Consulting Room Magazine | Volume 7: Issue 3 | July - September 2024

THE SKIN-MIND CONNECTION

The psychological impact of skin conditions ACNE

Hormonal acne in women and girls

Integrating lifestyle and traditional medicine

Protocols for management

ROSACEA

SKIN CONDITIONS

ISSUE OF THE CONSULTING

2024

According to The British Skin Foundation, 60% of people in the UK currently have a skin condition or have previously had a skin

As well as the aesthetic impact that conditions such as acne, psoriasis, eczema and rosacea can have on people, there is also a psychological impact, so we are kicking off our skin conditions special with specialist psychiatric nurse Nicola Noel writing about this (p18-19). We then hear about the patient experience from journalist Georgia Seago (p20-21), who shares her personal journey with

Next up, Dr Ginni Mannsberg explores hormonal acne in women and girls (p28-30), and Julie Scott shares her strategies for rosacea

As well as this we have Dr Arturo Almeida discussing complications management (p36-38) and Piroska Cavell giving her views on the

Our CPD article this month delves into a holistic 360 degree approach with Tracey Dennison (p58-61), and 11 years after winning The

Adobe/Jacob Lund

A 360-DEGREE

APPROACH

Tracey Dennison shares a patient case study demonstrating how to combine traditional and lifestyle medicine.

Georgia Seago shares her experience with guttate psoriasis.

LOSS IN AESTHETICS

Are you jumping on the band wagon asks Piroska Cavell. It is apparent, particularly in the aesthetics industry, that a lot of practitioners and businesses are encouraged to take up the next biggest thing incorporated in the blurred lines between aesthetics and wellbeing. But is this serving our patients?

CORRECTION

We chat to Katie Parobek, clinic director and founder of The Well clinic about their Complexion Correction treatment.

Dr Ginni Mansberg discusses the causes of hormonal acne and the solutions.

We speak to Professor David Sines about where we are in terms of the licensing scheme for cosmetic procedures in England.

NEWS

LEVELLING UP

Angela Brennan and Neil Pybis discuss Level 7 training, why it matters and how they became the first nurse-led OTHM Level 7 Aesthetic Injectables provider in England.

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

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.

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

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

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

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

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).

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

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

Emma Davies NIP Save Face Clinical Director. Nurse specialising in cosmetic medicine since 1998. Co-founder and pastChair of the British Association of Cosmetic Nurses.

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

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

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

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

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

CONTRIBUTORS

Georgia Seago is an editor and journalist specialising in beauty and aesthetics. She is a former editor of Aesthetic Medicine magazine and now works in digital fashion and beauty publishing.

PIROSKA CAVELL

Piroska has an MScin Cosmetic Medicine with an interest in tackling facial disfigurement due to injury, illness or surgery with the combination of treatment modalities. She also holds qualifications in obesity and weight management, prescribing and hormone health.

Dr Mansberg is a GP specialising in menopause. Based in Australia, she is the founder of Evidence Skincare (ESK), the author of The M Word and How to Thrive in Menopause, presenter, podcaster and columnist. She is a a founding member of the Asia-Pacific HPV Coalition.

Katie Parobek is the clinic director of The Well. Recognising the need for a holistic, all-in-one destination, she envisions a space where clients can seamlessly integrate beauty and wellbeing, supported by a world-class team of practitioners.

Dr Almeida is a consultant surgeon and cosmetic doctor. He has recently launched the world’s first course on prevention and management of complications after fat dissolving injectables. His latest initiative is a global network for the Aesthetic Community called “The Nexus Pro”.

Julie is an NMC registered Independent Nurse Prescriber, aesthetic injector, and trainer with over 30 years of experience in the field of plastics and skin rejuvenation. She is a mentor, international speaker & presenter on soft tissue fillers who is also a KOL for several leading aesthetic brands.

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.

TRACEY DENNISON

Tracey Dennison is an aesthetic nurse director, mentor and coach who has been in nursing for nearly three decades and been in aesthetics since 2014. She strives to continually develop her knowledge, skills and expertise and has undertaken extensive training to facilitate this.

Nicola is the founder of Brainworks Therapy, an online private mental health clinic, where she specialises in empowering professional women to rewire their brains, change their mindsets, manage emotions, build resilience, and improve overall mental health.

GEORGIA SEAGO

KATIE PAROBEK

VICKY ELDRIDGE

DR ARTURO ALMEIDA

DR GINNI MANSBERG

JULIE SCOTT

NICOLA NOEL

WHAT’S TRENDING

The Age Of Wellness report gives insights into what is really driving UK consumers through the doors of aesthetics clinics.

Global dermal filler and dermo-cosmetics brand Teoxane has published the ‘Age Of Wellness’ report.

Working with independent research agency DRG Global, Teoxane surveyed 2,500 respondents for the report.

Now, in partnership with some of the UK’s leading health professionals, they are issuing the findings to offer insights into what is really driving UK consumers through the doors of aesthetics clinics.

Survey highlights

• Over a third of women in the UK (43%) report having low selfesteem

• Skin quality is the second most popular dermal filler treatment indication (over lips, nose, jawline, eyes and more)

Lip filler isn’t the most in-demand dermal filler treatment for millennials – it’s not even in the top three. (62%) is to treat fine lines and wrinkles, (55%) is to improve skin quality, and (47%) is to brighten the under-eye area

• 74% of women reveal they’re more confident having photographs taken of them after having dermal filler treatment

• Six-in-10 women in the UK are worried about being judged for having dermal fillers

• There’s a change in filler treatment stigma as findings show women want to treat themselves and do something just

for them (30%), the second highest emotional driver after confidence-boosting (45%).

Looking to the future, the desire for aesthetic treatments appears to sit firmly with Gen Z. Over one third of 18–25-year-olds state they are likely to have an aesthetic treatment in the future, and 53% cite confidence as the key reason, with skin quality a secondary driver (32%).

• Over a third of Gen Z want aesthetic treatments, more than any other age group

• More than half (53%) of Gen Z’s want for aesthetic treatments is fuelled by confidence

Almost half (45%) of Gen Z desire and put under eye treatments as a top concern

Only 11% of Gen Z in the UK are concerned about unnatural results

• Gen Z say that skin quality is the other outcome they desire most (32%)

• UK’s leading practitioners cite social media as a driver for Gen Z treatments, thanks to the use of heavy and unrealistic filters

• Doctors warn Gen Z that social media beauty standards portray unrealistic expectations.

Leading doctors are putting this down to the increased usage of social media. There is far more content around dermal fillers available via social media platforms – TikTok, in particular, has seen huge growth in the UK since 2020, with monthly active

users increasing from just over four million in January 2020 to nearly 8.9 million in January 2024, and hashtags such as #lipfillers, #dermalfillers and #undereyefiller being viewed in the hundreds of millions. This could be a contributing factor to the younger, Gen Z and Millennial generations taking the lead in dermal filler usage in the UK.

Dr Christine Hall commented, “When social media really took off, people would come in with unrealistic expectations and requests, but patients are much more aware of this and that what they are seeing is perhaps not all that it seems. However, the rise in social media and digital presence has certainly made us all more aware of our appearance. Moreso, there is a rise in the acceptance and popularity of aesthetic treatments and the effects that dermal filler can have on facial profiles.”

Dr Bonnie Armstrong added: “I truly believe that social media, influencers and filters have a huge impact on the Gen Z patients. I think it can create unrealistic expectations for our patients and a desire to look different rather than embrace their own natural beauty. Often, patients will want to change their physical appearance to look like others on social media who may be photoshopped or filtered. It’s vital as practitioners that we work with our patients to appreciate their own beauty, to respect individualism and encourage natural enhancements, not huge changes.”

On the statistic that almost half (45%) of Gen Z desire and put under eye treatments as a top concern, Dr Hall said, “The majority of Gen Z patients come in with specific skin concerns –such as acne, acne scarring or rosacea or with specific treatments in mind such as lip filler, under eye filler, non-surgical rhinoplasty, and chin filler. Through the use of social media, filters, and Photoshop, younger patients are exposed daily to images that portray unrealistic expectations and unrealistic ideals of beauty.

“I think Gen Z patients are being influenced by edited images online and, therefore, feel they need treatments to achieve that look. Every day within my clinic, I will have conversations about normalising appearances and trying to break the beauty standards created online. It’s important for patients to understand that lines and skin texture are normal, and I am passionate about promoting natural enhancements and having my patients’ goals be to feel the best version of themselves, not someone else.”

Only 11% of Gen Z in the UK are concerned about unnatural results.

Dr Armstrong commented, “In my opinion, unless there is a medical or psychological need for treatment on a young patient, then we should withhold injectables until they are at an age in which they show appropriate physical signs of ageing. This age is hard to quantify as it can be different per person. Usually, we start to conservatively treat patients around the age of 30.”

Jordan Sheals, deputy country manager at Teoxane, said: “At Teoxane, we believe in an empowered culture. A place in which everyone can feel confident to take control and autonomy over what beauty means to them without fear of judgement or criticism from their peers.

“The truth is, beauty is an entirely individual concept and can be dependent on age, gender identity, ethnicity, sexuality, lifestyle, location...as well as simply personal preference! We aspire to work towards creating an environment that is inclusive and representative of all the factors that represent beauty, giving people the power to make choices that empower them to feel like the best versions of themselves.”

Mother of five dies after liquid BBL

A mother of five has died after undergoing a liquid Brazilian butt lift (BBL).

Alice Webb passed away at Gloucestershire Royal Hospital following complications from the procedure. At the time of publication, two people had been arrested on suspicion of manslaughter.

Webb fell ill after undergoing the procedure, which involved filler being injected into the buttocks, and died in the early hours of the morning of Tuesday, September 24. Her death marks the first fatality caused by this treatment being performed in a UK clinic.

In a joint statement from Sharon Bennett, chair of The British Association of Medical Aesthetic Nurses (BAMAN), and Dr Catherine Fairris, president of The British College of Aesthetic Medicine (BCAM), said: “BAMAN and BCAM are saddened by the recent death of Alice Webb following a liquid Brazilian Butt Lift (BBL) procedure. As two of the foremost associations which represent statutory registered nurses, doctors and dentists who work in the field of medical aesthetics, the safety and reasonable standard of patient care is our primary duty.

“This tragic incident highlights the urgent need for the Government to action the October 2023 consultation on regulation and recognise that all so-called ‘aesthetic treatments’ are medical procedures which are associated with risk. For this reason, they should only ever be carried out by appropriately qualified registered doctors, dentists and nurses, and should only ever be carried out in premises which meet the required standard for medical premises.”

Tristan Mehta, founder and CEO of Harley Academy stresses, “The UK urgently needs tighter regulatory frameworks to ensure only medically qualified practitioners can administer treatments, especially those as complex and potentially dangerous as BBLs. While BBLs are considered surgical, non-surgical aesthetic treatments such as dermal fillers and injectables are also being carried out by individuals who lack even the most basic medical qualifications. As it stands, almost anyone can legally perform these procedures with minimal or no training - this is simply unacceptable in an industry dealing with people’s health and well-being. This tragedy is yet another wake-up call to the entire industry and the Government, and we hope this spurs them to act now for better regulations.’’

British College of Aesthetic Medicine reveals results of its Annual Clinical Survey 2023/2024

The British College of Aesthetic Medicine (BCAM) has released the results of its annual clinical survey, giving insights, in particular, into complications management.

BCAM members reported 1,913 complications across all procedures in the 12 month period, with the significant majority being minor complications, including bruising or patient dissatisfaction with overall aesthetic results. Severe complications with BCAM members are extremely rare; for example, the risk of soft tissue infection is as low as 0.003% in injectable treatments.

By contrast, BCAM members provided treatment to correct 3,547 complications resulting from aesthetic procedures carried out by other practitioners. A significant proportion of these (60%) were reported to have been carried out by beauticians, and complications included soft tissue infections, necrosis and scarring. Many of these complications require specialist, long-term treatment to correct, and high volumes of patients are referred to the NHS for ongoing care as a result.

A number of BCAM members reported atypical complications resulting from botulinum toxin treatments performed by beauticians, including localised erythema, followed by blistering and, eventually, scarring. It is the expert clinical opinion of these members that such atypical reactions suggest the use of counterfeit products.

Additionally, 30% of members report requests for treatment from children under 18 years of age. BCAM members received 62 requests to correct botched injectable treatments with botulinum toxin or dermal fillers, a treatment which has been a criminal offence to administer to a child under 18 years of age in England since October 1, 2021.

Dr Catherine Fairris, president of BCAM said, “BCAM are proud that our members have low complication rates and prioritise patient safety and evidence-based medicine. Our data shows a continued rising trend in complications caused by unqualified lay injectors, and we urge the Government to take action and bring forward robust legislation that will put patient safety at its core. We are hopeful that the new labour government will take this matter seriously, we will of course be sharing our data with them.”

Royal Society of Medicine now recognises

aesthetic

medicine as a specialty

The Royal Society of Medicine (RSM) Aesthetics Congress 2024 marked a defining moment in the evolution of aesthetic medicine in the UK, celebrating the creation of the newly established Section of Aesthetic Medicine and Surgery.

This historic development was approved under the leadership of Dr Christopher Rowland Payne (consultant dermatologist) with the support of Professor Gillian Leng, president of the Royal Society of Medicine and Professor Roger Kirby, immediate past president of the RSM. The section’s leadership reflects a commitment to multidisciplinary excellence, with Mr Jona-than Britto (consultant plastic and craniofacial surgeon) as presidentelect and Dr Souphi Samizadeh (dental surgeon and aesthetic physician) serving as secretary and vice-president.

Held over two days – on September 6 at the Royal Society of Medicine and September 7 at Devonshire Dermatology – this congress established a platform to unite specialists from the fields of aesthetic medicine and surgery. It highlighted the future of aesthetic medicine and surgery through collaboration, education, and a multidisciplinary approach to patient care. Experts and pioneers from both surgical and non-surgical fields came together to share knowledge and discuss evidence-based approaches to a wide range of aesthetic concerns.

As part of its ongoing commitment to education and collaboration, the RSM Aesthetic Medicine and Surgery Section will host a minimum of four events per year.

The next meeting of the Section of Aesthetic Medicine and Surgery will take place on Thursday, November 28, 2024, at 6pm. This event will feature the formal inception of the section by Professor Gill Leng CBE, president of the RSM. Following this, there will be an interactive discussion led by Professor Bill Shanahan, consultant psychiatrist, offering a multidisciplinary perspective on aesthetic medicine, mental health, and patient care.

Pioneer of cosmetic botulinum toxin, Alastair Carruthers, passes away aged 79

Alastair Carruthers, the pioneering physician and esteemed member of the medical community whose contributions left an indelible mark on the field of dermatology has passed away aged 79 following a courageous battle with Parkinson’s Disease.

Alongside his wife, Dr Jean Carruthers, Alastair led the discovery of the cosmetic use of botulinum toxin A. In 1987, the couple shared medical office space. Jean, an ophthalmologist, used a dilute solution of botulinum toxin to manage a patient with uncontrollable blinking. After the treatment, they discovered the wrinkle-relaxing effects of the toxin. Through years of additional research, they presented their results at the 1991 ASDS Annual Meeting, and by 1993, the new treatment was sweeping the cosmetic medicine arena. Botox® was the first FDA-approved treatment of its kind – beginning with its 2002 approval for treating glabellar lines. This revolutionary cosmetic procedure represented an evolution in aesthetic medicine and inspired a whole new genre of injectable cosmetic treatment options. The Carruthers are largely to credit for making Botox® a household name, and his passing leaves a deep void for many of his colleagues.

Alastair became the first Canadian president of the American Society for Dermatologic Surgery (ASDS) from 2006 to 2007. He was passionate about fostering the future of dermatologic surgery through education and engagement, establishing the first annual ASDS Gala, the ASDS Stegman Circle fundraising initiative and the Society’s advocacy arm, ASDSA, during his presidential tenure. Throughout his career, Alastair published more than 100 articles and authored several textbooks. These contributions were recognised with numerous honors, including the ASDS Samuel J. Stegman, MD, Award for Outstanding Service in 2010, the Philip Frost and Eugene van Scott Leadership Award in 2012, the ASDS Leadership in Innovation Lectureship in 2014 and the ASDS President’s Award in 2015.

Alastair is survived by his beloved wife, Jean; his children Thomas (married to Jennifer), Robert (married to Mollie) and Graham (partner Steve Hunt); and his four grandchildren Ogden, Hazel, Benjamin and Audrey. He is also survived by his sisters, Gail Cosbie-Ross and Bobbie Lintott; his great-niece Sally Cotterell (Amy, Josh and Darcy); and his nephew Benjamin Cosbie-Ross (Poppy and Daisy).

HRH Princess Beatrice calls for ‘More, More, More’ sun safety during London school visit

British Skin Foundation (BSF) patron, HRH Princess Beatrice of York, visited a London school to highlight the importance of sun safety from a young age. Backing the BSF’s ‘More, More, More’ sun safety campaign, HRH joined an assembly of nine to 10 year-olds at St Mary’s & St John’s CE School in north London to learn about sun safety.

Led by BSF representatives consultant dermatologist, Dr Anjali Mahto and head of communications, Lisa Bickerstaffe – HRH listened as the team explained the importance of wearing more protective clothing, using more sunscreen and seeking more shade during the summer months. After busting the myths and finding out the facts about sun safety, the children presented their own sun safety posters to HRH and the BSF team. The children were also given their own BSF wide-brimmed hats to protect themselves from UV rays.

Higher botulinum toxin doses may be needed in sunnier climes, says study

Higher botulinum toxin doses may be needed in sunnier climes, says study

A recent study published in Plastic and Reconstructive Surgery has revealed that higher doses of botulinum toxin may be required to achieve optimal results in regions with higher sun exposure. This finding could have significant implications for cosmetic practitioners, particularly those working in sunnier climates.

The research compared the outcomes of glabellar treatments between two groups of women. The first group, consisting of 292 women, was treated in Malta during the summer, while the second group, comprising 231 women, was treated in London during the winter. The results showed that the Malta group required a higher average dose of toxin – 29.2 units compared to 27.3 units in the London group. The Malta group also needed more frequent top-up doses, averaging 2.24 units versus 1.98 units in the London group.

The study’s lead author, Dr Kim Borsky, a surgical trainee, suggested that the increased dosage requirement in sunnier climates could be due to several factors. One possibility is that higher temperatures or direct sunlight affect the body’s response to the toxin. Another theory is that the glabellar muscles, which are more active in summer due to increased squinting from bright sunlight, may require a higher dose for effective paralysis.

“Our results indicate that practitioners may need to adjust their toxin dosing protocols to account for the effects of climate on the results of this cosmetic treatment,” Dr Borsky commented. The study’s findings underscore the importance of considering environmental factors in cosmetic procedures, particularly in regions with significant sun exposure.

Over one in 10 menopausal women consider quitting work due to lack of employer support, new report reveals

A new report from HR consultancy hoomph has revealed alarming statistics about the impact of menopause on women in the workplace. Titled “Menopause in the workplace: Breaking the silence,” the report examines the effects of menopause on women’s professional lives, revealing that insufficient workplace support can drive some to consider leaving their positions. Alarmingly, more than one in 10 women (15%) have thought about quitting due to menopausal symptoms, particularly in high-stress sectors like technology and healthcare. Adding to this concern, a significant 70% of women feel unsupported by their employers during this critical transition, emphasising the urgent need for improved resources and support systems in the workplace.

NEWS IN BRIEF STORIES

MIAM course takes place in Brussels

The third annual Minimally Invasive Aesthetics (MIAM) course is set to take place in Brussels. Led by Professor Ali Ghanem, MIAM is a one-day intensive course which offers both beginner and advanced practitioners the opportunity to expand their skills and knowledge in the latest aesthetic techniques. The course will delve into the practical application of advanced regenerative techniques, such as PRP, nanofat, and exosomes, ensuring attendees leave equipped to incorporate these innovative procedures into their practice.

Thérapie founder Paul McGlade dies following short illness

Well-known Irish entrepreneur and founder of Thérapie Paul McGlade Sr has died after a short illness. The 69-year-old had a business career spanning over 50 years. He set up the first Thérapie clinic on Molesworth Street in 2001 with the aim of making aesthetic treatments more accessible. It is now the largest aesthetics chain in the EU. It has 75 clinics world-wide, 1,800 employees, and revenues of more than €120 million. It recently announced it would open another 65 clinics over the next three years and create 1,000 jobs.

JCCP welcomes Dr Patrick Treacy as Key Opinion Leader

The Joint Council for Cosmetic Practitioners (JCCP) is pleased to announce the appointment of Professor Dr Patrick Treacy as a JCCP Key Opinion Leader (KOL). This appointment recognises Dr Treacy’s exceptional contributions to the field of aesthetic medicine and aligns with JCCP’s commitment to advancing patient safety and professional standards in the cosmetic industry.

Teoxane launches season 3 of successful podcast ‘The Drop’ Teoxane has announced that it is launching a third season of its popular podcast The Drop. Season three follows two incredibly successful seasons which have amassed over 3,500 downloads in 32 countries across the globe, with patients and professionals alike tuning in for their drop of the latest wellness and aesthetics news.

Alma welcomes Revanesse to the family, elevating patient results and clinic success. Together, we are stronger.

Skn Group goes into administration

The Skn Group announced it will cease trading in July. In a statement posted on its website, the company, which owned ABC Medical, sk:n Clinics, The Harley Medical Group, Skinbrands and The Skin Experts, said: “It is with regret that we advise that the Skn Group, including sk:n, The Harley Medical Group, Skinbrands, The Skin Experts and ABC Medical, has ceased trading as of July 17. The Mole Clinic is a separate part of the group and continues to trade as normal.

“The company has undertaken an extensive process to secure investment to enable it to continue trading, but sadly, we have been unsuccessful. We recognise that this outcome will have a significant impact on our team members and customers, and we are deeply sorry for the stress and inconvenience this has caused. We are doing all we can to address the concerns of those affected. We will be contacting all clients [who are] still awaiting test results as soon as possible. All further updates will be provided on this website as and when available.”

Plastic surgeon Dr Paul Banwell and anonymous artist Epi collaborate on “art meets medicine” project

Plastic surgeon and art collector Dr Paul Banwell and anonymous young artist Epi have come together for a “surreal experiment” highlighting the painting style of the late, great Lucio Fontana, who is famous for his ‘slashed’ canvases and the associated art movement of ‘Spatialism’.

The pair have worked together to take a unique spin on the Fontana-esque slashed canvases; leveraging Mr Banwell’s surgical prowess to suture some of his own slashed canvases. Deeming his art ‘Destructivism’, Epi takes well-known works and defaces them in a tonguein-cheek way, often rendering them absurd, comic, surreal or even outright offensive. Epi commented, “This entire project has allowed me – a chancer and a vandal – to piggyback off of someone with a real job and genuine skill to create something truly exceptional.”

Dr Banwell, who also founded regenerative health supplement brand ARTIS London in 2024, said: “I think these pieces have turned out really well and look sensational framed. Sat next to an original they are unexpectedly thought-provoking. I am a huge fan of Fontana myself, and when Epi explained his ideas and concepts for this project, I jumped at the chance to be involved. The sutured canvases represent a very cheeky but clever twist on these worldfamous pieces and are a classic example of Epi’s wonderful humour.”

Research reveals individuality is the new modern beauty ideal

Attitudes towards beauty and aesthetics are changing in relation to individuality. Latest research reveals that nearly half (49%) of people agree there is no longer such a thing as ‘classic’ or ‘traditional’ beauty.

Over 6,500 consumers across 12 countries took part in the study by Allergan Aesthetics, 500 of which were from the UK. When consumers were asked what is considered attractive, the UK scored the highest in feeling comfortable in their own skin (77% vs 67% globally). 95% of UK consumers surveyed believe that beauty means different things to different people. The findings show that individuality is now considered the paramount factor in defining beauty.

Allergan Aesthetics faculty member Dr Jonquille Chantrey said, “Embracing individuality is the new benchmark for beauty. We are witnessing a profound shift in aesthetic treatments as more of our patients are seeking to enhance their unique features and not conform to traditional standards. As aesthetic professionals it is our role to help empower the unique beauty in everyone fostering a culture of self-love and inner confidence.”

NEWS IN BRIEF STORIES

FACExpo conference returns to London this November

The Facial Aesthetics Careers and Education Exposition (FACExpo) is returning on November 23 at the Queen Elizabeth II Centre (QQEII) in London. The programme will feature non-clinical talks designed to inspire entrepreneurship, with key discussions on business growth. The clinical talks will look at the latest evidence-based practices, such as the effects of biostimulators on facelift surgeries, the organisers share.

L’Oreal strengthens strategic partnership with Galderm L’Oreal has announced the acquisition of a 10% stake in pharmaceutical company Galderma. In addition to the acquisition, L’Oreal and Galderma have agreed to collaborate on a strategic scientific partnership, leveraging Galderma’s expertise in dermatological solutions and L’Oreal’s skin biology and diagnostic capabilities.

Cosmetic Courses and Roseway Labs collaborate

Aesthetic training provider Cosmetic Courses, compounding pharmacy Roseway Labs and insurance provider MRSL Insurance will be running a new Menopause Level 1 Training course. The course is designed to cater for the growing need for specialised women’s healthcare. The training will cover the biological changes during menopause, common symptoms and the latest treatment options. It is open to general practitioners, nurses and other healthcare providers.

ISAPS study reveals 14 years of aesthetics trends

A study published by the International Society of Aesthetic Plastic Surgery (ISAPS) in Aesthetic Plastic Surgery has shown an increase in procedures from 2009 to 2013. The study states there has been a ‘more pronounced’ increase in both surgical and nonsurgical procedures since 2021, with a 40% overall uptick in the last four years. Body and extremity procedures have seen a significant boost, with more than 5.1 million in 2023 compared to 2.6 million in 2009. The top non-surgical procedures were botulinum toxin, hyaluronic acid, hair removal, chemical peels and nonsurgical fat reduction.

REGULATION SPECULATION

We speak to Professor David Sines about where we are in terms of the licensing scheme for cosmetic procedures in England.

Following recent speculation on social media about what is happening with regard to the UK licensing scheme for non-surgical cosmetic procedures, we sat down with Professor David Sines, the chair of the Joint Council for Cosmetic Procedures (JCCP) to ask him for his insights into what’s really going on and where we currently stand.

Consulting Room: People have been speculating on social media that now we’ve got a new government, and the consultation is showing as “closed” and “published under the 2022-2024 Sunak Conservative Government” that we weren’t going to progress any further in terms of UK regulation. What’s really happening?

Professor David Sines: The bottom line is this: none of us know when the Government will respond to that first consultation (which closed in October 2023). What was very clear in my mind was that had the Government not announced the election, there would have been an announcement by the Conservative Government, which would have resulted in the publication of their consultation response.

There were 11,800 responses to that consultation. That is powerful! So, with that in mind, I remain confident that the new Government will be in a strong place to validate whatever recommendations the previous administration was going to make.

I am confident things will be on track, but

the timeline may not be fixed. Hopefully, we will receive the Government consultation by October. I cannot predict what will be included in the Government’s response document, but I think I have a good idea of where common sense should take us.

CR: So, it’s not all over?

DS: Absolutely not. It is far from over and let me just say this: if anyone thinks it is or if anyone tries to make that happen, then this will flaunt the very real sense of opinion and consensus held amongst the majority of members of the public and stakeholders who are supportive of a new system of regulation for the sector.

So many people have worked on the design of the licensing programme. I have seen the sector unite around this over the past four years.

We have had exceptional support from Labour Government colleagues in opposition. Labour MPs actually led the All-Party Parliamentary Group on Beauty, Aesthetics and Wellbeing. The Conservatives supported this too, of course. So, I remain confident this will be back on track.

CR: Anything else you think it’s important for us to say at this stage when we’re in this no man’s land, so to speak?

DS: I think there are a couple of other things that are important. Firstly, don’t

rush off to buy qualifications or find a quick fix because you may regret that in the absence of knowing what will be acceptable in the future.

I don’t think people should be panicking. Moral panic is completely unnecessary. Talk to people who are having the conversations. The JCCP is one of those organisations.

Make sure you have full malpractice insurance. I have seen some of the insurance certificates and the indemnities; watch out. There will be a wake-up call for some of those.

The other thing is to remember your complaints procedures and your redress. Inform members of the public of what you can do and what you can’t do. Being honest is important, but much more importantly, value yourself and your own credibility and be proud of what you do. We are all on a journey to enhance the quality of our practice and our accountability.

Professor Sines will give a regulation update and lead a Q&A at Hamilton Fraser’s Aesthetics Business Conference on Tuesday, October 8. To book tickets, visit: https://www. hamiltonfraser.co.uk/aestheticsbusiness-conference

EVENTS

Croma anatomy workshop, Vienna, Austria

Croma hosted a two-day anatomy workshop for delegates in the beautiful city of Vienna, Austria.

The course was taught by Dr Konstantin Frank and Dr Rita Poddar, and international delegates from the UK, Ireland, Netherlands, and Nordics attended.

After welcoming delegates at Croma Headquarters, day one consisted of theoretical sessions with Dr Frank covering ‘Ageing of the face and how we counteract it’ and Dr Poddar discussing ‘Countourel® Polydioxanone (PDO) Threads in Facial Rejuvenation: Composition, Clinical Applications, Anatomical Considerations, and Selection Criteria’.

This was followed on day two with a guided tour through the Croma state of the art manufacturing site and a laboratory site.

After the tour concluded, delegates were split into small groups to work on cadavers under the supervision of Dr Rita Poddar and Dr Konstantin Frank.

The course provided a refreshed and improved understanding of facial anatomy, enabling practitioners to offer consistent treatment results with complication management and avoidance techniques.

The event concluded with a delegate and speaker dinner hosted by Croma’s head office.

FACE, Business Design Centre, London

FACE 2024 took place in July at the Business Design Centre in London.

Delegates from around the world came together to explore the latest innovations and trends in aesthetics. The conference featured 180 scientific presentations spread across five theatres, with more than 100 leading brands exhibiting.

Attendees could choose from four main agendas, including Advanced Injectables, Multispecialty Aesthetics, Industry Workshops, and the newly introduced Aesthetics Open Stage, which was free for all attendees. Topics covered ranged from injectables and regenerative medicine to business and practice management, genital treatments, and the latest medical devices.

FACE 2025 will take place on June 26-27 at the Business Design Centre. Visit www.faceconference.com to find out more.

Eden Aesthetics Jetpeel™ launch,

Eden Aesthetics hosted an exclusive evening launch event at Home House to announce its appointment as UK distribution partner for Jetpeel™.

The evening commenced with welcome drinks and a floating dinner service with a Bridgerton-themed string quartet, and there was an opportunity for surgeons, doctors, nurses, and medical practitioners to network with industry leaders and journalists.

Eden Aesthetics’ managing director Lindsay Gray opened the presentation with a welcome and shared the exciting advancements at the company, before handing over to Tim Cranko, the CEO at JetPeel™.

Cranko showcased Tavtech’s heritage and the patented technology of JetPeel™, which uses jet pressure energy to generate fine mist, highvelocity jet streams of liquid micro-droplets mixed with air that gently but effectively penetrates the skin at subsonic speeds.

Dr Nisha Menon then shared her experience of JetPeel™ in her practice, with more data about the technology, showcasing the results, practical application, and integration in a non-surgical practice.

Introducing...

by FaceSTIM is one of the unique features of the amazing Jovena® device. An intense facial workout which helps to tighten, volumise, and tone the skin and muscles. FaceSTIM gives the face a healthier and naturally younger look in a non-invasive and comfortable way.

• Activation of all muscle and face skin fibres at the same time

• Increase of collagen and elastin which counteract the signs of ageing

• Immediate – and long lasting – visible results

• Lifting effect without the use of needles

• FaceStim is suitable for all skin types, so everyone can benefit from having less wrinkles and more lift.

• No stick-on pads – every face is unique

• Comfortable treatment taking only 30 minutes per session

• Zero consumable costs

• Easy to sell courses to your clients

• Marketing support including ‘Elevate’ sales event.

Jovena the Uniquely Versatile Device

Jovena is a cutting-edge bio-regenerative platform designed to transform your approach to aesthetic treatments. Jovena® takes on a unique approach to skin regeneration by combining two patented modalities in a single device. Not only does it feature the amazing FaceSTIM, RF DiatermoContraction® to reach deeper dermal layers and muscles, it also includes class leading Fractional Plasma® options for minimally invasive microsurgery, in the form of three highly innovative handpeices.

Contact us to schedule a demo or learn more about this revolutionary device. Call: 07734 101 275 or 07867 397 106 or visit: amp-uk.co.uk

SKIN CONDITIONS SPECIAL

In this section:

Skin conditions and psychology

Psoriasis

Acne

Pigmentation

Rosacea

Skin news

SKIN CONDITIONS SPECIAL

THE HIDDEN IMPACT OF SKIN CONDITIONS

Specialist psychiatric nurse Nicola Noel discusses the psychosocial fallout from skin conditions

You see it every day in your clinic – the flare-ups, the breakouts, the scars, and the insecurities. But what about the emotional damage simmering beneath the surface?

As aesthetic practitioners, it’s easy to get caught up in the ‘before and after’ shots, but what happens in between?

The truth is, skin conditions don’t just wreak havoc on your clients’ appearance; they can take a brutal toll on their mental health. If you only focus on surface-level solutions, you’re missing the bigger picture. Acne, eczema, psoriasis, rosacea – they aren’t just skin-deep problems. These conditions are tied to anxiety, depression, social withdrawal, and, in extreme cases, body dysmorphia.

So, what can you do as a clinic owner or aesthetic practitioner?

Hint: it’s more than just prescribing creams.

Understanding the emotional rollercoaster

Clients with skin issues often experience a ripple effect of emotions. That little patch of redness or cluster of breakouts is more than just a physical discomfort – it’s a ticking time bomb for their selfesteem. The constant need to cover up, the avoidance of social events, the anxious glances in every reflective surface. This emotional baggage can affect how they approach life, relationships, and even professional opportunities.

Studies have shown that individuals with visible skin conditions are more prone to

develop social anxiety and are at higher risk of developing long-term mental health disorders. And that’s your client sitting in front of you, not just an abstract statistic.

You’re not just treating a face – you’re treating a mind.

Speak the language of empathy (not just science)

It’s not enough to throw a prescription or treatment plan at your client. Yes, your laser machines, dermal fillers, and chemical peels can offer amazing results, but what sets your clinic apart is how you make your clients feel.

Here’s how you can step up your game:

• Ask, listen, repeat: Before diving into solutions, ask about their daily struggles. How do they feel about their skin? What have they tried before? Make it a habit to listen, really listen, to their responses. If you gloss over this part, you’re glossing over a vital step in the healing process.

• Normalise the conversation: Let them know they’re not alone. Nearly everyone experiences some form of skin condition in their lifetime. Make it clear that it’s nothing to be embarrassed about. Clients need to know that skin issues are common, manageable, and treatable. You’re the professional, but you’re also their partner in this journey.

• Follow-up like you mean it: The treatment doesn’t end once they leave your clinic. A thoughtful follow-

up call or message goes a long way in showing that you genuinely care about their progress – both mentally and physically.

The power of self-image

Skin conditions are often a trigger for self-image concerns, and that’s where you can really make a difference. But it’s not just about improving their outward appearance; it’s about boosting their confidence from the inside out.

Here’s a tip – mirror work.

Encourage your clients to look in the mirror and focus on the features they DO love about themselves. Help them shift from a negative self-focus to appreciating their unique beauty.

Offer subtle nudges during consultations that empower your clients. Phrases like “This treatment will highlight your natural

glow” or “This will enhance your confidence” hit differently than just “This will clear your skin.”

You’re not selling perfection – you’re selling self-belief.

Create a ‘safe space’ clinic

Your clinic should be a sanctuary where clients feel seen, heard, and understood –not just treated. Build an atmosphere that fosters openness and vulnerability.

Think beyond aesthetics:

• Mental health training for your team: Equip your staff with basic training on mental health awareness. They’re often the first point of contact and can set the tone for the entire experience. A little compassion goes a long way.

• Honest treatment plans: Be upfront about timelines and

potential outcomes. Unrealistic promises can erode trust and amplify a client’s insecurities. By managing expectations, you create an environment of transparency and integrity.

Offer the full package: Beyond skin deep

You want to retain clients, right? Then, focus on holistic care. Partner with mental health professionals or counsellors who specialise in body image issues. Offer referrals as part of your service or even host workshops on building confidence and self-acceptance. Show your clients that you’re invested in their total well-being, not just their skin’s surface.

Remember, when you address the psychological impact of skin conditions, you’re not just improving their appearance – you’re transforming their entire sense of self-worth.

Let’s talk business: Building loyalty through trust

At the end of the day, treating the psychosocial effects of skin conditions is good business. When your clients feel supported on all fronts, they’ll keep coming back. The connection you build isn’t just skin-deep – it’s client loyalty 101.

Want more tips on how to create a holistic approach that retains clients and boosts business?

Contact me directly www.brain-workstherapy.com for a consultation on integrating mental health awareness into your clinic’s everyday operations. It’s time to be the practitioner that stands out – not just for flawless results, but for creating clients who feel confident in their own skin.

Because in your business, it’s never just about the skin. Adobe/freshidea

SKINFLAMMATION

Georgia Seago shares her experience with guttate psoriasis

I’ve had guttate psoriasis since November 2021. It appeared overnight as a small rash on my lower stomach and upper thighs. Fast forward two years, it covered my legs, arms, back and bum and occasionally sprung up on my face. It was misdiagnosed by various doctors (including aesthetic doctors), and it was actually a podiatrist who eventually suggested psoriasis after noticing a patch on my foot.

In the beginning, I just thought I could live with it, half-heartedly applying steroid cream here and there when it was just a bit of red, itchy skin, but it kept spreading and getting worse until I decided that I definitely couldn’t live with it and I resolved to do something about it because it had started to take a real toll on my mental health. My psoriasis was all I could think about. It was making me more self-conscious than I’d ever been in my life, and the itchiness was unbearable at times. I’d scratch until my skin bled and quickly got used to seeing flakes of skin all over my furniture and on the inside of closefitting clothes.

I started to research heavily into inflammatory skin conditions and how to get rid of them on pretty much every platform you can think of: online

forums, books, social media, podcasts, white papers, and websites. Every day, I was encountering a new “miracle cure” in the form of a cream, pill or plant, but unsurprisingly, these were all too good to be true.

The only solution that consistently came up as being genuinely effective longterm from first-person accounts was a significant change in diet that focused on gut health. So, in March this year, I started working with nutritionist Maz Packham of Nourishful Nutrition.

She specialises in autoimmune conditions (and actually has one herself, which she managed to get under control by addressing her nutrition and lifestyle). She was actually able to come off her medication after working with a nutritionist before she decided to train as one herself, so I finally felt like I had some tangible evidence that this approach could work.

I asked Maz to explain the link between psoriasis and gut health: “A key factor is dysbiosis, which is an imbalance of bacteria in the gut; potentially a lack of commensals and key cornerstone species and an overgrowth of pathogenic or opportunistic types. The result can affect the gut-skin

axis, which is a complex relationship between gut health and skin conditions, including psoriasis. The gut microbiome influences the immune system’s activity, and dysbiosis can alter this immune response and lead to inflammation. This is especially relevant in autoimmunity and conditions such as psoriasis because it can promote inflammatory cytokines involved in psoriasis and even promote an autoimmune reaction in the first place.”

The first phase was a very strict elimination diet for six weeks, which sounds intense – and it was – but I got used to it quickly and it was actually pretty “easy” because I had such clear instructions and lots of support from Maz. The idea was to cut out anything that could possibly be inflammatory or allergenic: gluten, dairy, eggs, alcohol, sugar, caffeine, red meat, nightshades, soy, corn, citrus... like I said, it was very strict. One goal was to massively up my plant intake, aiming for 30 different plants a week (including herbs, spices, nuts and seeds), so I prioritised fruits and vegetables, made fresh juices and snacked on fruit, veg and nuts.

Other than that, I was focusing on protein and healthy fats, and the rest of my food was mainly fish, chicken,

Images provided by author

quinoa, sweet potatoes, homemade soups, and salads - basically a super-nutritious diet rich in fatty acids and detoxifying, nourishing foods that gave my liver and gut a chance to rest and rebalance.

I had herbal teas and matcha instead of coffee and lots of fresh ginger water. I was also taking several supplements throughout the process, which Maz recommended for overall immune and digestion support. During the various protocol stages of my overall plan, these included a liposomal B-vitamin and mineral complex, digestive enzymes, vitamin D3 and K2, glutathione, digestive bitters, silymarin liposomal glutamine, a plant-derived antifungal, a probiotic, omega-3, probiotic powder, and hydrolysed collagen.

A few weeks after starting the initial detox, I did a very in-depth gut-health stool test, which was expensive but so worth it. “There is evidence to demonstrate that those with psoriasis often have an imbalance in their gut microbiome – this can be anything from a reduction in the number of beneficial bacteria and an increase in potentially pathogenic types which can promote or worsen inflammation. A comprehensive stool test analyses the diversity of your individual microbes along with other diagnostics, including (but not limited to) inflammation markers, details on digestive function including protein metabolism, and a marker called zonulin, which can be an indicator (but is not definitive) of gut permeability,” explains Maz.

We got a very detailed report about every aspect of my gut health, which also gave a pretty good picture of my overall healthunsurprising given that 75% of the immune system is in the gut 1 – and highlighted several areas where I needed a lot of support, namely dysbiosis, a strep colonisation, fat malabsorption and evidence of immune suppression. This enabled Maz to tailor the supplements for the next phase to exactly what I needed.

This was when we introduced the anti-fungal, probiotic, omega-3, probiotic powder and glutamine.

After around six weeks, I started slowly re-introducing the foods I’d excluded whilst still being mindful of what I was putting into my body and continuing to focus on my overall health and wellbeing with the tools Maz taught me. And while I still don’t know what my triggers are, I do know that cleaning up my diet and working on my gut and liver health worked because around four months after starting working with Maz, my skin started to clear, and the psoriasis patches faded away. It was incredible to watch my skin heal, and I’m so happy I took regular pictures to monitor the progress because once it started getting better, it changed rapidly.

In the months since, I’ve had a lot going on in my personal life, which meant I fell off the diet and supplements big time, and the psoriasis has reappeared, albeit nowhere near as bad as it was. I’m now continuing to work with Maz to prioritise my diet in a more manageable way given the stress I’m experiencing (stress management via nervous system support is also an important part of my plan) because I’ve learnt that consistency is absolutely key, and if you can’t be consistent, you simply won’t see results. Now that I know this approach works, I’m confident that I can stop the current flare in its tracks and manage it back into remission. I really want to give other psoriasis sufferers hope, because you absolutely can heal your skin naturally through diet and lifestyle change – I’m proof!

References

1. https://pubmed.ncbi.nlm.nih.gov/33803407/#:~:text=With%20

HORMONAL ACNE

Dr Ginni Mansberg explains the causes and treatment options

Acne vulgaris is a chronic inflammatory disorder affecting the pilosebaceous unit, which is comprised1 of the hair follicle and its associated sebaceous or oil gland and arrector pili muscle with an aperture at the skin’s surface.

In this article, I will cover the impact of hormones on acne. I will cover everything from the reason that up to 85% of women get an acne flair before their period,2 through to hormonal conditions like polycystic ovaries and even perimenopausal breakout. And through it all – the role hormones play in this skin condition.

But first, a quick overview of the four critical drivers of acne. All acne have these things in common:

1. Overproduction of skin cells plus slowed skin cell turnover leads to a build-up of skin cells3 that obstruct the

pilosebaceous unit.

2. Excessive oil production. This is often impacted by various cyclical and life phase hormone changes.

3. An overgrowth of the Cutibacterium acnes (C. acnes) bacteria.4 This is part of the healthy microbiome of the skin, but when it becomes the predominant microbe, acne results.

4. Inflammation: Inflammation is at the heart of acne6 , increasing erythema, sensitivity and dryness. The C. acnes bacteria as well as any other trauma from scratching and picking, using the wrong skincare such as facial scrubs, or from sunburn, can also increase inflammation.

Which hormones can affect the skin?

• Testosterone: The main culprit here

is testosterone which stimulates the oil glands to grow and pump out sebum AKA oil.7 Both men and women have and produce testosterone. Testosterone not only increases the production of oil but is also pro-inflammatory in the skin8 and increases retention of keratinocytes8 so it increases plugging of the pilosebaceous units.

• Dihydroepiandrosterone sulphate (DHEA-S): DHEA-S is the main precursor hormone made by the adrenal glands that can be converted to either testosterone or oestrogen.9 Studies have shown that the higher the levels of DHEA-S in the blood, the worse the acne.10

• Oestrogen: Oestrogen inhibits the growth of oil glands and slows down the production of oil.7 It does this partly by competing with testosterone, inhibiting its acne-charging effects.11Oestrogens are also anti-

inflammatory12 and promote wound healing.13

How do hormones affect women with acne?

Menstrual acne flares

Just before the menstrual period, oestrogen and progesterone levels decline rapidly, removing the healing properties of oestrogen. Up to 85% of acne sufferers say it gets worse just before the period.14

Polycystic ovarian syndrome (PCOS)

This is the most common hormonal condition affecting women and girls.15 And acne is the commonest symptom of PCOS.16 Given how common acne is in PCOS, and conversely how common PCOS is in women with acne, we should screen for this condition17 in all women with adultonset acne.

Perimenopause

Acne is common in menopause transition, AKA perimenopause, with studies showing that 26.3% of women are affected by acne breakouts between the ages of 40 and 49.18 PCOS might be the missing link17 in some women.

Women with peri and menopausal acne tend to have a lot of skin sensitivity, along with more redness, issues with pigmentation and scarring.18

Management of hormonal acne

Hormonal anti-acne Ingredients

1. Soap-free, gentle cleanser

Soap dries, irritates and disrupts the chemistry of the skin.19 A gentle cleanser twice a day for mild to moderate acne has been shown to reduce pimples20 without damaging the skin barrier or resulting in an overproduction of oil.

2. Vitamin A

Vitamin A skincare products are the first line for treating acne. The American Academy of Dermatology guidelines21 for acne state that “retinoids are the core of topical therapy for acne.” Retinoids work against acne in four ways21 by combatting:

a) The build-up of excess skin that plugs the pilosebaceous glands

b) Excess oil production

c) Overgrowth of C. acnes

d) Immune system overactivity and inflammation.

Dermatologists commonly prescribe prescription-only retinoids, but studies show21 that 61% of people using

prescription retinoids for acne experience irritation.

Many dermatologists are now opting for an over-the-counter retinoid product like retinaldehyde, AKA retinal, the most effective and best-tolerated form22 of vitamin A. It is also more effective and less irritating than its OTC cousin, retinol.

3. Niacinamide

Niacinamide has been shown to improve skin barrier function,23 reduce inflammation24 and excess oil production.25

4. Ceramides

As mentioned previously, people with acne, including hormonal acne, have dry skin with an impaired skin barrier. Treatments like prescription vitamin A or benzoyl peroxide dry out the skin further. Studies have linked using ceramides in skincare to better outcomes in acne as they reduce TEWL, erythema and scaling.26

5. Salicylic acid

Salicylic acid a good option for acne27 as it is exfoliating and has anti-inflammatory and anti-microbial properties.28 It can be used as part of a cleanser, as a leave on balm or in dissolving microneedles to reduce pimple size and inflammation.

6. Hydroxy acids

Hydroxy acids are gentle exfoliators, helping to break down acne lesions29 while also helping improve the absorption of retinoids like retinal.30 But high concentrations can cause significant side effects.31 They can’t be used by people with sensitive skin. PHAS like gluconolactone or lactobionic acid provide similar effects as AHAs but do not cause the irritation of classical AHAs.32 PHAs are less well studied than AHAs, but those done on acne33 have shown success when used alone or in combination with other AHAs or vitamin A.34

The pH of skincare products

The acidity of the skin is essential to ensure an effective skin barrier. People with acne tend to have a more alkaline skin,35 making their acne worse. One study found there was a significant decrease in acne lesions after just four weeks of using an acidic cleanser and moisturiser.36

Procedures for hormonal acne

Laser and light therapy, as well as photodynamic therapy, have been used in studies for acne and acne scars with varying success. Other procedures, including chemical peels, injecting plateletrich plasma, fractional radiofrequency and in-clinic microneedling, all have evidence, especially for acne scars. In terms of which is best, studies have concluded that each method has advantages and disadvantages, and the best results may come from

combining different techniques (including effective skincare.)37

Dissolving microneedle patches

Relatively new in skincare, dissolving hyaluronic acid microneedle patches have been found to be both anti-bacterial and anti-inflammatory in acne.38 These microneedle patches gently penetrate the skin, delivering antiacne ingredients to the pimple, along with the hyaluronic acid itself, which has its own anti-inflammatory and wound healing properties.39

Self-care for hormonal acne

Given that stress40 and lack of sleep41 can make acne worse, getting these under control will help.

Medications for hormonal acne

Metformin

Multiple studies have found that metformin, a medication traditionally used for diabetes, has incredible benefits for all the symptoms of PCOS, including acne42, when combined with diet and exercise.

The combined oral contraceptive pill

The pill or combined oral contraceptive pill contains oestrogen, which decreases ovarian testosterone production43, reducing oil production and acne, especially in PCOS. All pills work well to do this.44 The synthetic progesterone – or progestin can either increase or decrease the effects of androgens, depending on which one is used. The most powerful anti-androgen progestins are cyproterone acetate and drosperinone.44

Spironolactone

This diuretic has remarkable anti-androgen effects, with studies showing it helps combat acne.44 It can cause fatigue and hypotension, and it can dysregulate the cycle.

Hormonal acne is super tricky and can be devastating to your patient’s selfimage, but, with patience and the right combination of treatments and skincare it can be managed.

SKIN CONDITIONS SPECIAL

Resources

1. Martel JL, Miao JH, Badri T, et al. Anatomy, Hair Follicle. [Updated 2024 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.

2. Zeichner J, Baldwin H, Cook-Bolden F, Eichenfeld L, Friedlander S, Rodriguez D. Emerging Issues in Adult Female Acne. J Clin Aesthet Dermatol v.10(1); 2017 Jan PMC5300732

3. Zasada Z, Budzisz E. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol. 2019 Aug; 36(4): 392–397.

4. Dréno, B., Pécastaings, S., Corvec, S., Veraldi, S., Khammari, A. and Roques, C. (2018), Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol, 32: 5-14. https://doi.org/10.1111/jdv.15043.

5. Dréno, B., Dagnelie, M.A., Khammari, A. et al. The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol 21 (Suppl 1), 18–24 (2020).

6. Kanwar, I. L., Haider, T., Kumari, A., Dubey, S., Jain, P., & Soni, V. (2018). Models for acne: A comprehensive study. Drug Discoveries & Therapeutics, 12(6), 329-340. https://doi.org/10.5582/ ddt.2018.01079​:contentReference[oaicite:0]{index=0}​:contentReference[oaicite:1]{index=1}.

7. Bagatin E, Freitas THP, Rivitti-Machado MC, Machado MCR, Ribeiro BM, Nunes S, Rocha MADD. Adult female acne: a guide to clinical practice. An Bras Dermatol. 2019 Jan-Feb;94(1):62-75. doi: 10.1590/abd1806-4841.20198203. Erratum in: An Bras Dermatol. 2019 Mar-Apr;94(2):255. doi: 10.1590/abd1806-4841.2019940202. Machado MCR [corrected to Rivitti-Machado MC].

8. Lai JJ, Chang P, Lai KP, Chen L, Chang C. The role of androgen and androgen receptor in skin-related disorders. Arch Dermatol Res. 2012 Sep;304(7):499-510. doi: 10.1007/s00403-0121265-x. Epub 2012 Jul 25. PMID: 22829074; PMCID: PMC3763909.

9. Labrie F, Luu-The V, Labrie C, Simard J. DHEA and its transformation into androgens and estrogens in peripheral target tissues: intracrinology. Front Neuroendocrinol. 2001 Jul;22(3):185-212. 10. Iftikhar U, Choudhry N. Serum levels of androgens in acne & their role in acne severity. Pak J Med Sci. 2019 Jan-Feb;35(1):146-150. doi: 10.12669/pjms.35.1.131. .

11. Zhang R, Zhou L, Lv M, Yue N, Fei W, Wang L, Liu Z, Zhang J. The Relevant of Sex Hormone Levels and Acne Grades in Patients with Acne Vulgaris: A Cross-Sectional Study in Beijing. Clin Cosmet Investig Dermatol. 2022;15:2211-2219.

12. Harding AT, Heaton NS. The Impact of Estrogens and Their Receptors on Immunity and Inflammation during Infection. Cancers (Basel). 2022 Feb 12;14(4):909. doi: 10.3390/ cancers14040909. PMID: 35205657; PMCID: PMC8870346.

13. Horng HC, Chang WH, Yeh CC, Huang BS, Chang CP, Chen YJ, Tsui KH, Wang PH. Estrogen Effects on Wound Healing. Int J Mol Sci. 2017 Nov 3;18(11):2325.

14. Ma L, Jiang H, Han T, Shi Y, Wang M, Jiang S, Yang S, Yao L, Jia Q, Shao L. The menstrual cycle regularity and skin: irregular menstrual cycle affects skin physiological properties and skin bacterial microbiome in urban Chinese women. BMC Womens Health. 2023 May 31;23(1):292. doi: 10.1186/s12905-023-02395-z.

15. Fauser BC, Tarlatzis BC, Rebar RW, Legro RS, Balen AH, Lobo R, Carmina E, Chang J, Yildiz BO, Laven JS, Boivin J, Petraglia F, Wijeyeratne CN, Norman RJ, Dunaif A, Franks S, Wild RA, Dumesic D, Barnhart K. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012 Jan;97(1):28-38.e25. doi: 10.1016/j.fertnstert.2011.09.024. Epub 2011 Dec 6. PMID: 22153789.

16. Franik G, Bizoń A, Włoch S, Kowalczyk K, Biernacka-Bartnik A, Madej P. Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2018 Jul;22(14):4411-4418. doi: 10.26355/eurrev_201807_15491. PMID: 30058676.

17. Carmina E, Dreno B, Lucky WA, Agak WG, Dokras A, Kim JJ, Lobo RA, Ramezani Tehrani F, Dumesic D. Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Endocr Soc. 2022 Feb 6;6(3):bvac003. doi: 10.1210/jendso/bvac003. Erratum in: J Endocr Soc. 2023 Jan 24;7(3):bvad006.

18. Khunger N, Mehrotra K. Menopausal Acne - Challenges And Solutions. Int J Womens Health. 2019 Oct 29;11:555-567. doi: 10.2147/IJWH.S174292. PMID: 31754313; PMCID: PMC6825478.

19. Gfatter R, Hackl P, Braun F. Effects of soap and detergents on skin surface pH, stratum corneum hydration and fat content in infants. Dermatology. 1997;195(3):258-62.

20. Choi JM, Lew VK, Kimball AB. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Pediatr Dermatol. 2006 Sep-Oct;23(5):421-7.

21. Leyden J, Stein-Gold L, Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatol Ther (Heidelb). 2017 Sep;7(3):293-304. doi: 10.1007/s13555-017-0185-2. Epub 2017 Jun 5. PMID: 28585191; PMCID: PMC5574737.

22. Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327-48. doi: 10.2147/ciia.2006.1.4.327. PMID: 18046911; PMCID: PMC2699641.

23. Tanno, O., Ota, Y., Kitamura, N., Katsube, T., & Inoue, S. (2000). Nicotinamide increases biosynthesis of ceramides as well as other stratum corneum lipids to improve the epidermal permeability barrier. British Journal of Dermatology, 143(3), 524-531. https://doi.org/10.1111/j.1365-2133.2000.03705.x​:contentReference[oaicite:0] {index=0}​:contentReference[oaicite:1]{index=1}.

24. Draelos ZD, Ertel K, Berge C. Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea. Cutis. 2005 Aug;76(2):135-41. PMID: 16209160.

25. Bains P, Kaur M, Kaur J, Sharma S. Nicotinamide: Mechanism of action and indications in dermatology. Indian J Dermatol Venereol Leprol 2018;84:234-237

26. Draelos, Z. D., Baalbaki, N., Colon, G., & Dreno, B. (2023). Ceramide-containing adjunctive skin care for skin barrier restoration during acne vulgaris treatment. Journal of Drugs in Dermatology, 22(2), 554-559. https://jddonline.com/articles/ceramide-containing-adjunctive-skin-care-for-skin-barrier-restoration-during-acne-vulgaris-treatment-S1545961623P0554X&#8203 ;:contentReference[oaicite:0]{index=0}​:contentReference[oaicite:1]{index=1}.

27. Liu H, Yu H, Xia J, Liu L, Liu GJ, Sang H, Peinemann F. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database Syst Rev. 2020 May 1;5(5):CD011368. doi: 10.1002/14651858.CD011368.pub2. PMID: 32356369; PMCID: PMC7193765.

28. Arif T. Salicylic acid as a peeling agent: a comprehensive review. Clin Cosmet Investig Dermatol. 2015 Aug 26;8:455-61. doi: 10.2147/CCID.S84765. PMID: 26347269; PMCID: PMC4554394. 29. Goodman G. “Managing acne vulgaris effectively” (2006). Australian Family Physician, 35(9), 733-735. Retrieved from https://www.racgp.org.au/afp/ backissues/2006/11018​:contentReference[oaicite:0]{index=0}​:contentReference[oaicite:1]{index=1}.

30. Dall’oglio F, Tedeschi A, Fabbrocini G, Veraldi S, Picardo M, Micali G. Cosmetics for acne: indications and recommendations for an evidence-based approach. G Ital Dermatol Venereol. 2015 Feb;150(1):1-11. Epub 2014 Oct 15. PMID: 25315288.

31. U.S. Food and Drug Administration. (n.d.). Alpha Hydroxy Acids. Retrieved from https://www.fda.gov/cosmetics/cosmetic-ingredients/alpha-hydroxy-acids#q4

32. Grimes PE, Green BA, Wildnauer RH, Edison BL. The use of polyhydroxy acids (PHAs) in photoaged skin. Cutis. 2004 Feb;73(2 Suppl):3-13. PMID: 15002656.

33. Hunt MJ, Barnetson RS. A comparative study of gluconolactone versus benzoyl peroxide in the treatment of acne. Australas J Dermatol. 1992;33(3):131-4.

34. Decker A, Graber EM. Over-the-counter Acne Treatments: A Review. J Clin Aesthet Dermatol. 2012 May;5(5):32-40. PMID: 22808307; PMCID: PMC3366450.

35. Prakash C, Bhargava P, Tiwari S, Majumdar B, Bhargava RK. Skin Surface pH in Acne Vulgaris: Insights from an Observational Study and Review of the Literature. J Clin Aesthet Dermatol. 2017 Jul;10(7):33-39. Epub 2017 Jul 1. PMID: 29104722; PMCID: PMC5605222.

36. Kurokawa I, Kobayashi M, Nomura Y, Abe M, Kerob D, Dreno B. The Role and Benefits of Dermocosmetics in Acne Management in Japan. Dermatol Ther (Heidelb). 2023 Jul;13(7):1423-1433. doi: 10.1007/s13555-023-00943-x. Epub 2023 Jun 20. PMID: 37338719; PMCID: PMC10307753.

37. Chilicka K, Rusztowicz M, Szyguła R, Nowicka D. Methods for the Improvement of Acne Scars Used in Dermatology and Cosmetology: A Review. J Clin Med. 2022 May 12;11(10):2744.

38. Zhang T, Sun B, Guo J, Wang M, Cui H, Mao H, Wang B, Yan F. Active pharmaceutical ingredient poly(ionic liquid)-based microneedles for the treatment of skin acne infection. Acta Biomater. 2020 Oct 1;115:136-147. doi: 10.1016/j.actbio.2020.08.023. Epub 2020 Aug 25. PMID: 32853804.

39. Kang H, Zuo Z, Lin R, Yao M, Han Y, Han J. The most promising microneedle device: present and future of hyaluronic acid microneedle patch. Drug Deliv. 2022 Dec;29(1):3087-3110.

40. Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017 Dec 5;10:503-506.

41. Schrom KP, Ahsanuddin S, Baechtold M, Tripathi R, Ramser A, Baron E. Acne Severity and Sleep Quality in Adults. Clocks Sleep. 2019 Dec 6;1(4):510-516. doi: 10.3390/clockssleep1040039.

42. Naseem, R., Iftikhar, A., Aamir, M., & Latif, A. (2022). Role of Metformin in the Management of Polycystic Ovarian Syndrome-Associated Acne: A Systematic Review. Cureus, 14(7), e26579. https://doi.org/10.7759/cureus.26579

43. Shah D, Patil M; National PCOS Working Group. Consensus Statement on the Use of Oral Contraceptive Pills in Polycystic Ovarian Syndrome Women in India. J Hum Reprod Sci. 2018 AprJun;11(2):96-118. doi: 10.4103/jhrs.JHRS_72_18. PMID: 30158805; PMCID: PMC6094524.

44. Gainder S, Sharma B. Update on Management of Polycystic Ovarian Syndrome for Dermatologists. Indian Dermatol Online J. 2019 Mar-Apr;10(2):97-105. doi: 10.4103/idoj.IDOJ_249_17. PMID: 30984582; PMCID: PMC6434760.

The revolutionary Diode Laser & 3D IPL Combination System

Taking the ordinary and making it extraordinary, we present Alpha—the first-ever Diode Laser and 3D IPL Combination System. Alpha merges cutting-edge technologies into a single, versatile device, opening up a realm of possibilities for your clinic. So, what sets ALPHA apart?

Dual Power, One Device Alpha seamlessly integrates two of the most sought-after aesthetic technologies: the 808nm Diode Laser and 3D IPL. This powerful synergy not only enhances treatment outcomes but also optimizes your clinic's efficiency, reducing costs and streamlining operations.

Better. Faster. Stronger. Alpha redefines control, flexibility, and performance. Engineered for precision, it offers customizable settings to tailor treatments to each individual. The latest 3rd Generation Hair removal applicators use Power Motion technology to ensure the fastest hair removal treatment times available and superior results in hair removal, delivering flawless outcomes in just one pass. With Alpha, IPL is reimagined—delivering precision and speed like never before.

Transform Your Clinic With over 20 clinical applications, Alpha empowers you to expand your aesthetic offerings and elevate your practice. From vascular lesions and acne vulgaris to skin rejuvenation, hair removal, rosacea, and pigmented lesions, the possibilities are endless.

Precision Meets Personalisation Say hello to Milo, your Melanin Guide. This intuitive digital diagnostic tool eliminates the guesswork by providing accurate skin type readings, ensuring a personalized and effective treatment experience for every client.

SKIN CONDITIONS SPECIAL

COMPLEXION CORRECTION

We chat to Katie Parobek, clinic director and founder of The Well clinic about their Complexion Correction treatment

Consulting Room: Can you explain the role of melanocytes in skin pigmentation and how their impairment leads to hyperpigmentation?

Katie Parobek: Melanocytes are specialised cells that produce melanin pigments responsible for skin, hair, and eye pigmentation. When exposed to sunlight, the melanocytes produce increased amounts of the pigment melanin, causing the skin to darken or tan. Hyperpigmentation is the darkening of the skin, most often caused by an abnormally high amount of the skin pigment melanin.

CR: How does melanin protect the skin from UV radiation?

KP: Melanin absorbs the dangerous UV rays that can do serious skin damage. This is the process that gives you a tan. A tan is, in fact, a sign that your skin is trying to keep UV rays from damaging your skin.

CR: What inspired The Well to develop the Complexion Correction treatment?

KP: We are inspired by the newest developments in technology, as well as identifying our clients’ needs. When we notice a trend

or pattern in clients presenting to us, this very much drives and informs us with regard to the development of treatments that are most useful to achieve goals.

CR: How does the AgeJET system differ from other skin rejuvenation technologies on the market?

KP: AgeJET works in the deeper layers of the skin, as opposed to more traditional laser treatments, which work superficially. Heating the skin’s deeper layers makes the treatments much more effective in targeting pigmentation, scarring, acne, and skin tightening. It is unique as it can treat a wide range of skin types and conditions.

CR: Can you elaborate on how nitrogen plasma technology works to regenerate skin tissue?/What physiological responses are triggered by this treatment, and how do they contribute to skin healing and rejuvenation?

KP: AgeJET plasma device uses medical grade nitrogen gas to deeply penetrate the skin and stimulate tissues in targeted areas. This process creates a thermal injury deep within the skin to allow new cells to regenerate, whilst also protecting the outer layers of skin. After treatment, the outer layer of skin sheds to reveal a new

Images provided by author

layer of revitalised and refreshed skin with improved laxity and texture.

CR: Can you discuss the safety measures in place to ensure the treatment is effective yet gentle on the skin?

KP: All advanced treatments are preceded by a consultation to ensure the right treatment is chosen within a patient’s treatment planning. Consultations consider medical history, including medications, other ongoing treatments, etc. With this treatment specifically, a patch test is done on the day of the treatment to determine the settings to be used for treatment. All patients are provided with pre-care instructions to allow them to prepare for treatment and are assessed on the day to ensure treatment can safely proceed. Post-care instructions are discussed and provided in writing.

CR: What kind of improvements can patients expect to see in their skin tone and texture post-treatment?

KP: Typical results include reduced wrinkles and fine lines, reduced pigmentation, lifted and tightened skin, reduced eyelid drooping, reduced pore size, and improved tone and texture.

CR: How long does it typically take to see optimal results, and how long do these results last?

KP: Everyone is different, and treatment plans are customised to suit each patients’ individual needs. Typically, on average a course of 3 monthly sessions is recommended for best results, and maintenance sessions may be required. Results last for 6-18 months – this is very much determined by how the skin Is looked after during and after treatment.

CR: How is the energy level customised for different treatment areas and skin types?

KP: The AgeJET device has adjustable settings that we select based on a variety of factors, including what we are treating and skin type.

CR: Are there any specific post-treatment care instructions that patients should follow to maximise results?

KP: Yes, we have specific instructions both to prepare the skin for treatment, and how to care for it after treatment. The main thing to remember is to boost hydration levels in the skin before treatment, and to use a gentle cleanser, and use only a light moisturiser after treatment. And of course, no picking or peeling the skin!

CR: What sets this treatment apart from other minimally invasive skin rejuvenation procedures available today?

KP: Unlike many skin rejuvenation therapies, the AgeJET targets the deeper layers of the skin rather than focusing on the skin surface. This results in much longer-lasting and more visible results than devices which only target the surface. The plasma created with the nitrogen gas preserves the skin’s outer layer while new skin layers form. This takes place over the ten days following treatment, and noticeable improvements to the surface of the skin appear much quicker than with other skin therapies.

SKIN CONDITIONS SPECIAL

UNDERSTANDING ROSACEA

Julie Scott on identification, diagnosis, causes, triggers, and treatment approaches

Rosacea is a chronic skin condition that I frequently encounter in my practice. It primarily affects the face, causing redness, visible blood vessels, and sometimes acnelike bumps. While often misunderstood or misdiagnosed, rosacea is quite common and can significantly impact a person’s confidence and quality of life. In this article, I’ll share how I identify and diagnose rosacea, explore potential causes and triggers, discuss various treatment options, and describe my personalised approach to managing this condition in a clinical setting.

Identifying and diagnosing rosacea

Interestingly, many patients don’t initially come to me with concerns about rosacea. More often, they present with other aesthetic concerns, such as fine lines, wrinkles, pigmentation issues or even menopausal symptoms. However, because I digitally analyse all of my patient’s skin, I’m able to diagnose underlying rosacea and inflammation early – sometimes even before my patient is fully aware of it.

This early detection is crucial. By identifying and addressing rosacea in its early stages, we can prevent the condition from worsening, which is vital since rosacea can be a truly debilitating skin disease. Addressing it early helps to preserve the integrity of the skin and prevents the more severe complications that can develop if the condition is left untreated.

Diagnosing rosacea can be challenging because its symptoms often mimic those of other skin conditions, such as acne or eczema. However, there are several signs and symptoms that I look for when diagnosing rosacea:

• Persistent facial redness: The most common sign of rosacea is persistent redness or flushing in the central part of the face. This redness often

resembles a blush or sunburn that doesn’t go away.

• Visible blood vessels (telangiectasia): In some cases, I notice small blood vessels that become visible on the surface of the skin, particularly on the nose and cheeks.

• Bumps and pimples: Unlike typical acne, the bumps and pimples associated with rosacea do not contain blackheads. They appear as small, red, pus-filled bumps.

• Thickened skin: In more severe cases, the skin may thicken and enlarge, especially around the nose (a condition known as rhinophyma). I’ve observed that this symptom is more common in men.

• Eye irritation (ocular rosacea): Many individuals with rosacea experience symptoms affecting the eyes, such as dryness, irritation, swollen eyelids, or a feeling of grittiness.

Potential causes and triggers of rosacea

While the precise cause of rosacea remains unknown, I consider several potential factors that may contribute to its development:

• Genetic predisposition: Many of my patients with rosacea have a family history of the condition, suggesting that genetics may play a role.

• Abnormal immune response: Some studies suggest that an overactive immune response may contribute to rosacea. Specifically, the presence of certain antimicrobial peptides in the skin, such as cathelicidin, may provoke inflammation and vascular changes seen in rosacea.

• Demodex mites: These tiny mites live on the skin of most people without

causing problems. However, higher numbers of Demodex mites have been found in the skin of people with rosacea, leading some researchers to speculate that these mites could trigger an inflammatory response in susceptible individuals.

• Environmental factors: External environmental factors like sun exposure, wind, and temperature extremes can contribute to rosacea flare-ups and inflammation

• Vascular abnormalities: Abnormalities in the facial blood vessels may contribute to rosacea by causing persistent facial redness and visible blood vessels. The exact cause of these vascular changes is not fully understood but could be linked to neurovascular dysregulation or other factors.

• Microbial factors: The bacterium Helicobacter pylori, linked to gastrointestinal infections, has been associated with rosacea. It may increase levels of the digestive hormone gastrin, potentially causing flushing and redness.

Once rosacea is identified, a critical part of management involves understanding and avoiding common triggers. Over the years, I’ve observed that several factors consistently aggravate symptoms in my patients:

• Sun exposure: UV radiation is a wellknown trigger for rosacea flare-ups. I advise my patients to protect their skin from the sun with broad-spectrum sunscreen and protective clothing.

• Hot or cold weather: Extreme temperatures can cause rosacea symptoms to worsen. Both hot, humid weather and cold, windy conditions can irritate the skin and lead to flareups.

• Stress and emotional upset: Stress,

anxiety, and other strong emotions can trigger rosacea due to their impact on the body’s hormonal and vascular systems.

• Dietary triggers: Spicy foods, hot beverages, and alcohol, particularly red wine, are common dietary triggers for rosacea.

• Skincare products: Harsh skincare products, especially those containing alcohol, fragrances, or other irritating ingredients, can worsen rosacea symptoms.

Tailored treatment approaches

While managing triggers and using topical or oral medications are crucial, I’ve found that in-clinic treatments can make a significant difference in strengthening the skin and reducing the severity of rosacea symptoms. Here’s how I approach these treatments:

• Medical-grade facials: Specifically tailored to rosacea-prone skin, focusing on soothing and strengthening the skin barrier. I use high-quality, medical-grade products

that reduce inflammation and hydrate the skin, helping to calm redness and prevent flare-ups. Regular facials help maintain skin health and provide significant improvements in the skin’s overall barrier function.

• Microneedling: This minimally invasive treatment is effective in improving the skin’s texture and reducing the appearance of visible blood vessels associated with rosacea. By creating controlled micro-injuries, microneedling stimulates the skin’s natural healing process, promoting collagen production and strengthening the skin over time. While it’s not suitable for everyone, when used appropriately, microneedling can significantly improve the skin’s appearance and reduce the frequency of flare-ups.

• LED therapy: LED therapy is particularly beneficial for rosacea patients. This treatment uses specific wavelengths of light to penetrate the skin, reducing inflammation, calming redness, and promoting healing. Red light therapy, in particular, is excellent for reducing inflammation

Adobe/sashka1313

and strengthening the skin’s barrier. Regular sessions of LED therapy can lead to noticeable improvements in skin tone and a reduction in overall skin sensitivity.

In addition to traditional in-clinic treatments, I’m currently undertaking studies using more advanced treatment options to help strengthen the skin and improve its resilience against rosacea:

• Profhilo: Although primarily known for its hydrating and rejuvenating properties, I’ve observed that Profhilo, despite being a pro-inflammatory treatment, often improves the skin condition of my rosacea patients. Profhilo works by stimulating the production of collagen and elastin, which can enhance the skin’s structural integrity and hydration. This, in turn, can help to calm the skin and reduce the frequency of flare-ups, even though this was not its original intended use.

• Polynucleotides: I’ve also been incorporating polynucleotides into treatment plans. These molecules

SKIN CONDITIONS SPECIAL

• play a crucial role in improving the skin’s cellular matrix, which helps in strengthening the skin’s overall structure and function. Polynucleotides work by promoting tissue regeneration and improving skin elasticity, which can be particularly beneficial for rosacea patients. By enhancing the cellular matrix, these treatments help to fortify the skin against external triggers and reduce the severity of rosacea symptoms over time.

Finally there are several medical-grade skincare ingredients that I find effective in treating rosacea. These ingredients help address the inflammation, redness, and sensitivity often associated with the condition.

• One key ingredient I often prescribe is niacinamide. Known for its anti-inflammatory properties, niacinamide helps reduce inflammation and soothe irritation, making it ideal for patients with rosacea. Additionally, it strengthens

References

• Ceramides are another essential ingredient. They help repair and protect the skin barrier and shield the skin from environmental irritants that can trigger inflammation. Ceramides are also excellent for hydration, as they are lipid molecules that lock in moisture and reduce inflammation.

• Lastly, hyaluronic acid is a favourite among patients due to its superior hydrating properties. It provides deep moisture without clogging pores, which is particularly beneficial for those experiencing dryness and irritation from rosacea.

Overall, these ingredients work best when used together as part of a comprehensive skincare regimen. It’s important to start with a tailored skincare routine, maintain it consistently, and integrate other in-clinic treatments for optimal management of rosacea.

the skin’s barrier function, enhancing its resilience and hydration.

• Another effective ingredient is azelaic acid, which is excellent for reducing inflammation. It works by targeting acne-causing bacteria and helping to minimise hyperpigmentation, redness, and uneven skin tone often seen in rosacea patients.

• Sulfur is an underrated yet highly effective ingredient due to its antiinflammatory and antibacterial properties. I frequently recommend the ZO Sulfur Mask for my patients as it helps reduce inflammation and the risk of breakouts by absorbing excess oils, which can be a contributing factor to rosacea flare-ups.

• Retinol can also be beneficial in improving skin texture and accelerating cell turnover, which helps prevent clogged pores that could exacerbate rosacea. However, I use retinol cautiously with my rosacea patients because it can increase skin sensitivity, so it’s not typically my first choice.

Final thoughts from my practice

Treating rosacea effectively requires a holistic approach that combines medical interventions with lifestyle changes and in-clinic treatments designed to strengthen the skin. What I find most rewarding is seeing the transformation in my patients— not just in how their skin looks, but in how it feels and how they feel about themselves. Rosacea, when left unchecked, can have a debilitating effect on the skin, leading to discomfort and a significant loss of selfesteem. By getting this chronic condition under control, I’ve seen patients regain their confidence and enjoy not only clearer skin but also healthier skin that feels good from the inside out.

For anyone dealing with rosacea, finding a practitioner who understands the condition and can offer a personalised, multi-faceted treatment plan is crucial. With the right strategies in place, it’s entirely possible to manage rosacea effectively, preventing it from worsening and minimising its impact on daily life.

1. National Rosacea Society. Available at: https://www.rosacea.org/ (Accessed: 05 August 2024).

2. Wilkin, J., Dahl, M., Detmar, M., Drake, L., Feinstein, A., Odom, R., and Powell, F. (2002) ‘Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea’, Journal of the American Academy of Dermatology.

3. Two, A. M., Wu, W., Gallo, R. L., and Hata, T. R. (2015) ‘Rosacea: Part I. Introduction, categorisation, histology, pathogenesis, and risk factors’, Journal of the American Academy of Dermatology.

4. Steinhoff, M., Schauber, J., and Leyden, J. J. (2013) ‘New insights into rosacea pathophysiology: A review of recent findings’, Journal of the American Academy of Dermatology.

SKIN NEWS

AlumierMD launches advanced sunscreen range with MultiEnvironmental Protection

AlumierMD has recently reformulated its sunscreen line to address more than just UV protection. The new range includes Sheer Hydration and Clear Shield, which are designed to combat six key environmental aggressors: infrared radiation, high energy visible light (HEV), pollution, UVA and UVB rays, and free radical damage.

This approach aligns with increasing consumer awareness and demand for skincare that does more than prevent sunburn, aiming to slow ageing and protect against everyday environmental stress.

Eden Aesthetics introduces Neova Silc Sheer 2.0 SPF 50

Neova’s new Silc Sheer 2.0, available from Eden Aesthetics, combines physical blockers and chemical filters, offering broad-spectrum SPF 50 protection while enhancing skin aesthetics.

This product is at the forefront of integrating DNA repair and photoaging science, providing a solution that not only prevents damage but also aids in cellular recovery. This innovative blend of protection and treatment represents a significant advancement in sunscreen technology, reflecting Neova’s 20 years of research in cellular regeneration.

In clinical trials 95% of patients noticed lasting enhancements in the mid-face area after the first treatment, with this improvement sustained three months later.

mesoestetic® unveils next-generation sunscreens with PHOTON Technology

mesoestetic® has launched an advanced version of its mesoprotech® sunscreens, now featuring the new PHOTON technology. This innovation is activated by solar radiation to increase protective efficacy and repair cell damage.

The upgraded line offers comprehensive protection against a broad spectrum of light, including UVB, UVA, HEV, and infrared radiation, and incorporates photolyase enzymes that repair DNA damage.

Environ advances skincare with new retinol boosters for enhanced longevity

Environ Skin Care has introduced two new intensifying retinol serums to its product lineup, developed to complement the daily use of vitamin A and target ageing at the cellular level.

These serums are designed to optimise the skin’s reception to retinoic acid, enhancing effects on wrinkles, elasticity, and moisture. Recommended as add-on boosters to daily vitamin A topical replenishment, the serums can be introduced when the skin is acclimatised to medium or high concentrations of vitamin A. The launch is supported by extensive research by Dr Des Fernandes, who emphasises the critical role of vitamin A in managing the biological age of the skin, offering users both preventative and reparative benefits.

SMART COMBINATION THERAPY

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:

Managing complications

Weight management in aesthetics

Abstracts

FROM FAT TO FAB… WITHOUT THE COMPLICATIONS

Mr Arturo Almeida delves into the hot topic of complications after fat-dissolving injections and shares his unique framework to prevent it

Fat-dissolving injections (FDIs), such as Aqualyx, have established themselves as an effective, non-surgical solution for reducing localised fat deposits. For patients seeking to reduce stubborn fat deposits in areas like the abdomen, thighs, or the annoying double chin, FDIs offer quick, effective results and can be combined with other body contouring treatment modalities. While FDIs are generally safe, the ability to prevent and manage complications is a skill every aesthetic practitioner must master.

In this article, I’ll explore not only the common and serious side effects associated with fat-dissolving injections but also a unique framework I have developed through 16 years of experience using FDIs that will help to prevent both side effects and complications. Shall we begin?

Understanding fat-dissolving injections

FDIs typically utilise deoxycholic acid, a compound naturally found in bile, to break down and destroy fat cells. Once the fat cells are broken down, an inflammatory reaction will occur where the macrophages remove the cell remnants and the released fat is eliminated through the lymphatic system. Typically, an average of three sessions are required. Though generally safe when administered by a trained professional, FDIs do carry the risk of complications, especially if proper care and technique are not followed.

Complications can range from common side effects like swelling to more serious issues such as skin necrosis. Adobe/HENADZY

Swelling

Bruises

COMMON SIDE EFFECTS

Discomfort/Pain

Numbness

Managing common side effects

POSSIBLE SIDE EFFECTS

Numbness

Inflammatory nodules

Hair loss

While most FDI treatments proceed smoothly, some common side effects are expected and must be managed to ensure patient comfort and satisfaction. Swelling, bruising, and pain are the most frequent complaints, but with proper management, they are generally short-lived.

Swelling, which occurs in up to 87% of patients, is caused by the inflammatory response as fat cells break down. Although swelling is part of the expected recovery process, it can cause anxiety for patients if not properly managed. Practitioners should reassure their patients that this is a normal response and will subside within a few days to a few weeks. Compression garments can help reduce swelling and speed up the recovery process by promoting lymphatic drainage. It’s also important to advise patients to avoid NSAIDs, as these can interfere with the necessary inflammatory response.

Bruising affects approximately 72% of patients and is typically caused by needle insertion. This minor issue can be minimised by applying cold compresses immediately after treatment and advising patients to avoid medications (unless prescribed for a medical condition) or supplements that may affect coagulation before their procedure. Bruising generally resolves within one to two weeks, and topical treatments such as arnica gel can speed up the healing process.

Discomfort/pain is normally well tolerated, and in many cases, perceived just like “muscle cramps” after exercise. The use of

RARE SIDE EFFECTS

Skin Necrosis

Dysphagia

Severe allergic reactions

local anaesthetics before treatment or mixed with the product can significantly reduce discomfort. Over-the-counter pain medications, such as paracetamol, are effective for managing post-procedure pain. However, if the pain persists, it’s important to schedule a follow-up consultation to rule out any complications.

Numbness is another common side effect, with 66% of patients reporting temporary nerve irritation. This usually resolves within a few weeks and does not typically require intervention beyond reassurance.

Other possible side effects

Induration, perceived as tissue hardening at the treated area, can occur in about 23% of patients. This hardening is part of the body’s inflammatory response to the breakdown of fat cells. Gentle massage can help prevent or alleviate induration, but in more persistent cases, deeper massage or physical therapy may be required.

Inflammatory nodules, occurring in around 13% of patients, are typically the result of localised inflammation in response to the injected solution. These nodules are usually harmless and resolve on their own, but in cases where they persist, intralesional steroid injections can be used to reduce inflammation.

Hair loss has been reported in up to 9% of male patients treated at the submental area. It is normally seen as patchy hair loss in this region and may prevent an even growth of the beard. This is a temporary side effect, with no specific treatment, and it resolves on its own, although it may take up to eight weeks for full recovery.

Managing serious complications

While much less common, serious complications can occur if FDIs are not administered correctly. Skin necrosis and dysphagia (difficulty swallowing) are among the more severe risks.

Skin necrosis, although uncommon, can occur when the lytic effect of deoxycholic acid affects the cell membrane of the epidermis and/or dermis cells. This mechanism is completely different from dermal fillers, where there is a compromise in the blood supply, whether extrinsic (compression of an artery) or intrinsic (intravascular occlusion by the filler). For this reason, symptoms are almost never acute but more subtle. Initially, a prolonged inflammatory reaction is seen, followed by hardening of the tissue and finally necrosis. This is a serious complication that requires immediate intervention, with oral antibiotics and effective wound debridement and management. The few case reports published show a restitutio ad integrum when properly managed. Exquisite

CLINICAL

injection technique and adherence to the 3R® Rule are essential for preventing this life-altering complication.

Dysphagia, which most often occurs when treating submental (double chin) fat, is another rare but serious complication reported in less than 2% of cases. This occurs when the marginal mandibular nerve is injured, affecting the ability to swallow. In most cases, dysphagia resolves with time, but severe cases may require intervention. Dietary adjustments and possibly medical treatments, such as muscle relaxants or oesophagal dilation, may be needed.

Severe allergic reactions, while extremely rare, can also occur, making thorough patient screening before the procedure crucial. Any previous allergic reactions to injections or medications should be noted, and a patch test might be advisable in high-risk patients. Should an allergic reaction occur, intravenous steroids should be administered, but in the rare case of anaphylaxis, epinephrine may be required.

The 3R® rule for prevention

One of the cornerstones of my practice and training is the 3R® Rule, a framework I developed specifically for preventing complications in aesthetic procedures, particularly with FDIs. The rule is simple yet highly effective:

Right patient: Selecting the right candidate for FDI is crucial. Not every patient is suited for fat-dissolving injections. For instance, patients with loose skin or certain underlying health conditions may be at greater risk for complications. Thorough screening and consultation are key to ensuring you have the right patient in your treatment chair.

Right area: This refers to understanding the anatomy of the area being treated. Certain areas are more prone to complications

due to their proximity to blood vessels, nerves, or other sensitive tissues. Knowing the correct injection depth and location is crucial for avoiding issues like skin necrosis or prolonged swelling.

Right technique: Even with the right patient and area, poor technique can still lead to complications. This is related to both the choice of product - not all FDI are equal - as well as deep knowledge of the chosen agent .Right technique involves not only the correct injection depth and product distribution but also the volume of the solution used. Administering too much product in one area can lead to unnecessary inflammation, while too little can result in ineffective treatment.

My 3R® Rule is not just a guidelin – it’s a commitment to delivering the safest and most effective treatment possible.

Patient education and aftercare

Preventing complications isn’t just about what happens in the clinic – it also extends to the aftercare you provide. Patient education plays a pivotal role in minimising complications. Patients should be fully informed about what to expect, including potential side effects, how long they will last, and when they should contact you if something feels amiss.

Clear aftercare instructions are crucial. Advise patients to wear compression garments when necessary, avoid strenuous exercise for a few days, and refrain from taking certain medications that may increase the risk of bleeding or swelling.

Follow-up appointments should be scheduled as part of the standard procedure. These appointments allow you to monitor the patient’s recovery and catch any potential complications early.

Mastering complication management

In conclusion, prevention is always better than cure. By selecting the right patients, understanding the anatomy of the treated area, and using the correct techniques, complications can often be avoided. However, in the rare instances when complications do arise, early intervention and management are key to ensuring positive outcomes.

As aesthetic practitioners, our responsibility is to not only provide treatments but to offer safe, effective solutions that enhance our patients’ quality of life. By mastering the prevention and management of FDI complications, you set yourself apart as a practitioner committed to excellence.

References

1. Farina GA, Cherubini K, Zancanaro MA, Gonçalves F. Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects and complications. J Cosmet Dermatol 2020;19:2497-2504

2. Fagien S, McChesney P, Subramanian M, Jones DH. Prevention and Management of injection-related adverse effects in facial aesthetics: Considerations for ATX-101 (Deoxycholic acid injection) treatment. Dermatol Surg 2016;42:11S:S300-S304

3. Di Toro G, Rauso R. Skin Necrosis following adipocytolytic solution injections. Aesthet Sur J 2016;36(2):NP74-NP76

4. Souyoul S, Gioe O, Emerson A, Hooper DO. Alopecia after injection of ATX-101 for reduction of submental fat. JAAD Case Reports 2017; 3(3):250-253

5. Amore R, Pinto H, Gritzalas K, Hernández C, Skwara-Guzikowska K, Amuso D, Leonardi V. Intralipotherapy, The State of the Art. Plast Reconstr Surg Glob Open 2016;4:e1085

Lead generation with full access to your clinic search stats in your Members Area to monitor performance and achieve your best ROI

Increased web presence and search engine optimisation (SEO)

FREE CPD-certified aesthetician training: The art of the aesthetic consultation

Multiple routes to engage directly with consumers including a public Q&A

Learn to harness the full power of your social media with our FREE online course

FREE certificated training on how to scale up and generate highpaying clinic clients on auto-pilot

FREE certified reception training: Converting calls to consultations with call-handling and CRM training

A clinic page with multiple links to your website/ways for clients to get in touch

Discounted access to ConsultingBot: An intelligent AI chatbot that engages in conversations with visitors to your website to increase sales enquiries and answer queries

Access CPD-certified articles, educational content and FREE business support

FREE Guidance and template documentation for Health & Safety, Human Resources and Employment Law compliance

Discounted rate for Cosmetic Recruitment services

FREE Unlimited classified advertising for equipment, rooms for lease or even your aesthetic business

Advertise your own training courses and events at a discounted rate

Discounted access to clinic building services and software

Increase your profile through becoming a blog author in our consumer and/or clinic facing blogs

Plus much, much more!

WEIGHT LOSS IN AESTHETICS

Are you jumping on the band wagon, asks Piroska Cavell

It is apparent, particularly in the aesthetics industry, that a lot of practitioners and businesses are encouraged to take up the next biggest thing incorporated in the blurred lines between aesthetics and wellbeing. But is this serving our patients?

There is a plethora of training courses now available for issues such as weight loss, but is a one- to two-day course ethical? Can that cover enough to help practitioners understand these complex issues? Does learning from a one-two day course online or how to use the pens make you any better than the non-medics who can also access the same level of training for weight loss?

I argue that there is a lot more to weight loss than just being able to prescribe and demonstrate the use of the medication. Statistics show that 13% of adults have considered suicide due to body image concerns1 and a direct correlation between an increased risk of depression with patients having a BMI of 30 and above.2 This is an extremely important area of concern.

Weight loss comes with a significant impact on the patient’s emotional and physical well-being. This is not a treatment that can be easily corrected or reversed. The mismanagement of weight loss treatment has the potential for devastating side effects and

psychological damage.

The attempt at regulation to protect patients is flimsy and, at best, confusing. From the Care Quality Commission (CQC): “The regulated activity of services in slimming clinics only applies where a medical practitioner provides or supervises advice or treatment in a clinic, including prescribing medicines, for the purposes of weight reduction” (CQC 2024).3

The key here is “In a clinic.” Although remote prescribing technically goes against regulations and guidelines relating to prescription-only medicine, remote prescribing linked to selling online products is a grey area, and some online pharmacies and companies providing online doctor services are exempt from CQC regulation. Also, the location title is ambiguous. If you do not class yourself as a “Slimming clinic”, you do not fall under CQC regulation. But if you are offering slimming services, you do. It has to do with the CQC regulatory requirement ‘The treatment of disease disorder and injury’; obesity is seen as a disease there, so if you are treating it, you should be registered with the CQC. This fluffy and non-specific language surrounding regulation serves to place vulnerable patients at increased risk rather than offer them protection. As a practitioner, can you hand on heart say you

understand the complexities of weight loss? Are you in a genuinely qualified position to discuss patients’ emotional drivers and establish plans for behavioural change? Do you fully understand the links between body image and disordered eating and how to identify and manage a patient with a history of disordered eating? Or are you actually profiting from vulnerable patients and the ease of making a sale?

Harsh, I know, but it is apparent that this is exactly what is happening in certain areas.

Intelligent, affluent patients who do not meet the criteria for these medications, individuals with a history of disordered eating and those who are desperate to lose weight as they are clinically and morbidly obese are all able to access these medications without any real consultation, safeguarding or support.

This leads to some patients suffering worrying side effects from

References

taking medication contraindicated with their other medicines or health conditions. Those who really need help and attempt to rely solely on weight loss drugs without vital guidance and support are often left in an even more desperately unhappy state.

It is impossible for a patient who genuinely requires weight loss treatments to sustain weight loss without significant input from a practitioner who can offer the experience and knowledge to create a personalised plan that is not just a diet sheet but a plan aimed at tackling emotional blocks, gut health, lifestyle, ingrained habits, addiction, and more.

If you are not formally qualified in weight management, and you cannot, or are not offering this level of service, essentially you are purely selling medication. You should ask yourself if this is the level of patient care and service you feel your patients deserve and is it ethical?

1. MentalHealth.Org.UK (2024) Body Image-How we Think and Feel About Our Bodies [Online] Available at: mentalhealthuk.org.

2. Moussa,O.M.Ardissimo,M.Kulatilake,P et al (2019) ‘Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition’ [Online] Clinical Obesity 9 (3) p12305 Available at: DOI: 10.1111/cob.12305.

3. Care Quality Commission (2024) Scope of registration: Who has to register? [Online] Available at: https://www.cqc.org.uk/ guidance-regulation/providers/scope-registration-who-has-register.

EFFICACY

AND SAFETY OF

CO2 FRACTIONAL LASER VERSUS

ER:YAG FRACTIONAL LASER IN THE TREATMENT OF ATROPHIC

ACNE SCAR: A META-ANALYSIS AND SYSTEMATIC REVIEW

Fei Liu MD, Qiujun Zhou PhD, Maocan Tao PhD, Luying Shu MD, Yi Cao PhD Journal of Cosmetic Dermatology. Volume23, Issue9. September 2024.

BACKGROUND:

To date, a consensus on the relative efficacy and safety of CO2 fractional laser versus erbium-doped yttrium aluminium garnet (Er:YAG) fractional laser treatments for atrophic acne scars has not been reached. This meta-analysis aims to systematically assess and compare their effectiveness and safety in clinical practice.

METHODS:

For this meta-analysis, we conducted comprehensive searches in Pubmed, Embase, and Cochrane databases, covering publications from their inception up to August 2023. Our focus was on studies comparing fractional CO2 laser with Er:YAG fractional laser treatments for atrophic acne scars. We excluded duplicate publications, research lacking full-text access, incomplete data, or cases where data extraction was not feasible. Additionally, animal experiments, reviews, and systematic reviews were not considered. Data analysis was performed using STATA 15.1.

RESULTS:

Eight studies (seven randomised controlled trials (RCTs) and a retrospective study) were included in this meta-analysis. The

sample size ranged from 28 to 106 with 418 patients, including 210 in the CO2 fractional group and 208 in the Er:YAG fractional group. The pooled results showed that the effective rate of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (OR = 1.81, 95% CI: 1.08–3.01) and the downtime of CO2 fractional laser in treating atrophic acne scar was significantly shorter than that of Er:YAG fractional laser (Weighted Mean Difference (WMD) = −2.11, 95% CI: −3.11 to −1.10). In addition, VAS of CO2 fractional laser in treating atrophic acne scar was significantly higher than that of Er:YAG fractional laser (WMD = 1.77, 95% CI: 1.32–2.21) and the duration of erythema of CO2 fractional laser in treating atrophic acne scar was significantly longer than that of Er:YAG fractional laser (WMD = 1.85, 95% CI: 1.63–2.07). However, there was no significant difference in the duration of pain and incidence of PIH between CO2 fractional laser and of Er:YAG fractional laser.

CONCLUSION:

When it comes to treating atrophic acne scars, CO2 fractional laser demonstrates superior efficacy and leads to shorter downtime. However, it is important to note that CO2 fractional laser treatments tend to result in higher pain intensity and may carry a higher risk of post-treatment pigmentation compared to Er:YAG fractional laser procedures.

CARBON-ASSISTED Q-SWITCHED ND:YAG LASER AND MICRONEEDLING DELIVERY OF BOTULINUM TOXIN: A PROSPECTIVE PILOT STUDY

Turco, Piergiorgio; Conforti, Claudio; D’Andrea, Francesco; La Padula, Simone Plastic and Reconstructive Surgery. 154(3):521-529, September 2024.

BACKGROUND:

Carbon-assisted, Q-switched, neodymium-doped yttriumaluminum-garnet laser treatment consists of applying a topical carbon suspension all over the face, followed by irradiation with a Q-switched 1064-nm neodymium-doped yttrium-aluminumgarnet laser. The delivery of multiple microdroplets of dilute onabotulinum toxin type A into the dermis has been investigated as a tool for facial rejuvenation. The aim of this study was to assess the effectiveness of the combined treatment with botulinum toxin and carbon peel laser (performed with a standardised technique) in patients with seborrhea, dilated pores, and wrinkles and to demonstrate its benefits in improving the overall skin aspect.

METHODS:

Patients enrolled in this prospective pilot study underwent three sessions of the combined treatment carried out three months apart. To evaluate the improvement of skin texture, wrinkles, dilated pores, and acne lesions, the Fitzpatrick Wrinkle Assessment Scale, the Physician Global Aesthetic Improvement Scale, a photographic scale for the pore assessment, and the Investigator Global Assessment of Acne scale were used. The FACE-Q was also administered to assess patient satisfaction. The scores obtained were compared using a paired t test.

RESULTS:

Twenty patients were recruited. The differences between pretreatment and posttreatment scores were statistically significant ( P < 0.05) on the Fitzpatrick Wrinkle Assessment Scale, Physician Global Aesthetic Improvement Scale, Investigator Global Assessment of Acne scale, FACE-Q, and photographic scale for the pore assessment.

CONCLUSION:

This combined protocol could be considered as a useful tool to treat skin flaws that affect texture, microroughness, and seborrhea and to reduce the size of enlarged pores. Its versatility allows for customised treatment with minimal discomfort to patients.

CLINICAL NEWS

Alma UK announces strategic collaboration with Prollenium to distribute Revanesse® and SoftFil® in the UK

Alma UK has announced an exciting new collaboration with Prollenium Medical Technologies, the innovators behind Revanesse® dermal fillers collection.

From September 1, 2024, Alma UK will be the exclusive distributor of Revanesse® and SoftFil® across the United Kingdom.

The new partnership represents a significant milestone in the aesthetics industry, merging Alma’s award-winning expertise in energybased devices with Revanesse’s groundbreaking injectable treatments, ensuring optimal outcomes for clinics and their patients. As part of this strategic alliance, the Prollenium UK team will now join Alma UK, forming the new Alma Injectables Division in the UK. This division will focus on providing comprehensive solutions to clinics, underpinned by the same customer-centric approach that has driven both Alma and Prollenium to the forefront of the industry.

The addition of Revanesse® and SoftFil® to Alma’s extensive range of products underscores the company’s commitment to providing cutting-edge, scientifically-backed technologies.

HA-Derma introduces Profhilo® Structura

HA-Derma has introduced Profhilo® Structura, an advanced injectable treatment designed to specifically target and regenerate superficial facial fat in the midface, to the UK market.

Developed by IBSA using the patented NAHYCO® technology, Profhilo® Structura represents a notable breakthrough in aesthetic medicine. It is the first injectable treatment specifically designed for adipose tissue restoration, clinically proven to help reposition superficial fat to its natural state. This addresses critical age-related concerns, including pronounced facial hollows, skin laxity, and altered facial contours resulting from midface fat loss.

Profhilo® Structura is injected in the preauricular area using a protocol that evaluates facial structure, including midface projection, hollows, laxity, and skin density. The treatment involves two sessions, typically one month apart, with minimal downtime, allowing patients to continue their daily activities immediately post-treatment.

In clinical trials 95% of patients noticed lasting enhancements in the mid-face area after the first treatment, with this improvement sustained three months later.

Surgeon Mr Paul Banwell unveils biohacking supplement

ARTIS London has launched the Regenerative Complex, a groundbreaking supplement designed to elevate NAD+ levels, which is key to promoting cellular health and vitality. The supplement, devised by award-winning plastic surgeon Mr Paul Banwell, harnesses the power of NAD+, sirtuin boosters, and antioxidants to enhance longevity genes, improve DNA repair, and curb inflammation while boosting immune function.

With a promise to restore youthful energy and optimise skin health, cognitive functions, and cardiovascular health, the Regenerative Complex stands out as a scientifically proven vegan formulation free from unnecessary binders and additives. This initiative not only represents a leap in anti-ageing solutions but also reflects ARTIS London’s commitment to clean health and environmental sustainability, dedicating part of its profits to the reforestation of the UK’s native Scots Pine.

Before After

SkinMed can Deliver to YOUR clinic the local cohort of the 2.5 million women over 35 who suffer from maturity onset acne? Click

TECHNOLOGY & INNOVATION SECTION

ALL-INCLUSIVE

Dr Tino Solomon discusses innovations which have made laser hair removal available to a more diverse clientele

Laser hair removal is one of the most popular non-injectable treatments. So what are the technological breakthroughs that mean (almost) nobody is excluded from having it any longer? To this day, patients’ biggest concerns when it comes to lasers, says cosmetic physician and surgeon Dr Tino Solomon, “are that they will burn the skin and that they’re just not safe on darker skin tones.”

It stems from the fact that for years, very specific lasers and highly skilled practitioners (not always guaranteed in the notoriously unregulated UK world of tweakments) were required for patients with dark skin or with very light hair. But today, safe, easy and painless permanent hair removal for (practically) all is a reality: 90% of candidates can successfully be treated thanks to some significant breakthroughs in laser technology.

To understand exactly how all the issues dogging hair removal lasers can now be bypassed, Solomon agreed to take us through the features of what he calls “the gold standard of hair removal lasers”: the Special Edition Soprano Titanium.

Triple-wavelength efficiency

It is now possible to simultaneously emit the three main laser frequencies that experts use to disable your hair follicles (755, 810 and 1064 nanometres) in a single laser pulse. Each frequency (or wavelength) reaches a different depth under the surface of the skin, ‘specialising’ in killing the root of the hair follicle, which is responsible for feeding the hair bulb and regenerating the hair. It means they tackle hair at different stages of growth, with different levels of pigment and different textures (such as light and fine or dark and coarse).

This type of simultaneous ‘3D’ technology is unique in the Soprano. Where single-frequency hair removal lasers have to be selected and calibrated carefully for the predominant hair type and growth phase, “this machine’s multi-level high-frequency pulses can blast hairs at any stage (not just in the anagen phase) and of almost every colour,” says Solomon. “It means the laser works much faster, with an average of six treatments needed where elsewhere it’s at least twelve.” This should, of course, save you money as well.

Apart from being far less painful, lower heat means that melanin in the skin won’t compete with melanin in the hair for energy absorption, so dark skin won’t get burned –which explains why the technology is safe for even the deepest skin tones and recently tanned skin. Lower heat (which is further guaranteed by gradual heating and continuous cooling) also means no inflammation – and that means the chances of post-inflammatory hyperpigmentation (PIH) are hugely reduced.

“We just don’t get hyperpigmentation with this machine,” says Solomon. AI in the future is set to make the process even more refined and personalised: it will perform skin analysis that takes into account lifestyle factors, environmental conditions, and genetic information, making hair removal lasers ever more foolproof.

Smart self-regulation safely blasts fine, light hair

The current machine already deploys “something very close to AI,” says Solomon. A self-regulatory gradual-heating mechanism automatically ‘reads’ the texture of every individual hair and calibrates the energy it delivers accordingly. “That further reduces the chances of over-powering any hair - even if it’s fine, light blonde or grey - and causing pain or damage.” Red and white hairs lack the pigment needed for lasers to work, so they are sadly still beyond their scope.

A ‘jumbo’ handpiece for speed and comfort

The large (4cm2) handpiece offers significant advantages that weren’t accessible before. Of course, it means treatment sessions take far less time, up to 20% faster than previous devices. A fullbody treatment now takes as little as 20 minutes.

It also increases the comfort factor. “The distribution of the focused energy over a larger surface area reduces the chances of damage or pain,” says Solomon. On top of that, the icy-cool applicator lowers the skin’s temperature “to the point where even deep and powerful laser penetration won’t hurt the patient.”

*2020 RARE Consulting Group Consumer Tracker

TECHNOLOGY & INNOVATION

GO WITH THE FLOW

We discover the latest innovative technology for intimate health – Caress Flow

As women across the world start using their voices to call for improved healthcare, particularly in the area of sexual and reproductive health, and with many aesthetic device manufacturers also offering technology for vulval and vaginal rejuvenation, we have seen the market for intimate health treatments within aesthetics expand significantly.

What once was dismissed as vanity – “the designer vagina” – has now become more widely accepted and talked about. We now know that these treatments can offer lifechanging results for women suffering from a range of concerns, from vaginal atrophy and painful sex to bladder weakness and dryness.

However, treatments for vaginal health issues often involve invasive procedures like lasers or radiofrequency treatments, which can be painful and require downtime for recovery.

This is why the UK launch of Caress Flow, a groundbreaking treatment that promises to transform the management of vaginal pathologies, is causing a stir.

What is Caress Flow?

Caress Flow claims to offer a painless alternative that does not require any postprocedure downtime. This is particularly beneficial for patients who are looking for less disruptive forms of treatment.

The innovative therapy offers a holistic, painless solution to a range of vaginal symptoms, with clinical evidence demonstrating significant benefits, including for breast cancer survivors.

Unlike traditional methods such as lasers or radiofrequency, Caress Flow utilises a unique combination of oxygen and hyaluronic acid to rejuvenate and heal vaginal tissues naturally. This method promotes tissue regeneration, improves

elasticity, and enhances overall vaginal health without the need for harsh chemicals or painful procedures.

Scientific rationale

Topical oxygen therapy is a cosmetic procedure that is becoming popular in skin treatment and other medical applications. Oxygen therapy is not a recent innovation in the medical field; other techniques of oxygen therapy, such as hyperbaric oxygen treatments, are widely used in the treatment of other skin diseases, including wound healing, burns, skin grafts, and others.

Hyperbaric oxygen therapy was also proposed as a skin rejuvenation and antiaging treatment. Oxygen therapy has a powerful regenerative, antibacterial and stimulating effect, increases the availability of oxygen to the tissues, promotes the increase in tissue repair processes and increases the synthesis of collagen, allowing normal hydroxylation of this protein. In fact, at tissue oxygen tensions lower than normal, collagen is not synthesised correctly, slowing the healing of ulcers and wounds. In addition, oxygen induces a neo-angiogenic stimulus by releasing factors such as Vascular Endothelial Growth Factor (VEGF). This function is essential for the restoration of the microcirculation in compromised vascular situations, re-establishing a vascular flow in the hypoxic areas that guarantees correct tissue regeneration.

Hyaluronic acid is a natural polysaccharide that forms a fundamental part of the extracellular matrix of the skin and cartilage. Hyaluronic acid has remarkable adhesive, moisturising and reparative properties of the vaginal mucosa.

Because of these properties, the synergistic association of highconcentration oxygen and hyaluronic acid has been shown to have therapeutic

effects in diseases involving tissue regeneration problems, including many gynaecological diseases.1-11

Indications

It is designed to address six prevalent vaginal conditions:

• Vulvo-vaginal atrophy – 85% decreased burning and 81% increased fluidity

• Urinary incontinence – 81% reduction of incontinence

• Recurrent candidiasis – 94% absence of recurrent candidiasis after three months and 83% absence of the current candidiasis after six months

• Urethral burn – 82% decreased burning

• Vestibulitis – 79% decreased itching and 79% reduction of injuries

• Lichen sclerosis – 83% pain relief and 83% decreased itching.

By providing a non-hormonal, natural alternative, Caress Flow eliminates the need for ongoing use of vaginal creams, offering a simpler, more effective solution for women. Affordable and accessible In

addition to its clinical efficacy, Caress Flow is also an affordable treatment option, making it accessible to a wider audience.

With lower costs compared to traditional laser and radiofrequency treatments and without the need for follow-up creams or additional procedures, Caress Flow is poised to become the go-to solution for women seeking effective and economical care.

Clinically proven benefits for breast cancer patients

A recent study published in the Climacteric Journal11 has also shown the effectiveness of Caress Flow in treating genito-urinary symptoms among breast cancer survivors.

The study demonstrated that after five treatments, patients experienced a substantial improvement in vaginal health, with 85% of participants reporting reduced pain and increased comfort during intercourse. These results remained consistent even 30 days after the last treatment, making Caress Flow a reliable option for long-term relief.

References

1. Origoni M, Cimmino C, Carminati G, Iachini E, Stefani C, Girardelli S, Salvatore S, Candiani M. Postmenopausal vulvovaginal atrophy (VVA) is positively improved by topical hyaluronic acid application. A prospective, observational study. Eur Rev Med Pharmacol Sci. 2016 Oct;20(20):4190-4195. PMID: 27831658

2. Jokar A, Davari T, Asadi N, Ahmadi F, Foruhari S. Comparison of the Hyaluronic Acid Vaginal Cream and Conjugated Estrogen Used in Treatment of Vaginal Atrophy of Menopause Women: A Randomized Controlled Clinical Trial. Int J Community Based Nurs Midwifery. 2016 Jan;4(1):69-78. PMID: 26793732; PMCID: PMC4709811.

3. Costantino D, Guaraldi C. Effectiveness and safety of vaginal suppositories for the treatment of the vaginal atrophy in postmenopausal women: an open, non-controlled clinical trial. Eur Rev Med Pharmacol Sci. 2008 Nov-Dec;12(6):411-6. PMID: 19146203.

4. Gordillo GM, Roy S, Khanna S, Schlanger R, Khandelwal S, Phillips G, Sen CK. Topical oxygen therapy induces vascular endothelial growth factor expression and improves closure of clinically presented chronic wounds. Clin Exp Pharmacol Physiol. 2008 Aug;35(8):957-64. doi: 10.1111/j.14401681.2008.04934.x. Epub 2008 Apr 21. PMID: 18430064; PMCID: PMC2574754.

5. Kellar RS, Audet RG, Roe DF, Rheins LA, Draelos ZD. Topically delivered dissolved oxygen reduces inflammation and positively influences structural proteins in healthy intact human skin. J Cosmet Dermatol. 2013 Jun;12(2):86-95. doi: 10.1111/jocd.12039. PMID: 23725301.

6. Roe DF, Gibbins BL, Ladizinsky DA. Topical dissolved oxygen penetrates skin: model and method. J Surg Res. 2010 Mar;159(1):e29-36. doi: 10.1016/j.jss.2009.10.039. Epub 2009 Nov 21. PMID: 20097370.

7. Condemi L, Di Giuseppe J, Delli Carpini G, Garoia F, Frega A, Ciavattini A. Vaginal natural oxygenation device (VNOD) for concomitant administration of hyaluronic acid and topical hyperbaric oxygen to treat vulvo-vaginal atrophy: a pilot study. Eur Rev Med Pharmacol Sci. 2018 Dec;22(23):8480-8486. doi: 10.26355/eurrev_201812_16548. PMID: 30556890.

8. https://www.presurgy.com/wp-content/uploads/2023/02/Relapsing-Candidiasis.pdf

9. https://www.presurgy.com/wp-content/uploads/2023/02/Lichen-Sclerosus-2021.pdf#:~:text=The%20 airbrush%20is%20used%20for,(w%20%2F%20v)%20solution.

10. https://www.presurgy.com/wp-content/uploads/2023/02/Urethral-Syndrome.pdf#:~:text=five%20 minutes%20of%20oxygen%20therapy,therapy%20combined%20with%20hyaluronic%20 acid.&text=Patients%20are%20taught%20home%20behavior,nutrition%2C%20indications%20for%20 sexual%20intercourse.

11. C. Massarotti, G. Asinaro, M. G. Schiaffino, C. Ronzini, I. Vacca, M. Lambertini, P. Anserini, L. Del Mastro & A. Cagnacci (2023): Vaginal oxygen plus hyaluronic acid on genitourinary symptoms of breast cancer survivors, Climacteric, DOI: 10.1080/13697137.2023.2167596. https://doi.org/10.1080/13697137.2023.2 167596

THERE’S SOMETHING THE AURA

We discover how Aura is bringing innovative reality technology to the aesthetic arena

Capturing ideal before-and-after (B&A) images with identical positioning and lighting has long been a challenge. The use of B&As is important from a research and teaching perspective and critical from a patient consultation, record-keeping, and litigation perspective.

“Aura” brings us precision aesthetic technology from the leaders in reality technology. Harnessing well-established reality technology, Aura is built upon Hexagon’s lineage of technological innovation spanning decades.

What is Aura, and how can it help me in my clinical practice?

Aura provides you with photorealistic 3D visualisations of the human face and neck, allowing us to work with a “3D digital twin” in a single image capture. In turn, this creates a common visual language between you and your patients, redefining the process of image capture and visualisation in consultations, teachings and clinical research.

Aura offers you a sophisticated product that generates and displays the patient’s “digital 3D” self for the first time in the aesthetic field.

Aura is part of Hexagon, the global leader in reality technology, the easy to use image capture device and intuitive platform delivers a new, powerful, yet simple photo-realistic facial imaging system by leveraging Hexagon’s expertise in sensors and software that capture our world in 3D with trusted, proven precision.

Norbert Hanke, EVP, Hexagon says, “We are thrilled to finally bring Hexagon’s expertise in reality technology to the most complex landscape of all – the human face. The Aura 3D Imaging System pushes the boundaries for what is possible in aesthetics. This powerful tool brings a shared visual language to the consultation process, enabling patients to better understand treatment recommendations and see clear proof of its effectiveness, transforming the patient-practitioner relationship while increasing ROI for aesthetic practitioners.”

Aura is unmatched, serving real-time and comprehensive analysis by harnessing state-of-the-art AI-based intelligence, which is directly accessible on the practitioner’s device. The imaging and analytics toolkit fosters a mutual visual language between the patients and practitioners, ultimately boosting consultations, encouraging sound decision-making, and fortifying patient trust and confidence.

Working in partnership with Aura 3D Imaging System, you can improve how patients visualise and interpret their current state, fostering a mutual understanding for coordinating their aesthetic journey. Comprehensive skin reports, including wrinkles, pores, red and brown spots, and texture, along with before-and-after images of the digital counterpart, amplify their trust in treatment plans. Moreover, Aura’s user-friendly and instinctive interface requires minimal training and brings the focus back to patient interaction and treatment planning.

Aura enables you to effectively portray your patients’ skin and appearance transformation over time, highlighting the clear enhancements associated with their treatment plan.

“The Aura System elevates aesthetic and dermatological care, analysing key skin aspects with precision. It’s easy to use and encourages direct patient interaction, elevating our clinical communication. Practical as well as high performance, it will be a valued asset in any modern skincare practice”, shares Dr Sophie Shotter.

Enhancing aesthetic practice standards

Experience to date shows that Aura is intuitive and can be incorporated in clinic without the necessity for extensive learning. With simple training, clinic staff, assistants, or technicians have the knowledge to work with Aura. Such ease of use of Aura bolsters consultation efficiency and user confidence.

An additional feature of Aura is its portability. The uniqueness of Aura’s hardware configuration blends multiple cameras into a single, portable, lightweight device, which comes in a carryon suitcase empowering you to transport it with ease between venues.

The Aura 3D Imaging System brings aesthetic and dermatological

consultations to a new height by analysing crucial skin aspects with unsurpassed precision.

“The Aura 3D Imaging system captures the patient in a single instance and offers aesthetic practitioners a photorealistic 3D visualisation, complete with skin analysis features and volume comparison. It also enables vector analysis of pre and posttreatment captures. Unlike other systems that need 3-4 photos to capture all features, Aura necessitates only a single capture. The Aura 3D Imaging system employs Hexagon’s tested and trusted technology, adapting it for the most challenging landscape ever captured in 3D – the human face,” says Hexagon’s Vice President of Innovation, Simon Mark.

In addition, Aura serves as a significant learning resource for practitioners and patients as it enables you to take pictures, carry out procedures, and subsequently examine the pre- and post-procedure outcomes together with both your patient and colleagues in clinical, teaching and research contexts. This ongoing cycle of conversation and analysis of the results with the patient supports you in pinpointing areas of enhancement, paving the way for superior results and patient outcomes

Aura is user-friendly and promotes direct engagement with patients and augments clinical dialogue. As a high-performing device, it is poised to be invaluable in any contemporary skincare practice. For further information, please visit aurareality.com, and for purchase information, please call AestheticSource, exclusive UK and Ireland distributor, on 01234 313130 or email

TECHNOLOGY PRODUCT NEWS

Alma launches Hybrid

Alma has launched Hybrid, a new device for scar treatment and advanced skin rejuvenation. The system uses a 70W CO2 integrated with 1570nm laser in one applicator to optimise ablation and minimise thermal damage to surrounding tissue. The transepidermal ultrasound technology enhances the delivery of topicals, maximising results and minimising recovery time by helping active ingredients work deeply in the skin. Also integrated into the device is Alma’s Hygrid tech, which uses a single scanner to weave lasers into the ideal pattern for patients’ skin.

Sciton introduces BBL Heroic

BBL Heroic is the newest standard in pulsed-light technology from Sciton. The device integrates an assortment of new technologies to ensure optimal results for patients. To improve treatment accuracy, an integrated motion sensor tracking function provides real-time, 3D spatial information about the handpiece’s position and orientation, alongside an automated pulse feature within the handpiece itself, to facilitate uniform treatments on all skin surfaces. Intelligent control (IC) is the brain behind this data, allowing the different parts of the machine to work in synergy.

4T Medical unveil new Eve Multi-Platform Device

4T Medical has announced the UK launch of the Eve, a state-of-the-art multi-platform aesthetic device developed and manufactured in South Korea. The Eve integrates four advanced technologies: Hydradermabrasion, Diamond Peeling, Microcurrent Therapy, and Electro Muscle Stimulation (EMS). Each function can be used independently or synergistically for comprehensive skin rejuvenation.

Biotec Italia introduces Lysiwave

Biotec Italia UK has unveiled its latest breakthrough: Lysiwave. The device, featuring patented microwaves coupled with a high-concentration oxygen flow, offers a comprehensive approach to treating cellulite, localised fat, and skin laxity. Unlike traditional methods, Lysiwave’s 2.45GHz microwaves penetrate deep into the skin’s layers, delivering controlled and confined heating without any downtime for the patient.

Dermalux launches Tri-Wave MD

Dermalux has launched the Tri-Wave MD. The device has the largest, adjustable four-pod head in the Dermalux range. The Tri-Wave MD delivers treatments over broad skin areas with unparalleled efficiency, capable of delivering up to 240 j/cm² in a single treatment session. The new device uses multiple wavelengths concurrently from singular wavelength LEDs, ensuring clinicians can target multiple symptoms in a single treatment, whilst reducing treatment time. This guarantees more reliable performance and predictable results, and is unique to Dermalux. Other LED devices on the market require the changing of LED heads for each wavelength, increasing treatment time.

BTL Aesthetics introduces EMFACE® Submentum

EMFACE® Submentum is a first-to-market, innovative solution to significantly reduce a double chin with no downtime and no pain. The EMFACE® Submentum targets layers from skin to muscle, enhancing the aesthetic appearance with precision and ease. The device has the ability to reach every layer, from muscle to skin, in as little as 20 minutes with zero downtime. Applying a patented combination of Synchronised RF+ and HIFESTM muscle stimulation in one applicator corrects and significantly improves key concerns around the chin and submentum area, resulting in an enhanced jawline and a more defined and sculpted appearance.

InMode introduces InMode Lift

InMode Lift includes a three-step treatment protocol designed to target fat and tighten skin to redefine the jawline. This device has three key aspects: skin tightening, targeted fat reduction and a radiance boosting massage. Forma uses InMode’s patented ‘ACE principle’, with a built-in temperature control sensor to ensure safety and efficacy. This unique feature ensures there is no risk of overheating the skin and optimal temperature is reached, resulting in collagen production to tighten and firm the skin to help sculpt the jawline.

Reception staffing solutions, keeping you in the conversation

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

T: 0191 720 3000

E: clientservices@aestheticresponse.co.uk www.aestheticresponse.co.uk

Elevate skills, efficiently & effectively Online Training Course

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

Join Aesthetic Response for excellence in medical aesthetics. Use the QR Code to book your discovery call.

WELLNESS SECTION

In this section: CPD Supplements

A 360-DEGREE APPROACH

Tracey Dennison shares a patient case study demonstrating how to combine traditional and lifestyle medicine.

Combining multiple evidence-based treatment approaches is crucial for providing optimal treatment outcomes, especially for patients with complex, multifaceted health issues.

Traditional medicine, lifestyle medicine, and complementary therapies each offer unique benefits and, when integrated, can address the diverse needs of patients more effectively than any single approach alone. The integration of these approaches is supported by a growing body of research demonstrating their individual and synergistic benefits. This case study explores the management of a patient with a significant medical and psychological history, highlighting the importance of a comprehensive, integrative treatment plan compiled by appropriately qualified medical professionals and usually involves multidisciplinary involvement.

The patient is a 69-year-old woman with a complex medical history, including substantial psychological trauma from her formative years and adult life. She is a caregiver to an older child with significant and complex needs. Her anxiety levels are exceptionally high, and she struggles with irritable bowel syndrome (IBS), rheumatoid arthritis, tinnitus, urinary frequency and urgency, poor sleep, dry skin, eczema, increasing allergies, and disordered eating. Socially, she is retired, with her husband managing household decisions and finances. Despite having three children, she has a very limited social circle and lacks confidence. She has no real support network, no daily routine, and does not smoke or drink alcohol. Primary care interventions have included lansoprazole for IBS, paracetamol for pain management, and antianxiety medication. Additionally, she had access to talking therapies in the past but has significant health anxiety, leading to multiple invasive investigations.

The management approach for this patient involved a comprehensive, patient-centred

consultation. The aim was to make her feel seen, heard, and validated, holistically addressing her needs through traditional and lifestyle medicine approaches.

Daily routine and sleep hygiene

Creating a daily routine was emphasised to help her feel safe and in control. Research indicates that establishing a consistent daily routine can significantly reduce anxiety and improve overall mental health.1 Additionally, getting exposure to daylight early in the day was recommended to reset her body clock. This is supported by findings that natural light exposure can improve sleep quality and mood by regulating circadian rhythms.2

Diet and nutritional interventions

Dietary modifications included reducing caffeine intake to improve sleep and bladder irritation. An anti-inflammatory diet low in refined sugar and high in anti-inflammatory foods like berries and cherries was also suggested, which can help manage rheumatoid arthritis and other inflammatory conditions.3 Introducing prebiotics and probiotics was recommended to enhance gut health, as these have been shown to alleviate symptoms of IBS and improve overall digestive health.4 Additionally, supplementation with vitamin D and magnesium bis-glycinate at night was advised to support bone health, reduce inflammation, and improve sleep quality.5

Alternative therapies

The potential benefits of acupuncture for pain management and relaxation were discussed, and an accredited practitioner was recommended. Studies have shown that acupuncture can be effective in reducing chronic pain and anxiety.6 Breethe work, a form of guided breathwork therapy, was also suggested for its potential to reduce stress and anxiety.7

Hormone Replacement Therapy and psychological support

Body Identical hormone replacement therapy (HRT) was considered as an option to address systemic and vaginal health issues, especially given the patient’s age and symptoms. The benefits and risks were clearly discussed, particularly with this being an older patient. Post-menopause, HRT can still help manage symptoms related to hormones, including anxiety and sleep disturbances.8

Referral to clinical psychology was made to provide ongoing mental health support, which is crucial for managing this lady’s significant health anxiety and likely posttraumatic stress disorder.

Nature and social support

Spending time in nature was encouraged, as it has been proven to reduce stress and improve mental well-being.9 Building this into a regular routine was also encouraged to help provide some daily structure and routine.

Simple coping strategies for intense stress were provided, and efforts to establish a network of support and social connections were initiated. Building social connections is vital for mental health, providing emotional support and a sense of belonging.10

WELLNESS

Discussion

The integrative approach used in managing this patient highlights the importance of combining traditional medicine with lifestyle and alternative therapies. Each intervention was based on credible research supporting its efficacy and safety.

The recommendation for a daily routine and early daylight exposure is grounded in solid evidence of their benefits for mental health and sleep regulation. For instance, Fisher et al. (2018)1 found that establishing daily routines can significantly reduce anxiety and improve mental health outcomes.

Additionally, Cseisler & Gooley (2007)2 provide substantial evidence on how daylight exposure impacts circadian rhythms and overall sleep quality.

Dietary changes and supplements, such as reducing caffeine intake, following an antiinflammatory diet, and using probiotics, are also supported by robust research. Studies by Sköldstam et al. (2003)3 and Rondanelli et al. (2017)4 demonstrate the benefits of these dietary interventions in reducing inflammation and improving gut health, respectively. The suggestion to supplement with vitamin D and magnesium is backed by research showing their role in reducing inflammation and improving sleep quality.5,11

Alternative therapies like acupuncture and breathwork have demonstrated effectiveness in clinical studies. Vickers et al. (2018)6 provide evidence that acupuncture can significantly reduce chronic pain and anxiety. Similarly, Jerath et al. (2006)7 support the benefits of breathwork in reducing stress and promoting relaxation.

Evidence supports the use of HRT and referral to clinical psychology, indicating their effectiveness in managing menopause-related symptoms and providing mental health support. The North American Menopause Society (NAMS, 2017)8 highlights the benefits of HRT for managing anxiety and sleep disturbances during menopause.

Finally, the encouragement to spend time in nature and build social connections is grounded in research showing the mental health benefits of these activities. Bratman

et al. (2015)9 demonstrate how nature exposure reduces stress, while Holt-Lunstad et al. (2010)10 provide a meta-analytic review of how social relationships impact mortality risk and mental health.

Conclusion

Natural biohacking and lifestyle medicine offer a robust framework for empowering patients to take charge of their health and well-being. By focusing on patient empowerment rather than costly treatment options, healthcare providers can support individuals in making sustainable lifestyle

changes. This patient-centred approach gradually introduces credible treatment options, enhancing compliance and longterm benefits.

This case study prioritises a holistic and personalised approach and demonstrates how integrating traditional and lifestyle medicine can lead to significant improvements in patient outcomes. The focus on patient empowerment, credible research-backed interventions, and sustainable lifestyle changes provides a model for managing complex, multifaceted health issues effectively.

References

1. Fisher, E. B., Thorpe, C. T., DeVellis, B. M., & DeVellis, R. F. (2018). Healthy coping, negative emotions, and diabetes management: A systematic review and appraisal. The Diabetes Educator, 33(6), 10801103.

2. Cseisler, C. A., & Gooley, J. J. (2007). Sleep and circadian rhythms in humans. Cold Spring Harbor Symposia on Quantitative Biology, 72, 579597.

3. Sköldstam, L., Hagfors, L., & Johansson, G. (2003). An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis. Annals of the Rheumatic Diseases, 62(3), 208214.

4. Rondanelli, M., Giacosa, A., Faliva, M. A., Perna, S., Algieri, F., & Peroni, G. (2017). Review on microbiota and effectiveness of probiotics use in older. Current Pharmaceutical Biotechnology, 18(9), 704713.

5. Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266281.

6. Vickers, A. J., Vertosick, E. A., Lewith, G., MacPherson, H., Foster, N. E., Sherman, K. J., ... & Linde, K. (2018). Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), 455474.

7. Jerath, R., Edry, J. W., Barnes, V. A., & Jerath, V. (2006). Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Medical Hypotheses, 67(3), 566571.

8. NAMS (North American Menopause Society). (2017). The 2017 hormone therapy position statement of The North American Menopause Society. Menopause, 24(7), 728753.

9. Bratman, G. N., Hamilton, J. P., Hahn, K. S., Daily, G. C., & Gross, J. J. (2015). Nature experience reduces rumination and subgenual prefrontal cortex activation. Proceedings of the National Academy of Sciences, 112(28), 85678572. 10. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.

11. Wienecke, T., & Nordin, C. (2016). Magnesium status and migraine. Cephalalgia, 36(5), 499507.

The UK’s largest congress shaping the future of medical aesthetics

LIVE injectable, device and skincare demonstrations on the latest products and treatments.

The UK’s largest congress shaping the future of medical aesthetics

140+ leading brands showcasing innovative solutions and products to suit your needs. Register free now

5 CPD certified conferences with over 120 world-class speakers.

Adobe/puhhha/provided by author

JUST LIKE A PILL

Vicky Eldridge streamlines her supplement regime with W-Wellness

My name is Vicky, and I am a supplement addict. There, I said it. Ever since turning 40, I have become more and more interested in supplements to the point that my kitchen has its own cupboard for them. I listen to a lot of health and wellness podcasts in my spare time and am always looking for ways to hack my health. This means I am a sucker for buying whatever supplement is recommend in the sponsored ads.

As a result, the algorithms know I am an easy target, and every day, I am bombarded with the latest supplement claiming to be able to solve my brain fog, stop me getting anxiety, help me lose weight or hold back ageing.

Now, I am an intelligent and educated woman, but I will admit when it comes to the supplements market, I know I have been conned more than a few times. And I

am not alone. It’s believed that a staggering 16.1 million Britons use supplements as a shortcut to overhaul their health. The supplements industry is booming, and supplements come in many different forms. However, in a crowded market, there is much debate about the sources and effectiveness of some of these, as well as concerns about ultra-processed supplements and their impact on our health.

I knew I was spending way too much money on supplements, with no idea what was actually working or not. Was I just producing very expensive, bright yellow pee and not much else?

Something needed to be done, and, thankfully, I met the team from W-Wellness at an event and asked if they could help. Turns out they could.

Working with W-Wellness

Since its launch, W-Wellness has created quite a stir in the industry, working with key influential practitioners and brands and hitting the market at the perfect time to tap into the increased trend for wellness.

W-Wellness is the UK’s first expert-led wellness platform that offers access to a curated selection of top-quality nutritional supplements, vitamins, and wellness products alongside comprehensive health and wellness guidance from a wealth of leading industry experts.

It was founded by Sophie Woodward and Sally Lefever-Bell, and is designed to cut through the noise – empowering consumers and practitioners alike and creating a much-needed synergy between supplement education and health.

It basically does all the research for you. The products it offers have been thoughtfully assembled by W-Experts and medical ambassadors who are dedicated to promoting holistic well-being, and W-Wellness has already partnered with a number of innovative and clinically-backed brands ahead of the launch, including Nuchido, Vida Glow, Zenii London and Nuzest.

Sophie says: “W-Wellness is not just a platform; it’s a movement – a revolution and a true destination in wellness. Feeling well and being the best version of yourself should not be something left to trial and error. Instead, W-Wellness will take the guesswork out of this journey and create what we believe will be the true home of wellness. We are excited to take patients and practitioners on this incredible journey as we empower people to take control of their health, happiness, and overall wellbeing.”

My consultation

I was booked in for a virtual consultation with nutritionist Maz Packman, and beforehand, I filled in a questionnaire about my diet and lifestyle and gave her an extensive list of what I was already taking.

The call with Maz was great. It was really interesting, and she really made me feel heard. She talked through everything with me, and while she recommended supplements, a lot of her advice was based

on lifestyle-based things I could do to support myself with my symptoms.

These included:

• Focus on phytoestrogens in the diet, e.g. soybeans, miso, flaxseed, flaxseed oil, chickpeas, lentils, kidney beans, sesame seeds, almonds, walnuts Prioritise my evening regime – raise the legs and have them against the wall for five to 10 mins before bed to activate the parasympathetic nervous system and encourage blood and nutrients to the gut

• Try to go to sleep in a cool room, avoid food and drink too close to bedtime, which can cause you to wake in the night, and try to go to bed and wake up and the same time every day as the body likes routine

• Ensure 30g of protein with each meal to stabilise blood sugar and prevent spikes and dips throughout the day and night.

• Movement after meals, even 10 mins of walking after eating to support blood glucose levels – there is mounting research to support this.

The supplement recommendations for me included:

1. QUI Menopause Formula Powder2 tsp in the morning with cold water

2. TNP Metabolic Gold - 1 x capsule (2

x a day with food)

3. BB Omega 3 - 2 capsules with food

4. BB Vitamin D - 3 sprays under the tongue

5. TNP Saffrosun Energy - 2 x capsules with breakfast

6. TNP Gut Love - 1 x capsule with breakfast

7. TNP Marine Magnesium 2 x capsules 30mins before bed

I saved myself over £100 by cancelling some of the subscriptions I had to supplements I just didn’t need and ordered my first box from W-Wellness. It was super easy and arrived a few days later, all packaged up nicely and with a little free gift, too. Rather than ordering things all over the place (and many of the supplements I was shipping in from the US), having everything in one place was really convenient. In addition, I have had reminders when I need to re-order and educational materials sent through. I feel like I have now really honed in my supplement habit and that I have experts on hand when it needs to shift and evolve with my needs, as it naturally will. I feel like it’s made life easier and my pocket lighter! What more could you ask for!

For more information visit https://wwellness.co.uk/

BUSINESS SECTION

In this section: Dr Leah Totton Hamilton Fraser Payments

Training

Cosmetics round-up

Dates for the diary

LIFE AS AN ENTREPRENEUR

We chat with Dr Leah Totton about her career in aesthetics and the lessons she’d learned as an entrepreneur.

It’s been 11 years since Dr Leah Totton heard those famous words from Lord Alan Sugar on BBC’s The Apprentice: “You are going to be my business partner.” The then 24-year-old had plans to open a chain of clinics – Dr Leah Clinics – and was impressed with her business plan and cool head in the show’s weekly tasks. With three sites up and running and her “most successful six months ever” under her belt for the first half of 2024, her plans have well and truly come to fruition. On October 8, 2024, at Hamilton Fraser’s Aesthetics Business Conference, she will share some of the secrets of her success as part of an Entrepreneur Masterclass.

Vicky Eldridge sat down with her to reflect on more than a decade in aesthetics.

Vicky Eldridge: What qualities do you think it takes to be an entrepreneur?

Dr Leah Totton: The most important thing is to be hard-working. That quality runs through every single entrepreneur I know – their work ethic is really, really high. Over the last decade, the real entrepreneurs, people who are really

running businesses that they’re scaling and who have lasted the course, haven’t just dipped in and out. I don’t think it’s possible to succeed in any business, not just aesthetics, without hard work unless you are very fortunate and start a completely novel concept. However, in most companies, unless you’re Steve Jobs or Mark Zuckerberg, you’re in marketplaces where you’re offering a service or product that already exists. Of the successful entrepreneurs I know, I’d say it’s correlated with how hard they work.

VE: That’s something that runs underneath being a doctor/medical professional, that sort of drive and work ethic.

LT: Yes. I think that is why we’ve seen the cosmetic space globally boom the way it has: because you’ve got a lot of very hardworking, very smart people who are now business owners. Most clinics are still owned by doctors in the UK. You’ve got highly educated, intelligent, and extremely hardworking business owners who are typically used to working in the NHS, a very demanding workplace.

That’s why it’s very competitive in the non-surgical space. Doctors make good entrepreneurs, and essentially, your competition, if you like, is normally every bit as intelligent, qualified, and hardworking as you are.

VE: Most people will know you from winning The Apprentice 11 years ago. How has that impacted and shaped your career as an entrepreneur? Was there anything you learned during that process?

LT: I learned the most, not necessarily from the process itself but from having Alan Sugar as a business partner. They’re two different things. During The Apprentice, you learn skills throughout the show, like the importance of marketing and branding. You learn a bit about advertising. You learn about leading a sales team, that sort of thing, which was useful.

I’ve learned a lot from Alan Sugar, but one of the most valuable things I’ve learned from him is not to look at what your competition is doing. Only focus on your own business. I was asked recently in an interview who I considered my competition

to be. I couldn’t name them. It really struck me that that is something I’ve learned from him through the years. We spend no time or energy doing competition analysis.

VE: I think that’s such a good point. Because a lot of people worry about what their local competition is doing.

LT: It’s a lot of wasted energy. My advice to anyone starting out now is it really makes no difference what anyone else is doing. You’ve got to do what you’re doing well, and your clients will come to you. They’ll go to someone else if you don’t do a good job.

Try to avoid the industry in-fighting; you shouldn’t spend your energy disputing that you are more qualified or better than a nurse or more than a dentist, or another doctor or surgeon. This interdisciplinary or cross-disciplinary bickering is confusing for patients and really unhelpful to the sector as a whole.

VE: How important do you think having a mentor is in business?

LT: I think it’s more important to have the skills and knowledge of the treatments, if I’m being honest. You can still succeed in aesthetics if you don’t have a business mentor. It’s more important to have a clinical mentor if you’re starting because they’re going to be things that you need to refer to outside of your practice, no matter what your skill level is.

VE: One of the things you had to do during the process for The Apprentice was a business plan. How important is having a business plan?

LT: I had to do it for The Apprentice, which was part of why I won the show. For me, obviously, it was very important to secure investment. If that is a route that you’re exploring as an entrepreneur, I think that’s something that more and more doctors are now looking at as a means of financing. Previously, a lot of aesthetic clinics were self-financed, but more recently, we’ve seen interest from investors in this space. It is becoming an attractive option for investors. It’s now a much more established industry than when I was pitching 11 years ago.

A business plan is important to obtain the initial investment, but in terms of day-today operations, you have to be fluid and flexible because there are things you’ll have no control over, such as a global health pandemic! We had planned to open another clinic in 2021, and then COVID hit. Obviously, that’s something that’s being delayed, and then I had a baby.

But having a roadmap is good in the initial phase of starting a business. I looked at mine as a roadmap of where we were going and what we hoped to do.

VE: What are some of the biggest challenges you faced when starting and running your business over the last few years? Is there any advice or something you’ve learned from challenges that have come up that you feel that other people might benefit from?

LT: In recent years, managing patient expectations has been something that we, as a practice, are becoming better at. We’ve had to work on it because we have to be realistic about what we can achieve as non-surgical clinics. We are not performing surgery, which can give more dramatic outcomes—we must make sure that we’re setting that expectation in an open, honest, and fair way.

We must understand the patient’s perspective before performing any treatments and make sure that that expectation is set appropriately.

We have extended our consult times for advanced treatments. We make sure the before-and-after material we use is realistic—images that will give a realistic view to the patient of what they may expect. I think that has been really important in terms of improving our patient journey.

VE: People often say that the biggest way to avoid complications is avoiding complaints, which all come from patient expectations.

LT: We have to be really honest and realistic about the result we can achieve as well as any potential risks and complications. We also have to be confident to decline treatment if the patient is not suitable, expectations are unlikely to be met, or we have concerns. Often, after the consultation process, we have patients decide not to go ahead, which is the right thing for them and the right thing for the business because they are patients who are often not seeking the type of subtle outcomes that we can deliver. It’s better and fairer for the patient to ascertain this early in the patient journey.

VE: Where do you see the industry and your clinics going in the future? What are you excited about for the future, and how are you continuing to grow and develop the business?

LT: We launched the skincare line in 2022. That’s something that has done really well, and our three clinics are doing very well. The clinics celebrated 10 years in business this year and are performing very well. We were delighted to win the best non-surgical transformation result in the 2023 Safety in Beauty awards. We won Most Trusted Clinic in the UK in 2023 and were a finalist for Best Aesthetic Doctor in the Aesthetic Awards in 2023.

We’ve just had the best six months of trading in the company’s history, the first six months of 2024, which is great.

I became a mum 18 months ago which has shaped my view and also the amount of time I have available but expanding the business is something we will consider in the coming few years.

CONSULTING ROOM ADVERTORIAL

HAMILTON FRASER COSMETIC INSURANCE

Hamilton Fraser is the UK’s leading provider of cosmetic insurance services. With over 25 years’ experience, we were the first ever insurance provider to offer medical malpractice insurance to the cosmetic sector.

We provide insurance for both essential and more specialised cosmetic procedures. From injectables and botulinum toxin to breast augmentations and polynucleotides, we are proud to cover the most comprehensive range of cosmetic treatments in the industry. We continuously incorporate new treatments and can also

tailor bespoke insurance to meet your unique requirements.

Our team of expert advisers has an excellent understanding of aesthetic insurance and are on hand to offer practical guidance.

“If you are covered by Hamilton Fraser, our in-house claims team will work with you to resolve complaints of dissatisfaction and try to prevent them from escalating into a formal claim. Insurance is not just an annual transaction. It’s all about providing peace of mind, both to you and your patients, by making sure that you have guidance and support whenever you need it.”

Eddie Hooker, founder and CEO, Hamilton Fraser

Hamilton Fraser was ‘highly commended’ for customer service at the Safety in Beauty Awards and won ‘Best Specialist Insurance Provider’ at the Insurance Choice Awards 2023, which was voted for by our customers.

“Hamilton Fraser has received incredible praise from its customers, with many complimenting its tailored products, indicating just how well Hamilton Fraser understands the fields in which it operates. Many have said that the company is easy to contact, with efficient and friendly service, giving additional peace of mind alongside its comprehensive policies. Congratulations, Hamilton Fraser, for this well-deserved win.”

Jacqueline Dewey, CEO, Smart Money People

Why choose Hamilton Fraser?

Outstanding customer service

Our team has an excellent understanding of cosmetic insurance and has been recognised for providing exceptional customer service, as well as comprehensive cover to aesthetic practitioners.

Comprehensive insurance cover

We provide tailor made insurance to protect you, your clinic and your equipment, and offer a standard indemnity limit of £5 million, which comes with a zero excess for many of the treatments we insure.

Extensive industry knowledge

We share our knowledge through guides, blogs and podcasts on our Content Hub and through CPD accredited presentations at events, including our annual Aesthetics Business Conference, taking place on 8 October 2024 in London.

Supporting the aesthetic sector

We work with leading organisations, such as the Joint Council for Cosmetic Practitioners (JCCP), who share our vision of raising standards and putting safety at the heart of the sector. Protect yourself and your customers with Hamilton Fraser

With medical malpractice claims on the rise, it’s vital to protect yourself against allegations of malpractice and negligence while carrying out aesthetic treatments.

Without adequate cover, you will be left to defend any allegations personally, which could incur significant legal costs. And if you are deemed to be at fault, compensation claims alone can run into hundreds of thousands of pounds, and that’s before loss of earnings and other costs are taken into account.

The financial consequences for practitioners arising from allegations of negligence relating to malpractice should not be underestimated – not to mention the risks to patients should something go seriously wrong.

Protect yourself and provide peace of mind to your clients with Hamilton Fraser cosmetic insurance. For more information, including the details of no-cost extensions that we have incorporated into our latest version, visit our website https:// www.hamiltonfraser.co.uk/ or call the team on 0800 63 43 881 to discuss your individual requirements.

provided by author

Images

SPENDING TOO MUCH ON PROCESSING PAYMENTS? (HINT: DEFINITELY!)

This month we are spotlighting Coherent Healthcare. Run by former clinic directors, Coherent helps clinics save time and money on payment processing. They specialise in helping healthcare clinics improve profit with lower cost, efficient payments, and they are delighted to share some words of wisdom with all Consulting Room clinics.

Make payments a value driver

There are many pitfalls around payment acceptance, all of which contribute to wasting time and money:

1. Over-reliance on practice management software

What practices think they get in efficiency (e.g. integrated payments with practice management software), they can lose in flexibility and cost. Just like you source specialist equipment for different medical procedures, you should similarly source payment products geared towards healthcare clinics for your practice.

2. Legacy tools

There has been extraordinary innovation in payments in recent years. As the economy

transitions to digital-first, some payment companies have met the call to modernise, where others have failed. If you haven’t explored modern payment solutions and instead rely on the same brand names that have been around since 2010, you’re likely leaving value on the table.

3. Paying too much

Everyone loves Amex. Except, no one ever stopped seeing their healthcare practitioner because Amex isn’t accepted. Your patients’ preferred methods of payment should not influence your business decisions. Amex tends to charge significantly more than standard Visa/ Mastercard transaction fees, so we would recommend not accepting it. We encourage you to avoid the Amex tax on your business.

4. Too many gateways

We often see practices that rely on too many payment acceptance products: point of sale/card machine, online booking, direct debit, bank transfer, and cash. Each additional payment gateway creates inefficiency and bloat in reconciliation. Payments made right should be seamless for patients and cost- and time-effective for practices. Don’t underestimate the time savings that come from having all payment data in one place. Managing many payment methods: direct debit, card payment, and pay by bank, isn’t necessarily a problem if you can manage everything from 1 portal.

And that’s where Coherent comes in…

Why switch to Coherent Healthcare?

Healthcare practitioners choose Coherent for a host of reasons:

• Cost Saving: Overall and most importantly, lower cost to take payments

• Ease: Remote payment links and in-clinic card machine payments.

• Efficiency: All payment types in one place – card payment, direct debit, bank payments.

• Accuracy: Every payment has a client ID and status.

• Support: <5 minute white-glove support from people who know healthcare and who work directly with reception/PAs to resolve issues.

Let’s dive into the two top benefits: saving money and ease…

Saving money

The main benefit of switching to Coherent is savings: lower cost payment processing. Clinics report as much as 90% savings per transaction. Unlike other modern payment providers which charge set fees, Coherent passes through underlying payment costs (those charged by Visa/Mastercard and the corresponding bank). This pricing is known as Interchange Plus and allows clinics to benefit from paying the true cost of the card used.

In addition to lower card fees, Coherent offers Pay by Bank as an alternative to card payment, where fees are as low as 0% + 30p per transaction, irrespective of the value. This instant bank transfer allows clients to pay by scanning a QR code that links to their mobile banking app. The savings are significant, especially for high-value transactions. As an example, Pay by Bank on a £1,000 payment can cost you as little as 30p whereas that same payment taken by card would have a fee of £14-20. These savings add up over time, with clinics enjoying £1000s in savings over the course of a year.

With Coherent as your payment partner, we like to think of ourselves as an extension of your team: monthly reports sharing insights around your payment mix with helpful hints on how to reduce payment fees further. And we’ll always be on-call at no extra cost for any questions regarding your financial operations.

Easy to change, easier to start

We begin any conversation by asking for your current payment statements to ensure we’re offering you the best possible rates.

Once you’re happy with our proposal, it takes less than a day to switch over to Coherent.

Once live, you can contact us 24/7 over WhatsApp, email or phone, and we aim to respond within 5 minutes.

Exclusive offer

From October-December, Coherent is offering a complimentary Coherent Quality Score audit (worth £2,000) to all Consulting Room clinic partners. The team will conduct a comprehensive review of your payment processing costs with the aim of helping you recapture hard-earned revenue. Simply reach out at hello@ coherenthealthcare.com, mentioning ‘Consulting Room’ in your enquiry.

Don’t just take our word for it

“I have had the pleasure of working with Coherent Healthcare since December 2023, and I cannot recommend them highly enough. As a healthcare professional running a busy clinic in Chelsea, I don’t have time to worry about financial operations like payment processing and insurance claims. Their team demonstrated an exceptional understanding of my clinic’s needs and circumstances, providing invaluable support throughout the process. They provided an audit of my current payment setup, making improvements on my then-current provider, Square, such as implementing Pay by Bank, lowering card fees and offering remote links for payments. I highly recommend them to any healthcare practice looking for best-value payments processing and billing.”

– Dr Chaban, London, August 2024

LEVELLING UP

Angela Brennan and Neil Pybis discuss Level 7 training, why it matters and how they became the first nurse-led OTHM Level 7 Aesthetic Injectables provider in England

At SATA here in Liverpool, we are about to have our first graduates on our Level 7 Diploma in Clinical Aesthetic Injectable Therapies. We wanted to share with you our journey from discussing possibilities in a Tesco coffee shop to becoming the first nurse-led OTHM Level 7 Aesthetic Injectables provider in England and the first OTHM Level 7 provider to be recognised and approved by the JCCP.

Neil and I, who own and run SATA, met around 12 years ago when we first entered the world of aesthetic practice. We became friendly over the course of multiple conferences, study days, and training events, and we recognised that we shared values regarding the position, reputation, and quality of aesthetic education. As nurse prescribers, we have nearly 60 years of clinical experience behind us in areas such as intensive care, accident and emergency, acute care and as community practitioners.

In addition, Neil’s experience as a trainer and speaker for major aesthetic manufacturers and my 17 years experience in higher education as programme developer/leader through to Director of School of Nursing at LJMU ensures that we have an excellent grounding in developing, delivering, assessing and evaluating the quality of clinical education programmes. Indeed, my dissertation for my Master’s degree was on measuring quality in clinical education. So, we think it’s fair to say that we have the knowledge and experience required in the field of aesthetic practice and education.

From the word go, when we first met in that coffee shop two years ago, we have always wanted to ensure that our level 7 programme was awarded by an accredited awarding body and also, importantly, recognised by the JCCP.

Why Level 7?

Some people may question why education for aesthetic practice has to be at the postgraduate level. Is this something the JCCP has thought up?

When we entered aesthetic practice, there were very few options available in terms of education to prepare us for practice in this new field: mostly one- or two-day

courses where we did perhaps one or two injections on a shared patient before being let loose.

When you compare this to post-registration requirements for qualified nurses who wish to specialise in a particular field (Specialist Practitioner or Advanced Practitioner awards), it would be almost laughable—if it weren’t so serious.

Thankfully, this situation is now changing due to all the work done following the Keogh Report on the surgical and nonsurgical cosmetic sector in 2013.

As a result of the Keogh Report, Health Education England (HEE) conducted a review in two parts of the qualifications that should be required for non-surgical cosmetic interventions. In its final report in 2015, HEE stated that qualifications for botulinum toxin and non-permanent dermal filler should be at Level 7 (postgraduate) rather than, as previously suggested, at Level 6.

The thinking behind this will be familiar to those of us who have undertaken postregistration qualifications in nursing in the past and include;

The high risk and complexity associated with botulinum toxin and dermal fillers.

• The recognition of the difference between administering injections for drug delivery and administering injections into the face to modify appearance.

• Because it is important for practitioners to be able to deal holistically with a patient who may require a combination of treatments.

• Because practitioners need to make complex decisions and risk assessments regarding their treatment plans which requires learning at Level 7.

The Higher Education Quality Assurance Agency has described Level 7 as follows:

“Much of the study undertaken for master’s degrees will have been set at, or informed by, the forefront of an academic or professional discipline. Students have shown originality in the application of

knowledge, and they will understand how the boundaries of knowledge are advanced through research. They will be able to deal with complex issues both systematically and creatively, and they will show originality in tackling and solving problems. They will have the qualities needed for employment in circumstances requiring sound judgement, personal responsibility and initiative in complex and unpredictable professional environments.”

If this doesn’t describe aesthetic practice, then what does? Of course, education in a specialist field of practice needs to be at the postgraduate level. Qualifications for all other specialist fields of practice are at Level 7. As with any post-registration or postgraduate course, some knowledge and skills will be transferable, but a lot will not. We all want to get recognition for our professional status as aesthetic practitioners, and this is only going to help that. This also shows that Level 7 was thought of and decided well before JCCP came along.

How do you know that your programme is at level 7?

This is where the choice of awarding body comes in. Again, thinking back to initial nursing or medical education, we have professional bodies that dictate the education standards, whether this be NMC or GMC, GDC, etc. This will include the length of the programme, clinical hours and expected outcomes for medical and nursing education in England. This means that wherever in the country you undertake your medical/nursing education you can be assured that the standards that you achieve are recognised and transferable. In relation to education for aesthetic practice, this is still not the case. We, therefore, need a way in which outcomes from aesthetic education can be standardised, whether you trained in Liverpool, London or anywhere else. The JCCP has started work in this area by recognising two awarding bodies whom they know meet all the standards for education in aesthetic practice at Level 7. They know because these awarding bodies have had to undergo an approval process to evidence that their curriculum meets the required outcome standards.

BUSINESS

Why JCCP Approval?

If you choose a Level 7 programme that is awarded by an approved awarding body, does this mean that it will definitely equate to all other Level 7 programmes? Well, the short answer is no.

Going back to our analogy of preregistration medical and nursing education, several institutions may offer this outcomebased curriculum, but this does not mean that they are all equal in terms of teaching strategies, resources, experience of staff, etc. In the world of higher education, this is where the Quality Assurance Agency (QAA) came in. The method of assuring quality in higher education is in a state of flux at the moment, with QAA withdrawing and the Office for Students (OfS) taking over. However, historically, QAA would undertake assessment and approval visits to a learning provider once every couple of years to ensure the quality of the learning environment, the teaching and learning, the student support and guidance policies, etc. This allowed potential students to judge the quality of the education provider before they gave them their hard-earned money and/or went into debt to obtain a qualification.

The JCCP is presently (and we believe in the future) undertaking this role for aesthetic education. Education providers such as ourselves have the opportunity to undergo an approval process with the JCCP to ensure the quality of the learning provider in all aspects of its curriculum delivery. This final quality assurance process is the only meaningful way that the quality, not only in terms of the level of learning and the curriculum outcomes are standardised, but also the quality of the teaching and learning, quality of teaching staff, resources, quality improvement initiatives etc. are all at the standard required to deliver quality Level 7 education to students.

The JCCP approval process is rigorous (to say the least). It involved the production of all our documentation and a twohour approval meeting at which we were required to answer questions from a panel of seven experts, including representatives from the JCCP Education Committee, clinical experts and education experts from Higher Education. This process was hard, there is no doubt, but it was extremely useful and enlightening to us, allowing us to drill down into detailed discussions of our teaching and learning methods, how we monitor quality in our programme, our student support and guidance methods,

our assessment and evaluation strategies and indeed every aspect of not just what we deliver but how we deliver it.

We believe that the JCCP has an important role to play in ensuring that standards are met and maintained in all aspects of education for aesthetic practitioners of the future. The level and outcome standards of programmes can be assured by the JCCP only recognising awarding bodies that can evidence that these standards have been met. The quality of the student experience, the teaching and learning, the experience of the teachers, the learning resources used, etc, can be assured by education providers undergoing and meeting the JCCP standards for education. In this way, as we go forward, we hope that the qualification of aesthetic practitioners will hold the same value across the board as NMC and GMC post-registration qualifications such as Specialist and Advanced Practitioner.

In the past, and to some extent this is still the case, education and training providers will present their students with certificates stating that they have undertaken a level 7 qualification with X, Y or Z training companies. When it comes to obtaining practice insurance based on these certificates, insurance companies have no knowledge of the status of that certificate, yet in the current environment, they will have to offer insurance based on these certificates. Insurance companies have indicated that they would welcome some standardisation in the level and quality of aesthetic education and training, or at the very least, some kind of accreditation by a body such as the JCCP to enable them to make more informed judgements about the insurance of practitioners.

When a person has trained as a nurse, doctor or dentist, insurance companies don’t need to ask where the training was undertaken because we have national quality assurance processes in place covering this training. We believe that the way forward is to have such a national

approach to quality assurance that recognises not just the curriculum but the provider- so that a Level 7 Diploma is actually that, and not a week-long course masquerading as a Level 7 Diploma.

At SATA, we offer the Level 7 Diploma in Clinical Aesthetic Injectable Therapies, awarded by OTHM and approved by the JCCP, both as full Diploma and Fast Track routes.

Our teaching and learning methods are based on a higher education or andragogy approach. Andragogy refers to principles and methods used with adult learners. Adults use their own experiences and the experiences of others to gain a better understanding of the curriculum. The five principles of andragogy are incorporated into the SATA model of education:

• A move from being dependent on others to being self-driven and independent.

• An increasing reservoir of experience, which becomes a deepening resource for their learning- certain things become intuitive. As adults move into new roles, their readiness to learn becomes oriented to those roles.

• The application of learning becomes immediate and more problem centred- they encounter problems and immediately apply their knowledge to solve those problems.

• Adults are internally motivated to learn. They want to grow in selfdevelopment and acquire new knowledge and skills.

Those first tentative discussion over coffee in Tesco’s have developed over the last 18 months into a Level 7 Diploma that we can be proud to promote to would be or experienced aesthetic practitioners. We would love to hear from you if you would like to discuss any aspect of our programmes or just to have a chat – over coffee.

Introducing...

EXO|E Skin Revitalizing Complex is an innovative skincare line that utilises biomimetic plant stem cell technology to rejuvenate and revitalise the skin.

Supporting the Building Blocks of Skin

The unique manufacturing process of EXO|E™ allows the extraction of stem cells, sourced from plants. In vitro exposure to a proinflammatory environment activates the stem cells, prompting the release of potent plant-derived secretory factors through exocytosis. The secretory factors contain exosomes, growth factors, interleukins, cytokines and peptides in their natural state - unaffected by freeze drying.

Suitable for all skin types and conditions, the complete treatment protocol includes D|TOX, EXO|E, and RE|PAIR, which can be used both in-clinic and at home to prepare skin pre-procedure or enhance treatment outcomes. It can also be used on its own to dramatically improve your youthful appearance.

As we age, collagen, elastin, and hyaluronic acid production is reduced affecting the appearance of the skin. EXO|E reduces inflammation, while significantly increasing collagen, elastin and hyaluronic acid production helping support the skin’s revitalizing process.

EXO|E offers several benefits to your practice, including increased patient retention and referrals, and the potential for new avenues for revenue. Less downtime and enhanced results make it a popular choice with patients seeking anti-ageing and common skin condition treatments. Contact us to schedule a demo or learn more about this revolutionary

Call: 07734 101 275 or 07867 397 106 or visit: amp-uk.co.uk

Immediatley post EXOIE applied to one side of face only No EXOIE 1 EXOIE Application

Q4 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!

If you are interested in launching your own brand skincare or developing your own bespoke formulations contact info@5squirrels.com to discuss your project.

The summer recess in parliaments has meant little change in the regulatory landscape in the last quarter, however with a new UK government promising more alignment with the EU a tabled overhaul of the EU cosmetic regulations could have a major impact int e coming months although there is a lot of internal politics and industry resistance to this.

Markets, however, have been very dynamic in the last quarter with convergence between pharma and cosmetic companies both in the medical and aesthetics space as appetite grows from both drug and aesthetics suppliers to widen their reach into consumer audiences.

Regulations

In August 2024 the UK Health and safety Executive published a technical report on the mandatory classifications for Tea tree Oil under the GB Classification, Labelling and Packaging Regulation. It is proposed that tea tree Oil will have a mandatory CMR 1B as a reproductive toxin. A final decision is due within 12 months.

This could effectively mean a ban on the chemicals used.

The data has been produced from forcefeeding animals. Tea tree Oil and industry specialists are challenging the report for topical use.

https://www.chemistryworld.com/ news/tea-tree-oil-faces-ban-in-uk-andeu-over-reprotoxicity/4020140.article

The ASA has begun clamping down on Menopause claims made around cosmetic products especially on social media with 5 influencers identified for investigation due to them making medicinal claims of treating menopause symptoms with moisturisers.

https://www.asa.org.uk/rulings/feelholdings-ltd-a24-1246372-feel-holdingsltd.html

A revision of the EU cosmetics regulations which has not been updated since 2013 has been suspended due to internal disagreement and its potential cost impacts to industry.

https://www.cosmeticsdesign-europe. com/Article/2024/07/10/Will-the-EUs-Cosmetics-Products-Regulationrevision-ever-happen

Johnson & Johnson has agreed to a $9 Bn+ settlement over ovarian cancer claims from talc, forcing a subsidiary to file for bankruptcy.

https://www.reuters.com/business/ healthcare-pharmaceuticals/johnsonjohnson-wins-over-longtime-holdouttalc-settlement-wsj-reports-2024-0904/#:~:text=Sept%204%20(Reuters)%20 %2D%20Johnson,familiar%20with%20the%20matter%20said

Markets

There have been several interesting acquisitions of cosmetic companies by pharmaceutical companies in the last quarter as the two, once separated by regulation industries, begin to diverge.

The trend is fuelled by an appetite for drug companies to recruit new audiences for blockbuster drugs following the success of Botox and Ozempic with the same target consumer groups.

• Taro Pharmaceuticals purchased Alchemee

• Febre Laboratories bought a stake in MiYe cosmetics and also acquired Glytone Megalabs bought a majority stake in DS laboratories

• Arrotex Pharma purchased Nude cosmetics and Makeup Cartel

https://beautymatter.com/articles/ the-pharma-beauty-fusion

In another interesting move following the L’Oréal investment in Galderma, Crown laboratories owner of Strivectin cosmetics have announced a merger with Revance A Texas based Fille rand Toxin company.

https://www.premiumbeautynews. com/en/crown-laboratories-toacquire,24291

The Body Shop’s remaining stores have been rescued by The Aurea group securing the jobs of 1300 employees. 7,000 jobs have already been lost by the company’s insolvency so far.

https://www.bbc.co.uk/news/articles/ cx2lzjlg182o

Scientific

Findings in Frontiers in Nutrition have indicated that an optimal dose of Omega 3’s can delay biological ageing; it indicated that an optimal dose of 1.1 grams per day could decrease phenotype ageing, but higher doses did not correlate with added benefits.

https://www.frontiersin.org/ journals/nutrition/articles/10.3389/ fnut.2024.1424156/full#h6

As controversy grows around the efficacy of some SPF products on the market and a recent Which? Report claiming many did not achieve the claims made. The issue revolves around the current test methods which essentially require in vivo tests by burning human skin to determine the SPF factor. Whilst there are ethical questions around the testing method there is debate around the accuracy of replicating the same results across the human population and different consumers to achieve the same results.

A new In Vitro method is being developed by the International Standardisation organisation which could lead to more predictable and ethical results. It should be available for use in early 2025.

https://www.cosmeticsdesigneurope.com/Article/2024/07/26/ How-sunscreen-testing-is-about-to-betransformed

L’Oréal has launched a new ingredient, Melasyl, to address localised pigmentation. The company claims that the groundbreaking new ingredient “Melasyl is a first-of-its-kind ingredient that helps to address localized skin pigmentation issues, with proven efficacy and wide accessibility that will enable more people to regain their self-confidence.”

Melasyl works by capturing melanin precursors before they turn into eumelanin and pheomelanin, which are coloured pigments. It’s designed to help with Age spots, post-acne marks, and Dark spots and provide a more even skin tone.

https://www.loreal.com/en/pressrelease/research-and-innovation/ melasyl/

THE AESTHETICS BUSINESS CONFERENCE 2024

Tuesday 8th October 2024, at the Royal College of Physicians, London

Hamilton Fraser presents the Aesthetics Business Conference, the dedicated business conference for aesthetic entrepreneurs seeking to establish an aesthetics business or take their existing venture to the next level.

For more information, please visit https://www.ccrlondon.com/

THE CLINICAL COSMETIC REGENERATIVE (CCR) COGRESS

Thursday 10th October 2024, at the ExCeL London

The Clinical Cosmetic Regenerative (CCR) Congress is dedicated to delivering evidencebased education and innovative products to shape the future of medical aesthetics. From injectables and devices to skincare and business.

For more information, please visit https://www.ccrlondon.com/

IAAFA CONFERENCE 2024

24th November 2024, at the De Vere Beaumont Estate, Windsor

Every year, IAAFA discusses the latest movements and innovations in the aesthetic industry. Their speakers and lectures are carefully selected and planned out to ensure that you stay up to date with the latest techniques and protocols, as well as gaining the most valuable amount of skills and knowledge possible during the conference, from top industry leaders.

For more information, please visit https://www.iaafa.net/

The UK’s largest congress shaping the future of medical aesthetics

Enhance your practice with:

• 140+ leading brands showcasing innovative solutions and products

• LIVE injectable, device and skincare demonstrations on the latest products and treatments

• 5 CPD certified conferences with over 120 world-class speakers

• Unparalleled networking opportunities

Become a menopause first responder

Get ready for a night of glitz and glamour

Entries and tickets are live! Friday 7th February 2025 at Grand Connaught Rooms, London

Over 40 Top experts

40 Exhibitors

500 Delegates

15 CPD-applied for hours

Champagne reception with networking opportunities

Hybrid conference with online and in person ticket options

Gain insight and new knowledge from industry leading KOL’s

TRAINING COURSES TRAINING

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

FOUNDATION IN WOMEN’S HEALTH

Any time | Flexible online

access

This foundation e-learning course has been developed to give practitioners a basic understanding into women’s health, the role of hormones and current menopause diagnosis and management. This course gives an introduction to bioidentical hormone therapy using the proven “Marion Gluck Method” that will enable medical practitioners to offer a personalised approach to balancing hormones.

THE ART OF AESTHETIC CONSULTATION

Any time | Flexible online access

Learn how to turn consultations into profitable sales with ConsultingRoom.com’s CPD-certified therapist training. Converting consultations effectively can boost your clinics revenue and save marketing expenses. Empower your therapists and aestheticians to make your clinic more profitable by creating lasting customer relationships. Don’t miss out on potential earnings; invest in your staff now.

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.