Welcome to the July/August issue of PRIME Journal. As the field of aesthetic and anti-ageing medicine continues to expand at a remarkable pace, this issue brings together some of the most exciting developments and expert perspectives driving the conversation forward.
We begin with a feature that offers a unique snapshot of what’s capturing the attention of aesthetic doctors around the world right now. Wendy Lewis speaks with leading practitioners who share the new treatments, technologies, and skincare innovations they’re most excited about—from next-generation neuromodulators and regenerative topicals to novel devices that promise more personalised results.
Combining aesthetic tools for optimised outcomes is a theme that continues to gain traction. Mariam Tsivtsivadze, MD, explores how threads, toxins, and fillers can work in harmony to deliver tailored solutions for facial lifting, harmonisation, and asymmetry correction. Her approach underscores the trend toward multi-modal, minimally invasive strategies that reflect patients’ increasing demand for customisation with minimal downtime.
Lips remain a focal point in many aesthetic treatments, and Olena Cherhava, PhD, introduces the 'sandwich technique' in lip augmentation—an individualised, multilayered injection approach that prioritises balance and natural aesthetic outcomes. Her insights reinforce the importance of anatomical precision and thoughtful layering in achieving consistent, patient-pleasing results.
Elsewhere in the issue, Yoonsu Ku, MD, presents a clinical evaluation of Bellacholine for submental fat reduction using ultrasound imaging. The data supports the treatment’s efficacy and precision, adding to the growing body of evidence for non-surgical body contouring techniques.
Affiliated partners:
International Journal of Aesthetic and Anti-Ageing Medicine
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Editor Balraj Juttla balraj.juttla@informa.com
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For practitioners with global aspirations, Vanessa Bird outlines a clear, practical roadmap to building an international profile—whether through conference speaking, authorship, training roles, or brand partnerships. Her advice is invaluable for those looking to grow beyond the borders of their current practice and make a meaningful impact on the international stage.
Finally, Jane Yoo, MD, addresses the growing role of artificial intelligence in aesthetic medicine. From streamlining consultations to improving marketing strategies and enhancing patient engagement, AI is no longer a futuristic concept but a practical tool for forward-thinking clinics.
We hope you enjoy the issue and look out for our bumper September/October issue coming to you in just a few short weeks.
Balraj Juttla Editor, PRIME balraj.juttla@informa.com
Lead the future of aesthetic medicine with AURA - 3D facial analysis technology
By seamlessly combining awardwinning hardware with intuitive software, Aura transforms 3D facial analysis into a visual, collaborative experience. With a single capture, it generates a photo-realistic digital twin of a patient’s face and neck, empowering dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan, dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan,and communicate with confidence.
July/August 2025
NEWS
7 Latest ASPS report unveils steady demand for plastic surgery amid economic uncertainty
8 Global Perfection Index reveals the most image-conscious cities
INDUSTRY INSIDER
10 What aesthetic doctors are excited about right now From groundbreaking neuromodulators to regenerative skincare, Wendy Lewis speaks to leading aesthetic doctors about the new treatments, technologies, and skincare innovations they are most excited about right now
14 Key steps to building a global profile
With the aesthetics industry becoming increasingly global, Vanessa Bird outlines the key steps practitioners can take to raise their international profile whether through speaking, publishing, training, or global partnerships
20 Menopause mania
Women suffering from symptoms related to menopause want to be heard. How can aesthetic providers effectively help with hot flashes, weight gain, and other related concerns? We asked three menopause experts about how best to care for women navigating the change
CASE STUDY
24 Clinical evaluation of Bellacholine for submental fat reduction using ultrasound imaging
Yoonsu Ku, MD, presents new data supporting Bellacholine as an effective and precise approach for submental fat reduction
AESTHETIC FEATURES
28 When a single approach is not enough: Combining threads, toxins, and fillers
Mariam Tsivtsivadze, MD, explains how combining treatments offers customised, minimally invasive solutions for concerns such as eyebrow lifting, facial harmonisation, and asymmetry correction
34 The ‘sandwich technique’ in lip augmentation
Olena Cherhava, PhD, explores how an individualised, multi-layered injection strategy can help achieve natural-looking, balanced results
PRACTICE MANAGEMENT
38 Artificial intelligence and the aesthetic practice
Jane Yoo, MD, shares best practices for using AI to improve the patient experience and market aesthetic services
EVENTS
42 A round-up of the major industry events around the world over the next 12 months
NEWS
A
round-up of news stories in the aesthetic and anti-ageing medicine industry
LATEST ASPS REPORT UNVEILS STEADY DEMAND FOR PLASTIC SURGERY AMID ECONOMIC UNCERTAINTY
Despite economic headwinds in 2024, overall patient demand for plastic surgery procedures remained steady, the American Society of Plastic Surgeons (ASPS) revealed in its latest annual report. The 2024 ASPS Procedural Statistics Report found that the total number of cosmetic surgeries and minimally invasive treatments remained stable in 2024, showing respective 1% and 3% year-over-year increases.
‘Patients continued to prioritise their aesthetic health in 2024 despite the unpredictable economic uncertainty they faced throughout the year, with growth across surgical procedures, minimally invasive treatments and reconstructive surgery,’ said ASPS President Scott Hollenbeck, MD. ‘People want to look and feel their best so they can face the challenges of everyday life with greater confidence. However, amid ongoing economic uncertainty, safety must remain the top priority. We strongly recommend that patients consult ASPS Member Surgeons for any cosmetic or reconstructive procedure to ensure the highest standard of care.’
Most popular procedures
Of the nearly 1.6 million cosmetic surgical procedures performed in 2024, the top five were:
■ Liposuction: 349,728 procedures
■ Breast augmentation: 306,196 procedures
■ Tummy tuck (abdominoplasty): 171,064 procedures
■ Breast lift: 153,616 procedures
■ Eyelid surgery: 120,755 procedures.
Of the over 28.5 million minimally invasive procedures in 2024, the top five were:
■ Hand surgery (i.e., carpal tunnel, arthritis, trigger finger): 208,480 procedures
■ Breast reconstruction: 162,579 procedures
■ Maxillofacial surgery: 54,747 procedures
■ Scar revision: 54,280 procedures.
Lifts, tucks, and weight loss
Plastic surgeons are playing an increasingly crucial role in many patients’ weight loss journeys, bringing both medical expertise and years of experience in helping individuals restore their physical health. For the first time, the 2024 ASPS Procedural Statistics Report has measured the prescription of weight loss medications by its members, with over 800,000 aesthetic patients utilising them to support their health goals in 2024.
The report found 20% of GLP-1 patients under the care of ASPS
Member Surgeons have already undergone plastic surgery, while 39% are considering a surgical procedure, and 41% are considering a nonsurgical procedure. While not a substitute for weight loss surgery, body contouring procedures can help
GLP-1 patients achieve balance, improved functionality and enhanced self-esteem. Tummy tucks remained the second most popular procedure, with a 1% increase from 2023. Facelifts and forehead lifts both grew by 1% as well. Buttock and thigh lifts rose by 3%, upper arm lifts grew by 2% and neck lifts climbed by 2%.
Injectables on the rise
Likely due to their affordability and short recovery times, minimally invasive injectable treatments grew 3% in 2024, well over the 1% increase that surgical cosmetic procedures saw. Injectables, known for their personalisation and subtle results, remained a clear favourite. Neuromodulators such as Botox® saw a 4% year-over-year increase, maintaining their spot as the top minimally invasive treatment, while HA fillers grew by 1%. Demand for lip and non-HA fillers remained consistently strong.
Safety before savings
Regardless of aesthetic goals or budget, safety must remain paramount. By choosing an ASPS Member Surgeon, patients can ensure they are getting the care they deserve. ASPS sets the standard for excellence in plastic surgery by prioritising expertise, ethics and patient care. ASPS Member Surgeons have been certified by the American Board of Plastic Surgery (ABPS) and have more than six years of surgical training and experience, with at least three years specifically dedicated to plastic surgery.
GLOBAL PERFECTION INDEX REVEALS THE MOST IMAGE-CONSCIOUS CITIES
LATEST REPORT UNVEILS THE GLOBAL LANDSCAPE OF BEAUTY IDEALS
Arecent report by MedicaDepot has unveiled the global landscape of beauty ideals, ranking 50 cities based on their imageconsciousness. The findings reveal how the pressure to conform to beauty standards differs across cultures, showcasing a spectrum of preferences for the ‘perfect’ face and body.
Top 10 most image-conscious cities
1. Singapore Known for its emphasis on symmetry, flawless skin, and subtle perfection, Singaporean beauty standards reflect an obsession with meticulous aesthetics.
2. Seoul With a strong preference for youthful, glass-skin looks and a V-line jaw, Seoulites are driven by a desire for idealised facial features popularised by local media.
3. Sydney The Australian city values an athletic physique and a beach-toned glow, emphasising an active lifestyle combined with a curated approach to beauty.
4. Milan Recognised for its sculpted elegance and fashion-driven aesthetics, Milan offers a blend of high-fashion influences and personal style.
5. Manila With a flair for soft glam influenced by beauty pageants and social media trends, Manila’s beauty culture embraces both traditional and contemporary ideals.
6. Dubai In this luxurious city, bold curves and sharp contouring are sought after, reflecting a distinctive taste for opulence and dramatic beauty.
7. Melbourne Esteemed for its refined casualness and wellness-focused attitudes, Melbourne embodies a more laid-back yet polished aesthetic.
8. London London’s approach is characterised by a subtle polish, emphasising a low-key yet high-maintenance elegance that captures the essence of looking effortlessly put-together.
9
. Istanbul This city celebrates structured femininity with cinema-inspired glam, blending historical influences with modern beauty standards.
10. Jakarta Jakarta’s beauty ideal involves a delicate charm combined with high-impact skin and body ideals, showcasing a blend of traditional elegance and contemporary trends.
The 5 least image-conscious cities
1. Oslo In this city, natural ageing is celebrated, and there is a strong culture of minimal enhancement.
2. Reykjavik Known for its rugged authenticity, Reykjavik exhibits low pressure regarding appearance, valuing genuine beauty.
3. Glasgow Practical beauty rules here, with minimal uptake of procedures, showing a down-to-earth approach to aesthetics.
4. Brussels Modest expectations thrive in Brussels, where there is no dominant aesthetic that dictates beauty standards.
5. Helsinki Valuing functional beauty, Helsinki prioritises personal comfort over polished appearances, emphasising individuality and practicality.
Subtlety across cities
While some cities pursue striking curves or bold enhancements, others, like London and Melbourne, lean towards a more discreet approach to beauty. Ideal traits often include well-toned figures, healthy skin, and a sense of composure. Aesthetic professionals across these cities note that the pursuit of perfection often takes the form of wellness rather than overt cosmetic procedures.
The
emotional
toll of beauty pressures
The report highlights that beauty pressure may often go unspoken. Many individuals feel the need to appear naturally attractive, successful, and well-groomed, all while facing invisible expectations on health, ageing, and online presence.
About the report
The Global Perfection Index was developed by MedicaDepot, an international supplier of skincare and aesthetic products. The ranking of these 50 cities took into account factors such as admired public figures, cultural beauty trends, demand for local aesthetic treatments, media behaviour, and insights from practitioners regarding body and face ideals.
Many individuals feel the need to appear naturally attractive, successful, and well-groomed, all while facing invisible expectations on health, ageing, and online presence.
NAD TEST HELPS WITH OBESITY TREATMENT
Many health professionals are beginning to recognise the importance of nicotinamide adenine dinucleotide (NAD) testing in optimising metabolic function, with growing interest in its potential applications for athletic performance, nutritional advice, and links to addiction treatment and reproductive health.
With increasing public interest in personalised health and longevity, measuring NAD levels, a vital coenzyme, could offer a practical way to understand the connection between nutrition, metabolism, and cellular health. Early test and clinical discussions suggest that NAD may be a key biomarker to help understand diet quality, inflammation, obesity-related metabolic dysfunction, and mitochondrial performance.
As the body’s active form of vitamin B3, NAD is central to over 500 cellular processes — including energy production, DNA repair, and immune response. While NAD levels do not naturally decline, poor diet quality, chronic inflammation, and obesity can cause this depletion, often without symptoms.
Highly processed modern diets, particularly those depleted of fat-soluble vitamins, have been linked to vitamin malabsorption and NAD depletion.
The goal of this report is to illustrate how cities define ‘perfection’ differently and to explore why beauty pressure remains a familiar experience worldwide, even as individual looks evolve.
Until recently, NAD testing has been costly, slow, and often inaccurate. NADMED, a spin-out from the University of Helsinki, has introduced a lab-based solution that overcomes these barriers. This new CE-marked method offers a fast, reliable, and cost-effective way to measure the most common forms of NAD: NAD+ and NADH, with their ratio providing valuable information on an individual’s cellular health. The insights from the test can offer a much deeper understanding of nutritional and metabolic health than traditional vitamin or biomarker tests alone.
WHAT AESTHETIC DOCTORS ARE EXCITED ABOUT RIGHT NOW
From groundbreaking neuromodulators to regenerative skincare, Wendy Lewis speaks to leading aesthetic doctors about the new treatments, technologies, and skincare innovations they are most excited about right now
SUNEEL CHILUKURI, MD, FAAD, FACMS
COSMETIC & DERMATOLOGIC SURGEON, REFRESH DERMATOLOGY, HOUSTON, TX, USA
Letybo ® (letibotulinumtoxinA) (Hugel, Inc., Korea) is the newest neurotoxin to receive FDA approval in the U.S. to treat moderate-to-severe glabellar lines in adults. FDA approval is supported by positive results from three completed phase III trials that enrolled more than 1,200 subjects in the U.S. and Europe.
The results from the clinical trials for letibotulinumtoxinA demonstrate efficacy, and a convincing safety profile in the treatment of glabellar lines.
WENDY LEWIS is Founder/ President of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy since 1997, author of 13 books, and frequent presenter on the international stage. Her first textbook, Aesthetic Clinic Marketing in the Digital Age (CRC Press) debuted a second edition in 2024.
email: wl@wendylewisco.com
I had the opportunity to travel to Korea to be treated personally with Letybo and to understand any subtle differences between this and the numerous other global neuromodulators. What fascinated me is how much neuromodulator competition there is in the global markets. With over 16 choices in Korea and with the option of purchasing less expensive neuromodulators there, Letybo has emerged as the number one neuromodulator in Korea. When I spoke with a number of plastic surgery and dermatology colleagues there, each said the reason they chose Letybo is due to the safety and efficacy of the product.
I’m excited to see what the globally trusted Letybo and other K-beauty products will provide for our U.S. toolbox.
A B C
Patient treated with 20 Units of Letybo® in the glabellar lines. (A) Before; (B) 4 weeks after; (C) 16 weeks after.
DR. RAJ TEETHE MBCHB BSC (HONS) MRCS ED AESTHETIC DOCTOR, YORKSHIRE SKIN CENTRE, UK
At the Yorkshire Skin Centre, we pride ourselves on utilising cutting-edge technologies to deliver exceptional patient outcomes. One of the most exciting platforms we have integrated into our practice is the NeoGen PSR by Energist, a revolutionary nitrogen plasma resurfacing system. This device stands out as a game-changer in the field of skin rejuvenation.
The NeoGen PSR uses controlled pulses of plasma energy, generated from nitrogen gas, to create a unique thermal effect on the skin. Unlike traditional resurfacing methods, it works across the epidermis and dermis without creating an open wound, making it safe and effective for a wide range of patients and skin types. The platform’s versatility allows for tailored treatment depths, from a light refresh to deep resurfacing, enabling precision in addressing concerns such as fine lines, wrinkles, pigmentation, acne scarring, and overall skin laxity.
What sets NeoGen apart is its non-fractional delivery, which ensures complete skin coverage for consistent results. It also stimulates long-term collagen remodelling and elastin regeneration, delivering noticeable improvements in skin quality over time. The technology’s safety profile, combined with its ability to achieve transformative outcomes without the risks associated with ablative lasers, makes it truly revolutionary.
To date, we have successfully performed over 2,000 NeoGen treatments, solidifying it as a cornerstone of our clinic’s approach to skin health and rejuvenation.
NeoGen is used extensively for full-face rejuvenation and targeted treatments like eyelid tightening, where it excels as a non-surgical option. Additionally, our surgeons incorporate NeoGen after blepharoplasty procedures and for managing surgical scars, leveraging its ability to enhance healing, improve scar appearance, and optimise overall surgical outcomes.
This device is particularly popular among women aged 35-65 who seek significant improvement without the downtime of traditional resurfacing. NeoGen also complements other advanced technologies in our portfolio, such as the UltraClear laser, enabling us to create bespoke combination treatments for enhanced results.
BRYAN G. FORLEY, MD, FACS PLASTIC SURGEON, NEW YORK, N.Y., USA
QuantumRF from InMode is an advanced, minimally invasive technology cleared for soft tissue contraction that safely deploys hightemperature fractionated bipolar radiofrequency (RF) energy to achieve significant skin tightening and adipose remodelling of the face, neck, and body. The Teflon-coated lightweight handpiece delivers subdermal bipolar RF pulses at customisable intervals and depths without damaging the dermis and makes procedures remarkably fast and more efficient than other RF devices.
QuantumRF is part of the new InMode IgniteRF platform. I have found great efficacy and predictability in my use of QuantumRF. Its reliability is enabled by the precise subcutaneous delivery of hightemperature fractionated bipolar RF energy released from the innovative applicator tip.
The inherent design and safety of this cutting-edge technology minimises the risk of damage to the dermis and speeds the recovery process with less swelling and bruising. Although the results evolve over six months, I have seen significant improvement as early as six weeks following the procedure. It can also be combined with the new InMode Morpheus8 burst technology for even better results.
QuantumRF has enabled me to expand my non-excisional skin tightening offerings for the face and body to meet the increasing patient demand for safe and effective minimally invasive treatment options. The pulsatile energy delivery system requires a limited injection of local anaesthesia and fewer passes of the applicator, thereby resulting in less downtime.
VIVIAN BUCAY, MD, FAAD
BOARD CERTIFIED DERMATOLOGIST
BUCAY CENTER FOR DERMATOLOGY AND AESTHETICS, SAN ANTONIO, TX, USA
AO2 Clear was invented and manufactured by O2 Partners LLC, Austin, TX. The ingredients are distilled water and oxygen nanobubbles. It was launched to help treat acne, with the idea that ‘good’ bacteria like oxygen, whereas ‘bad’ bacteria that contribute to acne do not thrive in oxygenated environments. Oxygen in the air or oxygen applied to the skin using forced air does not penetrate the skin barrier at the concentrations found in the normal atmosphere. The reason is that oxygen is too big to get through the pores. The water infused with billions of oxygen nanobubbles provides a delivery system that allows oxygen to enter the skin, slide down the follicle and get into the deeper layers of skin
where the initial acne lesion begins. This changes the oxygen tension in the skin, promoting the growth of good bacteria and inhibiting the growth of harmful bacteria, which promote inflammation that can damage the skin.
I instruct patients to add AO2 Clear twice daily into their daily skin care routine as the first step after cleansing. The kit comes with two pouches of the oxygenated water, each pouch lasting about 2 weeks. It’s very easy to use. They place one of the dehydrated sponges into the circular tray and squeeze water out of the pouch to saturate the sponge. Then AO2 Clear is applied to the face by gently patting the sponge against the skin over the facial areas, allowing it to air dry for 2 minutes, and then applying their skincare routine.
The applications are much broader than acne and include antiageing and skin pigmentary changes due to chronic photodamage. The idea is that by improving oxygenation and decreasing inflammation, signs of ageing such as uneven pigmentation or chronic redness induced by UVB exposure will improve. The simplicity of the product and its potential applications for conditions due to small blood vessel disease are exciting. The innovation is in the nanobubbles, which can deliver oxygen and other compounds that can speed up wound healing, rejuvenate the skin, or treat pigmentary issues.
ANJALI MAHTO, MBBCH, BSC, FRCP
CONSULTANT DERMATOLOGIST, SELF LONDON, LONDON, UK
AviClear is an FDA-cleared laser treatment designed to address mild to severe acne across all skin types. Developed by Cutera, it utilises a 1726 nm wavelength laser to selectively target and suppress sebaceous glands, reducing sebum production - the primary contributor to acne formation.
The standard protocol involves three 30-minute sessions, each spaced 4-6 weeks apart. During treatment, patients may experience a slight snapping sensation; however, the procedure is generally well-tolerated without the need for pain
relief. Clinical studies have demonstrated that 80% of patients achieved at least a 50% reduction in acne lesions within three months post-treatment, with results continuing to improve over time. Perhaps most notably, AviClear is a prescription-free, drug-free option that offers lasting clearance without significant side effects.
AviClear is ideal for those who cannot, or choose not, to take oral treatments, i.e. some athletes or individuals undergoing fertility treatments. Unlike medication, it avoids systemic side effects and delivers long-lasting results in three 30-minute sessions. As it offers a highly effective, prescription-free option that rivals pharmaceutical treatments without the associated risks, it’s been the most popular procedure at the clinic since we launched it a year ago.
In our practice, we primarily use AviClear to treat facial acne, though we’ve also seen fantastic results on the chest and back. It’s safe and effective for all skin types, making it a particularly viable option for patients with skin of colour. Many teenagers are also undergoing treatment, as their parents often tend to prefer drug-free alternatives to traditional acne medications. AviClear fits seamlessly into our acne treatment portfolio, complementing other skincare protocols. Its ability to deliver lasting results without systemic side effects makes it a revolutionary option for those seeking a safe, non-invasive, and highly effective solution for persistent acne.
Today’s patients are seeking regenerative treatments that go beyond surface beauty to improve the overall health and vitality of their skin. They’re moving away from overfilled, artificial looks and embracing results that enhance their natural beauty. Glo2Facial with RF Pro by Geneo delivers exactly that—offering a clinically supported approach to skin renewal without needles, downtime, or harsh interventions.
Developed by Geneo, Glo2Facial with RF Pro is a professional treatment that uses a layered, multi-technology protocol to stimulate the skin’s natural regenerative processes.
The treatment begins with RF Pro, which gently warms the dermal layer to promote new collagen and elastin production, improving the skin’s resilience and structure over time.
Following RF Pro, the treatment moves into Oxfoliation™, Geneo’s patented method that simultaneously exfoliates and polishes the skin’s
MICHAEL H. GOLD, MD
BOARD-CERTIFIED DERMATOLOGIST, FOUNDER & MEDICAL DIRECTOR OF GOLD SKIN CARE CENTER, NASHVILLE, TN, USA
Before and 12 months after final treatment session with AviClear. Photos courtesy of Dr. Mahto
surface while stimulating a natural oxygenation process from within to trigger cell renewal. Next, ultrasound technology is used to support the absorption of highly effective and all-natural ingredients with gentle microvibrations. The final step includes a hands-free sculpting massage that encourages fluid movement and a visibly refreshed appearance.
Glo2Facial with RF Pro is ideal for clients looking to improve skin texture, tone, and luminosity while supporting long-term skin health. By working both on the surface and within the deeper layers, the treatment restores skin vitality, strengthens the skin barrier, and delivers a fresh, naturally radiant appearance.
I love offering Glo2Facial with RF Pro because it gives my patients what they truly want: healthier, stronger, more beautiful skin without looking overdone. It’s an intelligent investment in their skin’s future—regenerative, refreshing, and results-driven.
JOAN VANDEPUTTE, MD, FCCP, FEBOPRAS
PLASTIC SURGEON, GENERAL HOSPITAL OF OUDENAARDE (AZ OUDENAARDE), PRIVATE PRACTICE AT OUDENAARDE, BELGIUM
For more than ten years I have been using Algeness® as a facial reshaping filler in my private practice.
Algeness is composed of agarose, a natural sugar extracted from seaweed. No cross-linking or other chemical modification is required for its formulation. Algeness is differentiated by offering very high G’ (resistance to deformation) and G” (up to almost 200 times that of HA fillers. It is completely saturated with water. It does not absorb fluid from the surrounding tissues. Within hours after injection, the particles are surrounded by a gentle histiocyte infiltrate. It does not cause tissue swelling in the mid or long term. These characteristics allow clinicians the opportunity for predictable, true and stable facial reshaping. The amount injected and the shape obtained in the clinic is what you get as a result. This is very relevant for midface expansion, jawline recontouring, and treatment of temporal hollows, as well as complex and demanding indications such as nasal reshaping.
As compared to hyaluronic acid gels (HA), the current golden standard in dermal fillers, Algeness is my number one reshaping filler for patients who have a history or signs of facial oedema, such as malar mounds or documented oedema after previous treatments, for stable, structural support and for patients requiring more than a few millilitres for adequate facial treatment.
Subcutaneous and deep injections
of Algeness combine very well with intradermal and immediate subdermal wrinkle injections with HA. It cannot be injected in the dermis, where the infiltrate would be more pronounced and noticeable. It will therefore not replace any of the current aesthetic armamentarium but rather open the gates for new indications and a larger group of clientele.
The company is preparing to submit the 3.5% DF concentration to the FDA for midface treatment, and in China, Algeness 2.5% VL was recently approved for the treatment of nasolabial folds.
Finally, a way to tighten and lift without using heat.
I am excited about SomaCell™ because the technology offers the unique opportunity to treat patients of all skin types across all ages, who desire lifting and tightening of facial skin without wounding the skin. My patients no longer have to worry about pre-treatment protocols, downtime, and complex post-treatment wound care. They are no longer burdened with ointments, dressings, and the need to take antibiotics and antiviral medications. FDA cleared and CE certified for treatment and repair of connective tissue, you can pre- and post-treat surgical patients for more rapid healing and optimal results while offering this as a spectacular stand-alone for nonsurgical patients. There is also no single-use disposable, making this a very lucrative patient offering.
When you take into account the ease of treatment, the comfort experienced during treatment, the efficacy, and the safety profile, SomaCell™ will be revolutionary in nonsurgical facial rejuvenation.
THOMAS C. SPALLA, MD
FACIAL PLASTIC SURGEON AT PHILADELPHIA
FACIAL PLASTIC SURGERY AND MEDSPA, AND CMO OF SOMACELL LLC PHILADELPHIA, PA, USA
Age 33 years. Algeness® DF 3.5% 1.4 ml per side deep on bone in anterolateral midface. (A) Before. (B) 6 months after injection of two syringes. Please note midface contour and apparent shortening of the lower eyelid, without direct injection on orbital margin
KEY STEPS TO BUILDING A GLOBAL PROFILE
With the aesthetics industry becoming increasingly global, Vanessa Bird outlines the key steps practitioners can take to raise their international profile whether through speaking, publishing, training, or global partnerships
GROWTH AND DEVELOPMENT WITHIN medical aesthetics takes many pathways. Professional development forms the foundations, with pillars of perceived success shaped by personal preference, ability, personality and, in some instances, by chance. What pillars are chosen and how high they are built are controlled by the individual, with more ambitious aesthetic professionals choosing to move onto the global stage in their quest for personal
and professional satisfaction. This article explores the various pillars for success that can lead to a global profile and how to develop and expand internationally. It will focus on maximising strengths, identifying relevant opportunities and building a roadmap to achieve professional goals. Readers will gain an understanding of how networking plays a role in recognition, learn how to develop key skills needed for profile development, pick up ways to avoid common pitfalls and recognise how and when to move quickly to maximise chances of success.
The importance of an international presence in aesthetic medicine
Why would, or should, a practitioner in aesthetics go global? What are the benefits, both personally and professionally? A key driver is to generate new business opportunities, and a desire to build stronger, more powerful professional networks through international expansion can help with this. From a clinical standpoint, adopting a global approach enhances creativity by recognising the legitimacy of different points of view and approaches as practitioners can access and learn from the rich cultures and practices across continents. This helps them stand out in a crowded marketplace and may be the difference between business growth and stagnation.
What does a global profile look like?
A global profile takes many forms. It may be focused on your clinic, either expanding abroad or becoming a visiting practitioner at a partner clinic. Perhaps you enjoy connecting with others and sharing knowledge? In this instance, you may wish to present at international conferences or travel as a Key Opinion Leader (KOL) to train others and educate peers. For those who are too busy to travel, embracing webinars and submitting content for industry magazines may be the preferred route to an international presence. Whatever path you take, it should benefit the aesthetics industry as a whole. Inspiring and motivating others, sharing experiences and best practice, and improving education and training all help to raise industry standards, which benefits patients and future
generations of aesthetic practitioners. It should also benefit the individual. Travel broadens the mind and allows you to meet new people who may be able to open more doors. It raises your profile, builds your brand, grows your business and helps make you money. With these benefits in mind, it’s worth consideration.
Where to begin?
It all starts with you. Ask yourself the following questions:
■ What are your reasons for wanting an international profile?
■ What skills do you have to help you achieve this?
■ What benefits can you deliver to the global aesthetics sector?
■ Are you ready for this next step or do you need further development?
It is important to identify your reasons for wanting international growth, as it helps you identify the right opportunities for you. This is paramount for success. Now, assess your core skills. What are you good at? Maybe you’re known for your advanced clinical techniques or for providing educational content on stage or in print. Perhaps you are commercially minded and excel at the business of aesthetics. If you have a speciality, now is the time to highlight this, as it may be what’s needed to accelerate your global journey. Do you have an established profile in your country of origin? If not, this needs to be somewhere you start before considering expansion overseas. This industry needs confident public speakers and practitioners who can teach, so what communication skills do you possess, and are you
It is important to identify your reasons for wanting international growth, as it helps you identify the right opportunities for you. This is paramount for success.
VANESSA BIRD, Managing Director, The Aesthetic Consultant, London, UK
charismatic enough to draw a crowd and influence others? Most importantly, credibility is essential. Without credibility, your peers will not engage with you, brands will not want to work with you, and the industry will not benefit from you taking that international step forward.
This is only half of the self-assessment needed. Other considerations include whether you are an introvert, ambivert or extrovert. Do you prefer one-to-one interactions, working with small groups, or do you actively enjoy larger audiences? Do people want to sit and listen to you, read what you write, learn from you or connect with you? Make time to objectively assess your strengths and weaknesses because this helps you identify suitable opportunities that match your skill set and character. It also allows you to develop any weaknesses and play to your strengths. After all, if you are an introvert who dislikes speaking in front of crowds, why invest time and energy submitting abstracts for conferences when you may be better suited as a visiting injector or published author?
Identifying the right opportunities
Now that you have assessed your strengths and weaknesses and decided what direction you wish to expand into, it is time to identify the right opportunities for you. Let's begin with international conferences as this is a popular step up for many. Research the global conference schedule and identify relevant conferences that fit your skill set and interests. Research past programmes and the faculty of speakers to give you insights on the tone of the conference and whether it suits your style. How can you cater for their audience? Is your content relevant? Build engaging, unique presentations, submit abstracts and make sure you strive to deliver original content that is beneficial to the target audience of each congress.
For those who wish to be a KOL working with global brands, match your skills with the key global players on the market today. It is easier to forge a relationship with a company if you already use their products or technology. Can you benefit their brand by providing clinical training, delivering webinars, or presentations?
For the teachers among you, consider expanding your love of training. Are there any training academies that can benefit from your skills and experience, or should you set up and develop your own, online and in person?
For those who want business expansion, look for clinics that would benefit from having you as a visiting practitioner. There may be treatments you can deliver they don't currently offer. Make sure you’re licensed to practice medicine in your country of choice and that your qualifications are recognised.
If your interest is in education and writing, research different publications and their style to identify good partnerships. Take into consideration cultural differences, legislation and tone and ask yourself whether you can commit to submitting original content their readers would appreciate. Although AI may well be seen as a blessing for many, it should be avoided when writing for publications to maintain standards and quality of content.
Do your homework
Once you've assessed strengths and weaknesses and identified relevant opportunities, it's time to research
Leverage your professional network. If you know of anyone who may be able to make introductions or provide insights that may help start conversations, now is the time to reach out. Be open to networking and meeting new people at conferences, training sessions, industry awards and social events.
your target areas of interest. Make sure your skills are a good match and that you’re adding value, then create your professional bio. A bio showcases your history, interests, qualifications, skills, and any unique selling points (USPs) that make you stand out. Create a standard and a short version and send them along with any abstracts, articles for publication or approaches to work with clinics, training academies or companies. It’s a great way to provide background before opening up discussions.
Utilise your network
Leverage your professional network. If you know of anyone who may be able to make introductions or provide insights that may help start conversations, now is the time to reach out. Be open to networking and meeting new people at conferences, training sessions, industry awards and social events. You can even connect using social media. One thing that should stay at the forefront of any networking you do is that it is a two-way street and should
be mutually beneficial and enjoyable for everyone. Build and nurture business connections for future growth and development.
Take action
Nothing happens without effort. If presenting at international conferences is the route for you, start writing abstracts and submit them in the appropriate format, with your bio, by the deadline. Keep records of ‘who, what and when’ you submitted and try not to repeat content. If you’re selected, play your part and actively promote your talk, attend other presentations, network with others and don’t be afraid to ask for feedback. We can always improve. For those wanting to be KOLs, reach out to salespeople you already work with and share ideas on how you can support their brand, whether that's through webinars, sponsored talks or training. If you have a passion for developing protocols, share your results with them and offer to educate other practitioners. Act as an ambassador, referring clients to them, posting positive social media content and even generating PR. For the trainers out there, build on protocols and techniques and be generous with the educational content you share in magazines and on social media. Connect with academies, cross-refer and offer your services. Could there be an opportunity to create something unique by partnering with them? For those wanting to practice abroad, utilise your network to identify relevant partnerships, schedule calls and discuss ways of working
together that are mutually beneficial. Commit to regular visits and discuss how you will split revenue. Once the partnership is in place, focus on consumer-facing promotions and build the hype. For the writers, start creating content that’s ready for publication and submit ideas/articles to editors (along with your bio). Once articles are published, share links to read them, then create a ‘brag file’ so you can easily show your style of writing to other publications.
Avoiding pitfalls
Developing a global profile is incredibly rewarding and feels fantastic. However, the biggest danger to global success can be our own ego. It’s great to be acknowledged, and at times we feel like a celebrity within our field. This intoxicating feeling of recognition and status is addictive, so if we don't remain grounded, we may start to believe the ‘hype'. We may become self-absorbed, arrogant, and in some instances, unprofessional. We may feel the pressure of up-and-coming global practitioners which can be a cause of stress and anxiety. So how do we overcome this? Identify and acknowledge if your behaviour starts to change for the worse. Ask the people closest to you if you’re showing signs of egotistical behaviour. There will always be situations where others are chosen over you, and we need to remember not to take it personally. Ask yourself what you can learn from these feelings, brush yourself down and remain ethical and professional at all times.
Another common pitfall is the dreaded imposter syndrome where you fear that you don’t live up to expectations, or perhaps you undervalue what you can bring to the global stage. Imposter syndrome is common in higher achievers. We compare ourselves unfavourably to others, doubt ourselves and may even self-sabotage situations we do not think we deserve. To avoid this, take time to objectively recognise your achievements and how far you have come. Again, ask your peers for honest and open feedback to help you overcome this.
Conclusion
Gaining an international advantage can be incredibly rewarding professionally and personally for those who want to take this step. The industry can benefit from what you have to offer, so make a note of the following key takeaways:
■ Know what you want
Although AI may well be seen as a blessing for many, it should be avoided when writing for publications to maintain standards and quality of content.
■ Keep yourself accountable and set clear goals
■ Know your timeline and track your progress
■ Review goals and progress regularly, and don't be afraid to adapt your approach and adjust your path if necessary
■ Celebrate any key milestones to stay motivated
■ Don’t take it personally if somebody secures the presentation, the KOL position, published article, or even the professional partnership you wanted.
Our industry is growing and there is room for everyone. If an international profile is for you, and you are prepared to work hard, act ethically and give back generously, take steps today and enjoy the ride.
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MENOPAUSE MANIA
Women suffering from symptoms related to menopause want to be heard.
How can aesthetic providers effectively help with hot flashes, weight gain, and other related concerns? We asked three menopause experts about how best to care for women navigating the change
MENOPAUSE HAS BECOME BIG BUSINESS AND THE TOPIC OF CONVERSATION. ‘THERE’S A $600 billion opening for businesses, [according to a report by Female Founders Fund], based on an average $2,000 a year that the 1 billion women expected to be in menopause worldwide by 2025 spend on prescriptions, doctor visits, treatments, devices, and products to address symptoms like night sweats, loss of libido, fatigue, and difficulty concentrating,’ as reported in a 2020 Forbes magazine article 1 .
Pharmaceutical manufacturers, entrepreneurs and femtech founders alike have responded with therapies that aim to make what can be decades of torture in a woman’s life more tolerable.
All the attention has been a long time coming, but like many physicians who have devoted their careers to menopause medicine, Monica Christmas, MD, is concerned about the lack of standards in treatment, misconceptions and unproven claims.
‘I think there are a lot of people that are doing things that are not evidence-based,’ says Dr Christmas, director of the Menopause Program at UChicago Medicine, in Chicago, US, and associate medical director of The Menopause Society.
Common misconceptions
For example, many don’t realise that there is no typical menopause patient. Menopause symptoms can happen in one’s 30s or early 40s, with some experiencing an onslaught of symptoms and others barely a hot flash.
‘There’s no one-size-fits all for symptoms and there’s no one-size-fits all for treatments,’ says Claudio N. Soares, MD, PhD, FRCPC, MBA, president of the Menopause Society and professor of psychiatry, Queen’s University School of Medicine, Kingston, Ontario.
Dr Soares explains, ‘It’s an opportunity if [clinicians] are in aesthetics, to get to know their clients well to really have the opportunity to identify if something is bothering them, what exactly is bothering them, and how they can help.’
Following the science
Hormone therapy is likely the most effective evidencebased therapy for management of menopause symptoms, including hot flashes, night sweats, sleep disturbances, mood disturbances and more, according to Stephanie S. Faubion, MD, MBA, director of the Mayo Clinic Center for Women’s Health, in Jacksonville, Florida, US, and medical director of the Menopause Society.
But the hormone therapy used for menopause symptoms is not ‘hormone replacement,’ she says.
‘…we are not trying to replace what the ovaries used to make. This is an important distinction. We use much lower doses to treat menopause symptoms,’ Dr Faubion says.
Compounded bioidentical hormones are almost never needed due to the availability of bioidentical hormones approved by the US Food and Drug Administration (FDA) and other global governmental agencies. Regulated hormone therapy is examined for purity, potency, efficacy and safety. In the US, that means that what is in the bottle has to be between 90% and 110% of what is actually on the label, which is not the case for unregulated compounded hormone therapy, Dr Faubion says.
Safety monitoring also is not as robust with compounded hormone therapy as with regulated hormone therapy, she adds. ‘To be clear, the term bioidentical means identical to what your body used to make, so what we’re talking about here is oestrogel for the oestrogen and progesterone for the progestogen and those are readily available in government-approved products,’ Dr Faubion says.
In addition to the treatment of vasomotor symptoms from menopause, indications include moderate to severe genitourinary symptoms, prevention of osteoporosis, and treatment of women who go through
premature menopause (before age 40). There can be downstream benefits, such as better sleep for a woman who has fewer hot flashes. But the therapy is not indicated for such things as sleep quality, weight loss, wrinkling or thinning skin.
‘Prescribing hormonal therapy in the hopes that it’s going to make somebody look younger is not an indication,’ Dr Christmas says.
The best time to prescribe it is usually in the first 10 years of menopause or before the age of 60, according to Dr Soares.
‘This is when oestrogen or hormonal therapy, in general, the benefits outweigh the risks,’ Dr Soares says. ‘If you’re in menopause for more than 10 years or are in your mid to late 60s, that’s probably not the best time or right time to start using oestrogen.’
In fact, for people who are over the age of 60 or more
Hormone therapy is likely the most effective evidence-based therapy for management of menopause symptoms, including hot flashes, night sweats, sleep disturbances, mood disturbances
MONICA CHRISTMAS, MD, director of the Menopause Program at UChicago Medicine, in Chicago, US, and associate medical director of The Menopause Society; CLAUDIO N. SOARES, MD, PHD, FRCPC, MBA, president of the Menopause Society and professor of psychiatry, Queen’s University School of Medicine, Kingston, Ontario; STEPHANIE S. FAUBION, MD, MBA, director of the Mayo Clinic Center for Women’s Health, in Jacksonville, Florida, US, and medical director of the Menopause Society
than 10 years from the onset of menopause, there’s evidence that being on hormone therapy has a higher associated risk of cognitive decline, according to Dr Christmas.
‘For women who are not good candidates for hormone therapy because of contraindications (e.g., oestrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence,’ according to the 2023 nonhormone therapy position statement of The North American Menopause Society, published in Menopause2 .
Among the treatments and therapies that have been shown to help some symptoms, according to the position statement, are cognitive-behavioural therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant, oxybutynin, and weight loss.
There is a distinction, however, between outcomes from hormonal therapy and nonhormonal options, according to Dr Christmas.
‘With hormone therapy, we can get about 80% or more reduction of hot flashes and night sweats. Oxybutynin, a medicine for overactive bladder, has been shown to have about a 70% reduction in hot flashes and night sweats. Other nonhormonal therapy options are between 40% to 65% reduction in hot flashes and night sweats,’ she says.
Is menopause a good time to start weight loss meds?
The value of weight loss drugs during menopause, when some women gain weight, is an interesting question, according to Dr Faubion.
Studies suggest weight loss is associated with a reduction of hot flashes.
‘The Women’s Health Initiative observational study3,4 showed that weight loss was associated with improvement in hot flashes,’ Dr. Faubion says. ‘Our team just received funding to study terzeptide for hot flashes, so there will be more on that topic coming soon.’
Over-the-counter supplements
There are no over-the-counter supplements that have been shown to be effective for menopause symptom management, according to Faubion, who points to the nonprofit watchdog group Truth in Advertising.org/, which sent letters to 100 menopause supplement companies5 urging them to review what could be deceptive marketing with claims the supplements treat a variety of menopausal
symptoms without the necessary scientific substantiation required by US governmental
Wearables
Wearables might help, depending on what one is trying to monitor.
‘Hot flashes are hard to monitor with wearable devices. Part of that is because they are measuring skin conductance changes, and these are not thought to be terribly accurate yet in women of colour,’ Dr Faubion says.
Apps or wearables that monitor healthy habits, like physical activity or sleep, could help with positive reinforcement, Dr Soares reasons.
And if a cooling device helps a woman to feel better during a hot flash, why not, the doctors say.
With hormone therapy, we can get about 80% or more reduction of hot flashes and night sweats. Oxybutynin, a medicine for overactive bladder, has been shown to have about a 70% reduction in hot flashes and night sweats.
References
1. Emma Hinchliffe. Menopause is a $600 billion opportunity, report finds [Internet]. Fortune. October 26, 2020. Available from: https://fortune.com/2020/10/26/ menopause-startups-female-founders-fundreport/
2. “The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. doi: 10.1097/ GME.0000000000002200. PMID: 37252752.
Commonsense lifestyle factors can make significant improvements in women’s quality of life before and during menopause.
Dr Soares encourages clinicians caring for these patients to look at healthy sleeping, dietary and physical activity, which have been shown to protect against many chronic problems, including depressive symptoms and anxiety.
Getting regular moderate to intense exercise is especially powerful, and providers shouldn’t shy away from educating women about the benefits of meeting physical activity goals.
‘When people know there is evidence6, they might put in some effort,’ Dr Soares says.
Things like modifying alcohol, caffeine, sugar, as well as weight loss, have been shown to help with sweats and mood, Dr Christmas adds.
Written by Lisette Hilton, contributing editor
3. Kroenke CH, Caan BJ, Stefanick ML, Anderson G, Brzyski R, Johnson KC, LeBlanc E, Lee C, La Croix AZ, Park HL, Sims ST, Vitolins M, Wallace R. Effects of a dietary intervention and weight change on vasomotor symptoms in the Women's Health Initiative. Menopause. 2012 Sep;19(9):980-8. doi: 10.1097/ gme.0b013e31824f606e. PMID: 22781782; PMCID: PMC3428489.
4. Huang AJ, Subak LL, Wing R, et al. An intensive behavioral weight loss intervention and hot flushes in women. Arch Intern Med. 2011;170:1161–7. doi: 10.1001/
archinternmed.2010.162. 5. truthinadvertising.org (TINA.org). Menopause Supplements. truthinadvertising. org (TINA.org). October 2024. 6. Yue, H., Yang, Y., Xie, F. et al. Effects of physical activity on depressive and anxiety symptoms of women in the menopausal transition and menopause: a comprehensive systematic review and meta-analysis of randomised controlled trials. Int J Behav Nutr Phys Act 22, 13 (2025). https://doi. org/10.1186/s12966-025-01712-z
CLINICAL EVALUATION OF BELLACHOLINE FOR SUBMENTAL FAT REDUCTION USING ULTRASOUND IMAGING
Yoonsu Ku, MD, presents new data supporting Bellacholine as an effective and precise approach for submental fat reduction
ABSTRACT
Submental fat reduction has gained increasing attention in aesthetic medicine due to the demand for minimally invasive procedures. Bellacholine, a deoxycholic acid (DCA)-based injectable, offers a targeted approach to adipocyte lysis with improved safety and precision.
Objective : This study aims to evaluate the clinical efficacy and safety of Bellacholine injections for submental fat reduction using real-world data and ultrasound-based measurements.
Methods: Eight adult patients underwent Bellacholine injections in the submental region using either a 33G 4 mm needle or a 23G 5 mm cannula. Fat layer thickness was measured before and after treatment using the Vscan Air™ ultrasound system. Three representative
AKEYWORDS
Deoxycholic acid, Bellacholine, submental fat,
cases were analysed in detail. Patient-reported outcomes and adverse events were also recorded.
Results: In a focused analysis of three representative cases, ultrasound imaging revealed a mean reduction of 18.4% (±4.1%) in submental fat thickness following Bellacholine treatment. One patient achieved a 31.7% decrease, despite minimal changes in body weight. Over 75% of participants reported visible improvement in submental contour, supporting both the objective and subjective efficacy of the treatment.
Conclusions: Bellacholine demonstrated significant efficacy and safety in reducing submental fat in a clinical setting. The use of ultrasound imaging provided objective validation of treatment outcomes. These findings support the potential of DCA-based injectables as a minimally invasive alternative for submental fat reduction.
S THE DEMAND FOR MINIMALLY INVASIVE COSMETIC procedures continues to rise, submental fat reduction has become a prominent area of interest in aesthetic medicine. Excess fat in the submental region, commonly referred to as a 'double chin,' can significantly impact facial contour and perceived age, leading many patients to seek effective treatment options with minimal downtime.
Traditional fat reduction modalities such as liposuction, cryolipolysis, ultrasoundbased therapies, and radiofrequency devices offer varying degrees of efficacy. However, these approaches often present limitations in terms of precision, invasiveness, recovery time, and risk of damage to surrounding tissues. In particular, the anatomical complexity of the submental area requires a treatment modality that allows for targeted fat removal with minimal collateral effects.
Deoxycholic acid (DCA), a bile acid derivative approved by the FDA for submental fat reduction, has emerged as a promising injectable solution. DCA induces selective adipocyte lysis, enabling precise fat targeting while preserving adjacent structures. Its injectable nature allows for controlled depth administration (typically 4–6 mm), making it especially suitable for anatomically sensitive regions such as the submental triangle.
Bellacholine (LG Chem Ltd., Korea), a DCA-based formulation, has recently gained attention for its clinical equivalence and potential advantages in real-world aesthetic practice. Despite its growing use, there remains a need for objective, quantifiable data
YOONSU KU, MD, Chief Director, Seoul Nine & Clinic, Cheonan, South Korea
to support its efficacy and safety. This study aims to evaluate the aesthetic outcomes of Bellacholine injections for submental fat reduction using ultrasound imaging, providing real-world evidence to guide clinical applications.
Methods
Study design and participants
This observational case series included eight adult patients who underwent submental fat reduction using Bellacholine injections. The mean age of participants was 31.75 years, and the mean baseline weight was 85.3 kg. Among these, three representative female cases (mean age: 27 years; mean BMI 29.65) were selected for detailed analysis. All patients provided informed consent prior to treatment.
Injection protocol
Bellacholine (deoxycholic acid) was administered subcutaneously into the submental region at a controlled depth of 4–6 mm. Depending on individual
anatomy and practitioner preference, either a 33G 4 mm needle or a 23G 5 mm cannula was used. Injection sites and volumes were customised per patient, with a total of 6 ml administered over three sessions (2 ml per visit).
Anatomical targeting and ultrasound guidance
The treatment area was defined as the 'submental triangle,' bordered superiorly by the mandibular line, inferiorly by the hyoid bone, and overlying the mylohyoid muscle. Ultrasound imaging was performed using the Vscan Air™ system to guide injection depth and assess fat layer thickness.
Standardised imaging was conducted along the midline using reference points. For consistent ultrasound imaging, a horizontal reference length of 3.40 cm was defined at the level of the platysma muscle, based on internal calibration, and the anterior belly of the digastric muscle was used bilaterally to ensure consistent positioning. Preplatysmal and subplatysmal fat thicknesses were measured before and after treatment.
Cannula design protocol
For procedures utilising a cannula, the following design steps were implemented (Figure 1):
■ Mark the entry point at the mental protuberance
■ Draw a vertical line approximately 4 cm downward
■ Define a horizontal line 1–1.5 cm below the submental crease
■ Create four evenly spaced injection lines to ensure uniform drug distribution.
Outcome measures
Primary outcomes included changes in submental fat thickness as measured by ultrasound. Secondary outcomes included patient-reported satisfaction and adverse events. Measurements were taken at baseline and after the final treatment session (3-month follow-up).
Ultrasound imaging was used to evaluate submental fat thickness before and after Bellacholine treatment in three
representative patients. The analysis revealed a mean reduction of 18.4% (±4.1%) in submental fat thickness following three treatment sessions.
Representative case outcomes
Three representative female patients were analysed in detail:
■ Patient A was 67.6 kg before the procedure with a BMI of 26.81, and just before the third procedure, the weight increased to 69.1 kg with a BMI of 27.33, but the double chin fat layer thickness decreased from 11.9 mm to 9.8 mm.
■ Patient B was 66.7 kg before the procedure with a BMI of 25.41, and just before the third procedure, the weight increased to 67.9 kg with a BMI of 25.87, but the double chin fat layer thickness decreased from 10.1 mm to 9.5 mm.
■ Patient C was 90.6 kg before the procedure with a BMI of 36.75, and just before the third procedure, the weight decreased slightly to 90.3 kg with a BMI of 36.63, but it is thought that this slight change was considered clinically insignificant for this case study. Double chin fat layer thickness decreased from 12.3 mm to 8.4 mm. These results suggest that localised fat reduction occurred independently of overall weight changes, supporting the targeted efficacy of Bellacholine.
Patient-reported outcomes
In a post-treatment survey, over 75% of participants reported visible improvement in submental contour compared to baseline. Subjective feedback indicated high satisfaction with the aesthetic outcome.
Adverse events and tolerability
Mild and transient adverse reactions were commonly reported, including:
■ Oedema: Present in most patients, resolving within 2–3 weeks
■ Dull aching or tingling: Transient and resolved spontaneously
■ Injection site pain: Mild to moderate in intensity, transient in nature.
No serious adverse events or complications were observed during the study period, indicating a favourable safety profile.
In addition, the participating patients also evaluated the degree of fat improvement positively.
In a survey asking about the degree of fat improvement compared to before the procedure, more than 75% of patients said they have improved their lower jaw fat compared to before the procedure.
Patient-reported discomfort and local reactions
Following treatment, participants commonly reported transient adverse sensations localised to the injection area. The most frequently noted symptom was post-procedural oedema, which persisted for approximately 2~3 weeks in the majority of cases. In addition, a dull aching or tingling sensation was reported by several subjects, typically resolving spontaneously without intervention. Immediate
Figure 1 Cannula design protocol
Figure 2
Submental fat thickness before and after Bellacholine treatment
pain following injection was also observed, generally characterised as mild to moderate in intensity and selflimiting in nature. No severe adverse events or complications were recorded during the study period.
Discussion
This study provides real-world clinical evidence supporting the efficacy and safety of Bellacholine, a deoxycholic acid (DCA)-based injectable, for submental fat reduction. The mean reduction of 18.4% (±4.1%) observed in these patients suggests a consistent and targeted adipocytic effect of deoxycholic acid-based treatment. Notably, this reduction occurred despite minor fluctuations in body weight and BMI, suggesting a localised effect independent of systemic weight changes.
Compared to traditional non-surgical modalities, such as cryolipolysis, ultrasound-based therapies, and radiofrequency devices, Bellacholine offers several advantages:
■ Precision targeting submental fat
■ Minimally invasive technique with short recovery time
■ High patient satisfaction, with over 75% reporting visible improvement.
The use of the Vscan Air™ ultrasound system enabled objective quantification of treatment outcomes, addressing a common limitation in aesthetic studies that rely heavily on subjective assessments or photographic comparisons. This imaging approach may serve as a standardised evaluation tool in future clinical protocols.
However, the study has limitations. The sample size was small (n=8), and only three representative cases were analysed in detail. The follow-up period was limited to three months, which may not capture long-term outcomes or recurrence.
Additionally, the study did not include a control group, which limits the ability to compare Bellacholine with other treatment modalities. Future studies should include larger, randomised controlled trials with extended follow-up and standardised imaging protocols to validate these findings and explore broader applications.
Conclusions
Bellacholine has demonstrated promising results as a minimally invasive treatment for submental fat reduction. The combination of targeted DCA-based adipolysis and ultrasound-guided evaluation supports its clinical utility in aesthetic practice. Given its favourable safety profile and high patient satisfaction, Bellacholine may serve as a viable alternative to existing non-surgical fat reduction methods. Further research with larger cohorts, longer follow-up periods, and comparative studies against other modalities is warranted to establish standardised treatment protocols and to explore its applicability in other anatomical regions.
Declaration of interest Dr Ku is a clinical advisor for LG Chem
Figure 3 Patient 1— photographic and ultrasound imaging. Submental fat thickness (the point where the depth is the longest)(A) baseline (before treatment) measurement: 11.9mm; (B) post-treatment (after 3 Sessions) measurements: 9.8mm
Figures 1–4
Figure 4 Patient 2 photographic and ultrasound imaging. Submental fat thickness (the point where the depth is the longest)(A) baseline (before treatment) measurement: 12.3 mm; (B) post-treatment (after 3 Sessions) measurements: 8.4mm
WHEN A SINGLE APPROACH IS NOT ENOUGH COMBINING THREADS, TOXINS, AND FILLERS
Mariam Tsivtsivadze, MD, explains how combining treatments offers customised, minimally invasive solutions for concerns such as eyebrow lifting, facial harmonisation, and asymmetry correction
MARIAM TSIVTSIVADZE, MD, Plastic and Reconstructive Surgeon, Tbilisi, Georgia
In modern aesthetic medicine, the pursuit of natural, long-lasting rejuvenation requires a multifaceted approach. The ‘Golden Triad’ method, combining threads, botulinum toxin (BoNTA), and hyaluronic acid (HA) fillers, addresses various aspects of facial changes, offering patients effective, minimally invasive solutions.
This article explores the application of this combination approach through three diverse patient cases: eyebrow lifting, full-face harmonisation, and facial asymmetry correction. By evaluating patients based on factors such as skin quality, muscle activity, and structural changes, personalised treatment plans were developed.
IN MODERN AESTHETIC MEDICINE, achieving natural, harmonious, and long-lasting results requires more than a single approach.
Nowadays, the most common combination treatment is a ‘Golden Triad’ approach that integrates modalities like threads, toxins, and fillers. It addresses multiple layers of ageing—restoring volume, improving skin quality, and providing structural support. This synergistic strategy ensures comprehensive rejuvenation and personalised outcomes tailored to each patient’s unique needs. As patient demand for minimally invasive procedures grows, the use of combination therapies continues to rise, offering solutions that balance efficacy, safety, and minimal downtime.
This article aims to highlight the importance of a combination approach for achieving optimal, long-lasting results across a range of patient needs. Many patients focus on a single concern, yet their conditions often require a multifaceted treatment plan for complete resolution. This article will discuss how to assess a patient and develop a personalised treatment strategy. The
The results demonstrated significant improvements in facial volume, skin texture, symmetry, and overall aesthetics, with long-lasting effects. The combined use of threads for tissue elevation, toxins for muscle relaxation, and fillers for volume restoration ensures comprehensive rejuvenation. This method enhances the benefits of each modality while reducing the limitations of single treatments. The findings underscore the importance of a holistic, customised approach to aesthetic procedures, which provides optimal results with minimal downtime. By understanding facial anatomy and patient-specific needs, this triad of treatments offers a powerful, evidencebased solution for modern aesthetic challenges.
effectiveness of this combined approach will be demonstrated through three patient cases, each with different indications:
■ Eyebrow lifting
■ Full face harmonisation
■ Correction of facial asymmetry.
The treatments discussed involve absorbable barbed threads (PLLA/CL), BoNTA (botulinum toxin A), and hyaluronic acid (HA) gel.
Patient assessments
Patients are evaluated based on their individual signs of ageing, personal desires, facial structural changes, muscular activity, skin laxity, and skin quality1 Anatomically, all facial layers are interconnected, meaning that treating one layer without considering the others can be insufficient. Therefore, a comprehensive, multi-layered approach is essential.
Eyebrow lifting is one of the most requested procedures, with patients often seeking elevation of the tail of the eyebrow. In the upper third of the face, bone structure, muscle activity, and soft tissue compartments play
A single treatment can’t fully address the complexities of facial ageing— combining modalities is key to lasting, natural results.
significant roles. Achieving a long-lasting effect requires combining multiple modalities, as a single approach (such as soft tissue repositioning with threads) may not be sufficient. The optimal result can be achieved with a combination of threads, toxins, and fillers, if necessary.
Materials and methods
The article reviews three cases with different indications where tailored treatment plans were developed. The results of each case are described below.
Case 1: Eyebrow lifting
Patient: 32 years old, seeking eyebrow elevation and nonsurgical canthopexy using threads (Figure 1A).
During an assessment, in the upper third of the face, high muscle activity was displayed: occipitofrontalis, temporalis, procerus, corrugator supercilii, and orbicularis oculi2. Therefore, due to the anatomical structure of the face, if threads are placed in the superficial fat compartments, the constant muscle contractions underneath could compromise thread fixation, which will cause the rapid loss of results, regardless of the type and method of thread implantation.
Treatment plan
In this particular case, the first step was an injection of 100U of Abo Botulinum toxin A (Figure 1B).
After 10 days from the BoNTA injection, absorbable bidirectional 50 cm barbed thread (PPLA/CL) was implanted into the subcutaneous fatty tissues. The lateral orbital compartment, ROOF, and middle forehead compartment were repositioned and fixed in an elevated position using threads. Furthermore, the lateral canthal tendon was elevated to a higher position, which changed the shape of the eye (Figure 1C).
Two weeks after the thread procedure, HA gel was injected into the temporal area (Figure 1D).
Results
The shape of the eyebrow and eye were feminised and improved, with results maintained for over two years.
Before the procedure, the distance between the lateral canthus and the tail of the eyebrow was 0.77 cm; after 9 months, the distance was 1.2 cm, and after 1 year, it was 1 cm.
The measurement in a straight line from the lateral canthus to the eyebrow before the procedure was 1.1 cm; after 9 months, it was 1.4 cm; and after 1 year, it was 1.22 cm (Figure 1E).
Measurements indicated a consistent increase in the distance between the lateral canthus and eyebrow. The overall effect lifted the tail of the eyebrow, enhanced the eye shape, and increased the distance between the eyebrow and upper eyelid.
Case 2: Full-face harmonisation
Patient: 56 years old, with signs of ageing and previous lower eyelid blepharoplasty causing eyelid retraction and scleral show. The patient requested lifting using threads (Figure 2A).
Figure 1 (A) Case 1. 32 year old patient seeking eyebrow elevation and non-surgical canthopexy using threads.
(B) Injection points for botulinum toxin. (C) Insertion of absorbable bi-directional 50 cm barbed thread (PPLA/CL). (D) Injection points for HA into the temporal area. (E) From left to right, before the procedure, after 9 months, and after 12 months.
Patient assessment begins with an evaluation of the periorbital region, revealing expressed wrinkles around the eyes, scleral show along sunken eyelids and tear trough deformity.
This patient has a negative vector, which indicates volume deflation in the cheekbone area. Furthermore, marionette lines are expressed, disturbance of the jawline is observed, and mentalis muscle activity and asymmetry in the mental area are present.
For such indications, a single approach is not enough. To achieve an optimal result, a combination method is preferred.
Treatment plan
Botulinum toxin injection to the orbicularis oculi muscle (15 U per side) and mentalis (20 U).
HA filler injection to the pretarsal and preseptal areas (0.3 cc and 0.4 cc, respectively) to correct scleral show and retraction. A further 0.4 cc in the cheeks for volumisation and at the chin area to treat asymmetry.
Insertion of threads (absorbable multidirectional barbed threads) in the cheek and (absorbable smooth twisted threads) for the marionette lines, followed by repositioning of the jawline (absorbable bidirectional barbed thread) and correction of the oval shape of the face.
Results
The treatment led to a refreshed and natural appearance with improved skin texture and corrected facial asymmetry. The shape of the face became more V-shaped, and the results were still evident a year after treatment.
The result can be well observed after 1 year from the procedure, which indicates long-lasting results ( Figure 2B).
Case 3: Correction of facial asymmetry
Patient: 67 years old, with hemifacial palsy due to a neurinoma, leading to eyelid retraction (ectropion) and severe facial volume loss (Figure 3A).
While assessing such a case, attention must be paid to eyebrow ptosis, which obstructs the patient’s vision, and ectropion, which, along with the aesthetic deformity, also causes dryness and irritation of the eye and can lead to loss of vision. Due to paresis, this patient has muscle and subcutaneous fatty tissue atrophy, which caused huge volume loss on the paralysed side of the face, extra skin laxity and inability to intake liquids without spilling.
In such cases, the mimic activity on the healthy side is overly active to compensate for the paralysed side of the face3. Due to the patient’s presented condition, a combination approach is required on the affected area of the face as well as on the healthy part.
The most effective combination of mini-invasive procedures for such a case is botulinum toxin injection and threads.
Treatment plan
On the paralysed side, the plan was as follows:
■ Eyebrow lifting with non-absorbable polypropylene bidirectional barbed thread (500 mm). As a result, the eyebrow height was increased, which in turn increased
AB
the results
AB
The treatment led to a refreshed and natural appearance with improved skin texture and corrected facial asymmetry.
the distance between the eyebrow and the eyelid margin. Consequently, the patient’s obstructed vision was improved
■ Thread treatment for the cheeks, mouth corners, and lower third of the face with polypropylene bidirectional threads. The combination of these threads enabled the repositioning of soft tissues, fixation of the skin and soft tissues in the elevated position and armouring around the mouth, which fixed the issue of liquid spillage
■ Further treatment with HA fillers, according to the principles of myomodulation, is instituted 1 month after threads and BoNTA in patients with the suitable selection criteria for the use of HA fillers.
Figure 2 (A) Case 2. 56 year old patient with signs of ageing and previous lower eyelid blepharoplasty causing eyelid retraction and scleral show. The patient requested lifting using threads. (B) 12 months post-treatment with botulinum toxin, HA fillers, and threads. The treatment led to a refreshed and natural appearance with improved skin texture and corrected facial asymmetry. The shape of the face became more V-shaped, and
were still evident a year after treatment.
Figure 3 (A) Case 3. 67 year old patient with hemifacial palsy due to a neurinoma, leading to eyelid retraction (ectropion) and severe facial volume loss. (B) 18 months post-treatment with botulinum toxin, HA fillers, and threads.
The combination of threads, toxins, and fillers represents a combined strategy in minimally invasive aesthetic medicine, providing comprehensive and natural results that address the various indications of different patients.
It is imperative that injectors possess a deep understanding of agonist and antagonist muscle groups, as levators and depressors work in opposition for normal, balanced facial expressions.
The healthy side was primarily treated with BoNTA and indicated doses are for AbobotulinumtoxinA. Botulinum toxin injections were administered to the following muscles:
To treat the jawline, botulinum toxin injections are required to the platysma, followed by threads to reposition the jowl compartment and HA filler injections to define the mandibular area.
Submental area
In the submental area, inject the platysma bands with botulinum toxin, followed by threads to correct skin laxity and reposition the subcutaneous fatty tissues.
Conclusions
The combination of threads, toxins, and fillers represents a combined strategy in minimally invasive aesthetic medicine, providing comprehensive and natural results that address the various indications of different patients. While threads offer tissue elevation and biostimulation, toxins effectively soften dynamic wrinkles by relaxing overactive muscles, and fillers restore lost volume and enhance facial contours5.
Treating contralateral, non-paralysed muscles in conjunction with ipsilateral paralysed muscles may result in long-lasting improvement of oral-ocular synkinesis; isolated ipsilateral injection generally causes only transient improvement. Fine, isolated muscle control on the paralysed side gradually improves with diminishing strength on the hyperdynamic side.
Results
To achieve symmetrical balance in patients with paresis, a complex treatment is required, especially when using minimally invasive methods. A result shown after 18 months was achieved by using non-absorbable threads once and botulinum toxin injections three times. Starting with high units is not advised on the healthy side, hence the procedure needs to be repeated several times. As you can see, after 18 months, symmetrical balance is achieved to the maximum level possible with a minimally invasive approach (Figure 3B).
Protocols for treatments using the ‘Golden Triad’ approach for other areas
Nose
Evaluate the depressor septi nasi, and if it is hyperdynamic, the first step is botulinum toxin injection, followed by insertion of threads for nose tip elevation and correction of the dorsum, or botulinum toxin injection, followed by HA filler injection4
Key points
The ‘Golden Triad’ method threads, toxins, and fillers delivers comprehensive, naturallooking facial rejuvenation by treating skin texture, muscular activity, and volume loss across all facial layers
Personalised patient assessments are critical to developing a combination treatment plan that accounts for muscle function, structural support, and aesthetic goals
By targeting skin, muscle, and structural volume together, the combined use of threads, toxins, and fillers creates more harmonious and comprehensive aesthetic outcomes
This integrated approach not only amplifies the individual benefits of each treatment modality but also creates a balanced and harmonious rejuvenation that is difficult to achieve with a single treatment alone. Moreover, by addressing multiple layers of the skin and underlying structures, the combination ensures long-lasting results, improved patient satisfaction, and a customisable treatment plan tailored to individual needs.
When implemented with evidence-based practices and a deep understanding of facial anatomy, the combination approach can minimise complications and recovery time while maximising outcomes. Its effectiveness lies in its ability to treat both static and dynamic aspects of facial ageing, making it an indispensable strategy in modern aesthetic medicine.
Declaration of interest None
References
1. Smith, A. B., Robinson, J. L., Cooper, K. F., et al. (2023). Combination therapy for facial rejuvenation: Synergistic effects of threads, toxins, and fillers. Aesthetic Surgery Journal, 43(4), 534-542.
2. Liu, M. C., Gupta, T. M., Johnson, P. H., et al. (2021). Botulinum toxin in the aesthetic treatment of facial wrinkles and lifting. Journal of Cosmetic Dermatology, 20(9), 2725-2733.
3. Peterson, L. K., Moore, F. D., Becker, R. T., et al. (2022). Non-surgical approaches to correct facial asymmetry using dermal fillers and botulinum toxin: A review. Journal of
Facial Plastic Surgery & Aesthetic Medicine, 24(3), 303-312.
4. Brown, L. D., Silva, R. M., Harrison, K. P., et al. (2020). Use of hyaluronic acid in facial rejuvenation: Clinical review of indications and applications. Dermatologic Surgery, 46(10), 1400-1411.
5. Hamilton, P. S., Fisher, K. L., Collins, M. A., et al. (2019). Combining botulinum toxin, hyaluronic acid, and threads in facial aesthetic rejuvenation: A review. Plastic and Reconstructive Surgery, 143(1), 12-20.
THE ‘SANDWICH TECHNIQUE’ IN LIP AUGMENTATION
Olena Cherhava, PhD, explores how an individualised, multi-layered injection strategy can help achieve natural-looking, balanced results
OLENA CHERHAVA, P h D, Lecturer of maxillofacial surgery and dentistry department of Ukrainian Military Medical Academy, Ukraine
This article clarifies the foundations of perioral region analysis from the perspective of its structure and presents a step-by-step protocol for lip contouring using the 'sandwich technique', which involves the layered injection of a hyaluronic acid-based filler. The essence of this protocol lies in several sequential, individualised stages of stratified filler administration. This method of injection enables the creation of an alternative lip shape while preserving its natural appearance.
AESTHETIC MEDICINE HAS ENTERED A NEW AND FASCINATING ERA.
The primary demand of modern patients is the individualisation of treatment plans and natural-looking results.
This requirement also applies to lip contouring procedures. It is worth noting that the lips represent a complex anatomical structure. To achieve truly impeccable results, we must take into account the presence of maxillofacial anomalies and deformities, as well as architectural features, facial expressions, gender, ethnic characteristics, age, professional activities, personal preferences, and other relevant factors. Such a detailed analysis logically transitions into a deeply individualised protocol for lip contouring.
Objective
Analysis of lip anatomy in terms of its architecture and planning of lip augmentation using the ‘sandwich technique’.
Materials and method
A systematic and comprehensive analysis of the patient’s appearance must be conducted prior to any minimally invasive intervention.
For this reason, before performing lip augmentation, it’s a good idea to spend several minutes conversing with the patient, asking questions, and encouraging the individual to express genuine, vivid, and diverse emotions. Simultaneously, the physician analyses the extra- and intraoral anatomy, the intensity of facial expressions, and their specific characteristics.
Before performing lip augmentation, it’s a good idea to spend several minutes conversing with the patient, asking questions, and encouraging the individual to express genuine, vivid, and diverse emotions.
Ideally, the practitioner should have the opportunity to photograph the patient according to a standard protocol and analyse the clinical situation and the appearance of the perioral zone in greater detail, not only in a static state but also during emotional expressions and speech.
The key to developing a lip augmentation protocol using the ‘sandwich technique’ lies in the analysis of anatomical structures of the so-called first, second, and third orders. To better understand this classification, Figure 1 provides an example, along with an explanation below.
First order
■ It is important to assess the initial shape of the lips and the proportions of the upper and lower lips
■ Take into account gender, ethnicity, age, the type of character, and professional activity of the client
■ A realistic approach starts with objectively comparing the natural anatomy and the expected result. Every lip shape has its own potential for enhancement some can be transformed significantly, while others have limited capacity for visible change.
A 1 2 3 B C
Second order
The second stage is the creation of the so-called ‘geography of the lips.’ Natural lips have ‘hills and slopes.’ These features attract the gaze of the opposite sex and encourage a more detailed examination and admiration.
A realistic approach starts with objectively comparing the natural anatomy and the expected result. Every lip shape has its own potential for enhancement.
Third order
■ Slight irregularities in the lips that create a unique anatomy
■ Is a personality marker
■ It gives a visual emphasis on the naturalness of the lips
■ This feature of the lips should be preserved as much as possible and, in no case, lost completely.
Figure 2 The 3 most popular lip shapes and injection techniques are schematically depicted depending on the desired lip shape in general.
Figure 1 Sequence of anatomical structures for analysis of (A) first order, (B) second order, and (C) third order.
Individualisation of the lip augmentation plan is a key aspect of creating natural shapes that suit the face of a particular patient.
The ‘sandwich technique’ involves the multilayer injection of a filler. However, the novelty of this injection technique is that each layer is injected using a different method.
The first layer of material is injected to create the overall volume and shape of the lips as a whole. We inject the filler in a linear retrograde or fan-shaped manner over the entire area.
The second layer is used to create the individual lip architecture. The filler is applied locally to form elevations, depressions, and fissures that make the lips attractive and erotic. At this stage, boluses of different diameters and small fans are ideal.
The third stage focuses on preserving and individualising the microrelief of the lips, which is crucial for achieving a natural-looking result. To preserve the microrelief, we use medium and low-density fillers. It is important to avoid hypercorrection. In this case, the rule to withdraw only 8090% of the desired filler volume works perfectly.
Results and their discussion
As an example, Figures 2–3 illustrate the stages of lip contouring and the injection schemes according to the ‘sandwich technique.’ It should be noted that each of these stages can be individualised by the injector. This approach allows for the consideration of all anatomical features of the patient and the creation of a correction formula that is unique and personalised each time.
The recommended products for this procedure are those of medium and low density. These integrate naturally into the lip tissues. It is important to inject 10-20% less than the planned amount. This philosophy reduces the likelihood of overcorrection.
Conclusions
Key points
The ‘Sandwich Technique’ involves a three-layered filler injection approach, each targeting different structural elements of the lips— volume, architecture, and microrelief—to ensure a natural and refined result
Anatomy-Driven Customisation is essential: the approach tailors treatments to each patient’s lip structure, facial expressions, ethnicity, gender, age, and lifestyle, enhancing both aesthetics and authenticity.
Preserving Lip Personality is a critical goal—unique microirregularities and natural contours are maintained rather than erased, allowing for truly individualised and realistic results.
The primary goal of an injection specialist should be to achieve a balance between facial features, lip shape, and volume.
The injector must understand the fundamental aesthetic principles governing facial harmony, both in static conditions and during emotional expressions, to achieve optimal, individualised, and always natural results. The ‘sandwich technique’ allows for the consideration of all the aforementioned anatomical features and the creation of personalised correction schemes that preserve or create new natural lip shapes and contours.
Declaration of interest None
References
1. Ali MJ, Ende K, Maas CS. Perioral rejuvenation and lip augmentation. Facial Plast Surg Clin North Am 2007:15:491-500
2. Barton FE Jr, Carruthers J, Coleman S, Graivier M. The role of toxins and fillers in perioral rejuvenation.
3.
Aesthet Surg J 2007; 27:632-640
Kontis TC, LacombeVG, Cosmetic injection techniques. New York: Thieme;2019.
4. Perkins SW. The corner of the mouth lift and management of the oral commissure groves. Facial Plast Surg Clin North Am 2007;15(4):471-621
Figure 3 (A) Initial patient presentation. (B) The first stage of filler augmentation aims to provide greater volume to the lips and prevent the drooping of the oral commissures.(C) The second stage of filler augmentation focuses on creating second-order anatomical structures on the lips.(D) The final result two weeks after augmentation.
ARTIFICIAL INTELLIGENCE AND THE AESTHETIC PRACTICE
Jane Yoo, MD, shares best practices for using AI to improve the patient experience and market aesthetic services
JANE YOO, MD, dermatologist, New York, US
ARTIFICIAL INTELLIGENCE (AI) IS everywhere you look. It has permeated our lives like an invisible force field that we cannot avoid. Within the aesthetic space, it offers the opportunity to transform and personalise the patient experience as well as streamline marketing efforts, leading to increased productivity and reduced costs. With the ability for AI to capture and synthesise a wide array of data and automate processes, aesthetic practices can leverage new technologies to deliver customised, high-quality services while maintaining operational efficiency.
Below are some ways businesses can capitalise on AI to enhance their aesthetic practices:
No longer do patients have to set foot in your physical office; now, they can see you 24/7 in the privacy of their own home, wherever they may be in the world, as long as they have internet access. You can create an avatar of yourself into a chatbot to interact with potential patients through the web or via an app and allow for them to have a virtual conversation, which then can lead to an in-person procedure visit all without them having to pick up the telephone and speak to a receptionist or a cosmetic coordinator. These AI-powered chatbots can easily schedule patient appointments, answer questions about pre- and post-treatment care, and support patients before, during, and after their cosmetic journey.
Selecting the right skincare products and aesthetic procedures with skin imaging GenAI
For existing patients, AI tools can be used to gather and analyse patient data, treatment history and devices available in the office to make personalised aesthetic product and treatment recommendations based on a patient’s skin type, medical condition, and consumer preferences.
Following the lead of major retailers who have utilised generative AI models such as virtual try on (VTO) for fashion and makeup, aesthetic practices can do the same in enabling savvy consumers to simulate what they may look like if they were to undergo a cosmetic or surgical procedure, imitate how individuals may age with time (give a real vs. actual age), and provide information on a variety of metrics for skin analysis (redness, wrinkles, etc.). AI Companies such as Perfect Corp, Modiface, Revieve, and Lululab allow aesthetic practices to customise their skin analysis technology through patient-facing websites, apps or kiosks. Haut.ai has developed SkinGPT, a tool allowing patients to virtually try on skincare products, and Generative. Skin, a website allowing users to upload their photo and see how certain skincare ingredients may affect their particular skin concerns, such as hyperpigmentation.
Taking this a step further, skin analysis tools allow users to develop a customised skincare routine based on the particular products that are selected and even enable tracking of skin health over time (perhaps even integrating with sensor technology), with the effect of various treatments. All of this information may be accessible to both aesthetic providers and patients through HIPAA-compliant portals, facilitating informed decisionmaking and increasing consumer trust, loyalty, and satisfaction.
Optimising
marketing efforts with AI
Data-driven targeting and content personalisation
Search engine optimisation (SEO)/social media analytics
AI-powered SEO tools, such as SEMrush, Google Ads, and Afrefs can analyse keywords, competitor strategies, and search trends to optimise website content. Improved visibility in search engines increases the likelihood of attracting new customers. Predictive analytics platforms like Tableau, Alteryx, and Google Analytics can forecast trends and needs, enabling proactive planning and outreach as well as the ability to refine the different types of services they provide.
Additionally, social media platforms like Buffer, Social Sprout, and Hootsuite use AI to track and analyse social media performance, identifying which content types and platforms generate the most or least engagement. These insights enable aesthetic practices to focus on high-impact marketing channels, resulting in significant cost savings.
For existing patients, AI tools can be used to gather and analyse patient data, treatment history and devices available in the office to make personalised aesthetic product and treatment recommendations based on a patient’s skin type, medical condition, and consumer preferences.
Using AI responsibly
The hype is there, but is it real? There remain some fundamental concepts to remember. Safeguarding patient data is paramount, and practices should implement robust encryption, comply with HIPAA regulations, and ensure transparency about how data is used. Since AI models must be trained on large quantities of diverse datasets, some platforms may run into issues of bias for certain skin types or conditions if they are not adequately represented. AI algorithms need to be regularly updated with new data otherwise they become inaccurate and worthless. Finally, human oversight is also needed in instances where automated processes may not be sufficient, such as managing patient complications.
Have a Constant Contact or Mailchimp list? AI tools can now segment audiences based on demographics, preferences, and behaviour, enabling marketers to craft targeted campaigns for specific groups. Need to create 500 personalised newsletters? Dynamic content creation tools such as Canva and Adobe Photoshop can now customise advertisements, emails, and social media posts to resonate with individual patients. Such personalisation fosters increased engagement, retention, and revenue.
AI has the potential to revolutionise the aesthetic industry by improving patient experiences through personalisation and refining marketing strategies through tailored customer segmentation. Aesthetic service providers can harness AI to deliver high-quality care and long-lasting relationships with patients. However, remember that AI is merely the vehicle, and humans are the drivers of aesthetic services.
For more information about AI and marketing: check out my colleague Wendy Lewis’ new book: Aesthetic Clinic Marketing in the Digital Age: www.routledge. com/Aesthetic-Clinic-Marketing-in-the-Digital-AgeFrom-Meta-to-AI/Lewis/p/book/9780367405182
Discover the AMWC Aesthetics Medicine Awards winners
Commemorating Excellence in Aesthetic and Anti-Aging Medicine!
In collaboration with the Aesthetic Multispecialty Society (AMS) , the 2025 AMWC Awards meticulously evaluated more than 1000 submissions hailing from 39 countries, contending for top accolades in categories across Best Products & Devices and Best Clinical Cases . Following an exhaustive review and shortlisting process, 220 standout entries emerged as finalists, ready for evaluation. The final round was judged by a distinguished panel of physicians specializing in aesthetics and anti-aging medicine, alongside over 22,000 votes from industry peers. The ultimate winners across the 24 categories were unveiled at a prestigious ceremony held at AMWC Monaco on March 27th, 2025.
Discover all finalists and winners on the AMWC website: www.amwc-conference.com
Best Products & Devices Winners
Best Skin Regenerative
Aesthetic Solution
GCell®
GLOBAL BIYOMEDIKAL www.globalbiyomedikal.com
GCell® is an advanced regenerative medicine device with Autologous Micrograft and SVF Technology in a fully closed, sterile system. With a 40-minute rapid processing time, homogenization, and photoactivation, it ensures high cell viability and effectiveness. GCell® is 100% autologous, chemical-free, and requires only local anesthesia.
Best Anti-Aging Supplement
Purasomes Xcell
DERMOAROMA
www.dermoaroma.com
Purasomes XCell supports gut health, immunity, and telomere longevity. With organic bovine colostrum, spirulina, and astragalus, it enhances digestion, reduces inflammation, and slows aging at a cellular level. Designed for radiant skin, stronger hair, and overall well-being.
Best Suspension Thread
Visage Excellence HA - Namica Technology
APTOS
aptos.global
Aptos 4th Generation Threads with NAMICA Technology – Lifting, Contouring, Armoring, Skin quality improvement with the revolutionary P(LA/CL) + HA with NAMICA technology. Unique characteristics as targeted delivery (minimizing loss of HA during threads injection); controlled gradual release of HA making it the first solid, long-lasting biostimulator.
Best Cosmetics
Biojuve®
CROWN AESTHETICS
www.skinpen.com/international
BIOJUVE® is a novel skin biome brand that uses a living Xycrobe™ Technology to optimize the overall skin biome and lead to healthier, younger-looking skin. Clinical studies show significant improvement in the appearance of skin texture, tone, fine lines, wrinkles, and photodamage on all skin types.
Best Aesthetic Device
Dermaviz UV QUANTIFICARE
www.quantificare.com
QuantifiCare revolutionizes clinical photography with standardized 3D imaging and 2D UV systems. Our tools ensure precise, reproducible assessments. Already used in trials, DermaViz UV replaces Wood’s lamps with UV flash, offering sharp visuals for pigmented/depigmented areas. Soon for consultations.
Best Laser Redtouch Pro DEKA
www.dekalaser.com
The exclusive 675 nm wavelength of RedTouch PRO, which is selectively absorbed by collagen, makes it the most revolutionary laser system of the year. With high efficacy, it stimulates collagen production and the formation of new collagen fibers. RedTouch PRO is also effective on dark phototypes and tanned skin.
Best Innovations in Treatment Protocols
Discovery Pico With Variopulse Technology® QUANTA SYSTEM
www.quantasystem.com
PICO celebrates 10 years of innovation with VarioPulse Technology®, offering precision and versatility. Featuring three picosecond pulse ranges and unique handpieces like PlasmaFrax and PhotoFrax, it customizes treatments. PicoFilling stimulates skin regeneration with minimal downtime, perfect for wrinkles, acne scars, and more.
Best Non-Invasive Body Shaping Technology
Wonder Axon
LEXTER MICROELECTRONIC ENGINEERING
SYSTEMS S.L.
www.wonder.clinic
Wonder Axon combines neuromuscular stimulation, electromagnetic emissions, and radiofrequency to enhance muscle tone, strength, and collagen production. This non-invasive treatment sculpts the body, tightens skin, and reduces fat, offering natural, balanced results.
Best Aesthetic Product & Device Integration
Cytocare 640 C Line With C Line
Plasma LABORATOIRE REVITACARE
www.revitacare.net
REVITACARE’s C Line Plasma and CYTOCARE 640 C Line duo combine cutting-edge plasma technology and ultrapure hyaluronic acid to reduce wrinkles, acne scars, and imperfections. In just 2 sessions, skin is intensely hydrated and smoothed for a youthful glow.
Best Injectable Dermal Filler
Restylane Lyft GALDERMA
www.galderma.com
Restylane Lyft is designed to provide lift, projection and structure. Its targeted placement and minimal product migration ensures precise outcomes. It has the highest G’ on the market and the lowest degree of modification, for the closest to skin’s own HA, delivering natural looking results.
Best Integrative Medicine
Dr Ernesto Delgado Cidranes Spain
From Aesthetics to Function: Restorative Action of Cytokines and Autologous Exosomes in Patients With Complex Dermatological Lesions
Best EnergyBased Treatment
Dr Yaryna Turkevych
Ukraine
Erasing the Signs of War
Best Hair Restoration Product
Purasomes HSC50+ DERMOAROMA
www.dermoaroma.com
Purasomes HSC 50+ Hair & Scalp
Complex combats hair loss in men and women by addressing root causes, accelerating cellular repair, and promoting hair follicle function. Clinically proven, it offers immediate and long-lasting results for healthier hair and scalp.
Best Injectable Body Fillers
Lanluma X & Lanluma V SINCLAIR sinclair.com
Lanluma is a PLLA-based implant designed to add volume and correct skin depressions. Injected as a suspension, it stimulates collagen production. Available in two versions—Lanluma V (210 mg) and Lanluma X (630 mg)—it suits various face and body areas, including the buttocks.
Best Intimate Health Solution
Intimate Excellence HA APTOS
aptos.global
Female confidence and health often suffer, and female pleasure is very complex.
Aptos Intimate Excellence Method (HA) was created to improving quality of life by treating urinary incontinence, postpartum defects, aesthetic concerns in gynecology using minimally invasive techniques, with a short recovery period and longlasting effect.
Best Neuromodulator
Relfydess GALDERMA
www.galderma.com
RelfydessTM is the next-generation neuromodulator designed with PEARLTM technology. It delivers an advanced performance with fast and sustained results for GLs and LCLs, giving patients a natural, revitalized look with a well-tolerated, ready-to-use, liquid formulation that is optimized for simple volumetric dosing.
Best Clinical Cases Winners
Best Genital Rejuvenation
Dr Pablo Gonzalez
Isaza
Colombia
In Office Topographic Labiaplasty as a Safe Aproach to Massive Labia Minora Hypertrophy
Best Non-Surgical Body Shaping
Dr Daniella Fakih
Lebanon
Combining CaHA With Micro-Needling RF for Stretch Mark Improvement
Best Hair Restoration
Dr Nuttorn Narupaves
Thailand
Combination of Optimize Methods for Best Hair Restoration in Burn Scar Alopecia Patient
Best Surgical Body Shaping
Dr Jaqueline
Rodrigues
Brazil
Abdominoplasty
Extended to Flanks to Avoid Anchor Scar
Best Threads Treatment
Dr Marion Delbaere
France
Medical Face and Neck
Lift With Permanent Threads (Combined With Neck Liposuccion)
Best Complication Treatment
Dr Thomas Rappl
Austria
Catheter-Assisted Application of Hyaluronidase After Hyaluronic Acid Induced Ischemia of the Upper Extremity
Best Surgical Facial Rejuvenation
Dr Adam Scheiner
United States
Upper and Lower Blepharoplasty and Full Face Resurfacing
Best Injectable for Skin Revitalization
Juvelook
VAIM GLOBAL
juvelook.com
JUVELOOK is a hybrid biostimulator for rejuvenating skin, reducing fine wrinkles, and treating scars, stretch marks, and tear troughs. It combines PDLLA, which stimulates collagen and elastin production, with hyaluronic acid, a biocompatible gel that hydrates instantly while restoring lost volume.
Best Condition Improvement Treatment
Dr Fernando Felice
Argentina
Aesthetic and Reconstructive Facial
Surgery Following a Serious Canine Bite to the Face
Best Non-Surgical Facial Beautification
Dr Iryna Smolanka
Ukraine
Beautification After Facial Nerve Injury
Best Skin Enhancement & Scar Treatment
Dr Dilek Basaran
Turkey
Erasing a Burn Scar
Non-Surgical Facial Rejuvenation
Ms Moonika Sibul
Estonia
Non-Surgical Facelift With Combination Treatment
Events
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Paris, France eadv.org/congress
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Congress of Dermatology and Anti-Aging Medicine
Warsaw, Poland kongres.dermatologia-estetyczna.pl
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AMWC Monaco
Monte Carlo, Monaco www.amwc-conference.com
26–27 JUNE 2026
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London, UK www.im-aesthetics.com
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17–20 SEPTEMBER 2025
AAFPRS Annual Meeting
Los Angeles, California www.aafprs.org/annual_meeting
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