Consulting Room Magazine | Volume 7: Issue 3 | October - December 2023

CONSULTING ROOM | VOLUME 6: ISSUE 4 | OCTOBER - DECEMBER 2023

20TH ANNIVERSARY SPECIAL! EXOSOMES REGENERATIVE THE REGENERATIVE A dive into their legality MEDICINE POWER OF DHEA and safety The future of aesthetics?

THROUGH THE AGES The evolution of aesthetic approaches

IN THIS ISSUE: REGENERATIVE AESTHETICS SPECIAL

ESTABLISHED IN 2003, CONSULTING ROOM BRINGS TOGETHER EVERYTHING YOU NEED TO DEVELOP AND GROW A SUCCESSFUL CLINIC BUSINESS IN AN INCREASINGLY DIFFICULT UK AND IRELAND MARKETPLACE.

EDITOR’S NOTE

WELCOME TO THE REGENERATIVE AESTHETICS ISSUE OF THE CONSULTING ROOM MAGAZINE FOR WINTER 2023 Shutterstock/Galaxy love design

Welcome to the latest issue of the Consulting Room magazine. We hope you are enjoying our new digital format!

Regenerative aesthetics. If there’s one buzzword that summarises trends in 2023, that’s it. Of course, regenerative medicine and regenerative aesthetics are nothing new, but they have come to the forefront this year with the wider use and popularity of treatments such as polynucleotides and exosomes. That’s why we thought it would be fitting to close out 2023 with a look at this exciting area of aesthetics, which many are touting as the future.

On pages 25-41 we give an overview of what these treatments are and why they are so popular before looking into the legalities around exosomes on pages 28-30. Roseway Labs provide this month’s CPD article examining the role of DHEA on pages 32-35, while Dr Abs Settipalli gives his views on the trend on pages 36-38. And if you are thinking about integrating polynucleotides into your practice but are not sure about insurance coverage, then turn to our business section on pages 78-79, where Hamilton Fraser will tell you everything you need to know.

As well as this, Dr Mei Yeoh looks at aesthetic approaches through the ages (p54-57); Paaven Patel tells you how your pharmacy can help you manage eczema on pages 70-71, and Lorna Bowes gives the secrets of making money while you sleep (p82-83).

We hope you enjoy this issue and look forward to bringing you more content in 2024!

Vicky Eldridge

2 | Consulting Room | Q4 2023

www.consultingroom.com | 3

CONTENTS Shutterstock/Galaxy love design/New Africa/LADO/Ground Picture/Galaxy love design/Bagus Production/Kourdakova Alena/Front Cover/Kotin

36

REGENERATIVE AESTHETICS: A COMPARATIVE DISCUSSION Dr Abs Settipalli gives his views on the rise of regenerative aesthetics and how they fit into existing practice.

32

THE REGENERATIVE POWER OF DHEA Miriam Martinez Callejas, Superintendent Pharmacist and cofounder of Roseway Labs, unveils the role of DHEA in human tissue rejuvenation.

80

26 THE WORD ON THE STREET An overview of the latest regenerative treatments taking the industry by storm.

86

44

SETTING BOUNDARIES

A CHANGING LANDSCAPE

NAME OF THE ROSE

Dr Tatyana Lapa-Enright on the benefit of setting personal and professional boundaries

Tracey Jones, a regulation consultant providing support related to CQC registration and inspection, gives her views on enhancing regulation in the sector.

Dr Nabil Elmahdawi on gynaecological rejuvenation in menopausal women and the Nrose protocol.

4 | Consulting Room | Q4 2023

04 - 07 CONTENTS 08 - 13 NEWS 14 - 23 EVENTS

24 - 41 REGENERATIVE SPECIAL 42 - 59 CLINICAL

60 - 67 TECHNOLOGY 68 - 75 SKIN

76 - 85 BUSINESS

86 - 94 TRAINING

28

TINY BUT DIVISIVE: A DEEP DIVE INTO THE LEGALITY AND SAFETY OF EXOSOMES Exosomes are the hot new kid on the regenerative beauty block. While those derived from humans are thought to have superior anti-ageing properties, they are illegal in the UK but are reported to be widely available in aesthetics. We get the expert lowdown…

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.

Shutterstock/Galaxy love design

Advertising & Membership Manager Rebecca Faulkner-Graham | Sales Manager E: rebecca.graham@consultingroom.co.uk T: 07568 359 741

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

Please be aware that some articles included in this magazine are certified for Continuing Professional Development (CPD) and may make a contribution to your personal CPD requirements.

To download a CPD Reflective Learning Form, produced in association with the British Association of Cosmetic Nurses (BACN) & the British College of Aesthetic Medicine (BCAM), please use the QR code or visit bit.ly/CR-CPD in your web browser.

www.consultingroom.com | 5

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.

Dr Patrick Treacy Founded the Ailesbury Clinic based in Dublin.

Current President of the RSM (London) Aesthetic Faculty. Chairman of the Irish Association of Cosmetic Doctors.

Dr Uliana Gout Educator & Speaker.

British College of Aesthetic Medicine Former President & Int. Peeling Society Board. Founded London Aesthetic Medicine Clinic & LAM Academy.

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.

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

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

Martyn Roe

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.

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

Mike Regan Certificated Laser Protection Adviser and Chair of the Association of Laser Safety Professionals.

Actively involved in laser safety and CEN standards.

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

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

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.

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

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

A Specialist Business Consultant and Co-Founder of The Consulting Room Group. Martyn is now Business Development Director of Clé Medical Ltd.

6 | Consulting Room | Q4 2023

CONTRIBUTORS

MIRIAM MARTÍNEZ CALLEJAS

TATYANA LAPA-ENRIGHT

Miriam is the Superintendent Pharmacist & Founder of Roseway Labs which allows her to provide the best medications to maintain a patient’s health and wellness. She holds a Master’s Degree in Pharmacy with international experience in bio-pharmacy research, compounding and nutrition.

Dr Tatyana Lapa-Enright is an experienced doctor specialising in cosmetic medicine and cosmetic dermatology. Tatyana also has extensive experience in using botulinum toxin for health benefits, including facial pain, bruxism, migraines and muscular skeletal problems.

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

DR ABS SETTIPALLI Dr Settipalli has trained all over the world, authored publications and directed clinical research in multiple countries.

His expertise varies from subjects such as biotechnology and dermatological biochemistry to bioelectromagnetics and quantum electrodynamics.

DR NABIL EL MAHDAWI Dr Nabil El Mahdawi is a trainer and safety educator and has received awards and commendations throughout his career.

His career and expertise led him his focus on functional and aesthetic improvements for cancer survivors to combat the ageing process of this gruelling illness.

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

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

MARYAM MCMILLAN

TRACEY JONES Tracey has been a nurse for 27 years and worked as a CQC specialist advisor for 10 years. Her company Inspire to Outstand, that she runs with an experienced CQC inspector, her business partner Sophie, supports clinics registering with the CQC and preparing for upcoming inspections.

Dr Maryam McMillan, an experienced dental surgeon, used her growing interest for facial aesthetics to develop Ambra Aesthetic Clinic. Clinical excellence is a must for Dr McMillan and with over 15 years of experience in the medical field, she ensures integrity and professionalism.

www.consultingroom.com | 7

NEWS

FACTS AND FIGURES

Shutterstock/Anton Vierietin

We look at the recently released trend reports and statistics from BAAPS and BCAM following their annual conferences BCAM 2023 Annual Clinical Review

handled someone else’s complications.

The British College of Aesthetic Medicine has released data from its annual audit of 357 members to inform on treatment popularity and complication management.

Most (69%) of the complications had come from treatments performed by beauticians, therapists and podiatrists, which is up from 60% last year. The rest were attributed to other aesthetic medicine doctors, surgeons, nurses and pharmacists.

While the frequency of treatments performed remains similar to last year, results demonstrate a staggering rise in complications caused by other practitioners being managed by BCAM members.

Complications BCAM members have treated 300 more complications from other practitioners since last year.

The total number has risen to 3,523 from 3,323 since 2022. Of the 357 BCAM members surveyed, 82% said they had

Dermal filler procedures continue to be associated with the biggest number of complications, while adverse events associated with botulinum toxin are not far behind: • • • •

Dermal fillers (44%) Botulinum toxin (30%) Threads (12%) Lasers and other energy-based devices (9%)

8 | Consulting Room | Q4 2023

Due to the lack of the denominator (number of procedures performed by nonphysician practitioners), it is impossible to estimate the relative rate of complications of injectable treatments performed by unregulated practitioners in the UK. BCAM president Catherine Fairris said, “We have found that dermal fillers continue to be the treatment with largest number of complications from nonmedical practitioners, which confirms how dangerous dermal fillers can be in the wrong hands. Notably, members report that these complications are often more severe and require specialised treatments. We strongly welcome the public consultation for a licensing scheme of aesthetic treatments, which will hopefully reduce the rate of complications and put patient safety first in the coming years.”

Trends in aesthetic plastic surgery revealed at the BAAPS Annual Scientific Conference World leading experts and thought leaders in the field of aesthetic plastic surgery have unveiled the latest industry trends and techniques at the British Association of Aesthetic Surgeons’ Annual Scientific Meeting.

The theme of this year’s conference was Elevation in Surgery: elevation of technique, results and patient experience.

According to the BAAPS annual audit, 31,057 cosmetic procedures took place in 2022, up 102% from the previous year. Partly responsible for this boom are advancements in techniques that help to improve patient outcomes, satisfaction and safety.

The future is facelifts: The ponytail lift, scarless beautification and global rejuvenation Chia Chi Kao, an esteemed facial surgeon located in Los Angeles, has gained widespread recognition for transforming facelift procedures. His innovative approach, dubbed the “Ponytail Lift,” involved discreet, minimal incisions strategically placed behind the ear and within the hairline. Unlike traditional methods that primarily focus on elevating the brow, Kao’s technique prioritises altering the brow’s shape rather than its height. Through skilful rotation of the outer brow, the emphasis is shifted from lifting to reshaping, mitigating the risk of a “windblown” or “surprised” appearance.

“One of the many interesting things about Dr Kao’s pioneering work is that it can be used earlier on in the ageing process, because it’s not so much about lifting sagging skin”, said BAAPS President Marc Pacifico.

In a recent survey of BAAPS members, 70% observed a trend for patients under 50 enquiring about facelifts. “It was observed that facelifts are often considered by patients in their early to mid 40s who usually have the mindset of maintenance rather than later rejuvenation”, adds Pacifico.

The Gliding Lip Lift With many celebrities taking to social media to renounce lip fillers, alternative techniques for achieving plump, natural-looking lips are gaining popularity. Jerry O’Daniel brings over 30 years of experience to the full spectrum of cosmetic and non-surgical procedures and is renowned for his anatomical approach to face, neck and lip lifting.

As O’Daniel points out, we judge age not by the eyes but by the lips, making them all the more crucial to get right.

The challenge with a traditional Bullhorn Lip lift is that if only the central third of the lip is lifted, in some patients it can over-elevate this section and might look unnatural and result in “bunny lips.”

O’Daniel’s Gliding Lip Lift helps with elevation of the lip more laterally as well as in the middle, helping to maintain natural proportions. It is done under local anaesthetic and scarring is minimal.

Small is the new big: Stem cell-enriched fat grafts for breast augmentation According to the BAAPS Annual Audit, Breast Reduction procedures were up by 122% in 2022, with many women choosing a smaller cup size due to lifestyle choices. “Women are being influenced by wellness and improving the quality of their lives, rather than aesthetic concerns,” says BAAP’s Vice President Nora Nugent.

Some are also having their implants removed due to implantassociated complications such as chronic pain, capsular contraction, breast deformities, or concerns over breast implant illness. Replacement with a new implant is therefore not desirable and alternatives are requested by patients to substitute the removed implant volume for a cosmetic satisfying result.

Whilst fat transfer treatments are a natural and effective alternative to artificial implants, their success has been limited by an unpredictable fat survival rate, previously thought to be between 40-60%. Aiming to improve treatment outcomes, a new fat enrichment technique has been developed to safely and efficaciously replace the implant volume with fat grafts enriched with ex vivo expanded stem cells.

By boosting naturally-occurring stem cells within the fat, that is harvested from the tummy or thighs, the new technique increases the fat survival rate to 80-100%, resulting in much more predictable treatment outcomes for patients.

www.consultingroom.com | 9

NEWS

The Medicines and Healthcare products Regulatory Agency (MHRA) has taken action against a rising threat to public health in the United Kingdom, seizing 369 potentially fake Ozempic weight loss injection pens since the beginning of the year. Concerns have been raised as a small number of individuals have been hospitalised due to complications believed to be associated with these illicit weight loss pens, obtained through ‘non-legitimate routes.’

EXAMPLE FALSIFIED PEN ON TOP, AND A GENUINE NOVO NORDISK PEN ON THE BOTTOM

Dr Alison Cave, the Chief Safety Officer of the MHRA, has emphasised the dangers of acquiring such products without a prescription.

“Buying these products without proper medical oversight poses a direct danger to health,” she warned. Cave highlighted that serious side effects, including hypoglycemic shock and coma, have been reported among those hospitalized, suggesting that the counterfeit pens may contain insulin rather than the intended semaglutide.

The European Medicines Agency has joined the investigation, confirming the presence of counterfeit Ozempic products in the market.

Counterfeiters have gone to great lengths, copying batch numbers, barcodes, and unique serial numbers directly from genuine packaging. However, consumers are urged to be vigilant as the actual packaging of the fake pens may vary in colour, with some having a clear lid instead of the authentic grey.

Former UK Health Minister Will Quince expressed his concerns, stating, “No one should put profit before the needs of patients, but fraudsters selling black market medicines like this are extremely dangerous and can put people’s health at risk.” Quince stressed the importance of adhering to medical advice, asserting that patients should only use medicines like Ozempic or Saxenda if prescribed by a legitimate source, such as their GP or another qualified prescriber.

The MHRA continues to investigate the origins and distribution networks of these counterfeit weight loss pens, urging the public to remain vigilant and report any suspicious products. As the investigation unfolds, authorities are working to ensure the safety of the public and eliminate these potentially harmful counterfeit medicines from circulation.

Four out of five surgeons unknowingly practicing without adequate insurance cover Up to 80% of surgeons are unknowingly not adequately covered by their insurance, leaving patients in limbo and prompting the UK’s sole trade union for surgeons and anaesthetists to call for an overhaul of the system.

The GMC requires all doctors and surgeons to have adequate protection in place to allow them to practise in the UK, which theoretically covers both the patient and the practitioner. However, providers are largely unregulated, with no external accountability or scrutiny, leaving it to their discretion as to whether they pay out or not. Although practitioners are covered by NHS indemnity, many aren’t aware that this cover does not extend to locum work, ‘Good Samaritan’ acts, or private practice. This means that in the event of a claim, patients will have to resort to suing the surgeon directly, and if they do not have the means to pay the compensation out of their own pocket, the patient will be left with nothing.

With 80% of surgeons relying on medical defence organisations (MDOs) to provide their insurance, the potential impact on patients is vast. The UK’s sole trade union for surgeons and the surgical team, the Confederation of British Surgery (CBS www.cbsgb.co.uk), is calling for an end to discretionary cover and a shift to contractual cover, which is closely monitored by financial authorities, ensuring it operates with transparency within the parameters of the contract. This type of indemnity cover offers clear guidelines as to how and when payouts will be made and will make payments within the terms of the contract, holding both parties accountable to its terms. Conversely, discretionary protection is a gamble, leaving payouts to a seemingly random system of chance.

Consultant plastic surgeon and President of the Confederation of British Surgery, Mark Henley, said: “It is a disconcerting truth that the vast majority of surgeons find themselves without adequate indemnity insurance coverage, with many oblivious to its limitations.

This jeopardises the practitioners and patients in the event of a claim, resulting in arduous legal battles that drain both finances and psychological wellbeing. Urgent and sweeping change is imperative to dismantle the current landscape plagued by unscrupulous insurance providers.”

The growing complexities and costs associated with private practice have led many surgeons to reconsider how they work. The lack of proportional increases in fees for private operations, combined with the costs of insurance products that may or may not pay out when needed, contributes to the challenges surgeons face in maintaining viable private practices whilst failing to protect patients.

10 | Consulting Room | Q4 2023

Image courtesy of Novo Nordisk/Shutterstock/Jacob Lund

DHSC releases its consultation document on the future of Counterfeit weight loss injection pens pose health risks

Industry trends revealed at CCR CCR has unveiled its annual Trends Report exploring current trends in surgical and nonsurgical aesthetics. Co-edited by Francesca Ogiermann-White, editor of Tatler’s annual Beauty & Cosmetic Surgery Guide and founder of The Beauty Triangle and Shannon Kilgariff, Aesthetics Journal editor and Aesthetics Event Manager, the report identified five key trends: Women’s Health, Medical Weight Management, Skin and Injectable Demands, Regenerative Aesthetics and LGBTQ+ Inclusive Aesthetics.

Commenting on the latter, Dr James Olding – a specialist registrar in oral and maxillofacial surgery and aesthetic practitioner, said, “We need to improve understanding of the differences between gender identity and sexuality and recognise that the two do not define one another. For example, there’s a common assumption that a homosexual man will want to look more feminine. In my experience of treating many gay men, this is absolutely not the case. Many have been called horrible names growing up and don’t want to be associated with feminine features, instead requesting masculinisation treatments like a stronger chin and jawline. Grouping stereotypical traits of gender and sexuality together is clumsy – we need to treat everyone as an individual.”

Shock as news of Dr Uchenna Okoye’s sudden death announced An inquest has revealed that Dr Uchenna Okoye died from a bleed on the brain.

The 53-year-old dentist, and founder of London Smiling, who starred on Channel 4 makeover show 10 Years Younger and was a regular contributor on ITV’s This Morning, died on 15 September after falling ill at home.

In a statement based on a coroner’s report, and released by Dr Okoye’s personal assistant, it said her “sudden death” was caused by a subarachnoid haemorrhage, an uncommon type of stroke caused by bleeding in the space between the brain and thin tissues that surround the brain, reported Sky News. The condition was caused by an aneurysm and “can happen for no apparent reason”, the statement read.

Dr Okoye’s family shared their sadness through a heartfelt message on Instagram, saying, “We are heartbroken to announce that Dr Uchenna Okoye sadly passed away after a sudden illness on Friday, September 15, 2023. We ask for your prayers and some privacy at this difficult time.”

Group of scientists from King’s College London, in partnership with the British Skin Foundation, are looking for individuals living with keloid scars to take part in survey A group of research scientists from King’s College London are appealing to those affected by keloid scars to fill out a survey in collaboration with the British Skin Foundation.

A previous survey published on the BSF blog generated vital results and helped the group broaden its focus to tackle both keloid pain and itch. Now, researchers are looking to collect data from a larger group of people to fully understand and study how keloids affect a range of people differently through a full spectrum of experiences.

The group is asking people with at least one keloid scar to answer questions about their appearance, symptoms, social impact, pain, itch, and other characteristics. “The purpose of the study is to understand how wounds heal and how this goes wrong in cases of severe scarring, such as keloid scars”, the website says. “We are interested in understanding why some people feel pain and itch in their scars and what causes this. This study is part of a PhD project.”

Completion of the questionnaire should take about 10-15 minutes, and questionnaire results will be anonymous. You can fill out the survey here: https://www.britishskinfoundation.org.uk/ news/help-scientists-better-understand-the-impact-of-your-keloid-scars

NEWS IN BRIEF STORIES Croma-Pharma becomes first company worldwide to achieve MDR approval in the aesthetic field Croma-Pharma has become the first industry company to achieve European certification under the Medical Device Regulation (MDR) 2027/745 for aesthetic purposes (MDR Annex XVI). This means that “Saypha® RICH” is the first of a total of seven CromaPharma product groups to successfully complete the strict MDR certification process. All other products from the Saypha® range will be approved by the first quarter of 2024.

Dr Sophie Shotter announces guest residency at Biolite Dubai Founder and medical director of the Illuminate Skin Clinic in Kent, Dr Sophie Shotter, has announced a new regular guest residency at Biolite Aesthetics Clinic, Dubai. Originally founded in London by Mona Mirza, the awardwinning Biolite Aesthetics Clinic has since established itself as a prestigious destination clinic and won recognition from HRH Sheikh Mohammed bin Rashid Al Maktoum himself for its success, spanning a 16-year residency in Dubai.

Dr Harry Singh launches new app for injectors Dr Harry Singh has announced the launch of a new app for injectors. The ‘Botulinum Toxin Converter app’ is a calculator that helps clinicians work out units of toxin, depending on the brand and how much diluent is used for reconstitution. The app aims to counteract any concerns about using a new toxin, using a dosages converter.

The app is available now, for free, on the Apple App Store and Google Play Store.

Cutera announces new UKI leadership Cutera has announced the appointment of Sam Keene as the new regional leader for the UK and Ireland. Having previously held a senior European marketing position at Cutera and with over 11 years working for device-led aesthetics brands, Keene will now lead the Cutera UK and Ireland team into 2024, in what the company say is “the next phase of our Cutera UK.”

www.consultingroom.com | 11

NEWS Experts call for increased measures in Ireland A group of aesthetic medicine experts in Ireland have called on their Government to respond to the unregulated use of botulinum toxin and other cosmetic treatments. In a letter sent to all TDs (Teachtaí Dála), the group of 30 doctors has called for a range of measures to deal with non-medics administering botulinum toxin to their clients.

The letter said: We are growing increasingly concerned about the exponential rise of lay persons including hairdressers, nail artists, make up artists etc. attending short one-day crash courses in ‘medical aesthetic procedures’, often in the UK, and setting up shop literally the next day, posing as ‘aesthetic medical practitioners’ or similar misleading titles. These individuals are utilising highly sinister social media strategies to prey on vulnerable members of the public. They offer high-risk cosmetic medical procedures at bargain prices, often in unsanitary and unregulated premises.”

JCCP shares its response to DHSC consultation on licensing of non-surgical cosmetic procedures The Joint Council for Cosmetic Practitioners (JCCP) has made its response to the Government’s public consultation on the licensing of non-surgical cosmetic procedures, which closed on October 28, available for the industry to read.

The statement said: “It has always been our opinion that the adoption of any new system of statutory reform and regulation must be determined within the context of a robust and enforceable licensing scheme. We have previously advised that any new regulatory regime should identify and put in place a nationally mandated standard for education and training for all aesthetic practitioners who perform invasive procedures as a condition of practice and should protect members of the public by requiring all practitioners to evidence possession of adequate medical insurance and indemnity, complaints procedures, fitness to practice compliance and the provision of consumer access to redress and compensation schemes. The importance of ensuring that all licensed practitioners operate from appropriately licenced hygienic and safe premises is also considered by the JCCP to be essential.”

The council also stated that it felt the Government’s proposal of a traffic light system was in line with what it had been advocating for but suggested amends to the categories, such as no needle fillers being moved from Green to Amber (subject to a required evidence-based review regarding ‘fail-safe’ devices); permanent dermal fillers being moved to Red; and all weight loss injectable and vitamin injectable procedures being moved to the Red category.

You can read the full response here: https://www.jccp.org.uk/ckfinder/userfiles/ files/DHSC%20Licensing%20of%20Non-Surgical%20Cosmetic%20Procedures%20 Consultation%20Response.pdf

ASA upholds multiple claims against providers of overseas surgery The Advertising Standards Authority (ASA) has upheld multiple claims against providers of overseas surgery, deeming their advertisements as trivialising the decision to undergo surgical procedures. Three separate ads from Turkish companies faced scrutiny. The first, promoting gastric balloon surgery, used phrases like ‘inner beauty’ and ‘permanent beauty,’ exploiting body image insecurities. The second encouraged nose jobs, offering time-limited discounts and implying that patients’ noses overshadowed their faces. The third advertised rhinoplasty as a “holiday,” downplaying the seriousness of surgery. The ASA found all three ads in violation of responsible advertising practices, demanding that they not reappear in the same format and avoid trivialising surgical decisions.

12 | Consulting Room | Q4 2023

NEWS IN BRIEF STORIES BAS announces 2024 conference The British Association of Sclerotherapists (BAS) has announced the details for its 2024 conference.

The meeting will take place on May 21 at Eton College Rowing Club, Dorney Lake Conference Centre, Windsor.

BAS president Philip Coleridge Smith said, “There are very few avenues available for UK practitioners to refine their sclerotherapy skills, share best practices, and discover how to improve patient outcomes. The BAS annual conference has become the go-to event for BAS members and nonmembers alike.” Visit bassclerotherapy. com/events/for details.

ABC Medical announces three new distribution partnerships ABC Medical (formerly ABC Lasers) has announced the addition of three new distribution partnerships into its portfolio. The new partnerships are with market-leading brands Cynosure, Deleo, and EMA Aesthetics Ltd. The new distribution agreements are part of ABC Medical’s ongoing diversification in the field of medical aesthetic devices.

BTL aesthetics announces Tim Taylor as new managing director BTL Aesthetics has appointed Tim Taylor as managing director following the departure of Zbynek Pistak.

Formerly at Cutera, Taylor joins the company at an exciting time for BTL. He says, “It is exciting to be at the helm of a business with a track record in game-changing innovation and a world-class leader in energy-based devices.”

ABG Lab welcomes Dr Aamer Khan as its Global Key Opinion Leader US biotech company ABG Lab has welcomed Dr Aamer Khan as its Global KOL. Dr Khan commented, “Regenerative medicine is the next big growth area in our industry. I am very excited and honoured to be partnering with such a progressive and forward-thinking brand like ABG Lab who have launched an innovative and ground-breaking concept to the injectable arena that specifically target and activate cellular regeneration of the skin.”

Shutterstock/David Soanes

Alma welcomes iconic Hollywood superstar, Kate Hudson as its new Global Brand Ambassador Alma Lasers has announced award-winning actress, entrepreneur, and inspirational figure in beauty, aesthetics, and wellbeing, Kate Hudson as its new Global Brand Ambassador.

Hudson is known around the world for her performances in iconic films such as “Almost Famous,” “How to Lose a Guy in 10 Days,” and the critically acclaimed 2022 Netflix hit “Glass Onion: A Knives Out Mystery.”

With their global educational campaign to look “Beyond The Trend” in aesthetics, Kate Hudson and Alma aim to showcase the empowerment of embracing natural beauty. The campaign highlights Alma’s awardwinning products, including Alma Harmony, Soprano, Opus and PrimeX, which have inspired numerous individuals worldwide, to foster confidence and inner peace with their bodies.

Directed by the award-winning American film director Anthony Mandler, known for his iconic music videos for notable artists like Rihanna, Jay Z, Beyoncé, Eminem, Shakira, Taylor Swift, and Selena Gomez, the brand new campaign guides the public on the significance of reliable aesthetic solutions over passing trends, by featuring Hudson illustrating actual beauty trends and fads that people naturally encounter on their social feeds every day. The campaign was showcased on social media and digital platforms throughout September.

“We are thrilled to welcome Hollywood star Kate Hudson as our new Global Brand Ambassador,” said Lior Dayan, Alma CEO. “Her remarkable talent and unwavering dedication to aesthetics, beauty, and wellness perfectly align with Alma’s mission.”

“Kate has captivated millions worldwide, not only through her acclaimed performances as an actress but also as an inspiring figure known for her authentic and natural beauty approach. We are truly excited to have her onboard in spreading Alma’s message worldwide”. He added.

“Partnering with Alma feels incredibly natural because we share the same passion,” said Hudson. “I’ve personally experienced Alma’s Harmony and Accent Prime treatments, and what I really like about them is that I could visually see the results on my skin. Alma’s dedication to promoting aesthetic solutions that enhance natural beauty truly resonates with me. I believe in empowering individuals to embrace their uniqueness and feel confident in their own bodies, and Alma makes it happen.”

JCCP training complaint upheld by the Advertising Standards Authority The Advertising Standards Authority (ASA) has upheld a complaint against a cosmetic training company in the North West of England following an intervention from the Joint Council for Cosmetic Practitioners (JCCP).

A post on Facebook from the training company concerned promoted a training course called “Pathway to Aesthetics” which was said to be “Fully Accredited.” The cost of this short training course was just £299. The ASA concluded that the ad was “likely to mislead” and that it breached the Committees of Advertising Practice Code.

The JCCP claimed the promotional post was misleading because it offered a training course for aesthetics procedures without making clear the nature, requirements or qualifications of the course. The JCCP also argued that to suggest the course was “Fully Accredited” and that potential students would be “Fully Qualified” was also misleading. The ASA agreed. The aesthetics training company has now been warned to ensure that it does not imply that courses it offers provide people with recognised qualifications if that is not the case.

Professor David Sines, the chair of JCCP said, “Cases like this underline the urgent need for better regulation in the non-surgical cosmetic treatments sector. The government has just concluded a national consultation on the introduction of a new licensing scheme that will ensure people who administer cosmetic procedures are properly experienced, trained and qualified, have the necessary insurance cover and operate from premises that are clean, hygienic and suitably licensed. This ASA ruling represents an explicit distinction between fully endorsed aesthetics qualifications and short CPD courses. The new proposed licensing scheme cannot be implemented quickly enough if we are to improve consumer safety and reduce the risk of injury and harm arising from inadequate training and ‘botched’ cosmetic treatments.”

The full ASA finding on this case can be found at https://www.asa.org.uk/rulings/tjc---blc-aesthetics-clinic---training-academy-a231198894-tjc--blc-aesthetics-clinic-training-academy.html Shutterstock/enciktepstudio

www.consultingroom.com | 13

EVENTS Pause Live! Business Design Centre, London November saw Pause Live! The sister consumer-focussed event to Menopause in Aesthetics (MiA) take place in London.

Over 1,500 visitors headed to the Business Design Centre in Islington to attend the ultimate ladies’ day out.

An educational stage, sponsored by Hormone Health, featured talks from leading experts, including Dr Raquel Amado, Dr Nicola Clayton, Nigel Denby, Dr Masud Haq, Dr Anne Henderson, Dr Martin Kinsella, Dr Shirin Lakhani, Dr Ioannis Liakas, Dr Ginni Mansberg, Dr Liz McCulloch, Dr Charlotte Norton, Dr Kate Organ, Dr Maja Schaedel and Dr Zoe Schaedel.

The Live Stage, presented by Vicky Eldridge and Leanne Stott, featured lots of fun and laughter with comedy legend Jenny Éclair, pop star Sinitta, Nicole and Joe Sealey from the Cheshire House Wives, Rants and Big Pants, The Wonderbirds, and The Menopause Mayhem Mother among the guests.

The event had a big community feel, and there were lots of conversations taking place that helped women feel more empowered and prepared for menopause.

The three workshops focussed on menopause and cancer, POI, and HR and saw a lot of insightful and, in some cases, emotional conversations taking place and helping ladies find their tribe.

The Wellness hubs, sponsored by Pharmstrong, were a place to seek some calm, enjoy meditation and breath work or have some fun learning different types of exercise. The hula-hooping session with Shakira Taylor had everybody laughing.

There was also a competition where each exhibitor had a QR code had to be scanned for the chance to win a retreat with Enaiya in Spain

14 | Consulting Room | Q4 2023

Other sponsors included BTL, ESK, BioID, The Slimming Clinic, DermaFocus and Monpure.

www.consultingroom.com | 15

EVENTS

HAMILTON FRASER HOSTS AESTHETICS BUSINESS CONFERENCE 2023 Hamilton Fraser’s annual Aesthetics Business Conference (ABC) returned for its sixth year on September 19, 2023 at the iconic grade one listed Royal College of Physicians. Hamilton Fraser launched ABC – the UK’s premier dedicated business conference for aesthetic practitioners – to provide practitioners with the business tools they need to get started in aesthetics and build a successful business while benefiting from a fantastic networking opportunity with lots of opportunities to interact with industry speakers and likeminded people.

The carefully selected industry speakers never fail to deliver, and this year was no exception. Dr Manav Bawa kicked off the day with his talk on how to start your business, followed by Dr Harry Singh, who focused on the patient journey. Dr Priya Chadha delivered a fantastic talk on training, and Owen Woods, Head of

Marketing at Hamilton Fraser, shared his top tips on marketing for practitioners.

Eddie Hooker, founder and CEO of Hamilton Fraser, imparted his insights on insurance before the focus turned to the major legislative change coming to the sector.

This year’s ABC was the first opportunity for practitioners to learn about the proposed licensing scheme for non-surgical cosmetic procedures, and top licensing barrister Sarah Clover delivered an excellent talk on this topic. Sarah was followed by Professor David Sines, who is well-known in the sector as Chair of the Joint Council for Cosmetic Practitioners (JCCP). There isn’t much David doesn’t know about the new regulations, and during the second half of the day, guests had the opportunity to learn how to prepare for the changes in the medicolegal session, where David was joined by Sarah and fellow JCCP board members Diane

16 | Consulting Room | Q4 2023

Hey and Andrew Rankin. The expert panel provided their advice to guests seeking answers to a range of questions, helping them to navigate the next stage in their aesthetic journey and future-proof their practice.

Sponsored by Merz Pharma, ABC 2023 offered up to eight hours of CPD-accredited points, knowledgeable speakers and exhibitors with a wide range of expertise in the aesthetic sector, and a champagne reception to round off the day.

If you couldn’t make it on the day, don’t worry – Hamilton Fraser has put together an ‘ABC 2023 podcast special’ where you can listen to highlights from interviews with all the speakers. Listen here. Hamilton Fraser will be sharing more insights from the ABC speakers over the coming weeks, so subscribe here to make sure you don’t miss out.

www.consultingroom.com | 17

EVENTS

GETHARLEY HOSTS ITS FIRSTEVER GETHARLEY GETAWAY In October, GetHarley hosted over 100 practitioners at the luxurious Oakley Court in Windsor, providing a fun-packed agenda designed to inspire, motivate and energise its community.

Guests were greeted with a branded coffee cart and refreshments before the day began with a warm welcome by founder and CEO, Charmaine Chow.

This was followed by a Fireside Chat all about building a thriving business, featuring speakers Georgia Stevenson (Index Ventures – the venture capital firm known for its investments in FarFetch, Glossier, Net A Porter, and now GetHarley), Anastasya Molodykh McFarlane (Cinven – Private Equity), Andrew Robb (ex-COO-Farfetch) and Chow.

The following session featured a panel discussion about entrepreneurial journeys with Chow and female founders – Michelle Kennedy (Peanut– an app for women to connect with women throughout every stage of their lives from pregnancy to menopause) and Whitney Hawkings, founder of FLOWERBX, an at-home, floral delivery service.

After a delicious, seasonal lunch of pumpkin soup, pasta and wedge sandwiches that allowed guests to connect with their peers and talk to brand sponsors – Revision, PCA SKIN, Epionce, Intradermology and Byonik, team members from GetHarley dived deeper into the GetHarley service. This featured guest practitioners Dr Sophie Shotter, Dr Amiee Vyas and Dr Nester Demosthenous giving the audience details of their own journeys with GetHarley.

The late afternoon was jammed packed with tennis (featuring GetHarley branded balls), swimming, cycling, and more, as guests chose to spend their time as they pleased before the uber glamorous black-tie dinner that took place outside in the Alex Eagle Club, where guests enjoyed a sumptuous three-course meal, under a canopy of lights.

The following day began with a beautiful buffet breakfast and then, for those with a clear head, it was backdown to the Alex Eagle club for pilates with Bryony Deery – a famous pilates instructor loved by many guests.

The weekend concluded with a delicious lunch before many guests left together on a coach back to London.

18 | Consulting Room | Q4 2023

Croma is More Circle Croma recently hosted an educational two-day event in Vienna, Austria, where they welcomed UK-based Dr Mayoni Gooneratne, Dr Amiee Vyas and Dr Rita Poddar, alongside Netherlands-based Dr Petra Dikrama and international delegates for tailored peerto-peer learning sessions and discussions.

The programme was developed specifically for dedicated practitioners, experienced medical advisors, brand ambassadors and key opinion leaders working with the Croma portfolio.

The two-day event was preluded with a welcome dinner and was opened the following day at the Croma headquarters by owner Gerhard Prinz and Head of Global Business Services Valentin Gruber, followed by Daniel De Boer, Global Director of Business Development & Strategy, sharing the Croma vision and providing information about the current and future aesthetic portfolio and market trends.

The first day included a tour of the production and laboratory, followed by Croma’s approach to clinic research, clinical studies and the ageing of the face. Customers then walked through the beautiful city of Vienna for a final dinner.

The second day took place at Palais Berg and was moderated by Dr Said Hilton from Germany.

Delegates were taken through lectures and live demonstrations of

the broad portfolio including: Saypha®, Croma’s Comprehensive HA Injectable Portfolio; Lift & Rejuvenate with Croma’s PDO Threads; and PhilArt, The New Trend in Aesthetic Medicine.

The event concluded with UK-based Prof Syed Haq presenting on Croma’s holistic approach to ageing.

“It was a massive honour to be invited to be part of the ‘Croma is more Circle’ event held in Vienna over two days”, said Dr Mayoni Gooneratne. “It was a wonderful opportunity to hear more about the recent and cutting-edge advancement in the use of skin injectables and to witness the whole portfolio that Croma has created and see it being utilised at its optimum. It was also a fantastic opportunity to interact with colleagues from different countries in Europe, as working in a clinic can sometimes be an insular experience, and therefore, it is always educational to share experiences and outcomes.”

www.consultingroom.com | 19

EVENTS Dr Shirin Lakhani’s ‘Let’s Get Intimate at Beyond Medispa, Harvey Nichols Members of the press were invited to Beyond Medispa at Harvey Nichols for a press breakfast and briefing entitled Let’s Get Intimate with Dr Shirin Lakhani.

Covering topics including menopause, sexual wellness, incontinence hormones, Lichen Sclerosus, and men’s health, the event also included a panel discussion with experts from Dr Lakhani’s sponsor partners for the event – InMode, Roseway Labs and Nuchido Time + – with informative discussions on women’s wellness, biological ageing, compounding, hormones and the latest advancements in the industry and cutting-edge technologies. Journalist Vicky Eldridge also joined the panel to share her experience with InMode’s VTone and Morpheus8 V. “We need to move away from the idea that women’s health is only relevant when you’ve had children or are going through the menopause”, Dr Lakhani said. “I want an environment where men and women can be completely open about how they are feeling. I want the education to be there for not just medical professionals but also the public.”

Talking about menopause, she added, “For men, hormones decline like a gentle stroll down a hill. For women, we fall off a cliff.”

But that doesn’t mean men’s health should be neglected, in fact, Dr Lakhani also used the event to introduce her new supplement P-Tox for boosting testosterone, improving blood flow and enhancing libido and strength of erections.

20 | Consulting Room | Q4 2023

AestheticSource skinbetter science® symposium AestheticSource hosted skinbetter science® symposiums at The Marylebone Hotel, London, and the Anantara, The Marker Dublin Hotel, Dublin, to showcase the launch of the ground-breaking Mystro™ Active Balance Serum.

The one day events welcomed attendees at The Marylebone Hotel, London, and the Anantara, The Marker Dublin Hotel, Dublin, and featured education and expertise from Dr Ash Soni (The Soni Clinic), Tracy May-Harriet (skinbetter® science) and Lorna Bowes (AestheticSource).

Agenda highlights included: •

Setting The Bar for Clinical Testing – what is relevant and why?

•

How Plant adaptogens balance skin: Mystro™ Active Balance Serum Launch

•

Intrinsic and Extrinsic Free Radical Damage – Topical Solutions

•

Award-Winning Retinoid With Proven Efficacy and Tolerability

•

Beyond Pigmentation – Approaches to skin discolouration

•

skinbetter science® - The non-negotiables to build patient routines in your business

The event opened with Lorna Bowes, AestheticSource founder and director, welcoming attendees and sharing the brand background and portfolio before introducing Tracy May-Harriet (skinbetter® science) and Dr Ash Soni. Guests included: Katie Hallam, Amba Logan, Alice Dring Fen, Dr Catherine Denning, and Andy Millward.

“It was an absolute pleasure to host the skinbetter® science symposium”, said Bowes. “Education is at the heart of our business and having the opportunity for a whole day sharing in-depth product and skin education, delivered by Tracy May Harriott and Dr. Ash Soni, was invaluable. Hearing such positive feedback from our guests always makes me smile.”

“Today has been absolutely wonderful. I found it really interesting learning a little bit more about the science of the brand and I’m a long time skinbetter® science fan” commented Avi Riley, from Fourways Aesthetic. “It was really good listening to other business owners too and just seeing their perspectives on skinbetter® science and how you can incorporate it into your brand. It was a really enjoyable day and I think we should do more of them, I can’t wait for the next one.”

www.consultingroom.com | 21

GENDER DIVERSITY SPECIAL EVENTS

BEAT IT

Dr Ravi Jain swims an ice mile to raise money for eating disorders charity BEAT

Shutterstock/DZiegler

22 | Consulting Room | Q4 2023

Anyone who follows Dr Ravi Jain on social media will have seen him regularly submerging himself in ice baths and swimming in the river behind his clinic at all times of the year.

The founder of the Riverbanks Aesthetics and Wellness Clinic in East Hyde has even given talks on the benefits of cold water swimming and immersion at industry events. But now he’s taking his passion for the cold to the next level by undertaking a gruelling ice swimming challenge to raise money for the eating disorder charity BEAT. Dr Jain discovered his passion for cold water swimming back in January 2021 when he did his first river dip, and from that point, he “was hooked”. “I got pretty good at ice baths and wanted a new challenge.

That’s when the ice mile came in”, he says.

On December 1, Dr Jain will be swimming in a loch in Scotland where water temperatures are expected to be below 5 degree or lower, in line with the International Ice Swimming Association (IISA) guidelines. If this wasn’t tough enough, he will be swimming a mile in these icy conditions.

The guidelines also say Dr Jain can’t rest or touch the ground and has to enter and exit the water unassisted. He also has to have witnesses and a medical team on standby for the real risk of severe hypothermia.

“I had pretty much mastered sitting in cold water, but swimming in it is a whole other challenge”, Dr Jain explains. “When I first embarked upon this journey, I had definitely overestimated my swimming ability – when I started training in November 2022, I could barely swim 100 metres without feeling like I’d done a marathon, and the idea of swimming a mile,

let alone in ice cold water felt impossible.

However, with the help of some amazing swimming coaches, pool and lakeside friends and the motivation of fundraising for BEAT, a charity with a cause deeply connected to my family’s heart, I have successfully swum a mile in open water, something which seemed impossible not so long ago. Now, the mission is to do it faster and colder so I can complete it before severe hypothermia kicks in when I will be pulled out of the water by the safety team!”

The charity Dr Jain is swimming for, BEAT, is the UK’s eating disorder charity and aims to end the pain and suffering caused by eating disorders; as he said, it’s a charity close to his heart.

He says, “This journey I’ve been on to swim an ice mile has been incredibly challenging but also deeply personal. From my family’s own experience of supporting a loved one suffering from an eating disorder, I know first-hand the toll eating disorders take not only on the afflicted individual but also on their families.

“Eating disorders really do test the strength of family relationships with countless mealtime battles, wanting to say the ‘right’ thing but getting shouted at instead, seeing my daughter stop enjoying things she used to love, withdrawing from her friends and quite literally have the life sucked out of her by the evil in her mind, something which, as a parent, was heartbreaking to see.

“What is particularly important to me about BEAT is their commitment to support those affected by eating disorders regardless of the state of their physical health. My daughter was fortunate to receive treatment from the local eating disorder services for anorexia a few years

ago; however, the current system fails the majority as only 6% of those suffering from eating disorders are actually underweight, and the current system often requires that a set of physical criteria including a certain weight are met to access specialist support.

I have also learned through supporting my daughter that just because somebody may be weight restored, it does not necessarily mean that they are no longer struggling, as eating disorders are not weight disorders and involve so much more than just food.

BEAT embraces this understanding of these illnesses as mental disorders. It works to bridge the gap in the system, striving to ensure that each person facing an eating disorder receives the care and support they need.

Any donations made will, therefore, pave the way for individuals and families to access life-changing support, which they may not have access to otherwise and will help BEAT continue to expand their support services and programmes across the country, as well as campaign for early support and changes to the current mental health system’s management of eating disorders.

“In conquering the ice mile, I hope that I will be able to fundraise a substantial amount to donate to BEAT, whose cause continues to resonate deep within me and that the waves I make through my icy endeavours will serve as a testament to the resilience of those fighting eating disorders.”

Dr Jain had raised £7,000 at the time of publication and is hoping to reach £10,000.

You can donate by visiting https:// www.justgiving.com/page/ravi-jainicemile

www.consultingroom.com | 23

IT’S TIME TO CHECK! ARE YOU ACTUALLY A CONSULTING ROOM MEMBER...

DID YOU KNOW...

Just because you receive our magazine, it doesn’t mean you are a Member and are benefitting from ALL the features of Membership!

DON’T PANIC!

Search consultingroom.com for your clinic and if you don’t appear, pop us an email at admin@consultingroom.com.

Becoming a Member of the largest and longest-running aesthetic community is something you cannot miss out on. It is the single best way to increase your clinic’s ROI. Don’t take our word for it. Ask any of our 700+ Members, which includes the UK’s premium clinics. They know that just one referral from us will pay for your Membership and why it really is a no-brainer!

REGENETATIVE AESTHETICS SPECIAL In this section: EXOSOMES, We dive into their legality and safety, REGENERATIVE MEDICINE, Is it the future of aesthetics?, CPD: The regenerative power of DHEA and IN PRACTICE, How do regenerative treatments fit into your clinic?

Shutterstock/Galaxy love design/New Africa/PeopleImages.com - Yuri A/Yuganov Konstantin

REGENERATIVE AESTHETICS SPECIAL

THE WORD ON THE STREET

Shutterstock/New Africa

An overview of the latest regenerative treatments taking the industry by storm If there’s a buzz word in aesthetic medicine at the moment it has to be ‘regenerative’. Many of the leading clinics offering nonsurgical aesthetic procedures are raving about this new group of treatments, which promise to ‘transform skin from within’.

But how do they work? And are they any better than other skincare products or devices?

“Regenerative medicine has been around for many years,” says ophthalmologist and oculoplastic surgeon Miss Jenny Doyle, explaining that while techniques have traditionally been used in general medicine to repair wounds and damaged tissue, they’ve

26 | Consulting Room | Q4 2023

gained traction in the world of aesthetics thanks to their ability to heal the damage – such as lines, wrinkles, dehydration and sun damage – caused by ageing.

Many can also treat thinning hair and poor scalp condition, while some can even be used in the intimate area.

Two of the most popular regenerative treatments to emerge over the last year or so are known as polynucleotides and exosomes.

Here we outline what they are and how they work…

Polynucleotides Using highly purified and sterilised DNA from fish, polynucleotides are injected into the areas of skin requiring treatment with the aim of reaching the fibroblasts. Dr Amado explains that fibroblasts are the cells responsible for our skin quality. “As we age, they get damaged and do not function as well, which leads to a decline in collagen and elastin production,” she explains, adding, “When the polynucleotides reach the fibroblasts, they are able to regenerate them or, in other words, get them working normally again.” As a result, we see an improvement in lines, wrinkles, sun damage, redness, acne, scarring and other skin concerns.

As an eye specialist, Miss Doyle loves how polynucleotides can improve the appearance around the eyes. “There are many treatments that we can’t use in this area for various reasons, but polynucleotides can be used safely and effectively. As they come in different strengths, we can tailor treatment for the more sensitive skin under the eyes and they can produce excellent results for those with dark circles, and hollowing and puffiness – although patients should expect additional puffiness to start with.”

a pen, stamp or roller. The exosome solution can then penetrate the skin to start the regeneration process.

Again, exosomes can treat a wide range of concerns, including fine lines and wrinkles, scars, sun damage, sagging skin, uneven texture, restricted hair growth and poor scalp condition.

Achieving Best Results With any regenerative procedure, a course of treatments is always recommended. One of the best things about regenerative treatments is that they come with minimal risk.

Dr Amado and Miss Doyle agree that regenerative treatments are also an excellent way to treat menopausal skin and hair, having seen fantastic results amongst their patients. They highlight that as well as being used on their own, you can combine regenerative techniques with other procedures such as dermal fillers to truly transform your ageing appearance.

Certain polynucleotide ranges also have products specifically for different areas of the body. Higher strengths are used to target concerns on areas such as the arms, thighs and knees, while products designed for the intimate area aim to tighten lost elasticity in the labia majora (the outer lips of your vulva).

In terms of hair, polynucleotides target the hair follicles which are responsible for producing healthy hair. When these are damaged, hair growth is restricted, and hair and scalp quality is poor – we often see dry, brittle hairs coming through. By regenerating hair follicles, we can stimulate hair growth and ensure that hair comes back stronger, thicker and healthier looking.

Exosomes Known as the ‘good’ messengers between cells in your body, Dr Amado explains that exosomes work by fusing to damaged cells to deliver essential proteins, amino acids and growth factors to repair and regenerate them. “They also hunt out other proteins that may be floating around the body and direct them to damaged cells to further help with rejuvenation,” she says.

Most practitioners will deliver exosomes to the areas requiring treatment via a process called microneedling. This involves creating tiny punctures in the skin (or scalp if you’re having your hair treated) with small needles attached to Shutterstock/PeopleImages.com - Yuri A

www.consultingroom.com | 27

REGENERATIVE AESTHETICS SPECIAL Exosomes are the hot new kid on the regenerative beauty block. While those derived from humans are thought to have superior anti-ageing properties, they are illegal in the UK but are reported to be widely available in aesthetics.

We get the expert lowdown…

Regenerative medicine is being hailed as the future and is becoming more widely practised in aesthetics due to the promise of exciting new treatments that heal tissues while restoring function that has succumbed to ageing, disease and environmental damage.

A new frontier of this research is focused on exosomes, nano-sized naturallyoccurring ‘extracellular vesicles’ produced by almost every cell of living organisms.

Plants and animals produce these tiny bundles of biological information, and so do we.

There are a lot of opposing opinions on which biological source is best, but to Dr Tunc Tiryaki, consultant plastic surgeon and founder of the London Regenerative Institute, it’s a no-brainer… “Human exosomes are the best because they are most similar to our genetics.”

The best way to harness exosomes, says Dr Tiryaki, is to use those extracted from donated young human tissue where the regenerative power is very strong and inject them. “But there are only two ways to sell an injectable material: to go through the pharmaceutical or medical device pathways.”

Avoiding these pathways, companies have been marketing and selling exosomes to be applied topically.

The problem is that cosmetic or off-label use of human biological products is illegal in Europe and the UK, but opinion also differs on whether that includes human exosomes topically applied, with further confusion surrounding whether using them is safe…

What are exosomes?

DNA (genetic information),” says Dr Sophie Shotter.

“They can speed up healing and repair after aesthetic treatments, as well as improve cellular communication and stimulate collagen, elastin and HA. The results can be extraordinary, and as a regenerative treatment, they have huge potential.”

What makes exosomes so attractive to the aesthetics community is their ability to instruct older cells to act like younger ones, crowning them as an anti-ageing powerhouse.

“Exosomes are the next megastar in regenerative medicine and will be bigger than Botox,” predicts Dr Shameema Damree, the founder and medical director of EvoCyte, the UK distributor for ExoCoBio, a Korean biotech company focused on exosome manufacture – human, plant and animal-derived.

EvoCyte previously supplied the biotech’s human-derived product before pivoting to rose exosomes “to be in line with UK and EU laws.”

Plant, animal and human-derived exosomes can all be ‘loaded’ with additional cargo, such as growth factors, to add to the regenerative benefits.

Application can be topical, but deeper penetration by injection or microneedling into the skin yields better results.

Are exosomes legal in the UK? Not the human ones. But still, “human exosomes are, unfortunately, widely being distributed in the UK at present,” says Shotter.

Exosomes are little lipid-encased sacs that act as messengers ferrying signalling molecules like proteins and other genetic materials to tell cells how to behave.

“Exosomes for skin rejuvenation started in Korea and the USA where the use of human-derived products is legal, and so there are many available across the globe from human sources.”

“Exosomes can contain many different substances – peptides, lipids, growth factors, vitamins and minerals, as well as

However, today, there is not a single exosome brand with a pharmaceutical licence, adds Dr Tiryaki. “So nowhere in the

28 | Consulting Room | Q4 2023

TINY BUT D A DEEP DIV THE LEGALI SAFETY OF E world are you allowed to inject it. Period!”

“There is a lot of misconception in our market,” says Damree. “But there are no regulatory approved exosomes regardless of the source [plant, animal or human derived]. We are still waiting on Phase III Trials for the use of exosomes in hospitals. This is why all the products have been registered for topical application.”

As no exosomes have been approved by the likes of the Food & Drug Association (FDA) or the MHRA, they are not allowed to be injected but can be applied legally, either topically or via microneedling.

But, as cosmetics are neither a pharmaceutical nor a medical device, they

DIVISIVE: VE INTO ITY AND EXOSOMES do not come under the Medicines and Healthcare Products Regulatory Agency’s (MHRA) government, leaving human exosomes sold for topical use off the agency’s radar.

The MHRA do, however, govern a doctor’s usage of illegal products, so those injecting exosomes or using human ones could be putting themselves and (some argue) their patients at risk.

“Similar to what we’ve seen with injectables, there are always going to be unlicensed products available, so it’s important for clinicians and practitioners to weave through all of the clinical data, safety and regulations wherever they are to make sure they’re using good products,”

Shutterstock/Galaxy love design

says surgeon and founder S-Thetics Miss Sherina Balaratnam.

“Human-derived ingredients are strictly banned in the UK, so if practitioners were to continue to use these materials, they would need to be able to fully justify their actions in a court of law, especially if there is a patient side effect.”

What about safety?

Our experts are divided on whether the use of human exosomes, regardless of legality, is safe.

Shotter says the potential dangers come with the risk of disease transmission and the transfer of genetic material.

On the other side, although human exosomes contain microRNA, Damree explains that they are not cells, so they cannot transmit diseases or viruses. “They can’t replicate or make a protein; they are just carriers of the code, so I think there is a lack of understanding of what an exosome truly is and many companies out there that claim to be selling exosomes but aren’t.”

“Cells are very big, and written on every cell is your nametag, your DNA,” says Dr Tiryaki.

“Exosomes are so small, they don’t have name tags.”

“I think people are becoming really narrowminded and think everything humanderived is wrong; It’s not!” Damree

www.consultingroom.com | 29

REGENERATIVE AESTHETICS SPECIAL continues. “People are forgetting about all the human-derived products used in hospitals… plasma, stem cells, bone marrow…”

“Some researchers will say the exosomes may be too small to produce any significant change to the human recipient, and others will say different,” says Balaratnam. “But as it stands, it is illegal, so for me, it’s binary - I want to practice safe, ethical, evidencebased medicine for my patients every day.”

Can plant and animal exosomes match up?

Regarding which exosome source is best, it depends on who you ask.

“A human exosome contains 1500 microRNA while a plant contains only around 20. How can you compare?” says Dr Tiryaki. “The only way to get a proper set of microRNA from plants is to select, say, 20 from a banana, 20 from a coconut, etc… plant exosomes are far less potent than human or animal.”

This sort of plant exosome cocktailing is already becoming established, with companies like AMP creating plant-derived exosomes from multiple sources.

“In my opinion, the area which is most exciting is plant and bacterial-derived exosomes,” says Shotter. “EXOIE from AMP uses ingredients from many different plants, as there is no ONE plant which has everything that human cells need to communicate.”

“To make a human exosome product, it has to be lyophilised/freeze-dried to protect it from oxygen,” Shotter continues. “This process destroys many of the beneficial ingredients, requiring more to be added.

This process is not needed with plant exosomes.”

To this, Dr Tiryaki says it depends on how the cold chain of the biological product is done. “If done properly, the efficacy should not be affected.”

Damree argues that all biological material should be frozen, adding that it’s not about the quantity of exosomes but rather the quality as well as the manufacturing abilities of the producer.

In EvoCyte’s pivot to provide plant exosomes, the company chose the finest Bulgarian roses “because the shape and size of those particular rose exosomes are very similar to ours, so can trigger our cells.”

As for the animal-derived, Dr Tiryaki, who is working with exosomes harvested from bovine umbilical cords, says that with 99% similarity to human genetics, they are a better option… “Plus, bovine products are legal and are already accepted cosmetic ingredients.”

The future of exosomes Damree believes that once the first humanderived exosome is approved for use in medicine, the regulations will start to move in favour of their topical application, but that could be a long way off.

“The core science is all derived from humans because that’s where the money has been invested by big pharmaceutical companies,” she says. “But for now, plant and animal are the best we can get,” she says.

“We are in an era where patients are asking more about plant-based and organic products,” adds Balaratnam, who uses EXOIE. “We have to go with the times, be agile and evolve with what consumer demand. You have to think outside the box and see what’s available.”

Biotechs who have been in the business of human exosomes will have the edge on all exosome development as they have the underlying technology and manufacturing capabilities to produce high-quality exosomes at scale, Damree adds.

During this hotbed of activity, it will be important to look into what companies are selling, where they get their exosomes from and the facilities in which they are isolating them.

“You cannot just trust that a company has exosomes,” says Dr Tiryaki. “They must be reputable and have peer-reviewed articles about their product and adhere to good manufacturing processes for extraction.”

Far more research is needed to understand these tiny but divisive bubbles of potential, but their prospects include targeted drug delivery and a new era of skincare and anti-ageing.

Shutterstock/Galaxy love design

30 | Consulting Room | Q4 2023

REGENERATIVE AESTHETICS SPECIAL

THE REGENERATIVE POWER OF DHEA

Miriam Martinez Callejas, Superintendent Pharmacist and co-founder of Roseway Labs, unveils the role of DHEA in human tissue rejuvenation.

Tissue regeneration is a complex and highly regulated process involving the replacement of damaged or dead cells with new, functional ones. It plays a pivotal role in maintaining the health and vitality of various tissues, including skin, muscle, bone and organs. As we age, cells naturally experience damage and get depleted, and by restoring these, our health benefits in a number of ways.

In this 15-minute article, we will explore the potential of DHEA to rejuvenate various tissues in the human body, starting with the effects that DHEA can have on bodily tissue.

We will then look at how it may deliver these results and other benefits that may be realised. Finally, we will touch on the available forms of DHEA and its safety as a medication.

Dehydroepiandrosterone (DHEA) is an androgenic steroid hormone primarily produced by the adrenal glands and in smaller quantities by the brain and the gonads. It converts in the body to the sex hormones testosterone and oestrogen, but its role extends far beyond that of a simple hormone precursor.

Taking DHEA rather than oestradiol and testosterone can reduce some of the side effects produced by HRT. As the body converts DHEA into smaller quantities of sex hormones, the approach is more gentle and better tolerated by people with sensitivities.

DHEA, also known as prasterone, is a controlled drug (Section 4, Class II) in the UK and can only be obtained via a prescription. It is not a food supplement and is a medication that must be prescribed by a qualified medical practitioner. There is one UK-licensed

medication containing DHEA – Intrarosa – which is licensed for vulvar and vaginal atrophy. Roseway Labs offers many forms of DHEA, such as capsules, pessaries, troches, gels and creams as compounded and manufactured unlicensed medication.

DHEA topical formulations have been explored for their potential to improve skin health, including reducing signs of ageing, increasing dermal thickness and enhancing skin elasticity1. These effects are thought to be related to DHEA’s influence on both collagen synthesis and hyaluronic acid synthesis, which improve skin hydration.

Enhanced moisture retention can lead to smoother and more supple skin. Whilst a topical dose would be significantly lower than an oral dose, there is still a chance that the DHEA is systemically absorbed through the skin, and this must be considered before prescribing.

be more beneficial to use a muco-adhesive gel or cream.

Studies have suggested that oral DHEA may have a modest effect on bone density in postmenopausal women. Tissue regeneration in bone is one factor, with an added benefit of the breakdown of DHEA into testosterone and oestrogen, both of which play a crucial role in maintaining bone density.

DHEA has been studied in the context of female fertility, particularly in women with diminished ovarian reserve (DOR).

DOR refers to a reduced number of eggs (oocytes) in a woman’s ovaries, which can impact fertility. Some studies have suggested that oral DHEA may help increase ovarian reserve, but its role is still subject to ongoing research.

DHEA taken orally may promote the repair of damaged skin tissue in wounds by accelerating the proliferation of skin cells and the formation of new blood vessels (angiogenesis), which is essential for tissue regeneration. These vessels deliver oxygen, nutrients, and immune cells to the regenerating tissue, facilitating the healing process.

In postmenopausal women, DHEA has been used to address issues related to vaginal atrophy and vaginal dryness.

DHEA’s local effects on the vaginal mucosa have been reported as increasing lubrication, thickening the local tissue and, as a result, reducing pain and the likelihood of infection. Whilst DHEA pessaries are often used to treat vaginal atrophy, in severe cases, the pessary does not sufficiently stick to the vaginal tissues for the duration of the treatment, and it can

Shutterstock/LADO

32 | Consulting Room | Q4 2023

www.consultingroom.com | 33

REGENERATIVE AESTHETICS SPECIAL DHEA, as opposed to its metabolites of testosterone and oestrogen, acts to regenerate tissue in three physiological ways.

Immune Modulation: DHEA has been shown to have immunomodulatory effects, which could indirectly influence tissue regeneration by reducing inflammation and promoting a balanced immune response that effectively responds to tissue damage without excessive inflammation or immune suppression.

Metabolism: DHEA is known to affect metabolism and energy levels, which can indirectly support tissue repair and regeneration by providing the necessary nutrients and energy for cellular processes.

Improved metabolism ensures that tissues receive adequate nutrients for regeneration. DHEA may increase insulin sensitivity in diabetic or pre-diabetic patients. Studies have suggested it can also modulate insulin-signalling pathways and enhance glucose uptake in adipose tissue.

Antioxidant Activity: DHEA possesses antioxidant properties, which means it can help neutralise harmful free radicals in the skin and reduce oxidative stress.

Free radicals can damage skin cells and accelerate the ageing process.

Other suggested benefits of DHEA include cell proliferation, lower inflammation, enhanced collagen production, vasodilation and increased metabolic function.

DHEA has been shown to stimulate cell proliferation, particularly in tissues with a high turnover rate, such as the skin and mucous membranes. Cell division replaces damaged or dead cells with new, functional ones and by promoting the growth and replication of cells, DHEA contributes to the regeneration of damaged tissues.

Chronic inflammation can hinder tissue regeneration. DHEA’s anti-inflammatory properties help reduce inflammation, creating a more conducive environment for tissue repair.

Collagen is a crucial component of connective tissues like skin and tendons and a key structural protein in the skin that provides strength and elasticity. DHEA has been linked to increased collagen production, aiding in tissue repair and rejuvenation, and it appears to stimulate the production of collagen in the skin.

This effect can contribute to improved skin firmness and a reduction in the appearance of fine lines and wrinkles.

Vasodilation, the widening of blood vessels, plays a vital role in tissue health and regeneration. Adequate blood flow ensures that tissues receive the necessary nutrients and oxygen for optimal function and repair whilst also facilitating the removal of waste products. DHEA has been associated with improved vasodilation and vascular endothelial function through several mechanisms, particularly nitric oxide production, which relaxes blood vessel walls. This effect can also help regulate blood pressure, reducing the strain on the cardiovascular system and improving overall tissue health.

The safety of taking DHEA either individually or as part of hormone replacement therapy depends on various factors, including the patient’s medical history, the dosage used and the duration of use. Using it at high doses or for extended periods without proper supervision can lead to androgenic side effects and potential health risks.

Clinicians should always monitor hormone levels to ensure they are within a safe and balanced range.

DHEA can be administered orally, vaginally or topically. Oral DHEA is convenient and works systemically but can be associated with variable absorption rates and potential first-pass metabolism effects, where stomach acid and liver detoxification

34 | Consulting Room | Q4 2023

reduce the bioavailability of the medication.

Often, oral doses of medication are higher in order to counter this effect. Vaginal DHEA pessaries, gels or creams allow for targeted delivery to the vaginal and pelvic tissues, with the aim of acting on the vaginal membranes for an extended period of time. Topical DHEA creams or gels can provide localised effects on the skin. This method offers control over the application site but may require consistent use for optimal results.

Did you find this article useful?

Send your follow-up questions to info@ rosewaylabs.com.

The Regenerative Power of DHEA Article

CONSULTINGROOM.COM (001376) November 2023

51418

References 1) Skin / Collagen (PDF) Effects of topical DHEA on ageing skin: A pilot study (researchgate.net) Modulation of Collagen Metabolism by the Topical Application of Dehydroepiandrosterone to Human Skin - ScienceDirect 2) Wounds The Sex Steroid Precursor DHEA Accelerates Cutaneous Wound Healing Via the Estrogen Receptors - ScienceDirect Sex Hormones and Wound Healing (hmpgloballearningnetwork.com) 3) Vagina The therapeutic effect of dehydroepiandrosterone (DHEA) on vulvovaginal atrophy - ScienceDirect Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy (nih.gov)

PubMed

4) Bone Density Oral dehydroepiandrosterone might prevent frequent tears in atrophic skin: A case report - PMC (nih.gov) DHEA in bone: the role in osteoporosis and fracture healing - PubMed (nih.gov) Effect of dehydroepiandrosterone supplementation on bone mineral density, bone markers, and body composition in older adults - PMC (nih.gov) 5) Fertility Life | Free Full-Text | Effects of Dehydroepiandrosterone (DHEA) Supplementation on Ovarian Cumulus Cells following In Vitro Fertilization (IVF)/Intra-Cytoplasmic Sperm Injection (ICSI) Treatment—A Systematic Review (mdpi.com) Is there a role for DHEA supplementation in women with diminished ovarian reserve? - PMC (nih.gov) Effects of dehydroepiandrosterone supplementation on women with poor ovarian response: A preliminary report and review ScienceDirect 6) Immune function DHEA Modulates Immune Function: A Review of Evidence - PubMed (nih.gov) Dehydroepiandrosterone as a regulator of immune cell function - ScienceDirect 7) Metabolism Dehydroepiandrosterone (DHEA): Biochemical, Physiological and Clinical Aspects - Google Books The adipose tissue metabolism: role of testosterone and dehydroepiandrosterone - PubMed (nih.gov) 8) Antioxidant Antioxidant Effects of Dehydroepiandrosterone Are Related to Up-regulation of Thioredoxin in SH-SY5Y Cells | Acta Biochimica et Biophysica Sinica | Oxford Academic Antioxidant activity of dioscorea and dehydroepiandrosterone (DHEA) in older humans - ScienceDirect 9) Cell proliferation Dehydroepiandrosterone Stimulates Endothelial Proliferation and Angiogenesis through Extracellular Signal-Regulated Kinase 1/2-Mediated Mechanisms - PMC (nih.gov) Dehydroepiandrosterone Increases Endothelial Cell Proliferation in Vitro and Improves Endothelial Function in Vivo by Mechanisms Independent of Androgen and Estrogen Receptors | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic (oup. com) 10) Inflammation Steroids make inflamed tissues less sticky | Science Signaling Dehydroepiandrosterone (DHEA) replacement decreases insulin resistance and lowers inflammatory cytokines in aging humans PMC (nih.gov) 11) Vascular Dehydroepiandrosterone supplementation improves endothelial function and insulin sensitivity in men - PubMed (nih.gov) Dehydroepiandrosterone and Cardiovascular Disease - ScienceDirect

To download a CPD Reflective Learning Form, produced in association with the British Association of Cosmetic Nurses (BACN) & the British College of Aesthetic Medicine (BCAM), please use the QR code or visit bit.ly/CR-CPD in your web browser.

www.consultingroom.com | 35

REGENERATIVE AESTHETICS SPECIAL

REGENERATIVE AESTHETICS: A COMPARATIVE DISCUSSION

Shutterstock/Galaxy love design

Dr Abs Settipalli gives his views on the rise of regenerative aesthetics and how they fit into existing practice Exosomes, polynucleotides, amino acids – there’s a lot of talk on ‘regenerative medicine’ nowadays There seems to be little talk about compairing them and knowing which to go with, though.

It’s an important discussion to be had if we are to do right by our patients.

The most important aspect of entering this comparative discussion

is to remain objective and factual in order to draw a valid conclusion. This means ignoring opinions and, most importantly, marketing.

Factually speaking, we can see what changes these products are attempting to make in the skin with the data the brands provide.

For instance, all these products talk about the fact that they produce collagen. However, clinicians must understand this is a copout and an extremely vague statement. Why? There are 28 types of collagen, and when it comes to tightening the skin, for example, most are completely useless.

Much is made of the ability of polynucleotides to produce collagen type I and III with ‘a bit’ of IV and VII. Yet some exosomes can help produce the same collagens as can implantables like PLLA. So, if they all aim to produce mainly type I and III, what benefit is there of choosing one over the other?

A better understanding of how tightening works anatomically is needed to answer that question. Again, factually speaking, tightness comes from bringing the layers together tighter. When we wish to tighten some papers together, we put a staple physically through them all and hold them together in a strong clasp. Do collagens I or III go through different layers? Factually speaking, no.

So what does? Proteins like collagens 17/4/7, laminins, fibronectin, etc., make up the DEJ, allowing the epidermis and dermis to come together tighter. None of the aforementioned products can claim that they produce the maximal physiological increase of those

36 | Consulting Room | Q4 2023

collagens such as IV and VII of any product in the world. In fact, collagen I is only held in position by using two strands of collagen VII that reach into the reticular layer under the DEJ like a child reaching down with both arms to hold a dropped ball as a matter of anatomical fact. So ask yourself: if COL1 is only given position (and therefore function in the dermis) from COL7, then how can increasing COL1 without maximal COL7 increase give any tightness increase? It can’t.

One must 100% understand the meaning of ‘physiological increase’ in this context too. When you treat a patient and an increase in collagen is seen – that’s a reaction. When the reaction completes, the baseline production rate is resumed. What if the baseline itself was increased to where the reaction level took us before such that we don’t have to keep injecting the patient every week for the rest of their life? That baseline is what we term the physiology and marks the difference in these products, giving a reaction and an increase in physiology. Why is this important? Results can last longer, be more intense and come much quicker.

So, which modality gives us the maximal physiological increase in these important proteins, not just COL1 and COL3? Well, the answer lies in reading between the lines of these brands.

Specifically, the fact that none of them uses the words ‘maximal physiological increase of COL4 and COL7’, etc., apart from one. It’s an exceptionally bold statement to make that isn’t done lightly or without vast amounts of proof to prevent litigation - hence why almost no one makes it.

The one product that makes this claim and has never had competition for it is Sunekos. What is it? It is an injectable product that has stood the test of time for many decades and is much simpler in formulation than many of the other available products.

Could it be because humans haven’t evolved to need salmon sperm in their faces (polynucleotides)? The answer should be obvious.

When we take cancer and place it into a collection of healthy

cells, most would say that what would happen is that the cancer spreads. However, Mintz 19751 showed us that the opposite can be true. This paper is one of the founding pillars of regenerative medicine. Why did this happen? Because the cells are ‘doing’ cancer. The environment was ‘doing’ perfect health. The environment won the ‘doing’ war and overpowered the cell. This shows unequivocally that cellular dysfunction can sometimes be a product of and be corrected by correcting the extracellular matrix.

Are you surprised now why so many products nowadays talk about ‘regeneration’?

However, there is only one ideal ECM. When we are growing as foetuses and children, we don’t play pick and mix with our ECM for optimal health - evolution has one choice and one choice only.

Last time I checked, salmon sperm was not included. Finding this fine balance in ECM composition means finding the right balance of signalling molecules such as HA, elastin, fibronectin, collagens (yes, collagens can be signalling molecules), etc. By nature, there is only one correct answer. This correct answer would maximally physiologically produce these collagens aforementioned, which seems to be beyond the scope of other products. Sunekos has patented this ECM balance, and this is the factual reason no product in the world can do the same thing. For example, if a patient wanted more elasticity in their skin, which type of collagen is ideal? None; elastin provides elasticity, as the name suggests.

When most products in this category can’t maximally produce it, how useful are they really? Factually speaking (again), Sunekos is the only product to claim maximal physiological production of this protein, too, as a result of hitting the ECM jackpot.

Its composition is non-crosslinked HA (not for hydration, but for signalling processes) and a balance of 6 amino acids: glycine, proline, alanine, valine, leucine, and lysine. ‘Balance’ is the operative word here; anyone can use the same amino acids, but the patented ratio between them is what creates nature’s desired ECM and can’t be copied - hence why the results are never copied.

What’s the result of all this?

Shutterstock/Galaxy love design

www.consultingroom.com | 37

REGENERATIVE AESTHETICS SPECIAL Instead of needing multiple sessions over 1-2 months with something like polynucleotides, Sunekos shows improvements and sometimes clearances of the problem after just one session.

The results can last for close to a year, and the risk is exceptionally minimal because it is composed of ingredients already in the skin, which have simply reduced over time. Anecdotal conversation has led many to see that three times the number of polynucleotide sessions needed to achieve the same result as with Sunekos.

I am now completing case studies of using it for active severe acne that is being cleared after one session only. In another set of ongoing cases, eczema areas are also being cleared after one session. This is something most products and manufacturers dream of.

This ECM concept is universal. The clue to how ‘in line’ we are with what makes nature work at its best is the fact that Sunekos has branched into sports medicine, gynaecology, sarcopenia, obesity, COVID, cellulite, stretch marks, wound healing, orthopaedics, dentistry and much more. The concept across these different branches is identical. The only difference is the delivery vehicles to place the ingredients in the right place unhindered. For example, the electrolyte composition of the body’s interstitial tissues is very different from that of the face, so the composition around the ingredients must be considered. In cellulite, the pathophysiology

contains high amounts of acidity - this is neutralised with the Sunekos Cell using alkalinity that prevents the active ingredients from being rendered useless before they have a chance to do their job. The full and in-depth theory of how Sunekos and ECM products work (with comparisons) is free on YouTube and the Dr Abs channel.

It should be clear now that the approach in deciding which products to use should begin with anatomical truths, which then dictates a need to compare physiological vs. reactive methodologies of gaining a result. The other portion is reading between the lines of what these many manufacturers state in their marketing and information. Admittedly, this is difficult - where else have you seen someone state the truth that COL1 doesn’t increase tightness without simultaneous maximal COL7 increase? However, with time, the free market should shift clinician’s choices once enough time has elapsed to see the difference in results.

Resources and references 1.

Mintz 1975: https://doi.org/10.1073/pnas.72.9.3585

Shutterstock/Galaxy love design

38 | Consulting Room | Q4 2023

BRINGING TOGETHER CONTINUAL LEARNING OPPORTUNITIES IN ONE UNIQUE PLACE

WWW.COSMETICTRAINING.CO.UK

REGENERATIVE AESTHETICS SPECIAL

THE EXO|E FACTOR

Miss Sherina Balaratnam, medical director of S-Thetics, discusses plant-derived exosomes Exosomes are, alongside polynucleotides, the current hot topics in medical aesthetics. Human exosomes have been available for some time. However, they are currently not allowed in the UK and EU due to the fact there is still a small percentage of human DNA and mRNA contained in the product from the donor, and the MHRA has outlawed any products containing human material, whether injectable or topically applied.

Whilst other mammal-derived exosomes are available, more recent developments in plant-derived exosomes demonstrate potential advantages over their controversial human counterparts.

It has long been accepted and proven that plant stem cells produce human cytokines, which enables the use of plant secretary factors for human cell signalling. Recently, plant-derived exosomes have become available in the UK and European markets.

Plant-derived exosomes are more accurately termed PDENs (plant-derived extra-cellular nanoparticles), as exosome is the term more commonly associated with those nanoparticles derived from mammalian cells.

One of the significant advantages of plant nanoparticles is that they don’t need to be freeze-dried or lyophilised and should

40 | Consulting Room | Q4 2023

be available in ready-to-use form. Freeze drying or lyophilising denatures the secretary factors of the cells meaning that simulated growth factors need to be added. The number of simulated growth factors added differs from manufacturer to manufacturer but is commonly less than 20. In contrast, PDENS can contain thousands of growth factors, cytokines, interleukins and peptides in their natural states, producing an increased reduction in inflammation and enhanced patient results.

I have been using plant-based products in my practice, S-Thetics in Beaconsfield, for over eight years and have seen the clinical effectiveness that these deliver to my patients’ skin. And they are delighted with their results.

When I first heard of the EXO|E plant-derived nanoparticles earlier this year, I was interested in learning more and seeing what they could further deliver for my patients. I even tried them myself and could see and feel the benefits quickly.

I met with one of the scientists behind the development of the range and was very impressed with the science and evidencebased research behind the products. There was robust data on the impactful reduction of inflammation, the production of collagen and elastin and the upregulation of hyaluronic acid by cells, the

latter of which I have never seen achieved by a topical formulation.

Data showed the inhibition of NFkB and, therefore, the reduction of pro-inflammatory cytokines, demonstrating a significant reduction in post-treatment inflammation. I have been carrying out fractionated treatments using lasers and radiofrequency needling for almost eight years now, both of which come with some recovery time for our patients; hence, I was keen to try the product to see how this could benefit patient recovery post-treatment.

The system is easy for both physicians and patients to use, and I like that the program for EXO|E is delivered over 11 days, providing 23 billion plant-derived exosomes to the patient. By spreading the delivery onto the skin over 11 days, cell receptors are not overloaded, and uptake is optimised.

The ingredients are altered during the 11-day programme to prepare the skin for an inflammatory treatment, to help it recover, and to provide the body with what it requires to generate superior and optimised results. My patients also enjoy being more involved with the “in-clinic/at-home treatment process, which requires them to do a twice-daily application five days prior to their clinic visit and the same for the following days.

Patients now arrive for their treatments less inflamed than before and with better-hydrated skin due to the intrinsically enhanced hyaluronic acid production by their own bodies. And they are seeing and feeling this benefit in just a few days of commencing the program. In this era of regenerative medicine and, where our patients and consumers are more educated and informed than

ever, to have a system that has an autologous effect on our bodies is a game-changer.

Following invasive in-clinic treatment such as fractionated radiofrequency needling, our patients’ skin is less inflamed than normal, reducing their overall downtime and speeding through to generate their optimised results.

Here at the clinic, we have been very impressed with the results.

From using EXO|E as a stand-alone facial treatment, I combine this with my other treatments and technologies, including HydraFacial, microneedling, Exion radiofrequency needling and EMFACE, as well as facial injectables. And our results have improved even more, leading to high patient satisfaction. I am excited to try the new DE|RIVE exosomes form EXO|E for hair stimulation and hair growth as I have personally seen the results from its skin treatments and have faith that this next version will deliver the same benefits for this category of patient who are becoming increasingly common in the aesthetics and regenerative space.

The results they have shown in androgenic alopecia, alopecia areata and telogen effluvium, as well as post-Covid hair loss, are compelling, and we have recently added the AquafirmeXS to enable us to deliver the DE|RIVE to the scalp without the need for any needles. Our patient comfort, experience and results have certainly made an impact on their overall satisfaction this year, and I look forward to what more there is to come of this revolutionary system.

Miss Sherina Balaratnam MBBS MRCS(Edin) MSc (UCL) Surgeon and Cosmetic Doctor Miss Balaratnam is a highly qualified and experienced doctor specialising in aesthetic medicine. She has a background in reconstructive plastic surgery and uses her deep understanding of anatomy and skin to improve functional and aesthetic outcomes.

She runs the multi-award-winning clinic, S-Thetics clinic, in Buckinghamshire and has been recognised with prestigious awards. She is also a published author and a global opinion leader in her field.Her clinical practice is backed by her academic expertise and she frequently participates in clinical research and medical conferences.

www.consultingroom.com | 41

HAIR SPECIAL

CLINICAL SECTION In this section: Intimate rejuvenation: The Nrose protocol, Through the ages: The evolution of aesthetic approaches, Dermal filler correction and placement in a patient with Tourette Syndrome and abstracts.

Shutterstock/Crystal_photo/Master1305/Lyubov Levitskaya/ wavebreakmedia

CLINICAL

NAME OF THE ROSE

Dr Nabil Elmahdawi on gynaecological rejuvenation in menopausal women and the Nrose protocol Menopause brings about significant changes in urogenital health for women. Urogenital atrophy is a physiological condition which most often occurs during and after menopause when the lack of the female hormone oestrogen affects the vagina, urethra and bladder trigone. After the menopause, the amount of oestrogen produced by the ovaries falls.

The lack of oestrogen leads to a thinning of the tissues around the vaginal area and a reduction in the number of small mucusproducing glands. There is also a loss of fat around the genitals, producing a different appearance than previously.

As a result, the vagina is shortened and loses elasticity with less lubricating mucus; the genital skin also looks paler. These changes usually take months or years and vary between women.

With age, at puberty, the labia become gradually larger and thicker, but the chief difference is in the keratinisation, which changes at a cellular level.

After puberty, the labia become more easily visible as their prominence increases.

As a woman continues to grow more mature, there is also an increase in labial thickness and length after pregnancy and delivery.

44 | Consulting Room | Q4 2023

Shutterstock/Kourdakova Alena

Menopause

of life, however, up to 1/3 of patients or more will never seek any medical help.

The most common vaginal atrophy symptoms reported in the International Menopause Society (IMS) recommendations are the same as those reported by women in the VIVA survey1:

Common procedures in managing urogenital changes:

• • • • • • •

Dryness (estimated 75%) Dyspareunia (estimated 38%) Vaginal itching, discharge, and pain (estimated 15%) Urinary symptoms associated with vaginal atrophy: Dysuria, nocturia, and urgency Urinary incontinence Recurrent urinary tract infections

Other medical conditions can result in early menopause, like cancer and cancer treatment with anti-cancer systemic therapy and radiation and other familial conditions. This is predominantly due to the lack of oestrogen production after that resulted in the change and lack of proliferation of the vaginal epithelium.

Caption: Schematic depiction of the effects of oestrogen on the vaginal epithelium2 Unfortunately, most women suffer in silence. In the VIVA study, nearly half (47%) of women who eventually saw an HCP about their symptoms waited more than six months, whereas 28% waited more than one year and 15% waited more than two years.1,3 According to the North American Menopause Society, up to 85% of menopausal women may experience urogenital dysfunction symptoms, and approximately 50% of postmenopausal women have these symptoms that impact urosexual function and quality

1. Vaginal lubricants and moisturisers: Over-the-counter vaginal lubricants and moisturisers can help alleviate vaginal dryness and discomfort during sexual activity.

2. Hormone Replacement Therapy (HRT): For women experiencing severe symptoms, hormone replacement therapy may be considered to supplement declining oestrogen levels and alleviate urogenital issues. However, HRT is not suitable for everyone, and its risks and benefits should be discussed with a healthcare professional.

3. Pelvic floor exercises: Strengthening pelvic floor muscles through Kegel exercises may help improve bladder control.

4. Topical oestrogen therapy: For some women, localised oestrogen treatments in the form of creams, rings, or tablets may be prescribed to address vaginal atrophy without systemic effects.

5. Behavioural strategies for urinary incontinence: Lifestyle modifications, bladder training, and avoiding certain triggers can help manage urinary incontinence.

6. Maintaining good hygiene: Proper hygiene practices can reduce the risk of urinary tract infections.

Other new emerging techniques to help vaginal rejuvenation rely on the use of non-hormonal based therapies like hyaluronic acid, Platelet Rich Plasma (PRP), growth factor serums and energy devices like radiofrequency and laser.

www.consultingroom.com | 45

CLINICAL The Nrose® Protocol The Nrose® protocol is the first non-hormonal combination therapy that has resulted in proven evidence of restoration of the urogenital physiology and alleviation of symptoms.

Nrose® protocol is made up of three important steps: 1. Labia majora physiological volume restoration using Intense Rose hyaluronic acid injectable gel.

2. Bipolar fractionated radiofrequency to restore and promote vaginal mucosa and vulval skin restoration.

3. The continuous use of the rejuvenation Rose gel intimal nonhormonal care serum to maintain and improve intimal health.

The Nrose® protocol has shown, according to Piotr Kolczewski, HA and radiofrequency for a holistic approach to the intimate area rejuvenation, 100% of patients satisfied with the volumetric effect after treatment, 100% improvement of the appearance of the vulva after the treatment, 100% of patients reported an increase in the vaginal hydration and 75% improvement in the urinary incontinence.4

Step 1: Labia volume restoration This is done by Intense Rose gel, which is a hyaluronic acid 28mg/ ml PEG polymer cross-linked gel. It comes in a 1ml syringe mixed with glycine and L-Proline to increase the level of the osmotic balance. Proline and glycine are crucial for stabilising the structure of the hydrogel, especially in terms of viscoelastic properties and thermodynamic balance. It is the only HA filler indicted and licenced for vulva atrophy correction and related symptoms.

P. Kubik, W. Gruszczyńskiet et al. published in the Academy of Aesthetic and Anit-Aging Medicine in Dermatologic Therapy that the advantage of Intense Rose gel on any other HA fillers due to PEG cross-linking is thermostability important not only from the pure resistance perspective.5 Results of the study point to the conclusion that the heat resistance of HA fillers cross-linking agent depends selection of dermal fillers is crucial in this case of using IR, RF, HIFU (or any other heat emitting device) over the injected filler and exposure of human PMN to Neauvia filler results in reduced migration and oxidative metabolism, as well as in reduced mRNA levels of key proinflammatory mediators like TNF-α and IL-8.

The outcome of augmentation and restoration of the Labia Majora Intense Rose Hydrogel HA –PEG Polymer, as published in the Journal of Biological Regulators and Homeostatic Agents by Zerbinati et al., was astonishing.6 Almost 100 % of patients (97100) out of 37 patients in the trial with labia hypotrophy, with an average age of 45 years old (36-68), tested for elasticity, volume, and overall evaluation of appearance have shown a significant and mean full improvement in all tested parameters.

The procedure of volume restoration in the aesthetic industry is called labia puff. It is performed using dermal fillers in a nonsurgical treatment procedure and takes approximately 20 to 30 minutes. Using an aseptic technique, the medical practitioner will first inject a local anaesthetic into the labia before injecting a precise amount of filler into the labia majora for volume enhancement as per the diagram. The treatment results can be seen immediately, and patients can return to their normal activities as soon as the procedure is completed. Dermal fillers used for

46 | Consulting Room | Q4 2023

labia puffing in our clinic last for approximately nine to 12 months and will require top-up injections to maintain the results.

The average amount in ml of Intense Rose Gel is 4ml (range 2 -6), which, in my experience, is sufficient.

Common side effects associated with the injection: • • • • •

Pain or stinging sensation when the injection is performed.

Localised swelling, redness and or tenderness.

Bleeding at the sites of injection.

Bruising. In rare cases, it may be severe and may persist for several weeks.

Numbness or itching of the area following injection.

Common side effects are expected to resolve spontaneously within the first few days of treatment. While not expected, it is possible that the reactions described may persist for longer than expected.

Uncommon side effects: • • • • •

Infection Inflammation Skin discoloration Infection or skin discolouration may occur within a few days or weeks to months following treatment.

Allergic or sensitivity reaction.

Very uncommon side effects: • •

Prolonged swelling, which may occur early or present after several weeks.

The blood supply to the skin may be interrupted by swelling or inadvertent injection into a vessel, causing pain, skin damage and possible scarring.

Appropriate training in qualified hands and proper aseptic procedures reduce the risk of side effects and complications to a minimum.

Shutterstock/Antonio Guillem

This treatment should not be done for: 1.

2.

3.

4.

5.

6.

7.

Pregnant or planning to be Pregnant patient within one year Breastfeeding ladies Previous allergies to HA fillers Have active herpes, acne or vaginal warts Active vulva cancer Bleeding disorder or on warfarin

Special caution should be taken with patients: 1.

2.

3.

4.

5.

6.

On steroids or aspirin Who are diabetic Who have a previous history of gynaecological malignancies Who have had recent gynaecological surgery Who are known to have body dysmorphia Who have a known history of hyaluronidase

Aftercare advice: During recovery after labia puffing, most patients report a smooth recovery. In experienced hands, side effects tend to be minimal and disappear within a week. It is advisable to keep the area as dry as possible, especially after showering or bathing. Most patients can resume sexual intercourse within 48 hours, but it might feel uncomfortable for the first week. After the procedure, patients should wear cotton underwear and avoid tight clothing for one week. In addition, avoid riding a bike or a horse for one week, as it might feel uncomfortable.

To alleviate discomfort, patients can take paracetamol and try to avoid aspirin and ibuprofen as they increase the risk of bruising.

However, minimal bruising is common, and it should subside spontaneously. Some patients may experience mild burning in the urine, which could be a possibility because of the disinfecting solution used before the procedure, but if it persists, you need to contact your GP. Occasionally, it might feel lumpy, or it might accompany minor swelling. Patients shouldn’t be alarmed. It is normal, and it could remain for the first week. So, straw-coloured discharge is not of any concern and should improve in two days.

It is recommended to use the aftercare growth factor gel at least twice a day and before sexual intercourse. *Urgent medical advice is strongly recommended if any of these symptoms progress and do not subside after one week or if you experience unbearable pain that persists and/or does not respond to normal analgesia, excessive skin discolouration, or foully smelled discharge.

Step 2: The use of radiofrequency with the Sectum device Bipolar RF works by heating up the underlying tissue and increasing heat shock proteins and collagen production without harming the surface. The 480 kHz electrical transfer interaction on cell receptors regulates certain precursor ion channels of the signalling cascade involved in maintaining cellular integrity.

This homeostatic control mechanism helps optimise cell maintenance, regeneration and proliferation.

The gynaecological mode has the advantages of a shaped handpiece, providing a painless, non-invasive and non-surgical treatment that allows patients to return to normal daily activities soon after the treatment. The gynaecological mode offers a wide range of internal and external gynaecological applications.

These also have advantages superior to other devices, such as short treatment time, temperature sensor inside the handpiece to control parameters to deliver the best treatment results, and automatic mode – intelligently select the output power of the device to maintain the desired therapeutic temperature for the entire treatment area throughout the treatment, replicability of each treatment and its effectiveness and quick results of therapy.

The device has adaptable delivery met. The Bipolar applicator is specifically designed for gynaecological treatments to optimise energy delivery. Only a single-use handpiece dedicated to a single patient and its working techniques: Pulse mode for patient comfort and in motion (continues).

www.consultingroom.com | 47

CLINICAL Monotherapy results according to the swine model test. The elastin and collagen fibres concentration increased distinctly after a treatment protocol: respectively, elastin on average 52.8% and collagen on average 103.6%.

Is the procedure painful?

Under trained, experienced hands with the use of local anaesthetics, there is minimal discomfort. Patients may need simple analgesia like paracetamol.

Step 3: Rejuvenation Rose Gel (Intimate Care Serum)

Do I need to be off from work?

The protocol is done within an hour at maximum. Most patients resume their daily activities as normal.

The third part of the protocol is the Rejuvenation Rose Gel ( Intimate Care Serum). A serum to be used twice daily to slow down the ageing process in the female intimate area and ass post-treatment serum designed to complete all gynaecological and intimate aesthetic treatments.

Key ingredients: •

Patented fractional hyaluronic acid for multidimensional hydration, protection, and soothing action Mimicking some PRP Growth Factors encapsulated in nanosomes: EGF-1 (anti-ox and collagen booster), ΑFGF & ΒFGF (as a collagen booster), GF-Q (helps stimulate the growth of epidermal and epithelial cells), VEGF (for reinforcing the capillaries barrier and nourish and oxygenating the tissue) Trehalose for deep hydration and to plump the skin. (a natural sugar with a humectant ingredient which helps to counteract glycation damage and improve skin hydration

•

•

Nrose protocol in action Session 1 INTENSE ROSE + SECTUM RF (VULVA AND VAGINAL WALL) + REJUVENATION ROSE GEL Session 2 (3-7 days interval) SECTUM RF (VULVA AND VAGINAL WALL) + REJUVENATION ROSE GEL Session 3 (3-7 days interval) SECTUM RF (VULVA AND VAGINAL WALL) + REJUVENATION ROSE GEL Session 4 (3-7 days interval) SECTUM RF (VULVA AND VAGINAL WALL) + REJUVENATION ROSE GEL

Frequently asked questions Here are some of the most common questions patients may ask you.

When can I resume my sexual activity?

It is safe to resume sexual activities within 48 hours. However, intercourse could be uncomfortable for two weeks.

Can I have it if I have had cancer in the past?

There is no clear contraindication, but discussing it with your oncologist is recommended.

Is there a risk of bleeding?

Typically, just a straw-coloured discharge at maximum for less than 24 hours. If this persists or increases, you should seek medical help.

How much is this cost?

It depends on how much the clinical assessment indicates the amount of HA filler required and if RF will be added to the procedure.

How soon do I see the improvement?

The improvement in the labia augmentation is an instance, but you may still improve up to 21 days from the treatment. After RF, how soon do I notice changes in the vagina moisture and elasticity and or stress incontinence? Typically, two to 12 weeks from completion of the four sessions Costing consideration The price of labia augmentation varies between clinics from £1,200 to £3,500. This usually depends on the volume correction required in the range of £300 to £550 per ml. Most patients require between 2-4ml, rarely more. RF varies between £300 to £600 per session. However, the full Nrose protocol, including Rejuvenation Gel, is from £2,500 to £5,000 at max. I know that some clinics do it for as cheap as £1,000 for a full protocol in a combination of surgical labiaplasty as a package.

References 1.

Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) - results from an international survey. Climacteric.

2012 Feb;15(1):36-44. doi: 10.3109/13697137.2011.647840. Epub 2011 Dec 14. PMID: 22168244.

2.

Sturdee DW, Panay N; International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010 Dec;13(6):509-22. doi: 10.3109/13697137.2010.522875. Epub 2010 Sep 30.

PMID: 20883118.

3.

Parish SJ, Nappi RE, Krychman ML, Kellogg-Spadt S, Simon JA, Goldstein JA, Kingsberg SA. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013 Jul 29;5:437-47. doi: 10.2147/IJWH.S44579. PMID: 23935388; PMCID: PMC3735281.

4.

Kolczewski P, Parafiniuk M, Zawodny P, Haddad R, Nalewczyńska A, Kolasa AK, Wiszniewska B, Menkes S, Bader A, Stabile G, Zerbinati N. Hyaluronic Acid and Radiofrequency in Patients with Urogenital Atrophy and Vaginal Laxity. Pharmaceuticals (Basel). 2022 Dec 16;15(12):1571. doi: 10.3390/ph15121571. PMID: 36559022; PMCID: PMC9788573.

5.

Cant find paper

6.

Zerbinati N, Haddad RG, Bader A, Rauso R, D’Este E, Cipolla G, Calligaro A, Gonzalez P, Salvatore S, Serafin D. A new hyaluronic acid polymer in the augmentation and restoration of labia majora. J Biol Regul Homeost Agents. 2017 APR-JUN;31(2 Suppl.

2):153-161. PMID: 28702976.

48 | Consulting Room | Q4 2023

Shutterstock/Michail Petrov

CLINICAL

IMPROVING QUALITY OF LIFE Dr Maryam McMillan discusses dermal filler correction and placement in a patient with Tourette Syndrome A 54-year-old white German female attended the clinic requesting facial aesthetic treatment in order to improve her cosmetic appearance and self-esteem. Her medical history was unremarkable, with the exception of a diagnosis of severe Tourette Syndrome (TS), which has been present since childhood. She advised that she had recently undergone invasive surgery in the form of implantation of a deep brain stimulator (DBS) as part of an experimental treatment for her severe TS. following placement of the DBS, she developed significant depression symptoms, sleep disturbance, excessive nail-biting and a worsening of her verbal tic.

Compounding this, she had recently had dermal fillers placed at another clinic and was unhappy with the cosmetic results, which has further worsened her self-esteem. The patient was distressed and tearful during the initial consultation as a result of her facial appearance and lack of self-esteem.

Patient examination, diagnosis and treatment plan A validated full-facial assessment was carried out.1 In view of her mention of depression symptoms and the relatively high incidence of depression in patients with TS2, a standard 2-point validated depression screener was conducted, which was

50 | Consulting Room | Q4 2023

negative for significant depression symptoms.3 A validated 7-point body dysmorphic disorder screener was carried out, which again was negative.4 The following diagnosis was provided: Multiple cosmetically unacceptable areas in the lips, cheeks and chin as a result of inappropriate placement of hyaluronic acidbased dermal filler (DF) combined with age-related facial wrinkles and loss of tear trough volume.

Following the assessment, the relative risks, benefits and costs of the various treatment options were discussed in accordance with current guidelines:1 •

•

Leave the lips alone and allow the natural dissolution of the previous DF (advised that this would likely take around six months or more) Dissolution of the DF with hyaluronidase (it was explained that this was a recognised off-license use of hyaluronidase;5 and there is a small risk (approximately 0.5%)6 of allergic reaction to the hyaluronidase – which could be mitigated by the use of ‘patch testing’ prior to placement.)

•

Consequent improvement in facial aesthetics – monotherapies or combination of botulinum toxin type A, thread lifts and DF.

Following discussion, she provided verbal and written informed consent to have the hyaluronidase and corrective DF treatment combined with botulinum toxin type A wrinkle reduction treatment, and MINTTM polydioxanone (PDO) thread lift. The aim of the treatment was explained to the patient – to create a naturallooking, cosmetically pleasing facial appearance through removal of the existing DF, placement of botulinum toxin type A, PDO thread lift and administration of new DF.

Treatment Written consent for the use of standardised clinical photographs1 for publication was obtained.

A standard aseptic technique was employed in each treatment session, and the skin was cleansed with a chlorhexidine-based solution.7 Aftercare instructions were given verbally and in written electronic format.

1. The facial anatomical landmarks were identified, and the areas of the face were anaesthetised using topical 5% lidocaine ointment.

Hyaluronidase (Hyalase®) was reconstituted using the Aesthetic Complications Expert Group (ACE) guidelines.5 Hyalase® was reconstituted with 5 ml bacteriostatic 0.9% saline solution.

Intradermal patch testing was conducted prior to placement of the Hyalase®5 - 4 units of Hyalase® were injected subcutaneously into the left forearm following skin preparation using chlorhexidine solution. No reaction was observed after 30 minutes.

A total of 4500 units of Hyalase® (3 x 1500unit vials) were injected into the lips, cheeks and chin using a 4mm 30G needle (a new needle tip was applied prior to lip injections to avoid using a contaminated or blunted needle following the forearm placement).

Following administration, the patient was observed for 60 minutes

to ensure no adverse reactions occurred, and during this period, aftercare instructions were given.5 2. Clinical review two weeks after the Hyalase®, the patient reported some residual ‘puffiness’, and examination revealed some areas of residual DF in the lips and chin as a result of incomplete dissolution of the DF. Following this, the patient was reconsented for the placement of further Hyalase®, aseptic skin preparation and local anaesthetic were applied, and in keeping with the standard protocol, patch testing was conducted, and a total of 4500 units of Hyalase® were injected into the lips and chin, and the patient was observed for 60 minutes and given aftercare instructions.

3. Clinical review two weeks after the second course of Hyalase®, the patient reported no symptoms, and clinical examination revealed complete dissolution of the DF. Further clinical photographs were taken.

AzzalureTM 125 speywood units were reconstituted with 0.63 ml bacteriostatic sodium chloride 9 mg/ml (0.9 %) solution for injection achieving 10 units/0.1 ml AzzalureTM. This was administered using a 32G needle – forehead (40 units), glabellar frown lines (50), outer canthus (15 on each side) 4. A clinical review was carried out three weeks post-AzzalureTM placement was conducted, and the patient was happy with the treatment outcome and was reconsented for PDO thread placement. Aseptic preparation was conducted as previously described, and the facial anatomical landmarks were identified.

MINTTM FINE (five on each side) and FIX PDO (two on each side) threads were used. The entry and exit points were determined in the face. The procedure was performed under local anaesthesia (2% lidocaine with adrenaline 1:80 000 ratio) at the needle insertion point and the exit point. In each entry point, a hole was made using a 18-G needle.

Images provided by author

Before and after front

Before and after profile

www.consultingroom.com | 51

CLINICAL The small risk of treatment site infection was discussed, and she was advised that in the event of any excessive redness or pain, she should return for assessment as she may require a course of antibiotics. The patient was advised to take over-the-counter analgesics (paracetamol and ibuprofen) as required after the treatment. It was also recommended that the patient wear a postsurgical facial garment for one week.

5. Following the placement of the threads, a review was conducted at three weeks, which was uneventful and again at eight weeks.

At this point, she was reconsented for DF placement and further clinical photographs were taken.

Aseptic preparation and local anaesthetic placement were conducted as previously described. The cheeks were treated with Teosyal Ultra Deep using a 25G cannula (1.2mL) and Teosyal RHA4 was placed in the cheeks using a 25G cannula with a further 0.6 mL placed in the midface using a retrograde technique and 0.6 mL placed each side accessing adjacent to the tragus. The lips were treated with Teosyal RHA2 with a 4-point entry technique using a 25G cannula. The entries were made 1.0-1.5cm below and above the commissures with a 23G pre-hole needle, and a 25G cannula was inserted into the upper and lower lips. The cupid’s bow was augmented using a 4mm needle. Overall, 1.2ml of DF was applied.

Teosyal Redensity II was used for the tear trough augmentation, with 0.5 mL placed under each eye using a 25G cannula.

6. A review at four weeks was conducted, and the patient was very satisfied with the cosmetic result and reported no postoperative

complications. Final clinical photographs were conducted. The patient expressed that the treatment has not only addressed her aesthetic concerns but has also reduced her levels of anxiety and depression, which has made a huge difference in her life.

The patient said, “I have been dealing with Tourette’s syndrome throughout my entire life, but it significantly worsened during the COVID-19 pandemic. The severity of my condition led to my referral to participate in a ground-breaking trial surgery for individuals with Tourette’s.

“This procedure involved deep brain surgery, also known as Deep Brain Stimulation (DBS). In a six-hour surgery, a device was implanted in my chest, and two electrodes were placed in my brain. These electrodes are then stimulated with an electric current. Given the lack of existing studies, it’s very much a trial-anderror process, with the ability to adjust the current as frequently as necessary.

“Throughout these adjustments, I experienced severe depression that caused a significant impact on my self-esteem. This resulted in sleepless nights over the course of several weeks, excessive nailbiting, and an increase in my verbal tics.

“Thanks to the care and expertise of Dr Miriam, my confidence has been restored over the past six months. I now feel like a completely new person. Dr Miriam’s treatment has not only addressed aesthetic concerns but has also worked to reduce my levels of anxiety and depression, which has made a world of difference in my life.”

Resources 1.

Urdiales-Gálvez F, Delgado NE, Figueiredo V, Lajo-Plaza JV, Mira M, Ortíz-Martí F, Del Rio-Reyes R, Romero-Álvarez N, Del Cueto SR, Segurado MA, Rebenaque CV. Preventing the Complications Associated with the Use of Dermal Fillers in Facial Aesthetic Procedures: An Expert Group Consensus Report. Aesthetic Plast Surg. 2017 Jun;41(3):667-677. doi: 10.1007/ s00266-017-0798-y. Epub 2017 Apr 14. Review.

2.

Piedad JC, Cavanna AE. Depression in Tourette syndrome: A controlled and comparison study. J Neurol Sci. 2016 May 15;364:128-32. doi: 10.1016/j.jns.2016.03.030. Epub 2016 Mar 19. PMID: 27084230.

3.

Depression in adults: treatment and management. NICE guideline [NG222] Published: 29 June 2022; found at: Recommendations | Depression in adults: treatment and management | Guidance | NICE (accessed 4 Nov 2023)

4.

Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW. Body Dysmorphic Disorder in aesthetic rhinoplasty: Validating a new screening tool. Laryngoscope. 2016 Aug;126(8):1739-45. doi: 10.1002/lary.25963. Epub 2016 May 25. PMID: 27223322.

5.

Publications | ACE UK (acegroup.online) [accessed 4 November 2023]

6.

Andre P, Fléchet ML. Angioedema after ovine hyaluronidase injection for treating hyaluronic acid overcorrection. J Cosmet Dermatol (2008) Jun;7(2):136-138

7.

Calfee DP, Farr BM. Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial. J Clin Microbiol. 2002;40:1660–1665. doi: 10.1128/ JCM.40.5.1660-1665.2002.

52 | Consulting Room | Q4 2023

CONVERTING CALLS TO CONSULTATIONS!

RECEPTIONIST TRAINING How effective is your receptionist in persuading potential clients to book a consultation?

With the correct call-handling and CRM training your front-of-house staff could easily convert more initial enquiry calls into consultations and increase your clinic’s or salon’s turnover by £1,000s each year.

R FREE FO NG TI CONSULM ROO RS! E B M E M

Missed or poorly handled telephone enquiries cost your business thousands of pounds a year and waste money that you spend on marketing and advertising to attract those calls in the first place.

You may think your clinic is already great at converting calls but you would be surprised how many clinics get it so wrong.

Our unique online, comprehensive, professional and certificated training can rectify mistakes effectively.

I’M INTERESTED...

Email us at admin@consultingroom.com. You can also call 01788 577 254 or visit ConsultingRoom.com to learn more about our online certificated training courses or ConsultingRoom.com Membership and all of its business-building benefits.

CLINICAL

THROUGH THE AGES Dr Mei Yeoh on the evolution of aesthetic approaches Dr Mei is a dentist who solely works in aesthetic medicine and has previously worked in Maxillofacial Surgery at a district general hospital. Currently she leads aesthetics clinics in both Leeds and Beverley, and specialises in the treatment of complex full-face cases and post surgical treatments. Dr Mei is well known for her treatment planning and approach for difficult cases and also take referrals from her colleagues for difficult and post surgical rhinoplasty treatments.

Dr Mei’s expertise extends beyond clinical practice as she provides training for medical professionals via dermal filler companies and her own established training academy in Yorkshire.

54 | Consulting Room | Q4 2023

Facial aesthetic procedures have undergone substantial evolution since their inception in the 1980s. Both clinicians and patients have witnessed a transformative shift in mindset. Today, embracing a multi-modality approach to treatment has become imperative. In this article, we delve into the spectrum of treatments individuals between the ages of 30 and beyond might contemplate.

In their 30s, patients often seek these treatments to enhance their youthful appearance, boost self-confidence, and maintain a competitive edge in their personal and professional lives. The psychological benefits frequently include increased self-esteem and a positive outlook.

As patients move into their 40s and 50s, the focus shifts towards combating visible signs of ageing, such as fine lines and volume loss. Aesthetic treatments in these age groups can lead to improved selfperception and a sense of rejuvenation, aiding in maintaining a vibrant self-image.

When individuals reach their 60s and 70s, the desire to age gracefully becomes paramount. While the psychological impact

remains positive, it often centres on embracing one’s natural ageing process and achieving a harmonious balance between how they feel and look. This age group is especially tricky to treat, as they were the original uses of Botox ™ in the 80s when the focus was on the upper third of the face, and there was not much further thought to the face or neck.

Overall, facial aesthetic treatments play a pivotal role in bolstering the psychological well-being of individuals across these age groups.

Patients in their 30s.

In the world of aesthetics, the age of 30 marks a significant milestone in a person’s life. Patients in their 30s are often at the crossroads between youth and adulthood, seeking treatments that not only enhance their physical appearance but also align with their emotional and psychological needs.

age group, common emotional concerns include concerns about early signs of ageing, career pressures, relationship status, and the desire to maintain a youthful and energetic appearance.

Addressing physical concerns Preventative measures Patients in their 30s often seek aesthetic treatments as a preventive measure. They may notice the emergence of fine lines, uneven skin tone, and mild volume loss.

They want to preserve their youthful looks and delay the need for more extensive interventions later in life.

Common Aesthetic Concerns: •

•

Many are transitioning into more established phases of their personal and professional lives, which can bring increased stress and the need for confidence and self-assurance. In this

Fine lines and wrinkles: Neurotoxinbased treatments like Botox and Azzalure can be effective in minimising expression lines and preventing the formation of deeper wrinkles.

Skin texture: Modalities like radiofrequency microneedling, HIFU, chemical peels, and laser therapy help to improve skin texture, reduce pigmentation irregularities, and stimulate collagen production.

Case Study 1 – Patient in their 30s

This patient came in for a consultation regarding her under-eye area; she felt that she always looked tired and down, even though she did not feel this way.

signs of lines in her skin with Botox ™ and then addressed the skin quality with a course of skin boosters. The patient followed a pH Formula skincare routine to improve her skin quality.

After a thorough consultation, we settled on a phased plan to treat the full face and improve her skin quality. During the course of treatment, the patient got a new job and wanted to feel more confident about her profile. At this point, we incorporated the nose and chin into the plan.

Aesthetic treatments for patients in their 30s go beyond just physical enhancement. They offer a unique opportunity to address the emotional concerns and desires of individuals at a pivotal point in their lives. We should approach this age group with empathy, providing personalised treatments that enhance both appearance and emotional well-being. By balancing beauty and emotion, we can help our patients embrace their 30s with confidence.

We treated this patient with a mixed range of dermal fillers for volume loss and volume enhancement. We addressed the early

www.consultingroom.com | 55

CLINICAL Patients in their 40s-50s

What patients in this age group look for:

Entering this age group is a significant milestone, marked by a unique blend of life experiences, self-discovery, and, inevitably, signs of ageing.

While embracing these changes is a part of the natural journey, many individuals in this age group seek facial aesthetic treatments to enhance their appearance and confidence.

For patients in their 40s-50s, this can be a time of self-reflection and reevaluation. Many individuals in this group have achieved personal and professional milestones, allowing them to focus more on themselves. It’s a time when confidence is at its peak, and the desire to maintain or regain a youthful appearance becomes a driving force.

• •

•

•

Wrinkle reduction: Fine lines and wrinkles are usually the most common concern.

Volume restoration: As collagen and elastin production decline, patients often notice a loss of facial volume. Dermal fillers are frequently sought to restore volume, particularly in the cheeks and midface.

Skin quality improvement: Improving skin texture and quality is a common goal. Patients aim to achieve a smoother, more radiant complexion and reduce the signs of ageing.

Confidence boost: Overall, patients in their forties seek aesthetic treatments to enhance their self-confidence and maintain a youthful appearance that aligns with how they feel.

Many of these individuals often establish a significant link between their appearance and their emotional state. For instance, those experiencing age-related changes in the marionette areas might wrongly perceive a perpetual expression of sadness or low spirits, even when their emotional state doesn’t align with this perception.

Case Study 2 – 40s-50s

This patient came in for a consultation for cheek fillers. She felt that she had lost volume and definition in this area and wanted to look more youthful.

After a thorough consultation, we devised a treatment plan to address her concerns.

The plan consisted of: • •

• • • •

Botox ™ to the upper third of the face Dermal fillers for volume replacement to the temples, under the eye, midface cheek, nose to mouth lines, lips, chin, prejowl and jawline.

Medical microneedling Skin boosters pH Formula resurfacing for pigmentation. pH Formula MELA homecare kit

Along the journey, my patient also lost weight as she had found a

56 | Consulting Room | Q4 2023

new sense of confidence, and this was also reflected in her dress sense!

The 40-50s age group represents a period of empowerment and self-assuredness, and facial aesthetics can complement this phase of life. By understanding the emotional mindset and unique needs of individuals in this age group, we can provide targeted treatments that enhance both appearance and self-confidence.

Patients in their 60s + For patients aged 60 and above who are new to facial aesthetic treatments, the initial consultation can be quite intimidating. In contrast, patients in their 30s and 40s tend to be more open to these treatments due to readily available online information.

This age group typically seeks solutions to address various signs of ageing. However, it is crucial to approach facial and neck treatments holistically in this age group, as selectively targeting specific areas may result in an unnatural appearance. In some

Shutterstock/Master1305

instances, surgical procedures may be recommended for the best possible outcomes, although the prospect of surgery can be daunting for most patients.

As for what patients in their 60s and beyond seek in aesthetic

treatments, they often show a greater degree of self-acceptance regarding their age and the ageing process. Consequently, their goal is to appear refreshed rather than “treated”. The emphasis for any treatment plan is on treatments that yield subtle results with a focus on rejuvenation rather than a dramatic transformation.

Case Study 3 – Patient in their 60s

This patient came in for a consultation for cheek fillers, but she wasn’t actually sure what that would do. After a thorough consultation, the patient expressed that she thought cheek fillers might make her look happier. However, I explained to the patient that she had great volume in this area and that my initial thoughts would be to address her skin quality.

The process of ageing gracefully constitutes a complex journey, and providing care to patients in this age category is particularly challenging. A comprehensive approach to treatment that addresses all aspects of facial ageing facilitates a holistic rejuvenation, ultimately helping patients attain a natural and enhanced version of themselves.

The plan consisted of:

In summary

•

Aesthetic practitioners should adopt a holistic approach when treating any patient. This involves not only addressing physical concerns but also considering the emotional and psychological aspects of the patient’s journey. Open and empathetic communication is key to understanding their motivations, expectations, and any underlying anxieties.

• • • •

Radiofrequency microneedling to the face and neck (course of 3) Hyperdiluted Radiesse to the face and neck (course of 3) pH Formula resurfacing for pigmentation. pH Formula MELA homecare kit Dermal fillers for volume loss and skin strengthening (cheeks, marionettes, perioral area)

www.consultingroom.com | 57

CLINICAL

Shutterstock/Lyubov Levitskaya

AN ABSENCE OF IMPERFECTIONS: A PROPOSED FRAMEWORK FOR DEFINING, ASSESSING, AND ACHIEVING SKIN GLOW Journal of Cosmetic Dermatology, November 6, 2023 https://doi.org/10.1111/jocd.16063

Greg J. Goodman MBBS, FACD, MD, GradDipClinEpi, Katherine Armour MBCHB (OTAGO), FACD, David Ong MBBS, DipSurgAnat, FAACS, Tanongkiet Tienthavorn MD, Yan Wu MD, PhD, Pei-Chun Chen MD, Elias Tam MD, Amanda Ong MBBS, Gina Messiha MBBS, FRACGP, Tara Telfer BA (Hons), Luiz E. T. Avelar MD

BACKGROUND:

RESULTS:

Skin glow is a subcomponent of skin quality. It has become entrenched in the cosmeceuticals and aesthetics lexicons as a synonym for health and youth but is not well-defined as a scientific metric.

Surveyed practitioners (n = 38) ranked skin quality as the fourth most important factor related to a person’s overall aesthetic first impression. Almost all (95%) respondents reported routinely assessing skin quality, citing serial photography (83%), and visual inspection (67%) as the main means of achieving this. The focus group defined skin glow as even reflectance from an unaffected papillary and reticular dermal collagen layer, which is created only when skin does not exhibit any characteristics that detract from this even reflectance. Due to its complexity, the focus group proposed a hierarchal framework for assessment, encompassing patient self-rating, practitioner severity rating, and supplemental use of validated measurement devices.

AIMS: To examine the concept of skin glow and determine if it is an objective concept that can be defined and quantified.

METHODS: Literature review was used to develop a survey on current concepts relating to skin quality. The survey results were analysed descriptively and presented to a focus group comprising five dermatologists and four aesthetic physicians. This group then discussed the concept of skin glow, how to define it and what metrics could be used to assess it.

58 | Consulting Room | Q4 2023

CONCLUSIONS: Skin glow can be defined and quantified. More work is warranted to develop a practical skin glow assessment tool suitable for use in the clinic setting.

Shutterstock/Iryna Kalamurza

NOVEL TREATMENT PROTOCOL FOR COMBINED TEAR TROUGH LIGAMENT STRETCHING AND INJECTION Plastic and Reconstructive Surgery 152(5):p 808e-816e, November 2023

Berros, Philippe MD; Atlan, Lilian MD; Hubschman, Sasha MD; Converset, Sophie MD; Enright, Kaitlyn M. MSc; Nikolis, Andreas MD, PhD

BACKGROUND: Complex anatomical changes have been the main challenge for optimal treatment results of tear trough deformities through hyaluronic acid (HA) injections. The authors present a novel technique consisting of a pre-injection tear trough ligament stretching (TTLS-I) leading to its release and compared its efficacy, safety, and patient satisfaction to tear trough deformity injection (TTDI).

METHODS: This was a four-year, retrospective, single-centre cohort study of 83 TTLS-I patients, with a follow-up period of 1 year. One hundred thirty-five TTDI patients served as a comparison group. Outcome analyses included the analysis of possible risk factors for adverse outcomes and comparative statistics between the complication and satisfaction rates of the two groups.

RESULTS: TTLS-I patients received significantly less HA (0.3 cc; range, 0.2 to 0.3 cc) than TTDI patients did (0.6 cc; range, 0.6 to 0.8 cc; P < 0.001). The injected HA amount was a significant predictive factor for complications (P < 0.05). Complication rates assessed during the follow-up visit for hematomas, oedema, and the need for corrective hyaluronidase injection were low in both groups, with no significant differences between the groups. TTDI patients had significantly higher rates (5.1%) of lump surface irregularities during follow-up, compared with 0% in the TTLS-I group (P < 0.05).

After one year of follow-up, 98.8% of TTLS-I patients were satisfied, whereas 95.6% of TTDI patients were satisfied, with no significant difference between groups.

CONCLUSIONS: TTLS-I is a novel, safe, and effective treatment method, necessitating significantly less HA compared with TTDI. Moreover, it leads to very high satisfaction rates and very low complication rates.

www.consultingroom.com | 59

RETHINKING MEDICAL AESTHETICS

Introducing...

2

1

1

3

FILLERS

Neauvia PEG HA Fillers are based on a unique cross-linker technology SXT - combining HA and PEG polymers. It gives Neauvia portfolio outstanding mechanical, rheological, and thermodynamic properties with a high safety profile and high tolerability. Thanks to these unique properties, they can be perfectly associated with Neauvia Energy Based Devices and Neauvia aesthetic cosmeceuticals, resulting in improved clinical results through synergistic effects and enhanced aesthetic results.1,2

2

DEVICES

Neauvia provides a range of energy-based devices for the aesthetic, gynecological and surgical markets. Neauvia devices are characterized by advanced electromedical engineering. They are based on specifically designed and integrated technology, allowing optimal results in combination with Neauvia’s PEG HA fillers and cosmeceuticals and ensuring maximum patient safety.1,2

3

AESTHETIC COSMECEUTICALS

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.

DISCOVER HOW NEAUVIA SCT CAN BENEFIT YOUR BUSINESS TODAY

W: NEAUVIA.UK

E: INFO@NEAUVIA.UK T: 07570 621 895

1. Kubik et al., HA PEGylated Filler in Association with an Infrared Energy Device for the Treatment of Facial Skin Aging: 150 Day Follow-Up Data Report, Pharmaceuticals 2022, 15, 1355, DOI: 10.3390/ph15111355. 2. Kolczewski et al., Hyaluronic Acid and Radiofrequency in Patients with Urogenital Atrophy and Vaginal Laxity, Pharmaceuticals 2022, 15, 1571, DOI: 10.3390/ph15121571.

TECHNOLOGY & INNOVATION SECTION

In this section: TargetCool, Combining exosomes and technology for hair regeneration and Product News

Shutterstock/Andrey_Popov/Dasha Petrenko/evgeny varlamov

TECHNOLOGY & INNOVATION

ON TARGET

We discover how TargetCool is revolutionising the way patients experience aesthetic treatments Launched by Cosmeditech in the UK earlier this year, TargetCool is a first-of-its-kind FDA and CE-approved technology that can be used to deliver skin treatments such as skinboosters, exosomes and other cosmeceuticals beneath the surface of the skin using a supersonic CO2 jet (up to 100m/s).

Using ground-breaking technology, including compressed CO2 cryogen (modulated by digital controls), IR sensors and a calibrated nozzle, TargetCool delivers precise, controlled and rapid cooling to the skin.

TargetCool can also be combined with shallow microneedling at a depth of 0.4mm. This is to open active channels on the epidermis so that a healthcare practitioner can subsequently use TargetCool in boosting mode to deliver medical-grade infusions such as hyaluronic acid serums, skinboosters and mesotherapy cocktails. TargetCool can also be used to deliver exosomes, which is the latest medical innovation for skin rejuvenation, following either microneedling, RF-needling or laser. Each boosting container can be filled with up to 3ml of the desired solution. There is no downtime for patients – in fact, the CO2 cooling helps to constrict blood vessels, improving circulation and oxygenation to the skin for improved healing times and quicker recovery.

Proven effect of TargetCool’s Skin Drug Delivery

This study compares the penetration of hyaluronic acid using fluorescence transillumination imaging results from ex vivo human-derived skin. The study evaluates three methods: topical application, TargetCool boosting mode post microneedling, and TargetCool boosting mode alone.

The imaging results demonstrate that TargetCool boosting mode alone is capable of delivering hyaluronic acid into the dermis with an increased penetration of 165%. Quantitative analysis of fluorescence intensities reveals a 215% increased rate of penetration if TargetCool is used in conjunction with microneedling, compared to the topical application group. These findings further underscore the efficacy of TargetCool boosting

62 | Consulting Room | Q4 2023

mode in delivering hyaluronic acid into the dermis.

TargetCool also has the ability to numb targeted areas prior to injections, ensuring a virtually pain-free experience for patients undergoing non-surgical treatments. This feature ensures patients are as comfortable as possible during non-surgical aesthetic procedures. Cosmeditech research shows that 93% of patients tested preferred TargetCool to lidocaine for lip filler treatments, and 78% of patients prefer TargetCool to lidocaine for general filler treatments. Without the need for lidocaine, waiting times can be kept to a minimum, enabling Healthcare Practitioners to treat more patients in a day.

The practitioner can also use TargetCool for precision cryotherapy, utilising its freezing nozzle, which uses liquid CO2 at -79degrees celcius, enabling the removal of skin tags, warts, verrucae and other skin lesions.

TargetCool in cooling mode can be used alongside lip fillers, general fillers, mesotherapy, toxin treatments, PRP therapy, subcutaneous injections and intramuscular injections.

TargetCool offers improved safety for injectables by helping prevent complications and damage to tissues. A consistent temperature is maintained throughout the treatment, which is repeatable with standardising treatment protocols.

The carbon rejuvenation delivered by TargetCool provides superior outcomes by reducing inflammation, increasing oxygen supply to tissues and increasing blood flow in the treated areas.

• • • •

Relieves the anxiety patients may feel throughout needlebased procedures.

Eliminates the time they spend waiting for the numbing cream to take effect.

Minimises their post-treatment bruising and swelling for a smooth recovery.

Takes their comfort to a new level before, during and after injections.

TargetCool is innovative because it combines all three modes (cooling for pain management, boosting and freezing) into one streamlined, ergonomic, easy-to-use device.

There is a one-off fee for the device, but ongoing consumables are minimal (canisters and boosting containers) - with that comes in clinic support from Cosmeditech, training, marketing material and social media tools.

For further information, visit www.targetcool.co.uk or email info@cosmeditech.com to book a demonstration in your clinic.

This patient received lip filler injections. Photo courtesy of Professor Lee

www.consultingroom.com | 63

TECHNOLOGY & INNOVATION AMP takes all-in-one facials to the next level with AquaFirmeXS Aesthetic Medical Partnership (AMP) has launched AquaFirmeXS, a second-generation multifunctional dermal health workstation that cleanses, exfoliates, hydrates and nourishes the skin to treat a variety of concerns from pigmentation, blemishes and textural irregularities to dullness, dehydration and hair and scalp health. AquaFirmeXS uses three handpieces – EVO, Exo2 and ULTRA – along with proprietary aqua-photonics technology to deeply yet gently cleanse and exfoliate the skin before nutrients are delivered deep into the skin.

Powered by patent-protected EXO|E technology, the vegan-friendly AquaFirmeXS serums correspond to the skin’s needs and are specifically designed to revitalise and defend against ageing.

In addition, AquaFirmeXS can be used as a needle-free delivery system for AMP’s unique plant-derived exosomes. It can be painlessly used to treat hair and scalp health concerns with a unique combination of DE|RIVE and ULTRA technology to deliver the hair-specific exosome growth factors to the follicular depth. These topicals are specifically designed to nourish the scalp and support hair health. While the inflammation-reducing and elastin, collagen, and HA-boosting EXO|E exosomes can be delivered more deeply into the skin with the ULTRA applicator for facial treatments.

The evolution of SmartXide PUNTO with two new handpieces Lynton, in partnership with Deka, is excited to introduce two new handpieces: µSCAR3, and Derma scan, compatible with Lynton’s SmartXide Punto CO2 laser. The new SmartXide handpieces are set to achieve and deliver major transformation to the skin, allowing effective, fast, and results-driven skin treatments. µSCAR3 treats deeper, thicker scars, such as acne, surgical scarring and burn scars, to promote skin rejuvenation, reduce fibrosis, and improve functionality. The µSCAR3 minimises the risk of post-treatment hyper and hypopigmentation thanks to the smaller spot size that generates greater ablation depths with minimal thermal deposition.

The Derma Scan CO2 scanner for surgical dermatology to enhance vaporisation capability of standard freehand pieces; it was specially designed for fast, tridimensional ablation with maximum and precise depth control.

SmartXide Punto CO2 laser handpieces can treat complex cases safely, such as scarring, surface pigmentation, and deep wrinkles.

Alma introduces Opus™ Opus represents the newest offering from laser manufacturer Alma.

Utilising patented unipolar radiofrequency and the first-of-its-kind fractional Plasma® technology, Opus™ provides two primary treatments – skin resurfacing and tightening – to smooth out uneven skin texture, patchy skin tone, and scar tissue and skin tightening for a significant improvement in agerelated skin imperfections, including wrinkles, fine lines, and laxity.

Opus™ offers minimally invasive treatments with little to no downtime, ensuring your clients can quickly resume their daily routines and is safe and effective for all skin types, including delicate areas of the face, neck, and décolleté.

BTL Aesthetics introduces EXION radiofrequency technology BTL Aesthetics has introduced its new device, EXION, to the UK market.

Designed with four different handpieces to treat over 20 areas of the body, the standout is the Fractional RF, a microneedling applicator that utilises AI pulse control together with monopolar radiofrequency (RF).

EXION Face induces hyaluronic acid (HA) production through combined RF and ultrasound; EXION Body targets skin laxity and fat loss within one applicator; EMFEMME 360 uses non-invasive RF to treat vaginal laxity and sexual dysfunction in eight minutes, according to the company and Clinical trials have shown that EXION can induce a 224% increase in HA, 85% increase in skin laxity and 22% in fat reduction.

Shutterstock/Kopytin Georgy

64 | Consulting Room | Q4 2023

SNOWBIRD FINANCE The only partner you need to finance both your business and your treatments.

EQUIPMENT | VEHICLES | LOANS | CASHFLOW | PATIENT Asset Finance

Treatment Finance

Competitive rates Choose from over a dozen funders Practice finance specialists Financial support for your entire project Service tailored to your specific needs

Highest acceptance rates Next day payment Instant decision Quick and easy application process Proactive application monitoring ensuring maximum uptake

Lasers | Scanners | Facial Devices | Clinic Refurbishment

Partner with us and utilise both solutions to see the impact that the Snowbird difference will have on you, your business, and your patients.

01932 874674

info@snowbirdfinance.co.uk

snowbirdfinance.co.uk

TECHNOLOGY & INNOVATION

DE|RIVE TIME

Shutterstock/LightField Studios

We find out about Aesthetic Medical Partnership’s newest launches, which combine plant-based exosomes and technology for hair regeneration treatments DE|RIVE is next in the plant-derived exosome EXO|E family.

DE|RIVE treatment involves a two-step process: an in-clinic application of a super concentrated in-clinic treatment containing 15 billion plant-derived exosomes and a home-use product applied morning and night between treatments containing 14.4 billion exosomes in 60mls.

The scientifically validated proprietary blend helps decrease inflammation and increase hydration and blood flow to the area.

The serum also aids the removal of dead cells from around the follicle whilst stimulating cell proliferation through the increased production of Cytokeratin 15 proteins, integral to the fortification of the bulb responsible for hair growth.

Like EXO|E, DE|RIVE IS 100% organic, vegan-friendly and chemical free. It is made using their patent-pending cultural practices to grow bio-based biomimetic stem cell suspensions from which they extract the factors incorporated into the EXO|E product lines.

66 | Consulting Room | Q4 2023

DE|RIVE can be applied in clinic in combination with a procedure such as microneedling, RF Microneedling or using the ULTRA ultrasound delivery applicator on AMP’s other new device, AquaFirmeXS. Cellular and structural change happens over time, so a repeated at-home application increases results and continually provides the follicles with nutrients.

Utilising the Ultra applicator on the AquaFirmeXS ensures the product is concentrated at around 4mm depth and provides visible improvement in as little as 30 days when used in conjunction with the homecare.

DE|RIVE is shown to be effective in the treatment of alopecia areata (autoimmune), androgenic alopecia, telogen effluvium, and post-Covid alopecia.

AMP’s second new product launch is the AquaFirmeXS. The next generation of hydrating exfoliation facial treatments, AquaFirmeXS, uses chemical-free, vegan-friendly serums powered by EXO|E technology to deliver lasting skin results. In addition to hydration and exfoliation with the Micro-cupping EVO applicator, AquaFirmeXS has the EXO2 Applicator for vibrating massage and surface CO2 and the ULTRA applicator using Ultrasound with biotherapies to further assist in delivering serums by improving absorption into the skin. Ultra can be used to deliver AMP’s Plant Derived Exosome products EXO|E and DE|RIVE more deeply into the skin as well as other active ingredients, including topical anaesthetic.

The difference between AquaFirmeXS Bio therapy serums really sets it apart from other hydrating facial devices. Formulated by the scientists behind EXO|E using proprietary blends of plant secretary factors and plant extracts, chosen to correspond with the skin’s need in a bio-based product to stimulate the body’s natural healing. The plants are specifically chosen using ancient Ayurvedic principles enhanced by modern scientific knowledge and technology.

AquaFirmeXS offers treatments for all skin types on the face, body and scalp and can be used in combination with existing in-clinic treatments such as radiofrequency, IPL, Laser and LED. AquaFirmeXS is also highly profitable delivering excellent returns on investment as well as results with treatment costs under £15 per patient.

For more information, visit www.amp-uk.co.uk

www.consultingroom.com | 67

NOT ABLE TO FULFIL YOUR CLINIC'S TRUE POTENTIAL WITH APPOINTMENTS? MISSING OUT ON THE FULL EARNING POTENTIAL WITHIN YOUR CLINIC? STAFFING ISSUES CAN BE A STRESSFUL CYCLE THAT CAN BE AVOIDED! Here at Consulting Room we have helped thousands of individual clinics and clinic chains since 2003 build their business using our services and now we’re here to take the effort out of finding staff for your clinic.

Using our recruitment service saves you time and ensures you get the best quality candidates, leaving you to focus on building your clinic's success.

WHY CHOOSE CONSULTING ROOM FOR YOUR COSMETIC RECRUITMENT?  Time-saving proven strategies to short-list the most qualified and suitable candidates  Quick turnaround on filling vacancies  Advanced candidate screening tools help you make better hiring decisions  Expert help with benchmarking salary brackets  Maximum exposure and improved efficiency: Adverts will be posted on thousands of other job sites including award-winning recruitment sites such as Indeed and Adzuna  Access to recruitment agent with expert aesthetic knowledge of current legislation and relevant requirements and qualifications for high-quality, fully trained candidates  Option of pre-interview vetting of your chosen candidates by trained recruitment agent

FIND THE RIGHT STAFF FOR YOUR AESTHETIC BUSINESS

BY CHOOSING CONSULTING ROOM AS YOUR RECRUITMENT SPECIALIST

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

SKIN SECTION In this section: Managing eczema, Skin Product News

Shutterstock/Beauty Agent Studio/dimid_86/pumatokoh/Orawan Pattarawimonchai

SKIN

MANAGING ECZEMA

Shutterstock/Fuss Sergey

Paaven Patel, Operations and Quality Assurance Pharmacist at Specialist Pharmacy, shares five ways your pharmacist can help manage eczema.

Eczema, a type of dermatitis, is a chronic inflammatory skin condition which is characterised by dry, itchy, and inflamed skin.

The skin can appear red and blistered and can be caused by a variety of factors such as genetics, environmental triggers, and allergies. According to the data in the UK, eczema is a common condition that affects around one in five children and one in 10 adults in the country.1 Now, more than ever, patients are seeking therapeutic options which are specifically tailored to their therapeutic needs, considering unique allergies, sensitivities, and intolerances. As the body’s largest organ, what you put on your skin matters and through personalised medication, we can really improve a patient’s overall health. Personalised medicine is useful for guiding the selection of medications based on the patient’s genetic profile, medical history, and responsiveness to previous treatments.

One of the main reasons why a prescriber will want to look into personalised therapy is due to patient dissatisfaction with their current treatment plan. If a patient is not complying due to a dislike of the consistency, smell, or side effects of their current treatment, then they are not going to be getting the desired results needed to treat their condition. In these circumstances, a preparation which has been prepared specifically for their needs may be the perfect solution to improve adherence and allay any fears or concerns that the patient might have about their treatment.2 For patients who are suffering with symptoms caused by eczema,

70 | Consulting Room | Q4 2023

a prescriber can work closely with a compounding pharmacy to formulate an all-in-one medication that can relieve redness, itching and swelling. The aim would be for patients to receive the exact required dose to relieve their symptoms, rather than using a standard medication which could potentially be too strong or not strong enough. Furthermore, ingredients can be combined in a synergistic approach, for example, vitamin E could be combined with hydrocortisone to relieve symptoms of redness and inflammation while adding moisturising effects. Another approach can be adding a numbing agent, such as lidocaine with clobetasone, which can help reduce the need for scratching whilst also treating inflammation.

Working with a compounding pharmacy means that only the highest quality ingredients are incorporated being into a medication. Compounding allows for the thoughtful consideration of how active pharmaceutical ingredients are best suited in a specific vehicle, thereby maximising efficacy and tolerability and providing the flexibility to customise treatments according to the patient’s concerns. The dosage strength of the active ingredients can be adjusted to meet patient requirements, and unique combinations of active ingredients can be developed in physiologically relevant ratios. Additives or ingredients to which the patient is allergic/sensitive can be removed, and the base can be changed, for example, if a patient prefers a cream to a gel, creating a superior product in terms of patient satisfaction and results.

The tailored approach is very often driven by the patient and their

personal preference. It will provide the best dose and form and deliver the benefits needed, with a far reduced risk of any side effects and improved adherence to therapy.3

to over-the-counter treatments, pharmacists can refer them to a dermatologist or healthcare provider for further evaluation and management.

Pharmacists can play a crucial role in helping patients manage eczema as they can help develop a personalised treatment plan which can offer a more effective and targeted approach to managing the condition. Five ways in which pharmacists can help manage eczema are explained below.

Expert medication information: For patients with more severe eczema, pharmacists can provide information about prescription medications commonly used to manage eczema, such as topical calcineurin inhibitors (e.g. tacrolimus) and topical corticosteroids.

They can also explain the potential side effects, proper application methods and adherence strategies.

Genetic testing: Genetic testing can help identify specific genetic variations associated with eczema and reveal specific biomarkers that will dictate whether a particular medication will be effective for that patient. The skin microbiome plays a role in eczema development, so by analysing an individual’s skin microbiota, one can help in identifying imbalances and guide interventions to restore a healthier skin microbiome.4 Allergen testing: Pharmacists can offer advice on allergen avoidance or testing strategies. This may include information on hypoallergenic products, like detergents and soaps, and guidance on identifying and minimising exposure to common allergens, such as dust mites, pet dander, and certain foods. Allergen-specific IgE blood tests or skin prick tests can pinpoint the specific allergens that trigger a person’s eczema. This information can guide allergen avoidance strategies.5 Signposting and referrals: Pharmacists can assist in monitoring a patient’s progress in managing their eczema. They can help patients track their symptoms and the effectiveness of their treatments. If a patient’s eczema worsens or does not respond

Condition education: Pharmacists can provide information on potential eczema triggers, such as dietary or environmental factors and how to manage the condition with advice on gentle skincare products. They can also advise on over-the-counter products where it could potentially be indicated for the patient. Engaging patients in their care and educating them about their condition is a fundamental aspect of personalised medicine. Understanding the individual’s needs and preferences is key to designing a successful treatment approach.6 Pharmacists play a key role in the management of eczema. Not only do they provide emotional support for what can be an incredibly distressing condition that may drastically impact their quality of life, but they can also answer questions and provide guidance to help patients manage their condition effectively.

Some patients may prefer natural remedies, while others may want pharmacological interventions. The treatment plan should be aligned with the patient’s preferences and priorities, and a pharmacist can help make this personalisation happen.

References 1.

Atopic Dermatitis Treatment, Symptoms & Causes | NIAMS [Internet]. [cited 2023 Oct 23]. Available from: https://www. niams.nih.gov/health-topics/atopic-dermatitis

2.

Mathur S, Sutton J. Personalised medicine could transform healthcare. Biomed Rep [Internet]. 2017 [cited 2023 Oct 23];7(1):3. Available from: /pmc/articles/PMC5492710/

3.

Dr Ghazala Azis-Scott posted on LinkedIn [Internet]. [cited 2023 Oct 23]. Available from: https://gr.linkedin. com/posts/dr-ghazala-aziz-scott-b861b432_ dermatology-pharmaceuticalcompounding-activity7024065777200701440-e2wn

4.

Exploring genetics and atopic dermatitis [Internet]. [cited 2023 Oct 23]. Available from: https://www. medicalnewstoday.com/articles/genetic-testing-and-atopicdermatitis-what-to-know

5.

5 Ways a Pharmacist Can Help People with Allergies and Asthma | Allergy & Asthma Network [Internet]. [cited 2023 Oct 23]. Available from: https://allergyasthmanetwork.org/ news/5-ways-a-pharmacist-can-help-people-with-allergiesand-asthma/

6.

Berk Cayci A, Pattison Rathbone A, Lindsey L. Practices and Perceptions of Community Pharmacists in the Management of Atopic Dermatitis: A Systematic Review and Thematic Synthesis. 2023 [cited 2023 Oct 23]; Available from: https:// doi.org/10.3390/healthcare11152159

Shutterstock/pumatokoh

www.consultingroom.com | 71

SKIN Galderma UK launches Alastin in the UK Alastin Skincare, one of Galderma’s premium brands, has now been launched in the UK. Known as the brand of choice for peri-procedure skincare in the US and for scientifically backed restorative daily skincare, Alastin has proven popular with consumers and healthcare professionals alike.

The Alastin range is formulated with unique TriHex technology, which harnesses the power of a proprietary blend of peptides, which helps to restore the appearance of collagen and elastin in depleted skin. The products are widely used to prepare the skin before injectable treatments as well as aesthetic procedures such as laser resurfacing and body sculpting and to promote healing and healthy skin afterwards.

“We are so excited to bring Alastin to the UK and share the Alastin love with UK physicians and their patients”, said Jackie Tuzee, Head of Marketing - Aesthetics UK&I.

Obagi Medical launches Nu-Cil™ Eyelash Enhancing Serum Obagi is excited to launch Nu-Cil™ Eyelash Enhancing Serum.

Formulated with an intelligent blend of efficacious ingredients, this clever eyelash serum works by targeting the growth phase of the lash cycle to nourish and build volume while delivering comprehensive lash support.

The ingredient profile of Biotin, Proprietary Lipid Compound, Sodium Hyaluronate and Panthenol enriches every lash with a potent dose of strengthening keratin, enriching lipids, hydrating hyaluronic acid and conditioning vitamin B5. Their bioavailability is amplified through Obagi’s patented delivery system, NouriPlex™, which tweaks the profile to target lashes when they need it most during the crucial growth phase.

A clinical study of Nu-Cil™ Eyelash Enhancing Serum showed 93% of participants said their eyelashes showed visible improvement after 16 weeks; 89% of participants said their eyelashes looked thicker and 89% of participants said their eyelashes looked more densely packed.

5 Squirrels Introduces the Change Management System Award-winning skincare manufacturer, 5 Squirrels, is thrilled to unveil its revolutionary new range, The Change Management System.

The Change Management System consists of two products designed to address the shifting skin texture, tone, and radiance that can occur during a time of life when hormones naturally decline. It comprises two expertly formulated products which contain clinically proven ingredients that are gentle on even the most sensitive skin.

Dr Shirin Lakhani introduces new male hormonal support supplement – P-Tox Dr Shirin Lakhani has unveiled a new supplement for male hormonal deficiencies, such as andropause, after noticing a demand for recommendations from some of her male patients.

The founder of Elite Aesthetics developed her own supplement after not being able to find anything on the market that had all the ingredients she wanted.

The supplement aims to aid wellbeing and alleviate symptoms of cognitive and sexual dysfunction.

The product is vegan and contains ingredients such as Red/Panax Ginseng, Propionyl-L-carnitine, and a range of other ingredients that have been clinically tested on their efficacy.

72 | Consulting Room | Q4 2023

Your free HR & Employment Law advice line powered

by Citation We know managing HR & Employment Law can take up a lot of time and can be costly if you get it wrong. Luckily, as a valued Consulting Room member, you have access to a dedicated expert right at your fingertips as part of your exclusive member benefits.

Powered by our partner Citation, you can access a FREE HR advice line manned by their dedicated HR consultant Jonathan. With over 10 years’ experience managing HR issues in industries ranging from hospitality and social care to transport, utilities and charities, he can advise on all aspects of HR and Employment Law and turn the complicated into clarity.

Let’s get ready for anything So, for friendly, confidential, commerciallyminded support with your HR & Employment Law issues, get in touch with Jonathan at Citation today by email appointmentswithjonathan@citation.co.uk or call 0161 504 0843 between 9am-5pm Monday-Friday and quote Consulting Room.

Ts and Cs apply

0161 504 0843 appointmentswithjonathan@citation.co.uk

Here’s a few examples of the issues he can help you with: •

Disciplinaries and grievances

•

Conflict at work

•

Sickness and absences

•

Probation periods

Syndeo

®

The future of skin health is here 12 Treatments in 1 Device

Seamless Gesture Control

Patented Vortex-Fusion Technology

Custom Backlight Colors

Automatic Serum Selection

Wireless Upgrades

Prompts to Upsell

Future Business Insights

01788 572 007

@hydrafacial_uk

www.hydrafacial.co.uk

With the most experienced aesthetic associates in the industry you’re in great hands.

D o w h a t tys oo uu rdc eo b est , ou est ! th e r

PR

Business support/ Virtual PA

Design and print services

Copywriting

Product launch

Lead Generation SEO / CPA / PPC

Production and filming

Business strategy and planning

Direct sales

Clinic/patient finance

Clinic refurbishment and build CQC experts

Marketing and advertising

The many benefits of outsourcing Saving money

Flexibility

Reduce overheads

Focus on you

Aesthetic Associates a lead generation agency.

Dedicated Experts. Just one call away.

07903 944 666 01702 870 190 www.aestheticassociates.co.uk Get social

linktr.ee/aestheticassociates

Do what you do best, outsource the rest.

Increase patients

BUSINESS SECTION In this section: Regulation, making money while you sleep, insurance and setting boundaries

Shutterstock/Celia Ong/ARTFULLY PHOTOGRAPHER/Kostikova Natalia/Ground Picture

BUSINESS

REGENERATIVE TREATMENTS (POLYNUCLEOTIDES): EVERYTHING YOU NEED TO KNOW At Hamilton Fraser, we are proud to provide insurance cover for the most comprehensive range of cosmetic treatments in aesthetics. We continuously monitor the sector to accommodate new treatments and make sure that we meet our customers’ needs.

As an aesthetic practitioner, you will know how important it is to stay ahead of patient trends and respond to innovation in the

aesthetics industry. But with the pace of change happening so fast, it can sometimes be difficult to know whether a trend is here to stay, or just a passing fad.

While demand for botulinum toxin, dermal fillers and chemical peels continues to grow, and these are still the most popular treatments amongst our customers, aesthetic practitioners looking to stay at the forefront of medical aesthetics are

78 | Consulting Room | Q4 2023

increasingly incorporating regenerative medicine (polynucleotides) into their practice. Regarded as the ‘gold standard’ in skin regeneration, there has been a rapid surge in popularity of polynucleotides to meet increasing patient demand. But while they’re a hot topic in aesthetics at the moment, what are they, are they here to stay, and how can Hamilton Fraser help you integrate polynucleotides into your practice?

What are polynucleotides?

A newly emerging revolutionary tool in regenerative medicine, polynucleotides work to stimulate fibroblasts at a cellular level to encourage restoration and regeneration of the skin from within. Unlike hyaluronic acid dermal fillers, the aim is not purely to add volume, but to regenerate.

Polynucleotides are long chains of nucleotides that make up DNA and RNA molecules. They are derived from fragments of fish DNA (which resemble human DNA), which means they have the ability to function as a biostimulator, kickstarting regeneration in the skin. Not only are they anti-inflammatory, thanks to their antioxidant properties, but they increase collagen production, resulting in a thicker, healthier epidermis.

Why are polynucleotides so popular with patients?

What are the potential side effects of polynucleotides?

One of the advantages of polynucelotides is that they have an excellent safety record and are generally highly tolerated. Although the risks and side effects are less than those of other injectable procedures, this will depend on the practitioner’s experience and technique. Patients may experience redness, swelling and bruising but this should settle after one to two days.

More serious side effects, such as allergic reactions, are extremely rare.

As with all treatments, it’s important to carry out a thorough pre-treatment consultation to assess the patient’s suitability. Explaining and documenting any potential side effects, and getting signed consent, is just as important as the treatment itself in case

Polynucleotides yield far more natural results and carry a lot less risk compared to many other injectables. Because they utilise natural DNA fractions, they are as close to natural as possible, offer some impressive benefits and results, and can be used in a wide range of applications as a rejuvenating treatment for older skin and as a preventative treatment for younger skin.

With patients increasingly focusing on achieving natural looking results, enhancing individual features by regenerating damage, and more interested in the longterm effects of treatments than a shortterm fix, the future looks promising for polynucleotides.

How are polynucleotides used?

Polynucleotides are being used to reverse the ageing of tissues and repair scarring by tackling the concern from the source, in contrast to the traditional approach, which focuses on treating symptoms. Some of the

you have a claim or complaint made against you. Make sure anything discussed in the consultation is noted, ideally in email form, so that you have an audit trail. It is also best practice to carry out a two-stage consenting process. When you see the patient twice, you can provide them with the details of any risks and benefits at the first appointment and evidence the consent at the second appointment.

How can Hamilton Fraser help you integrate polynucleotides into your clinic?

Hamilton Fraser can provide polynucleotides cover for doctors, dentists, nurses, dental hygienists, dental therapists, pharmacists, paramedics, operating department practitioners and physiotherapists within your

applications of polynucleotides include: •

Rejuvenating treatment for older skin to treat fine lines and wrinkles

•

Preventative treatment for younger skin

•

Rehydration for dull skin at any age

•

Treating dark circles as an alternative to tear trough fillers

•

Strengthening delicate areas of skin such as around the eyes and mouth

•

Reducing inflammation to helps with conditions such as rosacea

•

Treating hyperpigmentation, sun damage, scarring, stretch marks and acne

•

Treating alopecia and hair loss

In addition to their success rate with these applications, polynucleotides work well alongside other treatments, enhancing their effects, such as by boosting the longevity of anti-wrinkle injections.

medical malpractice insurance policy.

Polynucleotides are covered as standard for these medical professionals under mesotherapy skin rejuvenation, provided you have the relevant qualifications to perform this treatment. Training needs to be undertaken with a medical professional.

Learn more about regenerative treatments (polynucleotides).

If you are looking for insurance to cover polynucleotides, please contact the Hamilton Fraser team on 0800 634 3881 or email cosmeticsales@hamiltonfraser. co.uk.

Visit our treatment pages to find out more about the treatments we cover.

If a specific treatment is not listed, please give us a call to discuss your bespoke requirements.

www.consultingroom.com | 79

SETTING BOUNDARIES Dr Tatyana Lapa-Enright on the benefit of setting personal and professional boundaries If you are going to create more time for yourself, your mental health, skin, body, or whatever else you decide to implement, You are going to create changes.

No matter how small or big, it is worth considering that this takes time and space. Hence, work, home and social arrangements may need to be adjusted. To succeed in implementing these changes, even if they are only temporary, you may need to rethink your personal and professional boundaries.

In general, boundaries are the limits and rules of engagement we set for ourselves and others within social interactions and relationships. This can be in the context of intimate, family, personal and workplace relationships to keep us and others comfortable and emotionally content. When your personal and physical space is respected, you and others are more likely to feel heard, validated, appreciated and safe. There is no prescription for personal boundaries as they are mediated by social, cultural and personal contexts. They are much more fluid and dependent on circumstance.

On the other hand, professional boundaries are often regulated by employment contracts, office dynamics and professional codes of conduct. However, we all know how difficult it can be to keep this in check, and implementing changes here can be more challenging.

Below are some examples of the most common boundaries that apply to all work, home, intimate and personal relationships, health, and pretty much anything else.

1.

2.

3.

4.

5.

Time (how much time you spend with someone or doing something) Emotional (how emotionally available you are) Material (includes financial and monetary contributions) Self/others (how much energy you can give) Privacy (personal space, your body and privacy/ how much you want to share)

Re-evaluation of boundaries requires a degree of self-awareness; however, the simplest way to do it, I find, is to consider the five main domains of our lives: work, home (children, family members, pets), partner, social (friends/other non-work related engagements), self (menopause, andropause, health issues, whatever makes you happy, mental health). New categories can be created as appropriate.

Then, use a traffic system: Green (satisfied with current arrangements), Amber (not sure/needs further thought) and Red (needs adjustment).

80 | Consulting Room | Q4 2023

See example below: BOUNDARY

WORK

HOME

INTIMATE

SOCIAL

SELF

TIME EMOTIONAL MATERIAL SELF PRIVACY

Once this is completed, you can then clearly see what needs to be adjusted to give you more space to get what you need to be or simply to give you that space to pause. In the words of composer Truman Fisher: “The pause is as important as the note”.

In order to negotiate the boundaries, it is important to be assertive. Assertive does not mean aggressive. It means being able to express yourself and being able to show respect to others; it means being open and honest without being hostile or offensive.

Some people feel it is easier to say “yes” than “no”. But saying “no” is the key to establishing boundaries, reducing stress and resentment and limiting regret.

If you find it difficult to say no, practice it in front of the mirror.

Examples of saying “No” when you don’t have time.

1. I’m just swamped right now, so I can’t.

2. I’ve got too much on my plate right now.

3. I’m not able to make it this week/month/year.

Saying “No” to an Invitation or Offer 1. I’d love to, but I can’t.

2. Thanks for the offer, but I can’t.

3. I’m honoured, but I can’t.

There are a number of free resources that are available to deal with everyday stress: https://www.nhs.uk/every-mind-matters/mental-health-issues/ stress/ https://www.nhs.uk/mental-health/self-help/guides-tools-andactivities/tips-to-reduce-stress/ https://www.nhsinform.scot/healthy-living/mental-wellbeing/stress/ what-to-do-if-you-are-struggling-with-stress If you need more professional input to help with your symptoms, please ensure that the person is highly qualified and registered with an appropriate professional body.

Shutterstock/Bagus Production

www.consultingroom.com | 81

TURNOVER WHILE YOU SLEEP BUSINESS SKIN

Lorna Bowes reviews ideas for why and how to build a passive income stream from skincare sales 24 hours a day, seven days a week In aesthetic practice, we are focused on driving clinical excellence and patient satisfaction; however, alongside our desire for continuous clinical improvement, we have to understand our clients and their motivations and drivers for visiting us and then use that information to drive the future success of our businesses as well as the excellence in our clinical results.

revenue not only from repeated sales to existing patients but also new patients from referrals by happy patients and, importantly, better patient outcomes.

Concepts of passive income

•

Passive income is described as “making money while you sleep,” but there is so much more to it than that…

•

Passive income encompasses earnings generated with minimal ongoing effort or active involvement, in other words, the creation of a system that generates income on autopilot, generating revenue whether you’re in clinic or on a beach in the Maldives.

In our usual working days, we are patientfacing, and immediate sales of skincare to the patient in front of us is relatively straightforward (and for those reading this whose subconscious has just said, “No, it isn’t” - please do reach out, we can help you with this!), but following this up with repeat purchases over the years is way more complex. It is, however, one of the key success factors – great repeat skincare sales bring increased skincare

Let’s look more closely at passive income, according to leading e-commerce platform Shopify, the key points for passive income are:

•

Most successful passive income ideas are the result of hard work and repeat gains.

Adding passive income streams to your life can give you more freedom, flexibility, and money.

Dropshipping is one of the best passive income ideas to earn money from wherever you are.

How to build trust to enable ‘distant purchasing’ and dropshipping?

To get the best from your business, we can take ideas from many other ‘user interfaces’. The concept of User Experience is well documented and discussed widely in other contexts, and there are many lessons that are pertinent and commercially wise.

User Experience is defined as the sequence of actions taken by a user while he or she uses a product, digital interface, or service, leading to a rich and beneficial experience.

The process of identifying user needs

and creating solutions to address them is known as “UX design”.

UX design includes elements of branding, design, usability, and function other than the process of obtaining and integrating whatever the product or service may be.

According to research published by Forbes in February 2023, the return on investment on UX spend is 9,900%, or rather, a £1 investment can bring a £100 return. How much would you like to invest in growing your business?

Skyhook user research published in May 2023 demonstrated that 55% of the world’s companies actively conduct user testing to assess UX spending with the key business goals of: • • •

Driving revenue Maintaining a competitive edge Bolstering reputation

It is certainly something we have adopted in our business, with great effect. I commend it to you!

Concepts of UX design: In the workbook, you will find exercises to help you work through the following segments of the UX design process.

1.

Empathy: Put yourself in your

Shutterstock/Kostikova Natalia

82 | Consulting Room | Q4 2023

2.

3.

4.

5.

6.

7.

patient’s shoes. What are their expectations, what problems do they want to solve? What do they want a positive patient experience to look like?

Strategy: Goals, design, testing. What does success look like?

Usability: Reduce cognitive effort. Is booking treatments/buying from you intuitive?

Inclusivity: Notwithstanding your Personal Brand, take into account the demands of individuals of various ages, genders, races, ethnic backgrounds, socioeconomic levels, and other characteristics.

Validation: Test potential solutions.

Test again. Test again.

Product: Homecare sales (products, devices) to support in-clinic treatments and drive new business User Interface: Website, social, clinic, team

your social media voice, your advertising, how you work with PR, the design of your premises, your choice of training for your team, the products and treatments that you offer.

•

treatment trolley so you can open a conversation.

Provide a choice of SPF and suitable makeup for post-procedure, again with buying opportunities

Alongside this, try not to be the area’s bestkept secret; ensure existing patients, staff, friends, and family tell stories of success, share before and after photographs, and share their skincare journeys in relatable ways.

3) In-clinic ‘Point Of Sale’ material positioned to reach every patient

Careful product introductions:

•

1) Procedure Pairing Examples: •

•

Body procedures: Revision Skincare Bodifirm/Nectifirm with any body shaping or resurfacing treatments Lip Augmentation: Revision Skincare Youthful Lip Replenisher, NeoStrata Lip Wrinkle Repair for any mid and lower face injectables, and any facial energy device treatments Neuromodulators: Revision Skincare Revox Line Relaxer for any facial upper third procedures

Building success – implementing these ideas

•

Presence: Building the passive income needs a starting point. Having done your research and built your ideas, now to put them into practice:

2) In-Clinic Product Positioning

Brand consistency: it is critical to ensure your messaging is consistent through all touch points, whether that is your website,

•

•

•

•

Literature - skincare branded or clinic branded physical materials and/or QR codes so they can access your materials digitally Product tick sheets in the treatment room to ensure conversation around skincare “Have you picked up your homecare to support your treatment?” or a similar sign at the payment point

Use this link to register to receive a digital workbook to support turning your learnings from this article and your notes into a viable plan.

There are many ways to introduce patients to skincare. These are a few: Keep samples of cleansers in an area set aside for removing makeup prior to procedures and on the

www.consultingroom.com | 83

BUSINESS

DECEMBER ROUND-UP Shutterstock/ARTFULLY PHOTOGRAPHER

In this column, Gary Conroy, CEO of 5 Squirrels Ltd, will provide updates on the topical landscape of cosmetics. 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!

Regulations: 1. The SCCS has published new guidance on Retinol: The SCCS is of the opinion that vitamin A in cosmetics at the concentrations of 0.05% Retinol Equivalent (RE) in body lotion and 0.3% RE for other leave-on and rinse-off products is safe. A decision and potential timeline are due to be reached in November 2023. https://health.ec.europa.eu/ publications/revision-scientific-opinionsccs157616-vitamin-retinol-retinylacetate-retinyl-palmitate_en 2. EU publishes new draft regulations on some skincare ingredients, including: Clinic owners should be mindful of the new concentration limits when making purchasing decisions to keep themselves on the right side of the law.

•

• • •

Alpha Arbutin Triclocarbon UV filter 4-Methylbenzylidene Camphor

https://cosmeticsbusiness.com/ future-restrictions-on-key-skin-careingredients-in 3. New USA regulations are due to take effect for cosmetic products for the first time in 85 years, bringing the USA closer to EU and UK legislation.

The Modernization of Cosmetics Regulation Act of 2022 (MoCRA) redefines the standards within the US beauty industry and adds additional regulatory burden on suppliers, impacting the costs of goods. UK clinics are realising this in additional costs of imported US brands.

There will also be a new adverse event reporting requirement like the “Yellow Card” system in the UK, which clinics using US brands should familiarise themselves with.

Kojic Acid

84 | Consulting Room | Q4 2023

https://www.fda.gov/cosmetics/ cosmetics-laws-regulations/ modernization-cosmetics-regulation-act2022-mocra

4. The UK Office for Product Safety and Standards has launched two calls for data on potential endocrine disruptors.

If ingredients are used in products that children or pregnant women may use, relevant data to support the safety and exposure estimates should be provided for these populations.

1.

2.

3.

4.

5.

6.

7.

1Triclosan (CAS 3380-34-5) Triclocarban (CAS 101-20-2) 4-Methylbenzylidene camphor (CAS 36861-47-9 / 38102-62-4) Salicylic acid (CAS 69-72-7) Butylparaben (CAS 94-26-8) Methylparaben (CAS 99-76-3) Selected nano-particles

Interested parties should submit data by 15th December 2023. https://www.gov.uk/government/ news/call-for-data-safety-of-cosmeticingredients 5. The IFRA (International Fragrance Association) has published its 51st amendment. The new Standards incorporate restrictions/prohibitions based on either skin sensitisation and/ or systemic toxicity, depigmentation and potential genotoxicity effects. Formulations are due to be compliant by October 2025, and clinics may notice changes to product fragrances as brands incorporate these regulations.

2. Clariant to buy Lucas Meyer from IFF in $810 million deal.

(formerly palmitoyl oligopeptide) + palmitoyl tetrapeptide-7.

https://www.clariant.com/en/Corporate/ News/2022/10/Clariant-completesacquisition-of-BASFs-US

https://www.ibsaderma.co.uk/profhilofigura-body-cream/

3. Brexit Cut UK skincare exports by £850 M The British Beauty Council’s 2023 Value of Beauty report claimed this was largely the result of increased bureaucracy and trade barriers stifling sales since Britain’s withdrawal from the EU.

4.Galderma introduce Alastin, a pre and post-procedure product to restore the appearance of elastin and collagencontaining niacinamide, Palmitoyl Hexapeptide-12, Palmitoyl Tripeptide-1, Palmitoyl Tripeptide-5, Palmitoyl Dipeptide-5 and ceramide.

A British Chambers of Commerce survey found that 49% of UK exporters have reported difficulties adapting to the changes required to trade goods.

https://www.galderma.com/news/ alastin-skincare-galderma-announceslaunch-uk-and-direct-distribution-andexpansion-canada

https://britishbeautycouncil.com/howis-brexit-affecting-the-british-beautyindustry/

Clinical breakthroughs

4. In new findings, P&G, L’Oreal, and L’Occtain have been accused of greenwashing and added to www. greenwash.com’s hall of shame alongside Sainsbury’s, Coca-Cola, and Nike. https://greenwash.com/ 5. Kate Moss joins the British Beauty Council as ambassador - The supermodel launched her wellness brand Cosmoss last year and has fronted campaigns for the likes of Charlotte Tilbury, Rimmel and Dior.

https://ifrafragrance.org/news/ newsroom/notification-of-the-51stamendment-to-the-ifra-standards

https://britishbeautycouncil.com/ kate-moss-british-beauty-councilambassador/

6. The UK has launched an enquiry to investigate banning microplastics for disposable wipes (including removal pads).

Environmentally conscious clinic owners may wish to check if the products they supply contain wipes ahead of any new legislation.

New Product Launches

https://www.gov.uk/government/news/ consultation-launched-to-ban-wetwipes-containing-plastic

Markets 1. Unilever announces a Q3 sales decline and sells stake in Dollar Shave Club. https://www.unilever.com/news/ press-and-media/press-releases/2023/ unilever-announces-the-sale-of-dollarshave-club/

1. l.a.b. offers an Acne Drying Compound that can be applied following patch treatments. l.a.b. (light-activated beauty) takes skin patch technology to the next level with its acorn-sized, LED-enabled Light Therapy Patch, which provides 3-minute, hands-free spot treatments. https://skinbylab.com/ 2.Dr Levy introduces new pigment drops containing eight alpine plants, red algae, tranexamic acid, niacinamide and vitamin C. https://www.drlevy.swiss/en/product/ pigment-control-drops 3.HA-Derma launch Profhilo Figura Cream containing low and high molecular weight hyaluronic acid and palmitoyl tripeptide-1

1.Active Concepts Introduces the BioAuthentic Exosomes ingredients line for skincare manufacturers offering membrane proteins, guaranteeing structural stability, per the company. The BioAuthentic Exosomes line allows brands to choose a delivery system tailored to their intended benefits. https://activeconceptsllc.com/ newsevents/discover-ourgroundbreaking-bioauthenticexosomes/ 2. BASF has expanded its sun care portfolio with Tinomax CC (INCI: Calcium Carbonate, Hydroxyapatite). This ingredient offers a sensory improvement. It can enhance UV protection with SPF and UVA via light birefringence. The company has shown that formulations containing Tinomax CC tend to be significantly less sticky and greasy during application than those without this ingredient. These new innovative ingredients for SPF formulations are likely to become commonplace with ongoing regulatory discussion around the safety of Filters and Non-ionised metallic oxides. https://www.basf.com/global/en/media/ news-releases/2023/09/p-23-299.html 3.Trautec has won investment to scale up synthetic recombinant human collagen for skin care and aesthetics. The market for synthetic collagen is expected to reach $186 Bn by 2028, having only been introduced in 2022. https://www.trautec.us/product

www.consultingroom.com | 85

TRAINING Tracey Jones, a registered nurse and regulation consultant providing support for healthcare professionals related to CQC registration and inspection, gives her views on enhancing regulation in the sector The topic of enhancing regulation in the field of aesthetic medicine has been a longstanding focus of discussion within the medical and nursing community. With the recent initiation of public consultations regarding the licensing of non-surgical cosmetic procedures, it appears that change may finally be on the horizon.

While this sector is often referred to as an “industry,” we could argue that it should be viewed as a domain of medicine rather than a facet of beauty.

As a nurse running my own CQC-registered clinic, I have observed the proliferation of services provided by individuals with no medical training or education, offering treatments that are essentially medical procedures. We hope that the limited timeframe for the consultation did not deter responses and that it will ultimately lead to a genuine understanding of the public’s perspective.

Different groups have undertaken various initiatives to promote involvement, targeting both healthcare professionals and those in the beauty industry. However, we will not see the impact of this until the response is published. We anticipate that this is unlikely to be a swift process; there are indications that the final framework will not be enforced until 2026. This provides professionals with ample time to prepare for the aspects outlined in the consultation.

I would implore those operating in this field to exercise caution before embarking on costly alterations or educational programs, as the final enforcement is yet to be confirmed. While registration with the Care Quality Commission is outlined in the consultation document, professionals must recognise that the regulation of registered services will remain consistent. If you, as a medical practitioner, are offering services falling within the scope of registration, this applies now and will continue to do so. What may change is the inclusion of additional services under the scope of registration, while the requirements for achieving registration will remain unchanged.

Some have argued that the license may potentially lead to more regulation for those who are already subject to stringent oversight by their respective governing bodies.

Nevertheless, viewing this as a step toward a more regulated domain rather than an impediment is important. As regulatory consultants with years of experience in this sector, we have witnessed and worked with many professionals who have faced the threat of prosecution from the healthcare regulator. As healthcare professionals, we must enhance our understanding of which services fall within the purview of this regulatory scope to mitigate the distress and risk associated with such threats.

We must ensure that we adhere to the regulatory scope and lead by example for the public.

It is noteworthy that we have seen an uptake in professionals seeking support for CQC registration since the launch of the consultation, indicating that practitioners are preparing for the impending changes.

The three-tiered sections outlined in the proposal, referred to as the “rag rating,” within the proposed licensing scheme may not be novel information for those who have been following this initiative over the past few years. However, the specific treatments listed within those categories may be new. Some question whether all treatments with potential patient risks should indeed be classified in the “red” category, which necessitates registration with the Care Quality Commission in addition to being a medical practitioner.

This may account for the rise in inquiries we are experiencing.

It is evident that there will be shifts within these categories, with Professor David Sines of the JCCP suggesting that certain dermal filler procedures, such as rhinoplasty, should be viewed differently due to the risk and classified in the “red” category. One crucial aspect not clarified in the proposal is the requirement for healthcare regulation or medical registration for many treatments, which causes the biggest concern, such as all

86 | Consulting Room | Q4 2023

A CHANGI dermal fillers. This remains a concern as many lacking medical accountability are offering such procedures.

The Keogh Report 2013 emphasised the need for enhanced regulation in what the media called the “Wild West of medicine.”

It is disheartening that it has taken a decade to raise public awareness and Government action, primarily in response to a significant number of instances of substandard practice and injuries to the public. Amendments to the Health and Social Care Act have paved the way for change. The JCCP has been at the forefront of this effort, providing detailed

Shutterstock/Ground Picture

ING LANDSCAPE information in the licensing proposal that underscores the necessity for a license for the facilities offering treatments and the individuals administering them.

However, it does not specify how this will apply to clinics with medical and nursing teams already striving to establish robust governance structures and safety measures in line with CQC requirements and registration. We are left uncertain whether this license will be required for premises that are already CQC registered.

As the consultation implies, we will await the response. I anticipate this will be a slow process, with indications that final decisions may not be implemented until

2026, allowing for an extended period to implement these changes. Thus, professionals have ample time to prepare, whether by ensuring their facilities are appropriately equipped, pursuing further education, or seeking registration with the CQC. Like many others, I will closely monitor developments and submit my responses, as this is the only means by which we can facilitate meaningful change.

If you would like the help and support from of our CQC registration experts, call 07825 311900.

You can also visit www.inspiretooutstand.co.uk for more infromation.

Please quote ‘Consulting Room’ when enquiring.

www.consultingroom.com | 87

Menopause in Aesthetics (MIA) returns for 2024 Our aim is to empower aesthetic professionals with the knowledge and tools they need to better serve women going through menopause.

Charlotte Body MIA founder and MD

Following the huge success of the

outside the aesthetics industry

inaugural Menopause in Aesthetics

sharing their best practices.

(MIA) event in 2023, the conference is

Taking place at the Business Design

set to return for 2024 with a new,

Centre in London, the event is

bigger London venue and even more

expected to attract 500 delegates

expert speakers and engaging

and 40 exhibitors in person, with a

content than before.

further 300 tuning in via MIA's live

MIA is a must-attend event for anyone looking to provide

stream.

30 Top experts 40 Exhibitors 500 Delegates

Whether you want to integrate

menopause support in their

menopause services into your

aesthetic clinic.

practice or be more educated about

The hybrid conference will feature

This exciting one day event includes:

this demographic so you can refer

15 (CPD-applied for) talks, with

your patients to the right resources,

speakers from both within and

MIA is the place to be.

CPD points Masterclasses Online and in person ticket options

Our headline sponsor for Menopause in Aesthetics Conference 2024 is Roseway Labs www.rosewaylabs.com Thank you to our other sponsors

Topic pathways Treating male patients

Cancer and the menopause

Decreasing testosterone levels as a result of male

Surgical removal of the ovaries in ovarian and womb

menopause or andropause can lead to a number of

cancer as well as radiation therapy and chemotherapy

symptoms from lower sex drive to lack of energy and

for gynaecological and breast cancers can result in

loss of strength or muscle mass. We explore how to

ovarian failure and early menopause. We explore this

support male patients with hormonal changes.

important topic.

Skin and hair

Intimate health

The link between the skin and hormones is

From vaginal dryness and laxity to incontinence and low

well-documented. From dryness and pigmentation to

libido, intimate health concerns are something that

loss of collagen and elastin and hair loss, we explore the

impacts many women during menopause. Our experts

impact on the skin and hair caused by dramatic changes

will explore the treatments and solutions to give women

in hormone levels experienced during menopausal years.

and their vaginas a new lease of life during menopause.

Our speakers Dr Ginni Mansberg

Dr Anne Henderson

GP, TV presenter author of The M Word

Highly experienced consultant

and How to Thrive in Menopause and

gynaecologist and the owner of The

co-founder of ESK Skincare.

Amara Clinic for womens health.

Dr Shirin Lakhani

Miriam Martinez Callejas

GP and aesthetic practitioner,

Superintendent pharmacist (Roseway

specialising in intimate health, sexual

Labs). International experience in

dysfunction and menopause.

bio-pharmacy research and compounding.

Dr Nabil Elmahdawi

Dr Natasha Fernando

A senior consultant in clinical oncology, he

Head of clinical excellence at Medichecks

is passionate about supporting cancer

and a practising GP with over 12 years of

patients thrown into early menopause.

experience in the NHS.

Don’t miss out!

BOOK EARLY The event sold out last year so book early to avoid disappointment

To book your tickets now

Telephone us on 01702 870 190 or book online at www.menopauseia.co.uk

To better serve women on their journey through menopause

TRAINING

WE SPEAK TO NEIL PYBIS AND ANGELA BRENNAN FROM SKIN APPEAL TRAINING ACADEMY (SATA) ABOUT WHY THE RIGHT EDUCATION IS THE FUTURE OF AESTHETICS Education and training have always been considered important in aesthetics (by reputable practitioners, at least), but the difference between the two – education or training - what constitutes an adequate level, what specific knowledge and skills are required, and who gets to decide – have long been more of a grey area.

The current consultation around the safe practice of aesthetic medicine in England has brought these conversations into sharper focus, especially with the proposed ‘traffic light system’ raising valid questions about who will have the ‘right’ to deliver certain enhancements.

In summary, the proposed scheme (the consultation for which closed at the end of October) focuses on non-surgical cosmetic treatments that involve the injection of substances or needles inserted into the skin; the application of substances that penetrate the epidermis, threads placed under the skin; and the application of light, electricity, cold, or heat.

Each procedure has been roughly categorised by perceived risk level. Green (low risk) currently includes microneedling, mesotherapy, IPL, and LED therapies, and under current suggestions, practitioners who meet ‘agreed [but unconfirmed] standards can perform these without additional oversight.

Amber (medium risk) includes botulinum toxin and dermal filler injections. For these, only registered healthcare professionals who have achieved a minimum standard of education and are licensed would be allowed to perform these.

Lastly, there’s the Red (high risk) category.

This reserves certain treatments for specified regulated healthcare professionals, specifically those regulated

by CQC. The treatments currently in this category include thread lifting and hair restoration surgery.

It’s important to stress that we are at

the beginning of this process with many changes likely to emerge, but one thing is true – greater regulation and standards are coming. So, from an aesthetics education perspective, what should we expect in the near future?

With discussions around Level 7 diploma aesthetics qualifications potentially becoming the mandatory minimum level of certification to practice aesthetic medicine in England, we spoke to Neil Pybis and Angela Brennan from Skin Appeal Training Academy (SATA). Pybis and Brennan are nurse practitioners and prescribers, with a combined 60 years of experience in nursing and 24 years’ worth of expertise in aesthetic medicine. (Plus, there’s Brennan’s 17 years of experience in Nursing education as a lecturer and Director of the School of Health at John Moores University).

SATA has just been granted permission to deliver a Level 7 Education in Aesthetic Injectable Therapies course by the OTHM awarding body, making it the first Level 7 programme nationally approved by OTHM (one of only two JCCP award-accrediting bodies). SATA is also in the process of joining the JCCP education register, with the aim of becoming the first Nurse-led Academy on there to deliver Level 7 Aesthetic Education.

But what does Level 7 Aesthetic Education mean in practice? The Level 7 qualification aims to provide a sector-standard certification in aesthetics at a postgraduate level, and it is currently open only to suitably qualified medical professionals – in SATA’s case, specifically nurses, doctors, dentists, and midwives and pharmacists.

Flexibly designed for the working practitioner, the SATA Level 7 Diploma in Aesthetic Injectable Therapies will be delivered through a blended learning approach. This will include online learning, self-directed learning, practice observation and supervised practice.It comprises seven mandatory units including not only

90 | Consulting Room | Q4 2023

AN EDUCAT how to treat with botulinum toxin and fillers, but further insight into anatomy and physiology, assessment and treatment planning, managing possible complications, and education on the latest standards in aesthetic medicine.

“Level 7, aka Postgraduate studies, move us away from the understanding and application of knowledge into analysis and synthesis of a whole range of knowledge, concepts and ideas,” explains Brennan.

“We are looking for how the details make up the whole picture and what effect changes in one area can affect other related areas.”

If anyone views aesthetic medicine mainly as the ‘art of doing’, the thought of ‘ideas and concepts’ might feel alien. However, as both Pybis and Brennan are keen to stress, it’s arguably not training that’s going to make the industry safer - it’s quality education. Here’s the difference: “The terms ‘training’ and ‘education’ are often used interchangeably, but they represent distinct processes with different purposes and outcomes,” says Brennan. “Training is typically a practical,

Shutterstock/PeopleImages.com - Yuri A

TION skill-oriented process designed to equip individuals with specific competencies related to a particular task. Education is a broader, knowledge-focused process to provide individuals with a well-rounded understanding of various subjects. It emphasises intellectual and personal development.”

For example, the one-or-two-day training courses for botulinum toxin and dermal fillers are technically aesthetic training – despite their brevity. So are the courses where the training is given out as templates and diagrams, like a paint by numbers.

“The problem arises when practitioners who have undergone this kind of training meet the unexpected,” explains Brennan.

“Quite often, training courses are just about the actual task of injecting. There is so much more to the practice of aesthetic medicine. With a Level 7 education in aesthetics a practitioner can apply their knowledge to any given situation. This includes medical and psychological assessment, clinical decision making and risk assessment, understanding of causal factors and how to address these, treatment planning to meet individualised

needs, treatment itself, differential diagnosis of complications and aftercare” “We can train anyone to use a machine, but do we educate them on how to approach the time before and after using that machine?” continues Pybis. After all, doing a treatment is not just conducting the treatment itself – its everything around it, including safeguarding your patients.

That’s where education comes in.

“Education equips a practitioner with the knowledge to synthesise all of the myriad of factors that need to be taken into account when performing an aesthetic treatment,” Brennan continues. “It isn’t just the skill of putting a needle into somebody.

It’s to do with the depth of knowledge, and knowing what the risks are. Training is taskorientated, but with education, you may not even end up doing the treatment because one of the options is no treatment. You’re never normally told that in a training course.”

Pybis shares an example: “Recently, I had a lady who, on assessment, had literally no movement of the upper parts of the face when she tried to lift her eyebrows. So why

had she been to three different people who insisted that she needed a toxin in the forehead to reduce wrinkles? The last thing she needed was toxin.”

Thus, when we discuss the importance of both education and training in aesthetics, inevitably discussions around who has the appropriate background always emerge.

For Pybis and Brennan, as with many in the sector, the expertise of registered healthcare professionals is all-important.

“Assessment, diagnosis and patient-centred individual treatment plans are areas in which healthcare professionals have a wealth of experience,” says Brennan. “Their medical knowledge in anatomy, physiology, and pharmacology is there to be built upon and focussed onto aesthetic treatments.”

Furthermore, “the ‘soft skills’ of communication, active listening, observing and risk assessment come much more as second nature to those who have been educated to deal with all manner of patients.” For both Pybis and Brennan, noting their nursing backgrounds, that’s an area that sets aesthetic nurse practitioners apart.

www.consultingroom.com | 91

TRAINING However, there is still seemingly much work to be done. Both experts expressed some disappointment at the BACN’s responses to the recent “traffic light”proposals, for example, especially the restrictions to practice based on CQC accreditation. It has been seen as a missed opportunity to support the education and advancement of healthcare providers like nurses, especially those in specialist practitioner roles.

“If you’re a specialist practitioner, you are an expert in an area of practice, and you often have to have that autonomy of clinical decision-making - knowing what you can and can’t do” says Brennan. “So, I was a little bit disappointed to see that the main tenor of the BACN response was if there’s any risk at all, let’s move it into the red category, which means such treatments could only be carried out in CQC-registered premises. The BACN draft response included toxin and semi-permanent fillers to the face being moved to the red category. Now I know that lots of nurses are working in CQC-registered clinics, but many aren’t.”

“I feel that if you do the Level 7 and you are educated correctly by becoming a specialist in that sector, then there should be no reason for such treatments to be moved,” agrees Pybis. “I think toxins and skinboosters, for example, shouldn’t go anywhere near the red category. The education should be in place for people to

be able to carry these treatments out safely and they will be knowledgeable in the event of anything going wrong.”

Yet, neither expert is arguing that there isn’t a need for more oversight of some treatments “With threads, that’s different,” Pybis clarifies. “When they go wrong, they can drastically go wrong, and someone may even need surgical intervention. From that point of view, yes, they should be put in the red category.”

Ultimately, what the sector is probably missing within its currently drafted suggestions is a sense of nuance and clarity on requirements. As Brennan notes, “the next consultation is going to be on education and education standards. Maybe if we’d done that first and we’d established what level and depth of education a person needs before they can get a license in each category, then you could more clearly ask which category things should be in.”

Education again, it seems, really needs putting first, so that practitioners and patients can be suitably protected and, in the former’s case, actually celebrated for their expertise.

“I think at the end of the day, it’s about recognition,” says Brennan. “There’s a lot of misconceptions around the practice of aesthetics and once people recognise that in order to do this, you have to have been

appropriately educated, I think it will help to dispel some of the myths. Lots of people don’t think it’s any big deal because they go to their hairdresser and get “Botox”, or they go to their nail salon and get their lips done.”

“My ideal would be to get to a point where the NMC would recognise aesthetic nursing as an area of specialist practice,” continues Brennan. “The Level 7 Diploma could be a big jump towards that because the NMC specialist practitioner programme is 180 credits, with the last 60 credits undertaken by dissertation. The Level 7 course that we are putting forward will be 60 credits, so it’s not a million miles away. If you then top it up with a dissertation, you could move toward the equivalent of a special practitioner education, which is recognised by the NMC. That would be brilliant if we could get to that.”

“I think the minimum standard is going to have to be Level 7 to get this recognition, and that’s what we should be turning around and saying,” agrees Pybis in conclusion. After all, that will only reemphasise and distinguish what high-quality education can look like. And excellent education should be met with excitement, not concern by practitioners within the aesthetics sector.

Shutterstock/Pressmaster

92 | Consulting Room | Q4 2023

Dates For Your Diary...

MENOPAUSE IN AESTHETICS

Friday 9th February 2024, at the Business Design Centre, London This unique event unites aesthetic professionals from a broad spectrum of specialities to share knowledge and best practice in order to better serve women going through ‘the change’.

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

AESTHETICS CONFERENCE & EXHIBITION

15th - 16th March 2024, at the Business Design Centre, London ACE features over 80 companies showcasing the latest aesthetic technology making ACE a place to come together to source the newest products and information for your clinic.

All education is free-to-attend and CPD accredited.

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

THE SCOTTISH AESTHETIC CONFERENCE

Saturday 23rd March 2024, at the Hilton, Glasgow The largest medical aesthetic conference in Scotland, the Scottish Aesthetic Conference is for all medical aesthetic practitioners as well as those looking to start in the medical aesthetics industry.

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

AESTHETIC MEDICINE LIVE

10th - 11th May 2024, at Olympia, London Aesthetic Medicine Live is a free event and welcomes exhibitors, speakers, delegates and visitors to Olympia London for a fantastic two days of networking and education.

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

DO YOU HAVE A TRAINING COURSE TO PROMOTE? www.cosmetictraining.co.uk can help you reach your key aesthetic audience. Advertise your training courses, seminars, webinars and other aesthetic events for only £95 + VAT.

www.consultingroom.com | 93

Shutterstock/Africa Studio

TRAINING

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

MASTERING THE SCIENCE BEHIND POLYNUCLEOTIDES Dates throughout 2024 |London Gain insights into the science of polymerised polynucleotides, their immediate action against free radicals, and their role in tissue repair and aesthetic enhancement. Get hands-on experience through supervised practice to develop your knowledge, confidence and skill.

UNIVERSAL LIPS Dates throughout 2024 | Liverpool This fully rounded Intermediate Universal Lips Course will equip you with the tools to make a clinical judgement about which technique to use to treat your patients lips to establish the most successful outcome. Examine indepth, evidence based applied anatomy of the lip, to determine the safest most effective placement of hyaluronic acid into the lip. 12 CPD Hours available.

FOUNDATION BOTULINUM TOXIN AND DERMAL FILLER TRAINING Dates throughout 2024 | Glasgow Inspired Cosmetic Training’s Foundation Botulinum Toxin and Dermal Filler Training Course is a fun and educational training course is taught through online theory learning, demo videos, a ‘hands on’ practical training day and followed by unlimited business growth support. Provided you reach the required standard, you will gain a CPD certificate.

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.

94 | Consulting Room | Q4 2023