Consulting Room Magazine | Volume 8: Issue 4 | Oct - Dec 2024

EYES ON THE PRIZE

Treating the under eye area

COMPLICATIONS

Managing dermal filler blindness CPD Rosacea in menopause

ISSUE

OF THE CONSULTING ROOM MAGAZINE

In this issue, we are focussing on the eyes. One of the first areas to show the signs of ageing due to its delicate skin, treatments to

As part of our eyes special, we look at treatments for dry eyes (p18-19), polynucleotides for regenerating the under eye area (p20-22), Dr Patrick Treacy also shares his guidance on dermal filler

Also, in this issue, we look at complications from weight loss injections (p36-37), examine the role augmented reality is playing in plastic

As well as this, our CPD article, written by Julie Scott, explores managing menopausal rosacea (p56-57), and I try out exosomes with Dr

Before I sign off, I just wanted to say that I was very sad to hear the news of the passing of Dr Patrick Bowler, a pioneer in the sector. Patrick was a founding member of the British Association of Cosmetic Doctors, which later became the British College of Aesthetic Medicine (BCAM) and was for me personally someone I admired who was an integral part of my early years in aesthetics. Read our

Julie Scott shares her insights and experience with managing menopausal skin changes. AR in the OR: Boldly going where no surgery has gone before.

TAX AND VAT IN AESTHETICS

With the self-assessment tax return deadline fast approaching, Hamilton Fraser shares some practical tips to help aesthetic practitioners manage their tax and VAT responsibilities.

We chat with award-winning Consultant Oculoplastic Surgeon and aesthetic practitioner Dr Sabrina Shah-Desai about eye procedures. We round up

WEIGHING UP THE RISKS

Following the first reported death linked to weight loss jabs, we examine the risks of

medications.

BEAM ME UP, SCALPEL

DERMAL FILLER-RELATED BLINDNESS: CAUSES, PREVENTION, AND MANAGEMENT

Blindness caused by dermal fillers occurs due to vascular occlusion. When filler material, most commonly hyaluronic acid is inadvertently injected into or compresses an arterial vessel. Dr Patrick Treacy shares his insights with us.

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EDITORIAL BOARD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CONTRIBUTORS

DR MARYAM ZAMANI

With over 20 years of experience spanning two continents, Dr Zamani is both an American-trained and Board-Certified Ophthalmologist and specialist Consultant in the UK. This hybrid access and dual expertise places Dr Zamani at the forefront of the latest available treatments.

DR RAQUEL AMADO VICKY ELDRIDGE

Dr Amado, founder of Dr Raquel Skin and Medical Cosmetics, is a Level 7 Aesthetic Practitioner, Clinical Trainer, and international speaker specialising in regenerative aesthetics and holistic wellness. She focuses on full-face rejuvenation with natural, long-lasting results.

Dr Sabrina Shah-Desai is an awardwinning leading UK expert in surgical and technologically advanced cosmetic facial treatments, recognised by her peers and industry experts as a peri-orbital specialist with surgical, dermatological and aesthetic experience.

Dr Patrick Treacy is the founder of the Ailesbury Clinic, Dublin. Recognised globally as a leading pioneer and expert in aesthetic medicine, he is President of the Royal Society of Medicine (London) Aesthetic Faculty and Chairman of the Irish Association of Cosmetic Doctors.

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

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

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

Dr Nalluri qualified in India, and then did her early postgraduate training in paediatrics, followed by dermatology training from one of the largest dermatology units outside London (Northwest rotation - Manchester) and obtained CCT in 2016.

Sara Cheeney is an award-winning nurse prescriber and owner of Pure Perfection Clinic. She is an international speaker and KOL for both Hydrafacial and Inmode UK and is one of the UK’s leading speakers for ZO Skin Health. She also provides business coaching.

DR PATRICK TREACY DR RAJANI NALLURI

GARY CONROY

JULIE SCOTT SARA CHEENEY

DR SABRINA SHAH-DESAI

WHAT’S TRENDING

COSMETIC SURGERY TOURISM

BAAPS study finds more than half of patients regret having procedures abroad

A study presented to the British Association of Aesthetic Plastic Surgeons (BAAPS) showed that more than 50% of individuals who travel abroad for cosmetic surgery end up regretting their decision. The study, which won the BAAPS Hackett Memorial Prize 2024, delves into a decade of patient experiences at a UK tertiary plastic surgery unit, shedding light on the consequences of the growing trend of cosmetic tourism.

The retrospective study reviewed data from 103 patients referred to the plastic surgery unit from 2012 to 2022 with complications arising from procedures performed overseas. Patients participated in a telephone survey to share their experiences, with 48% responding. The findings underscore the hidden costs and potential risks of bargain procedures abroad, with Turkey emerging as a prominent destination.

Key Findings:

• Cost as a deciding factor: 83% of respondents cited the lower cost as the primary reason for choosing surgery abroad, with 57% paying less than £5,000 for the entire process, including surgery, travel, and accommodation.

• Regret among patients: Alarmingly, 66% of respondents stated they would not have made the same decision if given a second chance, with nearly half expressing outright regret.

• Top procedures and common complications: The most popular surgeries included abdominoplasty (28.1%), breast augmentation (17%), and liposuction (13.1%). The complications most frequently encountered included wound issues (33%), seroma (29.1%), and infection-related complications.

Nora Nugent, President of the BAAPS, emphasised the importance of educating the public:

“This research offers crucial insights that must inform future public health campaigns. Potential patients need to understand the risks involved with travelling abroad for cosmetic surgery, beyond just the financial savings.”

Theodore Pezas, Niall Kirkpatrick BAAPS/BAPRAS Aesthetic Fellow 2023 and winner of the Hackett Prize 2024 for this work affirmed:

“The purpose of this study was to better understand the patient experience of the process of cosmetic tourism in cases where surgery has resulted in complications requiring emergency management.

“Whilst no surgery is risk-free, and the majority of qualified plastic surgeons performing cosmetic surgery abroad do so to a very high standard, which is often comparable to the UK, what is not always comparable is the way in which certain procedures are offered and regulated.

“The practice of cosmetic tourism may seem like a cheap alternative but can facilitate an inadequate provision of post-operative care, which leaves patients worse off and comes at a cost to us all.”

The findings serve as a wake-up call to the dangers lurking behind the allure of cosmetic tourism, urging potential patients to weigh their options carefully and consider the full impact on their health and well-being.

Adobe/Zaleman

JCCP clarifies its position on use of terms “patient” versus “client” amid backlash

The Joint Council for Cosmetic Practitioners (JCCP) has clarified its position on the terminology used to describe those seeking aesthetic treatments following criticism from the British Association of Medical Aesthetic Nurses (BAMAN) and the British College of Aesthetic Medicine (BCAM).

It happened after the JCCP put a post up on social media about its recommendations on future standards and qualifications for non-surgical cosmetic practice suggesting individuals seeking non-surgical treatments be referred to as “clients” or “service users” rather than “patients.” The post was met with opposition from BAMAN and BCAM, with both groups strongly advocating for the continued use of the term “patient”.

In response, the JCCP clarified its position with Professor David Sines, executive chair and registrar, commenting: “The JCCP has no hesitation in advising that whenever regulated healthcare practitioners provide non-surgical procedures to members of the public, the term ‘patient’ should be used. This has always been our position and will continue to be so. Conversely, the JCCP is of the opinion that non-healthcare practitioners whose scope of practice is related to the sole provision of ‘cosmetic procedures’ should not be permitted to refer to their clients as ‘patients’.”

Dr Catherine Fairris, president of BCAM, said, “The bottom line is that as medical professionals (doctors, surgeons, dentists and nurses), we have a greater ethical and legal obligation to anyone that we treat. Our responsibility is enshrined in medical law, and whether we are performing a ‘cosmetic’ treatment or a treatment with wider medical implications, the person we are treating is our ‘patient’, and as such, we will always be held to the highest of standards in that relationship.”

Gareth Lewis, head of operations at BAMAN, said, “We are pleased with the JCCP’s clarification that it has always been their position that regulated healthcare professionals, such as nurses, doctors, and dentists, should continue to refer to those they treat as ‘patients.’ As the leading organisation for medical aesthetic nurses, we believe this distinction is vital to reflect the medical and ethical responsibilities unique to regulated medical professionals. We strongly advocate for clear and appropriate terminology to highlight the significant differences in accountability and standards of care between regulated medical professionals and non-regulated providers.”

Industry pioneer Dr Patrick Bowler passes away aged 74

Dr Patrick Bowler, a pioneering figure in aesthetic medicine and medical director of Courthouse Clinics, passed away peacefully on November 24, surrounded by his beloved family. He leaves behind a legacy defined by innovation, dedication, and unwavering commitment to patient care and education in aesthetic medicine.

Dr Bowler was widely recognised for his outstanding contributions to the field of cosmetic medicine. In 2013, he received the prestigious Brinkenhoff Award for Lifetime Achievement and Services to the Industry at the Aesthetic Awards. A passionate advocate for increased safety standards and ethical practices, Dr. Bowler revolutionised the non-surgical cosmetic industry, earning the respect and admiration of peers and patients alike.

As a founding member and Fellow of the British College of Aesthetic Medicine, and a member of the American Society for Laser Medicine and Surgery, Dr Bowler was a leading authority on cosmetic treatments. His expertise was frequently sought in media appearances, including GMTV, BBC Radio, and Channel 4’s Ten Years Younger. He was also the author of The Nervous Girl’s Guide to Nip and Tuck and contributed insightful articles to the Huffington Post.

In 1998, Dr Bowler established Courthouse Clinics in a historic courthouse in Brentwood, Essex. His visionary approach led to the creation of one of the first doctor-led clinics offering both surgical and non-surgical treatments. Under his guidance, the clinic expanded to 11 nationwide branches, setting a benchmark for accessible and exemplary cosmetic treatments.

Dr Bowler’s contributions touched countless lives – both the professionals he mentored and the patients he cared for. He is remembered not only as a trailblazer in his field but also as a kind and visionary leader whose work transformed the face of modern aesthetic medicine. He is survived by his colleagues, friends, and the countless individuals whose lives were enriched by his work. His legacy will live on through the standards he set and the lives he changed.

Wales becomes first in UK to implement licensing for special procedures, including electrolysis and semi-permanent make-up

Wales now has mandatory licensing rules in place to help protect the public’s health when getting acupuncture, body piercings, electrolysis, or tattoos, including semi-permanent make-up.

From Friday, November 29, practitioners and individuals in charge of premises or vehicles where any of four special procedures are performed must complete an infection prevention and control course for special procedures, and their premises and vehicles must meet strict safety standards, among other criteria.

These new measures, introduced by the Welsh Government, in a UK first, aim to reduce the hygiene and safety risks of these special procedures, such as bloodborne infections, by making sure only licensed practitioners can operate and procedures are only performed in approved premises and vehicles.

There are more than 4,000 practitioners operating in Wales who will need to be licensed, and over 2,000 premises will require approval under the new mandatory licensing scheme.

All individuals must apply for a licence or a premises or vehicle approval certificate from their local authority. A national register will publicise all valid licence holders and approval certificate holders in Wales.

Deputy Chief Medical Officer for Wales, Keith Reid, said, “This new licensing scheme provides important reassurance for anybody thinking about getting acupuncture, electrolysis, a piercing, tattoo or semi-permanent makeup that the practitioner they use is licensed and the premises or vehicle where the procedure is performed has been approved.

“The compulsory licensing scheme ensures that both clients and practitioners are protected, and I am pleased the measures have been widely welcomed by the industry. We want to see these special procedures take place hygienically, safely and in appropriate environments, and the licensing scheme will provide assurance that the appropriate standards are being met.”

New guidance issued on buttock augmentation following death of Alice Webb

The Joint Council for Cosmetic Practitioners (JCCP) has released a “Buttock augmentation and other body contouring procedures guidance for enforcement by Local Authority authorised officers report”, emphasising that “Liquid” BBL procedures using fillers or fat are surgical in nature. This follows the tragic death of Alice Webb, the first person in the UK to die because of a liquid BBL carried out by a non-medic.

The report emphasises that these procedures should only be performed by appropriately trained specialist plastic surgeons and fully qualified doctors registered with the General Medical Council (GMC). These doctors must also possess additional qualifications to perform surgical procedures and demonstrate proven, ongoing competence in conducting BBL procedures.

To combat the rise of unsafe practices, the JCCP guidelines are aimed at helping environmental health officers shut down and prosecute unqualified practitioners. The report has been approved by the Royal College of Surgeons in England and Scotland. The British Association of Aesthetic Plastic Surgeons (BAAPS), which has long been campaigning to raise awareness about the risks associated with BBLs, has contributed to and co-signed the report.

In 2018, due to rising concerns over the high death rates linked to surgical BBLs, BAAPS called for a four-year moratorium on the procedure among its members. In 2022, BAAPS introduced new guidelines advocating for the use of a safer technique called superficial gluteal lipofilling (SGL). BAAPS also advises surgeons to perform SGLs only with the assistance of ultrasound guidance, ensuring precise placement of the cannulas, a practice also endorsed by the JCCP.

Nora Nugent President of the BAAPS said, “We thank the JCCP for initiating this work and have collaborated with them to help produce the document. We have been campaigning for increased safety in aesthetics and recognition of the risk of unqualified practitioners performing invasive procedures for a long time. The recent tragic death related to buttock augmentation with filler yet again highlights the risks of invasive procedures. We hope that this document will help local authorities identify unsafe and unacceptably risky practice in this area and help lead to a safer environment and improved quality of care for patients.”

Elaine Sassoon, a member of the BAAPS Council who played a key role in the development of the report, said: “The cosmetic sector faces a lack of regulation for unlicensed medical practitioners, putting people’s health at serious risk, particularly with buttock fillers for BBL. While specialist surgeons follow safety guidelines, untrained individuals can inject unsafe, bulk-purchased products in unregulated settings. We have a duty of care to ensure the safety of our population.”

Circa Skin launches “Elevate to Expert”

Circa Skin, has unveiled its online learning platform, Elevate to Expert. This platform aims to empower aesthetic practitioners globally by delivering expertly designed courses focused on advanced techniques, client safety, and comprehensive complication management.

Elevate to Expert stands out for its focus on excellence, offering in-depth modules on anatomy, physiology, aetiology, and patient care. The platform’s blend of theory and practical application via high quality recordings of treatment ensures practitioners of all experience levels can confidently elevate their practice.

The initial course lineup includes “Neck Elegance with HA Fillers” by nurse prescriber Angie Lawrence; “Mission Tear Trough” by Dr Uche Aniagwu; “Temple Mastery” by Dr Wasif Razzaq and “Cheek Elevation for the Golden Years” by Dr Helen Marsden.

Visit www.elevatetoexpert.com to explore the courses and register.

Lorena Cosmetics Holdings SPV Announces Acquisition and ReLaunch of The Harley Medical Group & sk:n Clinic Group

Lorena Cosmetics Holdings SPV Limited has successfully acquired and re-launched the sk:n and The Harley Medical Group (THMG) aesthetic and cosmetic surgery clinic chains. Lorena Cosmetics has actively worked to re-employ many former sk:n and THMG employees and are dedicated to ensuring ongoing delivery of high-quality medical aesthetic and cosmetic services at over 30 clinic locations across the length of the UK, with flagships at London’s Harley Street. and Glasgow’s St. Vincent Street. The acquisition is part of a broader strategic consolidation which also includes The Skin Experts and ABC Medical – who now join leading ophthalmology providers Optical Express under the Lorena Investments group portfolio.

Over half of the re-opened sk:n clinics have benefitted from moving to upgraded premises within existing Optical Express clinics, all of which have full Care Quality Commission (CQC), Healthcare Improvement Scotland (HIS), or Healthcare Inspectorate Wales (HIW) registrations which allow for the delivery of advanced treatments and surgical procedures. “We are acutely aware of the impact the previous business liquidation had on patients, employees and suppliers alike,” said Stephen Hannan, clinical services director of Lorena Cosmetics. “As a patient-centric business already delivering care to stringent regulations and the highest standards of service, we are committed to rebuilding consumer trust by implementing a robust business infrastructure and support for patients affected by the previous closure to ensure they receive the best possible care moving forward. A Doctorled, clinician delivered model will ensure the highest standards of care are provided to patients”.

Death after BBL surgery in Turkey linked to poor medical care

An inquest found that a mother-of-three died following a Brazilian Butt Lift (BBL) in Turkey due to a lack of post-operative care and unqualified staff. Demi Agoglia, 26, from Little Hulton, Greater Manchester, travelled to Istanbul on January 4, 2024 for the procedure, which involves transferring fat to the hips and buttocks. She died on January 8, just three days after the surgery, from a fatal fat embolism, a condition where tissue enters the bloodstream.

The coroner, John Pollard, ruled that Ms Agoglia’s death was caused by misadventure, and post-procedure neglect. He concluded there was a lack of informed consent and inadequate post-operative care. “The care fell well below the expected standard, contributing significantly to Demi’s death,” he stated.

NEWS IN BRIEF STORIES

BOTOX® Cosmetic receives FDA approval for platysma bands Allergan Aesthetics, an AbbVie company, announced the US FDA approval of BOTOX® Cosmetic for temporary improvement in the appearance of moderate to severe vertical bands connecting the jaw and neck (platysma bands) in adults. BOTOX® Cosmetic is the first and only product with four aesthetic indication areas: forehead lines, frown lines, crow’s feet lines, and now platysma bands, making it the first product of its kind to go beyond the face.

BABTAC launches menopause best practice guide

The British Association of Beauty Therapy and Cosmetology has released Menopause: A BABTAC Best Practice Guide. The comprehensive 12-page guide contains an educational toolkit and provides resources to help beauty professionals treat menopausal clients. The guide has been created in partnership with menopause experts Tracy Munro, The Mindful Menopause Coach and Veerpal Sandhu, Advanced Clinical Pharmacist specialising in Women’s health and member of the British Menopause Society.

Skin of Colour Training 2025 Conference to be held in January The first in person Skin of Colour Training 2025 (SOCT 2025) will take place on January 23-24 at the Royal College of Physicians in London. The programme, entitled ‘Getting it Right the First Time’, focusses on how to correctly assess and manage black and brown-skinned patients, from the outset. There will also be bespoke, hands-on workshops designed for Skin of Colour (SOC) and a sponsored gala dinner on Thursday, January 23 in the RCP’s Dorchester library. Visit www.soctuk.org/2025.

Study investigates needle-free botulinum toxin delivery

A study published in Annals of Dermatology has found that a needlefree microjet drug injector could be a useful method for treating crow’s feet wrinkles with botulinum toxin due to its ability to reduce pain. The split-face study examined the effectiveness and safety of the needle-free injector, powered by an Er:YAG laser, for injecting toxin in crow’s feet wrinkles.

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

ITN Business and British Skin Foundation (BSF) collaborate to launch “The Future of

Dermatology”

ITN Business has partnered with British Skin Foundation to produce a compelling news-style digital programme spotlighting the future of dermatology.

Hosted by Sangeeta Kandola, the digital content series launched on December 5, 2024 and features thought leadership, expert commentary, exclusive interviews and real-world case studies, highlighting the psychological as well as physical effects of living with skin disease –from a common condition such as acne to rarer lipoedema, and celebrates the strides being made by the scientific and medical communities. The series also features short reporter-led case study films from Almirall, Lipoedema UK, L’Oreal and UCB.

British Skin Foundation CEO, Matthew Patey, OBE said: “Our ongoing relationship with ITN Business has once again allowed us to shine a light on British dermatology and highlight the need to continue supporting future research.”

Head of ITN Business, Nina Harrison-Bell said, “We’re delighted to partner with the British Skin Foundation once again this year to bring these critical stories to light. Through The Future of Dermatology, we hope to educate, inspire and raise awareness about the physical and psychological impacts of skin diseases and the latest innovations in dermatology.”

To view the programme please visit: business.itn.co.uk/the-future-of-dermatology.

Prof Patrick Treacy awarded Irish “Man of the Year” 2024

Professor Patrick Treacy was awarded ‘’Irish Man of The Year 2024” for humanitarianism and outstanding contributions to aesthetic medicine at the Cointreau Hi Style Awards 2024.

Prof Treacy is a best-selling author and globally esteemed leader in aesthetic medicine, celebrated for his pioneering contributions and numerous international accolades. He holds the position of visiting professor of dermatology at Isra University in Pakistan and is a fellow in cosmetic surgery and medicine at the Australian College. Additionally, he has been awarded a Laureate in Aesthetic Medicine from the Azerbaijan College.

He has also received two Lifetime Achievement Awards, one from Ireland and another recently from China. His Ailesbury Clinic has been awarded “Top Clinic in Ireland” five times within the past seven years. Dr Treacy’s innovative research has advanced patient safety by developing hyaluronidase protocols in aesthetic medicine. He has received global recognition for his work with stem cells, platelet-rich plasma, and growth signalling factors for skin rejuvenation and treating necrosis due to vascular occlusion. He has been awarded the prestigious AMEC Trophy three times in Paris and Monaco.

New Level 5 apprenticeship standard launched for aesthetic practitioners

The Institute for Apprenticeships and Technical Education (IfATE) has announced the launch of a consultation for the Level 5 Aesthetic Practitioner Apprenticeship Standard, specialising in skin rejuvenation. This comprehensive standard represents a significant advancement in regulated education for the aesthetics industry.

The new apprenticeship standard encompasses a wide range of techniques and procedures, including superficial and medium-grade chemical peels, microneedling and microinjury procedures, light-based skin rejuvenation techniques, mesotherapy using intradermal procedures, combination therapy approaches and advanced skin blemish removal.

The standard is now available for public consultation on the IfATE website. Stakeholders are encouraged to review and provide feedback on this important development in professional aesthetics education. For more information and to participate in the consultation, please visit: http://www.instituteforapprenticeships.org/developing-new-apprenticeships/apprenticeshipconsultations/

NEWS IN BRIEF STORIES

BAMAN and Evolus reveal 2025 partnership

The British Association of Medical Aesthetic Nurses (BAMAN) has announced a partnership with pharmaceutical company Evolus. The collaboration seeks to strengthen nurse education and advance the professionalisation of medical aesthetics. In addition to supporting education, Evolus plan to be the headline sponsor for the BAMAN 2025 Annual Meeting, and the primary sponsor at all 13 BAMAN regional events in 2025. Alongside these key events, the partnership will include three webinars and digital take-overs amongst other elements.

ASA rules against misleading weight loss supplement claims

The Advertising Standards Authority has ruled against a supplement company after misleading weight loss claims across three social media adverts posted in June 2024. The ASA upheld the complaint saying that any health claims made in advertising must be accompanied by a related authorised health claim under the GB NHC Register. It also emphasised that it is prohibited to imply that a food can prevent or cure human disease such as PCOS or menopausal symptoms.

DNA Repair Technology Webinar with Dr Angela Tewari and Neova SmartSkincare

Eden Aesthetics is hosting an exclusive webinar on Tuesday January 14, 2025 at 8pm (GMT) with Dr Angela Tewari as she educates practitioners on UVInduced DAN Damage and DNA repair technology. To book, email info@edenaesthetics.com for the Zoom link.

New research reveals that labiaplasty is the procedure with the fastest rise in popularity

New research has revealed that Labiaplasty is the procedure with the fastest rise in popularity. The study, put together by the cosmetic experts at the Harley Street Skin Clinic, analysed internal data and Google search data to reveal the cosmetic surgeries that the UK is the most interested in. You can read the full research here: https://www.harleystreetskinclinic.com/ data/uks-favourite-procedures/

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Plus much, much more!

EVENTS

Advancing Excellence in Medical Education with Dr Lee Walker

DermaFocus and AESTHETICARE united for a day of training and development in Leeds, led by award-winning aesthetic practitioner Dr Lee Walker.

The immersive programme focused on enhancing presentation and training delivery skills to elevate the standards of medical education in regenerative aesthetics.

Dr Walker shared his insight on engagement, interactivity, and the ability to convey warmth and empathy through storytelling. Faculty members practised techniques with one another reflected on their presentations through video reviews, and discussed how to strengthen their delivery through pitch, pace and pause.

Dr Walker said, “It’s great that companies are really beginning to invest in the development of faculty members, and this is the next step in the evolution of raising standards in the aesthetic industry.”

Hamilton Fraser presents The Aesthetic Business Conference (ABC), Royal College of Physicians, London

Hamilton Fraser hosted its seventh annual Aesthetic Business Conference (ABC) at the iconic Royal College of Physicians, London.

The meeting provided an invaluable opportunity for practitioners and clinic managers to learn and network with some of the most influential names in the aesthetics business.

Speakers included Dr Leah Totton, who gave a masterclass on becoming an entrepreneur and The Consulting Room’s own Dan Huxley, who took part in a safeguarding panel alongside Vicky Eldridge, Dr Shirin Lakhani and Hamilton Fraser founder and CEO Eddie Hooker.

Facexpo 2024, QEII Centre in London, Westminster

Facexpo 2024 took place at the prestigious QEII Centre in London, Westminster, bringing together some of the brightest minds and innovative voices in the aesthetics industry. With 300 attendees, a sold-out audience, and an exciting agenda, Facexpo has cemented its reputation as the must-attend conference for healthcare professionals in the field of aesthetics.

Experts covered a broad spectrum of topics, from cutting-edge aesthetic treatments and live demonstrations to the latest in regenerative medicine, ensuring that every attendee walked away with actionable insights and fresh perspectives.

The exhibition hall featured 26 sponsors and exhibitors who showcased the latest advancements in aesthetic technology, skincare, and injectables.

RAMCE 2024, Pullman Hotel, London

More than 300 medical professionals gathered in London in November to enhance their knowledge of regenerative aesthetic treatments. It was the second year for the Regenerative Aesthetic Medicine Conference and Exhibition (RAMCE), which took place in the Pullman Hotel London – a larger venue to accommodate the growing number of delegates and exhibitors.

Chaired by Professor Maurizio Cavallini, Dr David Eccleston and Dr Yusra Al-Mukthar, insightful educational sessions taught practitioners how to optimise results with innovative treatments and expert techniques.

Speakers explored the differences between polynucleotides and exosomes, treating the intimate area, chemical peeling’s regenerative action, and shaping regenerative medicine for your patients. There were also engaging panel discussions on the value of PRP and PRF, using combination approaches and the role of dermal fillers, toxins and threads in the regenerative space.

New products were also launched, with Dr Xavier Goodarzian introducing the audience to the Liquid Laser. This is an exciting new protocol that incorporates Purasomes (a unique combination of exosomes and growth factors), with chemical peeling and microneedling. Dr Goodarzian guided delegates through its application and showcased impressive results.

To conclude the day, Shannon Kilgariff, editor and event manager of Aesthetics and CCR, hosted an evening with Professor Cavallini to share more about how he came to become a polynucleotide pioneer. He has played a significant role in introducing Polynucleotides HPT® to the UK and is a faculty board member of RAMCE host sponsor, DermaFocus.

RAMCE 2025 will take place on November 8 at the Pullman Hotel London.

Aesthetic Medicine Ireland, RDS, Dublin

More than 640 aesthetic professionals attended Aesthetic Medicine Ireland’s third show at the RDS in Dublin.

Platinum sponsor Fillmed was joined by industry-leading brands, including InMode, SkinCeuticals, Crown Aesthetics, Lynton, Opatra, PRP Labs and Skinade, on the show floor.

The business stage agenda featured presentations on lead generation, patient attraction, ethical selling, transitioning to aesthetics, and the art of sales with speakers including Richard Gibbons, Dr Michelle Westcott, Vanessa Bird and Dr Cormac Lynch.

The clinical agenda hosted deep-dive sessions on regenerative aesthetics, combination treatments, aesthetics through the ages, and the future of aesthetics. Speakers included Claudia McGloin, Dr Juliah Tbarani O’Shea, Dr Patrick Treacy, Alexandra Mills, Dr Deniz Kanliada, Dr Emma Cunningham, Dr Michelle Westcott, and Eleanor Hartley.

Forming a unique partnership between patient, provider and supplier.

Aesthetic Medical Partnership Ltd (AMP) was founded by industry veterans Martyn Roe and Paul Simmonds to bring innovative regenerative technologies to the UK and Ireland marketplace.

With extensive experience in clinic ownership, distribution, and consultancy, AMP offers cutting-edge, patient-focused solutions designed to help aesthetic practices thrive. Our portfolio features carefully sourced products, with fair pricing and no unnecessary consumables.

We go beyond product supply, offering hands-on support, advanced training, and proven strategies to grow your business. At AMP, we’re committed to building genuine partnerships - because your success is our success. Let’s help your clinic flourish together.

FaceSTIM by Jovena

Jovena® is a revolutionary bio-regenerative platform that combines two patented modalities. FaceSTIM an intense facial workout is paired with class leading Fractional Plasma® options.

Alpha is the revolutionary Diode Laser & 3D IPL Combination System. The Alpha system merges cutting-edge technologies into a single,versatile device, opening up a realm of possibilities for your clinic.

EXO|E Skin Revitalising

EXO|E Skin Revitalising Complex is an innovative three step skincare line that utilises biomimetic plant stem cell technology to rejuvenate and revitalise the skin, whilst reducing downtime and inflammation.

PRP

Cellenis® Is the most trusted PRP technology that takes the complexity out of the plateletrich plasma (PRP) preparation process. Its specialised technology separates blood based on density using a unique gel and filter system.

BodySTIM is the combination of two cutting edge technologies using RF Diatermocontraction®. The RF Diathermic Pulse and thermal action combination promotes firming and tightening to multiple areas of the body simultaneously. BodySTIM by Imperium

AquaFirmeXS is a second-generation multifunctional dermal health workstation that cleanses, exfoliates, hydrates and nourishes the skin and scalp to treat a variety of concerns. Powered by EXO|E, to deliver Exosomes without needles.

DE|RIVE Hair

& Scalp

DE|RIVE is a patented 100% plant-based serum, to help improve hair and scalp health. With over 23 medical publications, the ingredients have been researched and are beneficial for all skin and hair types.

Cellenis® DermaFiller is a 100% natural injectable material which creates an immediate volumising effect that lasts. Its an autologous, biological filler providing extended release of platelet derived growth factors to volumise and regenerate

demonstration.

Alpha Pro Laser System

Cellenis®

Cellenis® DermaFiller

EYES SPECIAL

In this section

• Dry eyes

• Polynucleotides

• Eye treatments and techniques

• Under eye pigmentation

NOT A DRY EYE IN THE HOUSE

Thermal Mechanical Action (TMA) for the treatment of dry eye disease

Thermal Mechanical Action (TMA), a groundbreaking patented technology by Novoxel, represents a significant advancement in aesthetic medicine. By offering a clinical solution to a wide range of skin concerns, TMA is positioning itself as a compelling alternative to traditional laser and radiofrequency modalities. With numerous clinical studies and peer-reviewed publications supporting its efficacy and safety, this innovative approach is reshaping the landscape of skin rejuvenation and resurfacing.

Additionally, TMA has achieved FDA clearance for the treatment of dry eye disease, broadening its application beyond aesthetics and into therapeutic ophthalmology.

What is Thermal Mechanical Action (TMA)?

TMA operates on a distinct principle of delivering controlled heat to the skin through conduction, as opposed to the absorption-based mechanisms utilised by lasers. This unique mechanism allows for a more efficient and precise energy transfer, targeting the skin layers with minimal collateral damage.

Unlike lasers that rely on chromophore absorption and radiofrequency devices that generate heat via electromagnetic waves, TMA uses a matrix of tiny, heated tips to deliver pure thermal energy. This controlled conduction provides superior uniformity, ensuring consistent results while minimising the risk of side effects.

How does TMA Work?

The process begins with the device’s array of heated tips making brief, controlled contact with the skin. These tips reach

temperatures up to 400°C, creating microthermal zones within the skin. This localised delivery of heat initiates a cascade of physiological responses, including collagen remodelling, elastin synthesis, and enhanced skin turnover.

In the context of treating dry eye disease, TMA stimulates the meibomian glands, improving their function and increasing the production of the lipid layer of the tear film. This novel approach offers a non-invasive and radiation-free solution for a condition that affects millions globally.

A pivotal clinical study comparing TMA with traditional ablative lasers demonstrated comparable improvements in skin texture and elasticity, with TMA offering the added benefits of reduced downtime and greater treatment safety in sensitive areas.

Key Advantages of TMA Technology

1. No radiation: Unlike lasers, which can emit light radiation, TMA eliminates any associated risks by relying solely on conduction-based heat transfer. This makes it a safer option for patients concerned about long-term exposure to radiation.

2. Safe for the orbital region: TMA’s precision allows it to treat areas within the orbital socket, such as the delicate periorbital skin, with unparalleled safety and efficacy. This capability opens doors to treating fine lines and wrinkles in areas traditionally challenging for lasers and other energybased devices.

3. FDA-cleared for dry eye treatment: The FDA clearance for dry eye disease marks a significant milestone for TMA technology. By addressing the dysfunction of meibomian

glands, TMA provides an effective, non-invasive treatment option for a condition that impacts patients’ quality of life.

4. Versatile applications: TMA supports a range of treatments, from sub-ablative and non-ablative skin resurfacing to deeper remodelling procedures. Its versatility enables practitioners to customise treatment protocols for specific indications, including acne scars, hyperpigmentation, and overall skin rejuvenation.

Clinical evidence supporting TMA

A notable peer-reviewed study on TMA’s effectiveness in skin resurfacing highlighted its ability to deliver results comparable to fractional CO2 lasers while maintaining a significantly lower risk profile. Patients reported improvements in skin texture, tone, and firmness after a series of TMA treatments, with minimal downtime and discomfort.

In the realm of ophthalmology, clinical trials demonstrated significant improvement in dry eye disease symptoms following TMA treatments. Patients experienced enhanced tear quality and reduced ocular discomfort, with sustained benefits observed during follow-ups.

Another study focused on TMA’s impact on collagen regeneration demonstrated a 30% increase in dermal collagen density six months post-treatment. These findings underscore the long-term benefits of TMA for skin health and anti-ageing.

Revolutionising skin treatment with TMA

The emergence of Thermal Mechanical Action by Tixel marks a paradigm shift in aesthetic medicine and therapeutic ophthalmology. By addressing a broad spectrum of skin concerns with precision, safety, and versatility, TMA is paving the way for a 360-degree approach to skin health. Its ability to deliver pure heat through conduction, combined with its robust clinical validation and FDA clearance for dry eye disease, positions TMA as a credible and effective alternative to traditional energy-based modalities.

As the field of dermatology and ophthalmology continues to evolve, TMA stands out as a technology capable of meeting the growing demand for effective, patient-centred, and minimally invasive treatments.

References

1. [Clinical Study Comparison: TMA vs. Fractional CO2 Lasers in Skin Resurfacing, 2022].

2. [Long-Term Efficacy of TMA in Collagen Remodeling: A Six-Month Study, 2021].

3. [Safety and Precision of TMA in Treating Periorbital Skin, Journal of Aesthetic Medicine, 2023].

4. [Thermal Mechanical Action for the Treatment of Dry Eye Disease, Ophthalmic Advances, 2023].

REJUVENATING THE PERIOCULAR AREA

Dr Raquel Amado shares her regenerative approach to treating a male patient’s dark circles with Polynucleotides HPT®

Periocular dark circles are a common aesthetic complaint in both men and women. Many people report that they make them look tired and older than their years, which can lead to poor mental wellbeing, while having an impact on their quality of life.1

While dark eye circles are generally considered to affect both sexes equally, research suggests that men usually seek treatment less than women.1 In my experience, this tends to be because they are wary of traditional aesthetic procedures such as botulinum toxin or dermal fillers that they fear may alter their appearance or make them look unnatural. Of course, any ethical and skilled practitioner would

ensure this doesn’t happen, but getting these types of patients through the door can be challenging.

That’s why I’ve valued the introduction of regenerative approaches to my treatment portfolio. With both polynucleotides, exosomes and collagen-stimulating fillers, I’m able to address the source of concerns, providing natural results that develop over time and make patients look like the best version of themselves.

This was the case for a 44-year-old male Caucasian patient I recently treated with Polynucleotides HPT®. Here I outline his journey.

Concerns and assessment

My patient presented to clinic complaining about the hollows under his eyes. Upon assessment, I observed that along with the periocular hollowness, his tear troughs appeared dark and the skin was notably thin.

This correlates with typical periocular concerns. One study used multispectral image analysis, ultrasound and video capillaroscopy to determine that the three key physiological factors associated with dark circles in Caucasian patients are hyperpigmentation, a tendency for more dilated, thicker or increased number of capillaries, and thinner skin in the undereye area.2 It should be noted that there are some variations amongst different

ethnicities,2 which should be considered carefully before planning treatment.

Upon taking a medical and lifestyle history, I identified that this patient’s under-eye volume loss had occurred following significant weight loss. This contributed to a loss of facial fat, meaning underlying blood vessels become more visible, darkening the area under the eyes. General ageing had also led to bone loss, infraorbital laxity and wrinkles, which caused shadowing, while some people may naturally experience excessive pigmentation in the area.3 The patient had not regularly used SPF or skincare, which had accelerated the decline in skin quality.

As with all patients, I explained the ageing process to help him understand why he had seen these changes and what options were available to help. I recommended a course of three polynucleotide treatments in combination with NCTF and dermal fillers.

The patient made clear that he did not want dermal filler or botulinum toxin treatment but was open to regenerative approaches.

I then talked to him in more detail about Plinest® – the brand of polynucleotides I use that is created using patented Polynucleotides HPT® technology. After giving the patient time to consider his options, he booked in for his first Plinest® session.

Adobe/boyloso

Product choice and treatment protocol

On June 26, the patient presented to clinic for his first treatment. Before getting started, I reminded him of what he could expect during and after the procedure, giving him the opportunity to ask questions and reconfirm his consent.

I chose to use Plinest® , which comprises 20mg/ml of Polynucleotides HPT®. There is also a specific product for eyes – Plinest® Eye, which consists of 7.5mg/ml. I find this is a great option for patients with minimal periocular concerns or for those who have very delicate skin around their eyes. In this patient, however, I felt that the stronger product would produce a better result. The patient did not have any lymphatic compromise in the area, so I determined it was a safe option. I would, however, discourage practitioners from using the stronger product around the eyes without experience or if they have concerns about managing expectations. Plinest® can take up to a week to be fully absorbed, meaning the patient will have swelling for roughly this amount of time.

The DNA fractions used in Polynucleotides HPT® come from salmon trout that have been bred in fresh waters.

Created by Italian manufacturer Mastelli, the technology is renowned for its stringent purification and sterilisation process that ensures only the safest and most valuable active ingredients are used. It works by promoting a trophic and stimulating action on existing fibroblasts, which increases collagen synthesis and the viability and number of fibroblasts. This translates into having more collagen, elastin and hyaluronic acid. Dermal thickness will increase while inflammation is reduced. Multiple clinical studies have determined it is an effective treatment for fine lines and wrinkles, pigmentation, rosacea, scarring, poor tone and texture and, of course, dark circles.4-6

Prior to treatment, I numbed the skin with topical anaesthetic to minimise discomfort. A cannula was used to inject 0.8ml of Plinest® under the eye before I administered 0.2ml to the lateral canthal lines using a 4mm Sterijet 33G needle. This technique was repeated three weeks later, as per the standard protocol recommendations.

Results

Upon review on September 7, the patient was thrilled with the results. There was a clear reduction in dark circles, as well as an improvement in the appearance of fine lines around the eyes.

While I recommended a third treatment to further improve the outcome and increase the longevity of the results, the patient decided against it. Generally, we expect results from Plinest® treatment to last approximately six months.

Introducing Polynucleotides HPT® to my clinic has really changed the way I practice. Being able to offer regenerative approaches as alternatives means I attract a wider demographic, while the benefits of using these treatments in combination with other procedures allow me to boost skin health and optimise results.

References

1. Lim HGY, Fischer AH, Sung S, Kang S, Chien AL. Periocular Dark Circles: Correlates of Severity. Ann Dermatol. 2021 Oct;33(5):393-401. doi: 10.5021/ad.2021.33.5.393. Epub 2021 Sep 8. PMID: 34616119; PMCID: PMC8460477.

2. Mac-Mary S, Zornoza Solinis I, Predine O, Sainthillier JM, Sladen C, Bell M, O’Mahony M. Identification Of Three Key Factors Contributing To The Aetiology Of Dark Circles By Clinical And Instrumental Assessments Of The Infraorbital Region. Clin Cosmet Investig Dermatol. 2019 Dec 18;12:919-929. doi: 10.2147/CCID.S217956. PMID: 31908515; PMCID: PMC6927230.

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

4. Cavallini M, Bartoletti E, Maioli L, Massirone A, Pia Palmieri I, Papagni M, Priori M, Trocchi G; As Members of The Polynucleotides HPT™ Priming Board, Collegio Italiano delle Società Scientifiche di Medicina Estetica (Italian College of the Aesthetic Medicine Scientific Societies) - SIME, AGORÀ, SIES. Consensus report on the use of PN-HPT™ (polynucleotides highly purified technology) in aesthetic medicine. J Cosmet Dermatol. 2021 Mar;20(3):922-928. doi: 10.1111/jocd.13679. Epub 2020 Sep 21. PMID: 32799391; PMCID: PMC7984045. https://pubmed. ncbi.nlm.nih.gov/32799391/

5. Cavallini M, De Luca C, Prussia G, Raichi M. PN-HPT® (Polynucleotides Highly Purified Technology) in facial middle third rejuvenation. Exploring the potential. J Cosmet Dermatol. 2022 Feb;21(2):615-624. doi: 10.1111/jocd.14578. Epub 2021 Nov 17. Retraction in: J Cosmet Dermatol. 2023 Jul 26;: PMID: 34791770; PMCID: PMC9299481.

6. Colangelo MT, Govoni P, Belletti S, Squadrito F, Guizzardi S, Galli C. Polynucleotide biogel enhances tissue repair, matrix deposition and organization. J Biol Regul Homeost Agents. 2021 Jan-Feb;35(1):355-362. doi: 10.23812/20-320-L. PMID: 33480222. https://pubmed.ncbi. nlm.nih.gov/33480222/

Before and six weeks after two sessions of Plinest®

EYES SPECIAL

UNDERSTANDING UNDER-EYE PIGMENTATION

Dr

Rajani Nalluri discusses causes, treatments, and prevention tips

Under-eye pigmentation, often referred to as dark circles, is a common skin concern for many people. It can make one appear tired and dull which can be distressing for some people, so understanding its causes and knowing how to manage it can make a significant difference in improving one’s appearance. This article explores the various causes of under-eye pigmentation, available treatment options, and tips for prevention so that individuals can feel more confident and rejuvenated.

What are dark circles?

Dark circles, or periorbital hyperpigmentation, are dark patches that appear on the lower eyelids. Depending on skin tone, they may appear as a purple, brown, black, or even blue hue, and sometimes this discolouration extends to the upper eyelids, the inner part of the nose, or the upper cheeks.

It can affect both men and women of all ages. However, individuals with darker skin tones may notice these pigmentation marks becoming more pronounced, particularly after puberty or early adulthood.

While dark circles can make individuals appear tired, they are often more of a cosmetic concern rather than a health issue. However, some people seek dermatological or cosmetic treatments to improve their appearance and achieve a more refreshed, well-rested look.

Causes of under-eye pigmentation

Dark circles can be caused by various factors. Understanding these causes is the first step in addressing the condition effectively. The most common contributors include:

1. Genetic factors: Genetics play a

significant role in the development of dark circles. Individuals with a family history of dark circles, particularly those of Asian or Mediterranean descent, may be more prone to this condition. This is often due to inherited factors such as the natural shape of the bone structure, skin type, and skin tone.

2. Hyperpigmentation: Excess melanin production is a major cause of dark circles, particularly in individuals with darker skin tones. Post-inflammatory hyperpigmentation (PIH) may develop because of skin irritation, rubbing, or allergic reactions. Additionally, sun exposure can increase melanin production, exacerbating pigmentation under the eyes.

3. Vascular causes: Vascular dark circles typically have a reddish or bluish tint. This occurs when blood vessels beneath the thin skin around the eyes become more visible. The skin in this area is particularly delicate, and poor circulation can cause the blood vessels to appear darker, making the under-eye area look tired or dull.

4. Shadow effect: The shadow effect occurs when volume loss in the undereye area creates hollows, which cast shadows and make dark circles more noticeable. As individuals age, or due to genetic factors, fat and bone tissue may naturally thin, leading to more pronounced shadows in the tear trough area.

5. Dermal melanocytosis: Some people may experience dermal melanocytosis, a condition where birthmarks or other skin marks contribute to pigmentation around the eyes. These birthmarks may become more prominent with age or in response to environmental factors like sun exposure.

6. Periorbital oedema: Swelling

around the eyes, known as periorbital oedema, can make dark circles appear worse, particularly in the morning. This is often caused by fluid retention or certain medical conditions, including thyroid disease or allergies, which contribute to puffiness and worsen the appearance of dark circles.

7. Lifestyle factors: Factors such as sleep deprivation, stress, alcohol consumption, and smoking are common contributors to dark circles. Chronic stress can increase the production of Melanocyte-Stimulating Hormone (MSH), leading to darker pigmentation. Excessive sun exposure, dehydration, and frequent eye rubbing can also worsen the condition.

8. Nutritional deficiencies: Deficiencies in essential nutrients, especially iron, can lead to anaemia, which often presents as pale skin and dark circles. Chronic illness or poor nutrition can also contribute to a depleted appearance, making undereye pigmentation more prominent.

Treatment options for dark circles

Treatment for under-eye pigmentation varies depending on the underlying cause. Below are some common treatment options:

1. Topical treatments

• Vitamin C: Known for its antioxidant properties, vitamin C can help reduce melanin production and brighten the under-eye area. It is especially beneficial for individuals with pigmentation caused by sun exposure or post-inflammatory pigmentation

• Retinoids: Topical retinoids stimulate collagen production, improving skin texture and thickness. They can be helpful for reducing the appearance of dark circles caused by skin thinning.

• Caffeine: Often included in eye

Adobe/peopleimages.com

creams, caffeine constricts blood vessels and can reduce puffiness and the appearance of dark circles caused by vascular issues.

2. Chemical peels: Superficial chemical peels are an effective treatment to exfoliate the skin and reduce pigmentation. They are particularly useful for addressing surface-level pigmentation, such as that caused by sun exposure or post-inflammatory hyperpigmentation.

3. Laser treatments

• Fractional CO2 lasers and Q-switched lasers are designed to target excess pigmentation and stimulate collagen production in the under-eye area. These treatments can be particularly effective for reducing vascular dark circles and skin thinning.

Intense pulsed light (IPL): IPL is a noninvasive treatment that can address both pigmentation and redness by targeting blood vessels beneath the skin’s surface.

5. Surgical treatments: In more severe cases, blepharoplasty (eyelid surgery) or fat grafting can be performed to remove excess skin or fat, restoring a youthful and refreshed appearance. These procedures should only be carried out by experienced surgeons who specialise in facial aesthetics.

Prevention tips for dark circles

While treatments can help reduce the appearance of dark circles, prevention is equally important. Here are some helpful tips for minimising dark circles:

• Sleep well: Ensuring sufficient rest (seven to nine hours) allows the skin to regenerate and reduces the appearance of dark circles caused by fatigue.

4. Dermal fillers: For individuals with dark circles caused by volume loss in the under-eye area (tear troughs), dermal fillers like hyaluronic acid can restore lost volume, reduce shadows, and smooth the under-eye skin. This treatment helps plump the skin, making dark circles less noticeable.

• Protect your skin from the sun: Always use sunscreen around the eyes to prevent sun-induced pigmentation. Sunglasses and seeking shade during peak sun hours (11am to 3pm) are also effective preventive measures.

• Adopt a healthy lifestyle: Eating a balanced diet rich in vitamins and antioxidants, staying hydrated, and avoiding smoking and excessive alcohol consumption can all help maintain healthy skin.

• Gentle care: Avoid rubbing or scratching the delicate skin around the eyes. Use gentle makeup removal methods and avoid harsh skincare products that could irritate the sensitive skin under the eyes.

Conclusion

Dark circles are a common issue with various causes, from genetics and pigmentation to vascular issues and lifestyle factors.

While it may not be possible to get rid of them entirely, there are several treatment options – ranging from topical treatments to advanced procedures – can help improve their appearance.

Prevention through proper skincare and lifestyle habits also plays an important role in managing and reducing dark circles.

FUTURE EYE TRENDS

We chat with award-winning Consultant Oculoplastic Surgeon and aesthetic practitioner Dr Sabrina Shah-Desai about eye procedures

With over two decades of surgical and non-surgical experience, Dr Sabrina Shah-Desai is the medical director of two boutique clinics on Harley Street: Perfect Eyes Ltd & Perfect Skin Studio.

Dr Sabrina has been consistently recognised in the Tatler Top Doctors Guide as a leading expert in eye treatments for six consecutive years, from 2019 to 2024.Here, we chat to her about the latest trends and advances in eye procedures.

Consulting Room: Have you seen a rise in demand for eye procedures?

Dr Sabrina Shah-Desai: Yes, especially for surgery and polynucleotides.

CR: Have you noticed a decline in filler for tear trough (or in general)?

SSD: Yes overall, patients are not keen on under-eye fillers and deep fillers.

CR: What do you think about regenerative procedures for the under eye?

SSD: Very promising, an innovative way to treat the periorbital area, however, we need more long-term results.

CR: You travel a lot and teach abroad are there any techniques or procedures you have heard about that you feel are exciting for the future in eye treatments?

SSD: There is a technique I saw in Korea that is extremely promising. It is a modification of current expensive and cumbersome surgical techniques and uses the prolapsed eye bag fat, which is prepared in a specific manner and then injected into the eyelid cheek junction. I am offering this surgical procedure and seeing incredible early results.

CR: What innovative tech is there in this space?

SSD: I believe newer energy-based technology (which reduces pain and downtime) combined with bio-regenerative techniques is exciting.

CR: Is it important to consider skincare, and do people forget about the eyes? Do you need a specific eye product in your regime, and what ingredients work best, in your opinion?

SSD: Skincare is vital, especially for protecting the eye area. My perfect 360 eye Illuminate is my hero product, and I have been using it since 2022, it tackles pigment, depuffs the eyes and fills lines and wrinkles. The Eye regenerate LED mask is an excellent rejuvenator to stimulate cellular repair and regeneration.

WINDOWS OF THE SOUL

Dr Maryam Zamani, oculoplastic surgeon, facial aesthetics docto r and founder of MZ SKIN, shares her insights on treatments for the eyes and why the eyes make such an impact on the face overall.

People often come to me with a variety of concerns, such as puffy lower eyelids, dark circles and excess hooding on the upper eyelids. Their goal is to look refreshed and natural with subtle improvements to help them look their best at every age. Harmonious treatments that incorporate the different layers of the skin create the most natural outcomes and can include anything from neuromodulators or hyaluronic acid fillers to surgery.

Tear trough

Volume loss is a common reason whereby the eyelid-cheek junction elongates, exposing the anatomical tear trough and the appearance of dark circles. Often, hyaluronic acid can be injected along this anatomical tear trough at the eyelidcheek junction to improve this contour. This is an injection that takes minutes to administer and can last between 6-18 months, depending on the type of filler used. I do not recommend using permanent fillers in this area, as there is no recourse if there is a complication. Hyaluronic acid is optimal as it is temporary and potentially reversible (using another injection of an enzyme that breaks the hyaluronic acid down immediately)

Crow’s feet

Lines and wrinkles caused by the movement of the concentric orbicularis oculi muscle can be weakened using botulinum toxin. A few injections in the area can help elevate the latera l eyebrow and can be used to soften those lines and wrinkles. In others a bit of skin hydration with hyaluronic acid can be used to improve skin quality. Of course, good skin care is of utmost importance. There isn’t much downtime, and the results are pretty instant!

Eyelid area

Upper eyelid blepharoplasty is the gold standard for

Adobe/Jacob Lund

removing excess skin and medial fat from the upper eyelids. In younger patients that have only a small amount, I recommend a combination of injectables and sometimes a bit of Ultherapy to help tighten the skin in that area.

Dark circles

Dark circles are a common complaint in my office and can be caused by so many different reasons. One of the most common reasons for dark circles is loss of volume in the periorbital area. As we age, the eyelid-cheek junction becomes more prominent and where this junction was once confluent in youth, it becomes demarcated, giving the appearance of dark lower eyelids, sometimes referred to as eyelid bags or dark circles. This can become quite evident even from our 20s and progressively worsens as we age and the facial skin and underlying structures begin to sag. This can be treated with meticulously placed microdroplets of hyaluronic acid to help hydrate and volumise the area, giving an immediate rejuvenating effect to the eye.

Case study

A 63-year-old female (now 64) presented complaining of her eyelid heaviness, difficulty with sight, watching TV and putting on make-up. She expressed an overall feeling of being “tired-looking” and felt exhausted holding her eyelids up. She was also bothered by skin laxity in the periorbital area.

She was really only a surgical candidate. Her eyelids rested on her eyelashes, her lateral brows were low, and she had excess skin in the lower eyelids. I could have opted for surgery to remove the skin on the lower eyelids, but I find that a well-done ablative CO2 laser can achieve improved skin quality and tone without a scar and risk of other complications that can come with a lower eyelid skin excision blepharoplasty.

The patient’s eyelids were sitting on her eyelashes, she was constantly elevating her brows, and she had skin laxity in the lower eyelids. I opened for an upper eyelid blepharoplasty to address the skin and fat prolapse in the upper eyelid. Brow pexy to help improve the lateral brow and the lateral hooding as well as to help prevent it from further lowering with time. CO2 versus skin excision was discussed. The patient did not want the scar and the potential risks associated with the skin excision.

I love combining both surgery and laser to optimise results for the patient. Having the ability to use different modalities means I can offer them the best service.

www.drmaryamzamani.com

EYE SAVIOURS

We round up some of the best eye treatments and products

It’s never been easier to treat age-related concerns around the eye area. Whether it’s dark circles, hollowness, crow’s feet or droopy eyelids, there are a host of cutting-edge treatments and topical skincare options that offer effective solutions for the delicate periorbital region.

“The eye area is the aesthetic epicentre of the face”, says Dr Sabrina Shah-Desai, Oculoplastic Surgeon. “The skin around the eyes is as thin as tissue paper, and this delicate area is prone to various changes like wrinkles, discolouration and loss of elasticity. It is also one of the most demanding areas to work on because of its intricate functioning anatomy, and this is why it’s important to have a thorough assessment to ensure you are picking the right treatment to address your periorbital concern.”

Adobe/Elle Bramble/Cultura Creative

EYE TREATMENTS

THE NON-SURGICAL EYE LIFT

SofWave EyeLyft utilises ultrasound energy to precisely heat the mid-dermal tissue at a depth of 1.5mm – where collagen is most abundant. The collagen regeneration process triggered by SofWave helps improve the appearance of fine lines, wrinkles, and sagging skin around the eyes. When targeted along the brow bone, the treatment can produce an elevating effect, imparting a revitalised and refreshed look. www.sofwave.com

THE EYE REFRESHER

PhilArt Eye is a polynucleotide-based, injectable biostimulator that can work wonders to banish fine lines, crow’s feet, under-eye hollows and dark circles. Made with purified fragments of fish DNA, which closely resembles human DNA, PhilArt Eye has been specially designed for the periorbital area. It works by kick-starting the body’s own cell regeneration, leading to an improvement in skin quality around the eye area. It also restores elasticity and promotes hydration by stimulating new collagen production. Additionally, it can be used to address concerns such as eyebrow ptosis and drooping of the upper eyelids. www.cromapharma.com

THE EYE REJUVENATOR

AgeJET Plasma uses medical-grade nitrogen gas to create thermal injury deep within the skin. The handpiece generates controlled pulses of heat that precisely target collagen and stimulate its production. The procedure is painless and is ideal for the eye area since it preserves the outer layer of skin until fresh new skin forms. Expect regenerated skin with fewer lines and improved texture and tone after just one 15-minute session. www.curemedical.co.uk

EYE PRODUCTS

THE HIGH-TECH EYE CREAM

Dr Rabia W1 I-Shine Cream is a cutting-edge fusion of technology and skincare. The unique massaging microcurrent applicator dispenses a cocktail of hyaluronic acid, vitamin E, shea butter, witch hazel and beta-glucan upon contact with the skin. It works wonders to address common concerns such as dryness, dark circles and crow’s feet. The sophisticated cooling massaging applicator operating at 3000rpm enhances the absorption of the active ingredients while promoting circulation and banishing puffiness. www.skinw1.com

THE BRIGHTENING COMPLEX

Revision Skincare® C+ Brightening Eye Complex is clinically proven to prevent and minimise the look of dark circles and puffiness. Formulated with advanced MelaC+TM Technology - a powerhouse blend of 10% THD ascorbate (the most potent and stable form of Vitamin C), antioxidants, peptides and light-diffusing minerals - the cream works to flush away water retention while reducing the appearance of dark circles, leaving the eye area brighter, de-puffed and refreshed. www.revisionskincare.co.uk

THE MULTI-TASKING EYE CARE DUO

The Perfect 360 Dark Circle Corrector System is a two-step eyecare line from award-winning oculoplastic surgeon Dr Sabrina Shah Desai. Perfect 360 Eye Illuminate is a triple-action liposomal eye serum instilled with a cooling applicator. It comes fortified with a powerhouse of 18 potent ingredients designed to reverse and prevent age-related changes around the eyes, including fine lines, wrinkles, thinning skin, dark circles and puffiness. The multi-tasking Perfect 360 Eye Protect SPF30 is an airy sunscreen that protects the delicate eye area from UVA and UVB rays while simultaneously lightening pigmentation, strengthening, and hydrating the skin. www.drsabrina.com

THE ENERGIZING EYE MASK

Croma Energizing Eye Mask is perfect for giving tired and dehydrated skin a boost of hydration. The pampering under-eye patches are infused with soothing kiwi and cucumber extract, along with hyaluronic acid to nourish. Powerful antioxidants, including vitamin C, help to fight fatigue, making it the perfect wake-up call for the eye zone. www.cromaskincareshop.com

DEVICES

Made for the Neauvia combination approach.

Neauvia provides a range of energy-based devices for the aesthetic, gynecological and surgical treatments. They are characterized by advanced electromedical engineering, ensuring maximum patient safety. Neauvia devices are based on specifically designed and integrated technology, they can be combined with Neauvia’s PEG-HA fillers and aesthetic cosmeceuticals.1, 2

LASERME

The latest non-ablative fractional laser technology for skin resurfacing. Portable diode laser for all skin types.

KEY BENEFITS:

Scar removal (including acne marks)

Skin rejuvenation

Skin resurfacing

Pigmented lesions treatment such as age spots, sun spots and dyschromia Wrinkles and fine lines treatment

ZAFFIRO

Innovative treatment combining 2 technologies in 1: waterpeeling & infrared thermo-lifting.

KEY BENEFITS:

▶ Skin exfoliation and deep cleansing

▶ Lymphatic drainage

▶ Improvement of skin texture

▶ Reduction of the appearance of fine lines and wrinkles

▶ Face and body skin rejuvenation

▶ Wrinkles and fine lines treatment

Scan here to discover more neauvia.uk info@neauvia.uk 07570 621 895

Pharmaceuticals

https://doi.org/10.3390/ph15111355.

15, 1571. https://doi.org/10.3390/ph15121571.

*FDA clearance for treatment of benign pigmented lesions, such as, but not limited to lentigines (age spots), solar lentigos (sun spots), melasma, dyschromia, and for treatment of facial wrinkles and fine lines.

1. Kubik P, Jankau J, Rauso R, Galadari H, Protasoni M, Gruszczyński W, Grzanka D, Smolińska M, Antosik P, Piesiaków ML, Zerbinati N 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.

2. Kolczewski P, Parafiniuk M, Zawodny P, Haddad R, Nalewczyńska A, Kolasa AK, Wiszniewska B, Menkes S, Bader A, Stabile G and Zerbinati N. Hyaluronic Acid and radiofrequency in patients with urogenital atrophy and vaginal laxity.

2022,

CLINICAL SECTION

In this section

• Dermal filler blindness

• Weight loss injection complications

• Abstracts

DERMAL FILLER-RELATED BLINDNESS: CAUSES, PREVENTION, AND MANAGEMENT

Dermal fillers have become one of the most widely used minimally invasive procedures in aesthetic practice. Although many have reported a recent downturn in dermal filler use in their practice, attributed to the rise in popularity of regenerative procedures, the global dermal fillers market is still extensive, valued at $5.08 billion USD in 2023 and projected to grow to $10.16 billion by 2032.1

Despite their generally safe profile, complications such as blindness, though rare, are among the most severe outcomes. Understanding the mechanisms, preventive strategies, and treatment options for dermal filler-induced blindness is crucial for practitioners in aesthetic medicine.2

Understanding the mechanism of blindness from fillers

Blindness caused by dermal fillers occurs due to vascular occlusion. When filler material, most commonly hyaluronic acid –76% of cases according to a 2024 literature review2 – is inadvertently injected into or compresses an arterial vessel, it can cause retrograde embolisation. The filler can travel to the ophthalmic artery or its branches, leading to retinal artery occlusion (RAO) and subsequent visual loss.

Key studies, such as those by Lazzeri et al. (2012)3 and Kim EG et al. (2014)4, have demonstrated that even small volumes of filler injected into high-risk areas such as the glabella, nasal dorsum, or periorbital region can lead to blindness. Anatomical variations and high vascular density in these areas increase the risk of complications.

Risk areas and procedural considerations

Certain facial zones are considered high risk for vascular compromise. These include:

• Glabella: Injection into the supratrochlear or supraorbital arteries.

• Nasal dorsum: Connection with the angular and ophthalmic arteries.

• Periorbital region: Proximity to arterial branches supplying the retina.

In April 2024, a literature review was performed to identify all cases of visual complications caused by filler injection published between September 2018 and March 2023. It identified the sites that were the highest risk were the nose (40.6%), forehead (27.7%), and glabella (19.0%).

Practitioners must have an in-depth knowledge of facial anatomy to avoid these regions or employ safer techniques.

Preventive strategies

To mitigate the risk of dermal filler-related blindness, adherence to the following best practices is essential:

• Comprehensive training: Clinicians must undergo specialised training in dermal filler administration and complications management. Understanding vascular anatomy and high-risk zones is critical.

• Aspiration before injection: Aspiration prior to injecting filler can help identify if the needle is within a blood vessel, although this is not foolproof.

• Use of cannulas: Blunt-tip cannulas reduce the likelihood of penetrating blood vessels compared to sharp needles.

• Slow injection and minimal pressure: Slowly injecting small amounts of filler minimises the risk of embolisation.

• Patient positioning: Proper positioning of patients during the procedure ensures optimal visibility and safety.

• Real-time communication: Encouraging patients to report any pain or visual disturbances during the procedure can help identify early signs of vascular occlusion.

Early recognition and treatment of complications

Blindness due to filler embolism is typically sudden and often accompanied by severe pain or other visual symptoms.

The most common associated signs were ptosis (56.2%), ophthalmoplegia (44.1%), pain (31.2%), and blanching and other skin changes (73.2%).2 Nausea and headache may also occur.2 Strokelike features were seen in 19.2% of cases. 2

Early recognition is vital, as delays in treatment significantly reduce the chances of recovery. If you suspect a visual complication, stop injecting immediately.2

Management of dermal filler blindness

Filler-related blindness is an ophthalmologic emergency. The goal of treatment is to recanalise the vessel and reperfuse tissue.2 The most cited time window for reperfusion is 90 minutes.5 However, newer literature

suggests it may be as little as 10 to 15 minutes, emphasising the need for immediate recognition and management.6

The Aesthetic Surgery Journal review has a downloadable emergency guide.2 It recommends establishing a filler-induced blindness protocol and always having an abundant supply of nonexpired hyaluronidase on hand.2,7

It suggests having a pre-established relationship with an ophthalmologist or oculoplastic surgeon and, before starting treatment, briefly examine each eye separately and document:

• Pupillary response to light

• Extraocular muscle function

• Visual acuity.

Hyaluronidase injections

If hyaluronic acid filler has been used, hyaluronidase can be injected at the original filler treatment site, anywhere with skin ischemia, and along the arterial pathways leading to the eye.2

Subcutaneous injections of hyaluronidase (HYAL) at the filler injection site were reported to be the preferred method of management in 70% of cases in the most recent review of the data.2

The enzyme hyaluronidase breaks down hyaluronic acid and can restore blood flow when administered promptly.

Key considerations for hyaluronidase injections:

• Administer within hours of the onset of symptoms

• Performed by trained professionals to minimise risks.

The technique now favoured is the supraorbital method.

“Injectors are encouraged to attempt supratrochlear and supraorbital injections, with which hyaluronidase is injected adjacent to and inside the supraorbital and supratrochlear notches.”2

Subcutaneous injections of HYAL at the original injection site, along the path of the vessels, and around the supratrochlear and supraorbital artery notches or foramina are non-invasive and easy to carry out immediately at the bedside.

The review showed retrobulbar injections only demonstrated success in 5.3% of attempts and noted that its use “remains controversial”, adding, “recent papers suggest this technique is unlikely to be helpful and should only be attempted by physicians familiar with this treatment.”2,8,9,10,11

“The supraorbital method involves injecting hyaluronidase into the supraorbital foramen, specifically into the supraorbital artery, which is located above the eyebrow”, explains Dr Patrick Treacy, who proposed the supraorbital route instead of the retrobulbar one back in 2013.12-14 “This method requires no special skills, is less invasive than the retrobulbar method and can be effective in cases where the blood vessel blockage is closer to the surface of the skin.”15

CLINICAL

This technique is also supported in the ACE Group World Guidance, which reads: “Based on the current evidence regarding retrobulbar injections of hyaluronidase, the Aesthetic Complications Expert Group do not advocate this treatment for visual loss caused by hyaluronic acid filler. Injection of hyaluronidase into the supratrochlear or supraorbital arteries to reach the embolus seems a more sensible approach.” 16

In addition, recent literature indicates that increased ocular venous pressure may open arteriovenous shunts in the periorbital area, which may be advantageous when flooding this area with hyaluronidase.2,17

A groundbreaking case study by Nguyen et al. (2022)18 highlights the potential for significant vision recovery from fillerinduced blindness using a combined approach of intra-arterial hyaluronidase and thrombolytic agents. The case involved a 27-year-old female who experienced total vision loss and severe ocular symptoms following a 1.0 mL hyaluronic acid filler injection in the nasal dorsum. Prompt multidisciplinary intervention led to remarkable results.

Subcutaneous and retrobulbar hyaluronidase injections were initially administered, followed by intra-arterial hyaluronidase injections guided by digital subtraction angiography (DSA).

Despite partial recovery, a secondary occlusion occurred 13 hours later, leading to the use of intra-arterial thrombolysis with alteplase, a thrombolytic agent, combined with hyaluronidase.

Post-treatment, the patient’s vision improved significantly from no light perception (NLP) to 20/50 within three months.

The success achieved suggests that advanced techniques such as intra-arterial thrombolysis can be lifesaving in select cases.

Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen therapy can enhance tissue oxygenation and promote recovery in cases of partial ischemia. However, its efficacy is limited when used as a standalone treatment.

The Aesthetic Surgery Journal review2 showed that 29 cases underwent hyperbaric oxygen therapy, with 12 (41.4%)

experiencing improvements in vision, including five that recovered normal vision. The authors wrote: “It should be noted that hyperbaric oxygen was co-administered with other treatments, such as IATT and advanced HYAL rescue techniques (e.g., retrobulbar or supratrochlear injections). A total of 20 cases (6.6%) had anterior chamber puncture or paracentesis. Across studies, dozens of other management strategies were attempted, including ocular massage, aspirin, anticoagulants, acetazolamide, eye drops, nitroglycerin, antibiotics, mannitol, and prostaglandins.”

Alternative Interventions

The ACE Group World Guidance16 outlines other supportive therapies as:

• Anterior chamber paracentesis to immediately lower intraocular pressure

• Steroid administration, intravenous dexamethasone

• Judicious use of antibiotics for suspected infection

• Intravenous prostaglandin E14 to increase blood flow to the retina and decrease activation of thrombocytes and neutrophils.

Long-term outlook and ethical considerations

Blindness following dermal filler procedures often results in permanent visual loss, profoundly impacting patients’ quality of life. This underscores the importance of patient education, informed consent, and adherence to safety protocols. Practitioners must ensure that patients are fully aware of the potential risks, even if rare.

Conclusion

While dermal fillers remain a popular and largely safe cosmetic option, the risk of blindness is a stark reminder of the importance of procedural expertise, knowledge of anatomy, and prompt management of complications. Ongoing research and improved techniques will continue to enhance the safety of these procedures. By adhering to best practices and remaining vigilant, practitioners can minimise risks and ensure better outcomes for their patients.

You can watch Dr Patrick Treacy’s lecture on dermal filler blindness to the Royal College of Ophthalmology here:

https://www.youtube. com/watch?v=A4rg-ExCWEo

You can download ACE Group World’s guidance on Vision Loss Secondary to Cosmetic Filler Injection here:

https://uk.acegroup. online/wp-content/ uploads/2020/10/ACEGroup-Visual-Lossv2.7.pdf

References

1. Fortune Business Insights, Dermal Fillers Market Size, Share & Industry Analysis. Accessed December 12, 2024. https://www. fortunebusinessinsights.com/industry-reports/dermal-fillers-market-100939

2. Valerie C Doyon, Chaocheng Liu, Rebecca Fitzgerald, Shannon Humphrey, Derek Jones, Jean D A Carruthers, Katie Beleznay, Update on Blindness From Filler: Review of Prognostic Factors, Management Approaches, and a Century of Published Cases, Aesthetic Surgery Journal, Volume 44, Issue 10, October 2024, Pages 1091–1104, https://doi.org/10.1093/asj/sjae091

3. Lazzeri D, Agostini T, Figus M, Nardi M, et al, Blindness following cosmetic injections of the face. Plast Reconstr Surg 2012;129: 995–1012.

4. Kim EG, EOM TK, Kang SJ, Severe visual loss and cerebral infarction after injection of hyaluronic acid gel. J Craniofac Surg 2014;25:684–6.

5. Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal artery occlusion. Retinal survival time. Exp Eye Res. 2004;78(3):723–736. doi: 10.1016/S0014-4835(03)00214-8

6. Tobalem S, Schutz JS, Chronopoulos A. Central retinal artery occlusion-rethinking retinal survival time. BMC Ophthalmol. 2018;18(1):4–9. doi: 10.1186/s12886-018-0768-4

7. Jones DH, Fitzgerald R, Cox SE, et al. Preventing and treating adverse events of injectable fillers: evidence-based recommendations from the American society for dermatologic surgery multidisciplinary task force. Dermatologic Surg. 2021;47(2):214–226. doi: 10.1097/DSS.0000000000002921

8. Taylor GI, Shoukath S, Gascoigne A, Corlett RJ, Ashton MW. The functional anatomy of the ophthalmic angiosome and its implications in blindness as a complication of cosmetic facial filler procedures. Plast Reconstr Surg. 2020;146(4):745. doi: 10.1097/ PRS.0000000000007155

9. Goodman GJ, Magnusson MR, Callan P, et al. A consensus on minimizing the risk of hyaluronic acid embolic visual loss and suggestions for immediate bedside management. Aesthetic Surg J. 2020;40(9):1009–1021. doi: 10.1093/asj/sjz312

10. Martel A, Lagier J, Sarfati E, et al. Filler-induced blindness “seen” by ophthalmologists: case presentation and treatment algorithm. J Fr Ophtalmol. 2022;45(7):771–783. doi: 10.1016/j.jfo.2022.03.005

11. Lei Z, Qingyi Z, Hong X, et al. Long-term prognosis of vision loss caused by facial hyaluronic acid injections and the potential approaches to address this catastrophic event. Aesthetic Surg J. 2023;43(4):484–493. doi: 10.1093/asj/sjac329

12. https://www.linkedin.com/pulse/dr-patrick-treacy-discusses-dermal-filler-how-deal-them-treacy/

13. Treacy P, Facing complications. Body Language 2015;77:20 6.

14. https://www.youtube.com/watch?v=9xs9AGGm2dQ

15. Reversing dermal filler blindness | June 2023 - Aesthetic Medicine Magazine

16. https://uk.acegroup.online/wp-content/uploads/2020/10/ACE-Group-Visual-Loss-v2.7.pdf

17. Wang Y, Li Q, Ye Y, et al. Intra-arterial thrombolytic treatment for visual deficits caused by hyaluronic acid filler: efficacy, safety, and prognostic factors. Plast Reconstr Surg. 2023;152(6):1226–1233. doi: 10.1097/prs.0000000000010374

18. Nguyen HH, Tran HTT, Duong QH, Nguyen MD, Dao HX, Le DT. Significant Vision Recovery from Filler-Induced Complete Blindness with Combined Intra-Arterial Injection of Hyaluronidase and Thrombolytic Agents. Aesthetic Plast Surg. 2022 Apr;46(2):907-911. doi: 10.1007/s00266-021-02658-w. Epub 2021 Nov 12. PMID: 34767060.

CLINICAL

WEIGHING UP THE RISKS

Following the first reported death linked to weight loss jabs, we examine the risks of these medications

The pursuit of effective weight loss solutions has led to a surge in the popularity of medications such as Mounjaro, Wegovy, and Ozempic.

While these drugs have proven to be valuable tools for managing obesity and related conditions, recent events have underscored the significant risks associated with their use, particularly when they are not prescribed and monitored by qualified medical professionals. Understanding these risks and emphasising patient education is crucial for healthcare providers in mitigating harm.

The latest craze

Not since Botox® has a brand name become part of the cultural zeitgeist but since an army of celebs started attributing their dramatic weight loss to Ozempic it’s been hitting the headlines along with other brands of weight loss drug, and not always for positive reasons.

These injections work by suppressing appetite, increasing feelings of fullness, and delaying gastric emptying. By mimicking natural hormones released after eating, they can support adherence to diet plans and help decrease overall calorie consumption.

Some of these injections also lower blood sugar levels. When administered under prescription and ongoing medical supervision, they’ve proven clinically effective, particularly for individuals with Type 2 diabetes.

In an article on the risks of weight loss injections, theJoint Council for Cosmetic Practitioners (JCCP) wrote: “Weight loss

injections are not available over the counter due to their active ingredients, which should only be prescribed by a doctor or other independent prescriber. Purchasing these injections without a prescription from illegal suppliers, particularly online or social media sources, increases the risk of receiving counterfeit or unlicensed products. This practice can be dangerous and pose significant health risks.

“We have received over 50 complaints within a 12-month period regarding weight loss injections. This significant number of complaints in such a short timeframe highlights the growing concerns surrounding these treatments and underscores the need for increased scrutiny and regulation in this area of cosmetic medicine. These complaints frequently include screenshots of practitioners promoting the administration of the injections or seeking leads to acquire more of the product.”

Tragic incident highlights the risks

More recently things have escalated with the death of a nurse from North Lanarkshire has been linked to the use of a weight loss drug.

The BBC reported that Susan McGowan, 58, took two low-dose injections of tirzepatide, known under the brand name Mounjaro, over the course of about two weeks before her death on September 4.

It wrote: “Her death certificate, seen by the BBC, lists multiple organ failure, septic shock and pancreatitis as the immediate cause of death – but “the use of prescribed tirzepatide” is also recorded as a contributing factor.”

Dr Masud Haq, a highly respected

consultant in endocrinology and diabetes, provided critical insights following the tragic events. Speaking about Mounjaro, he explained:

“Mounjaro is a treatment licensed to help patients with weight loss. There have been recent concerns over its association with pancreatitis following the tragic death of a patient. Pancreatitis refers to inflammation of the pancreas and typically presents with severe persistent abdominal pain which sometimes radiates through to the back. It may or may not be accompanied with vomiting. If a patient develops these symptoms, they should immediately stop their treatment and seek urgent medical advice and attend A&E if required.

“The overall risk of developing pancreatitis with Mounjaro is very low with 0.23 patients per 100 years of exposure and is a recognised side effect in all glucagon-like peptide 1 (GLP-1) agonists. All patients who are being considered for Mounjaro should be screened for a previous history of pancreatitis as treatment may not be appropriate. They should also be counselled of this risk.”

There were also reports that a woman in her 50s passed away after allegedly receiving an injection from an unlicensed provider. This incident has led to arrests and raised questions about the regulation

and administration of such treatments. According to the JCCP, weight loss injections must always be prescribed and overseen by licensed professionals in regulated facilities. The JCCP warns that these drugs are powerful hormonal agents that should never be administered without strict medical oversight.

The rise of “Cowboy Clinics”

Sara Cheeney, founder of Pure Perfection Clinic, echoed these warnings, emphasising the dangers posed by unregulated providers.

“It is absolutely vital if patients do want to pursue this course of action, they contact a legitimate medical practice and have a thorough consultation rather than seeking a quick-fix solution,” said Sara. “We have seen and heard reports that some beauticians and online retailers are selling them alongside beauty products, which is completely wrong.”

Cheeney’s clinic ensures a structured approach to weight loss, combining medication with nutrition and exercise advice. However, the rise of unauthorised providers offering cheap, unverified products has introduced significant risks to patients, including overdosing and a lack of proper aftercare.

Regulatory guidance

The JCCP has urged stricter controls on weight loss medications to prevent further tragedies. All weight loss medicines should be prescribed through UK-registered pharmacies with comprehensive patient monitoring. The unlicensed administration of these drugs, often facilitated through social media and online sales, is a growing issue that demands immediate regulatory action.

The JCCP also highlighted the misleading portrayal of injectable weight loss treatments on social media, where they are marketed as quick fixes. These drugs, while effective, are powerful agents that affect hormonal and metabolic processes, making them unsuitable for unsupervised use. Stricter oversight and patient education are necessary to counter the risks posed by unlicensed providers.

“Ozempic Face” and other side effects

While the physical benefits of weight loss injections can be significant, they are not without aesthetic and health-related downsides. A phenomenon known as “Ozempic face” has been increasingly reported, characterised by sagging skin

and a prematurely aged appearance due to rapid fat loss. Experts stress that patients must be informed of these potential side effects as part of a comprehensive treatment plan that includes lifestyle changes and proper medical guidance.

Conclusion

Weight loss medications have transformative potential for managing obesity, but they must be administered responsibly.

Healthcare professionals play a vital role in ensuring that patients understand both the benefits and risks of these treatments. Recent tragic incidents underscore the importance of stringent regulation and medical oversight.

Patients should be encouraged to seek care from licensed providers in Care Quality Commission (CQC)-regulated facilities, where they can receive the necessary support and safeguards.

As demand for these medications grows, so does the responsibility of the medical community to advocate for safe practices and protect patients from the dangers of unregulated treatments.

Adobe/Oksana

TREATMENT OF MASSETER MUSCLE HYPERTROPHY WITH BOTULINUM TOXIN TYPE A INJECTION: A REVIEW OF ADVERSE EVENTS

Ayaka Nishikawa MD, Yoshiyuki Aikawa MD, Taro Kono MD, PhD Journal of Cosmetic Dermatology

BACKGROUND:

The popularity of non-invasive botulinum toxin type A (BTX-A) injections for masseter muscle hypertrophy is increasing among Asian individuals with a square-shaped lower face.

AIMS:

This study aimed to analyse the adverse events (AEs) caused by BTX-A injections into the masseter muscle.

PATIENTS/METHODS:

This observational study retrospectively evaluated 46 250 patients who underwent BTX-A injections into the masseter muscle in 2022. The inclusion criteria were the diagnosis of an AE by the physician at the return visit and subsequent follow-up of progress (n = 223). The patients who were lost to follow-up (n = 40) were excluded from the study.

RESULTS:

Among the 223 patients with AEs, the most common AE was paradoxical bulging (88.3%, n = 197/223). The average period from treatment until confirmation of improvement was 159.6 ± 113.6 days (range 13–667 days) for all AEs, all of which were temporary. The period until improvement was 166.1 days in the intervention group (n = 122) and 151.9 days in the observation group (n = 101) (p = 0.24). As the period until improvement of AEs included the period until the patients visited the clinics and the improvements were confirmed by physicians, the actual period was likely to have been shorter.

CONCLUSIONS:

(1) All AEs were temporary. (2) All AEs improved within 22.2 months (within 5.3 ± 3.8 months on average). (3) There was no significant difference between the intervention and observation groups in the period until the improvement of AEs.

MICRONEEDLING RADIOFREQUENCY ENHANCES POLY-LLACTIC ACID PENETRATION THAT EFFECTIVELY IMPROVES

FACIAL SKIN LAXITY WITHOUT LIPOLYSIS

Wu, Xianglei MD, PhD; Cen, Qingqing MD; Wang, Xue MD, PhD; Xiong, Ping MD, PhD; Wu, Xiujuan MD; Lin, Xiaoxi MD, PhD

Plastic and Reconstructive Surgery

BACKGROUND:

Microneedle fractional radiofrequency (MFR) is commonly used for skin laxity treatment, and poly-L-lactic acid (PLLA) can stimulate collagen synthesis in the body. However, the synergy of their combination for skin rejuvenation has not been proven. The authors aimed to evaluate the combined efficacy of PLLA and MRF and the potential mechanism underlying skin laxity.

METHODS:

This prospective, randomised study included C57BL/6 mice treated with MFR, MFR plus PLLA, and carbon dioxide laser plus PLLA and 32 patients who underwent split-face treatments with MFR or MFR plus PLLA twice every 2 months. The Global Aesthetic Improvement Scale, Facial Laxity Rating scale of the whole face, the Echelle d’Evaluation Clinique des Cicatrices d’Acne grading scale of acne scars, and VISIA parameters on both treated sides were evaluated. Dermatologic changes were measured by ultrasonography in the submental space, and adverse events were documented.

RESULTS:

PLLA was delivered by channels produced by MFR but not carbon dioxide laser in the mouse model. Thirty patients were treated with split-face MFR plus PLLA or MFR, revealing an improvement in VISIA wrinkle percentile (0.020) compared with the age-matched controls (0.000). The thickness of the dermis increased, whereas the fat layer did not change significantly. No adverse effects were observed.

CONCLUSIONS:

PLLA can be delivered through microchannels produced by MFR. PLLA enhances the efficacy of MFR for skin laxity without lipolysis.

Fractional Skin Rejuvenation

Unique patented TMA® technology

Scientifically validated Proven results

Using precisely controlled heat for delicate skin and stubborn conditions

Treats multiple indications including... Rosacea Pigmentation Melasma Blepharoplasty

Scarring

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OUTSTANDING OUTCOMES

SCAN TO FIND OUT MORE ABOUT THE TIXEL OR EMAIL

TECHNOLOGY & INNOVATION SECTION

In this section

• Acne innovations

• Augmented reality

• Combination treatments

• Trends

• Product news

TRENDS REVIEW AND PREDICTIONS

Leading aesthetic device company BTL shares its insights for 2025

This year marked a pivotal shift in the aesthetics industry, with trends moving towards regenerative treatments and longevityfocused therapies. BTL KOL’s report that patients are increasingly seeking treatments aimed at enhancing the body’s natural regenerative abilities, promoting a longer-lasting, more holistic approach to aesthetics. Social media platforms such as Instagram and TikTok have democratised access to information, normalising treatments that were once considered niche. This cultural shift, alongside innovations in medical technology, has propelled aesthetic procedures into mainstream wellness routines.

Emergence of longevity and regenerative medicine

“Longevity has become an emerging field of interest in aesthetic practices,” shares Dr Mohammed Enayat of Hum2n clinic, noting a rising desire among patients to slow the ageing process, improve quality of life, and enhance overall vitality. This patient-centred approach has influenced a surge in regenerative treatments, prioritising techniques that support skin and tissue health over time.

Dr Wassim Taktouk of Taktouk Clinic echoes this trend, emphasising that “patients are looking to harness their own bodies’ abilities to produce collagen, elastin, and hyaluronic acid” through methods like biostimulant injections and energy-based devices. These methods, designed to promote a natural and refreshed appearance, have become foundational in aesthetic offerings this year. 23MD’s Dr Suha Kersh, another advocate for the regenerative approach, adds that “regenerative medicine is gaining confidence, allowing a broader scope in treatment delivery for skin priming and tissue regeneration.”

This focus on self-renewal extends to intimate health awareness, with increased demand for treatments addressing women’s intimate wellness alongside traditional aesthetics, as noted by consultant gynaecologist Tania Adib.

The role of BTL sevices in 2024 trends

BTL devices have played an integral role in the movement toward longevity-focused and regenerative treatments, providing technology that aids in muscle maintenance and collagen production. “BTL supports muscle mass maintenance and even reverses age-related sarcopenia, especially in the pelvic floor,” says Dr Enayat.

Dr Kersh highlights the BTL portfolio’s “holistic approach” to healing and tissue regeneration, delivering healthier, tighter skin. Additionally, Dr Taktouk lauds the BTL EXION for its notable impact on collagen, elastin, and hyaluronic acid production, stating it’s an ideal complement to other aesthetic treatments.

For intimate health, Adib emphasises BTL’s EMSELLA device, which addresses vaginal health and pelvic floor strength to improve both comfort and quality of life.

Looking ahead: 2025 aesthetic predictions

Experts predict that regenerative and longevity-focused treatments will continue to thrive in 2025, with a few notable developments expected:

• Longevity and slowing the effects of ageing: Dr Enayat anticipates more in-depth conversations around muscle mass maintenance and a greater understanding of internal ageing processes. “Looking at the root cause and the inevitable future allows us to modulate patients’ current health states, focusing on maintaining and improving them,” says Dr Enayat. His approach aims to prevent decline and support long-term vitality, prioritising strategies that address ageing at its core and promoting sustained health for as long as possible. This focus on preventative care represents a significant shift in

aesthetic medicine, moving from surface-level treatments to practices that enhance both appearance and overall wellbeing.

• Biostimulating technologies: Dr Kersh foresees regenerative treatments becoming even more effective, particularly when integrated with cosmetic aesthetic treatments. “Combining SkinBoosters and biostimulants with BTL devices, such as EXION and EMFACE, delivers improved skin tone and firmness, paired with muscle strengthening for a natural lift,” she explains. This trend has become particularly relevant with the rise of weight-loss medications like Ozempic, which, while effective in reducing body weight, often results in skin laxity. This synergy between medical treatments and aesthetics reflects the industry’s shift toward addressing broader health and aesthetic needs, ensuring patients feel confident and rejuvenated at every stage of their journey.

• Quiet Luxury Face: Dr Wassim Taktouk anticipates that the demand for skin quality solutions through regenerative technologies will continue to surge as patients increasingly seek out non- and minimally invasive treatments. These options offer smooth, firm, “filter-like” skin, catering to the trend of achieving a natural yet polished appearance. According to Dr Taktouk, aesthetics is shifting towards what he describes as the “Quiet Luxury Face,” where patients desire subtle enhancements without a look that’s overly altered or artificial. “The skin doesn’t need to be wrinkle-free; it just has to look and feel its best,” he explains. To meet this demand, he advocates a holistic approach, combining advanced technologies, injectables, and professional-grade skincare. He and Dr. Kersh both foresee that this balanced method will become essential for achieving optimal skin health and a naturally refined appearance.

• Increased intimate health treatments: Adib expects to see a growing number of women and men seeking to optimise intimate health as they age, integrating these treatments as part of a comprehensive aesthetic routine. With advancements in technology and the availability of non-invasive solutions, treatments addressing intimate health are becoming more accessible and accepted, paving the way for an aesthetic landscape that prioritises both external and internal wellness.

In 2025, social media is predicted to remain a driving force behind the demand for aesthetic treatments, with platforms like TikTok continuing to spark viral discussions about procedures, product recommendations, and real patient experiences. This accessibility of information has created a hyper-informed consumer base eager to explore innovative and effective solutions.

A key trend emerging alongside this is the rise in the use of weight-loss medications such as Ozempic, which have taken the US and global markets by storm. While these treatments have provided transformative results for patients, rapid weight loss often leads to concerns about skin laxity, prompting a growing need for complementary aesthetic treatments. In fact, some US doctors now prescribe Ozempic only in combination with treatments such as those offered by BTL, ensuring patients achieve holistic, satisfying results that address both body composition and skin quality.

BTL’s cutting-edge portfolio of devices – including EMSCULPT NEO, EMSELLA, EMFACE, EXION, and EMTONE – is uniquely positioned to meet these growing demands.

By strengthening muscle, tightening skin, and promoting collagen and elastin production, these technologies provide effective, noninvasive solutions for addressing patient concerns. As consumers increasingly seek to refine and optimise their aesthetic outcomes, BTL’s innovative devices are set to lead the industry in 2025, catering to the needs of a more health-conscious and socially informed audience.

CLEARING THE WAY

We explore the technology behind AviClear®, the first and original FDAcleared energy-based device for long-term treatment of mild, moderate, and severe inflammatory acne

As acne affects 742 million patients daily, an alarming 48% are unsatisfied with their current acne treatment.1,2 But the acne treatment landscape is changing with the introduction of AviClear® by Cutera®, the first and original FDA-cleared energy-based device for longterm treatment of mild, moderate, and severe inflammatory acne.

AviClear® is powered by a 1726nm wavelength laser that targets sebaceous glands and suppresses sebum production. The treatment is effective and safe for all skin tones and Fitzpatrick skin types and is completed with three 30-minute treatments that are performed about one month apart. It effectively treats all severities and forms of acne, including hormonal, cystic and inflammatory. By targeting acne at its source, AviClear® helps patients enjoy long-term results and clearer skin without the need for cumbersome prescription medications and home treatment protocols.3

As dermatologists and practitioners know, traditional acne treatment protocols can be bothersome and frustrating for many patients. Antibiotics may work, but acne often returns once they are no longer taken. Retinoids and other topical prescription medications may effectively treat acne but rely on patient compliance. Isotretinoin is often used when all other treatments have failed, but common side effects like dry skin, rash, irritation, and an increase in the risk of birth defects often lead to patient resistance. AviClear® was created to help patients avoid these issues by providing a new solution for acne, which hasn’t been done in decades.

Clinical trials have been positive, with most patients reporting fewer, shorter and less intense acne breakouts following AviClear® treatment.4 As shown in the chart, trial results are just as impressive, as 80% of patients saw half their acne resolved three months after their final treatment, 87% reported that half their acne resolved six months after their final treatment, and 92% of patients saw at least half their acne resolved at 12 months after their final treatment. Finally, long-term data showed progressive improvement for 24 months after the final treatment with a 97% reduction in ILC (Inflammatory lesion count).5

The pattern of improvement is clear; unlike conventional acne treatments, AviClear® patients

continue to see results well after their treatment, with no side effects or prescriptions.

Patients report visible improvements soon after final treatment session, with the majority seeing continuing improvement for months after. In addition to the results, AviClear®’s AviCoolTM sapphire contact skin cooling and sensory controls ensure a tolerable patient experience. This winning combination puts AviClear® in the spotlight as an innovative and effective acne treatment for our time.

AviClear® is quickly becoming the new gold standard for acne treatment as dermatologists are reporting that results are comparable to those of isotretinoin but without the issues. There is no downtime, no blood tests, no prescriptions. Patients are confirming their results as over nine out of 10 self-report as being either satisfied or very satisfied.3

AviClear has changed the face of acne treatments as forward-thinking dermatologists and practitioners are seeing that the answer is clear. AviClear is becoming a leading acne treatment choice for providers and patients alike. By treating mild to severe acne and meeting patient demand for treatments that are convenient, easy, and safe, providers are truly escorting the future right into their offices.

For more information on AviClear please visit: https://aviclear.com/en-uk/

REFERENCES:

1. Global Acne Market Report 2016-2026

2. Hayran Y et al. Factors of affecting adherence and patient satisfaction of treatment: a cross sectional study of 500 patients with acne vulgris J. Dermatol Treat 2021; 32 (1):64-69

3. Data on file, Cutera Inc

4. Data on file. FDA clearance study. Cutera, Inc.

5. Data on file. Published Article JCD – Selective photothermolysis with a novel 1726 nm laser beam: A safe and effective solution for acne vulgaris

©2024 Cutera, Inc. All rights reserved.

Images

BEAM ME UP, SCALPEL

AR in the OR: Boldly going where no surgery has gone before

Science fiction has become science fact as surgeons get set to use holograms to transform surgical procedures as we know them.

Researchers are set to present a study entitled Does augmented and mixed reality have a future role in reconstructive surgery? Exploring a potential application in mandibular reconstruction at the winter meeting of the British Association of Plastic, Reconstructive, and Aesthetic Surgeons (BAPRAS). The study shows how, in the near future, AR headsets could be worn by surgeons to project holographic images onto patients’ bodies during surgery, improving surgical precision and patient outcomes whilst reducing preoperative time.

The study, originally carried out at Princess Alexandra Hospital in Australia, focused on using the technology on 3D-printed models to test the feasibility of using AR (augmented reality) and MR (mixed reality) during mandibular (lower jaw) surgery. Researchers discovered that by using holograms instead of traditional physical cutting guides, they are able to display additional data, such as key anatomy information and surgical plans. In doing so, this may, in future, allow for more precision during surgery and

save money by reducing preoperative planning time, decreasing turnaround time, and eliminating the need to print 3D cutting guides.

Resident medical officer Tyler Ferdinands, says, “Our early findings show that augmented and mixed reality has the potential to transform how surgeons plan and execute complex reconstructions. This preclinical pilot study demonstrates how AR/MR technology may improve efficiency while making complex anatomical details more accessible to the surgical team in real-time.”

The process is similar to traditional

surgeries, with the primary difference being the use of holograms instead of physical cutting guides. The surgeon scrubs for surgery whilst wearing the headset and then scans the patient’s QR code to register the device. The software loads the holograms specific to that patient and projects them onto their body. For the study, participants used the Microsoft HoloLens 2 headset, which features tracking technology similar to that of gaming headsets like the Oculus Quest.

The holographic image of the patient anatomy includes details such as bone anatomy, blood vessels, an outline of the skin and surgical cutting planes. The

final reconstruction is also displayed in the surgeon’s field of vision, allowing them to refer to it throughout the procedure.

Consultant plastic surgeon and BAPRAS president, Mani Ragbir, says, “This innovation aligns perfectly with our vision to advance surgical technology. By integrating AR/MR tools, we can equip surgeons with real-time, enhanced views that lead to safer, more efficient outcomes, particularly in complex cases like mandibular reconstruction. It is exciting to imagine AR as a significant part of the future of all surgery.”

AR involves superimposing computergenerated images or data onto a real-world view. In the study, this meant projecting information onto a 3D-printed model, but it could be used on live patients in the future. These holograms allow surgeons to see essential details without looking away from the surgical site.

MR combines elements of both the real world and virtual environments, allowing for more interactive and immersive experiences. Surgeons can interact with virtual components as if they were part of their physical environment, manipulating digital elements in real time.

ON THE PULSE

How Diatermocontraction™ takes muscle-stimulating treatments for the face and body to the next level

Energy-based devices have become a powerful tool in the aesthetics practitioners’ armoury for both the face and body. While body treatments have been largely focused on reducing pockets of fat and facial treatments on stimulating collagen production, in recent years, treatments that stimulate the muscles have also come to the fore as a powerful way to lift, tighten and tone.

Most systems on the market rely on electrical muscle stimulation (EMS), which uses low-frequency pulses to induce muscle contractions. This technology has been harnessed in medicine for decades, but it’s only recently been introduced in aesthetics.

However, EMS has its limitations:

• Limited depth penetration: Low-frequency pulses cannot penetrate deep into the muscle or cellular structure.

• Power constraints: Increasing EMS power results in significant discomfort for the patient, capping its effectiveness.

• Partial muscle contractions: Even with the addition of magnetic pulses, EMS systems cannot achieve full muscle fibre contraction.

In the spirit of innovation, the market has already evolved to welcome a new wave of muscle-stimulating treatments based on Diatermocontraction™ that take it to the next level.

Introducing FACESTIM and BODSTIM

The demand for combination therapies is driving forward growth in the non-surgical devices market, which was estimated at a value of $3.69 billion in 2024 and is forecasted to reach $8.03 billion by the end of 2034. And one company leading the way in this space is Brera.

In terms of muscle-stimulating devices, the company offers Jovena®, the mother platform for FACESTIM and BODYSTIM, its stand-alone device for body treatments, both distributed in the UK by Aesthetic Medical Partnership (AMP).

FACESTIM is a unique modality described as an “intense facial workout” that reaches the deeper dermal layers and muscles to tighten lax skin, restore lost volume, and tone facial muscles.

“FACESTIM provides visible lifting from the first treatment without

downtime or consumable costs and is perfect for my patients who increasingly want preventative and corrective treatments with a natural result and without downtime”, comments Dr Rita Rakus, Dr Rita Rakus Clinic, London.

BODYSTIM offers body treatments in a non-invasive and new way, combining numerous functions into one system to tone and tighten skin and muscle.

Both devices harness the power of Diatermocontraction™. Diatermocontraction™ by Brera is a single radiofrequency pulse that can deliver heat or muscle contraction, or both together, making it stand out against other devices on the market which do not deliver RF and muscle contraction in the same shot from the same generator.

Unlike other technologies that employ EMS, Diatermocontraction™ goes into the muscle and gives full contraction of the muscle fibres. Its high frequency also penetrates the cells and can be delivered at higher power while maintaining patient comfort. The result is a more pronounced, long-lasting lift and enhanced muscle tone. Additionally, this method stimulates high-frequency RF-induced collagen remodelling, substantially improving the skin’s overall appearance.

The advantage of Diatermocontraction™ technology

Jovena’s FACESTIM and BODYSTIM technologies are powered by Brera’s patented Diatermocontraction™, a revolutionary single radiofrequency (RF) pulse system. Unlike EMS, Diatermocontraction™ offers unique benefits that set it apart:

1. Heat and muscle contraction in one pulse: Diatermocontraction™ delivers RF energy capable of inducing heat, muscle contraction, or both simultaneously. This dual capability ensures efficient and effective treatment for a variety of aesthetic goals.

2. Deeper cellular penetration: The high-frequency RF pulse penetrates into the cellular structure, reaching muscle fibres that EMS cannot access. This enables a more comprehensive and effective treatment.

3. Full muscle fibre contraction: By targeting the entire muscle, Diatermocontraction™ achieves a level of contraction that EMS systems simply cannot match.

4. Higher power with patient comfort: The advanced RF pulse design allows for higher power levels without compromising patient comfort—a critical differentiator from the painful limitations of EMS technology.

Cost effective with no hidden expenses

Another major advantage of FACESTIM and BODYSTIM technologies is their operational cost efficiency. Unlike competitors that rely on costly consumables, these treatments require only a negligible amount of ultrasound gel (costing around £0.10 per session). This makes it a far more economical choice for clinics and patients alike.

With their advanced technology, FACESTIM and BODYSTIM offer transformative results in body contouring and facial rejuvenation. The ability to induce full muscle contractions, penetrate deeply into the muscle and cellular layers, and deliver combined heat and muscle stimulation ensures outcomes that outpace those of EMSbased systems.

THE POWER OF COMBINATION

Why patients are increasingly turning to the synergy of multiple treatments to achieve remarkable and personalised results

In the world of medical aesthetics, one trend has taken centre stage: the power of combination treatments. Practitioners are no longer relying on single procedures or products to address aesthetic concerns. Today, patients are increasingly turning to the synergy of multiple treatments to achieve remarkable and personalised results. By combining different procedures, practitioners can tailor treatment plans to meet each patient’s unique needs, delivering comprehensive outcomes that go beyond what any single treatment can achieve.

A leading player in this movement is Neauvia, a disruptive and scientifically based medical aesthetics company that is redefining the industry. Neauvia aims to inspire and shape the world of aesthetic medicine with disruptive energy, opening up new lifestyles and creating a community that embraces its new concept of aesthetics. Established in 2012, Neauvia is a high-growth multinational corporation with a presence in over 80 countries worldwide.

What sets Neauvia apart is its strong foundation in science and clinical data and its commitment to creating an iconic brand that resonates with consumers. The company’s philosophy is centred on continuous innovation and evidence-based solutions.

At the core of Neauvia’s success is its combination approach, with products carefully designed to work synergistically with each other and with the body’s natural processes. Neauvia’s R&D team has developed comprehensive treatment protocols, each supported by science and clinical research, that combine different restorative therapies and grant clinically proven superior results.1,2,3

Neauvia offers clinically proven combined solutions for healthcare practitioners and patients, featuring an in-house portfolio of products that includes PEG-HA fillers, energy-based devices and aesthetic cosmeceuticals.4,5,6

Thanks to a comprehensive range of high-end technologies working in synergy, Neauvia delivers safe and effective results for facial, body and intimate rejuvenation. Rethinking medical aesthetics as premium experiences by fully integrating this

approach into a modern and healthy lifestyle, Neauvia empowers all beauty lovers.

By harnessing the power of combination treatments, Neauvia is leading the way in transforming the landscape of medical aesthetics. Their products and protocols empower practitioners to offer customised solutions that are tailored to the individual, helping patients achieve satisfying and natural results. In a world where aesthetic treatments are becoming more personalised, Neauvia’s innovative approach is setting new standards for the industry, offering a comprehensive solution for those looking to age gracefully and confidently.

NLIFT THE MID-FACE SYNERGISTIC PROTOCOL

Age-related anatomical changes are most effectively managed through the combination of science and technology. For ageing patients, it is standard practice in most reputable aesthetic clinics to address volume loss while also focusing on ways to hydrate the skin, improve elasticity and boost fibroblast production to enhance overall skin structure and quality. For many, this has meant using an energybased device in one appointment followed by a waiting period of several weeks or months for the results to take effect before introducing dermal fillers. This process not only demands additional time from practitioners, supporting staff and patients but also raises the overall cost per treatment for everyone involved.

The NEAUVIA NLIFT SYNERGISTIC PROTOCOL, allows the combination of HA dermal fillers and an infrared energy-based device in one appointment.

Nlift is a combined protocol with clinically proven results7, a unique approach to treating different skin layers for volume and skin regeneration. It consists of a synergistic sequence of Neauvia treatments: Hydro Deluxe (linear HA filler enriched with CaHA, Glycine and L-Proline), Zaffiro (infrared and water-peeling energybased device), Stimulate (the only PEG-HA + CaHA Filler in the market, enriched with Glycine and L-Proline, recognised as “Best Injectable Dermal Filler” at AMWC 2024 Awards) and aesthetic cosmeceuticals.

The entire protocol is conducted over two sessions, spaced one week apart:

Session 1: The first session begins with skin preparation using New Born Skin, cleansing milk, and Wake Up Skin, an advanced tonic with antioxidants, to remove impurities and restore pH balance. This is followed by the injection of Hydro Deluxe into the dermis and epidermis. For post-treatment care, the Instant Recovery Mask, a bio-cellulose mask, is applied to calm and help restore the skin barrier. Additionally, the C-Shot Serum, a revitalising serum, and Ceramide Shield Cream, a restorative moisturiser, are used both in the clinic and at home to strengthen the skin and calm irritation.

Session 2 (one week later): The second session also begins with skin preparation using New Born Skin and Wake Up Skin. This is followed by Stimulate, a filler injection to restore lost volume of the soft tissue (choice of product can be adapted according to patient’s need). The session then includes a Zaffiro treatment to exfoliate and promote skin regeneration. For post-treatment care, the Instant Recovery Mask is applied again, along with continued use of the C-Shot Serum and Ceramide Shield Cream, both in the clinic and at home, to ensure optimal skin recovery and strengthening.

With this innovative approach, Nlift protocol, the different layers of the skin can be targeted, which results in volume and skin regeneration by means of the histological changes in the ECM.

Here’s a look at the key benefits8:

1. Fibroblast production

• +101% increase at 21 days

• +141% increase at 150 days

2. Improved skin elasticity

• +60% improvement at 21 days

• +72% improvement at 150 days

3. Boosted skin hydration

• +45% increase at 21 days

• +49% increase at 150 days

These results, compared to the baseline, demonstrate Nlift’s effectiveness in the short and long term.

Don’t miss the opportunity to explore the reliable effects of Neauvia’s combination approach, like the Nlift protocol. Whether you’re looking to enhance your clinic’s offerings or provide your patients with the latest advancements in medical aesthetics, Neauvia’s protocols deliver clinically proven, effective solutions. Discover how these innovative treatments can elevate your practice and meet the growing demand for personalised, comprehensive treatments.

Visit www.neauvia.uk to learn more and take the next step in redefining your clinic’s approach to patient satisfaction and results.

To support practitioners in their journey towards excellence, Neauvia has also launched The Neauvia Channel (www. neauviachannel.com ) is the first 24/7 Aesthetic Medicine Channel dedicated to healthcare practitioners. This innovative platform provides free access to online scientific on-demand videos, training and online events.

TECHNOLOGY PRODUCT NEWS

Lawmed introduces Caress Flow

Caress Flow, a groundbreaking treatment that promises to transform the management of vaginal pathologies, is now available in the UK. The innovative, non-invasive therapy offers a holistic, painless solution to a range of vaginal symptoms, with clinical evidence demonstrating significant benefits, including for breast cancer survivors. Unlike traditional methods such as lasers or radiofrequency, Caress Flow utilises a unique combination of oxygen and hyaluronic acid to rejuvenate and heal vaginal tissues naturally. This method promotes tissue regeneration, improves elasticity, and enhances overall vaginal health without the need for harsh chemicals or painful procedures.

Dermalux launches Tri-Wave MD

Dermalux has launched the Tri-Wave MD, described as “the most powerful phototherapy device in the world”, with the largest adjustable four-pod head in the Dermalux range. The Tri-Wave MD delivers treatments over broad skin areas with unparalleled efficiency, capable of delivering up to 240 j/cm² in a single treatment session.

The new device uses multiple wavelengths concurrently from singular wavelength LEDs, ensuring clinicians can target multiple symptoms in a single treatment whilst reducing treatment time. This guarantees more reliable performance and predictable results, and is unique to Dermalux. Other LED devices on the market require the changing of LED heads for each wavelength, increasing treatment time.

Dr Ian Strawford, founder of Skin Excellence Clinics, says: “The Dermalux Tri-Wave MD’s USP is its power. Used alone or alongside other treatments, it calms the skin and stimulates regenerative pathways.”

Hydrafacial unveils Hydralock HA Booster

Aesthetic device company Hydrafacial has introduced Hydralock HA booster, a new skincare booster to tackle dull and dehydrated skin.

Hydralock HA booster features a blend of triple hyaluronic acid complex, vitamin B5 and fruit extracts, specifically targeting individuals seeking to achieve hydrated skin while firming and minimising the appearance of wrinkles.

In a clinical study of 38 participants conducted by Hydrafacial, results found a 455% increase in hydration and a 57% reduction in the appearance of wrinkles immediately following the treatment. Additionally, 94% of participants reported their skin remained hydrated and moisturised 48 hours after the treatment.

Sisneo introduces Mesolux

Mesolux is a new medical-aesthetic face, scalp and body treatment device from Sisneo. Mesolux is a needle-free machine able to introduce various molecular weights into different layers of the skin. It combines transdermal electroporation with phototherapy, which is a non-invasive therapeutic conversion of light energy within the visible light spectrum into chemical and physical reactions that induce changes at the molecular level. With 633nm phototherapy, it enhances cellular metabolism, increasing the use of the active ingredient introduced, resulting in advanced results in all types of treatment. The 420nm applicator treats p.acnes bacterial.

The treatment device imparts long-term anti-ageing benefits to firm and lifts the face and neck areas, whilst the specially formulated mesotherapy ingredient solutions are selected to target individual facial and neck skin concerns, including wrinkles, skin laxity, acne, pigmentation and general rejuvenation. The device can also be used on the body to firm breasts or treat cellulite, thinning hair, localised adiposity or stretch marks.

Pure Impact™ by Sofwave™

Pure Impact™ by Sofwave™ is an innovative device for electric muscle stimulation (EMS) that firms up the body and tones muscle. The system is designed to stimulate multiple muscle groups and body areas simultaneously.

It is FDA-cleared to strengthen, tone, and firm the abdomen, buttocks, thighs, and arms. In a single session, up to 16 synchronised wireless electrodes work simultaneously to stimulate multiple muscle groups and areas of the body to deliver effective, superior muscle strengthening, firming and body toning. The PlyoPulse™ technology encapsulates the efficacy of controlled muscle stimulation, all within a concise 30-minute treatment. Each treatment session lasts 30 minutes. It’s recommended to have four biweekly sessions (twice a week).

The revolutionary Diode Laser & 3D IPL Combination System

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

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

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

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

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

SKIN SECTION

In this section:

• Menopausal rosacea

• Exosomes

• Skin news

MANAGING MENOPAUSAL ROSACEA AND SKIN CHANGES

Julie Scott shares her insights and experience with managing menopausal skin changes

Are you an aesthetic practitioner looking to enhance your expertise in managing menopausal skin changes?

With hormonal fluctuations exacerbating conditions like rosacea, it’s crucial to adopt a nuanced approach to skincare and treatment. This article aims to help you understand the unique skin challenges faced by menopausal women.

Learn how to effectively tailor your skincare regimens with key ingredients, employ advanced in-clinic treatments, and provide holistic care that addresses both the aesthetic and emotional needs of your patients. Drawing from years of clinical experience, I share insights into the prevalence of rosacea among menopausal patients and the strategies that have proven successful in my practice.

Unlock radiant skin during menopause

Over the years, I have noticed a marked prevalence of rosacea among my menopausal patients. This isn’t surprising, given that hormonal changes during menopause can significantly impact the skin. The decline in oestrogen levels that accompanies menopause can lead to increased sensitivity and a tendency towards redness and inflammation. For many women, these changes bring on new skin challenges, including the development or worsening of rosacea. In my practice, about 40% of menopausal patients report a noticeable onset or exacerbation of rosacea symptoms during their transition into menopause.

The impact of menopause on skin

The impact of menopause on the skin has made me ask, ‘Why are menopausal women more prone to Rosacea?’

Hormonal fluctuations during menopause, especially reduced oestrogen and increased androgens, can boost blood flow to the skin’s surface, resulting in flushing, redness, and rosacea-like symptoms. Alongside this, decreased collagen and natural oils make the skin thinner, drier, and more sensitive to irritation and inflammation. Many women who have not previously experienced rosacea may see new symptoms arise, while those with a history may notice their symptoms worsening. In addition to rosacea, menopause often brings issues such as dryness, reduced firmness, and increased sensitivity as the skin becomes more susceptible to irritants. Addressing these concerns holistically, with the medical needs in mind, is essential for effective management.

Understanding rosacea in menopausal skin

Rosacea is a chronic inflammatory skin condition that manifests as persistent redness, flushing, visible blood vessels, and, at times, acne-like bumps. For menopausal women, this condition can be particularly impactful, both physically and emotionally, due to increased skin sensitivity and visible symptoms that can affect selfconfidence.

Identifying rosacea vs. other skin concerns: During menopause, various skin issues such as dryness, fine lines, and sensitivity often arise, which can sometimes mask or mimic rosacea symptoms. It’s essential to differentiate rosacea from other concerns like eczema or menopausal flushing. Unlike transient menopausal flushes, rosacea redness tends to be more persistent and localised, often affecting the central areas of the face.

Common triggers for menopausal rosacea: Menopausal skin is especially susceptible to external triggers that can worsen rosacea

symptoms. Factors like sun exposure, spicy foods, alcohol, and temperature changes can all exacerbate redness and flushing. Additionally, psychological stress common during this life stage can trigger flare-ups, making stress management an essential part of managing rosacea.

Emotional and psychological impact: Rosacea often brings a visible aspect to menopausal changes, which can impact confidence and self-esteem. For some, this condition may feel like an unwelcome reminder of ageing, adding a layer of emotional complexity. As practitioners, it’s essential to recognise the psychological impact and incorporate supportive, empathetic care into treatment plans.

Tailoring skincare for menopausal patients with rosacea

When treating rosacea in menopausal patients, it’s important to understand the unique challenges. Menopausal skin is not only more sensitive but also more prone to dryness and irritation. Therefore, a tailored approach to skincare is essential to manage rosacea effectively while also addressing broader skin concerns.

Key skincare ingredients for rosacea management:

• Niacinamide: A form of vitamin B3 with strong antiinflammatory effects, niacinamide reduces redness and irritation, ideal for sensitive, rosacea-prone skin. It also strengthens the skin barrier, enhancing hydration and resilience.

• Azelaic acid: This gentle acid reduces inflammation, targets acne-causing bacteria, and minimises hyperpigmentation, helping even skin tone especially useful for menopausal rosacea flare-ups.

• Sulfur: With anti-inflammatory and antibacterial benefits, sulfur reduces inflammation and absorbs excess oil, which can trigger rosacea. I often recommend sulfur masks, like the ZO Sulfur Mask, to control oil and soothe the skin.

• Retinol: Known for anti-ageing, retinol also improves texture and boosts cell turnover, preventing clogged pores that exacerbate rosacea. I use it cautiously with rosacea patients, starting at lower concentrations and monitoring their skin’s response.

• Ceramides: Essential lipids that repair and protect the compromised skin barrier, helping retain moisture and shield against irritants that trigger inflammation.

• Hyaluronic acid: Provides deep hydration without clogging pores, soothing dry, sensitive skin and helping maintain moisture balance.

Creating a comprehensive skincare regimen:

For my menopausal patients with rosacea, I emphasise a gentle and hydrating skincare regime focused on strengthening the skin barrier and reducing inflammation. Key aspects include:

• Cleansing: Encourage patients to remove any soaps from their skincare routine, as soaps tend to have a high pH that can disrupt the skin barrier. Instead, use a mild, nonfoaming cleanser with a slightly acidic pH to maintain the skin’s natural oils.

• Hydration and barrier repair: Incorporate serums and products with niacinamide, ceramides, panthenol, and hyaluronic acid to soothe and deeply hydrate the skin,

reinforcing its natural barrier.

• Targeted treatments: Avoid high-pH products and harsh actives. For gentle exfoliation, consider PHAs (polyhydroxy acids) instead of AHAs, as they are less irritating. Additionally, retinal (a gentler form of vitamin A) is often better tolerated than retinoic acid for rosacea-prone skin.

• Sun protection: Recommend mineral or zinc-based sunscreens, as they are often better tolerated by sensitive skin. These provide broad-spectrum protection without the irritation that can come with chemical sunscreens.

• Hero products: Incorporate PHAs and salicylic acid where appropriate, as these ingredients are often well-tolerated by sensitive, rosacea-prone skin. Retinal, with its gentler profile, is generally preferred over retinol for these patients.

Some words of caution:

• Caution with vitamin C: When the skin barrier is compromised, avoid high-pH vitamin C formulations. If using vitamin C, opt for gentler versions with a pH suited to sensitive skin.

• Consider hormone testing: For patients presenting with both acne and rosacea, I suggest hormone testing to check levels of prolactin, androgens, and cortisol, which can influence skin health.

• pH sensitivity: For these patients, prioritise products with a pH no higher than 6.5, as this helps minimise irritation and supports a healthier skin barrier.

Innovative in-clinic approaches for menopausal rosacea

In addition to a tailored skincare routine, I am conducting a research study focused on exploring advanced in-clinic treatments specifically for menopausal rosacea patients. The aim of the study is to assess the effectiveness of Profhilo, exosomes, and polynucleotides in reducing inflammation and managing rosacea symptoms in this demographic.

• Profhilo: Known primarily for its hydrating and skin rejuvenation properties, Profhilo is being evaluated for its ability to strengthen skin structure and reduce inflammatory symptoms associated with rosacea. By stimulating collagen and elastin production, it may offer a unique benefit in managing the delicate and sensitive skin of menopausal patients.

• Exosomes: These cell-derived vesicles are rich in growth factors and anti-inflammatory agents, making them a promising option for rosacea treatment. The study examines how Exosomes can accelerate skin healing, reduce inflammation, and improve skin resilience, potentially offering a novel approach to managing rosacea.

• Polynucleotides: These molecules work to enhance cellular structure, elasticity, and tissue regeneration. By strengthening the skin’s foundational layers, polynucleotides may provide long-term improvement in rosacea symptoms and help menopausal skin better resist external triggers.

These studies aim to provide a deeper understanding of how these advanced treatments can offer more effective and sustained relief for rosacea symptoms, specifically in menopausal patients. It’s essential to follow up regularly with patients to monitor their progress and adjust treatments as needed. Menopausal skin can be unpredictable, and what works at one stage may need to be adjusted as their skin continues to change.

Addressing the emotional impact of menopausal skin changes

Menopause can bring about profound physical and emotional shifts, and skin issues like rosacea often add to the emotional strain. The visible symptoms of rosacea can affect self-esteem and create a sense of self-consciousness that impacts overall mental well-being. Providing empathetic, holistic care is essential; by managing these skin changes effectively, we can help women feel more at ease during this life transition. A combination of personalised skincare, targeted in-clinic treatments, and ongoing emotional support allows patients to feel truly cared for, addressing both their physical symptoms and their emotional needs. Educating patients about the underlying causes and treatment options also fosters a sense of control, reducing anxiety and promoting a more positive outlook on their skincare journey. This compassionate approach empowers women to embrace this stage of life with confidence.

And finally

Supporting menopausal patients with rosacea means addressing both the visible changes and the deeper emotional impact that often accompanies them. Many of my patients tell me how much they value the way I care for both their skin and their mental well-being, especially during this period of life. Menopause can be challenging, and rosacea’s visible symptoms can sometimes make women feel more self-conscious. I aim to give patients a renewed sense of confidence, knowing they have someone who genuinely cares about their overall wellness makes a world of difference.

References

• Wilkin, J., Dahl, M., Detmar, M., Drake, L., Feinstein, A., Odom, R., and Powell, F. (2002) ‘Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea’, Journal of the American Academy of Dermatology. https://pubmed.ncbi.nlm.nih.gov/11907512/

• Baber, R. J., Panay, N., and Fenton, A. (2016) ‘2016 IMS Recommendations on women’s midlife health and menopause hormone therapy’, https://pubmed.ncbi.nlm. nih.gov/26872610/

• National Rosacea Society. What is Rosacea? Available at: https://www.rosacea.org/ (Accessed: 25 September 2024).

• Vichy Laboratories. (n.d.) The impact of menopause on skin. Available at: https:// www.vichy.co.uk/skinconsult/the-impact-of-menopause-on-skin (Accessed: 2 October 2024).

• Steinhoff, M., Schauber, J., and Leyden, J. J. (2013) ‘New insights into rosacea pathophysiology: A review of recent findings’, Journal of the American Academy of Dermatology, 69(6), pp. S15-S26.https://pubmed.ncbi.nlm.nih.gov/24229632/

• Two, A. M., Wu, W., Gallo, R. L., and Hata, T. R. (2015) ‘Rosacea: Part I. Introduction, categorization, histology, pathogenesis, and risk factors’, Journal of the American Academy of Dermatology, 72(5), pp. 749-758. https://www.sciencedirect.com/science/ article/abs/pii/S0190962214018751

• Thiboutot, D., Anderson, R., Cook-Bolden, F., Draelos, Z., Gallo, R., Granstein, R. D., Webster, G. (2009) ‘Standard management options for rosacea, part 1: Overview and broad spectrum of care’, Cutis, 84(1), pp. 43-47. Available at: https://www.mdedge. com/ (Accessed: 25 September2024).

SKIN

BEST FACE FORWARD

Vicky Eldridge visits the Dr Raquel Skin and Medical Cosmetics clinic in West Malling, Kent, to try Purasomes exosomes and Alumier MD skincare

My skin had been feeling a bit dull and tired, and having spent most of 2024 writing about the exciting possibilities of regenerative treatments like exosomes; I was keen to test some out for myself.

So off I went to see Dr Raquel Amado at the Dr Raquel Skin and Medical Cosmetics in West Malling in my home county of Kent.

I had been to Dr Raquel for some microtoxin previously and was really happy with the results, so she suggested we take my skin journey a step further with exosomes alongside a comprehensive skincare regime.

After an initial comprehensive consultation, including looking at my skin under the Observ 3D camera, Dr Raquel suggested a course of three treatments using Purasomes spaced three months apart. For home care, I would be using Alumier MD’s products.

The first thing I will say about Raquel is that she absolutely never makes you feel rushed. She gave me her full time and attention at each appointment, and I never felt like I was being ushered out of the door.

The second thing is she is the absolute queen of pain management. The exosomes were to be delivered via SkinPen, and having had microneedling before, I wasn’t looking forward to it. I’d also tried polynucleotides and found them painful, so I was worried exosomes would be the same. I need not have feared. I was giving numbing at each visit and didn’t feel A THING. Raquel regularly checked in to make sure I was experiencing any discomfort. Honestly, I could have taken a nap!

The first treatment was on June 25, 2024, when I had microneedling at a depth of 1mm, with the exception of around the eyes, forehead and upper lip line where Dr Raquel used 0.5mm depth. I had a total of 3ml of the DermaFocus Purasomes SGC100+ Skin Glow Complex.

Purasomes SGC100+ Skin Glow Complex decreases the formation of pigmentation –which was much-needed for me – revitalises skin for radiance and vitality, reduces free radicals and creates a long-lasting protective barrier against sun radiation by promoting cell turnover, accelerating blood vessel formation, facilitating skin healing and decreasing inflammation.

My second treatment wasn’t until September 16, 2024, due to me having Covid and summer holidays. I once again had the Purasomes SGC100+ Skin Glow Complex with microneedling at a depth of 1mm, with the exception of around the eyes, forehead and upper lip line, where Dr Raquel used 0.75mm depth this time.

My final treatment was on October 15. I had Purasomes SGC100+ Skin Glow Complex and microneedling at a depth of 0.5mm everywhere due to how hormonally spotty I was.

The thing about regenerative procedures is you usually have to wait to see results, so there is not the instant “wow factor” there is with other procedures. However, that being said, having come in for my third appointment with particularly hormonal spotty skin, I was blown away by the overnight difference in my skin so much so that I took pictures to show Raquel, who noted how exosomes can help to calm really inflammed skin.

The downtime from the treatment was really manageable. My skin was quite red for two or three days afterwards and stung slightly like a sunburn. But the recovery was pretty quick and didn’t interfere with my daily activities.

In terms of skincare, we kept it simple while I had the exosomes treatment, keeping the vitamin C and retinol on hold until I had completed my last treatment.

Alongside my treatments, Dr Raquel prescribed a routine of Alumier MD products including:

1. SensiCalm: A gentle cream cleanser which smells divine. It purifies and cleanses while easing redness and irritation, leaving the skin feeling nourished, balanced and refreshed. I absolutely loved this product especially at night after removing my make-up to cleanse my skin before bed.

2. Bright & Clear: A refining, refreshing skin-conditioning solution both invigorates the complexion and champions the skin’s natural balance and cell renewal.

3. Ultimate Boost Serum: A rejuvenating, hydrating serum that boosts radiance and rejuvenation. It contains Sodium Hyaluronate and LMWHA, which work synergistically by binding water up to 1,000 times to skin cells, providing comprehensive hydration and repairing the skin both internally and externally. “Ultimate Boost Serum deeply hydrates the skin, replenishing moisture levels for intense and lasting multi-level hydration, helping to plump and smooth out fine lines and wrinkles whilst restoring the skin’s natural moisture barrier”, says Dr Raquel.

4. Alumience AGE: An advanced age defence serum formulated with potent antioxidants that protect the skin from premature ageing and oxidative stress triggered by pollution, free radicals, and AGEs (advanced glycation end products).

5. Refining Clay Mask: An innovative skin-refining mask with natural clays to absorb excess oil, deeply cleanse and banish shine without drying skin. I love a clay mask so it was great to have this in the mix.

6. And of course, SPF. I used Alumier’s Sheer Hydration Broad Spectrum SPF 30, which is a gorgeous, silky product that didn’t feel at all cakey on my skin, which meant I didn’t miss having a moisturiser in my routine.

After my final exosome treatment, I started on the retinol. I used Retinol Resurfacing Serum 1.0, and I have to say this is the best retinol product I have ever used. I have used really effective retinol products before, especially when my acne has been bad, but I have always really suffered from redness and dryness. With this product, I didn’t get that at all. The overnight impact of it was immediately visible from the first application. What’s special about it is its time-released formula that ensures continuous rejuvenation while you sleep, while niacinamide strengthens the skin’s tolerance, and a clinically-proven peptide unveils a smoother, firmer, more youthful complexion.

I also started using Alumier’s EverActive C&E + Peptide. Unlike other vitamin Cs I have used this didn’t oxidise and go brown. There’s a reason this product has won awards. It is uniquely packaged to ensure optimal freshness and efficacy. This high-strength serum features a blend of 15% Vitamin C, Vitamin E, and MATRIXYL® Synthe’6®, a powerful peptide, to target signs of ageing and revitalise the skin. It is clinically proven to reduce the depth and volume of wrinkles, improve surface homogeneity, and even out complexion within 56 days.

Following my course of treatment and using the products at home, I felt like my complexion was smoother and much more even. I was able to go makeup-free again, which I prefer most of the time but hadn’t been doing due to feeling my skin looked “blotchy”. Imaging showed a reduction in pigmentation and pore size. As someone who hasn’t wanted to go down the fillers route in my 40s, I love the prospect of regenerative injectables and would definitely have Purasomes again. It was also really nice, after 20 years in the industry, to commit myself to one product range rather than mixing and matching products from multiple ranges and I love everything about the Alumier range.

I was really pleased with how my skin improved over the course of the treatment. It has continued to do so, and people have commented on how well I look, which is the ultimate Litmas test.

SKIN PRODUCT NEWS

AestheticSource launches Revision Skincare® CMT Post-Procedure Cream™

Revision Skincare® CMT Post-Procedure Cream™ delivers an innovative solution for optimal post-procedure skin recovery, decreasing discomfort and reducing downtime. Featuring a first-of-its-kind, patent-pending neurocosmetic technology, this post-procedure cream has been clinically proven to help skin recover better and faster following chemical peels, micro-needling and laser treatments.

The neurocosmetic technology contains unique ingredients that enhance the communication between the skin and the brain. It targets the pathways that trigger this communication, such as TRPV1, a receptor found on skin cells and sensory neurons. This senses heat and distress in the skin, sending signals to the brain and resulting in the perception of discomfort. By suppressing this, it interrupts the skin’s pain cycle and reduces pain and discomfort. It also works to regenerate the epidermal barrier, reducing inflammatory reactions and allowing the skin to recover faster.

The formulation also combines pre- and postbiotics, ceramides and THD Ascorbate to bring the skin microbiome back to health, reduce moisture loss and provide antioxidant protection.

iS Clinical unveils Skin Renewal Collection

iS Clinical has introduced The Skin Renewal Collection, which contains brand favourites that are housed in a deluxe travel bag.

The kit contains the award-winning Cleansing Complex, a multi-tasking formula that gently yet effectively removes makeup and impurities without stripping skin of essential natural oils; Active Peel System, an advanced, two-step resurfacing treatment that provides controlled exfoliation while increasing hydration and rejuvenation; Reparative Moisture Emulsion, a lightweight, intensively rejuvenating moisturiser to keep skin feeling smooth and hydrated throughout the day and overnight and Retinol+ Emulsion 0.3 designed to smooth, soften and brighten the appearance of the skin.

Skin Life Analytics launches test to measure skin ageing

Skin Life Analytics, a testing company that improves skin health by putting personalised information into the hands of clinicians and their customers, has launched its innovative test.

Developed by Professor Mark Birch-Machin, a leading global expert in mitochondria and its relationship to skin ageing, Skin Life Analytics can non-invasively measure mitochondrial health in skin, giving patients and clinics the ability to see at the molecular level and make invisible damage visible. The test helps provide a personalised prescription, allowing clinicians to track mitochondrial health over time and slow the skin ageing of their clients.

AlumierMD creates limited-edition skincare kits to protect against winter-induced inflammaging

AlumierMD has created two limited edition skincare kits to support surges in patient needs in winter – both seasonally-impacted inflammaging and demand for party season-ready skin.

The Brightening Gift Set is a great introduction to medical-grade skincare or for people not currently exfoliating their skin, as it provides instant results. Patients will experience smoother, brighter and more glowing skin, helping to protect and maintain youthful complexions.

The Boosting Gift Set will re-energise the patient’s complexion, supporting the longevity of skin health. Its regenerative ingredients, including synthesised peptides, target the multiple root causes of ageing, such as DNA damage and cellular fatigue, to support the skin’s architecture and restore both radiance and rejuvenation.

BUSINESS SECTION

In this section

• Supplier relationships

• Tax and VAT

• Personalised skincare

PARTNERING WITH THE RIGHT SUPPLIERS

Sara Cheeney on the importance of working with the right suppliers

If you are a clinic owner, you will know how challenging it can be. And with so many aesthetic practitioners working in isolation, partnerships are key.

One vital yet often overlooked aspect of optimising your clinic’s operations is choosing the right suppliers. Establishing strong partnerships with suppliers not only enhances the quality of care you are able to provide to patients but also maximises your business potential too.

Understanding the importance of supplier relationships

The right suppliers play a crucial role in ensuring that clinics operate smoothly. But why is this? Suppliers give you access to everything from medical equipment to consumables, injectables and skincare. Whatever you are using in your clinic, someone has supplied it.

Having good relationships with your suppliers helps with reliable product availability, preferential pricing, and added value through services such as training and support.

As such, clinics should prioritise suppliers who align with their unique needs, values, and objectives. This involves being clear about the type of products and services required and conducting thorough research on potential suppliers.

Selecting the right suppliers

When evaluating supplier options, you should consider several key criteria:

1. Quality and reliability: It is essential that suppliers deliver high-quality products consistently. This reliability is critical in the medical field, where the stakes are high, and patient safety is paramount.

2. Reputation and experience: A supplier’s track record can provide insights into their reliability and performance. Practices should seek suppliers with proven experience in the healthcare sector and positive testimonials from other clinics and practitioners.

3. Responsiveness: Good suppliers should offer responsive customer service to address any concerns or issues that may arise. A supplier who is easy to communicate with and quick to resolve problems can save time and stress for medical professionals.

4. Cost competitiveness: While cost should not be the sole deciding factor, it is important to analyse pricing models. Favourable terms such as bulk discounts, flexible payment options, and loyalty programs can significantly affect a clinic’s bottom line.

5. Innovation and technology: As the healthcare industry evolves, technology plays an increasingly important role. Suppliers who invest in innovative solutions can provide clinics with tools that enhance patient care, streamline operations, and improve communication.

Establishing strong partnerships

Once you have identified who you feel are the right suppliers for you, building strong partnerships with them is crucial. This means more than just transactional relationships; it involves collaboration and open communication. Clinics should engage suppliers in discussions about long-term goals, enabling both parties to work towards shared objectives.

Regular meetings and performance evaluations can help both clinics and suppliers stay aligned and motivated to adapt to changes in the market or the clinic’s needs. Additionally, clinics can benefit from suppliers’ insights into industry trends, helping them stay ahead of the competition.

Conclusion

In summary, choosing the right suppliers is a strategic move for medical clinics looking to maximise their business potential. By prioritising quality, reliability, and innovation, clinics can improve operational efficiency and enhance patient care. As the healthcare environment continues to evolve, establishing strong partnerships with suppliers will be essential for clinics striving to succeed in a competitive landscape. Investing time in building and maintaining these relationships can yield significant returns, ultimately benefiting both the practice and its patients.

BUSINESS

With the self-assessment tax return deadline fast approaching, Hamilton Fraser shares some practical tips to help aesthetic practitioners manage their tax and VAT responsibilities

“Money makes the world go round”, but it can also make your head spin as a business owner. Many medical professionals transitioning into business ownership often find the financial, tax, and VAT obligations challenging. However, navigating the financial aspects of an aesthetic practice is crucial to business success.

Hamilton Fraser recently created a comprehensive guide to finance, tax, and VAT in aesthetics. Here, they share some of the tips and insights from that report.

Tax returns

Whether you are self-employed or managing a larger clinic, handling tax returns carefully is vital for compliance and maximising deductions.

For any business owner, understanding tax obligations is key. Whether you are self-employed or running a larger clinic, proper handling of tax returns helps you comply with financial regulations and can significantly affect the business’s bottom line through potential deductions and credits.

Key tax obligations for aesthetic practitioners

• Understanding taxable income: All income generated from aesthetic services, including treatments and product sales, is subject to income tax. It’s crucial to maintain thorough records of all transactions, as this will form the basis of your tax returns

• Deductible expenses: Many expenses incurred in the running of your clinic can be deducted from your taxable income. These include costs related to rent, utilities, equipment purchases, and maintenance, as well as expenses for staff training and salaries. Proper documentation of these expenses is critical for claiming them accurately on your tax returns

• Capital allowances: Investment in clinic equipment can often be counted as a capital expense, which may not be fully deductible in the year of purchase. Instead, these items might be eligible for capital allowances, which allow the cost to be written off

against taxable profits over several years. Understanding how to apply these allowances can significantly reduce your tax liability

• Employment taxes: If you employ staff, you’re responsible for deducting income tax and National Insurance contributions from their salaries under the PAYE (Pay As You Earn) system. You also need to make National Insurance contributions, which should be factored into your financial planning

• VAT obligations: Depending on your turnover, you may need to register for VAT. Once registered, you’ll need to charge VAT on applicable services and products, and you can reclaim any VAT you pay on business-related purchases. The distinction between cosmetic and medical treatments can affect VAT charges, as some medical procedures may be exempt.

Practical advice for managing tax returns

• Keep comprehensive records: Maintain detailed and accurate records of all financial transactions, including invoices, receipts, and bank statements. Digital accounting software can facilitate this process and help make sure that all figures are accurate and up-to-date

• Stay informed on tax changes: Tax laws can change frequently, so it’s important to stay updated on any changes that could affect your practice. This may involve consulting with a tax professional or attending relevant training and seminars

• Utilise professional help: Hiring an accountant specialising in medical or aesthetic practice taxation can be highly beneficial. They can provide advice tailored to your specific circumstances, helping to optimise your tax returns and make sure of compliance

• Plan for tax payments: Set aside funds regularly to cover your expected tax bill. This can prevent the financial strain of a large lump sum payment when taxes are due and can help avoid penalties for late payments

•

UNDERSTANDING

Common pitfalls to avoid

• Underreporting income: Report all income, including cash payments and ad hoc services, to avoid penalties.

• Overclaiming expenses: Claim only business-related expenses. Keep personal and business expenses separate to avoid complications with tax authorities

• Ignoring deadlines: Late submission of tax returns can result in penalties and interest charges. Keeping track of all relevant tax deadlines is essential

• Neglecting to update records: Regularly updating financial records can prevent discrepancies and issues during tax filing. This includes updating asset valuations and inventory lists

VAT in the aesthetics sector

VAT can be complex, especially in distinguishing between medical and cosmetic treatments. Read on to find out more.Navigating VAT (Value Added Tax) in the aesthetic sector can be a daunting task. VAT applies to most goods and services. In the aesthetics sector, businesses must determine whether their services are taxable or qualify as VATexempt medical treatments.

UNDERSTANDING TAX AND VAT IN AESTHETICS

VAT registration and thresholds

• VAT Registration: All aesthetic practices with a taxable turnover exceeding £90,000 in any 12-month rolling period must register for VAT. This includes income from both cosmetic treatments and other taxable supplies like product sales or training services

• Proactive compliance: Voluntary VAT registration before reaching the threshold can be beneficial. It allows businesses to establish compliance practices early and potentially limit HMRC’s ability to assess VAT obligations retrospectively beyond four years

Distinguishing medical vs. cosmetic treatments

• Legal requirements for exemption: To qualify for VAT exemption, treatments must be provided by a professional registered on a recognised medical register and must be primarily for medical purposes

• Documentation and proof: Accurate documentation is crucial. It’s not enough for a treatment to have a medical aspect; its primary purpose must be medical to qualify for VAT exemption. This means keeping detailed records that demonstrate the

medical necessity of each treatment on a patient-by-patient basis

Record-keeping for VAT purposes

• Importance of detailed records: Thorough patient records that clearly document the medical purpose of treatments are essential. This includes detailed notes on the diagnosis, the rationale for deciding on a particular treatment, and how the treatment serves a medical purpose

• Avoiding common pitfalls: A common mistake is the inadequate categorisation of treatments as either exempt or taxable without considering each case’s specifics. The VAT liability must be determined based on the primary purpose of the treatment, supported by clear and detailed evidence

Managing VAT on products and equipment

• VAT on sales: The VAT treatment of products depends on their use. If a product is sold separately from a treatment, it is typically a taxable sale. However, if it is provided as part of an exempt medical treatment, it may also be exempt from VAT.

• Equipment usage: The VAT on expensive equipment like lasers can be

recoverable if used solely for taxable cosmetic treatments. If used for both taxable and exempt treatments, only a portion of the VAT can be recovered, depending on the proportion of taxable sales

Strategies for VAT risk management

• Consulting VAT specialists: Given the VAT complexities in the aesthetics sector, working with a VAT specialist familiar with industry-specific challenges is crucial. This makes sure of correct VAT law interpretation and compliance

• Ongoing education and vigilance: Stay informed about VAT requirements and maintain meticulous records. This proactive approach helps in managing VAT risks effectively and means you are compliant with HMRC regulations.

For more insights including business planning, insurance considerations and profit and pricing, read Hamilton Fraser’s comprehensive guide to finance, tax and VAT and comprehensive guide to VAT in the aesthetics sector.

https://www.hamiltonfraser.co.uk/ content-hub/a-comprehensive-guideto-finance-tax-and-vat-in-aesthetics Adobe/Atchariya63

Reception staffing solutions, keeping you in the conversation

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

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

Empowering Practitioners to build a thriving aesthetic business

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

Core services include:

• Virtual clinic receptionists

• Appointment booking

• Deposits & payments

• Lead management

• Great customer service

• Affordable clinic support

T: 0191 720 3000

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

Elevate skills, efficiently & effectively Online Training Course

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

Course content includes:

• Interactive online learning

• Industry expert tuition

• Comprehensive curriculum

• Flexible & accessible program

• Modules & downloads

• Affordable training solution

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

BUSINESS

TOP 10 TIPS TO AVOID BEFORE LAUNCHING YOUR OWN SKINCARE RANGE

Gary Conroy from 5 Squirrels shares his advice

Launching a skincare brand can be an exhilarating journey, but it’s also fraught with challenges. Here are the top ten mistakes that entrepreneurs often make, along with insights on how to avoid them using principles from the lean startup methodology.

1. Buying too much product upfront

One of the most common pitfalls is overcommitting to inventory without a clear understanding of market demand. Entrepreneurs often invest heavily in product development but neglect to allocate sufficient funds for marketing. This can lead to a situation where you have plenty of product but no budget left to promote it.

5 Squirrels has a range of Bespoke Branding Solutions available in low minimum order quantities starting from just 10 units at low cost to support you in the early days to garner market traction without sacrificing your cash flow or overinvesting in stock.

Tip: Start with a minimum viable product (MVP) approach. Focus on a smaller batch that can be tested in the market. This way, you can gather feedback and adjust your offerings without the financial strain of excess inventory.

2. Not Identifying a route to market

Many new brands fail to define their distribution channels before launching. Without a clear route to market, even the best products may struggle to reach potential customers.

5 Squirrels have a wealth of experience to support you whether your route to market is direct to existing customers, retail through 3rd parties, online, distributor networks or a combination of multiple channels.

Tip: Conduct thorough market research to identify where your target audience shops. This could include online platforms,

local boutiques, or even pop-up events. Establishing these channels early on can help streamline your efforts and maximize visibility.

3. Not differentiating the brand In a saturated market, failing to differentiate your skincare brand can be detrimental. Many entrepreneurs assume their product’s quality will speak for itself, but without a unique value proposition, it can get lost among competitors.

5 Squirrels can support you identifying the pain points of your intended audience so we can tailor your brand language and benefits to let your customers know you understand their problem and you can fix it, which will help them feel the brand understands their issues.

Tip: Identify what makes your brand special. Whether it’s unique ingredients, sustainable packaging, or a specific focus on skin concerns, highlight these aspects in your branding and marketing strategies.

4. Focusing on design over target audience needs

While aesthetics are important, prioritising design over understanding your target audience’s needs can lead to disappointment. Beautiful packaging might attract attention, but if the product doesn’t meet customer expectations, they won’t return.

5 Squirrels’ high-quality bespoke design offering and high-quality clinical-evidenced products address both issues by attracting customers and delivering results. After all, many people will buy once on a promise but will only buy again based on results.

Tip: Engage in live market research. Use surveys, focus groups, and social media polls to gather insights into what your audience values most. Iterate your product design based on this feedback to ensure it resonates with your target demographic.

5. Spending too much on PR & advertising before distribution is set up

Many brands allocate substantial budgets toward PR and advertising before they have solid distribution channels in place. This can waste resources and create a disconnect between marketing efforts and product availability.

5 Squirrels can advise you on the best ways to build solid distribution channels, whether it is online partners, direct from your own e-shop or through other service providers so that any demand created by your brand awareness activities can be met and customers are not disappointed.

Tip: Build your distribution strategy first. Once you have reliable channels in place, then invest in PR and marketing campaigns that direct traffic to those points of sale.

6. Overspending

Entrepreneurs often overlook the importance of budgeting, leading to overspending on unnecessary features or services. This can quickly deplete funds that are better allocated elsewhere.

5 Squirrels can help you develop a robust business plan to bring your product to market and keep it trading without running out of cash too soon so that you have the best chance of building a sustainable, profitable business.

Tip: Create a detailed budget that outlines all expected expenses. Track your spending diligently and be prepared to pivot if certain areas are not yielding a return on investment.

7. Spending too much time on the website

While a professional website is crucial, many brands spend excessive time perfecting their online presence at the expense of product development and marketing. A website can always be

BUSINESS

improved, but a great product is essential.

5 Squirrels can support you with digital photography for your brand, and we have affiliates who can help with low-cost, highend website creation.

Tip: Launch with a functional, user-friendly website that highlights your brand and products. Use customer feedback to continuously enhance the site over time without sacrificing other critical areas of your business.

8. Ignoring customer feedback

In the early stages, feedback from customers can provide invaluable insights. Neglecting to listen to this feedback can lead to continued mistakes and missed opportunities for improvement.

5 Squirrels can support you to iterate on your brand based on the feedback, whether that be design or formulation elements, to continually meet your customer’s expectations.

Tip: Incorporate a feedback loop into your business model. Encourage customers to share their thoughts on your products and use this information to iterate and

enhance your offerings.

9. Scaling too quickly

Many brands experience initial success and feel pressured to scale rapidly. However, scaling without solidifying your foundation can lead to operational headaches and quality control issues.

5 Squirrels has a range of services to help you scale in a responsible way through forecasting and drawdowns without overstocking or running out of funds.

Tip: Adopt a lean approach by testing your product in smaller markets before scaling. Make sure you have the processes and infrastructure in place to handle larger volumes without compromising quality.

10. Forgetting to build a community

Finally, neglecting to foster a community around your brand can limit engagement and loyalty. Skincare is often a personal journey, and customers appreciate being part of a supportive community.

5 Squirrels can support you with digital marketing tools such as posts and direct mail marketing to help keep your customers engaged and part of the gang!

Tip: Utilise social media and online forums to create a space for customers to share their experiences. Build relationships and encourage discussions that align with your brand values, fostering a sense of belonging.

Conclusion

Launching a skincare brand requires careful planning, market understanding, and adaptability. By avoiding these common mistakes and implementing the principles of lean startup methodology, entrepreneurs can create a resilient brand that resonates with their target audience and thrives in a competitive landscape. Remember, the path to success is iterative—learn, adapt, and grow!

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

MENOPAUSE IN AESTHETICS (MIA) 2025

Friday 7th February 2025, at the Grand Connaught Rooms, London

Whether you want to offer menopause services in your clinic or to be more informed about menopause so that you can better serve patients on their journey through this transformative stage of life, MiA has you covered. From hormones and intimate health to longevity, lifestyle medicine and the synergy between aesthetics treatments and menopause, MiA brings together a multidisciplinary faculty to discuss the latest science and experience. For more information, please visit www.menopauseia.co.uk

AESTHETICS CONFERENCE & EXHIBITION (ACE) 2025

Friday 14th and Saturday 15th March 2025, at the Business Design Centre, London

Aesthetics Conference & Exhibition (ACE) is renowned for its exceptional educational programs, cutting-edge demonstrations, and exclusive networking opportunities. ACE empowers practitioners to remain at the forefront of the ever-evolving aesthetics field. Brought to you by Aesthetics, the brand behind the Aesthetics Journal, CCR, and The Aesthetics Awards, ACE helps medical professionals achieve clinical and business excellence.

For more information, please visit www.aestheticsconference.com

THE AESTHETIC AND ANTI-AGEING MEDICINE WORLD CONGRESS (AMWC)

Thursday 27th - Saturday 29th March 2025, at the Grimaldi Forum, Monaco

The Aesthetic and Anti-Ageing Medicine World Congress (AMWC) is the industry’s leading event focusing on the continuing education of physicians and the fostering of new, meaningful professional connections. With 23 years of conference production, AMWC offers an unparalleled level of expertise in this field. Attendees of AMWC Monaco will benefit from a top-tier scientific program presented by esteemed key opinion leaders and educators. For more information, please visit www.amwc-conference.com

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

Become a menopause first responder

Get ready for a night of glitz and glamour

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

Over 40 Top experts

40 Exhibitors

500 Delegates

15 CPD-applied for hours

Champagne reception with networking opportunities

Hybrid conference with online and in person ticket options

Gain insight and new knowledge from industry leading KOL’s

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

INTEGRATIVE MENS HEALTH

March | Marion Gluck Training Academy

This one-day course will explore personalised approaches to addressing symptoms experienced by many ageing males, such as fatigue, decreased libido, erectile dysfunction, depression, and more. The course will cover Testosterone Replacement Therapy (TRT) and DHEA supplementation with licensed therapies and compounded options, where appropriate.

THE ART OF AESTHETIC CONSULTATION TRAINING COURSES TRAINING

Any time | Flexible online access

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

TREATMENT GROWTH MASTERY COURSE

Anytime Online | Consulting Room Academy

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

POLYNUCLEOTIDE TRAINING COURSE

Various Dates Available | Cosmetic Courses

In partnership with Dermafocus, we are now offering our delegates training in Mastelli’s Polynucleotides High Purification Technology (PN HPTTM). Learn how to perform this revolutionary treatment safely to provide the best results for your patients.