy for vaginal atrophy in a model of ovariectomized mice; J Cell Mol Med. 2014 Sep;18(9):1895-907.

• Raghvendra Vikram Tey, 1 Pallavi Haldankar; Variability in Platelet-Rich Plasma Preparations Used in Regenerative Medicine: A Comparative Analysis; Stem Cells Int. 2022; 2022: 3852898.

Stephan Barrientos 1, Olivera Stojadinovic; Growth factors and cytokines in wound healing; Wound Repair Regen;2008 SepOct;16(5):585-601.

Pablo González Isaza; Use of Growth Factors for Vulvo/Vaginal Bio-Stimulation;Technol Int 2019 May 15:34:269-273.

• Erekson EA. The Vulvovaginal Symptoms Questionnaire: a questionnaire for measuring vulvovaginal symptoms in postmenopausal women. Menopause. 2013 Sep;20(9):973-9.

• Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause.2013;20(9):888–904.

• Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704–11

• Shen L, Zhang W, Yuan Y, Zhu W, Shang A. Vaginal microecological characteristics of women in different physiological and pathological period. Front Cell Infect Microbiol. 2022 Jul 22;12:959793.

Lorna Bowes is an experienced business owner, aesthetic nurse and trainer, having worked in aesthetics since the early 1990s. With extensive experience of delivering aesthetic procedures as well as an in-depth understanding of the global aesthetic medical market, she trains and lectures regularly on procedures and business management in aesthetics. Lorna specialises in cosmetic and medical skincare, treatments and peels. Lorna was a founding member of the British Association of Cosmetic Nurses and a Consulting Editor to the Journal of Aesthetic Medicine and she is the CEO of leading professional skincare distribution company, AestheticSource.

AestheticSource (www.aestheticsource.com) is the UK distributor of the awardwinning NeoStrata and Exuviance comprehensive ranges of clinically proven, dermatologist-developed skincare, peels and professional regimens featuring Hydroxy Acid technology, NeoGlucosamine and Apple Stem Cell Extract alongside other proven and powerful skincare ingredients to meet the needs of all skin types. AestheticSource have the expertise to provide you with world-renowned skin care products delivered in a timely manner, supported by bespoke marketing materials, a strong PR campaign, in-depth theory and practical training, post-training support, and friendly, helpful, knowledgeable staff to assist you.

Lorna loves leading the team, watching the ‘family’ develop, stretching their skills and working closely with the company’s customers and suppliers with a focus on trust, authenticity and passion, to support business growth for partner clinics in aesthetics and beauty.

NEAUVIA PEG FILLERS

A pioneering leap in hyaluronic acid filler innovation

In the ever-evolving landscape of medical aesthetics, Neauvia emerges as a revolutionary force with its PEG-HA Fillers, setting a new standard in the hyaluronic acid (HA) filler market. The hallmark of Neauvia fillers lies in their groundbreaking Smart Crosslinking Technology (SXT), a patented innovation seamlessly blending hyaluronic acid and polyethylene glycol (PEG) into a cohesive network. This convergence of science and artistry creates a unique synergy that distinguishes Neauvia from the rest.

Distinguished by its polyethylene glycol diacrylate (PEGDE) crosslinking, Neauvia’s technology boasts diverse molecular weights and chain lengths.1 This results in high conformational flexibility and shape modification without structural damage, setting the stage for a remarkable transformation in the world of aesthetic procedures.

Why PEG?

Neauvia’s strategic choice of PEG sets it apart, offering distinctive properties that elevate the efficacy of its gels to unprecedented levels. The gels exhibit high viscoelasticity and cohesivity, mirroring the mechanical properties of natural skin tissues. The immediate results achieved through Neauvia’s PEG-HA Fillers, combined with thermo-dynamic and thermo-stability properties, allow for the implementation of versatile and effective combined protocols.

Ensuring a High-Safety Profile, Neauvia’s fillers stand out with no pathologic inflammatory reactions* and no residual remains.1 The reversible filling aspect adds an extra layer of confidence, embodying Neauvia’s commitment to safety and patient satisfaction.

“Neauvia’s fillers are currently the only injectable products based on Hyaluronic Acid crosslinked with PEG that have been tested in vivo and in vitro, demonstrating favourable clinical results. Thanks to PEG, which gives Neauvia’s hydrogels unique rheological properties, you can have combined protocols through a synergistic approach.”

Prof. Nicola Zerbinati, dermatologist and Neauvia Scientific Director, Italy

References

*None detected so far with the use of Neauvia PEG-HA Fillers.

1. Clinical data on file

Neauvia’s Research and Development team has meticulously crafted monophasic and cohesive hydrogels, showcasing distinctive properties and gel consistencies. The patented Smart Crosslinking Technology (SXT) integrates different molecular weights and chain lengths, influencing the product’s behavior under mechanical stress during injection and throughout its life in the tissues.

From formulation to results, Neauvia’s commitment to excellence is evident. Each filler in Neauvia’s line is enriched with proteinogenic amino acids, Glycine and L-Proline, integral to the biosynthesis of proteins.2 These amino acids contribute to fine-tuning the rheological properties and swelling resistance, ensuring better control of the hydrogel’s swelling capacity in the post-implant phase.3

For those seeking a paradigm shift in medical aesthetics, Neauvia beckons you to explore its innovation at Neauviachannel.com. Join us in rethinking medical aesthetics and discover the transformative potential of Neauvia PEG-HA Fillers, where science meets art to redefine beauty.

2. Zerbinati, N.; Sommatis, S.; Maccario, C.; Capillo, M.C.; Grimaldi, G.; Alonci, G.; Protasoni, M. Rauso, R.; Mocchi, R. Toward Physicochemical and Rheological Characterization of Different HA Dermal Fillers Cross-Linked with Polyethylene Glycol Diglycidyl Ether. Polymers 2021, 13, 948

3. Marino F, Cosentino M, Legnaro M,et al. Immune profile of hyaluronic acid hydrogel polyethylene glycol crosslinked: An in vitro evaluation in human polymorphonuclear leukocytes.

4. Zerbinati, N.; Capillo, M.C.; Sommatis, S.; Maccario, C.; Alonci, G.; Rauso, R.; Galadari, H.; Guida, S.; Mocchi, R. Rheological Investigation as Tool to Assess Physicochemical Stability of a Hyaluronic Acid Dermal Filler Cross-Linked with Polyethylene Glycol Diglycidyl Ether and Containing Calcium Hydroxyapatite, Glycine and L-Proline. Gels 2022, 8, 264.

5: Zerbinati N, Lotti T, Monticelli D, Martina V, Cipolla G, D’Este E, Calligaro A, Mocchi R, Maccario C, Sommatis S, Lotti J, Wollina U, Tchernev G, França K. In Vitro Evaluation of the Sensitivity of a Hyaluronic Acid PEG Cross - Linked to Bovine Testes Hyaluronidase. Open Access Maced J Med Sci.

INFLAMMATORY NODULES

Dr

Patrick Treacy asks, what is causing dermal filler inflammat ory nodules?

Hyaluronic acid (HA)--based dermal fillers are injectable viscoelastic gels frequently used globally in aesthetic medicine to enhance youthfulness, replenish diminished volume, or improve areas of structural insufficiency.

The foremost objective of employing HA-based fillers is to secure an aesthetic improvement or rectify signs of soft tissue ageing, ensuring both the results’ longevity and the procedure’s safety.

While these fillers have been traditionally seen as immune system-neutral, the formulations of many products on the market have undergone significant alterations, especially in production.

Hyaluronic acid (HA), a polysaccharide prevalent in the skin’s extracellular matrix, possesses a notable capacity to bind and retain water molecules. This property is crucial for maintaining skin hydration and imparting volume.

Structurally, HA comprises repeated

disaccharide units of D-gluconic acid and D-N-acetylglucosamine, interconnected by β-1,4 glycosidic bonds. Beyond enzymatic degradation by hyaluronidase, HA is subject to breakdown by various factors, including mechanical stress, reactive oxygen species, fluctuations in temperature and pH, and ultrasonic waves. 1

Numerous hyaluronic acid (HA) fillers are available, each with unique properties like elastic modulus (G’), viscous modulus (G”), cohesivity, particle size, and HA concentration. These characteristics influence the suitability of a filler for specific procedures or skin types, its behaviour under mechanical stress once injected, and its dissolution response to hyaluronidase.

Extensive research has been conducted on the rheological properties of these fillers to guide clinicians in selecting the most appropriate filler. The elastic modulus (G’) is a crucial parameter for evaluating HA fillers because it encapsulates several critical aspects, such as HA concentration and crosslinking degree. Higher crosslinking and HA concentration generally result

in a higher G’ value. Fillers with a lower G’ are typically softer, while those with a higher G’ are firmer. However, G’ is not an infallible measure; for instance, variations in G’ values for the same filler have been observed to range widely, with differences up to 7.4 times due to

different methods of experimentation. 2

When injected, the immune system recognises all fillers as foreign entities. This typically triggers an inflammatory response around the implant, which is a standard reaction by the host body, leading eventually to the breakdown and absorption of biodegradable fillers. The extent of the body’s response can vary, ranging from minimal macrophage infiltration to an intense foreign-body granulomatous reaction accompanied by fibrosis. Different fillers elicit different reactions; for example, calcium hydroxylapatite tends to provoke a macrophage-dominant response, whereas hyaluronic acid (HA) is more likely to cause a lymphocytic infiltrate. The severity of this immune reaction depends on how immunetolerant the injected material is, which is influenced by various factors. These include the composition and volume of the substance injected, the shape and size of the particles, their ability to biodegrade, and, in the case of HA fillers, aspects such as HA concentration, the level of crosslinking, and the specific techniques used for HA structuring and crosslinking. 3

Modifying HA dermal fillers

Given its relatively brief half-life of less than one to four days in the skin, HA in dermal fillers is often chemically modified to enhance its stability and prolong cosmetic effects. Dermal fillers are histologically classified as either “volumisers,” which elicit a minimal cellular response, or “stimulators,” which induce a strong cellular reaction.

Hyaluronic acid (HA) fillers vary in properties such as crosslinking, gel particle size, and concentration. Extensive crosslinking is believed to enhance longevity due to increased resistance to degradation by native hyaluronidase. Similarly, larger gel particle sizes, due to their reduced total surface area, are more resistant to enzymatic degradation. However, larger particle sizes and increased concentration enhance the hydrophilic nature of the product, resulting in more tissue swelling post-procedure. Higher concentration, larger particle size, and greater crosslinking extend the product’s longevity and theoretically heighten the risk of adverse reactions.

Experience with higher molecular weight HA fillers (like SubQ, Voluma, and Macrolane) suggests they may be problematic regarding capsulation and delayed onset nodules. The most common modification technique involves crosslinking HA chains using 1,4-butanediol diglycidyl ether (BDDE), which forms ether bonds with HA’s hydroxyl groups. This crosslinking process preserves the β-1,4 glycosidic bonds’ accessibility for cleavage by hyaluronidase. These changes aim to enhance durability and tailor the fillers for particular uses.

Do these modifications cause problems?

Historically, HA fillers have been considered to be immunologically inactive due to their universal presence in living organisms and their nonspecificity to tissues. However, the crosslinking technologies employed by manufacturers to enhance the durability and adjust the characteristics of each HA filler differ significantly.

It is unclear how much the HA molecule can be altered before it becomes unrecognisable as native HA. However, it is plausible that extensive modifications might heighten the likelihood of an inflammatory response. 4 Additionally, the inherent properties of the filler or its breakdown products

could potentially trigger inflammation. However, these modifications, possibly in conjunction with other variables like the patient’s immune condition, events that activate the immune system, and bacterial contamination, can sometimes result in nodules appearing late after the treatment in a subset of patients. 5 Some of these lumps that appear several months after injecting hyaluronic acid dermal fillers are typically considered to be inflammatory rather than infective. These delayed inflammatory nodules usually present as firm to hard lumps at or near the filler injection sites. Inflammatory nodules resulting from hyaluronic acid dermal fillers often present with symptoms like pain, tenderness, or redness. The timing of their appearance, often weeks to over a year post-injection, with the most common onset around four months, is a critical factor in differentiating them from infective processes, which usually manifest more acutely. They are generally named “delayed onset nodules” (DON), a term which encompasses various conditions such as lumps, masses, nodules, areas of hardening, delayed hypersensitivity reactions, biofilms, sterile abscesses, and granulomas. There is often a significant overlap among these conditions, which is mirrored in their

treatment approaches. To move away from relying on histological categories that are generally not very informative for clinical practice, the UK-based Aesthetic Complications Expert Group prefers to use the term DON. It’s important to note that a granuloma is, in fact, a specific diagnosis based on tissue examination under a microscope, and therefore, only a lump or nodule should be identified as a granuloma with histological proof. 6 Personally, I feel all currently available fillers in the market are capable of inducing adverse inflammatory reactions, which can manifest both early and late after administration. This phenomenon became particularly poignant during the Covid pandemic when the vaccination program.

What is the prevalence of the problem?

The exact prevalence of these reactions remains unclear but is presumed to be considerable. Predominantly, the late-onset adverse effects are of an inflammatory and immunemediated nature. Common clinical manifestations include oedema, granulomas, sarcoid-like conditions, and panniculitis. Although less frequent, systemic granulomatous and autoimmune diseases, as well as acute hypersensitivity reactions, have been observed. Implanted, injected, and blood-contact biomaterials universally elicit a spectrum of adverse responses, emerging either early or late and varying from localised to systemic implications. The majority of fillers function primarily as adjuvants rather than direct T-cell activators within a context of genetic susceptibility. In terms of the immunological aspects of HA fillers, recent in vitro research by Hee and Messina (2022) provides insights. This study focused on the adaptive immune system, specifically investigating whether T-cell activation (a necessity for initiating an immunological reaction) was triggered by short, uncrossed HA fragments and uncrosslinked oligosaccharides (medium-size HA), as well as formulated Hylacross and VyCross HA (Juvéderm) dermal filler. The background to this study involves understanding that a local immune and inflammatory response occurs following antigen exposure, attracting leukocytes that engulf the antigen. The digested antigen is then presented to T cells,

which become sensitised and activated, subsequently releasing cytokines and chemokines that can cause tissue damage.

What is causing the problem?

From current literature, it is recognised that there is a prevalent belief that small HA fragments can induce inflammation within the body’s native tissues. These small molecules, including degraded native HA, are known to be involved in activating and advancing the immune response. The enzymatic breakdown of native HA is regulated by growth factors, cytokines (such as TGF, PDGF, EGF), and other proteins like kinases, which are specific to different cells and tissues. These growth factors influence the expression of HAS enzymes at the transcriptional level. HAS enzymes play a crucial role in both physiological and pathological processes in the body. 4 Furthermore, it’s known that native HA undergoes degradation via several pathways, primarily through enzymatic or specific means - predominantly via hyaluronan acid synthetase (HAS) enzymes. In humans, three HAS enzymes are better understood as key in this process, each existing in various isoforms. 5 In a soon-to-be-published laboratorybased study, a novel protocol involving multiple doses of hyaluronidase was utilised to degrade hyaluronic acid (HA)-based fillers. 6 This method facilitated the real-time observation of the viscoelastic properties of the fillers under nearly static conditions. Each filler underwent degradation via 20 sequential applications of hyaluronidase, administered at fiveminute intervals until the gel’s rigidity (G’) was reduced to 30 Pa or below. There were notable variations in the ease of degradation among different classes of fillers, influenced by their design and manufacturing technologies. Vycross fillers exhibited the highest resistance to degradation, while the Cohesive Polydensified Matrix filler was more easily degraded. 7-9

No clear link was found between the gel degradation characteristics and individual factors like HA concentration, HA chain length, or the extent of modification in each filler when these elements were considered in isolation. However, a broader correlation was observed with specific physicochemical properties. The manufacturing

technology emerged as a critical determinant of a filler’s reversibility. Understanding these differential degradation profiles of available commercial fillers enables clinicians to choose products with a higher safety margin, thanks to their enhanced reversibility.

Could Pro-inflammatory cytokines (PICs) give us the answer?

Pro-inflammatory cytokines play a pivotal role in the body’s immune response and can be deeply involved in the process of inflammation, including the formation of inflammatory nodules following hyaluronic acid (HA) filler injections. These cytokines, such as interleukins (IL-1, IL-6), tumour necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ), are signalling proteins released by cells, particularly immune cells, in response to various stimuli, including infection, trauma, or inflammation. In the context of HA filler injections, these cytokines could potentially contribute to the development of inflammatory nodules through several mechanisms:

• Triggering inflammation: Pro-inflammatory cytokines can initiate and amplify inflammatory processes. They recruit immune cells to the site of the HA filler, which can lead to the formation of nodules.

• Collagen degradation: Collagen, a primary structural protein in the skin, can be degraded by enzymes like matrix metalloproteinases (MMPs), which are regulated by pro-inflammatory cytokines. This degradation can affect the structural integrity of the skin and contribute to nodule formation.

• Immune system activation: Pro-inflammatory cytokines can activate various components of the immune system. This activation can lead to an exaggerated immune response to the HA filler, contributing to nodule formation.

• Foreign body reaction: The body may recognise the HA filler as a foreign material, leading to an inflammatory reaction mediated by cytokines.

As for their role as biological markers, pro-inflammatory cytokines could potentially be used to understand and

predict the occurrence of inflammatory nodules. 10-11 Elevated levels of these cytokines in the vicinity of HA filler injections might indicate an ongoing inflammatory process, suggesting a higher risk of nodule formation. However, the use of cytokines as reliable biomarkers for predicting HA filler-associated nodules requires further research, as many factors, including individual variability and the specific properties of the HA filler used, can influence the body’s response.

How to Treat Hyaluronic Acid Dermal Filler Inflammatory Nodules

The treatment of these complications is not yet established through rigorously designed research. The management of both acute and systemic reactions often presents challenges, necessitating the use of anti-inflammatory and, in some cases, immunosuppressive treatments. I usually advise treating these with antibiotics and steroids in combination. My protocol is as follows. I am aware that some physicians may disagree with my more liberal use of steroids, but I have the advantage of having dealt with hundreds of patients with good results.

1. Initial treatment should be with an antibiotic, either a macrolide (e.g., clarithromycin 500mg twice daily or doxycycline 100mg twice daily) as well as oral steroids (Dexamethasone 4mg daily x 5/7 considered)

2. If there has been no significant improvement after one week and the DON results from injection with hyaluronic acid dermal filler, then hyaluronidase mixed with diluted concentration of an intralesional steroid injection should be used

3. I recommend graduated injections of either DepoMedrone 0.1ml starting with 20mg/mL or Triamcinolone acetonide 0.1mL starting with a 10mg/mL concentration and then increasing concentration to 20mg/mL and 40mg/mL at four weekly intervals

4. When administering intralesional steroids, there is a small risk of post-treatment soft tissue atrophy, and the patient should be made aware of this effect

5. If there has still not been any significant improvement, consider punch biopsy, anaerobic and aerobic cultures, and the use of

Images provided by the author

1. 5FU or Methotrexate at 10mgs weekly for three months

2. Consider surgical excision as a last option

Using Methotrexate in dermal filler inflammatory nodules

During the Covid-19 pandemic, there were reports of individuals with cosmetic fillers experiencing adverse effects following their vaccination. It was believed that these side effects might be attributed to Type IV hypersensitivity,

References

leading to the formation of foreign body granulomas. Initially, treatments such as antihistamines, 5-fluorouracil, hyaluronidase, and intralesional steroids were used. Despite these efforts, a group of patients did not respond to these standard treatments.

The author assessed the effectiveness of the immunosuppressant drug methotrexate in treating delayed onset nodules associated with the Covid vaccine. This was specifically in 23 patients who had moderate facial disfigurement and were not responding

to the usual treatment methods. All these patients showed a positive response to a three-month course of methotrexate, at a dosage of 10mg, resulting in the resolution of their nodules. 13

Conclusion

The correlation between delayed-onset nodules and the use of any hyaluronic acid (HA) filler product represents a significant safety concern. However, the absence of comprehensive epidemiological data complicates the assessment of risk factors and the development of strategies for their mitigation. Addressing and effectively managing delayed-onset nodules post-HA filler injection is hampered by an incomplete understanding of their underlying causes. The production process may influence the degradation, but because the underlying cause is multifaceted, it adds complexity to identifying the specific mechanisms that lead to inflammation. The intricacy of any biological process typically makes initial investigation reliant on in vitro systems to attempt to decipher the process of an in vivo problem and its stages. I suggest we should be trying to identify these through measuring pre-inflammatory cytokines (PICs) when faced with such a patient presentation.

1. Plast Reconstr Surg Glob Open. (2022). Jun; Treatment of Delayed-onset Inflammatory Reactions to Hyaluronic Acid Filler: An Algorithmic Approach David K. Funt, MD, FACS

2. Rheologic and Physicochemical Properties Used to Differentiate Injectable Hyaluronic Acid Filler Products Fagien, Steven M.D.; Bertucci, Plastic and Reconstructive Surgery 143(4)

3. Alijotas-Reig J, Fernández-Figueras MT, Puig L. Late-onset inflammatory adverse reactions related to soft tissue filler injections. Clin Rev Allergy Immunol. 2013;45:97–108.

4. Lee JM, Kim YJ. Foreign body granulomas after using dermal fillers: pathophysiology, clinical appearance, histologic features, and treatment. Arch Plast Surg. 2015;42:232–239.

5. Marinho et al. (2021). Hyaluronic Acid: A Key Ingredient in the Therapy of Inflammation. Biomolecules, 11, 1518

6. J Clin Aesthet Dermatol. (2016). Nov; Management of Delayed Onset Nodules Martyn King, MD, Stephen Bassett, MD

7. Fallacara et al., 2018. Hyaluronic Acid in the Third Millennium Polymers, 10(7), 701

8. Cyphert et al. (2015). Size Matters: Molecular Weight Specificity of Hyaluronan Effects in Cell Biology International Journal of Cell Biology Volume 2015,8 pages

9. Comparison of Hyaluronidase-Mediated Degradation Kinetics of Commercially Available 4 Hyaluronic Acid Fillers In Vitro Jimmy Faivre PhD; Kevin Wu, PharmD; Mélanie Gallet, BSc Downloaded from https://academic.oup.com/asj/advance-article/ doi/10.1093/asj/sjae032/7609151 on 25 February 2024

10. Berdiaki et al. Hyaluronan and Reactive Oxygen Species Signaling—Novel Cues from the Matrix. Antioxidants 2023, 12, 824

11. Journal of Immunology and Regenerative Medicine In vitro inflammatory and immune response to uncrosslinked hyaluronic acid (HA) and HA fillers Christopher K. Hee, Darin J. Messina

12. Lemperle G, Gauthier-Hazan N, Wolters M, et al.. Foreign body granulomas after all injectable dermal fillers: part 1. Possible causes. Plast Reconstr Surg. 2009;123:1842–1863.

13. https://issuu.com/im-aesthetics/docs/prime_journal_nov_dec_2022/s/17360163

THE RISE OF REGENERATIVE AESTHETICS

Journal of Aesthetic Nursing. February 2024. Volume 13. Issue 1

Sharon Bennett

BACN Chair Sharon Bennett discusses how the emerging field of regenerative medicine is transforming the aesthetics industry.

In 2024, regenerative medicine and longevity health have emerged as pivotal fields in aesthetics, revolutionising our approach to beauty, wellness, and ageing. Regenerative medicine harnesses the body’s innate healing abilities to rejuvenate tissues, offering not just cosmetic enhancements but also enhancing overall skin health and vitality. This paradigm shift is integrating regenerative medicine principles into aesthetic practices, expanding the scope of treatments beyond mere appearance-focused solutions.

Regenerative medicine is reshaping the aesthetic landscape, offering innovative solutions that extend beyond solely cosmetic enhancements.

Longevity health emphasises a holistic approach to aesthetics, addressing underlying causes of ageing through lifestyle interventions, nutritional support, and personalised wellness plans. The introduction of innovative services such as polynucleotides, stem cell therapy, and improved energy devices signifies a rapid advancement in the field, encompassing various aspects like menopause, hormonal health, scar management, weight management, and cellular health.

Many conferences now focus on regenerative medicine and our April Spring Symposium will include some of these topics, as will the BACN 2024 September annual conference. These services are all part of a 360° approach to health and wellbeing and are essential in differentiating our practice as nurses working in medical aesthetics.

We must remove the beauty salon menu and adopt this more comprehensive approach to aesthetics.

‘Defined as a combination of intrinsic and extrinsic treatments and solutions which positively impacts wellness and age management, this developing sector is gaining ground because the public are able to able to access knowledge about evidenced lifestyle, wellness agemanagement treatments and pathways devoid of the restriction of disease orientated medicine available in the NHS’ (BACN, 2023).

Whilst progress in regenerative aesthetics is ground-breaking, it is not without challenges and ethical considerations. Patient safety and transparent communication about potential outcomes are crucial aspects that practitioners must navigate and striking a balance between innovation, and ethical responsibility is imperative to maintain the integrity of regenerative medicine in aesthetic practices.

EXOSOMES IN THE REAL WORLD OF MEDICAL AESTHETICS: A REVIEW

Aesthetic Plast Surg. 2024 Feb 5. Pinto H, Sánchez-Vizcaíno Mengual E.

BACKGROUND:

Exosomes are cell-derived nanovesicles that transport proteins, nucleic acids, and lipids and play a significant role in almost every physiological process in the human body. They have generated great interest, especially in the field of tissue regeneration. Studies in the last decade support their great regenerating and rejuvenating potential. However, the lack of standardized procedures, limited knowledge regarding their action mechanism, and little clinical evidence impair their implementation and approval in the medical setting. This review aimed to identify published studies and clinical trials using exosomes in human patients for clinical treatments in aesthetic medicine.

MATERIALS AND METHODS:

A systematic search was conducted in the PubMed database using the search term “exosomes” and 25 terms related to aesthetic medicine treatments in human patients. Additionally, a search was conducted in the ClinicalTrials.gov database for interventional clinical trials using exosomes for aesthetic treatments in adults 18 to ≥ 65 years of age.

RESULTS:

Nine articles were selected after debugging the initial list of published articles in which exosomes were related to aesthetic medicine (633 articles). Nine studies were identified from the initial search on ClinicalTrial.gov (104 trials with exosomes).

CONCLUSIONS:

There is no doubt about the scientific basis of exosome regenerative potential and the growing interest in exosomes in aesthetic medicine. However, companies must spend more on research to develop standardised and reliable procedures to obtain exosomes for their approval and application in clinical practice.

TECHNOLOGY & INNOVATION SECTION

In this section: Exosomes

Nanopass Micronjet Nanoneedles

EXOSOMES -

MY PERSONAL VOYAGE OF DISCOVERY

Martyn Roe, co-founder of Aesthetic Medical Partnership, shares his journey with exosomes

Unless you have been hiding under a rock for the last 12 months, one of the hottest and most controversial topics in aesthetics has been the use of exosomes. I have been researching the market since 2019 with the intention of introducing an exosome product as a distributor, and I have spoken with companies from several countries offering differing sources of exosomes.

As well as the source difference, I was offered many ranges of exosome quantity per vial as manufacturers adopted a ‘mine is bigger than theirs’ approach to this relatively new field.

Then, having spoken with the US scientists behind EXO|E, I settled on their Plant Extracellular Nanoparticle technology (PEN). There were a number of advantages of this technology. PENs are the plant version of exosomes, and EXO|E contains a high concentration of these in its product, along

with other important factors that I felt give it the edge. First, let’s look at exosomes: what are they, and how do they work?

What are exosomes?

Exosomes are microscopic vesicles ranging from 30-150 nanometres and are essential communication messengers. Once introduced to the target tissue, these tiny vesicles initiate cell-to-cell communication and deliver bioactive molecules that promote cellular regeneration and rejuvenation.

Exosomes can carry a diverse load of molecules, including microRNAs and mRNAs, interleukins, cytokines and lipids. Exosomes interact with recipient cells by binding to their surface receptors, which enables the internalisation of exosomes into the target cells; the exosome molecular load is then released and begins

to exert its effects. Exosomes are derived from many sources, and practitioners should be aware of the origin of the product they are using. Currently, in the UK and the EU, exosomes derived from human sources are not allowed to be used due to directive 2004/23/EC, which states, “In view of the risk of transmission of communicable diseases, the use of human cells, tissues and products is prohibited.” This means injectable and topical application of exosomes derived from a human source is prohibited. There can be no off-label use by prescribers either, as the products are not licensed for any use. This was a significant reason I opted against human-derived exosome products. As well as legality, other important factors influenced my decision.

Other sources of exosome products available in the UK include animal (mammal), fish and plant, which are all legally available. Mammal and fish-derived

Shutterstock/Galaxy love design

exosomes all still contain trace elements of the DNA of the donor, and several religions and lifestyle choice groups would not welcome their use on themselves.

Mammal, fish, and human-derived exosomes are all supplied as a lyophilised product that needs reconstitution before use. Lyophilising or freeze-drying denatures the proteins of a product. Try powdered milk! The denaturing of the proteins means the manufacturers must add back into the product synthetic growth factors, and the number that they add is typically between five to 20 – significantly reducing their effectiveness when compared with a product that has thousands of active growth factors in their natural state, such as EXO|E.

Mammalian and fish-derived exosomes also need help to get through the epidermal barrier. Despite only having licenses for topical application, they require either injection on needling into the skin or application post ablative procedure in order to attempt to get them where they need to be to have any effect, which to me was again a limiting factor in the marketability of such a product. When I discovered EXO|E, I discovered a product that is applied topically and can pass through the epidermal barrier.

What attracted me to EXO|E?

EXO|E is a consortia of plant stem cell extracts containing PDENS (plant exosomes) and other secretary cell factors derived from vegan sources.1-4 EXO|E is lipophilic, so it is applied topically to the skin and is not injected.

While I was focused on the quantity of exosomes in the product (because more is better, right?), Dr Rob King, from the manufacturer, explained to me that it isn’t just about the exosomes.

Exosomes are communication vesicles; increasing the quantity increases communication, but if you just take exosomes from any source, you don’t know what they are communicating and what they are carrying. Sure, they may improve certain outcomes just by increasing messaging, but with EXO|E in production, they actually induce an inflammatory environment that the plant stem cells are in and then extract the full composition of secretary factors released by the stem cells as they appropriately react to the inflammation. This extraction contains exosomes (there are 25 billion over the

entire 15-day EXO|E course), liposomes, growth factors, interleukins and cytokines – all focussed on reducing inflammation and repairing the damaged cells. So, in effect, these are targeted, programmed nanoparticles to reduce inflammation and promote wound healing. My mind was blown!

So why use exosomes with in-clinic treatments?

The four phases of wound healing are:

1. Haemostasis

2. Inflammation

3. Proliferative

4. Remodelling.5-6

The first phase is haemostasis. Haemostasis is the process of the wound being closed by clotting. It prevents blood loss, starts immediately after injury and lasts only five to 10 minutes. Platelets in the blood gather to stop bleeding by forming a clot. These platelets recruit a host of cells to come to the site of injury by secreting chemical signals. This results in a transition to the second phase, the inflammatory phase, which lasts four to six days and is characterised by the presence of erythema,

warmth, oedema, and pain.7-8 Stem cells, fibroblasts, endothelial cells, macrophages, and other cells are also called up to repair and regenerate the damaged tissues and transition to the 3rd phase of wound healing over the next six to 21 days. In this proliferative phase, new collagen and blood vessels are formed, healing and strengthening the damaged tissues. The fourth and final phase in wound healing is remodelling, also known as the maturation phase. From 21 days up to two years, the collagen fibres are thickened and strengthened.9-12

Skin rejuvenation treatment devices used in clinics aim to induce a targeted, measured, limited and clean injury to the skin to induce new collagen production and remodelling. This intentional skin injury results in inflammation that leaves the skin red, swollen, and tender, resulting in patient discomfort, a potentially lengthy recovery time of one to 12 weeks, and a patient experience that may deter them from completing the recommended number of treatments for optimal results.8

All clinics will have seen patients surprised by the pain during treatment and unable to cope with the downtime the treatment caused.

EXO_E Before and after CO2 laserStock Photo ID: 2094925657

TECHNOLOGY AND INNOVATION

EXO|E helps deliver rapid relief of symptoms that may be caused by any inflammatory process and helps generate noticeable tissue enhancement.

EXO|E works to minimise the Inflammatory 2nd Phase and quickly transition the targeted tissues to optimise the desired Proliferative 3rd Phase. The whole, balanced, and natural combination of exosomes, soluble factors, and other secretory factors derived from plant and yeast cells is a novel approach to wound healing and regenerative medicine. 10, 11

EXO|E’s powerful anti-inflammatory effect is produced through patented biotechnology to minimise inflammation, redness, swelling, pain, and discomfort induced during the 2nd phase and optimise the aim of the 3rd phase in which new collagen, elastin, blood vessels, hyaluronic acid is formed to renew, plump, moisturise and rejuvenate skin tissues.

This enhancement of the proliferative phase results in a clinically visible and tangible improvement of the treated tissues as well as providing a superior patient experience with much less discomfort, shortened recovery time, and much more likelihood of patient

compliance and desire to return and complete the course of treatments that may be required to achieve the desired clinical result.

Advantages of using vegan cell sources to produce the EXO|E product include: The exosomes and other secretory factors produce the desired action of the tissues using a universal cellular language; Being able to reproduce the same product consistently and routinely; Being free of potential pathogens, such as viruses and prions, that may be transmitted by products derived from human or animal sources.

EXO|E also does not have a single application approach, as used by the other products, where they are applied after an invasive treatment. The EXO|E treatment course is delivered over 15 days with 29 applications during this period. This is because secretary signals between cells have a paracrine effect, like how hormones in the blood have an endocrine effect.

These signals bind to cell receptors, and once the receptors are saturated, they have reached their limit to exert further effect. At this point, the paracrine response is either maxed out, or an opposite response to

counteract and reduce this signal is caused. In order to avoid the downregulation of the desired paracrine signals and to maximise the effect on the dynamic intracellular interaction, EXO|E is designed to deliver over 25 Billion nanoparticles over the 15day course of treatment to maintain and direct the desired anti-inflammatory effect and enhance the regenerative proliferative phase.

The EXO|E treatment kits comes in three parts.

Step 1

EXO|E’s pre-treatment product D|TOX is applied topically at home for seven days prior to the treatment by the patient morning and night. D|TOX stimulates cell autophagy, which clears up cellular debris, leaving healthy cells as well as increasing the body’s own production of hyaluronic acid resulting in better hydrated healthy cells, preparing the skin for treatment.

Step 2

EXO|E in clinic application. EXO|E is applied topically prior to any treatment. If using topical anaesthetic, EXO|E is applied 10 minutes prior to the anaesthetic and allowed to absorb. EXO|E in-clinic application contains over 15 billion

EXO_E before and after acne

nanoparticles and enhances the patient’s overall in-clinic experience by minimising redness and inflammation. Each application is shown to reduce inflammation by 61%. By reducing the patient’s background inflammation prior to treatment, the lower inflammation starting point will mean a lower peak of inflammation following the treatment – reducing patient risk and potential negative outcomes. The powerful natural formulation also helps to stimulate hydration, collagen, elastin and hyaluronic acid production.

Step 3

EXO|E’s post-treatment product RE|PAIR is applied topically at home for seven days post procedures morning and night. RE|PAIR helps control and reduce inflammation healing time and increase cell proliferation and hydration. It also helps to stimulate collagen, elastin and hyaluronic acid production for brighter, healthier skin.

The EXO|E regimen also includes a continual care regime where D|TOX serum can be applied at home by the patient daily in the morning to continue the autophagy effect on the cells and continue to stimulate cellular debris clean-up and promoting the production of hyaluronic acid and the RE|PAIR is applied daily at night for the reduction in inflammation and continued collagen and elastin benefits.

The continual care regime contains a lower concentration of PDENs, with five billion being contained in each 30ml bottle.

New in the UK are the DE|RIVE PDEN hair and scalp support products. DE|RIVE comes in a two-part kit:

1. A super concentrated syringe of over 15 billion nanoparticles specially formulated with plant-based biomimetic stem cell extracts for scalp and hair health.

2. A lower concentration home care serum for twice daily application to nourish the scalp and hair follicles, continuing the removal of dead skin cells and stimulating hydration and blood flow to the scalp.

DE|RIVE is applied topically in clinic and can also be micro-needled into the scalp or applied with the AquafirmeXS ULTRA technology to painlessly enhance delivery to the deeper follicles of the scalp and also provide ultrasonic stimulation of hair follicles. DE|RIVE is shown in studies to increase cytokeratin 15 protein levels, which are integral to the fortification of the hair shaft itself. Utilising the ULTRA technology in clinic and the DE|RIVE homecare, results can be seen as quickly as 30 days. A course of four treatments over six months is recommended.

The EXO|E technology, as well as the pipeline of plant-derived nanotechnology, excited me then and having seen it in action in many clinics now in the UK, including on my own face and scalp, is keeping me excited as we are taking aesthetic treatments to a different level of results whilst enhancing the patient experience in clinic and considerably reducing their post-procedure downtime. If you would like to know more about

EXO|E, DE|RIVE or the other regenerative products of AMP, please visit our website, www.amp-uk.co.uk

Resources

1. Liu JJ, Wang HW. Cryo-Electron Microscopy of Endogenous Yeast Exosomes. Methods Mol Biol. 2020;2062(Cdc):401-415. doi:10.1007/978-1-4939-9822-7_19

2. Teng Y, Xu F, Zhang X, et al. Plant-derived exosomal microRNAs inhibit lung inflammation induced by exosomes SARS-CoV-2 Nsp12. Mol Ther. 2021;29(8):2424-2440. doi:10.1016/j.ymthe.2021.05.005

3. Cui Y, Gao J, He Y, Jiang L. Plant extracellular vesicles. Protoplasma. 2020;257(1):3-12. doi:10.1007/s00709-019-01435-6

4. Dad HA, Gu TW, Zhu AQ, Huang LQ, Peng LH. Plant Exosome-like Nanovesicles: Emerging Therapeutics and Drug Delivery Nanoplatforms. Mol Ther. 2021;29(1):13-31. doi:10.1016/j.ymthe.2020.11.030

5. Hoyle NP, Seinkmaine E, Putker M, et al., Circadian actin dynamics drive rhythmic fibroblast mobilization during wound healing. Sci Transl Med. 2017;9(415):eaal2774. doi:10.1126/scitranslmed.aal2774.

6. Rodrigues M, Kosaric N, Bonham CA, Gurtner GC. Wound healing: A cellular perspective. Physiol Rev. 2019;99(1):665-706. doi:10.1152/physrev.00067.2017

7. . Liu T, Zhang L, Joo D, Sun SC. NF-κB signalling in inflammation. Signal Transduct Target Ther. 2017;2(April). doi:10.1038/ sigtrans.2017.234. 7.

8. Dinarello CA. Overview of the IL-1 family in innate inflammation and acquired immunity. Immunol Rev. 2018;281(1):8-27. doi:10.1111/imr.12621

9. McCance KL, Huether SE, Geneser F, et al. Collagen Structure and Stability. PLoS One. 2010;78(3):929-958. doi:10.1146/annurev. biochem.77.032207.120833.COLLAGEN

10. Tahergorabi Z, Khazaei M. A review on angiogenesis and its assays. Iran J Basic Med Sci. 2012;15(6):1110-1126.

11. Dinarello CA, Simon A, Van Der Meer JWM. Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases. Nat Rev Drug Discov. 2012;11(8):633-652. doi:10.1038/nrd3800

12. Pazyar N, Yaghoobi R, Rafiee E, Mehrabian A, Feily A. Skin wound healing and phytomedicine: A review. Skin Pharmacol Physiol. 2014;27(6):303-310. doi:10.1159/000357477

STAY SHARP!

Nanopass Micronjet Nanoneedles - A radical improvement in skin injectable delivery

Needles

Needles have been used to deliver medicines to the skin and deeper for over 150 years. The first hypodermic needle was probably made by Francis Rynd in Dublin in 1844. (1)

Aesthetic Doctors probably have the highest use of needles of all medical practitioners and have developed particular skills in using these devices to optimum effect.

Needles have a sharp tip to penetrate the skin; improvement of the profile of needles, their size both internally and externally and fabrication have advanced the delivery of all types of medication over the years.

Aesthetic practitioners use needles with a central lumen for any procedure that requires a product to be delivered into or beneath the skin. In general needles are used for the administration of local anaesthetic, botulinum toxin, dermal fillers and volumisers together with the ever-expanding number of skin boosters and regenerative products such as vitamins, minerals, amino acids, PRP, polynucleotides, cross-linked and non-cross-linked hyaluronic acid. Occasionally technology advances so that the very tools of our trade are upgraded overnight with dramatic effects.

Cannulae

The flexible metal cannula was introduced around 2005 for the administration of dermal fillers. I would suggest that this small simple device revolutionised the administration of fillers both in terms of safety and results and has permitted Aesthetic Doctors to reach virtually all areas of the face and achieve the most natural of results accordingly.

The flexible metal cannula differed from the IV cannula in being smaller and made of plastic. As an aside, the IV cannula was first created in the 16th Century for the transfusion of blood and the intravenous injection of a host of non-sterile non-compatible products such as egg white, milk and sugar, and made of quill. (2) Since the 1950’s IV cannulae have been available in a sterile presentation made from plastic and used for the infusion of medically registered compatible solutions.

Mesotherapy

I introduced Mesotherapy to the UK in 1993; a technique then used to address cellulite. Many small injections were made subdermally to improve local microcirculation, lymphatic drainage and reduce fat cell volume. Many devices appeared to assist Doctors in performing these micro-injections and to render the technique more

tolerable to their patients. A host of “pistolets”; automatic injectors powered by battery or compressed air (my alltime favourite) were developed and remain available today. Needles were adapted to penetrate only 4mm deep, although their ability to bruise depends entirely on the skill and attention of the practitioner.

With the advances in skin science, nutrition, cell growth and repair many injectable products are available to Aesthetic Practitioners to improve skin quality, such as nutritional cocktails, nucleotides, cross-linked and noncross-linked hyaluronic acid, amino acids, anti-oxidants such as glutathione and hyper-diluted botulinum toxin. Are we to keep using ancient needle technology and alarming gun-like devices for these sophisticated treatments that require regular maintenance?

Silicon technology

Since 2018 the use of silicon crystal technology to create a pain-free injection technique has been perfected and the results launched on the world market. Silicon can be etched and drilled using plasma technology, familiar to many Practitioners who use plasma to resurface the skin. Such sophisticated technology creates a perfectly smooth, short micron-jet capable of being inserted into the skin

Image courtesy of Murray Saunders

without pain and delivering a perfect microdose of the product.

Since flow rate varies inversely to length, a short micron jet facilitates the flow of the product making injection very easy.

The Nanopass Micronjet 600 system

I have been trialling this revolutionary delivery technology over the last three years. The Nanopass Micronjets are now commercially available and permit the practitioner to perform all injections into the skin using any medical product licenced for use in the skin.

There are three tiny jets made from silicon crystal fixed firmly into the hub.

These three jets are 6 microns long (short) and deliver the product into the skin, attaching onto a Luer-Lok syringe, ideally 3ml.

Each Nanopass Micronjet is packaged singly in a sterile presentation. One Nanopass Micronjet will serve for one full treatment since the silicon does not blunt during use.

The micronjet is inserted into the skin at 45 degrees, although for the scalp I find 90 degrees easier. Once in the skin the plunger can be depressed to administer a small bleb. The micronjet has a blue guide line which must be facing upwards at every insertion.

Having made one injection, the device is removed and replaced in the skin at about 1cm intervals.

The Micronjets are 0,6mm long and do not reach the capillaries in the papillary dermis. Thus bruising is impossible unless being particularly heavy handed on very fragile skin.

Because of their small size and ease of use injections around the periorbital area are easy and without the risk of bruising. All products and all viscosities can be used to reach the delicate eye area without fear of deeper injection. Injections into the scalp are also easy, pain-free and bruise free in a highly vascular area.

The face is another pleasant area to treat; the tougher skin of the chin area and around the mouth needs a bit more pressure on the plunger to achieve a decent bleb.

Injectable skin quality treatments all over the body are easy, quick and pain free to perform with little wastage and no bruising. Cellulite treatment is also readily performed over the convex surface of the thighs.

Treatments assisted by the Nanopass Micronjet system Mesotherapy – face, hair, cellulite, skin quality

Platelet rich Plasma Nucleotides

• Local Anaesthetic

• Mesobotox – fine lines, facial flushing.

• Axillary Hyperhidrosis

Benefits to the patien t

• Minimal discomfort of procedure

• Quicker recovery

• Absence of bruises

Benefits to the Practitioner

• Ease of use once technique mastered

No bruising

Minimal discomfort

• Consistent and predictable depth of injection

• All skin areas amenable to treatment

• Variety of products can be injected all with benefits as above.

• Increased patient satisfaction

• Increased patient retention

Summary

The Nanopass delivery system revolutionizes all injections made into the skin and will become the gold standard

• Precision engineered using plasma energy technology.

• Three perfect silicon crystal “needles” remain sharp throughout the treatment and deliver the injection at 0,4mm - 0,6mm beneath the surface depending on the angle.

• Controlled injection level permits sustained release of active products thus achieving better results.

Injection into a capillary is impossible owing to the unique design of the Nanopass tips avoiding bruises and rendering the procedure virtually painless.

• Each dose can be precisely adjusted.

• Minimal trauma to the patient ensures rapid recovery from the procedure and enhances the patient experience.

Training

Training is available. Email info@magroup.co.uk for details.

References

1. https://medicine.uq.edu.au/ blog/2018/12/history-syringesand-needles

2. Microcannula Utilization for Injectable Facial Fillers: Standard of Care? Kian Karimi, MD, FACS, Chester F. Griffiths, MD, FACS, […], and Dorna Pourang, BS+3View all authors and affiliations Volume 35, Issue 4

SKIN SECTION

In this section: Skin discolouration

New products

AviClear A

SKIN DISCOLOURATION

Lorna Bowes discusses the inflammation-pigmentation connection

In clinic, we see all too often how skin discolouration greatly impacts a person’s quality of life. It is a subject that has been documented for many centuries and is widely discussed both online and in dermatology, aesthetic and beauty conferences around the globe.

There are various types of skin discolouration, and ‘hyperpigmentation’ –meaning a skin condition with patches of skin that are darker than the surrounding skin – is often used as a generic term. Skin discolouration affects all skin tones and is often the result of chronic inflammation at a cellular level, resulting in visible irritation with redness accompanied by hyperpigmentation.

Different forms of skin discolouration may be associated with different skin tones

• Melasma is more prevalent in women and darker skin tones

• Hyperpigmentation/PIH is more prevalent in darker skin tones

• Rosacea is more prevalent in fairer in skin tones.

Melasma and hyperpigmentation

Melanocytes (pigment cells) produce excess melanin in the stratum basale through a process called melanogenesis, and the pigment travels to the skin’s surface.

Although the primary trigger of melanogenesis is UV exposure, it can also be caused by inflammation from other causes, hormonal stress and skin injury.

People with darker skin are more prone to stubborn generalised discolouration and patches.

Melasma and hyperpigmentation treatment

Put simply, there is no quick fix – treatment takes months of daily compliance and consistent maintenance.

Historically, hydroquinone has been the gold standard; however, it is a very controversial treatment with serious potential side effects; it is known as a melano-cytotoxic agent that can cause ochronosis, and therefore it can only be used for a short period of time. Rebound hyperpigmentation is a serious concern for

those treating hyperpigentary disorders with hydroquinone.

We have an array of non-hydroquinone products available to us, but traditionally, they have shown less efficacy, e.g. kojic acid, arbutin, azaleic acid, tranexamic acid, neoglucosamine, vitamin C, retinoic acid and niacinamide.

More recently, various forms of cysteamine have come to market. Cysteamine is a simple aminothiol produced naturally in human cells, with strong effects on melanogenesis pathways, and it is a potent antioxidant. It has been used as the gold standard positive control test agent in multiple studies demonstrating the efficacy of hydroquinone. The ability to now produce a topical application of this agent opens new treatment avenues for patients with pigmentary disorders.

Rosacea

Rosacea is a chronic inflammatory skin condition characterised by recurrent flushing, central facial erythema, and telangiectasia.

LL-37 peptide has a high prevalence and expression level in rosacea patients. This releases IL-8 inflammatory cytokine, which in turn leads to inflammation and underlying redness.

PDL therapy can positively affect telangiectasia but is not very effective on underlying redness. We need to bear in mind that laser treatment causes an increase in redness for up to two weeks due to irritation from the treatment.

Prescribed medication such as Oxymetazoline is used to alleviate underlying redness but is transient and only lasts 12 hours.

Rosacea – new approaches

Introducing heparan sulfate (HS), a naturally occurring molecule in the glycosaminoglycan (GAG) family that bathes ALL the cells in our body and contributes to skin development and homeostasis, actively promoting skin health. HS and other GAGs, such as hyaluronic acid, are well-known super hydrators that bind and retain water, contributing to skin hydration.

HS helps preserve the structural integrity of collagen and elastin fibres. In the skin, heparan sulfate plays a critical role, providing an environment to help decrease inflammation and increase the production of elastin and collagen, as well as providing epidermal and dermal hydration. Managing this immune response goes a long way in managing the irritation and potential subsequent pigmentation and redness.

As we age, our bodies make less and less heparan sulfate. Decreased levels of HS can lead to skin irritation and skin dryness. Dryness compromises the protective barrier, causing the skin to be more reactive to intrinsic and extrinsic factors, resulting in an inflammatory cascade.

Hence, there is a need to replenish HS and return the barrier and skin homeostasis. Aging skin loses heparin sulfate faster than collagen and elastin, impairing its ability to repair and renew.

Unfortunately, as with all glycosaminoglycans, heparan sulfate is a large molecule, too large to penetrate the skin.

Endogenous heparan sulfate during inflammation

Heparanase is an enzyme that is upregulated during inflammation. HS is specifically degraded by heparinase; this results in GF and cytokines that are no longer bound to the cell by the HS, and therefore, they cannot effectively signal the cell toward repair, resulting in continued production of proinflammatory cytokines and hence a proinflammatory state (proteolytic environment).

Exogenous heparan sulfate analog during inflammation

Heparan sulfate analog cannot be degraded by heparanase and, therefore, is resistant to degradation by heparanase and so is able to penetrate and occupy the voids left by the endogenous HS.

Once HSA fills the voids, growth factors and cytokines are bound back to the cell (even in the inflammatory proteolytic environment), allowing a return towards homeostasis and normal function.

The launch of a heparan sulfate analog (HSA) molecule in a topical range, reducing the size and polarity of the molecule and modifying the shape, all of which allow for easy penetration into the epidermis and dermis opens new doors for successful management of rosacea and the risk or inflammatory hyperpigmentation.

The combination of HSA and cysteamine, therefore, holds great promise for the

treatment of a wide range of pigmentary disorders.

Both of these great ingredients are now available in the UK and Ireland, under the exciting US brand, Senté.

‘Senté Cysteamine HAS Pigment & Tone Corrector’ contains Heparan Sulfate Analog (HSA), Cysteamine HCI, Niacinimide, THD Ascorbate and phospholipids, among other ingredients. ‘Senté Dermal Repair Cream’ and ‘Senté Dermal Repair Ultra Nourish’ are both based on Heparan Sulfate Analog

(HSA), the former has a light texture and also contains Vitamin E, and Green Tea Extract. The latter includes Ceramides, Omega, Fatty Acids 3, 6, 9, and Vitamin E, hence the name ‘Ultra Nourish’.

AestheticSource are delighted to be partnering with Senté in the UK and Ireland as exclusive distributor of this exciting range. For further details on training, business support and ordering call 01234 313 130, or email orders@aestheticsource.com.

ALL CLEAR

UK launch of AviClear marks exciting innovation in acne treatment

Cutera has launched AviClear, the first and original FDA-cleared energy device for the treatment of mild to severe acne.

AviClear’s 1726nm wavelength treats acne at the source by selectively targeting and suppressing the sebaceous gland safely and effectively. Designed with patient comfort in mind, AviClear is enhanced with AviCool™ contact cooling for an optimal and safe treatment experience.

AviClear stands as a formidable rival to traditional treatments like isotretinoin (Roaccutane), utilising cutting-edge technology to address acne at its core. AviClear is the only device that works directly on the sebaceous glands in the skin; its revolutionary 1726nm laser suppresses sebum production and provides a long-term solution for individuals dealing with acne of all severities.

Ahead of the launch, Cutera announced Dr Tapan Patel (Aesthetic Doctor, PHI Clinic) and Dr Anjali Mahto (Cosmetic Consultant, Dermatologist, Self London) as its UK and Ireland KOLs.

The duo co- presented a symposium on AviClear at the ACE conference earlier this month (March), as part of the official UK and Ireland launch of the device.

Having suffered from acne from an early age, Dr Mahto has a unique understanding of the patient journey. She says, “AviClear is one the most exciting developments in the world of acne in decades. I have wanted an AviClear device in my clinic since I saw the clinical trials in the US. I don’t think it’s possible to understate what a game-

changer this will be for the treatment of acne. I’m genuinely so excited to introduce this new approach – and alternative to medication-based treatments – to my acne patients.”

Dr Patel adds, “I have patients of all ages, skin tones and types suffering with acne. I am thrilled to be the first UK provider of AviClear, which significantly reduces the appearance and occurrence of breakouts after only three 30-minute sessions, with no downtime.”

How AviClear works

“AviClear uses laser therapy to selectively target the sebaceous glands, suppressing their activity. This halts the overproduction of sebum, knocking out a key trigger for the onset of acne, much as oral medications such as isotretinoin aim to do. AviClear is an FDA-cleared laser that is a genuine breakthrough in the field of dermatology, offering a long-term solution for mild, moderate and even severe acne,” says Dr Mahto.

Isotretinoin versus AviClear in a snapshot

Isotretinoin

Patients must be signed up to a pregnancy prevention programme which covers two methods of contraception (typically the pill and a barrier method).

Treatment protocol

“The AviClear protocol consists of three 30-minute treatments spaced three to four weeks apart, with no downtime after each; it provides a convenient and highly effective solution for acne sufferers.”

FDA clearance and clinical trials

“AviClear was initially cleared by the FDA on March 24 2022 as the first energy device able to successfully treat moderate and severe acne. Subsequently, it received an additional FDA clearance as the first and only device achieving long-term results treating mild to severe inflammatory acne vulgaris. Clinical trials have demonstrated impressive results, with 90% of patients experiencing visible improvement six months after their third session. Longterm efficacy was confirmed with a 92% improvement rate in 12-month clinical data. These results are seriously impressive, and I genuinely believe AviClear will change the lives of those unable or unwilling to take such types of treatment.”

But just how does it hold up the tablished “gold standard” acne treatment, isotretinoin?

AviClear

No birth control required.

Patients must have monthly blood and pregnancy tests. No pregnancy tests required. No bloodwork is typically required.

Systemic physical side-effects, including body-wide dry skin, sun-sensitivity, chapped lips, etc.

Mental wellbeing monitoring is required to safeguard against any potential negative impacts.

Unsuitable for those undergoing IVF, egg-freezing other fertility treatments.

No acne scarring treatment can be carried out at the same time.

No systemic side-effects; temporary dry skin may occur but is limited only to the treated area.

As no medication is taken, potential mental health sideeffects are extremely unlikely.

Suitable for anyone undergoing such fertility treatments.

Acne scarring treatment, such as with lasers, can be carried out alongside treatment.

Unsuitable for those unable to take oral medication. Suitable for anyone who cannot, or does not wish to, take oral medication.

In the comparative analysis above, AviClear emerges as a game-changer, eliminating many of the drawbacks with existing treatments, such as the need for birth control, frequent blood tests, etc, and without most of the potential side-effects associated with isotretinoin. AviClear is also suitable for all skin types and tones. Recent legislation introduced by the government will also affect how isotretinoin is prescribed, meaning that AviClear’s

introduction to the UK is very timely.

“AviClear comes at a pivotal time for acne treatment, offering a timely alternative in the face of recent legislative changes that add considerable extra overheads to the prescription process for isotretinoin, including the need for two prescribers for under-18s,” says Dr Mahto.

Joining Dr Patel and Dr Mahto on the AviClear faculty are Dr David Eccleston

(Clinical Director of MediZen), Mr Kambiz Golchin (ENT Consultant, Facial Plastic Surgeon & Clinical Professor, Dr Rita Rakus Clinic) and Dr John Quinn (Cosmetic Doctor, Founder & Clinical Director of Quinn Clinics). They too are among the first UK and Ireland clinics to offer the AviClear system as part of the initial commercial rollout.

AestheticSource announce Hydrinity Distribution Partnership

Dermatological skincare brand Hydrinity Accelerated Skin Science is now exclusively available in the UK and Ireland through AestheticSource. Hydrinity launches in Spring 2024 with three key products: Renewing HA Serum with PPM6 Technology, an ultra-hydrating serum that is clinically proven to reduce the signs of ageing by going deep into the dermal layer; Restorative HA Serum with powerful peptides and antioxidants to help neutralise free radicals, maintain optimal moisture levels, reduce inflammation and stimulate the skin’s natural recovery process; and Hyacyn Active Purifying Mist which contains Hypochlorous Acid (HOCl) to treat blemishes, renew compromised skin, and deeply calm stressed and sensitive skin types, including those prone to eczema, psoriasis, and rosacea.

Aesthetic Medical Partnership launches hair support system DE|RIVE

Aesthetic Medical Partnership (AMP) has unveiled a new addition to the EXO|E family of products. DE|RIVE is specifically formulated from the latest bio-based, patented plant-derived nanoparticle technology, allowing for continuous support to help nourish the skin and scalp while improving the appearance of thicker, fuller hair. It can be used in clinic as a standalone treatment or in combination with procedures such as microneedling, RF microneedling and ultrasound. The treatment is commonly used alongside AMP’s AquaFirmeXS.

Eden Aesthetics appointed official UK distributor for Velez

Specialist medical and aesthetic distributor Eden Aesthetics has expanded its brand portfolio with the introduction of Velez by Vesna skin treatment biotech masks. Velez masks are made from a high-tech 100% sterile material, originally developed to accelerate healing for injured and traumatised skin. This natural, renewable biopolymer of 100% pure cellulose has unique material properties due to its patented 3D nanostructured fibre network. Velez masks maintain a high humidity level that allows a steady but extensive cooling for up to two hours. The mask draws heat away from the skin and cools skin temperature by up to 6°C providing a soothing effect.

Mesoestetic launches mesopeel

Skincare brand Mesoestetic has launched its new generation of mesopeel combined peels designed to address ageing, pigmentation, oily/acne skin and sensitivity. The range includes 12 new combination peels, eight of which contain the new potency-enhancing MD complex with arginine, shikimic acid and caffeic acid. This means the new peels have greater efficacy, innovation, and scientific evidence, says the brand.

5 Squirrels unveils Clarify Collection

5 Squirrels has unveiled a new addition to its portfolio – The Clarify Collection – which is designed to meet the needs of people with oily and blemish-prone skin. Building on the success of Clear, a degreasing cleanser launched two years ago, the range includes a Control oil control serum, Remove oil control pads, and Zap blemish control pen to unclog pores and combat bacteria.

Calecim reveals new Eye Contour Lifting Cream

Eye Contour Lifting Cream is the latest addition to Calecim. The product has been developed to strengthen the skin, improve luminosity and support the delicate eye area. Ingredients include a gentle combination of organic acids, which work to accelerate the elimination of senescent cells that lead to fine lines and wrinkles. Cucumis sativus antioxidant, ascorbic acid, and lactic acid provide protective and soothing benefits, while niacinamide works to increase fatty acid ceramide levels in the skin and provides improved skin barrier function.

ESK announces Hydraboost HA Serum

Australian skincare brand ESK has announced its latest product – Hydraboost HA Serum. The serum harnesses a molecular blend containing 0.7% High Molecular Weight HA, 0.7% Medium Molecular Weight HA, and 0.2% Low Molecular Weight HA to target collagen growth, reduce signs of photo-ageing, accelerate wound healing, and improve skin hydration. It’s also indicated to aid the management of rosacea and eczema. The product also contains Panthenol, contributing to the serum’s effectiveness by reducing water loss, and enhancing hydration.

Cysteamine + HSA Pigment & Tone Corrector

Hyperpigmentation treatment mask with Cysteamine and HSA for more even-looking skin and improved appearance of dark spots.

Improves the appearance of dark spots in as early as 8 weeks with best results at 16 weeks

Dual technology

Targets hyperpigmentation and inflammation

Hydroquinone-free

15 minute treatment mask

Key ingredients: Heparan Sulfate Analog (HSA), Cysteamine HCI, Niacinamide, THD Ascorbate, phospholipids.

94% of subjects showed an improvement in hyperpigmentation at 16 weeks and agreed that their stubborn dark patches looked less noticeable.

Dual technology works from within to target inflammation that can lead to hyperpigmentation, improving the appearance of dark spots in as early as 8 weeks with best results at 16 weeks.

BUSINESS SECTION

In this section: 2024 topicals round-up Technology and pharma

TECHNOLOGY’S ROLE IN THE PHARMACEUTICAL INDUSTRY

Paaven Patel, Operations and Quality Assurance Pharmacist at Specialist Pharmacy, shares his trends and predictions

Advancements in technology have had a growing impact on a number of industries over the past few years, with the pharmaceutical industry seeing major technological advancements in the last decade. With growing discussions around digital transformation, artificial intelligence and advancing medical technology, what changes will be coming for the pharmaceutical industry? We’ve looked at the current trends and explored predictions for future advancements.

What trends has technology already made in the pharmaceutical industry?

Clinical Trials

Technological innovation has already made waves in the pharmaceutical industry. In such a complex industry, there are a lot of opportunities for different technologies to make a difference. One of the current trends is clinical trials for new drugs and treatments. Technology has accelerated the process of patient recruitment with artificial intelligence, narrowing down the best patients. Clinical trials can also now be conducted entirely virtually, eliminating the need for in-person interaction.1 Technology has also sped up the process of data collection and analysis in clinical trials, reducing trial durations and costs. Medable is one service already offering remote clinical trial services along with AI data reporting.2

Artificial intelligence (AI)

Artificial intelligence has also supported new drug discovery. Exscienta is one of many companies committed to using AI engineering to analyse huge datasets to develop new drugs. In January 2020, Exscienta announced the first molecule designed by Artificial Intelligence, DSP1181, to enter a Phase 1 Clinical trial. The drug is a candidate to treat obsessivecompulsive disorder and is currently being investigated as a treatment.

Pharmacogenomics

Pharmacogenomics is the use of genetic information to predict a patient’s response to specific drugs and minimise adverse reactions, which has also been enhanced by improving technology. Companies such as 23andMe and AncestryDNA already offer genetic testing services which provide insights into an individual’s response to drugs.3

Blockchain Technology

Blockchain technology has also begun to be used in the pharmaceutical industry. Blockchain technology can track the pharmaceutical supply chain to prevent counterfeiting. IBM’s Food Trust and MediLedger are already offering blockchain-based supply chain solutions. As MediLedger explains: “Blockchain is a mechanism to enforce business rules automatically between participants. Every participant in a blockchain network has a copy of the blockchain data and the rules being enforced on that data. No

single party can change the data or the rules. This creates trust between trading partners that was never possible before now.”4

How will technology continue to transform the industry? Our predictions

The continuing evolution of pharmacogenomic research will improve specialised medicine even further. Patients can be offered highly personalised and effective medications using genetic data. For Specialist Pharmacy, this means the ability to create compounded medications which are precisely calibrated to meet the unique genetic makeup of each patient. This approach enhances treatment whilst also improving patient safety and compliance. This technology will eventually lead to personalised healthcare solutions becoming more of the norm for patients.

While we’ve already seen digitalisation have an impact on clinical trials, it is likely digital treatments and telemedicine will only continue to grow. With improved technologies, patients will likely access healthcare options through applications. Remote monitoring through tech will also

become more common. This will likely improve patient access and allow for a wider range of care delivery.

We are also likely to see changes in drug development in the pharmaceutical industry. Data analytic tools will be used to assess and deliver decision-making in drug development, manufacturing and supply chain management. AI and machines will likely also take on potential drug candidates. Data-driven algorithms will be able to analyse huge data sets, including genetic information and chemical structures, in order to predict the effectiveness of compounds. This will substantially speed up the early stages of drug discovery.

Technology may also significantly impact pharmaceutical manufacturing, with further advancements in automation and robotics increasing efficiency and quality control in pharmaceutical production. AI may also be able to repurpose drugs by identifying which existing drugs could be used for new therapeutic purposes, saving time and resources.

Conclusion

It is fascinating to see the technological

advancements already making a profound impact on the pharmaceutical industry, with current trends such as digital clinical trials, genetic profiles informing patients of health concerns, and new AI drug discoveries transforming the industry landscape. Virtual trials are enhancing patient recruitment and data collection, accelerating the development of lifesaving therapies. The precision medicine approach, driven by pharmacogenomics, is ushering in an era of highly personalised treatment strategies, minimising adverse effects and maximising efficacy. AI-powered drug discovery is speeding up candidate identification and repurposing existing medications, leading to innovative solutions for various health conditions. Telemedicine is improving patient access to care and will continue to grow.

While it’s worth acknowledging the challenges of fully implementing future technological developments, such as cost and time restraints, resource limitations, green-manufacturing concerns and complex and up-and-coming regulatory requirements, it is clear technology will continue to bring about change in the pharmaceutical industry. The predictions for more specialised medicines,

streamlined drug discovery and drug repurposing and the continued growth of telemedicine will enhance patient wellbeing, reduce healthcare costs and lead to the development of new treatments. With the help of technology, the pharmaceutical industry is poised to become more patient-centric, efficient and effective. As these trends continue to evolve, we can anticipate a healthier future for all and an improved pharma industry.

References

1. Using digital technologies in clinical trials: current and future applications, Carmen Rosa, Lisa A. Marsch, Erin L. Winstanley, Meg Brunner, and Aimee N. C. Campbell. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC8734581/

2. https://www.medable.com/

3. Pharmacogenetic testing through the direct-to-consumer genetic testing company 23andMe. Mengfei Lu, Cathryn M. Lewis, Matthew Traylor. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5477417/

4. FAQ, How is blockchain technology utilised in the MediLedger Network https://www.mediledger.com/faq

A well organised conference with excellent lectures—in spite of being an aesthetic doctor for 22 years, I still picked up some good tips!

20TH - 21ST APRIL 2024

ROYAL COLLEGE OF PHYSICIANS REGENT’S PARK, LONDON

HAVE YOU BOOKED?

We're excited for the next Wigmore Presents in April and it all takes place in less than three months’ time!

Now in its third year, Wigmore Presents industry’s calendar. With an educationled agenda, delivered by the who’s who of the sector, it is no wonder that the event is getting more popular every year, while delivering for those coming back. The iconic central-London venue with

CPD points and accessible price point, don’t hurt either. Luckily for those who missed last year’s event, we have the return of two key lectures. Firstly, the review

could be seven by April. The unsponsored panel, which includes Dr David Eccleston, Dr Simon Ravichandran, Dr Sherina Balaratnam, Dr Tapan Patel, and Prof Syed Haq, chaired by Dr Tim Flynn and Mr Dalvi Humzah,

have not used yourself. It might be that in clinic, you

best outcomes?

Secondly, we have the return of the Blind Date event, where four aestheticians will separately evaluate a patient’s face and their concerns, before sharing their suggestions and step-by-step techniques to deliver. Dr Tim Flynn is back to give his professional opinion, and this time will be on stage with Dr David Eccleston, Dr Nestor Demosthenos and Julie Scott. Will they have the same approach? Will you agree? Pit your wits against the

Tickets can be purchased now—it is £150 for a one-day pass and £250 for twodays. The pass includes access to the agenda*, exhibition, refreshments and lunch.

The Saturday networking event can be purchased separately for £75.

panel by marking up their own model diagram to see how it compares!

New to this year, will be a look at the middle-aged male face, the non-surgical facelift, an introduction to threads led by Wigmore trainers, Dr Rita Poddar and Dr

As well as a review of the latest technologies coming to market, including the microbiome and skin

This was an excellent event from start to nish and it was one of those rare instances where I have left a conference truly feeling that I have learned something new and innovative that I can implement in my practice. I will most de nitely attend future events and recommend to colleagues. Thank you for a great weekend!

delivered by the University of Cambridge’s Dr Anton Enright. Alongside, will be lectures on developing your relationship with your patients, and bringing complementary treatments to your clinic to provide a 360-degree service.

David Hicks, Chairman of Wigmore Medical says, "If you are looking for pure, unbiased education, I would challenge any other meeting to match Wigmore Presents".

If you need a further push to book your place, the innovations. There will be plenty of time to discuss your there will be an evening reception on the Saturday night giving you an opportunity to catch-up with your friends

* Some lectures will only be accessible to HCPs.

Q1 2024 TOPICALS ROUND-UP

Shutterstock/Orawan Pattarawimonchai

In this monthly column, Gary Conroy, CEO of 5 Squirrels Ltd, will provide updates on the cosmetic topical landscape. He will focus on regulations, markets, new products, clinical breakthroughs, and scientific findings. The goal is to keep you and your patients informed about the latest developments in topicals, ensuring safety and enhancing treatment outcomes. Stay tuned for valuable insights and updates!

Since 2014, 5 Squirrels have helped skincare professionals to launch their own brand of skincare products and take back control of their business.

They have developed an award-winning portfolio of product formulations containing highly concentrated active ingredients to improve the skin’s overall health and appearance. They offer a one-stop shop that makes the whole process simple so you can get on with what you do best - looking after your clients’ skin.

If you would like more information about launching your own brand skincare with 5 Squirrels, they can be reached at info@5squirrels.com and www.5squirrels.com

The last quarter has seen transformational changes in consumer safety concerns and regulation changes to address these in both the EU and the USA, which are far-reaching both in terms of the impact of products on the marketplace and the cost of the associated regulatory burden in launching new products. Some of you may have seen price hikes from USA-imported brands as the most major overhaul of the regulations in nearly 100 years came into effect in December 2023.

UK REACH has yet to follow suit with some of these changes, and many new ingredients now available and deemed safe in other territories have not yet made it through Whitehall and onto the UK market.

Despite the inflationary burdens, the merger and acquisition landscape is highly active, with many healthcare professional brands being acquired and on the radar of investors driven by accelerated consumer growth and demand for high-end technical products.

Regulations:

1. The CTPA (Cosmetic & Toiletry Professional Association) have launched COSMILE, a new app designed to support consumers and create more transparency around ingredients and market claims.

This is a really handy app for clinicians to have on their phones, and it allows users to easily scan the ingredients list on cosmetic products to gain full insight into what they are and their benefits. It really helps demystify ingredients and filters out the facts from the marketing claims.

It would particularly come in useful when deciding which products to stock in clinic,

• Do they offer value for money?

Are the ingredients listed and legal for sale in the UK/EU?

Do the ingredients support the claims?

The App is available to download now in the usual App stores : COSMILE Europe app

More info at : https://cosmileeurope.eu/

2. The SCCS (Scientific Committee for Cosmetic Safety) in the EU has passed a new law on the safety of Retinol used in cosmetic products. This has not yet been passed into law in the UK, but it is expected to do so soon.

The maximum concentrations allowed of vitamin A in cosmetics will be 0.05% Retinol Equivalent (RE) in body lotion, and 0.3% RE for other leave-on and rinse-off products is safe.

The committee have concerns about consumer exposure to Vitamin A through dietary consumption and cosmetics, which could lead to a high intake and potential teratogenicity.

The timeline for these changes are:

No new products containing more than the above dose will be permitted to be placed onto the EU market after June 2025.

• All products containing more than the above dose must be removed from the EU marketplace and cannot be on retail shelves from 31st December 2026

https://www.cosmeticsdesign-europe.com/ Article/2023/12/22/Cosmetic-regulationsupdates-for-Europe

3. Cosmetics Europe Published Guidance on EU labelling of Additional Fragrance allergens. 80+ new allergens have now been added to the list, which must be legally highlighted in product ingredients to ensure patient safety. This comes shortly after Natasha’s Law in the UK, the tragic case of the teenager who died from anaphylaxis after consuming a sandwich at the airport. The regulatory pathway for cosmetics is increasing patient safety by following in the footsteps of food allergen warnings.

https://eur-lex.europa.eu/legal-content/EN/

4. In the USA, cosmetics regulations have been tightened to align more closely with EU laws, and cosmetics are now regulated by the FDA for the first time. MoCRA (the Modernisation of Cosmetic Regulation Act 2022) came into force after many delays on 31st December 2023. It is the most extensive change in cosmetic regulations since 1938 in the USA.

The new list of legal requirements is extensive. It puts a much heavier regulatory burden on manufacturers to ensure clearer and fairer labelling, improved safety, due diligence and more robust claims. It is not dissimilar to the EU Act enforced since 2013.

Clinics may have noticed price increases

from US brands they are purchasing. The additional costs may be due to this additional regulatory requirement and the associated costs.

https://www.fda.gov/cosmetics/cosmeticslaws-regulations/modernization-cosmeticsregulation-act-2022-mocra

5. The UV Filter 4-Mathylbenzylidene Camphor has now been banned in the EU due to safety concerns and must be removed from sale by the end of 2025. Clinics should check their SPF ingredients and make an informed decision.

https://health.ec.europa.eu/publications/4methylbenzylidene-camphor-4-mbc_en

6. Regulations have been further tightened within the EU Deforestation Regulation (EUDR) launched in June 2023. The rules state that ingredients such as

• Coffee Extracts

• Palm Oil

• Soya

• Wood oils

Do not come from land which has been deforested since December 2020 and have been produced following the laws of the source country, and products are covered by due diligence.

Clinic owners who are concerned about the impact products they supply may be having on deforestation should ask their suppliers for a Due Diligence Statement.

7. ASA (Advertising Standards Agency) has upheld a ruling on the advertising on social media regarding socially responsible advertising.

The CAP Code (Committee on Advertising Practice) states the advertising should be prepared with a sense of responsibility to consumers and society. The advert contained key messages and images perceived to target young people and, therefore, may have an effect on a younger audience’s insecurities about their appearance.

As injectables are now more heavily regulated around age and consent, clinics should be mindful of these guidelines when advertising products and other treatments, too, especially around teenage acne.

https://www.ctpa.org.uk/news/asa-rulingon-irresponsible-advertising-7434

Markets

1. Puig, the Spanish Beauty conglomerate, has acquired Dr Barbara Sturm skincare brand after Oprah Winfrey invested an undisclosed sum in the brand last year. Dr Sturm founded the brand in 2014 and has grown it to global sales of $150 Million in 2023. The acquisition price has not been disclosed. Well done, Dr Sturm!

https://www.businessoffashion.com/news/ beauty/barbara-sturm-acquired/

2. L’oreal has acquired water tech start-up Gjosa, a Swiss-based water-saving device company. The new owners plan to use the technology for new beauty developments as the cosmetic industry further moves towards better green credentials.

https://gjosa.com/about-gjosa/

3. Shiseido has acquired Dr. Dennis Gross Skincare to build its dermatologists-backed prestige holdings. Dr Gross launched his brand in 2020, and by 2022, he will have achieved sales of $100 million.

This acquisition comes during a boom of acquisitions for Dr. led Skincare brands

https://www.businessoffashion.com/news/ beauty/shiseido-acquire-dr-dennis-grossskincare/

https://www.gcimagazine.com/brandsproducts/skin-care/article/22874671/ beauty-enters-its-dermatological-skin-careera

4. Retail Beauty continues to buck the trend of most consumer markets worldwide, according to Circana, who report a 14% growth in the sector in 2023 with consumers testing the limits of innovation, bringing physical, digital and even psychological product expectations to the forefront of market expectations.

https://www.gcimagazine.com/ consumers-markets/news/22883142/ circana-and-credo-beauty-retail-20242025beauty-accelerate?utm_source=newsletterhtml&utm_medium=email&utm_ campaign=GCI+E-Newsletter+01-24-2024

5. Clinic owners should be mindful of this when considering how to maximise the retail space in clinic as a key business driver in 2024. With their main demographic attending clinic for treatment eager to shop for topicals, this is a key growth opportunity often overlooked where patients attend clinics for treatments but spend funds elsewhere on products.

6. Dyson has invested £500 Million into developing new beauty products to fulfil unmet consumer demand.

https://www.cosmeticsdesign-asia. com/Article/2024/01/11/Dyson-toramp-up-beauty-R-D-over-next-fouryears-to-fill-market-gaps?aca_news_ section=Global+Industry+News#

Scientific

1. Silab has presented MYOLINE, a new natural, relaxing active ingredient for sublimated skin derived from watercress plants. The company claim the ingredient has a myorelaxing effect by acting on the neuromuscular junction. It has a genuine “Botox-like” effect.

https://www.silab.fr/en/products/ skincare/119/myoline

2. Abbvie has identified 12 key contributors to the ageing process to help provide a roadmap to the longevity of the skin. These include telomere attrition, dysbiosis, chronic inflammation and disabled macroautophagy, to name a few.

The findings will be announced at Beauty Accelerate in March 2024 in Los Angeles.

https://www.cosmeticsandtoiletries. com/cosmetic-ingredients/actives/ news/22883179/abbvie-expert-todecode-the-beauty-of-longevity-at-beautyaccelerate?utm_source=newsletterhtml&utm_medium=email&utm_ campaign=CT+E-Newsletter+01-24-2024

3. Givaudan reveals precision fermentation hyaluronic acid breakthrough by directly obtaining the molecular weight required during the fermentation stage. The company claims a 90% reduction in their global footprint, reducing costs and improving yield whilst producing lower molecular weight HA.

This will directly target key proteins involved in barrier function, improving hydration and texture, resulting in 72 hours of hydration and an increase in skin smoothness of 66%.

https://www.cosmeticsdesign-europe.com/ Article/2024/01/10/Givaudan-s-sustainablehyaluronic-acid-breakthrough

4. A new study has been published to evaluate Cantella Asiatica, also from Givaudan, to solve stretch mark concerns. Stretch marks, also called striae, are a form of tissue damage caused by excessive dermis stretching and affect 60% to 90% of women during pregnancy.

The study concluded that Cantella Asiatica acts as a natural remodelling partner by decreasing Collagen Type 1 degradation, stimulating micro-circulation and tropelastin synthesis to fully replenish the dermis network. Elastin increased by 37%, and wound closure increased by 85% after 36 hours.

This may be a novel ingredient to be used by aesthetic practitioners for post procedural treatment.

https://www.mdpi.com/2079-9284/11/1/15

Keeping you in the conversation for thirteen years

Since 2011 Aesthetic Response have provided unique, tailored and bespoke business support to many of the UK’s leading and award winning clinics and practitioners.

At times when there aren’t enough hours in the day, we offer pro-active and accommodating staffing solutions, all with a human touch and highly-efficient processes and protocols, so you can focus on your talent and expertise as a medical aesthetic practitioner.

Empowering Practitioners to build a thriving aesthetic business

Our dedication, attention to detail, and extensive industry insight, coupled with our commitment to meaningful dialogue and efficient service, enable practitioners to attain the success and recognition as a trusted ambassador of safe, ethical, and effective aesthetic practice.

Core services include:

• Virtual clinic receptionists

• Appointment booking

• Deposits & payments

• Lead management

• Great customer service

• Affordable clinic support

Join Aesthetic Response for excellence in medical aesthetics.

Elevate your clinic now.

Elevate skills, efficiently & effectively Building on Success Training

We have launched our Aesthetic Front of House Training course, designed to elevate the standards of customer service in the industry. The content of the course has been tailored to allow receptionists to access content at their own pace and review whenever and wherever they are.

Course content includes:

• Interactive online learning

• Industry expert tuition

• Comprehensive curriculum

• Flexible & accessible program

• Modules & downloads

• Affordable training solution

T: 0191 720 3000

E: clientservices@aestheticresponse.co.uk

www.aestheticresponse.co.uk

Dates For Your Diary...

THE SCOTTISH AESTHETIC CONFERENCE

Saturday 23rd March 2024, at the Hilton, Glasgow

The largest medical aesthetic conference in Scotland, the Scottish Aesthetic Conference is for all medical aesthetic practitioners as well as those looking to start in the medical aesthetics industry.

For more information, please visit https://scottishaestheticconference.com

AESTHETIC MEDICINE LIVE

10th - 11th May 2024, at Olympia, London

Aesthetic Medicine Live is a free event and welcomes exhibitors, speakers, delegates and visitors to Olympia London for a fantastic two days of networking and education.

For more information, please visit https://aestheticmed.co.uk

BAS 2024 SCLEROTHERAPY CONFERENCE

21st May 2024, at Eton College Rowing Centre, Dorney Lake

Aimed at practitioners of microsclerotherapy and foam sclerotherapy this event has a varied programme of speakers interspersed with live demonstrations of varicose vein and thread vein treatmentss. Delegates will be able to update their BLS certification.

For more information, please visit www.bassclerotherapy.com

VEGAS COSMETIC SURGERY CONFERENCE 2024

30th May 2024, at Fontainebleau Las Vegas

VCS has a forward-thinking focus on breakthrough science for an intellectually curious community. For more information, please visit www.amwc-conference.com

SAVE THE DATE

WIGMORE PRESENTS

20TH - 21ST APRIL 2024

ROYAL COLLEGE OF PHYSICIANS REGENT’S PARK, LONDON

A well organised conference with excellent lectures—in spite of being an aesthetic doctor for 22 years, I still picked up some good tips!

Register now

TRAINING COURSES TRAINING

All the training course listed below and more can be found on www.cosmetictraining.co.uk

FOUNDATION BOTULINUM TOXIN AND DERMAL FILLER

4th May | Inspired Cosmetic Training

This fun and educational training course is taught through online theory learning, demo videos, a ‘hands on’ practical training day and followed by unlimited business growth support.

POLYNUCLEOTIDES

15th June | Acquisition Aesthetics

This Polynucleotides Training Programme begins with a deep dive into the theoretical aspects of this groundbreaking solution. Understanding the science of Polynucleotides is fundamental to their successful application in aesthetic procedures.

TREATMENT GROWTH MASTERY COURSE

Anytime Online | Consulting Room Academy

Want to convert more consultations into profitable sales? Teach your therapists and aestheticians how to convert more consultations into sales with our CPD-certificated therapist training. FREE for ConsultingRoom.com Members.

HORMONE THERAPIES INCLUDING BHRT

Anytime Online | Roseway Labs

These online courses teach you how sex hormones affect the female body, how imbalances manifest and how they can be treated with licensed medication, compounded medication (BHRT), supplements and dietary and lifestyle changes. All participants will receive an official CPD certification upon completion.